2014 Formulary -...
Transcript of 2014 Formulary -...
P.O. Box 52424, Phoenix, AZ 85072-2424
SilverScript (Employer PDP) sponsored by KelloggCompany
2014 Formulary(List of Covered Drugs)
PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WECOVER IN THIS PLAN
This formulary was updated on 08/29/2013. For more recent information or other questions, pleasecontact SilverScript (Employer PDP), at 1-866-693-4614 or, for TTY users, 1-866-236-1069, 24 hours aday, 7 days a week.
Note to existing members: This formulary has changed since last year. Please review this document tomake sure that it still contains the drugs you take.
When this drug list (formulary) refers to “we”, “us”, or “our”, it means SilverScript® InsuranceCompany. When it refers to “plan” or “our plan,” it means SilverScript (Employer PDP).
This document includes a list of the drugs (formulary) for our plan which is current as of 01/01/2014.For an updated formulary, please contact us. Our contact information, along with the date we lastupdated the formulary, appears on the front and back cover pages.
You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary,pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2015.
Y0080_FORM_Comp_10002CLT_2014_9425_2180_801
What is the SilverScript (Employer PDP) formulary?
A formulary is a list of covered drugs selected by SilverScript (Employer PDP) in consultation with ateam of health care providers, which represents the prescription therapies believed to be a necessary partof a quality treatment program.
SilverScript (Employer PDP) will generally cover the drugs listed in our formulary as long as the drug ismedically necessary, the prescription is filled at a SilverScript (Employer PDP) network pharmacy, andother plan rules are followed. For more information on how to fill your prescriptions, please review yourEvidence of Coverage.
Can the formulary (drug list) change?
Generally, if you are taking a drug on our 2014 formulary that was covered at the beginning of the year,we will not discontinue or reduce coverage of the drug during the 2014 coverage year except when anew, less expensive generic drug becomes available or when new adverse information about the safetyor effectiveness of a drug is released.
Other types of formulary changes, such as removing a drug from our formulary, will not affect memberswho are currently taking the drug. It will remain available at the same cost-sharing for those memberstaking it for the remainder of the coverage year.
We feel it is important that you have continued access for the remainder of the coverage year to theformulary drugs that were available when you chose our plan, except for cases in which you can saveadditional money or we can ensure your safety.
If we remove drugs from our formulary, or move a drug to a higher cost-sharing tier, we must notifyaffected members of the change at least 60 days before the change becomes effective, or at the time themember requests a refill of the drug, at which time the member will receive a 60-day supply of the drug.
If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’smanufacturer removes the drug from the market, we will immediately remove the drug from ourformulary and provide notice to members who take the drug.
The enclosed formulary is current as of January 1, 2014. To get updated information about the drugscovered by SilverScript (Employer PDP), please contact us. Our contact information appears on thefront and back cover pages.
If we have a mid-year non-maintenance formulary change (i.e. remove drugs from our formulary, addprior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a highercost-sharing tier), we will notify you by mail. We will also update our print formulary by reprinting itwith the new information. The updated formulary may be obtained by calling us. Our contactinformation appears on the front and back cover pages.
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How do I use the formulary?
There are two ways to find your drug within the formulary:
Medical ConditionThe formulary begins after this introduction on page 1. The drugs in this formulary are groupedinto categories depending on the type of medical conditions that they are used to treat. Forexample, drugs used to treat a heart condition are listed under the category, “Cardiovascular”. Ifyou know what your drug is used for, look for the category name in the list that begins on page 1.Then look under the category name for your drug.
Alphabetical ListingIf you are not sure what category to look under, you should look for your drug in the Index at theback of this document. The Index provides an alphabetical list of all of the drugs included in thisdocument. Both brand-name drugs and generic drugs are listed in the Index. Look in the Indexand find your drug. Next to your drug, you will see the page number where you can findcoverage information. Turn to the page listed in the Index and find the name of your drug in thefirst column of the list.
What are generic drugs?
SilverScript (Employer PDP) covers both brand-name drugs and generic drugs. A generic drug isapproved by the FDA as having the same active ingredient as the brand name drug. Generally, genericdrugs cost less than brand name drugs.
Are there any restrictions on my coverage?
Some covered drugs may have additional requirements or limits on coverage.
You can find out if your drug has any additional requirements or limits by looking in the formulary thatbegins on page 1. Our contact information, along with the date we last updated the formulary, appears onthe front and back cover pages.
You can ask us to make an exception to these restrictions or limits or for a list of other, similar drugsthat may treat your health condition. See the section, “How do I request an exception to the SilverScript(Employer PDP) formulary?” below for information about how to request an exception.
What if my drug is not on the formulary?
If your drug is not included in this formulary (list of covered drugs), you should first contact CustomerCare and ask if your drug is covered.
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If you learn that SilverScript (Employer PDP) does not cover your drug, you have two options
§ You can ask Customer Care for a list of similar drugs that are covered by our plan. When youreceive the list, show it to your doctor and ask him or her to prescribe a similar drug that iscovered by our plan.
§ You can ask us to make an exception and cover your drug. See below for information about howto request an exception.
SilverScript (Employer PDP) does not cover drugs that are covered under Medicare Part B as prescribedand dispensed. Generally, we only cover drugs, vaccines, biological products and medical supplies thatare covered under the Medicare Prescription Drug Benefit (Part D) and that are on our drug list.
How do I request an exception to the SilverScript (Employer PDP) formulary?
You can ask us to make an exception to our coverage rules. There are several types of exceptions thatyou can ask us to make.
§ You can ask us to cover your drug even if it is not on our formulary. If approved, this drug willbe covered at a pre-determined cost-sharing level, and you would not be able to ask us toprovide the drug at a lower cost-sharing level.
§ You can ask us to cover a formulary drug at a lower cost-sharing level if this drug is not on thespecialty tier. If approved this would lower the amount you must pay for your drug.
Please note, if we grant your request to cover a drug that is not on our formulary, you may not ask us toprovide a higher level of coverage for the drug.
Generally, SilverScript (Employer PDP) will only approve your request for an exception if thealternative drug is included on the plan’s formulary, the lower cost-sharing drug or additional utilizationrestrictions would not be as effective in treating your condition and/or would cause you to have adversemedical effects.
You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilizationrestriction exception. When you request a formulary, tiering or utilization restriction exception youshould submit a statement from your prescriber or physician supporting your request.
Generally, we must make our decision within 72 hours of getting your prescriber’s supporting statement.You can request an expedited (fast) exception if you or your doctor believe that your health could beseriously harmed by waiting up to 72 hours for a decision.
If your request to expedite is granted, we must give you a decision no later than 24 hours after we get asupporting statement from your doctor or other prescriber.
What do I do before I can talk to my doctor about changing my drugs or requesting anexception?
As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or,you may be taking a drug that is on our formulary but your ability to get it is limited. You should talk to
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your doctor to decide if you should switch to an appropriate drug that we cover or request a formularyexception so that we will cover the drug you take.
While you talk to your doctor to determine the right course of action for you, we may cover your drug incertain cases during the first 90 days you are a member of our plan.
For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we willcover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go toa network pharmacy.
After your first 30-day supply, we will not pay for these drugs, even if you have been a member of theplan less than 90 days.
If you are a resident of a long-term care facility, we will allow you to refill your prescription until wehave provided you with a 31-day transition supply, consistent with the dispensing increment, (unlessyou have a prescription written for fewer days). We will cover more than one refill of these drugs for thefirst 90 days you are a member of our plan. If you need a drug that is not on our formulary or if yourability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we willcover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while youpursue a formulary exception.
If you experience a change in your level of care, such as a move from a hospital to a home setting, andyou need a drug that is not on our formulary (or if your ability to get your drugs is limited), we maycover a one-time temporary supply from a network pharmacy for up to 30 days (or 31 days if you are along-term care resident) unless you have a prescription for fewer days. You should use the plan'sexception process if you wish to have continued coverage of the drug after the temporary supply isfinished.
For more information
For more detailed information about your SilverScript (Employer PDP) prescription drug coverage,please review your Evidence of Coverage.
If you have questions about our plan, please contact us. Our contact information, along with the date welast updated the formulary, appears on the front and back cover pages.
If you have general questions about Medicare prescription drug coverage, please call Medicare at1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call1-877-486-2048. Or, visit www.medicare.gov.
SilverScript (Employer PDP)'s Formulary
The formulary that begins on page 1 provides coverage information about some of the drugs covered byour plan. If you have trouble finding your drug in the list, turn to the Index at the back of this book.
The first column of the chart lists the drug name. Brand-name drugs are capitalized (e.g., SYNTHROID)and generic drugs are listed in lowercase italics (e.g., levothyroxine).
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The information in the Notes column tells you if SilverScript (Employer PDP) has any specialrequirements for coverage of your drug.
NM Not available at our mail-order pharmacies.
LA Limited Access. This prescription may be available only at certain pharmacies. For moreinformation consult your Pharmacy Directory or call Customer Care at 1-866-693-4614,24 hours a day, 7 days a week. TTY Users should call 1-866-236-1069.
HR High Risk Drug. According to medical experts, these drugs may cause more side effectsif you are 65 years of age or older. If you are taking one of these drugs, ask your doctor ifthere are safer options available.
B/D This drug may be covered under Medicare Part B or D depending upon thecircumstances. Information may need to be submitted describing the use and setting ofthe drug to make the determination.
GC We provide coverage of this prescription drug in the coverage gap. Please refer to yourEvidence of Coverage for more information about this coverage.
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NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 1
2014 602 4T Platinum BvD Comm_NT (Effective January 1)
Drug Name Requirements/Limits
ANALGESICS GOUT allopurinol inj 500mg (generic of ALOPRIM)
allopurinol tab (generic of ZYLOPRIM)
colchicine w/ probenecid COLCRYS probenecid ULORIC
MISCELLANEOUS diclofenac w/ misoprostol (generic of ARTHROTEC 50)
diclofenac w/ misoprostol (generic of ARTHROTEC 75)
DUEXIS VIMOVO
NSAIDS CELEBREX diclofenac potassium (generic of CATAFLAM)
diclofenac sodium (generic of VOLTAREN-XR) TB24
diclofenac sodium TBEC diflunisal etodolac CAPS; TABS etodolac er fenoprofen calcium TABS flurbiprofen TABS ibuprofen SUSP ibuprofen TABS 400mg, 600mg, 800mg
ketoprofen CAPS; CP24 mefenamic acid (generic of PONSTEL) CAPS
MELOXICAM SUSP 7.5 MG/5ML meloxicam tabs (generic of MOBIC)
nabumetone TABS NALFON NAPRELAN naproxen (generic of NAPROSYN) SUSP; TABS
naproxen (generic of EC-NAPROSYN) TBEC
Drug Name Requirements/Limits
naproxen sodium (generic of ANAPROX) TABS 275mg
naproxen sodium (generic of ANAPROX DS) TABS 550mg
oxaprozin (generic of DAYPRO) piroxicam (generic of FELDENE) CAPS
sulindac TABS 150mg sulindac (generic of CLINORIL) TABS 200mg
tolmetin sodium ZIPSOR
OPIOID ANALGESICS acetaminophen w/ codeine SOLN
acetaminophen w/ codeine TABS
acetaminophen w/ codeine (generic of TYLENOL/CODEINE #3) TABS
acetaminophen w/ codeine (generic of TYLENOL/CODEINE #4) TABS
butorphanol nasal spray butorphanol tartrate SOLN BUTRANS 5mcg/hr BUTRANS 10mcg/hr BUTRANS 20mcg/hr capital and codeine co-gesic 5-500mg (generic of LORTAB)
CONZIP 100mg CONZIP 200mg CONZIP 300mg hydrocodone-acetaminophen hydrocodone-acetaminophen 2.5-325mg
hydrocodone-acetaminophen 2.5-500mg
hydrocodone-acetaminophen 5-300mg (generic of XODOL)
hydrocodone-acetaminophen 5-325mg (generic of NORCO)
hydrocodone-acetaminophen 5-500mg (generic of LORTAB)
hydrocodone-acetaminophen 7.5-300mg (generic of XODOL)
hydrocodone-acetaminophen 7.5-325 mg/15ml (generic of HYCET)
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NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 2
Drug Name Requirements/Limits
hydrocodone-acetaminophen 7.5-325mg (generic of NORCO)
hydrocodone-acetaminophen 7.5-500mg (generic of LORTAB)
hydrocodone-acetaminophen 7.5-500mg/15ml (generic of LORTAB)
hydrocodone-acetaminophen 7.5-650mg (generic of ANEXSIA)
hydrocodone-acetaminophen 7.5-750mg
hydrocodone-acetaminophen 10-300mg (generic of XODOL)
hydrocodone-acetaminophen 10-500mg (generic of LORTAB)
hydrocodone-acetaminophen 10-650mg (generic of LORCET 10/650)
hydrocodone-acetaminophen 10-660mg
hydrocodone-acetaminophen 10-750mg (generic of MAXIDONE)
hydrocodone-acetaminophen tab 10-325mg (generic of NORCO)
hydrocodone-ibuprofen 2.5-200mg
hydrocodone-ibuprofen 7.5-200mg (generic of VICOPROFEN)
ibudone tab 5-200mg (generic of REPREXAIN)
reprexain 10/200 stagesic 500-5mg SYNALGOS-DC tramadol hcl er (generic of ULTRAM ER) TB24 100mg
tramadol hcl er (generic of ULTRAM ER) TB24 200mg
TRAMADOL HCL ER TB24 300mg
TRAMADOL HCL ER (BIPHASIC) 100MG
TRAMADOL HCL ER (BIPHASIC) 200MG
tramadol hcl er (biphasic) 300mg tramadol hcl tab 50 mg (generic of ULTRAM)
tramadol-acetaminophen (generic of ULTRACET)
vicodin (generic of XODOL)
Drug Name Requirements/Limits
vicodin es (generic of XODOL) vicodin hp (generic of XODOL)
OPIOID ANALGESICS, CII ABSTRAL NM
AVINZA CODEINE SULFATE TABS DILAUDID-HP INJ B/D
DURAMORPH B/D
endocet 5/325 (generic of PERCOCET)
endocet 7.5/325 (generic of PERCOCET)
endocet 10/325 (generic of PERCOCET)
ENDODAN EXALGO 8mg, 12mg EXALGO 16mg, 32mg NM
fentanyl citrate (generic of ACTIQ) LPOP
NM
fentanyl patch (generic of DURAGESIC)
FENTORA NM
hydromorphone hcl (generic of DILAUDID-5) LIQD
hydromorphone hcl (generic of DILAUDID-HP) SOLN 500mg/50ml
B/D
hydromorphone hcl (generic of DILAUDID) TABS
INFUMORPH 200 B/D
INFUMORPH 500 B/D
KADIAN LAZANDA NM
levorphanol tartrate TABS methadone hcl CONC methadone hcl SOLN methadone hcl (generic of DOLOPHINE HCL) TABS 5mg
methadone hcl (generic of DOLOPHINE) TABS 10mg
METHADONE INJ 10MG/ML MORPHINE SUL 20MG/ML ORAL SOL
MORPHINE SULFATE SOLN 10mg/5ml, 20mg/5ml
morphine sulfate SOLN .5mg/ml, 1mg/ml
B/D
MORPHINE SULFATE TABS
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NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 3
Drug Name Requirements/Limits
morphine sulfate ext-rel tab (generic of MS CONTIN) 15mg, 30mg, 60mg, 100mg
morphine sulfate ext-rel tab (generic of MS CONTIN) 200mg
MORPHINE SULFATE INJ 1mg/ml, 4mg/ml, 8mg/ml, 10mg/ml, 15mg/ml
B/D
morphine sulfate inj .5mg/ml, 1mg/ml
B/D
NUCYNTA NUCYNTA ER 50mg, 100mg NUCYNTA ER 150mg, 200mg, 250mg
ONSOLIS NM
OPANA ER (CRUSH RESISTANT
OXECTA OXYCODONE HCL CAPS OXYCODONE HCL CONC OXYCODONE HCL SOLN oxycodone hcl (generic of ROXICODONE) TABS 5mg, 15mg, 30mg
oxycodone hcl TABS 10mg, 20mg
oxycodone w/ acetaminophen SOLN
oxycodone w/ acetaminophen (generic of PERCOCET) TABS
oxycodone w/ acetaminophen (generic of PERCOCET) TABS
oxycodone w/ acetaminophen 2.5-325mg (generic of PERCOCET)
oxycodone w/ acetaminophen 5-325mg (generic of PERCOCET)
oxycodone w/ acetaminophen 5-500mg
oxycodone w/ acetaminophen 7.5-325mg (generic of PERCOCET)
oxycodone w/ acetaminophen 7.5-500mg (generic of PERCOCET)
oxycodone w/ acetaminophen 10-325mg (generic of PERCOCET)
Drug Name Requirements/Limits
oxycodone w/ acetaminophen 10-650mg (generic of PERCOCET)
oxycodone-aspirin (generic of PERCODAN)
oxycodone-ibuprofen OXYCONTIN oxymorphone hcl (generic of OPANA) TABS
SUBSYS NM
ANESTHETICS LOCAL ANESTHETICS lidocaine hcl (local anesth.) (generic of XYLOCAINE-MPF) 4%
lidocaine hcl (local anesth.) (generic of XYLOCAINE) .5%
B/D
lidocaine inj 0.5% (generic of XYLOCAINE-MPF)
B/D
lidocaine inj 1% (generic of XYLOCAINE) 1%
B/D
lidocaine inj 1% (generic of XYLOCAINE-MPF) 1%
B/D
lidocaine inj 1.5% (generic of XYLOCAINE-MPF)
B/D
lidocaine inj 2% (generic of XYLOCAINE) 2%
B/D
lidocaine inj 2% (generic of XYLOCAINE-MPF) 2%
B/D
ANTI-INFECTIVES ANTI-BACTERIALS - MISCELLANEOUS amikacin sulfate SOLN gentamicin in saline 0.9mg/ml gentamicin in saline 1.4mg/ml gentamicin in saline 60mg gentamicin in saline 80mg gentamicin in saline 100mg gentamicin sulfate SOLN neomycin sulfate TABS paromomycin sulfate CAPS streptomycin sulfate SOLR sulfadiazine TABS TOBI NEB B/D NM
tobramycin sulfate SOLN; SOLR tobramycin sulfate in saline
ANTI-INFECTIVES - MISCELLANEOUS ALBENZA ALINIA SUSR ALINIA TABS
3
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 4
Drug Name Requirements/Limits
AZACTAM 2gm AZACTAM/DEX INJ 1GM AZACTAM/DEX INJ 2GM NM
aztreonam (generic of AZACTAM)
BILTRICIDE clindamycin hcl (generic of CLEOCIN) CAPS
clindamycin palmitate hydrochloride (generic of CLEOCIN PEDIATRIC GRANULE)
clindamycin phosphate SOLN 150mg/ml
clindamycin phosphate (generic of CLEOCIN PHOSPHATE) SOLN 150mg/ml, 300mg/2ml, 600mg/4ml, 900mg/6ml, 9000mg/60ml
clindamycin phosphate in d5w (generic of CLEOCIN IN D5W)
colistimethate sodium (generic of COLY-MYCIN M) SOLR
CUBICIN B/D NM
dapsone TABS DARAPRIM DORIBAX erythromycin-sulfisoxazole FLAGYL CAPS FLAGYL ER imipenem-cilastatin (generic of PRIMAXIN IV)
INVANZ MACRODANTIN 25mg MEPRON NM
meropenem (generic of MERREM)
methenamine hippurate (generic of HIPREX)
METRO IV metronidazole (generic of FLAGYL) TABS
metronidazole inj NEBUPENT B/D
nitrofurantoin (generic of FURADANTIN) SUSP
nitrofurantoin macrocrystal (generic of MACRODANTIN)
nitrofurantoin monohyd macro (generic of MACROBID)
Drug Name Requirements/Limits
PENTAM 300 polymyxin b sulfate SOLR PRIMSOL SOL 50MG/5ML STROMECTOL sulfamethoxazole-trimethoprim SUSP
sulfamethoxazole-trimethoprim (generic of BACTRIM) TABS
sulfamethoxazole-trimethoprim (generic of BACTRIM DS) TABS
sulfamethoxazole-trimethoprim inj SYNERCID NM
trimethoprim TABS TYGACIL NM
vancomycin hcl (generic of VANCOCIN HCL) CAPS
NM
vancomycin hcl SOLR 10gm, 500mg, 1000mg, 5000mg
B/D
vancomycin hcl SOLR 750mg B/D
VIBATIV XIFAXAN TAB 200MG NM
ZYVOX NM
ANTIFUNGALS ABELCET B/D NM
AMBISOME B/D NM
AMPHOTEC B/D
amphotericin b SOLR B/D
CANCIDAS NM
ERAXIS NM
fluconazole (generic of DIFLUCAN) SUSR; TABS
fluconazole in dextrose fluconazole in nacl 100mg fluconazole in nacl 200mg fluconazole in nacl 400mg flucytosine (generic of ANCOBON) CAPS
NM
griseofulvin microsize SUSP griseofulvin microsize (generic of GRIFULVIN V) TABS
griseofulvin ultramicrosize (generic of GRIS-PEG)
itraconazole (generic of SPORANOX) CAPS
ketoconazole TABS LAMISIL PACK MYCAMINE 50mg MYCAMINE 100mg NM
NOXAFIL NM
4
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 5
Drug Name Requirements/Limits
nystatin TABS ONMEL SPORANOX SOL 10MG/ML NM
terbinafine hcl (generic of LAMISIL) TABS
VFEND SUS 40MG/ML NM
voriconazole (generic of VFEND) TABS
NM
voriconazole inj 200mg (generic of VFEND IV)
ANTIMALARIALS ATOVAQUONE-PROGUANIL HCL TAB 62.5-25 MG
atovaquone-proguanil hcl tab 250-100 mg (generic of MALARONE)
chloroquine phosphate TABS 250mg
chloroquine phosphate (generic of ARALEN) TABS 500mg
COARTEM mefloquine hcl PRIMAQUINE PHOSPHATE quinine sulfate (generic of QUALAQUIN) CAPS
ANTIRETROVIRAL AGENTS abacavir sulfate (generic of ZIAGEN)
APTIVUS NM
CRIXIVAN didanosine (generic of VIDEX EC)
EDURANT NM
EMTRIVA EPIVIR SOL 10MG/ML FUZEON NM
INTELENCE 25mg INTELENCE 100mg, 200mg NM
INVIRASE CAPS INVIRASE TABS NM
ISENTRESS CHEW 25mg ISENTRESS CHEW 100mg NM
ISENTRESS TABS NM
lamivudine (generic of EPIVIR) LEXIVA SUSP LEXIVA TABS NM
NEVIRAPINE SUSP nevirapine (generic of VIRAMUNE) TABS
Drug Name Requirements/Limits
NORVIR PREZISTA SUSP NM
PREZISTA TABS 75mg, 150mg PREZISTA TABS 400mg, 600mg, 800mg
NM
RESCRIPTOR RETROVIR IV INFUSION REYATAZ 100mg REYATAZ 150mg, 200mg, 300mg
NM
SELZENTRY NM
stavudine (generic of ZERIT) SUSTIVA VIDEX PEDIATRIC VIRACEPT NM
VIRAMUNE SUSP VIRAMUNE XR VIREAD NM
ZIAGEN SOLN zidovudine (generic of RETROVIR) CAPS; SYRP
zidovudine TABS
ANTIRETROVIRAL COMBINATION AGENTS ATRIPLA NM
COMPLERA NM
EPZICOM NM
KALETRA SOL NM
KALETRA TAB 100-25MG KALETRA TAB 200-50MG NM
lamivudine-zidovudine (generic of COMBIVIR)
NM
STRIBILD NM
TRIZIVIR NM
TRUVADA NM
ANTITUBERCULAR AGENTS CAPASTAT SULFATE NM
cycloserine CAPS ethambutol hcl (generic of MYAMBUTOL) TABS
isoniazid SOLN; SYRP isoniazid & rifampin isoniazid tabs MYCOBUTIN paser 4gm PRIFTIN pyrazinamide
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NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 6
Drug Name Requirements/Limits
rifampin (generic of RIFADIN) CAPS; SOLR
RIFATER SIRTURO NM LA
TRECATOR
ANTIVIRALS acyclovir (generic of ZOVIRAX) CAPS; SUSP; TABS
acyclovir sodium SOLN B/D
acyclovir sodium SOLR B/D
BARACLUDE SOLN BARACLUDE TABS NM
cidofovir (generic of VISTIDE) EPIVIR HBV famciclovir (generic of FAMVIR) foscarnet sodium ganciclovir inj 500mg (generic of CYTOVENE)
B/D
HEPSERA NM
INCIVEK NM
REBETOL SOLN NM
RELENZA DISKHALER ribapak NM
ribapak mis 600/day NM
ribasphere 400mg NM
ribasphere 600mg NM
ribasphere 200mg (generic of REBETOL) CAPS
NM
ribasphere 200mg (generic of COPEGUS) TABS
NM
ribavirin 200mg (generic of REBETOL) CAPS
NM
ribavirin 200mg (generic of COPEGUS) TABS
NM
rimantadine hydrochloride (generic of FLUMADINE)
TAMIFLU TYZEKA NM
valacyclovir hcl (generic of VALTREX) TABS
VALCYTE NM
VICTRELIS NM
CEPHALOSPORINS CEDAX cefaclor cefaclor monohydrate cefadroxil cefazolin inj cefazolin sodium 1gm, 20gm
Drug Name Requirements/Limits
cefazolin/dextrose cefdinir CEFEPIME 1GM SOLN CEFEPIME 2GM SOLN cefepime inj 1gm (generic of MAXIPIME)
cefepime inj 2gm (generic of MAXIPIME)
cefixime cefotaxime sodium (generic of CLAFORAN)
cefotetan disodium cefoxitin sodium CEFOXITIN SODIUM IN DEXTROSE
cefpodoxime proxetil cefprozil ceftazidime (generic of FORTAZ) SOLR 1gm, 2gm, 6gm
CEFTAZIDIME/DEXTROSE CEFTIN SUSR ceftriaxone sodium SOLR 1gm, 2gm, 10gm, 250mg
ceftriaxone sodium (generic of ROCEPHIN) SOLR 1gm, 500mg
cefuroxime axetil (generic of CEFTIN) TABS
cefuroxime sodium (generic of ZINACEF) 1.5gm, 7.5gm, 750mg
cefuroxime sodium 7.5mg soln cephalexin (generic of KEFLEX) CAPS 250mg, 500mg
cephalexin SUSR cephalexin TABS claforan 1gm, 2gm FORTAZ SOLN FORTAZ SOLR 500mg MAXIPIME SUPRAX CAPS suprax CHEW SUPRAX SUSR tazicef vial (generic of FORTAZ) TEFLARO
ERYTHROMYCINS/MACROLIDES AZITHROMYCIN PACK
6
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 7
Drug Name Requirements/Limits
azithromycin (generic of ZITHROMAX) SOLR 500mg
azithromycin (generic of ZITHROMAX) SUSR
azithromycin (generic of ZITHROMAX) TABS
clarithromycin SUSR 125mg/5ml
clarithromycin (generic of BIAXIN) SUSR 250mg/5ml
clarithromycin (generic of BIAXIN) TABS
clarithromycin (generic of BIAXIN XL) TB24
