Preferred Drug List - 1stAgency...INDOMETHACIN CAP 50MG - 30EA INDOMETHACIN CAP 75MG SR - 6EA LORTAB...

Preferred Preferred Preferred DrugDrugDrug ListListList

4-Tier Drug Program

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Preferred Brand & Generic Drugs

$10 Tier $20 Tier $40 Tier Discounts

Non-Preferred

ACNE PRODUCTS ERYDERM SOL 0.02 - 60ML ERYTHROMYCIN SOL 0.02 - 60ML

BENZOYL PER GEL 0.1 - 60GM BENZOYL PER GEL 0.025 - 60GM BENZOYL PER GEL 0.05 - 60GM CLINDAMYCIN SOL 0.01 - 60ML DESQUAM-E GEL 0.05 - 42GM

AVITA CRE 0.00025 - 20GM BENZOYL PER LIQ WASH 10% - 227GM BENZOYL PER LIQ WASH 2.5 - 227GM BENZOYL PER LIQ WASH 5% - 227GM DESQUAM-X GEL 0.1 - 85GM DESQUAM-X LIQ WASH 10% - 280GM EMGEL GEL 0.02 - 50GM ERYTHROMYCIN GEL 0.02 - 30GM ERYTHROMYCIN PAD 0.02 - 60EA ETHEXDERM LIQ BPW-10 - 150GM ETHEXDERM LIQ BPW-5 - 226GM SOD SUL/SULF LOT 10%-5% - 25GM

ACCUTANE AKNE-MYCIN AMNESTEEM AVAR AVITA AZELEX BENZAC AC BENZACLIN BENZAMYCIN BENZIQ WASH BENZL PEROX BREVOXYL BREVOXYL-4 BREVOXYL-8 CLARAVIS CLENIA CLEOCIN-T CLINDAGEL CLINDAMAX CLINDAMYCIN CLINDETS DIFFERIN DUAC ERYTHROMYCIN EVOCLIN METRONIDAZOL

ANALGESICS ALI-FLEX TAB 50-500MG - 30EA ASPIRIN TAB 975MG EC - 30EA BUT/APAP/CAF CAP - 30EA CODEINE SULF TAB 15MG - 30EA DOLOPHINE TAB 10MG - 30EA HYDROCET CAP 500-5MG - 15EA HYDROCO/APAP TAB 5-500MG - 30EA IBU TAB 400MG - 60EA IBUPROFEN TAB 400MG - 60EA INDOMETHACIN CAP 25MG - 30EA INDOMETHACIN CAP 50MG - 30EA INDOMETHACIN CAP 75MG SR - 6EA LORTAB 5 TAB - 30EA MARGESIC-H CAP 500-5MG - 20EA MEPERIDINE SOL 50MG/5ML - 20ML METHADONE TAB 5MG - 60EA METHADOSE TAB 5MG - 60EA MORPHINE SUL SUP 5MG - 6EA MS/L SOL 10MG/5ML - 100ML MSIR TAB 15MG - 30EA PIROXICAM CAP 10MG - 30EA PIROXICAM CAP 20MG - 30EA PROPO-N/APAP TAB 50/325 - 30EA PROPOXY HCL CAP 65MG - 60EA PROPOXY/APAP TAB 65-650MG - 30EA RMS SUP 10MG - 6EA

AMIGESIC TAB 500MG - 60EA APAP/CODEINE SOL 120-12/5 - 240ML APAP/CODEINE TAB 300-15MG - 30EA APAP/CODEINE TAB 300-30MG - 30EA APAP/HYDROCO TAB 500-5MG - 60EA ASPIRIN POW - 60GM BUT/ASA/CAFF CAP - 30EA BUT/ASA/CAFF TAB - 30EA BUTALBITAL TAB CPD - 40EA CAFGESIC CAP - 30EA CODEINE SULF TAB 30MG - 30EA ED-FLEX CAP - 40EA ENDOCET TAB 5-325MG - 60EA FRENADOL TAB - 30EA HYDROCO/APAP CAP 5-500MG - 30EA HYDROCO/APAP TAB 2.5-500 - 30EA HYDROCO/APAP TAB 5-325MG - 30EA HYDROCO/APAP TAB 7.5-500 - 60EA HYDROCO/APAP TAB 7.5-650 - 60EA HYDROCO/APAP TAB 7.5-750 - 60EA HYDROMORPHON TAB 2MG - 30EA IBU TAB 600MG - 90EA IBU TAB 800MG - 90EA IBUPROFEN POW - 30GM IBUPROFEN TAB 600MG - 90EA IBUPROFEN TAB 800MG - 90EA KETOROLAC TAB 10MG - 20EA LEVACET TAB - 20EA MECLOFEN SOD CAP 50MG - 30EA MELOXICAM TAB 15MG - 30EA MELOXICAM TAB 7.5MG - 30EA MEPERIDINE/ CAP PROMETH - 20EA METHADONE TAB 10MG - 120EA METHADOSE CON 10MG/ML - 180ML METHADOSE TAB 10MG - 90EA MORPHINE SUL SOL 10MG/5ML - 120ML MORPHINE SUL SOL 20MG/ML - 30ML MORPHINE SUL SUP 10MG - 12EA MORPHINE SUL TAB 10MG - 30EA MORPHINE SUL TAB 15MG - 60EA MOTRIN SUS 100/5ML - 200ML MOTRIN TAB 800MG - 30EA NAPROXEN SOD TAB 275MG - 60EA NAPROXEN SOD TAB 550MG - 60EA NAPROXEN TAB 250MG - 60EA NAPROXEN TAB 375MG - 60EA NAPROXEN TAB 500MG - 60EA OXYCOD/APAP CAP 5-500MG - 60EA OXYCOD/APAP TAB 5-325MG - 30EA OXYCOD/ASA TAB - 60EA OXYCODONE CAP 5MG - 60EA PROPO-N/APAP TAB 100-650 - 30EA RMS SUP 5MG - 12EA ROXICET TAB 5-325MG - 30EA ROXICODONE TAB 5MG - 30EA SALSALATE TAB 500MG - 60EA SALSALATE TAB 750MG - 60EA STAGESIC CAP 500-5MG - 30EA TETRA-MAG TAB 25-600MG - 60EA TYLENOL/COD TAB #3 - 30EA XODOL TAB 5-300MG - 10EA ZYDONE TAB 10-400MG - 20EA

APAP/CODEINE TAB 300-60MG - 60EA ASA/CODEINE TAB 325-30MG - 100EA ASCOMP CAP COD 30MG - 30EA BUT/APAP/CAF TAB - 30EA BUT/ASA/CAF/ CAP COD 30MG - 30EA BUTAL/APAP TAB 50-325 - 90EA BUTALBITAL CAP CPD - 90EA CHO MAG TRIS LIQ 500/5ML - 240ML CHO MAG TRIS TAB 500MG - 60EA CHO MAG TRIS TAB 750MG - 60EA DARVOCET-N TAB 50 - 30EA DARVON CAP CPD 65 - 30EA DEMEROL TAB 50MG - 30EA DICLOFENAC TAB 25MG EC - 60EA DICLOFENAC TAB 50MG DR - 60EA DICLOFENAC TAB 50MG EC - 60EA DILAUDID SUP 3MG - 6EA DOLGIC LQ ELX - 200ML ESGIC-PLUS TAB - 20EA ETH-OXYDOSE CON 20MG/ML - 30ML ETODOLAC CAP 300MG - 60EA ETODOLAC TAB 400MG - 60EA FENOPROFEN TAB 600MG - 60EA FIORINAL CAP - 20EA FLEXTRA DS TAB - 40EA FLURBIPROFEN TAB 100MG - 60EA HYDROCO/APAP TAB 10-650MG - 120EA HYDROCO/APAP TAB 7.5-325 - 60EA HYDROCODONE/ SOL APAP - 473ML IBUPROFEN SUS 100/5ML - 473ML INDOMETHACIN CAP 75MG CR - 30EA INDOMETHACIN CAP 75MG ER - 30EA KETOPROFEN CAP 50MG - 60EA KETOPROFEN CAP 75MG - 60EA LODINE TAB 400MG - 21EA MARTEN-TAB TAB 50-325 - 60EA MECLOFEN SOD CAP 100MG - 60EA MEPERIDINE TAB 50MG - 30EA MEPERITAB TAB 50MG - 30EA MEPROZINE CAP 50-25MG - 30EA METHADONE CON 10MG/ML - 30ML METHADONE SOL 5MG/5ML - 500ML METHADONE TAB 40MG - 90EA METHADOSE TAB 40MG - 90EA MORPHINE SUL TAB 30MG - 90EA MOTRIN TAB 400MG - 100EA MOTRIN TAB 600MG - 90EA MST 600 TAB - 60EA NAPROXEN SUS 125/5ML - 500ML NORCO TAB 5-325MG - 30EA NORCO TAB 7.5-325 - 30EA NOVASAL TAB 600MG - 44EA ORAMORPH SR TAB 15MG - 30EA OXYCODONE CON 20MG/ML - 30ML OXYCODONE TAB 5MG - 60EA OXYIR CAP 5MG - 100EA PANLOR DC CAP - 20EA PANLOR SS TAB - 20EA PENTAZOCINE/ TAB NALOXONE - 30EA PERCODAN TAB - 20EA ROXANOL SOL 20MG/ML - 30ML ROXICODONE SOL 5MG/5ML - 200ML SEDAPAP TAB 650-50MG - 90EA SUBUTEX SUB 8MG - 3EA

ACTIQ AMIGESIC ANAPROX DS ANEXSIA ANSAID ARAVA ARTHROTEC 50 ARTHROTEC 75 ASA/CODEINE AVINZA BALACET 325 BUT/APAP/CAF BUTORPHANOL CATAFLAM CELEBREX CHO MAG TRIS CODEINE CODEINE PHOS CODEINE SULF DARVOCET-N DARVON DARVON-N DAYPRO DEMEROL DICLOFEN POT DICLOFENAC DIFLUNISAL DILAUDID DILAUDID-5 DOLGIC PLUS DURABAC DURAGESIC EC-NAPROSYN ENDOCET ENDODAN EQUAGESIC ESGIC-PLUS ETODOLAC ETODOLAC CR ETODOLAC ER FELDENE FENTANYL FIORICET FIORICET/COD FIORINAL/COD FLEXTRA FLURBIPROFEN HUMIRA HUMIRA PEN HYDROMORPHON INDOCIN INDOCIN SR INDOMETHACIN KADIAN KETOPROFEN LAGESIC LEFLUNOMIDE LEVORPHANOL LODINE XL LORCET LORCET PLUS LORTAB 10 LORTAB 7.5 MEPERIDINE MEPERITAB METHADONE MOBIC MORPHINE MORPHINE SUL MS CONTIN MSIR NABUMETONE NALBUPHINE NALFON NAPRELAN NAPROSYN

Prices are subject to change and may not fall into the tiers as shown above. The discount tier are drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.

NEOBENZ MICR OSCION CLNSR PLEXION CLNS PLEXION CLTH PLEXION SCT PRASCION PRASCION AV RETIN-A RETIN-A MICR RETINOIC ACD ROSAC ROSADERM ROSANIL ROSULA SOD SUL/SULF SOD SULFACET SOTRET SULFACET-R SULFATOL SUPHERA TRETINOIN TRIAZ VANOXIDE-HC ZODERM

NORCO OPANA ORAMORPH SR ORUVAIL OXAPROZIN OXYCO/APAP OXYCOD-APAP OXYCODONE OXYCONTIN OXYFAST PENTA/APAP PERCOCET PHRENILIN PHRENILIN/ PIROXICAM PONSTEL PREVACID NAP PROPO-N/APAP RELAFEN RIDAURA ROXICET ROXICODONE STAFLEX SUBOXONE SUBUTEX SYNALGOS DC TALACEN TALWIN NX TOLMETIN SOD TRAMADL/APAP TRICOSAL TYLENOL/COD TYLOX ULTRACET ULTRAM ULTRAM ER VICODIN ES VICODIN HP VICOPROFEN VOLTAREN-XR ZEBUTAL ZORPRIN

ANTIANXIETY AGENTS ALPRAZOLAM TAB 0.25MG - 30EA ALPRAZOLAM TAB 0.5MG - 30EA CHLORDIAZEP CAP 10MG - 30EA CHLORDIAZEP CAP 25MG - 60EA CHLORDIAZEP CAP 5MG - 30EA DIAZEPAM TAB 10MG - 30EA DIAZEPAM TAB 2MG - 30EA DIAZEPAM TAB 5MG - 30EA HYDROXYZ PAM CAP 25MG - 30EA MEPROBAMATE TAB 200MG - 60EA MEPROBAMATE TAB 400MG - 60EA

ALPRAZOLAM TAB 1MG - 90EA HYDROXYZ HCL SYP 10MG/5ML - 480ML HYDROXYZ PAM CAP 100MG - 30EA HYDROXYZ PAM CAP 50MG - 30EA LORAZEPAM TAB 0.5MG - 30EA NIRAVAM TAB 0.25MG - 12EA

ALPRAZOLAM TAB 2MG - 90EA BUSPAR TAB 5MG - 30EA BUSPIRONE TAB 10MG - 60EA BUSPIRONE TAB 15MG - 60EA BUSPIRONE TAB 5MG - 60EA CLORAZ DIPOT TAB 7.5MG - 30EA DIAZEPAM CON 5MG/ML - 25ML HYDROXYZ HCL TAB 10MG - 30EA HYDROXYZ HCL TAB 25MG - 30EA HYDROXYZ HCL TAB 50MG - 30EA LIBRIUM CAP 25MG - 10EA LORAZEPAM TAB 1MG - 30EA LORAZEPAM TAB 2MG - 30EA OXAZEPAM CAP 10MG - 30EA OXAZEPAM CAP 15MG - 30EA XANAX TAB 0.25MG - 30EA

ALPRAZOLAM ATIVAN BUSPAR BUSPIRONE CLORAZ DIPOT LIBRIUM LORAZEPAM NIRAVAM OXAZEPAM TRANXENE T TRANXENE-SD VALIUM VISTARIL XANAX XANAX XR

ANTIASTHMATIC & RESPIRATORY AGENTS ALBUTEROL TAB 2MG - 60EA AMINOPHYLLIN TAB 100MG - 60EA AMINOPHYLLIN TAB 200MG - 60EA DYPHYLLIN-GG ELX 100-100 - 240ML THEOCHRON TAB 100MG CR - 30EA ALBUTEROL TAB 2MG - 60EA AMINOPHYLLIN TAB 100MG - 60EA AMINOPHYLLIN TAB 200MG - 60EA DYPHYLLIN-GG ELX 100-100 - 240ML THEOCHRON TAB 100MG CR - 30EA

ALBUTEROL NEB 0.00083 - 75ML ALBUTEROL NEB 0.005 - 20EA ALBUTEROL SYP 2MG/5ML - 240ML ALBUTEROL TAB 4MG - 60EA DIFIL-G TAB 200-300 - 30EA DILEX-G 400 TAB - 30EA DILEX-G TAB 200-200 - 60EA KIE SYP - 200ML METAPROTEREN SYP 10MG/5ML - 490ML METAPROTEREN TAB 10MG - 100EA METAPROTEREN TAB 20MG - 90EA PANFIL-G SYP - 180ML THEO-24 CAP 100MG CR - 30EA THEOCHRON TAB 200MG CR - 60EA THEOPHYLLINE SOL 80/15ML - 960ML THEOPHYLLINE TAB 100MG CR - 60EA THEOPHYLLINE TAB 100MG ER - 60EA THEOPHYLLINE TAB 100MG TD - 60EA THEOPHYLLINE TAB 200MG CR - 60EA THEOPHYLLINE TAB 200MG ER - 60EA THEOPHYLLINE TAB 200MG TD - 60EA THEOPHYLLINE TAB 300MG TD - 60EA

ALBUTEROL AER 90MCG - 17GM ALBUTEROL AER 90MCG RF - 17GM ALBUTEROL AER HFA - 8GM COPD TAB 200-200 - 90EA DY-G LIQ 100-100 - 473ML DYPHYLLIN/GG TAB 200-200 - 90EA IPRATROPIUM SPR 0.0006 - 15ML JAY-PHYL SYP - 180ML METAPROTEREN NEB 0.004 - 90ML PROAIR HFA AER - 8GM PROVENTIL AER 90MCG - 17GM PROVENTIL AER HFA - 6GM TERBUTALINE TAB 2.5MG - 60EA THEO-24 CAP 200MG CR - 30EA THEO-24 CAP 300MG CR - 30EA THEOCHRON TAB 300MG CR - 60EA THEOPHYLLINE TAB 300MG CR - 60EA THEOPHYLLINE TAB 300MG ER - 60EA THEOPHYLLINE TAB 450MG ER - 60EA TYZINE SOL 0.001 - 15ML UNIPHYL TAB 400MG CR - 30EA VENTOLIN HFA AER - 18GM

ACCOLATE ADVAIR DISKU AEROBID AEROBID-M ALBUTEROL ALUPENT INH ASMANEX 120 ASMANEX 14 ASMANEX 30 ASMANEX 60 ASTELIN NASA ATROVENT INH ATROVENT NAS AZMACORT BRETHINE COMBIVENT CROMOLYN SOD DUONEB DYLIX DYPHYLLIN-GG ELIXOPHYLLIN FLONASE FLOVENT FLOVENT HFA FLUNISOLIDE FLUTICASONE FORADIL INTAL INH IPRATROPIUM LUFYLLIN

ANALGESICS



Non-Preferred

SULINDAC TAB 150MG - 60EA SULINDAC TAB 200MG - 60EA TORADOL ORAL TAB 10MG - 20EA TRAMADOL HCL TAB 50MG - 60EA VICODIN TAB 5-500MG - 30EA VOPAC TAB 650-30MG - 40EA

Prices are subject to change and may not fall into the tiers as shown above. The discount tier are drugs listed without strength or quantity and are the drugs not listed in other tiers.

