PURSUANT TO 13CSR 70-20.030 DRUGS COVERED BY ......Active Pharmaceutical Ingredients (APIs) and...

December 14, 2020

PURSUANT TO 13CSR 70-20.030 DRUGS COVERED BY MEDICAID

Drugs falling outside the definition of a covered outpatient drug as defined in Section 1927 (k)(2), (k)(3), and (k)(4) of the Social Security Act are excluded. Active Pharmaceutical Ingredients (APIs) and excipients may be considered covered pharmacy services.

PURSUANT TO 13CSR 70-20.031 LIST OF DRUGS EXCLUDED FROM COVERAGE UNDER THE MO HEALTHNET PHARMACY PROGRAM

Drug or Drug Category Exceptions Reimbursable

Drugs used to promote fertility

Drugs used to treat sexual dysfunction

Drugs used to promote weight loss

Drugs used to promote hair growth

Drugs used for cosmetic purposes

Quazepam

Nonlegend Products Limited Coverage of Specific OTC

products, available pursuant to a

lawful prescription (see list)

Key:

Green = Products currently under open review. Completion date and conclusion columns are also blank.

Blue Bold=Most recent conclusions.

Advisory Meeting Month = the month this recommendation will be presented at the quarterly meeting of the Drug PA

Committee (Public Hearing) and the quarterly meeting of the Drug Utilization Review (DUR) Board. For additional

information on this process please visit http://www.dss.mo.gov/mhd/cs/pharmacy/pdf/newdrug_process.pdf

NEW DRUG STATUS

Trade Name Strength Dosage Form

Date

Review

Began

Date Review

Completed Conclusion

Advisory Committee Month

Orladeyo 110mg Capsule 12/14/2020 March/April

Orladeyo 150mg Capsule 12/14/2020 March/April

Dificid 40mg/ml Suspension 12/07/2020 March/April

Nyvepria 6mg/0.6ml Syringe 12/07/2020 March/April

Oxlumo 94.5mg/0.5ml Vial 12/07/2020 March/April

Retacrit 20,000unit/ml Vial 12/07/2020 March/April

Casirivimab 300mg/2.5ml Vial 11/30/2020 March/April

Casirivimab 1,332mg/11.1ml Vial 11/30/2020 March/April

Eysuvis 0.25% Drops 11/30/2020 March/April

Imdevimab 300mg/2.5ml Vial 11/30/2020 March/April

Imdevimab 1,332mg/11.1ml Vial 11/30/2020 March/April

Retacrit 20,000unit/2ml Vial 11/30/2020 March/April

Monoferric 1,000mg/10ml Vial 11/23/2020 March/April

Sutab 1.479-0.225-0.188gm Tablet 11/23/2020 March/April

Veklury 100mg Vial 11/23/2020 March/April

Barhemsys 5mg/2ml Vial 11/09/2020 March/April

Impeklo 0.05% Lotion 11/09/2020 March/April

http://www.dss.mo.gov/mhd/cs/pharmacy/pdf/otc_coveredproducts.pdf

http://www.dss.mo.gov/mhd/global/pages/calendar.htm

http://www.dss.mo.gov/mhd/global/pages/calendar.htm

http://www.dss.mo.gov/mhd/cs/pharmacy/pdf/newdrug_process.pdf

Twirla 120-30mcg/day Patch 11/02/2020 March/April

Uplizna 100mg/10ml Vial 11/02/2020 March/April

Epclusa 200/50mg Tablet 10/26/2020 March/April

Ultomiris 300mg/3ml Vial 10/26/2020 March/April

Ultomiris 1,100mg/11ml Vial 10/26/2020 March/April

Alkindi Sprinkle 0.5mg Capsule 10/19/2020 12/14/2020 PA Continued March/April

Alkindi Sprinkle 1mg Capsule 10/19/2020 12/14/2020 PA Continued March/April



Trelegy Ellipta 200-62.5-25mcg Inhaler 10/12/2020 12/07/2020 PDL Product March/April

Xerava 100mg Vial 10/05/2020 11/30/2020 PDL Product March/April

Xywav 0.5gm/ml Solution 09/28/2020 11/23/2020 Clinical Edit Dec/January

Armonair Digihaler 55mcg Inhaler 09/21/2020 11/16/2020 PDL Product Dec/January



Hemady 20mg Tablet 09/21/2020 11/16/2020 PA Continued Dec/January

Lampit 30mg Tablet 09/21/2020 11/16/2020 Open Access Dec/January

Lampit 120mg Tablet 09/21/2020 11/16/2020 Open Access Dec/January

Natesto 5.5mg/0.122gm Nasal Spray 09/21/2020 11/16/2020 PDL Product Dec/January

Cystadrops 0.37% Drops 09/14/2020 11/09/2020 Open Access Dec/January

Trulicity 4.5mg/0.5ml Pen 09/14/2020 11/09/2020 PDL Product Dec/January

Trulicity 3mg/0.5ml Pen 09/14/2020 11/09/2020 PDL Product Dec/January

Akynzeo 235-0.25mg/20ml Vial 09/07/2020 11/02/2020 PDL Product Dec/January

Ongentys 50mg Capsule 09/07/2020 11/02/2020 Open Access Dec/January

Phexxi 1.8-1-0.4% Gel 09/07/2020 11/02/2020 Open Access Dec/January

Viltepso 250mg/5ml Vial 09/07/2020 11/02/2020 Clinical Edit Dec/January

Airduo Digihaler 55-14mcg Inhaler 08/31/2020 10/26/2020 PDL Product Dec/January



Kesimpta 20mg/0.4ml Pen 08/31/2020 10/26/2020 PDL Product Dec/January

Enspryng 120mg/ml Syringe 08/24/2020 10/19/2020 Clinical Edit Dec/January

Vancomycin 750mg/150ml Bag 08/24/2020 10/19/2020 Open Access Dec/January

Vancomycin 1.25gm/250ml Bag 08/24/2020 10/19/2020 Open Access Dec/January

Vancomycin 1.75gm/350ml Bag 08/24/2020 10/19/2020 Open Access Dec/January

Evrysdi 0.75mg/ml Solution 08/17/2020 10/12/2020 Clinical Edit Dec/January

Mycapssa DR 20mg Capsule 08/17/2020 10/12/2020 Open Access Dec/January

Bafiertam DR 95mg Capsule 08/10/2020 10/05/2020 PDL Product Dec/January

Breztri Aerosphere 160-9-4.8mcg Inhaler 08/10/2020 10/05/2020 PDL Product Dec/January

Enbrel 25mg/0.5ml Vial 08/03/2020 09/28/2020 PDL Product Dec/January

Tecartus Infusion Bag 08/03/2020 09/28/2020 Clinical Edit Dec/January

Ortikos ER 6mg Capsule 07/27/2020 09/21/2020 PDL Product Dec/January

Ortikos ER 9mg Capsule 07/27/2020 09/21/2020 PDL Product Dec/January

Dojolvi 8.3KCAL/ml Liquid 07/20/2020 09/14/2020 Open Access Dec/January

Sirturo 20mg Tablet 07/20/2020 09/14/2020 Open Access Dec/January

Dupixent 300mg/2ml Pen 07/13/2020 09/07/2020 PDL Product Dec/January

Fintepla 2.2mg/ml Solution 07/13/2020 09/07/2020 Clinical Edit Dec/January

Rukobia ER 600mg

Tablet 07/13/2020 09/07/2020

Reference Product

Dec/January

Bynfezia 2500mcg/ml Pen 06/29/2020 08/24/2020 Open Access Sept/Oct

Lyumjev 100unit/ml Kwikpen 06/22/2020 08/17/2020 PDL Product Sept/Oct

Lyumjev 200unit/ml Kwikpen 06/22/2020 08/17/2020 PDL Product Sept/Oct

Lyumjev 100unit/ml Vial 06/22/2020 08/17/2020 PDL Product Sept/Oct

Kynmobi 10mg-15mg-20mg Sublingual Film 06/15/2020 08/10/2020 PDL Product Sept/Oct

Kynmobi 10mg Sublingual Film 06/15/2020 08/10/2020 PDL Product Sept/Oct





Zilxi 1.5% Foam 06/15/2020 08/10/2020 PDL Product Sept/Oct

Oriahnn 300-1-0.5mg/300mg Capsule 06/08/2020 08/03/2020 Clinical Edit Sept/Oct

Avsola 100mg Vial 06/01/2020 07/27/2020 PDL Product Sept/Oct

Harvoni 33.75mg-150mg Pellet Pack 06/01/2020 07/27/2020 PDL Product Sept/Oct

Harvoni 45mg-200mg Pellet Pack 06/01/2020 07/27/2020 PDL Product Sept/Oct

Nexlizet 180mg-10mg Tablet 06/01/2020 07/27/2020 PDL Product Sept/Oct

Sovaldi 150mg Pellet Pack 06/01/2020 07/27/2020 PDL Product Sept/Oct

Sovaldi 200mg Pellet Pack 06/01/2020 07/27/2020 PDL Product Sept/Oct

Zeposia 0.23mg-0.46mg Starter Pack 06/01/2020 07/27/2020 PDL Product Sept/Oct

Zeposia 0.23-0.46-0.92mg Kit 06/01/2020 07/27/2020 PDL Product Sept/Oct

Zeposia 0.92mg Capsule 06/01/2020 07/27/2020 PDL Product Sept/Oct

Xcopri 50mg Tablet 05/25/2020 07/20/2020 Clinical Edit Sept/Oct




Xcopri 12.5mg-25mg Tab Titration Pk 05/25/2020 07/20/2020 Clinical Edit Sept/Oct

Xcopri 50mg-100mg Tab Titration Pk 05/25/2020 07/20/2020 Clinical Edit Sept/Oct

Xcopri 150mg-200mg Tab Titration Pk 05/25/2020 07/20/2020 Clinical Edit Sept/Oct

Xcopri 250mg Daily Dose Tablet 05/25/2020 07/20/2020 Clinical Edit Sept/Oct

Xcopri 350mg Daily Dose Tablet 05/25/2020 07/20/2020 Clinical Edit Sept/Oct

Dilaudid 0.2mg/ml Syringe 05/25/2020 07/20/2020 Open Access Sept/Oct

Jynarque 15mg-15mg Tablet 05/25/2020 07/20/2020 Clinical Edit Sept/Oct

Jynarque 30mg-15mg Tablet 05/25/2020 07/20/2020 Clinical Edit Sept/Oct

Licart 1.3% Patch 05/25/2020 07/20/2020 PDL Product Sept/Oct

Osmolex ER 322mg/Day Tablet 05/25/2020 07/20/2020 PDL Product Sept/Oct

Durysta 10mcg Implant 05/18/2020 07/13/2020 PDL Product Sept/Oct

Dayvigo 5mg Tablet 05/11/2020 07/06/2020 PDL Product Sept/Oct

Dayvigo 10mg Tablet 05/11/2020 07/06/2020 PDL Product Sept/Oct

Fensolvi 45mg Syringe 05/11/2020 07/09/2020 Open Access Sept/Oct

Nymalize 30mg/5ml Oral Syringe 05/11/2020 07/06/2020 PDL Product Sept/Oct

Nymalize 60mg/10ml Oral Syringe 05/11/2020 07/06/2020 PDL Product Sept/Oct

Isturisa 1mg Tablet 04/20/2020 06/15/2020 Clinical Edit Sept/Oct



Koselugo 10mg Capsule 04/20/2020 06/15/2020 Clinical Edit Sept/Oct

Koselugo 25mg Capsule 04/20/2020 06/15/2020 Clinical Edit Sept/Oct

Anjeso 30mg/ml Vial 04/13/2020 06/08/2020 Open Access Sept/Oct

Hizentra 1gm/5ml Syringe 04/13/2020 06/08/2020 Open Access Sept/Oct



Ajovy 225mg/1.5ml Auto Injector 04/06/2020 06/01/2020 PDL Product Sept/Oct

Nexletol 180mg Tablet 04/06/2020 06/01/2020 PDL Product Sept/Oct

Promacta 25mg Suspension Pckt 04/06/2020 06/01/2020 PDL Product Sept/Oct

Talicia DR 10-250-12.5mg Capsule 03/30/2020 05/25/2020 Fiscal Edit June/July

Teriparatide 620mcg/2.48ml Pen 03/30/2020 05/25/2020 Clinical Edit June/July

Xepi 1% Cream 03/30/2020 05/25/2020 PA Continued June/July

Arazlo 0.045% Lotion 03/23/2020 05/18/2020 PDL Product June/July

Caplyta 42mg Capsule 03/23/2020 05/18/2020 Clinical Edit June/July

Nurtec ODT 75mg Tablet 03/23/2020 05/18/2020 PDL Product June/July

Palforzia Initial Dose Pack 0.5mg to 6mg Tablet 03/23/2020 05/18/2020 Clinical Edit June/July

Palforzia 3mg Tablet 03/23/2020 05/18/2020 Clinical Edit June/July











Zerviate 0.24% Eye Drop 03/23/2020 05/18/2020 PDL Product June/July

Potassium Phosphates 3mmol/ml Vial 03/16/2020 05/11/2020 Open Access June/July

Trijardy XR 5-2.5-1000mg Tablet 03/16/2020 05/11/2020 PDL Product June/July

Trijardy XR 12.5-2.5-1000mg Tablet 03/16/2020 05/11/2020 PDL Product June/July

Trijardy XR 10-5-1000mg Tablet 03/16/2020 05/11/2020 PDL Product June/July

Trijardy XR 25-5-1000mg Tablet 03/16/2020 05/11/2020 PDL Product June/July

Valtoco 5mg Nasal Spray 03/09/2020 05/04/2020 PA Continued June/July




Vyepti 100mg/ml Vial 03/09/2020 05/04/2020 PDL Product June/July

Jatenzo 158mg Capsule 03/02/2020 04/27/2020 PDL Product June/July



Bivalirudin 250mg/50ml Vial 02/24/2020 04/20/2020 Open Access June/July

Procysbi DR 75mg Granule Pack 02/24/2020 04/20/2020 PA Continued June/July

Procysbi DR 300mg Granule Pack 02/24/2020 04/20/2020 PA Continued June/July

Fetroja 1gm Vial 02/17/2020 04/13/2020 Open Access June/July

Tramadol Hcl 100mg Tablet 02/17/2020 04/13/2020 PDL Product June/July

Reyvow 50mg Tablet 02/10/2020 04/06/2020 PDL Product June/July

Reyvow 100mg Tablet 02/10/2020 04/06/2020 PDL Product June/July

Asmanex HFA 50mcg Inhaler 02/03/2020 03/30/2020 PDL Product June/July

Dulera 50mcg-5mcg Inhaler 02/03/2020 03/30/2020 PDL Product June/July

Riomet ER 500mg/5ml Suspension 02/03/2020 03/30/2020 PDL Product June/July

Amzeeq 4% Foam 01/27/2020 03/23/2020 PDL Product June/July

Tepezza 500mg Vial 01/27/2020 03/23/2020 PA Continued June/July

Glucagon 1mg Kit 01/20/2020 03/16/2020 PA Continued June/July

Quzyttir 10mg/ml Vial 01/20/2020 03/16/2020 PDL Product June/July

Ubrelvy 50mg Tablet 01/20/2020 03/16/2020 PDL Product June/July

Ubrelvy 100mg Tablet 01/20/2020 03/16/2020 PDL Product June/July

Xeljanz XR 22mg Tablet 01/20/2020 03/16/2020 PDL Product June/July

Divigel 1.25mg Gel Packet 01/13/2020 03/09/2020 Open Access June/July

Recarbrio 1.25gm Vial 01/13/2020 03/09/2020 Open Access June/July

Absorica LD 8mg Capsule 01/06/2020 03/02/2020 PA Continued June/July




Lanoxin 100mcg/ml Vial 12/23/2019 02/17/2020 Open Access March/April

Lanoxin 500mcg/2ml Vial 12/23/2019 02/17/2020 Open Access March/April

Secuado 3.8mg/24hr Patch 12/23/2019 02/17/2020 Reference List March/April

Secuado 5.7mg/24hr 3.8mg/24hr 12/23/2019 02/17/2020 Reference List March/April

Secuado 7.6mg/24hr 3.8mg/24hr 12/23/2019 02/17/2020 Reference List March/April

Vyondys-53 100mg/2ml Vial 12/23/2019 02/17/2020 Clinical Edit March/April

Egrifta SV 2mg Vial 12/16/2019 02/10/2020 PDL Product March/April

Eylea 2mg/0.05ml Vial 12/09/2019 02/03/2020 Open Access March/April

Oxbryta 500mg Tablet 12/09/2019 02/03/2020 Clinical Edit March/April

Givlaari 189mg/ml Vial 12/02/2019 01/27/2020 Clinical Edit March/April

Adakveo 100mg/10ml Vial 11/25/2019 01/20/2020 PA Continued March/April

Asceniv 10% Vial 11/25/2019 01/20/2020 Open Access March/April

Nplate 125mcg Vial 11/25/2019 01/20/2020 PDL Product March/April

Pretomanid 200mg Tablet 11/18/2019 01/13/2020 Open Access March/April

Ziextenzo 6mg/0.6ml Syringe 11/18/2019 01/13/2020 PDL Product March/April

Reblozyl 25mg Vial 11/18/2019 01/13/2020 PA Continued March/April

Reblozyl 75mg Vial 11/18/2019 01/13/2020 PA Continued March/April

Dexamethasone 10mg/ml Syringe 11/11/2019 01/06/2020 Open Access March/April

Olumiant 1mg Tablet 11/11/2019 01/06/2020 PDL Product March/April

Vumerity 231mg Capsule 11/11/2019 01/06/2020 PDL Product March/April

Wakix 4.45mg Tablet 11/11/2019 01/06/2020 Clinical Edit March/April

Wakix 17.8mg Tablet 11/11/2019 01/06/2020 Clinical Edit March/April

Gloperba 0.6mg/5ml Solution 11/04/2019 12/30/2019 PDL Product March/April

Trikafta 100/50/75mg-150mg Tablet 10/28/2019 12/23/2019 Clinical Edit March/April

