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Molina Healthcare of Ohio Preferred Drug List (Formulary)

(10/01/2019)

INTRODUCTION .......................................................................................................................................................................................................................................... 4 PREFACE ..................................................................................................................................................................................................................................................... 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE .......................................................................................................................................................................... 4 DRUG LIST PRODUCT DESCRIPTIONS ................................................................................................................................................................................................... 4 GENERIC SUBSTITUTION .......................................................................................................................................................................................................................... 4 PLAN DESIGN ............................................................................................................................................................................................................................................. 5 NON-COVERED MEDICATIONS ................................................................................................................................................................................................................ 5 STEP THERAPY (ST) .................................................................................................................................................................................................................................. 5 LEGEND ....................................................................................................................................................................................................................................................... 5 NOTICE ........................................................................................................................................................................................................................................................ 5 ANALGESICS .............................................................................................................................................................................................................................................. 6

ANALGESICS, OTHER ..................................................................................................................................................................................................................... 6 NSAIDs .............................................................................................................................................................................................................................................. 6 NSAIDs, TOPICAL ............................................................................................................................................................................................................................. 6 COX-2 INHIBITORS........................................................................................................................................................................................................................... 6 GOUT ................................................................................................................................................................................................................................................. 6 OPIOID ANALGESICS ...................................................................................................................................................................................................................... 6 NON-OPIOID ANALGESICS ............................................................................................................................................................................................................. 7 VISCOSUPPLEMENTS ..................................................................................................................................................................................................................... 7

ANTI-INFECTIVES ....................................................................................................................................................................................................................................... 7 ANTIBACTERIALS............................................................................................................................................................................................................................. 7 ANTIFUNGALS .................................................................................................................................................................................................................................. 8 ANTIMALARIALS ............................................................................................................................................................................................................................... 8 ANTIRETROVIRAL AGENTS ............................................................................................................................................................................................................ 8 ANTITUBERCULAR AGENTS ........................................................................................................................................................................................................... 9 ANTIVIRALS .................................................................................................................................................................................................................................... 10 MISCELLANEOUS........................................................................................................................................................................................................................... 10

ANTINEOPLASTIC AGENTS .................................................................................................................................................................................................................... 11 ALKYLATING AGENTS ................................................................................................................................................................................................................... 11 ANTIMETABOLITES ........................................................................................................................................................................................................................ 11 CYTOPROTECTIVE AGENTS ........................................................................................................................................................................................................ 11 HORMONAL ANTINEOPLASTIC AGENTS .................................................................................................................................................................................... 11 IMMUNOMODULATORS ................................................................................................................................................................................................................. 11 KINASE INHIBITORS ...................................................................................................................................................................................................................... 11 TOPOISOMERASE INHIBITORS .................................................................................................................................................................................................... 12 MISCELLANEOUS........................................................................................................................................................................................................................... 12

CARDIOVASCULAR.................................................................................................................................................................................................................................. 12 ACE INHIBITORS ............................................................................................................................................................................................................................ 12 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ............................................................................................................................................ 12 ACE INHIBITOR/DIURETIC COMBINATIONS................................................................................................................................................................................ 12 ADRENOLYTICS, CENTRAL .......................................................................................................................................................................................................... 12 ALDOSTERONE RECEPTOR ANTAGONISTS .............................................................................................................................................................................. 13 ALPHA BLOCKERS ......................................................................................................................................................................................................................... 13 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS .............................................................................................................................. 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ............................................................................................. 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ........................................................................... 13 ANTIARRHYTHMICS....................................................................................................................................................................................................................... 13 ANTILIPEMICS ................................................................................................................................................................................................................................ 13 BETA-BLOCKERS ........................................................................................................................................................................................................................... 14 BETA-BLOCKER/DIURETIC COMBINATIONS .............................................................................................................................................................................. 14 CALCIUM CHANNEL BLOCKERS .................................................................................................................................................................................................. 14 DIGITALIS GLYCOSIDES ............................................................................................................................................................................................................... 15 DIURETICS ...................................................................................................................................................................................................................................... 15 HEART FAILURE ............................................................................................................................................................................................................................. 15 NITRATES ....................................................................................................................................................................................................................................... 15 PULMONARY ARTERIAL HYPERTENSION .................................................................................................................................................................................. 16 MISCELLANEOUS........................................................................................................................................................................................................................... 16

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CENTRAL NERVOUS SYSTEM ................................................................................................................................................................................................................ 16 AMYOTROPHIC LATERAL SCLEROSIS ........................................................................................................................................................................................ 16 ANTIANXIETY .................................................................................................................................................................................................................................. 16 ANTICONVULSANTS ...................................................................................................................................................................................................................... 16 ANTIDEMENTIA .............................................................................................................................................................................................................................. 17 ANTIDEPRESSANTS ...................................................................................................................................................................................................................... 17 ANTIPARKINSONIAN AGENTS ...................................................................................................................................................................................................... 18 ANTIPSYCHOTICS.......................................................................................................................................................................................................................... 18 ATTENTION DEFICIT HYPERACTIVITY DISORDER .................................................................................................................................................................... 19 HUNTINGTON'S DISEASE AGENTS ............................................................................................................................................................................................. 19 HYPNOTICS .................................................................................................................................................................................................................................... 19 MIGRAINE ....................................................................................................................................................................................................................................... 19 MOOD STABILIZERS ...................................................................................................................................................................................................................... 20 MULTIPLE SCLEROSIS AGENTS .................................................................................................................................................................................................. 20 MUSCULOSKELETAL THERAPY AGENTS ................................................................................................................................................................................... 20 MYASTHENIA GRAVIS ................................................................................................................................................................................................................... 20 NARCOLEPSY/CATAPLEXY .......................................................................................................................................................................................................... 20 PSYCHOTHERAPEUTIC-MISCELLANEOUS ................................................................................................................................................................................. 20 MISCELLANEOUS........................................................................................................................................................................................................................... 21

ENDOCRINE AND METABOLIC ............................................................................................................................................................................................................... 21 ACROMEGALY ................................................................................................................................................................................................................................ 21 ANDROGENS .................................................................................................................................................................................................................................. 21 ANTIDIABETICS .............................................................................................................................................................................................................................. 21 CALCIUM RECEPTOR ANTAGONISTS ......................................................................................................................................................................................... 23 CALCIUM REGULATORS ............................................................................................................................................................................................................... 23 CARNITINE DEFICIENCY AGENTS ............................................................................................................................................................................................... 23 CONTRACEPTIVES ........................................................................................................................................................................................................................ 23 ENDOMETRIOSIS ........................................................................................................................................................................................................................... 24 ESTROGENS ................................................................................................................................................................................................................................... 24 ESTROGEN/PROGESTINS ............................................................................................................................................................................................................ 25 ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS ................................................................................................................. 25 GAUCHER DISEASE....................................................................................................................................................................................................................... 25 GLUCOCORTICOIDS ...................................................................................................................................................................................................................... 25 GLUCOSE ELEVATING AGENTS .................................................................................................................................................................................................. 25 HEREDITARY TYROSINEMIA TYPE 1 AGENTS ........................................................................................................................................................................... 25 HUMAN GROWTH HORMONES .................................................................................................................................................................................................... 25 HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ..................................................................................................................................................... 25 INSULIN-LIKE GROWTH FACTOR ................................................................................................................................................................................................. 25 PHOSPHATE BINDER AGENTS .................................................................................................................................................................................................... 25 POTASSIUM-REMOVING AGENTS ............................................................................................................................................................................................... 26 PROGESTINS .................................................................................................................................................................................................................................. 26 SELECTIVE ESTROGEN RECEPTOR MODULATORS ................................................................................................................................................................ 26 THYROID AGENTS ......................................................................................................................................................................................................................... 26 UREA CYCLE DISORDERS ............................................................................................................................................................................................................ 26 VASOPRESSIN RECEPTOR ANTAGONISTS ............................................................................................................................................................................... 26 VASOPRESSINS ............................................................................................................................................................................................................................. 26 MISCELLANEOUS........................................................................................................................................................................................................................... 26

GASTROINTESTINAL ............................................................................................................................................................................................................................... 26 ANTACIDS ....................................................................................................................................................................................................................................... 26 ANTIDIARRHEALS .......................................................................................................................................................................................................................... 26 ANTIEMETICS ................................................................................................................................................................................................................................. 27 ANTISPASMODICS ......................................................................................................................................................................................................................... 27 CHOLELITHOLYTICS ..................................................................................................................................................................................................................... 27 H2 RECEPTOR ANTAGONISTS ...................................................................................................................................................................................................... 27 INFLAMMATORY BOWEL DISEASE .............................................................................................................................................................................................. 27 IRRITABLE BOWEL SYNDROME ................................................................................................................................................................................................... 28 LAXATIVES/STOOL SOFTENERS ................................................................................................................................................................................................. 28 PANCREATIC ENZYMES ............................................................................................................................................................................................................... 28 PROSTAGLANDINS ........................................................................................................................................................................................................................ 28 PROTON PUMP INHIBITORS ......................................................................................................................................................................................................... 28 SALIVA STIMULANTS ..................................................................................................................................................................................................................... 29 STEROIDS, RECTAL ...................................................................................................................................................................................................................... 29 ULCER THERAPY COMBINATIONS .............................................................................................................................................................................................. 29 MISCELLANEOUS........................................................................................................................................................................................................................... 29

GENITOURINARY...................................................................................................................................................................................................................................... 29

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BENIGN PROSTATIC HYPERPLASIA ............................................................................................................................................................................................ 29 URINARY ANTISPASMODICS ........................................................................................................................................................................................................ 29 VAGINAL ANTI-INFECTIVES .......................................................................................................................................................................................................... 29 MISCELLANEOUS........................................................................................................................................................................................................................... 30

HEMATOLOGIC ......................................................................................................................................................................................................................................... 30 ANTICOAGULANTS ........................................................................................................................................................................................................................ 30 HEMATOPOIETIC GROWTH FACTORS ........................................................................................................................................................................................ 30 HEMOPHILIA A AGENTS ................................................................................................................................................................................................................ 30 HEMOPHILIA B AGENTS ................................................................................................................................................................................................................ 30 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS ............................................................................................................................................ 30 PLATELET AGGREGATION INHIBITORS...................................................................................................................................................................................... 30 PLATELET SYNTHESIS INHIBITORS ............................................................................................................................................................................................ 31 THROMBOCYTOPENIA AGENTS .................................................................................................................................................................................................. 31 MISCELLANEOUS........................................................................................................................................................................................................................... 31

IMMUNOLOGIC AGENTS ......................................................................................................................................................................................................................... 31 ALLERGENIC EXTRACTS .............................................................................................................................................................................................................. 31 AUTOIMMUNE AGENTS ................................................................................................................................................................................................................. 31 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) ..................................................................................................................................................... 31 IMMUNE GLOBULINS ..................................................................................................................................................................................................................... 31 IMMUNOMODULATORS ................................................................................................................................................................................................................. 31 IMMUNOSUPPRESSANTS ............................................................................................................................................................................................................. 32 VACCINES ....................................................................................................................................................................................................................................... 32

NUTRITIONAL/SUPPLEMENTS ............................................................................................................................................................................................................... 32 ELECTROLYTES ............................................................................................................................................................................................................................. 32 VITAMINS AND MINERALS ............................................................................................................................................................................................................ 32

RESPIRATORY .......................................................................................................................................................................................................................................... 34 ANAPHYLAXIS TREATMENT AGENTS ......................................................................................................................................................................................... 34 ANTICHOLINERGICS...................................................................................................................................................................................................................... 34 ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ............................................................................................................................................................... 34 ANTIHISTAMINES, LOW SEDATING ............................................................................................................................................................................................. 34 ANTIHISTAMINES, NONSEDATING .............................................................................................................................................................................................. 34 ANTIHISTAMINES, SEDATING ...................................................................................................................................................................................................... 34 ANTIHISTAMINE/DECONGESTANT COMBINATIONS ................................................................................................................................................................. 35 ANTITUSSIVES ............................................................................................................................................................................................................................... 35 ANTITUSSIVE COMBINATIONS ..................................................................................................................................................................................................... 35 BETA AGONISTS ............................................................................................................................................................................................................................ 35 CYSTIC FIBROSIS .......................................................................................................................................................................................................................... 35 DECONGESTANTS ......................................................................................................................................................................................................................... 36 DECONGESTANT/EXPECTORANT COMBINATIONS .................................................................................................................................................................. 36 EXPECTORANTS ............................................................................................................................................................................................................................ 36 LEUKOTRIENE MODULATORS ..................................................................................................................................................................................................... 36 MAST CELL STABILIZERS ............................................................................................................................................................................................................. 36 MEDICAL SUPPLIES....................................................................................................................................................................................................................... 36 NASAL ANTIHISTAMINES .............................................................................................................................................................................................................. 36 NASAL DECONGESTANTS ............................................................................................................................................................................................................ 36 NASAL STEROIDS .......................................................................................................................................................................................................................... 36 PHOSPHODIESTERASE-4 INHIBITORS ....................................................................................................................................................................................... 36 RESPIRATORY SYNCYTIAL VIRUS .............................................................................................................................................................................................. 36 SEVERE ASTHMA AGENTS ........................................................................................................................................................................................................... 37 STEROID/BETA AGONIST COMBINATIONS................................................................................................................................................................................. 37 STEROID INHALANTS .................................................................................................................................................................................................................... 37 XANTHINES ..................................................................................................................................................................................................................................... 37 XANTHINE COMBINATIONS .......................................................................................................................................................................................................... 37 MISCELLANEOUS........................................................................................................................................................................................................................... 37

TOPICAL .................................................................................................................................................................................................................................................... 37 DERMATOLOGY ............................................................................................................................................................................................................................. 37 MOUTH/THROAT/DENTAL AGENTS ............................................................................................................................................................................................. 40 OPHTHALMIC .................................................................................................................................................................................................................................. 40 OTIC ................................................................................................................................................................................................................................................. 42 VAGINAL .......................................................................................................................................................................................................................................... 43

NON-DISCRIMINATION STATEMENT ..................................................................................................................................................................................................... 44 INDEX ......................................................................................................................................................................................................................................................... 46

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INTRODUCTION

We are pleased to provide the 2019 Molina Healthcare of Ohio Preferred Drug List (Formulary) as a useful reference and informational tool. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients. The drugs represented have been reviewed by a Pharmacy and Therapeutics (P&T) Committee and are approved for inclusion. The document is reflective of current medical practice as of the date of review. The information contained in this document and its appendices is provided solely for the convenience of medical providers and is not intended to be comprehensive in nature. All the information in the document is provided as a reference for drug therapy selection. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. We assume no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information.

PREFACE

The document is organized by sections. Each section is divided by therapeutic drug class primarily defined by mechanism of action. Products are listed by generic name with brand name for reference only. Unless the cited drug is available as an injectable or an exception is specifically noted, generally, all applicable dosage forms and strengths of the drug cited are included in the document.

PHARMACY AND THERAPEUTICS (P&T) COMMITTEE

The services of a Pharmacy and Therapeutics Committee ("P&T Committee") are utilized to approve safe and clinically effective drug therapies. The P&T Committee is an advisory body of clinical professionals. The P&T Committee's voting members include physicians and pharmacists, all of whom have a broad background of clinical and academic expertise regarding prescription drugs. Voting members of the P&T Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers.

DRUG LIST PRODUCT DESCRIPTIONS

To assist in understanding which specific strengths and dosage forms on the document are covered, general principles are noted below.

• Listed products on the document generally include all strengths and dosage forms of the cited brand-name product.

• When a strength or dosage form is specified, only the specified strength and dosage form is on the document. Other strengths/dosage forms, including injectable dosage forms of the reference product are not.

• If the OTC and Prescription versions of the product are covered, then both are listed.

• Extended-release and delayed-release products require their own entry.

• Dosage forms on the document will be consistent with the category and use where listed.

GENERIC SUBSTITUTION

Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. In most instances, a brand-name drug for which a generic product becomes available will become non-formulary, with the generic product covered in its place, upon release of the generic product to the market. However, the document is subject to state specific regulations and rules regarding generic substitution and mandatory generic rules apply where appropriate. Generic drugs are usually priced lower than their brand-name equivalents. Prescription generic drugs are:

• Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured under the same strict standards that apply to brand-name drugs.

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• Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug (bioequivalence). Generics may be different from the brand in size, color and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug.

• Manufactured in the same strength and dosage form as the brand-name drugs.

When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug (therapeutic equivalence).

PLAN DESIGN

The document represents a closed formulary plan design. The medications listed on the document are covered by the plan as represented. Certain medications on the list are covered if utilization management criteria are met (i.e., Step Therapy, Prior Authorization, Quantity Limits, etc.); requests for use of such medications outside of their listed criteria will be reviewed for medical necessity. If a medication is not listed on the document, a formulary exception may be requested for coverage. Medical necessity or formulary exception requests will be reviewed based on drug-specific prior authorization criteria or standard non-formulary prescription request criteria. Log in to www.molinahealthcare.com to check coverage.

NON-COVERED MEDICATIONS

Please note that certain medications are not covered. This includes, but is not limited to:

• Fertility enhancing drugs

• Weight loss drugs

• Drugs and other agents used for cosmetic purposes or for hair growth

• Sexual dysfunction drugs

• Pharmaceuticals determined by the Federal Drug Administration (FDA) to be less than effective and identical, related or similar drugs (frequently referred to as “DESI 5 and 6” drugs)

STEP THERAPY (ST)

Step therapy (ST) drugs are covered after an adequate trial of a first-line drug has been tried and failed. Step therapy (ST) drugs may also be requested through the prior authorization process. Step therapy drug requests are reviewed based on medical necessity which takes into account the needs of different patient populations.

LEGEND

AL Age Limit

HRM High Risk Medications require PA for members age 65 and older

OTC Over the counter

PA Prior Authorization

PA, QL Quantity Limit is applied after Prior Authorization approval

QL Quantity Limit

SP Specialty Drug; these drugs must be obtained through a specialty pharmacy

ST Step Therapy

† Specific NDCs may not be reimbursable under the Molina Pharmacy Program

boldface

Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name

delayed-rel Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification

ext-rel Extended-release (also known as sustained-release), refer to the reference brand listed for clarification

NOTICE

The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. ©2019. All rights reserved. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers.

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ANALGESICS

ANALGESICS, OTHER

acetaminophen OTC, QL TYLENOL NSAIDs

ibuprofen OTC ADVIL naproxen sodium OTC ALEVE

diclofenac potassium diclofenac sodium delayed-rel diclofenac sodium delayed-rel/misoprostol PA ARTHROTEC

diclofenac sodium ext-rel diflunisal

etodolac etodolac ext-rel

fenoprofen 600 mg flurbiprofen ibuprofen

ketoprofen ketoprofen ext-rel

ketorolac QL meclofenamate meloxicam MOBIC

nabumetone naproxen NAPROSYN

oxaprozin DAYPRO piroxicam FELDENE sulindac

tolmetin 200 mg, 400 mg NSAIDs, TOPICAL

diclofenac sodium gel 1% QL VOLTAREN GEL COX-2 INHIBITORS

celecoxib PA CELEBREX GOUT

allopurinol ZYLOPRIM colchicine tabs QL COLCRYS

colchicine/probenecid febuxostat PA ULORIC

probenecid OPIOID ANALGESICS All Opioid Analgesics are subject to Ohio Department of Medicaid Opioid Policy:

butalbital/acetaminophen/caffeine/codeine 50/325/40/30 mg QL, *

butorphanol nasal spray QL, * codeine sulfate QL, * codeine/acetaminophen QL, * TYLENOL w/CODEINE

fentanyl citrate buccal PA, QL, * FENTORA fentanyl lozenge PA, QL, * ACTIQ

fentanyl sublingual PA, QL, * ABSTRAL fentanyl transdermal PA, QL DURAGESIC

hydrocodone/acetaminophen QL, * NORCO hydrocodone/acetaminophen soln 7.5-325 mg/15 mL PA, QL, * hydromorphone oral soln 1 mg/mL QL, * DILAUDID-5

hydromorphone tabs QL, * DILAUDID

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morphine QL, *

morphine ext-rel PA, QL KADIAN morphine ext-rel PA, QL MS CONTIN morphine supp QL, *

oxycodone QL, * oxycodone QL, * ROXICODONE

oxycodone ext-rel PA, QL OXYCONTIN oxycodone/acetaminophen QL, * oxycodone/aspirin QL, * PERCODAN

oxymorphone QL, * OPANA pentazocine/naloxone PA, QL, *

QL* all immediate-release opioid analgesics = Max quantity limit of 7 days supply per fill; Max quantity limit of 14

days supply per 45 days; Prior authorization required for existing utilizers dose > 60 mg morphine equivalent; new utilizers dose ≥ 30 mg morphine equivalent.