DIFICID NM
E.E.S. GRANULES ERYPED 200 ERYPED 400 erythromycin base CPEP; TABS erythromycin base TBEC erythromycin ethylsuccinate erythromycin lactobionate erythromycin stearate PCE ZMAX
FLUOROQUINOLONES AVELOX SOLN AVELOX TABS AVELOX ABC PACK CIPRO SUSR ciprofloxacin SOLN 200mg/20ml ciprofloxacin er (generic of CIPRO XR)
ciprofloxacin hcl TABS 100mg, 750mg
ciprofloxacin hcl (generic of CIPRO) TABS 250mg, 500mg
ciprofloxacin in d5w (generic of CIPRO I.V.-IN D5W)
ciprofloxacn inj FACTIVE levofloxacin SOLN 25mg/ml levofloxacin (generic of LEVAQUIN) SOLN 25mg/ml
levofloxacin (generic of LEVAQUIN) TABS
levofloxacin in d5w (generic of LEVAQUIN)
NOROXIN
Drug Name Requirements/Limits
PENICILLINS amoxicillin amoxicillin & pot clavulanate CHEW
amoxicillin & pot clavulanate (generic of AUGMENTIN) CHEW
amoxicillin & pot clavulanate SUSR
amoxicillin & pot clavulanate (generic of AUGMENTIN) SUSR
amoxicillin & pot clavulanate (generic of AUGMENTIN ES-600) SUSR
amoxicillin & pot clavulanate TABS
amoxicillin & pot clavulanate (generic of AUGMENTIN) TABS
amoxicillin & pot clavulanate (generic of AUGMENTIN XR) TB12
ampicillin ampicillin & sulbactam sodium ampicillin & sulbactam sodium (generic of UNASYN)
ampicillin & sulbactam sodium (generic of UNASYN BULK PACK)
ampicillin inj ampicillin sodium AUGMENTIN SUSR BACTOCILL IN DEXTROSE BICILLIN C-R BICILLIN L-A dicloxacillin sodium MOXATAG nafcillin sodium 1gm nafcillin sodium 2gm, 10gm NM
NALLPEN ISO-OSMOTIC IN DE NALLPEN/DEXTROSE oxacillin sodium 1gm, 2gm oxacillin sodium 10gm NM
PENICILLIN G POT IN DEXTROSE
PENICILLIN G POTASSIUM SOLN
penicillin g potassium SOLR penicillin g procaine penicillin g sodium
7
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 8
Drug Name Requirements/Limits
penicillin v potassium pfizerpen piperacillin sodium-tazobactam sodium (generic of ZOSYN)
TIMENTIN TIMENTIN INJ 3.1GM ZOSYN SOLN
TETRACYCLINES demeclocycline hcl DORYX doxycycline (monohydrate) CAPS 50mg
doxycycline (monohydrate) (generic of MONODOX) CAPS 75mg, 100mg
doxycycline (monohydrate) (generic of ADOXA) CAPS 150mg
doxycycline (monohydrate) (generic of VIBRAMYCIN) SUSR
doxycycline (monohydrate) (generic of ADOXA) TABS 50mg, 75mg, 100mg
doxycycline (monohydrate) (generic of ADOXA PAK 1/150) TABS 150mg
doxycycline hyclate CAPS 50mg doxycycline hyclate (generic of VIBRAMYCIN) CAPS 100mg
doxycycline hyclate SOLR doxycycline hyclate TABS doxycycline hyclate TBEC 75mg, 100mg
doxycycline hyclate (generic of DORYX) TBEC 150mg
minocycline hcl (generic of MINOCIN) CAPS 50mg, 100mg
minocycline hcl CAPS 75mg minocycline hcl TABS minocycline hcl (generic of SOLODYN) TB24
SOLODYN 55mg, 65mg, 80mg, 105mg, 115mg
NM
VIBRAMYCIN SUSR; SYRP
ANTINEOPLASTIC AGENTS ALKYLATING AGENTS BICNU B/D
BUSULFEX B/D
Drug Name Requirements/Limits
CEENU cyclophosphamide SOLR B/D
cyclophosphamide TABS B/D
dacarbazine 200mg B/D
EMCYT HEXALEN NM
IFEX INJ 3GM B/D
ifosfamide (generic of IFOSFAMIDE) SOLN
B/D
ifosfamide (generic of IFEX) SOLR 1gm
B/D
LEUKERAN melphalan hcl (generic of ALKERAN)
B/D NM
MUSTARGEN B/D
thiotepa SOLR B/D
TREANDA B/D NM
ZANOSAR B/D
ANTHRACYCLINES adriamycin 20mg B/D
adriamycin inj 2mg/ml B/D
daunorubicin hcl INJ B/D
daunorubicin hcl (generic of CERUBIDINE) SOLR
B/D
DOXIL B/D NM
doxorubicin hcl SOLN B/D
doxorubicin hcl SOLR 50mg B/D
EPIRUBICIN INJ 50MG B/D
epirubicin inj 50mg/25ml (generic of ELLENCE)
B/D
epirubicin inj 200mg (generic of ELLENCE)
B/D
idarubicin hcl (generic of IDAMYCIN PFS)
B/D NM
ANTIBIOTICS bleomycin sulfate B/D
COSMEGEN B/D NM
mitomycin SOLR 20mg B/D
ANTIMETABOLITES adrucil B/D
ALIMTA B/D NM
ARRANON B/D
cladribine B/D NM
CLOLAR B/D
cytarabine inj B/D
DACOGEN B/D NM
fludarabine phosphate SOLN B/D
fludarabine phosphate (generic of FLUDARA) SOLR
B/D
fluorouracil SOLN B/D
8
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 9
Drug Name Requirements/Limits
GEMCITABINE B/D NM
gemcitabine hcl (generic of GEMZAR) 1gm, 200mg
B/D NM
gemcitabine hcl 2gm B/D NM
mercaptopurine (generic of PURINETHOL) TABS
methotrexate sodium inj B/D
pentostatin (generic of NIPENT) B/D NM
TABLOID VIDAZA B/D NM
ANTIMITOTIC, TAXOIDS ABRAXANE B/D NM
DOCETAXEL CONC 20mg/0.5ml, 20mg/ml, 80mg/4ml
B/D NM
docetaxel CONC 140mg/7ml B/D NM
DOCETAXEL SOLN 80mg/8ml B/D NM
paclitaxel B/D
TAXOTERE B/D NM
ANTIMITOTIC, VINCA ALKALOIDS vinblastine sulfate SOLR B/D
vincristine sulfate B/D
vinorelbine tartrate (generic of NAVELBINE)
B/D
BIOLOGIC RESPONSE MODIFIERS AVASTIN B/D NM
ERBITUX B/D NM
ERIVEDGE NM LA
HERCEPTIN B/D NM
ISTODAX B/D NM
KADCYLA B/D NM
ONTAK B/D NM
PROLEUKIN B/D NM
RITUXAN NM
TORISEL B/D NM
VECTIBIX B/D NM
VELCADE B/D NM
ZOLINZA NM
HORMONAL ANTINEOPLASTIC AGENTS anastrozole (generic of ARIMIDEX) TABS
ARZERRA B/D NM
bicalutamide (generic of CASODEX)
DEPO-PROVERA INJ 400/ML B/D
ELIGARD 7.5mg, 22.5mg, 30mg B/D NM
ELIGARD 45mg B/D NM
exemestane (generic of AROMASIN)
FARESTON NM
FASLODEX B/D NM
Drug Name Requirements/Limits
FIRMAGON 80mg B/D NM
FIRMAGON 120mg B/D NM
flutamide letrozole (generic of FEMARA) TABS
leuprolide acetate KIT NM
LUPR DEP-PED INJ 11.25MG (3-MONTH)
NM
LUPR DEP-PED INJ 30MG (3-MONTH)
NM
LUPRON DEPOT 3.75mg, 7.5mg, 11.25mg
NM
LUPRON DEPOT INJ 22.5MG (3-MONTH)
NM
LUPRON DEPOT INJ 30MG (3-MONTH)
NM
LUPRON DEPOT-PED NM
LYSODREN MEGACE ES megestrol acetate (generic of MEGACE ORAL) SUSP
megestrol acetate TABS NILANDRON NM
SOLTAMOX tamoxifen citrate TABS TRELSTAR DEPOT MIXJECT NM
TRELSTAR LA MIXJECT NM
TRELSTAR MIXJECT NM
XTANDI NM LA
ZYTIGA NM
KINASE INHIBITORS AFINITOR NM
AFINITOR DISPERZ NM
BOSULIF NM
CAPRELSA NM LA
COMETRIQ NM
GLEEVEC NM
ICLUSIG NM
INLYTA NM LA
IRESSA NM
JAKAFI NM LA
MEKINIST NM
NEXAVAR NM LA
SPRYCEL NM
STIVARGA NM LA
SUTENT NM
TAFINLAR NM
TARCEVA NM
TASIGNA NM
TYKERB NM LA
9
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 10
Drug Name Requirements/Limits
VOTRIENT NM
XALKORI NM LA
ZELBORAF NM LA
MISCELLANEOUS DROXIA ELSPAR B/D NM
HALAVEN B/D NM
hydroxyurea (generic of HYDREA) CAPS
IXEMPRA KIT B/D NM
MATULANE NM
mitoxantrone hcl B/D NM
POMALYST CAP NM LA
SYLATRON NM
TARGRETIN CAPS NM
tretinoin CAPS NM
TRISENOX B/D NM
UVADEX B/D
PLATINUM-BASED AGENTS carboplatin SOLN B/D
cisplatin SOLN B/D
ELOXATIN B/D NM
oxaliplatin B/D NM
PROTECTIVE AGENTS amifostine crystalline (generic of ETHYOL)
B/D NM
dexrazoxane (generic of ZINECARD)
B/D NM
ELITEK B/D NM
KEPIVANCE B/D NM
leucovor ca inj B/D
leucovorin calcium SOLN B/D
leucovorin calcium SOLR 50mg, 200mg
B/D
leucovorin calcium SOLR 500mg
B/D
leucovorin calcium TABS mesna (generic of MESNEX) B/D
MESNEX TABS NM
TOPOISOMERASE INHIBITORS CAMPTOSAR 300mg/15ml B/D
ETOPOPHOS B/D
etoposide SOLN B/D
irinotecan hcl (generic of CAMPTOSAR) 40mg/2ml, 100mg/5ml
B/D NM
irinotecan hcl 500mg/25ml B/D NM
topotecan hcl (generic of HYCAMTIN) SOLR
B/D NM
CARDIOVASCULAR
Drug Name Requirements/Limits
ACE INHIBITOR COMBINATIONS amlodipine besylate-benazepril hcl (generic of LOTREL)
benazepril & hydrochlorothiazide benazepril & hydrochlorothiazide (generic of LOTENSIN HCT)
captopril & hydrochlorothiazide enalapril maleate & hydrochlorothiazide
enalapril maleate & hydrochlorothiazide (generic of VASERETIC)
fosinopril sodium & hydrochlorothiazide
lisinopril & hydrochlorothiazide (generic of PRINZIDE)
lisinopril & hydrochlorothiazide (generic of ZESTORETIC)
moexipril-hydrochlorothiazide (generic of UNIRETIC)
quinapril-hydrochlorothiazide (generic of ACCURETIC)
TARKA
ACE INHIBITORS benazepril hcl TABS 5mg benazepril hcl (generic of LOTENSIN) TABS 10mg, 20mg, 40mg
captopril TABS enalapril maleate (generic of VASOTEC) TABS
fosinopril sodium lisinopril (generic of ZESTRIL) TABS 2.5mg, 30mg, 40mg
lisinopril (generic of PRINIVIL) TABS 5mg, 10mg, 20mg
moexipril hcl (generic of UNIVASC)
perindopril erbumine 2mg perindopril erbumine (generic of ACEON) 4mg, 8mg
quinapril hcl (generic of ACCUPRIL)
ramipril (generic of ALTACE) trandolapril (generic of MAVIK)
ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone (generic of INSPRA) spironolactone (generic of ALDACTONE) TABS
10
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 11
Drug Name Requirements/Limits
ALPHA BLOCKERS doxazosin mesylate (generic of CARDURA)
prazosin hcl (generic of MINIPRESS)
terazosin hcl
ANGIOTENSIN II RECEPTOR ANTAGONIST COMBINATIONS AZOR BENICAR HCT candesartan cilexetil-hydrochlorothiazide (generic of ATACAND HCT)
EDARBYCLOR EXFORGE EXFORGE HCT irbesartan-hydrochlorothiazide (generic of AVALIDE)
losartan potassium & hydrochlorothiazide (generic of HYZAAR)
MICARDIS HCT TEVETEN HCT TRIBENZOR TWYNSTA valsartan-hydrochlorothiazide (generic of DIOVAN HCT)
ANGIOTENSIN II RECEPTOR ANTAGONISTS ATACAND BENICAR candesartan cilexetil (generic of ATACAND)
DIOVAN EDARBI eprosartan mesylate (generic of TEVETEN)
irbesartan (generic of AVAPRO) losartan potassium (generic of COZAAR)
MICARDIS TEVETEN 400mg
ANTIARRHYTHMICS amiodarone hcl SOLN amiodarone hcl TABS 100mg amiodarone hcl (generic of CORDARONE) TABS 200mg
amiodarone hcl TABS 400mg
Drug Name Requirements/Limits
amiodarone inj 50mg/ml disopyramide phosphate (generic of NORPACE)
flecainide acetate (generic of TAMBOCOR)
mexiletine hcl MULTAQ NORPACE CR propafenone hcl (generic of RYTHMOL SR) CP12
propafenone hcl (generic of RYTHMOL) TABS 150mg, 225mg
propafenone hcl TABS 300mg quinidine gluconate er quinidine sulfate sotalol hcl (generic of BETAPACE) 80mg, 120mg, 160mg
sotalol hcl 240mg sotalol hcl (afib/afl) (generic of BETAPACE AF)
TIKOSYN NM
ANTILIPEMICS, HMG-CoA REDUCTASE INHIBITORS ALTOPREV atorvastatin calcium (generic of LIPITOR)
CRESTOR fluvastatin sodium (generic of LESCOL)
LESCOL XL LIVALO lovastatin 10mg lovastatin (generic of MEVACOR) 20mg, 40mg
pravastatin sodium 10mg pravastatin sodium (generic of PRAVACHOL) 20mg, 40mg, 80mg
simvastatin (generic of ZOCOR) TABS 5mg, 10mg, 20mg, 40mg
simvastatin (generic of ZOCOR) TABS 80mg
ANTILIPEMICS, MISCELLANEOUS ADVICOR cholestyramine (generic of QUESTRAN)
11
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 12
Drug Name Requirements/Limits
cholestyramine light (generic of QUESTRAN LIGHT)
choline fenofibrate (generic of TRILIPIX)
colestipol hcl (generic of COLESTID)
fenofibrate (generic of TRICOR) 48mg, 145mg
fenofibrate (generic of LOFIBRA) 54mg, 160mg
FENOFIBRATE MICRONIZED 43mg, 130mg
fenofibrate micronized (generic of LOFIBRA) 67mg, 134mg, 200mg
FENOFIBRIC ACID FENOGLIDE gemfibrozil (generic of LOPID) TABS
LIPOFEN LOVAZA niacor NIASPAN SIMCOR TRIGLIDE TRILIPIX VASCEPA VYTORIN WELCHOL ZETIA
BETA-BLOCKER/DIURETIC COMBINATIONS atenolol & chlorthalidone (generic of TENORETIC 50)
atenolol & chlorthalidone (generic of TENORETIC 100)
bisoprolol & hydrochlorothiazide (generic of ZIAC)
metoprolol & hctz tab 50-25mg (generic of LOPRESSOR HCT)
metoprolol & hctz tab 100-25mg (generic of LOPRESSOR HCT)
metoprolol & hctz tab 100-50mg nadolol & bendroflumethiazide (generic of CORZIDE)
propranolol & hydrochlorothiazide
BETA-BLOCKERS acebutolol hcl (generic of SECTRAL) CAPS
Drug Name Requirements/Limits
atenolol (generic of TENORMIN) TABS
betaxolol hcl (generic of KERLONE)
bisoprolol fumarate (generic of ZEBETA)
BYSTOLIC carvedilol (generic of COREG) COREG CR labetalol hcl SOLN labetalol hcl (generic of TRANDATE) TABS
LEVATOL metoprolol succinate (generic of TOPROL XL)
metoprolol tartrate (generic of LOPRESSOR) SOLN
metoprolol tartrate TABS 25mg metoprolol tartrate (generic of LOPRESSOR) TABS 50mg, 100mg
nadolol (generic of CORGARD) TABS
pindolol propranolol hcl er (generic of INDERAL LA)
propranolol inj 1mg/ml propranolol sol propranolol tab timolol maleate TABS
CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS AMLODIPINE BESYLATE/ATORV
CALCIUM CHANNEL BLOCKERS amlodipine besylate (generic of NORVASC) TABS
CARDIZEM LA 120mg cartia xt (generic of CARDIZEM CD)
dilt-cd (generic of CARDIZEM CD)
dilt-xr 120mg, 180mg dilt-xr (generic of DILACOR XR) 240mg
diltiazem cap 120mg/24hr diltiazem cap er/12hr diltiazem hcl SOLN diltiazem hcl SOLR
12
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 13
Drug Name Requirements/Limits
diltiazem hcl (generic of CARDIZEM) TABS
diltiazem hcl coated beads (generic of CARDIZEM CD)
diltiazem hcl er (generic of TIAZAC)
diltiazem hcl extended release beads (generic of TIAZAC)
diltzac (generic of TIAZAC) felodipine isradipine matzim la (generic of CARDIZEM LA)
nicardipine hcl CAPS nifedipine (generic of ADALAT CC) TB24
nifedipine cc tab 90mg er (generic of ADALAT CC)
nifedipine cr (generic of ADALAT CC)
nifedipine er (generic of PROCARDIA XL)
nifedipine xl (generic of PROCARDIA XL)
nimodipine (generic of NIMOTOP) CAPS
nisoldipine (generic of SULAR) 8.5mg, 17mg, 34mg
nisoldipine 20mg, 25.5mg, 30mg, 40mg
NYMALIZE NM
taztia xt (generic of TIAZAC) verapamil hcl (generic of VERELAN PM) CP24 100mg, 200mg, 300mg
verapamil hcl (generic of VERELAN) CP24 120mg, 180mg, 240mg
VERAPAMIL HCL CP24 360mg verapamil hcl SOLN verapamil hcl TABS 40mg verapamil hcl (generic of CALAN) TABS 80mg, 120mg
verapamil hcl (generic of CALAN SR) TBCR
DIGITALIS GLYCOSIDES digoxin (generic of LANOXIN) TABS
digoxin inj (generic of LANOXIN) DIGOXIN SOL 50MCG/ML
Drug Name Requirements/Limits
LANOXIN PEDIATRIC LANOXIN TAB
DIRECT RENIN INHIBITORS/COMBINATIONS AMTURNIDE TEKAMLO TEKTURNA TEKTURNA HCT
DIURETICS acetazolamide (generic of DIAMOX) CP12
acetazolamide TABS acetazolamide sodium ALDACTAZIDE amiloride & hydrochlorothiazide amiloride hcl bumetanide chlorothiazide chlorthalidone 25mg, 50mg DIURIL SUS 250/5ML DYRENIUM EDECRIN furosemide SOLN furosemide (generic of LASIX) TABS
furosemide inj furosemide oral soln 8 mg/ml hydrochlorothiazide (generic of MICROZIDE) CAPS
hydrochlorothiazide TABS indapamide TABS methazolamide (generic of NEPTAZANE) TABS
methyclothiazide metolazone (generic of ZAROXOLYN) 2.5mg, 5mg
metolazone 10mg spironolactone & hydrochlorothiazide (generic of ALDACTAZIDE)
torsemide inj torsemide tabs (generic of DEMADEX)
triamterene & hydrochlorothiazide cap 37.5-25 mg (generic of DYAZIDE)
13
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 14
Drug Name Requirements/Limits
triamterene & hydrochlorothiazide tab 37.5-25 mg (generic of MAXZIDE-25)
triamterene & hydrochlorothiazide tab 75-50 mg (generic of MAXZIDE)
MISCELLANEOUS BIDIL clonidine & chlorthalidone clonidine hcl (generic of CATAPRES-TTS-1) PTWK .1mg/24hr
clonidine hcl (generic of CATAPRES-TTS-2) PTWK .2mg/24hr
clonidine hcl (generic of CATAPRES-TTS-3) PTWK .3mg/24hr
clonidine hcl (generic of CATAPRES) TABS
DEMSER NM
DIBENZYLINE hydralazine hcl SOLN; TABS midodrine hcl minoxidil TABS RANEXA
NITRATES DILATRATE SR ISORDIL TITRADOSE 40mg isosorbide dinitrate SUBL isosorbide dinitrate (generic of ISORDIL TITRADOSE) TABS 5mg
isosorbide dinitrate TABS 10mg, 20mg, 30mg
isosorbide dinitrate TBCR isosorbide mononitrate TABS isosorbide mononitrate (generic of IMDUR) TB24
minitran (generic of NITRO-DUR) NITRO-DUR .3mg/hr, .8mg/hr nitroglycerin OINT NITROGLYCERIN SOLN .4mg/spray
NITROGLYCERIN LINGUAL nitroglycerin patches NITROLINGUAL SPR PUMPSPRA
NITROMIST
Drug Name Requirements/Limits
NITROSTAT
PULMONARY ARTERIAL HYPERTENSION ADCIRCA NM
LETAIRIS NM LA
REMODULIN B/D NM LA
sildenafil citrate (pulmonary hypertension) (generic of REVATIO)
NM
TRACLEER NM LA
VENTAVIS B/D NM
CENTRAL NERVOUS SYSTEM ANTIANXIETY alprazolam CONC alprazolam (generic of XANAX) TABS 2mg
alprazolam (generic of XANAX) TABS .25mg, .5mg, 1mg
buspirone hcl TABS fluvoxamine maleate fluvoxamine maleate er (generic of LUVOX CR)
fluvoxamine tabs lorazepam CONC lorazepam (generic of ATIVAN) SOLN
lorazepam (generic of ATIVAN) TABS
ANTICONVULSANTS BANZEL SUSP NM
BANZEL TABS 200mg BANZEL TABS 400mg NM
carbamazepine CHEW carbamazepine (generic of CARBATROL) CP12
carbamazepine (generic of TEGRETOL) SUSP; TABS
carbamazepine (generic of TEGRETOL-XR) TB12
CELONTIN clonazepam (generic of KLONOPIN) TABS 1mg
clonazepam (generic of KLONOPIN) TABS 2mg
clonazepam (generic of KLONOPIN) TABS .5mg
clonazepam TBDP 1mg clonazepam TBDP 2mg clonazepam TBDP .5mg
14
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 15
Drug Name Requirements/Limits
clonazepam TBDP .25mg clonazepam TBDP .125mg clorazepate dipotassium (generic of TRANXENE T) 3.75mg, 7.5mg
clorazepate dipotassium (generic of TRANXENE T) 15mg
diazepam CONC diazepam SOLN diazepam (generic of VALIUM) TABS
DIAZEPAM GEL diazepam inj dilantin CHEW DILANTIN SUSP divalproex sodium (generic of DEPAKOTE SPRINKLES) CPSP
divalproex sodium (generic of DEPAKOTE ER) TB24
divalproex sodium (generic of DEPAKOTE) TBEC
ethosuximide (generic of ZARONTIN) CAPS; SOLN
felbamate (generic of FELBATOL) SUSP
NM
felbamate (generic of FELBATOL) TABS 400mg
felbamate (generic of FELBATOL) TABS 600mg
NM
gabapentin (generic of NEURONTIN) CAPS 100mg
gabapentin (generic of NEURONTIN) CAPS 300mg
gabapentin (generic of NEURONTIN) CAPS 400mg
gabapentin (generic of NEURONTIN) SOLN
gabapentin (generic of NEURONTIN) TABS 600mg
gabapentin (generic of NEURONTIN) TABS 800mg
GABITRIL 12mg, 16mg LAMICTAL ODT LAMICTAL STARTER LAMICTAL XR KIT lamotrigine (generic of LAMICTAL CHEWABLE DISPERS) CHEW
Drug Name Requirements/Limits
lamotrigine (generic of LAMICTAL) TABS
lamotrigine (generic of LAMICTAL XR) TB24
levetiracetam (generic of KEPPRA) SOLN; TABS
levetiracetam (generic of KEPPRA XR) TB24
LYRICA CAPS 25mg, 50mg, 75mg, 100mg, 150mg
LYRICA CAPS 200mg LYRICA CAPS 225mg, 300mg LYRICA SOLN ONFI TABS oxcarbazepine (generic of TRILEPTAL)
PEGANONE phenobarbital ELIX; TABS PHENOBARBITAL SODIUM 65mg/ml
phenobarbital sodium 130mg/ml phenytoin (generic of DILANTIN INFATABS) CHEW
phenytoin (generic of DILANTIN) SUSP
phenytoin inj 50mg/ml phenytoin sodium extended 30mg, 100mg
phenytoin sodium extended (generic of DILANTIN) 100mg
phenytoin sodium extended 200mg, 300mg
phenytoin sodium extended (generic of PHENYTEK) 200mg, 300mg
POTIGA primidone (generic of MYSOLINE) TABS
SABRIL NM LA
STAVZOR TEGRETOL TEGRETOL-XR tiagabine hcl (generic of GABITRIL)
topiramate (generic of TOPAMAX SPRINKLE) CPSP
topiramate (generic of TOPAMAX) TABS
TRILEPTAL SUSP
15
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 16
Drug Name Requirements/Limits
valproate sodium (generic of DEPACON) SOLN
valproate sodium (generic of DEPAKENE) SYRP
valproic acid (generic of DEPAKENE) CAPS
VIMPAT zonisamide (generic of ZONEGRAN) 25mg, 100mg
zonisamide 50mg
ANTIDEMENTIA ARICEPT 23mg donepezil odt 5mg (generic of ARICEPT ODT)
donepezil odt 10mg (generic of ARICEPT ODT)
donepezil tabs 5mg (generic of ARICEPT)
donepezil tabs 10mg (generic of ARICEPT)
EXELON SOLN EXELON PATCHES galantamine hydrobromide (generic of RAZADYNE ER) CP24
galantamine hydrobromide (generic of RAZADYNE) SOLN; TABS
NAMENDA NAMENDA TITRATION PAK NAMENDA XR NAMENDA XR TITRATION PACK
rivastigmine tartrate (generic of EXELON)
ANTIDEPRESSANTS amitriptyline hcl TABS amoxapine APLENZIN bupropion hcl (generic of WELLBUTRIN) TABS
bupropion hcl (generic of WELLBUTRIN SR) TB12
bupropion hcl (generic of WELLBUTRIN XL) TB24
citalopram hydrobromide SOLN citalopram hydrobromide (generic of CELEXA) TABS
clomipramine hcl (generic of ANAFRANIL) CAPS
Drug Name Requirements/Limits
CYMBALTA desipramine hcl (generic of NORPRAMIN) TABS
doxepin hcl CAPS; CONC EMSAM escitalopram oxalate (generic of LEXAPRO)
fluoxetine hcl (generic of PROZAC) CAPS
fluoxetine hcl (generic of PROZAC WEEKLY) CPDR
fluoxetine hcl SOLN fluoxetine hcl TABS 10mg, 20mg
FLUOXETINE HCL TABS 60mg FORFIVO XL imipramine hcl (generic of TOFRANIL) TABS
imipramine pamoate (generic of TOFRANIL-PM)
maprotiline hcl MARPLAN mirtazapine TABS 7.5mg mirtazapine (generic of REMERON) TABS 15mg, 30mg, 45mg
mirtazapine (generic of REMERON SOLTAB) TBDP
nefazodone hcl nortriptyline hcl (generic of PAMELOR) CAPS
nortriptyline hcl SOLN OLEPTRO paroxetine er tab (generic of PAXIL CR)
paroxetine hcl (generic of PAXIL) PAXIL SUSP PEXEVA phenelzine sulfate (generic of NARDIL) TABS
PRISTIQ protriptyline hcl (generic of VIVACTIL)
sertraline hcl (generic of ZOLOFT) CONC; TABS
tranylcypromine sulfate (generic of PARNATE)
trazodone hcl TABS
16
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 17
Drug Name Requirements/Limits
trimipramine maleate (generic of SURMONTIL)
venlafaxine cap er (generic of EFFEXOR XR)
venlafaxine tab venlafaxine tab er (generic of VENLAFAXINE HCL ER)
VIIBRYD
ANTIPARKINSONIAN AGENTS amantadine hcl CAPS; SYRP; TABS
APOKYN NM LA
AZILECT benztropine mesylate (generic of COGENTIN) SOLN
benztropine mesylate TABS bromocriptine mesylate CAPS bromocriptine mesylate (generic of PARLODEL) TABS
carbidopa-levodopa (generic of SINEMET) TABS
carbidopa-levodopa (generic of SINEMET CR) TBCR
carbidopa-levodopa (generic of PARCOPA) TBDP
CARBIDOPA/LEVODOPA/ENTACA
CARBIDOPA/LEVODOPA/ENTACA
CARBIDOPA/LEVODOPA/ENTACA
CARBIDOPA/LEVODOPA/ENTACA
CARBIDOPA/LEVODOPA/ENTACA
CARBIDOPA/LEVODOPA/ENTACA
ENTACAPONE LODOSYN MIRAPEX .75mg MIRAPEX ER NEUPRO PARLODEL CAPS pramipexole dihydrochloride .75mg
pramipexole dihydrochloride (generic of MIRAPEX) .125mg, .25mg, .5mg, 1mg, 1.5mg
ropinirole hydrochloride (generic of REQUIP) TABS
Drug Name Requirements/Limits
ropinirole hydrochloride (generic of REQUIP XL) TB24
selegiline hcl (generic of ELDEPRYL) CAPS
selegiline hcl TABS ZELAPAR
ANTIPSYCHOTICS ABILIFY SOLN NM
ABILIFY TABS 2mg, 5mg, 10mg, 15mg
ABILIFY TABS 20mg, 30mg NM
ABILIFY DISCMELT NM
ABILIFY INJ ABILIFY MAINTENA NM
chlorpromaz inj 25mg/ml chlorpromazine hcl TABS CLOZAPINE ODT clozapine tab (generic of CLOZARIL) 25mg, 100mg
clozapine tab 50mg, 200mg FANAPT FANAPT TITRATION PACK FAZACLO fluphenazine decanoate SOLN fluphenazine hcl GEODON INJ haloperidol TABS haloperidol decanoate (generic of HALDOL DECANOATE 50) SOLN 50mg/ml
haloperidol decanoate (generic of HALDOL DECANOATE 100) SOLN 100mg/ml
haloperidol lactate CONC haloperidol lactate (generic of HALDOL) SOLN
INVEGA INVEGA SUSTENNA 39mg/0.25ml, 78mg/0.5ml
INVEGA SUSTENNA 117mg/0.75ml, 156mg/ml, 234mg/1.5ml
NM
LATUDA loxapine succinate (generic of LOXITANE) CAPS 5mg, 25mg, 50mg
loxapine succinate CAPS 10mg olanzapine (generic of ZYPREXA) SOLR
17
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 18
Drug Name Requirements/Limits
olanzapine (generic of ZYPREXA) TABS
olanzapine odt (generic of ZYPREXA ZYDIS) 5mg, 10mg, 15mg
olanzapine odt (generic of ZYPREXA ZYDIS) 20mg
NM
ORAP perphenazine TABS quetiapine fumarate (generic of SEROQUEL)
RISPERDAL CONSTA 12.5mg, 25mg
RISPERDAL CONSTA 37.5mg, 50mg
NM
risperidone (generic of RISPERDAL)
risperidone odt (generic of RISPERDAL M-TAB) .5mg, 1mg, 2mg, 3mg, 4mg
risperidone odt .25mg SAPHRIS SEROQUEL XR thioridazine hcl TABS thiothixene trifluoperazine hcl ziprasidone hcl (generic of GEODON)
ATTENTION DEFICIT HYPERACTIVITY DISORDER amphetamine-dextroamphetamine cap sr 24hr 5 mg (generic of ADDERALL XR)
amphetamine-dextroamphetamine cap sr 24hr 10 mg (generic of ADDERALL XR)
amphetamine-dextroamphetamine cap sr 24hr 15 mg (generic of ADDERALL XR)
amphetamine-dextroamphetamine cap sr 24hr 20 mg (generic of ADDERALL XR)
amphetamine-dextroamphetamine cap sr 24hr 25 mg (generic of ADDERALL XR)
amphetamine-dextroamphetamine cap sr 24hr 30 mg (generic of ADDERALL XR)
Drug Name Requirements/Limits
amphetamine-dextroamphetamine tab 5 mg (generic of ADDERALL)
amphetamine-dextroamphetamine tab 7.5 mg
amphetamine-dextroamphetamine tab 10 mg (generic of ADDERALL)
amphetamine-dextroamphetamine tab 12.5 mg (generic of ADDERALL)
amphetamine-dextroamphetamine tab 15 mg
amphetamine-dextroamphetamine tab 20 mg (generic of ADDERALL)
amphetamine-dextroamphetamine tab 30 mg (generic of ADDERALL)
DAYTRANA 10mg/9hr, 20mg/9hr, 30mg/9hr
DAYTRANA 15mg/9hr INTUNIV metadate tab 20mg er METHYLIN CHEW TAB methylphenidate hcl (generic of RITALIN LA) CP24 20mg, 30mg
methylphenidate hcl (generic of RITALIN LA) CP24 40mg
methylphenidate hcl (generic of METADATE CD) CPCR 10mg, 20mg, 30mg
methylphenidate hcl (generic of METADATE CD) CPCR 40mg, 50mg, 60mg
methylphenidate hcl (generic of METHYLIN) SOLN 5mg/5ml
methylphenidate hcl (generic of METHYLIN) SOLN 10mg/5ml
methylphenidate hcl (generic of RITALIN) TABS 5mg, 10mg
methylphenidate hcl (generic of RITALIN) TABS 20mg
METHYLPHENIDATE HCL ER 18mg
methylphenidate hcl er (generic of CONCERTA) 27mg, 36mg
methylphenidate hcl er (generic of CONCERTA) 54mg
methylphenidate tab 10mg er methylphenidate tab 20mg er
18
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 19
Drug Name Requirements/Limits
QUILLIVANT XR RITALIN LA 10mg STRATTERA 10mg, 18mg, 25mg
STRATTERA 40mg STRATTERA 60mg, 80mg, 100mg
VYVANSE 20mg, 30mg VYVANSE 40mg, 50mg, 60mg, 70mg
HYPNOTICS EDLUAR INTERMEZZO LUNESTA ROZEREM SILENOR 3mg SILENOR 6mg zaleplon (generic of SONATA) zolpidem tartrate (generic of AMBIEN) TABS
zolpidem tartrate (generic of AMBIEN CR) TBCR
ZOLPIMIST
MIGRAINE ALSUMA AXERT cafergot tab 1-100mg dihydroergotamine mesylate (generic of D.H.E. 45) 1mg/ml
DIHYDROERGOTAMINE MESYLATE 4mg/ml
ergomar ergotamine w/ caffeine FROVA TAB 2.5MG naratriptan hcl (generic of AMERGE)
RELPAX rizatriptan benzoate (generic of MAXALT) TABS
rizatriptan benzoate (generic of MAXALT-MLT) TBDP
SUMATRIPTAN SUCCINATE SOLN
sumatriptan succinate (generic of IMITREX) TABS
SUMATRIPTAN SUCCINATE INJ 4mg/0.5ml
sumatriptan succinate inj (generic of IMITREX) 6mg/0.5ml
Drug Name Requirements/Limits
SUMAVEL DOSEPRO TREXIMET zolmitriptan (generic of ZOMIG) zolmitriptan odt (generic of ZOMIG ZMT)
ZOMIG SOLN ZOMIG TABS ZOMIG ZMT