Gvoke 0.5mg/0.1ml Syringe 10/21/2019 12/16/2019 PDL Product March/April

Gvoke 1mg/0.2ml Syringe 10/21/2019 12/16/2019 PDL Product March/April

Gvoke Hypopen 0.5mg/0.1ml Auto Injector 10/21/2019 12/16/2019 PDL Product March/April

Gvoke Hypopen 1mg/0.2ml Auto Injector 10/21/2019 12/16/2019 PDL Product March/April

Tovet 0.05% Foam 10/21/2019 12/16/2019 PDL Product March/April

Proair Digihaler 90mcg Inhaler 10/21/2019 12/16/2019 PDL Product March/April

Vancomycin 500mg/100ml Bag 10/21/2019 12/16/2019 Open Access March/April

Xembify 1g/5ml Vial 10/14/2019 12/09/2019 Open Access March/April




Harvoni 45mg-200mg Tablet 10/14/2019 12/09/2019 PDL Product March/April

Sovaldi 200mg Tablet 10/14/2019 12/09/2019 PDL Product March/April

Aklief 0.005% Cream 10/14/2019 12/09/2019 PDL Product March/April

Fasenra 30mg/ml Auto Injector 10/14/2019 12/09/2019 PDL Product March/April

Beouvu 6mg/0.05ml Vial 10/14/2019 12/09/2019 Open Access March/April

Drizalma Sprinkle 20 mg Capsule 10/07/2019 12/02/2019 PDL Product March/April




Relafen DS 1000 mg Tablet 10/07/2019 12/02/2019 PDL Product March/April

Diluent for Lefamulin Plastic Bag 09/30/2019 11/25/2019 PA Continued Dec/January

Duaklir Pressair 400-12 MCG Inhalation Powder 09/30/2019 11/25/2019 PDL Product Dec/January

Fiasp Penfill 100U/ml Cartridge 09/30/2019 11/25/2019 PDL Product Dec/January

Nourianz 20 mg Tablet 09/30/2019 11/25/2019 PA Continued Dec/January

Nourianz 40 mg Tablet 09/30/2019 11/25/2019 PA Continued Dec/January

Rybelsus 3 mg Tablet 09/30/2019 11/25/2019 PDL Product Dec/January



Xenleta 600 mg Tablet 09/30/2019 11/25/2019 PA Continued Dec/January

Xenleta 150 mg/15 ml Vial 09/30/2019 11/25/2019 PA Continued Dec/January

Heparin Sodium 5000U/ml Syringe 09/23/2019 11/18/2019 Open Access Dec/January

Memantine HCL 10 mg/5 ml Solution 09/23/2019 11/18/2019 PDL Product Dec/January

Tosymra 10 mg Nasal Spray 09/23/2019 11/18/2019 PDL Product Dec/January

Nayzilam 5 mg Nasal Spray 09/16/2019 11/11/2019 PA Continued Dec/January

Vyndamax 61 mg Capsule 09/02/2019 10/28/2019 Clinical Edit Dec/January

Rinvoq ER 15 mg Tablet 08/26/2019 10/21/2019 PDL Product Dec/January

Cuvitru 10 mg/50 ml Vial 08/26/2019 10/21/2019 Open Access Dec/January

Ferriprox 1000 mg Tablet 08/19/2019 10/14/2019 Open Access Dec/January

Corlanor 5 mg/5ml Solution 08/19/2019 10/14/2019 Clinical Edit Dec/January

Baqsimi 3 mg Spray 08/05/2019 09/30/2019 Open Access Dec/January

Adhansia XR 25 mg Capsule 07/29/2019 09/23/2019 PDL Product Dec/January






Vancomycin 2 gram/400 ml Bag 07/29/2019 09/23/2019 Open Access Dec/January

Katerzia 1 mg/ml Suspension 07/29/2019 09/23/2019 PDL Product Dec/January

Slynd 4 mg Tablet 07/15/2019 09/09/2019 Open Access Dec/January

Symjepi 0.15 mg/0.3 ml Syringe 07/15/2019 09/09/2019 PDL Product Dec/January

Thiola EC 100 mg Tablet 07/15/2019 09/09/2019 PA Continued Dec/January

Thiola EC 300 mg Tablet 07/15/2019 09/09/2019 PA Continued Dec/January

Eveko ODT 5 mg ODT Tablet 07/08/2019 09/02/2019 PDL Product Dec/January




Sunosi 75 mg Tablet 07/08/2019 09/02/2019 Clinical Edit Dec/January

Sunosi 150 mg Tablet 07/08/2019 09/02/2019 Clinical Edit Dec/January

Pyridostigmine BR 30 mg Tablet 07/01/2019 08/26/2019 PA Continued Dec/January

Ezallor Sprinkle 5 mg Capsule 07/01/2019 08/26/2019 PDL Product Dec/January




Symdeko 50/75 mg-75 mg Tablets 07/01/2019 08/26/2019 Clinical Edit Dec/January

Abilify Mycite 2 mg Kit 07/01/2019 08/26/2019 Clinical Edit Dec/January






Zulresso 100 mg/20ml Vial 07/01/2019 08/26/2019 PA Continued Dec/January

Kenalog-80 80 mg/ml Vial 06/24/2019 08/19/2019 Open Access Sept/October

Qtern 5 mg-5mg Tablet 06/24/2019 08/19/2019 PDL Product Sept/October

Dextenza 0.4 mg Insert 06/24/2019 08/19/2019 PDL Product Sept/October

Lidopure 5% Patch/Kit 06/17/2019 08/12/2019 Fiscal Edit Sept/October

Nucala 100 mg/ml Syringe 06/17/2019 08/12/2019 PDL Product Sept/October

Nucala 100 mg/ml Auto-Injector 06/17/2019 08/12/2019 PDL Product Sept/October

Nuvakaan 2.5%-2.5% Kit 06/17/2019 08/12/2019 PDL Edit Sept/October

Jornay PM 20 mg Capsule 06/17/2019 08/12/2019 PDL Product Sept/October





Zolgensma 2.6-3.0 kg Kit 06/17/2019 08/12/2019 Clinical Edit Sept/October





















Zolgensma 13.1-13.5 kg Kit 06/17/2019 08/12/2019 Clinical Edit Sept-October

Ruzurgi 10 mg Tablet 06/10/2019 08/05/2019 Clinical Edit Sept/October

Emgality 100 mg/ml Syringe 06/10/2019 08/05/2019 PDL Product Sept/October

Levothyroxine 100 mcg/5 ml Vial 06/03/2019 07/29/2019 Open Access Sept/October



Triferic 27.2 mg/5 ml Ampule 06/03/2019 07/29/2019 Open Access Sept/October

Egaten 250 mg Tablet 05/27/2019 07/22/2019 Open Access Sept/October

Beser 0.05% Kit 05/27/2019 07/22/2019 Fiscal Edit Sept/October

Cutaquig 16.5% Vial 05/20/2019 07/15/2019 Open Access Sept/October

Vyndaqel 20 mg Capsule 05/13/2019 07/08/2019 Clinical Edit Sept/October

Skyrizi 150 mg 2 Syringes Kit 05/06/2019 07/01/2019 PDL Product Sept/October

Duobrii 0.01%-0.045% Lotion 05/06/2019 07/01/2019 PDL Product Sept/October

Kalydeco 25 mg Granules Packet 05/06/2019 07/01/2019 Clinical Edit Sept/October

Bevyxxa 80 mg Capsule 05/06/2019 07/01/2019 PDL Product Sept/October

Bevyxxa 40 mg Capsule 05/06/2019 07/01/2019 PDL Product Sept/October

Heparin SOD 5,000 Unit/0.5 ml Syringe 04/29/2019 06/24/2019 Open Access Sept/October

Plenamine 15% Solution 04/29/2019 06/24/2019 Open Access Sept/October

Skyrizi 75 mg/0.83 ml Syringe 04/29/2019 06/24/2019 PDL Product Sept/October

Ingrezza 40mg – 80 mg Pack 04/29/2019 06/24/2019 PA Continued Sept/October

Diacomit 250 mg Capsule 04/22/2019 06/17/2019 Clinical Edit Sept/October

Diacomit 500 mg Capsule 04/22/2019 06/17/2019 Clinical Edit Sept/October

Diacomit 250 mg Powder Packet 04/22/2019 06/17/2019 Clinical Edit Sept/October

Diacomit 500 mg Powder Packet 04/22/2019 06/17/2019 Clinical Edit Sept/October

Evenity 210 mg 2 Syringe Pack 04/15/2019 06/10/2019 PA Continued Sept/October

Evenity 105 mg/1.17 ml Syringe 04/15/2019 06/10/2019 PA Continued Sept/October

Mavenclad 10 mg Tablet 04/08/2019 06/03/2019 PDL Product Sept/October

Rocklatan 0.02%-0.005% Eye Drop 04/01/2019 05/27/2019 PDL Product Sept/October

Mayzent 2 mg Tablet 04/01/2019 05/27/2019 PDL Product Sept/October

Mayzent 0.25 mg Tablet 04/01/2019 05/27/2019 PDL Product Sept/October

Mayzent 0.25 mg Pack 04/01/2019 05/27/2019 PDL Product Sept/October

Dxevo 11 Day 1.5 mg Tablet 03/25/2019 05/20/2019 PA Continued June/July

Aimovig 140 mg/ml Auto Injector 03/25/2019 05/20/2019 PDL Product June/July

Prograf 1 mg Granule Packet 03/18/2019 05/13/2019 Open Access June/July

Prograf 0.2 mg Granule Packet 03/18/2019 05/13/2019 Open Access June/July

Qmiiz ODT 7.5 mg Tablet 03/18/2019 05/13/2019 PDL Product June/July

Qmiiz ODT 15 mg Tablet 03/18/2019 05/13/2019 PDL Product June/July

Glycopyrrolate 0.2 mg/ml Syringe 03/18/2019 05/13/2019 Open Access June/July

Spravato 28 mg Nasal Spray 03/18/2019 05/13/2019 PA Continued June/July

Spravato 56 mg Nasal Spray Kit 03/18/2019 05/13/2019 PA Continued June/July

Spravato 84 mg Nasal Spray Kit 03/18/2019 05/13/2019 PA Continued June/July

Vancomycin 1 gram/200 ml Bag 03/11/2019 05/06/2019 Open Access June/July

Vancomycin 1.5 gram/300 ml Bag 03/11/2019 05/06/2019 Open Access June/July

Dsuvia 30 mcg Sublingual Tablet 03/11/2019 05/06/2019 Clinical Edit June/July

Nivestym 300 mcg/ml Vial 03/04/2019 04/29/2019 Open Access June/July

Nivestym 480 mcg/1.6 ml Vial 03/04/2019 04/29/2019 Open Access June/July

Lotemax SM 0.38% Ophth Gel 03/04/2019 04/29/2019 PDL Product June/July

Cablivi 11 mg Kit 03/04/2019 04/29/2019 PA Continued June/July

Cablivi 11 mg Vial 03/04/2019 04/29/2019 PA Continued June/July

Tirosint-Sol 13 mcg/ml Solution 02/25/2019 04/22/2019 PA Continued June/July












Tremfya 100 mg/ml Injector 02/25/2019 04/22/2019 PDL Product June/July

Apadaz 4.08-325 mg Tablet 02/18/2019 04/15/2019 Clinical Edit June/July



Inbrija 42 mg Inhalation Cap 02/18/2019 04/15/2019 PA Continued June/July

Motegrity 1 mg Tablet 02/18/2019 04/15/2019 PDL Product June/July

Motegrity 2 mg Tablet 02/18/2019 04/15/2019 PDL Product June/July

Oxervate 0.002% Eye drop 02/18/2019 04/15/2019 PA Continued June/July

Nuzyra 150 mg Tablet 02/18/2019 04/15/2019 PDL Product June/July

Nuzyra 100 mg Vial 02/18/2019 04/15/2019 PDL Product June/July

Firdapse 10 mg Tablet 02/18/2019 04/15/2019 PA Continued June/July

Levorphanol 3 mg Tablet 02/04/2019 04/01/2019 Clinical Edit June/July

Afrezza 90-8 / 90-12 Unit 02/04/2019 04/01/2019 PDL Product June/July

Krintafel 150 mg Tablet 01/21/2019 03/18/2019 Open Access June/July

Divigel 0.75 Mg Gel 01/21/2019 03/18/2019 Open Access June/July

Escitalopram Oxalate 10mg/10ml Solution 01/21/2019 03/18/2019 Clinical Edit June/July

D-Penamine 125 mg Tablet 01/21/2019 03/18/2019 Open Access June/July

Emgality 120 mg/ml Syringe 01/14/2019 03/11/2019 Clinical Edit June/July

Udenyca 6 mg/0.6 ml Syringe 01/14/2019 03/11/2019 PDL Product June/July

Gamifant 10 mg/2 ml Vial 01/14/2019 03/11/2019 PA Continued June/July

Gamifant 50 mg/10 ml Vial 01/14/2019 03/11/2019 PA Continued June/July

Yutiq 0.18 mg Implant 01/14/2019 03/11/2109 PDL Product June/July

Dexycu 9% Vial 01/14/2019 03/11/2019 PDL Product June/July

Vancomycin HCL 1.25 gram Vial 01/07/2019 03/04/2019 Open Access June/July

Promacta 12.5 mg Suspension 01/07/2019 03/04/2019 PDL Product June/July

Inveltys 1% Eye Drop 01/07/2019 03/04/2019 PDL Product June/July

Ultomiris 300 mg/30 ml Vial 12/31/2018 02/25/2019 PA Continued Mar/April

Tresiba 100 unit/ml Vial 12/31/2018 02/25/2019 PDL Product Mar/April

Actemra Actpen 162 mg/0.9 ml Pen 12/31/2018 02/25/2019 PDL Product Mar/April

Tirosint 175 mcg Capsule 12/24/2018 02/18/2019 PA Continued Mar/April

Tirosint 200 mcg Capsule 12/24/2018 02/18/2019 PA Continued Mar/April

Vancomycin HCL 1.5 gram Vial 12/17/2018 02/11/2019 Open Access Mar/April

Tolsura 65 mg Capsule 12/17/2018 02/11/2019 Clinical Edit Mar/April

Sympazan 5 mg Film 12/17/2018 02/11/2019 Clinical Edit Mar/April



Albuminex 5% Vial 12/10/2018 02/04/2019 Open Access Mar/April

Albuminex 25% Vial 12/10/2018 02/04/2019 Open Access Mar/April

Cequa 0.09% Solution 12/10/2018 02/04/2019 Open Access Mar/April

Khapzory 175 mg Vial 12/03/2018 01/28/2019 PA Continued Mar/April

Khapzory 300 mg Vial 12/03/2018 01/28/2019 PA Continued Mar/April

Yupelri 175 mcg/3ml Solution 11/26/2018 01/21/2019 PDL Product Mar/April

Revcovi 2.4 mg/1.5 ml Vial 11/19/2018 01/14/2019 PA Continued Mar/April

Dexmedetomidine 200 mcg/50 ml-D5W IV 11/19/2018 01/14/2019 Open Access Mar/April

Dexmedetomidine 400 mcg/100 ml-D5W IV 11/19/2018 01/14/2019 Open Access Mar/April