NON-OPIOID ANALGESICS

butalbital/acetaminophen 50/325 mg butalbital/acetaminophen/caffeine 50/325/40 mg QL ESGIC butalbital/aspirin/caffeine QL FIORINAL

tramadol ext-rel tabs PA tramadol immediate-release QL ULTRAM

tramadol/acetaminophen QL ULTRACET VISCOSUPPLEMENTS

hylan G-F 20 PA, SP SYNVISC-ONE

ANTI-INFECTIVES

ANTIBACTERIALS Aminoglycosides

neomycin

Cephalosporins First Generation

cefadroxil QL cephalexin caps 250 mg, 500 mg KEFLEX cephalexin caps 750 mg PA KEFLEX

cephalexin susp KEFLEX Second Generation

cefaclor QL cefaclor ext-rel CEFACLOR ER

cefprozil cefuroxime axetil

Third Generation

cefdinir QL

cefpodoxime Erythromycins/Macrolides

azithromycin ZITHROMAX clarithromycin

clarithromycin ext-rel erythromycin delayed-rel ERY-TAB erythromycin ethylsuccinate E.E.S.

erythromycin ethylsuccinate 200 mg/5 mL ERYPED erythromycin stearate ERYTHROCIN

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Fluoroquinolones

ciprofloxacin QL CIPRO levofloxacin QL LEVAQUIN moxifloxacin PA AVELOX

Penicillins

amoxicillin QL amoxicillin/clavulanate 200 mg/5 mL, 400 mg/5 mL AUGMENTIN amoxicillin/clavulanate chew tabs, tabs AUGMENTIN

ampicillin dicloxacillin

penicillin VK Sulfonamides

sulfadiazine sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS

Tetracyclines

doxycycline calcium syrup VIBRAMYCIN SYRUP doxycycline hyclate caps 50 mg, 100 mg VIBRAMYCIN doxycycline hyclate tabs 20 mg, 100 mg

doxycycline monohydrate minocycline MINOCIN

tetracycline ANTIFUNGALS

clotrimazole troches fluconazole QL DIFLUCAN griseofulvin microsize

griseofulvin ultramicrosize itraconazole SPORANOX

itraconazole oral soln PA SPORANOX ORAL SOLUTION ketoconazole

nystatin terbinafine tabs QL

ANTIMALARIALS

artemether/lumefantrine COARTEM atovaquone/proguanil MALARONE

chloroquine mefloquine

primaquine PRIMAQUINE ANTIRETROVIRAL AGENTS Antiretroviral Adjuvants

cobicistat TYBOST Antiretroviral Combinations

abacavir/dolutegravir/lamivudine TRIUMEQ abacavir/lamivudine EPZICOM

abacavir/lamivudine/zidovudine TRIZIVIR atazanavir/cobicistat EVOTAZ

bictegravir/emtricitabine/tenofovir alafenamide QL BIKTARVY darunavir/cobicistat PREZCOBIX dolutegravir/rilpivirine QL JULUCA

efavirenz/lamivudine/tenofovir disoproxil fumarate QL SYMFI, SYMFI LO

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elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide GENVOYA

elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate STRIBILD emtricitabine/rilpivirine/tenofovir alafenamide ODEFSEY emtricitabine/rilpivirine/tenofovir disoproxil fumarate COMPLERA

emtricitabine/tenofovir alafenamide DESCOVY emtricitabine/tenofovir disoproxil fumarate TRUVADA

lamivudine/tenofovir disoproxil fumarate QL CIMDUO lamivudine/zidovudine COMBIVIR

Chemokine Receptor Antagonists

maraviroc SELZENTRY

Fusion Inhibitors

enfuvirtide PA, SP FUZEON

Integrase Inhibitors

dolutegravir TIVICAY

raltegravir ISENTRESS raltegravir ISENTRESS HD

Non-nucleoside Reverse Transcriptase Inhibitors

efavirenz SUSTIVA

etravirine INTELENCE nevirapine VIRAMUNE nevirapine ext-rel 100 mg PA VIRAMUNE XR

nevirapine ext-rel 400 mg VIRAMUNE XR rilpivirine EDURANT

Nucleoside Reverse Transcriptase Inhibitors

abacavir ZIAGEN

didanosine delayed-rel VIDEX EC didanosine soln VIDEX emtricitabine EMTRIVA

lamivudine EPIVIR stavudine

zidovudine RETROVIR Nucleotide Reverse Transcriptase Inhibitors

tenofovir disoproxil fumarate powder VIREAD tenofovir disoproxil fumarate tabs VIREAD

Protease Inhibitors

atazanavir caps REYATAZ

atazanavir powder REYATAZ darunavir PREZISTA fosamprenavir susp LEXIVA

fosamprenavir tabs LEXIVA indinavir CRIXIVAN

lopinavir/ritonavir soln KALETRA lopinavir/ritonavir tabs KALETRA

nelfinavir VIRACEPT ritonavir caps, soln NORVIR ritonavir tabs NORVIR

saquinavir mesylate INVIRASE tipranavir APTIVUS

ANTITUBERCULAR AGENTS

bedaquiline PA SIRTURO

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cycloserine PA

ethambutol MYAMBUTOL ethionamide TRECATOR isoniazid syrup QL

isoniazid tabs pyrazinamide

rifampin RIFADIN rifapentine PRIFTIN

ANTIVIRALS Cytomegalovirus Agents

valganciclovir PA VALCYTE

Hepatitis Agents Hepatitis B

adefovir dipivoxil HEPSERA entecavir soln BARACLUDE entecavir tabs BARACLUDE

lamivudine soln EPIVIR-HBV lamivudine tabs EPIVIR-HBV

Hepatitis C

ledipasvir/sofosbuvir PA, SP, * HARVONI

ribavirin caps 200 mg PA, SP REBETOL ribavirin oral soln 40 mg/mL PA, SP REBETOL

ribavirin tabs 200 mg PA, SP sofosbuvir/velpatasvir PA, SP, * EPCLUSA sofosbuvir/velpatasvir/voxilaprevir PA, SP VOSEVI

* ledipasvir/sofosbuvir and sofosbuvir/velpatasvir are the preferred agents Herpes Agents

acyclovir caps, susp, tabs ZOVIRAX famciclovir

valacyclovir VALTREX Influenza Agents

oseltamivir QL TAMIFLU rimantadine FLUMADINE

zanamivir QL RELENZA MISCELLANEOUS

pyrantel OTC REESES PINWORM MEDICINE albendazole PA ALBENZA

atovaquone MEPRON clindamycin CLEOCIN dapsone

ivermectin PA STROMECTOL linezolid PA ZYVOX

metronidazole FLAGYL nitazoxanide susp PA ALINIA nitazoxanide tabs ALINIA

nitrofurantoin ext-rel HRM MACROBID nitrofurantoin macrocrystals HRM MACRODANTIN

nitrofurantoin susp HRM FURADANTIN paromomycin praziquantel PA BILTRICIDE

rifabutin MYCOBUTIN

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rifaximin PA XIFAXAN

trimethoprim vancomycin oral soln FIRVANQ

ANTINEOPLASTIC AGENTS

ALKYLATING AGENTS busulfan MYLERAN

chlorambucil LEUKERAN cyclophosphamide caps PA

estramustine PA EMCYT lomustine GLEOSTINE mechlorethamine gel PA VALCHLOR

melphalan ALKERAN temozolomide PA, SP TEMODAR

ANTIMETABOLITES

capecitabine PA, SP XELODA

mercaptopurine methotrexate TREXALL

methotrexate inj thioguanine TABLOID

CYTOPROTECTIVE AGENTS

leucovorin calcium LEUCOVORIN HORMONAL ANTINEOPLASTIC AGENTS Antiandrogens

bicalutamide CASODEX

flutamide nilutamide NILANDRON

Antiestrogens

tamoxifen QL

toremifene FARESTON Aromatase Inhibitors

anastrozole ARIMIDEX exemestane AROMASIN

letrozole FEMARA Progestins

megestrol acetate susp 40 mg/mL, tabs IMMUNOMODULATORS

lenalidomide PA, SP REVLIMID pomalidomide PA, SP POMALYST thalidomide PA, SP THALOMID

KINASE INHIBITORS

afatinib PA, SP GILOTRIF axitinib PA, SP INLYTA bosutinib PA, SP BOSULIF

cabozantinib PA, SP COMETRIQ dabrafenib PA, SP TAFINLAR

dasatinib PA, SP SPRYCEL erlotinib PA, SP TARCEVA everolimus PA, SP AFINITOR

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everolimus tablets for oral suspension PA, SP AFINITOR DISPERZ

ibrutinib PA, SP IMBRUVICA idelalisib PA, SP ZYDELIG imatinib mesylate PA, SP GLEEVEC

lapatinib PA, SP TYKERB nilotinib PA, SP TASIGNA

pazopanib PA, SP VOTRIENT regorafenib PA, SP STIVARGA ruxolitinib PA, SP JAKAFI

sorafenib PA, SP NEXAVAR sunitinib PA, SP SUTENT

trametinib PA, SP MEKINIST vandetanib PA, SP CAPRELSA

TOPOISOMERASE INHIBITORS

topotecan PA, SP HYCAMTIN

MISCELLANEOUS

aldesleukin PA, SP PROLEUKIN

bexarotene caps TARGRETIN caps etoposide hydroxyurea DROXIA

hydroxyurea HYDREA mitotane LYSODREN

procarbazine MATULANE tretinoin caps vorinostat PA, SP ZOLINZA

CARDIOVASCULAR

ACE INHIBITORS benazepril LOTENSIN captopril

enalapril VASOTEC fosinopril

lisinopril ZESTRIL moexipril perindopril

quinapril ACCUPRIL ramipril ALTACE

trandolapril ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS

amlodipine/benazepril QL LOTREL trandolapril/verapamil ext-rel TARKA

ACE INHIBITOR/DIURETIC COMBINATIONS

benazepril/hydrochlorothiazide LOTENSIN HCT

captopril/hydrochlorothiazide enalapril/hydrochlorothiazide VASERETIC fosinopril/hydrochlorothiazide

lisinopril/hydrochlorothiazide ZESTORETIC quinapril/hydrochlorothiazide ACCURETIC

ADRENOLYTICS, CENTRAL

clonidine CATAPRES

clonidine transdermal PA CATAPRES TTS guanfacine

13

ALDOSTERONE RECEPTOR ANTAGONISTS

eplerenone PA INSPRA spironolactone ALDACTONE

ALPHA BLOCKERS

doxazosin CARDURA

prazosin MINIPRESS terazosin

ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS

candesartan PA ATACAND candesartan/hydrochlorothiazide PA ATACAND HCT

eprosartan PA irbesartan AVAPRO

irbesartan/hydrochlorothiazide AVALIDE losartan COZAAR losartan/hydrochlorothiazide HYZAAR

olmesartan PA BENICAR olmesartan/hydrochlorothiazide PA BENICAR HCT

telmisartan PA MICARDIS telmisartan/hydrochlorothiazide PA MICARDIS HCT

valsartan DIOVAN valsartan/hydrochlorothiazide QL DIOVAN HCT

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS

amlodipine/olmesartan PA AZOR amlodipine/valsartan PA EXFORGE

amlodipine/valsartan/hydrochlorothiazide PA EXFORGE HCT ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS

olmesartan/amlodipine/hydrochlorothiazide PA TRIBENZOR ANTIARRHYTHMICS

amiodarone disopyramide NORPACE

disopyramide ext-rel NORPACE CR dofetilide SP TIKOSYN

dronedarone MULTAQ flecainide propafenone

propafenone ext-rel RYTHMOL SR sotalol BETAPACE

sotalol BETAPACE AF ANTILIPEMICS Bile Acid Resins

cholestyramine QUESTRAN/QUESTRAN LIGHT colestipol packets, tabs COLESTID

Cholesterol Absorption Inhibitors

ezetimibe ST * ZETIA

ST * Requires prior use of a HMG-CoA Reductase Inhibitor Fibrates

choline fenofibrate delayed-rel 45 mg TRILIPIX fenofibrate caps 150 mg LIPOFEN

14

fenofibrate tabs 48 mg PA TRICOR

fenofibrate tabs 54 mg, 160 mg fenofibrate tabs 145 mg TRICOR gemfibrozil LOPID

HMG-CoA Reductase Inhibitors

atorvastatin 10 mg, 20 mg, 40 mg LIPITOR

atorvastatin 80 mg QL LIPITOR lovastatin

pravastatin PRAVACHOL rosuvastatin QL CRESTOR

simvastatin ZOCOR Microsomal Triglyceride Transfer Protein Inhibitors

lomitapide PA JUXTAPID Niacins

niacin ext-rel PA NIASPAN Omega-3 Fatty Acids

omega-3 acid ethyl esters PA LOVAZA PCSK9 Inhibitors

evolocumab PA, SP, QL REPATHA evolocumab PA, SP, QL REPATHA PUSHTRONEX

Miscellaneous

mipomersen PA KYNAMRO

BETA-BLOCKERS

acebutolol

atenolol betaxolol

bisoprolol carvedilol COREG labetalol TRANDATE

metoprolol succinate ext-rel TOPROL-XL metoprolol tartrate 25 mg, 50 mg LOPRESSOR

nadolol CORGARD pindolol propranolol

propranolol ext-rel INDERAL LA timolol

BETA-BLOCKER/DIURETIC COMBINATIONS

atenolol/chlorthalidone

bisoprolol/hydrochlorothiazide ZIAC metoprolol/hydrochlorothiazide LOPRESSOR HCT

CALCIUM CHANNEL BLOCKERS Dihydropyridines

amlodipine NORVASC

felodipine ext-rel nicardipine

nifedipine PROCARDIA nifedipine ext-rel ADALAT CC nifedipine ext-rel PROCARDIA XL

nimodipine NIMOTOP

15

nisoldipine ext-rel SULAR

Nondihydropyridines

diltiazem CARDIZEM

diltiazem ext-rel diltiazem ext-rel CARDIZEM CD diltiazem ext-rel TIAZAC

diltiazem ext-rel, except 120 mg CARDIZEM LA verapamil ext-rel tabs CALAN SR

DIGITALIS GLYCOSIDES

digoxin LANOXIN

digoxin ped elixir AL DIURETICS Carbonic Anhydrase Inhibitors

acetazolamide acetazolamide ext-rel

methazolamide Loop Diuretics

bumetanide furosemide LASIX

torsemide DEMADEX Potassium-sparing Diuretics

amiloride Thiazides and Thiazide-like Diuretics

chlorthalidone hydrochlorothiazide

indapamide metolazone

chlorothiazide Diuretic Combinations

amiloride/hydrochlorothiazide spironolactone/hydrochlorothiazide ALDACTAZIDE triamterene/hydrochlorothiazide DYAZIDE

triamterene/hydrochlorothiazide MAXZIDE HEART FAILURE

isosorbide dinitrate/hydralazine BIDIL NITRATES Oral

isosorbide dinitrate ext-rel tabs

isosorbide dinitrate oral ISORDIL isosorbide mononitrate isosorbide mononitrate ext-rel

Sublingual

nitroglycerin sublingual NITROSTAT

Transdermal

nitroglycerin transdermal QL nitroglycerin transdermal QL NITRO-DUR

16

PULMONARY ARTERIAL HYPERTENSION Endothelin Receptor Antagonists

ambrisentan PA, SP, QL LETAIRIS bosentan PA, SP TRACLEER macitentan PA, SP, QL OPSUMIT

Phosphodiesterase Inhibitors

sildenafil PA, SP REVATIO Prostacyclin Receptor Agonists

selexipag PA, SP, QL UPTRAVI Prostaglandin Vasodilators

epoprostenol PA, SP VELETRI epoprostenol sodium PA, SP FLOLAN iloprost PA, SP VENTAVIS

treprostinil PA, SP REMODULIN treprostinil PA, SP TYVASO

Soluble Guanylate Cyclase Stimulators

riociguat PA, SP ADEMPAS

MISCELLANEOUS

hydralazine

methyldopa methyldopa/hydrochlorothiazide

metyrosine PA DEMSER midodrine minoxidil tabs

phentolamine inj ranolazine ext-rel RANEXA

CENTRAL NERVOUS SYSTEM

AMYOTROPHIC LATERAL SCLEROSIS

riluzole PA RILUTEK ANTIANXIETY Benzodiazepines

alprazolam XANAX alprazolam ext-rel PA XANAX XR

chlordiazepoxide clonazepam tabs KLONOPIN

clorazepate diazepam VALIUM

lorazepam ATIVAN oxazepam

Miscellaneous

buspirone QL clomipramine ANAFRANIL

fluvoxamine meprobamate

ANTICONVULSANTS

carbamazepine TEGRETOL

carbamazepine ext-rel CARBATROL carbamazepine ext-rel TEGRETOL-XR

17

clobazam PA ONFI

diazepam rectal gel DIASTAT divalproex sodium delayed-rel DEPAKOTE divalproex sodium ext-rel DEPAKOTE ER

ethosuximide ZARONTIN ethotoin PEGANONE

felbamate FELBATOL gabapentin QL NEURONTIN lacosamide PA VIMPAT

lamotrigine QL LAMICTAL levetiracetam KEPPRA

levetiracetam ext-rel KEPPRA XR methsuximide CELONTIN oxcarbazepine QL TRILEPTAL

perampanel PA FYCOMPA phenobarbital QL

phenytoin DILANTIN INFATABS phenytoin sodium extended DILANTIN

pregabalin PA, QL LYRICA primidone MYSOLINE rufinamide PA BANZEL

tiagabine GABITRIL topiramate sprinkle caps, tabs QL TOPAMAX

valproic acid DEPAKENE zonisamide ZONEGRAN

ANTIDEMENTIA

donepezil ARICEPT galantamine RAZADYNE

galantamine ext-rel RAZADYNE ER memantine NAMENDA

rivastigmine ANTIDEPRESSANTS Although these agents are primarily indicated for depression, some of these are also approved for other indications, including bipolar disorder, obsessive-compulsive disorder, panic disorder and premenstrual dysphoric disorder. Monoamine Oxidase Inhibitors (MAOIs)

isocarboxazid MARPLAN phenelzine NARDIL

tranylcypromine PARNATE Selective Serotonin Reuptake Inhibitors (SSRIs)

citalopram CELEXA escitalopram soln LEXAPRO escitalopram tabs LEXAPRO

fluoxetine caps 10 mg, 20 mg, 40 mg PROZAC paroxetine HCl susp PAXIL

paroxetine HCl tabs PAXIL sertraline ZOLOFT

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

duloxetine delayed-rel 20 mg, 30 mg, 60 mg CYMBALTA

venlafaxine ext-rel EFFEXOR XR venlafaxine tabs

Tricyclic Antidepressants (TCAs)

amitriptyline QL

18

amoxapine QL

desipramine NORPRAMIN doxepin imipramine HCl TOFRANIL

imipramine pamoate nortriptyline PAMELOR

protriptyline trimipramine SURMONTIL

Miscellaneous Agents

bupropion

bupropion ext-rel PA APLENZIN bupropion ext-rel QL WELLBUTRIN SR bupropion ext-rel QL WELLBUTRIN XL

chlordiazepoxide/amitriptyline loxapine

maprotiline mirtazapine REMERON thioridazine

trazodone 50 mg, 100 mg, 150 mg ANTIPARKINSONIAN AGENTS

amantadine QL benztropine QL

bromocriptine PARLODEL carbidopa/levodopa SINEMET carbidopa/levodopa ext-rel SINEMET CR

