MEMBER 2022 PREFERRED DRUG LIST

MEMBER

PREFERRED DRUG LIST2022

For group HMO, PPO and EPO members with an insurance plan that includes a prescription drug benefit

Effective January 1, 2022

Blue Cross and Blue Shield of Kansas City 2022 Preferred Drug List

IntroductionThe Prescription Drug List (PDL) has been developed and is maintained by the Medical and Pharmacy Management Committee of Blue Cross and Blue Shield of Kansas City (Blue KC). The committee is composed of practicing doctors and pharmacists within the Kansas City area. Quarterly meetings are held to evaluate new drug therapies and review drug utilization issues.

Medications are evaluated on the basis of safety, effectiveness, adverse events, proven advantages over existing agents and cost. Tier 1 medications are typically generic drugs that contain the same active ingredients as brand name drugs and have the lowest copay. New drugs will require an exception or prior authorization until they are reviewed by the committee.

While extensive, this is not an exhaustive list of all available medications and this list is subject to change. See the most current PDL by visiting your member portal at MyBlueKC.com. If you require additional information or clarification, contact our Clinical Pharmacy unit at 816-395-2176 or 800-228-1436.

Please be aware that as new products are released and post-marketing information on existing therapies becomes available, changes in the PDL status may occur. The committee may also implement prior authorization or other utilization management processes as deemed necessary. Doctors and pharmacists will be notified of any such changes via direct mailings.

How to use this list:1 Find the page number for your drug by searching the alphabetical index at the end.

2 Locate your drug and identify the Drug Tier. You will also want to note restrictions and preferred alternatives if applicable.

3 Refer to the Drug Tier description tables at the end of this introduction to identify the tier copay for your drug (based on the benefit schedule described in your member certificate or in your Blue KC benefit summary.

Prior Authorization/Drug Utilization ManagementSome drugs have coverage rules or have limits on the amount dispensed. In some cases, the prescriber must do something in order to obtain the drug. For example:

• Prior approval (or prior authorization): For some drugs, the prescriber must get approval from BlueKC before the prescription can be filled. Without that approval, the drug may not be covered.

• Quantity limits: For some drugs, there are limits to the amount of drug that may be obtained.

• Step Therapy: For some drugs, BlueKC requires step therapy. This means that drugs will have to be tried in a certain order for a medical condition. If the doctor feels that the first drugs are not appropriate, the prescriber will have to submit a prior authorization request.

Prescribers may request exceptions to these coverage rules or limits by submitting an electronic prior authorization request form. www.BlueKC.com > Providers > Forms > Prior Authorizations for Medications.

HOW TO REACH USBlue Cross and Blue Shield of Kansas City Pharmacy Services P.O. Box 419169 Kansas City, MO 64141-2735

816-395-2176 or 800-228-1436

www.BlueKC.com

Frequently asked questionsWhat is the difference between brand name drugs and generic drugs?When a drug company develops a new medication they apply for a patent. This patent protects the drug from being copied by other drug companies for a certain period of time. These drugs are brand name drugs. Once the patent period expires, other manufacturers can produce the same drug as long as they follow strict guidelines established by the Food and Drug Administration's (FDA) guidelines. These same drugs are generic drugs. Generic drugs are less expensive versions of those brand name drugs whose patents have expired. They are made with the same active ingredients of the brand name drug, but they may have a different color, shape or filler material. The cost of a generic drug is typically less than a brand name drug. All generic medications are approved by the FDA before they are released on the market.

What is the difference between a generic equivalent and a generic alternative?A generic equivalent is a medication that contains the same active ingredient and works the same way as the original brand name drug. A generic alternative is a generic medication that may not have the same active ingredient, but works in the same way as another drug.

What is a maintenance drug?A maintenance drug is a medication used to treat a chronic condition like diabetes or high blood pressure. The FDA must approve maintenance drugs as safe for long-term use. Blue KC uses a national drug information database called Medispan to determine which medications are included on the maintenance drug list. If your prescription is a maintenance drug, you can have it filled for several months instead of just one prescription at a time.

Does Blue KC cover all prescription drugs?Blue KC covers most prescription drugs. However, some drug classes require an additional benefit be added to your health insurance plan in order to be covered. This additional benefit is referred to as a ‘rider.’ Examples of such drug classes are fertility, birth control, impotency, and weight loss.

How is the tier level status determined for medications?The PDL is a list of prescription medications that have been reviewed and recommended by the Blue KC Medical and Pharmacy Management Committee.

The list has a combination of brand name and generic medications. Each of these medications has been reviewed for its safety, effectiveness, clinical outcomes, and cost. Doctors and pharmacists on the committee look at drug utilization issues, the number of adverse events, and any proven advantages over other drugs on the PDL. The most efficient and cost-effective drugs are on Tier 1 of the PDL.

Why does Blue KC require prior authorization for some drugs before they are covered?Blue KC may require prior authorization for some drugs or a class. Medications on the prior authorization list may have safety concerns or have FDA approval, only for a certain use. Some of the prior authorization medications may also have a lower-cost alternative that should be considered first or the drug may not be as effective as something else in the same drug class. Some medications are also on the prior authorization list because they have the potential to be misused. Your doctor and Blue KC will work together to get prior authorization and approval for your prescription when needed.

Do I need to show my member ID card at the pharmacy?Yes, show your member ID card to your pharmacist whenever you have a prescription filled. Your prescription claim is electronically transmitted to Blue KC when you fill your prescription. Please make sure the pharmacy has your most current health insurance information and correct birth date so there won’t be any delays or claim denials when we process your claim.

What do I do if I need to refill my prescription early (i.e., leaving on vacation, the doctor increased my dosage)? To have a prescription refilled early, have your pharmacist call the Pharmacy Customer Service unit at 816-395- 2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

What if I am out of town and need to have a prescription filled?Blue KC contracts with most major pharmacy chains and has a network of over 44,000 pharmacies nationwide. If the pharmacy you are using has difficulty in processing your prescription claim, have them contact the Pharmacy Customer Service unit for assistance at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

Why must some drugs be purchased through a Specialty Pharmacy?Specialty drugs are those that require special ordering, handling, clinical monitoring and/or customer service. These drugs are best purchased through a Specialty Pharmacy. Blue KC has a network of Specialty Pharmacies available to provide specialized care for patients with complex chronic health conditions to obtain

their medications and manage their health conditions. Specialty medications are limited to a 34 day supply.

What if I have questions about my prescription drug coverage?For more information on your prescription drug coverage, call the Pharmacy Customer Service unit at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

Miscellaneous Information

Specialty PharmacyA Specialty Pharmacy is one that provides specialized care for patients with complex chronic health conditions such as Rheumatoid Arthritis, Multiple Sclerosis or Psoriasis. Specialty drugs may be oral or injectable medications that can either be self-administered or administered by a health care professional. These pharmacies do everything from dispense the specialty medication to help patients manage their health condition. Most specialty medications are covered under the pharmacy benefit. Specialty medications are limited to a 34 day supply. The following is a list of other services provided by the Specialty Pharmacies:

• Assigns a Patient Care Coordinator who serves as a personal advocate and point of contact

• Offers access to a dedicated clinical staff of nurses and pharmacists who are knowledgeable about the medications and conditions

• Provides the necessary supplies to administer the medications — at no additional cost

• Offers care management programs to help patients get the most from their medications

• Provides patients with refill reminder calls

• Allows the medications to be delivered to either the physician’s office or patients home

• Works directly with patients to arrange a convenient shipment date

• Ships all medications overnight

• Coordinates with Blue KC to take care of billing issues

These services are provided to you at no additional cost. Prescriptions for a specialty medication will need to be filled at the Specialty Pharmacy listed below.

Optum Specialty Pharmacy Phone: 1-855-427-4682

Drug Tier DescriptionsTo find out what prescription drug tier is on your plan, please see the benefit schedule in your member certificate or in your Blue KC benefit summary.

1-Tier Benefit Drug Tier

Tier 1 copayG

G-S

Not CoveredPB

PB-S

Not CoveredNPB

NPB-S

2-Tier Benefit Drug Tier

Tier 1 copayG

G-S

Tier 2 copayPB

PB-S

Not CoveredNPB

NPB-S3-Tier Benefit Drug Tier

Tier 1 copayG

G-S

Tier 2 copayPB

PB-S

Tier 3 copayNPB

NPB-S3-Tier Retail/Specialty Benefit Drug TierTier 1 copay GTier 2 copay PBTier 3 copay NPBGeneric Specialty copay G-SPreferred Brand Specialty copay PB-SNon-Preferred Brand Specialty copay NPB-S4-Tier Benefit Drug Tier

Tier 1 copayG

G-STier 2 copay PB

Tier 3 copayPB-SNPB

Tier 4 copay NPB-S

List of AbbreviationsG Generic Drug.

G-S Generic Specialty Drug.

NPB Non-preferred Brand Drug.

NPB-S Non-preferred Brand Specialty Drug.

PB Preferred Brand Drug.

PB-S Preferred Brand Specialty Drug.

ACA Affordable Care Act. These preventative drugs may be covered at no cost (check your benefits to confirm).

M Maintenance Drug.

OTC Over the Counter. An OTC drug is a non-prescription drug.

PA Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval before you fill your prescription. If you don’t get approval, your plan may not cover the drug.

QL Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.

ST ST: Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

Blue Cross and Blue Shield of Kansas City

Table of Contents

Analgesics - Drugs for Pain.................................................................................................................................8Analgesics - Drugs for Pain and Inflammation.................................................................................................. 11Anesthetics........................................................................................................................................................13Anti-Addiction / Substance Abuse Treatment Agents....................................................................................... 13Antibacterials.....................................................................................................................................................14Anticoagulants...................................................................................................................................................18Anticonvulsants - Drugs for Seizures................................................................................................................ 18Antidementia Agents - Drugs for Alzheimer's Disease and Dementia.............................................................. 21Antidepressants.................................................................................................................................................21Antiemetics - Drugs for Nausea and Vomiting.................................................................................................. 24Antifungals.........................................................................................................................................................25Antigout Agents................................................................................................................................................. 27Anti-inflammatory Agents.................................................................................................................................. 28Antimigraine Agents.......................................................................................................................................... 28Antimyasthenic Agents......................................................................................................................................29Antimycobacterials............................................................................................................................................ 29Antineoplastics - Drugs for Cancer....................................................................................................................30Antiparasitics..................................................................................................................................................... 35Antiparkinson Agents........................................................................................................................................ 36Antiplatelets.......................................................................................................................................................37Antipsychotics - Drugs for Mood Disorders....................................................................................................... 37Antivirals............................................................................................................................................................40Anxiolytics - Drugs for Anxiety...........................................................................................................................44Bipolar Agents - Drugs for Mood Disorders.......................................................................................................45Blood Products and Modifiers - Drugs for Blood Disorders...............................................................................46Cardiovascular Agents - Drugs for Heart and Circulation Conditions............................................................... 46Central Nervous System Agents - Drugs for Attention Deficit Disorder............................................................ 54Central Nervous System Agents - Drugs for Multiple Sclerosis........................................................................ 58Central Nervous System Agents - Miscellaneous............................................................................................. 59Dental and Oral Agents - Drugs for Mouth and Throat Conditions....................................................................60Dermatological Agents - Drugs for Skin Conditions.......................................................................................... 61Diabetes - Antidiabetic Agents.......................................................................................................................... 68Diabetes - Glucose Monitoring.......................................................................................................................... 70Diabetes - Glycemic Agents.............................................................................................................................. 76Diabetes - Insulins.............................................................................................................................................76Electrolytes / Minerals / Metals / Vitamins.........................................................................................................78Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer................................................................................82Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions.................................................83Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment............................................. 86Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions.......................................................87Genitourinary Agents - Drugs for Prostate Conditions...................................................................................... 88Hormonal Agents - Adrenal............................................................................................................................... 89Hormonal Agents - Men's Health.......................................................................................................................90Hormonal Agents - Pituitary.............................................................................................................................. 90Hormonal Agents - Prostaglandins....................................................................................................................92Hormonal Agents - Selective Estrogen Receptor Modifying Agents................................................................. 92Hormonal Agents - Sex Hormones and Birth Control........................................................................................92Hormonal Agents - Thyroid............................................................................................................................. 100Immunological Agents - Drugs for Immune System Stimulation or Suppression............................................ 100Immunological Agents - Drugs for Vaccination............................................................................................... 104

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Inflammatory Bowel Disease Agents...............................................................................................................106Metabolic Bone Disease Agents - Drugs for Osteoporosis............................................................................. 107Metabolic Bone Disease Agents - Other......................................................................................................... 107Miscellaneous Therapeutic Agents................................................................................................................. 108Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation.........................................................109Ophthalmic Agents - Drugs for Glaucoma.......................................................................................................111Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions....................................................................... 112Otic Agents - Drugs for Ear Conditions........................................................................................................... 113Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold......................................................114Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions................................. 115Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis.................................................................. 119Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension.................................................. 119Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm.................................................................... 120Sleep Disorder Agents.................................................................................................................................... 121

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Drug Name Drug Tier Restrictions / Limits

CARVYKTI NPB

IBSRELA NPB

KORSUVA NPB

NEXICLON XR NPB M

PHYSICIANS EZ USE J/T/T KIT II NPB

REZIPRES NPB

VONJO NPB

Analgesics - Drugs for Pain

acetaminophen-codeine G

acetaminophen-codeine #2 G



ACTIQ NPB PA; QL (4 EA per 1 day)

ALLZITAL NPB ST

APADAZ NPB

apap-caff-dihydrocodeine oral capsule G

apap-caff-dihydrocodeine oral tablet NPB

ascomp-codeine G

bac G

BELBUCA PB ST; QL (2 EA per 1 day)

BENZHYDROCODONE-ACETAMINOPHEN NPB

BUPAP NPB ST

buprenorphine G ST; QL (0.15 EA per 1 day)

butalbital-acetaminophen capsule 50-300 mg oral

G

BUTALBITAL-ACETAMINOPHEN CAPSULE 50-300 MG ORAL

G ST

butalbital-acetaminophen oral tablet G

butalbital-apap-caff-cod G

butalbital-apap-caffeine G

butalbital-asa-caff-codeine G

butalbital-aspirin-caffeine G

butorphanol tartrate nasal G

BUTRANS NPB ST; QL (0.15 EA per 1 day)

carisoprodol-aspirin-codeine G

codeine sulfate G

CONZIP NPB ST; QL (1 EA per 1 day)

DILAUDID ORAL NPB

endocet G

Last Updated 3/16/2022

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ESGIC NPB ST

fentanyl citrate buccal lozenge on a handle G PA; QL (4 EA per 1 day)

FENTANYL CITRATE BUCCAL TABLET NPB ST; QL (4 EA per 1 day)

fentanyl transdermal patch 72 hour 100 mcg/hr, 75 mcg/hr

G ST; QL (1 EA per 1 day)

fentanyl transdermal patch 72 hour 12 mcg/hr, 25 mcg/hr, 37.5 mcg/hr, 50 mcg/hr, 62.5 mcg/hr, 87.5 mcg/hr

G ST; QL (0.5 EA per 1 day)

FENTORA NPB ST; QL (4 EA per 1 day)

FIORICET NPB ST

FIORICET/CODEINE NPB

hydrocodone bitartrate er oral capsule extended release 12 hour

NPB ST; QL (2 EA per 1 day)

hydrocodone bitartrate er oral tablet er 24 hour abuse-deterrent


hydrocodone-acetaminophen G

hydrocodone-ibuprofen G

hydromorphone hcl er G ST; QL (2 EA per 1 day)

hydromorphone hcl oral G

HYSINGLA ER NPB ST; QL (1 EA per 1 day)

LAZANDA NPB ST; QL (1 EA per 1 day)

levorphanol tartrate oral tablet 2 mg G

levorphanol tartrate oral tablet 3 mg NPB

LORTAB G

meperidine hcl oral G

methadone hcl intensol G ST

methadone hcl oral G ST

methadose oral concentrate 10 mg/ml G ST

methadose oral tablet soluble G ST

methadose sugar-free G ST

morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml

G

morphine sulfate (pf) intravenous solution 1 mg/ml

G

morphine sulfate er G ST; QL (3 EA per 1 day)

morphine sulfate er beads oral capsule extended release 24 hour 120 mg


morphine sulfate er beads oral capsule extended release 24 hour 30 mg, 45 mg, 60 mg, 75 mg, 90 mg


morphine sulfate oral G


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MS CONTIN NPB ST; QL (3 EA per 1 day)

NALOCET NPB

NUCYNTA PB

NUCYNTA ER NPB ST; QL (2 EA per 1 day)

OXAYDO NPB

OXYCODONE HCL ER NPB ST; QL (4 EA per 1 day)

oxycodone hcl oral capsule G

oxycodone hcl oral concentrate 100 mg/5ml G

oxycodone hcl oral solution G

oxycodone hcl oral tablet G

OXYCODONE-ACETAMINOPHEN ORAL SOLUTION

NPB

OXYCODONE-ACETAMINOPHEN ORAL TABLET 10-300 MG, 2.5-300 MG, 5-300 MG, 7.5-300 MG

NPB

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

G

OXYCONTIN PB ST; QL (4 EA per 1 day)

oxymorphone hcl G

oxymorphone hcl er G ST; QL (4 EA per 1 day)

pentazocine-naloxone hcl G

PERCOCET NPB

PROLATE NPB

ROXICODONE NPB

SUBSYS NPB PA; QL (16 EA per 1 day)

SYNAPRYN FUSEPAQ NPB

TENCON NPB ST

tramadol hcl er (biphasic) G ST; QL (1 EA per 1 day)

TRAMADOL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR


tramadol hcl er oral tablet extended release 24 hour


tramadol hcl oral tablet 100 mg G QL (4 EA per 1 day)

tramadol hcl oral tablet 50 mg G

tramadol-acetaminophen G

TREZIX NPB

ULTRACET NPB

ULTRAM NPB

VTOL LQ NPB ST

XTAMPZA ER PB ST; QL (2 EA per 1 day)


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ZEBUTAL NPB ST

Analgesics - Drugs for Pain and Inflammation

ANAPROX DS NPB ST

ARTHROTEC NPB ST

CAMBIA NPB ST; QL (9 EA per 25 days)

CATAFLAM NPB

CELEBREX NPB ST; QL (2 EA per 1 day)

celecoxib oral G QL (2 EA per 1 day)

DAYPRO NPB ST

DICLOFENAC CAP 35MG NPB ST; QL (4 EA per 1 day)

DICLOFENAC PATCH 1.3% NPB ST; QL (70 EA per 25 days)

diclofenac potassium oral tablet G

diclofenac sodium er G

diclofenac sodium external solution G

diclofenac sodium oral G

diclofenac-misoprostol G

diflunisal oral G

DUAL COMPLEX FORMULA 1 KIT NPB

DUEXIS NPB ST; QL (3 EA per 1 day)

EC-NAPROSYN NPB ST

ec-naproxen G

ENOVARX-DICLOFENAC SODIUM NPB

ENOVARX-IBUPROFEN NPB

ENOVARX-NAPROXEN NPB

etodolac G

etodolac er G

FBL KIT NPB

FELDENE NPB ST

fenoprofen calcium oral capsule NPB ST

fenoprofen calcium oral tablet G ST

fenortho NPB ST

FLECTOR PB ST; QL (70 EA per 25 days)

flurbiprofen oral G

ibuprofen oral tablet 400 mg, 600 mg, 800 mg G

ibuprofen-famotidine G ST; QL (3 EA per 1 day)

INDOCIN ORAL NPB ST

INDOCIN RECTAL NPB


11


indomethacin er G

INDOMETHACIN ORAL CAPSULE 20 MG NPB ST

indomethacin oral capsule 25 mg, 50 mg G

K.B.G.L IN TERODERM NPB

KETOPHENE RAPIDPAQ NPB

ketoprofen er G

ketoprofen oral G

KETOROLAC TROMETHAMINE NASAL NPB ST; QL (5 EA per 5 days)

ketorolac tromethamine oral G QL (20 EA per 1 fill)

LICART NPB ST

LODINE NPB ST

LOFENA NPB

meclofenamate sodium oral G

mefenamic acid oral G

meloxicam oral capsule G

meloxicam oral tablet G QL (2 EA per 1 day)

MOBIC NPB ST; QL (2 EA per 1 day)

nabumetone oral G

NALFON NPB ST

NAPRELAN NPB ST

NAPRO NPB

NAPROSYN NPB ST

naproxen oral G

naproxen sodium er oral tablet extended release 24 hour 375 mg, 500 mg

G

NAPROXEN SODIUM ER ORAL TABLET EXTENDED RELEASE 24 HOUR 750 MG

NPB ST

naproxen sodium oral tablet 275 mg, 550 mg G

naproxen-esomeprazole G QL (2 EA per 1 day)

oxaprozin G

PENNSAID NPB ST; QL (112 GM per 25 days)

piroxicam oral G

RELAFEN NPB

RELAFEN DS NPB ST; QL (2 EA per 1 day)

SPRIX NPB ST; QL (5 EA per 5 days)

sulindac oral G

TIVORBEX NPB ST

TRIPLE COMPLEX FORMULA 3 KIT NPB

VIMOVO NPB ST; QL (2 EA per 1 day)


12


VIVLODEX NPB ST

VP FC KIT NPB

VP GKL KIT NPB

ZIPSOR NPB ST; QL (4 EA per 1 day)

ZORVOLEX ORAL CAPSULE 18 MG NPB ST; QL (3 EA per 1 day)

ZORVOLEX ORAL CAPSULE 35 MG NPB ST; QL (4 EA per 1 day)

Anesthetics

ENOVARX-LIDOCAINE HCL NPB

ethyl chloride G

GEBAUERS PAIN EASE NPB

GEBAUERS SPRAY AND STRETCH NPB

glydo G

LETS NPB

lidocaine external ointment 5 % G

lidocaine external patch 5 % G

lidocaine hcl external solution G

lidocaine hcl urethral/mucosal G

LIDOCAINE-EPINEPHRINE (3 ML) NPB

lidocaine-prilocaine external cream G

LIDOCAINE-TETRACAINE NPB PA

LIDODERM NPB ST

PLIAGLIS EXTERNAL CREAM NPB PA

SYNERA NPB

VENIPUNCTURE PX1 PHLEBOTOMY NPB

ZTLIDO PB ST

Anti-Addiction / Substance Abuse Treatment Agents

acamprosate calcium G

APO-VARENICLINE PB ACA

buprenorphine hcl sublingual tablet sublingual 2 mg

G QL (12 EA per 1 day)

buprenorphine hcl sublingual tablet sublingual 8 mg


buprenorphine hcl-naloxone hcl sublingual film 12-3 mg


buprenorphine hcl-naloxone hcl sublingual film 2-0.5 mg





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buprenorphine hcl-naloxone hcl sublingual tablet sublingual 2-0.5 mg


buprenorphine hcl-naloxone hcl sublingual tablet sublingual 8-2 mg


bupropion hcl er (smoking det) G M; ACA

disulfiram oral G

KLOXXADO G

LUCEMYRA NPB QL (16 EA per 1 day)

naloxone hcl injection G

naloxone hcl nasal G

naltrexone hcl oral G

NARCAN G

NICOTROL NPB M; ACA

NICOTROL NS NPB M; ACA

SUBOXONE SUBLINGUAL FILM 12-3 MG G QL (2 EA per 1 day)

SUBOXONE SUBLINGUAL FILM 2-0.5 MG G QL (12 EA per 1 day)



varenicline tartrate G ACA

VIVITROL G

ZIMHI G

ZUBSOLV SUBLINGUAL TABLET 0.7-0.18 MG, 5.7-1.4 MG


ZUBSOLV SUBLINGUAL TABLET 1.4-0.36 MG G QL (12 EA per 1 day)




Antibacterials

ACTICLATE NPB ST

AEMCOLO NPB

ALTABAX NPB

amoxicillin G

amoxicillin-potassium clavulanate G

amoxicillin-potassium clavulanate er G

ampicillin G

ARIKAYCE PB-S PA

AUGMENTIN NPB


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AUGMENTIN ES-600 NPB

avidoxy G

azithromycin oral G

BACTRIM NPB

BACTRIM DS NPB

BAXDELA ORAL NPB

cefaclor G

cefaclor er G

cefadroxil G

cefdinir G

cefixime G

cefpodoxime proxetil G

cefprozil G

cefuroxime axetil G

CENTANY NPB

cephalexin G

CIPRO NPB

ciprofloxacin hcl oral G

clarithromycin er G

clarithromycin oral G

CLEOCIN NPB

clindamycin hcl oral G

clindamycin palmitate hcl G

clindamycin phosphate vaginal G

CLINDESSE NPB

colistimethate sodium (cba) G

COLY-MYCIN M NPB

coremino G

demeclocycline hcl G

dicloxacillin sodium G

DIFICID NPB

DORYX NPB ST

DORYX MPC NPB ST

doxycycline hyclate oral capsule G

doxycycline hyclate oral tablet G

doxycycline hyclate oral tablet delayed release 100 mg, 150 mg, 200 mg, 50 mg, 75 mg

G

DOXYCYCLINE HYCLATE ORAL TABLET DELAYED RELEASE 80 MG

NPB ST


15


doxycycline monohydrate oral G

E.E.S. 400 NPB

E.E.S. GRANULES NPB

ERYPED 200 NPB

ERYPED 400 NPB

ERY-TAB G

ERYTHROCIN STEARATE G

erythromycin base G

erythromycin ethylsuccinate oral G

erythromycin oral G

FIRST-METRONIDAZOLE NPB

FIRVANQ ORAL SOLUTION RECONSTITUTED 25 MG/ML

NPB

FIRVANQ ORAL SOLUTION RECONSTITUTED 50 MG/ML

NPB ST

FLAGYL NPB

fosfomycin tromethamine G

gentamicin sulfate external G

HUMATIN NPB

levofloxacin oral G

linezolid oral suspension reconstituted G QL (32.2 ML per 1 day)

linezolid oral tablet G QL (28 EA per 30 days)

MACROBID NPB

MACRODANTIN NPB

mafenide acetate external G

methenamine hippurate G

METRONIDAZOLE BENZO+SYRSPEND NPB

metronidazole in nacl intravenous solution 500-0.74 mg/100ml-%

G

metronidazole oral G

metronidazole vaginal G

MINOCYCLINE HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR

NPB ST

minocycline hcl er oral tablet extended release 24 hour

G

minocycline hcl oral G

MINOLIRA NPB ST

mondoxyne nl G

MONUROL NPB


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moxifloxacin hcl oral G

mupirocin calcium G

mupirocin external G

neomycin sulfate oral G

nitrofurantoin G

nitrofurantoin macrocrystal G

nitrofurantoin monohydrate macrocrystals G

NUVESSA NPB

NUZYRA ORAL NPB

ofloxacin oral G

paromomycin sulfate oral G

penicillin v potassium G

SEYSARA NPB ST

SILVADENE NPB

silver sulfadiazine external G

SIVEXTRO ORAL NPB QL (0.2 EA per 1 day)

SOLODYN NPB ST

SOLOSEC NPB

ssd G

sulfadiazine oral G

sulfamethoxazole-trimethoprim oral G

SULFAMYLON EXTERNAL CREAM PB

SULFAMYLON EXTERNAL PACKET NPB

sulfatrim pediatric G

SUPRAX NPB

TARGADOX NPB ST

TAZICEF INTRAVENOUS SOLUTION NPB

tetracycline hcl oral G

tinidazole oral G

trimethoprim oral G

VANCOCIN NPB

vancomycin hcl oral G

VANCOMYCIN+SYRSPEND SF NPB

vandazole G

VIBRAMYCIN NPB ST

XENLETA ORAL NPB

XEPI NPB PA

XIFAXAN PB PA


17


XIMINO NPB ST

ZITHROMAX ORAL NPB

ZITHROMAX TRI-PAK NPB

ZITHROMAX Z-PAK NPB

ZYVOX ORAL SUSPENSION RECONSTITUTED

NPB ST; QL (32.2 ML per 1 day)

ZYVOX ORAL TABLET NPB ST; QL (28 EA per 30 days)

Anticoagulants

ANTICOAGULANT SODIUM CITRATE NPB

ARIXTRA NPB QL (35 day supply per 180 days)

ELIQUIS DVT/PE STARTER PACK PB M; QL (3 EA per 1 day)

ELIQUIS ORAL TABLET 2.5 MG PB M; QL (2 EA per 1 day)

ELIQUIS ORAL TABLET 5 MG PB M; QL (3 EA per 1 day)

enoxaparin sodium subcutaneous G

fondaparinux sodium G QL (35 day supply per 180 days)

FRAGMIN PB

heparin (porcine) in nacl intravenous solution 1000-0.9 ut/500ml-%, 2000-0.9 unit/l-%

G

heparin sodium (porcine) G

heparin sodium (porcine) pf G

jantoven G

LOVENOX SUBCUTANEOUS NPB ST

PRADAXA PB M; QL (2 EA per 1 day)

SAVAYSA NPB M; QL (1 EA per 1 day)

warfarin sodium oral G

XARELTO ORAL SUSPENSION RECONSTITUTED

PB M; QL (20 ML per 1 day)

XARELTO ORAL TABLET 10 MG, 20 MG PB M; QL (1 EA per 1 day)

XARELTO ORAL TABLET 15 MG, 2.5 MG PB M; QL (2 EA per 1 day)

XARELTO STARTER PACK PB M; QL (1.7 EA per 1 day)

Anticonvulsants - Drugs for Seizures

APTIOM NPB

BANZEL NPB

BRIVIACT ORAL NPB

carbamazepine er G

carbamazepine oral G

CARBATROL NPB

CELONTIN PB

clobazam G


18


DEPAKOTE NPB ST

DEPAKOTE ER NPB ST

DEPAKOTE SPRINKLES NPB ST

DIACOMIT NPB-S PA

DIASTAT ACUDIAL NPB QL (2 EA per 1 fill)

DIASTAT PEDIATRIC NPB QL (2 EA per 1 fill)

diazepam rectal G QL (2 EA per 1 fill)

DILANTIN INFATABS NPB

DILANTIN ORAL CAPSULE 100 MG NPB

DILANTIN ORAL CAPSULE 30 MG PB

DILANTIN ORAL SUSPENSION NPB

divalproex sodium er G

divalproex sodium oral G

ELEPSIA XR ORAL TABLET EXTENDED RELEASE 24 HOUR 1000 MG


ELEPSIA XR ORAL TABLET EXTENDED RELEASE 24 HOUR 1500 MG


EPIDIOLEX PB-S PA

epitol G

ethosuximide oral G

FANATREX FUSEPAQ NPB

felbamate G

FELBATOL NPB

FINTEPLA NPB-S PA

FYCOMPA PB

gabapentin oral G

GABITRIL NPB

KEPPRA ORAL NPB ST

KEPPRA XR NPB ST

LAMICTAL NPB ST

LAMICTAL ODT NPB ST

LAMICTAL STARTER NPB ST

LAMICTAL XR NPB ST

lamotrigine er G

lamotrigine oral G

lamotrigine starter kit-blue G

lamotrigine starter kit-green G

lamotrigine starter kit-orange G

levetiracetam er G


19


levetiracetam oral G

MYSOLINE NPB

NAYZILAM PB

NEURONTIN NPB ST

ONFI NPB

oxcarbazepine G

OXTELLAR XR NPB ST

phenobarbital oral G

PHENYTEK NPB

phenytoin infatabs G

phenytoin oral G

phenytoin sodium extended G

primidone oral G

QUDEXY XR PB ST

roweepra G

rufinamide G

SABRIL NPB-S PA

SPRITAM NPB ST

subvenite G

subvenite starter kit-blue G

subvenite starter kit-green G

subvenite starter kit-orange G

SYMPAZAN NPB ST

TEGRETOL NPB

TEGRETOL-XR NPB

tiagabine hcl G

TOPAMAX NPB ST

TOPAMAX SPRINKLE NPB ST

topiramate er G

topiramate oral G

TRILEPTAL NPB ST

TROKENDI XR NPB ST

valproic acid oral G

VALTOCO NASAL LIQUID 10 MG/0.1ML, 5 MG/0.1ML

NPB-S QL (10 EA per 30 days)

VALTOCO NASAL LIQUID THERAPY PACK 10 MG/0.1ML, 7.5 MG/0.1ML


vigabatrin G-S PA

vigadrone G-S PA


20


VIMPAT ORAL PB

XCOPRI NPB ST

ZARONTIN NPB

ZONEGRAN NPB ST

zonisamide oral G

Antidementia Agents - Drugs for Alzheimer's Disease and Dementia

ARICEPT NPB ST; M

donepezil hcl G M

EXELON NPB ST; M; QL (1 EA per 1 day)

galantamine hydrobromide er G M; QL (1 EA per 1 day)

galantamine hydrobromide oral solution G M; QL (200 ML per 25 days)

galantamine hydrobromide oral tablet 12 mg G M

galantamine hydrobromide oral tablet 4 mg, 8 mg

G M; QL (2 EA per 1 day)

memantine hcl er G M; QL (1 EA per 1 day)

memantine hcl oral solution G M

memantine hcl oral tablet 10 mg, 5 mg G M

memantine hcl oral tablet 28 x 5 mg & 21 x 10 mg

NPB M

NAMENDA NPB ST; M

NAMENDA TITRATION PAK NPB ST; M

NAMENDA XR NPB ST; M; QL (1 EA per 1 day)

NAMZARIC ORAL CAPSULE ER 24 HOUR THERAPY PACK

PB ST; QL (56 EA per 365 days)

NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR

PB ST; QL (1 EA per 1 day)

RAZADYNE ER NPB ST; M; QL (1 EA per 1 day)

rivastigmine G M; QL (1 EA per 1 day)

rivastigmine tartrate G M; QL (2 EA per 1 day)

Antidepressants

amitriptyline hcl oral G

amoxapine G

ANAFRANIL NPB

APLENZIN NPB ST; M; QL (1 EA per 1 day)

BRISDELLE NPB ST; M; QL (1 EA per 1 day)

bupropion hcl er (sr) G M; QL (2 EA per 1 day)

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg



21


bupropion hcl er (xl) oral tablet extended release 24 hour 300 mg


BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG

NPB ST; M; QL (1 EA per 1 day)

bupropion hcl oral G M

CELEXA NPB ST; M; QL (2 EA per 1 day)

chlordiazepoxide-amitriptyline G

citalopram hydrobromide oral solution G M

citalopram hydrobromide oral tablet G M; QL (2 EA per 1 day)

clomipramine hcl oral G

CYMBALTA ORAL CAPSULE DELAYED RELEASE PARTICLES 20 MG, 30 MG


CYMBALTA ORAL CAPSULE DELAYED RELEASE PARTICLES 60 MG


desipramine hcl oral G

DESVENLAFAXINE ER NPB ST; M; QL (2 EA per 1 day)

desvenlafaxine succinate er G M; QL (2 EA per 1 day)

doxepin hcl oral capsule G

doxepin hcl oral concentrate G

DRIZALMA SPRINKLE ORAL CAPSULE DELAYED RELEASE SPRINKLE 20 MG, 30 MG, 40 MG


DRIZALMA SPRINKLE ORAL CAPSULE DELAYED RELEASE SPRINKLE 60 MG


duloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 40 mg


duloxetine hcl oral capsule delayed release particles 60 mg


EFFEXOR XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 150 MG


EFFEXOR XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG


EFFEXOR XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 75 MG


EMSAM NPB QL (1 EA per 1 day)

escitalopram oxalate oral solution G M

escitalopram oxalate oral tablet G M; QL (2 EA per 1 day)

FETZIMA PB ST; M; QL (1 EA per 1 day)

FETZIMA TITRATION PB ST; M; QL (28 EA per 365 days)

fluoxetine hcl (pmdd) G M; QL (3 EA per 1 day)

fluoxetine hcl oral capsule 10 mg, 20 mg G M; QL (3 EA per 1 day)


22


fluoxetine hcl oral capsule 40 mg G M; QL (2 EA per 1 day)

fluoxetine hcl oral capsule delayed release G M; QL (0.15 EA per 1 day)

fluoxetine hcl oral solution G M

fluoxetine hcl oral tablet 10 mg, 20 mg G M; QL (3 EA per 1 day)

fluoxetine hcl oral tablet 60 mg G M

fluvoxamine maleate G M

fluvoxamine maleate er G M; QL (2 EA per 1 day)

FORFIVO XL NPB ST; M; QL (1 EA per 1 day)

imipramine hcl oral G

imipramine pamoate G

LEXAPRO NPB ST; M; QL (2 EA per 1 day)

MARPLAN NPB

mirtazapine oral G QL (1 EA per 1 day)

NARDIL NPB

nefazodone hcl G M

NORPRAMIN NPB

nortriptyline hcl oral G

olanzapine-fluoxetine hcl oral capsule 12-25 mg, 12-50 mg, 6-50 mg


olanzapine-fluoxetine hcl oral capsule 3-25 mg, 6-25 mg


PAMELOR NPB

PARNATE NPB

paroxetine hcl er G M; QL (2 EA per 1 day)

paroxetine hcl oral suspension G M

paroxetine hcl oral tablet 10 mg, 40 mg G M; QL (1 EA per 1 day)

paroxetine hcl oral tablet 20 mg, 30 mg G M; QL (2 EA per 1 day)

paroxetine mesylate G M; QL (1 EA per 1 day)

PAXIL CR NPB ST; M; QL (2 EA per 1 day)

PAXIL ORAL SUSPENSION NPB ST; M

PAXIL ORAL TABLET 10 MG, 40 MG NPB ST; M; QL (1 EA per 1 day)

PAXIL ORAL TABLET 20 MG, 30 MG NPB ST; M; QL (2 EA per 1 day)

perphenazine-amitriptyline G

PEXEVA NPB ST; M; QL (2 EA per 1 day)

phenelzine sulfate oral G

PRISTIQ NPB ST; M; QL (2 EA per 1 day)

protriptyline hcl G

PROZAC ORAL CAPSULE 10 MG, 20 MG NPB ST; M; QL (3 EA per 1 day)

PROZAC ORAL CAPSULE 40 MG NPB ST; M; QL (2 EA per 1 day)


23


REMERON NPB QL (1 EA per 1 day)

REMERON SOLTAB NPB QL (1 EA per 1 day)

SERTRALINE HCL ORAL CAPSULE NPB ST; M

sertraline hcl oral concentrate G M

sertraline hcl oral tablet 100 mg, 50 mg G M; QL (2 EA per 1 day)

sertraline hcl oral tablet 25 mg G M; QL (8 EA per 1 day)

SPRAVATO (56 MG DOSE) NPB-S PA

SPRAVATO (84 MG DOSE) NPB-S PA

SYMBYAX NPB QL (3 EA per 1 day)

tranylcypromine sulfate G

trazodone hcl oral G

trimipramine maleate oral G

TRINTELLIX NPB ST; QL (1 EA per 1 day)

venlafaxine hcl er oral capsule extended release 24 hour 150 mg


venlafaxine hcl er oral capsule extended release 24 hour 37.5 mg


venlafaxine hcl er oral capsule extended release 24 hour 75 mg


venlafaxine hcl er oral tablet extended release 24 hour 150 mg, 225 mg


venlafaxine hcl er oral tablet extended release 24 hour 37.5 mg


venlafaxine hcl er oral tablet extended release 24 hour 75 mg


venlafaxine hcl oral tablet 100 mg G M; QL (3 EA per 1 day)

venlafaxine hcl oral tablet 25 mg, 37.5 mg, 50 mg, 75 mg


VIIBRYD PB ST; M; QL (1 EA per 1 day)

VIIBRYD STARTER PACK PB ST; M; QL (1 EA per 1 day)

WELLBUTRIN SR NPB ST; M; QL (2 EA per 1 day)

WELLBUTRIN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG


WELLBUTRIN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 300 MG


ZOLOFT ORAL CONCENTRATE NPB ST; M

ZOLOFT ORAL TABLET 100 MG, 50 MG NPB ST; M; QL (2 EA per 1 day)

ZOLOFT ORAL TABLET 25 MG NPB ST; M; QL (8 EA per 1 day)

