Maintenance Drug Pharmacy Program - CareSource
Transcript of Maintenance Drug Pharmacy Program - CareSource
Maintenance Drug Pharmacy Program CareSource offers a 90-day supply of certain maintenance medications as part of our pharmacy
program. Maintenance medications are used to treat long-term conditions or chronic illness. It is
important to take maintenance medications regularly and as prescribed.
Related to the Coronavirus (COVID-19) pandemic, all CareSource Ohio Medicaid
members are eligible for 90-day supplies of the medications listed below. Please note that
utilization edits will apply (dose and quantity limits and other safety edits) and some medications
may require Prior Authorization or Step before a 90-day supply will process.
1ST TIER UNIFINE PENTP 5MM 31G
1ST TIER UNIFINE PNTIP 4MM 32G
1ST TIER UNIFINE PNTIP 6MM 31G
1ST TIER UNIFINE PNTIP 8MM 31G
1ST TIER UNIFINE PNTP 12MM 29G
1ST TIER UNIFINE PNTP 29GX1/2"
1ST TIER UNIFINE PNTP 31GX1/4"
1ST TIER UNIFINE PNTIP 8MM 31G
1ST TIER UNIFINE PNTP 31GX3/16
1ST TIER UNIFINE PNTP 31GX5/16
1ST TIER UNIFINE PNTP 32GX5/32
1ST TIER COMFORTOUCH 28G LANCT
1ST TIER COMFORTOUCH 30G LANCT
24HR ALLERGY(LEVOCETIRZN) 5 MG
RELION 2-IN-1 LANCET DEVICE
2TEK CONTROL SOLUTION
2TEK GLUCOSE-WRIST MONITOR KIT
50 PLUS ADULT EYE HEALTH SFTGL
A THRU Z ADVANCED FORMULA TAB
A THRU Z MEN'S ULTIMATE TABLET
A THRU Z ADVANCED FORMULA TAB
A THRU Z ADVANCED FORMULA TAB
A THRU Z SELECT TABLET
A THRU Z SELECT WOMEN'S TABLET
A THRU Z SELECT MEN 50+ TABLET
A THRU Z SELECT MULTIVIT TAB
A THRU Z SELECT TABLET
A THRU Z SELECT 50 PLUS TABLET
ABACAVIR 20 MG/ML SOLUTION
ABACAVIR 300 MG TABLET
ABACAVIR-LAMIVUDINE 600-300 MG
ABACAVIR-LAMIVUDINE-ZIDOV TAB
ABC PLUS TABLET
ABDEK MULTIVITAMIN SOFTGEL
ABDEK MULTIVITAMIN DROP
ABDEK MULTIVITAMIN CHEW TAB
ABILIFY 10 MG TABLET
ABILIFY 15 MG TABLET
OHIO MEDICAID Effective April 1, 2020
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ABILIFY 2 MG TABLET
ABILIFY 20 MG TABLET
ABILIFY 30 MG TABLET
ABILIFY 5 MG TABLET
ABILIFY MAINTENA ER 300 MG SYR
ABILIFY MAINTENA ER 300 MG VL
ABILIFY MAINTENA ER 400 MG SYR
ABILIFY MAINTENA ER 400 MG VL
ABILIFY MYCITE 10 MG KIT
ABILIFY MYCITE 15 MG KIT
ABILIFY MYCITE 2 MG KIT
ABILIFY MYCITE 20 MG KIT
ABILIFY MYCITE 30 MG KIT
ABILIFY MYCITE 5 MG KIT
ABIRATERONE ACETATE 250 MG TAB
ABOUTTIME PEN NEEDLE 30G X 8MM
ABOUTTTIME PEN NEEDLE 31G X 5MM
ABOUTTIME PEN NEEDLE 31G X 8MM
ABOUTTIME PEN NEEDLE 32G X 4MM
ACACIA 1:20 (W/V) VIAL
ACAMPROSATE CALC DR 333 MG TAB
ACARBOSE 100 MG TABLET
ACARBOSE 25 MG TABLET
ACARBOSE 50 MG TABLET
ACCOLATE 10 MG TABLET
ACCOLATE 20 MG TABLET
ACCU-CHEK AVIVA SOLUTION
ACCU-CHEK COMPACT PLUS KIT
ACCU-CHEK COMBO SYSTEM
ACCU-CHEK MULTICLIX LANCETS
ACCU-CHEK MULTICLIX LANCET KIT
ACCU-CHEK AVIVA CONNECT METER
ACCU-CHEK AVIVA PLUS TEST STRP
ACCU-CHEK AVIVA PLUS METER
ACCU-CHEK COMPACT PLUS CONTROL
ACCU-CHEK COMPACT PLUS STRIPS
ACCU-CHEK FASTCLIX LANCET DRUM
ACCU-CHEK FASTCLIX LANCING DEV
ACCU-CHEK GUIDE L1-L2 CTRL SOL
ACCU-CHEK GUIDE ME GLUCOSE MTR
ACCU-CHEK GUIDE MONITOR SYSTEM
ACCU-CHEK GUIDE TEST STRIP
ACCU-CHEK NANO SMARTVIEW METER
ACCU-CHEK SAFE-T-PRO 23G LANCT
ACCU-CHEK SAFE-T-PRO PLUS 23G
ACCU-CHEK SMARTVIEW TEST STRIP
ACCU-CHEK SMARTVIEW CONTRL SOL
ACCU-CHEK SOFTCLIX LANCETS
ACCU-CHEK SOFTCLIX LANCET KIT
ACCUPRIL 10 MG TABLET
ACCUPRIL 20 MG TABLET
ACCUPRIL 40 MG TABLET
ACCUPRIL 5 MG TABLET
ACCURETIC 10-12.5 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ACCURETIC 20-12.5 MG TABLET
ACCURETIC 20-25 MG TABLET
ACCUTREND CHOLESTEROL CONTROL
ACCUTREND GLUCOSE CONTROL
ACCUTREND GLUCOSE TEST STRIP
ACCUTREND PLUS METER
ACEBUTOLOL 200 MG CAPSULE
ACEBUTOLOL 400 MG CAPSULE
ACETAZOLAMIDE 125 MG TABLET
ACETAZOLAMIDE 250 MG TABLET
ACETAZOLAMIDE ER 500 MG CAP
ACID CONTROL 150 MG TABLET
ACID CONTROL 75 MG TABLET
GNP ACID CONTROL 150 MG TABLET
ACID CONTROLLER 10 MG TABLET
ACID CONTROLLER 20 MG TABLET
CVS ACID CONTROLLER 10 MG TAB
CVS ACID CONTROLLER 20 MG TAB
QC ACID CONTROLLER 10 MG TAB
ACID REDUCER 200 MG TABLET
EQ ACID REDUCER 200 MG TABLET
SM ACID REDUCER 200 MG TABLET
ACID REDUCER 10 MG TABLET
ACID REDUCER 20 MG TABLET
EQ ACID REDUCER 10 MG TABLET
EQ ACID REDUCER 20 MG TABLET
GNP ACID REDUCER 10 MG TABLET
GNP ACID REDUCER 20 MG TABLET
PUB ACID REDUCER 10 MG TABLET
RA ACID REDUCER 10 MG TABLET
RA ACID REDUCER 20 MG TABLET
SM ACID REDUCER 10 MG TABLET
SM ACID REDUCER 20 MG TABLET
ACID REDUCER DR 20 MG CAP
ACID REDUCER 150 MG TABLET
ACID REDUCER 75 MG TABLET
CVS ACID REDUCER 150 MG TABLET
CVS ACID REDUCER 75 MG TABLET
EQ ACID REDUCER 150 MG TABLET
EQL ACID REDUCER 150 MG TABLET
EQL ACID REDUCER 75 MG TABLET
GNP ACID REDUCER 75 MG TABLET
GS ACID REDUCER 150 MG TABLET
GS ACID REDUCER 75 MG TABLET
HM ACID REDUCER 150 MG TABLET
HM ACID REDUCER 75 MG TABLET
RA ACID REDUCER 150 MG TABLET
SB ACID REDUCER 150 MG TABLET
SM ACID REDUCER 150 MG TABLET
SM ACID REDUCER 75 MG TABLET
SW ACID REDUCER 150 MG TABLET
ACIPHEX DR 20 MG TABLET
ACIPHEX SPRINKLE DR 10 MG CAP
ACIPHEX SPRINKLE DR 5 MG CAP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ACITRETIN 10 MG CAPSULE
ACITRETIN 17.5 MG CAPSULE
ACITRETIN 25 MG CAPSULE
ACREMONIUM 20,000 PNU/ML
ACTEMRA 162 MG/0.9 ML SYRINGE
ACTEMRA 200 MG/10 ML VIAL
ACTEMRA 400 MG/20 ML VIAL
ACTEMRA 80 MG/4 ML VIAL
ACTEMRA ACTPEN 162 MG/0.9 ML
ACTIGALL 300 MG CAPSULE
ACTI-LANCE LITE 28G LANCETS
ACTI-LANCE SPECIAL 17G LANCETS
ACTI-LANCE UNIVERS 23G LANCETS
ACTIMMUNE 100 MCG/0.5 ML VIAL
ACTIVE OB SOFTGEL
ACTIVELLA 0.5-0.1 MG TABLET
ACTIVELLA 1 MG-0.5 MG TABLET
ACTIVITE TABLET
ACTONEL 150 MG TABLET
ACTONEL 35 MG TABLET
ACTONEL 5 MG TABLET
ACTOPLUS MET 15 MG-500 MG TAB
ACTOPLUS MET 15 MG-850 MG TAB
ACTOPLUS MET XR 15-1,000 MG TB
ACTOPLUS MET XR 30-1,000 MG TB
ACTOS 15 MG TABLET
ACTOS 30 MG TABLET
ACTOS 45 MG TABLET
ACYCLOVIR 200 MG CAPSULE
ACYCLOVIR 200 MG/5 ML SUSP
ACYCLOVIR 400 MG TABLET
ACYCLOVIR 800 MG TABLET
ADAGEN 250 UNIT/ML VIAL
ADAKVEO 100 MG/10 ML VIAL
ADALAT CC 30 MG TABLET
ADALAT CC 60 MG TABLET
ADALAT CC 90 MG TABLET
ADCIRCA 20 MG TABLET
ADDAPRIN 200 MG TABLET
ADDERALL 10 MG TABLET
ADDERALL 12.5 MG TABLET
ADDERALL 15 MG TABLET
ADDERALL 20 MG TABLET
ADDERALL 30 MG TABLET
ADDERALL 5 MG TABLET
ADDERALL 7.5 MG TABLET
ADDERALL XR 10 MG CAPSULE
ADDERALL XR 15 MG CAPSULE
ADDERALL XR 20 MG CAPSULE
ADDERALL XR 25 MG CAPSULE
ADDERALL XR 30 MG CAPSULE
ADDERALL XR 5 MG CAPSULE
ADEMPAS 0.5 MG TABLET
ADEMPAS 1 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ADEMPAS 1.5 MG TABLET
ADEMPAS 2 MG TABLET
ADEMPAS 2.5 MG TABLET
ADHANSIA XR 25 MG CAPSULE
ADHANSIA XR 35 MG CAPSULE
ADHANSIA XR 45 MG CAPSULE
ADHANSIA XR 55 MG CAPSULE
ADHANSIA XR 70 MG CAPSULE
ADHANSIA XR 85 MG CAPSULE
ADLYXIN 20 MCG MAINTENANCE PK
ADMELOG 100 UNIT/ML VIAL
ADMELOG SOLOSTAR 100 UNIT/ML
ADULT ASPIRIN REGIMEN EC 81 MG
ADULT MULTI + OMEGA-3 GUMMIES
ADULT MULTI GUMMIES
ADULT MULTIVITAMIN EXTRA D3
ADULT MULTIVITAMIN GUMMIES
ADULT ONE DAILY GUMMIES
ADULT ONE DAILY MULTIVIT TAB
ADULTS 50 PLUS DAILY FORMULA
ADULTS 50 PLUS MULTIVITAMIN
ADULTS 50 PLUS MULTIVITAMIN TB
ADULTS' DAILY FORMULA TABLET
ADULTS MULTIVITAMIN CAPLET
ADULTS MULTIVITAMIN TABLET
ADVAIR 100-50 DISKUS
ADVAIR 250-50 DISKUS
ADVAIR 500-50 DISKUS
ADVAIR HFA 115-21 MCG INHALER
ADVAIR HFA 230-21 MCG INHALER
ADVAIR HFA 45-21 MCG INHALER
CVS ADVANCED GLUCOSE METER
CVS ADVANCED GLUCOSE TEST STR
CVS ADVANCED GLUCOSE TEST STR
ADVANCED LANCING DEVICE
PUB ADVANCED LANCING DEVICE
ADVANCED MULTI EA CHEW TABLET
ADVANCED TRAVEL 28G LANCETS
ADVANCED TRAVEL 30G LANCETS
ADVATE 1,201-1,800 UNIT VIAL
ADVATE 1,801-2,400 UNIT VIAL
ADVATE 2,401-3,600 UNIT VIAL
ADVATE 200-400 UNIT VIAL
ADVATE 3,601-4,800 UNIT VIAL
ADVATE 401-800 UNIT VIAL
ADVATE 801-1,200 UNIT VIAL
ADVIL 100 MG TABLET
ADVIL 200 MG CAPLET
ADVIL 200 MG GEL CAPLET
ADVIL 200 MG LIQUI-GEL CAPSULE
ADVIL 200 MG TABLET
ADVIL JR STR 100 MG TAB CHEW
ADVIL LIQUI-GELS 200 MG CAP
ADVIL MIGRAINE 200 MG CAPS
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ADVOCATE BLOOD GLUCOSE MONITOR
ADVOCATE CONTROL SOLUTION HIGH
ADVOCATE CONTROL SOLUTION LOW
ADVOCATE DUO GLU-WRIST MONITOR
ADVOCATE 26G LANCETS
ADVOCATE 30G LANCETS
ADVOCATE 26G LANCETS
ADVOCATE PEN NEEDLE 4MM 33G
ADVOCATE PEN NDL 12.7MM 29G
ADVOCATE PEN NEEDLES 5MM 31G
ADVOCATE PEN NEEDLES 8MM 31G
ADVOCATE REDI-CODE TEST STRIP
ADVOCATE REDI-CODE GLU METER
ADVOCATE REDI-CODE GLU MONITOR
ADVOCATE REDI-CODE PLUS METER
ADVOCATE REDI-CODE+ TEST STRIP
ADVOCATE REDI-CODE+ CTRL SOLN
ADVOCATE REDI-CODE+ CTRL SOLN
ADVOCATE INS 1 ML 31GX5/16"
ADVOCATE INS SYR 1 ML 29GX1/2"
ADVOCATE INS SYR 1 ML 30GX5/16
ADVOCATE INS 0.5 ML 30GX5/16"
ADVOCATE INS 0.5 ML 31GX5/16"
ADVOCATE INS SYR 0.5ML 29GX1/2
ADVOCATE INS 0.3 ML 30GX5/16"
ADVOCATE INS 0.3 ML 31GX5/16"
ADVOCATE INS SYR 0.3ML 29GX1/2
ADVOCATE TEST STRIP
ADYNOVATE 1,251-2,500 UNIT VL
ADYNOVATE 1,500 UNIT VIAL
ADYNOVATE 200-400 UNIT VIAL
ADYNOVATE 3,000 UNIT VIAL
ADYNOVATE 401-800 UNIT VIAL
ADYNOVATE 750 UNIT VIAL
ADYNOVATE 801-1,250 UNIT VIAL
ADZENYS ER 1.25 MG/ML SUSP
ADZENYS XR-ODT 12.5 MG TABLET
ADZENYS XR-ODT 15.7 MG TABLET
ADZENYS XR-ODT 18.8 MG TABLET
ADZENYS XR-ODT 3.1 MG TABLET
ADZENYS XR-ODT 6.3 MG TABLET
ADZENYS XR-ODT 9.4 MG TABLET
AEROSPAN 80 MCG INHALER
AFEDITAB CR 30 MG TABLET
AFEDITAB CR 60 MG TABLET
AFINITOR 10 MG TABLET
AFINITOR 2.5 MG TABLET
AFINITOR 5 MG TABLET
AFINITOR 7.5 MG TABLET
AFINITOR DISPERZ 2 MG TABLET
AFINITOR DISPERZ 3 MG TABLET
AFINITOR DISPERZ 5 MG TABLET
AFIRMELLE-28 TABLET
AFREZZA 12 UNIT CARTRIDGE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
AFREZZA 30-4 UNIT / 60-8 UNIT
AFREZZA 4 UNIT CARTRIDGE
AFREZZA 4 UNIT/8 UNIT/12 UNIT
AFREZZA 60-4 UNIT / 30-8 UNIT
AFREZZA 60-8 UNIT / 30-12 UNIT
AFREZZA 8 UNIT CARTRIDGE
AFREZZA 90-4 UNIT / 90-8 UNIT
AFREZZA 90-8 UNIT / 90-12 UNIT
AFSTYLA 1,000 UNIT VIAL
AFSTYLA 1,500 UNIT RANGE VIAL
AFSTYLA 2,000 UNIT VIAL
AFSTYLA 2,500 UNIT RANGE VIAL
AFSTYLA 250 UNIT VIAL
AFSTYLA 3,000 UNIT VIAL
AFSTYLA 500 UNIT VIAL
AGAMATRIX AMP TEST STRIPS
AGAMATRIX AMP GLUC MONITOR SYS
AGAMATRIX NORM-HI CONTROL SOLN
AGAMATRIX HIGH CONTROL SOLN
AGGRENOX 25 MG-200 MG CAPSULE
AGRYLIN 0.5 MG CAPSULE
AIMOVIG 140 MG/ML AUTOINJECTOR
AIMOVIG 70 MG/ML AUTOINJECTOR
AIMOVIG 140 MG DOSE-2 AUTOINJ
AIRDUO RESPICLICK 113-14 MCG
AIRDUO RESPICLICK 232-14 MCG
AIRDUO RESPICLICK 55-14 MCG
AJOVY 225 MG/1.5 ML SYRINGE
ALBA-LYBE LIQUID
ALBUTEROL 2.5 MG/0.5 ML SOL
ALBUTEROL 5 MG/ML SOLUTION
ALBUTEROL SUL 0.63 MG/3 ML SOL
ALBUTEROL SUL 1.25 MG/3 ML SOL
ALBUTEROL SUL 2.5 MG/3 ML SOLN
ALBUTEROL SULF 2 MG/5 ML SYRUP
ALBUTEROL SULFATE 2 MG TAB
ALBUTEROL SULFATE 4 MG TAB
ALBUTEROL SULFATE ER 4 MG TAB
ALBUTEROL SULFATE ER 8 MG TAB
ALBUTEROL HFA 90 MCG INHALER
ALDACTAZIDE 25-25 TABLET
ALDACTAZIDE 50-50 TABLET
ALDACTONE 100 MG TABLET
ALDACTONE 25 MG TABLET
ALDACTONE 50 MG TABLET
ALDER 1:20 (W/V) VIAL
ALDURAZYME 2.9 MG/5 ML VIAL
ALECENSA 150 MG CAPSULE
ALENDRONATE SOD 70 MG/75 ML
ALENDRONATE SODIUM 10 MG TAB
ALENDRONATE SODIUM 35 MG TAB
ALENDRONATE SODIUM 40 MG TAB
ALENDRONATE SODIUM 5 MG TABLET
ALENDRONATE SODIUM 70 MG TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ALEVE 220 MG CAPLET
ALEVE 220 MG GELCAP
ALEVE 220 MG LIQUID GEL CAP
ALEVE 220 MG TABLET
ALFUZOSIN HCL ER 10 MG TABLET
ALIQOPA 60 MG VIAL
ALISKIREN 150 MG TABLET
ALISKIREN 300 MG TABLET
ALIVE ONCE DAILY WOMEN 50 PLUS
ALIVE PRENATAL GUMMY
ALIVE WOMEN'S 50 PLUS TABLET
ALIVE WOMEN'S ENERGY MV TABLET
ALIVE WOMEN'S GUMMY VITAMIN
ALL DAY PAIN RELIEF 220 MG TAB
ALL DAY PAIN RLF 220 MG CAPLET
CVS ALL DAY PAIN RLF 220 MG TB
GNP ALL DAY PAIN RLF 220 MG TB
SM ALL DAY RELIEF 220 MG CAPLT
ALL DAY RELIEF 220 MG CAPLET
ALL DAY RELIEF 220 MG TABLET
PUB ALL DAY RELIEF 220 MG TAB
PUB ALL DAY RLF 220 MG CAPLET
CVS ALLERGY RELIEF 5 MG TABLET
ALLOPURINOL 100 MG TABLET
ALLOPURINOL 300 MG TABLET
ALOGLIPTIN 12.5 MG TABLET
ALOGLIPTIN 25 MG TABLET
ALOGLIPTIN 6.25 MG TABLET
ALOGLIPTIN-METFORMIN 12.5-1000
ALOGLIPTIN-METFORMIN 12.5-500
ALOGLIPTIN-PIOGLIT 12.5-15 MG
ALOGLIPTIN-PIOGLIT 12.5-30 MG
ALOGLIPTIN-PIOGLIT 12.5-45 MG
ALOGLIPTIN-PIOGLIT 25-15 MG TB
ALOGLIPTIN-PIOGLIT 25-30 MG TB
ALOGLIPTIN-PIOGLIT 25-45 MG TB
ALORA 0.025 MG PATCH
ALORA 0.05 MG PATCH
ALORA 0.075 MG PATCH
ALORA 0.1 MG PATCH
ALPHAGAN P 0.1% DROPS
ALPHAGAN P 0.15% EYE DROPS
ALPHANATE 1,000-400 UNIT VIAL
ALPHANATE 1,500-600 UNIT VIAL
ALPHANATE 2,000-800 UNIT VIAL
ALPHANATE 250-100 UNIT VIAL
ALPHANATE 500-200 UNIT VIAL
ALPHANINE SD 1,000 UNIT VIAL
ALPHANINE SD 1,500 UNIT VIAL
ALPHANINE SD 500 UNIT VIAL
ALPROLIX 1,000 UNIT NOMINAL
ALPROLIX 2,000 UNIT NOMINAL
ALPROLIX 250 UNIT NOMINAL
ALPROLIX 3,000 UNIT NOMINAL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ALPROLIX 4,000 UNIT NOMINAL
ALPROLIX 500 UNIT NOMINAL
ALTACE 1.25 MG CAPSULE
ALTACE 10 MG CAPSULE
ALTACE 2.5 MG CAPSULE
ALTACE 5 MG CAPSULE
ALTACHLORE 5% OINTMENT
ALTACHLORE 5% OPHTH SOLN
ALTAVERA-28 TABLET
ALTERNARIA 20,000 PNU/ML VIAL
ALTERNATE SITE 26G LANCETS
ALTOPREV 20 MG TABLET
ALTOPREV 40 MG TABLET
ALTOPREV 60 MG TABLET
ALUNBRIG 180 MG TABLET
ALUNBRIG 30 MG TABLET
ALUNBRIG 90 MG TABLET
ALVESCO 160 MCG INHALER
ALVESCO 80 MCG INHALER
ALYACEN 1-35 28 TABLET
ALYACEN 7-7-7-28 TABLET
ALYQ 20 MG TABLET
AMABELZ 0.5 MG-0.1 MG TABLET
AMABELZ 1 MG-0.5 MG TABLET
AMANTADINE 100 MG CAPSULE
AMANTADINE 100 MG TABLET
AMANTADINE 100 MG/10 ML SOLN
AMANTADINE 50 MG/5 ML SOLUTION
AMARYL 1 MG TABLET
AMARYL 2 MG TABLET
AMARYL 4 MG TABLET
AMBRISENTAN 10 MG TABLET
AMBRISENTAN 5 MG TABLET
AMERICAN BEECH 1:20 W/V VIAL
AMERICAN COCKROACH 1:20 (W/V)
AMERICAN ELM 1:20 (W/V) VIAL
AMERICAN SYCAMORE 1:20 (W/V)
AMETHIA 0.15-0.03-0.01 MG TAB
AMETHIA LO TABLET
AMETHYST 90-20 MCG TABLET
AMILORIDE HCL 5 MG TABLET
AMILORIDE HCL-HCTZ 5-50 MG TAB
AMIODARONE HCL 100 MG TABLET
AMIODARONE HCL 200 MG TABLET
AMIODARONE HCL 400 MG TABLET
AMITIZA 24 MCG CAPSULES
AMITIZA 8 MCG CAPSULE
AMITRIPTYLINE HCL 10 MG TAB
AMITRIPTYLINE HCL 100 MG TAB
AMITRIPTYLINE HCL 150 MG TAB
AMITRIPTYLINE HCL 25 MG TAB
AMITRIPTYLINE HCL 50 MG TAB
AMITRIPTYLINE HCL 75 MG TAB
AMLODIPINE BESYLATE 10 MG TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
AMLODIPINE BESYLATE 2.5 MG TAB
AMLODIPINE BESYLATE 5 MG TAB
AMLODIPINE-BENAZEPRIL 10-20 MG
AMLODIPINE-BENAZEPRIL 10-40 MG
AMLODIPINE-BENAZEPRIL 2.5-10
AMLODIPINE-BENAZEPRIL 5-10 MG
AMLODIPINE-BENAZEPRIL 5-20 MG
AMLODIPINE-BENAZEPRIL 5-40 MG
AMLODIPINE-ATORVAST 10-10 MG
AMLODIPINE-ATORVAST 10-20 MG
AMLODIPINE-ATORVAST 10-40 MG
AMLODIPINE-ATORVAST 10-80 MG
AMLODIPINE-ATORVAST 2.5-10 MG
AMLODIPINE-ATORVAST 2.5-20 MG
AMLODIPINE-ATORVAST 2.5-40 MG
AMLODIPINE-ATORVAST 5-10 MG
AMLODIPINE-ATORVAST 5-20 MG
AMLODIPINE-ATORVAST 5-40 MG
AMLODIPINE-ATORVAST 5-80 MG
AMLODIPINE-OLMESARTAN 10-20 MG
AMLODIPINE-OLMESARTAN 10-40 MG
AMLODIPINE-OLMESARTAN 5-20 MG
AMLODIPINE-OLMESARTAN 5-40 MG
AMLODIPINE-VALSARTAN 10-160 MG
AMLODIPINE-VALSARTAN 10-320 MG
AMLODIPINE-VALSARTAN 5-160 MG
AMLODIPINE-VALSARTAN 5-320 MG
AMLOD-VALSA-HCTZ 10-160-12.5MG
AMLOD-VALSA-HCTZ 10-160-25 MG
AMLOD-VALSA-HCTZ 10-320-25 MG
AMLOD-VALSA-HCTZ 5-160-12.5 MG
AMLOD-VALSA-HCTZ 5-160-25 MG
AMOXAPINE 100 MG TABLET
AMOXAPINE 150 MG TABLET
AMOXAPINE 25 MG TABLET
AMOXAPINE 50 MG TABLET
AMPHETAMINE ER 1.25 MG/ML SUSP
AMPHETAMINE SULFATE 10 MG TAB
AMPHETAMINE SULFATE 5 MG TAB
AMPYRA ER 10 MG TABLET
ANADROL-50 TABLET
ANAFRANIL 25 MG CAPSULE
ANAFRANIL 50 MG CAPSULE
ANAFRANIL 75 MG CAPSULE
ANAGRELIDE HCL 0.5 MG CAPSULE
ANAGRELIDE HCL 1 MG CAPSULE
ANAPROX DS 550 MG TABLET
ANASPAZ 0.125 MG TABLET ODT
ANASTROZOLE 1 MG TABLET
ANDRODERM 2 MG/24HR PATCH
ANDRODERM 4 MG/24HR PATCH
ANDROGEL 1% GEL PUMP
ANDROGEL 1%(2.5G) GEL PACKET
ANDROGEL 1%(5G) GEL PACKET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ANDROGEL 1.62% GEL PUMP
ANDROGEL 1.62%(1.25G) GEL PCKT
ANDROGEL 1.62%(2.5G) GEL PCKT
ANDROID 10 MG CAPSULE
ANDROXY 10 MG TABLET
ANGELIQ 0.25 MG-0.5 MG TABLET
ANGELIQ 0.5 MG-1 MG TABLET
ANIMAL CHEWS TABLET
ANIMAL SHAPES CHEWABLE TABLET
SM ANIMAL SHAPES COMPLETE CHEW
HM ANIMAL SHAPES COMPLETE CHEW
ANIMAS VIBE INSULIN PUMP-CGM
ANIMI-3 CAPSULE
ANNOVERA VAGINAL RING
ANORO ELLIPTA 62.5-25 MCG INH
ANTABUSE 250 MG TABLET
ANTABUSE 500 MG TABLET
ANTARA 30 MG CAPSULE
ANTARA 90 MG CAPSULE
SB ANTI-DIARRHEA 2 MG CAPLET
ANTI-DIARRHEAL 1 MG/7.5 ML SOL
ANTI-DIARRHEAL 2 MG CAPLET
ANTI-DIARRHEAL 2 MG SOFTGEL
ANTI-DIARRHEAL 2 MG TABLET
CVS ANTI-DIARRHEAL 2 MG CAPLET
CVS ANTI-DIARRHEAL 2 MG SFTGEL
EQ ANTI-DIARRHEAL 2 MG CAPLET
EQ ANTI-DIARRHEAL 2 MG SFTGEL
EQL ANTI-DIARRHEAL 2 MG CAPLET
GNP ANTI-DIARRHEAL 2 MG CAPLET
GS ANTI-DIARRHEAL 2 MG CAPLET
HM ANTI-DIARRHEAL 2 MG CAPLET
QC ANTI-DIARRHEAL 2 MG CAPLET
QC ANTI-DIARRHEAL 2 MG SOFTGEL
RA ANTI-DIARRHEAL 2 MG CAPLET
RA ANTI-DIARRHEAL 2 MG SOFTGEL
SM ANTI-DIARRHEAL 1 MG/7.5 ML
SM ANTI-DIARRHEAL 2 MG CAPLET
SM ANTI-DIARRHEAL 2 MG SOFTGEL
ANTIOXIDANT FORMULA TABLET
HM ANTIOXIDANT VITAMINS TABLET
SM ANTIOXIDANT VITAMINS TABLET
APATATE FORTE LIQUID
APIDRA 100 UNITS/ML VIAL
APIDRA SOLOSTAR 100 UNITS/ML
APLENZIN ER 174 MG TABLET
APLENZIN ER 348 MG TABLET
APLENZIN ER 522 MG TABLET
APOKYN 30 MG/3 ML CARTRIDGE
APRI 28 DAY TABLET
APRISO ER 0.375 GRAM CAPSULE
APTENSIO XR 10 MG CAPSULE
APTENSIO XR 15 MG CAPSULE
APTENSIO XR 20 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
APTENSIO XR 30 MG CAPSULE
APTENSIO XR 40 MG CAPSULE
APTENSIO XR 50 MG CAPSULE
APTENSIO XR 60 MG CAPSULE
APTIOM 200 MG TABLET
APTIOM 400 MG TABLET
APTIOM 600 MG TABLET
APTIOM 800 MG TABLET
APTIVUS 250 MG CAPSULE
APTIVUS 100 MG/ML SOLUTION
AQUADEKS CHEWABLE TABLET
AQUADEKS PEDIATRIC LIQUID
ARALAST NP 1,000 MG VIAL
ARALAST NP 500 MG VIAL
ARANELLE 28 TABLET
ARANESP 10 MCG/0.4 ML SYRINGE
ARANESP 100 MCG/0.5 ML SYRINGE
ARANESP 100 MCG/ML VIAL
ARANESP 150 MCG/0.3 ML SYRINGE
ARANESP 150 MCG/0.75 ML VIAL
ARANESP 200 MCG/0.4 ML SYRINGE
ARANESP 200 MCG/ML VIAL
ARANESP 25 MCG/0.42 ML SYRING
ARANESP 25 MCG/ML VIAL
ARANESP 300 MCG/0.6 ML SYRINGE
ARANESP 300 MCG/ML VIAL
ARANESP 40 MCG/0.4 ML SYRINGE
ARANESP 40 MCG/ML VIAL
ARANESP 500 MCG/1 ML SYRINGE
ARANESP 60 MCG/0.3 ML SYRINGE
ARANESP 60 MCG/ML VIAL
ARAVA 10 MG TABLET
ARAVA 20 MG TABLET
ARCALYST 220 MG INJECTION
ARCAPTA NEOHALER 75 MCG CAP
ARICEPT 10 MG TABLET
ARICEPT 23 MG TABLET
ARICEPT 5 MG TABLET
ARIMIDEX 1 MG TABLET
ARIPIPRAZOLE 1 MG/ML SOLUTION
ARIPIPRAZOLE 10 MG TABLET
ARIPIPRAZOLE 15 MG TABLET
ARIPIPRAZOLE 2 MG TABLET
ARIPIPRAZOLE 20 MG TABLET
ARIPIPRAZOLE 30 MG TABLET
ARIPIPRAZOLE 5 MG TABLET
ARIPIPRAZOLE ODT 10 MG TABLET
ARIPIPRAZOLE ODT 15 MG TABLET
ARISTADA ER 1064 MG/3.9 ML SYR
ARISTADA ER 441 MG/1.6 ML SYRN
ARISTADA ER 662 MG/2.4 ML SYRN
ARISTADA ER 882 MG/3.2 ML SYRN
ARIZONA CYPRESS 1:20 (W/V) VL
ARMODAFINIL 150 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ARMODAFINIL 200 MG TABLET
ARMODAFINIL 250 MG TABLET
ARMODAFINIL 50 MG TABLET
ARMONAIR RESPICLICK 113 MCG
ARMONAIR RESPICLICK 232 MCG
ARMONAIR RESPICLICK 55 MCG
ARMOUR THYROID 120 MG TABLET
ARMOUR THYROID 15 MG TABLET
ARMOUR THYROID 180 MG TABLET
ARMOUR THYROID 240 MG TABLET
ARMOUR THYROID 30 MG TABLET
ARMOUR THYROID 300 MG TABLET
ARMOUR THYROID 60 MG TABLET
ARMOUR THYROID 90 MG TABLET
ARNUITY ELLIPTA 100 MCG INH
ARNUITY ELLIPTA 200 MCG INH
ARNUITY ELLIPTA 50 MCG INH
AROMASIN 25 MG TABLET
ARTHROTEC 50 MG-200 MCG TAB
ARTHROTEC 75 MG-200 MCG TAB
ASACOL HD DR 800 MG TABLET
ASCENIV 10% VIAL
ASHLYNA 0.15-0.03-0.01 MG TAB
ASMANEX TWISTHALER 110 MCG #30
ASMANEX TWISTHALER 110 MCG #7
ASMANEX TWISTHALER 220 MCG #14
ASMANEX TWISTHALER 220 MCG #30
ASMANEX TWISTHALER 220 MCG #60
ASMANEX TWISTHALR 220 MCG #120
ASMANEX HFA 100 MCG INHALER
ASMANEX HFA 200 MCG INHALER
ASMANEX HFA 50 MCG INHALER
ASPERGILLUS FUMIGATUS 10000/ML
ASPERGILLUS FUMIGATUS 20000/ML
ASPIR EC 81 MG TABLET
ASPIRIN 325 MG TABLET
ASPIRIN 81 MG CHEWABLE TABLET
BAYER ASPIRIN 325 MG CAPLET
BAYER ASPIRIN 325 MG TABLET
CVS ASPIRIN 325 MG CAPLET
CVS ASPIRIN 325 MG TABLET
CVS ASPIRIN 81 MG CHEWABLE TAB
EQ ASPIRIN 325 MG TABLET
EQ ASPIRIN 81 MG CHEWABLE TAB
EQL ASPIRIN 325 MG TABLET
EQL ASPIRIN 81 MG CHEWABLE TAB
GNP ASPIRIN 325 MG TABLET
GNP ASPIRIN 81 MG CHEWABLE TAB
GS ASPIRIN 325 MG TABLET
GS ASPIRIN 81 MG CHEWABLE TAB
HM ASPIRIN 325 MG TABLET
HM ASPIRIN 81 MG CHEWABLE TAB
KRO ASPIRIN 325 MG TABLET
KRO ASPIRIN 81 MG CHEWABLE TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PUB ASPIRIN 325 MG TABLET
PUB ASPIRIN 81 MG CHEWABLE TAB
QC ASPIRIN 325 MG TABLET
QC ASPIRIN 81 MG CHEWABLE TAB
RA ASPIRIN 325 MG TABLET
RA ASPIRIN 81 MG CHEWABLE TAB
SB ASPIRIN 325 MG TABLET
SM ASPIRIN 325 MG TABLET
SM ASPIRIN 81 MG CHEWABLE TAB
ASPIRIN EC 325 MG TABLET
ASPIRIN EC 81 MG TABLET
CVS ASPIRIN EC 325 MG TABLET
CVS ASPIRIN EC 81 MG TABLET
EQ ASPIRIN EC 325 MG TABLET
EQ ASPIRIN EC 81 MG TABLET
EQL ASPIRIN EC 325 MG TABLET
EQL ASPIRIN EC 81 MG TABLET
GNP ASPIRIN EC 325 MG TABLET
GNP ASPIRIN EC 81 MG TABLET
GS ASPIRIN EC 325 MG TABLET
GS ASPIRIN EC 81 MG TABLET
HM ASPIRIN EC 325 MG TABLET
HM ASPIRIN EC 81 MG TABLET
QC ASPIRIN EC 325 MG TABLET
QC ASPIRIN EC 81 MG TABLET
RA ASPIRIN EC 325 MG TABLET
RA ASPIRIN EC 81 MG TABLET
SB ASPIRIN EC 81 MG TABLET
SM ASPIRIN EC 325 MG TABLET
SM ASPIRIN EC 81 MG TABLET
ASPIRIN-DIPYRIDAM ER 25-200 MG
ASPIRIN-OMEPRAZOL DR 325-40 MG
ASPIRIN-OMEPRAZOLE DR 81-40 MG
ASPIR-LOW EC 81 MG TABLET
ASPIR-TRIN EC 325 MG TABLET
ASSURE 4 TEST STRIPS
ASSURE 4 CONTROL SOLUTION
ASSURE DOSE CONTROL SOLUTION
ASSURE DOSE CONTROL SOLUTION
ASSURE HAEMOLANCE PLUS BLADE
ASSURE HAEMOLANCE PLUS 18G
ASSURE HAEMOLANCE PLUS 21G
ASSURE HAEMOLANCE PLUS 25G
ASSURE HAEMOLANCE PLUS 28G
ASSURE ID SYR 1 ML 29GX1/2"
ASSURE ID SYR 0.5 ML 29GX1/2"
ASSURE ID PEN NEEDLE 30GX3/16"
ASSURE ID PEN NEEDLE 30GX5/16"
ASSURE ID PEN NEEDLE 31GX3/16"
ASSURE LANCE 25G LANCETS
ASSURE LANCE 28G LANCETS
ASSURE LANCE 28G SAFETY LANCET
ASSURE LANCE PLUS 21G LANCETS
ASSURE LANCE PLUS 25G LANCETS
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ASSURE LANCE PLUS 30G LANCETS
ASSURE PLATINUM TEST STRIPS
ASSURE PLATINUM GLUCOSE METER
ASSURE PLATINUM TEST STRIP
ASSURE PRISM CONTROL SOLUTION
ASSURE PRISM MULTI TEST STRIPS
ASSURE PRISM MULTI METER
ASTAGRAF XL 0.5 MG CAPSULE
ASTAGRAF XL 1 MG CAPSULE
ASTAGRAF XL 5 MG CAPSULE
ASTEPRO 0.15% NASAL SPRAY
CVS AT HOME A1C TEST KIT
ATABEX EC CAPLET
ATACAND 16 MG TABLET
ATACAND 32 MG TABLET
ATACAND 4 MG TABLET
ATACAND 8 MG TABLET
ATACAND HCT 16-12.5 MG TAB
ATACAND HCT 32-12.5 MG TAB
ATACAND HCT 32-25 MG TABLET
ATAZANAVIR SULFATE 150 MG CAP
ATAZANAVIR SULFATE 200 MG CAP
ATAZANAVIR SULFATE 300 MG CAP
ATELVIA DR 35 MG TABLET
ATENOLOL 100 MG TABLET
ATENOLOL 25 MG TABLET
ATENOLOL 50 MG TABLET
ATENOLOL-CHLORTHALIDONE 100-25
ATENOLOL-CHLORTHALIDONE 50-25
ATOMOXETINE HCL 10 MG CAPSULE
ATOMOXETINE HCL 100 MG CAPSULE
ATOMOXETINE HCL 18 MG CAPSULE
ATOMOXETINE HCL 25 MG CAPSULE
ATOMOXETINE HCL 40 MG CAPSULE
ATOMOXETINE HCL 60 MG CAPSULE
ATOMOXETINE HCL 80 MG CAPSULE
ATORVASTATIN 10 MG TABLET
ATORVASTATIN 20 MG TABLET
ATORVASTATIN 40 MG TABLET
ATORVASTATIN 80 MG TABLET
ATRIPLA TABLET
ATROPINE 1% EYE DROPS
ATROPINE 1% EYE OINTMENT
ATROVENT 17 MCG HFA INHALER
AUBAGIO 14 MG TABLET
AUBAGIO 7 MG TABLET
AUBRA-28 TABLET
AUBRA EQ-28 TABLET
AUREOBASIDIUM 10,000 PNU/ML VL
AUREOBASIDIUM 20,000 PNU/ML VL
AUROVELA 1 MG-20 MCG TABLET
AUROVELA 21 1.5-30 TABLET
AUROVELA 24 FE 1 MG-20 MCG TAB
AUROVELA FE 1.5 MG-30 MCG TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
AUROVELA FE 1-20 TABLET
AURYXIA 210 MG TABLET
AUSTEDO 12 MG TABLET
AUSTEDO 6 MG TABLET
AUSTEDO 9 MG TABLET
AUSTRALIAN PINE 1:20 (W/V) VL
AUTOJECT 2 INJECTION DEVICE
AUTOLET IMPRESS LANCING DEVICE
AUTOPEN 1 TO 21 UNITS
AUTOPEN 2 TO 42 UNITS
BD AUTOSHIELD DUO NDL 5MMX30G
BD AUTOSHIELD NEEDLE 5MMX29G
BD AUTOSHIELD NEEDLE 8MMX29G
AUTOSOFT 30 INFUS SET 23" 13MM
AUTOSOFT 30 INFUS SET 43" 13MM
AUTOSOFT 90 INFUSN SET 23" 6MM
AUTOSOFT 90 INFUSN SET 23" 9MM
AUTOSOFT 90 INFUSN SET 43" 6MM
AUTOSOFT 90 INFUSN SET 43" 9MM
AUTOSOFT XC INFUSN SET 23" 6MM
AUTOSOFT XC INFUSN SET 23" 9MM
AUTOSOFT XC INFUSN SET 32" 6MM
AUTOSOFT XC INFUSN SET 43" 6MM
AUTOSOFT XC INFUSN SET 43" 9MM
AVALIDE 150-12.5 MG TABLET
AVALIDE 300-12.5 MG TABLET
AVANDAMET 2 MG-1,000 MG TAB
AVANDAMET 2 MG-500 MG TABLET
AVANDIA 2 MG TABLET
AVANDIA 4 MG TABLET
AVAPRO 150 MG TABLET
AVAPRO 300 MG TABLET
AVAPRO 75 MG TABLET
AVEED 750 MG/3 ML VIAL
AVIANE-28 TABLET
AVODART 0.5 MG SOFTGEL
AVONEX PREFILLED SYR 30 MCG
AVONEX PREFILLED SYR 30 MCG KT
AVONEX 30 MCG VIAL KIT
AVONEX PEN 30 MCG/0.5 ML KIT
AV-VITE FB TABLET
AV-VITE FB FORTE TABLET
AXIRON 30 MG/ACTUATION SOLN
AYGESTIN 5 MG TABLET
AYUNA-28 TABLET
AYVAKIT 100 MG TABLET
AYVAKIT 200 MG TABLET
AYVAKIT 300 MG TABLET
AZASAN 100 MG TABLET
AZASAN 75 MG TABLET
AZATHIOPRINE 50 MG TABLET
AZELASTINE 0.1% (137 MCG) SPRY
AZELASTINE 0.15% NASAL SPRAY
AZESCO TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
AZILECT 0.5 MG TABLET
AZILECT 1 MG TABLET
AZOPT 1% EYE DROPS
AZOR 10-20 MG TABLET
AZOR 10-40 MG TABLET
AZOR 5-20 MG TABLET
AZOR 5-40 MG TABLET
AZULFIDINE 500 MG TABLET
AZULFIDINE ENTAB 500 MG
AZURETTE 28 DAY TABLET
RA B-COMPLEX TABLET
B COMPLEX FORMULA #1 TABLET
B COMPLEX WITH VITAMIN C CAP
B COMPLEX-FOLIC ACID TABLET
BABY IRON-MULTIVITAMIN DROP
BACLOFEN 10 MG TABLET
BACLOFEN 10 MG/20 ML VIAL
BACLOFEN 20 MG TABLET
BACLOFEN 20,000 MCG/20 ML VIAL
BACLOFEN 40 MG/20 ML VIAL
BACLOFEN 5 MG TABLET
BACMIN CAPLET
BAHIA 1:20 (W/V) VIAL
CVS BAL B-100 TABLET
CVS BAL B-50 TABLET
BALANCE B-100 TABLET
BALANCE B-50 TABLET
RA BALANCED B-100 TABLET
BALANCED B-50 TABLET
RA BALANCED B-50 TABLET
BAL-CARE DHA COMBO PACK
BAL-CARE DHA ESSENTIAL PACK
BALCOLTRA TABLET
BALD CYPRESS 1:20 (W/V) VIAL
BALVERSA 3 MG TABLET
BALVERSA 4 MG TABLET
BALVERSA 5 MG TABLET
BALZIVA 28 TABLET
BANZEL 200 MG TABLET
BANZEL 40 MG/ML SUSPENSION
BANZEL 400 MG TABLET
BARACLUDE 0.05 MG/ML SOLUTION
BARACLUDE 0.5 MG TABLET
BARACLUDE 1 MG TABLET
BARIATRIC MV-IRON 45 MG CAP
BASAGLAR 100 UNIT/ML KWIKPEN
BAVENCIO 200 MG/10 ML VIAL
BAYBERRY 1:20 (W/V) VIAL
BAYER ASPIRIN 81 MG CHEW TAB
B-COMPLEX TABLET
B-COMPLEX PLUS VITAMIN C CPLT
B-COMPLEX PLUS VITAMIN C CPLT
GNP B-COMPLEX PLUS VIT C TAB
B-COMPLEX WITH C TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SM B COMPLEX WITH VIT C TABLET
BD MICROTAINER 21G LANCETS
BD MICROTAINER 30G LANCETS
BD ULTRA-FINE 33G LANCETS
BD ULTRA-FINE II 30G LANCETS
BEBULIN 200-1,200 UNITS VIAL
BECONASE AQ 0.042% SPRAY
BEE-ZEE TABLET
BEKYREE 28 DAY TABLET
BELEODAQ 500 MG VIAL
BELLADONNA-PHENOBARBITAL TAB
BELVIQ 10 MG TABLET
BELVIQ XR 20 MG TABLET
BENAZEPRIL HCL 10 MG TABLET
BENAZEPRIL HCL 20 MG TABLET
BENAZEPRIL HCL 40 MG TABLET
BENAZEPRIL HCL 5 MG TABLET
BENAZEPRIL-HCTZ 10-12.5 MG TAB
BENAZEPRIL-HCTZ 20-12.5 MG TAB
BENAZEPRIL-HCTZ 20-25 MG TAB
BENAZEPRIL-HCTZ 5-6.25 MG TAB
BENEFIX 1,000 UNIT RANGE
BENEFIX 2,000 UNIT RANGE
BENEFIX 250 UNIT RANGE
BENEFIX 3,000 UNIT RANGE
BENEFIX 500 UNIT RANGE
BENICAR 20 MG TABLET
BENICAR 40 MG TABLET
BENICAR 5 MG TABLET
BENICAR HCT 20-12.5 MG TABLET
BENICAR HCT 40-12.5 MG TABLET
BENICAR HCT 40-25 MG TABLET
BENLYSTA 120 MG VIAL
BENLYSTA 200 MG/ML AUTOINJECT
BENLYSTA 200 MG/ML SYRINGE
BENLYSTA 400 MG VIAL
BENTYL 10 MG CAPSULE
BENZTROPINE MES 0.5 MG TAB
BENZTROPINE MES 1 MG TABLET
BENZTROPINE MES 2 MG TABLET
BEOVU 6 MG/0.05 ML VIAL
BERINERT 500 UNIT KIT
BEROCCA EFFERVESCENT TABLET
BETAGAN 0.5% EYE DROPS
BETAPACE 120 MG TABLET
BETAPACE 160 MG TABLET
BETAPACE 240 MG TABLET
BETAPACE 80 MG TABLET
BETAPACE AF 120 MG TABLET
BETAPACE AF 160 MG TABLET
BETAPACE AF 80 MG TABLET
BETASERON 0.3 MG KIT
BETAXOLOL 10 MG TABLET
BETAXOLOL 20 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
BETAXOLOL HCL 0.5% EYE DROP
BETHANECHOL 10 MG TABLET
BETHANECHOL 25 MG TABLET
BETHANECHOL 5 MG TABLET
BETHANECHOL 50 MG TABLET
BETHKIS 300 MG/4 ML AMPULE
BETIMOL 0.25% EYE DROPS
BETIMOL 0.5% EYE DROPS
BETOPTIC S 0.25% EYE DROPS
BEVESPI AEROSPHERE INHALER
BEXAROTENE 75 MG CAPSULE
BEYAZ 28 TABLET
BICALUTAMIDE 50 MG TABLET
BIDIL TABLET
BIJUVA 1 MG-100 MG CAPSULE
BIKTARVY 50-200-25 MG TABLET
BIMATOPROST 0.03% EYE DROPS
BINOSTO 70 MG EFFERVESCENT TAB
BINOSTO 70 MG TABLET EFF
BIO-35 SOFTGEL
BIOCEL TABLET
BIOSUPP LIQUID
BIOTECT PLUS LIQUID
BIOTIN 1,000 MCG GUMMIES
BIOTIN 1,000 MCG TABLET
BIOTIN 10 MG TABLET
BIOTIN 10,000 MCG SOFTGEL
BIOTIN 10,000 MCG TABLET
BIOTIN 2,500 MCG SOFTGEL
BIOTIN 300 MCG TABLET
BIOTIN 5 MG TABLET
BIOTIN 5,000 MCG CAPSULE
BIOTIN 5,000 MCG FAST DISSOLVE
BIOTIN 5,000 MCG QUICK DISSOLV
BIOTIN 5,000 MCG SOFTGEL
BIOTIN 5,000 MCG TABLET
BIOTIN 800 MCG TABLET
CVS BIOTIN 1,000 MCG TABLET
CVS BIOTIN 10,000 MCG SOFTGEL
CVS BIOTIN 5,000 MCG CAPSULE
GNP BIOTIN 5,000 MCG CAPSULE
HM BIOTIN 10,000 MCG TABLET
HM BIOTIN 5,000 MCG CAPSULE
RA BIOTIN 2,500 MCG CAPSULE
SM BIOTIN 5,000 MCG CAPSULE
SM BIOTIN 5,000 MCG TABLET
SV BIOTIN 1,000 MCG SOFTGEL
SV BIOTIN 5,000 MCG SOFTGEL
BIOTIN FORTE 3 MG TABLET
BIOTIN FORTE 5 MG TABLET
BIOTIN PLUS-CALCIUM & VIT D3
BIOVOL SYRUP
BISOPROLOL FUMARATE 10 MG TAB
BISOPROLOL FUMARATE 5 MG TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
BISOPROLOL-HCTZ 10-6.25 MG TAB
BISOPROLOL-HCTZ 2.5-6.25 MG TB
BISOPROLOL-HCTZ 5-6.25 MG TAB
BIVIGAM 10% VIAL
BIVIGAM LIQUID 10% VIAL
BLACK WALNUT POLLEN 1:20 (W/V)
BLACK WILLOW 1:20 (W/V) VIAL
BLADDER 2.2 TABLET
BLISOVI 24 FE TABLET
BLISOVI FE 1.5-30 TABLET
BLISOVI FE 1-20 TABLET
BLOOD GLUCOSE CONTROL SOLUTION
GLUCOCOM BLOOD GLUCOSE METER
BLOOD GLUCOSE MONITORING SYST
CAREONE GLUCOSE MONITORING SYS
GS BLOOD GLUCOSE MONITOR SYS
REXALL GLUCOSE MONITORING SYS
UP & UP BLOOD MONITORING SYST
BLOOD GLUCOSE TEST STRIP
CAREONE BLOOD GLUCOSE TST STRP
EQ BLOOD GLUCOSE TEST STRIP
GHT BLOOD GLUCOSE TEST STRIP
GS BLOOD GLUCOSE TEST STRIP
REXALL BLOOD GLUCOSE TEST STRP
UP & UP BLOOD GLUCOSE TST STRP
BLOOD KETONE TEST STRIP
BLOOD LANCETS 30G
GLUCOSE CONTROL SOLUTION
FIFTY50 2.0 GLUCOSE METER
BODY, HAIR, SKIN AND NAILS CAP
BONIVA 150 MG TABLET
BONIVA 3 MG/3 ML SYRINGE
BOSENTAN 125 MG TABLET
BOSENTAN 62.5 MG TABLET
BOSULIF 100 MG TABLET
BOSULIF 400 MG TABLET
BOSULIF 500 MG TABLET
BOX ELDER 1:20 (W/V) VIAL
BRAFTOVI 50 MG CAPSULE
BRAFTOVI 75 MG CAPSULE
BRAINSTRONG PRENATAL COMBO PAC
BREEZE 2 DISC TEST STRIP
BREEZE 2 SOLUTION
BREEZE 2 SOLUTION
BREEZE 2 SOLUTION
BREO ELLIPTA 100-25 MCG INH
BREO ELLIPTA 200-25 MCG INH
BREVICON 28 TABLET
BRIELLYN TABLET
BRILINTA 60 MG TABLET
BRILINTA 90 MG TABLET
BRIMONIDINE 0.2% EYE DROP
BRIMONIDINE TARTRATE 0.15% DRP
BRIMONIDINE 0.15%-DORZOLAM 2%
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
BRINEURA 2X150MG/5ML-ELYTE KIT
BRISDELLE 7.5 MG CAPSULE
BRIVIACT 10 MG TABLET
BRIVIACT 10 MG/ML ORAL SOLN
BRIVIACT 100 MG TABLET
BRIVIACT 25 MG TABLET
BRIVIACT 50 MG TABLET
BRIVIACT 75 MG TABLET
