Your 2020 Formulary · colistimethate sodium (cba) 3 demeclocycline hcl 2 dicloxacillin sodium 1...

Your 2021 Premium Value Formulary Effective January 1, 2021

Understanding your formulary

What is a formulary?A formulary is a list of prescribed medications or other pharmacy care products, services or supplies chosen for their safety, cost, and effectiveness. Medications are listed by categories or classes and are placed into cost levels known as tiers. It includes both brand and generic prescription medications.

What are tiers? Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, set by your

employer or plan sponsor. This is how much you will pay when you fill a prescription.

The formulary gives you choices so you and your doctor can decide your best course of treatment. In this formulary, brand-name medications are shown in UPPERCASE (for example, BRAND DRUG). Generic medications are shown in lowercase (for example, generic drug).

Reading your formulary

About this formulary Where differences between this formulary and your benefit plan exist, the benefit plan documents rule.

This may not be a complete list of medications that are covered by your plan. Please review your benefit plan for full details.

Tier information

Drug Tier Includes Helpful Tips

Tier 1 $ Lowest-cost medicationsBrand name and generic medications can befound in any of the 4 tiers. The lower the tier,the less your medications will cost.

Tier 2 $$ Low-cost medications

Tier 3 $$$ Mid-range cost medications

Tier 4 $$$$ Highest-range cost medications

Drug list information

PA Prior Authorization – Your doctor is required to give OptumRx more information to determine coverage.

QL Quantity Limit – Medication may be limited to a certain quantity.

SP Specialty Medication – Medication is designated as specialty.

ST Step Therapy – Must try lower-cost medication(s) before a higher-cost medication can be covered.

Table of Contents

Analgesics - Drugs for Pain ............................................................................................................................. 4Analgesics - Drugs for Pain and Inflammation ...............................................................................................4Anesthetics ........................................................................................................................................................ 6Anti-Addiction / Substance Abuse Treatment Agents ...................................................................................7Antibacterials .....................................................................................................................................................7Anticoagulants ................................................................................................................................................ 10Anticonvulsants - Drugs for Seizures ........................................................................................................... 10Antidementia Agents - Drugs for Alzheimer's Disease and Dementia .......................................................11Antidepressants .............................................................................................................................................. 12Antiemetics - Drugs for Nausea and Vomiting ............................................................................................. 12Antifungals .......................................................................................................................................................13Antigout Agents .............................................................................................................................................. 14Anti-inflammatory Agents .............................................................................................................................. 14Antimigraine Agents ....................................................................................................................................... 14Antimyasthenic Agents .................................................................................................................................. 14Antimycobacterials ......................................................................................................................................... 14Antineoplastics - Drugs for Cancer ............................................................................................................... 14Antiparasitics ...................................................................................................................................................18Antiparkinson Agents ..................................................................................................................................... 19Antiplatelets .....................................................................................................................................................19Antipsychotics - Drugs for Mood Disorders .................................................................................................19Antivirals .......................................................................................................................................................... 20Anxiolytics - Drugs for Anxiety ......................................................................................................................22Bipolar Agents - Drugs for Mood Disorders ................................................................................................. 22Blood Products / Modifiers / Volume Expanders - Drugs for Bleeding Disorders ....................................22Cardiovascular Agents - Drugs for Heart and Circulation Conditions .......................................................23Central Nervous System Agents - Drugs for Attention Deficit Disorder ...................................................26Central Nervous System Agents - Drugs for Multiple Sclerosis .................................................................27Central Nervous System Agents - Miscellaneous ........................................................................................27Dental and Oral Agents - Drugs for Mouth and Throat Conditions ............................................................ 27Dermatological Agents - Drugs for Skin Conditions ................................................................................... 28Diabetes - Antidiabetic Agents ...................................................................................................................... 30Diabetes - Glucose Monitoring ...................................................................................................................... 31Diabetes - Glycemic Agents ........................................................................................................................... 31Diabetes - Insulins ...........................................................................................................................................32Electrolytes / Minerals / Metals / Vitamins .................................................................................................... 32Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer ........................................................................ 35Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions .......................................35Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment .....................................36Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions ............................................. 37Genitourinary Agents - Drugs for Prostate Conditions ............................................................................... 37Hormonal Agents - Adrenal ............................................................................................................................37Hormonal Agents - Men's Health ................................................................................................................... 38Hormonal Agents - Osteoporosis .................................................................................................................. 38Hormonal Agents - Pituitary ...........................................................................................................................38Hormonal Agents - Prostaglandins ............................................................................................................... 39Hormonal Agents - Sex Hormones and Birth Control ................................................................................. 39Hormonal Agents - Thyroid ............................................................................................................................ 43Immunological Agents - Drugs for Immune System Stimulation or Suppression ....................................43Immunological Agents - Drugs for Vaccination ........................................................................................... 44Inflammatory Bowel Disease Agents ............................................................................................................ 45

2

Metabolic Bone Disease Agents - Drugs for Osteoporosis ........................................................................ 46Metabolic Bone Disease Agents - Other ....................................................................................................... 46Miscellaneous Therapeutic Agents ............................................................................................................... 46Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation ..................................................47Ophthalmic Agents - Drugs for Glaucoma ....................................................................................................48Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions ................................................................. 48Otic Agents - Drugs for Ear Conditions ........................................................................................................ 49Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold ...............................................49Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions .........................50Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis ............................................................51Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension ...........................................51Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm ................................................................ 52Sleep Disorder Agents ....................................................................................................................................52

3

Drug Name Drug Tier Notes

Analgesics - Drugs for Pain and Inflammation

celecoxib oral 1 QL

diclofenac potassium 1

diclofenac sodium er 1

diclofenac sodium oral 1

diclofenac sodium transdermal gel 1 %

2 QL

diclofenac-misoprostol 2

diflunisal oral 2

etodolac 2

etodolac er 2

flurbiprofen oral 1

ibu 1

ibuprofen lysine 1

ibuprofen oral suspension

1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

1

indomethacin er 1

indomethacin oral capsule 25 mg, 50 mg

1

indomethacin sodium 1

ketoprofen oral capsule 50 mg, 75 mg

2

ketorolac tromethamine injection

1

ketorolac tromethamine intramuscular

1

ketorolac tromethamine oral

1 QL

meloxicam oral 1

nabumetone oral 1

naproxen dr 1

naproxen oral tablet 1

naproxen sodium oral tablet 275 mg, 550 mg

2

oxaprozin 2


piroxicam oral 2

sulindac oral 1

tolmetin sodium 2

Analgesics - Drugs for Pain

acetaminophen-codeine

1 QL

acetaminophen-codeine #2

1 QL


1 QL


1 QL

ascomp-codeine 2

buprenorphine hcl injection

3

buprenorphine transdermal patch weekly 10 mcg/hr, 15 mcg/hr, 20 mcg/hr, 5 mcg/hr

2 PA; QL

butalbital-acetaminophen oral tablet 50-325 mg

2

butalbital-apap-caff-cod 2

butalbital-apap-caffeine oral capsule

2

butalbital-apap-caffeine oral tablet

1

butalbital-asa-caff-codeine

2

butalbital-aspirin-caffeine

2

butorphanol tartrate injection

2

butorphanol tartrate nasal

2 QL

BUTRANS TRANSDERMAL PATCH WEEKLY 7.5 MCG/HR

3 PA; QL

For more information regarding the tiers and designations in this drug list, please see the Reading your formulary section of this booklet.

4


carisoprodol-aspirin-codeine

1

codeine sulfate 2 QL

endocet 1 QL

fentanyl 2 PA; QL

fentanyl citrate buccal lozenge on a handle

3 PA; QL

hydrocodone bitartrate er oral capsule er 12 hour abuse-deterrent 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg

3 PA; QL

hydrocodone-acetaminophen

1 QL

hydrocodone-ibuprofen 1 QL

hydromorphone hcl er oral tablet er 24 hour abuse-deterrent 12 mg, 16 mg, 32 mg, 8 mg

3 PA; QL

hydromorphone hcl injection solution 1 mg/ml, 2 mg/ml, 4 mg/ml

1

hydromorphone hcl oral 1 QL

hydromorphone hcl pf 1

lorcet hd oral tablet 10-325 mg

1 QL

lorcet oral tablet 5-325 mg

1 QL

meperidine hcl injection 1

meperidine hcl oral 1 QL

methadone hcl injection 1

methadone hcl intensol 1

methadone hcl oral concentrate

1

methadone hcl oral solution

1

methadone hcl oral tablet

1 PA

methadone hcl oral tablet soluble

1


methadose oral tablet soluble

1

methadose sugar-free 1

morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml

1 QL

morphine sulfate (pf) 1

morphine sulfate er 2 PA; QL

morphine sulfate er beads

3 PA; QL

morphine sulfate injection solution 2 mg/ml, 4 mg/ml, 5 mg/ml

1

morphine sulfate intramuscular device 10 mg/0.7ml

2

MORPHINE SULFATE INTRAVENOUS SOLUTION 1 MG/ML

2

morphine sulfate oral solution

1 QL

morphine sulfate oral tablet

2 QL

nalbuphine hcl injection 2

OXYCODONE HCL ER 3 PA; QL

oxycodone hcl oral capsule

1 QL

oxycodone hcl oral concentrate 100 mg/5ml

2 QL

oxycodone hcl oral solution

1 QL

oxycodone hcl oral tablet

1 QL

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1 QL

oxycodone-aspirin 2 QL


5


oxymorphone hcl 2 QL

oxymorphone hcl er 3 PA; QL

pentazocine-naloxone hcl

2 QL

tramadol hcl er (biphasic)

2 QL

tramadol hcl er oral capsule extended release 24 hour 150 mg

2 PA; QL

tramadol hcl er oral tablet extended release 24 hour

2 QL

tramadol hcl oral tablet 100 mg

2

tramadol hcl oral tablet 50 mg

2 QL

tramadol-acetaminophen

1 QL

Anesthetics

bupivacaine fisiopharma

1

bupivacaine hcl (pf) 1

bupivacaine hcl injection solution 0.25 %, 0.5 %

1

bupivacaine-epinephrine

1

bupivacaine-epinephrine (pf)

1

glydo 1

lidocaine external patch 5 %

2

lidocaine hcl (cardiac) 1

lidocaine hcl (cardiac) pf

1

lidocaine hcl (pf) 1

lidocaine hcl external solution

2

lidocaine hcl injection solution 0.5 %, 1 %

1


LIDOCAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 10 MG/ML, 60 MG/3ML

1

LIDOCAINE HCL SOLUTION 2 % INJECTION

2

lidocaine hcl solution 2 % injection

1

lidocaine hcl urethral/mucosal

1

lidocaine-epinephrine injection solution 0.5 %-1:200000, 1 %-1:100000, 1.5 %-1:200000, 2 %-1:200000

1

lidocaine-prilocaine external cream

1

MARCAINE INJECTION SOLUTION 0.25 %

1

MARCAINE PRESERVATIVE FREE

1

MARCAINE/EPINEPHRINE PF INJECTION SOLUTION 0.5% -1:200000

1

polocaine-mpf injection solution 2 %

1

ropivacaine hcl injection solution

2

SENSORCAINE 1

sensorcaine/epinephrine

1

sensorcaine-mpf injection solution 0.75 %

1

sensorcaine-mpf solution 0.25 % injection

1


6


SENSORCAINE-MPF SOLUTION 0.25 % INJECTION

1

sensorcaine-mpf solution 0.5 % injection

1

SENSORCAINE-MPF SOLUTION 0.5 % INJECTION

1

sensorcaine-mpf/epinephrine injection solution 0.25% -1:200000

1

SENSORCAINE-MPF/EPINEPHRINE INJECTION SOLUTION 0.5% -1:200000

1

Anti-Addiction / Substance Abuse Treatment Agents

acamprosate calcium 2

buprenorphine hcl sublingual

2 QL

buprenorphine hcl-naloxone hcl

2 QL

bupropion hcl er (smoking det)

1 QL

disulfiram oral 2

naloxone hcl injection solution

1

naloxone hcl injection solution cartridge

1

naloxone hcl injection solution prefilled syringe

1

naltrexone hcl oral 1

NARCAN 2

SUBLOCADE 3

VIVITROL 3

Antibacterials

amikacin sulfate injection

2


amoxicillin 1

amoxicillin-potassium clavulanate er

2

amoxicillin-potassium clavulanate oral

1

ampicillin 1

ampicillin sodium 2

ampicillin-sulbactam sodium

2

ARIKAYCE 4

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

3

avidoxy 1

azithromycin intravenous

1

azithromycin oral 1

aztreonam 2

BICILLIN L-A 3

cefaclor 2

cefaclor er 2

cefadroxil 1

cefazolin sodium injection

1

CEFAZOLIN SODIUM INTRAVENOUS SOLUTION PREFILLED SYRINGE

2

cefazolin sodium intravenous solution reconstituted

1

cefazolin sodium-dextrose intravenous solution

2

cefdinir 1

cefepime hcl injection 2

cefepime hcl intravenous solution

2

cefepime-dextrose 2

cefixime 2


7


cefotaxime sodium 1

cefoxitin sodium 2

cefpodoxime proxetil 2

cefprozil 1

ceftazidime and dextrose

2

ceftazidime injection 2

ceftriaxone sodium in dextrose

2

ceftriaxone sodium injection

1

ceftriaxone sodium intravenous

1

ceftriaxone sodium-dextrose

1

cefuroxime axetil 1

cefuroxime sodium 1

cephalexin 1

CIPRO ORAL SUSPENSION RECONSTITUTED

2

ciprofloxacin hcl oral 1

ciprofloxacin in d5w 2

clarithromycin er 2

clarithromycin oral suspension reconstituted

2

clarithromycin oral tablet

1

clindamycin hcl oral 1

clindamycin palmitate hcl

2

clindamycin phosphate in d5w

2

CLINDAMYCIN PHOSPHATE IN NACL

2

clindamycin phosphate injection

1

clindamycin phosphate vaginal

2


colistimethate sodium (cba)

3

daptomycin intravenous solution reconstituted 500 mg

3

demeclocycline hcl 2

dicloxacillin sodium 1

DIFICID 4

doxy 100 3

doxycycline hyclate intravenous

3

doxycycline hyclate oral capsule

1

doxycycline hyclate oral tablet 100 mg, 20 mg

1

doxycycline monohydrate oral capsule 100 mg, 50 mg

1

doxycycline monohydrate oral suspension reconstituted

2

doxycycline monohydrate oral tablet

1

ertapenem sodium 3

erythromycin base oral capsule delayed release particles

2

erythromycin base oral tablet

3

erythromycin base oral tablet delayed release

2

erythromycin ethylsuccinate oral

3

erythromycin oral 2

FORTAZ INJECTION SOLUTION RECONSTITUTED 500 MG

4

FORTAZ INTRAVENOUS

4

gentamicin in saline 1


8


gentamicin sulfate external

2

gentamicin sulfate injection

1

imipenem-cilastatin 3

levofloxacin in d5w 1

levofloxacin intravenous

2

levofloxacin oral solution

2

levofloxacin oral tablet 1

lincomycin hcl injection 2

linezolid in sodium chloride

4

linezolid intravenous 3

linezolid oral suspension reconstituted

3 QL

linezolid oral tablet 2 QL

mafenide acetate external

3

meropenem 2

MEROPENEM-SODIUM CHLORIDE

2

methenamine hippurate 2

metronidazole in nacl intravenous solution 5-0.79 mg/ml-%, 500-0.79 mg/100ml-%

1

metronidazole oral capsule

2

metronidazole oral tablet

1

metronidazole vaginal 2

MINOCIN INTRAVENOUS

3

minocycline hcl oral 2

mondoxyne nl oral capsule 100 mg

1

morgidox oral 1

moxifloxacin hcl in nacl 2


MOXIFLOXACIN HCL INTRAVENOUS

2

moxifloxacin hcl oral 2

mupirocin external 1

NAFCILLIN SODIUM IN DEXTROSE

3

nafcillin sodium injection solution reconstituted 1 gm, 2 gm

3

nafcillin sodium intravenous

3

neomycin sulfate oral 1

neomycin-polymyxin b gu

2

nitrofurantoin macrocrystal oral

1

nitrofurantoin monohydrate macrocrystals

1

ofloxacin oral 2

oxacillin sodium 3

paromomycin sulfate oral

2

penicillin g potassium 2

penicillin v potassium 1

piperacillin sod-tazobactam so

2

SILVADENE 1

silver sulfadiazine external

1

ssd 1

streptomycin sulfate intramuscular

4

sulfadiazine oral 3

sulfamethoxazole-trimethoprim intravenous

2

sulfamethoxazole-trimethoprim oral

1

sulfatrim pediatric 1


9


tazicef injection 2

TAZICEF INTRAVENOUS SOLUTION

2

tazicef intravenous solution reconstituted

2

tetracycline hcl oral 2

tinidazole oral 1

tobramycin sulfate injection solution

2

tobramycin sulfate injection solution reconstituted

3

trimethoprim oral 1

vancomycin hcl in dextrose intravenous solution 1-5 gm/200ml-%, 500-5 mg/100ml-%, 750-5 mg/150ml-%

3

vancomycin hcl in nacl intravenous solution 1-0.9 gm/200ml-%, 500-0.9 mg/100ml-%, 750-0.9 mg/150ml-%

2

VANCOMYCIN HCL INTRAVENOUS SOLUTION 1000 MG/10ML, 1250 MG/12.5ML, 1500 MG/15ML, 1750 MG/17.5ML, 2000 MG/20ML, 750 MG/7.5ML

