2016 Drug Formulary - Group Health Cooperative

Transcription

EFFECTIVE
OCTOBER 2016
2016 Drug Formulary
For federal employees and retirees on the Federal Employees Health Benefits Program
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Drug Formulary
INTRODUCTION
What is a formulary?
A formulary is a list of generic, brand, and specialty drugs. It is used by practitioners to identify drugs
that offer the best overall value, considering effectiveness, safety, and cost.
How is the drug formulary developed?
The formulary is developed by the Group Health Pharmacy and Therapeutics (P&T) Committee. The
P&T Committee is composed of physicians from various medical specialties, pharmacists, and a
consumer member. The P&T Committee reviews and selects the most appropriate drugs in each
class for the formulary based on safety, effectiveness, and cost. The P&T Committee meets quarterly
to review new and existing drugs to ensure that the formulary remains responsive to the needs of
members and providers.
How do I search the formulary?
Drugs on the formulary are listed by therapeutic class. An alphabetical index is included at the end of
this document to assist in locating specific drugs.
Drugs are listed by generic name if a generic is available. If there is no generic available, drugs are
listed by the brand name. Drugs are organized by class and drug formulary tier. Drugs administered
in a provider’s office or in a clinic (e.g., drugs given intravenously) may not be listed on the formulary.
For coverage of these drugs, refer to your Benefit Booklet.
How do I use the formulary to understand my drug coverage?
Drug coverage is based on an individual’s contracted benefit. Coverage for a specific drug is subject
to each member’s medical coverage agreement. Please consult your Benefit Booklet or call Customer
Service if you have questions about your drug coverage.
Group Health will only cover FDA-approved drugs used for non-experimental therapies. Most plans
exclude experimental and investigational drugs, over-the-counter drugs, drugs used in the treatment
of sexual dysfunction disorders, drugs for anticipated illnesses while traveling, or drugs used for
cosmetic purposes. Please consult your Benefit Booklet for limitations and exclusions.
Medications not listed in this document are not on the formulary at the time of publication.
The most current information is online at www.ghc.org. Non-formulary drugs are not covered unless
approved by the health plan as a coverage exception. The prescriber must contact Group Health to
determine the medical necessity of the non-formulary medication. An alternative formulary medication
will be recommended when clinically appropriate. If a coverage exception is not approved, the patient
is responsible for the full price of the drug.
Generic drugs are substituted when available and allowed by your prescriber. When a generic
is available, the brand-name drug is generally considered non-formulary and subject to a higher cost
share.
The drug formulary is updated periodically and is subject to change. If a drug will be removed
from the formulary, members who filled the drug in the prior three months will be notified by letter of
the upcoming change. A formulary change notice will also be posted on the member website at least
45 days prior to the effective date.
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What are the methods that Group Health uses to ensure appropriate and
safe use of formulary drugs?
Prior Authorization (PA)
The P&T Committee determines that certain drugs should require prior authorization before they will
be covered. These drugs most often have alternatives on the formulary, safety concerns, or a high
potential for inappropriate use. To request coverage for prior authorization drugs, you or your
prescriber must contact Group Health. Drugs requiring prior authorization are indicated with a “PA”
superscript next to the drug name.
Step Therapy (ST)
Step therapy requires you to try certain preferred drugs before receiving coverage for the drug you
were prescribed. Step therapy is added by the P&T Committee. Step therapy automatically looks at
your prescription history when you fill the drug you were prescribed. If you have tried the preferred
drugs required by step therapy, the drug you were prescribed will automatically be covered. To
request step therapy exceptions, you or your prescriber must contact Group Health. Drugs requiring
step therapy are indicated with a “ST” superscript next to the drug name.
Quantity Limit (QL)
A quantity limit defines how much of a particular drug you can get during a specific time period or the
maximum days supply that you can get at once. The P&T Committee determines if a drug should
have a quantity limit. To request exceptions to quantity limits, your prescriber must contact Group
Health. Drugs with quantity limits are indicated with “QL” superscript next to the drug name.