BROME 1:20 W/V VIAL
BROMOCRIPTINE 2.5 MG TABLET
BROMOCRIPTINE 5 MG CAPSULE
BROVANA 15 MCG/2 ML SOLUTION
BRUKINSA 80 MG CAPSULE
BUDESONIDE 0.25 MG/2 ML SUSP
BUDESONIDE 0.5 MG/2 ML SUSP
BUDESONIDE 1 MG/2 ML INH SUSP
BUDESONIDE 32 MCG NASAL SPRAY
BUDESONIDE-FORMOTEROL 160-4.5
BUDESONIDE-FORMOTEROL 80-4.5
BUFFERED ASPIRIN 325 MG TB
CVS BUFFERED ASPIRIN 325 MG TB
BUFFERIN 325 MG TABLET
BULLSEYE MINI SAFETY 21G
BULLSEYE MINI SAFETY 25G LANCT
BULLSEYE MINI SAFETY 28G LANCT
BUMETANIDE 0.5 MG TABLET
BUMETANIDE 1 MG TABLET
BUMETANIDE 2 MG TABLET
BUNAVAIL 2.1-0.3 MG FILM
BUNAVAIL 4.2-0.7 MG FILM
BUNAVAIL 6.3-1 MG FILM
BUPHENYL 500 MG TABLET
BUPHENYL POWDER
BUPRENO-NALOX 2-0.5 MG SL FILM
BUPRENOR-NALOX 12-3 MG SL FILM
BUPRENORPHIN-NALOXON 8-2 MG SL
BUPRENORPHN-NALOXN 2-0.5 MG SL
BUPRENORP-NALOX 4-1 MG SL FILM
BUPRENORP-NALOX 8-2 MG SL FILM
BUPROPION HCL 100 MG TABLET
BUPROPION HCL 75 MG TABLET
BUPROPION HCL ER 200 MG TABLET
BUPROPION HCL SR 100 MG TABLET
BUPROPION HCL SR 150 MG TABLET
BUPROPION HCL SR 200 MG TABLET
BUPROPION HCL XL 150 MG TABLET
BUPROPION HCL XL 300 MG TABLET
BUPROPION HCL XL 450 MG TABLET
BUSPIRONE HCL 10 MG TABLET
BUSPIRONE HCL 15 MG TABLET
BUSPIRONE HCL 30 MG TABLET
BUSPIRONE HCL 5 MG TABLET
BUSPIRONE HCL 7.5 MG TABLET
BYDUREON 2 MG VIAL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
BYDUREON BCISE 2 MG AUTOINJECT
BYDUREON 2 MG PEN INJECT
BYETTA 10 MCG DOSE PEN INJ
BYETTA 5 MCG DOSE PEN INJ
BYSTOLIC 10 MG TABLET
BYSTOLIC 2.5 MG TABLET
BYSTOLIC 20 MG TABLET
BYSTOLIC 5 MG TABLET
BYVALSON 5 MG-80 MG TABLET
CABERGOLINE 0.5 MG TABLET
CABOMETYX 20 MG TABLET
CABOMETYX 40 MG TABLET
CABOMETYX 60 MG TABLET
CADEAU DHA SOFTGEL
CADUET 10 MG-10 MG TABLET
CADUET 10 MG-20 MG TABLET
CADUET 10 MG-40 MG TABLET
CADUET 10 MG-80 MG TABLET
CADUET 2.5 MG-10 MG TABLET
CADUET 2.5 MG-20 MG TABLET
CADUET 2.5 MG-40 MG TABLET
CADUET 5 MG-10 MG TABLET
CADUET 5 MG-20 MG TABLET
CADUET 5 MG-40 MG TABLET
CADUET 5 MG-80 MG TABLET
CALAN 120 MG TABLET
CALAN 80 MG TABLET
CALAN SR 120 MG CAPLET
CALAN SR 180 MG CAPLET
CALAN SR 240 MG CAPLET
CALCITONIN-SALMON 200 UNITS SP
CALCITRIOL 0.25 MCG CAPSULE
CALCITRIOL 0.5 MCG CAPSULE
CALCITRIOL 1 MCG/ML SOLUTION
CVS CALCIUM CHEWABLES PLUS TAB
CALCIUM ACETATE 667 MG CAPSULE
CALCIUM ACETATE 667 MG GELCAP
CALCIUM ACETATE 667 MG TABLET
CAL PEPPER TREE 1:20 (W/V)
CALQUENCE 100 MG CAPSULE
CAMILA 0.35 MG TABLET
CAMRESE 0.15-0.03-0.01 MG TAB
CAMRESE LO TABLET
CANASA 1,000 MG SUPPOSITORY
CANDESARTAN CILEXETIL 16 MG TB
CANDESARTAN CILEXETIL 32 MG TB
CANDESARTAN CILEXETIL 4 MG TAB
CANDESARTAN CILEXETIL 8 MG TAB
CANDESARTAN-HCTZ 16-12.5 MG TB
CANDESARTAN-HCTZ 32-12.5 MG TB
CANDESARTAN-HCTZ 32-25 MG TAB
CANDIDA ALBICANS 10,000 PNU/ML
CANDIDA ALBICANS 20,000 PNU/ML
CAPLYTA 42 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CAPRELSA 100 MG TABLET
CAPRELSA 300 MG TABLET
CAPTOPRIL 100 MG TABLET
CAPTOPRIL 12.5 MG TABLET
CAPTOPRIL 25 MG TABLET
CAPTOPRIL 50 MG TABLET
CAPTOPRIL-HCTZ 25-15 MG TABLET
CAPTOPRIL-HCTZ 25-25 MG TABLET
CAPTOPRIL-HCTZ 50-15 MG TABLET
CAPTOPRIL-HCTZ 50-25 MG TABLET
CARAFATE 1 GM TABLET
CARAFATE 1 GM/10 ML SUSP
CARBAGLU 200 MG DISPER TABLET
CARBAMAZEPINE 100 MG TAB CHEW
CARBAMAZEPINE 100 MG/5 ML SUSP
CARBAMAZEPINE 200 MG TABLET
CARBAMAZEPINE 200 MG/10 ML LIQ
CARBAMAZEPINE 200 MG/10ML SUSP
CARBAMAZEPINE ER 100 MG CAP
CARBAMAZEPINE ER 100 MG TABLET
CARBAMAZEPINE ER 200 MG CAP
CARBAMAZEPINE ER 200 MG TABLET
CARBAMAZEPINE ER 300 MG CAP
CARBAMAZEPINE ER 400 MG TABLET
CARBATROL ER 100 MG CAPSULE
CARBATROL ER 200 MG CAPSULE
CARBATROL ER 300 MG CAPSULE
CARBIDOPA 25 MG TABLET
CARBIDOPA-LEVO 10-100 MG ODT
CARBIDOPA-LEVO 25-100 MG ODT
CARBIDOPA-LEVO 25-250 MG ODT
CARBIDOPA-LEVODOPA 10-100 TAB
CARBIDOPA-LEVODOPA 25-100 TAB
CARBIDOPA-LEVODOPA 25-250 TAB
CARBIDOPA-LEVO ER 25-100 TAB
CARBIDOPA-LEVO ER 50-200 TAB
CARBIDOPA-LEVODOPA 100 MG-ENTA
CARBIDOPA-LEVODOPA 125 MG-ENTA
CARBIDOPA-LEVODOPA 150 MG-ENTA
CARBIDOPA-LEVODOPA 200 MG-ENTA
CARBIDOPA-LEVODOPA 50 MG-ENTA
CARBIDOPA-LEVODOPA 75 MG-ENTA
CARDIZEM 120 MG TABLET
CARDIZEM 30 MG TABLET
CARDIZEM 60 MG TABLET
CARDIZEM CD 120 MG CAPSULE
CARDIZEM CD 180 MG CAPSULE
CARDIZEM CD 240 MG CAPSULE
CARDIZEM CD 300 MG CAPSULE
CARDIZEM CD 360 MG CAPSULE
CARDIZEM LA 120 MG TABLET
CARDIZEM LA 180 MG TABLET
CARDIZEM LA 240 MG TABLET
CARDIZEM LA 300 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CARDIZEM LA 360 MG TABLET
CARDIZEM LA 420 MG TABLET
CARDURA 1 MG TABLET
CARDURA 2 MG TABLET
CARDURA 4 MG TABLET
CARDURA 8 MG TABLET
CARDURA XL 4 MG TABLET
CARDURA XL 8 MG TABLET
CAREFINE PEN NEEDLE 12.7MM 29G
CAREFINE PEN NEEDLE 4MM 32G
CAREFINE PEN NEEDLE 5MM 32G
CAREFINE PEN NEEDLE 6MM 31G
CAREFINE PEN NEEDLE 8MM 30G
CAREFINE PEN NEEDLES 6MM 32G
CAREFINE PEN NEEDLES 8MM 31G
CAREONE ULTRA THIN LANCET
CARESENS CONTROL SOLUTION
CARESENS N TEST STRIPS
CARESENS N BLOOD GLUCOSE SYST
CARESENS N VOICE GLUCOSE METER
CARETOUCH GLUCOSE MONITOR SYS
CARETOUCH SYR 1 ML 28GX5/16"
CARETOUCH SYR 1 ML 29GX5/16"
CARETOUCH PEN NEEDLE 31GX1/4"
CARETOUCH PEN NEEDLE 31GX3/16"
CARETOUCH PEN NEEDLE 31GX5/16"
CARETOUCH PEN NEEDLE 32GX3/16"
CARETOUCH PEN NEEDLE 32GX5/32"
CARETOUCH TEST STRIP
CARETOUCH TWIST 28G LANCET
CARETOUCH TWIST 30G LANCET
CARETOUCH TWIST 33G LANCET
CARIMUNE NF 12 GM VIAL
CARIMUNE NF 6 GM VIAL
CARNITOR 330 MG TABLET
CARNITOR 100 MG/ML ORAL SOLN
CARNITOR SF 100 MG/ML ORAL SOL
CAROSPIR 25 MG/5 ML SUSPENSION
CARTEOLOL HCL 1% EYE DROPS
CARTIA XT 120 MG CAPSULE
CARTIA XT 180 MG CAPSULE
CARTIA XT 240 MG CAPSULE
CARTIA XT 300 MG CAPSULE
CARTRIDGE STAMPED IR 1200
CARVEDILOL 12.5 MG TABLET
CARVEDILOL 25 MG TABLET
CARVEDILOL 3.125 MG TABLET
CARVEDILOL 6.25 MG TABLET
CARVEDILOL ER 10 MG CAPSULE
CARVEDILOL ER 20 MG CAPSULE
CARVEDILOL ER 40 MG CAPSULE
CARVEDILOL ER 80 MG CAPSULE
CASODEX 50 MG TABLET
CATAPRES 0.1 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CATAPRES 0.2 MG TABLET
CATAPRES 0.3 MG TABLET
CATAPRES-TTS 1 PATCH
CATAPRES-TTS 2 PATCH
CATAPRES-TTS 3 PATCH
CATTLE EPITHELIUM 1:20 VIAL
CAVERJECT 20 MCG VIAL
CAVERJECT 40 MCG VIAL
CAVERJECT IMPULSE 10 MCG KIT
CAVERJECT IMPULSE 10 MCG SYRNG
CAVERJECT IMPULSE 20 MCG KIT
CAVERJECT IMPULSE 20 MCG SYRNG
CAZIANT 28 DAY TABLET
CEDAR ELM 1:20 (W/V) VIAL
CELEBREX 100 MG CAPSULE
CELEBREX 200 MG CAPSULE
CELEBREX 400 MG CAPSULE
CELEBREX 50 MG CAPSULE
CELECOXIB 100 MG CAPSULE
CELECOXIB 200 MG CAPSULE
CELECOXIB 400 MG CAPSULE
CELECOXIB 50 MG CAPSULE
CELEXA 10 MG TABLET
CELEXA 20 MG TABLET
CELEXA 40 MG TABLET
CELLCEPT 200 MG/ML ORAL SUSP
CELLCEPT 250 MG CAPSULE
CELLCEPT 500 MG TABLET
CELONTIN 300 MG KAPSEAL
CENTAMIN LIQUID
RA CENTRAL-VITE TABLET
RA CENTRAL-VITE TABLET
RA CENTRAL-VITE SENIOR TABLET
RA CENTRAL-VITE WOMEN'S TABLET
CENTRAM-CARE MULTIVIT-MIN LIQ
CENTRAVITES TABLET
CENTRAVITES 50 PLUS TABLET
CENTRAVITES 50 PLUS TABLET
CENTRAVITES ADULTS TABLET
CENTRUM MULTIVIT-MINERAL LIQ
CENTRUM CHEWABLES ADULTS TAB
CENTRUM COMPLETE MULTIVIT TAB
CENTRUM FLAVOR BURST ADULT CHW
CENTRUM FLAVOR BURST KIDS CHEW
CENTRUM KIDS CHEWABLE TABLET
CENTRUM MEN'S TABLET
CENTRUM MULTIGUMMIES
CENTRUM SILVER CHEWABLE TABLET
CENTRUM SILVER TABLET
CENTRUM SILVER MEN TABLET
CENTRUM SILVER ULTRA MEN'S TAB
CENTRUM SILVER WOMEN TABLET
CENTRUM SPECIALIST ENERGY TAB
CENTRUM SPECIALIST HEART TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CENTRUM SPECIALIST PRENATAL
CENTRUM ULTRA MEN'S TABLET
CENTRUM WOMEN TABLET
CENTURY TABLET
GNP CENTURY TABLET
CENTURY ADULTS 50 PLUS TABLET
CENTURY CARDIO TABLET
GNP CENTURY CARDIO TABLET
GNP CENTURY MATURE TABLET
EQL CENTURY MATURE TABLET
EQL CENTURY MEN'S TABLET
CENTURY ULTIMATE MEN'S TABLET
CENTURY ULTIMATE MEN'S TABLET
CENTURY ULTIMATE WOMEN'S TAB
CENTURY ULTIMATE WOMEN'S TAB
CEPROTIN 400-600 UNITS VIAL
CEPROTIN 800-1,200 UNITS VIAL
CEQUA 0.09% SOLUTION
CEQUR SIMPLICITY 2 UNIT PATCH
CERDELGA 84 MG CAPSULE
CEREFOLIN CAPLET
CEREZYME 400 UNIT VIAL
CEROVITE LIQUID
CEROVITE ADVANCED FORM TAB
CEROVITE JR TABLET CHEW
CEROVITE SENIOR TABLET
CERTA PLUS TABLET
CERTA VITE LIQUID
CERTAVITE SR-ANTIOXIDANT TAB
CERTAVITE-ANTIOXIDANT TABLET
CERTAVITE-ANTIOXIDANT LIQUID
CEVIMELINE HCL 30 MG CAPSULE
CHATEAL-28 TABLET
CHATEAL EQ-28 TABLET
CHEMSTRIP K
CHEMSTRIP UGK
CHEWABLE-VITE TABLET
CHEW-VITES-IRON TABLET CHEW
CHILD CHEW + IRON TAB CHEW
CVS CHILD CHEW VITAMN COMPLETE
RA CHILD COMPLETE CHEWABLE VIT
EQ CHILD COMPLETE CHEW TABLET
CHILD IBUPROFEN 100 MG/5 ML
LITTLE ANIMALS CHILD TB CHW
CHILD MULTIVITAMIN PLUS IRON
CHILD MULTIVITAMINS TAB CHEW
CVS CHILD VIT-MINERAL TAB
CHILDREN MULTIVITAMIN GUMMIES
CHILDREN'S ADVIL 100 MG/5 ML
CHILD ASPIRIN 81 MG CHEW TAB
CHILD ASPIRIN 81 MG TAB CHEW
CVS CHILD ASPIRIN CHEW TAB
RA CHILD ASPIRIN 81 MG CHW TAB
SB CHILD ASPIRIN 81 MG CHW TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SM CHILD ASPIRIN 81 MG CHW TAB
CHILDREN'S CHEW MULTIVITAMIN
CHILD'S CHEW MULTIVIT W/IRON
CHILD'S CHEW VITAMIN-IRON TAB
CHILDREN'S CHEWABLES
GNP CHILDREN'S CHEWABLES
CHILD'S CHEWABLE MULTIVIT TAB
CHILDRENS CHEW VITAMIN TAB
CHILDREN'S CHEWABLE VITAMIN
CHILD'S CHEWABLE VITAMIN TAB
CHILDREN'S CHEWABLES
GNP CHILDREN'S CHEWABLES
CHILDREN'S CHEWABLES
GNP CHILDREN'S CHEWABLES
CHILDREN'S CHEWABLES
GNP CHILDREN'S CHEWABLES
CHILDREN IBUPROFEN 100 MG/5 ML
CVS CHLD IBUPROFEN 100 MG/5 ML
EQ CHILD IBUPROFEN 100 MG/5 ML
EQL CHLD IBUPROFEN 100 MG/5 ML
GNP CHLD IBUPROFEN 100 MG/5 ML
GS CHILD IBUPROFEN 100 MG/5 ML
HM CHILD IBUPROFEN 100 MG/5 ML
KRO CHLD IBUPROFEN 100 MG/5 ML
QC CHILD IBUPROFEN 100 MG/5 ML
RA CHILD IBUPROFEN 100 MG/5 ML
SB CHILD IBUPROFEN 100 MG/5 ML
CHILDREN'S MOTRIN 100 MG/5 ML
CHILDREN'S MULTI-VIT GUMMIES
CHILDREN MULTIVITAMIN CHEW TAB
CHILDREN MULTIVITAMIN GUMMIES
CHILDREN MULTIVITAMIN GUMMIES
CHILDREN MULTIVITAMIN GUMMIES
CHILDREN MULTIVITAMIN CHEW TAB
EQ CHILD MULTIVITAMIN GUMMIES
CHILDREN MULTIVITAMIN GUMMIES
PUB CHILDREN'S PROFEN IB SUSP
PUB CHILDREN'S PROFENIB SUSP
CHILD VITAMIN-IRON TAB CHEW
CHILD'S OMEGA-3 DHA MULTIVITAM
CVS CHILD'S VITAMIN-IRON TB
CHLORDIAZEPO-AMITRIPTYL 5-12.5
CHLORDIAZEPOX-AMITRIPTYL 10-25
CHLORDIAZEPOXIDE-CLIDINIUM CAP
CHLOROTHIAZIDE 250 MG TABLET
CHLOROTHIAZIDE 500 MG TABLET
CHLORPROMAZINE 10 MG TABLET
CHLORPROMAZINE 100 MG TABLET
CHLORPROMAZINE 200 MG TABLET
CHLORPROMAZINE 25 MG TABLET
CHLORPROMAZINE 50 MG TABLET
CHLORPROPAMIDE 100 MG TABLET
CHLORPROPAMIDE 250 MG TABLET
CHLORTHALIDONE 25 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CHLORTHALIDONE 50 MG TABLET
CHOLBAM 250 MG CAPSULE
CHOLBAM 50 MG CAPSULE
CHOLESTYRAMINE PACKET
CHOLESTYRAMINE POWDER
CHOLESTYRAMINE LIGHT PACKET
CHOLESTYRAMINE LIGHT POWDER
CHOLINE MAG TRISAL LIQUID
CIALIS 10 MG TABLET
CIALIS 2.5 MG TABLET
CIALIS 20 MG TABLET
CIALIS 5 MG TABLET
CILOSTAZOL 100 MG TABLET
CILOSTAZOL 50 MG TABLET
CIMDUO 300-300 MG TABLET
CIMETIDINE 200 MG TABLET
CIMETIDINE 300 MG TABLET
CIMETIDINE 400 MG TABLET
CIMETIDINE 800 MG TABLET
CVS CIMETIDINE 200 MG TABLET
GNP CIMETIDINE 200 MG TABLET
CIMETIDINE 300 MG/5 ML SOLN
CIMZIA 200 MG VIAL KIT
CIMZIA 2X200 MG/ML SYRINGE KIT
CIMZIA 2X200 MG/ML(X3)START KT
CINACALCET HCL 30 MG TABLET
CINACALCET HCL 60 MG TABLET
CINACALCET HCL 90 MG TABLET
CINQAIR 100 MG/10 ML VIAL
CINRYZE 500 UNIT VIAL
CITALOPRAM HBR 10 MG TABLET
CITALOPRAM HBR 10 MG/5 ML SOLN
CITALOPRAM HBR 20 MG TABLET
CITALOPRAM HBR 20 MG/10 ML SOL
CITALOPRAM HBR 40 MG TABLET
CITRANATAL 90 DHA COMBO PACK
CITRANATAL ASSURE COMBO PACK
CITRANATAL B-CALM COMBO PACK
CITRANATAL DHA PACK
CITRANATAL HARMONY CAPSULE
CITRANATAL RX TABLET
C. CLADOSPORIOIDES 10,000/ML
C. CLADOSPORIOIDES 20,000/ML
C. SPHAEROSPERMUM 20,000/ML
CLARINEX 0.5 MG/ML (2.5 MG/5)
CLARINEX 5 MG TABLET
CLASSIC PRENATAL TABLET
CLEO 90 INFUSION SET 24" 6MM
CLEO 90 INFUSION SET 24" 9MM
CLEO 90 INFUSION SET 31" 6MM
CLEO 90 INFUSION SET 31" 9MM
CLEVER CHEK BLOOD GLUCOSE SYST
CLEVER CHEK ULTRA THIN 30G
CLEVER CHOICE GLUCOSE MONITOR
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CLEVER CHOICE BLOOD GLUCOS SYS
CLEVER CHOICE LVL 3 CONTRL SOL
CLEVER CHOICE LVL 1 CONTRL SOL
CLEVER CHOICE LVL 2 CONTRL SOL
CLEVER CHOICE HD GLUCOSE SYST
CLEVER CHOICE MICRO MONITOR
CLEVER CHOICE MICRO TEST STRIP
CLEVER CHOICE PRO TEST STRIP
CLEVER CHOICE PRO GLUCOSE MTR
CLEVER CHOICE TALK TEST STRIPS
CLEVER CHOICE TALK GLUCOSE SYS
CLEVER CHOICE TEST STRIPS
CLEVER CHOICE VOICE+ TST STRIP
CLICKFINE 31G X 1/4" NEEDLES
CLICKFINE 31G X 5/16" NEEDLES
CLICKFINE PEN NEEDLE 32GX5/32"
CLICKFINE UNIVERSAL 31G X 1/4"
CLICKFINE UNIVERSAL 31GX5/16"
GNP CLICKFINE 31G X 1/4" NDL
GNP CLICKFINE 31G X 5/16" NDL
CLIMARA 0.025 MG/DAY PATCH
CLIMARA 0.0375 MG/DAY PATCH
CLIMARA 0.05 MG/DAY PATCH
CLIMARA 0.06 MG/DAY PATCH
CLIMARA 0.075 MG/DAY PATCH
CLIMARA 0.1 MG/DAY PATCH
CLIMARA PRO PATCH
CLINPRO 5000 1.1% TOOTHPASTE
CLOBAZAM 10 MG TABLET
CLOBAZAM 2.5 MG/ML SUSPENSION
CLOBAZAM 20 MG TABLET
CLOMIPRAMINE 25 MG CAPSULE
CLOMIPRAMINE 50 MG CAPSULE
CLOMIPRAMINE 75 MG CAPSULE
CLONAZEPAM 0.125 MG DIS TAB
CLONAZEPAM 0.125 MG ODT
CLONAZEPAM 0.25 MG ODT
CLONAZEPAM 0.5 MG DIS TABLET
CLONAZEPAM 0.5 MG ODT
CLONAZEPAM 0.5 MG TABLET
CLONAZEPAM 1 MG DIS TABLET
CLONAZEPAM 1 MG ODT
CLONAZEPAM 1 MG TABLET
CLONAZEPAM 2 MG ODT
CLONAZEPAM 2 MG TABLET
CLONIDINE 0.1 MG/DAY PATCH
CLONIDINE 0.2 MG/DAY PATCH
CLONIDINE 0.3 MG/DAY PATCH
CLONIDINE HCL 0.1 MG TABLET
CLONIDINE HCL 0.2 MG TABLET
CLONIDINE HCL 0.3 MG TABLET
CLONIDINE HCL ER 0.1 MG TABLET
CLOPIDOGREL 75 MG TABLET
CLOZAPINE 100 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CLOZAPINE 200 MG TABLET
CLOZAPINE 25 MG TABLET
CLOZAPINE 50 MG TABLET
CLOZAPINE ODT 100 MG TABLET
CLOZAPINE ODT 12.5 MG TABLET
CLOZAPINE ODT 150 MG TABLET
CLOZAPINE ODT 200 MG TABLET
CLOZAPINE ODT 25 MG TABLET
CLOZARIL 100 MG TABLET
CLOZARIL 200 MG TABLET
CLOZARIL 25 MG TABLET
CLOZARIL 50 MG TABLET
C-NATE DHA SOFTGEL
COAGUCHEK LANCETS
COAGUCHEK PT TEST STRIPS
COAGUCHEK XS PT TEST STRIPS
COCKLEBUR 1:20 (W/V) VIAL
COLCHICINE 0.6 MG CAPSULE
COLCHICINE 0.6 MG TABLET
COLCRYS 0.6 MG TABLET
COLESEVELAM 625 MG TABLET
COLESEVELAM HCL 3.75 G PACKET
COLESTID 1 GM TABLET
COLESTID FLAVORED GRANULES
COLESTID GRANULES
COLESTID GRANULES PACKET
COLESTIPOL HCL 1 GM TABLET
COLESTIPOL HCL GRANULES
COLESTIPOL HCL GRANULES PACKET
COLESTIPOL MICRONIZED 1 GM TAB
SM COLOR LANCETS 21G
COMBIGAN 0.2%-0.5% EYE DROPS
COMBIPATCH 0.05-0.14 MG PTCH
COMBIPATCH 0.05-0.25 MG PTCH
COMBIVENT RESPIMAT 20-100 MCG
COMBIVIR TABLET
COMETRIQ 100 MG DAILY-DOSE PK
COMETRIQ 140 MG DAILY-DOSE PK
COMETRIQ 60 MG DAILY-DOSE PACK
COMFORT INFUSION SET 23" 17MM
COMFORT INFUSION SET 31" 17MM
COMFORT INFUSION SET 32" 17MM
COMFORT INFUSION SET 43" 17MM
COMFORT EZ SAFETY 23G LANCETS
COMFORT EZ SAFETY 28G LANCETS
COMFORT EZ INS 1 ML 31GX5/16"
COMFORT EZ SYR 1 ML 28GX1/2"
COMFORT EZ SYR 1 ML 29GX1/2"
COMFORT EZ SYR 1 ML 30GX1/2"
COMFORT EZ SYR 1 ML 30GX5/16"
COMFORT EZ INS 0.5ML 31GX5/16"
COMFORT EZ INSULIN SYR 0.5 ML
COMFORT EZ SYR 0.5 ML 28GX1/2"
COMFORT EZ SYR 0.5 ML 29GX1/2"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
COMFORT EZ SYR 0.5 ML 30GX1/2"
COMFORT EZ INS 0.3ML 30GX1/2"
COMFORT EZ INS 0.3ML 30GX5/16"
COMFORT EZ INSULIN SYR 0.3 ML
COMFORT EZ SYR 0.3 ML 29GX1/2"
COMFORT EZ PEN NEEDLE 12MM 29G
COMFORT EZ PEN NEEDLES 4MM 32G
COMFORT EZ PEN NEEDLES 4MM 33G
COMFORT EZ PEN NEEDLES 5MM 31G
COMFORT EZ PEN NEEDLES 5MM 32G
COMFORT EZ PEN NEEDLES 5MM 33G
COMFORT EZ PEN NEEDLES 6MM 31G
COMFORT EZ PEN NEEDLES 6MM 32G
COMFORT EZ PEN NEEDLES 6MM 33G
COMFORT EZ PEN NEEDLES 8MM 31G
COMFORT EZ PEN NEEDLES 8MM 32G
COMFORT EZ PEN NEEDLES 8MM 33G
COMFORT LANCETS
COMFORT SHORT INFUSION SET 23"
COMFORT SHORT INFUSION SET 31"
COMFORT SHORT INFUSION SET 32"
COMFORT SHORT INFUSION SET 43"
COMPANION TABLET
COMPLERA TABLET
SM COMPLETE ADVANCED TABLET
HM COMPLETE 50 PLUS TABLET
SM COMPLETE 50 PLUS TABLET
HM COMPLETE MEN TABLET
HM COMPLETE MEN 50 PLUS TABLET
COMPLETE MULTI TABLET
COMPLETE MULTI 50+ TABLET
COMPLETE MULTIVITAMIN TAB
EQ COMPLETE MULTIVITAMIN TAB
COMPLETE MULTIVIT-MINERAL LIQ
HM COMPLETE MULTI-VIT-MINERAL
SM COMPLETE MULTI-VIT-MINERAL
EQ COMPLETE MV ADLT 50 PLUS TB
COMPLETE NATAL DHA
SM COMPLETE PREMIUM VITAMIN TB
COMPLETE SENIOR TABLET
SM COMPLETE SENIOR FORMULA TAB
SM COMPLETE SENIOR FORMULA TAB
HM COMPLETE WOMEN TABLET
COMPLETENATE TABLET CHEW
COMPLEX B-100 TABLET SA
COMPLEX B-50 TABLET
COMTAN 200 MG TABLET
CONCEPT DHA CAPSULE
CONCEPT OB CAPSULE
CONCERTA ER 18 MG TABLET
CONCERTA ER 27 MG TABLET
CONCERTA ER 36 MG TABLET
CONCERTA ER 54 MG TABLET
CONSENSI 10-200 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CONSENSI 2.5-200 MG TABLET
CONSENSI 5-200 MG TABLET
CONSTULOSE 10 GM/15 ML SOLN
CONTACT DETACH INFUSN SET 23"
CONTACT DETACH INFUSN SET 32"
CONTACT DETACH INFUSN SET 43"
CONTOUR SOLUTION
CONTOUR SOLUTION
CONTOUR SOLUTION
CONTOUR METER
CONTOUR LINK METER
CONTOUR NEXT METER
CONTOUR NEXT LEV 1 CONTROL SOL
CONTOUR NEXT LEV 2 CONTROL SOL
CONTOUR NEXT EZ METER
CONTOUR NEXT LINK METER
CONTOUR NEXT LINK 2.4 METER KT
CONTOUR NEXT ONE METER
CONTOUR NEXT TEST STRIP
CONTOUR TEST STRIP
CONTRAVE ER 8-90 MG TABLET
CONTROL AST MONITORING SYSTEM
CONTROL AST TEST STRIP
FORA HIGH CONTROL SOLUTION
PRODIGY CONTROL SOLUTION
FORA LOW CONTROL SOLUTION
MEDPOINT CONTROL SOLUTION
COOL BLOOD GLUCOSE METER KIT
COOL BLOOD GLUCOSE METER
COOL CONTROL B SOLUTION
COOL CONTROL A SOLUTION
COOL GLUCOSE TEST STRIP
COPAXONE 20 MG/ML SYRINGE
COPAXONE 40 MG/ML SYRINGE
COPIKTRA 15 MG CAPSULE
COPIKTRA 25 MG CAPSULE
COREG 12.5 MG TABLET
COREG 25 MG TABLET
COREG 3.125 MG TABLET
COREG 6.25 MG TABLET
COREG CR 10 MG CAPSULE
COREG CR 20 MG CAPSULE
COREG CR 40 MG CAPSULE
COREG CR 80 MG CAPSULE
CORGARD 20 MG TABLET
CORGARD 40 MG TABLET
CORGARD 80 MG TABLET
CORIFACT KIT
CORLANOR 5 MG TABLET
CORLANOR 5 MG/5 ML ORAL SOLN
CORLANOR 7.5 MG TABLET
CORN POLLEN 1:20 W/V VIAL
CORTEF 10 MG TABLET
CORTEF 20 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CORTEF 5 MG TABLET
CORVITA TABLET
CORVITE TABLET
CORVITE FREE TABLET
CORZIDE 40-5 TABLET
CORZIDE 80-5 TABLET
COSENTYX 300 MG DOSE-2 SYRINGE
COSENTYX 150 MG/ML PEN INJECT
COSENTYX 300 MG DOSE-2 PENS
COSENTYX 150 MG/ML SYRINGE
COSOPT EYE DROPS
COSOPT PF EYE DROPS
COTELLIC 20 MG TABLET
COTEMPLA XR-ODT 17.3 MG TABLET
COTEMPLA XR-ODT 25.9 MG TABLET
COTEMPLA XR-ODT 8.6 MG TABLET
COUMADIN 1 MG TABLET
COUMADIN 10 MG TABLET
COUMADIN 2 MG TABLET
COUMADIN 2.5 MG TABLET
COUMADIN 3 MG TABLET
COUMADIN 4 MG TABLET
COUMADIN 5 MG TABLET
COUMADIN 6 MG TABLET
COUMADIN 7.5 MG TABLET
COVARYX TABLET
COVARYX H.S. TABLET
COZAAR 100 MG TABLET
COZAAR 25 MG TABLET
COZAAR 50 MG TABLET
CREON DR 12,000 UNITS CAPSULE
CREON DR 24,000 UNITS CAPSULE
CREON DR 3,000 UNITS CAPSULE
CREON DR 36,000 UNITS CAPSULE
CREON DR 6,000 UNITS CAPSULE
CRESTOR 10 MG TABLET
CRESTOR 20 MG TABLET
CRESTOR 40 MG TABLET
CRESTOR 5 MG TABLET
CRIXIVAN 200 MG CAPSULE
CRIXIVAN 400 MG CAPSULE
CROMOLYN 100 MG/5 ML ORAL CONC
CROMOLYN 20 MG/2 ML NEB SOLN
CRYSELLE-28 TABLET
CRYSVITA 10 MG/ML VIAL
CRYSVITA 20 MG/ML VIAL
CRYSVITA 30 MG/ML VIAL
CULTURELLE KIDS COMPLET MV CHW
CUPRIMINE 250 MG CAPSULE
CURVULARIA 20,000 PNU/ML VIAL
CUTAQUIG 16.5% (1 G/6 ML) VIAL
CUTAQUIG 16.5% (1.65 G/10 ML)
CUTAQUIG 16.5% (2 G/12 ML) VL
CUTAQUIG 16.5% (3.3 G/20 ML)
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CUTAQUIG 16.5% (4 G/24 ML) VL
CUTAQUIG 16.5% (8 G/48 ML) VL
CUVITRU 1 GRAM/5 ML VIAL
CUVITRU 10 GRAM/50 ML VIAL
CUVITRU 2 GRAM/10 ML VIAL
CUVITRU 4 GRAM/20 ML VIAL
CUVITRU 8 GRAM/ 40 ML VIAL
CUVPOSA 1 MG/5 ML SOLUTION
CYANOCOBALAMIN 1,000 MCG/ML
CYANOCOBALAMIN 10,000 MCG/10
CYANOCOBALAMIN 30,000 MCG/30
CYCLAFEM 1-35-28 TABLET
CYCLAFEM 7-7-7-28 TABLET
CYCLESSA 28 DAY TABLET
CYCLOSET 0.8 MG TABLET
CYCLOSPORINE 100 MG CAPSULE
CYCLOSPORINE 25 MG CAPSULE
CYCLOSPORINE 0.1% IN KLARITY
CYCLOSPORINE MODIFIED 100 MG
CYCLOSPORINE MODIFIED 100MG/ML
CYCLOSPORINE MODIFIED 25 MG
CYCLOSPORINE MODIFIED 50 MG
CYMBALTA 20 MG CAPSULE
CYMBALTA 30 MG CAPSULE
CYMBALTA 60 MG CAPSULE
CYRAMZA 100 MG/10 ML VIAL
CYRAMZA 500 MG/50 ML VIAL
CYRED 28 DAY TABLET
CYRED EQ 28 DAY TABLET
CYSTADANE 1 GRAM/1.7 ML POWDER
CYSTAGON 150 MG CAPSULE
CYSTAGON 50 MG CAPSULE
CYSTARAN 0.44% EYE DROPS
CYTO B7 5 MG/ML LIQUID
CYTOMEL 25 MCG TABLET
CYTOMEL 5 MCG TABLET
CYTOMEL 50 MCG TABLET
CYTOTEC 100 MCG TABLET
CYTOTEC 200 MCG TABLET
STD D.FARINAE 10,000 AU/ML
STD MITE D.PTERONYS 10,000/ML
CVS DAILY GUMMIES
CVS DAILY MULTIPLE TABLET
DAILY MULTIPLE TABLET
CVS DAILY MULTIPLE TABLET
CVS DAILY MULTIPLE TABLET
CVS DAILY MULTIPLE VITAMIN TAB
CVS DAILY MULTIPLE TABLET
DAILY MULTIPLE VITAMIN TAB
DAILY MULTIPLE VITAMIN TABLET
DAILY MULTIVITAMIN CAPSULE
DAILY MULTIVITAMIN-IRON TABLET
DAILY PRENATAL COMBO PACK
GNP DAILY PRENATAL COMBO PACK
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
DAILY VALUE MULTIVITAMIN TAB
DAILY VITAMIN + IRON TABLET
DAILY VITAMIN FORMULA TABLET
DAILY VITAMIN FORMULA-IRON TAB
DAILY VITAMIN FORMULA TABLET
DAILY VITE TABLET
DAILY-VITE TABLET
DAILY VITE WITH IRON TABLET
DAILY-VITES WITH IRON TABLET
DALFAMPRIDINE ER 10 MG TABLET
DALIRESP 250 MCG TABLET
DALIRESP 500 MCG TABLET
DANTRIUM 25 MG CAPSULE
DANTRIUM 50 MG CAPSULE
DANTROLENE SODIUM 100 MG CAP
DANTROLENE SODIUM 25 MG CAP
DANTROLENE SODIUM 50 MG CAP
DAPSONE 100 MG TABLET
DAPSONE 25 MG TABLET
DARIFENACIN ER 15 MG TABLET
DARIFENACIN ER 7.5 MG TABLET
DASETTA 1-35-28 TABLET
DASETTA 7/7/7-28 TABLET
DAURISMO 100 MG TABLET
DAURISMO 25 MG TABLET
DAYPRO 600 MG CAPLET
DAYSEE 0.15-0.03-0.01 MG TAB
DAYTRANA 10 MG/9 HR PATCH
DAYTRANA 15 MG/9 HR PATCH
DAYTRANA 20 MG/9 HOUR PATCH
DAYTRANA 30 MG/9 HOUR PATCH
DDAVP 0.01% NASAL SPRAY
DDAVP 0.1 MG TABLET
DDAVP 0.2 MG TABLET
DDAVP 10 MCG/0.1 ML SOLUTION
DEBLITANE 0.35 MG TABLET
DECUBI VITE CAPSULE
DEFERASIROX 125 MG TB FOR SUSP
DEFERASIROX 180 MG TABLET
DEFERASIROX 250 MG TB FOR SUSP
DEFERASIROX 360 MG TABLET
DEFERASIROX 500 MG TB FOR SUSP
DEFERASIROX 90 MG TABLET
DEKAS BARIATRIC CHEW TABLET
DEKAS ESSENTIAL LIQUID
DEKAS ESSENTIAL CAPSULE
DEKAS PLUS SOFTGEL
DEKAS PLUS CHEWABLE TABLET
DEKAS PLUS LIQUID
DELESTROGEN 10 MG/ML VIAL
DELESTROGEN 20 MG/ML VIAL
DELESTROGEN 40 MG/ML VIAL
DELSTRIGO 100-300-300 MG TAB
DELYLA-28 TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
DELZICOL DR 400 MG CAPSULE
DEMADEX 10 MG TABLET
DEMADEX 20 MG TABLET
DEMSER 250 MG CAPSULE
DENTA 5000 PLUS CREAM
DENTAGEL 1.1% GEL
DEPAKENE 250 MG CAPSULE
DEPAKENE 250 MG/5 ML SOLUTION
DEPAKOTE DR 125 MG TABLET
DEPAKOTE DR 250 MG TABLET
DEPAKOTE DR 500 MG TABLET
DEPAKOTE EC 125 MG TABLET
DEPAKOTE EC 250 MG TABLET
DEPAKOTE ER 250 MG TABLET
DEPAKOTE ER 500 MG TABLET
DEPAKOTE DR 125 MG SPRINKLE CP
DEPEN 250 MG TITRATAB
DEPO-ESTRADIOL 5 MG/ML VIAL
DEPO-PROVERA 150 MG/ML SYRINGE
DEPO-PROVERA 150 MG/ML VIAL
DEPO-PROVERA 400 MG/ML VIAL
DEPO-SUBQ PROVERA 104 SYRINGE
DEPO-TESTOSTERONE 100 MG/ML VL
DEPO-TESTOSTERONE 200 MG/ML
DEPO-TESTOSTERONE 200 MG/ML VL
DESCOVY 200-25 MG TABLET
DESIPRAMINE 10 MG TABLET
DESIPRAMINE 100 MG TABLET
DESIPRAMINE 150 MG TABLET
DESIPRAMINE 25 MG TABLET
DESIPRAMINE 50 MG TABLET
DESIPRAMINE 75 MG TABLET
DESLORATADINE 2.5 MG ODT
DESLORATADINE 5 MG ODT
DESLORATADINE 5 MG TABLET
DESMOPRESSIN 10 MCG/0.1 ML SPR
DESMOPRESSIN 0.01% SOLUTION
DESMOPRESSIN 0.01% SPRAY
DESMOPRESSIN ACETATE 0.1 MG TB
DESMOPRESSIN ACETATE 0.2 MG TB
DESOGEN 28 DAY TABLET
DESOGEST-ETH ESTRA 0.15-0.03MG
DESOGESTREL-ETHINYL ESTRAD TAB
DESOGESTR-ETH ESTRAD ETH ESTRA
DESOXYN 5 MG TABLET
DESVENLAFAXINE ER 100 MG TAB
DESVENLAFAXINE ER 50 MG TAB
DESVENLAFAXINE ER 50 MG TABLET
DESVENLAFAXINE FUM ER 100 MG
DESVENLAFAXINE FUM ER 50 MG
DESVENLAFAXINE SUC ER 100 MG
DESVENLAFAXINE SUC ER 25 MG TB
DESVENLAFAXINE SUC ER 50 MG TB
DETROL 1 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
DETROL 2 MG TABLET
DETROL LA 2 MG CAPSULE
DETROL LA 4 MG CAPSULE
DEXCOM RECEIVER KIT
DEXCOM G4 (PED) RECEIVER KIT
DEXCOM G4 RECEIVER KIT
DEXCOM G4 RECEIVER-SHARE (PED)
DEXCOM G4 RECEIVER-SHARE KIT
DEXCOM G4 TRANSMITTER KIT
DEXCOM G5 RECEIVER KIT
DEXCOM G5 TRANSMITTER KIT
DEXCOM G5-G4 SENSOR KIT
DEXCOM G6 RECEIVER
DEXCOM G6 SENSOR
DEXCOM G6 TRANSMITTER
DEXEDRINE SPANSULE 10 MG
DEXEDRINE SPANSULE 15 MG
DEXEDRINE SPANSULE 5 MG
DEXILANT DR 30 MG CAPSULE
DEXILANT DR 60 MG CAPSULE
DEXMETHYLPHENIDATE 10 MG TAB
DEXMETHYLPHENIDATE 2.5 MG TAB
DEXMETHYLPHENIDATE 5 MG TAB
DEXMETHYLPHENIDATE ER 10 MG CP
DEXMETHYLPHENIDATE ER 15 MG CP
DEXMETHYLPHENIDATE ER 20 MG CP
DEXMETHYLPHENIDATE ER 25 MG CP
DEXMETHYLPHENIDATE ER 30 MG CP
DEXMETHYLPHENIDATE ER 35 MG CP
DEXMETHYLPHENIDATE ER 40 MG CP
DEXMETHYLPHENIDATE ER 5 MG CAP
DEXTROAMPHETAMINE 10 MG TAB
DEXTROAMPHETAMINE 5 MG TAB
DEXTROAMPHETAMINE 5 MG/5 ML
DEXTROAMPHETAMINE ER 10 MG CAP
DEXTROAMPHETAMINE ER 15 MG CAP
DEXTROAMPHETAMINE ER 5 MG CAP
DEXTROAMP-AMPHET ER 10 MG CAP
DEXTROAMP-AMPHET ER 15 MG CAP
DEXTROAMP-AMPHET ER 20 MG CAP
DEXTROAMP-AMPHET ER 25 MG CAP
DEXTROAMP-AMPHET ER 30 MG CAP
DEXTROAMP-AMPHET ER 5 MG CAP
DEXTROAMP-AMPHETAM 12.5 MG TAB
DEXTROAMP-AMPHETAM 7.5 MG TAB
DEXTROAMP-AMPHETAMIN 10 MG TAB
DEXTROAMP-AMPHETAMIN 15 MG TAB
DEXTROAMP-AMPHETAMIN 20 MG TAB
DEXTROAMP-AMPHETAMIN 30 MG TAB
DEXTROAMP-AMPHETAMINE 5 MG TAB
DIABETES HEALTH PACK
DIABETES HEALTH FORMULA CAPLET
CVS DIABETES HEALTH SUPPORT
DIABETIC VITAMIN CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
DIACOMIT 250 MG CAPSULE
DIACOMIT 250 MG POWDER PACKET
DIACOMIT 500 MG CAPSULE
DIACOMIT 500 MG POWDER PACKET
DIALYVITE TABLET
DIALYVITE 3,000 TABLET
DIALYVITE 800 TABLET
DIALYVITE 800 WITH IRON TAB
DIALYVITE WITH ZINC TABLET
DIAMODE 2 MG TABLET
DIAMOX SEQUELS ER 500 MG CAP
DIASTIX REAGENT STRIPS
DIATRUE LEVEL 3 CONTROL SOLN
DIATRUE LEVEL 1 CONTROL SOLN
DIATRUE LEVEL 2 CONTROL SOLN
DIATRUE PLUS TEST STRIP
DIATRUE PLUS BLOOD GLUCOSE SYS
DICLOFENAC POT 50 MG TABLET
DICLOFENAC SOD DR 25 MG TAB
DICLOFENAC SOD DR 50 MG TAB
DICLOFENAC SOD DR 75 MG TAB
DICLOFENAC SOD EC 25 MG TAB
DICLOFENAC SOD EC 50 MG TAB
DICLOFENAC SOD EC 75 MG TAB
DICLOFENAC SOD ER 100 MG TAB
DICLOFENAC-MISOPROST 50-0.2 TB
DICLOFENAC-MISOPROST 50-200 TB
DICLOFENAC-MISOPROST 75-0.2 TB
DICLOFENAC-MISOPROST 75-200 TB
DICYCLOMINE 10 MG CAPSULE
DICYCLOMINE 10 MG/5 ML SOLN
DICYCLOMINE 20 MG TABLET
DIDANOSINE DR 125 MG CAPSULE
DIDANOSINE DR 200 MG CAPSULE
DIDANOSINE DR 250 MG CAPSULE
DIDANOSINE DR 400 MG CAPSULE
DIFLUNISAL 500 MG TABLET
DIGITEK 125 MCG TABLET
DIGITEK 250 MCG TABLET
DIGOX 125 MCG TABLET
DIGOX 250 MCG TABLET
DIGOXIN 0.05 MG/ML SOLUTION
DIGOXIN 0.125 MG TABLET
DIGOXIN 0.125 MG/2.5 ML SOLN
DIGOXIN 0.25 MG TABLET
DIGOXIN 0.25 MG/5 ML SOLUTION
DIGOXIN 125 MCG TABLET
DIGOXIN 250 MCG TABLET
DILANTIN 50 MG INFATAB
DILANTIN 100 MG CAPSULE
DILANTIN 100 MG KAPSEAL
DILANTIN 30 MG CAPSULE
DILANTIN 30 MG KAPSEAL
DILANTIN 125 MG/5 ML SUSP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
DILATRATE-SR 40 MG CAPSULE
DILTIAZEM 12HR ER 120 MG CAP
DILTIAZEM 12HR ER 60 MG CAP
DILTIAZEM 12HR ER 90 MG CAP
DILTIAZEM 24HR ER 120 MG CAP
DILTIAZEM 24HR ER 180 MG CAP
DILTIAZEM 24HR ER 240 MG CAP
DILTIAZEM 24HR ER 300 MG CAP
DILTIAZEM 24HR ER 360 MG CAP
DILTIAZEM 24HR ER 420 MG CAP
DILTIAZEM 24H ER(CD) 120 MG CP
DILTIAZEM 24H ER(CD) 180 MG CP
DILTIAZEM 24H ER(CD) 240 MG CP
DILTIAZEM 24H ER(CD) 300 MG CP
DILTIAZEM 24H ER(CD) 360 MG CP
DILTIAZEM 24H ER(LA) 180 MG TB
DILTIAZEM 24H ER(LA) 240 MG TB
DILTIAZEM 24H ER(LA) 300 MG TB
DILTIAZEM 24H ER(LA) 360 MG TB
DILTIAZEM 24H ER(LA) 420 MG TB
DILTIAZEM 24H ER(XR) 120 MG CP
DILTIAZEM 24H ER(XR) 180 MG CP
DILTIAZEM 24H ER(XR) 240 MG CP
DILTIAZEM 120 MG TABLET
DILTIAZEM 30 MG TABLET
DILTIAZEM 60 MG TABLET
DILTIAZEM 90 MG TABLET
DILT XR 120 MG CAPSULE
DILT XR 180 MG CAPSULE
DILT XR 240 MG CAPSULE
DILUENT FOR EPOPROSTENOL VIAL
DILUENT FOR FLOLAN VIAL
DILUENT FOR REMODULIN VIAL
STERILE DILUENT-TREPROSTINIL
DINO-LIFE IRON-ZINC TAB CHEW
DINO-LIFE EXTRA C CHEW TABLET
DINO-LIFE CHEWABLE TABLET
DIOVAN 160 MG TABLET
DIOVAN 320 MG TABLET
DIOVAN 40 MG TABLET
DIOVAN 80 MG TABLET
DIOVAN HCT 160-12.5 MG TAB
DIOVAN HCT 160-25 MG TABLET
DIOVAN HCT 320-12.5 MG TAB
DIOVAN HCT 320-25 MG TABLET
DIOVAN HCT 80-12.5 MG TABLET
DIPENTUM 250 MG CAPSULE
DIPYRIDAMOLE 25 MG TABLET
DIPYRIDAMOLE 50 MG TABLET
DIPYRIDAMOLE 75 MG TABLET
DISALCID 500 MG TABLET
DISALCID 750 MG TABLET
DISOPYRAMIDE 100 MG CAPSULE
DISOPYRAMIDE 150 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
DISULFIRAM 250 MG TABLET
DISULFIRAM 500 MG TABLET
DITROPAN XL 10 MG TABLET
DITROPAN XL 15 MG TABLET
DITROPAN XL 5 MG TABLET
DIURIL 250 MG/5 ML ORAL SUSP
DIVALPROEX DR 125 MG CAP SPRNK
DIVALPROEX SOD DR 125 MG TAB
DIVALPROEX SOD DR 250 MG TAB
DIVALPROEX SOD DR 500 MG TAB
DIVALPROEX SOD ER 250 MG TAB
DIVALPROEX SOD ER 500 MG TAB
DIVIGEL 0.25 MG GEL PACKET
DIVIGEL 0.5 MG GEL PACKET
DIVIGEL 0.75 MG GEL PACKET
DIVIGEL 1 MG GEL PACKET
DIVIGEL 1.25 MG GEL PACKET
DOFETILIDE 125 MCG CAPSULE
DOFETILIDE 250 MCG CAPSULE
DOFETILIDE 500 MCG CAPSULE
DOG EPITHELIUM 1:10 (W/V) VIAL
DOG EPITHELIUM 1:20 (W/V) VIAL
DOG FENNEL 1:20 (W/V) VIAL
DONEPEZIL HCL 10 MG TABLET
DONEPEZIL HCL 23 MG TABLET
DONEPEZIL HCL 5 MG TABLET
DONEPEZIL HCL ODT 10 MG TABLET
DONEPEZIL HCL ODT 5 MG TABLET
DONNATAL ELIXIR
DONNATAL TABLET
DORZOLAMIDE 2% EYE DROP
DORZOLAMIDE HCL 2% EYE DROPS
DORZOLAMIDE-TIMOLOL EYE DROPS
DORZOLAMIDE-TIMOLOL 2%-0.5%
DOTHELLE DHA SOFTGEL
DOTTI 0.025 MG PATCH
DOTTI 0.0375 MG PATCH
DOTTI 0.05 MG PATCH
DOTTI 0.075 MG PATCH
DOTTI 0.1 MG PATCH
DOVATO 50-300 MG TABLET
DOXAZOSIN MESYLATE 1 MG TAB
DOXAZOSIN MESYLATE 2 MG TAB
DOXAZOSIN MESYLATE 4 MG TAB
DOXAZOSIN MESYLATE 8 MG TAB
DOXEPIN 10 MG CAPSULE
DOXEPIN 10 MG/ML ORAL CONC
DOXEPIN 100 MG CAPSULE
DOXEPIN 150 MG CAPSULE
DOXEPIN 25 MG CAPSULE
DOXEPIN 50 MG CAPSULE
DOXEPIN 75 MG CAPSULE
DOXERCALCIFEROL 0.5 MCG CAP
DOXERCALCIFEROL 1 MCG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
DOXERCALCIFEROL 2.5 MCG CAP
DOXERCALCIFEROL 4 MCG/2 ML AMP
DOXERCALCIFEROL 4 MCG/2 ML VL
D-PENAMINE 125 MG TABLET
DRECHSLERA 10,000 PNU/ML
DRECHSLERA 20,000 PNU/ML
DRISDOL 1.25 MG (50,000 UNIT)
DRIZALMA SPRINKLE DR 20 MG CAP
DRIZALMA SPRINKLE DR 30 MG CAP
DRIZALMA SPRINKLE DR 40 MG CAP
DRIZALMA SPRINKLE DR 60 MG CAP
DROPLET 0.5 ML 29GX12.5MM(1/2)
DROPLET 0.5 ML 30GX12.5MM(1/2)
DROPLET 0.5ML 30GX12.5MM(1/2)
DROPLET INS 0.5ML 30GX6MM(1/2)
DROPLET INS 0.5ML 30GX8MM(1/2)
DROPLET INS 0.5ML 31GX6MM(1/2)
DROPLET INS 0.5ML 31GX8MM(1/2)
DROPLET INS SYR 1 ML 30GX6MM
DROPLET INS SYR 1 ML 30GX8MM
DROPLET INS SYR 1 ML 31GX6MM
DROPLET INS SYR 1 ML 31GX8MM
DROPLET INS SYR 1ML 29GX12.5MM
DROPLET INS SYR 1ML 30GX12.5MM
DROPLET INS 0.3 ML 29GX12.5MM
DROPLET INS 0.3ML 30GX12.5MM
DROPLET INS SYR 0.3 ML 30GX6MM
DROPLET INS SYR 0.3 ML 30GX8MM
DROPLET INS SYR 0.3 ML 31GX6MM
DROPLET INS SYR 0.3 ML 31GX8MM
DROPLET 30G LANCETS
DROPLET PEN NEEDLE 29GX1/2"
