TIER 1 PREFERRED GENERICS 2018 - Friday Health Plans · TIER 1 PREFERRED GENERICS 2018 Page 1 of 54...

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Friday Health plans of Colorado is serviced by TIER 1 PREFERRED GENERICS 2018 Page 1 of 54 Proprietary and Confidential The following is a list of Tier 1 preferred generic drugs covered on the Friday Health Plans formulary. This list is subject to change as new drugs become available.* Restrictions PA= Prior Authorization ST= Step Therapy Drug Name Formulary Tier Restrictions ALTERNATIVE THERAPY ALTERNATIVE THERAPY - ESTROGENIC AGENTS VP-GSTN T1 ALTERNATIVE THERAPY - UNCLASSIFIED epigallocatechin gallate(bulk) T1 ANALGESIC, ANTI-INFLAMMATORY OR ANTIPYRETIC ANALGESIC - CENTRAL ALPHA-2 RECEPTOR AGONISTS clonidine (pf) T1 ANALGESIC - NEUROLYSIS AGENTS ethanol (ethyl alcohol) T1 ANALGESIC NARCOTIC AGONISTS alfentanil T1 codeine sulfate T1 fentanyl T1 fentanyl citrate T1 PA fentanyl citrate (pf) T1 fentanyl citrate-0.9%nacl (pf) T1 hydromorph(pf)-ropiv-0.9% nacl T1 hydromorphone T1 hydromorphone (pf) T1 hydromorphone (pf)-0.9% nacl T1 hydromorphone in 0.9 % nacl T1 levorphanol tartrate T1 meperidine T1 meperidine (pf) T1 meperidine (pf) in 0.9 % nacl T1 methadone T1 morphine T1 morphine (pf) T1 morphine (pf) in 0.9 % nacl T1 morphine (pf) in dextrose 5 % T1

Transcript of TIER 1 PREFERRED GENERICS 2018 - Friday Health Plans · TIER 1 PREFERRED GENERICS 2018 Page 1 of 54...

Page 1: TIER 1 PREFERRED GENERICS 2018 - Friday Health Plans · TIER 1 PREFERRED GENERICS 2018 Page 1 of 54 Proprietary and Confidential ... fentanyl T1 fentanyl citrate T1 PA fentanyl citrate

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is serviced by

TIER 1 PREFERRED GENERICS

2018

Page 1 of 54

Proprietary and Confidential

The following is a list of Tier 1 preferred generic drugs covered on the Friday Health Plans formulary. This list is subject to change as new drugs

become available.*

Restrictions

PA= Prior Authorization

ST= Step Therapy

Drug Name Formulary Tier Restrictions

ALTERNATIVE THERAPY

ALTERNATIVE THERAPY - ESTROGENIC AGENTS

VP-GSTN T1

ALTERNATIVE THERAPY - UNCLASSIFIED

epigallocatechin gallate(bulk) T1

ANALGESIC, ANTI-INFLAMMATORY OR ANTIPYRETIC

ANALGESIC - CENTRAL ALPHA-2 RECEPTOR AGONISTS

clonidine (pf) T1

ANALGESIC - NEUROLYSIS AGENTS

ethanol (ethyl alcohol) T1

ANALGESIC NARCOTIC AGONISTS

alfentanil T1

codeine sulfate T1

fentanyl T1

fentanyl citrate T1 PA

fentanyl citrate (pf) T1

fentanyl citrate-0.9%nacl (pf) T1

hydromorph(pf)-ropiv-0.9% nacl T1

hydromorphone T1

hydromorphone (pf) T1

hydromorphone (pf)-0.9% nacl T1

hydromorphone in 0.9 % nacl T1

levorphanol tartrate T1

meperidine T1

meperidine (pf) T1

meperidine (pf) in 0.9 % nacl T1

methadone T1

morphine T1

morphine (pf) T1

morphine (pf) in 0.9 % nacl T1

morphine (pf) in dextrose 5 % T1

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Drug Name Formulary Tier Restrictions

morphine concentrate T1

morphine in 0.9 % nacl T1

oxycodone T1

oxymorphone T1

tramadol T1

ANALGESIC NARCOTIC CODEINE COMBINATIONS

acetaminophen-codeine T1

butalbital-acetaminop-caf-cod T1

ASCOMP WITH CODEINE T1

FIORINAL-CODEINE #3 T1

ANALGESIC NARCOTIC DIHYDROCODEINE COMBINATIONS

aspirin-caffeine-dihydrocodein T1

ANALGESIC NARCOTIC DIHYDROCODEINE, SALICYLATE ANALGESIC, XANTHINE COMB

aspirin-caffeine-dihydrocodein T1

ANALGESIC NARCOTIC FENTANYL COMBINATIONS

fentanyl (pf)-bupivacaine-nacl T1

ANALGESIC NARCOTIC HYDROCODONE AND NON-SALICYLATE COMBINATIONS

hydrocodone-acetaminophen T1

LORTAB ELIXIR T1

ANALGESIC NARCOTIC HYDROCODONE AND NSAID COMBINATIONS

hydrocodone-ibuprofen T1

ANALGESIC NARCOTIC HYDROCODONE COMBINATIONS

hydrocodone-acetaminophen T1

hydrocodone-ibuprofen T1

LORTAB ELIXIR T1

ANALGESIC NARCOTIC HYDROMORPHONE COMBINATIONS

hydromorphone-bupiv (pf)-nacl T1

ANALGESIC NARCOTIC OXYCODONE AND NON-SALICYLATE COMBINATIONS

oxycodone-acetaminophen T1

ENDOCET T1

ANALGESIC NARCOTIC OXYCODONE AND NSAID COMBINATIONS

ibuprofen-oxycodone T1

ANALGESIC NARCOTIC OXYCODONE AND SALICYLATE COMBINATIONS

oxycodone-aspirin T1

ANALGESIC NARCOTIC OXYCODONE COMBINATIONS

ibuprofen-oxycodone T1

oxycodone-acetaminophen T1

oxycodone-aspirin T1

ENDOCET T1

ANALGESIC NARCOTIC PARTIAL-MIXED AGONISTS

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Drug Name Formulary Tier Restrictions

buprenorphine T1

buprenorphine hcl T1

butorphanol tartrate T1

pentazocine-naloxone T1

ANALGESIC NARCOTIC TRAMADOL AND NON-SALICYLATE COMBINATIONS

tramadol-acetaminophen T1

ANALGESIC NARCOTIC TRAMADOL COMBINATIONS

tramadol-acetaminophen T1

ANALGESIC OR ANTIPYRETIC NON-NARCOTIC/SEDATIVE COMBINATIONS

butalbital-acetaminophen T1

butalbital-acetaminophen-caff T1

FIORICET T1

DMARD - ANTIMALARIALS

hydroxychloroquine T1

DMARD - ANTIMETABOLITES

methotrexate sodium T1

DMARD - IMMUNOSUPPRESSIVES

azathioprine T1

cyclophosphamide T1

cyclosporine T1

cyclosporine modified T1

mycophenolate mofetil T1

DMARD - OTHER

minocycline T1

sulfasalazine T1

DMARD - PYRIMIDINE SYNTHESIS INHIBITORS

leflunomide T1

NSAID ANALGESIC AND TOPICAL IRRITANT COUNTER-IRRITANT COMBINATIONS

COMFORT PAC-IBUPROFEN T1

NSAID ANALGESIC, CYCLOOXYGENASE-2 (COX-2) SELECTIVE INHIBITORS

celecoxib T1

NSAID ANALGESICS (COX NON-SPECIFIC) - ANTHRANILIC ACID DERIVATIVES

meclofenamate T1

NSAID ANALGESICS (COX NON-SPECIFIC) - OTHER

ketorolac T1

nabumetone T1

sulindac T1

tolmetin T1

NSAID ANALGESICS (COX NON-SPECIFIC) - OXICAM DERIVATIVES

meloxicam T1

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Drug Name Formulary Tier Restrictions

piroxicam T1

NSAID ANALGESICS (COX NON-SPECIFIC) - PROPIONIC ACID DERIVATIVES

fenoprofen T1

flurbiprofen T1

ibuprofen T1

ketoprofen T1

naproxen T1

naproxen sodium T1

oxaprozin T1

FENORTHO T1

NSAID ANALGESICS, (COX NON-SPECIFIC) - INDOLE ACETIC ACID DERIVATIVES

etodolac T1

indomethacin T1

SALICYLATE ANALGESIC AND SEDATIVE COMBINATIONS

butalbital-aspirin-caffeine T1

SALICYLATE ANALGESICS

diflunisal T1

salsalate T1

ANESTHETICS

GENERAL ANESTHETIC - INHALANT VOLATILE

isoflurane T1

sevoflurane T1

GENERAL ANESTHETIC - PARENTERAL, ARYLCYCLOHEXYLAMINES

ketamine T1

ketamine in 0.9 % sod chloride T1

GENERAL ANESTHETIC - PARENTERAL, BENZODIAZEPINES

midazolam T1

GENERAL ANESTHETIC - PARENTERAL, OTHERS

etomidate T1

GENERAL ANESTHETIC - PARENTERAL, PHENOL DERIVATIVES

propofol T1

GENERAL ANESTHETIC ADJUNCTS - NARCOTIC

fentanyl citrate (pf) T1

sufentanil citrate T1

GENERAL ANESTHETIC ADJUNCTS - NEUROLEPTIC, BUTYROPHENONE DERIVATIVE

droperidol T1

LOCAL ANESTHETIC - AMIDES

bupivacaine T1

bupivacaine (pf) T1

bupivacaine in nacl(pf) T1

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Drug Name Formulary Tier Restrictions

bupivacaine-dextrose-water(pf) T1

lidocaine (pf) in d7.5w T1

lidocaine (pf) T1

lidocaine hcl T1

lidocaine hcl(pf) in 0.9% nacl T1

mepivacaine (pf) T1

ropivacaine (pf) T1

POLOCAINE-MPF T1

XYLOCAINE-MPF T1

LOCAL ANESTHETIC - ESTERS

tetracaine hcl (pf) T1

LOCAL ANESTHETIC - SYMPATHOMIMETIC COMBINATIONS

bupivacaine-epinephrine T1

bupivacaine-epinephrine (pf) T1

lidocaine-epinephrine T1

lidocaine-epinephrine bit T1

SENSORCAINE-MPF/EPINEPHRINE T1

ANORECTAL PREPARATIONS

ANORECTAL - GLUCOCORTICOIDS

hydrocortisone acetate T1

ANUCORT-HC T1

PROCTO-PAK T1

PROCTOZONE-HC T1

ANORECTAL - HEMORRHOIDAL RECTAL GLUCOCORTICOID-LOCAL ANESTHETIC COMB

hydrocortisone-pramoxine T1

lidocaine hcl-hydrocortison ac T1

lidocaine-hydrocortisone-aloe T1

ANTIDOTES AND OTHER REVERSAL AGENTS

ANTIDOTE - ACETAMINOPHEN POISONING

acetylcysteine T1

acetylcysteine (bulk) T1

ANTIDOTE - ALCOHOL DEHYDROGENASE ENZYME INHIBITOR

fomepizole T1

ANTIDOTE - ANTICHOLINESTERASE AGENTS

physostigmine salicylate T1

ANTIDOTE - CHOLINESTERASE REACTIVATING AGENT

pralidoxime T1

ANTIDOTE - CYANIDE POISONING

sodium nitrite T1

sodium thiosulfate T1

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Drug Name Formulary Tier Restrictions