ANOREXIANTS PHENDIMETRAZ CAP 105MG CR - 30EA PHENTERMINE CAP 30MG - 30EA PHENTERMINE TAB 37.5MG - 30EA

DIETHYLPROP TAB 25MG - 90EA PHENDIMETRAZ TAB 35MG - 60EA

BONTRIL PDM TAB 35MG - 60EA BONTRIL SR CAP 105MG - 30EA DIETHYLPROP TAB 75MG CR - 30EA DIETHYLPROP TAB 75MG ER - 30EA

ADIPEX-P DIDREX IONAMIN-15 IONAMIN-30 MERIDIA PHENTERMINE TENUATE XENICAL

MAXAIR AUTOH NASACORT AQ NASAREL NASONEX PROLASTIN PROVENTIL PULMICORT QVAR RHINOCORT SEREVENT DIS SINGULAIR SPIRIVA TERBUTALINE THEO-24 THEOCAP THEOPHYLLINE TILADE UNIPHYL VOSPIRE ER XOLAIR XOPENEX XOPENEX HFA ZYFLO

ANTIBIOTICS AMOXICILLIN CAP 250MG - 30EA AMOXICILLIN CAP 500MG - 30EA AMOXICILLIN CHW 125MG - 10EA AMOXICILLIN CHW 200MG - 10EA AMOXICILLIN SUS 125/5ML - 150ML AMOXICILLIN SUS 200/5ML - 100ML AMOXIL CAP 250MG - 30EA AMOXIL CAP 500MG - 30EA AMOXIL DRO 50MG/ML - 30ML AMOXIL TAB 500MG - 12EA AMOXIL TAB 875MG - 1EA CEPHALEXIN SUS 125/5ML - 100ML CIPRO SUS 5G/100ML - 1ML CLARITHROMYC SUS 125/5ML - 14ML CLINDAMYCIN CAP 150MG - 4EA DOXYCYCL HYC CAP 100MG - 20EA DOXYCYCL HYC CAP 50MG - 30EA DOXYCYCL HYC TAB 100MG - 20EA ERYTHROMYCIN TAB 250MG - 40EA ERYTHROMYCIN TAB BS 500MG - 6EA ISONIAZID TAB 300MG - 30EA

AMOXICILLIN CHW 250MG - 30EA AMOXICILLIN CHW 400MG - 20EA AMOXICILLIN SUS 250/5ML - 300ML AMOXICILLIN SUS 400/5ML - 100ML AMOXICILLIN TAB 500MG - 30EA AMOXICILLIN TAB 875MG - 20EA AMOXIL SUS 250/5ML - 150ML AMOXIL SUS 400/5ML - 100ML AMPICILLIN CAP 250MG - 40EA AMPICILLIN CAP 500MG - 40EA AMPICILLIN SUS 250/5ML - 200ML CEPHALEXIN CAP 250MG - 28EA CEPHALEXIN CAP 500MG - 30EA CEPHALEXIN SUS 250/5ML - 200ML CIPROFLOXACN TAB 100MG - 6EA CIPROFLOXACN TAB 250MG - 14EA CIPROFLOXACN TAB 500MG - 20EA CIPROFLOXACN TAB 750MG - 20EA E.E.S. 200 SUS 200/5ML - 300ML E.E.S. 400 TAB 400MG - 30EA ERY-TAB TAB 250MG EC - 60EA ERY-TAB TAB 333MG EC - 30EA ERY-TAB TAB 500MG EC - 30EA

ALBENZA TAB 200MG - 16EA AMOX/K CLAV CHW 200MG - 20EA AMOX/K CLAV SUS 200/5ML - 100ML AZITHROMYCIN SUS 100/5ML - 15ML BILTRICIDE TAB 600MG - 3EA CEFACLOR CAP 250MG - 30EA CEFACLOR SUS 125/5ML - 150ML CIPRO XR TAB 500MG - 3EA DAPSONE TAB 100MG - 30EA DICLOXACILL CAP 250MG - 40EA DICLOXACILL CAP 500MG - 40EA DOXYCYC MONO CAP 100MG - 20EA DYNACIN CAP 50MG - 30EA E.E.S. 400 SUS 400/5ML - 360ML EES/SULFISOX SUS 200-600 - 400ML ERYPED 200 SUS 200/5ML - 300ML ERYPED 400 SUS 400/5ML - 200ML ERYTHROM EST SUS 125/5ML - 435ML MINOCYCLINE CAP 50MG - 30EA

ADOXA ADOXA PAK ALINIA AMIKACIN AMOCLAN AMOX/K CLAV AMPHOTERICIN AMPICILLIN AMP-SULBACTA AUGMENTIN AUGMENTIN XR AVELOX AVELOX ABC AZACTAM AZACTAM/DEX AZITHROMYCIN BACITRACIN BACTRIM DS BIAXIN CEDAX CEFACLOR CEFADROXIL CEFAZOLIN CEFOTAXIME CEFPODOXIME CEFPROZIL CEFTIN CEFTRIAXONE CEFUROXIME

CIPRO CIPRO (10%) CIPRO XR CIPROFLOXACN CLARITHROMYC CLEOCIN CLEOCIN PED CLEOCIN PHOS CLINDAMYCIN CLOTRIMAZOLE DAPSONE DECLOMYCIN DEMECLOCYCL DORYX DOXYCYC MONO DOXYCYCLINE DURICEF DYNACIN ERYTHROMYCIN ETHAMBUTOL FACTIVE FLAGYL FLAGYL ER FLOXIN FORTAZ GENTAMICIN GEOCILLIN ISONIAZID



Non-Preferred

ANTIBIOTICS MEBENDAZOLE CHW 100MG - 1EA METRONIDAZOL TAB 250MG - 21EA METRONIDAZOL TAB 500MG - 14EA NEOMYCIN TAB 500MG - 6EA PENICILLN VK SOL 125/5ML - 200ML PENICILLN VK SOL 250/5ML - 200ML SMZ-TMP TAB 400-80MG - 30EA SULFISOXAZOL TAB 0.5GM - 30EA TETRACYCLINE CAP 250MG - 30EA TRIMOX CAP 250MG - 30EA TRIMOX CAP 500MG - 30EA TRIMOX SUS 250/5ML - 100ML

ERYTHROCIN TAB 250MG - 40EA ERYTHROCIN TAB 500MG - 30EA ERYTHROM EST SUS 250/5ML - 145ML ERYTHROM ETH SUS 200/5ML - 150ML ERYTHROM ETH SUS 400/5ML - 150ML ERYTHROM ETH TAB 400MG - 30EA ERYTHROMYCIN CAP 250MG EC - 30EA ETHAMBUTOL TAB 100MG - 30EA GANTRIS PED SUS 500/5ML - 150ML ISONIAZID TAB 100MG - 90EA MINTEZOL CHW 500MG - 12EA MYAMBUTOL TAB 100MG - 30EA PENICILLN VK TAB 250MG - 30EA PENICILLN VK TAB 500MG - 28EA PRINCIPEN CAP 250MG - 30EA PRINCIPEN CAP 500MG - 28EA PRINCIPEN SUS 250/5ML - 150ML SMZ/TMP DS TAB 800-160 - 20EA SMZ-TMP SUS 200-40/5 - 280ML SULFATRIM SUS 200-40/5 - 400ML SUMYCIN TAB 250MG - 60EA TEQUIN TAB 400MG - 1EA TETRACYCLINE CAP 500MG - 60EA TRIMETHOPRIM TAB 100MG - 30EA VEETIDS SOL 125/5ML - 300ML VEETIDS SOL 250/5ML - 200ML VEETIDS TAB 250MG - 30EA

NYSTATIN SUS 100000U - 120ML OMNICEF SUS 125MG/5 - 60ML OXYTETRACYC POW - 60GM PCE TAB 500MG EC - 14EA PROLOPRIM TAB 100MG - 30EA PROQUIN XR TAB 500MG - 3EA TINDAMAX TAB 500MG - 4EA VEETIDS TAB 500MG - 40EA

LINCOCIN LORABID MEPRON METRONIDAZOL MINOCIN MINOCYCLINE MYCELEX MYCOBUTIN MYRAC NAFCILLIN NOROXIN NYSTATIN OFLOXACIN OMNICEF OMNI-PAC OXACILLIN PAROMOMYCIN PEN G SOD PENICILLN GK PENTAM 300 PERIOSTAT POLYMYXIN B


PRIMAXIN PYRAZINAMIDE RIFADIN RIFAMATE RIFAMPIN RIFATER SEPTRA DS SOLODYN SPECTRACEF SULFADIAZINE SUMYCIN SUPRAX TAZICEF TEQUIN TOBI TOBRAMYCIN TRECATOR VANCOMYCIN VANTIN VIBRAMYCIN XIFAXAN YODOXIN ZITHROMAX ZMAX ZOSYN ZYVOX

ANTIBIOTICS - TOPICAL GENTAMICIN CRE 0.001 - 15GM GENTAMICIN OIN 0.001 - 15GM

CENTANY OIN 0.02 - 15GM BACTROBAN CORTISPORIN GENTAMICIN MUPIROCIN TETRACYCLINE

ANTICONVULSANTS

CARBAMAZEPIN CHW 100MG - 60EA CARBAMAZEPIN TAB 200MG - 60EA CLONAZEPAM TAB 0.5MG - 30EA CLONAZEPAM TAB 1MG - 30EA CLONAZEPAM TAB 2MG - 30EA DILANTIN CAP 30MG - 30EA DILANTIN CHW 50MG - 30EA EPITOL TAB 200MG - 60EA

CARBAMAZEPIN SUS 100/5ML - 450ML CLONAZEP ODT TAB 0.25MG - 30EA CLONAZEP ODT TAB 0.5MG - 30EA DILANTIN CAP 100MG - 90EA PHENY SOD CAP PROMPT - 90EA PHENYTEK CAP 300MG - 30EA PHENYTOIN EX CAP 100MG - 90EA PRIMIDONE TAB 50MG - 60EA TEGRETOL CHW 100MG - 90EA TEGRETOL XR TAB 100MG - 60EA VALPROIC ACD SYP 250/5ML - 473ML ZONEGRAN CAP 25MG - 30EA ZONISAMIDE CAP 25MG - 60EA ZONISAMIDE CAP 50MG - 30EA

CARBATROL CELONTIN CLONAZEP ODT DEPAKENE DEPAKOTE DILANTIN-125 ETHOSUXIMIDE FELBATOL GABAPENTIN GABITRIL KEPPRA KLONOPIN KLONOPIN WAF LAMICTAL LAMOTRIGINE LYRICA MYSOLINE

NEURONTIN PEGANONE PHENYTEK PHENYTOIN PRIMIDONE TEGRETOL TEGRETOL XR TOPAMAX TRILEPTAL VALPROIC ACD ZARONTIN ZONEGRAN ZONISAMIDE

ANTIDEPRESSANTS AMITRIPTYLIN TAB 10MG - 30EA AMITRIPTYLIN TAB 25MG - 30EA AMITRIPTYLIN TAB 50MG - 30EA DESIPRAMINE TAB 10MG - 30EA DOXEPIN HCL CAP 10MG - 30EA NORTRIPTYLIN CAP 10MG - 30EA SERTRALINE TAB 100MG - 30EA SERTRALINE TAB 25MG - 30EA SERTRALINE TAB 50MG - 30EA TRAZODONE TAB 100MG - 30EA TRAZODONE TAB 50MG - 30EA

AMITRIPTYLIN POW - 30GM AMITRIPTYLIN TAB 100MG - 30EA AMITRIPTYLIN TAB 150MG - 30EA AMITRIPTYLIN TAB 75MG - 30EA CITALOPRAM TAB 10MG - 30EA CITALOPRAM TAB 20MG - 30EA CITALOPRAM TAB 40MG - 30EA CLOMIPRAMINE CAP 25MG - 30EA DESIPRAMINE TAB 25MG - 30EA DOXEPIN HCL CAP 100MG - 30EA DOXEPIN HCL CAP 150MG - 30EA DOXEPIN HCL CAP 25MG - 30EA DOXEPIN HCL CAP 50MG - 30EA DOXEPIN HCL CAP 75MG - 30EA ELAVIL TAB 25MG - 30EA FLUOXETINE CAP 20MG - 30EA IMIPRAM HCL TAB 10MG - 30EA IMIPRAM HCL TAB 25MG - 30EA IMIPRAM HCL TAB 50MG - 30EA MAPROTILINE TAB 25MG - 30EA MAPROTILINE TAB 50MG - 30EA MAPROTILINE TAB 75MG - 30EA NORTRIPTYLIN CAP 25MG - 30EA NORTRIPTYLIN CAP 50MG - 30EA NORTRIPTYLIN CAP 75MG - 30EA TRAZODONE TAB 150MG - 30EA

AMOXAPINE TAB 100MG - 30EA AMOXAPINE TAB 25MG - 60EA AMOXAPINE TAB 50MG - 30EA BUPROPION TAB 75MG - 60EA CLOMIPRAMINE CAP 50MG - 60EA DESIPRAMINE TAB 50MG - 30EA DESIPRAMINE TAB 75MG - 30EA DOXEPIN HCL CON 10MG/ML - 240ML ELAVIL TAB 75MG - 30EA FLUOXETINE CAP 10MG - 30EA FLUOXETINE TAB 10MG - 30EA FLUVOXAMINE TAB 25MG - 30EA FLUVOXAMINE TAB 50MG - 30EA

AMITRIPTYLIN AMOXAPINE ANAFRANIL BUDEPRION BUPROPION CELEXA CITALOPRAM CLOMIPRAMINE CYMBALTA DESIPRAMINE DESYREL DOXEPIN HCL EFFEXOR EFFEXOR XR EMSAM FLUOXETINE FLUVOXAMINE IMIPRAM PAM IMIPRAMINE LEXAPRO MARPLAN MIRTAZAPINE NARDIL NEFAZODONE NORPRAMIN NORTRIPTYLIN PAMELOR PARNATE

PAROXETINE PAXIL PAXIL CR PEXEVA PROZAC PROZAC WEEKL REMERON SARAFEM SERTRALINE SINEQUAN SURMONTIL TOFRANIL TOFRANIL-PM TRANYLCYPROM TRAZODONE VENLAFAXINE VIVACTIL WELLBUTRIN ZOLOFT

DIPHEN/ATROP LIQ 2.5/5 - 60ML DIPHEN/ATROP TAB 2.5MG - 30EA LOFENE TAB 2.5MG - 30EA LONOX TAB 2.5MG - 30EA

LOPERAMIDE CAP 2MG - 30EA

LOMOTIL TAB 2.5MG - 30EA PAREGORIC TIN 2MG/5ML - 120ML

MOTOFEN

ANTIDIARRHEALS



Non-Preferred


CENTRAL NERVOUS SYSTEM STIMULANTS DEXEDRINE TAB 5MG - 30EA

METHYLIN TAB 5MG - 30EA METHYLPHENID TAB 5MG - 30EA

AMPHETAMINE TAB 5MG - 30EA AMPHETAMINE TAB 7.5MG - 30EA DEXEDRINE CAP 5MG CR - 14EA DEXTROAMPHET TAB 5MG - 120EA DEXTROSTAT TAB 5MG - 120EA FOCALIN TAB 5MG - 30EA METADATE TAB 20MG ER - 30EA METHYLIN ER TAB 10MG - 30EA METHYLIN ER TAB 20MG - 30EA METHYLIN TAB 10MG - 60EA METHYLPHENID TAB 10MG - 60EA METHYLPHENID TAB 20MG CR - 30EA METHYLPHENID TAB 20MG ER - 30EA

ADDERALL ADDERALL XR AMPHETAMINE CONCERTA CYLERT DAYTRANA DESOXYN DEXEDRINE DEXTROAMPHET DEXTROSTAT FOCALIN

CHOLESTEROL-LOWERING AGENTS SIMVASTATIN TAB 10MG - 30EA SIMVASTATIN TAB 20MG - 30EA SIMVASTATIN TAB 40MG - 30EA SIMVASTATIN TAB 5MG - 30EA SIMVASTATIN TAB 80MG - 30EA

FENOFIBRATE CAP 67MG - 30EA GEMFIBROZIL TAB 600MG - 60EA LOFIBRA CAP 67MG - 30EA LOVASTATIN TAB 10MG - 30EA PRAVASTATIN TAB 10MG - 30EA PRAVASTATIN TAB 20MG - 30EA TRICOR TAB 48MG - 30EA TRICOR TAB 54MG - 30EA

ADVICOR ALTOPREV ANTARA CHOLESTYRAM COLESTID COLESTID FLA COLESTIPOL CRESTOR FENOFIBRATE LESCOL LESCOL XL LIPITOR LOFIBRA LOPID

LOVASTATIN MEVACOR NIASPAN OMACOR PRAVACHOL PRAVASTATIN PREVALITE QUESTRAN TRICOR TRIGLIDE VYTORIN WELCHOL ZETIA ZOCOR

CONTRACEPTIVES

ALESSE TAB -28 - 28EA APRI TAB - 28EA ARANELLE TAB - 28EA AVIANE TAB - 28EA CAMILA TAB 0.35MG - 28EA CESIA PAK - 28EA CRYSELLE-28 TAB 28 TABS - 28EA DEMULEN TAB 1/35-28 - 28EA ENPRESSE-28 TAB - 28EA ERRIN TAB 0.35MG - 28EA JOLIVETTE TAB 0.35MG - 28EA JUNEL 1.5/30 TAB - 21EA JUNEL 1/20 TAB - 21EA JUNEL FE TAB 39467 - 28EA KELNOR TAB 12785 - 28EA LEENA TAB - 28EA LESSINA-28 TAB - 28EA LEVLEN-28 TAB - 28EA LEVLITE TAB -28 - 28EA LEVORA-28 TAB 0.15/30 - 28EA LO/OVRAL TAB -28 - 28EA LOW-OGESTREL TAB - 28EA LUTERA TAB - 28EA MICROGESTIN TAB 1.5/30 - 21EA MICROGESTIN TAB 39467 - 21EA MICROGESTIN TAB FE 1/20 - 28EA MONONESSA TAB - 28EA NECON 7/7/7 TAB 28 DAY - 28EA ZOVIA 1/50E TAB - 28EA NECON TAB 0.5/35 - 28EA NECON TAB 1/35-28 - 28EA NECON TAB 1/50-28 - 28EA NECON TAB 47037 - 28EA NORA-BE TAB 0.35MG - 28EA NORTREL (21) TAB 12785 - 21EA NORTREL (28) TAB 12785 - 28EA NORTREL 28 TAB 0.5/35 - 28EA NORTREL7/7/7 TAB 28 DAYS - 28EA ORTHO MICRON TAB DIALPAK - 28EA ORTHO TRI- TAB CYCLEN - 28EA ORTHO-CYCLEN TAB 0.25/35 - 28EA ORTHO-NOVUM TAB 7/7/7-28 - 28EA OVCON-35 28 TAB - 28EA OVRETTE 28 TAB 0.075MG - 28EA PLAN B TAB 0.75MG - 2EA PORTIA-28 TAB - 28EA PREVIFEM TAB - 28EA RECLIPSEN TAB - 28EA SOLIA TAB - 28EA SPRINTEC 28 TAB 28 DAY - 28EA TRI-LEVLEN TAB 28 - 28EA TRINESSA TAB - 28EA TRIPHASIL 28 TAB - 28EA TRI-PREVIFEM TAB - 28EA TRI-SPRINTEC TAB - 28EA TRIVORA-28 TAB - 28EA VELIVET PAK - 28EA ZOVIA 1/35E TAB - 28EA