Bryhali 0.01% Lotion 11/19/2018 01/14/2019 PDL product Mar/April

Xolair 75 mg/0.5 ml Syringe 11/12/2018 01/07/2019 Clinical Edit Mar/April

Xolair 150 mg/ml Syringe 11/12/2018 01/07/2019 Clinical Edit Mar/April

Siklos 1,000 mg Tablet 11/12/2018 01/07/2019 PA Continued Mar/April

Xelpros 0.005% Drop 11/12/2018 01/07/2019 PDL Product Mar/April

Xyosted 50 mg/0.5 ml Auto Injector 11/12/2018 01/07/2019 PDL Product Mar/April

Xyosted 75 mg/0.5 ml Auto Injector 11/12/2018 01/07/2019 PDL Product Mar/April

Xyosted 100 mg/0.5 ml Auto injector 11/12/2018 01/07/2019 PDL Product Mar/April

Granix 480 mcg/1.6 ml Vial 11/12/2018 01/07/2019 Open Access Mar/April

Granix 300 mcg/ml Vial 11/12/2018 01/07/2019 Open Access Mar/April

Omegaven 10 gm/100 ml IV 11/12/2018 01/07/2019 Fiscal Edit Mar/April

Tegsedi 284 Mg/1.5 ml Syringe 11/12/2018 01/07/2019 Clinical Edit Mar/April

Lexette 0.05% Foam 11/05/2018 12/31/2018 PDL Product Mar/April

Zortress 1 mg Tablet 10/29/2018 12/24/2018 Open Access Mar/April

Dupixent 200 mg/1.14 ml Syringe 10/29/2018 12/24/2018 PDL Product Mar/April

Xofluza 20 mg Tablet 10/29/2018 12/24/2018 PA Continued Mar/April

Xofluza 40 mg Tablet 10/29/2018 12/24/2018 PA Continued Mar/April

Xerava 50 mg Vial 10/29/2018 12/24/2018 PDL Product Mar/April

Epidiolex 100 mg/ml Vial 10/29/2018 12/24/2018 Clinical Edit Mar/April

Arikayce 590 mg/8.4ml Vial 10/29/2018 12/24/2018 PDL Product Mar/April

Panzyga 10% Vial 10/22/2018 12/17/2018 Open Access Mar/April

Xarelto 2.5 mg Tablet 10/22/2018 12/17/2018 PDL Product Mar/April

Qbrexza 2.4% Cloth 10/15/2018 12/10/2018 PA Continued Mar/April

Tiglutik 50 mg/10 ml Suspension 10/15/2018 12/10/2018 PA Continued Mar/April

Altreno 0.05% Lotion 10/08/2018 12/03/2018 PDL Product Mar/April

Emgality 120 mg/ml Pen 10/08/2018 12/03/2018 PDL Product Mar/April

Nocdurna 55.3 mcg Tablet SL 10/08/2018 12/03/2018 Clinical Edit Mar/April

Nocdurna 27.7 mcg Tablet SL 10/08/2018 12/03/2018 Clinical Edit Mar/April

Palonosetron HCL 0.25 MG/5ML Vial 10/01/2018 11/26/2018 PDL Product Mar/April

Ztlido 1.8% Topical System 09/24/2018 11/19/2018 PDL Product Dec/Jan

Ajovy 225/mg/1.5 ml Syringe 09/24/2018 11/19/2018 Clinical Edit Dec/Jan

Glyrx-PF 0.2 mg / mL Vial 09/17/2018 11/12/2018 Open Access Dec/Jan

Nivestym 300 mcg / 0.5 mL Syringe 09/10/2018 11/05/2018 Open Access Dec/Jan

Nivestym 480 mcg / 0.8 mL Syringe 09/10/2018 11/05/2018 Open Access Dec/Jan

Vancomycin HCL 250 mg Vial 09/10/2018 11/05/2018 Open Access Dec/Jan

Zemdri 500 mg / 10 mL Vial 09/10/2018 11/05/2018 Open Access Dec/Jan

Onpattro 10 mg / 5 mL Vial 09/10/2018 11/05/2018 Clinical Edit Dec/Jan

Doptelet 20 mg Tablet 09/10/2018 11/05/2018 PDL Product Dec/Jan

Galafold 123 mg Capsule 09/10/2018 11/05/2018 Clinical Edit Dec/Jan

Signifor Lar 10 mg Vial Kit 09/03/2018 10/29/2018 Open Access Dec/Jan

Signifor Lar 30 mg Vial Kit 09/03/2018 10/29/2018 Open Access Dec/Jan

Takhzyro 300 mg / 2 mL Vial 09/03/2018 10/29/2018 PDL Product Dec/Jan

Ilumya 100 mg / mL Syringe 08/27/2018 10/22/2018 PDL Product Dec/Jan

Lenvima 12 mg Capsule 08/27/2018 10/22/2018 Fiscal Edit Dec/Jan

Lenvima 4 mg Capsule 08/27/2018 10/22/2018 Fiscal Edit Dec/Jan

Mulpleta 3 mg Tablet 08/27/2018 10/22/2018 PDL Product Dec/Jan

Poteligio 20 mg / 5 mL Vial 08/27/2018 10/22/2018 Open Access Dec/Jan

Perseris ER 90 mg Syringe Kit 08/20/2018 10/15/2018 CE/PDL Dec/Jan

Perseris ER 120 mg Syringe Kit 08/20/2018 10/15/2018 CE/PDL Dec/Jan

Orkambi 100 – 125 mg Granule Packet 08/13/2018 10/08/2018 Clinical Edit Dec/Jan

Orkambi 150 – 188 mg Granule Packet 08/13/2018 10/08/2018 Clinical Edit Dec/Jan

Kyprolis 10 mg Vial 08/13/2018 10/08/2018 Open Access Dec/Jan

Plenvu Powder Packets 140 – 9 – 5.2 Gram Powder Packet 08/13/2018 10/08/2018 Open Access Dec/Jan

Humira Pen CROHN – UC -HS

80 mg Pen Injection 08/06/2018 10/01/2018 PDL Product Dec/Jan

Humira Pen PSOR - UVEI 80 mg – 40 mg Pen Injection 08/06/2018 10/01/2018 PDL Product Dec/Jan

Lokelma 5 gram Powder Packet 08/06/2018 10/01/2018 PDL Product Dec/Jan

Lokelma 10 gram Powder Packet 08/06/2018 10/01/2018 PDL Product Dec/Jan

Tibsovo 250 mg Tablet 07/30/2018 09/24/2018 Fiscal Edit Dec/Jan

Macrilen 60 mg / 120 mL Solution 07/30/2018 09/24/2018 Open access Dec/Jan

Kapspargo Sprinkle 25 mg Capsule 07/30/2018 09/24/2018 PDL Product Dec/Jan




Nuplazid 10 mg Tablet 07/30/2018 09/24/2018 PDL Product Dec/Jan

Nuplazid 34 mg Capsule 07/30/2018 09/24/2018 PDL Product Dec/Jan

Orilissa 150 mg Tablet 07/30/2018 09/24/2018 Clinical Edit Dec/Jan

Orilissa 200 mg Tablet 07/30/2018 09/24/2018 Clinical Edit Dec/Jan

Butalbital - Acetaminophen 50 mg / 300 mg Capsule 07/30/2018 09/24/2018 Clinical Edit Dec/Jan

Fulphila 6 mg / 0.6 mL Syringe 07/16/2018 09/10/2018 Open Access Dec/Jan

Aristada Initio ER 675 mg / 2.4 Syringe 07/09/2018 09/03/2018 Clinical Edit Dec/Jan

Xeljanz 10 mg Tablet 06/25/2018 08/20/2018 PDL Product Sept/Oct

Roxybond 15 mg Tablet 06/25/2018 08/20/2018 Clinical Edit Sept/Oct

Roxybond 30 mg Tablet 06/25/2018 08/20/2018 Clinical Edit Sept/Oct

Siklos 100 mg Tablet 06/25/2018 08/20/2018 PA Continued Sept/Oct

Retacrit 40,000 Unit / mL Vial 06/18/2018 08/13/2018 PDL Product Sept/Oct

Olumiant 2 mg Tablet 06/11/2018 08/06/2018 PDL Product Sept/Oct

Kevzara 150 mg / 1.14 mL Pen Injection 06/11/2018 08/06/2018 PDL Product Sept/Oct

Kevzara 200 mg / 1.14 mL Pen Injection 06/11/2018 08/06/2018 PDL Product Sept/Oct

Retacrit 2,000 Units / mL Vial 06/11/2018 08/06/2018 PDL Product Sept/Oct




Palynziq 2.5 mg / 0.5 mL Syringe 06/11/2018 08/06/2018 Clinical Edit Sept/Oct

Palynziq 20 mg / mL Syringe 06/11/2018 08/06/2018 Clinical Edit Sept/Oct

Palynziq 10 mg / 0.5 mL Syringe 06/11/2018 08/06/2018 Clinical Edit Sept/Oct

Gilenya 0.25 mg Capsule 06/04/2018 07/30/2018 PDL Product Sept/Oct

Arnuity Ellipta 50 mcg Inhalation 06/04/2018 07/30/2018 PDL Product Sept/Oct

Lucemyra 0.18 mg Tablet 06/04/2018 07/30/2018 PDL Product Sept/Oct

Goprelto 4% Nasal Solution 06/04/2018 07/30/2018 PA Continued Sept/Oct

Cocaine HCL 4% Nasal Solution 06/04/2018 07/30/2018 PA Continued Sept/Oct

Aimovig 70 mg / ml Auto Injection 05/28/2018 07/23/2018 Clinical Edit Sept/Oct

Osmolex ER 129 mg Tablet 05/28/2018 07/23/2018 Continue PA Sept/Oct



Zenpep DR 3 – 10 – 14 K Capsule 05/28/2018 07/23/2018 PDL Product Sept/Oct

Baclofen 5 mg Tablet 05/21/2018 07/16/2018 PDL Product Sept/Oct

Zenpep DR 15 – 47 – 63 K Capsule 05/14/2018 07/09/2018 PDL Product Sept/Oct

Rhopressa 0.02 % Ophthalmic

Solution

05/14/2018 07/09/2018 PDL Product

Sept/Oct

Noctiva 0.83 mcg / 0.1 mL Spray 05/14/2018 07/09/2018 Continue PA Sept/Oct

Noctiva 1.66 mcg / 0.1 mL Spray 05/14/2018 07/09/2018 Continue PA Sept/Oct

Luxturna 1.5 X 10 EX 11 Vial 05/14/2018 07/09/2018 Clinical Edit Sept/Oct

Humira 40 mg / 0.4 mL Syringe Kit 05/07/2018 07/02/2018 PDL Product Sept/Oct

Humira Pen 40 mg / 0.4 mL Pen Kit 05/07/2018 07/02/2018 PDL Product Sept/Oct

Humira Pediatric Crohn’s 80 mg / 0.8 mL Syringe Kit 05/07/2018 07/02/2018 PDL Product Sept/Oct



Humira Pediatric Crohn’s 80 mg – 40 mg Syringe Kit 05/07/2018 07/02/2018 PDL Product Sept/Oct

Kymriah 6 x 10 Exp 8 Infusion Bag 05/07/2018 07/02/2018 Clinical Edit Sept/Oct

Jynarque 90 mg – 30 mg Tablet 04/30/2018 06/25/2018 Clinical Edit Sept/Oct



Crysvita 10 mg / mL Vial 04/30/2018 06/25/2018 Clinical Edit Sept/Oct



Balcoltra 0.1 – 0.02 mg Tablet 04/23/2018 06/18/2018 Open Access Sept/Oct

Zenpep DR 10 – 32 – 42 K DR Capsule 04/23/2018 06/18/2018 PDL Product Sept/Oct

Hyperrab 300 Unit / mL Vial 04/23/2018 06/18/2018 Open Access Sept/Oct

Toujeo Max Solostar 300 Unit / mL Insulin Pen 04/09/2018 06/04/2018 PDL Product Sept/Oct

Esomep – EZS Kit 20 mg Kit Cap SP 04/09/2018 06/04/2018 PDL Product Sept/Oct

Lucentis 0.3 mg / 0.05 mL Syringe 04/02/2018 05/28/2018 Open Access Sept/Oct

Zypitamag 1 mg Tablet 03/26/2018 05/21/2018 PDL Product June/July



Daliresp 250 mcg Tablet 03/19/2018 05/14/2018 PDL Product June/July

Tisseel VHSD 2 mL Kit 03/19/2018 05/14/2018 Open Access June/July



Tisseel VHSD 2 mL Syringe 03/19/2018 05/14/2018 Open Access June/July



Bonjesta ER 20 mg / 20 mg Tablet 03/12/2018 05/07/2018 Continue PA June/July

Makena 275 mg / 1.1 mL Auto Injection 03/05/2018 04/30/2018 Open Access June/July

Zenpep DR 5 k – 17 k – 24 k Capsule 02/26/2018 04/23/2018 PDL Product June/July

Zenpep DR 25 k – 79 k – 105 k Capsule 02/26/2018 04/23/2018 PDL Product June/July

Lonhala Magnair 25 mcg Vial – Neb 02/26/2018 04/23/2018 PDL Product June/July

Symdeko 100 / 150 mg – 150

mg Tablet 02/19/2018 04/16/2018 Clinical Edit

June/July

Sinuva 1350 mcg Implant 02/19/2018 04/16/2018 PDL Product June/July

Mepsevii 10 mg / 5 mL Vial 02/19/2018 04/16/2018 Clinical Edit June/July

Yescarta Infusion Bag 02/19/2018 04/16/2018 Clinical Edit June/July

Yescarta Cassette 02/19/2018 04/16/2018 Clinical Edit June/July

Xhance 93 mcg Nasal Spray 02/19/2018 04/16/2018 PDL Product June/July

Gocovri ER 68.5 mg Capsule 02/19/2018 04/16/2018 Open Access June/July

Gocovri ER 137 mg Capsule 02/19/2018 04/16/2018 Open Access June/July

Nityr 10 mg Tablet 02/19/2018 04/16/2018 Continue PA June/July



Segluromet 2.5 – 500 mg Tablet 02/12/2018 04/09/2018 PDL Product June/July




Endari 5 Gram Powder Pack 02/12/2018 04/09/2018 Open Access June/July

Luxturna With diluent SD Vial 02/05/2018 04/02/2018 Clinical Edit June/July

Eliquis 5 mg Tab DS PK 01/29/2018 03/26/2018 PDL Product June/July

Steglujan 5 mg - 100 mg Tablet 01/29/2018 03/26/2018 PDL Product June/July

Steglujan 15 mg – 100 mg Tablet 01/29/2018 03/26/2018 PDL Product June/July

Adzenys ER 1.25 mg / mL Oral Suspension 01/22/2018 03/19/2018 Clinical Edit June/July

Steglatro 5 mg Tablet 01/15/2018 03/12/2018 PDL Product June/July

Steglatro 15 mg Tablet 01/15/2018 03/12/2018 PDL Product June/July

Xigduo XR 2.5 mg – 1000 mg Tablet 01/15/2018 03/12/2018 PDL Product June/July

Zilretta 32 mg Vial 01/15/2018 03/12/2018 Open Access June/July

Baxdela 450 mg Tablet 01/15/2018 03/12/2018 Open Access June/July

Baxdela 300 mg Tablet 01/15/2018 03/12/2018 Open Access June/July

Duzallo 200 mg – 200 mg Tablet 01/15/2018 03/12/2018 PDL Product June/July

Duzallo 200 mg – 300 mg Tablet 01/15/2018 03/12/2018 PDL Product June/July

Lyrica CR 82.5 mg Tablet 01/08/2018 03/05/2018 PDL Product June/July

Lyrica CR 165 mg Tablet 01/08/2018 03/05/2018 PDL Product June/July

Lyrica CR 330 mg Tablet 01/08/2018 03/05/2018 PDL Product June/July

Solosec 2 gram Granule Packet 01/08/2018 03/05/2018 Open Access June/July

Prolastin – C 1000 mg / 20 mL Vial 01/08/2018 03/05/2018 Open Access June/July

Methylphenidate ER 72 mg Tablet 01/01/2018 02/26/2018 Clinical Edit June/July

Clenpiq 10 – 3.5 / 160 Solution 01/01/2018 02/26/2018 Open Access June/July

Fibryga 700 – 1300 mg Vial 01/01/2018 02/26/2018 Open Access June/July

Clinimix N9G15E 2.75 % - 7.5 % IV Solution 12/25/2017 02/19/2018 Open Access March/April

Clinimix N14G30E 4.25 % - 15 % IV Solution 12/25/2017 02/19/2018 Open Access March/April

Sublocade 100 mg / 0.5 mL Syringe 12/25/2017 02/19/2018 PDL Product March/April

Sublocade 300 mg / 1.5 mL Syringe 12/25/2017 02/19/2018 PDL Product March/April

Zenpep 40,000 Unit DR Capsule 12/11/2017 02/05/2018 PDL Product March/April

Ozempic 0.25 mg - 0.5 mg Pen Injector 12/11/2017 02/05/2018 PDL Product March/April

Ozempic 1 mg / 0.75 mL Pen Injector 12/11/2017 02/05/2018 PDL Product March/April

Prevymis 240 mg Tablet 12/04/2017 01/29/2018 Open Access March/April

Prevymis 480 mg Tablet 12/04/2017 01/29/2018 Open Access March/April

Prevymis 240 mg / 12 mL Vial 12/04/2017 01/29/2018 Open Access March/April

Prevymis 480 mg / 24 mL Vial 12/04/2017 01/29/2018 Open Access March/April

Zenpep 20,000 Unit DR Capsule 12/04/2017 01/29/2018 PDL Product March/April

Vyzulta 0.024 % Ophthalmic

Solution

12/04/2017 01/29/2018 PDL Product

March/April

Cinvanti 130 mg / 18 mL Vial 12/04/2017 01/29/2018 Open Access March/April

Retin-A Micro Pump 0.06 % Gel 11/20/2017 01/15/2018 PDL Product March/April

Fasenra 30 mg / mL Syringe 11/20/2017 01/15/2018 Clinical Edit March/April

Tracleer 32 mg Tablet for Susp 11/20/2017 01/15/2018 PDL Product March/April

Bydureon Bcise 2 mg Auto Inject 11/13/2017 01/08/2018 PDL Product March/April

Qtern 10 mg - 5 mg Tablet 11/13/2017 01/08/2018 PLD Product March/April

Benznidazole 12.5 mg Tablet 11/06/2017 01/01/2018 Open Access March/April

Benznidazole 100 mg Tablet 11/06/2017 01/01/2018 Open Access March/April

Ximino ER 45 mg Capsule 11/06/2017 01/01/2018 PDL Product March/April



Varubi 166.5 mg / 92.5 mL Vial 11/06/2017 01/01/2018 Open Access March/April

Enbrel 50 mg / mL Mini Cartridge 10/30/2017 12/25/2017 PDL Product March/April

Parsabiv 2.5 mg / 0.5 mL Vial 10/30/2017 12/25/2017 Open Access March/April

Parsabiv 5 mg / mL Vial 10/30/2017 12/25/2017 Open Access March/April

Parsabiv 10 mg / 2 mL Vial 10/30/2017 12/25/2017 Open Access March/April

Qvar Redihaler 40 mcg Inhalation 10/23/2017 12/18/2017 PDL Product March/April

Qvar Redihaler 80 mcg Inhalation 10/23/2017 12/18/2017 PDL Product March/April

Ingrezza 80 mg Capsule 10/16/2017 12/11/2017 Continue PA March/April

Fiasp 100 Unit / mL Vial / Flextouch 10/09/2017 12/04/2017 PDL Product March/April

Trelegy Ellipta 100 – 62.5 – 25 Inhalation 10/09/2017 12/04/2017 PDL Product March/April