Antiemetics - Drugs for Nausea and Vomiting

AKYNZEO ORAL PB QL (0.07 EA per 1 day)


24


ANTIVERT ORAL TABLET CHEWABLE NPB

aprepitant oral G QL (6 EA per 30 days)

aprepitant oral capsule 125 mg G QL (2 EA per 30 days)


aprepitant oral capsule 80 & 125 mg G QL (6 EA per 30 days)


BONJESTA NPB QL (2 EA per 1 day)

compro G

DICLEGIS NPB QL (4 EA per 1 day)

dimenhydrinate injection G

doxylamine-pyridoxine G QL (4 EA per 1 day)

dronabinol G QL (2 EA per 1 day)

EMEND ORAL CAPSULE NPB QL (4 EA per 30 days)

EMEND ORAL SUSPENSION RECONSTITUTED

NPB QL (0.1 EA per 1 day)

EMEND TRI-PACK NPB QL (6 EA per 30 days)

GIMOTI NPB

granisetron hcl oral G QL (0.14 EA per 1 day)

MARINOL NPB QL (2 EA per 1 day)

metoclopramide hcl oral G

ondansetron hcl oral solution G QL (4 ML per 1 day)

ondansetron hcl oral tablet 24 mg G QL (0.07 EA per 1 day)

ondansetron hcl oral tablet 4 mg, 8 mg G QL (4 EA per 1 day)

ondansetron odt G QL (4 EA per 1 day)

perphenazine oral G

prochlorperazine G

prochlorperazine maleate oral G

REGLAN NPB

SANCUSO PB QL (0.07 EA per 1 day)

scopolamine G

SYNDROS NPB QL (4 ML per 1 day)

TRANSDERM-SCOP NPB

trimethobenzamide hcl oral G

VARUBI (180 MG DOSE) PB QL (0.14 EA per 1 day)

ZUPLENZ NPB QL (0.34 EA per 1 day)

Antifungals

amphotericin b liposome G

ANCOBON NPB


25


BREXAFEMME NPB ST; QL (4 EA per 1 day)

ciclodan G

ciclopirox external G

ciclopirox olamine external G

clotrimazole mouth/throat G

clotrimazole-betamethasone G

CRESEMBA ORAL PB

DIFLUCAN ORAL SUSPENSION RECONSTITUTED

NPB

DIFLUCAN ORAL TABLET 100 MG, 200 MG, 50 MG

NPB

DIFLUCAN ORAL TABLET 150 MG NPB QL (3 EA per 25 days)

econazole nitrate external G

ECOZA NPB

ERTACZO NPB

EXELDERM NPB

EXTINA NPB

fluconazole oral suspension reconstituted G

fluconazole oral tablet 100 mg, 200 mg, 50 mg G

fluconazole oral tablet 150 mg G QL (3 EA per 25 days)

flucytosine oral G

griseofulvin microsize oral G

griseofulvin ultramicrosize G

GYNAZOLE-1 NPB

itraconazole oral capsule G QL (2 EA per 1 day)

itraconazole oral solution G

JUBLIA NPB ST

KERYDIN NPB ST; QL (10 ML per 25 days)

ketoconazole external G

ketoconazole oral G

ketodan external foam G

LOPROX EXTERNAL CREAM NPB

LOPROX EXTERNAL SHAMPOO NPB

LOPROX EXTERNAL SUSPENSION NPB

LULICONAZOLE NPB ST; QL (60 GM per 25 days)

LUZU NPB ST; QL (60 GM per 25 days)

MENTAX NPB

miconazole 3 G QL (3 EA per 25 days)

MICONAZOLE-ZINC OXIDE-PETROLAT NPB


26


naftifine hcl G

NAFTIN NPB

NOXAFIL ORAL SUSPENSION PB PA

NOXAFIL ORAL TABLET DELAYED RELEASE NPB PA

nyamyc G

nystatin external G

nystatin mouth/throat G

nystatin oral G

nystatin-triamcinolone G

nystop G

ORAVIG NPB

oxiconazole nitrate G

OXISTAT NPB

posaconazole G PA

SPORANOX ORAL CAPSULE NPB QL (2 EA per 1 day)

SPORANOX ORAL SOLUTION NPB

SPORANOX PULSEPAK NPB QL (2 EA per 1 day)

SULCONAZOLE NITRATE G

tavaborole G QL (10 ML per 25 days)

terbinafine hcl oral G QL (84 day supply per 180 days)

terconazole vaginal cream 0.4 % G QL (45 GM per 25 days)

terconazole vaginal cream 0.8 % G QL (20 GM per 25 days)

terconazole vaginal suppository G QL (3 EA per 25 days)

TOLSURA NPB ST

VFEND NPB

voriconazole oral G

VUSION NPB

XOLEGEL NPB

Antigout Agents

allopurinol oral G M

COLCHICINE ORAL CAPSULE NPB ST

colchicine oral tablet G

colchicine-probenecid G

COLCRYS NPB ST

febuxostat G M

GLOPERBA NPB ST

MITIGARE NPB ST

probenecid G M


27


ULORIC PB ST; M

ZYLOPRIM NPB M

Anti-inflammatory Agents

EMFLAZA NPB-S PA

Antimigraine Agents

AIMOVIG SUBCUTANEOUS SOLUTION AUTO-INJECTOR 140 MG/ML, 70 MG/ML

PB PA; M

AJOVY NPB PA; M; QL (4.5 ML per 81 days)

almotriptan malate G QL (18 EA per 25 days)

AMERGE NPB ST; QL (18 EA per 25 days)

CAFERGOT NPB

D.H.E. 45 NPB

dihydroergotamine mesylate injection G

dihydroergotamine mesylate nasal G QL (0.27 ML per 1 day)

eletriptan hydrobromide G QL (18 EA per 25 days)

EMGALITY PB PA; M

ERGOMAR NPB

ergotamine-caffeine G

FROVA NPB ST; QL (18 EA per 25 days)

frovatriptan succinate G QL (18 EA per 25 days)

IMITREX NASAL NPB ST; QL (0.4 EA per 1 day)

IMITREX ORAL NPB ST; QL (18 EA per 25 days)

IMITREX STATDOSE REFILL SUBCUTANEOUS SOLUTION CARTRIDGE 4 MG/0.5ML

NPB ST; QL (10 ML per 25 days)

IMITREX STATDOSE REFILL SUBCUTANEOUS SOLUTION CARTRIDGE 6 MG/0.5ML

NPB ST

IMITREX STATDOSE SYSTEM NPB ST; QL (10 ML per 25 days)

MAXALT NPB ST; QL (18 EA per 25 days)

MAXALT-MLT NPB ST; QL (18 EA per 25 days)

MIGERGOT G

MIGRANAL NPB QL (0.27 ML per 1 day)

naratriptan hcl G QL (18 EA per 25 days)

NURTEC PB PA; QL (0.27 EA per 1 day)

ONZETRA XSAIL NPB ST; QL (0.54 EA per 1 day)

RELPAX NPB ST; QL (18 EA per 25 days)

REYVOW NPB PA; QL (8 EA per 30 days)

rizatriptan benzoate G QL (18 EA per 25 days)


28


sumatriptan nasal G QL (0.4 EA per 1 day)

sumatriptan succinate oral G QL (18 EA per 25 days)

sumatriptan succinate refill subcutaneous solution cartridge subcutaneous solution cartridge 4 mg/0.5ml

G QL (10 ML per 25 days)

sumatriptan succinate refill subcutaneous solution cartridge subcutaneous solution cartridge 6 mg/0.5ml

G

sumatriptan succinate subcutaneous solution G QL (4 ML per 25 days)

sumatriptan succinate subcutaneous solution auto-injector


sumatriptan-naproxen sodium G QL (18 EA per 30 days)

TOSYMRA NPB-S ST; QL (0.4 EA per 1 day)

TREXIMET NPB ST; QL (18 EA per 30 days)

UBRELVY PB PA; QL (10 EA per 30 days)

ZEMBRACE SYMTOUCH NPB ST; QL (0.27 ML per 1 day)

ZOLMITRIPTAN NASAL SOLUTION 2.5 MG NPB ST; QL (0.4 EA per 1 day)

zolmitriptan nasal solution 5 mg G QL (0.4 EA per 1 day)

zolmitriptan oral G QL (18 EA per 25 days)

ZOMIG NASAL NPB ST; QL (0.4 EA per 1 day)

ZOMIG ORAL NPB ST; QL (18 EA per 25 days)

Antimyasthenic Agents

MESTINON ORAL SOLUTION G M

MESTINON ORAL TABLET NPB M

MESTINON ORAL TABLET EXTENDED RELEASE

NPB M

pyridostigmine bromide er G M

pyridostigmine bromide oral G M

Antimycobacterials

cycloserine oral NPB

dapsone oral G

ethambutol hcl oral G

isoniazid oral G

MYAMBUTOL NPB

MYCOBUTIN NPB

PASER NPB

PRETOMANID NPB

PRIFTIN PB

pyrazinamide oral G

rifabutin G


29


rifampin oral G

RIFAMPIN+SYRSPEND SF NPB

SIRTURO PB-S

TRECATOR NPB

Antineoplastics - Drugs for Cancer

abiraterone acetate G-S QL (4 EA per 1 day)

AFINITOR NPB-S QL (1 EA per 1 day)

AFINITOR DISPERZ NPB-S QL (1 EA per 1 day)

ALECENSA PB-S

ALKERAN ORAL NPB

ALUNBRIG ORAL TABLET 180 MG, 90 MG NPB-S PA; QL (1 EA per 1 day)

ALUNBRIG ORAL TABLET 30 MG NPB-S PA; QL (4 EA per 1 day)

ALUNBRIG ORAL TABLET THERAPY PACK NPB-S PA; QL (30 EA per 365 days)

anastrozole oral G ACA

ARIMIDEX NPB ST

AROMASIN NPB

AYVAKIT NPB-S PA

BALVERSA NPB-S PA

bexarotene G-S

bicalutamide G

BOSULIF PB-S

BRAFTOVI NPB-S PA

BRUKINSA NPB-S PA

CABOMETYX PB-S QL (1 EA per 1 day)

CALQUENCE NPB-S PA

capecitabine G-S

CAPRELSA ORAL TABLET 100 MG PB-S QL (2 EA per 1 day)

CAPRELSA ORAL TABLET 300 MG PB-S QL (1 EA per 1 day)

CASODEX NPB

COMETRIQ NPB-S QL (1 EA per 1 day)

COPIKTRA NPB-S PA

COTELLIC PB-S

cyclophosphamide oral capsule G

CYCLOPHOSPHAMIDE ORAL TABLET NPB

DAURISMO NPB-S PA

DROXIA PB-S

EMCYT PB-S

ENHERTU NPB


30


ERIVEDGE PB-S

ERLEADA PB-S PA

erlotinib hcl oral tablet 100 mg, 150 mg G-S

erlotinib hcl oral tablet 25 mg G-S QL (3 EA per 1 day)

etoposide oral G-S

EULEXIN NPB

everolimus oral tablet 10 mg, 2.5 mg, 5 mg, 7.5 mg

G-S QL (1 EA per 1 day)

everolimus oral tablet soluble G-S QL (1 EA per 1 day)

exemestane G ACA

EXKIVITY NPB-S

FARESTON NPB

FARYDAK NPB-S

FEMARA NPB

flutamide G

FOTIVDA NPB-S PA

GAVRETO NPB-S PA

GILOTRIF PB-S QL (1 EA per 1 day)

GLEEVEC ORAL TABLET 100 MG NPB-S ST; QL (3 EA per 1 day)

GLEEVEC ORAL TABLET 400 MG NPB-S ST; QL (2 EA per 1 day)

GLEOSTINE PB-S

HYCAMTIN ORAL PB-S

HYDREA NPB

hydroxyurea oral G

IBRANCE ORAL CAPSULE PB-S

IBRANCE ORAL TABLET PB-S PA

ICLUSIG ORAL TABLET 10 MG, 30 MG, 45 MG PB-S

ICLUSIG ORAL TABLET 15 MG PB-S QL (2 EA per 1 day)

IDHIFA PB-S PA; QL (1 EA per 1 day)

imatinib mesylate oral tablet 100 mg G-S QL (3 EA per 1 day)

imatinib mesylate oral tablet 400 mg G-S QL (2 EA per 1 day)

IMBRUVICA PB-S

INLYTA PB-S QL (4 EA per 1 day)

INQOVI NPB-S PA

INREBIC NPB-S

IRESSA PB-S

irinotecan hcl intravenous solution 300 mg/15ml G

JAKAFI ORAL TABLET 10 MG PB-S QL (2 EA per 1 day)


31


JAKAFI ORAL TABLET 15 MG, 20 MG, 25 MG, 5 MG

PB-S

KISQALI FEMARA NPB-S PA

KISQALI ORAL TABLET THERAPY PACK 200 MG

NPB-S PA

KOSELUGO PB-S PA

lapatinib ditosylate G-S QL (8 EA per 1 day)

lenalidomide G

LENVIMA ORAL CAPSULE THERAPY PACK 10 & 4 MG, 10 MG, 10 MG & 2 X 4 MG, 2 X 10 MG, 2 X 10 MG & 4 MG, 2 X 4 MG, 3 X 4 MG, 4 MG

PB-S

letrozole oral G

leucovorin calcium oral G

LEUKERAN PB

LONSURF PB-S

LORBRENA PB-S PA

LUMAKRAS NPB-S PA

LYNPARZA PB-S

LYSODREN PB-S

MATULANE PB-S

MEKINIST PB-S

MEKTOVI NPB-S PA

melphalan G

mercaptopurine oral G

MESNEX ORAL PB

MYLERAN PB-S

NERLYNX PB-S PA; QL (6 EA per 1 day)

NEXAVAR PB-S QL (4 EA per 1 day)

NILANDRON NPB-S

nilutamide G-S

NINLARO PB-S

NUBEQA PB-S

ODOMZO NPB-S

ONUREG NPB-S PA

ORGOVYX NPB-S PA

oxaliplatin intravenous solution 200 mg/40ml G

PADCEV NPB

PANRETIN NPB


32


PEMAZYRE NPB-S PA; QL (1 EA per 1 day)

PIQRAY PB-S PA

POMALYST PB-S QL (1 EA per 1 day)

PURIXAN PB-S

QINLOCK NPB-S PA

RETEVMO NPB-S PA

REVLIMID PB-S

ROZLYTREK PB-S

RUBRACA PB-S PA

RYDAPT PB-S PA

SCEMBLIX NPB-S

SIKLOS NPB-S ST

SOLTAMOX NPB ACA

SPRYCEL PB-S QL (1 EA per 1 day)

STIVARGA PB-S

sunitinib malate oral capsule 12.5 mg G QL (4 EA per 1 day)

sunitinib malate oral capsule 25 mg G QL (2 EA per 1 day)

sunitinib malate oral capsule 37.5 mg, 50 mg G QL (1 EA per 1 day)

SUTENT ORAL CAPSULE 12.5 MG NPB-S QL (4 EA per 1 day)

SUTENT ORAL CAPSULE 25 MG NPB-S QL (2 EA per 1 day)

SUTENT ORAL CAPSULE 37.5 MG, 50 MG NPB-S QL (1 EA per 1 day)

TABLOID PB-S

TABRECTA NPB-S PA

TAFINLAR PB-S

TAGRISSO ORAL TABLET 40 MG PB-S QL (1 EA per 1 day)

TAGRISSO ORAL TABLET 80 MG PB-S

TALZENNA PB-S PA

tamoxifen citrate oral G ACA

TARCEVA ORAL TABLET 100 MG, 150 MG PB-S

TARCEVA ORAL TABLET 25 MG PB-S QL (3 EA per 1 day)

TARGRETIN EXTERNAL PB

TARGRETIN ORAL NPB-S

TASIGNA PB-S QL (4 EA per 1 day)

TAZVERIK NPB-S PA

TEMODAR ORAL NPB-S

temozolomide G-S

TEPMETKO NPB-S PA

THALOMID PB-S


33


thiotepa injection solution reconstituted 100 mg G

TIBSOVO PB-S PA

toremifene citrate G

tretinoin oral G-S

TRUSELTIQ (100MG DAILY DOSE) NPB-S PA




TUKYSA NPB-S PA

TURALIO NPB-S

TYKERB PB-S QL (8 EA per 1 day)

UKONIQ NPB-S PA

VALCHLOR PB-S

VENCLEXTA PB-S

VENCLEXTA STARTING PACK PB-S

VERZENIO ORAL TABLET 100 MG, 150 MG, 200 MG

PB-S

VERZENIO ORAL TABLET 50 MG PB-S PA

VITRAKVI PB-S PA

VIZIMPRO PB-S PA

VOTRIENT PB-S QL (4 EA per 1 day)

WELIREG NPB-S PA

XALKORI ORAL CAPSULE 200 MG PB-S PA; QL (2 EA per 1 day)

XALKORI ORAL CAPSULE 250 MG PB-S QL (2 EA per 1 day)

XELODA NPB-S

XOSPATA PB-S PA

XPOVIO (100 MG ONCE WEEKLY) NPB-S PA


XPOVIO (40 MG TWICE WEEKLY) NPB-S PA





XTANDI ORAL CAPSULE PB-S QL (4 EA per 1 day)

XTANDI ORAL TABLET 40 MG PB-S QL (4 EA per 1 day)

XTANDI ORAL TABLET 80 MG PB-S QL (2 EA per 1 day)

YONSA PB-S PA

ZEJULA PB-S PA


34


ZELBORAF PB-S QL (8 EA per 1 day)

ZOLINZA PB-S QL (4 EA per 1 day)

ZYDELIG PB-S

ZYKADIA PB-S

ZYTIGA ORAL TABLET 250 MG NPB-S QL (4 EA per 1 day)

ZYTIGA ORAL TABLET 500 MG PB-S QL (4 EA per 1 day)

Antiparasitics

albendazole oral G

ALBENZA NPB

ALINIA ORAL SUSPENSION RECONSTITUTED

PB

ALINIA ORAL TABLET NPB

ARAKODA NPB

atovaquone G

atovaquone-proguanil hcl G

BENZNIDAZOLE PB

BILTRICIDE NPB

chloroquine phosphate oral tablet 250 mg G QL (4 EA per 1 day)

chloroquine phosphate oral tablet 500 mg G QL (2 EA per 1 day)

COARTEM PB

crotan G

DARAPRIM NPB-S ST

EGATEN NPB

EMVERM PB

hydroxychloroquine sulfate oral tablet 100 mg, 300 mg, 400 mg

G M

hydroxychloroquine sulfate oral tablet 200 mg G M; QL (2 EA per 1 day)

IMPAVIDO PB-S

ivermectin external lotion G

ivermectin oral G PA; QL (20 EA per 1 fill)

KRINTAFEL NPB

LAMPIT NPB

lindane G QL (60 ML per 25 days)

MALARONE NPB

malathion G

mefloquine hcl G

MEPRON NPB

NATROBA NPB QL (120 ML per 25 days)

NEBUPENT NPB QL (1 EA per 25 days)


35


nitazoxanide oral G

OVIDE NPB

pentamidine isethionate inhalation G QL (1 EA per 25 days)

permethrin external G

PLAQUENIL NPB M; QL (2 EA per 1 day)

praziquantel oral G

primaquine phosphate PB

pyrimethamine oral G-S PA

QUALAQUIN NPB

quinine sulfate oral G

spinosad G QL (120 ML per 25 days)

STROMECTOL NPB PA; QL (20 EA per 1 fill)

sulfurated lime G

Antiparkinson Agents

amantadine hcl oral G M

APOKYN PB-S QL (3 ML per 1 day)

apomorphine hcl subcutaneous G QL (3 ML per 1 day)

AZILECT NPB M

benztropine mesylate oral G

bromocriptine mesylate oral G

carbidopa oral G M

carbidopa-levodopa G M

carbidopa-levodopa er G M

carbidopa-levodopa-entacapone G M

COMTAN NPB M

entacapone G M

GOCOVRI NPB-S PA; M

INBRIJA NPB

KYNMOBI PB-S QL (5 EA per 1 day)

KYNMOBI TITRATION KIT PB-S QL (20 EA per 365 days)

LODOSYN NPB M

MIRAPEX ER NPB M

NEUPRO NPB M

NOURIANZ NPB-S PA

ONGENTYS NPB ST

OSMOLEX ER NPB ST; M

PARLODEL NPB

pramipexole dihydrochloride G M


36


pramipexole dihydrochloride er G M

rasagiline mesylate oral G M

ropinirole hcl G M

ropinirole hcl er G M

RYTARY NPB M

selegiline hcl oral G M

SINEMET NPB M

STALEVO 100 NPB M

STALEVO 125 NPB M

STALEVO 150 NPB M

STALEVO 200 NPB M

STALEVO 50 NPB M

STALEVO 75 NPB M

TASMAR NPB M

tolcapone G M

trihexyphenidyl hcl G

XADAGO NPB ST; M; QL (1 EA per 1 day)

ZELAPAR NPB M

Antiplatelets

aspirin-dipyridamole er G M

ASPIRIN-OMEPRAZOLE NPB ST; QL (1 EA per 1 day)

BRILINTA PB M

CABLIVI NPB-S PA; QL (1 EA per 1 day)

cilostazol G M

clopidogrel bisulfate oral G M

dipyridamole oral G M

DURLAZA NPB ST

EFFIENT NPB ST; M

PLAVIX NPB ST; M

prasugrel hcl G M

YOSPRALA NPB ST; QL (1 EA per 1 day)

ZONTIVITY PB M

Antipsychotics - Drugs for Mood Disorders

ABILIFY NPB ST; QL (1 EA per 1 day)

ABILIFY MAINTENA PB

ABILIFY MYCITE NPB-S PA; QL (1 EA per 1 day)

ABILIFY MYCITE MAINTENANCE KIT NPB-S QL (1 EA per 1 day)

ABILIFY MYCITE STARTER KIT NPB-S QL (1 EA per 1 day)


37


ADASUVE NPB

aripiprazole oral solution G QL (25 ML per 1 day)

aripiprazole oral tablet G QL (1 EA per 1 day)

aripiprazole oral tablet dispersible G QL (2 EA per 1 day)

ARISTADA PB

ARISTADA INITIO PB

asenapine maleate G QL (2 EA per 1 day)

CAPLYTA NPB ST; QL (1 EA per 1 day)

chlorpromazine hcl oral G

clozapine oral tablet 100 mg, 25 mg G QL (9 EA per 1 day)

clozapine oral tablet 200 mg G QL (4 EA per 1 day)

clozapine oral tablet 50 mg G QL (6 EA per 1 day)

clozapine oral tablet dispersible 100 mg, 25 mg G QL (9 EA per 1 day)

clozapine oral tablet dispersible 12.5 mg G QL (3 EA per 1 day)

clozapine oral tablet dispersible 150 mg NPB QL (6 EA per 1 day)

clozapine oral tablet dispersible 200 mg NPB QL (4 EA per 1 day)

CLOZARIL ORAL TABLET 100 MG, 25 MG NPB QL (9 EA per 1 day)

CLOZARIL ORAL TABLET 200 MG NPB QL (4 EA per 1 day)

CLOZARIL ORAL TABLET 50 MG NPB QL (6 EA per 1 day)

FANAPT NPB ST; QL (2 EA per 1 day)

FANAPT TITRATION PACK NPB ST; QL (8 EA per 180 days)

fluphenazine hcl G

GEODON INTRAMUSCULAR NPB

GEODON ORAL NPB QL (2 EA per 1 day)

HALDOL DECANOATE NPB

haloperidol decanoate intramuscular G

haloperidol lactate oral G

haloperidol oral G

INVEGA ORAL TABLET EXTENDED RELEASE 24 HOUR 1.5 MG, 3 MG, 9 MG

NPB QL (1 EA per 1 day)

INVEGA ORAL TABLET EXTENDED RELEASE 24 HOUR 6 MG


INVEGA SUSTENNA NPB

INVEGA TRINZA NPB

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

PB QL (1 EA per 1 day)

LATUDA ORAL TABLET 80 MG PB QL (2 EA per 1 day)

loxapine succinate G

molindone hcl G


38


NUPLAZID NPB

olanzapine oral G QL (1 EA per 1 day)

paliperidone er oral tablet extended release 24 hour 1.5 mg, 3 mg, 9 mg


paliperidone er oral tablet extended release 24 hour 6 mg


PERSERIS NPB

pimozide G

quetiapine fumarate er oral tablet extended release 24 hour 150 mg, 300 mg, 400 mg, 50 mg


quetiapine fumarate er oral tablet extended release 24 hour 200 mg


quetiapine fumarate oral tablet 100 mg, 200 mg, 25 mg, 50 mg


quetiapine fumarate oral tablet 300 mg, 400 mg G QL (2 EA per 1 day)

REXULTI NPB QL (1 EA per 1 day)

RISPERDAL CONSTA PB

RISPERDAL ORAL SOLUTION NPB QL (8 ML per 1 day)

RISPERDAL ORAL TABLET NPB QL (2 EA per 1 day)

risperidone oral solution G QL (8 ML per 1 day)

risperidone oral tablet G QL (2 EA per 1 day)

risperidone oral tablet dispersible G QL (2 EA per 1 day)

SAPHRIS NPB ST; QL (2 EA per 1 day)

SECUADO NPB ST; QL (1 EA per 1 day)

SEROQUEL ORAL TABLET 100 MG, 200 MG, 25 MG, 50 MG


SEROQUEL ORAL TABLET 300 MG, 400 MG NPB ST; QL (2 EA per 1 day)

SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG, 300 MG, 400 MG, 50 MG


SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 200 MG


thioridazine hcl oral G

thiothixene G

trifluoperazine hcl G

VERSACLOZ NPB QL (18 ML per 1 day)

VRAYLAR ORAL CAPSULE NPB ST; QL (1 EA per 1 day)

VRAYLAR ORAL CAPSULE THERAPY PACK NPB ST; QL (14 EA per 365 days)

ziprasidone hcl G QL (2 EA per 1 day)

ziprasidone mesylate G


39


ZYPREXA ORAL NPB QL (1 EA per 1 day)

ZYPREXA RELPREVV NPB

ZYPREXA ZYDIS NPB QL (1 EA per 1 day)

Antivirals

abacavir sulfate oral solution G QL (30 ML per 1 day)

abacavir sulfate oral tablet G QL (2 EA per 1 day)

abacavir sulfate-lamivudine G QL (1 EA per 1 day)

abacavir-lamivudine-zidovudine G QL (2 EA per 1 day)

acyclovir external cream G QL (5 GM per 25 days)

acyclovir external ointment G QL (30 GM per 25 days)

acyclovir oral G

adefovir dipivoxil G

APTIVUS PB QL (4 EA per 1 day)

atazanavir sulfate G

ATRIPLA NPB ST; QL (1 EA per 1 day)

BARACLUDE ORAL SOLUTION PB QL (21 ML per 1 day)

BARACLUDE ORAL TABLET NPB ST; QL (1 EA per 1 day)

BIKTARVY PB

CIMDUO PB

COMBIVIR NPB QL (2 EA per 1 day)

COMPLERA PB QL (1 EA per 1 day)

DELSTRIGO NPB

DENAVIR NPB

DESCOVY ORAL TABLET 120-15 MG PB

DESCOVY ORAL TABLET 200-25 MG PB ACA

DOVATO NPB

EDURANT PB QL (1 EA per 1 day)

efavirenz oral capsule G QL (2 EA per 1 day)

efavirenz oral tablet G QL (1 EA per 1 day)

efavirenz-emtricitab-tenofovir G QL (1 EA per 1 day)

efavirenz-lamivudine-tenofovir G

emtricitabine G QL (1 EA per 1 day)

emtricitabine-tenofovir df oral tablet 100-150 mg, 133-200 mg, 167-250 mg

G

emtricitabine-tenofovir df oral tablet 200-300 mg G QL (1 EA per 1 day)

EMTRIVA ORAL CAPSULE NPB QL (1 EA per 1 day)

EMTRIVA ORAL SOLUTION PB QL (24 ML per 1 day)

entecavir G QL (1 EA per 1 day)


40


EPCLUSA PB-S PA

EPIVIR HBV ORAL SOLUTION PB

EPIVIR HBV ORAL TABLET NPB QL (1 EA per 1 day)

EPIVIR ORAL SOLUTION NPB QL (30 ML per 1 day)

EPIVIR ORAL TABLET 150 MG NPB QL (2 EA per 1 day)

EPIVIR ORAL TABLET 300 MG NPB QL (1 EA per 1 day)

EPZICOM NPB QL (1 EA per 1 day)

etravirine oral tablet 100 mg G QL (6 EA per 1 day)

etravirine oral tablet 200 mg G QL (2 EA per 1 day)

EVOTAZ NPB QL (1 EA per 1 day)

famciclovir oral G

fosamprenavir calcium G QL (4 EA per 1 day)

FUZEON PB

GENVOYA PB

HARVONI PB-S PA

HEPSERA NPB

INTELENCE ORAL TABLET 100 MG NPB QL (6 EA per 1 day)

INTELENCE ORAL TABLET 200 MG NPB QL (2 EA per 1 day)

INTELENCE ORAL TABLET 25 MG PB QL (6 EA per 1 day)

INTRON A PB-S

ISENTRESS HD PB

ISENTRESS ORAL PACKET PB QL (2 EA per 1 day)

ISENTRESS ORAL TABLET PB QL (2 EA per 1 day)

ISENTRESS ORAL TABLET CHEWABLE 100 MG


ISENTRESS ORAL TABLET CHEWABLE 25 MG


JULUCA NPB

KALETRA ORAL SOLUTION NPB QL (16 ML per 1 day)

KALETRA ORAL TABLET 100-25 MG NPB QL (10 EA per 1 day)

KALETRA ORAL TABLET 200-50 MG NPB QL (4 EA per 1 day)

lamivudine oral solution G QL (30 ML per 1 day)

lamivudine oral tablet 100 mg, 300 mg G QL (1 EA per 1 day)

lamivudine oral tablet 150 mg G QL (2 EA per 1 day)

lamivudine-zidovudine G QL (2 EA per 1 day)

LEXIVA ORAL SUSPENSION PB QL (28 ML per 1 day)

LEXIVA ORAL TABLET NPB QL (4 EA per 1 day)

lopinavir-ritonavir oral solution G QL (16 ML per 1 day)

lopinavir-ritonavir oral tablet 100-25 mg G QL (10 EA per 1 day)


41


lopinavir-ritonavir oral tablet 200-50 mg G QL (4 EA per 1 day)

maraviroc G QL (2 EA per 1 day)

MAVYRET ORAL PACKET NPB PA

MAVYRET ORAL TABLET NPB-S PA

MOLNUPIRAVIR NPB QL (80 EA per 365 days)

nevirapine er oral tablet extended release 24 hour 100 mg


nevirapine er oral tablet extended release 24 hour 400 mg


nevirapine oral suspension G QL (40 ML per 1 day)

nevirapine oral tablet G QL (2 EA per 1 day)

NORVIR ORAL PACKET PB

NORVIR ORAL SOLUTION PB QL (16 ML per 1 day)

NORVIR ORAL TABLET NPB QL (6 EA per 1 day)

ODEFSEY PB

oseltamivir phosphate oral capsule 30 mg G QL (40 EA per 365 days)

oseltamivir phosphate oral capsule 45 mg, 75 mg

G QL (20 EA per 365 days)

oseltamivir phosphate oral suspension reconstituted


PAXLOVID NPB QL (60 EA per 365 days)

PEGASYS SUBCUTANEOUS SOLUTION PB-S QL (4 ML per 21 days)

PEGASYS SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PB-S QL (2 ML per 21 days)

PIFELTRO NPB

PREVYMIS ORAL PB

PREZCOBIX NPB

PREZISTA ORAL SUSPENSION PB QL (8 ML per 1 day)

PREZISTA ORAL TABLET 150 MG PB QL (6 EA per 1 day)




RELENZA DISKHALER PB QL (40 EA per 365 days)

RETROVIR ORAL CAPSULE NPB QL (6 EA per 1 day)

RETROVIR ORAL SYRUP NPB QL (60 ML per 1 day)

REYATAZ ORAL CAPSULE NPB

REYATAZ ORAL PACKET PB

ribavirin inhalation G-S

ribavirin oral G-S


42


rimantadine hcl G

ritonavir G QL (6 EA per 1 day)

RUKOBIA NPB

SELZENTRY ORAL SOLUTION PB

SELZENTRY ORAL TABLET 150 MG, 300 MG NPB QL (2 EA per 1 day)

SELZENTRY ORAL TABLET 25 MG, 75 MG PB

SITAVIG NPB ST; QL (0.07 EA per 1 day)

SOVALDI ORAL PACKET NPB-S PA

SOVALDI ORAL TABLET NPB-S PA; QL (1 EA per 1 day)

stavudine G QL (2 EA per 1 day)

STRIBILD PB QL (1 EA per 1 day)

SUSTIVA ORAL CAPSULE NPB QL (2 EA per 1 day)

SUSTIVA ORAL TABLET NPB QL (1 EA per 1 day)

SYMFI NPB

SYMFI LO NPB

SYMTUZA NPB

TAMIFLU ORAL CAPSULE 30 MG NPB QL (40 EA per 365 days)

TAMIFLU ORAL CAPSULE 45 MG, 75 MG NPB QL (20 EA per 365 days)

TAMIFLU ORAL SUSPENSION RECONSTITUTED

NPB QL (360 ML per 365 days)

TEMIXYS PB

tenofovir disoproxil fumarate G ACA; QL (1 EA per 1 day)

TIVICAY ORAL TABLET 10 MG, 25 MG PB

TIVICAY ORAL TABLET 50 MG PB QL (1 EA per 1 day)

TIVICAY PD PB

TRIUMEQ PB QL (1 EA per 1 day)

TRIZIVIR NPB QL (2 EA per 1 day)

TRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG

NPB ST

TRUVADA ORAL TABLET 200-300 MG NPB ST; QL (1 EA per 1 day)

TYBOST NPB QL (1 EA per 1 day)

valacyclovir hcl oral G QL (4 EA per 1 day)

VALCYTE NPB

valganciclovir hcl G

VALTREX NPB ST; QL (4 EA per 1 day)

VEMLIDY PB

VIEKIRA PAK NPB-S PA; QL (3 EA per 365 days)

VIRACEPT ORAL TABLET 250 MG PB QL (6 EA per 1 day)

VIRACEPT ORAL TABLET 625 MG PB QL (4 EA per 1 day)


43


VIRAMUNE XR NPB QL (1 EA per 1 day)

VIRAZOLE NPB-S

VIREAD ORAL POWDER PB QL (8 GM per 1 day)

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG


VIREAD ORAL TABLET 300 MG NPB QL (1 EA per 1 day)

VOCABRIA NPB

VOSEVI PB-S PA

XERESE NPB ST; QL (5 GM per 23 days)

XOFLUZA (40 MG DOSE) PB QL (4 day supply per 365 days)

XOFLUZA (80 MG DOSE) PB QL (4 day supply per 365 days)

ZEPATIER PB-S PA

ZIAGEN ORAL SOLUTION NPB QL (30 ML per 1 day)

ZIAGEN ORAL TABLET NPB QL (2 EA per 1 day)

zidovudine oral capsule G QL (6 EA per 1 day)

zidovudine oral syrup G QL (60 ML per 1 day)

zidovudine oral tablet G QL (2 EA per 1 day)

ZOVIRAX EXTERNAL CREAM NPB QL (5 GM per 25 days)

ZOVIRAX EXTERNAL OINTMENT NPB QL (30 GM per 25 days)

ZOVIRAX ORAL NPB

Anxiolytics - Drugs for Anxiety

alprazolam er oral tablet extended release 24 hour 0.5 mg, 1 mg


alprazolam er oral tablet extended release 24 hour 2 mg


alprazolam er oral tablet extended release 24 hour 3 mg


alprazolam intensol G QL (10 ML per 1 day)

alprazolam oral tablet G QL (6 EA per 1 day)

alprazolam oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg


alprazolam oral tablet dispersible 2 mg G QL (5 EA per 1 day)

alprazolam xr oral tablet extended release 24 hour 0.5 mg, 1 mg


alprazolam xr oral tablet extended release 24 hour 2 mg


alprazolam xr oral tablet extended release 24 hour 3 mg


ATIVAN ORAL NPB QL (4 EA per 1 day)

buspirone hcl oral G M


44


chlordiazepoxide hcl oral capsule 10 mg G QL (30 EA per 1 day)



clonazepam oral G QL (4 EA per 1 day)

clorazepate dipotassium oral tablet 15 mg G QL (6 EA per 1 day)

clorazepate dipotassium oral tablet 3.75 mg G QL (24 EA per 1 day)

clorazepate dipotassium oral tablet 7.5 mg G QL (12 EA per 1 day)

diazepam intensol G

diazepam oral G

DORAL NPB QL (1 EA per 1 day)

estazolam G QL (1 EA per 1 day)

HALCION NPB QL (2 EA per 1 day)

hydroxyzine hcl oral G

hydroxyzine pamoate oral G

KLONOPIN NPB QL (4 EA per 1 day)

lorazepam intensol G QL (5 ML per 1 day)

lorazepam oral concentrate 2 mg/ml G QL (5 ML per 1 day)

lorazepam oral tablet G QL (4 EA per 1 day)

meprobamate G

oxazepam G QL (4 EA per 1 day)

quazepam G QL (1 EA per 1 day)

TRANXENE-T NPB QL (12 EA per 1 day)

triazolam G QL (2 EA per 1 day)

VALIUM NPB ST

VISTARIL NPB

XANAX NPB ST; QL (6 EA per 1 day)

XANAX XR ORAL TABLET EXTENDED RELEASE 24 HOUR 0.5 MG, 1 MG


XANAX XR ORAL TABLET EXTENDED RELEASE 24 HOUR 2 MG


XANAX XR ORAL TABLET EXTENDED RELEASE 24 HOUR 3 MG


Bipolar Agents - Drugs for Mood Disorders

EQUETRO NPB

lithium carbonate er G

lithium carbonate oral G

LITHOBID NPB


45


Blood Products and Modifiers - Drugs for Blood Disorders

AGRYLIN NPB M

AMICAR NPB

aminocaproic acid oral G

anagrelide hcl G M

ASTRINGYN NPB

DOPTELET PB-S PA

HEXTEND NPB

LYSTEDA NPB

MULPLETA PB-S PA

NUWIQ INTRAVENOUS KIT 1500 UNIT NPB

NUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 1500 UNIT

NPB

PROMACTA PB-S PA

PYRUKYND NPB

PYRUKYND TAPER PACK NPB

RELEUKO NPB

TAVALISSE NPB-S PA

THROMBIN-JMI NPB

THROMBIN-JMI EPISTAXIS NPB

THROMBOGEN NPB

tranexamic acid oral G

Cardiovascular Agents - Drugs for Heart and Circulation Conditions

ACCUPRIL NPB M

ACCURETIC NPB ST; M

acebutolol hcl oral G M

ALDACTAZIDE NPB M

ALDACTONE NPB M

aliskiren fumarate G M

ALTACE NPB M

ALTOPREV NPB ST; M; QL (1 EA per 1 day)

amiloride hcl oral G M

amiloride-hydrochlorothiazide G M

amiodarone hcl oral G M

AMLODIPINE BES+SYRSPEND SF NPB ST; M

amlodipine besylate oral G M

amlodipine besylate-benazepril hcl G M


46


amlodipine besylate-valsartan G M

amlodipine-atorvastatin G M; QL (1 EA per 1 day)

amlodipine-olmesartan G M

ANTARA NPB ST; M; QL (1 EA per 1 day)

ATACAND NPB ST; M

ATACAND HCT NPB ST; M

atenolol oral G M

ATENOLOL+SYRSPEND SF NPB ST; M

atenolol-chlorthalidone G M

atorvastatin calcium oral tablet 10 mg, 20 mg G M; ACA; QL (1 EA per 1 day)

atorvastatin calcium oral tablet 40 mg, 80 mg G M; QL (1 EA per 1 day)

