WellCare of Nebraska€¦ · 2020 Comprehensive Dual Eligible Drug List (List of Covered Drugs)...

2020 Comprehensive Dual Eligible Drug List (List of Covered Drugs)

WellCare of Nebraska 00

Please read: This document contains information about the drugs we cover in this plan. Last updated (4/01/2020)

This plan has a limit of 248 dosage units, unless otherwise specified through a quantity limit.

Drug Name Preference Details Coverage Details

*Alternative Medicines*

*Alternative Medicine - Ly***

lycopene oral capsule 10 mg P

*Alternative Medicine - Me's***

melatonin maximum strength oral tablet 5 mg P

melatonin oral tablet 1 mg, 3 mg P

*Analgesics - Anti-Inflammatory*

*Nonsteroidal Anti-Inflammatory Agents (Nsaids)***

childrens ibuprofen oral suspension 40 mg/ml P

ibuprofen junior strength oral tablet chewable100 mg

P

ibuprofen oral capsule 200 mg P

ibuprofen oral suspension 100 mg/5ml P

ibuprofen oral tablet 200 mg P

naproxen sodium oral capsule 220 mg P

naproxen sodium oral tablet 220 mg P

*Analgesics - Nonnarcotic*

*Analgesic Combinations***

EXCEDRIN EXTRA STRENGTH ORAL TABLET 250-250-65 MG

P

sm tension headache oral tablet 500-65 mg P

womens menstrual relief oral tablet 500-25 mg

P

*Analgesics Other***

ACEPHEN RECTAL SUPPOSITORY 120 MG, 325 MG, 650 MG

P

acetaminophen oral solution 160 mg/5ml P

acetaminophen oral tablet 325 mg P QL (279 EA per 31 days)

acetaminophen oral tablet 500 mg P QL (186 EA per 31 days)

acetaminophen oral tablet chewable 325 mg P

apap extra strength oral tablet 500 mg P QL (186 EA per 31 days)

apap oral tablet 325 mg P QL (279 EA per 31 days)

childrens mapap rapid tabs oral tablet dispersible 80 mg

P

P=Preferred, Asterisk(*)=N/A, PA=Prior Authorization, ST=Step Therapy, QL=Quantity Limit, AL=Age Limit, OTC Products Require Rx, UPPERCASE= Brand name drugs/ lowercase italics= Generic drugs

1


childrens non-asa pain relief oral tablet chewable 80 mg

P

childrens non-aspirin oral tablet chewable 80 mg

P

childrens pain reliever oral tablet chewable80 mg

P

childrens silapap oral liquid 160 mg/5ml P

childrens tactinal oral tablet chewable 80 mg P

ed-apap oral liquid 160 mg/5ml P

FEVERALL INFANTS RECTAL SUPPOSITORY 80 MG

P

infants silapap oral solution 100 mg/ml P

JUNIOR MAPAP ORAL TABLET DISPERSIBLE 160 MG

P

MAPAP ACETAMINOPHEN EXTRA STR ORAL LIQUID 500 MG/15ML

P

mapap arthritis pain oral tablet extended release 650 mg

P QL (93 EA per 31 days)

MAPAP CHILDRENS ORAL SUSPENSION 160 MG/5ML

P

mapap oral capsule 500 mg P QL (186 EA per 31 days)

mapap oral tablet 325 mg P QL (279 EA per 31 days)

mapap oral tablet 500 mg P QL (186 EA per 31 days)

mapap oral tablet chewable 80 mg P

maxapap maximum strength oral tablet 500 mg


maxapap regular strength oral tablet 325 mg P QL (279 EA per 31 days)

non-aspirin extra strength oral tablet 500 mg P QL (186 EA per 31 days)

non-aspirin oral tablet 325 mg P QL (279 EA per 31 days)

non-aspirin pain relief oral tablet 325 mg P QL (279 EA per 31 days)

nortemp infants oral suspension 80 mg/0.8ml P

pain & fever childrens oral solution 160 mg/5ml

P

pain relief extra strength oral tablet 500 mg P QL (186 EA per 31 days)

pain relief oral tablet 500 mg P QL (186 EA per 31 days)

PHARBETOL EXTRA STRENGTH ORAL TABLET 500 MG


PHARBETOL ORAL TABLET 325 MG P QL (279 EA per 31 days)

P=Preferred, Asterisk(*)=N/A, PA=Prior Authorization, ST=Step Therapy, QL=Quantity Limit, AL=Age Limit, OTC Products Require Rx, UPPERCASE= Brand name drugs/ lowercase italics= Generic drugs2


q-pap oral tablet 325 mg P QL (279 EA per 31 days)

tactinal extra strength oral tablet 500 mg P QL (186 EA per 31 days)

tactinal oral tablet 325 mg P QL (279 EA per 31 days)

