CIGNA ADVANTAGE 4-TIER PRESCRIPTION DRUG LIST · location of your choice) and you can get up to a...

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CIGNA ADVANTAGE 4-TIER PRESCRIPTION DRUG LIST

Starting July 1, 2020

View your drug list online: Cigna.com/druglist

View your coverage info online: myCigna® app or website

24/7 Customer Service: 800.Cigna24 (800.244.6224) Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates. 927841 a CA Advantage 4-Tier 04/20 Last updated: 04/01/2020. This drug list is subject to change

and all prior versions are no longer in effect.

For California Preferred Provider Organization, Exclusive Provider Organization, Open Access Plus, Open Access Plus In Network, LocalPlus, LocalPlus IN, Surefit

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What's inside?

Information about your drug list 3

Frequently asked questions (FAQs) 3

Words you may need to know 7

Your prescription drug list 8

How to read this drug list 9

How to find your medication 12

List of prescription medications 15

Exclusions and limitations 163

Index of medications 164

Go online to find out which medications your plan covers. This document was last updated 04/01/20.* To see your plan’s current coverage information, log in to the myCigna® app or website. Click on “Coverage,” then select “Pharmacy” from the down menu. Under “Prescriptions,” type in the medication name. Questions? Call the toll-free number on your Cigna ID card. We’re here to help. You can also chat with us online on the myCigna website, Monday–Friday, 9:00 am–8:00 pm EST.

* Drug list created: originally created 01/01/2004

Last updated: 04/01/2020, for changes starting 07/01/2020

Next planned update: 05/01/2020, for changes starting 07/01/2020

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Information about your drug list Frequently asked questions (FAQs) Understanding your prescription medication coverage can be confusing. Here are answers to some commonly asked questions. Q. How often is my drug list updated? How do I

know if my medication coverage changed? A. Cigna reviews and updates the prescription drug list

every month. We make changes for many reasons – like when new medications become available or are no longer available, or when medication prices change. We try to give you many options to choose from to treat your health condition. These changes may include:1,2 › Moving a medication to a lower cost tier. This

can happen at any time during the year. › Moving a brand medication to a higher cost tier

when a generic becomes available. This can happen at any time during the year.

› Moving a medication to a higher cost tier and/or no longer covering a medication. This typically happens twice a year on January 1st and July 1st.

› Adding coverage requirements to a medication. For example, requiring approval from Cigna before a medication may be covered or adding a quantity limit to a medication.

When a medication changes tiers or is no longer covered, you may pay a different amount to fill that medication. It’s important to know that when we make a change that affects the coverage of a medication you’re taking, we let you know before it begins so you have time to talk with your doctor.

Q. Why doesn’t my plan cover certain medications? A. To help lower your overall health care costs, your

plan doesn’t cover certain high-cost brand medications because they have lower-cost, covered alternatives which are used to treat the same condition. Meaning, the alternative works the same or similar to the non-covered medication. If you’re taking a medication that your plan doesn’t cover and your doctor feels an alternative isn’t right for you, he or she can ask Cigna to consider approving coverage of your medication.

Your plan may also exclude certain medications or products from coverage. This is known as a “plan (or benefit) exclusion.” For example, your plan excludes: › Prescription medications used to treat

heartburn/stomach acid conditions (e.g., Nexium, Prilosec and any generics) and allergies (e.g., Allegra, Clarinex, Xyzal and any generics). These are available over-the-counter without a prescription.

› Medications used to treat lifestyle conditions (like infertility, weight loss, erectile dysfunction, smoking cessation3).

› Medications that aren’t approved by the U.S. Food and Drug Administration (FDA).

Q. How do you decide which medications are

covered? A. The Cigna Prescription Drug List is developed with

the help of Cigna’s Pharmacy and Therapeutics (P&T) Committee, which is a group of practicing doctors and pharmacists, most of whom work outside of Cigna. The group meets regularly to review medical evidence and information provided by federal agencies, drug manufacturers, medical professional associations, national organizations and peer-reviewed journals medications about the safety and effectiveness of medications that are newly approved by the FDA and medications already on the market. The Cigna Pharmacy Management® Business Decision Team then looks at the results of the P&T Committee’s clinical review, as well as the medication’s overall value and other factors before adding it to, or removing it from, the drug list.

Q. Are medications newly approved by the FDA

covered on my drug list? A. Newly approved medications may not be covered on

your drug list for the first six months after they receive FDA approval. These include, but are not limited to, medications, medical supplies or devices covered under standard pharmacy benefit plans. We review all newly approved medications to determine if they should be covered – and if so, at what tier level. If your doctor feels a currently covered medication isn’t right for you, he or she can ask Cigna to consider approving coverage of the newly approved medication.

Q. I see several medications on this drug list that

can be used to treat my condition. Will my doctor write me a prescription for all of them?

A. No. Just because a medication is listed on your plan’s drug list doesn’t mean your doctor will write you a prescription for it. Your doctor will work with you to find the medication he or she feels is best for your specific treatment.

Q. My medication needs approval before my plan

will cover it (also known as prior authorization). What do I need to do to get it covered?

A. Ask your doctor’s office to contact Cigna so we can start the coverage review process. They know how the review process works and will take care of everything for you. In case the office asks, they can download a request form from Cigna's provider portal at cignaforhcp.com. Cigna will review

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information your doctor provides to make sure you meet coverage guidelines for the medication. If you do, you’ll be approved for coverage of the medication. If you don’t meet guidelines, you and your doctor can appeal the decision. We’ll send you information either way.

For non-urgent requests, Cigna will let you and your doctor know within 72 hours of the decision. If approved, coverage will be provided until the prescription runs out (including refills). For urgent requests based on exigent circumstances, Cigna will let you and your doctor know within 24 hours of the decision. If approved, coverage will be provided for the duration of the exigency. If Cigna doesn’t respond to a completed prior authorization exception request within 72 hours of receiving a non-urgent request and 24 hours of receiving a request based on exigent circumstances, the request will be considered approved and your plan can’t deny coverage of the medication. Also, if you’ve already received approval from Cigna for your plan to cover your medication, Cigna can’t limit or exclude coverage for that medication if your doctor continues to prescribe it to treat your condition (as long as the medication is appropriately prescribed and is safe and effective in treating your condition).

Q. My plan doesn’t cover my medication. I need to

take it because it’s medically necessary for my treatment. What do I need to do to get my plan to cover it?

A. If your doctor feels that your medication is necessary for your treatment and an alternative isn’t right for you, he or she can ask Cigna to consider approving coverage of your medication. Ask your doctor’s office to contact Cigna so we can start the coverage review process. They know how the review process works and will take care of everything for you. In case the office asks, they can download a request form from Cigna's provider portal at cignaforhcp.com. Cigna will review information your doctor provides to make sure you meet coverage guidelines for the medication. If you do, you’ll be approved for coverage of your medication. If you don’t meet guidelines, you and your doctor can appeal the decision. We’ll send you information either way.

For non-urgent requests, Cigna will let you and your doctor know within 72 hours of the decision. If approved, coverage will be provided until the prescription runs out (including refills). For urgent requests based on exigent circumstances, Cigna will let you and your doctor know within 24 hours of the decision. If approved, coverage will be provided for the duration of the exigency. It’s important to know that when medications are approved, it’s typically for one year of coverage. If your medication is approved for less time, it’s because there’s a clinical reason based on Cigna's coverage

guidelines for the medication and/or the reviewing doctor.

Q. My medication is part of the Step Therapy

program. I don’t want to try an alternative. What do I need to do to get my medication covered?

A. If you and your doctor feel an alternative medication won’t work for you, your doctor can ask Cigna to consider approving coverage of your medication. Ask your doctor’s office to contact Cigna so we can start the coverage review process. They know how the review process works and will take care of everything for you. In case the office asks, they can download a request form from Cigna's provider portal at cignaforhcp.com. Cigna will review information your doctor provides to make sure you meet coverage guidelines for the medication. If you do, you’ll be approved for coverage of your medication. If you don’t meet guidelines, you and your doctor can appeal the decision. We’ll send you information either way.

For non-urgent requests, Cigna will let you and your doctor know within 72 hours of the decision. If approved, coverage will be provided until the prescription runs out (including refills). For urgent requests based on exigent circumstances, Cigna will let you and your doctor know within 24 hours of the decision. If approved, coverage will be provided for the duration of the exigency. If Cigna doesn’t respond to a completed prior authorization exception request within 72 hours of receiving a non-urgent request and 24 hours of receiving a request based on exigent circumstances, the request will be considered approved and your plan can’t deny coverage of the medication. Your Step Therapy rights under California State law: 1. A carrier may impose prior authorization

requirements on prescription drug benefits. 2. When there is more than one drug that is

appropriate for the treatment of a medical condition, a carrier may require step therapy. a. In circumstances where an insured is

changing policies, the new policy shall not require a repeat of step therapy when that insured is already being treated for a medical condition by a prescription drug provided that the drug is appropriately prescribed and is considered safe and effective. A new policy can impose a prior authorization requirement for the continued coverage of a prescription drug prescribed pursuant to step therapy imposed by the former policy. A new policy must also allow a prescribing provider to prescribe another drug covered by the new policy that is medically appropriate for the insured.

3. A carrier shall provide coverage for the medically necessary dosage and quantity of the drug prescribed for the treatment of a medical

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condition consistent with professionally recognized standards of practice.

Q. How can I find out how much I’ll pay for a

specific medication? A. Prescription prices can vary by pharmacy. Before

you fill your prescription, compare your costs online. Log in to the myCigna app or website and click on “Price a Medication” to see how much your medication may cost you at the different pharmacies in your plan's network. You can also see if there are lower-cost alternatives available.4

Q. How can I save money on my prescription

medications? A. You may be able to save money by switching to a

medication that’s on a lower tier (ex. generic or preferred brand) or by filling a 90-day supply, if your plan allows. You should talk with your doctor to find out if one of these options may work for you.

Q. What’s the difference between brand name and

generic medications? A. The FDA requires generic medications to provide

the same clinical benefit as its brand name versions.5 The FDA also requires generic makers to prove that the generic works in the same way as the brand name medication. This means that generic equivalent medications must:5 › Have the same active ingredient, strength and

dosage form as the brand name medication › Deliver the same amount of active ingredients

into the bloodstream in the same amount of time as the brand name medication

› Be used in the same way as the brand name medication

Generics typically cost much less than brand name medications – in some cases, up to 85% less.5 Just because generics cost less than brands, it doesn’t mean they’re lower-quality medications.

Q. How do I know which pharmacies are in my

network? A. There are thousands of retail pharmacies in your

plan's network. They include local pharmacies, grocery stores, retail chains and wholesale warehouse stores – all places where you may already shop. And some stores are open 24-hours. To find an in-network pharmacy near you, log in to the myCigna app or website. Then click on "Find Care & Costs" to start searching.

Q. Do I have to use home delivery to fill my

prescription? A. It depends on your plan. Some plans require you to

fill your maintenance medication and/or specialty medication through home delivery for it to be covered. You should log in to the myCigna app or website, or check your plan materials, to find out if your plan has this requirement.

Q. Can I fill my prescriptions by mail? A. Yes, as long as your plan offers home delivery.6

› If you’re taking a medication every day to treat an ongoing health condition like diabetes, high blood pressure, high cholesterol or asthma, you can order up to a 90-day supply through our home delivery pharmacy. To get started, call 800.835.3784.

› If you’re taking a specialty medication to treat a complex medical condition like multiple sclerosis, hepatitis C and rheumatoid arthritis, you can fill your prescription through Accredo, a Cigna specialty pharmacy. Accredo will ship your medication to your home (or location of your choice).7 To get started, call Accredo at 877.826.7657. They’re available Monday–Friday, 7:00 am–10:00 pm CST and on Saturdays, 7:00 am–4:00 pm CST. Be sure to call Accredo about two weeks before your next refill so they have time to get a new prescription from your doctor’s office. You can also talk with a pharmacist at any time, 24/7. To learn more about Accredo, go to Cigna.com/specialty.

Q. I take a medication every day to treat diabetes.

My plan requires me to fill my medication through home delivery. What do I need to do to get started?

A. Some plans require you to fill maintenance medications through home delivery. “Maintenance medications” are the medications you take every day to treat an ongoing health condition like diabetes, high blood pressure, high cholesterol or asthma. Some plans cover one or more fills at a retail pharmacy before switching to home delivery. You should check your plan materials to find out if your plan allows retail fills.

To get started using home delivery, call 800.835.3784. Our home delivery pharmacy will deliver your medications right to your door (or location of your choice) and you can get up to a 90-day supply of your medication at one time. They’ll also send you automatic reminders when it’s time to reorder. And you can manage your orders online or through the myCigna mobile app.

Q. I take a specialty medication to treat my multiple

sclerosis. My plan requires me to fill my medication through Accredo, a Cigna specialty pharmacy. What do I need to do to get started?

A. You should first check your plan materials. Some plans cover one or more fills at a retail pharmacy before switching to Accredo.

To get started using Accredo, call 877.826.7657. Representatives are available Monday–Friday, 7:00 am–10:00 pm CST and on Saturdays, 7:00 am–4:00 pm CST. Be sure to call Accredo about two weeks before your next refill so they have time to get a new prescription from

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your doctor’s office. You can also talk with a pharmacist at any time, 24/7. To learn more about Accredo, go to Cigna.com/specialty.

Q. I take a specialty medication that can only be

filled at certain pharmacies in the United States. How do I fill my prescription?

A. Talk with your doctor. He or she should be able to tell you which in-network pharmacies can fill your prescription. Once you find a pharmacy, ask your doctor to send them your prescription.

You may be able to use Accredo, a Cigna specialty pharmacy, to fill your prescription.6 Accredo has access to most specialty medications. Call 877.826.7657 for more information. Representatives are available Monday–Friday, 7:00 am–10:00 pm CST and on Saturdays, 7:00 am–4:00 pm CST.

Q. How can I fill my prescription? A. First, you’ll need to get a prescription from your

doctor. Then, your doctor can either: 1. Send it electronically to the in-network pharmacy

of your choice. 2. Give you a paper prescription. You can bring it

to the in-network pharmacy of your choice, or you can mail it to home delivery.6

Q. How can I get help with my specialty

medication? A. Managing a complex condition isn’t easy. As part of

your Cigna-administered pharmacy benefits, you have access to Accredo, a Cigna specialty pharmacy.6 Accredo’s team of specialty-trained pharmacists and nurses will provide you with the personalized care and support you need to manage your complex medical condition. They’ll help you work through side effects, check in with you and your doctor to see how your therapy’s going, help you get your medications approved for coverage, and more.

To get started using Accredo, call 877.826.7657. Representatives are available Monday–Friday, 7:00 am–10:00 pm CST and on Saturdays, 7:00 am–4:00 pm CST. To learn more about Accredo, go to Cigna.com/specialty.

Q. Where can I find more information about my

prescription medication plan? A. You can use the online tools and resources on the

myCigna app or website to help you better understand your pharmacy coverage. You can find out how much your medication costs, see which medications your plan covers, find an in-network pharmacy, ask a pharmacist a question and see your pharmacy claims and coverage details. You can also manage your home delivery prescription orders.6

Q. How can I find out my cost-share for each tier on my drug list?

A. Covered medications are divided into tiers (or cost-share levels). Typically, the higher the tier, the higher the price you’ll pay to fill the prescription. Here are three places you can go to find out how much you’ll pay for your medication based on the tier it’s listed in, including the maximum cost-share amount allowed:

1. Check your Cigna ID card. It lists your cost-

share for Tier 1, Tier 2, Tier 3 (and Tier 4 if you have a 4-Tier plan) medications.

2. Log in to the myCigna app or website to view your pharmacy coverage information. You can also use the “Price a Medication” feature to find out how much your medication may cost you at the different pharmacies in your plan's network.4

3. Check your Summary of Benefits coverage document.

Q. What’s the difference between medications

covered under the pharmacy benefit and medical benefit?

A. Some medications are covered under the pharmacy benefit, some are covered under the medical benefit, and others are covered under both benefits. Typically, medications that are injected or infused are covered under the medical benefit. These are administered at a doctor’s office, an infusion center or at home. Typically, medications that are self-administered and can be filled at a retail pharmacy or through home delivery are covered under the pharmacy benefit. Check your medical summary of benefits coverage to learn more about how your plan covers these medications.

Q. I take an oral cancer medication. How much will I

pay for my medication? A. On January 1, 2015, California passed a bill limiting

the cost-share for oral chemotherapy medications. This means that if you have both your medical and pharmacy benefits through Cigna, here’s how certain oral cancer medications are covered: › For copay plans: These medications will be

covered at 100%, or no cost-share ($0) to you. › For high deductible health plans (HDHPs) that

include a Health Savings Account (HSA) or qualified HDHPs: You’ll pay your plan deductible first. After that, these medications will be covered at 100%, or no cost-share ($0) to you. This is due to a federal HSA requirement.

› For plans with a combined deductible [including Health Reimbursements Accounts (HRAs) with a combined deductible]: You’ll pay your plan deductible first. After that, these medications will be covered at 100%, or no cost-share ($0) to you.

› For plans with a split deductible [including Health Reimbursements Accounts (HRAs) with a split deductible]: These medications will be covered at 100%, or no cost-share ($0) to you.

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Q. Which medications are covered under the health care reform law?

A. The Patient Protection and Affordable Care Act (PPACA), commonly referred to as “health care reform,” was signed into law on March 23, 2010. Under this law, certain preventive medications (including some over-the-counter medicines) may be available to you at no cost-share ($0), depending on your plan. Log in to the myCigna app or website, or check your plan materials, to learn more about how your plan covers preventive medications. You can also view the PPACA No Cost-Share Preventive Medications drug list at Cigna.com/druglist.

For more information about health care reform, visit www.informedonreform.com or Cigna.com.

Q. How are medications, devices and FDA-

approved diabetic, contraceptive and federally-mandated products covered under the pharmacy benefit?

A. Here is how these products are covered under the pharmacy benefit: › Preventive care medications and products

covered under the Patient Protection and Affordable Care Act (PPACA), also known as “health care reform:” • Contraceptives: Covered at 100%, or no

cost-share ($0) to you. Certain prescription contraceptives are available at their applicable cost-share.

• Tobacco cessation products: Up to two (2) 90-day courses of treatment per plan year are covered at 100%, or no cost-share ($0) to you. Certain prescription tobacco cessation products are available at their applicable cost-share.

• Certain vitamins: Covered at 100%, or no cost-share ($0) to you. All other prescription

vitamins are available at their applicable cost-share and deductible (if applicable).

› Certain over-the-counter (OTC) medicines: Covered at 100%, or no cost-share ($0) to you, if you have a prescription from a doctor. All other OTC medicines are excluded from coverage.

› Oral fertility medications: Covered at their applicable tier cost-share. For some plans, injectable fertility medications are covered under the medical benefit.

› Generic preventive care medications: Covered at 100%, or no cost-share ($0) to you before you meet your deductible. You’ll pay your deductible and applicable cost-share to fill a preferred brand and/or non-preferred brand preventive care medication.

› Diabetic supplies: Covered at their applicable cost-share.

› Growth Hormones: Need approval from Cigna before your plan will cover them (prior authorization). If you receive approval for coverage, you’ll pay your applicable tier cost-share to fill the medication.

› Vaccines: These are currently covered under the medical benefit. For plans renewing on 2/1/20 and later, on your plan's renewal date, vaccines will be covered under the pharmacy benefit. Not all plans will cover vaccines in the same way. Log in to the myCigna app or website, or check your plan materials, to find out how your specific plan covers them.

› Compounded medications: If the medication is more than $200, you’ll need approval from Cigna before your plan will cover them (prior authorization).

› Lifestyle and/or sexual dysfunction medication therapy: Not covered under the pharmacy benefit, unless your employer chooses to include coverage.

Words you may need to know › Brand name drug: A drug that is marketed under a

proprietary, trademark-protected name. A brand name drug is listed in this formulary in all CAPITAL letters.

› Coinsurance: A percentage of the cost of a covered

health care benefit that you pay after you have paid the deductible, if a deductible applies to the health care benefit.

› Copayment: A fixed dollar amount that you pay for a covered health care benefit after you have paid the deductible, if a deductible applies to the health care benefit.

› Deductible: The amount you pay for covered health care benefits that are subject to the deductible before your health insurer begins to pay. If your

health insurance policy has a deductible, it may have either one deductible or separate deductibles for medical benefits and prescription drug benefits. After you pay your deductible, you usually pay only a copayment or coinsurance for covered health care benefits. Your insurance company pays the rest.

› Drug tier: A group of prescription drugs that correspond to a specified cost sharing tier in your health insurance policy. The drug tier in which a prescription drug is placed determines your portion of the cost for the drug.

› Exception request: A request for coverage of a

non-formulary drug. If you, your designee, or your prescribing health care provider submits a request for coverage of a non-formulary drug, your insurer must cover the non-formulary drug when it is medically necessary for you to take the drug.

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› Exigent circumstances: When you are suffering from a medical condition that may seriously jeopardize your life, health, or ability to regain maximum function, or when you are undergoing a current course of treatment using a non-formulary drug.

› Formulary or prescription drug list: The list of

drugs that is covered by your health insurance policy under the prescription drug benefit of the policy.

› Generic drug: A drug that is the same as its brand

name drug equivalent in dosage, strength, effect, how it is taken, quality, safety, and intended use. A generic drug is listed in this formulary in italicized lowercase letters.

› Medically Necessary: Health care benefits needed to diagnose, treat, or prevent a medical condition or its symptoms and that meet accepted standards of medicine. Health insurance usually does not cover health care benefits that are not medically necessary.

› Non-formulary drug: A prescription drug that is not listed on this formulary.

› Out-of-pocket costs: Your expenses for health care benefits that aren't reimbursed by your health insurance. Out-of-pocket costs include deductibles, copayments, and coinsurance for covered health care benefits, plus all costs for health care benefits that are not covered.

› Prescribing provider: A health care provider who can write a prescription for a drug to diagnose, treat, or prevent a medical condition.

› Prescription: An oral, written, or electronic order from a prescribing provider authorizing a prescription drug to be provided to a specific individual.

› Prescription drug: A drug that by law requires a prescription.

› Prior Authorization: A decision by your health insurer that a health care benefit is medically necessary for you. If a prescription drug is subject to prior authorization in this formulary, your prescribing provider must request approval from your health insurer to cover the drug before you fill your prescription. Your health insurer must grant a prior authorization request when it is medically necessary for you to take the drug.

› Step Therapy: A specific sequence in which

prescription drugs for a particular medical condition must be tried. If a drug is subject to step therapy in this formulary, you may have to try one or more other drugs before your health insurance policy will cover that drug for your medical condition. If your prescribing provider submits a request for an exception to the step therapy requirement, your health insurer must grant the request when it is medically necessary for you to take the drug.

› Quantity Limits: For some medications, your plan will only cover up to a certain amount over a certain length of time. For example, 30mg per day for 30 days. Quantity limits help to make sure you’re receiving coverage for the right medication, in the right amount, and for the right situation. Your plan will only cover a larger amount if your doctor requests and receives approval from Cigna.

› Age Requirements: For certain medications, you must be within a specific age range for your plan to cover them. This is because some medications aren’t considered clinically appropriate for individuals who aren’t within that age range.

Your prescription drug list This document shows the medications covered on the Advantage 4-Tier Prescription Drug List as of July 1, 2020.1,2 All of these medications are approved by the U.S. Food and Drug Administration (FDA). The Advantage 4-Tier Prescription Drug List is updated often so it's important to know that this is not a complete list of the medications your plan covers. Also, your specific plan may not cover all of the medications in this document. Log in to the myCigna app or website, or check your plan materials, to learn more about the medications your plan covers. The Advantage 4-Tier Prescription Drug List also excludes from coverage prescription medications that are used to treat allergies (ex. Allegra, Clarinex, Xyzal and generics) and heartburn/stomach acid conditions (ex. Nexium, Prilosec and generics). These medications have over-the-counter (OTC) alternatives, which are available without a prescription.

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How to read this drug list Medications are listed alphabetically by their brand and generic names within their therapeutic category and class.* You can also find your medication using the index at the end of this drug list.

› The generic version of a brand name medication is listed in parentheses and all lowercase italicized letters next to the brand name medication.

› If a generic equivalent for a brand name medication is both available and covered, the generic will be listed separately from the brand name medication in all lowercase italicized letters.

› If a generic equivalent for a brand name medication isn’t available on the market or isn’t covered, the medication won’t be listed separately by its generic version.

› If a generic medication is marketed under a proprietary, trademark-protected brand name, the brand name medication will be listed after the generic version in parentheses and regular typeface with the first letter of each word capitalized. For example: ACCUPRIL (quinapril).

* Medications are listed in the therapeutic category and class provided by First Databank. Tiers Covered medications are divided into tiers or cost-share levels. Typically, the higher the tier, the higher the price you’ll pay to fill the prescription.

Tier 1

Typically generic medications (lowest-cost medications). Generics have the same strength and active ingredients as the brand name – but often cost much less.1

$

Tier 2

Typically preferred brand medications (medium-cost medications). These medications usually cost more than a generic, but less than a non-preferred brand.

$$

Tier 3

Typically non-preferred brand medications (higher-cost medications). These medications usually have generic versions and/or one or more preferred brand alternative. You’ll usually pay more for non-preferred medications.

$$$

Tier 4

Injectable specialty medications (highest-cost medications). These medications are used to treat complex medical conditions like multiple sclerosis, hepatitis C and rheumatoid arthritis.

$$$$

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Coverage requirements and limits Some medications on your drug list have extra requirements before your plan will cover them.* This helps to make sure you’re receiving coverage for the right medication, at the right cost, in the right amount and for the right situation. These medications will have an abbreviation next to them in the drug list. Here’s what each of the abbreviations mean.

PA Prior Authorization:* Certain medications need approval from Cigna before your plan will cover them. Cigna will review information your doctor provides to make sure you meet coverage guidelines for the medication.

QL Quantity Limit:* For some medications, your plan will only cover up to a certain amount over a certain length of time. For example, 30mg per day for 30 days. Your plan will only cover a larger amount if your doctor requests and receives approval from Cigna.

AGE Age Requirement:* For certain medications, you must be within a specific age range for your plan to cover them. This is because some medications aren’t considered clinically appropriate for individuals who aren’t within that age range.

ST

Step Therapy:* Certain high-cost medications are part of the Step Therapy program. Step Therapy encourages the use of lower-cost medications (typically generics and preferred brands) that can be used to treat the same condition as the higher-cost medication. These conditions include, but are not limited to, depression, high blood pressure, high cholesterol, skin conditions and sleep disorders. Your plan doesn’t cover the higher-cost Step Therapy medication until you try one or more alternatives first (unless you receive prior approval from Cigna).

SP

Specialty medications are used to treat complex medical conditions like multiple sclerosis, hepatitis C and rheumatoid arthritis. On this drug list, injectable specialty medications are covered on Tier 4. Oral specialty medications are covered on a lower tier (tiers 1-3). They are listed alphabetically by the condition they treat. Your plan may also limit coverage to a 30-day supply and/or require you to use a preferred specialty pharmacy to receive coverage. Log in to the myCigna app or website, or check your plan materials, to learn more about how your plan covers specialty medications.

HD

Home delivery medications: Some plans only cover certain medications if they’re filled through home delivery. Depending on your plan, you may be able to receive coverage for one, two or three fills at an in-network retail pharmacy before switching to home delivery. Log in to the myCigna app or website, or check your plan materials, to find out if your plan requires home delivery.

PPACA

No cost-share preventive medications: Health care reform under the Patient Protection and Affordable Care Act (PPACA) requires that most plans cover certain categories of medications and other products as preventive care services. These medications may be available to you at no cost-share (copay, coinsurance and/or deductible). Log in to the myCigna app or website, or check your plan materials, to learn more about how your plan covers preventive medications.

CSL Oral cancer medications subject to cost-share limits: State law in California limits the cost-share (or amount you’ll pay) for certain oral chemotherapy medications.

* These coverage requirements may not apply to your specific plan. That’s because some plans don’t have prior authorization, quantity limits, Step Therapy and/or age requirements. Log in to the myCigna app or website, or check your plan materials, to find out if your plan includes these specific coverage requirements.

11

Use the sample chart below to help you understand how to read this drug list. This chart is just an example. It may not show how these medications are actually covered on the Advantage 4-Tier Prescription Drug List.

Therapeutic drug category and class describes the condition the medication is used to treat Coverage requirements and limits lets you know if your plan has extra requirements before it will cover the medication Drug tier gives you an idea of how much you may pay for a medication Prescription drug name is the name of the medication Medications are listed in alphabetical order within each column Brand name medications are in all CAPITAL letters Generic medications are in lowercase italics

This chart is just a sample. It may not show how these medications are actually covered on the Advantage 4-Tier Prescription Drug List.

12

How to find your medication Find your condition in the alphabetical list below. Then go to that page to see the covered medications available to treat the condition.

Condition Page ANALGESICS (Pain Relief And Inflammatory Disease) 15–21

ANALGESICS (Urinary Tract Conditions) 21

ANESTHETICS (Miscellaneous) 22

ANESTHETICS (Pain Relief And Inflammatory Disease) 22–26

ANESTHETICS (Urinary Tract Conditions) 26

ANTIALLERGY (Allergy/Nasal Sprays) 26

ANTIARTHRITICS (Pain Relief And Inflammatory Disease) 26–29

ANTIASTHMATICS (Asthma/COPD/Respiratory) 29–31

ANTIBIOTICS (Ear Medications) 31, 32

ANTIBIOTICS (Eye Conditions) 32, 33

ANTIBIOTICS (Infections) 33–41

ANTIBIOTICS (Miscellaneous) 42

ANTIBIOTICS (Skin Conditions) 42, 43

ANTICOAGULANTS (Blood Thinners/ Anti-Clotting) 43, 44

ANTIDOTES (Gastrointestinal/Heartburn) 44, 45

ANTIDOTES (Substance Abuse) 45

ANTIFUNGALS (Eye Conditions) 45

ANTIFUNGALS (Feminine Products) 45

ANTIFUNGALS (Infections) 45, 46

ANTIFUNGALS (Skin Conditions) 46, 47

ANTIHISTAMINE AND DECONGESTANT COMBINATION (Allergy/Nasal Sprays) 47

ANTIHISTAMINES (Allergy/Nasal Sprays) 47

ANTIHISTAMINES (Eye Conditions) 47

ANTIHYPERGLYCEMICS (Diabetes) 48–50

ANTIINFECTIVES/MISCELLANEOUS (Feminine Products) 51

ANTIINFECTIVES/MISCELLANEOUS (Infections) 51, 52

ANTIINFECTIVES/MISCELLANEOUS (Miscellaneous) 52

Condition Page ANTIINFLAM.TUMOR NECROSIS FACTOR INHIBITING AGENTS (Pain Relief And Inflammatory Disease)

52, 53

ANTINEOPLASTICS (Cancer) 53–62

ANTINEOPLASTICS (Skin Conditions) 63

ANTIPARASITICS (Infections) 63

ANTIPARKINSON DRUGS (Parkinson's Disease) 63–65

ANTIPLATELET DRUGS (Blood Thinners/Anti-Clotting) 66

ANTIVIRALS (AIDS/HIV) 66–68

ANTIVIRALS (Eye Conditions) 68

ANTIVIRALS (Infections) 68–70

ANTIVIRALS (Skin Conditions) 70

AUTONOMIC DRUGS (Allergy/Nasal Sprays) 70

AUTONOMIC DRUGS (Alzheimer's Disease) 70, 71

AUTONOMIC DRUGS (Attention Deficit Hyperactivity Disorder) 71, 72

AUTONOMIC DRUGS (Blood Pressure/Heart Medications) 72

AUTONOMIC DRUGS (Miscellaneous) 72, 73

AUTONOMIC DRUGS (Urinary Tract Conditions) 73

BIOLOGICALS (Allergy/Nasal Sprays) 74

BIOLOGICALS (Blood Pressure/Heart Medications) 74

BIOLOGICALS (Miscellaneous) 74

BLOOD (Blood Modifiers/Bleeding Disorders) 74, 75

BLOOD (Blood Thinners/Anti-Clotting) 75, 76

CARDIAC DRUGS (Blood Pressure/Heart Medications) 76–79

CARDIOVASCULAR (Allergy/Nasal Sprays) 80

CARDIOVASCULAR (Asthma/COPD/Respiratory) 80, 81

CARDIOVASCULAR (Blood Pressure/Heart Medications) 81–86

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Condition Page CARDIOVASCULAR (Cholesterol Medications) 86–88

CARDIOVASCULAR (Miscellaneous) 88

CNS DRUGS (Alzheimer's Disease) 88, 89

CNS DRUGS (Miscellaneous) 89

CNS DRUGS (Multiple Sclerosis) 90

CNS DRUGS (Seizure Disorders) 90–93

CNS DRUGS (Sleep Disorders/Sedatives) 93

COLONY STIMULATING FACTORS (Blood Modifiers/Bleeding Disorders) 93, 94

COLONY STIMULATING FACTORS (Cancer) 94

CONTRACEPTIVES (Contraception Products) 94–96

COUGH/COLD PREPARATIONS (Cough/Cold Medications) 96, 97

DIAGNOSTIC (Miscellaneous) 97–100

DIURETICS (Diuretics) 100–102

EENT PREPS (Allergy/Nasal Sprays) 102

EENT PREPS (Ear Medications) 102

EENT PREPS (Eye Conditions) 102–106

ELECT/CALORIC/H2O (Dental Products) 106, 107

ELECT/CALORIC/H2O (Diabetes) 107

ELECT/CALORIC/H2O (Miscellaneous) 107, 108

ELECT/CALORIC/H2O (Nutritional/Dietary) 108–111

ELECT/CALORIC/H2O (Urinary Tract Conditions) 112

GASTROINTESTINAL (Cholesterol Medications) 112

GASTROINTESTINAL (Gastrointestinal/Heartburn) 112–118

GASTROINTESTINAL (Pain Relief And Inflammatory Disease) 118

GASTROINTESTINAL (Skin Conditions) 118

HORMONES (Gastrointestinal/Heartburn) 118

HORMONES (Hormonal Agents) 118–125

HORMONES (Infertility) 125, 126

HORMONES (Miscellaneous) 126

HORMONES (Osteoporosis Products) 126

Condition Page

IMMUNOSUPPRESSANTS (Miscellaneous) 126

IMMUNOSUPPRESSANTS (Pain Relief And Inflammatory Disease) 126, 127

IMMUNOSUPPRESSANTS (Skin Conditions) 127

IMMUNOSUPPRESSANTS (Transplant Medications) 127–129

MISCELLANEOUS MEDICAL SUPPLIES, DEVICES, NON-DRUG (Diabetes) 129

MUSCLE RELAXANTS (Pain Relief And Inflammatory Disease) 129, 130

PRE-NATAL VITAMINS (Nutritional/Dietary) 130

PSYCHOTHERAPEUTIC DRUGS (Anxiety/Depression/Bipolar Disorder) 130–136

PSYCHOTHERAPEUTIC DRUGS (Attention Deficit Hyperactivity Disorder) 136–138

PSYCHOTHERAPEUTIC DRUGS (Schizophrenia/Anti-Psychotics) 138–141

PSYCHOTHERAPEUTIC DRUGS (Sleep Disorders/Sedatives) 141

SEDATIVE/HYPNOTICS (Sleep Disorders/Sedatives) 141, 142

SKIN PREPS (Miscellaneous) 143

SKIN PREPS (Pain Relief And Inflammatory Disease) 143

SKIN PREPS (Skin Conditions) 144–149

THYROID PREPS (Hormonal Agents) 149, 150

UNCLASSIFIED DRUG PRODUCTS (AIDS/HIV) 150

UNCLASSIFIED DRUG PRODUCTS (Asthma/COPD/Respiratory) 151

UNCLASSIFIED DRUG PRODUCTS (Blood Modifiers/Bleeding Disorders) 151

UNCLASSIFIED DRUG PRODUCTS (Blood Pressure/Heart Medications) 152

UNCLASSIFIED DRUG PRODUCTS (Cancer) 152, 153

UNCLASSIFIED DRUG PRODUCTS (Dental Products) 153

UNCLASSIFIED DRUG PRODUCTS (Eye Conditions) 153

UNCLASSIFIED DRUG PRODUCTS (Gastrointestinal/Heartburn) 153

UNCLASSIFIED DRUG PRODUCTS (Hormonal Agents) 153, 154

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Condition Page UNCLASSIFIED DRUG PRODUCTS (Miscellaneous) 154–157

UNCLASSIFIED DRUG PRODUCTS (Multiple Sclerosis) 158

UNCLASSIFIED DRUG PRODUCTS (Nutritional/Dietary) 158

UNCLASSIFIED DRUG PRODUCTS (Osteoporosis Products) 158, 159

UNCLASSIFIED DRUG PRODUCTS (Pain Relief And Inflammatory Disease) 159

Condition Page UNCLASSIFIED DRUG PRODUCTS (Skin Conditions) 159

UNCLASSIFIED DRUG PRODUCTS (Substance Abuse) 159, 160

UNCLASSIFIED DRUG PRODUCTS (Urinary Tract Conditions) 160, 161

UNCLASSIFIED DRUG PRODUCTS (Weight Management) 161

VITAMINS (Nutritional/Dietary) 161, 162

• T1 - Typically generics • T2 - Typically preferred brands • T3 - Typically non-preferred brands • T4 - Injectable specialty medications • PA - Prior Authorization • QL - Quantity Limit • ST - Step Therapy • AGE - Age Requirement • SP - Specialty medication • HD - May require home delivery • PPACA - No cost-share preventive medications • CSL - Oral cancer medications subject to cost-share limits

15

Cigna Advantage 4-Tier Prescription Drug List

ANALGESICS (Pain Relief And Inflammatory Disease)

ANALGESIC, NON-SALICYLATE AND BARBITURATE COMBINAT

Prescription drug name Drug tier Coverage requirements and limits

butalbital/acetaminophen T1

ANALGESIC, SALICYLATE, BARBITURATE, XANTHINE COMB.

butalb-aspirin-caffe 50-325-40 T1 QL (6 tabs/day) butalbital-asa-caffeine cap (Fiorinal) T1 QL (6 caps/day)

FIORINAL (butalbital-aspirin-caffeine) T3 QL (6 caps/day)

ANALGESIC, NON-SALICYLATE, BARBITURATE, XANTHINE COMB

butalb/acetaminophen/caffeine T1 QL (6 caps/day) butalb/acetaminophen/caffeine (Esgic) T1 QL (6 caps/day)

butalb/acetaminophen/caffeine (Zebutal) T1 QL (6 caps/day)

ESGIC 50-325-40 MG TABLET (butalbital-acetaminophen-caffeine)

T3 QL (6 tabs/day)

ESGIC CAPSULE (butalbital-acetaminophen-caffeine) T3 QL (6 caps/day)

VTOL LQ T3 ZEBUTAL (butalbital-acetaminophen-caffeine) T3 QL (6 caps/day)

ANALGESIC/ANTIPYRETICS, SALICYLATES

choline salicyl/mag salicylate T1 HD diflunisal T1 HD

ANALGESIC/ANTIPYRETICS, NON-SALICYLATE

OFIRMEV T3

ANALGESICS, NEURONAL-TYPE CALCIUM CHANNEL BLOCKERS

PRIALT T4 SP

ANALGESICS, NON-OPIOID clonidine 1,000 mcg/10 ml vial (Duraclon) T1

clonidine 5,000 mcg/10 ml vial T1 DURACLON (clonidine hcl) T3

ANTIMIGRAINE PREPARATIONS

AIMOVIG AUTOINJECTOR T2 PA almotriptan malate T1 QL (12 tabs/30 days) AMERGE (naratriptan hcl) T3 QL (9 tabs/30 days) CAFERGOT (ergotamine-caffeine) T3 QL (40 tabs/28 days)

dihydroergotamine 1 mg/ml amp T1 QL (10 amps/30 days)


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ANTIMIGRAINE PREPARATIONS


dihydroergotamine 4 mg/ml spry T1 QL (8/30 days)

eletriptan hydrobromide (Relpax) T1 QL (6 tabs/30 days)

ergotamine tartrate/caffeine T1 ergotamine tartrate/caffeine (Cafergot) T1 QL (40 tabs/28 days)

FROVA (frovatriptan succinate) T3 QL (18 tabs/30 days) frovatriptan succinate (Frova) T1 QL (18 tabs/30 days) MAXALT (rizatriptan) T3 QL (12 tabs/30 days) MAXALT MLT (rizatriptan) T3 QL (12 tabs/30 days) naratriptan hcl (Amerge) T1 QL (9 tabs/30 days) RELPAX (eletriptan hbr) T3 QL (6 tabs/30 days) rizatriptan benzoate T1 QL (12 tabs/30 days) rizatriptan benzoate (Maxalt MLT) T1 QL (12 tabs/30 days)

rizatriptan benzoate (Maxalt) T1 QL (12 tabs/30 days) sumatriptan T1 QL (2 boxes/30 days) sumatriptan 4 mg/0.5 ml cart T1 QL (4ml/30 days) sumatriptan 4 mg/0.5 ml inject T1 QL (4ml/30 days) sumatriptan 6 mg/0.5 ml inject T1 QL (4ml/30 days) sumatriptan 6 mg/0.5 ml refill T1 QL (4ml/30 days) sumatriptan 6 mg/0.5 ml syrng T1 QL (4ml/30 days) sumatriptan 6 mg/0.5 ml vial T1 QL (5ml/30 days) sumatriptan succ 100 mg tablet T1 QL (9 tabs/30 days) sumatriptan succ 25 mg tablet T1 QL (9 tabs/30 days) sumatriptan succ 50 mg tablet T1 QL (9 tabs/30 days) sumatriptan succ/naproxen sod T1 QL (18 tabs/30 days) zolmitriptan T1 QL (12 tabs/30 days)

NSAIDS, CYCLOOXYGENASE INHIBITOR - TYPE ANALGESICS

diclofenac potassium T1 HD ketorolac 10 mg tablet T1 QL (20 tabs/30 days) HD ketorolac 15 mg/ml syringe T1 QL (40 ml/30 days) HD ketorolac 15 mg/ml vial T1 QL (40 ml/30 days) HD ketorolac 30 mg/ml carpuject T1 HD ketorolac 30 mg/ml syringe T1 QL (20ml/30 days) HD ketorolac 30 mg/ml vial T1 QL (20ml/30 days) HD ketorolac 60 mg/2 ml carpuject T1 QL (20ml/30 days) HD ketorolac 60 mg/2 ml syringe T1 QL (20ml/30 days) HD ketorolac 60 mg/2 ml vial T1 QL (20ml/30 days) HD mefenamic acid T1 HD


17


OPIOID ANALGESIC AND NON-SALICYLATE ANALGESICS


acetamin-codein 300-30 mg/12.5 T1

acetaminop-codeine 120-12 mg/5 T1

acetaminophen-cod #2 tablet T1 PA acetaminophen-cod #3 tablet (Tylenol-Codeine No.3) T1 PA

acetaminophen-cod #4 tablet (Tylenol-Codeine No.4) T1 PA

APADAZ T3 PA benzhydrocodone/acetaminophen (Apadaz) T1 PA

hydrocodone/acetaminophen T1 PA hydrocodone/acetaminophen (Norco) T1 PA

NORCO (lorcet hd) T3 PA NORCO (lorcet plus) T3 PA NORCO (lorcet) T3 PA oxycodone hcl/acetaminophen T1 PA oxycodone hcl/acetaminophen (Percocet) T1 PA

PERCOCET (oxycodone-acetaminophen) T3 PA

tramadol hcl/acetaminophen (Ultracet) T1

TYLENOL-CODEINE NO.3 (acetaminophen-codeine) T3 PA

TYLENOL-CODEINE NO.4 (acetaminophen-codeine) T3 PA

ULTRACET (tramadol hcl-acetaminophen) T3

OPIOID ANALGESIC AND NSAID COMBINATION

hydrocodone/ibuprofen T1 PA ibuprofen/oxycodone hcl T1 PA

OPIOID ANALGESIC AND SALICYLATE ANALGESIC COMB

oxycodone hcl/aspirin T1 PA

OPIOID ANALGESIC, ANESTHETIC ADJUNCT AGENTS alfentanil 500 mcg/ml ampul (Alfentanil Hcl) T1 PA

ALFENTANIL 500 MCG/ML AMPULE (alfentanil hcl) T3 PA

fentanyl 1,000 mcg/20 ml vial T1 fentanyl 100 mcg/2 ml ampul T1 fentanyl 100 mcg/2 ml vial T1 fentanyl 2,500 mcg/50 ml vial T1 fentanyl 250 mcg/5 ml ampul T1


18


OPIOID ANALGESIC, ANESTHETIC ADJUNCT AGENTS


fentanyl 250 mcg/5 ml vial T1 fentanyl 5,000 mcg/100 ml bag T1 fentanyl 50 mcg/ml vial T1 fentanyl 500 mcg/10 ml vial T1 fentanyl citrate/pf T1 remifentanil hcl (Ultiva) T1 PA sufentanil citrate T1 PA ULTIVA (remifentanil hcl) T3 PA

OPIOID ANALGESIC, NON-SALICYLATE, XANTHINE COMB

acetaminophen/caff/dihydrocod T1 PA acetaminophen/caff/dihydrocod (Trezix) T1 PA

TREZIX (acetamin-caff-dihydrocodeine) T3 PA

OPIOID ANALGESICS

ACTIQ (fentanyl citrate) T3 PA ARYMO ER T3 PA BELBUCA 150 MCG FILM T2 QL (2 films/day) BELBUCA 300 MCG FILM T2 QL (2 films/day) BELBUCA 450 MCG FILM T2 QL (2 films/day) BELBUCA 600 MCG FILM T2 QL (2 films/day) BELBUCA 75 MCG FILM T2 QL (2 films/day) BELBUCA 750 MCG FILM T2 QL (60 films/30 days) BELBUCA 900 MCG FILM T2 QL (2 films/day) BUPRENEX T3 buprenorphine (Butrans) T1 QL (4 patches/28 days) buprenorphine hcl T1 butorphanol 1 mg/ml vial T1 butorphanol 10 mg/ml spray T1 PA QL (6 bots/30 days) butorphanol 2 mg/ml vial T1 butorphanol 4 mg/2 ml vial T1 BUTRANS (buprenorphine) T3 QL (4 patches/28 days) codeine sulfate T1 PA DEMEROL T3 PA DILAUDID T3 PA DILAUDID (hydromorphone hcl) T3 PA

DOLOPHINE HCL (methadone hcl) T3 PA

DURAGESIC (fentanyl) T3 PA DURAMORPH T3f PA


19


OPIOID ANALGESICS


fentanyl T1 PA fentanyl (Duragesic) T1 PA fentanyl 100 mcg/2 ml carpujct T1 fentanyl 100 mcg/2 ml syringe T1 fentanyl 2,750 mcg/55 ml syr T1 fentanyl 250 mcg/5 ml syringe T1 fentanyl cit 100 mcg buccal tb (Fentora) T1 PA

fentanyl cit 200 mcg buccal tb (Fentora) T1 PA




fentanyl cit otfc 1,200 mcg (Actiq) T1 PA

fentanyl cit otfc 1,600 mcg (Actiq) T1 PA

fentanyl citrate otfc 200 mcg (Actiq) T1 PA




fentanyl citrate-0.9 % nacl/pf T1 fentanyl/bupivacaine/ns/pf T1 fentanyl/ropivacaine/ns/pf T1 FENTORA (fentanyl citrate) T3 PA hydrocodone bitartrate (Zohydro ER) T1 PA

hydromorphone 1 mg/ml-ns syrng T1 PA

hydromorphone 10 mg/50 ml-ns T1 PA

hydromorphone 2 mg/ml-ns syrng T1 PA



hydromorphone 30 mg/30 ml-ns T1




20


OPIOID ANALGESICS


hydromorphone 6 mg/30 ml-ns T1 PA hydromorphone hcl T1 PA hydromorphone hcl (Dilaudid) T1 PA hydromorphone hcl in water/pf T1 PA hydromorphone hcl/pf T1 PA HYSINGLA ER T2 PA INFUMORPH T3 PA KADIAN T3 PA KADIAN (morphine sulfate er) T3 PA LAZANDA T3 PA meperidine hcl T1 PA meperidine hcl/pf T1 PA methadone hcl T1 PA methadone hcl (Dolophine Hcl) T1 PA MORPHABOND ER T2 PA morphine 100mg/100ml-0.9% nacl T1 PA

morphine 2 mg/2 ml-0.9% nacl T1 PA morphine 2 mg/ml-0.9% nacl syr T1 PA

morphine 30 mg/30 ml-0.9% nacl T1 PA

morphine 4 mg/ml-0.9% nacl syr T1 PA

morphine 5 mg/5 ml-0.9% nacl T1 PA morphine 50 mg/50 ml-0.9% nacl T1


morphine 500mg/100ml-0.9% nacl T1 PA


morphine sulfate T1 PA morphine sulfate (Kadian) T1 PA morphine sulfate (MS Contin) T1 PA morphine sulfate/pf T1 PA MS CONTIN (morphine sulfate er) T3 PA

nalbuphine hcl T1 NUCYNTA T3 PA NUCYNTA ER T3 PA OPANA (oxymorphone hcl) T3 PA opium/belladonna alkaloids T1 PA OXAYDO T3 PA


21


OPIOID ANALGESICS


oxycodone hcl T1 PA oxymorphone hcl T1 PA oxymorphone hcl (Opana) T1 PA pentazocine hcl/naloxone hcl T1 PA tramadol er 100 mg tablet T1 QL (1 tab/day) tramadol er 200 mg tablet T1 QL (1 tab/day) tramadol er 300 mg tablet T1 QL (1 tab/day) tramadol hcl 100 mg tablet T1 tramadol hcl 50 mg tablet (Ultram) T1 QL (8 tabs/day)

tramadol hcl er 100 mg capsule T1 QL (1 cap/day)

tramadol hcl er 100 mg tablet T1 QL (1 tab/day) tramadol hcl er 150 mg capsule T1 QL (1 cap/day)

tramadol hcl er 200 mg capsule T1 QL (1 cap/day)

tramadol hcl er 200 mg tablet T1 QL (1 tab/day) tramadol hcl er 300 mg capsule T1 QL (1 cap/day)

tramadol hcl er 300 mg tablet T1 QL (1 tab/day) ULTRAM (tramadol hcl) T3 QL (8 tabs/day) XTAMPZA ER T2 PA ZOHYDRO ER (hydrocodone bitartrate er) T3 PA

OPIOID AND SALICYLATE ANALGESICS, BARBIT, XANTHINE codeine/butalbital/asa/caffein (Fiorinal With Codeine #3) T1 PA

FIORINAL WITH CODEINE #3 (butalbital compound-codeine) T3 PA

OPIOID, NON-SALICYL.ANALGESIC, BARBITURATE, XANTHINE

butalbit/acetamin/caff/codeine T1 PA butalbit/acetamin/caff/codeine (Fioricet With Codeine) T1 PA

FIORICET WITH CODEINE T3 PA

SKELETAL MUSCLE RELAXANT, SALICYLAT, OPIOID ANALGESC

carisoprodol/aspirin/codeine T1 PA

ANALGESICS (Urinary Tract Conditions)

URINARY TRACT ANALGESIC AGENTS

ELMIRON T3 RIMSO-50 T3


22

ANESTHETICS (Miscellaneous)

GENERAL ANESTHETICS, INHALANT


desflurane (Suprane) T1 FORANE (terrell) T3 isoflurane (Forane) T1 sevoflurane (Ultane) T1 SUPRANE (desflurane) T3 ULTANE (sevoflurane) T3

GENERAL ANESTHETICS, INJECTABLE

AMIDATE T3 AMIDATE (etomidate) T3 BREVITAL SODIUM T3 DIPRIVAN (propofol) T3 etomidate (Amidate) T1 KETALAR (ketamine hcl) T3 ketamine hcl T1 ketamine hcl (Ketalar) T1 ketamine hcl in 0.9 % nacl T1 methohexital in water/pf T1 propofol (Diprivan) T1

GENERAL ANESTHETICS, INJECTABLE-BENZODIAZEPINE TYPE

midazolam hcl T1 midazolam hcl in 0.9 % nacl/pf T1 midazolam hcl/pf T1 midazolam in 0.9 % sod.chlorid T1

ANESTHETICS (Pain Relief And Inflammatory Disease)

LOCAL ANESTHETICS

ARTICADENT DENTAL T3 bupivacaine hcl (Sensorcaine) T1 bupivacaine hcl in dextrose/pf (Marcaine Spinal) T1

bupivacaine hcl/0.9 % nacl/pf T1 bupivacaine hcl/epinephrine (Marcaine-epinephrine) T1

bupivacaine hcl/epinephrine/pf (Marcaine-epinephrine) T1

bupivacaine hcl/epinephrine/pf (Sensorcaine-mpf Epinephrine) T1

bupivacaine hcl/pf T1 bupivacaine hcl/pf (Sensorcaine-mpf) T1

CARBOCAINE (polocaine) T3 CARBOCAINE (polocaine-mpf) T3


23


LOCAL ANESTHETICS


chloroprocaine hcl/pf (Nesacaine-mpf) T1

CITANEST FORTE DENTAL T3 CITANEST PLAIN DENTAL T3 CLOROTEKAL T3 EXPAREL T3 lidocaine 0.5mg intraderm syst (Zingo) T1

lidocaine 100 mg/10 ml(1%) syr T1

lidocaine 100 mg/5 ml (2%) syr T1 lidocaine 50 mg/5 ml (1%) syrg T1 lidocaine hcl T1 lidocaine hcl 0.5% vial (Xylocaine) T1

lidocaine hcl 0.5% vial (Xylocaine-mpf) T1

lidocaine hcl 1% 20 mg/2 ml (Xylocaine-mpf) T1

lidocaine hcl 1% 20 mg/2 ml vl (Xylocaine-mpf) T1



lidocaine hcl 1% 50 mg/5 ml vl (Xylocaine-mpf) T1

lidocaine hcl 1% ampul (Xylocaine-mpf) T1

lidocaine hcl 1% vial (Xylocaine) T1

lidocaine hcl 1% vial (Xylocaine-mpf) T1

lidocaine hcl 1.5% ampul (Xylocaine-mpf) T1


lidocaine hcl 2% 40 mg/2 ml T1 lidocaine hcl 2% 40 mg/2 ml vl (Xylocaine-mpf) T1

lidocaine hcl 2% ampul T1 lidocaine hcl 2% jel urojet ac T1 lidocaine hcl 2% jelly T1 lidocaine hcl 2% jelly uro-jet T1 lidocaine hcl 2% vial (Xylocaine) T1

lidocaine hcl 2% vial (Xylocaine-mpf) T1

lidocaine hcl 4% ampul T1


24


LOCAL ANESTHETICS


lidocaine hcl 4% solution T1 lidocaine hcl/dextrose 7.5%/pf T1 lidocaine hcl/epinephrine T1 lidocaine hcl/epinephrine (Xylocaine With Epinephrine) T1

lidocaine hcl/epinephrine bit (Xylocaine Dental-epinephrine) T1

lidocaine with 8.4% sod bicarb T1 MARCAINE (bupivacaine hcl) T3 MARCAINE (sensorcaine-mpf) T3 MARCAINE SPINAL (bupivacaine-dextrose) T3

MARCAINE-EPINEPHRINE (bupivacaine hcl-epinephrine) T3

MARCAINE-EPINEPHRINE (sensorcaine-epinephrine) T3

MARCAINE-EPINEPHRINE (sensorcaine-mpf epinephrine) T3

mepivacaine hcl (Carbocaine) T1 mepivacaine hcl/pf (Carbocaine) T1

NAROPIN T3 NAROPIN (ropivacaine hcl) T3 NESACAINE T3 NESACAINE-MPF (chloroprocaine hcl) T3

ORABLOC T3 ropivacaine 0.2% 20 mg/10 ml (Naropin) T1

ropivacaine 0.2% 200 mg/100 ml (Naropin) T1




ROPIVACAINE 0.5% 1000 MG/200ML T3


ROPIVACAINE 0.5% 500 MG/100 ML T3


ropivacaine 1% 100 mg/10 ml vl (Naropin) T1

ropivacaine 1% 200 mg/20 ml vl (Naropin) T1


25


LOCAL ANESTHETICS


ropivacaine hcl 0.5% syringe T1 ropivacaine in 0.9% sod chl/pf T1 ropivacaine/epi/clonidine/ket T1 SENSORC MPF 0.75%-EPI 1:200000 T3

SENSORCAINE (bupivacaine hcl) T3

sensorcaine-mpf 0.25% vial (Sensorcaine-mpf) T1

SENSORCAINE-MPF 0.25% VIAL (sensorcaine-mpf) T3

sensorcaine-mpf 0.5% vial (Sensorcaine-mpf) T1

SENSORCAINE-MPF 0.5% VIAL (sensorcaine-mpf) T3

SENSORCAINE-MPF 0.75% VIAL (bupivacaine hcl) T3

sensorc-mpf 0.25%-epi 1:200000 (Marcaine-epinephrine)

T1

SENSORCN-MPF 0.5%-EPI 1:200000 (bupivacaine hcl-epinephrine)

T3

tetracaine hcl/pf T1 XYLOCAINE (lidocaine hcl) T3 XYLOCAINE DENTAL-EPINEPHRINE T3

XYLOCAINE DENTAL-EPINEPHRINE (lidocaine-epinephrine)

T3

XYLOCAINE WITH EPINEPHRINE T3

XYLOCAINE WITH EPINEPHRINE (lidocaine hcl-epinephrine)

T3

XYLOCAINE-MPF T3 XYLOCAINE-MPF (lidocaine hcl) T3

XYLOCAINE-MPF WITH EPINEPHRINE T3

ZINGO (lidocaine hcl) T3

TOPICAL LOCAL ANESTHETICS

CETACAINE T3 L.E.T. (LIDO-EPINEPH-TETRA) T3

lidocaine 5% ointment T1 QL (145gm/30 days) lidocaine 5% patch (Lidoderm) T1 lidocaine hcl T1 lidocaine hcl 4% solution T1


26


TOPICAL LOCAL ANESTHETICS


lidocaine/prilocaine T1 LIDODERM (lidocaine) T3 PAIN EASE MEDIUM STREAM SPRAY T3

SYNERA T3 ZTLIDO T2

ANESTHETICS (Urinary Tract Conditions)

URINARY TRACT ANESTHETIC/ANALGESIC AGNT (AZO-DYE)

phenazopyridine hcl (Pyridium) T1 PYRIDIUM (phenazopyridine hcl) T3

ANTIALLERGY (Allergy/Nasal Sprays)

MAST CELL STABILIZERS cromolyn 100 mg/5 ml oral conc (Gastrocrom) T1

GASTROCROM (cromolyn sodium) T3

ANTIARTHRITICS (Pain Relief And Inflammatory Disease)

ANALGESIC/ANTIPYRETICS, SALICYLATES

salsalate T1 HD

ANTI-ARTHRITIC AND CHELATING AGENTS

DEPEN (penicillamine) T4 PA SP penicillamine T4 PA SP penicillamine (Depen) T4 PA SP

ANTI-ARTHRITIC, FOLATE ANTAGONIST AGENTS

OTREXUP T3 PA RASUVO T2 PA

ANTI-INFLAMMATORY, PYRIMIDINE SYNTHESIS INHIBITOR

ARAVA (leflunomide) T3 HD leflunomide (Arava) T1 HD

ANTI-INFLAMMATORY, PHOSPHODIESTERASE-4 (PDE4) INHIB. OTEZLA 28 DAY STARTER PACK T4 PA QL (1 pack/180 days) SP

HD OTEZLA 30 MG TABLET T4 PA QL (2 tabs/day) SP HD

ANTI-INFLAMMATORY/ANTIARTHRITICS AGENTS, MISC.

DUROLANE T4 PA SP HD EUFLEXXA T4 PA SP HD GELSYN-3 T4 PA SP HD


27


ANTI-INFLAMMATORY/ANTIARTHRITICS AGENTS, MISC.