AVALIDE NPB ST; M

AVAPRO NPB ST; M

AZOR NPB ST; M

benazepril hcl oral G M

benazepril-hydrochlorothiazide G M

BENICAR NPB ST; M

BENICAR HCT NPB ST; M

BETAPACE NPB ST; M

BETAPACE AF NPB ST; M

betaxolol hcl oral G M

BIDIL NPB M

bisoprolol fumarate oral G M

bisoprolol-hydrochlorothiazide G M

bumetanide oral G M

BUMEX NPB M

BYSTOLIC NPB ST; M

CADUET NPB ST; M; QL (1 EA per 1 day)

CALAN SR NPB ST; M

candesartan cilexetil G M

candesartan cilexetil-hctz G M

captopril oral G M

CARDIZEM NPB ST; M

CARDIZEM CD NPB ST; M

CARDIZEM LA NPB ST; M

CARDURA ORAL TABLET 1 MG, 2 MG, 4 MG NPB ST; M; QL (1 EA per 1 day)

CARDURA ORAL TABLET 8 MG NPB ST; M; QL (2 EA per 1 day)

CAROSPIR NPB ST; M


47


cartia xt G M

carvedilol G M

carvedilol phosphate er G M

CATAPRES-TTS-1 NPB M; QL (0.2 EA per 1 day)



chlorthalidone G M

cholestyramine light G M

cholestyramine oral G M

clonidine G M; QL (0.2 EA per 1 day)

clonidine hcl oral G M

colesevelam hcl G M

COLESTID NPB ST; M

COLESTID FLAVORED NPB ST; M

colestipol hcl G M

CONJUPRI NPB ST

CONSENSI NPB ST; QL (1 EA per 1 day)

COREG NPB ST; M

COREG CR NPB ST; M

CORGARD NPB ST; M

CORLANOR ORAL SOLUTION NPB M; QL (15 ML per 1 day)

CORLANOR ORAL TABLET PB M; QL (2 EA per 1 day)

COZAAR NPB ST; M

CRESTOR NPB ST; M; QL (1 EA per 1 day)

DEMSER PB

DIBENZYLINE NPB

digitek G M

digox G M

digoxin oral G M

diltiazem hcl er G M

diltiazem hcl er beads G M

diltiazem hcl er coated beads G M

diltiazem hcl oral G M

dilt-xr G M

DIOVAN NPB ST; M

DIOVAN HCT NPB ST; M

disopyramide phosphate G M

DIURIL NPB M


48


dofetilide G

doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg G M; QL (1 EA per 1 day)

doxazosin mesylate oral tablet 8 mg G M; QL (2 EA per 1 day)

droxidopa G PA

DUTOPROL NPB ST; M

DYRENIUM NPB M

EDARBI PB ST; M

EDARBYCLOR PB ST; M

EDECRIN NPB M

enalapril maleate oral G M

enalapril-hydrochlorothiazide G M

ENTRESTO PB M; QL (2 EA per 1 day)

EPANED NPB M

eplerenone G M

ethacrynic acid G M

EXFORGE NPB ST; M

EXFORGE HCT NPB ST; M

EZALLOR SPRINKLE NPB ST; M

ezetimibe G M

EZETIMIBE-ROSUVASTATIN NPB ST

ezetimibe-simvastatin G M; QL (1 EA per 1 day)

felodipine er G M

fenofibrate micronized oral capsule 130 mg, 134 mg, 200 mg, 43 mg, 67 mg


FENOFIBRATE MICRONIZED ORAL CAPSULE 30 MG, 90 MG


fenofibrate oral capsule 134 mg, 200 mg, 67 mg G M; QL (1 EA per 1 day)

fenofibrate oral capsule 150 mg, 50 mg NPB M; QL (1 EA per 1 day)

fenofibrate oral tablet G M; QL (1 EA per 1 day)

fenofibric acid G M; QL (1 EA per 1 day)

FENOGLIDE NPB ST; M; QL (1 EA per 1 day)

FIBRICOR NPB ST; M; QL (1 EA per 1 day)

flecainide acetate G M

FLOLIPID NPB ST; M

fluvastatin sodium er G M; ACA; QL (1 EA per 1 day)

fluvastatin sodium oral capsule 20 mg G M; ACA; QL (1 EA per 1 day)

fluvastatin sodium oral capsule 40 mg G M; ACA; QL (2 EA per 1 day)

fosinopril sodium G M

fosinopril sodium-hctz G M


49


furosemide oral G M

gemfibrozil oral G M; QL (2 EA per 1 day)

GONITRO NPB M

guanfacine hcl G M

HEMANGEOL NPB-S M

hydralazine hcl oral G M

hydrochlorothiazide oral G M

HYZAAR NPB ST; M

icosapent ethyl G M

indapamide G M

INDERAL LA NPB ST; M

INDERAL XL NPB ST; M

INNOPRAN XL NPB ST; M

INSPRA NPB M

irbesartan G M

irbesartan-hydrochlorothiazide G M

ISORDIL TITRADOSE NPB M

isosorbide dinitrate G M

isosorbide mononitrate G M

isosorbide mononitrate er G M

isradipine G M

JUXTAPID PB-S PA; QL (1 EA per 1 day)

KAPSPARGO SPRINKLE NPB ST; M

KATERZIA NPB ST

labetalol hcl oral G M

LANOXIN ORAL NPB M

LASIX NPB M

LESCOL XL NPB ST; M; QL (1 EA per 1 day)

LIPITOR NPB ST; M; QL (1 EA per 1 day)

LIPOFEN PB ST; M; QL (1 EA per 1 day)

lisinopril oral G M

lisinopril-hydrochlorothiazide G M

LIVALO PB ST; M; QL (1 EA per 1 day)

LOPID NPB ST; M; QL (2 EA per 1 day)

LOPRESSOR NPB ST; M

losartan potassium oral G M

losartan potassium-hctz G M

LOTENSIN NPB M


50


LOTENSIN HCT NPB ST; M

LOTREL NPB ST; M

lovastatin oral tablet 10 mg G M; ACA; QL (1 EA per 1 day)

lovastatin oral tablet 20 mg, 40 mg G M; ACA; QL (2 EA per 1 day)

LOVAZA NPB M

matzim la G M

MAXZIDE NPB M

MAXZIDE-25 NPB ST; M

methyldopa G M

metolazone G M

metoprolol succinate er G M

metoprolol tartrate oral G M

metoprolol-hydrochlorothiazide G M

metyrosine G

mexiletine hcl oral G M

MICARDIS NPB ST; M

MICARDIS HCT NPB ST; M

midodrine hcl G

MINIPRESS NPB M

minoxidil oral G M

moexipril hcl G M

MULTAQ NPB M

nadolol oral G M

nebivolol hcl G M

NEXLETOL PB PA; QL (1 EA per 1 day)

NEXLIZET PB PA; QL (1 EA per 1 day)

niacin (antihyperlipidemic) G M

niacin er (antihyperlipidemic) G M

niacor G M

NIASPAN NPB M

nicardipine hcl oral G M

nifedipine er G M

nifedipine er osmotic release G M

nifedipine oral G M

nimodipine oral G

nisoldipine er G M

NITRO-BID G M

NITRO-DUR NPB M


51


nitroglycerin sublingual G M

nitroglycerin transdermal G M

nitroglycerin translingual G M

NITROLINGUAL NPB M

NITROMIST NPB M

NITROSTAT NPB M

NORPACE NPB M

NORPACE CR NPB M

NORTHERA NPB-S PA

NORVASC NPB ST; M

NYMALIZE NPB

olmesartan medoxomil oral G M

olmesartan medoxomil-hctz G M

olmesartan-amlodipine-hctz G M

omega-3-acid ethyl esters G M

PACERONE NPB M

pentoxifylline er G M

perindopril erbumine G M

phenoxybenzamine hcl oral G

pindolol G M

PRALUENT NPB PA

pravastatin sodium G M; ACA; QL (1 EA per 1 day)

prazosin hcl oral G M

PRESTALIA NPB ST; M

prevalite G M

PROCARDIA XL NPB ST; M

propafenone hcl G M

propafenone hcl er G M

propranolol hcl er G M

propranolol hcl oral G M

QBRELIS NPB M

QUESTRAN NPB ST; M

QUESTRAN LIGHT NPB ST; M

quinapril hcl G M

quinapril-hydrochlorothiazide G M

quinidine gluconate er G M

quinidine sulfate G M

ramipril G M


52


RANEXA NPB M

ranolazine er G M

RECTIV PB

REPATHA PB PA

REPATHA PUSHTRONEX SYSTEM PB PA

REPATHA SURECLICK PB PA

rosuvastatin calcium oral tablet 10 mg, 5 mg G M; ACA; QL (1 EA per 1 day)

rosuvastatin calcium oral tablet 20 mg, 40 mg G M; QL (1 EA per 1 day)

ROSZET NPB ST

RYTHMOL SR NPB M

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg

G M; ACA; QL (1 EA per 1 day)

simvastatin oral tablet 80 mg G M; QL (1 EA per 1 day)

sorine G M

sotalol hcl (af) G M

sotalol hcl oral G M

SOTYLIZE PB ST; M

spironolactone oral G M

spironolactone-hctz G M

SULAR NPB ST; M

taztia xt G M

TEKTURNA NPB ST; M

TEKTURNA HCT PB ST; M

telmisartan G M

telmisartan-amlodipine G M

telmisartan-hctz G M

TENORETIC 100 NPB ST; M

TENORETIC 50 NPB ST; M

TENORMIN NPB ST; M

THALITONE NPB M

tiadylt er G M

TIAZAC NPB ST; M

TIKOSYN NPB ST

timolol maleate oral G M

TOPROL XL NPB ST; M

torsemide G M

trandolapril G M

trandolapril-verapamil hcl er G M


53


triamterene oral G M

triamterene-hctz G M

TRIBENZOR NPB ST; M

TRICOR NPB ST; M; QL (1 EA per 1 day)

TRILIPIX NPB ST; M; QL (1 EA per 1 day)

valsartan G M

valsartan-hydrochlorothiazide G M

VASCEPA ORAL CAPSULE 0.5 GM PB M

VASCEPA ORAL CAPSULE 1 GM NPB M

VASERETIC NPB ST; M

VASOTEC NPB M

VECAMYL NPB-S

verapamil hcl er G M

verapamil hcl oral G M

VERELAN NPB ST; M

VERELAN PM NPB ST; M

VERQUVO NPB PA; QL (1 EA per 1 day)

VYNDAMAX NPB-S PA; QL (1 EA per 1 day)

VYNDAQEL NPB-S PA; QL (4 EA per 1 day)

VYTORIN NPB ST; M; QL (1 EA per 1 day)

WELCHOL NPB ST; M

ZESTORETIC NPB ST; M

ZESTRIL NPB M

ZETIA NPB ST; M

ZIAC NPB ST; M

ZOCOR NPB ST; M; QL (1 EA per 1 day)

ZYPITAMAG NPB ST; M

Central Nervous System Agents - Drugs for Attention Deficit Disorder

ADDERALL ORAL TABLET 10 MG, 12.5 MG, 15 MG, 5 MG, 7.5 MG


ADDERALL ORAL TABLET 20 MG, 30 MG NPB ST; QL (3 EA per 1 day)

ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 5 MG


ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 15 MG, 25 MG, 30 MG


ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 20 MG


ADHANSIA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 25 MG



54


ADHANSIA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 35 MG, 45 MG, 55 MG, 70 MG, 85 MG


ADZENYS XR-ODT NPB ST; QL (1 EA per 1 day)

amphetamine sulfate G QL (6 EA per 1 day)

amphetamine-dextroamphetamine er oral capsule extended release 24 hour 10 mg, 5 mg


amphetamine-dextroamphetamine er oral capsule extended release 24 hour 15 mg, 25 mg, 30 mg


amphetamine-dextroamphetamine er oral capsule extended release 24 hour 20 mg


amphetamine-dextroamphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 5 mg, 7.5 mg


amphetamine-dextroamphetamine oral tablet 20 mg, 30 mg


APTENSIO XR NPB ST; QL (1 EA per 1 day)

atomoxetine hcl oral capsule 10 mg, 18 mg, 25 mg, 40 mg


atomoxetine hcl oral capsule 100 mg, 60 mg, 80 mg


AZSTARYS NPB PA; QL (1 EA per 1 day)

clonidine hcl er G QL (4 EA per 1 day)

CONCERTA ORAL TABLET EXTENDED RELEASE 18 MG, 27 MG, 54 MG


CONCERTA ORAL TABLET EXTENDED RELEASE 36 MG


COTEMPLA XR-ODT ORAL TABLET EXTENDED RELEASE DISPERSIBLE 17.3 MG






DAYTRANA PB ST; QL (1 EA per 1 day)

DESOXYN NPB ST; QL (5 EA per 1 day)

DEXEDRINE ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG






dexmethylphenidate hcl G QL (2 EA per 1 day)


55


dexmethylphenidate hcl er oral capsule extended release 24 hour 10 mg, 15 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 mg


dexmethylphenidate hcl er oral capsule extended release 24 hour 20 mg


dextroamphetamine sulfate er oral capsule extended release 24 hour 10 mg






dextroamphetamine sulfate oral solution G QL (60 ML per 1 day)

dextroamphetamine sulfate oral tablet 10 mg G QL (6 EA per 1 day)

dextroamphetamine sulfate oral tablet 15 mg, 20 mg, 5 mg


dextroamphetamine sulfate oral tablet 30 mg G QL (2 EA per 1 day)

DYANAVEL XR NPB ST; QL (8 ML per 1 day)

EVEKEO NPB ST; QL (6 EA per 1 day)

EVEKEO ODT ORAL TABLET DISPERSIBLE 10 MG, 5 MG


EVEKEO ODT ORAL TABLET DISPERSIBLE 15 MG, 20 MG


FOCALIN NPB ST; QL (2 EA per 1 day)

FOCALIN XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 25 MG, 30 MG, 35 MG, 40 MG, 5 MG


FOCALIN XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 20 MG


guanfacine hcl er G QL (2 EA per 1 day)

INTUNIV NPB ST; QL (2 EA per 1 day)

JORNAY PM NPB ST; QL (1 EA per 1 day)

KAPVAY NPB ST; QL (4 EA per 1 day)

methamphetamine hcl G QL (5 EA per 1 day)

METHYLIN ORAL SOLUTION 10 MG/5ML NPB ST; QL (30 ML per 1 day)

METHYLIN ORAL SOLUTION 5 MG/5ML NPB ST; QL (60 ML per 1 day)

methylphenidate hcl er (cd) G QL (1 EA per 1 day)

methylphenidate hcl er (la) G QL (1 EA per 1 day)

methylphenidate hcl er (xr) G QL (1 EA per 1 day)

methylphenidate hcl er oral tablet extended release 10 mg, 36 mg


methylphenidate hcl er oral tablet extended release 18 mg, 27 mg, 54 mg



56


methylphenidate hcl er oral tablet extended release 20 mg


methylphenidate hcl er oral tablet extended release 24 hour 18 mg, 27 mg, 54 mg


methylphenidate hcl er oral tablet extended release 24 hour 36 mg


methylphenidate hcl er oral tablet extended release 72 mg


methylphenidate hcl oral solution 10 mg/5ml G QL (30 ML per 1 day)

methylphenidate hcl oral solution 5 mg/5ml G QL (60 ML per 1 day)

methylphenidate hcl oral tablet G QL (3 EA per 1 day)

methylphenidate hcl oral tablet chewable 10 mg G QL (6 EA per 1 day)

methylphenidate hcl oral tablet chewable 2.5 mg, 5 mg


MYDAYIS ORAL CAPSULE EXTENDED RELEASE 24 HOUR 12.5 MG


MYDAYIS ORAL CAPSULE EXTENDED RELEASE 24 HOUR 25 MG, 37.5 MG, 50 MG


PROCENTRA NPB ST; QL (60 ML per 1 day)

QELBREE ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG, 150 MG


QELBREE ORAL CAPSULE EXTENDED RELEASE 24 HOUR 200 MG


QUILLICHEW ER ORAL TABLET CHEWABLE EXTENDED RELEASE 20 MG, 40 MG


QUILLICHEW ER ORAL TABLET CHEWABLE EXTENDED RELEASE 30 MG


QUILLIVANT XR PB ST; QL (12 ML per 1 day)

relexxii NPB QL (1 EA per 1 day)

RITALIN NPB ST; QL (3 EA per 1 day)

RITALIN LA NPB ST; QL (1 EA per 1 day)

STRATTERA ORAL CAPSULE 10 MG, 18 MG, 25 MG, 40 MG


STRATTERA ORAL CAPSULE 100 MG, 60 MG, 80 MG


VYVANSE PB QL (1 EA per 1 day)

ZENZEDI ORAL TABLET 10 MG NPB ST; QL (6 EA per 1 day)

ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 5 MG, 7.5 MG


ZENZEDI ORAL TABLET 30 MG NPB ST; QL (2 EA per 1 day)


57


Central Nervous System Agents - Drugs for Multiple Sclerosis

AMPYRA NPB-S QL (2 EA per 1 day)

AUBAGIO NPB-S QL (1 EA per 1 day)

AVONEX PEN PB-S QL (0.04 EA per 1 day)

AVONEX PREFILLED PB-S QL (0.04 EA per 1 day)

BAFIERTAM PB-S QL (4 EA per 1 day)

BETASERON PB-S QL (0.5 EA per 1 day)

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML

PB-S QL (1 ML per 1 day)

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 40 MG/ML

PB-S QL (0.43 ML per 1 day)

dalfampridine er G-S QL (2 EA per 1 day)

dimethyl fumarate oral G-S QL (2 EA per 1 day)

dimethyl fumarate starter pack G-S QL (60 EA per 365 days)

EXTAVIA NPB-S ST; QL (0.5 EA per 1 day)

GILENYA NPB-S QL (1 EA per 1 day)

glatiramer acetate subcutaneous solution prefilled syringe 20 mg/ml

G-S QL (1 ML per 1 day)

glatiramer acetate subcutaneous solution prefilled syringe 40 mg/ml

G-S QL (0.43 ML per 1 day)

glatopa subcutaneous solution prefilled syringe 20 mg/ml

G-S QL (1 ML per 1 day)

glatopa subcutaneous solution prefilled syringe 40 mg/ml

G-S QL (0.43 ML per 1 day)

KESIMPTA PB-S QL (0.02 ML per 1 day)

MAVENCLAD NPB-S PA

MAYZENT ORAL TABLET 0.25 MG NPB-S QL (4 EA per 1 day)

MAYZENT ORAL TABLET 2 MG NPB-S QL (1 EA per 1 day)

MAYZENT STARTER PACK ORAL TABLET THERAPY PACK 12 X 0.25 MG


PLEGRIDY NPB-S ST; QL (0.04 ML per 1 day)

PLEGRIDY STARTER PACK NPB-S ST; QL (0.04 ML per 1 day)

PONVORY NPB-S ST; QL (1 EA per 1 day)

PONVORY STARTER PACK NPB-S ST; QL (28 EA per 365 days)

REBIF NPB-S ST; QL (0.22 ML per 1 day)

REBIF REBIDOSE NPB-S ST; QL (0.22 ML per 1 day)

REBIF REBIDOSE TITRATION PACK NPB-S ST; QL (4.2 ML per 365 days)

REBIF TITRATION PACK NPB-S ST; QL (4.2 ML per 365 days)

TECFIDERA STARTER PACK NPB-S ST; QL (60 EA per 365 days)


58


TECFIDERA ORAL CAPSULE DELAYED RELEASE

NPB-S ST; QL (2 EA per 1 day)

VUMERITY PB-S QL (4 EA per 1 day)

ZEPOSIA NPB-S QL (1 EA per 1 day)

ZEPOSIA 7-DAY STARTER PACK NPB-S QL (14 EA per 365 days)

ZEPOSIA STARTER KIT NPB-S QL (74 EA per 365 days)

Central Nervous System Agents - Miscellaneous

ADDYI NPB PA; QL (1 EA per 1 day)

ADIPEX-P NPB

AUSTEDO PB-S PA; QL (4 EA per 1 day)

benzphetamine hcl G

caffeine citrate oral G

CONTRAVE NPB PA

diethylpropion hcl er G

diethylpropion hcl oral G

EXSERVAN NPB ST; QL (2 EA per 1 day)

GRALISE ORAL PB ST; QL (66 EA per 365 days)

GRALISE ORAL TABLET 300 MG PB ST; QL (6 EA per 1 day)

GRALISE ORAL TABLET 600 MG PB ST; QL (3 EA per 1 day)

HORIZANT NPB ST; QL (2 EA per 1 day)

IMCIVREE NPB-S PA; QL (0.3 ML per 1 day)

INGREZZA ORAL CAPSULE 40 MG, 60 MG NPB-S PA; QL (2 EA per 1 day)

INGREZZA ORAL CAPSULE 80 MG NPB-S PA; QL (1 EA per 1 day)

INGREZZA ORAL CAPSULE THERAPY PACK NPB-S PA; QL (56 EA per 365 days)

LOMAIRA NPB PA

LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HOUR 165 MG, 82.5 MG


LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HOUR 330 MG


LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, 225 MG, 25 MG, 50 MG, 75 MG


LYRICA ORAL CAPSULE 300 MG NPB ST; QL (2 EA per 1 day)

LYRICA ORAL SOLUTION NPB ST; QL (30 ML per 1 day)

NUEDEXTA PB

phendimetrazine tartrate G

phendimetrazine tartrate er G

phentermine hcl oral G

pregabalin er oral tablet extended release 24 hour 165 mg, 82.5 mg



59


pregabalin er oral tablet extended release 24 hour 330 mg


pregabalin oral capsule 100 mg, 150 mg, 200 mg, 225 mg, 25 mg, 50 mg, 75 mg


pregabalin oral capsule 300 mg G QL (2 EA per 1 day)

pregabalin oral solution G QL (30 ML per 1 day)

QSYMIA NPB PA

RILUTEK NPB

riluzole G

SAVELLA PB M; QL (2 EA per 1 day)

SAVELLA TITRATION PACK PB M; QL (55 EA per 365 days)

SAXENDA NPB PA

TEGSEDI NPB-S PA

tetrabenazine G-S PA

TIGLUTIK NPB

VYLEESI NPB PA; QL (2.4 ML per 25 days)

WEGOVY NPB PA; QL (4 ML per 28 days)

XENAZINE NPB-S ST

XENICAL NPB PA

Dental and Oral Agents - Drugs for Mouth and Throat Conditions

CAPHOSOL MOUTH/THROAT SOLUTION NPB

cavarest G M

cevimeline hcl G M

chlorhexidine gluconate mouth/throat G

CLINPRO 5000 NPB M

DEBACTEROL NPB

DENTA 5000 PLUS NPB M

DENTAGEL NPB M

easygel G M

EVOXAC NPB M

FLUORIDEX NPB M

fluoridex daily renewal G M

FLUORIDEX ENHANCED WHITENING NPB M

FLUORIDEX SENSITIVITY RELIEF NPB M

FLUORIMAX 5000 NPB M

FLUORIMAX 5000 SENSITIVE NPB M

JUST RIGHT 5000 NPB M

lidocaine viscous hcl G


60


MOUTH KOTE NPB OTC

MOUTH KOTE REMINT NPB OTC

NAFRINSE DAILY ACIDULATED NPB

NAFRINSE DAILY/NEUTRAL NPB M

NAFRINSE WEEKLY NPB M

oralone G

PERIDEX NPB

periogard G

pilocarpine hcl oral G

PREVIDENT NPB M

PREVIDENT 5000 BOOSTER PLUS NPB M

PREVIDENT 5000 DRY MOUTH NPB M

PREVIDENT 5000 ENAMEL PROTECT NPB M

PREVIDENT 5000 ORTHO DEFENSE NPB M

PREVIDENT 5000 PLUS NPB M

PREVIDENT 5000 SENSITIVE NPB M

REMESENSE NPB

SALAGEN NPB

sf G M

sf 5000 plus G M

sodium fluoride 5000 enamel G M

sodium fluoride 5000 plus G M

sodium fluoride 5000 ppm dental cream G M

sodium fluoride 5000 ppm dental gel G M

sodium fluoride 5000 ppm dental paste NPB M

sodium fluoride 5000 sensitive G M

sodium fluoride dental G M

sodium fluoride mouth/throat G M

triamcinolone acetonide mouth/throat G

Dermatological Agents - Drugs for Skin Conditions

A.A.G.C. KIT IN TERODERM NPB

ABSORICA NPB ST; QL (2 EA per 1 day)

ABSORICA LD NPB ST

ACANYA NPB ST; QL (50 GM per 25 days)

accutane G QL (2 EA per 1 day)

acitretin G

ACZONE EXTERNAL GEL 5 % NPB


61


ACZONE EXTERNAL GEL 7.5 % PB

adapalene external cream G QL (45 GM per 25 days)

adapalene external gel 0.3 % G QL (45 GM per 25 days)

ADAPALENE EXTERNAL PAD NPB ST

ADAPALENE EXTERNAL SOLUTION G ST

adapalene-benzoyl peroxide external gel 0.1-2.5 %

G QL (45 GM per 25 days)

adapalene-benzoyl peroxide external gel 0.3-2.5 %

G

AKLIEF NPB ST; QL (1.8 GM per 1 day)

ala-cort external cream 2.5 % G

alclometasone dipropionate G

ALDARA NPB QL (12 EA per 25 days)

ALTRENO NPB

amcinonide G

amnesteem G QL (2 EA per 1 day)

AMZEEQ NPB ST

APEXICON E G ST; QL (60 GM per 25 days)

ARAZLO NPB ST; QL (50 GM per 25 days)

ATRALIN NPB QL (45 GM per 25 days)

AVITA EXTERNAL CREAM NPB QL (45 GM per 25 days)

AVITA EXTERNAL GEL NPB

azelaic acid external G

AZELEX NPB ST; QL (50 GM per 25 days)

BENZAMYCIN NPB ST

benzoyl peroxide-erythromycin G

betamethasone dipropionate aug G

betamethasone dipropionate external G

betamethasone valerate external G

BRYHALI NPB ST

calcipotriene external cream G QL (120 GM per 25 days)

CALCIPOTRIENE EXTERNAL FOAM NPB QL (120 GM per 25 days)

calcipotriene external ointment G QL (120 GM per 25 days)

calcipotriene external solution G QL (60 ML per 25 days)

calcipotriene-betameth diprop external ointment G QL (13.4 GM per 1 day)

calcipotriene-betameth diprop external suspension

G QL (4 GM per 1 day)

CALCITRENE NPB QL (120 GM per 25 days)

calcitriol external G QL (100 GM per 25 days)


62


CAPEX NPB ST; QL (120 ML per 25 days)

CARAC PB QL (30 GM per 25 days)

claravis G QL (2 EA per 1 day)

CLEOCIN-T NPB ST

clindacin etz external swab G

clindacin-p G

CLINDAGEL NPB ST

clindamycin phos-benzoyl perox external gel 1.2-5 %


clindamycin phos-benzoyl perox external gel 1-5 %, 1.2-2.5 %


clindamycin phosphate external G

clindamycin-tretinoin G

CLINOIN NPB

clobetasol prop emollient base G

clobetasol propionate e G

clobetasol propionate emulsion G

clobetasol propionate external G

CLOBEX NPB ST

CLOBEX SPRAY NPB ST

clocortolone pivalate G QL (90 GM per 25 days)

clodan external shampoo G

CLODERM NPB ST; QL (90 GM per 25 days)

coal tar external PB

CONDYLOX NPB

CORDRAN EXTERNAL CREAM NPB ST

CORDRAN EXTERNAL LOTION NPB ST

CORDRAN EXTERNAL OINTMENT NPB ST

CORDRAN EXTERNAL TAPE NPB ST; QL (2 EA per 25 days)

CUTIVATE NPB ST

dapsone external gel 5 % G

dapsone gel 7.5 % external NPB ST

DAPSONE GEL 7.5 % EXTERNAL NPB ST

DERMA-SMOOTHE/FS BODY NPB ST; QL (118.28 ML per 25 days)

DERMA-SMOOTHE/FS SCALP NPB ST; QL (118.28 ML per 25 days)

desonide external cream G QL (60 GM per 25 days)

desonide external gel G

desonide external lotion G QL (118 ML per 25 days)

desonide external ointment G QL (60 GM per 25 days)


63


DESOWEN NPB ST; QL (60 GM per 25 days)

desoximetasone external cream G QL (100 GM per 25 days)

desoximetasone external gel G QL (60 GM per 25 days)

desoximetasone external liquid G

desoximetasone external ointment G QL (100 GM per 25 days)

desrx G

diclofenac sodium external gel 3 % G QL (10 GM per 1 day)

DIFFERIN EXTERNAL CREAM NPB ST; QL (45 GM per 25 days)

DIFFERIN EXTERNAL GEL 0.3 % NPB ST; QL (45 GM per 25 days)

DIFFERIN EXTERNAL LOTION NPB ST; QL (59 ML per 25 days)

diflorasone diacetate external cream G QL (60 GM per 25 days)

diflorasone diacetate external ointment G

DIPROLENE NPB ST

DOVONEX NPB QL (120 GM per 25 days)

doxepin hcl external G QL (45 GM per 25 days)

doxycycline NPB ST

DRYSOL NPB

DUOBRII NPB ST

DUPIXENT SUBCUTANEOUS SOLUTION PEN-INJECTOR

PB-S PA; QL (0.29 ML per 1 day)

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/0.67ML, 300 MG/2ML


DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG/1.14ML


EFUDEX NPB

ELIDEL NPB ST; QL (100 GM per 25 days)

ENOVARX-TRAMADOL NPB

ENSTILAR PB QL (15 GM per 1 day)

EPIDUO NPB ST; QL (45 GM per 25 days)

EPIDUO FORTE NPB ST

EPIFOAM NPB ST

ery G

ERYGEL G

erythromycin external G

EUCRISA NPB ST; QL (60 GM per 25 days)

EVOCLIN NPB ST

FABIOR NPB ST; QL (50 GM per 25 days)

FINACEA EXTERNAL FOAM PB


64


FINACEA EXTERNAL GEL NPB ST

fluocinolone acetonide body G QL (118.28 ML per 25 days)

fluocinolone acetonide external cream 0.01 % G

fluocinolone acetonide external cream 0.025 % G QL (120 GM per 25 days)

fluocinolone acetonide external ointment G QL (120 GM per 25 days)

fluocinolone acetonide external solution G QL (90 ML per 25 days)

fluocinolone acetonide scalp G QL (118.28 ML per 25 days)

fluocinonide emulsified base G

fluocinonide external cream 0.05 % G

fluocinonide external cream 0.1 % G QL (0.24 GM per 25 days)

fluocinonide external gel G

fluocinonide external ointment G

fluocinonide external solution G

FLUOROPLEX NPB QL (30 GM per 25 days)

FLUOROURACIL EXTERNAL CREAM 0.5 % NPB QL (30 GM per 25 days)

fluorouracil external cream 5 % G

fluorouracil external solution G QL (10 ML per 25 days)

flurandrenolide G

fluticasone propionate external G

GORDOFILM NPB

halcinonide G

halobetasol propionate external cream G QL (50 GM per 25 days)

HALOBETASOL PROPIONATE EXTERNAL FOAM

NPB ST

halobetasol propionate external ointment G QL (50 GM per 25 days)

HALOG NPB ST

hydrocortisone butyr lipo base G

hydrocortisone butyrate G

hydrocortisone external cream 2.5 % G

hydrocortisone external lotion 2.5 % G

hydrocortisone external ointment 2.5 % G

hydrocortisone valerate G

imiquimod external cream 3.75 % G QL (28 EA per 25 days)

imiquimod external cream 5 % G QL (12 EA per 25 days)

imiquimod pump G QL (28 GM per 25 days)

IMPEKLO NPB ST

IMPOYZ NPB ST

isotretinoin oral G QL (2 EA per 1 day)


65


ivermectin external cream G

KENALOG EXTERNAL NPB ST

KLARON NPB ST

KLISYRI NPB QL (5 day supply per 30 days)

LEXETTE NPB ST

LOCOID NPB ST

LOCOID LIPOCREAM NPB ST

LUXIQ NPB ST

methoxsalen rapid G

METROCREAM NPB ST

METROGEL NPB ST

METROLOTION NPB ST

metronidazole external G

MIRVASO PB

mometasone furoate external G

myorisan G QL (2 EA per 1 day)

NEO-SYNALAR EXTERNAL CREAM NPB

neuac external gel G QL (45 GM per 25 days)

nolix G

NORITATE NPB ST

OLUX NPB ST

OLUX-E NPB ST

ONEXTON PB ST; QL (50 GM per 25 days)

ORACEA PB ST

PANDEL NPB ST

pimecrolimus G ST; QL (100 GM per 25 days)

podofilox external G

PRAMOSONE EXTERNAL CREAM 1-1 % NPB ST

PRAMOSONE EXTERNAL LOTION NPB ST

prednicarbate G

PROTOPIC NPB ST; QL (100 GM per 25 days)

PRUDOXIN G ST; QL (45 GM per 25 days)

PSORCON NPB ST; QL (60 GM per 25 days)

PYROGALLIC ACID NPB

QBREXZA PB QL (1 EA per 1 day)

REGRANEX PB QL (15 GM per 25 days)

RETIN-A EXTERNAL CREAM 0.025 % NPB QL (45 GM per 25 days)

RETIN-A EXTERNAL CREAM 0.05 %, 0.1 % NPB


66


RETIN-A EXTERNAL GEL NPB

RETIN-A MICRO GEL 0.04 %, 0.1 % NPB

RETIN-A MICRO PUMP NPB

RHOFADE PB

rosadan external cream G

rosadan external gel G

SANTYL PB

selenium sulfide external lotion G

SERNIVO NPB ST

SOOLANTRA PB

SORILUX NPB QL (120 GM per 25 days)

sulfacetamide sodium (acne) G

SYNALAR EXTERNAL CREAM NPB ST; QL (120 GM per 25 days)

SYNALAR EXTERNAL OINTMENT NPB ST; QL (120 GM per 25 days)

SYNALAR EXTERNAL SOLUTION NPB ST; QL (90 ML per 25 days)

TACLONEX EXTERNAL OINTMENT NPB QL (13.4 GM per 1 day)

TACLONEX EXTERNAL SUSPENSION NPB QL (4 GM per 1 day)

tacrolimus external G QL (100 GM per 25 days)

tazarotene external cream G QL (60 GM per 25 days)

TAZAROTENE EXTERNAL FOAM NPB ST; QL (50 GM per 25 days)

TAZORAC EXTERNAL CREAM NPB ST; QL (60 GM per 25 days)

TAZORAC EXTERNAL GEL NPB ST; QL (100 GM per 25 days)

TEMOVATE NPB ST

TEXACORT NPB ST

TOPICORT EXTERNAL CREAM NPB ST; QL (100 GM per 25 days)

TOPICORT EXTERNAL GEL NPB ST; QL (60 GM per 25 days)

TOPICORT EXTERNAL OINTMENT NPB ST; QL (100 GM per 25 days)

TOPICORT SPRAY NPB ST

tovet external foam G

tretinoin external cream 0.025 % G QL (45 GM per 25 days)

tretinoin external cream 0.05 %, 0.1 % G

tretinoin external gel 0.01 %, 0.025 % G

tretinoin external gel 0.05 % G QL (45 GM per 25 days)

tretinoin microsphere G

tretinoin microsphere pump G

triamcinolone acetonide external G

triamcinolone in absorbase G

TRIANEX G


67


triderm G

TRIDESILON NPB ST; QL (60 GM per 25 days)

tritocin G

ULTRAVATE NPB ST

VANOS NPB ST; QL (0.24 GM per 25 days)

VECTICAL NPB QL (100 GM per 25 days)

VELTIN NPB ST

VERDESO NPB ST

VEREGEN NPB

WINLEVI NPB PA

XERAC AC NPB

XEROFORM OIL EMULSION 2"X2" NPB

XEROFORM OIL EMULSION GAUZE NPB

XEROFORM PETROLAT PATCH 2"X2" NPB

XEROFORM PETROLAT PATCH 4"X4" NPB

zenatane G QL (2 EA per 1 day)

ZIANA NPB ST

ZILXI NPB ST

ZONALON NPB ST; QL (45 GM per 25 days)

ZYCLARA NPB ST; QL (28 EA per 25 days)

ZYCLARA PUMP EXTERNAL CREAM 2.5 % NPB ST; QL (7.5 GM per 25 days)

ZYCLARA PUMP EXTERNAL CREAM 3.75 % NPB ST; QL (28 GM per 25 days)

Diabetes - Antidiabetic Agents

acarbose oral G M

ACTOPLUS MET NPB ST; M; QL (3 EA per 1 day)

ACTOS NPB M; QL (1 EA per 1 day)

ADLYXIN NPB ST; M; QL (0.22 ML per 1 day)

ADLYXIN STARTER PACK NPB ST; M; QL (12 ML per 365 days)

ALOGLIPTIN BENZOATE NPB ST; M; QL (1 EA per 1 day)

ALOGLIPTIN-METFORMIN HCL NPB ST; M; QL (2 EA per 1 day)

ALOGLIPTIN-PIOGLITAZONE NPB ST; M; QL (1 EA per 1 day)

AMARYL NPB M

BYDUREON BCISE AUTOINJECTOR PB ST; M; QL (0.15 ML per 1 day)

BYETTA 10 MCG PEN PB ST; M; QL (0.08 ML per 1 day)

BYETTA 5 MCG PEN PB ST; M; QL (0.04 ML per 1 day)

CYCLOSET NPB M; QL (204 EA per 25 days)

DUETACT NPB ST; M; QL (1 EA per 1 day)

FARXIGA PB ST; M; QL (1 EA per 1 day)


68


glimepiride G M

glipizide er G M

glipizide ir G M

glipizide xl G M

glipizide-metformin hcl G M

GLUCOTROL XL NPB M

GLUMETZA ORAL TABLET EXTENDED RELEASE 24 HOUR 1000 MG


GLUMETZA ORAL TABLET EXTENDED RELEASE 24 HOUR 500 MG


glyburide micronized G M

glyburide oral G M

glyburide-metformin G M

GLYNASE NPB M

GLYXAMBI PB ST; M

INVOKAMET NPB ST; M; QL (2 EA per 1 day)

INVOKAMET XR NPB ST; M; QL (2 EA per 1 day)

INVOKANA NPB ST; M; QL (1 EA per 1 day)

JANUMET PB ST; M; QL (2 EA per 1 day)

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG, 50-500 MG

PB ST; M; QL (1 EA per 1 day)

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 50-1000 MG


JANUVIA PB ST; M; QL (1 EA per 1 day)

JARDIANCE PB ST; M; QL (1 EA per 1 day)

JENTADUETO PB ST; M; QL (2 EA per 1 day)

JENTADUETO XR PB ST; M

KAZANO NPB ST; M; QL (2 EA per 1 day)

KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HOUR 2.5-1000 MG


KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HOUR 5-1000 MG, 5-500 MG


metformin hcl er G M

metformin hcl er (mod) oral tablet extended release 24 hour 1000 mg

G ST; M; QL (2 EA per 1 day)

metformin hcl er (mod) oral tablet extended release 24 hour 500 mg

G ST; M; QL (4 EA per 1 day)

metformin hcl er (osm) G ST; M

metformin hcl oral solution G ST; M; QL (850 ML per 25 days)

metformin hcl oral tablet G M


69


miglitol G M

nateglinide G M

NESINA NPB ST; M; QL (1 EA per 1 day)

ONGLYZA NPB ST; M; QL (1 EA per 1 day)

OSENI NPB ST; M; QL (1 EA per 1 day)

OZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 2 MG/1.5ML

PB ST; M; QL (0.06 ML per 1 day)

OZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 4 MG/3ML

PB ST; M; QL (0.11 ML per 1 day)

pioglitazone hcl G M; QL (1 EA per 1 day)

pioglitazone hcl-glimepiride G M; QL (1 EA per 1 day)

pioglitazone hcl-metformin hcl G M; QL (3 EA per 1 day)

