TEXAS ERS (Effective 01/01/2014) · ULTRAM ER) TB24 100mg, 200mg 1 Drug Name Drug Tier...

PA - Prior Authorization QL - Quantity Limits ST - Step Therapy NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access

1

TEXAS ERS (Effective 01/01/2014)

Drug Name Drug Tier

Requirements/Limits

ANALGESICS GOUT allopurinol inj 500mg (generic of ALOPRIM)

1

allopurinol tab (generic of ZYLOPRIM)

1

colchicine w/ probenecid 1

COLCRYS 2

probenecid 1

ULORIC 2

MISCELLANEOUS diclofenac w/ misoprostol (generic of ARTHROTEC 50)

1

diclofenac w/ misoprostol (generic of ARTHROTEC 75)

1

DUEXIS 3

VIMOVO 2

NSAIDS CELEBREX 2

diclofenac potassium (generic of CATAFLAM)

1

diclofenac sodium (generic of VOLTAREN-XR) TB24

1

diclofenac sodium TBEC 1

diflunisal 1

etodolac CAPS; TABS 1

etodolac er 1

fenoprofen calcium TABS 1

flurbiprofen TABS 1

ibuprofen SUSP 1

ibuprofen TABS 400mg, 600mg, 800mg

1

ketoprofen CAPS; CP24 1

mefenamic acid (generic of PONSTEL) CAPS

1

MELOXICAM SUSP 7.5 MG/5ML

1

meloxicam tabs (generic of MOBIC)

1

nabumetone TABS 1

NALFON 3

NAPRELAN 3

naproxen (generic of NAPROSYN) SUSP; TABS

1

Drug Name Drug Tier

Requirements/Limits

naproxen (generic of EC-NAPROSYN) TBEC

1

naproxen sodium (generic of ANAPROX) TABS 275mg

1

naproxen sodium (generic of ANAPROX DS) TABS 550mg

1

oxaprozin (generic of DAYPRO)

1

piroxicam (generic of FELDENE) CAPS

1

sulindac TABS 150mg 1

sulindac (generic of CLINORIL) TABS 200mg

1

tolmetin sodium 1

ZIPSOR 3

OPIOID ANALGESICS acetaminophen w/ codeine SOLN

1

acetaminophen w/ codeine TABS

1

acetaminophen w/ codeine (generic of TYLENOL/CODEINE #3) TABS

1

acetaminophen w/ codeine (generic of TYLENOL/CODEINE #4) TABS

1

butorphanol nasal spray QL (10 mL / 30 days)

1 QL

butorphanol tartrate SOLN 1

BUTRANS 5mcg/hr, 10mcg/hr, 20mcg/hr

3

capital and codeine 3

CONZIP 3

hydrocodone-acetaminophen CAPS

1

hydrocodone-acetaminophen SOLN

3

hydrocodone-acetaminophen (generic of LORTAB) TABS

1

hydrocodone-acetaminophen 2.5-325mg

1


1

hydrocodone-acetaminophen 5-300mg (generic of XODOL)

1

hydrocodone-acetaminophen 5-325mg (generic of NORCO)

1


2

Drug Name Drug Tier

Requirements/Limits

hydrocodone-acetaminophen 5-500mg (generic of LORTAB)

1

hydrocodone-acetaminophen 7.5-300mg (generic of XODOL)

1

hydrocodone-acetaminophen 7.5-325 mg/15ml (generic of HYCET)

1

hydrocodone-acetaminophen 7.5-325mg (generic of NORCO)

1

hydrocodone-acetaminophen 7.5-500mg (generic of LORTAB)

1

hydrocodone-acetaminophen 7.5-500mg/ml (generic of LORTAB)

1

hydrocodone-acetaminophen 7.5-650mg (generic of ANEXSIA)

1


1

hydrocodone-acetaminophen 10-300mg (generic of XODOL)

1

hydrocodone-acetaminophen 10-500mg (generic of LORTAB)

1

hydrocodone-acetaminophen 10-650mg (generic of LORCET 10/650)

1

hydrocodone-acetaminophen 10-660mg

1

hydrocodone-acetaminophen 10-750mg (generic of MAXIDONE)

1

hydrocodone-acetaminophen tab 10-325mg (generic of NORCO)

1

hydrocodone-ibuprofen 1

hydrocodone-ibuprofen (generic of VICOPROFEN)

1

ibudone tab 5-200mg (generic of REPREXAIN)

1

reprexain 10/200 1

SYNALGOS-DC 3

tramadol hcl er (generic of ULTRAM ER) TB24 100mg, 200mg

1

Drug Name Drug Tier

Requirements/Limits

TRAMADOL HCL ER TB24 300mg

1

tramadol hcl er (biphasic) 100mg

1


1


1

tramadol hcl tab 50 mg (generic of ULTRAM)

1

tramadol-acetaminophen (generic of ULTRACET)

1

vicodin (generic of XODOL) 1

vicodin es (generic of XODOL)

1

vicodin hp (generic of XODOL)

1

OPIOID ANALGESICS, CII ABSTRAL

QL (120 ea / 30 days) 3 QL NM

AVINZA 2

CODEINE SULFATE TABS 1

DILAUDID-HP INJ 3 B/D

DURAMORPH 1 B/D

endocet 5/325 (generic of PERCOCET)

1

endocet 7.5/325 (generic of PERCOCET)

1

endocet 10/325 (generic of PERCOCET)

1

ENDODAN 1

EXALGO 8mg, 12mg 2

EXALGO 16mg, 32mg 2 NM

fentanyl citrate (generic of ACTIQ) LPOP

QL (120 lpop / 30 days)

1 QL NM

fentanyl patch (generic of DURAGESIC)

1

FENTORA QL (120 tabs / 30 days)

2 QL NM

hydromorphone hcl (generic of DILAUDID-5) LIQD

1

hydromorphone hcl (generic of DILAUDID-HP) SOLN 500mg/50ml

1 B/D

hydromorphone hcl (generic of DILAUDID) TABS

1

INFUMORPH 200 3 B/D

INFUMORPH 500 3 B/D


3

Drug Name Drug Tier

Requirements/Limits

KADIAN 2

LAZANDA QL (30 ea / 30 days)

2 QL NM

levorphanol tartrate TABS 1

methadone hcl (generic of METHADOSE) CONC

1

methadone hcl SOLN 1

methadone hcl (generic of DOLOPHINE HCL) TABS 5mg

1

methadone hcl (generic of DOLOPHINE) TABS 10mg

1

METHADONE INJ 10MG/ML 3

MORPHINE SUL 20MG/ML ORAL SOL

1

MORPHINE SULFATE SOLN 10mg/5ml, 20mg/5ml

1

morphine sulfate SOLN .5mg/ml, 1mg/ml

1 B/D

MORPHINE SULFATE TABS

1

morphine sulfate ext-rel tab (generic of MS CONTIN)

1

MORPHINE SULFATE INJ 1mg/ml, 4mg/ml, 8mg/ml, 10mg/ml, 15mg/ml

1 B/D

morphine sulfate inj .5mg/ml, 1mg/ml

1 B/D

NUCYNTA 2

NUCYNTA ER 2

ONSOLIS QL (120 ea / 30 days)

3 QL NM

OPANA ER (CRUSH RESISTANT

2

OXECTA 3

OXYCODONE HCL CAPS 1

OXYCODONE HCL CONC 1

OXYCODONE HCL SOLN 1

oxycodone hcl (generic of ROXICODONE) TABS 5mg, 15mg, 30mg

1

oxycodone hcl TABS 10mg, 20mg

1

oxycodone w/ acetaminophen SOLN

2

oxycodone w/ acetaminophen (generic of PERCOCET) TABS

1

Drug Name Drug Tier

Requirements/Limits

oxycodone w/ acetaminophen 2.5-325mg (generic of PERCOCET)

1

oxycodone w/ acetaminophen 5-325mg (generic of PERCOCET)

1

oxycodone w/ acetaminophen 5-500mg

1


1


1


1


1

oxycodone-aspirin (generic of PERCODAN)

1

oxycodone-ibuprofen 1

OXYCONTIN 10mg, 15mg, 20mg, 30mg

2

OXYCONTIN 40mg, 60mg, 80mg

QL (120 ea / 30 days)

2 QL

oxymorphone hcl (generic of OPANA) TABS

1

SUBSYS QL (120 ea / 30 days)

3 QL NM

ANESTHETICS LOCAL ANESTHETICS lidocaine hcl (local anesth.) (generic of XYLOCAINE-MPF) 4%

1

lidocaine hcl (local anesth.) (generic of XYLOCAINE) .5%

1 B/D

lidocaine inj 0.5% (generic of XYLOCAINE-MPF)

1 B/D

lidocaine inj 1% (generic of XYLOCAINE) 1%

1 B/D

lidocaine inj 1% (generic of XYLOCAINE-MPF) 1%

1 B/D

lidocaine inj 1.5% (generic of XYLOCAINE-MPF)

1 B/D

lidocaine inj 2% (generic of XYLOCAINE) 2%

1 B/D


4

Drug Name Drug Tier

Requirements/Limits

lidocaine inj 2% (generic of XYLOCAINE-MPF) 2%

1 B/D

ANTI-INFECTIVES ANTI-BACTERIALS - MISCELLANEOUS amikacin sulfate SOLN 1

gentamicin in saline 1

gentamicin sulfate SOLN 1

neomycin sulfate TABS 1

paromomycin sulfate CAPS 1

streptomycin sulfate SOLR 1

sulfadiazine TABS 3

TOBI NEB 2 B/D NM

tobramycin sulfate SOLN; SOLR

1

tobramycin sulfate in saline 2

ANTI-INFECTIVES - MISCELLANEOUS ALBENZA 3

ALINIA 2

AZACTAM 2gm 3

AZACTAM/DEX INJ 1GM 3

AZACTAM/DEX INJ 2GM 3 NM

aztreonam (generic of AZACTAM)

1

BILTRICIDE 2

clindamycin hcl (generic of CLEOCIN) CAPS

1

clindamycin palmitate hydrochloride (generic of CLEOCIN PEDIATRIC GRANULE)

1

clindamycin phosphate SOLN 150mg/ml

1

clindamycin phosphate (generic of CLEOCIN PHOSPHATE) SOLN 150mg/ml, 300mg/2ml, 600mg/4ml, 900mg/6ml, 9000mg/60ml

1

clindamycin phosphate in d5w (generic of CLEOCIN IN D5W)

1

colistimethate sodium (generic of COLY-MYCIN M) SOLR

1

CUBICIN 3 B/D NM

dapsone TABS 1

DARAPRIM 3

DORIBAX 3

Drug Name Drug Tier

Requirements/Limits

erythromycin-sulfisoxazole 1

FLAGYL CAPS 3

FLAGYL ER 3

imipenem-cilastatin (generic of PRIMAXIN IV)

1

INVANZ 3

MACRODANTIN 25mg 2

MEPRON 3 NM

meropenem (generic of MERREM)

1

methenamine hippurate (generic of HIPREX)

1

METRO IV 2

metronidazole (generic of FLAGYL) TABS

1

metronidazole inj 1

NEBUPENT 3 B/D

nitrofurantoin (generic of FURADANTIN) SUSP

1

nitrofurantoin macrocrystal (generic of MACRODANTIN)

1

nitrofurantoin monohyd macro (generic of MACROBID)

1

PENTAM 300 3

polymyxin b sulfate SOLR 1

PRIMSOL SOL 50MG/5ML 3

STROMECTOL 3

sulfamethoxazole-trimethoprim SUSP

1

sulfamethoxazole-trimethoprim (generic of BACTRIM) TABS

1

sulfamethoxazole-trimethoprim (generic of BACTRIM DS) TABS

1

sulfamethoxazole-trimethoprim inj

1

SYNERCID 3 NM

trimethoprim TABS 1

TYGACIL 3 NM

vancomycin hcl (generic of VANCOCIN HCL) CAPS

1 NM

vancomycin hcl SOLR 1 B/D

VIBATIV 3

XIFAXAN TAB 200MG 3 NM

ZYVOX SOLN 3 NM

ZYVOX SUSR; TABS 2 NM

ANTIFUNGALS


5

Drug Name Drug Tier

Requirements/Limits

ABELCET 3 B/D NM

AMBISOME 3 B/D NM

AMPHOTEC 3 B/D

amphotericin b SOLR 1 B/D

CANCIDAS 3 NM

ERAXIS 3 NM

fluconazole (generic of DIFLUCAN) SUSR; TABS

1

fluconazole in dextrose 1

fluconazole in nacl 1

flucytosine (generic of ANCOBON) CAPS

1 NM

griseofulvin microsize SUSP 1

griseofulvin microsize (generic of GRIFULVIN V) TABS

1

griseofulvin ultramicrosize (generic of GRIS-PEG)

1

itraconazole (generic of SPORANOX) CAPS

1

ketoconazole TABS 1

LAMISIL PACK 3

MYCAMINE 50mg 3

MYCAMINE 100mg 3 NM

NOXAFIL 3 NM

nystatin TABS 1

ONMEL 3

SPORANOX SOL 10MG/ML 3 NM

terbinafine hcl (generic of LAMISIL) TABS

1

VFEND SUS 40MG/ML 2 NM

voriconazole (generic of VFEND) TABS

1 NM

voriconazole inj 200mg (generic of VFEND IV)

1

ANTIMALARIALS ATOVAQUONE-PROGUANIL HCL TAB 62.5-25 MG

1

atovaquone-proguanil hcl tab 250-100 mg (generic of MALARONE)

1

chloroquine phosphate TABS 250mg

1

chloroquine phosphate (generic of ARALEN) TABS 500mg

1

COARTEM 2

mefloquine hcl 1

PRIMAQUINE PHOSPHATE 2

Drug Name Drug Tier

Requirements/Limits

quinine sulfate (generic of QUALAQUIN) CAPS

1

ANTIRETROVIRAL AGENTS abacavir sulfate (generic of ZIAGEN)

1

APTIVUS 3 NM

CRIXIVAN 3

didanosine (generic of VIDEX EC)

1

EDURANT 2 NM

EMTRIVA 2

EPIVIR SOL 10MG/ML 2

FUZEON 2 NM

INTELENCE 25mg 2

INTELENCE 100mg, 200mg 2 NM

INVIRASE CAPS 3

INVIRASE TABS 3 NM

ISENTRESS CHEW 25mg 2

ISENTRESS CHEW 100mg 2 NM

ISENTRESS TABS 2 NM

lamivudine (generic of EPIVIR)

1

LEXIVA SUSP 3

LEXIVA TABS 3 NM

NEVIRAPINE SUSP 1

nevirapine (generic of VIRAMUNE) TABS

1

NORVIR 2

PREZISTA SUSP 2 NM

PREZISTA TABS 75mg, 150mg

2

PREZISTA TABS 400mg, 600mg, 800mg

2 NM

RESCRIPTOR 2

RETROVIR IV INFUSION 2

REYATAZ 100mg 2

REYATAZ 150mg, 200mg, 300mg

2 NM

SELZENTRY 3 NM

stavudine (generic of ZERIT) 1

SUSTIVA 2

VIDEX PEDIATRIC 3

VIRACEPT 3 NM

VIRAMUNE SUSP 2

VIRAMUNE XR 2

VIREAD 2 NM

ZIAGEN SOLN 3


6

Drug Name Drug Tier

Requirements/Limits

zidovudine (generic of RETROVIR) CAPS; SYRP

1

zidovudine TABS 1

ANTIRETROVIRAL COMBINATION AGENTS ATRIPLA 2 NM

COMPLERA 3 NM

EPZICOM 3 NM

KALETRA SOL 2 NM

KALETRA TAB 100-25MG 2

KALETRA TAB 200-50MG 2 NM

lamivudine-zidovudine (generic of COMBIVIR)

1 NM

STRIBILD 3 NM

TRIZIVIR 3 NM

TRUVADA 2 NM

ANTITUBERCULAR AGENTS CAPASTAT SULFATE 3 NM

cycloserine CAPS 3

ethambutol hcl (generic of MYAMBUTOL) TABS

1

isoniazid SOLN; SYRP 1

isoniazid & rifampin 3

isoniazid tabs 1

MYCOBUTIN 3

paser 4gm 2

PRIFTIN 3

pyrazinamide 1

rifampin (generic of RIFADIN) CAPS; SOLR

1

RIFATER 3

SIRTURO 3 NM LA

TRECATOR 3

ANTIVIRALS acyclovir (generic of ZOVIRAX) CAPS; SUSP; TABS

1

acyclovir sodium 1 B/D

BARACLUDE SOLN 2

BARACLUDE TABS 2 NM

cidofovir (generic of VISTIDE) 1

EPIVIR HBV 2

famciclovir (generic of FAMVIR)

1

foscarnet sodium 1

ganciclovir inj 500mg (generic of CYTOVENE)

1 B/D

HEPSERA 3 NM

Drug Name Drug Tier

Requirements/Limits

INCIVEK 2 NM PA

REBETOL SOLN 2 NM PA

RELENZA DISKHALER 2

ribapak 3 NM PA

ribapak mis 600/day 3 NM PA

ribasphere 1 NM PA

ribasphere 200mg (generic of REBETOL) CAPS

1 NM PA

ribasphere 200mg (generic of COPEGUS) TABS

1 NM PA

ribavirin 200mg (generic of REBETOL) CAPS

1 NM PA

ribavirin 200mg (generic of COPEGUS) TABS

1 NM PA

rimantadine hydrochloride (generic of FLUMADINE)

1

TAMIFLU 2

TYZEKA 3 NM

valacyclovir hcl (generic of VALTREX) TABS

1

VALCYTE 2 NM

VICTRELIS 2 NM PA

CEPHALOSPORINS CEDAX 3

cefaclor 1

cefaclor monohydrate 2

cefadroxil 1

cefazolin inj 1

cefazolin sodium 1gm, 20gm 1

cefazolin/dextrose 2

cefdinir 1

CEFEPIME 1GM SOLN 3

CEFEPIME 2GM SOLN 3

cefepime inj 1gm (generic of MAXIPIME)

1

cefepime inj 2gm (generic of MAXIPIME)

1

cefixime 2

cefotaxime sodium (generic of CLAFORAN)

1

cefotetan disodium 3

cefoxitin sodium 1

CEFOXITIN SODIUM IN DEXTROSE

3

cefpodoxime proxetil 1

cefprozil 1


7

Drug Name Drug Tier

Requirements/Limits

ceftazidime (generic of FORTAZ) SOLR 1gm, 2gm, 6gm

1

CEFTAZIDIME/DEXTROSE 2

CEFTIN SUSR 3

ceftriaxone sodium SOLR 1gm, 2gm, 10gm, 250mg

1

ceftriaxone sodium (generic of ROCEPHIN) SOLR 1gm, 500mg

1

cefuroxime axetil (generic of CEFTIN) TABS

1

cefuroxime sodium (generic of ZINACEF) 1.5gm, 7.5gm, 750mg

1

cefuroxime sodium 7.5gm 1

cephalexin (generic of KEFLEX) CAPS 250mg, 500mg

1

cephalexin SUSR 1

cephalexin TABS 1

claforan 1gm, 2gm 3

FORTAZ SOLN 3

FORTAZ SOLR 500mg 3

MAXIPIME 3

SUPRAX CAPS; SUSR 2

suprax CHEW 2

tazicef vial (generic of FORTAZ)

1

TEFLARO 3

ERYTHROMYCINS/MACROLIDES AZITHROMYCIN PACK 1

azithromycin (generic of ZITHROMAX) SOLR 500mg

1

azithromycin (generic of ZITHROMAX) SUSR

1

azithromycin (generic of ZITHROMAX) TABS

1

clarithromycin SUSR 125mg/5ml

1

clarithromycin (generic of BIAXIN) SUSR 250mg/5ml

1

clarithromycin (generic of BIAXIN) TABS

1

clarithromycin (generic of BIAXIN XL) TB24

1

DIFICID 2 NM

E.E.S. GRANULES 3

Drug Name Drug Tier

Requirements/Limits

ERYPED 200 3

ERYPED 400 2

erythromycin base CPEP; TABS

1

erythromycin base TBEC 2

erythromycin ethylsuccinate 1

erythromycin lactobionate 3

erythromycin stearate 1

PCE 3

ZMAX 2

FLUOROQUINOLONES AVELOX SOLN 3

AVELOX TABS 2

AVELOX ABC PACK 2

CIPRO SUSR 2

ciprofloxacin SOLN 200mg/20ml

1

ciprofloxacin er (generic of CIPRO XR)

1

ciprofloxacin hcl TABS 100mg, 750mg

1

ciprofloxacin hcl (generic of CIPRO) TABS 250mg, 500mg

1

ciprofloxacin in d5w (generic of CIPRO I.V.-IN D5W)

1

ciprofloxacn inj 1

FACTIVE 3

levofloxacin SOLN 25mg/ml 1

levofloxacin (generic of LEVAQUIN) SOLN 25mg/ml

1

levofloxacin (generic of LEVAQUIN) TABS

1

levofloxacin in d5w (generic of LEVAQUIN)

1

NOROXIN 3

PENICILLINS amoxicillin 1

amoxicillin & pot clavulanate CHEW

1

amoxicillin & pot clavulanate (generic of AUGMENTIN) CHEW

1

amoxicillin & pot clavulanate SUSR

1

amoxicillin & pot clavulanate (generic of AUGMENTIN) SUSR

1


8

Drug Name Drug Tier

Requirements/Limits

amoxicillin & pot clavulanate (generic of AUGMENTIN ES-600) SUSR

1

amoxicillin & pot clavulanate TABS

1

amoxicillin & pot clavulanate (generic of AUGMENTIN) TABS

1

amoxicillin & pot clavulanate (generic of AUGMENTIN XR) TB12

1

ampicillin 1

ampicillin & sulbactam sodium 1

ampicillin & sulbactam sodium (generic of UNASYN)

1

ampicillin & sulbactam sodium (generic of UNASYN BULK PACK)

1

ampicillin inj 1

ampicillin sodium 1

AUGMENTIN SUSR 3

BACTOCILL IN DEXTROSE 3

BICILLIN C-R 3

BICILLIN L-A 3

dicloxacillin sodium 1

MOXATAG 3

nafcillin sodium 1gm 1

nafcillin sodium 2gm, 10gm 1 NM

NALLPEN ISO-OSMOTIC IN DE

3

NALLPEN/DEXTROSE 3

oxacillin sodium 1gm, 2gm 1

oxacillin sodium 10gm 1 NM

PENICILLIN G POT IN DEXTROSE

3

penicillin g potassium 1

PENICILLIN G POTASSIUM IN

3

penicillin g procaine 2

penicillin g sodium 1

penicillin v potassium 1

pfizerpen 1

piperacillin sodium-tazobactam sodium (generic of ZOSYN)

1

TIMENTIN 3

TIMENTIN INJ 3.1GM 3

ZOSYN SOLN 3

Drug Name Drug Tier

Requirements/Limits

TETRACYCLINES demeclocycline hcl 1

DORYX 3

doxycycline (monohydrate) CAPS 50mg

1

doxycycline (monohydrate) (generic of MONODOX) CAPS 75mg, 100mg

1

doxycycline (monohydrate) (generic of ADOXA) CAPS 150mg

1

doxycycline (monohydrate) (generic of VIBRAMYCIN) SUSR

1

doxycycline (monohydrate) (generic of ADOXA) TABS 50mg, 75mg, 100mg

1

doxycycline (monohydrate) (generic of ADOXA PAK 1/150) TABS 150mg

1

doxycycline hyclate CAPS 50mg

1

doxycycline hyclate (generic of VIBRAMYCIN) CAPS 100mg

1

doxycycline hyclate SOLR 1

doxycycline hyclate TABS 1

doxycycline hyclate TBEC 75mg, 100mg

1

doxycycline hyclate (generic of DORYX) TBEC 150mg

1

minocycline hcl (generic of MINOCIN) CAPS 50mg, 100mg

1

minocycline hcl CAPS 75mg 1

minocycline hcl TABS 1

minocycline hcl TB24 1

SOLODYN 3 NM

VIBRAMYCIN SUSR; SYRP 2

ANTINEOPLASTIC AGENTS ALKYLATING AGENTS BICNU 3 B/D

BUSULFEX 3 B/D

CEENU 2

cyclophosphamide SOLR; TABS

1 B/D

dacarbazine 200mg 1 B/D

EMCYT 2

HEXALEN 2 NM


9

Drug Name Drug Tier

Requirements/Limits

IFEX INJ 3GM 3 B/D

ifosfamide (generic of IFOSFAMIDE) SOLN

1 B/D

ifosfamide (generic of IFEX) SOLR 1gm

1 B/D

LEUKERAN 2

melphalan hcl (generic of ALKERAN)

1 B/D NM

MUSTARGEN 3 B/D

thiotepa SOLR 3 B/D

TREANDA 3 B/D NM

ZANOSAR 3 B/D

ANTHRACYCLINES adriamycin 20mg 1 B/D

adriamycin inj 2mg/ml 1 B/D

daunorubicin hcl INJ 1 B/D

daunorubicin hcl (generic of CERUBIDINE) SOLR

1 B/D

DOXIL 3 B/D NM

doxorubicin hcl SOLN 1 B/D

doxorubicin hcl SOLR 50mg 1 B/D

EPIRUBICIN INJ 50MG 3 B/D

epirubicin inj 50mg/25ml (generic of ELLENCE)

1 B/D

epirubicin inj 200mg (generic of ELLENCE)

1 B/D

idarubicin hcl (generic of IDAMYCIN PFS)

1 B/D NM

ANTIBIOTICS bleomycin sulfate 1 B/D

COSMEGEN 3 B/D NM

mitomycin SOLR 20mg 1 B/D

ANTIMETABOLITES adrucil 1 B/D

ALIMTA 3 B/D NM

ARRANON 3 B/D

cladribine 1 B/D NM

CLOLAR 3 B/D

cytarabine inj 1 B/D

DACOGEN 3 B/D NM

fludarabine phosphate SOLN

1 B/D

fludarabine phosphate (generic of FLUDARA) SOLR

1 B/D

fluorouracil SOLN 1 B/D

GEMCITABINE 3 B/D NM

gemcitabine hcl (generic of GEMZAR) 1gm, 200mg

1 B/D NM

Drug Name Drug Tier

Requirements/Limits

gemcitabine hcl 2gm 1 B/D NM

mercaptopurine (generic of PURINETHOL) TABS

1

methotrexate sodium inj 1 B/D

pentostatin (generic of NIPENT)

1 B/D NM

TABLOID 2

VIDAZA 3 B/D NM

ANTIMITOTIC, TAXOIDS ABRAXANE 3 B/D NM

DOCETAXEL CONC 20mg/0.5ml

3 B/D NM

DOCETAXEL CONC 20mg/ml, 80mg/4ml

1 B/D NM

docetaxel CONC 140mg/7ml 3 B/D NM

DOCETAXEL SOLN 80mg/8ml

3 B/D NM

paclitaxel 1 B/D

TAXOTERE 3 B/D NM

ANTIMITOTIC, VINCA ALKALOIDS vinblastine sulfate SOLR 2 B/D

vincristine sulfate 1 B/D

vinorelbine tartrate (generic of NAVELBINE)

1 B/D

BIOLOGIC RESPONSE MODIFIERS AVASTIN 3 B/D NM

ERBITUX 3 B/D NM

ERIVEDGE 3 NM LA PA

HERCEPTIN 3 B/D NM

ISTODAX 3 B/D NM

KADCYLA 3 B/D NM

ONTAK 3 B/D NM

PROLEUKIN 3 B/D NM

RITUXAN 3 NM PA

TORISEL 3 B/D NM

VECTIBIX 3 B/D NM

VELCADE 3 B/D NM

ZOLINZA 2 NM PA

HORMONAL ANTINEOPLASTIC AGENTS anastrozole (generic of ARIMIDEX) TABS

1

ARZERRA 3 B/D NM

bicalutamide (generic of CASODEX)

1

DEPO-PROVERA INJ 400/ML 3 B/D

ELIGARD 3 B/D NM

exemestane (generic of AROMASIN)

1

FARESTON 2 NM


10

Drug Name Drug Tier

Requirements/Limits

FASLODEX 2 B/D NM

FIRMAGON 3 B/D NM

flutamide 1

letrozole (generic of FEMARA) TABS

1

leuprolide acetate KIT 1 NM PA

LUPR DEP-PED INJ 11.25MG (3-MONTH)

2 NM PA

LUPR DEP-PED INJ 30MG (3-MONTH)