DROPLET PEN NEEDLE 29GX3/8"
DROPLET PEN NEEDLE 31GX1/4"
DROPLET PEN NEEDLE 31GX3/16"
DROPLET PEN NEEDLE 31GX5/16"
DROPLET PEN NEEDLE 32GX1/4"
DROPLET PEN NEEDLE 32GX3/16"
DROPLET PEN NEEDLE 32GX5/16"
DROPLET PEN NEEDLE 32GX5/32"
DROPSAFE PEN NEEDLE 31GX1/4"
DROPSAFE PEN NEEDLE 31GX5/16"
DROSP-EE-LEVOMEF 3-0.02-0.451
DROSP-EE-LEVOMEF 3-0.03-0.451
DROSPIRENONE-EE 3-0.02 MG TAB
DROSPIRENONE-EE 3-0.03 MG TAB
DROXIA 200 MG CAPSULE
DROXIA 300 MG CAPSULE
DROXIA 400 MG CAPSULE
DUAKLIR PRESSAIR 400-12MCG INH
DUAVEE 0.45-20 MG TABLET
DUET DHA 400 COMBO PACK
DUET DHA BALANCED (25 MG IRON)
DUETACT 30-2 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
DUETACT 30-4 MG TABLET
DUEXIS 800-26.6 MG TABLET
DULERA 100 MCG-5 MCG INHALER
DULERA 200 MCG-5 MCG INHALER
DULERA 50 MCG-5 MCG INHALER
DULOXETINE HCL DR 20 MG CAP
DULOXETINE HCL DR 30 MG CAP
DULOXETINE HCL DR 40 MG CAP
DULOXETINE HCL DR 60 MG CAP
DUONEB 0.5 MG-3 MG/3 ML SOLN
DUOPA 4.63 MG-20 MG/ML SUSPENS
DUPIXENT 200 MG/1.14 ML SYRING
DUPIXENT 300 MG/2 ML SYRINGE
DURLAZA ER 162.5 MG CAPSULE
DUTASTERIDE 0.5 MG CAPSULE
DUTASTERIDE-TAMSULOSIN 0.5-0.4
DUTOPROL 100-12.5 MG TABLET
DUTOPROL 25-12.5 MG TABLET
DUTOPROL 50-12.5 MG TABLET
DUZALLO 200-200 MG TABLET
DUZALLO 200-300 MG TABLET
DYANAVEL XR 2.5 MG/ML SUSP
DYAZIDE 37.5-25 CAPSULE
DYRENIUM 100 MG CAPSULE
DYRENIUM 50 MG CAPSULE
EASTERN COTTONWOOD 1:20 (W/V)
EASY COMFORT 30G LANCETS
EASY COMFORT 1 ML 31GX5/16"
EASY COMFORT 1 ML 32GX5/16"
EASY COMFORT INSULIN 1 ML SYR
EASY COMFORT SYR 1 ML 30GX1/2"
EASY COMFORT 0.5 ML 30GX1/2"
EASY COMFORT 0.5 ML 31GX5/16"
EASY COMFORT 0.5 ML 32GX5/16"
EASY COMFORT 0.5 ML SYRINGE
EASY COMFORT 0.3 ML SYRINGE
EASY COMFORT PEN NDL 31GX3/16"
EASY COMFORT PEN NDL 31GX5/16"
EASY COMFORT PEN NDL 33G 4MM
EASY COMFORT PEN NDL 33G 5MM
EASY COMFORT PEN NDL 33G 6MM
EASY COMFORT PEN NDL 31GX1/4"
EASY COMFORT PEN NDL 32GX5/32"
EASY GLIDE INS 1 ML 31GX6MM
EASY GLIDE INS 0.5 ML 31GX6MM
EASY GLIDE INS 0.3 ML 31GX6MM
EASY GLIDE PEN NEEDLE 4MM 33G
EASY PLUS II TEST STRIP
EASY PLUS II CONTROL SOLN HIGH
EASY PLUS II CONTROL SOLN LOW
EASY PLUS II BLOOD GLUCOSE SYS
EASY STEP GLUCOSE TEST STRIPS
EASY STEP BLOOD GLUCOSE METER
EASY STEP GLUCOSE SYSTEM KIT
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
EASY STEP CONTRL SOLN-HIGH
EASY STEP CONTROL SOLN-LOW
EASY STEP CONTROL SOLN-NORMAL
EASY TALK GLUCOSE TEST STRIP
EASY TALK HIGH CONTROL SOLN
EASY TALK CONTROL SOLN LOW
EASY TALK BLOOD GLUCOSE METER
EASY TALK GLUCOSE SYSTEM KIT
EASY TOUCH BUTTON 30G LANCETS
EASY TOUCH PRESSURE 30G LANCET
EASY TOUCH PULL-TOP 26G LANCET
EASY TOUCH PULL-TOP 28G LANCET
EASY TOUCH PULL-TOP 30G LANCET
EASY TOUCH PULL-TOP 32G LANCET
EASY TOUCH SAFETY 21G LANCETS
EASY TOUCH SAFETY 23G LANCETS
EASY TOUCH SAFETY 26G LANCETS
EASY TOUCH SAFETY 28G LANCETS
EASY TOUCH SAFETY 32G LANCETS
EASY TOUCH TWIST 26G LANCETS
EASY TOUCH TWIST 28G LANCETS
EASY TOUCH TWIST 30G LANCETS
EASY TOUCH TWIST 32G LANCETS
EASY TOUCH TWIST 33G LANCETS
EASY TOUCH INSULIN SYR 1 ML
EASY TOUCH INSULIN SYR 0.5 ML
EASY TOUCH INSULIN SYR 0.3 ML
EASY TOUCH HIGH-LOW CTRL SOLN
GNP EASY TOUCH HIGH-LOW SOLN
EASY TOUCH INSULN 1ML 29GX1/2"
EASY TOUCH INSULN 1ML 30GX1/2"
EASY TOUCH INSULN 1ML 30GX5/16
EASY TOUCH INSULN 1ML 31GX5/16
EASY TOUCH GLUCOSE MONITOR SYS
GNP EASY TOUCH GLUCOSE MONITOR
EASY TOUCH 1 ML SYR 29GX1/2"
EASY TOUCH 1 ML SYR 30GX1/2"
EASY TOUCH 0.5 ML SYR 29GX1/2"
EASY TOUCH 0.5 ML SYR 30GX5/16
EASY TOUCH 1 ML SYR 27GX1/2"
EASY TOUCH 1 ML SYR 30GX1/2"
EASY TOUCH 0.5 ML SYR 27GX1/2"
EASY TOUCH 0.5 ML SYR 30GX1/2"
EASY TOUCH 0.3 ML SYR 30GX1/2"
EASY TOUCH 28G LANCETS
EASY TOUCH LUER LOK INSUL 1 ML
EASY TOUCH PEN NEEDLE 29GX1/2"
EASY TOUCH PEN NEEDLE 30GX5/16
EASY TOUCH PEN NEEDLE 31GX1/4"
EASY TOUCH PEN NEEDLE 31GX3/16
EASY TOUCH PEN NEEDLE 31GX5/16
EASY TOUCH PEN NEEDLE 32GX1/4"
EASY TOUCH PEN NEEDLE 32GX3/16
EASY TOUCH PEN NEEDLE 32GX5/32
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
EASY TOUCH SAF PEN NDL 30G 5MM
EASY TOUCH INSULIN 1ML 29GX1/2
EASY TOUCH INSULIN 1ML 30GX1/2
EASY TOUCH INSULN 1ML 30GX5/16
EASY TOUCH INSULN 1ML 31GX5/16
EASY TOUCH GLUCOSE TEST STRIP
GNP EASY TOUCH GLUC TEST STRIP
EASY TOUCH UNI-SLIP SYR 1 ML
EASY TRAK GLUCOSE TEST STRIP
EASY TRAK CONTROL SOLN HIGH
EASY TRAK CONTROL SOLN LOW
EASY TRAK BLOOD GLUCOSE METER
EASY TRAK GLUCOSE SYSTEM KIT
EASY TWIST & CAP 28G LANCETS
EASYGLUCO METER
EASYGLUCO METER STARTER KIT
EASYGLUCO PLUS TEST STRIPS
EASYGLUCO PLUS METER KIT
EASYGLUCO PLUS STARTER KIT
EASYGLUCO PLUS CTRL SOL NORMAL
EASYGLUCO TEST STRIPS
EASYMAX GLUCOSE TEST STRIPS
EASYMAX LOW CONTROL SOLN
EASYMAX NORMAL CONTROL SOLN
EASYMAX 15 GLUCOSE TEST STRIP
EASYMAX 15 LEVEL 1 SOLUTION
EASYMAX 15 LEVEL 2 SOLUTION
EASYMAX L BLOOD GLUCOSE SYSTEM
EASYMAX NG BLOOD GLUCOSE SYS
EASYMAX NG GLUCOSE SYSTEM KIT
EASYMAX V SPEAKING GLUCOSE SYS
EASYMAX V2 BLOOD GLUCOSE SYS
EASY-TOUCH BLOOD GLUCOSE METER
EASY-TOUCH INS 1 ML 31GX5/16"
BD ECLIPSE 30GX1/2" SYRINGE
EC-NAPROSYN EC 375 MG TABLET
EC-NAPROSYN EC 500 MG TABLET
NAPROSYN EC 500 MG TABLET
EC-NAPROXEN DR 375 MG TABLET
EC-NAPROXEN DR 500 MG TABLET
ECOTRIN EC 325 MG TABLET
ECOTRIN EC 81 MG TABLET
ECPIRIN EC 325 MG TABLET
EDARBI 40 MG TABLET
EDARBI 80 MG TABLET
EDARBYCLOR 40-12.5 MG TABLET
EDARBYCLOR 40-25 MG TABLET
EDECRIN 25 MG TABLET
EDEX 10 MCG CARTRIDGE 2-PK KIT
EDEX 10 MCG CARTRIDGE 6-PK KIT
EDEX 20 MCG CARTRIDGE 2-PK KIT
EDEX 20 MCG CARTRIDGE 6-PK KIT
EDEX 40 MCG CARTRIDGE 2-PK KIT
EDEX 40 MCG CARTRIDGE 6-PK KIT
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ED-SPAZ 0.125 MG ODT
EDURANT 25 MG TABLET
EEMT DS 1.25-2.5 MG TABLET
EEMT HS 0.625-1.25 MG TABLET
EFAVIRENZ 200 MG CAPSULE
EFAVIRENZ 50 MG CAPSULE
EFAVIRENZ 600 MG TABLET
EFFER-K 10 MEQ TABLET EFF
EFFER-K 20 MEQ TABLET EFF
EFFER-K 25 MEQ TABLET EFF
EFFEXOR XR 150 MG CAPSULE
EFFEXOR XR 37.5 MG CAPSULE
EFFEXOR XR 75 MG CAPSULE
EFFIENT 10 MG TABLET
EFFIENT 5 MG TABLET
EGRIFTA 1 MG VIAL
EGRIFTA 2 MG VIAL
EGRIFTA SV 2 MG VIAL
ELAPRASE 6 MG/3 ML VIAL
ELDERCAPS CAPSULE
ELDERTONIC ELIXIR
ELELYSO 200 UNITS VIAL
ELEMENT COMPACT TEST STRIPS
ELEMENT COMPACT GLUCOSE METER
ELEMENT COMPACT SOLN HIGH
ELEMENT COMPACT SOLN NORMAL
ELEMENT COMPACT V GLUCOSE MTR
ELEMENT CONTROL SOLUTION HIGH
ELEMENT CONTROL SOLUTION LOW
ELEMENT CONTROL SOLN NORMAL
ELEMENT PLUS BLOOD GLUCOSE KIT
ELEMENT TEST STRIPS
ELESTRIN 0.06% GEL
ELIGARD 22.5 MG SYRINGE KIT
ELIGARD 30 MG SYRINGE KIT
ELIGARD 45 MG SYRINGE KIT
ELIGARD 7.5 MG SYRINGE KIT
ELINEST-28 TABLET
ELIPHOS 667 MG TABLET
ELIQUIS 2.5 MG TABLET
ELIQUIS 5 MG TABLET
ELITE-OB CAPLET
ELIXOPHYLLIN 80 MG/15 ML ELIX
ELLIS TONIC
ELOCTATE 1,000 UNIT NOMINAL
ELOCTATE 1,500 UNIT NOMINAL
ELOCTATE 2,000 UNIT NOMINAL
ELOCTATE 250 UNIT NOMINAL
ELOCTATE 3,000 UNIT NOMINAL
ELOCTATE 4,000 UNIT NOMINAL
ELOCTATE 5,000 UNIT NOMINAL
ELOCTATE 500 UNIT NOMINAL
ELOCTATE 6,000 UNIT NOMINAL
ELOCTATE 750 UNIT NOMINAL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ELON MATRIX 5000 COMPLETE TAB
ELON MATRIX COMPLETE TABLET
ELURYNG VAGINAL RING
EMBRACE GLUCOSE TEST STRIPS
EMBRACE TEST STRIPS
EMBRACE GLUC CONTROL SOLN HIGH
EMBRACE BLOOD GLUCOSE KIT
EMBRACE BLOOD GLUCOSE SYSTEM
EMBRACE 30G LANCETS
EMBRACE EVO TEST STRIPS
EMBRACE EVO LEVEL 1 CTRL SOLN
EMBRACE EVO LEVEL 2 CTRL SOLN
EMBRACE EVO BLOOD GLUCOSE KIT
EMBRACE GLUC CONTROL SOLN LOW
EMBRACE PRO CONTROL SOLUTION
EMBRACE PRO BLOOD GLUCOSE MTR
EMBRACE PRO TEST STRIP
EMBRACE TALK BLOOD GLUCOSE MTR
EMBRACE TALK BLOOD GLUCOSE SYS
EMBRACE TALK CTRL SOL-HIGH(L2)
EMBRACE TALK CTRL SOLN-LOW(L1)
EMBRACE TALK TEST STRIP
EMERGEN-C KIDZ 250 MG PACKET
EMFLAZA 18 MG TABLET
EMFLAZA 22.75 MG/ML ORAL SUSP
EMFLAZA 30 MG TABLET
EMFLAZA 36 MG TABLET
EMFLAZA 6 MG TABLET
EMGALITY 120 MG/ML PEN
EMGALITY 120 MG/ML SYRINGE
EMOQUETTE 28 DAY TABLET
EMSAM 12 MG/24 HOURS PATCH
EMSAM 6 MG/24 HOURS PATCH
EMSAM 9 MG/24 HOURS PATCH
EMTRIVA 10 MG/ML SOLUTION
EMTRIVA 200 MG CAPSULE
ENABLEX 15 MG TABLET
ENABLEX 7.5 MG TABLET
ENALAPRIL MALEATE 10 MG TAB
ENALAPRIL MALEATE 2.5 MG TAB
ENALAPRIL MALEATE 20 MG TAB
ENALAPRIL MALEATE 5 MG TABLET
ENALAPRIL-HCTZ 10-25 MG TABLET
ENALAPRIL-HCTZ 5-12.5 MG TAB
ENBRACE HR SOFTGEL
ENBREL 25 MG KIT
ENBREL 25 MG/0.5 ML SYRINGE
ENBREL 50 MG/ML SYRINGE
ENBREL 50 MG/ML MINI CARTRIDGE
ENBREL 50 MG/ML SURECLICK
ENDARI 5 GRAM POWDER PACKET
ENDUR-VM IRON-FREE SR TABLET
ENDUR-VM WITH IRON SR TABLET
ENGLISH PLANTAIN 1:20 (W/V) VL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ENLITE SYSTEM KIT
ENLITE GLUCOSE SENSOR
ENPRESSE-28 TABLET
ENSKYCE 28 TABLET
ENTACAPONE 200 MG TABLET
ENTECAVIR 0.5 MG TABLET
ENTECAVIR 1 MG TABLET
ENTRESTO 24 MG-26 MG TABLET
ENTRESTO 49 MG-51 MG TABLET
ENTRESTO 97 MG-103 MG TABLET
ENTYVIO 300 MG VIAL
ENULOSE 10 GM/15 ML SOLUTION
ENVARSUS XR 0.75 MG TABLET
ENVARSUS XR 1 MG TABLET
ENVARSUS XR 4 MG TABLET
ENZADYNE CAPSULE
EPANED 1 MG/ML ORAL SOLUTION
EPANED 1 MG/ML SOLUTION
EPICOCCUM 10,000 PNU/ML VIAL
EPICOCCUM 20,000 PNU/ML VIAL
EPIDIOLEX 100 MG/ML SOLUTION
EPITOL 200 MG TABLET
EPIVIR 10 MG/ML ORAL SOLN
EPIVIR 150 MG TABLET
EPIVIR 300 MG TABLET
EPIVIR HBV 100 MG TABLET
EPIVIR HBV 25 MG/5 ML SOLN
EPLERENONE 25 MG TABLET
EPLERENONE 50 MG TABLET
EPOGEN 10,000 UNITS/ML VIAL
EPOGEN 2,000 UNITS/ML VIAL
EPOGEN 20,000 UNITS/2 ML VIAL
EPOGEN 20,000 UNITS/ML VIAL
EPOGEN 3,000 UNITS/ML VIAL
EPOGEN 4,000 UNITS/ML VIAL
EPOPROSTENOL SODIUM 0.5 MG VL
EPOPROSTENOL SODIUM 1.5 MG VL
EPROSARTAN MESYLATE 600 MG TAB
EPZICOM TABLET
EQUETRO 100 MG CAPSULE
EQUETRO 200 MG CAPSULE
EQUETRO 300 MG CAPSULE
ERGOLOID MESYLATES 1 MG TAB
ERIVEDGE 150 MG CAPSULE
ERLEADA 60 MG TABLET
ERLOTINIB HCL 100 MG TABLET
ERLOTINIB HCL 150 MG TABLET
ERLOTINIB HCL 25 MG TABLET
ERRIN 0.35 MG TABLET
ESBRIET 267 MG CAPSULE
ESBRIET 267 MG TABLET
ESBRIET 801 MG TABLET
ESCAVITE TABLET CHEWABLE
ESCAVITE D TABLET CHEWABLE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ESCAVITE LQ DROPS
ESCITALOPRAM 10 MG TABLET
ESCITALOPRAM 20 MG TABLET
ESCITALOPRAM 5 MG TABLET
ESCITALOPRAM OXALATE 10MG/10ML
ESCITALOPRAM OXALATE 5 MG/5 ML
ESOMEP-EZS KIT
CVS ESOMEPRAZOLE MAG 20 MG CAP
ESOMEPRAZOLE MAG DR 20 MG CAP
ESOMEPRAZOLE MAG DR 40 MG CAP
GS ESOMEPRAZOLE MAG DR 20 MG
HM ESOMEPRAZOLE MAG DR 20 MG
RA ESOMEPRAZOLE MAG DR 20 MG
SM ESOMEPRAZOLE MAG DR 20 MG
ESOMEPRAZOLE DR 24.65 MG CAP
ESOMEPRAZOLE DR 49.3 MG CAP
ESPEROCT 1,000 UNIT VIAL
ESPEROCT 1,500 UNIT VIAL
ESPEROCT 2,000 UNIT VIAL
ESPEROCT 3,000 UNIT VIAL
ESPEROCT 500 UNIT VIAL
ESSENTIA TABLET
ESSENTIAL BALANCE TABLET
ESSENTIAL DAILY TABLET
ESSENTIAL MAN TABLET
ESSENTIAL MAN 50+ TABLET
ESSENTIAL WOMAN 50+ TABLET
ESTARYLLA 0.25-0.035 MG TABLET
ESTRACE 0.01% CREAM
ESTRACE 0.5 MG TABLET
ESTRACE 1 MG TABLET
ESTRACE 2 MG TABLET
ESTRADIOL 0.01% CREAM
ESTRADIOL 0.025 MG PATCH
ESTRADIOL 0.0375 MG PATCH
ESTRADIOL 0.0375 MG/DAY PATCH
ESTRADIOL 0.05 MG PATCH
ESTRADIOL 0.06 MG/DAY PATCH
ESTRADIOL 0.075 MG PATCH
ESTRADIOL 0.075 MG/DAY PATCH
ESTRADIOL 0.1 MG PATCH
ESTRADIOL 0.5 MG TABLET
ESTRADIOL 1 MG TABLET
ESTRADIOL 10 MCG VAGINAL INSRT
ESTRADIOL 2 MG TABLET
ESTRADIOL TDS 0.025 MG/DAY
ESTRADIOL TDS 0.0375 MG/DAY
ESTRADIOL TDS 0.05 MG/DAY
ESTRADIOL TDS 0.06 MG/DAY
ESTRADIOL TDS 0.075 MG/DAY
ESTRADIOL TDS 0.1 MG/DAY
ESTRADIOL 0.05 MG/DAY PATCH
ESTRADIOL 0.1 MG/DAY PATCH
ESTRADIOL VALERATE 20 MG/ML VL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ESTRADIOL VALERATE 40 MG/ML VL
ESTRADIOL-NORETH 0.5-0.1 MG TB
ESTRADIOL-NORETH 1-0.5 MG TAB
ESTRING 2 MG VAGINAL RING
ESTROGEL 0.06% GEL
ESTROGEN-METHYLTESTOS F.S. TAB
ESTROGEN-METHYLTESTOS H.S. TAB
ESTROPIPATE 0.625(0.75 MG) TAB
ESTROPIPATE 1.25(1.5 MG) TAB
ESTROPIPATE 2.5(3 MG) TAB
ESTROSTEP FE-28 TABLET
ETHACRYNIC ACID 25 MG TABLET
ETHOSUXIMIDE 250 MG CAPSULE
ETHOSUXIMIDE 250 MG/5 ML SOLN
ETHYNODIOL-ETH ESTRA 1MG-35MCG
ETHYNODIOL-ETH ESTRA 1MG-50MCG
ETIDRONATE DISODIUM 200 MG TAB
ETIDRONATE DISODIUM 400 MG TAB
ETODOLAC 200 MG CAPSULE
ETODOLAC 300 MG CAPSULE
ETODOLAC 400 MG TABLET
ETODOLAC 500 MG TABLET
ETODOLAC ER 400 MG TABLET
ETODOLAC ER 500 MG TABLET
ETODOLAC ER 600 MG TABLET
ETONOGESTREL-EE VAGINAL RING
EUTHYROX 100 MCG TABLET
EUTHYROX 112 MCG TABLET
EUTHYROX 125 MCG TABLET
EUTHYROX 137 MCG TABLET
EUTHYROX 150 MCG TABLET
EUTHYROX 175 MCG TABLET
EUTHYROX 200 MCG TABLET
EUTHYROX 25 MCG TABLET
EUTHYROX 50 MCG TABLET
EUTHYROX 75 MCG TABLET
EUTHYROX 88 MCG TABLET
EVAMIST 1.53 MG/SPRAY
EVEKEO 10 MG TABLET
EVEKEO 5 MG TABLET
EVEKEO ODT 10 MG
EVEKEO ODT 15 MG
EVEKEO ODT 20 MG
EVEKEO ODT 5 MG
EVENCARE G2 CONTROL SOLUTION
EVENCARE G2 TEST STRIP
EVENCARE G2 BLOOD GLUCOSE SYS
EVENCARE G3 CONTROL SOLUTION
EVENCARE G3 TEST STRIP
EVENCARE G3 BLOOD GLUCOSE SYS
EVENCARE MINI GLUCOSE TEST STR
EVENCARE MINI MONITOR SYSTEM
EVENCARE PROVIEW TEST STRIP
EVEROLIMUS 0.25 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
EVEROLIMUS 0.5 MG TABLET
EVEROLIMUS 0.75 MG TABLET
EVEROLIMUS 2.5 MG TABLET
EVEROLIMUS 5 MG TABLET
EVEROLIMUS 7.5 MG TABLET
EVERSENSE SMART TRANSMITTER
EVISTA 60 MG TABLET
EVOLUTION BLOOD GLUCOSE METER
EVOLUTION CONTROL SOLN NORMAL
EVOLUTION TEST STRIPS
EVOTAZ 300 MG-150 MG TABLET
EVOXAC 30 MG CAPSULE
EXELON 13.3 MG/24HR PATCH
EXELON 4.6 MG/24HR PATCH
EXELON 9.5 MG/24HR PATCH
EXEMESTANE 25 MG TABLET
EXFORGE 10-160 MG TABLET
EXFORGE 10-320 MG TABLET
EXFORGE 5-160 MG TABLET
EXFORGE 5-320 MG TABLET
EXFORGE HCT 10-160-12.5 MG TAB
EXFORGE HCT 10-160-25 MG TAB
EXFORGE HCT 10-320-25 MG TAB
EXFORGE HCT 5-160-12.5 MG TAB
EXFORGE HCT 5-160-25 MG TAB
EXJADE 125 MG TABLET
EXJADE 250 MG TABLET
EXJADE 500 MG TABLET
EXONDYS-51 100 MG/2 ML VIAL
EXONDYS-51 500 MG/10 ML VIAL
EXPECTA PRENATAL COMBO PACK
EXTAVIA 0.3 MG KIT
EXTAVIA 0.3 MG VIAL
CVS EYE HEALTH AND LUTEIN TAB
EQL EYE HEALTH PLUS LUTEIN TAB
EYE VITAMIN-MINERALS TABLET
EYEPROTECT TABLET
EYLEA 2 MG/0.05 ML SYRINGE
EYLEA 2 MG/0.05 ML VIAL
E-Z JECT COLORED LANCETS
E-Z JECT LANCETS
EZ SMART TEST STRIPS
EZ SMART SYSTEM KIT
EZ SMART 28G LANCETS
EZ SMART PLUS TEST STRIPS
EZ SMART PLUS SYSTEM KIT
EZALLOR SPRINKLE 10 MG CAPSULE
EZALLOR SPRINKLE 20 MG CAPSULE
EZALLOR SPRINKLE 40 MG CAPSULE
EZALLOR SPRINKLE 5 MG CAPSULE
EZETIMIBE 10 MG TABLET
EZETIMIBE-SIMVASTATIN 10-10 MG
EZETIMIBE-SIMVASTATIN 10-20 MG
EZETIMIBE-SIMVASTATIN 10-40 MG
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
EZETIMIBE-SIMVASTATIN 10-80 MG
E-ZJECT COLOR 32G LANCETS
E-ZJECT COLOR 33G LANCETS
E-ZJECT SUPER THIN 30G LANCETS
RA E-ZJECT 26G LANCETS
RA E-ZJECT 28G LANCETS
RA E-ZJECT 30G LANCETS
RA E-ZJECT COLOR 33G LANCETS
EZ-LETS 26G LANCETS
FA-8 CAPSULES
FABB TABLET
FABRAZYME 35 MG VIAL
FABRAZYME 5 MG VIAL
FALMINA-28 TABLET
FAMCICLOVIR 125 MG TABLET
FAMCICLOVIR 250 MG TABLET
FAMCICLOVIR 500 MG TABLET
EQ FAMOTIDINE 10 MG TABLET
FAMOTIDINE 10 MG TABLET
FAMOTIDINE 20 MG TABLET
FAMOTIDINE 40 MG TABLET
FAMOTIDINE 40 MG/5 ML SUSP
HM FAMOTIDINE 10 MG TABLET
HM FAMOTIDINE 20 MG TABLET
PUB FAMOTIDINE 20 MG TABLET
FAMVIR 125 MG TABLET
FAMVIR 250 MG TABLET
FAMVIR 500 MG TABLET
FANAPT 1 MG TABLET
FANAPT 10 MG TABLET
FANAPT 12 MG TABLET
FANAPT 2 MG TABLET
FANAPT 4 MG TABLET
FANAPT 6 MG TABLET
FANAPT 8 MG TABLET
FARESTON 60 MG TABLET
FARXIGA 10 MG TABLET
FARXIGA 5 MG TABLET
FASENRA 30 MG/ML SYRINGE
FASENRA PEN 30 MG/ML
FASLODEX 250 MG/5 ML SYRINGE
V-R FATIGUE REL COMPLEX CPL
FAYOSIM TABLET
FAZACLO 100 MG ODT
FAZACLO 12.5 MG ODT
FAZACLO 150 MG ODT
FAZACLO 200 MG ODT
FAZACLO 25 MG ODT
FEBUXOSTAT 40 MG TABLET
FEBUXOSTAT 80 MG TABLET
FEIBA NF 1,000 UNIT (NOMINAL)
FEIBA NF 2,500 UNIT (NOMINAL)
FEIBA NF 500 UNIT (NOMINAL)
FELBAMATE 400 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
FELBAMATE 600 MG TABLET
FELBAMATE 600 MG/5 ML SUSP
FELBATOL 400 MG TABLET
FELBATOL 600 MG TABLET
FELBATOL 600 MG/5 ML SUSP
FELDENE 10 MG CAPSULE
FELDENE 20 MG CAPSULE
FELODIPINE ER 10 MG TABLET
FELODIPINE ER 2.5 MG TABLET
FELODIPINE ER 5 MG TABLET
FEMARA 2.5 MG TABLET
FEMCON FE CHEWABLE TABLET
FEMHRT 0.5 MG-2.5 MCG TABLET
FEMRING 0.05 MG/DAY VAG RING
FEMRING 0.10 MG/DAY VAG RING
FEMYNOR 28 TABLET
FENOFIBRATE 120 MG TABLET
FENOFIBRATE 150 MG CAPSULE
FENOFIBRATE 160 MG TABLET
FENOFIBRATE 40 MG TABLET
FENOFIBRATE 50 MG CAPSULE
FENOFIBRATE 54 MG TABLET
FENOFIBRATE 145 MG TABLET
FENOFIBRATE 160 MG TABLET
FENOFIBRATE 48 MG TABLET
FENOFIBRATE 130 MG CAPSULE
FENOFIBRATE 134 MG CAPSULE
FENOFIBRATE 200 MG CAPSULE
FENOFIBRATE 43 MG CAPSULE
FENOFIBRATE 67 MG CAPSULE
FENOFIBRIC ACID 105 MG TABLET
FENOFIBRIC ACID 35 MG TABLET
FENOFIBRIC ACID DR 135 MG CAP
FENOFIBRIC ACID DR 45 MG CAP
FENOGLIDE 120 MG TABLET
FENOGLIDE 40 MG TABLET
FENOPROFEN 200 MG CAPSULE
FENOPROFEN 400 MG CAPSULE
FENOPROFEN 600 MG TABLET
FENORTHO 200 MG CAPSULE
FENORTHO 400 MG CAPSULE
FERRIPROX 1,000 MG TABLET
FERRIPROX 500 MG TABLET
FETZIMA ER 120 MG CAPSULE
FETZIMA ER 20 MG CAPSULE
FETZIMA ER 40 MG CAPSULE
FETZIMA ER 80 MG CAPSULE
FIASP 100 UNIT/ML VIAL
FIASP 100 UNIT/ML FLEXTOUCH
FIASP PENFILL 100 UNIT/ML CART
FIBRICOR 105 MG TABLET
FIBRICOR 35 MG TABLET
FIFTY50 SAFETY SEAL 30G LANCET
FIFTY50 SAFETY SEAL 32G LANCET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
FIFTY50 GLUCOSE TEST STRIP
FINASTERIDE 1 MG TABLET
FINASTERIDE 5 MG TABLET
FINE 30 UNIVERSAL 30G LANCETS
FINGERSTIX LANCETS
FIRDAPSE 10 MG TABLET
FIRE ANT 1:10 (W/V) VIAL
FIRE ANT 1:20 (W/V) VIAL
FIRMAGON 80 MG KIT
FIRST-LANSOPRAZOLE 3 MG/ML
FIRST-OMEPRAZOLE 2 MG/ML SUSP
FIRST 2% TESTOSTERONE OINT
FIRST-TESTOSTERONE MC 2% CR
FLANAX 220 MG TABLET
FLAVOXATE HCL 100 MG TABLET
FLEBOGAMMA DIF 10% VIAL
FLEBOGAMMA DIF 5% VIAL
FLECAINIDE ACETATE 100 MG TAB
FLECAINIDE ACETATE 150 MG TAB
FLECAINIDE ACETATE 50 MG TAB
FLINTSTONES TABLET CHEWABLE
FLINTSTONES MULTIVIT CHEW TAB
FLINTSTONES TAB CHEW
FLINTSTONES GUMMIES CHEW TAB
FLINTSTONES SOUR-GUM CHEW TAB
FLINTSTONES COMPLETE TABLET
FLINTSTONES COMPLETE CHEW TAB
FLINTSTONES COMPLETE GUMMIES
FLINTSTONES GUMMIES CHEW TAB
FLINTSTONES MULTI-VIT GUMMIES
FLINTSTONES MULTI-VIT GUMMIES
FLINTSTONES + CALCIUM TAB
FLINTSTONES EXTRA C TAB CHEW
FLINTSTONES EXTRA C GUMMIES
FLINTSTONES WITH IRON TAB CHEW
FLOLAN 0.5 MG VIAL
FLOLAN 1.5 MG VIAL
FLOLIPID 20 MG/5 ML ORAL SUSP
FLOLIPID 40 MG/5 ML ORAL SUSP
FLOMAX 0.4 MG CAPSULE
FLORIVA 0.25 MG CHEW TABLET
FLORIVA 0.5 MG CHEWABLE TABLET
FLORIVA 1 MG CHEWABLE TABLET
FLORIVA PLUS 0.25 MG/ML DROPS
FLORIVA PLUS 0.25 MG/ML DROP
FLOVENT 100 MCG DISKUS
FLOVENT 250 MCG DISKUS
FLOVENT 50 MCG DISKUS
FLOVENT HFA 110 MCG INHALER
FLOVENT HFA 220 MCG INHALER
FLOVENT HFA 44 MCG INHALER
FLUDROCORTISONE 0.1 MG TABLET
FLUNISOLIDE 0.025% SPRAY
FLUORABON 0.25 MG/0.6 ML DROPS
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
FLUORIDE 0.25 MG TABLET CHEW
FLUORIDE 0.5 MG TABLET CHEW
FLUORIDE 1 MG TABLET CHEWABLE
FLUORIDEX DAILY DEFENSE
FLUORIDEX DEFENSE 1.1% GEL
FLUORIDEX SENSITIV RLF PASTE
FLUORIDEX SENSITIVITY RLF GEL
FLUORITAB 0.5 MG TABLET CHEW
FLUORITAB 1 MG TABLET CHEW
FLUOXETINE DR 90 MG CAPSULE
FLUOXETINE 20 MG/5 ML SOLUTION
FLUOXETINE HCL 10 MG CAPSULE
FLUOXETINE HCL 10 MG TABLET
FLUOXETINE HCL 20 MG CAPSULE
FLUOXETINE HCL 20 MG TABLET
FLUOXETINE HCL 40 MG CAPSULE
FLUOXETINE HCL 60 MG TABLET
FLUPHENAZINE DEC 125 MG/5 ML
FLUPHENAZINE 1 MG TABLET
FLUPHENAZINE 10 MG TABLET
FLUPHENAZINE 2.5 MG TABLET
FLUPHENAZINE 2.5 MG/5 ML ELIX
FLUPHENAZINE 5 MG TABLET
FLUPHENAZINE 5 MG/ML CONC
FLURA-DROPS 0.25 MG/DROP
FLURBIPROFEN 100 MG TABLET
FLURBIPROFEN 50 MG TABLET
FLUTAMIDE 125 MG CAPSULE
FLUTICASONE PROP 50 MCG SPRAY
FLUTICASONE-SALMETEROL 100-50
FLUTICASONE-SALMETEROL 113-14
FLUTICASONE-SALMETEROL 232-14
FLUTICASONE-SALMETEROL 250-50
FLUTICASONE-SALMETEROL 500-50
FLUTICASONE-SALMETEROL 55-14
FLUVASTATIN ER 80 MG TABLET
FLUVASTATIN SODIUM 20 MG CAP
FLUVASTATIN SODIUM 40 MG CAP
FLUVOXAMINE MALEATE 100 MG TAB
FLUVOXAMINE MALEATE 25 MG TAB
FLUVOXAMINE MALEATE 50 MG TAB
FLUVOXAMINE ER 100 MG CAPSULE
FLUVOXAMINE ER 150 MG CAPSULE
FOCALGIN 90 DHA COMBO PACK
FOCALGIN CA COMBO PACK
FOCALIN 10 MG TABLET
FOCALIN 2.5 MG TABLET
FOCALIN 5 MG TABLET
FOCALIN XR 10 MG CAPSULE
FOCALIN XR 15 MG CAPSULE
FOCALIN XR 20 MG CAPSULE
FOCALIN XR 25 MG CAPSULE
FOCALIN XR 30 MG CAPSULE
FOCALIN XR 35 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
FOCALIN XR 40 MG CAPSULE
FOCALIN XR 5 MG CAPSULE
FOLBEE TABLET
FOLBEE PLUS TABLET
FOLBEE PLUS CZ TABLET
FOLBIC TABLET
FOLET ONE SOFTGEL
FOLGARD RX TABLET
CVS FOLIC ACID 800 MCG TABLET
FOLIC ACID 0.4 MG TABLET
FOLIC ACID 0.8 MG TABLET
FOLIC ACID 1 MG TABLET
FOLIC ACID 1,000 MCG TABLET
FOLIC ACID 20 MG CAPSULE
FOLIC ACID 400 MCG TABLET
FOLIC ACID 5 MG CAPSULE
FOLIC ACID 800 MCG CAPSULE
FOLIC ACID 800 MCG TABLET
GNP FOLIC ACID 400 MCG TABLET
HM FOLIC ACID 400 MCG TABLET
RA FOLIC ACID 0.4 MG TABLET
RA FOLIC ACID 800 MCG TABLET
SM FOLIC ACID 0.4 MG TABLET
SM FOLIC ACID 400 MCG TABLET
SV FOLIC ACID 800 MCG TABLET
FA-CYANCOBA-PYRIDOXINE TAB
FOLIC ACID-VIT B6-VIT B12 TAB
FOLIC ACID-VIT B6-VIT B12 TAB
FOLIVANE-OB CAPSULE
FOLPLEX 2.2 TABLET
FOLTABS 800 TABLET
FORA NORMAL CONTROL SOLUTION
FORA D10 BLOOD GLUCOSE SYSTEM
FORA D15 GLUCOSE-BP MONITOR
FORA D15G GLUCOSE TEST STRIPS
FORA D20 GLUCOSE TEST STRIPS
FORA D20 BLOOD GLUCOSE SYSTEM
FORA D40D GLUCOSE-BP MONITOR
FORA D40G GLUCOSE-BP MONITOR
FORA D40-G31 TEST STRIPS
FORA G20 GLUCOSE TEST STRIPS
FORA G20 BLOOD GLUCOSE SYSTEM
FORA G30A BLOOD GLUCOSE SYSTEM
FORA G30-PREMIUM V10 TEST STRP
FORA GD50 BLOOD GLUCOSE SYSTEM
FORA GD50 TEST STRIPS
FORA GTEL GLUCOSE TEST STRIP
FORA GTEL KETONE TEST STRIP
FORA GTEL MULTIFUNCTN MONITOR
FORA 30G LANCETS
FORA PREMIUM V10 GLUCOSE METER
FORA TEST N'GO VOICE SYSTEM
FORA BLOOD GLUCOSE TEST STRIP
FORA TN'G VOICE GLUCOSE METER
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
FORA TN'G VOICE TEST STRIPS
FORA V10 GLUCOSE TEST STRIP
FORA V10 BLOOD GLUCOSE SYSTEM
FORA V10-V12-D10-D20 STRIPS
FORA V10-V12-D10-D20 STRP-LNCT
FORA V12 GLUCOSE TEST STRIP
FORA V12 BLOOD GLUCOSE SYSTEM
FORA V20 GLUCOSE TEST STRIPS
FORA V20 BLOOD GLUCOSE SYSTEM
FORA V30A GLUCOSE TEST STRIP
FORA V30A BLOOD GLUCOSE SYSTEM
FORACARE GD20 TEST STRIPS
FORACARE GD20 GLUCOSE SYSTEM
FORACARE GD40 GLUCOSE STRIPS
FORACARE GD40A GLUCOSE SYSTEM
FORACARE GD40B GLUCOSE SYSTEM
FORACARE GDH HIGH CONTROL SOLN
FORACARE GDH LOW CONTROL SOLN
FORACARE GDH NORM CONTROL SOLN
FORACARE 30G LANCETS
FORADIL AEROLIZER 12 MCG CAP
FORFIVO XL 450 MG TABLET
FORTAMET ER 1,000 MG TABLET
FORTAMET ER 500 MG TABLET
FORTAVIT SOFTGEL
FORTEO 600 MCG/2.4 ML PEN INJ
FORTESTA 10 MG GEL PUMP
FORTISCARE CONTROL SOLN HIGH
FORTISCARE CONTROL SOLN LOW
FORTISCARE CONTROL SOLN NORMAL
FORTISCARE BLOOD GLUCOSE SYST
FORTISCARE GLUCOSE TEST STRIPS
FOSAMAX 70 MG TABLET
FOSAMAX PLUS D 70 MG-2,800 IU
FOSAMAX PLUS D 70 MG-5,600 IU
FOSAMPRENAVIR 700 MG TABLET
FOSINOPRIL SODIUM 10 MG TAB
FOSINOPRIL SODIUM 20 MG TAB
FOSINOPRIL SODIUM 40 MG TAB
FOSINOPRIL-HCTZ 10-12.5 MG TAB
FOSINOPRIL-HCTZ 20-12.5 MG TAB
FOSRENOL 1,000 MG POWDER PACK
FOSRENOL 1,000 MG TABLET CHEW
FOSRENOL 500 MG TABLET CHEW
FOSRENOL 750 MG POWDER PACKET
FOSRENOL 750 MG TABLET CHEW
FREEDAVITE TABLET
FREESTYLE CONTROL SOLUTION
FREESTYLE CONTROL SOLUTION
FREESTYLE FLASH SYSTEM KIT
FREESTYLE FREEDOM KIT
FREESTYLE FREEDOM LITE METER
FREESTYLE FREEDOM LITE NFRS
FREESTYLE INSULINX STRIP NFRS
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
FREESTYLE INSULINX TEST STRIP
FREESTYLE INSULINX GLUCOSE SYS
FREESTYLE INSULINX TEST STRIPS
FREESTYLE 28G LANCETS
FREESTYLE LIBRE 10 DAY READER
FREESTYLE LIBRE 10 DAY SENSOR
FREESTYLE LIBRE 14 DAY READER
FREESTYLE LIBRE 14 DAY SENSOR
FREESTYLE LITE METER
FREESTYLE LITE METER NFRS
FREESTYLE LITE TEST STRIP
FREESTYLE LITE TEST STRIP NFRS
FREESTYLE NAVIGATOR SENSOR KIT
FREESTYLE PREC 1 ML 30GX5/16"
FREESTYLE PREC 1 ML 31GX5/16"
FREESTYLE PREC 0.5 ML 30GX5/16
FREESTYLE PREC 0.5 ML 31GX5/16
FREESTYLE PREC NEO TEST STRIPS
FREESTYLE PRECISION NEO METER
FREESTYLE SIDEKICK II VALPK
FREESTYLE SYSTEM KIT
FREESTYLE TEST STRIPS
FREESTYLE TEST STRIPS NFRS
FREESTYLE UNISTIK 2 LANCETS
FRUITY VITAMINS TABLET CHEW
FULL SPECTRUM B WITH VIT C TAB
FULVESTRANT 250 MG/5 ML SYRING
FUROSEMIDE 10 MG/ML SOLUTION
FUROSEMIDE 20 MG TABLET
FUROSEMIDE 40 MG TABLET
FUROSEMIDE 40 MG/4 ML ORAL SOL
FUROSEMIDE 40 MG/5 ML SOLN
FUROSEMIDE 80 MG TABLET
FUSARIUM 10,000 PNU/ML
FUSARIUM 20,000 PNU/ML
FUZEON 90 MG VIAL
FYAVOLV 0.5 MG-2.5 MCG TABLET
FYAVOLV 1 MG-5 MCG TABLET
FYCOMPA 0.5 MG/ML ORAL SUSP
FYCOMPA 10 MG TABLET
FYCOMPA 12 MG TABLET
FYCOMPA 2 MG TABLET
FYCOMPA 4 MG TABLET
FYCOMPA 6 MG TABLET
FYCOMPA 8 MG TABLET
GABAPENTIN 100 MG CAPSULE
GABAPENTIN 250 MG/5 ML SOLN
GABAPENTIN 300 MG CAPSULE
GABAPENTIN 300 MG/6 ML SOLN
GABAPENTIN 400 MG CAPSULE
GABAPENTIN 600 MG TABLET
GABAPENTIN 800 MG TABLET
GABITRIL 12 MG TABLET
GABITRIL 16 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
GABITRIL 2 MG TABLET
GABITRIL 4 MG TABLET
GABLOFEN 10,000 MCG/20 ML SYRG
GABLOFEN 10,000 MCG/20 ML VIAL
GABLOFEN 20,000 MCG/20 ML SYRG
GABLOFEN 20,000 MCG/20 ML VIAL
GABLOFEN 40,000 MCG/20 ML SYRG
GABLOFEN 40,000 MCG/20 ML VIAL
GABLOFEN 50 MCG/ML SYRINGE
GALAFOLD 123 MG CAPSULE
GALANTAMINE ER 16 MG CAPSULE
GALANTAMINE ER 24 MG CAPSULE
GALANTAMINE ER 8 MG CAPSULE
GALANTAMINE HBR 12 MG TABLET
GALANTAMINE HBR 4 MG TABLET
GALANTAMINE HBR 8 MG TABLET
GALANTAMINE 4 MG/ML ORAL SOLN
GAMIFANT 10 MG/2 ML VIAL
GAMIFANT 50 MG/10 ML VIAL
GAMMAGARD LIQUID 10% VIAL
GAMMAGARD S-D 10 G (IGA<1) SOL
GAMMAGARD S-D 5 G (IGA<1) SOLN
GAMMAKED 1 GRAM/10 ML VIAL
GAMMAKED 10 GRAM/100 ML VIAL
GAMMAKED 2.5 GRAM/25 ML VIAL
GAMMAKED 20 GRAM/200 ML VIAL
GAMMAKED 5 GRAM/50 ML VIAL
GAMMAPLEX 10 GRAM/100 ML VIAL
GAMMAPLEX 20 GRAM/200 ML VIAL
GAMMAPLEX 5 GRAM/50 ML VIAL
GAMMAPLEX 10 GRAM/200 ML VIAL
GAMMAPLEX 20 GRAM/400 ML VIAL
GAMMAPLEX 5 GRAM/100 ML VIAL
GAMUNEX-C 1 GRAM/10 ML VIAL
GAMUNEX-C 10 GRAM/100 ML VIAL
GAMUNEX-C 2.5 GRAM/25 ML VIAL
GAMUNEX-C 20 GRAM/200 ML VIAL
GAMUNEX-C 40 GRAM/400 ML VIAL
GAMUNEX-C 5 GRAM/50 ML VIAL
GASTROCROM 100 MG/5 ML CONC
GATTEX 5 MG 30-VIAL KIT
GATTEX 5 MG ONE-VIAL KIT
GE100 BLOOD GLUCOSE SYSTEM
GE100 BLOOD GLUCOSE TEST STRIP
GE100 CONTROL SOLUTION NORMAL
GEL-KAM 0.4% DENTAL GEL
GELNIQUE 10% GEL PUMP
GELNIQUE 10% GEL SACHET
GELNIQUE 10% GEL SACHETS
GEMFIBROZIL 600 MG TABLET
GENERESS FE CHEWABLE TABLET
GENERLAC 10 GM/15 ML SOLUTION
GENGRAF 100 MG CAPSULE
GENGRAF 100 MG/ML SOLUTION
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
GENGRAF 25 MG CAPSULE
GENGRAF 50 MG CAPSULE
GENOTROPIN 12 MG CARTRIDGE
GENOTROPIN 5 MG CARTRIDGE
GENOTROPIN MINIQUICK 0.2 MG
GENOTROPIN MINIQUICK 0.4 MG
GENOTROPIN MINIQUICK 0.6 MG
GENOTROPIN MINIQUICK 0.8 MG
GENOTROPIN MINIQUICK 1 MG
GENOTROPIN MINIQUICK 1.2 MG
GENOTROPIN MINIQUICK 1.4 MG
GENOTROPIN MINIQUICK 1.6 MG
GENOTROPIN MINIQUICK 1.8 MG
GENOTROPIN MINIQUICK 2 MG
GENSTRIP GLUCOSE TEST STRIP
GENTEEL VACUUM LANCING DEVICE
GENVOYA TABLET
GEODON 20 MG CAPSULE
GEODON 40 MG CAPSULE
GEODON 60 MG CAPSULE
GEODON 80 MG CAPSULE
GERITOL COMPLETE TABLET
GERITOL TONIC
GERMAN COCKROACH 1:20 (W/V) VL
GIANVI 3 MG-0.02 MG TABLET
GILDAGIA 0.4 MG-0.035 MG TAB
GILENYA 0.5 MG CAPSULE
GILOTRIF 20 MG TABLET
GILOTRIF 30 MG TABLET
GILOTRIF 40 MG TABLET
GIVLAARI 189 MG/ML VIAL
GLASSIA 1 GM/50 ML VIAL
GLATIRAMER 20 MG/ML SYRINGE
GLATIRAMER 40 MG/ML SYRINGE
GLATOPA 20 MG/ML SYRINGE
GLATOPA 40 MG/ML SYRINGE
GLEEVEC 100 MG TABLET
GLEEVEC 400 MG TABLET
GLIMEPIRIDE 1 MG TABLET
GLIMEPIRIDE 2 MG TABLET
GLIMEPIRIDE 4 MG TABLET
GLIPIZIDE 10 MG TABLET
GLIPIZIDE 5 MG TABLET
GLIPIZIDE ER 10 MG TABLET
GLIPIZIDE ER 2.5 MG TABLET
GLIPIZIDE ER 5 MG TABLET
GLIPIZIDE XL 10 MG TABLET
GLIPIZIDE XL 2.5 MG TABLET
GLIPIZIDE XL 5 MG TABLET
GLIPIZIDE-METFORMIN 2.5-250 MG
GLIPIZIDE-METFORMIN 2.5-500 MG
GLIPIZIDE-METFORMIN 5-500 MG
GLOPERBA 0.6 MG/5 ML SOLUTION
GLUCO NAVII GLUCOSE TEST STRIP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
GLUCO NAVII GLUCOSE MONITOR KT
GLUCOCARD 01 METER KIT
GLUCOCARD 01 CONTROL SOLUTION
GLUCOCARD 01 CONTROL SOLUTION
GLUCOCARD 01 SENSOR PLUS STRIP
GLUCOCARD EXPRESSION TEST STRP
GLUCOCARD EXPRESSION CNTRL SLN
GLUCOCARD EXPRESSION METER
GLUCOCARD EXPRESSION METER KIT
GLUCOCARD SHINE TEST STRIPS
GLUCOCARD SHINE CONTROL SOLN
GLUCOCARD SHINE METER
GLUCOCARD SHINE METER KIT
GLUCOCARD SHINE CONNEX METER
GLUCOCARD SHINE EXPRESS METER
GLUCOCARD SHINE XL METER
GLUCOCARD VITAL TEST STRIPS
GLUCOCARD VITAL METER KIT
GLUCOCARD VITAL SENSOR STRIP
GLUCOCOM 33G LANCETS
GLUCOCOM BLOOD GLUCOSE KIT
GLUCOCOM VALUE KIT
GLUCOCOM CONTROL SOLUTION
GLUCOCOM CONTROL SOLUTION
GLUCOCOM GLUCOSE TEST STRIP
GLUCOCOM 28G LANCETS
GLUCOCOM 30G LANCETS
GLUCOPHAGE 1,000 MG TABLET
GLUCOPHAGE 500 MG TABLET
GLUCOPHAGE 850 MG TABLET
GLUCOPHAGE XR 500 MG TAB
GLUCOPHAGE XR 750 MG TAB
GLUCOSE CONTROL SOLN NORMAL
GLUCOSE CONTROL SOLN-NORMAL
FIFTY50 GLUCOSE CONTROL SOLN
GLUCOSE CONTROL SOLUTION
BLOOD GLUCOSE TEST STRIPS
V-R GLUCOSE TEST STRIP
GLUCOTROL 10 MG TABLET
GLUCOTROL 5 MG TABLET
GLUCOTROL XL 10 MG TABLET
GLUCOTROL XL 2.5 MG TABLET
GLUCOTROL XL 5 MG TABLET
GLUCOVANCE 2.5-500 MG TABLET
GLUCOVANCE 5-500 MG TABLET
GLUMETZA ER 1,000 MG TABLET
GLUMETZA ER 500 MG TABLET
GLYBURIDE 1.25 MG TABLET
GLYBURIDE 2.5 MG TABLET
GLYBURIDE 5 MG TABLET
GLYBURIDE MICRO 1.5 MG TAB
GLYBURIDE MICRO 3 MG TABLET
GLYBURIDE MICRO 6 MG TABLET
GLYBURIDE-METFORMIN 2.5-500 MG
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
GLYBURIDE-METFORMIN 5-500 MG
GLYBURID-METFORMIN 1.25-250 MG
GLYCATE 1.5 MG TABLET
GLYCOPYRROLATE 1 MG TABLET
GLYCOPYRROLATE 1.5 MG TABLET
GLYCOPYRROLATE 2 MG TABLET
GLYNASE 1.5 MG PRESTAB
GLYNASE 3 MG PRESTAB
GLYNASE 6 MG PRESTAB
GLYSET 100 MG TABLET
GLYSET 25 MG TABLET
GLYSET 50 MG TABLET
GLYXAMBI 10 MG-5 MG TABLET
GLYXAMBI 25 MG-5 MG TABLET
GMATE 30G LANCETS
GMATE CONTROL SOLUTION
GMATE SMART METER KIT
GMATE SMART STARTER KIT
GMATE TEST STRIPS
GMATE VOICE METER MONITOR SYST
GOCOVRI ER 137 MG CAPSULE
GOCOVRI ER 68.5 MG CAPSULE
GOLDENROD 1:20 W/V VIAL
GONITRO 0.4 MG SUBLINGUAL PWD
GRASTEK 2,800 BAU SL TABLET
GUANFACINE 1 MG TABLET
GUANFACINE 2 MG TABLET
GUANFACINE HCL ER 1 MG TABLET
GUANFACINE HCL ER 2 MG TABLET
GUANFACINE HCL ER 3 MG TABLET
GUANFACINE HCL ER 4 MG TABLET
GUARDIAN CONNECT TRANSMITTER
GUARDIAN LINK 3 TRANSMITTER
GUARDIAN REAL-TIME GLU MONITOR
GUARDIAN SENSOR 3
GUMMI BEAR MULTIVIT TAB CHEW
GUMMIES CHILDREN MULTIVITAMIN
CVS KIDS' MULTIVITAMIN GUMMY
CVS GUMMY DINOS VITAMIN
CVS CHILD GUMMY DINOS GUMMIES
CVS GUMMY DINOS GUMMIES
HACKBERRY 1:20 (W/V) VIAL
HAEGARDA 2,000 UNIT VIAL
HAEGARDA 3,000 UNIT VIAL
HAILEY 21 1.5 MG-30 MCG TAB
HAILEY 24 FE 1 MG-20 MCG TAB
HAIR FORMULA TABLET
HAIR VITAMINS
CVS HAIR, SKIN AND NAILS CPLT
SM HAIR, SKIN AND NAILS CAPLET
HAIR, SKIN AND NAILS TABLET
HAIR, SKIN AND NAILS CAPLET
HM HAIR, SKIN AND NAILS TABLET