PRECOSE NPB M

QTERN NPB ST; M

repaglinide G M

RIOMET NPB ST; M; QL (850 ML per 25 days)

RYBELSUS ORAL TABLET 14 MG, 7 MG PB ST; M; QL (1 EA per 1 day)

RYBELSUS ORAL TABLET 3 MG PB ST; M; QL (60 EA per 365 days)

SEGLUROMET NPB ST; M

SOLIQUA PB ST; M; QL (15 ML per 25 days)

STEGLATRO NPB ST; M

STEGLUJAN NPB ST; M

SYMLINPEN 120 PB ST; M; QL (19 ML per 25 days)

SYMLINPEN 60 PB ST; M; QL (11 ML per 25 days)

SYNJARDY PB ST; M

SYNJARDY XR PB ST; M

TRADJENTA PB ST; QL (1 EA per 1 day)

TRIJARDY XR PB ST

TRULICITY PB ST; M; QL (0.08 ML per 1 day)

VICTOZA PB ST; M; QL (0.3 ML per 1 day)

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 10-500 MG, 5-500 MG


XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 2.5-1000 MG

PB ST; M

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 5-1000 MG


XULTOPHY PB ST; M; QL (15 ML per 25 days)

Diabetes - Glucose Monitoring

ACCU-CHEK AVIVA DEVICE NPB OTC


70


ACCU-CHEK AVIVA PLUS KIT W/DEVICE NPB ST; OTC; QL (1 EA per 273 days)

ACCU-CHEK AVIVA PLUS TEST STRIPS NPBST; OTC; QL (300 EA per 25 days)

ACCU-CHEK FASTCLIX LANCET KIT PB OTC

ACCU-CHEK FASTCLIX LANCETS PB OTC

ACCU-CHEK GUIDE TEST STRIPS NPB ST; OTC; QL (1 EA per 273 days)

ACCU-CHEK GUIDE CONTROL NPB OTC

ACCU-CHEK GUIDE TEST STRIPS NPBST; OTC; QL (300 EA per 25 days)

ACCU-CHEK GUIDE KIT W/DEVICE NPB ST; OTC; QL (1 EA per 273 days)

ACCU-CHEK SAFE-T PRO LANCETS PB OTC

ACCU-CHEK SMARTVIEW CONTROL NPB OTC

ACCU-CHEK SMARTVIEW TEST STRIPS NPBST; OTC; QL (300 EA per 25 days)

ACCU-CHEK SOFTCLIX LANCET DEVICE KIT PB OTC

ACCU-CHEK SOFTCLIX LANCETS PB OTC

AGAMATRIX CONTROL LEVEL 2 NPB OTC

AGAMATRIX CONTROL LEVEL 4 NPB OTC

AGAMATRIX PRESTO TEST NPBST; OTC; QL (300 EA per 25 days)

ASSURE PLATINUM NPBST; OTC; QL (300 EA per 25 days)

AUTOLET LANCING DEVICE PB OTC

BIOTEL CARE BLOOD GLUCOSE NPB OTC; QL (1 EA per 273 days)

BIOTEL CARE BLOOD GLUCOSE SYST NPB ST; OTC; QL (1 EA per 273 days)

BLOOD GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

BLULINK CONTROL HIGH & LOW NPB OTC

BLULINK GLUCOSE MONITORING SYS NPB ST; OTC; QL (1 EA per 273 days)

BLULINK GLUCOSE TEST NPB OTC; QL (300 EA per 25 days)

CARETOUCH CONTROL SOL LEVEL 2 NPB OTC

CARETOUCH LANCING/EJECTOR PB OTC

CARETOUCH TEST NPBST; OTC; QL (300 EA per 25 days)

CEQUR SIMPLICITY STARTER NPB

CHEMSTRIP BG LOG BOOK PB OTC

CONTOUR CONTROL SOLUTION NPB OTC

CONTOUR MONITOR DEVICE NPB ST; OTC; QL (1 EA per 273 days)

CONTOUR MONITOR KIT W/DEVICE NPB ST; OTC; QL (1 EA per 273 days)

CONTOUR NEXT CONTROL SOLUTION NPB OTC


71


CONTOUR NEXT EZ KIT W/DEVICE NPB OTC; QL (1 EA per 273 days)

CONTOUR NEXT EZ KIT W/DEVICE NPB ST; OTC; QL (1 EA per 273 days)

CONTOUR NEXT LINK KIT W/DEVICE NPB ST; OTC; QL (1 EA per 273 days)

CONTOUR NEXT MONITOR KIT W/DEVICE NPB ST; OTC; QL (1 EA per 273 days)

CONTOUR NEXT ONE KIT NPB ST; OTC; QL (1 EA per 273 days)

CONTOUR NEXT TEST STRIPS NPBST; OTC; QL (300 EA per 25 days)

CONTOUR TEST STRIPS NPBST; OTC; QL (300 EA per 25 days)

DEXCOM G5 MOB/G4 PLAT SENSOR PB ST; QL (0.143 EA per 1 day)

DEXCOM G5 MOBILE RECEIVER PB ST; QL (1 EA per 273 days)

DEXCOM G5 MOBILE TRANSMITTER PB ST; QL (1 EA per 63 days)

DEXCOM G5 RECEIVER KIT PB ST; QL (1 EA per 273 days)

DEXCOM G6 RECEIVER PB ST; QL (1 EA per 273 days)

DEXCOM G6 SENSOR PB ST; QL (0.1 EA per 1 day)

DEXCOM G6 TRANSMITTER PB ST; QL (1 EA per 63 days)

DIATHRIVE BLOOD GLUCOSE METER NPB ST; OTC; QL (1 EA per 273 days)

DIATHRIVE BLOOD GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

DIATHRIVE GLUCOSE CONTROL SOLN NPB OTC

DIATHRIVE GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

DIATHRIVE LANCING DEVICE PB OTC

DIATHRIVE+ GLUCOSE MONITOR NPB ST; OTC; QL (1 EA per 273 days)

DIATHRIVE+ GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

DROPLET GENTEEL LANCING DEVICE PB OTC

EASY TALK PLUS II CONTROL NPB OTC

EASY TALK PLUS II TEST STRIPS NPB OTC; QL (300 EA per 25 days)

EASY TOUCH HEALTHPRO GLUCOSE NPB OTC; QL (300 EA per 25 days)

EASY TRAK II BLOOD GLUCOSE SYS NPB ST; OTC; QL (1 EA per 273 days)

EASY TRAK II CONTROL NPB OTC

EASY TRAK II GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

EASYMAX 15 LEVEL 2-3 CONTROL NPB OTC

EASYMAX CONTROL NPB OTC

GLUCOSE CONTROL SOLUTIONS NPB OTC

EMBRACE EVO GLUCOSE MONITOR NPB ST; OTC; QL (1 EA per 273 days)

EMBRACE LANCING DEVICE/EJECTOR PB OTC

EMBRACE PRESSURE ACTIVATED 21G PB OTC


72


EMBRACE PRESSURE ACTIVATED 28G PB OTC

EMBRACE TALK BLOOD GLUCOSE NPB ST; OTC; QL (1 EA per 273 days)

EMBRACE TALK GLUCOSE CONTROL NPB OTC

EMBRACE TALK GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

EMBRACE TALK MONITORING SYSTEM NPB ST; OTC; QL (1 EA per 273 days)

FORA 6 CONNECT NPBST; OTC; QL (300 EA per 25 days)

FORA GTEL BLOOD GLUCOSE SYSTEM NPB ST; OTC; QL (1 EA per 273 days)

FORA GTEL BLOOD GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

FORA TN'G ADVANCE PRO IN VITRO NPB OTC; QL (300 EA per 25 days)

FORTISCARE CONTROL NPB OTC

FORTISCARE G1 TEST STRIP NPB OTC; QL (300 EA per 25 days)

FORTISCARE T1 GLUCOSE SYSTEM NPB ST; OTC; QL (1 EA per 273 days)

FREESTYLE FREEDOM LITE NPB ST; OTC; QL (1 EA per 273 days)

FREESTYLE INSULINX TEST NPBST; OTC; QL (300 EA per 25 days)

FREESTYLE LIBRE 14 DAY READER PB ST; QL (1 EA per 273 days)

FREESTYLE LIBRE 14 DAY SENSOR PB ST; QL (0.072 EA per 1 day)

FREESTYLE LIBRE 2 READER PB ST; QL (1 EA per 273 days)

FREESTYLE LIBRE 2 SENSOR PB ST; QL (0.1 EA per 1 day)

FREESTYLE LIBRE READER PB ST; QL (1 EA per 273 days)

FREESTYLE LITE TEST NPBST; OTC; QL (300 EA per 25 days)

FREESTYLE PRECISION NEO TEST NPBST; OTC; QL (300 EA per 25 days)

FREESTYLE TEST NPBST; OTC; QL (300 EA per 25 days)

GENTEEL LANCING KIT (BLUE) PB OTC

GHT BLOOD GLUCOSE MONITOR NPB ST; OTC; QL (1 EA per 273 days)

GLUCOCARD 01 SENSOR PLUS NPBST; OTC; QL (300 EA per 25 days)

GLUCOCARD EXPRESSION TEST NPBST; OTC; QL (300 EA per 25 days)

GLUCOCARD SHINE CONNEX NPB ST; OTC; QL (1 EA per 273 days)

GLUCOCARD SHINE EXPRESS NPB ST; OTC; QL (1 EA per 273 days)

GLUCOCARD SHINE TEST NPBST; OTC; QL (300 EA per 25 days)

GLUCOCARD VITAL TEST NPBST; OTC; QL (300 EA per 25 days)


73


GOJJI BLOOD GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

GOJJI CONTROL NPB OTC

GOJJI LANCING DEVICE/CLEAR CAP PB OTC

HW EMBRACE PRO GLUCOSE METER NPB ST; OTC; QL (1 EA per 273 days)

HW EMBRACE PRO GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

HW EMBRACE TALK BLOOD GLUCOSE NPB ST; OTC; QL (1 EA per 273 days)

HW EMBRACE TALK GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

INFINITY BLOOD GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

KROGER HEALTHPRO GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

LANCETS PB OTC

LANCETS IN VITRO STRIP NPBST; OTC; QL (300 EA per 25 days)

MICRODOT TEST NPBST; OTC; QL (300 EA per 25 days)

MICROLET NEXT LANCING DEVICE PB OTC

ONE DROP BLOOD GLUCOSE MONITOR NPB ST; OTC; QL (1 EA per 273 days)

ONE DROP TEST NPBST; OTC; QL (300 EA per 25 days)

ONETOUCH CLUB LANCETS FINE PT PB OTC

ONETOUCH DELICA LANCETS 30G PB OTC

ONETOUCH DELICA LANCETS 33G PB OTC

ONETOUCH DELICA LANCING DEV PB OTC

ONETOUCH DELICA PLUS LANCET30G PB OTC

ONETOUCH DELICA PLUS LANCET33G PB OTC

ONETOUCH DELICA PLUS LANCING PB OTC

ONETOUCH DELICA SAFETY LANCING PB OTC

ONETOUCH FINEPOINT LANCETS PB OTC

ONETOUCH SOLUTIONS STARTER KIT NPB OTC; QL (1 EA per 273 days)

ONETOUCH ULTRA TEST STRIPS PB OTC; QL (300 EA per 25 days)

ONETOUCH ULTRA 2 KIT W/DEVICE PB OTC; QL (1 EA per 273 days)

ONETOUCH ULTRA MINI KIT W/DEVICE PB OTC; QL (1 EA per 273 days)

ONETOUCH ULTRASOFT LANCETS PB OTC

ONETOUCH VERIO KIT W/DEVICE PB OTC; QL (1 EA per 273 days)

ONETOUCH VERIO FLEX SYSTEM PB OTC; QL (1 EA per 273 days)


74


ONETOUCH VERIO IN VITRO SOLUTION HIGH

PB OTC

ONETOUCH VERIO TEST STRIPS PB OTC; QL (300 EA per 25 days)

ONETOUCH VERIO IQ SYSTEM PB OTC; QL (1 EA per 273 days)

ONETOUCH VERIO REFLECT KIT W/DEVICE PB OTC; QL (1 EA per 273 days)

POGO AUTOMATIC BLOOD GLUCOSE NPB ST; OTC; QL (1 EA per 273 days)

POGO AUTOMATIC TEST CARTRIDGES NPBST; OTC; QL (300 EA per 25 days)

PRECISION XTRA BLOOD GLUCOSE NPBST; OTC; QL (300 EA per 25 days)

PRODIGY NO CODING BLOOD GLUC NPB ST; OTC; QL (1 EA per 273 days)

RELION PREMIER CLASSIC NPB ST; OTC; QL (1 EA per 273 days)

RELION PREMIER TEST NPBST; OTC; QL (300 EA per 25 days)

RIGHTEST GT333 BLOOD GLUCOSE NPB ST; OTC; QL (1 EA per 273 days)

RIGHTEST GT333 BLOOD GLUCOSE IN VITRO

NPB OTC; QL (300 EA per 25 days)

SURESTEP PRO HIGH GLUCOSE NPB OTC

SURESTEP PRO LOW GLUCOSE NPB OTC

SURESTEP PRO NORMAL GLUCOSE NPB OTC

TRUE FOCUS BLOOD GLUCOSE METER NPB ST; OTC; QL (1 EA per 273 days)

TRUE METRIX BLOOD GLUCOSE TEST NPBST; OTC; QL (300 EA per 25 days)

TRUE METRIX LEVEL 1 NPB OTC



TRUE METRIX METER KIT NPB OTC; QL (1 EA per 273 days)

TRUE METRIX PRO BLOOD GLUCOSE NPBST; OTC; QL (300 EA per 25 days)

TRUETRACK TEST NPBST; OTC; QL (300 EA per 25 days)

UNISTRIP CONTROL IN VITRO SOLUTION LOW

NPB OTC

VIVAGUARD INO CONTROL SOLUTION NPB OTC

VIVAGUARD INO GLUCOSE METER NPB ST; OTC; QL (1 EA per 273 days)

VIVAGUARD INO SMART GLUC METER NPB ST; OTC; QL (1 EA per 273 days)

VIVAGUARD INO TEST STRIPS STRIP IN VITRO

NPB OTC; QL (300 EA per 25 days)

VIVAGUARD INO TEST STRIPS STRIP IN VITRO

NPBST; OTC; QL (300 EA per 25 days)

VIVAGUARD LANCING DEVICE PB OTC


75


Diabetes - Glycemic Agents

BAQSIMI ONE PACK NPB

BAQSIMI TWO PACK NPB

diazoxide oral G M

GLUCAGEN HYPOKIT PB

glucagon emergency kit 1 mg injection 1 mg G

GLUCAGON EMERGENCY KIT 1 MG INJECTION 1 MG

NPB

GLUCAGON EMERGENCY KIT NPB

GVOKE HYPOPEN 1-PACK NPB

GVOKE HYPOPEN 2-PACK NPB

GVOKE KIT NPB

GVOKE PFS NPB

PROGLYCEM NPB M

ZEGALOGUE NPB

Diabetes - Insulins

ADMELOG NPB ST; M; QL (50 ML per 25 days)

ADMELOG SOLOSTAR NPB ST; M; QL (45 ML per 25 days)

AFREZZA INHALATION POWDER 12 UNIT, 4 & 8 & 12 UNIT, 8 UNIT, 90 X 4 UNIT & 90X8 UNIT, 90 X 8 UNIT & 90X12 UNIT

NPB M

AFREZZA INHALATION POWDER 4 UNIT NPB M; QL (630 EA per 23 days)

APIDRA SOLOSTAR NPB ST; M; QL (45 ML per 25 days)

APIDRA VIAL NPB ST; M; QL (50 ML per 25 days)

AUM MINI INSULIN PEN NEEDLE 32G X 4 MM , 32G X 5 MM , 32G X 6 MM , 32G X 8 MM

NPB ST; M; OTC

AUM MINI PEN NEEDLES 33G X 4 MM , 33G X 5 MM , 33G X 6 MM

NPB ST; M; OTC

AUM READYGARD DUO PEN NEEDLE NPB ST; M; OTC

BASAGLAR KWIKPEN NPB ST; M

BD AUTOSHIELD DUO PEN NEEDLES NPB ST; M; OTC

BD ULTRA-FINE INSULIN SYRINGES NPB ST; OTC

BD ULTRA-FINE INSULIN SYRINGES NPB

BD ULTRA-FINE PEN NEEDLES NPB ST; M; OTC

BD ULTRA-FINE PEN NEEDLES NPB ST; M

DROPLET MICRON NPB ST; M; OTC

FIASP NPB ST; M; QL (50 ML per 25 days)

FIASP FLEXTOUCH NPB ST; M; QL (45 ML per 25 days)

FIASP PENFILL NPB ST; M; QL (45 ML per 25 days)


76


HUMALOG KWIKPEN PB M; QL (45 ML per 25 days)

HUMALOG MIX 50/50 KWIKPEN PB M; QL (45 ML per 25 days)

HUMALOG MIX 50/50 VIAL PB M; QL (50 ML per 25 days)

HUMALOG MIX 75/25 KWIKPEN PB M; QL (45 ML per 25 days)

HUMALOG MIX 75/25 VIAL PB M; QL (50 ML per 25 days)

HUMALOG SUBCUTANEOUS SOLUTION PB M; QL (50 ML per 25 days)

HUMALOG SUBCUTANEOUS SOLUTION CARTRIDGE

PB M; QL (15 ML per 34 days)

HUMALOG U-100 JUNIOR KWIKPEN PB M; QL (45 ML per 25 days)

HUMULIN 70/30 KWIKPEN PB M; OTC; QL (45 ML per 25 days)

HUMULIN 70/30 VIAL PB M; OTC; QL (45 ML per 25 days)

HUMULIN N KWIKPEN PB M; OTC

HUMULIN N VIAL PB M; OTC; QL (50 ML per 25 days)

HUMULIN R U-500 KWIKPEN PB M; QL (45 ML per 25 days)

HUMULIN R U-500 VIAL PB M; QL (50 ML per 25 days)

HUMULIN R VIAL PB M; OTC; QL (50 ML per 25 days)

INSULIN ASP PROT & ASP FLEXPEN NPB ST; M

INSULIN ASPART NPB ST; M

INSULIN ASPART FLEXPEN NPB ST; M; QL (45 ML per 25 days)

INSULIN ASPART PENFILL NPB ST; M; QL (45 ML per 25 days)

INSULIN ASPART PROT & ASPART NPB ST; M

INSULIN GLARGINE-YFGN NPB

INSULIN LISPRO NPB ST; M; QL (50 ML per 25 days)

INSULIN LISPRO (1 UNIT DIAL) NPB ST; M; QL (45 ML per 25 days)

INSULIN LISPRO JUNIOR KWIKPEN NPB ST; M; QL (45 ML per 25 days)

INSULIN LISPRO PROT & LISPRO NPB ST; M; QL (45 ML per 25 days)

INSULIN PEN NEEDLES NPB ST; M; OTC

INSULIN PEN NEEDLES 30G X 5 MM , 30G X 8 MM , 31G X 5 MM

PB ST; M; OTC

INSULIN SYRINGES NPB ST; OTC

INSULIN SYRINGES 31G X 15/64" 1 ML PB ST; OTC

LANTUS SOLOSTAR PB M

LANTUS U-100 VIAL PB M; QL (50 ML per 25 days)

LEVEMIR U-100 FLEXTOUCH PB M; QL (45 ML per 25 days)

LEVEMIR U-100 VIAL PB M; QL (50 ML per 25 days)

LYUMJEV KWIKPEN PB

LYUMJEV VIAL PB

NOVOFINE AUTOCOVER PEN NEEDLE NPB ST; M; OTC

NOVOFINE PEN NEEDLE NPB ST; M; OTC


77


NOVOFINE PLUS PEN NEEDLE NPB ST; M; OTC

NOVOLIN 70/30 FLEXPEN NPBST; M; OTC; QL (45 ML per 25 days)

NOVOLIN 70/30 FLEXPEN RELION NPBST; M; OTC; QL (45 ML per 25 days)

NOVOLIN 70/30 RELION NPBST; M; OTC; QL (45 ML per 25 days)

NOVOLIN 70/30 VIAL NPBST; M; OTC; QL (45 ML per 25 days)

NOVOLIN N FLEXPEN NPB ST; M; OTC

NOVOLIN N FLEXPEN RELION NPB ST; M; OTC

NOVOLIN N RELION NPBST; M; OTC; QL (50 ML per 25 days)

NOVOLIN N VIAL NPBST; M; OTC; QL (50 ML per 25 days)

NOVOLIN R FLEXPEN NPB ST; M; OTC

NOVOLIN R FLEXPEN RELION NPB ST; M; OTC

NOVOLIN R RELION NPBST; M; OTC; QL (50 ML per 25 days)

NOVOLIN R VIAL NPBST; M; OTC; QL (50 ML per 25 days)

NOVOLOG 70/30 FLEXPEN RELION NPB ST; M

NOVOLOG FLEXPEN NPB ST; M; QL (45 ML per 25 days)

NOVOLOG FLEXPEN RELION NPB ST; M; QL (45 ML per 25 days)

NOVOLOG MIX 70/30 FLEXPEN NPB ST; M

NOVOLOG MIX 70/30 RELION NPB ST; M

NOVOLOG MIX 70/30 VIAL NPB ST; M

NOVOLOG PENFILL NPB ST; M; QL (45 ML per 25 days)

NOVOLOG RELION NPB ST; M

NOVOLOG U-100 VIAL NPB ST; M

NOVOTWIST PEN NEEDLE NPB ST; M; OTC

SEMGLEE (YFGN) NPB

TOUJEO MAX SOLOSTAR PB M; QL (45 ML per 25 days)

TOUJEO SOLOSTAR PB M

TRESIBA PB M; QL (50 ML per 25 days)

TRESIBA FLEXTOUCH PB M; QL (45 ML per 25 days)

ULTIGUARD SAFEPACK SYR/NEEDLE NPB ST; OTC

Electrolytes / Minerals / Metals / Vitamins

ACCRUFER NPB

adc/f (0.5mg/ml) G ACA


78


ARGININE HCL INJECTION NPB

argyle sterile water G

ATABEX OB NPB

CALCIFOL NPB

CARBAGLU PB-S PA

carglumic acid G PA

CARNITOR ORAL NPB M

CARNITOR SF NPB M

CHEMET PB

CHROMAGEN NPB

cyanocobalamin injection solution 1000 mcg/ml G M

CYANOCOBALAMIN INJECTION SOLUTION 2000 MCG/ML

PB M

deferasirox G-S

deferasirox granules G-S

deferiprone oral tablet 1000 mg G

deferiprone oral tablet 500 mg G-S

DEXPANTHENOL INJECTION NPB

DILUENT FOR LEFAMULIN NPB

DRISDOL NPB

EDETATE DISODIUM INTRAVENOUS NPB

EFFER-K ORAL TABLET EFFERVESCENT 10 MEQ, 20 MEQ

NPB M

effer-k oral tablet effervescent 25 meq G M

ELITE-OB NPB

ergocalciferol oral capsule G

EXJADE PB-S

ferotrinsic G

FERRALET 90 NPB

FERRAPLUS 90 NPB

FERRIPROX PB-S

FERRIPROX TWICE-A-DAY PB-S

FERRO-PLEX NPB

fluoritab G M; ACA

folic acid oral tablet 1 mg G M

foltrin G

GALZIN NPB

GLUTATHIONE INJECTION SOLUTION 200 MG/ML

NPB


79


GLUTATHIONE INTRAVENOUS NPB

GLYCINE INJECTION NPB

HEMATRON-AF NPB

hydroxocobalamin acetate G

iodine strong oral G

JADENU NPB-S

JADENU SPRINKLE PB-S

JYNARQUE PB-S PA; QL (2 EA per 1 day)

klor-con G M

klor-con 10 G M

klor-con m10 G M

klor-con m15 G M

klor-con m20 G M

K-PHOS PB

k-prime G M

K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ, 8 MEQ

G M

K-TAB ORAL TABLET EXTENDED RELEASE 20 MEQ

NPB ST; M

k-tan plus G

levocarnitine oral solution G M

levocarnitine oral tablet G M

levocarnitine sf G M

LIPO NPB

LIPO-C NPB

LOKELMA PB

LYSINE HCL INJECTION NPB

MAGNESIUM SULFATE INJECTION NPB

MEPHYTON NPB

METHYLCOBALAMIN INJECTION SOLUTION RECONSTITUTED

NPB

MULTIGEN NPB

multi-vitamin/fluoride G ACA

multivitamin/fluoride tablet chewable 0.25 mg oral (rx)

G ACA

MULTIVITAMIN/FLUORIDE TABLET CHEWABLE 0.25 MG ORAL (RX)

NPB ACA

multivitamin/fluoride tablet chewable 0.5 mg oral G ACA

MULTIVITAMIN/FLUORIDE TABLET CHEWABLE 0.5 MG ORAL

NPB ACA


80


multivitamin/fluoride tablet chewable 1 mg oral G

MULTIVITAMIN/FLUORIDE TABLET CHEWABLE 1 MG ORAL

NPB

multi-vitamin/fluoride/iron G ACA

MULTI-VIT-FLOR ORAL TABLET CHEWABLE 0.25 MG, 0.5 MG

NPB ACA

MULTI-VIT-FLOR ORAL TABLET CHEWABLE 1 MG

NPB

MULTRYS NPB

nafrinse G M

nafrinse drops G M; ACA

NASCOBAL PB M

NEPHRON FA NPB

NESTABS NPB

NUTRIVIT PB

phospho-trin 250 neutral G

phytonadione oral G

polysaccharide iron forte G

POLY-VI-FLOR ORAL SUSPENSION NPB

POLY-VI-FLOR/IRON ORAL SUSPENSION NPB

POTASSIUM ACETATE INTRAVENOUS NPB

potassium chloride crys er G M

potassium chloride er G M

potassium chloride oral G M

potassium citrate er G M

PRENATVITE RX NPB

QUFLORA FE NPB

RELNATE DHA NPB

RENATABS WITH IRON NPB

SALINE-PHENOL NPB

SAMSCA PB-S PA; QL (2 EA per 1 day)

sod citrate-citric acid G

sodium fluoride oral solution 1.1 (0.5 f) mg/ml G M; ACA

sodium fluoride oral tablet 1.1 (0.5 f) mg G M; ACA

sodium fluoride oral tablet 2.2 (1 f) mg G M

sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

G M; ACA

sodium fluoride oral tablet chewable 2.2 (1 f) mg G M

sodium polystyrene sulfonate G


81


sps G

sterile water for irrigation G

SYPRINE NPB PA

TAURINE INJECTION NPB

THAM NPB

THE LIQUILIFT TRACE NPB

tolvaptan tablet 30 mg oral G PA; QL (2 EA per 1 day)

tolvaptan tablet 30 mg oral G-S PA; QL (2 EA per 1 day)

tolvaptan tablet 30 mg oral PB-S PA; QL (2 EA per 1 day)

TRI-AMINO NPB

trientine hcl G PA

TRIFERIC AVNU NPB

TRINATE NPB

TRI-VI-FLOR NPB

TRI-VI-FLORO NPB

tri-vite/fluoride G ACA

UROCIT-K 10 NPB M

UROCIT-K 15 NPB M

UROCIT-K 5 NPB M

VELTASSA PB

VINATE ONE G

vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut)

G

vitamins acd-fluoride G ACA

vp-pnv-dha NPB

water for irrigation, sterile G

WESCAP-C DHA NPB

WESCAP-PN DHA G

WESNATE DHA NPB

WILZIN NPB

Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer

ACIPHEX NPB ST; M; QL (2 EA per 1 day)

CARAFATE NPB M

cimetidine hcl G M

cimetidine oral tablet 300 mg, 400 mg, 800 mg G M

CYTOTEC NPB M

DEXILANT NPB ST; M; QL (2 EA per 1 day)


82


DEXLANSOPRAZOLE CAPSULE DELAYED RELEASE 60 MG ORAL


esomeprazole magnesium oral capsule delayed release 40 mg

PB M; QL (2 EA per 1 day)

esomeprazole magnesium oral packet G M; QL (2 EA per 1 day)

ESOMEPRAZOLE STRONTIUM NPB ST; M; QL (2 EA per 1 day)

famotidine oral suspension reconstituted G

famotidine oral tablet 40 mg G M

lansoprazole oral capsule delayed release 30 mg


lansoprazole oral tablet delayed release dispersible 30 mg


misoprostol oral G M

NEXIUM ORAL CAPSULE DELAYED RELEASE 40 MG


NEXIUM ORAL PACKET 10 MG, 20 MG, 40 MG


NEXIUM ORAL PACKET 2.5 MG, 5 MG PB ST; M; QL (2 EA per 1 day)

nizatidine G M

omeprazole oral capsule delayed release 10 mg, 40 mg


omeprazole-sodium bicarbonate PB M; QL (2 EA per 1 day)

pantoprazole sodium oral packet G M; QL (2 EA per 1 day)

pantoprazole sodium oral tablet delayed release PB M; QL (2 EA per 1 day)

PEPCID ORAL TABLET 40 MG NPB M

PREVACID NPB ST; M; QL (2 EA per 1 day)

PREVACID SOLUTAB ORAL TABLET DELAYED RELEASE DISPERSIBLE 30 MG


PRILOSEC NPB ST; M; QL (2 EA per 1 day)

PROTONIX ORAL NPB ST; M; QL (2 EA per 1 day)

RABEPRAZOLE SODIUM ORAL CAPSULE SPRINKLE


rabeprazole sodium oral tablet delayed release PB M; QL (2 EA per 1 day)

sucralfate oral G M

ZEGERID NPB ST; M; QL (2 EA per 1 day)

Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions

alosetron hcl G

alvimopan G

AMITIZA PB QL (2 EA per 1 day)

amoxicill-clarithro-lansopraz G QL (112 EA per 25 days)


83


ANASPAZ G

ATROPEN NPB

ATROPINE SULFATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 1.2 MG/3ML

NPB

cascara sagrada oral fluid extract NPB

CHENODAL PB-S PA

chlordiazepoxide-clidinium G

CLENPIQ PB ACA

constulose G

cromolyn sodium oral G

CUVPOSA NPB

dicyclomine hcl oral G

diphenoxylate-atropine G

ED-SPAZ G

ENTEREG NPB

enulose G

GASTROCROM NPB

GATTEX NPB-S

gavilyte-c G ACA

gavilyte-g G ACA

gavilyte-n with flavor pack G ACA

generlac G

GIALAX NPB ACA

GLYCATE NPB

glycopyrrolate oral solution G

glycopyrrolate oral tablet 1 mg, 2 mg G

GLYCOPYRROLATE ORAL TABLET 1.5 MG NPB

GOLYTELY NPB

HELIDAC THERAPY NPB

hyoscyamine sulfate oral elixir G

hyoscyamine sulfate oral solution G

hyoscyamine sulfate oral tablet G

hyoscyamine sulfate sl G

hyoscyamine sulfate sublingual G

hyosyne G

KRISTALOSE NPB

lactulose G

lactulose encephalopathy G


84


LIBRAX NPB ST

LINZESS PB QL (1 EA per 1 day)

LOMOTIL NPB

LOTRONEX NPB

LUBIPROSTONE PB QL (2 EA per 1 day)

methscopolamine bromide oral G

mineral oil heavy oral PB

MOTEGRITY NPB QL (1 EA per 1 day)

MOTOFEN NPB

MOVANTIK PB QL (1 EA per 1 day)

MOVIPREP NPB

MYTESI NPB QL (2 EA per 1 day)

NULEV G

NULYTELY LEMON-LIME NPB

OMECLAMOX-PAK NPB QL (80 EA per 25 days)

OSCIMIN NPB

OSMOPREP NPB ACA

peg 3350-kcl-na bicarb-nacl G ACA

peg-3350/electrolytes G ACA

peg-3350/electrolytes/ascorbat G ACA

peg-kcl-nacl-nasulf-na asc-c G ACA

PLENVU NPB ACA

PYLERA PB

RELISTOR ORAL NPB QL (3 EA per 1 day)

RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6ML

PB QL (0.6 ML per 1 day)

RELISTOR SUBCUTANEOUS SOLUTION 8 MG/0.4ML

PB QL (0.4 ML per 1 day)

RELTONE NPB M

ROBINUL NPB

ROBINUL-FORTE NPB

SEROSTIM PB-S PA

sodium bicarbonate oral powder G

SUPREP BOWEL PREP KIT PB ACA

SUTAB NPB QL (24 EA per 1 fill)

SYMPROIC PB QL (1 EA per 1 day)

TALICIA NPB QL (12 EA per 1 day)

TRULANCE PB QL (1 EA per 1 day)

URSO 250 NPB M


85


URSO FORTE NPB M

URSODIOL ORAL CAPSULE 200 MG, 400 MG NPB M

ursodiol oral capsule 300 mg G M

ursodiol oral tablet G M

URSODIOL+SYRSPEND SF NPB M

VIBERZI PB QL (2 EA per 1 day)

XERMELO PB-S PA; QL (3 EA per 1 day)

ZELNORM NPB QL (2 EA per 1 day)

ZORBTIVE NPB-S PA

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

betaine G

BUPHENYL NPB

CERDELGA PB-S

CHOLBAM PB-S

CREON PB

CYSTADANE PB-S

CYSTAGON PB-S

EVRYSDI NPB-S PA; QL (8 ML per 1 day)

GALAFOLD NPB-S PA; QL (0.5 EA per 1 day)

KUVAN PB-S PA

miglustat G-S

MYALEPT PB-S PA

nitisinone G-S

NITYR PB-S

OCALIVA PB-S PA; QL (1 EA per 1 day)

ORFADIN PB-S

PALYNZIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 10 MG/0.5ML


PALYNZIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 2.5 MG/0.5ML


PALYNZIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML

PB-S PA; QL (2 ML per 1 day)

PANCREAZE NPB ST

PERTZYE NPB ST

PROCYSBI NPB-S ST

RAVICTI PB-S

sapropterin dihydrochloride G-S PA

sodium phenylbutyrate oral G


86


STRENSIQ PB-S PA

SUCRAID PB-S

VIOKACE PB

XURIDEN PB-S QL (4 EA per 1 day)

ZAVESCA NPB-S ST

ZENPEP PB

Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions

acetic acid irrigation G

AURYXIA NPB

bethanechol chloride oral G

calcium acetate (phos binder) oral capsule G

CAVERJECT PB QL (0.2 EA per 1 day)

CAVERJECT IMPULSE PB QL (0.2 EA per 1 day)

CIALIS ORAL TABLET 10 MG, 20 MG NPB ST; QL (0.2 EA per 1 day)

CIALIS ORAL TABLET 2.5 MG, 5 MG NPB ST; QL (1 EA per 1 day)

CUPRIMINE NPB ST; M

darifenacin hydrobromide er G M

DEPEN TITRATABS NPB M

DETROL NPB ST; M

DETROL LA NPB ST; M

DITROPAN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 10 MG

NPB ST; M

DITROPAN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 5 MG


EDEX NPB QL (0.2 EA per 1 day)

ELMIRON PB PA

flavoxate hcl G M

FOSRENOL NPB ST

GELNIQUE PB ST; M; QL (34 GM per 25 days)

GEMTESA NPB ST

INTRAROSA NPB

lanthanum carbonate G

LITHOSTAT NPB

MUSE PB QL (0.2 EA per 1 day)

MYRBETRIQ PB ST

oxybutynin chloride er oral tablet extended release 24 hour 10 mg, 15 mg

G M


87


oxybutynin chloride er oral tablet extended release 24 hour 5 mg


oxybutynin chloride oral G M

OXYTROL NPB ST; M; QL (0.29 EA per 1 day)

penicillamine oral G M

phenazo oral tablet 200 mg G

phenazopyridine hcl oral tablet 100 mg, 200 mg G

PHOSLYRA PB

RENACIDIN NPB

RENAGEL NPB ST

RENVELA NPB

RIMSO-50 NPB

sevelamer carbonate G

sevelamer hcl G

sildenafil citrate oral tablet 100 mg, 25 mg, 50 mg

G QL (0.2 EA per 1 day)

solifenacin succinate G M

STENDRA NPB ST; M; QL (0.2 EA per 1 day)

tadalafil oral tablet 10 mg, 20 mg G QL (0.2 EA per 1 day)

tadalafil oral tablet 2.5 mg, 5 mg G QL (1 EA per 1 day)

THIOLA NPB-S PA

THIOLA EC NPB-S PA

tiopronin G PA

tolterodine tartrate G M

tolterodine tartrate er G M

TOVIAZ PB ST

trospium chloride G M

trospium chloride er G M

vardenafil hcl oral tablet G QL (0.2 EA per 1 day)

vardenafil hcl oral tablet dispersible G QL (6 EA per 25 days)

VELPHORO PB

VESICARE PB ST; M

VESICARE LS NPB M

VIAGRA NPB ST; QL (0.2 EA per 1 day)

Genitourinary Agents - Drugs for Prostate Conditions

alfuzosin hcl er G M

AVODART NPB ST; M

CARDURA XL NPB M; QL (1 EA per 1 day)


88


dutasteride oral G M

dutasteride-tamsulosin hcl G M

finasteride oral tablet 5 mg G M

FLOMAX NPB ST; M

JALYN NPB ST; M

PROSCAR NPB ST; M

RAPAFLO NPB ST; M

silodosin G M

tamsulosin hcl G M

terazosin hcl oral capsule 1 mg, 2 mg, 5 mg G M; QL (1 EA per 1 day)

terazosin hcl oral capsule 10 mg G M; QL (2 EA per 1 day)

UROXATRAL NPB ST; M

Hormonal Agents - Adrenal

CORTEF NPB

DECADRON G

DEXABLISS NPB ST

dexamethasone intensol G

dexamethasone oral elixir G

dexamethasone oral solution G

dexamethasone oral tablet G

dexamethasone oral tablet therapy pack G ST

DXEVO 11-DAY NPB ST

fludrocortisone acetate oral G M

HEMADY NPB

HEXATRIONE NPB

HIDEX 6-DAY PB ST

hydrocortisone oral G

MEDROL NPB

methylprednisolone oral G

MILLIPRED G

ORAPRED ODT NPB

PEDIAPRED NPB

prednisolone oral solution G

prednisolone sodium phosphate oral G

prednisone intensol G

prednisone oral G

RAYOS NPB ST

TAPERDEX 12-DAY NPB ST


89




ZCORT 7-DAY NPB ST

Hormonal Agents - Men's Health

ANDRODERM PB PA

ANDROGEL PUMP NPB

ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 40.5 MG/2.5GM (1.62%)

NPB

ANDROGEL TRANSDERMAL GEL 25 MG/2.5GM (1%), 50 MG/5GM (1%)

NPB ST

danazol oral G

DEPO-TESTOSTERONE NPB

EC-RX TESTOSTERONE NPB

FORTESTA NPB ST

JATENZO NPB PA

METHITEST PB

methyltestosterone oral G

NATESTO NPB ST

TESTIM NPB ST

testosterone cypionate intramuscular G

testosterone enanthate intramuscular G PA

testosterone transdermal G

VOGELXO NPB ST

VOGELXO PUMP NPB ST

XYOSTED NPB PA

Hormonal Agents - Pituitary

ACTHAR NPB-S PA; QL (0.3 ML per 34 days)

cabergoline G M; QL (1 EA per 1 day)

CETROTIDE PB

CHORIONIC GONADOTROPIN INTRAMUSCULAR

PB ST; QL (3 EA per 25 days)

clomiphene citrate oral G

CORTROPHIN NPB-S PA; QL (0.3 ML per 34 days)

DDAVP INJECTION G M

DDAVP ORAL NPB M

DDAVP PF G M

desmopressin ace spray refrig G M

desmopressin acetate injection G M

desmopressin acetate oral G M


90


desmopressin acetate pf G M

desmopressin acetate spray G M

EGRIFTA SV PB-S PA; QL (1 EA per 1 day)