ANTIDOTE - METHEMOGLOBINEMIA

methylene blue (antidote) T1

BENZODIAZEPINE REVERSAL AGENTS - BENZODIAZEPINE ANTAGONISTS

flumazenil T1

CHELATING AGENTS - IRON

deferoxamine T1

CHELATING AGENTS - OTHERS

betadex (bulk) T1

EMETICS

ipecac T1

OPIATE/NARCOTIC REVERSAL AGENTS - OPIATE ANTAGONISTS

naloxone T1

naltrexone T1

REVERSAL AGENTS - HEPARIN ANTAGONISTS

protamine T1

ANTI-INFECTIVE AGENTS

AMEBICIDES

paromomycin T1

AMINOGLYCOSIDE ANTIBIOTIC

amikacin T1

gentamicin T1

gentamicin (bulk) T1

gentamicin in nacl (iso-osm) T1

gentamicin sulfate (ped) (pf) T1

gentamicin sulfate (pf) T1

neomycin T1

streptomycin T1

tobramycin in 0.9 % nacl T1

tobramycin sulfate T1

AMINOPENICILLIN ANTIBIOTIC

amoxicillin T1

ampicillin T1

ampicillin sodium T1

AMINOPENICILLIN ANTIBIOTIC - BETA-LACTAMASE INHIBITOR COMBINATIONS

amoxicillin-pot clavulanate T1

ampicillin-sulbactam T1

ANTHELMINTIC AGENTS OTHER

ivermectin T1

ANTIBACTERIAL FOLATE ANTAGONIST - OTHER COMBINATIONS

sulfamethoxazole-trimethoprim T1

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Drug Name Formulary Tier Restrictions

ANTIBACTERIAL FOLATE ANTAGONIST OTHERS

trimethoprim T1

ANTIFUNGAL - ALLYLAMINES

terbinafine hcl T1

ANTIFUNGAL - AMPHOTERIC POLYENE MACROLIDES

amphotericin b T1

nystatin T1

ANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS)

caspofungin T1

ANTIFUNGAL - IMIDAZOLES

ketoconazole T1

ANTIFUNGAL - TRIAZOLES

fluconazole T1

fluconazole in dextrose(iso-o) T1

fluconazole in nacl (iso-osm) T1

voriconazole T1

ANTIFUNGAL OTHER

flucytosine T1

griseofulvin microsize T1

ANTILEPROTIC - SULFONE AGENTS

dapsone T1

ANTIMALARIAL COMBINATIONS

atovaquone-proguanil T1

ANTIMALARIALS

chloroquine phosphate T1

hydroxychloroquine T1

mefloquine T1

primaquine T1

quinine sulfate T1

ANTIPROTOZOAL-ANTIBACTERIAL 1ST GENERATION 2-METHYL-5-NITROIMIDAZOLE

metronidazole T1

metronidazole (bulk) T1

metronidazole in nacl (iso-os) T1

ANTIPROTOZOAL-ANTIBACTERIAL 2ND GENERATION 2-METHYL-5-NITROIMIDAZOLE

tinidazole T1

ANTIRETROVIRAL - NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIB (NNRTI)

nevirapine T1

ANTIRETROVIRAL - NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI)

abacavir T1

didanosine T1

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Drug Name Formulary Tier Restrictions

lamivudine T1

stavudine T1

zidovudine T1

ANTITUBERCULAR - D-ALANINE ANALOGS

cycloserine T1

ANTITUBERCULAR - ISONICOTINIC ACID DERIVATIVES

isoniazid T1

ANTITUBERCULAR - NIACINAMIDE DERIVATIVES

pyrazinamide T1

ANTITUBERCULAR - RIFAMYCIN AND DERIVATIVES

rifabutin T1

rifampin T1

ANTITUBERCULAR AGENTS OTHER

ethambutol T1

CARBAPENEM ANTIBIOTICS (THIENAMYCINS)

doripenem T1

meropenem T1

meropenem-0.9% sodium chloride T1

CEPHALOSPORIN ANTIBIOTICS - 1ST GENERATION

cefadroxil T1

cefazolin T1

cefazolin in dextrose (iso-os) T1

cefazolin in sterile water T1

cephalexin T1

CEPHALOSPORIN ANTIBIOTICS - 2ND GENERATION

cefaclor T1

cefotetan T1

cefotetan in dextrose, iso-osm T1

cefoxitin T1

cefoxitin in dextrose, iso-osm T1

cefprozil T1

cefuroxime axetil T1

cefuroxime sodium T1

CEPHALOSPORIN ANTIBIOTICS - 3RD GENERATION

cefdinir T1

cefditoren pivoxil T1

cefotaxime T1

cefpodoxime T1

ceftazidime T1

ceftazidime in d5w T1

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Drug Name Formulary Tier Restrictions

ceftriaxone T1

ceftriaxone in dextrose,iso-os T1

TAZICEF T1

CEPHALOSPORIN ANTIBIOTICS - 4TH GENERATION

cefepime T1

cefepime in dextrose 5 % T1

cefepime in dextrose,iso-osm T1

CHLORAMPHENICOL ANTIBIOTICS AND DERIVATIVES - SINGLE AGENTS

chloramphenicol sod succinate T1

CMV ANTIVIRAL AGENT - NUCLEOSIDE ANALOGS

valganciclovir T1 PA

CMV ANTIVIRAL AGENT - NUCLEOTIDE ANALOGS

cidofovir T1

FLUOROQUINOLONE ANTIBIOTICS

ciprofloxacin T1

ciprofloxacin hcl T1

ciprofloxacin in 5 % dextrose T1

ciprofloxacin lactate T1

levofloxacin T1

levofloxacin in d5w T1

moxifloxacin T1

ofloxacin T1

CIPRO T1

GLYCOPEPTIDE ANTIBIOTICS

vancomycin T1

vancomycin in 0.9% sodium cl T1

vancomycin in dextrose 5 % T1

HEPATITIS B TREATMENT- NUCLEOSIDE ANALOGS (ANTIVIRAL)

entecavir T1

HEPATITIS B TREATMENT- NUCLEOTIDE ANALOGS (ANTIVIRAL)

adefovir T1

HERPES ANTIVIRAL AGENT - PURINE ANALOGS

acyclovir T1

acyclovir sodium T1

valacyclovir T1

HERPES ANTIVIRAL AGENT - THYMIDINE ANALOGS

famciclovir T1

INFLUENZA ANTIVIRAL AGENTS - NEURAMINIDASE INHIBITORS

oseltamivir T1

INFLUENZA-A ANTIVIRAL AGENTS

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Drug Name Formulary Tier Restrictions

rimantadine T1

LINCOSAMIDE ANTIBIOTICS

clindamycin hcl T1

clindamycin in 5 % dextrose T1

clindamycin palmitate hcl T1

clindamycin phosphate T1

MACROLIDES

azithromycin T1

clarithromycin T1

erythromycin T1

erythromycin ethylsuccinate T1

ERY-TAB T1

MONOBACTAM ANTIBIOTICS

aztreonam T1

OXAZOLIDINONE ANTIBIOTICS

linezolid T1

PENICILLIN ANTIBIOTIC - NATURAL

penicillin g pot in dextrose T1

penicillin g potassium T1

penicillin g procaine T1

penicillin g sodium T1

penicillin v potassium T1

PENICILLIN ANTIBIOTIC - PENICILLINASE-RESISTANT

dicloxacillin T1

nafcillin T1

nafcillin in dextrose iso-osm T1

oxacillin T1

oxacillin in dextrose(iso-osm) T1

PENICILLIN ANTIBIOTIC, EXTENDED-SPECTRUM AND BETA-LACTAMASE INHIB COMB

piperacillin-tazobactam T1

POLYMYXINS AND DERIVATIVES - SINGLE AGENTS

bacitracin T1

polymyxin b sulfate T1

PROTEASE INHIBITORS (PEPTIDIC) ANTIRETROVIRAL

fosamprenavir T1

RIFAMYCINS AND RELATED DERIVATIVE ANTIBIOTICS

rifabutin T1

rifampin T1

SULFONAMIDE ANTIBIOTIC

sulfadiazine T1

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Drug Name Formulary Tier Restrictions

TETRACYCLINE ANTIBIOTICS

demeclocycline T1

doxycycline hyclate T1

doxycycline monohydrate T1

minocycline T1

ANTINEOPLASTICS

ANTINEOPLASTIC - ALKYLATING AGENT - NITROGEN MUSTARDS

cyclophosphamide T1

melphalan T1

ANTINEOPLASTIC - ANTIANDROGENS

bicalutamide T1

flutamide T1

ANTINEOPLASTIC - ANTIMETABOLITE - FOLIC ACID ANALOGS

methotrexate sodium T1

methotrexate sodium (pf) T1

ANTINEOPLASTIC - ANTIMETABOLITE - PURINE ANALOGS

mercaptopurine T1

ANTINEOPLASTIC - ANTIMETABOLITE - PYRIMIDINE ANALOGS

capecitabine T1

cytarabine T1

cytarabine (pf) T1

gemcitabine T1

ANTINEOPLASTIC - ANTIMETABOLITE - UREA DERIVATIVES

hydroxyurea T1

ANTINEOPLASTIC - AROMATASE INHIBITORS

anastrozole T1

letrozole T1

ANTINEOPLASTIC - PROGESTINS

megestrol T1

ANTINEOPLASTIC - RETINOIDS

tretinoin (chemotherapy) T1

ANTINEOPLASTIC - SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)

tamoxifen T1

ANTINEOPLASTIC - TOPOISOMERASE I INHIBITORS

irinotecan T1

ANTINEOPLASTIC - VINCA ALKALOIDS AND ANALOGS

vinorelbine T1

CARDIAC PROTECTIVE AGENTS USED IN CONJUNCTION WITH CHEMOTHERAPY

dexrazoxane hcl T1

METHOTREXATE RESCUE AGENTS

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Drug Name Formulary Tier Restrictions

leucovorin calcium T1

METHOTREXATE RESCUE AGENTS - FOLIC ACID ANTAGONIST TYPE

leucovorin calcium T1

levoleucovorin T1

URINARY TRACT PROTECTIVE AGENTS USED IN CONJUNCTION WITH CHEMOTHERAPY

mesna T1

ANTISEPTICS AND DISINFECTANTS

ANTISEPTIC - ALCOHOLS

alcohol swabs T1

ANTISEPTIC - OTHERS

formaldehyde T1

ANTISEPTIC - PHENOL DERIVATIVES

phenol T1

BIOLOGICALS

IMMUNE SERUMS - BOTULINUM ANTITOXINS

botulism antitoxin heptavalent T1

LIVE VACCINES

bcg vaccine, live (pf) T1

TOXOID VACCINE COMBINATIONS

tetanus,diphtheria tox ped(pf) T1

tetanus-diphtheria toxoids-td T1

VACCINE BACTERIAL - OTHER

bcg vaccine, live (pf) T1

CARDIOVASCULAR THERAPY AGENTS

ACE INHIBITOR AND CALCIUM CHANNEL BLOCKER COMBINATIONS

amlodipine-benazepril T1

trandolapril-verapamil T1

ACE INHIBITOR AND DIURETIC COMBINATIONS

benazepril-hydrochlorothiazide T1

captopril-hydrochlorothiazide T1

enalapril-hydrochlorothiazide T1

fosinopril-hydrochlorothiazide T1

lisinopril-hydrochlorothiazide T1

moexipril-hydrochlorothiazide T1

quinapril-hydrochlorothiazide T1

ACE INHIBITORS

benazepril T1

captopril T1

enalapril maleate T1

enalaprilat T1

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Drug Name Formulary Tier Restrictions

fosinopril T1

lisinopril T1

moexipril T1

perindopril erbumine T1

quinapril T1

ramipril T1

trandolapril T1

ALDOSTERONE RECEPTOR ANTAGONISTS

eplerenone T1

spironolactone T1

ALPHA-BETA BLOCKERS

carvedilol T1

labetalol T1

ANGIOTENSIN II RECEPTOR BLOCKER (ARB)-CALCIUM CHANNEL BLOCKER COMB.