HYALGAN T4 PA SP HD HYALGAN (visco-3) T4 PA SP HD hyaluronate sod, cross-linked T4 PA SP HD hyaluronate sodium (Triluron) T4 PA SP hyaluronate sodium (Triluron) T4 PA SP HD HYMOVIS T4 PA SP HD MONOVISC T4 PA SP HD ORTHOVISC T4 PA SP HD SYNVISC T4 PA SP HD SYNVISC-ONE T4 PA SP HD TRILURON (visco-3) T4 PA SP HD

ANTINFLAMMATORY, SEL.COSTIM.MOD., T-CELL INHIBITOR ORENCIA 125 MG/ML SYRINGE T4 PA QL (4 syringes/28 days)

SP HD ORENCIA 250 MG VIAL T4 PA SP HD ORENCIA 50 MG/0.4 ML SYRINGE T4 PA QL (4 syringes/28 days)

SP HD ORENCIA 87.5 MG/0.7 ML SYRINGE T4 PA QL (4 syringes/28 days)

SP HD

ORENCIA CLICKJECT T4 PA QL (4 injectors/28 days) SP HD

COLCHICINE

colchicine (Colcrys) T1 HD colchicine (Mitigare) T1 HD COLCRYS (colchicine) T3 HD MITIGARE (colchicine) T3 HD

GOLD SALTS

RIDAURA T3

HYPERURICEMIA TX - URATE-OXIDASE ENZYME-TYPE

ELITEK T4 SP KRYSTEXXA T4 PA SP

HYPERURICEMIA TX - XANTHINE OXIDASE INHIBITORS

allopurinol (Zyloprim) T1 HD allopurinol sodium (Aloprim) T1 HD ALOPRIM (allopurinol sodium) T3 HD febuxostat 40 mg tablet (Uloric) T1 QL (1 tab/day) HD febuxostat 80 mg tablet (Uloric) T1 HD ULORIC 40 MG TABLET (febuxostat) T3 QL (1 tab/day) HD

ULORIC 80 MG TABLET (febuxostat) T3 HD

ZYLOPRIM (allopurinol) T3 HD


28


JANUS KINASE (JAK) INHIBITORS


OLUMIANT T4 PA QL (1 tab/day) SP HD RINVOQ ER T4 PA QL (1 tab/day) SP HD XELJANZ T4 PA QL (2 tabs/day) SP HD XELJANZ XR T4 PA QL (1 tab/day) SP HD

NSAIDS (COX NON-SPEC.INHIB) AND PROSTAGLANDIN ANALOG ARTHROTEC 50 (diclofenac sodium-misoprostol) T3 ST HD

ARTHROTEC 75 (diclofenac sodium-misoprostol) T3 ST HD

diclofenac sodium/misoprostol (Arthrotec 50) T1 HD

diclofenac sodium/misoprostol (Arthrotec 75) T1 HD


CALDOLOR T3 HD DAYPRO (oxaprozin) T3 ST HD diclofenac sod dr 25 mg tab T1 HD diclofenac sod dr 50 mg tab T1 HD diclofenac sod dr 75 mg tab T1 HD diclofenac sod ec 25 mg tab T1 HD diclofenac sod ec 50 mg tab T1 HD diclofenac sod ec 75 mg tab T1 HD diclofenac sodium T1 HD EC-NAPROSYN (naproxen) T3 ST HD etodolac T1 HD etodolac (Lodine) T1 HD FELDENE (piroxicam) T3 ST HD fenoprofen calcium T1 HD fenoprofen calcium (Nalfon) T1 HD flurbiprofen T1 HD ibuprofen T1 HD indomethacin T1 HD indomethacin 25 mg capsule T1 HD indomethacin 50 mg capsule T1 HD ketoprofen T1 HD LODINE (etodolac) T3 ST HD meclofenamate sodium T1 HD meloxicam (Mobic) T1 HD MOBIC (meloxicam) T3 ST HD nabumetone T1 HD NALFON 400 MG CAPSULE (fenoprofen calcium) T3 ST HD


29




nalfon 600 mg tablet T1 ST HD NAPROSYN (naproxen) T3 ST HD naproxen T1 HD naproxen (EC-naprosyn) T1 HD naproxen (Naprosyn) T1 HD naproxen sodium T1 HD oxaprozin (Daypro) T1 HD piroxicam (Feldene) T1 HD QMIIZ ODT 15 MG TABLET T3 ST HD QMIIZ ODT 7.5 MG TABLET T3 ST QL (1 tab/day) HD sulindac T1 HD tolmetin sodium T1 HD

NSAIDS, CYCLOOXYGENASE-2 (COX-2) SELECTIVE INHIBITOR CELEBREX 100 MG CAPSULE (celecoxib) T3 ST QL (2 caps/day) HD

CELEBREX 200 MG CAPSULE (celecoxib) T3 ST QL (2 caps/day) HD

CELEBREX 400 MG CAPSULE (celecoxib) T3 ST QL (1 cap/day) HD

CELEBREX 50 MG CAPSULE (celecoxib) T3 ST QL (2 caps/day) HD

celecoxib 100 mg capsule (Celebrex) T1 QL (2 caps/day) HD


celecoxib 400 mg capsule (Celebrex) T1 QL (1 cap/day) HD


URICOSURIC AGENTS

probenecid T1 HD probenecid/colchicine T1 HD

ANTIASTHMATICS (Asthma/COPD/Respiratory)

5-LIPOXYGENASE INHIBITORS

zileuton T1 HD

ANTICHOLINERGICS, ORALLY INHALED LONG ACTING

INCRUSE ELLIPTA T2 HD LONHALA MAGNAIR REFILL T3 PA HD LONHALA MAGNAIR STARTER T3 PA HD

ANTICHOLINERGICS, ORALLY INHALED SHORT ACTING

ATROVENT HFA T2 HD ipratropium bromide T1 HD


30


BETA-ADRENERGIC AGENTS


albuterol sulf 2 mg/5 ml syrup T1 HD albuterol sulfate 2 mg tab T1 HD albuterol sulfate 4 mg tab T1 HD albuterol sulfate er 4 mg tab T1 HD albuterol sulfate er 8 mg tab T1 HD metaproterenol sulfate T1 HD terbutaline sulfate T1 HD

BETA-ADRENERGIC AGENTS, INHALED, SHORT ACTING

albuterol 2.5 mg/0.5 ml sol T1 albuterol 5 mg/ml solution T1 albuterol sul 0.63 mg/3 ml sol T1 albuterol sul 1.25 mg/3 ml sol T1 albuterol sul 2.5 mg/3 ml soln T1 albuterol sulfate (Proair Hfa) T1 levalbuterol hcl (Xopenex Concentrate) T1

levalbuterol hcl (Xopenex) T1 levalbuterol tartrate T1 PROAIR HFA (albuterol sulfate hfa) T2

PROAIR RESPICLICK T2 XOPENEX (levalbuterol hcl) T3 XOPENEX CONCENTRATE (levalbuterol concentrate) T3

BETA-ADRENERGIC AGENTS, ORALLY INHALED, LONG ACTING

BROVANA T3 HD PERFOROMIST T3 QL (240ml/30 days) HD SEREVENT DISKUS T2 HD

BETA-ADRENERGIC AND ANTICHOLINERGIC COMBO, INHALED

ANORO ELLIPTA T2 HD COMBIVENT RESPIMAT T3 HD ipratropium/albuterol sulfate T1 HD ADVAIR HFA T2 HD BREO ELLIPTA T2 HD DULERA T2 HD fluticasone propion/salmeterol T1 HD SYMBICORT T2 HD

BETA-ADRENERGIC-ANTICHOLINERGIC-GLUCOCORT, INHALED

TRELEGY ELLIPTA T2


31


GLUCOCORTICOIDS, ORALLY INHALED


budesonide (Pulmicort) T1 HD FLOVENT DISKUS T2 HD FLOVENT HFA T2 HD PULMICORT (budesonide) T3 HD QVAR REDIHALER T2 HD

INTERLEUKIN-5 (IL-5) RECEPTOR ALPHA ANTAGONIST, MAB

FASENRA T4 PA SP HD FASENRA PEN T4 PA SP HD

LEUKOTRIENE RECEPTOR ANTAGONISTS

ACCOLATE (zafirlukast) T3 HD montelukast sodium (Singulair) T1 HD SINGULAIR (montelukast sodium) T3 HD

zafirlukast (Accolate) T1 HD

MAST CELL STABILIZERS, ORALLY INHALED

cromolyn 20 mg/2 ml neb soln T1 QL (480ml/30 days) HD

MONOCLONAL ANTIBODIES TO IMMUNOGLOBULIN E (IGE)

XOLAIR T4 PA SP HD

MONOCLONAL ANTIBODY - INTERLEUKIN-5 ANTAGONISTS

CINQAIR T4 PA SP NUCALA T4 PA SP HD

MUCOLYTICS

acetylcysteine T1

PHOSPHODIESTERASE-4 (PDE4) INHIBITORS

DALIRESP 250 MCG TABLET T3 QL (28 tabs/180 days) HD DALIRESP 500 MCG TABLET T3 QL (2 tabs/day) HD

XANTHINES

aminophylline T1 HD THEO-24 T3 HD theophylline anhydrous T1 HD theophylline in dextrose 5 % T1 HD

ANTIBIOTICS (Ear Medications)

EAR PREPARATIONS, ANTIBIOTICS

CETRAXAL (ciprofloxacin hcl) T3 ciprofloxacin hcl (Cetraxal) T1 COLY-MYCIN S T3 CORTISPORIN-TC T3


32

ANTIBIOTICS (Ear Medications)

EAR PREPARATIONS, ANTIBIOTICS


neomycin/polymyxin b/hydrocort T1

ofloxacin T1

OTIC PREPARATIONS, ANTI-INFLAMMATORY-ANTIBIOTICS

CIPRO HC T3 CIPRODEX T3 CIPROFLOXACIN HCL-FLUOCINOLONE T3

OTOVEL T3

ANTIBIOTICS (Eye Conditions)

EYE ANTIBIOTIC AND GLUCOCORTICOID COMBINATIONS MAXITROL (neomycin-polymyxin-dexameth) T3

neomycin/bacit/p-myx/hydrocort T1

neomycin/polymyxin b/dexametha (Maxitrol) T1

neomycin/polymyxin b/hydrocort T1

PRED-G T3 TOBRADEX T3 TOBRADEX (tobramycin-dexamethasone) T3

TOBRADEX ST T3 tobramycin/dexamethasone (Tobradex) T1

ZYLET T3

EYE SULFONAMIDES BLEPH-10 (sulfacetamide sodium) T3

BLEPHAMIDE T3 BLEPHAMIDE S.O.P. T3 sulfacetamide sodium T1 sulfacetamide sodium (Bleph-10) T1

sulfacetamide/prednisolone sp T1

OPHTHALMIC ANTIBIOTICS

AZASITE T3 bacitracin T1 bacitracin/polymyxin b sulfate T1 BESIVANCE T3 CILOXAN T3 CILOXAN (ciprofloxacin hcl) T3


33

ANTIBIOTICS (Eye Conditions)

OPHTHALMIC ANTIBIOTICS


ciprofloxacin hcl (Ciloxan) T1 erythromycin base T1 gatifloxacin (Zymaxid) T1 gentamicin sulfate T1 levofloxacin T1 MOXEZA (moxifloxacin) T3 moxifloxacin hcl (Moxeza) T1 moxifloxacin hcl (Vigamox) T1 moxifloxacin(pf)/bal.salt sol2 T1 neomycin sulf/bacitracin/poly T1 neomycin/polymyxn b/gramicidin T1

OCUFLOX (ofloxacin) T3 ofloxacin (Ocuflox) T1 polymyxin b sulf/trimethoprim (Polytrim) T1

POLYTRIM (polymyxin b sul-trimethoprim) T3

tobramycin 0.3% eye drop (Tobrex) T1

TOBREX T3 TOBREX (tobramycin) T3 VIGAMOX (moxifloxacin) T3 ZYMAXID (gatifloxacin) T3

ANTIBIOTICS (Infections)

2ND GEN. ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL

SOLOSEC T3

ABSORBABLE SULFONAMIDE ANTIBACTERIAL AGENTS BACTRIM (sulfamethoxazole-trimethoprim) T3

BACTRIM DS (sulfamethoxazole-trimethoprim)

T3

sulfadiazine T1 sulfamethoxazole/trimethoprim T1 sulfamethoxazole/trimethoprim (Bactrim DS) T1

sulfamethoxazole/trimethoprim (Bactrim) T1

sulfamethoxazole/trimethoprim (Sulfatrim) T1

SULFATRIM (sulfamethoxazole-trimethoprim)

T3


34


AMINOGLYCOSIDE ANTIBIOTICS


amikacin sulfate T1 ARIKAYCE T4 PA SP gentamicin in nacl, iso-osm T1 gentamicin sulfate T1 gentamicin sulfate/pf T1 KITABIS PAK (tobramycin) T4 PA QL (10ml/day) SP HD neomycin sulfate T1 streptomycin sulfate T1 TOBI PODHALER T4 PA QL (8 caps/day) SP HD tobramycin 300 mg/5 ml ampule T4 PA QL (10ml/day) SP HD tobramycin pak 300 mg/5 ml (Kitabis Pak) T4 PA QL (10ml/day) SP HD

tobramycin sulfate T1 ZEMDRI T3

ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL AGENTS

FLAGYL (metronidazole) T3 METRO IV (metronidazole) T3 metronidazole (Flagyl) T1 metronidazole/sodium chloride (Metro Iv) T1

ANTIBIOTIC, ANTIBACTERIAL, MISC. HIPREX (methenamine hippurate) T3

meth/meblue/sod phos/psal/hyos T1

meth/meblue/sod phos/psal/hyos (Uretron D-S) T1

meth/meblue/sod phos/psal/hyos (Uribel) T1

methen/mblue/sal/sod phos/hyos T1

methenam/m.blue/salicyl/hyoscy T1 methenam/sod phos/mblue/hyoscy (Urogesic-Blue)

T1

methenamine hippurate (Hiprex) T1

methenamine mandelate T1 MONUROL T3 PRIMSOL T3 trimethoprim T1 URETRON D-S (utira-c) T3 URIBEL (vilamit mb) T3 UROGESIC-BLUE (uryl) T3


35


ANTIBIOTICS, MISCELLANEOUS, OTHER


bacitracin T1

ANTILEPROTICS

dapsone T1 THALOMID T4 PA SP HD

ANTI-MYCOBACTERIUM AGENTS ethambutol hcl T1 HD ethambutol hcl (Myambutol) T1 HD isoniazid T1 HD MYAMBUTOL (ethambutol hcl) T3 HD PASER T3 HD pyrazinamide T1 HD rifabutin T1 HD TRECATOR T3 HD

ANTITUBERCULAR ANTIBIOTICS CAPASTAT SULFATE T3 cycloserine T1 PRETOMANID T3 PA QL (1 tab/day) PRIFTIN T3 RIFADIN (rifampin) T3 RIFAMATE T3 rifampin (Rifadin) T1 RIFATER T3 SIRTURO T4 SP

BETALACTAMS

AZACTAM (aztreonam) T3 aztreonam (Azactam) T1 CAYSTON T4 PA QL (3ml/day) SP HD

CARBAPENEM ANTIBIOTICS (THIENAMYCINS)

ertapenem sodium (Invanz) T1 imipenem/cilastatin sodium T1 imipenem/cilastatin sodium (Primaxin) T1

INVANZ (ertapenem) T3 meropenem (Merrem) T1 meropenem-0.9% sodium chloride T1

MERREM (meropenem) T3 PRIMAXIN (imipenem-cilastatin sodium) T3

RECARBRIO T3 VABOMERE T3


36


CEPHALOSPORIN ANTIBIOTICS - 1ST GENERATION


cefadroxil T1 cefazolin sodium T1 cefazolin sodium in 0.9 % nacl T1 cefazolin sodium/dextrose,iso T1 cefazolin sodium/water T1 cephalexin T1 cephalexin (Keflex) T1 KEFLEX (cephalexin) T3

CEPHALOSPORIN ANTIBIOTICS - 2ND GENERATION

cefaclor T1 CEFOTAN (cefotetan) T3 cefotetan disod/isosm dextrose T1 cefotetan disodium (Cefotan) T1 cefoxitin sodium T1 cefoxitin sodium/dextrose,iso T1 cefprozil T1 cefuroxime axetil T1 cefuroxime sodium T1

CEPHALOSPORIN ANTIBIOTICS - 3RD GENERATION AVYCAZ T3 cefdinir T1 cefditoren pivoxil T1 cefditoren pivoxil (Spectracef) T1 cefixime (Suprax) T1 cefpodoxime proxetil T1 ceftazidime T1 ceftazidime in dextrose5%water T1

ceftriaxone in is-osm dextrose T1 ceftriaxone sodium T1 SPECTRACEF (cefditoren pivoxil) T3

SUPRAX T3 SUPRAX (cefixime) T3 ZERBAXA T3

CEPHALOSPORIN ANTIBIOTICS - 4TH GENERATION

cefepime hcl T1 cefepime hcl in dextrose 5 % T1 cefepime in iso-osm dextrose T1

CEPHALOSPORIN ANTIBIOTICS - SIDEROPHORE

FETROJA T3


37


CEPHALOSPORINS - 5TH GENERATION


TEFLARO T3

CHLORAMPHENICOL ANTIBIOTICS AND DERIVATIVES

chloramphenicol sod succinate T1

GLYCYLCYCLINES

tigecycline (Tygacil) T1 TYGACIL (tigecycline) T3

LINCOSAMIDE ANTIBIOTICS CLEOCIN HCL (clindamycin hcl) T3

CLEOCIN PALMITATE (clindamycin pediatric) T3

CLEOCIN PHOS 150 MG/ML VIAL (clindamycin phosphate) T3

CLEOCIN PHOS 300 MG/2 ML VIAL (clindamycin phosphate) T3

cleocin phos 300 mg/2ml addvan T1


CLEOCIN PHOS 600 MG/4ML ADDVAN T3

CLEOCIN PHOS 9 G/60 ML VIAL (clindamycin phosphate) T3


CLEOCIN PHOS 900 MG/6ML ADDVAN T3

clindamycin hcl (Cleocin Hcl) T1 clindamycin in 0.9 % sod chlor T1 clindamycin palmitate hcl (Cleocin Palmitate) T1

clindamycin phosphate (Cleocin Phosphate) T1

clindamycin phosphate/d5w T1 LINCOCIN (lincomycin hcl) T3 lincomycin hcl (Lincocin) T1

LIPOGLYCOPEPTIDE ANTIBIOTICS

DALVANCE T3 ORBACTIV T3 VIBATIV T3

MACROLIDE ANTIBIOTICS

azithromycin T1 azithromycin (Zithromax Tri-Pak) T1


38


MACROLIDE ANTIBIOTICS


azithromycin (Zithromax) T1 clarithromycin T1 DIFICID T3 QL (28 tabs/28 days) E.E.S. 400 T3 ERYPED 200 (erythromycin ethylsuccinate) T3

ERY-TAB (erythromycin) T3 ERYTHROCIN LACTOBIONATE T3

erythromycin base T1 erythromycin base (ERY-Tab) T1 erythromycin ethylsuccinate T1 erythromycin ethylsuccinate (E.E.S. 400) T1

erythromycin ethylsuccinate (Eryped 200) T1

erythromycin stearate T1 ZITHROMAX (azithromycin) T3 ZITHROMAX TRI-PAK (azithromycin) T3

NITROFURAN DERIVATIVES ANTIBACTERIAL AGENTS MACROBID (nitrofurantoin mono-macro) T3

MACRODANTIN (nitrofurantoin) T3

nitrofurantoin T1 nitrofurantoin macrocrystal (Macrodantin) T1

nitrofurantoin monohyd/m-cryst (Macrobid) T1

OXAZOLIDINONE ANTIBIOTICS

linezolid (Zyvox) T1 PA linezolid in dextrose 5% (Zyvox) T1

linezolid-0.9% sodium chloride T1 SIVEXTRO 200 MG TABLET T3 PA SIVEXTRO 200 MG VIAL T3 ZYVOX 100 MG/5 ML SUSPENSION (linezolid) T3 PA

ZYVOX 200 MG/100 ML-D5W T3 ZYVOX 600 MG TABLET (linezolid) T3 PA

ZYVOX 600 MG/300 ML-D5W (linezolid-d5w) T3


39


PENICILLIN ANTIBIOTICS


amoxicillin T1 amoxicillin/potassium clav T1 ampicillin sodium T1 ampicillin sodium/sulbactam na T1 ampicillin sodium/sulbactam na (Unasyn) T1

ampicillin trihydrate T1 BICILLIN C-R T3 BICILLIN L-A T3 dicloxacillin sodium T1 nafcillin in dextrose,iso-osm T1 nafcillin sodium T1 oxacillin in dextrose(iso-osm) T1 oxacillin sodium T1 pen g pot/dextrose-water T1 penicillin g potassium T1 penicillin g procaine T1 penicillin g sodium T1 penicillin v potassium T1 piperacillin sodium/tazobactam T1 piperacillin sodium/tazobactam (Zosyn) T1

UNASYN (ampicillin-sulbactam) T3

ZOSYN T3 ZOSYN (piperacillin-tazobactam) T3

PLEUROMUTILIN DERIVATIVES

XENLETA 150 MG/15 ML VIAL T3 XENLETA 600 MG TABLET T3 PA QL (10 tabs/30 days)

POLYMYXIN ANTIBIOTICS AND DERIVATIVES colistin (colistimethate na) (Coly-mycin M Parenteral) T1

COLY-MYCIN M PARENTERAL (colistimethate) T3

polymyxin b sulfate T1

QUINOLONE ANTIBIOTICS

AVELOX IV (moxifloxacin) T3 BAXDELA 300 MG VIAL T3 BAXDELA 450 MG TABLET T3 PA CIPRO T3 CIPRO (ciprofloxacin hcl) T3


40


QUINOLONE ANTIBIOTICS


ciprofloxacin hcl T1 ciprofloxacin hcl (Cipro) T1 ciprofloxacin in 5 % dextrose T1 LEVAQUIN (levofloxacin) T3 levofloxacin T1 levofloxacin (Levaquin) T1 levofloxacin in dextrose 5 % T1 moxifloxacin hcl T1 moxifloxacin/sod.ace,sul/water T1 moxifloxacin-sod.chloride(iso) (Avelox Iv) T1

ofloxacin T1

RIFAMYCINS AND RELATED DERIVATIVE ANTIBIOTICS

AEMCOLO T3 QL (12 tabs/3 days) XIFAXAN 200 MG TABLET T2 XIFAXAN 550 MG TABLET T2 QL (42 tabs/14 days)

STREPTOGRAMIN ANTIBIOTICS

SYNERCID T3

TETRACYCLINE ANTIBIOTICS

coremino er 135 mg tablet T1 coremino er 45 mg tablet T1 QL (1 tab/day) coremino er 90 mg tablet T1 demeclocycline hcl T1 doxycycline hyclate T1 doxycycline monohydrate T1 doxycycline monohydrate (Vibramycin) T1

MINOCIN T3 minocycline er 105 mg tablet T1 minocycline er 115 mg tablet T1 minocycline er 135 mg tablet T1 minocycline er 45 mg tablet T1 QL (1 tab/day) minocycline er 55 mg tablet T1 minocycline er 65 mg tablet T1 minocycline er 80 mg tablet T1 minocycline er 90 mg tablet T1 minocycline hcl T1 NUZYRA 100 MG VIAL T4 SP NUZYRA 150 MG TABLET T4 PA SP tetracycline hcl T1


41


TETRACYCLINE ANTIBIOTICS


VIBRAMYCIN T3 VIBRAMYCIN (doxycycline monohydrate) T3

XERAVA T3

VAGINAL ANTIBIOTICS

CLEOCIN T3 CLEOCIN (clindamycin phosphate) T3

clindamycin phosphate (Cleocin) T1

CLINDESSE T3 metronidazole T1 NUVESSA T3

VANCOMYCIN ANTIBIOTICS AND DERIVATIVES

FIRVANQ T2 FIRVANQ (vancomycin hcl) T2 vancomycin 1 gm add-van vial T1 vancomycin 1 gm vial T1 vancomycin 1 gram/200 ml bag T1 vancomycin 1.5 gram/300 ml bag T1

VANCOMYCIN 2 GRAM/400 ML BAG T3

vancomycin 250 mg/5 ml soln (Firvanq) T1

vancomycin 500 mg a-v vial T1 vancomycin 500 mg vial T1 VANCOMYCIN 500 MG/100 ML BAG T3

vancomycin hcl 1.25 gram vial T1 vancomycin hcl 1.5 gram vial T1 vancomycin hcl 10 gm vial T1 vancomycin hcl 125 mg capsule T1

vancomycin hcl 1g/200 ml bag T1 vancomycin hcl 250 mg capsule T1

vancomycin hcl 250 mg vial T1 vancomycin hcl 5 gm vial T1 vancomycin hcl 750 mg vial T1 vancomycin hcl in 5 % dextrose T1

vancomycin/0.9 % sod chloride T1


42

ANTIBIOTICS (Miscellaneous)

CYCLIC LIPOPEPTIDES


CUBICIN (daptomycin) T3 CUBICIN RF (daptomycin) T3 daptomycin T1 daptomycin (Cubicin Rf) T1

ANTIBIOTICS (Skin Conditions)

TOPICAL ANTIBIOTIC AND ANTI-INFLAMMATORY STEROID

CORTISPORIN T3 NEO-SYNALAR T3

TOPICAL ANTIBIOTICS BENZAMYCIN (erythromycin-benzoyl peroxide) T3

CENTANY (mupirocin) T3 CENTANY AT T3 CLEOCIN T (clindamycin phosphate) T3

clindacin etz 1% pledget T1 CLINDACIN ETZ KIT T3 CLINDACIN PAC T3 clindamycin phosphate T1 clindamycin phosphate (Cleocin T) T1

clindamycin phosphate (Evoclin) T1

ERYGEL (erythromycin) T3 erythromycin base in ethanol T1 erythromycin base in ethanol (Erygel) T1

erythromycin/benzoyl peroxide (Benzamycin) T1

EVOCLIN (clindamycin phosphate) T3

gentamicin sulfate T1 mupirocin (Centany) T1 mupirocin calcium T1 XEPI T3

TOPICAL SULFONAMIDES

mafenide acetate (Sulfamylon) T1 SILVADENE (ssd) T3 silver sulfadiazine (Silvadene) T1 sulfacetamide sod/sulfur/urea T1 sulfacetamide sodium/sulfur T1 sulfacetamide/sulfur/cleansr23 T1


43

ANTIBIOTICS (Skin Conditions)

TOPICAL SULFONAMIDES


SULFAMYLON T3 SULFAMYLON (mafenide acetate) T3

ANTICOAGULANTS (Blood Thinners/Anti-Clotting)

ANTICOAGULANTS, COUMARIN TYPE

COUMADIN (warfarin sodium) T3 PA HD warfarin sodium (Coumadin) T1 HD

CITRATES AS ANTICOAGULANTS

ACD SOLUTION A T3 ACD-A T3 sodium citrate T1 TRICITRASOL T3

DIRECT FACTOR XA INHIBITORS

BEVYXXA T3 QL (42 caps/42 days) ELIQUIS T2 SAVAYSA 15 MG TABLET T3 QL (1 tab/day) SAVAYSA 30 MG TABLET T3 QL (1 tab/day) SAVAYSA 60 MG TABLET T3 XARELTO T2

HEPARIN AND RELATED PREPARATIONS ARIXTRA (fondaparinux sodium) T4 QL (1 syringe/day) SP

enoxaparin 100 mg/ml syringe (Lovenox) T4 QL (2 syringes/day) SP

enoxaparin 120 mg/0.8 ml syr (Lovenox) T4 QL (2 syringes/day) SP

enoxaparin 150 mg/ml syringe (Lovenox) T4 QL (2 syringes/day) SP


enoxaparin 300 mg/3 ml vial (Lovenox) T4 QL (1 vial/day) SP




fondaparinux sodium (Arixtra) T4 QL (1 syringe/day) SP FRAGMIN 10,000 UNITS/ML SYRING T4 QL (2 syringes/day) SP

FRAGMIN 12,500 UNITS/0.5 ML T4 QL (2 syringes/day) SP FRAGMIN 15,000 UNITS/0.6 ML T4 QL (2 syringes/day) SP


44

ANTICOAGULANTS (Blood Thinners/Anti-Clotting)

HEPARIN AND RELATED PREPARATIONS


FRAGMIN 18,000 UNITS/0.72 ML T4 QL (2 syringes/day) SP

FRAGMIN 2,500 UNITS/0.2 ML SYR T4 QL (2 syringes/day) SP



FRAGMIN 95,000 UNITS/3.8 ML VL T4 QL (7 vials/30 days) SP

heparin sod,porcine/0.9 % nacl T1 heparin sod,pork in 0.45% nacl T1 heparin sodium, porcine T1 heparin sodium, porcine/d5w T1 heparin sodium, porcine/ns/pf T1 heparin sodium, porcine/pf T1 LOVENOX 100 MG/ML SYRINGE (enoxaparin sodium) T4 QL (2 syringes/day) SP

LOVENOX 120 MG/0.8 ML SYRINGE (enoxaparin sodium) T4 QL (2 syringes/day) SP

LOVENOX 150 MG/ML SYRINGE (enoxaparin sodium) T4 QL (2 syringes/day) SP


LOVENOX 300 MG/3 ML VIAL (enoxaparin sodium) T4 QL (1 vial/day) SP




THROMBIN INHIBITORS, SELECTIVE, DIRECT, REVERSIBLE

argatroban T4 SP HD argatroban in 0.9 % sod chlor T4 SP HD argatroban in nacl, iso-osmotic T1 HD PRADAXA T3 HD

THROMBIN INHIBITORS, SEL, DIRECT, REVERS-HIRUDIN TYPE

ANGIOMAX (bivalirudin) T3 bivalirudin T1 bivalirudin (Angiomax) T1 bivalirudin/0.9 % sodium chlor T1

ANTIDOTES (Gastrointestinal/Heartburn)

MU-OPIOID RECEPTOR ANTAGONISTS, PERIPHERALLY-ACTING

MOVANTIK T3 PA


45

ANTIDOTES (Gastrointestinal/Heartburn)

MU-OPIOID RECEPTOR ANTAGONISTS, PERIPHERALLY-ACTING


RELISTOR T3 PA SYMPROIC T3 PA

ANTIDOTES (Substance Abuse)

OPIOID ANTAGONISTS

naloxone hcl T1 naltrexone hcl T1 QL (180 tabs/30 days) NARCAN T2 QL (2 units/30 days)

ANTIFUNGALS (Eye Conditions)

OPHTHALMIC ANTIFUNGAL AGENTS

NATACYN T3

ANTIFUNGALS (Feminine Products)

VAGINAL ANTIFUNGALS

butoconazole nitrate T1 miconazole nitrate T1 terconazole T1

ANTIFUNGALS (Infections)

ANTIFUNGAL AGENTS

ANCOBON (flucytosine) T3 clotrimazole T1 CRESEMBA 186 MG CAPSULE T3 PA

CRESEMBA 372 MG VIAL T3 fluconazole T1 fluconazole in nacl,iso-osm T1 flucytosine (Ancobon) T1 itraconazole T1 ketoconazole T1 NOXAFIL T3 NOXAFIL (posaconazole) T3 ORAVIG T3 posaconazole (Noxafil) T1 terbinafine hcl T1 VFEND (voriconazole) T3 PA VFEND IV (voriconazole) T3 voriconazole 200 mg tablet (Vfend) T1 PA

voriconazole 200 mg vial (Vfend Iv) T1


46

ANTIFUNGALS (Infections)

ANTIFUNGAL AGENTS


voriconazole 40 mg/ml susp (Vfend) T1 PA

voriconazole 50 mg tablet (Vfend) T1 PA

ANTIFUNGAL ANTIBIOTICS

ABELCET T3 AMBISOME T3 amphotericin b T1 CANCIDAS (caspofungin acetate) T3

caspofungin acetate (Cancidas) T1

ERAXIS (WATER DILUENT) T3 griseofulvin ultramicrosize T1 griseofulvin, microsize T1 MYCAMINE T3 nystatin T1

ANTIFUNGALS (Skin Conditions)

TOPICAL ANTIFUNGAL/ANTI-INFLAMMATORY, STEROID AGENT clotrimazole/betamethasone dip T1

clotrimazole/betamethasone dip (Lotrisone) T1

LOTRISONE (clotrimazole-betamethasone) T3

TOPICAL ANTIFUNGALS

CICLODAN 8% KIT (ciclopirox) T3 ciclodan 8% solution T1 ciclopirox T1 ciclopirox olamine T1 ciclopirox olamine (Loprox) T1 ciclopirox/urea/camph/men/euc (Ciclodan) T1

econazole nitrate T1 ECOZA T3 ketoconazole T1 ketoconazole (Nizoral) T1 LOPROX (ciclopirox) T3 luliconazole T1 naftifine hcl T1 naftifine hcl (Naftin) T1 NAFTIN T3


47

ANTIFUNGALS (Skin Conditions)

TOPICAL ANTIFUNGALS


NAFTIN (naftifine hcl) T3 NIZORAL (ketoconazole) T3 nystatin T1 nystatin/triamcin T1 oxiconazole nitrate T1 sodium thiosulfate/sal acid T1 XOLEGEL T3

ANTIHISTAMINE AND DECONGESTANT COMBINATION (Allergy/Nasal Sprays)

1ST GEN ANTIHISTAMINE AND DECONGESTANT COMBINATION

phenylephrine hcl/prometh hcl T1

2ND GEN ANTIHISTAMINE AND DECONGESTANT COMBINATION

CLARINEX-D 12 HOUR T3 SEMPREX-D T3

ANTIHISTAMINES (Allergy/Nasal Sprays)

ANTIHISTAMINES - 1ST GENERATION

carbinoxamine maleate T1 clemastine fumarate T1 cyproheptadine hcl T1 dexchlorpheniramine maleate (Ryclora) T1

diphenhydramine hcl T1 hydroxyzine hcl T1 hydroxyzine pamoate T1 hydroxyzine pamoate (Vistaril) T1 KARBINAL ER T3 PHENERGAN (promethazine hcl) T3

promethazine hcl T1 promethazine hcl (Phenergan) T1 RYCLORA (dexchlorpheniramine maleate) T3

VISTARIL (hydroxyzine pamoate) T3

ANTIHISTAMINES (Eye Conditions)

EYE ANTIHISTAMINES

azelastine hcl 0.05% drops T1 epinastine hcl T1 olopatadine hcl 0.1% eye drops T1

olopatadine hcl 0.2% eye drop T1


48

ANTIHYPERGLYCEMICS (Diabetes)

ANTIHYPERGLY, INCRETIN MIMETIC (GLP-1 RECEP.AGONIST)


BYDUREON BCISE T2 ST QL (4 pens/28 days) HD BYDUREON PEN T2 ST QL (4 pens/28 days) HD BYETTA T2 ST QL (1 pen/30 days) HD OZEMPIC T2 ST QL (2 pens/28 days) HD RYBELSUS T2 ST QL (1 tab/day) HD TRULICITY T2 ST QL (4 pens/28 days) HD VICTOZA 2-PAK T2 ST QL (3 pens/30 days) HD VICTOZA 3-PAK T2 ST QL (3 pens/30 days) HD

ANTIHYPERGLY, INSULIN, LONG ACT-GLP-1 RECEPT.AGONIST

SOLIQUA 100-33 T2 HD XULTOPHY 100-3.6 T2 HD

ANTIHYPERGLYCEMC-SOD/GLUC COTRANSPORT2 (SGLT2) INHIB

FARXIGA T2 ST QL (1 tab/day) HD JARDIANCE T2 ST QL (1 tab/day) HD STEGLATRO T2 ST QL (1 tab/day) HD

ANTIHYPERGLYCEMIC - DOPAMINE RECEPTOR AGONISTS

CYCLOSET T3 HD

ANTIHYPERGLYCEMIC, ALPHA-GLUCOSIDASE INHIBITORS

acarbose (Precose) T1 HD GLYSET (miglitol) T3 HD miglitol (Glyset) T1 HD PRECOSE (acarbose) T3 HD

ANTIHYPERGLYCEMIC, AMYLIN ANALOG-TYPE

SYMLINPEN 120 T2 HD SYMLINPEN 60 T2 HD

ANTIHYPERGLYCEMIC, BIGUANIDE TYPE GLUCOPHAGE (metformin hcl) T3 HD

GLUCOPHAGE XR (metformin hcl er) T3 HD

metformin hcl (Glucophage Xr) T1 HD metformin hcl (Glucophage) T1 HD metformin hcl (Riomet) T1 HD RIOMET (metformin hcl) T3 HD RIOMET ER T3 HD

ANTIHYPERGLYCEMIC, DPP-4 INHIBITORS

JANUVIA T2 ST QL (1 tab/day) HD


49


ANTIHYPERGLYCEMIC, INSULIN-RELEASE STIMULANT TYPE


AMARYL (glimepiride) T3 HD glimepiride (Amaryl) T1 HD glipizide (Glucotrol Xl) T1 HD glipizide (Glucotrol) T1 HD GLUCOTROL (glipizide) T3 HD GLUCOTROL XL (glipizide xl) T3 HD glyburide T1 HD glyburide,micronized (Glynase) T1 HD GLYNASE (glyburide micronized) T3 HD

nateglinide (Starlix) T1 HD repaglinide T1 HD STARLIX (nateglinide) T3 HD

ANTIHYPERGLYCEMIC, SGLT-2 AND DPP-4 INHIBITOR COMB

GLYXAMBI T2 ST QL (1 tab/day) HD

ANTIHYPERGLYCEMIC, THIAZOLIDINEDIONE AND BIGUANIDE ACTOPLUS MET (pioglitazone-metformin) T3 HD

pioglitazone hcl/metformin hcl (Actoplus MET) T1 HD

ANTIHYPERGLYCEMIC, THIAZOLIDINEDIONE-SULFONYLUREA DUETACT (pioglitazone-glimepiride) T3 HD

pioglitazone hcl/glimepiride (Duetact) T1 HD

ANTIHYPERGLYCEMIC, DPP-4 INHIBITOR-BIGUANIDE COMBS.

JANUMET T2 ST QL (2 tabs/day) HD JANUMET XR 100-1,000 MG TABLET T2 ST QL (1 tab/day) HD

JANUMET XR 50-1,000 MG TABLET T2 ST QL (2 tabs/day) HD

JANUMET XR 50-500 MG TABLET T2 ST QL (1 tab/day) HD

ANTIHYPERGLYCEMIC, INSULIN-RELEASE STIM.-BIGUANIDE

glipizide/metformin hcl T1 HD glyburide/metformin hcl T1 HD

ANTIHYPERGLYCEMIC, THIAZOLIDINEDIONE (PPARG AGONIST)

ACTOS (pioglitazone hcl) T3 HD AVANDIA T3 HD pioglitazone hcl (Actos) T1 HD


50


ANTIHYPERGLYCEMIC-GLUCOCORTICOID RECEPTOR BLOCKER


KORLYM T4 PA SP

ANTIHYPERGLYCEMIC-SGLT2 INHIBITOR-BIGUANIDE COMBS.

SEGLUROMET T2 ST QL (2 tabs/day) HD SYNJARDY T2 ST QL (2 tabs/day) HD SYNJARDY XR 10-1,000 MG TABLET T2 ST QL (2 tabs/day) HD

SYNJARDY XR 12.5-1,000 MG TAB T2 ST QL (2 tabs/day) HD

SYNJARDY XR 25-1,000 MG TABLET T2 ST QL (1 tab/day) HD

SYNJARDY XR 5-1,000 MG TABLET T2 ST QL (2 tabs/day) HD

XIGDUO XR 10 MG-1,000 MG TAB T2 ST QL (1 tab/day) HD

XIGDUO XR 10 MG-500 MG TABLET T2 ST QL (1 tab/day) HD

XIGDUO XR 2.5 MG-1,000 MG TAB T2 ST QL (2 tabs/day) HD

XIGDUO XR 5 MG-1,000 MG TABLET T2 ST QL (2 tabs/day) HD

XIGDUO XR 5 MG-500 MG TABLET T2 ST QL (1 tab/day) HD

INSULINS

BASAGLAR KWIKPEN U-100 T2 QL (1.5ml/day) HD HUMALOG T2 QL (1.5ml/day) HD HUMALOG JUNIOR KWIKPEN T2 QL (1.5ml/day) HD

HUMALOG KWIKPEN U-100 T2 QL (1.5ml/day) HD HUMALOG KWIKPEN U-200 T2 QL (1ml/day) HD HUMALOG MIX 50-50 T2 QL (2ml/day) HD HUMALOG MIX 50-50 KWIKPEN T2 QL (2ml/day) HD

HUMALOG MIX 75-25 T2 QL (2ml/day) HD HUMALOG MIX 75-25 KWIKPEN T2 QL (2ml/day) HD

HUMULIN R U-500 T2 QL (1 ml/day) HD HUMULIN R U-500 KWIKPEN T2 QL (1 ml/day) HD INSULIN LISPRO T2 QL (1.5ml/day) HD INSULIN LISPRO KWIKPEN U-100 T2 QL (1.5ml/day) HD

LEVEMIR T2 QL (1.5ml/day) HD LEVEMIR FLEXTOUCH T2 QL (1.5ml/day) HD TRESIBA T2 QL (1.5ml/day) HD TRESIBA FLEXTOUCH U-100 T2 QL (1.5ml/day) HD TRESIBA FLEXTOUCH U-200 T2 QL (0.9ml/day) HD


51

ANTIINFECTIVES/MISCELLANEOUS (Feminine Products)

VAGINAL ANTISEPTICS


acetic acid/oxyquinoline T1

ANTIINFECTIVES/MISCELLANEOUS (Infections)

2ND GEN. ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL

tinidazole T1

AMEBICIDES

paromomycin sulfate T1

ANTHELMINTICS

albendazole (Albenza) T1 ALBENZA (albendazole) T3 BILTRICIDE (praziquantel) T3 EGATEN T3 PA ivermectin (Stromectol) T1 mebendazole T1 praziquantel (Biltricide) T1 STROMECTOL (ivermectin) T3

ANTIMALARIAL DRUGS atovaquone/proguanil hcl (Malarone) T1

chloroquine phosphate T1 COARTEM T3 PA QL (24 tabs/30 days) DARAPRIM T4 PA SP hydroxychloroquine sulfate (Plaquenil) T1

KRINTAFEL T3 PA QL (2 tabs/30 days) MALARONE (atovaquone-proguanil hcl) T3 PA

mefloquine hcl T1 PLAQUENIL (hydroxychloroquine sulfate) T3 PA

primaquine phosphate T1 QUALAQUIN (quinine sulfate) T3 PA quinine sulfate (Qualaquin) T1

ANTIPROTOZOAL DRUGS, MISCELLANEOUS

atovaquone T1 benznidazole T1 IMPAVIDO T3 PA NEBUPENT (pentamidine isethionate) T3

PENTAM 300 (pentamidine isethionate) T3


52

ANTIINFECTIVES/MISCELLANEOUS (Infections)

ANTIPROTOZOAL DRUGS, MISCELLANEOUS


pentamidine isethionate (Nebupent) T1

pentamidine isethionate (Pentam 300) T1

ANTIINFECTIVES/MISCELLANEOUS (Miscellaneous)

ANTIBACTERIAL AGENTS, MISCELLANEOUS

AMINOACETIC ACID (glycine) T3 glycine urologic solution (Aminoacetic Acid) T1

ANTIINFLAM.TUMOR NECROSIS FACTOR INHIBITING AGENTS (Pain Relief And Inflammatory Disease)

ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITOR

CIMZIA 200 MG VIAL KIT T4 PA QL (1 kit/28 days) SP HD CIMZIA 2X200 MG/ML SYRINGE KIT T4 PA QL (1 kit/28 days) SP HD

CIMZIA 2X200 MG/ML(X3)START KT T4 PA QL (1 kit/year) SP HD

ENBREL 25 MG KIT T4 PA QL (8 vials/28 days) SP HD

ENBREL 25 MG/0.5 ML SYRINGE T4 PA QL (8 syringes/28 days)

SP HD

ENBREL 50 MG/ML SYRINGE T4 PA QL (4 syringes/28 days) SP HD

ENBREL MINI T4 PA QL (4 cartridges/28 days) SP HD

ENBREL SURECLICK T4 PA QL (4 syringes/28 days) SP HD

HUMIRA T4 PA QL (2 syrings/28 days) SP HD

HUMIRA PEN T4 PA QL (2 pens/28 days) SP HD

HUMIRA PEN CROHN'S-UC-HS T4 PA QL (1 kit/year) SP HD

HUMIRA PEN PSOR-UVEITS-ADOL HS T4 PA QL (1 kit/year) SP HD

HUMIRA(CF) T4 PA QL (2 syrings/28 days) SP HD

HUMIRA(CF) PEDIATRIC CROHN'S T4 PA QL (1 kit/year) SP HD

HUMIRA(CF) PEN 40 MG/0.4 ML T4 PA QL (2 pens/28 days) SP

HD HUMIRA(CF) PEN 80 MG/0.8 ML T4 PA QL (1 kit/year) SP HD

HUMIRA(CF) PEN CROHN'S-UC-HS T4 PA QL (1 kit/year) SP HD

HUMIRA(CF) PEN PSOR-UV-ADOL HS T4 PA QL (1 kit/year) SP HD

INFLECTRA T4 PA SP HD REMICADE T4 PA SP HD


53

ANTIINFLAM.TUMOR NECROSIS FACTOR INHIBITING AGENTS (Pain Relief And Inflammatory Disease)

ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITOR


RENFLEXIS T4 PA SP HD SIMPONI 100 MG/ML PEN INJECTOR T4 PA QL (1 injector/28 days) SP

HD SIMPONI 100 MG/ML SYRINGE T4 PA QL (1 syringe/28 days) SP

HD SIMPONI ARIA T4 PA SP HD

ANTINEOPLASTICS (Cancer)

ANP - SELECTIVE RETINOID X RECEPTOR AGONISTS (RXR)

bexarotene (Targretin) T4 PA SP HD CSL TARGRETIN 75 MG CAPSULE (bexarotene) T4 PA SP HD CSL

ANTIBIOTIC ANTINEOPLASTICS

adriamycin 10 mg vial T4 PA SP adriamycin 10 mg/5 ml vial T4 PA SP adriamycin 20 mg/10 ml vial T4 PA SP adriamycin 200 mg/100 ml vial T4 PA SP ADRIAMYCIN 50 MG VIAL T4 PA SP adriamycin 50 mg/25 ml vial T4 PA SP bleomycin sulfate T4 PA SP COSMEGEN (dactinomycin) T4 PA SP dactinomycin (Cosmegen) T4 PA SP daunorubicin hcl T4 PA SP DOXIL (doxorubicin hcl liposome) T4 PA SP

doxorubicin hcl T4 PA SP doxorubicin hcl peg-liposomal (Doxil) T4 PA SP

ELLENCE (epirubicin hcl) T4 PA SP epirubicin hcl (Ellence) T4 PA SP IDAMYCIN PFS (idarubicin hcl) T4 PA SP idarubicin hcl (Idamycin Pfs) T4 PA SP mitomycin (Mutamycin) T4 PA SP MUTAMYCIN (mitomycin) T4 PA SP valrubicin (Valstar) T4 SP VALSTAR (valrubicin) T4 SP ZANOSAR T4 PA SP

ANTI-CD20 (B LYMPHOCYTE) MONOCLONAL ANTIBODY

ARZERRA T4 PA SP GAZYVA T4 PA SP RITUXAN T4 PA SP RITUXAN HYCELA T4 PA SP


54


ANTI-CD20 (B LYMPHOCYTE) MONOCLONAL ANTIBODY


RUXIENCE T4 PA SP TRUXIMA T4 PA SP

ANTINEOPLAST HUM VEGF INHIBITOR RECOMB MC ANTIBODY

AVASTIN T4 PA SP MVASI T4 PA SP ZIRABEV T4 PA SP

ANTINEOPLAST, HISTONE DEACETYLASE (HDAC) INHIBITORS

BELEODAQ T4 PA SP FARYDAK T4 PA SP HD CSL ISTODAX (romidepsin) T4 PA SP romidepsin (Istodax) T4 PA SP ZOLINZA T4 PA SP HD CSL

ANTINEOPLASTIC - ALKYLATING AGENTS ALKERAN 2 MG TABLET (melphalan) T4 SP CSL

ALKERAN 50 MG VIAL (melphalan hcl) T4 PA SP

BELRAPZO (bendamustine hcl) T4 PA SP HD

bendamustine hcl (Bendeka) T4 PA SP HD BENDEKA (bendamustine hcl) T4 PA SP HD BICNU (carmustine) T4 SP busulfan (Busulfex) T4 SP BUSULFEX (busulfan) T4 SP carboplatin T4 PA SP carmustine (Bicnu) T4 SP cisplatin 100 mg/100 ml vial T4 PA SP cisplatin 200 mg/200 ml vial T4 PA SP cisplatin 50 mg vial T1 cisplatin 50 mg/50 ml vial T4 PA SP cyclophosphamide 1 gm vial T4 SP cyclophosphamide 2 gm vial T4 SP cyclophosphamide 25 mg capsule T4 SP HD CSL

cyclophosphamide 50 mg capsule T4 SP HD CSL

cyclophosphamide 500 mg vial T4 SP EVOMELA T4 PA SP GLEOSTINE T2 CSL GLIADEL T4 SP CSL HYDREA (hydroxyurea) T3 CSL


55


ANTINEOPLASTIC - ALKYLATING AGENTS


hydroxyurea (Hydrea) T1 CSL IFEX T4 PA SP IFEX (ifosfamide) T4 PA SP ifosfamide T4 PA SP ifosfamide (Ifex) T4 PA SP LEUKERAN T2 CSL melphalan (Alkeran) T4 SP CSL melphalan hcl (Alkeran) T4 PA SP MYLERAN T2 CSL oxaliplatin T4 PA SP TEMODAR 100 MG CAPSULE (temozolomide) T4 PA SP HD CSL

TEMODAR 100 MG VIAL T4 PA SP TEMODAR 140 MG CAPSULE (temozolomide) T4 PA SP HD CSL

TEMODAR 180 MG CAPSULE (temozolomide) T4 PA SP HD CSL




temozolomide (Temodar) T4 PA SP HD CSL TEPADINA T4 PA SP TEPADINA (thiotepa) T4 PA SP thiotepa (Tepadina) T4 PA SP TREANDA T4 PA SP YONDELIS T4 PA SP HD

ANTINEOPLASTIC - ANTIANDROGENIC AGENTS

abiraterone acetate T4 PA SP HD CSL bicalutamide (Casodex) T1 CSL CASODEX (bicalutamide) T3 CSL ERLEADA T4 PA SP HD CSL flutamide T1 CSL nilutamide T1 QL (4 tabs/day) CSL NUBEQA T4 PA SP HD CSL XTANDI T4 PA SP HD CSL

ANTINEOPLASTIC - ANTIBIOTIC AND ANTIMETABOLITE

VYXEOS T4 PA SP

ANTINEOPLASTIC - ANTI-CD38 MONOCLONAL ANTIBODY

DARZALEX T4 PA SP HD


56


ANTINEOPLASTIC - ANTIMETABOLITES


ALIMTA T4 PA SP ARRANON T4 PA SP azacitidine (Vidaza) T4 PA SP capecitabine (Xeloda) T4 PA SP HD CSL cladribine T4 PA SP clofarabine (Clolar) T4 PA SP CLOLAR (clofarabine) T4 PA SP cytarabine T4 PA SP cytarabine/pf T4 PA SP DACOGEN (decitabine) T4 PA SP decitabine (Dacogen) T4 PA SP floxuridine T4 PA SP fludarabine phosphate T4 PA SP fluorouracil T4 PA SP fluorouracil 1,000 mg/20 ml vl T4 PA SP fluorouracil 2,500 mg/50 ml vl T4 PA SP fluorouracil 2.5 gm/50 ml btl T4 PA SP fluorouracil 2.5 gm/50 ml vial T4 PA SP fluorouracil 5 gm/100 ml btl T4 PA SP fluorouracil 5 gm/100 ml vial T4 PA SP fluorouracil 5,000 mg/100 ml T4 PA SP fluorouracil 500 mg/10 ml vial T4 PA SP FOLOTYN 20 MG/ML VIAL T4 PA SP FOLOTYN 40 MG/2 ML VIAL T4 PA SP gemcitabine hcl T4 PA SP INFUGEM T4 PA SP HD LONSURF T4 PA SP HD CSL mercaptopurine T1 CSL methotrexate 1 gm vial T1 methotrexate 2.5 mg tablet T1 CSL methotrexate 250 mg/10 ml vial T1

methotrexate 50 mg/2 ml vial T1 methotrexate sodium/pf T1 NIPENT T4 PA SP PURIXAN T4 SP CSL TABLOID T3 CSL TREXALL T2 CSL VIDAZA (azacitidine) T4 PA SP XATMEP T3 CSL XELODA (capecitabine) T4 PA SP HD CSL


57


ANTINEOPLASTIC - ANTI-SLAMF7 MONOCLONAL ANTIBODY


EMPLICITI T4 PA SP HD

ANTINEOPLASTIC - AROMATASE INHIBITORS

anastrozole (Arimidex) T1 HD CSL ARIMIDEX (anastrozole) T3 HD CSL AROMASIN (exemestane) T3 HD CSL exemestane (Aromasin) T1 HD CSL FEMARA (letrozole) T3 HD CSL letrozole (Femara) T1 HD CSL

ANTINEOPLASTIC - BRAF KINASE INHIBITORS

BRAFTOVI T4 PA SP CSL TAFINLAR T4 PA SP HD CSL ZELBORAF T4 PA SP HD CSL

ANTINEOPLASTIC - EPOTHILONES AND ANALOGS

IXEMPRA T4 PA SP

ANTINEOPLASTIC - HALICHONDRIN B ANALOGS

HALAVEN T4 PA SP

ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITOR

DAURISMO T4 PA SP HD CSL ERIVEDGE T4 PA SP HD CSL ODOMZO T4 PA SP HD CSL

ANTINEOPLASTIC - IMMUNOTHERAPY, VIRUS-BASED AGENTS

IMLYGIC T4 PA SP

ANTINEOPLASTIC - JANUS KINASE (JAK) INHIBITORS

JAKAFI T4 PA SP HD CSL

ANTINEOPLASTIC - MEK1 AND MEK2 KINASE INHIBITORS

COTELLIC T4 PA SP HD CSL MEKINIST T4 PA SP HD CSL MEKTOVI T4 PA SP CSL

ANTINEOPLASTIC - MTOR KINASE INHIBITORS

AFINITOR T4 PA SP HD CSL AFINITOR (everolimus) T4 PA SP HD CSL AFINITOR DISPERZ T4 PA SP CSL everolimus (Afinitor) T4 PA SP HD CSL temsirolimus (Torisel) T4 PA SP TORISEL (temsirolimus) T4 PA SP


58


ANTINEOPLASTIC - TOPOISOMERASE I INHIBITORS


CAMPTOSAR T4 PA SP CAMPTOSAR (irinotecan hcl) T4 PA SP HYCAMTIN 0.25 MG CAPSULE T4 PA SP HD CSL

HYCAMTIN 1 MG CAPSULE T4 PA SP HD CSL HYCAMTIN 4 MG VIAL (topotecan hcl) T4 PA SP HD

irinotecan hcl 100 mg/5 ml vl (Camptosar) T4 PA SP

irinotecan hcl 300 mg/15 ml vl (Camptosar) T4 SP

irinotecan hcl 40 mg/2 ml vial (Camptosar) T4 PA SP

irinotecan hcl 500 mg/25 ml vl T4 PA SP ONIVYDE T4 PA SP topotecan hcl T4 PA SP HD topotecan hcl (Hycamtin) T4 PA SP HD

ANTINEOPLASTIC - VEGF-A,B AND PLGF INHIBITORS

ZALTRAP T4 PA SP

ANTINEOPLASTIC - VEGFR ANTAGONIST

CYRAMZA T4 PA SP

ANTINEOPLASTIC - VINCA ALKALOIDS

MARQIBO T4 PA SP NAVELBINE (vinorelbine tartrate) T4 PA SP

vinblastine sulfate T4 PA SP vincristine sulfate T4 PA SP vinorelbine tartrate (Navelbine) T4 PA SP

ANTINEOPLASTIC- CD22 ANTIBODY-CYTOTOXIC ANTIBIOTIC

BESPONSA T4 PA SP

ANTINEOPLASTIC COMB - KINASE AND AROMATASE INHIBIT

KISQALI FEMARA CO-PACK T4 PA SP HD CSL

ANTINEOPLASTIC EGF RECEPTOR BLOCKER MCLON ANTIBODY ERBITUX T4 PA SP HERCEPTIN T4 PA SP HERCEPTIN HYLECTA T4 PA SP KANJINTI T4 PA SP OGIVRI T4 PA SP PERJETA T4 PA SP PORTRAZZA T4 PA SP TRAZIMERA T3 VECTIBIX T4 PA SP


59


ANTINEOPLASTIC IMMUNOMODULATOR AGENTS


POMALYST T4 PA SP HD CSL REVLIMID T4 PA SP HD CSL SYLATRON T4 PA SP HD

ANTINEOPLASTIC LHRH (GNRH) AGONIST, PITUITARY SUPPR.

ELIGARD T4 SP HD leuprolide acetate T4 PA SP HD LUPRON DEPOT T4 PA SP HD TRELSTAR T4 SP HD ZOLADEX T4 PA SP HD

ANTINEOPLASTIC LHRH (GNRH) ANTAGONIST, PITUIT.SUPPRS

FIRMAGON T4 PA SP HD

ANTINEOPLASTIC SYSTEMIC ENZYME INHIBITORS

ALECENSA T4 PA SP HD CSL ALIQOPA T4 PA SP ALUNBRIG T4 PA SP HD CSL BALVERSA T4 PA SP CSL bortezomib T4 PA SP BOSULIF T4 PA SP HD CSL BRUKINSA T4 PA QL (4 caps/day) SP CSL CABOMETYX T4 PA SP HD CSL CALQUENCE T4 PA SP CSL CAPRELSA T4 PA SP CSL COMETRIQ T4 PA SP HD CSL COPIKTRA T4 PA SP CSL erlotinib hcl T4 PA SP HD CSL GILOTRIF T4 PA SP HD CSL GLEEVEC (imatinib mesylate) T4 PA SP HD CSL IBRANCE T4 PA SP HD CSL ICLUSIG T4 PA SP CSL imatinib mesylate (Gleevec) T4 PA SP HD CSL IMBRUVICA T4 PA SP CSL INLYTA T4 PA SP HD CSL INREBIC T4 PA SP HD CSL IRESSA T4 PA SP HD CSL KISQALI T4 PA SP HD CSL KYPROLIS 10 MG VIAL T4 PA SP KYPROLIS 30 MG VIAL T4 PA SP HD KYPROLIS 60 MG VIAL T4 PA SP LENVIMA T4 PA SP HD CSL


60


ANTINEOPLASTIC SYSTEMIC ENZYME INHIBITORS


LORBRENA T4 PA SP HD CSL LYNPARZA T4 PA SP HD CSL NERLYNX T4 PA SP HD CSL NEXAVAR T4 PA SP HD CSL NINLARO T4 PA SP HD CSL PIQRAY T4 PA SP HD CSL ROZLYTREK T4 PA SP HD CSL RUBRACA T4 PA SP CSL RYDAPT T4 PA SP HD CSL SPRYCEL T4 PA SP HD CSL STIVARGA T4 PA SP HD CSL SUTENT T4 PA SP HD CSL TAGRISSO T4 PA SP HD CSL TALZENNA T4 PA SP HD CSL TASIGNA T4 PA SP HD CSL TURALIO T4 PA SP CSL TYKERB T4 PA SP HD CSL VELCADE T4 PA SP VERZENIO T4 PA SP HD CSL VITRAKVI T4 PA SP HD CSL VIZIMPRO T4 PA SP HD CSL VOTRIENT T4 PA SP HD CSL XALKORI T4 PA SP HD CSL XOSPATA T4 PA SP CSL ZEJULA T4 PA SP CSL ZYDELIG T4 PA SP HD CSL ZYKADIA T4 PA SP HD CSL

ANTINEOPLASTIC, ANTI-PROGRAMMED DEATH-1 (PD-1) MAB

KEYTRUDA T4 PA SP LIBTAYO T4 PA SP OPDIVO T4 PA SP HD

ANTINEOPLASTIC-B CELL LYMPHOMA-2 (BCL-2) INHIBITORS

VENCLEXTA T4 PA SP CSL VENCLEXTA STARTING PACK T4 PA SP CSL

ANTINEOPLASTIC-CD22 DIRECT ANTIBODY/CYTOTOXIN CONJ

LUMOXITI T4 PA SP

ANTINEOPLASTIC-INTERLEUKIN-6 (IL-6) INHIB, ANTIBODY

SYLVANT T4 PA SP


61


ANTINEOPLASTIC-ISOCITRATE DEHYDROGENASE INHIBITORS


IDHIFA T4 PA SP HD CSL TIBSOVO T4 PA SP CSL

ANTINEOPLASTICS ANTIBODY/ANTIBODY-DRUG COMPLEXES

ADCETRIS T4 PA SP BLINCYTO T4 PA SP CAMPATH T4 SP ENHERTU T4 PA SP HD KADCYLA T4 PA SP PADCEV T4 PA SP POLIVY T4 PA SP POTELIGEO T4 PA SP UNITUXIN T4 PA SP ZEVALIN T4 PA SP

ANTINEOPLASTICS, MISCELLANEOUS

ABRAXANE T4 PA SP arsenic trioxide T4 PA SP arsenic trioxide (Trisenox) T4 PA SP ASPARLAS T4 PA SP bcg live T4 SP dacarbazine T4 PA SP docetaxel 160 mg/16 ml vial T4 PA SP docetaxel 160 mg/8 ml vial T4 PA SP HD docetaxel 20 mg/2 ml vial T4 PA SP docetaxel 20 mg/ml vial (Taxotere) T4 PA SP

docetaxel 200 mg/10 ml vial T4 PA SP docetaxel 80 mg/4 ml vial (Taxotere) T4 PA SP

docetaxel 80 mg/8 ml vial T4 PA SP ERWINAZE T4 PA SP ETOPOPHOS T4 PA SP etoposide T4 PA SP etoposide 1,000 mg/50 ml vial T4 PA SP etoposide 100 mg/5 ml vial T4 PA SP etoposide 50 mg capsule T4 SP HD CSL etoposide 500 mg/25 ml vial T4 PA SP JEVTANA T4 PA SP HD LYSODREN T2 CSL MATULANE T4 SP CSL mitoxantrone hcl T4 PA SP


62


ANTINEOPLASTICS, MISCELLANEOUS


ONCASPAR T4 PA SP paclitaxel T4 PA SP SYNRIBO T4 PA SP TAXOTERE (docetaxel) T4 PA SP teniposide T4 PA SP tretinoin 10 mg capsule T1 PA CSL TRISENOX (arsenic trioxide) T4 PA SP

ANTINEOPLASTIC-SELECT INHIB OF NUCLEAR EXP (SINE)

XPOVIO T4 PA SP CSL

ANTI-PROGRAMMED CELL DEATH-LIGAND 1 (PD-L1) MAB

BAVENCIO T4 PA SP IMFINZI T4 PA SP TECENTRIQ T4 PA SP HD

CYTOTOXIC T-LYMPHOCYTE ANTIGEN (CTLA-4) RMC ANTIBODY

YERVOY T4 PA SP

IMMUNOMODULATORS

ACTIMMUNE T4 PA SP HD ALFERON N T4 PA SP HD INTRON A T4 PA SP HD PROLEUKIN T4 PA SP

PHOTOACTIVATED, ANTINEOPLASTIC AGENTS (SYSTEMIC)

PHOTOFRIN T4 SP

RADIOACTIVE THERAPEUTIC AGENTS

AZEDRA DOSIMETRIC T4 PA SP AZEDRA THERAPEUTIC T4 PA SP

SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS) FARESTON (toremifene citrate) T3 QL (2 tabs/day) HD CSL

FASLODEX (fulvestrant) T4 PA SP HD fulvestrant (Faslodex) T4 PA SP HD SOLTAMOX T2 HD CSL tamoxifen citrate T1 HD PPACA CSL toremifene citrate (Fareston) T1 QL (2 tabs/day) HD CSL

STEROID ANTINEOPLASTICS

EMCYT T4 SP HD CSL megestrol 20 mg tablet T1 CSL megestrol 40 mg tablet T1 CSL


63

ANTINEOPLASTICS (Skin Conditions)

PHOTOACT, TOPICAL ANTINEOPLAST, PREMALIGNANT LESIONS


LEVULAN T4 SP

TOPICAL ANTINEOPLASTIC PREMALIGNANT LESION AGENTS

EFUDEX (fluorouracil) T3 FLUOROPLEX T2 fluorouracil 0.5% cream T1 fluorouracil 2% topical soln T1 fluorouracil 5% cream (Efudex) T1 fluorouracil 5% topical soln T1 PANRETIN T4 SP HD PICATO T3 TARGRETIN 1% GEL T4 SP HD TOLAK T3 VALCHLOR T4 SP HD

ANTIPARASITICS (Infections)

ANTIPARASITICS

ALINIA T3

TOPICAL ANTIPARASITICS

crotamiton T1 ELIMITE (permethrin) T3 lindane T1 malathion (Ovide) T1 NATROBA (spinosad) T3 OVIDE (malathion) T3 permethrin (Elimite) T1 SKLICE T3 spinosad (Natroba) T1 ULESFIA T3

ANTIPARKINSON DRUGS (Parkinson's Disease)

ANTIPARKINSONISM DRUGS, ANTICHOLINERGIC

benztropine mesylate T1 HD benztropine mesylate (Cogentin) T1 HD

COGENTIN (benztropine mesylate) T3 HD

trihexyphenidyl hcl T1 HD

ANTIPARKINSONISM DRUGS, OTHER

amantadine hcl T1 HD APOKYN T4 PA SP HD


64




AZILECT 0.5 MG TABLET (rasagiline mesylate) T3 QL (1 tab/day) HD

AZILECT 1 MG TABLET (rasagiline mesylate) T3 HD

bromocriptine mesylate (Parlodel) T1 HD

carbidopa/levodopa T1 HD carbidopa/levodopa (Sinemet 10-100) T1 HD

carbidopa/levodopa (Sinemet 25-100) T1 HD

carbidopa/levodopa (Sinemet 25-250) T1 HD

carbidopa/levodopa (Sinemet CR) T1 HD

carbidopa/levodopa/entacapone (Stalevo 100) T1 HD






COMTAN (entacapone) T3 HD entacapone (Comtan) T1 HD INBRIJA T4 PA SP HD MIRAPEX (pramipexole dihydrochloride) T3 HD

MIRAPEX ER 0.375 MG TABLET (pramipexole er) T3 QL (1 tab/day) HD

MIRAPEX ER 0.75 MG TABLET (pramipexole er) T3 HD



MIRAPEX ER 3 MG TABLET (pramipexole er) T3 HD



NEUPRO T3 HD NOURIANZ T4 PA QL (1 tab/day) SP HD OSMOLEX ER T3 QL (1 tab/day) HD PARLODEL (bromocriptine mesylate) T3 HD


65




pramipexole di-hcl (Mirapex) T1 HD pramipexole er 0.375 mg tablet (Mirapex ER) T1 QL (1 tab/day) HD

pramipexole er 0.75 mg tablet (Mirapex ER) T1 HD

pramipexole er 1.5 mg tablet (Mirapex ER) T1 QL (1 tab/day) HD

pramipexole er 2.25 mg tablet (Mirapex ER) T1 QL (1 tab/day) HD

pramipexole er 3 mg tablet (Mirapex ER) T1 HD



rasagiline mesylate 0.5 mg tab (Azilect) T1 QL (1 tab/day) HD

rasagiline mesylate 1 mg tab (Azilect) T1 HD

ropinirole hcl T1 HD RYTARY T3 HD selegiline hcl T1 HD SINEMET 10-100 (carbidopa-levodopa) T3 HD

SINEMET 25-100 (carbidopa-levodopa) T3 HD

SINEMET 25-250 (carbidopa-levodopa) T3 HD

SINEMET CR (carbidopa-levodopa er) T3 HD

STALEVO 100 (carbidopa-levodopa-entacapone) T3 HD






TASMAR (tolcapone) T3 HD tolcapone (Tasmar) T1 HD XADAGO T3 ST HD

DECARBOXYLASE INHIBITORS

carbidopa T1


66

ANTIPLATELET DRUGS (Blood Thinners/Anti-Clotting)

PLATELET AGGREGATION INHIBITORS


AGGRASTAT T3 HD AGGRENOX (aspirin-dipyridamole er) T3 HD

aspirin/dipyridamole (Aggrenox) T1 HD

aspirin/omeprazole T1 HD BRILINTA T2 HD cilostazol T1 HD clopidogrel bisulfate T1 HD clopidogrel bisulfate (Plavix) T1 HD dipyridamole 25 mg tablet T1 HD dipyridamole 50 mg tablet T1 HD dipyridamole 75 mg tablet T1 HD DURLAZA T3 HD EFFIENT (prasugrel hcl) T3 HD eptifibatide T1 HD eptifibatide (Integrilin) T1 HD INTEGRILIN (eptifibatide) T3 HD PLAVIX (clopidogrel) T3 HD prasugrel hcl (Effient) T1 HD ZONTIVITY T3 HD

PLATELET REDUCING AGENTS

AGRYLIN (anagrelide hcl) T3 anagrelide hcl T1 anagrelide hcl (Agrylin) T1

ANTIVIRALS (AIDS/HIV)

ANTIRETROVIRAL - ANTI-CD4 DOMAIN 2 MONOCLONAL AB

TROGARZO T4 PA SP HD

ANTIRETROVIRAL-INTEGRASE INHIBITOR AND NNRTI COMB.

JULUCA T4 PA SP

ANTIRETROVIRAL-INTEGRASE INHIBITOR AND NRTI COMB.

DOVATO T4 SP

ANTIRETROVIRAL-NRTIS AND INTEGRASE INHIBITORS COMB

TRIUMEQ T4 SP

ANTIRETROVIRAL-NUCLEOSIDE, NUCLEOTIDE, PROTEASE INH.

SYMTUZA T4 SP

ANTIVIRALS, HIV-SPEC, NON-PEPTIDIC PROTEASE INHIB

APTIVUS T4 PA SP


67


ANTIVIRALS, HIV-SPEC, NON-PEPTIDIC PROTEASE INHIB


PREZCOBIX T4 PA SP PREZISTA T4 SP

ANTIVIRALS, HIV-SPEC, NUCLEOSIDE-NUCLEOTIDE ANALOG

CIMDUO T4 PA SP DESCOVY T4 PA SP TEMIXYS T4 PA SP TRUVADA T4 SP

ANTIVIRALS, HIV-SPEC., NUCLEOSIDE ANALOG, RTI COMB

abacavir sulfate/lamivudine T4 PA SP abacavir/lamivudine/zidovudine T4 PA SP lamivudine/zidovudine T4 SP

ANTIVIRALS, HIV-SPECIFIC, CCR5 CO-RECEPTOR ANTAG.

SELZENTRY T4 PA SP

ANTIVIRALS, HIV-SPECIFIC, FUSION INHIBITORS

FUZEON T4 PA SP HD

ANTIVIRALS, HIV-SPECIFIC, NON-NUCLEOSIDE, RTI

EDURANT T4 PA SP efavirenz T4 PA SP INTELENCE T4 PA SP nevirapine T4 PA SP PIFELTRO T4 PA SP

ANTIVIRALS, HIV-SPECIFIC, NUCLEOSIDE ANALOG, RTI

abacavir sulfate T4 PA SP EMTRIVA T4 PA SP lamivudine 10 mg/ml oral soln T4 SP lamivudine 150 mg tablet T4 SP lamivudine 300 mg tablet T4 PA SP RETROVIR T4 PA SP zidovudine T4 SP tenofovir disoproxil fumarate T4 PA SP VIREAD T4 PA SP

ANTIVIRALS, HIV-SPECIFIC, PROTEASE INHIBITOR COMB

KALETRA T4 PA SP lopinavir/ritonavir T4 PA SP

ANTIVIRALS, HIV-SPECIFIC, PROTEASE INHIBITORS

atazanavir sulfate T4 PA SP EVOTAZ T4 PA SP


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ANTIVIRALS, HIV-SPECIFIC, PROTEASE INHIBITORS


fosamprenavir calcium T4 PA SP INVIRASE T4 PA SP LEXIVA T4 PA SP NORVIR T4 SP REYATAZ T4 PA SP ritonavir T4 SP

ANTIVIRALS, HIV-1 INTEGRASE STRAND TRANSFER INHIBTR

ISENTRESS T4 SP ISENTRESS HD T4 PA SP TIVICAY T4 SP

ARTV NUCLEOSIDE, NUCLEOTIDE, NON-NUCLEOSIDE RTI COMB

ATRIPLA T4 PA SP COMPLERA T4 PA SP DELSTRIGO T4 PA SP ODEFSEY T4 PA SP SYMFI T4 SP SYMFI LO T4 SP

ARV-NUCLEOSIDE, NUCLEOTIDE RTI, INTEGRASE INHIBITORS

BIKTARVY T4 SP GENVOYA T4 SP STRIBILD T4 PA SP

ANTIVIRALS (Eye Conditions)

EYE ANTIVIRALS

trifluridine T1 ZIRGAN T3

ANTIVIRALS (Infections)

ANTIVIRAL MONOCLONAL ANTIBODIES

SYNAGIS T4 PA SP HD

ANTIVIRALS, GENERAL

acyclovir T1 acyclovir sodium T1 cidofovir T4 SP CYTOVENE (ganciclovir sodium) T4 SP

famciclovir T1 FOSCAVIR T3 ganciclovir T4 SP


69


ANTIVIRALS, GENERAL


ganciclovir sodium T4 SP ganciclovir sodium (Cytovene) T4 SP oseltamivir 6 mg/ml suspension (Tamiflu) T1 QL (180ml/30 days)

oseltamivir phos 30 mg capsule (Tamiflu) T1 QL (20/30 days)



PREVYMIS 240 MG TABLET T4 SP HD PREVYMIS 240 MG/12 ML VIAL T4 SP

PREVYMIS 480 MG TABLET T4 SP HD PREVYMIS 480 MG/24 ML VIAL T4 SP

RAPIVAB T3 RELENZA T3 QL (20/30 days) rimantadine hcl T1 TAMIFLU 30 MG CAPSULE (oseltamivir phosphate) T3 QL (20/30 days)

TAMIFLU 45 MG CAPSULE (oseltamivir phosphate) T3 QL (10/30 days)

TAMIFLU 6 MG/ML SUSPENSION (oseltamivir phosphate)

T3 QL (180ml/30 days)

TAMIFLU 75 MG CAPSULE (oseltamivir phosphate) T3 QL (10/30 days)

valacyclovir hcl (Valtrex) T1 valganciclovir hcl T1 VALTREX (valacyclovir) T3 XOFLUZA T3 QL (2 tabs/30 days)

HEP C - NS5A, NS3/4A, NON-NUCLEO.NS5B INHIB COMB.