CYCLESSA DEPO-PROVERA DESOGEN-28 ESTROSTEP FE KARIVA LO/OVRAL-28 LOESTRIN LOESTRIN 24 LOESTRIN FE MEDROXYPR AC MIRCETTE MIRENA MODICON NORDETTE-28 NUVARING OGESTREL ORTHO EVRA ORTHO TRI-CY ORTHO-CEPT ORTHO-NOVUM OVCON 50 OVCON-35 OVRAL SEASONALE SEASONIQUE TRI-LEVLEN TRI-NORINYL YASMIN 28 YAZ ZEMPLAR ZOMETA

FOCALIN XR METADATE CD METHYLIN METHYLPHENID PEMOLINE PROVIGIL RITALIN RITALIN LA RITALIN SR STRATTERA

CORTICOSTEROIDS - TOPICAL

CORTICOSTEROIDS - ORAL CORTEF TAB 20MG - 3EA DEXAMETHASON PAK 0.75MG - 12EA DEXAMETHASON TAB 0.5MG - 30EA DEXAMETHASON TAB 0.75MG - 12EA DEXAMETHASON TAB 6MG - 4EA PREDNISOLONE SYP 5MG/5ML - 30ML PREDNISOLONE TAB 5MG - 30EA PREDNISONE PAK 5MG - 21EA PREDNISONE TAB 10MG - 30EA PREDNISONE TAB 2.5MG - 30EA PREDNISONE TAB 20MG - 30EA PREDNISONE TAB 50MG - 3EA PREDNISONE TAB 5MG - 30EA

CORTEF TAB 5MG - 30EA DECADRON TAB 0.75MG - 21EA DEXAMETHASON ELX 0.5/5ML - 240ML DEXAMETHASON TAB 1MG - 30EA DEXAMETHASON TAB 2MG - 30EA MEDROL TAB 16MG - 4EA MEDROL TAB 32MG - 2EA MEDROL TAB 8MG - 8EA METHYLPRED PAK 4MG - 21EA METHYLPRED TAB 4MG - 30EA METHYLPRED TAB 8MG - 8EA PREDNISOLONE SOL 15MG/5ML - 30ML PREDNISONE PAK 10MG - 21EA

CORTISONE AC TAB 25MG - 45EA DEXAMETHASON CON 1MG/ML - 50ML DEXAMETHASON TAB 1.5MG - 51EA FLORINEF TAB 0.1MG - 30EA FLUDROCORT TAB 0.1MG - 30EA HYDROCORT TAB 20MG - 45EA MEDROL PAK 4MG - 21EA MEDROL TAB 2MG - 30EA ORAPRED SOL 15MG/5ML - 30ML PREDNISONE CON 5MG/ML - 30ML PREDNISONE TAB 1MG - 120EA

ARISTOCORT BETAMETHASON CELESTONE CORTEF DECADRON DEXAMETH SOD DEXAMETHASON ENTOCORT EC FLUDROCORT HYDROCORTONE MEDROL METHYLPRED PREDNISOLONE PREDNISONE STERAPRED TRIAMCINOLON

ALA-CORT CRE 0.01 - 66GM CETACORT LOT 0.01 - 60ML DESOWEN CRE 0.0005 - 1GM FLUOCIN ACET CRE 0.00025 - 60GM HYDROCORT CRE 0.01 - 28GM HYDROCORT OIN 0.01 - 28GM PROCTO-KIT CRE 0.01 - 28GM PROCTO-PAK CRE 0.01 - 30GM TRIAMCINOLON CRE 0.00025 - 80GM TRIAMCINOLON CRE 0.001 - 80GM TRIAMCINOLON CRE 0.005 - 15GM TRIAMCINOLON OIN 0.00025 - 80GM TRIAMCINOLON OIN 0.005 - 15GM

ALCLOMETASON CRE 0.0005 - 15GM ARISTOCORT A CRE 0.005 - 30GM BETAMETH DIP CRE 0.0005 - 45GM BETAMETH DIP LOT 0.0005 - 60ML BETAMETH DIP OIN 0.0005 - 45GM BETAMETH VAL CRE 0.001 - 45GM BETAMETH VAL LOT 0.001 - 60ML BETAMETH VAL OIN 0.001 - 45GM BETA-VAL CRE 0.001 - 45GM BETA-VAL LOT 0.001 - 60ML FLUOCIN ACET CRE 0.0001 - 60GM FLUOCIN ACET OIN 0.00025 - 60GM FLUOCIN ACET SOL 0.0001 - 60ML FLUOCINONIDE CRE 0.0005 - 60GM HC BUTYRATE OIN 0.001 - 15GM HYDROCORT CRE 0.025 - 30GM HYDROCORT LOT 0.01 - 118ML HYDROCORT OIN 0.025 - 28GM HYDROCORT SOL BUTYRATE - 60ML HYDROCORT/AB OIN 0.01 - 120GM LACTICARE-HC LOT 0.01 - 120ML NUTRACORT LOT 0.01 - 120ML TRIAMCINOLON LOT 0.00025 - 60ML TRIAMCINOLON LOT 0.001 - 60ML TRIAMCINOLON OIN 0.001 - 80GM

ACLOVATE CRE 0.0005 - 15GM ALA-SCALP LOT 0.02 - 30ML AMCINONIDE CRE 0.001 - 30GM CLODERM CRE 0.001 - 15GM CORDRAN 24X3 TAP 4MCG/CM - 1EA DESONIDE CRE 0.0005 - 60GM DESONIDE OIN 0.0005 - 60GM DESOXIMETAS CRE 0.0005 - 60GM DESOXIMETAS CRE 0.0025 - 60GM ELOCON LOT 0.001 - 30ML ELOCON OIN 0.001 - 15GM EMBELINE E CRE 0.0005 - 30GM EPIFOAM AER 0.01 - 10GM FLUOCINONIDE CRE -E 0.05% - 60GM FLUOCINONIDE GEL 0.0005 - 60GM FLUOCINONIDE SOL 0.0005 - 60ML HC BUTYRATE CRE 0.001 - 30GM HC PRAMOXINE CRE 0.025 - 28GM HC VALERATE CRE 0.002 - 45GM HC VALERATE OIN 0.002 - 45GM MOMETASONE CRE 0.001 - 45GM TEMOVATE GEL 0.0005 - 15GM U-CORT CRE 0.01 - 28GM

ACLOVATE ALCLOMETASON AMCINONIDE APEXICON APEXICON E ARISTOCORT A AUG BETAMET BETA DIPROP BETAMETH DIP CAPEX CLOBETASOL CLOBETASOL E CLOBEX CORDRAN CORDRAN 80X3 CORDRAN SP CORMAX CORTANE-B CUTIVATE CYCLOCORT DERMATOP DESONIDE DESOWEN DESOXIMETAS DIFLORASONE DIPROLENE DIPROLENE AF ELOCON EMBELINE FLUOCINONIDE FLUTICASONE HALOBETASOL



Non-Preferred


HALOG HYDROCORT HYDROCORT AC HYDROCRTSONE HYTONE KENALOG LACTICARE-HC LIDAMANTLE LIDEX LIDOCAINE/HC LOCOID LOCOID LIPO LOKARA LUXIQ MOMETASONE NOVACORT NUTRACORT OLUX PANDEL PRAMOSONE PROCTOCORT PSORCON E TACLONEX TEMOVATE TEXACORT TOPICORT TOPICORT LP TRIAMCINOLON TRIDESILON ULTRAVATE VANOS WESTCORT

COUGH/COLD/ALLERGY PRODUCTS ANDEHIST NR SYP 4-45MG/M - 60ML CARBINO-PSE SYP 2-25MG - 90ML CHERATUSSIN SOL DAC - 240ML CHERATUSSIN SYP AC - 240ML CHLORDEX GP SYP - 60ML CHLOR-MES D SYP LIQUID - 240ML CODAL-DH SYP - 120ML CODITUSS DH SYP - 120ML COLDCOUGH SYP - 120ML COLDMIST LA TAB 12HR - 20EA COTUSS-V SYP 5-100/5 - 120ML CYTUSS HC SYP - 240ML DALLERGY SYP - 120ML DE-CHLOR HC SYP LIQUID - 120ML DEHISTINE SYP - 120ML DM HB/PE/CPM SYP STRAWBER - 120ML DONATUSSIN DRO PED - 30ML ED A-HIST TAB 8-20 CR - 20EA GFN795/PSE85 TAB - 20EA GFN800/PSE60 TAB - 20EA GG/PSE SR TAB 12HR - 30EA GUAIFENEX PS TAB 80-800MG - 20EA GUIATUSS AC SYP 10-100/5 - 180ML GUIATUSS DAC SOL - 120ML HISTA-VENT TAB 12HR - 14EA HYDRO/PE/CTM SYP - 180ML HYDROCOD/HOM SYP 5-1.5/5 - 120ML HYDRON EX SYP LIQUID - 120ML HYDRON PSC LIQ - 120ML HYPHED SYP - 120ML LODRANE 12D TAB 6-45MG - 14EA MARCOF SYP EXPCTRNT - 100ML M-END LIQ (REFORM) - 120ML MINTUSS G SYP - 4ML MINTUSS NX SYP 3-150MG/ - 120ML MYTUSSIN AC SYP 10-100/5 - 120ML NOHIST TAB 8-20MG - 20EA NOREL DM SOL - 60ML P CHLOR GG SOL DROPS - 30ML

ALLFEN C TAB 5-1000MG - 20EA AMBI 1000/55 TAB - 30EA AMBI 40/1000 TAB - 20EA AMBI 60/580/ TAB 30 - 20EA AMBI 80/780/ TAB 40 - 20EA AMDRY-C TAB - 30EA ANAPLEX DM SYP - 180ML ANAPLEX DMX SUS - 120ML ANAPLEX HD SOL 30-2-1.7 - 120ML BENZONATATE CAP 100MG - 30EA BIDEX TAB 400MG - 60EA BIDEX-DM TAB 30-800CR - 20EA BROMATANE DX SYP - 120ML BROMAXEFED SYP RF - 90ML BROMETANE DX SYP - 180ML BROMFENEX PD CAP 6-60MGCR - 30EA BROMHIST-PDX SYP - 120ML BROMOPHED DX SYP - 240ML BROMPHENEX SYP DM - 120ML BROMPLEX DM SYP - 120ML BROMPLEX HD SOL 30-2-1.7 - 120ML BROVEX SR CAP 9-90MG - 14EA B-TUSS LIQ - 120ML CARBATUSS SYP - 120ML CARBETAPEN/ TAB CHLORPHN - 14EA CARBOFED DM SYP - 120ML CAR-B-PEN TAB CHLOR-TA - 10EA CODAFED SYP EXPECT - 120ML COLDCOUGH PD SYP - 118ML COLDEC TAB 4-60MG - 21EA COLDEX-A SR TAB 4-40-20 - 28EA CORFEN-DM LIQ - 180ML CPM/PSE CAP 8-120 SR - 60EA CPM/PSE SYP - 180ML CRANTEX HC SYP - 60ML CRANTEX SYP 7.5/100 - 120ML DACEX-PE TAB - 20EA D-AMINE-SR CAP 8-120 CR - 60EA DE-CHLOR DM SYP LIQUID - 180ML DE-CHLOR G SYP - 240ML

ACETYLCYST SOL 0.1 - 30ML ACETYLCYST SOL 0.2 - 30ML ALLFEN-DM TAB 55-1000 - 20EA ALTEX-PSE TAB 120-600 - 60EA AMIBID DM TAB 30-600CR - 60EA AMI-TEX LA TAB 30-600MG - 20EA AMITEX PSE TAB 120-600 - 60EA ANDEHIST DM DRO NR - 30ML ANDEHIST DM SYP NR - 120ML ATUSS HD CAP 30-2-5MG - 30EA ATUSS HX CAP 5-300MG - 30EA BELLAHIST-D TAB LA - 30EA BENZONATATE CAP 200MG - 30EA BIDHIST-D TAB 6-45MG - 60EA BPM/HYDROCOD LIQ /PSE - 180ML BROM T/DM T/ SUS PSE T - 120ML BROMATAN-DM SUS - 120ML BROMFENEX CAP 12-120CR - 60EA BROMFENEX PE CAP 12-15MG - 20EA BROVEX HC LIQ 30-3-2.5 - 120ML BROVEX-D SUS 12-20MG - 120ML CANGES-HC LIQ - 240ML CARB/PE/GG SYP - 210ML CARBAXEFED D DRO RF - 30ML CARBAXEFED DRO 1-15/ML - 30ML CARBOFED DM DRO - 30ML CARDEC DM SYP - 120ML CERON-DM SYP - 180ML CERTUSS TAB - 30EA CHLOREX-A TAB 4-40-20 - 60EA CODICLEAR DH SYP 3.5-100 - 120ML COLDCOUGH HC SYP - 240ML COLDEC D TAB 8-80MG - 60EA C-PHEN DM SYP - 100ML CPM 8/PE 20/ TAB MSC 1.25 - 60EA CPM/PSE CAP 8-120 CR - 20EA CPM/PSE/MSC TAB - 60EA CRANTEX LA TAB 30-600MG - 20EA CRANTEX LAC CAP 30-400MG - 30EA

ACETYLCYST AH-CHEW ALLEGRA-D ALLERX BIOHIST LA BROMAXEFED CERON-DM CLARINEX-D CODEINE/GG COFEX-DM DALLERGY-JR DRIHIST DURAHIST D DURATUSS DURATUSS HD DYTAN-D DYTAN-HC ENTEX PSE GFN1000/DM50 GFN1200/DM60 GG/PSE GUAIFEN/PSE GUAIMAX-D HISTUSSIN HC HYDROCODONE K-TAN LEVALL G LEVALL-12 MAXIFED DM PSE/GG QUAD-TUSS RESCON-JR RESPA DM RESPI-TANN RONDEC RONDEC-DM R-TANNA RYNATAN RYNATAN PED SEMPREX-D SYMTAN TESSALON TETRA TANN TOURO DM TRITUSS-ER TUSSI-12D TUSSIONEX TUSSI-ORGANI VIRATAN-DM ZYRTEC-D

COUGH/COLD/ALLERGY PRODUCTS



Non-Preferred

PE/HCOD/CPM SYP - 120ML PHENYLEPHRIN LIQ HD - 120ML PHENYLHISTIN SOL EXPECT - 120ML PROMETH VC SYP 6.25-5/5 - 180ML PROMETH/COD SYP 6.25-10 - 120ML PROMETHAZINE SYP DM - 240ML PRO-RED SYP - 120ML PSE/DM/GG SYP 40-15-10 - 100ML PSE-DM-GG TAB - 14EA PSEUDOEPHEDR TAB /GG/DM - 10EA PSEUDOVENT TAB DM - 14EA Q-V TUSSIN SYP - 120ML QV-ALLERGY SYP - 120ML SU-TUSS DM ELX 200-20/5 - 120ML SU-TUSS HD ELX - 120ML TRI-VENT DPC SYP 6-2-15/5 - 120ML VITUSSIN SYP 5-100/5 - 120ML WELLBID-D TAB 40-600MG - 20EA

DE-CHLOR MR SYP - 120ML DE-CHLOR NX SOL LIQUID - 240ML DECONSAL II CAP 20-375MG - 10EA DETUSS LIQ - 240ML DM/PE/CPM LIQ - 240ML DM/PSE/GG TAB - 20EA DONATUSSIN SYP - 150ML DRITUSS DM ELX 200-20/5 - 120ML DRITUSS HD ELX - 240ML DUOMAX TAB 40-1200 - 20EA DURAFLU TAB - 10EA DURAHIST PE TAB - 15EA DYNEX HD LIQ 45-6-200 - 50ML ED-A-HIST DM LIQ - 120ML ENDACOF-DM SYP - 120ML ENDACOF-HC SOL 30-2-1.7 - 240ML ENDACOF-PLUS LIQ - 120ML ENDACOF-XP SYP - 240ML EXEFEN-DM TAB 55-1000 - 20EA EXETUSS TAB 25-900MG - 15EA EXTENDRYL JR TAB - 20EA GANI-TUSS DM LIQ 100-10/5 - 180ML GFN1200/DM60 TAB /PSE 120 - 20EA GFN600/PE20 TAB - 40EA GFN600/PE40 TAB - 30EA GFN600/PSE60 TAB /DM30 SA - 20EA GG/CARBETA TAB - 20EA GG/PSE CR TAB 600-120 - 60EA GG/PSE TAB 12HR - 20EA GUAIFENESIN LIQ AC - 120ML GUAIFENESIN LIQ DM - 240ML GUAIFENEX GP TAB 120/1200 - 14EA GUAIFENEX TAB PSE 60 - 30EA GUAIPHEN-PD TAB - 20EA HC TUSSIVE SYP - 240ML HCOD/PE/CPM LIQ - 180ML HISTACOL DM SYP - 150ML HISTINEX HC SYP - 240ML HISTINEX PV SYP - 240ML HUMIBID LA TAB 600-300 - 20EA HYDRO PRO DM TAB - 20EA HYDROCOD/GG SYP 5-100/5 - 120ML HYDRO-DP SYP - 240ML HYDRON CP SYP LIQUID - 180ML HYDRON KGS SYP - 120ML HYDRO-PC II SYP - 240ML HYDRO-PC II SYP PLUS - 120ML HYDRO-TUSSIN ELX DM - 120ML HYDRO-TUSSIN SOL HD - 180ML HYDRO-TUSSIN SYP 15-2-3MG - 120ML HYDRO-TUSSIN SYP CBX - 180ML HYDRO-TUSSIN SYP DHC - 120ML HYDRO-TUSSIN SYP EXP - 120ML HYDRO-TUSSIN SYP XP - 120ML HY-KXP SYP - 120ML IOPHEN C-NR LIQ 10-100/5 - 180ML KGS-HC SYP - 180ML LIQUIBID-PD TAB 25-275MG - 20EA LOHIST-12D TAB 6-45MG - 50EA LUSONEX TAB - 30EA MAXIFED TAB 80-780MG - 20EA MAXIFED-G TAB 60-580CR - 20EA MEDENT LD TAB - 20EA MINTUSS DR SYP - 180ML MINTUSS MS SYP 38627 - 180ML MUCO-FEN DM TAB 60-1000 - 20EA MYTUSSIN DAC SOL - 240ML NACON TAB - 30EA NALEX-A LIQ - 100ML NALEX-A TAB - 20EA NESCON-PD TAB 25-275MG - 20EA NOREL SR TAB - 20EA NY-TANNIC TAB 9-25MG - 14EA ORGAN-I NR TAB 200MG - 60EA PANCOF XP SYP - 120ML PANNAZ TAB - 20EA PE/GG LA TAB 20-600MG - 20EA PE/GG TAB 15-600MG - 20EA PEDIATEX DM LIQ - 120ML PEDIATEX-D LIQ - 180ML PHENCLOR TAN SUS PEDI - 60ML PHENYLHIST LIQ DH - 480ML PHLEMEX TAB - 20EA POLY HIST TAB FORTE - 20EA POLY-TUSSIN SYP - 120ML POLY-TUSSIN SYP DM - 240ML PROMETH VC/ SYP CODEINE - 240ML PSE BROM DM SYP - 240ML PSE/GG CR TAB 120-600 - 20EA