*Salicylate Combinations***

effervescent pain relief oral tablet effervescent 325-1000-1916 mg

P

tri-buffered aspirin oral tablet 325 mg P

*Salicylates***

aspirin childrens oral tablet chewable 81 mg P

aspirin ec low dose oral tablet delayed release 81 mg

P

aspirin ec oral tablet delayed release 325 mg P

aspirin oral tablet 325 mg, 81 mg P

aspirin oral tablet chewable 81 mg P

aspirin rectal suppository 300 mg, 600 mg P

ECPIRIN ORAL TABLET DELAYED RELEASE 325 MG

P

eq aspirin oral tablet delayed release 500 mg P

sb backache extra strength oral tablet 500 mg

P

*Anorectal Agents*

*Rectal Anesthetic Combinations***

hemorrhoidal rectal cream 1-0.25-14.4-15 % P

*Rectal Combinations - Misc.***

eq hemorrhoidal rectal suppository 0.25-85.39 %

P

goodsense hemorrhoidal rectal ointment0.25-14-74.9 %

P

hemorrhoidal rectal ointment 0.25-3-14-71.9 %

P

hemorrhoidal rectal suppository 0.25 %, 0.25-3-85.5 %, 0.25-85.39 %

P

sm hemorrhoidal rectal cream 0.25-3-12-18 %

P

*Rectal Local Anesthetics***

dibucaine rectal ointment 1 % P

lidocaine (anorectal) external cream 5 % P

PROCTOFOAM RECTAL FOAM 1 % P


3


*Antacids*

*Antacid & Simethicone***

antacid anti-gas max strength oral suspension 400-400-40 mg/5ml

P

antacid anti-gas oral suspension 200-200-20 mg/5ml

P

antacid extra strength oral suspension 400-400-40 mg/5ml

P

antacid iii oral suspension 400-400-40 mg/5ml

P

gnp antacid & anti-gas oral tablet chewable1000-60 mg

P

MAALOX ADVANCED MAX ST ORAL SUSPENSION 400-400-40 MG/5ML

P

MAALOX MAX ORAL SUSPENSION 400-400-40 MG/5ML

P

MAALOX MULTI SYMPTOM MAX ST ORAL SUSPENSION 400-400-40 MG/5ML

P

milantex extra strength oral suspension 400-400-40 mg/5ml

P

MINTOX PLUS ORAL TABLET CHEWABLE 200-200-25 MG

P

*Antacid Combinations***

ACID GONE ORAL TABLET CHEWABLE 160-105 MG

P

GAVISCON EXTRA RELIEF FORMULA ORAL SUSPENSION 508-475 MG/10ML

P

GAVISCON ORAL SUSPENSION 95-358 MG/15ML

P

GAVISCON ORAL TABLET CHEWABLE 80-14.2 MG

P

gnp antacid oral tablet chewable 550-110 mg P

gnp foaming antacid oral tablet chewable 80-20 mg

P

mag-al oral liquid 200-200 mg/5ml P

MI-ACID ORAL TABLET CHEWABLE 700-300 MG

P



*Antacids - Aluminum Salts***

aluminum hydroxide gel oral suspension 320 mg/5ml

P

*Antacids - Bicarbonate***

sodium bicarbonate oral tablet 325 mg, 650 mg

P

*Antacids - Calcium Salts***

antacid oral tablet chewable 500 mg P

calcium antacid extra strength oral tablet chewable 750 mg

P

calcium antacid oral tablet chewable 500 mg P

calcium antacid ultra max st oral tablet chewable 1000 mg

P

calcium carbonate antacid oral suspension1250 mg/5ml

P

calcium carbonate antacid oral tablet 648 mg P

calcium carbonate antacid oral tablet chewable 500 mg

P

CAL-GEST ANTACID ORAL TABLET CHEWABLE 500 MG

P

MAALOX ORAL TABLET CHEWABLE 600 MG

P

TITRALAC ORAL TABLET CHEWABLE 420 MG

P

TUMS CHEWY DELIGHTS ORAL TABLET CHEWABLE 1177 MG

P

*Antacids - Magnesium Salts***

magnesium oxide oral tablet 250 mg, 400 mg, 420 mg

P

*Anthelmintics*

*Anthelmintics***

reeses pinworm medicine oral suspension144 (50 base) mg/ml

P

*Antiasthmatic And Bronchodilator Agents*

*Mixed Adrenergics***

S2 (RACEPINEPHRINE) INHALATION NEBULIZATION SOLUTION 2.25 %

P


5


*Antidiabetics*

*Diabetic Other - Combinations***

ra glucose oral tablet chewable 4-6 gm-mg P

*Diabetic Other***

BD GLUCOSE ORAL TABLET CHEWABLE 5 GM

P

glucose oral tablet chewable 4 gm P

INSTA-GLUCOSE ORAL GEL 77.4 % P

*Human Insulin***

HUMULIN 70/30 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML

P

HUMULIN 70/30 SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

P

HUMULIN N KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNIT/ML

P

HUMULIN N SUBCUTANEOUS SUSPENSION 100 UNIT/ML

P

HUMULIN R INJECTION SOLUTION 100 UNIT/ML

P

*Antidiarrheal/Probiotic Agents*

*Antidiarrheal/Probiotic Agents - Misc.***

bismatrol oral suspension 262 mg/15ml P

bismatrol oral tablet chewable 262 mg P

bismuth oral tablet chewable 262 mg P

diotame oral tablet chewable 262 mg P

gnp pink bismuth oral tablet 262 mg P

KAOPECTATE EXTRA STRENGTH ORAL SUSPENSION 525 MG/15ML

P

KAOPECTATE ORAL SUSPENSION 262 MG/15ML

P

KAO-TIN ORAL SUSPENSION 262 MG/15ML

P

pink bismuth oral suspension 262 mg/15ml P

pink bismuth oral tablet chewable 262 mg P

stomach relief oral suspension 262 mg/15ml, 527 mg/30ml

P



stomach relief oral tablet chewable 262 mg P

stomach relief plus oral suspension 525 mg/15ml

P

*Antidiarrheal/Probiotic Combinations***

acidophilus/pectin oral capsule P

*Antidiarrheals*

*Antidiarrheal Agents - Misc.***

bismatrol oral suspension 262 mg/15ml P

bismatrol oral tablet chewable 262 mg P

bismuth oral tablet chewable 262 mg P

diotame oral tablet chewable 262 mg P

gnp pink bismuth oral tablet 262 mg P

KAOPECTATE EXTRA STRENGTH ORAL SUSPENSION 525 MG/15ML

P

KAOPECTATE ORAL SUSPENSION 262 MG/15ML

P

KAO-TIN ORAL SUSPENSION 262 MG/15ML

P

pink bismuth oral suspension 262 mg/15ml P

pink bismuth oral tablet chewable 262 mg P

stomach relief oral suspension 262 mg/15ml, 527 mg/30ml

P

stomach relief oral tablet chewable 262 mg P

stomach relief plus oral suspension 525 mg/15ml

P

*Antidiarrheal Combinations***

acidophilus/pectin oral capsule P

*Antiperistaltic Agents***

anti-diarrheal oral liquid 1 mg/5ml P

LOPERAMIDE A-D ORAL TABLET 2 MG P

loperamide hcl oral liquid 1 mg/5ml P

loperamide hcl oral suspension 1 mg/7.5ml P

sm anti-diarrheal oral capsule 2 mg P

*Antidotes And Specific Antagonists*

*Antidotes And Specific Antagonists***

ACTIDOSE WITH SORBITOL ORAL LIQUID 25 GM/120ML

P


7


actidose-aqua oral liquid 25 gm/120ml P

EZ CHAR ORAL SUSPENSION RECONSTITUTED

P

ipecac oral syrup P

*Antidotes*

*Antidotes***

ACTIDOSE WITH SORBITOL ORAL LIQUID 25 GM/120ML

P

actidose-aqua oral liquid 25 gm/120ml P

EZ CHAR ORAL SUSPENSION RECONSTITUTED

P

ipecac oral syrup P

*Antiemetics*

*Antiemetic Combinations***

anti-nausea oral solution 1.87-1.87-21.5 P

*Antiemetics - Anticholinergic***

dimenhydrinate oral tablet 50 mg P

meclizine hcl oral tablet 12.5 mg, 25 mg P

travel sickness oral tablet chewable 25 mg P

*Antihistamines*

*Antihistamines - Alkylamines***

ALA-HIST IR ORAL TABLET 2 MG P

aller-chlor oral syrup 2 mg/5ml P

aller-chlor oral tablet 4 mg P

allergy oral tablet 4 mg P

allergy relief oral tablet 4 mg P

chlorhist oral tablet 4 mg P

chlorpheniramine maleate er oral tablet extended release 12 mg

P

DIABETIC TUSSIN ALLERGY ORAL SYRUP 2 MG/5ML

P

ED CHLORPED ORAL LIQUID 2 MG/ML P

J-TAN PD ORAL LIQUID 1 MG/ML P

VANAHIST PD ORAL LIQUID 0.625 MG/ML P

*Antihistamines - Ethanolamines***

aler-cap oral capsule 25 mg P

aler-dryl oral tablet 50 mg P



alertab oral tablet 25 mg P

allergy relief childrens oral liquid 12.5 mg/5ml P

altaryl oral elixir 12.5 mg/5ml P

altaryl oral syrup 12.5 mg/5ml P

anti-hist allergy oral tablet 25 mg P

BANOPHEN ORAL CAPSULE 25 MG P

BANOPHEN ORAL LIQUID 12.5 MG/5ML P

BANOPHEN ORAL TABLET 25 MG P

BENADRYL ALLERGY CHILDRENS ORAL LIQUID 12.5 MG/5ML

P

complete allergy medication oral tablet 25 mg P

complete allergy relief oral tablet 25 mg P

diphenhist oral capsule 25 mg P

diphenhist oral liquid 12.5 mg/5ml P

diphenhist oral tablet 25 mg P

diphenhydramine hcl oral capsule 25 mg, 50 mg

P

diphenhydramine hcl oral tablet 25 mg P

genahist oral capsule 25 mg P

gnp dayhist allergy oral tablet 1.34 mg P

pharbedryl oral capsule 25 mg, 50 mg P

q-dryl oral capsule 25 mg P

q-dryl oral liquid 12.5 mg/5ml P

SCOT-TUSSIN ALLERGY RELIEF ORAL LIQUID 12.5 MG/5ML

P

siladryl allergy oral liquid 12.5 mg/5ml P

silphen cough oral syrup 12.5 mg/5ml P

TOTAL ALLERGY MEDICINE ORAL LIQUID 12.5 MG/5ML

P

total allergy oral tablet 25 mg P

*Antihistamines - Non-Sedating***

allergy oral tablet dispersible 10 mg P

cetirizine hcl childrens alrgy oral syrup 1 mg/ml

P QL (300 ML per 31 days)

cetirizine hcl childrens oral solution 1 mg/ml P QL (300 ML per 31 days)

cetirizine hcl oral tablet 10 mg, 5 mg P


9


cetirizine hcl oral tablet chewable 10 mg, 5 mg

P

childrens loratadine oral syrup 5 mg/5ml P QL (310 ML per 31 days)

fexofenadine hcl childrens oral suspension30 mg/5ml

P

fexofenadine hcl oral tablet 180 mg, 60 mg P

loratadine hives relief oral solution 5 mg/5ml P QL (300 ML per 31 days)

loratadine oral tablet 10 mg P

*Antiseptics & Disinfectants*

*Chlorine Antiseptic Combinations***

dakins external solution 0.4-0.5 % P

*Chlorine Antiseptics***

chlorhexidine gluconate external liquid 2 % P

chlorhexidine gluconate external liquid 4 % P QL (480 ML per 31 days)