ELIGARD SUBCUTANEOUS KIT 30 MG PB-S QL (0.009 EA per 1 day)

FIRMAGON PB-S QL (0.036 EA per 1 day)

FIRMAGON (240 MG DOSE) PB-S QL (0.006 EA per 1 day)

FOLLISTIM AQ NPB ST

fyremadel G-S ST

ganirelix acetate G-S ST

GENOTROPIN PB-S PA

GENOTROPIN MINIQUICK PB-S PA

GONAL-F PB

GONAL-F RFF PB

GONAL-F RFF REDIJECT PB

HUMATROPE NPB-S PA

INCRELEX PB-S PA

ISTURISA NPB-S PA

LANREOTIDE ACETATE PB-S

leuprolide acetate injection G-S

LEUPROLIDE ACETATE-BUPIVACAINE NPB

LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT 3.75 MG

PB-S


NPB-S


PB-S


NPB-S

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG

NPB-S

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG

NPB-S

LUPRON DEPOT-PED (1-MONTH) PB-S PA

LUPRON DEPOT-PED (3-MONTH) PB PA

MENOPUR PB

MYCAPSSA NPB

NOCDURNA NPB M

NORDITROPIN FLEXPRO PB-S PA

NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 10000 UNIT

PB QL (3 EA per 25 days)


91


NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT

PB

NUTROPIN AQ NUSPIN 10 NPB-S PA



octreotide acetate G-S

OMNITROPE SUBCUTANEOUS SOLUTION CARTRIDGE

PB-S PA

OMNITROPE SUBCUTANEOUS SOLUTION RECONSTITUTED

NPB-S PA

ORILISSA ORAL TABLET 150 MG PB PA; QL (1 EA per 1 day)

ORILISSA ORAL TABLET 200 MG PB PA; QL (2 EA per 1 day)

OVIDREL PB

PREGNYL PB ST; QL (3 EA per 25 days)

SAIZEN NPB-S PA

SAIZENPREP NPB-S PA

SANDOSTATIN NPB-S

SOMATULINE DEPOT PB-S

SOMAVERT PB-S

STIMATE PB M

SYNAREL PB

TRIPTODUR NPB-S QL (0.006 EA per 1 day)

ZOMACTON NPB-S PA

ZOMACTON (FOR ZOMA-JET 10) NPB-S PA

Hormonal Agents - Prostaglandins

KORLYM NPB-S PA; QL (4 EA per 1 day)

Hormonal Agents - Selective Estrogen Receptor Modifying Agents

EVISTA NPB PA; M

OSPHENA NPB

raloxifene hcl G PA; M

Hormonal Agents - Sex Hormones and Birth Control

ACTIVELLA NPB M

afirmelle G M; ACA

ALORA NPB M; QL (0.4 EA per 1 day)

altavera G M; ACA

alyacen 1/35 G M; ACA

alyacen 7/7/7 G M; ACA


92


amabelz G M

amethia G M; ACA; QL (1 EA per 1 day)

amethyst G M; ACA

ANGELIQ NPB M

ANNOVERA NPB ACA

apri G M; ACA

aranelle G M; ACA

ashlyna G M; ACA; QL (1 EA per 1 day)

aubra G M; ACA

aubra eq G M; ACA

aurovela 1.5/30 G M; ACA

aurovela 1/20 G M; ACA

aurovela 24 fe G M; ACA

aurovela fe 1.5/30 G M; ACA

aurovela fe 1/20 G M; ACA

aviane G M; ACA

AYGESTIN NPB M

ayuna G M; ACA

azurette G M; ACA

BALCOLTRA NPB ST; M

balziva G M; ACA

BEYAZ NPB ST; M

BIJUVA NPB

blisovi 24 fe G M; ACA

blisovi fe 1.5/30 G M; ACA

blisovi fe 1/20 G M; ACA

briellyn G M; ACA

camila G M; ACA

camrese G M; ACA; QL (1 EA per 1 day)

camrese lo G M; ACA; QL (1 EA per 1 day)

caziant G M; ACA

charlotte 24 fe G M; ACA

chateal G M; ACA

chateal eq G M; ACA

CLIMARA NPB M; QL (0.2 EA per 1 day)

CLIMARA PRO NPB ST; M; QL (0.2 EA per 1 day)

COMBIPATCH PB M

CRINONE PB QL (0.6 GM per 1 day)


93


cryselle-28 G M; ACA

cyclafem 1/35 G M; ACA

cyclafem 7/7/7 G M; ACA

cyred G M; ACA

cyred eq G M; ACA

dasetta 1/35 G M; ACA

dasetta 7/7/7 G M; ACA

daysee G M; ACA; QL (1 EA per 1 day)

deblitane G M; ACA

DELESTROGEN NPB

delyla G M; ACA

DEPO-ESTRADIOL PB

DEPO-PROVERA NPB QL (0.02 ML per 1 day)

DEPO-SUBQ PROVERA 104 NPB ACA; QL (0.02 ML per 1 day)

desogestrel-ethinyl estradiol G M; ACA

DIVIGEL TRANSDERMAL GEL 0.25 MG/0.25GM, 0.5 MG/0.5GM

NPB M; QL (34 EA per 28 days)

DIVIGEL TRANSDERMAL GEL 0.75 MG/0.75GM, 1.25 MG/1.25GM

NPB M

DIVIGEL TRANSDERMAL GEL 1 MG/GM NPB M; QL (34 GM per 28 days)

dolishale G M; ACA

dotti G M; QL (0.4 EA per 1 day)

drospiren-eth estrad-levomefol G M; ACA

drospirenone-ethinyl estradiol G M; ACA

DUAVEE PB

EC-RX ESTRADIOL NPB

EC-RX PROGESTERONE NPB

ELESTRIN NPB M; QL (52 GM per 28 days)

elinest G M; ACA

ELLA NPB QL (1 EA per 25 days)

eluryng G M; ACA; QL (1 EA per 25 days)

emoquette G M; ACA

ENDOMETRIN NPB ST

enpresse-28 G M; ACA

enskyce G M; ACA

errin G M; ACA

estarylla G M; ACA

ESTRACE NPB M

estradiol oral G M


94


estradiol transdermal patch twice weekly G M; QL (0.4 EA per 1 day)

estradiol transdermal patch weekly G M; QL (0.2 EA per 1 day)

estradiol vaginal G M

estradiol valerate intramuscular G

estradiol-norethindrone acet G M

ESTRING PB M; QL (0.012 EA per 1 day)

ESTROGEL NPB M; QL (50 GM per 28 days)

ESTROSTEP FE NPB ST; M

ethynodiol diac-eth estradiol G M; ACA

etonogestrel-ethinyl estradiol ring 0.12-0.015 mg/24hr vaginal

G M; ACA; QL (1 EA per 25 days)

etonogestrel-ethinyl estradiol ring 0.12-0.015 mg/24hr vaginal

NPB M; ACA; QL (1 EA per 25 days)

EVAMIST NPB M; QL (17 ML per 28 days)

falmina G M; ACA

fayosim G M; ACA; QL (1 EA per 1 day)

FEMHRT NPB M

FEMRING NPB ST; M; QL (0.012 EA per 1 day)

femynor G M; ACA

fyavolv G M

gemmily G M; ACA

GENERESS FE NPB ST; M

hailey 1.5/30 G M; ACA

hailey 24 fe G M; ACA

hailey fe 1.5/30 G M; ACA

hailey fe 1/20 G M; ACA

heather G M; ACA

iclevia G M; ACA; QL (1 EA per 1 day)

IMVEXXY MAINTENANCE PACK NPB M

IMVEXXY STARTER PACK NPB M

incassia G M; ACA

introvale G M; ACA; QL (1 EA per 1 day)

isibloom G M; ACA

jaimiess G M; ACA; QL (1 EA per 1 day)

jasmiel G M; ACA

jencycla G M; ACA

jinteli G M

jolessa G M; ACA; QL (1 EA per 1 day)

juleber G M; ACA


95


junel 1.5/30 G M; ACA

junel 1/20 G M; ACA

junel fe 1.5/30 G M; ACA

junel fe 1/20 G M; ACA

junel fe 24 G M; ACA

kaitlib fe G M; ACA

kalliga G M; ACA

kariva G M; ACA

kelnor 1/35 G M; ACA

kelnor 1/50 G M; ACA

kurvelo G M; ACA

larin 1.5/30 G M; ACA

larin 1/20 G M; ACA

larin 24 fe G M; ACA

larin fe 1.5/30 G M; ACA

larin fe 1/20 G M; ACA

larissia G M; ACA

layolis fe G M; ACA

leena G M; ACA

lessina G M; ACA

levonest G M; ACA

levonorgest-eth est & eth est G M; ACA; QL (1 EA per 1 day)

levonorgest-eth estrad 91-day G M; ACA; QL (1 EA per 1 day)

levonorgestrel-ethinyl estrad G M; ACA

levonorg-eth estrad triphasic G M; ACA

levora 0.15/30 (28) G M; ACA

lillow G M; ACA

LO LOESTRIN FE PB ST; M

LOESTRIN 1.5/30 (21) NPB ST; M

LOESTRIN 1/20 (21) NPB ST; M

LOESTRIN FE 1.5/30 NPB ST; M

LOESTRIN FE 1/20 NPB ST; M

lojaimiess G M; ACA; QL (1 EA per 1 day)

loryna G M; ACA

LOSEASONIQUE NPB ST; M; QL (1 EA per 1 day)

low-ogestrel G M; ACA

lo-zumandimine G M; ACA

lutera G M; ACA


96


lyleq G M; ACA

lyllana G M; QL (0.4 EA per 1 day)

lyza G M; ACA

marlissa G M; ACA

medroxyprogesterone acetate intramuscular G ACA; QL (0.02 ML per 1 day)

medroxyprogesterone acetate oral G M

megestrol acetate oral suspension G

megestrol acetate oral tablet G-S

MENEST NPB M

MENOSTAR NPB M; QL (0.2 EA per 1 day)

merzee G M; ACA

microgestin 1.5/30 G M; ACA

microgestin 1/20 G M; ACA

microgestin 24 fe G M; ACA

microgestin fe 1.5/30 G M; ACA

microgestin fe 1/20 G M; ACA

mili G M; ACA

mimvey G M

MINASTRIN 24 FE NPB ST; M

MINIVELLE NPB ST; M; QL (0.4 EA per 1 day)

MIRCETTE NPB ST; M

mono-linyah G M; ACA

MYFEMBREE PB PA; QL (1 EA per 1 day)

NATAZIA NPB ST; M

necon 0.5/35 (28) G M; ACA

NEXTSTELLIS NPB ACA

nikki G M; ACA

nora-be G M; ACA

norethin ace-eth estrad-fe G M; ACA

norethindrone acetate oral G M

norethindrone acet-ethinyl est G M; ACA

norethindrone oral G M; ACA

norethindrone-eth estradiol G M

norethin-eth estradiol-fe G M; ACA

norgestimate-eth estradiol G M; ACA

norgestimate-ethinyl estradiol triphasic G M; ACA

norlyda G M; ACA

norlyroc G M; ACA


97


nortrel 0.5/35 (28) G M; ACA

nortrel 1/35 (21) G M; ACA

nortrel 1/35 (28) G M; ACA

nortrel 7/7/7 G M; ACA

NUVARING NPB M; QL (1 EA per 25 days)

nylia 1/35 G M; ACA

nylia 7/7/7 G M; ACA

nymyo G M; ACA

ocella G M; ACA

ORIAHNN PB PA; QL (2 EA per 1 day)

orsythia G M; ACA

philith G M; ACA

pimtrea G M; ACA

pirmella 1/35 G M; ACA

pirmella 7/7/7 G M; ACA

portia-28 G M; ACA

PREFEST NPB M

PREMARIN ORAL PB M

PREMARIN VAGINAL PB M

PREMPHASE PB M

PREMPRO PB M

previfem G M; ACA

progesterone intramuscular G

PROGESTERONE MICRONIZED TRANSDERMAL

NPB

progesterone oral G

PROMETRIUM NPB

PROVERA NPB M

QUARTETTE NPB ST; M; QL (1 EA per 1 day)

reclipsen G M; ACA

rivelsa G M; ACA; QL (1 EA per 1 day)

SAFYRAL NPB ST; M

SEASONIQUE NPB ST; M; QL (1 EA per 1 day)

setlakin G M; ACA; QL (1 EA per 1 day)

sharobel G M; ACA

simliya G M; ACA

simpesse G M; ACA; QL (1 EA per 1 day)

SLYND NPB


98


sprintec 28 G M; ACA

sronyx G M; ACA

syeda G M; ACA

tarina 24 fe G M; ACA

tarina fe 1/20 G M; ACA

tarina fe 1/20 eq G M; ACA

taysofy G M; ACA

TAYTULLA NPB ST; M

tilia fe G M; ACA

tri femynor G M; ACA

tri-estarylla G M; ACA

tri-legest fe G M; ACA

tri-linyah G M; ACA

tri-lo-estarylla G M; ACA

tri-lo-marzia G M; ACA

tri-lo-mili G M; ACA

tri-lo-sprintec G M; ACA

tri-mili G M; ACA

tri-nymyo G M; ACA

tri-previfem G M; ACA

tri-sprintec G M; ACA

trivora (28) G M; ACA

tri-vylibra G M; ACA

tri-vylibra lo G M; ACA

tulana G M; ACA

TWIRLA NPB ST

tyblume G M; ACA

tydemy G M; ACA

VAGIFEM NPB ST; M

velivet G M; ACA

vestura G M; ACA

vienva G M; ACA

viorele G M; ACA

VIVELLE-DOT NPB ST; M; QL (0.4 EA per 1 day)

volnea G M; ACA

vyfemla G M; ACA

vylibra G M; ACA

wera G M; ACA


99


wymzya fe G M; ACA

xulane G M; ACA

YASMIN 28 NPB ST; M

YAZ NPB ST; M

yuvafem G M

zafemy G M; ACA

zovia 1/35 (28) G M; ACA

zovia 1/35e (28) G M; ACA

zumandimine G M; ACA

Hormonal Agents - Thyroid

ARMOUR THYROID G M

CYTOMEL NPB ST; M

euthyrox NPB M

levo-t NPB M

LEVOTHYROXINE SODIUM ORAL CAPSULE NPB M

levothyroxine sodium oral tablet G M

levoxyl G M

liothyronine sodium oral G M

methimazole oral G M

NATURE-THROID G M

np thyroid G M

propylthiouracil oral G M

SODIUM IODIDE I-131 NPB

SYNTHROID NPB M

THYQUIDITY NPB M

TIROSINT NPB M

TIROSINT-SOL NPB M

unithroid G M

WESTHROID G M

WP THYROID G M

Immunological Agents - Drugs for Immune System Stimulation or Suppression

ACTEMRA ACTPEN NPB-S PA

ACTEMRA SUBCUTANEOUS NPB-S PA; QL (3.6 ML per 21 days)

ARAVA NPB M; QL (1 EA per 1 day)

ARCALYST NPB-S PA

ASTAGRAF XL NPB ST

AZASAN NPB


100


azathioprine oral G

BEBTELOVIMAB NPB

BENLYSTA SUBCUTANEOUS PB-S PA

CELLCEPT NPB

CIMZIA PB-S PA

CIMZIA PREFILLED KIT PB-S PA

CIMZIA STARTER KIT PB-S PA

COSENTYX (300 MG DOSE) NPB-S PA; QL (2 ML per 23 days)

COSENTYX 150 MG/ML SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML

NPB-S PA; QL (2 ML per 23 days)

COSENTYX 150 MG/ML SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 75 MG/0.5ML

NPB-S PA

COSENTYX SENSOREADY (300 MG) NPB-S PA; QL (2 ML per 23 days)

COSENTYX SENSOREADY PEN NPB-S PA; QL (2 ML per 23 days)

CUTAQUIG SUBCUTANEOUS SOLUTION 1 GM/6ML, 2 GM/12ML, 4 GM/24ML, 8 GM/48ML

NPB

cyclosporine modified G

cyclosporine oral G

ENBREL MINI NPB-S PA; QL (4 ML per 25 days)

ENBREL SUBCUTANEOUS SOLUTION NPB-S PA; QL (8 ML per 25 days)

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG/0.5ML


ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 50 MG/ML


ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED

NPB-S PA; QL (8 EA per 25 days)

ENBREL SURECLICK NPB-S PA; QL (4 ML per 25 days)

ENSPRYNG NPB-S PA

ENVARSUS XR NPB ST

everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 mg, 1 mg

G

FIRAZYR PB-S PA

gengraf G

HUMIRA PB-S PA; QL (2 EA per 25 days)

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 MG/0.8ML

PB-S PA

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 MG/0.8ML & 40MG/0.4ML

PB-S PA; QL (2 EA per 25 days)


101


HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.4ML, 40 MG/0.8ML


HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML

PB-S PA

HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML


HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML

PB-S PA

HUMIRA PEN-PEDIATRIC UC START PB-S PA

HUMIRA PEN-PS/UV/ADOL HS START PB-S PA; QL (2 EA per 25 days)

HUMIRA PEN-PSOR/UVEIT STARTER PB-S PA

icatibant acetate G-S PA

ILUMYA NPB-S PA

IMURAN NPB

KEVZARA NPB-S PA

KINERET NPB-S PA; QL (19 ML per 21 days)

leflunomide oral G M; QL (1 EA per 1 day)

LUPKYNIS NPB-S PA; QL (6 EA per 1 day)

methotrexate oral G

methotrexate sodium G

methotrexate sodium (pf) G

mycophenolate mofetil oral G

mycophenolate sodium G

MYFORTIC NPB

NEORAL NPB

OLUMIANT NPB-S PA

ORENCIA CLICKJECT NPB-S PA

ORENCIA SUBCUTANEOUS NPB-S PA

ORLADEYO NPB-S PA; QL (1 EA per 1 day)

OTEZLA ORAL TABLET PB-S PA; QL (2 EA per 1 day)

OTEZLA ORAL TABLET THERAPY PACK PB-S PA; QL (55 EA per 21 days)

OTREXUP NPB-S ST; QL (1.6 ML per 21 days)

PROGRAF ORAL NPB

RAPAMUNE NPB

RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.2ML

PB-S QL (0.8 ML per 21 days)

RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 12.5 MG/0.25ML



102
















REDITREX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 10 MG/0.4ML


REDITREX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 12.5 MG/0.5ML










REDITREX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG/ML




REZUROCK NPB-S PA; QL (1 EA per 1 day)

RIDAURA PB M

RINVOQ PB-S PA

sajazir G-S PA

SANDIMMUNE ORAL CAPSULE NPB

SANDIMMUNE ORAL SOLUTION PB

SILIQ NPB-S PA

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 100 MG/ML

PB-S PA; QL (1 ML per 21 days)

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MG/0.5ML

PB-S PA; QL (0.5 ML per 21 days)

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/ML

PB-S PA; QL (1 ML per 21 days)


103


SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 50 MG/0.5ML

PB-S PA; QL (0.5 ML per 21 days)

sirolimus oral G

SKYRIZI PB-S PA

SKYRIZI (150 MG DOSE) PB-S PA

SKYRIZI PEN PB-S PA

SOTROVIMAB NPB

STELARA SUBCUTANEOUS PB-S PA

tacrolimus oral G

TAKHZYRO SUBCUTANEOUS SOLUTION NPB-S PA

TAKHZYRO SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

NPB

TALTZ NPB-S PA

TREMFYA PB-S PA

TREXALL NPB

XATMEP NPB-S

XELJANZ ORAL SOLUTION PB-S PA

XELJANZ ORAL TABLET PB-S PA; QL (2 EA per 1 day)

XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 11 MG

PB-S PA; QL (2 EA per 1 day)

XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 22 MG

PB-S PA; QL (1 EA per 1 day)

ZORTRESS NPB

Immunological Agents - Drugs for Vaccination

ACTHIB PB ACA

ADACEL PB ACA

AFLURIA QUADRIVALENT PB ACA

BEXSERO PB ACA

BOOSTRIX PB ACA

COMIRNATY NPB ACA

DAPTACEL PB ACA

DENGVAXIA NPB

DIPHTHERIA-TETANUS TOXOIDS DT PB ACA

ENGERIX-B PB ACA

FLUAD QUADRIVALENT PB ACA

FLUARIX QUADRIVALENT PB ACA

FLUBLOK QUADRIVALENT PB ACA

FLUCELVAX QUADRIVALENT PB ACA


104


FLULAVAL QUADRIVALENT PB ACA

FLUMIST QUADRIVALENT NPB ACA

FLUZONE HIGH-DOSE QUADRIVALENT PB ACA

FLUZONE QUADRIVALENT PB ACA

GARDASIL 9 PB ACA

HAVRIX NPB ACA

HEPLISAV-B NPB ACA

HIBERIX PB ACA

INFANRIX PB ACA

IPOL PB ACA

JANSSEN COVID-19 VACCINE PB ACA

KINRIX NPB ACA

MENACTRA PB ACA

MENQUADFI PB ACA

MENVEO NPB ACA

M-M-R II PB ACA

MODERNA COVID-19 VAC (BOOSTER) NPB

MODERNA COVID-19 VACCINE PB ACA

PEDIARIX PB ACA

PEDVAX HIB PB ACA

PENTACEL PB ACA

PFIZER COVID-19 VAC-TRIS 5-11Y NPB ACA

PFIZER COVID-19 VAC-TRIS 6M-4Y NPB

PFIZER-BIONT COVID-19 VAC-TRIS NPB ACA

PFIZER-BIONTECH COVID-19 VACC PB ACA

PNEUMOVAX 23 PB ACA

PREHEVBRIO NPB

PREVNAR 13 PB ACA

PREVNAR 20 PB

PROQUAD PB ACA

QUADRACEL INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

NPB ACA

QUADRACEL SUSPENSION INTRAMUSCULAR

NPB ACA

QUADRACEL SUSPENSION INTRAMUSCULAR

PB ACA

RECOMBIVAX HB PB ACA

ROTARIX NPB ACA

ROTATEQ PB ACA


105


SHINGRIX PB ACA

TDVAX PB ACA

TENIVAC NPB ACA

TETANUS-DIPHTHERIA TOXOIDS TD PB ACA

TRUMENBA PB ACA

TWINRIX PB ACA

VAQTA NPB ACA

VARIVAX PB ACA

VAXELIS NPB ACA

VAXNEUVANCE PB

Inflammatory Bowel Disease Agents

ANALPRAM-HC NPB

ANUSOL-HC EXTERNAL NPB ST

APRISO NPB M

ASACOL HD NPB ST; M

AZULFIDINE NPB M

AZULFIDINE EN-TABS NPB M

balsalazide disodium G

budesonide er G

budesonide oral G

CANASA NPB M

COLAZAL NPB

CORTENEMA NPB

CORTIFOAM NPB ST

DELZICOL NPB ST; M

DIPENTUM NPB ST; M

hydrocortisone (perianal) G

hydrocortisone ace-pramoxine external cream 1-1 %

G

hydrocortisone rectal G

LIALDA NPB M

mesalamine er oral capsule 0.375 gm G M

mesalamine oral G M

mesalamine rectal G M

mesalamine-cleanser G

ORTIKOS NPB ST

PENTASA PB M

PROCTOCORT EXTERNAL NPB ST


106


PROCTOFOAM HC NPB

procto-med hc G

procto-pak G

proctosol hc G

proctozone-hc G

ROWASA NPB

SFROWASA NPB M

sulfasalazine oral G M

UCERIS ORAL NPB

UCERIS RECTAL PB

Metabolic Bone Disease Agents - Drugs for Osteoporosis

ACTONEL ORAL TABLET 150 MG NPB ST; M; QL (0.04 EA per 1 day)

ACTONEL ORAL TABLET 35 MG NPB ST; M; QL (0.15 EA per 1 day)

alendronate sodium oral solution G M; QL (300 ML per 21 days)

alendronate sodium oral tablet 10 mg, 5 mg G M; QL (1 EA per 1 day)

alendronate sodium oral tablet 35 mg, 70 mg G M; QL (0.15 EA per 1 day)

ATELVIA NPB ST; M; QL (0.15 EA per 1 day)

BINOSTO NPB ST; M; QL (0.15 EA per 1 day)

BONIVA NPB ST; M; QL (0.04 EA per 1 day)

calcitonin (salmon) injection G M

calcitonin (salmon) nasal G M; QL (0.13 ML per 1 day)

FORTEO NPB-S PA; QL (3 ML per 21 days)

FOSAMAX NPB ST; M; QL (0.15 EA per 1 day)

FOSAMAX PLUS D NPB ST; QL (0.15 EA per 1 day)

ibandronate sodium oral G M; QL (0.04 EA per 1 day)

RAYALDEE NPB M

risedronate sodium oral tablet 150 mg G M; QL (0.04 EA per 1 day)

risedronate sodium oral tablet 30 mg G M

risedronate sodium oral tablet 35 mg G M; QL (0.15 EA per 1 day)

risedronate sodium oral tablet 5 mg G M; QL (1 EA per 1 day)

risedronate sodium oral tablet delayed release G M; QL (0.15 EA per 1 day)

TERIPARATIDE (RECOMBINANT) PB-S PA; QL (3 ML per 21 days)

TYMLOS PB-S PA

Metabolic Bone Disease Agents - Other

calcitriol oral G M

cinacalcet hcl G

doxercalciferol oral G M


107


NATPARA PB-S PA; QL (0.08 EA per 1 day)

paricalcitol oral G M

ROCALTROL NPB M

SENSIPAR NPB

ZEMPLAR ORAL NPB M

Miscellaneous Therapeutic Agents

ACCULA SARS-COV-2 NPB

ALPHA-LIPOIC ACID INJECTION NPB

AMINOPMRMS NPB

APP SLIM RMS NPB

asilnasalrms G

BACTERIOSTATIC WATER(BENZ ALC) NPB

BD VERITOR SYSTEM SARS-COV-2 NPB

BINAXNOW COVID-19 AG CARD NPB

BYLVAY NPB-S PA

BYLVAY (PELLETS) NPB-S PA

COBAS LIAT SARS-COV-2 ASSAY NPB

COVID-19 SPECIMEN COLLECTION NPB OTC

COVID-19 TESTING BY PHARMACIST NPB OTC

DIASCREEN 1B NPB OTC

DIASCREEN 1K STRIP NPB OTC

DOJOLVI NPB PA

EC-RX DHEA NPB

ENDARI NPB-S PA

ergoloid mesylates oral G M

FIRDAPSE NPB-S PA

GRASTEK PB

ID NOW COVID-19 NPB

INSPIREASE RESERVOIR BAGS NPB

J-TIP KIT W/VIAL ADAPTERS NPB

KATE FARMS PEPTIDE 1.5 ENTERAL NPB

KATE FARMS STANDARD 1.4 ENTERAL NPB

KERENDIA NPB PA; QL (1 EA per 1 day)

methergine G

methylergonovine maleate oral G

ODACTRA PB

OMNIPOD DASH 5 PACK PODS PB PA; QL (10 EA per 30 days)

ORALAIR NPB


108


ORALAIR ADULT STARTER PACK NPB

ORALAIR CHILDRENS STARTER PACK NPB

OXBRYTA NPB-S PA; QL (3 EA per 1 day)

PALFORZIA NPB-S PA

PHEXXI NPB PA; QL (60 GM per 60 days)

QUICKVUE SARS ANTIGEN TEST NPB

RAGWITEK PB

SOFIA SARS ANTIGEN FIA NPB

SOFIA2 SARS ANTIGEN FIA NPB

sorbitol-mannitol NPB

VISTOGARD PB-S

XPERT XPRESS SARS-COV-2 NPB

ZOKINVY NPB-S PA; QL (4 EA per 1 day)

Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation

ACULAR NPB

ACULAR LS NPB

ACUVAIL NPB ST

ALOCRIL NPB ST

ALOMIDE NPB ST

ALREX PB ST

AZASITE PB

azelastine hcl ophthalmic G

bacitracin ophthalmic G

bepotastine besilate G

BEPREVE NPB ST

BESIVANCE NPB

BETADINE OPHTHALMIC PREP NPB

BLEPH-10 NPB

bromfenac sodium (once-daily) G QL (6.8 ML per 365 days)

BROMSITE NPB QL (20 ML per 365 days)

CILOXAN NPB

ciprofloxacin hcl ophthalmic G

cromolyn sodium ophthalmic G

dexamethasone sodium phosphate ophthalmic G

diclofenac sodium ophthalmic G

difluprednate G

DUREZOL NPB


109


epinastine hcl G

erythromycin ophthalmic G

EYSUVIS NPB PA

FLAREX NPB ST

fluorometholone G

flurbiprofen sodium G

FML NPB ST

FML FORTE NPB ST

FML LIQUIFILM NPB ST

gatifloxacin ophthalmic G

gentak G

gentamicin sulfate ophthalmic G

ILEVRO PB QL (0.2 ML per 1 day)

INVELTYS PB ST

ketorolac tromethamine ophthalmic G

levofloxacin ophthalmic G

LOTEMAX OPHTHALMIC GEL NPB QL (20 GM per 365 days)

LOTEMAX OPHTHALMIC OINTMENT PB QL (14 GM per 365 days)

LOTEMAX OPHTHALMIC SUSPENSION PB

LOTEMAX SM PB

loteprednol etabonate ophthalmic gel G QL (20 GM per 365 days)

loteprednol etabonate ophthalmic suspension G

MAXIDEX NPB ST

MITOSOL NPB

moxifloxacin hcl (2x day) G

moxifloxacin hcl ophthalmic solution G

NATACYN PB

NEVANAC NPB ST; QL (0.2 ML per 1 day)

OCUFLOX NPB

ofloxacin ophthalmic G

olopatadine hcl ophthalmic solution 0.1 % G

POVIDONE-IODINE OPHTHALMIC NPB

PRED FORTE NPB ST

PRED MILD NPB ST

prednisolone acetate ophthalmic G

prednisolone sodium phosphate ophthalmic G

PROLENSA PB QL (12 ML per 365 days)

sulfacetamide sodium ophthalmic G


110


tobramycin ophthalmic G

TOBREX NPB

trifluridine G

TRIPLE PMB NPB

TRIPLE PMK NPB

UPNEEQ NPB PA

VIGAMOX NPB

ZERVIATE NPB ST

ZIRGAN NPB

ZYMAXID NPB

Ophthalmic Agents - Drugs for Glaucoma

acetazolamide er G M

acetazolamide oral G M

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % PB M

ALPHAGAN P OPHTHALMIC SOLUTION 0.15 %

NPB M

apraclonidine hcl G

AZOPT NPB M

betaxolol hcl ophthalmic G M

BETIMOL NPB M

BETOPTIC-S NPB M

bimatoprost ophthalmic G M; QL (0.1 ML per 1 day)

brimonidine tartrate ophthalmic G M

brinzolamide G M

carteolol hcl G M

COMBIGAN PB M

COSOPT NPB ST; M

COSOPT PF NPB ST; M

dorzolamide hcl ophthalmic G M

dorzolamide hcl-timolol mal G M

dorzolamide hcl-timolol mal pf G M

IOPIDINE NPB

ISOPTO CARPINE NPB M

ISTALOL NPB ST; M

KEVEYIS NPB-S PA; QL (4 EA per 1 day)

latanoprost ophthalmic G M

levobunolol hcl G M

LUMIGAN PB M; QL (0.1 ML per 1 day)


111


methazolamide oral G M

pilocarpine hcl ophthalmic G M

RHOPRESSA PB M

ROCKLATAN NPB ST; M; QL (0.1 ML per 1 day)

SIMBRINZA NPB M

timolol maleate (once-daily) G M

timolol maleate ocudose G M

timolol maleate ophthalmic G M

timolol maleate pf G M

TIMOPTIC NPB M

TIMOPTIC OCUDOSE NPB ST; M

TIMOPTIC-XE NPB M

TRAVATAN Z NPB M; QL (10 ML per 30 days)

travoprost (bak free) G M; QL (10 ML per 30 days)

VYZULTA NPB M; QL (0.2 ML per 1 day)

XALATAN NPB ST; M

XELPROS NPB ST; M; QL (0.1 ML per 1 day)

ZIOPTAN NPB ST; M; QL (1 EA per 1 day)

Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions

ak-poly-bac G

AKTEN NPB

ALCAINE NPB

altafrin G

atropine sulfate ophthalmic ointment G M

atropine sulfate ophthalmic solution 1 % G M

bacitracin-polymyxin b ophthalmic G

bacitra-neomycin-polymyxin-hc G

BLEPHAMIDE NPB

BLEPHAMIDE S.O.P. NPB

CEQUA NPB PA; M; QL (2 EA per 1 day)

CYCLOGYL NPB M

CYCLOMYDRIL NPB M

cyclopentolate hcl ophthalmic G M

CYSTADROPS NPB-S PA; QL (0.072 ML per 1 day)

CYSTARAN PB-S PA; QL (2.15 ML per 1 day)

DOUBLE PM NPB

homatropaire G M


112


ISOPTO ATROPINE NPB ST; M

LACRISERT NPB

MAXITROL NPB

MEMBRANEBLUE NPB

neomycin-bacitracin zn-polymyx G

neomycin-polymyxin-dexameth ophthalmic ointment

G

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

G

neomycin-polymyxin-gramicidin G

neomycin-polymyxin-hc ophthalmic G

neo-polycin G

neo-polycin hc G

OXERVATE PB-S PA; QL (2 ML per 1 day)

phenylephrine hcl ophthalmic G

polycin G

polymyxin b-trimethoprim G

POLYTRIM NPB

PRED-G NPB

PRED-G S.O.P. NPB

proparacaine hcl ophthalmic G

RESTASIS NPB M; QL (2 EA per 1 day)

RESTASIS MULTIDOSE PB M; QL (2 ML per 1 day)

sulfacetamide-prednisolone ophthalmic solution G

TOBRADEX OPHTHALMIC OINTMENT PB

TOBRADEX OPHTHALMIC SUSPENSION NPB

TOBRADEX ST PB

tobramycin-dexamethasone G

TROPICAMIDE-PHENYLEPHRINE NPB

VISIONBLUE NPB

XIIDRA PB M

ZYLET PB

Otic Agents - Drugs for Ear Conditions

acetic acid otic G

CETRAXAL NPB ST

CIPRO HC NPB

CIPRODEX NPB ST

ciprofloxacin hcl otic G

ciprofloxacin-dexamethasone G


113


CIPROFLOXACIN-FLUOCINOLONE PF PB

cortic-nd G

CORTISPORIN-TC NPB

DERMOTIC NPB

flac G

fluocinolone acetonide otic G

hydrocortisone-acetic acid G

neomycin-polymyxin-hc otic G

ofloxacin otic G

OTOVEL PB

PRAMOTIC NPB

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

azelastine hcl nasal G QL (2 ML per 1 day)

azelastine-fluticasone G QL (0.77 GM per 1 day)

BECONASE AQ NPB ST; QL (1 GM per 1 day)

benzonatate G

carbinoxamine maleate G

CLARINEX NPB QL (1 EA per 1 day)

CLARINEX-D 12 HOUR NPB QL (2 EA per 1 day)

clemastine fumarate oral syrup G

clemastine fumarate oral tablet 2.68 mg G

cyproheptadine hcl oral G

desloratadine PB QL (1 EA per 1 day)

DICOPANOL FUSEPAQ NPB

DICOPANOL RAPIDPAQ NPB

diphenhydramine hcl oral elixir G

DYMISTA NPB ST; QL (0.77 GM per 1 day)

FASENRA PB-S PA

FASENRA PEN PB-S PA

flunisolide nasal PB QL (0.84 ML per 1 day)

GILPHEX TR NPB

guaiatussin ac G OTC

guaifenesin ac G OTC

guaifenesin-dm oral liquid 10-100 mg/5ml G

HYCODAN NPB

hydrocodone polst-chlorphen polst er susp G

hydrocodone-homatropine G


114


hydromet G

HYPERSAL NPB

ipratropium bromide nasal G

KARBINAL ER NPB

maxi-tuss ac G OTC

mometasone furoate nasal PB QL (1.14 GM per 1 day)

NUCALA PB-S PA; QL (0.11 EA per 1 day)

olopatadine hcl nasal G QL (1.02 GM per 1 day)

OMNARIS NPB ST; QL (0.42 GM per 1 day)

PATANASE NPB QL (1.02 GM per 1 day)

promethazine hcl oral G

promethazine hcl rectal G

promethazine vc G

promethazine vc/codeine G

promethazine-codeine G

promethazine-dm G

promethazine-phenyleph-codeine G

promethazine-phenylephrine G

promethegan G

pseudoephedrine-bromphen-dm G

QNASL PB ST; QL (0.36 GM per 1 day)

QNASL CHILDRENS PB ST; QL (0.23 GM per 1 day)

RYCLORA NPB

ryvent NPB

sodium chloride inhalation G

TUXARIN ER NPB

TUZISTRA XR NPB

virtussin ac w/alc oral liquid 100-10 mg/5ml G OTC

XHANCE NPB ST; QL (1.1 ML per 1 day)

XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PB-S PA

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED


ZETONNA NPB ST; QL (0.21 GM per 1 day)

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

ACCOLATE NPB ST; M; QL (2 EA per 1 day)

acetylcysteine inhalation G


115


ADVAIR DISKUS PB M; QL (2 EA per 1 day)

ADVAIR HFA PB M; QL (0.4 GM per 1 day)

AIRDUO DIGIHALER NPB ST; M; QL (0.04 EA per 1 day)

AIRDUO RESPICLICK 113/14 NPB ST; M; QL (0.04 EA per 1 day)



albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation

G M; QL (1.2 GM per 1 day)

ALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) MCG/ACT INHALATION

NPB ST; M; QL (1.2 GM per 1 day)

albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%

G M; QL (630 ML per 30 days)

albuterol sulfate inhalation nebulization solution (5 mg/ml) 0.5%

G M; QL (5 ML per 1 day)

albuterol sulfate inhalation nebulization solution 0.63 mg/3ml, 1.25 mg/3ml

G M; QL (12.5 ML per 1 day)

albuterol sulfate inhalation nebulization solution 2.5 mg/0.5ml


albuterol sulfate oral G M

ALVESCO NPB ST; M; QL (0.41 GM per 1 day)

ANORO ELLIPTA PB M; QL (2 EA per 1 day)

arformoterol tartrate G ST; M; QL (4 ML per 1 day)

ARMONAIR DIGIHALER NPB M; QL (0.04 EA per 1 day)

ARNUITY ELLIPTA PB M; QL (1 EA per 1 day)

ASMANEX (120 METERED DOSES) PB M; QL (0.04 EA per 1 day)




ASMANEX HFA PB M; QL (0.44 GM per 1 day)

ATROVENT HFA PB M; QL (0.86 GM per 1 day)

AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 0.1 MG/0.1ML

NPB QL (0.07 EA per 1 day)

AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.15ML, 0.3 MG/0.3ML

NPB ST

BEVESPI AEROSPHERE PB M; QL (0.36 GM per 1 day)

BREO ELLIPTA PB M; QL (2 EA per 1 day)

BREZTRI AEROSPHERE PB QL (0.36 GM per 1 day)

BROVANA NPB ST; M; QL (4 ML per 1 day)

budesonide inhalation G M; QL (120 ML per 30 days)


116


BUDESONIDE-FORMOTEROL FUMARATE NPB M; QL (0.34 GM per 1 day)

COMBIVENT RESPIMAT PB QL (0.27 GM per 1 day)

cromolyn sodium inhalation G M

DALIRESP ORAL TABLET 250 MCG PB PA

DALIRESP ORAL TABLET 500 MCG PB PA; QL (1 EA per 1 day)

DUAKLIR PRESSAIR NPB ST; QL (0.04 EA per 1 day)

DULERA INHALATION AEROSOL 100-5 MCG/ACT

NPB ST; M; QL (13 GM per 25 days)

DULERA INHALATION AEROSOL 200-5 MCG/ACT, 50-5 MCG/ACT

NPB ST; M; QL (0.44 GM per 1 day)