amlodipine-olmesartan T1

amlodipine-valsartan T1

telmisartan-amlodipine T1

ANGIOTENSIN II RECEPTOR BLOCKER (ARB)-CALCIUM CHANNEL BLOCKER-DIURETIC

amlodipine-valsartan-hcthiazid T1

olmesartan-amlodipin-hcthiazid T1

ANGIOTENSIN II RECEPTOR BLOCKER (ARB)-DIURETIC COMBINATIONS

candesartan-hydrochlorothiazid T1

irbesartan-hydrochlorothiazide T1

losartan-hydrochlorothiazide T1

olmesartan-hydrochlorothiazide T1

telmisartan-hydrochlorothiazid T1

valsartan-hydrochlorothiazide T1

ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)

candesartan T1

eprosartan T1

irbesartan T1

losartan T1

olmesartan T1

telmisartan T1

valsartan T1

ANTIANGINAL - CORONARY VASODILATORS (NITRATES)

isosorbide dinitrate T1

isosorbide mononitrate T1

nitroglycerin T1

nitroglycerin in 5 % dextrose T1

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Drug Name Formulary Tier Restrictions

ANTIARRHYTHMIC - CLASS IA

disopyramide phosphate T1

procainamide T1

quinidine gluconate T1

quinidine sulfate T1

ANTIARRHYTHMIC - CLASS IB

lidocaine (pf) T1

lidocaine in 5 % dextrose (pf) T1

mexiletine T1

phenytoin sodium T1

ANTIARRHYTHMIC - CLASS IC

flecainide T1

propafenone T1

ANTIARRHYTHMIC - CLASS II

esmolol T1

sotalol T1

SOTALOL AF T1

ANTIARRHYTHMIC - CLASS III

amiodarone T1

amiodarone in dextrose 5 % T1

ibutilide fumarate T1

ANTIARRHYTHMIC - CLASS IV

diltiazem hcl T1

verapamil T1

ANTIARRHYTHMIC OTHERS

adenosine T1

ANTIHYPERLIPIDEMIC - BILE ACID SEQUESTRANTS

cholestyramine (with sugar) T1

colestipol T1

CHOLESTYRAMINE LIGHT T1

PREVALITE T1

ANTIHYPERLIPIDEMIC - FIBRIC ACID DERIVATIVES

fenofibrate T1

fenofibrate micronized T1

fenofibrate nanocrystallized T1

fenofibric acid T1

fenofibric acid (choline) T1

gemfibrozil T1

ANTIHYPERLIPIDEMIC - HMG COA REDUCTASE INHIBITORS (STATINS)

atorvastatin T1

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Drug Name Formulary Tier Restrictions

fluvastatin T1 ST

lovastatin T1

pravastatin T1

rosuvastatin T1

simvastatin T1

ANTIHYPERLIPIDEMIC - NICOTINIC ACID DERIVATIVES

niacin T1

ANTIHYPERLIPIDEMIC - SELECTIVE CHOLESTEROL ABSORPTION INHIBITOR

ezetimibe T1 ST

ANTIHYPERLIPIDEMIC AGENTS - DIETARY SOURCE

TRIKLO T1

ANTIHYPERLIPIDEMIC AGENTS - DIETARY SOURCE COMBINATIONS

vitamin e T1

ANTIHYPERLIPIDEMIC HMG COA REDUCT INHIB AND CALCIUM CHANNEL BLOCKER

amlodipine-atorvastatin T1

ANTIHYPERLIPIDEMIC-HMG COA REDUCT INHIB AND CHOLESTEROL ABSORP INHIBIT

ezetimibe-simvastatin T1

BETA BLOCKERS CARDIAC SELECTIVE

atenolol T1

betaxolol T1

bisoprolol fumarate T1

esmolol T1

metoprolol succinate T1

metoprolol tartrate T1

BETA BLOCKERS CARDIAC SELECTIVE, INTRINSIC SYMPATHOMIMETIC ACTIVITY

acebutolol T1

BETA BLOCKERS NON-CARDIAC SELECT., INTRINSIC SYMPATHOMIMETIC ACTIVITY

pindolol T1

BETA BLOCKERS NON-CARDIAC SELECTIVE

nadolol T1

propranolol T1

sotalol T1

timolol maleate T1

SOTALOL AF T1

CALCIUM CHANNEL BLOCKERS - BENZOTHIAZEPINES

diltiazem hcl T1

diltiazem hcl in 0.9% nacl T1

CARTIA XT T1

TAZTIA XT T1

CALCIUM CHANNEL BLOCKERS - DIHYDROPYRIDINES

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Drug Name Formulary Tier Restrictions

amlodipine T1

felodipine T1

nicardipine T1

nifedipine T1

CALCIUM CHANNEL BLOCKERS - DIHYDROPYRIDINES - CEREBROVASCULAR SPECIFIC

nimodipine T1

CALCIUM CHANNEL BLOCKERS - PHENYLAKYLAMINES

verapamil T1

CARDIAC INOTROPES - PHOSPHODIESTERASE INHIBITORS

milrinone T1

milrinone in 5 % dextrose T1

CARDIAC SELECTIVE BETA BLOCKER-THIAZIDE DIURETIC AND RELATED COMB.

atenolol-chlorthalidone T1

bisoprolol-hydrochlorothiazide T1

metoprolol ta-hydrochlorothiaz T1

CARDIOVASCULAR SYMPATHOMIMETIC - ANAPHYLAXIS THERAPY SINGLE AGENTS

epinephrine T1

ADYPHREN T1

CARDIOVASCULAR SYMPATHOMIMETICS

dobutamine T1

dobutamine in d5w T1

dopamine T1

dopamine in 5 % dextrose T1

ephedrine sulfate T1

ephedrine sulfate-0.9%nacl(pf) T1

epinephrine T1

midodrine T1

norepinephrine bitartrate T1

phenylephrine hcl T1

phenylephrine hcl in 0.9% nacl T1

CENTRAL ALPHA-2 AGONISTS-THIAZIDE DIURETIC AND RELATED COMB.

methyldopa-hydrochlorothiazide T1

CENTRAL ALPHA-2 RECEPTOR AGONISTS

clonidine T1

clonidine hcl T1

guanfacine T1

methyldopa T1

methyldopate T1

DIGITALIS GLYCOSIDES

digoxin T1

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Drug Name Formulary Tier Restrictions

DIRECT ACTING VASODILATORS

hydralazine T1

DIURETIC - ALDOSTERONE RECEPTOR ANTAGONIST, NON-SELECTIVE

spironolactone T1

DIURETIC - ALDOSTERONE RECEPTOR ANTAGONIST, SELECTIVE

eplerenone T1

DIURETIC - CARBONIC ANHYDRASE INHIBITORS

acetazolamide T1

acetazolamide sodium T1

methazolamide T1

DIURETIC - INORGANIC SALT

ammonium chloride T1

DIURETIC - LOOP

bumetanide T1

ethacrynate sodium T1

furosemide T1

torsemide T1

DIURETIC - OSMOTIC

mannitol 10 % T1

mannitol 20 % T1

mannitol 25 % T1

mannitol 5 % T1

DIURETIC - POTASSIUM SPARING

amiloride T1

DIURETIC - POTASSIUM SPARING-THIAZIDE AND RELATED COMBINATIONS

amiloride-hydrochlorothiazide T1

spironolacton-hydrochlorothiaz T1

triamterene-hydrochlorothiazid T1

DIURETIC - THIAZIDES AND RELATED

chlorothiazide T1

chlorthalidone T1

hydrochlorothiazide T1

indapamide T1

methyclothiazide T1

metolazone T1

GANGLIONIC BLOCKING, NON-DEPOLARIZING

VECAMYL T1

MUSCARINIC RECEPTOR ANTAGONISTS (ANTICHOLINERGIC)

atropine T1

atropine (bulk) T1

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Drug Name Formulary Tier Restrictions

NON-CARDIAC SELECTIVE BETA BLOCKER-THIAZIDE DIURETIC AND RELATED COMB.

nadolol-bendroflumethiazide T1

propranolol-hydrochlorothiazid T1

PATENT DUCTUS ARTERIOSUS (PDA) TREATMENT AGENTS , NSAID-TYPE

indomethacin sodium T1

PATENT DUCTUS ARTERIOSUS (PDA) TREATMENT AGENTS, PROSTAGLANDIN-TYPE

alprostadil T1

PERIPHERAL ALPHA-1 RECEPTOR BLOCKERS

doxazosin T1

prazosin T1

terazosin T1

PERIPHERAL VASODILATORS, SINGLE AGENTS

isoxsuprine T1

papaverine T1

PULMONARY ANTIHYPERTENSIVE AGENTS - PROSTACYCLIN-TYPE

epoprostenol (glycine) T1 PA

CENTRAL NERVOUS SYSTEM AGENTS

ANTIANXIETY AGENT - ANTIHISTAMINE TYPE

hydroxyzine hcl T1

hydroxyzine pamoate T1

ANTIANXIETY AGENT - BENZODIAZEPINES

alprazolam T1

chlordiazepoxide hcl T1

clonazepam T1

clorazepate dipotassium T1

diazepam T1

lorazepam T1

oxazepam T1

ALPRAZOLAM INTENSOL T1

DIAZEPAM INTENSOL T1

ANTIANXIETY AGENT - DICARBAMATE TYPE

meprobamate T1

ANTIANXIETY AGENT - NON-BENZODIAZEPINE

buspirone T1

ANTICONVULSANT - BARBITURATES AND DERIVATIVES

phenobarbital T1

phenobarbital sodium T1

primidone T1

ANTICONVULSANT - BENZODIAZEPINES

clonazepam T1

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Drug Name Formulary Tier Restrictions

diazepam T1

ANTICONVULSANT - CARBAMATES

felbamate T1

ANTICONVULSANT - CARBOXYLIC ACID DERIVATIVES

divalproex T1

valproic acid T1

valproic acid (as sodium salt) T1

ANTICONVULSANT - GABA ANALOGS

gabapentin T1

ANTICONVULSANT - HYDANTOINS

fosphenytoin T1

phenytoin T1

phenytoin sodium T1

phenytoin sodium extended T1

ANTICONVULSANT - IMINOSTILBENE DERIVATIVES

carbamazepine T1

oxcarbazepine T1

ANTICONVULSANT - MONOSACCHARIDE DERIVATIVES

topiramate T1

ANTICONVULSANT - PHENYLTRIAZINE DERIVATIVES

lamotrigine T1

ANTICONVULSANT - PYRROLIDINE DERIVATIVES

levetiracetam T1

ANTICONVULSANT - SUCCINIMIDES

ethosuximide T1

ANTICONVULSANT - SULFONAMIDE DERIVATIVES

zonisamide T1

ANTIDEPRESSANT - ALPHA-2 RECEPTOR ANTAGONISTS (NASSA)

mirtazapine T1

ANTIDEPRESSANT - MAO INHIBITOR NONSELECTIVE AND IRREVERSIBLE-TYPES A,B

phenelzine T1

ANTIDEPRESSANT - SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)

citalopram T1

escitalopram oxalate T1

fluoxetine T1

fluvoxamine T1

paroxetine hcl T1

sertraline T1

ANTIDEPRESSANT - SEROTONIN-2 ANTAGONIST-REUPTAKE INHIBITORS (SARIS)

nefazodone T1

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Drug Name Formulary Tier Restrictions

trazodone T1

ANTIDEPRESSANT - SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)