dakins (1/2 strength) external solution 0.25 % P

REMEDY ANTIMICROBIAL CLEANSER EXTERNAL LIQUID 0.12 %

P

*Iodine Antiseptics***

BETADINE SKIN CLEANSER EXTERNAL SOLUTION 7.5 %

P

BETADINE SWAB AID EXTERNAL SWAB 10 %

P

OPERAND POVIDONE-IODINE EXTERNAL SOLUTION 10 %

P

povidone-iodine external ointment 10 % P

povidone-iodine external solution 10 % P

*Cardiovascular Agents - Misc.*

*Peripheral Vasodilators***

niacin flush free oral capsule 500 mg P

*Chemicals*

*Fixed Oils***

hm castor oil oil P

*Liquids***

camphor spirit spirit P

glycerin liquid P

*Solvents***

sm isopropyl alcohol solution 50 % P



*Contraceptives*

*Emergency Contraceptives***

MY WAY ORAL TABLET 1.5 MG P

*Cough/Cold/Allergy*

*Antihistamine-Analgesics***

ACETA-GESIC ORAL TABLET 12.5-325 MG P

*Antitussive - Nonnarcotic***

benzonatate oral capsule 100 mg, 200 mg P

dextromethorphan polistirex er oral suspension extended release 30 mg/5ml

P

ROBITUSSIN CHILDRENS COUGH LA ORAL SYRUP 7.5 MG/5ML

P

*Antitussive - Opioid***

hydrocodone-homatropine oral syrup 5-1.5 mg/5ml

P

hydrocodone-homatropine oral tablet 5-1.5 mg

P

*Antitussive-Antihistamine-Analgesic***

DELSYM NIGHT TIME MULTI-SYMPT ORAL LIQUID 15-6.25-325 MG/15ML

P

*Antitussive-Expectorant***

DIABETIC TUSSIN MAX ST ORAL LIQUID 10-200 MG/5ML

P

extra action cough oral syrup 100-10 mg/5ml P

MUCINEX FAST-MAX DM MAX ORAL LIQUID 20-400 MG/20ML

P

mucus relief dm cough oral tablet 20-400 mg P

tussin dm oral liquid 100-10 mg/5ml P

*Antitussive-Expectorants-Decongestant***

cheratussin dac oral solution 30-10-100 mg/5ml

P

LORTUSS EX ORAL LIQUID 30-10-100 MG/5ML

P

robafen cf cough/cold oral syrup 5-10-100 mg/5ml

P

TUSNEL C ORAL SYRUP 30-10-100 MG/5ML

P


11


tussin cf cough & cold oral liquid 5-10-100 mg/5ml

P

*Aromatic Inhalants***

gnp chest rub external ointment 4.8-1.2-2.6 %

P

sm medicated chest rub external ointment4.73-1.2-2.6 %

P

*Decongestant & Antihistamine***

ALAVERT ALLERGY/SINUS ORAL TABLET EXTENDED RELEASE 12 HOUR 5-120 MG

P

ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 12 HOUR 60-120 MG

P

allergy relief/nasal decongest oral tablet extended release 24 hour 10-240 mg

P

BROTAPP ORAL LIQUID 1-15 MG/5ML P

cetirizine-pseudoephedrine er oral tablet extended release 12 hour 5-120 mg

P

childrens cold & allergy oral elixir 1-2.5 mg/5ml

P

ED A-HIST ORAL TABLET 4-10 MG P

fexofenadine-pseudoephed er oral tablet extended release 24 hour 180-240 mg

P

Q-TAPP ORAL ELIXIR 1-15 MG/5ML P

SUDOGEST SINUS/ALLERGY ORAL TABLET 4-60 MG

P

TRIAMINIC COLD & ALLERGY ORAL SYRUP 1-2.5 MG/5ML

P

triprolidine-pse oral tablet 2.5-60 mg P

*Decongestant W/ Expectorant***

tussin pe oral liquid 5-100 mg/5ml P

*Expectorants***

diabetic siltussin das-na oral liquid 100 mg/5ml

P

mucus relief oral tablet 400 mg P

refenesen 400 oral tablet 400 mg P

refenesen oral tablet 200 mg P

robafen oral syrup 100 mg/5ml P



*Misc. Respiratory Inhalants***

BRONCHO SALINE INHALATION AEROSOL SOLUTION 0.9 %

P

sodium chloride inhalation nebulization solution 0.9 %

P

*Non-Narc Antitussive-Antihistamine***

DIMETAPP LONG ACT COUGH/COLD ORAL SYRUP 1-7.5 MG/5ML

P

promethazine-dm oral syrup 6.25-15 mg/5ml P

ROBITUSSIN CHILD COUGH/COLD LA ORAL LIQUID 1-7.5 MG/5ML

P

*Non-Narc Antitussive-Decongestant-Antihistamine***

brotapp dm oral liquid 15-1-5 mg/5ml P

cold/cough childrens oral elixir 2.5-1-5 mg/5ml

P

kidkare cough/cold oral liquid 15-1-5 mg/5ml P

m-end dm oral liquid 15-2-15 mg/5ml P

nohist-dm oral liquid 10-4-15 mg/5ml P

rynex dm oral liquid 2.5-1-5 mg/5ml P

VANACOF ORAL LIQUID 30-1-12.5 MG/5ML P

*Opioid Antitussive-Antihistamine***

hydrocod polst-cpm polst er oral suspension extended release 10-8 mg/5ml

P

promethazine-codeine oral syrup 6.25-10 mg/5ml

P

TUSSICAPS ORAL CAPSULE EXTENDED RELEASE 12 HOUR 10-8 MG, 5-4 MG

P

*Opioid Antitussive-Decongestant-Antihistamine***

phenylhistine dh oral liquid 30-2-10 mg/5ml P

promethazine vc/codeine oral syrup 6.25-5-10 mg/5ml

P

*Dermatologicals*

*Acne Products***

acne medication 10 external lotion 10 % P

acne medication 5 external lotion 5 % P

BENZEPRO EXTERNAL FOAM 5.3 % P


13


BENZEPRO SHORT CONTACT EXTERNAL FOAM 9.8 %

P

benzoyl peroxide cleanser external liquid 6 % P

benzoyl peroxide cleanser external lotion 3 %, 6 %, 9 %

P

benzoyl peroxide external gel 10 %, 2.5 %, 5 %

P

benzoyl peroxide wash external liquid 5 % P

PANOXYL WASH EXTERNAL LIQUID 10 % P

PANOXYL-4 CREAMY WASH EXTERNAL LIQUID 4 %

P

*Analgesics - Topical***

MINERAL ICE EXTERNAL GEL 2 % P

*Antibiotic Mixtures Topical***

bacitracin-neomycin-polymyxin external ointment 400-5-5000

P

double antibiotic external ointment 500-10000 unit/gm

P

sm antibiotic plus pain relief external cream3.5-10000-10

P

triple antibiotic external ointment 3.5-400-5000 , 5-400-5000

P

triple antibiotic plus external ointment 1 % P

*Antibiotics - Topical***

bacitracin external ointment 500 unit/gm P

bacitracin zinc external ointment 500 unit/gm P

*Antifungals - Topical Combinations***

BAZA EXTERNAL KIT P

BREEZEE MIST EXTERNAL AEROSOL POWDER

P

*Antifungals - Topical***

anti-fungal external powder 1 % P

athletes foot spray external aerosol 1 % P

FUNGOID-D EXTERNAL CREAM 1 % P

gnp gentian violet external solution 1 % P

LAMISIL ADVANCED EXTERNAL GEL 1 % P

LAMISIL AF DEFENSE EXTERNAL AEROSOL POWDER 1 %

P



terbinafine hcl external cream 1 % P

tolnaftate external solution 1 % P

*Antihistamines - Topical***

anti-itch maximum strength external cream 2 %

P

anti-itch maximum strength external solution2 %

P

BENADRYL ITCH STOPPING EXTERNAL GEL 2 %

P

itch relief external cream 2 % P

*Antihistamine-Topical Combinations***

gnp itch relief extra strength external liquid 2-0.1 %

P

itch relief extra strength external cream 2-0.1 %

P

sm caldyphen clear external lotion 1-2 % P

*Antipruritic Combinations - Topical***

camphor phenol cold sore external gel 10.8-4.7 %

P

gnp anti-itch external lotion 0.5-0.5 % P

qc antiseptic pain relief external liquid 10.8-4.7 %

P

*Antiseborrheic Combinations***

sebex external shampoo 2-2 % P

*Antiseborrheic Products***

anti-dandruff external shampoo 1 % P

DHS ZINC EXTERNAL SHAMPOO 2 % P

*Antivirals - Topical***

ABREVA EXTERNAL CREAM 10 % P

*Astringents***

DR SMITHS DIAPER EXTERNAL OINTMENT 10 %

P

medi pads external pad 50-10 % P

SECURA PROTECTIVE EXTERNAL CREAM 10 %

P

zinc oxide external ointment 20 % P


15


*Corticosteroids - Topical***

AVEENO ANTI-ITCH MAX ST EXTERNAL CREAM 1 %

P

hydrocortisone external cream 0.5 %, 1 % P

hydrocortisone external lotion 1 % P

hydrocortisone external ointment 0.5 %, 1 % P

hydrocortisone max st external cream 1 % P

hydrocortisone max st/12 moist external cream 1 %

P

HYDROSKIN EXTERNAL CREAM 1 % P

kp hydrocortisone external cream 1 % P

PREPARATION H EXTERNAL CREAM 1 % P

SCALPICIN MAXIMUM STRENGTH EXTERNAL SOLUTION 1 %

P

tgt anti-itch/aloe/vit e external cream 1 % P

*Emollient Combinations***

mineral oil-hydrophil petrolat external ointment

P

*Emollient/Keratolytic Agents***

urea 20 intensive hydrating external cream20 %

P

*Emollients***

AMLACTIN EXTERNAL LOTION 12 % P QL (400 GM per 31 days)

ammonium lactate external cream 12 % P QL (400 GM per 31 days)

ammonium lactate external lotion 12 % P QL (400 GM per 31 days)

BAZA CLEAR EXTERNAL OINTMENT P

gnp glycerin external liquid 99.5 % P

ra hydrating healing external ointment P

SWEEN 24 EXTERNAL CREAM P

*Eyelid Cleansers & Lubricants***

SYSTANE LID WIPES EXTERNAL PAD P

*Imidazole-Related Antifungals - Topical***

alevazol external ointment 1 % P

antifungal external cream 2 % P

clotrimazole external cream 1 % P

clotrimazole external solution 1 % P



CRITIC-AID CLEAR AF EXTERNAL OINTMENT 2 %

P

DESENEX EXTERNAL POWDER 2 % P

DESENEX SPRAY EXTERNAL AEROSOL 2 %

P

FUNGOID TINCTURE EXTERNAL KIT 2 % P

FUNGOID TINCTURE EXTERNAL SOLUTION 2 %

P

miconazole nitrate external aerosol powder 2 %

P

*Keratolytic/Antimitotic Agents***

CLEAR AWAY 1-STEP WART REMOVER EXTERNAL PAD 40 %

P

COMPOUND W EXTERNAL LIQUID 17 % P

COMPOUND W MAXIMUM STRENGTH EXTERNAL GEL 17 %

P

DHS SAL EXTERNAL SHAMPOO 3 % P

FREEZONE EXTERNAL LIQUID 17.6 % P

gnp scalp relief external liquid 3 % P

SALACTIC FILM EXTERNAL SOLUTION 17 %

P

*Liniment Combinations***

gnp cold & hot extra strength external ointment 7.6-29 %

P

THERA-GESIC PLUS EXTERNAL CREAM P

*Liniments***

BLUE-EMU SUPER STRENGTH EXTERNAL CREAM

P

MOBISYL EXTERNAL CREAM 10 % P

sm cold & hot therapy balm external ointment15-15 %

P

sm pain relief/menthol external gel P

trixaicin external cream 0.025 % P

*Local Anesthetics - Topical***

burn relief external aerosol 0.5 % P

capsaicin external cream 0.025 % P QL (60 gms per 30 days)

dibucaine external ointment 1 % P

gnp capsaicin external liquid 0.15 % P


17


lidocaine external cream 4 % P

trixaicin hp external cream 0.075 % P

*Lubricants***

MAXILUBE EXTERNAL GEL P

*Misc. Topical Combinations***

SENSI-CARE PROTECTIVE BARRIER EXTERNAL OINTMENT 49-15 %

P

*Misc. Topical***

sm medicated wipes external pad 50 % P

sm witch hazel external liquid P

sm witch hazel external solution 86 % P

*Scabicide Combinations***

lice killing maximum strength external shampoo 0.33-4 %

P

sm lice killing external shampoo 0.33-4 % P

*Scabicides & Pediculicides***

hm lice treatment external liquid 1 % P

permethrin external lotion 1 % P

*Skin Cleansers***

BEDSIDE-CARE EXTERNAL SOLUTION P

*Skin Protectants***

ALOE VESTA SKIN CONDITIONER EXTERNAL LOTION 3 %

P

AMERIPHOR EXTERNAL OINTMENT P

BAZA CLEANSE & PROTECT EXTERNAL LOTION 2 %

P

MINERIN EXTERNAL CREAM P

SECURA DIMETHICONE PROTECTANT EXTERNAL CREAM 5 %

P

SWEEN 24 SKIN PROTECTANT EXTERNAL CREAM 6 %

P

THERASEAL HAND PROTECTION EXTERNAL LOTION 1 %

P

*Tar Products***

IONIL-T EXTERNAL SHAMPOO 1 % P

TERA-GEL TAR EXTERNAL SHAMPOO 0.5 %

P



X-SEB T PEARL EXTERNAL SHAMPOO 10 %

P

*Topical Anesthetic Combinations***

CALADRYL EXTERNAL LOTION 1-8 % P

CALLERGY CLEAR EXTERNAL LOTION 1-0.1 %

P

gnp aloe vera/lidocaine external gel 0.5 % P

gnp medicated first aid spray external aerosol 20-0.13 %

P

ITCH-X EXTERNAL GEL 1-10 % P

ITCH-X EXTERNAL SOLUTION 1-10 % P

LANACANE FIRST AID 2-IN-1 EXTERNAL AEROSOL 20-0.2 %

P

lidocaine-transparent dressing external kit 4 %

P

*Topical Steroid Combinations***

hydrocortisone-aloe external cream 0.5 %, 1 %

P

sm hydrocortisone plus external cream 1 % P

*Dietary Products/Dietary Management Products*

*Dietary Management Product Combinations***

FOLBIC RF ORAL TABLET 1.13-25-2 MG P

FOLTANX ORAL TABLET 3-35-2 MG P

FOLTANX RF ORAL CAPSULE 3-90.314-2-35 MG

P

l-methylfolate forte oral capsule 15-90.314 mg, 7.5-90.314 mg

P

METAFOLBIC ORAL TABLET 6-1-50-5 MG P

METAFOLBIC PLUS ORAL TABLET 6-2-600 MG

P

METAFOLBIC PLUS RF ORAL TABLET 6-90.314-2-600 MG

P

*Digestive Aids*

*Digestive Enzymes***

lactase enzyme oral tablet 3000 unit P

lactase fast acting oral tablet 9000 unit P


19


*Gastrointestinal Agents - Misc.*

*Antiflatulents***

anti-gas oral capsule 166 mg P

GAS-X EXTRA STRENGTH ORAL CAPSULE 125 MG

P

GAS-X EXTRA STRENGTH ORAL TABLET CHEWABLE 125 MG

P

GAS-X ULTRA STRENGTH ORAL CAPSULE 180 MG

P

mi-acid gas relief oral tablet chewable 80 mg P

mytab gas oral tablet chewable 80 mg P

simethicone oral suspension 40 mg/0.6ml P

simethicone oral tablet chewable 80 mg P

*Phosphate Binder Agents***

CALPHRON ORAL TABLET 667 MG P

*Genitourinary Agents - Miscellaneous*

*Urinary Analgesics***

AZO URINARY PAIN RELIEF ORAL TABLET 99.5 MG

P

phenazopyridine hcl oral tablet 95 mg P

urinary pain relief max st oral tablet 97.5 mg P

*Hematopoietic Agents*

*Cobalamin Combinations***

vitamin b12-folic acid oral tablet 500-400 mcg P

*Cobalamins***

cyanocobalamin injection solution 1000 mcg/ml

P

vitamin b-12 er oral tablet extended release1000 mcg

P

vitamin b-12 oral lozenge 500 mcg P

vitamin b-12 oral tablet 100 mcg, 1000 mcg, 250 mcg, 500 mcg

P

vitamin b-12 sublingual tablet sublingual1000 mcg

P

*Folic Acid/Folate Combinations***

FOLTABS 800 ORAL TABLET 800-10-115 MCG-MG-MCG

P



*Folic Acid/Folates***

folic acid oral tablet 1 mg, 400 mcg, 800 mcg P

*Iron Combinations***

FOLITAB 500 ORAL TABLET EXTENDED RELEASE 105-500-0.8 MG

P

INTEGRA ORAL CAPSULE 62.5-62.5-40-3 MG

P

iron 100 plus oral tablet 100-250-0.025-1 mg P

TANDEM ORAL CAPSULE 162-115.2 MG P

*Iron***

FERATE ORAL TABLET 240 (27 FE) MG P

FER-IN-SOL ORAL SOLUTION 75 (15 FE) MG/ML

P

FERRIMIN 150 ORAL TABLET 150 MG P

ferro-bob oral tablet 325 (65 fe) mg P

ferrous fumarate oral tablet 29 mg P

ferrous gluconate oral tablet 324 (37.5 fe) mg, 324 (38 fe) mg

P

ferrous sulfate er oral tablet extended release140 (45 fe) mg

P

ferrous sulfate oral elixir 220 (44 fe) mg/5ml P

ferrous sulfate oral liquid 220 (44 fe) mg/5ml P

ferrous sulfate oral syrup 300 (60 fe) mg/5ml P

ferrous sulfate oral tablet 325 (65 fe) mg P

ferrous sulfate oral tablet delayed release324 (65 fe) mg, 325 (65 fe) mg

P

ferrousul oral tablet 325 (65 fe) mg P

gnp iron oral tablet 200 (65 fe) mg P

gnp iron oral tablet extended release 142 (45 fe) mg

P

HEMOCYTE ORAL TABLET 324 (106 FE) MG

P

iron oral tablet 325 (65 fe) mg, 90 (18 fe) mg P

POLY-IRON 150 ORAL CAPSULE 150 MG P

slow release iron oral tablet extended release160 (50 fe) mg

P

sm slow release iron oral tablet extended release 143 (45 fe) mg

P


21


*Hypnotics*

*Antihistamine Hypnotic Combinations***

headache pm oral tablet 25-500 mg P QL (62 EA per 31 days)

mapap pm oral tablet 500-25 mg P QL (62 EA per 31 days)

pain relief pm extra strength oral tablet 500-25 mg

P QL (62 EA per 31 Days)

pain reliever pm oral tablet 500-25 mg P QL (62 EA per 31 days)