carbidopa/levodopa/entacapone ST * STALEVO entacapone ST * COMTAN

pramipexole MIRAPEX ropinirole

selegiline selegiline orally disintegrating tablets ZELAPAR trihexyphenidyl QL

ST * Requires prior use of carbidopa/levodopa ANTIPSYCHOTICS Atypicals

aripiprazole QL ABILIFY

aripiprazole ext-rel inj ABILIFY MAINTENA aripiprazole lauroxil ext-rel inj ARISTADA aripiprazole lauroxil ext-rel inj ARISTADA INITIO

asenapine PA, * SAPHRIS clozapine CLOZARIL

iloperidone PA, * FANAPT lurasidone PA, * LATUDA olanzapine ZYPREXA

olanzapine pamoate ext-rel inj ZYPREXA RELPREVV paliperidone ext-rel PA, * INVEGA

paliperidone palmitate ext-rel inj INVEGA SUSTENNA paliperidone palmitate ext-rel inj PA, * INVEGA TRINZA quetiapine SEROQUEL

quetiapine ext-rel PA, * SEROQUEL XR risperidone RISPERDAL

risperidone long-acting inj RISPERDAL CONSTA ziprasidone QL GEODON

19

* Psychiatrists exempt from PA Miscellaneous

chlorpromazine fluphenazine

haloperidol perphenazine

perphenazine/amitriptyline pimozide thiothixene

trifluoperazine ATTENTION DEFICIT HYPERACTIVITY DISORDER

amphetamine/dextroamphetamine mixed salts AL, QL ADDERALL amphetamine/dextroamphetamine mixed salts ext-rel AL, QL ADDERALL XR

atomoxetine AL, ST * STRATTERA clonidine ext-rel AL, PA KAPVAY dexmethylphenidate AL FOCALIN

dexmethylphenidate ext-rel AL, PA FOCALIN XR dextroamphetamine 5 mg, 10 mg AL, QL

dextroamphetamine ext-rel AL, QL DEXEDRINE SPANSULE guanfacine ext-rel AL, PA INTUNIV

lisdexamfetamine AL, PA, QL VYVANSE methylphenidate AL METHYLIN methylphenidate AL RITALIN

methylphenidate ext-rel AL, QL CONCERTA methylphenidate ext-rel AL, QL METADATE CD

methylphenidate ext-rel 10 mg AL, QL methylphenidate ext-rel 10 mg, 60 mg AL, PA, QL RITALIN LA methylphenidate ext-rel 20 mg AL, QL METADATE ER

methylphenidate ext-rel 20 mg, 30 mg, 40 mg AL, QL RITALIN LA ST * Requires prior use of methylphenidate or an amphetamine HUNTINGTON'S DISEASE AGENTS

tetrabenazine PA XENAZINE

HYPNOTICS Benzodiazepines

estazolam temazepam QL RESTORIL triazolam QL

Nonbenzodiazepines

zolpidem QL AMBIEN MIGRAINE Ergotamine Derivatives

dihydroergotamine spray QL MIGRANAL ergotamine/caffeine CAFERGOT

Selective Serotonin Agonists

almotriptan PA, QL

naratriptan QL AMERGE rizatriptan QL MAXALT

rizatriptan orally disintegrating tabs QL MAXALT-MLT sumatriptan QL IMITREX sumatriptan inj QL IMITREX

20

sumatriptan nasal spray QL IMITREX

MOOD STABILIZERS

carbamazepine ext-rel EQUETRO

lithium carbonate lithium carbonate ext-rel tabs 300 mg LITHOBID lithium carbonate ext-rel tabs 450 mg

MULTIPLE SCLEROSIS AGENTS

dalfampridine ext-rel PA, SP AMPYRA dimethyl fumarate delayed-rel PA, SP TECFIDERA fingolimod PA, SP GILENYA

glatiramer 20 mg/mL PA, SP COPAXONE interferon beta-1a PA, SP AVONEX

interferon beta-1b PA, SP EXTAVIA teriflunomide PA, SP AUBAGIO

MUSCULOSKELETAL THERAPY AGENTS

baclofen 10 mg, 20 mg carisoprodol/aspirin QL

carisoprodol/aspirin/codeine PA chlorzoxazone 500 mg

cyclobenzaprine 5 mg, 10 mg QL dantrolene DANTRIUM

methocarbamol ROBAXIN orphenadrine ext-rel orphenadrine/aspirin/caffeine PA

tizanidine tabs ZANAFLEX MYASTHENIA GRAVIS

pyridostigmine MESTINON NARCOLEPSY/CATAPLEXY

armodafinil PA NUVIGIL modafinil PA, QL PROVIGIL

sodium oxybate PA XYREM PSYCHOTHERAPEUTIC-MISCELLANEOUS Alcohol Deterrents

acamprosate calcium disulfiram ANTABUSE

Opioid Antagonists

naloxone inj

naloxone nasal spray NARCAN naltrexone

Partial Opioid Agonists

buprenorphine ext-rel inj PA SUBLOCADE

buprenorphine sublingual Partial Opioid Agonist/Opioid Antagonist Combinations

buprenorphine/naloxone buccal film BUNAVAIL buprenorphine/naloxone sublingual film SUBOXONE

buprenorphine/naloxone sublingual tabs buprenorphine/naloxone sublingual tabs ZUBSOLV

21

Pseudobulbar Affect dextromethorphan/quinidine PA NUEDEXTA

Smoking Deterrents

nicotine polacrilex gum OTC, QL NICORETTE

nicotine polacrilex lozenge OTC NICORETTE nicotine transdermal OTC, QL

bupropion ext-rel ZYBAN varenicline ST * CHANTIX

ST * Requires prior use of nicotine or bupropion ext-rel MISCELLANEOUS

guanidine PA

ENDOCRINE AND METABOLIC

ACROMEGALY octreotide acetate SANDOSTATIN

pegvisomant PA, SP SOMAVERT ANDROGENS

oxandrolone PA oxymetholone PA ANADROL-50 testosterone cypionate PA DEPO-TESTOSTERONE

testosterone enanthate PA DELATESTRYL testosterone gel PA ANDROGEL

testosterone gel PA FORTESTA ANTIDIABETICS Alpha-glucosidase Inhibitors

acarbose PRECOSE miglitol GLYSET

Amylin Analogs

pramlintide ST * SYMLINPEN

ST * Requires prior use of insulin therapy Biguanides

metformin GLUCOPHAGE metformin ext-rel GLUCOPHAGE XR

Biguanide/Sulfonylurea Combinations

glipizide/metformin

glyburide/metformin HRM Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

alogliptin ST * NESINA ST * Requires trial of metformin, metformin-containing product, Sulfonylurea or Sulfonylurea Combination Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations

alogliptin/metformin ST * KAZANO

ST * Requires trial of metformin, metformin-containing product, Sulfonylurea or Sulfonylurea Combination Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Insulin Sensitizer Combinations

alogliptin/pioglitazone ST * OSENI

22

ST * Requires trial of metformin, metformin-containing product, Sulfonylurea or Sulfonylurea Combination Incretin Mimetic Agents

liraglutide ST * VICTOZA

semaglutide PA OZEMPIC ST * Requires prior use of metformin AND an oral hypoglycemic agent Insulins

insulin human OTC, QL HUMULIN R

insulin human OTC, QL NOVOLIN R insulin isophane human OTC HUMULIN N insulin isophane human OTC NOVOLIN N

insulin isophane human 70%/regular 30% OTC HUMULIN 70/30 insulin isophane human 70%/regular 30% OTC NOVOLIN 70/30

insulin aspart protamine 70%/insulin aspart 30% NOVOLOG MIX 70/30 insulin glargine BASAGLAR insulin glargine PA, QL TOUJEO SOLOSTAR

insulin human inhalation powder PA AFREZZA insulin human vial PA, QL HUMULIN R U-500 VIAL

insulin lispro QL ADMELOG insulin lispro QL ADMELOG SOLOSTAR insulin lispro protamine/insulin lispro HUMALOG MIX

Insulin Sensitizers

pioglitazone ACTOS

Insulin Sensitizer/Biguanide Combinations

pioglitazone/metformin ACTOPLUS MET pioglitazone/metformin ext-rel PA ACTOPLUS MET XR

Insulin Sensitizer/Sulfonylurea Combinations

pioglitazone/glimepiride PA DUETACT Meglitinides

nateglinide STARLIX

repaglinide PRANDIN Meglitinide/Biguanide Combinations

repaglinide/metformin PA Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors

ertugliflozin ST * STEGLATRO ST * Requires trial of DDP-4 Inhibitor or DPP-4 Inhibitor/Biguanide Combination Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor/Biguanide Combinations

ertugliflozin/metformin ST * SEGLUROMET

ST * Requires trial of DDP-4 Inhibitor or DPP-4 Inhibitor/Biguanide Combination Sulfonylureas

glimepiride AMARYL glipizide GLUCOTROL

glipizide ext-rel GLUCOTROL XL glyburide HRM glyburide micronized HRM GLYNASE

23

tolbutamide

Supplies

alcohol swabs OTC, QL

blood glucose monitoring kits OTC TRUE METRIX AIR kits blood glucose monitoring kits OTC TRUE METRIX kits blood glucose test strips OTC TRUE METRIX test strips

insulin syringes, needles OTC lancets OTC

insulin infusion disposable pump PA OMNIPOD INSULIN INFUSION PUMP CALCIUM RECEPTOR ANTAGONISTS

cinacalcet PA SENSIPAR CALCIUM REGULATORS Bisphosphonates

alendronate tabs FOSAMAX alendronate soln

ibandronate PA BONIVA Calcitonins

calcitonin-salmon spray MIACALCIN Parathyroid Hormones

abaloparatide PA, SP TYMLOS Miscellaneous

denosumab PA, SP PROLIA CARNITINE DEFICIENCY AGENTS

levocarnitine oral soln, tabs CARNITOR

CONTRACEPTIVES EE = ethinyl estradiol Monophasic 20 mcg Estrogen

levonorgestrel/EE 0.1/20

norethindrone acetate/EE 1/20 LOESTRIN 1/20 norethindrone acetate/EE 1/20 and iron LOESTRIN FE 1/20

30 mcg Estrogen

desogestrel/EE 0.15/30 APRI drospirenone/EE 3/30 YASMIN

levonorgestrel/EE 0.15/30 norethindrone acetate/EE 1.5/30 LOESTRIN 1.5/30

norethindrone acetate/EE 1.5/30 and iron LOESTRIN FE 1.5/30 norgestrel/EE 0.3/30

35 mcg Estrogen

ethynodiol diacetate/EE 1/35

norethindrone/EE 0.5/35 norethindrone/EE 1/35 ORTHO-NOVUM 1/35 norgestimate/EE 0.25/35

50 mcg Estrogen

ethynodiol diacetate/EE 1/50 KELNOR 1/50

norgestrel/EE 0.5/50 OGESTREL

24

Biphasic

desogestrel/EE MIRCETTE Triphasic

desogestrel/EE CAZIANT, VELIVET levonorgestrel/EE

norethindrone/EE QL ORTHO-NOVUM 7/7/7 norethindrone/EE 0.5-35/1-35/0.5-35 mg-mcg norgestimate/EE ORTHO TRI-CYCLEN LO

norgestimate/EE 0.18-35/0.215-35/0.25-35 mg-mcg Extended Cycle

levonorgestrel/EE 0.1/20 and EE 10 QL AMETHIA LO, CAMRESE LO levonorgestrel/EE 0.15/30 QL INTROVALE, JOLESSA, SETLAKIN

Continuous

levonorgestrel/EE 0.09/20

Progestin Only

norethindrone

norethindrone ORTHO MICRONOR Emergency Contraception

levonorgestrel OTC, QL PLAN B ONE-STEP ulipristal QL ELLA

Implant

etonogestrel implant SP NEXPLANON

Injectable

medroxyprogesterone acetate vial 150 mg/mL DEPO-PROVERA

Progestin Intrauterine Device

levonorgestrel-releasing IUD SP, QL KYLEENA

levonorgestrel-releasing IUD SP, QL LILETTA levonorgestrel-releasing IUD SP, QL MIRENA

levonorgestrel-releasing IUD SP, QL SKYLA Transdermal

norelgestromin/EE QL XULANE Vaginal

etonogestrel/EE ring NUVARING Miscellaneous

condoms, male OTC, QL nonoxynol-9 OTC GYNOL II

ENDOMETRIOSIS

danazol

nafarelin PA SYNAREL ESTROGENS Oral

estradiol HRM ESTRACE estrogens, esterified PA MENEST

25

Transdermal estradiol PA ALORA

estradiol HRM CLIMARA Vaginal

estradiol vaginal crm ESTRACE CREAM estradiol vaginal tabs PA VAGIFEM

ESTROGEN/PROGESTINS Oral

EE/norethindrone acetate JINTELI EE/norethindrone acetate 0.5 mg/2.5 mcg FEMHRT estradiol/norethindrone acetate PA ACTIVELLA

estradiol/norgestimate PREFEST ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS

conjugated estrogens/bazedoxifene PA DUAVEE GAUCHER DISEASE

miglustat PA ZAVESCA GLUCOCORTICOIDS

cortisone acetate dexamethasone

dexamethasone concentrate 1 mg/mL DEXAMETHASONE INTENSOL fludrocortisone

hydrocortisone CORTEF methylprednisolone MEDROL methylprednisolone 2 mg MEDROL

prednisolone sodium phosphate soln 5 mg/5 mL, 15 mg/5 mL, 25 mg/5 mL prednisolone syrup

prednisone prednisone concentrate 5 mg/mL PREDNISONE INTENSOL

GLUCOSE ELEVATING AGENTS

glucose tablets OTC

diazoxide PROGLYCEM glucagon, human recombinant QL GLUCAGEN HYPOKIT glucagon, human recombinant QL GLUCAGON EMERGENCY KIT

HEREDITARY TYROSINEMIA TYPE 1 AGENTS

nitisinone PA ORFADIN

HUMAN GROWTH HORMONES

somatropin PA, SP OMNITROPE HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS

calcitriol (1,25-D3) QL ROCALTROL doxercalciferol HECTOROL paricalcitol ZEMPLAR

INSULIN-LIKE GROWTH FACTOR

mecasermin PA, SP INCRELEX

PHOSPHATE BINDER AGENTS

calcium acetate lanthanum chew tabs PA FOSRENOL lanthanum powder PA FOSRENOL

26

POTASSIUM-REMOVING AGENTS

sodium polystyrene sulfonate SPS PROGESTINS Oral

medroxyprogesterone acetate PROVERA norethindrone acetate AYGESTIN

progesterone, micronized PROMETRIUM Vaginal

progesterone gel PA CRINONE progesterone supp FIRST-PROGESTERONE VGS

progesterone vaginal inserts ENDOMETRIN SELECTIVE ESTROGEN RECEPTOR MODULATORS

raloxifene EVISTA THYROID AGENTS Antithyroid Agents

methimazole TAPAZOLE propylthiouracil

Thyroid Supplements

levothyroxine levothyroxine LEVOXYL levothyroxine SYNTHROID

liothyronine CYTOMEL liotrix THYROLAR

thyroid ARMOUR THYROID UREA CYCLE DISORDERS

sodium phenylbutyrate BUPHENYL VASOPRESSIN RECEPTOR ANTAGONISTS

tolvaptan PA, SP SAMSCA VASOPRESSINS

desmopressin spray PA STIMATE desmopressin spray, tabs DDAVP

MISCELLANEOUS

cabergoline

methylergonovine METHERGINE

GASTROINTESTINAL

ANTACIDS alumina/magnesia OTC MAALOX alumina/magnesia/simethicone OTC MAALOX

alumina/magnesia/simethicone OTC MYLANTA aluminum hydroxide OTC

calcium carbonate OTC sodium bicarbonate OTC

ANTIDIARRHEALS

bismuth subsalicylate OTC PEPTO-BISMOL

loperamide OTC diphenoxylate/atropine LOMOTIL

27

loperamide

ANTIEMETICS

dextrose/fructose/phosphoric acid OTC EMETROL

dimenhydrinate OTC DRAMAMINE meclizine OTC aprepitant caps PA EMEND

aprepitant susp PA EMEND dronabinol PA MARINOL

granisetron tabs ST*, QL meclizine

metoclopramide REGLAN metoclopramide orally-disintegrating tabs PA ondansetron QL ZOFRAN

prochlorperazine promethazine HRM

promethazine supp 12.5 mg, 25 mg HRM scopolamine transdermal TRANSDERM SCOP trimethobenzamide caps TIGAN

ST * Requires prior use of ondansetron ANTISPASMODICS

dicyclomine BENTYL glycopyrrolate tabs 1 mg, 2 mg

hyoscyamine sulfate ext-rel caps hyoscyamine sulfate ext-rel tabs LEVBID

hyoscyamine sulfate oral soln, elixir hyoscyamine sulfate orally disintegrating tabs ANASPAZ hyoscyamine sulfate orally disintegrating tabs LEVSIN

methscopolamine bromide propantheline

CHOLELITHOLYTICS

ursodiol ACTIGALL

ursodiol URSO H2 RECEPTOR ANTAGONISTS

cimetidine OTC TAGAMET HB famotidine OTC PEPCID

ranitidine OTC ZANTAC cimetidine famotidine PEPCID

nizatidine ranitidine ZANTAC

INFLAMMATORY BOWEL DISEASE Oral Agents

balsalazide budesonide delayed-rel caps ENTOCORT EC mesalamine delayed-rel PA DELZICOL

mesalamine delayed-rel tabs ASACOL HD mesalamine delayed-rel tabs PA LIALDA

mesalamine ext-rel caps APRISO olsalazine DIPENTUM sulfasalazine AZULFIDINE

sulfasalazine delayed-rel AZULFIDINE EN-TABS

28

Rectal Agents hydrocortisone acetate foam CORTIFOAM

hydrocortisone enema mesalamine rectal susp ROWASA

mesalamine supp CANASA IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome with Constipation

lubiprostone PA AMITIZA Irritable Bowel Syndrome with Diarrhea

alosetron ST * LOTRONEX ST * Requires prior use of Metamucil, psyllium and dicyclomine LAXATIVES/STOOL SOFTENERS

bisacodyl OTC DULCOLAX bisacodyl enema OTC FLEET docusate calcium OTC

docusate sodium OTC COLACE karaya gum OTC KARAYA GUM

magnesium citrate OTC magnesium hydroxide OTC MILK OF MAGNESIA methylcellulose OTC CITRUCEL

mineral oil OTC FLEET MINERAL OIL ENEMA polyethylene glycol 3350 powder OTC MIRALAX

psyllium powder OTC KONSYL senna OTC sennosides OTC SENOKOT

sennosides/docusate sodium OTC SENNA PLUS sodium phosphates OTC

lactulose packets KRISTALOSE lactulose soln

peg 3350/electrolytes COLYTE peg 3350/electrolytes COLYTE FLAVORED peg 3350/electrolytes GOLYTELY

peg 3350/electrolytes NULYTELY PANCREATIC ENZYMES

pancrelipase delayed-rel CREON pancrelipase delayed-rel PANCREAZE

pancrelipase delayed-rel ZENPEP PROSTAGLANDINS

misoprostol CYTOTEC PROTON PUMP INHIBITORS

esomeprazole magnesium delayed-rel OTC, QL NEXIUM 24HR lansoprazole delayed-rel OTC, QL PREVACID 24HR

omeprazole magnesium delayed-rel OTC, QL PRILOSEC OTC omeprazole/sodium bicarbonate OTC, QL, PA ZEGERID OTC lansoprazole delayed-rel QL PREVACID

lansoprazole delayed-rel orally-disintegrating tabs QL, PA PREVACID omeprazole delayed-rel QL

omeprazole powder for suspension QL PRILOSEC pantoprazole delayed-rel packets for suspension QL, PA PROTONIX pantoprazole delayed-rel tabs QL PROTONIX