Zodex 12 - Day 1.5 mg Tablet 10/09/2017 12/04/2017 Continue PA March/April

Symproic 0.2 mg Tablet 10/09/2017 12/04/2017 PDL Product March/April

Vabomere 2 gram Vial 10/09/2017 12/04/2017 Open Access March/April

Nymalize 30 mg / 10 mL Solution 09/25/2017 11/20/2017 PDL Product Dec/Jan

Jetrea 1.25 mg / mL Vial 09/18/2017 11/13/2017 Continue PA Dec/Jan

Kymriah Infusion Bag 09/11/2017 11/06/2017 Continue PA Dec/Jan

Triptodur 22.5 mg Vial / Kit 09/11/2017 11/06/2017 Continue PA Dec/Jan

Nestabs One 38 – 1 – 225 mg Softgel Capsule 09/11/2017 11/06/2017 Open Access Dec/Jan

Carospir 25 mg / 5 mL Oral Suspension 09/04/2017 10/30/2017 Open Access Dec/Jan

Pertzye 24 K – 86.25 K DR Capsule 08/28/2017 10/23/2017 PDL Product Dec/Jan

Humalog Junior 100 Unit / mL KwikPen 08/21/2017 10/16/2017 PDL Product Dec/Jan

Radicava 30 mg / 100 mL Solution 08/21/2017 10/16/2017 Continue PA Dec/Jan

Nerlynx 40 mg Tablet 08/21/2017 10/16/2017 Open Access Dec/Jan

Mavyret 100 – 400 mg Tablet 08/14/2017 10/09/2017 PDL Product Dec/Jan

Armonair Respiclick 55 mcg Aer Pow Ba 08/14/2017 10/09/2017 PDL Product Dec/Jan



Cotempla XR-ODT 8.6 mg Tablet 08/07/2017 10/02/2017 Clinical Edit Dec/Jan



Totect 500 mg Vial 08/07/2017 10/02/2017 Open Access Dec/Jan

Renflexis 100 mg Vial 07/31/2017 09/25/2017 PDL Product Dec/Jan

Benlysta 200 mg / mL Auto Inject 07/31/2017 09/25/2017 Continue PA Dec/Jan

Benlysta 200 mg / mL Syringe 07/31/2017 09/25/2017 Continue PA Dec/Jan

Vosevi 400 – 100 mg Tablet 07/31/2017 09/25/2017 PDL Product Dec/Jan

Tremfya 100 mg / mL Syringe 07/24/2017 09/18/2017 PDL Product Dec/Jan

Haegarda 2,000 Unit Vial 07/17/2017 09/11/2017 Open Access Dec/Jan

Haegarda 3,000 Unit Vial 07/17/2017 09/11/2017 Open Access Dec/Jan

Jadenu Sprinkle 180 mg Granule 07/03/2017 08/28/2017 Open Access Dec/Jan



Elite-OB 50 – 1.25 mg Tablet 07/03/2017 08/28/2017 Open Access Dec/Jan

Afrezza 8 Unit Cartridge Inhaler 07/03/2017 08/28/2017 PDL Product Dec/Jan

Afrezza 12 Unit Cartridge Inhaler 07/03/2017 08/28/2017 PDL Product Dec/Jan

Mydayis ER 12.5 mg Capsule 07/03/2017 08/28/2017 Clinical Edit Dec/Jan

Mydayis ER 25 mg Capsule 07/03/2017 08/28/2017 Clinical Edit Dec/Jan

Mydayis ER 37.5 mg Capsule 07/03/2017 08/28/2017 Clinical Edit Dec/Jan

Mydayis ER 50 mg Capsule 07/03/2017 08/28/2017 Clinical Edit Dec/Jan

Panhematin 350 mg Vial 07/03/2017 08/28/2017 Continue PA Dec/Jan

Ingrezza 40 mg Capsule 07/03/2017 08/28/2017 Continue PA Dec/Jan

Syndros 5 mg / mL Solution 06/26/2017 08/21/2017 Open Access Sept/Oct

Orenitram ER 5 mg Tablet 06/26/2017 08/21/2017 PDL Product Sept/Oct

Aristada ER 1064 mg / 3.9 mL Syringe 06/12/2017 08/07/2017 Clinical Edit Sept/Oct

Brineura 150 mg / 5 mL Injection Kit 06/12/2017 08/07/2017 Clinical Edit Sept/Oct

Gelfoam JMI 5000 Unit Powder Kit 06/05/2017 07/31/2017 Open Access Sept/Oct

Xatmep 2.5 mg / mL Oral Solution 06/05/2017 07/31/2017 PDL Product Sept/Oct

Kevzara 150 mg / 1.14 mL Syringe 05/29/2017 07/24/2017 PDL Product Sept/Oct

Kevzara 200 mg / 1.14 mL Syringe 05/29/2017 07/24/2017 PDL Product Sept/Oct

Xadago 50 mg Tablet 05/29/2017 07/24/2017 Open Access Sept/Oct

Xadago 100 mg Tablet 05/29/2017 07/24/2017 Open Access Sept/Oct

Arymo ER 15 mg Tablet 05/29/2017 07/24/2017 PDL Product Sept/Oct



Xermelo 250 mg Tablet 05/29/2017 07/24/2017 Open Access Sept/Oct

Orencia 50 mg / 0.4 mL Syringe 05/22/2017 07/17/2017 PDL Product Sept/Oct

Orencia 87.5 mg / 0.7 mL Syringe 05/22/2017 07/17/2017 PDL Product Sept/Oct

Gelfoam JMI 5000 Unit Sponge Kit 05/22/2017 07/17/2017 Open Access Sept/Oct

Morphabond ER 15 mg Tablet 05/22/2017 07/17/2017 PDL Product Sept/Oct




Brineura 300 mg / 10 mL Vial 05/22/2017 07/17/2017 Clinical Edit Sept/Oct

Narcan 2 mg Nasal Spray 05/15/2017 07/10/2017 PDL Product Sept/Oct

Quflora Fe Ped 0.25 mg / mL Drops 05/08/2017 07/03/2017 Open Access Sept/Oct

Tymlos 80 mcg / 0.04 mL Pen Injector 05/08/2017 07/03/2017 Clinical Edit Sept/Oct

Multivitamin - Fluoride 0.25 mg / mL Drops 05/01/2017 06/26/2017 Open Access Sept/Oct

Multivitamin - Fluoride 0.5 mg / mL Drops 05/01/2017 06/26/2017 Open Access Sept/Oct

Esbriet 267 mg Tablet 04/24/2017 06/19/2017 Continue PA Sept/Oct

Esbriet 801 mg Tablet 04/24/2017 06/19/2017 Continue PA Sept/Oct

Airduo Respiclick 55 – 14 mcg Aer Pow Ba 04/24/2017 06/19/2017 PDL Product Sept/Oct



Acetaminophen, Caffeine and Dihydrocodeine

325 mg – 30 mg – 16 mg

Tablet 04/24/2017 06/19/2017 Clinical Edit Sept/Oct

Gelnique 10 % Gel Pump 04/17/2017 06/12/2017 PDL Product Sept/Oct

Austedo 6 mg Tablet 04/10/2017 06/05/2017 Continue PA Sept/Oct



Dupixent 300 mg / 2 mL Syringe 04/03/2017 05/29/2017 PDL Product Sept/Oct

Synjardy XR 10 mg – 1000 mg Tablet 04/03/2017 05/29/2017 PDL Product Sept/Oct



Synjardy XR 12.5 mg – 1000 mg Tablet 04/03/2017 05/29/2017 PDL Product Sept/Oct

Ocrevus 300 mg / 10 mL Vial 04/03/2017 05/29/2017 PDL Product Sept/Oct

Gammaplex 5 Gram / 50 mL Vial 04/03/2017 05/29/2017 Open Access Sept/Oct



Pennsaid 2% Solution Pack 04/03/2017 05/29/2017 PDL Product Sept/Oct

Siliq 210 mg / 1.5 mL Syringe 03/27/2017 05/22/2017 PDL Product June/July

Ellzia Pak 0.1% - 5% Kit 03/13/2017 05/08/2017 PDL Product June/July

Ilaris 150 mg / mL Vial 03/13/2017 05/08/2017 PDL Product June/July

Rhofade 1% Cream (G) 03/13/2017 05/08/2017 Continue PA June/July

Vyvanse 10 mg Chew Tablet 03/13/2017 05/08/2017 Clinical Edit June/July






Ryvent 6 mg Tablet 02/27/2017 04/24/2017 PDL Product June/July

Emflaza 6 mg Tablet 02/20/2017 04/17/2017 Clinical Edit June/July




Emflaza 22.75 mg / mL Oral SUSP 02/20/2017 04/17/2017 Clinical Edit June/July

Triferic 272 mg Powder Pack 02/20/2017 04/17/2017 Open Access June/July

Yosprala 81 mg – 40 mg Tablet 02/20/2017 04/17/2017 PDL Product June/July

Yosprala 325 mg – 40 mg Tablet 02/20/2017 04/17/2017 PDL Product June/July

Linzess 72 mcg Capsule 02/06/2017 04/03/2017 PDL Product June/July

Prenatal Plus 27 – 1 – 250 mg Combo Pack 02/06/2017 04/03/2017 Open Access June/July

Eucrisa 2% Ointment 01/16/2017 03/13/2017 PDL Product June/July

Primacare 30 – 1 – 300 mg Capsule 01/16/2017 03/13/2017 Open Access June/July

Lucentis 0.5 mg / 0.05 mL Syringe 01/09/2017 03/06/2017 Open Access June/July

Epaned 1 mg / mL Solution 01/09/2017 03/06/2017 PDL Product June/July

Afrezza 4 unit/ 8 unit/12 unit Cart w/Dev 01/02/2017 02/27/2017 PDL Product June/July

Zubsolv 0.7- 0.18 mg Tablet 01/02/2017 02/27/2017 PDL Product June/July

Spinraza 12 mg / 5mL Vial 01/02/2017 02/27/2017 Clinical Edit June/July

Loprox 0.77 % Topical Kit 12/26/2017 02/20/2017 PDL Product March/April

Adlyxin 10-20 mcg Pen Injector 12/19/2017 02/13/2017 PDL Product March/April

Adlyxin 20 mcg / 0.2 mL Pen Injector 12/19/2017 02/13/2017 PDL Product March/April

Soliqua 100 units – 33 mcg Pen Injector 12/19/2017 02/13/2017 PDL Product March/April

Evzio 2 mg / 0.4 mL Pen Injector 12/19/2017 02/13/2017 PDL Product March/April

Xultophy 100 units – 3.6mg/mL Pen Injector 11/28/2016 01/23/2017 PDL Product March/April

Euflexxa 20 mg / 2 mL Syringe 11/21/2016 01/16/2017 Open Access March/April

Vemlidy 25 mg Tablet 11/21/2016 01/16/2017 Open Access March/April

Dexeryl Emollient Cream 11/21/2016 01/16/2017 Open Access March/April

Pertzye 4000 units – lipase DR Capsule 11/21/2016 01/16/2017 PDL Product March/April

Rayaldee ER 30 mcg Capsule 11/14/2016 01/09/2017 Continue PA March/April

Rayaldee ER 30 mcg Capsule 11/14/2016 01/09/2017 Continue PA March/April

Pancreaze 2600 units – lipase DR Capsule 11/14/2016 01/09/2017 PDL Product March/April

Namzaric 7–10 mg / 14-10 mg Cap Dospak 11/07/2016 01/02/2017 PDL Product March/April

Restasis 0.05 % Ophth Soln 11/07/2016 01/02/2017 Continue PA March/April

DEKAs Essential 2000–2000–75-2000 Liquid 10/31/2016 12/26/2017 Open Access March/April

DEKAs Plus Chew Tablet 10/31/2016 12/26/2017 Open Access March/April

Prenatal Formula-DHA 28 – 0.8 – 235 mg Softgel Capsule 10/31/2016 12/26/2017 Open Access March/April

Dexmedetomidine 400 mcg/4 mL Vial 10/31/2016 12/26/2017 Open Access March/April

Dexmedetomidine 1000 mcg/10 mL Vial 10/31/2016 12/26/2017 Open Access March/April

Hydromorphone HCl 1 mg/1 mL Ampule 10/31/2016 12/26/2017 Clinical Edit March/April



Aggrastat 3.75 mg/15 mL Vial 10/31/2016 12/26/2017 Open Access March/April

Inflectra 100 mg/10 mL Vial 10/24/2016 12/19/2017 PDL Product March/April

Kyleena 17.5 mcg/24 hr IUD 10/17/2016 12/12/2016 Fiscal Edit March/April

Pancreaze 4200 units – lipase DR Capsule 10/17/2016 12/12/2016 PDL Product March/April

Pancreaze 10,500 units – lipase DR Capsule 10/17/2016 12/12/2016 PDL Product March/April



Vascepa 0.5 Gram Capsule 10/17/2016 12/12/2016 PDL Product March/April

MiCort - HC 2.5 % Cream 10/17/2016 12/12/2016 PDL Product March/April

BromSite 0.075% Ophth Soln 10/10/2016 12/05/2016 PDL Product March/April

Sustol 10 mg/0.4 mL Syringe 10/10/2016 12/05/2016 PDL Product March/April

Treximet 10 / 60 mg Tablet 10/10/2016 12/05/2016 PDL Product March/April

TriCare Prenatal DHA 5 – 2 - 300 Chew Tablet 10/10/2016 12/05/2016 Open Access March/April

Stelara 130 mg/26 mL Vial 10/03/2016 11/28/2016 PDL Product March/April

Cuvitru 1 Gram/5 mL Vial 10/03/2016 11/28/2016 Open Access March/April




Exondys 51 500 mg/10 mL Vial 09/26/2016 11/21/2016 Continue PA Dec/Jan

Exondys 51 100 mg/2 mL Vial 09/26/2016 11/21/2016 Continue PA Dec/Jan

Taytulla 1 mg-20 mcg Capsule 09/26/2016 11/21/2016 Open Access Dec/Jan

Invokamet XR 50 - 500 mg Tablet 09/26/2016 11/21/2016 PDL Product Dec/Jan

Invokamet XR 50 - 1,000 mg Tablet Tablet 09/26/2016 11/21/2016 PDL Product Dec/Jan

Invokamet XR 150 - 500 mg Tablet 09/26/2016 11/21/2016 PDL Product Dec/Jan

Invokamet XR 150 - 1,000 mg Tablet Tablet 09/26/2016 11/21/2016 PDL Product Dec/Jan

DermacinRX Therazole 1 mg/0.05mg/20% Combo Pack 09/26/2016 11/21/2016 Continue PA Dec/Jan

GoNitro 0.4 mg Powder Pack 09/26/2016 11/21/2016 Continue PA Dec/Jan

Namzaric 7 mg – 10 mg Capsule 09/05/2016 10/31/2016 PDL Product Dec/Jan

Namzaric 21 mg – 10 mg Capsule 09/05/2016 10/31/2016 PDL Product Dec/Jan

Zurampic 200 mg Tablet 08/29/2016 10/24/2016 PDL Product Dec/Jan

Tis-U-Sol Pentalyte 800-40/100 Irrigation Solution 08/29/2016 10/24/2016 Open Access Dec/Jan

Relistor 150 mg Tablet 08/29/2016 10/24/2016 PDL Product Dec/Jan

Orfadin 20 mg Capsule 08/22/2016 10/17/2016 Open Access Dec/Jan

Xtampza ER 9 mg Capsule 08/08/2016 10/03/2016 PDL Product Dec/Jan

Xtampza ER 13.5 mg Capsule 08/08/2016 10/03/2016 PDL Product Dec/Jan




Nuplazid 17 mg Tablet 08/08/2016 10/03/2016 Clinical Edit Dec/Jan

Probuphine 74.2 mg Implant 08/08/2016 10/03/2016 PDL Product Dec/Jan

Ocaliva 5 mg Tablet 08/08/2016 10/03/2016 PDL Product Dec/Jan

Ocaliva 10 mg Tablet 08/08/2016 10/03/2016 PDL Product Dec/Jan

Viekira XR 8.33-50 mg Tablet 08/01/2016 09/26/2016 PDL Product Dec/Jan

Lidortral 3.88% Cream (G) 08/01/2016 09/26/2016 Continue PA Dec/Jan

Emend 125 mg SUSP Recon 07/25/2016 09/19/2016 PDL Product Dec/Jan

Xiidra 5% Droperette 07/25/2016 09/19/2016 Open Access Dec/Jan

Oxycodone 10mg/0.5 mL Syringe 07/25/2016 09/19/2016 Clinical Edit Dec/Jan

Loprox 0.77% Combo Pack 07/18/2016 09/12/2016 PDL Product Dec/Jan

Otrexup 12.5 mg/0.4 mL Auto Injector 07/18/2016 09/12/2016 PDL Product Dec/Jan

Repatha Pushtronex 420 mg/3.5 mL Wear Injector 07/18/2016 09/12/2016 Clinical Edit Dec/Jan

Dermacinrx Cinlone I CPI 40 mg/mL Kit 07/18/2016 09/12/2016 Continue PA Dec/Jan

Zinbryta 150 mg/mL Syringe 07/11/2016 09/05/2016 PDL Product Dec/Jan

Bevespi Aerosphere 9 - 4.58 mcg HFA AER AD 07/11/2016 09/05/2016 PDL Product Dec/Jan

Morgidox 50 mg Kit 07/11/2016 09/05/2016 PDL Product Dec/Jan

Doryx MPC 120 mg Tablet 07/11/2016 09/05/2016 PDL Product Dec/Jan

Epclusa 400 mg – 100 mg Tablet 07/04/2016 08/29/2016 PDL Product Sept/Oct

Orencia 125 mg/mL Auto Injector 06/27/2016 08/22/2016 PDL Product Sept/Oct

Jentadueto XR 2.5 mg – 1,000 mg Tablet 06/27/2016 08/22/2016 PDL Product Sept/Oct