*Antihistamine Hypnotics***

compoz oral capsule 50 mg P

compoz oral tablet 50 mg P

diphenhydramine hcl (sleep) oral tablet 50 mg

P

NYTOL ORAL TABLET 25 MG P

SIMPLY SLEEP ORAL TABLET 25 MG P

sleep aid oral tablet 25 mg P

sleep tabs oral tablet 25 mg P

sleep-tabs oral tablet 25 mg P

SOMINEX ORAL TABLET 25 MG P

tetra-formula nighttime sleep oral tablet 50 mg

P

*Laxatives*

*Bulk Laxatives***

CITRUCEL ORAL POWDER P

CITRUCEL ORAL TABLET 500 MG P

fiber laxative oral tablet 625 mg P

fiber oral tablet 625 mg P

FIBERGEN ORAL TABLET 625 MG P

fiber-lax oral tablet 625 mg P

konsyl daily fiber oral packet 100 % P

KONSYL FIBER ORAL TABLET 625 MG P

KONSYL ORAL PACKET 60.3 % P

METAMUCIL ORAL CAPSULE 0.36 GM P

METAMUCIL ORAL WAFER P

METAMUCIL SMOOTH TEXTURE ORAL PACKET 28 %

P

METAMUCIL SMOOTH TEXTURE ORAL POWDER 28.3 %, 58.6 %

P



natural fiber therapy oral powder 30.9 %, 48.57 %

P

natural vegetable fiber oral powder 48.57 % P

REGULOID ORAL CAPSULE 0.52 GM P

UNIFIBER ORAL POWDER P

*Laxative Combinations***

SENNA PROMPT ORAL CAPSULE 9-500 MG

P

*Laxatives - Miscellaneous***

cvs glycerin adult rectal suppository 2 gm P

PEDIA-LAX RECTAL SUPPOSITORY 1 GM P

peg 3350 oral packet P

peg 3350 oral powder P

SANI-SUPP PEDIATRIC RECTAL SUPPOSITORY 1.2 GM

P

sorbitol oral solution 70 % P

*Laxatives & Dss***

DOC-Q-LAX ORAL TABLET 8.6-50 MG P

PERI-COLACE ORAL TABLET 8.6-50 MG P

senna plus oral tablet 8.6-50 mg P

senna s oral tablet 8.6-50 mg P

senna-docusate sodium oral tablet 8.6-50 mg P

SENNALAX-S ORAL TABLET 8.6-50 MG P

senna-s oral tablet 8.6-50 mg P

senna-time s oral tablet 8.6-50 mg P

sennosides-docusate sodium oral tablet 8.6-50 mg

P

*Lubricant Laxatives***

FLEET OIL RECTAL ENEMA P

sm mineral oil oral oil P

*Saline Laxative Mixtures***

enema rectal enema 7-19 gm/118ml P

ra saline laxative oral solution 2.7-7.2 gm/5ml P

*Saline Laxatives***

citrate of magnesia oral solution 1.745 gm/30ml

P


23


CITROMA ORAL SOLUTION 1.745 GM/30ML

P

DULCOLAX MILK OF MAGNESIA ORAL SUSPENSION 400 MG/5ML

P

gnp epsom salt oral granules P

magnesium citrate oral solution 1.745 gm/30ml

P

milk of magnesia concentrate oral suspension 2400 mg/10ml

P

milk of magnesia oral suspension 400 mg/5ml, 7.75 %

P

*Stimulant Laxatives***

BISAC-EVAC RECTAL SUPPOSITORY 10 MG

P

biscolax rectal suppository 10 mg P

CARTERS LITTLE PILLS ORAL TABLET DELAYED RELEASE 5 MG

P

correct oral tablet delayed release 5 mg P

CORRECTOL ORAL TABLET DELAYED RELEASE 5 MG

P

ducodyl oral tablet delayed release 5 mg P

EX-LAX ORAL TABLET CHEWABLE 15 MG P

EX-LAX ULTRA ORAL TABLET DELAYED RELEASE 5 MG

P

FEENAMINT ORAL TABLET DELAYED RELEASE 5 MG

P

FLEET BISACODYL RECTAL ENEMA 10 MG/30ML

P

FLEET LAXATIVE ORAL TABLET DELAYED RELEASE 5 MG

P

gentle laxative oral tablet delayed release 5 mg

P

gnp castor oil oral oil 100 % P

laxative rectal suppository 10 mg P

natural senna laxative oral tablet 64.8-324 mg

P

senexon oral liquid 8.8 mg/5ml P

senexon oral tablet 8.6 mg P

senna lax oral tablet 8.6 mg P



senna laxative oral tablet 25 mg, 8.6 mg P

senna oral syrup 8.8 mg/5ml P

senna oral tablet 8.6 mg P

SENNA SMOOTH ORAL TABLET 15 MG P

SENNACON ORAL TABLET 8.6 MG P

senna-lax oral tablet 8.6 mg P

senna-tabs oral tablet 8.6 mg P

senna-time oral tablet 8.6 mg P

SENNO ORAL TABLET 8.6 MG P

SENOKOT XTRA ORAL TABLET 17.2 MG P

stimulant laxative oral tablet delayed release5 mg

P

womens laxative oral tablet delayed release5 mg

P

*Surfactant Laxatives***

COLACE CLEAR ORAL CAPSULE 50 MG P

CORRECTOL EXTRA GENTLE ORAL CAPSULE 100 MG

P

diocto oral liquid 50 mg/5ml P

diocto oral syrup 60 mg/15ml P

docqlace oral capsule 100 mg P

docu soft oral capsule 100 mg P

docusate calcium oral capsule 240 mg P

docusate sodium oral tablet 100 mg P

DOCUSIL ORAL CAPSULE 100 MG P

DOK ORAL CAPSULE 100 MG, 250 MG P

DOK ORAL TABLET 100 MG P

dss oral capsule 100 mg, 250 mg P

DULCOLAX STOOL SOFTENER ORAL CAPSULE 100 MG

P

ENEMEEZ MINI RECTAL ENEMA 283 MG/5ML

P

ENEMEEZ PLUS RECTAL ENEMA 20-283 MG

P

KAO-TIN ORAL CAPSULE 240 MG P

laxa basic oral capsule 100 mg P

PEDIA-LAX ORAL LIQUID 50 MG/15ML P


25


silace oral liquid 150 mg/15ml P

silace oral syrup 60 mg/15ml P

SOF-LAX ORAL CAPSULE 100 MG P

stool softener oral capsule 100 mg, 250 mg P

SURFAK ORAL CAPSULE 240 MG P

*Medical Devices*

*Respiratory Therapy Supplies***

ACE AEROSOL CLOUD ENHANCER P QL (2 EA per 365 days)

IN-CHECK DIAL FLOW TRAINER DEVICE P QL (2 EA per 365 days)

PFLEX P QL (2 EA per 365 days)

THRESHOLD IMT P QL (2 EA per 365 days)

THRESHOLD PEP DEVICE P QL (2 EA per 365 days)

WINDMILL TRAINER P QL (2 EA per 365 days)

*Spacer/Aerosol-Holding Chambers & Supplies***

AEROCHAMBER MV P QL (2 EA per 365 days)

AEROCHAMBER PLUS FLO-VU P QL (2 EA per 365 days)

AEROCHAMBER PLUS FLO-VU LARGE P QL (2 EA per 365 days)

AEROCHAMBER PLUS FLO-VU SMALL P QL (2 EA per 365 days)

AEROCHAMBER PLUS FLO-VU W/MASK P QL (2 EA per 365 days)

AEROCHAMBER W/FLOWSIGNAL P QL (2 EA per 365 days)

AEROCHAMBER Z-STAT PLUS P QL (2 EA per 365 days)

AEROCHAMBER Z-STAT PLUS CHAMBR P QL (2 EA per 365 days)

EASIVENT P QL (2 EA per 365 days)

MICROCHAMBER P QL (2 EA per 365 days)

MICROSPACER P QL (2 EA per 365 days)

OPTICHAMBER ADVANTAGE P QL (2 EA per 365 days)

OPTIHALER P QL (2 EA per 365 days)

OPTIHALER DEVICE P QL (2 EA per 365 days)

POCKET CHAMBER DEVICE P QL (2 EA per 365 days)

POCKET SPACER DEVICE P QL (2 EA per 365 days)

WATCHHALER DEVICE P QL (2 EA per 365 days)