HAIR, SKIN AND NAILS CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SV HAIR, SKIN AND NAILS CAPLET
HAIR, SKIN AND NAILS SOFTGEL
HALDOL DECANOATE 100 AMPUL
HALDOL DECANOATE 50 AMPUL
HALOPERIDOL 0.5 MG TABLET
HALOPERIDOL 1 MG TABLET
HALOPERIDOL 10 MG TABLET
HALOPERIDOL 2 MG TABLET
HALOPERIDOL 20 MG TABLET
HALOPERIDOL 5 MG TABLET
HALOPERIDOL DEC 100 MG/ML AMP
HALOPERIDOL DEC 100 MG/ML VIAL
HALOPERIDOL DEC 250 MG/5 ML VL
HALOPERIDOL DEC 50 MG/ML VIAL
HALOPERIDOL DEC 500 MG/5 ML VL
HALOPERIDOL DECAN 50 MG/ML AMP
HALOPERIDOL DEC 100 MG/ML AMP
HALOPERIDOL LAC 2 MG/ML CONC
HARD NAILS 2.5 MG CAPSULE
HARMONY GLUCOSE TEST STRIP
HEALTHPRO CONTROL SOLN-L1, L3
HEALTHPRO GLUCOSE MONITOR SYST
HEALTHPRO GLUCOSE TEST STRIPS
HEALTHWISE INS 1 ML 30GX5/16"
HEALTHWISE INS 1 ML 31GX5/16"
HEALTHWISE INS 0.5ML 30GX5/16"
HEALTHWISE INS 0.5ML 31GX5/16"
HEALTHWISE INS 0.3ML 30GX5/16"
HEALTHWISE INS 0.3ML 31GX5/16"
HEALTHWISE PEN NEEDLE 31G 5MM
HEALTHWISE PEN NEEDLE 31G 8MM
HEALTHWISE PEN NEEDLE 32G 4MM
HEALTHY ACCENTS PENTIP 4MM 32G
HEALTHY ACCENTS PENTIP 5MM 31G
HEALTHY ACCENTS PENTIP 6MM 31G
HEALTHY ACCENTS PENTIP 8MM 31G
HEALTHY ACCENTS PENTP 12MM 29G
HEALTHY ACCENTS UNILET 30G
GNP HEALTHY EYES TABLET
HEALTHY EYES TABLET
GNP HEALTHY EYES SUPERVISION
HEALTHY EYES SUPERVISION SFTGL
HEARTBURN & ACID REFLUX TABS
EQL HEARTBURN PREVEN 20 MG TAB
EQL HEARTBURN PREVENTION TAB
HEARTBURN RELIEF 200 MG TABLET
SM HEARTBURN RELIEF 200 MG TAB
HEARTBURN RELIEF 10 MG TABLET
HEARTBURN RELIEF 20 MG TABLET
EQL HEARTBURN RELIEF 75 MG TAB
HEARTBURN RELIEF 150 MG TAB
HEARTBURN RELIEF 150 MG TABLET
HEARTBURN TREATMENT 20 MG CAP
HEARTBURN TREATMNT 24 HR 15 MG
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
HEATHER 0.35 MG TABLET
HECTOROL 0.5 MCG CAPSULE
HECTOROL 1 MCG CAPSULE
HECTOROL 2 MCG/ML VIAL
HECTOROL 2.5 MCG CAPSULE
HECTOROL 4 MCG/2 ML VIAL
HELIXATE FS 1,000 UNIT VIAL
HELIXATE FS 2,000 UNIT VIAL
HELIXATE FS 250 UNIT VIAL
HELIXATE FS 3,000 UNITS VIAL
HELIXATE FS 500 UNIT VIAL
HEMENATAL OB TABLET
HEMENATAL OB + DHA COMBO PACK
HEMLIBRA 105 MG/0.7 ML VIAL
HEMLIBRA 150 MG/ML VIAL
HEMLIBRA 30 MG/ML VIAL
HEMLIBRA 60 MG/0.4 ML VIAL
HEMOFIL M 1,000 UNIT NOMINAL
HEMOFIL M 1,700 UNIT NOMINAL
HEMOFIL M 250 UNIT NOMINAL
HEMOFIL M 500 UNIT NOMINAL
HERCEPTIN 150 MG VIAL
HERCEPTIN 440 MG VIAL
HERCEPTIN HYLECTA 600MG-10,000
HERZUMA 150 MG VIAL
HERZUMA 420 MG VIAL
HETLIOZ 20 MG CAPSULE
HIZENTRA 1 GRAM/5 ML VIAL
HIZENTRA 10 GRAM/50 ML VIAL
HIZENTRA 2 GRAM/10 ML VIAL
HIZENTRA 4 GRAM/20 ML VIAL
HOMAPIN 10 TABLET
HOMATROPAIRE 5% EYE DROPS
HOMATROPINE 5% EYE DROPS
HOMOCYSTEINE FORMULA TABLET
HONEY BEARS-IRON-ZINC TAB CHEW
HONEY BEARS CHEWABLE TABLET
HONEY BEE VENOM 100 MCG/ML VL
HORIZANT ER 300 MG TABLET
HORIZANT ER 600 MG TABLET
HORSE EPITHELIUM 1:10 (W/V) VL
HORSE EPITHELIUM 1:20 (W/V) VL
HUMALOG 100 UNIT/ML VIAL
HUMALOG 100 UNITS/ML CARTRIDGE
HUMALOG JR 100 UNIT/ML KWIKPEN
HUMALOG 100 UNITS/ML KWIKPEN
HUMALOG 200 UNITS/ML KWIKPEN
HUMALOG MIX 50-50 VIAL
HUMALOG MIX 50-50 KWIKPEN
HUMALOG MIX 75-25 VIAL
HUMALOG MIX 75-25 KWIKPEN
HUMAPEN LUXURA HD
HUMATE-P 1,200 UNIT VWF:RCO
HUMATE-P 2,400 UNIT VWF:RCO
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
HUMATE-P 600 UNIT VWF:RCO
HUMATROPE 12 MG CARTRIDGE
HUMATROPE 24 MG CARTRIDGE
HUMATROPE 5 MG VIAL
HUMATROPE 6 MG CARTRIDGE
HUMIRA 10 MG/0.2 ML SYRINGE
HUMIRA 20 MG/0.4 ML SYRINGE
HUMIRA 40 MG/0.8 ML SYRINGE
HUMIRA PEN 40 MG/0.8 ML
HUMIRA(CF) 10 MG/0.1 ML SYRING
HUMIRA(CF) 20 MG/0.2 ML SYRING
HUMIRA(CF) 40 MG/0.4 ML SYRING
HUMIRA(CF) PEDI CROHN 80MG/0.8
HUMIRA(CF) PEN 40 MG/0.4 ML
HUMULIN 70/30 KWIKPEN
HUMULIN 70-30 VIAL
HUMULIN N 100 UNIT/ML VIAL
HUMULIN N 100 UNITS/ML VIAL
HUMULIN N 100 UNITS/ML KWIKPEN
HUMULIN R 100 UNIT/ML VIAL
HUMULIN R 100 UNITS/ML VIAL
HUMULIN R 500 UNITS/ML VIAL
HUMULIN R 500 UNITS/ML KWIKPEN
HYDRALAZINE 10 MG TABLET
HYDRALAZINE 100 MG TABLET
HYDRALAZINE 25 MG TABLET
HYDRALAZINE 50 MG TABLET
HYDREA 500 MG CAPSULE
HYDROCHLOROTHIAZIDE 12.5 MG CP
HYDROCHLOROTHIAZIDE 12.5 MG TB
HYDROCHLOROTHIAZIDE 25 MG TAB
HYDROCHLOROTHIAZIDE 50 MG TAB
HYDROCORTISONE 10 MG TABLET
HYDROCORTISONE 20 MG TABLET
HYDROCORTISONE 5 MG TABLET
HYDROXYCHLOROQUINE 200 MG TAB
HYDROXYUREA 500 MG CAPSULE
HYLAVITE TABLET
HYOSCYAMINE 0.125 MG ODT
HYOSCYAMINE 0.125 MG TAB SL
HYOSCYAMINE 0.125 MG/5 ML ELIX
HYOSCYAMINE 0.125 MG/ML DROP
HYOSCYAMINE SULF 0.125 MG TAB
HYOSCYAMINE ER 0.375 MG TAB
HYOSCYAMINE SR 0.375 MG TAB
HYOSYNE 0.125 MG/ML DROP
HYOSYNE 125 MCG/5 ML ELIXIR
HYPOLANCE AST LANCING KIT
HYQVIA 10 GM-800 UNIT PACK
HYQVIA 2.5 GM-200 UNIT PACK
HYQVIA 20 GM-1,600 UNIT PACK
HYQVIA 30 GM-2,400 UNIT PACK
HYQVIA 5 GM-400 UNIT PACK
HYZAAR 100-12.5 TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
HYZAAR 100-25 TABLET
HYZAAR 50-12.5 TABLET
IBANDRONATE 3 MG/3 ML SYRINGE
IBANDRONATE 3 MG/3 ML VIAL
IBANDRONATE SODIUM 150 MG TAB
IBRANCE 100 MG CAPSULE
IBRANCE 125 MG CAPSULE
IBRANCE 75 MG CAPSULE
IBU 400 MG TABLET
IBU 600 MG TABLET
IBU 800 MG TABLET
IBU-200 200 MG TABLET
IBU-DROPS 40 MG/ML SUSP DRPS
CVS IBUPROFEN 200 MG CAPLET
CVS IBUPROFEN 200 MG CAPSULE
CVS IBUPROFEN 200 MG SOFTGEL
CVS IBUPROFEN 200 MG TABLET
CVS IBUPROFEN IB 200 MG TABLET
CVS IBUPROFEN JR STR 100 MG TB
EQ IBUPROFEN 200 MG CAPLET
EQ IBUPROFEN 200 MG SOFTGEL
EQ IBUPROFEN 200 MG TABLET
EQ IBUPROFEN JR STR 100 MG TAB
EQL IBUPROFEN 200 MG CAPLET
EQL IBUPROFEN 200 MG SOFTGEL
EQL IBUPROFEN 200 MG TABLET
EQL IBUPROFEN JR 100 MG TB CHW
GNP IBUPROFEN 200 MG CAPLET
GNP IBUPROFEN 200 MG SOFTGEL
GNP IBUPROFEN 200 MG TABLET
GNP IBUPROFEN JR STR 100 MG TB
GS IBUPROFEN 200 MG CAPLET
GS IBUPROFEN 200 MG SOFTGEL
GS IBUPROFEN 200 MG TABLET
HM IBUPROFEN 200 MG CAPLET
HM IBUPROFEN 200 MG CAPSULE
HM IBUPROFEN 200 MG TABLET
HM IBUPROFEN JR STR 100 MG CHW
IBUPROFEN 100 MG/5 ML SUSP
IBUPROFEN 200 MG CAPLET
IBUPROFEN 200 MG CAPSULE
IBUPROFEN 200 MG SOFTGEL
IBUPROFEN 200 MG TABLET
IBUPROFEN 200 MG/10 ML SUSP
IBUPROFEN 400 MG TABLET
IBUPROFEN 50 MG/1.25 ML SUSP
IBUPROFEN 600 MG TABLET
IBUPROFEN 800 MG TABLET
IBUPROFEN JR STR 100 MG CHEW
IBUPROFEN JR STR 100 MG TB CHW
KRO IBUPROFEN 200 MG CAPLET
KRO IBUPROFEN 200 MG TABLET
KRO IBUPROFEN JR STR 100 MG TB
PUB IBUPROFEN 200 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PUB IBUPROFEN JR 100 MG CHEW
QC IBUPROFEN 200 MG CAPLET
QC IBUPROFEN 200 MG SOFTGEL
RA IBUPROFEN 100 MG/5 ML SUSP
RA IBUPROFEN 200 MG CAPLET
RA IBUPROFEN 200 MG LIQUID GEL
RA IBUPROFEN 200 MG SOFTGEL
RA IBUPROFEN 200 MG TABLET
RA IBUPROFEN JR STR 100 MG CHW
SB IBUPROFEN 200 MG CAPLET
SB IBUPROFEN 200 MG TABLET
SM IBUPROFEN 100 MG/5 ML SUSP
SM IBUPROFEN 200 MG CAPLET
SM IBUPROFEN 200 MG SOFTGEL
SM IBUPROFEN 200 MG TABLET
SM IBUPROFEN IB 100 MG TABLET
SM IBUPROFEN IB 200 MG CAPLET
CVS IBUPROFEN IB 200 MG CPLT
CVS IBUPROFEN IB 200 MG TAB
HM IBUPROFEN IB 100 MG CHEW TB
HM IBUPROFEN IB 200 MG CAPLET
HM IBUPROFEN IB 200 MG TABLET
QC IBUPROFEN IB 200 MG CAPLET
QC IBUPROFEN IB 200 MG TABLET
SM IBUPROFEN IB 100 MG CHEW TB
SM IBUPROFEN IB 200 MG CAPLET
SM IBUPROFEN IB 200 MG TABLET
ICAPS TABLET
ICAPS AREDS FORMULA DR TABLET
I-CAPS WITH LUTEIN-OMEGA 3 SFG
ICAPS AREDS SOFTGEL
ICAPS AREDS2 SOFTGEL
ICAPS AREDS2 CHEWABLE TABLET
ICAPS AREDS2 TABLET
ICAPS MV TABLET
ICLUSIG 15 MG TABLET
ICLUSIG 45 MG TABLET
IDELVION 1,000 UNIT RANGE VIAL
IDELVION 2,000 UNIT RANGE VIAL
IDELVION 250 UNIT RANGE VIAL
IDELVION 3,500 UNIT RANGE VIAL
IDELVION 500 UNIT RANGE VIAL
IDHIFA 100 MG TABLET
IDHIFA 50 MG TABLET
IGLUCOSE BLOOD GLUCOSE MONITOR
IGLUCOSE TEST STRIP
ILARIS 150 MG/ML VIAL
ILUMYA 100 MG/ML SYRINGE
ILUVIEN 0.19 MG IMPLANT
IMATINIB MESYLATE 100 MG TAB
IMATINIB MESYLATE 400 MG TAB
IMBRUVICA 140 MG CAPSULE
IMBRUVICA 140 MG TABLET
IMBRUVICA 280 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
IMBRUVICA 420 MG TABLET
IMBRUVICA 560 MG TABLET
IMBRUVICA 70 MG CAPSULE
IMFINZI 120 MG/2.4 ML VIAL
IMFINZI 500 MG/10 ML VIAL
IMIPRAMINE HCL 10 MG TABLET
IMIPRAMINE HCL 25 MG TABLET
IMIPRAMINE HCL 50 MG TABLET
IMIPRAMINE PAMOATE 100 MG CAP
IMIPRAMINE PAMOATE 125 MG CAP
IMIPRAMINE PAMOATE 150 MG CAP
IMIPRAMINE PAMOATE 75 MG CAP
IMLYGIC 100 MILLION PFU/ML VL
IMODIUM A-D 1 MG/7.5 ML LIQUID
IMODIUM A-D 2 MG CAPLET
IMODIUM MULTI-SYMPTOM REL CPLT
IMURAN 50 MG TABLET
IMVEXXY 10 MCG MAINTENANCE PAK
IMVEXXY 4 MCG MAINTENANCE PACK
INBRIJA 42 MG INHALATION CAP
INCASSIA 0.35 MG TABLET
INCONTROL PEN NEEDLE 12MM 29G
INCONTROL PEN NEEDLE 4MM 32G
INCONTROL PEN NEEDLE 5MM 31G
INCONTROL PEN NEEDLE 6MM 31G
INCONTROL PEN NEEDLE 8MM 31G
INCONTROL SUPER THIN 30G LANCT
INCONTROL ULTRA THIN 28G LANCT
INCRELEX 40 MG/4 ML VIAL
INCRUSE ELLIPTA 62.5 MCG INH
INDAPAMIDE 1.25 MG TABLET
INDAPAMIDE 2.5 MG TABLET
INDERAL LA 120 MG CAPSULE
INDERAL LA 160 MG CAPSULE
INDERAL LA 60 MG CAPSULE
INDERAL LA 80 MG CAPSULE
INDERAL XL 120 MG CAPSULE
INDERAL XL 80 MG CAPSULE
INDOCIN 25 MG/5 ML SUSPENSION
INDOMETHACIN 25 MG CAPSULE
INDOMETHACIN 50 MG CAPSULE
INDOMETHACIN ER 75 MG CAPSULE
INFANTS' ADVIL 50 MG/1.25 ML
INFANTS IBU-DROPS SUSPENSION
EQL INF IBUPROFEN 50 MG/1.25ML
INFANT IBUPROFEN 50 MG/1.25 ML
CVS INF IBUPROFEN 50 MG/1.25ML
EQ INF IBUPROFEN 50 MG/1.25 ML
HM INF IBUPROFEN 50 MG/1.25 ML
INFANT IBUPROFEN 50 MG/1.25 ML
QC INF IBUPROFEN 50 MG/1.25 ML
SB INF IBUPROFEN 50 MG/1.25 ML
CVS INFANT IBUPROFEN SUSP DROP
GNP INFANT IBUPROFEN SUSP DROP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
INFANT IBUPROFEN 50 MG/1.25 ML
RA INFANT IBUPROFEN SUSP DROP
SM INFANT IBUPROFEN SUSP DROP
INFANTS' MOTRIN 50 MG/1.25 ML
INFANT'S MOTRIN 50 MG/1.25 ML
PUB INFANTS PROFENIB DROPS
INFANT-TODDLER MULTIVIT DROP
INFANT-TODDLER MULTIVIT-IRON
INFANT-TODDLER TRI-VIT DROP
INFINITY METER KIT
INFINITY STARTER KIT
INFINITY CONTROL SOLN HIGH
INFINITY CONTROL SOLN LOW
INFINITY CONTROL SOLN NORMAL
INFINITY TEST STRIPS
INFINITY VOICE CTRL SOLN-LVL 2
INFINITY VOICE GLUCOSE MONITOR
INFINITY VOICE TEST STRIP
INFLECTRA 100 MG VIAL
INFUSION SET 23"
INFUSION SET 23" 6MM
INFUSION SET 23" 9MM
INFUSION SET 43"
INFUSION SET 43" 6MM
INFUSION SET 43" 9MM
INGREZZA 40 MG CAPSULE
INGREZZA 80 MG CAPSULE
INJECT EASE 28G LANCETS
INJECT EASE 30G LANCETS
INLYTA 1 MG TABLET
INLYTA 5 MG TABLET
INNOPRAN XL 120 MG CAPSULE
INNOPRAN XL 80 MG CAPSULE
INPEN (FOR HUMALOG) BLUE
INPEN (FOR HUMALOG) GREY
INPEN (FOR HUMALOG) PINK
INPEN (NOVOLOG OR FIASP) BLUE
INPEN (NOVOLOG OR FIASP) GREY
INPEN (NOVOLOG OR FIASP) PINK
INREBIC 100 MG CAPSULE
INSET 30 INFUSION SET 23"
INSET INFUSION SET 23" 6MM
INSET INFUSION SET 23" 9MM
INSPRA 25 MG TABLET
INSPRA 50 MG TABLET
INSULIN ASPART 100 UNIT/ML VL
INSULIN ASPART 100 UNIT/ML PEN
INSULIN ASPART 100 UNIT/ML CRT
INSULIN ASPART PROT-INSULN ASP
INSULIN CARTRIDGE 3 ML
INSULIN LISPRO 100 UNIT/ML VL
INSULIN LISPRO 100 UNIT/ML PEN
COMFORT POINT PEN NDL 29GX1/2"
COMFORT POINT PEN NDL 31GX1/3"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
COMFORT POINT PEN NDL 31GX1/4"
COMFORT POINT PEN NDL 31GX1/6"
BD INS SYR 0.3 ML 8MMX31G(1/2)
BD SYR 0.3 ML 6MMX31G (1/2)
INSULIN SYR 0.3ML 31GX1/4(1/2)
BD INS SYRN UF 1 ML 12.7MMX30G
BD INSULIN SYR 1 ML 12.7MMX30G
BD INSULIN SYR 1 ML 25GX1"
BD INSULIN SYR 1 ML 25GX5/8"
BD INSULIN SYR 1 ML 26GX1/2"
BD INSULIN SYR 1 ML 27GX12.7MM
BD INSULIN SYR 1 ML 27GX5/8"
BD INSULIN SYR 1 ML 28GX1/2"
BD INSULIN SYR 1 ML 29GX1/2"
BD INSULIN SYR 1 ML 29GX12.7MM
BD INSULIN SYR 1 ML 30GX1/2"
BD INSULIN SYR 1 ML 31GX15/64"
BD INSULIN SYR 1 ML 31GX5/16"
BD INSULIN SYR 1 ML 8MMX31G
BD INSULIN SYR UF 1 ML 8MMX31G
BD UF INS SYR 1 ML 30GX1/2"
CA INSULIN SYR 1 ML 29GX1/2"
CA INSULIN SYR 1 ML 30GX5/16"
CA INSULIN SYR 1 ML 31GX5/16"
CAREONE SYR 1 ML 30GX1/2"
CAREONE SYR 1 ML 31GX5/16"
EQL INS SYR 1 ML 29GX1/2"
EQL INSULIN 1 ML SYRINGE
EQL INSULIN SYR 1 ML 31GX5/16"
EXEL INS SYR U100 1 ML 28GX1/2
EXEL U100 1 ML 30GX5/16"
EXEL U100 INS SYR 1 ML 29GX1/2
FIFTY50 INS SYR 1 ML 31GX5/16"
GNP INSULIN SYR 1 ML 31GX5/16"
INSULIN 1 ML SYRINGE
INSULIN SYRIN 1 ML 29GX1/2"
INSULIN SYRINGE 1 ML
INSULIN SYRINGE 1 ML 27GX1/2"
INSULIN SYRINGE 1 ML 28GX1/2"
INSULIN SYRINGE 1 ML 29GX1/2"
INSULIN SYRINGE 1 ML 30GX1/2"
INSULIN SYRINGE 1 ML 30GX5/16"
INSULIN SYRINGE 1 ML 31GX1/4"
INSULIN SYRINGE 1 ML 31GX5/16"
INSULIN SYRINGE U100 1 ML
KINRAY INS SYR 1 ML 31GX5/16"
KMART VALU PLUS SYRINGE 1 ML
KRO INSULIN SYR 1 ML 30GX5/16"
KROGER INS SYR 1 ML 29GX1/2"
KROGER INS SYR 1 ML 31GX5/16"
LEADER INS SYR 1 ML 28GX1/2"
LEADER INS SYR 1 ML 29GX1/2"
LEADER INS SYR 1 ML 30GX5/16"
LEADER INS SYR 1 ML 31GX5/16"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
MS INS SYR 1 ML 29GX1/2"
MS INS SYRINGE 1 ML 30GX1/2"
MS INSULIN SYR 1 ML 31GX5/16"
PREF PLUS SYRING 1 ML 29GX1/2"
PREFERRED PLUS SYRINGE 1 ML
PREFPLS INS SYR 1 ML 30GX5/16"
PUB INS SYRINGE 1 ML 30GX1/2"
PUB INSULIN SYR 1 ML 31GX5/16"
RA INS SYR 1 ML 29GX1/2"
RA INS SYRINGE 1 ML 30GX5/16"
RELION INS SYR 1 ML 29GX1/2"
RELION INS SYR 1 ML 30GX5/16"
RELION INS SYR 1 ML 31GX15/64"
RELION INS SYR 1 ML 31GX5/16"
RELI-ON INSULIN 1 ML SYR
SM INS SYR 1 ML 29GX1/2"
SM INS SYRINGE 1 ML 28GX1/2"
SM INS SYRINGE 1 ML 30GX5/16"
SM INSULIN SYR 1 ML 31GX5/16"
ULTCARE INS SYR 1 ML 31GX5/16"
ULTICARE INS SAFETY 1ML 29X1/2
ULTICARE INS SYR 1 ML 28GX1/2"
ULTICARE INS SYR 1 ML 29GX1/2"
ULTICARE SYR 1 ML 30GX5/16"
BD INSULIN SYRINGE 1 ML
BD INS SYR UF 0.5ML 12.7MMX30G
BD INS SYRNG 0.5 ML 29GX12.7MM
BD INS SYRNG UF 0.5 ML 8MMX31G
BD INSUL SYR 0.5 ML 31GX15/64"
BD INSULIN SYR 0.5 ML 28GX1/2"
BD INSULIN SYR 0.5 ML 29GX1/2"
BD INSULIN SYR 0.5 ML 30GX1/2"
BD INSULIN SYR 0.5 ML 8MMX31G
BD INSULIN SYR 0.5ML 31GX5/16"
BD SYRINGE 0.5 ML 12.7MMX30G
CA INS SYR 0.5 ML 30GX5/16"
CA INS SYR 0.5 ML 31GX5/16"
CA INSULIN SYR 0.5 ML 29GX1/2"
CAREONE SYR 0.5 ML 30GX1/2"
CAREONE SYR 0.5 ML 31GX5/16"
EQL INSUL SYR 0.5 ML 31GX5/16"
EQL INSULIN 0.5 ML SYRINGE
EXEL U100 0.5 ML 28GX1/2"
EXEL U100 0.5 ML 29GX1/2"
EXEL U100 0.5 ML 30GX5/16"
FIFTY50 INS 0.5 ML 31GX5/16"
GNP INSUL SYR 0.5 ML 31GX5/16"
INSULIN 1/2 ML SYRINGE
INSULIN SYRIN 0.5 ML 28GX1/2"
INSULIN SYRIN 0.5 ML 29GX1/2"
INSULIN SYRIN 0.5 ML 30GX1/2"
INSULIN SYRIN 0.5 ML 30GX5/16"
INSULIN SYRIN 0.5 ML 31GX5/16"
INSULIN SYRING 0.5 ML 27GX1/2"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
INSULIN SYRING 0.5 ML 29GX1/2"
INSULIN SYRINGE 0.5 ML 31GX1/4
KINRAY SYRING 0.5 ML 31GX5/16"
KMART VALU PLUS SYR 1/2 ML
KRO INS SYRIN 0.5 ML 31GX5/16"
KROGER INS SYR 0.5 ML 29GX1/2"
KROGER SYR 0.5 ML 30GX5/16"
LEADER INS SYR 0.5 ML 28GX1/2"
LEADER INS SYR 0.5 ML 29GX1/2"
LEADER INS SYR 0.5 ML 30GX1/2"
LEADER SYRING 0.5 ML 31GX5/16"
MS INS SYR 0.5 ML 29GX1/2"
MS INSUL SYR 0.5 ML 30GX1/2"
MS INSUL SYR 0.5 ML 31GX5/16"
PREF PLUS SYR 0.5 ML 30GX5/16"
PREFERRED PLUS 0.5 ML 29GX1/2"
PREFERRED PLUS SYRINGE 0.5 ML
PUB INSUL SYR 0.5 ML 30GX1/2"
PUB INSUL SYR 0.5 ML 31GX5/16"
RA INS SYR 0.5 ML 29GX1/2"
RA INS SYR 0.5 ML 30GX5/16"
RELION INS SYR 0.5 ML 29GX1/2"
RELION INS SYR 0.5 ML 31GX6MM
RELI-ON INSULIN 0.5 ML SYR
RELION INSULIN SYR 0.5 ML
RELION SYR 0.5 ML 30GX5/16"
RELION SYRING 0.5 ML 31GX5/16"
SCHNUCKS SYR 0.5 ML 29GX1/2"
SCHNUCKS SYR 0.5 ML 30GX5/16"
SM INS SYR 0.5 ML 29GX1/2"
SM INS SYR 0.5 ML 30GX5/16"
SM INSUL SYR 0.5 ML 31GX5/16"
SM INSULIN SYR 0.5 ML 28GX1/2"
SURE-JECT INS 0.5 ML 31GX5/16"
ULTICARE SAFETY 0.5 ML 29GX1/2
ULTICARE SYR 0.5 ML 29GX1/2"
ULTICARE SYR 0.5 ML 30GX5/16"
ULTICARE SYR 0.5 ML 31GX5/16"
ULTICARE SYRIN 0.5 ML 28GX1/2"
BD INS SYR UF 0.3ML 12.7MMX30G
BD INS SYRNG 0.3 ML 29GX12.7MM
BD INS SYRNG UF 0.3 ML 8MMX31G
BD INSUL SYR 0.3 ML 31GX15/64"
BD INSULIN SYR 0.3 ML 28GX1/2"
BD INSULIN SYR 0.3 ML 29GX1/2"
BD INSULIN SYR 0.3 ML 31GX5/16
BD INSULIN SYR 0.3 ML 8MMX31G
BD INSULIN U100-3/10 ML SYR
BD SYRINGE 0.3 ML 12.7MMX30G
BROOKS INSULIN 0.3ML SYRN
CA INS SYR 0.3 ML 30GX5/16"
CA INS SYR 0.3 ML 31GX5/16"
CA INSULIN SYR 0.3 ML 29GX1/2"
CAREONE SYR 0.3 ML 30GX1/2"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
CAREONE SYR 0.3 ML 31GX5/16"
EQL INSUL SYR 0.3 ML 31GX5/16"
EQL INSULIN 0.3 ML SYRINGE
EXEL U100 0.3 ML 29GX1/2"
EXEL U100 0.3 ML 30GX5/16"
FIFTY50 INS 0.3 ML 31GX5/16"
GNP INS SYR 0.3 ML 29GX1/2"
GNP INSUL SYR 0.3 ML 31GX5/16"
INSULIN 3/10 ML SYRINGE
INSULIN SYR 0.3 ML 30GX5/16"
INSULIN SYRIN 0.3 ML 29GX1/2"
INSULIN SYRIN 0.3 ML 30GX1/2"
INSULIN SYRIN 0.3 ML 30GX5/16"
INSULIN SYRIN 0.3 ML 31GX5/16"
INSULIN SYRINGE 0.3 ML
INSULIN SYRINGE 0.3 ML 31GX1/4
KINRAY SYRING 0.3 ML 31GX5/16"
KRO INS SYR 0.3 ML 29GX1/2"
KROGER INS SYR 0.3 ML 30GX5/16
KROGER SYRING 0.3 ML 31GX5/16"
LEADER INS SYR 0.3 ML 29GX1/2"
LEADER INSULIN SYRINGE 0.3 ML
LEADER SYRING 0.3 ML 31GX5/16"
MS INSUL SYR 0.3 ML 31GX5/16"
MS INSULIN SYR 0.3 ML 29GX1/2"
MS INSULIN SYRINGE 0.3 ML
PREF PLUS INS 0.3 ML 29GX1/2"
PREFERRED PLUS 0.3 ML 30GX5/16
PUB INS SYRIN 0.3 ML 30GX1/2"
PUB INSUL SYR 0.3 ML 31GX5/16"
RELION INS SYR 0.3 ML 29GX1/2"
RELION INS SYR 0.3 ML 30GX5/16
RELION INS SYR 0.3 ML 31GX6MM
RELI-ON INSULIN 0.3 ML SYR
RELION SYRING 0.3 ML 31GX5/16"
SM INS SYRING 0.3 ML 30GX5/16"
SM INSUL SYR 0.3 ML 31GX5/16"
SM INSULIN SYR 0.3 ML 29GX1/2"
SURE-JECT INS 0.3 ML 31GX5/16"
TERUMO INS SYR 0.3 ML 29GX1/2"
ULTICARE SYR 0.3 ML 30GX5/16"
ULTICARE SYR 0.3 ML 31GX5/16"
ULTICARE SYRIN 0.3 ML 29GX1/2"
INSUPEN 30G ULTRAFIN NEEDLE
INSUPEN 31G ULTRAFIN NEEDLE
INSUPEN 32G 6MM PEN NEEDLE
INSUPEN 32G 8MM PEN NEEDLE
INSUPEN PEN NEEDLE 29GX1/2"
INSUPEN PEN NEEDLE 29GX12MM
INSUPEN PEN NEEDLE 30GX8MM
INSUPEN PEN NEEDLE 31GX3/16"
INSUPEN PEN NEEDLE 31GX5/16"
INSUPEN PEN NEEDLE 31GX6MM
INSUPEN PEN NEEDLE 31GX8MM
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
INSUPEN PEN NEEDLE 32GX4MM
INSUPEN PEN NEEDLE 32GX5/32"
INSUPEN PEN NEEDLE 32GX6MM
INSUPEN PEN NEEDLE 32GX8MM
INSUPEN PEN NEEDLE 33GX4MM
BD INTEGRA SYR 1 ML 29GX1/2"
INTELENCE 100 MG TABLET
INTELENCE 200 MG TABLET
INTELENCE 25 MG TABLET
INTRON A 10 MILLION UNITS VIAL
INTRON A 18 MILLION UNIT/3 ML
INTRON A 18 MILLION UNITS VIAL
INTRON A 25 MILLION UNIT/2.5ML
INTRON A 50 MILLION UNITS VIAL
INTROVALE 0.15-0.03 MG TABLET
INTUNIV ER 1 MG TABLET
INTUNIV ER 2 MG TABLET
INTUNIV ER 3 MG TABLET
INTUNIV ER 4 MG TABLET
INVACARE 30G LANCETS
INVEGA ER 1.5 MG TABLET
INVEGA ER 3 MG TABLET
INVEGA ER 6 MG TABLET
INVEGA ER 9 MG TABLET
INVEGA SUSTENNA 117 MG/0.75 ML
INVEGA SUSTENNA 156 MG/ML SYRG
INVEGA SUSTENNA 234 MG/1.5 ML
INVEGA SUSTENNA 39 MG/0.25 ML
INVEGA SUSTENNA 78 MG/0.5 ML
INVEGA TRINZA 273 MG/0.875 ML
INVEGA TRINZA 410 MG/1.315 ML
INVEGA TRINZA 546 MG/1.75 ML
INVEGA TRINZA 819 MG/2.625 ML
INVIRASE 200 MG CAPSULE
INVIRASE 500 MG TABLET
INVOKAMET 150-1,000 MG TABLET
INVOKAMET 150-500 MG TABLET
INVOKAMET 50-1,000 MG TABLET
INVOKAMET 50-500 MG TABLET
INVOKAMET XR 150-1,000 MG TAB
INVOKAMET XR 150-500 MG TABLET
INVOKAMET XR 50-1,000 MG TAB
INVOKAMET XR 50-500 MG TABLET
INVOKANA 100 MG TABLET
INVOKANA 300 MG TABLET
IPRATROPIUM 0.03% SPRAY
IPRATROPIUM BR 0.02% SOLN
IPRAT-ALBUT 0.5-3(2.5) MG/3 ML
I-PRIN 200 MG TABLET
IRBESARTAN 150 MG TABLET
IRBESARTAN 300 MG TABLET
IRBESARTAN 75 MG TABLET
IRBESARTAN-HCTZ 150-12.5 MG TB
IRBESARTAN-HCTZ 300-12.5 MG TB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
IRENKA DR 40 MG CAPSULE
IRESSA 250 MG TABLET
ISENTRESS 100 MG POWDER PACKET
ISENTRESS 100 MG TABLET CHEW
ISENTRESS 25 MG TABLET CHEW
ISENTRESS 400 MG TABLET
ISENTRESS HD 600 MG TABLET
ISIBLOOM 28 DAY TABLET
ISOCHRON 40 MG TABLET SA
ISOPTO ATROPINE 1% EYE DROP
ISOPTO ATROPINE 1% EYE DROPS
ISOPTO CARPINE 1% EYE DROPS
ISOPTO CARPINE 2% EYE DROPS
ISOPTO CARPINE 4% EYE DROPS
ISORDIL 40 MG TABLET
ISORDIL TITRADOSE 5 MG TAB
ISOSORBIDE DINITRATE 10 MG TAB
ISOSORBIDE DINITRATE 20 MG TAB
ISOSORBIDE DINITRATE 30 MG TAB
ISOSORBIDE DINITRATE 40 MG TAB
ISOSORBIDE DINITRATE 5 MG TAB
ISOSORBIDE DINITR ER 40 MG TAB
ISOSORBIDE MONONIT 10 MG TAB
ISOSORBIDE MONONIT 20 MG TAB
ISOSORBIDE MONONIT ER 120 MG
ISOSORBIDE MONONIT ER 30 MG TB
ISOSORBIDE MONONIT ER 60 MG TB
ISOXSUPRINE 10 MG TABLET
ISOXSUPRINE 20 MG TABLET
ISRADIPINE 2.5 MG CAPSULE
ISRADIPINE 5 MG CAPSULE
ISTALOL 0.5% EYE DROPS
I-VITE PROTECT TABLET
I-VITE TABLET
IXINITY 1,000 UNIT RANGE
IXINITY 1,000 UNIT RANGE-2 VLS
IXINITY 1,000 UNIT VIAL
IXINITY 1,000 UNIT VIAL -2 VLS
IXINITY 1,500 UNIT RANGE
IXINITY 1,500 UNIT RANGE-2 VLS
IXINITY 1,500 UNIT VIAL
IXINITY 1,500 UNIT VIAL -2 VLS
IXINITY 2,000 UNIT RANGE
IXINITY 250 UNIT RANGE
IXINITY 3,000 UNIT RANGE
IXINITY 500 UNIT RANGE
IXINITY 500 UNIT VIAL
JADENU 180 MG TABLET
JADENU 360 MG TABLET
JADENU 90 MG TABLET
JADENU SPRINKLE 180 MG GRANULE
JADENU SPRINKLE 360 MG GRANULE
JADENU SPRINKLE 90 MG GRANULE
JAIMIESS 0.15-0.03-0.01 MG TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
JAKAFI 10 MG TABLET
JAKAFI 15 MG TABLET
JAKAFI 20 MG TABLET
JAKAFI 25 MG TABLET
JAKAFI 5 MG TABLET
JALYN 0.5-0.4 MG CAPSULE
JANTOVEN 1 MG TABLET
JANTOVEN 10 MG TABLET
JANTOVEN 2 MG TABLET
JANTOVEN 2.5 MG TABLET
JANTOVEN 3 MG TABLET
JANTOVEN 4 MG TABLET
JANTOVEN 5 MG TABLET
JANTOVEN 6 MG TABLET
JANTOVEN 7.5 MG TABLET
JANUMET 50-1,000 MG TABLET
JANUMET 50-500 MG TABLET
JANUMET XR 100-1,000 MG TABLET
JANUMET XR 50-1,000 MG TABLET
JANUMET XR 50-500 MG TABLET
JANUVIA 100 MG TABLET
JANUVIA 25 MG TABLET
JANUVIA 50 MG TABLET
JARDIANCE 10 MG TABLET
JARDIANCE 25 MG TABLET
JASMIEL 3 MG-0.02 MG TABLET
JATENZO 158 MG CAPSULE
JATENZO 198 MG CAPSULE
JATENZO 237 MG CAPSULE
JAZZ WIRELESS 2 METER KIT
JENCYCLA 0.35 MG TABLET
JENTADUETO 2.5 MG-1000 MG TAB
JENTADUETO 2.5 MG-500 MG TAB
JENTADUETO 2.5 MG-850 MG TAB
JENTADUETO XR 2.5 MG-1,000 MG
JENTADUETO XR 5 MG-1,000 MG TB
JEVANTIQUE LO 0.5 MG-2.5 MCG
JINTELI 1 MG-5 MCG TABLET
JIVI 1,000 UNIT VIAL
JIVI 2,000 UNIT VIAL
JIVI 3,000 UNIT VIAL
JIVI 500 UNIT VIAL
JOHNSON GRASS 1:20 (W/V)
JOLESSA 0.15 MG-0.03 MG TABLET
JOLIVETTE TABLET
JORNAY PM 100 MG CAPSULE
JORNAY PM 20 MG CAPSULE
JORNAY PM 40 MG CAPSULE
JORNAY PM 60 MG CAPSULE
JORNAY PM 80 MG CAPSULE
JULEBER 28 DAY TABLET
JULUCA 50-25 MG TABLET
JUNEL 1 MG-20 MCG TABLET
JUNEL 1.5 MG-30 MCG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
JUNEL FE 1 MG-20 MCG TABLET
JUNEL FE 1.5 MG-30 MCG TABLET
JUNEL FE 24 TABLET
JUXTAPID 10 MG CAPSULE
JUXTAPID 20 MG CAPSULE
JUXTAPID 30 MG CAPSULE
JUXTAPID 40 MG CAPSULE
JUXTAPID 5 MG CAPSULE
JUXTAPID 60 MG CAPSULE
JYNARQUE 15 MG TABLET
JYNARQUE 30 MG TABLET
JYNARQUE 45 MG-15 MG TABLET
JYNARQUE 60 MG-30 MG TABLET
JYNARQUE 90 MG-30 MG TABLET
K EFFERVESCENT 25 MEQ TABLET
KAITLIB FE CHEWABLE TABLET
KALETRA 100-25 MG TABLET
KALETRA 200-50 MG TABLET
KALETRA 80 MG-20 MG/ML SOLN
KALLIGA 28 DAY TABLET
KALYDECO 150 MG TABLET
KALYDECO 25 MG GRANULES PACKET
KALYDECO 50 MG GRANULES PACKET
KALYDECO 75 MG GRANULES PACKET
KANJINTI 150 MG VIAL
KANJINTI 420 MG VIAL
KANUMA 20 MG/10 ML VIAL
KAPOK 1:20 W/V VIAL
KAPSPARGO SPRINKLE 100 MG CAP
KAPSPARGO SPRINKLE 200 MG CAP
KAPSPARGO SPRINKLE 25 MG CAP
KAPSPARGO SPRINKLE 50 MG CAP
KAPVAY ER 0.1 MG TABLET
KARIVA 28 DAY TABLET
KATERZIA 1 MG/ML SUSPENSION
KAZANO 12.5-1,000 MG TABLET
KAZANO 12.5-500 MG TABLET
KELNOR 1-35 28 TABLET
KELNOR 1-50 TABLET
KELP-LECITHIN-VIT B-6 CAPSULE
KELP-LECITHIN-VIT B-6 TABLET
KENWOOD THERAPEUTIC LIQUID
KEPPRA 1,000 MG TABLET
KEPPRA 100 MG/ML ORAL SOLN
KEPPRA 250 MG TABLET
KEPPRA 500 MG TABLET
KEPPRA 750 MG TABLET
KEPPRA XR 500 MG TABLET
KEPPRA XR 750 MG TABLET
KETO-DIASTIX REAGENT STRIPS
CVS KETONE CARE TEST STRIP
KETONE TEST STRIP
RELION KETONE TEST STRIP
KETOPROFEN 50 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
KETOPROFEN 75 MG CAPSULE
KETOPROFEN ER 200 MG CAPSULE
KETOSTIX REAGENT STRIP
KEVEYIS 50 MG TABLET
KEVZARA 150 MG/1.14 ML PEN INJ
KEVZARA 150 MG/1.14 ML SYRINGE
KEVZARA 200 MG/1.14 ML PEN INJ
KEVZARA 200 MG/1.14 ML SYRINGE
KEYTRUDA 100 MG/4 ML VIAL
KHEDEZLA ER 100 MG TABLET
KHEDEZLA ER 50 MG TABLET
KIDS COD LIVER OIL +D TAB CHEW
KIDS MULTIVIT-MINERALS GUMMIES
KIMIDESS 28 DAY TABLET
KINERET 100 MG/0.67 ML SYRINGE
KISQALI 200 MG DAILY DOSE
KISQALI 400 MG DAILY DOSE
KISQALI 600 MG DAILY DOSE
KISQALI FEMARA 200 MG CO-PACK
KISQALI FEMARA 400 MG CO-PACK
KISQALI FEMARA 600 MG CO-PACK
KITABIS PAK 300 MG/5 ML
KLONOPIN 0.5 MG TABLET
KLONOPIN 1 MG TABLET
KLONOPIN 2 MG TABLET
KLOR-CON 20 MEQ PACKET
KLOR-CON 25 MEQ PACKET
KLOR-CON 10 MEQ TABLET
KLOR-CON 8 MEQ TABLET
KLOR-CON M10 TABLET
KLOR-CON M15 TABLET
KLOR-CON M20 TABLET
KLOR-CON SPRINKLE ER 10 MEQ CP
KLOR-CON SPRINKLE ER 8 MEQ CAP
KLOR-CON-EF 25 MEQ TAB EFF
KOATE 1,000 UNIT VIAL
KOATE 250 UNIT VIAL
KOATE 500 UNIT VIAL
KOATE-DVI 1,000 UNIT VIAL
KOATE-DVI 250 UNIT VIAL
KOATE-DVI 500 UNIT VIAL
KOBEE TABLET
KOCHIA 1:20 (W/V) VIAL
KOGENATE FS 1,000 UNITS VIAL
KOGENATE FS 2,000 UNIT VIAL
KOGENATE FS 250 UNIT VIAL
KOGENATE FS 3,000 UNITS VIAL
KOGENATE FS 500 UNIT VIAL
KOMBIGLYZE XR 2.5-1,000 MG TAB
KOMBIGLYZE XR 5-1,000 MG TAB
KOMBIGLYZE XR 5-500 MG TABLET
KORLYM 300 MG TABLET
KOSHER PRENATAL PLUS IRON TAB
KOVALTRY 1,000 UNIT KIT
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
KOVALTRY 1,000 UNIT VIAL
KOVALTRY 2,000 UNIT KIT
KOVALTRY 2,000 UNIT VIAL
KOVALTRY 250 UNIT KIT
KOVALTRY 250 UNIT VIAL
KOVALTRY 3,000 UNIT KIT
KOVALTRY 3,000 UNIT VIAL
KOVALTRY 500 UNIT KIT
KOVALTRY 500 UNIT VIAL
K-PAX IMMUNE SUPPORT TABLET
KPN PRENATAL TABLET
KPN TABLET
KRISTALOSE 10 GM PACKET
KRISTALOSE 20 GM PACKET
KRYSTEXXA 8 MG/ML VIAL
K-SOL 10% (20 MEQ/15 ML) LIQ
K-SOL 20% (40 MEQ/15 ML) LIQ
K-TAB ER 10 MEQ TABLET
K-TAB ER 20 MEQ TABLET
K-TAB ER 8 MEQ TABLET
KURVELO TABLET
KUVAN 100 MG POWDER PACKET
KUVAN 100 MG TABLET
KUVAN 500 MG POWDER PACKET
KYLEENA 19.5 MG SYSTEM
KYNAMRO 200 MG/ML SYRINGE
KYPROLIS 10 MG VIAL
KYPROLIS 30 MG VIAL
KYPROLIS 60 MG VIAL
LABETALOL HCL 100 MG TABLET
LABETALOL HCL 200 MG TABLET
LABETALOL HCL 300 MG TABLET
LACTULOSE 10 GM PACKET
LACTULOSE 10 GM/15 ML SOLUTION
LACTULOSE 20 GM/30 ML SOLUTION
LAMB'S QUARTERS 1:20 (W/V) VL
LAMICTAL 100 MG TABLET
LAMICTAL 150 MG TABLET
LAMICTAL 200 MG TABLET
LAMICTAL 25 MG DISPER TABLET
LAMICTAL 25 MG TABLET
LAMICTAL 5 MG DISPER TABLET
LAMICTAL ODT 100 MG TABLET
LAMICTAL ODT 200 MG TABLET
LAMICTAL ODT 25 MG TABLET
LAMICTAL ODT 50 MG TABLET
LAMICTAL XR 100 MG TABLET
LAMICTAL XR 200 MG TABLET
LAMICTAL XR 25 MG TABLET
LAMICTAL XR 250 MG TABLET
LAMICTAL XR 300 MG TABLET
LAMICTAL XR 50 MG TABLET
LAMIVUDINE 10 MG/ML ORAL SOLN
LAMIVUDINE 100 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
LAMIVUDINE 150 MG TABLET
LAMIVUDINE 300 MG TABLET
LAMIVUDINE HBV 100 MG TABLET
LAMIVUDINE-ZIDOVUDINE TABLET
LAMOTRIGINE 100 MG TABLET
LAMOTRIGINE 150 MG TABLET
LAMOTRIGINE 200 MG TABLET
LAMOTRIGINE 25 MG DISPER TAB
LAMOTRIGINE 25 MG TABLET
LAMOTRIGINE 5 MG DISPER TABLET
LAMOTRIGINE ER 100 MG TABLET
LAMOTRIGINE ER 200 MG TABLET
LAMOTRIGINE ER 25 MG TABLET
LAMOTRIGINE ER 250 MG TABLET
LAMOTRIGINE ER 300 MG TABLET
LAMOTRIGINE ER 50 MG TABLET
LAMOTRIGINE ODT 100 MG TABLET
LAMOTRIGINE ODT 200 MG TABLET
LAMOTRIGINE ODT 25 MG TABLET
LAMOTRIGINE ODT 50 MG TABLET
LANCET 30G-GLUCOSE TEST STRIP
ASSURE COMFORT 28G LANCETS
ASSURE COMFORT 30G LANCETS
BD LANCETS 33G
CVS THIN 26G LANCETS
E-ZJECT THIN LANCETS
KROGER LANCETS
LANCETS
LANCETS 26G X 1.8MM
LANCETS 28G LANCETS
LANCETS 30G
LANCETS 33G
LANCETS ULTRA FINE 28G
MEDISENSE THIN LANCETS
MEIJER LANCETS
PHARMACIST CHOICE 30G LANCETS
PHARMACIST CHOICE 33G LANCETS
PREFERRED PLUS LANCETS
PREFERRED PLUS THIN LANCETS
PUB 28G LANCETS
RELION THIN 26G LANCETS
SAPS CARE 30G LANCETS
SAPS TWIST TOP 30G LANCET
SAPS TWIST TOP 30G LANCETS
SM LANCETS 21G
TWIST LANCETS
LANCETS THIN 23G
LANCETS ULTRA THIN 26G
CVS LANCING DEVICE
GS LANCING DEVICE AND LANCETS
KRO LANCING DEVICE
LANCING DEVICE
LIVE BETTER ADVANCED LANCING
RA HEALTH CARE LANCING DEVICE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
RELION LANCING DEVICE
LANOXIN 125 MCG TABLET
LANOXIN 187.5 MCG TABLET
LANOXIN 250 MCG TABLET
LANOXIN 62.5 MCG TABLET
CVS LANSOPRAZOLE DR 15 MG CAP
EQ LANSOPRAZOLE DR 15 MG CAP
EQL LANSOPRAZOLE DR 15 MG CAP
GS LANSOPRAZOLE DR 15 MG CAP
HM LANSOPRAZOLE DR 15 MG CAP
LANSOPRAZOLE DR 15 MG CAPSULE
LANSOPRAZOLE DR 30 MG CAPSULE
LANSOPRAZOLE ODT 15 MG TABLET
LANSOPRAZOLE ODT 30 MG TABLET
RA LANSOPRAZOLE DR 15 MG CAP
SM LANSOPRAZOLE DR 15 MG CAP
LANTHANUM CARB 1,000 MG TB CHW
LANTHANUM CARB 500 MG TAB CHEW
LANTHANUM CARB 750 MG TAB CHEW
LANTUS 100 UNIT/ML VIAL
LANTUS SOLOSTAR 100 UNIT/ML
LANZO LANCING DEVICE
LARIN 1.5 MG-30 MCG TABLET
LARIN 21 1-20 TABLET
LARIN 24 FE 1 MG-20 MCG TABLET
LARIN FE 1.5-30 TABLET
LARIN FE 1-20 TABLET
LARISSIA-28 TABLET
LARTRUVO 190 MG/19 ML VIAL
LARTRUVO 500 MG/50 ML VIAL
LASIX 20 MG TABLET
LASIX 40 MG TABLET
LASIX 80 MG TABLET
LATANOPROST 0.005% EYE DROPS
LATANOPROST 0.005% EYE DROP
LATUDA 120 MG TABLET
LATUDA 20 MG TABLET
LATUDA 40 MG TABLET
LATUDA 60 MG TABLET
LATUDA 80 MG TABLET
LAYOLIS FE CHEWABLE TABLET
LEENA 28 TABLET
LEFLUNOMIDE 10 MG TABLET
LEFLUNOMIDE 20 MG TABLET
LEMTRADA 12 MG/1.2 ML VIAL
LENVIMA 10 MG DAILY DOSE
LENVIMA 12 MG DAILY DOSE
LENVIMA 14 MG DAILY DOSE
LENVIMA 18 MG DAILY DOSE
LENVIMA 20 MG DAILY DOSE
LENVIMA 24 MG DAILY DOSE
LENVIMA 4 MG CAPSULE
LENVIMA 8 MG DAILY DOSE
LESCOL 20 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
LESCOL 40 MG CAPSULE
LESCOL XL 80 MG TABLET
LESSINA-28 TABLET
LETAIRIS 10 MG TABLET
LETAIRIS 5 MG TABLET
LETROZOLE 2.5 MG TABLET
LEUPROLIDE 2WK 1 MG/0.2 ML KIT
LEUPROLIDE 2WK 14 MG/2.8 ML KT
LEVALBUTEROL CONC 1.25 MG/0.5
LEVALBUTEROL 0.31 MG/3 ML SOL
LEVALBUTEROL 0.63 MG/3 ML SOL
LEVALBUTEROL 1.25 MG/3 ML SOL
LEVALBUTEROL TAR HFA 45MCG INH
LEVBID ER 0.375 MG TABLET
LEVEMIR 100 UNIT/ML VIAL
LEVEMIR FLEXTOUCH 100 UNIT/ML
LEVETIRACETAM 1,000 MG TABLET
LEVETIRACETAM 100 MG/ML SOLN
LEVETIRACETAM 250 MG TABLET
LEVETIRACETAM 500 MG TABLET
LEVETIRACETAM 500 MG/5 ML SOLN
LEVETIRACETAM 750 MG TABLET
LEVETIRACETAM ER 500 MG TABLET
LEVETIRACETAM ER 750 MG TABLET
LEVITRA 10 MG TABLET
LEVITRA 2.5 MG TABLET
LEVITRA 20 MG TABLET
LEVITRA 5 MG TABLET
LEVOBUNOLOL 0.5% EYE DROPS
LEVOCARNITINE 330 MG TABLET
LEVOCARNITINE 1 G/10 ML SOLN
LEVOCARNITINE SF 1 G/10 ML SOL
LEVOCETIRIZINE 2.5 MG/5 ML SOL
LEVOCETIRIZINE 5 MG TABLET
LEVOMEFOLATE DHA CAPSULE
LEVONEST-28 TABLET
LEVONOR-ETH ESTRA 0.09-0.02 MG
LEVONOR-ETH ESTRAD 0.1-0.02 MG
LEVONOR-ETH ESTRAD 0.15-0.03
LEVONOR-ETH ESTRAD TRIPHASIC
LEVONO-E ESTRAD 0.15-0.03-0.01
LEVONOR-E ESTRAD 0.1-0.02-0.01
LEVONORG 0.15MG-EE 20-25-30MCG
LEVORA-28 TABLET
LEVO-T 100 MCG TABLET
LEVO-T 112 MCG TABLET
LEVO-T 125 MCG TABLET
LEVO-T 137 MCG TABLET
LEVO-T 150 MCG TABLET
LEVO-T 175 MCG TABLET
LEVO-T 200 MCG TABLET
LEVO-T 25 MCG TABLET
LEVO-T 300 MCG TABLET
LEVO-T 50 MCG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
LEVO-T 75 MCG TABLET
LEVO-T 88 MCG TABLET
LEVOTHYROXINE 0.025 MG TABLET
LEVOTHYROXINE 0.05 MG TABLET
LEVOTHYROXINE 0.075 MG TABLET
LEVOTHYROXINE 0.088 MG TABLET
LEVOTHYROXINE 0.1 MG TABLET
LEVOTHYROXINE 0.112 MG TABLET
LEVOTHYROXINE 0.125 MG TABLET