3

vancomycin hcl intravenous solution reconstituted

2

vancomycin hcl oral capsule

2

vandazole 2

XEPI 2

ZITHROMAX ORAL PACKET

1

ZOSYN 3


ZYVOX INTRAVENOUS SOLUTION 200 MG/100ML

4

Anticoagulants

ELIQUIS 2 QL

ELIQUIS DVT/PE STARTER PACK ORAL TABLET 5 MG

2 QL

enoxaparin sodium 2 QL

fondaparinux sodium 3 QL

FRAGMIN 3 QL

HEPARIN (PORCINE) IN NACL INTRAVENOUS SOLUTION 5000-0.9 UT/500ML-%

2

heparin sodium (porcine) injection solution

2

heparin sodium (porcine) pf injection solution 5000 unit/0.5ml

2

jantoven 1

PRADAXA 2 QL

THROMBATE III 3

warfarin sodium oral 1

XARELTO 2 QL

XARELTO STARTER PACK

2 QL

Anticonvulsants - Drugs for Seizures

BANZEL 3 PA

BRIVIACT 3 ST

carbamazepine er 2

carbamazepine oral 2

CELONTIN 3

clobazam 2 PA

DIACOMIT 3 PA

diazepam rectal 3 QL


10


divalproex sodium er 1

divalproex sodium oral capsule delayed release sprinkle

2

divalproex sodium oral tablet delayed release

1

EPIDIOLEX 3 PA

epitol 2

ethosuximide oral 2

felbamate 3

fosphenytoin sodium 1

FYCOMPA 3 ST

gabapentin oral 1

lamotrigine er 2

lamotrigine oral kit 3

lamotrigine oral tablet 1

lamotrigine oral tablet chewable

1

lamotrigine oral tablet dispersible

3 ST

lamotrigine starter kit-blue

3

lamotrigine starter kit-green

3

lamotrigine starter kit-orange

3

levetiracetam er 2

levetiracetam intravenous

1

levetiracetam oral 1

oxcarbazepine 2

phenobarbital oral 1

phenytoin infatabs 1

phenytoin oral 1

phenytoin sodium extended

1

phenytoin sodium injection

1

primidone oral 1


roweepra 1

roweepra xr 2

subvenite 1

subvenite starter kit-blue

3

subvenite starter kit-green

3

subvenite starter kit-orange

3

SYMPAZAN 3 PA

tiagabine hcl 3

topiramate er 3 ST

topiramate oral 1

valproate sodium intravenous

1

valproic acid oral 1

vigabatrin 4 PA

vigadrone 4 PA

VIMPAT 3 ST

zonisamide oral 1

Antidementia Agents - Drugs for Alzheimer's Disease and Dementia

donepezil hcl 1

galantamine hydrobromide

2

galantamine hydrobromide er

2

memantine hcl er 2 QL

memantine hcl oral solution

3 ST

memantine hcl oral tablet 10 mg, 5 mg

1

memantine hcl oral tablet 28 x 5 mg & 21 x 10 mg

2

rivastigmine 2

rivastigmine tartrate 2


11


Antidepressants

amitriptyline hcl oral 1

amoxapine 2

bupropion hcl er (sr) 1 QL

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg

1 QL

bupropion hcl oral 1

chlordiazepoxide-amitriptyline

2

citalopram hydrobromide

1

clomipramine hcl oral 2

desipramine hcl oral 2

desvenlafaxine succinate er

2 QL

doxepin hcl oral capsule

1

doxepin hcl oral concentrate

1

duloxetine hcl oral 1 QL

escitalopram oxalate oral solution

2

escitalopram oxalate oral tablet

1

fluoxetine hcl (pmdd) 2

fluoxetine hcl oral capsule

1

fluoxetine hcl oral capsule delayed release

2 QL

fluoxetine hcl oral solution

2

fluoxetine hcl oral tablet 2

fluvoxamine maleate 1

fluvoxamine maleate er 2 QL

imipramine hcl oral 1

imipramine pamoate 2

maprotiline hcl 2


mirtazapine oral 1

nefazodone hcl 2

nortriptyline hcl oral 1

olanzapine-fluoxetine hcl

2 QL

paroxetine hcl 1

paroxetine hcl er 2

paroxetine mesylate 2 QL

phenelzine sulfate oral 2

protriptyline hcl 2

sertraline hcl oral 1

tranylcypromine sulfate 2

trazodone hcl oral 1

trimipramine maleate oral

2

venlafaxine hcl 1

venlafaxine hcl er oral capsule extended release 24 hour

1

venlafaxine hcl er oral tablet extended release 24 hour 225 mg

2

Antiemetics - Drugs for Nausea and Vomiting

aprepitant oral capsule 125 mg, 40 mg, 80 mg

2 QL

aprepitant oral capsule 80 & 125 mg

3 QL

CINVANTI 3

compro 2

dronabinol 2 PA; QL

granisetron hcl intravenous

1

granisetron hcl oral 2 QL

meclizine hcl oral tablet 1

metoclopramide hcl injection

1

metoclopramide hcl oral solution

1


12


metoclopramide hcl oral tablet

1

metoclopramide hcl oral tablet dispersible

3 ST

ondansetron hcl injection

1

ondansetron hcl oral solution

1 QL

ondansetron hcl oral tablet 24 mg

1 QL

ondansetron hcl oral tablet 4 mg, 8 mg

1

ondansetron odt 1

palonosetron hcl intravenous solution

2

palonosetron hcl intravenous solution prefilled syringe

3

perphenazine oral 2

prochlorperazine 2

prochlorperazine edisylate injection

2

prochlorperazine maleate oral

1

scopolamine 2

trimethobenzamide hcl oral

2

Antifungals

ABELCET 3

AMBISOME 3

amphotericin b intravenous

3

BIO-STATIN ORAL CAPSULE

1

caspofungin acetate 3

ciclodan 1

ciclopirox external gel 2

ciclopirox external shampoo

2

ciclopirox external solution

1


ciclopirox olamine external cream

1

ciclopirox olamine external suspension

2

clotrimazole 3 1

clotrimazole external 1

clotrimazole mouth/throat

1

clotrimazole-betamethasone

1

CRESEMBA 4

cvs clotrimazole 3 1

econazole nitrate external

1

fluconazole in sodium chloride

2

fluconazole oral 1

flucytosine oral 4

griseofulvin microsize oral

2

griseofulvin ultramicrosize

2

itraconazole oral 2 PA

ketoconazole external cream

1

ketoconazole external shampoo

1

ketoconazole oral 1

miconazole 3 vaginal suppository

2

naftifine hcl external cream

2

nyamyc 1

nystatin external 1

nystatin mouth/throat 1

nystatin oral 2

nystatin-triamcinolone 1

nystop 1

terbinafine hcl oral 1 QL

terconazole 1


13


voriconazole intravenous

4

voriconazole oral 3

Antigout Agents

allopurinol oral 1

allopurinol sodium 1

colchicine-probenecid 1

COLCRYS 2

probenecid 1

Anti-inflammatory Agents

EMFLAZA 4 PA

Antimigraine Agents

almotriptan malate 2 QL

dihydroergotamine mesylate injection

3 PA; QL

dihydroergotamine mesylate nasal

3 PA; QL

eletriptan hydrobromide 2 QL

EMGALITY 3 PA; QL

EMGALITY (300 MG DOSE)

3 PA; QL

ergotamine-caffeine 3

naratriptan hcl 2 QL

rizatriptan benzoate 1 QL

sumatriptan nasal 3 ST; QL

sumatriptan succinate oral

1 QL

sumatriptan succinate refill

3 ST; QL

sumatriptan succinate subcutaneous solution

2 ST; QL

sumatriptan succinate subcutaneous solution auto-injector

3 ST; QL

sumatriptan succinate subcutaneous solution prefilled syringe

2 ST; QL

zolmitriptan oral 2 QL


Antimyasthenic Agents

pyridostigmine bromide er

3

pyridostigmine bromide oral solution

2

pyridostigmine bromide oral tablet 60 mg

2

Antimycobacterials

CAPASTAT SULFATE 4

dapsone oral 2

ethambutol hcl oral 2

isoniazid injection 1

isoniazid oral syrup 3

isoniazid oral tablet 1

PASER 1

PRIFTIN 2

pyrazinamide oral 2

rifabutin 3

rifampin intravenous 2

rifampin oral 2

SIRTURO 4

TRECATOR 2

Antineoplastics - Drugs for Cancer

abiraterone acetate 4 PA

ABRAXANE 4

ADCETRIS 4 PA

adriamycin 2

AFINITOR DISPERZ 4 PA

AFINITOR ORAL TABLET 10 MG

4 PA; QL

ALECENSA 4 PA

ALIMTA 4

ALIQOPA 4 PA

ALUNBRIG 4 PA; QL

anastrozole oral 1

ARRANON 3


14


arsenic trioxide intravenous

4

ARZERRA 4 PA

AVASTIN 4 PA

azacitidine 4

BALVERSA 4 PA

BELEODAQ 4 PA

BELRAPZO 4 PA

BENDAMUSTINE HCL INTRAVENOUS SOLUTION 100 MG/4ML

4 PA

BENDEKA 4 PA

bexarotene 4 PA

bicalutamide 1

bleomycin sulfate 2

BLINCYTO 4 PA

BORTEZOMIB 4 PA

BOSULIF 4 PA

BRAFTOVI 4 PA

busulfan 4

CABOMETYX 4 PA

CALQUENCE 4 PA

CAMPATH 4

CAMPTOSAR INTRAVENOUS SOLUTION 300 MG/15ML

2

capecitabine 3 PA

CAPRELSA ORAL TABLET 100 MG

4 PA; QL

CAPRELSA ORAL TABLET 300 MG

4 PA

carboplatin 2

carmustine 4

cisplatin intravenous solution

2

cladribine 3

clofarabine 4


COMETRIQ (100 MG DAILY DOSE)

4 PA


4 PA


4 PA

COPIKTRA 4 PA

COTELLIC 4 PA

cyclophosphamide injection

3

cyclophosphamide oral 3

CYRAMZA 4 PA

cytarabine 1

cytarabine (pf) 1

dacarbazine 2

dactinomycin 4

DARZALEX 4 PA

daunorubicin hcl 2

DAURISMO 4 PA

decitabine 4 PA

dexrazoxane hcl 3

docetaxel intravenous concentrate

3

docetaxel intravenous solution

4

doxorubicin hcl 2

doxorubicin hcl liposomal

2

DROXIA 2

ELITEK 4

EMPLICITI 3 PA

ENHERTU 4 PA

epirubicin hcl 2

ERBITUX 4 PA

ERIVEDGE 4 PA

ERLEADA 4 PA

erlotinib hcl oral tablet 100 mg, 150 mg

4 PA


15


erlotinib hcl oral tablet 25 mg

4 PA; QL

ETHYOL 3

ETOPOPHOS 2

etoposide intravenous 2

etoposide oral 3

everolimus oral tablet 2.5 mg, 5 mg, 7.5 mg

4 PA; QL

exemestane 2

FARYDAK 4 PA

floxuridine injection 4

fludarabine phosphate 3

fluorouracil intravenous 1

flutamide 2

FOLOTYN 1 PA

fulvestrant 4

GAZYVA 4 PA

gemcitabine hcl 2

GILOTRIF 4 PA; QL

GLEOSTINE 3

GLIADEL WAFER 4

HALAVEN 4 PA

HERCEPTIN 4 PA

HYCAMTIN ORAL 4

hydroxyurea oral 1

IBRANCE 4 PA

ICLUSIG ORAL TABLET 15 MG

4 PA; QL

ICLUSIG ORAL TABLET 45 MG

4 PA

idarubicin hcl 4

IDHIFA 4 PA; QL

ifosfamide 3

imatinib mesylate 4 PA

IMBRUVICA 4 PA

IMFINZI 4 PA

INLYTA 4 PA

IRESSA 4 PA


irinotecan hcl intravenous solution 100 mg/5ml, 40 mg/2ml, 500 mg/25ml

2

irinotecan hcl intravenous solution 300 mg/15ml

4

IXEMPRA KIT 4

JAKAFI ORAL TABLET 10 MG

4 PA; QL

JAKAFI ORAL TABLET 15 MG, 20 MG, 25 MG, 5 MG

4 PA

JEVTANA 4 PA

KADCYLA 4 PA

KEYTRUDA 4 PA

KISQALI (200 MG DOSE)

4 PA


4 PA


4 PA

KISQALI FEMARA (400 MG DOSE)

4 PA

KISQALI FEMARA (600 MG DOSE)

4 PA

KISQALI FEMARA(200 MG DOSE)

4 PA

KOSELUGO 4 PA

KYPROLIS 4 PA

LARTRUVO 4 PA

LENVIMA (10 MG DAILY DOSE)

4 PA


4 PA


4 PA


4 PA


4 PA


16



4 PA


4 PA


4 PA

letrozole oral 1

leucovorin calcium injection

2

leucovorin calcium oral 2

LEUKERAN 3

LONSURF 4 PA

LORBRENA 4 PA

LYNPARZA 4 PA

LYSODREN 3

MARQIBO 4

MATULANE 3

MEKINIST 4 PA

MEKTOVI 4 PA

melphalan 2

melphalan hcl 2

mercaptopurine oral 2

mesna 2

MESNEX ORAL 3

mitomycin intravenous 3

mitoxantrone hcl 4 PA

mutamycin 4

MYLERAN 3

NAVELBINE 2

NERLYNX 4 PA; QL

NEXAVAR 4 PA

nilutamide 4

NINLARO 4 PA

NIPENT 3

ODOMZO 4 PA

ONIVYDE 4

OPDIVO 4 PA


oxaliplatin intravenous solution 100 mg/20ml, 50 mg/10ml

2

oxaliplatin intravenous solution reconstituted

2

paclitaxel intravenous concentrate 100 mg/16.7ml, 150 mg/25ml, 30 mg/5ml, 300 mg/50ml

2

PADCEV 4 PA

PANRETIN 4

paraplatin intravenous solution 150 mg/15ml, 450 mg/45ml, 50 mg/5ml, 600 mg/60ml

2

PERJETA 4 PA

PIQRAY (200 MG DAILY DOSE)

4 PA


4 PA


4 PA

POLIVY INTRAVENOUS SOLUTION RECONSTITUTED 140 MG

4 PA

POMALYST 4 PA

PORTRAZZA 4 PA

POTELIGEO 4 PA

PROLEUKIN 4

PURIXAN 3

QINLOCK 4 PA

REVLIMID 4 PA

RITUXAN 4 PA

RITUXAN HYCELA 4 PA

RUBRACA 4 PA

RYDAPT 4 PA

SPRYCEL 4 PA

STIVARGA 4 PA


17


SUTENT 4 PA

SYLVANT 4 PA

SYNRIBO 4 PA

TABLOID 3

TAFINLAR 4 PA

TAGRISSO ORAL TABLET 40 MG

4 PA; QL

TAGRISSO ORAL TABLET 80 MG

4 PA

TALZENNA 4 PA

tamoxifen citrate oral 1

TARGRETIN EXTERNAL

4 PA

TASIGNA 4 PA

TECENTRIQ INTRAVENOUS SOLUTION 1200 MG/20ML

4 PA

TEMODAR INTRAVENOUS

3

temozolomide 3 PA

teniposide 4

THALOMID 4 PA

thiotepa injection 3

TIBSOVO 4 PA

toposar 2

topotecan hcl 2

toremifene citrate 3

tretinoin oral 4

TRISENOX 4

TUKYSA 4 PA

TURALIO 4 PA

TYKERB 4 PA

UNITUXIN 4 PA

VALCHLOR 4 PA

valrubicin 4

VECTIBIX 4

VELCADE 4 PA


VENCLEXTA 4 PA

VENCLEXTA STARTING PACK

3 PA

VERZENIO 4 PA

vinblastine sulfate 2

vincristine sulfate 1

vinorelbine tartrate 2

VITRAKVI 4 PA

VIZIMPRO 4 PA

VOTRIENT 4 PA

VYXEOS 4 PA

XALKORI 4 PA

XOFIGO 4

XOSPATA 4 PA

XTANDI 4 PA

YERVOY 4 PA

YONDELIS 4

YONSA 4 PA

ZALTRAP 4 PA

ZANOSAR 3

ZEJULA 4 PA

ZELBORAF 4 PA

ZEPZELCA 4 PA

ZOLINZA 4 PA

ZYDELIG 4 PA

ZYTIGA ORAL TABLET 500 MG

4 PA

Antiparasitics

albendazole oral 3 PA

ALINIA 3

ARAKODA 2

atovaquone oral 3

atovaquone-proguanil hcl

2

BENZNIDAZOLE 3

chloroquine phosphate oral

2

COARTEM 2


18


DARAPRIM 4 PA

hydroxychloroquine sulfate oral

2

IMPAVIDO 4

ivermectin oral 2

KRINTAFEL 2

lindane 2

malathion 2

mefloquine hcl 1

NEBUPENT 2

permethrin external 2

PLAQUENIL 2

praziquantel oral 3

primaquine phosphate 2

pyrimethamine oral 4 PA

quinine sulfate oral 2 PA

spinosad 2

Antiparkinson Agents

amantadine hcl oral capsule

2

amantadine hcl oral syrup

1

amantadine hcl oral tablet

2

APOKYN 4 PA; QL

benztropine mesylate injection

2

benztropine mesylate oral

1

bromocriptine mesylate oral

2

carbidopa oral 3

carbidopa-levodopa er 2

carbidopa-levodopa oral tablet

1

carbidopa-levodopa oral tablet dispersible

2

carbidopa-levodopa-entacapone

2


entacapone 2

pramipexole dihydrochloride

1

pramipexole dihydrochloride er

3 ST

rasagiline mesylate oral 3

ropinirole hcl 1

ropinirole hcl er 2

selegiline hcl oral 2

tolcapone 4 ST

trihexyphenidyl hcl 1

Antiplatelets

aspirin-dipyridamole er 2

BRILINTA 3

CABLIVI 4 PA; QL

cilostazol 1

clopidogrel bisulfate oral

1

dipyridamole oral 2

prasugrel hcl 2

Antipsychotics - Drugs for Mood Disorders

ABILIFY MAINTENA 3

aripiprazole oral solution

2 QL

aripiprazole oral tablet 2 QL

aripiprazole oral tablet dispersible

3 ST; QL

ARISTADA 3

ARISTADA INITIO 3

chlorpromazine hcl injection

3

chlorpromazine hcl oral 2

clozapine 2 QL

FANAPT 3 ST; QL

fluphenazine decanoate injection

2

fluphenazine hcl 2


19


haloperidol decanoate intramuscular

2

haloperidol lactate 1

haloperidol oral 1

INVEGA SUSTENNA 3

INVEGA TRINZA 3

LATUDA 3 ST; QL

loxapine succinate 2

olanzapine intramuscular

2

olanzapine oral tablet 1 QL

olanzapine oral tablet dispersible

2 QL

paliperidone er 3 ST; QL

pimozide 2

quetiapine fumarate 1 QL

quetiapine fumarate er 2 QL

RISPERDAL CONSTA 3

risperidone oral solution

1 QL

risperidone oral tablet 1 QL

risperidone oral tablet dispersible

2 QL

thioridazine hcl oral 2

thiothixene 2

trifluoperazine hcl 2

VERSACLOZ 3 QL

VRAYLAR ORAL CAPSULE

3 ST; QL

ziprasidone hcl 2 QL

ziprasidone mesylate 2

ZYPREXA RELPREVV 3

Antivirals

abacavir sulfate 2

abacavir sulfate-lamivudine

2

abacavir-lamivudine-zidovudine

3


acyclovir external ointment

2

acyclovir oral 1

acyclovir sodium 1

adefovir dipivoxil 3

APTIVUS 3

atazanavir sulfate 3

BARACLUDE ORAL SOLUTION

3 QL

BIKTARVY 3

cidofovir intravenous 3

CIMDUO 3

COMPLERA 3

CRIXIVAN 3

DELSTRIGO 3

didanosine 2

DOVATO 3

EDURANT 3

efavirenz 3

efavirenz-emtricitab-tenofovir

2

emtricitabine-tenofovir df

2

EMTRIVA 2

entecavir 3 QL

EPCLUSA 4 PA; QL

EPIVIR HBV ORAL SOLUTION

2

EVOTAZ 3

famciclovir oral 2

fosamprenavir calcium 3

FUZEON 3

GANCICLOVIR 4

ganciclovir sodium intravenous solution

4

ganciclovir sodium intravenous solution reconstituted

3

GENVOYA 3


20


HARVONI ORAL PACKET

4

HARVONI ORAL TABLET

4 PA; QL

INTELENCE 3

INTRON A 3 PA

INVIRASE 3

ISENTRESS 3

ISENTRESS HD 3

JULUCA 3

KALETRA ORAL TABLET

3

lamivudine 2

lamivudine-zidovudine 2

LEXIVA ORAL SUSPENSION

3

lopinavir-ritonavir 2

MAVYRET 4 PA; QL

nevirapine 2

nevirapine er 2

NORVIR ORAL PACKET

2

NORVIR ORAL SOLUTION

2

ODEFSEY 3

oseltamivir phosphate oral

2 QL

PEGASYS 4 PA

PEGASYS PROCLICK 4 PA

PEGINTRON 3 PA

PIFELTRO 3

PREVYMIS INTRAVENOUS

2

PREVYMIS ORAL 4

PREZCOBIX 3

PREZISTA 3

RETROVIR INTRAVENOUS

2


REYATAZ ORAL PACKET

3

ribavirin oral 2

rimantadine hcl 2

ritonavir 2

SELZENTRY 3 PA

stavudine 2

STRIBILD 3

SYMFI 3

SYMFI LO 3

SYMTUZA 3

TEMIXYS 3

tenofovir disoproxil fumarate

3

TIVICAY 3

TRIUMEQ 3

TROGARZO 4 PA

TRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG

2

TYBOST 2

valacyclovir hcl oral 1 QL

valganciclovir hcl 3

VEMLIDY 3

VIRACEPT 3

VIREAD ORAL POWDER

3

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG

3

VOSEVI 4 PA

XOFLUZA (40 MG DOSE)

2 QL

XOFLUZA (80 MG DOSE)

2 QL

ZEPATIER 4 PA; QL

zidovudine 2


21


Anxiolytics - Drugs for Anxiety

alprazolam er 1 QL

alprazolam intensol 2 QL

alprazolam oral tablet 1 QL

alprazolam xr 1 QL

buspirone hcl oral 1

chlordiazepoxide hcl 1 QL

clonazepam oral tablet 1 QL

clonazepam oral tablet dispersible

2 QL

clorazepate dipotassium

2 QL

diazepam intensol 2

diazepam oral concentrate

2

diazepam oral solution 1

diazepam oral tablet 1

estazolam 1 QL

hydroxyzine hcl oral 1

hydroxyzine pamoate oral

1

lorazepam injection 1

lorazepam intensol 1 QL

lorazepam oral concentrate 2 mg/ml

1 QL

lorazepam oral tablet 1 QL

meprobamate 2

oxazepam 2 QL

triazolam 1 QL

Bipolar Agents - Drugs for Mood Disorders

EQUETRO 2

lithium 2

lithium carbonate er 1

lithium carbonate oral 1


Blood Products / Modifiers / Volume Expanders - Drugs for Bleeding Disorders

ADVATE 4

ADYNOVATE 4

AFSTYLA 4

ALPHANATE/VWF COMPLEX/HUMAN

4

ALPHANINE SD 4

ALPROLIX 4

aminocaproic acid intravenous

3

aminocaproic acid oral 3

anagrelide hcl 2

ARANESP (ALBUMIN FREE)