MISCELLANEOUS EQUETRO GRALISE 300mg GRALISE 600mg GRALISE STARTER HORIZANT lithium carbonate CAPS lithium carbonate TABS lithium carbonate (generic of LITHOBID) TBCR 300mg
lithium carbonate TBCR 450mg LITHIUM CITRATE MESTINON SYRUP MESTINON TIMESPAN NUEDEXTA pyridostigmine bromide (generic of MESTINON) TABS
REGONOL RILUTEK NM
riluzole (generic of RILUTEK) SAVELLA 12.5mg SAVELLA 25mg SAVELLA 50mg SAVELLA 100mg SAVELLA TITRATION PACK XENAZINE NM LA
MULTIPLE SCLEROSIS AGENTS AMPYRA NM LA
AUBAGIO NM
AVONEX NM
AVONEX PEN NM
BETASERON NM
COPAXONE NM
EXTAVIA NM
GILENYA NM
REBIF NM
REBIF TITRATION PACK NM
TECFIDERA 120mg NM
TECFIDERA 240mg NM
TECFIDERA STARTER PACK NM
19
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 20
Drug Name Requirements/Limits
TYSABRI NM LA
MUSCULOSKELETAL THERAPY AGENTS AMRIX 15mg AMRIX 30mg baclofen TABS chlorzoxazone (generic of PARAFON FORTE DSC) TABS
cyclobenzaprine hcl (generic of FLEXERIL) TABS 5mg, 10mg
cyclobenzaprine hcl (generic of FEXMID) TABS 7.5mg
dantrolene sodium (generic of DANTRIUM) CAPS
methocarbamol (generic of ROBAXIN) TABS 500mg
methocarbamol (generic of ROBAXIN-750) TABS 750mg
tizanidine (generic of ZANAFLEX) CAPS
tizanidine TABS 2mg tizanidine (generic of ZANAFLEX) TABS 4mg
NARCOLEPSY/CATAPLEXY modafinil (generic of PROVIGIL) 100mg
modafinil (generic of PROVIGIL) 200mg
NM
NUVIGIL XYREM NM LA
PSYCHOTHERAPEUTIC-MISC buprenorphine hcl SUBL buprenorphine hcl-naloxone hcl sl (generic of SUBOXONE)
bupropion hcl (smoking deterrent) (generic of ZYBAN)
CAMPRAL CHANTIX CHANTIX STARTER PACK disulfiram (generic of ANTABUSE) TABS
naloxone hcl SOLN naltrexone hcl (generic of REVIA) TABS
NICOTROL INHALER NICOTROL NS SARAFEM SUBOXONE MIS 2-0.5MG SUBOXONE MIS 4-1MG SUBOXONE MIS 8-2MG
Drug Name Requirements/Limits
SUBOXONE MIS 12-3MG VIVITROL NM
ENDOCRINE AND METABOLIC ANDROGENS ANDRODERM ANDROGEL 1% ANDROGEL 1.62% AXIRON fluoxymesterone TABS FORTESTA oxandrolone (generic of OXANDRIN) TABS
STRIANT TESTIM testosterone cypionate OIL testosterone enanthate (generic of DELATESTRYL) OIL
ANTIDIABETICS, INJECTABLE ALCOHOL PREPS PADS APIDRA APIDRA SOLOSTAR BYDUREON BYETTA GAUZE PADS 2X2 HUMALOG HUMALOG KWIKPEN HUMALOG MIX 50/50 HUMALOG MIX 50/50 KWIKPEN HUMALOG MIX 75/25 HUMALOG MIX 75/25 KWIKPEN HUMULIN 70/30 HUMULIN 70/30 PEN HUMULIN N HUMULIN N U-100 PEN HUMULIN R HUMULIN R U-500 (CONCENTRATE)
B/D NM
INSULIN PEN NEEDLES INSULIN SAFETY NEEDLES INSULIN SYRINGES LANTUS LANTUS SOLOSTAR LEVEMIR LEVEMIR FLEXPEN NOVOLIN 70/30 NOVOLIN 70/30 RELION NOVOLIN N
20
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 21
Drug Name Requirements/Limits
NOVOLIN N RELION NOVOLIN R NOVOLIN R RELION NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX 70/30 NOVOLOG MIX 70/30 PREFILL SYMLINPEN 60 SYMLINPEN 120 VICTOZA
ANTIDIABETICS, ORAL acarbose (generic of PRECOSE) ACTOPLUS MET XR 15-1000MG ACTOPLUS MET XR 30-1000MG glimepiride (generic of AMARYL) 1mg
glimepiride (generic of AMARYL) 2mg
glimepiride (generic of AMARYL) 4mg
glipizide (generic of GLUCOTROL) TABS 5mg
glipizide (generic of GLUCOTROL) TABS 10mg
glipizide er (generic of GLUCOTROL XL) 2.5mg
glipizide er (generic of GLUCOTROL XL) 5mg
glipizide er (generic of GLUCOTROL XL) 10mg
glipizide-metformin 2.5-250mg (generic of METAGLIP)
glipizide-metformin 2.5-500mg glipizide-metformin 5-500mg GLUMETZA 500mg GLUMETZA 1000mg glyburide 1.25mg glyburide 2.5mg glyburide 5mg glyburide micronized (generic of GLYNASE) 1.5mg
glyburide micronized (generic of GLYNASE) 3mg
glyburide micronized (generic of GLYNASE) 6mg
glyburide-metformin 1.25-250mg (generic of GLUCOVANCE)
glyburide-metformin 2.5-500mg (generic of GLUCOVANCE)
Drug Name Requirements/Limits
glyburide-metformin 5-500mg (generic of GLUCOVANCE)
GLYSET INVOKANA 100mg INVOKANA 300mg JANUMET JANUMET XR TAB 50-500MG JANUMET XR TAB 50-1000 JANUMET XR TAB 100-1000 JANUVIA JENTADUETO JUVISYNC KAZANO KOMBIGLYZE XR 2.5-1000MG KOMBIGLYZE XR 5-500MG KOMBIGLYZE XR 5-1000MG metformin er (generic of GLUCOPHAGE XR) 500mg
metformin er (generic of GLUCOPHAGE XR) 750mg
metformin hcl (generic of GLUCOPHAGE) TABS 500mg
metformin hcl (generic of GLUCOPHAGE) TABS 850mg
metformin hcl (generic of GLUCOPHAGE) TABS 1000mg
metformin hcl (generic of FORTAMET) TB24 500mg
metformin hcl (generic of FORTAMET) TB24 1000mg
nateglinide (generic of STARLIX) NESINA 6.25mg NESINA 12.5mg NESINA 25mg ONGLYZA OSENI TAB 12.5-15MG OSENI TAB 12.5-30MG OSENI TAB 12.5-45MG OSENI TAB 25-15MG OSENI TAB 25-30MG OSENI TAB 25-45MG pioglitazone hcl (generic of ACTOS)
pioglitazone hcl-glimepiride (generic of DUETACT)
pioglitazone hcl-metformin hcl (generic of ACTOPLUS MET)
PRANDIMET
21
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 22
Drug Name Requirements/Limits
PRANDIN 2mg PRANDIN .5mg, 1mg RIOMET TRADJENTA
BISPHOSPHONATES ACTONEL alendronate sodium SOLN alendronate sodium TABS 5mg, 10mg, 35mg, 40mg
alendronate sodium (generic of FOSAMAX) TABS 70mg
ATELVIA BINOSTO BONIVA SOLN B/D
FOSAMAX PLUS D ibandronate sodium (generic of BONIVA)
B/D
pamidronate disodium SOLN 6mg/ml
B/D
pamidronate disodium SOLN 30mg/10ml, 90mg/10ml
B/D
zoledronic inj 4mg/5ml (generic of ZOMETA)
B/D NM
ZOMETA B/D NM
CALCIUM RECEPTOR ANTAGONISTS SENSIPAR 30mg NM
SENSIPAR 60mg, 90mg NM
CHELATING AGENTS CHEMET EXJADE NM LA
FERRIPROX NM
kionex (generic of KAYEXALATE) POWD
kionex SUSP sodium polystyrene sulfonate sps sus 15gm/60ml SYPRINE NM
CONTRACEPTIVES altavera BEYAZ CAMRESE LO TAB DEPO-SUBQ PROVERA 104 desogestrel & ethinyl estradiol (generic of DESOGEN)
desogestrel-ethinyl estradiol (biphasic) (generic of MIRCETTE)
Drug Name Requirements/Limits
desogestrel-ethinyl estradiol (triphasic) (generic of CYCLESSA)
drospirenone-ethinyl estradiol (generic of YASMIN 28)
drospirenone-ethinyl estradiol (generic of YAZ)
ELLA ethynodiol diacet & eth estrad GENERESS FE GIANVI heather tab 0.35mg (generic of NOR-QD)
JOLIVETTE LEENA levonorgestrel & eth estradiol levonorgestrel-eth estradiol (triphasic)
levonorgestrel-ethinyl estradiol (91-day)
levonorgestrel-ethinyl estradiol (91-day) (generic of SEASONIQUE)
levonorgestrel-ethinyl estradiol (continuous)
LO LOESTRIN FE LOESTRIN 24 FE medroxyprogesterone acetate (contraceptive) (generic of DEPO-PROVERA CONTRACEPTIV)
MINASTRIN 24 FE MONONESSA myzilra NECON 1/50-28 NECON 7/7/7 necon 10/11 28 day next choice tab 1.5mg (generic of PLAN B ONE-STEP)
NORA-BE norethin acet & estrad-fe (generic of LOESTRIN FE 1.5/30)
norethin acet & estrad-fe (generic of LOESTRIN FE 1/20)
norethindrone & eth estradiol (generic of BREVICON-28)
norethindrone & eth estradiol (generic of NORINYL 1+35)
22
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 23
Drug Name Requirements/Limits
norethindrone & eth estradiol (generic of OVCON-35)
norethindrone & ethinyl estradiol-fe (generic of FEMCON FE)
norethindrone (contraceptive) (generic of NOR-QD) .35mg
norethindrone (contraceptive) (generic of ORTHO MICRONOR) .35mg
norethindrone acet & eth estra (generic of LOESTRIN 1.5/30-21)
norethindrone acet & eth estra (generic of LOESTRIN 1/20-21)
norethindrone acetate-ethinyl estradiol-fe (generic of ESTROSTEP FE)
norethindrone-eth estradiol (triphasic) (generic of ORTHO-NOVUM 7/7/7)
norethindrone-eth estradiol (triphasic) (generic of TRI-NORINYL 28)
norgestimate-ethinyl estradiol (generic of ORTHO-CYCLEN)
norgestimate-ethinyl estradiol (triphasic) (generic of ORTHO TRI-CYCLEN)
norgestrel & ethinyl estradiol NORINYL 1+50 NUVARING OCELLA ORTHO EVRA ORTHO TRI-CYCLEN LO philith (generic of OVCON-35) QUARTETTE SOLIA syeda (generic of YASMIN 28) TRINESSA vestura (generic of YAZ) viorele (generic of MIRCETTE) zarah (generic of YASMIN 28) zenchent tab (generic of OVCON-35)
zovia
ENDOMETRIOSIS danazol CAPS SYNAREL NM
ENZYME REPLACEMENTS
Drug Name Requirements/Limits
ADAGEN NM LA
ALDURAZYME NM LA
BUPHENYL TAB 500MG NM
CARBAGLU NM LA
CEREZYME NM
CYSTADANE NM
CYSTAGON NM
ELAPRASE NM
ELELYSO NM
FABRAZYME NM
KUVAN NM
levocarnitine (metabolic modifiers) (generic of CARNITOR)
B/D
LUMIZYME NM
MYOZYME NM
NAGLAZYME NM LA
ORFADIN NM LA
PROCYSBI NM LA
sodium phenylbutyrate (generic of BUPHENYL)
NM
VPRIV NM
ZAVESCA NM LA
ESTROGEN/PROGESTINS estradiol & norethindrone acetate (generic of ACTIVELLA)
norethindrone acetate-ethinyl estradiol
ESTROGENS ALORA COMBIPATCH DELESTROGEN 10mg/ml estradiol (generic of CLIMARA) PTWK
estradiol (generic of ESTRACE) TABS
estradiol cypionate OIL estradiol vaginal ESTRADIOL VALERATE OIL 10mg/ml
estradiol valerate (generic of DELESTROGEN) OIL 20mg/ml, 40mg/ml
ESTRING estropipate TABS FEMRING menest MENOSTAR MINIVELLE
23
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 24
Drug Name Requirements/Limits
PREMARIN PREMARIN CREAM PREMARIN INJ PREMPHASE PREMPRO VAGIFEM VIVELLE-DOT
GLUCOCORTICOIDS a-hydrocort inj 100mg CELESTONE cortisone acetate TABS DEPO-MEDROL 20mg/ml dexamethasone CONC dexamethasone ELIX; SOLN; TABS
dexamethasone sodium phosphate
dexpak taperpak 13 day FLO-PRED fludrocortisone acetate TABS hydrocortisone (generic of CORTEF) TABS
MEDROL 2mg methylprednisolone (generic of MEDROL DOSEPAK) TABS 4mg
methylprednisolone (generic of MEDROL) TABS 4mg, 8mg, 16mg, 32mg
methylprednisolone acetate (generic of DEPO-MEDROL)
methylprednisolone sod succ (generic of SOLU-MEDROL)
ORAPRED ODT prednisolone (generic of PRELONE) SOLN
prednisolone TABS prednisolone sodium phosphate (generic of PEDIAPRED) 5mg/5ml
prednisolone sodium phosphate 10mg/5ml
prednisolone sodium phosphate (generic of ORAPRED) 15mg/5ml
prednisolone sodium phosphate 25mg/5ml
prednisone CONC prednisone SOLN; TABS
Drug Name Requirements/Limits
RAYOS SOLU-CORTEF 100MG SOLU-CORTEF 250MG SOLU-CORTEF 500MG SOLU-CORTEF 1000MG SOLU-MEDROL 2gm veripred
GLUCOSE ELEVATING AGENTS GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT PROGLYCEM NM
HUMAN GROWTH HORMONES GENOTROPIN NM
GENOTROPIN MINIQUICK .2mg
NM
GENOTROPIN MINIQUICK .4mg, .6mg, .8mg, 1mg, 1.2mg, 1.4mg, 1.6mg, 1.8mg, 2mg
NM
HUMATROPE NM
HUMATROPE COMBO PACK NM
NORDITROPIN FLEXPRO NM
NORDITROPIN NORDIFLEX PEN
NM
NUTROPIN NM
NUTROPIN AQ NM
NUTROPIN AQ NUSPIN 5 NM
NUTROPIN AQ PEN NM
OMNITROPE 5.8MG NM
OMNITROPE 5MG NM
OMNITROPE 10MG NM
SAIZEN NM
SAIZEN CLICK.EASY NM
SEROSTIM NM
TEV-TROPIN NM
ZORBTIVE NM
MISCELLANEOUS cabergoline calcitonin (salmon) nasal spray (generic of MIACALCIN)
CHORIONIC GONADOTROPIN SOLR
NM
EGRIFTA NM
FORTICAL SPR 200/ACT INCRELEX NM LA
methylergonovine maleate (generic of METHERGINE) TABS
MIACALCIN INJ 200U/ML B/D
NOVAREL INJ 10000UNT NM
24
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 25
Drug Name Requirements/Limits
octreotide acetate (generic of SANDOSTATIN) 50mcg/ml, 100mcg/ml, 200mcg/ml
NM
octreotide acetate (generic of SANDOSTATIN) 500mcg/ml, 1000mcg/ml
NM
PREGNYL W/DILUENT BENZYL NM
PROLIA NM
SAMSCA NM
SANDOSTATIN LAR DEPOT NM
SOMATULINE DEPOT NM
SOMAVERT NM LA
XGEVA NM
PARATHYROID HORMONES FORTEO NM
PHOSPHATE BINDER AGENTS calcium acetate (phosphate binder) (generic of PHOSLO) CAPS
calcium acetate (phosphate binder) (generic of ELIPHOS) TABS
FOSRENOL PHOSLYRA RENAGEL RENVELA
PROGESTINS CRINONE ENDOMETRIN medroxyprogesterone acetate (generic of PROVERA)
norethindrone acetate (generic of AYGESTIN) TABS
progesterone micronized (generic of PROMETRIUM) CAPS
SELECTIVE ESTROGEN RECEPTOR MODULATORS EVISTA
THYROID AGENTS LEVOTHROID levothyroxine sodium (generic of SYNTHROID) TABS
LEVOXYL liothyronine sodium (generic of TRIOSTAT) SOLN
liothyronine sodium (generic of CYTOMEL) TABS
methimazole (generic of TAPAZOLE) TABS
Drug Name Requirements/Limits
propylthiouracil TABS SYNTHROID TIROSINT UNITHROID
VASOPRESSINS DESMOPRESSIN ACETATE SOLN
desmopressin acetate (generic of DDAVP) TABS
desmopressin acetate inj (generic of DDAVP)
desmopressin acetate spray (generic of DDAVP)
desmopressin acetate spray refrigerated
STIMATE NM
GASTROINTESTINAL ANTIEMETICS ALOXI NM
ANTIVERT 50mg CESAMET B/D NM
compro supp dronabinol (generic of MARINOL) 2.5mg, 5mg
B/D
dronabinol (generic of MARINOL) 10mg
B/D NM
EMEND CAPS 40mg EMEND CAPS 80mg B/D
EMEND CAPS 125mg B/D
EMEND PAK 80 & 125 B/D
granisetron hcl SOLN 2mg/10ml B/D NM
granisetron hcl SOLN .1mg/ml, 1mg/ml
granisetron hcl TABS B/D
meclizine hcl (generic of ANTIVERT)
metoclopramide hcl SOLN metoclopramide hcl (generic of REGLAN) TABS
metoclopramide hcl inj 5 mg/ml METOZOLV ODT ondansetron hcl (generic of ZOFRAN) TABS 4mg, 8mg
B/D
ondansetron hcl TABS 24mg B/D
ondansetron hcl inj 4mg/2ml ondansetron hcl inj (generic of ZOFRAN) 40mg/20ml
ondansetron hcl oral soln (generic of ZOFRAN)
B/D
25
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 26
Drug Name Requirements/Limits
ondansetron odt (generic of ZOFRAN ODT)
B/D
prochlorperazine inj 5 mg/ml prochlorperazine maleate TABS prochlorperazine supp promethazine hcl (generic of PHENERGAN) SOLN
promethazine hcl SUPP; SYRP; TABS
SANCUSO NM
TRANSDERM-SCOP
ANTISPASMODICS ATROPINE SULFATE SOLN .05mg/ml, .1mg/ml
BENTYL SOLN CANTIL CUVPOSA dicyclomine hcl (generic of BENTYL) CAPS; TABS
dicyclomine hcl SOLN glycopyrrolate (generic of ROBINUL) SOLN
glycopyrrolate (generic of ROBINUL) TABS 1mg
glycopyrrolate (generic of ROBINUL FORTE) TABS 2mg
methscopolamine bromide (generic of PAMINE) TABS 2.5mg
methscopolamine bromide (generic of PAMINE FORTE) TABS 5mg
H2-RECEPTOR ANTAGONISTS cimetidine TABS cimetidine inj 150mg/ml cimetidine sol 300/5ml famotidine SOLN famotidine (generic of PEPCID) SUSR
famotidine (generic of PEPCID) TABS 20mg, 40mg
nizatidine CAPS 150mg nizatidine (generic of AXID) CAPS 300mg
nizatidine (generic of AXID) SOLN
ranitidine hcl CAPS ranitidine hcl (generic of ZANTAC) SOLN
Drug Name Requirements/Limits
ranitidine hcl (generic of ZANTAC) SYRP
ranitidine hcl (generic of ZANTAC) TABS 150mg, 300mg
INFLAMMATORY BOWEL DISEASE APRISO ASACOL ASACOL HD balsalazide disodium (generic of COLAZAL)
budesonide (generic of ENTOCORT EC) CP24
NM
CANASA DELZICOL DIPENTUM NM
GIAZO hydrocortisone (intrarectal) (generic of CORTENEMA) 100mg/60ml
HYDROCORTISONE (INTRARECTAL) 100mg/60ml
LIALDA mesalamine enema mesalamine enema kit (generic of ROWASA)
PENTASA SFROWASA sulfasalazine dr (generic of AZULFIDINE EN-TABS)
sulfasalazine ir (generic of AZULFIDINE)
UCERIS
LAXATIVES COLYTE-FLAVOR PACKS GOLYTELY HALFLYTELY BOWEL PREP/FLA
kristalose pak lactulose lactulose (encephalopathy) MOVIPREP NULYTELY/FLAVOR PACKS OSMOPREP peg 3350-kcl-sod bicarb-sod chloride-sod sulfate (generic of COLYTE-FLAVOR PACKS)
PEG 3350-KCL-SOD BICARB-SOD CHLORIDE-SOD SULFATE
26
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 27
Drug Name Requirements/Limits
peg 3350-kcl-sod bicarb-sod chloride-sod sulfate (generic of GOLYTELY)
peg 3350-potassium chloride-sod bicarbonate-sod chloride (generic of NULYTELY/FLAVOR PACKS)
polyethylene glycol 3350 PACK; POWD
PREPOPIK RELISTOR SUCLEAR SUPREP BOWEL PREP VISICOL
MISCELLANEOUS AMITIZA CARAFATE SUSP cromolyn sodium (mastocytosis) (generic of GASTROCROM)
NM
diphenoxylate w/ atropine LIQD diphenoxylate w/ atropine (generic of LOMOTIL) TABS
GATTEX NM LA
HELIDAC NM
LINZESS CAP 145MCG LINZESS CAP 290MCG loperamide hcl CAPS LOTRONEX NM
misoprostol (generic of CYTOTEC)
OMECLAMOX-PAK PREVPAC PYLERA SUCRAID NM
sucralfate (generic of CARAFATE) TABS
ursodiol (generic of ACTIGALL) CAPS
ursodiol (generic of URSO 250) TABS 250mg
ursodiol (generic of URSO FORTE) TABS 500mg
XIFAXAN TAB 550MG NM
PANCREATIC ENZYMES CREON PANCREAZE PERTZYE ULTRESA VIOKACE 10440 UNIT VIOKACE 20880 UNIT NM
Drug Name Requirements/Limits
ZENPEP
PROTON PUMP INHIBITORS ACIPHEX DEXILANT lansoprazole (generic of PREVACID) CPDR
NEXIUM NEXIUM GRANULES 2.5MG DR NEXIUM GRANULES 5MG DR NEXIUM GRANULES 10MG DR NEXIUM GRANULES 20MG DR NEXIUM GRANULES 40MG DR NEXIUM I.V. omeprazole (generic of PRILOSEC) CPDR 10mg, 40mg
omeprazole (generic of PRILOSEC) CPDR 20mg
pantoprazole sodium (generic of PROTONIX) SOLR
pantoprazole sodium (generic of PROTONIX) TBEC
PREVACID SOLUTAB PROTONIX PACK ZEGERID PACK
GENITOURINARY BENIGN PROSTATIC HYPERPLASIA alfuzosin hcl (generic of UROXATRAL)
AVODART CARDURA XL finasteride (generic of PROSCAR) TABS 5mg
JALYN RAPAFLO tamsulosin hcl (generic of FLOMAX)
MISCELLANEOUS bethanechol chloride (generic of URECHOLINE) TABS
ELMIRON POTASSIUM CITRATE (ALKALINIZER) 540mg
POTASSIUM CITRATE (ALKALINIZER) 1080mg
UROCIT-K
URINARY ANTISPASMODICS DETROL LA ENABLEX
27
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 28
Drug Name Requirements/Limits
GELNIQUE MYRBETRIQ oxybutynin chloride SYRP; TABS
oxybutynin chloride (generic of DITROPAN XL) TB24
OXYTROL tolterodine tartrate (generic of DETROL)
TOVIAZ trospium chloride (generic of SANCTURA XR) CP24
trospium chloride (generic of SANCTURA) TABS
VESICARE
VAGINAL ANTI-INFECTIVES CLEOCIN VAG SUPP 100MG clindamycin cre 2% vag (generic of CLEOCIN)
metronidazole vaginal (generic of METROGEL-VAGINAL)
miconazole nitrate vaginal terconazole vaginal (generic of TERAZOL 7) CREA .4%
terconazole vaginal (generic of TERAZOL 3) CREA .8%
terconazole vaginal (generic of TERAZOL 3) SUPP
VANDAZOLE ZAZOLE
HEMATOLOGIC ANTICOAGULANTS COUMADIN COUMADIN INJ ELIQUIS enoxaparin sodium (generic of LOVENOX) 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml, 80mg/0.8ml, 300mg/3ml
enoxaparin sodium (generic of LOVENOX) 100mg/ml, 120mg/0.8ml, 150mg/ml
NM
fondaparinux sodium (generic of ARIXTRA) 2.5mg/0.5ml
fondaparinux sodium (generic of ARIXTRA) 5mg/0.4ml, 7.5mg/0.6ml, 10mg/0.8ml
NM
FRAGMIN 2500unit/0.2ml, 5000unit/0.2ml
Drug Name Requirements/Limits
FRAGMIN 7500unit/0.3ml, 10000unit/ml, 12500unit/0.5ml, 15000unit/0.6ml, 18000unt/0.72ml, 25000unit/ml
NM
HEP SOD/NACL INJ 25000 HEPARIN (PORCINE) IN SODIUM CHLORIDE 100U/ML
heparin sod inj 1000u/ml B/D
HEPARIN SOD INJ 2000U/ML B/D
HEPARIN SOD INJ 2500U/ML B/D
heparin sod inj 5000u/0.5ml B/D
heparin sod inj 5000u/ml B/D
heparin sod inj 10000u/ml B/D
heparin sod inj 20000u/ml B/D
HEPARIN SODIUM/D5W HEPARIN SODIUM/SODIUM CHL
PRADAXA warfarin sodium (generic of COUMADIN)
XARELTO
HEMATOPOIETIC GROWTH FACTORS ARANESP ALBUMIN FREE 25mcg/0.42ml, 25mcg/ml, 40mcg/0.4ml, 40mcg/ml, 60mcg/0.3ml, 60mcg/ml
NM
ARANESP ALBUMIN FREE 100mcg/0.5ml, 100mcg/ml, 150mcg/0.3ml, 150mcg/0.75ml, 200mcg/0.4ml, 200mcg/ml, 300mcg/0.6ml, 300mcg/ml, 500mcg/ml
NM
EPOGEN NM
LEUKINE NM
MOZOBIL NM
NEULASTA NM
NEUMEGA NM
NEUPOGEN NM
PROCRIT 2000unit/ml, 3000unit/ml, 4000unit/ml, 10000unit/ml
NM
PROCRIT 20000unit/ml, 40000unit/ml
NM
MISCELLANEOUS anagrelide hcl 1mg anagrelide hcl (generic of AGRYLIN) .5mg
cilostazol (generic of PLETAL) pentoxifylline (generic of TRENTAL) TBCR
28
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 29
Drug Name Requirements/Limits
PROMACTA NM LA
tranexamic acid (generic of CYKLOKAPRON) SOLN
tranexamic acid (generic of LYSTEDA) TABS
PLATELET AGGREGATION INHIBITORS AGGRENOX BRILINTA clopidogrel bisulfate (generic of PLAVIX)
dipyridamole (generic of PERSANTINE) TABS
EFFIENT
IMMUNOLOGIC AGENTS DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (DMARDS) ACTEMRA NM
CIMZIA NM
ENBREL NM
HUMIRA NM
HUMIRA PEN NM
HUMIRA PEN-CROHNS STARTER KIT
NM
HUMIRA PEN-PSORIASIS STARTER KIT
NM
hydroxychloroquine sulfate (generic of PLAQUENIL)
KINERET NM
leflunomide (generic of ARAVA) TABS
methotrexate sodium B/D
methotrexate sodium tabs ORENCIA NM
REMICADE NM
RHEUMATREX SIMPONI 50mg/0.5ml NM
XELJANZ NM
IMMUNOGLOBULINS CARIMUNE NANOFILTERED NM
FLEBOGAMMA NM
FLEBOGAMMA DIF NM
GAMASTAN S/D B/D NM
GAMMAGARD LIQUID NM
GAMMAGARD S/D NM
GAMMAKED NM
GAMMAPLEX NM
GAMUNEX NM
GAMUNEX-C NM
GAMUNEX-C 1GM/10ML NM
Drug Name Requirements/Limits
OCTAGAM NM
PRIVIGEN NM
IMMUNOMODULATORS ACTIMMUNE NM LA
ARCALYST NM
INFERGEN NM
INTRON-A B/D NM
INTRON-A W/DILUENT B/D NM
PEG-INTRON NM
PEG-INTRON REDIPEN NM
PEGASYS NM
PEGASYS PROCLICK NM
REVLIMID NM LA
THALOMID NM
IMMUNOSUPPRESSANTS ATGAM B/D
azathioprine (generic of IMURAN) TABS 50mg
B/D
azathioprine TABS 75mg, 100mg
B/D
azathioprine inj 100mg B/D
CELLCEPT SUSR B/D NM
CELLCEPT INTRAVENOUS B/D
cyclosporine (generic of SANDIMMUNE) CAPS; SOLN
B/D
cyclosporine modified (for microemulsion) (generic of NEORAL) CAPS 25mg, 100mg
B/D
cyclosporine modified (for microemulsion) CAPS 50mg
B/D
cyclosporine modified (for microemulsion) (generic of NEORAL) SOLN
B/D
mycophenolate mofetil (generic of CELLCEPT)
B/D
MYFORTIC 180mg B/D
MYFORTIC 360mg B/D NM
NEORAL B/D
NULOJIX B/D NM
PROGRAF CAPS 5mg B/D NM
PROGRAF CAPS .5mg, 1mg B/D
PROGRAF SOLN B/D
RAPAMUNE SOLN B/D NM
RAPAMUNE TABS 1mg, 2mg B/D NM
RAPAMUNE TABS .5mg B/D
SANDIMMUNE CAPS B/D
SANDIMMUNE SOLN B/D
SIMULECT B/D
tacrolimus (generic of PROGRAF) CAPS 5mg
B/D NM
29
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 30
Drug Name Requirements/Limits
tacrolimus (generic of PROGRAF) CAPS .5mg, 1mg
B/D
THYMOGLOBULIN B/D NM
ZORTRESS B/D NM
VACCINES ACTHIB ADACEL BOOSTRIX CERVARIX COMVAX DAPTACEL DECAVAC B/D
DIPHTHERIA/TETANUS TOXOID
B/D
ENGERIX-B SUSP B/D
GARDASIL HAVRIX HIBERIX IMOVAX RABIES (H.D.C.V.) INFANRIX IPOL INACTIVATED IPV IXIARO M-M-R II W/DILUENT 10 DOS MENACTRA MENHIBRIX MENOMUNE-A/C/Y/W-135 MENVEO PEDVAX HIB PROQUAD RABAVERT RECOMBIVAX HB B/D
ROTATEQ SYNAGIS NM
TETANUS TOXOID ADSORBED B/D
TETANUS/DIPHTHERIA TOXOID
B/D
TWINRIX B/D
TYPHIM VI VAQTA VARIVAX YF-VAX ZOSTAVAX
NUTRITIONAL/SUPPLEMENTS ELECTROLYTES ammonium chloride SOLN KLOR-CON 8 KLOR-CON 10
Drug Name Requirements/Limits
klor-con m15 klor-con m20 MAGNESIUM SULFATE SOLN 40mg/ml, 80mg/ml
magnesium sulfate SOLN 50% MAGNESIUM SULFATE IN D5W 1%
MAGNESIUM SULFATE IN D5W 2%
POTASSIUM CHLORIDE TBCR potassium chloride caps er (generic of MICRO-K)
potassium chloride microencapsulated crystals cr
SOD FLUORIDE 2.2MG TAB SODIUM CHLORIDE SOLN 2.5meq/ml
TPN ELECTROLYTES B/D
IV NUTRITION AMINOSYN B/D
AMINOSYN 7%/ELECTROLYTES
B/D
AMINOSYN II B/D
AMINOSYN II 8.5%/ELECTROL B/D
AMINOSYN INJ 8.5/LYTE B/D
AMINOSYN M B/D
AMINOSYN-HBC B/D
AMINOSYN-PF B/D
AMINOSYN-PF 7% B/D
AMINOSYN-RF B/D
CLINIMIX 2.75%/DEXTROSE 5% B/D
CLINIMIX 4.25%/DEXTROSE 5% B/D
CLINIMIX 4.25%/DEXTROSE 10%
B/D
CLINIMIX 4.25%/DEXTROSE 20%
B/D
CLINIMIX 4.25%/DEXTROSE 25%
B/D
CLINIMIX 5%/DEXTROSE 15% B/D
CLINIMIX 5%/DEXTROSE 20% B/D
CLINIMIX 5%/DEXTROSE 25% B/D
CLINIMIX E 2.75%/DEXTROSE 5%
B/D
CLINIMIX E 2.75%/DEXTROSE 10%
B/D
CLINIMIX E 4.25%/DEXTROSE B/D
CLINIMIX E 4.25%/DEXTROSE 5%
B/D
CLINIMIX E 4.25%/DEXTROSE 25%
B/D
30
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 31
Drug Name Requirements/Limits
CLINIMIX E 5%/DEXTROSE 15%
B/D
CLINIMIX E 5%/DEXTROSE 20%
B/D
CLINIMIX E 5%/DEXTROSE 25%
B/D
clinisol sf 15% B/D
FREAMINE HBC 6.9% B/D
FREAMINE III B/D
HEPATAMINE B/D
hepatasol 8 B/D
INTRALIPID INJ 20% B/D
INTRALIPID INJ 30% B/D
NEPHRAMINE B/D
premasol 6% B/D
premasol 10% B/D
PROCALAMINE B/D
PROSOL B/D
travasol B/D
TROPHAMINE B/D
IV REPLACEMENT SOLUTIONS DEXTROSE SOLN 50% dextrose SOLN 70% DEXTROSE 2.5%/NACL 0.45% DEXTROSE 5% DEXTROSE 5% /ELECTROLYTE DEXTROSE 5%/LACTATED RING
DEXTROSE 5%/NACL 0.2% DEXTROSE 5%/NACL 0.3% DEXTROSE 5%/NACL 0.9% DEXTROSE 5%/NACL 0.33% DEXTROSE 5%/NACL 0.45% DEXTROSE 5%/NACL 0.225% DEXTROSE 5%/POTASSIUM CHL
DEXTROSE 10% FLEX CONTAIN
DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%
DEXTROSE 10%/NACL 0.45% electrolyte-m in dextrose ELECTROLYTE-M IN DEXTROSE
ELECTROLYTE-R IN DEXTROSE
IONOSOL-B/DEXTROSE 5% IONOSOL-MB/DEXTROSE 5% ISOLYTE P
Drug Name Requirements/Limits
isolyte s KCL0.15%/D5W/NACL0.2% KCL0.15%/D5W/NACL0.225% kcl 0.3%/d5w/lr iv lac ri KCL 0.3%/D5W/NACL 0.9% KCL 0.3%/D5W/NACL 0.45% KCL 0.15%/D5W/LR KCL 0.15%/D5W/NACL 0.9% KCL 0.075%/D5W/NACL 0.45% KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ
kcl 20 meq/l (0.15%) in nacl 0.45% inj
KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ
KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.2% INJ
KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.2% INJ
KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ
LACTATED RINGERS VIAFLEX NORMOSOL-R PLASMA-LYTE A PLASMA-LYTE-56/D5W PLASMA-LYTE-148 POTASSIUM CHLORIDE SOLN 10meq/100ml, 20meq/100ml, 30meq/100ml
potassium chloride (generic of POTASSIUM CHLORIDE) SOLN 40meq/100ml
potassium chloride SOLN .4meq/ml, 2meq/ml, 10meq/50ml
POTASSIUM CHLORIDE 0.3%/D POTASSIUM CHLORIDE 0.15% POTASSIUM CHLORIDE 0.22% RINGER'S SODIUM CHLORIDE SOLN .9%, 3%, 5%
SODIUM CHLORIDE 0.45% VIA
VITAMINS calcitriol (generic of ROCALTROL) CAPS
B/D
calcitriol SOLN 1mcg/ml B/D
31
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 32
Drug Name Requirements/Limits
calcitriol (generic of ROCALTROL) SOLN 1mcg/ml
B/D
HECTOROL CAPS B/D
HECTOROL SOLN B/D
PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC)
ZEMPLAR CAPS 1mcg, 2mcg B/D
ZEMPLAR CAPS 4mcg B/D NM
ZEMPLAR SOLN B/D
OPHTHALMIC ANTI-INFECTIVE/ANTI-INFLAMMATORY bacitracin-poly-neomycin-hc blephamide OINT BLEPHAMIDE SUSP neomycin-polymy-dexameth (generic of MAXITROL)
neomycin-polymyxin-hc (ophth) PRED-G PRED-G S.O.P. sulfacetamide sod-prednisolone TOBRADEX OINT TOBRADEX ST tobramycin-dexamethasone (generic of TOBRADEX)
ZYLET
ANTI-INFECTIVES AZASITE bacitracin (ophthalmic) bacitracin-polymyxin b (ophth) BESIVANCE CILOXAN OIN 0.3% OP ciprofloxacin hcl (ophth) (generic of CILOXAN)
erythromycin (ophth) gentamicin sulfate (ophth) OINT gentamicin sulfate (ophth) (generic of GARAMYCIN) SOLN
levofloxacin (ophth) MOXEZA NATACYN neomycin-bacitracin zn-polymyxin neomycin-polymy-gramicid (generic of NEOSPORIN)
ofloxacin (ophth) (generic of OCUFLOX)
polymyxin b-trimethoprim (generic of POLYTRIM)