*Minerals & Electrolytes*

*Calcium Combinations***

cal/mag oral tablet 200-100 mg P



CALCET CREAMY BITES ORAL TABLET CHEWABLE 500-400 MG-UNIT

P

CALCITRATE ORAL TABLET 315-250 MG-UNIT

P

cal-citrate plus vitamin d oral tablet 250-100 mg-unit

P

calcium + d3 oral tablet 600-200 mg-unit P

calcium 500/d oral tablet chewable 500-400 mg-unit

P

calcium 600+d plus minerals oral tablet 600-400 mg-unit

P

calcium 600-d oral tablet 600-400 mg-unit P

calcium carb-cholecalciferol oral tablet 600-400 mg-unit

P

calcium carbonate-vitamin d oral tablet 500-400 mg-unit, 600-400 mg-unit

P

calcium high potency/vitamin d oral tablet600-200 mg-unit

P

calcium oral tablet 500-125 mg-unit P

calcium oral tablet chewable 500-100 mg-unit P

calcium-carb 600 + d oral tablet 600-125 mg-unit

P

calcium-magnesium-vitamin d oral tablet400-166.7-133.3 mg-mg-unit

P

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

P

calcium-vitamin d oral tablet 500-125 mg-unit, 600-125 mg-unit, 600-200 mg-unit

P

CALTRATE 600+D ORAL TABLET 600-800 MG-UNIT

P

CELEBRATE CALCIUM PLUS 500 ORAL TABLET CHEWABLE 500-333 MG-UNIT

P

gnp vitamin d-400 oral tablet 90-400 mg-unit P

liquid calcium/vitamin d oral capsule 600-200 mg-unit

P

MAGNEBIND 300 ORAL TABLET 250-300 MG

P

OS-CAL EXTRA D3 ORAL TABLET 500-600 MG-UNIT

P


27


OYSCO 500+D ORAL TABLET 500-200 MG-UNIT

P

oyst-cal d oral tablet 250-125 mg-unit P

oyster calcium + d oral tablet 250-125 mg-unit

P

oyster shell calcium + d oral tablet 500-400 mg-unit

P

oyster shell calcium 500 + d oral tablet 500-125 mg-unit

P

oyster shell calcium/d oral tablet 250-125 mg-unit, 500-200 mg-unit

P

oyster shell calcium/vitamin d oral packet500-200 mg-unit

P

oyster shell calcium/vitamin d oral tablet 250-125 mg-unit, 500-200 mg-unit

P

oyster shell/vitamin d oral tablet 600-125 mg-unit

P

parva-cal oral tablet 250-100 mg-unit, 500-200 mg-unit

P

risacal-d oral tablet 105-81-120 mg-mg-unit P

sm calcium citrate-vit d oral tablet 315-200 mg-unit

P

sm calcium soft chews oral tablet chewable500-200-40 mg-unt-mcg

P

super cal/mag oral tablet 333.333-166.667 mg

P

*Calcium***

CAL-CARB FORTE ORAL TABLET 1250 (500 CA) MG

P

CALCI-CHEW ORAL TABLET CHEWABLE 1250 (500 CA) MG

P

CALCITRATE ORAL TABLET 950 MG P

calcium 600 oral tablet 600 mg P

calcium acetate oral tablet 668 (169 ca) mg P

calcium carbonate oral suspension 1250 (500 ca) mg/5ml

P

calcium carbonate oral tablet 1250 (500 ca) mg, 1500 (600 ca) mg, 600 mg

P



calcium carbonate oral tablet chewable 260 mg

P

calcium citrate oral granules 760 mg/3.5gm P

calcium citrate oral tablet 250 mg P

calcium gluconate oral tablet 50 mg, 500 mg P

calcium high potency oral tablet 600 mg P

calcium lactate oral tablet 100 mg, 648 mg P

calcium oral tablet 600 mg P

calcium oyster shell oral tablet 1250 (500 ca) mg

P

calcium-carb 600 oral tablet 600 mg P

cal-lac oral capsule 500 mg P

CALTRATE 600 ORAL TABLET 1500 (600 CA) MG

P

chelated calcium oral tablet 200 mg P

OYSCO 500 ORAL TABLET 500 MG P

OYSTERCAL ORAL TABLET 500 MG P

*Electrolytes Oral***

ORALYTE ORAL SOLUTION P

*Iodine Products***

kelp oral tablet 150 mcg P

*Magnesium Combinations***

SLOW-MAG ORAL TABLET DELAYED RELEASE 71.5-119 MG

P

*Magnesium***

chelated magnesium oral tablet 100 mg P

MAG64 ORAL TABLET EXTENDED RELEASE 535 (64 MG) MG

P

mag-delay oral tablet extended release 535 (64 mg) mg

P

magnacaps oral capsule 100 mg P

magnesium gluconate oral tablet 27.5 mg P

magnesium oral tablet 250 mg P

magnesium oxide 400 oral packet 240 mg P

magnesium oxide oral tablet 400 (240 mg) mg, 420 (252 mg) mg

P


29


MAGNESIUM-OXIDE ORAL TABLET 400 (241.3 MG) MG

P

MAGONATE ORAL LIQUID 1000 (54 MG) MG/5ML

P

MAG-TAB SR ORAL TABLET EXTENDED RELEASE 84 MG (7MEQ)

P

*Mineral Combinations***

gnp cal mag zinc +d3 oral tablet P

*Potassium***

potassium oral tablet 99 mg P

*Sodium***

sodium chloride oral tablet 1 gm P

*Trace Minerals***

chromium oral tablet 200 mcg P

chromium picolinate oral tablet 200 mcg P

oceanic selenium oral tablet 50 mcg P

selenium er oral tablet extended release 200 mcg

P

sm selenium oral tablet 200 mcg P

*Zinc***

ORAZINC ORAL CAPSULE 220 (50 ZN) MG P

zinc gluconate oral tablet 50 mg P

zinc mouth/throat lozenge 10 mg P

zinc oral tablet 30 mg, 50 mg P

zinc sulfate oral capsule 220 (50 zn) mg P

zinc sulfate oral tablet 220 (50 zn) mg P

zinc-220 oral capsule 220 (50 zn) mg P

*Mouth/Throat/Dental Agents*

*Anesthetics Topical Oral - Combinations***

CEPACOL EXTRA STRENGTH MOUTH/THROAT LOZENGE 15-2.6 MG

P

sore throat mouth/throat lozenge 15-3.6 mg P

*Antiseptics - Mouth/Throat***

sore throat spray mouth/throat liquid 1.4 % P



*Lozenge - Combinations***

DELSYM COUGH RELIEF MOUTH/THROAT LOZENGE 5-5 MG

P

*Multivitamins*

*B-Complex Vitamins***

b-complex/b-12 oral tablet P

*B-Complex W/ C & E + Zn***

bee zee oral tablet P

*B-Complex W/ C & Folic Acid***

b-complex/vitamin c oral tablet P

DIALYVITE 800 ORAL TABLET 0.8 MG P

NEPHRONEX ORAL TABLET P

RENAL ORAL CAPSULE 1 MG P

rena-vite rx oral tablet 1 mg P

reno caps oral capsule 1 mg P

vita-bee/c oral tablet P

*B-Complex W/ C***

total b/c oral tablet P

vitamin b complex-c oral capsule P

*B-Complex W/ Folic Acid***

sm balanced b-100 oral tablet P

*B-Complex W/ Minerals***

geravim oral liquid P

*B-Complex W/Biotin & Folic Acid***

SUPER QUINTS B-50 ORAL TABLET P

*Multiple Vitamins W/ Calcium***

gnp one daily womens health oral tablet P

*Multiple Vitamins W/ Iron***

daily-vite/iron/beta-carotene oral tablet P

*Multiple Vitamins W/ Minerals***

advanced diabetic multivitamin oral tablet P

AQUADEKS ORAL TABLET CHEWABLE P

centamin oral liquid P

centavite a-z complete-mineral oral tablet P

centavite oral liquid P


31


CEROVITE ADVANCED FORMULA ORAL TABLET

P

CERTAVITE/ANTIOXIDANTS ORAL LIQUID P

gerivite complete oral tablet P

ICAPS ORAL CAPSULE P

multivitamin & mineral oral liquid P

SUPER NU-THERA ORAL TABLET P

thera vital m oral tablet P

therabasic-m oral tablet P

therapeutic liquid oral solution P

therapeutic-m oral tablet P

TOTAL FORMULA 3 ORAL TABLET P

vitamins a-d-e/selenium oral tablet P

zinc oral lozenge P

*Multivitamins***

daily multiple vitamins oral tablet P

daily vite oral tablet P

daily vites oral tablet P

multi-day oral tablet P

multi-vitamin oral tablet P

multi-vitamins oral tablet P

once daily oral tablet P

one-daily multi vitamins oral tablet P

THERA ORAL TABLET P

THERA/BETA-CAROTENE ORAL TABLET P

therapeutic oral tablet P

thera-tabs oral tablet P

*Ped Multiple Vitamins W/ Minerals & C***

AQUADEKS ORAL LIQUID P

gnp childrens complete oral tablet chewable30 mg

P

gnp zoochews gummies oral tablet chewableP

VITALETS ORAL TABLET CHEWABLE 40 MG

P

zoo friends oral tablet chewable 60 mg P



*Ped Mv W/ Fluoride***

multi-vitamin/fluoride oral tablet chewable 0.5 mg

P

*Ped Mv W/ Iron***

animal shapes plus iron oral tablet chewable15 mg

P

polyvitamin/iron oral solution 10 mg/ml P

*Ped Vitamins Acd W/ Iron***

MYKIDZ IRON ORAL SUSPENSION 10 MG/2ML

P

*Pediatric Multiple Vitamins W/ C & Fa***

ANIMAL SHAPES ORAL TABLET CHEWABLE WITH C & FA

P

childrens chewable multi vits oral tablet chewable

P

*Pediatric Multiple Vitamins W/ C***

polyvitamin oral solution 35 mg/ml P

*Pediatric Multiple Vitamins W/ Extra C & Fa***

gnp childrens chewables/ex c oral tablet chewable

P

*Pediatric Multiple Vitamins***

multi-delyn oral liquid P

*Pediatric Vitamins A & D W/ C***

tri-vitamin oral solution 1500-400-35 P

*Prenatal Mv & Min W/Fe-Fa***

kpn prenatal oral tablet 0.1 mg P

pnv prenatal plus multivit+dha oral 27-1 & 312 mg

P

prenatal formula a-free oral tablet 9-0.267 mg P

prenatal low iron oral tablet 27-0.8 mg P

prenatal oral tablet 6.75-0.2 mg P

prenatal vitamins oral tablet 28-0.8 mg P

VINACAL B ORAL 20-1 & 25 (2) MG P

*Prenatal Mv & Min W/Fe-Fa-Dha***

ENFAMIL EXPECTA ORAL 28-0.8 & 200 MG

P


33


*Specialty Vitamins Products***

ICAPS LUTEIN & ZEAXANTHIN ORAL TABLET DELAYED RELEASE

P

ICAPS LUTEIN-ZEAXANTHIN ORAL TABLET EXTENDED RELEASE

P

vitamins for hair oral tablet P

*Vitamins A & D***

cod liver oil oral capsule P

vitamin a & d oral tablet 10000-400 unit P

*Vitamins W/ Lipotropics***

balanced b-50 oral tablet P

*Nasal Agents - Systemic And Topical*

*Nasal Agents - Misc.***

altamist spray nasal solution 0.65 % P

AYR NASAL SOLUTION 0.65 % P

deep sea nasal spray nasal solution 0.65 % P

HUMIST NASAL SOLUTION 0.65 % P

LITTLE NOSES SALINE NASAL SOLUTION 0.65 %

P

NASAL MOIST NASAL SOLUTION 0.65 % P

na-zone nasal solution 0.65 % P

OCEAN FOR KIDS NASAL SOLUTION 0.65 %

P

saline mist spray nasal solution 0.65 % P

saline nasal spray nasal solution 0.65 % P

sea soft nasal mist nasal solution 0.65 % P

*Nasal Agents Misc. - Combinations***

OCEAN COMPLETE SINUS RINSE NASAL AEROSOL SOLUTION

P

sinus wash kettle neti pot nasal kit 2300-700 mg

P

sinus wash saline refills nasal packet 2300-700 mg

P

*Nasal Decongestant Inhalers***

BENZEDREX NASAL INHALER P



*Nasal Mast Cell Stabilizers***

cromolyn sodium nasal aerosol solution 5.2 mg/act

P

*Systemic Decongestants***

childrens silfedrine oral liquid 15 mg/5ml P

nasal decongestant oral syrup 30 mg/5ml P

nasal decongestant pe max st oral tablet 10 mg

P

pseudoephedrine hcl oral tablet 30 mg, 60 mg

P

SUDAFED 12 HOUR ORAL TABLET EXTENDED RELEASE 12 HOUR 120 MG

P

*Topical Decongestants***

nasal four nasal solution 1 % P

nasal spray extra moisturizing nasal solution0.05 %

P

*Nutrients*

*Amino Acids-Single***

l-tryptophan oral tablet 500 mg P

*Misc. Nutritional Substances***

fish oil oral capsule 1000 mg, 500 mg P

fish oil oral capsule delayed release 1000 mg P

omega-3 oral capsule 1400 mg P

sm omega-3 fish oil oral capsule 1200 mg P

*Ophthalmic Agents*

*Artificial Tear And Lubricant Combinations***

artificial tears ophthalmic ointment 83-15 % P

GENTEAL OPHTHALMIC GEL 0.25-0.3 % P

gnp artificial tears ophthalmic solution 5-6 mg/ml

P

HYPOTEARS OPHTHALMIC SOLUTION 1-1 %

P

REFRESH OPHTHALMIC SOLUTION 1.4-0.6 %

P

REFRESH OPTIVE ADVANCED OPHTHALMIC SOLUTION 0.5-1-0.5 %

P


35


REFRESH OPTIVE OPHTHALMIC GEL 1-0.9 %

P

REFRESH OPTIVE OPHTHALMIC SOLUTION 0.5-0.9 %

P

REFRESH OPTIVE SENSITIVE OPHTHALMIC SOLUTION 0.5-0.9 %

P

SYSTANE OPHTHALMIC SOLUTION 0.4-0.3 %

P

TEARS AGAIN OPHTHALMIC OINTMENT P

*Artificial Tear Ointments***

ULTRA FRESH PM OPHTHALMIC OINTMENT

P

*Artificial Tear Solutions***

tears again ophthalmic solution P

*Artificial Tears And Lubricants***

artificial tears ophthalmic solution 1.4 % P QL (15 ML per 31 days)