ELIXOPHYLLIN NPB M

epinephrine injection solution auto-injector 0.15 mg/0.15ml, 0.15 mg/0.3ml

G QL (4 EA per 25 days)

epinephrine injection solution auto-injector 0.3 mg/0.3ml

G

EPIPEN 2-PAK NPB ST

EPIPEN JR 2-PAK NPB ST; QL (4 EA per 25 days)

ESBRIET PB-S PA

FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/BLIST, 50 MCG/BLIST


FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 250 MCG/BLIST


FLOVENT HFA INHALATION AEROSOL 110 MCG/ACT, 220 MCG/ACT

PB M; QL (0.8 GM per 1 day)

FLOVENT HFA INHALATION AEROSOL 44 MCG/ACT

PB M; QL (0.71 GM per 1 day)

fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose


FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT

NPB ST; M; QL (0.04 EA per 1 day)

formoterol fumarate inhalation G M; QL (4 ML per 1 day)

INCRUSE ELLIPTA NPB ST; M; QL (1 EA per 1 day)

ipratropium bromide inhalation G M; QL (10.42 ML per 1 day)

ipratropium-albuterol G QL (18 ML per 1 day)

levalbuterol hcl inhalation nebulization solution 0.31 mg/3ml, 0.63 mg/3ml

G QL (18 ML per 1 day)


117


levalbuterol hcl inhalation nebulization solution 1.25 mg/0.5ml


levalbuterol hcl inhalation nebulization solution 1.25 mg/3ml

G QL (9 ML per 1 day)

LEVALBUTEROL HFA INHALATION AEROSOL 45 MCG/ACT

NPB ST; QL (1 GM per 1 day)

LONHALA MAGNAIR REFILL KIT NPB M; QL (2 ML per 1 day)

LONHALA MAGNAIR STARTER KIT NPB M; QL (2 ML per 1 day)

montelukast sodium oral packet G M

montelukast sodium oral tablet G M; QL (1 EA per 1 day)

montelukast sodium oral tablet chewable G M; QL (1 EA per 1 day)

OFEV PB-S PA

PERFOROMIST NPB M; QL (4 ML per 1 day)

PROAIR DIGIHALER NPB ST; M; QL (0.07 EA per 1 day)

PROAIR HFA NPB ST; M; QL (1.2 GM per 1 day)

PROAIR RESPICLICK NPB ST; M; QL (0.07 EA per 1 day)

PROVENTIL HFA NPB ST; M; QL (1.2 GM per 1 day)

PULMICORT FLEXHALER PB M; QL (0.07 EA per 1 day)

PULMICORT SUSPENSION NPB ST; M; QL (120 ML per 30 days)

QVAR REDIHALER PB M; QL (0.71 GM per 1 day)

SEREVENT DISKUS PB M; QL (2 EA per 1 day)

SINGULAIR ORAL PACKET NPB ST; M

SINGULAIR ORAL TABLET NPB ST; M; QL (1 EA per 1 day)

SINGULAIR ORAL TABLET CHEWABLE NPB ST; M; QL (1 EA per 1 day)

SPIRIVA HANDIHALER PB ST; M; QL (1 EA per 1 day)

SPIRIVA RESPIMAT PB M; QL (0.14 GM per 1 day)

STIOLTO RESPIMAT PB M; QL (0.14 GM per 1 day)

STRIVERDI RESPIMAT PB M; QL (0.14 GM per 1 day)

SYMBICORT PB M; QL (0.34 GM per 1 day)

SYMJEPI NPB

terbutaline sulfate oral G M

THEO-24 NPB M

theophylline G M

theophylline er G M

TRELEGY ELLIPTA PB M; QL (2 EA per 1 day)

TUDORZA PRESSAIR NPB ST; QL (0.04 EA per 1 day)

VENTOLIN HFA NPB ST; M; QL (1.2 GM per 1 day)

wixela inhub G M; QL (2 EA per 1 day)

XOPENEX CONCENTRATE NPB QL (3 EA per 1 day)


118


XOPENEX HFA NPB ST; QL (1 GM per 1 day)

XOPENEX INHALATION NEBULIZATION SOLUTION 0.31 MG/3ML, 0.63 MG/3ML

NPB QL (18 ML per 1 day)

XOPENEX INHALATION NEBULIZATION SOLUTION 1.25 MG/3ML

NPB QL (9 ML per 1 day)

YUPELRI PB M; QL (3 ML per 1 day)

zafirlukast G M; QL (2 EA per 1 day)

zileuton er G ST; M; QL (4 EA per 1 day)

ZYFLO NPB ST; M

Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis

BETHKIS PB-S QL (224 ML per 25 days)

BRONCHITOL NPB

BRONCHITOL TOLERANCE TEST NPB

CAYSTON PB-S

KALYDECO PB-S PA

KITABIS PAK PB-S QL (280 ML per 25 days)

ORKAMBI ORAL PACKET PB-S PA; QL (2 EA per 1 day)

ORKAMBI ORAL TABLET PB-S PA; QL (4 EA per 1 day)

PULMOZYME PB

SYMDEKO PB-S PA; QL (2 EA per 1 day)

TOBI NEBULIZER NPB QL (280 ML per 25 days)

TOBI PODHALER PB QL (8 EA per 1 day)

tobramycin inhalation nebulization solution 300 mg/4ml

G-S QL (224 ML per 25 days)

tobramycin nebulization solution 300 mg/5ml inhalation


TOBRAMYCIN NEBULIZATION SOLUTION 300 MG/5ML INHALATION


TRIKAFTA PB-S PA; QL (3 EA per 1 day)

Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension

ADCIRCA NPB-S PA; QL (2 EA per 1 day)

ADEMPAS PB-S PA; QL (3 EA per 1 day)

alyq G-S PA; QL (2 EA per 1 day)

ambrisentan G-S PA; QL (1 EA per 1 day)

bosentan G-S PA; QL (2 EA per 1 day)

LETAIRIS NPB-S PA; QL (1 EA per 1 day)

OPSUMIT PB-S PA; QL (1 EA per 1 day)

ORENITRAM NPB-S PA


119


REVATIO ORAL SUSPENSION RECONSTITUTED

NPB-S PA; QL (7.5 ML per 1 day)

REVATIO ORAL TABLET NPB-S PA; QL (3 EA per 1 day)

sildenafil citrate oral suspension reconstituted G-S PA; QL (7.5 ML per 1 day)

sildenafil citrate oral tablet 20 mg G-S PA; QL (3 EA per 1 day)

tadalafil (pah) G-S PA; QL (2 EA per 1 day)

TRACLEER 62.5 MG, 125 MG NPB-S PA; QL (2 EA per 1 day)

TRACLEER 32 MG PB-S PA; QL (4 EA per 1 day)

UPTRAVI ORAL TABLET PB-S PA; QL (2 EA per 1 day)

UPTRAVI ORAL TABLET THERAPY PACK PB-S PA; QL (400 EA per 365 days)

VENTAVIS NPB-S PA; QL (9 ML per 1 day)

Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm

AMRIX NPB ST

BACLOFEN ORAL SOLUTION NPB

baclofen oral tablet G

carisoprodol oral G

chlorzoxazone oral tablet 250 mg G ST

chlorzoxazone oral tablet 375 mg, 500 mg, 750 mg

G

cyclobenzaprine hcl er G

cyclobenzaprine hcl oral G

CYCLOPHENE RAPIDPAQ NPB

DANTRIUM ORAL NPB ST

dantrolene sodium oral G

ENOVARX-BACLOFEN NPB

ENOVARX-CYCLOBENZAPRINE HCL NPB

FEXMID NPB ST

LORZONE NPB ST

metaxalone G

methocarbamol oral G

NORGESIC FORTE NPB ST

orphenadrine citrate er G

ORPHENGESIC FORTE NPB ST

OZOBAX NPB

SKELAXIN NPB ST

SOMA NPB ST

TABRADOL FUSEPAQ NPB

TABRADOL RAPIDPAQ NPB


120


tizanidine hcl oral G

VANADOM NPB ST

ZANAFLEX NPB ST

Sleep Disorder Agents

AMBIEN NPB ST; QL (2 EA per 1 day)

AMBIEN CR NPB ST; QL (1 EA per 1 day)

armodafinil oral tablet 150 mg, 200 mg, 250 mg G PA; QL (1 EA per 1 day)

armodafinil oral tablet 50 mg G PA; QL (2 EA per 1 day)

BELSOMRA NPB ST; QL (1 EA per 1 day)

DAYVIGO NPB ST; QL (1 EA per 1 day)

doxepin hcl oral tablet G QL (1 EA per 1 day)

EDLUAR NPB ST; QL (1 EA per 1 day)

eszopiclone G QL (1 EA per 1 day)

flurazepam hcl G QL (1 EA per 1 day)

HETLIOZ NPB-S PA; QL (1 EA per 1 day)

HETLIOZ LQ NPB-S PA

LUNESTA NPB ST; QL (1 EA per 1 day)

modafinil oral tablet 100 mg G PA; QL (2 EA per 1 day)

modafinil oral tablet 200 mg G PA; QL (1 EA per 1 day)

NUVIGIL ORAL TABLET 150 MG, 200 MG, 250 MG

NPB PA; QL (1 EA per 1 day)

NUVIGIL ORAL TABLET 50 MG NPB PA; QL (2 EA per 1 day)

PROVIGIL ORAL TABLET 100 MG NPB PA; QL (2 EA per 1 day)

PROVIGIL ORAL TABLET 200 MG NPB PA; QL (1 EA per 1 day)

ramelteon G QL (1 EA per 1 day)

RESTORIL ORAL CAPSULE 15 MG, 30 MG, 7.5 MG


RESTORIL ORAL CAPSULE 22.5 MG NPB

ROZEREM NPB ST; QL (1 EA per 1 day)

SILENOR NPB ST; QL (1 EA per 1 day)

SUNOSI PB PA; QL (1 EA per 1 day)

temazepam oral capsule 15 mg, 30 mg, 7.5 mg G QL (2 EA per 1 day)

temazepam oral capsule 22.5 mg G

WAKIX NPB-S PA; QL (2 EA per 1 day)

XYREM NPB-S PA; QL (540 ML per 23 days)

XYWAV NPB-S PA; QL (18 ML per 1 day)

zaleplon oral capsule 10 mg G QL (2 EA per 1 day)

zaleplon oral capsule 5 mg G QL (1 EA per 1 day)

zolpidem tartrate er G QL (1 EA per 1 day)


121


zolpidem tartrate oral G QL (2 EA per 1 day)

zolpidem tartrate sublingual G QL (1 EA per 1 day)

ZOLPIMIST NPB ST; QL (0.26 ML per 1 day)


122

Index of Drugs

A.A.G.C. KIT IN TERODERM... 61abacavir sulfate.........................40abacavir sulfate-lamivudine...... 40abacavir-lamivudine-zidovudine.................................40ABILIFY.....................................37ABILIFY MAINTENA................. 37ABILIFY MYCITE...................... 37ABILIFY MYCITE MAINTENANCE KIT................. 37ABILIFY MYCITE STARTER KIT............................................ 37abiraterone acetate................... 30ABSORICA............................... 61ABSORICA LD..........................61acamprosate calcium................ 13ACANYA................................... 61acarbose................................... 68ACCOLATE.............................115ACCRUFER.............................. 78ACCU-CHEK AVIVA DEVICE...70ACCU-CHEK AVIVA PLUS KIT W/DEVICE..........................71ACCU-CHEK FASTCLIX LANCET KIT............................. 71ACCU-CHEK FASTCLIX LANCETS................................. 71ACCU-CHEK GUIDE CONTROL................................ 71ACCU-CHEK GUIDE KIT W/DEVICE................................ 71ACCU-CHEK GUIDE TEST STRIPS..................................... 71ACCU-CHEK SAFE-T PRO LANCETS................................. 71ACCU-CHEK SMARTVIEW CONTROL................................ 71ACCU-CHEK SMARTVIEW TEST STRIPS...........................71ACCU-CHEK SOFTCLIX LANCET DEVICE KIT...............71ACCU-CHEK SOFTCLIX LANCETS................................. 71ACCULA SARS-COV-2.......... 108ACCUPRIL................................46ACCURETIC............................. 46accutane................................... 61acebutolol hcl............................ 46acetaminophen-codeine..............8acetaminophen-codeine #2.........8acetaminophen-codeine #3.........8acetaminophen-codeine #4.........8

acetazolamide.........................111acetazolamide er.....................111acetic acid......................... 87, 113acetylcysteine......................... 115ACIPHEX.................................. 82acitretin..................................... 61ACTEMRA.............................. 100ACTEMRA ACTPEN...............100ACTHAR................................... 90ACTHIB...................................104ACTICLATE.............................. 14ACTIQ......................................... 8ACTIVELLA...............................92ACTONEL............................... 107ACTOPLUS MET...................... 68ACTOS......................................68ACULAR................................. 109ACULAR LS............................ 109ACUVAIL.................................109acyclovir.................................... 40ACZONE............................. 61, 62ADACEL..................................104adapalene................................. 62ADAPALENE............................ 62adapalene-benzoyl peroxide.....62ADASUVE.................................38adc/f (0.5mg/ml)........................ 78ADCIRCA................................119ADDERALL............................... 54ADDERALL XR......................... 54ADDYI....................................... 59adefovir dipivoxil ....................... 40ADEMPAS.............................. 119ADHANSIA XR....................54, 55ADIPEX-P................................. 59ADLYXIN...................................68ADLYXIN STARTER PACK...... 68ADMELOG................................ 76ADMELOG SOLOSTAR........... 76ADVAIR DISKUS.................... 116ADVAIR HFA.......................... 116ADZENYS XR-ODT.................. 55AEMCOLO................................ 14AFINITOR................................. 30AFINITOR DISPERZ.................30afirmelle.................................... 92AFLURIA QUADRIVALENT....104AFREZZA..................................76AGAMATRIX CONTROL LEVEL 2....................................71AGAMATRIX CONTROL LEVEL 4....................................71

AGAMATRIX PRESTO TEST...71AGRYLIN.................................. 46AIMOVIG...................................28AIRDUO DIGIHALER..............116AIRDUO RESPICLICK 113/14116AIRDUO RESPICLICK 232/14116AIRDUO RESPICLICK 55/14..116AJOVY...................................... 28AKLIEF......................................62ak-poly-bac............................. 112AKTEN.................................... 112AKYNZEO.................................24ala-cort...................................... 62albendazole...............................35ALBENZA..................................35albuterol sulfate.......................116albuterol sulfate hfa.................116ALBUTEROL SULFATE HFA. 116ALCAINE.................................112alclometasone dipropionate...... 62ALDACTAZIDE......................... 46ALDACTONE............................ 46ALDARA....................................62ALECENSA...............................30alendronate sodium................ 107alfuzosin hcl er.......................... 88ALINIA.......................................35aliskiren fumarate......................46ALKERAN................................. 30allopurinol..................................27ALLZITAL....................................8almotriptan malate.................... 28ALOCRIL.................................109ALOGLIPTIN BENZOATE........ 68ALOGLIPTIN-METFORMIN HCL...........................................68ALOGLIPTIN-PIOGLITAZONE. 68ALOMIDE................................109ALORA......................................92alosetron hcl..............................83ALPHAGAN P......................... 111ALPHA-LIPOIC ACID..............108alprazolam................................ 44alprazolam er............................ 44alprazolam intensol................... 44alprazolam xr............................ 44ALREX.................................... 109ALTABAX..................................14ALTACE.................................... 46altafrin..................................... 112altavera..................................... 92ALTOPREV...............................46

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ALTRENO................................. 62ALUNBRIG................................30ALVESCO............................... 116alvimopan..................................83alyacen 1/35..............................92alyacen 7/7/7.............................92alyq......................................... 119amabelz.................................... 93amantadine hcl..........................36AMARYL................................... 68AMBIEN.................................. 121AMBIEN CR............................ 121ambrisentan............................ 119amcinonide................................62AMERGE.................................. 28amethia..................................... 93amethyst................................... 93AMICAR.................................... 46amiloride hcl..............................46amiloride-hydrochlorothiazide... 46aminocaproic acid..................... 46AMINOPMRMS.......................108amiodarone hcl......................... 46AMITIZA....................................83amitriptyline hcl......................... 21AMLODIPINE BES+SYRSPEND SF............... 46amlodipine besylate.................. 46amlodipine besylate-benazepril hcl............................................. 46amlodipine besylate-valsartan.. 47amlodipine-atorvastatin.............47amlodipine-olmesartan..............47amnesteem............................... 62amoxapine................................ 21amoxicill-clarithro-lansopraz..... 83amoxicillin................................. 14amoxicillin-potassium clavulanate................................14amoxicillin-potassium clavulanate er............................14amphetamine sulfate.................55amphetamine-dextroamphetamine.................. 55amphetamine-dextroamphetamine er.............. 55amphotericin b liposome........... 25ampicillin................................... 14AMPYRA...................................58AMRIX.....................................120AMZEEQ...................................62ANAFRANIL..............................21anagrelide hcl............................46

ANALPRAM-HC......................106ANAPROX DS.......................... 11ANASPAZ................................. 84anastrozole............................... 30ANCOBON................................25ANDRODERM.......................... 90ANDROGEL..............................90ANDROGEL PUMP.................. 90ANGELIQ.................................. 93ANNOVERA..............................93ANORO ELLIPTA................... 116ANTARA................................... 47ANTICOAGULANT SODIUM CITRATE...................................18ANTIVERT................................ 25ANUSOL-HC...........................106APADAZ......................................8apap-caff-dihydrocodeine........... 8APEXICON E............................ 62APIDRA SOLOSTAR................ 76APIDRA VIAL............................76APLENZIN................................ 21APOKYN................................... 36apomorphine hcl....................... 36APO-VARENICLINE................. 13APP SLIM RMS...................... 108apraclonidine hcl..................... 111aprepitant.................................. 25apri............................................ 93APRISO.................................. 106APTENSIO XR..........................55APTIOM.................................... 18APTIVUS...................................40ARAKODA................................ 35aranelle..................................... 93ARAVA....................................100ARAZLO....................................62ARCALYST............................. 100arformoterol tartrate................ 116ARGININE HCL........................ 79argyle sterile water....................79ARICEPT.................................. 21ARIKAYCE................................14ARIMIDEX.................................30aripiprazole............................... 38ARISTADA................................ 38ARISTADA INITIO.................... 38ARIXTRA.................................. 18armodafinil .............................. 121ARMONAIR DIGIHALER........ 116ARMOUR THYROID...............100ARNUITY ELLIPTA.................116AROMASIN...............................30

ARTHROTEC............................11ASACOL HD........................... 106ascomp-codeine..........................8asenapine maleate....................38ashlyna......................................93asilnasalrms............................ 108ASMANEX (120 METERED DOSES).................................. 116ASMANEX (14 METERED DOSES).................................. 116ASMANEX (30 METERED DOSES).................................. 116ASMANEX (60 METERED DOSES).................................. 116ASMANEX HFA...................... 116aspirin-dipyridamole er..............37ASPIRIN-OMEPRAZOLE......... 37ASSURE PLATINUM................ 71ASTAGRAF XL....................... 100ASTRINGYN............................. 46ATABEX OB..............................79ATACAND.................................47ATACAND HCT........................ 47atazanavir sulfate......................40ATELVIA................................. 107atenolol..................................... 47ATENOLOL+SYRSPEND SF... 47atenolol-chlorthalidone..............47ATIVAN..................................... 44atomoxetine hcl.........................55atorvastatin calcium.................. 47atovaquone............................... 35atovaquone-proguanil hcl..........35ATRALIN...................................62ATRIPLA................................... 40ATROPEN.................................84ATROPINE SULFATE.............. 84atropine sulfate....................... 112ATROVENT HFA.................... 116AUBAGIO..................................58aubra.........................................93aubra eq....................................93AUGMENTIN............................ 14AUGMENTIN ES-600............... 15AUM MINI INSULIN PEN NEEDLE....................................76AUM MINI PEN NEEDLES....... 76AUM READYGARD DUO PEN NEEDLE....................................76aurovela 1.5/30......................... 93aurovela 1/20............................ 93aurovela 24 fe........................... 93aurovela fe 1.5/30..................... 93

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aurovela fe 1/20........................ 93AURYXIA.................................. 87AUSTEDO.................................59AUTOLET LANCING DEVICE.. 71AUVI-Q....................................116AVALIDE...................................47AVAPRO................................... 47aviane....................................... 93avidoxy......................................15AVITA........................................62AVODART.................................88AVONEX PEN...........................58AVONEX PREFILLED.............. 58AYGESTIN................................93ayuna........................................ 93AYVAKIT...................................30AZASAN..................................100AZASITE................................. 109azathioprine............................ 101azelaic acid............................... 62azelastine hcl.................. 109, 114azelastine-fluticasone............. 114AZELEX.................................... 62AZILECT................................... 36azithromycin..............................15AZOPT.................................... 111AZOR........................................ 47AZSTARYS............................... 55AZULFIDINE........................... 106AZULFIDINE EN-TABS.......... 106azurette..................................... 93bac.............................................. 8bacitracin.................................109bacitracin-polymyxin b............ 112bacitra-neomycin-polymyxin-hc................................................ 112BACLOFEN.............................120baclofen.................................. 120BACTERIOSTATIC WATER(BENZ ALC)............... 108BACTRIM..................................15BACTRIM DS............................15BAFIERTAM............................. 58BALCOLTRA.............................93balsalazide disodium...............106BALVERSA............................... 30balziva.......................................93BANZEL.................................... 18BAQSIMI ONE PACK............... 76BAQSIMI TWO PACK...............76BARACLUDE............................ 40BASAGLAR KWIKPEN............. 76BAXDELA................................. 15

BD AUTOSHIELD DUO PEN NEEDLES................................. 76BD ULTRA-FINE INSULIN SYRINGES............................... 76BD ULTRA-FINE PEN NEEDLES................................. 76BD VERITOR SYSTEM SARS-COV-2..................................... 108BEBTELOVIMAB.................... 101BECONASE AQ......................114BELBUCA................................... 8BELSOMRA............................ 121benazepril hcl............................47benazepril-hydrochlorothiazide. 47BENICAR.................................. 47BENICAR HCT..........................47BENLYSTA............................. 101BENZAMYCIN.......................... 62BENZHYDROCODONE-ACETAMINOPHEN.....................8BENZNIDAZOLE...................... 35benzonatate............................ 114benzoyl peroxide-erythromycin. 62benzphetamine hcl....................59benztropine mesylate................36bepotastine besilate................ 109BEPREVE............................... 109BESIVANCE........................... 109BETADINE OPHTHALMIC PREP...................................... 109betaine...................................... 86betamethasone dipropionate.... 62betamethasone dipropionate aug............................................ 62betamethasone valerate........... 62BETAPACE...............................47BETAPACE AF......................... 47BETASERON............................58betaxolol hcl...................... 47, 111bethanechol chloride.................87BETHKIS.................................119BETIMOL................................ 111BETOPTIC-S.......................... 111BEVESPI AEROSPHERE.......116bexarotene................................ 30BEXSERO...............................104BEYAZ...................................... 93bicalutamide..............................30BIDIL......................................... 47BIJUVA..................................... 93BIKTARVY................................ 40BILTRICIDE.............................. 35bimatoprost............................. 111

BINAXNOW COVID-19 AG CARD......................................108BINOSTO................................107BIOTEL CARE BLOOD GLUCOSE................................ 71BIOTEL CARE BLOOD GLUCOSE SYST...................... 71bisoprolol fumarate................... 47bisoprolol-hydrochlorothiazide.. 47BLEPH-10............................... 109BLEPHAMIDE.........................112BLEPHAMIDE S.O.P.............. 112blisovi 24 fe............................... 93blisovi fe 1.5/30......................... 93blisovi fe 1/20............................ 93BLOOD GLUCOSE TEST.........71BLULINK CONTROL HIGH & LOW..........................................71BLULINK GLUCOSE MONITORING SYS.................. 71BLULINK GLUCOSE TEST...... 71BONIVA.................................. 107BONJESTA............................... 25BOOSTRIX............................. 104bosentan................................. 119BOSULIF...................................30BRAFTOVI................................ 30BREO ELLIPTA...................... 116BREXAFEMME.........................26BREZTRI AEROSPHERE.......116briellyn.......................................93BRILINTA..................................37brimonidine tartrate................. 111brinzolamide............................111BRISDELLE.............................. 21BRIVIACT................................. 18bromfenac sodium (once-daily)................................................ 109bromocriptine mesylate.............36BROMSITE............................. 109BRONCHITOL........................ 119BRONCHITOL TOLERANCE TEST.......................................119BROVANA.............................. 116BRUKINSA................................30BRYHALI...................................62budesonide..................... 106, 116budesonide er......................... 106BUDESONIDE-FORMOTEROL FUMARATE..117bumetanide............................... 47BUMEX..................................... 47BUPAP........................................8

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BUPHENYL...............................86buprenorphine.............................8buprenorphine hcl..................... 13buprenorphine hcl-naloxone hcl....................................... 13, 14bupropion hcl............................ 22bupropion hcl er (smoking det). 14bupropion hcl er (sr)..................21bupropion hcl er (xl)............ 21, 22BUPROPION HCL ER (XL)...... 22buspirone hcl.............................44butalbital-acetaminophen............8BUTALBITAL-ACETAMINOPHEN.....................8butalbital-apap-caff-cod.............. 8butalbital-apap-caffeine...............8butalbital-asa-caff-codeine..........8butalbital-aspirin-caffeine............ 8butorphanol tartrate.....................8BUTRANS...................................8BYDUREON BCISE AUTOINJECTOR...................... 68BYETTA 10 MCG PEN............. 68BYETTA 5 MCG PEN............... 68BYLVAY.................................. 108BYLVAY (PELLETS)...............108BYSTOLIC................................ 47cabergoline............................... 90CABLIVI.................................... 37CABOMETYX........................... 30CADUET................................... 47CAFERGOT.............................. 28caffeine citrate...........................59CALAN SR................................ 47CALCIFOL................................ 79calcipotriene..............................62CALCIPOTRIENE..................... 62calcipotriene-betameth diprop...62calcitonin (salmon).................. 107CALCITRENE........................... 62calcitriol............................. 62, 107calcium acetate (phos binder)...87CALQUENCE............................30CAMBIA.................................... 11camila........................................93camrese.................................... 93camrese lo................................ 93CANASA................................. 106candesartan cilexetil ................. 47candesartan cilexetil-hctz..........47capecitabine..............................30CAPEX......................................63CAPHOSOL.............................. 60

CAPLYTA..................................38CAPRELSA...............................30captopril .................................... 47CARAC..................................... 63CARAFATE...............................82CARBAGLU.............................. 79carbamazepine......................... 18carbamazepine er..................... 18CARBATROL............................ 18carbidopa.................................. 36carbidopa-levodopa.................. 36carbidopa-levodopa er.............. 36carbidopa-levodopa-entacapone............................... 36carbinoxamine maleate...........114CARDIZEM............................... 47CARDIZEM CD......................... 47CARDIZEM LA..........................47CARDURA................................ 47CARDURA XL...........................88CARETOUCH CONTROL SOL LEVEL 2....................................71CARETOUCH LANCING/EJECTOR................ 71CARETOUCH TEST................. 71carglumic acid........................... 79carisoprodol............................ 120carisoprodol-aspirin-codeine.......8CARNITOR............................... 79CARNITOR SF..........................79CAROSPIR............................... 47carteolol hcl.............................111cartia xt..................................... 48carvedilol...................................48carvedilol phosphate er.............48CARVYKTI.................................. 8cascara sagrada....................... 84CASODEX................................ 30CATAFLAM...............................11CATAPRES-TTS-1................... 48CATAPRES-TTS-2................... 48CATAPRES-TTS-3................... 48cavarest.................................... 60CAVERJECT.............................87CAVERJECT IMPULSE............87CAYSTON...............................119caziant.......................................93cefaclor..................................... 15cefaclor er................................. 15cefadroxil ...................................15cefdinir...................................... 15cefixime.....................................15cefpodoxime proxetil ................. 15

cefprozil .....................................15cefuroxime axetil ....................... 15CELEBREX...............................11celecoxib................................... 11CELEXA....................................22CELLCEPT............................. 101CELONTIN................................18CENTANY.................................15cephalexin.................................15CEQUA................................... 112CEQUR SIMPLICITY STARTER................................. 71CERDELGA.............................. 86CETRAXAL............................. 113CETROTIDE............................. 90cevimeline hcl........................... 60charlotte 24 fe........................... 93chateal...................................... 93chateal eq................................. 93CHEMET...................................79CHEMSTRIP BG LOG BOOK...71CHENODAL.............................. 84chlordiazepoxide hcl................. 45chlordiazepoxide-amitriptyline...22chlordiazepoxide-clidinium........84chlorhexidine gluconate............ 60chloroquine phosphate..............35chlorpromazine hcl....................38chlorthalidone............................48chlorzoxazone.........................120CHOLBAM................................ 86cholestyramine..........................48cholestyramine light.................. 48CHORIONIC GONADOTROPIN.................... 90CHROMAGEN.......................... 79CIALIS.......................................87ciclodan.....................................26ciclopirox................................... 26ciclopirox olamine..................... 26cilostazol................................... 37CILOXAN................................ 109CIMDUO................................... 40cimetidine..................................82cimetidine hcl............................ 82CIMZIA....................................101CIMZIA PREFILLED KIT.........101CIMZIA STARTER KIT........... 101cinacalcet hcl.......................... 107CIPRO.......................................15CIPRO HC.............................. 113CIPRODEX............................. 113ciprofloxacin hcl........ 15, 109, 113

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ciprofloxacin-dexamethasone. 113CIPROFLOXACIN-FLUOCINOLONE PF.............. 114citalopram hydrobromide.......... 22claravis......................................63CLARINEX.............................. 114CLARINEX-D 12 HOUR..........114clarithromycin............................15clarithromycin er........................15clemastine fumarate................114CLENPIQ.................................. 84CLEOCIN.................................. 15CLEOCIN-T...............................63CLIMARA.................................. 93CLIMARA PRO......................... 93clindacin etz.............................. 63clindacin-p.................................63CLINDAGEL..............................63clindamycin hcl..........................15clindamycin palmitate hcl.......... 15clindamycin phosphate....... 15, 63clindamycin phosphate-benzoyl peroxide.......................63clindamycin-tretinoin................. 63CLINDESSE..............................15CLINOIN................................... 63CLINPRO 5000......................... 60clobazam...................................18clobetasol prop emollient base. 63clobetasol propionate................63clobetasol propionate e.............63clobetasol propionate emulsion 63CLOBEX................................... 63CLOBEX SPRAY...................... 63clocortolone pivalate................. 63clodan....................................... 63CLODERM................................ 63clomiphene citrate.....................90clomipramine hcl....................... 22clonazepam...............................45clonidine....................................48clonidine hcl.............................. 48clonidine hcl er.......................... 55clopidogrel bisulfate.................. 37clorazepate dipotassium........... 45clotrimazole...............................26clotrimazole-betamethasone.....26clozapine...................................38CLOZARIL................................ 38coal tar...................................... 63COARTEM................................ 35COBAS LIAT SARS-COV-2 ASSAY.................................... 108

codeine sulfate............................8COLAZAL................................106COLCHICINE............................27colchicine.................................. 27colchicine-probenecid............... 27COLCRYS.................................27colesevelam hcl........................ 48COLESTID................................ 48COLESTID FLAVORED............48colestipol hcl............................. 48colistimethate sodium (cba)...... 15COLY-MYCIN M....................... 15COMBIGAN............................ 111COMBIPATCH.......................... 93COMBIVENT RESPIMAT....... 117COMBIVIR................................ 40COMETRIQ...............................30COMIRNATY.......................... 104COMPLERA..............................40compro...................................... 25COMTAN.................................. 36CONCERTA..............................55CONDYLOX..............................63CONJUPRI................................48CONSENSI............................... 48constulose.................................84CONTOUR CONTROL SOLUTION................................71CONTOUR MONITOR DEVICE.....................................71CONTOUR MONITOR KIT W/DEVICE................................ 71CONTOUR NEXT CONTROL SOLUTION................................71CONTOUR NEXT EZ KIT W/DEVICE................................ 72CONTOUR NEXT LINK KIT W/DEVICE................................ 72CONTOUR NEXT MONITOR KIT W/DEVICE..........................72CONTOUR NEXT ONE KIT......72CONTOUR NEXT TEST STRIPS..................................... 72CONTOUR TEST STRIPS........72CONTRAVE.............................. 59CONZIP...................................... 8COPAXONE..............................58COPIKTRA................................30CORDRAN................................63COREG.....................................48COREG CR...............................48coremino................................... 15CORGARD................................48

CORLANOR..............................48CORTEF................................... 89CORTENEMA......................... 106cortic-nd.................................. 114CORTIFOAM.......................... 106CORTISPORIN-TC................. 114CORTROPHIN..........................90COSENTYX (300 MG DOSE).101COSENTYX 150 MG/ML........ 101COSENTYX SENSOREADY (300 MG).................................101COSENTYX SENSOREADY PEN.........................................101COSOPT.................................111COSOPT PF........................... 111COTELLIC................................ 30COTEMPLA XR-ODT............... 55COVID-19 SPECIMEN COLLECTION......................... 108COVID-19 TESTING BY PHARMACIST........................ 108COZAAR................................... 48CREON..................................... 86CRESEMBA..............................26CRESTOR................................ 48CRINONE................................. 93cromolyn sodium.......84, 109, 117crotan........................................ 35cryselle-28.................................94CUPRIMINE..............................87CUTAQUIG............................. 101CUTIVATE................................ 63CUVPOSA................................ 84cyanocobalamin........................ 79CYANOCOBALAMIN................ 79cyclafem 1/35............................94cyclafem 7/7/7...........................94cyclobenzaprine hcl................ 120cyclobenzaprine hcl er............ 120CYCLOGYL............................ 112CYCLOMYDRIL...................... 112cyclopentolate hcl................... 112CYCLOPHENE RAPIDPAQ....120cyclophosphamide.................... 30CYCLOPHOSPHAMIDE........... 30cycloserine................................ 29CYCLOSET...............................68cyclosporine............................ 101cyclosporine modified............. 101CYMBALTA...............................22cyproheptadine hcl..................114cyred......................................... 94cyred eq.................................... 94

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CYSTADANE............................ 86CYSTADROPS....................... 112CYSTAGON..............................86CYSTARAN............................ 112CYTOMEL...............................100CYTOTEC.................................82D.H.E. 45.................................. 28dalfampridine er........................ 58DALIRESP.............................. 117danazol..................................... 90DANTRIUM............................. 120dantrolene sodium.................. 120dapsone.............................. 29, 63DAPSONE................................ 63DAPTACEL............................. 104DARAPRIM............................... 35darifenacin hydrobromide er..... 87dasetta 1/35.............................. 94dasetta 7/7/7............................. 94DAURISMO...............................30DAYPRO...................................11daysee...................................... 94DAYTRANA.............................. 55DAYVIGO................................121DDAVP......................................90DDAVP PF................................ 90DEBACTEROL..........................60deblitane................................... 94DECADRON............................. 89deferasirox................................ 79deferasirox granules................. 79deferiprone................................79DELESTROGEN.......................94DELSTRIGO............................. 40delyla.........................................94DELZICOL.............................. 106demeclocycline hcl....................15DEMSER...................................48DENAVIR.................................. 40DENGVAXIA........................... 104DENTA 5000 PLUS.................. 60DENTAGEL...............................60DEPAKOTE.............................. 19DEPAKOTE ER........................ 19DEPAKOTE SPRINKLES......... 19DEPEN TITRATABS.................87DEPO-ESTRADIOL.................. 94DEPO-PROVERA..................... 94DEPO-SUBQ PROVERA 104...94DEPO-TESTOSTERONE......... 90DERMA-SMOOTHE/FS BODY.63DERMA-SMOOTHE/FS SCALP...................................... 63

DERMOTIC.............................114DESCOVY................................ 40desipramine hcl.........................22desloratadine.......................... 114desmopressin ace spray refrig..90desmopressin acetate...............90desmopressin acetate pf...........91desmopressin acetate spray..... 91desogestrel-ethinyl estradiol..... 94desonide................................... 63DESOWEN............................... 64desoximetasone........................64DESOXYN................................ 55desrx......................................... 64DESVENLAFAXINE ER............22desvenlafaxine succinate er......22DETROL................................... 87DETROL LA.............................. 87DEXABLISS.............................. 89dexamethasone........................ 89dexamethasone intensol........... 89dexamethasone sodium phosphate............................... 109DEXCOM G5 MOB/G4 PLAT SENSOR...................................72DEXCOM G5 MOBILE RECEIVER................................72DEXCOM G5 MOBILE TRANSMITTER........................ 72DEXCOM G5 RECEIVER KIT.. 72DEXCOM G6 RECEIVER......... 72DEXCOM G6 SENSOR............ 72DEXCOM G6 TRANSMITTER..72DEXEDRINE............................. 55DEXILANT................................ 82DEXLANSOPRAZOLE..............83dexmethylphenidate hcl............ 55dexmethylphenidate hcl er........ 56DEXPANTHENOL.....................79dextroamphetamine sulfate.......56dextroamphetamine sulfate er.. 56DIACOMIT................................ 19DIASCREEN 1B......................108DIASCREEN 1K......................108DIASTAT ACUDIAL.................. 19DIASTAT PEDIATRIC...............19DIATHRIVE BLOOD GLUCOSE METER...................72DIATHRIVE BLOOD GLUCOSE TEST...................... 72DIATHRIVE GLUCOSE CONTROL SOLN......................72DIATHRIVE GLUCOSE TEST.. 72

DIATHRIVE LANCING DEVICE.....................................72DIATHRIVE+ GLUCOSE MONITOR................................. 72DIATHRIVE+ GLUCOSE TEST.........................................72diazepam............................ 19, 45diazepam intensol..................... 45diazoxide...................................76DIBENZYLINE.......................... 48DICLEGIS................................. 25DICLOFENAC CAP 35MG........11DICLOFENAC PATCH 1.3%.... 11diclofenac potassium................ 11diclofenac sodium....... 11, 64, 109diclofenac sodium er................. 11diclofenac-misoprostol.............. 11dicloxacillin sodium................... 15DICOPANOL FUSEPAQ.........114DICOPANOL RAPIDPAQ....... 114dicyclomine hcl..........................84diethylpropion hcl...................... 59diethylpropion hcl er..................59DIFFERIN................................. 64DIFICID..................................... 15diflorasone diacetate.................64DIFLUCAN................................ 26diflunisal.................................... 11difluprednate........................... 109digitek........................................48digox......................................... 48digoxin.......................................48dihydroergotamine mesylate.....28DILANTIN..................................19DILANTIN INFATABS............... 19DILAUDID................................... 8diltiazem hcl.............................. 48diltiazem hcl er.......................... 48diltiazem hcl er beads............... 48diltiazem hcl er coated beads... 48dilt-xr......................................... 48DILUENT FOR LEFAMULIN.....79dimenhydrinate......................... 25dimethyl fumarate..................... 58dimethyl fumarate starter pack..58DIOVAN.................................... 48DIOVAN HCT............................48DIPENTUM............................. 106diphenhydramine hcl...............114diphenoxylate-atropine..............84DIPHTHERIA-TETANUS TOXOIDS DT.......................... 104DIPROLENE............................. 64