desvenlafaxine T1

desvenlafaxine fumarate T1

desvenlafaxine succinate T1

duloxetine T1

venlafaxine T1

ANTIDEPRESSANT - TRICYCLIC AND ANTIPSYCHOTIC, PHENOTHIAZINE COMB

perphenazine-amitriptyline T1

ANTIDEPRESSANT - TRICYCLIC-BENZODIAZEPINE COMBINATIONS

amitriptyline-chlordiazepoxide T1

ANTIDEPRESSANT-NOREPINEPHRINE AND DOPAMINE REUPTAKE INHIBITORS (NDRIS)

bupropion hcl T1

ANTIDEPRESSANT-TRICYCLICS AND RELATED (NON-SELECT REUPTAKE INHIBITORS)

amitriptyline T1

amoxapine T1

clomipramine T1 PA

desipramine T1

doxepin T1

imipramine hcl T1

imipramine pamoate T1

maprotiline T1

nortriptyline T1

protriptyline T1

ANTIPARKINSON - DOPAMINERGIC-PERIPH COMT-DOPA-DECARBOXYLASE INHIB COMB

carbidopa-levodopa-entacapone T1

ANTIPARKINSON - DOPAMINERG-PERIPHERAL DOPA-DECARBOXYLASE INHIBIT COMB

carbidopa-levodopa T1

ANTIPARKINSON ADJUVANT - PERIPHERAL COMT INHIBITORS

entacapone T1

ANTIPARKINSON THERAPY - ANTICHOLINERGIC AGENTS

benztropine T1

trihexyphenidyl T1

ANTIPARKINSON THERAPY - MONOAMINE OXIDASE INHIBITOR(MAO-B)

rasagiline T1

selegiline hcl T1

ANTIPARKINSON THERAPY - NON-ERGOT DOPAMINE AGONIST AGENTS

amantadine hcl T1

pramipexole T1

ropinirole T1

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Drug Name Formulary Tier Restrictions

ANTIPSYCHOTIC - ATYPICAL DOPAMINE-SEROTONIN ANTAG- BENZISOTHIAZOLONES

ziprasidone hcl T1

ANTIPSYCHOTIC - ATYPICAL DOPAMINE-SEROTONIN ANTAG- BENZISOXAZOLE DERIV

paliperidone T1

risperidone T1

ANTIPSYCHOTIC - ATYPICAL DOPAMINE-SEROTONIN ANTAG-DIBENZODIAZEPINE DER

clozapine T1

ANTIPSYCHOTIC - BUTYROPHENONE DERIVATIVES

haloperidol T1

haloperidol decanoate T1

haloperidol lactate T1

ANTIPSYCHOTIC - DIBENZOXAZEPINE DERIVATIVES

loxapine succinate T1

ANTIPSYCHOTIC - PHENOTHIAZINES, ALIPHATIC

chlorpromazine T1

ANTIPSYCHOTIC - PHENOTHIAZINES, PIPERAZINE

fluphenazine hcl T1

perphenazine T1

prochlorperazine maleate T1

trifluoperazine T1

ANTIPSYCHOTIC - PHENOTHIAZINES, PIPERIDINE

thioridazine T1

ANTIPSYCHOTIC - THIOXANTHENES

thiothixene T1

ANTIPSYCHOTIC -ATYPICAL DOPAMINE-SEROTONIN ANTAG-DIBENZOTHIAZEPINE DER

quetiapine T1

ANTIPSYCHOTIC -ATYPICAL DOPAMINE-SEROTONIN ANTAG-THIENOBENZODIAZEPINES

olanzapine T1

ANTIPSYCHOTIC-ATYPICAL,D2 RECEPTOR PARTIAL AGONIST-5HT SEROTONIN MIXED

aripiprazole T1

ATTENTION DEFICIT-HYPERACTIVITY (ADHD) THERAPY, STIMULANT-TYPE

dexmethylphenidate T1

dextroamphetamine T1

dextroamphetamine-amphetamine T1

methylphenidate hcl T1

ATTENTION DEFICIT-HYPERACTIVITY DISORDER (ADHD) THERAPY, NRI-TYPE

atomoxetine T1

BENZODIAZEPINES

amitriptyline-chlordiazepoxide T1

chlordiazepoxide-clidinium T1

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Drug Name Formulary Tier Restrictions

diazepam T1

lorazepam T1

DIAZEPAM INTENSOL T1

BIPOLAR THERAPY AGENTS - ANTICONVULSANT TYPE

carbamazepine T1

divalproex T1

lamotrigine T1

valproic acid T1

valproic acid (as sodium salt) T1

BIPOLAR THERAPY AGENTS - ATYPICAL ANTIPSYCHOTICS

aripiprazole T1

olanzapine T1

quetiapine T1

risperidone T1

ziprasidone hcl T1

BIPOLAR THERAPY AGENTS - LITHIUM

lithium carbonate T1

CNS STIMULANT - AMPHETAMINE COMBINATIONS

dextroamphetamine-amphetamine T1

CNS STIMULANT - AMPHETAMINES

dextroamphetamine T1

DEXEDRINE SPANSULE T1

CNS STIMULANT - ANALEPTICS

caffeine citrate T1

caffeine-sodium benzoate T1

doxapram T1

FIBROMYALGIA AGENTS - SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS)

duloxetine T1

MIGRAINE THERAPY - ANALGESIC-VASOCONSTRICTORS

isomethepten-caf-acetaminophen T1

MIGRAINE THERAPY - ANALGESIC-VASOCONSTRICTOR-SEDATIVE COMBINATIONS

isometh-dichloral-acetaminophn T1

MIGRAINE THERAPY - CARBOXYLIC ACID DERIVATIVES

divalproex T1

MIGRAINE THERAPY - ERGOT ALKALOIDS AND DERIVATIVES

dihydroergotamine T1

MIGRAINE THERAPY - ERGOT COMBINATIONS

MIGERGOT T1

MIGRAINE THERAPY - SELECTIVE SEROTONIN AGONISTS 5-HT(1)

eletriptan hbr T1

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Drug Name Formulary Tier Restrictions

naratriptan T1

rizatriptan T1

sumatriptan succinate T1

zolmitriptan T1

NARCOLEPSY THERAPY AGENTS - STIMULANT-TYPE, PIPERADINE DERIVATIVE

methylphenidate hcl T1

NARCOLEPSY THERAPY AGENTS- STIMULANT-TYPE,SYMPATHOMIMETIC,AMPHETAMINES

dextroamphetamine T1

SEDATIVE-HYPNOTIC - BARBITURATES

phenobarbital T1

phenobarbital sodium T1

SEDATIVE-HYPNOTIC - BENZODIAZEPINES

estazolam T1

flurazepam T1

lorazepam T1

midazolam T1

quazepam T1

temazepam T1

triazolam T1

SEDATIVE-HYPNOTIC - GABA-RECEPTOR MODULATORS

eszopiclone T1

zaleplon T1

zolpidem T1

SEDATIVE-HYPNOTIC - SELECTIVE ALPHA2-ADRENORECEPTOR AGONISTS

dexmedetomidine T1

CHEMICAL DEPENDENCY, AGENTS TO TREAT

AGENTS FOR NARCOTIC WITHDRAWAL

buprenorphine hcl T1 ST

ALCOHOL ABSTINENCE THERAPY - GLUTAMATE AND GABA SYSTEM TYPE

acamprosate T1

ALCOHOL DETERRENTS

disulfiram T1

SMOKING DETERRENTS - NE AND DOPAMINE REUPTAKE INHIBITOR (NDRI)-TYPE

bupropion hcl T1

SMOKING DETERRENTS - NICOTINE-TYPE

nicotine (polacrilex) T1

CHEMICALS-PHARMACEUTICAL ADJUVANTS

BULK CHEMICALS

belladonna tincture (bulk) T1

CHEMICALS - ACIDS

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Drug Name Formulary Tier Restrictions

glycolic acid (bulk) T1

CHEMICALS - BASES

sodium hydroxide (bulk) T1

CHEMICALS - SOLVENTS

ethyl alcohol (bulk) T1

sodium succinate T1

PHARMACEUTICAL ADJUVANT - ANTICORROSIVE AGENTS

butylated hydroxytoluene T1

sodium bisulfite T1

PHARMACEUTICAL ADJUVANT - FLAVORING AGENTS

banana creme flavor (bulk) T1

ethyl acetate T1

PHARMACEUTICAL ADJUVANT - INHALATION VEHICLES

sodium chloride T1

PHARMACEUTICAL ADJUVANT - ORAL VEHICLES

sorbitol T1

PHARMACEUTICAL ADJUVANT - SUSPENDING AGENTS

oleic acid T1

PHARMACEUTICAL ADJUVANT - TABLETING

cellulose (bulk) T1

lactose (bulk) T1

magnesium stearate T1

COGNITIVE DISORDER THERAPY

ALZHEIMER'S DISEASE THERAPY - CHOLINESTERASE INHIBITORS

donepezil T1

galantamine T1

rivastigmine tartrate T1

ALZHEIMER'S DISEASE THERAPY - NMDA RECEPTOR ANTAGONISTS

memantine T1

COGNITIVE DISORDER THERAPY - CEREBRAL VASODILATORS

ergoloid T1

CONTRACEPTIVES

CONTRACEPTIVE INJECTABLE - PROGESTIN

medroxyprogesterone T1

CONTRACEPTIVE ORAL - BIPHASIC

DAYSEE T1

KARIVA (28) T1

VIORELE (28) T1

CONTRACEPTIVE ORAL - MONOPHASIC

desogestrel-ethinyl estradiol T1

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Drug Name Formulary Tier Restrictions

drospirenone-e.estradiol-lm.fa T1

drospirenone-ethinyl estradiol T1

ethynodiol diac-eth estradiol T1

levonorgestrel-ethinyl estrad T1

mibelas 24 fe T1

noreth-ethinyl estradiol-iron T1

norethindrone-e.estradiol-iron T1

norgestimate-ethinyl estradiol T1

AMETHYST T1

APRI T1

AVIANE T1

BRIELLYN T1

CYCLAFEM 1/35 (28) T1

ELINEST T1

EMOQUETTE T1

GIANVI (28) T1

GILDAGIA T1

ISIBLOOM T1

JOLESSA T1

JUNEL 1.5/30 (21) T1

JUNEL 1/20 (21) T1

JUNEL FE 1.5/30 (28) T1

JUNEL FE 1/20 (28) T1

KELNOR 1/35 (28) T1

LILLOW T1

LORYNA (28) T1

MELODETTA 24 FE T1

MICROGESTIN FE 1.5/30 (28) T1

MICROGESTIN FE 1/20 (28) T1

MONONESSA (28) T1

NORTREL 0.5/35 (28) T1

NORTREL 1/35 (21) T1

NORTREL 1/35 (28) T1

OCELLA T1

ORSYTHIA T1

PHILITH T1

PIRMELLA T1

QUASENSE T1

RAJANI T1

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Drug Name Formulary Tier Restrictions

SPRINTEC (28) T1

SRONYX T1

ZARAH T1

ZOVIA 1/35E (28) T1

ZOVIA 1/50E (28) T1

CONTRACEPTIVE ORAL - PROGESTIN

CAMILA T1

HEATHER T1

NORLYDA T1

CONTRACEPTIVE ORAL - QUADRAPHASIC

FAYOSIM T1

RIVELSA T1

CONTRACEPTIVE ORAL - TRIPHASIC

norgestimate-ethinyl estradiol T1

ALYACEN 7/7/7 (28) T1

ARANELLE (28) T1

CAZIANT (28) T1

CYCLAFEM 7/7/7 (28) T1

DASETTA 7/7/7 (28) T1

LEVONEST (28) T1

MYZILRA T1

NECON 7/7/7 (28) T1

NORTREL 7/7/7 (28) T1

TILIA FE T1

TRI FEMYNOR T1

TRINESSA (28) T1

TRI-PREVIFEM (28) T1

TRI-SPRINTEC (28) T1

CONTRACEPTIVE TRANSDERMAL COMBINATIONS

XULANE T1

CONTRACEPTIVE TRANSDERMAL COMBINATIONS - ESTROGEN AND PROGESTIN COMB.