Drug Name Requirements/Limits
sulfacetamide sodium (ophth) OINT
sulfacetamide sodium (ophth) (generic of BLEPH-10) SOLN
tobramycin sulfate (ophth) (generic of TOBREX)
TOBREX OINT 0.3% trifluridine (generic of VIROPTIC) SOLN
VIGAMOX ZIRGAN ZYMAXID
ANTI-INFLAMMATORIES ACUVAIL ALREX BROMDAY bromfenac sodium (ophth) dexamethasone sodium phosphate (ophth)
diclofenac sodium (ophth) DUREZOL FLAREX FLUOROMETHOLONE SUSP FLUOROMETHOLONE (OPHTH) flurbiprofen sodium (generic of OCUFEN)
FML FML FORTE ILEVRO ketorolac tromethamine (ophth) (generic of ACULAR LS) .4%
ketorolac tromethamine (ophth) (generic of ACULAR) .5%
LOTEMAX MAXIDEX NEVANAC PRED MILD PREDNISOLONE ACETATE SUSP
prednisolone sodium phosphate (ophth)
VEXOL
ANTIALLERGICS ALOCRIL ALOMIDE azelastine hcl (ophth) (generic of OPTIVAR)
BEPREVE
32
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 33
Drug Name Requirements/Limits
cromolyn sodium (ophth) EMADINE epinastine hcl (ophth) (generic of ELESTAT)
LASTACAFT PATADAY PATANOL
ANTIGLAUCOMA ALPHAGAN P 0.1% AZOPT betaxolol hcl (ophth) BETIMOL BETOPTIC-S brimonidine sol 0.2% BRIMONIDINE SOL 0.15% carteolol hcl (ophth) COMBIGAN COSOPT PF dorzolamide hcl (generic of TRUSOPT)
dorzolamide hcl-timolol maleate (generic of COSOPT)
ISOPTO CARPINE ISTALOL latanoprost (generic of XALATAN)
levobunolol hcl (generic of BETAGAN) .5%
LEVOBUNOLOL HCL .25% LUMIGAN .01% metipranolol (generic of OPTIPRANOLOL)
PHOSPHOLINE IODIDE PILOCARPINE HCL SOLN PILOPINE HS timolol maleate (ophth) (generic of TIMOPTIC)
TIMOLOL MALEATE GEL TIMOPTIC OCUDOSE TRAVATAN Z ZIOPTAN
MISCELLANEOUS ak-con BOTOX 100unit NM
LACRISERT PROLENSA proparacaine hcl (generic of ALCAINE) SOLN
Drug Name Requirements/Limits
RESTASIS XEOMIN NM
RESPIRATORY ANTICHOLINERGIC/BETA AGONIST COMBINATIONS COMBIVENT COMBIVENT RESPIMAT ipratropium-albuterol (generic of DUONEB)
B/D
ANTICHOLINERGICS ATROVENT HFA ipratropium bromide (nasal) (generic of ATROVENT)
ipratropium sol inhal B/D
SPIRIVA HANDIHALER TUDORZA PRESSAIR
ANTIHISTAMINE/DECONGESTANT COMBINATIONS CLARINEX-D SEMPREX-D
ANTIHISTAMINES ASTEPRO azelastine hcl (generic of ASTELIN)
cetirizine syrup CLARINEX SYRP cyproheptadine hcl SYRP; TABS
desloratadine (generic of CLARINEX) TABS
desloratadine (generic of CLARINEX REDITABS) TBDP
diphenhydram inj 50mg/ml hydroxyzine hcl SOLN; TABS hydroxyzine pamoate (generic of VISTARIL) CAPS 25mg, 50mg
hydroxyzine pamoate CAPS 100mg
levocetirizine soln 2.5mg/5ml (generic of XYZAL)
levocetirizine tab 5 mg (generic of XYZAL)
PATANASE
BETA AGONISTS albuterol sulfate (generic of ACCUNEB) NEBU .63mg/3ml, 1.25mg/3ml
B/D
albuterol sulfate NEBU .083%, .5%
B/D
33
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 34
Drug Name Requirements/Limits
albuterol sulfate SYRP albuterol sulfate TABS albuterol sulfate er (generic of VOSPIRE ER)
ARCAPTA NEOHALER BROVANA B/D
FORADIL AEROLIZER levalbuterol conc 1.25mg/0.5ml (generic of XOPENEX CONCENTRATE)
B/D
LEVALBUTEROL HCL NEBU B/D
PERFOROMIST B/D
PROAIR HFA PROVENTIL HFA SEREVENT DISKUS terbutaline sulfate SOLN; TABS VENTOLIN HFA XOPENEX HFA
LEUKOTRIENE RECEPTOR ANTAGONISTS montelukast sodium (generic of SINGULAIR) CHEW; PACK; TABS
zafirlukast (generic of ACCOLATE)
ZYFLO CR NM
MAST CELL STABILIZERS cromolyn sodium NEBU B/D
MISCELLANEOUS acetylcysteine SOLN 10%, 20% B/D
ADRENACLICK ARALAST NP NM LA
AUVI-Q CAYSTON NM LA
DALIRESP DYMISTA EPIPEN 2-PAK EPIPEN-JR 2-PAK GLASSIA NM LA
PROLASTIN-C NM LA
PULMOZYME B/D NM
tetrahydrozoline hcl SOLN tyzine pediatric nasal dr XOLAIR NM LA
ZEMAIRA NM LA
NASAL STEROIDS BECONASE AQ flunisolide (nasal)
Drug Name Requirements/Limits
fluticasone propionate (nasal) (generic of FLONASE)
NASONEX OMNARIS QNASL RHINOCORT AQUA triamcinolone acetonide (nasal) (generic of NASACORT AQ)
VERAMYST ZETONNA
STEROID INHALANTS ALVESCO ASMANEX ASMANEX 14 METERED DOSES
budesonide (inhalation) (generic of PULMICORT)
B/D
FLOVENT DISKUS 50mcg/blist, 100mcg/blist
FLOVENT DISKUS 250mcg/blist
FLOVENT HFA PULMICORT FLEXHALER PULMICORT INH SUSP B/D NM
QVAR 40mcg/act QVAR 80mcg/act
STEROID/BETA-AGONIST COMBINATIONS ADVAIR DISKUS ADVAIR HFA DULERA SYMBICORT
XANTHINES aminophylline inj LUFYLLIN theo-24 theophylline ELIX theophylline TB12; TB24
TOPICAL DERMATOLOGY, ACNE ABSORICA NM
ACANYA ACZONE adapalene (generic of DIFFERIN) AKNE-MYCIN ATRALIN AVITA CREA
34
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 35
Drug Name Requirements/Limits
AVITA GEL AZELEX benzoyl peroxide-erythromycin (generic of BENZAMYCIN)
CLINDAGEL clindamycin phosphate (topical) (generic of EVOCLIN) FOAM
clindamycin phosphate (topical) (generic of CLEOCIN-T) GEL; LOTN; SOLN; SWAB
clindamycin phosphate-benzoyl peroxide (generic of BENZACLIN)
DIFFERIN GEL .3% DIFFERIN LOTN EPIDUO erythromycin (acne aid) isotretinoin cap 10 mg myorisan sulfacetamide sodium (acne) (generic of KLARON)
tretin x tretinoin (generic of RETIN-A) CREA; GEL
TRETINOIN MICROSPHERE .1%
TRETINOIN MICROSPHERE .04%
VELTIN zenatane ZIANA
DERMATOLOGY, ACTINIC KERATOSIS CARAC FLUOROPLEX fluorouracil (topical) (generic of EFUDEX) CREA
fluorouracil (topical) SOLN PICATO SOLARAZE
DERMATOLOGY, ANTIBIOTICS ALTABAX BACTROBAN NASAL CORTISPORIN CREA; OINT gentamicin sulfate (topical) mafenide acetate (generic of SULFAMYLON) PACK
mupirocin (generic of BACTROBAN) OINT
Drug Name Requirements/Limits
mupirocin calcium (topical) (generic of BACTROBAN)
PHISOHEX SILVER SULFADIAZINE CREA SSD SULFAMYLON CREA THERMAZENE
DERMATOLOGY, ANTIFUNGALS ciclopirox (generic of LOPROX) GEL
ciclopirox cre 0.77% ciclopirox shampoo 1% (generic of LOPROX SHAMPOO)
ciclopirox sus 0.77% clotrimazole (topical) econazole nitrate CREA EXELDERM ketoconazole (topical) CREA ketoconazole (topical) (generic of EXTINA) FOAM
MENTAX NAFTIN CREA NAFTIN GEL 1% nystatin (topical) nystatin pow 100000 OXISTAT
DERMATOLOGY, ANTIPRURITIC CORTIFOAM hydrocortisone (rectal) (generic of ANUSOL-HC)
procto-pak cre 1% proctozone cre -hc 2.5% (generic of ANUSOL-HC)
PRUDOXIN CRE 5% ZONALON
DERMATOLOGY, ANTIPSORIATICS calcipotriene (generic of DOVONEX) CREA
calcipotriene OINT; SOLN CALCITRIOL OINT 8-MOP OXSORALEN ULTRA NM
SORIATANE NM
SORILUX STELARA NM
TAZORAC
DERMATOLOGY, ANTISEBORRHEICS
35
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 36
Drug Name Requirements/Limits
ketoconazole shampoo (generic of NIZORAL)
selenium sulfide (generic of SELSUN SHAMPOO) LOTN
DERMATOLOGY, ANTIVIRALS acyclovir topical (generic of ZOVIRAX)
DENAVIR XERESE ZOVIRAX CREA
DERMATOLOGY, CORTICOSTEROIDS alclometasone dipropionate (generic of ACLOVATE) CREA
alclometasone dipropionate OINT
amcinonide CREA; LOTN amcinonide OINT betamethasone dipropionate (topical)
betamethasone dipropionate augmented (generic of DIPROLENE AF) CREA
betamethasone dipropionate augmented GEL
betamethasone dipropionate augmented (generic of DIPROLENE) LOTN; OINT
betamethasone valerate CREA; LOTN; OINT
betamethasone valerate (generic of LUXIQ) FOAM
CAPEX clobetasol propionate (generic of TEMOVATE) CREA; GEL; OINT; SOLN
clobetasol propionate (generic of OLUX) FOAM
clobetasol propionate (generic of CLOBEX) LOTN; SHAM
clobetasol propionate emollient base (generic of TEMOVATE E)
clobetasol propionate emulsion (generic of OLUX-E)
CLOBEX LIQD CLODERM PUMP CORDRAN DESONATE DESONIDE CREA desonide (generic of DESOWEN) LOTN; OINT
Drug Name Requirements/Limits
desowen oint kit 0.05% desoximetasone (generic of TOPICORT) CREA
desoximetasone (generic of TOPICORT) GEL
DESOXIMETASONE OINT .05%
desoximetasone (generic of TOPICORT) OINT .25%
diflorasone diacetate fluocinolone acetonide CREA .01%
fluocinolone acetonide (generic of SYNALAR) CREA .025%
fluocinolone acetonide (generic of DERMA-SMOOTHE/FS BODY) OIL
fluocinolone acetonide (generic of SYNALAR) OINT
fluocinolone acetonide (generic of SYNALAR) SOLN
fluocinonide CREA; GEL; OINT; SOLN
fluocinonide emulsified base fluticasone propionate (generic of CUTIVATE) CREA; LOTN; OINT
halobetasol propionate (generic of ULTRAVATE)
HALOG hydrocortisone (topical) hydrocortisone butyrate (generic of LOCOID)
hydrocortisone valerate CREA hydrocortisone valerate (generic of WESTCORT) OINT
KENALOG LOCOID LOTN LOCOID LIPOCREAM LOKARA LOTN 0.05% mometasone furoate (generic of ELOCON) CREA; OINT; SOLN
PANDEL PREDNICARBATE CREA prednicarbate (generic of DERMATOP) OINT
TACLONEX texacort TOPICORT LIQD
36
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 37
Drug Name Requirements/Limits
triamcinolone acetonide (topical) urea-hc acetate (generic of CARMOL-HC)
VANOS VERDESO
DERMATOLOGY, LOCAL ANESTHETICS lidocaine OINT lidocaine hcl GEL lidocaine hcl (generic of XYLOCAINE) SOLN 4%
lidocaine-prilocaine (generic of EMLA)
B/D
LIDODERM SYNERA
DERMATOLOGY, MISCELLANEOUS SKIN AND MUCOUS MEMBRANE ammonium lactate (generic of LAC-HYDRIN) CREA; LOTN
CONDYLOX GEL ELIDEL FINACEA imiquimod (generic of ALDARA) CREA
laclotion lotn 12% (generic of LAC-HYDRIN)
METROGEL metronidazole (topical) (generic of METROCREAM) CREA
metronidazole (topical) (generic of METROGEL) GEL 1%
metronidazole (topical) GEL .75%
metronidazole (topical) (generic of METROLOTION) LOTN
ORACEA OXSORALEN PANRETIN NM
PENNSAID podofilox (generic of CONDYLOX) SOLN
PROTOPIC RECTIV rosadan cre 0.75% (generic of METROCREAM)
TARGRETIN GEL NM
VOLTAREN GEL 1% ZYCLARA NM
DERMATOLOGY, SCABICIDES AND PEDICULIDES
Drug Name Requirements/Limits
EURAX malathion (generic of OVIDE) permethrin (generic of ELIMITE) CREA
SKLICE ULESFIA
DERMATOLOGY, WOUND CARE AGENTS acetic acid .25% neomycin/polymyxin b gu (generic of NEOSPORIN GU IRRIGANT)
SANTYL SODIUM CHLORIDE 0.9% STERILE WATER IRRIGATION
MOUTH/THROAT/DENTAL AGENTS cevimeline hcl (generic of EVOXAC)
chlorhexidine gluconate (mouth-throat) (generic of PERIDEX)
clotrimazole TROC lidocaine hcl (mouth-throat) nystatin (mouth-throat) periogard sol 0.12% (generic of PERIDEX)
pilocarpine hcl (oral) (generic of SALAGEN)
triamcinolone acetonide (mouth)
OTIC acetic acid (otic) acetic acid sol/hc (generic of VOSOL HC)
acetic acid-aluminum acetate CIPRO HC CIPRODEX COLY-MYCIN S CORTISPORIN-TC fluocinolone acetonide (otic) (generic of DERMOTIC)
hydrocortisone w/acetic acid (generic of VOSOL HC)
neomycin-polymyxin-hc (otic) (generic of CORTISPORIN) SOLN
neomycin-polymyxin-hc (otic) SUSP
ofloxacin (otic)
37
38
Index 8 8-MOP .............................. 35 A abacavir sulfate ...................5 ABELCET............................4 ABILIFY............................. 17 ABILIFY DISCMELT ......... 17 ABILIFY INJ ...................... 17 ABILIFY MAINTENA ......... 17 ABRAXANE ........................9 ABSORICA ....................... 34 ABSTRAL............................2 ACANYA ........................... 34 acarbose ........................... 21 ACCOLATE
see zafirlukast ............... 34 ACCUNEB
see albuterol sulfate ...... 33 ACCUPRIL
see quinapril hcl ............ 10 ACCURETIC
see quinapril-hydrochlorothiazide .................................. 10
acebutolol hcl .................... 12 ACEON
see perindopril erbumine ...................................... 10
acetaminophen w/ codeine .1 acetazolamide ................... 13 acetazolamide sodium ...... 13 acetic acid ......................... 37 acetic acid (otic) ................ 37 acetic acid sol/hc ............... 37 acetic acid-aluminum acetate .......................................... 37 acetylcysteine ................... 34 ACIPHEX .......................... 27 ACLOVATE
see alclometasone dipropionate ................... 36
ACTEMRA ........................ 29 ACTHIB ............................. 30 ACTIGALL
see ursodiol ................... 27 ACTIMMUNE .................... 29 ACTIQ
see fentanyl citrate ..........2 ACTIVELLA
see estradiol & norethindrone acetate ... 23
ACTONEL ......................... 22 ACTOPLUS MET
see pioglitazone hcl-metformin hcl ........... 21
ACTOPLUS MET XR 15-1000MG ....................... 21 ACTOPLUS MET XR 30-1000MG ....................... 21 ACTOS
see pioglitazone hcl ....... 21 ACULAR
see ketorolac tromethamine (ophth) .... 32
ACULAR LS see ketorolac tromethamine (ophth) .... 32
ACUVAIL .......................... 32 acyclovir .............................. 6 acyclovir sodium ................. 6 acyclovir topical ................ 36 ACZONE ........................... 34 ADACEL ........................... 30 ADAGEN ........................... 23 ADALAT CC
see nifedipine ................ 13 see nifedipine cc tab 90mg er ................................... 13 see nifedipine cr ............ 13
adapalene ......................... 34 ADCIRCA .......................... 14 ADDERALL
see amphetamine-dextroamphetamine tab 10 mg......... 18 see amphetamine-dextroamphetamine tab 12.5 mg...... 18 see amphetamine-dextroamphetamine tab 20 mg......... 18 see amphetamine-dextroamphetamine tab 30 mg......... 18 see amphetamine-dextroamphetamine tab 5 mg .......... 18
ADDERALL XR
see amphetamine-dextroamphetamine cap sr 24hr 10 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 15 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 20 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 25 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 30 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 5 mg ...................................... 18
ADOXA see doxycycline (monohydrate) ................. 8
ADOXA PAK 1/150 see doxycycline (monohydrate) ................. 8
ADRENACLICK ................ 34 adriamycin .......................... 8 adriamycin inj 2mg/ml ......... 8 adrucil ................................. 8 ADVAIR DISKUS .............. 34 ADVAIR HFA .................... 34 ADVICOR ......................... 11 AFINITOR ........................... 9 AFINITOR DISPERZ .......... 9 AGGRENOX ..................... 29 AGRYLIN
see anagrelide hcl ......... 28 a-hydrocort inj 100mg ....... 24 ak-con ............................... 33 AKNE-MYCIN ................... 34 ALBENZA ........................... 3 albuterol sulfate .......... 33, 34 albuterol sulfate er ............ 34 ALCAINE
38
39
see proparacaine hcl ..... 33 alclometasone dipropionate .......................................... 36 ALCOHOL PREPS ............ 20 ALDACTAZIDE ................. 13
see spironolactone & hydrochlorothiazide ....... 13
ALDACTONE see spironolactone ........ 10
ALDARA see imiquimod ............... 37
ALDURAZYME ................. 23 alendronate sodium .......... 22 alfuzosin hcl ...................... 27 ALIMTA ...............................8 ALINIA ................................3 ALKERAN
see melphalan hcl ...........8 allopurinol inj 500mg ...........1 allopurinol tab ......................1 ALOCRIL........................... 32 ALOMIDE .......................... 32 ALOPRIM
see allopurinol inj 500mg .1 ALORA .............................. 23 ALOXI ............................... 25 ALPHAGAN P 0.1% .......... 33 alprazolam ........................ 14 ALREX .............................. 32 ALSUMA ........................... 19 ALTABAX .......................... 35 ALTACE
see ramipril .................... 10 altavera ............................. 22 ALTOPREV ....................... 11 ALVESCO ......................... 34 amantadine hcl .................. 17 AMARYL
see glimepiride .............. 21 AMBIEN
see zolpidem tartrate ..... 19 AMBIEN CR
see zolpidem tartrate ..... 19 AMBISOME .........................4 amcinonide ........................ 36 AMERGE
see naratriptan hcl ......... 19 amifostine crystalline ......... 10 amikacin sulfate ..................3 amiloride &
hydrochlorothiazide ........... 13 amiloride hcl ...................... 13 aminophylline inj ............... 34 AMINOSYN ....................... 30 AMINOSYN 7%/ELECTROLYTES ....... 30 AMINOSYN II .................... 30 AMINOSYN II 8.5%/ELECTROL .............. 30 AMINOSYN INJ 8.5/LYTE 30 AMINOSYN M ................... 30 AMINOSYN-HBC .............. 30 AMINOSYN-PF ................. 30 AMINOSYN-PF 7% ........... 30 AMINOSYN-RF ................. 30 amiodarone hcl ................. 11 amiodarone inj 50mg/ml.... 11 AMITIZA ............................ 27 amitriptyline hcl ................. 16 amlodipine besylate .......... 12 AMLODIPINE BESYLATE/ATORV .......... 12 amlodipine besylate-benazepril hcl ..... 10 ammonium chloride .......... 30 ammonium lactate ............ 37 amoxapine ........................ 16 amoxicillin ........................... 7 amoxicillin & pot clavulanate ............................................ 7 amphetamine-dextroamphetamine cap sr 24hr 10 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 15 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 20 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 25 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 30 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 5 mg .... 18 amphetamine-dextroamphetamine tab 10 mg ............... 18 amphetamine-dextroamphetamine tab 12.5 mg ............ 18 amphetamine-dextroamphetamine tab 15 mg ............... 18 amphetamine-dextroamphetamine tab 20 mg ............... 18
amphetamine-dextroamphetamine tab 30 mg ............... 18 amphetamine-dextroamphetamine tab 5 mg ................. 18 amphetamine-dextroamphetamine tab 7.5 mg .............. 18 AMPHOTEC ....................... 4 amphotericin b .................... 4 ampicillin ............................. 7 ampicillin & sulbactam sodium ................................ 7 ampicillin inj ........................ 7 ampicillin sodium ................ 7 AMPYRA .......................... 19 AMRIX .............................. 20 AMTURNIDE .................... 13 ANAFRANIL
see clomipramine hcl .... 16 anagrelide hcl ................... 28 ANAPROX
see naproxen sodium ...... 1 ANAPROX DS
see naproxen sodium ...... 1 anastrozole ......................... 9 ANCOBON
see flucytosine ................ 4 ANDRODERM .................. 20 ANDROGEL 1% ............... 20 ANDROGEL 1.62% .......... 20 ANEXSIA
see hydrocodone-acetaminophen 7.5-650mg .................. 2
ANTABUSE see disulfiram ................ 20
ANTIVERT ........................ 25 see meclizine hcl ........... 25
ANUSOL-HC see hydrocortisone (rectal) ...................................... 35 see proctozone cre -hc 2.5% .............................. 35
APIDRA ............................ 20 APIDRA SOLOSTAR ........ 20 APLENZIN ........................ 16 APOKYN ........................... 17 APRISO ............................ 26 APTIVUS ............................ 5 ARALAST NP ................... 34 ARALEN
39
40
see chloroquine phosphate ........................5
ARANESP ALBUMIN FREE .......................................... 28 ARAVA
see leflunomide ............. 29 ARCALYST ....................... 29 ARCAPTA NEOHALER .... 34 ARICEPT .......................... 16
see donepezil tabs 10mg ...................................... 16 see donepezil tabs 5mg 16
ARICEPT ODT see donepezil odt 10mg 16 see donepezil odt 5mg .. 16
ARIMIDEX see anastrozole ...............9
ARIXTRA see fondaparinux sodium ...................................... 28
AROMASIN see exemestane ..............9
ARRANON ..........................8 ARTHROTEC 50
see diclofenac w/ misoprostol ......................1
ARTHROTEC 75 see diclofenac w/ misoprostol ......................1
ARZERRA ...........................9 ASACOL ........................... 26 ASACOL HD ..................... 26 ASMANEX ........................ 34 ASMANEX 14 METERED DOSES ............................. 34 ASTELIN
see azelastine hcl .......... 33 ASTEPRO ......................... 33 ATACAND ......................... 11
see candesartan cilexetil ...................................... 11
ATACAND HCT see candesartan cilexetil-hydrochlorothiazide .................................... 11
ATELVIA ........................... 22 atenolol ............................. 12 atenolol & chlorthalidone ... 12 ATGAM ............................. 29 ATIVAN
see lorazepam ............... 14 atorvastatin calcium .......... 11 atovaquone-proguanil hcl tab 250-100 mg ......................... 5 ATOVAQUONE-PROGUANIL HCL TAB 62.5-25 MG ...... 5 ATRALIN ........................... 34 ATRIPLA ............................. 5 ATROPINE SULFATE ...... 26 ATROVENT
see ipratropium bromide (nasal) ........................... 33
ATROVENT HFA .............. 33 AUBAGIO ......................... 19 AUGMENTIN ...................... 7
see amoxicillin & pot clavulanate ...................... 7
AUGMENTIN ES-600 see amoxicillin & pot clavulanate ...................... 7
AUGMENTIN XR see amoxicillin & pot clavulanate ...................... 7
AUVI-Q ............................. 34 AVALIDE
see irbesartan-hydrochlorothiazide ................................ 11
AVAPRO see irbesartan ............... 11
AVASTIN ............................ 9 AVELOX ............................. 7 AVELOX ABC PACK .......... 7 AVINZA ............................... 2 AVITA ......................... 34, 35 AVODART ........................ 27 AVONEX ........................... 19 AVONEX PEN .................. 19 AXERT .............................. 19 AXID
see nizatidine ................ 26 AXIRON ............................ 20 AYGESTIN
see norethindrone acetate ...................................... 25
AZACTAM ........................... 4 see aztreonam ................ 4
AZACTAM/DEX INJ 1GM ... 4 AZACTAM/DEX INJ 2GM ... 4 AZASITE ........................... 32
azathioprine ...................... 29 azathioprine inj 100mg ...... 29 azelastine hcl .................... 33 azelastine hcl (ophth) ........ 32 AZELEX ............................ 35 AZILECT ........................... 17 azithromycin ....................... 7 AZITHROMYCIN ................ 6 AZOPT .............................. 33 AZOR ................................ 11 aztreonam ........................... 4 AZULFIDINE
see sulfasalazine ir ........ 26 AZULFIDINE EN-TABS
see sulfasalazine dr ...... 26 B bacitracin (ophthalmic) ...... 32 bacitracin-polymyxin b (ophth) .............................. 32 bacitracin-poly-neomycin-hc.......................................... 32 baclofen ............................ 20 BACTOCILL IN DEXTROSE............................................ 7 BACTRIM
see sulfamethoxazole-trimethoprim ................................. 4
BACTRIM DS see sulfamethoxazole-trimethoprim ................................. 4
BACTROBAN see mupirocin ................ 35 see mupirocin calcium (topical) ......................... 35
BACTROBAN NASAL ....... 35 balsalazide disodium ........ 26 BANZEL ............................ 14 BARACLUDE ...................... 6 BECONASE AQ................ 34 benazepril & hydrochlorothiazide ........... 10 benazepril hcl ................... 10 BENICAR .......................... 11 BENICAR HCT ................. 11 BENTYL ............................ 26
see dicyclomine hcl ....... 26 BENZACLIN
see clindamycin
40
41
phosphate-benzoyl peroxide......................... 35
BENZAMYCIN see benzoyl peroxide-erythromycin ... 35
benzoyl peroxide-erythromycin ...... 35 benztropine mesylate ........ 17 BEPREVE ......................... 32 BESIVANCE ..................... 32 BETAGAN
see levobunolol hcl ........ 33 betamethasone dipropionate (topical) ............................. 36 betamethasone dipropionate augmented ........................ 36 betamethasone valerate ... 36 BETAPACE
see sotalol hcl ................ 11 BETAPACE AF
see sotalol hcl (afib/afl) .. 11 BETASERON .................... 19 betaxolol hcl ...................... 12 betaxolol hcl (ophth) .......... 33 bethanechol chloride ......... 27 BETIMOL .......................... 33 BETOPTIC-S .................... 33 BEYAZ .............................. 22 BIAXIN
see clarithromycin ...........7 BIAXIN XL
see clarithromycin ...........7 bicalutamide ........................9 BICILLIN C-R ......................7 BICILLIN L-A .......................7 BICNU .................................8 BIDIL ................................. 14 BILTRICIDE ........................4 BINOSTO .......................... 22 bisoprolol & hydrochlorothiazide ........... 12 bisoprolol fumarate ........... 12 bleomycin sulfate ................8 BLEPH-10
see sulfacetamide sodium (ophth) ........................... 32
blephamide ....................... 32 BLEPHAMIDE ................... 32 BONIVA ............................ 22
see ibandronate sodium 22
BOOSTRIX ....................... 30 BOSULIF ............................ 9 BOTOX ............................. 33 BREVICON-28
see norethindrone & eth estradiol ......................... 22
BRILINTA .......................... 29 BRIMONIDINE SOL 0.15% .......................................... 33 brimonidine sol 0.2%......... 33 BROMDAY ........................ 32 bromfenac sodium (ophth) 32 bromocriptine mesylate ..... 17 BROVANA ........................ 34 budesonide ....................... 26 budesonide (inhalation) ..... 34 bumetanide ....................... 13 BUPHENYL
see sodium phenylbutyrate ...................................... 23
BUPHENYL TAB 500MG .. 23 buprenorphine hcl ............. 20 buprenorphine hcl-naloxone hcl sl.................................. 20 bupropion hcl .................... 16 bupropion hcl (smoking deterrent) .......................... 20 buspirone hcl .................... 14 BUSULFEX ......................... 8 butorphanol nasal spray ...... 1 butorphanol tartrate ............ 1 BUTRANS ........................... 1 BYDUREON ..................... 20 BYETTA ............................ 20 BYSTOLIC ........................ 12 C cabergoline ....................... 24 cafergot tab 1-100mg ........ 19 CALAN