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dipyridamole..............................37disopyramide phosphate...........48disulfiram...................................14DITROPAN XL.......................... 87DIURIL...................................... 48divalproex sodium..................... 19divalproex sodium er.................19DIVIGEL....................................94dofetilide....................................49DOJOLVI.................................108dolishale....................................94donepezil hcl............................. 21DOPTELET............................... 46DORAL......................................45DORYX..................................... 15DORYX MPC............................ 15dorzolamide hcl.......................111dorzolamide hcl-timolol mal.... 111dorzolamide hcl-timolol mal pf 111dotti ........................................... 94DOUBLE PM...........................112DOVATO...................................40DOVONEX................................ 64doxazosin mesylate.................. 49doxepin hcl..................22, 64, 121doxercalciferol.........................107doxycycline............................... 64doxycycline hyclate................... 15DOXYCYCLINE HYCLATE.......15doxycycline monohydrate......... 16doxylamine-pyridoxine.............. 25DRISDOL.................................. 79DRIZALMA SPRINKLE............. 22dronabinol................................. 25DROPLET GENTEEL LANCING DEVICE....................72DROPLET MICRON................. 76drospiren-eth estrad-levomefol. 94drospirenone-ethinyl estradiol...94DROXIA.................................... 30droxidopa.................................. 49DRYSOL................................... 64DUAKLIR PRESSAIR............. 117DUAL COMPLEX FORMULA 1 KIT............................................ 11DUAVEE................................... 94DUETACT................................. 68DUEXIS.....................................11DULERA................................. 117duloxetine hcl............................ 22DUOBRII................................... 64DUPIXENT................................64DUREZOL...............................109

DURLAZA................................. 37dutasteride................................ 89dutasteride-tamsulosin hcl........ 89DUTOPROL.............................. 49DXEVO 11-DAY........................89DYANAVEL XR.........................56DYMISTA................................ 114DYRENIUM...............................49E.E.S. 400.................................16E.E.S. GRANULES................... 16EASY TALK PLUS II CONTROL................................ 72EASY TALK PLUS II TEST STRIPS..................................... 72EASY TOUCH HEALTHPRO GLUCOSE................................ 72EASY TRAK II BLOOD GLUCOSE SYS........................ 72EASY TRAK II CONTROL........ 72EASY TRAK II GLUCOSE TEST.........................................72easygel......................................60EASYMAX 15 LEVEL 2-3 CONTROL................................ 72EASYMAX CONTROL.............. 72EC-NAPROSYN........................11ec-naproxen.............................. 11econazole nitrate.......................26ECOZA......................................26EC-RX DHEA..........................108EC-RX ESTRADIOL................. 94EC-RX PROGESTERONE....... 94EC-RX TESTOSTERONE........ 90EDARBI.....................................49EDARBYCLOR......................... 49EDECRIN..................................49EDETATE DISODIUM.............. 79EDEX........................................ 87EDLUAR................................. 121ED-SPAZ.................................. 84EDURANT.................................40efavirenz................................... 40efavirenz-emtricitab-tenofovir....40efavirenz-lamivudine-tenofovir.. 40EFFER-K...................................79effer-k........................................79EFFEXOR XR........................... 22EFFIENT................................... 37EFUDEX................................... 64EGATEN................................... 35EGRIFTA SV.............................91ELEPSIA XR............................. 19ELESTRIN................................ 94

eletriptan hydrobromide............ 28ELIDEL......................................64ELIGARD.................................. 91elinest........................................94ELIQUIS....................................18ELIQUIS DVT/PE STARTER PACK........................................ 18ELITE-OB..................................79ELIXOPHYLLIN...................... 117ELLA......................................... 94ELMIRON..................................87eluryng...................................... 94EMBRACE EVO GLUCOSE MONITOR................................. 72EMBRACE LANCING DEVICE/EJECTOR...................72EMBRACE PRESSURE ACTIVATED 21G...................... 72EMBRACE PRESSURE ACTIVATED 28G...................... 73EMBRACE TALK BLOOD GLUCOSE................................ 73EMBRACE TALK GLUCOSE CONTROL................................ 73EMBRACE TALK GLUCOSE TEST.........................................73EMBRACE TALK MONITORING SYSTEM...........73EMCYT..................................... 30EMEND..................................... 25EMEND TRI-PACK................... 25EMFLAZA................................. 28EMGALITY................................28emoquette................................. 94EMSAM.....................................22emtricitabine..............................40emtricitabine-tenofovir df...........40EMTRIVA.................................. 40EMVERM.................................. 35enalapril maleate.......................49enalapril-hydrochlorothiazide.... 49ENBREL..................................101ENBREL MINI......................... 101ENBREL SURECLICK............ 101ENDARI.................................. 108endocet....................................... 8ENDOMETRIN..........................94ENGERIX-B............................ 104ENHERTU.................................30ENOVARX-BACLOFEN..........120ENOVARX-CYCLOBENZAPRINE HCL.... 120

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ENOVARX-DICLOFENAC SODIUM....................................11ENOVARX-IBUPROFEN.......... 11ENOVARX-LIDOCAINE HCL....13ENOVARX-NAPROXEN........... 11ENOVARX-TRAMADOL........... 64enoxaparin sodium....................18enpresse-28.............................. 94enskyce.....................................94ENSPRYNG............................101ENSTILAR................................ 64entacapone............................... 36entecavir................................... 40ENTEREG.................................84ENTRESTO.............................. 49enulose..................................... 84ENVARSUS XR...................... 101EPANED................................... 49EPCLUSA................................. 41EPIDIOLEX............................... 19EPIDUO.................................... 64EPIDUO FORTE....................... 64EPIFOAM..................................64epinastine hcl.......................... 110epinephrine............................. 117EPIPEN 2-PAK....................... 117EPIPEN JR 2-PAK.................. 117epitol......................................... 19EPIVIR...................................... 41EPIVIR HBV..............................41eplerenone................................ 49EPZICOM..................................41EQUETRO................................ 45ergocalciferol.............................79ergoloid mesylates.................. 108ERGOMAR............................... 28ergotamine-caffeine.................. 28ERIVEDGE............................... 31ERLEADA................................. 31erlotinib hcl................................31errin...........................................94ERTACZO.................................26ery............................................. 64ERYGEL................................... 64ERYPED 200............................ 16ERYPED 400............................ 16ERY-TAB.................................. 16ERYTHROCIN STEARATE...... 16erythromycin............... 16, 64, 110erythromycin base.....................16erythromycin ethylsuccinate......16ESBRIET.................................117escitalopram oxalate................. 22

ESGIC.........................................9esomeprazole magnesium........83ESOMEPRAZOLE STRONTIUM.............................83estarylla.....................................94estazolam..................................45ESTRACE................................. 94estradiol.............................. 94, 95estradiol valerate.......................95estradiol-norethindrone acet..... 95ESTRING.................................. 95ESTROGEL.............................. 95ESTROSTEP FE.......................95eszopiclone............................. 121ethacrynic acid.......................... 49ethambutol hcl...........................29ethosuximide.............................19ethyl chloride.............................13ethynodiol diac-eth estradiol..... 95etodolac.................................... 11etodolac er................................ 11etonogestrel-ethinyl estradiol.... 95etoposide.................................. 31etravirine................................... 41EUCRISA.................................. 64EULEXIN...................................31euthyrox.................................. 100EVAMIST.................................. 95EVEKEO................................... 56EVEKEO ODT...........................56everolimus.........................31, 101EVISTA..................................... 92EVOCLIN.................................. 64EVOTAZ....................................41EVOXAC................................... 60EVRYSDI.................................. 86EXELDERM.............................. 26EXELON................................... 21exemestane.............................. 31EXFORGE................................ 49EXFORGE HCT........................ 49EXJADE.................................... 79EXKIVITY..................................31EXSERVAN.............................. 59EXTAVIA...................................58EXTINA..................................... 26EYSUVIS................................ 110EZALLOR SPRINKLE...............49ezetimibe...................................49EZETIMIBE-ROSUVASTATIN..49ezetimibe-simvastatin............... 49FABIOR.....................................64falmina...................................... 95

famciclovir................................. 41famotidine................................. 83FANAPT....................................38FANAPT TITRATION PACK..... 38FANATREX FUSEPAQ.............19FARESTON.............................. 31FARXIGA.................................. 68FARYDAK................................. 31FASENRA............................... 114FASENRA PEN.......................114fayosim......................................95FBL KIT.....................................11febuxostat................................. 27felbamate.................................. 19FELBATOL................................19FELDENE................................. 11felodipine er.............................. 49FEMARA................................... 31FEMHRT................................... 95FEMRING................................. 95femynor..................................... 95fenofibrate................................. 49fenofibrate micronized...............49FENOFIBRATE MICRONIZED. 49fenofibric acid............................49FENOGLIDE............................. 49fenoprofen calcium....................11fenortho.....................................11fentanyl....................................... 9fentanyl citrate.............................9FENTANYL CITRATE.................9FENTORA...................................9ferotrinsic.................................. 79FERRALET 90.......................... 79FERRAPLUS 90....................... 79FERRIPROX............................. 79FERRIPROX TWICE-A-DAY.... 79FERRO-PLEX........................... 79FETZIMA...................................22FETZIMA TITRATION...............22FEXMID.................................. 120FIASP........................................76FIASP FLEXTOUCH.................76FIASP PENFILL........................ 76FIBRICOR.................................49FINACEA............................ 64, 65finasteride................................. 89FINTEPLA.................................19FIORICET................................... 9FIORICET/CODEINE..................9FIRAZYR.................................101FIRDAPSE.............................. 108FIRMAGON...............................91

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FIRMAGON (240 MG DOSE)... 91FIRST-METRONIDAZOLE....... 16FIRVANQ.................................. 16flac.......................................... 114FLAGYL.................................... 16FLAREX.................................. 110flavoxate hcl.............................. 87flecainide acetate...................... 49FLECTOR................................. 11FLOLIPID.................................. 49FLOMAX................................... 89FLOVENT DISKUS................. 117FLOVENT HFA....................... 117FLUAD QUADRIVALENT....... 104FLUARIX QUADRIVALENT....104FLUBLOK QUADRIVALENT...104FLUCELVAX QUADRIVALENT.................... 104fluconazole................................26flucytosine................................. 26fludrocortisone acetate..............89FLULAVAL QUADRIVALENT. 105FLUMIST QUADRIVALENT....105flunisolide................................ 114fluocinolone acetonide...... 65, 114fluocinolone acetonide body..... 65fluocinolone acetonide scalp.....65fluocinonide...............................65fluocinonide emulsified base.....65FLUORIDEX............................. 60fluoridex daily renewal.............. 60FLUORIDEX ENHANCED WHITENING............................. 60FLUORIDEX SENSITIVITY RELIEF..................................... 60FLUORIMAX 5000.................... 60FLUORIMAX 5000 SENSITIVE 60fluoritab..................................... 79fluorometholone...................... 110FLUOROPLEX..........................65FLUOROURACIL......................65fluorouracil ................................ 65fluoxetine hcl....................... 22, 23fluoxetine hcl (pmdd).................22fluphenazine hcl........................ 38flurandrenolide.......................... 65flurazepam hcl.........................121flurbiprofen................................ 11flurbiprofen sodium................. 110flutamide................................... 31fluticasone propionate...............65fluticasone-salmeterol............. 117

FLUTICASONE-SALMETEROL........................117fluvastatin sodium..................... 49fluvastatin sodium er................. 49fluvoxamine maleate................. 23fluvoxamine maleate er.............23FLUZONE HIGH-DOSE QUADRIVALENT.................... 105FLUZONE QUADRIVALENT.. 105FML.........................................110FML FORTE............................110FML LIQUIFILM...................... 110FOCALIN.................................. 56FOCALIN XR............................ 56folic acid.................................... 79FOLLISTIM AQ......................... 91foltrin......................................... 79fondaparinux sodium.................18FORA 6 CONNECT.................. 73FORA GTEL BLOOD GLUCOSE SYSTEM.................73FORA GTEL BLOOD GLUCOSE TEST...................... 73FORA TN'G ADVANCE PRO....73FORFIVO XL.............................23formoterol fumarate.................117FORTEO................................. 107FORTESTA...............................90FORTISCARE CONTROL........ 73FORTISCARE G1 TEST STRIP....................................... 73FORTISCARE T1 GLUCOSE SYSTEM................................... 73FOSAMAX.............................. 107FOSAMAX PLUS D................ 107fosamprenavir calcium.............. 41fosfomycin tromethamine..........16fosinopril sodium....................... 49fosinopril sodium-hctz............... 49FOSRENOL.............................. 87FOTIVDA.................................. 31FRAGMIN................................. 18FREESTYLE FREEDOM LITE. 73FREESTYLE INSULINX TEST. 73FREESTYLE LIBRE 14 DAY READER................................... 73FREESTYLE LIBRE 14 DAY SENSOR...................................73FREESTYLE LIBRE 2 READER................................... 73FREESTYLE LIBRE 2 SENSOR...................................73FREESTYLE LIBRE READER..73

FREESTYLE LITE TEST.......... 73FREESTYLE PRECISION NEO TEST................................ 73FREESTYLE TEST...................73FROVA......................................28frovatriptan succinate................28furosemide................................ 50FUZEON................................... 41fyavolv.......................................95FYCOMPA................................ 19fyremadel.................................. 91gabapentin................................ 19GABITRIL..................................19GALAFOLD...............................86galantamine hydrobromide....... 21galantamine hydrobromide er... 21GALZIN..................................... 79ganirelix acetate........................91GARDASIL 9...........................105GASTROCROM........................84gatifloxacin.............................. 110GATTEX....................................84gavilyte-c...................................84gavilyte-g...................................84gavilyte-n with flavor pack.........84GAVRETO................................ 31GEBAUERS PAIN EASE.......... 13GEBAUERS SPRAY AND STRETCH................................. 13GELNIQUE............................... 87gemfibrozil .................................50gemmily.....................................95GEMTESA................................ 87GENERESS FE........................ 95generlac.................................... 84gengraf....................................101GENOTROPIN..........................91GENOTROPIN MINIQUICK......91gentak..................................... 110gentamicin sulfate............. 16, 110GENTEEL LANCING KIT (BLUE)...................................... 73GENVOYA................................ 41GEODON.................................. 38GHT BLOOD GLUCOSE MONITOR................................. 73GIALAX..................................... 84GILENYA.................................. 58GILOTRIF................................. 31GILPHEX TR...........................114GIMOTI..................................... 25glatiramer acetate..................... 58glatopa...................................... 58

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GLEEVEC................................. 31GLEOSTINE............................. 31glimepiride.................................69glipizide er.................................69glipizide ir.................................. 69glipizide xl................................. 69glipizide-metformin hcl.............. 69GLOPERBA.............................. 27GLUCAGEN HYPOKIT............. 76glucagon emergency kit ............ 76GLUCAGON EMERGENCY KIT............................................ 76GLUCOCARD 01 SENSOR PLUS.........................................73GLUCOCARD EXPRESSION TEST.........................................73GLUCOCARD SHINE CONNEX...................................73GLUCOCARD SHINE EXPRESS................................. 73GLUCOCARD SHINE TEST.....73GLUCOCARD VITAL TEST......73GLUCOSE CONTROL SOLUTIONS............................. 72GLUCOTROL XL...................... 69GLUMETZA.............................. 69GLUTATHIONE.................. 79, 80glyburide................................... 69glyburide micronized................. 69glyburide-metformin.................. 69GLYCATE................................. 84GLYCINE.................................. 80glycopyrrolate............................84GLYCOPYRROLATE................84glydo......................................... 13GLYNASE................................. 69GLYXAMBI................................69GOCOVRI................................. 36GOJJI BLOOD GLUCOSE TEST.........................................74GOJJI CONTROL..................... 74GOJJI LANCING DEVICE/CLEAR CAP............... 74GOLYTELY............................... 84GONAL-F.................................. 91GONAL-F RFF.......................... 91GONAL-F RFF REDIJECT....... 91GONITRO................................. 50GORDOFILM............................ 65GRALISE.................................. 59granisetron hcl.......................... 25GRASTEK...............................108griseofulvin microsize................26

griseofulvin ultramicrosize.........26guaiatussin ac......................... 114guaifenesin ac.........................114guaifenesin-dm....................... 114guanfacine hcl...........................50guanfacine hcl er.......................56GVOKE HYPOPEN 1-PACK.....76GVOKE HYPOPEN 2-PACK.....76GVOKE KIT...............................76GVOKE PFS............................. 76GYNAZOLE-1........................... 26hailey 1.5/30..............................95hailey 24 fe................................95hailey fe 1.5/30..........................95hailey fe 1/20.............................95halcinonide................................65HALCION.................................. 45HALDOL DECANOATE............ 38halobetasol propionate..............65HALOBETASOL PROPIONATE.......................... 65HALOG..................................... 65haloperidol................................ 38haloperidol decanoate...............38haloperidol lactate.....................38HARVONI..................................41HAVRIX...................................105heather......................................95HELIDAC THERAPY................ 84HEMADY...................................89HEMANGEOL........................... 50HEMATRON-AF........................80heparin (porcine) in nacl........... 18heparin sodium (porcine).......... 18heparin sodium (porcine) pf...... 18HEPLISAV-B...........................105HEPSERA.................................41HETLIOZ.................................121HETLIOZ LQ........................... 121HEXATRIONE...........................89HEXTEND.................................46HIBERIX..................................105HIDEX 6-DAY........................... 89homatropaire...........................112HORIZANT................................59HUMALOG................................77HUMALOG KWIKPEN.............. 77HUMALOG MIX 50/50 KWIKPEN................................. 77HUMALOG MIX 50/50 VIAL......77HUMALOG MIX 75/25 KWIKPEN................................. 77HUMALOG MIX 75/25 VIAL......77

HUMALOG U-100 JUNIOR KWIKPEN................................. 77HUMATIN..................................16HUMATROPE........................... 91HUMIRA..................................101HUMIRA PEDIATRIC CROHNS START....................101HUMIRA PEN......................... 102HUMIRA PEN-CD/UC/HS STARTER............................... 102HUMIRA PEN-PEDIATRIC UC START.................................... 102HUMIRA PEN-PS/UV/ADOL HS START.............................. 102HUMIRA PEN-PSOR/UVEIT STARTER............................... 102HUMULIN 70/30 KWIKPEN...... 77HUMULIN 70/30 VIAL...............77HUMULIN N KWIKPEN............ 77HUMULIN N VIAL..................... 77HUMULIN R U-500 KWIKPEN..77HUMULIN R U-500 VIAL.......... 77HUMULIN R VIAL..................... 77HW EMBRACE PRO GLUCOSE METER...................74HW EMBRACE PRO GLUCOSE TEST...................... 74HW EMBRACE TALK BLOOD GLUCOSE................................ 74HW EMBRACE TALK GLUCOSE TEST...................... 74HYCAMTIN............................... 31HYCODAN.............................. 114hydralazine hcl.......................... 50HYDREA................................... 31hydrochlorothiazide...................50hydrocodone bitartrate er............9hydrocodone polst-chlorphen polst er susp............................114hydrocodone-acetaminophen..... 9hydrocodone-homatropine...... 114hydrocodone-ibuprofen............... 9hydrocortisone............ 65, 89, 106hydrocortisone (perianal)........ 106hydrocortisone ace-pramoxine106hydrocortisone butyr lipo base.. 65hydrocortisone butyrate............ 65hydrocortisone valerate.............65hydrocortisone-acetic acid...... 114hydromet................................. 115hydromorphone hcl..................... 9hydromorphone hcl er................. 9hydroxocobalamin acetate........ 80

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hydroxychloroquine sulfate....... 35hydroxyurea.............................. 31hydroxyzine hcl......................... 45hydroxyzine pamoate................45hyoscyamine sulfate................. 84hyoscyamine sulfate sl..............84hyosyne.....................................84HYPERSAL.............................115HYSINGLA ER............................9HYZAAR................................... 50ibandronate sodium................ 107IBRANCE.................................. 31IBSRELA.....................................8ibuprofen................................... 11ibuprofen-famotidine................. 11icatibant acetate......................102iclevia........................................ 95ICLUSIG....................................31icosapent ethyl.......................... 50ID NOW COVID-19................. 108IDHIFA...................................... 31ILEVRO...................................110ILUMYA...................................102imatinib mesylate...................... 31IMBRUVICA.............................. 31IMCIVREE.................................59imipramine hcl...........................23imipramine pamoate................. 23imiquimod..................................65imiquimod pump........................65IMITREX................................... 28IMITREX STATDOSE REFILL..28IMITREX STATDOSE SYSTEM................................... 28IMPAVIDO................................ 35IMPEKLO.................................. 65IMPOYZ.................................... 65IMURAN..................................102IMVEXXY MAINTENANCE PACK........................................ 95IMVEXXY STARTER PACK..... 95INBRIJA.................................... 36incassia..................................... 95INCRELEX................................ 91INCRUSE ELLIPTA................ 117indapamide............................... 50INDERAL LA............................. 50INDERAL XL............................. 50INDOCIN...................................11INDOMETHACIN...................... 12indomethacin.............................12indomethacin er........................ 12INFANRIX............................... 105

INFINITY BLOOD GLUCOSE TEST.........................................74INGREZZA................................59INLYTA..................................... 31INNOPRAN XL..........................50INQOVI..................................... 31INREBIC................................... 31INSPIREASE RESERVOIR BAGS...................................... 108INSPRA.....................................50INSULIN ASP PROT & ASP FLEXPEN..................................77INSULIN ASPART.................... 77INSULIN ASPART FLEXPEN... 77INSULIN ASPART PENFILL.....77INSULIN ASPART PROT & ASPART....................................77INSULIN GLARGINE-YFGN..... 77INSULIN LISPRO......................77INSULIN LISPRO (1 UNIT DIAL).........................................77INSULIN LISPRO JUNIOR KWIKPEN................................. 77INSULIN LISPRO PROT & LISPRO.....................................77INSULIN PEN NEEDLES..........77INSULIN SYRINGES................ 77INTELENCE..............................41INTRAROSA............................. 87INTRON A.................................41introvale.................................... 95INTUNIV....................................56INVEGA.................................... 38INVEGA SUSTENNA................38INVEGA TRINZA...................... 38INVELTYS...............................110INVOKAMET.............................69INVOKAMET XR.......................69INVOKANA............................... 69iodine strong............................. 80IOPIDINE................................ 111IPOL........................................105ipratropium bromide........ 115, 117ipratropium-albuterol............... 117irbesartan.................................. 50irbesartan-hydrochlorothiazide..50IRESSA.....................................31irinotecan hcl.............................31ISENTRESS..............................41ISENTRESS HD....................... 41isibloom.....................................95isoniazid.................................... 29ISOPTO ATROPINE............... 113

ISOPTO CARPINE................. 111ISORDIL TITRADOSE.............. 50isosorbide dinitrate....................50isosorbide mononitrate..............50isosorbide mononitrate er......... 50isotretinoin.................................65isradipine...................................50ISTALOL................................. 111ISTURISA................................. 91itraconazole...............................26ivermectin............................35, 66JADENU....................................80JADENU SPRINKLE.................80jaimiess..................................... 95JAKAFI................................31, 32JALYN.......................................89JANSSEN COVID-19 VACCINE................................ 105jantoven.................................... 18JANUMET................................. 69JANUMET XR........................... 69JANUVIA...................................69JARDIANCE..............................69jasmiel.......................................95JATENZO..................................90jencycla..................................... 95JENTADUETO.......................... 69JENTADUETO XR.................... 69jinteli ..........................................95jolessa.......................................95JORNAY PM............................. 56J-TIP KIT W/VIAL ADAPTERS108JUBLIA......................................26juleber....................................... 95JULUCA.................................... 41junel 1.5/30............................... 96junel 1/20.................................. 96junel fe 1.5/30........................... 96junel fe 1/20.............................. 96junel fe 24................................. 96JUST RIGHT 5000....................60JUXTAPID.................................50JYNARQUE.............................. 80K.B.G.L IN TERODERM........... 12kaitlib fe.....................................96KALETRA..................................41kalliga........................................96KALYDECO............................ 119KAPSPARGO SPRINKLE.........50KAPVAY....................................56KARBINAL ER........................ 115kariva........................................ 96KATE FARMS PEPTIDE 1.5...108

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KATE FARMS STANDARD 1.4................................................ 108KATERZIA................................ 50KAZANO................................... 69kelnor 1/35................................ 96kelnor 1/50................................ 96KENALOG.................................66KEPPRA................................... 19KEPPRA XR............................. 19KERENDIA..............................108KERYDIN.................................. 26KESIMPTA................................58ketoconazole.............................26ketodan..................................... 26KETOPHENE RAPIDPAQ........ 12ketoprofen................................. 12ketoprofen er.............................12KETOROLAC TROMETHAMINE.....................12ketorolac tromethamine.... 12, 110KEVEYIS.................................111KEVZARA............................... 102KINERET................................ 102KINRIX.................................... 105KISQALI.................................... 32KISQALI FEMARA.................... 32KITABIS PAK.......................... 119KLARON................................... 66KLISYRI.................................... 66KLONOPIN............................... 45klor-con..................................... 80klor-con 10................................ 80klor-con m10............................. 80klor-con m15............................. 80klor-con m20............................. 80KLOXXADO.............................. 14KOMBIGLYZE XR.....................69KORLYM...................................92KORSUVA.................................. 8KOSELUGO..............................32K-PHOS.................................... 80k-prime...................................... 80KRINTAFEL.............................. 35KRISTALOSE........................... 84KROGER HEALTHPRO GLUCOSE TEST...................... 74K-TAB....................................... 80k-tan plus.................................. 80kurvelo...................................... 96KUVAN......................................86KYNMOBI................................. 36KYNMOBI TITRATION KIT.......36labetalol hcl............................... 50

LACRISERT............................113lactulose....................................84lactulose encephalopathy......... 84LAMICTAL................................ 19LAMICTAL ODT........................19LAMICTAL STARTER...............19LAMICTAL XR.......................... 19lamivudine.................................41lamivudine-zidovudine.............. 41lamotrigine................................ 19lamotrigine er............................ 19lamotrigine starter kit-blue.........19lamotrigine starter kit-green...... 19lamotrigine starter kit-orange.... 19LAMPIT..................................... 35LANCETS................................. 74LANOXIN.................................. 50LANREOTIDE ACETATE......... 91lansoprazole..............................83lanthanum carbonate................ 87LANTUS SOLOSTAR............... 77LANTUS U-100 VIAL................ 77lapatinib ditosylate.................... 32larin 1.5/30................................ 96larin 1/20................................... 96larin 24 fe.................................. 96larin fe 1.5/30............................ 96larin fe 1/20............................... 96larissia.......................................96LASIX........................................50latanoprost.............................. 111LATUDA....................................38layolis fe.................................... 96LAZANDA................................... 9leena......................................... 96leflunomide..............................102lenalidomide..............................32LENVIMA.................................. 32LESCOL XL.............................. 50lessina.......................................96LETAIRIS................................ 119letrozole.................................... 32LETS......................................... 13leucovorin calcium.................... 32LEUKERAN...............................32leuprolide acetate......................91LEUPROLIDE ACETATE-BUPIVACAINE..........................91levalbuterol hcl................ 117, 118LEVALBUTEROL HFA............118LEVEMIR U-100 FLEXTOUCH.77LEVEMIR U-100 VIAL...............77levetiracetam.............................20

levetiracetam er........................ 19levobunolol hcl........................ 111levocarnitine..............................80levocarnitine sf.......................... 80levofloxacin....................... 16, 110levonest.....................................96levonorgest-eth est & eth est.... 96levonorgest-eth estrad 91-day.. 96levonorgestrel-ethinyl estrad.....96levonorg-eth estrad triphasic.....96levora 0.15/30 (28)....................96levorphanol tartrate..................... 9levo-t....................................... 100LEVOTHYROXINE SODIUM.. 100levothyroxine sodium.............. 100levoxyl..................................... 100LEXAPRO................................. 23LEXETTE.................................. 66LEXIVA..................................... 41LIALDA....................................106LIBRAX..................................... 85LICART..................................... 12lidocaine....................................13lidocaine hcl.............................. 13lidocaine hcl urethral/mucosal...13lidocaine viscous hcl................. 60LIDOCAINE-EPINEPHRINE (3 ML)............................................13lidocaine-prilocaine................... 13LIDOCAINE-TETRACAINE.......13LIDODERM............................... 13lillow.......................................... 96lindane...................................... 35linezolid..................................... 16LINZESS................................... 85liothyronine sodium................. 100LIPITOR.................................... 50LIPO..........................................80LIPO-C...................................... 80LIPOFEN...................................50lisinopril ..................................... 50lisinopril-hydrochlorothiazide.....50lithium carbonate.......................45lithium carbonate er.................. 45LITHOBID................................. 45LITHOSTAT.............................. 87LIVALO..................................... 50LO LOESTRIN FE.....................96LOCOID.................................... 66LOCOID LIPOCREAM.............. 66LODINE.....................................12LODOSYN................................ 36LOESTRIN 1.5/30 (21)..............96

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LOESTRIN 1/20 (21).................96LOESTRIN FE 1.5/30............... 96LOESTRIN FE 1/20.................. 96LOFENA....................................12lojaimiess.................................. 96LOKELMA................................. 80LOMAIRA..................................59LOMOTIL.................................. 85LONHALA MAGNAIR REFILL KIT.......................................... 118LONHALA MAGNAIR STARTER KIT.........................118LONSURF.................................32LOPID....................................... 50lopinavir-ritonavir.................41, 42LOPRESSOR............................50LOPROX................................... 26lorazepam................................. 45lorazepam intensol....................45LORBRENA.............................. 32LORTAB......................................9loryna........................................ 96LORZONE...............................120losartan potassium....................50losartan potassium-hctz............ 50LOSEASONIQUE..................... 96LOTEMAX...............................110LOTEMAX SM........................ 110LOTENSIN................................ 50LOTENSIN HCT........................51loteprednol etabonate............. 110LOTREL.................................... 51LOTRONEX.............................. 85lovastatin...................................51LOVAZA....................................51LOVENOX.................................18low-ogestrel...............................96loxapine succinate.................... 38lo-zumandimine.........................96LUBIPROSTONE......................85LUCEMYRA.............................. 14LULICONAZOLE.......................26LUMAKRAS.............................. 32LUMIGAN................................111LUNESTA............................... 121LUPKYNIS.............................. 102LUPRON DEPOT (1-MONTH)..91LUPRON DEPOT (3-MONTH)..91LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG..91LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG..91

LUPRON DEPOT-PED (1-MONTH)....................................91LUPRON DEPOT-PED (3-MONTH)....................................91lutera......................................... 96LUXIQ....................................... 66LUZU.........................................26lyleq...........................................97lyllana........................................97LYNPARZA............................... 32LYRICA..................................... 59LYRICA CR...............................59LYSINE HCL............................. 80LYSODREN.............................. 32LYSTEDA..................................46LYUMJEV KWIKPEN................77LYUMJEV VIAL.........................77lyza............................................97MACROBID...............................16MACRODANTIN....................... 16mafenide acetate...................... 16MAGNESIUM SULFATE...........80MALARONE..............................35malathion.................................. 35maraviroc.................................. 42MARINOL..................................25marlissa.....................................97MARPLAN.................................23MATULANE.............................. 32matzim la...................................51MAVENCLAD............................58MAVYRET.................................42MAXALT....................................28MAXALT-MLT........................... 28MAXIDEX................................110MAXITROL..............................113maxi-tuss ac............................115MAXZIDE.................................. 51MAXZIDE-25.............................51MAYZENT.................................58MAYZENT STARTER PACK.... 58meclofenamate sodium.............12MEDROL...................................89medroxyprogesterone acetate.. 97mefenamic acid.........................12mefloquine hcl...........................35megestrol acetate..................... 97MEKINIST................................. 32MEKTOVI..................................32meloxicam.................................12melphalan................................. 32memantine hcl...........................21memantine hcl er...................... 21

MEMBRANEBLUE..................113MENACTRA............................105MENEST................................... 97MENOPUR................................91MENOSTAR..............................97MENQUADFI.......................... 105MENTAX................................... 26MENVEO................................ 105meperidine hcl.............................9MEPHYTON..............................80meprobamate............................45MEPRON.................................. 35mercaptopurine......................... 32merzee...................................... 97mesalamine.............................106mesalamine er oral capsule 0.375 gm................................. 106mesalamine-cleanser..............106MESNEX...................................32MESTINON............................... 29metaxalone............................. 120metformin hcl er........................ 69metformin hcl er (mod)..............69metformin hcl er (osm).............. 69metformin hcl ir ......................... 69methadone hcl............................ 9methadone hcl intensol............... 9methadose.................................. 9methadose sugar-free.................9methamphetamine hcl...............56methazolamide........................112methenamine hippurate............ 16methergine.............................. 108methimazole............................100METHITEST..............................90methocarbamol....................... 120methotrexate........................... 102methotrexate sodium.............. 102methotrexate sodium (pf)........ 102methoxsalen rapid.....................66methscopolamine bromide........85METHYLCOBALAMIN.............. 80methyldopa............................... 51methylergonovine maleate......108METHYLIN................................56methylphenidate hcl.................. 57methylphenidate hcl er........56, 57methylphenidate hcl er (cd).......56methylphenidate hcl er (la)........56methylphenidate hcl er (xr)....... 56methylprednisolone...................89methyltestosterone....................90metoclopramide hcl...................25

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metolazone............................... 51metoprolol succinate er.............51metoprolol tartrate.....................51metoprolol-hydrochlorothiazide.51METROCREAM........................ 66METROGEL..............................66METROLOTION........................66metronidazole..................... 16, 66METRONIDAZOLE BENZO+SYRSPEND................16metronidazole in nacl................ 16metyrosine................................ 51mexiletine hcl............................ 51MICARDIS................................ 51MICARDIS HCT........................ 51miconazole 3.............................26MICONAZOLE-ZINC OXIDE-PETROLAT............................... 26MICRODOT TEST.................... 74microgestin 1.5/30.....................97microgestin 1/20........................97microgestin 24 fe.......................97microgestin fe 1.5/30.................97microgestin fe 1/20....................97MICROLET NEXT LANCING DEVICE.....................................74midodrine hcl.............................51MIGERGOT.............................. 28miglitol.......................................70miglustat....................................86MIGRANAL............................... 28mili .............................................97MILLIPRED............................... 89mimvey......................................97MINASTRIN 24 FE....................97mineral oil heavy....................... 85MINIPRESS.............................. 51MINIVELLE............................... 97minocycline hcl..........................16MINOCYCLINE HCL ER...........16minocycline hcl er..................... 16MINOLIRA.................................16minoxidil .................................... 51MIRAPEX ER............................36MIRCETTE................................97mirtazapine............................... 23MIRVASO................................. 66misoprostol................................83MITIGARE.................................27MITOSOL................................110M-M-R II.................................. 105MOBIC...................................... 12modafinil ..................................121

MODERNA COVID-19 VAC (BOOSTER)............................ 105MODERNA COVID-19 VACCINE................................ 105moexipril hcl.............................. 51molindone hcl............................38MOLNUPIRAVIR.......................42mometasone furoate......... 66, 115mondoxyne nl............................16mono-linyah.............................. 97montelukast sodium................ 118MONUROL................................16morphine sulfate......................... 9morphine sulfate (concentrate)... 9morphine sulfate (pf)................... 9morphine sulfate er..................... 9morphine sulfate er beads.......... 9MOTEGRITY.............................85MOTOFEN................................ 85MOUTH KOTE.......................... 61MOUTH KOTE REMINT........... 61MOVANTIK............................... 85MOVIPREP............................... 85moxifloxacin hcl.................17, 110moxifloxacin hcl (2x day).........110MS CONTIN..............................10MULPLETA............................... 46MULTAQ................................... 51MULTIGEN............................... 80multivitamin/fluoride............ 80, 81MULTIVITAMIN/FLUORIDE80, 81multi-vitamin/fluoride................. 80multi-vitamin/fluoride/iron.......... 81MULTI-VIT-FLOR......................81MULTRYS.................................81mupirocin.................................. 17mupirocin calcium..................... 17MUSE........................................87MYALEPT................................. 86MYAMBUTOL........................... 29MYCAPSSA.............................. 91MYCOBUTIN............................ 29mycophenolate mofetil ............ 102mycophenolate sodium........... 102MYDAYIS..................................57MYFEMBREE........................... 97MYFORTIC............................. 102MYLERAN.................................32myorisan................................... 66MYRBETRIQ.............................87MYSOLINE............................... 20MYTESI.....................................85nabumetone.............................. 12

nadolol...................................... 51nafrinse..................................... 81NAFRINSE DAILY ACIDULATED........................... 61NAFRINSE DAILY/NEUTRAL...61nafrinse drops........................... 81NAFRINSE WEEKLY................61naftifine hcl................................27NAFTIN..................................... 27NALFON................................... 12NALOCET................................. 10naloxone hcl..............................14naltrexone hcl............................14NAMENDA................................ 21NAMENDA TITRATION PAK....21NAMENDA XR.......................... 21NAMZARIC............................... 21NAPRELAN...............................12NAPRO..................................... 12NAPROSYN..............................12naproxen................................... 12naproxen sodium...................... 12naproxen sodium er.................. 12NAPROXEN SODIUM ER........ 12naproxen-esomeprazole........... 12naratriptan hcl........................... 28NARCAN...................................14NARDIL.....................................23NASCOBAL.............................. 81NATACYN...............................110NATAZIA...................................97nateglinide.................................70NATESTO................................. 90NATPARA............................... 108NATROBA.................................35NATURE-THROID.................. 100NAYZILAM................................ 20nebivolol hcl.............................. 51NEBUPENT.............................. 35necon 0.5/35 (28)......................97nefazodone hcl..........................23neomycin sulfate....................... 17neomycin-bacitracin zn-polymyx...................................113neomycin-polymyxin-dexameth................................................ 113neomycin-polymyxin-gramicidin................................113neomycin-polymyxin-hc.. 113, 114neo-polycin..............................113neo-polycin hc.........................113NEORAL................................. 102NEO-SYNALAR........................ 66

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NEPHRON FA.......................... 81NERLYNX................................. 32NESINA.....................................70NESTABS................................. 81neuac........................................ 66NEUPRO...................................36NEURONTIN.............................20NEVANAC...............................110nevirapine................................. 42nevirapine er............................. 42NEXAVAR.................................32NEXICLON XR............................8NEXIUM.................................... 83NEXLETOL............................... 51NEXLIZET.................................51NEXTSTELLIS.......................... 97niacin (antihyperlipidemic)........ 51niacin er (antihyperlipidemic).... 51niacor........................................ 51NIASPAN.................................. 51nicardipine hcl........................... 51NICOTROL............................... 14NICOTROL NS......................... 14nifedipine...................................51nifedipine er.............................. 51nifedipine er osmotic release.... 51nikki...........................................97NILANDRON.............................32nilutamide..................................32nimodipine.................................51NINLARO.................................. 32nisoldipine er.............................51nitazoxanide..............................36nitisinone...................................86NITRO-BID................................51NITRO-DUR..............................51nitrofurantoin............................. 17nitrofurantoin macrocrystal........17nitrofurantoin monohydrate macrocrystals............................17nitroglycerin...............................52NITROLINGUAL....................... 52NITROMIST.............................. 52NITROSTAT..............................52NITYR....................................... 86nizatidine...................................83NOCDURNA............................. 91nolix...........................................66nora-be......................................97NORDITROPIN FLEXPRO....... 91norethin ace-eth estrad-fe.........97norethindrone............................97norethindrone acetate............... 97

norethindrone acet-ethinyl est...97norethindrone-eth estradiol....... 97norethin-eth estradiol-fe............ 97NORGESIC FORTE................120norgestimate-eth estradiol........ 97norgestimate-ethinyl estradiol triphasic.....................................97NORITATE................................66norlyda...................................... 97norlyroc..................................... 97NORPACE................................ 52NORPACE CR.......................... 52NORPRAMIN............................ 23NORTHERA..............................52nortrel 0.5/35 (28)..................... 98nortrel 1/35 (21)........................ 98nortrel 1/35 (28)........................ 98nortrel 7/7/7...............................98nortriptyline hcl..........................23NORVASC................................ 52NORVIR.................................... 42NOURIANZ............................... 36NOVAREL...........................91, 92NOVOFINE AUTOCOVER PEN NEEDLE........................... 77NOVOFINE PEN NEEDLE....... 77NOVOFINE PLUS PEN NEEDLE....................................78NOVOLIN 70/30 FLEXPEN...... 78NOVOLIN 70/30 FLEXPEN RELION.....................................78NOVOLIN 70/30 RELION......... 78NOVOLIN 70/30 VIAL............... 78NOVOLIN N FLEXPEN.............78NOVOLIN N FLEXPEN RELION.....................................78NOVOLIN N RELION................78NOVOLIN N VIAL..................... 78NOVOLIN R FLEXPEN.............78NOVOLIN R FLEXPEN RELION.....................................78NOVOLIN R RELION................78NOVOLIN R VIAL..................... 78NOVOLOG 70/30 FLEXPEN RELION.....................................78NOVOLOG FLEXPEN.............. 78NOVOLOG FLEXPEN RELION.....................................78NOVOLOG MIX 70/30 FLEXPEN..................................78NOVOLOG MIX 70/30 RELION.....................................78NOVOLOG MIX 70/30 VIAL......78