GENTEAL MILD TO MODERATE OPHTHALMIC SOLUTION 0.3 %

P

ISOPTO TEARS OPHTHALMIC SOLUTION 0.5 %

P

liquitears ophthalmic solution 1.4 % P QL (15 ML per 31 Days)

natures tears ophthalmic solution 0.4 % P

polyvinyl alcohol ophthalmic solution 1.4 % P QL (15 ML per 31 Days)

REFRESH CELLUVISC OPHTHALMIC SOLUTION 1 %

P

REFRESH PLUS OPHTHALMIC SOLUTION 0.5 %

P

SYSTANE OVERNIGHT THERAPY OPHTHALMIC GEL 0.3 %

P

*Gonioscopic Solutions***

GONAK OPHTHALMIC SOLUTION 2.5 % P

*Ophthalmic Antiallergic***

ALAWAY OPHTHALMIC SOLUTION 0.025 %

P

ketotifen fumarate ophthalmic solution 0.025 %

P



*Ophthalmic Decongestant Combinations***

gnp eye drops ophthalmic solution 0.05-0.1-1-1 %

P

hm eye drops ophthalmic solution 0.012-0.2 %

P

*Ophthalmic Decongestants***

eye drops ophthalmic solution 0.05 % P

*Ophthalmic Hyperosmolar Products***

MURO 128 OPHTHALMIC SOLUTION 2 % P

sodium chloride (hypertonic) ophthalmic ointment 5 %

P

sodium chloride (hypertonic) ophthalmic solution 5 %

P

*Ophthalmic Irrigation Solutions***

eye irrigating ophthalmic solution 99.05 % P

EYE STREAM OPHTHALMIC SOLUTION P

*Otic Agents*

*Otic Agents - Miscellaneous***

auraphene-b otic solution 6.5 % P

ear drops earwax aid otic solution 6.5 % P

earwax treatment drops otic solution 6.5 % P

E-R-O EAR DROPS OTIC SOLUTION 6.5 % P

E-R-O EAR WAX REMOVAL SYSTEM OTIC SOLUTION 6.5 %

P

MURINE EAR OTIC SOLUTION 6.5 % P

MURINE EAR WAX REMOVAL SYSTEM OTIC SOLUTION 6.5 %

P

OTIX OTIC SOLUTION 6.5 % P

SWIM EAR OTIC LIQUID 95 % P

*Psychotherapeutic And Neurological Agents - Misc.*

*Smoking Deterrents***

NICORETTE MINI MOUTH/THROAT LOZENGE 2 MG


nicotine polacrilex mouth/throat gum 2 mg, 4 mg


nicotine polacrilex mouth/throat lozenge 4 mg P QL (620 EA per 31 days)


37


nicotine transdermal kit 21-14-7 mg/24hr P QL (56 EA per 365 days)

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


*Ulcer Drugs*

*H-2 Antagonist-Antacid Combinations***

dual action complete oral tablet chewable 10-800-165 mg

P

*H-2 Antagonists***

acid reducer maximum strength oral tablet 20 mg

P

acid reducer oral tablet 75 mg P

cimetidine oral tablet 200 mg P

famotidine oral tablet 10 mg P

ZANTAC 150 MAXIMUM STRENGTH ORAL TABLET 150 MG

P

*Proton Pump Inhibitors***

omeprazole oral tablet delayed release 20 mg

P

*Vaginal Products*

*Imidazole-Related Antifungals***

clotrimazole vaginal cream 1 % P

gnp tioconazole 1 vaginal ointment 6.5 % P

GYNE-LOTRIMIN 3 VAGINAL CREAM 2 % P

miconazole 1 vaginal kit 1200 & 2 mg & % P

miconazole 3 applicator vaginal kit 200 & 2 mg-% (9gm)

P

miconazole 3 combo pack vaginal kit 200 & 2 mg-% (9gm)

P

miconazole nitrate vaginal cream 2 % P

miconazole nitrate vaginal suppository 100 mg

P

MONISTAT 3 VAGINAL CREAM 4 % P

*Miscellaneous Vaginal Products***

anti-itch vaginal cream 5-2 % P

*Vitamins*

*Biotin***

biotin oral capsule 5000 mcg P



biotin oral tablet 10 mg, 300 mcg, 5 mg P

*Vitamin A***

beta carotene oral capsule 10000 unit P

vitamin a oral capsule 10000 unit, 8000 unit P

vitamin a palmitate oral tablet 10000 unit, 15000 unit

P

vitamin a-beta carotene oral tablet 15000-10000 unit

P

*Vitamin B-1***

vitamin b-1 oral tablet 100 mg, 250 mg, 50 mg

P

*Vitamin B-2***

vitamin b-2 oral tablet 100 mg P

*Vitamin B-3***

ENDUR-ACIN ORAL TABLET EXTENDED RELEASE 500 MG

P

niacin er oral capsule extended release 250 mg, 500 mg

P

niacin er oral tablet extended release 250 mg P

niacin oral tablet 100 mg, 250 mg, 50 mg, 500 mg

P

niacinamide oral tablet 500 mg P

*Vitamin B-6***

vitamin b-6 er oral tablet extended release200 mg

P

vitamin b-6 oral tablet 100 mg, 25 mg, 250 mg, 50 mg, 500 mg

P

*Vitamin C***

ascorbic acid oral tablet 1000 mg, 250 mg, 500 mg

P

ascorbic acid oral tablet chewable 250 mg P

c-500 oral tablet chewable 500 mg P

vita-c oral crystals P

vitamin c er oral capsule extended release500 mg

P

vitamin c er oral tablet extended release 500 mg

P

vitamin c oral packet 500 mg P


39


vitamin c oral powder P

vitamin c oral syrup 500 mg/5ml P

vitamin c oral tablet 100 mg, 1000 mg, 250 mg, 500 mg

P

vitamin c oral tablet chewable 100 mg, 250 mg

P

*Vitamin D***

CALCIFEROL ORAL SOLUTION 8000 UNIT/ML

P

d 10000 oral capsule 250 mcg (10000 ut) P

d 5000 oral tablet 125 mcg (5000 ut) P

DECARA ORAL CAPSULE 1.25 MG (50000 UT), 625 MCG (25000 UT)

P

DIALYVITE VITAMIN D3 MAX ORAL TABLET 1.25 MG (50000 UT)

P

D-VI-SOL ORAL LIQUID 400 UNIT/ML P

vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut)

P QL (4 EA per 28 Days)

vitamin d oral tablet 50 mcg (2000 ut) P

vitamin d2 oral tablet 10 mcg (400 unit) P

vitamin d3 oral capsule 10 mcg (400 unit), 125 mcg (5000 ut), 25 mcg (1000 ut), 50 mcg (2000 ut)

P

vitamin d3 oral tablet 25 mcg (1000 ut), 75 mcg (3000 ut)

P

vitamin d3 oral tablet chewable 10 mcg (400 unit)

P

vitamin d-400 oral tablet 10 mcg (400 unit) P

*Vitamin E***

vitamin e oral capsule 100 unit, 1000 unit, 200 unit, 400 unit

P

vitamin e oral tablet chewable 400 unit P

*Vitamin K***

vitamin k (phytonadione) oral tablet 100 mcg P


IndexABREVA................................ 15ACE AEROSOL CLOUD ENHANCER.......................... 26ACEPHEN............................... 1ACETA-GESIC...................... 11acetaminophen........................ 1ACID GONE............................ 4acid reducer...........................38acid reducer maximum strength..................................38acidophilus/pectin.................... 7acne medication 10............... 13acne medication 5................. 13ACTIDOSE WITH SORBITOL.......................... 7, 8actidose-aqua.......................... 8advanced diabetic multivitamin............................31AEROCHAMBER MV............ 26AEROCHAMBER PLUS FLO-VU................................. 26AEROCHAMBER PLUS FLO-VU LARGE.................... 26AEROCHAMBER PLUS FLO-VU SMALL.....................26AEROCHAMBER PLUS FLO-VU W/MASK..................26AEROCHAMBER W/FLOWSIGNAL...................26AEROCHAMBER Z-STAT PLUS..................................... 26AEROCHAMBER Z-STAT PLUS CHAMBR.....................26ALA-HIST IR............................8ALAVERT ALLERGY/SINUS.12ALAWAY................................36aler-cap....................................8aler-dryl....................................8alertab......................................9alevazol................................. 16ALLEGRA-D ALLERGY & CONGESTION...................... 12aller-chlor.................................8allergy.................................. 8, 9allergy relief............................. 8allergy relief childrens..............9

allergy relief/nasal decongest .............................. 12ALOE VESTA SKIN CONDITIONER..................... 18altamist spray ........................ 34altaryl ....................................... 9aluminum hydroxide gel ...........5AMERIPHOR.........................18AMLACTIN............................ 16ammonium lactate ................. 16ANIMAL SHAPES..................33animal shapes plus iron .........33antacid ..................................... 5antacid anti-gas ....................... 4antacid anti-gas max strength ....................................4antacid extra strength.............. 4antacid iii ..................................4anti-dandruff .......................... 15anti-diarrheal............................7antifungal............................... 16anti-fungal ..............................14anti-gas ..................................20anti-hist allergy ........................ 9anti-itch.................................. 38anti-itch maximum strength ... 15anti-nausea..............................8apap .........................................1apap extra strength..................1AQUADEKS.....................31, 32artificial tears................... 35, 36ascorbic acid..........................39aspirin...................................... 3aspirin childrens .......................3aspirin ec ................................. 3aspirin ec low dose .................. 3athletes foot spray................. 14auraphene-b.......................... 37AVEENO ANTI-ITCH MAX ST.......................................... 16AYR....................................... 34AZO URINARY PAIN RELIEF.................................. 20bacitracin ............................... 14bacitracin zinc........................14bacitracin-neomycin-polymyxin...............................14

balanced b-50........................34BANOPHEN............................ 9BAZA..................................... 14BAZA CLEANSE & PROTECT............................. 18BAZA CLEAR........................ 16b-complex/b-12......................31b-complex/vitamin c...............31BD GLUCOSE......................... 6BEDSIDE-CARE....................18bee zee ..................................31BENADRYL ALLERGY CHILDRENS............................9BENADRYL ITCH STOPPING............................ 15BENZEDREX.........................34BENZEPRO...........................13BENZEPRO SHORT CONTACT............................. 14benzonatate ...........................11benzoyl peroxide ................... 14benzoyl peroxide cleanser.....14benzoyl peroxide wash.......... 14beta carotene.........................39BETADINE SKIN CLEANSER........................... 10BETADINE SWAB AID.......... 10biotin................................ 38, 39BISAC-EVAC.........................24biscolax..................................24bismatrol.............................. 6, 7bismuth................................ 6, 7BLUE-EMU SUPER STRENGTH...........................17BREEZEE MIST.................... 14BRONCHO SALINE.............. 13BROTAPP............................. 12brotapp dm ............................ 13burn relief...............................17c-500......................................39cal/mag.................................. 26CALADRYL............................19CAL-CARB FORTE............... 28CALCET CREAMY BITES.....27CALCI-CHEW........................28CALCIFEROL........................ 40CALCITRATE.................. 27, 28