29

SALIVA STIMULANTS cevimeline EVOXAC

pilocarpine tabs SALAGEN STEROIDS, RECTAL

petrolatum/mineral oil/shark liver oil/phenylephrine oint OTC PREPARATION H pramoxine/phenylephrine/glycerin/petrolatum OTC PREPARATION H

hydrocortisone crm ANUSOL-HC 2.5% hydrocortisone crm PROCTOCORT 1%

ULCER THERAPY COMBINATIONS

lansoprazole + amoxicillin + clarithromycin

MISCELLANEOUS

loperamide/simethicone OTC IMODIUM

simethicone OTC cholic acid PA CHOLBAM cromolyn sodium GASTROCROM

glycopyrrolate PA CUVPOSA sucralfate susp CARAFATE

sucralfate tabs CARAFATE

GENITOURINARY

BENIGN PROSTATIC HYPERPLASIA alfuzosin ext-rel PA UROXATRAL

doxazosin CARDURA doxazosin ext-rel PA CARDURA XL dutasteride PA AVODART

dutasteride/tamsulosin PA JALYN finasteride 5 mg PROSCAR

silodosin PA RAPAFLO tamsulosin FLOMAX terazosin

URINARY ANTISPASMODICS

oxybutynin transdermal OTC, PA OXYTROL FOR WOMEN

oxybutynin oxybutynin ext-rel DITROPAN XL

tolterodine PA DETROL tolterodine ext-rel PA DETROL LA

trospium trospium ext-rel PA

VAGINAL ANTI-INFECTIVES

clotrimazole OTC GYNE-LOTRIMIN miconazole OTC

tioconazole OTC VAGISTAT-1 clindamycin CLINDESSE

clindamycin crm CLEOCIN clindamycin vaginal supp CLEOCIN clotrimazole

metronidazole METROGEL-VAGINAL miconazole

nystatin vaginal tab terconazole crm, supp

30

MISCELLANEOUS acetohydroxamic acid PA LITHOSTAT

bethanechol URECHOLINE methenamine mandelate

pentosan polysulfate sodium ELMIRON potassium citrate UROCIT-K potassium citrate/citric acid CYTRA-K

potassium citrate/sodium citrate/citric acid CYTRA-3 potassium/sodium acid phosphates PA K-PHOS

sodium citrate/citric acid CYTRA-2

HEMATOLOGIC

ANTICOAGULANTS Injectable

dalteparin QL*, PA FRAGMIN

enoxaparin QL*, PA LOVENOX QL* Ten days supply allowed unless a PA is initiated Oral

apixaban PA ELIQUIS

rivaroxaban PA XARELTO warfarin COUMADIN

Synthetic Heparinoid-like Agents

fondaparinux QL*, PA ARIXTRA

QL* Ten days supply allowed unless a PA is initiated HEMATOPOIETIC GROWTH FACTORS

darbepoetin alfa PA, SP ARANESP epoetin alfa PA, SP EPOGEN

epoetin alfa PA, SP PROCRIT filgrastim PA, SP NEUPOGEN filgrastim-sndz PA, SP ZARXIO

pegfilgrastim PA, SP NEULASTA sargramostim PA, SP LEUKINE

HEMOPHILIA A AGENTS

antihemophilic factor, recombinant PA, SP ADVATE

antihemophilic factor, recombinant PA, SP HELIXATE FS antihemophilic factor, recombinant PA, SP KOGENATE FS

antihemophilic factor/von Willebrand factor complex (human) PA, SP HUMATE-P HEMOPHILIA B AGENTS

factor IX concentrate PA, SP BENEFIX PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS

eculizumab PA, SP SOLIRIS PLATELET AGGREGATION INHIBITORS

aspirin OTC clopidogrel PLAVIX

dipyridamole ext-rel/aspirin AGGRENOX dipyridamole tabs prasugrel PA EFFIENT

31

PLATELET SYNTHESIS INHIBITORS anagrelide AGRYLIN

THROMBOCYTOPENIA AGENTS

eltrombopag PA, SP PROMACTA

MISCELLANEOUS

aminocaproic acid soln AMICAR aminocaproic acid tabs AMICAR cilostazol

deferasirox PA, SP EXJADE pentoxifylline ext-rel

succimer CHEMET

IMMUNOLOGIC AGENTS

ALLERGENIC EXTRACTS ragweed pollen allergen extract PA RAGWITEK timothy grass pollen allergen extract PA GRASTEK

AUTOIMMUNE AGENTS

adalimumab PA, SP HUMIRA

apremilast PA, SP OTEZLA etanercept PA, SP ENBREL

sarilumab PA, SP KEVZARA DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs)

auranofin RIDAURA hydroxychloroquine PLAQUENIL

leflunomide ARAVA methotrexate penicillamine CUPRIMINE

penicillamine PA DEPEN TITRA IMMUNE GLOBULINS

cytomegalovirus immune globulin PA, SP CYTOGAM hepatitis B immune globulin PA, SP HEPAGAM B

immune globulin PA, SP CARIMUNE immune globulin PA, SP FLEBOGAMMA

immune globulin PA, SP GAMMAGARD immune globulin PA, SP GAMUNEX-C immune globulin PA, SP HIZENTRA

immune globulin PA, SP PRIVIGEN immune globulin PA, SP WINRHO SDF

immune globulin, gamma (IGG) PA, SP GAMASTAN S/D lymphocyte immune globulin anti-thymocyte G PA ATGAM rabies immune globulin PA, SP HYPERRAB S/D

rho D immune globulin PA, SP HYPERRHO rho D immune globulin RHOGAM

rho D immune globulin PA, SP RHOPHYLAC IMMUNOMODULATORS Interferons

interferon alfa-2b PA, SP INTRON A interferon gamma-1b PA, SP ACTIMMUNE

peginterferon alfa-2a PA, SP PEGASYS

32

Miscellaneous canakinumab PA, SP ILARIS

rilonacept PA, SP ARCALYST IMMUNOSUPPRESSANTS Antimetabolites

azathioprine AZASAN

azathioprine IMURAN mycophenolate mofetil CELLCEPT

Calcineurin Inhibitors

cyclosporine QL SANDIMMUNE cyclosporine, modified NEORAL

tacrolimus QL PROGRAF Rapamycin Derivatives

mycophenolate sodium delayed-rel MYFORTIC sirolimus QL RAPAMUNE

VACCINES

pneumococcal vaccine QL PNEUMOVAX 23

pneumococcal vaccine QL PREVNAR 13 zoster vaccine AL* ZOSTAVAX

zoster vaccine recombinant AL**, QL SHINGRIX AL* Covered for ages 60 years and older AL** Covered for ages 50 years and older

NUTRITIONAL/SUPPLEMENTS

ELECTROLYTES Potassium

potassium chloride ext-rel potassium chloride liquid

VITAMINS AND MINERALS Folic Acid

folic acid Prenatal Vitamins and Supplements

docosahexaenoic acid OTC PRENATAL DHA prenatal vitamins fast dissolving tabs OTC CALNA

prenatal vitamins without A/ferrous fumarate/folic acid 9-0.267 mg OTC PRENATAL FORMULA A-FREE prenatal vitamins without A/iron polysaccharide complex/folic acid 155-1 mg OTC EZFE FORTE prenatal vitamins/carbonyl iron/folic acid tabs PRENATABS RX

prenatal vitamins/carbonyl iron/folic acid tabs PRENATAL PLUS IRON prenatal vitamins/docusate/ferrous fumarate/folic acid 29-1 mg † PRENATAL 19

prenatal vitamins/docusate/ferrous fumarate/folic acid ext-rel 90-1 mg MYNATE 90 PLUS prenatal vitamins/docusate/iron carbonyl/folic acid 90-1 mg † MYNATAL, MYNATAL ADVANCE prenatal vitamins/ferrous bisglycinate chelate/folic acid ATABEX OB, VINATE II

prenatal vitamins/ferrous bisglycinate/folic acid + omega-3 delayed-rel OTC BE WELL ROUNDED PAK prenatal vitamins/ferrous fumarate/folic acid 6.75-0.2 mg OTC PRENATAL TAB

prenatal vitamins/ferrous fumarate/folic acid 13.5-0.4 mg OTC PERRY PRENATAL prenatal vitamins/ferrous fumarate/folic acid 15-1 mg O-CAL PRENATAL

prenatal vitamins/ferrous fumarate/folic acid 27-0.8 mg + DHA 200 mg OTC CENTRUM SPECIALIST PRENATAL PAK, SIMILAC PRENATAL EARLY SHIELD

prenatal vitamins/ferrous fumarate/folic acid 27-1 mg + DHA 300 mg OTC THERANATAL COMPLETE

33

prenatal vitamins/ferrous fumarate/folic acid 27-1 mg † M-VIT, NIVA-PLUS, PRENATAL TAB 27-1 MG, PNV FOLIC ACID + IRON, O-CAL FA, PRENATAL VITAMIN TAB LOW IRON, PNV PRENATAL PLUS

prenatal vitamins/ferrous fumarate/folic acid 27-1 mg OTC, † THERANATAL

prenatal vitamins/ferrous fumarate/folic acid 28-0.975 mg + DHA 200 mg OTC COMPLETE PRENATAL + DHA, PRENATAL + DHA, PRENATAL + DHA WOMENS

prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 223 mg OTC ONE-A-DAY PRENATAL PAK prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 440 mg OTC ONE-A-DAY PRENATAL PAK, GNP

DAILY PRENATAL, RA ONE DAILY PRENATAL, SM ONE DAILY PRENATAL, HM ONE DAILY PRENATAL

prenatal vitamins/ferrous fumarate/folic acid 29-1 mg † CO-NATAL FA

prenatal vitamins/ferrous fumarate/folic acid 60-1 mg VINATE ONE, TRINATAL RX1 prenatal vitamins/ferrous fumarate/folic acid 65-1 mg VITAFOL-OB, MYNATAL-Z, MYNATAL

PLUS

prenatal vitamins/ferrous fumarate/folic acid 75-1 mg NATALVIT prenatal vitamins/ferrous fumarate/folic acid chew tabs 29-1 mg COMPLETENATE, SE-NATAL 19,

PRENATAL 19 prenatal vitamins/ferrous fumarate/folic acid/fish oil OTC PRENATAL OMEGA-3, YOUR LIFE

PRENATAL

prenatal vitamins/ferrous fumarate/folic acid/omega-3 27-0.8-228 mg OTC PRENATAL MULTI + DHA prenatal vitamins/ferrous fumarate/folic acid/omega-3 28-0.8-235 mg OTC PRENATAL FORMULA prenatal vitamins/ferrous fumarate/l-methylfolate/folic acid 27-0.5-0.5 mg † TL FOLATE

prenatal vitamins/ferrous succinate/folic acid OTC NUTRIENTS PRENATAL prenatal vitamins/iron carbonyl/folic acid 29-1 mg † PRENATAL + FE

prenatal vitamins/iron carbonyl/folic acid + DHA OTC BRAINSTRONG PRENATAL prenatal vitamins/l-methylfolate + fish oil/choline OTC PRENATAL DHA PAK MULTI prenatal vitamins/minerals/ferrous fumarate/folic acid/DHA OTC PRENATAL MULTI + DHA

prenatal vitamins/minerals/folic acid/fish oil chew tabs OTC CVS PRENATAL CHEW GUMMY prenatal vitamins/minerals/iron/folic acid 0.1 mg OTC KPN PRENATAL

prenatal vitamins/minerals/iron/folic acid 1 mg MYNATAL prenatal vitamins/selenium/ferrous fumarate/folic acid 9-0.5 mg OTC PRENATAL FORMULA

prenatal vitamins/selenium/ferrous fumarate/folic acid 27-1 mg VINATE M Miscellaneous

acidophilus/pectin OTC arginine OTC ascorbic acid OTC VITAMIN C

b-complex/vitamin c/folic acid caps OTC calcium OTC

calcium/vitamin D OTC cholecalciferol (D3) OTC VITAMIN D coenzyme Q10-vitamin E OTC LIQ-10

electrolyte soln, oral OTC PEDIALYTE ferrous fumarate OTC

ferrous gluconate OTC FERGON ferrous sulfate OTC, QL FEOSOL

inositol niacinate OTC NIACIN FLUSH FREE magnesium chloride ex-rel OTC SLOW-MAG magnesium oxide OTC MAG-OX 400

niacin OTC niacin ext-rel OTC

omega-3 fatty acids OTC FISH OIL omega-3 fatty acids OTC SEA-OMEGA pediatric multivitamin liquid OTC MULTI-DELYN, PEDIAVIT

34

polysaccharide iron complex caps, drops OTC NOVAFERRUM

polysaccharide iron complex/cholecalciferol liq OTC NOVAFERRUM pyridoxine 25 mg, 50 mg OTC VITAMIN B-6 riboflavin tabs 100 mg OTC VITAMIN B-2

tocopherols-tocotrienols OTC AQUA-E ubidecarenone OTC COENZYME Q10

ubiquinol liposomal OTC CYTO-Q vitamin E OTC VITAMIN E zinc OTC

cyanocobalamin inj ergocalciferol (D2)

ferrous fumarate/vitamin C/vitamin B12/folic acid FERROGELS FORTE ferrous fumarate/vitamin C/vitamin B12/folic acid FERROGELS FORTE SOFTGEL fluoride drops, tabs

multivitamins/fluoride drops, tabs multivitamins/fluoride/iron drops, tabs

phytonadione MEPHYTON polysaccharide iron forte

vitamin ADC/fluoride drops vitamin ADC/fluoride/iron drops vitamin B complex/vitamin C/folic acid NEPHROCAPS

zinc sulfate

RESPIRATORY

ANAPHYLAXIS TREATMENT AGENTS epinephrine QL EPIPEN

epinephrine QL EPIPEN JR. ANTICHOLINERGICS

ipratropium soln QL ipratropium, CFC-free aerosol QL ATROVENT HFA

umeclidinium QL INCRUSE ELLIPTA ANTICHOLINERGIC/BETA AGONIST COMBINATIONS Short Acting

ipratropium/albuterol soln QL ipratropium/albuterol, CFC-free aerosol QL COMBIVENT RESPIMAT

Long Acting

tiotropium/olodaterol PA STIOLTO RESPIMAT

umeclidinium/vilanterol QL ANORO ELLIPTA ANTIHISTAMINES, LOW SEDATING

cetirizine OTC ZYRTEC cetirizine

levocetirizine PA ANTIHISTAMINES, NONSEDATING

fexofenadine tabs 180 mg OTC ALLEGRA loratadine caps OTC, PA CLARITIN loratadine tabs OTC CLARITIN

ANTIHISTAMINES, SEDATING

chlorpheniramine OTC clemastine OTC diphenhydramine OTC BENADRYL

carbinoxamine PA

35

clemastine

cyproheptadine diphenhydramine hydroxyzine HCl

hydroxyzine pamoate VISTARIL ANTIHISTAMINE/DECONGESTANT COMBINATIONS

cetirizine/pseudoephedrine ext-rel OTC ZYRTEC-D 12 Hour fexofenadine/pseudoephedrine ext-rel OTC, PA ALLEGRA-D

loratadine/pseudoephedrine ext-rel OTC CLARITIN-D triprolidine/pseudoephedrine liq, syp OTC

acrivastine/pseudoephedrine SEMPREX-D chlorpheniramine/phenylephrine susp promethazine/phenylephrine

ANTITUSSIVES

dextromethorphan syrup 15 mg/5 mL OTC

benzonatate 100 mg. 200 mg QL TESSALON ANTITUSSIVE COMBINATIONS Opioid

codeine/guaifenesin liquid OTC

codeine/guaifenesin/pseudoephedrine OTC codeine/chlorpheniramine/phenylephrine PA CAPCOF codeine/promethazine

codeine/promethazine/phenylephrine hydrocodone/homatropine

Non-opioid

dextromethorphan/guaifenesin ext-rel OTC MUCINEX DM

dextromethorphan/guaifenesin liq, soln, syp OTC dextromethorphan/guaifenesin/pseudoephedrine liq 10 mg/100 mg/30 mg/5 mL OTC dextromethorphan/phenylephrine/chlorpheniramine/acetaminophen OTC ROBITUSSIN COLD/FLU

dextromethorphan/promethazine dextromethorphan/pyrilamine OTC CAPRON DM

BETA AGONISTS Inhalants Short Acting

albuterol soln QL albuterol sulfate, CFC-free aerosol QL, * PROAIR HFA

albuterol sulfate, CFC-free aerosol QL, * VENTOLIN HFA * Both brand and generic VENTOLIN HFA and PROAIR HFA are covered Long Acting Hand-held Active Inhalation

salmeterol xinafoate QL SEREVENT

Oral Agents

albuterol albuterol ext-rel metaproterenol

terbutaline CYSTIC FIBROSIS

aztreonam lysine inhalation soln PA CAYSTON dornase alfa PA, SP PULMOZYME

36

tobramycin inhalation powder PA, SP TOBI PODHALER

tobramycin inhalation soln PA, SP BETHKIS tobramycin inhalation soln PA, SP TOBI

DECONGESTANTS

phenylephrine OTC SUDAFED PE pseudoephedrine OTC SUDAFED

pseudoephedrine ext-rel OTC SUDAFED DECONGESTANT/EXPECTORANT COMBINATIONS

pseudoephedrine/guaifenesin ext-rel OTC MUCINEX D EXPECTORANTS

guaifenesin ext-rel OTC MUCINEX guaifenesin liq OTC DIABETIC TUSSIN

guaifenesin liq, syp, tabs OTC ROBITUSSIN LEUKOTRIENE MODULATORS

montelukast SINGULAIR montelukast granules ST * SINGULAIR

zafirlukast ACCOLATE zileuton ST * ZYFLO

zileuton ext-rel ST * ST * Requires prior use of inhaled corticosteroid therapy MAST CELL STABILIZERS

cromolyn sodium nasal spray OTC NASALCROM cromolyn soln for inhalation QL

MEDICAL SUPPLIES

mask OTC, QL MASK spacer OTC, QL AEROCHAMBER vaporizer OTC, QL VAPORIZER

peak flow meter TRUZONE peak flow meter sodium chloride for inhalation

NASAL ANTIHISTAMINES

azelastine spray QL

NASAL DECONGESTANTS

oxymetazoline spray OTC AFRIN

phenylephrine spray OTC NEO-SYNEPHRINE epinephrine nasal soln 0.1% ADRENALIN 1:1000

NASAL STEROIDS

fluticasone spray OTC FLONASE ALLERGY RELIEF

triamcinolone acetonide spray OTC, PA flunisolide spray QL fluticasone spray QL

PHOSPHODIESTERASE-4 INHIBITORS

roflumilast PA DALIRESP

RESPIRATORY SYNCYTIAL VIRUS

palivizumab PA, SP SYNAGIS

37

SEVERE ASTHMA AGENTS omalizumab PA, SP XOLAIR

STEROID/BETA AGONIST COMBINATIONS

budesonide/formoterol AL*, QL SYMBICORT

fluticasone/salmeterol QL AIRDUO RESPICLICK fluticasone/salmeterol QL WIXELA INHUB