Jentadueto XR 5 mg – 1,000 mg Tablet 06/27/2016 08/22/2016 PDL Product Sept/Oct

Vopac MDS 1.5% Kit 06/27/2016 08/22/2016 PDL Product Sept/Oct

Lazanda 300 mcg Nasal Spray 06/20/2016 08/15/2016 Clinical Edit Sept/Oct

Fycompa 0.5 mg/mL Oral Suspension 06/20/2016 08/15/2016 Clinical Edit Sept/Oct

Tricare Prenatal DHA 4.5 – 1 – 150 Pack 06/13/2016 08/08/2016 Open Access Sept/Oct

Delzicol DR 400 mg Capsule 06/06/2016 08/01/2016 PDL Product Sept/Oct

Venipuncture CPI 2.5% Kit 06/06/2016 08/01/2016 Continue PA Sept/Oct

Dermacin RX ZRM 5%/5% Kit 06/06/2016 08/01/2016 PDL Product Sept/Oct

Hyqvia IG/HY 2.5 gm – 200 Units Injection 05/30/2016 07/25/2016 Open Access Sept/Oct

Hyqvia IG/HY 5 gm – 400 Units Injection 05/30/2016 07/25/2016 Open Access Sept/Oct




Cetylev 500 mg Tablet 05/30/2016 07/25/2016 Open Access Sept/Oct

Cetylev 2.5 gm Tablet 05/30/2016 07/25/2016 Open Access Sept/Oct

Orfadin 4mg/mL Oral Suspension 05/30/2016 07/25/2016 Continue PA Sept/Oct

Daklinza 90 mg Tablet 05/23/2016 07/18/2016 PDL Product Sept/Oct

Briviact 10 mg Tablet 05/23/2016 07/18/2016 Clinical Edit Sept/Oct





Briviact 10 mg/mL Oral Solution 05/23/2016 07/18/2016 Clinical Edit Sept/Oct

Migranow 50 mg Tab-Gel Kit 05/23/2016 07/18/2016 PDL Product Sept/Oct

Mirvaso 0.33% Gel Pump 05/16/2016 07/11/2016 Continue PA Sept/Oct

Viberzi 75 mg Tablet 05/16/2016 07/11/2016 Clinical Edit Sept/Oct

Viberzi 100 mg Tablet 05/16/2016 07/11/2016 Clinical Edit Sept/Oct

Otiprio 6% Vial 05/16/2016 07/11/2016 PDL Product Sept/Oct

Floriva Plus 0.25 mg/mL Drops 05/16/2016 07/11/2016 Open Access Sept/Oct

Spritam 250 mg Tablet 05/16/2016 07/11/2016 Clinical Edit Sept/Oct




Tolak 4% Cream (G) 05/09/2016 07/04/2016 Open Access Sept/Oct

Ultravate 0.05% Lotion 05/02/2016 06/27/2016 PDL Product Sept/Oct

Oralair 100 – 300 IR Tab SUBL 05/02/2016 06/27/2016 Continue PA Sept/Oct

Renacidin 6.602 g/100 mL Irrigation Solution 04/25/2016 06/20/2016 Open Access Sept/Oct

Onzetra Xsail 11 mg Aer Pow Ba 04/25/2016 06/20/2016 PDL Product Sept/Oct

Aczone 7.5% Gel Pump 04/18/2016 06/13/2016 Continue PA Sept/Oct

Vitafol 3.33 - 0.33 mg Chew Tab 04/18/2016 06/13/2016 Open Access Sept/Oct

Otrexup 17.5 mg/0.4 mL Auto Injector 04/18/2016 06/13/2016 PDL Product Sept/Oct

Otrexup 22.5 mg/0.4 mL Auto Injector 04/18/2016 06/13/2016 PDL Product Sept/Oct

Xrylix 1.5% Kit 04/18/2016 06/13/2016 PDL Product Sept/Oct

Pain Relief Collection 500 mg Kit 04/18/2016 06/13/2016 PDL Product Sept/Oct

Narcan 4 mg Spray 04/18/2016 06/13/2016 PDL Product Sept/Oct

IV Infusion CPI 2.5% Kit 04/11/2016 06/06/2016 Continue PA Sept/Oct

Nexium 24HR 20 mg Tablet 04/04/2016 05/30/2016 PDL Product Sept/Oct

Taltz 80 mg/ mL Auto Inj/Syringe 04/04/2016 05/30/2016 PDL Product Sept/Oct

Sernivo 0.05% Spray 04/04/2016 05/30/2016 PDL Product Sept/Oct

Adzenys XR - ODT 3.1 mg Tablet 03/28/2016 05/23/2016 Clinical Edit June/July






Zembrace Symtouch 3 mg/0.5 mL Pen Injector 03/28/2016 05/23/2016 PDL Product June/July

Makena 250 mg/ mL PF SD Vial 03/21/2016 05/16/2016 Open Access June/July

Humulin R 500 Units/ mL Insulin Pen 03/07/2016 05/02/2016 PDL Product June/July

Xeljanz XR 11 mg Tablet 03/07/2016 05/02/2016 PDL Product June/July

Metoprolol 37.5 mg Tablet 03/07/2016 05/02/2016 PDL Product June/July

Metoprolol 75 mg Tablet 03/07/2016 05/02/2016 PDL Product June/July

Vraylar 1.5 mg Capsule 02/22/2016 04/18/2016 Clinical Edit June/July

Vraylar 3 mg Capsule 02/22/2016 04/18/2016 Clinical Edit June/July

Vraylar 4.5 mg Capsule 02/22/2016 04/18/2016 Clinical Edit June/July

Vraylar 6 mg Capsule 02/22/2016 04/18/2016 Clinical Edit June/July

Vraylar 1.5 mg - 3 mg Pack 02/22/2016 04/18/2016 Clinical Edit June/July

Xeomin 200 Unit Vial 02/08/2016 04/04/2016 Clinical Edit June/July

Zepatier 50 mg - 100 mg Tablet 02/08/2016 04/04/2016 PDL Product June/July

Ticanase 50 mcg - 0.9% Kit 02/08/2016 04/04/2016 PDL Product June/July

Quillichew ER 20 mg Chew Tab 02/01/2016 03/28/2016 Clinical Edit June/July



Nufera Tablet 01/25/2016 03/21/2016 Continue PA June/July

Dyanaval XR 2.5 mg/ mL Susp 01/25/2016 03/21/2016 Clinical Edit June/July

Pradaxa 110 mg Capsule 01/11/2016 03/07/2016 PDL Product June/July

Enstilar 0.005%-0.064% Foam 01/11/2016 03/07/2016 PDL Product June/July

Nutropin AQ Nuspin 10 mg/2 mL Injector 01/11/2016 03/07/2016 PDL Product June/July

Nutropin AQ Nuspin 20 mg/2 mL Injector 01/11/2016 03/07/2016 PDL Product June/July

OB Complete Gold Softgel 01/11/2016 03/07/2016 Open Access June/July

Uptravi 200 mcg Tablet 01/04/2016 02/29/2016 PDL Product June/July




Uptravi 1,000 mcg Tablet 01/04/2016 02/29/2016 PDL Product June/July




Uptravi 200-800 Titration Pack 01/04/2016 02/29/2016 PDL Product June/July

Vivlodex 5 mg Capsule 12/07/2015 02/08/2016 PDL Product Mar/Apr

Vivlodex 10 mg Capsule 12/07/2015 02/08/2016 PDL Product Mar/Apr

Ferriprox 100 mg/ mL Solution 12/07/2015 02/08/2016 Open Access Mar/Apr

Veltassa 8.4 gm Powder Packet 11/30/2015 02/01/2016 Open Access Mar/Apr



Belbuca 75 mcg Film 11/30/2015 02/01/2016 PDL Product Mar/Apr







Seebri Neohaler 15.6 mcg Cap w/Dev 11/16/2015 01/18/2016 PDL Product Mar/Apr

Utibron Neohaler 27.5 mcg – 15.6 mcg Cap w/Dev 11/16/2015 01/18/2016 PDL Product Mar/Apr

Nucala 100 mg Vial 11/16/2015 01/18/2016 Clinical Edit Mar/Apr

DermacinRx PureFolix 5000 units Tablet 11/09/2015 01/11/2016 Continue PA Mar/Apr

Tresiba Flextouch 200 units/ mL Insulin Pen 11/02/2015 01/04/2016 PDL Product Mar/Apr

Tresiba Flextouch 100 units/ mL Insulin Pen 11/02/2015 01/04/2016 PDL Product Mar/Apr

Strensiq 18mg/0.45 mL Vial 11/02/2015 01/04/2016 Continue PA Mar/Apr

Strensiq 28mg /0.7 mL Vial 11/02/2015 01/04/2016 Continue PA Mar/Apr

Strensiq 40mg/ mL Vial 11/02/2015 01/04/2016 Continue PA Mar/Apr

Strensiq 80mg/0.8 mL Vial 11/02/2015 01/04/2016 Continue PA Mar/Apr

Fusion Sprinkles 7 mg - 250 mcg Powd Pack 10/26/2015 12/28/2016 Open Access Mar/Apr

Keveyis 50 mg Tablet 10/19/2015 12/21/2015 Continue PA Mar/Apr

Aristada ER 441 mg/1.6 mL Syringe 10/12/2015 12/14/2015 Clinical Edit Mar/Apr



Spiriva Respimat 1.25 mcg Mist Inhal 10/05/2015 12/07/2015 PDL Product Mar/Apr

Vitafol Fe+ 90 – 1 – 200 mg Capsule 10/05/2015 12/07/2015 Open Access Mar/Apr

DermacinRx Silazone 0.1% Kit 10/05/2015 12/07/2015 Continue PA Mar/Apr

Mucinex 25 – 650/20 Liquid 09/14/2015 11/16/2015 PDL Product Dec/Jan

Brilinta 60 mg Tablet 09/14/2015 11/16/2015 PDL Product Dec/Jan

Zubsolv 11.4 mg – 2.9 mg Tablet 09/14/2015 11/16/2015 PDL Product Dec/Jan

Zubsolv 2.9 mg – 0.71 mg Tablet 09/14/2015 11/16/2015 PDL Product Dec/Jan

Otrexup 7.5 mg – 0.4 mg Auto Injection 09/14/2015 11/16/2015 PDL Product Dec/Jan

Synjardy 5 mg – 500 mg Tablet 09/07/2015 11/09/2015 PDL Product Dec/Jan

Synjardy 12.5 mg – 1,000 mg Tablet 09/07/2015 11/09/2015 PDL Product Dec/Jan

Synjardy 5 mg – 1,000 mg Tablet 09/07/2015 11/09/2015 PDL Product Dec/Jan

Synjardy 12.5 mg – 500 mg Tablet 09/07/2015 11/09/2015 PDL Product Dec/Jan

Repatha 140 mg/mL Syringe 09/07/2015 11/09/2015 Clinical Edit Dec/Jan

Repatha 140 mg/mL Pen Injector 09/07/2015 11/09/2015 Clinical Edit Dec/Jan

Zecuity 6.5 mg/4 HR Patch 08/31/2015 11/02/2015 PDL Product Dec/Jan

Finacea 15% Foam 08/24/2015 10/26/2015 Continue PA Dec/Jan

Hycofenix 2.5 – 30 – 200/5 mL Solution 08/17/2015 10/19/2015 PDL Product Dec/Jan

Daklinza 30 mg Tablet 08/03/2015 10/05/2015 Continue PA Dec/Jan

Daklinza 60 mg Tablet 08/03/2015 10/05/2015 Continue PA Dec/Jan

Praluent 75 mg/mL Pen/Syringe 08/03/2015 10/05/2015 Clinical Edit Dec/Jan

Praluent 150 mg/mL Pen/Syringe 08/03/2015 10/05/2015 Clinical Edit Dec/Jan

Technivie 12.5 – 75 mg Tab DS PK 08/03/2015 10/05/2015 Continue PA Dec/Jan

Epiduo Forte 0.3% - 2.5% Gel Pump 07/27/2015 09/28/2015 PDL Product Dec/Jan

Texavite LQ 7 mg – 0.25 mg/mL Drops 07/27/2015 09/28/2015 Continue PA Dec/Jan

Dermacin RX Surgical 2% - 4% - 5% Kit 07/27/2015 09/28/2015 Continue PA Dec/Jan

Omidria 1% - 3% Vial 07/27/2015 09/28/2015 Continue PA Dec/Jan

Dermacin RX Lexitral 1.5% – 0.025% Cream 07/20/2015 09/21/2015 Continue PA Dec/Jan

Rexulti 0.25 mg Tablet 07/20/2015 09/21/2015 Clinical Edit Dec/Jan

Rexulti 0.5 mg Tablet 07/20/2015 09/21/2015 Clinical Edit Dec/Jan

Rexulti 1 mg Tablet 07/20/2015 09/21/2015 Clinical Edit Dec/Jan




Entresto 24 mg – 26 mg Tablet 07/13/2015 09/14/2015 Clinical Edit Dec/Jan



Novolog Diluting Medium Vial 07/13/2015 09/14/2015 Open Access Dec/Jan

Orkambi 22 mg – 125 mg Tablet 07/13/2015 09/14/2015 Clinical Edit Dec/Jan

Ritalin LA 60 mg Capsule 07/06/2015 09/07/2015 Clinical Edit Dec/Jan

Avar LS 10% - 2% Foam 07/06/2015 09/07/2015 Continue PA Dec/Jan

Avar 9.5% - 5% Foam 07/06/2015 09/07/2015 Continue PA Dec/Jan

Ovace Plus 9.8% Foam 07/06/2015 09/07/2015 Continue PA Dec/Jan

Humalog Kwikpen 200 unit/mL Insul Pen 06/29/2015 08/31/2015 PDL Product Sept/Oct

Afrezza 8 unit - 60/12 unit - 30 Cart w/Dev 06/29/2015 08/31/2015 PDL Product Sept/Oct

Dermacin RX Silapak 0.1% - 5% Kit 06/29/2015 08/31/2015 Continue PA Sept/Oct

Breo Ellipta 200 - 25 mcg Blst w/Dev 06/22/2015 08/24/2015 PDL Product Sept/Oct

Tristart DHA 31 – 1 - 200 mg Capsule 06/22/2015 08/24/2015 Open Access Sept/Oct

Poly-Vi-Flor FS 0.25 mg Film 06/22/2015 08/24/2015 Continue PA Sept/Oct

Poly-Vi-Flor FS 0.5 mg Film 06/22/2015 08/24/2015 Continue PA Sept/Oct

Kuvan 500 mg Powd Pack 06/22/2015 08/24/2015 Open Access Sept/Oct

Irenka DR 40 mg Capsule 06/08/2015 08/10/2015 Clinical Edit Sept/Oct

Invega Trinza 273 mg/0.845 mL Syringe 06/08/2015 08/10/2015 Clinical Edit Sept/Oct




Doryx DR 50 mg Tablet 06/08/2015 08/10/2015 PDL Product Sept/Oct

Seroquel XR 50 - 200 - 300 mg Tab DS PK 06/01/2015 08/03/2015 Clinical Edit Sept/Oct

Stiolto Respimat Inhal 2.5 - 2.5 mcg Inhal Spray 06/01/2015 08/03/2015 PDL Product Sept/Oct

Glucagon 1 mg Vial 05/25/2015 07/27/2015 Open Access Sept/Oct

Juxtapid 30 mg Capsule 05/25/2015 07/27/2015 PDL Product Sept/Oct



Enbrace HR 1.5 - 8.73 mg Capsule 05/18/2015 07/20/2015 Open Access Sept/Oct

Viibryd 10 - 20 mg Starter Pack 05/11/2015 07/13/2015 Clinical Edit Sept/Oct

Saphris 2.5 mg Tab SUBL 05/11/2015 07/13/2015 Clinical Edit Sept/Oct

Tivorbex 20 mg Capsule 05/11/2015 07/13/2015 PDL Product Sept/Oct

Tivorbex 40 mg Capsule 05/11/2015 07/13/2015 PDL Product Sept/Oct

Aptensio XR 10 mg Capsule 05/11/2015 07/13/2015 Clinical Edit Sept/Oct







Fosrenol 750 mg Powder Packet 05/11/2015 07/13/2015 PDL Product Sept/Oct

Fosrenol 1,000 mg Powder Packet 05/11/2015 07/13/2015 PDL Product Sept/Oct

Midazolam HCL 2.5 mL Syrup 05/11/2015 07/13/2015 Clinical Edit Sept/Oct

Provida DHA 32 – 1.25 mg Capsule 04/27/2015 06/29/2015 Open Access Sept/Oct

Corlanor 5 mg Tablet 04/27/2015 06/29/2015 Clinical Edit Sept/Oct

Corlanor 7.5 mg Tablet 04/27/2015 06/29/2015 Clinical Edit Sept/Oct

Sandostatin LAR Depot 10 mg Vial/Kit 04/20/2015 06/22/2015 Open Access Sept/Oct



Namzaric 14 mg – 10 mg Capsule 04/20/2015 06/22/2015 PDL Product Sept/Oct

Namzaric 28 mg – 10 mg Capsule 04/20/2015 06/22/2015 PDL Product Sept/Oct

Aranesp 10 mcg/0.4 mL Syringe 04/20/2015 06/22/2015 PDL Product Sept/Oct

Jadenu 90 mg Tablet 04/13/2015 06/15/2015 Open Access Sept/Oct



Proair Respiclick 90 mcg Aer Pow Ba 04/13/2015 06/15/2015 PDL Product Sept/Oct

Pristiq ER 25 mg Tablet 04/06/2015 06/08/2015 Clinical Edit Sept/Oct

Prefera-OB Plus DHA 28-6-1 mg Combo Pack 04/06/2015 06/08/2015 Open Access Sept/Oct