41

cal-citrate plus vitamin d........ 27calcium............................ 27, 29calcium + d3.......................... 27calcium 500/d........................ 27calcium 600........................... 28calcium 600+d plus minerals. 27calcium 600-d........................ 27calcium acetate......................28calcium antacid........................5calcium antacid extra strength....................................5calcium antacid ultra max st.... 5calcium carb-cholecalciferol.. 27calcium carbonate........... 28, 29calcium carbonate antacid.......5calcium carbonate-vitamin d..27calcium citrate........................29calcium gluconate..................29calcium high potency............. 29calcium high potency/vitamin d.............................................27calcium lactate.......................29calcium oyster shell............... 29calcium-carb 600................... 29calcium-carb 600 + d............. 27calcium-magnesium-vitamin d.............................................27calcium-magnesium-zinc....... 27calcium-vitamin d...................27CAL-GEST ANTACID..............5cal-lac.................................... 29CALLERGY CLEAR.............. 19CALPHRON...........................20CALTRATE 600.....................29CALTRATE 600+D................ 27camphor phenol cold sore..... 15camphor spirit........................ 10capsaicin................................17CARTERS LITTLE PILLS......24CELEBRATE CALCIUM PLUS 500.............................. 27centamin................................ 31centavite................................ 31centavite a-z complete-mineral...................................31CEPACOL EXTRA STRENGTH...........................30

CEROVITE ADVANCED FORMULA............................. 32CERTAVITE/ANTIOXIDANTS............................................ 32cetirizine hcl.......................9, 10cetirizine hcl childrens............. 9cetirizine hcl childrens alrgy.....9cetirizine-pseudoephedrine er ........................................... 12chelated calcium ....................29chelated magnesium............. 29cheratussin dac ..................... 11childrens chewable multi vits. 33childrens cold & allergy..........12childrens ibuprofen .................. 1childrens loratadine............... 10childrens mapap rapid tabs..... 1childrens non-asa pain relief....2childrens non-aspirin............... 2childrens pain reliever..............2childrens silapap ......................2childrens silfedrine.................35childrens tactinal ......................2chlorhexidine gluconate.........10chlorhist ................................... 8chlorpheniramine maleate er... 8chromium ...............................30chromium picolinate...............30cimetidine.............................. 38citrate of magnesia ................ 23CITROMA.............................. 24CITRUCEL.............................22CLEAR AWAY 1-STEP WART REMOVER.................17clotrimazole ..................... 16, 38cod liver oil.............................34COLACE CLEAR...................25cold/cough childrens..............13complete allergy medication .... 9complete allergy relief..............9COMPOUND W.....................17COMPOUND W MAXIMUM STRENGTH...........................17compoz.................................. 22correct....................................24CORRECTOL........................ 24CORRECTOL EXTRA GENTLE................................ 25

CRITIC-AID CLEAR AF.........17cromolyn sodium................... 35cvs glycerin adult ................... 23cyanocobalamin.....................20d 10000 ..................................40d 5000 ....................................40daily multiple vitamins ............32daily vite.................................32daily vites...............................32daily-vite/iron/beta-carotene .. 31dakins.................................... 10dakins (1/2 strength)..............10DECARA................................40deep sea nasal spray............ 34DELSYM COUGH RELIEF....31DELSYM NIGHT TIME MULTI-SYMPT...................... 11DESENEX............................. 17DESENEX SPRAY................ 17dextromethorphan polistirex er ........................................... 11DHS SAL............................... 17DHS ZINC..............................15diabetic siltussin das-na........ 12DIABETIC TUSSIN ALLERGY................................ 8DIABETIC TUSSIN MAX ST. 11DIALYVITE 800..................... 31DIALYVITE VITAMIN D3 MAX.......................................40dibucaine........................... 3, 17dimenhydrinate........................ 8DIMETAPP LONG ACT COUGH/COLD...................... 13diocto ..................................... 25diotame................................6, 7diphenhist ................................ 9diphenhydramine hcl............... 9diphenhydramine hcl (sleep). 22docqlace................................ 25DOC-Q-LAX...........................23docu soft ................................ 25docusate calcium...................25docusate sodium ................... 25DOCUSIL...............................25DOK.......................................25double antibiotic.....................14DR SMITHS DIAPER............ 15


dss......................................... 25dual action complete..............38ducodyl.................................. 24DULCOLAX MILK OF MAGNESIA............................24DULCOLAX STOOL SOFTENER........................... 25D-VI-SOL............................... 40ear drops earwax aid............. 37earwax treatment drops.........37EASIVENT.............................26ECPIRIN.................................. 3ED A-HIST.............................12ED CHLORPED.......................8ed-apap................................... 2effervescent pain relief............ 3ENDUR-ACIN........................ 39enema....................................23ENEMEEZ MINI.....................25ENEMEEZ PLUS...................25ENFAMIL EXPECTA............. 33eq aspirin................................. 3eq hemorrhoidal.......................3E-R-O EAR DROPS.............. 37E-R-O EAR WAX REMOVAL SYSTEM............. 37EXCEDRIN EXTRA STRENGTH.............................1EX-LAX..................................24EX-LAX ULTRA..................... 24extra action cough................. 11eye drops...............................37eye irrigating.......................... 37EYE STREAM....................... 37EZ CHAR.................................8famotidine.............................. 38FEENAMINT..........................24FERATE................................ 21FER-IN-SOL.......................... 21FERRIMIN 150...................... 21ferro-bob................................ 21ferrous fumarate.................... 21ferrous gluconate...................21ferrous sulfate........................21ferrous sulfate er....................21ferrousul.................................21FEVERALL INFANTS..............2fexofenadine hcl.................... 10

fexofenadine hcl childrens..... 10fexofenadine-pseudoephed er ........................................... 12fiber........................................22fiber laxative .......................... 22FIBERGEN............................ 22fiber-lax..................................22fish oil .................................... 35FLEET BISACODYL..............24FLEET LAXATIVE................. 24FLEET OIL.............................23FOLBIC RF............................19folic acid.................................21FOLITAB 500.........................21FOLTABS 800....................... 20FOLTANX.............................. 19FOLTANX RF........................ 19FREEZONE........................... 17FUNGOID TINCTURE...........17FUNGOID-D.......................... 14GAS-X EXTRA STRENGTH..20GAS-X ULTRA STRENGTH..20GAVISCON..............................4GAVISCON EXTRA RELIEF FORMULA............................... 4genahist................................... 9GENTEAL..............................35GENTEAL MILD TO MODERATE.......................... 36gentle laxative ........................24geravim..................................31gerivite complete ................... 32glucose.................................... 6glycerin.................................. 10gnp aloe vera/lidocaine ..........19gnp antacid.............................. 4gnp antacid & anti-gas.............4gnp anti-itch ........................... 15gnp artificial tears.................. 35gnp cal mag zinc +d3 ............ 30gnp capsaicin .........................17gnp castor oil ......................... 24gnp chest rub .........................12gnp childrens chewables/ex c.............................................33gnp childrens complete ..........32gnp cold & hot extra strength.17gnp dayhist allergy ...................9

gnp epsom salt...................... 24gnp eye drops........................37gnp foaming antacid................ 4gnp gentian violet .................. 14gnp glycerin........................... 16gnp iron ..................................21gnp itch relief extra strength .. 15gnp medicated first aid spray .19gnp one daily womens health .....................................31gnp pink bismuth ................. 6, 7gnp scalp relief...................... 17gnp tioconazole 1 .................. 38gnp vitamin d-400 .................. 27gnp zoochews gummies........ 32GONAK..................................36goodsense hemorrhoidal......... 3GYNE-LOTRIMIN 3............... 38headache pm .........................22HEMOCYTE.......................... 21hemorrhoidal............................3hm castor oil .......................... 10hm eye drops .........................37hm lice treatment ................... 18HUMIST.................................34HUMULIN 70/30...................... 6HUMULIN 70/30 KWIKPEN.....6HUMULIN N.............................6HUMULIN N KWIKPEN........... 6HUMULIN R.............................6hydrocod polst-cpm polst er.. 13hydrocodone-homatropine.....11hydrocortisone ....................... 16hydrocortisone max st........... 16hydrocortisone max st/12 moist ...................................... 16hydrocortisone-aloe............... 19HYDROSKIN......................... 16HYPOTEARS........................ 35ibuprofen ..................................1ibuprofen junior strength ..........1ICAPS....................................32ICAPS LUTEIN & ZEAXANTHIN........................34ICAPS LUTEIN-ZEAXANTHIN........................34IN-CHECK DIAL FLOW TRAINER...............................26