VIEKIRA PAK T4 PA SP HD

HEP C - NS5A, NS3/4A, NUCLEOTIDE NS5B INHIB COMBO

VOSEVI T4 PA SP HD

HEP C VIRUS, NUCLEOTIDE ANALOG NS5B POLYMERASE INH

SOVALDI 200 MG TABLET T4 PA QL (1 tab/day) SP HD SOVALDI 400 MG TABLET T4 PA SP HD

HEP C VIRUS-NS5B POLYMERASE AND NS5A INHIB. COMBO.

LEDIPASVIR-SOFOSBUVIR T4 PA SP HD SOFOSBUVIR-VELPATASVIR T4 PA SP HD


70


HEPATITIS B TREATMENT AGENTS


adefovir dipivoxil (Hepsera) T4 SP HD BARACLUDE 0.05 MG/ML SOLUTION T4 SP HD

BARACLUDE 0.5 MG TABLET (entecavir) T4 QL (1 tab/day) SP HD

BARACLUDE 1 MG TABLET (entecavir) T4 SP HD

entecavir 0.5 mg tablet (Baraclude) T4 QL (1 tab/day) SP HD

entecavir 1 mg tablet (Baraclude) T4 SP HD

EPIVIR HBV 100 MG TABLET (lamivudine hbv) T4 SP

EPIVIR HBV 25 MG/5 ML SOLN T4 SP

HEPSERA (adefovir dipivoxil) T4 SP HD lamivudine (Epivir HBV) T4 SP VEMLIDY T4 SP HD

HEPATITIS C TREATMENT AGENTS

PEGASYS T4 PA SP HD PEGINTRON T4 PA SP HD ribavirin T4 SP HD

HEPATITIS C VIRUS- NS5A AND NS3/4A INHIBITOR COMB

MAVYRET T4 PA SP HD ZEPATIER T4 PA SP HD

ANTIVIRALS (Skin Conditions)

TOPICAL GENITAL WART-HPV TREATMENT AGENTS

VEREGEN T3

AUTONOMIC DRUGS (Allergy/Nasal Sprays)

ANAPHYLAXIS THERAPY AGENTS

epinephrine (Episnap) T1 epinephrine 0.15 mg auto-injct T1 QL (2 packs/30 days) epinephrine 0.3 mg auto-inject T1 QL (2 packs/30 days) EPINEPHRINESNAP-EMS (adyphren amp) T3

EPINEPHRINESNAP-V (adyphren amp) T3

EPISNAP (adyphren amp) T3

AUTONOMIC DRUGS (Alzheimer's Disease)

CHOLINESTERASE INHIBITORS

ARICEPT (donepezil hcl) T3 HD


71

AUTONOMIC DRUGS (Alzheimer's Disease)

CHOLINESTERASE INHIBITORS


BLOXIVERZ (neostigmine methylsulfate) T3 HD

donepezil hcl T1 HD donepezil hcl (Aricept) T1 HD EXELON (rivastigmine) T3 HD galantamine er 16 mg capsule (Razadyne ER) T1 HD

galantamine er 24 mg capsule (Razadyne ER) T1 HD

galantamine er 8 mg capsule (Razadyne ER) T1 QL (1 cap/day) HD

galantamine hbr T1 HD galantamine hbr (Razadyne) T1 HD MESTINON (pyridostigmine bromide er) T3 HD

MESTINON (pyridostigmine bromide) T3 HD

neostigmine methylsulfate T1 HD neostigmine methylsulfate (Bloxiverz) T1 HD

physostigmine salicylate T1 HD pyridostigmine bromide (Mestinon) T1 HD

RAZADYNE (galantamine hbr) T3 HD RAZADYNE ER 16 MG CAPSULE (galantamine er) T3 HD

RAZADYNE ER 24 MG CAPSULE (galantamine er) T3 HD

RAZADYNE ER 8 MG CAPSULE (galantamine er) T3 QL (1 cap/day) HD

REGONOL T3 HD rivastigmine (Exelon) T1 HD rivastigmine tartrate T1 HD

AUTONOMIC DRUGS (Attention Deficit Hyperactivity Disorder)

ADRENERGICS, AROMATIC, NON-CATECHOLAMINE ADDERALL (dextroamphetamine-amphetamine)

T3 AGE ST

amphetamine T1 QL (15ml/day) amphetamine sulfate (Evekeo) T1 AGE dextroamp-amphet er 10 mg cap T1 AGE QL (1 cap/day)

dextroamp-amphet er 15 mg cap T1 AGE QL (1 cap/day)

dextroamp-amphet er 20 mg cap T1 AGE QL (1 per day)


72

AUTONOMIC DRUGS (Attention Deficit Hyperactivity Disorder)

ADRENERGICS, AROMATIC, NON-CATECHOLAMINE




dextroamp-amphet er 5 mg cap T1 AGE QL (1 cap/day)

dextroamphetamine er 10 mg cap T1 AGE QL (1 cap/day)

dextroamphetamine er 15 mg cap T1 AGE QL (3/day)

dextroamphetamine er 5 mg cap T1 AGE QL (1 cap/day)

dextroamphetamine sulfate T1 AGE dextroamphetamine sulfate (Zenzedi) T1 AGE

dextroamphetamine/amphetamine (Adderall) T1 AGE

EVEKEO (amphetamine sulfate) T3 AGE ST

methamphetamine hcl T1 AGE ZENZEDI T3 AGE ST ZENZEDI (dextroamphetamine sulfate) T3 AGE ST

AUTONOMIC DRUGS (Blood Pressure/Heart Medications)

ADRENERGIC VASOPRESSOR AGENTS

midodrine hcl T1 NORTHERA T4 PA SP HD

ALPHA-ADRENERGIC BLOCKING AGENTS DIBENZYLINE (phenoxybenzamine hcl) T3 HD

phenoxybenzamine hcl (Dibenzyline) T1 HD

phentolamine mesylate T1 HD

AUTONOMIC DRUGS (Miscellaneous)

ADRENERGIC AGENTS, CATECHOLAMINES

ADRENALIN T3 dopamine hcl T1 dopamine hcl in dextrose 5 % T1 epinephrine 0.1 mg/ml syringe T1 epinephrine 1 mg/10 ml abbojct T1

epinephrine 1 mg/ml ampul T1 epinephrine hcl in 0.9 % nacl T1 epinephrine hcl in dextrose 5% T1


73

AUTONOMIC DRUGS (Miscellaneous)

ADRENERGIC AGENTS, CATECHOLAMINES


isoproterenol hcl T1 isoproterenol hcl (Isuprel) T1 ISUPREL (isoproterenol hcl) T3 LEVOPHED (norepinephrine bitartrate) T3

norepinephrine bit/0.9 % nacl T1 norepinephrine bitartrate T1 norepinephrine bitartrate (Levophed) T1

norepinephrine bitartrate/d5w T1

NEUROMUSCULAR BLOCKING AGENTS ANECTINE (succinylcholine chloride) T3

atracurium besylate T1 BOTOX 100 UNIT VIAL T4 PA SP BOTOX 200 UNIT VIAL T4 PA SP HD cisatracurium besylate (Nimbex) T1 DYSPORT T4 PA SP HD MYOBLOC T4 PA SP NIMBEX (cisatracurium besylate) T3

pancuronium bromide T1 QUELICIN (succinylcholine chloride) T3

rocuronium bromide T1 succinylcholine chloride T1 succinylcholine chloride (Quelicin) T1

succinylcholine/sod clr, iso/pf T1 vecuronium bromide T1 vecuronium bromide/water T1 XEOMIN T4 PA SP HD

AUTONOMIC DRUGS (Urinary Tract Conditions)

PARASYMPATHETIC AGENTS

bethanechol chloride T1 HD bethanechol chloride (Urecholine) T1 HD

cevimeline hcl (Evoxac) T1 HD EVOXAC (cevimeline hcl) T3 HD guanidine hcl T1 HD pilocarpine hcl (Salagen) T1 HD SALAGEN (pilocarpine hcl) T3 HD URECHOLINE (bethanechol chloride) T3 HD


74

BIOLOGICALS (Allergy/Nasal Sprays)

ALLERGENIC EXTRACTS, THERAPEUTIC


GRASTEK T3 PA QL (1 tab/day) ODACTRA T3 PA QL (1 tab/day) ORALAIR T3 PA QL (1 tab/day) RAGWITEK T3 PA QL (1 tab/day)

BIOLOGICALS (Blood Pressure/Heart Medications)

PLASMA KALLIKREIN INHIBITORS

TAKHZYRO T4 PA SP HD

BIOLOGICALS (Miscellaneous)

ANTISERA

HYPERRHO S-D T4 SP MICRHOGAM ULTRA-FILTERED PLUS T4 SP

RHOGAM ULTRA-FILTERED PLUS T4 SP

RHOPHYLAC T4 SP WINRHO SDF T4 SP HD

PKU TREATMENT AGENTS - PHENYLALANINE AMMONIA LYASE

PALYNZIQ T4 PA SP HD

BLOOD (Blood Modifiers/Bleeding Disorders)

AGENTS TO TX THROMBOTIC THROMBOCYTOPENIC PURPURA

CABLIVI T4 PA SP

ANTIFIBRINOLYTIC AGENTS

AMICAR (aminocaproic acid) T4 SP HD aminocaproic acid T4 SP HD aminocaproic acid (Amicar) T4 SP HD CYKLOKAPRON (tranexamic acid) T4 SP

FIBRYGA T4 PA SP LYSTEDA (tranexamic acid) T4 SP RIASTAP T4 PA SP tranexamic acid (Cyklokapron) T4 SP tranexamic acid (Lysteda) T4 SP TRANEXAMIC ACID-NACL T4 SP

BLOOD FACTORS, MISCELLANEOUS

VONVENDI T4 SP HD

COAGULANTS

protamine sulfate T1


75

BLOOD (Blood Modifiers/Bleeding Disorders)

FACTOR IX COMPLEX (PCC) PREPARATIONS


KCENTRA T4 SP PROFILNINE T4 PA SP HD

FACTOR X PREPARATIONS

COAGADEX T4 PA SP

FACTOR XIII PREPARATIONS

CORIFACT T4 PA SP TRETTEN T4 PA SP

HEMOPHILIA TREATMENT AGENTS, NON-FACTOR REPLACEMENT

HEMLIBRA T4 PA SP HD

HUMAN MONOCLONAL ANTIBODY COMPLEMENT (C5) INHIBITOR

SOLIRIS T4 PA SP ULTOMIRIS T4 PA SP HD

PROTEIN C PREPARATIONS

CEPROTIN T4 PA SP

SICKLE CELL ANEMIA AGENTS

ADAKVEO T4 PA SP DROXIA T2 SIKLOS T3 PA

TOPICAL HEMOSTATICS

AVITENE T3 ENDO-AVITENE T3 GELFOAM T3 GELFOAM COMPRESSED T3 MONSEL'S T3 RECOTHROM T3 SYRINGE AVITENE T3 TACHOSIL T3 THROMBI-GEL T3 THROMBIN-JMI T3 THROMBI-PAD T3 ULTRAFOAM T3

BLOOD (Blood Thinners/Anti-Clotting)

ANTICOAGULANT REVERSAL AGENT FOR FACTOR XA INHIB.

ANDEXXA T4 SP

ANTICOAGULANT REVERSAL AGENT, DIRECT THROMBIN INHIB

PRAXBIND T4 SP


76

BLOOD (Blood Thinners/Anti-Clotting)

HEMORRHEOLOGIC AGENTS


pentoxifylline T1 HD

THROMBOLYTIC - NUCLEOTIDE TYPE

DEFITELIO T4 PA SP

THROMBOLYTIC ENZYMES

ACTIVASE T3 CATHFLO ACTIVASE T3 RETAVASE T3 TNKASE T3

CARDIAC DRUGS (Blood Pressure/Heart Medications)

ANTIANGINAL, ANTI-ISCHEMIC AGENTS, NON-HEMODYNAMIC

RANEXA (ranolazine er) T3 QL (4 tabs/day) HD ranolazine (Ranexa) T1 QL (4 tabs/day) HD

ANTIARRHYTHMICS

adenosine 12 mg/4 ml syringe T1 HD adenosine 12 mg/4 ml vial T1 HD adenosine 6 mg/2 ml syringe T1 HD adenosine 6 mg/2 ml vial T1 HD amiodarone hcl T1 HD amiodarone hcl (Pacerone) T1 HD bretylium tosylate T1 HD CORVERT (ibutilide fumarate) T3 PA HD disopyramide phosphate (Norpace) T1 HD

dofetilide 125 mcg capsule (Tikosyn) T1 QL (8 caps/day) HD



flecainide acetate T1 HD ibutilide fumarate (Corvert) T1 HD lidocaine hcl 1% abboject T1 HD lidocaine hcl 1% syringe T1 HD lidocaine hcl 2% abboject T1 HD lidocaine hcl 2% luer-jet T1 HD lidocaine hcl 2% syringe T1 HD lidocaine hcl 2% vial T1 HD lidocaine hcl/dextrose 5 %/pf T1 HD mexiletine hcl T1 HD MULTAQ T3 HD


77


ANTIARRHYTHMICS


NEXTERONE T3 HD NORPACE (disopyramide phosphate) T3 PA HD

NORPACE CR T3 HD PACERONE 100 MG TABLET (amiodarone hcl) T3 PA HD

pacerone 200 mg tablet T1 HD PACERONE 400 MG TABLET (amiodarone hcl) T3 PA HD

procainamide hcl T1 HD propafenone hcl T1 HD propafenone hcl (Rythmol Sr) T1 HD quinidine gluconate T1 HD quinidine sulfate T1 HD RYTHMOL SR (propafenone hcl er) T3 PA HD

TIKOSYN 125 MCG CAPSULE (dofetilide) T3 PA QL (8 caps/day) HD



CALCIUM CHANNEL BLOCKING AGENTS

ADALAT CC (nifedipine er) T3 HD amlodipine besylate (Norvasc) T1 HD CALAN SR (verapamil er) T3 HD CARDENE I.V. T3 HD CARDIZEM LA 120 MG TABLET T3 QL (1 tab/day) HD

CARDIZEM LA 180 MG TABLET (matzim la) T3 HD





CLEVIPREX T3 HD diltiazem hcl T1 HD diltiazem hcl (Cardizem La) T1 HD diltiazem hcl (Tiazac) T1 HD diltiazem hcl in 0.9% nacl T1 HD diltiazem hcl/d5w T1 HD felodipine T1 HD


78


CALCIUM CHANNEL BLOCKING AGENTS


isradipine T1 HD KATERZIA T3 QL (10ml/day) HD nicardipine hcl T1 HD nicardipine hcl-0.9% sod chlor T1 HD nifedipine T1 HD nifedipine (Adalat Cc) T1 HD nifedipine (Procardia Xl) T1 HD nifedipine (Procardia) T1 HD nimodipine T1 HD nisoldipine er 17 mg tablet (Sular) T1 HD

nisoldipine er 20 mg tablet T1 QL (1 tab/day) HD nisoldipine er 25.5 mg tablet T1 HD nisoldipine er 30 mg tablet T1 HD nisoldipine er 34 mg tablet (Sular) T1 HD

nisoldipine er 40 mg tablet T1 HD nisoldipine er 8.5 mg tablet (Sular) T1 HD

NORVASC (amlodipine besylate) T3 HD

NYMALIZE T3 HD PROCARDIA (nifedipine) T3 HD PROCARDIA XL (nifedipine er) T3 HD SULAR (nisoldipine) T3 HD TIAZAC (tiadylt er) T3 HD verapamil hcl T1 HD verapamil hcl (Calan SR) T1 HD verapamil hcl (Verelan PM) T1 HD verapamil hcl (Verelan) T1 HD VERELAN (verapamil hcl) T3 HD VERELAN (verapamil sr) T3 HD VERELAN PM T3 HD VERELAN PM (verapamil er pm) T3 HD

CARDIOPLEGIC SOLUTIONS

cardioplegic 21 (reperfus 4:1) T1 cardioplegic no.14 (maint 8:1) T1 cardioplegic no.15(induct 8:1) T1 cardioplegic no.17(induct 4:1) T1 cardioplegic no.18(induct 8:1) T1 cardioplegic no.19 (maint 4:1) T1


79


CARDIOPLEGIC SOLUTIONS


cardioplegic no.20 (maint 4:1) T1 cardioplegic no.22(induct 4:1) T1 cardioplegic no.26 (maint 4:1) T1 cardioplegic solution no.1 (Plegisol) T1

cardioplegic solution no.10 T1 cardioplegic solution no.16 T1 PLEGISOL (cardioplegic) T3

DIGITALIS GLYCOSIDES

digoxin T1 HD digoxin (Lanoxin) T1 HD LANOXIN T3 HD LANOXIN (digoxin) T3 HD LANOXIN PEDIATRIC T3 HD

HEART RATE REDUCING, SELECTIVE I (F) CURRENT INHIB.

CORLANOR T2 PA HD

INOTROPIC DRUGS

dobutamine hcl T1 dobutamine hcl in dextrose 5 % T1 milrinone lactate T1 milrinone lactate/d5w T1

VASODILATORS, CORONARY

DILATRATE-SR T3 HD

isosorbide dinitrate T1 HD

isosorbide mononitrate T1 HD

NITRO-DUR T3 HD NITRO-DUR (nitroglycerin patch) T3 HD

nitroglycerin T1 HD

nitroglycerin (Nitro-Dur) T1 HD nitroglycerin (Nitrolingual) T1 HD

nitroglycerin (Nitrostat) T1 HD

nitroglycerin in 5 % dextrose T1 HD

NITROLINGUAL (nitroglycerin) T3 HD

NITROMIST T3 HD

NITROSTAT (nitroglycerin) T3 HD


80

CARDIOVASCULAR (Allergy/Nasal Sprays)

SYMPATHOMIMETIC AGENTS


AKOVAZ (ephedrine sulfate) T3 BIORPHEN T3 ephedrine sulfate T1 ephedrine sulfate (Akovaz) T1 ephedrine sulfate/0.9% nacl/pf T1 phenylephrine hcl (Vazculep) T1 phenylephrine hcl in 0.9% nacl T1 VAZCULEP (phenylephrine hcl) T3

CARDIOVASCULAR (Asthma/COPD/Respiratory)

PULM ANTI-HTN, SOLUBLE GUANYLATE CYCLASE STIMULATOR

ADEMPAS T4 PA SP HD

PULM.ANTI-HTN, SEL.C-GMP PHOSPHODIESTERASE T5 INHIB

ADCIRCA (tadalafil) T4 PA SP HD REVATIO (sildenafil citrate) T4 PA SP HD REVATIO (sildenafil citrate) T4 PA SP HD sildenafil citrate (Revatio) T4 PA SP HD sildenafil citrate (Revatio) T4 PA SP HD tadalafil (Adcirca) T4 PA SP HD

PULMONARY ANTI-HTN, ENDOTHELIN RECEPTOR ANTAGONIST

ambrisentan (Letairis) T4 PA SP HD bosentan (Tracleer) T4 PA SP HD LETAIRIS (ambrisentan) T4 PA SP HD OPSUMIT T4 PA SP HD TRACLEER 125 MG TABLET (bosentan) T4 PA SP HD

TRACLEER 32 MG TABLET FOR SUSP T4 PA SP HD

TRACLEER 62.5 MG TABLET (bosentan) T4 PA SP HD

PULMONARY ANTIHYPERTENSIVES, PROSTACYCLIN-TYPE epoprostenol sodium (glycine) (Flolan) T4 PA SP

FLOLAN (epoprostenol sodium) T4 PA SP

ORENITRAM ER T4 PA SP HD REMODULIN (treprostinil) T4 PA SP HD treprostinil sodium (Remodulin) T4 PA SP HD TYVASO T4 PA SP HD TYVASO INSTITUTIONAL START KIT T4 PA SP HD

TYVASO REFILL KIT T4 PA SP HD


81

CARDIOVASCULAR (Asthma/COPD/Respiratory)

PULMONARY ANTIHYPERTENSIVES, PROSTACYCLIN-TYPE


TYVASO STARTER KIT T4 PA SP HD UPTRAVI T4 PA SP HD VELETRI T4 PA SP HD VENTAVIS T4 PA SP HD

CARDIOVASCULAR (Blood Pressure/Heart Medications)

ACE INHIBITOR-CALCIUM CHANNEL BLOCKER COMBINATION

amlodipine besylate/benazepril T1 HD PRESTALIA 14 MG-10 MG TABLET T3 HD

PRESTALIA 3.5 MG-2.5 MG TABLET T3 QL (1 tab/day) HD

PRESTALIA 7 MG-5 MG TABLET T3 QL (1 tab/day) HD

trandolapril/verapamil hcl T1 HD

ACE INHIBITOR-THIAZIDE OR THIAZIDE-LIKE DIURETIC

benazepril/hydrochlorothiazide T1 HD captopril-hctz 25-15 mg tablet T1 QL (3 tabs/day) HD captopril-hctz 25-25 mg tablet T1 QL (2 tabs/day) HD captopril-hctz 50-15 mg tablet T1 QL (3 tabs/day) HD captopril-hctz 50-25 mg tablet T1 QL (2 tabs/day) HD enalapril/hydrochlorothiazide T1 HD fosinopril/hydrochlorothiazide T1 HD lisinopril/hydrochlorothiazide T1 HD quinapril/hydrochlorothiazide T1 HD

ALPHA/BETA-ADRENERGIC BLOCKING AGENTS

carvedilol (Coreg) T1 HD carvedilol er 10 mg capsule (Coreg CR) T1 QL (1 cap/day) HD

carvedilol er 20 mg capsule (Coreg CR) T1 QL (1 cap/day) HD

carvedilol er 40 mg capsule (Coreg CR) T1 QL (1 cap/day) HD

carvedilol er 80 mg capsule (Coreg CR) T1 HD

COREG (carvedilol) T3 ST HD COREG CR 10 MG CAPSULE (carvedilol er) T3 ST QL (1 cap/day) HD

COREG CR 20 MG CAPSULE (carvedilol er) T3 ST QL (1 cap/day) HD

COREG CR 40 MG CAPSULE (carvedilol er) T3 ST QL (1 cap/day) HD

COREG CR 80 MG CAPSULE (carvedilol er) T3 ST HD

labetalol hcl T1 HD


82


ALPHA-ADRENERGIC BLOCKING AGENTS


CARDURA (doxazosin mesylate) T3 HD

CARDURA XL T3 HD doxazosin mesylate (Cardura) T1 HD MINIPRESS (prazosin hcl) T3 HD prazosin hcl (Minipress) T1 HD terazosin hcl T1 HD

ANGIOTEN.RECEPTR ANTAG-CALCIUM CHANL BLKR-THIAZIDE

amlodipine/valsartan/hcthiazid T1 HD olmesartan/amlodipin/hcthiazid T1 HD

ANGIOTENSIN RECEPT-NEPRILYSIN INHIBITOR COMB (ARNI)

ENTRESTO T2 HD

ANGIOTENSIN RECEPTOR ANTAG.-THIAZIDE DIURETIC COMB

candesartan/hydrochlorothiazide T1 HD irbesartan/hydrochlorothiazide T1 HD losartan/hydrochlorothiazide T1 HD olmesartan-hctz 20-12.5 mg tab T1 QL (1 tab/day) HD

olmesartan-hctz 40-12.5 mg tab T1 HD

olmesartan-hctz 40-25 mg tab T1 HD telmisartan-hctz 40-12.5 mg tb T1 QL (1 tab/day) HD telmisartan-hctz 80-12.5 mg tb T1 HD telmisartan-hctz 80-25 mg tab T1 HD valsartan/hydrochlorothiazide T1 HD

ANGIOTENSIN RECEPTOR BLOCKR-CALCIUM CHANNEL BLOCKR

amlodipine besylate/valsartan T1 HD amlodipine-olmesartan 10-20 mg T1 HD

amlodipine-olmesartan 10-40 mg T1 HD

amlodipine-olmesartan 5-20 mg T1 QL (1 tab/day) HD

amlodipine-olmesartan 5-40 mg T1 HD

telmisartan-amlodipine 40-10 T1 HD telmisartan-amlodipine 40-5 mg T1 QL (1 tab/day) HD

telmisartan-amlodipine 80-10 T1 HD telmisartan-amlodipine 80-5 mg T1 HD


83


ANTIHYPERTENSIVES, ACE INHIBITORS


benazepril hcl T1 HD captopril T1 HD enalapril maleate T1 HD enalaprilat dihydrate T1 HD EPANED T3 HD fosinopril sodium T1 HD lisinopril T1 HD moexipril hcl T1 HD perindopril erbumine T1 HD QBRELIS T3 HD quinapril hcl T1 HD ramipril T1 HD trandolapril T1 HD

ANTIHYPERTENSIVES, ANGIOTENSIN RECEPTOR ANTAGONIST

candesartan cilexetil T1 HD eprosartan mesylate T1 HD irbesartan T1 HD losartan potassium T1 HD olmesartan medoxomil 20 mg tab T1 QL (1 tab/day) HD

olmesartan medoxomil 40 mg tab T1 HD

olmesartan medoxomil 5 mg tab T1 HD

telmisartan 20 mg tablet T1 QL (1 tab/day) HD telmisartan 40 mg tablet T1 QL (1 tab/day) HD telmisartan 80 mg tablet T1 HD valsartan T1 HD

ANTIHYPERTENSIVES, GANGLIONIC BLOCKERS

mecamylamine hcl T1

ANTIHYPERTENSIVES, MISCELLANEOUS

DEMSER T3 HD NITROPRESS (sodium nitroprusside) T3 HD

nitroprusside sodium (Nitropress) T1 HD

ANTIHYPERTENSIVES, SYMPATHOLYTIC

CATAPRES (clonidine hcl) T3 HD CATAPRES-TTS 1 (clonidine) T3 HD CATAPRES-TTS 2 (clonidine) T3 HD CATAPRES-TTS 3 (clonidine) T3 HD


84


ANTIHYPERTENSIVES, SYMPATHOLYTIC


clonidine (Catapres-TTS 1) T1 HD clonidine (Catapres-TTS 2) T1 HD clonidine (Catapres-TTS 3) T1 HD clonidine hcl 0.1 mg tablet (Catapres) T1 HD

clonidine hcl 0.2 mg tablet (Catapres) T1 HD

clonidine hcl 0.3 mg tablet (Catapres) T1 HD

guanfacine hcl T1 HD methyldopa T1 HD methyldopa/hydrochlorothiazide T1 HD

ANTIHYPERTENSIVES, VASODILATORS

CORLOPAM T3 HD hydralazine hcl T1 HD minoxidil T1 HD

BETA-ADRENERGIC BLOCKING AGENTS

acebutolol hcl T1 HD atenolol (Tenormin) T1 HD BETAPACE AF (sotalol af) T3 ST HD betaxolol hcl T1 HD bisoprolol fumarate T1 HD BREVIBLOC (esmolol hcl) T3 HD BREVIBLOC (esmolol hcl-sodium chloride) T3 HD

CORGARD (nadolol) T3 ST HD esmolol hcl (Brevibloc) T1 HD esmolol in sodium chloride,iso (Brevibloc) T1 HD

HEMANGEOL T3 HD INDERAL LA (propranolol hcl er) T3 ST HD INDERAL XL T3 ST HD INNOPRAN XL T3 ST HD KAPSPARGO SPRINKLE T3 ST HD LOPRESSOR (metoprolol tartrate) T3 ST HD

metoprolol succinate (Toprol XL) T1 HD

metoprolol tartrate T1 HD metoprolol tartrate (Lopressor) T1 HD nadolol (Corgard) T1 HD pindolol T1 HD propranolol hcl T1 HD


85


BETA-ADRENERGIC BLOCKING AGENTS


propranolol hcl (Inderal LA) T1 HD sotalol hcl T1 HD sotalol hcl (Betapace AF) T1 HD SOTYLIZE T3 ST HD TENORMIN (atenolol) T3 ST HD timolol maleate T1 HD TOPROL XL (metoprolol succinate) T3 ST HD

BETA-BLOCKERS AND THIAZIDE, THIAZIDE-LIKE DIURETICS atenolol/chlorthalidone (Tenoretic 100) T1 HD

atenolol/chlorthalidone (Tenoretic 50) T1 HD

bisoprolol/hydrochlorothiazide (Ziac) T1 HD

DUTOPROL T3 ST HD LOPRESSOR HCT (metoprolol-hydrochlorothiazide)

T3 ST HD

metoprolol/hydrochlorothiazide T1 HD metoprolol/hydrochlorothiazide (Lopressor HCT) T1 HD

propranolol/hydrochlorothiazid T1 HD TENORETIC 100 (atenolol-chlorthalidone) T3 ST HD

TENORETIC 50 (atenolol-chlorthalidone) T3 ST HD

ZIAC (bisoprolol-hydrochlorothiazide) T3 ST HD

MUSCARINIC RECEPTOR ANTAGONISTS (ANTICHOLINERGIC)

ATROPEN T3

PATENT DUCTUS ARTERIOSUS TREAT. AGENTS, NSAID-TYPE

ibuprofen lysine/pf (Neoprofen) T1 indomethacin 1 mg vial T1 NEOPROFEN (ibuprofen lysine) T3

RENIN INHIBITOR, DIRECT

aliskiren 150 mg tablet T1 QL (1 tab/day) HD aliskiren 300 mg tablet T1 HD

VASODILATORS, COMBINATION

BIDIL T3 QL (6 tabs/day)

VASODILATORS, MISCELLANEOUS

alprostadil T1 PROSTIN VR PEDIATRIC T3


86


VASODILATORS, PERIPHERAL


ergoloid mesylates T1 isoxsuprine hcl T1 papaverine hcl T1

CARDIOVASCULAR (Cholesterol Medications)

ANTIHYPERLIP.HMG COA REDUCT INHIB-CHOLEST.AB.INHIB

ezetimibe/simvastatin T1 HD

ANTIHYPERLIPID- HMG-COA RI-CALCIUM CHANNEL BLOCKER amlodipine-atorvast 10-10 mg (Caduet) T1 HD

amlodipine-atorvast 10-20 mg (Caduet) T1 HD



amlodipine-atorvast 2.5-10 mg T1 HD amlodipine-atorvast 2.5-20 mg T1 QL (1 tab/day) HD amlodipine-atorvast 2.5-40 mg T1 QL (1 tab/day) HD amlodipine-atorvast 5-10 mg (Caduet) T1 HD

amlodipine-atorvast 5-20 mg (Caduet) T1 QL (1 tab/day) HD

amlodipine-atorvast 5-40 mg (Caduet) T1 QL (1 tab/day) HD


CADUET 10 MG-10 MG TABLET (amlodipine-atorvastatin)

T3 HD


T3 HD


T3 HD


T3 HD


T3 HD


T3 QL (1 tab/day) HD

CADUET 5 MG-40 MG TABLET (amlodipine-atorvastatin) T3 QL (1 tab/day) HD


T3 HD


87


ANTIHYPERLIPIDEMIC - MTP INHIBITOR


JUXTAPID T4 PA SP HD

ANTIHYPERLIPIDEMIC - PCSK9 INHIBITORS

REPATHA PUSHTRONEX T2 PA REPATHA SURECLICK T2 PA REPATHA SYRINGE T2 PA

ANTIHYPERLIPIDEMIC-HMGCOA REDUCTASE INHIB (STATINS)

atorvastatin 10 mg tablet T1 HD PPACA atorvastatin 20 mg tablet T1 HD PPACA atorvastatin 40 mg tablet T1 HD atorvastatin 80 mg tablet T1 HD fluvastatin sodium T1 HD PPACA lovastatin 10 mg tablet T1 HD lovastatin 20 mg tablet T1 HD PPACA lovastatin 40 mg tablet T1 HD PPACA pravastatin sodium T1 HD PPACA rosuvastatin calcium 10 mg tab T1 QL (1 tab/day) HD PPACA rosuvastatin calcium 20 mg tab T1 QL (1 tab/day) HD rosuvastatin calcium 40 mg tab T1 HD rosuvastatin calcium 5 mg tab T1 QL (1 tab/day) HD PPACA simvastatin 10 mg tablet T1 HD PPACA simvastatin 20 mg tablet T1 HD PPACA simvastatin 40 mg tablet T1 HD PPACA simvastatin 5 mg tablet T1 HD simvastatin 80 mg tablet T1 QL (1 tab/day) HD

BILE SALT SEQUESTRANTS cholestyramine (with sugar) (Questran) T1 HD

cholestyramine/aspartame T1 HD cholestyramine/aspartame (Questran Light) T1 HD

colesevelam hcl (Welchol) T1 HD COLESTID T3 HD COLESTID (colestipol hcl) T3 HD colestipol hcl (Colestid) T1 HD QUESTRAN (cholestyramine) T3 HD QUESTRAN LIGHT (prevalite) T3 HD WELCHOL (colesevelam hcl) T3 HD

LIPOTROPICS

ezetimibe (Zetia) T1 HD fenofibrate T1 HD


88


LIPOTROPICS


fenofibrate (Lipofen) T1 HD fenofibrate nanocrystallized (Tricor) T1 HD

fenofibrate,micronized T1 HD fenofibric acid (choline) (Trilipix) T1 HD

fenofibric acid (Fibricor) T1 HD FIBRICOR T3 ST HD FIBRICOR (fenofibric acid) T3 ST HD gemfibrozil (Lopid) T1 HD LIPOFEN (fenofibrate) T3 ST HD LOPID (gemfibrozil) T3 HD niacin T1 HD niacin (Niaspan) T1 HD NIASPAN (niacin er) T3 HD TRICOR (fenofibrate) T3 ST HD TRIGLIDE T3 ST HD TRILIPIX (fenofibric acid) T3 ST HD ZETIA (ezetimibe) T3 HD

CARDIOVASCULAR (Miscellaneous)

VENOSCLEROSING AGENTS

ASCLERA T4 PA SP ETHAMOLIN T3 sodium tetradecyl sulfate (Sotradecol) T1

SOTRADECOL T3 SOTRADECOL (sodium tetradecyl sulfate) T3

CNS DRUGS (Alzheimer's Disease)

ALZHEIMER'S THERAPY, NMDA RECEPTOR ANTAGONISTS

memantine hcl T1 HD memantine hcl (Namenda) T1 HD memantine hcl er 14 mg capsule (Namenda XR) T1 QL (1 cap/day) HD

memantine hcl er 21 mg capsule (Namenda XR) T1 HD

memantine hcl er 28 mg capsule (Namenda XR) T1 HD

memantine hcl er 7 mg capsule (Namenda XR) T1 QL (1 cap/day) HD

NAMENDA (memantine hcl) T3 HD


89

CNS DRUGS (Alzheimer's Disease)

ALZHEIMER'S THX, NMDA RECEPTOR ANTAG-CHOLINES INHIB


NAMENDA XR 14 MG CAPSULE (memantine hcl er) T3 QL (1 cap/day) HD

NAMENDA XR 21 MG CAPSULE (memantine hcl er) T3 HD

NAMENDA XR 28 MG CAPSULE (memantine hcl er) T3 HD

NAMENDA XR 7 MG CAPSULE (memantine hcl er) T3 QL (1 cap/day) HD

NAMENDA XR TITRATION PACK T3 QL (112/365 days) HD

NAMZARIC 14 MG-10 MG CAPSULE T3 QL (2 caps/day) HD




NAMZARIC TITRATION PACK T3 QL (112/365 days) HD

CNS DRUGS (Miscellaneous)

ALCOHOL, SYSTEMIC USE

ethyl alcohol T1

AMYOTROPHIC LATERAL SCLEROSIS AGENTS

RADICAVA T4 PA SP RILUTEK (riluzole) T4 SP HD riluzole (Rilutek) T4 SP HD TIGLUTIK T4 PA SP

CENTRAL NERVOUS SYSTEM STIMULANTS

DOPRAM T3

DRUGS TO TREAT MOVEMENT DISORDERS

AUSTEDO T4 PA SP HD INGREZZA T4 PA SP INGREZZA INITIATION PACK T4 PA QL (28 caps/year) SP tetrabenazine T4 SP HD

PSEUDOBULBAR AFFECT (PBA) AGENTS, NMDA ANTAGONISTS

NUEDEXTA T3 QL (4 caps/day)

XANTHINES

CAFCIT (caffeine citrate) T3 HD caffeine citrate T1 HD caffeine citrate (Cafcit) T1 HD caffeine/sodium benzoate T1 HD


90

CNS DRUGS (Multiple Sclerosis)

AGENTS TO TREAT MULTIPLE SCLEROSIS


AVONEX T4 PA SP HD AVONEX PEN T4 PA SP HD BETASERON T4 PA SP HD EXTAVIA T4 PA SP HD GILENYA 0.25 MG CAPSULE T4 PA SP GILENYA 0.5 MG CAPSULE T4 PA SP HD glatiramer acetate T4 PA SP HD LEMTRADA T4 PA SP HD MAVENCLAD T4 PA SP HD MAYZENT 0.25 MG STARTER PACK T4 PA SP

MAYZENT 0.25 MG TABLET T4 PA SP HD MAYZENT 2 MG TABLET T4 PA SP HD OCREVUS T4 PA SP HD PLEGRIDY T4 PA SP HD PLEGRIDY PEN T4 PA SP HD REBIF T4 PA SP HD REBIF REBIDOSE T4 PA SP HD TECFIDERA T4 PA SP HD

AGTS TX NEUROMUSC TRANSMISSION DIS, POT-CHAN BLKR

AMPYRA (dalfampridine er) T4 PA SP HD dalfampridine (Ampyra) T4 PA SP HD FIRDAPSE T4 PA QL (8 tabs/day) SP RUZURGI T4 PA SP

CNS DRUGS (Seizure Disorders)

ANTICONVULSANT - BENZODIAZEPINE TYPE

clobazam (Onfi) T1 HD clonazepam T1 HD clonazepam (Klonopin) T1 HD DIASTAT (diazepam) T3 PA HD DIASTAT ACUDIAL (diazepam) T3 PA HD

diazepam 10 mg rectal gel syst (Diastat Acudial) T1 HD

diazepam 2.5 mg rectal gel sys (Diastat) T1 HD

diazepam 20 mg rectal gel syst (Diastat Acudial) T1 HD

KLONOPIN (clonazepam) T3 PA HD NAYZILAM T2 PA QL (10/30 days) HD ONFI (clobazam) T3 PA HD


91


ANTICONVULSANT - CANNABINOID TYPE


EPIDIOLEX T4 PA SP HD

ANTICONVULSANTS

APTIOM 200 MG TABLET T3 PA QL (1 tab/day) HD APTIOM 400 MG TABLET T3 PA QL (1 tab/day) HD APTIOM 600 MG TABLET T3 PA HD APTIOM 800 MG TABLET T3 PA HD BANZEL 200 MG TABLET T3 PA QL (16 tabs/day) HD BANZEL 40 MG/ML SUSPENSION T3 PA QL (80ml/day) HD

BANZEL 400 MG TABLET T3 PA QL (8 tabs/day) HD BRIVIACT 10 MG TABLET T3 PA HD BRIVIACT 10 MG/ML ORAL SOLN T3 PA HD

BRIVIACT 100 MG TABLET T3 PA HD BRIVIACT 25 MG TABLET T3 PA HD BRIVIACT 50 MG TABLET T3 PA HD BRIVIACT 50 MG/5 ML VIAL T3 HD BRIVIACT 75 MG TABLET T3 PA HD carbamazepine T1 HD carbamazepine (Carbatrol) T1 HD carbamazepine (Tegretol XR) T1 HD carbamazepine (Tegretol) T1 HD CARBATROL (carbamazepine er) T3 PA HD

CELONTIN T2 HD CEREBYX (fosphenytoin sodium) T3 HD

DEPAKOTE (divalproex sodium) T3 PA HD

DEPAKOTE ER (divalproex sodium er) T3 PA HD

DEPAKOTE SPRINKLE (divalproex sodium) T3 PA HD

DIACOMIT T4 PA SP HD DILANTIN 100 MG CAPSULE (phenytoin sodium extended) T3 PA HD

DILANTIN 30 MG CAPSULE T2 PA HD DILANTIN 50 MG INFATAB (phenytoin) T3 PA HD

DILANTIN-125 (phenytoin) T3 PA HD divalproex sodium (Depakote ER) T1 HD

divalproex sodium (Depakote Sprinkle) T1 HD

divalproex sodium (Depakote) T1 HD


92


ANTICONVULSANTS


ethosuximide (Zarontin) T1 HD felbamate T1 HD fosphenytoin sodium (Cerebyx) T1 HD FYCOMPA 0.5 MG/ML ORAL SUSP T2 PA HD

FYCOMPA 10 MG TABLET T2 PA HD FYCOMPA 12 MG TABLET T2 PA HD FYCOMPA 2 MG TABLET T2 PA HD FYCOMPA 4 MG TABLET T2 PA QL (1 tab/day) HD FYCOMPA 6 MG TABLET T2 PA QL (1 tab/day) HD FYCOMPA 8 MG TABLET T2 PA HD gabapentin T1 HD gabapentin (Neurontin) T1 HD GABITRIL 12 MG TABLET (tiagabine hcl) T3 PA QL (8 tabs/day) HD

GABITRIL 16 MG TABLET (tiagabine hcl) T3 PA QL (6 tabs/day) HD

GABITRIL 2 MG TABLET (tiagabine hcl) T3 PA HD

GABITRIL 4 MG TABLET (tiagabine hcl) T3 PA HD

KEPPRA (levetiracetam) T3 HD lamotrigine T1 HD levetiracetam T1 HD levetiracetam (Keppra) T1 HD levetiracetam in nacl (iso-os) T1 HD LYRICA (pregabalin) T2 PA HD NEURONTIN (gabapentin) T3 PA HD oxcarbazepine T1 HD OXTELLAR XR T3 PA HD PEGANONE T2 HD PHENYTEK (phenytoin sodium extended) T3 PA HD

phenytoin T1 HD phenytoin (Dilantin) T1 HD phenytoin (Dilantin-125) T1 HD phenytoin sodium T1 HD phenytoin sodium extended (Dilantin) T1 HD

phenytoin sodium extended (Phenytek) T1 HD

pregabalin T1 HD pregabalin (Lyrica) T1 HD primidone T1 HD


93


ANTICONVULSANTS


SPRITAM T3 PA HD TEGRETOL (carbamazepine) T3 PA HD TEGRETOL (epitol) T3 PA HD TEGRETOL XR (carbamazepine er) T3 PA HD

tiagabine hcl 12 mg tablet (Gabitril) T1 QL (8 tabs/day) HD

tiagabine hcl 16 mg tablet (Gabitril) T1 QL (6 tabs/day) HD

tiagabine hcl 2 mg tablet (Gabitril) T1 HD

tiagabine hcl 4 mg tablet (Gabitril) T1 HD

topiramate T1 HD valproic acid T1 HD valproic acid (as sodium salt) T1 HD vigabatrin T4 SP HD VIMPAT 10 MG/ML SOLUTION T3 PA HD

VIMPAT 100 MG TABLET T3 PA HD VIMPAT 150 MG TABLET T3 PA HD VIMPAT 200 MG TABLET T3 PA HD VIMPAT 200 MG/20 ML VIAL T3 HD VIMPAT 50 MG TABLET T3 PA HD ZARONTIN (ethosuximide) T3 PA HD zonisamide T1 HD

CNS DRUGS (Sleep Disorders/Sedatives)

NARCOLEPSY TX-H3-RECEPT.ANTAGONIST/INVERSE AGONIST

WAKIX T4 PA QL (2 tabs/day) SP HD

COLONY STIMULATING FACTORS (Blood Modifiers/Bleeding Disorders)

ERYTHROPOIESIS-STIMULATING AGENTS

ARANESP T4 PA SP EPOGEN T4 PA SP MIRCERA T4 PA SP PROCRIT T4 PA SP RETACRIT T4 PA SP

LEUKOCYTE (WBC) STIMULANTS

FULPHILA T4 PA SP GRANIX T4 SP LEUKINE T4 SP NEULASTA 6 MG/0.6 ML SYRINGE T4 PA SP


94

COLONY STIMULATING FACTORS (Blood Modifiers/Bleeding Disorders)

LEUKOCYTE (WBC) STIMULANTS


NEULASTA ONPRO 6 MG/0.6 ML KIT T4 PA SP HD

NEUPOGEN T4 PA SP NIVESTYM T4 PA SP UDENYCA T4 PA SP ZARXIO T4 SP HD ZIEXTENZO T4 PA SP

THROMBOPOIETIN RECEPTOR AGONISTS

DOPTELET T4 PA SP HD MULPLETA T4 PA SP HD NPLATE T4 PA SP PROMACTA T4 PA SP HD

COLONY STIMULATING FACTORS (Cancer)

CXCR4 CHEMOKINE RECEPTOR ANTAGONIST

MOZOBIL T4 PA SP

CONTRACEPTIVES (Contraception Products)

CONTRACEPTIVES, INTRAVAGINAL, SYSTEMIC

ANNOVERA T3 etonogestrel/ethinyl estradiol (Nuvaring) T1 PPACA

NUVARING (etonogestrel-ethinyl estradiol) T3

CONTRACEPTIVES, INJECTABLE DEPO-PROVERA 150 MG/ML SYRINGE (medroxyprogesterone acetate)

T3

DEPO-PROVERA 150 MG/ML VIAL (medroxyprogesterone acetate)

T3

DEPO-SUBQ PROVERA 104 T3 medroxyprogesterone 150 mg/ml (Depo-Provera) T1 PPACA

CONTRACEPTIVES, ORAL

BALCOLTRA T3 HD BEYAZ (drospirenone-eth estra-levomef) T3 HD

desog-e.estradiol/e.estradiol (Mircette) T1 HD PPACA

desogestrel-ethinyl estradiol T1 HD PPACA drospir/eth estra/levomefol ca (Beyaz) T1 HD PPACA


95




drospir/eth estra/levomefol ca (Safyral) T1 HD PPACA

ELLA T3 HD PPACA ESTROSTEP FE (tri-legest fe) T3 HD ethinyl estradiol/drospirenone (Yasmin 28) T1 HD PPACA

ethinyl estradiol/drospirenone (Yaz) T1 HD PPACA

ethynodiol d-ethinyl estradiol T1 HD PPACA GENERESS FE (norethin-eth estra-ferrous fum) T3 HD

LAYOLIS FE (norethin-eth estra-ferrous fum) T3 HD

levonorgestrel-ethin estradiol T1 HD PPACA l-norgest/e.estradiol-e.estrad (Loseasonique) T1 HD PPACA

l-norgest/e.estradiol-e.estrad (Quartette) T1 HD PPACA

l-norgest/e.estradiol-e.estrad (Seasonique) T1 HD PPACA

LO LOESTRIN FE T2 HD LOESTRIN (norethindron-ethinyl estradiol) T3 HD

LOESTRIN FE (norethindrone-eth estradiol-fe) T3 HD

LOESTRIN FE (tarina fe 1-20 eq) T3 HD

LOSEASONIQUE (levonorg-eth estrad eth estrad) T3 HD

MINASTRIN 24 FE (norethin-eth estra-ferrous fum) T3 HD

MIRCETTE (viorele) T3 HD NATAZIA T3 HD noreth-ethinyl estradiol/iron T1 HD PPACA noreth-ethinyl estradiol/iron (Layolis Fe) T1 HD PPACA

norethind-eth estrad 1-0.02 mg (Loestrin) T1 HD PPACA

norethindrone (Ortho Micronor) T1 HD PPACA norethindrone ac-eth estradiol (Loestrin) T1 HD PPACA

norethindrone-e.estradiol-iron T1 HD PPACA norethindrone-e.estradiol-iron (Estrostep FE) T1 HD PPACA

norethindrone-e.estradiol-iron (Loestrin FE) T1 HD PPACA

norethindrone-e.estradiol-iron (Minastrin 24 FE) T1 HD PPACA

norethindrone-ethin. estradiol T1 HD PPACA


96




norethindrone-ethin. estradiol (Ortho-Novum) T1 HD PPACA

norethin-ee 1.5-0.03 mg(21) tb (Loestrin) T1 HD PPACA

norgestimate-ethinyl estradiol T1 HD PPACA norgestrel-ethinyl estradiol T1 HD norgestrel-ethinyl estradiol T1 HD PPACA ORTHO MICRONOR (tulana) T3 HD ORTHO-NOVUM (pirmella) T3 HD QUARTETTE (rivelsa) T3 HD SAFYRAL (tydemy) T3 HD SEASONIQUE (simpesse) T3 HD SLYND T3 HD TAYTULLA T2 HD YASMIN 28 (zumandimine) T3 HD YAZ (nikki) T3 HD

CONTRACEPTIVES, TRANSDERMAL

norelgestromin/ethin.estradiol T1 HD PPACA

INTRA-UTERINE DEVICES (IUDS)

KYLEENA T4 SP LILETTA T4 SP MIRENA T4 SP PARAGARD T 380-A T4 SP SKYLA T4 SP

COUGH/COLD PREPARATIONS (Cough/Cold Medications)

ANTITUSSIVES, NON-OPIOID

benzonatate T1 benzonatate (Tessalon Perle) T1 TESSALON PERLE (benzonatate) T3

NON-OPIOID ANTITUS-1ST GEN.ANTIHISTAMINE-DECONGEST brompheniramine/pseudoephed/dm T1

NON-OPIOID ANTITUSSIVE-1ST GEN ANTIHISTAMINE COMB.

promethazine/dextromethorphan T1

OPIOID ANTITUSSIV-1ST GEN. ANTIHISTAMINE-DECONGEST

promethazine/phenyleph/codeine T1 PA QL (480ml/30 days)

OPIOID ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE

hydrocodone/chlorphen p-stirex T1 PA


97

COUGH/COLD PREPARATIONS (Cough/Cold Medications)

OPIOID ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE


promethazine hcl/codeine T1 PA QL (480ml/30 days) TUXARIN ER T3 PA QL (2 tabs/day) TUZISTRA XR T3 PA QL (960ml/30 days)

OPIOID ANTITUSSIVE-ANTICHOLINERGIC COMBINATIONS hydrocodone bit/homatrop me-br T1 PA QL (480ml/30 days)

hydrocodone-homatropine 5-1.5 T1 PA QL (180 tabs/30 days)

hydrocodone-homatropine soln T1 PA QL (480ml/30 days) hydrocodone-homatropine syrup T1 PA QL (480ml/30 days)

DIAGNOSTIC (Miscellaneous)

ADRENAL RADIOACTIVE DIAGNOSTICS

ADREVIEW T3

BILIARY DIAGNOSTICS CHOLETEC (tc99m mebrofenin prep) T3

kit for prep tc-99m/mebrofenin (Choletec) T1

BILIARY DIAGNOSTICS, RADIOPAQUE IC GREEN (indocyanine green) T3

indocyanine green (IC Green) T1

CARDIOVASCULAR DIAGNOSTICS - RADIOACTIVE

AMMONIA N-13 T3 kit for tc 99m/sestamibi no.1 T1 kit for tc-99m/sod pyrophospht T1 MYOVIEW T3 thallous chloride tl-201 T1

CARDIOVASCULAR DIAGNOSTICS, NON-RADIOPAQUE AGENTS

adenosine 60 mg/20 ml vial T1 adenosine 90 mg/30 ml vial T1 DEFINITY T3 dipyridamole 5 mg/ml vial T1 LEXISCAN T3 OPTISON T3

CARDIOVASCULAR DIAGNOSTICS-RADIOPAQUE

ISOVUE-200 T3 ISOVUE-250 T3 ISOVUE-300 T3


98


CARDIOVASCULAR DIAGNOSTICS-RADIOPAQUE


ISOVUE-370 T3 ISOVUE-M 200 T3 ISOVUE-M 300 T3 OMNIPAQUE T3 OPTIRAY 240 T3 OPTIRAY 300 T3 OPTIRAY 320 T3 OPTIRAY 350 T3 ULTRAVIST T3 VISIPAQUE T3

CEREBRAL SPINAL RADIOACTIVE DIAGNOSTICS

CERETEC T3 INDIUM IN-111 DTPA T3 DOTAREM T3 MAGNEVIST T3 MULTIHANCE T3 MULTIHANCE MULTIPACK T3 OMNISCAN T3 PROHANCE T3 PROHANCE MULTIPACK T3

DIAGNOSTIC PREPARATIONS, MISCELLANEOUS

ARIDOL T3 DMSA T3 GADAVIST T3 GLUCAGEN DIAGNOSTIC 1 MG VIAL T3

glucagon hcl T1 isosulfan blue T1 kit for tc 99m/sod thiosulfate T1 kit for tc-99m/medronate sod T1 lidocaine hcl/glycerin T1 LIPIODOL T3 LUMASON T3 NETSPOT T3 PROVOCHOLINE T3

DIAGNOSTIC RADIOPHARM - AMYLOID PLAQUE IMAGING

AMYVID T3 VIZAMYL T3 PA

DIAGNOSTIC RADIOPHARM - DOPAMINE TRANSPORTER (DAT)

DATSCAN T3


99


EYE DIAGNOSTIC AGENTS


AK-FLUOR T3 fluorescein sodium (Fluor-I-Strip AT) T1

FLUORESCITE T3 FLUOR-I-STRIP AT (glostrips) T3 ful-glo 1 mg opth strip (Fluor-I-Strip AT) T1

FUL-GLO EYE STRIPS T3 lissamine green T1

FLUORESCENCE CYSTOSCOPY/OPTICAL IMAGING AGENTS

CYSVIEW T3

GASTROINTESTINAL RADIOPAQUE DIAGNOSTICS

ENTERO VU T3 E-Z DISK T3 E-Z-HD T3 E-Z-PAQUE T3 E-Z-PASTE T3 LIQUID E-Z PAQUE T3 LIQUID POLIBAR PLUS T3 READI-CAT 2 T3 SITZMARKS T3 TAGITOL T3 VARIBAR HONEY T3 VARIBAR NECTAR T3 VARIBAR PUDDING T3 VARIBAR THIN HONEY T3 VARIBAR THIN LIQUID T3

HEPATIC DIAGNOSTICS

EOVIST T3

HISTAMINE PREPARATIONS

HISTATROL INTRADERMAL T3 HISTATROL PERCUTANEOUS T3

METABOLIC FUNCTION DIAGNOSTICS

CHIRHOSTIM T3 METOPIRONE T3 R-GENE 10 T3

RADIOACTIVE DX RADIOLABEL OF AUTOLOGOUS LEUKOCYTES

indium in-111 oxyquinoline T1


100


RADIOACTIVE DX RADIOLABEL OF SYNTHETIC AMINO ACIDS


AXUMIN T3

RADIOACTIVE METABOLIC FUNCTION DIAGNOSTICS

fludeoxyglucose f-18 T1

RADIOPHARMACEUTICALS ELEMENTS TECHNELITE TC-99M GENERATOR T3

RENAL FUNCTION DIAGNOSTICS AGENTS

INDIGO CARMINE T3

URINARY TRACT RADIOPAQUE DIAGNOSTICS

CONRAY-43 T3 CYSTO-CONRAY II T3 CYSTOGRAFIN T3 CYSTOGRAFIN-DILUTE T3 diatrizoate meglumine, sodium (Gastrografin) T1

GASTROGRAFIN (md-gastroview) T3

DIURETICS (Diuretics)

ARGININE VASOPRESSIN (AVP) RECEPTOR ANTAGONISTS

JYNARQUE 15 MG TABLET T4 SP HD JYNARQUE 30 MG TABLET T4 SP HD JYNARQUE 45 MG-15 MG TABLET T4 PA SP

JYNARQUE 60 MG-30 MG TABLET T4 PA SP

JYNARQUE 90 MG-30 MG TABLET T4 PA SP

SAMSCA T4 SP HD VAPRISOL-5% DEXTROSE T3

CARBONIC ANHYDRASE INHIBITORS

acetazolamide T1 HD acetazolamide sodium T1 HD methazolamide T1 HD

LOOP DIURETICS

bumetanide T1 HD ethacrynate sodium (Sodium Edecrin) T1 HD

furosemide T1 HD furosemide (Lasix) T1 HD furosemide in 0.9 % nacl T1 HD


101


LOOP DIURETICS


LASIX (furosemide) T3 HD SODIUM EDECRIN (ethacrynate sodium) T3 HD

torsemide T1 HD

OSMOTIC DIURETICS

mannitol T1 mannitol (Osmitrol) T1 OSMITROL T3 OSMITROL (mannitol) T3 RESECTISOL T3

POTASSIUM SPARING DIURETICS

ALDACTONE (spironolactone) T3 HD amiloride hcl T1 HD CAROSPIR T3 HD DYRENIUM (triamterene) T3 HD eplerenone (Inspra) T1 HD INSPRA (eplerenone) T3 HD spironolactone (Aldactone) T1 HD triamterene (Dyrenium) T1 HD

POTASSIUM SPARING DIURETICS IN COMBINATION

ALDACTAZIDE T3 HD ALDACTAZIDE (spironolactone-hctz) T3 HD

amiloride/hydrochlorothiazide T1 HD DYAZIDE (triamterene-hydrochlorothiazide) T3 HD

MAXZIDE (triamterene-hydrochlorothiazide) T3 HD

MAXZIDE-25 MG (triamterene-hydrochlorothiazide) T3 HD

spironolact/hydrochlorothiazid (Aldactazide) T1 HD

triamterene/hydrochlorothiazid (Dyazide) T1 HD

triamterene/hydrochlorothiazid (Maxzide) T1 HD

triamterene/hydrochlorothiazid (Maxzide-25 Mg) T1 HD

THIAZIDE AND RELATED DIURETICS chlorothiazide sodium (Sodium Diuril) T1 HD

chlorthalidone T1 HD DIURIL T3 HD


102


THIAZIDE AND RELATED DIURETICS


hydrochlorothiazide T1 HD indapamide T1 HD metolazone T1 HD SODIUM DIURIL (chlorothiazide sodium) T3 HD

EENT PREPS (Allergy/Nasal Sprays)

NASAL ANTIHISTAMINE azelastine 0.1% (137 mcg) spry T1 HD

azelastine 0.15% nasal spray T1 HD olopatadine 665 mcg nasal spry (Patanase) T1 HD

PATANASE (olopatadine hcl) T3 HD

NASAL ANTI-INFLAMMATORY STEROIDS

flunisolide T1 HD fluticasone prop 50 mcg spray T1 HD mometasone furoate 50 mcg spry T1 QL (4 bots/30 days) HD

SINUVA T4 PA SP HD

NOSE PREPARATIONS, MISCELLANEOUS (RX)

ipratropium bromide T1 HD

NOSE PREPARATIONS, VASOCONSTRICTORS (RX)

ADRENALIN CHLORIDE T3

EENT PREPS (Ear Medications)

EAR PREPARATIONS ANTI-INFLAMMATORY DERMOTIC (fluocinolone acetonide oil) T3

fluocinolone acetonide oil (Dermotic) T1

EAR PREPARATIONS, MISC. ANTI-INFECTIVES

acetic acid T1 hydrocortisone/acetic acid T1

EENT PREPS (Eye Conditions)

ARTIFICIAL TEARS

LACRISERT T3

EYE ANTI-INFECTIVES (RX ONLY)

BETADINE T3


103


EYE ANTI-INFLAMMATORY AGENTS


ACULAR (ketorolac tromethamine) T3

ACULAR LS (ketorolac tromethamine) T3

ACUVAIL T3 ALREX T3 bromfenac sodium T1 BROMSITE T3 dexamethasone 0.1% eye drop T1 diclofenac 0.1% eye drops T1 DUREZOL T3 FLAREX T3 fluorometholone (FML) T1 flurbiprofen sodium T1 FML (fluorometholone) T3 FML FORTE T3 FML S.O.P. T3 ILEVRO T3 ILUVIEN T4 SP INVELTYS T3 ketorolac 0.4% ophth solution (Acular LS) T1

ketorolac 0.5% ophth solution (Acular) T1

LOTEMAX T3 LOTEMAX (loteprednol etabonate) T3

LOTEMAX SM T3 loteprednol etabonate (Lotemax) T1 MAXIDEX T3 NEVANAC T3 OZURDEX T4 SP PRED FORTE (prednisolone acetate) T3

PRED MILD T3 prednisolone acetate (Pred Forte) T1

prednisolone sodium phosphate T1

PROLENSA T3 TRIESENCE T3

EYE IRRIGATIONS balanced salt irrig soln no.2 (BSS) T1

BSS (balanced salt) T3


104


EYE LOCAL ANESTHETICS


AKTEN T3 ALCAINE (proparacaine hcl) T3 ALTAFLUOR BENOX T3 FLUCAINE (fluorescein-proparacaine) T3

proparacaine hcl (Alcaine) T1 proparacaine/fluorescein sod (Flucaine) T1

tetracaine hcl T1 TETRAVISC T3 TETRAVISC FORTE T3

EYE MAST CELL STABILIZERS

cromolyn 4% eye drops T1

EYE MYDRIATIC AND NSAID COMBINATIONS

OMIDRIA T3

EYE PREPARATIONS, MISCELLANEOUS (OTC)

GELFILM T3

EYE VASOCONSTRICTORS

phenylephrine hcl T1

MIOTICS AND OTHER INTRAOCULAR PRESSURE REDUCERS

ALPHAGAN P T3 HD ALPHAGAN P (brimonidine tartrate) T3 HD

apraclonidine hcl T1 HD AZOPT T3 HD betaxolol hcl T1 HD BETIMOL T3 HD BETOPTIC S T3 HD bimatoprost T1 QL (10 gm/30 days) HD brimonidine tartrate T1 HD brimonidine tartrate (Alphagan P) T1 HD carteolol hcl T1 HD COMBIGAN T2 HD COSOPT (dorzolamide-timolol) T3 HD COSOPT PF (dorzolamide-timolol) T3 HD

dorzolamide hcl (Trusopt) T1 HD dorzolamide hcl/timolol maleat (Cosopt) T1 HD

dorzolamide/timolol/pf (Cosopt Pf) T1 HD


105


MIOTICS AND OTHER INTRAOCULAR PRESSURE REDUCERS


IOPIDINE T3 HD ISOPTO CARPINE (pilocarpine hcl) T3 HD

ISTALOL (timolol maleate) T3 HD latanoprost (Xalatan) T1 HD levobunolol hcl T1 HD MIOCHOL-E T3 HD MIOSTAT T3 HD PHOSPHOLINE IODIDE T3 HD pilocarpine hcl (Isopto Carpine) T1 HD RHOPRESSA T3 HD ROCKLATAN T3 HD SIMBRINZA T2 HD timolol maleate (Istalol) T1 HD timolol maleate (Timoptic) T1 HD timolol maleate (Timoptic-XE) T1 HD TIMOPTIC (timolol maleate) T3 HD TIMOPTIC OCUDOSE T3 HD TIMOPTIC-XE (timolol maleate) T3 HD

TRAVATAN Z (travoprost) T3 HD travoprost (Travatan Z) T1 HD TRUSOPT (dorzolamide hcl) T3 HD XALATAN (latanoprost) T3 HD XELPROS T3 HD ZIOPTAN T3 ST QL (2 boxes/30 days) HD

MYDRIATICS

atropine sulfate T1 HD atropine sulfate (Isopto Atropine) T1 HD

CYCLOGYL (cyclopentolate hcl) T3 HD

CYCLOMYDRIL T3 HD cyclopentolat/tropic/phenyleph T1 HD cyclopentolate hcl (Cyclogyl) T1 HD homatropine hbr T1 HD ISOPTO ATROPINE (atropine sulfate) T3 HD

MYDRIACYL (tropicamide) T3 HD PAREMYD T3 HD tropicamide T1 HD tropicamide (Mydriacyl) T1 HD


106


OPHTH VASC. ENDOTHELIAL GROWTH FACTOR ANTAGONISTS


EYLEA T4 PA SP MACUGEN T4 PA SP

OPHTH. VEGF-A RECEPTOR ANTAG. RCMB MC ANTIBODY

BEOVU T4 PA SP LUCENTIS T4 PA SP

OPHTHALMIC ANTIFIBROTIC AGENTS

MITOSOL T3

OPHTHALMIC ANTI-INFLAMMATORY IMMUNOMODULATOR-TYPE

CEQUA T3 HD RESTASIS T2 HD RESTASIS MULTIDOSE T2 HD XIIDRA T2 HD

OPHTHALMIC CYSTINE DEPLETING AGENTS

CYSTARAN T4 QL (120ml/28 days) SP

OPHTHALMIC HUMAN NERVE GROWTH FACTOR (HNGF)

OXERVATE T4 PA SP HD

OPHTHALMIC PREPARATIONS, MISCELLANEOUS

AMVISC T4 SP AMVISC PLUS T4 SP DISCOVISC T3 DUOVISC T3 hyaluronate sodium T4 SP VISCOAT T3

OPHTHALMIC PROTEOLYTIC ENZYME AGENTS

JETREA T4 PA SP

OPHTHALMIC SURGICAL AIDS

CELLUGEL (ocucoat) T3 hypromellose (Cellugel) T1 MEMBRANEBLUE T3 VISIONBLUE T3

ELECT/CALORIC/H2O (Dental Products)

FLUORIDE PREPARATIONS

CLINPRO 5000 (fluoridex) T3 fluoride (sodium) (Clinpro 5000) T1

fluoride (sodium) (Prevident 5000 Plus) T1


107

ELECT/CALORIC/H2O (Dental Products)

FLUORIDE PREPARATIONS


fluoride (sodium) (Prevident) T1 FLUORIDEX SENSITIVITY RELIEF T3

PREVIDENT T3 PREVIDENT (sodium fluoride) T3 PREVIDENT 5000 T3 PREVIDENT 5000 ENAMEL PROTECT T3

PREVIDENT 5000 PLUS (sodium fluoride 5000 plus) T3

PREVIDENT 5000 SENSITIVE T3

ELECT/CALORIC/H2O (Diabetes)

AGENTS TO TREAT HYPOGLYCEMIA (HYPERGLYCEMICS)

BAQSIMI T3 QL (2/30 days) GLUCAGEN 1 MG HYPOKIT T2 QL (2 pens/30 days) GLUCAGON 1 MG EMERGENCY KIT T2 QL (2 pens/30 days)