* Covered for ages under 12 years old STEROID INHALANTS

beclomethasone breath-activated aerosol QL QVAR REDIHALER budesonide inhalation susp AL PULMICORT RESPULES

fluticasone furoate QL ARNUITY ELLIPTA fluticasone propionate, CFC-free aerosol 44 mcg, 110 mcg AL*, QL FLOVENT HFA mometasone QL ASMANEX TWISTHALER

mometasone, CFC-free aerosol QL ASMANEX HFA AL* Covered for ages 11 years old and under XANTHINES

aminophylline

theophylline elixir ELIXOPHYLLIN theophylline ext-rel caps THEO-24

theophylline ext-rel tabs theophylline liquid

XANTHINE COMBINATIONS

dyphylline/guaifenesin PA

MISCELLANEOUS

sodium chloride soln OTC OCEAN

acetylcysteine caffeine citrate soln AL*, QL ephedrine HCl OTC EPHEDRINE HCL

ipratropium nasal spray AL* Covered for ages 1 year old and under

TOPICAL

DERMATOLOGY Acne Oral

isotretinoin PA

Topical

adapalene gel 0.1% OTC, AL, QL DIFFERIN OTC

benzoyl peroxide OTC, AL adapalene AL, PA DIFFERIN

benzoyl peroxide AL clindamycin gel, lotion AL, QL, ST* CLEOCIN T clindamycin soln AL

clindamycin/benzoyl peroxide BENZACLIN erythromycin soln AL

sulfacetamide lotion 10% KLARON sulfacetamide/sulfur crm, gel, lotion, pads tretinoin crm 0.025%, 0.05%, 0.1% AL, ST** RETIN-A

tretinoin gel 0.01%, 0.025% AL, ST** RETIN-A

38

ST * Requires prior use of clindamycin soln or erythromycin soln ST ** Requires prior use of DIFFERIN OTC Actinic Keratosis

fluorouracil EFUDEX

fluorouracil soln Antibiotics

bacitracin/polymyxin B OTC POLYSPORIN neomycin/bacitracin/polymyxin B OTC NEOSPORIN

neomycin/bacitracin/polymyxin/pramoxine OTC NEOSPORIN+PN gentamicin mupirocin

polymyxin B/bacitracin POLYSPORIN silver sulfadiazine SILVADENE

Antifungals

clotrimazole 1% OTC

clotrimazole oint OTC, PA ALEVAZOL miconazole OTC FUNGOID TINCTURE

miconazole OTC MICATIN terbinafine OTC LAMISIL AT tolnaftate OTC TINACTIN

ciclopirox LOPROX ciclopirox topical soln 8% PENLAC

clotrimazole econazole ketoconazole crm, shampoo 2%

nystatin Anti-infective/Anti-inflammatory Combinations

neomycin/polymyxin B/bacitracin/hydrocortisone oint CORTISPORIN OINTMENT Antipsoriatics Topical

calcipotriene crm, oint, soln 0.005% DOVONEX

tazarotene crm 0.05%, gel 0.05%, 0.1% TAZORAC tazarotene crm 0.1% TAZORAC

Antiseborrheics

coal tar shampoo OTC NEUTROGENA

salicylic acid/sulfur shampoo OTC SEBULEX selenium sulfide shampoo 1% OTC SELSUN BLUE ketoconazole shampoo 2% NIZORAL SHAMPOO

sulfacetamide sodium Atopic Dermatitis Topical

pimecrolimus PA ELIDEL

tacrolimus PA PROTOPIC Corticosteroids Low Potency

hydrocortisone crm, gel, lotion, oint, soln 1% OTC CORTIZONE-10 hydrocortisone oint 0.5% OTC

hydrocortisone/aloe vera crm 0.5%, 1% OTC alclometasone crm, oint 0.05% QL

39

desonide crm, oint 0.05% QL DESOWEN

desonide lotion 0.05% PA, QL DESOWEN fluocinolone acetonide soln 0.01% hydrocortisone crm, lotion, oint 2.5%

Medium Potency

betamethasone valerate crm, lotion, oint 0.1%

desoximetasone crm 0.05% TOPICORT LP fluocinolone acetonide crm, oint 0.025%

fluocinolone acetonide oil 0.01% DERMA-SMOOTHE-FS flurandrenolide tape CORDRAN

fluticasone propionate crm 0.05%, oint 0.005% CUTIVATE hydrocortisone butyrate crm, oint, soln 0.1% LOCOID hydrocortisone valerate crm, oint 0.2%

mometasone crm, oint 0.1% QL ELOCON mometasone lotion 0.1% ELOCON

prednicarbate crm, oint 0.1% PA triamcinolone acetonide crm, lotion, oint 0.025% triamcinolone acetonide crm, lotion, oint 0.1%

High Potency

amcinonide crm, lotion, oint 0.1%

betamethasone dipropionate augmented crm 0.05% DIPROLENE AF betamethasone dipropionate augmented lotion 0.05% QL DIPROLENE

betamethasone dipropionate crm, lotion, oint 0.05% QL desoximetasone crm 0.25% TOPICORT diflorasone diacetate crm 0.05%

diflorasone diacetate emollient crm 0.05% fluocinonide crm 0.05% QL

fluocinonide gel, oint 0.05% fluocinonide soln 0.05% QL

triamcinolone acetonide crm, oint 0.5% Very High Potency

betamethasone dipropionate augmented gel, oint 0.05% QL DIPROLENE clobetasol propionate crm, gel, oint, soln 0.05% TEMOVATE clobetasol propionate foam 0.05% OLUX

clobetasol propionate shampoo 0.05% CLOBEX diflorasone diacetate oint 0.05%

Emollients

emollient lotion OTC DML

mineral oil-hydrophilic petrolatum OTC PETROLATUM ammonium lactate 12% LAC-HYDRIN

Local Analgesics

lidocaine patch 4% OTC, QL LIDOCARE

lidocaine patch 5% PA LIDODERM Local Anesthetics

lidocaine crm 4% OTC LMX 4 lidocaine 5% crm lidocaine/prilocaine

Rosacea

metronidazole crm 0.75% METROCREAM metronidazole gel 0.75% metronidazole gel 1% METROGEL

40

metronidazole lotion 0.75% METROLOTION

sulfacetamide/sulfur Scabicides and Pediculicides

permethrin OTC pyrethrins/piperonyl butoxide OTC RID SHAMPOO crotamiton crm EURAX

crotamiton lotion EURAX malathion OVIDE

permethrin spinosad NATROBA

Wound Care Agents

becaplermin PA REGRANEX

Miscellaneous Skin and Mucous Membrane

aluminum hydroxide OTC DERMAGRAN

calamine lotion OTC capsaicin OTC ZOSTRIX capsaicin/menthol/methyl salicylate OTC ZIKS

dimethicone 1% crm OTC 4-N-1 CREAM diphenhydramine/zinc acetate OTC BENADRYL

docosanol OTC ABREVA lidocaine OTC BACTINE

nail scrub OTC NAIL SCRUB LIQ W/BRUSH povidone-iodine OTC BETADINE salicylic acid OTC

sodium chloride soln OTC zinc acetate OTC DERMAFIX

acyclovir crm, oint 5% PA ZOVIRAX bexarotene gel TARGRETIN collagen/lidocaine/aloe vera/vit E REGENECARE

collagenase PA, QL SANTYL imiquimod PA ALDARA

mafenide SULFAMYLON podofilox soln CONDYLOX trypsin/balsam/castor oil

MOUTH/THROAT/DENTAL AGENTS Anesthetics - Topical Oral

lidocaine viscous Steroids - Mouth/Throat

triamcinolone paste Miscellaneous

chlorhexidine PERIDEX sodium fluoride PREVIDENT 5000

OPHTHALMIC Antiallergics

ketotifen OTC, QL azelastine PA cromolyn sodium

phenylephrine Antifungals

natamycin NATACYN

41

Anti-infectives

bacitracin ciprofloxacin ophth oint CILOXAN ciprofloxacin ophth soln CILOXAN

erythromycin gentamicin

levofloxacin 0.5% moxifloxacin PA VIGAMOX

neomycin/polymyxin B/gramicidin ofloxacin OCUFLOX polymyxin B/bacitracin

polymyxin B/trimethoprim POLYTRIM sulfacetamide soln 10% BLEPH-10

tobramycin TOBREX tobramycin oint TOBREX tobramycin soln TOBREX

Anti-infective/Anti-inflammatory Combinations

gentamicin/prednisolone acetate PRED-G

neomycin/polymyxin B/bacitracin/hydrocortisone oint neomycin/polymyxin B/dexamethasone MAXITROL

neomycin/polymyxin B/hydrocortisone susp sulfacetamide/prednisolone phosphate 10%/0.25%

tobramycin/dexamethasone oint 0.3%/0.1% TOBRADEX tobramycin/dexamethasone susp 0.3%/0.05% TOBRADEX ST tobramycin/dexamethasone susp 0.3%/0.1% TOBRADEX

Anti-inflammatories Nonsteroidal

bromfenac sodium PA diclofenac sodium flurbiprofen

ketorolac 0.4% ACULAR LS ketorolac 0.5% ACULAR

Steroidal

dexamethasone MAXIDEX

dexamethasone sodium phosphate fluorometholone 0.1% susp FML LIQUIFILM

fluorometholone 0.25% FML FORTE prednisolone acetate 0.12% PRED MILD prednisolone acetate 1% PRED FORTE

prednisolone phosphate 1% Antivirals

ganciclovir PA ZIRGAN trifluridine

Beta-blockers Nonselective

carteolol levobunolol timolol hemihydrate BETIMOL

timolol maleate TIMOPTIC timolol maleate gel TIMOPTIC-XE

42

Selective betaxolol 0.25% BETOPTIC S

betaxolol 0.5% Carbonic Anhydrase Inhibitors Topical

brinzolamide AZOPT

dorzolamide TRUSOPT Carbonic Anhydrase Inhibitor/Beta-blocker Combinations

dorzolamide/timolol maleate COSOPT Dry Eye Disease

lifitegrast ST* XIIDRA ST * Requires prior use of OTC lubricant and ointment Immunomodulators

cyclosporine RESTASIS

Mydriatics

atropine

cyclopentolate CYCLOGYL cyclopentolate/phenylephrine CYCLOMYDRIL

homatropine tropicamide

Parasympathomimetics

pilocarpine ISOPTO CARPINE Prostaglandins

latanoprost XALATAN Sympathomimetics

brimonidine 0.15% ALPHAGAN P

Sympathomimetic/Beta-blocker Combinations

brimonidine/timolol COMBIGAN

Miscellaneous

artificial tears OTC ARTIFICIAL TEARS

carboxymethylcellulose sodium OTC REFRESH sodium chloride OTC MURO-128 echothiophate iodide PHOSPHOLINE IODIDE

naphazoline 0.1% proparacaine 0.5%

tetracaine 0.5% OTIC Anti-infectives

acetic acid ciprofloxacin otic CETRAXAL

ofloxacin otic Anti-infective/Anti-inflammatory Combinations

acetic acid/hydrocortisone neomycin/polymyxin B/hydrocortisone CORTISPORIN OTIC

43

Miscellaneous carbamide peroxide 6.5% OTC DEBROX

fluocinolone acetonide DERMOTIC VAGINAL

acetic acid soln OTC

44

NON-DISCRIMINATION STATEMENT

45

46

INDEX

4 4-N-1 CREAM, 40

A abacavir, 9 abacavir/dolutegravir/lamivudine, 8 abacavir/lamivudine, 8 abacavir/lamivudine/zidovudine, 8 abaloparatide, 23 ABILIFY, 18 ABILIFY MAINTENA, 18 ABREVA, 40 ABSTRAL, 6 acamprosate calcium, 20 acarbose, 21 ACCOLATE, 36 ACCUPRIL, 12 ACCURETIC, 12 acebutolol, 14 acetaminophen, 6 acetazolamide, 15 acetazolamide ext-rel, 15 acetic acid, 42 acetic acid soln, 43 acetic acid/hydrocortisone, 42 acetohydroxamic acid, 30 acetylcysteine, 37 acidophilus/pectin, 33 acrivastine/pseudoephedrine, 35 ACTIGALL, 27 ACTIMMUNE, 31 ACTIQ, 6 ACTIVELLA, 25 ACTOPLUS MET, 22 ACTOPLUS MET XR, 22 ACTOS, 22 ACULAR, 41 ACULAR LS, 41 acyclovir caps, susp, tabs, 10 acyclovir crm, oint 5%, 40 ADALAT CC, 14 adalimumab, 31 adapalene, 37 adapalene gel 0.1%, 37 ADDERALL, 19 ADDERALL XR, 19 adefovir dipivoxil, 10 ADEMPAS, 16 ADMELOG, 22 ADMELOG SOLOSTAR, 22 ADRENALIN 1

1000, 36 ADVATE, 30 ADVIL, 6 AEROCHAMBER, 36 afatinib, 11 AFINITOR, 11 AFINITOR DISPERZ, 12 AFREZZA, 22 AFRIN, 36 AGGRENOX, 30 AGRYLIN, 31

AIRDUO RESPICLICK, 37 albendazole, 10 ALBENZA, 10 albuterol, 35 albuterol ext-rel, 35 albuterol soln, 35 albuterol sulfate, CFC-free aerosol, 35 alclometasone crm, oint 0.05%, 38 alcohol swabs, 23 ALDACTAZIDE, 15 ALDACTONE, 13 ALDARA, 40 aldesleukin, 12 alendronate soln, 23 alendronate tabs, 23 ALEVAZOL, 38 ALEVE, 6 alfuzosin ext-rel, 29 ALINIA, 10 ALKERAN, 11 ALLEGRA, 34 ALLEGRA-D, 35 allopurinol, 6 almotriptan, 19 alogliptin, 21 alogliptin/metformin, 21 alogliptin/pioglitazone, 21 ALORA, 25 alosetron, 28 ALPHAGAN P, 42 alprazolam, 16 alprazolam ext-rel, 16 ALTACE, 12 alumina/magnesia, 26 alumina/magnesia/simethicone, 26 aluminum hydroxide, 26, 40 amantadine, 18 AMARYL, 22 AMBIEN, 19 ambrisentan, 16 amcinonide crm, lotion, oint 0.1%, 39 AMERGE, 19 AMETHIA LO, 24 AMICAR, 31 amiloride, 15 amiloride/hydrochlorothiazide, 15 aminocaproic acid soln, 31 aminocaproic acid tabs, 31 aminophylline, 37 amiodarone, 13 AMITIZA, 28 amitriptyline, 17 amlodipine, 14 amlodipine/benazepril, 12 amlodipine/olmesartan, 13 amlodipine/valsartan, 13 amlodipine/valsartan/hydrochlorothiazide, 13 ammonium lactate 12%, 39 amoxapine, 18 amoxicillin, 8 amoxicillin/clavulanate 200 mg/5 mL, 400 mg/5 mL, 8 amoxicillin/clavulanate chew tabs, tabs, 8 amphetamine/dextroamphetamine mixed salts, 19

47

amphetamine/dextroamphetamine mixed salts ext-rel, 19 ampicillin, 8 AMPYRA, 20 ANADROL-50, 21 ANAFRANIL, 16 anagrelide, 31 ANASPAZ, 27 anastrozole, 11 ANDROGEL, 21 ANORO ELLIPTA, 34 ANTABUSE, 20 antihemophilic factor, recombinant, 30 antihemophilic factor/von Willebrand factor complex (human), 30 ANUSOL-HC 2.5%, 29 apixaban, 30 APLENZIN, 18 apremilast, 31 aprepitant caps, 27 aprepitant susp, 27 APRI, 23 APRISO, 27 APTIVUS, 9 AQUA-E, 34 ARANESP, 30 ARAVA, 31 ARCALYST, 32 arginine, 33 ARICEPT, 17 ARIMIDEX, 11 aripiprazole, 18 aripiprazole ext-rel inj, 18 aripiprazole lauroxil ext-rel inj, 18 ARISTADA, 18 ARISTADA INITIO, 18 ARIXTRA, 30 armodafinil, 20 ARMOUR THYROID, 26 ARNUITY ELLIPTA, 37 AROMASIN, 11 artemether/lumefantrine, 8 ARTHROTEC, 6 artificial tears, 42 ARTIFICIAL TEARS, 42 ASACOL HD, 27 ascorbic acid, 33 asenapine, 18 ASMANEX HFA, 37 ASMANEX TWISTHALER, 37 aspirin, 30 ATABEX OB, 32 ATACAND, 13 ATACAND HCT, 13 atazanavir caps, 9 atazanavir powder, 9 atazanavir/cobicistat, 8 atenolol, 14 atenolol/chlorthalidone, 14 ATGAM, 31 ATIVAN, 16 atomoxetine, 19 atorvastatin 10 mg, 20 mg, 40 mg, 14 atorvastatin 80 mg, 14 atovaquone, 10 atovaquone/proguanil, 8 atropine, 42 ATROVENT HFA, 34

AUBAGIO, 20 AUGMENTIN, 8 auranofin, 31 AVALIDE, 13 AVAPRO, 13 AVELOX, 8 AVODART, 29 AVONEX, 20 axitinib, 11 AYGESTIN, 26 AZASAN, 32 azathioprine, 32 azelastine, 40 azelastine spray, 36 azithromycin, 7 AZOPT, 42 AZOR, 13 aztreonam lysine inhalation soln, 35 AZULFIDINE, 27 AZULFIDINE EN-TABS, 27

B bacitracin, 41 bacitracin/polymyxin B, 38 baclofen 10 mg, 20 mg, 20 BACTINE, 40 balsalazide, 27 BANZEL, 17 BARACLUDE, 10 BASAGLAR, 22 b-complex/vitamin c/folic acid caps, 33 BE WELL ROUNDED PAK, 32 becaplermin, 40 beclomethasone breath-activated aerosol, 37 bedaquiline, 9 BENADRYL, 34, 40 benazepril, 12 benazepril/hydrochlorothiazide, 12 BENEFIX, 30 BENICAR, 13 BENICAR HCT, 13 BENTYL, 27 BENZACLIN, 37 benzonatate 100 mg. 200 mg, 35 benzoyl peroxide, 37 benztropine, 18 BETADINE, 40 betamethasone dipropionate augmented crm 0.05%, 39 betamethasone dipropionate augmented gel, oint 0.05%, 39 betamethasone dipropionate augmented lotion 0.05%, 39 betamethasone dipropionate crm, lotion, oint 0.05%, 39 betamethasone valerate crm, lotion, oint 0.1%, 39 BETAPACE, 13 BETAPACE AF, 13 betaxolol, 14 betaxolol 0.25%, 41 betaxolol 0.5%, 42 bethanechol, 30 BETHKIS, 36 BETIMOL, 41 BETOPTIC S, 41 bexarotene caps, 12 bexarotene gel, 40 bicalutamide, 11 bictegravir/emtricitabine/tenofovir alafenamide, 8 BIDIL, 15

48

BIKTARVY, 8 BILTRICIDE, 10 bisacodyl, 28 bisacodyl enema, 28 bismuth subsalicylate, 26 bisoprolol, 14 bisoprolol/hydrochlorothiazide, 14 BLEPH-10, 41 blood glucose monitoring kits, 23 blood glucose test strips, 23 BONIVA, 23 bosentan, 16 BOSULIF, 11 bosutinib, 11 BRAINSTRONG PRENATAL, 33 brimonidine 0.15%, 42 brimonidine/timolol, 42 brinzolamide, 42 bromfenac sodium, 41 bromocriptine, 18 budesonide delayed-rel caps, 27 budesonide inhalation susp, 37 budesonide/formoterol, 37 bumetanide, 15 BUNAVAIL, 20 BUPHENYL, 26 buprenorphine ext-rel inj, 20 buprenorphine sublingual, 20 buprenorphine/naloxone buccal film, 20 buprenorphine/naloxone sublingual film, 20 buprenorphine/naloxone sublingual tabs, 20 bupropion, 18 bupropion ext-rel, 18, 21 buspirone, 16 busulfan, 11 butalbital/acetaminophen 50/325 mg, 7 butalbital/acetaminophen/caffeine 50/325/40 mg, 7 butalbital/acetaminophen/caffeine/codeine 50/325/40/30 mg, 6 butalbital/aspirin/caffeine, 7 butorphanol nasal spray, 6