Drugs Limited to Select Pharmacies
Some drugs are required to be dispensed from a preferred specialty pharmacy vendor. Members with
an out-of-network benefit may use other pharmacies; however, they may pay a higher cost share.
Please consult your Benefit Booklet for limitations and exclusions. Drugs limited to select pharmacies
are listed on the MyGroupHealth Formulary webpage.
Covered Diabetic Supplies
Some diabetic supplies may be covered at a Tier 1 cost share if they are filled as a prescription.
These items are:
x
x
x
Preferred blood glucose strips:
o One Touch Verio
o One Touch Ultra
o Prodigy – prior authorization required
o Breeze 2 – prior authorization required
o Contour Next – prior authorization required
o Freestyle – prior authorization required
Disposable insulin syringes and needles
Lancing devices and lancets
Preferred blood glucose meters are covered only when filled through mail order pharmacy.
Mail Order Pharmacy Service
Mail order is convenient and efficiently utilizes Group Health’s resources. This service works best for
drugs that must be taken on regular basis, such as birth control pills and drugs for high blood
pressure, high cholesterol, or other chronic conditions.
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To begin using mail order, ask your prescriber to send your prescription directly to the Mail Order
Pharmacy. To transfer an existing prescription from a retail pharmacy, contact the Mail Order
Pharmacy.
Address:
Group Health Mail Order Pharmacy
PO Box 34383
Seattle, WA 98124-1383
Phone: 800-245-RXRX (1-800-245-7979)
Fax: 206-901-4443, or toll-free 1-800-350-1683
Specialty Drugs
Specialty drugs are high-cost drugs prescribed by a physician for the treatment of complex
conditions. Some specialty products are dispensed from a preferred specialty pharmacy vendor.
Over-the-Counter (OTC) Drugs
A few plans offer coverage for OTC drugs. For these plans, a list of covered OTC drugs can be found
in Appendix A. You may contact Customer Service at 1-888-901-4636 to find if you have OTC drug
coverage.
Preventative Medications and Preferred Contraceptives
Most plans cover Affordable Care Act (ACA) requirements for preventative care medications and
contraceptives in full. Please consult your Benefit Booklet under “Preventive Services” or call
Customer Service if you have questions about your coverage for these drugs. Covered preventative
drugs are listed on the MyGroupHealth Formulary webpage.
In accordance with the Affordable Care Act (ACA) requirements for preventive services, most Group
Health plans provide full coverage for contraceptives. If your plan offers ACA benefits, all
prescribed FDA approved contraceptive methods from on the Group Health formulary list will be
covered in full when obtained in-network. For plans with out-of-network (OON) benefits,
contraceptives will be subject to the OON cost-share. Covered contraceptives are listed on the
MyGroupHealth Formulary webpage.
How do I get additional information?
Please contact Customer Service at 1-888-901-4636 with any questions or concerns regarding the
information contained in this document.
The most current drug formulary is available at www.ghc.org.
Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
AMEBICIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTINEOPLASTICS, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTIBIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
PROGESTERONE ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32
DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32
GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33
GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35
HEMATOLOGICAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35
HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35
ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36
HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38
ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40
HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41
ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43
ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
45
NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46
NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
54
MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55
GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
57
COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
57
ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
58
RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
59
TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
59
VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
59
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
59
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
59
MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
59
MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60
DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60
MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
65
MISCELLANEOUS AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
66
oxacillin inj 1gm
oxacillin inj 10gm
oxacillin inj 2gm
pen G proc inj 600000
Augmentin Sus ES-600
Augmentin Sus 125/5ML
Augmentin Sus 250/5ML
Augmentin TAB 500MG
Augmentin TAB 875MG
Augmentin XR TAB 12HR
Moxatag TAB 775MG
Pfizerpen-G Inj 20mu
Pfizerpen-G Inj 5mu
Unasyn Inj 1.5gm
Unasyn Inj 15gm
Unasyn Inj 3gm
October 2016
ANTI-INFECTIVES
PENICILLINS
TIER 01
TIER 02
TIER 03
GENERIC
amox/k clav chw 200MG
amox/k clav chw 400MG
amox/k clav sus 200/5ML
amox/k clav TAB 250-125
amox/k clav TAB 500-125
amox/k clav TAB 875MG
amoxicillin chw 125MG
amoxicillin chw 250MG
amoxicillin sus 125/5ML
amoxicillin sus 250MG/5m
amoxicillin CAP 250MG
amoxicillin CAP 500MG
amoxicillin TAB 875MG
ampicillin inj 1gm
ampicillin inj 10gm
ampicillin inj 125MG
ampicillin inj 2gm
ampicillin sus 125/5ML
ampicillin sus 250/5ML
ampicillin CAP 250MG
ampicillin CAP 500MG
dicloxacill CAP 250MG
dicloxacill CAP 500MG
nafcillin inj 1gm
nafcillin inj 10gm
nafcillin inj 2gm
pen G sod inj 5000000
penicilln vk sol 125/5ML
penicilln vk sol 250/5ML
penicilln vk TAB 250MG
penicilln vk TAB 500MG
penicilln GK inj 20mu
penicilln GK inj 5mu
pfizerpen-G inj 5mu
PREFERRED