GLUCAGON 1 MG EMERGENCY KIT T3

GVOKE SYRINGE T3 QL (2 syrings/30 days) PROGLYCEM T3

ELECT/CALORIC/H2O (Miscellaneous)

BICARBONATE PRODUCING/CONTAINING AGENTS

sodium acetate T1 sodium bicarbonate T1 sodium bicarbonate in d5w T1

IV SOLUTIONS: DEXTROSE AND LACTATED RINGERS

dextrose 5%-lactated ringers T1

IV SOLUTIONS: DEXTROSE-SALINE

dextrose 10 % and 0.2 % nacl T1 dextrose 10 % and 0.45 % nacl T1 dextrose 2.5 % and 0.45 % nacl T1

dextrose 5 % and 0.3 % nacl T1 dextrose 5 % and 0.9 % nacl T1 dextrose 5 %-0.2 % sod chlorid T1 dextrose 5 %-0.45 % sod chlord T1

IV SOLUTIONS: DEXTROSE-WATER

dextrose 10 % in water T1 dextrose 20 % in water T1


108

ELECT/CALORIC/H2O (Miscellaneous)

IV SOLUTIONS: DEXTROSE-WATER


dextrose 25 % in water T1 dextrose 30 % in water T1 dextrose 40 % in water T1 dextrose 5 % in water T1 dextrose 50 % in water T1 dextrose 70 % in water T1

NUCLEIC ACID/NUCLEOTIDE SUPPLEMENTS

XURIDEN T4 PA SP

PARENTERAL AMINO ACID SOLUTIONS AND COMBINATIONS

AMINOSYN II T3 AMINOSYN-PF T3 CLINIMIX T3 CLINIMIX E T3 CLINISOL T3 FREAMINE HBC T3 FREAMINE III T3 HEPATAMINE T3 KABIVEN T3 NEPHRAMINE T3 PERIKABIVEN T3 plenamine 15% solution T1 PLENAMINE 15% SOLUTION T3 PREMASOL T3 PROCALAMINE T3 PROSOL T3 SYNTHAMIN 17 WITHOUT ELTYE T3

TRAVASOL T3 TROPHAMINE T3

ELECT/CALORIC/H2O (Nutritional/Dietary)

CALCIUM REPLACEMENT

calcium chloride T1 CALCIUM GLU 2,000MG/100ML-NACL T3

calcium gluc 1,000mg/50ml-nacl T1 calcium gluconate T1 calcium gluconate in 0.9% nacl T1

ELECTROLYTE DEPLETERS

AURYXIA T3 QL (12 tabs/day) calcium acetate T1


109


ELECTROLYTE DEPLETERS


FOSRENOL 1,000 MG POWDER PACK T2

FOSRENOL 1,000 MG TABLET CHEW (lanthanum carbonate)

T3

FOSRENOL 500 MG TABLET CHEW (lanthanum carbonate) T3

FOSRENOL 750 MG POWDER PACKET T2

FOSRENOL 750 MG TABLET CHEW (lanthanum carbonate) T3

lanthanum carbonate (Fosrenol) T1

LOKELMA T3 PHOSLYRA T3 RENAGEL (sevelamer hcl) T3 RENVELA (sevelamer carbonate) T3

sevelamer carbonate (Renvela) T1

sevelamer hcl T1 sevelamer hcl (Renagel) T1 sodium polystyrene sulfon/sorb T1 sodium polystyrene sulfonate T1 sps 15 gm/60 ml suspension T1 SPS 30 GM/120 ML ENEMA SUSP T3

VELPHORO T3 VELTASSA T3

ELECTROLYTE MAINTENANCE

electrolyte-48 solution/d5w T1 HYPERLYTE CR T3 IONOSOL MB-DEXTROSE 5% T3 ISOLYTE P WITH DEXTROSE T3 ISOLYTE S T3 NORMOSOL-M AND DEXTROSE T3

NORMOSOL-R T3 NORMOSOL-R AND DEXTROSE T3

NORMOSOL-R PH 7.4 T3 PLASMA-LYTE 148 T3 PLASMA-LYTE A PH 7.4 T3 ringer's solution T1 ringer's solution,lactated T1 TPN ELECTROLYTES T3


110


IODINE CONTAINING AGENTS


potassium iodide T1 potassium iodide/iodine T1

IRON REPLACEMENT

FERAHEME T3 FERRLECIT (sod ferric gluconate complex) T3

ferrous fum/vit c/b12-if/folic T1 INFED T3 INJECTAFER T3 iron ps complex/b12/folic acid T1 sodium ferric gluconat/sucrose (Ferrlecit) T1

TRIFERIC T3 PA VENOFER T3

MAGNESIUM SALTS REPLACEMENT

magnesium chloride T1 magnesium sulfate T1 magnesium sulfate in water T1 magnesium sulfate/d5w T1

MINERAL REPLACEMENT, MISCELLANEOUS

chromic chloride T1 cupric chloride T1 manganese chloride T1 manganese sulfate T1 multitrace-4 conc vial T1 multitrace-4 vial T1 MULTITRACE-4 VIAL T3 selenium T1 TRACE ELEMENTS-4 T3 zinc/copper/mangan/chrom/selen T1

PHOSPHATE REPLACEMENT

GLYCOPHOS T3 potassium phos,m-basic-d-basic T1

sod phosphate,monobasic-dibas T1

POTASSIUM REPLACEMENT EFFER-K 10 MEQ TABLET EFF T3

EFFER-K 20 MEQ TABLET EFF T3


111


POTASSIUM REPLACEMENT


effer-k 25 meq tablet eff T1 klor-con 10 meq tablet (K-Tab ER) T1

KLOR-CON 10 MEQ TABLET (potassium chloride) T3

klor-con 8 meq tablet (K-Tab ER) T1

KLOR-CON 8 MEQ TABLET (potassium chloride) T3

KLOR-CON M15 T3 K-TAB ER (potassium chloride) T3 potassium acetate T1 potassium bicarbonate/cit ac T1 potassium chloride T1 potassium chloride (K-Tab ER) T1 potassium chloride in 0.9%nacl T1 potassium chloride in d5w T1 potassium chloride in lr-d5 T1 potassium chloride in water T1 potassium chloride/d5-0.2%nacl T1

potassium chloride/d5-0.45nacl T1 potassium chloride/d5-0.9%nacl T1

potassium chloride-0.45% nacl T1 potassium cl/lido/0.9 % nacl T1

SODIUM/SALINE PREPARATIONS

0.9 % sodium chloride T1 sodium chloride T1 sodium chloride 0.45 % T1 sodium chloride 0.9 % (flush) T1 sodium chloride 3 % T1 sodium chloride 5 % T1 SWABFLUSH T3

ZINC REPLACEMENT

zinc chloride T1 zinc sulfate 10 mg/10 ml vial T1 zinc sulfate 25 mg/5 ml vial T1 ZINC SULFATE 30 MG/10 ML VIAL T3


112

ELECT/CALORIC/H2O (Urinary Tract Conditions)

DIALYSIS SOLUTIONS


DELFLEX WITH 1.5% DEXTROSE T3



DIANEAL PD-2 W-1.5% DEXTROSE T3



DIANEAL WITH 1.5% DEXTROSE T3



EXTRANEAL ICODEXTRIN DIALYSIS T3

PRISMASOL T3

URINARY PH MODIFIERS

K-PHOS NO.2 T3 HD K-PHOS ORIGINAL T3 HD ORACIT T3 HD potassium citrate (Urocit-K) T1 HD potassium citrate/citric acid T1 HD RENACIDIN T3 HD UROCIT-K (potassium citrate er) T3 HD

GASTROINTESTINAL (Cholesterol Medications)

LIPOTROPICS LOVAZA (omega-3 acid ethyl esters) T3 HD

omega-3 acid ethyl esters (Lovaza) T1 HD

VASCEPA T2 PA HD

GASTROINTESTINAL (Gastrointestinal/Heartburn)

AMMONIA INHIBITORS AMMONUL (sodium phenylacet-sod benzoate) T3 HD

BUPHENYL (sodium phenylbutyrate) T4 SP HD

lactulose T1 HD lactulose 10 gm/15 ml solution T1 HD


113


AMMONIA INHIBITORS


LITHOSTAT T3 HD RAVICTI T4 PA SP HD sodium benzoate/sod phenylacet (Ammonul) T1 HD

sodium phenylbutyrate (Buphenyl) T4 SP HD

ANTICHOLINERGICS, QUATERNARY AMMONIUM

chlordiazepoxide/clidinium br T1 CUVPOSA T3 GLYCATE (glycopyrrolate) T3 glycopyrrolate T1 glycopyrrolate (Glycate) T1 propantheline bromide T1

ANTICHOLINERGICS/ANTISPASMODICS

BENTYL (dicyclomine hcl) T3 dicyclomine hcl T1 dicyclomine hcl (Bentyl) T1

ANTIDIARRHEAL - G.I. CHLORIDE CHANNEL INHIBITORS

MYTESI T3

ANTIDIARRHEAL - TRYPTOPHAN HYDROXYLASE INHIBITOR

XERMELO T4 PA SP

ANTIDIARRHEALS

diphenoxylate hcl/atropine T1 diphenoxylate hcl/atropine (Lomotil) T1

LOMOTIL (diphenoxylate-atropine) T3

loperamide hcl T1 MOTOFEN T3 opium tincture T1 PA paregoric T1

ANTIEMETIC, CANNABINOID-TYPE

dronabinol T1

ANTIEMETIC/ANTIVERTIGO AGENTS

AKYNZEO 235-0.25 MG VIAL T3 PA AKYNZEO 300-0.5 MG CAPSULE T3 PA QL (4 caps/28 days)

ALOXI (palonosetron hcl) T3 PA aprepitant 125 mg capsule T1 QL (4 caps/28 days)


114


ANTIEMETIC/ANTIVERTIGO AGENTS


aprepitant 125-80-80 mg pack (Emend) T1 QL (12 caps/28 days)

aprepitant 40 mg capsule (Emend) T1 QL (1 cap/28 days)

aprepitant 80 mg capsule (Emend) T1 QL (8 caps/28 days)

BONJESTA T3 CINVANTI T3 PA DICLEGIS (doxylamine succ-pyridoxine hcl) T3

dimenhydrinate T1 doxylamine succinate/vit b6 (Diclegis) T1

EMEND 125 MG POWDER PACKET T3 PA QL (12 caps/28 days)

EMEND 150 MG VIAL (fosaprepitant dimeglumine) T3 PA

EMEND 40 MG CAPSULE (aprepitant) T3 PA QL (1 cap/28 days)

EMEND 80 MG CAPSULE (aprepitant) T3 PA QL (8 caps/28 days)

EMEND TRIPACK (aprepitant) T3 PA QL (12 caps/28 days) fosaprepitant dimeglumine (Emend) T1 PA

granisetron hcl T1 granisetron hcl/pf T1 ondansetron T1 ondansetron hcl T1 ondansetron hcl/pf T1 palonosetron hcl T1 PA palonosetron hcl (Aloxi) T1 PA prochlorperazine T1 prochlorperazine edisylate T1 prochlorperazine maleate T1 promethazine hcl T1 SANCUSO T3 PA QL (4 patches/30 days) scopolamine (Transderm-Scop) T1

SUSTOL T3 PA TIGAN T3 TIGAN (trimethobenzamide hcl) T3

TRANSDERM-SCOP (scopolamine) T3

trimethobenzamide hcl (Tigan) T1 VARUBI T3 PA QL (4 tabs/28 days)


115


ANTI-ULCER PREPARATIONS


CARAFATE 1 GM TABLET (sucralfate) T3 HD

CARAFATE 1 GM/10 ML SUSP (sucralfate) T2 HD

CYTOTEC (misoprostol) T3 HD misoprostol (Cytotec) T1 HD sucralfate (Carafate) T1 HD

ANTI-ULCER-H.PYLORI AGENTS

lansoprazole/amoxiciln/clarith T1 TALICIA T3

BELLADONNA ALKALOIDS

ANASPAZ (nulev) T3 HD atropine sulfate T1 HD atropine sulfate/0.9 %sod chlr T1 HD DONNATAL (phenobarbital-belladonna) T3 HD

DONNATAL (phenohytro) T3 HD hyoscyamine 0.125 mg odt (Anaspaz) T1 HD

hyoscyamine 0.125 mg tab sl (Levsin-SL) T1 HD

hyoscyamine 0.125 mg/5 ml elix T1 HD

hyoscyamine 0.125 mg/ml drop T1 HD hyoscyamine sulf 0.125 mg tab (Levsin) T1 HD

hyoscyamine sulfate T1 HD hyoscyamine sulfate (Anaspaz) T1 HD hyoscyamine sulfate (Levbid) T1 HD hyoscyamine sulfate (Levsin) T1 HD hyoscyamine sulfate (Levsin-SL) T1 HD

HYOSCYAMINE SULFATE 0.5 MG/ML T3 HD

LEVBID (symax-sr) T3 HD LEVSIN T3 HD LEVSIN (oscimin) T3 HD LEVSIN-SL (symax-sl) T3 HD methscopolamine bromide T1 HD phenobarb/hyoscy/atropine/scop (Donnatal) T1 HD

SYMAX DUOTAB T3 HD

BILE SALTS

ACTIGALL (ursodiol) T3 HD


116


BILE SALTS


CHENODAL T4 SP HD CHOLBAM T4 PA SP HD URSO (ursodiol) T3 HD URSO FORTE (ursodiol) T3 HD ursodiol (Actigall) T1 HD ursodiol (Urso Forte) T1 HD ursodiol (Urso) T1 HD

CHOLERETICS

KINEVAC T3

CHRONIC INFLAM. COLON DX, 5-A-SALICYLAT, RECTAL TX

CANASA (mesalamine) T3 mesalamine 1,000 mg supp (Canasa) T1

mesalamine 4 gm/60 ml enema (Sfrowasa) T1

mesalamine 4 gm/60 ml kit T1 SFROWASA (mesalamine) T3

DRUG TX-CHRONIC INFLAM. COLON DX, 5-AMINOSALICYLAT

APRISO (mesalamine er) T3 HD AZULFIDINE (sulfasalazine dr) T3 HD AZULFIDINE (sulfasalazine) T3 HD balsalazide disodium T1 HD LIALDA (mesalamine) T3 HD mesalamine T1 HD mesalamine (Apriso) T1 HD mesalamine 800 mg dr tablet T1 HD mesalamine dr 1.2 gm tablet (Lialda) T1 HD

PENTASA T2 HD sulfasalazine (Azulfidine) T1 HD

FARNESOID X RECEPTOR (FXR) AGONIST, BILE AC ANALOG

OCALIVA T4 PA SP HD

GASTRIC ENZYMES

SUCRAID T4 PA SP

HISTAMINE H2-RECEPTOR INHIBITORS

cimetidine hcl T1 HD famotidine T1 HD nizatidine T1 HD ranitidine hcl T1 HD


117


IBS AGENTS, MIXED OPIOID RECEP AGONISTS/ANTAGONISTS


VIBERZI T3 HD

IBS-C/CIC AGENTS, GUANYLATE CYCLASE-C AGONIST

LINZESS T2 TRULANCE T2

INTEGRIN RECEPTOR ANTAGONIST, MONOCLONAL ANTIBODY

ENTYVIO T4 PA SP HD

INTESTINAL MOTILITY STIMULANTS

metoclopramide hcl T1 metoclopramide hcl (Reglan) T1 MOTEGRITY T3 REGLAN (metoclopramide hcl) T3

IRRITABLE BOWEL SYNDROME AGENTS, 5-HT3 ANTAGONIST

alosetron hcl T4 SP HD

IV FAT EMULSIONS

CLINOLIPID T3 INTRALIPID T3 NUTRILIPID T3 OMEGAVEN T3 SMOFLIPID T3

LAXATIVES AND CATHARTICS

AMITIZA T2 bisac/nacl/nahco3/kcl/peg 3350 T1 PPACA

CLENPIQ T2 PPACA KRISTALOSE T3 KRISTALOSE (lactulose) T3 lactulose T1 lactulose 10 gm packet (Kristalose) T1

lactulose 10 gm/15 ml solution T1 lactulose 20 gm/30 ml solution T1 peg3350/sod sulf,bicarb,cl/kcl T1 PPACA PREPOPIK T2 PPACA sodium chloride/nahco3/kcl/peg T1 PPACA

SUPREP T2 PPACA

LOCAL ANORECTAL NITRATE PREPARATIONS

RECTIV T3


118


PANCREATIC ENZYMES


CREON T2 HD PANCREAZE T3 HD PERTZYE T3 HD VIOKACE T3 HD ZENPEP T2 HD

PROTON-PUMP INHIBITORS

NEXIUM DR 10 MG PACKET T2 QL (120 packs/30 days) HD NEXIUM DR 2.5 MG PACKET T2 QL (480 packs/30 days) HD NEXIUM DR 20 MG PACKET T2 QL (2 packs/day) HD NEXIUM DR 40 MG PACKET T2 QL (30 packs/30 days) HD NEXIUM DR 5 MG PACKET T2 QL (240 packs/30 days) HD

RECTAL PREPARATIONS

hydrocortisone acetate T1

SBS - GLUCAGON-LIKE PEPTIDE-2 (GLP-2) ANALOGS

GATTEX T4 PA SP HD

GASTROINTESTINAL (Pain Relief And Inflammatory Disease)

HEMORRHOID PREP, ANTI-INFLAM STEROID-LOCAL ANESTHET ANALPRAM HC (hydrocortisone-pramoxine) T3

hydrocortisone/lidocaine/aloe T1 hydrocortisone/pramoxine (Analpram HC) T1

lidocaine/hydrocortisone ac T1 PROCORT T3 PROCTOFOAM-HC T3

GASTROINTESTINAL (Skin Conditions)

KERATINOCYTE GROWTH FACTOR (KGF)

KEPIVANCE T4 SP

HORMONES (Gastrointestinal/Heartburn)

RECTAL/LOWER BOWEL PREP., GLUCOCORT. (NON-HEMORR)

CORTENEMA (hydrocortisone) T3 hydrocortisone (Cortenema) T1

HORMONES (Hormonal Agents)

ADRENOCORTICOTROPHIC HORMONES

ACTHAR T4 PA SP HD ACTHREL T4 SP cosyntropin T1


119


ANDROGEN/ESTROGEN PREPS FOR FEMALE SEXUAL DYSFUNC


INTRAROSA T3

ANDROGENIC AGENTS

ANDRODERM T3 PA QL (1 patch/day) ANDROGEL 1%(2.5G) GEL PACKET (testosterone) T3 PA QL (150gm/30 days)

ANDROGEL 1%(5G) GEL PACKET (testosterone) T3 PA QL (2 packs/day)

ANDROGEL 1.62% GEL PUMP (testosterone) T3 PA QL (150gm/30 days)

ANDROGEL 1.62%(1.25G) GEL PCKT (testosterone) T3 PA QL (2 packs/day)

ANDROGEL 1.62%(2.5G) GEL PCKT (testosterone) T3 PA QL (150gm/30 days)

AVEED T4 PA SP DEPO-TESTOSTERONE (testosterone cypionate) T3

JATENZO T3 methyltestosterone T1 STRIANT T3 PA QL (2/day) TESTOPEL T3 PA testosterone 1.62% (2.5 g) pkt (Androgel) T1 PA QL (150gm/30 days)

testosterone 1.62% gel pump (Androgel) T1 PA QL (150gm/30 days)

testosterone 1.62%(1.25 g) pkt (Androgel) T1 PA QL (2 packs/day)

testosterone 10 mg gel pump T1 PA QL (120 gm/30 days) testosterone 12.5 mg/1.25 gram T1 PA QL (150gm/30 days)

testosterone 25 mg/2.5 gm pkt (Androgel) T1 PA QL (150gm/30 days)

testosterone 30 mg/1.5 ml pump T1 PA QL (180ml/30 days)

testosterone 50 mg/5 gram gel T1 PA QL (2 tubes/day) testosterone 50 mg/5 gram pkt (Androgel) T1 PA QL (2 packs/day)

testosterone cypionate (Depo-testosterone) T1

testosterone enanthate T1

ANTIDIURETIC AND VASOPRESSOR HORMONES

desmopressin 0.01% solution T1 desmopressin 0.01% spray T1 desmopressin 10 mcg/0.1 ml spr T1

desmopressin 40 mcg/10 ml vial T4 SP

desmopressin ac 4 mcg/ml ampul T4 SP


120


ANTIDIURETIC AND VASOPRESSOR HORMONES


desmopressin ac 4 mcg/ml vial T4 SP desmopressin acetate 0.1 mg tb T1

desmopressin acetate 0.2 mg tb T1

NOCTIVA T3 PA STIMATE T4 SP VASOSTRICT T3

ESTROGEN AND PROGESTIN COMBINATIONS

BIJUVA T3 HD

ESTROGEN/ANDROGEN COMBINATIONS

estrogen, ester/me-testosterone T1 HD

ESTROGENIC AGENTS

ACTIVELLA (mimvey) T3 HD ALORA (estradiol) T3 QL (16 patches/28 days) HD CLIMARA (estradiol) T3 HD CLIMARA PRO T3 HD COMBIPATCH T3 HD DELESTROGEN T3 HD DELESTROGEN (estradiol valerate) T3 HD

DEPO-ESTRADIOL T3 HD DIVIGEL T3 HD ELESTRIN T3 HD ESTRACE (estradiol) T3 HD estradiol (Vivelle-dot) T1 QL (16 patches/28 days) HD estradiol 0.025 mg patch (Vivelle-Dot) T1 QL (16 patches/28 days) HD

estradiol 0.0375 mg patch (Vivelle-Dot) T1 QL (16 patches/28 days) HD

estradiol 0.0375 mg/day patch (Climara) T1 HD






estradiol 0.5 mg tablet (Estrace) T1 HD

estradiol 1 mg tablet (Estrace) T1 HD


121


ESTROGENIC AGENTS


estradiol 2 mg tablet (Estrace) T1 HD estradiol tds 0.025 mg/day (Climara) T1 HD

estradiol tds 0.0375 mg/day (Climara) T1 HD





estradiol valerate (Delestrogen) T1 HD

estradiol/norethindrone acet T1 HD estradiol/norethindrone acet (Activella) T1 HD

ESTROGEL T3 HD EVAMIST T3 HD FEMHRT (norethindron-ethinyl estradiol) T3 HD

MENEST T3 HD MENOSTAR T3 QL (8 patches/28 days) HD MINIVELLE (estradiol) T3 QL (16 patches/28 days) HD norethind-eth estrad 0.5-2.5 (Femhrt) T1 HD

norethindrone ac-eth estradiol T1 HD norethindrone ac-eth estradiol (Femhrt) T1 HD

norethin-eth estrad 1 mg-5 mcg T1 HD

PREFEST T3 HD PREMARIN T2 HD PREMPHASE T2 HD PREMPRO T2 HD VIVELLE-DOT (estradiol) T3 QL (16 patches/28 days) HD

ESTROGEN-PROGESTIN WITH ANTIMINERALOCORTICOID COMB

ANGELIQ T3 HD

ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MOD (SERM) COMB

DUAVEE T2

GLUCOCORTICOIDS BETA 1 (readysharp betamethasone) T3

betamethasone acetate, sod phos (Beta 1) T1


122


GLUCOCORTICOIDS


betamethasone acetate, sod phos (Celestone) T1

budesonide T1 PA QL (56 tabs/180 days) budesonide (Entocort EC) T1 CELESTONE (betamethasone sod phos-acetate) T3

CORTEF (hydrocortisone) T3 cortisone acetate T1 DEPO-MEDROL T3 DEPO-MEDROL (methylprednisolone acetate) T3

dexamethasone T1 DEXAMETHASONE 10 MG/ML SYRING T3

dexamethasone 10 mg/ml vial T1 dexamethasone 100 mg/10 ml vl T1

dexamethasone 120 mg/30 ml vl T1

dexamethasone 20 mg/5 ml vial T1

dexamethasone 4 mg/ml syringe T1

dexamethasone 4 mg/ml vial T1 EMFLAZA T4 PA SP HD ENTOCORT EC (budesonide ec) T3

hydrocortisone (Cortef) T1 KENALOG-10 T3 KENALOG-40 (triamcinolone acetonide) T3

KENALOG-80 T3 MEDROL T3 MEDROL (methylprednisolone) T3 MEDROLOAN II SUIK (p-care d80g) T3

me-prednis/norfluran/hfc 245fa (Medroloan II Suik) T1

methylprednisolone (Medrol) T1 methylprednisolone acetate (Depo-Medrol) T1

methylprednisolone sod succ T1 methylprednisolone sod succ (Solu-Medrol) T1

ORAPRED ODT (prednisolone sodium phos odt) T3

PEDIAPRED (prednisolone sodium phosphate) T3


123


GLUCOCORTICOIDS


prednisolone T1 prednisolone sodium phosphate T1

prednisolone sodium phosphate (Orapred ODT) T1

prednisolone sodium phosphate (Pediapred) T1

prednisone T1 PRO-C-DURE 5 (p-care k80) T3 PRO-C-DURE 6 T3 SOLU-CORTEF T3 SOLU-MEDROL T3 SOLU-MEDROL (methylprednisolone sodium succ)

T3

triamcinolone acetonide (Kenalog-40) T1

triamcinolone acetonide (Pro-C-Dure 5) T1

ZILRETTA T3 PA

GROWTH HORMONES

HUMATROPE T4 PA SP HD NORDITROPIN FLEXPRO T4 PA SP HD SEROSTIM T4 PA SP HD ZORBTIVE T4 PA SP HD

LHRH (GNRH) AGONIST ANALOG AND PROGESTIN COMB

LUPANETA PACK T4 PA SP HD

LHRH (GNRH) AGONIST ANALOG PITUITARY SUPPRESSANTS

LUPRON DEPOT T4 PA SP HD SYNAREL T4 PA SP HD

LHRH (GNRH) ANTAGONIST, PITUITARY SUPPRESSANT AGENTS

CETROTIDE T4 PA SP ganirelix acet 250 mcg/0.5 ml (Ganirelix Acetate) T4 PA SP

GANIRELIX ACET 250 MCG/0.5 ML (ganirelix acetate) T4 PA SP

ORILISSA 150 MG TABLET T2 PA QL (24 months of treament/lifetime)

ORILISSA 200 MG TABLET T2 PA QL (6 months theapy/lifetime)

LHRH (GNRH) AGNST PIT.SUP-CENTRAL PRECOCIOUS PUBERTY

LUPRON DEPOT-PED T4 PA SP HD SUPPRELIN LA T4 PA SP HD TRIPTODUR T4 PA SP


124


MINERALOCORTICOIDS


fludrocortisone acetate T1 HD

OXYTOCICS

carboprost tromethamine T1 CERVIDIL T3 HEMABATE T3 methylergonovine maleate T1 oxytocin (Pitocin) T1 oxytocin/0.9 % sodium chloride T1 oxytocin/ringer's lactate T1 PITOCIN (oxytocin) T3 PREPIDIL T3 PROSTIN E2 VAGINAL SUPPOSITORY T3

PARATHYROID HORMONES

NATPARA T4 PA SP HD

PITUITARY SUPPRESSIVE AGENTS

cabergoline T1 QL (16 tabs/28 days) HD danazol T1 HD

PROGESTATIONAL AGENTS AYGESTIN (norethindrone acetate) T3 HD

DEPO-PROVERA 400 MG/ML VIAL T2 HD

hydroxyprogesterone 1.25 g/5ml T4 SP HD

medroxyprogesterone 10 mg tab (Provera) T1 HD

medroxyprogesterone 2.5 mg tab T1 HD

medroxyprogesterone 5 mg tab (Provera) T1 HD

norethindrone acetate (Aygestin) T1 HD

progesterone 100 mg capsule (Prometrium) T1 HD

progesterone 200 mg capsule (Prometrium) T1 HD

progesterone 500 mg/10 ml vial T4 SP HD

PROMETRIUM (progesterone) T3 HD PROVERA (medroxyprogesterone acetate)

T3 HD

RENIN-ANGIOTENSIN-ALDOSTERONE SYS. (RAAS) HORMONES

GIAPREZA T4 SP


125


SOMATOSTATIC AGENTS


octreotide acetate T4 PA SP HD SANDOSTATIN 0.05 MG/ML AMPUL T4 PA SP HD

SANDOSTATIN 0.1 MG/ML AMPUL T4 PA SP HD

SANDOSTATIN 0.5 MG/ML AMPUL T4 PA SP HD

SANDOSTATIN LAR DEPOT T4 PA SP SIGNIFOR T4 PA SP HD SIGNIFOR LAR T4 PA SP HD SOMATULINE DEPOT T4 PA SP HD

VAGINAL ESTROGEN FOR SEXUAL DYSFUNCTION IMVEXXY 10 MCG MAINTENANCE PAK T3 QL (16/28 days) HD

IMVEXXY 10 MCG STARTER PACK T3 QL (36/28 days) HD

IMVEXXY 4 MCG MAINTENANCE PACK T3 QL (16/28 days) HD

IMVEXXY 4 MCG STARTER PACK T3 QL (36/28 days) HD

VAGINAL ESTROGEN PREPARATIONS

ESTRACE (estradiol) T3 HD estradiol (Vagifem) T1 QL (36 tabs/28 days) HD estradiol 0.01% cream (Estrace) T1 HD

estradiol 10 mcg vaginal insrt (Vagifem) T1 QL (36 tabs/28 days) HD

ESTRING T3 QL (2 rings/90 days) HD FEMRING T3 HD PREMARIN T2 HD VAGIFEM (yuvafem) T3 QL (36 tabs/28 days) HD

HORMONES (Infertility)

FERTILITY STIMULATING PREPARATIONS, NON-FSH

clomiphene citrate T1

FOLLICLE-STIMULATING AND LUTEINIZING HORMONES

MENOPUR T4 PA SP

FOLLICLE-STIMULATING HORMONE (FSH)

FOLLISTIM AQ T4 PA SP GONAL-F T4 PA SP GONAL-F RFF T4 PA SP GONAL-F RFF REDI-JECT T4 PA SP


126

HORMONES (Infertility)

HUMAN CHORIONIC GONADOTROPIN (HCG)


chorionic gonadotropin, human (Pregnyl) T4 PA SP

NOVAREL T4 PA SP NOVAREL (chorionic gonadotropin) T4 PA SP

OVIDREL T4 PA SP PREGNYL (chorionic gonadotropin) T4 PA SP

PREGNANCY FACILITATING/MAINTAINING AGENT, HORMONAL

CRINONE T3 ENDOMETRIN T3

PREGNANCY MAINTAINING AGENT, HORMONAL hydroxyprogest 1,250 mg/5 ml (Makena) T4 PA SP

hydroxyprogest 250 mg/ml vial (Makena) T4 PA SP

MAKENA T4 PA SP MAKENA (hydroxyprogesterone caproate)

T4 PA SP

HORMONES (Miscellaneous)

LEPTIN HORMONE ANALOGS

MYALEPT T4 PA SP HD

HORMONES (Osteoporosis Products)

BONE FORMATION STIMULATING AGTS - PTH REL PEPTIDES

TYMLOS T4 PA QL (1 pen/30 days) SP HD

BONE RESORPTION INHIBITORS

calcitonin, salmon, synthetic T1 HD MIACALCIN T3 HD

IMMUNOSUPPRESSANTS (Miscellaneous)

IMMUNOSUPPRESSANT-INTERFERON GAMMA INHIBITOR, MAB

GAMIFANT T4 PA SP

IMMUNOSUPPRESSANTS (Pain Relief And Inflammatory Disease)

INTERLEUKIN-4 (IL-4) RECEPTOR ALPHA ANTAGONIST, MAB

DUPIXENT T4 PA SP HD

INTERLEUKIN-6 (IL-6) RECEPTOR INHIBITORS ACTEMRA 162 MG/0.9 ML SYRINGE T4 PA QL (4 syringes/28 days)

SP HD


127

IMMUNOSUPPRESSANTS (Pain Relief And Inflammatory Disease)

INTERLEUKIN-6 (IL-6) RECEPTOR INHIBITORS


ACTEMRA 200 MG/10 ML VIAL T4 PA SP HD



ACTEMRA ACTPEN T4 PA QL (4 pens/28 days) SP HD

KEVZARA 150 MG/1.14 ML PEN INJ T4 PA QL (2 pens/28 days) SP

HD KEVZARA 150 MG/1.14 ML SYRINGE T4 PA QL (2 syrings/28 days) SP

HD KEVZARA 200 MG/1.14 ML PEN INJ T4 PA QL (2 pens/28 days) SP

HD KEVZARA 200 MG/1.14 ML SYRINGE T4 PA QL (2 syrings/28 days) SP

HD MONOCLONAL ANTIBODY-HUMAN INTERLEUKIN 12/23 INHIB

STELARA 130 MG/26 ML VIAL T4 PA SP HD STELARA 45 MG/0.5 ML SYRINGE T4 PA QL (1 syringe/84 days) SP

HD STELARA 45 MG/0.5 ML VIAL T4 PA QL (1 vial/84 days) SP HD STELARA 90 MG/ML SYRINGE T4 PA QL (1 syringe/84 days) SP

HD IMMUNOSUPPRESSANTS (Skin Conditions)

TOPICAL IMMUNOSUPPRESSIVE AGENTS

ELIDEL (pimecrolimus) T3 pimecrolimus (Elidel) T1 PROTOPIC (tacrolimus) T3 tacrolimus 0.03% ointment (Protopic) T1

tacrolimus 0.1% ointment (Protopic) T1

IMMUNOSUPPRESSANTS (Transplant Medications)

IMMUNOSUPP - MONOCLONAL AB INHIBITING T LYMPH FXN

SIMULECT T4 SP

IMMUNOSUPPRESSIVES

ASTAGRAF XL T4 SP HD AZASAN T4 SP HD azathioprine (Imuran) T4 SP HD azathioprine sodium T1 CELLCEPT 200 MG/ML ORAL SUSP (mycophenolate mofetil) T4 SP HD

CELLCEPT 250 MG CAPSULE (mycophenolate mofetil)

T4 SP HD


128


IMMUNOSUPPRESSIVES


CELLCEPT 500 MG TABLET (mycophenolate mofetil) T4 SP HD

CELLCEPT 500 MG VIAL (mycophenolate mofetil) T4 SP

cyclosporine 100 mg capsule (Sandimmune) T4 SP HD

cyclosporine 25 mg capsule (Sandimmune) T4 SP HD

cyclosporine 250 mg/5 ml ampul (Sandimmune) T4 SP

cyclosporine, modified T4 SP HD cyclosporine, modified (Neoral) T4 SP HD ENVARSUS XR T4 SP HD IMURAN (azathioprine) T4 SP HD mycophenolate 200 mg/ml susp (Cellcept) T4 SP HD

mycophenolate 250 mg capsule (Cellcept) T4 SP HD

mycophenolate 500 mg tablet (Cellcept) T4 SP HD

mycophenolate 500 mg vial (Cellcept) T4 SP

mycophenolate sodium (Myfortic) T4 SP HD

MYFORTIC (mycophenolic acid) T4 SP HD

NEORAL (gengraf) T4 SP HD NULOJIX T4 SP PROGRAF 0.2 MG GRANULE PACKET T4 SP HD

PROGRAF 0.5 MG CAPSULE (tacrolimus) T4 SP HD

PROGRAF 1 MG CAPSULE (tacrolimus) T4 SP HD

PROGRAF 1 MG GRANULE PACKET T4 SP HD

PROGRAF 5 MG CAPSULE (tacrolimus) T4 SP HD

PROGRAF 5 MG/ML AMPULE T4 SP RAPAMUNE (sirolimus) T4 SP HD SANDIMMUNE 100 MG CAPSULE (cyclosporine) T4 SP HD

SANDIMMUNE 100 MG/ML SOLN T4 SP HD

SANDIMMUNE 25 MG CAPSULE (cyclosporine) T4 SP HD

SANDIMMUNE 50 MG/ML AMPUL (cyclosporine) T4 SP

sirolimus (Rapamune) T4 SP HD


129


IMMUNOSUPPRESSIVES


tacrolimus 0.5 mg capsule (Prograf) T4 SP HD

tacrolimus 1 mg capsule (Prograf) T4 SP HD

tacrolimus 5 mg capsule (Prograf) T4 SP HD

ZORTRESS T4 SP HD

MISCELLANEOUS MEDICAL SUPPLIES, DEVICES, NON-DRUG (Diabetes)

DIABETIC SUPPLIES

V-GO 20 T2 V-GO 30 T2 V-GO 40 T2

MUSCLE RELAXANTS (Pain Relief And Inflammatory Disease)

SKELETAL MUSCLE RELAXANTS

baclofen T1 baclofen (Gablofen) T1 carisoprodol (Soma) T1 carisoprodol/aspirin T1 chlorzoxazone T1 cyclobenzaprine hcl T1 cyclobenzaprine hcl (Fexmid) T1 DANTRIUM (dantrolene sodium) T3

DANTRIUM (revonto) T3 dantrolene sodium T1 dantrolene sodium (Dantrium) T1 FEXMID (cyclobenzaprine hcl) T3 GABLOFEN T3 GABLOFEN (baclofen) T3 LIORESAL INTRATHECAL T3 metaxalone T1 metaxalone (Skelaxin) T1 methocarbamol T1 methocarbamol (Robaxin) T1 methocarbamol (Robaxin-750) T1 NORGESIC FORTE (orphengesic forte) T3

orphenadrine citrate T1 orphenadrine/aspirin/caffeine (Norgesic Forte) T1

OZOBAX T3


130

MUSCLE RELAXANTS (Pain Relief And Inflammatory Disease)

SKELETAL MUSCLE RELAXANTS


ROBAXIN (methocarbamol) T3 ROBAXIN-750 (methocarbamol) T3

RYANODEX T3 SKELAXIN (metaxalone) T3 SOMA (carisoprodol) T3 tizanidine hcl T1 tizanidine hcl (Zanaflex) T1 ZANAFLEX (tizanidine hcl) T3

PRE-NATAL VITAMINS (Nutritional/Dietary)

PRENATAL VITAMIN PREPARATIONS

CITRANATAL 90 DHA T3 CITRANATAL ASSURE T3 CITRANATAL DHA T3 CITRANATAL HARMONY T3 CITRANATAL RX T3 OBSTETRIX EC T3 OBTREX DHA (obstetrix dha) T3 pnv 66/iron/folic/docusate/dha T1 pnv 69/iron/folic/docusate/dha T1 pnv 80/iron fum/folic/dss/dha T1 pnv/ferrous fum/docusate/folic T1 pnv/iron,carb/docusat/folic ac T1 prenat 115/iron fum/folic/dss T1 prenatal 12/iron/folic/dss/om3 (Obtrex DHA) T1

prenatal vit/iron bisgly/folic T1 prenatal vits15/iron/folic/dss T1 VITAFOL FE+ T3 VIVA DHA T3

PSYCHOTHERAPEUTIC DRUGS (Anxiety/Depression/Bipolar Disorder)

ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS

mirtazapine T1 HD mirtazapine (Remeron) T1 HD REMERON (mirtazapine) T3 HD

ANTI-ANXIETY - BENZODIAZEPINES

alprazolam T1 alprazolam (Xanax XR) T1 alprazolam (Xanax) T1


131


ANTI-ANXIETY - BENZODIAZEPINES


chlordiazepoxide hcl T1 clorazepate dipotassium T1 clorazepate dipotassium (Tranxene T-Tab) T1

diazepam 10 mg tablet (Valium) T1

diazepam 10 mg/2 ml carpuject T1 diazepam 10 mg/2 ml syringe T1 diazepam 2 mg tablet (Valium) T1 diazepam 5 mg tablet (Valium) T1 diazepam 5 mg/5 ml solution T1 diazepam 5 mg/ml oral conc T1 diazepam 50 mg/10 ml vial T1 lorazepam T1 oxazepam T1 TRANXENE T-TAB (clorazepate dipotassium) T3

VALIUM (diazepam) T3 XANAX (alprazolam) T3 XANAX XR (alprazolam xr) T3

ANTI-ANXIETY DRUGS

buspirone hcl T1 meprobamate T1

ANTIDEPRESSANT - NMDA RECEPTOR ANTAGONIST

SPRAVATO T4 PA SP

BIPOLAR DISORDER DRUGS

EQUETRO T3 HD lithium carbonate T1 HD lithium carbonate (Lithobid) T1 HD lithium citrate T1 HD LITHOBID (lithium carbonate er) T3 PA HD

MAOIS -NON-SELECTIVE, IRREVERSIBLE ANTIDEPRESSANTS

MARPLAN T3 QL (12 tabs/day) NARDIL (phenelzine sulfate) T3 phenelzine sulfate (Nardil) T1 tranylcypromine sulfate T1

MONOAMINE OXIDASE (MAO) INHIBITOR ANTIDEPRESSANTS EMSAM 12 MG/24 HOURS PATCH T3 QL (1 patch/day)


132


MONOAMINE OXIDASE (MAO) INHIBITOR ANTIDEPRESSANTS


EMSAM 6 MG/24 HOURS PATCH T3 QL (2 patches/day)

EMSAM 9 MG/24 HOURS PATCH T3 QL (1 patch/day)

NOREPINEPHRINE AND DOPAMINE REUPTAKE INHIB (NDRIS)

bupropion hcl 100 mg tablet T1 QL (4 tabs/day) HD bupropion hcl 75 mg tablet T1 QL (6 tabs/day) HD bupropion hcl sr 100 mg tablet (Wellbutrin SR) T1 QL (4 tabs/day) HD

bupropion hcl sr 150 mg tablet (Wellbutrin SR) T1 QL (2 tabs/day) HD

bupropion hcl sr 200 mg tablet (Wellbutrin SR) T1 QL (2 tabs/day) HD

bupropion hcl xl 150 mg tablet T1 QL (3 tabs/day) HD bupropion hcl xl 300 mg tablet T1 QL (1 tab/day) HD bupropion hcl xl 450 mg tablet (Forfivo XL) T1 QL (1 tab/day) HD

FORFIVO XL (bupropion xl) T3 ST QL (1 tab/day) HD WELLBUTRIN SR 100 MG TABLET (bupropion hcl sr) T3 ST QL (4 tabs/day) HD

WELLBUTRIN SR 150 MG TABLET (bupropion hcl sr) T3 ST QL (2 tabs/day) HD

WELLBUTRIN SR 200 MG TABLET (bupropion hcl sr) T3 ST QL (2 tabs/day) HD

SELECTIVE SEROTONIN 5-HT2A INVERSE AGONISTS (SSIA)

NUPLAZID T4 PA SP HD

SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS) CELEXA 10 MG TABLET (citalopram hbr) T3 ST QL (6 tabs/day) HD

CELEXA 20 MG TABLET (citalopram hbr) T3 ST QL (3 tabs/day) HD

CELEXA 40 MG TABLET (citalopram hbr) T3 ST QL (1 tab/day) HD

citalopram hbr 10 mg tablet (Celexa) T1 QL (6 tabs/day) HD

citalopram hbr 10 mg/5 ml soln T1 QL (30ml/day) HD citalopram hbr 20 mg tablet (Celexa) T1 QL (3 tabs/day) HD

citalopram hbr 20 mg/10 ml sol T1 QL (30ml/day) HD citalopram hbr 40 mg tablet (Celexa) T1 QL (1 tab/day) HD

escitalopram 10 mg tablet T1 QL (2 tabs/day) HD escitalopram 20 mg tablet T1 QL (1 tab/day) HD escitalopram 5 mg tablet T1 QL (4 tabs/day) HD escitalopram oxalate 5 mg/5 ml T1 QL (20ml/day) HD fluoxetine 20 mg/5 ml solution T1 QL (20ml/day) HD


133


SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS)


fluoxetine hcl T1 QL (4 caps/28 days) HD fluoxetine hcl 10 mg capsule (Prozac) T1 QL (8 caps/day) HD

fluoxetine hcl 10 mg tablet (Sarafem) T1 HD

fluoxetine hcl 20 mg capsule (Prozac) T1 QL (4 caps/day) HD

fluoxetine hcl 20 mg tablet (Sarafem) T1 HD

fluoxetine hcl 40 mg capsule (Prozac) T1 QL (2 caps/day) HD

fluoxetine hcl 60 mg tablet T1 QL (1 tab/day) HD fluvoxamine er 100 mg capsule T1 QL (3 caps/day) HD fluvoxamine er 150 mg capsule T1 QL (2 caps/day) HD fluvoxamine maleate 100 mg tab T1 QL (3 tabs/day) HD

fluvoxamine maleate 25 mg tab T1 QL (12 tabs/day) HD fluvoxamine maleate 50 mg tab T1 QL (6 tabs/day) HD paroxetine cr 12.5 mg tablet (Paxil CR) T1 QL (6 tabs/day) HD

paroxetine cr 25 mg tablet (Paxil CR) T1 QL (3 tabs/day) HD

paroxetine cr 37.5 mg tablet (Paxil CR) T1 QL (2 tabs/day) HD

paroxetine er 12.5 mg tablet (Paxil CR) T1 QL (1 tab/day) HD

paroxetine er 25 mg tablet (Paxil CR) T1 QL (3 tabs/day) HD

paroxetine er 37.5 mg tablet (Paxil CR) T1 QL (2 tabs/day) HD

paroxetine hcl 10 mg tablet (Paxil) T1 QL (6 tabs/day) HD



paroxetine hcl 40 mg tablet (Paxil) T1 QL (1 tab/day) HD

PAXIL 10 MG TABLET (paroxetine hcl) T3 ST QL (6 tabs/day) HD

PAXIL 10 MG/5 ML SUSPENSION T3 ST QL (30ml/day) HD



PAXIL 40 MG TABLET (paroxetine hcl) T3 ST QL (1 tab/day) HD

PAXIL CR 12.5 MG TABLET (paroxetine er) T3 ST QL (1 tab/day) HD


134


SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS)


PAXIL CR 25 MG TABLET (paroxetine er) T3 ST QL (3 tabs/day) HD

PAXIL CR 37.5 MG TABLET (paroxetine er) T3 ST QL (2 tabs/day) HD

PROZAC 10 MG PULVULE (fluoxetine hcl) T3 ST QL (8 caps/day) HD



SARAFEM T3 ST HD SARAFEM (fluoxetine hcl) T3 ST HD sertraline 20 mg/ml oral conc (Zoloft) T1 QL (10ml/day) HD

sertraline hcl 100 mg tablet (Zoloft) T1 QL (2 tabs/day) HD



ZOLOFT 100 MG TABLET (sertraline hcl) T3 ST QL (2 tabs/day) HD

ZOLOFT 20 MG/ML ORAL CONC (sertraline hcl) T3 ST QL (10ml/day) HD



SEROTONIN-2 ANTAGONIST/REUPTAKE INHIBITORS (SARIS)

nefazodone hcl T1 HD trazodone hcl T1 HD

SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) DESVENLAFAXINE ER 100 MG TAB T3 ST QL (4 tabs/day) HD

DESVENLAFAXINE ER 50 MG TAB T3 ST QL (8 tabs/day) HD

desvenlafaxine suc er 100 mg T1 QL (2 tabs/day) HD desvenlafaxine suc er 25 mg tb T1 QL (16 tabs/day) HD desvenlafaxine suc er 50 mg tb T1 QL (8 tabs/day) HD duloxetine hcl dr 20 mg cap T1 QL (6 caps/day) HD duloxetine hcl dr 30 mg cap T1 QL (4 caps/day) HD duloxetine hcl dr 40 mg cap T1 QL (3 caps/day) HD duloxetine hcl dr 60 mg cap T1 QL (2 caps/day) HD EFFEXOR XR 150 MG CAPSULE (venlafaxine hcl er) T3 ST QL (2 caps/day) HD

EFFEXOR XR 37.5 MG CAPSULE (venlafaxine hcl er) T3 ST QL (8 caps/day) HD


135


SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS)


EFFEXOR XR 75 MG CAPSULE (venlafaxine hcl er) T3 ST QL (4 caps/day) HD

FETZIMA 20-40 MG TITRATION PAK T3 ST QL (28 caps/180 days)

HD FETZIMA ER 120 MG CAPSULE T3 ST QL (1 cap/day) HD

FETZIMA ER 20 MG CAPSULE T3 ST QL (6 caps/day) HD

FETZIMA ER 40 MG CAPSULE T3 ST QL (3 caps/day) HD

FETZIMA ER 80 MG CAPSULE T3 ST QL (1 cap/day) HD

venlafaxine hcl 100 mg tablet T1 QL (3 tabs/day) HD venlafaxine hcl 25 mg tablet T1 QL (15 tabs/day) HD venlafaxine hcl 37.5 mg tablet T1 QL (10 tabs/day) HD venlafaxine hcl 50 mg tablet T1 QL (7 tabs/day) HD venlafaxine hcl 75 mg tablet T1 QL (5 tabs/day) HD venlafaxine hcl er 150 mg cap (Effexor XR) T1 QL (2 caps/day) HD

venlafaxine hcl er 150 mg tab T1 QL (2 tabs/day) HD venlafaxine hcl er 225 mg tab T1 QL (1 tab/day) HD venlafaxine hcl er 37.5 mg cap (Effexor XR) T1 QL (8 caps/day) HD

venlafaxine hcl er 37.5 mg tab T1 QL (8 tabs/day) HD venlafaxine hcl er 75 mg cap (Effexor XR) T1 QL (4 caps/day) HD

venlafaxine hcl er 75 mg tab T1 QL (4 tabs/day) HD

SSRI AND 5HT1A PARTIAL AGONIST ANTIDEPRESSANTS

VIIBRYD 10 MG TABLET T3 ST QL (1 tab/day) HD VIIBRYD 10-20 MG STARTER PACK T3 ST HD

VIIBRYD 20 MG TABLET T3 ST QL (1 tab/day) HD VIIBRYD 40 MG TABLET T3 ST HD

SSRI, SEROTONIN RECEPTOR MODULATOR ANTIDEPRESSANTS

TRINTELLIX 10 MG TABLET T3 ST QL (1 tab/day) HD TRINTELLIX 20 MG TABLET T3 ST HD TRINTELLIX 5 MG TABLET T3 ST QL (1 tab/day) HD

TRICYCLIC ANTIDEPRESSANT-BENZODIAZEPINE COMBINATNS

amitriptyline/chlordiazepoxide T1 HD

TRICYCLIC ANTIDEPRESSANT-PHENOTHIAZINE COMBINATNS

perphenazine/amitriptyline hcl T1 HD

TRICYCLIC ANTIDEPRESSANTS, REL.NON-SEL.REUPT-INHIB

amitriptyline hcl T1 HD


136


TRICYCLIC ANTIDEPRESSANTS, REL.NON-SEL.REUPT-INHIB


amoxapine T1 HD clomipramine hcl T1 HD desipramine hcl T1 HD desipramine hcl (Norpramin) T1 HD doxepin 10 mg capsule T1 HD doxepin 10 mg/ml oral conc T1 HD doxepin 100 mg capsule T1 HD doxepin 150 mg capsule T1 HD doxepin 25 mg capsule T1 HD doxepin 50 mg capsule T1 HD doxepin 75 mg capsule T1 HD imipramine hcl T1 HD imipramine pamoate T1 HD maprotiline hcl T1 HD NORPRAMIN (desipramine hcl) T3 HD

nortriptyline hcl T1 HD protriptyline hcl T1 HD trimipramine maleate T1 HD

PSYCHOTHERAPEUTIC DRUGS (Attention Deficit Hyperactivity Disorder)

TX FOR ADHD - SELECTIVE ALPHA-2 RECEPTOR AGONIST

clonidine hcl (Kapvay) T1 guanfacine hcl (Intuniv) T1 INTUNIV (guanfacine hcl er) T3 KAPVAY (clonidine hcl er) T3

TX FOR ATTENTION DEFICIT-HYPERACT (ADHD)/NARCOLEPSY

DAYTRANA T3 AGE QL (1 patch/day) dexmethylphenidate er 10 mg cp T1 AGE QL (1 cap/day)

dexmethylphenidate er 15 mg cp T1 AGE QL (1 per day)

dexmethylphenidate er 20 mg cp T1 AGE QL (1 cap/day)





dexmethylphenidate er 5 mg cap T1 AGE QL (1 cap/day)


137


TX FOR ATTENTION DEFICIT-HYPERACT (ADHD)/NARCOLEPSY


dexmethylphenidate hcl (Focalin) T1 AGE

FOCALIN (dexmethylphenidate hcl) T3 AGE ST

METHYLIN (methylphenidate hcl) T3 AGE

methylphenidate er 10 mg tab T1 AGE QL (2/day) methylphenidate er 18 mg tab T1 AGE QL (1 per day) methylphenidate er 20 mg tab T1 AGE QL (3/day) methylphenidate er 27 mg tab T1 AGE QL (1 tab/day) methylphenidate er 36 mg tab T1 AGE QL (1 tab/day) methylphenidate er 54 mg tab T1 AGE QL (1 tab/day) methylphenidate er 72 mg tab T1 AGE QL (1 tab/day) methylphenidate hcl T1 AGE methylphenidate hcl T1 AGE QL (1 cap/day) methylphenidate hcl T1 AGE QL (1 tab/day) methylphenidate hcl T1 AGE QL (3 tabs/day) methylphenidate hcl (Methylin) T1 AGE methylphenidate hcl (Ritalin) T1 AGE methylphenidate la 10 mg cap T1 AGE QL (1 cap/day) methylphenidate la 20 mg cap T1 AGE QL (1 cap/day) methylphenidate la 30 mg cap T1 AGE QL (1 cap/day) methylphenidate la 40 mg cap T1 AGE QL (1 per day) methylphenidate la 60 mg cap T1 AGE QL (1 cap/day) QUILLIVANT XR T3 AGE QL (12ml/day) RITALIN (methylphenidate hcl) T3 AGE ST

TX FOR ATTENTION DEFICIT-HYPERACT.(ADHD), NRI-TYPE atomoxetine hcl 10 mg capsule (Strattera) T1 HD

atomoxetine hcl 100 mg capsule (Strattera) T1 HD



atomoxetine hcl 40 mg capsule (Strattera) T1 QL (1 cap/day) HD



STRATTERA 10 MG CAPSULE (atomoxetine hcl) T3 HD



138


TX FOR ATTENTION DEFICIT-HYPERACT.(ADHD), NRI-TYPE




STRATTERA 40 MG CAPSULE (atomoxetine hcl) T3 QL (1 cap/day) HD



PSYCHOTHERAPEUTIC DRUGS (Schizophrenia/Anti-Psychotics)

ANTIPSYCH, DOPAMINE ANTAG., DIPHENYLBUTYLPIPERIDINES

pimozide T1

ANTIPSYCHOTIC, ATYPICAL, DOPAMINE, SEROTONIN ANTAGNST

clozapine T1 clozapine (Clozaril) T1 CLOZARIL 100 MG TABLET (clozapine) T3 ST

CLOZARIL 200 MG TABLET (clozapine) T3

CLOZARIL 25 MG TABLET (clozapine) T3 ST

CLOZARIL 50 MG TABLET (clozapine) T3

FANAPT 1 MG TABLET T3 ST QL (4 tabs/day) FANAPT 10 MG TABLET T3 ST QL (4 tabs/day) FANAPT 12 MG TABLET T3 ST FANAPT 2 MG TABLET T3 ST QL (4 tabs/day) FANAPT 4 MG TABLET T3 ST QL (4 tabs/day) FANAPT 6 MG TABLET T3 ST QL (4 tabs/day) FANAPT 8 MG TABLET T3 ST QL (4 tabs/day) FANAPT TITRATION PACK T3 ST QL (4 packs/year) GEODON T3 INVEGA ER 1.5 MG TABLET (paliperidone er) T3 ST

INVEGA ER 3 MG TABLET (paliperidone er) T3 ST QL (1 tab/day)

INVEGA ER 6 MG TABLET (paliperidone er) T3 ST

INVEGA ER 9 MG TABLET (paliperidone er) T3 ST

INVEGA SUSTENNA 117 MG/0.75 ML T3 QL (2 syrings/28 days)

INVEGA SUSTENNA 156 MG/ML SYRG T3 QL (1 syringe/28 days)

INVEGA SUSTENNA 234 MG/1.5 ML T3 QL (1 syringe/28 days)


139


ANTIPSYCHOTIC, ATYPICAL, DOPAMINE, SEROTONIN ANTAGNST




INVEGA TRINZA T3 QL (2 injectors/90 days) LATUDA 120 MG TABLET T2 LATUDA 20 MG TABLET T2 LATUDA 40 MG TABLET T2 QL (1 tab/day) LATUDA 60 MG TABLET T2 QL (1 tab/day) LATUDA 80 MG TABLET T2 olanzapine T1 olanzapine (Zyprexa) T1 paliperidone er 1.5 mg tablet (Invega) T1

paliperidone er 3 mg tablet (Invega) T1 QL (1 tab/day)

paliperidone er 6 mg tablet (Invega) T1

paliperidone er 9 mg tablet (Invega) T1

PERSERIS T3 QL (1 kit/28 days) quetiapine fumarate (Seroquel XR) T1

quetiapine fumarate (Seroquel) T1 RISPERDAL (risperidone) T3 ST RISPERDAL CONSTA T3 QL (4 syringes/28 days) risperidone T1 risperidone (Risperdal) T1 SAPHRIS T3 ST SECUADO T3 SEROQUEL (quetiapine fumarate) T3 ST

SEROQUEL XR (quetiapine fumarate er) T3 ST

ziprasidone hcl T1 ZYPREXA (olanzapine) T2 ZYPREXA RELPREVV 210 MG VL KIT T3 QL (4 vials/28 days)

ZYPREXA RELPREVV 300 MG VL KIT T3 QL (4 vials/28 days)

ZYPREXA RELPREVV 405 MG VL KIT T3 QL (2 vials/28 days)

ANTIPSYCHOTIC-ATYPICAL, D3/D2 PARTIAL AG-5HT MIXED

VRAYLAR 1.5 MG CAPSULE T3 ST QL (1 cap/day) VRAYLAR 1.5 MG-3 MG PACK T3 ST


140


ANTIPSYCHOTIC-ATYPICAL, D3/D2 PARTIAL AG-5HT MIXED


VRAYLAR 3 MG CAPSULE T3 ST QL (1 cap/day) VRAYLAR 4.5 MG CAPSULE T3 ST VRAYLAR 6 MG CAPSULE T3 ST

ANTIPSYCHOTICS, ATYP, D2 PARTIAL AGONIST/5HT MIXED ABILIFY MAINTENA ER 300 MG SYR T3 QL (2 injectors/30 days)

ABILIFY MAINTENA ER 300 MG VL T3 QL (2 injectors/30 days)

ABILIFY MAINTENA ER 400 MG SYR T3 QL (2 injectors/30 days)

ABILIFY MAINTENA ER 400 MG VL T3

aripiprazole T1 aripiprazole 1 mg/ml solution T1 aripiprazole 10 mg tablet T1 aripiprazole 15 mg tablet T1 aripiprazole 2 mg tablet T1 aripiprazole 20 mg tablet T1 aripiprazole 30 mg tablet T1 aripiprazole 5 mg tablet T1 QL (1 tab/day) ARISTADA ER 1064 MG/3.9 ML SYR T3

ARISTADA ER 441 MG/1.6 ML SYRN T3 QL (2 syrings/30 days)



ARISTADA INITIO T3 REXULTI 0.25 MG TABLET T3 ST QL (1 tab/day) REXULTI 0.5 MG TABLET T3 ST QL (1 tab/day) REXULTI 1 MG TABLET T3 ST QL (1 tab/day) REXULTI 2 MG TABLET T3 ST QL (1 tab/day) REXULTI 3 MG TABLET T3 ST REXULTI 4 MG TABLET T3 ST

ANTIPSYCHOTICS, DOPAMINE AND SEROTONIN ANTAGONISTS

loxapine succinate T1

ANTIPSYCHOTICS, DOPAMINE ANTAGONISTS, THIOXANTHENES

thiothixene T1

ANTIPSYCHOTICS, DOPAMINE ANTAGONISTS, BUTYROPHENONES

droperidol T1 HALDOL (haloperidol lactate) T3


141


ANTIPSYCHOTICS, DOPAMINE ANTAGONISTS, BUTYROPHENONES


HALDOL DECANOATE 100 (haloperidol decanoate 100) T3

HALDOL DECANOATE 50 (haloperidol decanoate) T3

haloperidol T1 haloperidol decanoate T1 haloperidol decanoate (Haldol Decanoate 100) T1

haloperidol decanoate (Haldol Decanoate 50) T1

haloperidol lactate T1 haloperidol lactate (Haldol) T1

ANTIPSYCHOTICS, DOPAMINE ANTAGONST, DIHYDROINDOLONES

molindone hcl T1

ANTIPSYCHOTICS, PHENOTHIAZINES

chlorpromazine hcl T1 fluphenazine decanoate T1 fluphenazine hcl T1 perphenazine T1 thioridazine hcl T1 trifluoperazine hcl T1

SSRI-ANTIPSYCH, ATYPICAL, DOPAMINE, SEROTONIN ANTAG

olanzapine/fluoxetine hcl T1 olanzapine/fluoxetine hcl (Symbyax) T1

SYMBYAX (olanzapine-fluoxetine hcl) T3

PSYCHOTHERAPEUTIC DRUGS (Sleep Disorders/Sedatives)

NARCOLEPSY AND SLEEP DISORDER THERAPY AGENTS

armodafinil T1 PA modafinil T1 PA SUNOSI T2 PA QL (1 tab/day)

SEDATIVE/HYPNOTICS (Sleep Disorders/Sedatives)

ANTI-NARCOLEPSY, ANTI-CATAPLEXY, SEDATIVE-TYPE AGENT

XYREM T4 PA SP

BARBITURATES

AMYTAL SODIUM T3 NEMBUTAL SODIUM (pentobarbital sodium) T3 PA

pentobarbital sodium (Nembutal Sodium) T1 PA


142

SEDATIVE/HYPNOTICS (Sleep Disorders/Sedatives)

BARBITURATES


phenobarbital T1 phenobarbital sodium T1 SECONAL SODIUM T3 PA

HYPNOTICS, MELATONIN MT1/MT2 RECEPTOR AGONISTS

HETLIOZ T4 PA SP HD ramelteon (Rozerem) T1 QL (1 tab/day) ROZEREM (ramelteon) T3 ST QL (1 tab/day)

SEDATIVE-HYPNOTICS - BENZODIAZEPINES

DORAL (quazepam) T3 estazolam T1 flurazepam hcl T1 HALCION (triazolam) T3 lorazepam T1 quazepam (Doral) T1 temazepam T1 triazolam T1 triazolam (Halcion) T1

SEDATIVE-HYPNOTICS, NON-BARBITURATE

BELSOMRA T2 ST dexmedetomidine hcl T1 dexmedetomidine hcl (Precedex) T1

dexmedetomidine in 0.9 % nacl (Precedex) T1

doxepin hcl 3 mg tablet (Silenor) T1 QL (1 tab/day)

doxepin hcl 6 mg tablet (Silenor) T1

eszopiclone (Lunesta) T1 LUNESTA (eszopiclone) T3 ST PRECEDEX (dexmedetomidine hcl) T3

PRECEDEX (dexmedetomidine-0.9% nacl) T3

SILENOR 3 MG TABLET (doxepin hcl) T3 ST QL (1 tab/day)

SILENOR 6 MG TABLET (doxepin hcl) T3 ST

zaleplon T1 zolpidem tart er 12.5 mg tab T1 zolpidem tart er 6.25 mg tab T1 QL (1 tab/day) zolpidem tartrate T1


143

SKIN PREPS (Miscellaneous)

IRRIGANTS


acetic acid T1 mannitol/sorbitol solution T1 neomycin sulf/polymyxin b sulf T1 PHYSIOLYTE T3 PHYSIOSOL T3 ringer's solution T1 ringer's solution, lactated T1 sodium chloride irrig solution T1 sorbitol solution T1 TIS-U-SOL PENTALYTE T3 water for irrigation, sterile T1

SKIN PREPS (Pain Relief And Inflammatory Disease)

ANTIPSORIATIC AGENTS, SYSTEMIC

acitretin T1

COSENTYX (2 SYRINGES) T4 PA QL (2 syrings/28 days) SP HD

COSENTYX PEN T4 PA QL (1 pen/28 days) SP HD

COSENTYX PEN (2 PENS) T4 PA QL (2 pens/28 days) SP HD

COSENTYX SYRINGE T4 PA QL (1 syringe/28 days) SP HD

ILUMYA T4 PA QL (1 syringe/84 days) SP HD

methoxsalen (Oxsoralen-ultra) T1 OXSORALEN-ULTRA (methoxsalen) T3

TALTZ AUTOINJECTOR T4 PA QL (1 injector/28 days) SP HD

TALTZ AUTOINJECTOR (2 PACK) T4 PA QL (1 injector/28 days) SP

HD TALTZ AUTOINJECTOR (3 PACK) T4 PA QL (1 injector/28 days) SP

HD

TALTZ SYRINGE T4 PA QL (1 syringe/28 days) SP HD

TREMFYA 100 MG/ML INJECTOR T4 PA QL (1 injector/56 days) SP

HD TREMFYA 100 MG/ML SYRINGE T4 PA QL (1 syringe/56 days) SP

HD TOPICAL ANTI-INFLAMMATORY, NSAIDS

DICLOFENAC EPOLAMINE T3 ST QL (2 patches/day) HD diclofenac sodium 1% gel (Voltaren) T1 QL (1000gm/30 days) HD

FLECTOR T3 ST QL (2 patches/day) HD PENNSAID T3 HD VOLTAREN (diclofenac sodium) T3 ST QL (1000gm/30 days) HD


144

SKIN PREPS (Skin Conditions)

ACNE AGENTS, SYSTEMIC


isotretinoin T1 QL (150 days therapy/210 days)

ACNE AGENTS, TOPICAL

adapalene/benzoyl peroxide T1 clindamycin phos/benzoyl perox T1

clindamycin/tretinoin T1 dapsone T1 KLARON (sulfacetamide sodium) T3

sulfacetamide sodium (Klaron) T1

ANTIPERSPIRANTS

DRYSOL T3

ANTIPSORIATICS AGENTS

anthralin T1 calcipotriene T1 calcitriol 3 mcg/g ointment T1 QL (800gm/30 days) tazarotene T1

ANTISEBORRHEIC AGENTS

OVACE PLUS T3 PROMISEB T2 selenium sulfide T1 sulfacetamide sodium T1

DIABETIC ULCER PREPARATIONS, TOPICAL

REGRANEX T3 PA QL (2 tubs/30 days)

EMOLLIENTS

ammonium lactate T1 ATOPICLAIR (pruclair) T3 BIAFINE (sonafine) T3 CELACYN T3 ELETONE T3 emollient combination no.10 (Biafine) T1

emollient combination no.35 (Mimyx) T1

emollient combination no.44 T1 HALUCORT T3 lactic acid T1 LUXAMEND T3 MIMYX (prumyx) T3


145


EMOLLIENTS


NEOSALUS T3 vite ac/grape/hyaluronic acid (Atopiclair) T1

HYPOPIGMENTATION AGENTS

hydroquinone T1 hydroquinone microspheres T1 TRI-LUMA T3

IMMUNOMODULATORS

imiquimod T1

IRRITANTS/COUNTER-IRRITANTS

methyl salicylate T1 QUTENZA T3

KERATOLYTICS

benzoyl peroxide microspheres T1 CONDYLOX T3 HYDRO 40 T3 INOVA T3 KERALYT (salicylic acid) T3 KERALYT SCALP T3 podofilox T1 podophyllum resin T1 salicylic acid T1 salicylic acid (Keralyt) T1 salicylic acid (Salvax) T1 salicylic acid/ceramide comb 1 T1 SALVAX (salicylic acid) T3 SALVAX DUO PLUS T3 silver nitrate T1 silver nitrate applicator T1 UMECTA T3 URAMAXIN (urea) T3 urea T1 urea (Uramaxin) T1

PROTECTIVES

BIONECT T3 protectives2/ceramide 1,3,6-11 T1 RADIAPLEXRX T3 zinc oxide T1


146


ROSACEA AGENTS, TOPICAL


azelaic acid (Finacea) T1 FINACEA T3 FINACEA (azelaic acid) T3 ivermectin (Soolantra) T1 METROCREAM (rosadan) T3 METROGEL (metronidazole) T3 METROLOTION (metronidazole) T3

metronidazole T1 metronidazole (Metrocream) T1 metronidazole (Metrogel) T1 metronidazole (Metrolotion) T1 rosadan 0.75% cream (Metrocream) T1

ROSADAN 0.75% CREAM KIT T3 rosadan 0.75% gel T1 ROSADAN 0.75% GEL KIT T3 SOOLANTRA (ivermectin) T2

TISSUE/WOUND ADHESIVES

ARTISS T3 TISSEEL VHSD T3

TOP. ANTI-INFLAM., PHOSPHODIESTERASE-4 (PDE4) INHIB

EUCRISA T2

TOPICAL AGENTS, MISCELLANEOUS

MEDIHONEY T3 TRI-CHLOR T3 trichloroacetic acid T1

TOPICAL ANTIBIOTIC PLEUROMUTILIN DERIVATIVES

ALTABAX T3

TOPICAL ANTI-INFLAMMATORY STEROIDAL

ALA-SCALP T3 ST alclometasone dipropionate T1 amcinonide T1 betamethasone dipropionate T1 betamethasone valerate T1 betamethasone valerate (Luxiq) T1

betamethasone/propylene glyc T1 betamethasone/propylene glyc (Diprolene) T1


147




BRYHALI T3 ST CAPEX SHAMPOO T3 ST clobetasol propionate T1 clobetasol propionate (Olux) T1 clobetasol propionate (Temovate) T1

clobetasol propionate/emoll T1 clobetasol propionate/emoll (Olux-E) T1

clocortolone pivalate (Cloderm) T1 CLODAN 0.05% KIT T3 ST clodan 0.05% shampoo T1 CLODERM (clocortolone pivalate) T3 ST

CORDRAN 0.025% CREAM T3 CORDRAN 0.05% CREAM (nolix) T3 ST

CORDRAN 0.05% LOTION (nolix) T3 ST

CORDRAN 0.05% OINTMENT (flurandrenolide) T3 ST

CORDRAN 4 MCG/SQ CM TAPE LARGE T3 ST

DERMA-SMOOTHE-FS (fluocinolone acetonide) T3 ST

DESONATE T3 ST desonide T1 desonide (Tridesilon) T1 DESOWEN (desonide) T3 ST desoximetasone (Topicort) T1 diflorasone diacetate T1 diflorasone diacetate/emoll T1 DIPROLENE (betamethasone diprop augmented) T3 ST

ELOCON (mometasone furoate) T3 ST

fluocinolone acetonide T1 fluocinolone acetonide (Derma-Smoothe-FS) T1

fluocinolone acetonide (Synalar) T1

fluocinolone/shower cap (Derma-Smoothe-FS) T1

fluocinonide T1 fluocinonide/emollient base T1 flurandrenolide (Cordran) T1 fluticasone prop 0.005% oint T1


148




fluticasone prop 0.05% cream T1 fluticasone prop 0.05% lotion T1 fluticasone propionate T1 halobetasol propionate T1 hydrocortisone T1 hydrocortisone acetate T1 hydrocortisone butyrate T1 hydrocortisone butyrate/emoll T1 hydrocortisone valerate T1 IMPOYZ T3 ST LUXIQ (betamethasone valerate) T3 ST

mometasone furoate 0.1% cream (Elocon) T1

mometasone furoate 0.1% oint T1 mometasone furoate 0.1% soln T1 NUCORT T3 ST OLUX (clobetasol propionate) T3 ST OLUX-E (tovet emollient) T3 ST PANDEL T3 ST prednicarbate T1 SCALACORT DK T3 ST SYNALAR T3 ST SYNALAR (fluocinolone acetonide) T3 ST

SYNALAR TS T3 ST TEMOVATE (clobetasol propionate) T3 ST

TEXACORT T3 ST TOPICORT T3 ST TOPICORT (desoximetasone) T3 ST triamcinolone acetonide T1 TRIDESILON (desonide) T3 ST

TOPICAL ANTI-INFLAMMATORY STEROID-LOCAL ANESTHETIC

ANALPRAM HC T3 EPIFOAM T2 hydrocortisone/pramoxine (Pramosone) T1

lidocaine/hydrocortisone ac T1 PRAMOSONE T3 PRAMOSONE (hydrocortisone-pramoxine) T3


149


TOPICAL PREPARATIONS, ANTIBACTERIALS


dermazene cream T1 DERMAZENE CREAM PACKET T3

hydrocortisone/iodoquinol T1 hydrocortisone/iodoquinol/aloe T1 iodine/potassium iodide T1 IODOFLEX T3 IODOSORB T3 silver nitrate T1

TOPICAL VIT D ANALOG/ANTI-INFLAMMATORY STEROID

calcipotriene/betamethasone T1

TOPICAL/MUCOUS MEMBR./SUBCUT. ENZYMES

AMPHADASE T3 SANTYL T3 QL (60gm/30 days) VITRASE T3

VITAMIN A DERIVATIVES

adapalene T1 AGE tretinoin 0.01% gel T1 tretinoin 0.025% cream T1 AGE tretinoin 0.025% gel T1 tretinoin 0.05% cream T1 AGE tretinoin 0.05% gel T1 AGE tretinoin 0.1% cream T1 AGE tretinoin microspheres T1 AGE

THYROID PREPS (Hormonal Agents)

ANTITHYROID PREPARATIONS

methimazole (Tapazole) T1 HD propylthiouracil T1 HD TAPAZOLE (methimazole) T3 HD

THYROID FUNCTION DIAGNOSTIC AGENTS

THYROGEN T4 SP

THYROID HORMONES

ARMOUR THYROID T3 HD ARMOUR THYROID (thyroid) T3 HD CYTOMEL (liothyronine sodium) T3 HD

EUTHYROX (levoxyl) T3 HD EUTHYROX (unithroid) T3 HD


150

THYROID PREPS (Hormonal Agents)

THYROID HORMONES


LEVO-T (levothyroxine sodium) T3 HD

LEVO-T (levoxyl) T3 HD LEVO-T (unithroid) T3 HD levothyroxine sodium T1 HD levothyroxine sodium (Synthroid) T1 HD

levothyroxine sodium (Unithroid) T1 HD

liothyronine sodium (Cytomel) T1 HD liothyronine sodium (Triostat) T1 HD SYNTHROID (levothyroxine sodium) T3 HD

SYNTHROID (levoxyl) T3 HD SYNTHROID (unithroid) T3 HD thyroid, pork T1 HD thyroid, pork (Armour Thyroid) T1 HD TIROSINT T3 HD TIROSINT-SOL T3 HD TRIOSTAT (liothyronine sodium) T3 HD

UNITHROID 100 MCG TABLET (levoxyl) T3 HD








UNITHROID 300 MCG TABLET (levothyroxine sodium) T3 HD


unithroid 75 mcg tablet (Synthroid) T1 HD


UNCLASSIFIED DRUG PRODUCTS (AIDS/HIV)

CYTOCHROME P450 INHIBITORS

TYBOST T4 SP


151

UNCLASSIFIED DRUG PRODUCTS (Asthma/COPD/Respiratory)

CYSTIC FIBROSIS-CFTR POTENTIATOR-CORRECTOR COMBIN.