C cabergoline, 26 cabozantinib, 11 CAFERGOT, 19 caffeine citrate soln, 37 calamine lotion, 40 CALAN SR, 15 calcipotriene crm, oint, soln 0.005%, 38 calcitonin-salmon spray, 23 calcitriol (1,25-D3), 25 calcium, 33 calcium acetate, 25 calcium carbonate, 26 calcium/vitamin D, 33 CALNA, 32 CAMRESE LO, 24 canakinumab, 32 CANASA, 28 candesartan, 13 candesartan/hydrochlorothiazide, 13 CAPCOF, 35 capecitabine, 11 CAPRELSA, 12 CAPRON DM, 35 capsaicin, 40

capsaicin/menthol/methyl salicylate, 40 captopril, 12 captopril/hydrochlorothiazide, 12 CARAFATE, 29 carbamazepine, 16 carbamazepine ext-rel, 16, 20 carbamide peroxide 6.5%, 42 CARBATROL, 16 carbidopa/levodopa, 18 carbidopa/levodopa ext-rel, 18 carbidopa/levodopa/entacapone, 18 carbinoxamine, 34 carboxymethylcellulose sodium, 42 CARDIZEM, 15 CARDIZEM CD, 15 CARDIZEM LA, 15 CARDURA, 13, 29 CARDURA XL, 29 CARIMUNE, 31 carisoprodol/aspirin, 20 carisoprodol/aspirin/codeine, 20 CARNITOR, 23 carteolol, 41 carvedilol, 14 CASODEX, 11 CATAPRES, 12 CATAPRES TTS, 12 CAYSTON, 35 CAZIANT, 24 cefaclor, 7 CEFACLOR ER, 7 cefaclor ext-rel, 7 cefadroxil, 7 cefdinir, 7 cefpodoxime, 7 cefprozil, 7 cefuroxime axetil, 7 CELEBREX, 6 celecoxib, 6 CELEXA, 17 CELLCEPT, 32 CELONTIN, 17 CENTRUM SPECIALIST PRENATAL PAK, 32 cephalexin caps 250 mg, 500 mg, 7 cephalexin caps 750 mg, 7 cephalexin susp, 7 cetirizine, 34 cetirizine/pseudoephedrine ext-rel, 35 CETRAXAL, 42 cevimeline, 29 CHANTIX, 21 CHEMET, 31 chlorambucil, 11 chlordiazepoxide, 16 chlordiazepoxide/amitriptyline, 18 chlorhexidine, 40 chloroquine, 8 chlorothiazide, 15 chlorpheniramine, 34 chlorpheniramine/phenylephrine susp, 35 chlorpromazine, 19 chlorthalidone, 15 chlorzoxazone 500 mg, 20 CHOLBAM, 29 cholecalciferol (D3), 33 cholestyramine, 13

49

cholic acid, 29 choline fenofibrate delayed-rel 45 mg, 13 ciclopirox, 38 ciclopirox topical soln 8%, 38 cilostazol, 31 CILOXAN, 41 CIMDUO, 9 cimetidine, 27 cinacalcet, 23 CIPRO, 8 ciprofloxacin, 8 ciprofloxacin ophth oint, 41 ciprofloxacin ophth soln, 41 ciprofloxacin otic, 42 citalopram, 17 CITRUCEL, 28 clarithromycin, 7 clarithromycin ext-rel, 7 CLARITIN, 34 CLARITIN-D, 35 clemastine, 34 CLEOCIN, 10, 29 CLEOCIN T, 37 CLIMARA, 25 clindamycin, 10, 29 clindamycin crm, 29 clindamycin gel, lotion, 37 clindamycin soln, 37 clindamycin vaginal supp, 29 clindamycin/benzoyl peroxide, 37 CLINDESSE, 29 clobazam, 17 clobetasol propionate crm, gel, oint, soln 0.05%, 39 clobetasol propionate foam 0.05%, 39 clobetasol propionate shampoo 0.05%, 39 CLOBEX, 39 clomipramine, 16 clonazepam tabs, 16 clonidine, 12 clonidine ext-rel, 19 clonidine transdermal, 12 clopidogrel, 30 clorazepate, 16 clotrimazole, 29, 38 clotrimazole 1%, 38 clotrimazole oint, 38 clotrimazole troches, 8 clozapine, 18 CLOZARIL, 18 coal tar shampoo, 38 COARTEM, 8 cobicistat, 8 codeine sulfate, 6 codeine/acetaminophen, 6 codeine/chlorpheniramine/phenylephrine, 35 codeine/guaifenesin liquid, 35 codeine/guaifenesin/pseudoephedrine, 35 codeine/promethazine, 35 codeine/promethazine/phenylephrine, 35 COENZYME Q10, 34 coenzyme Q10-vitamin E, 33 COLACE, 28 colchicine tabs, 6 colchicine/probenecid, 6 COLCRYS, 6 COLESTID, 13

colestipol packets, tabs, 13 collagen/lidocaine/aloe vera/vit E, 40 collagenase, 40 COLYTE, 28 COLYTE FLAVORED, 28 COMBIGAN, 42 COMBIVENT RESPIMAT, 34 COMBIVIR, 9 COMETRIQ, 11 COMPLERA, 9 COMPLETE PRENATAL + DHA, 33 COMPLETENATE, 33 COMTAN, 18 CO-NATAL FA, 33 CONCERTA, 19 condoms, male, 24 CONDYLOX, 40 conjugated estrogens/bazedoxifene, 25 COPAXONE, 20 CORDRAN, 39 COREG, 14 CORGARD, 14 CORTEF, 25 CORTIFOAM, 28 cortisone acetate, 25 CORTISPORIN OINTMENT, 38 CORTISPORIN OTIC, 42 CORTIZONE-10, 38 COSOPT, 42 COUMADIN, 30 COZAAR, 13 CREON, 28 CRESTOR, 14 CRINONE, 26 CRIXIVAN, 9 cromolyn sodium, 29, 40 cromolyn sodium nasal spray, 36 cromolyn soln for inhalation, 36 crotamiton crm, 40 crotamiton lotion, 40 CUPRIMINE, 31 CUTIVATE, 39 CUVPOSA, 29 CVS PRENATAL CHEW GUMMY, 33 cyanocobalamin inj, 34 cyclobenzaprine 5 mg, 10 mg, 20 CYCLOGYL, 42 CYCLOMYDRIL, 42 cyclopentolate, 42 cyclopentolate/phenylephrine, 42 cyclophosphamide caps, 11 cycloserine, 10 cyclosporine, 32, 42 cyclosporine, modified, 32 CYMBALTA, 17 cyproheptadine, 35 CYTOGAM, 31 cytomegalovirus immune globulin, 31 CYTOMEL, 26 CYTO-Q, 34 CYTOTEC, 28 CYTRA-2, 30 CYTRA-3, 30 CYTRA-K, 30

50

D dabrafenib, 11 dalfampridine ext-rel, 20 DALIRESP, 36 dalteparin, 30 danazol, 24 DANTRIUM, 20 dantrolene, 20 dapsone, 10 darbepoetin alfa, 30 darunavir, 9 darunavir/cobicistat, 8 dasatinib, 11 DAYPRO, 6 DDAVP, 26 DEBROX, 42 deferasirox, 31 DELATESTRYL, 21 DELZICOL, 27 DEMADEX, 15 DEMSER, 16 denosumab, 23 DEPAKENE, 17 DEPAKOTE, 17 DEPAKOTE ER, 17 DEPEN TITRA, 31 DEPO-PROVERA, 24 DEPO-TESTOSTERONE, 21 DERMAFIX, 40 DERMAGRAN, 40 DERMA-SMOOTHE-FS, 39 DERMOTIC, 43 DESCOVY, 9 desipramine, 18 desmopressin spray, 26 desmopressin spray, tabs, 26 desogestrel/EE, 24 desogestrel/EE 0.15/30, 23 desonide crm, oint 0.05%, 38 desonide lotion 0.05%, 38 DESOWEN, 38 desoximetasone crm 0.05%, 39 desoximetasone crm 0.25%, 39 DETROL, 29 DETROL LA, 29 dexamethasone, 25, 41 dexamethasone concentrate 1 mg/mL, 25 DEXAMETHASONE INTENSOL, 25 dexamethasone sodium phosphate, 41 DEXEDRINE SPANSULE, 19 dexmethylphenidate, 19 dexmethylphenidate ext-rel, 19 dextroamphetamine 5 mg, 10 mg, 19 dextroamphetamine ext-rel, 19 dextromethorphan syrup 15 mg/5 mL, 35 dextromethorphan/guaifenesin ext-rel, 35 dextromethorphan/guaifenesin liq, soln, syp, 35 dextromethorphan/guaifenesin/pseudoephedrine liq 10 mg/100 mg/30

mg/5 mL, 35 dextromethorphan/phenylephrine/chlorpheniramine/acetaminophen, 35 dextromethorphan/promethazine, 35 dextromethorphan/pyrilamine, 35 dextromethorphan/quinidine, 21 dextrose/fructose/phosphoric acid, 27 DIABETIC TUSSIN, 36 DIASTAT, 17

diazepam, 16 diazepam rectal gel, 17 diazoxide, 25 diclofenac potassium, 6 diclofenac sodium, 41 diclofenac sodium delayed-rel, 6 diclofenac sodium delayed-rel/misoprostol, 6 diclofenac sodium ext-rel, 6 diclofenac sodium gel 1%, 6 dicloxacillin, 8 dicyclomine, 27 didanosine delayed-rel, 9 didanosine soln, 9 DIFFERIN, 37 DIFFERIN OTC, 37 diflorasone diacetate crm 0.05%, 39 diflorasone diacetate emollient crm 0.05%, 39 diflorasone diacetate oint 0.05%, 39 DIFLUCAN, 8 diflunisal, 6 digoxin, 15 digoxin ped elixir, 15 dihydroergotamine spray, 19 DILANTIN, 17 DILANTIN INFATABS, 17 DILAUDID, 6 DILAUDID-5, 6 diltiazem, 15 diltiazem ext-rel, 15 diltiazem ext-rel, except 120 mg, 15 dimenhydrinate, 27 dimethicone 1% crm, 40 dimethyl fumarate delayed-rel, 20 DIOVAN, 13 DIOVAN HCT, 13 DIPENTUM, 27 diphenhydramine, 34, 35 diphenhydramine/zinc acetate, 40 diphenoxylate/atropine, 26 DIPROLENE, 39 DIPROLENE AF, 39 dipyridamole ext-rel/aspirin, 30 dipyridamole tabs, 30 disopyramide, 13 disopyramide ext-rel, 13 disulfiram, 20 DITROPAN XL, 29 divalproex sodium delayed-rel, 17 divalproex sodium ext-rel, 17 DML, 39 docosahexaenoic acid, 32 docosanol, 40 docusate calcium, 28 docusate sodium, 28 dofetilide, 13 dolutegravir, 9 dolutegravir/rilpivirine, 8 donepezil, 17 dornase alfa, 35 dorzolamide, 42 dorzolamide/timolol maleate, 42 DOVONEX, 38 doxazosin, 13, 29 doxazosin ext-rel, 29 doxepin, 18 doxercalciferol, 25

51

doxycycline calcium syrup, 8 doxycycline hyclate caps 50 mg, 100 mg, 8 doxycycline hyclate tabs 20 mg, 100 mg, 8 doxycycline monohydrate, 8 DRAMAMINE, 27 dronabinol, 27 dronedarone, 13 drospirenone/EE 3/30, 23 DROXIA, 12 DUAVEE, 25 DUETACT, 22 DULCOLAX, 28 duloxetine delayed-rel 20 mg, 30 mg, 60 mg, 17 DURAGESIC, 6 dutasteride, 29 dutasteride/tamsulosin, 29 DYAZIDE, 15 dyphylline/guaifenesin, 37

E E.E.S., 7 echothiophate iodide, 42 econazole, 38 eculizumab, 30 EDURANT, 9 EE/norethindrone acetate, 25 EE/norethindrone acetate 0.5 mg/2.5 mcg, 25 efavirenz, 9 efavirenz/lamivudine/tenofovir disoproxil fumarate, 8 EFFEXOR XR, 17 EFFIENT, 30 EFUDEX, 38 electrolyte soln, oral, 33 ELIDEL, 38 ELIQUIS, 30 ELIXOPHYLLIN, 37 ELLA, 24 ELMIRON, 30 ELOCON, 39 eltrombopag, 31 elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide, 9 elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate, 9 EMCYT, 11 EMEND, 27 EMETROL, 27 emollient lotion, 39 emtricitabine, 9 emtricitabine/rilpivirine/tenofovir alafenamide, 9 emtricitabine/rilpivirine/tenofovir disoproxil fumarate, 9 emtricitabine/tenofovir alafenamide, 9 emtricitabine/tenofovir disoproxil fumarate, 9 EMTRIVA, 9 enalapril, 12 enalapril/hydrochlorothiazide, 12 ENBREL, 31 ENDOMETRIN, 26 enfuvirtide, 9 enoxaparin, 30 entacapone, 18 entecavir soln, 10 entecavir tabs, 10 ENTOCORT EC, 27 EPCLUSA, 10 ephedrine HCl, 37 EPHEDRINE HCL, 37 epinephrine, 34

epinephrine nasal soln 0.1%, 36 EPIPEN, 34 EPIPEN JR., 34 EPIVIR, 9 EPIVIR-HBV, 10 eplerenone, 13 epoetin alfa, 30 EPOGEN, 30 epoprostenol, 16 epoprostenol sodium, 16 eprosartan, 13 EPZICOM, 8 EQUETRO, 20 ergocalciferol (D2), 34 ergotamine/caffeine, 19 erlotinib, 11 ertugliflozin, 22 ertugliflozin/metformin, 22 ERYPED, 7 ERY-TAB, 7 ERYTHROCIN, 7 erythromycin, 41 erythromycin delayed-rel, 7 erythromycin ethylsuccinate, 7 erythromycin ethylsuccinate 200 mg/5 mL, 7 erythromycin soln, 37 erythromycin stearate, 7 escitalopram soln, 17 escitalopram tabs, 17 ESGIC, 7 esomeprazole magnesium delayed-rel, 28 estazolam, 19 ESTRACE, 24 ESTRACE CREAM, 25 estradiol, 24, 25 estradiol vaginal crm, 25 estradiol vaginal tabs, 25 estradiol/norethindrone acetate, 25 estradiol/norgestimate, 25 estramustine, 11 estrogens, esterified, 24 etanercept, 31 ethambutol, 10 ethionamide, 10 ethosuximide, 17 ethotoin, 17 ethynodiol diacetate/EE 1/35, 23 ethynodiol diacetate/EE 1/50, 23 etodolac, 6 etodolac ext-rel, 6 etonogestrel implant, 24 etonogestrel/EE ring, 24 etoposide, 12 etravirine, 9 EURAX, 40 everolimus, 11 everolimus tablets for oral suspension, 12 EVISTA, 26 evolocumab, 14 EVOTAZ, 8 EVOXAC, 29 exemestane, 11 EXFORGE, 13 EXFORGE HCT, 13 EXJADE, 31 EXTAVIA, 20

52

ezetimibe, 13 EZFE FORTE, 32

F factor IX concentrate, 30 famciclovir, 10 famotidine, 27 FANAPT, 18 FARESTON, 11 febuxostat, 6 felbamate, 17 FELBATOL, 17 FELDENE, 6 felodipine ext-rel, 14 FEMARA, 11 FEMHRT, 25 fenofibrate caps 150 mg, 13 fenofibrate tabs 145 mg, 14 fenofibrate tabs 48 mg, 14 fenofibrate tabs 54 mg, 160 mg, 14 fenoprofen 600 mg, 6 fentanyl citrate buccal, 6 fentanyl lozenge, 6 fentanyl sublingual, 6 fentanyl transdermal, 6 FENTORA, 6 FEOSOL, 33 FERGON, 33 FERROGELS FORTE, 34 FERROGELS FORTE SOFTGEL, 34 ferrous fumarate, 33 ferrous fumarate/vitamin C/vitamin B12/folic acid, 34 ferrous gluconate, 33 ferrous sulfate, 33 fexofenadine tabs 180 mg, 34 fexofenadine/pseudoephedrine ext-rel, 35 filgrastim, 30 filgrastim-sndz, 30 finasteride 5 mg, 29 fingolimod, 20 FIORINAL, 7 FIRST-PROGESTERONE VGS, 26 FIRVANQ, 11 FISH OIL, 33 FLAGYL, 10 FLEBOGAMMA, 31 flecainide, 13 FLEET, 28 FLEET MINERAL OIL ENEMA, 28 FLOLAN, 16 FLOMAX, 29 FLONASE ALLERGY RELIEF, 36 FLOVENT HFA, 37 fluconazole, 8 fludrocortisone, 25 FLUMADINE, 10 flunisolide spray, 36 fluocinolone acetonide, 43 fluocinolone acetonide crm, oint 0.025%, 39 fluocinolone acetonide oil 0.01%, 39 fluocinolone acetonide soln 0.01%, 39 fluocinonide crm 0.05%, 39 fluocinonide gel, oint 0.05%, 39 fluocinonide soln 0.05%, 39 fluoride drops, tabs, 34 fluorometholone 0.1% susp, 41

fluorometholone 0.25%, 41 fluorouracil, 38 fluorouracil soln, 38 fluoxetine caps 10 mg, 20 mg, 40 mg, 17 fluphenazine, 19 flurandrenolide tape, 39 flurbiprofen, 6, 41 flutamide, 11 fluticasone furoate, 37 fluticasone propionate crm 0.05%, oint 0.005%, 39 fluticasone propionate, CFC-free aerosol 44 mcg, 110 mcg, 37 fluticasone spray, 36 fluticasone/salmeterol, 37 fluvoxamine, 16 FML FORTE, 41 FML LIQUIFILM, 41 FOCALIN, 19 FOCALIN XR, 19 folic acid, 32 fondaparinux, 30 FORTESTA, 21 FOSAMAX, 23 fosamprenavir susp, 9 fosamprenavir tabs, 9 fosinopril, 12 fosinopril/hydrochlorothiazide, 12 FOSRENOL, 25 FRAGMIN, 30 FUNGOID TINCTURE, 38 FURADANTIN, 10 furosemide, 15 FUZEON, 9 FYCOMPA, 17

G gabapentin, 17 GABITRIL, 17 galantamine, 17 galantamine ext-rel, 17 GAMASTAN S/D, 31 GAMMAGARD, 31 GAMUNEX-C, 31 ganciclovir, 41 GASTROCROM, 29 gemfibrozil, 14 gentamicin, 38, 41 gentamicin/prednisolone acetate, 41 GENVOYA, 9 GEODON, 18 GILENYA, 20 GILOTRIF, 11 glatiramer 20 mg/mL, 20 GLEEVEC, 12 GLEOSTINE, 11 glimepiride, 22 glipizide, 22 glipizide ext-rel, 22 glipizide/metformin, 21 GLUCAGEN HYPOKIT, 25 GLUCAGON EMERGENCY KIT, 25 glucagon, human recombinant, 25 GLUCOPHAGE, 21 GLUCOPHAGE XR, 21 glucose tablets, 25 GLUCOTROL, 22 GLUCOTROL XL, 22

53

glyburide, 22 glyburide micronized, 22 glyburide/metformin, 21 glycopyrrolate, 29 glycopyrrolate tabs 1 mg, 2 mg, 27 GLYNASE, 22 GLYSET, 21 GNP DAILY PRENATAL, 33 GOLYTELY, 28 granisetron tabs, 27 GRASTEK, 31 griseofulvin microsize, 8 griseofulvin ultramicrosize, 8 guaifenesin ext-rel, 36 guaifenesin liq, 36 guaifenesin liq, syp, tabs, 36 guanfacine, 12 guanfacine ext-rel, 19 guanidine, 21 GYNE-LOTRIMIN, 29 GYNOL II, 24

H haloperidol, 19 HARVONI, 10 HECTOROL, 25 HELIXATE FS, 30 HEPAGAM B, 31 hepatitis B immune globulin, 31 HEPSERA, 10 HIZENTRA, 31 HM ONE DAILY PRENATAL, 33 homatropine, 42 HUMALOG MIX, 22 HUMATE-P, 30 HUMIRA, 31 HUMULIN 70/30, 22 HUMULIN N, 22 HUMULIN R, 22 HUMULIN R U-500 VIAL, 22 HYCAMTIN, 12 hydralazine, 16 HYDREA, 12 hydrochlorothiazide, 15 hydrocodone/acetaminophen, 6 hydrocodone/acetaminophen soln 7.5-325 mg/15 mL, 6 hydrocodone/homatropine, 35 hydrocortisone, 25 hydrocortisone acetate foam, 28 hydrocortisone butyrate crm, oint, soln 0.1%, 39 hydrocortisone crm, 29 hydrocortisone crm, gel, lotion, oint, soln 1%, 38 hydrocortisone crm, lotion, oint 2.5%, 39 hydrocortisone enema, 28 hydrocortisone oint 0.5%, 38 hydrocortisone valerate crm, oint 0.2%, 39 hydrocortisone/aloe vera crm 0.5%, 1%, 38 hydromorphone oral soln 1 mg/mL, 6 hydromorphone tabs, 6 hydroxychloroquine, 31 hydroxyurea, 12 hydroxyzine HCl, 35 hydroxyzine pamoate, 35 hylan G-F 20, 7 hyoscyamine sulfate ext-rel caps, 27 hyoscyamine sulfate ext-rel tabs, 27

hyoscyamine sulfate oral soln, elixir, 27 hyoscyamine sulfate orally disintegrating tabs, 27 HYPERRAB S/D, 31 HYPERRHO, 31 HYZAAR, 13