3 PA

BENEFIX 4

COAGADEX 4

CORIFACT 4

DOPTELET 4 PA

ELOCTATE 4

FEIBA 4

FIBRYGA 4

HEMLIBRA 4

HEMOFIL M 4

HUMATE-P 4

IDELVION 4

IXINITY 4

KOATE 4

KOATE-DVI 4

KOGENATE FS 4

KOVALTRY 4

LEUKINE 3 PA

MOZOBIL 4 PA; QL

NEULASTA 4 PA

NEULASTA ONPRO 4 PA

NOVOEIGHT 4


22


NOVOSEVEN RT 4

NPLATE 4 PA

NUWIQ 4

OBIZUR 3

PANHEMATIN 4

PROFILNINE 4

PROFILNINE SD INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 1500 UNIT

4

PROMACTA ORAL PACKET 12.5 MG

4 PA

PROMACTA ORAL TABLET

4 PA

REBINYN INTRAVENOUS SOLUTION RECONSTITUTED 2000 UNIT

4

REBLOZYL 4 PA

RECOMBINATE 4

RETACRIT 3 PA

RIASTAP 4

RIXUBIS 4

SOLIRIS 4 PA

TAVALISSE 4 PA

tranexamic acid intravenous

2

tranexamic acid oral 2

TRETTEN 4

VONVENDI 4

WILATE 4

XYNTHA 4

XYNTHA SOLOFUSE 4

ZARXIO 3 PA


Cardiovascular Agents - Drugs for Heart and Circulation Conditions

acebutolol hcl oral 1

acetazolamide sodium 2

adenosine intravenous solution 12 mg/4ml, 6 mg/2ml

1

alprostadil injection 3

amiloride hcl oral 1

amiloride-hydrochlorothiazide

1

amiodarone hcl 1

amlodipine besylate oral

1

amlodipine besylate-benazepril hcl

1

amlodipine besylate-valsartan

2

amlodipine-olmesartan 2

amlodipine-valsartan-hctz

2

atenolol oral 1

atenolol-chlorthalidone 1

atorvastatin calcium oral

1

benazepril hcl oral 1

benazepril-hydrochlorothiazide

2

betaxolol hcl oral 1

bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide

1

bumetanide 1

candesartan cilexetil 2

candesartan cilexetil-hctz

2

captopril oral 2


23


captopril-hydrochlorothiazide

2

cartia xt 2

carvedilol 1

carvedilol phosphate er 2

chlorothiazide sodium 1

chlorthalidone 1

cholestyramine light 2

cholestyramine oral 2

clonidine 1

clonidine hcl oral 1

colestipol hcl 2

digitek 1

digox 1

digoxin injection 1

digoxin oral 1

diltiazem hcl er beads 1

diltiazem hcl er coated beads

2

diltiazem hcl er oral capsule extended release 12 hour

2

diltiazem hcl intravenous

2

diltiazem hcl oral 1

DILTIAZEM HCL-DEXTROSE

2

dilt-xr 2

disopyramide phosphate

2

dobutamine hcl 2

dobutamine in d5w 2

dofetilide 2

dopamine hcl intravenous

1

doxazosin mesylate oral

1

enalapril maleate oral 1


enalapril-hydrochlorothiazide

1

ENTRESTO 3 QL

eplerenone 2

ethacrynic acid 3 ST

ezetimibe 1

felodipine er 1

fenofibrate micronized oral capsule 134 mg, 200 mg, 43 mg, 67 mg

2

fenofibrate oral capsule 134 mg, 200 mg, 67 mg

2

fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg

1

fenofibric acid oral capsule delayed release

2

flecainide acetate 2

fosinopril sodium 1

fosinopril sodium-hctz 1

furosemide injection 1

furosemide oral 1

gemfibrozil oral 1

guanfacine hcl 1

hydralazine hcl injection

1

hydralazine hcl oral 1

hydrochlorothiazide oral

1

ibutilide fumarate 3

indapamide 1

irbesartan 1

irbesartan-hydrochlorothiazide

1

isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg

2

isosorbide mononitrate 1


24


isosorbide mononitrate er

1

isradipine 2

JUXTAPID 4 PA; QL

labetalol hcl intravenous solution

1

labetalol hcl oral 1

LANOXIN ORAL TABLET 62.5 MCG

3

lisinopril oral 1

lisinopril-hydrochlorothiazide

1

losartan potassium oral 1

losartan potassium-hctz 1

lovastatin 1

mannitol intravenous 1

matzim la 2

methyldopa 1

methyldopa-hydrochlorothiazide

2

metolazone 1

metoprolol succinate er 1

metoprolol tartrate intravenous

1

metoprolol tartrate oral 1

metoprolol-hydrochlorothiazide

2

mexiletine hcl oral 2

midodrine hcl 2

milrinone lactate 3

milrinone lactate in dextrose

1

minoxidil oral 1

moexipril hcl 1

niacin er (antihyperlipidemic)

2

nicardipine hcl 2


NICARDIPINE HCL IN NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE

2

nifedipine er 1

nifedipine er osmotic release

1

nifedipine oral 2

nimodipine oral 3

nisoldipine er 2

NITRO-DUR TRANSDERMAL PATCH 24 HOUR 0.3 MG/HR, 0.8 MG/HR

3 ST

nitroglycerin sublingual 1

nitroglycerin transdermal

1

nitroglycerin translingual

2

NORTHERA 4 PA

olmesartan medoxomil oral

1

olmesartan medoxomil-hctz

1

olmesartan-amlodipine-hctz

2

omega-3-acid ethyl esters

2 PA

OSMITROL 3

pentoxifylline er 1

perindopril erbumine 1

phenoxybenzamine hcl oral

4

phenylephrine hcl intravenous solution 10 mg/ml

2

PHENYLEPHRINE HCL INTRAVENOUS SOLUTION PREFILLED SYRINGE 0.4 MG/10ML

2


25


PHENYLEPHRINE HCL-NACL INTRAVENOUS SOLUTION 20-0.9 MG/250ML-%

2

PHENYLEPHRINE HCL-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 0.5-0.9 MG/5ML-%

2

pindolol 2

PRALUENT 3 PA; QL

pravastatin sodium 1

prazosin hcl oral 1

prevalite 2

procainamide hcl injection

2

propafenone hcl 1

propafenone hcl er 2

propranolol hcl er 2

propranolol hcl intravenous

1

propranolol hcl oral 1

propranolol-hctz 1

quinapril hcl 1

quinapril-hydrochlorothiazide

1

quinidine gluconate er 3

quinidine sulfate 1

ramipril 1

ranolazine er 2

REPATHA 3 PA; QL

REPATHA PUSHTRONEX SYSTEM

3 PA; QL

REPATHA SURECLICK

3 PA; QL

rosuvastatin calcium 1

simvastatin oral 1


sorine 1

sotalol hcl (af) 1

SOTALOL HCL INTRAVENOUS

3

sotalol hcl oral 1

SOTYLIZE 3

spironolactone oral 1

spironolactone-hctz 1

taztia xt 1

telmisartan 1

telmisartan-hctz 2

tiadylt er 1

timolol maleate oral 2

torsemide 1

trandolapril 1

trandolapril-verapamil hcl er

2

triamterene-hctz 1

valsartan 1

valsartan-hydrochlorothiazide

1

verapamil hcl er oral capsule extended release 24 hour

2

verapamil hcl er oral tablet extended release

1

verapamil hcl intravenous

2

verapamil hcl oral 1

WELCHOL 2

Central Nervous System Agents - Drugs for Attention Deficit Disorder

ADDERALL XR 1 PA; QL

amphetamine sulfate 2 PA; QL

amphetamine-dextroamphetamine

2 PA; QL

atomoxetine hcl 2 QL


26


clonidine hcl er 2

dexmethylphenidate hcl 1 PA; QL

dexmethylphenidate hcl er

2 PA; QL

dextroamphetamine sulfate

2 PA; QL

dextroamphetamine sulfate er

2 PA; QL

guanfacine hcl er 2

methylphenidate hcl er (cd)

2 PA; QL

methylphenidate hcl er (la)

2 PA; QL

methylphenidate hcl er oral tablet extended release 10 mg, 18 mg, 27 mg, 36 mg, 54 mg, 72 mg

2 PA; QL

methylphenidate hcl er oral tablet extended release 24 hour

2 PA; QL

methylphenidate hcl oral solution

2 PA; QL

methylphenidate hcl oral tablet

1 PA; QL

methylphenidate hcl oral tablet chewable

2 PA; QL

relexxii 2 PA; QL

Central Nervous System Agents - Drugs for Multiple Sclerosis

AUBAGIO 4 PA; QL

AVONEX PEN 4 PA; QL

AVONEX PREFILLED 4 PA; QL

BETASERON 4 PA; QL

dalfampridine er 3 PA; QL

EXTAVIA 4 PA; QL

GILENYA 4 PA; QL

glatiramer acetate 3 PA; QL

glatopa 3 PA; QL


LEMTRADA 4 PA

OCREVUS 4 PA; QL

REBIF 4 PA; QL

REBIF REBIDOSE 4 PA; QL

REBIF REBIDOSE TITRATION PACK

4 PA; QL

REBIF TITRATION PACK

4 PA; QL

TYSABRI 4 PA; QL

Central Nervous System Agents - Miscellaneous

AUSTEDO 4 PA; QL

benzphetamine hcl oral tablet 50 mg

1 PA

caffeine citrate 3

diethylpropion hcl er 1 PA

diethylpropion hcl oral 1 PA

phendimetrazine tartrate

1 PA

phendimetrazine tartrate er

1 PA

phentermine hcl oral 1 PA

pregabalin oral capsule 2 QL

RADICAVA 4 PA

riluzole 2 PA; QL

TEGSEDI 4 PA

tetrabenazine 4 PA

TIGLUTIK 4 PA; QL

Dental and Oral Agents - Drugs for Mouth and Throat Conditions

cavarest 1

cevimeline hcl 2

chlorhexidine gluconate mouth/throat

1

CLINPRO 5000 1

DENTA 5000 PLUS 1


27


DENTAGEL 1

FLUORIDEX 1

FLUORIDEX ENHANCED WHITENING

1

FLUORIDEX SENSITIVITY RELIEF

1

KEPIVANCE 4

lidocaine hcl mouth/throat

2

lidocaine viscous hcl 1

oralone 2

paroex 1

periogard 1

pilocarpine hcl oral 2

PREVIDENT 5000 BOOSTER PLUS

1

PREVIDENT 5000 DRY MOUTH

1

PREVIDENT 5000 ENAMEL PROTECT

1

PREVIDENT 5000 ORTHO DEFENSE

1

PREVIDENT 5000 PLUS

1

PREVIDENT 5000 SENSITIVE

1

PREVIDENT DENTAL 1

sf 1

sf 5000 plus 1

sodium fluoride 5000 plus

1

sodium fluoride 5000 ppm

1

sodium fluoride 5000 sensitive

1

sodium fluoride dental 1

TOPEX TOPICAL ANESTHETIC

1


triamcinolone acetonide mouth/throat

2

Dermatological Agents - Drugs for Skin Conditions

acitretin 3

adapalene external cream

2 PA

adapalene external gel 2 PA

adapalene-benzoyl peroxide

2

ala-cort 1

alclometasone dipropionate

2

ALTRENO 2 PA

ALUMINUM CHLORIDE ANHYDROUS

4

ALUMINUM CHLORIDE HEXAHYDRATE POWDER

4

amcinonide external lotion

3

ammonium lactate external

1

amnesteem 2 PA

azelaic acid external 2

benzoyl peroxide-erythromycin

2

beser external lotion 2

betamethasone dipropionate aug external cream

1

betamethasone dipropionate aug external gel

2

betamethasone dipropionate aug external lotion

2


28


betamethasone dipropionate aug external ointment

2

betamethasone dipropionate external

2

betamethasone valerate external

2

CALAMINE 4

calcipotriene external cream

2

calcipotriene external ointment

2

calcipotriene external solution

2

calcitriol external 3

claravis 2 PA

clindacin etz external swab

2

clindacin-p 2

clindamycin phos-benzoyl perox external gel 1-5 %, 1.2-5 %

2

clindamycin phosphate external foam

2

clindamycin phosphate external gel

2

clindamycin phosphate external lotion

2

clindamycin phosphate external solution

1

clindamycin phosphate external swab

2

clindamycin-tretinoin 3

clobetasol prop emollient base

2

clobetasol propionate e 2

clobetasol propionate emulsion

2

clobetasol propionate external

2

clocortolone pivalate 2


clodan external shampoo

2

desonide external cream

2

desonide external lotion 2

desonide external ointment

2

desoximetasone external cream 0.25 %

2

desoximetasone external gel

2

desoximetasone external liquid

2

desoximetasone external ointment 0.25 %

2

DRYSOL 1

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; QL

ery 2

erythromycin external 2

EUCRISA 3 ST

finasteride oral tablet 1 mg

1

fluocinolone acetonide body

2

fluocinolone acetonide external

2

fluocinolone acetonide scalp

2

fluocinonide emulsified base

2

fluocinonide external cream 0.05 %

2

fluocinonide external gel

2

fluocinonide external ointment

2

fluocinonide external solution

2


29


fluorouracil external cream 5 %

2

fluorouracil external solution

2

fluticasone propionate external cream

1

fluticasone propionate external lotion

2

fluticasone propionate external ointment

1

halobetasol propionate external cream

2

halobetasol propionate external ointment

2

hydrocortisone butyrate external cream

2

hydrocortisone butyrate external ointment

2

hydrocortisone butyrate external solution

2

hydrocortisone external cream 1 %, 2.5 %

1

hydrocortisone external lotion 2.5 %

1

hydrocortisone external ointment 1 %, 2.5 %

1

hydrocortisone valerate 2

imiquimod external 2

isotretinoin oral 2 PA

methoxsalen rapid 3

metronidazole external 2

mometasone furoate external

1

myorisan 2 PA

neuac external gel 2

pimecrolimus 3 ST

podofilox external 2

prednicarbate external cream 0.1 %

2

rosadan external cream 2


rosadan external gel 2

SCENESSE 4 PA

selenium sulfide external lotion

1

sulfacetamide sodium (acne)

2

tacrolimus external ointment

2

tazarotene external 2 PA

tovet external foam 2

tretinoin external 2 PA

tretinoin microsphere 3 PA

tretinoin microsphere pump external gel 0.04 %, 0.1 %

3 PA

triamcinolone acetonide external cream

1

triamcinolone acetonide external lotion

1

triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 %

1

TRI-CHLOR 2

triderm 1

XERAC AC 1

zenatane 2 PA

Diabetes - Antidiabetic Agents

acarbose oral 1

BYDUREON 3 ST; QL

BYDUREON BCISE AUTOINJECTOR

3 ST; QL

FARXIGA 2 ST

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1

glipizide-metformin hcl 2

glyburide micronized 1


30


glyburide oral 1

glyburide-metformin 1

JARDIANCE 2 ST

KAZANO 2 ST

metformin hcl er 1

metformin hcl ir 1

miglitol 2

nateglinide 2

NESINA 2 ST

OSENI 2 ST

OZEMPIC 3 ST; QL

pioglitazone hcl 1

pioglitazone hcl-glimepiride

2

pioglitazone hcl-metformin hcl

2

repaglinide 2

SOLIQUA 3 ST; QL

SYMLINPEN 120 3 PA

SYMLINPEN 60 3 PA

SYNJARDY 2 ST

SYNJARDY XR 2 ST

tolbutamide 2

TRULICITY SUBCUTANEOUS SOLUTION PEN-INJECTOR 0.75 MG/0.5ML, 1.5 MG/0.5ML

3 ST; QL

VICTOZA 3 ST; QL

XIGDUO XR 2 ST

Diabetes - Glucose Monitoring

CEQUR SIMPLICITY 2U

1

CEQUR SIMPLICITY INSERTER

1

CEQUR SIMPLICITY STARTER

1


INPEN 100-BLUE-LILLY

1

INPEN 100-BLUE-NOVO

1

INPEN 100-GRAY-LILLY

1

INPEN 100-GREY-NOVO

1

INPEN 100-PINK-LILLY

1

INPEN 100-PINK-NOVO

1

LANCETS 1

NOVOPEN ECHO 1

ONETOUCH ULTRA 1 QL

ONETOUCH ULTRA 2 KIT W/DEVICE

1

ONETOUCH ULTRA MINI KIT W/DEVICE

1

ONETOUCH VERIO KIT W/DEVICE

1

ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE

1

ONETOUCH VERIO TEST STRIPS

1 QL

ONETOUCH VERIO IQ SYSTEM

1

ONETOUCH VERIO REFLECT

1

ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE

1

Diabetes - Glycemic Agents

diazoxide oral 3

GLUCAGON EMERGENCY KIT INJECTION KIT

3

PROGLYCEM 3


31


Diabetes - Insulins

BD AUTOSHIELD DUO PEN NEEDLES

1

BD ULTRA-FINE INSULIN SYRINGES

1

BD ULTRA-FINE PEN NEEDLES

1

BD VEO INSULIN SYR U/F 1/2UNIT

1

DROPLET MICRON 1

HUMALOG KWIKPEN 2

HUMALOG MIX 50/50 KWIKPEN

2

HUMALOG MIX 50/50 VIAL

2

HUMALOG MIX 75/25 KWIKPEN

2

HUMALOG MIX 75/25 VIAL

2

HUMALOG U-100 JUNIOR KWIKPEN

2

HUMALOG VIAL 2

HUMULIN 70/30 KWIKPEN

2

HUMULIN 70/30 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2

HUMULIN R U-500 KWIKPEN

2

HUMULIN R U-500 VIAL

2

HUMULIN R VIAL 2

INSULIN PEN NEEDLES

1

INSULIN SYRINGES 1

LANTUS SOLOSTAR 2

LANTUS U-100 VIAL 2

MAXICOMFORT SYR 27G X 1/2"