ORKAMBI 100 MG-125 MG TABLET T4 PA QL (4 tabs/day) SP HD

ORKAMBI 100-125 MG GRANULE PKT T4 PA QL (2 packs/day) SP HD

ORKAMBI 150-188 MG GRANULE PKT T4 PA QL (2 packs/day) SP HD

ORKAMBI 200 MG-125 MG TABLET T4 PA QL (4 tabs/day) SP HD

SYMDEKO T4 PA QL (2 tabs/day) SP HD TRIKAFTA T4 PA QL (3 tabs/day) SP HD

CYSTIC FIB-TRANSMEMB CONDUCT.REG. (CFTR) POTENTIATOR

KALYDECO 150 MG TABLET T4 PA QL (2 tabs/day) SP HD KALYDECO 25 MG GRANULES PACKET T4 PA QL (2 packs/day) SP HD

KALYDECO 50 MG GRANULES PACKET T4 PA QL (2 packs/day) SP HD

KALYDECO 75 MG GRANULES PACKET T4 PA QL (2 packs/day) SP HD

LUNG SURFACTANTS

CUROSURF T3 INFASURF T3 SURVANTA T3

MUCOLYTICS

PULMOZYME T4 PA SP HD

PULMONARY FIBROSIS - SYSTEMIC ENZYME INHIBITORS

OFEV T4 PA SP HD

SYSTEMIC ENZYME INHIBITORS

ARALAST NP T4 PA SP GLASSIA T4 PA SP PROLASTIN C T4 PA SP ZEMAIRA T4 PA SP

UNCLASSIFIED DRUG PRODUCTS (Blood Modifiers/Bleeding Disorders)

ANTIPORPHYRIA FACTORS

PANHEMATIN T4 SP

ERYTHROID MATURATION AGENTS

REBLOZYL T4 PA SP

SPLEEN TYROSINE KINASE INHIBITORS

TAVALISSE T4 PA SP


152

UNCLASSIFIED DRUG PRODUCTS (Blood Pressure/Heart Medications)

BRADYKININ B2 RECEPTOR ANTAGONISTS


icatibant acetate T4 PA SP HD

C1 ESTERASE INHIBITORS

BERINERT T4 PA SP HD CINRYZE T4 PA SP HD HAEGARDA T4 PA SP HD RUCONEST T4 PA SP HD

PLASMA KALLIKREIN INHIBITORS

KALBITOR T4 PA SP HD

UNCLASSIFIED DRUG PRODUCTS (Cancer)

CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS

dexrazoxane hcl (Zinecard) T4 SP ETHYOL T4 SP KHAPZORY T3 PA leucovorin cal 100 mg/10 ml vl T1 leucovorin cal 500 mg/50 ml vl T1 leucovorin calcium 10 mg tab T1 CSL leucovorin calcium 100 mg vial T1 leucovorin calcium 15 mg tab T1 CSL leucovorin calcium 200 mg vial T1 leucovorin calcium 25 mg tab T1 CSL leucovorin calcium 350 mg vial T1 leucovorin calcium 5 mg tab T1 CSL leucovorin calcium 50 mg vial T1 leucovorin calcium 500 mg vl T1 levoleucovorin calcium T1 PA mesna (Mesnex) T4 SP MESNEX 1 GRAM/10 ML VIAL (mesna) T4 SP

MESNEX 400 MG TABLET T4 SP CSL VISTOGARD T4 SP CSL VORAXAZE T4 PA SP ZINECARD (dexrazoxane) T4 SP

INTRAPLEURAL SCLEROSING AGENTS, ANTINEOPLAST. ADJ.

SCLEROSOL T3 STERITALC T3 talc T1

RADIOACTIVE THERAPEUTIC AGENTS

LUTATHERA T4 PA SP QUADRAMET T3 PA


153

UNCLASSIFIED DRUG PRODUCTS (Cancer)

TISSUE PROTECTIVE TX OF CHEMOTHERAPY EXTRAVASATION


TOTECT T3

UNCLASSIFIED DRUG PRODUCTS (Dental Products)

DENTAL AIDS AND PREPARATIONS

chlorhexidine gluconate T1 triamcinolone acetonide T1

PERIODONTAL COLLAGENASE INHIBITORS

doxycycline hyclate T1

UNCLASSIFIED DRUG PRODUCTS (Eye Conditions)

INSULIN-LIKE GROWTH FACTOR RECEPTOR (IGF-R) INHIB

TEPEZZA T4 PA SP HD

OCULAR PHOTOACTIVATED VESSEL-OCCLUDING AGENTS

VISUDYNE T4 SP

UNCLASSIFIED DRUG PRODUCTS (Gastrointestinal/Heartburn)

CALCIMIMETIC, PARATHYROID CALCIUM ENHANCER

cinacalcet hcl (Sensipar) T4 SP PARSABIV T4 PA SP SENSIPAR (cinacalcet hcl) T4 SP

ORAL MUCOSITIS/STOMATITIS AGENTS

ORAMAGICRX T3

SALIVA STIMULANT AGENTS

NUMOISYN T3

UNCLASSIFIED DRUG PRODUCTS (Hormonal Agents)

BONE FORMATION STIM. AGENTS - PARATHYROID HORMONE

FORTEO T4 PA QL (1 pen/28 days) SP HD

GROWTH HORMONE RECEPTOR ANTAGONISTS

SOMAVERT T4 PA SP HD

HYPERPARATHYROID TX AGENTS - VITAMIN D ANALOG-TYPE

doxercalciferol T1 paricalcitol 1 mcg capsule (Zemplar) T4 SP HD

paricalcitol 10 mcg/2 ml vial T4 SP paricalcitol 10 mcg/2 ml vial (Zemplar) T4 SP

paricalcitol 2 mcg capsule (Zemplar) T4 SP HD


154

UNCLASSIFIED DRUG PRODUCTS (Hormonal Agents)

HYPERPARATHYROID TX AGENTS - VITAMIN D ANALOG-TYPE


paricalcitol 2 mcg/ml vial T4 SP paricalcitol 2 mcg/ml vial (Zemplar) T4 SP

paricalcitol 4 mcg capsule T4 SP HD paricalcitol 5 mcg/ml vial T4 SP paricalcitol 5 mcg/ml vial (Zemplar) T4 SP

RAYALDEE T3 ZEMPLAR 1 MCG CAPSULE (paricalcitol) T4 SP HD

ZEMPLAR 10 MCG/2 ML VIAL (paricalcitol) T4 SP

ZEMPLAR 2 MCG CAPSULE (paricalcitol) T4 SP HD

ZEMPLAR 2 MCG/ML VIAL (paricalcitol) T4 SP

ZEMPLAR 5 MCG/ML VIAL (paricalcitol) T4 SP

MENOPAUSAL SYMPT SUPP-SEL ESTROGEN RECEP MODULATOR

OSPHENA T3 HD

UNCLASSIFIED DRUG PRODUCTS (Miscellaneous)

ABORTIFACIENT-PROGESTERONE RECEPTOR ANTAGONISTS

MIFEPREX (mifepristone) T3 mifepristone (Mifeprex) T1

ACID AND ALKALI POISON ANTIDOTES

methylene blue T1 PROVAYBLUE T3

AGENTS TO TX PERIODIC PARALYSIS - CARBON ANHYD INH

KEVEYIS T4 SP

AMMONIA INHIBITORS

CARBAGLU T4 SP HD

AMYLOIDOSIS AGENTS-TRANSTHYRETIN (TTR) SUPPRESSION

ONPATTRO T4 PA SP TEGSEDI T4 PA SP HD

ANTI-ALCOHOLIC PREPARATIONS

acamprosate calcium T1 ANTABUSE (disulfiram) T3 disulfiram (Antabuse) T1 VIVITROL T4 SP HD


155


ANTIDOTES, MISCELLANEOUS


ACETADOTE (acetylcysteine) T3 acetylcysteine (Acetadote) T1 CYANOKIT T3 DIGIFAB T3 fomepizole T1 sodium nitrite T1

ANTIFIBROTIC THERAPY - PYRIDONE ANALOGS

ESBRIET T4 PA SP HD

BENZODIAZEPINE ANTAGONISTS

flumazenil T1

CHOLINESTERASE REACTIVAT.-MUSCARINIC ANTG.ANTIDOTE

DUODOTE T3

CHOLINESTERASE REACTIVATING, ORGANOPHOS. ANTIDOTES

pralidoxime chloride T1 PROTOPAM CHLORIDE T3

DILUENT SOLUTIONS diluent for epoprostenol(glyc) (Ph 12 Diluent For Flolan) T1

DILUENT FOR LEFAMULIN(XENLETA) T3

diluent for treprostinil (gly) T1 ELLIOTTS B T3 PH 12 DILUENT FOR FLOLAN (diluent for epoprostenol) T3

DRUGS TO TREAT ACUTE HEPATIC PORPHYRIA (AHP)

GIVLAARI T4 PA SP HD

DRUGS TO TREAT HEREDITARY TYROSINEMIA

nitisinone (Orfadin) T4 PA SP HD NITYR T4 PA SP ORFADIN T4 PA SP ORFADIN (nitisinone) T4 PA SP

DRUGS TO TX GAUCHER DX-TYPE 1, SUBSTRATE REDUCING

CERDELGA T4 PA SP HD miglustat (Zavesca) T4 PA SP HD ZAVESCA (miglustat) T4 PA SP HD

GENERAL INHALATION AGENTS

HYPER-SAL T3 HYPER-SAL (sodium chloride) T3


156


GENERAL INHALATION AGENTS


nebusal 3% vial T1 NEBUSAL 6% VIAL T3 sodium chloride for inhalation T1 sodium chloride for inhalation (Hyper-Sal) T1

GENETIC D/O TX-EXON INCLUSION ANTISENSE OLIGONUCLE

SPINRAZA T4 PA SP HD

GENETIC D/O TX-EXON SKIPPING ANTISENSE OLIGONUCLEO

EXONDYS-51 T4 PA SP VYONDYS-53 T4 PA SP

LEAD POISONING, AGENTS TO TREAT (CHELATING-TYPE)

edetate calcium disodium T1 PA

MENOPAUSAL SYMPTOMS SUPPRESSANT - SSRIS BRISDELLE (paroxetine mesylate) T3 QL (1 cap/day) HD

paroxetine mesylate (Brisdelle) T1 QL (1 cap/day) HD

METABOLIC DISEASE ENZYME REPLACE, HYPOPHOSPHATASIA

STRENSIQ T4 PA SP

METABOLIC DISEASE ENZYME REPLACEMENT, BATTEN DISEA

BRINEURA T4 PA SP

METABOLIC DISEASE ENZYME REPLACEMENT, FABRY'S DX

FABRAZYME T4 PA SP HD

METABOLIC DISEASE ENZYME REPLACEMENT, GAUCHER'S DX

CEREZYME T4 PA SP HD ELELYSO T4 PA SP VPRIV T4 PA SP HD

METABOLIC DISEASE ENZYME REPLACEMENT, POMPE DISEASE

LUMIZYME T4 PA SP

METABOLIC DX ENZYME REPLACE, MUCOPOLYSACCHARIDOSIS

ALDURAZYME T4 PA SP HD ELAPRASE T4 PA SP MEPSEVII T4 PA SP NAGLAZYME T4 PA SP VIMIZIM T4 PA SP

METABOLIC DX ENZYME REPLACEMENT, LYSO.ACID LIP.DEF.

KANUMA T4 PA SP


157


METABOLIC DX ENZYME REPLACEMT, SEV.COMB.IMMUNE DEF.


REVCOVI T4 PA SP

METALLIC POISON, AGENTS TO TREAT

BAL IN OIL T3 PA CHEMET T3 deferasirox (Exjade) T4 SP HD deferasirox (Jadenu) T4 SP HD deferoxamine mesylate T1 deferoxamine mesylate (Desferal Mesylate) T1

DESFERAL MESYLATE (deferoxamine mesylate) T3

EXJADE (deferasirox) T4 PA SP HD FERRIPROX T4 PA SP GALZIN T3 JADENU T4 PA SP HD JADENU (deferasirox) T4 PA SP HD JADENU SPRINKLE T4 PA SP HD NITHIODOTE T3 pentetate calcium trisodium T1 pentetate zinc trisodium T1 RADIOGARDASE T3 sodium thiosulfate T1 trientine hcl T4 PA SP HD

MISCELLANEOUS AGENTS

NEXAVIR T4 SP

PHARMACOLOGICAL CHAPERONE-ALPHA-GALACTOSID.A STABZ

GALAFOLD T4 PA SP HD

PKU TX AGENT-COFACTOR OF PHENYLALANINE HYDROXYLASE

KUVAN T4 PA SP HD

PROTEIN STABILIZERS

VYNDAMAX T4 PA QL (1 cap/day) SP HD VYNDAQEL T4 PA QL (4 caps/day) SP HD

SODIUM/SALINE PREPARATIONS

bacteriostatic sodium chloride T1

TOPICAL/MUCOUS MEMBR./SUBCUT. ENZYMES

HYLENEX T4 SP HD

WATER

water for inj., bacteriostatic T1 water for injection, sterile T1


158

UNCLASSIFIED DRUG PRODUCTS (Multiple Sclerosis)

LEUKOCYTE ADHESION INHIB, ALPHA4-MEDIAT IGG4K MC AB


TYSABRI T4 PA SP HD

UNCLASSIFIED DRUG PRODUCTS (Nutritional/Dietary)

METABOLIC DEFICIENCY AGENTS

CARNITOR T3 CARNITOR (levocarnitine) T3 CARNITOR SF (levocarnitine sf) T3

CYSTADANE T4 SP levocarnitine (Carnitor SF) T1 levocarnitine (Carnitor) T1 levocarnitine (with sugar) (Carnitor) T1

UNCLASSIFIED DRUG PRODUCTS (Osteoporosis Products)

BONE FORMATION AGENTS - SCLEROSTIN INHIBITOR, MONO

EVENITY T4 PA QL (2 syrings/month) SP EVENITY (2 SYRINGES) T4 PA QL (2 syrings/month) SP

BONE RESORPTION INHIBITOR AND VITAMIN D COMBS.

FOSAMAX PLUS D T3 ST HD

BONE RESORPTION INHIBITORS ACTONEL (risedronate sodium) T3 ST HD

alendronate sodium T1 HD alendronate sodium (Fosamax) T1 HD ATELVIA (risedronate sodium dr) T3 ST HD

BINOSTO T3 ST HD BONIVA 150 MG TABLET (ibandronate sodium) T3 ST HD

BONIVA 3 MG/3 ML SYRINGE (ibandronate sodium) T4 SP HD

EVISTA (raloxifene hcl) T3 HD FOSAMAX (alendronate sodium) T3 ST HD

ibandronate 3 mg/3 ml syringe (Boniva) T4 SP HD

ibandronate 3 mg/3 ml vial T4 SP HD ibandronate sodium 150 mg tab (Boniva) T1 HD

pamidronate disodium T4 SP HD PROLIA T4 PA SP HD raloxifene hcl (Evista) T1 HD PPACA RECLAST (zoledronic acid) T4 SP HD


159

UNCLASSIFIED DRUG PRODUCTS (Osteoporosis Products)

BONE RESORPTION INHIBITORS


risedronate sodium T1 HD risedronate sodium (Actonel) T1 HD risedronate sodium (Atelvia) T1 HD XGEVA T4 PA SP HD zoledronic ac/mannitol/0.9nacl T4 SP HD zoledronic acid T4 SP HD zoledronic acid/mannitol-water T4 SP HD zoledronic acid/mannitol-water (Reclast) T4 SP HD

UNCLASSIFIED DRUG PRODUCTS (Pain Relief And Inflammatory Disease)

ANTI-INFLAM. INTERLEUKIN-1 RECEPTOR ANTAGONIST

ARCALYST T4 PA SP HD

ANTI-INFLAMMATORY, INTERLEUKIN-1 BETA BLOCKERS

ILARIS T4 PA SP HD

FIBROMYALGIA AGENTS, SEROTONIN-NOREPINEPH RU INHIB

SAVELLA T3 HD

IMMUNOMODULATOR, B-LYMPHOCYTE STIM (BLYS)-SPEC INHIB

BENLYSTA 120 MG VIAL T4 PA SP BENLYSTA 200 MG/ML AUTOINJECT T4 PA SP HD

BENLYSTA 200 MG/ML SYRINGE T4 PA SP HD

BENLYSTA 400 MG VIAL T4 PA SP

JOINT CONTRACTURE THERAPY, COLLAGENASE ENZYME

XIAFLEX T3 PA SP

UNCLASSIFIED DRUG PRODUCTS (Skin Conditions)

WOUND HEALING AGENTS, LOCAL balsam peru/castor oil (Venelex) T1

VENELEX T3 VENELEX (dermulcera) T3

UNCLASSIFIED DRUG PRODUCTS (Substance Abuse)

OPIOID WITHDRAWAL THER, ALPHA-2 ADRENERGIC AGONIST

LUCEMYRA T2 QL (168 tabs/14 days)

OPIOID WITHDRAWAL THERAPY AGENTS, OPIOID-TYPE

BUNAVAIL T2 buprenorphine hcl T1


160

UNCLASSIFIED DRUG PRODUCTS (Substance Abuse)

OPIOID WITHDRAWAL THERAPY AGENTS, OPIOID-TYPE


buprenorphine hcl/naloxone hcl T1 buprenorphine hcl/naloxone hcl (Suboxone) T1

PROBUPHINE T2 SUBLOCADE T4 SP SUBOXONE (buprenorphine-naloxone) T3

ZUBSOLV T2

UNCLASSIFIED DRUG PRODUCTS (Urinary Tract Conditions)

BENIGN PROSTATIC HYPERTROPHY/MICTURITION AGENTS

alfuzosin hcl (Uroxatral) T1 HD AVODART (dutasteride) T3 HD dutasteride (Avodart) T1 HD finasteride (Proscar) T1 HD FLOMAX (tamsulosin hcl) T3 HD PROSCAR (finasteride) T3 HD RAPAFLO 4 MG CAPSULE (silodosin) T3 QL (1 cap/day) HD

RAPAFLO 8 MG CAPSULE (silodosin) T3 HD

silodosin 4 mg capsule (Rapaflo) T1 QL (1 cap/day) HD

silodosin 8 mg capsule (Rapaflo) T1 HD

tamsulosin hcl (Flomax) T1 HD UROXATRAL (alfuzosin hcl er) T3 HD

BPH 5-ALPHA-REDUCTASE INHIB-ALPHA1-ADRENOCEP ANTAG dutasteride/tamsulosin hcl (Jalyn) T1 HD

JALYN (dutasteride-tamsulosin) T3 HD

CYSTINE-DEPLETING AGENTS, NEPHROPATHIC CYSTINOSIS

CYSTAGON T4 SP PROCYSBI DR 25 MG CAPSULE T4 PA SP HD

PROCYSBI DR 300 MG GRANULE PKT T3

PROCYSBI DR 75 MG CAPSULE T4 PA SP HD

PROCYSBI DR 75 MG GRANULE PKT T3

KIDNEY STONE AGENTS

THIOLA T4 SP THIOLA EC T4 SP


161

UNCLASSIFIED DRUG PRODUCTS (Urinary Tract Conditions)

URINARY TRACT ANTISPASMODIC, M (3) SELECTIVE ANTAG.


darifenacin er 15 mg tablet T1 HD darifenacin er 7.5 mg tablet T1 QL (1 tab/day) HD solifenacin 10 mg tablet T1 HD solifenacin 5 mg tablet T1 QL (1 tab/day) HD

URINARY TRACT ANTISPASMODIC/ANTIINCONTINENCE AGENT

flavoxate hcl T1 HD oxybutynin chloride T1 HD tolterodine tart er 2 mg cap T1 QL (1 cap/day) HD tolterodine tart er 4 mg cap T1 HD tolterodine tartrate T1 HD trospium chloride T1 HD

UNCLASSIFIED DRUG PRODUCTS (Weight Management)

APPETITE STIM. FOR ANOREXIA, CACHEXIA, WASTING SYND. MEGACE ES (megestrol acetate) T2

megestrol 625 mg/5 ml susp (Megace ES) T1

megestrol acet 40 mg/ml susp T1 megestrol acet 400 mg/10 ml T1

VITAMINS (Nutritional/Dietary)

FOLIC ACID PREPARATIONS

folic acid T1

MULTIVITAMIN PREPARATIONS

INFUVITE ADULT T3 M.V.I. ADULT T3 multivit, ther.w-iron,hematinic T1 multivit39/iron/mfolat/dss/dha T1 mvn no.53/iron/folic/dss/dha T1

PEDIATRIC VITAMIN PREPARATIONS

INFUVITE PEDIATRIC T3 M.V.I. PEDIATRIC T3

VITAMIN A PREPARATIONS

AQUASOL A T3 vitamins b1, b2, b3, b5, and b6 T1 HD

VITAMIN B1 PREPARATIONS

thiamine hcl T1


162

VITAMINS (Nutritional/Dietary)



cyanocobalamin (vitamin b-12) T1 cyanocobalamin (vitamin b-12) (Physicians EZ Use B-12) T1

hydroxocobalamin T1 PHYSICIANS EZ USE B-12 (b-12 compliance) T3


pyridoxine hcl (vitamin b6) T1

VITAMIN C PREPARATIONS

ASCOR T3 ascorbic acid T1

VITAMIN D PREPARATIONS calcitriol 0.25 mcg capsule (Rocaltrol) T1 HD

calcitriol 0.5 mcg capsule (Rocaltrol) T1 HD

calcitriol 1 mcg/ml ampul T1 HD calcitriol 1 mcg/ml solution (Rocaltrol) T1 HD

DRISDOL (vitamin d2) T3 HD ergocalciferol (vitamin d2) (Drisdol) T1 HD

ROCALTROL (calcitriol) T3 HD

VITAMIN K PREPARATIONS

MEPHYTON (phytonadione) T3 phytonadione (vit k1) T1 phytonadione (vit k1) (Mephyton) T1

163

Exclusions and limitations Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and be medically necessary. If your plan provides coverage for certain preventive prescription drugs with no cost-share, you may be required to use an in-network pharmacy to fill the prescription. If you use a pharmacy that does not participate in your plan’s network, the prescription may not be covered. Certain drugs may require prior authorization, or be subject to step therapy, quantity limits or other utilization management requirements. Plans generally do not provide coverage for the following under the pharmacy benefit, except as required by state or federal law, or by the terms of your specific plan:8 › over-the-counter (OTC) medicines (those that do not

require a prescription) except insulin unless state or federal law requires coverage of such medicines;

› prescription medications or supplies for which there is a prescription or OTC therapeutic equivalent or therapeutic alternative;

› doctor-administered injectable medications covered under the Plan’s medical benefit, unless otherwise covered under the Plan’s prescription drug list or approved by Cigna;

› implantable contraceptive devices covered under the Plan’s medical benefit;

› medications that are not medically necessary; › experimental or investigational medications, including

FDA-approved medications used for purposes other than those approved by the FDA unless the medication is recognized for the treatment of the particular indication;

› medications that are not approved by the Food & Drug Administration (FDA);

› prescription and non-prescription devices, supplies, and appliances other than those supplies specifically listed as covered;

› medications used for fertility, sexual dysfunction, cosmetic purposes, weight loss, smoking cessation, or athletic enhancement;

› prescription vitamins (other than prenatal vitamins) or dietary supplements unless state or federal law requires coverage of such products;

› immunization agents, biological products for allergy immunization, biological sera, blood, blood plasma and other blood products or fractions and medications used for travel prophylaxis;

› replacement of prescription medications and related supplies due to loss or theft;

› medications which are to be taken by or administered to a covered person while they are a patient in a licensed hospital, skilled nursing facility, rest home or similar institution which operates on its premises or allows to be operated on its premises a facility for dispensing pharmaceuticals;

› prescriptions more than one year from the date of issue; or

› coverage for prescription medication products for the amount dispensed (days’ supply) which is more than the applicable supply limit, or is less than any applicable supply minimum set forth in The Schedule, or which is more than the quantity limit(s) or dosage limit(s) set by the P&T Committee.

› more than one prescription order or refill for a given prescription supply period for the same prescription medication product prescribed by one or more doctors and dispensed by one or more pharmacies.

› prescription medication products dispensed outside the jurisdiction of the United States, except as required for emergency or urgent care treatment. In addition to the plan’s standard pharmacy exclusions, certain new FDA-approved medication products (including, but not limited to, medications, medical supplies or devices that are covered under standard pharmacy benefit plans) may not be covered for the first six months of market availability unless approved by Cigna as medically necessary.

164

Index of medications

0

0.9 % sodium chloride ......................................................... 111

A

abacavir sulfate ..................................................................... 67 abacavir sulfate/lamivudine ................................................. 67 abacavir/lamivudine/zidovudine ........................................... 67 ABELCET ................................................................................ 46 ABILIFY MAINTENA ER 300 MG SYR .................................... 140 ABILIFY MAINTENA ER 300 MG VL ...................................... 140 ABILIFY MAINTENA ER 400 MG SYR .................................... 140 ABILIFY MAINTENA ER 400 MG VL ...................................... 140 abiraterone acetate .............................................................. 55 ABRAXANE ............................................................................. 61 acamprosate calcium .......................................................... 154 acarbose (Precose) ................................................................ 48 ACCOLATE (zafirlukast) .......................................................... 31 ACD SOLUTION A ................................................................... 43 ACD-A .................................................................................... 43 acebutolol hcl ........................................................................ 84 ACETADOTE (acetylcysteine) ............................................... 155 acetamin-codein 300-30 mg/12.5 ......................................... 17 acetaminop-codeine 120-12 mg/5 ........................................ 17 acetaminophen/caff/dihydrocod .......................................... 18 acetaminophen/caff/dihydrocod (Trezix) .............................. 18 acetaminophen-cod #2 tablet ............................................... 17 acetaminophen-cod #3 tablet (Tylenol-Codeine No.3) .......... 17 acetaminophen-cod #4 tablet (Tylenol-Codeine No.4) .......... 17 acetazolamide ..................................................................... 100 acetazolamide sodium ........................................................ 100 acetic acid ............................................................. 51, 102, 143 acetic acid/oxyquinoline ........................................................ 51 acetylcysteine ................................................................ 31, 155 acetylcysteine (Acetadote) .................................................. 155 acitretin ............................................................................... 143 ACTEMRA 162 MG/0.9 ML SYRINGE ................................... 126 ACTEMRA 200 MG/10 ML VIAL ........................................... 127 ACTEMRA 400 MG/20 ML VIAL ........................................... 127 ACTEMRA 80 MG/4 ML VIAL ............................................... 127 ACTEMRA ACTPEN ............................................................... 127 ACTHAR ............................................................................... 118 ACTHREL .............................................................................. 118 ACTIGALL (ursodiol) ............................................................. 115 ACTIMMUNE ......................................................................... 62 ACTIQ (fentanyl citrate) ........................................................ 18 ACTIVASE ............................................................................... 76 ACTIVELLA (mimvey) ........................................................... 120 ACTONEL (risedronate sodium) ........................................... 158 ACTOPLUS MET (pioglitazone-metformin) ............................ 49 ACTOS (pioglitazone hcl) ....................................................... 49 ACULAR (ketorolac tromethamine) ..................................... 103 ACULAR LS (ketorolac tromethamine) ................................ 103 ACUVAIL .............................................................................. 103

acyclovir ................................................................................ 68 acyclovir sodium .................................................................... 68 ADAKVEO .............................................................................. 75 ADALAT CC (nifedipine er) ..................................................... 77 adapalene ................................................................... 144, 149 adapalene/benzoyl peroxide ............................................... 144 ADCETRIS ............................................................................... 61 ADCIRCA (tadalafil) ................................................................ 80 ADDERALL (dextroamphetamine-amphetamine) ................. 71 adefovir dipivoxil (Hepsera) .................................................. 70 ADEMPAS .............................................................................. 80 adenosine 12 mg/4 ml syringe .............................................. 76 adenosine 12 mg/4 ml vial .................................................... 76 adenosine 6 mg/2 ml syringe ................................................ 76 adenosine 6 mg/2 ml vial ...................................................... 76 adenosine 60 mg/20 ml vial .................................................. 97 adenosine 90 mg/30 ml vial .................................................. 97 ADRENALIN ................................................................... 72, 102 ADRENALIN CHLORIDE ........................................................ 102 ADREVIEW ............................................................................. 97 adriamycin 10 mg vial ........................................................... 53 adriamycin 10 mg/5 ml vial .................................................. 53 adriamycin 20 mg/10 ml vial ................................................ 53 adriamycin 200 mg/100 ml vial ............................................ 53 ADRIAMYCIN 50 MG VIAL ..................................................... 53 adriamycin 50 mg/25 ml vial ................................................ 53 ADVAIR HFA .......................................................................... 30 AEMCOLO .............................................................................. 40 AFINITOR ............................................................................... 57 AFINITOR (everolimus) .......................................................... 57 AFINITOR DISPERZ ................................................................. 57 AGGRASTAT ........................................................................... 66 AGGRENOX (aspirin-dipyridamole er) ................................... 66 AGRYLIN (anagrelide hcl) ...................................................... 66 AIMOVIG AUTOINJECTOR ..................................................... 15 AK-FLUOR .............................................................................. 99 AKOVAZ (ephedrine sulfate) ................................................. 80 AKTEN .................................................................................. 104 AKYNZEO 235-0.25 MG VIAL ............................................... 113 AKYNZEO 300-0.5 MG CAPSULE .......................................... 113 ALA-SCALP ........................................................................... 146 albendazole (Albenza) ........................................................... 51 ALBENZA (albendazole) ......................................................... 51 albuterol 2.5 mg/0.5 ml sol ................................................... 30 albuterol 5 mg/ml solution ................................................... 30 albuterol sul 0.63 mg/3 ml sol ............................................... 30 albuterol sul 1.25 mg/3 ml sol ............................................... 30 albuterol sul 2.5 mg/3 ml soln .............................................. 30 albuterol sulf 2 mg/5 ml syrup .............................................. 30 albuterol sulfate (Proair Hfa) ................................................ 30 albuterol sulfate 2 mg tab ..................................................... 30 albuterol sulfate 4 mg tab ..................................................... 30 albuterol sulfate er 4 mg tab ................................................ 30 albuterol sulfate er 8 mg tab ................................................ 30 ALCAINE (proparacaine hcl) ................................................ 104

165

alclometasone dipropionate ............................................... 146 ALDACTAZIDE ...................................................................... 101 ALDACTAZIDE (spironolactone-hctz) ................................... 101 ALDACTONE (spironolactone) ............................................. 101 ALDURAZYME ...................................................................... 156 ALECENSA .............................................................................. 59 alendronate sodium ............................................................ 158 alendronate sodium (Fosamax) ........................................... 158 alfentanil 500 mcg/ml ampul (Alfentanil Hcl) ....................... 17 ALFENTANIL 500 MCG/ML AMPULE (alfentanil hcl) ............. 17 ALFERON N ............................................................................ 62 alfuzosin hcl (Uroxatral) ...................................................... 160 ALIMTA .................................................................................. 56 ALINIA .................................................................................... 63 ALIQOPA ................................................................................ 59 aliskiren 150 mg tablet .......................................................... 85 aliskiren 300 mg tablet .......................................................... 85 ALKERAN 2 MG TABLET (melphalan) ..................................... 54 ALKERAN 50 MG VIAL (melphalan hcl) .................................. 54 allopurinol (Zyloprim) ............................................................ 27 allopurinol sodium (Aloprim) ................................................. 27 almotriptan malate ............................................................... 15 ALOPRIM (allopurinol sodium) .............................................. 27 ALORA (estradiol) ................................................................ 120 alosetron hcl ........................................................................ 117 ALOXI (palonosetron hcl) .................................................... 113 ALPHAGAN P ....................................................................... 104 ALPHAGAN P (brimonidine tartrate) ................................... 104 alprazolam .......................................................................... 130 alprazolam (Xanax XR) ........................................................ 130 alprazolam (Xanax) ............................................................. 130 alprostadil ............................................................................. 85 ALREX .................................................................................. 103 ALTABAX .............................................................................. 146 ALTAFLUOR BENOX ............................................................. 104 ALUNBRIG .............................................................................. 59 amantadine hcl ..................................................................... 63 AMARYL (glimepiride) ........................................................... 49 AMBISOME ............................................................................ 46 ambrisentan (Letairis) ........................................................... 80 amcinonide .......................................................................... 146 AMERGE (naratriptan hcl) ..................................................... 15 AMICAR (aminocaproic acid) ................................................. 74 AMIDATE ............................................................................... 22 AMIDATE (etomidate) ........................................................... 22 amikacin sulfate .................................................................... 34 amiloride hcl ........................................................................ 101 amiloride/hydrochlorothiazide ............................................ 101 AMINOACETIC ACID (glycine) ................................................ 52 aminocaproic acid ................................................................. 74 aminocaproic acid (Amicar) .................................................. 74 aminophylline ........................................................................ 31 AMINOSYN II ....................................................................... 108 AMINOSYN-PF ..................................................................... 108 amiodarone hcl ..................................................................... 76 amiodarone hcl (Pacerone) ................................................... 76 AMITIZA ............................................................................... 117 amitriptyline hcl .................................................................. 135

amitriptyline/chlordiazepoxide ........................................... 135 amlodipine besylate (Norvasc) .............................................. 77 amlodipine besylate/benazepril ............................................ 81 amlodipine besylate/valsartan ............................................. 82 amlodipine/valsartan/hcthiazid ............................................ 82 amlodipine-atorvast 10-10 mg (Caduet) ............................... 86 amlodipine-atorvast 10-20 mg (Caduet) ............................... 86 amlodipine-atorvast 10-40 mg (Caduet) ............................... 86 amlodipine-atorvast 10-80 mg (Caduet) ............................... 86 amlodipine-atorvast 2.5-10 mg ............................................. 86 amlodipine-atorvast 2.5-20 mg ............................................. 86 amlodipine-atorvast 2.5-40 mg ............................................. 86 amlodipine-atorvast 5-10 mg (Caduet) ................................. 86 amlodipine-atorvast 5-20 mg (Caduet) ................................. 86 amlodipine-atorvast 5-40 mg (Caduet) ................................. 86 amlodipine-atorvast 5-80 mg (Caduet) ................................. 86 amlodipine-olmesartan 10-20 mg ......................................... 82 amlodipine-olmesartan 10-40 mg ......................................... 82 amlodipine-olmesartan 5-20 mg ........................................... 82 amlodipine-olmesartan 5-40 mg ........................................... 82 AMMONIA N-13 .................................................................... 97 ammonium lactate .............................................................. 144 AMMONUL (sodium phenylacet-sod benzoate) ................. 112 amoxapine .......................................................................... 136 amoxicillin ............................................................................. 39 amoxicillin/potassium clav .................................................... 39 AMPHADASE ....................................................................... 149 amphetamine ........................................................................ 71 amphetamine sulfate (Evekeo) ............................................. 71 amphotericin b ...................................................................... 46 ampicillin sodium .................................................................. 39 ampicillin sodium/sulbactam na ........................................... 39 ampicillin sodium/sulbactam na (Unasyn) ............................ 39 ampicillin trihydrate .............................................................. 39 AMPYRA (dalfampridine er) .................................................. 90 AMVISC ............................................................................... 106 AMVISC PLUS ...................................................................... 106 AMYTAL SODIUM ................................................................ 141 AMYVID ................................................................................. 98 anagrelide hcl ........................................................................ 66 anagrelide hcl (Agrylin) ......................................................... 66 ANALPRAM HC ............................................................ 118, 148 ANALPRAM HC (hydrocortisone-pramoxine) ...................... 118 ANASPAZ (nulev) ................................................................. 115 anastrozole (Arimidex) .......................................................... 57 ANCOBON (flucytosine) ........................................................ 45 ANDEXXA ............................................................................... 75 ANDRODERM ...................................................................... 119 ANDROGEL 1.62% GEL PUMP (testosterone) ...................... 119 ANDROGEL 1.62%(1.25G) GEL PCKT (testosterone) ........... 119 ANDROGEL 1.62%(2.5G) GEL PCKT (testosterone) ............. 119 ANDROGEL 1%(2.5G) GEL PACKET (testosterone) .............. 119 ANDROGEL 1%(5G) GEL PACKET (testosterone) ................. 119 ANECTINE (succinylcholine chloride) .................................... 73 ANGELIQ .............................................................................. 121 ANGIOMAX (bivalirudin) ....................................................... 44 ANNOVERA ............................................................................ 94 ANORO ELLIPTA ..................................................................... 30

166

ANTABUSE (disulfiram) ....................................................... 154 anthralin .............................................................................. 144 APADAZ ................................................................................. 17 APOKYN ................................................................................. 63 apraclonidine hcl ................................................................. 104 aprepitant 125 mg capsule ................................................. 113 aprepitant 125-80-80 mg pack (Emend) ............................. 114 aprepitant 40 mg capsule (Emend) ..................................... 114 aprepitant 80 mg capsule (Emend) ..................................... 114 APRISO (mesalamine er) ..................................................... 116 APTIOM 200 MG TABLET ....................................................... 91 APTIOM 400 MG TABLET ....................................................... 91 APTIOM 600 MG TABLET ....................................................... 91 APTIOM 800 MG TABLET ....................................................... 91 APTIVUS ................................................................................ 66 AQUASOL A ......................................................................... 161 ARALAST NP ........................................................................ 151 ARANESP ............................................................................... 93 ARAVA (leflunomide) ............................................................ 26 ARCALYST ............................................................................ 159 argatroban ............................................................................ 44 argatroban in 0.9 % sod chlor ............................................... 44 argatroban in nacl,iso-osmotic ............................................. 44 ARICEPT (donepezil hcl) ........................................................ 70 ARIDOL .................................................................................. 98 ARIKAYCE ............................................................................... 34 ARIMIDEX (anastrozole) ........................................................ 57 aripiprazole ......................................................................... 140 aripiprazole 1 mg/ml solution ............................................. 140 aripiprazole 10 mg tablet .................................................... 140 aripiprazole 15 mg tablet .................................................... 140 aripiprazole 2 mg tablet ...................................................... 140 aripiprazole 20 mg tablet .................................................... 140 aripiprazole 30 mg tablet .................................................... 140 aripiprazole 5 mg tablet ...................................................... 140 ARISTADA ER 1064 MG/3.9 ML SYR .................................... 140 ARISTADA ER 441 MG/1.6 ML SYRN .................................... 140 ARISTADA ER 662 MG/2.4 ML SYRN .................................... 140 ARISTADA ER 882 MG/3.2 ML SYRN .................................... 140 ARISTADA INITIO ................................................................. 140 ARIXTRA (fondaparinux sodium) ........................................... 43 armodafinil .......................................................................... 141 ARMOUR THYROID .............................................................. 149 ARMOUR THYROID (thyroid) ............................................... 149 AROMASIN (exemestane) ..................................................... 57 ARRANON .............................................................................. 56 arsenic trioxide ...................................................................... 61 arsenic trioxide (Trisenox) ..................................................... 61 ARTHROTEC 50 (diclofenac sodium-misoprostol) ................. 28 ARTHROTEC 75 (diclofenac sodium-misoprostol) ................. 28 ARTICADENT DENTAL ............................................................ 22 ARTISS ................................................................................. 146 ARYMO ER ............................................................................. 18 ARZERRA ................................................................................ 53 ASCLERA ................................................................................ 88 ASCOR ................................................................................. 162 ascorbic acid ........................................................................ 162 ASPARLAS .............................................................................. 61

aspirin/dipyridamole (Aggrenox) .......................................... 66 aspirin/omeprazole ............................................................... 66 ASTAGRAF XL ....................................................................... 127 atazanavir sulfate ................................................................. 67 ATELVIA (risedronate sodium dr) ........................................ 158 atenolol (Tenormin) .............................................................. 84 atenolol/chlorthalidone (Tenoretic 100) ............................... 85 atenolol/chlorthalidone (Tenoretic 50) ................................. 85 atomoxetine hcl 10 mg capsule (Strattera) ......................... 137 atomoxetine hcl 100 mg capsule (Strattera) ....................... 137 atomoxetine hcl 18 mg capsule (Strattera) ......................... 137 atomoxetine hcl 25 mg capsule (Strattera) ......................... 137 atomoxetine hcl 40 mg capsule (Strattera) ......................... 137 atomoxetine hcl 60 mg capsule (Strattera) ......................... 137 atomoxetine hcl 80 mg capsule (Strattera) ......................... 137 ATOPICLAIR (pruclair) .......................................................... 144 atorvastatin 10 mg tablet ..................................................... 87 atorvastatin 20 mg tablet ..................................................... 87 atorvastatin 40 mg tablet ..................................................... 87 atorvastatin 80 mg tablet ..................................................... 87 atovaquone ........................................................................... 51 atovaquone/proguanil hcl (Malarone) .................................. 51 atracurium besylate .............................................................. 73 ATRIPLA ................................................................................. 68 ATROPEN ............................................................................... 85 atropine sulfate ........................................................... 105, 115 atropine sulfate (Isopto Atropine) ....................................... 105 atropine sulfate/0.9 %sod chlr ............................................ 115 ATROVENT HFA ..................................................................... 29 AURYXIA .............................................................................. 108 AUSTEDO ............................................................................... 89 AVANDIA ............................................................................... 49 AVASTIN ................................................................................ 54 AVEED ................................................................................. 119 AVELOX IV (moxifloxacin) ...................................................... 39 AVITENE ................................................................................ 75 AVODART (dutasteride) ...................................................... 160 AVONEX ................................................................................. 90 AVONEX PEN ......................................................................... 90 AVYCAZ .................................................................................. 36 AXUMIN .............................................................................. 100 AYGESTIN (norethindrone acetate) ..................................... 124 azacitidine (Vidaza) ............................................................... 56 AZACTAM (aztreonam) ......................................................... 35 AZASAN ............................................................................... 127 AZASITE ................................................................................. 32 azathioprine (Imuran) ......................................................... 127 azathioprine sodium ............................................................ 127 AZEDRA DOSIMETRIC ............................................................ 62 AZEDRA THERAPEUTIC .......................................................... 62 azelaic acid (Finacea) .......................................................... 146 azelastine 0.1% (137 mcg) spry ........................................... 102 azelastine 0.15% nasal spray .............................................. 102 azelastine hcl 0.05% drops .................................................... 47 AZILECT 0.5 MG TABLET (rasagiline mesylate) ...................... 64 AZILECT 1 MG TABLET (rasagiline mesylate) ......................... 64 azithromycin .................................................................... 37, 38 azithromycin (Zithromax Tri-Pak) .......................................... 37

167

azithromycin (Zithromax) ...................................................... 38 AZOPT .................................................................................. 104 aztreonam (Azactam) ............................................................ 35 AZULFIDINE (sulfasalazine dr) ............................................. 116 AZULFIDINE (sulfasalazine) .................................................. 116

B

bacitracin ........................................................................ 32, 35 bacitracin/polymyxin b sulfate .............................................. 32 baclofen ............................................................................... 129 baclofen (Gablofen) ............................................................. 129 bacteriostatic sodium chloride ............................................ 157 BACTRIM (sulfamethoxazole-trimethoprim) ......................... 33 BACTRIM DS (sulfamethoxazole-trimethoprim) ................... 33 BAL IN OIL ............................................................................ 157 balanced salt irrig soln no.2 (BSS) ....................................... 103 BALCOLTRA ........................................................................... 94 balsalazide disodium ........................................................... 116 balsam peru/castor oil (Venelex) ........................................ 159 BALVERSA .............................................................................. 59 BANZEL 200 MG TABLET ....................................................... 91 BANZEL 40 MG/ML SUSPENSION .......................................... 91 BANZEL 400 MG TABLET ....................................................... 91 BAQSIMI .............................................................................. 107 BARACLUDE 0.05 MG/ML SOLUTION .................................... 70 BARACLUDE 0.5 MG TABLET (entecavir) ............................... 70 BARACLUDE 1 MG TABLET (entecavir) .................................. 70 BASAGLAR KWIKPEN U-100 .................................................. 50 BAVENCIO ............................................................................. 62 BAXDELA 300 MG VIAL .......................................................... 39 BAXDELA 450 MG TABLET ..................................................... 39 bcg live .................................................................................. 61 BELBUCA 150 MCG FILM ....................................................... 18 BELBUCA 300 MCG FILM ....................................................... 18 BELBUCA 450 MCG FILM ....................................................... 18 BELBUCA 600 MCG FILM ....................................................... 18 BELBUCA 75 MCG FILM ......................................................... 18 BELBUCA 750 MCG FILM ....................................................... 18 BELBUCA 900 MCG FILM ....................................................... 18 BELEODAQ ............................................................................. 54 BELRAPZO (bendamustine hcl) .............................................. 54 BELSOMRA .......................................................................... 142 benazepril hcl ........................................................................ 83 benazepril/hydrochlorothiazide ............................................ 81 bendamustine hcl (Bendeka) ................................................. 54 BENDEKA (bendamustine hcl) ............................................... 54 BENLYSTA 120 MG VIAL ...................................................... 159 BENLYSTA 200 MG/ML AUTOINJECT ................................... 159 BENLYSTA 200 MG/ML SYRINGE ......................................... 159 BENLYSTA 400 MG VIAL ...................................................... 159 BENTYL (dicyclomine hcl) .................................................... 113 BENZAMYCIN (erythromycin-benzoyl peroxide) ................... 42 benzhydrocodone/acetaminophen (Apadaz) ........................ 17 benznidazole ......................................................................... 51 benzonatate .......................................................................... 96 benzonatate (Tessalon Perle) ................................................ 96 benzoyl peroxide microspheres ........................................... 145 benztropine mesylate ............................................................ 63

benztropine mesylate (Cogentin) .......................................... 63 BEOVU ................................................................................. 106 BERINERT ............................................................................ 152 BESIVANCE ............................................................................ 32 BESPONSA ............................................................................. 58 BETA 1 (readysharp betamethasone) ................................. 121 BETADINE ............................................................................ 102 betamethasone acetate,sod phos (Beta 1) ......................... 121 betamethasone acetate,sod phos (Celestone) .................... 122 betamethasone dipropionate .............................................. 146 betamethasone valerate ..................................................... 146 betamethasone valerate (Luxiq) ......................................... 146 betamethasone/propylene glyc .......................................... 146 betamethasone/propylene glyc (Diprolene) ........................ 146 BETAPACE AF (sotalol af) ....................................................... 84 BETASERON ........................................................................... 90 betaxolol hcl .................................................................. 84, 104 bethanechol chloride ............................................................. 73 bethanechol chloride (Urecholine) ........................................ 73 BETIMOL .............................................................................. 104 BETOPTIC S .......................................................................... 104 BEVYXXA ................................................................................ 43 bexarotene (Targretin) .......................................................... 53 BEYAZ (drospirenone-eth estra-levomef) ............................. 94 BIAFINE (sonafine) .............................................................. 144 bicalutamide (Casodex) ......................................................... 55 BICILLIN C-R ........................................................................... 39 BICILLIN L-A ........................................................................... 39 BICNU (carmustine) ............................................................... 54 BIDIL ...................................................................................... 85 BIJUVA ................................................................................. 120 BIKTARVY ............................................................................... 68 BILTRICIDE (praziquantel) ..................................................... 51 bimatoprost ......................................................................... 104 BINOSTO .............................................................................. 158 BIONECT .............................................................................. 145 BIORPHEN ............................................................................. 80 bisac/nacl/nahco3/kcl/peg 3350 ........................................ 117 bisoprolol fumarate ............................................................... 84 bisoprolol/hydrochlorothiazide (Ziac) ................................... 85 bivalirudin ............................................................................. 44 bivalirudin (Angiomax) .......................................................... 44 bivalirudin/0.9 % sodium chlor .............................................. 44 bleomycin sulfate .................................................................. 53 BLEPH-10 (sulfacetamide sodium) ........................................ 32 BLEPHAMIDE ......................................................................... 32 BLEPHAMIDE S.O.P. ............................................................... 32 BLINCYTO .............................................................................. 61 BLOXIVERZ (neostigmine methylsulfate) .............................. 71 BONIVA 150 MG TABLET (ibandronate sodium) ................. 158 BONIVA 3 MG/3 ML SYRINGE (ibandronate sodium) .......... 158 BONJESTA ............................................................................ 114 bortezomib ............................................................................ 59 bosentan (Tracleer) ............................................................... 80 BOSULIF ................................................................................. 59 BOTOX 100 UNIT VIAL ........................................................... 73 BOTOX 200 UNIT VIAL ........................................................... 73 BRAFTOVI .............................................................................. 57

168

BREO ELLIPTA ........................................................................ 30 bretylium tosylate ................................................................. 76 BREVIBLOC (esmolol hcl) ....................................................... 84 BREVIBLOC (esmolol hcl-sodium chloride) ............................ 84 BREVITAL SODIUM ................................................................ 22 BRILINTA ................................................................................ 66 brimonidine tartrate ............................................................ 104 brimonidine tartrate (Alphagan P) ...................................... 104 BRINEURA ............................................................................ 156 BRISDELLE (paroxetine mesylate) ....................................... 156 BRIVIACT 10 MG TABLET ....................................................... 91 BRIVIACT 10 MG/ML ORAL SOLN .......................................... 91 BRIVIACT 100 MG TABLET ..................................................... 91 BRIVIACT 25 MG TABLET ....................................................... 91 BRIVIACT 50 MG TABLET ....................................................... 91 BRIVIACT 50 MG/5 ML VIAL .................................................. 91 BRIVIACT 75 MG TABLET ....................................................... 91 bromfenac sodium .............................................................. 103 bromocriptine mesylate (Parlodel) ........................................ 64 brompheniramine/pseudoephed/dm .................................... 96 BROMSITE ........................................................................... 103 BROVANA .............................................................................. 30 BRUKINSA .............................................................................. 59 BRYHALI ............................................................................... 147 BSS (balanced salt) .............................................................. 103 budesonide .................................................................... 31, 122 budesonide (Entocort EC) .................................................... 122 budesonide (Pulmicort) ......................................................... 31 bumetanide ......................................................................... 100 BUNAVAIL ............................................................................ 159 BUPHENYL (sodium phenylbutyrate) .................................. 112 bupivacaine hcl (Sensorcaine) ............................................... 22 bupivacaine hcl in dextrose/pf (Marcaine Spinal) ................. 22 bupivacaine hcl/0.9 % nacl/pf ............................................... 22 bupivacaine hcl/epinephrine (Marcaine-epinephrine) .......... 22 bupivacaine hcl/epinephrine/pf (Marcaine-epinephrine) ..... 22 bupivacaine hcl/epinephrine/pf (Sensorcaine-mpf

Epinephrine) ...................................................................... 22 bupivacaine hcl/pf ................................................................. 22 bupivacaine hcl/pf (Sensorcaine-mpf) ................................... 22 BUPRENEX ............................................................................. 18 buprenorphine (Butrans) ....................................................... 18 buprenorphine hcl ................................................. 18, 159, 160 buprenorphine hcl/naloxone hcl ......................................... 160 buprenorphine hcl/naloxone hcl (Suboxone) ....................... 160 bupropion hcl 100 mg tablet ............................................... 132 bupropion hcl 75 mg tablet ................................................. 132 bupropion hcl sr 100 mg tablet (Wellbutrin SR) .................. 132 bupropion hcl sr 150 mg tablet (Wellbutrin SR) .................. 132 bupropion hcl sr 200 mg tablet (Wellbutrin SR) .................. 132 bupropion hcl xl 150 mg tablet ........................................... 132 bupropion hcl xl 300 mg tablet ........................................... 132 bupropion hcl xl 450 mg tablet (Forfivo XL) ........................ 132 buspirone hcl ....................................................................... 131 busulfan (Busulfex) ................................................................ 54 BUSULFEX (busulfan) ............................................................. 54 butalb/acetaminophen/caffeine ........................................... 15 butalb/acetaminophen/caffeine (Esgic) ................................ 15

butalb/acetaminophen/caffeine (Zebutal) ............................ 15 butalb-aspirin-caffe 50-325-40 ............................................. 15 butalbit/acetamin/caff/codeine ........................................... 21 butalbit/acetamin/caff/codeine (Fioricet With Codeine) ...... 21 butalbital/acetaminophen .................................................... 15 butalbital-asa-caffeine cap (Fiorinal) .................................... 15 butoconazole nitrate ............................................................. 45 butorphanol 1 mg/ml vial ..................................................... 18 butorphanol 10 mg/ml spray ................................................ 18 butorphanol 2 mg/ml vial ..................................................... 18 butorphanol 4 mg/2 ml vial .................................................. 18 BUTRANS (buprenorphine) ................................................... 18 BYDUREON BCISE .................................................................. 48 BYDUREON PEN ..................................................................... 48 BYETTA .................................................................................. 48

C

cabergoline ......................................................................... 124 CABLIVI .................................................................................. 74 CABOMETYX .......................................................................... 59 CADUET 10 MG-10 MG TABLET (amlodipine-atorvastatin) .. 86 CADUET 10 MG-20 MG TABLET (amlodipine-atorvastatin) .. 86 CADUET 10 MG-40 MG TABLET (amlodipine-atorvastatin) .. 86 CADUET 10 MG-80 MG TABLET (amlodipine-atorvastatin) .. 86 CADUET 5 MG-10 MG TABLET (amlodipine-atorvastatin) .... 86 CADUET 5 MG-20 MG TABLET (amlodipine-atorvastatin) .... 86 CADUET 5 MG-40 MG TABLET (amlodipine-atorvastatin) .... 86 CADUET 5 MG-80 MG TABLET (amlodipine-atorvastatin) .... 86 CAFCIT (caffeine citrate) ....................................................... 89 CAFERGOT (ergotamine-caffeine) ......................................... 15 caffeine citrate ...................................................................... 89 caffeine citrate (Cafcit) .......................................................... 89 caffeine/sodium benzoate ..................................................... 89 CALAN SR (verapamil er) ....................................................... 77 calcipotriene ................................................................ 144, 149 calcipotriene/betamethasone ............................................. 149 calcitonin,salmon,synthetic ................................................. 126 calcitriol 0.25 mcg capsule (Rocaltrol) ................................ 162 calcitriol 0.5 mcg capsule (Rocaltrol) .................................. 162 calcitriol 1 mcg/ml ampul ................................................... 162 calcitriol 1 mcg/ml solution (Rocaltrol) ............................... 162 calcitriol 3 mcg/g ointment ................................................. 144 calcium acetate ................................................................... 108 calcium chloride .................................................................. 108 CALCIUM GLU 2,000MG/100ML-NACL ............................... 108 calcium gluc 1,000mg/50ml-nacl ........................................ 108 calcium gluconate ............................................................... 108 calcium gluconate in 0.9% nacl ........................................... 108 CALDOLOR ............................................................................. 28 CALQUENCE .......................................................................... 59 CAMPATH .............................................................................. 61 CAMPTOSAR .......................................................................... 58 CAMPTOSAR (irinotecan hcl) ................................................ 58 CANASA (mesalamine) ........................................................ 116 CANCIDAS (caspofungin acetate) .......................................... 46 candesartan cilexetil ............................................................. 83 candesartan/hydrochlorothiazide ......................................... 82 CAPASTAT SULFATE ............................................................... 35

169

capecitabine (Xeloda) ............................................................ 56 CAPEX SHAMPOO ................................................................ 147 CAPRELSA .............................................................................. 59 captopril .......................................................................... 81, 83 captopril-hctz 25-15 mg tablet .............................................. 81 captopril-hctz 25-25 mg tablet .............................................. 81 captopril-hctz 50-15 mg tablet .............................................. 81 captopril-hctz 50-25 mg tablet .............................................. 81 CARAFATE 1 GM TABLET (sucralfate) .................................. 115 CARAFATE 1 GM/10 ML SUSP (sucralfate) .......................... 115 CARBAGLU ........................................................................... 154 carbamazepine ...................................................................... 91 carbamazepine (Carbatrol) ................................................... 91 carbamazepine (Tegretol XR) ................................................ 91 carbamazepine (Tegretol) ..................................................... 91 CARBATROL (carbamazepine er) ........................................... 91 carbidopa ........................................................................ 64, 65 carbidopa/levodopa .............................................................. 64 carbidopa/levodopa (Sinemet 10-100) .................................. 64 carbidopa/levodopa (Sinemet 25-100) .................................. 64 carbidopa/levodopa (Sinemet 25-250) .................................. 64 carbidopa/levodopa (Sinemet CR) ......................................... 64 carbidopa/levodopa/entacapone (Stalevo 100) ................... 64 carbidopa/levodopa/entacapone (Stalevo 125) ................... 64 carbidopa/levodopa/entacapone (Stalevo 150) ................... 64 carbidopa/levodopa/entacapone (Stalevo 200) ................... 64 carbidopa/levodopa/entacapone (Stalevo 50) ..................... 64 carbidopa/levodopa/entacapone (Stalevo 75) ..................... 64 carbinoxamine maleate ........................................................ 47 CARBOCAINE (polocaine) ...................................................... 22 CARBOCAINE (polocaine-mpf) .............................................. 22 carboplatin ............................................................................ 54 carboprost tromethamine ................................................... 124 CARDENE I.V. ......................................................................... 77 cardioplegic 21 (reperfus 41) ................................................ 78 cardioplegic no.14 (maint 81) ............................................... 78 cardioplegic no.15(induct 81) ................................................ 78 cardioplegic no.17(induct 41 ................................................. 78 cardioplegic no.18(induct 81) ................................................ 78 cardioplegic no.19 (maint 41) ............................................... 78 cardioplegic no.20 (maint 41) ............................................... 79 cardioplegic no.22(induct 41) ................................................ 79 cardioplegic no.26 (maint 41) ............................................... 79 cardioplegic solution no.1 (Plegisol) ...................................... 79 cardioplegic solution no.10 ................................................... 79 cardioplegic solution no.16 ................................................... 79 CARDIZEM LA 120 MG TABLET .............................................. 77 CARDIZEM LA 180 MG TABLET (matzim la) ........................... 77 CARDIZEM LA 240 MG TABLET (matzim la) ........................... 77 CARDIZEM LA 300 MG TABLET (matzim la) ........................... 77 CARDIZEM LA 360 MG TABLET (matzim la) ........................... 77 CARDIZEM LA 420 MG TABLET (matzim la) ........................... 77 CARDURA (doxazosin mesylate) ............................................ 82 CARDURA XL .......................................................................... 82 carisoprodol (Soma) ............................................................ 129 carisoprodol/aspirin ...................................................... 21, 129 carisoprodol/aspirin/codeine ................................................ 21 carmustine (Bicnu) ................................................................ 54