see verapamil hcl .......... 13 CALAN SR
see verapamil hcl .......... 13 calcipotriene ...................... 35 calcitonin (salmon) nasal spray ................................. 24 calcitriol ....................... 31, 32 CALCITRIOL ..................... 35 calcium acetate (phosphate binder) ............................... 25 CAMPRAL ........................ 20
CAMPTOSAR ................... 10 see irinotecan hcl .......... 10
CAMRESE LO TAB .......... 22 CANASA ........................... 26 CANCIDAS ......................... 4 candesartan cilexetil ......... 11 candesartan cilexetil-hydrochlorothiazide.......................................... 11 CANTIL ............................. 26 CAPASTAT SULFATE ........ 5 CAPEX ............................. 36 capital
and codeine .................... 1 CAPRELSA ........................ 9 captopril ............................ 10 captopril & hydrochlorothiazide ........... 10 CARAC ............................. 35 CARAFATE ...................... 27
see sucralfate ................ 27 CARBAGLU ...................... 23 carbamazepine ................. 14 CARBATROL
see carbamazepine ....... 14 CARBIDOPA/LEVODOPA/ENTACA ............................. 17 carbidopa-levodopa .......... 17 carboplatin ........................ 10 CARDIZEM
see diltiazem hcl ............ 13 CARDIZEM CD
see cartia xt ................... 12 see dilt-cd ...................... 12 see diltiazem hcl coated beads ............................ 13
CARDIZEM LA.................. 12 see matzim la ................ 13
CARDURA see doxazosin mesylate 11
CARDURA XL .................. 27 CARIMUNE NANOFILTERED .............. 29 CARMOL-HC
see urea-hc acetate ...... 37 CARNITOR
see levocarnitine (metabolic modifiers) ..... 23
carteolol hcl (ophth) .......... 33 cartia xt ............................. 12
41
42
carvedilol ........................... 12 CASODEX
see bicalutamide .............9 CATAFLAM
see diclofenac potassium 1 CATAPRES
see clonidine hcl ............ 14 CATAPRES-TTS-1
see clonidine hcl ............ 14 CATAPRES-TTS-2
see clonidine hcl ............ 14 CATAPRES-TTS-3
see clonidine hcl ............ 14 CAYSTON ......................... 34 CEDAX ...............................6 CEENU ...............................8 cefaclor ...............................6 cefaclor monohydrate .........6 cefadroxil.............................6 cefazolin inj .........................6 cefazolin sodium .................6 cefazolin/dextrose ...............6 cefdinir ................................6 CEFEPIME 1GM SOLN ......6 CEFEPIME 2GM SOLN ......6 cefepime inj 1gm .................6 cefepime inj 2gm .................6 cefixime ...............................6 cefotaxime sodium ..............6 cefotetan disodium ..............6 cefoxitin sodium ..................6 CEFOXITIN SODIUM IN DEXTROSE ........................6 cefpodoxime proxetil ...........6 cefprozil...............................6 ceftazidime ..........................6 CEFTAZIDIME/DEXTROSE ............................................6 CEFTIN ...............................6
see cefuroxime axetil .......6 ceftriaxone sodium ..............6 cefuroxime axetil .................6 cefuroxime sodium ..............6 cefuroxime sodium 7.5mg soln .....................................6 CELEBREX .........................1 CELESTONE .................... 24 CELEXA
see citalopram hydrobromide ................ 16
CELLCEPT ....................... 29 see mycophenolate mofetil ...................................... 29
CELLCEPT INTRAVENOUS .......................................... 29 CELONTIN ........................ 14 cephalexin ........................... 6 CEREZYME ...................... 23 CERUBIDINE
see daunorubicin hcl ....... 8 CERVARIX ....................... 30 CESAMET ........................ 25 cetirizine syrup .................. 33 cevimeline hcl ................... 37 CHANTIX .......................... 20 CHANTIX STARTER PACK .......................................... 20 CHEMET ........................... 22 chlorhexidine gluconate (mouth-throat) ................... 37 chloroquine phosphate........ 5 chlorothiazide .................... 13 chlorpromaz inj 25mg/ml ... 17 chlorpromazine hcl ............ 17 chlorthalidone ................... 13 chlorzoxazone ................... 20 cholestyramine .................. 11 cholestyramine light .......... 12 choline fenofibrate ............ 12 CHORIONIC GONADOTROPIN ............ 24 ciclopirox ........................... 35 ciclopirox cre 0.77% .......... 35 ciclopirox shampoo 1% ..... 35 ciclopirox sus 0.77% ......... 35 cidofovir .............................. 6 cilostazol ........................... 28 CILOXAN
see ciprofloxacin hcl (ophth) ........................... 32
CILOXAN OIN 0.3% OP ... 32 cimetidine .......................... 26 cimetidine inj 150mg/ml .... 26 cimetidine sol 300/5ml ...... 26 CIMZIA .............................. 29 CIPRO ................................ 7
see ciprofloxacin hcl ........ 7 CIPRO HC ........................ 37 CIPRO I.V.-IN D5W
see ciprofloxacin in d5w .. 7
CIPRO XR see ciprofloxacin er ......... 7
CIPRODEX ....................... 37 ciprofloxacin ........................ 7 ciprofloxacin er ................... 7 ciprofloxacin hcl .................. 7 ciprofloxacin hcl (ophth) .... 32 ciprofloxacin in d5w ............ 7 ciprofloxacn inj .................... 7 cisplatin ............................. 10 citalopram hydrobromide .. 16 cladribine ............................ 8 claforan ............................... 6 CLAFORAN
see cefotaxime sodium ... 6 CLARINEX ........................ 33
see desloratadine .......... 33 CLARINEX REDITABS
see desloratadine .......... 33 CLARINEX-D .................... 33 clarithromycin ..................... 7 CLEOCIN
see clindamycin cre 2% vag ................................ 28 see clindamycin hcl ......... 4
CLEOCIN IN D5W see clindamycin phosphate in d5w ............ 4
CLEOCIN PEDIATRIC GRANULE
see clindamycin palmitate hydrochloride................... 4
CLEOCIN PHOSPHATE see clindamycin phosphate ....................... 4
CLEOCIN VAG SUPP 100MG .............................. 28 CLEOCIN-T
see clindamycin phosphate (topical) ........ 35
CLIMARA see estradiol .................. 23
CLINDAGEL ..................... 35 clindamycin cre 2% vag .... 28 clindamycin hcl ................... 4 clindamycin palmitate hydrochloride ...................... 4 clindamycin phosphate ....... 4 clindamycin phosphate (topical) ............................. 35
42
43
clindamycin phosphate in d5w .....................................4 clindamycin phosphate-benzoyl peroxide .......................................... 35 CLINIMIX 2.75%/DEXTROSE 5% ..... 30 CLINIMIX 4.25%/DEXTROSE 10% ... 30 CLINIMIX 4.25%/DEXTROSE 20% ... 30 CLINIMIX 4.25%/DEXTROSE 25% ... 30 CLINIMIX 4.25%/DEXTROSE 5% ..... 30 CLINIMIX 5%/DEXTROSE 15% ................................... 30 CLINIMIX 5%/DEXTROSE 20% ................................... 30 CLINIMIX 5%/DEXTROSE 25% ................................... 30 CLINIMIX E 2.75%/DEXTROSE 10% ... 30 CLINIMIX E 2.75%/DEXTROSE 5% ..... 30 CLINIMIX E 4.25%/DEXTROSE ........... 30 CLINIMIX E 4.25%/DEXTROSE 25% ... 30 CLINIMIX E 4.25%/DEXTROSE 5% ..... 30 CLINIMIX E 5%/DEXTROSE 15% ................................... 31 CLINIMIX E 5%/DEXTROSE 20% ................................... 31 CLINIMIX E 5%/DEXTROSE 25% ................................... 31 clinisol sf 15% ................... 31 CLINORIL
see sulindac ....................1 clobetasol propionate ........ 36 clobetasol propionate emollient base ................... 36 clobetasol propionate emulsion............................ 36 CLOBEX ........................... 36
see clobetasol propionate ...................................... 36
CLODERM PUMP ............. 36 CLOLAR..............................8
clomipramine hcl ............... 16 clonazepam ................ 14, 15 clonidine & chlorthalidone . 14 clonidine hcl ...................... 14 clopidogrel bisulfate .......... 29 clorazepate dipotassium ... 15 clotrimazole ....................... 37 clotrimazole (topical) ......... 35 CLOZAPINE ODT ............. 17 clozapine tab ..................... 17 CLOZARIL
see clozapine tab .......... 17 COARTEM .......................... 5 codeine
and capital ....................... 1 CODEINE SULFATE .......... 2 COGENTIN
see benztropine mesylate ...................................... 17
co-gesic 5-500mg ............... 1 COLAZAL
see balsalazide disodium ...................................... 26
colchicine w/ probenecid ..... 1 COLCRYS .......................... 1 COLESTID
see colestipol hcl ........... 12 colestipol hcl ..................... 12 colistimethate sodium ......... 4 COLY-MYCIN M
see colistimethate sodium ........................................ 4
COLY-MYCIN S ................ 37 COLYTE-FLAVOR PACKS .......................................... 26
see peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ............................ 26
COMBIGAN ...................... 33 COMBIPATCH .................. 23 COMBIVENT .................... 33 COMBIVENT RESPIMAT . 33 COMBIVIR
see lamivudine-zidovudine ........................................ 5
COMETRIQ ........................ 9 COMPLERA ........................ 5 compro supp ..................... 25 COMVAX .......................... 30 CONCERTA
see methylphenidate hcl er ...................................... 18
CONDYLOX ..................... 37 see podofilox ................. 37
CONZIP .............................. 1 COPAXONE ..................... 19 COPEGUS
see ribasphere 200mg .... 6 see ribavirin 200mg ......... 6
CORDARONE see amiodarone hcl ....... 11
CORDRAN ....................... 36 COREG
see carvedilol ................ 12 COREG CR ...................... 12 CORGARD
see nadolol .................... 12 CORTEF
see hydrocortisone ........ 24 CORTENEMA
see hydrocortisone (intrarectal) .................... 26
CORTIFOAM .................... 35 cortisone acetate .............. 24 CORTISPORIN ................. 35
see neomycin-polymyxin-hc (otic) .............................. 37
CORTISPORIN-TC ........... 37 CORZIDE
see nadolol & bendroflumethiazide ...... 12
COSMEGEN ....................... 8 COSOPT
see dorzolamide hcl-timolol maleate ........ 33
COSOPT PF ..................... 33 COUMADIN ...................... 28
see warfarin sodium ...... 28 COUMADIN INJ ................ 28 COZAAR
see losartan potassium . 11 CREON ............................. 27 CRESTOR ........................ 11 CRINONE ......................... 25 CRIXIVAN ........................... 5 cromolyn sodium............... 34 cromolyn sodium (mastocytosis) .................. 27 cromolyn sodium (ophth) .. 33
43
44
CUBICIN .............................4 CUTIVATE
see fluticasone propionate ...................................... 36
CUVPOSA ........................ 26 CYCLESSA
see desogestrel-ethinyl estradiol (triphasic) ........ 22
cyclobenzaprine hcl .......... 20 cyclophosphamide ..............8 cycloserine ..........................5 cyclosporine ...................... 29 cyclosporine modified (for microemulsion) .................. 29 CYKLOKAPRON
see tranexamic acid ...... 29 CYMBALTA ....................... 16 cyproheptadine hcl ............ 33 CYSTADANE .................... 23 CYSTAGON ...................... 23 cytarabine inj .......................8 CYTOMEL
see liothyronine sodium . 25 CYTOTEC
see misoprostol ............. 27 CYTOVENE
see ganciclovir inj 500mg 6 D D.H.E. 45
see dihydroergotamine mesylate ........................ 19
dacarbazine ........................8 DACOGEN ..........................8 DALIRESP ........................ 34 danazol ............................. 23 DANTRIUM
see dantrolene sodium .. 20 dantrolene sodium ............ 20 dapsone ..............................4 DAPTACEL ....................... 30 DARAPRIM .........................4 daunorubicin hcl ..................8 DAYPRO
see oxaprozin ..................1 DAYTRANA ...................... 18 DDAVP
see desmopressin acetate ...................................... 25 see desmopressin acetate inj ................................... 25
see desmopressin acetate spray ............................. 25
DECAVAC ........................ 30 DELATESTRYL
see testosterone enanthate ...................... 20
DELESTROGEN ............... 23 see estradiol valerate .... 23
DELZICOL ........................ 26 DEMADEX
see torsemide tabs ........ 13 demeclocycline hcl .............. 8 DEMSER .......................... 14 DENAVIR .......................... 36 DEPACON
see valproate sodium .... 16 DEPAKENE
see valproate sodium .... 16 see valproic acid ........... 16
DEPAKOTE see divalproex sodium ... 15
DEPAKOTE ER see divalproex sodium ... 15
DEPAKOTE SPRINKLES see divalproex sodium ... 15
DEPO-MEDROL ............... 24 see methylprednisolone acetate .......................... 24
DEPO-PROVERA CONTRACEPTIV
see medroxyprogesterone acetate (contraceptive) .. 22
DEPO-PROVERA INJ 400/ML ................................ 9 DEPO-SUBQ PROVERA 104 .................................... 22 DERMA-SMOOTHE/FS BODY
see fluocinolone acetonide ...................................... 36
DERMATOP see prednicarbate ......... 36
DERMOTIC see fluocinolone acetonide (otic) .............................. 37
desipramine hcl ................. 16 desloratadine .................... 33 desmopressin acetate ....... 25 DESMOPRESSIN ACETATE .......................................... 25
desmopressin acetate inj .. 25 desmopressin acetate spray.......................................... 25 desmopressin acetate spray refrigerated ....................... 25 DESOGEN
see desogestrel & ethinyl estradiol ........................ 22
desogestrel & ethinyl estradiol ............................ 22 desogestrel-ethinyl estradiol (biphasic) .......................... 22 desogestrel-ethinyl estradiol (triphasic) .......................... 22 DESONATE ...................... 36 desonide ........................... 36 DESONIDE ....................... 36 DESOWEN
see desonide ................. 36 desowen oint kit 0.05% ..... 36 desoximetasone................ 36 DESOXIMETASONE ........ 36 DETROL
see tolterodine tartrate .. 28 DETROL LA ...................... 27 dexamethasone ................ 24 dexamethasone sodium phosphate ......................... 24 dexamethasone sodium phosphate (ophth)............. 32 DEXILANT ........................ 27 dexpak taperpak 13 day ... 24 dexrazoxane ..................... 10 dextrose ............................ 31 DEXTROSE ...................... 31 DEXTROSE 10% FLEX CONTAIN ......................... 31 DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%.......................................... 31 DEXTROSE 10%/NACL 0.45% ............................... 31 DEXTROSE 2.5%/NACL 0.45% ............................... 31 DEXTROSE 5% ................ 31 DEXTROSE 5% /ELECTROLYTE ............... 31 DEXTROSE 5%/LACTATED RING ................................. 31 DEXTROSE 5%/NACL 0.2%
44
45
.......................................... 31 DEXTROSE 5%/NACL 0.225% .............................. 31 DEXTROSE 5%/NACL 0.3% .......................................... 31 DEXTROSE 5%/NACL 0.33% ................................ 31 DEXTROSE 5%/NACL 0.45% ................................ 31 DEXTROSE 5%/NACL 0.9% .......................................... 31 DEXTROSE 5%/POTASSIUM CHL ...... 31 DIAMOX
see acetazolamide ........ 13 diazepam .......................... 15 DIAZEPAM GEL ............... 15 diazepam inj ...................... 15 DIBENZYLINE .................. 14 diclofenac potassium ..........1 diclofenac sodium ...............1 diclofenac sodium (ophth) . 32 diclofenac w/ misoprostol ....1 dicloxacillin sodium .............7 dicyclomine hcl .................. 26 didanosine...........................5 DIFFERIN ......................... 35
see adapalene ............... 34 DIFICID ...............................7 diflorasone diacetate ......... 36 DIFLUCAN
see fluconazole ...............4 diflunisal ..............................1 digoxin .............................. 13 digoxin inj .......................... 13 DIGOXIN SOL 50MCG/ML .......................................... 13 dihydroergotamine mesylate .......................................... 19 DIHYDROERGOTAMINE MESYLATE ....................... 19 DILACOR XR
see dilt-xr ....................... 12 dilantin .............................. 15 DILANTIN.......................... 15
see phenytoin ................ 15 see phenytoin sodium extended........................ 15
DILANTIN INFATABS see phenytoin ................ 15
DILATRATE SR ................ 14 DILAUDID
see hydromorphone hcl ... 2 DILAUDID-5
see hydromorphone hcl ... 2 DILAUDID-HP
see hydromorphone hcl ... 2 DILAUDID-HP INJ .............. 2 dilt-cd ................................ 12 diltiazem cap 120mg/24hr . 12 diltiazem cap er/12hr......... 12 diltiazem hcl ................ 12, 13 diltiazem hcl coated beads 13 diltiazem hcl er .................. 13 diltiazem hcl extended release beads ................... 13 dilt-xr ................................. 12 diltzac ................................ 13 DIOVAN ............................ 11 DIOVAN HCT
see valsartan-hydrochlorothiazide .................................. 11
DIPENTUM ....................... 26 diphenhydram inj 50mg/ml 33 diphenoxylate w/ atropine . 27 DIPHTHERIA/TETANUS TOXOID ............................ 30 DIPROLENE
see betamethasone dipropionate augmented 36
DIPROLENE AF see betamethasone dipropionate augmented 36
dipyridamole ..................... 29 disopyramide phosphate ... 11 disulfiram .......................... 20 DITROPAN XL
see oxybutynin chloride . 28 DIURIL SUS 250/5ML ....... 13 divalproex sodium ............. 15 docetaxel ............................ 9 DOCETAXEL ...................... 9 DOLOPHINE
see methadone hcl .......... 2 DOLOPHINE HCL
see methadone hcl .......... 2 donepezil odt 10mg .......... 16 donepezil odt 5mg ............ 16 donepezil tabs 10mg ......... 16
donepezil tabs 5mg ........... 16 DORIBAX ........................... 4 DORYX ............................... 8
see doxycycline hyclate .. 8 dorzolamide hcl................. 33 dorzolamide hcl-timolol maleate ............................. 33 DOVONEX
see calcipotriene ........... 35 doxazosin mesylate .......... 11 doxepin hcl ....................... 16 DOXIL ................................. 8 doxorubicin hcl .................... 8 doxycycline (monohydrate) . 8 doxycycline hyclate ............. 8 dronabinol ......................... 25 drospirenone-ethinyl estradiol ............................ 22 DROXIA ............................ 10 DUETACT
see pioglitazone hcl-glimepiride ............... 21
DUEXIS .............................. 1 DULERA ........................... 34 DUONEB
see ipratropium-albuterol ...................................... 33
DURAGESIC see fentanyl patch ........... 2
DURAMORPH .................... 2 DUREZOL ........................ 32 DYAZIDE
see triamterene & hydrochlorothiazide cap 37.5-25 mg .................... 13
DYMISTA .......................... 34 DYRENIUM ...................... 13 E E.E.S. GRANULES ............. 7 EC-NAPROSYN
see naproxen .................. 1 econazole nitrate .............. 35 EDARBI ............................ 11 EDARBYCLOR ................. 11 EDECRIN ......................... 13 EDLUAR ........................... 19 EDURANT .......................... 5 EFFEXOR XR
see venlafaxine cap er .. 17 EFFIENT ........................... 29
45
46
EFUDEX see fluorouracil (topical) 35
EGRIFTA .......................... 24 ELAPRASE ....................... 23 ELDEPRYL
see selegiline hcl ........... 17 electrolyte-m in dextrose ... 31 ELECTROLYTE-M IN DEXTROSE ...................... 31 ELECTROLYTE-R IN DEXTROSE ...................... 31 ELELYSO.......................... 23 ELESTAT
see epinastine hcl (ophth) ...................................... 33
ELIDEL ............................. 37 ELIGARD ............................9 ELIMITE
see permethrin .............. 37 ELIPHOS
see calcium acetate (phosphate binder) ........ 25
ELIQUIS ............................ 28 ELITEK ............................. 10 ELLA ................................. 22 ELLENCE
see epirubicin inj 200mg ..8 see epirubicin inj 50mg/25ml .......................8
ELMIRON.......................... 27 ELOCON
see mometasone furoate ...................................... 36
ELOXATIN ........................ 10 ELSPAR ............................ 10 EMADINE.......................... 33 EMCYT ...............................8 EMEND ............................. 25 EMEND PAK 80 & 125 ..... 25 EMLA
see lidocaine-prilocaine . 37 EMSAM ............................. 16 EMTRIVA ............................5 ENABLEX ......................... 27 enalapril maleate ............... 10 enalapril maleate & hydrochlorothiazide ........... 10 ENBREL............................ 29 endocet 10/325 ...................2 endocet 5/325 .....................2
endocet 7.5/325 .................. 2 ENDODAN .......................... 2 ENDOMETRIN .................. 25 ENGERIX-B ...................... 30 enoxaparin sodium ........... 28 ENTACAPONE ................. 17 ENTOCORT EC
see budesonide ............. 26 EPIDUO ............................ 35 epinastine hcl (ophth)........ 33 EPIPEN 2-PAK ................. 34 EPIPEN-JR 2-PAK ............ 34 epirubicin inj 200mg ............ 8 EPIRUBICIN INJ 50MG ...... 8 epirubicin inj 50mg/25ml ..... 8 EPIVIR
see lamivudine ................ 5 EPIVIR HBV ........................ 6 EPIVIR SOL 10MG/ML ....... 5 eplerenone ........................ 10 EPOGEN .......................... 28 eprosartan mesylate ......... 11 EPZICOM ........................... 5 EQUETRO ........................ 19 ERAXIS ............................... 4 ERBITUX ............................ 9 ergomar ............................ 19 ergotamine w/ caffeine ...... 19 ERIVEDGE ......................... 9 ERYPED 200 ...................... 7 ERYPED 400 ...................... 7 erythromycin (acne aid) .... 35 erythromycin (ophth) ......... 32 erythromycin base .............. 7 erythromycin ethylsuccinate 7 erythromycin lactobionate ... 7 erythromycin stearate ......... 7 erythromycin-sulfisoxazole .. 4 escitalopram oxalate ......... 16 ESTRACE
see estradiol .................. 23 estradiol ............................ 23 estradiol & norethindrone acetate .............................. 23 estradiol cypionate ............ 23 estradiol vaginal ................ 23 estradiol valerate .............. 23 ESTRADIOL VALERATE .. 23 ESTRING .......................... 23 estropipate ........................ 23
ESTROSTEP FE see norethindrone acetate-ethinyl estradiol-fe ...................................... 23
ethambutol hcl .................... 5 ethosuximide .................... 15 ethynodiol diacet & eth estrad ................................ 22 ETHYOL
see amifostine crystalline ...................................... 10
etodolac .............................. 1 etodolac er .......................... 1 ETOPOPHOS ................... 10 etoposide .......................... 10 EURAX ............................. 37 EVISTA ............................. 25 EVOCLIN
see clindamycin phosphate (topical) ........ 35
EVOXAC see cevimeline hcl ......... 37
EXALGO ............................. 2 EXELDERM ...................... 35 EXELON ........................... 16
see rivastigmine tartrate 16 EXELON PATCHES ......... 16 exemestane ........................ 9 EXFORGE ........................ 11 EXFORGE HCT ................ 11 EXJADE ............................ 22 EXTAVIA .......................... 19 EXTINA
see ketoconazole (topical) ...................................... 35
F FABRAZYME .................... 23 FACTIVE ............................ 7 famciclovir ........................... 6 famotidine ......................... 26 FAMVIR
see famciclovir ................ 6 FANAPT ........................... 17 FANAPT TITRATION PACK.......................................... 17 FARESTON ........................ 9 FASLODEX ........................ 9 FAZACLO ......................... 17 felbamate .......................... 15 FELBATOL
46
47
see felbamate ................ 15 FELDENE
see piroxicam ..................1 felodipine........................... 13 FEMARA
see letrozole ....................9 FEMCON FE
see norethindrone & ethinyl estradiol-fe ......... 23
FEMRING ......................... 23 fenofibrate ......................... 12 fenofibrate micronized ....... 12 FENOFIBRATE MICRONIZED ................... 12 FENOFIBRIC ACID ........... 12 FENOGLIDE ..................... 12 fenoprofen calcium ..............1 fentanyl citrate .....................2 fentanyl patch ......................2 FENTORA ...........................2 FERRIPROX ..................... 22 FEXMID
see cyclobenzaprine hcl 20 FINACEA .......................... 37 finasteride ......................... 27 FIRMAGON .........................9 FLAGYL ..............................4