XULANE T1

EMERGENCY CONTRACEPTIVES

MY WAY T1

NEXT CHOICE ONE DOSE T1

EMERGENCY CONTRACEPTIVES - PROGESTIN TYPE

MY WAY T1

NEXT CHOICE ONE DOSE T1

DERMATOLOGICAL

ACNE THERAPY SYSTEMIC - TETRACYCLINES

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Drug Name Formulary Tier Restrictions

minocycline T1

ACNE THERAPY TOPICAL - ANTI-INFECTIVE

clindamycin phosphate T1

erythromycin with ethanol T1

metronidazole T1

ACNE THERAPY TOPICAL - ANTI-INFECTIVE-KERATOLYTIC COMBINATIONS

erythromycin-benzoyl peroxide T1

sulfacetamide sodium-sulfur T1

sulfacetamide sod-sulfur-urea T1

sulfacetamide-sulfur-cleansr23 T1

sulfact na-sul-avobnz-otn-ocsa T1

ACNE THERAPY TOPICAL - KERATOLYTIC

benzoyl peroxide T1

potassium hydroxide T1

BP WASH ACNE TREATMENT T1

ACNE THERAPY TOPICAL - RETINOID COMBINATIONS OTHER

adapalene-benzoyl peroxide T1

ACNE THERAPY TOPICAL - RETINOIDS AND DERIVATIVES

adapalene T1

DERMATOLOGICAL - ANTIBACTERIAL AMINOGLYCOSIDES

gentamicin T1

DERMATOLOGICAL - ANTIBACTERIAL OTHER

mupirocin T1

mupirocin calcium T1

silver nitrate T1

NORMLGEL AG T1

DERMATOLOGICAL - ANTIBACTERIAL SULFONAMIDES

sulfacetamide sodium-sulfur T1

DERMATOLOGICAL - ANTIFUNGAL AMPHOTERIC POLYENE MACROLIDES

nystatin T1

DERMATOLOGICAL - ANTIFUNGAL COMBINATIONS OTHER

EXODERM T1

DERMATOLOGICAL - ANTIFUNGAL HYDROXYPYRIDINONE

ciclopirox T1

ciclopirox-ure-camph-menth-euc T1

DERMATOLOGICAL - ANTIFUNGAL IMIDAZOLE AND RELATED AGENTS

clotrimazole T1

ketoconazole T1

oxiconazole T1

DERMATOLOGICAL - ANTIFUNGAL-GLUCOCORTICOID COMBINATIONS

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clotrimazole-betamethasone T1

iodoquinol-hc T1

nystatin-triamcinolone T1

DERMATOLOGICAL - ANTIFUNGALS OTHER

triacetin T1

DERMATOLOGICAL - ANTINEOPLASTIC ANTIMETABOLITES

fluorouracil T1

DERMATOLOGICAL - ANTIPSORIATIC AGENTS SYSTEMIC, VITAMIN A DERIVATIVES

acitretin T1

DERMATOLOGICAL - ANTIPSORIATIC AGENTS TOPICAL

calcipotriene T1

calcitriol T1

tazarotene T1

DERMATOLOGICAL - ANTISEBORRHEIC

selenium sulfide T1

sulfacetamide sodium T1

DERMATOLOGICAL - BURN PRODUCTS ANTI-INFECTIVE

silver sulfadiazine T1

DERMATOLOGICAL - DEPIGMENTING AGENTS

hydroquinone T1

hydroquinone microspheres T1

DERMATOLOGICAL - EMOLLIENT COMBINATIONS OTHER

HPR PLUS-MB HYDROGEL T1

MB HYDROGEL T1

MB HYDROGEL (CYCLOMETHICONE) T1

DERMATOLOGICAL - EMOLLIENT MIXTURES

AVO CREAM T1

EMULSION SB T1

HPR T1

HPR PLUS T1

PRUCLAIR T1

PRUMYX T1

PRUTECT T1

SONAFINE T1

DERMATOLOGICAL - EMOLLIENTS

ammonium lactate T1

urea T1

DERMATOLOGICAL - GLUCOCORTICOID

alclometasone T1

amcinonide T1

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Drug Name Formulary Tier Restrictions

betamethasone dipropionate T1

betamethasone valerate T1

betamethasone, augmented T1

desonide T1

diflorasone T1

fluocinolone T1

fluocinolone and shower cap T1

fluocinonide T1

fluticasone T1

halobetasol propionate T1

hydrocortisone T1

hydrocortisone butyrate T1

hydrocortisone valerate T1

hydrocortisone-pramoxine T1

mometasone T1

prednicarbate T1

triamcinolone acetonide T1

FLUOCINONIDE-E T1

PROCTO-PAK T1

PROCTOZONE-HC T1

SCALACORT T1

TRIDERM T1

DERMATOLOGICAL - GLUCOCORTICOID-EMOLLIENT COMBINATIONS

hydrocortisone-min oil-wht pet T1

DERMATOLOGICAL - GLUCOCORTICOID-LOCAL ANESTHETIC COMBINATIONS

hydrocortisone-pramoxine T1

lidocaine hcl-hydrocortison ac T1

DERMATOLOGICAL - IMMUNOMODULATOR - IMIDAZOQUINOLINAMINES

imiquimod T1

DERMATOLOGICAL - KERATOLYTIC-ANTIMITOTIC COMBINATIONS

silver nitrate applicators T1

DERMATOLOGICAL - KERATOLYTIC-ANTIMITOTIC SINGLE AGENTS

podofilox T1

salicylic acid T1

salicylic acid er-ceramides T1

trichloroacetic acid T1

urea T1

BP-50% UREA T1

UMECTA T1

DERMATOLOGICAL - KERATOPLASTIC TAR PRODUCTS

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coal tar T1

DERMATOLOGICAL - LOCAL ANESTHETIC COMBINATIONS

lidocaine-prilocaine T1

DERMATOLOGICAL - LOCAL ANESTHETIC GAS SINGLE AGENTS

ethyl chloride T1

DERMATOLOGICAL - PROTECTANT COMBINATIONS

HYGEL T1

PR CREAM T1

DERMATOLOGICAL - ROSACEA THERAPY, TOPICAL

metronidazole T1

sulfacetamide sod-sulfur-urea T1

sulfact na-sul-avobnz-otn-ocsa T1

DERMATOLOGICAL - TOPICAL LOCAL ANESTHETIC AMIDES

lidocaine hcl T1

lidocaine-tetracaine T1

DERMATOLOGICAL - TOPICAL LOCAL ANESTHETIC ESTERS

cocaine T1

DERMATOLOGICAL IRRITANTS-COUNTER-IRRITANT SINGLE AGENTS

methyl salicylate T1

SCABICIDE AND PEDICULICIDE SINGLE AGENTS

lindane T1

permethrin T1

spinosad T1

DIAGNOSTIC AGENTS

CONTRAST MEDIA - BARIUM

LIQUID E-Z PAQUE T1

CONTRAST MEDIA - IODINATED IONIC

MD-GASTROVIEW T1

DIAGNOSTIC DRUGS - CARDIOVASCULAR

dipyridamole T1

DIAGNOSTIC DRUGS - IN VIVO OTHER

isosulfan blue T1

DIAGNOSTIC DRUGS - PITUITARY FUNCTION

cosyntropin T1

DIAGNOSTIC RADIOPHARMACEUTICALS - BONE OR SKELETAL IMAGING

kit prep of tc-99m-sod pyroph T1

kit prep tc-99m-medronate sod T1

DIAGNOSTIC RADIOPHARMACEUTICALS - HEPATOBILIARY IMAGING

kit prep of tc-99m-mebrofenin T1

DIAGNOSTIC RADIOPHARMACEUTICALS - MISC.

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Drug Name Formulary Tier Restrictions

kit for tc 99m-sod thiosulfate T1

DIAGNOSTIC RADIOPHARMACEUTICALS - MYOCARDIAL PERFUSION IMAGING

kit for tc 99m-sestamibi no.1 T1

kit prep of tc-99m-sod pyroph T1

thallous chloride tl-201 T1

DIAGNOSTIC RADIOPHARMACEUTICALS - RADIOLABELING AUTOLOGOUS LEUKOCYTES

indium in-111 oxyquinoline T1

EATING DISORDER THERAPY

ANOREXIANTS

diethylpropion T1

phendimetrazine tartrate T1

APPETITE STIMULANTS - PROGESTIN HORMONE TYPE

megestrol T1

ELECTROLYTE BALANCE-NUTRITIONAL PRODUCTS

B-COMPLEX VITAMIN COMBINATIONS

FOLBEE PLUS T1

MYNEPHROCAPS T1

RENAL CAPS T1

RENO CAPS T1

TRIPHROCAPS T1

VIRT-VITE PLUS T1

B-COMPLEX VITAMINS AND COMBINATIONS

RENA-VITE RX T1

VOL-CARE RX T1

DEXTROSE AND LACTATED RINGER'S SOLUTIONS

dextrose 5 %-lactated ringers T1

DEXTROSE AND SODIUM CHLORIDE SOLUTIONS

d10 %-0.45 % sodium chloride T1

d2.5 %-0.45 % sodium chloride T1

d5 % and 0.9 % sodium chloride T1

d5 %-0.45 % sodium chloride T1

dextrose 10 % and 0.2 % nacl T1

dextrose 5%-0.2 % sod chloride T1

dextrose 5%-0.3 % sod.chloride T1

DEXTROSE SOLUTIONS

dextrose 10 % in water (d10w) T1

dextrose 20 % in water (d20w) T1

dextrose 25 % in water (d25w) T1

dextrose 30 % in water (d30w) T1

dextrose 40 % in water (d40w) T1

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dextrose 5 % in water (d5w) T1

dextrose 50 % in water (d50w) T1

dextrose 70 % in water (d70w) T1

DEXTROSE SOLUTIONS, CONCENTRATED

dextrose 20 % in water (d20w) T1

dextrose 25 % in water (d25w) T1

dextrose 30 % in water (d30w) T1

dextrose 40 % in water (d40w) T1

dextrose 50 % in water (d50w) T1

dextrose 70 % in water (d70w) T1

DIETARY PRODUCT - DIETARY SUPPLEMENTS

VP-ZEL T1

DILUENTS - SODIUM CHLORIDE

sodium chloride 0.9 % T1

DILUENTS - STERILE WATER FOR INJECTION

water for inject, bacteriostat T1

water for injection, sterile T1

ELECTROLYTE DEPLETERS - ION EXCHANGE RESIN

sodium polystyrene sulfonate T1

KIONEX (WITH SORBITOL) T1

SPS (WITH SORBITOL) T1

IRRIGATION SOLUTIONS

lactated ringers T1

ringer's T1

water for irrigation, sterile T1

MINERALS AND ELECTROLYTES - BICARBONATE PRODUCING OR CONTAINING AGENTS

sodium acetate T1

sodium bicarbonate T1

sodium lactate T1

MINERALS AND ELECTROLYTES - CALCIUM REPLACEMENT

calcium acetate T1

calcium chloride T1

calcium gluconate T1

calcium gluconate in 0.9% nacl T1

calcium gluconate in d5w T1

MINERALS AND ELECTROLYTES - CALCIUM REPLACEMENT COMBINATIONS

CALCIUM-FOLIC ACID-VITAMIN D T1

TL G-FOL OS T1

MINERALS AND ELECTROLYTES - ELECTROLYTES AND DEXTROSE

dextrose 5 % in ringer's T1

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Drug Name Formulary Tier Restrictions