C-TANNA 12 SUS 4-30MG/5 - 86ML DALLERGY JR CAP 4-20MG - 60EA DALLERGY TAB - 60EA DALLERGY TAB ER - 60EA DEC-CHLORPHN LIQ - 30ML DEC-CHLORPHN SYP DM - 120ML DECONEX TAB 30-900MG - 30EA DECONGESTINE CAP 8-120 TR - 60EA DIHYDRO-CP SYP - 240ML DONATUSSIN DRO - 30ML DONATUSSIN SYP DC - 240ML DREXOPHED TAB 6-120 SR - 100EA DURADEX TAB - 20EA DURAHIST TAB - 20EA DURAPHEN DM TAB - 30EA DURAPHEN II TAB - 30EA DURAPHEN II TAB DM - 30EA DURAPHEN TAB FORTE - 20EA DURATUSS GP TAB 25-1200 - 14EA DYTAN-CS SUS SUSP - 75ML ENTEX LA CAP 30-400MG - 20EA EXCOF-SF LIQ - 180ML EXTENDRYL DM TAB - 20EA EXTENDRYL SR TAB - 60EA FLUTUSS XP LIQ 5-150MG - 200ML G/P TAB 1200-75 - 30EA GFN/DM/PSE TAB - 30EA GFN/PSE TAB 1200/120 - 30EA GFN1000/DM60 TAB - 60EA GFN1200/DM20 TAB /PE40 - 30EA GFN1200/PE40 TAB - 30EA GFN800/PE25 TAB - 60EA GG/DM LA TAB - 60EA GG/PE TAB 1200-25 - 14EA GG/PE TAB 900-25MG - 20EA GG/PSE CR TAB 600-60MG - 60EA GUAIF/PHENYL TAB 600-40MG - 60EA GUAIFE/PSEUD TAB - 60EA GUAIFEN PE TAB - 60EA GUAIFEN PSE TAB 600-120 - 60EA GUAIFENESIN TAB /DM ER - 60EA GUAIFENESIN TAB 200MG - 180EA GUAIFENESIN TAB 400MG - 90EA GUAIFENESIN TAB DM - 60EA GUAIFENEX DM TAB 30-600CR - 60EA GUAIFENEX TAB PSE 120 - 60EA GUAPHEN II TAB DM - 30EA HISTATAB PH TAB - 60EA HISTA-VENT TAB DA - 60EA HISTEX HC LIQ - 180ML HUMIBID DM CAP CR - 20EA HYCODAN SYP 5-1.5/5 - 120ML HYDEX PD LIQ - 240ML HYDROCOD/GG SYP 3.5-100 - 120ML HYDROCODONE/ TAB HOMATROP - 30EA HYDROMET SYP 5-1.5/5 - 240ML HYDRO-TUSSIN SYP HG - 120ML IOPHEN DM-NR LIQ 10-100/5 - 240ML IOTEX PSE TAB 120-600 - 60EA JAYCOF-HC LIQ - 240ML J-MAX TAB - 30EA KRONOFED-A CAP 8-120 CR - 60EA LEV/PSE/GG CAP 90-400MG - 30EA LODRANE D SUS - 120ML LUSONEX TAB 20-800MG - 60EA MAX HC LIQ - 240ML MAXIPHEN DM TAB - 20EA MAXIPHEN TAB - 30EA M-CLEAR SYP - 240ML MEDENT DM TAB - 30EA MIRAPHEN PSE TAB 120-600 - 60EA MUCOMYST SOL 0.2 - 30ML NALEX SOL EXPECT - 180ML NOREL EX TAB 40-800MG - 30EA NOREL LA TAB 8-40MG - 30EA PCM ALLERGY TAB - 60EA PCM LA TAB - 60EA PE/GG TAB 25-900 - 20EA PEDIATEX SUS 12DM - 150ML PHENAVENT LA CAP 30-400MG - 20EA PHENAVENT PE CAP 7.5-200 - 20EA PHENYL CHLOR SUS TAN - 90ML PHLEMEX TAB FORTE - 30EA POLY HIST DM LIQ - 180ML POT GUAIACO/ SYP HYDROCOD - 240ML PSE/CPM CAP 100-12MG - 30EA PSE/METHSCOP TAB 120/2.5 - 30EA PSEUDO/GG LA TAB 12HR - 60EA


PSE/GG SR TAB 50-1200 - 20EA PSE/HYDROCOD LIQ /CARBINX - 200ML PSEUDO MAX TAB - 20EA PULMARI-GP LIQ 20-100MG - 120ML QUINDAL-HD SYP - 180ML RALIX TAB - 20EA RESPA-1ST TAB CR - 30EA RESPAIRE-60 CAP CR - 30EA RESPA-PE TAB 18-600 - 30EA RHINACON A TAB - 20EA RINDAL HD SYP PLUS - 120ML RINDAL HPD SYP - 240ML RU-HIST TAB FORTE - 20EA SITREX TAB 30-1200 - 14EA SUDAL 12 CHW 4-30MG - 15EA SUDAL TAB 60-500CR - 20EA TOURO CC TAB - 14EA TRIANT-HC LIQ - 125ML TRIKOF-D TAB SR 12HR - 20EA TRI-VENT HC LIQ - 180ML TUSSI-BID TAB - 20EA TUSSIGON TAB 5MG - 40EA TUSSINATE SYP - 120ML UNI-COF EXP SYP - 150ML UNI-COF SYP - 150ML VI-Q-TUSS SYP 5-100/5 - 120ML WELLBID-D TAB 1200 - 20EA XPECT-HC TAB 5-600MG - 10EA ZYMINE HC LIQ - 120ML ZYMINE-D LIQ 1.25-45 - 105ML

PSEUDOVENT CAP 400 - 20EA PSEUDOVENT CAP PED CR - 60EA P-V TUSSIN TAB - 30EA PYRILAFEN TA SUS 30-5MG/5 - 120ML QDALL CAP 12-100MG - 30EA QUAL-TUSSIN SYP DC - 240ML RESCON-MX TAB - 20EA RHINABID CAP 12-15MG - 20EA SIMUC-HD SOL - 180ML TANNATE 12 S SUS - 118ML TANNATE DMP- SUS DEX - 60ML TANNATE-12D SUS S - 120ML TANNIC-12 TAB 5-60MG - 20EA TOURO LA TAB - 30EA TRITAL DM LIQ - 473ML TRI-TANNATE SUS PED - 100ML UNI ALL 12 SUS - 120ML UNI-TANN D CHW 25-10MG - 30EA UNI-TEX ER CAP 120/10 - 60EA VISVEX HC LIQ - 180ML XPECT-AT TAB - 30EA Z-COF HC LIQ - 240ML ZEPHREX LA TAB 120-600 - 20EA ZTUSS LIQ EXPECT - 180ML

COUGH/COLD/ALLERGY PRODUCTS



Non-Preferred


DENTA 5000 CRE PLUS - 51GM DENTAGEL GEL 0.011 - 56GM ETHEDENT CHW 0.25MG - 30EA ETHEDENT CHW 0.5MG - 30EA ETHEDENT CHW 1MG - 30EA ETHEDENT CRE DENTAL - 51GM ETHEDENT GEL 0.011 - 56GM FLUOR-A-DAY CHW 0.25MG - 4EA FLUOR-A-DAY CHW 0.5MG - 120EA FLUOR-A-DAY CHW 1MG - 30EA GEL-KAM GEL 0.004 - 122GM KARIGEL-N GEL 0.011 - 120ML LOZI-FLUR LOZ 1MG - 30EA LURIDE CHW 0.5MG - 54EA LURIDE CHW 1MG - 120EA LURIDE DRO 0.5MG/ML - 50ML SF 5000 PLUS CRE 0.011 - 51GM SF GEL 0.011 - 56GM SOD FLUORIDE DRO 0.5MG/ML - 5ML

CHLORHEX GLU SOL 0.0012 - 473ML CONTROLRX CRE 0.011 - 51GM DENTA 5000 CRE PLUS 2PK - 102GM GEL-KAM CON 0.0063 - 283GM PERIDEX SOL 0.0012 - 473ML PERIOGARD SOL 0.0012 - 473ML PHOS FLUR SOL 0.00044 - 473ML PHOS-FLUR GEL 0.011 - 51GM PREVIDENT CRE 5000 PLS - 51GM PREVIDENT GEL 1.1% CHR - 56GM PREVIDENT GEL 1.1% MIN - 56GM PREVIDENT PST 5000 BST - 106ML PREVIDENT SOL RINSE - 473ML STAN FLUORID CON 0.0063 - 283GM

DENTAL/FLUORIDE AGENTS

DERMATOLOGICAL AGENTS - MISC. ANESTACON GEL 2% JELLY - 15ML ARZOL SILVER MIS NITR APP - 10EA DRYSOL SOL 0.2 - 35ML HYPERCARE SOL 0.2 - 35ML LIDOCAINE OIN 0.05 - 35GM LINDANE LOT 0.01 - 60ML SALICYLIC AC POW - 120GM SILVER SULFA CRE 0.01 - 50GM SSD AF CRE 0.01 - 50GM SSD CRE 0.01 - 50GM THERMAZENE CRE 0.01 - 50GM XERAC-AC SOL 0.0625 - 35ML

ALUMINUM CL SOL 0.2 - 35ML BIAFINE RE EMU - 46GM COAL TAR SOL USP - 120ML ETHYL CHLOR AER - 103ML EURAX CRE 0.1 - 60GM EURAX LOT 0.1 - 60ML GRANUL-DERM AER - 113GM GRANULEX AER - 113GM HYDROQUINONE SOL 0.03 - 29ML LIDOCAINE GEL 0.02 - 30ML LIDOCAINE GEL 2% JELLY - 30ML LIDOCAINE SOL 0.04 - 50ML LINDANE SHA 0.01 - 60ML SELENIUM SUL LOT 0.025 - 120ML SELENIUM SUL SHA 0.025 - 118ML SELSUN SHA 0.025 - 120ML SILVADENE CRE 0.01 - 50GM

ACTICIN CRE 0.05 - 60GM AMMONIUM LAC CRE 0.12 - 280GM DENAVIR CRE 0.01 - 1GM KOVIA 6.5 OIN - 30GM KOVIA OIN 0.83/G - 30GM LACLOTION LOT 0.12 - 225GM LACTIC ACID CRE 0.1 - 113GM LACTIC ACID CRE E - 113GM LACTIC ACID CRE VIT E - 113GM LIDOCAINE CRE 0.03 - 28GM METRONIDAZOL GEL 0.0075 - 45GM MEXAR WASH LIQ - 170ML PERMETHRIN CRE 0.05 - 60GM RADIAPLEXRX GEL - 170GM SULFAMYLON CRE 85MG/GM - 57GM TBC AER - 113GM XYLOCAINE GEL 0.02 - 30ML

ACCUZYME AMMONIUM LAC ATOPICLAIR AVAGE BENOQUIN BENSAL HP BIAFINE BIONECT BOTOX COSMET CARAC CARMOL SCALP CEROVEL COCAINE HCL CONDYLOX DOVONEX EFUDEX ELDOPAQUE ELDOQUIN ELIDEL ELIMITE EPIQUIN MICR ETHEZYME FINACEA FLUOROPLEX FLUOROURACIL GLADASE GLYQUIN XM HYDROQUINONE KERALAC KERALYT KERATOL 40 LAC-HYDRIN LACTINOL LEVULAN KERA LIDAMANTLE LIDOC/PRILOC LIDOCAINE LIDODERM LUSTRA LUSTRA-ULTRA METROCREAM METROGEL METROLOTION METRONIDAZOL MIMYX NORITATE

OVIDE OXSORALEN-UL PANAFIL PANAFIL SE PAPA-UREA-CH PAP-UREA PODOCON PODOFILOX PROPECIA PROTOPIC PRUDOXIN PSORIATEC RAPTIVA RE 10 WASH RE 40 REGRANEX RENOVA ROSULA NS SALEX SANTYL SEB-PREV SELSEB SOLAGE SOLARAZE SORIATANE SULFAMYLON TARGRETIN TAZORAC TRETINOIN EM TRI-LUMA UMECTA UMECTA NAIL UREA UREA NAIL UREA-C40 UREALAC UREALAC NAIL VANAMIDE VANIQA XCLAIR XENADERM X-VIATE ZIOX ZIOX 405 ZONALON ZOVIRAX

DIABETIC - INJECTABLES APIDRA

BYETTA GLUCAGEN HUMALOG HUMALOG MIX HUMALOG PEN HUMULIN R LANTUS LEVEMIR NOVOLOG NOVOLOG MIX PROGLYCEM

DIABETIC ORAL AGENTS GLIPIZIDE TAB 5MG - 30EA GLYBURIDE TAB 1.25MG - 30EA TOLAZAMIDE TAB 100MG - 30EA

AMARYL TAB 1MG - 30EA CHLORPROPAM TAB 100MG - 30EA DIABETA TAB 2.5MG - 30EA GLIMEPIRIDE TAB 1MG - 30EA GLIMEPIRIDE TAB 2MG - 30EA GLIMEPIRIDE TAB 4MG - 30EA GLIPIZIDE ER TAB 2.5MG - 30EA GLIPIZIDE ER TAB 5MG - 30EA GLIPIZIDE TAB 10MG - 60EA GLIPIZIDE XL TAB 2.5MG - 30EA GLIPIZIDE XL TAB 5MG - 30EA GLUCOTROL TAB 5MG - 30EA GLUCOTROL XL TAB 2.5MG - 30EA GLUCOTROL XL TAB 5MG - 30EA GLYBURID MCR TAB 1.5MG - 30EA GLYBURID MCR TAB 3MG - 30EA GLYBURIDE TAB 2.5MG - 30EA MICRONASE TAB 1.25MG - 30EA TOLAZAMIDE TAB 250MG - 30EA

AMARYL TAB 2MG - 30EA CHLORPROPAM TAB 250MG - 30EA GLIPIZIDE ER TAB 10MG - 30EA GLIPIZIDE XL TAB 10MG - 30EA GLYBURIDE TAB 5MG - 60EA METAGLIP TAB 2.5-250M - 30EA METAGLIP TAB 5-500MG - 30EA METFORMIN TAB 1000MG - 60EA METFORMIN TAB 500MG - 60EA METFORMIN TAB 500MG ER - 60EA METFORMIN TAB 850MG - 60EA MICRONASE TAB 5MG - 30EA TOLAZAMIDE TAB 500MG - 60EA TOLBUTAMIDE TAB 500MG - 60EA

ACTOPLUS MET ACTOS AMARYL AVANDAMET AVANDARYL AVANDIA DIABETA DIABINESE FORTAMET GLIP/METFORM GLUCOPHAGE GLUCOTROL GLUCOTROL XL GLYBURID MCR GLYNASE GLYSET METAGLIP METFORMIN PRANDIN PRECOSE RIOMET STARLIX

DIGESTIVE AIDS

PANCREASE MT CAP 4 - 90EA PANCRELIPASE 4500UNIT - 100EA PANCRELIPASE TAB - 90EA PANGESTYM EC CAP - 90EA PANOCAPS CAP - 90EA PANOKASE TAB - 100EA

CREON DYGASE KUTRASE KU-ZYME KU-ZYME-HP LAPASE LIPRAM PALCAPS PANCREASE PANCRECARB PANCRELIPASE PANCRON 10

DIURETICS ACETAZOLAMID TAB 250MG - 30EA ALDACTONE TAB 25MG - 4EA AMILOR/HCTZ TAB 18384 - 30EA CHLOROTHIAZ TAB 250MG - 30EA CHLOROTHIAZ TAB 500MG - 30EA CHLORTHALID TAB 25MG - 30EA CHLORTHALID TAB 50MG - 30EA FUROSEMIDE TAB 20MG - 30EA FUROSEMIDE TAB 40MG - 30EA FUROSEMIDE TAB 80MG - 30EA HYDROCHLOROT TAB 25MG - 30EA HYDROCHLOROT TAB 50MG - 30EA INDAPAMIDE TAB 1.25MG - 30EA INDAPAMIDE TAB 2.5MG - 30EA LASIX TAB 20MG - 30EA TRIAMT/HCTZ TAB 75-50MG - 30EA

ACETAZOLAMID TAB 125MG - 60EA AMILORIDE TAB 5MG - 30EA BUMETANIDE TAB 0.5MG - 30EA BUMETANIDE TAB 1MG - 30EA EDECRIN TAB 50MG - 30EA FUROSEMIDE SOL 10MG/ML - 60ML FUROSEMIDE SOL 8MG/ML - 150ML HYDROCHLOROT CAP 12.5MG - 30EA LASIX TAB 40MG - 30EA METHYCLOTHIA TAB 5MG - 30EA MIDAMOR TAB 5MG - 30EA SPIRONO/HCTZ TAB 25/25 - 30EA SPIRONOLACT TAB 25MG - 30EA TORSEMIDE TAB 10MG - 30EA TORSEMIDE TAB 5MG - 30EA TRIAM/HCTZ CAP 37.5-25 - 30EA TRIAMT/HCTZ CAP 50-25MG - 30EA TRIAMT/HCTZ TAB 37.5-25 - 30EA