see metronidazole ...........4 FLAGYL ER ........................4 FLAREX ............................ 32 FLEBOGAMMA ................. 29 FLEBOGAMMA DIF .......... 29 flecainide acetate .............. 11 FLEXERIL
see cyclobenzaprine hcl 20 FLOMAX
see tamsulosin hcl ......... 27 FLONASE
see fluticasone propionate (nasal) ........................... 34
FLO-PRED ........................ 24 FLOVENT DISKUS ........... 34 FLOVENT HFA ................. 34 fluconazole ..........................4 fluconazole in dextrose .......4 fluconazole in nacl 100mg...4 fluconazole in nacl 200mg...4 fluconazole in nacl 400mg...4 flucytosine ...........................4 FLUDARA
see fludarabine phosphate ........................................ 8
fludarabine phosphate ........ 8 fludrocortisone acetate...... 24 FLUMADINE
see rimantadine hydrochloride ................... 6
flunisolide (nasal) .............. 34 fluocinolone acetonide ...... 36 fluocinolone acetonide (otic) .......................................... 37 fluocinonide ....................... 36 fluocinonide emulsified base .......................................... 36 FLUOROMETHOLONE .... 32 FLUOROMETHOLONE (OPHTH) ........................... 32 FLUOROPLEX .................. 35 fluorouracil .......................... 8 fluorouracil (topical) .......... 35 fluoxetine hcl ..................... 16 FLUOXETINE HCL ........... 16 fluoxymesterone ............... 20 fluphenazine decanoate .... 17 fluphenazine hcl ................ 17 flurbiprofen .......................... 1 flurbiprofen sodium ........... 32 flutamide ............................. 9 fluticasone propionate ....... 36 fluticasone propionate (nasal) ............................... 34 fluvastatin sodium ............. 11 fluvoxamine maleate ......... 14 fluvoxamine maleate er ..... 14 fluvoxamine tabs ............... 14 FML................................... 32 FML FORTE ..................... 32 fondaparinux sodium......... 28 FORADIL AEROLIZER ..... 34 FORFIVO XL .................... 16 FORTAMET
see metformin hcl .......... 21 FORTAZ ............................. 6
see ceftazidime ............... 6 see tazicef vial ................. 6
FORTEO ........................... 25 FORTESTA ....................... 20 FORTICAL SPR 200/ACT . 24 FOSAMAX
see alendronate sodium 22
FOSAMAX PLUS D .......... 22 foscarnet sodium ................ 6 fosinopril sodium ............... 10 fosinopril sodium & hydrochlorothiazide ........... 10 FOSRENOL ...................... 25 FRAGMIN ......................... 28 FREAMINE HBC 6.9% ..... 31 FREAMINE III ................... 31 FROVA TAB 2.5MG .......... 19 FURADANTIN
see nitrofurantoin ............ 4 furosemide ........................ 13 furosemide inj ................... 13 furosemide oral soln 8 mg/ml.......................................... 13 FUZEON ............................. 5 G gabapentin ........................ 15 GABITRIL ......................... 15
see tiagabine hcl ........... 15 galantamine hydrobromide 16 GAMASTAN S/D............... 29 GAMMAGARD LIQUID ..... 29 GAMMAGARD S/D ........... 29 GAMMAKED ..................... 29 GAMMAPLEX ................... 29 GAMUNEX ....................... 29 GAMUNEX-C .................... 29 GAMUNEX-C 1GM/10ML . 29 ganciclovir inj 500mg .......... 6 GARAMYCIN
see gentamicin sulfate (ophth) ........................... 32
GARDASIL ....................... 30 GASTROCROM
see cromolyn sodium (mastocytosis) ............... 27
GATTEX ........................... 27 GAUZE PADS 2X2 ........... 20 GELNIQUE ....................... 28 GEMCITABINE ................... 9 gemcitabine hcl ................... 9 gemfibrozil ........................ 12 GEMZAR
see gemcitabine hcl ........ 9 GENERESS FE ................ 22 GENOTROPIN.................. 24 GENOTROPIN MINIQUICK.......................................... 24
47
48
gentamicin in saline 0.9mg/ml .............................3 gentamicin in saline 1.4mg/ml .............................3 gentamicin in saline 100mg.3 gentamicin in saline 60mg...3 gentamicin in saline 80mg...3 gentamicin sulfate ...............3 gentamicin sulfate (ophth) . 32 gentamicin sulfate (topical) .......................................... 35 GEODON
see ziprasidone hcl ........ 18 GEODON INJ .................... 17 GIANVI .............................. 22 GIAZO ............................... 26 GILENYA .......................... 19 GLASSIA........................... 34 GLEEVEC ...........................9 glimepiride......................... 21 glipizide ............................. 21 glipizide er ......................... 21 glipizide-metformin 2.5-250mg ......................... 21 glipizide-metformin 2.5-500mg ......................... 21 glipizide-metformin 5-500mg .......................................... 21 GLUCAGEN HYPOKIT ..... 24 GLUCAGON EMERGENCY KIT .................................... 24 GLUCOPHAGE
see metformin hcl .......... 21 GLUCOPHAGE XR
see metformin er ........... 21 GLUCOTROL
see glipizide ................... 21 GLUCOTROL XL
see glipizide er .............. 21 GLUCOVANCE
see glyburide-metformin 1.25-250mg ................... 21 see glyburide-metformin 2.5-500mg ..................... 21 see glyburide-metformin 5-500mg ........................ 21
GLUMETZA ...................... 21 glyburide ........................... 21 glyburide micronized ......... 21 glyburide-metformin
1.25-250mg ....................... 21 glyburide-metformin 2.5-500mg ......................... 21 glyburide-metformin 5-500mg ............................ 21 glycopyrrolate ................... 26 GLYNASE
see glyburide micronized ...................................... 21
GLYSET ............................ 21 GOLYTELY ....................... 26
see peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ............................ 27
GRALISE .......................... 19 GRALISE STARTER......... 19 granisetron hcl .................. 25 GRIFULVIN V
see griseofulvin microsize ........................................ 4
griseofulvin microsize.......... 4 griseofulvin ultramicrosize ... 4 GRIS-PEG
see griseofulvin ultramicrosize .................. 4
H HALAVEN ......................... 10 HALDOL
see haloperidol lactate .. 17 HALDOL DECANOATE 100
see haloperidol decanoate ...................................... 17
HALDOL DECANOATE 50 see haloperidol decanoate ...................................... 17
HALFLYTELY BOWEL PREP/FLA ........................ 26 halobetasol propionate...... 36 HALOG ............................. 36 haloperidol ........................ 17 haloperidol decanoate....... 17 haloperidol lactate ............. 17 HAVRIX ............................ 30 heather tab 0.35mg ........... 22 HECTOROL ...................... 32 HELIDAC .......................... 27 HEP SOD/NACL INJ 25000 .......................................... 28 HEPARIN (PORCINE) IN SODIUM CHLORIDE
100U/ML ........................... 28 heparin sod inj 10000u/ml . 28 heparin sod inj 1000u/ml ... 28 heparin sod inj 20000u/ml . 28 HEPARIN SOD INJ 2000U/ML ......................... 28 HEPARIN SOD INJ 2500U/ML ......................... 28 heparin sod inj 5000u/0.5ml.......................................... 28 heparin sod inj 5000u/ml ... 28 HEPARIN SODIUM/D5W . 28 HEPARIN SODIUM/SODIUM CHL .... 28 HEPATAMINE .................. 31 hepatasol 8 ....................... 31 HEPSERA .......................... 6 HERCEPTIN ....................... 9 HEXALEN ........................... 8 HIBERIX ........................... 30 HIPREX
see methenamine hippurate ......................... 4
HORIZANT ....................... 19 HUMALOG ....................... 20 HUMALOG KWIKPEN ...... 20 HUMALOG MIX 50/50 ...... 20 HUMALOG MIX 50/50 KWIKPEN ......................... 20 HUMALOG MIX 75/25 ...... 20 HUMALOG MIX 75/25 KWIKPEN ......................... 20 HUMATROPE ................... 24 HUMATROPE COMBO PACK ................................ 24 HUMIRA ........................... 29 HUMIRA PEN ................... 29 HUMIRA PEN-CROHNS STARTER KIT .................. 29 HUMIRA PEN-PSORIASIS STARTER KIT .................. 29 HUMULIN 70/30 ............... 20 HUMULIN 70/30 PEN ....... 20 HUMULIN N ...................... 20 HUMULIN N U-100 PEN ... 20 HUMULIN R ...................... 20 HUMULIN R U-500 (CONCENTRATE) ............ 20 HYCAMTIN
see topotecan hcl .......... 10
48
49
HYCET see hydrocodone-acetaminophen 7.5-325 mg/15ml ........1
hydralazine hcl .................. 14 HYDREA
see hydroxyurea ............ 10 hydrochlorothiazide ........... 13 hydrocodone-acetaminophen ............................................1 hydrocodone-acetaminophen 10-300mg ............................2 hydrocodone-acetaminophen 10-500mg ............................2 hydrocodone-acetaminophen 10-650mg ............................2 hydrocodone-acetaminophen 10-660mg ............................2 hydrocodone-acetaminophen 10-750mg ............................2 hydrocodone-acetaminophen 2.5-325mg ...........................1 hydrocodone-acetaminophen 2.5-500mg ...........................1 hydrocodone-acetaminophen 5-300mg ..............................1 hydrocodone-acetaminophen 5-325mg ..............................1 hydrocodone-acetaminophen 5-500mg ..............................1 hydrocodone-acetaminophen 7.5-300mg ...........................1 hydrocodone-acetaminophen 7.5-325 mg/15ml .................1 hydrocodone-acetaminophen 7.5-325mg ...........................2 hydrocodone-acetaminophen 7.5-500mg ...........................2 hydrocodone-acetaminophen 7.5-500mg/15ml ..................2 hydrocodone-acetaminophen 7.5-650mg ...........................2 hydrocodone-acetaminophen 7.5-750mg ...........................2 hydrocodone-acetaminophen tab 10-325mg ......................2 hydrocodone-ibuprofen 2.5-200mg ...........................2 hydrocodone-ibuprofen 7.5-200mg ...........................2
hydrocortisone .................. 24 hydrocortisone (intrarectal) .......................................... 26 HYDROCORTISONE (INTRARECTAL) .............. 26 hydrocortisone (rectal) ...... 35 hydrocortisone (topical) ..... 36 hydrocortisone butyrate .... 36 hydrocortisone valerate..... 36 hydrocortisone w/acetic acid .......................................... 37 hydromorphone hcl ............. 2 hydroxychloroquine sulfate .......................................... 29 hydroxyurea ...................... 10 hydroxyzine hcl ................. 33 hydroxyzine pamoate ........ 33 HYZAAR
see losartan potassium & hydrochlorothiazide ....... 11
I ibandronate sodium .......... 22 ibudone tab 5-200mg .......... 2 ibuprofen ............................. 1 ICLUSIG ............................. 9 IDAMYCIN PFS
see idarubicin hcl ............ 8 idarubicin hcl ....................... 8 IFEX
see ifosfamide ................. 8 IFEX INJ 3GM ..................... 8 ifosfamide ........................... 8 IFOSFAMIDE
see ifosfamide ................. 8 ILEVRO ............................. 32 IMDUR
see isosorbide mononitrate ................... 14
imipenem-cilastatin ............. 4 imipramine hcl ................... 16 imipramine pamoate ......... 16 imiquimod ......................... 37 IMITREX
see sumatriptan succinate ...................................... 19 see sumatriptan succinate inj................................... 19
IMOVAX RABIES (H.D.C.V.) .......................................... 30 IMURAN
see azathioprine ............ 29 INCIVEK ............................. 6 INCRELEX ........................ 24 indapamide ....................... 13 INDERAL LA
see propranolol hcl er .... 12 INFANRIX ......................... 30 INFERGEN ....................... 29 INFUMORPH 200 ............... 2 INFUMORPH 500 ............... 2 INLYTA ............................... 9 INSPRA
see eplerenone ............. 10 INSULIN PEN NEEDLES . 20 INSULIN SAFETY NEEDLES ......................... 20 INSULIN SYRINGES ........ 20 INTELENCE ....................... 5 INTERMEZZO .................. 19 INTRALIPID INJ 20% ....... 31 INTRALIPID INJ 30% ....... 31 INTRON-A ........................ 29 INTRON-A W/DILUENT .... 29 INTUNIV ........................... 18 INVANZ .............................. 4 INVEGA ............................ 17 INVEGA SUSTENNA ........ 17 INVIRASE ........................... 5 INVOKANA ....................... 21 IONOSOL-B/DEXTROSE 5% .................................... 31 IONOSOL-MB/DEXTROSE 5% .................................... 31 IPOL INACTIVATED IPV .. 30 ipratropium bromide (nasal).......................................... 33 ipratropium sol inhal .......... 33 ipratropium-albuterol ......... 33 irbesartan .......................... 11 irbesartan-hydrochlorothiazide........................................ 11 IRESSA .............................. 9 irinotecan hcl .................... 10 ISENTRESS ....................... 5 ISOLYTE P ....................... 31 isolyte s ............................. 31 isoniazid .............................. 5 isoniazid & rifampin ............. 5 isoniazid tabs ...................... 5 ISOPTO CARPINE ........... 33
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ISORDIL TITRADOSE ...... 14 see isosorbide dinitrate . 14
isosorbide dinitrate ............ 14 isosorbide mononitrate ...... 14 isotretinoin cap 10 mg ....... 35 isradipine........................... 13 ISTALOL ........................... 33 ISTODAX ............................9 itraconazole .........................4 IXEMPRA KIT ................... 10 IXIARO .............................. 30 J JAKAFI ................................9 JALYN ............................... 27 JANUMET ......................... 21 JANUMET XR TAB 100-1000 ........................... 21 JANUMET XR TAB 50-1000 .......................................... 21 JANUMET XR TAB 50-500MG ......................... 21 JANUVIA ........................... 21 JENTADUETO .................. 21 JOLIVETTE ....................... 22 JUVISYNC ........................ 21 K KADCYLA ...........................9 KADIAN...............................2 KALETRA SOL ...................5 KALETRA TAB 100-25MG ..5 KALETRA TAB 200-50MG ..5 KAYEXALATE
see kionex ..................... 22 KAZANO ........................... 21 KCL 0.075%/D5W/NACL 0.45% ................................ 31 KCL 0.15%/D5W/LR ......... 31 KCL 0.15%/D5W/NACL 0.9% .................................. 31 kcl 0.3%/d5w/lr iv lac ri ...... 31 KCL 0.3%/D5W/NACL 0.45% ................................ 31 KCL 0.3%/D5W/NACL 0.9% .......................................... 31 KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 31 kcl 20 meq/l (0.15%) in nacl 0.45% inj ........................... 31 KCL 20 MEQ/L (0.15%) IN
NACL 0.45% INJ ............... 31 KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 31 KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 31 KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ ................. 31 KCL0.15%/D5W/NACL0.2% .......................................... 31 KCL0.15%/D5W/NACL0.225% ...................................... 31 KEFLEX
see cephalexin ................ 6 KENALOG ........................ 36 KEPIVANCE ..................... 10 KEPPRA
see levetiracetam .......... 15 KEPPRA XR
see levetiracetam .......... 15 KERLONE
see betaxolol hcl ........... 12 ketoconazole ....................... 4 ketoconazole (topical) ....... 35 ketoconazole shampoo ..... 36 ketoprofen ........................... 1 ketorolac tromethamine (ophth) .............................. 32 KINERET .......................... 29 kionex ............................... 22 KLARON
see sulfacetamide sodium (acne) ............................ 35
KLONOPIN see clonazepam ............ 14
KLOR-CON 10 .................. 30 KLOR-CON 8 .................... 30 klor-con m15 ..................... 30 klor-con m20 ..................... 30 KOMBIGLYZE XR 2.5-1000MG ...................... 21 KOMBIGLYZE XR 5-1000MG ......................... 21 KOMBIGLYZE XR 5-500MG .......................................... 21 kristalose pak .................... 26 KUVAN ............................. 23 L labetalol hcl ....................... 12
LAC-HYDRIN see ammonium lactate .. 37 see laclotion lotn 12% ... 37
laclotion lotn 12%.............. 37 LACRISERT ..................... 33 LACTATED RINGERS VIAFLEX ........................... 31 lactulose ........................... 26 lactulose (encephalopathy).......................................... 26 LAMICTAL
see lamotrigine .............. 15 LAMICTAL CHEWABLE DISPERS
see lamotrigine .............. 15 LAMICTAL ODT................ 15 LAMICTAL STARTER ...... 15 LAMICTAL XR .................. 15
see lamotrigine .............. 15 LAMISIL .............................. 4
see terbinafine hcl ........... 5 lamivudine .......................... 5 lamivudine-zidovudine ........ 5 lamotrigine ........................ 15 LANOXIN
see digoxin .................... 13 see digoxin inj ............... 13
LANOXIN PEDIATRIC ...... 13 LANOXIN TAB .................. 13 lansoprazole ..................... 27 LANTUS ........................... 20 LANTUS SOLOSTAR ....... 20 LASIX
see furosemide.............. 13 LASTACAFT ..................... 33 latanoprost ........................ 33 LATUDA ........................... 17 LAZANDA ........................... 2 LEENA .............................. 22 leflunomide ....................... 29 LESCOL
see fluvastatin sodium ... 11 LESCOL XL ...................... 11 LETAIRIS .......................... 14 letrozole .............................. 9 leucovor ca inj ................... 10 leucovorin calcium ............ 10 LEUKERAN ........................ 8 LEUKINE .......................... 28 leuprolide acetate ............... 9
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levalbuterol conc 1.25mg/0.5ml .................... 34 LEVALBUTEROL HCL ...... 34 LEVAQUIN
see levofloxacin ...............7 see levofloxacin in d5w....7
LEVATOL .......................... 12 LEVEMIR .......................... 20 LEVEMIR FLEXPEN ......... 20 levetiracetam ..................... 15 levobunolol hcl .................. 33 LEVOBUNOLOL HCL ....... 33 levocarnitine (metabolic modifiers) .......................... 23 levocetirizine soln 2.5mg/5ml .......................................... 33 levocetirizine tab 5 mg ...... 33 levofloxacin .........................7 levofloxacin (ophth) ........... 32 levofloxacin in d5w ..............7 levonorgestrel & eth estradiol .......................................... 22 levonorgestrel-eth estradiol (triphasic) .......................... 22 levonorgestrel-ethinyl estradiol (91-day) .............. 22 levonorgestrel-ethinyl estradiol (continuous) ........ 22 levorphanol tartrate .............2 LEVOTHROID ................... 25 levothyroxine sodium ........ 25 LEVOXYL.......................... 25 LEXAPRO
see escitalopram oxalate ...................................... 16
LEXIVA ...............................5 LIALDA ............................. 26 lidocaine ............................ 37 lidocaine hcl ...................... 37 lidocaine hcl (local anesth.) .3 lidocaine hcl (mouth-throat) .......................................... 37 lidocaine inj 0.5% ................3 lidocaine inj 1% ...................3 lidocaine inj 1.5% ................3 lidocaine inj 2% ...................3 lidocaine-prilocaine ........... 37 LIDODERM ....................... 37 LINZESS CAP 145MCG ... 27 LINZESS CAP 290MCG ... 27
liothyronine sodium ........... 25 LIPITOR
see atorvastatin calcium 11 LIPOFEN .......................... 12 lisinopril ............................. 10 lisinopril & hydrochlorothiazide ........... 10 lithium carbonate .............. 19 LITHIUM CITRATE ........... 19 LITHOBID
see lithium carbonate .... 19 LIVALO ............................. 11 LO LOESTRIN FE ............ 22 LOCOID ............................ 36
see hydrocortisone butyrate ......................... 36
LOCOID LIPOCREAM ...... 36 LODOSYN ........................ 17 LOESTRIN 1.5/30-21
see norethindrone acet & eth estra ........................ 23
LOESTRIN 1/20-21 see norethindrone acet & eth estra ........................ 23
LOESTRIN 24 FE ............. 22 LOESTRIN FE 1.5/30
see norethin acet & estrad-fe ........................ 22
LOESTRIN FE 1/20 see norethin acet & estrad-fe ........................ 22
LOFIBRA see fenofibrate .............. 12 see fenofibrate micronized ...................................... 12
LOKARA LOTN 0.05%...... 36 LOMOTIL
see diphenoxylate w/ atropine ......................... 27
loperamide hcl .................. 27 LOPID
see gemfibrozil .............. 12 LOPRESSOR
see metoprolol tartrate .. 12 LOPRESSOR HCT
see metoprolol & hctz tab 100-25mg ...................... 12 see metoprolol & hctz tab 50-25mg ........................ 12
LOPROX
see ciclopirox ................ 35 LOPROX SHAMPOO
see ciclopirox shampoo 1% ................................. 35
lorazepam ......................... 14 LORCET 10/650
see hydrocodone-acetaminophen 10-650mg ................... 2
LORTAB see co-gesic 5-500mg ..... 1 see hydrocodone-acetaminophen 10-500mg ................... 2 see hydrocodone-acetaminophen 5-500mg ..................... 1 see hydrocodone-acetaminophen 7.5-500mg .................. 2 see hydrocodone-acetaminophen 7.5-500mg/15ml ......... 2
losartan potassium ............ 11 losartan potassium & hydrochlorothiazide ........... 11 LOTEMAX ........................ 32 LOTENSIN
see benazepril hcl ......... 10 LOTENSIN HCT
see benazepril & hydrochlorothiazide ....... 10
LOTREL see amlodipine besylate-benazepril hcl . 10
LOTRONEX ...................... 27 lovastatin .......................... 11 LOVAZA ........................... 12 LOVENOX
see enoxaparin sodium . 28 loxapine succinate ............ 17 LOXITANE
see loxapine succinate .. 17 LUFYLLIN ......................... 34 LUMIGAN ......................... 33 LUMIZYME ....................... 23 LUNESTA ......................... 19 LUPR DEP-PED INJ 11.25MG (3-MONTH) ......... 9 LUPR DEP-PED INJ 30MG
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(3-MONTH) .........................9 LUPRON DEPOT ................9 LUPRON DEPOT INJ 22.5MG (3-MONTH) ...........9 LUPRON DEPOT INJ 30MG (3-MONTH) .........................9 LUPRON DEPOT-PED .......9 LUVOX CR
see fluvoxamine maleate er ................................... 14
LUXIQ see betamethasone valerate.......................... 36
LYRICA ............................. 15 LYSODREN ........................9 LYSTEDA
see tranexamic acid ...... 29 M MACROBID
see nitrofurantoin monohyd macro ...............4
MACRODANTIN .................4 see nitrofurantoin macrocrystal ....................4
mafenide acetate .............. 35 magnesium sulfate ............ 30 MAGNESIUM SULFATE ... 30 MAGNESIUM SULFATE IN D5W 1% ............................ 30 MAGNESIUM SULFATE IN D5W 2% ............................ 30 MALARONE
see atovaquone-proguanil hcl tab 250-100 mg ..........5
malathion .......................... 37 maprotiline hcl ................... 16 MARINOL
see dronabinol ............... 25 MARPLAN ......................... 16 MATULANE ...................... 10 matzim la........................... 13 MAVIK
see trandolapril .............. 10 MAXALT
see rizatriptan benzoate 19 MAXALT-MLT
see rizatriptan benzoate 19 MAXIDEX .......................... 32 MAXIDONE
see
hydrocodone-acetaminophen 10-750mg ................... 2
MAXIPIME .......................... 6 see cefepime inj 1gm ...... 6 see cefepime inj 2gm ...... 6
MAXITROL see neomycin-polymy-dexameth .................................... 32
MAXZIDE see triamterene & hydrochlorothiazide tab 75-50 mg ....................... 14
MAXZIDE-25 see triamterene & hydrochlorothiazide tab 37.5-25 mg .................... 14
meclizine hcl ..................... 25 MEDROL .......................... 24
see methylprednisolone 24 MEDROL DOSEPAK
see methylprednisolone 24 medroxyprogesterone acetate .............................. 25 medroxyprogesterone acetate (contraceptive) ..... 22 mefenamic acid ................... 1 mefloquine hcl ..................... 5 MEGACE ES ...................... 9 MEGACE ORAL
see megestrol acetate ..... 9 megestrol acetate ............... 9 MEKINIST ........................... 9 MELOXICAM SUSP 7.5 MG/5ML .............................. 1 meloxicam tabs ................... 1 melphalan hcl ...................... 8 MENACTRA ...................... 30 menest .............................. 23 MENHIBRIX ...................... 30 MENOMUNE-A/C/Y/W-135 .......................................... 30 MENOSTAR ..................... 23 MENTAX ........................... 35 MENVEO .......................... 30 MEPRON ............................ 4 mercaptopurine ................... 9 meropenem ......................... 4 MERREM
see meropenem .............. 4
mesalamine enema .......... 26 mesalamine enema kit ...... 26 mesna ............................... 10 MESNEX .......................... 10
see mesna .................... 10 MESTINON
see pyridostigmine bromide ......................... 19
MESTINON SYRUP ......... 19 MESTINON TIMESPAN ... 19 METADATE CD
see methylphenidate hcl 18 metadate tab 20mg er ....... 18 METAGLIP