1


NOVOFINE AUTOCOVER PEN NEEDLE

1

NOVOFINE PEN NEEDLE

1

NOVOFINE PLUS PEN NEEDLE

1

NOVOTWIST PEN NEEDLE

1

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

Electrolytes / Minerals / Metals / Vitamins

adc/f (0.5mg/ml) 1

airavite 1

ALANINE 4

argyle sterile saline 1

argyle sterile water 1

ATABEX OB 1

bp vit 3 3

CALCIUM CHLORIDE DIHYDRATE POWDER

4

CALCIUM GLUCONATE

4

CALCIUM GLUCONATE ANHYDROUS

4

CALCIUM GLUCONATE MONOHYDRATE

4

CALCIUM LACTATE PENTAHYDRATE

4

CALCIUM PHOSPHATE DIBASIC

4

CALCIUM PHOSPHATE TRIBASIC

4

CARBAGLU 3


32


CHOLINE BITARTRATE POWDER

4

clovique 4 PA

curity sterile saline 1

cyanocobalamin injection solution 1000 mcg/ml

1

CYANOCOBALAMIN INJECTION SOLUTION 2000 MCG/ML

1

deferasirox oral tablet soluble

4 PA

dextrose in lactated ringers

1

dextrose-nacl intravenous solution 5-0.2 %, 5-0.3 %, 5-0.33 %, 5-0.45 %, 5-0.9 %

1

dextrose-sodium chloride

1

DL-ALANINE 4

DL-LEUCINE 4

DL-PHENYLALANINE 4

EFFER-K ORAL TABLET EFFERVESCENT 10 MEQ, 20 MEQ

1

effer-k oral tablet effervescent 25 meq

1

ELITE-OB 1

ergocalciferol oral capsule

1

fabb 1

fa-vitamin b-6-vitamin b-12

1

fluoritab 1

folbee 1

folic acid oral tablet 1 mg

1

folplex 2.2 1


hematinic/folic acid 1

hemocyte-f 1

hydroxocobalamin acetate

1

JADENU 4 PA

JADENU SPRINKLE 4 PA

JYNARQUE ORAL TABLET

4 QL

JYNARQUE ORAL TABLET THERAPY PACK 45 & 15 MG, 60 & 30 MG, 90 & 30 MG

4 QL

kcl in dextrose-nacl 1

kionex 2

klor-con 10 1

klor-con m10 1

KLOR-CON M15 2

klor-con m20 1

klor-con oral packet 2

klor-con oral tablet extended release

1

klor-con sprinkle 1

klor-con/ef 1

K-PHOS-NEUTRAL 1

k-prime 1

lactated ringers intravenous

1

L-ALANINE 4

L-ARGININE 4

L-CYSTINE 4

levocarnitine oral solution

2

levocarnitine oral tablet 2

levocarnitine sf 2

L-GLUTAMIC ACID 4

L-HISTIDINE MONOHYDROCHLORIDE POWDER

4

L-LEUCINE 4


33


L-PHENYLALANINE 4

L-PROLINE 4

L-TRYPTOPHAN 4

L-TYROSINE 4

ludent oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg, 2.2 (1 f) mg

1

L-VALINE POWDER 4

MAGNESIUM CARBONATE HEAVY

4

MAGNESIUM CARBONATE POWDER

4

magnesium chloride injection

2

M-NATAL PLUS 1

monoject flush syringe 1

monoject sodium chloride flush

1

multi prenatal 1

multi-vitamin/fluoride 1

multivitamin/fluoride oral solution

1

multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg

1

multivitamins/fluoride 1

mvc-fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg

1

na ferric gluc cplx in sucrose

2

nafrinse 1

nafrinse drops 1

NEONATAL PLUS 1

NESTABS 2

normal saline flush 1

nufol 1


ONE VITE WOMENS PLUS

1

PHOSPHA 250 NEUTRAL

1

phosphorous 1

phospho-trin 250 neutral

1

pnv prenatal plus multivit+dha oral 27-1 & 312 mg

1

potassium acetate intravenous

1

potassium bicarbonate oral

1

potassium chloride crys er

1

potassium chloride er 1

potassium chloride intravenous

2

potassium chloride oral solution

2

potassium citrate er 2

PRENATA ORAL TABLET CHEWABLE 29-1 MG

1

prenatal oral tablet 27-0.8 mg, 27-1 mg, 28-0.8 mg

1

prenatal plus iron 1

RELNATE DHA 2

saline flush 1

saline flush zr 1

SAMSCA 4 QL

SODIUM ASCORBATE POWDER

4

sodium bicarbonate intravenous solution 7.5 %

2

sodium chloride (pf) 1

sodium chloride flush 1


34


sodium chloride injection

1

sodium chloride intravenous

1

sodium chloride irrigation

1

sodium fluoride oral 1

sodium polystyrene sulfonate

2

sps 2

sterile water for irrigation

1

swabflush saline flush 1

TAURINE POWDER 4

THREONINE 4

trientine hcl 4 PA

TRINATE 1

tri-vitamin/fluoride 1

tri-vite/fluoride 1

TRYPTOPHAN 4

UDAMIN SP 1

VALINE 4

virt-gard 1

virt-phos 250 neutral 1

vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut)

1

vitamins acd-fluoride 1

vp-pnv-dha 1

water for irrigation, sterile

1

westab one 1

Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer

cimetidine hcl 1

cimetidine oral 1

famotidine intravenous 1


famotidine oral suspension reconstituted

1

famotidine oral tablet 20 mg, 40 mg

1

famotidine premixed 1

lansoprazole oral capsule delayed release

1 QL

lansoprazole oral tablet delayed release dispersible 15 mg

3 ST; QL

misoprostol oral 1

nizatidine 2

omeprazole oral capsule delayed release

1 QL

pantoprazole sodium intravenous

1

pantoprazole sodium oral tablet delayed release

1 QL

rabeprazole sodium oral tablet delayed release

1 QL

sucralfate oral tablet 1

Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions

alosetron hcl 3 PA

amoxicill-clarithro-lansopraz

3

ANASPAZ 1

atropine sulfate injection solution 8 mg/20ml

2

atropine sulfate injection solution prefilled syringe 0.25 mg/5ml

2

constulose 1


35


cromolyn sodium oral 3

dicyclomine hcl intramuscular

2

dicyclomine hcl oral 1

diphenoxylate-atropine oral liquid

3

diphenoxylate-atropine oral tablet

1

ED-SPAZ 1

enulose 1

GATTEX 4 PA

gavilyte-c 1

gavilyte-g 1

gavilyte-n with flavor pack

1

generlac 1

glycopyrrolate injection solution

2

glycopyrrolate oral tablet 1 mg, 2 mg

1

hyoscyamine sulfate oral

1

hyoscyamine sulfate sl 1

hyoscyamine sulfate sublingual

1

hyosyne 1

lactulose encephalopathy

1

lactulose oral solution 1

LINZESS 2 ST; QL

loperamide hcl oral capsule

1

methscopolamine bromide oral

2

mineral oil heavy oral 1

NULEV 1

oscimin 1

peg 3350-kcl-na bicarb-nacl

1

peg-3350/electrolytes 1


propantheline bromide oral

2

SYMPROIC 2 ST; QL

trilyte 1

ursodiol oral 2

XERMELO 4 PA; QL

Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment

CERDELGA 4 PA

CEREZYME 4 PA

CHOLBAM 4 PA

CREON 3

CRYSVITA 4 PA

CYSTAGON 2

ELAPRASE 4 PA

ELELYSO 4 PA

FABRAZYME 4 PA

KANUMA 4 PA

KUVAN 4 PA

L-GLUTAMIC ACID HCL

4

LUMIZYME 4 PA

MEPSEVII 4 PA

miglustat 4 PA

MYALEPT 4 PA

NAGLAZYME 3 PA

NITYR 4 PA

OCALIVA 4 PA; QL

ORFADIN 4 PA

PALYNZIQ 4 PA; QL

PROCYSBI ORAL CAPSULE DELAYED RELEASE

4 PA

RAVICTI 4 PA

REVCOVI 4 PA


36


sod benz-sod phenylacet

4

sodium phenylbutyrate oral

4

STRENSIQ 4 PA

SUCRAID 4

VIMIZIM 4 PA

VPRIV 4 PA

XURIDEN 4 PA; QL

ZENPEP 3

Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions

acetic acid irrigation 1

bethanechol chloride oral

2

calcium acetate (phos binder)

2

calcium acetate oral tablet 667 mg

2

darifenacin hydrobromide er

2

DEPEN TITRATABS 4

flavoxate hcl 2

GELNIQUE 3 ST

lanthanum carbonate 3

oxybutynin chloride er 1

oxybutynin chloride oral 1

penicillamine oral capsule

4 PA

penicillamine oral tablet 4

phenazo oral tablet 200 mg

1

phenazopyridine hcl oral tablet 100 mg, 200 mg

1

sevelamer carbonate 2

sevelamer hcl 3


sildenafil citrate oral tablet 100 mg, 25 mg, 50 mg

1 QL

solifenacin succinate 2

tadalafil oral 2 QL

THIOLA 4

tolterodine tartrate 2

tolterodine tartrate er 2

trospium chloride 2

trospium chloride er 2

uretron d/s oral tablet 2

urin ds oral tablet 2

utrona-c 2

Genitourinary Agents - Drugs for Prostate Conditions

alfuzosin hcl er 1

dutasteride oral 1

dutasteride-tamsulosin hcl

2

finasteride oral tablet 5 mg

1

silodosin 2

tamsulosin hcl 1

terazosin hcl 1

Hormonal Agents - Adrenal

DEPO-MEDROL INJECTION SUSPENSION 20 MG/ML

2

DEXAMETHASONE (LA) INJECTION SUSPENSION 8 MG/ML

1

dexamethasone oral elixir

1

dexamethasone oral solution

1

dexamethasone oral tablet

1


37


dexamethasone oral tablet therapy pack

2

dexamethasone sod phosphate pf injection solution

1

dexamethasone sodium phosphate injection

1

fludrocortisone acetate oral

1

hydrocortisone oral 1

KENALOG INJECTION SUSPENSION 10 MG/ML

1

METHYLPREDNISOLONE ACETATE SUSPENSION 40 MG/ML INJECTION

1

methylprednisolone acetate suspension 40 mg/ml injection

1

METHYLPREDNISOLONE ACETATE SUSPENSION 80 MG/ML INJECTION

1

methylprednisolone acetate suspension 80 mg/ml injection

1

methylprednisolone oral

1

methylprednisolone sodium succ injection solution reconstituted 1000 mg, 125 mg, 40 mg

1

prednisolone oral solution

1

prednisolone sodium phosphate oral solution

1

prednisolone sodium phosphate oral tablet dispersible

2

prednisone intensol 2


prednisone oral 1

SOLU-CORTEF 2

triamcinolone acetonide injection suspension 40 mg/ml

1

Hormonal Agents - Men's Health

ANDRODERM 2 PA

danazol oral 2

METHYLTESTOSTERONE

4

methyltestosterone oral 3 PA

oxandrolone oral 3 PA; QL

testosterone cypionate intramuscular

1 PA

testosterone enanthate intramuscular

2 PA

testosterone transdermal

2 PA

Hormonal Agents - Osteoporosis

raloxifene hcl 2

Hormonal Agents - Pituitary

ACTHAR 4 PA

cabergoline 2

CETROTIDE 3 PA

chorionic gonadotropin intramuscular

2 PA

clomiphene citrate oral 1

desmopressin ace spray refrig

2

desmopressin acetate injection

3

desmopressin acetate oral

2

desmopressin acetate spray

2

EGRIFTA SV 4 PA; QL

ELIGARD 3 PA; QL


38


FENSOLVI (6 MONTH) 3 PA; QL

FIRMAGON 3 PA; QL

FIRMAGON (240 MG DOSE)

3 PA; QL

FOLLISTIM AQ 4 PA

GENOTROPIN 3 PA

GENOTROPIN MINIQUICK

3 PA

HUMATROPE 3 PA

INCRELEX 4 PA

leuprolide acetate injection

3 PA

LUPANETA PACK 3 PA; QL

LUPRON DEPOT (1-MONTH)

3 PA

LUPRON DEPOT (3-MONTH)

3 PA

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG

3 PA

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG

3 PA

LUPRON DEPOT-PED (1-MONTH)

3 PA

LUPRON DEPOT-PED (3-MONTH)

4 PA

MENOPUR 4 PA

NOCDURNA 2

novarel intramuscular solution reconstituted 10000 unit

2 PA

NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT

2 PA

octreotide acetate 3 PA

OVIDREL 2 PA


oxytocin injection 1

pregnyl 2 PA

SIGNIFOR 4 PA; QL

SOMATULINE DEPOT 4 PA

SOMAVERT 4 PA

SUPPRELIN LA 4 PA; QL

TRELSTAR MIXJECT 3 PA; QL

TRIPTODUR 4 PA; QL

VANTAS 3 PA; QL

ZOLADEX 3 QL

Hormonal Agents - Prostaglandins

KORLYM 4 PA; QL

Hormonal Agents - Sex Hormones and Birth Control

afirmelle 1

altavera 1

alyacen 1/35 1

alyacen 7/7/7 1

amabelz 2

amethia 2 QL

amethia lo 2 QL

amethyst 2

apri 1

aranelle 1

ashlyna 2 QL

aubra 1

aubra eq 1

aurovela 1.5/30 1

aurovela 1/20 1

aurovela 24 fe 2

aurovela fe 1.5/30 1

aurovela fe 1/20 1

aviane 1

ayuna 1

azurette 1


39


balziva 1

bekyree 1

blisovi 24 fe 2

blisovi fe 1.5/30 1

blisovi fe 1/20 1

briellyn 1

camila 1

camrese 2 QL

camrese lo 2 QL

caziant 1

charlotte 24 fe 2

chateal 1

chateal eq 1

CLIMARA PRO 2

cryselle-28 1

cyclafem 1/35 1

cyclafem 7/7/7 1

cyred 1

cyred eq 1

dasetta 1/35 1

dasetta 7/7/7 1

daysee 2 QL

deblitane 1

delyla 1

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

3

desogestrel-ethinyl estradiol

1

DIVIGEL TRANSDERMAL GEL 0.25 MG/0.25GM, 0.5 MG/0.5GM, 0.75 MG/0.75GM, 1 MG/GM

2

dotti 2

drospiren-eth estrad-levomefol

2


drospirenone-ethinyl estradiol

2

elinest 1

ELLA 2

eluryng 2

emoquette 1

enpresse-28 1

enskyce 1

errin 1

estarylla 1

estradiol oral 1

estradiol transdermal 2

estradiol vaginal 2

estradiol valerate intramuscular

2

estradiol-norethindrone acet

2

ethynodiol diac-eth estradiol

1

etonogestrel-ethinyl estradiol

2

falmina 1

fayosim 2 QL

femynor 1

fyavolv 2

gianvi 2

hailey 1.5/30 1

hailey 24 fe 2

hailey fe 1.5/30 1

hailey fe 1/20 1

heather 1

hydroxyprogesterone caproate intramuscular

3 PA

incassia 1

introvale 1 QL

isibloom 1

jaimiess 2 QL

jasmiel 2


40


jencycla 1

jinteli 2

jolessa 1 QL

juleber 1

junel 1.5/30 1

junel 1/20 1

junel fe 1.5/30 1

junel fe 1/20 1

junel fe 24 2

kaitlib fe 2

kalliga 1

kariva 1

kelnor 1/35 1

kelnor 1/50 1

kurvelo 1

larin 1.5/30 1

larin 1/20 1

larin 24 fe 2

larin fe 1.5/30 1

larin fe 1/20 1

larissia 1

layolis fe 2

leena 1

lessina 1

levonest 1

levonorgest-eth est & eth est

2 QL

levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 &0.01 mg

2 QL

levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg

1 QL

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg

1


levonorgestrel-ethinyl estrad oral tablet 90-20 mcg

2

levonorg-eth estrad triphasic

1

levora 0.15/30 (28) 1

lillow 1

lojaimiess 2 QL

lopreeza 2

loryna 2

low-ogestrel 1

lo-zumandimine 2

lutera 1

lyza 1

marlissa 1

medroxyprogesterone acetate oral

1

megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml

1

megestrol acetate oral suspension 625 mg/5ml

3

megestrol acetate oral tablet

1

melodetta 24 fe 2

mibelas 24 fe 2

microgestin 1.5/30 1

microgestin 1/20 1

microgestin fe 1.5/30 1

microgestin fe 1/20 1

mili 1

mimvey 2

mono-linyah 1

necon 0.5/35 (28) 1

nikki 2

nora-be 1

norethin ace-eth estrad-fe oral tablet

1


41


norethin ace-eth estrad-fe oral tablet chewable

2

norethindrone acetate oral

2

norethindrone acet-ethinyl est

1

norethindrone oral 1

norethindrone-eth estradiol

2

norethin-eth estradiol-fe 2

norgestimate-eth estradiol

1

norgestimate-ethinyl estradiol triphasic

1

norlyda 1

norlyroc 1

nortrel 0.5/35 (28) 1

nortrel 1/35 (21) 1

nortrel 1/35 (28) 1

nortrel 7/7/7 1

ocella 2

orsythia 1

philith 1

pimtrea 1

pirmella 1/35 1

pirmella 7/7/7 1

portia-28 1

PREMARIN ORAL 2

PREMPHASE 2

PREMPRO 2

previfem 1

progesterone intramuscular

2

progesterone micronized oral

2

reclipsen 1

rivelsa 2 QL

setlakin 1 QL


sharobel 1

simliya 1

simpesse 2 QL

sprintec 28 1

sronyx 1

syeda 2

tarina 24 fe 2

tarina fe 1/20 1

tarina fe 1/20 eq 1

tilia fe 2

tri femynor 1

tri-estarylla 1

tri-legest fe 2

tri-linyah 1

tri-lo-estarylla 1

tri-lo-marzia 1

tri-lo-mili 1

tri-lo-sprintec 1

tri-mili 1

tri-previfem 1

tri-sprintec 1

trivora (28) 1

tri-vylibra 1

tri-vylibra lo 1

tulana 1

tydemy 2

velivet 1

vienva 1

viorele 1

volnea 1

vyfemla 1

vylibra 1

wera 1

wymzya fe 2

xulane 2

yuvafem 2

zarah 2


42


zovia 1/35e (28) 1

zumandimine 2

Hormonal Agents - Thyroid

ARMOUR THYROID 1

euthyrox 1

levo-t 1

levothyroxine sodium intravenous solution reconstituted

1

levothyroxine sodium oral

1

levoxyl 1

liothyronine sodium intravenous

1

liothyronine sodium oral 1

methimazole oral 1

NATURE-THROID 1

np thyroid 1

propylthiouracil oral 2

unithroid 1

WESTHROID 1

WP THYROID 1

Immunological Agents - Drugs for Immune System Stimulation or Suppression

ACTEMRA 4 PA

ACTEMRA ACTPEN 4 PA

ACTIMMUNE 4 PA

ARCALYST 4 PA

AZASAN 3

azathioprine oral 1

azathioprine sodium 1

BENLYSTA INTRAVENOUS

3 PA

BENLYSTA SUBCUTANEOUS

4 PA


BERINERT 4 PA; QL

BIVIGAM 4 PA

CARIMUNE NF 4 PA

CELLCEPT 3

CIMZIA PREFILLED KIT

3 PA

CIMZIA STARTER KIT 3 PA

CINRYZE 4 PA

CUVITRU 4 PA

cyclosporine intravenous

2

cyclosporine modified 2

cyclosporine oral 3

CYTOGAM 3 PA

ENTYVIO 4 PA

everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 mg

3 PA

FLEBOGAMMA DIF 4 PA

GAMASTAN 2 PA

GAMIFANT INTRAVENOUS SOLUTION 10 MG/2ML

4 PA

GAMMAGARD 4 PA

GAMMAGARD S/D LESS IGA

4 PA

GAMMAKED 4 PA

GAMMAPLEX 4 PA

GAMUNEX-C 4 PA

gengraf 2

HAEGARDA 4 PA

HIZENTRA SUBCUTANEOUS SOLUTION

4 PA

HUMIRA 3 PA

HUMIRA PEDIATRIC CROHNS START

3 PA

HUMIRA PEN 3 PA


43


HUMIRA PEN-CD/UC/HS STARTER

3 PA

HUMIRA PEN-PS/UV/ADOL HS START

3 PA

HYPERRHO S/D 2

HYQVIA 4 PA

ILARIS 4 PA; QL

IMURAN 3

INFLECTRA 3 PA

KALBITOR 4 PA; QL

KINERET 4 PA

leflunomide oral 2

methotrexate (anti-rheumatic)

2

methotrexate oral 1

methotrexate sodium 1

methotrexate sodium (pf)

1

MICRHOGAM ULTRA-FILTERED PLUS

2

mycophenolate mofetil 2

mycophenolate mofetil hcl

2

mycophenolate sodium 3

MYFORTIC 3

NEORAL 3

NULOJIX 3 PA

OCTAGAM 4 PA

ORENCIA 4 PA

ORENCIA CLICKJECT 4 PA

OTEZLA 3 PA

PRIVIGEN 4 PA

PROGRAF ORAL PACKET

3

RAPAMUNE ORAL SOLUTION

3

RENFLEXIS 3 PA


RHOGAM ULTRA-FILTERED PLUS

2

RINVOQ 3 PA

RUCONEST 4 PA; QL

SANDIMMUNE ORAL 3

SIMPONI 3 PA

sirolimus oral 3

SKYRIZI (150 MG DOSE)

3 PA

STELARA SUBCUTANEOUS

3 PA; QL

SYNAGIS 3 PA

tacrolimus oral 2

TALTZ 3 PA

temsirolimus 4

THYMOGLOBULIN 3

TICE BCG 3

TREMFYA 3 PA

XATMEP 3 ST

XELJANZ 3 PA

XELJANZ XR 3 PA

ZORTRESS 3 PA

Immunological Agents - Drugs for Vaccination

ACTHIB 1

ADACEL 1

AFLURIA QUADRIVALENT

2

BCG VACCINE 2

BEXSERO 2

BOOSTRIX 1

DAPTACEL 1

DIPHTHERIA-TETANUS TOXOIDS DT

2

ENGERIX-B 2

FLUAD 2


44


FLUAD QUADRIVALENT

2

FLUARIX QUADRIVALENT

2

FLUBLOK QUADRIVALENT

2

FLUCELVAX QUADRIVALENT

2

FLULAVAL QUADRIVALENT

2

FLUMIST QUADRIVALENT

2

FLUZONE HIGH-DOSE QUADRIVALENT

2

FLUZONE QUADRIVALENT

2

GARDASIL 9 2

HAVRIX 2

HEPLISAV-B 2

HIBERIX 1

IMOVAX RABIES 3

INFANRIX 1

IPOL 2

IXIARO 2

KINRIX 2

MENACTRA 2

MENVEO 2

M-M-R II 2

PEDIARIX 2

PEDVAX HIB 2

PENTACEL 2

PNEUMOVAX 23 2

PREVNAR 13 2

PROQUAD 2

QUADRACEL 2

RABAVERT 3

RECOMBIVAX HB 2

ROTARIX 2


ROTATEQ 2

SHINGRIX 2

STAMARIL 2

TDVAX 1

TENIVAC 1

TETANUS-DIPHTHERIA TOXOIDS TD

1

TRUMENBA 2

TWINRIX 2

TYPHIM VI 2

VAQTA 2

VARIVAX 2

VAXCHORA 2

VIVOTIF 2

YF-VAX 2

Inflammatory Bowel Disease Agents

APRISO 2

balsalazide disodium 2

budesonide er 3

budesonide oral 2

hydrocortisone (perianal)