2 NM PA

LUPRON DEPOT 3.75mg, 7.5mg, 11.25mg

2 NM PA

LUPRON DEPOT INJ 22.5MG (3-MONTH)

2 NM PA

LUPRON DEPOT INJ 30MG (3-MONTH)

2 NM PA

LUPRON DEPOT-PED 2 NM PA

LYSODREN 2

MEGACE ES 2

megestrol acetate (generic of MEGACE ORAL) SUSP

1

megestrol acetate TABS 1

NILANDRON 2 NM

SOLTAMOX 3

tamoxifen citrate TABS 1

TRELSTAR DEPOT MIXJECT

2 NM PA

TRELSTAR LA MIXJECT 2 NM PA

TRELSTAR MIXJECT 2 NM PA

XTANDI 3 NM LA PA

ZYTIGA 3 NM PA

KINASE INHIBITORS AFINITOR 2 NM PA

AFINITOR DISPERZ 2 NM PA

BOSULIF 3 NM PA

CAPRELSA 3 NM LA PA

COMETRIQ 3 NM PA

GLEEVEC 2 NM PA

ICLUSIG 3 NM PA

INLYTA 3 NM LA PA

IRESSA 3 NM

JAKAFI 3 NM LA PA

MEKINIST 3 NM PA

NEXAVAR 2 NM LA PA

SPRYCEL 2 NM PA

STIVARGA 3 NM LA PA

SUTENT 2 NM PA

TAFINLAR 3 NM PA

TARCEVA 2 NM PA

Drug Name Drug Tier

Requirements/Limits

TASIGNA 2 NM PA

TYKERB 2 NM LA PA

VOTRIENT 2 NM PA

XALKORI 3 NM LA PA

ZELBORAF 3 NM LA PA

MISCELLANEOUS DROXIA 2

ELSPAR 3 B/D NM

HALAVEN 3 B/D NM

hydroxyurea (generic of HYDREA) CAPS

1

IXEMPRA KIT 3 B/D NM

MATULANE 2 NM

mitoxantrone hcl 1 B/D NM

POMALYST CAP 3 NM LA PA

SYLATRON 2 NM PA

TARGRETIN CAPS 2 NM PA

tretinoin CAPS 1 NM

TRISENOX 3 B/D NM

UVADEX 3 B/D

PLATINUM-BASED AGENTS carboplatin SOLN 1 B/D

cisplatin SOLN 1 B/D

ELOXATIN 3 B/D NM

oxaliplatin 1 B/D NM

PROTECTIVE AGENTS amifostine crystalline (generic of ETHYOL)

1 B/D NM

dexrazoxane (generic of ZINECARD)

1 B/D NM

ELITEK 3 B/D NM

KEPIVANCE 3 B/D NM

leucovor ca inj 1 B/D

leucovorin calcium SOLN; SOLR

1 B/D

leucovorin calcium TABS 1

mesna (generic of MESNEX) 1 B/D

MESNEX TABS 3 NM

TOPOISOMERASE INHIBITORS CAMPTOSAR 300mg/15ml 3 B/D

ETOPOPHOS 3 B/D

etoposide SOLN 1gm/50ml, 500mg/25ml

1 B/D

irinotecan (generic of CAMPTOSAR)

1 B/D NM

irinotecan hcl (generic of CAMPTOSAR) 40mg/2ml

1 B/D NM

irinotecan hcl 500mg/25ml 1 B/D NM


11

Drug Name Drug Tier

Requirements/Limits

topotecan hcl (generic of HYCAMTIN) SOLR

1 B/D NM

CARDIOVASCULAR ACE INHIBITOR COMBINATIONS amlodipine besylate-benazepril hcl (generic of LOTREL)

1

benazepril & hydrochlorothiazide

1

benazepril & hydrochlorothiazide (generic of LOTENSIN HCT)

1

captopril & hydrochlorothiazide

1

enalapril maleate & hydrochlorothiazide

1

enalapril maleate & hydrochlorothiazide (generic of VASERETIC)

1

fosinopril sodium & hydrochlorothiazide

1

lisinopril & hydrochlorothiazide (generic of ZESTORETIC)

1

moexipril-hydrochlorothiazide (generic of UNIRETIC)

1

quinapril-hydrochlorothiazide (generic of ACCURETIC)

1

TARKA 2

ACE INHIBITORS benazepril hcl TABS 5mg 1

benazepril hcl (generic of LOTENSIN) TABS 10mg, 20mg, 40mg

1

captopril TABS 1

enalapril maleate (generic of VASOTEC) TABS

1

fosinopril sodium 1

lisinopril (generic of ZESTRIL) TABS 2.5mg, 30mg, 40mg

1

lisinopril (generic of PRINIVIL) TABS 5mg, 10mg, 20mg

1

moexipril hcl (generic of UNIVASC)

1

perindopril erbumine 2mg 1

perindopril erbumine (generic of ACEON) 4mg, 8mg

1

quinapril hcl (generic of ACCUPRIL)

1

Drug Name Drug Tier

Requirements/Limits

ramipril (generic of ALTACE) 1

trandolapril (generic of MAVIK)

1

ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone (generic of INSPRA)

1

spironolactone (generic of ALDACTONE) TABS

1

ALPHA BLOCKERS doxazosin mesylate (generic of CARDURA)

1

prazosin hcl (generic of MINIPRESS)

1

terazosin hcl 1

ANGIOTENSIN II RECEPTOR ANTAGONIST COMBINATIONS AZOR 2

BENICAR HCT 2

candesartan cilexetil-hydrochlorothiazide (generic of ATACAND HCT)

1

EDARBYCLOR 3

EXFORGE 2

EXFORGE HCT 2

irbesartan-hydrochlorothiazide (generic of AVALIDE)

1

losartan potassium & hydrochlorothiazide (generic of HYZAAR)

1

MICARDIS HCT 2

TEVETEN HCT 3

TRIBENZOR 2

TWYNSTA 3

valsartan-hydrochlorothiazide (generic of DIOVAN HCT)

1

ANGIOTENSIN II RECEPTOR ANTAGONISTS ATACAND 3

BENICAR 2

candesartan cilexetil (generic of ATACAND)

1

DIOVAN 2

EDARBI 3

eprosartan mesylate (generic of TEVETEN)

1

irbesartan (generic of AVAPRO)

1


12

Drug Name Drug Tier

Requirements/Limits

losartan potassium (generic of COZAAR)

1

MICARDIS 2

TEVETEN 400mg 3

ANTIARRHYTHMICS amiodarone hcl SOLN 1

amiodarone hcl TABS 100mg

2

amiodarone hcl (generic of CORDARONE) TABS 200mg

1

amiodarone hcl TABS 400mg

1

amiodarone inj 50mg/ml 1

disopyramide phosphate (generic of NORPACE)

1

flecainide acetate 1

mexiletine hcl 1

MULTAQ 3

NORPACE CR 2

propafenone hcl (generic of RYTHMOL SR) CP12

1

propafenone hcl (generic of RYTHMOL) TABS 150mg, 225mg

1

propafenone hcl TABS 300mg

1

quinidine gluconate er 1

quinidine sulfate 1

sotalol hcl (generic of BETAPACE) 80mg, 120mg, 160mg

1

sotalol hcl 240mg 1

sotalol hcl (afib/afl) (generic of BETAPACE AF)

1

TIKOSYN 2 NM PA

ANTILIPEMICS, HMG-CoA REDUCTASE INHIBITORS ALTOPREV 3

atorvastatin calcium (generic of LIPITOR)

1

CRESTOR 2

fluvastatin sodium (generic of LESCOL)

1

LESCOL XL 2

LIVALO 3

lovastatin 10mg 1

Drug Name Drug Tier

Requirements/Limits

lovastatin (generic of MEVACOR) 20mg, 40mg

1

pravastatin sodium 10mg 1

pravastatin sodium (generic of PRAVACHOL) 20mg, 40mg, 80mg

1

simvastatin (generic of ZOCOR) TABS

1

ANTILIPEMICS, MISCELLANEOUS ADVICOR 3

cholestyramine (generic of QUESTRAN)

1

cholestyramine light (generic of QUESTRAN LIGHT)

1

choline fenofibrate (generic of TRILIPIX)

1

colestipol hcl (generic of COLESTID)

1

fenofibrate (generic of TRICOR) 48mg, 145mg

1

fenofibrate (generic of LOFIBRA) 54mg, 160mg

1

FENOFIBRATE MICRONIZED 43mg, 130mg

1

fenofibrate micronized (generic of LOFIBRA) 67mg, 134mg, 200mg

1

FENOFIBRIC ACID 1

FENOGLIDE 3

gemfibrozil (generic of LOPID) TABS

1

LIPOFEN 2

LOVAZA 2

niacor 1

NIASPAN 2

SIMCOR 2

TRIGLIDE 3

TRILIPIX 2

VASCEPA 3

VYTORIN 2

WELCHOL 2

ZETIA 2

BETA-BLOCKER/DIURETIC COMBINATIONS atenolol & chlorthalidone (generic of TENORETIC 50)

1

atenolol & chlorthalidone (generic of TENORETIC 100)

1


13

Drug Name Drug Tier

Requirements/Limits

bisoprolol & hydrochlorothiazide (generic of ZIAC)

1

metoprolol & hctz tab 50-25mg (generic of LOPRESSOR HCT)

1

metoprolol & hctz tab 100-25mg (generic of LOPRESSOR HCT)

1

metoprolol & hctz tab 100-50mg

1

nadolol & bendroflumethiazide (generic of CORZIDE)

1

propranolol & hydrochlorothiazide

1

BETA-BLOCKERS acebutolol hcl (generic of SECTRAL) CAPS

1

atenolol (generic of TENORMIN) TABS

1

betaxolol hcl (generic of KERLONE)

1

bisoprolol fumarate (generic of ZEBETA)

1

BYSTOLIC 2

carvedilol (generic of COREG)

1

COREG CR 2

labetalol hcl SOLN 1

labetalol hcl (generic of TRANDATE) TABS

1

LEVATOL 3

metoprolol succinate (generic of TOPROL XL)

1

metoprolol tartrate (generic of LOPRESSOR) SOLN

1

metoprolol tartrate TABS 25mg

1

metoprolol tartrate (generic of LOPRESSOR) TABS 50mg, 100mg

1

nadolol (generic of CORGARD) TABS

1

pindolol 1

propranolol hcl er (generic of INDERAL LA)

1

propranolol inj 1mg/ml 1

propranolol sol 1

propranolol tab 1

Drug Name Drug Tier

Requirements/Limits

timolol maleate TABS 1

CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS AMLODIPINE BESYLATE/ATORV

1

CALCIUM CHANNEL BLOCKERS amlodipine besylate (generic of NORVASC) TABS

1

CARDIZEM LA 120mg 3

cartia xt (generic of CARDIZEM CD)

1

dilt-cd (generic of CARDIZEM CD)

1

dilt-xr 120mg, 180mg 1

dilt-xr (generic of DILACOR XR) 240mg

1

diltiazem cap 120mg/24hr 1

diltiazem cap er/12hr 1

diltiazem hcl SOLN 1

diltiazem hcl SOLR 3

diltiazem hcl (generic of CARDIZEM) TABS

1

diltiazem hcl coated beads (generic of CARDIZEM CD)

1

diltiazem hcl er (generic of TIAZAC)

1

diltiazem hcl extended release beads (generic of TIAZAC)

1

diltzac (generic of TIAZAC) 1

felodipine 1

isradipine 1

matzim la (generic of CARDIZEM LA)

1

nicardipine hcl CAPS 1

nifedipine (generic of ADALAT CC) TB24

1

nifedipine cc tab 90mg er (generic of ADALAT CC)

1

nifedipine cr (generic of ADALAT CC)

1

nifedipine er (generic of PROCARDIA XL)

1

nifedipine xl (generic of PROCARDIA XL)

1

nimodipine CAPS 1

nisoldipine (generic of SULAR) 8.5mg, 17mg, 34mg

1

nisoldipine 20mg, 25.5mg, 30mg, 40mg

1


14

Drug Name Drug Tier

Requirements/Limits

NYMALIZE 3 NM

taztia xt (generic of TIAZAC) 1

verapamil hcl (generic of VERELAN PM) CP24 100mg, 200mg, 300mg

1

verapamil hcl (generic of VERELAN) CP24 120mg, 180mg, 240mg

1

VERAPAMIL HCL CP24 360mg

1

verapamil hcl SOLN 1

verapamil hcl TABS 40mg 1

verapamil hcl (generic of CALAN) TABS 80mg, 120mg

1

verapamil hcl (generic of CALAN SR) TBCR

1

DIGITALIS GLYCOSIDES digoxin (generic of LANOXIN) TABS

1

digoxin inj (generic of LANOXIN)

1

DIGOXIN SOL 50MCG/ML 1

LANOXIN PEDIATRIC 3

LANOXIN TAB 2

DIRECT RENIN INHIBITORS/COMBINATIONS AMTURNIDE 2

TEKAMLO 2

TEKTURNA 2

TEKTURNA HCT 2

DIURETICS acetazolamide (generic of DIAMOX) CP12

1

acetazolamide TABS 1

acetazolamide sodium 1

ALDACTAZIDE 3

amiloride & hydrochlorothiazide

1

amiloride hcl 1

bumetanide 1

chlorothiazide 1

chlorthalidone 25mg, 50mg 1

DIURIL SUS 250/5ML 2

DYRENIUM 3

EDECRIN 3

furosemide SOLN 1

Drug Name Drug Tier

Requirements/Limits

furosemide (generic of LASIX) TABS

1

furosemide inj 1

furosemide oral soln 8 mg/ml 1

hydrochlorothiazide (generic of MICROZIDE) CAPS

1

hydrochlorothiazide TABS 1

indapamide TABS 1

methazolamide (generic of NEPTAZANE) TABS

1

methyclothiazide 1

metolazone (generic of ZAROXOLYN) 2.5mg, 5mg

1

metolazone 10mg 1

spironolactone & hydrochlorothiazide (generic of ALDACTAZIDE)

1

torsemide inj 1

torsemide tabs (generic of DEMADEX)

1

triamterene & hydrochlorothiazide cap 37.5-25 mg (generic of DYAZIDE)

1

triamterene & hydrochlorothiazide tab 37.5-25 mg (generic of MAXZIDE-25)

1

triamterene & hydrochlorothiazide tab 75-50 mg (generic of MAXZIDE)

1

MISCELLANEOUS BIDIL 2

clonidine & chlorthalidone 1

clonidine hcl (generic of CATAPRES-TTS-1) PTWK .1mg/24hr

1


1


1

clonidine hcl (generic of CATAPRES) TABS

1

DEMSER 3 NM

DIBENZYLINE 3

hydralazine hcl SOLN; TABS 1

midodrine hcl 1


15

Drug Name Drug Tier

Requirements/Limits

minoxidil TABS 1

RANEXA 2

NITRATES DILATRATE SR 3

ISORDIL TITRADOSE 40mg 2

isosorbide dinitrate SUBL 1

isosorbide dinitrate (generic of ISORDIL TITRADOSE) TABS 5mg

1

isosorbide dinitrate TABS 10mg, 20mg, 30mg

1

isosorbide dinitrate TBCR 1

isosorbide mononitrate TABS

1

isosorbide mononitrate (generic of IMDUR) TB24

1

minitran (generic of NITRO-DUR)

1

NITRO-DUR .3mg/hr, .8mg/hr

2

nitroglycerin OINT 2

NITROGLYCERIN SOLN .4mg/spray

1

NITROGLYCERIN LINGUAL 1

nitroglycerin patches 1

NITROLINGUAL SPR PUMPSPRA

2

NITROMIST 2

NITROSTAT 2

PULMONARY ARTERIAL HYPERTENSION ADCIRCA 2 NM PA

LETAIRIS 2 NM LA PA

REMODULIN 2 B/D NM LA

sildenafil citrate (pulmonary hypertension) (generic of REVATIO)

1 NM PA

TRACLEER 2 NM LA PA

VENTAVIS 2 B/D NM

CENTRAL NERVOUS SYSTEM ANTIANXIETY alprazolam CONC 1

alprazolam (generic of XANAX) TABS

1

buspirone hcl TABS 1

fluvoxamine maleate 1

fluvoxamine maleate er (generic of LUVOX CR)

1

Drug Name Drug Tier

Requirements/Limits

fluvoxamine tabs 1

lorazepam CONC 1

lorazepam (generic of ATIVAN) SOLN; TABS

1

ANTICONVULSANTS BANZEL SUSP 3 NM

BANZEL TABS 200mg 3

BANZEL TABS 400mg 3 NM

carbamazepine CHEW 1

carbamazepine (generic of CARBATROL) CP12

1

carbamazepine (generic of TEGRETOL) SUSP; TABS

1

carbamazepine (generic of TEGRETOL-XR) TB12

1

CELONTIN 3

clonazepam (generic of KLONOPIN) TABS

1

clonazepam TBDP 1

clorazepate dipotassium (generic of TRANXENE T)

1

diazepam CONC; SOLN 1

diazepam (generic of VALIUM) TABS

1

DIAZEPAM GEL 1

diazepam inj 1

dilantin CHEW 2

DILANTIN SUSP 2

divalproex sodium (generic of DEPAKOTE SPRINKLES) CPSP

1

divalproex sodium (generic of DEPAKOTE ER) TB24

1

divalproex sodium (generic of DEPAKOTE) TBEC

1

ethosuximide (generic of ZARONTIN) CAPS; SOLN

1

felbamate (generic of FELBATOL) SUSP

1 NM

felbamate (generic of FELBATOL) TABS 400mg

1

felbamate (generic of FELBATOL) TABS 600mg

1 NM

gabapentin (generic of NEURONTIN) CAPS; SOLN; TABS

1

GABITRIL 12mg, 16mg 2

LAMICTAL ODT 2


16

Drug Name Drug Tier

Requirements/Limits

LAMICTAL STARTER 2

LAMICTAL XR KIT 2

lamotrigine (generic of LAMICTAL CHEWABLE DISPERS) CHEW

1

lamotrigine (generic of LAMICTAL) TABS

1

lamotrigine (generic of LAMICTAL XR) TB24

1

levetiracetam (generic of KEPPRA) SOLN; TABS

1

levetiracetam (generic of KEPPRA XR) TB24

1

LYRICA 2

ONFI TABS 3

oxcarbazepine (generic of TRILEPTAL)

1

PEGANONE 3

phenobarbital ELIX; TABS 1

PHENOBARBITAL SODIUM 65mg/ml

1

phenobarbital sodium 130mg/ml

1

phenytoin (generic of DILANTIN INFATABS) CHEW

1

phenytoin (generic of DILANTIN) SUSP

1

phenytoin inj 50mg/ml 1

phenytoin sodium extended 30mg, 100mg

2

phenytoin sodium extended (generic of DILANTIN) 100mg

1

phenytoin sodium extended 200mg, 300mg

3

phenytoin sodium extended (generic of PHENYTEK) 200mg, 300mg

1

POTIGA 3

primidone (generic of MYSOLINE) TABS

1

SABRIL 2 NM LA PA

STAVZOR 3

TEGRETOL 2

TEGRETOL-XR 2

tiagabine hcl (generic of GABITRIL)

1

Drug Name Drug Tier

Requirements/Limits

topiramate (generic of TOPAMAX SPRINKLE) CPSP

1

topiramate (generic of TOPAMAX) TABS

1

TRILEPTAL SUSP 2

valproate sodium (generic of DEPACON) SOLN

1

valproate sodium (generic of DEPAKENE) SYRP

1

valproic acid (generic of DEPAKENE) CAPS

1

VIMPAT 2

zonisamide (generic of ZONEGRAN) 25mg, 100mg

1

zonisamide 50mg 1

ANTIDEMENTIA ARICEPT 23mg 2

donepezil odt 5mg (generic of ARICEPT ODT)

1

donepezil odt 10mg (generic of ARICEPT ODT)

1

donepezil tabs 5mg (generic of ARICEPT)

1

donepezil tabs 10mg (generic of ARICEPT)

1

EXELON SOLN 3

EXELON PATCHES 2

galantamine hydrobromide (generic of RAZADYNE ER) CP24

1

galantamine hydrobromide (generic of RAZADYNE) SOLN; TABS

1

NAMENDA 2

NAMENDA TITRATION PAK 2

NAMENDA XR 2

NAMENDA XR TITRATION PACK

2

rivastigmine tartrate (generic of EXELON)

1

ANTIDEPRESSANTS amitriptyline hcl TABS 1

amoxapine 2

APLENZIN 3

bupropion hcl (generic of WELLBUTRIN) TABS

1

bupropion hcl (generic of WELLBUTRIN SR) TB12

1


17

Drug Name Drug Tier

Requirements/Limits

bupropion hcl (generic of WELLBUTRIN XL) TB24

1

citalopram hydrobromide SOLN

1

citalopram hydrobromide (generic of CELEXA) TABS

1

clomipramine hcl (generic of ANAFRANIL) CAPS

1

CYMBALTA 2

desipramine hcl (generic of NORPRAMIN) TABS

1

doxepin hcl CAPS; CONC 1

EMSAM 3

escitalopram oxalate (generic of LEXAPRO)

1

fluoxetine hcl (generic of PROZAC) CAPS

1

fluoxetine hcl (generic of PROZAC WEEKLY) CPDR

1

fluoxetine hcl SOLN 1

fluoxetine hcl TABS 10mg, 20mg

1

FLUOXETINE HCL TABS 60mg

2

FORFIVO XL 3

imipramine hcl (generic of TOFRANIL) TABS

1

imipramine pamoate (generic of TOFRANIL-PM)

1

maprotiline hcl 1

MARPLAN 2

mirtazapine TABS 7.5mg 1

mirtazapine (generic of REMERON) TABS 15mg, 30mg, 45mg

1

mirtazapine (generic of REMERON SOLTAB) TBDP

1

nefazodone hcl 1

nortriptyline hcl (generic of PAMELOR) CAPS

1

nortriptyline hcl SOLN 1

OLEPTRO 3

paroxetine er tab (generic of PAXIL CR)

1

paroxetine hcl (generic of PAXIL)

1

PAXIL SUSP 3

PEXEVA 3

Drug Name Drug Tier

Requirements/Limits

phenelzine sulfate (generic of NARDIL) TABS

1

PRISTIQ 2

protriptyline hcl (generic of VIVACTIL)

1

sertraline hcl (generic of ZOLOFT) CONC; TABS

1

tranylcypromine sulfate (generic of PARNATE)

1

trazodone hcl TABS 1

trimipramine maleate 1

venlafaxine cap er (generic of EFFEXOR XR)

1

venlafaxine tab 1

venlafaxine tab er (generic of VENLAFAXINE HCL ER)

1

VIIBRYD 2

ANTIPARKINSONIAN AGENTS amantadine hcl CAPS; SYRP; TABS

1

APOKYN 2 NM LA PA

AZILECT 2

benztropine mesylate (generic of COGENTIN) SOLN

1

benztropine mesylate TABS 1

bromocriptine mesylate CAPS

1

bromocriptine mesylate (generic of PARLODEL) TABS

1

carbidopa-levodopa (generic of SINEMET) TABS

1

carbidopa-levodopa (generic of SINEMET CR) TBCR

1

carbidopa-levodopa (generic of PARCOPA) TBDP

1

CARBIDOPA/LEVODOPA/ENTACA

1


1


1


1


1


1


18

Drug Name Drug Tier

Requirements/Limits

entacapone (generic of COMTAN)

1

LODOSYN 3

MIRAPEX .75mg 3

MIRAPEX ER 3

NEUPRO 2

PARLODEL CAPS 2

pramipexole dihydrochloride .75mg

1

pramipexole dihydrochloride (generic of MIRAPEX) .125mg, .25mg, .5mg, 1mg, 1.5mg

1

ropinirole hydrochloride (generic of REQUIP) TABS

1

ropinirole hydrochloride (generic of REQUIP XL) TB24

1

selegiline hcl (generic of ELDEPRYL) CAPS

1

selegiline hcl TABS 1

ZELAPAR 3

ANTIPSYCHOTICS ABILIFY SOLN 2 NM

ABILIFY TABS 2mg, 5mg, 10mg, 15mg

2

ABILIFY TABS 20mg, 30mg 2 NM

ABILIFY DISCMELT 2 NM

ABILIFY INJ 2

ABILIFY MAINTENA 3 NM

chlorpromaz inj 25mg/ml 3

chlorpromazine hcl TABS 1

CLOZAPINE ODT 1

clozapine tab (generic of CLOZARIL) 25mg, 100mg

1

clozapine tab 50mg, 200mg 1

FANAPT 3

FANAPT TITRATION PACK 3

FAZACLO 3

fluphenazine decanoate SOLN

1

fluphenazine hcl 1

GEODON INJ 3

haloperidol TABS 1

haloperidol decanoate (generic of HALDOL DECANOATE 50) SOLN 50mg/ml

1

Drug Name Drug Tier

Requirements/Limits

haloperidol decanoate (generic of HALDOL DECANOATE 100) SOLN 100mg/ml

1

haloperidol lactate CONC 1

haloperidol lactate (generic of HALDOL) SOLN

1

INVEGA 3

INVEGA SUSTENNA 39mg/0.25ml, 78mg/0.5ml

3

INVEGA SUSTENNA 117mg/0.75ml, 156mg/ml, 234mg/1.5ml

3 NM

LATUDA 20mg, 40mg, 80mg, 120mg

2

loxapine succinate (generic of LOXITANE) CAPS 5mg

1

loxapine succinate CAPS 10mg, 25mg, 50mg

1

olanzapine (generic of ZYPREXA)

1

olanzapine odt (generic of ZYPREXA ZYDIS) 5mg, 10mg, 15mg

1

olanzapine odt (generic of ZYPREXA ZYDIS) 20mg

1 NM

ORAP 3

perphenazine TABS 1

quetiapine fumarate (generic of SEROQUEL)

1

RISPERDAL CONSTA 12.5mg, 25mg

2

RISPERDAL CONSTA 37.5mg, 50mg

2 NM

risperidone (generic of RISPERDAL)

1

risperidone odt (generic of RISPERDAL M-TAB) .5mg, 1mg, 2mg, 3mg, 4mg

1

risperidone odt .25mg 1

SAPHRIS 3

SEROQUEL XR 2

thioridazine hcl TABS 1

thiothixene 1

trifluoperazine hcl 1

ziprasidone hcl (generic of GEODON)

1

ATTENTION DEFICIT HYPERACTIVITY DISORDER


19

Drug Name Drug Tier

Requirements/Limits

amphetamine-dextroamphetamine cap sr 24hr 5 mg (generic of ADDERALL XR)

1


1


1


1


1


1

amphetamine-dextroamphetamine tab 5 mg (generic of ADDERALL)

1

amphetamine-dextroamphetamine tab 7.5 mg

1


1

amphetamine-dextroamphetamine tab 12.5 mg (generic of ADDERALL)

1

amphetamine-dextroamphetamine tab 15 mg

1


1


1

DAYTRANA 2

INTUNIV 2

metadate tab 20mg er 1

METHYLIN CHEW TAB 2

methylphenidate hcl (generic of RITALIN LA) CP24

1

methylphenidate hcl (generic of METADATE CD) CPCR

1

methylphenidate hcl (generic of METHYLIN) SOLN

1

methylphenidate hcl (generic of RITALIN) TABS

1

methylphenidate hcl TBCR 1

Drug Name Drug Tier

Requirements/Limits

METHYLPHENIDATE HCL ER 18mg

1

methylphenidate hcl er (generic of CONCERTA) 27mg, 36mg, 54mg

1

QUILLIVANT XR 2

RITALIN LA 10mg 2

STRATTERA 2

VYVANSE 2

HYPNOTICS EDLUAR 3

INTERMEZZO 3

LUNESTA 2

ROZEREM 3

SILENOR 2

zaleplon (generic of SONATA) 1

zolpidem tartrate (generic of AMBIEN) TABS

1

zolpidem tartrate (generic of AMBIEN CR) TBCR

1

ZOLPIMIST 3

MIGRAINE ALSUMA 3

AXERT 3

cafergot tab 1-100mg 2

dihydroergotamine mesylate (generic of D.H.E. 45) 1mg/ml

1

DIHYDROERGOTAMINE MESYLATE 4mg/ml

1

ergomar 3

ergotamine w/ caffeine 2

FROVA TAB 2.5MG 3

naratriptan hcl (generic of AMERGE)