see glipizide-metformin 2.5-250mg ..................... 21
metformin er ..................... 21 metformin hcl .................... 21 methadone hcl .................... 2 METHADONE INJ 10MG/ML............................................ 2 methazolamide ................. 13 methenamine hippurate ...... 4 METHERGINE
see methylergonovine maleate ......................... 24
methimazole ..................... 25 methocarbamol ................. 20 methotrexate sodium ........ 29 methotrexate sodium inj ...... 9 methotrexate sodium tabs 29 methscopolamine bromide 26 methyclothiazide ............... 13 methylergonovine maleate 24 METHYLIN
see methylphenidate hcl 18 METHYLIN CHEW TAB .... 18 methylphenidate hcl .......... 18 methylphenidate hcl er ...... 18 METHYLPHENIDATE HCL ER ..................................... 18 methylphenidate tab 10mg er.......................................... 18 methylphenidate tab 20mg er.......................................... 18 methylprednisolone ........... 24 methylprednisolone acetate.......................................... 24 methylprednisolone sod succ.......................................... 24
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metipranolol ...................... 33 metoclopramide hcl ........... 25 metoclopramide hcl inj 5 mg/ml ................................ 25 metolazone ....................... 13 metoprolol & hctz tab 100-25mg .......................... 12 metoprolol & hctz tab 100-50mg .......................... 12 metoprolol & hctz tab 50-25mg ............................ 12 metoprolol succinate ......... 12 metoprolol tartrate ............. 12 METOZOLV ODT .............. 25 METRO IV ...........................4 METROCREAM
see metronidazole (topical).......................... 37 see rosadan cre 0.75% . 37
METROGEL ...................... 37 see metronidazole (topical).......................... 37
METROGEL-VAGINAL see metronidazole vaginal ...................................... 28
METROLOTION see metronidazole (topical).......................... 37
metronidazole .....................4 metronidazole (topical) ...... 37 metronidazole inj .................4 metronidazole vaginal ....... 28 MEVACOR
see lovastatin ................ 11 mexiletine hcl .................... 11 MIACALCIN
see calcitonin (salmon) nasal spray .................... 24
MIACALCIN INJ 200U/ML. 24 MICARDIS ........................ 11 MICARDIS HCT ................ 11 miconazole nitrate vaginal. 28 MICRO-K
see potassium chloride caps er........................... 30
MICROZIDE see hydrochlorothiazide 13
midodrine hcl ..................... 14 MINASTRIN 24 FE ............ 22 MINIPRESS
see prazosin hcl ............ 11 minitran ............................. 14 MINIVELLE ....................... 23 MINOCIN
see minocycline hcl ......... 8 minocycline hcl ................... 8 minoxidil ............................ 14 MIRAPEX .......................... 17
see pramipexole dihydrochloride .............. 17
MIRAPEX ER .................... 17 MIRCETTE
see desogestrel-ethinyl estradiol (biphasic) ........ 22 see viorele ..................... 23
mirtazapine ....................... 16 misoprostol ....................... 27 mitomycin ............................ 8 mitoxantrone hcl ............... 10 M-M-R II W/DILUENT 10 DOS .................................. 30 MOBIC
see meloxicam tabs......... 1 modafinil ........................... 20 moexipril hcl ...................... 10 moexipril-hydrochlorothiazide ........................................ 10 mometasone furoate ......... 36 MONODOX
see doxycycline (monohydrate) ................. 8
MONONESSA .................. 22 montelukast sodium .......... 34 MORPHINE SUL 20MG/ML ORAL SOL .......................... 2 morphine sulfate ................. 2 MORPHINE SULFATE ....... 2 morphine sulfate ext-rel tab 3 morphine sulfate inj ............. 3 MORPHINE SULFATE INJ . 3 MOVIPREP ....................... 26 MOXATAG .......................... 7 MOXEZA ........................... 32 MOZOBIL .......................... 28 MS CONTIN
see morphine sulfate ext-rel tab ........................ 3
MULTAQ ........................... 11 mupirocin .......................... 35 mupirocin calcium (topical) 35
MUSTARGEN ..................... 8 MYAMBUTOL
see ethambutol hcl .......... 5 MYCAMINE ........................ 4 MYCOBUTIN ...................... 5 mycophenolate mofetil ...... 29 MYFORTIC ....................... 29 myorisan ........................... 35 MYOZYME ....................... 23 MYRBETRIQ .................... 28 MYSOLINE
see primidone................ 15 myzilra .............................. 22 N nabumetone ........................ 1 nadolol .............................. 12 nadolol & bendroflumethiazide ......... 12 nafcillin sodium ................... 7 NAFTIN ............................. 35 NAGLAZYME ................... 23 NALFON ............................. 1 NALLPEN ISO-OSMOTIC IN DE ....................................... 7 NALLPEN/DEXTROSE ....... 7 naloxone hcl ..................... 20 naltrexone hcl ................... 20 NAMENDA ........................ 16 NAMENDA TITRATION PAK.......................................... 16 NAMENDA XR .................. 16 NAMENDA XR TITRATION PACK ................................ 16 NAPRELAN ........................ 1 NAPROSYN
see naproxen .................. 1 naproxen ............................. 1 naproxen sodium ................ 1 naratriptan hcl ................... 19 NARDIL
see phenelzine sulfate .. 16 NASACORT AQ
see triamcinolone acetonide (nasal) ........... 34
NASONEX ........................ 34 NATACYN ........................ 32 nateglinide ........................ 21 NAVELBINE
see vinorelbine tartrate .... 9 NEBUPENT ........................ 4
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NECON 1/50-28 ................ 22 necon 10/11 28 day .......... 22 NECON 7/7/7 .................... 22 nefazodone hcl .................. 16 neomycin sulfate .................3 neomycin/polymyxin b gu .. 37 neomycin-bacitracin zn-polymyxin ..................... 32 neomycin-polymy-dexameth .......................................... 32 neomycin-polymy-gramicid .......................................... 32 neomycin-polymyxin-hc (ophth) .............................. 32 neomycin-polymyxin-hc (otic) .......................................... 37 NEORAL ........................... 29
see cyclosporine modified (for microemulsion) ........ 29
NEOSPORIN see neomycin-polymy-gramicid ...................................... 32
NEOSPORIN GU IRRIGANT see neomycin/polymyxin b gu .................................. 37
NEPHRAMINE .................. 31 NEPTAZANE
see methazolamide ....... 13 NESINA............................. 21 NEULASTA ....................... 28 NEUMEGA ........................ 28 NEUPOGEN ..................... 28 NEUPRO........................... 17 NEURONTIN
see gabapentin .............. 15 NEVANAC ......................... 32 nevirapine ...........................5 NEVIRAPINE ......................5 NEXAVAR ...........................9 NEXIUM ............................ 27 NEXIUM GRANULES 10MG DR ..................................... 27 NEXIUM GRANULES 2.5MG DR ..................................... 27 NEXIUM GRANULES 20MG DR ..................................... 27 NEXIUM GRANULES 40MG DR ..................................... 27 NEXIUM GRANULES 5MG
DR..................................... 27 NEXIUM I.V. ..................... 27 next choice tab 1.5mg ....... 22 niacor ................................ 12 NIASPAN .......................... 12 nicardipine hcl ................... 13 NICOTROL INHALER ....... 20 NICOTROL NS ................. 20 nifedipine .......................... 13 nifedipine cc tab 90mg er .. 13 nifedipine cr ...................... 13 nifedipine er ...................... 13 nifedipine xl ....................... 13 NILANDRON ....................... 9 nimodipine ........................ 13 NIMOTOP
see nimodipine .............. 13 NIPENT
see pentostatin ................ 9 nisoldipine ......................... 13 NITRO-DUR ...................... 14
see minitran ................... 14 nitrofurantoin ....................... 4 nitrofurantoin macrocrystal .. 4 nitrofurantoin monohyd macro .................................. 4 nitroglycerin ...................... 14 NITROGLYCERIN ............ 14 NITROGLYCERIN LINGUAL .......................................... 14 nitroglycerin patches ......... 14 NITROLINGUAL SPR PUMPSPRA ...................... 14 NITROMIST ...................... 14 NITROSTAT ..................... 14 nizatidine ........................... 26 NIZORAL
see ketoconazole shampoo ....................... 36
NORA-BE ......................... 22 NORCO
see hydrocodone-acetaminophen 5-325mg ..................... 1 see hydrocodone-acetaminophen 7.5-325mg .................. 2 see hydrocodone-acetaminophen tab 10-325mg ............. 2
NORDITROPIN FLEXPRO.......................................... 24 NORDITROPIN NORDIFLEX PEN ............. 24 norethin acet & estrad-fe .. 22 norethindrone & eth estradiol.................................... 22, 23 norethindrone & ethinyl estradiol-fe ........................ 23 norethindrone (contraceptive) .................. 23 norethindrone acet & eth estra .................................. 23 norethindrone acetate ....... 25 norethindrone acetate-ethinyl estradiol ............................ 23 norethindrone acetate-ethinyl estradiol-fe ........................ 23 norethindrone-eth estradiol (triphasic) .......................... 23 norgestimate-ethinyl estradiol ............................ 23 norgestimate-ethinyl estradiol (triphasic) ........... 23 norgestrel & ethinyl estradiol.......................................... 23 NORINYL 1+35
see norethindrone & eth estradiol ........................ 22
NORINYL 1+50 ................. 23 NORMOSOL-R ................. 31 NOROXIN ........................... 7 NORPACE
see disopyramide phosphate ..................... 11
NORPACE CR .................. 11 NORPRAMIN
see desipramine hcl ...... 16 NOR-QD
see heather tab 0.35mg 22 see norethindrone (contraceptive) .............. 23
nortriptyline hcl ................. 16 NORVASC
see amlodipine besylate 12 NORVIR .............................. 5 NOVAREL INJ 10000UNT 24 NOVOLIN 70/30................ 20 NOVOLIN 70/30 RELION . 20 NOVOLIN N ...................... 20
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NOVOLIN N RELION ........ 21 NOVOLIN R ...................... 21 NOVOLIN R RELION ........ 21 NOVOLOG ........................ 21 NOVOLOG FLEXPEN ...... 21 NOVOLOG MIX 70/30 ...... 21 NOVOLOG MIX 70/30 PREFILL ........................... 21 NOXAFIL.............................4 NUCYNTA ...........................3 NUCYNTA ER .....................3 NUEDEXTA ...................... 19 NULOJIX ........................... 29 NULYTELY/FLAVOR PACKS .............................. 26
see peg 3350-potassium chloride-sod bicarbonate-sod chloride ...................................... 27
NUTROPIN ....................... 24 NUTROPIN AQ ................. 24 NUTROPIN AQ NUSPIN 5 24 NUTROPIN AQ PEN ......... 24 NUVARING ....................... 23 NUVIGIL............................ 20 NYMALIZE ........................ 13 nystatin ...............................5 nystatin (mouth-throat) ...... 37 nystatin (topical) ................ 35 nystatin pow 100000 ......... 35 O OCELLA ............................ 23 OCTAGAM ........................ 29 octreotide acetate ............. 25 OCUFEN
see flurbiprofen sodium . 32 OCUFLOX
see ofloxacin (ophth) ..... 32 ofloxacin (ophth) ............... 32 ofloxacin (otic) ................... 37 olanzapine................... 17, 18 olanzapine odt ................... 18 OLEPTRO ......................... 16 OLUX
see clobetasol propionate ...................................... 36
OLUX-E see clobetasol propionate emulsion ........................ 36
OMECLAMOX-PAK .......... 27
omeprazole ....................... 27 OMNARIS ......................... 34 OMNITROPE 10MG ......... 24 OMNITROPE 5.8MG ........ 24 OMNITROPE 5MG ........... 24 ondansetron hcl ................ 25 ondansetron hcl inj ............ 25 ondansetron hcl oral soln .. 25 ondansetron odt ................ 26 ONFI ................................. 15 ONGLYZA ......................... 21 ONMEL ............................... 5 ONSOLIS ............................ 3 ONTAK ............................... 9 OPANA
see oxymorphone hcl ...... 3 OPANA ER (CRUSH RESISTANT ........................ 3 OPTIPRANOLOL
see metipranolol ............ 33 OPTIVAR
see azelastine hcl (ophth) ...................................... 32
ORACEA ........................... 37 ORAP ................................ 18 ORAPRED
see prednisolone sodium phosphate ..................... 24
ORAPRED ODT ............... 24 ORENCIA ......................... 29 ORFADIN .......................... 23 ORTHO EVRA .................. 23 ORTHO MICRONOR
see norethindrone (contraceptive) .............. 23
ORTHO TRI-CYCLEN see norgestimate-ethinyl estradiol (triphasic) ........ 23
ORTHO TRI-CYCLEN LO . 23 ORTHO-CYCLEN
see norgestimate-ethinyl estradiol ......................... 23
ORTHO-NOVUM 7/7/7 see norethindrone-eth estradiol (triphasic) ........ 23
OSENI TAB 12.5-15MG .... 21 OSENI TAB 12.5-30MG .... 21 OSENI TAB 12.5-45MG .... 21 OSENI TAB 25-15MG ....... 21 OSENI TAB 25-30MG ....... 21
OSENI TAB 25-45MG ....... 21 OSMOPREP ..................... 26 OVCON-35
see norethindrone & eth estradiol ........................ 23 see philith ...................... 23 see zenchent tab ........... 23
OVIDE see malathion ................ 37
oxacillin sodium .................. 7 oxaliplatin .......................... 10 OXANDRIN
see oxandrolone............ 20 oxandrolone ...................... 20 oxaprozin ............................ 1 oxcarbazepine .................. 15 OXECTA ............................. 3 OXISTAT .......................... 35 OXSORALEN ................... 37 OXSORALEN ULTRA ....... 35 oxybutynin chloride ........... 28 oxycodone hcl ..................... 3 OXYCODONE HCL ............ 3 oxycodone w/ acetaminophen ................... 3 oxycodone w/ acetaminophen 10-325mg .. 3 oxycodone w/ acetaminophen 10-650mg .. 3 oxycodone w/ acetaminophen 2.5-325mg . 3 oxycodone w/ acetaminophen 5-325mg .... 3 oxycodone w/ acetaminophen 5-500mg .... 3 oxycodone w/ acetaminophen 7.5-325mg . 3 oxycodone w/ acetaminophen 7.5-500mg . 3 oxycodone-aspirin............... 3 oxycodone-ibuprofen .......... 3 OXYCONTIN ...................... 3 oxymorphone hcl ................ 3 OXYTROL ........................ 28 P paclitaxel ............................. 9 PAMELOR
see nortriptyline hcl ....... 16 pamidronate disodium ...... 22 PAMINE
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see methscopolamine bromide ......................... 26
PAMINE FORTE see methscopolamine bromide ......................... 26
PANCREAZE .................... 27 PANDEL............................ 36 PANRETIN ........................ 37 pantoprazole sodium ......... 27 PARAFON FORTE DSC
see chlorzoxazone ........ 20 PARCOPA
see carbidopa-levodopa 17 PARLODEL ....................... 17
see bromocriptine mesylate ........................ 17
PARNATE see tranylcypromine sulfate ............................ 16
paromomycin sulfate ...........3 paroxetine er tab ............... 16 paroxetine hcl .................... 16 paser 4gm ...........................5 PATADAY ......................... 33 PATANASE ....................... 33 PATANOL ......................... 33 PAXIL ................................ 16
see paroxetine hcl ......... 16 PAXIL CR
see paroxetine er tab ..... 16 PCE ....................................7 PEDIAPRED
see prednisolone sodium phosphate ...................... 24
PEDVAX HIB .................... 30 peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ..... 26, 27 PEG 3350-KCL-SOD BICARB-SOD CHLORIDE-SOD SULFATE .......................................... 26 peg 3350-potassium chloride-sod bicarbonate-sod chloride ............................. 27 PEGANONE ...................... 15 PEGASYS ......................... 29 PEGASYS PROCLICK ..... 29 PEG-INTRON ................... 29 PEG-INTRON REDIPEN... 29 PENICILLIN G POT IN
DEXTROSE ........................ 7 penicillin g potassium .......... 7 PENICILLIN G POTASSIUM ............................................ 7 penicillin g procaine ............ 7 penicillin g sodium .............. 7 penicillin v potassium .......... 8 PENNSAID ....................... 37 PENTAM 300 ...................... 4 PENTASA ......................... 26 pentostatin .......................... 9 pentoxifylline ..................... 28 PEPCID
see famotidine ............... 26 PERCOCET
see endocet 10/325 ......... 2 see endocet 5/325 ........... 2 see endocet 7.5/325 ........ 2 see oxycodone w/ acetaminophen ................ 3 see oxycodone w/ acetaminophen 10-325mg ........................................ 3 see oxycodone w/ acetaminophen 10-650mg ........................................ 3 see oxycodone w/ acetaminophen 2.5-325mg ........................................ 3 see oxycodone w/ acetaminophen 5-325mg . 3 see oxycodone w/ acetaminophen 7.5-325mg ........................................ 3 see oxycodone w/ acetaminophen 7.5-500mg ........................................ 3
PERCODAN see oxycodone-aspirin .... 3
PERFOROMIST ............... 34 PERIDEX
see chlorhexidine gluconate (mouth-throat) ...................................... 37 see periogard sol 0.12% 37
perindopril erbumine ......... 10 periogard sol 0.12% .......... 37 permethrin ......................... 37 perphenazine .................... 18 PERSANTINE
see dipyridamole ........... 29 PERTZYE ......................... 27 PEXEVA ........................... 16 pfizerpen ............................. 8 phenelzine sulfate ............. 16 PHENERGAN
see promethazine hcl .... 26 phenobarbital .................... 15 phenobarbital sodium ....... 15 PHENOBARBITAL SODIUM.......................................... 15 PHENYTEK
see phenytoin sodium extended ....................... 15
phenytoin .......................... 15 phenytoin inj 50mg/ml ....... 15 phenytoin sodium extended.......................................... 15 philith ................................ 23 PHISOHEX ....................... 35 PHOSLO
see calcium acetate (phosphate binder) ........ 25
PHOSLYRA ...................... 25 PHOSPHOLINE IODIDE .. 33 PICATO ............................ 35 PILOCARPINE HCL ......... 33 pilocarpine hcl (oral) ......... 37 PILOPINE HS ................... 33 pindolol ............................. 12 pioglitazone hcl ................. 21 pioglitazone hcl-glimepiride.......................................... 21 pioglitazone hcl-metformin hcl ..................................... 21 piperacillin sodium-tazobactam sodium 8 piroxicam ............................ 1 PLAN B ONE-STEP
see next choice tab 1.5mg ...................................... 22
PLAQUENIL see hydroxychloroquine sulfate ........................... 29
PLASMA-LYTE A.............. 31 PLASMA-LYTE-148 .......... 31 PLASMA-LYTE-56/D5W ... 31 PLAVIX
see clopidogrel bisulfate 29 PLETAL
56
57
see cilostazol ................. 28 podofilox............................ 37 polyethylene glycol 3350 ... 27 polymyxin b sulfate .............4 polymyxin b-trimethoprim .. 32 POLYTRIM
see polymyxin b-trimethoprim ............... 32
POMALYST CAP .............. 10 PONSTEL
see mefenamic acid ........1 potassium chloride ............ 31 POTASSIUM CHLORIDE 30, 31
see potassium chloride .. 31 POTASSIUM CHLORIDE 0.15% ................................ 31 POTASSIUM CHLORIDE 0.22% ................................ 31 POTASSIUM CHLORIDE 0.3%/D .............................. 31 potassium chloride caps er .......................................... 30 potassium chloride microencapsulated crystals cr ....................................... 30 POTASSIUM CITRATE (ALKALINIZER) ................. 27 POTIGA ............................ 15 PRADAXA ......................... 28 pramipexole dihydrochloride .......................................... 17 PRANDIMET ..................... 21 PRANDIN .......................... 22 PRAVACHOL
see pravastatin sodium.. 11 pravastatin sodium ............ 11 prazosin hcl ....................... 11 PRECOSE
see acarbose ................. 21 PRED MILD ...................... 32 PRED-G ............................ 32 PRED-G S.O.P. ................ 32 prednicarbate .................... 36 PREDNICARBATE ........... 36 prednisolone ..................... 24 PREDNISOLONE ACETATE .......................................... 32 prednisolone sodium phosphate ......................... 24
prednisolone sodium phosphate (ophth) ............. 32 prednisone ........................ 24 PREGNYL W/DILUENT BENZYL ............................ 25 PRELONE
see prednisolone ........... 24 PREMARIN ....................... 24 PREMARIN CREAM ......... 24 PREMARIN INJ ................ 24 premasol 10% ................... 31 premasol 6% ..................... 31 PREMPHASE ................... 24 PREMPRO ........................ 24 PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC) .......................................... 32 PREPOPIK ....................... 27 PREVACID
see lansoprazole ........... 27 PREVACID SOLUTAB ...... 27 PREVPAC ......................... 27 PREZISTA .......................... 5 PRIFTIN .............................. 5 PRILOSEC
see omeprazole ............. 27 PRIMAQUINE PHOSPHATE ............................................ 5 PRIMAXIN IV
see imipenem-cilastatin ... 4 primidone .......................... 15 PRIMSOL SOL 50MG/5ML . 4 PRINIVIL
see lisinopril .................. 10 PRINZIDE
see lisinopril & hydrochlorothiazide ....... 10
PRISTIQ ........................... 16 PRIVIGEN ......................... 29 PROAIR HFA .................... 34 probenecid .......................... 1 PROCALAMINE ................ 31 PROCARDIA XL
see nifedipine er ............ 13 see nifedipine xl ............ 13
prochlorperazine inj 5 mg/ml .......................................... 26 prochlorperazine maleate . 26 prochlorperazine supp ...... 26 PROCRIT .......................... 28
procto-pak cre 1%............. 35 proctozone cre -hc 2.5% ... 35 PROCYSBI ....................... 23 progesterone micronized .. 25 PROGLYCEM ................... 24 PROGRAF ........................ 29
see tacrolimus ......... 29, 30 PROLASTIN-C.................. 34 PROLENSA ...................... 33 PROLEUKIN ....................... 9 PROLIA ............................ 25 PROMACTA ..................... 29 promethazine hcl .............. 26 PROMETRIUM
see progesterone micronized ..................... 25
propafenone hcl ................ 11 proparacaine hcl ............... 33 propranolol & hydrochlorothiazide ........... 12 propranolol hcl er .............. 12 propranolol inj 1mg/ml ...... 12 propranolol sol .................. 12 propranolol tab .................. 12 propylthiouracil ................. 25 PROQUAD ....................... 30 PROSCAR
see finasteride ............... 27 PROSOL ........................... 31 PROTONIX ....................... 27
see pantoprazole sodium ...................................... 27
PROTOPIC ....................... 37 protriptyline hcl ................. 16 PROVENTIL HFA ............. 34 PROVERA
see medroxyprogesterone acetate .......................... 25
PROVIGIL see modafinil ................. 20
PROZAC see fluoxetine hcl .......... 16
PROZAC WEEKLY see fluoxetine hcl .......... 16
PRUDOXIN CRE 5% ........ 35 PULMICORT
see budesonide (inhalation) .................... 34
PULMICORT FLEXHALER.......................................... 34
57
58
PULMICORT INH SUSP ... 34 PULMOZYME ................... 34 PURINETHOL
see mercaptopurine .........9 PYLERA ............................ 27 pyrazinamide .......................5 pyridostigmine bromide ..... 19 Q QNASL .............................. 34 QUALAQUIN
see quinine sulfate ..........5 QUARTETTE .................... 23 QUESTRAN
see cholestyramine ....... 11 QUESTRAN LIGHT
see cholestyramine light 12 quetiapine fumarate .......... 18 QUILLIVANT XR ............... 19 quinapril hcl ....................... 10 quinapril-hydrochlorothiazide .......................................... 10 quinidine gluconate er ....... 11 quinidine sulfate ................ 11 quinine sulfate .....................5 QVAR ................................ 34 R RABAVERT ....................... 30 ramipril .............................. 10 RANEXA ........................... 14 ranitidine hcl ...................... 26 RAPAFLO ......................... 27 RAPAMUNE ...................... 29 RAYOS ............................. 24 RAZADYNE
see galantamine hydrobromide ................ 16
RAZADYNE ER see galantamine hydrobromide ................ 16
REBETOL ...........................6 see ribasphere 200mg .....6 see ribavirin 200mg .........6
REBIF ............................... 19 REBIF TITRATION PACK . 19 RECOMBIVAX HB ............ 30 RECTIV ............................. 37 REGLAN
see metoclopramide hcl. 25 REGONOL ........................ 19 RELENZA DISKHALER ......6