LEVOTHYROXINE 0.137 MG TABLET
LEVOTHYROXINE 0.15 MG TABLET
LEVOTHYROXINE 0.175 MG TABLET
LEVOTHYROXINE 100 MCG TABLET
LEVOTHYROXINE 112 MCG TABLET
LEVOTHYROXINE 125 MCG TABLET
LEVOTHYROXINE 137 MCG TABLET
LEVOTHYROXINE 150 MCG TABLET
LEVOTHYROXINE 175 MCG TABLET
LEVOTHYROXINE 200 MCG TABLET
LEVOTHYROXINE 25 MCG TABLET
LEVOTHYROXINE 300 MCG TABLET
LEVOTHYROXINE 50 MCG TABLET
LEVOTHYROXINE 75 MCG TABLET
LEVOTHYROXINE 88 MCG TABLET
LEVOXYL 100 MCG TABLET
LEVOXYL 112 MCG TABLET
LEVOXYL 125 MCG TABLET
LEVOXYL 137 MCG TABLET
LEVOXYL 150 MCG TABLET
LEVOXYL 175 MCG TABLET
LEVOXYL 200 MCG TABLET
LEVOXYL 25 MCG TABLET
LEVOXYL 50 MCG TABLET
LEVOXYL 75 MCG TABLET
LEVOXYL 88 MCG TABLET
LEVSIN 0.125 MG TABLET
LEVSIN-SL 0.125 MG TABLET SL
LEXAPRO 10 MG TABLET
LEXAPRO 20 MG TABLET
LEXAPRO 5 MG TABLET
LEXAPRO 5 MG/5 ML SOLUTION
LEXIVA 50 MG/ML SUSPENSION
LEXIVA 700 MG TABLET
LIALDA DR 1.2 GM TABLET
LIBERTY LEV 1 GLUCOSE CTRL SOL
LIBERTY LEV 2 GLUCOSE CTRL SOL
LIBERTY BLOOD GLUCOSE MONITOR
LIBERTY TEST STRIPS
LIBRAX CAPSULE
LIBTAYO 350 MG/7 ML VIAL
LIFE-PACK MEN'S
LIFE-PACK WOMEN'S
LILETTA 52 MG SYSTEM
LILLOW-28 TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
LINZESS 145 MCG CAPSULE
LINZESS 290 MCG CAPSULE
LINZESS 72 MCG CAPSULE
LIORESAL IT 0.05 MG/1 ML AMP
LIORESAL IT 10 MG/20 ML AMPULE
LIORESAL IT 10 MG/20 ML KIT
LIORESAL IT 10 MG/5 ML AMPULE
LIORESAL IT 10 MG/5 ML KIT
LIORESAL IT 40 MG/20 ML AMPULE
LIORESAL IT 40 MG/20 ML KIT
LIOTHYRONINE SOD 25 MCG TAB
LIOTHYRONINE SOD 5 MCG TAB
LIOTHYRONINE SOD 50 MCG TAB
LIPITOR 10 MG TABLET
LIPITOR 20 MG TABLET
LIPITOR 40 MG TABLET
LIPITOR 80 MG TABLET
LIPOFEN 150 MG CAPSULE
LIPOFEN 50 MG CAPSULE
LIPOTRIAD CAPLET
LIPOTRIAD VISIONARY SOFTGEL
LIQUID CALCIUM 600-VIT D3 SFGL
LISINOPRIL 10 MG TABLET
LISINOPRIL 2.5 MG TABLET
LISINOPRIL 20 MG TABLET
LISINOPRIL 30 MG TABLET
LISINOPRIL 40 MG TABLET
LISINOPRIL 5 MG TABLET
LISINOPRIL-HCTZ 10-12.5 MG TAB
LISINOPRIL-HCTZ 20-12.5 MG TAB
LISINOPRIL-HCTZ 20-25 MG TAB
GNP LITE COAT ASA 325 MG TAB
LITE COAT ASPIRIN 325 MG TAB
LITE TOUCH 28G LANCETS
LITE TOUCH 30G LANCETS
LITE TOUCH 33G LANCETS
LITE TOUCH 31GX1/4" PEN NEEDLE
LITE TOUCH PEN NEEDLE 29G
LITE TOUCH PEN NEEDLE 31G
LITE TOUCH INSULIN 1 ML SYR
LITE TOUCH INSULIN SYR 1 ML
LITE TOUCH INSULIN 0.5 ML SYR
LITE TOUCH INSULIN SYR 0.5 ML
LITE TOUCH INSULIN SYR 0.3 ML
LITETOUCH SYRIN 1 ML 28GX1/2"
LITETOUCH SYRIN 1 ML 29GX1/2"
LITETOUCH SYRIN 1 ML 30GX5/16"
LITETOUCH INS 0.5 ML 31GX5/16"
LITETOUCH SYR 0.5 ML 28GX1/2"
LITETOUCH SYR 0.5 ML 29GX1/2"
LITETOUCH SYR 0.5 ML 30GX5/16"
LITETOUCH INS 0.3 ML 29GX1/2"
LITETOUCH INS 0.3 ML 30GX5/16"
LITETOUCH INS 0.3 ML 31GX5/16"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
LITHIUM 8 MEQ/5 ML SOLUTION
LITHIUM CARBONATE 150 MG CAP
LITHIUM CARBONATE 300 MG CAP
LITHIUM CARBONATE 300 MG TAB
LITHIUM CARBONATE 600 MG CAP
LITHIUM CARBONATE ER 300 MG TB
LITHIUM CARBONATE ER 450 MG TB
LITHOBID ER 300 MG TABLET
LITTLE ANIMALS-IRON TAB CHEW
LITTLE ANIMALS-IRON TAB CHEW
LIVALO 1 MG TABLET
LIVALO 2 MG TABLET
LIVALO 4 MG TABLET
L-METHYL-MC TABLET
L-METHYL-MC NAC TABLET
LO LOESTRIN FE 1-10 TABLET
LODINE 400 MG TABLET
LODOSYN 25 MG TABLET
LOESTRIN 21 1.5-30 TABLET
LOESTRIN 21 1-20 TABLET
LOESTRIN FE 1.5-30 TABLET
LOESTRIN FE 1-20 TABLET
LOFIBRA 160 MG TABLET
LOFIBRA 54 MG TABLET
LOFIBRA 134 MG CAPSULE
LOFIBRA 200 MG CAPSULE
LOFIBRA 67 MG CAPSULE
LOJAIMIESS 0.1-0.02-0.01 TAB
LOKELMA 10 GRAM POWDER PACKET
LOKELMA 5 GRAM POWDER PACKET
LOMEDIA 24 FE 1 MG-20 MCG TAB
LONHALA MAGNAIR 25 MCG REFILL
CVS LOPERAMIDE 1 MG/7.5 ML LIQ
CVS LOPERAMIDE 1 MG/7.5 ML SUS
EQ LOPERAMIDE 1 MG/7.5 ML SUSP
EQL LOPERAMIDE 1 MG/7.5 ML SUS
HM LOPERAMIDE 1 MG/7.5 ML LIQ
HM LOPERAMIDE 2 MG SOFTGEL
LOPERAMIDE 1 MG/5 ML LIQUID
LOPERAMIDE 1 MG/5 ML SOLUTION
LOPERAMIDE 1 MG/7.5 ML LIQUID
LOPERAMIDE 1 MG/7.5 ML SOLN
LOPERAMIDE 1 MG/7.5 ML SUSP
LOPERAMIDE 2 MG CAPLET
LOPERAMIDE 2 MG CAPSULE
LOPERAMIDE 2 MG TABLET
LOPERAMIDE 2 MG/15 ML SUSP
RA LOPERAMIDE 1 MG/7.5 ML SUSP
SM LOPERAMIDE 1 MG/7.5 ML LIQ
LOPID 600 MG TABLET
LOPINAVIR-RITONAVIR 80-20MG/ML
LOPREEZA 0.5 MG-0.1 MG TABLET
LOPREEZA 1 MG-0.5 MG TABLET
LOPRESSOR 100 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
LOPRESSOR 50 MG TABLET
LOPRESSOR HCT 50-25 TABLET
LORBRENA 100 MG TABLET
LORBRENA 25 MG TABLET
LORYNA 3 MG-0.02 MG TABLET
LOSARTAN POTASSIUM 100 MG TAB
LOSARTAN POTASSIUM 25 MG TAB
LOSARTAN POTASSIUM 50 MG TAB
LOSARTAN-HCTZ 100-12.5 MG TAB
LOSARTAN-HCTZ 100-25 MG TAB
LOSARTAN-HCTZ 50-12.5 MG TAB
LOSEASONIQUE TABLET
LOTENSIN 10 MG TABLET
LOTENSIN 20 MG TABLET
LOTENSIN 40 MG TABLET
LOTENSIN HCT 10-12.5 MG TABLET
LOTENSIN HCT 20-12.5 MG TABLET
LOTENSIN HCT 20-25 MG TABLET
LOTREL 10-20 MG CAPSULE
LOTREL 10-40 MG CAPSULE
LOTREL 5-10 MG CAPSULE
LOTREL 5-20 MG CAPSULE
LOTREL 5-40 MG CAPSULE
LOVASTATIN 10 MG TABLET
LOVASTATIN 20 MG TABLET
LOVASTATIN 40 MG TABLET
LOVAZA 1 GM CAPSULE
LOW DOSE ASPIRIN EC 81 MG TAB
LOW-OGESTREL-28 TABLET
LOXAPINE 10 MG CAPSULE
LOXAPINE 25 MG CAPSULE
LOXAPINE 5 MG CAPSULE
LOXAPINE 50 MG CAPSULE
LO-ZUMANDIMINE 3 MG-0.02 MG TB
LUCENTIS 0.3 MG VIAL
LUCENTIS 0.3 MG/0.05 ML SYRING
LUCENTIS 0.3 MG/0.05 ML VIAL
LUCENTIS 0.5 MG VIAL
LUCENTIS 0.5 MG/0.05 ML SYRING
LUCENTIS 0.5 MG/0.05 ML VIAL
LUDENT FLUORIDE 0.25 MG TB CHW
LUDENT FLUORIDE 0.5 MG TB CHEW
LUDENT FLUORIDE 1 MG TAB CHEW
BD LUER-LOK SYRINGE 1 ML
LUMIGAN 0.01% EYE DROPS
LUMIZYME 50 MG VIAL
LUPRON DEPOT 22.5 MG 3MO KIT
LUPRON DEPOT 45 MG 6MO KIT
LUPRON DEPOT 7.5 MG KIT
LUPRON DEPOT-4 MONTH KIT
LUPRON DEPOT-PED 11.25 MG 3MO
LUPRON DEPOT-PED 11.25 MG KIT
LUPRON DEPOT-PED 15 MG KIT
LUPRON DEPOT-PED 30 MG 3MO KIT
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
LUPRON DEPOT-PED 7.5 MG KIT
LUTERA-28 TABLET
LYNPARZA 100 MG TABLET
LYNPARZA 150 MG TABLET
LYNPARZA 50 MG CAPSULE
LYRICA 100 MG CAPSULE
LYRICA 150 MG CAPSULE
LYRICA 20 MG/ML ORAL SOLUTION
LYRICA 200 MG CAPSULE
LYRICA 225 MG CAPSULE
LYRICA 25 MG CAPSULE
LYRICA 300 MG CAPSULE
LYRICA 50 MG CAPSULE
LYRICA 75 MG CAPSULE
LYRICA CR 165 MG TABLET
LYRICA CR 330 MG TABLET
LYRICA CR 82.5 MG TABLET
LYSIPLEX PLUS LIQUID
LYSODREN 500 MG TABLET
LYSTEDA 650 MG TABLET
LYZA 0.35 MG TABLET
MACNATAL CN DHA SOFTGEL
MACUGEN 0.3 MG/90 MICROLITERS
MACULAR BENEFITS COMBO PACK
MACULAR HEALTH FORMULA CAPSULE
MACUVEX CAPSULE
MACUVITE EYE CARE TABLET
MACUZIN CAPSULE
MAGELLAN INSULIN SYRINGE 1 ML
MAGELLAN INSULIN SYR 0.5 ML
MAGELLAN INSULIN SYR 0.3 ML
MAGELLAN INSUL SYRINGE 0.5 ML
MAGELLAN INSUL SYRINGE 0.3 ML
MAPROTILINE 25 MG TABLET
MAPROTILINE 50 MG TABLET
MAPROTILINE 75 MG TABLET
MARLISSA-28 TABLET
MARNATAL-F CAPSULE
MARPLAN 10 MG TABLET
MATZIM LA 180 MG TABLET
MATZIM LA 240 MG TABLET
MATZIM LA 300 MG TABLET
MATZIM LA 360 MG TABLET
MATZIM LA 420 MG TABLET
MAVENCLAD 10 MG X 10 TABLET PK
MAVENCLAD 10 MG X 4 TABLET PK
MAVENCLAD 10 MG X 5 TABLET PK
MAVENCLAD 10 MG X 6 TABLET PK
MAVENCLAD 10 MG X 7 TABLET PK
MAVENCLAD 10 MG X 8 TABLET PK
MAVENCLAD 10 MG X 9 TABLET PK
MAVIK 1 MG TABLET
MAVIK 2 MG TABLET
MAXI-COMFORT INS 1 ML 28GX1/2"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
MAXI-COMFORT INS 0.5 ML 28G
MAXICOMFORT II PEN NDL 31GX6MM
MAXICOMFORT INS 1 ML 27GX1/2"
MAXICOMFORT INS 0.5ML 27GX1/2"
MAXICOMFORT PEN NDL 29G X 5MM
MAXICOMFORT PEN NDL 29G X 8MM
MAXIMIN PACK
QC MAXIMUM DAILY MULTIVIT TAB
MAXINATE TABLET
MAXZIDE 75 MG-50 MG TABLET
MAXZIDE 37.5 MG-25 MG TABLET
MAYZENT 0.25 MG TABLET
MAYZENT 2 MG TABLET
MEBOLIC TABLET
MECLOFENAMATE 100 MG CAPSULE
MECLOFENAMATE 50 MG CAPSULE
MEDIPROXEN TABLET
MEDISENSE H-L CONTROL SOLUTION
MEDISENSE H-M-L CONTROL SOLN
MEDISENSE MID CONTROL SOLUTION
MEDISENSE GLUC-KET CONT SOL
MEDISENSE GLUC-KET CONT SOL
MEDISENSE THIN 28G LANCETS
MEDLANCE PLUS 21G LANCETS
MEDLANCE PLUS 30G LANCETS
MEDLANCE PLUS EXTRA 21G LANCET
MEDLANCE PLUS LITE 25G LANCETS
MEDLANCE PLUS SPECIAL BLADE
MEDROXYPROGESTERONE 10 MG TAB
MEDROXYPROGESTERONE 150 MG/ML
MEDROXYPROGESTERONE 2.5 MG TAB
MEDROXYPROGESTERONE 5 MG TAB
MEDTYCHOLL-B COMP-LIVER CAP
MEGA BIOTIN 10,000 MCG SOFTGEL
GNP MEGA MULTI FOR WOMEN TAB
MEGA MULTI FOR WOMEN TAB
GNP MEGA MULTI FOR MEN TABLET
MEGA MULTI FOR MEN TABLET
MEGA MULTIVIT-CHELATED MIN TAB
MEGACE 40 MG/ML ORAL SUSP
MEGACE ES 625 MG/5 ML SUSP
MEGESTROL 625 MG/5 ML SUSP
MEGESTROL 800 MG/20 ML SUSP
MEGESTROL ACET 40 MG/ML SUSP
MEGESTROL ACET 400 MG/10 ML
MEGESTROL ACET 800 MG/20 ML
MEKINIST 0.5 MG TABLET
MEKINIST 2 MG TABLET
MEKTOVI 15 MG TABLET
MELALEUCA 1:20 (W/V) VIAL
MELODETTA 24 FE CHEWABLE TAB
MELOXICAM 15 MG TABLET
MELOXICAM 7.5 MG TABLET
MEMANTINE HCL 10 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
MEMANTINE HCL 10 MG/5 ML SOLN
MEMANTINE HCL 2 MG/ML SOLUTION
MEMANTINE HCL 5 MG TABLET
MEMANTINE HCL ER 14 MG CAPSULE
MEMANTINE HCL ER 21 MG CAPSULE
MEMANTINE HCL ER 28 MG CAPSULE
MEMANTINE HCL ER 7 MG CAPSULE
CVS MENS 50 PLUS ADVANCED TAB
HM MENS 50 PLUS ADV ONE DAILY
MEN 50 PLUS MULTIVITAMIN TAB
MENEST 0.3 MG TABLET
MENEST 0.625 MG TABLET
MENEST 1.25 MG TABLET
MENEST 2.5 MG TABLET
MENOSTAR 14 MCG/DAY PATCH
MEN'S 50 PLUS DAILY FORMULA TB
MEN'S DAILY FORMULA TABLET
MEN'S DAILY FORMULA CAPSULE
CVS MEN'S DAILY GUMMIES
QC MEN'S DAILY MULTIVIT-MIN TB
MEN'S DAILY PACK
MEN'S MULTIVITAMIN CAPLET
MEN'S MULTIVITAMIN GUMMIES
CVS MEN'S MULTI-VIT TABLET
MENS MULTIVIT HIGH POTENCY TAB
EQL ONE DAILY MEN'S TABLET
HM MEN'S ONE DAILY TABLET
RA MEN'S ONE DAILY TABLET
SM MEN'S ONE DAILY TABLET
MEN'S PACK
MEPSEVII 10 MG/5 ML VIAL
MERCAPTOPURINE 50 MG TABLET
MERIBIN 5 MG CAPSULE
MESALAMINE 1,000 MG SUPP
MESALAMINE 4 GM/60 ML ENEMA
MESALAMINE 800 MG DR TABLET
MESALAMINE DR 1.2 GM TABLET
MESALAMINE 4 GM/60 ML KIT
MESALAMINE DR 400 MG CAPSULE
MESALAMINE ER 0.375 GRAM CAP
MESQUITE 1:20 (W/V) VIAL
MESTINON 180 MG TIMESPAN
MESTINON 60 MG TABLET
MESTINON 60 MG/5 ML SYRUP
METADATE CD 10 MG CAPSULE
METADATE CD 20 MG CAPSULE
METADATE CD 30 MG CAPSULE
METADATE CD 40 MG CAPSULE
METADATE CD 50 MG CAPSULE
METADATE CD 60 MG CAPSULE
METADATE ER 20 MG TABLET
METAFOLBIC TABLET
METAFOLBIC PLUS CAPLET
METAPROTERENOL 10 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
METAPROTERENOL 10 MG/5 ML SYR
METAPROTERENOL 20 MG TABLET
METFORMIN ER 1,000 MG GASTR-TB
METFORMIN ER 500 MG GASTRC-TB
METFORMIN ER 1,000 MG OSM-TAB
METFORMIN ER 500 MG OSMOTIC TB
METFORMIN HCL 1,000 MG TABLET
METFORMIN HCL 500 MG TABLET
METFORMIN HCL 500 MG/5 ML SOLN
METFORMIN HCL 850 MG TABLET
METFORMIN HCL ER 500 MG TABLET
METFORMIN HCL ER 750 MG TABLET
METHAMPHETAMINE 5 MG TABLET
METHAZOLAMIDE 25 MG TABLET
METHAZOLAMIDE 50 MG TABLET
METHIMAZOLE 10 MG TABLET
METHIMAZOLE 5 MG TABLET
METHITEST 10 MG TABLET
METHOTREXATE 2.5 MG TABLET
METHOXSALEN 10 MG CAPSULE
METHOXSALEN 10 MG SOFTGEL
METHSCOPOLAMINE BROM 5 MG TAB
METHYCLOTHIAZIDE 5 MG TABLET
METHYLDOPA 250 MG TABLET
METHYLDOPA 500 MG TABLET
METHYLDOPA-HCTZ 250-15 MG TAB
METHYLDOPA-HCTZ 250-25 MG TAB
METHYLIN 10 MG/5 ML SOLUTION
METHYLIN 5 MG/5 ML SOLUTION
METHYLPHENIDATE ER 10 MG TAB
METHYLPHENIDATE ER 18 MG TAB
METHYLPHENIDATE ER 20 MG TAB
METHYLPHENIDATE ER 27 MG TAB
METHYLPHENIDATE ER 36 MG TAB
METHYLPHENIDATE ER 54 MG TAB
METHYLPHENIDATE ER 72 MG TAB
METHYLPHENIDATE ER(LA) 10MG CP
METHYLPHENIDATE ER(LA) 20MG CP
METHYLPHENIDATE ER(LA) 30MG CP
METHYLPHENIDATE ER(LA) 40MG CP
METHYLPHENIDATE 10 MG CHEW TAB
METHYLPHENIDATE 10 MG TABLET
METHYLPHENIDATE 10 MG/5 ML SOL
METHYLPHENIDATE 2.5 MG CHEW TB
METHYLPHENIDATE 20 MG TABLET
METHYLPHENIDATE 5 MG CHEW TAB
METHYLPHENIDATE 5 MG TABLET
METHYLPHENIDATE 5 MG/5 ML SOLN
METHYLPHENIDATE CD 10 MG CAP
METHYLPHENIDATE CD 20 MG CAP
METHYLPHENIDATE CD 30 MG CAP
METHYLPHENIDATE CD 40 MG CAP
METHYLPHENIDATE CD 50 MG CAP
METHYLPHENIDATE CD 60 MG CAP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
METHYLPHENIDATE ER(CD) 10MG CP
METHYLPHENIDATE ER(CD) 20MG CP
METHYLPHENIDATE ER(CD) 30MG CP
METHYLPHENIDATE ER(CD) 40MG CP
METHYLPHENIDATE ER(CD) 50MG CP
METHYLPHENIDATE ER(CD) 60MG CP
METHYLPHENIDATE LA 10 MG CAP
METHYLPHENIDATE LA 20 MG CAP
METHYLPHENIDATE LA 30 MG CAP
METHYLPHENIDATE LA 40 MG CAP
METHYLPHENIDATE LA 60 MG CAP
METHYLTESTOSTERONE 10 MG CAP
METIPRANOLOL 0.3% EYE DROPS
METOLAZONE 10 MG TABLET
METOLAZONE 2.5 MG TABLET
METOLAZONE 5 MG TABLET
METOPROLOL SUCC ER 100 MG TAB
METOPROLOL SUCC ER 200 MG TAB
METOPROLOL SUCC ER 25 MG TAB
METOPROLOL SUCC ER 50 MG TAB
METOPROLOL ER-HCTZ 100-12.5 MG
METOPROLOL ER-HCTZ 25-12.5 MG
METOPROLOL ER-HCTZ 50-12.5 MG
METOPROLOL TARTRATE 100 MG TAB
METOPROLOL TARTRATE 25 MG TAB
METOPROLOL TARTRATE 37.5 MG TB
METOPROLOL TARTRATE 50 MG TAB
METOPROLOL TARTRATE 75 MG TAB
METOPROLOL-HCTZ 100-25 MG TAB
METOPROLOL-HCTZ 100-50 MG TAB
METOPROLOL-HCTZ 50-25 MG TAB
MEXILETINE 150 MG CAPSULE
MEXILETINE 200 MG CAPSULE
MEXILETINE 250 MG CAPSULE
MIACALCIN 200 UNIT NASAL SPRAY
MIBELAS 24 FE CHEWABLE TABLET
MICARDIS 20 MG TABLET
MICARDIS 40 MG TABLET
MICARDIS 80 MG TABLET
MICARDIS HCT 40-12.5 MG TABLET
MICARDIS HCT 80-12.5 MG TABLET
MICARDIS HCT 80-25 MG TABLET
RELION MICRO TEST STRIPS
RELION MICRO THIN 33G LANCET
CVS MICRO THIN 33G LANCETS
EQL MICRO THIN 33G LANCETS
GNP MICRO THIN 33G LANCETS
HEB MICRO THIN 33G LANCETS
MICRO THIN 33G LANCETS
SM MICRO THIN 33G LANCETS
MICRODOT HIGH-LOW CONTROL SOL
MICRODOT TEST STRIPS
MICRODOT NORMAL CONTROL SOLUT
MICRODOT BLOOD GLUCOSE SYSTEM
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
MICRODOT PEN NEEDLE 31GX6MM
MICRODOT PEN NEEDLE 32GX4MM
MICRODOT PEN NEEDLE 33GX4MM
MICRODOT XTRA TEST STRIPS
MICROGESTIN 21 1.5-30 TAB
MICROGESTIN 21 1-20 TABLET
MICROGESTIN 24 FE 1 MG-20 MCG
MICROGESTIN FE 1.5-30 TAB
MICROGESTIN FE 1-20 TABLET
MICROLET LANCETS
MICROLET 2 LANCING DEVICE
MICROLET NEXT LANCING DEVICE
BD MICROTAINER LANCETS
MICROZIDE 12.5 MG CAPSULE
MIDOL 220 MG CAPLET
MIGLITOL 100 MG TABLET
MIGLITOL 25 MG TABLET
MIGLITOL 50 MG TABLET
MIGLUSTAT 100 MG CAPSULE
MILI 0.25-0.035 MG TABLET
MILLTRIUM SENIOR MULTIVIT TAB
MIMVEY 1-0.5 MG TABLET
MIMVEY LO 0.5-0.1 MG TABLET
MINASTRIN 24 FE CHEWABLE TAB
MINI PRENATAL TABLET
MINI ULTRA-THIN II PEN NDL 31G
MINILINK REAL-TIME TRANSMITTER
MINIMED INFUSION SET
MINIMED 630G GUARDIAN START KT
MINIMED RESERVOIR 1.8 ML
MINIMED RESERVOIR 3 ML
MINIPRESS 1 MG CAPSULE
MINIPRESS 2 MG CAPSULE
MINIPRESS 5 MG CAPSULE
MINITRAN 0.1 MG/HR PATCH
MINITRAN 0.2 MG/HR PATCH
MINITRAN 0.4 MG/HR PATCH
MINITRAN 0.6 MG/HR PATCH
MINIVELLE 0.025 MG PATCH
MINIVELLE 0.0375 MG PATCH
MINIVELLE 0.05 MG PATCH
MINIVELLE 0.075 MG PATCH
MINIVELLE 0.1 MG PATCH
MINOXIDIL 10 MG TABLET
MINOXIDIL 2.5 MG TABLET
MIO INFUSION SET 18"
MIO INFUSION SET 23"
MIO INFUSION SET 32"
MIRAPEX 0.125 MG TABLET
MIRAPEX 0.25 MG TABLET
MIRAPEX 0.5 MG TABLET
MIRAPEX 0.75 MG TABLET
MIRAPEX 1 MG TABLET
MIRAPEX 1.5 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
MIRAPEX ER 0.375 MG TABLET
MIRAPEX ER 0.75 MG TABLET
MIRAPEX ER 1.5 MG TABLET
MIRAPEX ER 2.25 MG TABLET
MIRAPEX ER 3 MG TABLET
MIRAPEX ER 3.75 MG TABLET
MIRAPEX ER 4.5 MG TABLET
MIRCERA 100 MCG/0.3 ML SYRINGE
MIRCERA 150 MCG/0.3 ML SYRINGE
MIRCERA 200 MCG/0.3 ML SYRINGE
MIRCERA 30 MCG/0.3 ML SYRINGE
MIRCERA 50 MCG/0.3 ML SYRINGE
MIRCERA 75 MCG/0.3 ML SYRINGE
MIRCETTE 28 DAY TABLET
MIRENA 52 MG SYSTEM
MIRTAZAPINE 15 MG ODT
MIRTAZAPINE 15 MG TABLET
MIRTAZAPINE 30 MG ODT
MIRTAZAPINE 30 MG TABLET
MIRTAZAPINE 45 MG ODT
MIRTAZAPINE 45 MG TABLET
MIRTAZAPINE 7.5 MG TABLET
MISOPROSTOL 100 MCG TABLET
MISOPROSTOL 200 MCG TABLET
MITIGARE 0.6 MG CAPSULE
MITOXANTRONE 20 MG/10 ML VIAL
MITOXANTRONE 25 MG/12.5 ML VL
MITOXANTRONE 30 MG/15 ML VIAL
MIXED ASPERGILLUS 20000 PNU/ML
MIXED FEATHERS 1:20 (W/V) VL
MIXED RAGWEED 1:20 (W/V)
MIXED VESPID VENOM 1,650 MCG
MIXED VESPID VENOM 300 MCG/ML
M-NATAL PLUS TABLET
MOBIC 15 MG TABLET
MOBIC 7.5 MG TABLET
MODAFINIL 100 MG TABLET
MODAFINIL 200 MG TABLET
MOEXIPRIL HCL 15 MG TABLET
MOEXIPRIL HCL 7.5 MG TABLET
MOEXIPRIL-HCTZ 15-12.5 MG TAB
MOEXIPRIL-HCTZ 15-25 MG TABLET
MOEXIPRIL-HCTZ 7.5-12.5 MG TAB
MOLINDONE HCL 10 MG TABLET
MOLINDONE HCL 25 MG TABLET
MOLINDONE HCL 5 MG TABLET
MOMETASONE FUROATE 50 MCG SPRY
MONOCAPS TABLET
MONOCLATE-P 1,000 UNIT KIT
MONOCLATE-P 1,500 UNIT KIT
MONOJECT 0.5 ML SYRN 28GX1/2"
MONOJECT INSULIN SYR U-100
MONOJECT 1 ML SYRN 27X1/2"
MONOJECT 1 ML SYRN 28GX1/2"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
MONOJECT INSUL SYR U100 1 ML
MONOJECT INSULIN SYR 1 ML
MONOJECT SYRINGE 1 ML
MONOJECT INSUL SYR U100
MONOJECT INSUL SYR U100 0.5 ML
MONOJECT INSULIN SYR 0.5 ML
MONOJECT INSULIN SYR U-100
MONOJECT SYRINGE 0.5 ML
MONOJECT INSUL SYR U100
MONOJECT INSULIN SYR 0.3 ML
MONOJECT INSULIN SYRN 3/10 ML
MONOJECT SYRINGE 0.3 ML
MONOLET 21G LANCETS
MONOLET THIN 28G LANCETS
MONO-LINYAH 28 TABLET
MONONESSA 28 TABLET
MONONINE 1,000 UNIT VIAL
MONTELUKAST SOD 10 MG TABLET
MONTELUKAST SOD 4 MG GRANULES
MONTELUKAST SOD 4 MG TAB CHEW
MONTELUKAST SOD 5 MG TAB CHEW
MOSQUITO 1:100 (W/V) VIAL
MOTEGRITY 1 MG TABLET
MOTEGRITY 2 MG TABLET
MOTRIN IB 200 MG CAPLET
MOTRIN IB 200 MG LIQUID GEL
MOUNTAIN CEDAR 1:20 (W/V) VIAL
MOUSE EPITHELIUM 1:20 (W/V)
MTERYTI COMBO PACK
MTERYTI FOLIC 5 COMBO PACK
MUCOR 10,000 PNU/ML VIAL
MUCOR 20,000 PNU/ML VIAL
MUGWORT 1:20 (W/V) VIAL
MULTAQ 400 MG TABLET
MULTI COMPLETE-IRON TABLET
MULTI FOR HER SOFTGEL
MULTI FOR HER TABLET
MULTI FOR HER 50 PLUS SOFTGEL
MULTI-BETIC TABLET
MULTI-DAY PLUS IRON TABLET
MULTI-DAY PLUS MINERALS TABLET
MULTI-DELYN WITH IRON LIQUID
MULTIFUNCTION (GLUC-KETONE) KT
MULTI-LANCET DEVICE 2 KIT
MULTILEX TABLET
MULTILEX T-M TABLET
MULTIPLE VITAMIN W-MINERALS TB
MULTIPLE VITAMIN PLAIN TAB
MULTIPLE VITAMIN TABLET
MULTIPLE VITAMINS TABLET
MULTIVITAMIN TABLET
MULTIVITAMIN LIQUID
MULTI-VITAMIN GUMMIES
PUB MULTIVITAMIN 50 PLUS TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
MULTI-VITAMIN DAILY TABLET
MULTIVIT-FLUOR-IRON 0.25 MG/ML
MULTIVIT-FLUOR 0.25 MG/ML DROP
MULTIVIT-FLUOR 0.5 MG/ML DROP
MULTIVIT-FLUOR 0.25 MG TAB CHW
MULTIVIT-FLUOR 0.5 MG TAB CHEW
MULTIVIT-FLUORIDE 1 MG TAB CHW
MULTIVIT-FLUOR 0.25 MG TAB CHW
MULTIVIT-FLUOR 0.5 MG TAB CHEW
MULTIVIT-FLUORIDE 1 MG TAB CHW
MULTIVIT-FLUOR 0.25 MG/ML DROP
MULTIVIT-FLUOR 0.5 MG/ML DROP
MULTI-VITAMIN-MINERALS TABLET
MULTIVITAMIN WOMEN 50 PLUS TAB
MULTIVIT-IRON-FLUOR 0.25 MG/ML
MULTIVITAMINS CAPSULE
MULTIVITAMINS TABLET
SM MULTIVITAMINS TABLET
CVS DAILY VIT-IRON-CAL TAB
MULTIVIT-IRON-FL 0.25 MG/ML
MULTIVIT-FLUOR 0.25 MG/ML DROP
MULTIVIT-FLUOR 0.5 MG/ML DROP
MULTIVIT WITH IRON TAB CHEW
DAILY MULTI VITAMIN-IRON TAB
MULTIPLE VITAMIN WITH IRON TAB
MULTIVITAMINS-IRON TABLET
SM MULTIVITAMIN W-IRON TAB
DAILY MULTIVIT-MINERALS TAB
MULTIVIT-MINERALS TABLET
MULTIVITAMIN-MINERAL LIQUID
MULTIVIT-MINERAL HP CAP
MULTI-VITE LIQUID
MURO-128 5% EYE DROPS
MURO-128 5% EYE OINTMENT
MUSE 1,000 MCG URETHRAL SUPP
MUSE 125 MCG URETHRAL SUPPOS
MUSE 250 MCG URETHRAL SUPPOS
MUSE 500 MCG URETHRAL SUPPOS
MVC-FLUORIDE 0.25 MG TAB CHEW
MVC-FLUORIDE 0.5 MG TAB CHEW
MVC-FLUORIDE 1 MG TAB CHEW
MVW COMPLETE FORMUL PEDIA DRPS
MVW COMPLETE FORMUL D3000 CHEW
MVW COMPLETE FORMUL D3000 SFGL
MVW COMPLETE FORMUL D5000 CHEW
MVW COMPLETE FORMUL D5000 SFGL
MVW COMPLETE FORM MULTIVIT CHW
MVW COMPLETE FORM MULTIVI SFGL
MVW COMPLETE FORM MULTIVI SFGL
MYALEPT 11.3 MG (5 MG/ML) VIAL
MYCOPHENOLATE 200 MG/ML SUSP
MYCOPHENOLATE 250 MG CAPSULE
MYCOPHENOLATE 500 MG TABLET
MYCOPHENOLIC ACID DR 180 MG TB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
MYCOPHENOLIC ACID DR 360 MG TB
MYDAYIS ER 12.5 MG CAPSULE
MYDAYIS ER 25 MG CAPSULE
MYDAYIS ER 37.5 MG CAPSULE
MYDAYIS ER 50 MG CAPSULE
MYFORTIC 180 MG TABLET
MYFORTIC 360 MG TABLET
MYGLUCOHEALTH TEST STRIPS
MYGLUCOHEALTH MONITORING KIT
MYGLUCOHEALTH CONTROL SOLN PAK
MYGLUCOHEALTH 30G LANCETS
MYNATAL ULTRACAPLET
MYNATAL CAPSULE
MYNATAL ADVANCE TABLET
MYNATAL PLUS CAPTAB
MYNATAL-Z CAPTAB
MYNATE 90 PLUS CAPLET SA
MYNEPHROCAPS SOFTGEL
MYNEPHRON CAPSULE
MYRBETRIQ ER 25 MG TABLET
MYRBETRIQ ER 50 MG TABLET
MYSOLINE 250 MG TABLET
MYSOLINE 50 MG TABLET
MYVITALIFE SOFT-GEL CAPSULE
MYZILRA-28 TABLET
NABUMETONE 500 MG TABLET
NABUMETONE 750 MG TABLET
NADOLOL 20 MG TABLET
NADOLOL 40 MG TABLET
NADOLOL 80 MG TABLET
NADOLOL-BENDROFLU 40-5 MG TAB
NADOLOL-BENDROFLU 80-5 MG TAB
NAGLAZYME 5 MG/5 ML VIAL
NALFON 400 MG CAPSULE
NALFON 600 MG TABLET
NAMENDA 10 MG TABLET
NAMENDA 2 MG/ML SOLUTION
NAMENDA 5 MG TABLET
NAMENDA XR 14 MG CAPSULE
NAMENDA XR 21 MG CAPSULE
NAMENDA XR 28 MG CAPSULE
NAMENDA XR 7 MG CAPSULE
NAMZARIC 14 MG-10 MG CAPSULE
NAMZARIC 21 MG-10 MG CAPSULE
NAMZARIC 28 MG-10 MG CAPSULE
NAMZARIC 7 MG-10 MG CAPSULE
BD NANO 2 GEN PEN NDL 32GX4MM
NANO VM 1-3 POWDER
NANO VM 4-8 POWDER
NANOVM 9-18 POWDER
NANOVM T/F POWDER
NAPRELAN CR 375 MG TABLET
NAPRELAN CR 500 MG TABLET
NAPRELAN CR 750 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
NAPROSYN 125 MG/5 ML SUSPEN
NAPROSYN 500 MG TABLET
NAPROXEN 125 MG/5 ML SUSPEN
NAPROXEN 250 MG TABLET
NAPROXEN 375 MG TABLET
NAPROXEN 500 MG KIT
NAPROXEN 500 MG TABLET
NAPROXEN DR 375 MG TABLET
NAPROXEN DR 500 MG TABLET
NAPROXEN EC 375 MG TABLET
NAPROXEN EC 500 MG TABLET
CVS NAPROXEN SOD 220 MG CAPLET
CVS NAPROXEN SOD 220 MG TABLET
CVS NAPROXEN SODIUM 220 MG CAP
EQ NAPROXEN SOD 220 MG CAPLET
EQ NAPROXEN SOD 220 MG TABLET
EQ NAPROXEN SODIUM 220 MG CAP
EQL NAPROXEN SOD 220 MG CAPLET
EQL NAPROXEN SOD 220 MG TABLET
EQL NAPROXEN SODIUM 220 MG CAP
GNP NAPROXEN SOD 220 MG CAPLET
GNP NAPROXEN SOD 220 MG TABLET
GS NAPROXEN SOD 220 MG CAPLET
GS NAPROXEN SOD 220 MG TABLET
HM NAPROXEN SOD 220 MG CAPLET
HM NAPROXEN SODIUM 220 MG CAP
NAPROXEN SODIUM 220 MG CAPLET
NAPROXEN SODIUM 220 MG CAPSULE
NAPROXEN SODIUM 220 MG TABLET
NAPROXEN SODIUM 275 MG TAB
NAPROXEN SODIUM 550 MG TAB
PUB NAPROXEN SOD 220 MG TABLET
QC NAPROXEN SOD 220 MG TABLET
RA NAPROXEN SOD 220 MG TABLET
RA NAPROXEN SODIUM 220 MG CAP
SB NAPROXEN SOD 220 MG CAPLET
SM NAPROXEN SOD 220 MG CAPLET
SM NAPROXEN SOD 220 MG TABLET
SM NAPROXEN SODIUM 220 MG CAP
NAPROXEN SOD CR 375 MG TABLET
NAPROXEN SOD CR 500 MG TABLET
NAPROXEN SODIUM DS 550 MG TAB
NAPROXEN SOD ER 375 MG TABLET
NAPROXEN SOD ER 500 MG TABLET
NAPROXEN-ESOMEPRAZ DR 375-20MG
NAPROXEN-ESOMEPRAZ DR 500-20MG
NARDIL 15 MG TABLET
NASCOBAL 500 MCG NASAL SPRAY
NASONEX 50 MCG NASAL SPRAY
NATACHEW TABLET
NATAZIA 28 TABLET
NATEGLINIDE 120 MG TABLET
NATEGLINIDE 60 MG TABLET
NATELLE ONE CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
NATESTO NASAL 5.5 MG/0.122 GM
NATPARA 100 MCG DOSE CARTRIDGE
NATPARA 25 MCG DOSE CARTRIDGE
NATPARA 50 MCG DOSE CARTRIDGE
NATPARA 75 MCG DOSE CARTRIDGE
NATURE-THROID 113.75 MG TABLET
NATURE-THROID 130 MG TABLET
NATURE-THROID 146.25 MG TABLET
NATURE-THROID 16.25 MG TABLET
NATURE-THROID 162.5 MG TABLET
NATURE-THROID 195 MG TABLET
NATURE-THROID 260 MG TABLET
NATURE-THROID 32.5 MG TABLET
NATURE-THROID 325 MG TABLET
NATURE-THROID 48.75 MG TABLET
NATURE-THROID 65 MG TABLET
NATURE-THROID 81.25 MG TABLET
NATURE-THROID 97.5 MG TABLET
NEBUPENT 300 MG INHAL POWDER
NECON 0.5-35-28 TABLET
NECON 10-11-28 TABLET
NECON 1-35-28 TABLET
NECON 7-7-7-28 TABLET
NECON 1-50-28 TABLET
RELI ON 31G X 1/4" NEEDLES
NEEVODHA CAPSULE
NEFAZODONE HCL 100 MG TABLET
NEFAZODONE HCL 150 MG TABLET
NEFAZODONE HCL 200 MG TABLET
NEFAZODONE HCL 250 MG TABLET
NEFAZODONE HCL 50 MG TABLET
NEORAL 100 MG GELATIN CAPSULE
NEORAL 100 MG/ML SOLUTION
NEORAL 25 MG GELATIN CAPSULE
NEOVITE TABLET
NEPHPLEX RX TABLET
NEPHROCAPS SOFTGEL
NEPHRONEX LIQUID
NEPHRO-VITE TABLET
NEPHRO-VITE RX TABLET
NEPTAZANE 25 MG TABLET
NEPTAZANE 50 MG TABLET
NESINA 12.5 MG TABLET
NESINA 25 MG TABLET
NESINA 6.25 MG TABLET
NESTABS TABLET
NESTABS ABC PRENATAL COMBO PK
NESTABS DHA COMBO PACK
NESTABS ONE SOFTGEL
NEUPRO 1 MG/24 HR PATCH
NEUPRO 2 MG/24 HR PATCH
NEUPRO 3 MG/24 HR PATCH
NEUPRO 4 MG/24 HR PATCH
NEUPRO 6 MG/24 HR PATCH
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
NEUPRO 8 MG/24 HR PATCH
NEURONTIN 100 MG CAPSULE
NEURONTIN 250 MG/5 ML SOLN
NEURONTIN 250 MG/5 ML SOLUTION
NEURONTIN 300 MG CAPSULE
NEURONTIN 400 MG CAPSULE
NEURONTIN 600 MG TABLET
NEURONTIN 800 MG TABLET
NEUTEK 2TEK TEST STRIPS
NEVIRAPINE 200 MG TABLET
NEVIRAPINE 50 MG/5 ML SUSP
NEVIRAPINE ER 100 MG TABLET
NEVIRAPINE ER 400 MG TABLET
NEWGEN TABLET
RELION NEWTEK METER KIT
NEXA PLUS SOFTGEL
NEXAVAR 200 MG TABLET
NEXIUM DR 10 MG PACKET
NEXIUM DR 2.5 MG PACKET
NEXIUM DR 20 MG CAPSULE
NEXIUM DR 20 MG PACKET
NEXIUM DR 40 MG CAPSULE
NEXIUM DR 40 MG PACKET
NEXIUM DR 5 MG PACKET
NEXIUM 24HR 20 MG CAPSULE
NEXIUM 24HR 20 MG TABLET
NEXLETOL 180 MG TABLET
NIACIN 500 MG CAPSULE SA
NIACIN 500 MG TABLET
NIACIN ER 250 MG CAPSULE
NIACIN ER 500 MG CAPSULE
NIACIN SA 250 MG CAPSULE
NIACIN TR 250 MG CAPSULE
NIACIN TR 500 MG CAPSULE
GNP NIACIN 400 MG CAPSULE
NIACIN ER 1,000 MG TABLET
NIACIN ER 500 MG TABLET
NIACIN ER 750 MG TABLET
CVS NIACIN FLUSH FREE 500 MG
NIACIN FLUSH FREE 500 MG CAP
SV NIACIN FLUSH FREE 500 MG
NIACIN FLUSH-FREE 500 MG CAP
NIACIN INOSITOL 500 MG CAPSULE
NIACOR 500 MG TABLET
NIASPAN ER 1,000 MG TABLET
NIASPAN ER 500 MG TABLET
NIASPAN ER 750 MG TABLET
NICARDIPINE 20 MG CAPSULE
NICARDIPINE 30 MG CAPSULE
NICOMIDE TABLET
NICOMIDE TABLET
NIFEDIPINE 10 MG CAPSULE
NIFEDIPINE 20 MG CAPSULE
NIFEDIPINE ER 30 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
NIFEDIPINE ER 60 MG TABLET
NIFEDIPINE ER 90 MG TABLET
NIKKI 3 MG-0.02 MG TABLET
NILANDRON 150 MG TABLET
NILUTAMIDE 150 MG TABLET
NINLARO 2.3 MG CAPSULE
NINLARO 3 MG CAPSULE
NINLARO 4 MG CAPSULE
NISOLDIPINE ER 17 MG TABLET
NISOLDIPINE ER 20 MG TABLET
NISOLDIPINE ER 25.5 MG TABLET
NISOLDIPINE ER 30 MG TABLET
NISOLDIPINE ER 34 MG TABLET
NISOLDIPINE ER 40 MG TABLET
NISOLDIPINE ER 8.5 MG TABLET
NITISINONE 10 MG CAPSULE
NITISINONE 2 MG CAPSULE
NITISINONE 5 MG CAPSULE
NITRO-BID 2% OINTMENT
NITRO-DUR 0.1 MG/HR PATCH
NITRO-DUR 0.2 MG/HR PATCH
NITRO-DUR 0.3 MG/HR PATCH
NITRO-DUR 0.4 MG/HR PATCH
NITRO-DUR 0.6 MG/HR PATCH
NITRO-DUR 0.8 MG/HR PATCH
NITROGLYCERIN 0.3 MG TABLET SL
NITROGLYCERIN 0.4 MG TABLET SL
NITROGLYCERIN 0.6 MG TABLET SL
NITROGLYCERIN 400 MCG SPRAY
NITROGLYCERIN ER 2.5 MG CAP
NITROGLYCERIN ER 6.5 MG CAP
NITROGLYCERIN ER 9 MG CAPSULE
NITROGLYCERIN LINGUAL 0.4 MG
NITROGLYCERIN 0.1 MG/HR PATCH
NITROGLYCERIN 0.2 MG/HR PATCH
NITROGLYCERIN 0.4 MG/HR PATCH
NITROGLYCERIN 0.6 MG/HR PATCH
NITROLINGUAL 0.4 MG SPRAY
NITROMIST 400 MCG SPRAY
NITROSTAT 0.3 MG TABLET SL
NITROSTAT 0.4 MG TABLET SL
NITROSTAT 0.6 MG TABLET SL
NITRO-TIME ER 2.5 MG CAPSULE
NITRO-TIME ER 6.5 MG CAPSULE
NITRO-TIME ER 9 MG CAPSULE
NITYR 10 MG TABLET
NITYR 2 MG TABLET
NITYR 5 MG TABLET
NIVA-FOL TABLET
NIVA-PLUS TABLET
NIZATIDINE 15 MG/ML SOLUTION
NIZATIDINE 150 MG CAPSULE
NIZATIDINE 300 MG CAPSULE
NO FLUSH NIACIN 400 MG CAP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
NOCDURNA 27.7 MCG TABLET SL
NOCDURNA 55.3 MCG TABLET SL
NOCTIVA 0.83 MCG/0.1 ML SPRAY
NOCTIVA 1.66 MCG/0.1 ML SPRAY
NORA-BE TABLET
NORDITROPIN FLEXPRO 10 MG/1.5
NORDITROPIN FLEXPRO 15 MG/1.5
NORDITROPIN FLEXPRO 30 MG/3 ML
NORDITROPIN FLEXPRO 5 MG/1.5
NORETHINDRONE 0.35 MG TABLET
NORETHINDRONE 5 MG TABLET
NORETH-EE-FE 1.5-0.03MG(21)-75
NORETHIND-ETH ESTRAD 0.5-2.5
NORETHIND-ETH ESTRAD 1-0.02 MG
NORETHIN-EE 1.5-0.03 MG(21) TB
NORETHIN-ETH ESTRAD 1 MG-5 MCG
NORET-ESTR-FE 0.4-0.035(21)-75
NORETHIN-ESTRA-FE 0.8-0.025 MG
NORETH-ESTRAD-FE 1-0.02(21)-75
NORETH-ESTRAD-FE 1-0.02(24)-75
NORG-EE 0.18-0.215-0.25/0.025
NORG-EE 0.18-0.215-0.25/0.035
NORG-ETHIN ESTRA 0.25-0.035 MG
NORG-ETHIN ESTR 0.5-0.05 MG TB
NORINYL 1-35 28 TABLET
NORLYDA 0.35 MG TABLET
NORLYROC 0.35 MG TABLET
NORPACE 100 MG CAPSULE
NORPACE 150 MG CAPSULE
NORPACE CR 100 MG CAPSULE
NORPACE CR 150 MG CAPSULE
NORPRAMIN 10 MG TABLET
NORPRAMIN 25 MG TABLET
NORTHERA 100 MG CAPSULE
NORTHERA 200 MG CAPSULE
NORTHERA 300 MG CAPSULE
NORTREL 0.5-35-28 TABLET
NORTREL 1-35 21 TABLET
NORTREL 1-35 28 TABLET
NORTREL 7-7-7-28 TABLET
NORTRIPTYLINE 10 MG/5 ML SOLN
NORTRIPTYLINE 20 MG/10 ML SOLN
NORTRIPTYLINE HCL 10 MG CAP
NORTRIPTYLINE HCL 25 MG CAP
NORTRIPTYLINE HCL 50 MG CAP
NORTRIPTYLINE HCL 75 MG CAP
NORVASC 10 MG TABLET
NORVASC 2.5 MG TABLET
NORVASC 5 MG TABLET
NORVIR 100 MG POWDER PACKET
NORVIR 100 MG TABLET
NORVIR 80 MG/ML SOLUTION
NOURIANZ 20 MG TABLET
NOURIANZ 40 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
NOVA MAX BLOOD GLUCOSE METER
NOVA MAX GLUCOSE CONTROL SOLN
NOVA MAX GLUCOSE TEST STRIP
NOVA SAFETY 23G LANCETS
NOVA SAFETY 28G LANCETS
NOVA SUREFLEX THIN LANCETS
NOVAFERRUM PED MULTIVIT-IRON
NOVAMAX PLUS KETONE TEST STRIP
NOVAMAX PLUS GLU-KET CTRL SOLN
NOVAMV MULTIVITAMIN DROP
NOVOEIGHT 1,000 UNIT VIAL
NOVOEIGHT 1,500 UNIT VIAL
NOVOEIGHT 2,000 UNIT VIAL
NOVOEIGHT 250 UNIT VIAL
NOVOEIGHT 3,000 UNIT VIAL
NOVOEIGHT 500 UNIT VIAL
NOVOFINE 30G X 1/3" NEEDLES
NOVOFINE 32G NEEDLES
NOVOFINE AUTOCOVER 30G NEEDLE
NOVOFINE PLUS PEN NDL 32GX1/6"
NOVOLIN 70-30 100 UNIT/ML VIAL
RELION NOVOLIN 70-30 VIAL
NOVOLIN 70-30 FLEXPEN
RELION NOVOLIN 70-30 FLEXPEN
NOVOLIN N 100 UNIT/ML VIAL
RELION NOVOLIN N 100 UNIT/ML
NOVOLIN N 100 UNIT/ML FLEXPEN
RELION NOVOLIN N U-100 FLEXPEN
NOVOLIN R 100 UNIT/ML VIAL
RELION NOVOLIN R 100 UNIT/ML
NOVOLIN R 100 UNIT/ML FLEXPEN
RELION NOVOLIN R U-100 FLEXPEN
NOVOLOG 100 UNIT/ML CARTRIDGE
NOVOLOG 100 UNIT/ML VIAL
NOVOLOG 100 UNIT/ML FLEXPEN
NOVOLOG 100 UNITS/ML FLEXPEN
NOVOLOG MIX 70-30 VIAL
NOVOLOG MIX 70-30 FLEXPEN
NOVOPEN 3 INSULIN DEVICE
NOVOPEN ECHO INSULIN DEVICE
NOVOTWIST NEEDLE 32G 5MM
NP THYROID 120 MG TABLET
NP THYROID 15 MG TABLET
NP THYROID 30 MG TABLET
NP THYROID 60 MG TABLET
NP THYROID 90 MG TABLET
NPLATE 125 MCG VIAL
NPLATE 250 MCG VIAL
NPLATE 500 MCG VIAL
NUBEQA 300 MG TABLET
NUCALA 100 MG VIAL
NUCALA 100 MG/ML AUTO-INJECTOR
NUCALA 100 MG/ML SYRINGE
NULEV 0.125 MG CHEWABLE MELT
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
NULL
NULOJIX 250 MG VIAL
NUPLAZID 10 MG TABLET
NUPLAZID 17 MG TABLET
NUPLAZID 34 MG CAPSULE
NUTRICAP CAPLET
NUTRIVIT LIQUID
NUTROPIN AQ PEN CARTRIDGE
NUTROPIN AQ NUSPIN 10 INJECTOR
NUTROPIN AQ NUSPIN 20 INJECTOR
NUTROPIN AQ NUSPIN 5 INJECTOR
NUVARING VAGINAL RING
NUVIGIL 150 MG TABLET
NUVIGIL 200 MG TABLET
NUVIGIL 250 MG TABLET
NUVIGIL 50 MG TABLET
NUWIQ 1,000 UNIT VIAL
NUWIQ 1,000 UNIT VIAL PACK
NUWIQ 2,000 UNIT VIAL
NUWIQ 2,000 UNIT VIAL PACK
NUWIQ 2,500 UNIT VIAL
NUWIQ 2,500 UNIT VIAL PACK
NUWIQ 250 UNIT VIAL
NUWIQ 250 UNIT VIAL PACK
NUWIQ 3,000 UNIT VIAL
NUWIQ 3,000 UNIT VIAL PACK
NUWIQ 4,000 UNIT VIAL
NUWIQ 4,000 UNIT VIAL PACK
NUWIQ 500 UNIT VIAL
NUWIQ 500 UNIT VIAL PACK
OB COMPLETE CAPLET
OB COMPLETE GOLD SOFTGEL
OB COMPLETE ONE SOFTGEL
OB COMPLETE PETITE SOFTGEL
OB COMPLETE PREMIER TABLET
OB COMPLETE WITH DHA SOFTGEL
OBSTETRIX DHA COMBO PAK
OBSTETRIX EC CAPLET
OBSTETRIX ONE SOFTGEL
OBTREX DHA PRENATAL VITAMIN
O-CAL FA TABLET
O-CAL PRENATAL TABLET
OCALIVA 10 MG TABLET
OCALIVA 5 MG TABLET
OCELLA 3 MG-0.03 MG TABLET