electrolyte-48 in d5w T1

MINERALS AND ELECTROLYTES - IODINE

LUGOLS T1

STRONG IODINE T1

MINERALS AND ELECTROLYTES - IRON

sodium ferric gluconat-sucrose T1

MINERALS AND ELECTROLYTES - IRON COMBINATIONS

CENTRATEX T1

CORVITA 150 T1

FEROCON T1

FERRAPLUS 90 T1

FERREX 150 FORTE T1

FERREX 150 FORTE PLUS T1

FERREX 28 T1

FERROCITE PLUS T1

FOLIVANE-F T1

FOLIVANE-PLUS T1

HEMATINIC PLUS VIT/MINERALS T1

HEMATINIC/FOLIC ACID T1

HEMATOGEN FA T1

HEMATOGEN FORTE T1

HEMETAB T1

IFEREX 150 FORTE T1

MULTIGEN T1

MULTIGEN FOLIC T1

MULTIGEN PLUS T1

POLY-IRON 150 FORTE T1

TARON FORTE T1

TL ICON T1

TL-HEM 150 T1

TRIGELS-F FORTE T1

MINERALS AND ELECTROLYTES - MAGNESIUM

magnesium chloride T1

magnesium sulfate T1

magnesium sulfate in d5w T1

magnesium sulfate in lr T1

magnesium sulfate in water T1

MINERALS AND ELECTROLYTES - MANGANESE

manganese chloride T1

MINERALS AND ELECTROLYTES - PHOSPHATE

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Drug Name Formulary Tier Restrictions

potassium phosphate m-/d-basic T1

sodium phosphate T1

sodium phosphate in 0.9 % nacl T1

MINERALS AND ELECTROLYTES - POTASSIUM COMBINATIONS

potassium bicarb and chloride T1

MINERALS AND ELECTROLYTES - POTASSIUM FOR INJECTION

potassium acetate T1

potassium chlorid-d5-0.45%nacl T1

potassium chloride T1

potassium chloride in 0.9%nacl T1

potassium chloride in 5 % dex T1

potassium chloride in lr-d5 T1

potassium chloride-0.45 % nacl T1

potassium chloride-d5-0.2%nacl T1

potassium chloride-d5-0.3%nacl T1

potassium chloride-d5-0.9%nacl T1

MINERALS AND ELECTROLYTES - POTASSIUM, ORAL

potassium bicarb-citric acid T1

potassium chloride T1

MINERALS AND ELECTROLYTES - TRACE MINERAL COMBINATIONS

MULTITRACE-4 T1

MULTITRACE-4 CONCENTRATE T1

MULTITRACE-4 NEONATAL T1

MULTITRACE-5 T1

MULTITRACE-5 CONCENTRATE T1

MINERALS AND ELECTROLYTES - TRACE MINERALS

chromium chloride T1

selenium T1

COPPER CHLORIDE T1

MINERALS AND ELECTROLYTES - ZINC

zinc chloride T1

zinc sulfate T1

MULTIVITAMIN AND MINERAL COMBINATIONS

ADVANCED AM-PM T1

V-C FORTE T1

VIC-FORTE T1

MULTIVITAMINS

L-METHYL-MC T1

METAFOLBIC T1

PUREVIT DUALFE PLUS T1

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SE-TAN PLUS T1

VIT 3 T1

PARENTERAL NUTRITION - AMINO ACID SOLUTIONS

cysteine (l-cysteine) T1

CLINISOL SF 15 % T1

PEDIATRIC VITAMINS

MVW COMPLETE FORMUL PEDIATRIC T1

PEDIATRIC VITAMINS WITH FLUORIDE COMBINATIONS

MULTIVITAMIN WITH FLUORIDE T1

MULTI-VITAMIN WITH FLUORIDE T1

MULTIVITAMINS WITH FLUORIDE T1

TRIPLE VITAMIN WITH FLUORIDE T1

TRI-VITAMIN WITH FLUORIDE T1

VITAMINS A,C,D AND FLUORIDE T1

PRENATAL VITAMINS AND MINERALS

C-NATE DHA T1

COMPLETE NATAL DHA T1

COMPLETENATE T1

ELITE OB WITH DHA T1

ELITE-OB 400 T1

EXTRA-VIRT PLUS DHA T1

FOLIVANE-OB T1

HEMENATAL OB T1

HEMENATAL OB + DHA T1

LEVOMEFOLATE DHA T1

MYNATAL T1

MYNATAL ADVANCE T1

MYNATAL PLUS T1

MYNATAL-Z T1

MYNATE 90 PLUS T1

OBSTETRIX DHA T1

PNV OB+DHA T1

PNV-DHA T1

PNV-DHA + DOCUSATE T1

PNV-OMEGA T1

PNV-SELECT T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

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PRENA1 TRUE T1

PRENAISSANCE T1

PRENAISSANCE PLUS T1

PRENATAL 19 (WITH DOCUSATE) T1

PRENATAL LOW IRON T1

PRENATAL PLUS T1

PRENATAL PLUS (CALCIUM CARB) T1

PRENATAL-U T1

RELNATE DHA T1

SE-NATAL 19 T1

SE-NATAL 19 (WITH DOCUSATE) T1

TARON-C DHA T1

TARON-PREX PRENATAL-DHA T1

TL-SELECT T1

TRIADVANCE T1

TRINATAL GT T1

TRINATAL RX 1 T1

TRIVEEN-DUO DHA T1

TRIVEEN-ONE T1

TRIVEEN-PRX RNF T1

TRUST NATAL DHA T1

ULTIMATECARE ONE T1

ULTIMATECARE ONE NF T1

VEMAVITE-PRX-2 T1

VENA-BAL DHA T1

VINACAL T1

VINATE GT T1

VINATE II T1

VINATE M T1

VINATE ONE T1

VINATE PN CARE T1

VINATE ULTRA T1

VIRT-PN T1

VIRT-PN DHA T1

VIRT-PN PLUS T1

VIRT-SELECT T1

VOL-NATE T1

VOL-TAB RX T1

VP-CH PLUS T1

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Drug Name Formulary Tier Restrictions

VP-CH-PNV T1

VP-HEME ONE T1

VP-PNV-DHA T1

ZATEAN-CH T1

ZATEAN-PN DHA T1

ZATEAN-PN PLUS T1

PRENATAL VITAMINS WITHOUT IRON

VP-GGR-B6 T1

ZINGIBER T1

RINGER'S AND LACTATED RINGER'S SOLUTIONS

lactated ringers T1

ringer's T1

SODIUM CHLORIDE FLUSHES

sodium chloride 0.9 % T1

SODIUM CHLORIDE SOLUTIONS, CONCENTRATED

sodium chloride T1

sodium chloride 3 % T1

sodium chloride 5 % T1

SODIUM CHLORIDE, PARENTERAL

sodium chloride T1

sodium chloride 0.45 % T1

sodium chloride 0.9 % T1

sodium chloride 3 % T1

sodium chloride 5 % T1

STERILE WATER FOR INJECTION

water for injection, sterile T1

VITAMINS - B PREPARATION COMBINATIONS

folic acid-vit b6-vit b12 T1

FABB T1

FOLBIC RF T1

LMTHF-PYRIDOXINE-CYANOCOBALAMN T1

TL GARD RX T1

VITAMINS - B-1, THIAMINE AND DERIVATIVES

thiamine hcl (vitamin b1) T1

VITAMINS - B-12, CYANOCOBALAMIN AND DERIVATIVES

cyanocobalamin (vitamin b-12) T1

hydroxocobalamin T1

PHYSICIANS EZ USE B-12 T1

VITAMINS - B-3, NIACIN AND DERIVATIVES

niacin T1

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niacinamide (bulk) T1

VITAMINS - B-6, PYRIDOXINE AND DERIVATIVES

pyridoxine (vitamin b6) T1

VITAMINS - C, ASCORBIC ACID AND DERIVATIVES

ascorbic acid (vitamin c) T1

VITAMINS - D DERIVATIVES

calcitriol T1

ergocalciferol (vitamin d2) T1

VITAMINS - E

vitamin e T1

wheat germ oil T1

VITAMINS - FOLIC ACID AND DERIVATIVES

folic acid T1

levomefolate calcium T1

VITAMINS - FOLIC ACID COMBINATIONS

folic acid-vit b6-vit b12 T1

FABB T1

TL GARD RX T1

VITAMINS - K, PHYTONADIONE AND DERIVATIVES

phytonadione (vit k1) (bulk) T1

phytonadione (vitamin k1) T1

VITAMIN K T1

VITAMIN K1 T1

ENDOCRINE

AGENTS TO TREAT HYPOGLYCEMIA (HYPERGLYCEMICS)

glucagon hcl T1

ANDROGEN - SINGLE AGENTS

methyltestosterone T1

testosterone T1

testosterone (bulk) T1

testosterone cypionate T1

testosterone enanthate T1

ANTIDIURETIC AND VASOPRESSOR HORMONES

desmopressin T1 PA

vasopressin T1

ANTIHYPERGLYCEMIC - ALPHA-GLUCOSIDASE INHIBITORS

acarbose T1

ANTIHYPERGLYCEMIC - DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS

alogliptin T1

ANTIHYPERGLYCEMIC - MEGLITINIDE ANALOG AND BIGUANIDE COMBINATIONS

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repaglinide-metformin T1

ANTIHYPERGLYCEMIC - MEGLITINIDE ANALOGS

nateglinide T1

repaglinide T1

ANTIHYPERGLYCEMIC - SULFONYLUREA AND BIGUANIDE COMBINATIONS

glipizide-metformin T1

glyburide-metformin T1

ANTIHYPERGLYCEMIC - SULFONYLUREA DERIVATIVES

chlorpropamide T1

glimepiride T1

glipizide T1

glyburide T1

glyburide micronized T1

tolazamide T1

tolbutamide T1

ANTIHYPERGLYCEMIC - THIAZOLIDINEDIONE AND SULFONYLUREA COMBINATIONS

pioglitazone-glimepiride T1

ANTIHYPERGLYCEMIC-DIPEPTIDYL PEPTIDASE-4 INHIBIT AND THIAZOLIDINEDIONE

alogliptin-pioglitazone T1

ANTIHYPERGLYCEMIC-DIPEPTIDYL PEPTIDASE-4(DPP-4)INHIBITOR AND BIGUANIDE

alogliptin-metformin T1

ANTITHYROID AGENTS, THIONAMIDES - IMIDAZOLE DERIVATIVES

methimazole T1

ANTITHYROID AGENTS, THIONAMIDES - THIOURACIL DERIVATIVES

propylthiouracil T1

BONE RESORPTION INHIBITORS - BISPHOSPHONATES

alendronate T1

etidronate disodium T1

ibandronate T1

risedronate T1

CALCITONINS

calcitonin (salmon) T1

ESTROGEN-ANDROGEN

estrogens-methyltestosterone T1

ESTROGEN-PROGESTIN

estradiol-norethindrone acet T1

norethindrone ac-eth estradiol T1

AMABELZ T1

JINTELI T1

ESTROGENS

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estradiol T1

estradiol valerate T1

estropipate T1

FERTILITY ENHANCER - OVULATION STIMULANT - SYNTHETIC (NON-FSH)