Bicillin C-R Inj 1200000
Bicillin C-R Inj 900/300
Bicillin L-a Inj 1200000
NON PREFERRED
amox-pot cla TAB ER
amp-sulbacta inj 1.5gm
amp-sulbacta inj 1-0.5gm
amp-sulbacta inj 10-5gm
amp-sulbacta inj 15gm
amp-sulbacta inj 2-1gm
amp-sulbacta inj 3gm
CEPHALOSPORIN
FIRST GENERATION
GENERIC
TIER 01
TIER 03
cefadroxil sus 250/5ML
cefadroxil sus 500/5ML
cefadroxil CAP 500MG
cefadroxil TAB 1gm
cefazolin inj 1gm
cefazolin inj 10gm
cefazolin inj 500MG
cephalexin sus 125/5ML
cephalexin sus 250/5ML
cephalexin CAP 250MG
NON PREFERRED
cefazolin inj 100gm
cefazolin inj 20gm
cefazolin inj 300gm
cephalexin TAB 250MG
cephalexin TAB 500MG
Keflex CAP 250MG
Keflex CAP 500MG
Keflex CAP 750MG
SECOND GENERATION
GENERIC
TIER 01
TIER 02
TIER 03
cefotetan inj 1gm/10ML
cefotetan inj 10G
cefotetan inj 2gm/20ML
cefprozil sus 125/5ML
cefprozil sus 250/5ML
cefprozil TAB 250MG
cefprozil TAB 500MG
cefuroxime inj 1.5gm
cefuroxime inj 7.5gm
cefuroxime inj 750MG
cefuroxime TAB 250MG
cefuroxime TAB 500MG
PREFERRED
Ceftin Sus 125/5ML
Ceftin Sus 250/5ML
NON PREFERRED
cefaclor sus 125/5ML
cefaclor CAP 250MG
cefaclor CAP 500MG
cefaclor ER TAB 500MG
cefoxitin inj 10gm
cefuroxime inj 225gm
Cefotan Inj 1gm/10ML
Cefotan Inj 2gm
Ceftin TAB 250MG
Effective October 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
1
Ceftin TAB 500MG
Zinacef Inj 1.5gm
Zinacef Inj 7.5gm
Zinacef Inj 750MG
THIRD GENERATION
GENERIC
TIER 01
TIER 02
TIER 03
cefdinir sus 125/5ML
cefdinir sus 250/5ML
cefdinir CAP 300MG
cefixime sus 100/5ML
cefixime sus 200/5ML
cefotaxime inj 1gm
cefotaxime inj 10gm
cefotaxime inj 500MG
ceftazidime inj 1gm
ceftazidime inj 2gm
ceftazidime inj 6gm
ceftriaxone inj 1gm
ceftriaxone inj 2gm
ceftriaxone inj 250MG
ceftriaxone inj 500MG
tazicef inj 1gm
tazicef inj 2gm
tazicef inj 6gm
PREFERRED
Suprax CAP 400MG
Suprax Sus 500/5ML
NON PREFERRED
cefditoren TAB 200MG
cefditoren TAB 400MG
cefotaxime inj 2gm
cefpodo prox sus 100/5ML
cefpodo prox sus 50MG/5ML
cefpodoxime TAB 100MG
cefpodoxime TAB 200MG
ceftibuten sus 180/5ML
ceftibuten CAP 400MG
ceftriaxone inj 100gm
Cedax CAP 400MG
Cedax Sus 180/5ML
Claforan Inj 1gm
Claforan Inj 10gm
Claforan Inj 2gm
Claforan Inj 500MG
Fortaz Inj 1gm
Fortaz Inj 2gm
Fortaz Inj 500MG
Fortaz Inj 6gm
Rocephin Inj 1gm
Spectracef TAB 200MG
Spectracef TAB 400MG
Suprax Chw 100MG
Suprax Chw 200MG
Suprax Sus 100/5ML
Suprax Sus 200/5ML
FOURTH GENERATION
NON PREFERRED
TIER 03
cefepime inj 1gm
cefepime inj 2gm
Maxipime Inj 1gm
Maxipime Inj 2gm
MACROLIDES
TIER 01
GENERIC
azithromycin pow 1gm PAK
azithromycin sus 100/5ML
azithromycin sus 200/5ML
azithromycin TAB 250MG
TIER 02
TIER 03
clarithromyc sus 125/5ML
clarithromyc sus 250/5ML
clarithromyc TAB 250MG
clarithromyc TAB 500MG
PREFERRED
E.e.s. Gran Sus 200/5ML
Eryped Sus 200/5ML
Eryped Sus 400/5ML
NON PREFERRED
clarithromyc TAB 500MG ER
e.e.s. 400 TAB 400MG
erythrom ETH TAB 400MG
erythromycin CAP 250MG EC
erythromycin TAB 250MG bs
erythromycin TAB 500MG bs
Biaxin Sus 250/5ML
Biaxin TAB 250MG
Biaxin TAB 500MG
PA
Dificid TAB 200MG
Ery-TAB Tab 250MG EC