Hydroxyzine 50 mg/25 mL Syrup 04/06/2015 06/08/2015 Open Access Sept/Oct

Avycaz 2.5 g Vial 04/06/2015 06/08/2015 Open Access Sept/Oct

Cholbam 50 mg Capsule 04/06/2015 06/08/2015 PDL Product Sept/Oct

Cholbam 250 mg Capsule 04/06/2015 06/08/2015 PDL Product Sept/Oct

Liletta 18.6 mcg/24 IUD 04/06/2015 06/08/2015 Fiscal Edit Sept/Oct

Natpara 25 mcg Cartridge 04/06/2015 06/08/2015 Clinical Edit Sept/Oct




Mircera 200 mcg/0.3 mL Syringe 03/30/2015 06/01/2015 PDL Product June/July

Cresemba 186 mg Capsule 03/30/2015 06/01/2015 Continued PA June/July

Kalydeco 50 mg Gran Pack 03/23/2015 05/25/2015 Open Access June/July

Kalydeco 75 mg Gran Pack 03/23/2015 05/25/2015 Open Access June/July

Natesto 5.5 mg/0.122 gm Nasal Gel MD Pump

03/16/2015 05/18/2015 PDL Product June/July

Toujeo Solostar 300 units/mL Insulin Pen 03/09/2015 05/11/2015 PDL Product June/July

Nuvessa Vaginal 1.3% Gel 03/09/2015 05/11/2015 PDL Product June/July

Fentanyl 37.5 mcg/hr Patch 03/02/2015 05/04/2015 PDL Product June/July

Fentanyl 62.5 mgc/hr Patch 03/02/2015 05/04/2015 PDL Product June/July

Fentanyl 87.5 mcg/hr Patch 03/02/2015 05/04/2015 PDL Product June/July

Rosula 10%-4.5% Wash 03/02/2015 05/04/2015 PA Continued June/July

Pazeo 0.7% Eye Drops 02/23/2015 04/27/2015 PDL Product June/July

Signifor LAR 20 mg Vial/Kit 02/23/2015 04/27/2015 Open Access June/July



Otezla 10 – 20 – 30 mg TAB DS PK 02/16/2015 04/20/2015 PDL Product June/July

Sotylize 5 mg / mL Solution 02/16/2015 04/20/2015 PDL Product June/July

Zubsolv 8.6 – 2.1 mg Tab SUBL 02/09/2015 04/13/2015 PDL Product June/July

Glyxambi 10 mg – 5 mg Tablet 02/09/2015 04/13/2015 PDL Product June/July

Glyxambi 25 mg – 5 mg Tablet 02/09/2015 04/13/2015 PDL Product June/July

Movantik 25 mg Tablet 02/09/2015 04/13/2015 PA Continued June/July

Movantik 12.5 mg Tablet 02/09/2015 04/13/2015 PA Continued June/July

Cosentyx 150 mg / mL Syringe 02/09/2015 04/13/2015 PDL Product June/July

Cosentyx 150 mg / mL PEN INJCTR 02/09/2015 04/13/2015 PDL Product June/July

Duopa 4.63 mg – 20 mg / mL INT PMP SP 02/09/2015 04/13/2015 PA Continued June/July

Lidocaine HC 0.5 % - 3 % Cream (G) / Appl 02/02/2015 04/06/2015 Open Access June/July

Feriva FA 110 mg – 1 mg Capsule 01/26/2015 03/30/2015 PA Continued June/July

Rytary 61.25 – 245 mg Capsule ER 01/26/2015 03/30/2015 Open Access June/July




Paricalcitol 2 mcg/mL Vial 01/26/2015 03/30/2015 Open Access June/July

Onexton 1.2 % - 3.75% Gel (gram) 01/26/2015 03/30/2015 Open Access June/July

Savaysa 60 mg TABLET 01/19/2015 03/23/2015 PDL Product June/July



Vyvanse 10 mg CAPSULE 01/19/2015 03/23/2015 Clinical Edit June/July

Abilify Maintena 300 mg SUS ER SYR 01/19/2015 03/23/2015 Clinical Edit June/July

Abilify Maintena 400 mg SUS ER SYR 01/19/2015 03/23/2015 Clinical Edit June/July

Children’s Qnasl 40 mcg HFA AER AD 01/12/2015 03/16/2015 PDL Product June/July

Zerbaxa 1.5 G Vial 12/29/2014 03/02/2015 PDL Product Mar/April

Soolantra 1 % Cream (G) 12/29/2014 03/02/2015 PDL Product Mar/April

Viekira PAK 12.5 – 75 – 50 TAB DS PK 12/29/2014 03/02/2015 PDL Product Mar/April

Afrezza 4 Unit (60) CART W/DEV 12/29/2014 03/02/2015 PDL Product Mar/April

Afrezza 4 Unit (30) CART W/DEV 12/29/2014 03/02/2015 PDL Product Mar/April

Afrezza 4 Unit CART W/DEV 12/29/2014 03/02/2015 PDL Product Mar/April

Zenpep 40 k – 136 k Capsule DR 12/22/2014 02/23/2015 PDL Product Mar/April

Arnuity Ellipta 200 mcg BLST W/DEV 12/22/2014 02/23/2015 PDL Product Mar/April

Arnuity Ellipta 100 mcg BLST W/DEV 12/22/2014 02/23/2015 PDL Product Mar/April

Incruse Ellipta 62.5 mcg BLST W/DEV 12/22/2014 02/23/2015 PDL Product Mar/April

Mircera 100 mcg / 0.3 Syringe 12/22/2014 02/23/2015 PDL Product Mar/April



Oralair 100 IR Tab SUBL 12/15/2014 02/16/2015 PA Continued Mar/April

Hysingla ER 120 mg Tablet 12/15/2014 02/16/2015 PDL Product Mar/April







Sodium Sulfacetamide 10 % CLNSR GEL 12/15/2014 02/16/2015 PDL Product Mar/April

Onexton 1.2 % - 3.75 % Gel w/Pump 12/15/2014 02/16/2015 PDL Product Mar/April

Asmanex HFA 200 mcg HFA AER AD 12/15/2014 02/16/2015 PDL Product Mar/April

Asmanex HFA 100 mcg HFA AER AD 12/15/2014 02/16/2015 PDL Product Mar/April

Escavite LQ 6 – .25 mg / mL Drops 12/15/2014 02/16/2015 Open Acces Mar/April

Prenate Mini 18 – 1 – 350 mg Capsule 12/08/2014 02/09/2015 Open Access Mar/April

Belsomra 20 mg Tablet 12/08/2014 02/09/2015 PDL Product Mar/April




Uceris 2 mg Foam / APPL 11/24/2014 01/26/2015 PDL Product Mar/April

Feriva 75 – 1 – 175 mg Tablet 11/03/2014 01/05/2015 Open Access Mar/April

Gamunex-C 40 G / 400 mL Vial 11/03/2014 01/05/2015 Open Access Mar/April

Xigduo XR 10 – 1000 mg Tab BP 24 H 11/03/2014 01/05/2015 PDL Product Mar/April

Xigduo XR 10 mg – 500 mg Tab BP 24 H 11/03/2014 01/05/2015 PDL Product Mar/April



Prenate Pixie 10 – 1 – 200 mg Capsule 10/27/2014 12/29/2014 Open Access Mar/April

ANA-LEX 2 % – 2 % - 1 % Kit 10/27/2014 12/29/2014 PA Continued Mar/April

Esbriet 267 mg Capsule 10/27/2014 12/29/2014 Open Access Mar/April

OFEV 150 mg Capsule 10/27/2014 12/29/2014 Open Access Mar/April

OFEV 100 mg Capsule 10/27/2014 12/29/2014 Open Access Mar/April

Akynzeo 300 – 0.5 mg Capsule 10/20/2014 12/22/2014 PDL Product Mar/April

Harvoni 90 – 400 mg Tablet 10/20/2014 12/22/2014 PDL Product Mar/April

Morphine SUlphate 10 mg / mL Syringe 10/20/2014 12/22/2014 Open Access Mar/April

Morphine Sulfate 8 mg / mL Syringe 10/20/2014 12/22/2014 Open Access Mar/April

Humira 10 mg / 0.2 mL Syringe Kit 10/20/2014 12/22/2014 PDL Product Mar/April

Prenate Essential 18 – 1 – 300 mg Capsule 10/13/2014 12/15/2014 Open Access Mar/April

Bionect 0.2 % Foam 10/13/2014 12/15/2014 Open Access Mar/April

Plegridy 63 – 94 mcg PEN INJCTR 10/13/2014 12/15/2014 PDL Product Mar/April

Plegridy 125 mcg / 0.5 PEN INJCTR 10/13/2014 12/15/2014 PDL Product Mar/April

Xarelto 15 mg – 20 mg Tab DS PK 10/13/2014 12/15/2014 PDL Product Mar/April

Sumavel Dosepro 4 mg / 0.5 mL NDL FR INJ 10/13/2014 12/15/2014 PDL Product Mar/April

Aminosyn II 8.5 % IV SOLN 10/13/2014 12/15/2014 Open Access Mar/April

Aminosyn II 7 % IV SOLN 10/13/2014 12/15/2014 Open Access Mar/April

Aminosyn-RF 5.2 % IV SOLN 10/13/2014 12/15/2014 Open Access Mar/April

Midazolam 10 mg / 2 mL Syringe 10/06/2014 12/08/2014 Open Access Mar/April

TL Folate 27 mg – 1 mg Tablet 10/06/2014 12/08/2014 Open Access Mar/April

Trulicity 1.5 mg / 0.5 mL Pen Injector 10/06/2014 12/08/2014 PDL Product Mar/April

Trulicity 0.75 mg / 0.5 mL Pen Injector 10/06/2014 12/08/2014 PDL Product Mar/April

Hyqvia 30 g / 300 mL Vial 09/29/2014 12/01/2014 Open Access Dec/Jan




Hyqvia 2.5 g / 25 mL Vial 09/29/2014 12/01/2014 Open Access Dec/Jan

Copaxone 20 mg / mL Syringe 09/29/2014 12/01/2014 PDL Product Dec/Jan

Butrans 7.5 MCG/HR Patch 09/22/2014 11/24/2014 PDL Product Dec/Jan

Somavert 25 mg Vial 09/22/2014 11/24/2014 Open Access Dec/Jan

Somavert 30 mg Vial 09/22/2014 11/24/2014 Open Access Dec/Jan

Revatio 10 mg / mL SUSP Recon 09/15/2014 11/17/2014 PDL Product Dec/Jan

Multivitamins with Fluoride 0.25 mg / mL Drops 09/15/2014 11/17/2014 Open Access Dec/Jan

Multivitamins with Fluoride 0.5 mg / mL Drops 09/15/2014 11/17/2014 Open Access Dec/Jan

Ruconest 2100 Units Vial 09/08/2014 11/10/2014 Open Access Dec/Jan

Orbactiv 400 mg Vial 09/08/2014 11/10/2014 Open Access Dec/Jan

Absorica 35 mg Capsule 09/08/2014 11/10/2014 PA Continued Dec/Jan

Absorica 25 mg Capsule 09/08/2014 11/10/2014 PA Continued Dec/Jan

Supprelin LA 50 mg Kit 09/08/2014 11/10/2014 PA Continued Dec/Jan

Rasuvo 20 mg / 0.4 mL Auto Injct 09/01/2014 11/03/2014 PDL Product Dec/Jan

Rasuvo 17.5 / 0.35 Auto Injct 09/01/2014 11/03/2014 PDL Product Dec/Jan








Rasuvo 7.5 mg / 0.15 Auto Injct 09/01/2014 11/03/2014 PDL Product Dec/Jan

Cerdelga 84 mg Capsule 09/01/2014 11/03/2014 Open Access Dec/Jan

Striverdi Respimat 2.5 mcg Mist Inhal 08/25/2014 10/27/2014 PDL Product Dec/Jan

Vimpat 50 mg – 100 mg Tab DS PK 08/25/2014 10/27/2014 Clinical Edit Dec/Jan

Northera 300 mg Capsule 08/18/2014 10/20/2014 Open Access Dec/Jan



Invokamet 150 – 1000 mg Tablet 08/18/2014 10/20/2014 PDL Product Dec/Jan

Invokamet 150 – 500 mg Tablet 08/18/2014 10/20/2014 PDL Product Dec/Jan

Invokamet 50 - 1000 mg Tablet 08/18/2014 10/20/2014 PDL Product Dec/Jan

Invokamet 50 mg – 500 mg Tablet 08/18/2014 10/20/2014 PDL Product Dec/Jan

Citranatal RX 27-1-50 mg Tablet 08/18/2014 10/20/2014 Open Access Dec/Jan

Quflora 0.5 mg / mL Drops 08/11/2014 10/13/2014 Open Access Dec/Jan

Quflora 0.25 mg / mL Drops 08/11/2014 10/13/2014 Open Access Dec/Jan

Jardiance 25 mg Tablet 08/11/2014 10/13/2014 PDL Product Dec/Jan

Jardiance 10 mg Tablet 08/11/2014 10/13/2014 PDL Product Dec/Jan

Ryanodex 250 mg Vial 08/04/2014 10/06/2014 Open Access Dec/Jan

Bydureon Pen 2 mg / 0.65mL Pen Injector 07/21/2014 09/22/2014 PDL Product Dec/Jan

Prenate Elite 20 mg – 1 mg Tablet 07/14/2014 09/15/2014 Open Access Dec/Jan

Nascobal 500 MCG / SPR Spray 07/14/2014 09/15/2014 Open Access Dec/Jan

Clodan 0.05 % KTSHM CLN 07/14/2014 09/15/2014 PDL Product Dec/Jan

Neo-Synalar 0.5 – 0.025 % Cream (G) 07/14/2014 09/15/2014 PA Continued Dec/Jan

Ovace Plus 9.8 % Lotion 07/14/2014 09/15/2014 PA Continued Dec/Jan

Prenate DHA 18 – 1 – 300 mg Capsule 07/07/2014 09/08/2014 Open Access Dec/Jan

Prenate Star 20 mg – 1 mg Tablet 07/07/2014 09/08/2014 Open Access Dec/Jan

Neuac 1.2 (1) % – 5 % Gel ER (G) 07/07/2014 09/08/2014 PDL Product Dec/Jan

Multivitamins w/ Fluoride & Fe 0.25 – 10 / mL Drops 07/07/2014 09/08/2014 Open Access Dec/Jan

Sivextro 200 mg Tablet 06/30/2014 09/01/2014 Open Access Sept/Oct

Sivextro 200 mg Vial 06/30/2014 09/01/2014 Open Access Sept/Oct

Escavite D 6 mg – 0.25 mg Tablet Chewable BPH

06/23/2014 08/25/2014 Open Access Sept/Oct

Qudexy XR 150 mg Cap SPR 24 06/16/2014 08/18/2014 Clinical Edit Sept/Oct

Qudexy XR 100 mg CAP SPR 24 06/16/2014 08/18/2014 Clinical Edit Sept/Oct




Jublia 10 % Sol w/appl 06/16/2014 08/18/2014 PDL Product Sept/Oct

Tanzeum 50 mg / 0.5 mL Pen Inject 06/16/2014 08/18/2014 PDL Product Sept/Oct

Tanzeum 30 mg / 0.5 mL Pen Inject 06/16/2014 08/18/2014 PDL Product Sept/Oct

Evzio 0.4 mg / 0.4 Auto Inject 06/09/2014 08/11/2014 PA Continued Sept/Oct

Select-OB 29 mg – 1 mg Tab Chewable 06/09/2014 08/11/2014 Open Access Sept/Oct

Retin-A Micro Pump 0.08% Gel w/ pump 06/09/2014 08/11/2014 PDL Product Sept/Oct

Citranatal DHA 27-1-50 mg Combo Pkg 06/09/2014 08/11/2014 Open Access Sept/Oct

Sylvant 400 mg Vial 06/02/2014 08/04/2014 Open Access Sept/Oct

Sylvant 100 mg Vial 06/02/2014 08/04/2014 Open Access Sept/Oct

Vitafol Nano 18 mg – 1 mg Tablet 06/02/2014 08/04/2014 Open Access Sept/Oct

Entyvio 300 mg Vial 05/26/2014 07/28/2014 PDL Product Sept/Oct

Hydrocort-Lidocaine 2% - 2% - 1% Kit 05/26/2014 07/28/2014 PA Continued Sept/Oct

Karbinal 4 mg / 5 mL SUS ER 12H 05/26/2014 07/28/2014 PDL Product Sept/Oct

Hemangeol 4.28 mg / mL Solution 05/19/2014 07/21/2014 PDL Product Sept/Oct

Sitavig 50 mg MA BUC Tab 05/19/2014 07/21/2014 PDL Product Sept/Oct

Zontivity 2.08 mg Tablet 05/19/2014 07/21/2014 PDL Product Sept/Oct

Zenzedi 30 mg Tablet 05/12/2014 07/14/2014 Clinical Edit Sept/Oct



Citranatal Assure 35-1-50 mg Combo PKG 05/12/2014 07/14/2014 Open Access Sept/Oct

VP CH Ultra 27/1/50 mg Capsule 05/05/2014 07/07/2014 Open Access Sept/Oct

Multivitamins-A,B,D,E,K,ZN 1000 – 800 Capsule 05/05/2014 07/07/2014 Open Access Sept/Oct

Multi-Vitamin-Flour-Iron 0.25 – 10/1 Drops 05/05/2014 07/07/2014 Open Access Sept/Oct

Multi-Vitamin W-Fluoride 0.5 mg / mL Drops 05/05/2014 07/07/2014 Open Access Sept/Oct