clomiphene citrate T1

GLUCOCORTICOID SALT COMBINATIONS

betamethasone acet,sod phos T1

GLUCOCORTICOIDS

cortisone T1

dexamethasone T1

dexamethasone in 0.9 % sod chl T1

dexamethasone sodium phos (pf) T1

dexamethasone sodium phosphate T1

hydrocortisone T1

methylprednisolone T1

methylprednisolone acetate T1

methylprednisolone sodium succ T1

prednisolone T1

prednisolone sodium phosphate T1

prednisone T1

DEXAMETHASONE INTENSOL T1

MILLIPRED DP T1

PREDNISONE INTENSOL T1

GONADOTROPIN INHIBITOR PITUITARY SUPPRESSANTS

danazol T1

INSULIN RESPONSE ENHANCERS - BIGUANIDES

metformin T1

INSULIN RESPONSE ENHANCERS - THIAZOLIDINEDIONES (PPAR-GAMMA AGONISTS)

pioglitazone T1

MENOPAUSAL SYMPTOMS SUPPRESSANT-SSRI ANTIDEPRESSANT TYPE

paroxetine mesylate T1

MINERALOCORTICOIDS

fludrocortisone T1

OXYTOCIC - ERGOT ALKALOIDS

methylergonovine T1

OXYTOCIC - OXYTOCIN AND ANALOGS

oxytocin T1

oxytocin in dextrose 5 % in lr T1

PROGESTINS

medroxyprogesterone T1

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Drug Name Formulary Tier Restrictions

norethindrone acetate T1

progesterone T1

progesterone micronized T1

PROLACTIN INHIBITOR - ERGOT DERIVATIVE DOPAMINE RECEPTOR AGONISTS

cabergoline T1

SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)

raloxifene T1

THYROID HORMONES - SYNTHETIC T3 (TRIIODOTHYRONINE)

liothyronine T1

THYROID HORMONES - SYNTHETIC T4 (THYROXINE)

levothyroxine T1

GASTROINTESTINAL THERAPY AGENTS

ANTACID - ALUMINUM

aluminum hydroxide gel T1

ANTIDIARRHEAL - ANTIPERISTALTIC AGENTS

opium tincture T1

paregoric T1

ANTIDIARRHEAL ANTIPERISTALTIC-ANTICHOLINERGIC COMBINATIONS

diphenoxylate-atropine T1

ANTIEMETIC - ANTICHOLINERGICS

scopolamine base T1

ANTIEMETIC - ANTIHISTAMINES

dimenhydrinate T1

meclizine T1

ANTIEMETIC - PHENOTHIAZINES

prochlorperazine T1

prochlorperazine maleate T1

promethazine T1

ANTIEMETIC - SELECTIVE SEROTONIN 5-HT3 ANTAGONISTS

granisetron (pf) T1

granisetron hcl T1

ondansetron T1

ondansetron hcl T1

ondansetron hcl (pf) T1

ondansetron in 0.9 % sod chlor T1

ANTIEMETIC - SUBSTANCE P-NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS

aprepitant T1

COLONIC ACIDIFIER (AMMONIA INHIBITOR)

lactulose T1

GALLSTONE SOLUBILIZING (LITHOLYSIS) AGENTS

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ursodiol T1

GASTRIC ACID SECRETION REDUCERS - HISTAMINE H2-RECEPTOR ANTAGONISTS

cimetidine T1

cimetidine hcl T1

famotidine T1

famotidine (pf) T1

famotidine (pf)-nacl (iso-os) T1

nizatidine T1

ranitidine hcl T1

GASTRIC ACID SECRETION REDUCING AGENTS - PROTON PUMP INHIBITORS (PPIS)

pantoprazole T1

rabeprazole T1

GASTRIC MUCOSA - CYTOPROTECTIVE PROSTAGLANDIN ANALOGS

misoprostol T1

GASTROINTESTINAL PROKINETIC AGENTS - D2 ANTAGONIST/5-HT4 AGONISTS

metoclopramide hcl T1

GI ANTISPASMODIC - BELLADONNA ALKALOIDS

atropine T1

atropine (bulk) T1

belladonna tincture (bulk) T1

hyoscyamine sulfate T1

scopolamine hbr T1

GI ANTISPASMODIC - QUATERNARY AMMONIUM COMPOUNDS

glycopyrrolate T1

propantheline T1

GI ANTISPASMODIC - SYNTHETIC TERTIARY AMINES

dicyclomine T1

GI ANTISPASMODIC AND BENZODIAZEPINE COMBINATIONS

chlordiazepoxide-clidinium T1

GI ANTISPASMODIC COMBINATIONS OTHER

belladonna alkaloids-opium T1

chlordiazepoxide-clidinium T1

BELLADONNA-OPIUM T1

INFLAMMATORY BOWEL AGENT - AMINOSALICYLATES AND RELATED AGENTS

balsalazide T1

mesalamine T1

sulfasalazine T1

INFLAMMATORY BOWEL AGENT - GLUCOCORTICOIDS

hydrocortisone T1

IRRITABLE BOWEL SYNDROME (IBS) AGENTS

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alosetron T1 PA

LAXATIVE - SALINE AND OSMOTIC

lactulose T1

polyethylene glycol 3350 T1

sorbitol T1

LAXATIVE - SALINE/OSMOTIC MIXTURES

peg 3350-electrolytes T1

peg-electrolyte soln T1

PEPTIC ULCER - GASTRIC LUMEN ADHERENT CYTOPROTECTIVES

sucralfate T1

GENITOURINARY THERAPY

G.U. IRRIGANTS

acetic acid T1

glycine urologic solution T1

sorbitol T1

sorbitol-mannitol T1

G.U. IRRIGANTS - ANTI-INFECTIVE

neomycin-polymyxin b gu T1

PHOSPHATE BINDERS

calcium acetate T1

sevelamer carbonate T1

PROSTATIC HYPERTROPHY AGENT - ALPHA-1-ADRENOCEPTOR ANTAGONISTS

alfuzosin T1

tamsulosin T1

PROSTATIC HYPERTROPHY AGENT - TYPE II 5-ALPHA REDUCTASE INHIBITORS

finasteride T1

URINARY ACIDIFIER - OTHERS

ammonium chloride T1

URINARY ALKALINIZER - CITRATES

potassium citrate T1

sodium citrate-citric acid T1

CYTRA-3 T1

SHOHL'S MODIFIED T1

TRICITRATES T1

URINARY ANALGESICS

phenazopyridine T1

URINARY ANTIBACTERIAL - METHENAMINE AND SALTS

methenamine hippurate T1

methenamine mandelate T1

URINARY ANTIBACTERIAL - NITROFURAN DERIVATIVES

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MACRODANTIN T1

URINARY ANTIBACTERIAL - QUINOLONES

ciprofloxacin (mixture) T1

URINARY ANTI-INFECTIVE METHENAMINE-ANTISPAS-ANALG COMBINATIONS

HYOPHEN T1

PHOSPHASAL T1

UR N-C T1

URIN DS T1

URO-MP T1

USTELL T1

URINARY ANTI-INFECTIVE METHENAMINE-ANTISPASMODIC COMBINATIONS

URYL T1

URINARY ANTISPASMODIC - SMOOTH MUSCLE RELAXANTS

flavoxate T1

oxybutynin chloride T1

tolterodine T1

trospium T1

URINARY RETENTION THERAPY - PARASYMPATHOMIMETIC AGENTS

bethanechol chloride T1

GOUT AND HYPERURICEMIA THERAPY

GOUT ACUTE THERAPY - ANTIMITOTICS

colchicine T1

GOUT AND HYPERURICEMIA - ANTIMITOTIC-URICOSURIC COMBINATIONS

probenecid-colchicine T1

HYPERURICEMIA THERAPY - URICOSURICS

probenecid T1

HYPERURICEMIA THERAPY - XANTHINE OXIDASE INHIBITORS

allopurinol T1

HEMATOLOGICAL AGENTS

ANTICOAGULANTS - CITRATE-BASED

anticoag citrate phos dextrose T1

ANTICOAGULANTS - COUMARIN

warfarin T1

HEMOSTATIC SYSTEMIC - ANTIFIBRINOLYTIC AGENTS

aminocaproic acid T1

tranexamic acid T1

HEMOSTATIC TOPICAL AGENTS

AVITENE FLOUR T1

SYRINGE AVITENE T1

ULTRAFOAM T1

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HEPARIN FLUSH FORMULATIONS

heparin (porcine) in 0.9% nacl T1

heparin (porcine) in nacl (pf) T1

heparin flush(porcine)-0.9nacl T1

heparin lock flush (porcine) T1

heparin, porcine (pf) T1

HEP FLUSH-10 (PF) T1

HEPARINS

heparin (porcine) T1

heparin (porcine) (bulk) T1

heparin (porcine) in 0.9% nacl T1

heparin (porcine) in 5 % dex T1

heparin (porcine) in nacl (pf) T1

heparin flush(porcine)-0.9nacl T1

heparin lock flush (porcine) T1

heparin(porcine) in 0.45% nacl T1

heparin, porcine (pf) T1

HEP FLUSH-10 (PF) T1

HUMAN ALBUMIN

albumin, human 25 % T1

albumin, human 5 % T1

INDIRECT FACTOR XA INHIBITORS

fondaparinux T1

LOW MOLECULAR WEIGHT HEPARINS

enoxaparin T1

FRAGMIN T1

PLASMA EXPANDERS

hetastarch 6 % in 0.9 % nacl T1

PLATELET AGGREGATION INHIBITOR COMBINATIONS

aspirin-dipyridamole T1

PLATELET AGGREGATION INHIBITORS - PHOSPHODIESTERASE III INHIBITORS

cilostazol T1

PLATELET AGGREGATION INHIBITORS - QUINAZOLINE AGENTS

anagrelide T1

PLATELET AGGREGATION INHIBITORS - THIENOPYRIDINE AGENTS

clopidogrel T1

prasugrel T1

ticlopidine T1

PLATELET AGGREGATION INHIB-PDESTERASE AND ADENOSINE DEAMINASE INHIBITR

dipyridamole T1

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THROMBIN INHIBITOR - SELECTIVE DIRECT AND REVERSIBLE

argatroban T1

argatroban in 0.9 % sod chlor T1

argatroban in nacl (iso-os) T1

THROMBIN INHIBITOR - SELECTIVE DIRECT AND REVERSIBLE - HIRUDIN TYPE

bivalirudin T1

IMMUNOSUPPRESSIVE AGENTS

IMMUNOSUPPRESSIVE - CALCINEURIN INHIBITORS

cyclosporine T1

cyclosporine (bulk) T1

cyclosporine modified T1

tacrolimus T1

IMMUNOSUPPRESSIVE - INOSINE MONOPHOSPHATE DEHYDROGENASE INHIBITORS

mycophenolate mofetil T1

IMMUNOSUPPRESSIVE - PURINE ANALOGS

azathioprine T1

LOCOMOTOR SYSTEM

ANTIMYASTHENIC AGENT - REVERSIBLE CHOLINESTERASE INHIBITORS

neostigmine methylsulfate T1

pyridostigmine bromide T1

ANTIMYASTHENIC AGENTS OTHER

guanidine T1

NEUROMUSCULAR BLOCKER - DEPOLARIZING AGENTS

succinylcholine chloride T1

NEUROMUSCULAR BLOCKER - NONDEPOLARIZING AGENTS

atracurium T1

cisatracurium T1

pancuronium T1

rocuronium T1

vecuronium bromide T1

SKELETAL MUSCLE RELAXANT - ANALGESIC SALICYLATE COMBINATIONS

carisoprodol-aspirin T1

SKELETAL MUSCLE RELAXANT - CENTRAL MUSCLE RELAXANTS

baclofen T1

chlorzoxazone T1

cyclobenzaprine T1

metaxalone T1

methocarbamol T1

orphenadrine citrate T1

tizanidine T1

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SKELETAL MUSCLE RELAXANT - DIRECT MUSCLE RELAXANTS

dantrolene T1

REVONTO T1

SKELETAL MUSCLE RELAXANT - NARCOTIC ANALGESIC COMBINATIONS

carisoprodol-asa-codeine T1

SKELETAL MUSCLE RELAXANT, SALICYLATE, AND NARCOTIC ANALGESIC COMB.