ALDACTAZIDE TAB 25/25 - 30EA BUMETANIDE TAB 2MG - 30EA BUMEX TAB 0.5MG - 30EA BUMEX TAB 1MG - 30EA DEMADEX TAB 10MG - 30EA DEMADEX TAB 5MG - 30EA DIURIL SUS 250/5ML - 150ML DYAZIDE CAP 37.5-25 - 30EA DYRENIUM CAP 50MG - 30EA LASIX TAB 80MG - 30EA LOZOL TAB 1.25MG - 30EA MAXZIDE-25 TAB - 30EA METHAZOLAMID TAB 25MG - 60EA METHAZOLAMID TAB 50MG - 60EA METOLAZONE TAB 2.5MG - 30EA METOLAZONE TAB 5MG - 30EA SPIRONOLACT TAB 100MG - 30EA SPIRONOLACT TAB 50MG - 30EA THALITONE TAB 15MG - 30EA TORSEMIDE TAB 20MG - 30EA

ALDACTAZIDE ALDACTONE BUMEX DEMADEX DIAMOX DYRENIUM EDECRIN MAXZIDE METOLAZONE TORSEMIDE ZAROXOLYN



Non-Preferred


PANGES PANOCAPS PANOKASE-16 PLARETASE ULTRACAPS ULTRASE VIOKASE

ENDOCRINE AND METABOLIC DRUGS - MISC. METHERGINE TAB 0.2MG - 9EA CLOMIPHENE TAB 50MG - 5EA

DDAVP TAB 0.1MG - 7EA ACTHAR HP BUPHENYL CABERGOLINE CARNITOR CLOMID CYSTADANE CYTADREN DDAVP DESMOPRESSIN DOSTINEX EVISTA

FOLLISTIM AQ GANIRELIX AC GENOTROPIN HECTOROL LEVOCARNITIN NORDITROPIN NOVAREL NUTROPIN NUTROPIN AQ OCTREOTIDE SAIZEN SANDOSTATIN SENSIPAR SOMAVERT STIMATE ZEMPLAR

GASTROINTESTINAL AGENTS ANTI-SPAS TAB - 40EA ANTISPASMOD 16MG/5ML - 240ML BELLA ALK/PB TAB 16.2MG - 60EA CIMETIDINE TAB 200MG - 30EA METOCLOPRAM POW MONOHYDR - GM

CIMETIDINE TAB 300MG - 60EA CIMETIDINE TAB 400MG - 60EA CIMETIDINE TAB 800MG - 30EA DICYCLOMINE CAP 10MG - 90EA DICYCLOMINE TAB 20MG - 60EA DONNATAL TAB - 30EA ENULOSE SOL 10GM/15 - 473ML FAMOTIDINE TAB 20MG - 60EA FAMOTIDINE TAB 40MG - 30EA GENERLAC SOL 10GM/15 - 473ML HYOSCYAMINE TAB 0.375 TR - 30EA METOCLOPRAM SYP 5MG/5ML-473ML METOCLOPRAM TAB 10MG - 120EA METOCLOPRAMI POW HCL USP- 1GM NULEV TAB 0.125MG - 20EA PRO-BANTHINE TAB 7.5MG - 30EA RANITIDINE TAB 150MG - 60EA RANITIDINE TAB 300MG - 30EA TAGAMET TAB 300MG - 15EA

B & O 15-A SUP SUPPRETT - 12EA B & O 16-A SUP SUPPRETT - 12EA BELLA ALK/PB ELX - 240ML BENTYL CAP 10MG - 90EA BENTYL SYP 10MG/5ML - 240ML BENTYL TAB 20MG - 50EA CYTOTEC TAB 100MCG - 30EA DICYCLOMINE SOL 10MG/5ML -240ML HYOSCYAMINE CAP 0.375 CR - 60EA HYOSCYAMINE CAP 0.375 SR - 60EA HYOSCYAMINE CAP 0.375 TR - 60EA HYOSCYAMINE DRO 0.125/ML - 15ML HYOSCYAMINE SUB 0.125MG - 30EA HYOSCYAMINE TAB 0.375 SR - 60EA HYOSYNE DRO 0.125/ML - 15ML LEVSIN TAB 0.125MG - 40EA METOCLOPRAM TAB 5MG - 120EA PHOSLO TAB 667MG - 90EA PROPANTHELIN TAB 15MG - 90EA SAL-TROPINE TAB 0.4MG - 60EA SYMAX-SL SUB 0.125MG - 30EA

ACIPHEX ACTIGALL ALKABEL-SR AMITIZA ATROPINE SUL AXID BELLA/OPIUM BELLATAL ER CARAFATE CHLORD/CLIDI CIMETIDINE CYTOTEC DONNATAL FOSRENOL GLYCOPYRROL HELIDAC HYOSCYAMINE LEVBID LEVSIN/SL LEVSINEX LIBRAX LOTRONEX METOCLOPRAM MISOPROSTOL NEXIUM NIZATIDINE OMEPRAZOLE PAMINE

GENITOURINARY PRODUCTS MICONAZOLE CRE 0.02 - 1GM PHENAZOPYRID TAB 200MG - 6EA PYRIDIUM TAB 200MG - 3EA SODIUM CHLOR SOL 0.9%IRR-1000ML UROBLUE TAB - 20EA UROGESIC-BLU TAB - 30EA UTRONA TAB - 30EA

AMINO ACID CRE CERVICAL - 77GM AMINO-CERV CRE - 77GM CITRIC ACID/ SOL SOD CITR - 473ML CYTRA-2 SOL - 473ML CYTRA-3 SYP - 473ML CYTRA-K SOL - 473ML HYOSPAZ TAB 0.15MG - 60EA K CITRATE SOL CITR ACD - 240ML K-PHOS TAB MF - 90EA METHENAM MAN TAB 0.5GM - 60EA MICONAZOLE 3 KIT COMBO PK - 1EA MICONAZOLE 3 PAK COMBO PK - 1EA OXYBUTYNIN TAB 5MG - 60EA PHENAZOPYRID TAB 100MG - 30EA POT CITRATE TAB 540MG - 30EA SHOHL'S SOL MODIFIED - 960ML URIMAR T TAB - 30EA URIMAR-T TAB - 30EA URIMAX TAB - 12EA URISEPTIC TAB - 30EA URISYM CAP - 20EA URO BLUE TAB - 30EA UROCIT-K 5 TAB - 30EA USEPT TAB - 30EA

ACID JELLY GEL VAG/APPL - 85GM ACIDIC VAG GEL - 85GM HYOSCYAMINE TAB 0.15MG - 60EA K-PHOS TAB NO 2 - 120EA MACRODANTIN CAP 25MG - 30EA METHENAM MAN TAB 1GM - 60EA METROGEL VAG GEL 0.0075 - 70GM NEGGRAM TAB 250MG - 30EA NITROFUR MAC CAP 100MG - 30EA NITROFUR MAC CAP 50MG - 30EA NITROFURANTN CAP 100MG - 14EA PHENAZOPYRID TAB PLUS - 30EA POLYCITRA SYP - 473ML POLYCITRA-K POW CRYSTALS-100EA POLYCITRA-K SOL - 473ML RELAGARD GEL - 50GM RENACIDIN SOL IRR - 500ML URISED TAB - 30EA URITACT DS TAB - 30EA UROCIT-K 10 TAB - 60EA UROQID #2 TAB - 60EA UTA CAP - 30EA UTIRA TAB - 30EA VAGIFEM TAB 25MCG - 8EA VANDAZOLE GEL 0.0075 - 70GM

AVODART BETHANECHOL BICITRA CARDURA XL CLEOCIN CLEOCIN VAG CLINDAMAX CLINDAMYCIN CLINDESSE CYSTAGON CYSTOSPAZ DETROL DETROL LA DITROPAN DITROPAN XL ELMIRON ENABLEX ESTRACE VAG ESTRING FEMRING FINASTERIDE FLAVOXATE FLOMAX FURADANTIN GYNAZOLE-1 HIPREX LITHOSTAT MACROBID MACRODANTIN MANDELAMINE METHENAM HIP MHP-A



Non-Preferred


PEPCID PHOSLO PREVACID PREVPAC PRILOSEC PROTONIX RANITIDINE REGLAN RENAGEL ROBINUL ROBINUL FORT SCOPOLAMINE SUCRALFATE SYMAX DUOTAB SYMAX FASTAB SYMAX-SR URSO 250 URSO FORTE URSODIOL ZANTAC ZEGERID ZELNORM

MICONAZOLE 3 MONUROL NALIDIXIC NEGGRAM NEO/POLY GU NEOSPORIN GU NYSTATIN OXYBUTYNIN OXYTROL POT CITRATE PREMARIN VAG PROSCAR PROSED EC PROSED/DS PYRIDIUM RIMSO-50 SANCTURA TERAZOL 3 TERAZOL 7 TERCONAZOLE THIOLA URECHOLINE URELIEF PLUS URELLE UREX URISPAS URITACT-EC UROXATRAL VESICARE ZAZOLE

GOUT MEDICATIONS ALLOPURINOL TAB 100MG - 30EA ALLOPURINOL TAB 300MG - 30EA

SULFINPYRAZ TAB 100MG - 60EA COLCHICINE TAB 0.6MG - 30EA PROBEN/COLCH TAB 500-0.5 - 30EA ZYLOPRIM TAB 300MG - 30EA

PROBENECID TAB 500MG

HEART/HIGH BLOOD PRESSURE MEDICATIONS ATENOLOL TAB 25MG - 30EA ATENOLOL TAB 50MG - 30EA CAPTOPRIL TAB 12.5MG - 60EA CAPTOPRIL TAB 25MG - 60EA CAPTOPRIL TAB 50MG - 60EA HYDRAL/HCTZ CAP 25/25 - 30EA HYDRAL/HCTZ CAP 50/50 - 30EA HYDRALAZINE TAB 10MG - 90EA ISOSORB DIN SUB 2.5MG - 60EA ISOSORB DIN SUB 5MG - 90EA ISOSORB DIN TAB 10MG - 90EA ISOSORB DIN TAB 30MG - 30EA ISOSORB DIN TAB 5MG - 90EA LANOXICAPS CAP 0.05MG - 3EA LANOXIN TAB 0.125MG - 30EA LANOXIN TAB 0.25MG - 30EA METHYLD/HCTZ TAB 250/25 - 30EA METOPROLOL TAB 50MG - 60EA NITROGLYCER CAP 2.5MG TD - 60EA NITROGLYCER SUB 0.3MG - 100EA NITROGLYCER SUB 0.4MG - 25EA NITROGLYCER SUB 0.6MG - 100EA NITROQUICK SUB 0.3MG - 100EA

ACEBUTOLOL CAP 200MG - 30EA ALDORIL-D50 TAB 500/50 - 15EA ATENOL/CHLOR TAB 100-25MG - 30EA ATENOL/CHLOR TAB 50-25MG - 30EA ATENOLOL TAB 100MG - 30EA CAPTOPR/HCTZ TAB 25-25MG - 30EA CAPTOPR/HCTZ TAB 50-25MG - 30EA CAPTOPRIL TAB 100MG - 60EA CLONIDINE TAB 0.1MG - 60EA CLONIDINE TAB 0.2MG - 60EA CLONIDINE TAB 0.3MG - 60EA CORGARD TAB 80MG - 3EA DIGITEK TAB 0.125MG - 30EA DIGITEK TAB 0.25MG - 30EA DIGOXIN PED DRO 0.05/ML - 60ML DIGOXIN TAB 0.125MG - 30EA DIGOXIN TAB 0.25MG - 30EA DILTIAZEM TAB 120MG - 30EA DILTIAZEM TAB 30MG - 90EA DILTIAZEM TAB 60MG - 90EA ENALAPRIL TAB 2.5MG - 30EA FOSINOPRIL TAB 10MG - 30EA FOSINOPRIL TAB 20MG - 30EA FOSINOPRIL TAB 40MG - 30EA HYDRALAZINE TAB 100MG - 90EA HYDRALAZINE TAB 25MG - 90EA

ACEBUTOLOL CAP 400MG - 30EA ADALAT CC TAB 60MG ER - 14EA AFEDITAB TAB 30MG CR - 30EA BENAZEP/HCTZ TAB 10-12.5 - 30EA BENAZEP/HCTZ TAB 20-12.5 - 30EA BENAZEP/HCTZ TAB 20-25MG - 30EA BENAZEP/HCTZ TAB 5-6.25 - 30EA BENAZEPRIL TAB 10MG - 30EA BENAZEPRIL TAB 20MG - 30EA BENAZEPRIL TAB 40MG - 30EA BENAZEPRIL TAB 5MG - 30EA BETAXOLOL TAB 10MG - 30EA BISOPRL/HCTZ TAB 10/6.25 - 30EA BISOPRL/HCTZ TAB 2.5/6.25 - 30EA BISOPRL/HCTZ TAB 5/6.25MG - 30EA BISOPROL FUM TAB 10MG - 30EA BISOPROL FUM TAB 5MG - 30EA CAPTOPR/HCTZ TAB 25-15MG - 60EA CARTIA XT CAP 120/24HR - 30EA CARTIA XT CAP 180/24HR - 30EA CLORPRES TAB 0.1-15MG - 30EA CLORPRES TAB 0.2-15MG - 30EA DIGOXIN SOL 0.05/ML - 60ML DILTIA XT CAP 120MG/24 - 30EA

ACCUPRIL ACCURETIC ACEON ADALAT CC AFEDITAB ALTACE AMIODARONE ATACAND ATACAND HCT ATENOLOL AVALIDE AVAPRO BENICAR BENICAR HCT BETAPACE BETAPACE AF BETAXOLOL BIDIL CADUET CALAN CALAN SR CAPOTEN CAPOZIDE CAPTOPR/HCTZ CARDENE CARDENE SR CARDIZEM CARDIZEM CD CARDIZEM LA CARDURA CARTIA XT CATAPRES

HEART/HIGH BLOOD PRESSURE MEDICATIONS NITROQUICK SUB 0.4MG - 25EA NITROQUICK SUB 0.6MG - 100EA NITROSTAT SUB 0.4MG - 25EA NITRO-TIME CAP 2.5MG CR - 60EA PAPAVERINE CAP 150MG ER - 50EA PAPAVERINE SOL 30MG/ML - 10ML PROPRAN/HCTZ TAB 40/25 - 30EA PROPRAN/HCTZ TAB 80/25 - 30EA PROPRANOLOL TAB 10MG - 60EA PROPRANOLOL TAB 60MG - 60EA QUINIDINE SU TAB 200MG - 30EA VERAPAMIL TAB 120MG - 30EA

HYDRALAZINE TAB 50MG - 90EA ISOPTIN SR TAB 180MG - 7EA ISOSORB DIN TAB 20MG - 90EA ISOSORB MONO TAB 60MG ER - 30EA LABETALOL TAB 100MG - 60EA LANOXICAPS CAP 0.1MG - 30EA LANOXICAPS CAP 0.2MG - 30EA LISINOPRIL TAB 2.5MG - 30EA METHYLD/HCTZ TAB 250/15 - 60EA METHYLDOPA TAB 250MG - 60EA METHYLDOPA TAB 500MG - 60EA METOPROLOL TAB 100MG - 60EA METOPROLOL TAB 25MG - 60EA NADOLOL TAB 20MG - 30EA NADOLOL TAB 40MG - 30EA NIFEDIPINE CAP 10MG - 60EA NIFEDIPINE CAP 20MG - 31EA NITROBID OIN 0.02 - 60GM NITROGLYCER CAP 2.5MG CR - 60EA NITROGLYCER CAP 2.5MG ER - 60EA NITROGLYCER CAP 2.5MG SR - 60EA NITROGLYCER CAP 6.5MG CR - 60EA NITROGLYCER CAP 6.5MG ER - 60EA NITROGLYCER CAP 6.5MG TD - 60EA NITROGLYCER CAP 9MG TD - 60EA NITROSTAT SUB 0.3MG - 100EA NITROSTAT SUB 0.6MG - 100EA NITRO-TIME CAP 9MG CR - 60EA PAPAVERINE POW USP - 10GM PARA-TIME CAP 150MG ER - 60EA PINDOLOL TAB 10MG - 60EA PINDOLOL TAB 5MG - 60EA PRAZOSIN HCL CAP 1MG - 60EA PROCAINAMIDE CAP 250MG - 60EA PROCAINAMIDE TAB 500MG CR - 60EA PROPRANOLOL SOL 20MG/5ML - 150ML PROPRANOLOL TAB 20MG - 60EA PROPRANOLOL TAB 40MG - 60EA PROPRANOLOL TAB 80MG - 60EA QUINIDINE GL TAB 324MG SA - 60EA QUINIDINE SU TAB 300MG - 60EA RESERPINE TAB 0.1MG - 30EA TIMOLOL MAL TAB 10MG - 30EA TIMOLOL MAL TAB 5MG - 30EA VERAPAMIL TAB 240MG ER - 30EA VERAPAMIL TAB 240MG SR - 30EA VERAPAMIL TAB 40MG - 90EA VERAPAMIL TAB 80MG - 90EA