Multi-Vitamin W-Fluoride 0.25 mg / mL Drops 05/05/2014 07/07/2014 Open Access Sept/Oct

Myalept FNL 5 mg/ mL Vial 04/28/2014 06/30/2014 Open Access Sept/Oct

Monovisc 88 mg / 4 mL Syringe 04/28/2014 06/30/2014 Open Access Sept/Oct

Ragwitek 12 Unit Tab SUGL 04/28/2014 06/30/2014 PA Continued Sept/Oct

Grastek 2800 BAU Tab SUBL 04/28/2014 06/30/2014 PA Continued Sept/Oct

Alcortin A 2 %-1 % - 1% Gel (gram) 04/21/2014 06/23/2014 PDL Product Sept/Oct

Citranatal 90-1-300 mg Combo Pkg 04/21/2014 06/23/2014 Open Access Sept/Oct

Diclegis 10 mg – 10 mg Tablet DR 03/31/2014 06/02/2014 PA Continued June/July

Orenitram ER 2.5 mg Tablet ER 03/31/2014 06/02/2014 PDL Product June/July

Orenitram ER 1 mg Tablet ER 03/31/2014 06/02/2014 PDL Product June/July



Otezla 10-20-30 mg Tablet DS PK 03/31/2014 06/02/2014 PDL Product June/July

Otezla 30 mg Tablet 03/31/2014 06/02/2014 PDL Product June/July

Ibandronate Sodium 3 mg/ 3 mL Vial 03/24/2014 05/26/2014 PDL Product June/July

Desvenlafaxine Fumarate ER 100 mg Tablet ER 24 03/24/2014 05/26/2014 Clinical Edit June/July

Desvenlafaxine Fumarate ER 50 mg Tablet ER 24 03/24/2014 05/26/2014 Clinical Edit June/July

Xartemis XR 7.5-325 mg Tablet 03/24/2014 05/26/2014 PDL Product June/July

Aveed 750 mg/ 3 mL Vial 03/17/2014 05/19/2014 Open Access June/July

Vinate DHA RF 27-1.13 mg Capsule 03/17/2014 05/19/2014 Open Access June/July

Hetlioz 20 mg Capsule 03/17/2014 05/19/2014 Clinical Edit June/July

Morphine Sulfate 4 mg/mL Syringe 03/17/2014 05/19/2014 Open Access June/July

Morphine Sulfate 2 mg/ mL Syringe 03/17/2014 05/19/2014 Open Access June/July

Kuvan 100 mg POWD Pack 03/03/2014 05/05/2014 Open Access June/July

Anoro Ellipta 62.5-25 MCG Diskw/Dev 03/03/2014 05/05/2014 PDL Product June/July

Vimizim 5 mg/5 mL Vial 02/24/2014 04/28/2014 Open Access June/July

Nuvigil 200 mg Tablet 02/24/2014 04/28/2014 Clinical Edit June/July

Aptiom 800 mg Tablet 02/24/2014 04/28/2014 Clinical Edit June/July




Citranatal Harmony 27-1-50 mg Capsule 02/24/2014 04/28/2014 Open Access June/July

Luzu 1% Cream (G) 02/17/2014 04/21/2014 PDL Product June/July

Velphoro 500 mg Iron Chewable Tablet 02/10/2014 04/14/2014 PDL Product June/July

Zohydro ER 50 mg Cap ER 12 H 02/10/2014 04/14/2014 PDL Product June/July






Copaxone 40 mg/mL Syringe 02/03/2014 04/07/2014 PDL Product June/July

Fycompa 12 mg Tablet 02/03/2014 04/07/2014 Clinical Edit June/July

Fycompa 10 mg Tablet 02/03/2014 04/07/2014 Clinical Edit June/July

Lanoxin 187.5 mcg Tablet 02/03/2014 04/07/2014 Open Access June/July

Adasuve 10 mg AER POW BA 01/27/2014 3/31/2014 Clinical Edit June/July

Pennsaid 20 mg/g (2%) Sol MD PMP 01/27/2014 3/31/2014 PDL Product June/July

Quflora 1 mg Chewable Tablet 01/27/2014 3/31/2014 PA Continued June/July

Quflora 0.5 mg Chewable Tablet 01/27/2014 3/31/2014 PA Continued June/July

Quflora 0.25 mg Chewable Tablet 01/27/2014 3/31/2014 PA Continued June/July

Lupaneta Pack 3.75 mg – 5 mg Kit Syr Tablet 01/27/2014 3/31/2014 Open Access June/July

Duavee 0.45 – 20 mg Tablet 01/27/2014 3/31/2014 PA Continued June/July

Farxiga 10 mg Tablet 01/27/2014 3/31/2014 PDL Product June/July

Farxiga 5 mg Tablet 01/27/2014 3/31/2014 PDL Product June/July

Horizant 300 mg Tablet ER 24 01/13/2014 03/17/2014 PDL Edit June/July

Zubsolv 5.7 – 1.4 mg Tab Subl 01/06/2014 03/10/2014 Clinical Edit June/July

Fycompa 8 mg Tablet 12/30/2013 03/03/2014 Clinical Edit Mar/April




Otrexup 25 mg / 0.4 mL Auto Inject 12/30/2013 03/03/2014 PDL Product Mar/April




Khedezla 50 mg Tablet ER 24 12/23/2013 02/24/2014 Clinical Edit Mar/April

Khedezla 100 mg Tablet ER 24 12/23/2013 02/24/2014 Clinical Edit Mar/April

Aerospan 80 mcg HFA AER AD 12/16/2013 02/17/2014 PDL Product Mar/April

Sovaldi 400 mg Tablet 12/16/2013 02/17/2014 PDL Product Mar/April

Avar 9.5 % - 5 % Med Pad 12/16/2013 02/17/2014 PA Continued Mar/April

Avar LS 10 % - 2 % Med Pad 12/16/2013 02/17/2014 PA Continued Mar/April

Zomig 2.5 mg Spray 12/02/2013 02/03/2014 PDL Product Mar/April

Olysio 150 mg Capsule 12/02/2013 02/03/2014 PDL Product Mar/April

Levofloxacin 500 mg/20mL Solution 11/25/2013 01/27/2014 PDL Product Mar/April

Levofloxacin 250 mg/10 mL Solution 11/25/2013 01/27/2014 PDL Product Mar/April

Sumadan XLT 9% - 4.5% CMB CLN CR 11/25/2013 01/27/2014 PA Continued Mar/April

Prenaissance Next-B 1.2 – 42 mg Tablet 11/25/2013 01/27/2014 Open Access Mar/April

Versacloz 50 mg/mL Oral Susp 11/25/2013 01/27/2014 Clinical Edit Mar/April

Fetzima 80 mg CAP SA 24 H 11/25/2013 01/27/2014 Clinical Edit Mar/April



Fetzima 120 mg Cap SA 24 H 11/25/2013 01/27/2014 Clinical Edit Mar/April

Fetzima 20-40 mg Cap 24 HDSPK 11/25/2013 01/27/2014 Clinical Edit Mar/April

Epaned 1 mg/mL Soln Recon 11/18/2013 01/27/2014 PDL Product Mar/April

Antara 90 mg Capsule 11/18/2013 01/20/2014 PDL Product Mar/April

Antara 30 mg Capsule 11/18/2013 01/20/2014 PDL Product Mar/April

Aciphex Sprinkle 10 mg Capsule DR Spr 11/11/2013 01/13/2014 PDL Product Mar/April

Aciphex Sprinkle 5 mg Capsule DR Spr 11/11/2013 01/13/2014 PDL Product Mar/April

Actemra 162 mg/0.9 Disposable

Syringe 11/04/2013 01/06/2014 PDL Product Mar/April

Zorvolex 35 mg Capsule 11/04/2013 01/06/2014 PDL Product Mar/April

Zorvolex 18 mg Capsule 11/04/2013 01/06/2014 PDL Product Mar/April

Opsumit 10 mg Tablet 10/28/2013 12/30/2013 PDL Product Mar/April

Pro-Red AC 1-5-9 mg / 5 Liquid 10/21/2013 12/23/2013 PDL Product Mar/April

Valchlor 0.016 % Gel (gram) 10/21/2013 12/23/2013 Open Access Mar/April

Cyproheptadine 4 mg/ 10 mL Syrup 10/21/2013 12/23/2013 Open Access Mar/April

Brintellex 20 mg Tablet 10/14/2013 12/16/2013 Clinical Edit Mar/April



Adempas 2.5 mg Tablet 10/14/2013 12/16/2013 PDL Product Mar/April

Adempas 2 mg Tablet 10/14/2013 12/16/2013 PDL Product Mar/April


Adempas 1 mg Tablet 10/14/2013 12/16/2013 PDL Product Mar/April


Procysbi 75 mg Capsule DR 09/30/2013 12/02/2013 PA Continued Dec/Jan

Procysbi 25 mg Capsule DR 09/30/2013 12/02/2013 PA Continued Dec/Jan

Prenate Enhance 28-1-400 mg Capsule 09/30/2013 12/02/2013 Open Access Dec/Jan

Prenate Restore 27-1-400 mg Capsule 09/30/2013 12/02/2013 Open Access Dec/Jan

Bethkis 300 mg / 4 mL Ampul-Neb 09/30/2013 12/02/2013 PDL Product Dec/Jan

Vitafol Ultra 29-1-200 mg Capsule 09/30/2013 12/02/2013 Open Access Dec/Jan

Latuda 60 mg Tablet 09/23/2013 11/25/2013 Clinical Edit Dec/Jan

Morphine Sulfate 10 mg / 0.5 mL Disposable

Syringe 09/23/2013 11/25/2013 Clinical Edit Dec/Jan

Corvite FE 150 mg – 1 mg Tablet 09/23/2013 11/25/2013 PA Cont Dec/Jan

Butrans 15 mcg / HR Patch 09/23/2013 11/25/2013 PDL Product Dec/Jan

Nymalize 60 mg / 20 mL Solution 09/16/2013 11/18/2013 PDL Product Dec/Jan

Escavite LQ 0.25-10/1 Drops 09/09/2013 11/11/2013 Open Access Dec/Jan

Hydrocodone-Acetaminophen 2.5-108/5 Solution 09/09/2013 11/11/2013 Clinical Edit Dec/Jan

Hydrocodone-Acetaminophen 7.5-325/15 Solution 09/09/2013 11/11/2013 Clinical Edit Dec/Jan

Lo Minastrin FE 1 mg – 10(24) Tablets 09/02/2013 11/04/2013 Open Access Dec/Jan

Mirvaso 0.33% Gel (gram) 09/02/2013 11/04/2013 PA Continued Dec/Jan

Esomeprazole Strontium 40 mg Capsule DR 08/26/2013 10/28/2013 PDL Product Dec/Jan

Esomeprazole Strontium 20 mg Capsule DR 08/26/2013 10/28/2013 PDL Product Dec/Jan

Trokendi XR 200 mg Capsule 08/26/2013 10/28/2013 Clinical Edit Dec/Jan




Fabior 0.1% Foam 08/26/2013 10/28/2013 PDL Product Dec/Jan

Onfi 2.5 mg/mL Oral Suspension 08/12/2013 10/14/2013 Clinical Edit Dec/Jan

Brisdelle 7.5 mg Capsule 08/05/2013 10/07/2013 Clinical Edit Dec/Jan

Simponi Aria 50 mg 4 mL Vial 08/05/2013 10/07/2013 PDL Product Dec/Jan

Simponi 100 mg/mL Pen Injector 08/05/2013 10/07/2013 PDL Product Dec/Jan

Injectafer 750 mg/15 mL Vial 08/05/2013 10/07/2013 PA Continued Dec/Jan

Fioricet with Codeine 50-300-40 Capsule 07/29/2013 09/30/2013 Clinical Edit Dec/Jan

Naftin 2% Gel 07/22/2013 09/23/2013 Open Access Dec/Jan

Bloxiverz 1 mg/mL Vial 07/15/2013 09/16/2013 Open Access Dec/Jan

Bloxiverz 0.5 mg/mL Vial 07/15/2013 09/16/2013 Open Access Dec/Jan

Quartette 0.15 mg (84) TBDSPK 3MO 07/15/2013 09/16/2013 Open Access Dec/Jan

Breo Ellipta 100 – 25 mcg AER POW BA 07/15/2013 09/16/2013 PDL Product Dec/Jan

Infanate Balance 29-1-50 mg Capsule 07/08/2013 09/09/2013 Open Access Dec/Jan

Nymalize 60 mg/ 20 mL Solution 07/08/2013 09/09/2013 PDL Product Dec/Jan

Prenate AM 1 mg – 500 mg Tablet 07/01/2013 09/02/2013 Open Access Dec/Jan

Active OB 20-1-320 mg Capsule 07/01/2013 09/02/2013 Open Access Dec/Jan

Nestabs ABC 32-1-120 mg Combo Pack 06/24/2013 08/26/2013 Open Access Sept/Oct

Active FE 75-1.25 mg Tablet 06/24/2013 08/26/2013 Open Access Sept/Oct

Provida OB 40-1.25 mg Capsule 06/24/2013 08/26/2013 Open Access Sept/Oct

Doryx 200 mg Tablet DR 06/24/2013 08/26/2013 PDL Product Sept/Oct

Mekinist 2 mg Tablet 06/24/2013 08/26/2013 Open Access Sept/Oct

Mekinist 0.5 mg Tablet 06/24/2013 08/26/2013 Open Access Sept/Oct

Neevodha 27-1.13 mg Capsule 06/17/2013 08/19/2013 Open Access Sept/Oct

Revlimid 20 mg Capsule 06/17/2013 08/19/2013 Open Access Sept/Oct

Tecfidera 120-240 mg Capsule DR 06/10/2013 08/12/2013 PDL Product Sept/Oct

Tecfidera 120 mg Capsule DR 06/10/2013 08/12/2013 PDL Product Sept/Oct

Tecfidera 240 mg Capsule DR 06/10/2013 08/12/2013 PDL Product Sept/Oct


Zenzedi 7.5 mg Tablet 06/10/2013 08/12/2013 Clinical Edit Sept/Oct

TL Triseb Cream 06/10/2013 08/12/2013 Open Access Sept/Oct

Minastrin 24 Fe 1 mg – 20 (24) Chewable Tablet 06/10/2013 08/12/2013 Open Access Sept/Oct

Simponi 100 mg/mL Syringe 06/03/2013 08/05/2013 PDL Product Sept/Oct

Suprax 400 mg Capsule 06/03/2013 08/05/2013 Open Access Sept/Oct

Juxtapid 10mg Capsule 05/20/2013 07/22/2013 PA Continued Sept/Oct

Juxtapid 5 mg Capsule 05/20/2013 07/22/2013 PA Continued Sept/Oct

Liptruzet 10 mg – 80 mg Tablet 05/13/2013 07/15/2013 PDL Product Sept/Oct




Juxtapid 20 mg Capsule 05/13/2013 07/15/2013 PA Continued Sept/Oct

Namenda XR 7-14-21-28 Titration

Pack Capsule 05/06/2013 07/08/2013 PDL Product Sept/Oct

Namenda XR 28 mg Capsule 05/06/2013 07/08/2013 PDL Product Sept/Oct




Sirturo 100 mg Tablet 04/29/2013 07/01/2013 Open Access Sept/Oct

Prednisolone AC Micronized PWD

100% Powder 04/29/2013 07/01/2013 Open Access Sept/Oct

Simbrinza 1% - 0.2% Drops Susp 04/29/2013 07/01/2013 Open Access Sept/Oct

Creon 36-114-180 Capsule DR 04/29/2013 07/01/2013 PDL Product Sept/Oct

Oxtellar XR 600 mg Tablet 04/22/2013 06/24/2013 Clinical Edit Sept/Oct

Oxtellar XR 300 mg Tablet 04/22/2013 06/24/2013 Clinical Edit Sept/Oct

Ravicti 1.1 gram/ml Liquid 04/22/2013 06/24/2013 Open Access Sept/Oct

Osphena 60 mg Tablet 04/22/2013 06/24/2013 Open Access Sept/Oct

Cystaran 0.44% Drops 04/22/2013 06/24/2013 Open Access Sept/Oct

Topicort 0.25% Spray 04/22/2013 06/24/2013 PDL Product Sept/Oct

Sodium Sulfacetamide-sulfur 9 %-4.5% Cleanser 04/22/2013 06/24/2013 PA Cont Sept/Oct

Precedex 400 mcg/100 Infusion 04/22/2013 06/24/2013 Open Access Sept/Oct

Tricare Prenatal Compleat 27 mg- 1 mg CMB Tab CP 04/15/2013 06/17/2013 Open Access Sept/Oct

Vituz 5 mg - 4 mg/5 Solution 04/15/2013 06/17/2013 PA Cont Sept/Oct

Desvenlafaxine ER 100 mg Tab ER 24 H 04/15/2013 06/17/2013 Clinical Edit Sept/Oct

Desvenlafaxine ER 50 mg Tab ER 24 H 04/15/2013 06/17/2013 Clinical Edit Sept/Oct

Suprax 500 mg/5 ml Susp Recon 04/15/2013 06/17/2013 Open Access Sept/Oct

Prolensa 0.07% Drops 04/15/2013 06/17/2013 PDL Product Sept/Oct

Invokana 300 mg Tablet 04/08/2013 06/10/2013 PDL Product Sept/Oct

Invokana 100 mg Tablet 04/08/2013 06/10/2013 PDL Product Sept/Oct

TOBI Podhaler 28 mg Capsule 04/08/2013 06/10/2013 PDL Product Sept/Oct

Suclear 210g-17.5g Soln RC SQ 04/01/2013 06/03/2013 Open Access Sept/Oct

Brevital Sodium 200 mg Vial 03/25/2013 05/27/2013 Open Access Jun/July

Tri-Estarylla 7days X 3 Tablet 03/25/2013 05/27/2013 Open Access Jun/July

Signifor 0.3mg/ml Ampule 03/18/2013 05/20/2013 Open Access Jun/July



Abilify Maintena 400 mg Vial 03/11/2013 05/13/2013 Clinical Edit Jun/July

Abilify Maintena 300 mg Vial 03/11/2013 05/13/2013 Clinical Edit Jun/July

PNV Folic Acid + Iron 27 mg-1mg Tablet 03/04/2013 05/06/2013 Open Access Jun/July