carisoprodol-asa-codeine T1

MEDICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT (DME)

MEDICAL SUPPLIES AND DME - GLUCOSE MONITORING TEST SUPPLIES

blood glucose contrl hi,normal T1

lancets T1

lancing device T1

lancing device with lancets T1

MEDICAL SUPPLIES AND DME - INSULIN NEEDLES-SYRINGES AND ADMIN SUPPLIES

insulin syr/ndl u100 half mark T1

insulin syringe needleless T1

insulin syringe-needle u-100 T1

insulin syringes (disposable) T1

pen needle, diabetic T1

MEDICAL SUPPLIES AND DME - NEEDLES AND SYRINGES

huber safety needles (disp.) T1

needle (disp) 16 g T1

needle (disp) 18 g T1

needle (disp) 19 g T1

needle (disp) 23 gauge T1

needles, huber disposable T1

safety needles T1

syringe (disposable) T1

syringe (reusable) T1

syringe with needle T1

syringe with needle, safety T1

tuberculin-allergy syringes T1

MEDICAL SUPPLY, FDB SUPERSET

MEDICAL SUPPLY, FDB SUPERSET

blood glucose contrl hi,normal T1

huber safety needles (disp.) T1

insulin syr/ndl u100 half mark T1

insulin syringe needleless T1

insulin syringe-needle u-100 T1

insulin syringes (disposable) T1

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lancets T1

lancing device T1

lancing device with lancets T1

needle (disp) 16 g T1

needle (disp) 18 g T1

needle (disp) 19 g T1

needle (disp) 23 gauge T1

needles, huber disposable T1

pen needle, diabetic T1

safety needles T1

syringe (disposable) T1

syringe (reusable) T1

syringe with needle T1

syringe with needle, safety T1

tuberculin-allergy syringes T1

METABOLIC MODIFIERS

HYPERPARATHYROID TREATMENT AGENTS - VITAMIN D ANALOG-TYPE

doxercalciferol T1

paricalcitol T1

METABOLIC MODIFIER - CARNITINE REPLENISHER AGENTS

levocarnitine T1

levocarnitine (with sugar) T1

METABOLIC MODIFIER - UREA CYCLE DISORDER AGENTS-CONJUGATING AGENTS

sodium benzoate-sod phenylacet T1

sodium phenylbutyrate T1

MOUTH-THROAT-DENTAL - PREPARATIONS

DENTAL PRODUCT - FLUORIDE PREPARATIONS

fluoride (sodium) T1

FLURA-DROPS T1

DENTAL PRODUCT - LOCAL ANESTHETICS

bupivacaine-epinephrine bitart T1

lidocaine-epinephrine bit T1

mepivacaine (pf) T1

MOUTH AND THROAT - ANTIFUNGALS

clotrimazole T1

nystatin T1

MOUTH AND THROAT - ANTISEPTICS

chlorhexidine gluconate T1

MOUTH AND THROAT - GLUCOCORTICOIDS

triamcinolone acetonide T1

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MOUTH AND THROAT - LOCAL ANESTHETIC AMIDES

lidocaine hcl T1

MOUTH AND THROAT - SALIVA STIMULANTS

pilocarpine hcl T1

PERIODONTAL PRODUCT - TETRACYCLINE-TYPE, COLLAGENASE INHIBITORS

doxycycline hyclate T1

OPHTHALMIC AGENTS

MIOTICS - DIRECT ACTING

pilocarpine hcl T1

OPHTHALMIC - ANTIBACTERIAL-GLUCOCORTICOID COMBINATIONS

neomycin-bacitracin-poly-hc T1

neomycin-polymyxin b-dexameth T1

neomycin-polymyxin-hc T1

sulfacetamide-prednisolone T1

tobramycin-dexamethasone T1

OPHTHALMIC - ANTICHOLINERGICS

atropine T1

cyclopentolate T1

homatropine hbr T1

tropicamide T1

OPHTHALMIC - ANTIHISTAMINES

azelastine T1

epinastine T1

olopatadine T1

OPHTHALMIC - ANTI-INFLAMMATORY, GLUCOCORTICOIDS

dexamethasone sodium phosphate T1

fluorometholone T1

prednisolone acetate T1

prednisolone sodium phosphate T1

OPHTHALMIC - ANTI-INFLAMMATORY, NSAIDS

bromfenac T1

diclofenac sodium T1

flurbiprofen sodium T1

ketorolac T1

OPHTHALMIC - BETA BLOCKERS-CARBONIC ANHYDRASE INHIBITOR COMBINATIONS

dorzolamide-timolol T1

OPHTHALMIC - CARBONIC ANHYDRASE INHIBITORS

dorzolamide T1

OPHTHALMIC - DECONGESTANTS

phenylephrine hcl T1

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OPHTHALMIC - DIAGNOSTIC AGENTS

fluorescein (bulk) T1

fluorescein-proparacaine T1

FLUORESCITE T1

FUL-GLO T1

OPHTHALMIC - INTRAOCULAR PRESSURE REDUCING AGENTS, BETA-BLOCKERS

betaxolol T1

carteolol T1

levobunolol T1

metipranolol T1

timolol maleate T1

OPHTHALMIC - LOCAL ANESTHETIC ESTERS

proparacaine T1

tetracaine hcl T1

tetracaine hcl (pf) T1

OPHTHALMIC - MAST CELL STABILIZERS

cromolyn T1

OPHTHALMIC - SURGICAL AIDS OTHER

OCUCOAT T1

OPHTHALMIC ANTIBACTERIAL MIXTURES

bacitracin-polymyxin b T1

neomycin-bacitracin-polymyxin T1

neomycin-polymyxin-gramicidin T1

polymyxin b sulf-trimethoprim T1

OPHTHALMIC ANTIBIOTIC - AMINOGLYCOSIDES

gentamicin T1

tobramycin T1

OPHTHALMIC ANTIBIOTIC - DEHYDROPEPTIDASE INHIBITORS

bacitracin T1

OPHTHALMIC ANTIBIOTIC - FLUOROQUINOLONES

ciprofloxacin hcl T1

levofloxacin T1

moxifloxacin T1

ofloxacin T1

OPHTHALMIC ANTIBIOTIC - MACROLIDES

erythromycin T1

OPHTHALMIC ANTIBIOTIC - SULFONAMIDES

sulfacetamide sodium T1

OPHTHALMIC ANTIVIRALS

trifluridine T1

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OPHTHALMIC-INTRAOCULAR PRESS. REDUCING, SEL. ALPHA ADRENERGIC AGONISTS

apraclonidine T1

brimonidine T1

OPHTHALMIC-INTRAOCULAR PRESSURE REDUCING AGENTS, PROSTAGLANDIN ANALOGS

bimatoprost T1

latanoprost T1

ORGAN PRESERVATION SOLUTIONS

CARDIOPLEGIC SOLUTIONS

cardioplegic soln T1

OTIC

OTIC - ANTI-INFECTIVE-GLUCOCORTICOID COMBINATIONS

neomycin-polymyxin-hc T1

OTIC - ANTI-INFECTIVES OTHER

acetic acid T1

OTIC - FLUOROQUINOLONES

ciprofloxacin hcl T1

ofloxacin T1

OTIC - GLUCOCORTICOIDS

fluocinolone acetonide oil T1

hydrocortisone-acetic acid T1

RESPIRATORY THERAPY AGENTS

1ST GENERATION ANTIHISTAMINE-DECONGESTANT COMBINATIONS

CENTERGY T1

PROMETHAZINE VC T1

ANTIHISTAMINE - 1ST GENERATION - ETHANOLAMINES

carbinoxamine maleate T1

clemastine T1

diphenhydramine hcl T1

ANTIHISTAMINE - 1ST GENERATION - ETHYLENEDIAMINES

tripelennamine (bulk) T1

ANTIHISTAMINE - 1ST GENERATION - PHENOTHIAZINES

promethazine T1

ANTIHISTAMINE - 1ST GENERATION - PIPERIDINES

cyproheptadine T1

ANTIHISTAMINES - 1ST GENERATION

carbinoxamine maleate T1

clemastine T1

cyproheptadine T1

diphenhydramine hcl T1

promethazine T1

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ANTIHISTAMINES - 2ND GENERATION

desloratadine T1

levocetirizine T1

ANTIHISTAMINES - 2ND GENERATION - PIPERAZINES

levocetirizine T1

ANTIHISTAMINES - 2ND GENERATION - PIPERIDINES

desloratadine T1

ANTITUSSIVES - NONNARCOTIC

benzonatate T1

ASTHMA THERAPY - ALPHA/BETA ADRENERGIC AGENTS

epinephrine T1

ASTHMA THERAPY - LEUKOTRIENE RECEPTOR ANTAGONISTS

montelukast T1

zafirlukast T1

ASTHMA THERAPY - XANTHINES

aminophylline T1

aminophylline (bulk) T1

theophylline T1

theophylline in dextrose 5 % T1

ASTHMA/COPD THERAPY - BETA 2-ADRENERGIC AGENTS, INHALED, SHORT ACTING

albuterol sulfate T1

levalbuterol hcl T1

levalbuterol tartrate T1

ASTHMA/COPD THERAPY - BETA ADRENERGIC AGENTS

metaproterenol T1

terbutaline T1

ASTHMA/COPD THERAPY - BETA ADRENERGIC-ANTICHOLINERGIC COMBINATIONS

ipratropium-albuterol T1

ASTHMA/COPD THERAPY - BETA ADRENERGIC-GLUCOCORTICOID COMBINATIONS

fluticasone-salmeterol T1

MUCOLYTICS

acetylcysteine T1

acetylcysteine (bulk) T1

NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE COMBINATIONS

hydrocodone-chlorpheniramine T1

promethazine-codeine T1

NARCOTIC ANTITUSSIVE-ANTICHOLINERGIC COMBINATIONS

hydrocodone-homatropine T1

NARCOTIC ANTITUSSIVE-EXPECTORANT COMBINATIONS

codeine-guaifenesin T1

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M-CLEAR WC T1

RELCOF C T1

NASAL ANTICHOLINERGICS

ipratropium bromide T1

NASAL ANTIHISTAMINES

azelastine T1

NON-NARC ANTITUSSIVE-1ST GEN. ANTIHISTAMINE-DECONGESTANT COMBINATIONS

CENTERGY DM T1

NON-NARCOTIC ANTITUSSIVE-ANTIHISTAMINE COMBINATIONS

promethazine-dm T1

PLEURAL SCLEROSING AGENTS

sterile talc T1

VAGINAL PRODUCTS

VAGINAL ANTIBACTERIAL - LINCOSAMIDES

clindamycin phosphate T1

VAGINAL ANTIFUNGAL - IMIDAZOLES

GYNAZOLE-1 T1

MICONAZOLE-3 T1

VAGINAL ANTIFUNGAL - TRIAZOLES

terconazole T1

VAGINAL ANTIPROTOZOAL-ANTIBACTERIAL - NITROIMIDAZOLE DERIVATIVES

metronidazole T1

VAGINAL ANTISEPTIC MIXTURES

RELAGARD T1

VAGINAL ESTROGENS

estradiol T1

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54

Index

INDEX \e " " \c "3" \h "A" \z "1033"