OCREVUS 300 MG/10 ML VIAL
OCTAGAM 10% VIAL
OCTAGAM 5% VIAL
OCTREOTIDE 1,000 MCG/5 ML VIAL
OCTREOTIDE 1,000 MCG/ML VIAL
OCTREOTIDE 5,000 MCG/5 ML VIAL
OCTREOTIDE ACET 0.05 MG/ML VL
OCTREOTIDE ACET 100 MCG/ML AMP
OCTREOTIDE ACET 100 MCG/ML SYR
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
OCTREOTIDE ACET 100 MCG/ML VL
OCTREOTIDE ACET 200 MCG/ML VL
OCTREOTIDE ACET 50 MCG/ML AMP
OCTREOTIDE ACET 50 MCG/ML SYR
OCTREOTIDE ACET 50 MCG/ML VIAL
OCTREOTIDE ACET 500 MCG/ML AMP
OCTREOTIDE ACET 500 MCG/ML SYR
OCTREOTIDE ACET 500 MCG/ML VL
OCULAR VITAMINS TABLET
OCUTABS TABLET
OCUVEL CAPSULE
OCUVITE ADULT 50 PLUS SOFTGEL
OCUVITE ADULT 50 PLUS SOFTGEL
OCUVITE EYE PLUS MULTI TABLET
OCUVITE WITH LUTEIN TABLET
ODACTRA 12 SQ-HDM SL TABLET
ODEFSEY TABLET
ODOMZO 200 MG CAPSULE
OFEV 100 MG CAPSULE
OFEV 150 MG CAPSULE
OGESTREL TABLET
OGIVRI 150 MG VIAL
OGIVRI 420 MG VIAL
OLANZAPINE 10 MG TABLET
OLANZAPINE 15 MG TABLET
OLANZAPINE 2.5 MG TABLET
OLANZAPINE 20 MG TABLET
OLANZAPINE 5 MG TABLET
OLANZAPINE 7.5 MG TABLET
OLANZAPINE ODT 10 MG TABLET
OLANZAPINE ODT 15 MG TABLET
OLANZAPINE ODT 20 MG TABLET
OLANZAPINE ODT 5 MG TABLET
OLANZAPINE-FLUOXETINE 12-25 MG
OLANZAPINE-FLUOXETINE 12-50 MG
OLANZAPINE-FLUOXETINE 3-25 MG
OLANZAPINE-FLUOXETINE 6-25 MG
OLANZAPINE-FLUOXETINE 6-50 MG
OLIVE TREE 1:20 (W/V) VIAL
OLMESARTAN MEDOXOMIL 20 MG TAB
OLMESARTAN MEDOXOMIL 40 MG TAB
OLMESARTAN MEDOXOMIL 5 MG TAB
OLMSRTN-AMLDPN-HCTZ 20-5-12.5
OLMSRTN-AMLDPN-HCTZ 40-10-12.5
OLMSRTN-AMLDPN-HCTZ 40-10-25MG
OLMSRTN-AMLDPN-HCTZ 40-5-12.5
OLMSRTN-AMLDPN-HCTZ 40-5-25 MG
OLMESARTAN-HCTZ 20-12.5 MG TAB
OLMESARTAN-HCTZ 40-12.5 MG TAB
OLMESARTAN-HCTZ 40-25 MG TAB
OLUMIANT 1 MG TABLET
OLUMIANT 2 MG TABLET
OMEGA-3 ETHYL ESTERS 1 GM CAP
OMEPPI 20 MG-1,100 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
OMEPPI 40 MG-1,100 MG CAPSULE
CVS OMEPRAZOLE DR 20 MG TABLET
EQ OMEPRAZOLE DR 20 MG TABLET
EQL OMEPRAZOLE DR 20 MG TABLET
GNP OMEPRAZOLE DR 20 MG TABLET
GS OMEPRAZOLE DR 20 MG TABLET
HM OMEPRAZOLE DR 20 MG TABLET
OMEPRAZOLE DR 10 MG CAPSULE
OMEPRAZOLE DR 20 MG CAPSULE
OMEPRAZOLE DR 20 MG TABLET
OMEPRAZOLE DR 40 MG CAPSULE
PUB OMEPRAZOLE DR 20 MG TABLET
RA OMEPRAZOLE DR 20 MG TABLET
SB OMEPRAZOLE DR 20 MG TABLET
SM OMEPRAZOLE DR 20 MG TABLET
SW OMEPRAZOLE DR 20 MG TABLET
CVS OMEPRAZOLE MAG DR 20.6 MG
EQ OMEPRAZOLE MAG DR 20.6 MG
OMEPRAZOLE MAG DR 20 MG CAP
OMEPRAZOLE MAG DR 20.6 MG CAP
QC OMEPRAZOLE MAG DR 20.6 MG
CVS OMEPRAZOLE-BICARB 20-1,100
OMEPRAZOLE-BICARB 20-1,100 CAP
OMEPRAZOLE-BICARB 20-1,680 PKT
OMEPRAZOLE-BICARB 40-1,100 CAP
OMEPRAZOLE-BICARB 40-1,680 PKT
OMNARIS 50 MCG NASAL SPRAY
OMNICAP TABLET
OMNIPOD 10 PACK
OMNIPOD 5 PACK POD
OMNIPOD DASH 5 PACK POD
OMNITROPE 10 MG/1.5 ML CRTG
OMNITROPE 5 MG/1.5 ML CRTG
OMNITROPE 5.8 MG VIAL
OMNIVEX TABLET
ON CALL EXPRESS CTRL SOLN PAK
ON CALL EXPRESS METER
ON CALL EXPRESS METER SYSTEM
ON CALL EXPRESS TEST STRIP
ON CALL 30G LANCET
ON CALL PLUS CONTROL SOLUTION
ON CALL PLUS 30G LANCET
ON CALL PLUS METER
ON CALL PLUS TEST STRIP
ON CALL VIVID CONTROL SOLUTION
ON CALL VIVID METER
ON CALL VIVID PAL METER
ON CALL VIVID TEST STRIP
ONCE DAILY TABLET
ONCOVITE TABLET
ONE A DAY PRENATAL DHA PACK
GNP ONE DAILY TABLET
ONE DAILY TABLET
ONE DAILY WOMEN 50 PLUS TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ONE DAILY COMPLETE TABLET
ONE DAILY COMPLETE TABLET
RA ONE DAILY ENERGY TABLET
ONE DAILY ESSENTIAL TABLET
CVS ONE DAILY ESSENTIAL TABLET
ONE DAILY ESSENTIAL TABLET
RA ONE DAILY ESSENTIAL TABLET
ONE DAILY FOR MEN TABLET
ONE DAILY FOR MEN 50+ ADV TAB
ONE DAILY FOR WOMEN TABLET
ONE DAILY FOR WOMEN 50+ ADV TB
ONE DAILY GUMMY VITES GUMMIE
ONE DAILY HEALTHY WEIGHT TAB
ONE DAILY MAXIMUM TABLET
RA ONE DAILY MAXIMUM TABLET
EQ ONE DAILY MEN'S TABLET
EQ ONE DAILY MEN'S 50 PLUS TAB
EQL ONE DAILY MENS 50 PLUS ADV
ONE DAILY MEN'S 50 PLUS D3 TAB
RA ONE DAILY MEN'S 50 PLUS D3
ONE DAILY MEN'S 50+ TABLET
CVS ONE DAILY MEN'S HEALTH TAB
ONE DAILY MEN'S HEALTH TABLET
ONE DAILY MULTIVITAMIN TAB
ONE DAILY MULTIVITAMIN TABLET
SM ONE DAILY MULTIVITAMIN TAB
ONE DAILY MULTIVITAMIN-IRON TB
ONE DAILY MULTIVIT-MINERAL TAB
ONE DAILY PLUS IRON TABLET
ONE DAILY WITH MINERALS TABLET
HM ONE DAILY PRENATAL COMBO PK
RA ONE DAILY PRENATAL DHA PACK
SM ONE DAILY PRENATAL COMBO PK
ONE DAILY WITH IRON-CALCIUM TB
ONCE DAILY WITH IRON TABLET
ONE DAILY WOMEN'S TABLET
EQ ONE DAILY WOMEN'S TABLET
RA ONE DAILY WOMEN'S TABLET
ONE DAILY WOMENS 50 PLUS TAB
CVS ONE DAILY WOMEN'S 50 PLUS
EQL ONE DAILY WOMEN'S 50 PLUS
HM ONE DAILY WOMEN'S 50 PLUS
ONE DAILY WOMEN'S 50+ TABLET
CVS ONE DAILY WOMEN'S FORMULA
EQ ONE DAILY WOMEN'S HEALTH TB
ONE DAILY WOMEN'S HEALTH TAB
ONE DAILY WOMEN'S MULTIVITAMIN
ONE-A-DAY CHOLESTEROL PLUS TAB
ONE-A-DAY ENERGY TABLET
ONE-A-DAY ESSENTIAL TABLET
ONE-A-DAY KID'S GUMMIES
ONE-A-DAY MAX FORMULA TAB
ONE-A-DAY MEN VITACRAVES GUMMY
ONE-A-DAY MENOPAUSE FORMULA TB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ONE-A-DAY MEN'S TABLET
ONE-A-DAY MEN'S 50 PLUS TABLET
ONE-A-DAY MEN'S 50 PLUS TABLET
ONE-A-DAY PROACTIVE 65 PLUS TB
ONE-A-DAY TEEN ADVANTAGE TAB
ONE-A-DAY TEEN ADVANTAGE TAB
ONE-A-DAY TEEN HER VITACRAVES
ONE-A-DAY TEEN HIM VITACRAVES
ONE-A-DAY VITACRAVES GUMMIES
ONE-A-DAY VITACRAVES IMMUNITY
ONE-A-DAY VITACRAVES OMEGA-3
ONE-A-DAY VITACRAVES SOUR GMMY
ONE-A-DAY WEIGHTSMART TABLET
ONE-A-DAY WOMEN VITACRAVES
ONE-A-DAY WOMEN'S TABLET
ONE-A-DAY WOMEN'S TABLET
ONE-A-DAY WOMEN'S TABLET
ONE-A-DAY WOMEN'S 50 PLUS TAB
ONE-A-DAY WOMEN'S HEALTHY SKIN
ONE-A-DAY WOMEN'S PETITES TAB
ONE-A-DAY PRENATAL 1 DHA SFGL
ONE-DAILY MULTI-VIT POWDER PKT
ONE-DAILY MULTI-VITAMIN TAB
ONE-DAILY MULTI-VIT-IRON TAB
ONE-DAILY MULTIVIT-MINERAL PWD
ONE-TABLET-DAILY
ONETOUCH DELICA 30G LANCETS
ONETOUCH DELICA 33G LANCETS
ONETOUCH DELICA LANCING DEV
ONETOUCH DELICA PLUS LANC DEV
ONETOUCH DELICA PLUS 30G LANCT
ONETOUCH DELICA PLUS 33G LANCT
ONETOUCH ULTRASOFT LANCETS
ONETOUCH SURESOFT 18G LANC DEV
ONETOUCH SURESOFT 21G LANC DEV
ONETOUCH SURESOFT 28G LANC DEV
ONETOUCH ULTRA BLUE TEST STRP
ONETOUCH ULTRA CONTROL SOLN
ONETOUCH ULTRA2 GLUCOSE SYST
ONETOUCH ULTRAMINI METER
ONETOUCH VERIO TEST STRIP
ONETOUCH VERIO HIGH CNTRL SOL
ONETOUCH VERIO MID CNTRL SOLN
ONETOUCH VERIO METER SYSTEM
ONETOUCH VERIO FLEX SYSTEM KIT
ONETOUCH VERIO IQ METER
ONETOUCH VERIO SYNC SYST KIT
ONEVITE TABLET
ONFI 10 MG TABLET
ONFI 2.5 MG/ML SUSPENSION
ONFI 20 MG TABLET
ONGLYZA 2.5 MG TABLET
ONGLYZA 5 MG TABLET
ONPATTRO 10 MG/5 ML VIAL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ON-THE-GO 30G LANCETS
SHOPKO ON-THE-GO 30G LANCETS
OPDIVO 100 MG/10 ML VIAL
OPDIVO 240 MG/24 ML VIAL
OPDIVO 40 MG/4 ML VIAL
OPSUMIT 10 MG TABLET
OPTISOURCE TABLET CHEWABLE
OPTIUM TEST STRIP
OPTIUM EZ TEST STRIP
SM OPTI-VITAMIN TABLET
OPTIVITE P.M.T. TABLET
OPTUMRX GLUCOSE CONTROL SOLN
OPTUMRX TEST STRIP
OPTUMRX BLOOD GLUCOSE METER
OPTUMRX BLOOD GLUCOSE SYSTEM
OPURITY MULTIVITAMIN TAB CHEW
ORALAIR 300 IR SUBLINGUAL TAB
ORAP 1 MG TABLET
ORAP 2 MG TABLET
ORENCIA 125 MG/ML SYRINGE
ORENCIA 50 MG/0.4 ML SYRINGE
ORENCIA 87.5 MG/0.7 ML SYRINGE
ORENCIA 250 MG VIAL
ORENCIA CLICKJECT 125 MG/ML
ORENITRAM ER 0.125 MG TABLET
ORENITRAM ER 0.25 MG TABLET
ORENITRAM ER 1 MG TABLET
ORENITRAM ER 2.5 MG TABLET
ORENITRAM ER 5 MG TABLET
ORFADIN 10 MG CAPSULE
ORFADIN 2 MG CAPSULE
ORFADIN 20 MG CAPSULE
ORFADIN 4 MG/ML SUSPENSION
ORFADIN 5 MG CAPSULE
ORILISSA 150 MG TABLET
ORKAMBI 100 MG-125 MG TABLET
ORKAMBI 100-125 MG GRANULE PKT
ORKAMBI 150-188 MG GRANULE PKT
ORKAMBI 200 MG-125 MG TABLET
ORSYTHIA-28 TABLET
ORTHO MICRONOR 0.35 MG TABLET
ORTHO TRI-CYCLEN 28 TABLET
ORTHO TRI-CYCLEN LO TABLET
ORTHO-CYCLEN 28 TABLET
ORTHO-NOVUM 1-35-28 TABLET
ORTHO-NOVUM 7-7-7-28 TABLET
OSCIMIN 0.125 MG ODT
OSCIMIN 0.125 MG TABLET
OSCIMIN SL 0.125 MG TABLET
OSCIMIN SR 0.375 MG TABLET
OSENI 12.5-15 MG TABLET
OSENI 12.5-30 MG TABLET
OSENI 12.5-45 MG TABLET
OSENI 25-15 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
OSENI 25-30 MG TABLET
OSENI 25-45 MG TABLET
OSMOLEX ER 129 MG TABLET
OSMOLEX ER 193 MG TABLET
OSMOLEX ER 258 MG TABLET
OSPHENA 60 MG TABLET
OTEZLA 30 MG TABLET
OTREXUP 10 MG/0.4 ML AUTO-INJ
OTREXUP 12.5 MG/0.4 ML AUTOINJ
OTREXUP 15 MG/0.4 ML AUTO-INJ
OTREXUP 17.5 MG/0.4 ML AUTOINJ
OTREXUP 20 MG/0.4 ML AUTO-INJ
OTREXUP 22.5 MG/0.4 ML AUTOINJ
OTREXUP 25 MG/0.4 ML AUTO-INJ
OTREXUP 7.5 MG/0.4 ML AUTO-INJ
OVCON-35 28 TABLET
OXANDRIN 10 MG TABLET
OXANDRIN 2.5 MG TABLET
OXANDROLONE 10 MG TABLET
OXANDROLONE 2.5 MG TABLET
OXAPROZIN 600 MG CAPLET
OXAPROZIN 600 MG TABLET
OXBRYTA 500 MG TABLET
OXCARBAZEPINE 150 MG TABLET
OXCARBAZEPINE 300 MG TABLET
OXCARBAZEPINE 300 MG/5 ML SUSP
OXCARBAZEPINE 600 MG TABLET
OXSORALEN-ULTRA 10 MG CAP
OXTELLAR XR 150 MG TABLET
OXTELLAR XR 300 MG TABLET
OXTELLAR XR 600 MG TABLET
OXYBUTYNIN 5 MG TABLET
OXYBUTYNIN 5 MG/5 ML SYRUP
OXYBUTYNIN CL ER 10 MG TABLET
OXYBUTYNIN CL ER 15 MG TABLET
OXYBUTYNIN CL ER 5 MG TABLET
OXYTROL 3.9 MG/24HR PATCH
OXYTROL FOR WOMEN 3.9 MG/24HR
OZEMPIC 0.25-0.5 MG DOSE PEN
OZEMPIC 1 MG DOSE PEN
OZOBAX 5 MG/5 ML SOLUTION
PACERONE 100 MG TABLET
PACERONE 200 MG TABLET
PACERONE 400 MG TABLET
PADCEV 20 MG VIAL
PADCEV 30 MG VIAL
PALFORZIA 12 MG (LEVEL 3)
PALFORZIA 120 MG (LEVEL 7)
PALFORZIA 160 MG (LEVEL 8)
PALFORZIA 20 MG (LEVEL 4)
PALFORZIA 200 MG (LEVEL 9)
PALFORZIA 240 MG (LEVEL 10)
PALFORZIA 3 MG (LEVEL 1)
PALFORZIA 300 MG (LEVEL 11)
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PALFORZIA 300 MG (MAINTENANCE)
PALFORZIA 40 MG (LEVEL 5)
PALFORZIA 6 MG (LEVEL 2)
PALFORZIA 80 MG (LEVEL 6)
PALIPERIDONE ER 1.5 MG TABLET
PALIPERIDONE ER 3 MG TABLET
PALIPERIDONE ER 6 MG TABLET
PALIPERIDONE ER 9 MG TABLET
PALYNZIQ 10 MG/0.5 ML SYRINGE
PALYNZIQ 20 MG/ML SYRINGE
PAMELOR 10 MG CAPSULE
PAMELOR 25 MG CAPSULE
PAMELOR 50 MG CAPSULE
PAMELOR 75 MG CAPSULE
PANCREAZE DR 10,500 UNIT CAP
PANCREAZE DR 16,800 UNIT CAP
PANCREAZE DR 2,600 UNIT CAP
PANCREAZE DR 21,000 UNIT CAP
PANCREAZE DR 4,200 UNIT CAP
PANTOPRAZOLE SOD DR 20 MG TAB
PANTOPRAZOLE SOD DR 40 MG TAB
PANZYGA 10% (1 G/10 ML) VIAL
PANZYGA 10% (10 G/100 ML) VIAL
PANZYGA 10% (2.5 G/25 ML) VIAL
PANZYGA 10% (20 G/200 ML) VIAL
PANZYGA 10% (30 G/300 ML) VIAL
PANZYGA 10% (5 G/50 ML) VIAL
PARADIGM RESERVOIR 1.8 ML
PARADIGM RESERVOIR 3 ML
PARADIGM REAL-TIME SYSTEM
PARAGARD T 380-A IUD
PARICALCITOL 1 MCG CAPSULE
PARICALCITOL 10 MCG/2 ML VIAL
PARICALCITOL 2 MCG CAPSULE
PARICALCITOL 2 MCG/ML VIAL
PARICALCITOL 4 MCG CAPSULE
PARICALCITOL 5 MCG/ML VIAL
PARLODEL 2.5 MG TABLET
PARLODEL 5 MG CAPSULE
PARNATE 10 MG TABLET
PAROXETINE CR 12.5 MG TABLET
PAROXETINE CR 25 MG TABLET
PAROXETINE CR 37.5 MG TABLET
PAROXETINE ER 12.5 MG TABLET
PAROXETINE ER 25 MG TABLET
PAROXETINE ER 37.5 MG TABLET
PAROXETINE HCL 10 MG TABLET
PAROXETINE HCL 20 MG TABLET
PAROXETINE HCL 30 MG TABLET
PAROXETINE HCL 40 MG TABLET
PAROXETINE MESYLATE 7.5 MG CAP
PARSABIV 10 MG/2 ML VIAL
PARSABIV 2.5 MG/0.5 ML VIAL
PARSABIV 5 MG/ML VIAL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PAXIL 10 MG TABLET
PAXIL 10 MG/5 ML SUSPENSION
PAXIL 20 MG TABLET
PAXIL 30 MG TABLET
PAXIL 40 MG TABLET
PAXIL CR 12.5 MG TABLET
PAXIL CR 25 MG TABLET
PAXIL CR 37.5 MG TABLET
PECAN POLLEN 1:20 (W/V) VIAL
PEDIA POLY-VITE DROPS
PEDIA POLY-VITE WITH IRON DROP
PEDIA TRI-VITE DROP
PEGANONE 250 MG TABLET
EQL PEN 8MM 31G X 5/16" NEEDLE
FIFTY50 PEN 31G X 3/16" NEEDLE
FIFTY50 PEN 31G X 5/16" NEEDLE
FIFTY50 PEN NEEDLE 32G X 1/4"
FIFTY50 PEN NEEDLE 32G X 5/32"
GNP CLICKFINE PEN NDL 31GX1/4"
GNP CLICKFINE PEN NDL 31GX5/16
GS PEN NEEDLE 31G X 5/16"
GS PEN NEEDLE 31G X 5MM
GS PEN NEEDLE 31G X 6MM
GS PEN NEEDLE 31G X 8MM
GS PEN NEEDLE 32G X 4MM
GS PEN NEEDLE 32G X 6MM
KRO PEN NEEDLE 4MM X 32G
KRO PEN NEEDLE 4MM X 33G
KRO PEN NEEDLE 5MM X 31G
KRO PEN NEEDLE 6MM X 31G
KRO PEN NEEDLE 8MM X 31G
KROGER PEN NEEDLES 31G X 5/16"
LIVE BETTER PEN NEEDLES 8MM
MS PEN NEEDLE 6MM 31G
PEN NEEDLE 29G 12MM
PEN NEEDLE 30G X 5/16"
PEN NEEDLE 31G 5MM
PEN NEEDLE 31G 6MM
PEN NEEDLE 31G 8MM
PEN NEEDLE 31G X 1/4"
PEN NEEDLE 31G X 3/16"
PEN NEEDLE 31G X 5/16"
PEN NEEDLE 31G X 8MM
PEN NEEDLE 32G 4MM
PEN NEEDLE 32G X 1/4"
PEN NEEDLE 32G X 3/16"
PEN NEEDLE 32G X 5/32"
PEN NEEDLE 6MM 31G
PEN NEEDLES 12MM 29G
PEN NEEDLES 8MM 31G
PUB PEN 12MM 29G NEEDLES
PUB PEN 8MM 31G NEEDLES
PUB PEN NEEDLE 6MM 31G
RA PEN NEEDLE 31GX3/16"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
RA PEN NEEDLE 31GX5/16"
RELION MINI PEN 31G X 1/4" NDL
RELION PEN 29G NEEDLE
RELION PEN 31G NEEDLE
RELION PEN NEEDLE 29GX1/2"
RELION PEN NEEDLE 31GX1/4"
RELION PEN NEEDLE 31GX5/16"
RELION PEN NEEDLE 32GX5/32"
TODAY'S HLTH PN NEEDLE 6MM 31G
LEADER PEN NEEDLES 12MM 29G
PEN NEEDLES 12MM 29G
PEN NEEDLES 4MM 32G
PEN NEEDLES 5MM 31G
PEN NEEDLES 6MM 31G
PEN NEEDLES 8MM 31G
PENICILLAMINE 250 MG CAPSULE
PENICILLAMINE 250 MG TABLET
PENICILLIUM NOTATUM 10,000/ML
PENICILLIUM NOTATUM 20,000/ML
PENTAMIDINE 300 MG INHAL POWDR
PENTASA 250 MG CAPSULE
PENTASA 500 MG CAPSULE
PENTIPS PEN NEEDLE 29GX1/2"
PENTIPS PEN NEEDLE 31GX1/4"
PENTIPS PEN NEEDLE 31GX3/16"
PENTIPS PEN NEEDLE 31GX5/16"
PENTIPS PEN NEEDLE 32GX5/32"
PENTIPS PEN NEEDLE 6MM 31G
PENTOXIFYLLINE ER 400 MG TAB
PEPCID 20 MG TABLET
PEPCID 40 MG TABLET
PEPCID 40 MG/5 ML ORAL SUSP
PEPCID AC 10 MG TABLET
PEPCID AC 20 MG TABLET
PERFOROMIST 20 MCG/2 ML SOLN
PERINDOPRIL ERBUMINE 2 MG TAB
PERINDOPRIL ERBUMINE 4 MG TAB
PERINDOPRIL ERBUMINE 8 MG TAB
PERIOMED 0.63% DENTAL RINSE
PERPHENAZINE 16 MG TABLET
PERPHENAZINE 2 MG TABLET
PERPHENAZINE 4 MG TABLET
PERPHENAZINE 8 MG TABLET
PERPHEN-AMITRIP 2 MG-10 MG TAB
PERPHEN-AMITRIP 2 MG-25 MG TAB
PERPHEN-AMITRIP 4 MG-10 MG TAB
PERPHEN-AMITRIP 4 MG-25 MG TAB
PERPHEN-AMITRIP 4 MG-50 MG TAB
PERRY PRENATAL CAPSULE
PERSERIS ER 120 MG SYRINGE KIT
PERSERIS ER 90 MG SYRINGE KIT
PERTZYE DR 16,000 UNIT CAPSULE
PERTZYE DR 24,000 UNIT CAPSULE
PERTZYE DR 4,000 UNIT CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PERTZYE DR 8,000 UNIT CAPSULE
PEXEVA 10 MG TABLET
PEXEVA 20 MG TABLET
PEXEVA 30 MG TABLET
PEXEVA 40 MG TABLET
PH 12 DILUENT FOR FLOLAN
PHARMACIST CHOICE TEST STRIPS
PHARMACIST CHOICE GLUCOSE SYS
PHARMACIST CHOICE MINI GLU SYS
PHENELZINE SULFATE 15 MG TAB
PHENOBARBITAL 100 MG TABLET
PHENOBARBITAL 15 MG TABLET
PHENOBARBITAL 16.2 MG TABLET
PHENOBARBITAL 20 MG/5 ML ELIX
PHENOBARBITAL 20 MG/5 ML SOLN
PHENOBARBITAL 30 MG TABLET
PHENOBARBITAL 32.4 MG TABLET
PHENOBARBITAL 60 MG TABLET
PHENOBARBITAL 64.8 MG TABLET
PHENOBARBITAL 97.2 MG TABLET
PHENOBARBITAL-BELLADONNA ELIXR
PHENOHYTRO ELIXIR
PHENOHYTRO TABLET
PHENYTEK 200 MG CAPSULE
PHENYTEK 300 MG CAPSULE
PHENYTOIN 100 MG/4 ML SUSP
PHENYTOIN 125 MG/5 ML SUSP
PHENYTOIN 50 MG INFATAB
PHENYTOIN 50 MG TABLET CHEW
PHENYTOIN 50 MG/ML AMPUL
PHENYTOIN SOD EXT 100 MG CAP
PHENYTOIN SOD EXT 200 MG CAP
PHENYTOIN SOD EXT 300 MG CAP
PHILITH 0.4-0.035 MG TABLET
PHOMA 20,000 PNU/ML VIAL
PHOS-FLUR ORAL RINSE
PHOSLYRA 667 MG/5 ML SOLUTION
PHOSPHOLINE IODIDE 0.125%
PIFELTRO 100 MG TABLET
PILOCARPINE 1% EYE DROPS
PILOCARPINE 2% EYE DROPS
PILOCARPINE 4% EYE DROPS
PILOCARPINE HCL 5 MG TABLET
PILOCARPINE HCL 7.5 MG TABLET
PIMOZIDE 1 MG TABLET
PIMOZIDE 2 MG TABLET
PIMTREA 28 DAY TABLET
PINDOLOL 10 MG TABLET
PINDOLOL 5 MG TABLET
PIOGLITAZONE HCL 15 MG TABLET
PIOGLITAZONE HCL 30 MG TABLET
PIOGLITAZONE HCL 45 MG TABLET
PIOGLITAZONE-GLIMEPIRIDE 30-2
PIOGLITAZONE-GLIMEPIRIDE 30-4
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PIOGLITAZONE-METFORMIN 15-500
PIOGLITAZONE-METFORMIN 15-850
PIP 28G LANCET
PIP 30G LANCET
PIQRAY 200 MG DAILY DOSE
PIQRAY 250 MG DAILY DOSE
PIQRAY 300 MG DAILY DOSE
PIRMELLA 1-35 28 TABLET
PIRMELLA 1-35-28 TABLET
PIRMELLA 7-7-7-28 TABLET
PIROXICAM 10 MG CAPSULE
PIROXICAM 20 MG CAPSULE
PLAQUENIL 200 MG TABLET
PLAVIX 75 MG TABLET
PLEGRIDY 125 MCG/0.5 ML SYRING
PLEGRIDY 125 MCG/0.5 ML PEN
PNV 29-1 TABLET
PNV OB+DHA COMBO PACK
PNV-DHA SOFTGEL
PNV-DHA + DOCUSATE SOFTGEL
PNV-OMEGA SOFTGEL
PNV-SELECT TABLET
PNV-VP-U CAPSULE
POLY VITAMIN-IRON CHEWABLE TAB
POLY-VI-FLOR 0.25 MG TAB CHEW
POLY-VI-FLOR 0.5 MG TAB CHEW
POLY-VI-FLOR 1 MG TAB CHEW
POLY-VI-FLOR 0.25 MG DROPS
POLY-VI-FLOR WITH IRON 0.5 MG
POLY-VI-FLOR WITH IRON 0.25 MG
POLY-VI-SOL DROPS
POLY-VI-SOL WITH IRON DROPS
POLY-VITA DROPS
POLY-VITA WITH IRON DROPS
POLY-VITAMIN TAB CHEW
POLY-VITAMIN DROPS
POLYVITAMIN WITH IRON TAB CHEW
POLYVITAMIN W-IRON DROPS
POMALYST 1 MG CAPSULE
POMALYST 2 MG CAPSULE
POMALYST 3 MG CAPSULE
POMALYST 4 MG CAPSULE
PORTIA-28 TABLET
POTABA 500 MG CAPSULE
POTASSIUM 99 MG CAPLET
GNP POTASSIUM 99 MG TABLET
HM POTASSIUM 99 MG TABLET
POTASSIUM 99 MG TABLET
SM POTASSIUM 99 MG CAPLET
SM POTASSIUM 99 MG TABLET
POTASSIUM 25 MEQ TABLET EFF
POTASSIUM CL 25 MEQ TAB EFF
POTASSIUM CL 10% (20 MEQ/15ML)
POTASSIUM CL 10% (40 MEQ/30ML)
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
POTASSIUM CL 20 MEQ PACKET
POTASSIUM CL 20% (40 MEQ/15ML)
POTASSIUM CL ER 10 MEQ CAPSULE
POTASSIUM CL ER 10 MEQ TABLET
POTASSIUM CL ER 20 MEQ TABLET
POTASSIUM CL ER 8 MEQ CAPSULE
POTASSIUM CL ER 8 MEQ TABLET
POTASSIUM CITRATE ER 10 MEQ TB
POTASSIUM CITRATE ER 15 MEQ TB
POTASSIUM CITRATE ER 5 MEQ TAB
CVS POTASSIUM GLUC 595 MG CPLT
POTASSIUM 99 MG TABLET
POTASSIUM GLU 99(595) MG CAPLT
POTASSIUM GLUC 500 MG TABLET
POTASSIUM GLUC 550 MG TABLET
POTASSIUM GLUC 595 MG CAPLET
POTASSIUM GLUC 595 MG TABLET
POTASSIUM GLUC ER 595 MG TAB
POTASSIUM GLUCONATE 595 CAPLET
POTASSIUM GLUCONATE 595 MG TAB
RA POTASSIUM GLUC 2.5 MEQ TB
RA POTASSIUM GLUC 595 MG TAB
SV POTASSIUM GLUC 595 MG CPLT
POTELIGEO 20 MG/5 ML VIAL
POTIGA 200 MG TABLET
POTIGA 300 MG TABLET
POTIGA 400 MG TABLET
POTIGA 50 MG TABLET
PR NATAL 400 COMBO PACK
PR NATAL 400 EC COMBO PACK
PR NATAL 430 COMBO PACK
PR NATAL 430 EC COMBO PACK
PRADAXA 110 MG CAPSULE
PRADAXA 150 MG CAPSULE
PRADAXA 75 MG CAPSULE
PRALUENT 150 MG/ML PEN
PRALUENT 75 MG/ML PEN
PRALUENT 75 MG/ML SYRINGE
PRAMIPEXOLE 0.125 MG TABLET
PRAMIPEXOLE 0.25 MG TABLET
PRAMIPEXOLE 0.5 MG TABLET
PRAMIPEXOLE 0.75 MG TABLET
PRAMIPEXOLE 1 MG TABLET
PRAMIPEXOLE 1.5 MG TABLET
PRAMIPEXOLE ER 0.375 MG TABLET
PRAMIPEXOLE ER 0.75 MG TABLET
PRAMIPEXOLE ER 1.5 MG TABLET
PRAMIPEXOLE ER 2.25 MG TABLET
PRAMIPEXOLE ER 3 MG TABLET
PRAMIPEXOLE ER 3.75 MG TABLET
PRAMIPEXOLE ER 4.5 MG TABLET
PRANDIN 0.5 MG TABLET
PRANDIN 1 MG TABLET
PRANDIN 2 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PRASUGREL 10 MG TABLET
PRASUGREL 5 MG TABLET
PRAVACHOL 20 MG TABLET
PRAVACHOL 40 MG TABLET
PRAVACHOL 80 MG TABLET
PRAVASTATIN SODIUM 10 MG TAB
PRAVASTATIN SODIUM 20 MG TAB
PRAVASTATIN SODIUM 40 MG TAB
PRAVASTATIN SODIUM 80 MG TAB
PRAZOSIN 1 MG CAPSULE
PRAZOSIN 2 MG CAPSULE
PRAZOSIN 5 MG CAPSULE
PRECISION PCX TEST STRIPS
PRECISION PCX PLUS TEST STR
PRECISION POINT OF CARE STR
PRECISION Q-I-D TEST STRIPS
PRECISION XTR B-KETONE STRIP
PRECISION XTRA TEST STRIPS
PRECISION XTRA MONITOR
PRECISION XTRA MONITOR NFRS
PRECISION XTRA KETONE-GLUC KIT
PRECOSE 100 MG TABLET
PRECOSE 25 MG TABLET
PRECOSE 50 MG TABLET
PREFERA OB TABLET
PREFERA-OB ONE SOFTGEL
PREFERA-OB PLUS DHA COMBO PACK
PREFEST TABLET
PREGABALIN 100 MG CAPSULE
PREGABALIN 150 MG CAPSULE
PREGABALIN 20 MG/ML SOLUTION
PREGABALIN 200 MG CAPSULE
PREGABALIN 225 MG CAPSULE
PREGABALIN 25 MG CAPSULE
PREGABALIN 300 MG CAPSULE
PREGABALIN 50 MG CAPSULE
PREGABALIN 75 MG CAPSULE
PREGENNA TABLET
PREMARIN 0.3 MG TABLET
PREMARIN 0.45 MG TABLET
PREMARIN 0.625 MG TABLET
PREMARIN 0.9 MG TABLET
PREMARIN 1.25 MG TABLET
PREMARIN VAGINAL CREAM-APPL
RELION PREMIER BLU GLUCOSE MTR
RELION PREMIER COMPACT METER
RELION PREMIER TEST STRIP
RELION PREMIER VOICE GLUCO MTR
KRO PREMIUM BLOOD GLUCOSE SYST
PREMIUM BLOOD GLUCOSE SYSTEM
KRO PREMIUM BLOOD GLUCOSE TEST
PREMIUM BLOOD GLUCOSE TEST STR
PREMIUM BLOOD GLUCOSE TST STRP
PREMIUM V10 GLUCOSE TEST STRIP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PREMIUM V10 BLOOD GLUCOSE MTR
PREMPHASE 0.625-5 MG TABLET
PREMPRO 0.3 MG-1.5 MG TABLET
PREMPRO 0.45-1.5 MG TABLET
PREMPRO 0.625-2.5 MG TABLET
PREMPRO 0.625-5 MG TABLET
PRENA1 CHEW TABLET
PRENA1 PEARL SOFTGEL
PRENA1 TRUE COMBO PACK
PRENAISSANCE CAPSULE
PRENAISSANCE PLUS SOFTGEL
PRENATA CHEWABLE TABLET
PRENATABS FA TABLET
PRENATABS RX TABLET
PRENATAL GUMMIES
HM PRENATAL TABLET
PRENATAL CAPLET
PRENATAL TABLET
QC PRENATAL TABLET
SM PRENATAL TABLET
SV PRENATAL TABLET
CVS PRENATAL GUMMIES
PRENATAL TABLET
PRENATAL TABLET
CVS PRENATAL GUMMY VITAMINS
PRENATAL TABLET
PRENATAL + DHA COMBO PACK
PRENATAL 19 CHEWABLE TABLET
PRENATAL 19 TABLET
PRENATAL 19 TABLET
PRENATAL 19 CHEWABLE TABLET
PRENATAL COMPLETE CAPLET
PRENATAL FORMULA TABLET
PRENATAL FORMULA TABLET
PRENATAL FORMULA-DHA SOFTGEL
CVS PRENATAL GUMMIES
PRENATAL LOW IRON TABLET
PRENATAL MULTI TABLET
PRENATAL MULTI-DHA SOFTGEL
CVS PRENATAL MULTI-DHA SOFTGEL
PRENATAL MULTI-DHA SOFTGEL
PRENATAL MULTIVITAMIN TABLET
PRENATAL MULTIVITAMIN TABLET
PRENATAL MULTIVITAMIN-DHA SFGL
PRENATAL ONE DAILY TABLET
PRENATAL PLUS IRON TABLET
PNV PRENATAL PLUS MULTIVIT TAB
PRENATAL PLUS TABLET
PRENATAL PLUS-DHA COMBO PACK
PRENATAL PLUS-DHA COMBO PACK
PRENATAL PLUS-DHA COMBO PACK
PRENATAL VITAMIN TABLET
PRENATAL VITAMIN TABLET
PRENATAL VITAMIN TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PRENATAL + DHA COMBO PACK
PRENATAL VITAMIN PLUS LOW IRON
GS PRENATAL VITAMINS TABLET
SV PRENATAL VITAMINS TABLET
GNP PRENATAL VITAMINS TABLET
PRENATAL TABLET
PRENATAL VITAMINS TABLET
SM PRENATAL VITAMINS TABLET
CVS PRENATAL VITAMINS TABLET
CVS PRENATAL VITAMIN TABLET
PRENATAL TABLET
PRENATAL TABLET
RA PRENATAL TABLET
PRENATAL-U CAPSULE
PRENATE AM TABLET
PRENATE CHEWABLE TABLET
PRENATE DHA SOFTGEL
PRENATE DHA SOFTGEL
PRENATE ELITE TABLET
PRENATE ELITE TABLET
PRENATE ENHANCE SOFTGEL
PRENATE ESSENTIAL SOFTGEL
PRENATE ESSENTIAL SOFTGEL
PRENATE MINI SOFTGEL
PRENATE PIXIE SOFTGEL
PRENATE RESTORE SOFTGEL
PRENATE STAR TABLET
PREPLUS CA-FE 27 MG-FA 1 MG TB
PREQUE 10 TABLET
PRESERVISION AREDS SOFTGEL
PRESERVISION AREDS TABLET
PRESERVISION LUTEIN SOFTGEL
PRESSURE ACTIVATED 21G LANCETS
PRESSURE ACTIVATED 28G LANCETS
PRESTALIA 14 MG-10 MG TABLET
PRESTALIA 3.5 MG-2.5 MG TABLET
PRESTALIA 7 MG-5 MG TABLET
PRESTO PRO BLOOD GLUCOSE METER
PRETAB 29 MG-1 MG TABLET
PREVACID 15 MG SOLUTAB
PREVACID 30 MG SOLUTAB
PREVACID DR 15 MG CAPSULE
PREVACID DR 30 MG CAPSULE
PREVACID 24HR DR 15 MG CAPSULE
PREVALITE PACKET
PREVALITE POWDER
PREVIDENT 0.2% RINSE
PREVIDENT 1.1% GEL
PREVIDENT 5000 BOOSTER PLUS
PREVIDENT DENTAL RINSE
PREVIDENT 5000 1.1% DRY MOUTH
PREVIDENT 5000 ENAMEL PROTECT
PREVIDENT 5000 PLUS CREAM
PREVIDENT 5000 SENSITIVE PASTE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PREVIFEM TABLET
PREZCOBIX 800 MG-150 MG TABLET
PREZISTA 100 MG/ML SUSPENSION
PREZISTA 150 MG TABLET
PREZISTA 600 MG TABLET
PREZISTA 75 MG TABLET
PREZISTA 800 MG TABLET
PRILOSEC DR 10 MG SUSPENSION
PRILOSEC DR 2.5 MG SUSPENSION
PRILOSEC OTC 20 MG TABLET
PRILOSEC OTC 20.6 MG TABLET
PRIMACARE SOFTGEL
PRIMIDONE 250 MG TABLET
PRIMIDONE 50 MG TABLET
PRINIVIL 10 MG TABLET
PRINIVIL 20 MG TABLET
PRINIVIL 5 MG TABLET
PRISTIQ ER 100 MG TABLET
PRISTIQ ER 25 MG TABLET
PRISTIQ ER 50 MG TABLET
PRIVET 1:20 (W/V) VIAL
PRIVIGEN 10% VIAL
PRO COMFORT 1 ML 30GX1/2"
PRO COMFORT 1 ML 30GX5/16"
PRO COMFORT 1 ML 31GX5/16"
PRO COMFORT 0.5 ML 30GX1/2"
PRO COMFORT 0.5 ML 30GX5/16"
PRO COMFORT 0.5 ML 31GX5/16"
PRO COMFORT 31G LANCET
PRO COMFORT 30G LANCETS
PRO COMFORT PEN NDL 31GX5/16"
PRO COMFORT PEN NDL 32G X 1/4"
PRO COMFORT PEN NDL 4MM 32G
PRO COMFORT PEN NDL 5MM 32G
PRO VOICE V8 GLUCOSE MONITOR
PRO VOICE V8-V9 TEST STRIP
PRO VOICE V9 GLUCOSE MONITOR
PROAIR DIGIHALER 90 MCG INHALR
PROAIR HFA 90 MCG INHALER
PROAIR RESPICLICK 90 MCG INHLR
PROBENECID 500 MG TABLET
PROBENECID-COLCHICINE TABLET
PROCARDIA 10 MG CAPSULE
PROCARDIA XL 30 MG TABLET
PROCARDIA XL 60 MG TABLET
PROCARDIA XL 90 MG TABLET
PROCENTRA 5 MG/5 ML SOLUTION
PROCERV HP TABLET
PROCRIT 10,000 UNITS/ML VIAL
PROCRIT 2,000 UNITS/ML VIAL
PROCRIT 20,000 UNITS/ML VIAL
PROCRIT 3,000 UNITS/ML VIAL
PROCRIT 4,000 UNITS/ML VIAL
PROCRIT 40,000 UNITS/ML VIAL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PROCYSBI DR 25 MG CAPSULE
PROCYSBI DR 300 MG GRANULE PKT
PROCYSBI DR 75 MG CAPSULE
PROCYSBI DR 75 MG GRANULE PKT
PRODIGY AUTOCODE METER KIT
PRODIGY AUTOCODE MONITOR SYST
PRODIGY CONTROL SOLUTION LOW
PRODIGY INS SYR 1ML 28GX1/2"
PRODIGY SYRNG 0.5 ML 31GX5/16"
PRODIGY SYRNGE 0.3ML 31GX5/16"
PRODIGY PRESSURE ACTIVATED 28G
PRODIGY SAFETY 26G LANCETS
PRODIGY NO CODING TEST STRIPS
PRODIGY POCKET METER KIT
PRODIGY TWIST TOP 28G LANCET
PRODIGY VOICE METER KIT
PROFENO 600 MG TABLET
PROFILNINE 1,000 UNIT VIAL
PROFILNINE 1,500 UNIT VIAL
PROFILNINE 500 UNIT VIAL
PROGESTERONE 100 MG CAPSULE
PROGESTERONE 200 MG CAPSULE
PROGLYCEM 50 MG/ML ORAL SUSP
PROGRAF 0.2 MG GRANULE PACKET
PROGRAF 0.5 MG CAPSULE
PROGRAF 1 MG CAPSULE
PROGRAF 1 MG GRANULE PACKET
PROGRAF 5 MG CAPSULE
PROLASTIN C 1,000 MG VIAL
PROLASTIN C 1,000 MG/20 ML VL
PROLIA 60 MG/ML SYRINGE
PROMACTA 12.5 MG SUSPEN PACKET
PROMACTA 12.5 MG TABLET
PROMACTA 25 MG TABLET
PROMACTA 50 MG TABLET
PROMACTA 75 MG TABLET
PROMETRIUM 100 MG CAPSULE
PROMETRIUM 200 MG CAPSULE
PROPAFENONE HCL 150 MG TABLET
PROPAFENONE HCL 225 MG TAB
PROPAFENONE HCL 300 MG TAB
PROPAFENONE HCL ER 225 MG CAP
PROPAFENONE HCL ER 325 MG CAP
PROPAFENONE HCL ER 425 MG CAP
PROPANTHELINE 15 MG TABLET
PROPECIA 1 MG TABLET
PROPRANOLOL 10 MG TABLET
PROPRANOLOL 20 MG TABLET
PROPRANOLOL 20 MG/5 ML SOLN
PROPRANOLOL 40 MG TABLET
PROPRANOLOL 40 MG/5 ML SOLN
PROPRANOLOL 60 MG TABLET
PROPRANOLOL 80 MG TABLET
PROPRANOLOL ER 120 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
PROPRANOLOL ER 160 MG CAPSULE
PROPRANOLOL ER 60 MG CAPSULE
PROPRANOLOL ER 80 MG CAPSULE
PROPRANOLOL-HCTZ 40-25 MG TAB
PROPRANOLOL-HCTZ 80-25 MG TAB
PROPYLTHIOURACIL 50 MG TABLET
PRORENAL QD SOFTGEL
PROSCAR 5 MG TABLET
PROSIGHT TABLET
PROTECT CARDIO AF SOFTGEL
PROTECT IRON TABLET
PROTECT PLUS NF LIQUID
PROTECT PLUS SO SOFTGEL
PROTONIX 40 MG SUSPENSION
PROTONIX DR 20 MG TABLET
PROTONIX DR 40 MG TABLET
PROTRIPTYLINE HCL 10 MG TABLET
PROTRIPTYLINE HCL 5 MG TABLET
PROVENT NASAL DEVICE
PROVENT STARTER KIT
PROVENTIL HFA 90 MCG INHALER
PROVERA 10 MG TABLET
PROVERA 2.5 MG TABLET
PROVERA 5 MG TABLET
PROVIDA DHA CAPSULE
PROVIDA OB CAPSULE
PROVIGIL 100 MG TABLET
PROVIGIL 200 MG TABLET
PROVIL 200 MG TABLET
PROZAC 10 MG PULVULE
PROZAC 20 MG PULVULE
PROZAC 40 MG PULVULE
PROZAC WEEKLY 90 MG CAPSULE
PULMICORT 0.25 MG/2 ML RESPUL
PULMICORT 0.5 MG/2 ML RESPULE
PULMICORT 1 MG/2 ML RESPULE
PULMICORT 180 MCG FLEXHALER
PULMICORT 90 MCG FLEXHALER
PULMOZYME 1 MG/ML AMPUL
PURE COMFORT 30G TWIST LANCET
PURE COMFORT PEN NDL 32G 4MM
PURE COMFORT PEN NDL 32G 5MM
PURE COMFORT PEN NDL 32G 6MM
PURE COMFORT PEN NDL 32G 8MM
PURE COMFORT 30G SAFETY LANCET
PUREFE OB PLUS CAPSULE
PUREFE PLUS CAPSULE
PURIXAN 20 MG/ML ORAL SUSP
PUSH BUTTON SAFETY 28G LANCET
PYRIDOSTIGMINE 60 MG/5 ML SOLN
PYRIDOSTIGMINE BR 30 MG TABLET
PYRIDOSTIGMINE BR 60 MG TABLET
PYRIDOSTIGMINE ER 180 MG TAB
QBRELIS 1MG/ML SOLUTION
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
QMIIZ ODT 15 MG TABLET
QMIIZ ODT 7.5 MG TABLET
QNASL 80 MCG NASAL SPRAY
QNASL CHILDREN'S 40 MCG SPRAY
QSYMIA 11.25 MG-69 MG CAPSULE
QSYMIA 15 MG-92 MG CAPSULE
QSYMIA 3.75 MG-23 MG CAPSULE
QSYMIA 7.5 MG-46 MG CAPSULE
QTERN 10 MG-5 MG TABLET
QTERN 5 MG-5 MG TABLET
QUARTETTE TABLET
QUASENSE 0.15-0.03 MG TABLET
QUDEXY XR 100 MG CAPSULE
QUDEXY XR 150 MG CAPSULE
QUDEXY XR 200 MG CAPSULE
QUDEXY XR 25 MG CAPSULE
QUDEXY XR 50 MG CAPSULE
QUEEN PALM 1:20 (W/V) VIAL
QUESTRAN PACKET
QUESTRAN POWDER
QUESTRAN LIGHT POWDER
QUETIAPINE FUMARATE 100 MG TAB
QUETIAPINE FUMARATE 200 MG TAB
QUETIAPINE FUMARATE 25 MG TAB
QUETIAPINE FUMARATE 300 MG TAB
QUETIAPINE FUMARATE 400 MG TAB
QUETIAPINE FUMARATE 50 MG TAB
QUETIAPINE ER 150 MG TABLET
QUETIAPINE ER 200 MG TABLET
QUETIAPINE ER 300 MG TABLET
QUETIAPINE ER 400 MG TABLET
QUETIAPINE ER 50 MG TABLET
QUFLORA PED 0.5 MG/ML DROP
QUFLORA 0.125 MG GUMMIES
QUFLORA PED 0.25 MG CHEW TAB
QUFLORA PED 0.5 MG CHEW TAB
QUFLORA PED 1 MG CHEW TAB
QUFLORA PED 0.25 MG/ML DROP
QUFLORA FE 0.25 MG CHEW TABLET
QUFLORA FE PED 0.25 MG/ML DROP
QUICK RELEASE TEFLN CANNULA
QUICK-SET PARADIGM SET 18"
QUICK-SET PARADIGM SET 32"
QUILLICHEW ER 20 MG CHEW TAB
QUILLICHEW ER 30 MG CHEW TAB
QUILLICHEW ER 40 MG CHEW TAB
QUILLIVANT XR 25 MG/5 ML SUSP
QUINAPRIL 10 MG TABLET
QUINAPRIL 20 MG TABLET
QUINAPRIL 40 MG TABLET
QUINAPRIL 5 MG TABLET
QUINAPRIL-HCTZ 10-12.5 MG TAB
QUINAPRIL-HCTZ 20-12.5 MG TAB
QUINAPRIL-HCTZ 20-25 MG TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
QUINIDINE GLUC ER 324 MG TAB
QUINIDINE SULFATE 200 MG TAB
QUINIDINE SULFATE 300 MG TAB
QUINTABS TABLET
QUINTABS-M TABLET
QUINTABS-M IRON FREE TABLET
QUINTET BLOOD GLUCOSE SYSTEM
QUINTET AC GLUCOSE TEST STRIPS
QUINTET AC BLOOD GLUCOSE METER
QVAR 40 MCG ORAL INHALER
QVAR 80 MCG ORAL INHALER
QVAR REDIHALER 40 MCG
QVAR REDIHALER 80 MCG
RABBIT EPITHELIUM 1:10 (W/V)
RABBIT EPITHELIUM 1:20 (W/V)
RABEPRAZOLE DR 10 MG SPRNKL CP
RABEPRAZOLE SOD DR 20 MG TAB
RADICAVA 30 MG/100 ML BAG
RAGWITEK SUBLINGUAL TABLET
RAJANI 28 TABLET
RALOXIFENE HCL 60 MG TABLET
RAMIPRIL 1.25 MG CAPSULE
RAMIPRIL 10 MG CAPSULE
RAMIPRIL 2.5 MG CAPSULE
RAMIPRIL 5 MG CAPSULE
RANEXA ER 1,000 MG TABLET
RANEXA ER 500 MG TABLET
CVS RANITIDINE 75 MG TABLET
EQ RANITIDINE 150 MG TABLET
EQ RANITIDINE 75 MG TABLET
PUB RANITIDINE 150 MG TABLET
RANITIDINE 15 MG/ML SYRUP
RANITIDINE 150 MG CAPSULE
RANITIDINE 150 MG TABLET
RANITIDINE 150 MG/10 ML SYRUP
RANITIDINE 300 MG CAPSULE
RANITIDINE 300 MG TABLET
RANITIDINE 75 MG TABLET
RANOLAZINE ER 1,000 MG TABLET
RANOLAZINE ER 500 MG TABLET
RAPAFLO 4 MG CAPSULE
RAPAFLO 8 MG CAPSULE
RAPAMUNE 0.5 MG TABLET
RAPAMUNE 1 MG TABLET
RAPAMUNE 1 MG/ML ORAL SOLN
RAPAMUNE 2 MG TABLET
RASAGILINE MESYLATE 0.5 MG TAB
RASAGILINE MESYLATE 1 MG TAB
RASUVO 10 MG/0.2 ML AUTOINJ
RASUVO 12.5 MG/0.25 ML AUTOINJ
RASUVO 15 MG/0.3 ML AUTOINJ
RASUVO 17.5 MG/0.35 ML AUTOINJ
RASUVO 20 MG/0.4 ML AUTOINJ
RASUVO 22.5 MG/0.45 ML AUTOINJ
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
RASUVO 25 MG/0.5 ML AUTOINJ
RASUVO 27.5 MG/0.55 ML AUTOINJ
RASUVO 30 MG/0.6 ML AUTOINJ
RASUVO 7.5 MG/0.15 ML AUTOINJ
RAVICTI 1.1 GRAM/ML LIQUID
RAYALDEE ER 30 MCG CAPSULE
RAZADYNE 12 MG TABLET
RAZADYNE 4 MG TABLET
RAZADYNE 8 MG TABLET
RAZADYNE ER 16 MG CAPSULE
RAZADYNE ER 24 MG CAPSULE
RAZADYNE ER 8 MG CAPSULE
READYLANCE 21G SAFETY LANCETS
READYLANCE 23G SAFETY LANCETS
READYLANCE 26G SAFETY LANCETS
READYLANCE 28G SAFETY LANCETS
READYLANCE 30G SAFETY LANCETS
REBIF 22 MCG/0.5 ML SYRINGE
REBIF 44 MCG/0.5 ML SYRINGE
REBIF REBIDOSE 22 MCG/0.5 ML
REBIF REBIDOSE 44 MCG/0.5 ML
REBLOZYL 25 MG VIAL
REBLOZYL 75 MG VIAL
RECLIPSEN 28 DAY TABLET
RECOMBINATE 1,241-1,800 UNIT V
RECOMBINATE 1,801-2,400 UNIT V