CARNITOR ........................................................................... 158 CARNITOR (levocarnitine) ................................................... 158 CARNITOR SF (levocarnitine sf) ........................................... 158 CAROSPIR ............................................................................ 101 carteolol hcl ......................................................................... 104 carvedilol (Coreg) .................................................................. 81 carvedilol er 10 mg capsule (Coreg CR) ................................. 81 carvedilol er 20 mg capsule (Coreg CR) ................................. 81 carvedilol er 40 mg capsule (Coreg CR) ................................. 81 carvedilol er 80 mg capsule (Coreg CR) ................................. 81 CASODEX (bicalutamide) ....................................................... 55 caspofungin acetate (Cancidas) ............................................ 46 CATAPRES (clonidine hcl) ...................................................... 83 CATAPRES-TTS 1 (clonidine) .................................................. 83 CATAPRES-TTS 2 (clonidine) .................................................. 83 CATAPRES-TTS 3 (clonidine) .................................................. 83 CATHFLO ACTIVASE ............................................................... 76 CAYSTON ............................................................................... 35 cefaclor .................................................................................. 36 cefadroxil ............................................................................... 36 cefazolin sodium ................................................................... 36 cefazolin sodium in 0.9 % nacl .............................................. 36 cefazolin sodium/dextrose,iso ............................................... 36 cefazolin sodium/water ........................................................ 36 cefdinir .................................................................................. 36 cefditoren pivoxil ................................................................... 36 cefditoren pivoxil (Spectracef) ............................................... 36 cefepime hcl .......................................................................... 36 cefepime hcl in dextrose 5 % ................................................. 36 cefepime in iso-osm dextrose ................................................ 36 cefixime (Suprax) ................................................................... 36 CEFOTAN (cefotetan) ............................................................ 36 cefotetan disod/isosm dextrose ............................................ 36 cefotetan disodium (Cefotan) ............................................... 36 cefoxitin sodium .................................................................... 36 cefoxitin sodium/dextrose,iso ............................................... 36 cefpodoxime proxetil ............................................................. 36 cefprozil ................................................................................. 36 ceftazidime ............................................................................ 36 ceftazidime in dextrose5%water ........................................... 36 ceftriaxone in is-osm dextrose .............................................. 36 ceftriaxone sodium ................................................................ 36 cefuroxime axetil ................................................................... 36 cefuroxime sodium ................................................................ 36 CELACYN .............................................................................. 144 CELEBREX 100 MG CAPSULE (celecoxib) ............................... 29 CELEBREX 200 MG CAPSULE (celecoxib) ............................... 29 CELEBREX 400 MG CAPSULE (celecoxib) ............................... 29 CELEBREX 50 MG CAPSULE (celecoxib) ................................. 29 celecoxib 100 mg capsule (Celebrex) ..................................... 29 celecoxib 200 mg capsule (Celebrex) ..................................... 29 celecoxib 400 mg capsule (Celebrex) ..................................... 29 celecoxib 50 mg capsule (Celebrex) ....................................... 29 CELESTONE (betamethasone sod phos-acetate) ................ 122 CELEXA 10 MG TABLET (citalopram hbr) ............................. 132 CELEXA 20 MG TABLET (citalopram hbr) ............................. 132 CELEXA 40 MG TABLET (citalopram hbr) ............................. 132

170

CELLCEPT 200 MG/ML ORAL SUSP (mycophenolate mofetil) ................................................ 127

CELLCEPT 250 MG CAPSULE (mycophenolate mofetil) ....... 127 CELLCEPT 500 MG TABLET (mycophenolate mofetil) .......... 128 CELLCEPT 500 MG VIAL (mycophenolate mofetil) .............. 128 CELLUGEL (ocucoat) ............................................................ 106 CELONTIN .............................................................................. 91 CENTANY (mupirocin) ........................................................... 42 CENTANY AT .......................................................................... 42 cephalexin ............................................................................. 36 cephalexin (Keflex) ................................................................ 36 CEPROTIN .............................................................................. 75 CEQUA ................................................................................. 106 CERDELGA ........................................................................... 155 CEREBYX (fosphenytoin sodium) ........................................... 91 CERETEC ................................................................................ 98 CEREZYME ........................................................................... 156 CERVIDIL .............................................................................. 124 CETACAINE ............................................................................ 25 CETRAXAL (ciprofloxacin hcl) ................................................ 31 CETROTIDE .......................................................................... 123 cevimeline hcl (Evoxac) ......................................................... 73 CHEMET ............................................................................... 157 CHENODAL .......................................................................... 116 CHIRHOSTIM ......................................................................... 99 chloramphenicol sod succinate ............................................. 37 chlordiazepoxide hcl ............................................................ 131 chlordiazepoxide/clidinium br ............................................. 113 chlorhexidine gluconate ...................................................... 153 chloroprocaine hcl/pf (Nesacaine-mpf) ................................. 23 chloroquine phosphate .......................................................... 51 chlorothiazide sodium (Sodium Diuril) ................................ 101 chlorpromazine hcl .............................................................. 141 chlorthalidone ..................................................................... 101 chlorzoxazone ...................................................................... 129 CHOLBAM ............................................................................ 116 cholestyramine (with sugar) (Questran) ............................... 87 cholestyramine/aspartame ................................................... 87 cholestyramine/aspartame (Questran Light) ........................ 87 CHOLETEC (tc99m mebrofenin prep) .................................... 97 choline salicyl/mag salicylate ................................................ 15 chorionic gonadotropin, human (Pregnyl) .......................... 126 chromic chloride .................................................................. 110 CICLODAN 8% KIT (ciclopirox) ............................................... 46 ciclodan 8% solution .............................................................. 46 ciclopirox ............................................................................... 46 ciclopirox olamine ................................................................. 46 ciclopirox olamine (Loprox) ................................................... 46 ciclopirox/urea/camph/men/euc (Ciclodan) ......................... 46 cidofovir ................................................................................ 68 cilostazol ............................................................................... 66 CILOXAN ................................................................................ 32 CILOXAN (ciprofloxacin hcl) ................................................... 32 CIMDUO ................................................................................ 67 cimetidine hcl ...................................................................... 116 CIMZIA 200 MG VIAL KIT ....................................................... 52 CIMZIA 2X200 MG/ML SYRINGE KIT ...................................... 52 CIMZIA 2X200 MG/ML(X3)START KT ..................................... 52

cinacalcet hcl (Sensipar) ...................................................... 153 CINQAIR ................................................................................. 31 CINRYZE ............................................................................... 152 CINVANTI ............................................................................. 114 CIPRO .............................................................................. 32, 39 CIPRO (ciprofloxacin hcl) ....................................................... 39 CIPRO HC ............................................................................... 32 CIPRODEX .............................................................................. 32 ciprofloxacin hcl ......................................................... 31, 33, 40 ciprofloxacin hcl (Cetraxal) .................................................... 31 ciprofloxacin hcl (Ciloxan) ..................................................... 33 ciprofloxacin hcl (Cipro) ......................................................... 40 CIPROFLOXACIN HCL-FLUOCINOLONE .................................. 32 ciprofloxacin in 5 % dextrose ................................................. 40 cisatracurium besylate (Nimbex) .......................................... 73 cisplatin 100 mg/100 ml vial ................................................. 54 cisplatin 200 mg/200 ml vial ................................................. 54 cisplatin 50 mg vial ............................................................... 54 cisplatin 50 mg/50 ml vial ..................................................... 54 citalopram hbr 10 mg tablet (Celexa) ................................. 132 citalopram hbr 10 mg/5 ml soln .......................................... 132 citalopram hbr 20 mg tablet (Celexa) ................................. 132 citalopram hbr 20 mg/10 ml sol .......................................... 132 citalopram hbr 40 mg tablet (Celexa) ................................. 132 CITANEST FORTE DENTAL ...................................................... 23 CITANEST PLAIN DENTAL ....................................................... 23 CITRANATAL 90 DHA ........................................................... 130 CITRANATAL ASSURE ........................................................... 130 CITRANATAL DHA ................................................................ 130 CITRANATAL HARMONY ...................................................... 130 CITRANATAL RX ................................................................... 130 cladribine ............................................................................... 56 CLARINEX-D 12 HOUR ........................................................... 47 clarithromycin ....................................................................... 38 clemastine fumarate ............................................................. 47 CLENPIQ .............................................................................. 117 CLEOCIN ..................................................................... 37, 41, 42 CLEOCIN (clindamycin phosphate) ........................................ 41 CLEOCIN HCL (clindamycin hcl) ............................................. 37 CLEOCIN PALMITATE (clindamycin pediatric) ....................... 37 CLEOCIN PHOS 150 MG/ML VIAL (clindamycin phosphate) .. 37 CLEOCIN PHOS 300 MG/2 ML VIAL (clindamycin phosphate)37 cleocin phos 300 mg/2ml addvan ......................................... 37 CLEOCIN PHOS 600 MG/4 ML VIAL (clindamycin phosphate)37 CLEOCIN PHOS 600 MG/4ML ADDVAN ................................. 37 CLEOCIN PHOS 9 G/60 ML VIAL (clindamycin phosphate) .... 37 CLEOCIN PHOS 900 MG/6 ML VIAL (clindamycin phosphate)37 CLEOCIN PHOS 900 MG/6ML ADDVAN ................................. 37 CLEOCIN T (clindamycin phosphate) ..................................... 42 CLEVIPREX ............................................................................. 77 CLIMARA (estradiol) ............................................................ 120 CLIMARA PRO ...................................................................... 120 clindacin etz 1% pledget ........................................................ 42 CLINDACIN ETZ KIT ................................................................ 42 CLINDACIN PAC ..................................................................... 42 clindamycin hcl (Cleocin Hcl) ................................................. 37 clindamycin in 0.9 % sod chlor .............................................. 37 clindamycin palmitate hcl (Cleocin Palmitate) ...................... 37

171

clindamycin phos/benzoyl perox ......................................... 144 clindamycin phosphate ............................................. 37, 41, 42 clindamycin phosphate (Cleocin Phosphate) ......................... 37 clindamycin phosphate (Cleocin T) ........................................ 42 clindamycin phosphate (Cleocin) ........................................... 41 clindamycin phosphate (Evoclin) ........................................... 42 clindamycin phosphate/d5w ................................................. 37 clindamycin/tretinoin .......................................................... 144 CLINDESSE ............................................................................. 41 CLINIMIX .............................................................................. 108 CLINIMIX E ........................................................................... 108 CLINISOL .............................................................................. 108 CLINOLIPID .......................................................................... 117 CLINPRO 5000 (fluoridex) .................................................... 106 clobazam (Onfi) ..................................................................... 90 clobetasol propionate ......................................................... 147 clobetasol propionate (Olux) ............................................... 147 clobetasol propionate (Temovate) ...................................... 147 clobetasol propionate/emoll ............................................... 147 clobetasol propionate/emoll (Olux-E) ................................. 147 clocortolone pivalate (Cloderm) .......................................... 147 CLODAN 0.05% KIT .............................................................. 147 clodan 0.05% shampoo ....................................................... 147 CLODERM (clocortolone pivalate) ....................................... 147 clofarabine (Clolar) ................................................................ 56 CLOLAR (clofarabine) ............................................................ 56 clomiphene citrate .............................................................. 125 clomipramine hcl ................................................................. 136 clonazepam ........................................................................... 90 clonazepam (Klonopin) .......................................................... 90 clonidine (Catapres-TTS 1) ..................................................... 84 clonidine (Catapres-TTS 2) ..................................................... 84 clonidine (Catapres-TTS 3) ..................................................... 84 clonidine 1,000 mcg/10 ml vial (Duraclon) ............................ 15 clonidine 5,000 mcg/10 ml vial ............................................. 15 clonidine hcl (Kapvay) ......................................................... 136 clonidine hcl 0.1 mg tablet (Catapres) .................................. 84 clonidine hcl 0.2 mg tablet (Catapres) .................................. 84 clonidine hcl 0.3 mg tablet (Catapres) .................................. 84 clopidogrel bisulfate .............................................................. 66 clopidogrel bisulfate (Plavix) ................................................. 66 clorazepate dipotassium ..................................................... 131 clorazepate dipotassium (Tranxene T-Tab) ......................... 131 CLOROTEKAL ......................................................................... 23 clotrimazole ..................................................................... 45, 46 clotrimazole/betamethasone dip .......................................... 46 clotrimazole/betamethasone dip (Lotrisone) ........................ 46 clozapine ............................................................................. 138 clozapine (Clozaril) .............................................................. 138 CLOZARIL 100 MG TABLET (clozapine) ................................ 138 CLOZARIL 200 MG TABLET (clozapine) ................................ 138 CLOZARIL 25 MG TABLET (clozapine) .................................. 138 CLOZARIL 50 MG TABLET (clozapine) .................................. 138 COAGADEX ............................................................................ 75 COARTEM .............................................................................. 51 codeine sulfate ...................................................................... 18 codeine/butalbital/asa/caffein (Fiorinal With Codeine #3) ... 21 COGENTIN (benztropine mesylate) ....................................... 63

colchicine (Colcrys) ................................................................ 27 colchicine (Mitigare) ............................................................. 27 COLCRYS (colchicine) ............................................................. 27 colesevelam hcl (Welchol) ..................................................... 87 COLESTID ............................................................................... 87 COLESTID (colestipol hcl) ...................................................... 87 colestipol hcl (Colestid) .......................................................... 87 colistin (colistimethate na) (Coly-mycin M Parenteral) ......... 39 COLY-MYCIN M PARENTERAL (colistimethate) ..................... 39 COLY-MYCIN S ....................................................................... 31 COMBIGAN .......................................................................... 104 COMBIPATCH ...................................................................... 120 COMBIVENT RESPIMAT ......................................................... 30 COMETRIQ ............................................................................ 59 COMPLERA ............................................................................ 68 COMTAN (entacapone) ......................................................... 64 CONDYLOX .......................................................................... 145 CONRAY-43 ......................................................................... 100 COPIKTRA .............................................................................. 59 CORDRAN 0.025% CREAM .................................................. 147 CORDRAN 0.05% CREAM (nolix) ......................................... 147 CORDRAN 0.05% LOTION (nolix) ......................................... 147 CORDRAN 0.05% OINTMENT (flurandrenolide) .................. 147 CORDRAN 4 MCG/SQ CM TAPE LARGE ............................... 147 COREG (carvedilol) ................................................................ 81 COREG CR 10 MG CAPSULE (carvedilol er) ............................ 81 COREG CR 20 MG CAPSULE (carvedilol er) ............................ 81 COREG CR 40 MG CAPSULE (carvedilol er) ............................ 81 COREG CR 80 MG CAPSULE (carvedilol er) ............................ 81 coremino er 135 mg tablet .................................................... 40 coremino er 45 mg tablet ...................................................... 40 coremino er 90 mg tablet ...................................................... 40 CORGARD (nadolol) ............................................................... 84 CORIFACT .............................................................................. 75 CORLANOR ............................................................................ 79 CORLOPAM ........................................................................... 84 CORTEF (hydrocortisone) .................................................... 122 CORTENEMA (hydrocortisone) ............................................ 118 cortisone acetate ................................................................ 122 CORTISPORIN .................................................................. 31, 42 CORTISPORIN-TC ................................................................... 31 CORVERT (ibutilide fumarate) ............................................... 76 COSENTYX (2 SYRINGES) ..................................................... 143 COSENTYX PEN .................................................................... 143 COSENTYX PEN (2 PENS) ..................................................... 143 COSENTYX SYRINGE ............................................................. 143 COSMEGEN (dactinomycin) .................................................. 53 COSOPT (dorzolamide-timolol) ........................................... 104 COSOPT PF (dorzolamide-timolol) ...................................... 104 cosyntropin .......................................................................... 118 COTELLIC ............................................................................... 57 COUMADIN (warfarin sodium) .............................................. 43 CREON ................................................................................. 118 CRESEMBA 186 MG CAPSULE ............................................... 45 CRESEMBA 372 MG VIAL ....................................................... 45 CRINONE ............................................................................. 126 cromolyn 100 mg/5 ml oral conc (Gastrocrom) .................... 26 cromolyn 20 mg/2 ml neb soln .............................................. 31

172

cromolyn 4% eye drops ....................................................... 104 crotamiton ............................................................................. 63 CUBICIN (daptomycin) .......................................................... 42 CUBICIN RF (daptomycin) ...................................................... 42 cupric chloride ..................................................................... 110 CUROSURF ........................................................................... 151 CUVPOSA ............................................................................. 113 cyanocobalamin (vitamin b-12) .......................................... 162 cyanocobalamin (vitamin b-12) (Physicians EZ Use B-12) ... 162 CYANOKIT ............................................................................ 155 cyclobenzaprine hcl ............................................................. 129 cyclobenzaprine hcl (Fexmid) .............................................. 129 CYCLOGYL (cyclopentolate hcl) ........................................... 105 CYCLOMYDRIL ..................................................................... 105 cyclopentolat/tropic/phenyleph .......................................... 105 cyclopentolate hcl (Cyclogyl) ............................................... 105 cyclophosphamide 1 gm vial ................................................. 54 cyclophosphamide 2 gm vial ................................................. 54 cyclophosphamide 25 mg capsule ......................................... 54 cyclophosphamide 50 mg capsule ......................................... 54 cyclophosphamide 500 mg vial ............................................. 54 cycloserine ............................................................................. 35 CYCLOSET .............................................................................. 48 cyclosporine 100 mg capsule (Sandimmune) ...................... 128 cyclosporine 25 mg capsule (Sandimmune) ........................ 128 cyclosporine 250 mg/5 ml ampul (Sandimmune) ................ 128 cyclosporine, modified ......................................................... 128 cyclosporine, modified (Neoral) .......................................... 128 CYKLOKAPRON (tranexamic acid) ......................................... 74 cyproheptadine hcl ................................................................ 47 CYRAMZA .............................................................................. 58 CYSTADANE ......................................................................... 158 CYSTAGON ........................................................................... 160 CYSTARAN ........................................................................... 106 CYSTO-CONRAY II ................................................................ 100 CYSTOGRAFIN ...................................................................... 100 CYSTOGRAFIN-DILUTE ......................................................... 100 CYSVIEW ................................................................................ 99 cytarabine ............................................................................. 56 cytarabine/pf ......................................................................... 56 CYTOMEL (liothyronine sodium) ......................................... 149 CYTOTEC (misoprostol) ....................................................... 115 CYTOVENE (ganciclovir sodium) ............................................ 68

D

dacarbazine ........................................................................... 61 DACOGEN (decitabine) .......................................................... 56 dactinomycin (Cosmegen) ..................................................... 53 dalfampridine (Ampyra) ........................................................ 90 DALIRESP 250 MCG TABLET .................................................. 31 DALIRESP 500 MCG TABLET .................................................. 31 DALVANCE ............................................................................. 37 danazol ................................................................................ 124 DANTRIUM (dantrolene sodium) ........................................ 129 DANTRIUM (revonto) .......................................................... 129 dantrolene sodium .............................................................. 129 dantrolene sodium (Dantrium) ............................................ 129 dapsone ......................................................................... 35, 144

daptomycin ........................................................................... 42 daptomycin (Cubicin Rf) ........................................................ 42 DARAPRIM ............................................................................. 51 darifenacin er 15 mg tablet ................................................. 161 darifenacin er 7.5 mg tablet ................................................ 161 DARZALEX .............................................................................. 55 DATSCAN ............................................................................... 98 daunorubicin hcl .................................................................... 53 DAURISMO ............................................................................ 57 DAYPRO (oxaprozin) .............................................................. 28 DAYTRANA .......................................................................... 136 decitabine (Dacogen) ............................................................ 56 deferasirox (Exjade) ............................................................ 157 deferasirox (Jadenu) ............................................................ 157 deferoxamine mesylate ....................................................... 157 deferoxamine mesylate (Desferal Mesylate) ....................... 157 DEFINITY ................................................................................ 97 DEFITELIO .............................................................................. 76 DELESTROGEN ..................................................................... 120 DELESTROGEN (estradiol valerate) ..................................... 120 DELFLEX WITH 1.5% DEXTROSE .......................................... 112 DELFLEX WITH 2.5% DEXTROSE .......................................... 112 DELFLEX WITH 4.25% DEXTROSE ........................................ 112 DELSTRIGO ............................................................................ 68 demeclocycline hcl ................................................................ 40 DEMEROL .............................................................................. 18 DEMSER ................................................................................. 83 DEPAKOTE (divalproex sodium) ............................................ 91 DEPAKOTE ER (divalproex sodium er) ................................... 91 DEPAKOTE SPRINKLE (divalproex sodium) ............................ 91 DEPEN (penicillamine) ........................................................... 26 DEPO-ESTRADIOL ................................................................ 120 DEPO-MEDROL .................................................................... 122 DEPO-MEDROL (methylprednisolone acetate) ................... 122 DEPO-PROVERA 150 MG/ML SYRINGE (medroxyprogesterone

acetate) ............................................................................. 94 DEPO-PROVERA 150 MG/ML VIAL (medroxyprogesterone

acetate) ............................................................................. 94 DEPO-PROVERA 400 MG/ML VIAL ...................................... 124 DEPO-SUBQ PROVERA 104 .................................................... 94 DEPO-TESTOSTERONE (testosterone cypionate) ................ 119 DERMA-SMOOTHE-FS (fluocinolone acetonide) ................. 147 dermazene cream ............................................................... 149 DERMAZENE CREAM PACKET .............................................. 149 DERMOTIC (fluocinolone acetonide oil) .............................. 102 DESCOVY ............................................................................... 67 DESFERAL MESYLATE (deferoxamine mesylate) ................. 157 desflurane (Suprane) ............................................................. 22 desipramine hcl ................................................................... 136 desipramine hcl (Norpramin) .............................................. 136 desmopressin 0.01% solution .............................................. 119 desmopressin 0.01% spray .................................................. 119 desmopressin 10 mcg/0.1 ml spr ........................................ 119 desmopressin 40 mcg/10 ml vial ......................................... 119 desmopressin ac 4 mcg/ml ampul ....................................... 119 desmopressin ac 4 mcg/ml vial ........................................... 120 desmopressin acetate 0.1 mg tb ......................................... 120 desmopressin acetate 0.2 mg tb ......................................... 120

173

desog-e.estradiol/e.estradiol (Mircette) ............................... 94 desogestrel-ethinyl estradiol ................................................. 94 DESONATE ........................................................................... 147 desonide .............................................................................. 147 desonide (Tridesilon) ........................................................... 147 DESOWEN (desonide) .......................................................... 147 desoximetasone (Topicort) .................................................. 147 DESVENLAFAXINE ER 100 MG TAB ...................................... 134 DESVENLAFAXINE ER 50 MG TAB ........................................ 134 desvenlafaxine suc er 100 mg ............................................. 134 desvenlafaxine suc er 25 mg tb ........................................... 134 desvenlafaxine suc er 50 mg tb ........................................... 134 dexamethasone ........................................................... 103, 122 dexamethasone 0.1% eye drop ........................................... 103 DEXAMETHASONE 10 MG/ML SYRING ................................ 122 dexamethasone 10 mg/ml vial ............................................ 122 dexamethasone 100 mg/10 ml vl ........................................ 122 dexamethasone 120 mg/30 ml vl ........................................ 122 dexamethasone 20 mg/5 ml vial ......................................... 122 dexamethasone 4 mg/ml syringe ........................................ 122 dexamethasone 4 mg/ml vial .............................................. 122 dexchlorpheniramine maleate (Ryclora) ............................... 47 dexmedetomidine hcl .......................................................... 142 dexmedetomidine hcl (Precedex) ........................................ 142 dexmedetomidine in 0.9 % nacl (Precedex) ......................... 142 dexmethylphenidate er 10 mg cp ........................................ 136 dexmethylphenidate er 15 mg cp ........................................ 136 dexmethylphenidate er 20 mg cp ........................................ 136 dexmethylphenidate er 25 mg cp ........................................ 136 dexmethylphenidate er 30 mg cp ........................................ 136 dexmethylphenidate er 35 mg cp ........................................ 136 dexmethylphenidate er 40 mg cp ........................................ 136 dexmethylphenidate er 5 mg cap ........................................ 136 dexmethylphenidate hcl (Focalin) ....................................... 137 dexrazoxane hcl (Zinecard) ................................................. 152 dextroamp-amphet er 10 mg cap ......................................... 71 dextroamp-amphet er 15 mg cap ......................................... 71 dextroamp-amphet er 20 mg cap ......................................... 71 dextroamp-amphet er 25 mg cap ......................................... 72 dextroamp-amphet er 30 mg cap ......................................... 72 dextroamp-amphet er 5 mg cap ........................................... 72 dextroamphetamine er 10 mg cap ........................................ 72 dextroamphetamine er 15 mg cap ........................................ 72 dextroamphetamine er 5 mg cap .......................................... 72 dextroamphetamine sulfate .................................................. 72 dextroamphetamine sulfate (Zenzedi) .................................. 72 dextroamphetamine/amphetamine (Adderall) ..................... 72 dextrose 10 % and 0.2 % nacl .............................................. 107 dextrose 10 % and 0.45 % nacl ............................................ 107 dextrose 10 % in water ........................................................ 107 dextrose 2.5 % and 0.45 % nacl ........................................... 107 dextrose 20 % in water ........................................................ 107 dextrose 25 % in water ........................................................ 108 dextrose 30 % in water ........................................................ 108 dextrose 40 % in water ........................................................ 108 dextrose 5 % and 0.3 % nacl ................................................ 107 dextrose 5 % and 0.9 % nacl ................................................ 107 dextrose 5 % in water .......................................................... 108

dextrose 5 %-0.2 % sod chlorid ............................................ 107 dextrose 5 %-0.45 % sod chlord .......................................... 107 dextrose 5%-lactated ringers .............................................. 107 dextrose 50 % in water ........................................................ 108 dextrose 70 % in water ........................................................ 108 DIACOMIT .............................................................................. 91 DIANEAL PD-2 W-1.5% DEXTROSE ...................................... 112 DIANEAL PD-2 W-2.5% DEXTROSE ...................................... 112 DIANEAL PD-2 W-4.25% DEXTROSE .................................... 112 DIANEAL WITH 1.5% DEXTROSE .......................................... 112 DIANEAL WITH 2.5% DEXTROSE .......................................... 112 DIANEAL WITH 4.25% DEXTROSE ........................................ 112 DIASTAT (diazepam) .............................................................. 90 DIASTAT ACUDIAL (diazepam) .............................................. 90 diatrizoate meglumine, sodium (Gastrografin) ................... 100 diazepam 10 mg rectal gel syst (Diastat Acudial) ................. 90 diazepam 10 mg tablet (Valium) ......................................... 131 diazepam 10 mg/2 ml carpuject ......................................... 131 diazepam 10 mg/2 ml syringe ............................................. 131 diazepam 2 mg tablet (Valium) ........................................... 131 diazepam 2.5 mg rectal gel sys (Diastat) .............................. 90 diazepam 20 mg rectal gel syst (Diastat Acudial) ................. 90 diazepam 5 mg tablet (Valium) ........................................... 131 diazepam 5 mg/5 ml solution ............................................. 131 diazepam 5 mg/ml oral conc ............................................... 131 diazepam 50 mg/10 ml vial ................................................. 131 DIBENZYLINE (phenoxybenzamine hcl) ................................. 72 DICLEGIS (doxylamine succ-pyridoxine hcl) ........................ 114 diclofenac 0.1% eye drops ................................................... 103 DICLOFENAC EPOLAMINE ................................................... 143 diclofenac potassium ............................................................ 16 diclofenac sod dr 25 mg tab .................................................. 28 diclofenac sod dr 50 mg tab .................................................. 28 diclofenac sod dr 75 mg tab .................................................. 28 diclofenac sod ec 25 mg tab .................................................. 28 diclofenac sod ec 50 mg tab .................................................. 28 diclofenac sod ec 75 mg tab .................................................. 28 diclofenac sodium ......................................................... 28, 143 diclofenac sodium 1% gel (Voltaren) ................................... 143 diclofenac sodium/misoprostol (Arthrotec 50) ..................... 28 diclofenac sodium/misoprostol (Arthrotec 75) ..................... 28 dicloxacillin sodium ............................................................... 39 dicyclomine hcl .................................................................... 113 dicyclomine hcl (Bentyl) ...................................................... 113 DIFICID .................................................................................. 38 diflorasone diacetate .......................................................... 147 diflorasone diacetate/emoll ................................................ 147 diflunisal ................................................................................ 15 DIGIFAB ............................................................................... 155 digoxin ................................................................................... 79 digoxin (Lanoxin) ................................................................... 79 dihydroergotamine 1 mg/ml amp ......................................... 15 dihydroergotamine 4 mg/ml spry ......................................... 16 DILANTIN 100 MG CAPSULE (phenytoin sodium extended) . 91 DILANTIN 30 MG CAPSULE .................................................... 91 DILANTIN 50 MG INFATAB (phenytoin) ................................. 91 DILANTIN-125 (phenytoin) .................................................... 91 DILATRATE-SR ....................................................................... 79

174

DILAUDID ............................................................................... 18 DILAUDID (hydromorphone hcl) ........................................... 18 diltiazem hcl .......................................................................... 77 diltiazem hcl (Cardizem La) ................................................... 77 diltiazem hcl (Tiazac) ............................................................. 77 diltiazem hcl in 0.9% nacl ...................................................... 77 diltiazem hcl/d5w .................................................................. 77 diluent for epoprostenol(glyc) (Ph 12 Diluent For Flolan) ... 155 DILUENT FOR LEFAMULIN(XENLETA) .................................. 155 diluent for treprostinil (gly) ................................................. 155 dimenhydrinate ................................................................... 114 diphenhydramine hcl ............................................................. 47 diphenoxylate hcl/atropine ................................................. 113 diphenoxylate hcl/atropine (Lomotil) .................................. 113 DIPRIVAN (propofol) ............................................................. 22 DIPROLENE (betamethasone diprop augmented) .............. 147 dipyridamole 25 mg tablet .................................................... 66 dipyridamole 5 mg/ml vial .................................................... 97 dipyridamole 50 mg tablet .................................................... 66 dipyridamole 75 mg tablet .................................................... 66 DISCOVISC ........................................................................... 106 disopyramide phosphate (Norpace) ...................................... 76 disulfiram (Antabuse) .......................................................... 154 DIURIL .................................................................................. 101 divalproex sodium (Depakote ER) ......................................... 91 divalproex sodium (Depakote Sprinkle) ................................. 91 divalproex sodium (Depakote) .............................................. 91 DIVIGEL ................................................................................ 120 DMSA .................................................................................... 98 dobutamine hcl ..................................................................... 79 dobutamine hcl in dextrose 5 % ............................................ 79 docetaxel 160 mg/16 ml vial ................................................. 61 docetaxel 160 mg/8 ml vial ................................................... 61 docetaxel 20 mg/2 ml vial ..................................................... 61 docetaxel 20 mg/ml vial (Taxotere) ...................................... 61 docetaxel 200 mg/10 ml vial ................................................. 61 docetaxel 80 mg/4 ml vial (Taxotere) ................................... 61 docetaxel 80 mg/8 ml vial ..................................................... 61 dofetilide 125 mcg capsule (Tikosyn) .................................... 76 dofetilide 250 mcg capsule (Tikosyn) .................................... 76 dofetilide 500 mcg capsule (Tikosyn) .................................... 76 DOLOPHINE HCL (methadone hcl) ........................................ 18 donepezil hcl .......................................................................... 71 donepezil hcl (Aricept) ........................................................... 71 DONNATAL (phenobarbital-belladonna) ............................. 115 DONNATAL (phenohytro) .................................................... 115 dopamine hcl ......................................................................... 72 dopamine hcl in dextrose 5 % ................................................ 72 DOPRAM ............................................................................... 89 DOPTELET .............................................................................. 94 DORAL (quazepam) ............................................................. 142 dorzolamide hcl (Trusopt) ................................................... 104 dorzolamide hcl/timolol maleat (Cosopt) ............................ 104 dorzolamide/timolol/pf (Cosopt Pf) .................................... 104 DOTAREM .............................................................................. 98 DOVATO ................................................................................ 66 doxazosin mesylate (Cardura) ............................................... 82 doxepin 10 mg capsule ........................................................ 136

doxepin 10 mg/ml oral conc ................................................ 136 doxepin 100 mg capsule ...................................................... 136 doxepin 150 mg capsule ...................................................... 136 doxepin 25 mg capsule ........................................................ 136 doxepin 50 mg capsule ........................................................ 136 doxepin 75 mg capsule ........................................................ 136 doxepin hcl 3 mg tablet (Silenor) ......................................... 142 doxepin hcl 6 mg tablet (Silenor) ......................................... 142 doxercalciferol ..................................................................... 153 DOXIL (doxorubicin hcl liposome) ......................................... 53 doxorubicin hcl ...................................................................... 53 doxorubicin hcl peg-liposomal (Doxil) ................................... 53 doxycycline hyclate ....................................................... 40, 153 doxycycline monohydrate ..................................................... 40 doxycycline monohydrate (Vibramycin) ................................ 40 doxylamine succinate/vit b6 (Diclegis) ................................ 114 DRISDOL (vitamin d2) .......................................................... 162 dronabinol ........................................................................... 113 droperidol ............................................................................ 140 drospir/eth estra/levomefol ca (Beyaz) ................................. 94 drospir/eth estra/levomefol ca (Safyral) ............................... 95 DROXIA .................................................................................. 75 DRYSOL ................................................................................ 144 DUAVEE ............................................................................... 121 DUETACT (pioglitazone-glimepiride) ..................................... 49 DULERA ................................................................................. 30 duloxetine hcl dr 20 mg cap ................................................ 134 duloxetine hcl dr 30 mg cap ................................................ 134 duloxetine hcl dr 40 mg cap ................................................ 134 duloxetine hcl dr 60 mg cap ................................................ 134 DUODOTE ............................................................................ 155 DUOVISC .............................................................................. 106 DUPIXENT ............................................................................ 126 DURACLON (clonidine hcl) .................................................... 15 DURAGESIC (fentanyl) ........................................................... 18 DURAMORPH ........................................................................ 18 DUREZOL ............................................................................. 103 DURLAZA ............................................................................... 66 DUROLANE ............................................................................ 26 dutasteride (Avodart) .......................................................... 160 dutasteride/tamsulosin hcl (Jalyn) ...................................... 160 DUTOPROL ............................................................................ 85 DYAZIDE (triamterene-hydrochlorothiazide) ...................... 101 DYRENIUM (triamterene) .................................................... 101 DYSPORT ............................................................................... 73

E

E.E.S. 400 ............................................................................... 38 EC-NAPROSYN (naproxen) .................................................... 28 econazole nitrate .................................................................. 46 ECOZA ................................................................................... 46 edetate calcium disodium ................................................... 156 EDURANT .............................................................................. 67 efavirenz ................................................................................ 67 EFFER-K 10 MEQ TABLET EFF .............................................. 110 EFFER-K 20 MEQ TABLET EFF .............................................. 110 effer-k 25 meq tablet eff ..................................................... 111 EFFEXOR XR 150 MG CAPSULE (venlafaxine hcl er) ............ 134

175

EFFEXOR XR 37.5 MG CAPSULE (venlafaxine hcl er) ........... 134 EFFEXOR XR 75 MG CAPSULE (venlafaxine hcl er) .............. 135 EFFIENT (prasugrel hcl) ......................................................... 66 EFUDEX (fluorouracil) ............................................................ 63 EGATEN ................................................................................. 51 ELAPRASE ............................................................................ 156 electrolyte-48 solution/d5w ................................................ 109 ELELYSO ............................................................................... 156 ELESTRIN ............................................................................. 120 ELETONE .............................................................................. 144 eletriptan hydrobromide (Relpax) ......................................... 16 ELIDEL (pimecrolimus) ......................................................... 127 ELIGARD ................................................................................ 59 ELIMITE (permethrin) ............................................................ 63 ELIQUIS .................................................................................. 43 ELITEK .................................................................................... 27 ELLA ....................................................................................... 95 ELLENCE (epirubicin hcl) ........................................................ 53 ELLIOTTS B ........................................................................... 155 ELMIRON ............................................................................... 21 ELOCON (mometasone furoate) ......................................... 147 EMCYT ................................................................................... 62 EMEND 125 MG POWDER PACKET ...................................... 114 EMEND 150 MG VIAL (fosaprepitant dimeglumine) ........... 114 EMEND 40 MG CAPSULE (aprepitant) ................................. 114 EMEND 80 MG CAPSULE (aprepitant) ................................. 114 EMEND TRIPACK (aprepitant) ............................................. 114 EMFLAZA ............................................................................. 122 emollient combination no.10 (Biafine) ................................ 144 emollient combination no.35 (Mimyx) ................................ 144 emollient combination no.44 .............................................. 144 EMPLICITI .............................................................................. 57 EMSAM 12 MG/24 HOURS PATCH ...................................... 131 EMSAM 6 MG/24 HOURS PATCH ........................................ 132 EMSAM 9 MG/24 HOURS PATCH ........................................ 132 EMTRIVA ............................................................................... 67 enalapril maleate .................................................................. 83 enalapril/hydrochlorothiazide ............................................... 81 enalaprilat dihydrate ............................................................. 83 ENBREL 25 MG KIT ................................................................ 52 ENBREL 25 MG/0.5 ML SYRINGE ........................................... 52 ENBREL 50 MG/ML SYRINGE ................................................. 52 ENBREL MINI ......................................................................... 52 ENBREL SURECLICK ................................................................ 52 ENDO-AVITENE ...................................................................... 75 ENDOMETRIN ...................................................................... 126 ENHERTU ............................................................................... 61 enoxaparin 100 mg/ml syringe (Lovenox) ............................. 43 enoxaparin 120 mg/0.8 ml syr (Lovenox) .............................. 43 enoxaparin 150 mg/ml syringe (Lovenox) ............................. 43 enoxaparin 30 mg/0.3 ml syr (Lovenox) ................................ 43 enoxaparin 300 mg/3 ml vial (Lovenox) ................................ 43 enoxaparin 40 mg/0.4 ml syr (Lovenox) ................................ 43 enoxaparin 60 mg/0.6 ml syr (Lovenox) ................................ 43 enoxaparin 80 mg/0.8 ml syr (Lovenox) ................................ 43 entacapone (Comtan) ........................................................... 64 entecavir 0.5 mg tablet (Baraclude) ...................................... 70 entecavir 1 mg tablet (Baraclude) ......................................... 70

ENTERO VU ........................................................................... 99 ENTOCORT EC (budesonide ec) ........................................... 122 ENTRESTO ............................................................................. 82 ENTYVIO .............................................................................. 117 ENVARSUS XR ...................................................................... 128 EOVIST ................................................................................... 99 EPANED ................................................................................. 83 ephedrine sulfate .................................................................. 80 ephedrine sulfate (Akovaz) .................................................... 80 ephedrine sulfate/0.9% nacl/pf ............................................. 80 EPIDIOLEX .............................................................................. 91 EPIFOAM ............................................................................. 148 epinastine hcl ........................................................................ 47 epinephrine (Episnap) ........................................................... 70 epinephrine 0.1 mg/ml syringe ............................................. 72 epinephrine 0.15 mg auto-injct ............................................. 70 epinephrine 0.3 mg auto-inject ............................................. 70 epinephrine 1 mg/10 ml abbojct ........................................... 72 epinephrine 1 mg/ml ampul .................................................. 72 epinephrine hcl in 0.9 % nacl ................................................. 72 epinephrine hcl in dextrose 5% ............................................. 72 EPINEPHRINESNAP-EMS (adyphren amp) ............................. 70 EPINEPHRINESNAP-V (adyphren amp) .................................. 70 epirubicin hcl (Ellence) ........................................................... 53 EPISNAP (adyphren amp) ...................................................... 70 EPIVIR HBV 100 MG TABLET (lamivudine hbv) ...................... 70 EPIVIR HBV 25 MG/5 ML SOLN ............................................. 70 eplerenone (Inspra) ............................................................. 101 EPOGEN ................................................................................. 93 epoprostenol sodium (glycine) (Flolan) ................................. 80 eprosartan mesylate ............................................................. 83 eptifibatide ............................................................................ 66 eptifibatide (Integrilin) .......................................................... 66 EQUETRO ............................................................................. 131 ERAXIS (WATER DILUENT) ..................................................... 46 ERBITUX ................................................................................. 58 ergocalciferol (vitamin d2) (Drisdol) .................................... 162 ergoloid mesylates ................................................................ 86 ergotamine tartrate/caffeine ................................................ 16 ergotamine tartrate/caffeine (Cafergot) .............................. 16 ERIVEDGE .............................................................................. 57 ERLEADA ................................................................................ 55 erlotinib hcl ........................................................................... 59 ertapenem sodium (Invanz) .................................................. 35 ERWINAZE ............................................................................. 61 ERYGEL (erythromycin) ......................................................... 42 ERYPED 200 (erythromycin ethylsuccinate) .......................... 38 ERY-TAB (erythromycin) ........................................................ 38 ERYTHROCIN LACTOBIONATE ............................................... 38 erythromycin base ...................................................... 33, 38, 42 erythromycin base (ERY-Tab) ................................................ 38 erythromycin base in ethanol ................................................ 42 erythromycin base in ethanol (Erygel) .................................. 42 erythromycin ethylsuccinate ................................................. 38 erythromycin ethylsuccinate (E.E.S. 400) .............................. 38 erythromycin ethylsuccinate (Eryped 200) ............................ 38 erythromycin stearate ........................................................... 38 erythromycin/benzoyl peroxide (Benzamycin) ...................... 42

176

ESBRIET ............................................................................... 155 escitalopram 10 mg tablet .................................................. 132 escitalopram 20 mg tablet .................................................. 132 escitalopram 5 mg tablet .................................................... 132 escitalopram oxalate 5 mg/5 ml ......................................... 132 ESGIC 50-325-40 MG TABLET (butalbital-acetaminophen-

caffeine) ............................................................................ 15 ESGIC CAPSULE (butalbital-acetaminophen-caffeine) .......... 15 esmolol hcl (Brevibloc) .......................................................... 84 esmolol in sodium chloride,iso (Brevibloc) ............................ 84 estazolam ............................................................................ 142 ESTRACE (estradiol) ..................................................... 120, 125 estradiol (Vagifem) .............................................................. 125 estradiol (Vivelle-dot) .......................................................... 120 estradiol 0.01% cream (Estrace) .......................................... 125 estradiol 0.025 mg patch (Vivelle-Dot) ................................ 120 estradiol 0.0375 mg patch (Vivelle-Dot) .............................. 120 estradiol 0.0375 mg/day patch (Climara) ........................... 120 estradiol 0.05 mg patch (Vivelle-Dot) .................................. 120 estradiol 0.06 mg/day patch (Climara) ............................... 120 estradiol 0.075 mg patch (Vivelle-Dot) ................................ 120 estradiol 0.075 mg/day patch (Climara) ............................. 120 estradiol 0.1 mg patch (Vivelle-Dot) .................................... 120 estradiol 0.5 mg tablet (Estrace) ......................................... 120 estradiol 1 mg tablet (Estrace) ............................................ 120 estradiol 10 mcg vaginal insrt (Vagifem) ............................ 125 estradiol 2 mg tablet (Estrace) ............................................ 121 estradiol tds 0.025 mg/day (Climara) ................................. 121 estradiol tds 0.0375 mg/day (Climara) ............................... 121 estradiol tds 0.05 mg/day (Climara) ................................... 121 estradiol tds 0.06 mg/day (Climara) ................................... 121 estradiol tds 0.075 mg/day (Climara) ................................. 121 estradiol tds 0.1 mg/day (Climara) ..................................... 121 estradiol valerate (Delestrogen) .......................................... 121 estradiol/norethindrone acet .............................................. 121 estradiol/norethindrone acet (Activella) ............................. 121 ESTRING .............................................................................. 125 ESTROGEL ............................................................................ 121 estrogen,ester/me-testosterone ......................................... 120 ESTROSTEP FE (tri-legest fe) .................................................. 95 eszopiclone (Lunesta) .......................................................... 142 ethacrynate sodium (Sodium Edecrin) ................................ 100 ethambutol hcl ...................................................................... 35 ethambutol hcl (Myambutol) ................................................ 35 ETHAMOLIN ........................................................................... 88 ethinyl estradiol/drospirenone (Yasmin 28) .......................... 95 ethinyl estradiol/drospirenone (Yaz) ..................................... 95 ethosuximide (Zarontin) ........................................................ 92 ethyl alcohol .......................................................................... 89 ethynodiol d-ethinyl estradiol ............................................... 95 ETHYOL ................................................................................ 152 etodolac ................................................................................ 28 etodolac (Lodine) ................................................................... 28 etomidate (Amidate) ............................................................. 22 etonogestrel/ethinyl estradiol (Nuvaring) ............................. 94 ETOPOPHOS .......................................................................... 61 etoposide ............................................................................... 61 etoposide 1,000 mg/50 ml vial .............................................. 61

etoposide 100 mg/5 ml vial ................................................... 61 etoposide 50 mg capsule ....................................................... 61 etoposide 500 mg/25 ml vial ................................................. 61 EUCRISA .............................................................................. 146 EUFLEXXA .............................................................................. 26 EUTHYROX (levoxyl) ............................................................ 149 EUTHYROX (unithroid) ........................................................ 149 EVAMIST .............................................................................. 121 EVEKEO (amphetamine sulfate) ............................................ 72 EVENITY ............................................................................... 158 EVENITY (2 SYRINGES) ......................................................... 158 everolimus (Afinitor) ............................................................. 57 EVISTA (raloxifene hcl) ........................................................ 158 EVOCLIN (clindamycin phosphate) ........................................ 42 EVOMELA .............................................................................. 54 EVOTAZ ................................................................................. 67 EVOXAC (cevimeline hcl) ....................................................... 73 EXELON (rivastigmine) .......................................................... 71 exemestane (Aromasin) ........................................................ 57 EXJADE (deferasirox) ........................................................... 157 EXONDYS-51 ........................................................................ 156 EXPAREL ................................................................................ 23 EXTAVIA ................................................................................. 90 EXTRANEAL ICODEXTRIN DIALYSIS ...................................... 112 EYLEA ................................................................................... 106 E-Z DISK ................................................................................. 99 ezetimibe (Zetia) ................................................................... 87 ezetimibe/simvastatin ........................................................... 86 E-Z-HD ................................................................................... 99 E-Z-PAQUE ............................................................................. 99 E-Z-PASTE .............................................................................. 99

F

FABRAZYME ........................................................................ 156 famciclovir ............................................................................. 68 famotidine ........................................................................... 116 FANAPT 1 MG TABLET ......................................................... 138 FANAPT 10 MG TABLET ....................................................... 138 FANAPT 12 MG TABLET ....................................................... 138 FANAPT 2 MG TABLET ......................................................... 138 FANAPT 4 MG TABLET ......................................................... 138 FANAPT 6 MG TABLET ......................................................... 138 FANAPT 8 MG TABLET ......................................................... 138 FANAPT TITRATION PACK .................................................... 138 FARESTON (toremifene citrate) ............................................ 62 FARXIGA ................................................................................ 48 FARYDAK ............................................................................... 54 FASENRA ............................................................................... 31 FASENRA PEN ........................................................................ 31 FASLODEX (fulvestrant) ......................................................... 62 febuxostat 40 mg tablet (Uloric) ........................................... 27 febuxostat 80 mg tablet (Uloric) ........................................... 27 felbamate .............................................................................. 92 FELDENE (piroxicam) ............................................................. 28 felodipine .............................................................................. 77 FEMARA (letrozole) ............................................................... 57 FEMHRT (norethindron-ethinyl estradiol) .......................... 121 FEMRING ............................................................................. 125

177

fenofibrate ...................................................................... 87, 88 fenofibrate (Lipofen) ............................................................. 88 fenofibrate nanocrystallized (Tricor) ..................................... 88 fenofibrate,micronized .......................................................... 88 fenofibric acid (choline) (Trilipix) ........................................... 88 fenofibric acid (Fibricor) ........................................................ 88 fenoprofen calcium ............................................................... 28 fenoprofen calcium (Nalfon) ................................................. 28 fentanyl ..................................................................... 17, 18, 19 fentanyl (Duragesic) .............................................................. 19 fentanyl 1,000 mcg/20 ml vial ............................................... 17 fentanyl 100 mcg/2 ml ampul ............................................... 17 fentanyl 100 mcg/2 ml carpujct ............................................ 19 fentanyl 100 mcg/2 ml syringe .............................................. 19 fentanyl 100 mcg/2 ml vial .................................................... 17 fentanyl 2,500 mcg/50 ml vial ............................................... 17 fentanyl 2,750 mcg/55 ml syr ............................................... 19 fentanyl 250 mcg/5 ml ampul ............................................... 17 fentanyl 250 mcg/5 ml syringe .............................................. 19 fentanyl 250 mcg/5 ml vial .................................................... 18 fentanyl 5,000 mcg/100 ml bag ............................................ 18 fentanyl 50 mcg/ml vial ........................................................ 18 fentanyl 500 mcg/10 ml vial .................................................. 18 fentanyl cit 100 mcg buccal tb (Fentora) .............................. 19 fentanyl cit 200 mcg buccal tb (Fentora) .............................. 19 fentanyl cit 400 mcg buccal tb (Fentora) .............................. 19 fentanyl cit 600 mcg buccal tb (Fentora) .............................. 19 fentanyl cit 800 mcg buccal tb (Fentora) .............................. 19 fentanyl cit otfc 1,200 mcg (Actiq) ........................................ 19 fentanyl cit otfc 1,600 mcg (Actiq) ........................................ 19 fentanyl citrate otfc 200 mcg (Actiq) ..................................... 19 fentanyl citrate otfc 400 mcg (Actiq) ..................................... 19 fentanyl citrate otfc 600 mcg (Actiq) ..................................... 19 fentanyl citrate otfc 800 mcg (Actiq) ..................................... 19 fentanyl citrate/pf ................................................................. 18 fentanyl citrate-0.9 % nacl/pf ............................................... 19 fentanyl/bupivacaine/ns/pf .................................................. 19 fentanyl/ropivacaine/ns/pf ................................................... 19 FENTORA (fentanyl citrate) ................................................... 19 FERAHEME .......................................................................... 110 FERRIPROX .......................................................................... 157 FERRLECIT (sod ferric gluconate complex) .......................... 110 ferrous fum/vit c/b12-if/folic .............................................. 110 FETROJA ................................................................................ 36 FETZIMA 20-40 MG TITRATION PAK .................................... 135 FETZIMA ER 120 MG CAPSULE ............................................ 135 FETZIMA ER 20 MG CAPSULE .............................................. 135 FETZIMA ER 40 MG CAPSULE .............................................. 135 FETZIMA ER 80 MG CAPSULE .............................................. 135 FEXMID (cyclobenzaprine hcl) ............................................. 129 FIBRICOR ............................................................................... 88 FIBRICOR (fenofibric acid) ..................................................... 88 FIBRYGA ................................................................................. 74 FINACEA .............................................................................. 146 FINACEA (azelaic acid) ......................................................... 146 finasteride (Proscar) ............................................................ 160 FIORICET WITH CODEINE ...................................................... 21 FIORINAL (butalbital-aspirin-caffeine) .................................. 15

FIORINAL WITH CODEINE #3 (butalbital compound-codeine) .......................................................................................... 21

FIRDAPSE ............................................................................... 90 FIRMAGON ............................................................................ 59 FIRVANQ ................................................................................ 41 FIRVANQ (vancomycin hcl) .................................................... 41 FLAGYL (metronidazole) ........................................................ 34 FLAREX ................................................................................ 103 flavoxate hcl ........................................................................ 161 flecainide acetate .................................................................. 76 FLECTOR .............................................................................. 143 FLOLAN (epoprostenol sodium) ............................................ 80 FLOMAX (tamsulosin hcl) .................................................... 160 FLOVENT DISKUS ................................................................... 31 FLOVENT HFA ........................................................................ 31 floxuridine ............................................................................. 56 FLUCAINE (fluorescein-proparacaine) ................................. 104 fluconazole ............................................................................ 45 fluconazole in nacl,iso-osm ................................................... 45 flucytosine (Ancobon) ............................................................ 45 fludarabine phosphate .......................................................... 56 fludeoxyglucose f-18 ........................................................... 100 fludrocortisone acetate ....................................................... 124 flumazenil ............................................................................ 155 flunisolide ............................................................................ 102 fluocinolone acetonide ................................................ 102, 147 fluocinolone acetonide (Derma-Smoothe-FS) ..................... 147 fluocinolone acetonide (Synalar) ......................................... 147 fluocinolone acetonide oil (Dermotic) ................................. 102 fluocinolone/shower cap (Derma-Smoothe-FS) .................. 147 fluocinonide ......................................................................... 147 fluocinonide/emollient base ................................................ 147 fluorescein sodium (Fluor-I-Strip AT) ..................................... 99 FLUORESCITE ......................................................................... 99 fluoride (sodium) (Clinpro 5000) ......................................... 106 fluoride (sodium) (Prevident 5000 Plus) .............................. 106 fluoride (sodium) (Prevident) .............................................. 107 FLUORIDEX SENSITIVITY RELIEF ........................................... 107 FLUOR-I-STRIP AT (glostrips) ................................................. 99 fluorometholone (FML) ....................................................... 103 FLUOROPLEX ......................................................................... 63 fluorouracil ...................................................................... 56, 63 fluorouracil 0.5% cream ........................................................ 63 fluorouracil 1,000 mg/20 ml vl .............................................. 56 fluorouracil 2,500 mg/50 ml vl .............................................. 56 fluorouracil 2.5 gm/50 ml btl ................................................ 56 fluorouracil 2.5 gm/50 ml vial ............................................... 56 fluorouracil 2% topical soln ................................................... 63 fluorouracil 5 gm/100 ml btl ................................................. 56 fluorouracil 5 gm/100 ml vial ................................................ 56 fluorouracil 5,000 mg/100 ml ............................................... 56 fluorouracil 5% cream (Efudex) ............................................. 63 fluorouracil 5% topical soln ................................................... 63 fluorouracil 500 mg/10 ml vial .............................................. 56 fluoxetine 20 mg/5 ml solution ........................................... 132 fluoxetine hcl ....................................................................... 133 fluoxetine hcl 10 mg capsule (Prozac) ................................. 133 fluoxetine hcl 10 mg tablet (Sarafem) ................................. 133

178

fluoxetine hcl 20 mg capsule (Prozac) ................................. 133 fluoxetine hcl 20 mg tablet (Sarafem) ................................. 133 fluoxetine hcl 40 mg capsule (Prozac) ................................. 133 fluoxetine hcl 60 mg tablet .................................................. 133 fluphenazine decanoate ...................................................... 141 fluphenazine hcl .................................................................. 141 flurandrenolide (Cordran) ................................................... 147 flurazepam hcl ..................................................................... 142 flurbiprofen ................................................................... 28, 103 flurbiprofen sodium ............................................................. 103 flutamide ............................................................................... 55 fluticasone prop 0.005% oint .............................................. 147 fluticasone prop 0.05% cream ............................................. 148 fluticasone prop 0.05% lotion .............................................. 148 fluticasone prop 50 mcg spray ............................................ 102 fluticasone propion/salmeterol ............................................. 30 fluticasone propionate ........................................................ 148 fluvastatin sodium ................................................................. 87 fluvoxamine er 100 mg capsule ........................................... 133 fluvoxamine er 150 mg capsule ........................................... 133 fluvoxamine maleate 100 mg tab ....................................... 133 fluvoxamine maleate 25 mg tab ......................................... 133 fluvoxamine maleate 50 mg tab ......................................... 133 FML (fluorometholone) ....................................................... 103 FML FORTE .......................................................................... 103 FML S.O.P. ........................................................................... 103 FOCALIN (dexmethylphenidate hcl) .................................... 137 folic acid .............................................................................. 161 FOLLISTIM AQ ...................................................................... 125 FOLOTYN 20 MG/ML VIAL ..................................................... 56 FOLOTYN 40 MG/2 ML VIAL .................................................. 56 fomepizole ........................................................................... 155 fondaparinux sodium (Arixtra) .............................................. 43 FORANE (terrell) .................................................................... 22 FORFIVO XL (bupropion xl) .................................................. 132 FORTEO ............................................................................... 153 FOSAMAX (alendronate sodium) ........................................ 158 FOSAMAX PLUS D ................................................................ 158 fosamprenavir calcium .......................................................... 68 fosaprepitant dimeglumine (Emend) .................................. 114 FOSCAVIR .............................................................................. 68 fosinopril sodium ................................................................... 83 fosinopril/hydrochlorothiazide .............................................. 81 fosphenytoin sodium (Cerebyx) ............................................. 92 FOSRENOL 1,000 MG POWDER PACK ................................. 109 FOSRENOL 1,000 MG TABLET CHEW

(lanthanum carbonate) ................................................... 109 FOSRENOL 500 MG TABLET CHEW (lanthanum carbonate) 109 FOSRENOL 750 MG POWDER PACKET ................................. 109 FOSRENOL 750 MG TABLET CHEW (lanthanum carbonate) 109 FRAGMIN 10,000 UNITS/ML SYRING ..................................... 43 FRAGMIN 12,500 UNITS/0.5 ML ............................................ 43 FRAGMIN 15,000 UNITS/0.6 ML ............................................ 43 FRAGMIN 18,000 UNITS/0.72 ML ......................................... 44 FRAGMIN 2,500 UNITS/0.2 ML SYR ....................................... 44 FRAGMIN 5,000 UNITS/0.2 ML SYR ....................................... 44 FRAGMIN 7,500 UNITS/0.3 ML SYR ....................................... 44 FRAGMIN 95,000 UNITS/3.8 ML VL ....................................... 44

FREAMINE HBC .................................................................... 108 FREAMINE III ....................................................................... 108 FROVA (frovatriptan succinate) ............................................ 16 frovatriptan succinate (Frova) ............................................... 16 ful-glo 1 mg opth strip (Fluor-I-Strip AT) ............................... 99 FUL-GLO EYE STRIPS .............................................................. 99 FULPHILA ............................................................................... 93 fulvestrant (Faslodex) ............................................................ 62 furosemide .......................................................................... 100 furosemide (Lasix) ............................................................... 100 furosemide in 0.9 % nacl ..................................................... 100 FUZEON ................................................................................. 67 FYCOMPA 0.5 MG/ML ORAL SUSP ........................................ 92 FYCOMPA 10 MG TABLET ...................................................... 92 FYCOMPA 12 MG TABLET ...................................................... 92 FYCOMPA 2 MG TABLET ........................................................ 92 FYCOMPA 4 MG TABLET ........................................................ 92 FYCOMPA 6 MG TABLET ........................................................ 92 FYCOMPA 8 MG TABLET ........................................................ 92

G

gabapentin ............................................................................ 92 gabapentin (Neurontin) ........................................................ 92 GABITRIL 12 MG TABLET (tiagabine hcl) ............................... 92 GABITRIL 16 MG TABLET (tiagabine hcl) ............................... 92 GABITRIL 2 MG TABLET (tiagabine hcl) ................................. 92 GABITRIL 4 MG TABLET (tiagabine hcl) ................................. 92 GABLOFEN ........................................................................... 129 GABLOFEN (baclofen) .......................................................... 129 GADAVIST .............................................................................. 98 GALAFOLD ........................................................................... 157 galantamine er 16 mg capsule (Razadyne ER) ...................... 71 galantamine er 24 mg capsule (Razadyne ER) ...................... 71 galantamine er 8 mg capsule (Razadyne ER) ........................ 71 galantamine hbr .................................................................... 71 galantamine hbr (Razadyne) ................................................. 71 GALZIN ................................................................................ 157 GAMIFANT ........................................................................... 126 ganciclovir ....................................................................... 68, 69 ganciclovir sodium ................................................................ 69 ganciclovir sodium (Cytovene) .............................................. 69 ganirelix acet 250 mcg/0.5 ml (Ganirelix Acetate) .............. 123 GANIRELIX ACET 250 MCG/0.5 ML (ganirelix acetate) ........ 123 GASTROCROM (cromolyn sodium) ....................................... 26 GASTROGRAFIN (md-gastroview) ....................................... 100 gatifloxacin (Zymaxid) ........................................................... 33 GATTEX ................................................................................ 118 GAZYVA ................................................................................. 53 GELFILM .............................................................................. 104 GELFOAM .............................................................................. 75 GELFOAM COMPRESSED ....................................................... 75 GELSYN-3 ............................................................................... 26 gemcitabine hcl ..................................................................... 56 gemfibrozil (Lopid) ................................................................ 88 GENERESS FE (norethin-eth estra-ferrous fum) .................... 95 gentamicin in nacl, iso-osm ................................................... 34 gentamicin sulfate ..................................................... 33, 34, 42 gentamicin sulfate/pf ............................................................ 34

179

GENVOYA .............................................................................. 68 GEODON .............................................................................. 138 GIAPREZA ............................................................................ 124 GILENYA 0.25 MG CAPSULE .................................................. 90 GILENYA 0.5 MG CAPSULE .................................................... 90 GILOTRIF ................................................................................ 59 GIVLAARI ............................................................................. 155 GLASSIA ............................................................................... 151 glatiramer acetate ................................................................ 90 GLEEVEC (imatinib mesylate) ................................................ 59 GLEOSTINE ............................................................................ 54 GLIADEL ................................................................................. 54 glimepiride (Amaryl) .............................................................. 49 glipizide (Glucotrol Xl) ........................................................... 49 glipizide (Glucotrol) ............................................................... 49 glipizide/metformin hcl ......................................................... 49 GLUCAGEN 1 MG HYPOKIT .................................................. 107 GLUCAGEN DIAGNOSTIC 1 MG VIAL ..................................... 98 GLUCAGON 1 MG EMERGENCY KIT ..................................... 107 glucagon hcl .......................................................................... 98 GLUCOPHAGE (metformin hcl) .............................................. 48 GLUCOPHAGE XR (metformin hcl er) .................................... 48 GLUCOTROL (glipizide) .......................................................... 49 GLUCOTROL XL (glipizide xl) .................................................. 49 glyburide ............................................................................... 49 glyburide,micronized (Glynase) ............................................. 49 glyburide/metformin hcl ....................................................... 49 GLYCATE (glycopyrrolate) .................................................... 113 glycine urologic solution (Aminoacetic Acid) ......................... 52 GLYCOPHOS ......................................................................... 110 glycopyrrolate ..................................................................... 113 glycopyrrolate (Glycate) ...................................................... 113 GLYNASE (glyburide micronized) ........................................... 49 GLYSET (miglitol) ................................................................... 48 GLYXAMBI ............................................................................. 49 GONAL-F .............................................................................. 125 GONAL-F RFF ....................................................................... 125 GONAL-F RFF REDI-JECT ...................................................... 125 granisetron hcl .................................................................... 114 granisetron hcl/pf ................................................................ 114 GRANIX .................................................................................. 93 GRASTEK ................................................................................ 74 griseofulvin ultramicrosize .................................................... 46 griseofulvin, microsize ........................................................... 46 guanfacine hcl ............................................................... 84, 136 guanfacine hcl (Intuniv) ....................................................... 136 guanidine hcl ......................................................................... 73 GVOKE SYRINGE .................................................................. 107

H

HAEGARDA .......................................................................... 152 HALAVEN ............................................................................... 57 HALCION (triazolam) ........................................................... 142 HALDOL (haloperidol lactate) .............................................. 140 HALDOL DECANOATE 100 (haloperidol decanoate 100) ..... 141 HALDOL DECANOATE 50 (haloperidol decanoate) .............. 141 halobetasol propionate ....................................................... 148 haloperidol .......................................................................... 141

haloperidol decanoate ........................................................ 141 haloperidol decanoate (Haldol Decanoate 100) ................. 141 haloperidol decanoate (Haldol Decanoate 50) ................... 141 haloperidol lactate .............................................................. 141 haloperidol lactate (Haldol) ................................................ 141 HALUCORT ........................................................................... 144 HEMABATE .......................................................................... 124 HEMANGEOL ......................................................................... 84 HEMLIBRA ............................................................................. 75 heparin sod,porcine/0.9 % nacl ............................................. 44 heparin sod,pork in 0.45% nacl ............................................. 44 heparin sodium,porcine ........................................................ 44 heparin sodium,porcine/d5w ................................................ 44 heparin sodium,porcine/ns/pf ............................................... 44 heparin sodium,porcine/pf .................................................... 44 HEPATAMINE ...................................................................... 108 HEPSERA (adefovir dipivoxil) ................................................. 70 HERCEPTIN ............................................................................ 58 HERCEPTIN HYLECTA ............................................................. 58 HETLIOZ ............................................................................... 142 HIPREX (methenamine hippurate) ........................................ 34 HISTATROL INTRADERMAL .................................................... 99 HISTATROL PERCUTANEOUS ................................................. 99 homatropine hbr ................................................................. 105 HUMALOG ............................................................................. 50 HUMALOG JUNIOR KWIKPEN ................................................ 50 HUMALOG KWIKPEN U-100 .................................................. 50 HUMALOG KWIKPEN U-200 .................................................. 50 HUMALOG MIX 50-50 ........................................................... 50 HUMALOG MIX 50-50 KWIKPEN ........................................... 50 HUMALOG MIX 75-25 ........................................................... 50 HUMALOG MIX 75-25 KWIKPEN ........................................... 50 HUMATROPE ....................................................................... 123 HUMIRA ................................................................................ 52 HUMIRA PEN ......................................................................... 52 HUMIRA PEN CROHN'S-UC-HS .............................................. 52 HUMIRA PEN PSOR-UVEITS-ADOL HS ................................... 52 HUMIRA(CF) .......................................................................... 52 HUMIRA(CF) PEDIATRIC CROHN'S ......................................... 52 HUMIRA(CF) PEN 40 MG/0.4 ML .......................................... 52 HUMIRA(CF) PEN 80 MG/0.8 ML .......................................... 52 HUMIRA(CF) PEN CROHN'S-UC-HS ........................................ 52 HUMIRA(CF) PEN PSOR-UV-ADOL HS .................................... 52 HUMULIN R U-500 ................................................................ 50 HUMULIN R U-500 KWIKPEN ................................................ 50 HYALGAN ............................................................................... 27 HYALGAN (visco-3) ................................................................ 27 hyaluronate sod, cross-linked ................................................ 27 hyaluronate sodium ...................................................... 27, 106 hyaluronate sodium (Triluron) .............................................. 27 HYCAMTIN 0.25 MG CAPSULE ............................................... 58 HYCAMTIN 1 MG CAPSULE .................................................... 58 HYCAMTIN 4 MG VIAL (topotecan hcl) ................................. 58 hydralazine hcl ...................................................................... 84 HYDREA (hydroxyurea) .......................................................... 54 HYDRO 40 ............................................................................ 145 hydrochlorothiazide ............................................................ 102 hydrocodone bit/homatrop me-br ........................................ 97