43

infants silapap..........................2INSTA-GLUCOSE................... 6INTEGRA...............................21IONIL-T..................................18ipecac...................................... 8iron.........................................21iron 100 plus.......................... 21ISOPTO TEARS.................... 36itch relief................................ 15itch relief extra strength......... 15ITCH-X...................................19J-TAN PD................................ 8JUNIOR MAPAP......................2KAOPECTATE.................... 6, 7KAOPECTATE EXTRA STRENGTH.........................6, 7KAO-TIN........................ 6, 7, 25kelp........................................ 29ketotifen fumarate..................36kidkare cough/cold.................13KONSYL................................ 22konsyl daily fiber.................... 22KONSYL FIBER.................... 22kp hydrocortisone.................. 16kpn prenatal...........................33lactase enzyme......................19lactase fast acting..................19LAMISIL ADVANCED............14LAMISIL AF DEFENSE......... 14LANACANE FIRST AID 2-IN-1........................................19laxa basic...............................25laxative.................................. 24lice killing maximum strength.18lidocaine................................ 18lidocaine (anorectal)................ 3lidocaine-transparent dressing................................. 19liquid calcium/vitamin d..........27liquitears................................ 36LITTLE NOSES SALINE....... 34l-methylfolate forte................. 19LOPERAMIDE A-D..................7loperamide hcl......................... 7loratadine...............................10loratadine hives relief.............10LORTUSS EX........................11l-tryptophan............................35

lycopene .................................. 1MAALOX..................................5MAALOX ADVANCED MAX ST............................................ 4MAALOX MAX.........................4MAALOX MULTI SYMPTOM MAX ST................................... 4MAG64.................................. 29mag-al......................................4mag-delay ..............................29magnacaps ............................ 29MAGNEBIND 300..................27magnesium ............................ 29magnesium citrate ................. 24magnesium gluconate ........... 29magnesium oxide.............. 5, 29magnesium oxide 400 ........... 29MAGNESIUM-OXIDE............ 30MAGONATE.......................... 30MAG-TAB SR........................ 30mapap ......................................2MAPAP ACETAMINOPHEN EXTRA STR............................ 2mapap arthritis pain................. 2MAPAP CHILDRENS.............. 2mapap pm ..............................22maxapap maximum strength... 2maxapap regular strength ........2MAXILUBE............................ 18meclizine hcl ............................ 8medi pads .............................. 15melatonin................................. 1melatonin maximum strength .. 1m-end dm.............................. 13METAFOLBIC........................19METAFOLBIC PLUS............. 19METAFOLBIC PLUS RF....... 19METAMUCIL......................... 22METAMUCIL SMOOTH TEXTURE..............................22MI-ACID...................................4mi-acid gas relief ................... 20miconazole 1......................... 38miconazole 3 applicator .........38miconazole 3 combo pack..... 38miconazole nitrate ........... 17, 38MICROCHAMBER.................26MICROSPACER....................26

milantex extra strength............ 4milk of magnesia....................24milk of magnesia concentrate............................24MINERAL ICE........................14mineral oil-hydrophil petrolat . 16MINERIN............................... 18MINTOX PLUS........................ 4MOBISYL...............................17MONISTAT 3......................... 38MUCINEX FAST-MAX DM MAX.......................................11mucus relief........................... 12mucus relief dm cough .......... 11multi-day................................ 32multi-delyn ............................. 33multi-vitamin.......................... 32multivitamin & mineral ........... 32multi-vitamin/fluoride ..............33multi-vitamins.........................32MURINE EAR........................ 37MURINE EAR WAX REMOVAL SYSTEM............. 37MURO 128.............................37MY WAY................................ 11MYKIDZ IRON....................... 33mytab gas .............................. 20naproxen sodium..................... 1nasal decongestant............... 35nasal decongestant pe max st ............................................35nasal four...............................35NASAL MOIST...................... 34nasal spray extra moisturizing ........................... 35natural fiber therapy ...............23natural senna laxative............24natural vegetable fiber ........... 23natures tears..........................36na-zone ..................................34NEPHRONEX........................31niacin..................................... 39niacin er ................................. 39niacin flush free ..................... 10niacinamide........................... 39NICORETTE MINI................. 37nicotine.................................. 38nicotine polacrilex.................. 37


nohist-dm...............................13non-aspirin...............................2non-aspirin extra strength........2non-aspirin pain relief.............. 2nortemp infants........................2NYTOL...................................22OCEAN COMPLETE SINUS RINSE....................................34OCEAN FOR KIDS................34oceanic selenium...................30omega-3................................ 35omeprazole............................38once daily.............................. 32one-daily multi vitamins......... 32OPERAND POVIDONE-IODINE.................................. 10OPTICHAMBER ADVANTAGE........................ 26OPTIHALER.......................... 26ORALYTE..............................29ORAZINC.............................. 30OS-CAL EXTRA D3...............27OTIX...................................... 37OYSCO 500...........................29OYSCO 500+D......................28oyst-cal d............................... 28oyster calcium + d................. 28oyster shell calcium + d......... 28oyster shell calcium 500 + d.. 28oyster shell calcium/d............ 28oyster shell calcium/vitamin d.............................................28oyster shell/vitamin d............. 28OYSTERCAL.........................29pain & fever childrens.............. 2pain relief................................. 2pain relief extra strength.......... 2pain relief pm extra strength.. 22pain reliever pm..................... 22PANOXYL WASH..................14PANOXYL-4 CREAMY WASH....................................14parva-cal................................28PEDIA-LAX......................23, 25peg 3350................................23PERI-COLACE...................... 23permethrin............................. 18PFLEX................................... 26

pharbedryl ................................9PHARBETOL...........................2PHARBETOL EXTRA STRENGTH.............................2phenazopyridine hcl ...............20phenylhistine dh.....................13pink bismuth ........................ 6, 7pnv prenatal plus multivit+dha ........................... 33POCKET CHAMBER.............26POCKET SPACER................ 26POLY-IRON 150....................21polyvinyl alcohol.................... 36polyvitamin.............................33polyvitamin/iron......................33potassium .............................. 30povidone-iodine ..................... 10prenatal ..................................33prenatal formula a-free.......... 33prenatal low iron.................... 33prenatal vitamins ................... 33PREPARATION H................. 16PROCTOFOAM.......................3promethazine vc/codeine.......13promethazine-codeine ........... 13promethazine-dm...................13pseudoephedrine hcl ............. 35qc antiseptic pain relief.......... 15q-dryl........................................9q-pap ....................................... 3Q-TAPP................................. 12ra glucose ................................ 6ra hydrating healing ............... 16ra saline laxative ....................23reeses pinworm medicine........5refenesen ...............................12refenesen 400 ........................12REFRESH............................. 35REFRESH CELLUVISC........ 36REFRESH OPTIVE............... 36REFRESH OPTIVE ADVANCED...........................35REFRESH OPTIVE SENSITIVE............................36REFRESH PLUS................... 36REGULOID............................23REMEDY ANTIMICROBIAL CLEANSER........................... 10

RENAL...................................31rena-vite rx.............................31reno caps...............................31risacal-d ................................. 28robafen.................................. 12robafen cf cough/cold............ 11ROBITUSSIN CHILD COUGH/COLD LA.................13ROBITUSSIN CHILDRENS COUGH LA............................11rynex dm................................13S2 (RACEPINEPHRINE).........5SALACTIC FILM....................17saline mist spray....................34saline nasal spray ..................34SANI-SUPP PEDIATRIC....... 23sb backache extra strength..... 3SCALPICIN MAXIMUM STRENGTH...........................16SCOT-TUSSIN ALLERGY RELIEF.................................... 9sea soft nasal mist.................34sebex ..................................... 15SECURA DIMETHICONE PROTECTANT...................... 18SECURA PROTECTIVE........15selenium er ............................ 30senexon................................. 24senna .....................................25senna lax............................... 24senna laxative........................25senna plus............................. 23SENNA PROMPT..................23senna s.................................. 23SENNA SMOOTH................. 25SENNACON.......................... 25senna-docusate sodium........ 23senna-lax............................... 25SENNALAX-S........................23senna-s..................................23senna-tabs.............................25senna-time.............................25senna-time s .......................... 23SENNO..................................25sennosides-docusate sodium ................................... 23SENOKOT XTRA.................. 25


45

SENSI-CARE PROTECTIVE BARRIER...............................18silace..................................... 26siladryl allergy..........................9silphen cough.......................... 9simethicone........................... 20SIMPLY SLEEP.....................22sinus wash kettle neti pot...... 34sinus wash saline refills......... 34sleep aid................................ 22sleep tabs.............................. 22sleep-tabs.............................. 22slow release iron....................21SLOW-MAG...........................29sm antibiotic plus pain relief.. 14sm anti-diarrheal......................7sm balanced b-100................ 31sm calcium citrate-vit d.......... 28sm calcium soft chews...........28sm caldyphen clear................15sm cold & hot therapy balm... 17sm hemorrhoidal......................3sm hydrocortisone plus..........19sm isopropyl alcohol.............. 10sm lice killing......................... 18sm medicated chest rub........ 12sm medicated wipes.............. 18sm mineral oil........................ 23sm omega-3 fish oil............... 35sm pain relief/menthol........... 17sm selenium.......................... 30sm slow release iron..............21sm tension headache.............. 1sm witch hazel....................... 18sodium bicarbonate................. 5sodium chloride............... 13, 30sodium chloride (hypertonic). 37SOF-LAX............................... 26SOMINEX.............................. 22sorbitol................................... 23sore throat............................. 30sore throat spray....................30stimulant laxative................... 25stomach relief...................... 6, 7stomach relief plus...................7stool softener......................... 26SUDAFED 12 HOUR.............35

SUDOGEST SINUS/ALLERGY.................. 12super cal/mag........................ 28SUPER NU-THERA...............32SUPER QUINTS B-50........... 31SURFAK................................ 26SWEEN 24............................ 16SWEEN 24 SKIN PROTECTANT...................... 18SWIM EAR............................ 37SYSTANE..............................36SYSTANE LID WIPES...........16SYSTANE OVERNIGHT THERAPY..............................36tactinal ..................................... 3tactinal extra strength.............. 3TANDEM............................... 21TEARS AGAIN...................... 36tears again .............................36TERA-GEL TAR.................... 18terbinafine hcl........................ 15tetra-formula nighttime sleep. 22tgt anti-itch/aloe/vit e..............16THERA.................................. 32thera vital m........................... 32THERA/BETA-CAROTENE...32therabasic-m ..........................32THERA-GESIC PLUS............17therapeutic .............................32therapeutic liquid ................... 32therapeutic-m .........................32THERASEAL HAND PROTECTION....................... 18thera-tabs .............................. 32THRESHOLD IMT................. 26THRESHOLD PEP................ 26TITRALAC............................... 5tolnaftate ................................15total allergy .............................. 9TOTAL ALLERGY MEDICINE............................... 9total b/c .................................. 31TOTAL FORMULA 3............. 32travel sickness ......................... 8TRIAMINIC COLD & ALLERGY.............................. 12tri-buffered aspirin ....................3triple antibiotic........................14

triple antibiotic plus ................ 14triprolidine-pse....................... 12tri-vitamin ............................... 33trixaicin .................................. 17trixaicin hp ............................. 18TUMS CHEWY DELIGHTS..... 5TUSNEL C.............................11TUSSICAPS.......................... 13tussin cf cough & cold............12tussin dm ............................... 11tussin pe................................ 12ULTRA FRESH PM............... 36UNIFIBER..............................23urea 20 intensive hydrating... 16urinary pain relief max st....... 20VANACOF............................. 13VANAHIST PD.........................8VINACAL B............................33vita-bee/c............................... 31vita-c ...................................... 39VITALETS..............................32vitamin a................................ 39vitamin a & d..........................34vitamin a palmitate.................39vitamin a-beta carotene ......... 39vitamin b complex-c...............31vitamin b-1............................. 39vitamin b-12........................... 20vitamin b-12 er .......................20vitamin b12-folic acid............. 20vitamin b-2............................. 39vitamin b-6............................. 39vitamin b-6 er.........................39vitamin c.......................... 39, 40vitamin c er............................ 39vitamin d................................ 40vitamin d (ergocalciferol)....... 40vitamin d2.............................. 40vitamin d3.............................. 40vitamin d-400......................... 40vitamin e................................ 40vitamin k (phytonadione) ....... 40vitamins a-d-e/selenium .........32vitamins for hair..................... 34WATCHHALER..................... 26WINDMILL TRAINER............ 26womens laxative.................... 25womens menstrual relief..........1


X-SEB T PEARL....................19ZANTAC 150 MAXIMUM STRENGTH...........................38zinc.................................. 30, 32zinc gluconate........................30zinc oxide...............................15zinc sulfate.............................30zinc-220................................. 30zoo friends............................. 32


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WellCare of Nebraska€¦ · 2020 Comprehensive Dual Eligible Drug List (List of Covered Drugs)...

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Transcript of WellCare of Nebraska€¦ · 2020 Comprehensive Dual Eligible Drug List (List of Covered Drugs)...