1

RELPAX 2

rizatriptan benzoate (generic of MAXALT) TABS

1

rizatriptan benzoate (generic of MAXALT-MLT) TBDP

1

SUMATRIPTAN SUCCINATE SOLN

1

sumatriptan succinate (generic of IMITREX) TABS

1

SUMATRIPTAN SUCCINATE INJ 4mg/0.5ml

1


20

Drug Name Drug Tier

Requirements/Limits

sumatriptan succinate inj (generic of IMITREX) 6mg/0.5ml

1

SUMAVEL DOSEPRO 2

TREXIMET 2

zolmitriptan (generic of ZOMIG)

1

zolmitriptan odt (generic of ZOMIG ZMT)

1

ZOMIG 2

ZOMIG ZMT 2

MISCELLANEOUS EQUETRO 3

GRALISE 2

GRALISE STARTER 2

HORIZANT 3

lithium carbonate CAPS 1

lithium carbonate TABS 1

lithium carbonate (generic of LITHOBID) TBCR 300mg

1

lithium carbonate TBCR 450mg

1

LITHIUM CITRATE 2

MESTINON SYRUP 2

MESTINON TIMESPAN 2

NUEDEXTA 2

pyridostigmine bromide (generic of MESTINON) TABS

1

REGONOL 2

RILUTEK 3 NM

riluzole (generic of RILUTEK) 1

SAVELLA 2

SAVELLA TITRATION PACK 2

XENAZINE 2 NM LA PA

MULTIPLE SCLEROSIS AGENTS AMPYRA 3 NM LA PA

AUBAGIO 3 NM PA

AVONEX 2 NM PA

AVONEX PEN 2 NM PA

BETASERON 2 NM

COPAXONE 2 NM PA

EXTAVIA 2 NM PA

GILENYA 3 NM PA

REBIF 3 NM PA

REBIF TITRATION PACK 3 NM PA

TECFIDERA 3 NM PA

Drug Name Drug Tier

Requirements/Limits

TECFIDERA STARTER PACK

3 NM PA

TYSABRI 3 NM LA PA

MUSCULOSKELETAL THERAPY AGENTS AMRIX 3

baclofen TABS 1

chlorzoxazone (generic of PARAFON FORTE DSC) TABS

1

cyclobenzaprine hcl (generic of FLEXERIL) TABS 5mg, 10mg

1

cyclobenzaprine hcl (generic of FEXMID) TABS 7.5mg

1

dantrolene sodium (generic of DANTRIUM) CAPS

1

methocarbamol (generic of ROBAXIN) TABS 500mg

1

methocarbamol (generic of ROBAXIN-750) TABS 750mg

1

tizanidine (generic of ZANAFLEX) CAPS

1

tizanidine TABS 2mg 1

tizanidine (generic of ZANAFLEX) TABS 4mg

1

NARCOLEPSY/CATAPLEXY modafinil (generic of PROVIGIL) 100mg

1

modafinil (generic of PROVIGIL) 200mg

1 NM

NUVIGIL 2

XYREM 2 NM LA PA

PSYCHOTHERAPEUTIC-MISC buprenorphine hcl SUBL 1

buprenorphine hcl-naloxone hcl sl (generic of SUBOXONE)

1

bupropion hcl (smoking deterrent) (generic of ZYBAN)

1

CAMPRAL 2

CHANTIX QL (336 tabs / 365 days)

2 QL

CHANTIX STARTER PACK QL (106 tabs / 365 days)

2 QL

disulfiram (generic of ANTABUSE) TABS

1


21

Drug Name Drug Tier

Requirements/Limits

naloxone hcl SOLN 1

naltrexone hcl (generic of REVIA) TABS

1

NICOTROL INHALER 3

NICOTROL NS 3

SARAFEM 3

SUBOXONE MIS 2-0.5MG 3

SUBOXONE MIS 4-1MG 3



VIVITROL 3 NM

ENDOCRINE AND METABOLIC ANDROGENS ANDRODERM 2

ANDROGEL 1% 3

ANDROGEL 1.62% 3

AXIRON 2

fluoxymesterone TABS 3

FORTESTA 2

oxandrolone (generic of OXANDRIN) TABS

1

STRIANT 3

TESTIM 2

testosterone cypionate OIL 1

testosterone enanthate (generic of DELATESTRYL) OIL

1

ANTIDIABETICS, INJECTABLE ALCOHOL PREPS PADS 2

APIDRA 2

APIDRA SOLOSTAR 2

BYDUREON 2

BYETTA 3

HUMALOG 3

HUMALOG KWIKPEN 3

HUMALOG MIX 50/50 3

HUMALOG MIX 50/50 KWIKPEN

3

HUMALOG MIX 75/25 3

HUMALOG MIX 75/25 KWIKPEN

3

HUMULIN 70/30 3

HUMULIN 70/30 PEN 3

HUMULIN N 3

HUMULIN N U-100 PEN 3

HUMULIN R 3

Drug Name Drug Tier

Requirements/Limits

HUMULIN R U-500 (CONCENTRATE)

2 B/D NM

LANTUS 2

LANTUS SOLOSTAR 2

LEVEMIR 2

LEVEMIR FLEXPEN 2

NOVOLIN 70/30 2

NOVOLIN 70/30 RELION 3

NOVOLIN N 2

NOVOLIN N RELION 3

NOVOLIN R 2

NOVOLIN R RELION 3

NOVOLOG 2

NOVOLOG FLEXPEN 2

NOVOLOG MIX 70/30 2

NOVOLOG MIX 70/30 PREFILL

2

SYMLINPEN 60 2

SYMLINPEN 120 2

VICTOZA 2

ANTIDIABETICS, ORAL acarbose (generic of PRECOSE)

1

ACTOPLUS MET XR 15-1000MG

3

ACTOPLUS MET XR 30-1000MG

3

glimepiride (generic of AMARYL)

1

glipizide (generic of GLUCOTROL) TABS

1

glipizide er (generic of GLUCOTROL XL)

1

glipizide-metformin 2.5-250mg (generic of METAGLIP)

1

glipizide-metformin 2.5-500mg 1

glipizide-metformin 5-500mg 1

GLUMETZA 3

glyburide 1

glyburide micronized (generic of GLYNASE)

1

glyburide-metformin 1.25-250mg (generic of GLUCOVANCE)

1

glyburide-metformin 2.5-500mg (generic of GLUCOVANCE)

1


22

Drug Name Drug Tier

Requirements/Limits

glyburide-metformin 5-500mg (generic of GLUCOVANCE)

1

GLYSET 3

INVOKANA 3

JANUMET 2

JANUMET XR TAB 50-500MG

2

JANUMET XR TAB 50-1000 2

JANUMET XR TAB 100-1000 2

JANUVIA 2

JENTADUETO 2

JUVISYNC 2

KAZANO 3

KOMBIGLYZE XR 2.5-1000MG

3

KOMBIGLYZE XR 5-500MG 3

KOMBIGLYZE XR 5-1000MG 3

metformin er (generic of GLUCOPHAGE XR)

1

metformin hcl (generic of GLUCOPHAGE) TABS

1

metformin hcl (generic of FORTAMET) TB24

1

nateglinide (generic of STARLIX)

1

NESINA 3

ONGLYZA 3

OSENI TAB 12.5-15MG 3



OSENI TAB 25-15MG 3

OSENI TAB 25-30MG 3

OSENI TAB 25-45MG 3

pioglitazone hcl (generic of ACTOS)

1

pioglitazone hcl-glimepiride (generic of DUETACT)

1

pioglitazone hcl-metformin hcl (generic of ACTOPLUS MET)

1

PRANDIMET 3

PRANDIN 2

RIOMET 3

TRADJENTA 2

BISPHOSPHONATES ACTONEL 2

alendronate sodium SOLN 1

Drug Name Drug Tier

Requirements/Limits

alendronate sodium TABS 5mg, 10mg, 35mg, 40mg

1

alendronate sodium (generic of FOSAMAX) TABS 70mg

1

ATELVIA 2

BINOSTO 3

BONIVA SOLN 3 B/D

FOSAMAX PLUS D 3

ibandronate sodium (generic of BONIVA)

1 B/D

pamidronate disodium SOLN 1 B/D

zoledronic inj 4mg/5ml (generic of ZOMETA)

1 B/D NM

ZOMETA 3 B/D NM

CALCIUM RECEPTOR ANTAGONISTS SENSIPAR 2 NM

CHELATING AGENTS CHEMET 3

EXJADE 3 NM LA PA

FERRIPROX 3 NM PA

kionex (generic of KAYEXALATE) POWD

1

kionex SUSP 1

sodium polystyrene sulfonate 1

sps sus 15gm/60ml 1

SYPRINE 3 NM

CONTRACEPTIVES altavera 1

BEYAZ 2

CAMRESE LO TAB 1

DEPO-SUBQ PROVERA 104 2

desogestrel & ethinyl estradiol (generic of DESOGEN)

1

desogestrel-ethinyl estradiol (biphasic) (generic of MIRCETTE)

1

desogestrel-ethinyl estradiol (triphasic) (generic of CYCLESSA)

1

drospirenone-ethinyl estradiol (generic of YASMIN 28)

1

drospirenone-ethinyl estradiol (generic of YAZ)

1

ELLA 2

ethynodiol diacet & eth estrad 1

GENERESS FE 3

GIANVI 1


23

Drug Name Drug Tier

Requirements/Limits

heather tab 0.35mg (generic of NOR-QD)

1

JOLIVETTE 1

LEENA 1

levonorgestrel & eth estradiol 1

levonorgestrel-eth estradiol (triphasic)

1

levonorgestrel-ethinyl estradiol (91-day)

1

levonorgestrel-ethinyl estradiol (91-day) (generic of SEASONIQUE)

1

levonorgestrel-ethinyl estradiol (continuous)

1

LO LOESTRIN FE 2

LOESTRIN 24 FE 2

medroxyprogesterone acetate (contraceptive) (generic of DEPO-PROVERA CONTRACEPTIV)

1

MINASTRIN 24 FE 3

MONONESSA 1

myzilra 1

NECON 1/50-28 1

NECON 7/7/7 1

necon 10/11 28 day 2

next choice tab 1.5mg (generic of PLAN B ONE-STEP)

1

NORA-BE 1

norethin acet & estrad-fe (generic of LOESTRIN FE 1.5/30)

1

norethin acet & estrad-fe (generic of LOESTRIN FE 1/20)

1

norethindrone & eth estradiol (generic of BREVICON-28)

1

norethindrone & eth estradiol (generic of NORINYL 1+35)

1

norethindrone & eth estradiol (generic of OVCON-35)

1

norethindrone & ethinyl estradiol-fe (generic of FEMCON FE)

1

norethindrone (contraceptive) (generic of NOR-QD) .35mg

1

Drug Name Drug Tier

Requirements/Limits

norethindrone (contraceptive) (generic of ORTHO MICRONOR) .35mg

1

norethindrone acet & eth estra (generic of LOESTRIN 1.5/30-21)

1

norethindrone acet & eth estra (generic of LOESTRIN 1/20-21)

1

norethindrone acetate-ethinyl estradiol-fe (generic of ESTROSTEP FE)

1

norethindrone-eth estradiol (triphasic) (generic of ORTHO-NOVUM 7/7/7)

1

norethindrone-eth estradiol (triphasic) (generic of TRI-NORINYL 28)

1

norgestimate-ethinyl estradiol (generic of ORTHO-CYCLEN)

1

norgestimate-ethinyl estradiol (triphasic) (generic of ORTHO TRI-CYCLEN)

1

norgestrel & ethinyl estradiol 1

NORINYL 1+50 2

NUVARING 2

OCELLA 1

ORTHO EVRA 2

ORTHO TRI-CYCLEN LO 2

philith (generic of OVCON-35) 1

QUARTETTE 3

SOLIA 1

syeda (generic of YASMIN 28)

1

TRINESSA 1

vestura (generic of YAZ) 1

viorele (generic of MIRCETTE)

1

zarah (generic of YASMIN 28) 1

zenchent tab (generic of OVCON-35)

1

zovia 1

ENDOMETRIOSIS danazol CAPS 1

SYNAREL 2 NM

ENZYME REPLACEMENTS ADAGEN 3 NM LA PA

ALDURAZYME 3 NM LA PA


24

Drug Name Drug Tier

Requirements/Limits

BUPHENYL TAB 500MG 3 NM

CARBAGLU 3 NM LA PA

CEREZYME 3 NM PA

CYSTADANE 3 NM

CYSTAGON 3 NM PA

ELAPRASE 3 NM PA

ELELYSO 3 NM PA

FABRAZYME 3 NM PA

KUVAN 2 NM PA

levocarnitine (metabolic modifiers) (generic of CARNITOR)

1 B/D

LUMIZYME 3 NM

MYOZYME 3 NM PA

NAGLAZYME 3 NM LA PA

ORFADIN 3 NM LA PA

PROCYSBI 3 NM LA PA

sodium phenylbutyrate (generic of BUPHENYL)

1 NM

VPRIV 3 NM PA

ZAVESCA 3 NM LA PA

ESTROGEN/PROGESTINS estradiol & norethindrone acetate (generic of ACTIVELLA)

1

norethindrone acetate-ethinyl estradiol

1

ESTROGENS ALORA 3

COMBIPATCH 2

DELESTROGEN 10mg/ml 3

estradiol (generic of CLIMARA) PTWK

1

estradiol (generic of ESTRACE) TABS

1

estradiol cypionate OIL 3

estradiol vaginal 3

ESTRADIOL VALERATE OIL 10mg/ml

1

estradiol valerate (generic of DELESTROGEN) OIL 20mg/ml, 40mg/ml

1

ESTRING 3

estropipate TABS 1

FEMRING 3

menest 2

MENOSTAR 3

MINIVELLE 3

Drug Name Drug Tier

Requirements/Limits

PREMARIN 2

PREMARIN CREAM 2

PREMARIN INJ 3

PREMPHASE 2

PREMPRO 2

VAGIFEM 2

VIVELLE-DOT 2

GLUCOCORTICOIDS a-hydrocort inj 100mg 1

CELESTONE 3

cortisone acetate TABS 1

DEPO-MEDROL 20mg/ml 3

dexamethasone CONC; ELIX; SOLN; TABS

1

dexamethasone sodium phosphate

1

dexpak taperpak 13 day 2

FLO-PRED 3

fludrocortisone acetate TABS

1

hydrocortisone (generic of CORTEF) TABS

1

MEDROL 2mg 2

methylprednisolone (generic of MEDROL DOSEPAK) TABS 4mg

1

methylprednisolone (generic of MEDROL) TABS 4mg, 8mg, 16mg, 32mg

1

methylprednisolone acetate (generic of DEPO-MEDROL)

1

methylprednisolone sod succ (generic of SOLU-MEDROL)

1

ORAPRED ODT 2

prednisolone (generic of PRELONE) SOLN

1

prednisolone TABS 3

prednisolone sodium phosphate (generic of PEDIAPRED) 5mg/5ml

1

prednisolone sodium phosphate 10mg/5ml

3

prednisolone sodium phosphate (generic of ORAPRED) 15mg/5ml

1

prednisolone sodium phosphate 25mg/5ml

1

prednisone CONC 2


25

Drug Name Drug Tier

Requirements/Limits

prednisone SOLN; TABS 1

RAYOS 3

SOLU-CORTEF 100MG 3

SOLU-CORTEF 250MG 2

SOLU-CORTEF 500MG 3

SOLU-CORTEF 1000MG 3

SOLU-MEDROL 2gm 3

veripred 3

GLUCOSE ELEVATING AGENTS GLUCAGEN HYPOKIT 2

GLUCAGON EMERGENCY KIT

2

PROGLYCEM 3 NM

HUMAN GROWTH HORMONES GENOTROPIN 3 NM PA

GENOTROPIN MINIQUICK 3 NM PA

HUMATROPE 2 NM PA

HUMATROPE COMBO PACK 2 NM PA

NORDITROPIN FLEXPRO 2 NM PA

NORDITROPIN NORDIFLEX PEN

2 NM PA

NUTROPIN 3 NM PA

NUTROPIN AQ 3 NM PA

NUTROPIN AQ NUSPIN 5 3 NM PA

NUTROPIN AQ PEN 3 NM PA

OMNITROPE 5.8MG 3 NM PA

OMNITROPE 5MG 3 NM PA

OMNITROPE 10MG 3 NM PA

SAIZEN 3 NM PA

SAIZEN CLICK.EASY 3 NM PA

SEROSTIM 3 NM PA

TEV-TROPIN 3 NM

ZORBTIVE 3 NM PA

MISCELLANEOUS cabergoline 1

calcitonin (salmon) nasal spray (generic of MIACALCIN)

1

CHORIONIC GONADOTROPIN SOLR

1 NM PA

EGRIFTA 3 NM PA

FORTICAL SPR 200/ACT 2

INCRELEX 3 NM LA PA

methylergonovine maleate (generic of METHERGINE) TABS

1

MIACALCIN INJ 200U/ML 2 B/D

NOVAREL INJ 10000UNT 1 NM

Drug Name Drug Tier

Requirements/Limits

octreotide acetate (generic of SANDOSTATIN)

1 NM

PREGNYL W/DILUENT BENZYL

1 NM

PROLIA 3 NM

SAMSCA 3 NM PA

SANDOSTATIN LAR DEPOT 3 NM PA

SOMATULINE DEPOT 3 NM PA

SOMAVERT 3 NM LA PA

XGEVA 3 NM PA

PARATHYROID HORMONES FORTEO 2 NM PA

PHOSPHATE BINDER AGENTS calcium acetate (phosphate binder) (generic of PHOSLO) CAPS

1

calcium acetate (phosphate binder) (generic of ELIPHOS) TABS

1

FOSRENOL 2

PHOSLYRA 2

RENAGEL 3

RENVELA 2

PROGESTINS CRINONE 2

ENDOMETRIN 2

medroxyprogesterone acetate (generic of PROVERA)

1

norethindrone acetate (generic of AYGESTIN) TABS

1

progesterone micronized (generic of PROMETRIUM) CAPS

1

SELECTIVE ESTROGEN RECEPTOR MODULATORS EVISTA 2

THYROID AGENTS LEVOTHROID 1

levothyroxine sodium (generic of SYNTHROID) TABS

1

LEVOXYL 1

liothyronine sodium (generic of TRIOSTAT) SOLN

1

liothyronine sodium (generic of CYTOMEL) TABS

1

methimazole (generic of TAPAZOLE) TABS

1


26

Drug Name Drug Tier

Requirements/Limits

propylthiouracil TABS 1

SYNTHROID 2

TIROSINT 3

UNITHROID 1

VASOPRESSINS DESMOPRESSIN ACETATE SOLN

1

desmopressin acetate (generic of DDAVP) TABS

1

desmopressin acetate inj (generic of DDAVP)

1

desmopressin acetate spray (generic of DDAVP)

1

desmopressin acetate spray refrigerated

1

STIMATE 3 NM

GASTROINTESTINAL ANTIEMETICS ALOXI 3 NM

ANTIVERT 50mg 3

CESAMET 3 B/D NM

compro supp 1

dronabinol (generic of MARINOL) 2.5mg, 5mg

1 B/D

dronabinol (generic of MARINOL) 10mg

1 B/D NM

EMEND CAPS 40mg 2

EMEND CAPS 80mg, 125mg

2 B/D

EMEND PAK 80 & 125 2 B/D

granisetron hcl SOLN 2mg/10ml

2 B/D NM

granisetron hcl SOLN .1mg/ml, 1mg/ml

1

granisetron hcl TABS 1 B/D

meclizine hcl (generic of ANTIVERT)

1

metoclopramide hcl SOLN 1

metoclopramide hcl (generic of REGLAN) TABS

1

metoclopramide hcl inj 5 mg/ml

1

METOZOLV ODT 3

ondansetron hcl (generic of ZOFRAN) TABS 4mg, 8mg

1 B/D

ondansetron hcl TABS 24mg 1 B/D

ondansetron hcl inj 4mg/2ml 1

ondansetron hcl inj (generic of ZOFRAN) 40mg/20ml

1

Drug Name Drug Tier

Requirements/Limits

ondansetron hcl oral soln (generic of ZOFRAN)

1 B/D

ondansetron odt (generic of ZOFRAN ODT)

1 B/D

prochlorperazine inj 5 mg/ml 1

prochlorperazine maleate TABS

1

prochlorperazine supp 1

promethazine hcl (generic of PHENERGAN) SOLN

1

promethazine hcl SUPP; SYRP; TABS

1

SANCUSO 2 NM

TRANSDERM-SCOP 2

ANTISPASMODICS ATROPINE SULFATE SOLN .05mg/ml, .1mg/ml

1

BENTYL SOLN 3

CANTIL 3

CUVPOSA 3

dicyclomine hcl (generic of BENTYL) CAPS; TABS

1

dicyclomine hcl SOLN 1

glycopyrrolate (generic of ROBINUL) SOLN

1

glycopyrrolate (generic of ROBINUL) TABS 1mg

1

glycopyrrolate (generic of ROBINUL FORTE) TABS 2mg

1

methscopolamine bromide (generic of PAMINE) TABS 2.5mg

1

methscopolamine bromide (generic of PAMINE FORTE) TABS 5mg

1

H2-RECEPTOR ANTAGONISTS cimetidine TABS 1

cimetidine inj 150mg/ml 1

cimetidine sol 300/5ml 1

famotidine SOLN 1

famotidine (generic of PEPCID) SUSR

1

famotidine (generic of PEPCID) TABS 20mg, 40mg

1

nizatidine CAPS 150mg 1

nizatidine (generic of AXID) CAPS 300mg

1


27

Drug Name Drug Tier

Requirements/Limits

nizatidine (generic of AXID) SOLN

1

ranitidine hcl CAPS 1

ranitidine hcl (generic of ZANTAC) SOLN

1

ranitidine hcl (generic of ZANTAC) SYRP

1

ranitidine hcl (generic of ZANTAC) TABS 150mg, 300mg

1

INFLAMMATORY BOWEL DISEASE APRISO 2

ASACOL 2

ASACOL HD 2

balsalazide disodium (generic of COLAZAL)

1

budesonide (generic of ENTOCORT EC) CP24

1 NM

CANASA 2

DELZICOL 3

DIPENTUM 2 NM

GIAZO 3

hydrocortisone (intrarectal) (generic of CORTENEMA) 100mg/60ml

1

HYDROCORTISONE (INTRARECTAL) 100mg/60ml

1

LIALDA 2

mesalamine enema 1

mesalamine enema kit (generic of ROWASA)

1

PENTASA 2

SFROWASA 2

sulfasalazine dr (generic of AZULFIDINE EN-TABS)

1

sulfasalazine ir (generic of AZULFIDINE)

1

UCERIS 3

LAXATIVES COLYTE-FLAVOR PACKS 3

GOLYTELY 2

HALFLYTELY BOWEL PREP/FLA

3

kristalose pak 2

lactulose 1

lactulose (encephalopathy) 1

MOVIPREP 2

Drug Name Drug Tier

Requirements/Limits

NULYTELY/FLAVOR PACKS 2

OSMOPREP 3

peg 3350-kcl-sod bicarb-sod chloride-sod sulfate (generic of COLYTE-FLAVOR PACKS)

1

peg 3350-kcl-sod bicarb-sod chloride-sod sulfate (generic of GOLYTELY)

1

peg 3350-potassium chloride-sod bicarbonate-sod chloride (generic of NULYTELY/FLAVOR PACKS)

1

polyethylene glycol 3350 PACK; POWD

1

PREPOPIK 3

RELISTOR 2

SUCLEAR 3

SUPREP BOWEL PREP 2

VISICOL 3

MISCELLANEOUS AMITIZA 2

CARAFATE SUSP 2

cromolyn sodium (mastocytosis) (generic of GASTROCROM)

1 NM

diphenoxylate w/ atropine LIQD

1

diphenoxylate w/ atropine (generic of LOMOTIL) TABS

1

GATTEX 3 NM LA PA

HELIDAC 3 NM

LINZESS CAP 145MCG 2

LINZESS CAP 290MCG 2

loperamide hcl CAPS 1

LOTRONEX 2 NM

misoprostol (generic of CYTOTEC)

1

OMECLAMOX-PAK 3

PREVPAC 2

PYLERA 2

SUCRAID 3 NM

sucralfate (generic of CARAFATE) TABS

1

ursodiol (generic of ACTIGALL) CAPS

1

ursodiol (generic of URSO 250) TABS 250mg

1


28

Drug Name Drug Tier

Requirements/Limits

ursodiol (generic of URSO FORTE) TABS 500mg

1

XIFAXAN TAB 550MG 2 NM

PANCREATIC ENZYMES CREON 2

PANCREAZE 3

PERTZYE 3

ULTRESA 2

VIOKACE 10440 UNIT 2

VIOKACE 20880 UNIT 2 NM

ZENPEP 2

PROTON PUMP INHIBITORS ACIPHEX 3

DEXILANT 3

lansoprazole (generic of PREVACID) CPDR

1

NEXIUM 3

NEXIUM GRANULES 2.5MG DR

3

NEXIUM GRANULES 5MG DR

3


3


3


3

NEXIUM I.V. 3

omeprazole (generic of PRILOSEC) CPDR

1

pantoprazole sodium (generic of PROTONIX)

1

PREVACID SOLUTAB 3

PROTONIX PACK 3

ZEGERID PACK 3

GENITOURINARY BENIGN PROSTATIC HYPERPLASIA alfuzosin hcl (generic of UROXATRAL)

1

AVODART 2

CARDURA XL 3

finasteride (generic of PROSCAR) TABS 5mg

1

JALYN 2

RAPAFLO 2

tamsulosin hcl (generic of FLOMAX)

1

MISCELLANEOUS

Drug Name Drug Tier

Requirements/Limits

bethanechol chloride (generic of URECHOLINE) TABS

1

ELMIRON 2

POTASSIUM CITRATE (ALKALINIZER) 540mg

1

POTASSIUM CITRATE (ALKALINIZER) 1080mg

1

UROCIT-K 2

URINARY ANTISPASMODICS DETROL LA 2

ENABLEX 3

GELNIQUE 2

MYRBETRIQ 3

oxybutynin chloride SYRP; TABS

1

oxybutynin chloride (generic of DITROPAN XL) TB24

1

OXYTROL 3

tolterodine tartrate (generic of DETROL)

1

TOVIAZ 2

trospium chloride (generic of SANCTURA XR) CP24

1

trospium chloride (generic of SANCTURA) TABS

1

VESICARE 2

VAGINAL ANTI-INFECTIVES CLEOCIN VAG SUPP 100MG 2

clindamycin cre 2% vag (generic of CLEOCIN)

1

metronidazole vaginal (generic of METROGEL-VAGINAL)

1

miconazole nitrate vaginal 1

terconazole vaginal (generic of TERAZOL 7) CREA .4%

1

terconazole vaginal (generic of TERAZOL 3) CREA .8%

1

terconazole vaginal (generic of TERAZOL 3) SUPP

1

VANDAZOLE 1

ZAZOLE 1

HEMATOLOGIC ANTICOAGULANTS COUMADIN 3

COUMADIN INJ 3

ELIQUIS 2


29

Drug Name Drug Tier

Requirements/Limits

enoxaparin sodium (generic of LOVENOX) 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml, 80mg/0.8ml, 300mg/3ml

1

enoxaparin sodium (generic of LOVENOX) 100mg/ml, 120mg/0.8ml, 150mg/ml

1 NM

fondaparinux sodium (generic of ARIXTRA) 2.5mg/0.5ml

1

fondaparinux sodium (generic of ARIXTRA) 5mg/0.4ml, 7.5mg/0.6ml, 10mg/0.8ml

1 NM

FRAGMIN 2500unit/0.2ml, 5000unit/0.2ml

2

FRAGMIN 7500unit/0.3ml, 10000unit/ml, 12500unit/0.5ml, 15000unit/0.6ml, 18000unt/0.72ml, 25000unit/ml

2 NM

HEP SOD/NACL INJ 25000 2

HEPARIN (PORCINE) IN SODIUM CHLORIDE 100U/ML

2

heparin sod inj 1000u/ml 1 B/D

HEPARIN SOD INJ 2000U/ML

2 B/D

HEPARIN SOD INJ 2500U/ML

2 B/D

heparin sod inj 5000u/0.5ml 1 B/D




HEPARIN SODIUM/D5W 1

HEPARIN SODIUM/SODIUM CHL

1

PRADAXA 2

warfarin sodium (generic of COUMADIN)

1

XARELTO 2

HEMATOPOIETIC GROWTH FACTORS ARANESP ALBUMIN FREE 25mcg/0.42ml, 25mcg/ml, 40mcg/0.4ml, 40mcg/ml, 60mcg/0.3ml, 60mcg/ml, 100mcg/0.5ml, 100mcg/ml, 150mcg/0.3ml, 200mcg/0.4ml, 200mcg/ml, 300mcg/0.6ml, 300mcg/ml, 500mcg/ml