1

hydrocortisone rectal 2

LIALDA 2

mesalamine oral capsule delayed release

3

mesalamine oral tablet delayed release 800 mg

3

mesalamine rectal 3

mesalamine-cleanser 3

procto-med hc 1

procto-pak 1

proctosol hc 1

proctozone-hc 1

SFROWASA 3


45


sulfasalazine oral 1

UCERIS RECTAL 2

Metabolic Bone Disease Agents - Drugs for Osteoporosis

alendronate sodium oral solution

2

alendronate sodium oral tablet 10 mg, 5 mg

1

alendronate sodium oral tablet 35 mg, 70 mg

1 QL

calcitonin (salmon) 2 QL

FORTEO 4 PA

ibandronate sodium intravenous

2 QL

ibandronate sodium oral

1 QL

pamidronate disodium 2

PROLIA 3 PA; QL

RAYALDEE 3

risedronate sodium oral tablet 150 mg, 35 mg

2 QL

risedronate sodium oral tablet 30 mg, 5 mg

2

risedronate sodium oral tablet delayed release

2 QL

TYMLOS 3 PA

XGEVA 3 PA

zoledronic acid 2

Metabolic Bone Disease Agents - Other

calcitriol intravenous 1

calcitriol oral 1

cinacalcet hcl 3 PA

doxercalciferol intravenous

3

NATPARA 4 PA; QL


paricalcitol 2

Miscellaneous Therapeutic Agents

acetylcysteine intravenous

3

ADAKVEO 4 PA

ALBUKED 25 2

ALBUKED 5 2

albumin human 2

albumin-zlb 2

alburx 2

ALBUTEIN 2

ASPARTAME 4

ASPARTAME (NUTRASWEET)

4

BOTOX 3 PA

BREATHE EASE LARGE

1

BREATHE EASE MEDIUM

1

BREATHE EASE SMALL

1

BREATHERITE 1

BROMELAIN 4

CETYLCIDE-G 4

CHARCOAL ACTIVATED

4

CHLORHEXIDINE GLUCONATE SOLUTION 20 %

2

CLEVER CHOICE HOLDING CHAMBER

1

COMPACT SPACE CHAMBER/LG MASK

1

COMPACT SPACE CHAMBER/MED MASK

1

COMPACT SPACE CHAMBER/SM MASK

1

deferoxamine mesylate 2


46


dexmedetomidine hcl in nacl intravenous solution 200 mcg/50ml, 400 mcg/100ml

3

DEXMEDETOMIDINE HCL INTRAVENOUS SOLUTION 1000 MCG/10ML, 400 MCG/4ML

3

dexmedetomidine hcl intravenous solution 200 mcg/2ml

1

DUROLANE 2 PA

DYSPORT 3 PA

EASIVENT 1

ergoloid mesylates oral 3

EUFLEXXA 2 PA

FIRDAPSE 4 PA

FLEXBUMIN 2

flumazenil intravenous 1

GELSYN-3 2 PA

heparin lock flush 1

heparin sodium lock flush

1

HUMAN ALBUMIN GRIFOLS

2

kedbumin 2

methergine 3 QL

methylergonovine maleate injection

2

methylergonovine maleate oral

3 QL

MICROCHAMBER DEVICE

1

MYOBLOC 3 PA

PLASBUMIN-25 2

PLASBUMIN-5 2

POCKET SPACER 1

PRO COMFORT SPACER ADULT

1


PRO COMFORT SPACER CHILD

1

PRO COMFORT SPACER INFANT

1

PROCARE SPACER/ADULT MASK

1

PROCARE SPACER/CHILD MASK

1

SACCHARIN 4

sodium thiosulfate intravenous

2

VISTOGARD 4

XEOMIN 3 PA

XIAFLEX 4 PA

Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation

azelastine hcl ophthalmic

1

bacitracin ophthalmic 2

bromfenac sodium (once-daily)

2 QL

ciprofloxacin hcl ophthalmic

1

cromolyn sodium ophthalmic

1

dexamethasone sodium phosphate ophthalmic

2

diclofenac sodium ophthalmic

1

epinastine hcl 2

erythromycin ophthalmic

1

fluorometholone 2

flurbiprofen sodium 1

FML FORTE 2

gatifloxacin ophthalmic 2

gentak 1


47


gentamicin sulfate ophthalmic

1

ketorolac tromethamine ophthalmic

1

levofloxacin ophthalmic 2

moxifloxacin hcl (2x day)

2

moxifloxacin hcl ophthalmic

2

NATACYN 3

ofloxacin ophthalmic 1

olopatadine hcl ophthalmic

2

OZURDEX 3

prednisolone acetate ophthalmic

2

prednisolone sodium phosphate ophthalmic

2

sulfacetamide sodium ophthalmic

1

tobramycin ophthalmic 1

trifluridine 2

Ophthalmic Agents - Drugs for Glaucoma

acetazolamide er 2

acetazolamide oral 2

apraclonidine hcl 2

betaxolol hcl ophthalmic

2

bimatoprost ophthalmic 2 QL

brimonidine tartrate ophthalmic

2

carteolol hcl 1

DORZOLAMIDE HCL SOLUTION 2 % OPHTHALMIC

1

dorzolamide hcl solution 2 % ophthalmic

1

dorzolamide hcl-timolol mal

1


dorzolamide hcl-timolol mal pf

2

KEVEYIS 4 PA; QL

latanoprost ophthalmic 1

levobunolol hcl 1

LUMIGAN 2 QL

methazolamide oral 3

pilocarpine hcl ophthalmic

2

timolol maleate ophthalmic solution

1

travoprost (bak free) 2 QL

Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions

ak-poly-bac 1

ALTACAINE 1

altafrin ophthalmic solution 10 %

2

atropine sulfate ophthalmic ointment

1

atropine sulfate ophthalmic solution 1 %

2

bacitracin-polymyxin b ophthalmic

1

bacitra-neomycin-polymyxin-hc

2

cyclopentolate hcl ophthalmic

1

CYSTARAN 4 PA; QL

EYLEA INTRAVITREAL SOLUTION

3 PA

homatropaire 1

LUCENTIS 3 PA

neomycin-bacitracin zn-polymyx

1

neomycin-polymyxin-dexameth ophthalmic ointment

1


48


neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

1

neomycin-polymyxin-gramicidin

2

neomycin-polymyxin-hc ophthalmic

2

neo-polycin 1

neo-polycin hc 2

OXERVATE 4 PA; QL

phenylephrine hcl ophthalmic solution 10 %

2

polycin 1

polymyxin b-trimethoprim

1

proparacaine hcl ophthalmic

1

sulfacetamide-prednisolone ophthalmic solution

1

tetracaine hcl ophthalmic

1

tobramycin-dexamethasone

2

VISUDYNE 3

Otic Agents - Drugs for Ear Conditions

acetic acid otic 1

ciprofloxacin hcl otic 2

flac 2

fluocinolone acetonide otic

2

hydrocortisone-acetic acid

2

neomycin-polymyxin-hc otic

2

ofloxacin otic 2


Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold

azelastine hcl nasal 1 QL

azelastine-fluticasone 2

benzonatate 1

bromfed dm 1

carbinoxamine maleate oral solution

1

carbinoxamine maleate oral tablet 4 mg

1

cetirizine hcl oral solution

1

CINQAIR 3 PA

cyproheptadine hcl oral 1

desloratadine oral tablet

1

desloratadine oral tablet dispersible

2

diphenhydramine hcl injection

1

diphenhydramine hcl oral elixir

1

FASENRA 4 PA

FASENRA PEN 4 PA

flunisolide nasal 2 QL

fluticasone propionate nasal

1

hydrocodone polst-chlorphen polst er susp

2 PA; QL

hydrocodone-homatropine

1 PA; QL

hydromet 1 PA; QL

ipratropium bromide nasal

1

levocetirizine dihydrochloride oral

1

mometasone furoate nasal

2 QL


49


nebusal inhalation nebulization solution 3 %

1

NUCALA 4 PA; QL

olopatadine hcl nasal 2 QL

promethazine hcl injection

1

promethazine hcl oral 1

promethazine hcl rectal 2

promethazine-codeine 1 PA; QL

promethazine-dm 1

promethazine-phenyleph-codeine

2 PA; QL

promethazine-phenylephrine

1

promethegan 2

pseudoephedrine-bromphen-dm oral syrup

1

pulmosal inhalation nebulization solution 7 %

1

ryvent 2

sodium chloride inhalation

1

XOLAIR 3 PA

Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions

acetylcysteine inhalation

2

ADVAIR DISKUS 2 QL

ADVAIR HFA 2 QL

albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation

1 QL


ALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) MCG/ACT INHALATION

1 QL

albuterol sulfate inhalation

1 QL

ANORO ELLIPTA 2 QL

ARALAST NP 4 PA

ARNUITY ELLIPTA 2 QL

ASMANEX (120 METERED DOSES)

2


2

ASMANEX (30 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 110 MCG/INH

2 QL

ASMANEX (30 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 220 MCG/INH

2


2


2 QL

ASMANEX HFA 2 QL

ATROVENT HFA 3 ST; QL

AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 0.1 MG/0.1ML

3 QL

BREO ELLIPTA 2

BROVANA 3 ST; QL

budesonide inhalation 2 QL

COMBIVENT RESPIMAT

2 QL


50


cromolyn sodium inhalation

3

DALIRESP 3 PA

epinephrine injection solution auto-injector

2

EPIPEN 2-PAK 3

ESBRIET 4 PA

FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT

2 QL

GLASSIA 4 PA

INCRUSE ELLIPTA 2 QL

ipratropium bromide inhalation

1 QL

ipratropium-albuterol 1 QL

LONHALA MAGNAIR REFILL KIT

3 ST; QL

LONHALA MAGNAIR STARTER KIT

3 ST; QL

metaproterenol sulfate oral

2

montelukast sodium oral

1

OFEV 4 PA

PROLASTIN-C 4 PA

QVAR REDIHALER 2 QL

SEREVENT DISKUS 2 QL

SPIRIVA HANDIHALER

2 QL

SPIRIVA RESPIMAT 2 QL

STIOLTO RESPIMAT 2 QL

STRIVERDI RESPIMAT

2 QL

SYMBICORT 2 QL

terbutaline sulfate injection

3


terbutaline sulfate oral 2

theophylline 2

theophylline er 2

TRELEGY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-62.5-25 MCG/INH

2 QL

VENTOLIN HFA 1 QL

YUPELRI 3 ST; QL

zafirlukast 2

ZEMAIRA 4 PA

Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis

BETHKIS 4

CAYSTON 4 PA

KALYDECO 4 PA

ORKAMBI 4 PA; QL

PULMOZYME 4 PA

SYMDEKO 4 PA; QL

tobramycin inhalation nebulization solution 300 mg/5ml

4

Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension

ADEMPAS 4 PA; QL

alyq 3 PA; QL

ambrisentan 4 PA; QL

bosentan 4 PA; QL

epoprostenol sodium 3 PA

OPSUMIT 4 PA; QL

ORENITRAM 4 PA

sildenafil citrate intravenous

2 PA


51


sildenafil citrate oral suspension reconstituted

4 PA; QL

sildenafil citrate oral tablet 20 mg

2 PA; QL

tadalafil (pah) 3 PA; QL

TRACLEER 32 MG 4 PA; QL

treprostinil injection solution 50 mg/20ml

4 PA

TYVASO 4 PA; QL

TYVASO REFILL 4 PA; QL

TYVASO STARTER 4 PA; QL

UPTRAVI 4 PA; QL

VELETRI 3 PA

VENTAVIS 4 PA; QL

Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm

baclofen oral 1

carisoprodol oral 1

chlorzoxazone oral tablet 500 mg

2

cyclobenzaprine hcl oral

1

dantrolene sodium oral 2

metaxalone 2

methocarbamol injection

1

methocarbamol oral 1

orphenadrine citrate er 1

orphenadrine citrate injection

2

tizanidine hcl oral 1

Sleep Disorder Agents

armodafinil 2 PA; QL

doxepin hcl oral tablet 3 QL

eszopiclone 1 QL

flurazepam hcl 1 PA; QL


HETLIOZ 4 PA; QL

modafinil 2 PA; QL

temazepam 1 QL

XYREM 4 PA; QL

zaleplon 1 QL

zolpidem tartrate er 2

zolpidem tartrate oral 1 QL


52


53

Index of Drugs

abacavir sulfate.........................20abacavir sulfate-lamivudine...... 20abacavir-lamivudine-zidovudine.................................20ABELCET..................................13ABILIFY MAINTENA................. 19abiraterone acetate................... 14ABRAXANE.............................. 14acamprosate calcium.................. 7acarbose................................... 30acebutolol hcl............................ 23acetaminophen-codeine..............4acetaminophen-codeine #2.........4acetaminophen-codeine #3.........4acetaminophen-codeine #4.........4acetazolamide...........................48acetazolamide er.......................48acetazolamide sodium.............. 23acetic acid........................... 37, 49acetylcysteine..................... 46, 50acitretin..................................... 28ACTEMRA................................ 43ACTEMRA ACTPEN.................43ACTHAR................................... 38ACTHIB.....................................44ACTIMMUNE............................ 43acyclovir.................................... 20acyclovir sodium....................... 20ADACEL....................................44ADAKVEO.................................46adapalene................................. 28adapalene-benzoyl peroxide.....28adc/f (0.5mg/ml)........................ 32ADCETRIS................................14ADDERALL XR......................... 26adefovir dipivoxil ....................... 20ADEMPAS................................ 51adenosine................................. 23adriamycin.................................14ADVAIR DISKUS...................... 50ADVAIR HFA............................ 50ADVATE....................................22ADYNOVATE............................22AFINITOR................................. 14AFINITOR DISPERZ.................14afirmelle.................................... 39AFLURIA QUADRIVALENT......44AFSTYLA.................................. 22airavite...................................... 32ak-poly-bac............................... 48ala-cort...................................... 28ALANINE...................................32albendazole...............................18

ALBUKED 25............................ 46ALBUKED 5.............................. 46albumin human......................... 46albumin-zlb................................46alburx........................................ 46ALBUTEIN................................ 46albuterol sulfate.........................50albuterol sulfate hfa...................50ALBUTEROL SULFATE HFA... 50alclometasone dipropionate...... 28ALECENSA...............................14alendronate sodium.................. 46alfuzosin hcl er.......................... 37ALIMTA..................................... 14ALINIA.......................................18ALIQOPA.................................. 14allopurinol..................................14allopurinol sodium..................... 14almotriptan malate.................... 14alosetron hcl..............................35ALPHANATE/VWF COMPLEX/HUMAN.................. 22ALPHANINE SD........................22alprazolam................................ 22alprazolam er............................ 22alprazolam intensol................... 22alprazolam xr............................ 22ALPROLIX................................ 22alprostadil ..................................23ALTACAINE.............................. 48altafrin....................................... 48altavera..................................... 39ALTRENO................................. 28ALUMINUM CHLORIDE ANHYDROUS........................... 28ALUMINUM CHLORIDE HEXAHYDRATE....................... 28ALUNBRIG................................14alyacen 1/35..............................39alyacen 7/7/7.............................39alyq........................................... 51amabelz.................................... 39amantadine hcl..........................19AMBISOME...............................13ambrisentan.............................. 51amcinonide................................28amethia..................................... 39amethia lo................................. 39amethyst................................... 39amikacin sulfate.......................... 7amiloride hcl..............................23amiloride-hydrochlorothiazide... 23aminocaproic acid..................... 22

amiodarone hcl......................... 23amitriptyline hcl......................... 12amlodipine besylate.................. 23amlodipine besylate-benazepril hcl............................................. 23amlodipine besylate-valsartan.. 23amlodipine-olmesartan..............23amlodipine-valsartan-hctz......... 23ammonium lactate.....................28amnesteem............................... 28amoxapine................................ 12amoxicill-clarithro-lansopraz..... 35amoxicillin................................... 7amoxicillin-potassium clavulanate..................................7amoxicillin-potassium clavulanate er..............................7amphetamine sulfate.................26amphetamine-dextroamphetamine.................. 26amphotericin b.......................... 13ampicillin..................................... 7ampicillin sodium.........................7ampicillin-sulbactam sodium....... 7anagrelide hcl............................22ANASPAZ................................. 35anastrozole............................... 14ANDRODERM.......................... 38ANORO ELLIPTA..................... 50APOKYN................................... 19apraclonidine hcl....................... 48aprepitant.................................. 12apri............................................ 39APRISO.................................... 45APTIVUS...................................20ARAKODA................................ 18ARALAST NP............................50aranelle..................................... 39ARANESP (ALBUMIN FREE)...22ARCALYST............................... 43argyle sterile saline................... 32argyle sterile water....................32ARIKAYCE..................................7aripiprazole............................... 19ARISTADA................................ 19ARISTADA INITIO.................... 19armodafinil ................................ 52ARMOUR THYROID.................43ARNUITY ELLIPTA...................50ARRANON................................ 14arsenic trioxide..........................15ARZERRA.................................15ascomp-codeine..........................4

54

ashlyna......................................39ASMANEX (120 METERED DOSES).................................... 50ASMANEX (14 METERED DOSES).................................... 50ASMANEX (30 METERED DOSES).................................... 50ASMANEX (60 METERED DOSES).................................... 50ASMANEX (7 METERED DOSES).................................... 50ASMANEX HFA........................ 50ASPARTAME............................46ASPARTAME (NUTRASWEET)...................... 46aspirin-dipyridamole er..............19ATABEX OB..............................32atazanavir sulfate......................20atenolol..................................... 23atenolol-chlorthalidone..............23atomoxetine hcl.........................26atorvastatin calcium.................. 23atovaquone............................... 18atovaquone-proguanil hcl..........18atropine sulfate................... 35, 48ATROVENT HFA...................... 50AUBAGIO..................................27aubra.........................................39aubra eq....................................39AUGMENTIN.............................. 7aurovela 1.5/30......................... 39aurovela 1/20............................ 39aurovela 24 fe........................... 39aurovela fe 1.5/30..................... 39aurovela fe 1/20........................ 39AUSTEDO.................................27AUVI-Q......................................50AVASTIN...................................15aviane....................................... 39avidoxy........................................7AVONEX PEN...........................27AVONEX PREFILLED.............. 27ayuna........................................ 39azacitidine................................. 15AZASAN....................................43azathioprine.............................. 43azathioprine sodium..................43azelaic acid............................... 28azelastine hcl...................... 47, 49azelastine-fluticasone............... 49azithromycin................................7aztreonam................................... 7azurette..................................... 39

bacitracin...................................47bacitracin-polymyxin b.............. 48bacitra-neomycin-polymyxin-hc 48baclofen.................................... 52balsalazide disodium.................45BALVERSA............................... 15balziva.......................................40BANZEL.................................... 10BARACLUDE............................ 20BCG VACCINE......................... 44BD AUTOSHIELD DUO PEN NEEDLES................................. 32BD ULTRA-FINE INSULIN SYRINGES............................... 32BD ULTRA-FINE PEN NEEDLES................................. 32BD VEO INSULIN SYR U/F 1/2UNIT.....................................32bekyree..................................... 40BELEODAQ.............................. 15BELRAPZO...............................15benazepril hcl............................23benazepril-hydrochlorothiazide. 23BENDAMUSTINE HCL............. 15BENDEKA.................................15BENEFIX...................................22BENLYSTA............................... 43BENZNIDAZOLE...................... 18benzonatate.............................. 49benzoyl peroxide-erythromycin. 28benzphetamine hcl....................27benztropine mesylate................19BERINERT................................43beser......................................... 28betamethasone dipropionate.... 29betamethasone dipropionate aug...................................... 28, 29betamethasone valerate........... 29BETASERON............................27betaxolol hcl........................ 23, 48bethanechol chloride.................37BETHKIS...................................51bexarotene................................ 15BEXSERO.................................44bicalutamide..............................15BICILLIN L-A...............................7BIKTARVY................................ 20bimatoprost............................... 48BIO-STATIN..............................13bisoprolol fumarate................... 23bisoprolol-hydrochlorothiazide.. 23BIVIGAM................................... 43bleomycin sulfate...................... 15