180

hydrocodone bitartrate (Zohydro ER) .................................... 19 hydrocodone/acetaminophen ............................................... 17 hydrocodone/acetaminophen (Norco) .................................. 17 hydrocodone/chlorphen p-stirex ........................................... 96 hydrocodone/ibuprofen ........................................................ 17 hydrocodone-homatropine 5-1.5 .......................................... 97 hydrocodone-homatropine soln ............................................ 97 hydrocodone-homatropine syrup .......................................... 97 hydrocortisone ..................................... 102, 118, 122, 148, 149 hydrocortisone (Cortef) ....................................................... 122 hydrocortisone (Cortenema) ............................................... 118 hydrocortisone acetate ............................................... 118, 148 hydrocortisone butyrate ...................................................... 148 hydrocortisone butyrate/emoll ........................................... 148 hydrocortisone valerate ...................................................... 148 hydrocortisone/acetic acid .................................................. 102 hydrocortisone/iodoquinol .................................................. 149 hydrocortisone/iodoquinol/aloe ......................................... 149 hydrocortisone/lidocaine/aloe ............................................ 118 hydrocortisone/pramoxine (Analpram HC) ......................... 118 hydrocortisone/pramoxine (Pramosone) ............................ 148 hydromorphone 1 mg/ml-ns syrng ........................................ 19 hydromorphone 10 mg/50 ml-ns .......................................... 19 hydromorphone 2 mg/ml-ns syrng ........................................ 19 hydromorphone 20 mg/100 ml-ns ........................................ 19 hydromorphone 25 mg/50 ml-ns .......................................... 19 hydromorphone 30 mg/30 ml-ns .......................................... 19 hydromorphone 50 mg/50 ml-ns .......................................... 19 hydromorphone 55 mg/55 ml-ns .......................................... 19 hydromorphone 6 mg/30 ml-ns ............................................ 20 hydromorphone hcl ............................................................... 20 hydromorphone hcl (Dilaudid) .............................................. 20 hydromorphone hcl in water/pf ............................................ 20 hydromorphone hcl/pf .......................................................... 20 hydroquinone ...................................................................... 145 hydroquinone microspheres ................................................ 145 hydroxocobalamin ............................................................... 162 hydroxychloroquine sulfate (Plaquenil) ................................. 51 hydroxyprogest 1,250 mg/5 ml (Makena) .......................... 126 hydroxyprogest 250 mg/ml vial (Makena) .......................... 126 hydroxyprogesterone 1.25 g/5ml ........................................ 124 hydroxyurea (Hydrea) ........................................................... 55 hydroxyzine hcl ...................................................................... 47 hydroxyzine pamoate ............................................................ 47 hydroxyzine pamoate (Vistaril) ............................................. 47 HYLENEX .............................................................................. 157 HYMOVIS ............................................................................... 27 hyoscyamine 0.125 mg odt (Anaspaz) ................................ 115 hyoscyamine 0.125 mg tab sl (Levsin-SL) ............................ 115 hyoscyamine 0.125 mg/5 ml elix ......................................... 115 hyoscyamine 0.125 mg/ml drop .......................................... 115 hyoscyamine sulf 0.125 mg tab (Levsin) .............................. 115 hyoscyamine sulfate ............................................................ 115 hyoscyamine sulfate (Anaspaz) ........................................... 115 hyoscyamine sulfate (Levbid) .............................................. 115 hyoscyamine sulfate (Levsin) ............................................... 115 hyoscyamine sulfate (Levsin-SL) .......................................... 115 HYOSCYAMINE SULFATE 0.5 MG/ML .................................. 115

HYPERLYTE CR ..................................................................... 109 HYPERRHO S-D ...................................................................... 74 HYPER-SAL ........................................................................... 155 HYPER-SAL (sodium chloride) .............................................. 155 hypromellose (Cellugel) ....................................................... 106 HYSINGLA ER ......................................................................... 20

I

ibandronate 3 mg/3 ml syringe (Boniva) ............................ 158 ibandronate 3 mg/3 ml vial ................................................. 158 ibandronate sodium 150 mg tab (Boniva) .......................... 158 IBRANCE ................................................................................ 59 ibuprofen .................................................................... 17, 28, 85 ibuprofen lysine/pf (Neoprofen) ............................................ 85 ibuprofen/oxycodone hcl ....................................................... 17 ibutilide fumarate (Corvert) .................................................. 76 IC GREEN (indocyanine green) .............................................. 97 icatibant acetate ................................................................. 152 ICLUSIG .................................................................................. 59 IDAMYCIN PFS (idarubicin hcl) .............................................. 53 idarubicin hcl (Idamycin Pfs) ................................................. 53 IDHIFA ................................................................................... 61 IFEX ....................................................................................... 55 IFEX (ifosfamide) ................................................................... 55 ifosfamide ............................................................................. 55 ifosfamide (Ifex) .................................................................... 55 ILARIS .................................................................................. 159 ILEVRO ................................................................................. 103 ILUMYA ............................................................................... 143 ILUVIEN ............................................................................... 103 imatinib mesylate (Gleevec) .................................................. 59 IMBRUVICA ........................................................................... 59 IMFINZI .................................................................................. 62 imipenem/cilastatin sodium .................................................. 35 imipenem/cilastatin sodium (Primaxin) ................................ 35 imipramine hcl .................................................................... 136 imipramine pamoate ........................................................... 136 imiquimod ........................................................................... 145 IMLYGIC ................................................................................. 57 IMPAVIDO ............................................................................. 51 IMPOYZ ............................................................................... 148 IMURAN (azathioprine) ....................................................... 128 IMVEXXY 10 MCG MAINTENANCE PAK ............................... 125 IMVEXXY 10 MCG STARTER PACK ....................................... 125 IMVEXXY 4 MCG MAINTENANCE PACK ............................... 125 IMVEXXY 4 MCG STARTER PACK ......................................... 125 INBRIJA .................................................................................. 64 INCRUSE ELLIPTA ................................................................... 29 indapamide ......................................................................... 102 INDERAL LA (propranolol hcl er) ........................................... 84 INDERAL XL ............................................................................ 84 INDIGO CARMINE ................................................................ 100 INDIUM IN-111 DTPA ............................................................ 98 indium in-111 oxyquinoline ................................................... 99 indocyanine green (IC Green) ................................................ 97 indomethacin .................................................................. 28, 85 indomethacin 1 mg vial ......................................................... 85 indomethacin 25 mg capsule ................................................ 28

181

indomethacin 50 mg capsule ................................................ 28 INFASURF ............................................................................ 151 INFED ................................................................................... 110 INFLECTRA ............................................................................. 52 INFUGEM ............................................................................... 56 INFUMORPH .......................................................................... 20 INFUVITE ADULT .................................................................. 161 INFUVITE PEDIATRIC ............................................................ 161 INGREZZA .............................................................................. 89 INGREZZA INITIATION PACK .................................................. 89 INJECTAFER ......................................................................... 110 INLYTA ................................................................................... 59 INNOPRAN XL ........................................................................ 84 INOVA .................................................................................. 145 INREBIC ................................................................................. 59 INSPRA (eplerenone) ........................................................... 101 INSULIN LISPRO ..................................................................... 50 INSULIN LISPRO KWIKPEN U-100 .......................................... 50 INTEGRILIN (eptifibatide) ...................................................... 66 INTELENCE ............................................................................. 67 INTRALIPID .......................................................................... 117 INTRAROSA .......................................................................... 119 INTRON A .............................................................................. 62 INTUNIV (guanfacine hcl er) ................................................ 136 INVANZ (ertapenem) ............................................................. 35 INVEGA ER 1.5 MG TABLET (paliperidone er) ..................... 138 INVEGA ER 3 MG TABLET (paliperidone er) ........................ 138 INVEGA ER 6 MG TABLET (paliperidone er) ........................ 138 INVEGA ER 9 MG TABLET (paliperidone er) ........................ 138 INVEGA SUSTENNA 117 MG/0.75 ML ................................. 138 INVEGA SUSTENNA 156 MG/ML SYRG ................................ 138 INVEGA SUSTENNA 234 MG/1.5 ML ................................... 138 INVEGA SUSTENNA 39 MG/0.25 ML ................................... 139 INVEGA SUSTENNA 78 MG/0.5 ML ..................................... 139 INVEGA TRINZA ................................................................... 139 INVELTYS ............................................................................. 103 INVIRASE ............................................................................... 68 iodine/potassium iodide ...................................................... 149 IODOFLEX ............................................................................ 149 IODOSORB ........................................................................... 149 IONOSOL MB-DEXTROSE 5% ............................................... 109 IOPIDINE .............................................................................. 105 ipratropium bromide ..................................................... 29, 102 ipratropium/albuterol sulfate ............................................... 30 irbesartan ........................................................................ 82, 83 irbesartan/hydrochlorothiazide ............................................ 82 IRESSA ................................................................................... 59 irinotecan hcl 100 mg/5 ml vl (Camptosar) ........................... 58 irinotecan hcl 300 mg/15 ml vl (Camptosar) ......................... 58 irinotecan hcl 40 mg/2 ml vial (Camptosar) .......................... 58 irinotecan hcl 500 mg/25 ml vl .............................................. 58 iron ps complex/b12/folic acid ............................................ 110 ISENTRESS ............................................................................. 68 ISENTRESS HD ........................................................................ 68 isoflurane (Forane) ................................................................ 22 ISOLYTE P WITH DEXTROSE ................................................. 109 ISOLYTE S ............................................................................. 109 isoniazid ................................................................................ 35

isoproterenol hcl ................................................................... 73 isoproterenol hcl (Isuprel) ..................................................... 73 ISOPTO ATROPINE (atropine sulfate) .................................. 105 ISOPTO CARPINE (pilocarpine hcl) ...................................... 105 isosorbide dinitrate ............................................................... 79 isosorbide mononitrate ......................................................... 79 isosulfan blue ........................................................................ 98 isotretinoin .......................................................................... 144 ISOVUE-200 ........................................................................... 97 ISOVUE-250 ........................................................................... 97 ISOVUE-300 ........................................................................... 97 ISOVUE-370 ........................................................................... 98 ISOVUE-M 200 ....................................................................... 98 ISOVUE-M 300 ....................................................................... 98 isoxsuprine hcl ....................................................................... 86 isradipine ............................................................................... 78 ISTALOL (timolol maleate) ................................................... 105 ISTODAX (romidepsin) ........................................................... 54 ISUPREL (isoproterenol hcl) .................................................. 73 itraconazole ........................................................................... 45 ivermectin (Soolantra) ......................................................... 146 ivermectin (Stromectol) ......................................................... 51 IXEMPRA ............................................................................... 57

J

JADENU ............................................................................... 157 JADENU (deferasirox) .......................................................... 157 JADENU SPRINKLE ............................................................... 157 JAKAFI .................................................................................... 57 JALYN (dutasteride-tamsulosin) .......................................... 160 JANUMET .............................................................................. 49 JANUMET XR 100-1,000 MG TABLET ..................................... 49 JANUMET XR 50-1,000 MG TABLET ....................................... 49 JANUMET XR 50-500 MG TABLET .......................................... 49 JANUVIA ................................................................................ 48 JARDIANCE ............................................................................ 48 JATENZO .............................................................................. 119 JETREA ................................................................................. 106 JEVTANA ................................................................................ 61 JULUCA .................................................................................. 66 JUXTAPID ............................................................................... 87 JYNARQUE 15 MG TABLET .................................................. 100 JYNARQUE 30 MG TABLET .................................................. 100 JYNARQUE 45 MG-15 MG TABLET ...................................... 100 JYNARQUE 60 MG-30 MG TABLET ...................................... 100 JYNARQUE 90 MG-30 MG TABLET ...................................... 100

K

KABIVEN .............................................................................. 108 KADCYLA ............................................................................... 61 KADIAN .................................................................................. 20 KADIAN (morphine sulfate er) ............................................... 20 KALBITOR ............................................................................ 152 KALETRA ................................................................................ 67 KALYDECO 150 MG TABLET ................................................. 151 KALYDECO 25 MG GRANULES PACKET ................................ 151 KALYDECO 50 MG GRANULES PACKET ................................ 151 KALYDECO 75 MG GRANULES PACKET ................................ 151

182

KANJINTI ................................................................................ 58 KANUMA ............................................................................. 156 KAPSPARGO SPRINKLE .......................................................... 84 KAPVAY (clonidine hcl er) .................................................... 136 KARBINAL ER ......................................................................... 47 KATERZIA ............................................................................... 78 KCENTRA ............................................................................... 75 KEFLEX (cephalexin) .............................................................. 36 KENALOG-10 ........................................................................ 122 KENALOG-40 (triamcinolone acetonide) ............................. 122 KENALOG-80 ........................................................................ 122 KEPIVANCE .......................................................................... 118 KEPPRA (levetiracetam) ........................................................ 92 KERALYT (salicylic acid) ....................................................... 145 KERALYT SCALP .................................................................... 145 KETALAR (ketamine hcl) ........................................................ 22 ketamine hcl .......................................................................... 22 ketamine hcl (Ketalar) ........................................................... 22 ketamine hcl in 0.9 % nacl ..................................................... 22 ketoconazole ................................................................... 45, 46 ketoconazole (Nizoral) ........................................................... 46 ketoprofen ............................................................................. 28 ketorolac 0.4% ophth solution (Acular LS) ........................... 103 ketorolac 0.5% ophth solution (Acular) ............................... 103 ketorolac 10 mg tablet .......................................................... 16 ketorolac 15 mg/ml syringe .................................................. 16 ketorolac 15 mg/ml vial ........................................................ 16 ketorolac 30 mg/ml carpuject ............................................... 16 ketorolac 30 mg/ml syringe .................................................. 16 ketorolac 30 mg/ml vial ........................................................ 16 ketorolac 60 mg/2 ml carpuject ............................................ 16 ketorolac 60 mg/2 ml syringe ............................................... 16 ketorolac 60 mg/2 ml vial ..................................................... 16 KEVEYIS ............................................................................... 154 KEVZARA 150 MG/1.14 ML PEN INJ .................................... 127 KEVZARA 150 MG/1.14 ML SYRINGE ................................... 127 KEVZARA 200 MG/1.14 ML PEN INJ .................................... 127 KEVZARA 200 MG/1.14 ML SYRINGE ................................... 127 KEYTRUDA ............................................................................. 60 KHAPZORY ........................................................................... 152 KINEVAC .............................................................................. 116 KISQALI ............................................................................ 58, 59 KISQALI FEMARA CO-PACK .................................................... 58 kit for prep tc-99m/mebrofenin (Choletec) ........................... 97 kit for tc 99m/sestamibi no.1 ................................................ 97 kit for tc 99m/sod thiosulfate ................................................ 98 kit for tc-99m/medronate sod ............................................... 98 kit for tc-99m/sod pyrophospht ............................................ 97 KITABIS PAK (tobramycin) ..................................................... 34 KLARON (sulfacetamide sodium) ........................................ 144 KLONOPIN (clonazepam) ....................................................... 90 klor-con 10 meq tablet (K-Tab ER) ...................................... 111 KLOR-CON 10 MEQ TABLET (potassium chloride) ............... 111 klor-con 8 meq tablet (K-Tab ER) ......................................... 111 KLOR-CON 8 MEQ TABLET (potassium chloride) ................. 111 KLOR-CON M15 ................................................................... 111 KORLYM ................................................................................. 50 K-PHOS NO.2 ....................................................................... 112

K-PHOS ORIGINAL ............................................................... 112 KRINTAFEL ............................................................................. 51 KRISTALOSE ......................................................................... 117 KRISTALOSE (lactulose) ....................................................... 117 KRYSTEXXA ............................................................................ 27 K-TAB ER (potassium chloride) ............................................ 111 KUVAN ................................................................................. 157 KYLEENA ................................................................................ 96 KYPROLIS 10 MG VIAL ........................................................... 59 KYPROLIS 30 MG VIAL ........................................................... 59 KYPROLIS 60 MG VIAL ........................................................... 59

L

L.E.T. (LIDO-EPINEPH-TETRA) ................................................ 25 labetalol hcl ........................................................................... 81 LACRISERT ........................................................................... 102 lactic acid ............................................................................ 144 lactulose ...................................................................... 112, 117 lactulose 10 gm packet (Kristalose) .................................... 117 lactulose 10 gm/15 ml solution ................................... 112, 117 lactulose 20 gm/30 ml solution ........................................... 117 lamivudine (Epivir HBV) ......................................................... 70 lamivudine 10 mg/ml oral soln ............................................. 67 lamivudine 150 mg tablet ..................................................... 67 lamivudine 300 mg tablet ..................................................... 67 lamivudine/zidovudine .......................................................... 67 lamotrigine ............................................................................ 92 LANOXIN ................................................................................ 79 LANOXIN (digoxin) ................................................................. 79 LANOXIN PEDIATRIC .............................................................. 79 lansoprazole/amoxiciln/clarith ........................................... 115 lanthanum carbonate (Fosrenol) ........................................ 109 LASIX (furosemide) .............................................................. 101 latanoprost (Xalatan) .......................................................... 105 LATUDA 120 MG TABLET ..................................................... 139 LATUDA 20 MG TABLET ....................................................... 139 LATUDA 40 MG TABLET ....................................................... 139 LATUDA 60 MG TABLET ....................................................... 139 LATUDA 80 MG TABLET ....................................................... 139 LAYOLIS FE (norethin-eth estra-ferrous fum) ........................ 95 LAZANDA ............................................................................... 20 LEDIPASVIR-SOFOSBUVIR ...................................................... 69 leflunomide (Arava) ............................................................... 26 LEMTRADA ............................................................................ 90 LENVIMA ............................................................................... 59 LETAIRIS (ambrisentan) ......................................................... 80 letrozole (Femara) ................................................................. 57 leucovorin cal 100 mg/10 ml vl ........................................... 152 leucovorin cal 500 mg/50 ml vl ........................................... 152 leucovorin calcium 10 mg tab ............................................. 152 leucovorin calcium 100 mg vial ........................................... 152 leucovorin calcium 15 mg tab ............................................. 152 leucovorin calcium 200 mg vial ........................................... 152 leucovorin calcium 25 mg tab ............................................. 152 leucovorin calcium 350 mg vial ........................................... 152 leucovorin calcium 5 mg tab ............................................... 152 leucovorin calcium 50 mg vial ............................................. 152 leucovorin calcium 500 mg vl .............................................. 152

183

LEUKERAN ............................................................................. 55 LEUKINE ................................................................................. 93 leuprolide acetate ................................................................. 59 levalbuterol hcl (Xopenex Concentrate) ................................ 30 levalbuterol hcl (Xopenex) ..................................................... 30 levalbuterol tartrate .............................................................. 30 LEVAQUIN (levofloxacin) ....................................................... 40 LEVBID (symax-sr) ............................................................... 115 LEVEMIR ................................................................................ 50 LEVEMIR FLEXTOUCH ............................................................ 50 levetiracetam ........................................................................ 92 levetiracetam (Keppra) .......................................................... 92 levetiracetam in nacl (iso-os) ................................................ 92 levobunolol hcl .................................................................... 105 levocarnitine (Carnitor SF) ................................................... 158 levocarnitine (Carnitor) ....................................................... 158 levocarnitine (with sugar) (Carnitor) ................................... 158 levofloxacin ..................................................................... 33, 40 levofloxacin (Levaquin) .......................................................... 40 levofloxacin in dextrose 5 % .................................................. 40 levoleucovorin calcium ........................................................ 152 levonorgestrel-ethin estradiol ............................................... 95 LEVOPHED (norepinephrine bitartrate) ................................ 73 LEVO-T (levothyroxine sodium) ........................................... 150 LEVO-T (levoxyl) .................................................................. 150 LEVO-T (unithroid) ............................................................... 150 levothyroxine sodium .......................................................... 150 levothyroxine sodium (Synthroid) ........................................ 150 levothyroxine sodium (Unithroid) ........................................ 150 LEVSIN ................................................................................. 115 LEVSIN (oscimin) ................................................................. 115 LEVSIN-SL (symax-sl) ........................................................... 115 LEVULAN ............................................................................... 63 LEXISCAN ............................................................................... 97 LEXIVA ................................................................................... 68 LIALDA (mesalamine) .......................................................... 116 LIBTAYO ................................................................................. 60 lidocaine 0.5mg intraderm syst (Zingo) ................................. 23 lidocaine 100 mg/10 ml(1%) syr ............................................ 23 lidocaine 100 mg/5 ml (2%) syr ............................................. 23 lidocaine 5% ointment ........................................................... 25 lidocaine 5% patch (Lidoderm) .............................................. 25 lidocaine 50 mg/5 ml (1%) syrg ............................................. 23 lidocaine hcl ................................................... 23, 24, 25, 76, 98 lidocaine hcl 0.5% vial (Xylocaine) ......................................... 23 lidocaine hcl 0.5% vial (Xylocaine-mpf) ................................. 23 lidocaine hcl 1.5% ampul (Xylocaine-mpf) ............................ 23 lidocaine hcl 1% 20 mg/2 ml (Xylocaine-mpf) ....................... 23 lidocaine hcl 1% 20 mg/2 ml vl (Xylocaine-mpf) .................... 23 lidocaine hcl 1% 300 mg/30 ml (Xylocaine-mpf) ................... 23 lidocaine hcl 1% 50 mg/5 ml (Xylocaine-mpf) ....................... 23 lidocaine hcl 1% 50 mg/5 ml vl (Xylocaine-mpf) .................... 23 lidocaine hcl 1% abboject ...................................................... 76 lidocaine hcl 1% ampul (Xylocaine-mpf) ................................ 23 lidocaine hcl 1% syringe ........................................................ 76 lidocaine hcl 1% vial (Xylocaine) ............................................ 23 lidocaine hcl 1% vial (Xylocaine-mpf) .................................... 23 lidocaine hcl 2% 100 mg/5 ml (Xylocaine-mpf) ..................... 23

lidocaine hcl 2% 40 mg/2 ml ................................................. 23 lidocaine hcl 2% 40 mg/2 ml vl (Xylocaine-mpf) ................... 23 lidocaine hcl 2% abboject ...................................................... 76 lidocaine hcl 2% ampul .......................................................... 23 lidocaine hcl 2% jel urojet ac ................................................. 23 lidocaine hcl 2% jelly ............................................................. 23 lidocaine hcl 2% jelly uro-jet .................................................. 23 lidocaine hcl 2% luer-jet ........................................................ 76 lidocaine hcl 2% syringe ........................................................ 76 lidocaine hcl 2% vial ........................................................ 23, 76 lidocaine hcl 2% vial (Xylocaine) ............................................ 23 lidocaine hcl 2% vial (Xylocaine-mpf) .................................... 23 lidocaine hcl 4% ampul .......................................................... 23 lidocaine hcl 4% solution ................................................. 24, 25 lidocaine hcl/dextrose 5 %/pf ................................................ 76 lidocaine hcl/dextrose 7.5%/pf .............................................. 24 lidocaine hcl/epinephrine ...................................................... 24 lidocaine hcl/epinephrine (Xylocaine With Epinephrine) ....... 24 lidocaine hcl/epinephrine bit

(Xylocaine Dental-epinephrine) ........................................ 24 lidocaine hcl/glycerin ............................................................ 98 lidocaine with 8.4% sod bicarb .............................................. 24 lidocaine/hydrocortisone ac ........................................ 118, 148 lidocaine/prilocaine ............................................................... 26 LIDODERM (lidocaine) ........................................................... 26 LILETTA .................................................................................. 96 LINCOCIN (lincomycin hcl) ..................................................... 37 lincomycin hcl (Lincocin) ........................................................ 37 lindane .................................................................................. 63 linezolid (Zyvox) ..................................................................... 38 linezolid in dextrose 5% (Zyvox) ............................................ 38 linezolid-0.9% sodium chloride .............................................. 38 LINZESS ................................................................................ 117 LIORESAL INTRATHECAL ...................................................... 129 liothyronine sodium (Cytomel) ............................................ 150 liothyronine sodium (Triostat) ............................................. 150 LIPIODOL ............................................................................... 98 LIPOFEN (fenofibrate) ........................................................... 88 LIQUID E-Z PAQUE ................................................................. 99 LIQUID POLIBAR PLUS ........................................................... 99 lisinopril ........................................................................... 81, 83 lisinopril/hydrochlorothiazide ............................................... 81 lissamine green ..................................................................... 99 lithium carbonate ................................................................ 131 lithium carbonate (Lithobid) ............................................... 131 lithium citrate ...................................................................... 131 LITHOBID (lithium carbonate er) ......................................... 131 LITHOSTAT ........................................................................... 113 l-norgest/e.estradiol-e.estrad (Loseasonique) ...................... 95 l-norgest/e.estradiol-e.estrad (Quartette) ............................ 95 l-norgest/e.estradiol-e.estrad (Seasonique) .......................... 95 LO LOESTRIN FE ..................................................................... 95 LODINE (etodolac) ................................................................. 28 LOESTRIN (norethindron-ethinyl estradiol) .......................... 95 LOESTRIN FE (norethindrone-eth estradiol-fe) ..................... 95 LOESTRIN FE (tarina fe 1-20 eq) ............................................ 95 LOKELMA ............................................................................. 109 LOMOTIL (diphenoxylate-atropine) .................................... 113

184

LONHALA MAGNAIR REFILL ................................................... 29 LONHALA MAGNAIR STARTER ............................................... 29 LONSURF ............................................................................... 56 loperamide hcl ..................................................................... 113 LOPID (gemfibrozil) ............................................................... 88 lopinavir/ritonavir ................................................................. 67 LOPRESSOR (metoprolol tartrate) ......................................... 84 LOPRESSOR HCT (metoprolol-hydrochlorothiazide) ............. 85 LOPROX (ciclopirox) .............................................................. 46 lorazepam ................................................................... 131, 142 LORBRENA ............................................................................. 60 losartan potassium ................................................................ 83 losartan/hydrochlorothiazide ................................................ 82 LOSEASONIQUE (levonorg-eth estrad eth estrad) ................ 95 LOTEMAX ............................................................................ 103 LOTEMAX (loteprednol etabonate) ..................................... 103 LOTEMAX SM ...................................................................... 103 loteprednol etabonate (Lotemax) ....................................... 103 LOTRISONE (clotrimazole-betamethasone) .......................... 46 lovastatin 10 mg tablet ......................................................... 87 lovastatin 20 mg tablet ......................................................... 87 lovastatin 40 mg tablet ......................................................... 87 LOVAZA (omega-3 acid ethyl esters) ................................... 112 LOVENOX 100 MG/ML SYRINGE (enoxaparin sodium) ......... 44 LOVENOX 120 MG/0.8 ML SYRINGE (enoxaparin sodium) .... 44 LOVENOX 150 MG/ML SYRINGE (enoxaparin sodium) ......... 44 LOVENOX 30 MG/0.3 ML SYRINGE (enoxaparin sodium) ...... 44 LOVENOX 300 MG/3 ML VIAL (enoxaparin sodium) ............. 44 LOVENOX 40 MG/0.4 ML SYRINGE (enoxaparin sodium) ...... 44 LOVENOX 60 MG/0.6 ML SYRINGE (enoxaparin sodium) ...... 44 LOVENOX 80 MG/0.8 ML SYRINGE (enoxaparin sodium) ...... 44 loxapine succinate ............................................................... 140 LUCEMYRA .......................................................................... 159 LUCENTIS ............................................................................. 106 luliconazole ........................................................................... 46 LUMASON ............................................................................. 98 LUMIZYME ........................................................................... 156 LUMOXITI .............................................................................. 60 LUNESTA (eszopiclone) ....................................................... 142 LUPANETA PACK .................................................................. 123 LUPRON DEPOT ............................................................. 59, 123 LUPRON DEPOT-PED ........................................................... 123 LUTATHERA ......................................................................... 152 LUXAMEND ......................................................................... 144 LUXIQ (betamethasone valerate) ........................................ 148 LYNPARZA .............................................................................. 60 LYRICA (pregabalin) ............................................................... 92 LYSODREN ............................................................................. 61 LYSTEDA (tranexamic acid) .................................................... 74

M

M.V.I. ADULT ....................................................................... 161 M.V.I. PEDIATRIC ................................................................. 161 MACROBID (nitrofurantoin mono-macro) ............................ 38 MACRODANTIN (nitrofurantoin) ........................................... 38 MACUGEN ........................................................................... 106 mafenide acetate (Sulfamylon) ............................................. 42 magnesium chloride ............................................................ 110

magnesium sulfate .............................................................. 110 magnesium sulfate in water ............................................... 110 magnesium sulfate/d5w ..................................................... 110 MAGNEVIST ........................................................................... 98 MAKENA .............................................................................. 126 MAKENA (hydroxyprogesterone caproate) ......................... 126 MALARONE (atovaquone-proguanil hcl) ............................... 51 malathion (Ovide) ................................................................. 63 manganese chloride ............................................................ 110 manganese sulfate .............................................................. 110 mannitol ...................................................................... 101, 143 mannitol (Osmitrol) ............................................................. 101 mannitol/sorbitol solution .................................................. 143 maprotiline hcl .................................................................... 136 MARCAINE (bupivacaine hcl) ................................................ 24 MARCAINE (sensorcaine-mpf) .............................................. 24 MARCAINE SPINAL (bupivacaine-dextrose) .......................... 24 MARCAINE-EPINEPHRINE (bupivacaine hcl-epinephrine) ..... 24 MARCAINE-EPINEPHRINE (sensorcaine-epinephrine) ........... 24 MARCAINE-EPINEPHRINE (sensorcaine-mpf epinephrine) ... 24 MARPLAN ............................................................................ 131 MARQIBO .............................................................................. 58 MATULANE ............................................................................ 61 MAVENCLAD ......................................................................... 90 MAVYRET .............................................................................. 70 MAXALT (rizatriptan) ............................................................. 16 MAXALT MLT (rizatriptan) ..................................................... 16 MAXIDEX ............................................................................. 103 MAXITROL (neomycin-polymyxin-dexameth) ....................... 32 MAXZIDE (triamterene-hydrochlorothiazide) ..................... 101 MAXZIDE-25 MG (triamterene-hydrochlorothiazide) ......... 101 MAYZENT 0.25 MG STARTER PACK ....................................... 90 MAYZENT 0.25 MG TABLET ................................................... 90 MAYZENT 2 MG TABLET ........................................................ 90 mebendazole ......................................................................... 51 mecamylamine hcl ................................................................ 83 meclofenamate sodium ......................................................... 28 MEDIHONEY ........................................................................ 146 MEDROL .............................................................................. 122 MEDROL (methylprednisolone) .......................................... 122 MEDROLOAN II SUIK (p-care d80g) ..................................... 122 medroxyprogesterone 10 mg tab (Provera) ........................ 124 medroxyprogesterone 150 mg/ml (Depo-Provera) ............... 94 medroxyprogesterone 2.5 mg tab ....................................... 124 medroxyprogesterone 5 mg tab (Provera) .......................... 124 mefenamic acid ..................................................................... 16 mefloquine hcl ....................................................................... 51 MEGACE ES (megestrol acetate) ......................................... 161 megestrol 20 mg tablet ......................................................... 62 megestrol 40 mg tablet ......................................................... 62 megestrol 625 mg/5 ml susp (Megace ES) .......................... 161 megestrol acet 40 mg/ml susp ............................................ 161 megestrol acet 400 mg/10 ml ............................................. 161 MEKINIST ............................................................................... 57 MEKTOVI ............................................................................... 57 meloxicam (Mobic) ................................................................ 28 melphalan (Alkeran) .............................................................. 55 melphalan hcl (Alkeran) ........................................................ 55

185

memantine hcl ...................................................................... 88 memantine hcl (Namenda) ................................................... 88 memantine hcl er 14 mg capsule (Namenda XR) .................. 88 memantine hcl er 21 mg capsule (Namenda XR) .................. 88 memantine hcl er 28 mg capsule (Namenda XR) .................. 88 memantine hcl er 7 mg capsule (Namenda XR) .................... 88 MEMBRANEBLUE ................................................................ 106 MENEST ............................................................................... 121 MENOPUR ........................................................................... 125 MENOSTAR .......................................................................... 121 meperidine hcl ....................................................................... 20 meperidine hcl/pf .................................................................. 20 MEPHYTON (phytonadione) ................................................ 162 mepivacaine hcl (Carbocaine) ............................................... 24 mepivacaine hcl/pf (Carbocaine) .......................................... 24 me-prednis/norfluran/hfc 245fa (Medroloan II Suik) .......... 122 meprobamate ..................................................................... 131 MEPSEVII ............................................................................. 156 mercaptopurine ..................................................................... 56 meropenem (Merrem) ........................................................... 35 meropenem-0.9% sodium chloride ........................................ 35 MERREM (meropenem) ........................................................ 35 mesalamine ......................................................................... 116 mesalamine (Apriso) ........................................................... 116 mesalamine 1,000 mg supp (Canasa) ................................. 116 mesalamine 4 gm/60 ml enema (Sfrowasa) ....................... 116 mesalamine 4 gm/60 ml kit ................................................ 116 mesalamine 800 mg dr tablet ............................................. 116 mesalamine dr 1.2 gm tablet (Lialda) ................................. 116 mesna (Mesnex) .................................................................. 152 MESNEX 1 GRAM/10 ML VIAL (mesna) ............................... 152 MESNEX 400 MG TABLET .................................................... 152 MESTINON (pyridostigmine bromide er) .............................. 71 MESTINON (pyridostigmine bromide) ................................... 71 metaproterenol sulfate ......................................................... 30 metaxalone ......................................................................... 129 metaxalone (Skelaxin) ......................................................... 129 metformin hcl (Glucophage Xr) ............................................. 48 metformin hcl (Glucophage) ................................................. 48 metformin hcl (Riomet) ......................................................... 48 meth/meblue/sod phos/psal/hyos ........................................ 34 meth/meblue/sod phos/psal/hyos (Uretron D-S) .................. 34 meth/meblue/sod phos/psal/hyos (Uribel) ........................... 34 methadone hcl ...................................................................... 20 methadone hcl (Dolophine Hcl) ............................................. 20 methamphetamine hcl .......................................................... 72 methazolamide ................................................................... 100 methen/mblue/sal/sod phos/hyos ........................................ 34 methenam/m.blue/salicyl/hyoscy ......................................... 34 methenam/sod phos/mblue/hyoscy (Urogesic-Blue) ............ 34 methenamine hippurate (Hiprex) .......................................... 34 methenamine mandelate ...................................................... 34 methimazole (Tapazole) ...................................................... 149 methocarbamol ................................................................... 129 methocarbamol (Robaxin) ................................................... 129 methocarbamol (Robaxin-750) ........................................... 129 methohexital in water/pf ...................................................... 22 methotrexate 1 gm vial ......................................................... 56

methotrexate 2.5 mg tablet .................................................. 56 methotrexate 250 mg/10 ml vial .......................................... 56 methotrexate 50 mg/2 ml vial .............................................. 56 methotrexate sodium/pf ....................................................... 56 methoxsalen (Oxsoralen-ultra) ........................................... 143 methscopolamine bromide ................................................. 115 methyl salicylate ................................................................. 145 methyldopa ........................................................................... 84 methyldopa/hydrochlorothiazide .......................................... 84 methylene blue .................................................................... 154 methylergonovine maleate ................................................. 124 METHYLIN (methylphenidate hcl) ....................................... 137 methylphenidate er 10 mg tab ............................................ 137 methylphenidate er 18 mg tab ............................................ 137 methylphenidate er 20 mg tab ............................................ 137 methylphenidate er 27 mg tab ............................................ 137 methylphenidate er 36 mg tab ............................................ 137 methylphenidate er 54 mg tab ............................................ 137 methylphenidate er 72 mg tab ............................................ 137 methylphenidate hcl ............................................................ 137 methylphenidate hcl (Methylin) .......................................... 137 methylphenidate hcl (Ritalin) .............................................. 137 methylphenidate la 10 mg cap ............................................ 137 methylphenidate la 20 mg cap ............................................ 137 methylphenidate la 30 mg cap ............................................ 137 methylphenidate la 40 mg cap ............................................ 137 methylphenidate la 60 mg cap ............................................ 137 methylprednisolone (Medrol) .............................................. 122 methylprednisolone acetate (Depo-Medrol) ....................... 122 methylprednisolone sod succ .............................................. 122 methylprednisolone sod succ (Solu-Medrol) ....................... 122 methyltestosterone ............................................................. 119 metoclopramide hcl ............................................................ 117 metoclopramide hcl (Reglan) .............................................. 117 metolazone ......................................................................... 102 METOPIRONE ........................................................................ 99 metoprolol succinate (Toprol XL) .......................................... 84 metoprolol tartrate ............................................................... 84 metoprolol tartrate (Lopressor) ............................................ 84 metoprolol/hydrochlorothiazide ........................................... 85 metoprolol/hydrochlorothiazide (Lopressor HCT) ................. 85 METRO IV (metronidazole) ................................................... 34 METROCREAM (rosadan) .................................................... 146 METROGEL (metronidazole) ............................................... 146 METROLOTION (metronidazole) ......................................... 146 metronidazole .......................................................... 34, 41, 146 metronidazole (Flagyl) .......................................................... 34 metronidazole (Metrocream) .............................................. 146 metronidazole (Metrogel) ................................................... 146 metronidazole (Metrolotion) ............................................... 146 metronidazole/sodium chloride (Metro Iv) ........................... 34 mexiletine hcl ........................................................................ 76 MIACALCIN .......................................................................... 126 miconazole nitrate ................................................................ 45 MICRHOGAM ULTRA-FILTERED PLUS .................................... 74 midazolam hcl ....................................................................... 22 midazolam hcl in 0.9 % nacl/pf ............................................. 22 midazolam hcl/pf .................................................................. 22

186

midazolam in 0.9 % sod.chlorid ............................................. 22 midodrine hcl ......................................................................... 72 MIFEPREX (mifepristone) .................................................... 154 mifepristone (Mifeprex) ...................................................... 154 miglitol (Glyset) ..................................................................... 48 miglustat (Zavesca) ............................................................. 155 milrinone lactate ................................................................... 79 milrinone lactate/d5w ........................................................... 79 MIMYX (prumyx) ................................................................. 144 MINASTRIN 24 FE (norethin-eth estra-ferrous fum) ............. 95 MINIPRESS (prazosin hcl) ...................................................... 82 MINIVELLE (estradiol) .......................................................... 121 MINOCIN ............................................................................... 40 minocycline er 105 mg tablet ................................................ 40 minocycline er 115 mg tablet ................................................ 40 minocycline er 135 mg tablet ................................................ 40 minocycline er 45 mg tablet .................................................. 40 minocycline er 55 mg tablet .................................................. 40 minocycline er 65 mg tablet .................................................. 40 minocycline er 80 mg tablet .................................................. 40 minocycline er 90 mg tablet .................................................. 40 minocycline hcl ...................................................................... 40 minoxidil ................................................................................ 84 MIOCHOL-E ......................................................................... 105 MIOSTAT ............................................................................. 105 MIRAPEX (pramipexole dihydrochloride) .............................. 64 MIRAPEX ER 0.375 MG TABLET (pramipexole er) ................. 64 MIRAPEX ER 0.75 MG TABLET (pramipexole er) ................... 64 MIRAPEX ER 1.5 MG TABLET (pramipexole er) ..................... 64 MIRAPEX ER 2.25 MG TABLET (pramipexole er) ................... 64 MIRAPEX ER 3 MG TABLET (pramipexole er) ........................ 64 MIRAPEX ER 3.75 MG TABLET (pramipexole er) ................... 64 MIRAPEX ER 4.5 MG TABLET (pramipexole er) ..................... 64 MIRCERA ............................................................................... 93 MIRCETTE (viorele) ................................................................ 95 MIRENA ................................................................................. 96 mirtazapine ......................................................................... 130 mirtazapine (Remeron) ....................................................... 130 misoprostol (Cytotec) .......................................................... 115 MITIGARE (colchicine) ........................................................... 27 mitomycin (Mutamycin) ........................................................ 53 MITOSOL ............................................................................. 106 mitoxantrone hcl ................................................................... 61 MOBIC (meloxicam) .............................................................. 28 modafinil ............................................................................. 141 moexipril hcl .......................................................................... 83 molindone hcl ...................................................................... 141 mometasone furoate 0.1% cream (Elocon) ......................... 148 mometasone furoate 0.1% oint ........................................... 148 mometasone furoate 0.1% soln .......................................... 148 mometasone furoate 50 mcg spry ...................................... 102 MONOVISC ............................................................................ 27 montelukast sodium (Singulair) ............................................ 31 MONUROL ............................................................................. 34 MORPHABOND ER ................................................................. 20 morphine 100mg/100ml-0.9% nacl ....................................... 20 morphine 2 mg/2 ml-0.9% nacl ............................................. 20 morphine 2 mg/ml-0.9% nacl syr .......................................... 20

morphine 30 mg/30 ml-0.9% nacl ......................................... 20 morphine 4 mg/ml-0.9% nacl syr .......................................... 20 morphine 5 mg/5 ml-0.9% nacl ............................................. 20 morphine 50 mg/50 ml-0.9% nacl ......................................... 20 morphine 500mg/100ml-0.9% nacl ....................................... 20 morphine 55 mg/55 ml-0.9% nacl ......................................... 20 morphine sulfate ................................................................... 20 morphine sulfate (Kadian) ..................................................... 20 morphine sulfate (MS Contin) ............................................... 20 morphine sulfate/pf .............................................................. 20 MOTEGRITY ......................................................................... 117 MOTOFEN ........................................................................... 113 MOVANTIK ............................................................................ 44 MOXEZA (moxifloxacin) ........................................................ 33 moxifloxacin hcl ............................................................... 33, 40 moxifloxacin hcl (Moxeza) ..................................................... 33 moxifloxacin hcl (Vigamox) ................................................... 33 moxifloxacin(pf)/bal.salt sol2 ................................................ 33 moxifloxacin/sod.ace,sul/water ............................................ 40 moxifloxacin-sod.chloride(iso) (Avelox Iv) ............................. 40 MOZOBIL ............................................................................... 94 MS CONTIN (morphine sulfate er) ........................................ 20 MULPLETA ............................................................................. 94 MULTAQ ................................................................................ 76 MULTIHANCE ........................................................................ 98 MULTIHANCE MULTIPACK .................................................... 98 multitrace-4 conc vial .......................................................... 110 multitrace-4 vial .................................................................. 110 MULTITRACE-4 VIAL ............................................................ 110 multivit,ther.w-iron,hematinic ............................................ 161 multivit39/iron/mfolat/dss/dha .......................................... 161 mupirocin (Centany) .............................................................. 42 mupirocin calcium ................................................................. 42 MUTAMYCIN (mitomycin) ..................................................... 53 MVASI .................................................................................... 54 mvn no.53/iron/folic/dss/dha ............................................. 161 MYALEPT ............................................................................. 126 MYAMBUTOL (ethambutol hcl) ............................................. 35 MYCAMINE ............................................................................ 46 mycophenolate 200 mg/ml susp (Cellcept) ......................... 128 mycophenolate 250 mg capsule (Cellcept) .......................... 128 mycophenolate 500 mg tablet (Cellcept) ............................ 128 mycophenolate 500 mg vial (Cellcept) ................................ 128 mycophenolate sodium (Myfortic) ...................................... 128 MYDRIACYL (tropicamide) ................................................... 105 MYFORTIC (mycophenolic acid) .......................................... 128 MYLERAN .............................................................................. 55 MYOBLOC .............................................................................. 73 MYOVIEW .............................................................................. 97 MYTESI ................................................................................ 113

N

nabumetone .......................................................................... 28 nadolol (Corgard) .................................................................. 84 nafcillin in dextrose,iso-osm .................................................. 39 nafcillin sodium ..................................................................... 39 naftifine hcl ........................................................................... 46 naftifine hcl (Naftin) .............................................................. 46

187

NAFTIN ............................................................................ 46, 47 NAFTIN (naftifine hcl) ............................................................ 47 NAGLAZYME ........................................................................ 156 nalbuphine hcl ....................................................................... 20 NALFON 400 MG CAPSULE (fenoprofen calcium) ................. 28 nalfon 600 mg tablet ............................................................. 29 naloxone hcl .......................................................................... 45 naltrexone hcl ........................................................................ 45 NAMENDA (memantine hcl) ................................................. 88 NAMENDA XR 14 MG CAPSULE (memantine hcl er) ............. 89 NAMENDA XR 21 MG CAPSULE (memantine hcl er) ............. 89 NAMENDA XR 28 MG CAPSULE (memantine hcl er) ............. 89 NAMENDA XR 7 MG CAPSULE (memantine hcl er) ............... 89 NAMENDA XR TITRATION PACK ............................................ 89 NAMZARIC 14 MG-10 MG CAPSULE ...................................... 89 NAMZARIC 21 MG-10 MG CAPSULE ...................................... 89 NAMZARIC 28 MG-10 MG CAPSULE ...................................... 89 NAMZARIC 7 MG-10 MG CAPSULE ........................................ 89 NAMZARIC TITRATION PACK ................................................. 89 NAPROSYN (naproxen) .......................................................... 29 naproxen ............................................................................... 29 naproxen (EC-naprosyn) ........................................................ 29 naproxen (Naprosyn) ............................................................. 29 naproxen sodium ................................................................... 29 naratriptan hcl (Amerge) ...................................................... 16 NARCAN ................................................................................ 45 NARDIL (phenelzine sulfate) ................................................ 131 NAROPIN ............................................................................... 24 NAROPIN (ropivacaine hcl) .................................................... 24 NATACYN ............................................................................... 45 NATAZIA ................................................................................ 95 nateglinide (Starlix) ............................................................... 49 NATPARA ............................................................................. 124 NATROBA (spinosad) ............................................................. 63 NAVELBINE (vinorelbine tartrate) ......................................... 58 NAYZILAM ............................................................................. 90 NEBUPENT (pentamidine isethionate) .................................. 51 nebusal 3% vial .................................................................... 156 NEBUSAL 6% VIAL ................................................................ 156 nefazodone hcl .................................................................... 134 NEMBUTAL SODIUM (pentobarbital sodium) ..................... 141 neomycin sulf/bacitracin/poly ............................................... 33 neomycin sulf/polymyxin b sulf ........................................... 143 neomycin sulfate ................................................................... 34 neomycin/bacit/p-myx/hydrocort ......................................... 32 neomycin/polymyxin b/dexametha (Maxitrol) ...................... 32 neomycin/polymyxin b/hydrocort ......................................... 32 neomycin/polymyxn b/gramicidin ........................................ 33 NEOPROFEN (ibuprofen lysine) ............................................. 85 NEORAL (gengraf) ................................................................ 128 NEOSALUS ........................................................................... 145 neostigmine methylsulfate .................................................... 71 neostigmine methylsulfate (Bloxiverz) .................................. 71 NEO-SYNALAR ....................................................................... 42 NEPHRAMINE ...................................................................... 108 NERLYNX ................................................................................ 60 NESACAINE ............................................................................ 24 NESACAINE-MPF (chloroprocaine hcl) .................................. 24

NETSPOT ............................................................................... 98 NEULASTA 6 MG/0.6 ML SYRINGE ........................................ 93 NEULASTA ONPRO 6 MG/0.6 ML KIT .................................... 94 NEUPOGEN ............................................................................ 94 NEUPRO ................................................................................ 64 NEURONTIN (gabapentin) ..................................................... 92 NEVANAC ............................................................................ 103 nevirapine ............................................................................. 67 NEXAVAR ............................................................................... 60 NEXAVIR .............................................................................. 157 NEXIUM DR 10 MG PACKET ................................................ 118 NEXIUM DR 2.5 MG PACKET ............................................... 118 NEXIUM DR 20 MG PACKET ................................................ 118 NEXIUM DR 40 MG PACKET ................................................ 118 NEXIUM DR 5 MG PACKET .................................................. 118 NEXTERONE ........................................................................... 77 niacin ..................................................................................... 88 niacin (Niaspan) .................................................................... 88 NIASPAN (niacin er) ............................................................... 88 nicardipine hcl ....................................................................... 78 nicardipine hcl-0.9% sod chlor ............................................... 78 nifedipine .............................................................................. 78 nifedipine (Adalat Cc) ............................................................ 78 nifedipine (Procardia Xl) ........................................................ 78 nifedipine (Procardia) ............................................................ 78 nilutamide ............................................................................. 55 NIMBEX (cisatracurium besylate) .......................................... 73 nimodipine ............................................................................ 78 NINLARO ............................................................................... 60 NIPENT .................................................................................. 56 nisoldipine er 17 mg tablet (Sular) ........................................ 78 nisoldipine er 20 mg tablet ................................................... 78 nisoldipine er 25.5 mg tablet ................................................ 78 nisoldipine er 30 mg tablet ................................................... 78 nisoldipine er 34 mg tablet (Sular) ........................................ 78 nisoldipine er 40 mg tablet ................................................... 78 nisoldipine er 8.5 mg tablet (Sular) ....................................... 78 NITHIODOTE ........................................................................ 157 nitisinone (Orfadin) ............................................................. 155 NITRO-DUR ............................................................................ 79 NITRO-DUR (nitroglycerin patch) .......................................... 79 nitrofurantoin ........................................................................ 38 nitrofurantoin macrocrystal (Macrodantin) .......................... 38 nitrofurantoin monohyd/m-cryst (Macrobid) ....................... 38 nitroglycerin .......................................................................... 79 nitroglycerin (Nitro-Dur) ........................................................ 79 nitroglycerin (Nitrolingual) .................................................... 79 nitroglycerin (Nitrostat) ........................................................ 79 nitroglycerin in 5 % dextrose ................................................. 79 NITROLINGUAL (nitroglycerin) .............................................. 79 NITROMIST ............................................................................ 79 NITROPRESS (sodium nitroprusside) ..................................... 83 nitroprusside sodium (Nitropress) ......................................... 83 NITROSTAT (nitroglycerin) .................................................... 79 NITYR ................................................................................... 155 NIVESTYM ............................................................................. 94 nizatidine ............................................................................. 116 NIZORAL (ketoconazole) ....................................................... 47

188

NOCTIVA .............................................................................. 120 NORCO (lorcet hd) ................................................................. 17 NORCO (lorcet plus) .............................................................. 17 NORCO (lorcet) ...................................................................... 17 NORDITROPIN FLEXPRO ...................................................... 123 norelgestromin/ethin.estradiol ............................................. 96 norepinephrine bit/0.9 % nacl ............................................... 73 norepinephrine bitartrate ..................................................... 73 norepinephrine bitartrate (Levophed) ................................... 73 norepinephrine bitartrate/d5w ............................................. 73 noreth-ethinyl estradiol/iron ................................................. 95 noreth-ethinyl estradiol/iron (Layolis Fe) .............................. 95 norethind-eth estrad 0.5-2.5 (Femhrt) ................................ 121 norethind-eth estrad 1-0.02 mg (Loestrin) ............................ 95 norethindrone (Ortho Micronor) ........................................... 95 norethindrone acetate (Aygestin) ....................................... 124 norethindrone ac-eth estradiol ..................................... 95, 121 norethindrone ac-eth estradiol (Femhrt) ............................. 121 norethindrone ac-eth estradiol (Loestrin) ............................. 95 norethindrone-e.estradiol-iron .............................................. 95 norethindrone-e.estradiol-iron (Estrostep FE) ....................... 95 norethindrone-e.estradiol-iron (Loestrin FE) ......................... 95 norethindrone-e.estradiol-iron (Minastrin 24 FE) ................. 95 norethindrone-ethin. estradiol ........................................ 95, 96 norethindrone-ethin. estradiol (Ortho-Novum) ..................... 96 norethin-ee 1.5-0.03 mg(21) tb (Loestrin) ............................. 96 norethin-eth estrad 1 mg-5 mcg ......................................... 121 NORGESIC FORTE (orphengesic forte) ................................ 129 norgestimate-ethinyl estradiol .............................................. 96 norgestrel-ethinyl estradiol ................................................... 96 NORMOSOL-M AND DEXTROSE .......................................... 109 NORMOSOL-R ...................................................................... 109 NORMOSOL-R AND DEXTROSE ............................................ 109 NORMOSOL-R PH 7.4 .......................................................... 109 NORPACE (disopyramide phosphate) ................................... 77 NORPACE CR ......................................................................... 77 NORPRAMIN (desipramine hcl) ........................................... 136 NORTHERA ............................................................................ 72 nortriptyline hcl ................................................................... 136 NORVASC (amlodipine besylate) ........................................... 78 NORVIR .................................................................................. 68 NOURIANZ ............................................................................. 64 NOVAREL ............................................................................. 126 NOVAREL (chorionic gonadotropin) .................................... 126 NOXAFIL ................................................................................ 45 NOXAFIL (posaconazole) ....................................................... 45 NPLATE .................................................................................. 94 NUBEQA ................................................................................ 55 NUCALA ................................................................................. 31 NUCORT .............................................................................. 148 NUCYNTA .............................................................................. 20 NUCYNTA ER ......................................................................... 20 NUEDEXTA ............................................................................. 89 NULOJIX ............................................................................... 128 NUMOISYN .......................................................................... 153 NUPLAZID ............................................................................ 132 NUTRILIPID .......................................................................... 117 NUVARING (etonogestrel-ethinyl estradiol) ......................... 94

NUVESSA ............................................................................... 41 NUZYRA 100 MG VIAL ........................................................... 40 NUZYRA 150 MG TABLET ...................................................... 40 NYMALIZE .............................................................................. 78 nystatin ........................................................................... 46, 47 nystatin/triamcin .................................................................. 47

O

OBSTETRIX EC ...................................................................... 130 OBTREX DHA (obstetrix dha) ............................................... 130 OCALIVA .............................................................................. 116 OCREVUS ............................................................................... 90 octreotide acetate ............................................................... 125 OCUFLOX (ofloxacin) ............................................................. 33 ODACTRA .............................................................................. 74 ODEFSEY ................................................................................ 68 ODOMZO ............................................................................... 57 OFEV .................................................................................... 151 OFIRMEV ............................................................................... 15 ofloxacin ..................................................................... 32, 33, 40 ofloxacin (Ocuflox) ................................................................ 33 OGIVRI ................................................................................... 58 olanzapine ................................................................... 139, 141 olanzapine (Zyprexa) ........................................................... 139 olanzapine/fluoxetine hcl .................................................... 141 olanzapine/fluoxetine hcl (Symbyax) .................................. 141 olmesartan medoxomil 20 mg tab ........................................ 83 olmesartan medoxomil 40 mg tab ........................................ 83 olmesartan medoxomil 5 mg tab .......................................... 83 olmesartan/amlodipin/hcthiazid .......................................... 82 olmesartan-hctz 20-12.5 mg tab ........................................... 82 olmesartan-hctz 40-12.5 mg tab ........................................... 82 olmesartan-hctz 40-25 mg tab .............................................. 82 olopatadine 665 mcg nasal spry (Patanase) ....................... 102 olopatadine hcl 0.1% eye drops ............................................ 47 olopatadine hcl 0.2% eye drop .............................................. 47 OLUMIANT ............................................................................ 28 OLUX (clobetasol propionate) ............................................. 148 OLUX-E (tovet emollient) .................................................... 148 omega-3 acid ethyl esters (Lovaza) ..................................... 112 OMEGAVEN ......................................................................... 117 OMIDRIA ............................................................................. 104 OMNIPAQUE ......................................................................... 98 OMNISCAN ............................................................................ 98 ONCASPAR ............................................................................ 62 ondansetron ........................................................................ 114 ondansetron hcl .................................................................. 114 ondansetron hcl/pf .............................................................. 114 ONFI (clobazam) .................................................................... 90 ONIVYDE ................................................................................ 58 ONPATTRO .......................................................................... 154 OPANA (oxymorphone hcl) ................................................... 20 OPDIVO ................................................................................. 60 opium tincture ..................................................................... 113 opium/belladonna alkaloids .................................................. 20 OPSUMIT ............................................................................... 80 OPTIRAY 240 ......................................................................... 98 OPTIRAY 300 ......................................................................... 98

189

OPTIRAY 320 ......................................................................... 98 OPTIRAY 350 ......................................................................... 98 OPTISON ................................................................................ 97 ORABLOC ............................................................................... 24 ORACIT ................................................................................ 112 ORALAIR ................................................................................ 74 ORAMAGICRX ...................................................................... 153 ORAPRED ODT (prednisolone sodium phos odt) ................ 122 ORAVIG .................................................................................. 45 ORBACTIV .............................................................................. 37 ORENCIA 125 MG/ML SYRINGE ............................................. 27 ORENCIA 250 MG VIAL .......................................................... 27 ORENCIA 50 MG/0.4 ML SYRINGE ......................................... 27 ORENCIA 87.5 MG/0.7 ML SYRINGE ...................................... 27 ORENCIA CLICKJECT ............................................................... 27 ORENITRAM ER ..................................................................... 80 ORFADIN ............................................................................. 155 ORFADIN (nitisinone) .......................................................... 155 ORILISSA 150 MG TABLET ................................................... 123 ORILISSA 200 MG TABLET ................................................... 123 ORKAMBI 100 MG-125 MG TABLET .................................... 151 ORKAMBI 100-125 MG GRANULE PKT ................................ 151 ORKAMBI 150-188 MG GRANULE PKT ................................ 151 ORKAMBI 200 MG-125 MG TABLET .................................... 151 orphenadrine citrate ........................................................... 129 orphenadrine/aspirin/caffeine (Norgesic Forte) ................. 129 ORTHO MICRONOR (tulana) .................................................. 96 ORTHO-NOVUM (pirmella) ................................................... 96 ORTHOVISC ........................................................................... 27 oseltamivir 6 mg/ml suspension (Tamiflu) ............................ 69 oseltamivir phos 30 mg capsule (Tamiflu) ............................. 69 oseltamivir phos 45 mg capsule (Tamiflu) ............................. 69 oseltamivir phos 75 mg capsule (Tamiflu) ............................. 69 OSMITROL ........................................................................... 101 OSMITROL (mannitol) ......................................................... 101 OSMOLEX ER ......................................................................... 64 OSPHENA ............................................................................. 154 OTEZLA 28 DAY STARTER PACK ............................................. 26 OTEZLA 30 MG TABLET .......................................................... 26 OTOVEL ................................................................................. 32 OTREXUP ............................................................................... 26 OVACE PLUS ........................................................................ 144 OVIDE (malathion) ................................................................ 63 OVIDREL .............................................................................. 126 oxacillin in dextrose(iso-osm) ................................................ 39 oxacillin sodium ..................................................................... 39 oxaliplatin .............................................................................. 55 oxaprozin (Daypro) ................................................................ 29 OXAYDO ................................................................................ 20 oxazepam ............................................................................ 131 oxcarbazepine ....................................................................... 92 OXERVATE ........................................................................... 106 oxiconazole nitrate ................................................................ 47 OXSORALEN-ULTRA (methoxsalen) ..................................... 143 OXTELLAR XR ......................................................................... 92 oxybutynin chloride ............................................................. 161 oxycodone hcl .................................................................. 17, 21 oxycodone hcl/acetaminophen ............................................. 17

oxycodone hcl/acetaminophen (Percocet) ............................ 17 oxycodone hcl/aspirin ........................................................... 17 oxymorphone hcl ................................................................... 21 oxymorphone hcl (Opana) ..................................................... 21 oxytocin (Pitocin) ................................................................. 124 oxytocin/0.9 % sodium chloride .......................................... 124 oxytocin/ringer's lactate ..................................................... 124 OZEMPIC ............................................................................... 48 OZOBAX ............................................................................... 129 OZURDEX ............................................................................. 103

P

PACERONE 100 MG TABLET (amiodarone hcl) ...................... 77 pacerone 200 mg tablet ........................................................ 77 PACERONE 400 MG TABLET (amiodarone hcl) ...................... 77 paclitaxel ............................................................................... 62 PADCEV ................................................................................. 61 PAIN EASE MEDIUM STREAM SPRAY .................................... 26 paliperidone er 1.5 mg tablet (Invega) ................................ 139 paliperidone er 3 mg tablet (Invega) ................................... 139 paliperidone er 6 mg tablet (Invega) ................................... 139 paliperidone er 9 mg tablet (Invega) ................................... 139 palonosetron hcl .................................................................. 114 palonosetron hcl (Aloxi) ...................................................... 114 PALYNZIQ .............................................................................. 74 pamidronate disodium ........................................................ 158 PANCREAZE ......................................................................... 118 pancuronium bromide ........................................................... 73 PANDEL ............................................................................... 148 PANHEMATIN ...................................................................... 151 PANRETIN .............................................................................. 63 papaverine hcl ....................................................................... 86 PARAGARD T 380-A ............................................................... 96 paregoric ............................................................................. 113 PAREMYD ............................................................................ 105 paricalcitol 1 mcg capsule (Zemplar) .................................. 153 paricalcitol 10 mcg/2 ml vial ............................................... 153 paricalcitol 10 mcg/2 ml vial (Zemplar) .............................. 153 paricalcitol 2 mcg capsule (Zemplar) .................................. 153 paricalcitol 2 mcg/ml vial .................................................... 154 paricalcitol 2 mcg/ml vial (Zemplar) ................................... 154 paricalcitol 4 mcg capsule ................................................... 154 paricalcitol 5 mcg/ml vial .................................................... 154 paricalcitol 5 mcg/ml vial (Zemplar) ................................... 154 PARLODEL (bromocriptine mesylate) .................................... 64 paromomycin sulfate ............................................................ 51 paroxetine cr 12.5 mg tablet (Paxil CR) ............................... 133 paroxetine cr 25 mg tablet (Paxil CR) .................................. 133 paroxetine cr 37.5 mg tablet (Paxil CR) ............................... 133 paroxetine er 12.5 mg tablet (Paxil CR) .............................. 133 paroxetine er 25 mg tablet (Paxil CR) ................................. 133 paroxetine er 37.5 mg tablet (Paxil CR) .............................. 133 paroxetine hcl 10 mg tablet (Paxil) ..................................... 133 paroxetine hcl 20 mg tablet (Paxil) ..................................... 133 paroxetine hcl 30 mg tablet (Paxil) ..................................... 133 paroxetine hcl 40 mg tablet (Paxil) ..................................... 133 paroxetine mesylate (Brisdelle) ........................................... 156 PARSABIV ............................................................................ 153

190

PASER .................................................................................... 35 PATANASE (olopatadine hcl) ............................................... 102 PAXIL 10 MG TABLET (paroxetine hcl) ................................. 133 PAXIL 10 MG/5 ML SUSPENSION ......................................... 133 PAXIL 20 MG TABLET (paroxetine hcl) ................................. 133 PAXIL 30 MG TABLET (paroxetine hcl) ................................. 133 PAXIL 40 MG TABLET (paroxetine hcl) ................................. 133 PAXIL CR 12.5 MG TABLET (paroxetine er) .......................... 133 PAXIL CR 25 MG TABLET (paroxetine er) ............................. 134 PAXIL CR 37.5 MG TABLET (paroxetine er) .......................... 134 PEDIAPRED (prednisolone sodium phosphate) ................... 122 peg3350/sod sulf,bicarb,cl/kcl ............................................ 117 PEGANONE ............................................................................ 92 PEGASYS ................................................................................ 70 PEGINTRON ........................................................................... 70 pen g pot/dextrose-water ..................................................... 39 penicillamine ......................................................................... 26 penicillamine (Depen) ............................................................ 26 penicillin g potassium ............................................................ 39 penicillin g procaine .............................................................. 39 penicillin g sodium ................................................................. 39 penicillin v potassium ............................................................ 39 PENNSAID ............................................................................ 143 PENTAM 300 (pentamidine isethionate) ............................... 51 pentamidine isethionate (Nebupent) .................................... 52 pentamidine isethionate (Pentam 300) ................................. 52 PENTASA ............................................................................. 116 pentazocine hcl/naloxone hcl ................................................ 21 pentetate calcium trisodium ............................................... 157 pentetate zinc trisodium ..................................................... 157 pentobarbital sodium (Nembutal Sodium) .......................... 141 pentoxifylline ......................................................................... 76 PERCOCET (oxycodone-acetaminophen) .............................. 17 PERFOROMIST ....................................................................... 30 PERIKABIVEN ....................................................................... 108 perindopril erbumine ............................................................. 83 PERJETA ................................................................................. 58 permethrin (Elimite) .............................................................. 63 perphenazine ............................................................... 135, 141 perphenazine/amitriptyline hcl ........................................... 135 PERSERIS .............................................................................. 139 PERTZYE ............................................................................... 118 PH 12 DILUENT FOR FLOLAN (diluent for epoprostenol) .... 155 phenazopyridine hcl (Pyridium) ............................................. 26 phenelzine sulfate (Nardil) .................................................. 131 PHENERGAN (promethazine hcl) ........................................... 47 phenobarb/hyoscy/atropine/scop (Donnatal) .................... 115 phenobarbital ...................................................................... 142 phenobarbital sodium ......................................................... 142 phenoxybenzamine hcl (Dibenzyline) .................................... 72 phentolamine mesylate ......................................................... 72 phenylephrine hcl .................................................... 47, 80, 104 phenylephrine hcl (Vazculep) ................................................ 80 phenylephrine hcl in 0.9% nacl .............................................. 80 phenylephrine hcl/prometh hcl ............................................. 47 PHENYTEK (phenytoin sodium extended) ............................. 92 phenytoin .............................................................................. 92 phenytoin (Dilantin) .............................................................. 92

phenytoin (Dilantin-125) ....................................................... 92 phenytoin sodium .................................................................. 92 phenytoin sodium extended (Dilantin) .................................. 92 phenytoin sodium extended (Phenytek) ................................ 92 PHOSLYRA ........................................................................... 109 PHOSPHOLINE IODIDE ......................................................... 105 PHOTOFRIN ........................................................................... 62 PHYSICIANS EZ USE B-12 (b-12 compliance) ....................... 162 PHYSIOLYTE ......................................................................... 143 PHYSIOSOL .......................................................................... 143 physostigmine salicylate ....................................................... 71 phytonadione (vit k1) .......................................................... 162 phytonadione (vit k1) (Mephyton) ...................................... 162 PICATO .................................................................................. 63 PIFELTRO ............................................................................... 67 pilocarpine hcl (Isopto Carpine) .......................................... 105 pilocarpine hcl (Salagen) ....................................................... 73 pimecrolimus (Elidel) ........................................................... 127 pimozide .............................................................................. 138 pindolol ................................................................................. 84 pioglitazone hcl (Actos) ......................................................... 49 pioglitazone hcl/glimepiride (Duetact) .................................. 49 pioglitazone hcl/metformin hcl (Actoplus MET) .................... 49 piperacillin sodium/tazobactam ........................................... 39 piperacillin sodium/tazobactam (Zosyn) ............................... 39 PIQRAY .................................................................................. 60 piroxicam (Feldene) ............................................................... 29 PITOCIN (oxytocin) .............................................................. 124 PLAQUENIL (hydroxychloroquine sulfate) ............................ 51 PLASMA-LYTE 148 ............................................................... 109 PLASMA-LYTE A PH 7.4 ........................................................ 109 PLAVIX (clopidogrel) .............................................................. 66 PLEGISOL (cardioplegic) ........................................................ 79 PLEGRIDY ............................................................................... 90 PLEGRIDY PEN ....................................................................... 90 plenamine 15% solution ...................................................... 108 PLENAMINE 15% SOLUTION ................................................ 108 pnv 66/iron/folic/docusate/dha .......................................... 130 pnv 69/iron/folic/docusate/dha .......................................... 130 pnv 80/iron fum/folic/dss/dha ............................................ 130 pnv/ferrous fum/docusate/folic .......................................... 130 pnv/iron,carb/docusat/folic ac ........................................... 130 podofilox ............................................................................. 145 podophyllum resin ............................................................... 145 POLIVY ................................................................................... 61 polymyxin b sulf/trimethoprim (Polytrim) ............................. 33 polymyxin b sulfate ............................................................... 39 POLYTRIM (polymyxin b sul-trimethoprim) .......................... 33 POMALYST ............................................................................. 59 PORTRAZZA ........................................................................... 58 posaconazole (Noxafil) .......................................................... 45 potassium acetate ............................................................... 111 potassium bicarbonate/cit ac ............................................. 111 potassium chloride .............................................................. 111 potassium chloride (K-Tab ER) ............................................ 111 potassium chloride in 0.9%nacl ........................................... 111 potassium chloride in d5w .................................................. 111 potassium chloride in lr-d5 .................................................. 111