2 NM PA

Drug Name Drug Tier

Requirements/Limits

ARANESP ALBUMIN FREE 150mcg/0.75ml

3 NM PA

EPOGEN 2 NM PA

LEUKINE 3 NM PA

MOZOBIL 2 NM PA

NEULASTA 2 NM PA

NEUMEGA 3 NM PA

NEUPOGEN 2 NM PA

PROCRIT 2 NM PA

MISCELLANEOUS anagrelide hcl 1mg 1

anagrelide hcl (generic of AGRYLIN) .5mg

1

cilostazol (generic of PLETAL) 1

pentoxifylline TBCR 1

PROMACTA 2 NM LA PA

tranexamic acid (generic of CYKLOKAPRON) SOLN

1

tranexamic acid (generic of LYSTEDA) TABS

1

PLATELET AGGREGATION INHIBITORS AGGRENOX 2

BRILINTA 2

clopidogrel bisulfate (generic of PLAVIX)

1

dipyridamole (generic of PERSANTINE) TABS

1

EFFIENT 2

IMMUNOLOGIC AGENTS DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (DMARDS) ACTEMRA 3 NM PA

CIMZIA 3 NM PA

ENBREL 2 NM PA

HUMIRA 2 NM PA

HUMIRA PEN 2 NM PA

HUMIRA PEN-CROHNS STARTER KIT

2 NM PA

HUMIRA PEN-PSORIASIS STARTER KIT

2 NM PA

hydroxychloroquine sulfate (generic of PLAQUENIL)

1

KINERET 3 NM PA

leflunomide (generic of ARAVA) TABS

1

methotrexate sodium 2 B/D

methotrexate sodium tabs 1

ORENCIA 3 NM PA


30

Drug Name Drug Tier

Requirements/Limits

REMICADE 3 NM PA

RHEUMATREX 2

SIMPONI 50mg/0.5ml 3 NM PA

XELJANZ 3 NM PA

IMMUNOGLOBULINS CARIMUNE NANOFILTERED 3 NM PA

FLEBOGAMMA 3 NM PA

FLEBOGAMMA DIF 3 NM PA

GAMASTAN S/D 2 B/D NM

GAMMAGARD LIQUID 3 NM PA

GAMMAGARD S/D 3 NM PA

GAMMAKED 3 NM PA

GAMMAPLEX 3 NM PA

GAMUNEX 3 NM PA

GAMUNEX-C 1GM/10ML 3 NM PA

GAMUNEX-C 2.5GM/25ML 3 NM PA




OCTAGAM 3 NM PA

PRIVIGEN 3 NM PA

IMMUNOMODULATORS ACTIMMUNE 3 NM LA PA

ARCALYST 3 NM PA

INFERGEN 2 NM PA

INTRON-A 2 B/D NM

INTRON-A W/DILUENT 2 B/D NM

PEG-INTRON 2 NM PA

PEG-INTRON REDIPEN 2 NM PA

PEGASYS 2 NM PA

PEGASYS PROCLICK 2 NM PA

REVLIMID 2 NM LA PA

THALOMID 2 NM PA

IMMUNOSUPPRESSANTS ATGAM 3 B/D

azathioprine (generic of IMURAN) TABS 50mg

1 B/D

azathioprine TABS 75mg, 100mg

2 B/D

azathioprine inj 100mg 1 B/D

CELLCEPT SUSR 2 B/D NM

CELLCEPT INTRAVENOUS 3 B/D

cyclosporine (generic of SANDIMMUNE) CAPS; SOLN

1 B/D

cyclosporine modified (for microemulsion) (generic of NEORAL) CAPS 25mg, 100mg

1 B/D

Drug Name Drug Tier

Requirements/Limits

cyclosporine modified (for microemulsion) CAPS 50mg

1 B/D

cyclosporine modified (for microemulsion) (generic of NEORAL) SOLN

1 B/D

mycophenolate mofetil (generic of CELLCEPT)

1 B/D

MYFORTIC 180mg 2 B/D

MYFORTIC 360mg 2 B/D NM

NEORAL 2 B/D

NULOJIX 3 B/D NM

PROGRAF CAPS 5mg 2 B/D NM

PROGRAF CAPS .5mg, 1mg

2 B/D

PROGRAF SOLN 3 B/D

RAPAMUNE SOLN 2 B/D NM

RAPAMUNE TABS 1mg, 2mg

2 B/D NM

RAPAMUNE TABS .5mg 2 B/D

SANDIMMUNE CAPS 2 B/D

SANDIMMUNE SOLN 2 B/D

SIMULECT 3 B/D

tacrolimus (generic of PROGRAF) CAPS 5mg

1 B/D NM

tacrolimus (generic of PROGRAF) CAPS .5mg, 1mg

1 B/D

THYMOGLOBULIN 3 B/D NM

ZORTRESS 3 B/D NM

VACCINES ACTHIB 2

ADACEL 2

BOOSTRIX 2

CERVARIX 2

COMVAX 2

DAPTACEL 2

DECAVAC 2 B/D

DIPHTHERIA/TETANUS TOXOID

2 B/D

ENGERIX-B SUSP 2 B/D

GARDASIL 2

HAVRIX 2

HIBERIX 2

IMOVAX RABIES (H.D.C.V.) 2

INFANRIX 2

IPOL INACTIVATED IPV 2

IXIARO 2


31

Drug Name Drug Tier

Requirements/Limits

M-M-R II W/DILUENT 10 DOS

2

MENACTRA 2

MENHIBRIX 2

MENOMUNE-A/C/Y/W-135 2

MENVEO 2

PEDVAX HIB 2

PROQUAD 2

RABAVERT 2

RECOMBIVAX HB 2 B/D

ROTATEQ 2

SYNAGIS 3 NM

TETANUS TOXOID ADSORBED

2 B/D

TETANUS/DIPHTHERIA TOXOID

2 B/D

TWINRIX 2 B/D

TYPHIM VI 2

VAQTA 2

VARIVAX 2

YF-VAX 2

ZOSTAVAX 2

NUTRITIONAL/SUPPLEMENTS ELECTROLYTES ammonium chloride SOLN 3

KLOR-CON 8 1

KLOR-CON 10 1

klor-con m15 1

klor-con m20 1

MAGNESIUM SULFATE SOLN 40mg/ml, 80mg/ml

2

magnesium sulfate SOLN 50%

1

MAGNESIUM SULFATE IN D5W

2

POTASSIUM CHLORIDE TBCR

1

potassium chloride caps er (generic of MICRO-K)

1

potassium chloride microencapsulated crystals cr

1

SODIUM CHLORIDE SOLN 2.5meq/ml

1

TPN ELECTROLYTES 1 B/D

IV NUTRITION AMINOSYN 3 B/D

AMINOSYN 7%/ELECTROLYTES

3 B/D

Drug Name Drug Tier

Requirements/Limits

AMINOSYN II 3 B/D

AMINOSYN II 8.5%/ELECTROL

1 B/D

AMINOSYN INJ 8.5/LYTE 1 B/D

AMINOSYN M 3 B/D

AMINOSYN-HBC 3 B/D

AMINOSYN-PF 3 B/D

AMINOSYN-PF 7% 3 B/D

AMINOSYN-RF 3 B/D

CLINIMIX 2.75%/DEXTROSE 5%

3 B/D


3 B/D


3 B/D


3 B/D


3 B/D

CLINIMIX 5%/DEXTROSE 15%

3 B/D


3 B/D


3 B/D

CLINIMIX E 2.75%/DEXTROSE 5%

3 B/D


3 B/D

CLINIMIX E 4.25%/DEXTROSE

3 B/D


3 B/D


3 B/D

CLINIMIX E 5%/DEXTROSE 15%

3 B/D


3 B/D


3 B/D

clinisol sf 15% 1 B/D

FREAMINE HBC 6.9% 3 B/D

FREAMINE III 3 B/D

HEPATAMINE 1 B/D

hepatasol 8 1 B/D

INTRALIPID INJ 20% 1 B/D

INTRALIPID INJ 30% 2 B/D

NEPHRAMINE 3 B/D

premasol 6% 1 B/D


32

Drug Name Drug Tier

Requirements/Limits

premasol 10% 3 B/D

PROCALAMINE 3 B/D

PROSOL 3 B/D

travasol 3 B/D

TROPHAMINE 3 B/D

IV REPLACEMENT SOLUTIONS DEXTROSE SOLN 50% 1

dextrose SOLN 70% 1

DEXTROSE 2.5%/NACL 0.45%

1

DEXTROSE 5% 1

DEXTROSE 5% /ELECTROLYTE

2

DEXTROSE 5%/LACTATED RING

1

DEXTROSE 5%/NACL 0.2% 1





DEXTROSE 5%/NACL 0.225%

1

DEXTROSE 5%/POTASSIUM CHL

1

DEXTROSE 10% FLEX CONTAIN

1

DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%

2

DEXTROSE 10%/NACL 0.45%

1

electrolyte-m in dextrose 1

ELECTROLYTE-M IN DEXTROSE

1

ELECTROLYTE-R IN DEXTROSE

3

IONOSOL-B/DEXTROSE 5% 3

IONOSOL-MB/DEXTROSE 5%

3

ISOLYTE P 3

isolyte s 3

KCL0.15%/D5W/NACL0.2% 1

KCL0.15%/D5W/NACL0.225%

2

kcl 0.3%/d5w/lr iv lac ri 3

KCL 0.3%/D5W/NACL 0.9% 1

KCL 0.3%/D5W/NACL 0.45% 1

KCL 0.15%/D5W/LR 3

KCL 0.15%/D5W/NACL 0.9% 1

Drug Name Drug Tier

Requirements/Limits

KCL 0.075%/D5W/NACL 0.45%

1

KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ

1

kcl 20 meq/l (0.15%) in nacl 0.45% inj

1

KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ

1


1


1

KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ

1

LACTATED RINGERS VIAFLEX

1

NORMOSOL-R 3

PLASMA-LYTE A 3

PLASMA-LYTE-56/D5W 3

PLASMA-LYTE-148 3

potassium chloride (generic of POTASSIUM CHLORIDE) SOLN 40meq/100ml

1

potassium chloride SOLN .4meq/ml, 2meq/ml, 10meq/100ml, 10meq/50ml, 20meq/100ml, 30meq/100ml

1

POTASSIUM CHLORIDE 0.3%/D

1

POTASSIUM CHLORIDE 0.15%

1

POTASSIUM CHLORIDE 0.22%

1

RINGER'S 1

SODIUM CHLORIDE SOLN .9%, 3%, 5%

1

SODIUM CHLORIDE 0.45% VIA

1

VITAMINS calcitriol (generic of ROCALTROL) CAPS

1 B/D

calcitriol SOLN 1mcg/ml 1 B/D

calcitriol (generic of ROCALTROL) SOLN 1mcg/ml

1 B/D

HECTOROL CAPS 2 B/D

HECTOROL SOLN 3 B/D


33

Drug Name Drug Tier

Requirements/Limits

ZEMPLAR CAPS 1mcg, 2mcg

2 B/D

ZEMPLAR CAPS 4mcg 2 B/D NM

ZEMPLAR SOLN 3 B/D

OPHTHALMIC ANTI-INFECTIVE/ANTI-INFLAMMATORY bacitracin-poly-neomycin-hc 1

blephamide OINT 2

BLEPHAMIDE SUSP 3

neomycin-polymy-dexameth (generic of MAXITROL)

1

neomycin-polymyxin-hc (ophth)

1

PRED-G 3

PRED-G S.O.P. 3

sulfacetamide sod-prednisolone

1

TOBRADEX OINT 3

TOBRADEX ST 2

tobramycin-dexamethasone (generic of TOBRADEX)

1

ZYLET 2

ANTI-INFECTIVES AZASITE 2

bacitracin (ophthalmic) 1

bacitracin-polymyxin b (ophth) 1

BESIVANCE 2

CILOXAN OIN 0.3% OP 2

ciprofloxacin hcl (ophth) (generic of CILOXAN)

1

erythromycin (ophth) 1

gentamicin sulfate (ophth) OINT

1

gentamicin sulfate (ophth) (generic of GARAMYCIN) SOLN

1

levofloxacin (ophth) 1

MOXEZA 2

NATACYN 2

neomycin-bacitracin zn-polymyxin

1

neomycin-polymy-gramicid (generic of NEOSPORIN)

1

ofloxacin (ophth) (generic of OCUFLOX)

1

polymyxin b-trimethoprim (generic of POLYTRIM)

1

Drug Name Drug Tier

Requirements/Limits

sulfacetamide sodium (ophth) OINT

1

sulfacetamide sodium (ophth) (generic of BLEPH-10) SOLN

1

tobramycin sulfate (ophth) (generic of TOBREX)

1

TOBREX OINT 0.3% 2

trifluridine (generic of VIROPTIC) SOLN

1

VIGAMOX 2

ZIRGAN 3

ZYMAXID 3

ANTI-INFLAMMATORIES ACUVAIL 3

ALREX 2

BROMDAY 2

bromfenac sodium (ophth) 1

dexamethasone sodium phosphate (ophth)

1

diclofenac sodium (ophth) 1

DUREZOL 2

FLAREX 3

FLUOROMETHOLONE SUSP

1

FLUOROMETHOLONE (OPHTH)

1

flurbiprofen sodium (generic of OCUFEN)

1

FML 2

FML FORTE 2

ILEVRO 3

ketorolac tromethamine (ophth) (generic of ACULAR LS) .4%

1

ketorolac tromethamine (ophth) (generic of ACULAR) .5%

1

LOTEMAX 2

MAXIDEX 2

NEVANAC 3

PRED MILD 2

PREDNISOLONE ACETATE SUSP

1

prednisolone sodium phosphate (ophth)

2

VEXOL 3

ANTIALLERGICS


34

Drug Name Drug Tier

Requirements/Limits

ALOCRIL 3

ALOMIDE 3

azelastine hcl (ophth) (generic of OPTIVAR)

1

BEPREVE 2

cromolyn sodium (ophth) 1

EMADINE 3

epinastine hcl (ophth) (generic of ELESTAT)

1

LASTACAFT 2

PATADAY 2

PATANOL 3

ANTIGLAUCOMA ALPHAGAN P 0.1% 2

AZOPT 2

betaxolol hcl (ophth) 1

BETIMOL 2

BETOPTIC-S 2

brimonidine sol 0.2% 1

BRIMONIDINE SOL 0.15% 1

carteolol hcl (ophth) 1

COMBIGAN 2

COSOPT PF 2

dorzolamide hcl (generic of TRUSOPT)

1

dorzolamide hcl-timolol maleate (generic of COSOPT)

1

ISOPTO CARPINE 3

ISTALOL 2

latanoprost (generic of XALATAN)

1

levobunolol hcl (generic of BETAGAN) .5%

1

LEVOBUNOLOL HCL .25% 1

LUMIGAN 2

metipranolol (generic of OPTIPRANOLOL)

1

PHOSPHOLINE IODIDE 2

PILOCARPINE HCL SOLN 1

PILOPINE HS 2

timolol maleate (ophth) (generic of TIMOPTIC)

1

TIMOLOL MALEATE GEL 1

TIMOPTIC OCUDOSE 3

TRAVATAN Z 2

ZIOPTAN 2

MISCELLANEOUS

Drug Name Drug Tier

Requirements/Limits

ak-con 1

BOTOX 100unit 3 NM PA

LACRISERT 3

PROLENSA 2

proparacaine hcl (generic of ALCAINE) SOLN

1

RESTASIS 2

XEOMIN 3 NM PA

RESPIRATORY ANTICHOLINERGIC/BETA AGONIST COMBINATIONS COMBIVENT 3

COMBIVENT RESPIMAT 2

ipratropium-albuterol (generic of DUONEB)

1 B/D

ANTICHOLINERGICS ATROVENT HFA 3

ipratropium bromide (nasal) (generic of ATROVENT)

1

ipratropium sol inhal 1 B/D

SPIRIVA HANDIHALER 2

TUDORZA PRESSAIR 2

ANTIHISTAMINE/DECONGESTANT COMBINATIONS CLARINEX-D 3

SEMPREX-D 3

ANTIHISTAMINES ASTEPRO 2

azelastine hcl (generic of ASTELIN)

1

cetirizine syrup 1

CLARINEX SYRP 3

cyproheptadine hcl SYRP; TABS

1

desloratadine (generic of CLARINEX) TABS

1

desloratadine (generic of CLARINEX REDITABS) TBDP

1

diphenhydram inj 50mg/ml 1

hydroxyzine hcl SOLN; TABS

1

hydroxyzine pamoate (generic of VISTARIL) CAPS 25mg, 50mg

1

hydroxyzine pamoate CAPS 100mg

1


35

Drug Name Drug Tier

Requirements/Limits

levocetirizine soln 2.5mg/5ml (generic of XYZAL)

1

levocetirizine tab 5 mg (generic of XYZAL)

1

PATANASE 3

BETA AGONISTS albuterol sulfate (generic of ACCUNEB) NEBU .63mg/3ml, 1.25mg/3ml

1 B/D

albuterol sulfate NEBU .083%, .5%

1 B/D

albuterol sulfate SYRP 1

albuterol sulfate TABS 1

albuterol sulfate er (generic of VOSPIRE ER)

1

ARCAPTA NEOHALER 2

BROVANA 3 B/D

FORADIL AEROLIZER 2

levalbuterol conc 1.25mg/0.5ml (generic of XOPENEX CONCENTRATE)

1 B/D

LEVALBUTEROL HCL NEBU 1.25mg/3ml

1 B/D

levalbuterol hcl (generic of XOPENEX) NEBU .31mg/3ml, .63mg/3ml

1 B/D

PERFOROMIST 2 B/D

PROAIR HFA 2

PROVENTIL HFA 2

SEREVENT DISKUS 2

terbutaline sulfate SOLN; TABS

1

VENTOLIN HFA 3

XOPENEX HFA 2

LEUKOTRIENE RECEPTOR ANTAGONISTS montelukast sodium (generic of SINGULAIR) CHEW; PACK; TABS

1

zafirlukast (generic of ACCOLATE)

1

ZYFLO CR 3 NM

MAST CELL STABILIZERS cromolyn sodium NEBU 1 B/D

MISCELLANEOUS acetylcysteine SOLN 10%, 20%

1 B/D

ADRENACLICK 3

Drug Name Drug Tier

Requirements/Limits

ARALAST NP 3 NM LA PA

AUVI-Q 2

CAYSTON 3 NM LA PA

DALIRESP 2

DYMISTA 3

EPIPEN 2-PAK 2

EPIPEN-JR 2-PAK 2

GLASSIA 3 NM LA PA

PROLASTIN-C 3 NM LA PA

PULMOZYME 2 B/D NM

tetrahydrozoline hcl SOLN 3

tyzine pediatric nasal dr 3

XOLAIR 2 NM LA PA

ZEMAIRA 3 NM LA PA

NASAL STEROIDS BECONASE AQ 3

flunisolide (nasal) 1

fluticasone propionate (nasal) (generic of FLONASE)

1

NASONEX 2

OMNARIS 3

QNASL 3

RHINOCORT AQUA 3

triamcinolone acetonide (nasal) (generic of NASACORT AQ)

1

VERAMYST 3

ZETONNA 3

STEROID INHALANTS ALVESCO 3

ASMANEX 2

ASMANEX 14 METERED DOSES

2

budesonide (inhalation) (generic of PULMICORT)

1 B/D

FLOVENT DISKUS 2

FLOVENT HFA 2

PULMICORT FLEXHALER 2

PULMICORT INH SUSP 3 B/D NM

QVAR 2

STEROID/BETA-AGONIST COMBINATIONS ADVAIR DISKUS 2

ADVAIR HFA 2

DULERA 2

SYMBICORT 2

XANTHINES


36

Drug Name Drug Tier

Requirements/Limits

aminophylline inj 1

LUFYLLIN 3

theo-24 2

theophylline ELIX 2

theophylline TB12; TB24 1

TOPICAL DERMATOLOGY, ACNE ABSORICA 3 NM

ACANYA 2

ACZONE 3

adapalene (generic of DIFFERIN)

1

AKNE-MYCIN 3

ATRALIN 2

AVITA CREA 1

AVITA GEL 1

AZELEX 3

benzoyl peroxide-erythromycin (generic of BENZAMYCIN)

1

CLINDAGEL 3

clindamycin phosphate (topical) (generic of EVOCLIN) FOAM

1

clindamycin phosphate (topical) (generic of CLEOCIN-T) GEL; LOTN; SOLN; SWAB

1

clindamycin phosphate-benzoyl peroxide (generic of BENZACLIN)

1

DIFFERIN GEL .3% 2

DIFFERIN LOTN 2

EPIDUO 2

erythromycin (acne aid) 1

isotretinoin cap 10 mg 1

myorisan 1

sulfacetamide sodium (acne) (generic of KLARON)

1

tretin x 3

tretinoin (generic of RETIN-A) CREA; GEL

1

TRETINOIN MICROSPHERE 1

VELTIN 2

zenatane 1

ZIANA 3

DERMATOLOGY, ACTINIC KERATOSIS

Drug Name Drug Tier

Requirements/Limits

CARAC 2

FLUOROPLEX 3

fluorouracil (topical) (generic of EFUDEX) CREA

1

fluorouracil (topical) SOLN 1

PICATO 2

SOLARAZE 2

DERMATOLOGY, ANTIBIOTICS ALTABAX 2

BACTROBAN NASAL 3

CORTISPORIN CREA; OINT

3

gentamicin sulfate (topical) 1

mafenide acetate (generic of SULFAMYLON) PACK

1

mupirocin (generic of BACTROBAN) OINT

1

mupirocin calcium (topical) (generic of BACTROBAN)

1

PHISOHEX 3

SILVER SULFADIAZINE CREA

1

SSD 1

SULFAMYLON CREA 2

THERMAZENE 1

DERMATOLOGY, ANTIFUNGALS ciclopirox (generic of LOPROX) GEL

1

ciclopirox cre 0.77% 1

ciclopirox shampoo 1% (generic of LOPROX SHAMPOO)

1

ciclopirox sus 0.77% 1

clotrimazole (topical) 1

econazole nitrate CREA 1

EXELDERM 3

ketoconazole (topical) CREA 1

ketoconazole (topical) (generic of EXTINA) FOAM

1

MENTAX 2

NAFTIN CREA 3

NAFTIN GEL 1% 3

nystatin (topical) 1

nystatin pow 100000 1

OXISTAT 2

DERMATOLOGY, ANTIPRURITIC CORTIFOAM 2


37

Drug Name Drug Tier

Requirements/Limits

hydrocortisone (rectal) (generic of ANUSOL-HC)

1

procto-pak cre 1% 1

proctozone cre -hc 2.5% (generic of ANUSOL-HC)

1

PRUDOXIN CRE 5% 1

ZONALON 3

DERMATOLOGY, ANTIPSORIATICS calcipotriene (generic of DOVONEX) CREA

1

calcipotriene OINT; SOLN 1

CALCITRIOL OINT 1

8-MOP 3

OXSORALEN ULTRA 2 NM

SORIATANE 2 NM

SORILUX 2

STELARA 3 NM PA

TAZORAC 2

DERMATOLOGY, ANTISEBORRHEICS ketoconazole shampoo (generic of NIZORAL)

1

selenium sulfide (generic of SELSUN SHAMPOO) LOTN

1

DERMATOLOGY, ANTIVIRALS acyclovir topical (generic of ZOVIRAX)

1

DENAVIR 3

XERESE 3

ZOVIRAX CREA 3

DERMATOLOGY, CORTICOSTEROIDS alclometasone dipropionate (generic of ACLOVATE) CREA

1

alclometasone dipropionate OINT

1

amcinonide CREA; LOTN 1

amcinonide OINT 3

betamethasone dipropionate (topical)

1

betamethasone dipropionate augmented (generic of DIPROLENE AF) CREA

1

betamethasone dipropionate augmented GEL

1

betamethasone dipropionate augmented (generic of DIPROLENE) LOTN; OINT

1

Drug Name Drug Tier

Requirements/Limits

betamethasone valerate CREA; LOTN; OINT

1

betamethasone valerate (generic of LUXIQ) FOAM

1

CAPEX 2

clobetasol propionate (generic of TEMOVATE) CREA; GEL; OINT; SOLN

1

clobetasol propionate (generic of OLUX) FOAM

1

clobetasol propionate (generic of CLOBEX) LOTN; SHAM

1

clobetasol propionate emollient base (generic of TEMOVATE E)

1

clobetasol propionate emulsion (generic of OLUX-E)

1

CLOBEX LIQD 2

CLODERM PUMP 3

CORDRAN 3

DESONATE 3

DESONIDE CREA 1

desonide (generic of DESOWEN) LOTN; OINT

1

desowen oint kit 0.05% 2

desoximetasone (generic of TOPICORT) CREA

1

desoximetasone (generic of TOPICORT) GEL

1

DESOXIMETASONE OINT .05%

1

desoximetasone (generic of TOPICORT) OINT .25%

1

diflorasone diacetate 1

fluocinolone acetonide CREA .01%

1

fluocinolone acetonide (generic of SYNALAR) CREA .025%

1

fluocinolone acetonide (generic of DERMA-SMOOTHE/FS BODY) OIL

1

fluocinolone acetonide (generic of SYNALAR) OINT

1

fluocinolone acetonide (generic of SYNALAR) SOLN

1


38

Drug Name Drug Tier

Requirements/Limits

fluocinonide CREA; GEL; OINT; SOLN

1

fluocinonide emulsified base 1

fluticasone propionate (generic of CUTIVATE) CREA; LOTN; OINT

1

halobetasol propionate (generic of ULTRAVATE)

1

HALOG 3

hydrocortisone (topical) 1

hydrocortisone butyrate (generic of LOCOID)

1

hydrocortisone valerate CREA

1

hydrocortisone valerate (generic of WESTCORT) OINT

1

KENALOG 3

LOCOID LOTN 3

LOCOID LIPOCREAM 2

LOKARA LOTN 0.05% 1

mometasone furoate (generic of ELOCON) CREA; OINT; SOLN

1

PANDEL 3

PREDNICARBATE CREA 1

prednicarbate (generic of DERMATOP) OINT

1

TACLONEX 3

texacort 2

TOPICORT LIQD 3

triamcinolone acetonide (topical)

1

urea-hc acetate (generic of CARMOL-HC)

1

VANOS 3

VERDESO 3

DERMATOLOGY, LOCAL ANESTHETICS lidocaine OINT 1

lidocaine hcl GEL 1

lidocaine hcl (generic of XYLOCAINE) SOLN 4%

1

lidocaine-prilocaine (generic of EMLA)

1 B/D

LIDODERM 2 PA

SYNERA 3

DERMATOLOGY, MISCELLANEOUS SKIN AND MUCOUS MEMBRANE

Drug Name Drug Tier

Requirements/Limits

ammonium lactate (generic of LAC-HYDRIN) CREA; LOTN

1

CONDYLOX GEL 2

ELIDEL 2

FINACEA 2

imiquimod (generic of ALDARA) CREA

1

laclotion lotn 12% (generic of LAC-HYDRIN)

1

METROGEL 2

metronidazole (topical) (generic of METROCREAM) CREA

1

metronidazole (topical) (generic of METROGEL) GEL 1%

1

metronidazole (topical) GEL .75%

1

metronidazole (topical) (generic of METROLOTION) LOTN

1

ORACEA 2

OXSORALEN 3

PANRETIN 3 NM

PENNSAID 2

podofilox (generic of CONDYLOX) SOLN

1

PROTOPIC 2

RECTIV 3

rosadan cre 0.75% (generic of METROCREAM)

1

TARGRETIN GEL 3 NM PA

VOLTAREN GEL 1% 2

ZYCLARA 2 NM

DERMATOLOGY, SCABICIDES AND PEDICULIDES EURAX 3

malathion (generic of OVIDE) 1

permethrin (generic of ELIMITE) CREA

1

SKLICE 3

ULESFIA 3

DERMATOLOGY, WOUND CARE AGENTS acetic acid .25% 1

neomycin/polymyxin b gu (generic of NEOSPORIN GU IRRIGANT)

1

SANTYL 3


39

Drug Name Drug Tier

Requirements/Limits

SODIUM CHLORIDE 0.9% 1

STERILE WATER IRRIGATION

1

MOUTH/THROAT/DENTAL AGENTS cevimeline hcl (generic of EVOXAC)

1

chlorhexidine gluconate (mouth-throat) (generic of PERIDEX)