DILTIA XT CAP 180MG/24 - 30EA DILTIA XT CAP 240MG/24 - 30EA DILTIAZEM CAP 120MG CD - 30EA DILTIAZEM CAP 120MG ER - 30EA DILTIAZEM CAP 120MG/24 - 30EA DILTIAZEM CAP 180MG ER - 30EA DILTIAZEM CAP 180MG/24 - 30EA DILTIAZEM CAP 240MG XR - 30EA DILTIAZEM CAP 90MG ER - 30EA DILTIAZEM TAB 90MG - 90EA DOXAZOSIN TAB 1MG - 30EA DOXAZOSIN TAB 2MG - 30EA DOXAZOSIN TAB 4MG - 30EA DOXAZOSIN TAB 8MG - 30EA ENALAPR/HCTZ TAB 10-25MG - 30EA ENALAPR/HCTZ TAB 5-12.5MG - 30EA ENALAPRIL TAB 10MG - 30EA ENALAPRIL TAB 5MG - 30EA GUANABENZ TAB 4MG - 60EA GUANABENZ TAB 8MG - 60EA GUANFACINE TAB 1MG - 30EA GUANFACINE TAB 2MG - 30EA INDERAL TAB 10MG - 60EA ISOSORB MONO TAB 120MG ER - 30EA ISOSORB MONO TAB 20MG - 60EA ISOSORB MONO TAB 30MG ER - 30EA ISRADIPINE CAP 2.5MG - 30EA LABETALOL TAB 200MG - 60EA LABETALOL TAB 300MG - 60EA LANOXIN PED ELX 0.05/ML - 60ML LISINOP/HCTZ TAB 10-12.5 - 30EA LISINOP/HCTZ TAB 20-12.5 - 30EA LISINOP/HCTZ TAB 20-25MG - 30EA LISINOPRIL TAB 10MG - 30EA LISINOPRIL TAB 20MG - 30EA LISINOPRIL TAB 30MG - 30EA LISINOPRIL TAB 40MG - 30EA LISINOPRIL TAB 5MG - 30EA MAVIK TAB 1MG - 30EA MAVIK TAB 2MG - 30EA MAVIK TAB 4MG - 30EA METOPRL/HCTZ TAB 50-25MG - 30EA MINIPRESS CAP 1MG - 60EA MINOXIDIL TAB 10MG - 30EA MINOXIDIL TAB 2.5MG - 60EA NADOLOL TAB 80MG - 30EA NICARDIPINE CAP 20MG - 90EA NICARDIPINE CAP 30MG - 60EA NIFEDIAC CC TAB 30MG ER - 30EA NIFEDICAL XL TAB 30MG - 30EA NIFEDIPINE TAB 30MG ER - 30EA NITROGLYCER CAP 9MG CR - 60EA NITROGLYCER CAP 9MG ER - 60EA NITROGLYCER DIS 0.4MG/HR - 30EA NITRO-TRANSD DIS 0.2MG/HR - 30EA PRAZOSIN HCL CAP 2MG - 60EA PRAZOSIN HCL CAP 5MG - 60EA PRINIVIL TAB 10MG - 30EA PRINIVIL TAB 20MG - 30EA PRINIVIL TAB 5MG - 30EA PRINZIDE TAB 20-12.5 - 30EA PRINZIDE TAB 20-25MG - 30EA PROCAINAMIDE TAB 750MG ER - 120EA PROPRANOLOL SOL 40MG/5ML - 300ML QNAPRIL/HCTZ TAB 10-12.5 - 30EA QNAPRIL/HCTZ TAB 20-12.5 - 30EA QNAPRIL/HCTZ TAB 20-25MG - 30EA QUINARETIC TAB 10/12.5 - 30EA QUINARETIC TAB 20/12.5 - 30EA QUINARETIC TAB 20-25MG - 30EA QUINIDINE GL TAB 324MG CR - 60EA RESERPINE TAB 0.25MG - 30EA TAZTIA XT CAP 120MG/24 - 30EA TAZTIA XT CAP 180MG/24 - 30EA TENORETIC TAB -100 - 30EA TERAZOSIN CAP 10MG - 30EA TERAZOSIN CAP 1MG - 30EA TERAZOSIN CAP 2MG - 30EA TERAZOSIN CAP 5MG - 30EA TIMOLOL MAL TAB 20MG - 60EA TOPROL XL TAB 25MG - 30EA TOPROL XL TAB 50MG - 30EA VERAPAMIL CAP 120MG ER - 30EA VERAPAMIL CAP 120MG SR - 30EA VERAPAMIL CAP 180MG ER - 30EA VERAPAMIL CAP 180MG SR - 30EA VERAPAMIL CAP 240MG ER - 30EA VERAPAMIL CAP 240MG SR - 30EA VERAPAMIL TAB 120MG ER - 30EA VERAPAMIL TAB 120MG SR - 30EA VERAPAMIL TAB 180MG ER - 30EA VERAPAMIL TAB 180MG SR - 30EA

CATAPRES-TTS CLONIDINE CLORPRES CORDARONE COREG CORGARD CORZIDE COVERA-HS COZAAR DIBENZYLINE DILACOR XR DILATRATE SR DILTIAZEM DIOVAN DIOVAN HCT DISOPYRAMIDE DYNACIRC DYNACIRC CR ENALAPRIL ETHMOZINE FELODIPINE FLECAINIDE FOSINOP/HCTZ HYTRIN HYZAAR IMDUR INDERAL INDERAL LA INDERIDE INNOPRAN XL INSPRA ISMO ISOPTIN SR ISORDIL ISOSORB DIN ISOSORB MONO ISOXSUPRINE ISRADIPINE KERLONE LEVATOL LEXXEL LOPRESS HCT LOPRESSOR LOTENSIN LOTENSIN HCT LOTREL METOPRL/HCTZ METOPROLOL MEXILETINE MIDODRINE MINITRAN MONOKET MONOPRIL MONOPRIL HCT NADOLOL NIFEDIAC CC NIFEDICAL XL NIFEDIPINE NITREK NITRO-DUR NITROGLYCER NITROGLYCERI NITROLINGUAL NORPACE NORVASC PACERONE PAPAVERINE PLENDIL PRINIVIL PROAMATINE PROCAINAMIDE PROCANBID PROCARDIA PROCARDIA XL PRONESTYL PROPAFENONE PROPRANOLOL QUINAPRIL QUINIDINE SU RANEXA RESERPINE REVATIO RYTHMOL RYTHMOL SR SECTRAL SORINE SOTALOL AF SOTALOL HCL SULAR TAMBOCOR TARKA TAZTIA XT TENEX TENORMIN TEVETEN TEVETEN HCT TIAZAC TIKOSYN TIMOLOL TOPROL XL TRACLEER TRANDATE UNIRETIC UNIVASC VASERETIC VASOTEC VERAPAMIL VERELAN VERELAN PM ZEBETA ZESTORETIC ZESTRIL ZIAC



Non-Preferred


HEMATOPOIETIC AGENTS CHROMAGEN CAP - 30EA FE C PLUS TAB - 30EA FEROCON CAP - 30EA FEROTRINSIC CAP - 30EA FERROUS SULF ELX 220/5ML - 150ML FOLTRIN CAP - 30EA HEMOCYTE-F TAB - 30EA MYFERON 150 CAP FORTE - 30EA NUFOL TAB - 14EA TANDEM F CAP - 10EA

CARDIOTEK RX TAB - 30EA CHROMAGEN CAP FORTE - 30EA COMBGEN TAB - 30EA CONISON CAP - 30EA ED CYTE F TAB - 60EA FA/B12/B6 TAB - 30EA FA-B6-B12 TAB - 30EA FABB TAB - 30EA FERO-FOLIC TAB -500 - 30EA FOLAMIN TAB - 30EA FOLBALIN TAB - 30EA FOLBALIN TAB PLUS - 30EA FOLBEE TAB - 30EA FOLBIC TAB - 30EA FOLCAPS TAB - 30EA FOLGARD RX TAB - 30EA FOLGARD RX TAB 2.2 - 30EA FOLIC ACID TAB 1MG - 30EA FOLPACE RX TAB - 30EA FOLPLEX 2.2 TAB - 30EA ICAR-C PLUS TAB - 30EA SENILEZOL ELX - 480ML

ANIMI-3 CAP - 30EA DROXIA CAP 300MG - 30EA FOLTX TAB - 30EA FUMATINIC CAP - 60EA HEMAX TAB SR - 60EA METANX TAB - 30EA NIFEREX GOLD TAB - 30EA NIFEREX-150 CAP - 30EA NIFEREX-150 CAP FORTE - 30EA PROFERRIN- TAB FORTE - 60EA REPLIVA 21/7 TAB - 28EA

CALAFOL RX CEREFOLIN DROXIA EPOGEN LEUKINE NASCOBAL NEULASTA PROCRIT

HORMONES MEDROXYPR AC TAB 10MG - 10EA ESSIAN H.S. TAB - 11EA

ESTRADIOL TAB 0.5MG - 30EA ESTRADIOL TAB 1MG - 30EA ESTRADIOL TAB 2MG - 30EA ESTROPIPATE TAB 0.75MG - 30EA ESTROPIPATE TAB 1.5MG - 30EA GYNODIOL TAB 0.5MG - 30EA GYNODIOL TAB 1.5MG - 30EA GYNODIOL TAB 1MG - 30EA GYNODIOL TAB 2MG - 30EA MEDROXYPR AC TAB 2.5MG - 30EA MEDROXYPR AC TAB 5MG - 30EA MENEST TAB 0.3MG - 30EA ORTHO-EST TAB 0.625 - 30EA ORTHO-EST TAB 1.25 - 30EA PROVERA TAB 10MG - 10EA

ALORA DIS 0.025MG - 8EA AYGESTIN TAB 5MG - 12EA EEMT HS TAB - 30EA ESCLIM DIS 0.0375MG - 8EA ESTRADIOL DIS 0.025MG - 4EA ESTRADIOL DIS 0.05MG - 4EA ESTRADIOL DIS 0.06MG - 4EA ESTRADIOL DIS 0.075MG - 4EA ESTRADIOL DIS 0.1MG - 4EA ESTROPIPATE TAB 3MG - 30EA MENEST TAB 0.625MG - 30EA MENEST TAB 1.25MG - 30EA OGEN TAB 0.625 - 30EA OGEN TAB 1.25 - 15EA PROGESTERONE POW - 30GM PROVERA TAB 5MG - 30EA SYNTEST H.S. TAB - 30EA

ACTIVELLA ALORA CENESTIN CLIMARA CLIMARA PRO COMBIPATCH DELESTROGEN EEMT ENJUVIA ESSIAN ESTRACE ESTRADERM ESTRADIOL ESTRASORB ESTRATEST ESTRATEST HS ESTRIOL ESTROGEL ESTRONE FEMHRT FEMHRT 1/5 FEMTRACE MEGACE ES

HYPNOTIC & SEDATIVE AGENTS CHLORAL HYDR SYP 500/5ML - 10ML FLURAZEPAM CAP 15MG - 30EA FLURAZEPAM CAP 30MG - 30EA HALCION TAB 0.125MG - 2EA PHENOBARB TAB 100MG - 60EA PHENOBARB TAB 15MG - 60EA PHENOBARB TAB 16.2MG - 60EA PHENOBARB TAB 30MG - 90EA PHENOBARB TAB 32.4MG - 90EA PHENOBARB TAB 60MG - 60EA PHENOBARB TAB 64.8MG - 60EA PHENOBARB TAB 97.2MG - 30EA

PHENOBARB ELX 20MG/5ML - 473ML SOMNOTE CAP 500MG - 12EA TEMAZEPAM CAP 15MG - 30EA TEMAZEPAM CAP 30MG - 30EA TRIAZOLAM TAB 0.125MG - 30EA TRIAZOLAM TAB 0.25MG - 30EA

ESTAZOLAM TAB 1MG - 30EA ESTAZOLAM TAB 2MG - 30EA

AMBIEN AMBIEN CR AQUACHLORAL BUTISOL SOD DALMANE HALCION LUNESTA MEBARAL MEPHOBARB PROSOM RESTORIL ROZEREM SONATA



Non-Preferred


MENEST MENOSTAR NORETHIN ACE OGEN PREFEST PREMARIN PREMPHASE PREMPRO PROGESTERONE PROMETRIUM PROVERA SYNTEST D.S. VIVELLE VIVELLE-DOT

IMPOTENCE AGENTS CIALIS TAB 5MG - 6EA

LEVITRA TAB 5MG - 2EA CAVERJECT CIALIS EDEX LEVITRA MUSE VIAGRA

INFLAMMATORY BOWEL AGENTS

SULFASALAZIN TAB 500MG - 120EA SULFAZINE TAB 500MG - 120EA

ASACOL AZULFIDINE CANASA COLAZAL

LAXATIVES LACTULOSE SOL 10GM/15 - 473ML

CONSTULOSE SOL 10GM/15 - 946ML KRISTALOSE PAK 10GM - 30EA POLYETH GLYC POW 3350 NF - 527GM

GLYCOLAX GOLYTELY HALFLYTELY KRISTALOSE MIRALAX

DIPENTUM PENTASA ROWASA SULFASALAZIN SULFAZINE EC

OSMOPREP VISICOL



Non-Preferred


OTIC PRODUCTS A/B OTIC SOL - 15ML ACE ACD/ALUM SOL 2% OTIC - 60ML ACETIC ACID SOL 2% OTIC - 15ML ALLERGEN SOL OTIC - 15ML ANTIBEN SOL OTIC - 15ML ANTIPY/BENZO SOL OTIC - 10ML AURODEX SOL OTIC - 15ML AUROGUARD SOL - 15ML AUROTO SOL OTIC - 10ML NEO/POLY/HC SOL 1% OTIC - 10ML

ACETASOL HC SOL OTIC - 10ML ACETIC ACID SOL /HC OTIC - 10ML AERO OTIC HC SOL - 10ML ANTIBIOT EAR SUS 1% OTIC - 10ML BOROFAIR SOL 2% OTIC - 60ML CORTOMYCIN SOL 1% OTIC - 10ML CYOTIC DRO - 10ML EAR-GESIC DRO OTIC - 15ML NEO/POLY/HC SUS 1% OTIC - 10ML OTICAINE SOL 20% OTIC - 15ML OTIRX DRO - 10ML OTOZONE SOL OTIC - 12ML PRAMOTIC DRO 1-0.1% - 10ML UNI-OTIC LIQ 1-0.1% - 10ML ZOLENE HC DRO - 10ML ZOTANE HC DRO AQUEOUS - 10ML

ANTIBIOT EAR SOL 1% OTIC - 10ML CORTANE-B DRO AQ OTIC - 10ML CORTANE-B DRO OTIC - 10ML CORTOMYCIN SUS 1% OTIC - 10ML DERMOTIC OIL 0.0001 - 20ML OTOMAR-HC DRO - 15ML ZOTO-HC SOL OTIC - 10ML

CIPRO HC CIPRODEX COLY-MYCIN-S CORTIC-ND CORTISPORIN CRESYLATE FLOXIN OTIC

MOUTH & THROAT PRODUCTS - MISC. LIDOCAINE SOL 2% VISC - 100ML TRIAM DENTAL PST 0.001 - 5GM

GELCLAIR GEL - 30ML NUMOISYN LOZ - 100EA TRIAMCIN/ORA PST 0.001 - 5GM

FIRST-MOUTHW SUS BLM - 237ML APHTHASOL EVOXAC PILOCARPINE SALAGEN XYLOCAINE

MUSCLE RELAXANTS CYCLOBENZAPR TAB 10MG - 30EA ORPHENGESIC TAB - 12EA

CHLORZOXAZON TAB 500MG - 60EA CYCLOBENZAPR TAB 5MG - 30EA METHOCARBAM TAB 500MG - 60EA METHOCARBAM TAB 750MG - 60EA

CARISOPR/ASA TAB 200-325 - 60EA CARISOPRODOL TAB 350MG - 90EA

BACLOFEN CARISOPRODOL CYCLOBENZAPR DANTRIUM DANTROLENE FLEXERIL LIORESAL INT NORGESIC ORPH/ASA/CAF

ORPHEN CPD ORPHENADRINE ORPHENGESIC PARAFON FORT ROBAXIN-750 SKELAXIN SOMA TIZANIDINE ZANAFLEX

OPHTHALMIC PRODUCTS AK-DILATE SOL 10% OP - 5ML AK-DILATE SOL 2.5% OP - 2ML AK-PENTOLATE SOL 1% OP - 2ML AK-TOB SOL 0.3% OP - 5ML AK-TROL SUS 0.1% OP - 5ML ATROPIN-CARE SOL 1% OP - 2ML ATROPINE SUL OIN 1% OP - 3GM BAC/NEO/POLY OIN OP - 3GM BACITRACIN OIN OP - 3GM DECADRON OIN 0.05% OP - 3GM DEXAMETH PHO SOL 0.1% OP - 5ML DEXASPORIN SUS 0.1% OP - 5ML ERYTHROMYCIN OIN OP - 3GM GENOPTIC SOL 0.3% OP - 5ML GENTACIDIN SOL 0.3% OP - 5ML GENTAFAIR SOL 0.3% OP - 5ML GENTAK SOL 0.3% OP - 5ML GENTAMICIN SOL 0.3% OP - 5ML METHADEX SUS 0.1% OP - 5ML NEO/POLY/DEX OIN 0.1% OP - 3GM NEO/POLY/DEX SUS 0.1% OP - 5ML PHENYLEPHRIN SOL 2.5% OP - 3ML PILOCARPINE SOL 0.5% OP - 15ML PILOCARPINE SOL 6% OP - 15ML PILOPTIC-1 SOL 1% OP - 15ML PILOPTIC-1/2 SOL 0.5% OP - 15ML SOD SULFACET SOL 10% OP - 15ML SULFACET SOD OIN 10% OP - 3GM SULFACET SOD SOL 10% OP - 15ML TIMOLOL MAL SOL 0.25% OP - 5ML TOBRAMYCIN SOL 0.3% OP - 5ML

AK-CON SOL 0.1% OP - 15ML ATROPINE SUL SOL 1% OP - 5ML BAC/POLY/NEO OIN /HC OP1% - 3GM BLEPH-10 SOL 10% OP - 5ML CYCLOMYDRIL SOL OP - 2ML CYCLOPENTOL SOL 1% OP - 15ML DIPIVEFRIN SOL 0.1% OP - 10ML FLUOROMETHOL SUS 0.1% OP - 5ML FLUOR-OP SUS 0.1% OP - 5ML FLURBIPROFEN SOL 0.03% OP - 2ML GENTAK OIN 0.3% OP - 3GM GENTAMICIN OIN 0.3% OP - 3GM HOMATROPAIRE SOL 5% OP - 5ML LEVOBUNOLOL SOL 0.25% OP - 10ML NAPHAZOLE SOL 0.1% OP - 15ML NAPHAZOLINE SOL 0.1% OP - 15ML NEO/BAC/POLY OIN OP - 3GM NEO/POLY/BAC OIN /HC OP1% - 3GM PILOCAR SOL 6% OP - 15ML PILOCARPINE SOL 3% OP - 15ML PILOPTIC-2 SOL 2% OP - 15ML POLYMYXIN B/ SOL TRIMETHP - 10ML PRED SOD PHO SOL 1% OP - 5ML PREDNISOL SOL 1% OP - 5ML PREDNISOLONE SUS 1% OP - 5ML SULF/PRED NA SOL OP - 10ML TIMOLOL MAL SOL 0.5% OP - 5ML TRIMETHOPRIM SOL POLYMYXN - 10ML