BLINCYTO................................ 15blisovi 24 fe............................... 40blisovi fe 1.5/30......................... 40blisovi fe 1/20............................ 40BOOSTRIX............................... 44BORTEZOMIB.......................... 15bosentan................................... 51BOSULIF...................................15BOTOX..................................... 46bp vit 3...................................... 32BRAFTOVI................................ 15BREATHE EASE LARGE......... 46BREATHE EASE MEDIUM.......46BREATHE EASE SMALL..........46BREATHERITE.........................46BREO ELLIPTA........................ 50briellyn.......................................40BRILINTA..................................19brimonidine tartrate................... 48BRIVIACT................................. 10BROMELAIN.............................46bromfed dm...............................49bromfenac sodium (once-daily).47bromocriptine mesylate.............19BROVANA................................ 50budesonide......................... 45, 50budesonide er........................... 45bumetanide............................... 23bupivacaine fisiopharma............. 6bupivacaine hcl........................... 6bupivacaine hcl (pf).....................6bupivacaine-epinephrine.............6bupivacaine-epinephrine (pf)...... 6buprenorphine.............................4buprenorphine hcl................... 4, 7buprenorphine hcl-naloxone hcl............................................... 7bupropion hcl............................ 12bupropion hcl er (smoking det)... 7bupropion hcl er (sr)..................12bupropion hcl er (xl).................. 12buspirone hcl.............................22busulfan.................................... 15butalbital-acetaminophen............4butalbital-apap-caff-cod.............. 4butalbital-apap-caffeine...............4butalbital-asa-caff-codeine..........4butalbital-aspirin-caffeine............ 4butorphanol tartrate.....................4BUTRANS...................................4BYDUREON..............................30BYDUREON BCISE AUTOINJECTOR...................... 30

55

cabergoline............................... 38CABLIVI.................................... 19CABOMETYX........................... 15caffeine citrate...........................27CALAMINE................................29calcipotriene..............................29calcitonin (salmon).................... 46calcitriol............................... 29, 46calcium acetate......................... 37calcium acetate (phos binder)...37CALCIUM CHLORIDE DIHYDRATE............................. 32CALCIUM GLUCONATE.......... 32CALCIUM GLUCONATE ANHYDROUS........................... 32CALCIUM GLUCONATE MONOHYDRATE......................32CALCIUM LACTATE PENTAHYDRATE.....................32CALCIUM PHOSPHATE DIBASIC....................................32CALCIUM PHOSPHATE TRIBASIC................................. 32CALQUENCE............................15camila........................................40CAMPATH................................ 15CAMPTOSAR........................... 15camrese.................................... 40camrese lo................................ 40candesartan cilexetil ................. 23candesartan cilexetil-hctz..........23CAPASTAT SULFATE..............14capecitabine..............................15CAPRELSA...............................15captopril .................................... 23captopril-hydrochlorothiazide.... 24CARBAGLU.............................. 32carbamazepine......................... 10carbamazepine er..................... 10carbidopa.................................. 19carbidopa-levodopa.................. 19carbidopa-levodopa er.............. 19carbidopa-levodopa-entacapone............................... 19carbinoxamine maleate.............49carboplatin................................ 15CARIMUNE NF......................... 43carisoprodol.............................. 52carisoprodol-aspirin-codeine.......5carmustine................................ 15carteolol hcl...............................48cartia xt..................................... 24carvedilol...................................24

carvedilol phosphate er.............24caspofungin acetate..................13cavarest.................................... 27CAYSTON.................................51caziant.......................................40cefaclor....................................... 7cefaclor er................................... 7cefadroxil .....................................7cefazolin sodium......................... 7CEFAZOLIN SODIUM................ 7cefazolin sodium-dextrose.......... 7cefdinir........................................ 7cefepime hcl................................7cefepime-dextrose...................... 7cefixime.......................................7cefotaxime sodium...................... 8cefoxitin sodium.......................... 8cefpodoxime proxetil ................... 8cefprozil .......................................8ceftazidime..................................8ceftazidime and dextrose............ 8ceftriaxone sodium......................8ceftriaxone sodium in dextrose... 8ceftriaxone sodium-dextrose.......8cefuroxime axetil ......................... 8cefuroxime sodium......................8celecoxib..................................... 4CELLCEPT............................... 43CELONTIN................................10cephalexin...................................8CEQUR SIMPLICITY 2U.......... 31CEQUR SIMPLICITY INSERTER................................31CEQUR SIMPLICITY STARTER................................. 31CERDELGA.............................. 36CEREZYME.............................. 36cetirizine hcl.............................. 49CETROTIDE............................. 38CETYLCIDE-G..........................46cevimeline hcl........................... 27CHARCOAL ACTIVATED.........46charlotte 24 fe........................... 40chateal...................................... 40chateal eq................................. 40chlordiazepoxide hcl................. 22chlordiazepoxide-amitriptyline...12chlorhexidine gluconate............ 27CHLORHEXIDINE GLUCONATE............................46chloroquine phosphate..............18chlorothiazide sodium............... 24chlorpromazine hcl....................19

chlorthalidone............................24chlorzoxazone...........................52CHOLBAM................................ 36cholestyramine..........................24cholestyramine light.................. 24CHOLINE BITARTRATE...........33chorionic gonadotropin..............38ciclodan.....................................13ciclopirox................................... 13ciclopirox olamine..................... 13cidofovir.....................................20cilostazol................................... 19CIMDUO................................... 20cimetidine..................................35cimetidine hcl............................ 35CIMZIA PREFILLED KIT...........43CIMZIA STARTER KIT............. 43cinacalcet hcl............................ 46CINQAIR................................... 49CINRYZE.................................. 43CINVANTI................................. 12CIPRO.........................................8ciprofloxacin hcl.............. 8, 47, 49ciprofloxacin in d5w.....................8cisplatin..................................... 15citalopram hydrobromide.......... 12cladribine...................................15claravis......................................29clarithromycin..............................8clarithromycin er..........................8CLEVER CHOICE HOLDING CHAMBER................................ 46CLIMARA PRO......................... 40clindacin etz.............................. 29clindacin-p.................................29clindamycin hcl............................8clindamycin palmitate hcl............ 8clindamycin phosphate......... 8, 29clindamycin phosphate in d5w.... 8CLINDAMYCIN PHOSPHATE IN NACL......................................8clindamycin phosphate-benzoyl peroxide.......................29clindamycin-tretinoin................. 29CLINPRO 5000......................... 27clobazam...................................10clobetasol prop emollient base. 29clobetasol propionate................29clobetasol propionate e.............29clobetasol propionate emulsion 29clocortolone pivalate................. 29clodan....................................... 29clofarabine................................ 15

56

clomiphene citrate.....................38clomipramine hcl....................... 12clonazepam...............................22clonidine....................................24clonidine hcl.............................. 24clonidine hcl er.......................... 27clopidogrel bisulfate.................. 19clorazepate dipotassium........... 22clotrimazole...............................13clotrimazole 3............................13clotrimazole-betamethasone.....13clovique.....................................33clozapine...................................19COAGADEX..............................22COARTEM................................ 18codeine sulfate............................5colchicine-probenecid............... 14COLCRYS.................................14colestipol hcl............................. 24colistimethate sodium (cba)........ 8COMBIVENT RESPIMAT......... 50COMETRIQ (100 MG DAILY DOSE).......................................15COMETRIQ (140 MG DAILY DOSE).......................................15COMETRIQ (60 MG DAILY DOSE).......................................15COMPACT SPACE CHAMBER/LG MASK............... 46COMPACT SPACE CHAMBER/MED MASK............46COMPACT SPACE CHAMBER/SM MASK.............. 46COMPLERA..............................20compro...................................... 12constulose.................................35COPIKTRA................................15CORIFACT................................22COTELLIC................................ 15CREON..................................... 36CRESEMBA..............................13CRIXIVAN................................. 20cromolyn sodium...........36, 47, 51cryselle-28.................................40CRYSVITA................................ 36curity sterile saline.................... 33CUVITRU.................................. 43cvs clotrimazole 3..................... 13cyanocobalamin........................ 33CYANOCOBALAMIN................ 33cyclafem 1/35............................40cyclafem 7/7/7...........................40cyclobenzaprine hcl.................. 52

cyclopentolate hcl..................... 48cyclophosphamide.................... 15cyclosporine.............................. 43cyclosporine modified............... 43cyproheptadine hcl....................49CYRAMZA................................ 15cyred......................................... 40cyred eq.................................... 40CYSTAGON..............................36CYSTARAN.............................. 48cytarabine................................. 15cytarabine (pf)........................... 15CYTOGAM................................43dacarbazine.............................. 15dactinomycin............................. 15dalfampridine er........................ 27DALIRESP................................ 51danazol..................................... 38dantrolene sodium.................... 52dapsone.................................... 14DAPTACEL............................... 44daptomycin..................................8DARAPRIM............................... 19darifenacin hydrobromide er..... 37DARZALEX............................... 15dasetta 1/35.............................. 40dasetta 7/7/7............................. 40daunorubicin hcl........................15DAURISMO...............................15daysee...................................... 40deblitane................................... 40decitabine..................................15deferasirox................................ 33deferoxamine mesylate.............46DELSTRIGO............................. 20delyla.........................................40demeclocycline hcl......................8DENTA 5000 PLUS.................. 27DENTAGEL...............................28DEPEN TITRATABS.................37DEPO-MEDROL....................... 37DEPO-PROVERA..................... 40desipramine hcl.........................12desloratadine............................ 49desmopressin ace spray refrig..38desmopressin acetate...............38desmopressin acetate spray..... 38desogestrel-ethinyl estradiol..... 40desonide................................... 29desoximetasone........................29desvenlafaxine succinate er......12dexamethasone.................. 37, 38DEXAMETHASONE (LA)..........37

dexamethasone sod phosphate pf............................. 38dexamethasone sodium phosphate........................... 38, 47DEXMEDETOMIDINE HCL...... 47dexmedetomidine hcl................ 47dexmedetomidine hcl in nacl.....47dexmethylphenidate hcl............ 27dexmethylphenidate hcl er........ 27dexrazoxane hcl........................15dextroamphetamine sulfate.......27dextroamphetamine sulfate er.. 27dextrose in lactated ringers.......33dextrose-nacl............................ 33dextrose-sodium chloride..........33DIACOMIT................................ 10diazepam............................ 10, 22diazepam intensol..................... 22diazoxide...................................31diclofenac potassium.................. 4diclofenac sodium................. 4, 47diclofenac sodium er................... 4diclofenac-misoprostol................ 4dicloxacillin sodium..................... 8dicyclomine hcl..........................36didanosine.................................20diethylpropion hcl...................... 27diethylpropion hcl er..................27DIFICID....................................... 8diflunisal...................................... 4digitek........................................24digox......................................... 24digoxin.......................................24dihydroergotamine mesylate.....14diltiazem hcl.............................. 24diltiazem hcl er.......................... 24diltiazem hcl er beads............... 24diltiazem hcl er coated beads... 24DILTIAZEM HCL-DEXTROSE.. 24dilt-xr......................................... 24diphenhydramine hcl.................49diphenoxylate-atropine..............36DIPHTHERIA-TETANUS TOXOIDS DT............................ 44dipyridamole..............................19disopyramide phosphate...........24disulfiram.....................................7divalproex sodium..................... 11divalproex sodium er.................11DIVIGEL....................................40DL-ALANINE.............................33DL-LEUCINE.............................33DL-PHENYLALANINE.............. 33

57

dobutamine hcl..........................24dobutamine in d5w....................24docetaxel...................................15dofetilide....................................24donepezil hcl............................. 11dopamine hcl.............................24DOPTELET............................... 22DORZOLAMIDE HCL............... 48dorzolamide hcl.........................48dorzolamide hcl-timolol mal...... 48dorzolamide hcl-timolol mal pf.. 48dotti ........................................... 40DOVATO...................................20doxazosin mesylate.................. 24doxepin hcl..........................12, 52doxercalciferol...........................46doxorubicin hcl.......................... 15doxorubicin hcl liposomal..........15doxy 100..................................... 8doxycycline hyclate..................... 8doxycycline monohydrate........... 8dronabinol................................. 12DROPLET MICRON................. 32drospiren-eth estrad-levomefol. 40drospirenone-ethinyl estradiol...40DROXIA.................................... 15DRYSOL................................... 29duloxetine hcl............................ 12DUPIXENT................................29DUROLANE.............................. 47dutasteride................................ 37dutasteride-tamsulosin hcl........ 37DYSPORT.................................47EASIVENT................................ 47econazole nitrate.......................13ED-SPAZ.................................. 36EDURANT.................................20efavirenz................................... 20efavirenz-emtricitab-tenofovir....20EFFER-K...................................33effer-k........................................33EGRIFTA SV.............................38ELAPRASE............................... 36ELELYSO..................................36eletriptan hydrobromide............ 14ELIGARD.................................. 38elinest........................................40ELIQUIS....................................10ELIQUIS DVT/PE STARTER PACK........................................ 10ELITEK......................................15ELITE-OB..................................33ELLA......................................... 40

ELOCTATE............................... 22eluryng...................................... 40EMFLAZA................................. 14EMGALITY................................14EMGALITY (300 MG DOSE).... 14emoquette................................. 40EMPLICITI................................ 15emtricitabine-tenofovir df...........20EMTRIVA.................................. 20enalapril maleate.......................24enalapril-hydrochlorothiazide.... 24endocet....................................... 5ENGERIX-B.............................. 44ENHERTU.................................15enoxaparin sodium....................10enpresse-28.............................. 40enskyce.....................................40entacapone............................... 19entecavir................................... 20ENTRESTO.............................. 24ENTYVIO.................................. 43enulose..................................... 36EPCLUSA................................. 20EPIDIOLEX............................... 11epinastine hcl............................ 47epinephrine............................... 51EPIPEN 2-PAK......................... 51epirubicin hcl............................. 15epitol......................................... 11EPIVIR HBV..............................20eplerenone................................ 24epoprostenol sodium.................51EQUETRO................................ 22ERBITUX.................................. 15ergocalciferol.............................33ergoloid mesylates.................... 47ergotamine-caffeine.................. 14ERIVEDGE............................... 15ERLEADA................................. 15erlotinib hcl..........................15, 16errin...........................................40ertapenem sodium...................... 8ery............................................. 29erythromycin................... 8, 29, 47erythromycin base.......................8erythromycin ethylsuccinate........8ESBRIET...................................51escitalopram oxalate................. 12estarylla.....................................40estazolam..................................22estradiol.................................... 40estradiol valerate.......................40estradiol-norethindrone acet..... 40

eszopiclone............................... 52ethacrynic acid.......................... 24ethambutol hcl...........................14ethosuximide.............................11ethynodiol diac-eth estradiol..... 40ETHYOL....................................16etodolac...................................... 4etodolac er.................................. 4etonogestrel-ethinyl estradiol.... 40ETOPOPHOS........................... 16etoposide.................................. 16EUCRISA.................................. 29EUFLEXXA............................... 47euthyrox.................................... 43everolimus...........................16, 43EVOTAZ....................................20exemestane.............................. 16EXTAVIA...................................27EYLEA...................................... 48ezetimibe...................................24fabb........................................... 33FABRAZYME............................ 36falmina...................................... 40famciclovir................................. 20famotidine................................. 35famotidine premixed..................35FANAPT....................................19FARXIGA.................................. 30FARYDAK................................. 16FASENRA................................. 49FASENRA PEN.........................49fa-vitamin b-6-vitamin b-12....... 33fayosim......................................40FEIBA........................................22felbamate.................................. 11felodipine er.............................. 24femynor..................................... 40fenofibrate................................. 24fenofibrate micronized...............24fenofibric acid............................24FENSOLVI (6 MONTH).............39fentanyl....................................... 5fentanyl citrate.............................5FIBRYGA.................................. 22finasteride........................... 29, 37FIRDAPSE................................ 47FIRMAGON...............................39FIRMAGON (240 MG DOSE)... 39flac............................................ 49flavoxate hcl.............................. 37FLEBOGAMMA DIF..................43flecainide acetate...................... 24FLEXBUMIN............................. 47

58

floxuridine..................................16FLUAD...................................... 44FLUAD QUADRIVALENT......... 45FLUARIX QUADRIVALENT......45FLUBLOK QUADRIVALENT.....45FLUCELVAX QUADRIVALENT...................... 45fluconazole................................13fluconazole in sodium chloride..13flucytosine................................. 13fludarabine phosphate.............. 16fludrocortisone acetate..............38FLULAVAL QUADRIVALENT... 45flumazenil ..................................47FLUMIST QUADRIVALENT......45flunisolide.................................. 49fluocinolone acetonide........ 29, 49fluocinolone acetonide body..... 29fluocinolone acetonide scalp.....29fluocinonide...............................29fluocinonide emulsified base.....29FLUORIDEX............................. 28FLUORIDEX ENHANCED WHITENING............................. 28FLUORIDEX SENSITIVITY RELIEF..................................... 28fluoritab..................................... 33fluorometholone........................ 47fluorouracil .......................... 16, 30fluoxetine hcl............................. 12fluoxetine hcl (pmdd).................12fluphenazine decanoate............19fluphenazine hcl........................ 19flurazepam hcl...........................52flurbiprofen.................................. 4flurbiprofen sodium................... 47flutamide................................... 16fluticasone propionate.........30, 49FLUTICASONE-SALMETEROL..........................51fluvoxamine maleate................. 12fluvoxamine maleate er.............12FLUZONE HIGH-DOSE QUADRIVALENT...................... 45FLUZONE QUADRIVALENT.... 45FML FORTE..............................47folbee........................................ 33folic acid.................................... 33FOLLISTIM AQ......................... 39FOLOTYN................................. 16folplex 2.2..................................33fondaparinux sodium.................10FORTAZ......................................8

FORTEO................................... 46fosamprenavir calcium.............. 20fosinopril sodium....................... 24fosinopril sodium-hctz............... 24fosphenytoin sodium................. 11FRAGMIN................................. 10fulvestrant................................. 16furosemide................................ 24FUZEON................................... 20fyavolv.......................................40FYCOMPA................................ 11gabapentin................................ 11galantamine hydrobromide....... 11galantamine hydrobromide er... 11GAMASTAN..............................43GAMIFANT............................... 43GAMMAGARD.......................... 43GAMMAGARD S/D LESS IGA..43GAMMAKED............................. 43GAMMAPLEX........................... 43GAMUNEX-C............................ 43GANCICLOVIR......................... 20ganciclovir sodium.................... 20GARDASIL 9.............................45gatifloxacin................................ 47GATTEX....................................36gavilyte-c...................................36gavilyte-g...................................36gavilyte-n with flavor pack.........36GAZYVA................................... 16GELNIQUE............................... 37GELSYN-3................................ 47gemcitabine hcl......................... 16gemfibrozil .................................24generlac.................................... 36gengraf......................................43GENOTROPIN..........................39GENOTROPIN MINIQUICK......39gentak....................................... 47gentamicin in saline.................... 8gentamicin sulfate................. 9, 48GENVOYA................................ 20gianvi.........................................40GILENYA.................................. 27GILOTRIF................................. 16GLASSIA...................................51glatiramer acetate..................... 27glatopa...................................... 27GLEOSTINE............................. 16GLIADEL WAFER.....................16glimepiride.................................30glipizide er.................................30glipizide ir.................................. 30

glipizide xl................................. 30glipizide-metformin hcl.............. 30GLUCAGON EMERGENCY KIT............................................ 31glyburide................................... 31glyburide micronized................. 30glyburide-metformin.................. 31glycopyrrolate............................36glydo........................................... 6granisetron hcl.......................... 12griseofulvin microsize................13griseofulvin ultramicrosize.........13guanfacine hcl...........................24guanfacine hcl er.......................27HAEGARDA..............................43hailey 1.5/30..............................40hailey 24 fe................................40hailey fe 1.5/30..........................40hailey fe 1/20.............................40HALAVEN................................. 16halobetasol propionate..............30haloperidol................................ 20haloperidol decanoate...............20haloperidol lactate.....................20HARVONI..................................21HAVRIX.....................................45heather......................................40hematinic/folic acid....................33HEMLIBRA................................22hemocyte-f................................ 33HEMOFIL M.............................. 22HEPARIN (PORCINE) IN NACL........................................ 10heparin lock flush...................... 47heparin sodium (porcine).......... 10heparin sodium (porcine) pf...... 10heparin sodium lock flush......... 47HEPLISAV-B.............................45HERCEPTIN............................. 16HETLIOZ...................................52HIBERIX....................................45HIZENTRA................................ 43homatropaire.............................48HUMALOG KWIKPEN.............. 32HUMALOG MIX 50/50 KWIKPEN................................. 32HUMALOG MIX 50/50 VIAL......32HUMALOG MIX 75/25 KWIKPEN................................. 32HUMALOG MIX 75/25 VIAL......32HUMALOG U-100 JUNIOR KWIKPEN................................. 32HUMALOG VIAL....................... 32