RECOMBINATE 220-400 UNIT VIAL
RECOMBINATE 401-800 UNIT VIAL
RECOMBINATE 801-1,240 UNIT VL
RED BIRCH 1:20 (W/V) VIAL
RED CEDAR 1:20 (W/V) VIAL
RED MAPLE 1:20 (W/V) VIAL
RED MULBERRY 1:20 (W/V) VIAL
REFUAH PLUS TEST STRIPS
REFUAH PLUS MONITORING SYSTEM
REFUAH PLUS CONTROL SOLUTION
RELEXXII ER 72 MG TABLET
RELIAMED 28G LANCETS
RELIAMED 30G LANCETS
RELIAMED SAFETY SEAL 28G LANCT
RELIAMED SAFETY SEAL 30G LANCT
RELION ALL-IN-ONE METER KIT
RELION CONFIRM SYSTEM KIT
RELION CONFIRM-MICRO TEST STRP
RELION MICRO SYSTEM KIT
RELION PEN NEEDLES 32GX5/32"
RELION PRIME BLOOD GLUCOSE MTR
RELION PRIME TEST STRIPS
RELION THIN 26G LANCETS
REMEDIENT CAPSULE
REMERON 15 MG SOLTAB
REMERON 15 MG TABLET
REMERON 30 MG SOLTAB
REMERON 30 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
REMERON 45 MG SOLTAB
REMERON 45 MG TABLET
REMICADE 100 MG VIAL
REMODULIN 1 MG/ML VIAL
REMODULIN 10 MG/ML VIAL
REMODULIN 2.5 MG/ML VIAL
REMODULIN 5 MG/ML VIAL
RENAGEL 400 MG TABLET
RENAGEL 800 MG TABLET
RENAL CAPS SOFTGEL
RENAL VITAMIN TABLET
RENAL-VITE TABLET
RENA-VITE TABLET
RENA-VITE RX TABLET
RENFLEXIS 100 MG VIAL
RENO CAPS SOFTGEL
RENVELA 0.8 GM POWDER PACKET
RENVELA 2.4 GM POWDER PACKET
RENVELA 800 MG TABLET
REPAGLINIDE 0.5 MG TABLET
REPAGLINIDE 1 MG TABLET
REPAGLINIDE 2 MG TABLET
REPAGLINIDE-METFORMIN 1-500 MG
REPAGLINIDE-METFORMIN 2-500 MG
REPATHA 420 MG/3.5ML PUSHTRONX
REPATHA 140 MG/ML SURECLICK
REPATHA 140 MG/ML SYRINGE
REQ49+ TABLET
REQUIP 0.25 MG TABLET
REQUIP 0.5 MG TABLET
REQUIP 1 MG TABLET
REQUIP 2 MG TABLET
REQUIP 3 MG TABLET
REQUIP 4 MG TABLET
REQUIP 5 MG TABLET
REQUIP XL 12 MG TABLET
REQUIP XL 2 MG TABLET
REQUIP XL 4 MG TABLET
REQUIP XL 6 MG TABLET
REQUIP XL 8 MG TABLET
RESCRIPTOR 100 MG TABLET
RESCRIPTOR 200 MG TABLET
RESTASIS 0.05% EYE EMULSION
RESTASIS MULTIDOSE 0.05% EYE
RETACRIT 10,000 UNIT/ML VIAL
RETACRIT 2,000 UNIT/ML VIAL
RETACRIT 3,000 UNIT/ML VIAL
RETACRIT 4,000 UNIT/ML VIAL
RETACRIT 40,000 UNIT/ML VIAL
RETISERT IMPLANT
RETROVIR 10 MG/ML SYRUP
RETROVIR 100 MG CAPSULE
REVATIO 10 MG/ML ORAL SUSP
REVATIO 20 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
REVCOVI 2.4 MG/1.5 ML VIAL
REVEAL BLOOD GLUCOSE METER
REVEAL TEST STRIP
REVLIMID 10 MG CAPSULE
REVLIMID 15 MG CAPSULE
REVLIMID 2.5 MG CAPSULE
REVLIMID 20 MG CAPSULE
REVLIMID 25 MG CAPSULE
REVLIMID 5 MG CAPSULE
REXULTI 0.25 MG TABLET
REXULTI 0.5 MG TABLET
REXULTI 1 MG TABLET
REXULTI 2 MG TABLET
REXULTI 3 MG TABLET
REXULTI 4 MG TABLET
REYATAZ 150 MG CAPSULE
REYATAZ 200 MG CAPSULE
REYATAZ 300 MG CAPSULE
REYATAZ 50 MG POWDER PACKET
RHIZOPUS 20,000 PNU/ML VIAL
RHOPRESSA 0.02% OPHTH SOLUTION
RIDAURA 3 MG CAPSULE
RIGHT STEP PRENATAL VIT TAB
RIGHTEST CONTROL SOLUTION HIGH
RIGHTEST CONTROL SOLN NORMAL
RIGHTEST GL300 30G LANCETS
RIGHTEST GM100 SYSTEM KIT
RIGHTEST GM300 SYSTEM KIT
RIGHTEST GM550 SYSTEM KIT
RIGHTEST GS100 TEST STRIPS
RIGHTEST GS300 TEST STRIPS
RIGHTEST GS550 TEST STRIPS
RILUTEK 50 MG TABLET
RILUZOLE 50 MG TABLET
RINVOQ ER 15 MG TABLET
RIOMET 500 MG/5 ML SOLUTION
RIOMET ER 500 MG/5 ML SUSP
RISEDRONATE SODIUM 150 MG TAB
RISEDRONATE SODIUM 35 MG TAB
RISEDRONATE SODIUM 5 MG TABLET
RISEDRONATE SOD DR 35 MG TAB
RISPERDAL 0.25 MG TABLET
RISPERDAL 0.5 MG TABLET
RISPERDAL 1 MG TABLET
RISPERDAL 1 MG/ML SOLUTION
RISPERDAL 2 MG TABLET
RISPERDAL 3 MG TABLET
RISPERDAL 4 MG TABLET
RISPERDAL CONSTA 12.5 MG VIAL
RISPERDAL CONSTA 25 MG VIAL
RISPERDAL CONSTA 37.5 MG VIAL
RISPERDAL CONSTA 50 MG VIAL
RISPERDAL M-TAB 0.5 MG ODT
RISPERDAL M-TAB 1 MG ODT
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
RISPERDAL M-TAB 2 MG ODT
RISPERDAL M-TAB 3 MG ODT
RISPERDAL M-TAB 4 MG ODT
RISPERIDONE 0.25 MG TABLET
RISPERIDONE 0.5 MG TABLET
RISPERIDONE 1 MG TABLET
RISPERIDONE 1 MG/1 ML ORAL SYR
RISPERIDONE 1 MG/ML SOLUTION
RISPERIDONE 2 MG TABLET
RISPERIDONE 2 MG/2 ML ORAL SYR
RISPERIDONE 3 MG TABLET
RISPERIDONE 3 MG/3 ML ORAL SYR
RISPERIDONE 4 MG TABLET
RISPERIDONE 0.25 MG ODT
RISPERIDONE 0.5 MG ODT
RISPERIDONE 1 MG ODT
RISPERIDONE 2 MG ODT
RISPERIDONE 3 MG ODT
RISPERIDONE 4 MG ODT
RITALIN 10 MG TABLET
RITALIN 20 MG TABLET
RITALIN 5 MG TABLET
RITALIN LA 10 MG CAPSULE
RITALIN LA 20 MG CAPSULE
RITALIN LA 30 MG CAPSULE
RITALIN LA 40 MG CAPSULE
RITONAVIR 100 MG TABLET
RITUXAN 100 MG/10 ML VIAL
RITUXAN 500 MG/50 ML VIAL
RITUXAN HYCELA 1,400 MG-23,400
RITUXAN HYCELA 1,600 MG-26,800
RIVASTIGMINE 13.3 MG/24HR PTCH
RIVASTIGMINE 4.6 MG/24HR PATCH
RIVASTIGMINE 9.5 MG/24HR PATCH
RIVASTIGMINE 1.5 MG CAPSULE
RIVASTIGMINE 3 MG CAPSULE
RIVASTIGMINE 4.5 MG CAPSULE
RIVASTIGMINE 6 MG CAPSULE
RIVELSA TABLET
RIXUBIS 1,000 UNIT NOMINAL
RIXUBIS 2,000 UNIT NOMINAL
RIXUBIS 250 UNIT NOMINAL
RIXUBIS 3,000 UNIT NOMINAL
RIXUBIS 500 UNIT NOMINAL
R-NATAL OB SOFTGEL
ROBINUL 1 MG TABLET
ROBINUL FORTE 2 MG TABLET
ROCALTROL 0.25 MCG CAPSULE
ROCALTROL 0.5 MCG CAPSULE
ROCALTROL 1 MCG/ML ORAL SOLN
ROCKLATAN 0.02%-0.005% EYE DRP
ROPINIROLE HCL ER 12 MG TABLET
ROPINIROLE HCL ER 2 MG TABLET
ROPINIROLE HCL ER 4 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ROPINIROLE HCL ER 6 MG TABLET
ROPINIROLE HCL ER 8 MG TABLET
ROPINIROLE HCL 0.25 MG TABLET
ROPINIROLE HCL 0.5 MG TABLET
ROPINIROLE HCL 1 MG TABLET
ROPINIROLE HCL 2 MG TABLET
ROPINIROLE HCL 3 MG TABLET
ROPINIROLE HCL 4 MG TABLET
ROPINIROLE HCL 5 MG TABLET
ROSUVASTATIN CALCIUM 10 MG TAB
ROSUVASTATIN CALCIUM 20 MG TAB
ROSUVASTATIN CALCIUM 40 MG TAB
ROSUVASTATIN CALCIUM 5 MG TAB
ROUGH MARSH ELDER 1:20 (W/V)
ROUGH PIGWEED 1:20 (W/V) VIAL
ROWASA 4 GM/60 ML ENEMA KIT
ROWEEPRA 1,000 MG TABLET
ROWEEPRA 500 MG TABLET
ROWEEPRA 750 MG TABLET
ROWEEPRA XR 500 MG TABLET
ROWEEPRA XR 750 MG TABLET
ROZLYTREK 100 MG CAPSULE
ROZLYTREK 200 MG CAPSULE
RUBRACA 200 MG TABLET
RUBRACA 250 MG TABLET
RUBRACA 300 MG TABLET
RULAVITE DHA SOFTGEL
RUSSIAN THISTLE 1:20 (W/V) VL
RUZURGI 10 MG TABLET
RYBELSUS 14 MG TABLET
RYBELSUS 3 MG TABLET
RYBELSUS 7 MG TABLET
RYDAPT 25 MG CAPSULE
RYTARY ER 23.75 MG-95 MG CAP
RYTARY ER 36.25 MG-145 MG CAP
RYTARY ER 48.75 MG-195 MG CAP
RYTARY ER 61.25 MG-245 MG CAP
RYTHMOL SR 225 MG CAPSULE
RYTHMOL SR 325 MG CAPSULE
RYTHMOL SR 425 MG CAPSULE
SABRIL 500 MG POWDER PACKET
SABRIL 500 MG TABLET
S. CEREVISIAE 20,000 PNU/ML
BD SAFE-CLIP BY MAIL SYSTEM
BD SAFE-CLIP NEEDL STORAGE DEV
SAFESNAP INSUL SYRINGE 0.3 ML
SAFESNAP INSULIN SYRINGE 1 ML
SAFESNAP INSUL SYRINGE 0.5 ML
SAFETY 21G LANCETS
SAFETY 28G LANCETS
SAFETY LANCETS 26G
SAFETY PEN NEEDLE 5MM X 31G
SAFETY SEAL 28G LANCETS
SAFETY SEAL 30G LANCETS
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
BD SAFETYGLD INS 1 ML 13MMX29G
BD SAFETYGLID INS 1 ML 6MMX31G
BD SAFTYGLD INS 0.5 ML 6MMX31G
BD SAFTYGLD INS 0.3 ML 6MMX31G
BD SAFETGLD INS 0.5 ML 8MMX30G
BD SAFETGLD INS 0.5ML 13MMX29G
BD SAFETGLD INS 0.3 ML 8MMX31G
BD SAFETGLD INS 0.3ML 13MMX29G
BD SAFETYGLIDE SYRINGE 27GX5/8
SAFETY-LET 30G LANCETS
SAFYRAL TABLET
SAGEBRUSH 1:20 (W/V) VIAL
SAIZEN 5 MG VIAL
SAIZEN 8.8 MG CLICK.EASY CARTG
SAIZEN 8.8 MG VIAL
SAIZEN 8.8 MG SAIZENPREP CART
SALAGEN 5 MG TABLET
SALAGEN 7.5 MG TABLET
SALSALATE 500 MG TABLET
SALSALATE 750 MG TABLET
SAMSCA 15 MG TABLET
SAMSCA 30 MG TABLET
SANDIMMUNE 100 MG CAPSULE
SANDIMMUNE 100 MG/ML SOLN
SANDIMMUNE 25 MG CAPSULE
SANDOSTATIN 0.05 MG/ML AMPUL
SANDOSTATIN 0.1 MG/ML AMPUL
SANDOSTATIN 0.2 MG/ML VIAL
SANDOSTATIN 0.5 MG/ML AMPUL
SANDOSTATIN 1 MG/ML VIAL
SANDOSTATIN LAR DEPOT 10 MG KT
SANDOSTATIN LAR DEPOT 10 MG VL
SANDOSTATIN LAR DEPOT 20 MG KT
SANDOSTATIN LAR DEPOT 30 MG KT
SAPHRIS 10 MG TAB SUBLINGUAL
SAPHRIS 2.5 MG TAB SUBLINGUAL
SAPHRIS 5 MG TAB SUBLINGUAL
SARAFEM 10 MG TABLET
SARAFEM 20 MG TABLET
SARCLISA 100 MG/5 ML VIAL
SARCLISA 500 MG/25 ML VIAL
SAVAYSA 15 MG TABLET
SAVAYSA 30 MG TABLET
SAVAYSA 60 MG TABLET
SAVELLA 100 MG TABLET
SAVELLA 12.5 MG TABLET
SAVELLA 25 MG TABLET
SAVELLA 50 MG TABLET
SAXENDA 18 MG/3 ML PEN
SCENESSE 16 MG IMPLANT
SCOOBY-DOO ONE A DAY TABLET
SCOOBY-DOO ONE A DAY GUMMIES
SEASONIQUE 0.15-0.03-0.01 TAB
SECTRAL 200 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SECTRAL 400 MG CAPSULE
SECUADO 3.8 MG/24 HR PATCH
SECUADO 5.7 MG/24 HR PATCH
SECUADO 7.6 MG/24 HR PATCH
SEEBRI NEOHALER 15.6 MCG INHAL
SEGLUROMET 2.5-1,000 MG TABLET
SEGLUROMET 2.5-500 MG TABLET
SEGLUROMET 7.5-1,000 MG TABLET
SEGLUROMET 7.5-500 MG TABLET
SELECT-OB CHEWABLE CAPLET
SELECT-OB CHEWABLE CAPLET
SELECT-OB + DHA PACK
SELEGILINE HCL 5 MG CAPSULE
SELEGILINE HCL 5 MG TABLET
SELZENTRY 150 MG TABLET
SELZENTRY 20 MG/ML ORAL SOLN
SELZENTRY 25 MG TABLET
SELZENTRY 300 MG TABLET
SELZENTRY 75 MG TABLET
SE-NATAL 19 CHEWABLE TABLET
SE-NATAL-19 TABLET
SENIOR TABS
SENSIPAR 30 MG TABLET
SENSIPAR 60 MG TABLET
SENSIPAR 90 MG TABLET
SENTRY TABLET
SENTRY SENIOR MULTIVITAMIN TAB
SENTRY SENIOR TABLET
SEREVENT DISKUS 50 MCG
SEROQUEL 100 MG TABLET
SEROQUEL 200 MG TABLET
SEROQUEL 25 MG TABLET
SEROQUEL 300 MG TABLET
SEROQUEL 400 MG TABLET
SEROQUEL 50 MG TABLET
SEROQUEL XR 150 MG TABLET
SEROQUEL XR 200 MG TABLET
SEROQUEL XR 300 MG TABLET
SEROQUEL XR 400 MG TABLET
SEROQUEL XR 50 MG TABLET
SEROSTIM 4 MG VIAL
SEROSTIM 5 MG VIAL
SEROSTIM 6 MG VIAL
SERTRALINE 20 MG/ML ORAL CONC
SERTRALINE HCL 100 MG TABLET
SERTRALINE HCL 25 MG TABLET
SERTRALINE HCL 50 MG TABLET
SETLAKIN 0.15 MG-0.03 MG TAB
SEVELAMER 0.8 GM POWDER PACKET
SEVELAMER 2.4 GM POWDER PACKET
SEVELAMER CARBONATE 800 MG TAB
SEVELAMER HCL 400 MG TABLET
SEVELAMER HCL 800 MG TABLET
SF 1.1% GEL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SF 5000 PLUS CREAM
SFROWASA 4 GM/60 ML ENEMA
SHAGBARK HICKORY 1:20 (W/V) VL
SHAROBEL 0.35 MG TABLET
SHEEP SORREL 1:20 (W/V) VIAL
SORREL-DOCK MIX 1:20 (W/V)
SHORT RAGWEED 1:20 (W/V) VIAL
SIDEKICK BLOOD GLUCOSE SYSTEM
SIGNIFOR 0.3 MG/ML AMPULE
SIGNIFOR 0.6 MG/ML AMPULE
SIGNIFOR 0.9 MG/ML AMPULE
SIGNIFOR LAR 10 MG KIT
SIGNIFOR LAR 20 MG KIT
SIGNIFOR LAR 20 MG VIAL
SIGNIFOR LAR 30 MG KIT
SIGNIFOR LAR 40 MG KIT
SIGNIFOR LAR 40 MG VIAL
SIGNIFOR LAR 60 MG KIT
SIGNIFOR LAR 60 MG VIAL
SIKLOS 1,000 MG TABLET
SIKLOS 100 MG TABLET
SILDENAFIL 10 MG/ML ORAL SUSP
SILDENAFIL 100 MG TABLET
SILDENAFIL 20 MG TABLET
SILDENAFIL 25 MG TABLET
SILDENAFIL 50 MG TABLET
SILHOUETTE INFUSION SET 23"
SILHOUETTE INFUSION SET 43"
SILIQ 210 MG/1.5 ML SYRINGE
SILODOSIN 4 MG CAPSULE
SILODOSIN 8 MG CAPSULE
SIMBRINZA 1%-0.2% EYE DROPS
SIMILAC PRENATAL COMBO PACK
SIMLIYA 28 DAY TABLET
SIMPESSE 0.15-0.03-0.01 MG TAB
SIMPONI 100 MG/ML PEN INJECTOR
SIMPONI 100 MG/ML SYRINGE
SIMPONI 50 MG/0.5 ML PEN INJEC
SIMPONI 50 MG/0.5 ML SYRINGE
SIMPONI ARIA 50 MG/4 ML VIAL
SIMVASTATIN 10 MG TABLET
SIMVASTATIN 20 MG TABLET
SIMVASTATIN 20 MG/5 ML SUSP
SIMVASTATIN 40 MG TABLET
SIMVASTATIN 5 MG TABLET
SIMVASTATIN 80 MG TABLET
SINEMET 10-100 MG TABLET
SINEMET 25-100 MG TABLET
SINEMET 25-250 MG TABLET
SINEMET CR 25-100 TABLET
SINEMET CR 50-200 TABLET
SINGLE-LET LANCETS
SINGULAIR 10 MG TABLET
SINGULAIR 4 MG GRANULES
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SINGULAIR 4 MG TABLET CHEW
SINGULAIR 5 MG TABLET CHEW
SIROLIMUS 0.5 MG TABLET
SIROLIMUS 1 MG TABLET
SIROLIMUS 1 MG/ML SOLUTION
SIROLIMUS 2 MG TABLET
SKYLA 13.5 MG SYSTEM
SKYRIZI 150 MG DOSE KIT-2 SYRN
SLYND 4 MG TABLET
SMART SENSE COLOR 33G LANCETS
SMART SENSE STANDARD 21G
SMART SENSE THIN 26G LANCETS
SMART SENSE MONITORING SYSTEM
SMART SENSE TEST STRIPS
SMARTEST CONTROL SOLUTION
SMARTEST EJECT METER
SMARTEST LANCET
SMARTEST PERSONA STARTER KIT
SMARTEST PRONTO STARTER KIT
SMARTEST PROTEGE METER
SMARTEST TEST STRIPS
SOCHLOR 5% EYE DROPS
SOCHLOR 5% EYE OINTMENT
CVS SODIUM CHLORIDE 5% EYE DRP
CVS SODIUM CHLORIDE 5% OINT
RA SODIUM CHLORIDE 5% EYE DROP
SODIUM CHLORIDE 5% EYE DROP
SODIUM CHLORIDE 5% EYE OINT
SODIUM CHLORIDE 5% OPHT SOLN
SODIUM FLUORIDE 0.25 (0.55) MG
SODIUM FLUORIDE 0.5 MG(1.1 MG)
SODIUM FLUORIDE 0.5 MG/ML DROP
SODIUM FLUORIDE 1 MG (2.2 MG)
SODIUM FLUORIDE 1.1% CREAM
SODIUM FLUORIDE 1.1% GEL
SODIUM FLUORIDE 5000 PLUS CRM
SODIUM PHENYLBUTYRATE 500MG TB
SODIUM PHENYLBUTYRATE POWDER
SOF-SENSOR
SOF-SET ULTIMATE QR SET
SOF-SET MICRO INFUSION SET
SOFT TOUCH LANCETS
SOLIFENACIN 10 MG TABLET
SOLIFENACIN 5 MG TABLET
SOLIQUA 100 UNIT-33 MCG/ML PEN
SOLIRIS 300 MG/30 ML VIAL
SOLO TABLET
SOLTAMOX 10 MG/5 ML SOLN
SOLTAMOX 20 MG/10 ML SOLN
SOLUS V2 AUDIBLE METER
SOLUS V2 AUDIBLE METER SYS KIT
SOLUS V2 28G LANCETS
SOLUS V2 CONTROL SOLUTION HIGH
SOLUS V2 CONTROL SOLUTION LOW
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SOLUS V2 30G TWIST LANCETS
SOLUS V2 LANCING DEVICE
SOLUS V2 AUDIBLE TEST STRIPS
SOMATULINE DEPOT 120 MG/0.5 ML
SOMATULINE DEPOT 60 MG/0.2 ML
SOMATULINE DEPOT 90 MG/0.3 ML
SOMAVERT 10 MG VIAL
SOMAVERT 15 MG VIAL
SOMAVERT 20 MG VIAL
SOMAVERT 25 MG VIAL
SOMAVERT 30 MG VIAL
SORIATANE 10 MG CAPSULE
SORIATANE 17.5 MG CAPSULE
SORIATANE 25 MG CAPSULE
SORINE 120 MG TABLET
SORINE 160 MG TABLET
SORINE 240 MG TABLET
SORINE 80 MG TABLET
SOTALOL 120 MG TABLET
SOTALOL 160 MG TABLET
SOTALOL 240 MG TABLET
SOTALOL 80 MG TABLET
SOTALOL AF 120 MG TABLET
SOTALOL AF 160 MG TABLET
SOTALOL AF 80 MG TABLET
SOTYLIZE 5 MG/ML ORAL SOLUTION
CVS SPECTRAVITE ADULT GUMMY
CVS SPECTRAVITE ADULT 50 PLUS
CVS SPECTRAVITE ADULT TAB CHEW
CVS SPECTRAVITE ADULT 50+ TABS
CVS SPECTRAVITE ADVANCED TAB
CVS SPECTRAVITE MEN'S TABLET
CVS SPECTRAVITE SENIOR TAB
CVS SPECTRAVITE SENIOR TABLET
CVS SPECTRAVITE ULTRA MEN TAB
CVS SPECTRAVITE ULTRA MEN'S TB
CVS SPECTRAVITE ULTRA WOMEN TB
CVS SPECTRAVITE WOMEN'S TABLET
SPINRAZA 12 MG/5 ML VIAL
SPINY PIGWEED 1:20 W/V VIAL
SPIRIVA 18 MCG CP-HANDIHALER
SPIRIVA RESPIMAT 1.25 MCG INH
SPIRIVA RESPIMAT 2.5 MCG INH
SPIRONOLACTONE 100 MG TABLET
SPIRONOLACTONE 25 MG TABLET
SPIRONOLACTONE 50 MG TABLET
SPIRONOLACTONE-HCTZ 25-25 TAB
SPRAVATO 56 MG DOSE PACK
SPRAVATO 84 MG DOSE PACK
SPRINTEC 28 DAY TABLET
SPRITAM 1,000 MG TABLET
SPRITAM 250 MG TABLET
SPRITAM 500 MG TABLET
SPRITAM 750 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SPRYCEL 100 MG TABLET
SPRYCEL 140 MG TABLET
SPRYCEL 20 MG TABLET
SPRYCEL 50 MG TABLET
SPRYCEL 70 MG TABLET
SPRYCEL 80 MG TABLET
SRONYX 0.10-0.02 MG TABLET
ST. JOSEPH ASPIRIN 81 MG CHEW
ST. JOSEPH ASPIRIN EC 81 MG TB
STALEVO 100 TABLET
STALEVO 125 TABLET
STALEVO 150 TABLET
STALEVO 200 TABLET
STALEVO 50 TABLET
STALEVO 75 TABLET
STD BERMUDA GRASS 10,000/ML
STD MIX MITE 5,000-5,000 UNIT
STD RYE GRASS 100,000 BAU/ML
STD SWEET VERNAL 100,000/ML
STD CAT HAIR 10,000 BAU/ML
STD JUNE GRASS 100,000 BAU/ML
STD MEADOW FESCUE 100,000/ML
STD ORCHARD GRASS 100,000/ML
STD RED TOP GRASS 100,000/ML
STD TIMOTHY GRASS 10,000/ML
STD TIMOTHY GRASS 100,000/ML
STARLIX 120 MG TABLET
STARLIX 60 MG TABLET
STAVUDINE 15 MG CAPSULE
STAVUDINE 20 MG CAPSULE
STAVUDINE 30 MG CAPSULE
STAVUDINE 40 MG CAPSULE
STAXYN 10 MG ODT
STEGLATRO 15 MG TABLET
STEGLATRO 5 MG TABLET
STEGLUJAN 15-100 MG TABLET
STEGLUJAN 5-100 MG TABLET
STELARA 45 MG/0.5 ML SYRINGE
STELARA 45 MG/0.5 ML VIAL
STELARA 90 MG/ML SYRINGE
STENDRA 100 MG TABLET
STENDRA 200 MG TABLET
STENDRA 50 MG TABLET
STERILANCE TL TWIST 30G LANCET
STERILANCE TL TWIST 32G LANCET
STIMATE 1.5 MG/ML NASAL SPRAY
STIOLTO RESPIMAT INHAL SPRAY
STRATTERA 10 MG CAPSULE
STRATTERA 100 MG CAPSULE
STRATTERA 18 MG CAPSULE
STRATTERA 25 MG CAPSULE
STRATTERA 40 MG CAPSULE
STRATTERA 60 MG CAPSULE
STRATTERA 80 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
STRENSIQ 18 MG/0.45 ML VIAL
STRENSIQ 28 MG/0.7 ML VIAL
STRENSIQ 40 MG/ML VIAL
STRENSIQ 80 MG/0.8 ML VIAL
STRESS B WITH ZINC TABLET
EQL STRESS B-COMPLEX TABLET
STRESS B-COMPLEX TABLET
STRESS FORMULA TABLET
SM STRESS FORMULA+ZINC TABLET
CVS STRESS FORMULA-ZINC TAB
STRESS FORMULA WITH ZINC TAB
STRESS-C WITH ZINC TABLET
STRESS-C TABLET
STRESSTABS W/ZINC TABLET
STRIANT 30 MG MUCOADHESIVE
STRIBILD TABLET
STRIVERDI RESPIMAT INHAL SPRAY
STROVITE FORTE CAPLET
STROVITE ONE CAPLET
STUART ONE CAPSULE
SUBLOCADE 100 MG/0.5 ML SYRING
SUBLOCADE 300 MG/1.5 ML SYRING
SUBOXONE 12 MG-3 MG SL FILM
SUBOXONE 2 MG-0.5 MG SL FILM
SUBOXONE 4 MG-1 MG SL FILM
SUBOXONE 8 MG-2 MG SL FILM
SUBVENITE 100 MG TABLET
SUBVENITE 150 MG TABLET
SUBVENITE 200 MG TABLET
SUBVENITE 25 MG TABLET
SUCRAID 8,500 UNITS/ML SOLN
SUCRALFATE 1 GM TABLET
SUCRALFATE 1 GM/10 ML SUSP
SULAR ER 17 MG TABLET
SULAR ER 34 MG TABLET
SULAR ER 8.5 MG TABLET
SULFASALAZINE 500 MG TABLET
SULFASALAZINE DR 500 MG TAB
SULINDAC 150 MG TABLET
SULINDAC 200 MG TABLET
SUNOSI 150 MG TABLET
SUNOSI 75 MG TABLET
SUNVITE TABLET
CVS SUPER B COMPLEX CAPLET
CVS SUPER B COMPLEX-VIT C CPLT
SM SUPER B COMPLEX-C CAPLET
SUPER B MAXI COMPLEX CAPLET
SUPER B WITH VIT C CAPSULE
SUPER B-50 COMPLEX CAPSULE
SUPER GINSENG MULTIVIT CAP
SUPER MULTIPLE VIT-MINERAL TAB
SUPER MULTIPLE CAPSULE
SUPER MULTIPLE-LOW IRON TABLET
SUPER MULTIVITAMIN TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SUPER QUINTS B-50 TABLETS
SUPER QUINTS B-50 TABLET
SUPER THERA VITE M TABLET
KROGER SUPER THIN LANCETS
PC SUPER THIN 30G LANCETS
SM SUPER THIN 30G LANCETS
SMART SENSE SUPER THIN 30G
SUPER THIN 28G LANCETS
SUPER THIN 30G LANCETS
SUPERPLEX-T TABLET
SUPERVITE LIQUID
SUPPORT LIQUID
SUPPORT-500 SOFTGEL
SUPPRELIN LA 50 MG KIT
SURE COMFORT 30G PEN NEEDLE
SURE COMFORT 31G PEN NEEDLE
SURE COMFORT PEN NDL 29GX1/2"
SURE COMFORT PEN NDL 31GX3/16"
SURE COMFORT PEN NDL 32GX1/4"
SURE COMFORT PEN NDL 32GX5/32"
SURE COMFORT 1 ML SYRINGE
SURE COMFORT 0.5 ML SYRINGE
SURE COMFORT 0.3 ML SYRINGE
SURE COMFORT 3/10 ML SYRINGE
SURE COMFORT INS 1 ML 31GX1/4"
SURE COMFORT INS 0.5ML 31GX1/4
SURE COMFORT INS 0.3ML 31GX1/4
SURE COMFORT 18G LANCETS
SURE COMFORT 21G LANCETS
SURE COMFORT 23G LANCETS
SURE COMFORT 28G LANCETS
SURE COMFORT 30G LANCETS
SURE-FINE PEN NEEDLES 12.7MM
SURE-FINE PEN NEEDLES 5MM
SURE-FINE PEN NEEDLES 8MM
NOVA SUREFLEX LANCING DEVICE
SURE-JECT INSU SYR U100 1 ML
SURE-JECT INSUL SYR U100 1 ML
SURE-JECT INSULIN SYRINGE 1 ML
SURE-JECT INSU SYR U100 0.5 ML
SURE-JECT INSU SYR U100 0.3 ML
SURE-LANCE 26G LANCETS
SURE-LANCE FLAT LANCETS
SURE-LANCE THIN 28G LANCETS
SURE-LANCE ULTRA THIN 30G
SURE-T PARADIGM 18" SET
SURE-T PARADIGM 23" SET
SURE-T PARADIGM 32" SET
SURE-TEST EASYPLUS MINI STRIP
SURE-TEST EASYPLUS MINI SOLN
SURE-TEST EASYPLUS MINI METER
SURE-TOUCH LANCET
SURMONTIL 100 MG CAPSULE
SURMONTIL 25 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SURMONTIL 50 MG CAPSULE
SUSTIVA 200 MG CAPSULE
SUSTIVA 50 MG CAPSULE
SUSTIVA 600 MG TABLET
SUTENT 12.5 MG CAPSULE
SUTENT 25 MG CAPSULE
SUTENT 37.5 MG CAPSULE
SUTENT 50 MG CAPSULE
SWEETGUM 1:20 (W/V) VIAL
SYEDA 28 TABLET
SYLATRON 200 MCG KIT
SYLATRON 300 MCG KIT
SYLATRON 600 MCG KIT
SYLVANT 100 MG VIAL
SYLVANT 400 MG VIAL
SYMAX FASTABS 0.125 MG TABLET
SYMAX DUOTAB
SYMAX-SL 0.125 MG TABLET SL
SYMAX-SR 0.375 MG TABLET
SYMBICORT 160-4.5 MCG INHALER
SYMBICORT 80-4.5 MCG INHALER
SYMBYAX 12-25 MG CAPSULE
SYMBYAX 12-50 MG CAPSULE
SYMBYAX 3-25 MG CAPSULE
SYMBYAX 6-25 MG CAPSULE
SYMBYAX 6-50 MG CAPSULE
SYMDEKO 100/150 MG-150 MG TABS
SYMDEKO 50/75 MG-75 MG TABLETS
SYMFI 600-300-300 MG TABLET
SYMFI LO 400-300-300 MG TABLET
SYMLINPEN 120 PEN INJECTOR
SYMLINPEN 60 PEN INJECTOR
SYMPAZAN 10 MG FILM
SYMPAZAN 20 MG FILM
SYMPAZAN 5 MG FILM
SYMTUZA 800-150-200-10 MG TAB
SYNJARDY 12.5-1,000 MG TABLET
SYNJARDY 12.5-500 MG TABLET
SYNJARDY 5-1,000 MG TABLET
SYNJARDY 5-500 MG TABLET
SYNJARDY XR 10-1,000 MG TABLET
SYNJARDY XR 12.5-1,000 MG TAB
SYNJARDY XR 25-1,000 MG TABLET
SYNJARDY XR 5-1,000 MG TABLET
SYNRIBO 3.5 MG/ML VIAL
SYNTHROID 0.137 MG TABLET
SYNTHROID 100 MCG TABLET
SYNTHROID 112 MCG TABLET
SYNTHROID 125 MCG TABLET
SYNTHROID 137 MCG TABLET
SYNTHROID 150 MCG TABLET
SYNTHROID 175 MCG TABLET
SYNTHROID 200 MCG TABLET
SYNTHROID 25 MCG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
SYNTHROID 300 MCG TABLET
SYNTHROID 50 MCG TABLET
SYNTHROID 75 MCG TABLET
SYNTHROID 88 MCG TABLET
T:30 INFUSION SET 23" 13MM
T:30 INFUSION SET 43" 13MM
T:90 INFUSION SET 23" 6MM
T:90 INFUSION SET 23" 9MM
T:90 INFUSION SET 43" 9MM
T:FLEX 4.8 ML CARTRIDGE
T:SLIM 3 ML CARTRIDGE
T:SLIM G4 3 ML CARTRIDGE
TAB-A-VITE TABLET
TAB-A-VITE MULTIVIT WITH IRON
TAB-A-VITE WITH IRON TABLET
TAB-A-VITE-MINERALS TABLET
TACROLIMUS 0.5 MG CAPSULE
TACROLIMUS 1 MG CAPSULE
TACROLIMUS 5 MG CAPSULE
TADALAFIL 10 MG TABLET
TADALAFIL 2.5 MG TABLET
TADALAFIL 20 MG TABLET
TADALAFIL 5 MG TABLET
TAFINLAR 50 MG CAPSULE
TAFINLAR 75 MG CAPSULE
TAGAMET HB 200 MG TABLET
TAKHZYRO 300 MG/2 ML VIAL
TALL RAGWEED 1:20 W/V VIAL
TALTZ 80 MG/ML AUTOINJECTOR
TALTZ 80 MG/ML AUTOINJ (2-PK)
TALTZ 80 MG/ML AUTOINJ (3-PK)
TALTZ 80 MG/ML SYRINGE
TALTZ 80 MG/ML SYRINGE (2-PK)
TALTZ 80 MG/ML SYRINGE (3-PK)
TAMOXIFEN 10 MG TABLET
TAMOXIFEN 20 MG TABLET
TAMSULOSIN HCL 0.4 MG CAPSULE
TANZEUM 30 MG PEN INJECT
TANZEUM 50 MG PEN INJECT
TAPAZOLE 10 MG TABLET
TAPAZOLE 5 MG TABLET
TARCEVA 100 MG TABLET
TARCEVA 150 MG TABLET
TARCEVA 25 MG TABLET
TARGRETIN 75 MG CAPSULE
TARINA 24 FE 1 MG-20 MCG TAB
TARINA FE 1-20 TABLET
TARINA FE 1-20 EQ TABLET
TARKA ER 1-240 MG TABLET
TARKA ER 2-180 MG TABLET
TARKA ER 2-240 MG TABLET
TARKA ER 4-240 MG TABLET
TARON-C DHA CAPSULE
TARON-PREX PRENATAL DHA CAP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TASIGNA 150 MG CAPSULE
TASIGNA 200 MG CAPSULE
TASIGNA 50 MG CAPSULE
TASMAR 100 MG TABLET
TAYTULLA 1 MG-20 MCG CAPSULE
TAZTIA XT 120 MG CAPSULE
TAZTIA XT 180 MG CAPSULE
TAZTIA XT 240 MG CAPSULE
TAZTIA XT 300 MG CAPSULE
TAZTIA XT 360 MG CAPSULE
TAZVERIK 200 MG TABLET
TECENTRIQ 1,200 MG/20 ML VIAL
TECENTRIQ 840 MG/14 ML VIAL
TECFIDERA DR 120 MG CAPSULE
TECFIDERA DR 240 MG CAPSULE
TECHLITE 0.3 ML 29GX12MM (1/2)
TECHLITE 0.3 ML 30GX12MM (1/2)
TECHLITE 0.3 ML 30GX8MM (1/2)
TECHLITE 0.3 ML 31GX6MM (1/2)
TECHLITE 0.3 ML 31GX8MM (1/2)
TECHLITE 0.5 ML 29GX12MM (1/2)
TECHLITE 0.5 ML 30GX12MM (1/2)
TECHLITE 0.5 ML 30GX8MM (1/2)
TECHLITE 0.5 ML 31GX6MM (1/2)
TECHLITE 0.5 ML 31GX8MM (1/2)
TECHLITE INS SYR 1 ML 29GX12MM
TECHLITE INS SYR 1 ML 30GX12MM
TECHLITE INS SYR 1 ML 30GX8MM
TECHLITE INS SYR 1 ML 31GX6MM
TECHLITE INS SYR 1 ML 31GX8MM
TECHLITE 25G LANCETS
TECHLITE 28G LANCETS
TECHLITE 30G LANCETS
TECHLITE PEN NEEDLE 29GX1/2"
TECHLITE PEN NEEDLE 29GX3/8"
TECHLITE PEN NEEDLE 31GX1/4"
TECHLITE PEN NEEDLE 31GX3/16"
TECHLITE PEN NEEDLE 31GX5/16"
TECHLITE PEN NEEDLE 32GX1/4"
TECHLITE PEN NEEDLE 32GX5/16"
TECHLITE PEN NEEDLE 32GX5/32"
TEGRETOL 100 MG/5 ML SUSP
TEGRETOL 200 MG TABLET
TEGRETOL XR 100 MG TABLET
TEGRETOL XR 200 MG TABLET
TEGRETOL XR 400 MG TABLET
TEGSEDI 284 MG/1.5 ML SYRINGE
TEKTURNA 150 MG TABLET
TEKTURNA 300 MG TABLET
TEKTURNA HCT 150-12.5 MG TAB
TEKTURNA HCT 150-25 MG TABLET
TEKTURNA HCT 300-12.5 MG TAB
TEKTURNA HCT 300-25 MG TABLET
TELCARE TEST STRIPS
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TELCARE BLOOD GLUCOSE MONITOR
TELCARE ULTRA THIN 30G LANCETS
TELCARE BGM BLOOD GLUCOSE KIT
TELCARE CONTROL SOLUTION
TELMISARTAN 20 MG TABLET
TELMISARTAN 40 MG TABLET
TELMISARTAN 80 MG TABLET
TELMISARTAN-AMLODIPINE 40-10
TELMISARTAN-AMLODIPINE 40-5 MG
TELMISARTAN-AMLODIPINE 80-10
TELMISARTAN-AMLODIPINE 80-5 MG
TELMISARTAN-HCTZ 40-12.5 MG TB
TELMISARTAN-HCTZ 80-12.5 MG TB
TELMISARTAN-HCTZ 80-25 MG TAB
TEMIXYS 300-300 MG TABLET
TENEX 1 MG TABLET
TENEX 2 MG TABLET
TENOFOVIR DISOP FUM 300 MG TB
TENORETIC 100 TABLET
TENORETIC 50 TABLET
TENORMIN 100 MG TABLET
TENORMIN 25 MG TABLET
TENORMIN 50 MG TABLET
TERAZOSIN 1 MG CAPSULE
TERAZOSIN 10 MG CAPSULE
TERAZOSIN 2 MG CAPSULE
TERAZOSIN 5 MG CAPSULE
TERBUTALINE SULFATE 2.5 MG TAB
TERBUTALINE SULFATE 5 MG TAB
TERUMO INS SYRINGE U100-1 ML
TERUMO INS SYRINGE U100-1/2 ML
TERUMO INS SYRNG U100-1/2 ML
TERUMO INS SYRINGE U100-1/3 ML
TEST N'GO GLUCOSE TEST STRIP
TEST N'GO BLOOD GLUCOSE SYSTEM
PHARMACIST CHOICE TEST STRIPS
TESTIM 1% (50MG) GEL
TESTONE CIK KIT
TESTOPEL 75 MG PELLETS
TESTOSTERONE 1.62% (2.5 G) PKT
TESTOSTERONE 1.62% GEL PUMP
TESTOSTERONE 1.62%(1.25 G) PKT
TESTOSTERONE 10 MG GEL PUMP
TESTOSTERONE 12.5 MG/1.25 GRAM
TESTOSTERONE 200 MG PELLET
TESTOSTERONE 25 MG/2.5 GM PKT
TESTOSTERONE 30 MG/1.5 ML PUMP
TESTOSTERONE 50 MG/5 GRAM GEL
TESTOSTERONE 50 MG/5 GRAM PKT
TESTOSTERON CYP 1,000 MG/10 ML
TESTOSTERON CYP 2,000 MG/10 ML
TESTOSTERONE CYP 1,000 MG/5 ML
TESTOSTERONE CYP 100 MG/ML
TESTOSTERONE CYP 200 MG/ML
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TESTOSTERONE CYP 250 MG/5 ML
TESTOSTERONE CYP 500 MG/2.5 ML
TESTOSTERONE CYP 500 MG/5 ML
TESTOSTERONE CYP 6,000 MG/30ML
TESTOSTERON ENAN 1,000 MG/5 ML
TESTOSTERONE ENAN 200 MG/ML
TESTOSTERONE PROP 1,000MG/10ML
TESTRED 10 MG CAPSULE
TETRABENAZINE 12.5 MG TABLET
TETRABENAZINE 25 MG TABLET
TEXAVITE LQ DROPS
THALOMID 100 MG CAPSULE
THALOMID 150 MG CAPSULE
THALOMID 200 MG CAPSULE
THALOMID 50 MG CAPSULE
THEO-24 ER 100 MG CAPSULE
THEO-24 ER 200 MG CAPSULE
THEO-24 ER 300 MG CAPSULE
THEO-24 ER 400 MG CAPSULE
THEOCHRON ER 100 MG TABLET
THEOCHRON ER 200 MG TABLET
THEOPHYLLINE 80 MG/15 ML SOLN
THEOPHYLLINE ER 400 MG TABLET
THEOPHYLLINE ER 600 MG TABLET
THEOPHYLLINE ER 100 MG TABLET
THEOPHYLLINE ER 200 MG TABLET
THEOPHYLLINE ER 300 MG TAB
THEOPHYLLINE ER 450 MG TAB
THERA TABLET
THERA CAPLET
THERA M PLUS TABLET
THERAGRAN-M PREMIER 50+ CAPLET
THERA-M CAPLET
THERA-M TABLET
THERA-M CAPLET
THERA-M CAPLET
THERAMILL FORTE CAPSULE
THERANATAL CORE NUTRITION TAB
THERANATAL COMPLETE COMBO
THERANATAL LACTATION COMBO PCK
THERANATAL ONE SOFTGEL
THERANATAL OVAVITE COMBO PACK
THERANATAL PLUS COMBO PACK
SM THERAPEUTIC M TABLET
GNP THERAPEUTIC-M CAPLET
THERAPEUTIC-M CAPLET
THERAPEUTIC-M TABLET
THERA-TABS CAPLET
THERA-TABS M CAPLET
THERATRUM COMPLETE TABLET
THERATRUM COMPLETE 50 PLUS TAB
THERATRUM COMPLETE 50 PLUS TAB
THEREMS TABLET
THEREMS-H TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
THEREMS-M TABLET
LONGS THIN LANCETS 26G
LONGS THIN LANCETS 30G
RELION THIN 26G LANCETS
SM THIN LANCETS 26G
THIN 26G LANCETS
THIN LANCETS 28G
WALGREENS THIN LANCETS
THINPRO INS SYRIN U100-1 ML
THINPRO INS SYRIN U100-0.5 ML
THINPRO INS SYRIN U100-0.3 ML
THIOLA 100 MG TABLET
THIOLA EC 100 MG TABLET
THIOLA EC 300 MG TABLET
THIORIDAZINE 10 MG TABLET
THIORIDAZINE 100 MG TABLET
THIORIDAZINE 25 MG TABLET
THIORIDAZINE 50 MG TABLET
THIOTHIXENE 1 MG CAPSULE
THIOTHIXENE 10 MG CAPSULE
THIOTHIXENE 2 MG CAPSULE
THIOTHIXENE 5 MG CAPSULE
THRIVITE 19 TABLET
THRIVITE RX TABLET
THYROID 120 MG TABLET
THYROID 15 MG TABLET
THYROID 30 MG TABLET
THYROID 60 MG TABLET
THYROID 90 MG TABLET
THYROLAR-1 STRENGTH TABLET
THYROLAR-1/2 STRENGTH TAB
THYROLAR-1/4 STRENGTH TAB
THYROLAR-2 STRENGTH TABLET
THYROLAR-3 STRENGTH TABLET
TIADYLT ER 120 MG CAPSULE
TIADYLT ER 180 MG CAPSULE
TIADYLT ER 240 MG CAPSULE
TIADYLT ER 300 MG CAPSULE
TIADYLT ER 360 MG CAPSULE
TIADYLT ER 420 MG CAPSULE
TIAGABINE HCL 12 MG TABLET
TIAGABINE HCL 16 MG TABLET
TIAGABINE HCL 2 MG TABLET
TIAGABINE HCL 4 MG TABLET
TIAZAC ER 120 MG CAPSULE
TIAZAC ER 180 MG CAPSULE
TIAZAC ER 240 MG CAPSULE
TIAZAC ER 300 MG CAPSULE
TIAZAC ER 360 MG CAPSULE
TIAZAC ER 420 MG CAPSULE
TIBSOVO 250 MG TABLET
TICANASE KIT
TICASPRAY KIT
TICLOPIDINE 250 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TIGLUTIK 50 MG/10 ML SUSP
TIKOSYN 125 MCG CAPSULE
TIKOSYN 250 MCG CAPSULE
TIKOSYN 500 MCG CAPSULE
TILIA FE 28 TABLET
TIMOLOL 0.25% GEL-SOLUTION
TIMOLOL 0.25% GFS GEL-SOLUTION
TIMOLOL 0.5% EYE DROP
TIMOLOL 0.5% GEL-SOLUTION
TIMOLOL 0.5% GFS GEL-SOLUTION
TIMOLOL MALEATE 0.25% EYE DROP
TIMOLOL MALEATE 0.5% EYE DROPS
TIMOLOL MALEATE 10 MG TABLET
TIMOLOL MALEATE 20 MG TABLET
TIMOLOL MALEATE 5 MG TABLET
TIMOL 0.5%-BRIM 0.15%-DORZO 2%
TIMOLOL-BRIMONI-DORZOL-LATANOP
TIMOLOL 0.5%-DORZOLAMIDE 2%
TIMO 0.5%-DORZ 2%-LATAN 0.005%
TIMOLOL 0.5%-LATANOPROS 0.005%
TIMOPTIC 0.25% EYE DROP
TIMOPTIC 0.25% EYE DROPS
TIMOPTIC 0.5% EYE DROP
TIMOPTIC 0.5% EYE DROPS
TIMOPTIC 0.25% OCUDOSE DROP
TIMOPTIC 0.5% OCUDOSE DROP
TIMOPTIC-XE 0.25% EYE GEL-SOLN
TIMOPTIC-XE 0.25% EYE SOLN
TIMOPTIC-XE 0.5% EYE SOLN
TIMOPTIC-XE 0.5% GEL-SOLUTION
TIROSINT 100 MCG CAPSULE
TIROSINT 112 MCG CAPSULE
TIROSINT 125 MCG CAPSULE
TIROSINT 13 MCG CAPSULE
TIROSINT 137 MCG CAPSULE
TIROSINT 150 MCG CAPSULE
TIROSINT 175 MCG CAPSULE
TIROSINT 200 MCG CAPSULE
TIROSINT 25 MCG CAPSULE
TIROSINT 50 MCG CAPSULE
TIROSINT 75 MCG CAPSULE
TIROSINT 88 MCG CAPSULE
TIROSINT-SOL 100 MCG/ML SOLN
TIROSINT-SOL 112 MCG/ML SOLN
TIROSINT-SOL 125 MCG/ML SOLN
TIROSINT-SOL 13 MCG/ML SOLN
TIROSINT-SOL 137 MCG/ML SOLN
TIROSINT-SOL 150 MCG/ML SOLN
TIROSINT-SOL 175 MCG/ML SOLN
TIROSINT-SOL 200 MCG/ML SOLN
TIROSINT-SOL 25 MCG/ML SOLN
TIROSINT-SOL 50 MCG/ML SOLN
TIROSINT-SOL 75 MCG/ML SOLN
TIROSINT-SOL 88 MCG/ML SOLN
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TIVICAY 10 MG TABLET
TIVICAY 25 MG TABLET
TIVICAY 50 MG TABLET
TIZANIDINE HCL 2 MG CAPSULE
TIZANIDINE HCL 2 MG TABLET
TIZANIDINE HCL 4 MG CAPSULE
TIZANIDINE HCL 4 MG TABLET
TIZANIDINE HCL 6 MG CAPSULE
TL GARD RX TABLET
TOBAKIENT CAPSULE
TOBI 300 MG/5 ML SOLUTION
TOBI PODHALER 28 MG INHALE CAP
TOBRAMYCIN 300 MG/5 ML AMPULE
TOBRAMYCIN PAK 300 MG/5 ML
TOFRANIL 10 MG TABLET
TOFRANIL 25 MG TABLET
TOFRANIL 50 MG TABLET
TOLAZAMIDE 250 MG TABLET
TOLAZAMIDE 500 MG TABLET
TOLBUTAMIDE 500 MG TABLET
TOLCAPONE 100 MG TABLET
TOLMETIN SODIUM 200 MG TAB
TOLMETIN SODIUM 400 MG CAP
TOLMETIN SODIUM 600 MG TAB
TOLTERODINE TARTRATE 1 MG TAB
TOLTERODINE TARTRATE 2 MG TAB
TOLTERODINE TART ER 2 MG CAP
TOLTERODINE TART ER 4 MG CAP
TOPAMAX 100 MG TABLET
TOPAMAX 15 MG SPRINKLE CAP
TOPAMAX 200 MG TABLET
TOPAMAX 25 MG SPRINKLE CAP
TOPAMAX 25 MG TABLET
TOPAMAX 50 MG TABLET
TOPCARE CLICKFINE 31G X 1/4"
TOPCARE CLICKFINE 31G X 5/16"
TOPCARE ULTRA COMFORT SYRINGE
TOPCARE ULTRA COMFORT SYRINGE
TOPCARE ULTRA COMFORT SYRINGE
TOPCARE UNIVERSAL1 33G LANCETS
TOPCARE UNIVERSAL1 THIN LANCET
TOPIRAMATE 100 MG TABLET
TOPIRAMATE 15 MG SPRINKLE CAP
TOPIRAMATE 200 MG TABLET
TOPIRAMATE 25 MG SPRINKLE CAP
TOPIRAMATE 25 MG TABLET
TOPIRAMATE 50 MG TABLET
TOPIRAMATE ER 100 MG CAPSULE
TOPIRAMATE ER 150 MG CAPSULE
TOPIRAMATE ER 200 MG CAPSULE
TOPIRAMATE ER 25 MG CAPSULE
TOPIRAMATE ER 50 MG CAPSULE
TOPROL XL 100 MG TABLET
TOPROL XL 200 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TOPROL XL 25 MG TABLET
TOPROL XL 50 MG TABLET
TOREMIFENE CITRATE 60 MG TAB
TORSEMIDE 10 MG TABLET
TORSEMIDE 100 MG TABLET
TORSEMIDE 20 MG TABLET
TORSEMIDE 5 MG TABLET
TOTAL B WITH VIT C CAPLET
TOTALDAY MULTIPLE TABLET SA
TOUJEO MAX SOLOSTR 300 UNIT/ML
TOUJEO SOLOSTAR 300 UNIT/ML
TOVIAZ ER 4 MG TABLET
TOVIAZ ER 8 MG TABLET
TRACLEER 125 MG TABLET
TRACLEER 32 MG TABLET FOR SUSP
TRACLEER 62.5 MG TABLET
TRADJENTA 5 MG TABLET
TRANDOLAPRIL 1 MG TABLET
TRANDOLAPRIL 2 MG TABLET
TRANDOLAPRIL 4 MG TABLET
TRANDOLAPR-VERAPAM ER 1-240 MG
TRANDOLAPR-VERAPAM ER 2-180 MG
TRANDOLAPR-VERAPAM ER 2-240 MG
TRANDOLAPR-VERAPAM ER 4-240 MG
TRANEXAMIC ACID 650 MG TABLET
TRANYLCYPROMINE SULF 10 MG TAB
TRAVATAN Z 0.004% EYE DROP
TRAVOPROST 0.004% EYE DROP
TRAVOPROST 0.004% EYE DROP
TRAZIMERA 420 MG VIAL
TRAZODONE 100 MG TABLET
TRAZODONE 150 MG TABLET