AK-POLY-BAC OIN OP - 3GM ALBALON SOL LIQUIFLM - 15ML BACIT/POLYMY OIN OP - 3GM BRIMONIDINE SOL 0.2% OP - 5ML CROMOLYN SOD SOL 4% OP - 10ML CYCLOGYL SOL 1% OP - 5ML ECONOPRED PL SUS 1% OP - 5ML FLAREX SUS 0.1% OP - 5ML FML FORTE SUS 0.25% OP - 5ML FML LIQUIFLM SUS 0.1% OP - 5ML FML S.O.P. OIN 0.1% OP - 3GM FML-S SUS LIQUIFLM - 5ML HMS LIQUIFLM SUS 1% OP - 5ML ISO CARBACHO SOL 1.5% OP - 15ML ISO HOMATROP SOL 2% OP - 5ML ISO HOMATROP SOL 5% OP - 5ML ISO HYOSCINE SOL 0.25% OP - 5ML ISOPTO CARP SOL 2% OP - 15ML LEVOBUNOLOL SOL 0.5% OP - 10ML METIPRANOLOL SOL 0.003 - 10ML METIPRANOLOL SOL 0.3% OPH- 10ML NEO/POLY/GRA SOL OP - 10ML OCUTRICIN SOL OP - 10ML PILOCAR SOL 1% OP - 15ML PILOCAR SOL 2% OP - 15ML PILOCAR SOL 4% OP - 15ML PILOCARPINE SOL 1% OP - 15ML PILOCARPINE SOL 2% OP - 15ML PILOCARPINE SOL 4% OP - 15ML POLYTRIM SOL OP - 10ML PRED MILD SUS 0.12% OP - 5ML PRED-G S.O.P OIN OP - 3GM PRED-G SUS OP - 5ML TIMOLOL GEL SOL 0.25% OP - 5ML TIMOLOL GEL SOL 0.5% OP - 5ML TIMOPTIC SOL 0.5% OP - 10ML TIMOPTIC-XE SOL 0.25% OP - 5ML TIMOPTIC-XE SOL 0.5% OP - 5ML VEXOL SUS 1% OP - 5ML

ACULAR ACULAR LS ALAMAST ALOCRIL ALOMIDE ALPHAGAN P ALREX AZOPT BETAGAN BETAXOLOL BETIMOL BETOPTIC-S BLEPHAMIDE BOTOX CARTEOLOL CILOXAN CIPROFLOXACN CORTISPORIN COSOPT CYCLOGYL ELESTAT IOPIDINE ISO ATROPINE ISO CARBACHO ISTALOL KETOTIFEN LACRISERT LOTEMAX LUMIGAN MAXIDEX MAXITROL MYDRIACYL NATACYN NEO/POLY/HC NEVANAC OCUFLOX OPTIPRANOLOL OPTIVAR PATANOL PHOSPHOLINE PILOPINE HS POLY-PRED PRED FORTE PROPINE QUIXIN RESTASIS TOBRADEX TOBREX TRAVATAN TRIFLURIDINE

AMIDRINE CAP - 30EA DURADRIN CAP - 30EA EPIDRIN CAP - 30EA ISOMETH/APAP CAP DICHLOR - 30EA MIDRIN CAP - 25EA MIGQUIN CAP - 30EA MIGRATINE CAP - 30EA MIGRAZONE CAP - 30EA MIGRIN-A CAP - 30EA

BELLAMINE S TAB - 60EA BELLAMINE TAB - 60EA BELLASPAS TAB - 60EA BEL-TABS TAB - 60EA EPERBEL-S TAB - 60EA SPASTRIN TAB - 60EA

AMERGE CAFERGOT DEPAKOTE ER DIHYDROERGOT ERGOMAR ERGOTAM/CAFF FROVA IMITREX MAXALT MAXALT-MLT MIGERGOT

MIGRANAL RELPAX ZOMIG ZOMIG ZMT

MIGRAINE TREATMENT

PEDIATRIC VITAMINS

MULT VIT-BET CHW /FL 1MG - 30EA MULTI-VIT/FL CHW 0.5MG - 30EA MULTI-VIT/FL DRO 0.25MG - 50ML MULTI-VIT/FL DRO 0.5MG/ML - 50ML POLY-VIT/FE DRO /FL 0.25 - 50ML POLY-VIT/FL DRO 0.25MG - 50ML POLY-VITAMIN DRO 0.5MG - 50ML TRI-VIT/FLUO DRO 0.25MG - 50ML

MULT VIT-BET CHW FL 0.5MG - 100EA MULT VIT-BET CHW FL0.25MG 100EA MULTI VIT/FL CHW 0.25MG - 30EA MULTI-VIT/FL CHW 1MG - 30EA

POTASSIUM REPLACEMENT THERAPY K+ POTASSIUM POW 20MEQ - 30EA KAON-CL-10 TAB 10MEQ CR - 30EA KLOR-CON 8 TAB 8MEQ ER - 30EA KLOR-CON POW 20MEQ - 30EA KLOR-CON-25 POW 25MEQ - 30EA K-VESCENT POW 20MEQ - 30EA K-VESCENT TAB 25MEQ EF - 30EA POT CHLORIDE CAP 10MEQ CR- 30EA POT CHLORIDE LIQ 0.1 - 473ML POT CHLORIDE LIQ 0.2 - 480ML POT CHLORIDE LIQ 10% SF - 473ML POT CHLORIDE LIQ 20% SF - 473ML POT CHLORIDE POW 20MEQ - 30EA POT CHLORIDE TAB 8MEQ CR - 30EA POT CHLORIDE TAB 8MEQ ER - 30EA POT CHLORIDE TAB 8MEQ SA - 30EA POT CHLORIDE TAB 8MEQ SR - 30EA

K-EFFERVESCE TAB 25MEQ EF- 30EA KLOR-CON 10 TAB 10MEQ ER - 30EA KLOR-CON M10 TAB 10MEQ ER 30EA KLOR-CON M15 TAB - 30EA KLOR-CON M20 TAB 20MEQ ER- 30EA KLOR-CON/EF TAB 25MEQ FR - 30EA KLOTRIX TAB 10MEQ CR - 30EA K-LYTE/CL TAB CITRUS - 10EA K-TABS TAB 10MEQ CR - 30EA POT BICARBON TAB 25MEQ EF - 30EA POT CHLORIDE CAP 10MEQ ER- 30EA POT CHLORIDE TAB 10MEQ CR- 30EA POT CHLORIDE TAB 10MEQ ER- 30EA POT CHLORIDE TAB 20MEQ CR- 30EA POT CHLORIDE TAB 20MEQ ER- 30EA POT CHLORIDE TAB 25MEQ EF - 30EA POT EFFERVES TAB 25MEQ EF- 30EA POTASSIUM TAB 25MEQ EF - 30EA

KAON ELX 20MEQ/15 - 480ML K-DUR TAB 10MEQ CR - 90EA K-DUR TAB 20MEQ CR - 30EA K-LYTE-ORANG TAB 25MEQ EF - 30EA MICRO-K CAP 10MEQ CR - 30EA MICRO-K CAP 8MEQ CR - 30EA

KAY CIEL K-LYTE DS NORMAL SALIN

PRENATAL VITAMINS CARENATE 600 MIS COMBO PA- 40EA INATAL ADV TAB - 30EA INATAL ULTRA TAB - 30EA MATERNITY TAB - 30EA M-VIT TAB 27-1MG - 30EA NATACAPS CAP - 30EA NATAFORT TAB - 30EA NATALCARE RX TAB - 30EA NATALCARE TAB PIC - 30EA NATALCARE TAB PICFORTE - 30EA NATALCARE TAB PLUS - 30EA NATATAB FA TAB - 30EA NIFEREX PN TAB - 30EA PRENATABS FA TAB - 30EA PRENATAL MR TAB 90 FE - 30EA PRENATAL MTR TAB SELENIUM 30EA PRENATAL NF TAB PLUS - 30EA PRENATAL PLS TAB - 30EA PRENATAL PLS TAB /IRON - 30EA PRENATAL RX TAB - 30EA PRENATAL RX TAB BETA-CAR - 30EA PRENATAL RX1 TAB - 30EA PRENATAL S TAB - 30EA PRENATAL TAB LOW IRON - 30EA PRENATAL TAB PLUS - 30EA PRENATAL Z TAB - 30EA PRENATAL Z TAB ADV FORM - 30EA TRINATE TAB - 30EA ULTRA NATAL TAB - 30EA ULTRA NATAL TAB CARE - 30EA VINATE M TAB - 30EA VINATE ULTRA TAB - 30EA

ADV NATALCAR TAB - 30EA ADVANCED-RF TAB NATALCAR- 30EA ANEMAGEN OB CAP - 30EA CAL-NATE TAB - 30EA CITRACAL TAB PREN RX - 30EA DUET CHW - 30EA DUET TAB - 30EA MARNATAL-F MIS PLUS DUO - 60EA NATALCARE TAB GLOSSTAB - 30EA NATALCARE TAB THREE - 30EA NATATAB RX TAB 29-1MG - 30EA NATELLE EZ TAB - 30EA NATELLE TAB - 30EA NATELLE TAB PREFER - 30EA NIFEREX-PN TAB FORTE - 60EA NOVANATAL TAB - 30EA NUTRINATE CHW - 30EA NUTRISPIRE TAB - 30EA OBSTETRIX EC TAB - 30EA PRENAFIRST TAB - 30EA PRENATABS RX TAB - 30EA PRENATABS TAB OBN - 30EA PRENATAL 19 CHW TAB - 30EA PRENATAL 19 TAB - 30EA PRENATAL AD TAB - 30EA PRENATAL FOR TAB 28-1MG - 30EA TANDEM OB CAP - 30EA VINATAL 600 MIS - 30EA VINATE II TAB - 30EA

CITRACAL DHA PAK PRENATAL- 60EA ICAR PRENATA MIS SOFTGEL - 120EA NATACHEW CHW - 30EA PRECARE CHW - 30EA PRECARE TAB CONCEIVE - 30EA PRECARE TAB PRENATAL - 30EA PREMESIS RX TAB - 30EA STRONGSTART CHW - 30EA STRONGSTART TAB - 30EA

OPTINATE PRIMACARE



Non-Preferred


PERPHEN/AMIT TAB 2-10MG - 30EA PERPHEN/AMIT TAB 2-25MG - 30EA PERPHEN/AMIT TAB 4-10MG - 30EA

AMITRIP/CDP TAB 12.5-5MG - 14EA CDP/AMITRIP TAB 10-25MG - 30EA CDP/AMITRIP TAB 5-12.5MG - 60EA ERGOLOID MES SUB 1MG SL - 60EA ERGOLOID MES TAB 1MG ORAL-90EA PERPHEN/AMIT TAB 4-25MG - 60EA PERPHEN/AMIT TAB 4-50MG - 30EA

AMITRIP/CDP ANTABUSE ARICEPT AVONEX CAMPRAL COGNEX COPAXONE

EXELON NAMENDA ORAP RAZADYNE RAZADYNE ER REBIF REBIF TITRTN REMINYL SYMBYAX

PARKINSONS DRUGS AMANTADINE CAP 100MG - 60EA

BENZTROPINE TAB 0.5MG - 60EA BENZTROPINE TAB 1MG - 60EA BENZTROPINE TAB 2MG - 60EA TRIHEXYPHEN TAB 2MG - 60EA TRIHEXYPHEN TAB 5MG - 60EA

AMANTADINE SYP 50MG/5ML - 480ML AMANTADINE TAB 100MG - 30EA CARB/LEVO TAB 10-100MG - 90EA KEMADRIN TAB 5MG - 30EA PARLODEL TAB 2.5MG - 7EA PERGOLIDE TAB 0.05MG - 30EA TRIHEXYPHEN ELX 0.4MG/ML - 473ML

AKINETON APOKYN AZILECT BROMOCRIPTIN CARB/LEVO CARB/LEVO ER CARB/LEVO SR COMTAN ELDEPRYL LODOSYN MIRAPEX PARCOPA PARLODEL

PERGOLIDE PERMAX REQUIP SELEGILINE SINEMET SINEMET CR STALEVO 100 STALEVO 150 STALEVO 50 SYMMETREL TASMAR

PSYCHOTHERAPEUTIC AGENTS - MISC.

RECTAL PREPARATIONS LIDAZONE HC KIT - 1EA ANUCORT-HC SUP 25MG - 12EA

ANUMED-HC SUP 25MG - 24EA HEMORRHOIDAL SUP -HC 25MG-12EA HYDROCORT AC SUP 25MG - 12EA PROCTOCREAM CRE HC 2.5% - 30GM RECTASOL-HC SUP 25MG - 12EA

HC PRAMOXINE CRE - 28GM HYDROCORTISO CRE 0.025 - 45GM PROCTO-KIT CRE 0.025 - 28GM PROCTOSOL HC CRE 0.025 - 28GM PROCTOSOL SUP 25MG - 14EA PROCTOZONE CRE -HC 2.5% - 30GM

ANALPRAM-HC ANAMANTLE HC ANUSOL-HC CORTIFOAM HEMRIL-30 HYDROCORT



Non-Preferred


THYROID MEDICATIONS ARMOUR THYRO TAB 120MG - 30EA ARMOUR THYRO TAB 15MG - 30EA ARMOUR THYRO TAB 30MG - 30EA ARMOUR THYRO TAB 60MG - 30EA ARMOUR THYRO TAB 90MG - 30EA LEVOTHROID TAB 137MCG - 30EA THYROID TAB 120MG - 30EA THYROID TAB 130MG - 30EA THYROID TAB 15MG - 30EA THYROID TAB 195MG - 30EA THYROID TAB 30MG - 30EA THYROID TAB 32.5MG - 30EA THYROID TAB 60MG - 30EA THYROID TAB 65MG - 30EA THYROID TAB 90MG - 30EA WESTHROID TAB 30MG - 30EA WESTHROID TAB 60MG - 30EA

ARMOUR THYRO TAB 180MG - 30EA LEVOTHROID TAB 100MCG - 30EA LEVOTHROID TAB 112MCG - 30EA LEVOTHROID TAB 125MCG - 30EA LEVOTHROID TAB 150MCG - 30EA LEVOTHROID TAB 175MCG - 30EA LEVOTHROID TAB 200MCG - 30EA LEVOTHROID TAB 25MCG - 30EA LEVOTHROID TAB 50MCG - 30EA LEVOTHROID TAB 75MCG - 30EA LEVOTHROID TAB 88MCG - 30EA LEVOTHYROXIN TAB 100MCG - 30EA LEVOTHYROXIN TAB 112MCG - 30EA LEVOTHYROXIN TAB 125MCG - 30EA LEVOTHYROXIN TAB 137MCG - 30EA LEVOTHYROXIN TAB 150MCG - 30EA LEVOTHYROXIN TAB 175MCG - 30EA LEVOTHYROXIN TAB 200MCG - 30EA LEVOTHYROXIN TAB 25MCG - 30EA LEVOTHYROXIN TAB 50MCG - 30EA LEVOTHYROXIN TAB 75MCG - 30EA LEVOTHYROXIN TAB 88MCG - 30EA LEVOXYL TAB 100MCG - 30EA LEVOXYL TAB 112MCG - 30EA LEVOXYL TAB 125MCG - 30EA LEVOXYL TAB 137MCG - 30EA LEVOXYL TAB 150MCG - 30EA LEVOXYL TAB 175MCG - 30EA LEVOXYL TAB 200MCG - 30EA LEVOXYL TAB 25MCG - 30EA LEVOXYL TAB 50MCG - 30EA LEVOXYL TAB 75MCG - 30EA LEVOXYL TAB 88MCG - 30EA METHIMAZOLE TAB 5MG - 30EA PROPYLTHIOUR TAB 50MG - 60EA SYNTHROID TAB 100MCG - 30EA SYNTHROID TAB 112MCG - 30EA SYNTHROID TAB 125MCG - 30EA SYNTHROID TAB 137MCG - 30EA SYNTHROID TAB 25MCG - 30EA SYNTHROID TAB 50MCG - 30EA SYNTHROID TAB 75MCG - 30EA SYNTHROID TAB 88MCG - 30EA THYROID TAB 180MG - 30EA THYROLAR-1/2 TAB 30MG - 30EA THYROLAR-1/4 TAB 15MG - 30EA UNITHROID TAB 88MCG - 30EA UNITHROID TAB 100MCG - 30EA UNITHROID TAB 112MCG - 30EA UNITHROID TAB 125MCG - 30EA UNITHROID TAB 150MCG - 30EA UNITHROID TAB 175MCG - 30EA UNITHROID TAB 200MCG - 30EA UNITHROID TAB 25MCG - 30EA UNITHROID TAB 50MCG - 30EA UNITHROID TAB 75MCG - 30EA

ARMOUR THYRO TAB 240MG - 30EA ARMOUR THYRO TAB 300MG - 30EA CYTOMEL TAB 25MCG - 30EA CYTOMEL TAB 5MCG - 30EA LEVOTHROID TAB 300MCG - 30EA LEVOTHYROXIN TAB 300MCG - 30EA LEVOXYL TAB 300MCG - 30EA METHIMAZOLE TAB 10MG - 30EA SYNTHROID TAB 150MCG - 30EA SYNTHROID TAB 175MCG - 30EA SYNTHROID TAB 200MCG - 30EA SYNTHROID TAB 300MCG - 30EA TAPAZOLE TAB 5MG - 30EA THYROID TAB 300MG - 30EA THYROLAR-1 TAB 60MG - 30EA THYROLAR-2 TAB 120MG - 30EA THYROLAR-3 TAB 180MG - 30EA UNITHROID TAB 300MCG - 30EA

CYTOMEL LEVOTHYROXIN LIOTHYRONINE L-THYRONINE TAPAZOLE

LIDAZONE LIDOCAINE/HC PROCTOCORT PROCTOFOAM PROCTOSERT

VITAMINS & MINERALS - MISC. B-PLEX PLUS TAB - 30EA DIALYVITE TAB - 30EA DRISDOL CAP 50000UNT - 4EA K-PHOS TAB - 30EA MEPHYTON TAB 5MG - 1EA RENAL CAP SOFTGEL - 30EA VICA FORTE CAP - 30EA VITA CON CAP FORTE - 30EA VITAMIN D CAP 50000UNT - 4EA ZINC SULFATE CAP 220MG - 30EA

BACMIN TAB - 30EA CAROMEGA TAB - 30EA DEXFOL TAB - 30EA FOLBEE PLUS TAB - 30EA FOLGARD OS TAB - 60EA K-PHOS TAB NEUTRAL - 90EA MULT FOL 500 TAB CR - 30EA NEPHROCAPS CAP - 30EA NEPHRO-VITE TAB RX - 30EA NUTRIFAC ZX TAB - 30EA RENA-VITE RX TAB - 30EA RENAX TAB 2.5MG - 30EA SSKI SOL 1GM/ML - 30ML STROVITE TAB ADVANCE - 30EA THEROBEC TAB PLUS - 30EA VICON FORTE CAP - 30EA VITAPLEX TAB - 30EA VITAPLEX TAB PLUS - 30EA