59

HUMAN ALBUMIN GRIFOLS... 47HUMATE-P............................... 22HUMATROPE........................... 39HUMIRA....................................43HUMIRA PEDIATRIC CROHNS START......................43HUMIRA PEN........................... 43HUMIRA PEN-CD/UC/HS STARTER................................. 44HUMIRA PEN-PS/UV/ADOL HS START................................ 44HUMULIN 70/30 KWIKPEN...... 32HUMULIN 70/30 VIAL...............32HUMULIN N KWIKPEN............ 32HUMULIN N VIAL..................... 32HUMULIN R U-500 KWIKPEN..32HUMULIN R U-500 VIAL.......... 32HUMULIN R VIAL..................... 32HYCAMTIN............................... 16hydralazine hcl.......................... 24hydrochlorothiazide...................24hydrocodone bitartrate er............5hydrocodone polst-chlorphen polst er susp..............................49hydrocodone-acetaminophen..... 5hydrocodone-homatropine........ 49hydrocodone-ibuprofen............... 5hydrocortisone.............. 30, 38, 45hydrocortisone (perianal).......... 45hydrocortisone butyrate............ 30hydrocortisone valerate.............30hydrocortisone-acetic acid........ 49hydromet................................... 49hydromorphone hcl..................... 5hydromorphone hcl er................. 5hydromorphone hcl pf................. 5hydroxocobalamin acetate........ 33hydroxychloroquine sulfate....... 19hydroxyprogesterone caproate. 40hydroxyurea.............................. 16hydroxyzine hcl......................... 22hydroxyzine pamoate................22hyoscyamine sulfate................. 36hyoscyamine sulfate sl..............36hyosyne.....................................36HYPERRHO S/D.......................44HYQVIA.................................... 44ibandronate sodium.................. 46IBRANCE.................................. 16ibu............................................... 4ibuprofen..................................... 4ibuprofen lysine...........................4ibutilide fumarate.......................24

ICLUSIG....................................16idarubicin hcl............................. 16IDELVION................................. 22IDHIFA...................................... 16ifosfamide..................................16ILARIS.......................................44imatinib mesylate...................... 16IMBRUVICA.............................. 16IMFINZI..................................... 16imipenem-cilastatin..................... 9imipramine hcl...........................12imipramine pamoate................. 12imiquimod..................................30IMOVAX RABIES......................45IMPAVIDO................................ 19IMURAN....................................44incassia..................................... 40INCRELEX................................ 39INCRUSE ELLIPTA.................. 51indapamide............................... 24indomethacin...............................4indomethacin er.......................... 4indomethacin sodium.................. 4INFANRIX................................. 45INFLECTRA.............................. 44INLYTA..................................... 16INPEN 100-BLUE-LILLY...........31INPEN 100-BLUE-NOVO..........31INPEN 100-GRAY-LILLY.......... 31INPEN 100-GREY-NOVO.........31INPEN 100-PINK-LILLY............31INPEN 100-PINK-NOVO...........31INSULIN PEN NEEDLES..........32INSULIN SYRINGES................ 32INTELENCE..............................21INTRON A.................................21introvale.................................... 40INVEGA SUSTENNA................20INVEGA TRINZA...................... 20INVIRASE................................. 21IPOL..........................................45ipratropium bromide............ 49, 51ipratropium-albuterol................. 51irbesartan.................................. 24irbesartan-hydrochlorothiazide..24IRESSA.....................................16irinotecan hcl.............................16ISENTRESS..............................21ISENTRESS HD....................... 21isibloom.....................................40isoniazid.................................... 14isosorbide dinitrate....................24isosorbide mononitrate..............24

isosorbide mononitrate er......... 25isotretinoin.................................30isradipine...................................25itraconazole...............................13ivermectin..................................19IXEMPRA KIT........................... 16IXIARO......................................45IXINITY..................................... 22JADENU....................................33JADENU SPRINKLE.................33jaimiess..................................... 40JAKAFI......................................16jantoven.................................... 10JARDIANCE..............................31jasmiel.......................................40jencycla..................................... 41JEVTANA..................................16jinteli ..........................................41jolessa.......................................41juleber....................................... 41JULUCA.................................... 21junel 1.5/30............................... 41junel 1/20.................................. 41junel fe 1.5/30........................... 41junel fe 1/20.............................. 41junel fe 24................................. 41JUXTAPID.................................25JYNARQUE.............................. 33KADCYLA................................. 16kaitlib fe.....................................41KALBITOR................................ 44KALETRA..................................21kalliga........................................41KALYDECO.............................. 51KANUMA...................................36kariva........................................ 41KAZANO................................... 31kcl in dextrose-nacl................... 33kedbumin.................................. 47kelnor 1/35................................ 41kelnor 1/50................................ 41KENALOG.................................38KEPIVANCE............................. 28ketoconazole.............................13ketoprofen................................... 4ketorolac tromethamine........ 4, 48KEVEYIS...................................48KEYTRUDA.............................. 16KINERET.................................. 44KINRIX...................................... 45kionex........................................33KISQALI (200 MG DOSE).........16KISQALI (400 MG DOSE).........16

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KISQALI (600 MG DOSE).........16KISQALI FEMARA (400 MG DOSE).......................................16KISQALI FEMARA (600 MG DOSE).......................................16KISQALI FEMARA(200 MG DOSE).......................................16klor-con..................................... 33klor-con 10................................ 33klor-con m10............................. 33KLOR-CON M15....................... 33klor-con m20............................. 33klor-con sprinkle........................33klor-con/ef................................. 33KOATE......................................22KOATE-DVI...............................22KOGENATE FS........................ 22KORLYM...................................39KOSELUGO..............................16KOVALTRY...............................22K-PHOS-NEUTRAL.................. 33k-prime...................................... 33KRINTAFEL.............................. 19kurvelo...................................... 41KUVAN......................................36KYPROLIS................................ 16labetalol hcl............................... 25lactated ringers......................... 33lactulose....................................36lactulose encephalopathy......... 36L-ALANINE............................... 33lamivudine.................................21lamivudine-zidovudine.............. 21lamotrigine................................ 11lamotrigine er............................ 11lamotrigine starter kit-blue.........11lamotrigine starter kit-green...... 11lamotrigine starter kit-orange.... 11LANCETS................................. 31LANOXIN.................................. 25lansoprazole..............................35lanthanum carbonate................ 37LANTUS SOLOSTAR............... 32LANTUS U-100 VIAL................ 32L-ARGININE............................. 33larin 1.5/30................................ 41larin 1/20................................... 41larin 24 fe.................................. 41larin fe 1.5/30............................ 41larin fe 1/20............................... 41larissia.......................................41LARTRUVO.............................. 16latanoprost................................ 48

LATUDA....................................20layolis fe.................................... 41L-CYSTINE............................... 33leena......................................... 41leflunomide................................44LEMTRADA.............................. 27LENVIMA (10 MG DAILY DOSE).......................................16LENVIMA (12 MG DAILY DOSE).......................................16LENVIMA (14 MG DAILY DOSE).......................................16LENVIMA (18 MG DAILY DOSE).......................................16LENVIMA (20 MG DAILY DOSE).......................................16LENVIMA (24 MG DAILY DOSE).......................................17LENVIMA (4 MG DAILY DOSE).......................................17LENVIMA (8 MG DAILY DOSE).......................................17lessina.......................................41letrozole.................................... 17leucovorin calcium.................... 17LEUKERAN...............................17LEUKINE...................................22leuprolide acetate......................39levetiracetam.............................11levetiracetam er........................ 11levobunolol hcl.......................... 48levocarnitine..............................33levocarnitine sf.......................... 33levocetirizine dihydrochloride....49levofloxacin........................... 9, 48levofloxacin in d5w......................9levonest.....................................41levonorgest-eth est & eth est.... 41levonorgest-eth estrad 91-day.. 41levonorgestrel-ethinyl estrad.....41levonorg-eth estrad triphasic.....41levora 0.15/30 (28)....................41levo-t......................................... 43levothyroxine sodium................ 43levoxyl....................................... 43LEXIVA..................................... 21L-GLUTAMIC ACID...................33L-GLUTAMIC ACID HCL.......... 36L-HISTIDINE MONOHYDROCHLORIDE....... 33LIALDA......................................45lidocaine......................................6lidocaine hcl.......................... 6, 28

LIDOCAINE HCL........................ 6lidocaine hcl (cardiac)................. 6lidocaine hcl (cardiac) pf............. 6lidocaine hcl (pf)..........................6lidocaine hcl urethral/mucosal.....6lidocaine viscous hcl................. 28lidocaine-epinephrine..................6lidocaine-prilocaine..................... 6lillow.......................................... 41lincomycin hcl..............................9lindane...................................... 19linezolid....................................... 9linezolid in sodium chloride......... 9LINZESS................................... 36liothyronine sodium................... 43lisinopril ..................................... 25lisinopril-hydrochlorothiazide.....25lithium........................................22lithium carbonate.......................22lithium carbonate er.................. 22L-LEUCINE............................... 33lojaimiess.................................. 41LONHALA MAGNAIR REFILL KIT............................................ 51LONHALA MAGNAIR STARTER KIT...........................51LONSURF.................................17loperamide hcl...........................36lopinavir-ritonavir.......................21lopreeza.................................... 41lorazepam................................. 22lorazepam intensol....................22LORBRENA.............................. 17lorcet........................................... 5lorcet hd...................................... 5loryna........................................ 41losartan potassium....................25losartan potassium-hctz............ 25lovastatin...................................25low-ogestrel...............................41loxapine succinate.................... 20lo-zumandimine.........................41L-PHENYLALANINE................. 34L-PROLINE............................... 34L-TRYPTOPHAN...................... 34L-TYROSINE............................ 34LUCENTIS................................ 48ludent........................................ 34LUMIGAN..................................48LUMIZYME............................... 36LUPANETA PACK.................... 39LUPRON DEPOT (1-MONTH)..39LUPRON DEPOT (3-MONTH)..39

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LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG..39LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG..39LUPRON DEPOT-PED (1-MONTH)....................................39LUPRON DEPOT-PED (3-MONTH)....................................39lutera......................................... 41L-VALINE.................................. 34LYNPARZA............................... 17LYSODREN.............................. 17lyza............................................41mafenide acetate........................ 9MAGNESIUM CARBONATE.... 34MAGNESIUM CARBONATE HEAVY......................................34magnesium chloride..................34malathion.................................. 19mannitol.................................... 25maprotiline hcl...........................12MARCAINE................................. 6MARCAINE PRESERVATIVE FREE.......................................... 6MARCAINE/EPINEPHRINE PF............................................... 6marlissa.....................................41MARQIBO................................. 17MATULANE.............................. 17matzim la...................................25MAVYRET.................................21MAXICOMFORT SYR 27G X 1/2"............................................32meclizine hcl............................. 12medroxyprogesterone acetate.. 41mefloquine hcl...........................19megestrol acetate..................... 41MEKINIST................................. 17MEKTOVI..................................17melodetta 24 fe......................... 41meloxicam...................................4melphalan................................. 17melphalan hcl............................17memantine hcl...........................11memantine hcl er...................... 11MENACTRA..............................45MENOPUR................................39MENVEO.................................. 45meperidine hcl.............................5meprobamate............................22MEPSEVII................................. 36mercaptopurine......................... 17meropenem.................................9

MEROPENEM-SODIUM CHLORIDE................................. 9mesalamine...............................45mesalamine-cleanser................45mesna....................................... 17MESNEX...................................17metaproterenol sulfate.............. 51metaxalone............................... 52metformin hcl er........................ 31metformin hcl ir ......................... 31methadone hcl............................ 5methadone hcl intensol............... 5methadose.................................. 5methadose sugar-free.................5methazolamide..........................48methenamine hippurate.............. 9methergine................................ 47methimazole..............................43methocarbamol......................... 52methotrexate............................. 44methotrexate (anti-rheumatic)...44methotrexate sodium................ 44methotrexate sodium (pf).......... 44methoxsalen rapid.....................30methscopolamine bromide........36methyldopa............................... 25methyldopa-hydrochlorothiazide...................25methylergonovine maleate........47methylphenidate hcl.................. 27methylphenidate hcl er..............27methylphenidate hcl er (cd).......27methylphenidate hcl er (la)........27methylprednisolone...................38METHYLPREDNISOLONE ACETATE................................. 38methylprednisolone acetate...... 38methylprednisolone sodium succ...........................................38METHYLTESTOSTERONE...... 38methyltestosterone....................38metoclopramide hcl.............12, 13metolazone............................... 25metoprolol succinate er.............25metoprolol tartrate.....................25metoprolol-hydrochlorothiazide.25metronidazole....................... 9, 30metronidazole in nacl.................. 9mexiletine hcl............................ 25mibelas 24 fe.............................41miconazole 3.............................13MICRHOGAM ULTRA-FILTERED PLUS...................... 44

MICROCHAMBER.................... 47microgestin 1.5/30.....................41microgestin 1/20........................41microgestin fe 1.5/30.................41microgestin fe 1/20....................41midodrine hcl.............................25miglitol.......................................31miglustat....................................36mili .............................................41milrinone lactate........................25milrinone lactate in dextrose..... 25mimvey......................................41mineral oil heavy....................... 36MINOCIN.................................... 9minocycline hcl............................9minoxidil .................................... 25mirtazapine............................... 12misoprostol................................35mitomycin..................................17mitoxantrone hcl........................17M-M-R II.................................... 45M-NATAL PLUS........................34modafinil ....................................52moexipril hcl.............................. 25mometasone furoate........... 30, 49mondoxyne nl..............................9monoject flush syringe.............. 34monoject sodium chloride flush.34mono-linyah.............................. 41montelukast sodium.................. 51morgidox..................................... 9morphine sulfate......................... 5MORPHINE SULFATE............... 5morphine sulfate (concentrate)... 5morphine sulfate (pf)................... 5morphine sulfate er..................... 5morphine sulfate er beads.......... 5MOXIFLOXACIN HCL.................9moxifloxacin hcl.....................9, 48moxifloxacin hcl (2x day)...........48moxifloxacin hcl in nacl............... 9MOZOBIL..................................22multi prenatal............................ 34multivitamin/fluoride.................. 34multi-vitamin/fluoride................. 34multivitamins/fluoride................ 34mupirocin.................................... 9mutamycin.................................17mvc-fluoride.............................. 34MYALEPT................................. 36mycophenolate mofetil .............. 44mycophenolate mofetil hcl........ 44mycophenolate sodium............. 44

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MYFORTIC............................... 44MYLERAN.................................17MYOBLOC................................ 47myorisan................................... 30na ferric gluc cplx in sucrose.....34nabumetone................................ 4nafcillin sodium........................... 9NAFCILLIN SODIUM IN DEXTROSE................................ 9nafrinse..................................... 34nafrinse drops........................... 34naftifine hcl................................13NAGLAZYME............................36nalbuphine hcl.............................5naloxone hcl................................7naltrexone hcl..............................7naproxen..................................... 4naproxen dr.................................4naproxen sodium........................ 4naratriptan hcl........................... 14NARCAN.....................................7NATACYN.................................48nateglinide.................................31NATPARA................................. 46NATURE-THROID.................... 43NAVELBINE..............................17NEBUPENT.............................. 19nebusal..................................... 50necon 0.5/35 (28)......................41nefazodone hcl..........................12neomycin sulfate......................... 9neomycin-bacitracin zn-polymyx.....................................48neomycin-polymyxin b gu........... 9neomycin-polymyxin-dexameth............................................ 48, 49neomycin-polymyxin-gramicidin..................................49neomycin-polymyxin-hc............ 49NEONATAL PLUS.................... 34neo-polycin................................49neo-polycin hc...........................49NEORAL................................... 44NERLYNX................................. 17NESINA.....................................31NESTABS................................. 34neuac........................................ 30NEULASTA............................... 22NEULASTA ONPRO.................22nevirapine................................. 21nevirapine er............................. 21NEXAVAR.................................17niacin er (antihyperlipidemic).... 25

nicardipine hcl........................... 25NICARDIPINE HCL IN NACL... 25nifedipine...................................25nifedipine er.............................. 25nifedipine er osmotic release.... 25nikki...........................................41nilutamide..................................17nimodipine.................................25NINLARO.................................. 17NIPENT.....................................17nisoldipine er.............................25NITRO-DUR..............................25nitrofurantoin macrocrystal..........9nitrofurantoin monohydrate macrocrystals..............................9nitroglycerin...............................25NITYR....................................... 36nizatidine...................................35NOCDURNA............................. 39nora-be......................................41norethin ace-eth estrad-fe...41, 42norethindrone............................42norethindrone acetate............... 42norethindrone acet-ethinyl est...42norethindrone-eth estradiol....... 42norethin-eth estradiol-fe............ 42norgestimate-eth estradiol........ 42norgestimate-ethinyl estradiol triphasic.....................................42norlyda...................................... 42norlyroc..................................... 42normal saline flush.................... 34NORTHERA..............................25nortrel 0.5/35 (28)..................... 42nortrel 1/35 (21)........................ 42nortrel 1/35 (28)........................ 42nortrel 7/7/7...............................42nortriptyline hcl..........................12NORVIR.................................... 21novarel...................................... 39NOVAREL.................................39NOVOEIGHT............................ 22NOVOFINE AUTOCOVER PEN NEEDLE........................... 32NOVOFINE PEN NEEDLE....... 32NOVOFINE PLUS PEN NEEDLE....................................32NOVOPEN ECHO.....................31NOVOSEVEN RT..................... 23NOVOTWIST PEN NEEDLE.... 32np thyroid.................................. 43NPLATE.................................... 23NUCALA................................... 50

nufol.......................................... 34NULEV...................................... 36NULOJIX...................................44NUWIQ......................................23nyamyc......................................13nystatin......................................13nystatin-triamcinolone............... 13nystop....................................... 13OBIZUR.................................... 23OCALIVA.................................. 36ocella.........................................42OCREVUS................................ 27OCTAGAM................................44octreotide acetate..................... 39ODEFSEY.................................21ODOMZO..................................17OFEV........................................ 51ofloxacin..........................9, 48, 49olanzapine.................................20olanzapine-fluoxetine hcl.......... 12olmesartan medoxomil..............25olmesartan medoxomil-hctz...... 25olmesartan-amlodipine-hctz......25olopatadine hcl....................48, 50omega-3-acid ethyl esters.........25omeprazole............................... 35ondansetron hcl........................ 13ondansetron odt........................ 13ONE VITE WOMENS PLUS..... 34ONETOUCH ULTRA.................31ONETOUCH ULTRA 2 KIT W/DEVICE................................ 31ONETOUCH ULTRA MINI KIT W/DEVICE................................ 31ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE..........31ONETOUCH VERIO IQ SYSTEM................................... 31ONETOUCH VERIO KIT W/DEVICE................................ 31ONETOUCH VERIO REFLECT..................................31ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE..........31ONIVYDE..................................17OPDIVO.................................... 17OPSUMIT..................................51oralone...................................... 28ORENCIA..................................44ORENCIA CLICKJECT............. 44ORENITRAM............................ 51ORFADIN..................................36ORKAMBI................................. 51