1

clotrimazole TROC 1

lidocaine hcl (mouth-throat) 1

nystatin (mouth-throat) 1

periogard sol 0.12% (generic of PERIDEX)

1

pilocarpine hcl (oral) (generic of SALAGEN)

1

triamcinolone acetonide (mouth)

1

OTIC acetic acid (otic) 1

acetic acid sol/hc (generic of VOSOL HC)

1

acetic acid-aluminum acetate 1

CIPRO HC 2

CIPRODEX 2

COLY-MYCIN S 3

CORTISPORIN-TC 3

fluocinolone acetonide (otic) (generic of DERMOTIC)

1

hydrocortisone w/acetic acid (generic of VOSOL HC)

1

neomycin-polymyxin-hc (otic) (generic of CORTISPORIN) SOLN

1

neomycin-polymyxin-hc (otic) SUSP

1

ofloxacin (otic) 1

40

Index 8 8-MOP .............................. 37 A abacavir sulfate ...................5 ABELCET............................5 ABILIFY............................. 18 ABILIFY DISCMELT ......... 18 ABILIFY INJ ...................... 18 ABILIFY MAINTENA ......... 18 ABRAXANE ........................9 ABSORICA ....................... 36 ABSTRAL............................2 ACANYA ........................... 36 acarbose ........................... 21 ACCOLATE

see zafirlukast ............... 35 ACCUNEB

see albuterol sulfate ...... 35 ACCUPRIL

see quinapril hcl ............ 11 ACCURETIC

see quinapril-hydrochlorothiazide .................................. 11

acebutolol hcl .................... 13 ACEON

see perindopril erbumine ...................................... 11

acetaminophen w/ codeine .1 acetazolamide ................... 14 acetazolamide sodium ...... 14 acetic acid ......................... 38 acetic acid (otic) ................ 39 acetic acid sol/hc ............... 39 acetic acid-aluminum acetate .......................................... 39 acetylcysteine ................... 35 ACIPHEX .......................... 28 ACLOVATE

see alclometasone dipropionate ................... 37

ACTEMRA ........................ 29 ACTHIB ............................. 30 ACTIGALL

see ursodiol ................... 27 ACTIMMUNE .................... 30 ACTIQ

see fentanyl citrate ..........2 ACTIVELLA

see estradiol & norethindrone acetate ... 24

ACTONEL ......................... 22 ACTOPLUS MET

see pioglitazone hcl-metformin hcl ........... 22

ACTOPLUS MET XR 15-1000MG ....................... 21 ACTOPLUS MET XR 30-1000MG ....................... 21 ACTOS

see pioglitazone hcl ....... 22 ACULAR

see ketorolac tromethamine (ophth) .... 33

ACULAR LS see ketorolac tromethamine (ophth) .... 33

ACUVAIL .......................... 33 acyclovir .............................. 6 acyclovir sodium ................. 6 acyclovir topical ................ 37 ACZONE ........................... 36 ADACEL ........................... 30 ADAGEN ........................... 23 ADALAT CC

see nifedipine ................ 13 see nifedipine cc tab 90mg er ................................... 13 see nifedipine cr ............ 13

adapalene ......................... 36 ADCIRCA .......................... 15 ADDERALL

see amphetamine-dextroamphetamine tab 10 mg......... 19 see amphetamine-dextroamphetamine tab 12.5 mg...... 19 see amphetamine-dextroamphetamine tab 20 mg......... 19 see amphetamine-dextroamphetamine tab 30 mg......... 19 see amphetamine-dextroamphetamine tab 5 mg .......... 19

ADDERALL XR

see amphetamine-dextroamphetamine cap sr 24hr 10 mg ...................................... 19 see amphetamine-dextroamphetamine cap sr 24hr 15 mg ...................................... 19 see amphetamine-dextroamphetamine cap sr 24hr 20 mg ...................................... 19 see amphetamine-dextroamphetamine cap sr 24hr 25 mg ...................................... 19 see amphetamine-dextroamphetamine cap sr 24hr 30 mg ...................................... 19 see amphetamine-dextroamphetamine cap sr 24hr 5 mg ...................................... 19

ADOXA see doxycycline (monohydrate) ................. 8

ADOXA PAK 1/150 see doxycycline (monohydrate) ................. 8

ADRENACLICK ................ 35 adriamycin .......................... 9 adriamycin inj 2mg/ml ......... 9 adrucil ................................. 9 ADVAIR DISKUS .............. 35 ADVAIR HFA .................... 35 ADVICOR ......................... 12 AFINITOR ......................... 10 AFINITOR DISPERZ ........ 10 AGGRENOX ..................... 29 AGRYLIN

see anagrelide hcl ......... 29 a-hydrocort inj 100mg ....... 24 ak-con ............................... 34 AKNE-MYCIN ................... 36 ALBENZA ........................... 4 albuterol sulfate ................ 35 albuterol sulfate er ............ 35 ALCAINE

41

see proparacaine hcl ..... 34 alclometasone dipropionate .......................................... 37 ALCOHOL PREPS ............ 21 ALDACTAZIDE ................. 14

see spironolactone & hydrochlorothiazide ....... 14

ALDACTONE see spironolactone ........ 11

ALDARA see imiquimod ............... 38

ALDURAZYME ................. 23 alendronate sodium .......... 22 alfuzosin hcl ...................... 28 ALIMTA ...............................9 ALINIA ................................4 ALKERAN

see melphalan hcl ...........9 allopurinol inj 500mg ...........1 allopurinol tab ......................1 ALOCRIL........................... 34 ALOMIDE .......................... 34 ALOPRIM

see allopurinol inj 500mg .1 ALORA .............................. 24 ALOXI ............................... 26 ALPHAGAN P 0.1% .......... 34 alprazolam ........................ 15 ALREX .............................. 33 ALSUMA ........................... 19 ALTABAX .......................... 36 ALTACE

see ramipril .................... 11 altavera ............................. 22 ALTOPREV ....................... 12 ALVESCO ......................... 35 amantadine hcl .................. 17 AMARYL

see glimepiride .............. 21 AMBIEN

see zolpidem tartrate ..... 19 AMBIEN CR

see zolpidem tartrate ..... 19 AMBISOME .........................5 amcinonide ........................ 37 AMERGE

see naratriptan hcl ......... 19 amifostine crystalline ......... 10 amikacin sulfate ..................4 amiloride &

hydrochlorothiazide ........... 14 amiloride hcl ...................... 14 aminophylline inj ............... 36 AMINOSYN ....................... 31 AMINOSYN 7%/ELECTROLYTES ....... 31 AMINOSYN II .................... 31 AMINOSYN II 8.5%/ELECTROL .............. 31 AMINOSYN INJ 8.5/LYTE 31 AMINOSYN M ................... 31 AMINOSYN-HBC .............. 31 AMINOSYN-PF ................. 31 AMINOSYN-PF 7% ........... 31 AMINOSYN-RF ................. 31 amiodarone hcl ................. 12 amiodarone inj 50mg/ml.... 12 AMITIZA ............................ 27 amitriptyline hcl ................. 16 amlodipine besylate .......... 13 AMLODIPINE BESYLATE/ATORV .......... 13 amlodipine besylate-benazepril hcl ..... 11 ammonium chloride .......... 31 ammonium lactate ............ 38 amoxapine ........................ 16 amoxicillin ........................... 7 amoxicillin & pot clavulanate ........................................ 7, 8 amphetamine-dextroamphetamine cap sr 24hr 10 mg .. 19 amphetamine-dextroamphetamine cap sr 24hr 15 mg .. 19 amphetamine-dextroamphetamine cap sr 24hr 20 mg .. 19 amphetamine-dextroamphetamine cap sr 24hr 25 mg .. 19 amphetamine-dextroamphetamine cap sr 24hr 30 mg .. 19 amphetamine-dextroamphetamine cap sr 24hr 5 mg .... 19 amphetamine-dextroamphetamine tab 10 mg ............... 19 amphetamine-dextroamphetamine tab 12.5 mg ............ 19 amphetamine-dextroamphetamine tab 15 mg ............... 19 amphetamine-dextroamphetamine tab 20 mg ............... 19

amphetamine-dextroamphetamine tab 30 mg ............... 19 amphetamine-dextroamphetamine tab 5 mg ................. 19 amphetamine-dextroamphetamine tab 7.5 mg .............. 19 AMPHOTEC ....................... 5 amphotericin b .................... 5 ampicillin ............................. 8 ampicillin & sulbactam sodium ................................ 8 ampicillin inj ........................ 8 ampicillin sodium ................ 8 AMPYRA .......................... 20 AMRIX .............................. 20 AMTURNIDE .................... 14 ANAFRANIL

see clomipramine hcl .... 17 anagrelide hcl ................... 29 ANAPROX

see naproxen sodium ...... 1 ANAPROX DS

see naproxen sodium ...... 1 anastrozole ......................... 9 ANCOBON

see flucytosine ................ 5 ANDRODERM .................. 21 ANDROGEL 1% ............... 21 ANDROGEL 1.62% .......... 21 ANEXSIA

see hydrocodone-acetaminophen 7.5-650mg .................. 2

ANTABUSE see disulfiram ................ 20

ANTIVERT ........................ 26 see meclizine hcl ........... 26

ANUSOL-HC see hydrocortisone (rectal) ...................................... 37 see proctozone cre -hc 2.5% .............................. 37

APIDRA ............................ 21 APIDRA SOLOSTAR ........ 21 APLENZIN ........................ 16 APOKYN ........................... 17 APRISO ............................ 27 APTIVUS ............................ 5 ARALAST NP ................... 35 ARALEN

42

see chloroquine phosphate ........................5

ARANESP ALBUMIN FREE .......................................... 29 ARAVA

see leflunomide ............. 29 ARCALYST ....................... 30 ARCAPTA NEOHALER .... 35 ARICEPT .......................... 16

see donepezil tabs 10mg ...................................... 16 see donepezil tabs 5mg 16

ARICEPT ODT see donepezil odt 10mg 16 see donepezil odt 5mg .. 16

ARIMIDEX see anastrozole ...............9

ARIXTRA see fondaparinux sodium ...................................... 29

AROMASIN see exemestane ..............9

ARRANON ..........................9 ARTHROTEC 50

see diclofenac w/ misoprostol ......................1

ARTHROTEC 75 see diclofenac w/ misoprostol ......................1

ARZERRA ...........................9 ASACOL ........................... 27 ASACOL HD ..................... 27 ASMANEX ........................ 35 ASMANEX 14 METERED DOSES ............................. 35 ASTELIN

see azelastine hcl .......... 34 ASTEPRO ......................... 34 ATACAND ......................... 11

see candesartan cilexetil ...................................... 11

ATACAND HCT see candesartan cilexetil-hydrochlorothiazide .................................... 11

ATELVIA ........................... 22 atenolol ............................. 13 atenolol & chlorthalidone ... 12 ATGAM ............................. 30 ATIVAN

see lorazepam ............... 15 atorvastatin calcium .......... 12 atovaquone-proguanil hcl tab 250-100 mg ......................... 5 ATOVAQUONE-PROGUANIL HCL TAB 62.5-25 MG ...... 5 ATRALIN ........................... 36 ATRIPLA ............................. 6 ATROPINE SULFATE ...... 26 ATROVENT

see ipratropium bromide (nasal) ........................... 34

ATROVENT HFA .............. 34 AUBAGIO ......................... 20 AUGMENTIN ...................... 8

see amoxicillin & pot clavulanate .................. 7, 8

AUGMENTIN ES-600 see amoxicillin & pot clavulanate ...................... 8

AUGMENTIN XR see amoxicillin & pot clavulanate ...................... 8

AUVI-Q ............................. 35 AVALIDE

see irbesartan-hydrochlorothiazide ................................ 11

AVAPRO see irbesartan ............... 11

AVASTIN ............................ 9 AVELOX ............................. 7 AVELOX ABC PACK .......... 7 AVINZA ............................... 2 AVITA ............................... 36 AVODART ........................ 28 AVONEX ........................... 20 AVONEX PEN .................. 20 AXERT .............................. 19 AXID

see nizatidine .......... 26, 27 AXIRON ............................ 21 AYGESTIN

see norethindrone acetate ...................................... 25

AZACTAM ........................... 4 see aztreonam ................ 4

AZACTAM/DEX INJ 1GM ... 4 AZACTAM/DEX INJ 2GM ... 4 AZASITE ........................... 33

azathioprine ...................... 30 azathioprine inj 100mg ...... 30 azelastine hcl .................... 34 azelastine hcl (ophth) ........ 34 AZELEX ............................ 36 AZILECT ........................... 17 azithromycin ....................... 7 AZITHROMYCIN ................ 7 AZOPT .............................. 34 AZOR ................................ 11 aztreonam ........................... 4 AZULFIDINE

see sulfasalazine ir ........ 27 AZULFIDINE EN-TABS

see sulfasalazine dr ...... 27 B bacitracin (ophthalmic) ...... 33 bacitracin-polymyxin b (ophth) .............................. 33 bacitracin-poly-neomycin-hc.......................................... 33 baclofen ............................ 20 BACTOCILL IN DEXTROSE............................................ 8 BACTRIM

see sulfamethoxazole-trimethoprim ................................. 4

BACTRIM DS see sulfamethoxazole-trimethoprim ................................. 4

BACTROBAN see mupirocin ................ 36 see mupirocin calcium (topical) ......................... 36

BACTROBAN NASAL ....... 36 balsalazide disodium ........ 27 BANZEL ............................ 15 BARACLUDE ...................... 6 BECONASE AQ................ 35 benazepril & hydrochlorothiazide ........... 11 benazepril hcl ................... 11 BENICAR .......................... 11 BENICAR HCT ................. 11 BENTYL ............................ 26

see dicyclomine hcl ....... 26 BENZACLIN

see clindamycin

43

phosphate-benzoyl peroxide......................... 36

BENZAMYCIN see benzoyl peroxide-erythromycin ... 36

benzoyl peroxide-erythromycin ...... 36 benztropine mesylate ........ 17 BEPREVE ......................... 34 BESIVANCE ..................... 33 BETAGAN

see levobunolol hcl ........ 34 betamethasone dipropionate (topical) ............................. 37 betamethasone dipropionate augmented ........................ 37 betamethasone valerate ... 37 BETAPACE

see sotalol hcl ................ 12 BETAPACE AF

see sotalol hcl (afib/afl) .. 12 BETASERON .................... 20 betaxolol hcl ...................... 13 betaxolol hcl (ophth) .......... 34 bethanechol chloride ......... 28 BETIMOL .......................... 34 BETOPTIC-S .................... 34 BEYAZ .............................. 22 BIAXIN

see clarithromycin ...........7 BIAXIN XL

see clarithromycin ...........7 bicalutamide ........................9 BICILLIN C-R ......................8 BICILLIN L-A .......................8 BICNU .................................8 BIDIL ................................. 14 BILTRICIDE ........................4 BINOSTO .......................... 22 bisoprolol & hydrochlorothiazide ........... 13 bisoprolol fumarate ........... 13 bleomycin sulfate ................9 BLEPH-10

see sulfacetamide sodium (ophth) ........................... 33

blephamide ....................... 33 BLEPHAMIDE ................... 33 BONIVA ............................ 22

see ibandronate sodium 22

BOOSTRIX ....................... 30 BOSULIF .......................... 10 BOTOX ............................. 34 BREVICON-28

see norethindrone & eth estradiol ......................... 23

BRILINTA .......................... 29 BRIMONIDINE SOL 0.15% .......................................... 34 brimonidine sol 0.2%......... 34 BROMDAY ........................ 33 bromfenac sodium (ophth) 33 bromocriptine mesylate ..... 17 BROVANA ........................ 35 budesonide ....................... 27 budesonide (inhalation) ..... 35 bumetanide ....................... 14 BUPHENYL

see sodium phenylbutyrate ...................................... 24

BUPHENYL TAB 500MG .. 24 buprenorphine hcl ............. 20 buprenorphine hcl-naloxone hcl sl.................................. 20 bupropion hcl .............. 16, 17 bupropion hcl (smoking deterrent) .......................... 20 buspirone hcl .................... 15 BUSULFEX ......................... 8 butorphanol nasal spray ...... 1 butorphanol tartrate ............ 1 BUTRANS ........................... 1 BYDUREON ..................... 21 BYETTA ............................ 21 BYSTOLIC ........................ 13 C cabergoline ....................... 25 cafergot tab 1-100mg ........ 19 CALAN

see verapamil hcl .......... 14 CALAN SR

see verapamil hcl .......... 14 calcipotriene ...................... 37 calcitonin (salmon) nasal spray ................................. 25 calcitriol ............................. 32 CALCITRIOL ..................... 37 calcium acetate (phosphate binder) ............................... 25 CAMPRAL ........................ 20

CAMPTOSAR ................... 10 see irinotecan ................ 10 see irinotecan hcl .......... 10

CAMRESE LO TAB .......... 22 CANASA ........................... 27 CANCIDAS ......................... 5 candesartan cilexetil ......... 11 candesartan cilexetil-hydrochlorothiazide.......................................... 11 CANTIL ............................. 26 CAPASTAT SULFATE ........ 6 CAPEX ............................. 37 capital

and codeine .................... 1 CAPRELSA ...................... 10 captopril ............................ 11 captopril & hydrochlorothiazide ........... 11 CARAC ............................. 36 CARAFATE ...................... 27

see sucralfate ................ 27 CARBAGLU ...................... 24 carbamazepine ................. 15 CARBATROL

see carbamazepine ....... 15 CARBIDOPA/LEVODOPA/ENTACA ............................. 17 carbidopa-levodopa .......... 17 carboplatin ........................ 10 CARDIZEM

see diltiazem hcl ............ 13 CARDIZEM CD

see cartia xt ................... 13 see dilt-cd ...................... 13 see diltiazem hcl coated beads ............................ 13

CARDIZEM LA.................. 13 see matzim la ................ 13

CARDURA see doxazosin mesylate 11

CARDURA XL .................. 28 CARIMUNE NANOFILTERED .............. 30 CARMOL-HC

see urea-hc acetate ...... 38 CARNITOR

see levocarnitine (metabolic modifiers) ..... 24

carteolol hcl (ophth) .......... 34

44

cartia xt ............................. 13 carvedilol ........................... 13 CASODEX

see bicalutamide .............9 CATAFLAM

see diclofenac potassium 1 CATAPRES

see clonidine hcl ............ 14 CATAPRES-TTS-1



see clonidine hcl ............ 14 CAYSTON ......................... 35 CEDAX ...............................6 CEENU ...............................8 cefaclor ...............................6 cefaclor monohydrate .........6 cefadroxil.............................6 cefazolin inj .........................6 cefazolin sodium .................6 cefazolin/dextrose ...............6 cefdinir ................................6 CEFEPIME 1GM SOLN ......6 CEFEPIME 2GM SOLN ......6 cefepime inj 1gm .................6 cefepime inj 2gm .................6 cefixime ...............................6 cefotaxime sodium ..............6 cefotetan disodium ..............6 cefoxitin sodium ..................6 CEFOXITIN SODIUM IN DEXTROSE ........................6 cefpodoxime proxetil ...........6 cefprozil...............................6 ceftazidime ..........................7 CEFTAZIDIME/DEXTROSE ............................................7 CEFTIN ...............................7

see cefuroxime axetil .......7 ceftriaxone sodium ..............7 cefuroxime axetil .................7 cefuroxime sodium ..............7 CELEBREX .........................1 CELESTONE .................... 24 CELEXA

see citalopram hydrobromide ................ 17

CELLCEPT ....................... 30

see mycophenolate mofetil ...................................... 30

CELLCEPT INTRAVENOUS .......................................... 30 CELONTIN ........................ 15 cephalexin ........................... 7 CEREZYME ...................... 24 CERUBIDINE

see daunorubicin hcl ....... 9 CERVARIX ....................... 30 CESAMET ........................ 26 cetirizine syrup .................. 34 cevimeline hcl ................... 39 CHANTIX .......................... 20 CHANTIX STARTER PACK .......................................... 20 CHEMET ........................... 22 chlorhexidine gluconate (mouth-throat) ................... 39 chloroquine phosphate........ 5 chlorothiazide .................... 14 chlorpromaz inj 25mg/ml ... 18 chlorpromazine hcl ............ 18 chlorthalidone ................... 14 chlorzoxazone ................... 20 cholestyramine .................. 12 cholestyramine light .......... 12 choline fenofibrate ............ 12 CHORIONIC GONADOTROPIN ............ 25 ciclopirox ........................... 36 ciclopirox cre 0.77% .......... 36 ciclopirox shampoo 1% ..... 36 ciclopirox sus 0.77% ......... 36 cidofovir .............................. 6 cilostazol ........................... 29 CILOXAN

see ciprofloxacin hcl (ophth) ........................... 33

CILOXAN OIN 0.3% OP ... 33 cimetidine .......................... 26 cimetidine inj 150mg/ml .... 26 cimetidine sol 300/5ml ...... 26 CIMZIA .............................. 29 CIPRO ................................ 7

see ciprofloxacin hcl ........ 7 CIPRO HC ........................ 39 CIPRO I.V.-IN D5W

see ciprofloxacin in d5w .. 7 CIPRO XR

see ciprofloxacin er ......... 7 CIPRODEX ....................... 39 ciprofloxacin ........................ 7 ciprofloxacin er ................... 7 ciprofloxacin hcl .................. 7 ciprofloxacin hcl (ophth) .... 33 ciprofloxacin in d5w ............ 7 ciprofloxacn inj .................... 7 cisplatin ............................. 10 citalopram hydrobromide .. 17 cladribine ............................ 9 claforan ............................... 7 CLAFORAN

see cefotaxime sodium ... 6 CLARINEX ........................ 34

see desloratadine .......... 34 CLARINEX REDITABS

see desloratadine .......... 34 CLARINEX-D .................... 34 clarithromycin ..................... 7 CLEOCIN

see clindamycin cre 2% vag ................................ 28 see clindamycin hcl ......... 4

CLEOCIN IN D5W see clindamycin phosphate in d5w ............ 4

CLEOCIN PEDIATRIC GRANULE

see clindamycin palmitate hydrochloride................... 4

CLEOCIN PHOSPHATE see clindamycin phosphate ....................... 4

CLEOCIN VAG SUPP 100MG .............................. 28 CLEOCIN-T

see clindamycin phosphate (topical) ........ 36

CLIMARA see estradiol .................. 24

CLINDAGEL ..................... 36 clindamycin cre 2% vag .... 28 clindamycin hcl ................... 4 clindamycin palmitate hydrochloride ...................... 4 clindamycin phosphate ....... 4 clindamycin phosphate (topical) ............................. 36 clindamycin phosphate in

45

d5w .....................................4 clindamycin phosphate-benzoyl peroxide .......................................... 36 CLINIMIX 2.75%/DEXTROSE 5% ..... 31 CLINIMIX 4.25%/DEXTROSE 10% ... 31 CLINIMIX 4.25%/DEXTROSE 20% ... 31 CLINIMIX 4.25%/DEXTROSE 25% ... 31 CLINIMIX 4.25%/DEXTROSE 5% ..... 31 CLINIMIX 5%/DEXTROSE 15% ................................... 31 CLINIMIX 5%/DEXTROSE 20% ................................... 31 CLINIMIX 5%/DEXTROSE 25% ................................... 31 CLINIMIX E 2.75%/DEXTROSE 10% ... 31 CLINIMIX E 2.75%/DEXTROSE 5% ..... 31 CLINIMIX E 4.25%/DEXTROSE ........... 31 CLINIMIX E 4.25%/DEXTROSE 25% ... 31 CLINIMIX E 4.25%/DEXTROSE 5% ..... 31 CLINIMIX E 5%/DEXTROSE 15% ................................... 31 CLINIMIX E 5%/DEXTROSE 20% ................................... 31 CLINIMIX E 5%/DEXTROSE 25% ................................... 31 clinisol sf 15% ................... 31 CLINORIL

see sulindac ....................1 clobetasol propionate ........ 37 clobetasol propionate emollient base ................... 37 clobetasol propionate emulsion............................ 37 CLOBEX ........................... 37

see clobetasol propionate ...................................... 37

CLODERM PUMP ............. 37 CLOLAR..............................9 clomipramine hcl ............... 17

clonazepam ...................... 15 clonidine & chlorthalidone . 14 clonidine hcl ...................... 14 clopidogrel bisulfate .......... 29 clorazepate dipotassium ... 15 clotrimazole ....................... 39 clotrimazole (topical) ......... 36 CLOZAPINE ODT ............. 18 clozapine tab ..................... 18 CLOZARIL

see clozapine tab .......... 18 COARTEM .......................... 5 codeine

and capital ....................... 1 CODEINE SULFATE .......... 2 COGENTIN

see benztropine mesylate ...................................... 17

COLAZAL see balsalazide disodium ...................................... 27

colchicine w/ probenecid ..... 1 COLCRYS .......................... 1 COLESTID

see colestipol hcl ........... 12 colestipol hcl ..................... 12 colistimethate sodium ......... 4 COLY-MYCIN M

see colistimethate sodium ........................................ 4

COLY-MYCIN S ................ 39 COLYTE-FLAVOR PACKS .......................................... 27

see peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ............................ 27

COMBIGAN ...................... 34 COMBIPATCH .................. 24 COMBIVENT .................... 34 COMBIVENT RESPIMAT . 34 COMBIVIR

see lamivudine-zidovudine ........................................ 6

COMETRIQ ...................... 10 COMPLERA ........................ 6 compro supp ..................... 26 COMTAN

see entacapone ............. 18 COMVAX .......................... 30 CONCERTA

see methylphenidate hcl er ...................................... 19

CONDYLOX ..................... 38 see podofilox ................. 38

CONZIP .............................. 1 COPAXONE ..................... 20 COPEGUS

see ribasphere 200mg .... 6 see ribavirin 200mg ......... 6

CORDARONE see amiodarone hcl ....... 12

CORDRAN ....................... 37 COREG

see carvedilol ................ 13 COREG CR ...................... 13 CORGARD

see nadolol .................... 13 CORTEF

see hydrocortisone ........ 24 CORTENEMA

see hydrocortisone (intrarectal) .................... 27

CORTIFOAM .................... 36 cortisone acetate .............. 24 CORTISPORIN ................. 36

see neomycin-polymyxin-hc (otic) .............................. 39

CORTISPORIN-TC ........... 39 CORZIDE

see nadolol & bendroflumethiazide ...... 13

COSMEGEN ....................... 9 COSOPT

see dorzolamide hcl-timolol maleate ........ 34

COSOPT PF ..................... 34 COUMADIN ...................... 28

see warfarin sodium ...... 29 COUMADIN INJ ................ 28 COZAAR

see losartan potassium . 12 CREON ............................. 28 CRESTOR ........................ 12 CRINONE ......................... 25 CRIXIVAN ........................... 5 cromolyn sodium............... 35 cromolyn sodium (mastocytosis) .................. 27 cromolyn sodium (ophth) .. 34

46

CUBICIN .............................4 CUTIVATE

see fluticasone propionate ...................................... 38

CUVPOSA ........................ 26 CYCLESSA

see desogestrel-ethinyl estradiol (triphasic) ........ 22

cyclobenzaprine hcl .......... 20 cyclophosphamide ..............8 cycloserine ..........................6 cyclosporine ...................... 30 cyclosporine modified (for microemulsion) .................. 30 CYKLOKAPRON

see tranexamic acid ...... 29 CYMBALTA ....................... 17 cyproheptadine hcl ............ 34 CYSTADANE .................... 24 CYSTAGON ...................... 24 cytarabine inj .......................9 CYTOMEL

see liothyronine sodium . 25 CYTOTEC

see misoprostol ............. 27 CYTOVENE

see ganciclovir inj 500mg 6 D D.H.E. 45

see dihydroergotamine mesylate ........................ 19

dacarbazine ........................8 DACOGEN ..........................9 DALIRESP ........................ 35 danazol ............................. 23 DANTRIUM

see dantrolene sodium .. 20 dantrolene sodium ............ 20 dapsone ..............................4 DAPTACEL ....................... 30 DARAPRIM .........................4 daunorubicin hcl ..................9 DAYPRO

see oxaprozin ..................1 DAYTRANA ...................... 19 DDAVP

see desmopressin acetate ...................................... 26 see desmopressin acetate inj ................................... 26

see desmopressin acetate spray ............................. 26

DECAVAC ........................ 30 DELATESTRYL

see testosterone enanthate ...................... 21

DELESTROGEN ............... 24 see estradiol valerate .... 24

DELZICOL ........................ 27 DEMADEX

see torsemide tabs ........ 14 demeclocycline hcl .............. 8 DEMSER .......................... 14 DENAVIR .......................... 37 DEPACON

see valproate sodium .... 16 DEPAKENE

see valproate sodium .... 16 see valproic acid ........... 16

DEPAKOTE see divalproex sodium ... 15

DEPAKOTE ER see divalproex sodium ... 15

DEPAKOTE SPRINKLES see divalproex sodium ... 15

DEPO-MEDROL ............... 24 see methylprednisolone acetate .......................... 24