CALCITRIOL CAP 0.25MCG - 30EA DIATX ZN TAB - 30EA IBERET-FOLIC TAB 500 CR - 30EA PHOSPHA 250 TAB NEUTRAL - 180EA ROCALTROL CAP 0.25MCG - 30EA

CALCITRIOL ENCORA NIC 750 NICOMIDE

FREQUENTLY ASKED QUESTIONS Where can I use my card? Your card is accepted at over 54,000 participating pharmacies throughout the United States. The network includes pharmacy chains, such as CVS, Rite Aid, Medicine Shoppe, Walgreens, Wal-Mart, and more, as well as thousands of independent pharmacies through-out the country. Pharmacy location information can be obtained by contacting customer service. If a neighborhood pharmacy is not already participating in our network, please have them call us. We will send them information about how then can participate in the network so that you can take advantage of the savings as soon as possible. What if my pharmacy doesn't recognize the card? Pharmacies may not be familiar with every prescription program in which they participate. If the pharmacist does not recognize your card or if you encounter a problem at the pharmacy, DO NOT leave without having the pharmacy call the toll-free number printed on the ID card. What is my average discount on Non-Preferred Drugs? Members are currently receiving an average discount of approximately 19% on brand name drugs. There is no guaranteed percent-age savings on every prescription purchase. The price paid depends upon the pharmacy and the type and quantity of drug purchased. Pharmacies, just like other retail stores, compete against each other and may have special prices on some products. When this is the case, we cannot discount the pharmacy's already low price, but a member will receive the advantage of the pharmacy's special pric-ing. THE MEMBER ALWAYS RECEIVES THE LOWER OF THE CONTRACT PRICE OR THE PHARMACY'S PRICE. What is a generic drug? Once a patent on a brand name drug expires, other drug companies may make a generic version of the drug, with the approval of the Food and Drug Administration (FDA). The FDA's standards for quality are the same for all manufacturers. This means the generic drug contains the same active ingredients as the brand name whose patent has expired, and that its as safe, potent and effective. How can I keep my prescription drug costs down? The use of generic prescription drugs, whenever available, is most cost effective. Don't be shy - discuss your prescription options with your doctor. Ask whether an alternative, less expensive option would work for your condition. How will I know if there's a generic equivalent available? Simply ask your local pharmacist or call the Customer Service Department to find out about generic equivalents for your prescription. Also ask your doctor to prescribe generics whenever possible and appropriate. (Your enrollment packet will include helpful materials you can share with your doctor. What is the difference between brand name and generic drugs? The brand name is the trade name under which the product is advertised and sold, and is protected by patents so that it can only be produced by one manufacturer for a pre-determined number of years. Once a patent expires, other companies may manufacture a generic equivalent, providing they follow stringent FDA regulations for safety. Generic drugs are drugs for which the patent has ex-pired, allowing other manufacturers to produce and distribute the product under a generic name. Generics are essentially a chemical copy of their brand name equivalents. The color or shape may be different, but the active ingredients must be the same for both. The preferred drug list contains only FDA approved generic medications. What is a preferred drug list? A preferred drug list is a list of recommended prescription medications that is created, reviewed and continually updated by a team of physicians and pharmacists. The preferred drug list contains a wide range of generic and brand name preferred products that have been approved by the Food and Drug Administration (FDA). Your doctor can use this list to select medications for your health care needs, while helping you maximize your prescription drug benefit. A medication becomes a preferred drug based first on safety and efficacy, then on cost-effectiveness. What is the difference between a preferred brand name drug vs. a non-preferred brand name drug? A preferred brand name drug is a medication that has been reviewed and approved by a group of physicians and pharmacists, and has been selected for preferred status based on its proven clinical and cost effectiveness. A non-preferred brand name drug is a medication that has been reviewed by the same team of physicians and pharmacists who determined that an alternative drug that is clinically equivalent and most cost effective is available. These designations may change as new clinical information becomes avail-able. What drugs are considered preferred (formulary) on Discount Plans? The Product Guide contains certain brand drugs for which the member's price is the scheduled amount listed. Drugs that are chemi-cally or therapeutically similar to drugs listed on the Product Guide are not discounted. Prices are subject to change due to manufac-turer price changes to pharmacies. On these drugs, the participant enjoys two distinct discounts; one through the pharmacy network and the second through the manufacturer. What if the brand drug I am taking is not discounted? If you are currently taking a medication that has similar active ingredients or is used to treat the same conditions as the preferred brand drugs on the product guide, it will still be discounted. You will pay the negotiated price for that drug. To take advantage of the potential program savings on listed preferred drugs, you should ask your Pharmacist (where regulations permit) or a Doctor to change your medication, where medically appropriate, to a less expensive product listed in the product guide.



Non-Preferred

ANTIFUNGALS FLUCONAZOLE TAB 50MG - 3EA

DIFLUCAN TAB 150MG - 1EA FLUCONAZOLE TAB 100MG - 7EA FLUCONAZOLE TAB 150MG - 1EA

DIFLUCAN TAB 100MG - 2EA FLUCONAZOLE SUS 10MG/ML - 35ML GRIFULVIN V TAB MICR 500 - 30EA GRISEOFULVIN SUS 125/5ML - 120ML NYSTATIN TAB 500000 - 60EA

AMPHOCIN AMPHOTERICIN ANCOBON BIO-STATIN CANCIDAS DIFLUCAN FLUCONAZOLE FLUCONAZOLE/ GRIFULVIN V GRIS-PEG ITRACONAZOLE KETOCONAZOLE LAMISIL MICONAZOLE NIZORAL NYSTATIN SPORANOX VFEND VFEND IV

ANTIFUNGALS - TOPICAL NYSTAT/TRIAM CRE - 30GM NYSTAT/TRIAM OIN - 30GM NYSTATIN CRE 100000 - 30GM NYSTATIN OIN 100000 - 30GM

CLIOQUIN/HC CRE 3-1% - 20GM NIZORAL A-D SHA 0.01 - 207ML

CLOTRIMAZOLE CRE 0.01 - 30GM CLOTRIMAZOLE SOL 0.01 - 30ML EXELDERM CRE 0.01 - 30GM EXELDERM SOL 0.01 - 30ML KETOCONAZOLE CRE 0.02 - 30GM KETOCONAZOLE SHA 0.02 - 120ML NIZORAL SHA 0.02 - 120ML NYAMYC POW 100000 - 15GM NYSTATIN POW 100000 - 15GM NYSTOP POW 100000 - 15GM

CICLOPIROX CLOTRIM/BETA CLOTRIMAZOLE DERMAZENE ECONAZOLE ERTACZO HYDROC IODO HYDROCORT/ KURIC LAMISIL LOPROX LOTRISONE

ANTIHISTAMINES

ANTIMALARIALS QUININE SULF CAP 324MG - 60EA

DARAPRIM TAB 25MG - 30EA QUININE SULF CAP 200MG - 30EA

MEFLOQUINE TAB 250MG - 4EA QUININE SULF CAP 325MG - 30EA QUININE SULF CAP 5GR - 30EA QUININE SULF TAB 260MG - 30EA

CHLOROQUINE HYDROXYCHLOR MALARONE PLAQUENIL PRIMAQUINE QUINACRINE


CARBINOXAMIN LIQ 4MG/5ML - 4ML CHLORPHENIR CAP 12MG ER - 30EA CHLORPHENIR CAP 12MG TR - 60EA CYPROHEPTAD SYP 2MG/5ML - 240ML CYPROHEPTAD TAB 4MG - 90EA DIPHENHYDRAM CAP 25MG - 30EA DIPHENHYDRAM CAP 50MG - 30EA DIPHENHYDRAM ELX 12.5/5ML - 20ML DYTUSS SYP 12.5/5ML - 240ML HYDRAMINE ELX 12.5/5ML - 120ML

CHLORPHENIR CAP 8MG ER - 60EA DEXCHLORPHEN SYP 2MG/5ML - 240ML FEXOFENADINE TAB 30MG - 30EA LODRANE 24 CAP - 20EA NOHIST-EXT TAB 8-2.5MG - 30EA PHENADOZ SUP 12.5MG - 12EA PHENADOZ SUP 25MG - 12EA PHENERGAN SUP 50MG - 3EA PHENERGAN TAB 25MG - 20EA PROMETHAZINE POW - 10GM PROMETHAZINE SUP 12.5MG - 12EA PROMETHAZINE SUP 25MG - 12EA PROMETHAZINE SYP 6.25/5ML - 240ML PROMETHAZINE TAB 12.5MG - 30EA PROMETHAZINE TAB 25MG - 30EA PROMETHEGAN SUP 12.5MG - 12EA PROMETHEGAN SUP 25MG - 12EA UNI-TANN CHW 25MG - 15EA

BIDHIST TAB - 60EA BPM TAB 6MG - 60EA BROMPHENIRAM CHW 12MG - 30EA CARBINOXAMIN CAP 10MG SR - 30EA CLEMASTINE SYP 0.5/5ML - 240ML CLEMASTINE TAB 2.68MG - 60EA DEXCHLOR TAB 6MG CR - 60EA DEXCHLORPHEN TAB 4MG CR - 60EA DEXCHLORPHEN TAB 6MG CR - 60EA J-TAN SUS - 100ML LODRANE 12HR TAB - 60EA LOHIST-12 TAB 12 HOUR - 60EA PALGIC TAB 4MG - 30EA PROMETHAZINE POW HCL - 10GM PROMETHAZINE TAB 50MG - 30EA QDALL AR CAP 12MG - 30EA RYNEZE TAB 8-2.5MG - 20EA VAZOL LIQ 2MG/5ML - 180ML

ALLEGRA BROVEX BROVEX CT CHLORPHENIR CLARINEX CLARINEX RDT DIPHENHYDRAM DYTAN FEXOFENADINE HISTEX IE HISTEX PD 12 PHENERGAN PROMETHAZINE PROMETHEGAN ZYRTEC

MENTAX MICONAZOLE MONISTAT MYCOSTATIN NAFTIN NYSTATIN NYSTAT-RX OXISTAT PEDI-DRI PENLAC SPECTAZOLE

ANTI-NAUSEANTS MECLIZINE CHW 25MG - 60EA MECLIZINE TAB 12.5MG - 30EA MECLIZINE TAB 25MG - 30EA TRIMETHOBENZ SUP 100MG - 10EA TRIMETHOBENZ SUP 200MG - 10EA

TEBAMIDE SUP 100MG - 10EA TEBAMIDE SUP 200MG - 10EA

ANTIVERT TAB 12.5MG - 60EA MALDEMAR TAB 0.4MG - 90EA SCOPACE TAB 0.4MG - 60EA TRANSDERM-SC DIS 1.5MG - 4EA TRIMETHOBENZ CAP 300MG - 30EA VERTIN-32 TAB - 30EA

ANTIVERT ANZEMET EMEND KYTRIL MARINOL TIGAN ZOFRAN

ANTINEOPLASTICS

LEUCOVOR CA TAB 5MG - 4EA

CYTOXAN TAB 25MG - 10EA MEGESTROL AC TAB 20MG - 60EA METHOTREXATE TAB 2.5MG - 24EA

ADRUCIL ALKERAN ARIMIDEX AROMASIN CASODEX CYCLOPHOSPH CYTOXAN DACARBAZINE DEPO-PROVERA ELIGARD ELOXATIN ETOPOSIDE FARESTON FEMARA FLUTAMIDE GLEEVEC HEXALEN HYDREA HYDROXYUREA INTRON-A IRESSA LEUKERAN LUPR DEP-PED LUPRON

LYSODREN MATULANE MEGACE ORAL MEGESTROL AC MERCAPTOPUR MITOMYCIN MUSTARGEN MYLERAN NEXAVAR NILANDRON NOLVADEX PACLITAXEL PURINETHOL SPRYCEL SUTENT TABLOID TAMOXIFEN TARCEVA TARGRETIN TEMODAR THIOTEPA TREXALL VELCADE XELODA

ANTIVIRALS

ACYCLOVIR CAP 200MG - 60EA ACYCLOVIR TAB 400MG - 60EA

ACYCLOVIR TAB 800MG - 35EA RIMANTADINE TAB 100MG - 14EA

ACYCLOVIR APTIVUS COMBIVIR COPEGUS CRIXIVAN CYTOVENE DIDANOSINE EMTRIVA EPIVIR EPZICOM FAMVIR FORTOVASE FOSCAVIR FUZEON GANCICLOVIR HEPSERA HIVID INVIRASE KALETRA LEXIVA NORVIR PEGASYS PEG-INTRON

ANTIPSYCHOTICS



Non-Preferred

BLOOD MODIFIERS

COUMADIN TAB 1MG - 30EA COUMADIN TAB 2.5MG - 30EA COUMADIN TAB 2MG - 30EA COUMADIN TAB 3MG - 30EA COUMADIN TAB 4MG - 30EA COUMADIN TAB 5MG - 30EA DIPYRIDAMOLE TAB 25MG - 90EA JANTOVEN TAB 10MG - 30EA JANTOVEN TAB 1MG - 30EA JANTOVEN TAB 2.5MG - 30EA JANTOVEN TAB 2MG - 30EA JANTOVEN TAB 3MG - 30EA JANTOVEN TAB 4MG - 30EA JANTOVEN TAB 5MG - 30EA JANTOVEN TAB 6MG - 30EA JANTOVEN TAB 7.5MG - 30EA PENTOXIFYLLI TAB 400MG ER - 90EA PENTOXIL TAB 400MG CR - 90EA TICLOPIDINE TAB 250MG - 60EA WARFARIN TAB 10MG - 30EA WARFARIN TAB 1MG - 30EA WARFARIN TAB 2.5MG - 30EA WARFARIN TAB 2MG - 30EA WARFARIN TAB 3MG - 30EA WARFARIN TAB 4MG - 30EA WARFARIN TAB 5MG - 30EA WARFARIN TAB 6MG - 30EA WARFARIN TAB 7.5MG - 30EA

AGGRENOX AGRYLIN ALBUMIN HUM ALBUMINAR-25 AMICAR AMINOCAPR AC ANAGRELIDE CATHFLO ACTI CILOSTAZOL CLOPIDOGREL COUMADIN DIPYRIDAMOLE FRAGMIN HEPARIN LOCK HEPARIN SOD INNOHEP LOVENOX PENTOXIFYLLI PERSANTINE PLAVIX PLETAL TICLID TRENTAL


HALOPERIDOL POW USP - GM HALOPERIDOL TAB 0.5MG - 30EA HALOPERIDOL TAB 10MG - 30EA HALOPERIDOL TAB 1MG - 30EA HALOPERIDOL TAB 2MG - 30EA HALOPERIDOL TAB 5MG - 30EA LITHIUM CARB CAP 150MG - 30EA THIORIDAZINE TAB 150MG - 15EA THIORIDAZINE TAB 15MG - 30EA

CHLORPROMAZ TAB 10MG - 30EA CHLORPROMAZ TAB 25MG - 30EA FLUPHENAZINE TAB 1MG - 30EA FLUPHENAZINE TAB 2.5MG - 30EA FLUPHENAZINE TAB 5MG - 30EA HALOPERIDOL TAB 20MG - 30EA LITHIUM CARB CAP 300MG - 90EA LITHIUM CARB CAP 600MG - 60EA LITHIUM CARB TAB 300MG - 90EA LITHIUM CITR SYP 8MEQ/5ML - 500ML LOXAPINE CAP 5MG - 30EA PERPHENAZINE TAB 2MG - 30EA PERPHENAZINE TAB 4MG - 30EA PERPHENAZINE TAB 8MG - 30EA PROCHLORPER TAB 5MG - 30EA THIORIDAZINE TAB 100MG - 30EA THIORIDAZINE TAB 10MG - 60EA THIORIDAZINE TAB 200MG - 30EA THIORIDAZINE TAB 25MG - 30EA THIORIDAZINE TAB 50MG - 30EA THIOTHIXENE CAP 10MG - 30EA THIOTHIXENE CAP 1MG - 30EA THIOTHIXENE CAP 2MG - 30EA THIOTHIXENE CAP 5MG - 30EA TRIFLUOPERAZ TAB 1MG - 30EA TRIFLUOPERAZ TAB 2MG - 30EA TRIFLUOPERAZ TAB 5MG - 30EA

CHLORPROMAZ TAB 100MG - 30EA CHLORPROMAZ TAB 200MG - 30EA CHLORPROMAZ TAB 50MG - 60EA CLOZAPINE TAB 25MG - 28EA CLOZAPINE TAB 50MG - 14EA COMPRO SUP 25MG - 12EA FLUPHENAZINE ELX 2.5/5ML - 60ML FLUPHENAZINE TAB 10MG - 60EA HALOPERIDOL CON 2MG/ML - 120ML LITHIUM CARB TAB 300MG ER - 60EA LITHIUM CARB TAB 450MG ER - 60EA LITHOBID TAB 300MG SR - 60EA LOXAPINE CAP 10MG - 30EA LOXAPINE CAP 25MG - 30EA MOBAN TAB 5MG - 30EA PROCHLORPER SUP 25MG - 12EA PROCHLORPER TAB 10MG - 30EA TRIFLUOPERAZ TAB 10MG - 30EA

ABILIFY CHLORPROMAZ CLOZAPINE CLOZARIL EQUETRO ESKALITH CR FAZACLO FLUPHENAZINE GEODON HALDOL DECAN HALOPERIDOL LITHOBID LOXAPINE LOXITANE MOBAN NAVANE PERPHENAZINE PROCHLORPER PROLIXIN PROLIXIN-DEC RISPERDAL RISPERDAL M SEROQUEL ZYPREXA ZYPREXA ZYDI

PREZISTA REBETOL RESCRIPTOR RETROVIR REYATAZ RIBAPAK RIBASPHERE RIBAVIRIN SUSTIVA TAMIFLU TRIZIVIR TRUVADA VALCYTE VALTREX VIDEX EC VIRACEPT VIRAMUNE VIREAD ZERIT ZIAGEN ZIDOVUDINE

Preferred Drug List - 1stAgency...INDOMETHACIN CAP 50MG - 30EA INDOMETHACIN CAP 75MG SR - 6EA LORTAB...

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