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orphenadrine citrate.................. 52orphenadrine citrate er..............52orsythia..................................... 42oscimin......................................36oseltamivir phosphate............... 21OSENI.......................................31OSMITROL............................... 25OTEZLA.................................... 44OVIDREL.................................. 39oxacillin sodium...........................9oxaliplatin.................................. 17oxandrolone.............................. 38oxaprozin.................................... 4oxazepam................................. 22oxcarbazepine...........................11OXERVATE.............................. 49oxybutynin chloride................... 37oxybutynin chloride er............... 37oxycodone hcl............................. 5OXYCODONE HCL ER.............. 5oxycodone-acetaminophen.........5oxycodone-aspirin.......................5oxymorphone hcl.........................6oxymorphone hcl er.................... 6oxytocin.....................................39OZEMPIC..................................31OZURDEX................................ 48paclitaxel................................... 17PADCEV................................... 17paliperidone er.......................... 20palonosetron hcl........................13PALYNZIQ................................ 36pamidronate disodium...............46PANHEMATIN.......................... 23PANRETIN................................17pantoprazole sodium.................35paraplatin.................................. 17paricalcitol................................. 46paroex....................................... 28paromomycin sulfate...................9paroxetine hcl............................12paroxetine hcl er....................... 12paroxetine mesylate..................12PASER......................................14PEDIARIX................................. 45PEDVAX HIB............................ 45peg 3350-kcl-na bicarb-nacl......36peg-3350/electrolytes................36PEGASYS.................................21PEGASYS PROCLICK............. 21PEGINTRON.............................21penicillamine............................. 37penicillin g potassium..................9

penicillin v potassium.................. 9PENTACEL............................... 45pentazocine-naloxone hcl........... 6pentoxifylline er......................... 25perindopril erbumine................. 25periogard...................................28PERJETA..................................17permethrin.................................19perphenazine............................ 13phenazo.................................... 37phenazopyridine hcl.................. 37phendimetrazine tartrate........... 27phendimetrazine tartrate er.......27phenelzine sulfate..................... 12phenobarbital............................ 11phenoxybenzamine hcl............. 25phentermine hcl........................ 27phenylephrine hcl................25, 49PHENYLEPHRINE HCL........... 25PHENYLEPHRINE HCL-NACL.26phenytoin.................................. 11phenytoin infatabs.....................11phenytoin sodium......................11phenytoin sodium extended...... 11philith.........................................42PHOSPHA 250 NEUTRAL........34phosphorous............................. 34phospho-trin 250 neutral........... 34PIFELTRO................................ 21pilocarpine hcl..................... 28, 48pimecrolimus.............................30pimozide....................................20pimtrea...................................... 42pindolol......................................26pioglitazone hcl......................... 31pioglitazone hcl-glimepiride.......31pioglitazone hcl-metformin hcl.. 31piperacillin sod-tazobactam so....9PIQRAY (200 MG DAILY DOSE).......................................17PIQRAY (250 MG DAILY DOSE).......................................17PIQRAY (300 MG DAILY DOSE).......................................17pirmella 1/35............................. 42pirmella 7/7/7............................ 42piroxicam.....................................4PLAQUENIL..............................19PLASBUMIN-25........................ 47PLASBUMIN-5.......................... 47PNEUMOVAX 23...................... 45pnv prenatal plus multivit+dha.. 34POCKET SPACER................... 47

podofilox....................................30POLIVY..................................... 17polocaine-mpf............................. 6polycin.......................................49polymyxin b-trimethoprim..........49POMALYST.............................. 17portia-28....................................42PORTRAZZA............................ 17potassium acetate.....................34potassium bicarbonate..............34potassium chloride.................... 34potassium chloride crys er........ 34potassium chloride er................34potassium citrate er...................34POTELIGEO............................. 17PRADAXA.................................10PRALUENT...............................26pramipexole dihydrochloride..... 19pramipexole dihydrochloride er.19prasugrel hcl............................. 19pravastatin sodium....................26praziquantel.............................. 19prazosin hcl...............................26prednicarbate............................ 30prednisolone............................. 38prednisolone acetate.................48prednisolone sodium phosphate........................... 38, 48prednisone................................ 38prednisone intensol...................38pregabalin................................. 27pregnyl...................................... 39PREMARIN............................... 42PREMPHASE........................... 42PREMPRO................................42PRENATA................................. 34prenatal..................................... 34prenatal plus iron...................... 34prevalite.................................... 26PREVIDENT............................. 28PREVIDENT 5000 BOOSTER PLUS.........................................28PREVIDENT 5000 DRY MOUTH.....................................28PREVIDENT 5000 ENAMEL PROTECT.................................28PREVIDENT 5000 ORTHO DEFENSE................................. 28PREVIDENT 5000 PLUS.......... 28PREVIDENT 5000 SENSITIVE.28previfem.................................... 42PREVNAR 13............................45PREVYMIS............................... 21

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PREZCOBIX............................. 21PREZISTA................................ 21PRIFTIN.................................... 14primaquine phosphate.............. 19primidone.................................. 11PRIVIGEN.................................44PRO COMFORT SPACER ADULT...................................... 47PRO COMFORT SPACER CHILD....................................... 47PRO COMFORT SPACER INFANT..................................... 47probenecid................................ 14procainamide hcl.......................26PROCARE SPACER/ADULT MASK........................................47PROCARE SPACER/CHILD MASK........................................47prochlorperazine....................... 13prochlorperazine edisylate........ 13prochlorperazine maleate......... 13procto-med hc........................... 45procto-pak................................. 45proctosol hc...............................45proctozone-hc........................... 45PROCYSBI............................... 36PROFILNINE............................ 23PROFILNINE SD...................... 23progesterone.............................42progesterone micronized.......... 42PROGLYCEM........................... 31PROGRAF................................ 44PROLASTIN-C..........................51PROLEUKIN............................. 17PROLIA.....................................46PROMACTA..............................23promethazine hcl.......................50promethazine-codeine.............. 50promethazine-dm...................... 50promethazine-phenyleph-codeine..................................... 50promethazine-phenylephrine.... 50promethegan.............................50propafenone hcl........................ 26propafenone hcl er.................... 26propantheline bromide.............. 36proparacaine hcl....................... 49propranolol hcl.......................... 26propranolol hcl er...................... 26propranolol-hctz........................ 26propylthiouracil ..........................43PROQUAD................................45protriptyline hcl..........................12

pseudoephedrine-bromphen-dm............................................. 50pulmosal....................................50PULMOZYME........................... 51PURIXAN.................................. 17pyrazinamide.............................14pyridostigmine bromide.............14pyridostigmine bromide er.........14pyrimethamine.......................... 19QINLOCK..................................17QUADRACEL............................45quetiapine fumarate.................. 20quetiapine fumarate er.............. 20quinapril hcl...............................26quinapril-hydrochlorothiazide.... 26quinidine gluconate er...............26quinidine sulfate........................ 26quinine sulfate...........................19QVAR REDIHALER.................. 51RABAVERT...............................45rabeprazole sodium.................. 35RADICAVA................................27raloxifene hcl.............................38ramipril ...................................... 26ranolazine er............................. 26RAPAMUNE..............................44rasagiline mesylate................... 19RAVICTI....................................36RAYALDEE...............................46REBIF....................................... 27REBIF REBIDOSE....................27REBIF REBIDOSE TITRATION PACK.................... 27REBIF TITRATION PACK.........27REBINYN.................................. 23REBLOZYL............................... 23reclipsen....................................42RECOMBINATE........................23RECOMBIVAX HB.................... 45relexxii .......................................27RELNATE DHA.........................34RENFLEXIS.............................. 44repaglinide................................ 31REPATHA................................. 26REPATHA PUSHTRONEX SYSTEM................................... 26REPATHA SURECLICK........... 26RETACRIT................................ 23RETROVIR............................... 21REVCOVI..................................36REVLIMID................................. 17REYATAZ................................. 21

RHOGAM ULTRA-FILTERED PLUS.........................................44RIASTAP...................................23ribavirin..................................... 21rifabutin..................................... 14rifampin..................................... 14riluzole.......................................27rimantadine hcl..........................21RINVOQ....................................44risedronate sodium................... 46RISPERDAL CONSTA..............20risperidone................................ 20ritonavir..................................... 21RITUXAN.................................. 17RITUXAN HYCELA...................17rivastigmine...............................11rivastigmine tartrate.................. 11rivelsa........................................42RIXUBIS....................................23rizatriptan benzoate.................. 14ropinirole hcl..............................19ropinirole hcl er......................... 19ropivacaine hcl............................ 6rosadan..................................... 30rosuvastatin calcium................. 26ROTARIX.................................. 45ROTATEQ.................................45roweepra................................... 11roweepra xr............................... 11RUBRACA................................ 17RUCONEST..............................44RYDAPT................................... 17ryvent........................................ 50SACCHARIN.............................47saline flush................................ 34saline flush zr............................ 34SAMSCA...................................34SANDIMMUNE......................... 44SCENESSE.............................. 30scopolamine..............................13selegiline hcl............................. 19selenium sulfide........................ 30SELZENTRY.............................21SENSORCAINE..........................6sensorcaine/epinephrine.............6sensorcaine-mpf..................... 6, 7SENSORCAINE-MPF................. 7sensorcaine-mpf/epinephrine......7SENSORCAINE-MPF/EPINEPHRINE................... 7SEREVENT DISKUS................ 51sertraline hcl..............................12setlakin......................................42

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sevelamer carbonate................ 37sevelamer hcl............................37sf............................................... 28sf 5000 plus...............................28SFROWASA............................. 45sharobel.................................... 42SHINGRIX.................................45SIGNIFOR.................................39sildenafil citrate............. 37, 51, 52silodosin.................................... 37SILVADENE................................9silver sulfadiazine........................9simliya....................................... 42simpesse...................................42SIMPONI...................................44simvastatin................................ 26sirolimus....................................44SIRTURO..................................14SKYRIZI (150 MG DOSE).........44sod benz-sod phenylacet.......... 37SODIUM ASCORBATE............ 34sodium bicarbonate...................34sodium chloride...................35, 50sodium chloride (pf).................. 34sodium chloride flush................ 34sodium fluoride....................28, 35sodium fluoride 5000 plus......... 28sodium fluoride 5000 ppm.........28sodium fluoride 5000 sensitive..28sodium phenylbutyrate..............37sodium polystyrene sulfonate... 35sodium thiosulfate..................... 47solifenacin succinate.................37SOLIQUA.................................. 31SOLIRIS....................................23SOLU-CORTEF........................ 38SOMATULINE DEPOT............. 39SOMAVERT..............................39sorine........................................ 26SOTALOL HCL......................... 26sotalol hcl.................................. 26sotalol hcl (af)............................26SOTYLIZE.................................26spinosad....................................19SPIRIVA HANDIHALER............51SPIRIVA RESPIMAT................ 51spironolactone...........................26spironolactone-hctz...................26sprintec 28................................ 42SPRYCEL................................. 17sps............................................ 35sronyx....................................... 42ssd.............................................. 9

STAMARIL................................ 45stavudine...................................21STELARA..................................44sterile water for irrigation...........35STIOLTO RESPIMAT............... 51STIVARGA................................17STRENSIQ................................37streptomycin sulfate.................... 9STRIBILD..................................21STRIVERDI RESPIMAT........... 51SUBLOCADE..............................7subvenite...................................11subvenite starter kit-blue...........11subvenite starter kit-green........ 11subvenite starter kit-orange...... 11SUCRAID..................................37sucralfate.................................. 35sulfacetamide sodium............... 48sulfacetamide sodium (acne).... 30sulfacetamide-prednisolone...... 49sulfadiazine................................. 9sulfamethoxazole-trimethoprim...9sulfasalazine............................. 46sulfatrim pediatric........................9sulindac.......................................4sumatriptan............................... 14sumatriptan succinate............... 14sumatriptan succinate refill ....... 14SUPPRELIN LA........................ 39SUTENT....................................18swabflush saline flush............... 35syeda........................................ 42SYLVANT..................................18SYMBICORT.............................51SYMDEKO................................ 51SYMFI....................................... 21SYMFI LO................................. 21SYMLINPEN 120...................... 31SYMLINPEN 60........................ 31SYMPAZAN.............................. 11SYMPROIC...............................36SYMTUZA.................................21SYNAGIS.................................. 44SYNJARDY...............................31SYNJARDY XR.........................31SYNRIBO..................................18TABLOID...................................18tacrolimus............................30, 44tadalafil ......................................37tadalafil (pah)............................ 52TAFINLAR.................................18TAGRISSO............................... 18TALTZ....................................... 44

TALZENNA............................... 18tamoxifen citrate........................18tamsulosin hcl........................... 37TARGRETIN............................. 18tarina 24 fe................................ 42tarina fe 1/20............................. 42tarina fe 1/20 eq........................ 42TASIGNA.................................. 18TAURINE.................................. 35TAVALISSE.............................. 23tazarotene................................. 30tazicef........................................10TAZICEF................................... 10taztia xt......................................26TDVAX...................................... 45TECENTRIQ............................. 18TEGSEDI.................................. 27telmisartan................................ 26telmisartan-hctz.........................26temazepam............................... 52TEMIXYS.................................. 21TEMODAR................................ 18temozolomide............................18temsirolimus..............................44teniposide..................................18TENIVAC.................................. 45tenofovir disoproxil fumarate.....21terazosin hcl..............................37terbinafine hcl............................13terbutaline sulfate......................51terconazole............................... 13testosterone.............................. 38testosterone cypionate..............38testosterone enanthate............. 38TETANUS-DIPHTHERIA TOXOIDS TD............................ 45tetrabenazine............................ 27tetracaine hcl.............................49tetracycline hcl.......................... 10THALOMID............................... 18theophylline...............................51theophylline er...........................51THIOLA..................................... 37thioridazine hcl.......................... 20thiotepa..................................... 18thiothixene.................................20THREONINE.............................35THROMBATE III ....................... 10THYMOGLOBULIN...................44tiadylt er.................................... 26tiagabine hcl..............................11TIBSOVO.................................. 18TICE BCG................................. 44

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TIGLUTIK..................................27tilia fe.........................................42timolol maleate....................26, 48tinidazole...................................10TIVICAY.................................... 21tizanidine hcl............................. 52tobramycin.......................... 48, 51tobramycin sulfate.....................10tobramycin-dexamethasone......49tolbutamide............................... 31tolcapone.................................. 19tolmetin sodium...........................4tolterodine tartrate.....................37tolterodine tartrate er.................37TOPEX TOPICAL ANESTHETIC........................... 28topiramate................................. 11topiramate er.............................11toposar...................................... 18topotecan hcl.............................18toremifene citrate...................... 18torsemide.................................. 26TOUJEO MAX SOLOSTAR...... 32TOUJEO SOLOSTAR...............32tovet.......................................... 30TRACLEER...............................52tramadol hcl er............................ 6tramadol hcl er (biphasic)............6tramadol hcl ir ............................. 6tramadol-acetaminophen............ 6trandolapril ................................ 26trandolapril-verapamil hcl er......26tranexamic acid.........................23tranylcypromine sulfate............. 12travoprost (bak free)..................48trazodone hcl............................ 12TRECATOR.............................. 14TRELEGY ELLIPTA..................51TRELSTAR MIXJECT...............39TREMFYA.................................44treprostinil ................................. 52tretinoin............................... 18, 30tretinoin microsphere................ 30tretinoin microsphere pump...... 30TRETTEN................................. 23tri femynor................................. 42triamcinolone acetonide 28, 30, 38triamterene-hctz........................ 26triazolam................................... 22TRI-CHLOR.............................. 30triderm.......................................30trientine hcl................................35tri-estarylla................................ 42

trifluoperazine hcl......................20trifluridine.................................. 48trihexyphenidyl hcl.................... 19tri-legest fe................................ 42tri-linyah.................................... 42tri-lo-estarylla............................ 42tri-lo-marzia............................... 42tri-lo-mili .................................... 42tri-lo-sprintec............................. 42trilyte......................................... 36trimethobenzamide hcl..............13trimethoprim.............................. 10tri-mili ........................................ 42trimipramine maleate................ 12TRINATE...................................35tri-previfem................................ 42TRIPTODUR............................. 39TRISENOX................................18tri-sprintec................................. 42TRIUMEQ................................. 21tri-vitamin/fluoride......................35tri-vite/fluoride........................... 35trivora (28).................................42tri-vylibra................................... 42tri-vylibra lo................................42TROGARZO..............................21trospium chloride.......................37trospium chloride er.................. 37TRULICITY............................... 31TRUMENBA..............................45TRUVADA.................................21TRYPTOPHAN......................... 35TUKYSA....................................18tulana........................................ 42TURALIO.................................. 18TWINRIX...................................45TYBOST....................................21tydemy...................................... 42TYKERB....................................18TYMLOS................................... 46TYPHIM VI................................ 45TYSABRI...................................27TYVASO................................... 52TYVASO REFILL...................... 52TYVASO STARTER..................52UCERIS.................................... 46UDAMIN SP.............................. 35unithroid.................................... 43UNITUXIN................................. 18UPTRAVI.................................. 52uretron d/s.................................37urin ds....................................... 37ursodiol..................................... 36

utrona-c.....................................37valacyclovir hcl..........................21VALCHLOR...............................18valganciclovir hcl.......................21VALINE..................................... 35valproate sodium.......................11valproic acid.............................. 11valrubicin...................................18valsartan................................... 26valsartan-hydrochlorothiazide... 26VANCOMYCIN HCL................. 10vancomycin hcl......................... 10vancomycin hcl in dextrose.......10vancomycin hcl in nacl.............. 10vandazole..................................10VANTAS....................................39VAQTA......................................45VARIVAX.................................. 45VAXCHORA..............................45VECTIBIX..................................18VELCADE................................. 18VELETRI................................... 52velivet........................................42VEMLIDY.................................. 21VENCLEXTA.............................18VENCLEXTA STARTING PACK........................................ 18venlafaxine hcl.......................... 12venlafaxine hcl er...................... 12VENTAVIS................................ 52VENTOLIN HFA........................51verapamil hcl.............................26verapamil hcl er.........................26VERSACLOZ............................ 20VERZENIO................................18VICTOZA.................................. 31vienva........................................42vigabatrin.................................. 11vigadrone.................................. 11VIMIZIM.................................... 37VIMPAT.....................................11vinblastine sulfate..................... 18vincristine sulfate...................... 18vinorelbine tartrate.................... 18viorele....................................... 42VIRACEPT................................ 21VIREAD.....................................21virt-gard.....................................35virt-phos 250 neutral................. 35VISTOGARD.............................47VISUDYNE................................49vitamin d (ergocalciferol)...........35vitamins acd-fluoride................. 35

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VITRAKVI..................................18VIVITROL....................................7VIVOTIF.................................... 45VIZIMPRO.................................18volnea....................................... 42VONVENDI............................... 23voriconazole..............................14VOSEVI.....................................21VOTRIENT................................18vp-pnv-dha................................ 35VPRIV....................................... 37VRAYLAR................................. 20vyfemla......................................42vylibra........................................42VYXEOS................................... 18warfarin sodium.........................10water for irrigation, sterile..........35WELCHOL................................ 26wera.......................................... 42westab one................................35WESTHROID............................ 43WILATE.....................................23WP THYROID........................... 43wymzya fe................................. 42XALKORI.................................. 18XARELTO................................. 10XARELTO STARTER PACK.....10XATMEP................................... 44XELJANZ.................................. 44XELJANZ XR............................ 44XEOMIN....................................47XEPI..........................................10XERAC AC................................30XERMELO................................ 36XGEVA......................................46XIAFLEX................................... 47XIGDUO XR..............................31XOFIGO.................................... 18XOFLUZA (40 MG DOSE)........ 21XOFLUZA (80 MG DOSE)........ 21XOLAIR.....................................50XOSPATA................................. 18XTANDI.....................................18xulane....................................... 42XURIDEN..................................37XYNTHA................................... 23XYNTHA SOLOFUSE...............23XYREM..................................... 52YERVOY................................... 18YF-VAX..................................... 45YONDELIS................................18YONSA..................................... 18YUPELRI...................................51

yuvafem.................................... 42zafirlukast..................................51zaleplon.....................................52ZALTRAP..................................18ZANOSAR.................................18zarah......................................... 42ZARXIO.....................................23ZEJULA.....................................18ZELBORAF............................... 18ZEMAIRA.................................. 51zenatane................................... 30ZENPEP....................................37ZEPATIER................................ 21ZEPZELCA............................... 18zidovudine.................................21ziprasidone hcl.......................... 20ziprasidone mesylate................ 20ZITHROMAX.............................10ZOLADEX................................. 39zoledronic acid.......................... 46ZOLINZA...................................18zolmitriptan................................14zolpidem tartrate....................... 52zolpidem tartrate er................... 52zonisamide................................11ZORTRESS.............................. 44ZOSYN......................................10zovia 1/35e (28)........................ 43zumandimine.............................43ZYDELIG...................................18ZYPREXA RELPREVV............. 20ZYTIGA..................................... 18ZYVOX......................................10

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