TRAZODONE 300 MG TABLET
TRAZODONE 50 MG TABLET
TRELEGY ELLIPTA 100-62.5-25
TRELSTAR 11.25 MG VIAL
TRELSTAR 22.5 MG VIAL
TRELSTAR 3.75 MG VIAL
TREMFYA 100 MG/ML INJECTOR
TREMFYA 100 MG/ML SYRINGE
TREPROSTINIL 100 MG/20 ML VIAL
TREPROSTINIL 20 MG/20 ML VIAL
TREPROSTINIL 200 MG/20 ML VIAL
TREPROSTINIL 50 MG/20 ML VIAL
TRESIBA 100 UNIT/ML VIAL
TRESIBA FLEXTOUCH 100 UNIT/ML
TRESIBA FLEXTOUCH 200 UNIT/ML
TRETTEN 2,500 UNIT VIAL
TREXALL 10 MG TABLET
TREXALL 15 MG TABLET
TREXALL 5 MG TABLET
TREXALL 7.5 MG TABLET
TRI FEMYNOR 28 TABLET
TRIAMTERENE 100 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TRIAMTERENE 50 MG CAPSULE
TRIAMTERENE-HCTZ 37.5-25 MG CP
TRIAMTERENE-HCTZ 37.5-25 MG CP
TRIAMTERENE-HCTZ 37.5-25 MG TB
TRIAMTERENE-HCTZ 50-25 MG CAP
TRIAMTERENE-HCTZ 75-50 MG TAB
TRIBENZOR 20-5-12.5 MG TABLET
TRIBENZOR 40-10-12.5 MG TABLET
TRIBENZOR 40-10-25 MG TABLET
TRIBENZOR 40-5-12.5 MG TABLET
TRIBENZOR 40-5-25 MG TABLET
TRI-BUFFERED ASPIRIN 325 MG
TRI-BUFFERED ASPIRIN 325 MG TB
TRICARE PRENATAL TABLET
TRICARE PRENATAL CHEWABLE TAB
TRICARE PRENATAL DHA ONE SFTGL
TRICARE PRENATAL DHA ONE SFTGL
TRICARE PRENATAL WITH DHA PACK
TRICHOPHYTON 20,000 PNU/ML VL
TRICOR 145 MG TABLET
TRICOR 48 MG TABLET
TRI-ESTARYLLA TABLET
TRIFERIC 27.2 MG/5 ML AMPULE
TRIFERIC 272 MG POWDER PACKET
TRIFERIC 272 MG/50 ML AMPULE
TRIFLUOPERAZINE 1 MG TABLET
TRIFLUOPERAZINE 10 MG TABLET
TRIFLUOPERAZINE 2 MG TABLET
TRIFLUOPERAZINE 5 MG TABLET
TRIGLIDE 160 MG TABLET
TRIHEXYPHENIDYL 2 MG TABLET
TRIHEXYPHENIDYL 2 MG/5 ML ELX
TRIHEXYPHENIDYL 5 MG TABLET
TRIJARDY XR 10-5-1,000 MG TAB
TRIJARDY XR 12.5-2.5-1,000 MG
TRIJARDY XR 25-5-1,000 MG TAB
TRIJARDY XR 5-2.5-1,000 MG TAB
TRIKAFTA 100/50/75 MG-150 MG
TRIKLO 1 GM CAPSULE
TRI-LEGEST FE-28 DAY TABLET
TRILEPTAL 150 MG TABLET
TRILEPTAL 300 MG TABLET
TRILEPTAL 300 MG/5 ML SUSP
TRILEPTAL 600 MG TABLET
TRI-LINYAH TABLET
TRILIPIX DR 135 MG CAPSULE
TRILIPIX DR 45 MG CAPSULE
TRI-LO-ESTARYLLA TABLET
TRI-LO-MARZIA TABLET
TRI-LO-MILI TABLET
TRI-LO-SPRINTEC TABLET
TRI-MILI 28 TABLET
TRIMIPRAMINE MALEATE 100 MG CP
TRIMIPRAMINE MALEATE 25 MG CAP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TRIMIPRAMINE MALEATE 50 MG CAP
TRINATAL RX 1 TABLET
TRINATE TABLET
TRINAZ TABLET
TRINESSA TABLET
TRINESSA LO TABLET
TRI-NORINYL 28 TABLET
TRINTELLIX 10 MG TABLET
TRINTELLIX 20 MG TABLET
TRINTELLIX 5 MG TABLET
TRIPHROCAPS SOFTGEL
TRI-PREVIFEM TABLET
TRIPTODUR 22.5 MG KIT
TRI-SPRINTEC TABLET
TRISTART DHA SOFTGEL
TRIUMEQ 600-50-300 MG TABLET
TRIVEEN-DUO DHA COMBO PACK
TRI-VI-FLOR 0.25 MG DROPS
TRI-VI-FLOR 0.5 MG DROPS
TRI-VI-SOL DROPS
TRI-VIT-FLUOR-IRON 0.25 MG/ML
TRI-VITA DROPS
TRI-VITAMIN DROPS
TRI-VIT-FLUOR 0.25 MG/ML DROP
TRI-VIT-FLUOR 0.5 MG/ML DROP
TRI-VITE-FLUORIDE 0.25 MG/ML
TRI-VITE-FLUORIDE 0.5 MG/ML
TRIVORA-28 TABLET
TRI-VYLIBRA 28 TABLET
TRI-VYLIBRA LO TABLET
TRIZIVIR TABLET
TROGARZO 200 MG/1.33 ML VIAL
TROKENDI XR 100 MG CAPSULE
TROKENDI XR 200 MG CAPSULE
TROKENDI XR 25 MG CAPSULE
TROKENDI XR 50 MG CAPSULE
TROPICAL LIQUID NUTRITION
TROSPIUM CHLORIDE 20 MG TABLET
TROSPIUM CHLORIDE ER 60 MG CAP
TRUE COMFORT 1 ML 31GX5/16"
TRUE COMFORT 0.5 ML 31GX5/16"
TRUE COMFORT 30G LANCET
TRUE COMFORT PEN NDL 31GX5MM
TRUE COMFORT PEN NDL 31GX6MM
TRUE COMFORT PEN NDL 32GX4MM
TRUE METRIX LEVEL 3 CTRL SOLN
TRUE METRIX LEVEL 1 CTRL SOLN
TRUE METRIX LEVEL 2 CTRL SOLN
HUMANA TRUE METRIX AIR GLU MTR
HUMANA TRUE METRIX AIR METER
TRUE METRIX AIR GLUCOSE METER
TRUE METRIX BLOOD GLUCOSE MTR
HUMANA TRUE METRIX TEST STRIP
TRUE METRIX GLUCOSE TEST STRIP
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TRUE METRIX GO GLUCOSE METER
TRUE2GO BLOOD GLUCOSE SYSTEM
TRUECONTROL GLUCOSE SOLUTION
TRUECONTROL GLUCOSE SOLUTION
TRUEPLUS SYR 1ML 28GX1/2"
TRUEPLUS SYR 1ML 29GX1/2"
TRUEPLUS SYR 1ML 30GX5/16"
TRUEPLUS SYR 1ML 31GX5/16"
TRUEPLUS SYR 0.5ML 28GX1/2"
TRUEPLUS SYR 0.5ML 29GX1/2"
TRUEPLUS SYR 0.5ML 30GX5/16"
TRUEPLUS SYR 0.5ML 31GX5/16"
TRUEPLUS SYR 0.3ML 29GX1/2"
TRUEPLUS SYR 0.3ML 30GX5/16"
TRUEPLUS SYR 0.3ML 31GX5/16"
TRUEPLUS KETONE TEST STRIP
TRUEPLUS SAFETY 28G LANCET
TRUEPLUS 26G LANCETS
TRUEPLUS 30G LANCETS
TRUEPLUS 33G LANCETS
TRUEPLUS SAFETY 28G LANCET
TRUEPLUS SAFETY 28G LANCETS
TRUEPLUS SUPER THIN 28G LANCET
TRUEPLUS ULTRA THIN 30G LANCET
TRUEPLUS DIABETIC MULTIVITAMIN
TRUEPLUS PEN NEEDLE 29GX1/2"
TRUEPLUS PEN NEEDLE 31G X 1/4"
TRUEPLUS PEN NEEDLE 31GX3/16"
TRUEPLUS PEN NEEDLE 31GX5/16"
TRUEPLUS PEN NEEDLE 32GX5/32"
HUMANA TRUERESULT GLUCOSE MTR
TRUERESULT BLOOD GLUCOSE SYSTM
TRUETEST CONTROL SOLN HIGH
TRUETEST CONTROL SOLUTION LOW
TRUETEST CONTROL SOLN NORMAL
HUMANA TRUETEST TEST STRIPS
TRUETEST GLUCOSE TEST STRIP
TRUETEST GLUCOSE TEST STRIPS
TRUETRACK BLOOD GLUCOSE SYSTEM
TRUETRACK SMART SYSTEM
TRUETRACK GLUCOSE TEST STRIPS
TRULANCE 3 MG TABLET
TRULICITY 0.75 MG/0.5 ML PEN
TRULICITY 1.5 MG/0.5 ML PEN
TRUSOPT 2% EYE DROPS
TRUST NATAL DHA
TRUSTEEL INFUSION SET 23" 6MM
TRUSTEEL INFUSION SET 23" 8MM
TRUSTEEL INFUSION SET 32" 6MM
TRUSTEEL INFUSION SET 32" 8MM
TRUVADA 100 MG-150 MG TABLET
TRUVADA 133 MG-200 MG TABLET
TRUVADA 167 MG-250 MG TABLET
TRUVADA 200 MG-300 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
TUDORZA PRESSAIR 400 MCG INHAL
TULANA 0.35 MG TABLET
TURALIO 200 MG CAPSULE
TWIST LANCETS 30G
TWIST LANCETS 32G
TWYNSTA 40-10 MG TABLET
TWYNSTA 40-5 MG TABLET
TWYNSTA 80-10 MG TABLET
TWYNSTA 80-5 MG TABLET
TYBOST 150 MG TABLET
TYDEMY TABLET
TYKERB 250 MG TABLET
TYMLOS 80 MCG DOSE PEN INJECTR
TYR COOLER LIQUID
TYSABRI 300 MG/15 ML VIAL
TYVASO 1.74 MG/2.9 ML SOLUTION
TYVASO INHALATION REFILL KIT
UDAMIN SP CAPLET
ULORIC 40 MG TABLET
ULORIC 80 MG TABLET
ULTICARE SYR 1 ML 30GX5/16"
ULTICARE SYRINGE 1 ML 29GX1/2"
ULTICARE INS SYR 1 ML 30GX1/2"
ULTICARE SYR 1 ML 31GX5/16"
ULTICARE SYRINGE 1 ML 30GX1/2"
ULTICARE INS 0.5 ML 30GX1/2"
ULTICARE SYR 0.5 ML 30GX1/2"
ULTICARE SYR 0.5 ML 31GX5/16"
ULTICARE INS 0.3 ML 30GX1/2"
ULTICARE SYR 0.3 ML 30GX1/2"
ULTICARE SYR 0.3 ML 31GX5/16"
ULTICARE SYR 0.3 ML 29GX1/2"
ULTICARE SYR 0.3 ML 30GX5/16"
ULTICARE SYR 0.5 ML 29GX1/2"
ULTICARE SYR 0.5 ML 30GX5/16"
ULTICAR INS 0.3ML 31GX1/4(1/2)
ULTICARE INS 1 ML 31GX1/4"
ULTICARE INS 0.5 ML 31GX1/4"
ULTICARE INS 0.3 ML 31GX1/4"
HM ULTICARE PEN NEEDLE 4MM 32G
HM ULTICARE PEN NEEDLE 6MM 31G
HM ULTICARE PEN NEEDLE 8MM 31G
ULTICARE PEN NDL 12.7 MM 29G
ULTICARE PEN NEEDLE 31GX3/16"
ULTICARE PEN NEEDLE 4MM 32G
ULTICARE PEN NEEDLE 6MM 31G
ULTICARE PEN NEEDLE 8 MM 31G
ULTICARE PEN NEEDLE 8MM 31G
ULTICARE PEN NEEDLES 12MM 29G
ULTICARE PEN NEEDLES 4MM 32G
ULTICARE PEN NEEDLES 6MM 31G
ULTICARE PEN NEEDLES 6MM 32G
ULTICARE PEN NEEDLES 8MM 31G
YOURX ULTICARE PEN NDL 4MM 32G
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
YOURX ULTICARE PEN NDL 6MM 31G
YOURX ULTICARE PEN NDL 8MM 31G
ULTIGUARD SAFE PACK 31GX1/4"
ULTIGUARD SAFE PACK 31GX3/16"
ULTIGUARD SAFE PACK 31GX5/16"
ULTIGUARD SAFE PACK 32GX1/4"
ULTIGUARD SAFE PACK 32GX5/32"
ULTI-LANCE AUTO-AD DEVICE
ULTILET BASIC 30G LANCETS
ULTILET CLASSIC 26G LANCETS
ULTILET CLASSIC 28G LANCETS
ULTILET CLASSIC 30G LANCETS
ULTILET CLASSIC 33G LANCETS
INSULIN SYRINGE 1 ML
ULTILET INSULIN SYRINGE 1 ML
INSULIN SYRINGE 0.5 ML
ULTILET INSULIN SYRINGE 0.5 ML
INSULIN SYRINGE 0.3 ML
ULTILET INSULIN SYRINGE 0.3 ML
ULTILET 28G LANCETS
ULTILET 30G LANCETS
ULTILET 33G LANCETS
ULTILET PEN NEEDLE
ULTILET PEN NEEDLE 4MM 32G
ULTILET SAFETY 23G LANCETS
RELION ULTIMA TEST STRIPS
ULTIMA TEST STRIPS
RELION ULTIMA GLUCOSE METER
SM ULTIMATE MEN'S COMPLETE TAB
HM ULTIMATE WOMEN'S 50+ TABLET
SM ULTIMATE WOMEN'S 50+ TABLET
ULTIMATECARE ONE CAPSULE
ULTIMATECARE ONE NF CAPSULE
ULTOMIRIS 300 MG/30 ML VIAL
ULTRA B-100 COMPLEX TABLET
GNP ULT C 0.3ML 29GX1/2" (1/2)
SM ULT CFT 0.3ML 31GX5/16(1/2)
ULT CFT 0.3 ML 29GX1/2" (1/2)
ULT CFT 0.3 ML 30GX5/16" (1/2)
ULT CFT 0.3 ML 31GX5/16" (1/2)
DRUG MART ULTRA COMFORT SYR
GNP ULTR COMFORT 1 ML 29GX1/2"
GNP ULTRA COMFORT 1 ML SYRINGE
GNP ULTRA COMFRT 1 ML 28GX1/2"
ULTRA COMFORT 1 ML 28GX1/2"
ULTRA COMFORT 1 ML 29GX1/2"
ULTRA COMFORT 1 ML 30GX5/16"
ULTRA COMFORT 1 ML 31GX5/16"
ULTRA COMFORT 1 ML SYRINGE
DRUG MART ULTRA COMFORT SYR
GNP ULT CMFRT 0.5 ML 29GX1/2"
GNP ULTR CMFRT 0.5 ML 28GX1/2"
GNP ULTR CMFRT 0.5 ML 30GX5/16
GNP ULTRA COMFORT 0.5 ML SYR
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ULTRA COMFORT 0.5 ML 28GX1/2"
ULTRA COMFORT 0.5 ML 29GX1/2"
ULTRA COMFORT 0.5 ML 30GX5/16"
ULTRA COMFORT 0.5 ML 31GX5/16"
ULTRA COMFORT 0.5 ML SYRINGE
DRUG MART ULTRA COMFORT SYR
GNP ULTRA COMFORT 3/10 ML SYR
ULTRA COMFORT 0.3 ML 29GX1/2"
ULTRA COMFORT 0.3 ML SYRINGE
ULTRA FREEDA TABLET
ULTRA FREEDA WITH IRON TABLET
ULTRA THIN PEN NDL 32G X 4MM
ULTRA THIN 31G LANCET
CVS ULTRA THIN 30G LANCETS
LIVE BETTER ULTRA THIN LANCET
PHARMACIST CHOICE 28G LANCETS
RELION ULTRA THIN 30G LANCETS
ULTRA THIN 28G LANCETS
ULTRA THIN 30G LANCETS
ULTRA THIN 31G LANCETS
ULTRA THIN 33G LANCETS
WALGREENS ULTRA THIN LANCETS
RELION ULTRA THIN PLUS LANCETS
RELION ULTRA THIN PLUS 33G
ULTRACARE INS 1 ML 30G X 5/16"
ULTRACARE INS 1 ML 30GX1/2"
ULTRACARE INS 1 ML 31G X 5/16"
ULTRACARE INS 0.5 ML 30GX1/2"
ULTRACARE INS 0.5 ML 30GX5/16"
ULTRACARE INS 0.5 ML 31GX5/16"
ULTRACARE INS 0.3 ML 30GX5/16"
ULTRACARE INS 0.3 ML 31GX5/16"
ULTRA-CARE 30G LANCETS
ULTRACARE PEN NEEDLE 31GX1/4"
ULTRACARE PEN NEEDLE 31GX3/16"
ULTRACARE PEN NEEDLE 31GX5/16"
ULTRACARE PEN NEEDLE 32GX1/4"
ULTRACARE PEN NEEDLE 32GX3/16"
ULTRACARE PEN NEEDLE 32GX5/32"
ULTRACARE PEN NEEDLE 33GX5/32"
BD UF MICRO PEN NEEDLE 6MMX32G
BD UF MINI PEN NEEDLE 5MMX31G
BD UF NANO PEN NEEDLE 4MMX32G
BD UF ORIG PEN NDL 12.7MMX29G
BD UF SHORT PEN NEEDLE 8MMX31G
ULTRALANCE 26G LANCETS
ULTRALANCE 28G LANCETS
ULTRA-THIN II 26G LANCET
ULTRA-THIN II 28G LANCETS
ULTRA-THIN II 30G LANCETS
ULTRA-THIN II PEN NDL 29GX1/2"
ULTRA-THIN II PEN NDL 31GX5/16
ULTRA-THIN II 1 ML 31GX5/16"
ULTRA-THIN II INS SYR 1 ML 29G
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ULTRA-THIN II INS SYR 1 ML 30G
ULTRA-THIN II INS 0.5 ML 29G
ULTRA-THIN II INS 0.5 ML 30G
ULTRA-THIN II INS 0.5 ML 31G
ULTRA-THIN II INS 0.3 ML 29G
ULTRA-THIN II INS 0.3 ML 30G
ULTRA-THIN II INS 0.3 ML 31G
ULTRATLC LANCETS
ULTRATRAK CONTROL SOLUTION
ULTRATRAK TEST STRIP
ULTRATRAK CONTROL SOL NORMAL
ULTRATRAK BLOOD GLUCOSE METER
ULTRATRAK PRO GLUCOSE MTR SYS
ULTRATRAK PRO METER KIT
ULTRATRAK ULTIMATE CNTRL SOLN
ULTRATRAK ULTIMATE TEST STRIPS
ULTRATRAK ULTIMATE GLUCOSE MTR
UNICOMPLEX-M TABLET
CAREONE UNIFINE PENTIP 4MM 32G
CAREONE UNIFINE PENTIP 5MM 31G
CAREONE UNIFINE PENTIP 6MM 31G
CAREONE UNIFINE PENTIP 8MM 31G
CAREONE UNIFINE PNTP 12MM 29G
PC UNIFINE PENTIPS 12MM NEEDLE
PC UNIFINE PENTIPS 6MM NEEDLE
PC UNIFINE PENTIPS 8MM NEEDLE
QC UNIFINE PENTIPS 32GX5/32"
SHOPKO UNIFINE PENTIPS 4MM 32G
SHOPKO UNIFINE PENTIPS 5MM 31G
SHOPKO UNIFINE PENTIPS 8MM 31G
SHOPKO UNIFINE PNTIPS 12MM 29G
UNIFINE PENTIPS 12MM 29G
UNIFINE PENTIPS 31GX3/16"
UNIFINE PENTIPS 32GX1/4"
UNIFINE PENTIPS 32GX5/32"
UNIFINE PENTIPS 33GX5/32"
UNIFINE PENTIPS 6MM 31G
UNIFINE PENTIPS 6MM NEEDLE
UNIFINE PENTIPS 8MM 31G
UNIFINE PENTIPS 8MM NEEDLE
UNIFINE PENTIPS NEEDLES 29G
CAREONE UNIFINE PENTP 29GX1/2"
CAREONE UNIFINE PENTP 31GX1/4"
CAREONE UNIFINE PNTP 31GX3/16"
CAREONE UNIFINE PNTP 31GX5/16"
CAREONE UNIFINE PNTP 32GX5/32"
HEB UNIFINE PNTP PLUS 31GX3/16
PUB UNIFINE PNTP PLUS 31GX3/16
SHOPKO UNIFINE PENTIPS 4MM 32G
SHOPKO UNIFINE PENTIPS 5MM 31G
SHOPKO UNIFINE PENTIPS 8MM 31G
SHOPKO UNIFINE PNTIPS 12MM 29G
UNIFINE PENTIPS PLUS 29GX1/2"
UNIFINE PENTIPS PLUS 31GX1/4"
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
UNIFINE PENTIPS PLUS 31GX3/16"
UNIFINE PENTIPS PLUS 31GX5/16"
UNIFINE PENTIPS PLUS 32GX5/32"
UNIFINE PENTIPS PLUS 33GX5/32"
WM UNIFINE PENTIP PLUS 4MM 32G
WM UNIFINE PENTIP PLUS 5MM 31G
WM UNIFINE PENTIP PLUS 6MM 31G
WM UNIFINE PENTIP PLUS 8MM 31G
UNIFINE SAFECONTROL 30GX3/16"
UNILET COMFORTOUCH 26G LANCETS
UNILET COMFORTOUCH LANCET
UNILET EXCELITE LANCET
UNILET EXCELITE II LANCET
UNILET GP LANCET
UNILET GP LANCET SUPERLITE
UNILET MICRO THIN 33G LANCET
FIFTY50 UNILET 33G LANCETS
QC UNILET SUPER THIN 30G LANCT
QC UNILET ULTRA THIN 28G LANCT
SHOPKO UNILET SUPER THIN 30G
SHOPKO UNILET ULTRA THIN 28G
UNILET MICRO THIN 33G LANCETS
UNILET SUPER THIN 30G LANCETS
UNILET ULTRA THIN 28G LANCETS
UNISTIK 2 1.8 MM LANCING DEVIC
UNISTIK 2 2.4 MM DEVICE
UNISTIK 2 COMFORT 1.8 MM DEVIC
UNISTIK-2 3 MM DEVICE
UNISTIK 2 NORMAL 0.81MM DEVICE
UNISTIK 3 COMFORT LANCET
UNISTIK 3 GENTLE 30G LANCETS
UNISTIK 3 GENTLE ON-THE-GO 30G
UNISTIK 3 NORMAL 23G LANCETS
UNISTIK 3 SAFETY 21G LANCETS
UNISTIK 3 1.8 MM LANCING DEVIC
UNISTIK 3 COMFORT 1.8 ML DEVIC
UNISTIK 3 EXTRA 21G LANCETS
UNISTIK 3 NEONATAL 1.8 ML DEV
UNISTIK CZT COMFORT 28G LANCET
UNISTIK CZT NORMAL 23G LANCETS
UNISTIK PRO 21G LANCET
UNISTIK PRO 25G LANCET
UNISTIK PRO 28G LANCET
UNISTIK SAFETY 28G LANCET
UNISTIK SAFETY 30G LANCETS
UNISTIK TOUCH 21G LANCETS
UNISTIK TOUCH 23G LANCETS
UNISTIK TOUCH 28G LANCETS
UNISTIK TOUCH 30G LANCETS
UNISTRIP CONTROL SOLUTION HIGH
UNISTRIP CONTROL SOLUTION LOW
UNISTRIP1 GLUCOSE TEST STRIP
UNITHROID 100 MCG TABLET
UNITHROID 112 MCG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
UNITHROID 125 MCG TABLET
UNITHROID 137 MCG TABLET
UNITHROID 150 MCG TABLET
UNITHROID 175 MCG TABLET
UNITHROID 200 MCG TABLET
UNITHROID 25 MCG TABLET
UNITHROID 300 MCG TABLET
UNITHROID 50 MCG TABLET
UNITHROID 75 MCG TABLET
UNITHROID 88 MCG TABLET
GNP UNIVERSAL 1 STANDARD 21G
GNP UNIVERSAL 1 SUPER THIN 30G
GNP UNIVERSAL 1 THIN 26G LANCT
GS UNIVERSAL 1 MICRO THIN 33G
GS UNIVERSAL 1 THIN 26G LANCET
GS UNIVERSAL 1 ULTRA THIN 30G
KRO UNIVERSAL 1 THIN 26G LANCT
MEIJER UNIVERSAL 1 26G LANCETS
REXALL UNIVERSAL 1 30G LANCETS
UNIVERSAL 1 33G LANCETS
UPTRAVI 1,000 MCG TABLET
UPTRAVI 1,200 MCG TABLET
UPTRAVI 1,400 MCG TABLET
UPTRAVI 1,600 MCG TABLET
UPTRAVI 200 MCG TABLET
UPTRAVI 400 MCG TABLET
UPTRAVI 600 MCG TABLET
UPTRAVI 800 MCG TABLET
URECHOLINE 10 MG TABLET
URECHOLINE 25 MG TABLET
URECHOLINE 5 MG TABLET
URECHOLINE 50 MG TABLET
UROCIT-K ER 15 MEQ TABLET
UROCIT-K SR 10 MEQ TABLET
UROCIT-K SR 5 MEQ TABLET
UROSEX TABLET
UROXATRAL 10 MG TABLET
URSO 250 MG TABLET
URSO FORTE 500 MG TABLET
URSODIOL 250 MG TABLET
URSODIOL 300 MG CAPSULE
URSODIOL 500 MG TABLET
UTIBRON NEOHALER 27.5-15.6 MCG
VAGIFEM 10 MCG VAGINAL TAB
VALACYCLOVIR HCL 1 GRAM TABLET
VALACYCLOVIR HCL 500 MG TABLET
VALCHLOR 0.016% GEL
VALCYTE 450 MG TABLET
VALCYTE 50 MG/ML SOLUTION
VALGANCICLOVIR 450 MG TABLET
VALGANCICLOVIR HCL 50 MG/ML
VALPROIC ACID 250 MG CAPSULE
VALPROIC ACID 250 MG/5 ML ORAL
VALPROIC ACID 250 MG/5 ML SOLN
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
VALPROIC ACID 500 MG/10 ML SOL
VALSARTAN 160 MG TABLET
VALSARTAN 320 MG TABLET
VALSARTAN 40 MG TABLET
VALSARTAN 80 MG TABLET
VALSARTAN-HCTZ 160-12.5 MG TAB
VALSARTAN-HCTZ 160-25 MG TAB
VALSARTAN-HCTZ 320-12.5 MG TAB
VALSARTAN-HCTZ 320-25 MG TAB
VALSARTAN-HCTZ 80-12.5 MG TAB
VALTREX 1 GM CAPLET
VALTREX 500 MG CAPLET
VANISHPOINT U-100 29X1/2 SYR
VANISHPOINT 0.5 ML 30GX1/2" SY
VANISHPOINT INS 1 ML 30GX3/16"
VANTAS 50 MG KIT
VARDENAFIL HCL 10 MG ODT
VARDENAFIL HCL 10 MG TABLET
VARDENAFIL HCL 2.5 MG TABLET
VARDENAFIL HCL 20 MG TABLET
VARDENAFIL HCL 5 MG TABLET
VARISOFT INFUSION SET 23" 13MM
VARISOFT INFUSION SET 23" 17MM
VARISOFT INFUSION SET 32" 13MM
VARISOFT INFUSION SET 32" 17MM
VARISOFT INFUSION SET 43" 13MM
VARISOFT INFUSION SET 43" 17MM
VASCEPA 0.5 GM CAPSULE
VASCEPA 1 GM CAPSULE
VASERETIC 10-25 MG TABLET
VASOTEC 10 MG TABLET
VASOTEC 2.5 MG TABLET
VASOTEC 20 MG TABLET
VASOTEC 5 MG TABLET
VB7 MAX POWDER
V-C FORTE CAPSULE
VECAMYL 2.5 MG TABLET
VELETRI 0.5 MG VIAL
VELETRI 1.5 MG VIAL
VELIVET 28 DAY TABLET
VELPHORO 500 MG CHEWABLE TAB
VELTASSA 16.8 GM POWDER PACKET
VELTASSA 25.2 GM POWDER PACKET
VELTASSA 8.4 GM POWDER PACKET
VEMAVITE-PRX 2 CAPSULE
VEMLIDY 25 MG TABLET
VENCLEXTA 10 MG TABLET
VENCLEXTA 100 MG TABLET
VENCLEXTA 50 MG TABLET
VENLAFAXINE HCL 100 MG TABLET
VENLAFAXINE HCL 25 MG TABLET
VENLAFAXINE HCL 37.5 MG TABLET
VENLAFAXINE HCL 50 MG TABLET
VENLAFAXINE HCL 75 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
VENLAFAXINE HCL ER 150 MG CAP
VENLAFAXINE HCL ER 150 MG TAB
VENLAFAXINE HCL ER 225 MG TAB
VENLAFAXINE HCL ER 37.5 MG CAP
VENLAFAXINE HCL ER 37.5 MG TAB
VENLAFAXINE HCL ER 75 MG CAP
VENLAFAXINE HCL ER 75 MG TAB
VENTAVIS 10 MCG/1 ML SOLUTION
VENTAVIS 20 MCG/1 ML SOLUTION
VENTOLIN HFA 90 MCG INHALER
BD VEO INS 0.3ML 6MMX31G (1/2)
BD VEO INS SYRING 1 ML 6MMX31G
BD VEO INS SYRN 0.5 ML 6MMX31G
BD VEO INS SYRN 0.3 ML 6MMX31G
VERAMYST 27.5 MCG NASAL SPRAY
VERAPAMIL ER 120 MG CAPSULE
VERAPAMIL ER 120 MG TABLET
VERAPAMIL ER 180 MG CAPSULE
VERAPAMIL ER 180 MG TABLET
VERAPAMIL ER 240 MG CAPSULE
VERAPAMIL ER 240 MG TABLET
VERAPAMIL ER PM 100 MG CAPSULE
VERAPAMIL ER PM 200 MG CAPSULE
VERAPAMIL ER PM 300 MG CAPSULE
VERAPAMIL 120 MG TABLET
VERAPAMIL 360 MG CAP PELLET
VERAPAMIL 40 MG TABLET
VERAPAMIL 80 MG TABLET
VERAPAMIL SR 120 MG CAPSULE
VERAPAMIL SR 180 MG CAPSULE
VERAPAMIL SR 240 MG CAPSULE
VERASENS BLOOD GLUCOSE METER
VERASENS CONTROL SOLN-LEVEL 1
VERASENS METER STARTER KIT
VERASENS TEST STRIP
VERELAN 120 MG CAP PELLET
VERELAN 180 MG CAP PELLET
VERELAN 240 MG CAP PELLET
VERELAN 360 MG CAP PELLET
VERELAN PM 100 MG CAP PELLET
VERELAN PM 200 MG CAP PELLET
VERELAN PM 300 MG CAP PELLET
VERSACLOZ 50 MG/ML SUSPENSION
VERZENIO 100 MG TABLET
VERZENIO 150 MG TABLET
VERZENIO 200 MG TABLET
VERZENIO 50 MG TABLET
VESICARE 10 MG TABLET
VESICARE 5 MG TABLET
VESTURA 3 MG-0.02 MG TABLET
V-GO 20 DISPOSABLE DEVICE
V-GO 30 DISPOSABLE DEVICE
V-GO 40 DISPOSABLE DEVICE
VIAGRA 100 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
VIAGRA 25 MG TABLET
VIAGRA 50 MG TABLET
VIBERZI 100 MG TABLET
VIBERZI 75 MG TABLET
VIC-FORTE CAPSULE
VICTOZA 2-PAK 18 MG/3 ML PEN
VICTOZA 3-PAK 18 MG/3 ML PEN
VIDEX 2 GM PEDIATRIC SOLN
VIDEX 4 GM PEDIATRIC SOLN
VIDEX EC 125 MG CAPSULE
VIDEX EC 200 MG CAPSULE
VIDEX EC 250 MG CAPSULE
VIDEX EC 400 MG CAPSULE
VIENVA-28 TABLET
VIGABATRIN 500 MG POWDER PACKT
VIGABATRIN 500 MG TABLET
VIGADRONE 500 MG POWDER PACKET
VIIBRYD 10 MG TABLET
VIIBRYD 20 MG TABLET
VIIBRYD 40 MG TABLET
VIMIZIM 5 MG/5 ML VIAL
VIMOVO DR 375-20 MG TABLET
VIMOVO DR 500-20 MG TABLET
VIMPAT 10 MG/ML SOLUTION
VIMPAT 100 MG TABLET
VIMPAT 150 MG TABLET
VIMPAT 200 MG TABLET
VIMPAT 50 MG TABLET
VINACAL B PRENATAL COMBO PACK
VINATE CARE CHEWABLE TABLET
VINATE DHA RF GELCAP
VINATE ONE TABLET
VINATE-M TABLET
VIOKACE 10,440-39,150 UNITS TB
VIOKACE 20,880-78,300 UNITS TB
VIORELE 28 DAY TABLET
VIRACEPT 250 MG TABLET
VIRACEPT 625 MG TABLET
VIRAMUNE 200 MG TABLET
VIRAMUNE 50 MG/5 ML SUSP
VIRAMUNE XR 100 MG TABLET
VIRAMUNE XR 400 MG TABLET
VIREAD 150 MG TABLET
VIREAD 200 MG TABLET
VIREAD 250 MG TABLET
VIREAD 300 MG TABLET
VIREAD POWDER
VIRGINIA LIVE OAK 1:20 (W/V)
VIRT-ADVANCE TABLET
VIRT-C DHA SOFTGEL
VIRT-CAPS SOFTGEL
VIRT-GARD TABLET
VIRT-NATE TABLET
VIRT-NATE DHA SOFTGEL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
VIRT-PN TABLET
VIRT-PN DHA SOFTGEL
VIRT-PN PLUS SOFTGEL
VIRTPREX CAPSULE
VIRT-SELECT CAPSULE
VIRT-VITE TABLET
VIRT-VITE FORTE TABLET
VIRT-VITE GT TABLET
VISION FORMULA TABLET
VISION FORMULA SOFTGEL
CVS VISION FORMULA TABLET
EQ VISION FORMULA TABLET
VISION FORMULA WITH LUTEIN TAB
VISION PLUS LUTEIN VITAMIN TAB
VISION VITAMINS TABLET
BP VIT 3 CAPSULE
VITA-BEE WITH C TABLET
VITABEX PLUS CAPSULE
VITACEL TABLET
VITAFOL FE PLUS SOFTGEL
VITAFOL FE+ DOCUSATE COMBO PCK
VITAFOL GUMMIES
VITAFOL NANO TABLET
VITAFOL ULTRA SOFTGEL
VITAFOL-OB CAPLET
VITAFOL-OB+DHA COMBO PACK
VITAFOL-ONE CAPSULE
VITALEE TABLET
VITALETS TABLET CHEWABLE
VITALETS TABLET CHEWABLE
VITAMEDMD ONE RX SOFTGEL
VITAMEDMD REDICHEW RX TAB CHEW
VITAMIN A & D CAPSULE
VITAMIN AND MINERALS TABLET
B COMPLEX CAPSULE
B COMPLEX TABLET
B-COMPLEX WITH B12 TABLET
EQL B COMPLEX 50 TABLET
RA B-COMPLEX-VITAMIN B-12 TAB
VITAMIN B COMPLEX CAPSULE
VITAMIN B COMPLEX SOFTGEL
VITAMIN B COMPLEX TABLET
SM VITAMIN B COMPLEX TABLET
VITAMIN B COMPLEX TABLET
SM VITAMIN B-100 COMPLEX TAB
VITAMIN B-100 COMPLEX TABLET
VITAMIN B-50 COMPLEX TABLET
RA B-COMPLEX WITH VIT C TAB SA
B-COMPLEX W-VITAMIN C CAPLET
CVS B-COMPLEX-VIT C CAPLET
VITAMIN B COMPLEX-VIT C CAP
VITAMIN B COMPLEX-VIT C CAPLET
VITAMIN D2 1.25MG(50,000 UNIT)
VITAMIN D3-ALOE 1,000 UNIT TAB
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
VITAMIN-MINERAL LIQUID
VIT A,C,D-FLUORIDE 0.25 MG/ML
VIT A,C,D-FLUORIDE 0.5 MG/ML
VIT A,D,C-FLUORIDE 0.25 MG/ML
VITAMINS A-D-E TABLET
VITAMINS FOR HAIR TABLET
VITAPEARL SOFTGEL
VITATRUE COMBO PACK
VITATRUM TABLET
VITEKTA 150 MG TABLET
VITEKTA 85 MG TABLET
VITRAKVI 100 MG CAPSULE
VITRAKVI 20 MG/ML SOLUTION
VITRAKVI 25 MG CAPSULE
VITRUM 50 PLUS SENIOR TABLET
VITRUM SENIOR TABLET
VIVAGUARD INO CONTROL SOLUTION
VIVAGUARD INO GLUCOSE METER
VIVAGUARD INO TEST STRIP
VIVAGUARD LANCET
VIVELLE-DOT 0.025 MG PATCH
VIVELLE-DOT 0.0375 MG PATCH
VIVELLE-DOT 0.05 MG PATCH
VIVELLE-DOT 0.075 MG PATCH
VIVELLE-DOT 0.1 MG PATCH
VIVITROL 380 MG VIAL + DILUENT
VIVLODEX 10 MG CAPSULE
VIVLODEX 5 MG CAPSULE
VIZIMPRO 15 MG TABLET
VIZIMPRO 30 MG TABLET
VIZIMPRO 45 MG TABLET
VOCALPOINT GLUCOSE CONTROL SOL
VOGELXO 12.5 MG/1.25 GRAM PUMP
VOGELXO 50 MG/5 GRAM GEL
VOGELXO 50 MG/5 GRAM GEL PACKT
VOL-CARE RX TABLET
VOL-NATE TABLET
VOLNEA 0.15-0.02-0.01 MG TAB
VOL-PLUS TABLET
VOL-TAB RX TABLET
VOLTAREN-XR 100 MG TABLET
VOTRIENT 200 MG TABLET
VP-CH-PNV PRENATAL SOFTGEL
VP-GGR-B6 TABLET
VP-HEME OB TABLET
VP-HEME ONE SOFTGEL
VP-PNV-DHA SOFTGEL
VPRIV 400 UNITS VIAL
VP-VITE RX TABLET
VRAYLAR 1.5 MG CAPSULE
VRAYLAR 3 MG CAPSULE
VRAYLAR 4.5 MG CAPSULE
VRAYLAR 6 MG CAPSULE
VUMERITY DR 231 MG CAPSULE
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
VYEPTI 100 MG/ML VIAL
VYFEMLA 28 TABLET
VYLIBRA 28 TABLET
VYNDAMAX 61 MG CAPSULE
VYNDAQEL 20 MG CAPSULE
VYONDYS-53 100 MG/2 ML VIAL
VYTORIN 10-10 MG TABLET
VYTORIN 10-20 MG TABLET
VYTORIN 10-40 MG TABLET
VYTORIN 10-80 MG TABLET
VYVANSE 10 MG CAPSULE
VYVANSE 10 MG CHEWABLE TABLET
VYVANSE 20 MG CAPSULE
VYVANSE 20 MG CHEWABLE TABLET
VYVANSE 30 MG CAPSULE
VYVANSE 30 MG CHEWABLE TABLET
VYVANSE 40 MG CAPSULE
VYVANSE 40 MG CHEWABLE TABLET
VYVANSE 50 MG CAPSULE
VYVANSE 50 MG CHEWABLE TABLET
VYVANSE 60 MG CAPSULE
VYVANSE 60 MG CHEWABLE TABLET
VYVANSE 70 MG CAPSULE
VYZULTA 0.024% OPHTH SOLUTION
WAKIX 17.8 MG TABLET
WAKIX 4.45 MG TABLET
WAL-PROFEN 200 MG CAPLET
WAL-PROFEN 200 MG CAPSULE
WAL-PROFEN 200 MG SOFTGEL
WAL-PROFEN 200 MG TABLET
WAL-PROXEN 220 MG CAPLET
WAL-PROXEN 220 MG TABLET
WAL-ZAN 150 MG TABLET
WAL-ZAN 75 MG TABLET
WARFARIN SODIUM 1 MG TABLET
WARFARIN SODIUM 10 MG TABLET
WARFARIN SODIUM 2 MG TABLET
WARFARIN SODIUM 2.5 MG TABLET
WARFARIN SODIUM 3 MG TABLET
WARFARIN SODIUM 4 MG TABLET
WARFARIN SODIUM 5 MG TABLET
WARFARIN SODIUM 6 MG TABLET
WARFARIN SODIUM 7.5 MG TABLET
WASP VENOM PROTEIN 100 MCG/ML
WASP VENOM PROTEIN 550 MCG VL
WAVESENSE AMP SYSTEM KIT
WAVESENSE CONTROL SOLN NORMAL
WAVESENSE JAZZ TEST STRIPS
WAVESENSE PRESTO TEST STRIPS
WAVESENSE PRESTO SYSTEM KIT
WELCHOL 3.75G PACKET
WELCHOL 625 MG TABLET
WELLBUTRIN SR 100 MG TABLET
WELLBUTRIN SR 150 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
WELLBUTRIN SR 200 MG TABLET
WELLBUTRIN XL 150 MG TABLET
WELLBUTRIN XL 300 MG TABLET
WELLESSE MULT VITAMIN PLUS LIQ
WERA 0.5/0.035 MG 28 TABLET
WESTAB MAX TABLET
WESTAB ONE TABLET
WESTERN JUNIPER 1:20 (W/V)
WESTHROID 130 MG TABLET
WESTHROID 195 MG TABLET
WESTHROID 32.5 MG TABLET
WESTHROID 65 MG TABLET
WESTHROID 97.5 MG TABLET
WEST-VITE WITH FOLIC ACID TAB
WHITE ASH 1:20 (W/V) VIAL
WHITE BIRCH 1:20 (W/V) VIAL
WHITE FACED HORNET 100 MCG/ML
WHITE MULBERRY 1:20 W/V VIAL
WHITE OAK 1:20 (W/V) VIAL
WHITE PINE 1:20 (W/V) VIAL
WHITE-FACED HORNET 550 MCG VL
WILATE 450-450 UNIT VIAL
WILATE 900-900 UNIT VIAL
WIXELA 100-50 INHUB
WIXELA 250-50 INHUB
WIXELA 500-50 INHUB
WOMEN'S 50 PLUS DAILY FORMULA
CVS WOMEN'S ACTIVE TABLET
BAYER WOMEN'S ASPIRIN TABLET
V-R WOMEN'S COMPLEX CAPLET
WOMEN'S DAILY CAPLET
WOMEN'S DAILY FORMULA CAPLET
WOMEN'S DAILY FORMULA CAPLET
WOMEN'S DAILY FORMULA TABLET
CVS WOMEN'S DAILY GUMMIES
WOMEN'S DAILY PACK
WOMEN'S MULTIVITAMIN GUMMIES
WOMEN'S MULTIVITAMIN TABLET
WOMENS MULTIVIT HI POTENCY TAB
WOMEN MULTIVIT W-BIOTIN GUMMY
HM WOMEN'S ONE DAILY TABLET
SM WOMEN'S ONE DAILY TABLET
CVS WOMEN'S PRENATAL PLUS DHA
WP THYROID 113.75 MG TABLET
WP THYROID 130 MG TABLET
WP THYROID 16.25 MG TABLET
WP THYROID 32.5 MG TABLET
WP THYROID 48.75 MG TABLET
WP THYROID 65 MG TABLET
WP THYROID 81.25 MG TABLET
WP THYROID 97.5 MG TABLET
WYMZYA FE CHEWABLE TABLET
XADAGO 100 MG TABLET
XADAGO 50 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
XALATAN 0.005% EYE DROPS
XALKORI 200 MG CAPSULE
XALKORI 250 MG CAPSULE
XARELTO 10 MG TABLET
XARELTO 15 MG TABLET
XARELTO 2.5 MG TABLET
XARELTO 20 MG TABLET
XATMEP 2.5 MG/ML ORAL SOLUTION
XELJANZ 10 MG TABLET
XELJANZ 5 MG TABLET
XELJANZ XR 11 MG TABLET
XELJANZ XR 22 MG TABLET
XELPROS 0.005% EYE DROP
XEMBIFY 20% (1 G/5 ML) VIAL
XEMBIFY 20% (10 G/50 ML) VIAL
XEMBIFY 20% (2 G/10 ML) VIAL
XEMBIFY 20% (4 G/20 ML) VIAL
XENAZINE 12.5 MG TABLET
XENAZINE 25 MG TABLET
XENICAL 120 MG CAPSULE
XHANCE 93 MCG NASAL SPRAY
XIFAXAN 550 MG TABLET
XIGDUO XR 10 MG-1,000 MG TAB
XIGDUO XR 10 MG-500 MG TABLET
XIGDUO XR 2.5 MG-1,000 MG TAB
XIGDUO XR 5 MG-1,000 MG TABLET
XIGDUO XR 5 MG-500 MG TABLET
XIIDRA 5% EYE DROPS
XOLAIR 150 MG VIAL
XOLAIR 150 MG/ML SYRINGE
XOLAIR 75 MG/0.5 ML SYRINGE
XOPENEX 0.31 MG/3 ML SOLUTION
XOPENEX 0.63 MG/3 ML SOLUTION
XOPENEX 1.25 MG/3 ML SOLUTION
XOPENEX CONC 1.25 MG/0.5 ML
XOPENEX HFA 45 MCG INHALER
XOSPATA 40 MG TABLET
XPOVIO 100 MG ONCE WEEKLY DOSE
XPOVIO 60 MG ONCE WEEKLY DOSE
XPOVIO 80 MG ONCE WEEKLY DOSE
XPOVIO 80 MG TWICE WEEKLY DOSE
XTANDI 40 MG CAPSULE
XULANE PATCH
XULTOPHY 100 UNIT-3.6MG/ML PEN
XURIDEN GRANULE PACKET
XYNTHA 1,000 UNIT KIT
XYNTHA 2,000 UNIT KIT
XYNTHA 250 UNIT KIT
XYNTHA 500 UNIT KIT
XYNTHA SOLOFUSE 1,000 UNIT KIT
XYNTHA SOLOFUSE 2,000 UNIT KIT
XYNTHA SOLOFUSE 250 UNIT KIT
XYNTHA SOLOFUSE 3,000 UNIT KIT
XYNTHA SOLOFUSE 500 UNIT KIT
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
XYOSTED 100 MG/0.5 ML AUTO-INJ
XYOSTED 50 MG/0.5 ML AUTO-INJ
XYOSTED 75 MG/0.5 ML AUTO-INJ
XYZAL 2.5 MG/5 ML SOLUTION
XYZAL 5 MG TABLET
XYZBAC TABLET
YASMIN 28 TABLET
YAZ 28 TABLET
YELETS TABLET
YELLOW DOCK 1:20 (W/V) VIAL
YELLOW HORNET VENOM 100 MCG/ML
YELLOW HORNET VENOM 550 MCG VL
YELLOW JACKET VENOM 100 MCG/ML
YELLOW JACKET VENOM 550 MCG VL
YONDELIS 1 MG VIAL
YONSA 125 MG TABLET
YOSPRALA DR 325-40 MG TABLET
YOSPRALA DR 81-40 MG TABLET
YUPELRI 175 MCG/3 ML SOLUTION
YUTIQ 0.18 MG IMPLANT
YUVAFEM 10 MCG VAGINAL INSERT
YUVAFEM 10 MCG VAGINAL TABLET
ZAFIRLUKAST 10 MG TABLET
ZAFIRLUKAST 20 MG TABLET
ZALTRAP 100 MG/4 ML VIAL
ZALTRAP 200 MG/8 ML VIAL
ZALVIT TABLET
ZANAFLEX 2 MG CAPSULE
ZANAFLEX 4 MG CAPSULE
ZANAFLEX 4 MG TABLET
ZANAFLEX 6 MG CAPSULE
ZANTAC 150 MG TABLET
ZANTAC 300 MG TABLET
ZANTAC 75 MG TABLET
ZARAH TABLET
ZARONTIN 250 MG CAPSULE
ZARONTIN 250 MG/5 ML SOLUTION
ZATEAN-CH CAPSULE
ZATEAN-PN DHA CAPSULE
ZATEAN-PN PLUS SOFTGEL
ZAVESCA 100 MG CAPSULE
ZEBETA 10 MG TABLET
ZEBETA 5 MG TABLET
ZEGERID 20 MG CAPSULE
ZEGERID 20 MG PACKET
ZEGERID 40 MG CAPSULE
ZEGERID 40 MG PACKET
ZEGERID OTC 20-1,100 MG CAP
ZEJULA 100 MG CAPSULE
ZELAPAR 1.25 MG ODT TABLET
ZELBORAF 240 MG TABLET
ZEMAIRA 1,000 MG VIAL
ZEMPLAR 1 MCG CAPSULE
ZEMPLAR 10 MCG/2 ML VIAL
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ZEMPLAR 2 MCG CAPSULE
ZEMPLAR 2 MCG/ML VIAL
ZEMPLAR 5 MCG/ML VIAL
ZENCHENT 0.4 MG-35 MCG TABLET
ZENCHENT FE TABLET CHEWABLE
ZENPEP DR 10,000 UNIT CAPSULE
ZENPEP DR 15,000 UNIT CAPSULE
ZENPEP DR 20,000 UNIT CAPSULE
ZENPEP DR 25,000 UNIT CAPSULE
ZENPEP DR 3,000 UNIT CAPSULE
ZENPEP DR 40,000 UNIT CAPSULE
ZENPEP DR 5,000 UNIT CAPSULE
ZENZEDI 10 MG TABLET
ZENZEDI 15 MG TABLET
ZENZEDI 2.5 MG TABLET
ZENZEDI 20 MG TABLET
ZENZEDI 30 MG TABLET
ZENZEDI 5 MG TABLET
ZENZEDI 7.5 MG TABLET
ZERIT 1 MG/ML SOLUTION
ZERIT 15 MG CAPSULE
ZERIT 20 MG CAPSULE
ZERIT 30 MG CAPSULE
ZERIT 40 MG CAPSULE
ZESTORETIC 10-12.5 MG TABLET
ZESTORETIC 20-12.5 MG TABLET
ZESTORETIC 20-25 MG TABLET
ZESTRIL 10 MG TABLET
ZESTRIL 2.5 MG TABLET
ZESTRIL 20 MG TABLET
ZESTRIL 30 MG TABLET
ZESTRIL 40 MG TABLET
ZESTRIL 5 MG TABLET
ZETIA 10 MG TABLET
ZETONNA 37 MCG NASAL SPRAY
ZIAC 10-6.25 MG TABLET
ZIAC 2.5-6.25 MG TABLET
ZIAC 5-6.25 MG TABLET
ZIAGEN 20 MG/ML SOLUTION
ZIAGEN 300 MG TABLET
ZIDOVUDINE 100 MG CAPSULE
ZIDOVUDINE 300 MG TABLET
ZIDOVUDINE 50 MG/5 ML SYRUP
ZILEUTON ER 600 MG TABLET
ZINBRYTA 150 MG/ML SYRINGE
ZINGIBER TABLET
ZIOPTAN 0.0015% EYE DROPS
ZIPRASIDONE HCL 20 MG CAPSULE
ZIPRASIDONE HCL 40 MG CAPSULE
ZIPRASIDONE HCL 60 MG CAPSULE
ZIPRASIDONE HCL 80 MG CAPSULE
ZOCOR 10 MG TABLET
ZOCOR 20 MG TABLET
ZOCOR 40 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ZOCOR 5 MG TABLET
ZOCOR 80 MG TABLET
ZOLADEX 10.8 MG IMPLANT SYRN
ZOLADEX 3.6 MG IMPLANT SYRN
ZOLEDRONIC ACID 4 MG/100 ML
ZOLEDRONIC ACID 4 MG VIAL
ZOLEDRONIC ACID 4 MG/5 ML VIAL
ZOLOFT 100 MG TABLET
ZOLOFT 20 MG/ML ORAL CONC
ZOLOFT 25 MG TABLET
ZOLOFT 50 MG TABLET
ZOMACTON 10 MG VIAL
ZOMACTON 5 MG VIAL
ZOMETA 4 MG/5 ML VIAL
ZONEGRAN 100 MG CAPSULE
ZONEGRAN 25 MG CAPSULE
ZONISAMIDE 100 MG CAPSULE
ZONISAMIDE 25 MG CAPSULE
ZONISAMIDE 50 MG CAPSULE
ZONTIVITY 2.08 MG TABLET
ZOO FRIENDS TABLET CHEWABLE
ZOO FRIENDS COMPLETE TAB CHEW
ZOO FRIENDS GUMMIES
ZORTRESS 0.25 MG TABLET
ZORTRESS 0.5 MG TABLET
ZORTRESS 0.75 MG TABLET
ZORTRESS 1 MG TABLET
ZORVOLEX 18 MG CAPSULE
ZORVOLEX 35 MG CAPSULE
ZOVIA 1-35E TABLET
ZOVIA 1-50E TABLET
ZOVIRAX 200 MG CAPSULE
ZOVIRAX 200 MG/5 ML SUSP
ZOVIRAX 400 MG TABLET
ZOVIRAX 800 MG TABLET
ZUBSOLV 0.7-0.18 MG TABLET SL
ZUBSOLV 1.4-0.36 MG TABLET SL
ZUBSOLV 11.4-2.9 MG TABLET SL
ZUBSOLV 2.9-0.71 MG TABLET SL
ZUBSOLV 5.7-1.4 MG TABLET SL
ZUBSOLV 8.6-2.1 MG TABLET SL
ZUMANDIMINE 3 MG-0.03 MG TAB
ZURAMPIC 200 MG TABLET
ZYDELIG 100 MG TABLET
ZYDELIG 150 MG TABLET
ZYFLO 600 MG FILMTAB
ZYFLO CR 600 MG TABLET
ZYKADIA 150 MG CAPSULE
ZYKADIA 150 MG TABLET
ZYLOPRIM 100 MG TABLET
ZYLOPRIM 300 MG TABLET
ZYPITAMAG 1 MG TABLET
ZYPITAMAG 2 MG TABLET
ZYPITAMAG 4 MG TABLET
OHIO MEDICAID Effective April 1, 2020
The maintenance drug list is subject to change Last Updated: 4/1/2020 OH-MED-P-54803
ZYPREXA 10 MG TABLET
ZYPREXA 15 MG TABLET
ZYPREXA 2.5 MG TABLET
ZYPREXA 20 MG TABLET
ZYPREXA 5 MG TABLET
ZYPREXA 7.5 MG TABLET
ZYPREXA RELPREVV 210 MG VIAL
ZYPREXA RELPREVV 210 MG VL KIT
ZYPREXA RELPREVV 300 MG VIAL
ZYPREXA RELPREVV 300 MG VL KIT
ZYPREXA RELPREVV 405 MG VIAL
ZYPREXA RELPREVV 405 MG VL KIT
ZYPREXA ZYDIS 10 MG TABLET
ZYPREXA ZYDIS 15 MG TABLET
ZYPREXA ZYDIS 20 MG TABLET
ZYPREXA ZYDIS 5 MG TABLET
ZYTIGA 250 MG TABLET
ZYTIGA 500 MG TABLET
ZYVIT TABLET