DEPO-PROVERA CONTRACEPTIV

see medroxyprogesterone acetate (contraceptive) .. 23

DEPO-PROVERA INJ 400/ML ................................ 9 DEPO-SUBQ PROVERA 104 .................................... 22 DERMA-SMOOTHE/FS BODY

see fluocinolone acetonide ...................................... 37

DERMATOP see prednicarbate ......... 38

DERMOTIC see fluocinolone acetonide (otic) .............................. 39

desipramine hcl ................. 17 desloratadine .................... 34 desmopressin acetate ....... 26 DESMOPRESSIN ACETATE .......................................... 26

desmopressin acetate inj .. 26 desmopressin acetate spray.......................................... 26 desmopressin acetate spray refrigerated ....................... 26 DESOGEN

see desogestrel & ethinyl estradiol ........................ 22

desogestrel & ethinyl estradiol ............................ 22 desogestrel-ethinyl estradiol (biphasic) .......................... 22 desogestrel-ethinyl estradiol (triphasic) .......................... 22 DESONATE ...................... 37 desonide ........................... 37 DESONIDE ....................... 37 DESOWEN

see desonide ................. 37 desowen oint kit 0.05% ..... 37 desoximetasone................ 37 DESOXIMETASONE ........ 37 DETROL

see tolterodine tartrate .. 28 DETROL LA ...................... 28 dexamethasone ................ 24 dexamethasone sodium phosphate ......................... 24 dexamethasone sodium phosphate (ophth)............. 33 DEXILANT ........................ 28 dexpak taperpak 13 day ... 24 dexrazoxane ..................... 10 dextrose ............................ 32 DEXTROSE ...................... 32 DEXTROSE 10% FLEX CONTAIN ......................... 32 DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%.......................................... 32 DEXTROSE 10%/NACL 0.45% ............................... 32 DEXTROSE 2.5%/NACL 0.45% ............................... 32 DEXTROSE 5% ................ 32 DEXTROSE 5% /ELECTROLYTE ............... 32 DEXTROSE 5%/LACTATED RING ................................. 32 DEXTROSE 5%/NACL 0.2%

47

.......................................... 32 DEXTROSE 5%/NACL 0.225% .............................. 32 DEXTROSE 5%/NACL 0.3% .......................................... 32 DEXTROSE 5%/NACL 0.33% ................................ 32 DEXTROSE 5%/NACL 0.45% ................................ 32 DEXTROSE 5%/NACL 0.9% .......................................... 32 DEXTROSE 5%/POTASSIUM CHL ...... 32 DIAMOX

see acetazolamide ........ 14 diazepam .......................... 15 DIAZEPAM GEL ............... 15 diazepam inj ...................... 15 DIBENZYLINE .................. 14 diclofenac potassium ..........1 diclofenac sodium ...............1 diclofenac sodium (ophth) . 33 diclofenac w/ misoprostol ....1 dicloxacillin sodium .............8 dicyclomine hcl .................. 26 didanosine...........................5 DIFFERIN ......................... 36

see adapalene ............... 36 DIFICID ...............................7 diflorasone diacetate ......... 37 DIFLUCAN

see fluconazole ...............5 diflunisal ..............................1 digoxin .............................. 14 digoxin inj .......................... 14 DIGOXIN SOL 50MCG/ML .......................................... 14 dihydroergotamine mesylate .......................................... 19 DIHYDROERGOTAMINE MESYLATE ....................... 19 DILACOR XR

see dilt-xr ....................... 13 dilantin .............................. 15 DILANTIN.......................... 15

see phenytoin ................ 16 see phenytoin sodium extended........................ 16

DILANTIN INFATABS see phenytoin ................ 16

DILATRATE SR ................ 15 DILAUDID

see hydromorphone hcl ... 2 DILAUDID-5

see hydromorphone hcl ... 2 DILAUDID-HP

see hydromorphone hcl ... 2 DILAUDID-HP INJ .............. 2 dilt-cd ................................ 13 diltiazem cap 120mg/24hr . 13 diltiazem cap er/12hr......... 13 diltiazem hcl ...................... 13 diltiazem hcl coated beads 13 diltiazem hcl er .................. 13 diltiazem hcl extended release beads ................... 13 dilt-xr ................................. 13 diltzac ................................ 13 DIOVAN ............................ 11 DIOVAN HCT

see valsartan-hydrochlorothiazide .................................. 11

DIPENTUM ....................... 27 diphenhydram inj 50mg/ml 34 diphenoxylate w/ atropine . 27 DIPHTHERIA/TETANUS TOXOID ............................ 30 DIPROLENE

see betamethasone dipropionate augmented 37

DIPROLENE AF see betamethasone dipropionate augmented 37

dipyridamole ..................... 29 disopyramide phosphate ... 12 disulfiram .......................... 20 DITROPAN XL

see oxybutynin chloride . 28 DIURIL SUS 250/5ML ....... 14 divalproex sodium ............. 15 docetaxel ............................ 9 DOCETAXEL ...................... 9 DOLOPHINE

see methadone hcl .......... 3 DOLOPHINE HCL

see methadone hcl .......... 3 donepezil odt 10mg .......... 16 donepezil odt 5mg ............ 16 donepezil tabs 10mg ......... 16

donepezil tabs 5mg ........... 16 DORIBAX ........................... 4 DORYX ............................... 8

see doxycycline hyclate .. 8 dorzolamide hcl................. 34 dorzolamide hcl-timolol maleate ............................. 34 DOVONEX

see calcipotriene ........... 37 doxazosin mesylate .......... 11 doxepin hcl ....................... 17 DOXIL ................................. 9 doxorubicin hcl .................... 9 doxycycline (monohydrate) . 8 doxycycline hyclate ............. 8 dronabinol ......................... 26 drospirenone-ethinyl estradiol ............................ 22 DROXIA ............................ 10 DUETACT

see pioglitazone hcl-glimepiride ............... 22

DUEXIS .............................. 1 DULERA ........................... 35 DUONEB

see ipratropium-albuterol ...................................... 34

DURAGESIC see fentanyl patch ........... 2

DURAMORPH .................... 2 DUREZOL ........................ 33 DYAZIDE

see triamterene & hydrochlorothiazide cap 37.5-25 mg .................... 14

DYMISTA .......................... 35 DYRENIUM ...................... 14 E E.E.S. GRANULES ............. 7 EC-NAPROSYN

see naproxen .................. 1 econazole nitrate .............. 36 EDARBI ............................ 11 EDARBYCLOR ................. 11 EDECRIN ......................... 14 EDLUAR ........................... 19 EDURANT .......................... 5 EFFEXOR XR

see venlafaxine cap er .. 17 EFFIENT ........................... 29

48

EFUDEX see fluorouracil (topical) 36

EGRIFTA .......................... 25 ELAPRASE ....................... 24 ELDEPRYL

see selegiline hcl ........... 18 electrolyte-m in dextrose ... 32 ELECTROLYTE-M IN DEXTROSE ...................... 32 ELECTROLYTE-R IN DEXTROSE ...................... 32 ELELYSO.......................... 24 ELESTAT

see epinastine hcl (ophth) ...................................... 34

ELIDEL ............................. 38 ELIGARD ............................9 ELIMITE

see permethrin .............. 38 ELIPHOS

see calcium acetate (phosphate binder) ........ 25

ELIQUIS ............................ 28 ELITEK ............................. 10 ELLA ................................. 22 ELLENCE

see epirubicin inj 200mg ..9 see epirubicin inj 50mg/25ml .......................9

ELMIRON.......................... 28 ELOCON

see mometasone furoate ...................................... 38

ELOXATIN ........................ 10 ELSPAR ............................ 10 EMADINE.......................... 34 EMCYT ...............................8 EMEND ............................. 26 EMEND PAK 80 & 125 ..... 26 EMLA

see lidocaine-prilocaine . 38 EMSAM ............................. 17 EMTRIVA ............................5 ENABLEX ......................... 28 enalapril maleate ............... 11 enalapril maleate & hydrochlorothiazide ........... 11 ENBREL............................ 29 endocet 10/325 ...................2 endocet 5/325 .....................2

endocet 7.5/325 .................. 2 ENDODAN .......................... 2 ENDOMETRIN .................. 25 ENGERIX-B ...................... 30 enoxaparin sodium ........... 29 entacapone ....................... 18 ENTOCORT EC

see budesonide ............. 27 EPIDUO ............................ 36 epinastine hcl (ophth)........ 34 EPIPEN 2-PAK ................. 35 EPIPEN-JR 2-PAK ............ 35 epirubicin inj 200mg ............ 9 EPIRUBICIN INJ 50MG ...... 9 epirubicin inj 50mg/25ml ..... 9 EPIVIR

see lamivudine ................ 5 EPIVIR HBV ........................ 6 EPIVIR SOL 10MG/ML ....... 5 eplerenone ........................ 11 EPOGEN .......................... 29 eprosartan mesylate ......... 11 EPZICOM ........................... 6 EQUETRO ........................ 20 ERAXIS ............................... 5 ERBITUX ............................ 9 ergomar ............................ 19 ergotamine w/ caffeine ...... 19 ERIVEDGE ......................... 9 ERYPED 200 ...................... 7 ERYPED 400 ...................... 7 erythromycin (acne aid) .... 36 erythromycin (ophth) ......... 33 erythromycin base .............. 7 erythromycin ethylsuccinate 7 erythromycin lactobionate ... 7 erythromycin stearate ......... 7 erythromycin-sulfisoxazole .. 4 escitalopram oxalate ......... 17 ESTRACE

see estradiol .................. 24 estradiol ............................ 24 estradiol & norethindrone acetate .............................. 24 estradiol cypionate ............ 24 estradiol vaginal ................ 24 estradiol valerate .............. 24 ESTRADIOL VALERATE .. 24 ESTRING .......................... 24 estropipate ........................ 24

ESTROSTEP FE see norethindrone acetate-ethinyl estradiol-fe ...................................... 23

ethambutol hcl .................... 6 ethosuximide .................... 15 ethynodiol diacet & eth estrad ................................ 22 ETHYOL

see amifostine crystalline ...................................... 10

etodolac .............................. 1 etodolac er .......................... 1 ETOPOPHOS ................... 10 etoposide .......................... 10 EURAX ............................. 38 EVISTA ............................. 25 EVOCLIN

see clindamycin phosphate (topical) ........ 36

EVOXAC see cevimeline hcl ......... 39

EXALGO ............................. 2 EXELDERM ...................... 36 EXELON ........................... 16

see rivastigmine tartrate 16 EXELON PATCHES ......... 16 exemestane ........................ 9 EXFORGE ........................ 11 EXFORGE HCT ................ 11 EXJADE ............................ 22 EXTAVIA .......................... 20 EXTINA

see ketoconazole (topical) ...................................... 36

F FABRAZYME .................... 24 FACTIVE ............................ 7 famciclovir ........................... 6 famotidine ......................... 26 FAMVIR

see famciclovir ................ 6 FANAPT ........................... 18 FANAPT TITRATION PACK.......................................... 18 FARESTON ........................ 9 FASLODEX ...................... 10 FAZACLO ......................... 18 felbamate .......................... 15 FELBATOL

49

see felbamate ................ 15 FELDENE

see piroxicam ..................1 felodipine........................... 13 FEMARA

see letrozole .................. 10 FEMCON FE

see norethindrone & ethinyl estradiol-fe ......... 23

FEMRING ......................... 24 fenofibrate ......................... 12 fenofibrate micronized ....... 12 FENOFIBRATE MICRONIZED ................... 12 FENOFIBRIC ACID ........... 12 FENOGLIDE ..................... 12 fenoprofen calcium ..............1 fentanyl citrate .....................2 fentanyl patch ......................2 FENTORA ...........................2 FERRIPROX ..................... 22 FEXMID

see cyclobenzaprine hcl 20 FINACEA .......................... 38 finasteride ......................... 28 FIRMAGON ....................... 10 FLAGYL ..............................4

see metronidazole ...........4 FLAGYL ER ........................4 FLAREX ............................ 33 FLEBOGAMMA ................. 30 FLEBOGAMMA DIF .......... 30 flecainide acetate .............. 12 FLEXERIL

see cyclobenzaprine hcl 20 FLOMAX

see tamsulosin hcl ......... 28 FLONASE

see fluticasone propionate (nasal) ........................... 35

FLO-PRED ........................ 24 FLOVENT DISKUS ........... 35 FLOVENT HFA ................. 35 fluconazole ..........................5 fluconazole in dextrose .......5 fluconazole in nacl ..............5 flucytosine ...........................5 FLUDARA

see fludarabine phosphate ........................................9

fludarabine phosphate ........ 9 fludrocortisone acetate...... 24 FLUMADINE

see rimantadine hydrochloride ................... 6

flunisolide (nasal) .............. 35 fluocinolone acetonide ...... 37 fluocinolone acetonide (otic) .......................................... 39 fluocinonide ....................... 38 fluocinonide emulsified base .......................................... 38 FLUOROMETHOLONE .... 33 FLUOROMETHOLONE (OPHTH) ........................... 33 FLUOROPLEX .................. 36 fluorouracil .......................... 9 fluorouracil (topical) .......... 36 fluoxetine hcl ..................... 17 FLUOXETINE HCL ........... 17 fluoxymesterone ............... 21 fluphenazine decanoate .... 18 fluphenazine hcl ................ 18 flurbiprofen .......................... 1 flurbiprofen sodium ........... 33 flutamide ........................... 10 fluticasone propionate ....... 38 fluticasone propionate (nasal) ............................... 35 fluvastatin sodium ............. 12 fluvoxamine maleate ......... 15 fluvoxamine maleate er ..... 15 fluvoxamine tabs ............... 15 FML................................... 33 FML FORTE ..................... 33 fondaparinux sodium......... 29 FORADIL AEROLIZER ..... 35 FORFIVO XL .................... 17 FORTAMET

see metformin hcl .......... 22 FORTAZ ............................. 7

see ceftazidime ............... 7 see tazicef vial ................. 7

FORTEO ........................... 25 FORTESTA ....................... 21 FORTICAL SPR 200/ACT . 25 FOSAMAX

see alendronate sodium 22 FOSAMAX PLUS D .......... 22 foscarnet sodium ................ 6

fosinopril sodium ............... 11 fosinopril sodium & hydrochlorothiazide ........... 11 FOSRENOL ...................... 25 FRAGMIN ......................... 29 FREAMINE HBC 6.9% ..... 31 FREAMINE III ................... 31 FROVA TAB 2.5MG .......... 19 FURADANTIN

see nitrofurantoin ............ 4 furosemide ........................ 14 furosemide inj ................... 14 furosemide oral soln 8 mg/ml.......................................... 14 FUZEON ............................. 5 G gabapentin ........................ 15 GABITRIL ......................... 15

see tiagabine hcl ........... 16 galantamine hydrobromide 16 GAMASTAN S/D............... 30 GAMMAGARD LIQUID ..... 30 GAMMAGARD S/D ........... 30 GAMMAKED ..................... 30 GAMMAPLEX ................... 30 GAMUNEX ....................... 30 GAMUNEX-C 10GM/100ML.......................................... 30 GAMUNEX-C 1GM/10ML . 30 GAMUNEX-C 2.5GM/25ML.......................................... 30 GAMUNEX-C 20GM/200ML.......................................... 30 GAMUNEX-C 5GM/50ML . 30 ganciclovir inj 500mg .......... 6 GARAMYCIN

see gentamicin sulfate (ophth) ........................... 33

GARDASIL ....................... 30 GASTROCROM

see cromolyn sodium (mastocytosis) ............... 27

GATTEX ........................... 27 GELNIQUE ....................... 28 GEMCITABINE ................... 9 gemcitabine hcl ................... 9 gemfibrozil ........................ 12 GEMZAR

see gemcitabine hcl ........ 9 GENERESS FE ................ 22

50

GENOTROPIN .................. 25 GENOTROPIN MINIQUICK .......................................... 25 gentamicin in saline ............4 gentamicin sulfate ...............4 gentamicin sulfate (ophth) . 33 gentamicin sulfate (topical) .......................................... 36 GEODON

see ziprasidone hcl ........ 18 GEODON INJ .................... 18 GIANVI .............................. 22 GIAZO ............................... 27 GILENYA .......................... 20 GLASSIA........................... 35 GLEEVEC ......................... 10 glimepiride......................... 21 glipizide ............................. 21 glipizide er ......................... 21 glipizide-metformin 2.5-250mg ......................... 21 glipizide-metformin 2.5-500mg ......................... 21 glipizide-metformin 5-500mg .......................................... 21 GLUCAGEN HYPOKIT ..... 25 GLUCAGON EMERGENCY KIT .................................... 25 GLUCOPHAGE

see metformin hcl .......... 22 GLUCOPHAGE XR

see metformin er ........... 22 GLUCOTROL

see glipizide ................... 21 GLUCOTROL XL

see glipizide er .............. 21 GLUCOVANCE

see glyburide-metformin 1.25-250mg ................... 21 see glyburide-metformin 2.5-500mg ..................... 21 see glyburide-metformin 5-500mg ........................ 22

GLUMETZA ...................... 21 glyburide ........................... 21 glyburide micronized ......... 21 glyburide-metformin 1.25-250mg ....................... 21 glyburide-metformin 2.5-500mg ......................... 21

glyburide-metformin 5-500mg ............................ 22 glycopyrrolate ................... 26 GLYNASE

see glyburide micronized ...................................... 21

GLYSET ............................ 22 GOLYTELY ....................... 27

see peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ............................ 27

GRALISE .......................... 20 GRALISE STARTER......... 20 granisetron hcl .................. 26 GRIFULVIN V

see griseofulvin microsize ........................................ 5

griseofulvin microsize.......... 5 griseofulvin ultramicrosize ... 5 GRIS-PEG

see griseofulvin ultramicrosize .................. 5

H HALAVEN ......................... 10 HALDOL

see haloperidol lactate .. 18 HALDOL DECANOATE 100

see haloperidol decanoate ...................................... 18

HALDOL DECANOATE 50 see haloperidol decanoate ...................................... 18

HALFLYTELY BOWEL PREP/FLA ........................ 27 halobetasol propionate...... 38 HALOG ............................. 38 haloperidol ........................ 18 haloperidol decanoate....... 18 haloperidol lactate ............. 18 HAVRIX ............................ 30 heather tab 0.35mg ........... 23 HECTOROL ...................... 32 HELIDAC .......................... 27 HEP SOD/NACL INJ 25000 .......................................... 29 HEPARIN (PORCINE) IN SODIUM CHLORIDE 100U/ML ........................... 29 heparin sod inj 10000u/ml . 29 heparin sod inj 1000u/ml ... 29

heparin sod inj 20000u/ml . 29 HEPARIN SOD INJ 2000U/ML ......................... 29 HEPARIN SOD INJ 2500U/ML ......................... 29 heparin sod inj 5000u/0.5ml.......................................... 29 heparin sod inj 5000u/ml ... 29 HEPARIN SODIUM/D5W . 29 HEPARIN SODIUM/SODIUM CHL .... 29 HEPATAMINE .................. 31 hepatasol 8 ....................... 31 HEPSERA .......................... 6 HERCEPTIN ....................... 9 HEXALEN ........................... 8 HIBERIX ........................... 30 HIPREX

see methenamine hippurate ......................... 4

HORIZANT ....................... 20 HUMALOG ....................... 21 HUMALOG KWIKPEN ...... 21 HUMALOG MIX 50/50 ...... 21 HUMALOG MIX 50/50 KWIKPEN ......................... 21 HUMALOG MIX 75/25 ...... 21 HUMALOG MIX 75/25 KWIKPEN ......................... 21 HUMATROPE ................... 25 HUMATROPE COMBO PACK ................................ 25 HUMIRA ........................... 29 HUMIRA PEN ................... 29 HUMIRA PEN-CROHNS STARTER KIT .................. 29 HUMIRA PEN-PSORIASIS STARTER KIT .................. 29 HUMULIN 70/30 ............... 21 HUMULIN 70/30 PEN ....... 21 HUMULIN N ...................... 21 HUMULIN N U-100 PEN ... 21 HUMULIN R ...................... 21 HUMULIN R U-500 (CONCENTRATE) ............ 21 HYCAMTIN

see topotecan hcl .......... 11 HYCET

see hydrocodone-acetaminoph

51

en 7.5-325 mg/15ml ........2 hydralazine hcl .................. 14 HYDREA

see hydroxyurea ............ 10 hydrochlorothiazide ........... 14 hydrocodone-acetaminophen ............................................1 hydrocodone-acetaminophen 10-300mg ............................2 hydrocodone-acetaminophen 10-500mg ............................2 hydrocodone-acetaminophen 10-650mg ............................2 hydrocodone-acetaminophen 10-660mg ............................2 hydrocodone-acetaminophen 10-750mg ............................2 hydrocodone-acetaminophen 2.5-325mg ...........................1 hydrocodone-acetaminophen 2.5-500mg ...........................1 hydrocodone-acetaminophen 5-300mg ..............................1 hydrocodone-acetaminophen 5-325mg ..............................1 hydrocodone-acetaminophen 5-500mg ..............................2 hydrocodone-acetaminophen 7.5-300mg ...........................2 hydrocodone-acetaminophen 7.5-325 mg/15ml .................2 hydrocodone-acetaminophen 7.5-325mg ...........................2 hydrocodone-acetaminophen 7.5-500mg ...........................2 hydrocodone-acetaminophen 7.5-500mg/ml ......................2 hydrocodone-acetaminophen 7.5-650mg ...........................2 hydrocodone-acetaminophen 7.5-750mg ...........................2 hydrocodone-acetaminophen tab 10-325mg ......................2 hydrocodone-ibuprofen .......2 hydrocortisone .................. 24 hydrocortisone (intrarectal) .......................................... 27 HYDROCORTISONE (INTRARECTAL) ............... 27 hydrocortisone (rectal) ...... 37

hydrocortisone (topical) ..... 38 hydrocortisone butyrate .... 38 hydrocortisone valerate..... 38 hydrocortisone w/acetic acid .......................................... 39 hydromorphone hcl ............. 2 hydroxychloroquine sulfate .......................................... 29 hydroxyurea ...................... 10 hydroxyzine hcl ................. 34 hydroxyzine pamoate ........ 34 HYZAAR

see losartan potassium & hydrochlorothiazide ....... 11

I ibandronate sodium .......... 22 ibudone tab 5-200mg .......... 2 ibuprofen ............................. 1 ICLUSIG ........................... 10 IDAMYCIN PFS

see idarubicin hcl ............ 9 idarubicin hcl ....................... 9 IFEX

see ifosfamide ................. 9 IFEX INJ 3GM ..................... 9 ifosfamide ........................... 9 IFOSFAMIDE

see ifosfamide ................. 9 ILEVRO ............................. 33 IMDUR

see isosorbide mononitrate ................... 15

imipenem-cilastatin ............. 4 imipramine hcl ................... 17 imipramine pamoate ......... 17 imiquimod ......................... 38 IMITREX

see sumatriptan succinate ...................................... 19 see sumatriptan succinate inj................................... 20

IMOVAX RABIES (H.D.C.V.) .......................................... 30 IMURAN

see azathioprine ............ 30 INCIVEK ............................. 6 INCRELEX ........................ 25 indapamide ....................... 14 INDERAL LA

see propranolol hcl er .... 13

INFANRIX ......................... 30 INFERGEN ....................... 30 INFUMORPH 200 ............... 2 INFUMORPH 500 ............... 2 INLYTA ............................. 10 INSPRA

see eplerenone ............. 11 INTELENCE ....................... 5 INTERMEZZO .................. 19 INTRALIPID INJ 20% ....... 31 INTRALIPID INJ 30% ....... 31 INTRON-A ........................ 30 INTRON-A W/DILUENT .... 30 INTUNIV ........................... 19 INVANZ .............................. 4 INVEGA ............................ 18 INVEGA SUSTENNA ........ 18 INVIRASE ........................... 5 INVOKANA ....................... 22 IONOSOL-B/DEXTROSE 5% .................................... 32 IONOSOL-MB/DEXTROSE 5% .................................... 32 IPOL INACTIVATED IPV .. 30 ipratropium bromide (nasal).......................................... 34 ipratropium sol inhal .......... 34 ipratropium-albuterol ......... 34 irbesartan .......................... 11 irbesartan-hydrochlorothiazide........................................ 11 IRESSA ............................ 10 irinotecan .......................... 10 irinotecan hcl .................... 10 ISENTRESS ....................... 5 ISOLYTE P ....................... 32 isolyte s ............................. 32 isoniazid .............................. 6 isoniazid & rifampin ............. 6 isoniazid tabs ...................... 6 ISOPTO CARPINE ........... 34 ISORDIL TITRADOSE ...... 15

see isosorbide dinitrate . 15 isosorbide dinitrate ............ 15 isosorbide mononitrate ..... 15 isotretinoin cap 10 mg ....... 36 isradipine .......................... 13 ISTALOL ........................... 34 ISTODAX ............................ 9 itraconazole ........................ 5

52

IXEMPRA KIT ................... 10 IXIARO .............................. 30 J JAKAFI .............................. 10 JALYN ............................... 28 JANUMET ......................... 22 JANUMET XR TAB 100-1000 ........................... 22 JANUMET XR TAB 50-1000 .......................................... 22 JANUMET XR TAB 50-500MG ......................... 22 JANUVIA ........................... 22 JENTADUETO .................. 22 JOLIVETTE ....................... 23 JUVISYNC ........................ 22 K KADCYLA ...........................9 KADIAN...............................3 KALETRA SOL ...................6 KALETRA TAB 100-25MG ..6 KALETRA TAB 200-50MG ..6 KAYEXALATE

see kionex ..................... 22 KAZANO ........................... 22 KCL 0.075%/D5W/NACL 0.45% ................................ 32 KCL 0.15%/D5W/LR ......... 32 KCL 0.15%/D5W/NACL 0.9% .................................. 32 kcl 0.3%/d5w/lr iv lac ri ...... 32 KCL 0.3%/D5W/NACL 0.45% ................................ 32 KCL 0.3%/D5W/NACL 0.9% .......................................... 32 KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 32 kcl 20 meq/l (0.15%) in nacl 0.45% inj ........................... 32 KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ ............... 32 KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 32 KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 32 KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ ................. 32

KCL0.15%/D5W/NACL0.2% .......................................... 32 KCL0.15%/D5W/NACL0.225% ...................................... 32 KEFLEX

see cephalexin ................ 7 KENALOG ........................ 38 KEPIVANCE ..................... 10 KEPPRA

see levetiracetam .......... 16 KEPPRA XR

see levetiracetam .......... 16 KERLONE

see betaxolol hcl ........... 13 ketoconazole ....................... 5 ketoconazole (topical) ....... 36 ketoconazole shampoo ..... 37 ketoprofen ........................... 1 ketorolac tromethamine (ophth) .............................. 33 KINERET .......................... 29 kionex ............................... 22 KLARON

see sulfacetamide sodium (acne) ............................ 36

KLONOPIN see clonazepam ............ 15

KLOR-CON 10 .................. 31 KLOR-CON 8 .................... 31 klor-con m15 ..................... 31 klor-con m20 ..................... 31 KOMBIGLYZE XR 2.5-1000MG ...................... 22 KOMBIGLYZE XR 5-1000MG ......................... 22 KOMBIGLYZE XR 5-500MG .......................................... 22 kristalose pak .................... 27 KUVAN ............................. 24 L labetalol hcl ....................... 13 LAC-HYDRIN

see ammonium lactate .. 38 see laclotion lotn 12% ... 38

laclotion lotn 12% .............. 38 LACRISERT ...................... 34 LACTATED RINGERS VIAFLEX ........................... 32 lactulose ............................ 27 lactulose (encephalopathy)