I ibandronate, 23 ibrutinib, 12 ibuprofen, 6 idelalisib, 12 ILARIS, 32 iloperidone, 18 iloprost, 16 imatinib mesylate, 12 IMBRUVICA, 12 imipramine HCl, 18 imipramine pamoate, 18 imiquimod, 40 IMITREX, 19, 20 immune globulin, 31 immune globulin, gamma (IGG), 31 IMODIUM, 29 IMURAN, 32 INCRELEX, 25 INCRUSE ELLIPTA, 34 indapamide, 15 INDERAL LA, 14 indinavir, 9 INLYTA, 11 inositol niacinate, 33 INSPRA, 13 insulin aspart protamine 70%/insulin aspart 30%, 22 insulin glargine, 22 insulin human, 22 insulin human inhalation powder, 22 insulin human vial, 22 insulin infusion disposable pump, 23 insulin isophane human, 22 insulin isophane human 70%/regular 30%, 22 insulin lispro, 22 insulin lispro protamine/insulin lispro, 22 insulin syringes, needles, 23 INTELENCE, 9 interferon alfa-2b, 31 interferon beta-1a, 20 interferon beta-1b, 20 interferon gamma-1b, 31 INTRON A, 31 INTROVALE, 24 INTUNIV, 19 INVEGA, 18 INVEGA SUSTENNA, 18 INVEGA TRINZA, 18 INVIRASE, 9 ipratropium nasal spray, 37 ipratropium soln, 34 ipratropium, CFC-free aerosol, 34 ipratropium/albuterol soln, 34 ipratropium/albuterol, CFC-free aerosol, 34 irbesartan, 13 irbesartan/hydrochlorothiazide, 13 ISENTRESS, 9 ISENTRESS HD, 9 isocarboxazid, 17 isoniazid syrup, 10

54

isoniazid tabs, 10 ISOPTO CARPINE, 42 ISORDIL, 15 isosorbide dinitrate ext-rel tabs, 15 isosorbide dinitrate oral, 15 isosorbide dinitrate/hydralazine, 15 isosorbide mononitrate, 15 isosorbide mononitrate ext-rel, 15 isotretinoin, 37 itraconazole, 8 itraconazole oral soln, 8 ivermectin, 10

J JAKAFI, 12 JALYN, 29 JINTELI, 25 JOLESSA, 24 JULUCA, 8 JUXTAPID, 14

K KADIAN, 7 KALETRA, 9 KAPVAY, 19 karaya gum, 28 KARAYA GUM, 28 KAZANO, 21 KEFLEX, 7 KELNOR 1/50, 23 KEPPRA, 17 KEPPRA XR, 17 ketoconazole, 8 ketoconazole crm, shampoo 2%, 38 ketoconazole shampoo 2%, 38 ketoprofen, 6 ketoprofen ext-rel, 6 ketorolac, 6 ketorolac 0.4%, 41 ketorolac 0.5%, 41 ketotifen, 40 KEVZARA, 31 KLARON, 37 KLONOPIN, 16 KOGENATE FS, 30 KONSYL, 28 K-PHOS, 30 KPN PRENATAL, 33 KRISTALOSE, 28 KYLEENA, 24 KYNAMRO, 14

L labetalol, 14 LAC-HYDRIN, 39 lacosamide, 17 lactulose packets, 28 lactulose soln, 28 LAMICTAL, 17 LAMISIL AT, 38 lamivudine, 9 lamivudine soln, 10 lamivudine tabs, 10 lamivudine/tenofovir disoproxil fumarate, 9 lamivudine/zidovudine, 9 lamotrigine, 17 lancets, 23

LANOXIN, 15 lansoprazole + amoxicillin + clarithromycin, 29 lansoprazole delayed-rel, 28 lansoprazole delayed-rel orally-disintegrating tabs, 28 lanthanum chew tabs, 25 lanthanum powder, 25 lapatinib, 12 LASIX, 15 latanoprost, 42 LATUDA, 18 ledipasvir/sofosbuvir, 10 leflunomide, 31 lenalidomide, 11 LETAIRIS, 16 letrozole, 11 LEUCOVORIN, 11 leucovorin calcium, 11 LEUKERAN, 11 LEUKINE, 30 LEVAQUIN, 8 LEVBID, 27 levetiracetam, 17 levetiracetam ext-rel, 17 levobunolol, 41 levocarnitine oral soln, tabs, 23 levocetirizine, 34 levofloxacin, 8 levofloxacin 0.5%, 41 levonorgestrel, 24 levonorgestrel/EE, 24 levonorgestrel/EE 0.09/20, 24 levonorgestrel/EE 0.1/20, 23 levonorgestrel/EE 0.1/20 and EE 10, 24 levonorgestrel/EE 0.15/30, 23, 24 levonorgestrel-releasing IUD, 24 levothyroxine, 26 LEVOXYL, 26 LEVSIN, 27 LEXAPRO, 17 LEXIVA, 9 LIALDA, 27 lidocaine, 40 lidocaine 5% crm, 39 lidocaine crm 4%, 39 lidocaine patch 4%, 39 lidocaine patch 5%, 39 lidocaine viscous, 40 lidocaine/prilocaine, 39 LIDOCARE, 39 LIDODERM, 39 lifitegrast, 42 LILETTA, 24 linezolid, 10 liothyronine, 26 liotrix, 26 LIPITOR, 14 LIPOFEN, 13 LIQ-10, 33 liraglutide, 22 lisdexamfetamine, 19 lisinopril, 12 lisinopril/hydrochlorothiazide, 12 lithium carbonate, 20 lithium carbonate ext-rel tabs 300 mg, 20 lithium carbonate ext-rel tabs 450 mg, 20 LITHOBID, 20

55

LITHOSTAT, 30 LMX 4, 39 LOCOID, 39 LOESTRIN 1.5/30, 23 LOESTRIN 1/20, 23 LOESTRIN FE 1.5/30, 23 LOESTRIN FE 1/20, 23 lomitapide, 14 LOMOTIL, 26 lomustine, 11 loperamide, 26, 27 loperamide/simethicone, 29 LOPID, 14 lopinavir/ritonavir soln, 9 lopinavir/ritonavir tabs, 9 LOPRESSOR, 14 LOPRESSOR HCT, 14 LOPROX, 38 loratadine caps, 34 loratadine tabs, 34 loratadine/pseudoephedrine ext-rel, 35 lorazepam, 16 losartan, 13 losartan/hydrochlorothiazide, 13 LOTENSIN, 12 LOTENSIN HCT, 12 LOTREL, 12 LOTRONEX, 28 lovastatin, 14 LOVAZA, 14 LOVENOX, 30 loxapine, 18 lubiprostone, 28 lurasidone, 18 lymphocyte immune globulin anti-thymocyte G, 31 LYRICA, 17 LYSODREN, 12

M MAALOX, 26 macitentan, 16 MACROBID, 10 MACRODANTIN, 10 mafenide, 40 magnesium chloride ex-rel, 33 magnesium citrate, 28 magnesium hydroxide, 28 magnesium oxide, 33 MAG-OX 400, 33 MALARONE, 8 malathion, 40 maprotiline, 18 maraviroc, 9 MARINOL, 27 MARPLAN, 17 mask, 36 MASK, 36 MATULANE, 12 MAXALT, 19 MAXALT-MLT, 19 MAXIDEX, 41 MAXITROL, 41 MAXZIDE, 15 mecasermin, 25 mechlorethamine gel, 11 meclizine, 27

meclofenamate, 6 MEDROL, 25 medroxyprogesterone acetate, 26 medroxyprogesterone acetate vial 150 mg/mL, 24 mefloquine, 8 megestrol acetate susp 40 mg/mL, tabs, 11 MEKINIST, 12 meloxicam, 6 melphalan, 11 memantine, 17 MENEST, 24 MEPHYTON, 34 meprobamate, 16 MEPRON, 10 mercaptopurine, 11 mesalamine delayed-rel, 27 mesalamine delayed-rel tabs, 27 mesalamine ext-rel caps, 27 mesalamine rectal susp, 28 mesalamine supp, 28 MESTINON, 20 METADATE CD, 19 METADATE ER, 19 metaproterenol, 35 metformin, 21 metformin ext-rel, 21 methazolamide, 15 methenamine mandelate, 30 METHERGINE, 26 methimazole, 26 methocarbamol, 20 methotrexate, 11, 31 methotrexate inj, 11 methscopolamine bromide, 27 methsuximide, 17 methylcellulose, 28 methyldopa, 16 methyldopa/hydrochlorothiazide, 16 methylergonovine, 26 METHYLIN, 19 methylphenidate, 19 methylphenidate ext-rel, 19 methylphenidate ext-rel 10 mg, 19 methylphenidate ext-rel 10 mg, 60 mg, 19 methylphenidate ext-rel 20 mg, 19 methylphenidate ext-rel 20 mg, 30 mg, 40 mg, 19 methylprednisolone, 25 methylprednisolone 2 mg, 25 metoclopramide, 27 metoclopramide orally-disintegrating tabs, 27 metolazone, 15 metoprolol succinate ext-rel, 14 metoprolol tartrate 25 mg, 50 mg, 14 metoprolol/hydrochlorothiazide, 14 METROCREAM, 39 METROGEL, 39 METROGEL-VAGINAL, 29 METROLOTION, 39 metronidazole, 10, 29 metronidazole crm 0.75%, 39 metronidazole gel 0.75%, 39 metronidazole gel 1%, 39 metronidazole lotion 0.75%, 39 metyrosine, 16 MIACALCIN, 23 MICARDIS, 13

56

MICARDIS HCT, 13 MICATIN, 38 miconazole, 29, 38 midodrine, 16 miglitol, 21 miglustat, 25 MIGRANAL, 19 MILK OF MAGNESIA, 28 mineral oil, 28 mineral oil-hydrophilic petrolatum, 39 MINIPRESS, 13 MINOCIN, 8 minocycline, 8 minoxidil tabs, 16 mipomersen, 14 MIRALAX, 28 MIRAPEX, 18 MIRCETTE, 24 MIRENA, 24 mirtazapine, 18 misoprostol, 28 mitotane, 12 MOBIC, 6 modafinil, 20 moexipril, 12 mometasone, 37 mometasone crm, oint 0.1%, 39 mometasone lotion 0.1%, 39 mometasone, CFC-free aerosol, 37 montelukast, 36 montelukast granules, 36 morphine, 7 morphine ext-rel, 7 morphine supp, 7 moxifloxacin, 8, 41 MS CONTIN, 7 MUCINEX, 36 MUCINEX D, 36 MUCINEX DM, 35 MULTAQ, 13 MULTI-DELYN, 33 multivitamins/fluoride drops, tabs, 34 multivitamins/fluoride/iron drops, tabs, 34 mupirocin, 38 MURO-128, 42 M-VIT, 32 MYAMBUTOL, 10 MYCOBUTIN, 10 mycophenolate mofetil, 32 mycophenolate sodium delayed-rel, 32 MYFORTIC, 32 MYLANTA, 26 MYLERAN, 11 MYNATAL, 32, 33 MYNATAL ADVANCE, 32 MYNATAL PLUS, 33 MYNATAL-Z, 33 MYNATE 90 PLUS, 32 MYSOLINE, 17

N nabumetone, 6 nadolol, 14 nafarelin, 24 nail scrub, 40 NAIL SCRUB LIQ W/BRUSH, 40

naloxone inj, 20 naloxone nasal spray, 20 naltrexone, 20 NAMENDA, 17 naphazoline 0.1%, 42 NAPROSYN, 6 naproxen, 6 naproxen sodium, 6 naratriptan, 19 NARCAN, 20 NARDIL, 17 NASALCROM, 36 NATACYN, 40 NATALVIT, 33 natamycin, 40 nateglinide, 22 NATROBA, 40 nelfinavir, 9 neomycin, 7 neomycin/bacitracin/polymyxin B, 38 neomycin/bacitracin/polymyxin/pramoxine, 38 neomycin/polymyxin B/bacitracin/hydrocortisone oint, 38, 41 neomycin/polymyxin B/dexamethasone, 41 neomycin/polymyxin B/gramicidin, 41 neomycin/polymyxin B/hydrocortisone, 42 neomycin/polymyxin B/hydrocortisone susp, 41 NEORAL, 32 NEOSPORIN, 38 NEOSPORIN+PN, 38 NEO-SYNEPHRINE, 36 NEPHROCAPS, 34 NESINA, 21 NEULASTA, 30 NEUPOGEN, 30 NEURONTIN, 17 NEUTROGENA, 38 nevirapine, 9 nevirapine ext-rel 100 mg, 9 nevirapine ext-rel 400 mg, 9 NEXAVAR, 12 NEXIUM 24HR, 28 NEXPLANON, 24 niacin, 33 niacin ext-rel, 14, 33 NIACIN FLUSH FREE, 33 NIASPAN, 14 nicardipine, 14 NICORETTE, 21 nicotine polacrilex gum, 21 nicotine polacrilex lozenge, 21 nicotine transdermal, 21 nifedipine, 14 nifedipine ext-rel, 14 NILANDRON, 11 nilotinib, 12 nilutamide, 11 nimodipine, 14 NIMOTOP, 14 nisoldipine ext-rel, 15 nitazoxanide susp, 10 nitazoxanide tabs, 10 nitisinone, 25 NITRO-DUR, 15 nitrofurantoin ext-rel, 10 nitrofurantoin macrocrystals, 10 nitrofurantoin susp, 10

57

nitroglycerin sublingual, 15 nitroglycerin transdermal, 15 NITROSTAT, 15 NIVA-PLUS, 32 nizatidine, 27 NIZORAL SHAMPOO, 38 nonoxynol-9, 24 NORCO, 6 norelgestromin/EE, 24 norethindrone, 24 norethindrone acetate, 26 norethindrone acetate/EE 1.5/30, 23 norethindrone acetate/EE 1.5/30 and iron, 23 norethindrone acetate/EE 1/20, 23 norethindrone acetate/EE 1/20 and iron, 23 norethindrone/EE, 24 norethindrone/EE 0.5-35/1-35/0.5-35 mg-mcg, 24 norethindrone/EE 0.5/35, 23 norethindrone/EE 1/35, 23 norgestimate/EE, 24 norgestimate/EE 0.18-35/0.215-35/0.25-35 mg-mcg, 24 norgestimate/EE 0.25/35, 23 norgestrel/EE 0.3/30, 23 norgestrel/EE 0.5/50, 23 NORPACE, 13 NORPACE CR, 13 NORPRAMIN, 18 nortriptyline, 18 NORVASC, 14 NORVIR, 9 NOVAFERRUM, 33, 34 NOVOLIN 70/30, 22 NOVOLIN N, 22 NOVOLIN R, 22 NOVOLOG MIX 70/30, 22 NUEDEXTA, 21 NULYTELY, 28 NUTRIENTS PRENATAL, 33 NUVARING, 24 NUVIGIL, 20 nystatin, 8, 38 nystatin vaginal tab, 29

O O-CAL FA, 33 O-CAL PRENATAL, 32 OCEAN, 37 octreotide acetate, 21 OCUFLOX, 41 ODEFSEY, 9 ofloxacin, 41 ofloxacin otic, 42 OGESTREL, 23 olanzapine, 18 olanzapine pamoate ext-rel inj, 18 olmesartan, 13 olmesartan/amlodipine/hydrochlorothiazide, 13 olmesartan/hydrochlorothiazide, 13 olsalazine, 27 OLUX, 39 omalizumab, 36 omega-3 acid ethyl esters, 14 omega-3 fatty acids, 33 omeprazole delayed-rel, 28 omeprazole magnesium delayed-rel, 28 omeprazole powder for suspension, 28

omeprazole/sodium bicarbonate, 28 OMNIPOD INSULIN INFUSION PUMP, 23 OMNITROPE, 25 ondansetron, 27 ONE-A-DAY PRENATAL PAK, 33 ONFI, 17 OPANA, 7 OPSUMIT, 16 ORFADIN, 25 orphenadrine ext-rel, 20 orphenadrine/aspirin/caffeine, 20 ORTHO MICRONOR, 24 ORTHO TRI-CYCLEN LO, 24 ORTHO-NOVUM 1/35, 23 ORTHO-NOVUM 7/7/7, 24 oseltamivir, 10 OSENI, 21 OTEZLA, 31 OVIDE, 40 oxandrolone, 21 oxaprozin, 6 oxazepam, 16 oxcarbazepine, 17 oxybutynin, 29 oxybutynin ext-rel, 29 oxybutynin transdermal, 29 oxycodone, 7 oxycodone ext-rel, 7 oxycodone/acetaminophen, 7 oxycodone/aspirin, 7 OXYCONTIN, 7 oxymetazoline spray, 36 oxymetholone, 21 oxymorphone, 7 OXYTROL FOR WOMEN, 29 OZEMPIC, 22

P paliperidone ext-rel, 18 paliperidone palmitate ext-rel inj, 18 palivizumab, 36 PAMELOR, 18 PANCREAZE, 28 pancrelipase delayed-rel, 28 pantoprazole delayed-rel packets for suspension, 28 pantoprazole delayed-rel tabs, 28 paricalcitol, 25 PARLODEL, 18 PARNATE, 17 paromomycin, 10 paroxetine HCl susp, 17 paroxetine HCl tabs, 17 PAXIL, 17 pazopanib, 12 peak flow meter, 36 PEDIALYTE, 33 pediatric multivitamin liquid, 33 PEDIAVIT, 33 peg 3350/electrolytes, 28 PEGANONE, 17 PEGASYS, 31 pegfilgrastim, 30 peginterferon alfa-2a, 31 pegvisomant, 21 penicillamine, 31 penicillin VK, 8

58

PENLAC, 38 pentazocine/naloxone, 7 pentosan polysulfate sodium, 30 pentoxifylline ext-rel, 31 PEPCID, 27 PEPTO-BISMOL, 26 perampanel, 17 PERCODAN, 7 PERIDEX, 40 perindopril, 12 permethrin, 40 perphenazine, 19 perphenazine/amitriptyline, 19 PERRY PRENATAL, 32 PETROLATUM, 39 petrolatum/mineral oil/shark liver oil/phenylephrine oint, 29 phenelzine, 17 phenobarbital, 17 phentolamine inj, 16 phenylephrine, 36, 40 phenylephrine spray, 36 phenytoin, 17 phenytoin sodium extended, 17 PHOSPHOLINE IODIDE, 42 phytonadione, 34 pilocarpine, 42 pilocarpine tabs, 29 pimecrolimus, 38 pimozide, 19 pindolol, 14 pioglitazone, 22 pioglitazone/glimepiride, 22 pioglitazone/metformin, 22 pioglitazone/metformin ext-rel, 22 piroxicam, 6 PLAN B ONE-STEP, 24 PLAQUENIL, 31 PLAVIX, 30 pneumococcal vaccine, 32 PNEUMOVAX 23, 32 PNV FOLIC ACID + IRON, 33 PNV PRENATAL PLUS, 33 podofilox soln, 40 polyethylene glycol 3350 powder, 28 polymyxin B/bacitracin, 38, 41 polymyxin B/trimethoprim, 41 polysaccharide iron complex caps, drops, 33 polysaccharide iron complex/cholecalciferol liq, 34 polysaccharide iron forte, 34 POLYSPORIN, 38 POLYTRIM, 41 pomalidomide, 11 POMALYST, 11 potassium chloride ext-rel, 32 potassium chloride liquid, 32 potassium citrate, 30 potassium citrate/citric acid, 30 potassium citrate/sodium citrate/citric acid, 30 potassium/sodium acid phosphates, 30 povidone-iodine, 40 pramipexole, 18 pramlintide, 21 pramoxine/phenylephrine/glycerin/petrolatum, 29 PRANDIN, 22 prasugrel, 30 PRAVACHOL, 14

pravastatin, 14 praziquantel, 10 prazosin, 13 PRECOSE, 21 PRED FORTE, 41 PRED MILD, 41 PRED-G, 41 prednicarbate crm, oint 0.1%, 39 prednisolone acetate 0.12%, 41 prednisolone acetate 1%, 41 prednisolone phosphate 1%, 41 prednisolone sodium phosphate soln 5 mg/5 mL, 15 mg/5 mL, 25 mg/5

mL, 25 prednisolone syrup, 25 prednisone, 25 prednisone concentrate 5 mg/mL, 25 PREDNISONE INTENSOL, 25 PREFEST, 25 pregabalin, 17 PRENATABS RX, 32 PRENATAL + DHA, 33 PRENATAL + DHA WOMENS, 33 PRENATAL + FE, 33 PRENATAL 19, 32, 33 PRENATAL DHA, 32 PRENATAL DHA PAK MULTI, 33 PRENATAL FORMULA, 33 PRENATAL FORMULA A-FREE, 32 PRENATAL MULTI + DHA, 33 PRENATAL OMEGA-3, 33 PRENATAL PLUS IRON, 32 PRENATAL TAB, 32 PRENATAL TAB 27-1 MG, 33 PRENATAL VITAMIN TAB LOW IRON, 33 prenatal vitamins fast dissolving tabs, 32 prenatal vitamins without A/ferrous fumarate/folic acid 9-0.267 mg, 32 prenatal vitamins without A/iron polysaccharide complex/folic acid 155-1 mg,