NOVOLOG PENFILL................ 78NOVOLOG RELION................. 78NOVOLOG U-100 VIAL............ 78NOVOTWIST PEN NEEDLE.... 78NOXAFIL...................................27np thyroid................................ 100NUBEQA...................................32NUCALA................................. 115NUCYNTA.................................10NUCYNTA ER...........................10NUEDEXTA.............................. 59NULEV...................................... 85NULYTELY LEMON-LIME........ 85NUPLAZID................................ 39NURTEC................................... 28NUTRIVIT................................. 81NUTROPIN AQ NUSPIN 10..... 92NUTROPIN AQ NUSPIN 20..... 92NUTROPIN AQ NUSPIN 5....... 92NUVARING............................... 98NUVESSA.................................17NUVIGIL..................................121NUWIQ......................................46NUZYRA................................... 17nyamyc......................................27nylia 1/35...................................98nylia 7/7/7..................................98NYMALIZE................................ 52nymyo....................................... 98nystatin......................................27nystatin-triamcinolone............... 27nystop....................................... 27OCALIVA.................................. 86ocella.........................................98octreotide acetate..................... 92OCUFLOX...............................110ODACTRA.............................. 108ODEFSEY.................................42ODOMZO..................................32OFEV...................................... 118ofloxacin....................17, 110, 114olanzapine.................................39olanzapine-fluoxetine hcl.......... 23olmesartan medoxomil..............52olmesartan medoxomil-hctz...... 52olmesartan-amlodipine-hctz......52olopatadine hcl................110, 115OLUMIANT............................. 102OLUX........................................ 66OLUX-E.....................................66OMECLAMOX-PAK.................. 85omega-3-acid ethyl esters.........52omeprazole............................... 83

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omeprazole-sodium bicarbonate............................... 83OMNARIS............................... 115OMNIPOD DASH 5 PACK PODS......................................108OMNITROPE............................ 92ondansetron hcl........................ 25ondansetron odt........................ 25ONE DROP BLOOD GLUCOSE MONITOR.............. 74ONE DROP TEST.....................74ONETOUCH CLUB LANCETS FINE PT.................................... 74ONETOUCH DELICA LANCETS 30G..........................74ONETOUCH DELICA LANCETS 33G..........................74ONETOUCH DELICA LANCING DEV..........................74ONETOUCH DELICA PLUS LANCET30G............................. 74ONETOUCH DELICA PLUS LANCET33G............................. 74ONETOUCH DELICA PLUS LANCING.................................. 74ONETOUCH DELICA SAFETY LANCING.................................. 74ONETOUCH FINEPOINT LANCETS................................. 74ONETOUCH SOLUTIONS STARTER KIT...........................74ONETOUCH ULTRA 2 KIT W/DEVICE................................ 74ONETOUCH ULTRA MINI KIT W/DEVICE................................ 74ONETOUCH ULTRA TEST STRIPS..................................... 74ONETOUCH ULTRASOFT LANCETS................................. 74ONETOUCH VERIO FLEX SYSTEM................................... 74ONETOUCH VERIO IQ SYSTEM................................... 75ONETOUCH VERIO KIT W/DEVICE.......................... 74, 75ONETOUCH VERIO REFLECT KIT W/DEVICE........ 75ONEXTON................................ 66ONFI......................................... 20ONGENTYS..............................36ONGLYZA.................................70ONUREG.................................. 32ONZETRA XSAIL......................28

OPSUMIT................................119ORACEA...................................66ORALAIR................................ 108ORALAIR ADULT STARTER PACK...................................... 109ORALAIR CHILDRENS STARTER PACK.................... 109oralone...................................... 61ORAPRED ODT........................89ORAVIG.................................... 27ORENCIA................................102ORENCIA CLICKJECT........... 102ORENITRAM.......................... 119ORFADIN..................................86ORGOVYX................................32ORIAHNN................................. 98ORILISSA................................. 92ORKAMBI............................... 119ORLADEYO............................ 102orphenadrine citrate er............120ORPHENGESIC FORTE........ 120orsythia..................................... 98ORTIKOS................................106OSCIMIN...................................85oseltamivir phosphate............... 42OSENI.......................................70OSMOLEX ER.......................... 36OSMOPREP............................. 85OSPHENA................................ 92OTEZLA.................................. 102OTOVEL................................. 114OTREXUP...............................102OVIDE.......................................36OVIDREL.................................. 92oxaliplatin.................................. 32oxaprozin.................................. 12OXAYDO...................................10oxazepam................................. 45OXBRYTA...............................109oxcarbazepine...........................20OXERVATE............................ 113oxiconazole nitrate.................... 27OXISTAT...................................27OXTELLAR XR......................... 20oxybutynin chloride................... 88oxybutynin chloride er......... 87, 88oxycodone hcl........................... 10OXYCODONE HCL ER............ 10OXYCODONE-ACETAMINOPHEN...................10oxycodone-acetaminophen.......10OXYCONTIN.............................10oxymorphone hcl.......................10

oxymorphone hcl er.................. 10OXYTROL.................................88OZEMPIC..................................70OZOBAX................................. 120PACERONE..............................52PADCEV................................... 32PALFORZIA............................ 109paliperidone er.......................... 39PALYNZIQ................................ 86PAMELOR................................ 23PANCREAZE............................ 86PANDEL....................................66PANRETIN................................32pantoprazole sodium.................83paricalcitol............................... 108PARLODEL...............................36PARNATE................................. 23paromomycin sulfate.................17paroxetine hcl............................23paroxetine hcl er....................... 23paroxetine mesylate..................23PASER......................................29PATANASE.............................115PAXIL........................................23PAXIL CR..................................23PAXLOVID................................ 42PEDIAPRED............................. 89PEDIARIX............................... 105PEDVAX HIB.......................... 105peg 3350-kcl-na bicarb-nacl......85peg-3350/electrolytes................85peg-3350/electrolytes/ascorbat.85PEGASYS.................................42peg-kcl-nacl-nasulf-na asc-c..... 85PEMAZYRE.............................. 33penicillamine............................. 88penicillin v potassium................ 17PENNSAID................................12PENTACEL............................. 105pentamidine isethionate............ 36PENTASA............................... 106pentazocine-naloxone hcl......... 10pentoxifylline er......................... 52PEPCID.....................................83PERCOCET.............................. 10PERFOROMIST......................118PERIDEX.................................. 61perindopril erbumine................. 52periogard...................................61permethrin.................................36perphenazine............................ 25perphenazine-amitriptyline........23PERSERIS................................39

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PERTZYE................................. 86PEXEVA....................................23PFIZER COVID-19 VAC-TRIS 5-11Y...................................... 105PFIZER COVID-19 VAC-TRIS 6M-4Y..................................... 105PFIZER-BIONT COVID-19 VAC-TRIS............................... 105PFIZER-BIONTECH COVID-19 VACC................................. 105phenazo.................................... 88phenazopyridine hcl.................. 88phendimetrazine tartrate........... 59phendimetrazine tartrate er.......59phenelzine sulfate..................... 23phenobarbital............................ 20phenoxybenzamine hcl............. 52phentermine hcl........................ 59phenylephrine hcl....................113PHENYTEK...............................20phenytoin.................................. 20phenytoin infatabs.....................20phenytoin sodium extended...... 20PHEXXI...................................109philith.........................................98PHOSLYRA.............................. 88phospho-trin 250 neutral........... 81PHYSICIANS EZ USE J/T/T KIT II ........................................... 8phytonadione............................ 81PIFELTRO................................ 42pilocarpine hcl................... 61, 112pimecrolimus.............................66pimozide....................................39pimtrea...................................... 98pindolol......................................52pioglitazone hcl......................... 70pioglitazone hcl-glimepiride.......70pioglitazone hcl-metformin hcl.. 70PIQRAY.................................... 33pirmella 1/35............................. 98pirmella 7/7/7............................ 98piroxicam...................................12PLAQUENIL..............................36PLAVIX..................................... 37PLEGRIDY................................58PLEGRIDY STARTER PACK... 58PLENVU....................................85PLIAGLIS.................................. 13PNEUMOVAX 23.................... 105podofilox....................................66POGO AUTOMATIC BLOOD GLUCOSE................................ 75

POGO AUTOMATIC TEST CARTRIDGES.......................... 75polycin.....................................113polymyxin b-trimethoprim........113polysaccharide iron forte...........81POLYTRIM..............................113POLY-VI-FLOR......................... 81POLY-VI-FLOR/IRON............... 81POMALYST.............................. 33PONVORY................................ 58PONVORY STARTER PACK... 58portia-28....................................98posaconazole............................27POTASSIUM ACETATE........... 81potassium chloride.................... 81potassium chloride crys er........ 81potassium chloride er................81potassium citrate er...................81POVIDONE-IODINE............... 110PRADAXA.................................18PRALUENT...............................52pramipexole dihydrochloride..... 36pramipexole dihydrochloride er.37PRAMOSONE...........................66PRAMOTIC............................. 114prasugrel hcl............................. 37pravastatin sodium....................52praziquantel.............................. 36prazosin hcl...............................52PRECISION XTRA BLOOD GLUCOSE................................ 75PRECOSE................................ 70PRED FORTE.........................110PRED MILD............................ 110PRED-G.................................. 113PRED-G S.O.P....................... 113prednicarbate............................ 66prednisolone............................. 89prednisolone acetate...............110prednisolone sodium phosphate......................... 89, 110prednisone................................ 89prednisone intensol...................89PREFEST................................. 98pregabalin................................. 60pregabalin er....................... 59, 60PREGNYL.................................92PREHEVBRIO........................ 105PREMARIN............................... 98PREMPHASE........................... 98PREMPRO................................98PRENATVITE RX..................... 81PRESTALIA.............................. 52

PRETOMANID.......................... 29PREVACID................................83PREVACID SOLUTAB..............83prevalite.................................... 52PREVIDENT............................. 61PREVIDENT 5000 BOOSTER PLUS.........................................61PREVIDENT 5000 DRY MOUTH.....................................61PREVIDENT 5000 ENAMEL PROTECT.................................61PREVIDENT 5000 ORTHO DEFENSE................................. 61PREVIDENT 5000 PLUS.......... 61PREVIDENT 5000 SENSITIVE.61previfem.................................... 98PREVNAR 13..........................105PREVNAR 20..........................105PREVYMIS............................... 42PREZCOBIX............................. 42PREZISTA................................ 42PRIFTIN.................................... 29PRILOSEC................................83primaquine phosphate.............. 36primidone.................................. 20PRISTIQ....................................23PROAIR DIGIHALER..............118PROAIR HFA.......................... 118PROAIR RESPICLICK............118probenecid................................ 27PROCARDIA XL....................... 52PROCENTRA........................... 57prochlorperazine....................... 25prochlorperazine maleate......... 25PROCTOCORT...................... 106PROCTOFOAM HC................ 107procto-med hc......................... 107procto-pak............................... 107proctosol hc.............................107proctozone-hc......................... 107PROCYSBI............................... 86PRODIGY NO CODING BLOOD GLUC.......................... 75progesterone.............................98PROGESTERONE MICRONIZED........................... 98PROGLYCEM........................... 76PROGRAF.............................. 102PROLATE................................. 10PROLENSA............................ 110PROMACTA..............................46promethazine hcl.....................115promethazine vc......................115

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promethazine vc/codeine........ 115promethazine-codeine............ 115promethazine-dm.................... 115promethazine-phenyleph-codeine................................... 115promethazine-phenylephrine.. 115promethegan...........................115PROMETRIUM......................... 98propafenone hcl........................ 52propafenone hcl er.................... 52proparacaine hcl..................... 113propranolol hcl.......................... 52propranolol hcl er...................... 52propylthiouracil ........................100PROQUAD..............................105PROSCAR................................ 89PROTONIX............................... 83PROTOPIC............................... 66protriptyline hcl..........................23PROVENTIL HFA................... 118PROVERA................................ 98PROVIGIL............................... 121PROZAC................................... 23PRUDOXIN............................... 66pseudoephedrine-bromphen-dm........................................... 115PSORCON................................66PULMICORT FLEXHALER.....118PULMICORT SUSPENSION.. 118PULMOZYME......................... 119PURIXAN.................................. 33PYLERA....................................85pyrazinamide.............................29pyridostigmine bromide.............29pyridostigmine bromide er.........29pyrimethamine.......................... 36PYROGALLIC ACID................. 66PYRUKYND.............................. 46PYRUKYND TAPER PACK...... 46QBRELIS.................................. 52QBREXZA.................................66QELBREE................................. 57QINLOCK..................................33QNASL....................................115QNASL CHILDRENS.............. 115QSYMIA.................................... 60QTERN..................................... 70QUADRACEL..........................105QUALAQUIN.............................36QUARTETTE............................ 98quazepam................................. 45QUDEXY XR.............................20QUESTRAN.............................. 52

QUESTRAN LIGHT.................. 52quetiapine fumarate.................. 39quetiapine fumarate er.............. 39QUFLORA FE........................... 81QUICKVUE SARS ANTIGEN TEST.......................................109QUILLICHEW ER......................57QUILLIVANT XR....................... 57quinapril hcl...............................52quinapril-hydrochlorothiazide.... 52quinidine gluconate er...............52quinidine sulfate........................ 52quinine sulfate...........................36QVAR REDIHALER................ 118RABEPRAZOLE SODIUM........ 83rabeprazole sodium.................. 83RAGWITEK.............................109raloxifene hcl.............................92ramelteon................................ 121ramipril ...................................... 52RANEXA................................... 53ranolazine er............................. 53RAPAFLO................................. 89RAPAMUNE............................102rasagiline mesylate................... 37RASUVO.........................102, 103RAVICTI....................................86RAYALDEE.............................107RAYOS..................................... 89RAZADYNE ER........................ 21REBIF....................................... 58REBIF REBIDOSE....................58REBIF REBIDOSE TITRATION PACK.................... 58REBIF TITRATION PACK.........58reclipsen....................................98RECOMBIVAX HB.................. 105RECTIV.....................................53REDITREX..............................103REGLAN................................... 25REGRANEX..............................66RELAFEN................................. 12RELAFEN DS........................... 12RELENZA DISKHALER............ 42RELEUKO.................................46relexxii .......................................57RELION PREMIER CLASSIC...75RELION PREMIER TEST......... 75RELISTOR................................ 85RELNATE DHA.........................81RELPAX....................................28RELTONE................................. 85REMERON................................24

REMERON SOLTAB................ 24REMESENSE........................... 61RENACIDIN.............................. 88RENAGEL.................................88RENATABS WITH IRON.......... 81RENVELA................................. 88repaglinide................................ 70REPATHA................................. 53REPATHA PUSHTRONEX SYSTEM................................... 53REPATHA SURECLICK........... 53RESTASIS.............................. 113RESTASIS MULTIDOSE........ 113RESTORIL.............................. 121RETEVMO................................ 33RETIN-A..............................66, 67RETIN-A MICRO GEL 0.04 %, 0.1 %.........................................67RETIN-A MICRO PUMP........... 67RETROVIR............................... 42REVATIO................................ 120REVLIMID................................. 33REXULTI...................................39REYATAZ................................. 42REYVOW.................................. 28REZIPRES.................................. 8REZUROCK............................103RHOFADE................................ 67RHOPRESSA......................... 112ribavirin..................................... 42RIDAURA................................103rifabutin..................................... 29rifampin..................................... 30RIFAMPIN+SYRSPEND SF..... 30RIGHTEST GT333 BLOOD GLUCOSE................................ 75RILUTEK...................................60riluzole.......................................60rimantadine hcl..........................43RIMSO-50................................. 88RINVOQ..................................103RIOMET.................................... 70risedronate sodium................. 107RISPERDAL..............................39RISPERDAL CONSTA..............39risperidone................................ 39RITALIN.................................... 57RITALIN LA...............................57ritonavir..................................... 43rivastigmine...............................21rivastigmine tartrate.................. 21rivelsa........................................98rizatriptan benzoate.................. 28

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ROBINUL.................................. 85ROBINUL-FORTE.....................85ROCALTROL.......................... 108ROCKLATAN.......................... 112ropinirole hcl..............................37ropinirole hcl er......................... 37rosadan..................................... 67rosuvastatin calcium................. 53ROSZET................................... 53ROTARIX................................ 105ROTATEQ...............................105ROWASA................................ 107roweepra................................... 20ROXICODONE......................... 10ROZEREM.............................. 121ROZLYTREK............................ 33RUBRACA................................ 33rufinamide................................. 20RUKOBIA..................................43RYBELSUS...............................70RYCLORA...............................115RYDAPT................................... 33RYTARY................................... 37RYTHMOL SR.......................... 53ryvent...................................... 115SABRIL..................................... 20SAFYRAL..................................98SAIZEN..................................... 92SAIZENPREP........................... 92sajazir......................................103SALAGEN................................. 61SALINE-PHENOL..................... 81SAMSCA...................................81SANCUSO................................ 25SANDIMMUNE....................... 103SANDOSTATIN........................ 92SANTYL.................................... 67SAPHRIS.................................. 39sapropterin dihydrochloride.......86SAVAYSA................................. 18SAVELLA.................................. 60SAVELLA TITRATION PACK... 60SAXENDA.................................60SCEMBLIX................................33scopolamine..............................25SEASONIQUE.......................... 98SECUADO................................ 39SEGLUROMET.........................70selegiline hcl............................. 37selenium sulfide........................ 67SELZENTRY.............................43SEMGLEE (YFGN)................... 78SENSIPAR..............................108

SEREVENT DISKUS.............. 118SERNIVO..................................67SEROQUEL.............................. 39SEROQUEL XR........................ 39SEROSTIM............................... 85SERTRALINE HCL................... 24sertraline hcl..............................24setlakin......................................98sevelamer carbonate................ 88sevelamer hcl............................88SEYSARA................................. 17sf............................................... 61sf 5000 plus...............................61SFROWASA........................... 107sharobel.................................... 98SHINGRIX...............................106SIKLOS..................................... 33sildenafil citrate................. 88, 120SILENOR................................ 121SILIQ.......................................103silodosin.................................... 89SILVADENE..............................17silver sulfadiazine......................17SIMBRINZA............................ 112simliya....................................... 98simpesse...................................98SIMPONI.........................103, 104simvastatin................................ 53SINEMET.................................. 37SINGULAIR.............................118sirolimus..................................104SIRTURO..................................30SITAVIG....................................43SIVEXTRO................................17SKELAXIN.............................. 120SKYRIZI.................................. 104SKYRIZI (150 MG DOSE).......104SKYRIZI PEN..........................104SLYND...................................... 98sod citrate-citric acid................. 81sodium bicarbonate...................85sodium chloride.......................115sodium fluoride....................61, 81sodium fluoride 5000 enamel....61sodium fluoride 5000 plus......... 61sodium fluoride 5000 ppm.........61sodium fluoride 5000 sensitive..61SODIUM IODIDE I-131........... 100sodium phenylbutyrate..............86sodium polystyrene sulfonate... 81SOFIA SARS ANTIGEN FIA...109SOFIA2 SARS ANTIGEN FIA.109solifenacin succinate.................88

SOLIQUA.................................. 70SOLODYN................................ 17SOLOSEC.................................17SOLTAMOX.............................. 33SOMA..................................... 120SOMATULINE DEPOT............. 92SOMAVERT..............................92SOOLANTRA............................67sorbitol-mannitol......................109SORILUX.................................. 67sorine........................................ 53sotalol hcl.................................. 53sotalol hcl (af)............................53SOTROVIMAB........................ 104SOTYLIZE.................................53SOVALDI.................................. 43spinosad....................................36SPIRIVA HANDIHALER..........118SPIRIVA RESPIMAT.............. 118spironolactone...........................53spironolactone-hctz...................53SPORANOX..............................27SPORANOX PULSEPAK..........27SPRAVATO (56 MG DOSE)..... 24SPRAVATO (84 MG DOSE)..... 24sprintec 28................................ 99SPRITAM.................................. 20SPRIX....................................... 12SPRYCEL................................. 33sps............................................ 82sronyx....................................... 99ssd............................................ 17STALEVO 100.......................... 37STALEVO 125.......................... 37STALEVO 150.......................... 37STALEVO 200.......................... 37STALEVO 50............................ 37STALEVO 75............................ 37stavudine...................................43STEGLATRO............................ 70STEGLUJAN.............................70STELARA................................104STENDRA.................................88sterile water for irrigation...........82STIMATE.................................. 92STIOLTO RESPIMAT............. 118STIVARGA................................33STRATTERA.............................57STRENSIQ................................87STRIBILD..................................43STRIVERDI RESPIMAT......... 118STROMECTOL......................... 36SUBOXONE..............................14

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SUBSYS................................... 10subvenite...................................20subvenite starter kit-blue...........20subvenite starter kit-green........ 20subvenite starter kit-orange...... 20SUCRAID..................................87sucralfate.................................. 83SULAR...................................... 53SULCONAZOLE NITRATE.......27sulfacetamide sodium............. 110sulfacetamide sodium (acne).... 67sulfacetamide-prednisolone.... 113sulfadiazine............................... 17sulfamethoxazole-trimethoprim.17SULFAMYLON..........................17sulfasalazine........................... 107sulfatrim pediatric......................17sulfurated lime...........................36sulindac.....................................12sumatriptan............................... 29sumatriptan succinate............... 29sumatriptan succinate refill subcutaneous solution cartridge.................................... 29sumatriptan-naproxen sodium.. 29sunitinib malate......................... 33SUNOSI.................................. 121SUPRAX................................... 17SUPREP BOWEL PREP KIT....85SURESTEP PRO HIGH GLUCOSE................................ 75SURESTEP PRO LOW GLUCOSE................................ 75SURESTEP PRO NORMAL GLUCOSE................................ 75SUSTIVA...................................43SUTAB...................................... 85SUTENT....................................33syeda........................................ 99SYMBICORT...........................118SYMBYAX.................................24SYMDEKO.............................. 119SYMFI....................................... 43SYMFI LO................................. 43SYMJEPI.................................118SYMLINPEN 120...................... 70SYMLINPEN 60........................ 70SYMPAZAN.............................. 20SYMPROIC...............................85SYMTUZA.................................43SYNALAR................................. 67SYNAPRYN FUSEPAQ............ 10SYNAREL................................. 92

SYNDROS................................ 25SYNERA................................... 13SYNJARDY...............................70SYNJARDY XR.........................70SYNTHROID...........................100SYPRINE.................................. 82TABLOID...................................33TABRADOL FUSEPAQ.......... 120TABRADOL RAPIDPAQ......... 120TABRECTA...............................33TACLONEX...............................67tacrolimus..........................67, 104tadalafil ......................................88tadalafil (pah).......................... 120TAFINLAR.................................33TAGRISSO............................... 33TAKHZYRO............................ 104TALICIA.................................... 85TALTZ..................................... 104TALZENNA............................... 33TAMIFLU...................................43tamoxifen citrate........................33tamsulosin hcl........................... 89TAPERDEX 12-DAY................. 89TAPERDEX 6-DAY................... 90TAPERDEX 7-DAY................... 90TARCEVA................................. 33TARGADOX..............................17TARGRETIN............................. 33tarina 24 fe................................ 99tarina fe 1/20............................. 99tarina fe 1/20 eq........................ 99TASIGNA.................................. 33TASMAR................................... 37TAURINE.................................. 82tavaborole................................. 27TAVALISSE.............................. 46taysofy.......................................99TAYTULLA................................99tazarotene................................. 67TAZAROTENE..........................67TAZICEF................................... 17TAZORAC.................................67taztia xt......................................53TAZVERIK................................ 33TDVAX.................................... 106TECFIDERA........................58, 59TEGRETOL...............................20TEGRETOL-XR........................ 20TEGSEDI.................................. 60TEKTURNA...............................53TEKTURNA HCT...................... 53telmisartan................................ 53

telmisartan-amlodipine..............53telmisartan-hctz.........................53temazepam............................. 121TEMIXYS.................................. 43TEMODAR................................ 33TEMOVATE.............................. 67temozolomide............................33TENCON...................................10TENIVAC................................ 106tenofovir disoproxil fumarate.....43TENORETIC 100...................... 53TENORETIC 50........................ 53TENORMIN...............................53TEPMETKO.............................. 33terazosin hcl..............................89terbinafine hcl............................27terbutaline sulfate....................118terconazole............................... 27TERIPARATIDE (RECOMBINANT)................... 107TESTIM.....................................90testosterone.............................. 90testosterone cypionate..............90testosterone enanthate............. 90TETANUS-DIPHTHERIA TOXOIDS TD.......................... 106tetrabenazine............................ 60tetracycline hcl.......................... 17TEXACORT.............................. 67THALITONE..............................53THALOMID............................... 33THAM........................................82THE LIQUILIFT TRACE............82THEO-24.................................118theophylline.............................118theophylline er.........................118THIOLA..................................... 88THIOLA EC............................... 88thioridazine hcl.......................... 39thiotepa..................................... 34thiothixene.................................39THROMBIN-JMI........................46THROMBIN-JMI EPISTAXIS.... 46THROMBOGEN........................46THYQUIDITY.......................... 100tiadylt er.................................... 53tiagabine hcl..............................20TIAZAC..................................... 53TIBSOVO.................................. 34TIGLUTIK..................................60TIKOSYN.................................. 53tilia fe.........................................99timolol maleate..................53, 112

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timolol maleate (once-daily).... 112timolol maleate ocudose......... 112timolol maleate pf....................112TIMOPTIC...............................112TIMOPTIC OCUDOSE............112TIMOPTIC-XE.........................112tinidazole...................................17tiopronin.................................... 88TIROSINT............................... 100TIROSINT-SOL.......................100TIVICAY.................................... 43TIVICAY PD.............................. 43TIVORBEX................................12tizanidine hcl........................... 121TOBI NEBULIZER.................. 119TOBI PODHALER...................119TOBRADEX............................ 113TOBRADEX ST.......................113tobramycin...................... 111, 119TOBRAMYCIN........................ 119tobramycin-dexamethasone....113TOBREX................................. 111tolcapone.................................. 37TOLSURA................................. 27tolterodine tartrate.....................88tolterodine tartrate er.................88tolvaptan................................... 82TOPAMAX................................ 20TOPAMAX SPRINKLE..............20TOPICORT............................... 67TOPICORT SPRAY.................. 67topiramate................................. 20topiramate er.............................20TOPROL XL..............................53toremifene citrate...................... 34torsemide.................................. 53TOSYMRA................................ 29TOUJEO MAX SOLOSTAR...... 78TOUJEO SOLOSTAR...............78tovet.......................................... 67TOVIAZ..................................... 88TRACLEER.............................120TRADJENTA.............................70TRAMADOL HCL ER................10tramadol hcl er.......................... 10tramadol hcl er (biphasic)..........10tramadol hcl ir ........................... 10tramadol-acetaminophen.......... 10trandolapril ................................ 53trandolapril-verapamil hcl er......53tranexamic acid.........................46TRANSDERM-SCOP................25TRANXENE-T........................... 45

tranylcypromine sulfate............. 24TRAVATAN Z..........................112travoprost (bak free)................112trazodone hcl............................ 24TRECATOR.............................. 30TRELEGY ELLIPTA................118TREMFYA...............................104TRESIBA...................................78TRESIBA FLEXTOUCH............78tretinoin............................... 34, 67tretinoin microsphere................ 67tretinoin microsphere pump...... 67TREXALL................................ 104TREXIMET................................29TREZIX..................................... 10tri femynor................................. 99triamcinolone acetonide...... 61, 67triamcinolone in absorbase....... 67TRI-AMINO............................... 82triamterene................................54triamterene-hctz........................ 54TRIANEX.................................. 67triazolam................................... 45TRIBENZOR............................. 54TRICOR.................................... 54triderm.......................................68TRIDESILON............................ 68trientine hcl................................82tri-estarylla................................ 99TRIFERIC AVNU...................... 82trifluoperazine hcl......................39trifluridine................................ 111trihexyphenidyl hcl.................... 37TRIJARDY XR.......................... 70TRIKAFTA...............................119tri-legest fe................................ 99TRILEPTAL...............................20tri-linyah.................................... 99TRILIPIX................................... 54tri-lo-estarylla............................ 99tri-lo-marzia............................... 99tri-lo-mili .................................... 99tri-lo-sprintec............................. 99trimethobenzamide hcl..............25trimethoprim.............................. 17tri-mili ........................................ 99trimipramine maleate................ 24TRINATE...................................82TRINTELLIX..............................24tri-nymyo................................... 99TRIPLE COMPLEX FORMULA 3 KIT......................................... 12TRIPLE PMB...........................111

TRIPLE PMK...........................111tri-previfem................................ 99TRIPTODUR............................. 92tri-sprintec................................. 99tritocin....................................... 68TRIUMEQ................................. 43TRI-VI-FLOR.............................82TRI-VI-FLORO.......................... 82tri-vite/fluoride........................... 82trivora (28).................................99tri-vylibra................................... 99tri-vylibra lo................................99TRIZIVIR................................... 43TROKENDI XR......................... 20TROPICAMIDE-PHENYLEPHRINE..................113trospium chloride.......................88trospium chloride er.................. 88TRUE FOCUS BLOOD GLUCOSE METER...................75TRUE METRIX BLOOD GLUCOSE TEST...................... 75TRUE METRIX LEVEL 1.......... 75TRUE METRIX LEVEL 2.......... 75TRUE METRIX LEVEL 3.......... 75TRUE METRIX METER............ 75TRUE METRIX PRO BLOOD GLUCOSE................................ 75TRUETRACK TEST..................75TRULANCE...............................85TRULICITY............................... 70TRUMENBA............................106TRUSELTIQ (100MG DAILY DOSE).......................................34TRUSELTIQ (125MG DAILY DOSE).......................................34TRUSELTIQ (50MG DAILY DOSE).......................................34TRUSELTIQ (75MG DAILY DOSE).......................................34TRUVADA.................................43TUDORZA PRESSAIR........... 118TUKYSA....................................34tulana........................................ 99TURALIO.................................. 34TUXARIN ER.......................... 115TUZISTRA XR........................ 115TWINRIX.................................106TWIRLA.................................... 99tyblume..................................... 99TYBOST....................................43tydemy...................................... 99TYKERB....................................34

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TYMLOS................................. 107UBRELVY................................. 29UCERIS.................................. 107UKONIQ....................................34ULORIC.................................... 28ULTIGUARD SAFEPACK SYR/NEEDLE........................... 78ULTRACET............................... 10ULTRAM................................... 10ULTRAVATE.............................68UNISTRIP CONTROL...............75unithroid.................................. 100UPNEEQ.................................111UPTRAVI................................ 120UROCIT-K 10............................82UROCIT-K 15............................82UROCIT-K 5..............................82UROXATRAL............................ 89URSO 250.................................85URSO FORTE.......................... 86URSODIOL............................... 86ursodiol..................................... 86URSODIOL+SYRSPEND SF....86VAGIFEM..................................99valacyclovir hcl..........................43VALCHLOR...............................34VALCYTE..................................43valganciclovir hcl.......................43VALIUM.....................................45valproic acid.............................. 20valsartan................................... 54valsartan-hydrochlorothiazide... 54VALTOCO.................................20VALTREX..................................43VANADOM..............................121VANCOCIN............................... 17vancomycin hcl......................... 17VANCOMYCIN+SYRSPEND SF............................................. 17vandazole..................................17VANOS..................................... 68VAQTA....................................106vardenafil hcl.............................88varenicline tartrate.................... 14VARIVAX................................ 106VARUBI (180 MG DOSE)......... 25VASCEPA................................. 54VASERETIC..............................54VASOTEC.................................54VAXELIS................................. 106VAXNEUVANCE.....................106VECAMYL.................................54VECTICAL................................ 68

velivet........................................99VELPHORO.............................. 88VELTASSA............................... 82VELTIN..................................... 68VEMLIDY.................................. 43VENCLEXTA.............................34VENCLEXTA STARTING PACK........................................ 34VENIPUNCTURE PX1 PHLEBOTOMY......................... 13venlafaxine hcl.......................... 24venlafaxine hcl er...................... 24VENTAVIS.............................. 120VENTOLIN HFA......................118verapamil hcl.............................54verapamil hcl er.........................54VERDESO................................ 68VEREGEN................................ 68VERELAN................................. 54VERELAN PM...........................54VERQUVO................................ 54VERSACLOZ............................ 39VERZENIO................................34VESICARE................................88VESICARE LS.......................... 88vestura...................................... 99VFEND......................................27VIAGRA.................................... 88VIBERZI.................................... 86VIBRAMYCIN............................17VICTOZA.................................. 70VIEKIRA PAK............................43vienva........................................99vigabatrin.................................. 20vigadrone.................................. 20VIGAMOX............................... 111VIIBRYD....................................24VIIBRYD STARTER PACK....... 24VIMOVO....................................12VIMPAT.....................................21VINATE ONE............................ 82VIOKACE.................................. 87viorele....................................... 99VIRACEPT................................ 43VIRAMUNE XR......................... 44VIRAZOLE................................ 44VIREAD.....................................44virtussin ac w/alc.....................115VISIONBLUE.......................... 113VISTARIL.................................. 45VISTOGARD...........................109vitamin d (ergocalciferol)...........82vitamins acd-fluoride................. 82

VITRAKVI..................................34VIVAGUARD INO CONTROL SOLUTION................................75VIVAGUARD INO GLUCOSE METER..................................... 75VIVAGUARD INO SMART GLUC METER.......................... 75VIVAGUARD INO TEST STRIPS..................................... 75VIVAGUARD LANCING DEVICE.....................................75VIVELLE-DOT...........................99VIVITROL..................................14VIVLODEX................................ 13VIZIMPRO.................................34VOCABRIA............................... 44VOGELXO................................ 90VOGELXO PUMP..................... 90volnea....................................... 99VONJO........................................8voriconazole..............................27VOSEVI.....................................44VOTRIENT................................34VP FC KIT.................................13VP GKL KIT.............................. 13vp-pnv-dha................................ 82VRAYLAR................................. 39VTOL LQ...................................10VUMERITY............................... 59VUSION.................................... 27vyfemla......................................99VYLEESI................................... 60vylibra........................................99VYNDAMAX..............................54VYNDAQEL.............................. 54VYTORIN.................................. 54VYVANSE................................. 57VYZULTA................................112WAKIX.................................... 121warfarin sodium.........................18water for irrigation, sterile..........82WEGOVY..................................60WELCHOL................................ 54WELIREG................................. 34WELLBUTRIN SR.....................24WELLBUTRIN XL..................... 24wera.......................................... 99WESCAP-C DHA...................... 82WESCAP-PN DHA....................82WESNATE DHA........................82WESTHROID.......................... 100WILZIN......................................82WINLEVI................................... 68

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wixela inhub............................ 118WP THYROID......................... 100wymzya fe............................... 100XADAGO...................................37XALATAN................................112XALKORI.................................. 34XANAX......................................45XANAX XR................................45XARELTO................................. 18XARELTO STARTER PACK.....18XATMEP................................. 104XCOPRI.................................... 21XELJANZ................................ 104XELJANZ XR.......................... 104XELODA................................... 34XELPROS............................... 112XENAZINE................................ 60XENICAL...................................60XENLETA..................................17XEPI..........................................17XERAC AC................................68XERESE................................... 44XERMELO................................ 86XEROFORM OIL EMULSION 2"X2"......................................... 68XEROFORM OIL EMULSION GAUZE......................................68XEROFORM PETROLAT PATCH 2"X2"............................68XEROFORM PETROLAT PATCH 4"X4"............................68XHANCE................................. 115XIFAXAN...................................17XIGDUO XR..............................70XIIDRA.................................... 113XIMINO..................................... 18XOFLUZA (40 MG DOSE)........ 44XOFLUZA (80 MG DOSE)........ 44XOLAIR...................................115XOLEGEL................................. 27XOPENEX CONCENTRATE.. 118XOPENEX HFA...................... 119XOPENEX NEB...................... 119XOSPATA................................. 34XPERT XPRESS SARS-COV-2.............................................. 109XPOVIO (100 MG ONCE WEEKLY)..................................34XPOVIO (40 MG ONCE WEEKLY)..................................34XPOVIO (40 MG TWICE WEEKLY)..................................34

XPOVIO (60 MG ONCE WEEKLY)..................................34XPOVIO (60 MG TWICE WEEKLY)..................................34XPOVIO (80 MG ONCE WEEKLY)..................................34XPOVIO (80 MG TWICE WEEKLY)..................................34XTAMPZA ER........................... 10XTANDI.....................................34xulane..................................... 100XULTOPHY...............................70XURIDEN..................................87XYOSTED.................................90XYREM................................... 121XYWAV................................... 121YASMIN 28............................. 100YAZ......................................... 100YONSA..................................... 34YOSPRALA...............................37YUPELRI.................................119yuvafem.................................. 100zafemy.................................... 100zafirlukast................................119zaleplon...................................121ZANAFLEX............................. 121ZARONTIN................................21ZAVESCA................................. 87ZCORT 7-DAY.......................... 90ZEBUTAL..................................11ZEGALOGUE............................76ZEGERID.................................. 83ZEJULA.....................................34ZELAPAR..................................37ZELBORAF............................... 35ZELNORM................................ 86ZEMBRACE SYMTOUCH........ 29ZEMPLAR............................... 108zenatane................................... 68ZENPEP....................................87ZENZEDI...................................57ZEPATIER................................ 44ZEPOSIA.................................. 59ZEPOSIA 7-DAY STARTER PACK........................................ 59ZEPOSIA STARTER KIT.......... 59ZERVIATE.............................. 111ZESTORETIC........................... 54ZESTRIL................................... 54ZETIA........................................54ZETONNA...............................115ZIAC..........................................54ZIAGEN.....................................44

ZIANA....................................... 68zidovudine.................................44zileuton er............................... 119ZILXI......................................... 68ZIMHI........................................ 14ZIOPTAN................................ 112ziprasidone hcl.......................... 39ziprasidone mesylate................ 39ZIPSOR.....................................13ZIRGAN.................................. 111ZITHROMAX.............................18ZITHROMAX TRI-PAK..............18ZITHROMAX Z-PAK................. 18ZOCOR..................................... 54ZOKINVY................................ 109ZOLINZA...................................35ZOLMITRIPTAN........................29zolmitriptan................................29ZOLOFT....................................24zolpidem tartrate..................... 122zolpidem tartrate er................. 121ZOLPIMIST............................. 122ZOMACTON............................. 92ZOMACTON (FOR ZOMA-JET 10).............................................92ZOMIG...................................... 29ZONALON.................................68ZONEGRAN..............................21zonisamide................................21ZONTIVITY............................... 37ZORBTIVE................................ 86ZORTRESS............................ 104ZORVOLEX.............................. 13zovia 1/35 (28)........................ 100zovia 1/35e (28)...................... 100ZOVIRAX.................................. 44ZTLIDO..................................... 13ZUBSOLV................................. 14zumandimine...........................100ZUPLENZ..................................25ZYCLARA................................. 68ZYCLARA PUMP...................... 68ZYDELIG...................................35ZYFLO.................................... 119ZYKADIA...................................35ZYLET.....................................113ZYLOPRIM................................28ZYMAXID................................ 111ZYPITAMAG............................. 54ZYPREXA................................. 40ZYPREXA RELPREVV............. 40ZYPREXA ZYDIS......................40ZYTIGA..................................... 35

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ZYVOX......................................18

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MEMBER 2022 PREFERRED DRUG LIST

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