.......................................... 27 LAMICTAL

see lamotrigine .............. 16 LAMICTAL CHEWABLE DISPERS

see lamotrigine .............. 16 LAMICTAL ODT................ 15 LAMICTAL STARTER ...... 16 LAMICTAL XR .................. 16

see lamotrigine .............. 16 LAMISIL .............................. 5

see terbinafine hcl ........... 5 lamivudine .......................... 5 lamivudine-zidovudine ........ 6 lamotrigine ........................ 16 LANOXIN

see digoxin .................... 14 see digoxin inj ............... 14

LANOXIN PEDIATRIC ...... 14 LANOXIN TAB .................. 14 lansoprazole ..................... 28 LANTUS ........................... 21 LANTUS SOLOSTAR ....... 21 LASIX

see furosemide.............. 14 LASTACAFT ..................... 34 latanoprost ........................ 34 LATUDA ........................... 18 LAZANDA ........................... 3 LEENA .............................. 23 leflunomide ....................... 29 LESCOL

see fluvastatin sodium ... 12 LESCOL XL ...................... 12 LETAIRIS .......................... 15 letrozole ............................ 10 leucovor ca inj ................... 10 leucovorin calcium ............ 10 LEUKERAN ........................ 9 LEUKINE .......................... 29 leuprolide acetate ............. 10 levalbuterol conc 1.25mg/0.5ml .................... 35 levalbuterol hcl .................. 35 LEVALBUTEROL HCL ..... 35 LEVAQUIN

see levofloxacin............... 7 see levofloxacin in d5w ... 7

LEVATOL ......................... 13 LEVEMIR .......................... 21

53

LEVEMIR FLEXPEN ......... 21 levetiracetam ..................... 16 levobunolol hcl .................. 34 LEVOBUNOLOL HCL ....... 34 levocarnitine (metabolic modifiers) .......................... 24 levocetirizine soln 2.5mg/5ml .......................................... 35 levocetirizine tab 5 mg ...... 35 levofloxacin .........................7 levofloxacin (ophth) ........... 33 levofloxacin in d5w ..............7 levonorgestrel & eth estradiol .......................................... 23 levonorgestrel-eth estradiol (triphasic) .......................... 23 levonorgestrel-ethinyl estradiol (91-day) .............. 23 levonorgestrel-ethinyl estradiol (continuous) ........ 23 levorphanol tartrate .............3 LEVOTHROID ................... 25 levothyroxine sodium ........ 25 LEVOXYL.......................... 25 LEXAPRO

see escitalopram oxalate ...................................... 17

LEXIVA ...............................5 LIALDA ............................. 27 lidocaine ............................ 38 lidocaine hcl ...................... 38 lidocaine hcl (local anesth.) .3 lidocaine hcl (mouth-throat) .......................................... 39 lidocaine inj 0.5% ................3 lidocaine inj 1% ...................3 lidocaine inj 1.5% ................3 lidocaine inj 2% ............... 3, 4 lidocaine-prilocaine ........... 38 LIDODERM ....................... 38 LINZESS CAP 145MCG ... 27 LINZESS CAP 290MCG ... 27 liothyronine sodium ........... 25 LIPITOR

see atorvastatin calcium 12 LIPOFEN........................... 12 lisinopril ............................. 11 lisinopril & hydrochlorothiazide ........... 11 lithium carbonate ............... 20

LITHIUM CITRATE ........... 20 LITHOBID

see lithium carbonate .... 20 LIVALO ............................. 12 LO LOESTRIN FE ............ 23 LOCOID ............................ 38

see hydrocortisone butyrate ......................... 38

LOCOID LIPOCREAM ...... 38 LODOSYN ........................ 18 LOESTRIN 1.5/30-21

see norethindrone acet & eth estra ........................ 23

LOESTRIN 1/20-21 see norethindrone acet & eth estra ........................ 23

LOESTRIN 24 FE ............. 23 LOESTRIN FE 1.5/30

see norethin acet & estrad-fe ........................ 23

LOESTRIN FE 1/20 see norethin acet & estrad-fe ........................ 23

LOFIBRA see fenofibrate .............. 12 see fenofibrate micronized ...................................... 12

LOKARA LOTN 0.05%...... 38 LOMOTIL

see diphenoxylate w/ atropine ......................... 27

loperamide hcl .................. 27 LOPID

see gemfibrozil .............. 12 LOPRESSOR

see metoprolol tartrate .. 13 LOPRESSOR HCT

see metoprolol & hctz tab 100-25mg ...................... 13 see metoprolol & hctz tab 50-25mg ........................ 13

LOPROX see ciclopirox ................ 36

LOPROX SHAMPOO see ciclopirox shampoo 1% ................................. 36

lorazepam ......................... 15 LORCET 10/650

see hydrocodone-acetaminoph

en 10-650mg ................... 2 LORTAB

see hydrocodone-acetaminophen .................................... 1 see hydrocodone-acetaminophen 10-500mg ................... 2 see hydrocodone-acetaminophen 5-500mg ..................... 2 see hydrocodone-acetaminophen 7.5-500mg .................. 2 see hydrocodone-acetaminophen 7.5-500mg/ml ............. 2

losartan potassium ............ 12 losartan potassium & hydrochlorothiazide ........... 11 LOTEMAX ........................ 33 LOTENSIN

see benazepril hcl ......... 11 LOTENSIN HCT

see benazepril & hydrochlorothiazide ....... 11

LOTREL see amlodipine besylate-benazepril hcl . 11

LOTRONEX ...................... 27 lovastatin .......................... 12 LOVAZA ........................... 12 LOVENOX

see enoxaparin sodium . 29 loxapine succinate ............ 18 LOXITANE

see loxapine succinate .. 18 LUFYLLIN ......................... 36 LUMIGAN ......................... 34 LUMIZYME ....................... 24 LUNESTA ......................... 19 LUPR DEP-PED INJ 11.25MG (3-MONTH) ....... 10 LUPR DEP-PED INJ 30MG (3-MONTH) ....................... 10 LUPRON DEPOT ............. 10 LUPRON DEPOT INJ 22.5MG (3-MONTH) ......... 10 LUPRON DEPOT INJ 30MG (3-MONTH) ....................... 10

54

LUPRON DEPOT-PED ..... 10 LUVOX CR

see fluvoxamine maleate er ................................... 15

LUXIQ see betamethasone valerate.......................... 37

LYRICA ............................. 16 LYSODREN ...................... 10 LYSTEDA

see tranexamic acid ...... 29 M MACROBID

see nitrofurantoin monohyd macro ...............4

MACRODANTIN .................4 see nitrofurantoin macrocrystal ....................4

mafenide acetate .............. 36 magnesium sulfate ............ 31 MAGNESIUM SULFATE ... 31 MAGNESIUM SULFATE IN D5W .................................. 31 MALARONE

see atovaquone-proguanil hcl tab 250-100 mg ..........5

malathion .......................... 38 maprotiline hcl ................... 17 MARINOL

see dronabinol ............... 26 MARPLAN ......................... 17 MATULANE ...................... 10 matzim la........................... 13 MAVIK

see trandolapril .............. 11 MAXALT

see rizatriptan benzoate 19 MAXALT-MLT

see rizatriptan benzoate 19 MAXIDEX .......................... 33 MAXIDONE

see hydrocodone-acetaminophen 10-750mg ...................2

MAXIPIME ..........................7 see cefepime inj 1gm ......6 see cefepime inj 2gm ......6

MAXITROL see neomycin-polymy-dexamet

h .................................... 33 MAXZIDE

see triamterene & hydrochlorothiazide tab 75-50 mg ....................... 14

MAXZIDE-25 see triamterene & hydrochlorothiazide tab 37.5-25 mg .................... 14

meclizine hcl ..................... 26 MEDROL .......................... 24

see methylprednisolone 24 MEDROL DOSEPAK

see methylprednisolone 24 medroxyprogesterone acetate .............................. 25 medroxyprogesterone acetate (contraceptive) ..... 23 mefenamic acid ................... 1 mefloquine hcl ..................... 5 MEGACE ES .................... 10 MEGACE ORAL

see megestrol acetate ... 10 megestrol acetate ............. 10 MEKINIST ......................... 10 MELOXICAM SUSP 7.5 MG/5ML .............................. 1 meloxicam tabs ................... 1 melphalan hcl ...................... 9 MENACTRA ...................... 31 menest .............................. 24 MENHIBRIX ...................... 31 MENOMUNE-A/C/Y/W-135 .......................................... 31 MENOSTAR ..................... 24 MENTAX ........................... 36 MENVEO .......................... 31 MEPRON ............................ 4 mercaptopurine ................... 9 meropenem ......................... 4 MERREM

see meropenem .............. 4 mesalamine enema .......... 27 mesalamine enema kit ...... 27 mesna ............................... 10 MESNEX ........................... 10

see mesna ..................... 10 MESTINON

see pyridostigmine bromide ......................... 20

MESTINON SYRUP ......... 20 MESTINON TIMESPAN ... 20 METADATE CD

see methylphenidate hcl 19 metadate tab 20mg er ....... 19 METAGLIP

see glipizide-metformin 2.5-250mg ..................... 21

metformin er ..................... 22 metformin hcl .................... 22 methadone hcl .................... 3 METHADONE INJ 10MG/ML............................................ 3 METHADOSE

see methadone hcl .......... 3 methazolamide ................. 14 methenamine hippurate ...... 4 METHERGINE

see methylergonovine maleate ......................... 25

methimazole ..................... 25 methocarbamol ................. 20 methotrexate sodium ........ 29 methotrexate sodium inj ...... 9 methotrexate sodium tabs 29 methscopolamine bromide 26 methyclothiazide ............... 14 methylergonovine maleate 25 METHYLIN

see methylphenidate hcl 19 METHYLIN CHEW TAB .... 19 methylphenidate hcl .......... 19 methylphenidate hcl er ...... 19 METHYLPHENIDATE HCL ER ..................................... 19 methylprednisolone ........... 24 methylprednisolone acetate.......................................... 24 methylprednisolone sod succ.......................................... 24 metipranolol ...................... 34 metoclopramide hcl ........... 26 metoclopramide hcl inj 5 mg/ml ................................ 26 metolazone ....................... 14 metoprolol & hctz tab 100-25mg ......................... 13 metoprolol & hctz tab 100-50mg ......................... 13 metoprolol & hctz tab

55

50-25mg ............................ 13 metoprolol succinate ......... 13 metoprolol tartrate ............. 13 METOZOLV ODT .............. 26 METRO IV ...........................4 METROCREAM

see metronidazole (topical).......................... 38 see rosadan cre 0.75% . 38

METROGEL ...................... 38 see metronidazole (topical).......................... 38

METROGEL-VAGINAL see metronidazole vaginal ...................................... 28

METROLOTION see metronidazole (topical).......................... 38

metronidazole .....................4 metronidazole (topical) ...... 38 metronidazole inj .................4 metronidazole vaginal ....... 28 MEVACOR

see lovastatin ................ 12 mexiletine hcl .................... 12 MIACALCIN

see calcitonin (salmon) nasal spray .................... 25

MIACALCIN INJ 200U/ML. 25 MICARDIS ........................ 12 MICARDIS HCT ................ 11 miconazole nitrate vaginal. 28 MICRO-K

see potassium chloride caps er........................... 31

MICROZIDE see hydrochlorothiazide 14

midodrine hcl ..................... 14 MINASTRIN 24 FE ............ 23 MINIPRESS

see prazosin hcl ............ 11 minitran ............................. 15 MINIVELLE ....................... 24 MINOCIN

see minocycline hcl .........8 minocycline hcl ....................8 minoxidil ............................ 15 MIRAPEX .......................... 18

see pramipexole dihydrochloride .............. 18

MIRAPEX ER .................... 18 MIRCETTE

see desogestrel-ethinyl estradiol (biphasic) ........ 22 see viorele ..................... 23

mirtazapine ....................... 17 misoprostol ....................... 27 mitomycin ............................ 9 mitoxantrone hcl ............... 10 M-M-R II W/DILUENT 10 DOS .................................. 31 MOBIC

see meloxicam tabs......... 1 modafinil ........................... 20 moexipril hcl ...................... 11 moexipril-hydrochlorothiazide ........................................ 11 mometasone furoate ......... 38 MONODOX

see doxycycline (monohydrate) ................. 8

MONONESSA .................. 23 montelukast sodium .......... 35 MORPHINE SUL 20MG/ML ORAL SOL .......................... 3 morphine sulfate ................. 3 MORPHINE SULFATE ....... 3 morphine sulfate ext-rel tab 3 morphine sulfate inj ............. 3 MORPHINE SULFATE INJ . 3 MOVIPREP ....................... 27 MOXATAG .......................... 8 MOXEZA ........................... 33 MOZOBIL .......................... 29 MS CONTIN

see morphine sulfate ext-rel tab ........................ 3

MULTAQ ........................... 12 mupirocin .......................... 36 mupirocin calcium (topical) 36 MUSTARGEN ..................... 9 MYAMBUTOL

see ethambutol hcl .......... 6 MYCAMINE ........................ 5 MYCOBUTIN ...................... 6 mycophenolate mofetil ...... 30 MYFORTIC ....................... 30 myorisan ........................... 36 MYOZYME ........................ 24 MYRBETRIQ .................... 28

MYSOLINE see primidone................ 16

myzilra .............................. 23 N nabumetone ........................ 1 nadolol .............................. 13 nadolol & bendroflumethiazide ......... 13 nafcillin sodium ................... 8 NAFTIN ............................. 36 NAGLAZYME ................... 24 NALFON ............................. 1 NALLPEN ISO-OSMOTIC IN DE ....................................... 8 NALLPEN/DEXTROSE ....... 8 naloxone hcl ..................... 21 naltrexone hcl ................... 21 NAMENDA ........................ 16 NAMENDA TITRATION PAK.......................................... 16 NAMENDA XR .................. 16 NAMENDA XR TITRATION PACK ................................ 16 NAPRELAN ........................ 1 NAPROSYN

see naproxen .................. 1 naproxen ............................. 1 naproxen sodium ................ 1 naratriptan hcl ................... 19 NARDIL

see phenelzine sulfate .. 17 NASACORT AQ

see triamcinolone acetonide (nasal) ........... 35

NASONEX ........................ 35 NATACYN ........................ 33 nateglinide ........................ 22 NAVELBINE

see vinorelbine tartrate .... 9 NEBUPENT ........................ 4 NECON 1/50-28................ 23 necon 10/11 28 day .......... 23 NECON 7/7/7 .................... 23 nefazodone hcl ................. 17 neomycin sulfate ................. 4 neomycin/polymyxin b gu . 38 neomycin-bacitracin zn-polymyxin ..................... 33 neomycin-polymy-dexameth.......................................... 33

56

neomycin-polymy-gramicid .......................................... 33 neomycin-polymyxin-hc (ophth) .............................. 33 neomycin-polymyxin-hc (otic) .......................................... 39 NEORAL ........................... 30

see cyclosporine modified (for microemulsion) ........ 30

NEOSPORIN see neomycin-polymy-gramicid ...................................... 33

NEOSPORIN GU IRRIGANT see neomycin/polymyxin b gu .................................. 38

NEPHRAMINE .................. 31 NEPTAZANE

see methazolamide ....... 14 NESINA............................. 22 NEULASTA ....................... 29 NEUMEGA ........................ 29 NEUPOGEN ..................... 29 NEUPRO........................... 18 NEURONTIN

see gabapentin .............. 15 NEVANAC ......................... 33 nevirapine ...........................5 NEVIRAPINE ......................5 NEXAVAR ......................... 10 NEXIUM ............................ 28 NEXIUM GRANULES 10MG DR ..................................... 28 NEXIUM GRANULES 2.5MG DR ..................................... 28 NEXIUM GRANULES 20MG DR ..................................... 28 NEXIUM GRANULES 40MG DR ..................................... 28 NEXIUM GRANULES 5MG DR ..................................... 28 NEXIUM I.V. ...................... 28 next choice tab 1.5mg ....... 23 niacor ................................ 12 NIASPAN .......................... 12 nicardipine hcl ................... 13 NICOTROL INHALER ....... 21 NICOTROL NS ................. 21 nifedipine........................... 13 nifedipine cc tab 90mg er .. 13

nifedipine cr ...................... 13 nifedipine er ...................... 13 nifedipine xl ....................... 13 NILANDRON ..................... 10 nimodipine ........................ 13 NIPENT

see pentostatin ................ 9 nisoldipine ......................... 13 NITRO-DUR ...................... 15

see minitran ................... 15 nitrofurantoin ....................... 4 nitrofurantoin macrocrystal .. 4 nitrofurantoin monohyd macro .................................. 4 nitroglycerin ...................... 15 NITROGLYCERIN ............ 15 NITROGLYCERIN LINGUAL .......................................... 15 nitroglycerin patches ......... 15 NITROLINGUAL SPR PUMPSPRA ...................... 15 NITROMIST ...................... 15 NITROSTAT ..................... 15 nizatidine ..................... 26, 27 NIZORAL

see ketoconazole shampoo ....................... 37

NORA-BE ......................... 23 NORCO

see hydrocodone-acetaminophen 5-325mg ..................... 1 see hydrocodone-acetaminophen 7.5-325mg .................. 2 see hydrocodone-acetaminophen tab 10-325mg ............. 2

NORDITROPIN FLEXPRO .......................................... 25 NORDITROPIN NORDIFLEX PEN ............. 25 norethin acet & estrad-fe ... 23 norethindrone & eth estradiol .......................................... 23 norethindrone & ethinyl estradiol-fe ........................ 23 norethindrone (contraceptive) .................. 23 norethindrone acet & eth

estra .................................. 23 norethindrone acetate ....... 25 norethindrone acetate-ethinyl estradiol ............................ 24 norethindrone acetate-ethinyl estradiol-fe ........................ 23 norethindrone-eth estradiol (triphasic) .......................... 23 norgestimate-ethinyl estradiol ............................ 23 norgestimate-ethinyl estradiol (triphasic) ........... 23 norgestrel & ethinyl estradiol.......................................... 23 NORINYL 1+35

see norethindrone & eth estradiol ........................ 23

NORINYL 1+50 ................. 23 NORMOSOL-R ................. 32 NOROXIN ........................... 7 NORPACE

see disopyramide phosphate ..................... 12

NORPACE CR .................. 12 NORPRAMIN

see desipramine hcl ...... 17 NOR-QD

see heather tab 0.35mg 23 see norethindrone (contraceptive) .............. 23

nortriptyline hcl ................. 17 NORVASC

see amlodipine besylate 13 NORVIR .............................. 5 NOVAREL INJ 10000UNT 25 NOVOLIN 70/30................ 21 NOVOLIN 70/30 RELION . 21 NOVOLIN N ...................... 21 NOVOLIN N RELION ........ 21 NOVOLIN R ...................... 21 NOVOLIN R RELION ........ 21 NOVOLOG ....................... 21 NOVOLOG FLEXPEN ...... 21 NOVOLOG MIX 70/30 ...... 21 NOVOLOG MIX 70/30 PREFILL ........................... 21 NOXAFIL ............................ 5 NUCYNTA .......................... 3 NUCYNTA ER .................... 3 NUEDEXTA ...................... 20

57

NULOJIX ........................... 30 NULYTELY/FLAVOR PACKS .............................. 27

see peg 3350-potassium chloride-sod bicarbonate-sod chloride ...................................... 27

NUTROPIN ....................... 25 NUTROPIN AQ ................. 25 NUTROPIN AQ NUSPIN 5 25 NUTROPIN AQ PEN ......... 25 NUVARING ....................... 23 NUVIGIL............................ 20 NYMALIZE ........................ 14 nystatin ...............................5 nystatin (mouth-throat) ...... 39 nystatin (topical) ................ 36 nystatin pow 100000 ......... 36 O OCELLA ............................ 23 OCTAGAM ........................ 30 octreotide acetate ............. 25 OCUFEN

see flurbiprofen sodium . 33 OCUFLOX

see ofloxacin (ophth) ..... 33 ofloxacin (ophth) ............... 33 ofloxacin (otic) ................... 39 olanzapine......................... 18 olanzapine odt ................... 18 OLEPTRO ......................... 17 OLUX


OLUX-E see clobetasol propionate emulsion ........................ 37

OMECLAMOX-PAK .......... 27 omeprazole ....................... 28 OMNARIS ......................... 35 OMNITROPE 10MG ......... 25 OMNITROPE 5.8MG ........ 25 OMNITROPE 5MG ........... 25 ondansetron hcl ................ 26 ondansetron hcl inj ............ 26 ondansetron hcl oral soln .. 26 ondansetron odt ................ 26 ONFI ................................. 16 ONGLYZA ......................... 22 ONMEL ...............................5

ONSOLIS ............................ 3 ONTAK ............................... 9 OPANA

see oxymorphone hcl ...... 3 OPANA ER (CRUSH RESISTANT ........................ 3 OPTIPRANOLOL

see metipranolol ............ 34 OPTIVAR

see azelastine hcl (ophth) ...................................... 34

ORACEA ........................... 38 ORAP ................................ 18 ORAPRED

see prednisolone sodium phosphate ..................... 24

ORAPRED ODT ............... 24 ORENCIA ......................... 29 ORFADIN .......................... 24 ORTHO EVRA .................. 23 ORTHO MICRONOR

see norethindrone (contraceptive) .............. 23

ORTHO TRI-CYCLEN see norgestimate-ethinyl estradiol (triphasic) ........ 23

ORTHO TRI-CYCLEN LO . 23 ORTHO-CYCLEN

see norgestimate-ethinyl estradiol ......................... 23

ORTHO-NOVUM 7/7/7 see norethindrone-eth estradiol (triphasic) ........ 23

OSENI TAB 12.5-15MG .... 22 OSENI TAB 12.5-30MG .... 22 OSENI TAB 12.5-45MG .... 22 OSENI TAB 25-15MG ....... 22 OSENI TAB 25-30MG ....... 22 OSENI TAB 25-45MG ....... 22 OSMOPREP ..................... 27 OVCON-35

see norethindrone & eth estradiol ......................... 23 see philith ...................... 23 see zenchent tab ........... 23

OVIDE see malathion ................ 38

oxacillin sodium .................. 8 oxaliplatin .......................... 10 OXANDRIN

see oxandrolone............ 21 oxandrolone ...................... 21 oxaprozin ............................ 1 oxcarbazepine .................. 16 OXECTA ............................. 3 OXISTAT .......................... 36 OXSORALEN ................... 38 OXSORALEN ULTRA ....... 37 oxybutynin chloride ........... 28 oxycodone hcl ..................... 3 OXYCODONE HCL ............ 3 oxycodone w/ acetaminophen ................... 3 oxycodone w/ acetaminophen 10-325mg .. 3 oxycodone w/ acetaminophen 10-650mg .. 3 oxycodone w/ acetaminophen 2.5-325mg . 3 oxycodone w/ acetaminophen 5-325mg .... 3 oxycodone w/ acetaminophen 5-500mg .... 3 oxycodone w/ acetaminophen 7.5-325mg . 3 oxycodone w/ acetaminophen 7.5-500mg . 3 oxycodone-aspirin............... 3 oxycodone-ibuprofen .......... 3 OXYCONTIN ...................... 3 oxymorphone hcl ................ 3 OXYTROL ........................ 28 P paclitaxel ............................. 9 PAMELOR

see nortriptyline hcl ....... 17 pamidronate disodium ...... 22 PAMINE

see methscopolamine bromide ......................... 26

PAMINE FORTE see methscopolamine bromide ......................... 26

PANCREAZE .................... 28 PANDEL ........................... 38 PANRETIN ....................... 38 pantoprazole sodium ........ 28 PARAFON FORTE DSC

see chlorzoxazone ........ 20 PARCOPA

58

see carbidopa-levodopa 17 PARLODEL ....................... 18

see bromocriptine mesylate ........................ 17

PARNATE see tranylcypromine sulfate ............................ 17

paromomycin sulfate ...........4 paroxetine er tab ............... 17 paroxetine hcl .................... 17 paser 4gm ...........................6 PATADAY ......................... 34 PATANASE ....................... 35 PATANOL ......................... 34 PAXIL ................................ 17

see paroxetine hcl ......... 17 PAXIL CR

see paroxetine er tab ..... 17 PCE ....................................7 PEDIAPRED

see prednisolone sodium phosphate ...................... 24

PEDVAX HIB .................... 31 peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ........... 27 peg 3350-potassium chloride-sod bicarbonate-sod chloride ............................. 27 PEGANONE ...................... 16 PEGASYS ......................... 30 PEGASYS PROCLICK ..... 30 PEG-INTRON ................... 30 PEG-INTRON REDIPEN... 30 PENICILLIN G POT IN DEXTROSE ........................8 penicillin g potassium ..........8 PENICILLIN G POTASSIUM IN ........................................8 penicillin g procaine ............8 penicillin g sodium ...............8 penicillin v potassium ..........8 PENNSAID ........................ 38 PENTAM 300 ......................4 PENTASA ......................... 27 pentostatin ..........................9 pentoxifylline ..................... 29 PEPCID

see famotidine ............... 26 PERCOCET

see endocet 10/325 .........2

see endocet 5/325 ........... 2 see endocet 7.5/325 ........ 2 see oxycodone w/ acetaminophen ................ 3 see oxycodone w/ acetaminophen 10-325mg ........................................ 3 see oxycodone w/ acetaminophen 10-650mg ........................................ 3 see oxycodone w/ acetaminophen 2.5-325mg ........................................ 3 see oxycodone w/ acetaminophen 5-325mg . 3 see oxycodone w/ acetaminophen 7.5-325mg ........................................ 3 see oxycodone w/ acetaminophen 7.5-500mg ........................................ 3

PERCODAN see oxycodone-aspirin .... 3

PERFOROMIST ............... 35 PERIDEX

see chlorhexidine gluconate (mouth-throat) ...................................... 39 see periogard sol 0.12% 39

perindopril erbumine ......... 11 periogard sol 0.12% .......... 39 permethrin ......................... 38 perphenazine .................... 18 PERSANTINE

see dipyridamole ........... 29 PERTZYE ......................... 28 PEXEVA ........................... 17 pfizerpen ............................. 8 phenelzine sulfate ............. 17 PHENERGAN

see promethazine hcl .... 26 phenobarbital .................... 16 phenobarbital sodium........ 16 PHENOBARBITAL SODIUM .......................................... 16 PHENYTEK

see phenytoin sodium extended ....................... 16

phenytoin .......................... 16 phenytoin inj 50mg/ml ....... 16

phenytoin sodium extended.......................................... 16 philith ................................ 23 PHISOHEX ....................... 36 PHOSLO

see calcium acetate (phosphate binder) ........ 25

PHOSLYRA ...................... 25 PHOSPHOLINE IODIDE .. 34 PICATO ............................ 36 PILOCARPINE HCL ......... 34 pilocarpine hcl (oral) ......... 39 PILOPINE HS ................... 34 pindolol ............................. 13 pioglitazone hcl ................. 22 pioglitazone hcl-glimepiride.......................................... 22 pioglitazone hcl-metformin hcl ..................................... 22 piperacillin sodium-tazobactam sodium 8 piroxicam ............................ 1 PLAN B ONE-STEP

see next choice tab 1.5mg ...................................... 23

PLAQUENIL see hydroxychloroquine sulfate ........................... 29

PLASMA-LYTE A.............. 32 PLASMA-LYTE-148 .......... 32 PLASMA-LYTE-56/D5W ... 32 PLAVIX

see clopidogrel bisulfate 29 PLETAL

see cilostazol................. 29 podofilox ........................... 38 polyethylene glycol 3350 .. 27 polymyxin b sulfate ............. 4 polymyxin b-trimethoprim .. 33 POLYTRIM

see polymyxin b-trimethoprim ............... 33

POMALYST CAP .............. 10 PONSTEL

see mefenamic acid ........ 1 potassium chloride ............ 32 POTASSIUM CHLORIDE . 31

see potassium chloride . 32 POTASSIUM CHLORIDE 0.15% ............................... 32