32 prenatal vitamins/carbonyl iron/folic acid tabs, 32 prenatal vitamins/docusate/ferrous fumarate/folic acid 29-1 mg, 32 prenatal vitamins/docusate/ferrous fumarate/folic acid ext-rel 90-1 mg, 32 prenatal vitamins/docusate/iron carbonyl/folic acid 90-1 mg, 32 prenatal vitamins/ferrous bisglycinate chelate/folic acid, 32 prenatal vitamins/ferrous bisglycinate/folic acid + omega-3 delayed-rel, 32 prenatal vitamins/ferrous fumarate/folic acid 13.5-0.4 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 15-1 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 27-0.8 mg + DHA 200 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 27-1 mg, 32, 33 prenatal vitamins/ferrous fumarate/folic acid 27-1 mg + DHA 300 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 223 mg,

33 prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 440 mg,

33 prenatal vitamins/ferrous fumarate/folic acid 28-0.975 mg + DHA 200 mg, 33 prenatal vitamins/ferrous fumarate/folic acid 29-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid 6.75-0.2 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 60-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid 65-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid 75-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid chew tabs 29-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid/fish oil, 33 prenatal vitamins/ferrous fumarate/folic acid/omega-3 27-0.8-228 mg, 33 prenatal vitamins/ferrous fumarate/folic acid/omega-3 28-0.8-235 mg, 33 prenatal vitamins/ferrous fumarate/l-methylfolate/folic acid 27-0.5-0.5 mg, 33 prenatal vitamins/ferrous succinate/folic acid, 33 prenatal vitamins/iron carbonyl/folic acid + DHA, 33

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prenatal vitamins/iron carbonyl/folic acid 29-1 mg, 33 prenatal vitamins/l-methylfolate + fish oil/choline, 33 prenatal vitamins/minerals/ferrous fumarate/folic acid/DHA, 33 prenatal vitamins/minerals/folic acid/fish oil chew tabs, 33 prenatal vitamins/minerals/iron/folic acid 0.1 mg, 33 prenatal vitamins/minerals/iron/folic acid 1 mg, 33 prenatal vitamins/selenium/ferrous fumarate/folic acid 27-1 mg, 33 prenatal vitamins/selenium/ferrous fumarate/folic acid 9-0.5 mg, 33 PREPARATION H, 29 PREVACID, 28 PREVACID 24HR, 28 PREVIDENT 5000, 40 PREVNAR 13, 32 PREZCOBIX, 8 PREZISTA, 9 PRIFTIN, 10 PRILOSEC, 28 PRILOSEC OTC, 28 primaquine, 8 PRIMAQUINE, 8 primidone, 17 PRIVIGEN, 31 PROAIR HFA, 35 probenecid, 6 procarbazine, 12 PROCARDIA, 14 PROCARDIA XL, 14 prochlorperazine, 27 PROCRIT, 30 PROCTOCORT 1%, 29 progesterone gel, 26 progesterone supp, 26 progesterone vaginal inserts, 26 progesterone, micronized, 26 PROGLYCEM, 25 PROGRAF, 32 PROLEUKIN, 12 PROLIA, 23 PROMACTA, 31 promethazine, 27 promethazine supp 12.5 mg, 25 mg, 27 promethazine/phenylephrine, 35 PROMETRIUM, 26 propafenone, 13 propafenone ext-rel, 13 propantheline, 27 proparacaine 0.5%, 42 propranolol, 14 propranolol ext-rel, 14 propylthiouracil, 26 PROSCAR, 29 PROTONIX, 28 PROTOPIC, 38 protriptyline, 18 PROVERA, 26 PROVIGIL, 20 PROZAC, 17 pseudoephedrine, 36 pseudoephedrine ext-rel, 36 pseudoephedrine/guaifenesin ext-rel, 36 psyllium powder, 28 PULMICORT RESPULES, 37 PULMOZYME, 35 pyrantel, 10 pyrazinamide, 10 pyrethrins/piperonyl butoxide, 40

pyridostigmine, 20 pyridoxine 25 mg, 50 mg, 34

Q QUESTRAN/QUESTRAN LIGHT, 13 quetiapine, 18 quetiapine ext-rel, 18 quinapril, 12 quinapril/hydrochlorothiazide, 12 QVAR REDIHALER, 37

R RA ONE DAILY PRENATAL, 33 rabies immune globulin, 31 ragweed pollen allergen extract, 31 RAGWITEK, 31 raloxifene, 26 raltegravir, 9 ramipril, 12 RANEXA, 16 ranitidine, 27 ranolazine ext-rel, 16 RAPAFLO, 29 RAPAMUNE, 32 RAZADYNE, 17 RAZADYNE ER, 17 REBETOL, 10 REESES PINWORM MEDICINE, 10 REFRESH, 42 REGENECARE, 40 REGLAN, 27 regorafenib, 12 REGRANEX, 40 RELENZA, 10 REMERON, 18 REMODULIN, 16 repaglinide, 22 repaglinide/metformin, 22 REPATHA, 14 REPATHA PUSHTRONEX, 14 RESTASIS, 42 RESTORIL, 19 RETIN-A, 37 RETROVIR, 9 REVATIO, 16 REVLIMID, 11 REYATAZ, 9 rho D immune globulin, 31 RHOGAM, 31 RHOPHYLAC, 31 ribavirin caps 200 mg, 10 ribavirin oral soln 40 mg/mL, 10 ribavirin tabs 200 mg, 10 riboflavin tabs 100 mg, 34 RID SHAMPOO, 40 RIDAURA, 31 rifabutin, 10 RIFADIN, 10 rifampin, 10 rifapentine, 10 rifaximin, 11 rilonacept, 32 rilpivirine, 9 RILUTEK, 16 riluzole, 16 rimantadine, 10 riociguat, 16

60

RISPERDAL, 18 RISPERDAL CONSTA, 18 risperidone, 18 risperidone long-acting inj, 18 RITALIN, 19 RITALIN LA, 19 ritonavir caps, soln, 9 ritonavir tabs, 9 rivaroxaban, 30 rivastigmine, 17 rizatriptan, 19 rizatriptan orally disintegrating tabs, 19 ROBAXIN, 20 ROBITUSSIN, 36 ROBITUSSIN COLD/FLU, 35 ROCALTROL, 25 roflumilast, 36 ropinirole, 18 rosuvastatin, 14 ROWASA, 28 ROXICODONE, 7 rufinamide, 17 ruxolitinib, 12 RYTHMOL SR, 13

S SALAGEN, 29 salicylic acid, 40 salicylic acid/sulfur shampoo, 38 salmeterol xinafoate, 35 SAMSCA, 26 SANDIMMUNE, 32 SANDOSTATIN, 21 SANTYL, 40 SAPHRIS, 18 saquinavir mesylate, 9 sargramostim, 30 sarilumab, 31 scopolamine transdermal, 27 SEA-OMEGA, 33 SEBULEX, 38 SEGLUROMET, 22 selegiline, 18 selegiline orally disintegrating tablets, 18 selenium sulfide shampoo 1%, 38 selexipag, 16 SELSUN BLUE, 38 SELZENTRY, 9 semaglutide, 22 SEMPREX-D, 35 SE-NATAL 19, 33 senna, 28 SENNA PLUS, 28 sennosides, 28 sennosides/docusate sodium, 28 SENOKOT, 28 SENSIPAR, 23 SEREVENT, 35 SEROQUEL, 18 SEROQUEL XR, 18 sertraline, 17 SETLAKIN, 24 SHINGRIX, 32 sildenafil, 16 silodosin, 29 SILVADENE, 38

silver sulfadiazine, 38 simethicone, 29 SIMILAC PRENATAL EARLY SHIELD, 32 simvastatin, 14 SINEMET, 18 SINEMET CR, 18 SINGULAIR, 36 sirolimus, 32 SIRTURO, 9 SKYLA, 24 SLOW-MAG, 33 SM ONE DAILY PRENATAL, 33 sodium bicarbonate, 26 sodium chloride, 42 sodium chloride for inhalation, 36 sodium chloride soln, 37, 40 sodium citrate/citric acid, 30 sodium fluoride, 40 sodium oxybate, 20 sodium phenylbutyrate, 26 sodium phosphates, 28 sodium polystyrene sulfonate, 26 sofosbuvir/velpatasvir, 10 sofosbuvir/velpatasvir/voxilaprevir, 10 SOLIRIS, 30 somatropin, 25 SOMAVERT, 21 sorafenib, 12 sotalol, 13 spacer, 36 spinosad, 40 spironolactone, 13 spironolactone/hydrochlorothiazide, 15 SPORANOX, 8 SPORANOX ORAL SOLUTION, 8 SPRYCEL, 11 SPS, 26 STALEVO, 18 STARLIX, 22 stavudine, 9 STEGLATRO, 22 STIMATE, 26 STIOLTO RESPIMAT, 34 STIVARGA, 12 STRATTERA, 19 STRIBILD, 9 STROMECTOL, 10 SUBLOCADE, 20 SUBOXONE, 20 succimer, 31 sucralfate susp, 29 sucralfate tabs, 29 SUDAFED, 36 SUDAFED PE, 36 SULAR, 15 sulfacetamide lotion 10%, 37 sulfacetamide sodium, 38 sulfacetamide soln 10%, 41 sulfacetamide/prednisolone phosphate 10%/0.25%, 41 sulfacetamide/sulfur, 39 sulfacetamide/sulfur crm, gel, lotion, pads, 37 sulfadiazine, 8 sulfamethoxazole/trimethoprim, 8 sulfamethoxazole/trimethoprim DS, 8 SULFAMYLON, 40 sulfasalazine, 27

61

sulfasalazine delayed-rel, 27 sulindac, 6 sumatriptan, 19 sumatriptan inj, 19 sumatriptan nasal spray, 20 sunitinib, 12 SURMONTIL, 18 SUSTIVA, 9 SUTENT, 12 SYMBICORT, 37 SYMFI, 8 SYMFI LO, 8 SYMLINPEN, 21 SYNAGIS, 36 SYNAREL, 24 SYNTHROID, 26 SYNVISC-ONE, 7

T TABLOID, 11 tacrolimus, 32, 38 TAFINLAR, 11 TAGAMET HB, 27 TAMIFLU, 10 tamoxifen, 11 tamsulosin, 29 TAPAZOLE, 26 TARCEVA, 11 TARGRETIN, 40 TARGRETIN caps, 12 TARKA, 12 TASIGNA, 12 tazarotene crm 0.05%, gel 0.05%, 0.1%, 38 tazarotene crm 0.1%, 38 TAZORAC, 38 TECFIDERA, 20 TEGRETOL, 16 TEGRETOL-XR, 16 telmisartan, 13 telmisartan/hydrochlorothiazide, 13 temazepam, 19 TEMODAR, 11 TEMOVATE, 39 temozolomide, 11 tenofovir disoproxil fumarate powder, 9 tenofovir disoproxil fumarate tabs, 9 terazosin, 13, 29 terbinafine, 38 terbinafine tabs, 8 terbutaline, 35 terconazole crm, supp, 29 teriflunomide, 20 TESSALON, 35 testosterone cypionate, 21 testosterone enanthate, 21 testosterone gel, 21 tetrabenazine, 19 tetracaine 0.5%, 42 tetracycline, 8 thalidomide, 11 THALOMID, 11 THEO-24, 37 theophylline elixir, 37 theophylline ext-rel caps, 37 theophylline ext-rel tabs, 37 theophylline liquid, 37

THERANATAL, 33 THERANATAL COMPLETE, 32 thioguanine, 11 thioridazine, 18 thiothixene, 19 thyroid, 26 THYROLAR, 26 tiagabine, 17 TIAZAC, 15 TIGAN, 27 TIKOSYN, 13 timolol, 14 timolol hemihydrate, 41 timolol maleate, 41 timolol maleate gel, 41 TIMOPTIC, 41 TIMOPTIC-XE, 41 timothy grass pollen allergen extract, 31 TINACTIN, 38 tioconazole, 29 tiotropium/olodaterol, 34 tipranavir, 9 TIVICAY, 9 tizanidine tabs, 20 TL FOLATE, 33 TOBI, 36 TOBI PODHALER, 35 TOBRADEX, 41 TOBRADEX ST, 41 tobramycin, 41 tobramycin inhalation powder, 35 tobramycin inhalation soln, 36 tobramycin oint, 41 tobramycin soln, 41 tobramycin/dexamethasone oint 0.3%/0.1%, 41 tobramycin/dexamethasone susp 0.3%/0.05%, 41 tobramycin/dexamethasone susp 0.3%/0.1%, 41 TOBREX, 41 tocopherols-tocotrienols, 34 TOFRANIL, 18 tolbutamide, 23 tolmetin 200 mg, 400 mg, 6 tolnaftate, 38 tolterodine, 29 tolterodine ext-rel, 29 tolvaptan, 26 TOPAMAX, 17 TOPICORT, 39 TOPICORT LP, 39 topiramate sprinkle caps, tabs, 17 topotecan, 12 TOPROL-XL, 14 toremifene, 11 torsemide, 15 TOUJEO SOLOSTAR, 22 TRACLEER, 16 tramadol ext-rel tabs, 7 tramadol immediate-release, 7 tramadol/acetaminophen, 7 trametinib, 12 TRANDATE, 14 trandolapril, 12 trandolapril/verapamil ext-rel, 12 TRANSDERM SCOP, 27 tranylcypromine, 17 trazodone 50 mg, 100 mg, 150 mg, 18

62

TRECATOR, 10 treprostinil, 16 tretinoin caps, 12 tretinoin crm 0.025%, 0.05%, 0.1%, 37 tretinoin gel 0.01%, 0.025%, 37 TREXALL, 11 triamcinolone acetonide crm, lotion, oint 0.025%, 39 triamcinolone acetonide crm, lotion, oint 0.1%, 39 triamcinolone acetonide crm, oint 0.5%, 39 triamcinolone acetonide spray, 36 triamcinolone paste, 40 triamterene/hydrochlorothiazide, 15 triazolam, 19 TRIBENZOR, 13 TRICOR, 14 trifluoperazine, 19 trifluridine, 41 trihexyphenidyl, 18 TRILEPTAL, 17 TRILIPIX, 13 trimethobenzamide caps, 27 trimethoprim, 11 trimipramine, 18 TRINATAL RX1, 33 triprolidine/pseudoephedrine liq, syp, 35 TRIUMEQ, 8 TRIZIVIR, 8 tropicamide, 42 trospium, 29 trospium ext-rel, 29 TRUE METRIX AIR kits, 23 TRUE METRIX kits, 23 TRUE METRIX test strips, 23 TRUSOPT, 42 TRUVADA, 9 TRUZONE peak flow meter, 36 trypsin/balsam/castor oil, 40 TYBOST, 8 TYKERB, 12 TYLENOL, 6 TYLENOL w/CODEINE, 6 TYMLOS, 23 TYVASO, 16

U ubidecarenone, 34 ubiquinol liposomal, 34 ulipristal, 24 ULORIC, 6 ULTRACET, 7 ULTRAM, 7 umeclidinium, 34 umeclidinium/vilanterol, 34 UPTRAVI, 16 URECHOLINE, 30 UROCIT-K, 30 UROXATRAL, 29 URSO, 27 ursodiol, 27

V VAGIFEM, 25 VAGISTAT-1, 29 valacyclovir, 10 VALCHLOR, 11 VALCYTE, 10 valganciclovir, 10

VALIUM, 16 valproic acid, 17 valsartan, 13 valsartan/hydrochlorothiazide, 13 VALTREX, 10 vancomycin oral soln, 11 vandetanib, 12 vaporizer, 36 VAPORIZER, 36 varenicline, 21 VASERETIC, 12 VASOTEC, 12 VELETRI, 16 VELIVET, 24 venlafaxine ext-rel, 17 venlafaxine tabs, 17 VENTAVIS, 16 VENTOLIN HFA, 35 verapamil ext-rel tabs, 15 VIBRAMYCIN, 8 VIBRAMYCIN SYRUP, 8 VICTOZA, 22 VIDEX, 9 VIDEX EC, 9 VIGAMOX, 41 VIMPAT, 17 VINATE II, 32 VINATE M, 33 VINATE ONE, 33 VIRACEPT, 9 VIRAMUNE, 9 VIRAMUNE XR, 9 VIREAD, 9 VISTARIL, 35 VITAFOL-OB, 33 vitamin ADC/fluoride drops, 34 vitamin ADC/fluoride/iron drops, 34 vitamin B complex/vitamin C/folic acid, 34 VITAMIN B-2, 34 VITAMIN B-6, 34 VITAMIN C, 33 VITAMIN D, 33 vitamin E, 34 VITAMIN E, 34 VOLTAREN GEL, 6 vorinostat, 12 VOSEVI, 10 VOTRIENT, 12 VYVANSE, 19

W warfarin, 30 WELLBUTRIN SR, 18 WELLBUTRIN XL, 18 WINRHO SDF, 31 WIXELA INHUB, 37

X XALATAN, 42 XANAX, 16 XANAX XR, 16 XARELTO, 30 XELODA, 11 XENAZINE, 19 XIFAXAN, 11 XIIDRA, 42 XOLAIR, 36

63

XULANE, 24 XYREM, 20

Y YASMIN, 23 YOUR LIFE PRENATAL, 33

Z zafirlukast, 36 ZANAFLEX, 20 zanamivir, 10 ZANTAC, 27 ZARONTIN, 17 ZARXIO, 30 ZAVESCA, 25 ZEGERID OTC, 28 ZELAPAR, 18 ZEMPLAR, 25 ZENPEP, 28 ZESTORETIC, 12 ZESTRIL, 12 ZETIA, 13 ZIAC, 14 ZIAGEN, 9 zidovudine, 9 ZIKS, 40 zileuton, 36 zileuton ext-rel, 36 zinc, 34

zinc acetate, 40 zinc sulfate, 34 ziprasidone, 18 ZIRGAN, 41 ZITHROMAX, 7 ZOCOR, 14 ZOFRAN, 27 ZOLINZA, 12 ZOLOFT, 17 zolpidem, 19 ZONEGRAN, 17 zonisamide, 17 ZOSTAVAX, 32 zoster vaccine, 32 zoster vaccine recombinant, 32 ZOSTRIX, 40 ZOVIRAX, 10, 40 ZUBSOLV, 20 ZYBAN, 21 ZYDELIG, 12 ZYFLO, 36 ZYLOPRIM, 6 ZYPREXA, 18 ZYPREXA RELPREVV, 18 ZYRTEC, 34 ZYRTEC-D 12 Hour, 35 ZYVOX, 10