RELISTOR ........................ 27 RELPAX ............................ 19 REMERON
see mirtazapine ............. 16 REMERON SOLTAB
see mirtazapine ............. 16 REMICADE ....................... 29 REMODULIN .................... 14 RENAGEL ......................... 25 RENVELA ......................... 25 REPREXAIN
see ibudone tab 5-200mg 2 reprexain 10/200 ................. 2 REQUIP
see ropinirole hydrochloride ................. 17
REQUIP XL see ropinirole hydrochloride ................. 17
RESCRIPTOR .................... 5 RESTASIS ........................ 33 RETIN-A
see tretinoin ................... 35 RETROVIR
see zidovudine ................ 5 RETROVIR IV INFUSION ... 5 REVATIO
see sildenafil citrate (pulmonary hypertension) ...................................... 14
REVIA see naltrexone hcl ......... 20
REVLIMID ......................... 29 REYATAZ ........................... 5 RHEUMATREX ................. 29 RHINOCORT AQUA ......... 34 ribapak ................................ 6 ribapak mis 600/day ............ 6 ribasphere ........................... 6 ribasphere 200mg ............... 6 ribavirin 200mg ................... 6 RIFADIN
see rifampin ..................... 6 rifampin ............................... 6 RIFATER ............................ 6 RILUTEK ........................... 19
see riluzole .................... 19 riluzole .............................. 19 rimantadine hydrochloride ... 6 RINGER'S ......................... 31
RIOMET ............................ 22 RISPERDAL
see risperidone.............. 18 RISPERDAL CONSTA ..... 18 RISPERDAL M-TAB
see risperidone odt ........ 18 risperidone ........................ 18 risperidone odt .................. 18 RITALIN
see methylphenidate hcl 18 RITALIN LA ...................... 19
see methylphenidate hcl 18 RITUXAN ............................ 9 rivastigmine tartrate .......... 16 rizatriptan benzoate .......... 19 ROBAXIN
see methocarbamol ....... 20 ROBAXIN-750
see methocarbamol ....... 20 ROBINUL
see glycopyrrolate ......... 26 ROBINUL FORTE
see glycopyrrolate ......... 26 ROCALTROL
see calcitriol ............ 31, 32 ROCEPHIN
see ceftriaxone sodium ... 6 ropinirole hydrochloride .... 17 rosadan cre 0.75% ............ 37 ROTATEQ ........................ 30 ROWASA
see mesalamine enema kit ...................................... 26
ROXICODONE see oxycodone hcl .......... 3
ROZEREM ........................ 19 RYTHMOL
see propafenone hcl ...... 11 RYTHMOL SR
see propafenone hcl ...... 11 S SABRIL ............................. 15 SAIZEN ............................. 24 SAIZEN CLICK.EASY ....... 24 SALAGEN
see pilocarpine hcl (oral) ...................................... 37
SAMSCA .......................... 25 SANCTURA
see trospium chloride .... 28
58
59
SANCTURA XR see trospium chloride .... 28
SANCUSO ........................ 26 SANDIMMUNE
see cyclosporine ............ 29 SANDIMMUNE CAPS ....... 29 SANDIMMUNE SOLN ....... 29 SANDOSTATIN
see octreotide acetate ... 25 SANDOSTATIN LAR DEPOT ............................. 25 SANTYL ............................ 37 SAPHRIS .......................... 18 SARAFEM ......................... 20 SAVELLA .......................... 19 SAVELLA TITRATION PACK ................................ 19 SEASONIQUE
see levonorgestrel-ethinyl estradiol (91-day) .......... 22
SECTRAL see acebutolol hcl .......... 12
selegiline hcl ..................... 17 selenium sulfide ................ 36 SELSUN SHAMPOO
see selenium sulfide ...... 36 SELZENTRY .......................5 SEMPREX-D ..................... 33 SENSIPAR ........................ 22 SEREVENT DISKUS ........ 34 SEROQUEL
see quetiapine fumarate 18 SEROQUEL XR ................ 18 SEROSTIM ....................... 24 sertraline hcl ...................... 16 SFROWASA ..................... 26 sildenafil citrate (pulmonary hypertension) .................... 14 SILENOR .......................... 19 SILVER SULFADIAZINE... 35 SIMCOR............................ 12 SIMPONI ........................... 29 SIMULECT ........................ 29 simvastatin ........................ 11 SINEMET
see carbidopa-levodopa 17 SINEMET CR
see carbidopa-levodopa 17 SINGULAIR
see montelukast sodium 34
SIRTURO ............................ 6 SKLICE ............................. 37 SOD FLUORIDE 2.2MG TAB ................................... 30 SODIUM CHLORIDE .. 30, 31 SODIUM CHLORIDE 0.45% VIA .................................... 31 SODIUM CHLORIDE 0.9% .......................................... 37 sodium phenylbutyrate ...... 23 sodium polystyrene sulfonate .......................................... 22 SOLARAZE ....................... 35 SOLIA ............................... 23 SOLODYN .......................... 8
see minocycline hcl ......... 8 SOLTAMOX ........................ 9 SOLU-CORTEF 1000MG . 24 SOLU-CORTEF 100MG ... 24 SOLU-CORTEF 250MG ... 24 SOLU-CORTEF 500MG ... 24 SOLU-MEDROL ............... 24
see methylprednisolone sod succ ........................ 24
SOMATULINE DEPOT ..... 25 SOMAVERT ...................... 25 SONATA
see zaleplon .................. 19 SORIATANE ..................... 35 SORILUX .......................... 35 sotalol hcl .......................... 11 sotalol hcl (afib/afl) ............ 11 SPIRIVA HANDIHALER .... 33 spironolactone .................. 10 spironolactone & hydrochlorothiazide ........... 13 SPORANOX
see itraconazole .............. 4 SPORANOX SOL 10MG/ML ............................................ 5 SPRYCEL ........................... 9 sps sus 15gm/60ml ........... 22 SSD .................................. 35 stagesic 500-5mg ............... 2 STARLIX
see nateglinide .............. 21 stavudine ............................ 5 STAVZOR ......................... 15 STELARA ......................... 35 STERILE WATER
IRRIGATION ..................... 37 STIMATE .......................... 25 STIVARGA ......................... 9 STRATTERA .................... 19 streptomycin sulfate ............ 3 STRIANT .......................... 20 STRIBILD ........................... 5 STROMECTOL ................... 4 SUBOXONE
see buprenorphine hcl-naloxone hcl sl ......... 20
SUBOXONE MIS 12-3MG 20 SUBOXONE MIS 2-0.5MG.......................................... 20 SUBOXONE MIS 4-1MG .. 20 SUBOXONE MIS 8-2MG .. 20 SUBSYS ............................. 3 SUCLEAR ......................... 27 SUCRAID ......................... 27 sucralfate .......................... 27 SULAR
see nisoldipine .............. 13 sulfacetamide sodium (acne).......................................... 35 sulfacetamide sodium (ophth) .............................. 32 sulfacetamide sod-prednisolone .............. 32 sulfadiazine ......................... 3 sulfamethoxazole-trimethoprim ......................................... 4 sulfamethoxazole-trimethoprim inj .................................... 4 SULFAMYLON ................. 35
see mafenide acetate .... 35 sulfasalazine dr ................. 26 sulfasalazine ir .................. 26 sulindac .............................. 1 sumatriptan succinate ....... 19 SUMATRIPTAN SUCCINATE ..................... 19 sumatriptan succinate inj .. 19 SUMATRIPTAN SUCCINATE INJ............... 19 SUMAVEL DOSEPRO ...... 19 suprax ................................. 6 SUPRAX ............................. 6 SUPREP BOWEL PREP .. 27 SURMONTIL
see trimipramine maleate
59
60
...................................... 17 SUSTIVA.............................5 SUTENT..............................9 syeda ................................ 23 SYLATRON ....................... 10 SYMBICORT ..................... 34 SYMLINPEN 120 .............. 21 SYMLINPEN 60 ................ 21 SYNAGIS .......................... 30 SYNALAR
see fluocinolone acetonide ...................................... 36
SYNALGOS-DC ..................2 SYNAREL ......................... 23 SYNERA ........................... 37 SYNERCID .........................4 SYNTHROID ..................... 25
see levothyroxine sodium ...................................... 25
SYPRINE .......................... 22 T TABLOID.............................9 TACLONEX ....................... 36 tacrolimus.................... 29, 30 TAFINLAR ...........................9 TAMBOCOR
see flecainide acetate .... 11 TAMIFLU.............................6 tamoxifen citrate ..................9 tamsulosin hcl ................... 27 TAPAZOLE
see methimazole ........... 25 TARCEVA ...........................9 TARGRETIN ............... 10, 37 TARKA .............................. 10 TASIGNA ............................9 TAXOTERE .........................9 tazicef vial ...........................6 TAZORAC ......................... 35 taztia xt ............................. 13 TECFIDERA ...................... 19 TECFIDERA STARTER PACK ................................ 19 TEFLARO ...........................6 TEGRETOL ....................... 15
see carbamazepine ....... 14 TEGRETOL-XR ................ 15
see carbamazepine ....... 14 TEKAMLO ......................... 13 TEKTURNA ....................... 13
TEKTURNA HCT .............. 13 TEMOVATE
see clobetasol propionate ...................................... 36
TEMOVATE E see clobetasol propionate emollient base ............... 36
TENORETIC 100 see atenolol & chlorthalidone ................ 12
TENORETIC 50 see atenolol & chlorthalidone ................ 12
TENORMIN see atenolol ................... 12
TERAZOL 3 see terconazole vaginal . 28
TERAZOL 7 see terconazole vaginal . 28
terazosin hcl ...................... 11 terbinafine hcl ..................... 5 terbutaline sulfate ............. 34 terconazole vaginal ........... 28 TESTIM ............................. 20 testosterone cypionate ...... 20 testosterone enanthate ..... 20 TETANUS TOXOID ADSORBED ...................... 30 TETANUS/DIPHTHERIA TOXOID ............................ 30 tetrahydrozoline hcl ........... 34 TEVETEN ......................... 11
see eprosartan mesylate ...................................... 11
TEVETEN HCT ................. 11 TEV-TROPIN .................... 24 texacort ............................. 36 THALOMID ....................... 29 theo-24 .............................. 34 theophylline ....................... 34 THERMAZENE ................. 35 thioridazine hcl .................. 18 thiotepa ............................... 8 thiothixene ........................ 18 THYMOGLOBULIN ........... 30 tiagabine hcl ...................... 15 TIAZAC
see diltiazem hcl er........ 13 see diltiazem hcl extended release beads ................ 13
see diltzac ..................... 13 see taztia xt ................... 13
TIKOSYN .......................... 11 TIMENTIN ........................... 8 TIMENTIN INJ 3.1GM ......... 8 timolol maleate ................. 12 timolol maleate (ophth) ..... 33 TIMOLOL MALEATE GEL 33 TIMOPTIC
see timolol maleate (ophth) ........................... 33
TIMOPTIC OCUDOSE ..... 33 TIROSINT ......................... 25 tizanidine .......................... 20 TOBI NEB ........................... 3 TOBRADEX ...................... 32
see tobramycin-dexamethasone .................................... 32
TOBRADEX ST ................ 32 tobramycin sulfate............... 3 tobramycin sulfate (ophth) 32 tobramycin sulfate in saline 3 tobramycin-dexamethasone.......................................... 32 TOBREX
see tobramycin sulfate (ophth) ........................... 32
TOBREX OINT 0.3% ........ 32 TOFRANIL
see imipramine hcl ........ 16 TOFRANIL-PM
see imipramine pamoate ...................................... 16
tolmetin sodium................... 1 tolterodine tartrate............. 28 TOPAMAX
see topiramate .............. 15 TOPAMAX SPRINKLE
see topiramate .............. 15 TOPICORT ....................... 36
see desoximetasone ..... 36 topiramate ......................... 15 topotecan hcl .................... 10 TOPROL XL
see metoprolol succinate ...................................... 12
TORISEL ............................ 9 torsemide inj ..................... 13 torsemide tabs .................. 13
60
61
TOVIAZ ............................. 28 TPN ELECTROLYTES ..... 30 TRACLEER ....................... 14 TRADJENTA ..................... 22 tramadol hcl er ....................2 TRAMADOL HCL ER ..........2 TRAMADOL HCL ER (BIPHASIC) 100MG ............2 TRAMADOL HCL ER (BIPHASIC) 200MG ............2 tramadol hcl er (biphasic) 300mg .................................2 tramadol hcl tab 50 mg .......2 tramadol-acetaminophen ....2 TRANDATE
see labetalol hcl ............. 12 trandolapril ........................ 10 tranexamic acid ................. 29 TRANSDERM-SCOP ........ 26 TRANXENE T
see clorazepate dipotassium ................... 15
tranylcypromine sulfate ..... 16 travasol ............................. 31 TRAVATAN Z .................... 33 trazodone hcl .................... 16 TREANDA ...........................8 TRECATOR ........................6 TRELSTAR DEPOT MIXJECT.............................9 TRELSTAR LA MIXJECT....9 TRELSTAR MIXJECT .........9 TRENTAL
see pentoxifylline ........... 28 tretin x ............................... 35 tretinoin ....................... 10, 35 TRETINOIN MICROSPHERE ............... 35 TREXIMET ........................ 19 triamcinolone acetonide (mouth) ............................. 37 triamcinolone acetonide (nasal) ............................... 34 triamcinolone acetonide (topical) ............................. 37 triamterene & hydrochlorothiazide cap 37.5-25 mg ........................ 13 triamterene & hydrochlorothiazide tab
37.5-25 mg ........................ 14 triamterene & hydrochlorothiazide tab 75-50 mg ........................... 14 TRIBENZOR ..................... 11 TRICOR
see fenofibrate .............. 12 trifluoperazine hcl .............. 18 trifluridine .......................... 32 TRIGLIDE ......................... 12 TRILEPTAL ....................... 15
see oxcarbazepine ........ 15 TRILIPIX ........................... 12
see choline fenofibrate .. 12 trimethoprim ........................ 4 trimipramine maleate ........ 17 TRINESSA ........................ 23 TRI-NORINYL 28
see norethindrone-eth estradiol (triphasic) ........ 23
TRIOSTAT see liothyronine sodium . 25
TRISENOX ....................... 10 TRIZIVIR ............................. 5 TROPHAMINE .................. 31 trospium chloride .............. 28 TRUSOPT
see dorzolamide hcl ...... 33 TRUVADA ........................... 5 TUDORZA PRESSAIR ..... 33 TWINRIX ........................... 30 TWYNSTA ........................ 11 TYGACIL ............................ 4 TYKERB ............................. 9 TYLENOL/CODEINE #3
see acetaminophen w/ codeine ............................ 1
TYLENOL/CODEINE #4 see acetaminophen w/ codeine ............................ 1
TYPHIM VI ........................ 30 TYSABRI .......................... 20 TYZEKA .............................. 6 tyzine pediatric nasal dr .... 34 U UCERIS ............................ 26 ULESFIA ........................... 37 ULORIC .............................. 1 ULTRACET
see
tramadol-acetaminophen 2 ULTRAM
see tramadol hcl tab 50 mg ................................... 2
ULTRAM ER see tramadol hcl er .......... 2
ULTRAVATE see halobetasol propionate ..................... 36
ULTRESA ......................... 27 UNASYN
see ampicillin & sulbactam sodium ............................ 7
UNASYN BULK PACK see ampicillin & sulbactam sodium ............................ 7
UNIRETIC see moexipril-hydrochlorothiazide .................................. 10
UNITHROID ...................... 25 UNIVASC
see moexipril hcl ........... 10 urea-hc acetate ................. 37 URECHOLINE
see bethanechol chloride ...................................... 27
UROCIT-K ........................ 27 UROXATRAL
see alfuzosin hcl ............ 27 URSO 250
see ursodiol ................... 27 URSO FORTE
see ursodiol ................... 27 ursodiol ............................. 27 UVADEX ........................... 10 V VAGIFEM ......................... 24 valacyclovir hcl.................... 6 VALCYTE ........................... 6 VALIUM
see diazepam ................ 15 valproate sodium .............. 16 valproic acid ...................... 16 valsartan-hydrochlorothiazide........................................ 11 VALTREX
see valacyclovir hcl ......... 6 VANCOCIN HCL
see vancomycin hcl ......... 4
61
62
vancomycin hcl ...................4 VANDAZOLE .................... 28 VANOS ............................. 37 VAQTA .............................. 30 VARIVAX .......................... 30 VASCEPA ......................... 12 VASERETIC
see enalapril maleate & hydrochlorothiazide ....... 10
VASOTEC see enalapril maleate .... 10
VECTIBIX............................9 VELCADE ...........................9 VELTIN ............................. 35 venlafaxine cap er ............. 17 VENLAFAXINE HCL ER
see venlafaxine tab er ... 17 venlafaxine tab .................. 17 venlafaxine tab er .............. 17 VENTAVIS ........................ 14 VENTOLIN HFA ................ 34 VERAMYST ...................... 34 verapamil hcl ..................... 13 VERAPAMIL HCL ............. 13 VERDESO ........................ 37 VERELAN
see verapamil hcl .......... 13 VERELAN PM
see verapamil hcl .......... 13 veripred ............................. 24 VESICARE ........................ 28 vestura .............................. 23 VEXOL .............................. 32 VFEND
see voriconazole .............5 VFEND IV
see voriconazole inj 200mg .............................5
VFEND SUS 40MG/ML .......5 VIBATIV ..............................4 VIBRAMYCIN ......................8
see doxycycline (monohydrate) .................8 see doxycycline hyclate ...8
vicodin .................................2 vicodin es ............................2 vicodin hp ............................2 VICOPROFEN
see hydrocodone-ibuprofen
7.5-200mg ....................... 2 VICTOZA .......................... 21 VICTRELIS ......................... 6 VIDAZA ............................... 9 VIDEX EC
see didanosine ................ 5 VIDEX PEDIATRIC ............. 5 VIGAMOX ......................... 32 VIIBRYD ........................... 17 VIMOVO ............................. 1 VIMPAT ............................ 16 vinblastine sulfate ............... 9 vincristine sulfate ................ 9 vinorelbine tartrate .............. 9 VIOKACE 10440 UNIT...... 27 VIOKACE 20880 UNIT...... 27 viorele ............................... 23 VIRACEPT .......................... 5 VIRAMUNE ......................... 5
see nevirapine ................. 5 VIRAMUNE XR ................... 5 VIREAD .............................. 5 VIROPTIC
see trifluridine ................ 32 VISICOL ............................ 27 VISTARIL
see hydroxyzine pamoate ...................................... 33
VISTIDE see cidofovir .................... 6
VIVACTIL see protriptyline hcl ....... 16
VIVELLE-DOT .................. 24 VIVITROL ......................... 20 VOLTAREN GEL 1% ........ 37 VOLTAREN-XR
see diclofenac sodium ..... 1 voriconazole ........................ 5 voriconazole inj 200mg ....... 5 VOSOL HC
see acetic acid sol/hc .... 37 see hydrocortisone w/acetic acid .................. 37
VOSPIRE ER see albuterol sulfate er .. 34
VOTRIENT ........................ 10 VPRIV ............................... 23 VYTORIN .......................... 12 VYVANSE ......................... 19
W warfarin sodium ................ 28 WELCHOL ........................ 12 WELLBUTRIN
see bupropion hcl .......... 16 WELLBUTRIN SR
see bupropion hcl .......... 16 WELLBUTRIN XL
see bupropion hcl .......... 16 WESTCORT
see hydrocortisone valerate ......................... 36
X XALATAN
see latanoprost.............. 33 XALKORI .......................... 10 XANAX
see alprazolam .............. 14 XARELTO ......................... 28 XELJANZ .......................... 29 XENAZINE ........................ 19 XEOMIN ........................... 33 XERESE ........................... 36 XGEVA ............................. 25 XIFAXAN TAB 200MG ........ 4 XIFAXAN TAB 550MG ...... 27 XODOL
see hydrocodone-acetaminophen 10-300mg ................... 2 see hydrocodone-acetaminophen 5-300mg ..................... 1 see hydrocodone-acetaminophen 7.5-300mg .................. 1 see vicodin ...................... 2 see vicodin es ................. 2 see vicodin hp ................. 2
XOLAIR ............................ 34 XOPENEX CONCENTRATE
see levalbuterol conc 1.25mg/0.5ml ................ 34
XOPENEX HFA ................ 34 XTANDI .............................. 9 XYLOCAINE
see lidocaine hcl ............ 37 see lidocaine hcl (local anesth.) ........................... 3 see lidocaine inj 1% ........ 3
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see lidocaine inj 2% .........3 XYLOCAINE-MPF
see lidocaine hcl (local anesth.) ...........................3 see lidocaine inj 0.5% ......3 see lidocaine inj 1% .........3 see lidocaine inj 1.5% ......3 see lidocaine inj 2% .........3
XYREM ............................. 20 XYZAL
see levocetirizine soln 2.5mg/5ml ...................... 33 see levocetirizine tab 5 mg ...................................... 33
Y YASMIN 28
see drospirenone-ethinyl estradiol ......................... 22 see syeda ...................... 23 see zarah ....................... 23
YAZ see drospirenone-ethinyl estradiol ......................... 22 see vestura .................... 23
YF-VAX ............................. 30 Z zafirlukast .......................... 34 zaleplon ............................ 19 ZANAFLEX
see tizanidine ................ 20 ZANOSAR ...........................8 ZANTAC
see ranitidine hcl ........... 26 zarah ................................. 23 ZARONTIN
see ethosuximide .......... 15 ZAROXOLYN
see metolazone ............. 13 ZAVESCA ......................... 23 ZAZOLE ............................ 28 ZEBETA
see bisoprolol fumarate . 12 ZEGERID .......................... 27 ZELAPAR.......................... 17
ZELBORAF ....................... 10 ZEMAIRA .......................... 34 ZEMPLAR ......................... 32 zenatane ........................... 35 zenchent tab ..................... 23 ZENPEP ........................... 27 ZERIT
see stavudine .................. 5 ZESTORETIC
see lisinopril & hydrochlorothiazide ....... 10
ZESTRIL see lisinopril .................. 10
ZETIA ................................ 12 ZETONNA ......................... 34 ZIAC
see bisoprolol & hydrochlorothiazide ....... 12
ZIAGEN .............................. 5 see abacavir sulfate ........ 5
ZIANA ............................... 35 zidovudine ........................... 5 ZINACEF
see cefuroxime sodium ... 6 ZINECARD
see dexrazoxane ........... 10 ZIOPTAN .......................... 33 ziprasidone hcl .................. 18 ZIPSOR .............................. 1 ZIRGAN ............................ 32 ZITHROMAX
see azithromycin ............. 7 ZMAX .................................. 7 ZOCOR
see simvastatin ............. 11 ZOFRAN
see ondansetron hcl ...... 25 see ondansetron hcl inj . 25 see ondansetron hcl oral soln ................................ 25
ZOFRAN ODT see ondansetron odt...... 26
zoledronic inj 4mg/5ml ...... 22 ZOLINZA ............................. 9
zolmitriptan ....................... 19 zolmitriptan odt ................. 19 ZOLOFT
see sertraline hcl ........... 16 zolpidem tartrate ............... 19 ZOLPIMIST ....................... 19 ZOMETA ........................... 22
see zoledronic inj 4mg/5ml ...................................... 22
ZOMIG .............................. 19 see zolmitriptan ............. 19
ZOMIG ZMT ..................... 19 see zolmitriptan odt ....... 19
ZONALON ........................ 35 ZONEGRAN
see zonisamide ............. 16 zonisamide ....................... 16 ZORBTIVE ........................ 24 ZORTRESS ...................... 30 ZOSTAVAX ...................... 30 ZOSYN ............................... 8
see piperacillin sodium-tazobactam sodium ............................ 8
zovia ................................. 23 ZOVIRAX .......................... 36
see acyclovir ................... 6 see acyclovir topical ...... 36
ZYBAN see bupropion hcl (smoking deterrent) ....... 20
ZYCLARA ......................... 37 ZYFLO CR ........................ 34 ZYLET .............................. 32 ZYLOPRIM
see allopurinol tab ........... 1 ZYMAXID .......................... 32 ZYPREXA
see olanzapine ........ 17, 18 ZYPREXA ZYDIS
see olanzapine odt ........ 18 ZYTIGA ............................... 9 ZYVOX ............................... 4
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This formulary was updated on 08/29/2013. For more recent information or other questions, please contactSilverScript (Employer PDP), at 1-866-693-4614 or, for TTY users, 1-866-236-1069, 24 hours a day, 7 daysa week.
This information is available for free in other languages. Please call our Customer Care number at1-866-693-4614 (TTY: 1-866-236-1069), 24 hours a day, 7 days a week. Esta información estádisponible gra1-866-236-1069tuitamente en otros idiomas. Llame a nuestro Servicio al Miembro, al1-866-693-4614 (teléfono de texto (TTY): 1-866-236-1069), las 24 horas del día, los 7 días de lasemana.
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