191

potassium chloride in water ................................................ 111 potassium chloride/d5-0.2%nacl ......................................... 111 potassium chloride/d5-0.45nacl .......................................... 111 potassium chloride/d5-0.9%nacl ......................................... 111 potassium chloride-0.45% nacl ........................................... 111 potassium citrate (Urocit-K) ................................................ 112 potassium citrate/citric acid ................................................ 112 potassium cl/lido/0.9 % nacl ............................................... 111 potassium iodide ................................................................. 110 potassium iodide/iodine ...................................................... 110 potassium phos,m-basic-d-basic ......................................... 110 POTELIGEO ............................................................................ 61 PRADAXA ............................................................................... 44 pralidoxime chloride ............................................................ 155 pramipexole di-hcl (Mirapex) ................................................ 65 pramipexole er 0.375 mg tablet (Mirapex ER) ...................... 65 pramipexole er 0.75 mg tablet (Mirapex ER) ........................ 65 pramipexole er 1.5 mg tablet (Mirapex ER) .......................... 65 pramipexole er 2.25 mg tablet (Mirapex ER) ........................ 65 pramipexole er 3 mg tablet (Mirapex ER) ............................. 65 pramipexole er 3.75 mg tablet (Mirapex ER) ........................ 65 pramipexole er 4.5 mg tablet (Mirapex ER) .......................... 65 PRAMOSONE ....................................................................... 148 PRAMOSONE (hydrocortisone-pramoxine) ......................... 148 prasugrel hcl (Effient) ............................................................ 66 pravastatin sodium ............................................................... 87 PRAXBIND .............................................................................. 75 praziquantel (Biltricide) ......................................................... 51 prazosin hcl (Minipress) ........................................................ 82 PRECEDEX (dexmedetomidine hcl) ..................................... 142 PRECEDEX (dexmedetomidine-0.9% nacl) .......................... 142 PRECOSE (acarbose) .............................................................. 48 PRED FORTE (prednisolone acetate) ................................... 103 PRED MILD .......................................................................... 103 PRED-G .................................................................................. 32 prednicarbate ...................................................................... 148 prednisolone ................................................................ 103, 123 prednisolone acetate (Pred Forte) ....................................... 103 prednisolone sodium phosphate ................................. 103, 123 prednisolone sodium phosphate (Orapred ODT) ................. 123 prednisolone sodium phosphate (Pediapred) ...................... 123 prednisone ........................................................................... 123 PREFEST ............................................................................... 121 pregabalin ............................................................................. 92 pregabalin (Lyrica) ................................................................ 92 PREGNYL (chorionic gonadotropin) ..................................... 126 PREMARIN ................................................................... 121, 125 PREMASOL .......................................................................... 108 PREMPHASE ........................................................................ 121 PREMPRO ............................................................................ 121 prenat 115/iron fum/folic/dss ............................................. 130 prenatal 12/iron/folic/dss/om3 (Obtrex DHA) .................... 130 prenatal vit/iron bisgly/folic ................................................ 130 prenatal vits15/iron/folic/dss .............................................. 130 PREPIDIL .............................................................................. 124 PREPOPIK ............................................................................ 117 PRESTALIA 14 MG-10 MG TABLET ......................................... 81 PRESTALIA 3.5 MG-2.5 MG TABLET ....................................... 81

PRESTALIA 7 MG-5 MG TABLET ............................................. 81 PRETOMANID ........................................................................ 35 PREVIDENT .......................................................................... 107 PREVIDENT (sodium fluoride) ............................................. 107 PREVIDENT 5000 ................................................................. 107 PREVIDENT 5000 ENAMEL PROTECT ................................... 107 PREVIDENT 5000 PLUS (sodium fluoride 5000 plus) ........... 107 PREVIDENT 5000 SENSITIVE ................................................ 107 PREVYMIS 240 MG TABLET ................................................... 69 PREVYMIS 240 MG/12 ML VIAL ............................................ 69 PREVYMIS 480 MG TABLET ................................................... 69 PREVYMIS 480 MG/24 ML VIAL ............................................ 69 PREZCOBIX ............................................................................ 67 PREZISTA ............................................................................... 67 PRIALT ................................................................................... 15 PRIFTIN .................................................................................. 35 primaquine phosphate .......................................................... 51 PRIMAXIN (imipenem-cilastatin sodium) .............................. 35 primidone .............................................................................. 92 PRIMSOL ................................................................................ 34 PRISMASOL ......................................................................... 112 PROAIR HFA (albuterol sulfate hfa) ....................................... 30 PROAIR RESPICLICK ............................................................... 30 probenecid ............................................................................ 29 probenecid/colchicine ........................................................... 29 PROBUPHINE ....................................................................... 160 procainamide hcl ................................................................... 77 PROCALAMINE .................................................................... 108 PROCARDIA (nifedipine) ........................................................ 78 PROCARDIA XL (nifedipine er) ............................................... 78 PRO-C-DURE 5 (p-care k80) ................................................. 123 PRO-C-DURE 6 ..................................................................... 123 prochlorperazine ................................................................. 114 prochlorperazine edisylate .................................................. 114 prochlorperazine maleate ................................................... 114 PROCORT ............................................................................. 118 PROCRIT ................................................................................ 93 PROCTOFOAM-HC ............................................................... 118 PROCYSBI DR 25 MG CAPSULE ............................................ 160 PROCYSBI DR 300 MG GRANULE PKT .................................. 160 PROCYSBI DR 75 MG CAPSULE ............................................ 160 PROCYSBI DR 75 MG GRANULE PKT .................................... 160 PROFILNINE ........................................................................... 75 progesterone 100 mg capsule (Prometrium) ...................... 124 progesterone 200 mg capsule (Prometrium) ...................... 124 progesterone 500 mg/10 ml vial ......................................... 124 PROGLYCEM ........................................................................ 107 PROGRAF 0.2 MG GRANULE PACKET .................................. 128 PROGRAF 0.5 MG CAPSULE (tacrolimus) ............................ 128 PROGRAF 1 MG CAPSULE (tacrolimus) ............................... 128 PROGRAF 1 MG GRANULE PACKET ..................................... 128 PROGRAF 5 MG CAPSULE (tacrolimus) ............................... 128 PROGRAF 5 MG/ML AMPULE .............................................. 128 PROHANCE ............................................................................ 98 PROHANCE MULTIPACK ........................................................ 98 PROLASTIN C ....................................................................... 151 PROLENSA ........................................................................... 103 PROLEUKIN ............................................................................ 62

192

PROLIA ................................................................................. 158 PROMACTA ............................................................................ 94 promethazine hcl ..................................................... 47, 97, 114 promethazine hcl (Phenergan) .............................................. 47 promethazine hcl/codeine ..................................................... 97 promethazine/dextromethorphan ........................................ 96 promethazine/phenyleph/codeine ........................................ 96 PROMETRIUM (progesterone) ............................................ 124 PROMISEB ........................................................................... 144 propafenone hcl .................................................................... 77 propafenone hcl (Rythmol Sr) ................................................ 77 propantheline bromide ........................................................ 113 proparacaine hcl (Alcaine) .................................................. 104 proparacaine/fluorescein sod (Flucaine) ............................. 104 propofol (Diprivan) ................................................................ 22 propranolol hcl ................................................................ 84, 85 propranolol hcl (Inderal LA) ................................................... 85 propranolol/hydrochlorothiazid ............................................ 85 propylthiouracil ................................................................... 149 PROSCAR (finasteride) ......................................................... 160 PROSOL ............................................................................... 108 PROSTIN E2 VAGINAL SUPPOSITORY ................................... 124 PROSTIN VR PEDIATRIC ......................................................... 85 protamine sulfate .................................................................. 74 protectives2/ceramide 1,3,6-11 .......................................... 145 PROTOPAM CHLORIDE ........................................................ 155 PROTOPIC (tacrolimus) ........................................................ 127 protriptyline hcl ................................................................... 136 PROVAYBLUE ....................................................................... 154 PROVERA (medroxyprogesterone acetate) ......................... 124 PROVOCHOLINE .................................................................... 98 PROZAC 10 MG PULVULE (fluoxetine hcl) ........................... 134 PROZAC 20 MG PULVULE (fluoxetine hcl) ........................... 134 PROZAC 40 MG PULVULE (fluoxetine hcl) ........................... 134 PULMICORT (budesonide) ..................................................... 31 PULMOZYME ....................................................................... 151 PURIXAN ................................................................................ 56 pyrazinamide ......................................................................... 35 PYRIDIUM (phenazopyridine hcl) .......................................... 26 pyridostigmine bromide (Mestinon) ...................................... 71 pyridoxine hcl (vitamin b6) .................................................. 162

Q

QBRELIS ................................................................................. 83 QMIIZ ODT 15 MG TABLET .................................................... 29 QMIIZ ODT 7.5 MG TABLET ................................................... 29 QUADRAMET ....................................................................... 152 QUALAQUIN (quinine sulfate) ............................................... 51 QUARTETTE (rivelsa) ............................................................. 96 quazepam (Doral) ................................................................ 142 QUELICIN (succinylcholine chloride) ..................................... 73 QUESTRAN (cholestyramine) ................................................ 87 QUESTRAN LIGHT (prevalite) ................................................ 87 quetiapine fumarate (Seroquel XR) ..................................... 139 quetiapine fumarate (Seroquel) .......................................... 139 QUILLIVANT XR .................................................................... 137 quinapril hcl ........................................................................... 83 quinapril/hydrochlorothiazide ............................................... 81

quinidine gluconate ............................................................... 77 quinidine sulfate .................................................................... 77 quinine sulfate (Qualaquin) ................................................... 51 QUTENZA ............................................................................. 145 QVAR REDIHALER .................................................................. 31

R

RADIAPLEXRX ...................................................................... 145 RADICAVA ............................................................................. 89 RADIOGARDASE .................................................................. 157 RAGWITEK ............................................................................. 74 raloxifene hcl (Evista) .......................................................... 158 ramelteon (Rozerem) .......................................................... 142 ramipril .................................................................................. 83 RANEXA (ranolazine er) ......................................................... 76 ranitidine hcl ....................................................................... 116 ranolazine (Ranexa) .............................................................. 76 RAPAFLO 4 MG CAPSULE (silodosin) ................................... 160 RAPAFLO 8 MG CAPSULE (silodosin) ................................... 160 RAPAMUNE (sirolimus) ....................................................... 128 RAPIVAB ................................................................................ 69 rasagiline mesylate 0.5 mg tab (Azilect) ............................... 65 rasagiline mesylate 1 mg tab (Azilect) .................................. 65 RASUVO ................................................................................. 26 RAVICTI ................................................................................ 113 RAYALDEE ............................................................................ 154 RAZADYNE (galantamine hbr) ............................................... 71 RAZADYNE ER 16 MG CAPSULE (galantamine er) ................. 71 RAZADYNE ER 24 MG CAPSULE (galantamine er) ................. 71 RAZADYNE ER 8 MG CAPSULE (galantamine er) ................... 71 READI-CAT 2 .......................................................................... 99 REBIF ..................................................................................... 90 REBIF REBIDOSE .................................................................... 90 REBLOZYL ............................................................................ 151 RECARBRIO ............................................................................ 35 RECLAST (zoledronic acid) ................................................... 158 RECOTHROM ......................................................................... 75 RECTIV ................................................................................. 117 REGLAN (metoclopramide hcl) ............................................ 117 REGONOL .............................................................................. 71 REGRANEX ........................................................................... 144 RELENZA ................................................................................ 69 RELISTOR ............................................................................... 45 RELPAX (eletriptan hbr) ......................................................... 16 REMERON (mirtazapine) ..................................................... 130 REMICADE ............................................................................. 52 remifentanil hcl (Ultiva) ........................................................ 18 REMODULIN (treprostinil) ..................................................... 80 RENACIDIN .......................................................................... 112 RENAGEL (sevelamer hcl) .................................................... 109 RENFLEXIS ............................................................................. 53 RENVELA (sevelamer carbonate) ........................................ 109 repaglinide ............................................................................ 49 REPATHA PUSHTRONEX ........................................................ 87 REPATHA SURECLICK ............................................................. 87 REPATHA SYRINGE ................................................................ 87 RESECTISOL ......................................................................... 101 RESTASIS .............................................................................. 106

193

RESTASIS MULTIDOSE ......................................................... 106 RETACRIT ............................................................................... 93 RETAVASE .............................................................................. 76 RETROVIR .............................................................................. 67 REVATIO (sildenafil citrate) ................................................... 80 REVCOVI .............................................................................. 157 REVLIMID ............................................................................... 59 REXULTI 0.25 MG TABLET .................................................... 140 REXULTI 0.5 MG TABLET ...................................................... 140 REXULTI 1 MG TABLET ......................................................... 140 REXULTI 2 MG TABLET ......................................................... 140 REXULTI 3 MG TABLET ......................................................... 140 REXULTI 4 MG TABLET ......................................................... 140 REYATAZ ................................................................................ 68 R-GENE 10 ............................................................................. 99 RHOGAM ULTRA-FILTERED PLUS .......................................... 74 RHOPHYLAC ........................................................................... 74 RHOPRESSA ......................................................................... 105 RIASTAP ................................................................................. 74 ribavirin ................................................................................. 70 RIDAURA ................................................................................ 27 rifabutin ................................................................................. 35 RIFADIN (rifampin) ................................................................ 35 RIFAMATE .............................................................................. 35 rifampin (Rifadin) .................................................................. 35 RIFATER ................................................................................. 35 RILUTEK (riluzole) .................................................................. 89 riluzole (Rilutek) .................................................................... 89 rimantadine hcl ..................................................................... 69 RIMSO-50 .............................................................................. 21 RINVOQ ER ............................................................................ 28 RIOMET (metformin hcl) ....................................................... 48 RIOMET ER ............................................................................ 48 risedronate sodium ............................................................. 159 risedronate sodium (Actonel) .............................................. 159 risedronate sodium (Atelvia) ............................................... 159 RISPERDAL (risperidone) ..................................................... 139 RISPERDAL CONSTA ............................................................. 139 risperidone .......................................................................... 139 risperidone (Risperdal) ........................................................ 139 RITALIN (methylphenidate hcl) ........................................... 137 ritonavir ................................................................................. 68 RITUXAN ................................................................................ 53 RITUXAN HYCELA ................................................................... 53 rivastigmine (Exelon) ............................................................. 71 rivastigmine tartrate ............................................................. 71 rizatriptan benzoate .............................................................. 16 rizatriptan benzoate (Maxalt MLT) ....................................... 16 rizatriptan benzoate (Maxalt) ............................................... 16 ROBAXIN (methocarbamol) ................................................. 130 ROBAXIN-750 (methocarbamol) ......................................... 130 ROCALTROL (calcitriol) ........................................................ 162 ROCKLATAN ......................................................................... 105 rocuronium bromide ............................................................. 73 romidepsin (Istodax) ............................................................. 54 ropinirole hcl ......................................................................... 65 ropivacaine 0.2% 20 mg/10 ml (Naropin) ............................. 24 ropivacaine 0.2% 200 mg/100 ml (Naropin) ......................... 24

ropivacaine 0.2% 40 mg/20 ml (Naropin) ............................. 24 ropivacaine 0.2% 400 mg/200 ml (Naropin) ......................... 24 ropivacaine 0.5% 100 mg/20 ml (Naropin) ........................... 24 ROPIVACAINE 0.5% 1000 MG/200ML ................................... 24 ropivacaine 0.5% 150 mg/30 ml (Naropin) ........................... 24 ROPIVACAINE 0.5% 500 MG/100 ML .................................... 24 ropivacaine 0.75% 150 mg/20 ml (Naropin) ......................... 24 ropivacaine 1% 100 mg/10 ml vl (Naropin) ........................... 24 ropivacaine 1% 200 mg/20 ml vl (Naropin) ........................... 24 ropivacaine hcl 0.5% syringe ................................................. 25 ropivacaine in 0.9% sod chl/pf .............................................. 25 ropivacaine/epi/clonidine/ket ............................................... 25 rosadan 0.75% cream (Metrocream) .................................. 146 ROSADAN 0.75% CREAM KIT ............................................... 146 rosadan 0.75% gel ............................................................... 146 ROSADAN 0.75% GEL KIT .................................................... 146 rosuvastatin calcium 10 mg tab ............................................ 87 rosuvastatin calcium 20 mg tab ............................................ 87 rosuvastatin calcium 40 mg tab ............................................ 87 rosuvastatin calcium 5 mg tab .............................................. 87 ROZEREM (ramelteon) ........................................................ 142 ROZLYTREK ............................................................................ 60 RUBRACA ............................................................................... 60 RUCONEST ........................................................................... 152 RUXIENCE .............................................................................. 54 RUZURGI ................................................................................ 90 RYANODEX .......................................................................... 130 RYBELSUS .............................................................................. 48 RYCLORA (dexchlorpheniramine maleate) ............................ 47 RYDAPT ................................................................................. 60 RYTARY .................................................................................. 65 RYTHMOL SR (propafenone hcl er) ....................................... 77

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SAFYRAL (tydemy) ................................................................. 96 SALAGEN (pilocarpine hcl) .................................................... 73 salicylic acid ........................................................................ 145 salicylic acid (Keralyt) .......................................................... 145 salicylic acid (Salvax) ........................................................... 145 salicylic acid/ceramide comb 1 ........................................... 145 salsalate ................................................................................ 26 SALVAX (salicylic acid) ......................................................... 145 SALVAX DUO PLUS .............................................................. 145 SAMSCA ............................................................................... 100 SANCUSO ............................................................................. 114 SANDIMMUNE 100 MG CAPSULE (cyclosporine) ................ 128 SANDIMMUNE 100 MG/ML SOLN ....................................... 128 SANDIMMUNE 25 MG CAPSULE (cyclosporine) .................. 128 SANDIMMUNE 50 MG/ML AMPUL (cyclosporine) .............. 128 SANDOSTATIN 0.05 MG/ML AMPUL ................................... 125 SANDOSTATIN 0.1 MG/ML AMPUL ..................................... 125 SANDOSTATIN 0.5 MG/ML AMPUL ..................................... 125 SANDOSTATIN LAR DEPOT .................................................. 125 SANTYL ................................................................................ 149 SAPHRIS ............................................................................... 139 SARAFEM ............................................................................. 134 SARAFEM (fluoxetine hcl) ................................................... 134 SAVAYSA 15 MG TABLET ....................................................... 43

194

SAVAYSA 30 MG TABLET ....................................................... 43 SAVAYSA 60 MG TABLET ....................................................... 43 SAVELLA .............................................................................. 159 SCALACORT DK .................................................................... 148 SCLEROSOL .......................................................................... 152 scopolamine (Transderm-Scop) ........................................... 114 SEASONIQUE (simpesse) ....................................................... 96 SECONAL SODIUM ............................................................... 142 SECUADO ............................................................................. 139 SEGLUROMET ........................................................................ 50 selegiline hcl .......................................................................... 65 selenium ...................................................................... 110, 144 selenium sulfide ................................................................... 144 SELZENTRY ............................................................................. 67 SEMPREX-D ........................................................................... 47 SENSIPAR (cinacalcet hcl) .................................................... 153 SENSORC MPF 0.75%-EPI 1200000 ....................................... 25 SENSORCAINE (bupivacaine hcl) ........................................... 25 sensorcaine-mpf 0.25% vial (Sensorcaine-mpf) ..................... 25 SENSORCAINE-MPF 0.25% VIAL (sensorcaine-mpf) .............. 25 sensorcaine-mpf 0.5% vial (Sensorcaine-mpf) ....................... 25 SENSORCAINE-MPF 0.5% VIAL (sensorcaine-mpf) ................ 25 SENSORCAINE-MPF 0.75% VIAL (bupivacaine hcl) ................ 25 sensorc-mpf 0.25%-epi 1200000 (Marcaine-epinephrine) .... 25 SENSORCN-MPF 0.5%-EPI 1200000

(bupivacaine hcl-epinephrine) .......................................... 25 SEREVENT DISKUS ................................................................. 30 SEROQUEL (quetiapine fumarate) ....................................... 139 SEROQUEL XR (quetiapine fumarate er) ............................. 139 SEROSTIM ............................................................................ 123 sertraline 20 mg/ml oral conc (Zoloft) ................................ 134 sertraline hcl 100 mg tablet (Zoloft) .................................... 134 sertraline hcl 25 mg tablet (Zoloft) ...................................... 134 sertraline hcl 50 mg tablet (Zoloft) ...................................... 134 sevelamer carbonate (Renvela) ........................................... 109 sevelamer hcl ...................................................................... 109 sevelamer hcl (Renagel) ...................................................... 109 sevoflurane (Ultane) .............................................................. 22 SFROWASA (mesalamine) ................................................... 116 SIGNIFOR ............................................................................. 125 SIGNIFOR LAR ...................................................................... 125 SIKLOS ................................................................................... 75 sildenafil citrate (Revatio) ..................................................... 80 SILENOR 3 MG TABLET (doxepin hcl) .................................. 142 SILENOR 6 MG TABLET (doxepin hcl) .................................. 142 silodosin 4 mg capsule (Rapaflo) ......................................... 160 silodosin 8 mg capsule (Rapaflo) ......................................... 160 SILVADENE (ssd) .................................................................... 42 silver nitrate ................................................................ 145, 149 silver nitrate applicator ....................................................... 145 silver sulfadiazine (Silvadene) ............................................... 42 SIMBRINZA .......................................................................... 105 SIMPONI 100 MG/ML PEN INJECTOR .................................... 53 SIMPONI 100 MG/ML SYRINGE ............................................. 53 SIMPONI ARIA ....................................................................... 53 SIMULECT ............................................................................ 127 simvastatin 10 mg tablet ...................................................... 87 simvastatin 20 mg tablet ...................................................... 87

simvastatin 40 mg tablet ...................................................... 87 simvastatin 5 mg tablet ........................................................ 87 simvastatin 80 mg tablet ...................................................... 87 SINEMET 10-100 (carbidopa-levodopa) ................................ 65 SINEMET 25-100 (carbidopa-levodopa) ................................ 65 SINEMET 25-250 (carbidopa-levodopa) ................................ 65 SINEMET CR (carbidopa-levodopa er) ................................... 65 SINGULAIR (montelukast sodium) ........................................ 31 SINUVA ................................................................................ 102 sirolimus (Rapamune) ......................................................... 128 SIRTURO ................................................................................ 35 SITZMARKS ............................................................................ 99 SIVEXTRO 200 MG TABLET .................................................... 38 SIVEXTRO 200 MG VIAL ......................................................... 38 SKELAXIN (metaxalone) ....................................................... 130 SKLICE .................................................................................... 63 SKYLA ..................................................................................... 96 SLYND .................................................................................... 96 SMOFLIPID .......................................................................... 117 sod phosphate,monobasic-dibas ......................................... 110 sodium acetate .................................................................... 107 sodium benzoate/sod phenylacet (Ammonul) .................... 113 sodium bicarbonate ............................................................ 107 sodium bicarbonate in d5w ................................................. 107 sodium chloride ............................................ 111, 117, 143, 156 sodium chloride 0.45 % ....................................................... 111 sodium chloride 0.9 % (flush) .............................................. 111 sodium chloride 3 % ............................................................ 111 sodium chloride 5 % ............................................................ 111 sodium chloride for inhalation ............................................ 156 sodium chloride for inhalation (Hyper-Sal) ......................... 156 sodium chloride irrig solution .............................................. 143 sodium chloride/nahco3/kcl/peg ........................................ 117 sodium citrate ....................................................................... 43 SODIUM DIURIL (chlorothiazide sodium) ............................ 102 SODIUM EDECRIN (ethacrynate sodium) ............................ 101 sodium ferric gluconat/sucrose (Ferrlecit) .......................... 110 sodium nitrite ...................................................................... 155 sodium phenylbutyrate (Buphenyl) ..................................... 113 sodium polystyrene sulfon/sorb .......................................... 109 sodium polystyrene sulfonate ............................................. 109 sodium tetradecyl sulfate (Sotradecol) ................................. 88 sodium thiosulfate ........................................................ 47, 157 sodium thiosulfate/sal acid ................................................... 47 SOFOSBUVIR-VELPATASVIR ................................................... 69 solifenacin 10 mg tablet ...................................................... 161 solifenacin 5 mg tablet ........................................................ 161 SOLIQUA 100-33 .................................................................... 48 SOLIRIS .................................................................................. 75 SOLOSEC ................................................................................ 33 SOLTAMOX ............................................................................ 62 SOLU-CORTEF ...................................................................... 123 SOLU-MEDROL .................................................................... 123 SOLU-MEDROL (methylprednisolone sodium succ) ............ 123 SOMA (carisoprodol) ........................................................... 130 SOMATULINE DEPOT ........................................................... 125 SOMAVERT .......................................................................... 153 SOOLANTRA (ivermectin) .................................................... 146

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sorbitol solution ................................................................... 143 sotalol hcl .............................................................................. 85 sotalol hcl (Betapace AF) ....................................................... 85 SOTRADECOL ......................................................................... 88 SOTRADECOL (sodium tetradecyl sulfate) ............................. 88 SOTYLIZE ................................................................................ 85 SOVALDI 200 MG TABLET ...................................................... 69 SOVALDI 400 MG TABLET ...................................................... 69 SPECTRACEF (cefditoren pivoxil) ........................................... 36 spinosad (Natroba) ................................................................ 63 SPINRAZA ............................................................................ 156 spironolact/hydrochlorothiazid (Aldactazide) ..................... 101 spironolactone (Aldactone) ................................................. 101 SPRAVATO ........................................................................... 131 SPRITAM ................................................................................ 93 SPRYCEL ................................................................................. 60 sps 15 gm/60 ml suspension ............................................... 109 SPS 30 GM/120 ML ENEMA SUSP ....................................... 109 STALEVO 100 (carbidopa-levodopa-entacapone) ................. 65 STALEVO 125 (carbidopa-levodopa-entacapone) ................. 65 STALEVO 150 (carbidopa-levodopa-entacapone) ................. 65 STALEVO 200 (carbidopa-levodopa-entacapone) ................. 65 STALEVO 50 (carbidopa-levodopa-entacapone) ................... 65 STALEVO 75 (carbidopa-levodopa-entacapone) ................... 65 STARLIX (nateglinide) ............................................................ 49 STEGLATRO ............................................................................ 48 STELARA 130 MG/26 ML VIAL ............................................. 127 STELARA 45 MG/0.5 ML SYRINGE ....................................... 127 STELARA 45 MG/0.5 ML VIAL .............................................. 127 STELARA 90 MG/ML SYRINGE ............................................. 127 STERITALC ............................................................................ 152 STIMATE .............................................................................. 120 STIVARGA .............................................................................. 60 STRATTERA 10 MG CAPSULE (atomoxetine hcl) .................. 137 STRATTERA 100 MG CAPSULE (atomoxetine hcl) ................ 137 STRATTERA 18 MG CAPSULE (atomoxetine hcl) .................. 138 STRATTERA 25 MG CAPSULE (atomoxetine hcl) .................. 138 STRATTERA 40 MG CAPSULE (atomoxetine hcl) .................. 138 STRATTERA 60 MG CAPSULE (atomoxetine hcl) .................. 138 STRATTERA 80 MG CAPSULE (atomoxetine hcl) .................. 138 STRENSIQ ............................................................................ 156 streptomycin sulfate .............................................................. 34 STRIANT ............................................................................... 119 STRIBILD ................................................................................ 68 STROMECTOL (ivermectin) .................................................... 51 SUBLOCADE ......................................................................... 160 SUBOXONE (buprenorphine-naloxone) .............................. 160 succinylcholine chloride ......................................................... 73 succinylcholine chloride (Quelicin) ........................................ 73 succinylcholine/sod clr,iso/pf ................................................ 73 SUCRAID .............................................................................. 116 sucralfate (Carafate) ........................................................... 115 sufentanil citrate ................................................................... 18 SULAR (nisoldipine) ............................................................... 78 sulfacetamide sod/sulfur/urea .............................................. 42 sulfacetamide sodium ............................................. 32, 42, 144 sulfacetamide sodium (Bleph-10) .......................................... 32 sulfacetamide sodium (Klaron) ........................................... 144

sulfacetamide sodium/sulfur ................................................ 42 sulfacetamide/prednisolone sp ............................................. 32 sulfacetamide/sulfur/cleansr23 ............................................ 42 sulfadiazine ........................................................................... 33 sulfamethoxazole/trimethoprim ........................................... 33 sulfamethoxazole/trimethoprim (Bactrim DS) ...................... 33 sulfamethoxazole/trimethoprim (Bactrim) ........................... 33 sulfamethoxazole/trimethoprim (Sulfatrim) ......................... 33 SULFAMYLON ........................................................................ 43 SULFAMYLON (mafenide acetate) ........................................ 43 sulfasalazine (Azulfidine) ..................................................... 116 SULFATRIM (sulfamethoxazole-trimethoprim) ..................... 33 sulindac ................................................................................. 29 sumatriptan ........................................................................... 16 sumatriptan 4 mg/0.5 ml cart ............................................... 16 sumatriptan 4 mg/0.5 ml inject ............................................ 16 sumatriptan 6 mg/0.5 ml inject ............................................ 16 sumatriptan 6 mg/0.5 ml refill .............................................. 16 sumatriptan 6 mg/0.5 ml syrng ............................................ 16 sumatriptan 6 mg/0.5 ml vial ................................................ 16 sumatriptan succ 100 mg tablet ........................................... 16 sumatriptan succ 25 mg tablet ............................................. 16 sumatriptan succ 50 mg tablet ............................................. 16 sumatriptan succ/naproxen sod ............................................ 16 SUNOSI ................................................................................ 141 SUPPRELIN LA ...................................................................... 123 SUPRANE (desflurane) ........................................................... 22 SUPRAX ................................................................................. 36 SUPRAX (cefixime) ................................................................. 36 SUPREP ................................................................................ 117 SURVANTA .......................................................................... 151 SUSTOL ................................................................................ 114 SUTENT .................................................................................. 60 SWABFLUSH ........................................................................ 111 SYLATRON ............................................................................. 59 SYLVANT ................................................................................ 60 SYMAX DUOTAB .................................................................. 115 SYMBICORT ........................................................................... 30 SYMBYAX (olanzapine-fluoxetine hcl) ................................. 141 SYMDEKO ............................................................................ 151 SYMFI .................................................................................... 68 SYMFI LO ............................................................................... 68 SYMLINPEN 120 .................................................................... 48 SYMLINPEN 60 ...................................................................... 48 SYMPROIC ............................................................................. 45 SYMTUZA ............................................................................... 66 SYNAGIS ................................................................................ 68 SYNALAR .............................................................................. 148 SYNALAR (fluocinolone acetonide) ..................................... 148 SYNALAR TS ......................................................................... 148 SYNAREL .............................................................................. 123 SYNERA .................................................................................. 26 SYNERCID .............................................................................. 40 SYNJARDY .............................................................................. 50 SYNJARDY XR 10-1,000 MG TABLET ...................................... 50 SYNJARDY XR 12.5-1,000 MG TAB ......................................... 50 SYNJARDY XR 25-1,000 MG TABLET ...................................... 50 SYNJARDY XR 5-1,000 MG TABLET ........................................ 50

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SYNRIBO ................................................................................ 62 SYNTHAMIN 17 WITHOUT ELTYE ........................................ 108 SYNTHROID (levothyroxine sodium) ................................... 150 SYNTHROID (levoxyl) ........................................................... 150 SYNTHROID (unithroid) ....................................................... 150 SYNVISC ................................................................................. 27 SYNVISC-ONE ......................................................................... 27 SYRINGE AVITENE .................................................................. 75

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TABLOID ................................................................................ 56 TACHOSIL .............................................................................. 75 tacrolimus 0.03% ointment (Protopic) ................................ 127 tacrolimus 0.1% ointment (Protopic) .................................. 127 tacrolimus 0.5 mg capsule (Prograf) ................................... 129 tacrolimus 1 mg capsule (Prograf) ...................................... 129 tacrolimus 5 mg capsule (Prograf) ...................................... 129 tadalafil (Adcirca) .................................................................. 80 TAFINLAR ............................................................................... 57 TAGITOL ................................................................................ 99 TAGRISSO .............................................................................. 60 TAKHZYRO ............................................................................. 74 talc ...................................................................................... 152 TALICIA ................................................................................ 115 TALTZ AUTOINJECTOR ......................................................... 143 TALTZ AUTOINJECTOR (2 PACK) .......................................... 143 TALTZ AUTOINJECTOR (3 PACK) .......................................... 143 TALTZ SYRINGE .................................................................... 143 TALZENNA ............................................................................. 60 TAMIFLU 30 MG CAPSULE (oseltamivir phosphate) ............. 69 TAMIFLU 45 MG CAPSULE (oseltamivir phosphate) ............. 69 TAMIFLU 6 MG/ML SUSPENSION (oseltamivir phosphate) ... 69 TAMIFLU 75 MG CAPSULE (oseltamivir phosphate) ............. 69 tamoxifen citrate ................................................................... 62 tamsulosin hcl (Flomax) ...................................................... 160 TAPAZOLE (methimazole) ................................................... 149 TARGRETIN 1% GEL ............................................................... 63 TARGRETIN 75 MG CAPSULE (bexarotene) ........................... 53 TASIGNA ................................................................................ 60 TASMAR (tolcapone) ............................................................. 65 TAVALISSE ........................................................................... 151 TAXOTERE (docetaxel) ........................................................... 62 TAYTULLA .............................................................................. 96 tazarotene ........................................................................... 144 TECENTRIQ ............................................................................ 62 TECFIDERA ............................................................................. 90 TECHNELITE TC-99M GENERATOR ...................................... 100 TEFLARO ................................................................................ 37 TEGRETOL (carbamazepine) .................................................. 93 TEGRETOL (epitol) ................................................................. 93 TEGRETOL XR (carbamazepine er) ........................................ 93 TEGSEDI ............................................................................... 154 telmisartan 20 mg tablet ...................................................... 83 telmisartan 40 mg tablet ...................................................... 83 telmisartan 80 mg tablet ...................................................... 83 telmisartan-amlodipine 40-10 ............................................... 82 telmisartan-amlodipine 40-5 mg ........................................... 82 telmisartan-amlodipine 80-10 ............................................... 82

telmisartan-amlodipine 80-5 mg .......................................... 82 telmisartan-hctz 40-12.5 mg tb ............................................. 82 telmisartan-hctz 80-12.5 mg tb ............................................. 82 telmisartan-hctz 80-25 mg tab ............................................. 82 temazepam ......................................................................... 142 TEMIXYS ................................................................................ 67 TEMODAR 100 MG CAPSULE (temozolomide) ...................... 55 TEMODAR 100 MG VIAL ........................................................ 55 TEMODAR 140 MG CAPSULE (temozolomide) ...................... 55 TEMODAR 180 MG CAPSULE (temozolomide) ...................... 55 TEMODAR 20 MG CAPSULE (temozolomide) ........................ 55 TEMODAR 250 MG CAPSULE (temozolomide) ...................... 55 TEMODAR 5 MG CAPSULE (temozolomide) .......................... 55 TEMOVATE (clobetasol propionate) ................................... 148 temozolomide (Temodar) ...................................................... 55 temsirolimus (Torisel) ............................................................ 57 teniposide .............................................................................. 62 tenofovir disoproxil fumarate ............................................... 67 TENORETIC 100 (atenolol-chlorthalidone) ............................ 85 TENORETIC 50 (atenolol-chlorthalidone) .............................. 85 TENORMIN (atenolol) ............................................................ 85 TEPADINA .............................................................................. 55 TEPADINA (thiotepa) ............................................................. 55 TEPEZZA .............................................................................. 153 terazosin hcl .......................................................................... 82 terbinafine hcl ....................................................................... 45 terbutaline sulfate ................................................................. 30 terconazole ............................................................................ 45 TESSALON PERLE (benzonatate) ........................................... 96 TESTOPEL ............................................................................ 119 testosterone 1.62% (2.5 g) pkt (Androgel) .......................... 119 testosterone 1.62% gel pump (Androgel) ............................ 119 testosterone 1.62%(1.25 g) pkt (Androgel) ......................... 119 testosterone 10 mg gel pump ............................................. 119 testosterone 12.5 mg/1.25 gram ........................................ 119 testosterone 25 mg/2.5 gm pkt (Androgel) ......................... 119 testosterone 30 mg/1.5 ml pump ....................................... 119 testosterone 50 mg/5 gram gel .......................................... 119 testosterone 50 mg/5 gram pkt (Androgel) ........................ 119 testosterone cypionate (Depo-testosterone) ...................... 119 testosterone enanthate ....................................................... 119 tetrabenazine ........................................................................ 89 tetracaine hcl ................................................................ 25, 104 tetracaine hcl/pf .................................................................... 25 tetracycline hcl ...................................................................... 40 TETRAVISC ........................................................................... 104 TETRAVISC FORTE ................................................................ 104 TEXACORT ........................................................................... 148 thallous chloride tl-201 ......................................................... 97 THALOMID ............................................................................ 35 THEO-24 ................................................................................ 31 theophylline anhydrous ......................................................... 31 theophylline in dextrose 5 % ................................................. 31 thiamine hcl ......................................................................... 161 THIOLA ................................................................................ 160 THIOLA EC ........................................................................... 160 thioridazine hcl .................................................................... 141 thiotepa (Tepadina) .............................................................. 55

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thiothixene .......................................................................... 140 THROMBI-GEL ....................................................................... 75 THROMBIN-JMI ..................................................................... 75 THROMBI-PAD ....................................................................... 75 THYROGEN .......................................................................... 149 thyroid,pork ......................................................................... 150 thyroid,pork (Armour Thyroid) ............................................ 150 tiagabine hcl 12 mg tablet (Gabitril) ..................................... 93 tiagabine hcl 16 mg tablet (Gabitril) ..................................... 93 tiagabine hcl 2 mg tablet (Gabitril) ....................................... 93 tiagabine hcl 4 mg tablet (Gabitril) ....................................... 93 TIAZAC (tiadylt er) ................................................................. 78 TIBSOVO ................................................................................ 61 TIGAN .................................................................................. 114 TIGAN (trimethobenzamide hcl) ......................................... 114 tigecycline (Tygacil) ............................................................... 37 TIGLUTIK ................................................................................ 89 TIKOSYN 125 MCG CAPSULE (dofetilide) ............................... 77 TIKOSYN 250 MCG CAPSULE (dofetilide) ............................... 77 TIKOSYN 500 MCG CAPSULE (dofetilide) ............................... 77 timolol maleate ............................................................. 85, 105 timolol maleate (Istalol) ...................................................... 105 timolol maleate (Timoptic) .................................................. 105 timolol maleate (Timoptic-XE) ............................................. 105 TIMOPTIC (timolol maleate) ................................................ 105 TIMOPTIC OCUDOSE ........................................................... 105 TIMOPTIC-XE (timolol maleate) .......................................... 105 tinidazole ............................................................................... 51 TIROSINT ............................................................................. 150 TIROSINT-SOL ...................................................................... 150 TISSEEL VHSD ...................................................................... 146 TIS-U-SOL PENTALYTE ......................................................... 143 TIVICAY .................................................................................. 68 tizanidine hcl ....................................................................... 130 tizanidine hcl (Zanaflex) ...................................................... 130 TNKASE .................................................................................. 76 TOBI PODHALER .................................................................... 34 TOBRADEX ............................................................................. 32 TOBRADEX (tobramycin-dexamethasone) ............................ 32 TOBRADEX ST ........................................................................ 32 tobramycin 0.3% eye drop (Tobrex) ...................................... 33 tobramycin 300 mg/5 ml ampule .......................................... 34 tobramycin pak 300 mg/5 ml (Kitabis Pak) ........................... 34 tobramycin sulfate ................................................................ 34 tobramycin/dexamethasone (Tobradex) ............................... 32 TOBREX .................................................................................. 33 TOBREX (tobramycin) ............................................................ 33 TOLAK .................................................................................... 63 tolcapone (Tasmar) ............................................................... 65 tolmetin sodium .................................................................... 29 tolterodine tart er 2 mg cap ................................................ 161 tolterodine tart er 4 mg cap ................................................ 161 tolterodine tartrate ............................................................. 161 TOPICORT ............................................................................ 148 TOPICORT (desoximetasone) .............................................. 148 topiramate ............................................................................ 93 topotecan hcl ......................................................................... 58 topotecan hcl (Hycamtin) ...................................................... 58

TOPROL XL (metoprolol succinate) ....................................... 85 toremifene citrate (Fareston) ................................................ 62 TORISEL (temsirolimus) ......................................................... 57 torsemide ............................................................................ 101 TOTECT ................................................................................ 153 TPN ELECTROLYTES ............................................................. 109 TRACE ELEMENTS-4 ............................................................. 110 TRACLEER 125 MG TABLET (bosentan) ................................. 80 TRACLEER 32 MG TABLET FOR SUSP ..................................... 80 TRACLEER 62.5 MG TABLET (bosentan) ................................ 80 tramadol er 100 mg tablet .................................................... 21 tramadol er 200 mg tablet .................................................... 21 tramadol er 300 mg tablet .................................................... 21 tramadol hcl 100 mg tablet ................................................... 21 tramadol hcl 50 mg tablet (Ultram) ...................................... 21 tramadol hcl er 100 mg capsule ............................................ 21 tramadol hcl er 100 mg tablet .............................................. 21 tramadol hcl er 150 mg capsule ............................................ 21 tramadol hcl er 200 mg capsule ............................................ 21 tramadol hcl er 200 mg tablet .............................................. 21 tramadol hcl er 300 mg capsule ............................................ 21 tramadol hcl er 300 mg tablet .............................................. 21 tramadol hcl/acetaminophen (Ultracet) ............................... 17 trandolapril ..................................................................... 81, 83 trandolapril/verapamil hcl .................................................... 81 tranexamic acid (Cyklokapron) ............................................. 74 tranexamic acid (Lysteda) ..................................................... 74 TRANEXAMIC ACID-NACL ...................................................... 74 TRANSDERM-SCOP (scopolamine) ...................................... 114 TRANXENE T-TAB (clorazepate dipotassium) ...................... 131 tranylcypromine sulfate ...................................................... 131 TRAVASOL ........................................................................... 108 TRAVATAN Z (travoprost) .................................................... 105 travoprost (Travatan Z) ....................................................... 105 TRAZIMERA ........................................................................... 58 trazodone hcl ...................................................................... 134 TREANDA ............................................................................... 55 TRECATOR ............................................................................. 35 TRELEGY ELLIPTA ................................................................... 30 TRELSTAR .............................................................................. 59 TREMFYA 100 MG/ML INJECTOR ........................................ 143 TREMFYA 100 MG/ML SYRINGE .......................................... 143 treprostinil sodium (Remodulin) ............................................ 80 TRESIBA ................................................................................. 50 TRESIBA FLEXTOUCH U-100 .................................................. 50 TRESIBA FLEXTOUCH U-200 .................................................. 50 tretinoin 0.01% gel .............................................................. 149 tretinoin 0.025% cream ....................................................... 149 tretinoin 0.025% gel ............................................................ 149 tretinoin 0.05% cream ......................................................... 149 tretinoin 0.05% gel .............................................................. 149 tretinoin 0.1% cream ........................................................... 149 tretinoin 10 mg capsule ........................................................ 62 tretinoin microspheres ........................................................ 149 TRETTEN ................................................................................ 75 TREXALL ................................................................................. 56 TREZIX (acetamin-caff-dihydrocodeine) ................................ 18 triamcinolone acetonide ...................................... 123, 148, 153

198

triamcinolone acetonide (Kenalog-40) ................................ 123 triamcinolone acetonide (Pro-C-Dure 5) .............................. 123 triamterene (Dyrenium) ...................................................... 101 triamterene/hydrochlorothiazid (Dyazide) .......................... 101 triamterene/hydrochlorothiazid (Maxzide) ......................... 101 triamterene/hydrochlorothiazid (Maxzide-25 Mg) ............. 101 triazolam ............................................................................. 142 triazolam (Halcion) .............................................................. 142 TRI-CHLOR ........................................................................... 146 trichloroacetic acid .............................................................. 146 TRICITRASOL .......................................................................... 43 TRICOR (fenofibrate) ............................................................. 88 TRIDESILON (desonide) ....................................................... 148 trientine hcl ......................................................................... 157 TRIESENCE ........................................................................... 103 TRIFERIC .............................................................................. 110 trifluoperazine hcl ............................................................... 141 trifluridine ............................................................................. 68 TRIGLIDE ................................................................................ 88 trihexyphenidyl hcl ................................................................ 63 TRIKAFTA ............................................................................. 151 TRILIPIX (fenofibric acid) ....................................................... 88 TRI-LUMA ............................................................................ 145 TRILURON (visco-3) ............................................................... 27 trimethobenzamide hcl (Tigan) ........................................... 114 trimethoprim ......................................................................... 34 trimipramine maleate ......................................................... 136 TRINTELLIX 10 MG TABLET .................................................. 135 TRINTELLIX 20 MG TABLET .................................................. 135 TRINTELLIX 5 MG TABLET .................................................... 135 TRIOSTAT (liothyronine sodium) ......................................... 150 TRIPTODUR .......................................................................... 123 TRISENOX (arsenic trioxide) .................................................. 62 TRIUMEQ ............................................................................... 66 TROGARZO ............................................................................ 66 TROPHAMINE ...................................................................... 108 tropicamide ......................................................................... 105 tropicamide (Mydriacyl) ...................................................... 105 trospium chloride ................................................................ 161 TRULANCE ........................................................................... 117 TRULICITY .............................................................................. 48 TRUSOPT (dorzolamide hcl) ................................................ 105 TRUVADA .............................................................................. 67 TRUXIMA ............................................................................... 54 TURALIO ................................................................................ 60 TUXARIN ER ........................................................................... 97 TUZISTRA XR .......................................................................... 97 TYBOST ................................................................................ 150 TYGACIL (tigecycline) ............................................................. 37 TYKERB .................................................................................. 60 TYLENOL-CODEINE NO.3 (acetaminophen-codeine) ............. 17 TYLENOL-CODEINE NO.4 (acetaminophen-codeine) ............. 17 TYMLOS ............................................................................... 126 TYSABRI ............................................................................... 158 TYVASO ............................................................................ 80, 81 TYVASO INSTITUTIONAL START KIT ....................................... 80 TYVASO REFILL KIT ................................................................. 80 TYVASO STARTER KIT ............................................................. 81

U

UDENYCA .............................................................................. 94 ULESFIA ................................................................................. 63 ULORIC 40 MG TABLET (febuxostat) ..................................... 27 ULORIC 80 MG TABLET (febuxostat) ..................................... 27 ULTANE (sevoflurane) ........................................................... 22 ULTIVA (remifentanil hcl) ...................................................... 18 ULTOMIRIS ............................................................................ 75 ULTRACET (tramadol hcl-acetaminophen) ............................ 17 ULTRAFOAM .......................................................................... 75 ULTRAM (tramadol hcl) ......................................................... 21 ULTRAVIST ............................................................................. 98 UMECTA .............................................................................. 145 UNASYN (ampicillin-sulbactam) ............................................ 39 UNITHROID 100 MCG TABLET (levoxyl) .............................. 150 UNITHROID 112 MCG TABLET (levoxyl) .............................. 150 UNITHROID 125 MCG TABLET (levoxyl) .............................. 150 UNITHROID 137 MCG TABLET (levoxyl) .............................. 150 UNITHROID 150 MCG TABLET (levoxyl) .............................. 150 UNITHROID 175 MCG TABLET (levoxyl) .............................. 150 UNITHROID 200 MCG TABLET (levoxyl) .............................. 150 UNITHROID 25 MCG TABLET (levoxyl) ................................ 150 UNITHROID 300 MCG TABLET (levothyroxine sodium) ....... 150 UNITHROID 50 MCG TABLET (levoxyl) ................................ 150 unithroid 75 mcg tablet (Synthroid) .................................... 150 UNITHROID 88 MCG TABLET (levoxyl) ................................ 150 UNITUXIN .............................................................................. 61 UPTRAVI ................................................................................ 81 URAMAXIN (urea) ............................................................... 145 urea ..................................................................................... 145 urea (Uramaxin) .................................................................. 145 URECHOLINE (bethanechol chloride) .................................... 73 URETRON D-S (utira-c) .......................................................... 34 URIBEL (vilamit mb) .............................................................. 34 UROCIT-K (potassium citrate er) ......................................... 112 UROGESIC-BLUE (uryl) ........................................................... 34 UROXATRAL (alfuzosin hcl er) ............................................. 160 URSO (ursodiol) ................................................................... 116 URSO FORTE (ursodiol) ....................................................... 116 ursodiol (Actigall) ................................................................ 116 ursodiol (Urso Forte) ........................................................... 116 ursodiol (Urso) ..................................................................... 116

V

VABOMERE ............................................................................ 35 VAGIFEM (yuvafem) ............................................................ 125 valacyclovir hcl (Valtrex) ....................................................... 69 VALCHLOR ............................................................................. 63 valganciclovir hcl ................................................................... 69 VALIUM (diazepam) ............................................................ 131 valproic acid .......................................................................... 93 valproic acid (as sodium salt) ................................................ 93 valrubicin (Valstar) ................................................................ 53 valsartan ......................................................................... 82, 83 valsartan/hydrochlorothiazide .............................................. 82 VALSTAR (valrubicin) ............................................................. 53 VALTREX (valacyclovir) .......................................................... 69 vancomycin 1 gm add-van vial .............................................. 41

199

vancomycin 1 gm vial ............................................................ 41 vancomycin 1 gram/200 ml bag ........................................... 41 vancomycin 1.5 gram/300 ml bag ........................................ 41 VANCOMYCIN 2 GRAM/400 ML BAG .................................... 41 vancomycin 250 mg/5 ml soln (Firvanq) ............................... 41 vancomycin 500 mg a-v vial .................................................. 41 vancomycin 500 mg vial ........................................................ 41 VANCOMYCIN 500 MG/100 ML BAG ..................................... 41 vancomycin hcl 1.25 gram vial .............................................. 41 vancomycin hcl 1.5 gram vial ................................................ 41 vancomycin hcl 10 gm vial .................................................... 41 vancomycin hcl 125 mg capsule ............................................ 41 vancomycin hcl 1g/200 ml bag ............................................. 41 vancomycin hcl 250 mg capsule ............................................ 41 vancomycin hcl 250 mg vial .................................................. 41 vancomycin hcl 5 gm vial ...................................................... 41 vancomycin hcl 750 mg vial .................................................. 41 vancomycin hcl in 5 % dextrose ............................................. 41 vancomycin/0.9 % sod chloride ............................................. 41 VAPRISOL-5% DEXTROSE ..................................................... 100 VARIBAR HONEY .................................................................... 99 VARIBAR NECTAR .................................................................. 99 VARIBAR PUDDING ................................................................ 99 VARIBAR THIN HONEY ........................................................... 99 VARIBAR THIN LIQUID ........................................................... 99 VARUBI ................................................................................ 114 VASCEPA .............................................................................. 112 VASOSTRICT ........................................................................ 120 VAZCULEP (phenylephrine hcl) ............................................. 80 VECTIBIX ................................................................................ 58 vecuronium bromide ............................................................. 73 vecuronium bromide/water .................................................. 73 VELCADE ................................................................................ 60 VELETRI .................................................................................. 81 VELPHORO ........................................................................... 109 VELTASSA ............................................................................ 109 VEMLIDY ................................................................................ 70 VENCLEXTA ............................................................................ 60 VENCLEXTA STARTING PACK ................................................. 60 VENELEX .............................................................................. 159 VENELEX (dermulcera) ........................................................ 159 venlafaxine hcl 100 mg tablet ............................................. 135 venlafaxine hcl 25 mg tablet ............................................... 135 venlafaxine hcl 37.5 mg tablet ............................................ 135 venlafaxine hcl 50 mg tablet ............................................... 135 venlafaxine hcl 75 mg tablet ............................................... 135 venlafaxine hcl er 150 mg cap (Effexor XR) ......................... 135 venlafaxine hcl er 150 mg tab ............................................. 135 venlafaxine hcl er 225 mg tab ............................................. 135 venlafaxine hcl er 37.5 mg cap (Effexor XR) ........................ 135 venlafaxine hcl er 37.5 mg tab ............................................ 135 venlafaxine hcl er 75 mg cap (Effexor XR) ........................... 135 venlafaxine hcl er 75 mg tab ............................................... 135 VENOFER ............................................................................. 110 VENTAVIS .............................................................................. 81 verapamil hcl ......................................................................... 78 verapamil hcl (Calan SR) ........................................................ 78 verapamil hcl (Verelan PM) ................................................... 78

verapamil hcl (Verelan) ......................................................... 78 VEREGEN ............................................................................... 70 VERELAN (verapamil hcl) ....................................................... 78 VERELAN (verapamil sr) ........................................................ 78 VERELAN PM ......................................................................... 78 VERELAN PM (verapamil er pm) ........................................... 78 VERZENIO .............................................................................. 60 VFEND (voriconazole) ............................................................ 45 VFEND IV (voriconazole) ....................................................... 45 V-GO 20 ............................................................................... 129 V-GO 30 ............................................................................... 129 V-GO 40 ............................................................................... 129 VIBATIV ................................................................................. 37 VIBERZI ................................................................................ 117 VIBRAMYCIN ......................................................................... 41 VIBRAMYCIN (doxycycline monohydrate) ............................. 41 VICTOZA 2-PAK ...................................................................... 48 VICTOZA 3-PAK ...................................................................... 48 VIDAZA (azacitidine) .............................................................. 56 VIEKIRA PAK .......................................................................... 69 vigabatrin .............................................................................. 93 VIGAMOX (moxifloxacin) ....................................................... 33 VIIBRYD 10 MG TABLET ....................................................... 135 VIIBRYD 10-20 MG STARTER PACK ...................................... 135 VIIBRYD 20 MG TABLET ....................................................... 135 VIIBRYD 40 MG TABLET ....................................................... 135 VIMIZIM .............................................................................. 156 VIMPAT 10 MG/ML SOLUTION ............................................. 93 VIMPAT 100 MG TABLET ....................................................... 93 VIMPAT 150 MG TABLET ....................................................... 93 VIMPAT 200 MG TABLET ....................................................... 93 VIMPAT 200 MG/20 ML VIAL ................................................ 93 VIMPAT 50 MG TABLET ......................................................... 93 vinblastine sulfate ................................................................. 58 vincristine sulfate .................................................................. 58 vinorelbine tartrate (Navelbine) ............................................ 58 VIOKACE .............................................................................. 118 VIREAD .................................................................................. 67 VISCOAT .............................................................................. 106 VISIONBLUE ......................................................................... 106 VISIPAQUE ............................................................................. 98 VISTARIL (hydroxyzine pamoate) .......................................... 47 VISTOGARD ......................................................................... 152 VISUDYNE ............................................................................ 153 VITAFOL FE+ ........................................................................ 130 vitamins b1,b2,b3,b5,and b6 ............................................... 161 vite ac/grape/hyaluronic acid (Atopiclair) .......................... 145 VITRAKVI ............................................................................... 60 VITRASE ............................................................................... 149 VIVA DHA ............................................................................ 130 VIVELLE-DOT (estradiol) ...................................................... 121 VIVITROL ............................................................................. 154 VIZAMYL ................................................................................ 98 VIZIMPRO .............................................................................. 60 VOLTAREN (diclofenac sodium) .......................................... 143 VONVENDI ............................................................................. 74 VORAXAZE ........................................................................... 152 voriconazole 200 mg tablet (Vfend) ...................................... 45

200

voriconazole 200 mg vial (Vfend Iv) ...................................... 45 voriconazole 40 mg/ml susp (Vfend) ..................................... 46 voriconazole 50 mg tablet (Vfend) ........................................ 46 VOSEVI .................................................................................. 69 VOTRIENT .............................................................................. 60 VPRIV ................................................................................... 156 VRAYLAR 1.5 MG CAPSULE .................................................. 139 VRAYLAR 1.5 MG-3 MG PACK .............................................. 139 VRAYLAR 3 MG CAPSULE ..................................................... 140 VRAYLAR 4.5 MG CAPSULE .................................................. 140 VRAYLAR 6 MG CAPSULE ..................................................... 140 VTOL LQ ................................................................................. 15 VYNDAMAX ......................................................................... 157 VYNDAQEL ........................................................................... 157 VYONDYS-53 ........................................................................ 156 VYXEOS .................................................................................. 55

W

WAKIX ................................................................................... 93 warfarin sodium (Coumadin) ................................................ 43 water for inj.,bacteriostatic ................................................. 157 water for injection,sterile .................................................... 157 water for irrigation,sterile ................................................... 143 WELCHOL (colesevelam hcl) .................................................. 87 WELLBUTRIN SR 100 MG TABLET (bupropion hcl sr) .......... 132 WELLBUTRIN SR 150 MG TABLET (bupropion hcl sr) .......... 132 WELLBUTRIN SR 200 MG TABLET (bupropion hcl sr) .......... 132 WINRHO SDF ......................................................................... 74

X

XADAGO ................................................................................ 65 XALATAN (latanoprost) ....................................................... 105 XALKORI ................................................................................. 60 XANAX (alprazolam) ............................................................ 131 XANAX XR (alprazolam xr) ................................................... 131 XARELTO ................................................................................ 43 XATMEP ................................................................................. 56 XELJANZ ................................................................................. 28 XELJANZ XR ............................................................................ 28 XELODA (capecitabine) .......................................................... 56 XELPROS .............................................................................. 105 XENLETA 150 MG/15 ML VIAL ............................................... 39 XENLETA 600 MG TABLET ..................................................... 39 XEOMIN ................................................................................. 73 XEPI ....................................................................................... 42 XERAVA ................................................................................. 41 XERMELO ............................................................................. 113 XGEVA ................................................................................. 159 XIAFLEX ................................................................................ 159 XIFAXAN 200 MG TABLET ...................................................... 40 XIFAXAN 550 MG TABLET ...................................................... 40 XIGDUO XR 10 MG-1,000 MG TAB ........................................ 50 XIGDUO XR 10 MG-500 MG TABLET ...................................... 50 XIGDUO XR 2.5 MG-1,000 MG TAB ....................................... 50 XIGDUO XR 5 MG-1,000 MG TABLET ..................................... 50 XIGDUO XR 5 MG-500 MG TABLET ........................................ 50 XIIDRA ................................................................................. 106 XOFLUZA ................................................................................ 69

XOLAIR .................................................................................. 31 XOLEGEL ................................................................................ 47 XOPENEX (levalbuterol hcl) ................................................... 30 XOPENEX CONCENTRATE (levalbuterol concentrate) ........... 30 XOSPATA ............................................................................... 60 XPOVIO .................................................................................. 62 XTAMPZA ER ......................................................................... 21 XTANDI .................................................................................. 55 XULTOPHY 100-3.6 ................................................................ 48 XURIDEN .............................................................................. 108 XYLOCAINE (lidocaine hcl) ..................................................... 25 XYLOCAINE DENTAL-EPINEPHRINE ........................................ 25 XYLOCAINE DENTAL-EPINEPHRINE (lidocaine-epinephrine) . 25 XYLOCAINE WITH EPINEPHRINE ............................................ 25 XYLOCAINE WITH EPINEPHRINE (lidocaine hcl-epinephrine) 25 XYLOCAINE-MPF .................................................................... 25 XYLOCAINE-MPF (lidocaine hcl) ............................................ 25 XYLOCAINE-MPF WITH EPINEPHRINE ................................... 25 XYREM ................................................................................. 141

Y

YASMIN 28 (zumandimine) ................................................... 96 YAZ (nikki) ............................................................................. 96 YERVOY ................................................................................. 62 YONDELIS .............................................................................. 55

Z

zafirlukast (Accolate) ............................................................ 31 zaleplon ............................................................................... 142 ZALTRAP ................................................................................ 58 ZANAFLEX (tizanidine hcl) ................................................... 130 ZANOSAR ............................................................................... 53 ZARONTIN (ethosuximide) .................................................... 93 ZARXIO .................................................................................. 94 ZAVESCA (miglustat) ........................................................... 155 ZEBUTAL (butalbital-acetaminophen-caffeine) ..................... 15 ZEJULA ................................................................................... 60 ZELBORAF .............................................................................. 57 ZEMAIRA ............................................................................. 151 ZEMDRI .................................................................................. 34 ZEMPLAR 1 MCG CAPSULE (paricalcitol) ............................. 154 ZEMPLAR 10 MCG/2 ML VIAL (paricalcitol) ......................... 154 ZEMPLAR 2 MCG CAPSULE (paricalcitol) ............................. 154 ZEMPLAR 2 MCG/ML VIAL (paricalcitol) .............................. 154 ZEMPLAR 5 MCG/ML VIAL (paricalcitol) .............................. 154 ZENPEP ................................................................................ 118 ZENZEDI ................................................................................. 72 ZENZEDI (dextroamphetamine sulfate) ................................ 72 ZEPATIER ............................................................................... 70 ZERBAXA ................................................................................ 36 ZETIA (ezetimibe) .................................................................. 88 ZEVALIN ................................................................................. 61 ZIAC (bisoprolol-hydrochlorothiazide) .................................. 85 zidovudine ............................................................................. 67 ZIEXTENZO ............................................................................. 94 zileuton .................................................................................. 29 ZILRETTA .............................................................................. 123 zinc chloride ........................................................................ 111

201

zinc oxide ............................................................................. 145 zinc sulfate 10 mg/10 ml vial .............................................. 111 zinc sulfate 25 mg/5 ml vial ................................................ 111 ZINC SULFATE 30 MG/10 ML VIAL ....................................... 111 zinc/copper/mangan/chrom/selen ..................................... 110 ZINECARD (dexrazoxane) .................................................... 152 ZINGO (lidocaine hcl) ............................................................ 25 ZIOPTAN .............................................................................. 105 ziprasidone hcl ..................................................................... 139 ZIRABEV ................................................................................. 54 ZIRGAN .................................................................................. 68 ZITHROMAX (azithromycin) .................................................. 38 ZITHROMAX TRI-PAK (azithromycin) ..................................... 38 ZOHYDRO ER (hydrocodone bitartrate er) ............................ 21 ZOLADEX ................................................................................ 59 zoledronic ac/mannitol/0.9nacl .......................................... 159 zoledronic acid .................................................................... 159 zoledronic acid/mannitol-water .......................................... 159 zoledronic acid/mannitol-water (Reclast) ........................... 159 ZOLINZA ................................................................................. 54 zolmitriptan ........................................................................... 16 ZOLOFT 100 MG TABLET (sertraline hcl) ............................. 134 ZOLOFT 20 MG/ML ORAL CONC (sertraline hcl) ................. 134 ZOLOFT 25 MG TABLET (sertraline hcl) ............................... 134 ZOLOFT 50 MG TABLET (sertraline hcl) ............................... 134

zolpidem tart er 12.5 mg tab .............................................. 142 zolpidem tart er 6.25 mg tab .............................................. 142 zolpidem tartrate ................................................................ 142 zonisamide ............................................................................ 93 ZONTIVITY ............................................................................. 66 ZORBTIVE ............................................................................ 123 ZORTRESS ............................................................................ 129 ZOSYN ................................................................................... 39 ZOSYN (piperacillin-tazobactam) .......................................... 39 ZTLIDO ................................................................................... 26 ZUBSOLV ............................................................................. 160 ZYDELIG ................................................................................. 60 ZYKADIA ................................................................................ 60 ZYLET ..................................................................................... 32 ZYLOPRIM (allopurinol) ......................................................... 27 ZYMAXID (gatifloxacin) .......................................................... 33 ZYPREXA (olanzapine) ......................................................... 139 ZYPREXA RELPREVV 210 MG VL KIT .................................... 139 ZYPREXA RELPREVV 300 MG VL KIT .................................... 139 ZYPREXA RELPREVV 405 MG VL KIT .................................... 139 ZYVOX 100 MG/5 ML SUSPENSION (linezolid) ...................... 38 ZYVOX 200 MG/100 ML-D5W ............................................... 38 ZYVOX 600 MG TABLET (linezolid) ........................................ 38 ZYVOX 600 MG/300 ML-D5W (linezolid-d5w) ...................... 38

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Cigna reserves the right to make changes to the Drug List without notice. Your plan may cover additional medications; please refer to your enrollment materials for details. Cigna does not take responsibility for any medication decisions made by the doctor or pharmacist. Cigna may receive payments from manufacturers of certain preferred brand medications, and in limited instances, certain non-preferred brand medications, that may or may not be shared with your plan depending on its arrangement with Cigna. Depending upon plan design, market conditions, the extent to which manufacturer payments are shared with your plan and other factors as of the date of service, the preferred brand medication may or may not represent the lowest-cost brand medication within its class for you and/or your plan.

1. State laws in Texas and Louisiana may require your plan to cover your medication at your current benefit level until your plan renews. This means that if your medication is taken off the drug list, is moved to a higher cost-share tier or needs approval from Cigna before your plan will cover it, these changes may not begin until your plan’s renewal date. To find out if these state laws apply to your plan, please call Customer Service using the number on your Cigna ID card. 2. State law in Illinois may require your plan to cover your medications at your current benefit level until your plan renews. This means that if you currently have approval through a review process for your plan to cover your medication, the drug list change(s) listed here may not affect you until your plan renewal date. If you don’t currently have approval through a coverage review process, you may continue to receive coverage at your current benefit level if your doctor requests it. To find out if this state law applies to your plan, please call Customer Service using the number on your Cigna ID card. 3. Smoking cessation medications are not typically covered under the plan, except as required by law or by the terms of your specific plan. Costs and complete details of the plan’s prescription drug coverage, including a full list of exclusions and limitations, are set forth in the plan documents. If there are any differences between the information provided here and the plan documents, the information in the plan documents takes complete precedence. 4. Prices shown on myCigna are not guaranteed and coverage is subject to your plan terms and conditions. Visit myCigna for more information. 5. U.S. Food and Drug Administration (FDA) website, “Generic Drug Facts.” Last updated 06/01/18. 6. Not all plans offer home delivery and Accredo as a covered pharmacy option. Please log in to the myCigna app or website, or check your plan materials, to learn more about the pharmacies in your plan’s network. 7. As allowable by law. 8. Costs and complete details of the plan’s prescription drug coverage are set forth in the plan documents. If there are any differences between the information provided here and the plan documents, the information in the plan documents takes complete precedence. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., Accredo Health Group, Inc., Express Scripts, Inc., Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (CHC-TN), and Cigna HealthCare of Texas, Inc. Policy forms: OK - HP-APP-1 et al (CHLIC), OR - HP-POL38 02-13 (CHLIC), TN - HP-POL43/HC-CER1V1 et al (CHLIC), GSA-COVER, et al (CHC-TN). “Accredo” refers to Accredo Health Group, Inc. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. “Accredo” is a trademark of Express Scripts Strategic Development, Inc. 927841 a CA Advantage 4-Tier 04/20 © 2020 Cigna. Some content provided under license.

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Transcript of CIGNA ADVANTAGE 4-TIER PRESCRIPTION DRUG LIST · location of your choice) and you can get up to a...