59

POTASSIUM CHLORIDE 0.22% ................................ 32 POTASSIUM CHLORIDE 0.3%/D .............................. 32 potassium chloride caps er .......................................... 31 potassium chloride microencapsulated crystals cr ....................................... 31 POTASSIUM CITRATE (ALKALINIZER) ................. 28 POTIGA ............................ 16 PRADAXA ......................... 29 pramipexole dihydrochloride .......................................... 18 PRANDIMET ..................... 22 PRANDIN .......................... 22 PRAVACHOL

see pravastatin sodium.. 12 pravastatin sodium ............ 12 prazosin hcl ....................... 11 PRECOSE

see acarbose ................. 21 PRED MILD ...................... 33 PRED-G ............................ 33 PRED-G S.O.P. ................ 33 prednicarbate .................... 38 PREDNICARBATE ........... 38 prednisolone ..................... 24 PREDNISOLONE ACETATE .......................................... 33 prednisolone sodium phosphate ......................... 24 prednisolone sodium phosphate (ophth) ............. 33 prednisone .................. 24, 25 PREGNYL W/DILUENT BENZYL ............................ 25 PRELONE

see prednisolone ........... 24 PREMARIN ....................... 24 PREMARIN CREAM ......... 24 PREMARIN INJ ................. 24 premasol 10% ................... 32 premasol 6% ..................... 31 PREMPHASE ................... 24 PREMPRO ........................ 24 PREPOPIK ........................ 27 PREVACID

see lansoprazole ........... 28

PREVACID SOLUTAB ...... 28 PREVPAC ......................... 27 PREZISTA .......................... 5 PRIFTIN .............................. 6 PRILOSEC

see omeprazole ............. 28 PRIMAQUINE PHOSPHATE ............................................ 5 PRIMAXIN IV

see imipenem-cilastatin ... 4 primidone .......................... 16 PRIMSOL SOL 50MG/5ML . 4 PRINIVIL

see lisinopril .................. 11 PRISTIQ ........................... 17 PRIVIGEN ......................... 30 PROAIR HFA .................... 35 probenecid .......................... 1 PROCALAMINE ................ 32 PROCARDIA XL

see nifedipine er ............ 13 see nifedipine xl ............ 13

prochlorperazine inj 5 mg/ml .......................................... 26 prochlorperazine maleate . 26 prochlorperazine supp ...... 26 PROCRIT .......................... 29 procto-pak cre 1% ............. 37 proctozone cre -hc 2.5% ... 37 PROCYSBI ....................... 24 progesterone micronized .. 25 PROGLYCEM ................... 25 PROGRAF ........................ 30

see tacrolimus ............... 30 PROLASTIN-C .................. 35 PROLENSA ...................... 34 PROLEUKIN ....................... 9 PROLIA ............................. 25 PROMACTA ..................... 29 promethazine hcl .............. 26 PROMETRIUM

see progesterone micronized ..................... 25

propafenone hcl ................ 12 proparacaine hcl ............... 34 propranolol & hydrochlorothiazide ........... 13 propranolol hcl er .............. 13 propranolol inj 1mg/ml....... 13 propranolol sol .................. 13

propranolol tab .................. 13 propylthiouracil ................. 26 PROQUAD ....................... 31 PROSCAR

see finasteride ............... 28 PROSOL ........................... 32 PROTONIX ....................... 28

see pantoprazole sodium ...................................... 28

PROTOPIC ....................... 38 protriptyline hcl ................. 17 PROVENTIL HFA ............. 35 PROVERA

see medroxyprogesterone acetate .......................... 25

PROVIGIL see modafinil ................. 20

PROZAC see fluoxetine hcl .......... 17

PROZAC WEEKLY see fluoxetine hcl .......... 17

PRUDOXIN CRE 5% ........ 37 PULMICORT

see budesonide (inhalation) .................... 35

PULMICORT FLEXHALER.......................................... 35 PULMICORT INH SUSP ... 35 PULMOZYME ................... 35 PURINETHOL

see mercaptopurine ........ 9 PYLERA ........................... 27 pyrazinamide ...................... 6 pyridostigmine bromide ..... 20 Q QNASL ............................. 35 QUALAQUIN

see quinine sulfate .......... 5 QUARTETTE .................... 23 QUESTRAN

see cholestyramine ....... 12 QUESTRAN LIGHT

see cholestyramine light 12 quetiapine fumarate .......... 18 QUILLIVANT XR ............... 19 quinapril hcl ...................... 11 quinapril-hydrochlorothiazide.......................................... 11 quinidine gluconate er ....... 12 quinidine sulfate ................ 12

60

quinine sulfate .....................5 QVAR ................................ 35 R RABAVERT ....................... 31 ramipril .............................. 11 RANEXA ........................... 15 ranitidine hcl ...................... 27 RAPAFLO ......................... 28 RAPAMUNE ...................... 30 RAYOS ............................. 25 RAZADYNE

see galantamine hydrobromide ................ 16

RAZADYNE ER see galantamine hydrobromide ................ 16

REBETOL ...........................6 see ribasphere 200mg .....6 see ribavirin 200mg .........6

REBIF ............................... 20 REBIF TITRATION PACK . 20 RECOMBIVAX HB ............ 31 RECTIV ............................. 38 REGLAN

see metoclopramide hcl. 26 REGONOL ........................ 20 RELENZA DISKHALER ......6 RELISTOR ........................ 27 RELPAX ............................ 19 REMERON

see mirtazapine ............. 17 REMERON SOLTAB

see mirtazapine ............. 17 REMICADE ....................... 30 REMODULIN .................... 15 RENAGEL ......................... 25 RENVELA ......................... 25 REPREXAIN

see ibudone tab 5-200mg 2 reprexain 10/200 .................2 REQUIP

see ropinirole hydrochloride ................. 18

REQUIP XL see ropinirole hydrochloride ................. 18

RESCRIPTOR ....................5 RESTASIS ........................ 34 RETIN-A

see tretinoin ................... 36

RETROVIR see zidovudine ................ 6

RETROVIR IV INFUSION ... 5 REVATIO

see sildenafil citrate (pulmonary hypertension) ...................................... 15

REVIA see naltrexone hcl ......... 21

REVLIMID ......................... 30 REYATAZ ........................... 5 RHEUMATREX ................. 30 RHINOCORT AQUA ......... 35 ribapak ................................ 6 ribapak mis 600/day ............ 6 ribasphere ........................... 6 ribasphere 200mg ............... 6 ribavirin 200mg ................... 6 RIFADIN

see rifampin ..................... 6 rifampin ............................... 6 RIFATER ............................ 6 RILUTEK ........................... 20

see riluzole .................... 20 riluzole .............................. 20 rimantadine hydrochloride ... 6 RINGER'S ......................... 32 RIOMET ............................ 22 RISPERDAL

see risperidone .............. 18 RISPERDAL CONSTA ...... 18 RISPERDAL M-TAB

see risperidone odt ........ 18 risperidone ........................ 18 risperidone odt .................. 18 RITALIN

see methylphenidate hcl 19 RITALIN LA ....................... 19

see methylphenidate hcl 19 RITUXAN ............................ 9 rivastigmine tartrate .......... 16 rizatriptan benzoate .......... 19 ROBAXIN

see methocarbamol ....... 20 ROBAXIN-750

see methocarbamol ....... 20 ROBINUL

see glycopyrrolate ......... 26 ROBINUL FORTE

see glycopyrrolate ......... 26

ROCALTROL see calcitriol .................. 32

ROCEPHIN see ceftriaxone sodium ... 7

ropinirole hydrochloride .... 18 rosadan cre 0.75% ............ 38 ROTATEQ ........................ 31 ROWASA

see mesalamine enema kit ...................................... 27

ROXICODONE see oxycodone hcl .......... 3

ROZEREM ........................ 19 RYTHMOL

see propafenone hcl ...... 12 RYTHMOL SR

see propafenone hcl ...... 12 S SABRIL ............................. 16 SAIZEN ............................. 25 SAIZEN CLICK.EASY ....... 25 SALAGEN

see pilocarpine hcl (oral) ...................................... 39

SAMSCA .......................... 25 SANCTURA

see trospium chloride .... 28 SANCTURA XR

see trospium chloride .... 28 SANCUSO ........................ 26 SANDIMMUNE

see cyclosporine ........... 30 SANDIMMUNE CAPS ...... 30 SANDIMMUNE SOLN ...... 30 SANDOSTATIN

see octreotide acetate ... 25 SANDOSTATIN LAR DEPOT ............................. 25 SANTYL ............................ 38 SAPHRIS .......................... 18 SARAFEM ........................ 21 SAVELLA .......................... 20 SAVELLA TITRATION PACK ................................ 20 SEASONIQUE

see levonorgestrel-ethinyl estradiol (91-day) .......... 23

SECTRAL see acebutolol hcl ......... 13

selegiline hcl ..................... 18

61

selenium sulfide ................ 37 SELSUN SHAMPOO

see selenium sulfide ...... 37 SELZENTRY .......................5 SEMPREX-D ..................... 34 SENSIPAR ........................ 22 SEREVENT DISKUS ........ 35 SEROQUEL

see quetiapine fumarate 18 SEROQUEL XR ................ 18 SEROSTIM ....................... 25 sertraline hcl ...................... 17 SFROWASA ..................... 27 sildenafil citrate (pulmonary hypertension) .................... 15 SILENOR .......................... 19 SILVER SULFADIAZINE... 36 SIMCOR............................ 12 SIMPONI ........................... 30 SIMULECT ........................ 30 simvastatin ........................ 12 SINEMET

see carbidopa-levodopa 17 SINEMET CR

see carbidopa-levodopa 17 SINGULAIR

see montelukast sodium 35 SIRTURO ............................6 SKLICE ............................. 38 SODIUM CHLORIDE .. 31, 32 SODIUM CHLORIDE 0.45% VIA .................................... 32 SODIUM CHLORIDE 0.9% .......................................... 39 sodium phenylbutyrate ...... 24 sodium polystyrene sulfonate .......................................... 22 SOLARAZE ....................... 36 SOLIA ............................... 23 SOLODYN ..........................8 SOLTAMOX ...................... 10 SOLU-CORTEF 1000MG.. 25 SOLU-CORTEF 100MG ... 25 SOLU-CORTEF 250MG ... 25 SOLU-CORTEF 500MG ... 25 SOLU-MEDROL ................ 25

see methylprednisolone sod succ ........................ 24

SOMATULINE DEPOT ..... 25 SOMAVERT ...................... 25

SONATA see zaleplon .................. 19

SORIATANE ..................... 37 SORILUX .......................... 37 sotalol hcl .......................... 12 sotalol hcl (afib/afl) ............ 12 SPIRIVA HANDIHALER .... 34 spironolactone .................. 11 spironolactone & hydrochlorothiazide ........... 14 SPORANOX

see itraconazole .............. 5 SPORANOX SOL 10MG/ML ............................................ 5 SPRYCEL ......................... 10 sps sus 15gm/60ml ........... 22 SSD .................................. 36 STARLIX

see nateglinide .............. 22 stavudine ............................ 5 STAVZOR ......................... 16 STELARA ......................... 37 STERILE WATER IRRIGATION ..................... 39 STIMATE .......................... 26 STIVARGA ........................ 10 STRATTERA .................... 19 streptomycin sulfate ............ 4 STRIANT .......................... 21 STRIBILD ............................ 6 STROMECTOL ................... 4 SUBOXONE

see buprenorphine hcl-naloxone hcl sl ......... 20

SUBOXONE MIS 12-3MG 21 SUBOXONE MIS 2-0.5MG .......................................... 21 SUBOXONE MIS 4-1MG .. 21 SUBOXONE MIS 8-2MG .. 21 SUBSYS ............................. 3 SUCLEAR ......................... 27 SUCRAID .......................... 27 sucralfate .......................... 27 SULAR

see nisoldipine .............. 13 sulfacetamide sodium (acne) .......................................... 36 sulfacetamide sodium (ophth) .............................. 33 sulfacetamide

sod-prednisolone .............. 33 sulfadiazine ......................... 4 sulfamethoxazole-trimethoprim ......................................... 4 sulfamethoxazole-trimethoprim inj .................................... 4 SULFAMYLON ................. 36

see mafenide acetate .... 36 sulfasalazine dr ................. 27 sulfasalazine ir .................. 27 sulindac .............................. 1 sumatriptan succinate ....... 19 SUMATRIPTAN SUCCINATE ..................... 19 sumatriptan succinate inj .. 20 SUMATRIPTAN SUCCINATE INJ............... 19 SUMAVEL DOSEPRO ...... 20 suprax ................................. 7 SUPRAX ............................. 7 SUPREP BOWEL PREP .. 27 SUSTIVA ............................ 5 SUTENT ........................... 10 syeda ................................ 23 SYLATRON ...................... 10 SYMBICORT .................... 35 SYMLINPEN 120 .............. 21 SYMLINPEN 60 ................ 21 SYNAGIS .......................... 31 SYNALAR

see fluocinolone acetonide ...................................... 37

SYNALGOS-DC.................. 2 SYNAREL ......................... 23 SYNERA ........................... 38 SYNERCID ......................... 4 SYNTHROID .................... 26

see levothyroxine sodium ...................................... 25

SYPRINE .......................... 22 T TABLOID ............................ 9 TACLONEX ...................... 38 tacrolimus ......................... 30 TAFINLAR ........................ 10 TAMIFLU ............................ 6 tamoxifen citrate ............... 10 tamsulosin hcl ................... 28 TAPAZOLE

see methimazole ........... 25

62

TARCEVA ......................... 10 TARGRETIN ............... 10, 38 TARKA .............................. 11 TASIGNA .......................... 10 TAXOTERE .........................9 tazicef vial ...........................7 TAZORAC ......................... 37 taztia xt ............................. 14 TECFIDERA ...................... 20 TECFIDERA STARTER PACK ................................ 20 TEFLARO ...........................7 TEGRETOL ....................... 16

see carbamazepine ....... 15 TEGRETOL-XR ................ 16

see carbamazepine ....... 15 TEKAMLO ......................... 14 TEKTURNA ....................... 14 TEKTURNA HCT .............. 14 TEMOVATE


TEMOVATE E see clobetasol propionate emollient base ............... 37

TENORETIC 100 see atenolol & chlorthalidone ................ 12

TENORETIC 50 see atenolol & chlorthalidone ................ 12

TENORMIN see atenolol ................... 13

TERAZOL 3 see terconazole vaginal . 28

TERAZOL 7 see terconazole vaginal . 28

terazosin hcl ...................... 11 terbinafine hcl ......................5 terbutaline sulfate .............. 35 terconazole vaginal ........... 28 TESTIM ............................. 21 testosterone cypionate ...... 21 testosterone enanthate ..... 21 TETANUS TOXOID ADSORBED ...................... 31 TETANUS/DIPHTHERIA TOXOID ............................ 31 tetrahydrozoline hcl ........... 35 TEVETEN ......................... 12

see eprosartan mesylate ...................................... 11

TEVETEN HCT ................. 11 TEV-TROPIN .................... 25 texacort ............................. 38 THALOMID ....................... 30 theo-24 .............................. 36 theophylline ....................... 36 THERMAZENE ................. 36 thioridazine hcl .................. 18 thiotepa ............................... 9 thiothixene ........................ 18 THYMOGLOBULIN ........... 30 tiagabine hcl ...................... 16 TIAZAC

see diltiazem hcl er........ 13 see diltiazem hcl extended release beads ................ 13 see diltzac ..................... 13 see taztia xt ................... 14

TIKOSYN .......................... 12 TIMENTIN ........................... 8 TIMENTIN INJ 3.1GM ......... 8 timolol maleate .................. 13 timolol maleate (ophth) ..... 34 TIMOLOL MALEATE GEL 34 TIMOPTIC

see timolol maleate (ophth) ........................... 34

TIMOPTIC OCUDOSE ...... 34 TIROSINT ......................... 26 tizanidine ........................... 20 TOBI NEB ........................... 4 TOBRADEX ...................... 33

see tobramycin-dexamethasone .................................... 33

TOBRADEX ST ................ 33 tobramycin sulfate ............... 4 tobramycin sulfate (ophth) 33 tobramycin sulfate in saline . 4 tobramycin-dexamethasone .......................................... 33 TOBREX

see tobramycin sulfate (ophth) ........................... 33

TOBREX OINT 0.3% ........ 33 TOFRANIL

see imipramine hcl ........ 17 TOFRANIL-PM

see imipramine pamoate ...................................... 17

tolmetin sodium................... 1 tolterodine tartrate............. 28 TOPAMAX

see topiramate .............. 16 TOPAMAX SPRINKLE

see topiramate .............. 16 TOPICORT ....................... 38

see desoximetasone ..... 37 topiramate ......................... 16 topotecan hcl .................... 11 TOPROL XL

see metoprolol succinate ...................................... 13

TORISEL ............................ 9 torsemide inj ..................... 14 torsemide tabs .................. 14 TOVIAZ ............................. 28 TPN ELECTROLYTES ..... 31 TRACLEER ...................... 15 TRADJENTA .................... 22 tramadol hcl er .................... 2 TRAMADOL HCL ER .......... 2 tramadol hcl er (biphasic) 100mg ................................. 2 tramadol hcl er (biphasic) 200mg ................................. 2 tramadol hcl er (biphasic) 300mg ................................. 2 tramadol hcl tab 50 mg ....... 2 tramadol-acetaminophen .... 2 TRANDATE

see labetalol hcl ............ 13 trandolapril ........................ 11 tranexamic acid................. 29 TRANSDERM-SCOP ........ 26 TRANXENE T

see clorazepate dipotassium ................... 15

tranylcypromine sulfate ..... 17 travasol ............................. 32 TRAVATAN Z ................... 34 trazodone hcl .................... 17 TREANDA .......................... 9 TRECATOR ........................ 6 TRELSTAR DEPOT MIXJECT .......................... 10 TRELSTAR LA MIXJECT . 10 TRELSTAR MIXJECT ....... 10

63

tretin x ............................... 36 tretinoin ....................... 10, 36 TRETINOIN MICROSPHERE ............... 36 TREXIMET ........................ 20 triamcinolone acetonide (mouth) ............................. 39 triamcinolone acetonide (nasal) ............................... 35 triamcinolone acetonide (topical) ............................. 38 triamterene & hydrochlorothiazide cap 37.5-25 mg ........................ 14 triamterene & hydrochlorothiazide tab 37.5-25 mg ........................ 14 triamterene & hydrochlorothiazide tab 75-50 mg ........................... 14 TRIBENZOR ..................... 11 TRICOR

see fenofibrate ............... 12 trifluoperazine hcl .............. 18 trifluridine .......................... 33 TRIGLIDE ......................... 12 TRILEPTAL ....................... 16

see oxcarbazepine ........ 16 TRILIPIX ........................... 12

see choline fenofibrate .. 12 trimethoprim ........................4 trimipramine maleate ........ 17 TRINESSA ........................ 23 TRI-NORINYL 28

see norethindrone-eth estradiol (triphasic) ........ 23

TRIOSTAT see liothyronine sodium . 25

TRISENOX ........................ 10 TRIZIVIR .............................6 TROPHAMINE .................. 32 trospium chloride ............... 28 TRUSOPT

see dorzolamide hcl ...... 34 TRUVADA ...........................6 TUDORZA PRESSAIR ..... 34 TWINRIX ........................... 31 TWYNSTA ........................ 11 TYGACIL.............................4 TYKERB............................ 10

TYLENOL/CODEINE #3 see acetaminophen w/ codeine ............................ 1

TYLENOL/CODEINE #4 see acetaminophen w/ codeine ............................ 1

TYPHIM VI ........................ 31 TYSABRI .......................... 20 TYZEKA .............................. 6 tyzine pediatric nasal dr .... 35 U UCERIS ............................ 27 ULESFIA ........................... 38 ULORIC .............................. 1 ULTRACET

see tramadol-acetaminophen . 2

ULTRAM see tramadol hcl tab 50 mg ................................... 2

ULTRAM ER see tramadol hcl er .......... 2

ULTRAVATE see halobetasol propionate ..................... 38

ULTRESA ......................... 28 UNASYN

see ampicillin & sulbactam sodium ............................. 8

UNASYN BULK PACK see ampicillin & sulbactam sodium ............................. 8

UNIRETIC see moexipril-hydrochlorothiazide .................................. 11

UNITHROID ...................... 26 UNIVASC

see moexipril hcl ........... 11 urea-hc acetate ................. 38 URECHOLINE

see bethanechol chloride ...................................... 28

UROCIT-K ........................ 28 UROXATRAL

see alfuzosin hcl ............ 28 URSO 250

see ursodiol ................... 27 URSO FORTE

see ursodiol ................... 28

ursodiol ....................... 27, 28 UVADEX ........................... 10 V VAGIFEM ......................... 24 valacyclovir hcl.................... 6 VALCYTE ........................... 6 VALIUM

see diazepam ................ 15 valproate sodium .............. 16 valproic acid ...................... 16 valsartan-hydrochlorothiazide........................................ 11 VALTREX

see valacyclovir hcl ......... 6 VANCOCIN HCL

see vancomycin hcl ......... 4 vancomycin hcl ................... 4 VANDAZOLE .................... 28 VANOS ............................. 38 VAQTA ............................. 31 VARIVAX .......................... 31 VASCEPA ......................... 12 VASERETIC

see enalapril maleate & hydrochlorothiazide ....... 11

VASOTEC see enalapril maleate .... 11

VECTIBIX ........................... 9 VELCADE ........................... 9 VELTIN ............................. 36 venlafaxine cap er............. 17 VENLAFAXINE HCL ER

see venlafaxine tab er ... 17 venlafaxine tab ................. 17 venlafaxine tab er ............. 17 VENTAVIS ........................ 15 VENTOLIN HFA................ 35 VERAMYST ...................... 35 verapamil hcl .................... 14 VERAPAMIL HCL ............. 14 VERDESO ........................ 38 VERELAN

see verapamil hcl .......... 14 VERELAN PM

see verapamil hcl .......... 14 veripred ............................. 25 VESICARE ....................... 28 vestura .............................. 23 VEXOL .............................. 33 VFEND

64

see voriconazole .............5 VFEND IV

see voriconazole inj 200mg .............................5

VFEND SUS 40MG/ML .......5 VIBATIV ..............................4 VIBRAMYCIN ......................8

see doxycycline (monohydrate) .................8 see doxycycline hyclate ...8

vicodin .................................2 vicodin es ............................2 vicodin hp ............................2 VICOPROFEN

see hydrocodone-ibuprofen ...2

VICTOZA .......................... 21 VICTRELIS .........................6 VIDAZA ...............................9 VIDEX EC

see didanosine ................5 VIDEX PEDIATRIC .............5 VIGAMOX ......................... 33 VIIBRYD............................ 17 VIMOVO..............................1 VIMPAT............................. 16 vinblastine sulfate ...............9 vincristine sulfate ................9 vinorelbine tartrate ..............9 VIOKACE 10440 UNIT ...... 28 VIOKACE 20880 UNIT ...... 28 viorele ............................... 23 VIRACEPT ..........................5 VIRAMUNE .........................5

see nevirapine .................5 VIRAMUNE XR ...................5 VIREAD...............................5 VIROPTIC

see trifluridine ................ 33 VISICOL ............................ 27 VISTARIL

see hydroxyzine pamoate ...................................... 34

VISTIDE see cidofovir ....................6

VIVACTIL see protriptyline hcl ....... 17

VIVELLE-DOT ................... 24 VIVITROL.......................... 21 VOLTAREN GEL 1% ........ 38

VOLTAREN-XR see diclofenac sodium ..... 1

voriconazole ........................ 5 voriconazole inj 200mg ....... 5 VOSOL HC

see acetic acid sol/hc .... 39 see hydrocortisone w/acetic acid .................. 39

VOSPIRE ER see albuterol sulfate er .. 35

VOTRIENT ........................ 10 VPRIV ............................... 24 VYTORIN .......................... 12 VYVANSE ......................... 19 W warfarin sodium ................ 29 WELCHOL ........................ 12 WELLBUTRIN

see bupropion hcl .......... 16 WELLBUTRIN SR

see bupropion hcl .......... 16 WELLBUTRIN XL

see bupropion hcl .......... 17 WESTCORT

see hydrocortisone valerate ......................... 38

X XALATAN

see latanoprost .............. 34 XALKORI .......................... 10 XANAX

see alprazolam .............. 15 XARELTO ......................... 29 XELJANZ .......................... 30 XENAZINE ........................ 20 XEOMIN ............................ 34 XERESE ........................... 37 XGEVA ............................. 25 XIFAXAN TAB 200MG ........ 4 XIFAXAN TAB 550MG ...... 28 XODOL

see hydrocodone-acetaminophen 10-300mg ................... 2 see hydrocodone-acetaminophen 5-300mg ..................... 1 see hydrocodone-acetaminophen 7.5-300mg .................. 2

see vicodin ...................... 2 see vicodin es ................. 2 see vicodin hp ................. 2

XOLAIR ............................ 35 XOPENEX

see levalbuterol hcl ....... 35 XOPENEX CONCENTRATE

see levalbuterol conc 1.25mg/0.5ml ................ 35

XOPENEX HFA ................ 35 XTANDI ............................ 10 XYLOCAINE

see lidocaine hcl ............ 38 see lidocaine hcl (local anesth.) ........................... 3 see lidocaine inj 1% ........ 3 see lidocaine inj 2% ........ 3

XYLOCAINE-MPF see lidocaine hcl (local anesth.) ........................... 3 see lidocaine inj 0.5% ..... 3 see lidocaine inj 1% ........ 3 see lidocaine inj 1.5% ..... 3 see lidocaine inj 2% ........ 4

XYREM ............................. 20 XYZAL

see levocetirizine soln 2.5mg/5ml ..................... 35 see levocetirizine tab 5 mg ...................................... 35

Y YASMIN 28

see drospirenone-ethinyl estradiol ........................ 22 see syeda ...................... 23 see zarah ...................... 23

YAZ see drospirenone-ethinyl estradiol ........................ 22 see vestura ................... 23

YF-VAX ............................. 31 Z zafirlukast ......................... 35 zaleplon ............................ 19 ZANAFLEX

see tizanidine ................ 20 ZANOSAR .......................... 9 ZANTAC

see ranitidine hcl ........... 27 zarah ................................. 23

65

ZARONTIN see ethosuximide .......... 15

ZAROXOLYN see metolazone ............. 14

ZAVESCA ......................... 24 ZAZOLE ............................ 28 ZEBETA

see bisoprolol fumarate . 13 ZEGERID .......................... 28 ZELAPAR.......................... 18 ZELBORAF ....................... 10 ZEMAIRA .......................... 35 ZEMPLAR ......................... 33 zenatane ........................... 36 zenchent tab ..................... 23 ZENPEP............................ 28 ZERIT

see stavudine ..................5 ZESTORETIC

see lisinopril & hydrochlorothiazide ....... 11

ZESTRIL see lisinopril ................... 11

ZETIA ................................ 12 ZETONNA ......................... 35 ZIAC

see bisoprolol & hydrochlorothiazide ....... 13

ZIAGEN...............................5 see abacavir sulfate ........5

ZIANA ............................... 36 zidovudine ...........................6 ZINACEF

see cefuroxime sodium ... 7 ZINECARD

see dexrazoxane ........... 10 ZIOPTAN .......................... 34 ziprasidone hcl .................. 18 ZIPSOR .............................. 1 ZIRGAN ............................ 33 ZITHROMAX

see azithromycin ............. 7 ZMAX .................................. 7 ZOCOR

see simvastatin ............. 12 ZOFRAN

see ondansetron hcl ...... 26 see ondansetron hcl inj . 26 see ondansetron hcl oral soln ................................ 26

ZOFRAN ODT see ondansetron odt...... 26

zoledronic inj 4mg/5ml ...... 22 ZOLINZA ............................. 9 zolmitriptan ....................... 20 zolmitriptan odt ................. 20 ZOLOFT

see sertraline hcl ........... 17 zolpidem tartrate ............... 19 ZOLPIMIST ....................... 19 ZOMETA ........................... 22

see zoledronic inj 4mg/5ml ...................................... 22

ZOMIG .............................. 20 see zolmitriptan ............. 20

ZOMIG ZMT ...................... 20

see zolmitriptan odt ....... 20 ZONALON ........................ 37 ZONEGRAN

see zonisamide ............. 16 zonisamide ....................... 16 ZORBTIVE ........................ 25 ZORTRESS ...................... 30 ZOSTAVAX ...................... 31 ZOSYN ............................... 8

see piperacillin sodium-tazobactam sodium ............................ 8

zovia ................................. 23 ZOVIRAX .......................... 37

see acyclovir ................... 6 see acyclovir topical ...... 37

ZYBAN see bupropion hcl (smoking deterrent) ....... 20

ZYCLARA ......................... 38 ZYFLO CR ........................ 35 ZYLET .............................. 33 ZYLOPRIM

see allopurinol tab ........... 1 ZYMAXID .......................... 33 ZYPREXA

see olanzapine .............. 18 ZYPREXA ZYDIS

see olanzapine odt ........ 18 ZYTIGA ............................. 10 ZYVOX ............................... 4

TEXAS ERS (Effective 01/01/2014) · ULTRAM ER) TB24 100mg, 200mg 1 Drug Name Drug Tier...

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Transcript of TEXAS ERS (Effective 01/01/2014) · ULTRAM ER) TB24 100mg, 200mg 1 Drug Name Drug Tier...