Kynamro 200 mg/ml Disp Syringe 03/04/2013 05/06/2013 Open Access Jun/July

Delzicol 400 mg Capsule DR 02/18/2013 04/15/2013 PDL Product Jun/July

Rebif Rebidose 8.8-22 (6) Pen Injector 02/18/2013 04/15/2013 PDL Product Jun/July

Rebif Rebidose 22mcg/.5ml Pen Injector 02/18/2013 04/15/2013 PDL Product Jun/July

Rebif Rebidose 44mcg/.5ml Pen Injector 02/18/2013 04/15/2013 PDL Product Jun/July

Codeine Sulfate 15 mg/2.5ml Solution 02/18/2013 04/15/2013 Clinical Edit Jun/July

Codeine Sulfate 30 mg/5ml Solution 02/18/2013 04/15/2013 Clinical Edit Jun/July

Auvi-Q 0.15 mg/0.15 Auto Injector 02/04/2013 04/01/2013 PDL Product Jun/July

Auvi-Q 0.3 mg/0.3 Auto Injector 02/04/2013 04/01/2013 PDL Product Jun/July

Nesina 6.25 mg Tablet 02/04/2013 04/01/2013 PDL Product Jun/July

Kazano 12.5 mg-1000 mg Tablet 02/04/2013 04/01/2013 PDL Product Jun/July

Kazano 12.5 mg-500 mg Tablet 02/04/2013 04/01/2013 PDL Product Jun/July

Oseni 25 mg-45 mg Tablet 02/04/2013 04/01/2013 PDL Product Jun/July



Oseni 12.5-45 mg Tablet 02/04/2013 04/01/2013 PDL Product Jun/July



Gablofen 10,000 mcg/20 ml Disposable

Syringe 02/04/2013 04/01/2013 Open Access Jun/July





Sumatriptan Powder 02/04/2013 04/01/2013 PDL Product Jun/July

Skyla 14mcg/24hr IUD 01/21/2013 03/18/2013 Fiscal Edit Jun/July

Citranatal Harmony 29-1-50 mg Capsule 01/14/2013 03/11/2013 Open Access Jun/July

Fusion Plus 130-1.25 mg Capsule 01/14/2013 03/11/2013 Open Access Jun/July

Virt-Vite Plus 1-2.5-25 mg Tablet 01/14/2013 03/11/2013 Open Access Jun/July

Eliquis 2.5 mg Tablet 01/07/2013 03/04/2013 PDL Product Jun/July

Eliquis 5 mg Tablet 01/07/2013 03/04/2013 PDL Product Jun/July

Quillivant XR 5 mg/ml Suspension 01/07/2013 03/04/2013 Clinical Edit Jun/July

Lotemax 0.5% Gel 12/31/2012 02/25/2013 PDL Product Mar/Apr

Methyltesterone Micro 100% Powder 12/31/2012 02/25/2013 Open Access Mar/Apr

Nexa Select 29-1.25-55 Capsule 12/31/2012 02/25/2013 Open Access Mar/Apr

Ilevro 0.3% Drops 12/24/2012 02/18/2013 PDL Product Mar/Apr

Giazo 1.1 gm Tablet 12/24/2012 02/18/2013 PDL Product Mar/Apr

Opana ER 7.5 mg Tablet ER 12H 12/17/2012 02/11/2013 PDL Product Mar/Apr

Opana ER 15 mg Tablet ER 12H 12/17/2012 02/11/2013 PDL Product Mar/Apr

Synalar 0.025% Cream 12/10/2012 02/04/2013 PDL Product Mar/Apr

Synalar 0.025% Ointment 12/10/2012 02/04/2013 PDL Product Mar/Apr

Onmel 200 mg Tablet 12/03/2012 01/28/2013 PDL Product Mar/Apr

Lidocaine-Hydrocortisone 2.5-3% Gel 12/03/2012 01/28/2013 PA Continued Mar/Apr

TL-Select DHA 29-1.25-55 Capsule 12/03/2012 01/28/2013 Open Access Mar/Apr

Suboxone 12 mg-3 mg sl Film 12/03/2012 01/28/2013 Clinical Edit Mar/Apr

Suboxone 4 mg-1 mg sl Film 12/03/2012 01/28/2013 Clinical Edit Mar/Apr

Pliaglis 7%-7% Cream 11/26/2012 01/21/2013 Open Access Mar/Apr

Linzess 290 mcg Capsule 11/19/2012 01/14/2013 Clinical Edit Mar/Apr

Linzess 145 mcg Capsule 11/19/2012 01/14/2013 Clinical Edit Mar/Apr

Xeljanz 5 mg Tablet 11/12/2012 01/07/2013 PDL Product Mar/Apr

Ultresa DR 13.8-27.6 k

(13,800 Unit) Capsule 11/05/2012 12/31/2012 PDL Product Mar/Apr

Ultresa DR 20.7-41.4 k


Ultresa DR 23-46-46 k


Lithium Citrate 8 meq/5 ml Solution 11/05/2012 12/31/2012 Clinical Edit Mar/Apr

TL-Fluorivite 7.5-0.25 mg Tablet Chewable 10/29/2012 12/24/2012 Open Access Mar/Apr

Juvisync 50-10 mg Tablet 10/29/2012 12/24/2012 PDL Product Mar/Apr



OB Complete Petite 35-5-1 mg Capsule 10/29/2012 12/24/2012 Open Access Mar/Apr

Suprax 100 mg Tablet Chewable 10/15/2012 12/10/2012 Open Access Mar/Apr

Suprax 200 mg Tablet Chewable 10/15/2012 12/10/2012 Open Access Mar/Apr

Androgel 1.62%(1.25g) Gel Packet 10/15/2012 12/10/2012 PDL Product Mar/Apr

Androgel 1.62%(2.5g) Gel Packet 10/15/2012 12/10/2012 PDL Product Mar/Apr

Prepopik 10-12/16.1(1) Powder Packet 10/01/2012 11/26/2012 Open Access Mar/Apr

Aubagio 7 mg Tablet 10/01/2012 11/26/2012 PDL Product Mar/Apr

Aubagio 14 mg Tablet 10/01/2012 11/26/2012 PDL Product Mar/Apr

Morphine Sulfate 2 mg/ml Cartridge 10/01/2012 11/26/2012 Clinical Edit Mar/Apr




Prednisolone Sodium

Phosphate 25 mg/5 ml Solution 10/01/2012 11/26/2012 Open Access Mar/Apr

Veletri 0.5 mg Vial 09/24/2012 11/19/2012 PDL Product Dec/Jan

Synalar TS 0.01% Kit 09/24/2012 11/19/2012 PDL Product Dec/Jan

Exelon 13.3 mg/24H Patch TD 24 09/24/2012 11/19/2012 PDL Product Dec/Jan

Rayos 5 mg Tablet DR 09/10/2012 11/05/2012 PA Continued Dec/Jan



Latuda 120 mg Tablet 09/10/2012 11/05/2012 Clinical Edit Dec/Jan

Kadian 150 mg Cap ER Pel 09/10/2012 11/05/2012 PDL Product Dec/Jan




Lyrica 20 mg/ml Solution 09/10/2012 11/05/2012 PDL Product Dec/Jan

Gabapentin 250 mg/cup Solution 09/03/2012 10/29/2012 Clinical Edit Dec/Jan

Gabapentin 300 mg/6 ml Solution 09/03/2012 10/29/2012 Clinical Edit Dec/Jan

Forfivo XL 450 mg Tablet ER 24H 09/03/2012 10/29/2012 Clinical Edit Dec/Jan

Exalgo 32 mg Tablet ER 24H 09/03/2012 10/29/2012 PDL Product Dec/Jan

Myrbetriq 50 mg Tablet ER 24H 09/03/2012 10/29/2012 PDL Product Dec/Jan

Myrbetriq 25 mg Tablet ER 24H 09/03/2012 10/29/2012 PDL Product Dec/Jan

Tudorza Pressair 400 mcg Aer Pow BA 09/03/2012 10/29/2012 PDL Product Dec/Jan

Nexium 5 mg Suspdr packet 09/03/2012 10/29/2012 PDL Product Dec/Jan

Nexium 2.5 mg Suspdr packet 09/03/2012 10/29/2012 PDL Product Dec/Jan

Kapvay 0.1-0.2 mg Tablet ER Dspk 08/27/2012 10/22/2012 Clinical Edit Dec/Jan

Nexa Plus 29-1.25-55 Capsule 08/27/2012 10/22/2012 Open Access Dec/Jan

B-Nexa 1.2-42 mg Tablet 08/27/2012 10/22/2012 Open Access Dec/Jan

Binosto 70 mg Tablet 08/27/2012 10/22/2012 PDL Product Dec/Jan

Zyclara 2.5% Cream MD PMP 08/20/2012 10/15/2012 Open Access Dec/Jan

Lucentis 0.3 mg/0.05 ml Vial 08/20/2012 10/15/2012 Open Access Dec/Jan

VP-PNV-DHA 28-1-200 mg Capsule 08/13/2012 10/08/2012 Open Access Dec/Jan

Viokace 20.9-78.3 K Tablet 08/13/2012 10/08/2012 PDL Product Dec/Jan

Viokace 10.4-39.2 K Tablet 08/13/2012 10/08/2012 PDL Product Dec/Jan

Ultravate X 0.05%-10% Combo Package 07/23/2012 09/17/2012 PDL Product Dec/Jan

Ultravate X 0.05%-10% Combo Oint Cr 07/23/2012 09/17/2012 PDL Product Dec/Jan

Ketodan 2% Combo Package 07/09/2012 09/03/2012 PA Continued Dec/Jan

Ciclodan 0.77% Combo Package 07/09/2012 09/03/2012 PDL Product Dec/Jan

Nuvail 16% Solution 07/02/2012 08/27/2012 PA Continued Dec/Jan

Neupro 3 mg/24 HR Patch TD24 07/02/2012 08/27/2012 PDL Product Dec/Jan



Angeliq 0.5-0.25 mg Tablet 07/02/2012 08/27/2012 Open Access Dec/Jan

Gablofen 20K mcg/20 Vial 07/02/2012 08/27/2012 Open Access Dec/Jan

Sklice 0.5% Lotion 06/25/2012 08/20/2012 Open Access Sept/Oct

Combivent Respimat 20-100 mcg Inhal Spray 06/25/2012 08/20/2012 PDL Product Sept/Oct

Tricare 27 mg-1 mg Tablet 06/18/2012 08/13/2012 Open Access Sept/Oct

Zetonna 37 mcg Nasal Spray 06/11/2012 08/06/2012 PDL Product Sept/Oct

Codeine Sulfate 30 mg/5 mL Solution 06/11/2012 08/06/2012 Clinical Edit Sept/Oct

Phentolamine Mesylate 5 mg/mL (1) Vial 06/11/2012 08/06/2012 Open Access Sept/Oct

Dymista 137-50 mcg Spray/Pump 06/11/2012 08/06/2012 PA Continued Sept/Oct

Citranatal B-Calm 20-1-25 mg Tablet 06/04/2012 07/30/2012 Open Access Sept/Oct

Sorilux 0.005% Foam 06/04/2012 07/30/2012 PDL Product Sept/Oct

Viva CT 28 mg – 1 mg Chew Tabs 05/28/2012 07/23/2012 Open Access Sept/Oct

Omeclamox-pak 20 (20) -500 Combo package 05/21/2012 07/16/2012 Clinical Edit Sept/Oct

Berinert 500 (10 mL) Vial 05/14/2012 07/09/2012 Open Access Sept/Oct

Digoxin 0.25 mg/5 mL Solution 05/14/2012 07/09/2012 Open Access Sept/Oct

Ribapak 200-400 mg Tab DS PK 05/14/2012 07/09/2012 PDL Product Sept/Oct

Uramaxin GT 45% Kit Cream Gel 05/14/2012 07/09/2012 PA Continued Sept/Oct

Elelyso 200 unit Vial 05/14/2012 07/09/2012 Open Access Sept/Oct

Bal-Care DHA Essential 27-1-374 mg Combo Package 05/07/2012 07/02/2012 Open Access Sept/Oct

Gelnique 28 mg/0.92 G Gel MD PMP 04/30/2012 06/25/2012 PDL Product Sept/Oct

Rosadan 0.75% Kit CL & Gel 04/30/2012 06/25/2012 PA Continued Sept/Oct

Viibryd 10/20/40 mg Tab DS PK 04/30/2012 06/25/2012 Clinical Edit Sept/Oct

Differin 0.3% Gel 04/23/2012 06/18/2012 PDL Product Sept/Oct

Revlimid 2.5 mg Capsule 04/23/2012 06/18/2012 Open Access Sept/Oct

Vitafol-Plus 27-1-200 mg Capsule 04/23/2012 06/18/2012 Open Access Sept/Oct

Potiga 400 mg Tablet 04/23/2012 06/18/2012 Clinical Edit Sept/Oct




Avonex 30 mcg/.5 mL Pen IJ Kit 04/16/2012 06/11/2012 PDL Product Sept/Oct

Lidovir 4%-4% Ointment (G) 04/16/2012 06/11/2012 Open Access Sept/Oct

Qnasl 80 mcg Nasal Spray 04/02/2012 05/28/2012 PDL Product Sept/Oct

Omontys 10 mg/mL Vial 04/02/2012 05/28/2012 PDL Product Sept/Oct

Intermezzo 3.5 mg Tablet Sublingual 03/26/2012 05/21/2012 PDL Product June/July

Intermezzo 1.75 mg Tablet Sublingual 03/26/2012 05/21/2012 PDL Product June/July

Lidocaine 5% Ointment (G) 03/26/2012 05/21/2012 PA Continued June/July

Aqua Glycolic HC 2% Combo Package 03/26/2012 05/21/2012 PA Continued June/July

Orbivan CF 50 mg – 300 mg Tablet 03/26/2012 05/21/2012 PA Continued June/July

Diazepam 5 mg/5 ml cup Solution 03/12/2012 05/07/2012 Open Access June/July

Cosopt PF 2%-0.5% Droperette 03/05/2012 04/30/2012 Open Access June/July

Picato 0.05% Gel (EA) 02/27/2012 04/23/2012 Open Access June/July

Picato 0.015% Gel (EA) 02/27/2012 04/23/2012 Open Access June/July

Zioptan 0.0015% Droperette 02/27/2012 04/23/2012 PDL Product June/July

Zyclara 3.75% CRM MD PMP 02/20/2012 04/16/2012 PA Continued June/July

Hydrocodone Acetaminophen 7.5-325/CP Solution 02/20/2012 04/16/2012 Open Access June/July

Naftin 2% Cream (G) 02/20/2012 04/16/2012 Open Access June/July

Janumet XR 100-1000 mg TBMP 24H 02/13/2012 04/09/2012 PDL Product June/July



Kalydeco 150 mg Tablet 02/06/2012 04/02/2012 Open Access June/July

Hylase 2.5% Gel 02/06/2012 04/02/2012 Open Access June/July

Bydureon 2 mg Vial 02/06/2012 04/02/2012 PDL Product June/July

Jentadueto 2.5 mg-500 mg Tablet 02/06/2012 04/02/2012 PDL Product June/July



Relistor 8 mg/0.4 mL Disp Syringe 01/30/2012 03/26/2012 Clinical Edit June/July

Relistor 12 mg/0.6 mL Disp Syringe 01/30/2012 03/26/2012 Clinical Edit June/July

Latuda 20 mg Tablet 01/30/2012 03/26/2012 Clinical Edit June/July

Oxecta 5 mg Tablet 01/30/2012 03/26/2012 Clinical Edit June/July

Oxecta 7.5 mg Tablet 01/30/2012 03/26/2012 Clinical Edit June/July

Xyntha Solofuse 250 (+/-) Syringe Kit 01/30/2012 03/26/2012 Open Access June/July

Xyntha Solofuse 500 (+/-) Syringe Kit 01/30/2012 03/26/2012 Open Access June/July

Prenata 29 mg-1 mg Tab Chewable 01/30/2012 03/26/2012 Open Access June/July

Rectiv 0.4% Ointment (G) 01/30/2012 03/26/2012 Open Access June/July

Promacta 12.5 mg Tablet 01/23/2012 03/19/2012 Open Access June/July

Edarbyclor 40-25 mg Tablet 01/16/2012 03/12/2012 PDL Product June/July

Edarbyclor 40-12.5 mg Tablet 01/16/2012 03/12/2012 PDL Product June/July

Pedipirox-4 8% Kit 01/16/2012 03/12/2012 PDL Product June/July

Dutoprol 100-12.5 mg Tablet ER 24H 01/16/2012 03/12/2012 PDL Product June/July



Citranatal Harmony 30-1-50 mg Capsule 01/16/2012 03/12/2012 Open Access June/July

B-Nexa 40-1.2-100 Tablet 01/02/2012 02/27/2012 Open Access June/July

PURSUANT TO 13CSR 70-20.030 DRUGS COVERED BY ......Active Pharmaceutical Ingredients (APIs) and...

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Transcript of PURSUANT TO 13CSR 70-20.030 DRUGS COVERED BY ......Active Pharmaceutical Ingredients (APIs) and...