Erythrocin TAB 250MG
PCE TAB 333MG EC
PCE TAB 500MG EC
Zithromax Pow 1gm PAK
Zithromax Sus 100/5ML
Zithromax Sus 200/5ML
Zithromax TAB Tri-PAK
Zithromax TAB Z-PAK
Zithromax TAB 250MG
Zithromax TAB 500MG
Zithromax TAB 600MG
Zmax Sus 2gm
TETRACYCLINES
TIER 01
TIER 03
GENERIC
avidoxy TAB 100MG
doxycyc mono CAP 100MG
doxycyc mono CAP 50MG
doxycyc mono TAB 100MG
doxycyc CAP 100MG
doxycyc CAP 50MG
doxycycline CAP 150MG
minocycline CAP 100MG
mondoxyne nl CAP 100MG
NON PREFERRED
demeclocycl TAB 150MG
demeclocycl TAB 300MG
doxycycl HYC CAP 100MG
doxycycl HYC CAP 50MG
doxycycl HYC TAB 100MG
doxycycl HYC TAB 100MG DR
doxycycline sus 25MG/5ML
minocin CAP 75MG
minocycline TAB 100MG
2
PA
minocycline TAB 135MG ER
PA
PA
morgidox CAP 1X100MG
morgidox CAP 1X50MG
morgidox CAP 2X100MG
tetracycline CAP 250MG
tetracycline CAP 500MG
Acticlate TAB 150MG
Acticlate TAB 75MG
Adoxa CAP 150MG
Adoxa PAK 1/ TAB 100MG
Adoxa TAB 100MG
Adoxa TAB 50MG
Adoxa TAB 75MG
Alodox Kit 20MG
Avidoxy DK Kit
Doryx Mpc TAB 120MG
Doryx TAB 200MG
Doryx TAB 50MG
Minocin CAP 100MG
Minocin CAP 50MG
Minocin Kit 100MG
Minocin Kit 50MG
Monodox CAP 100MG
Monodox CAP 75MG
Morgidox Kit 1X100MG
Morgidox Kit 1X50MG
Morgidox Kit 2X100MG
Nicazeldoxy Kit 30
Nicazeldoxy Kit 60
Nutridox Kit
PA
Solodyn TAB 105MG
PA
Solodyn TAB 115MG
PA
Solodyn TAB 55MG
PA
Solodyn TAB 65MG
PA
Solodyn TAB 80MG
Targadox TAB 50MG
Vibramycin CAP 100MG
Vibramycin Sus 25MG/5ML
Vibramycin Syp 50MG/5ML
Cipro TAB 500MG
Cipro XR TAB 1000MG
Cipro XR TAB 500MG
Factive TAB 320MG
Levaquin Sol 25MG/ML
Levaquin TAB 250MG
Levaquin TAB 500MG
Levaquin TAB 750MG
Noroxin TAB 400MG
AMINOGLYCOSIDES
TIER 01
TIER 03
TIER 04
TIER 05
SULFONAMIDES
TIER 03
TIER 02
TIER 03
GENERIC
ciprofloxacn sus 250MG/5
ciprofloxacn sus 500MG/5
ciprofloxacn TAB 100MG
levofloxacin sol 25MG/ML
levofloxacin TAB 250MG
moxifloxacin TAB 400MG
PREFERRED
Cipro (5%) Sus 250MG/5
NON PREFERRED
ciprofloxacn TAB 500MG ER
ofloxacin TAB 400MG
Avelox Abc TAB 400MG
Avelox TAB 400MG
Cipro (10%) Sus 500MG/5
Cipro TAB 250MG
NON PREFERRED
sulfadiazine TAB 500MG
ANTIMYCOBACTERIAL AGENTS
TIER 01
QUINOLONES
TIER 01
GENERIC
amikacin inj 1gm/4ML
amikacin inj 500/2ML
gentamicin inj 10MG/ML
gentamicin inj 40MG/ML
neomycin TAB 500MG
tobramycin inj 1.2/30ML
tobramycin inj 1.2gm
tobramycin inj 10MG/ML
tobramycin inj 40MG/ML
tobramycin inj 80MG/2ML
NON PREFERRED
paromomycin CAP 250MG
streptomycin inj 1gm
SPECIALTY
QL,PA
tobramycin neb 300/5ML
NON-PREFERRED BRAND SPECIALTY
QL,PA
Bethkis Neb 300/4ML
QL,PA
Kitabis PAK Neb 300/5ML
QL,PA
Tobi Neb 300/5ML
QL,PA
Tobi Podhalr CAP 28MG
TIER 02
TIER 03
TIER 05
GENERIC
ethambutol TAB 100MG
ethambutol TAB 400MG
isoniazid syp 50MG/5ML
isoniazid TAB 100MG
isoniazid TAB 300MG
pyrazinamide TAB 500MG
rifabutin CAP 150MG
rifampin CAP 150MG
rifampin CAP 300MG
PREFERRED
PA
Priftin TAB 150MG
NON PREFERRED
cycloserine CAP 250MG
isoniazid inj 100MG/ML
Capastat SUL Inj 1gm
Myambutol TAB 100MG
Myambutol TAB 400MG
Mycobutin CAP 150MG
Paser Gra 4gm
Rifadin CAP 150MG
Rifadin CAP 300MG
Rifamate CAP
Rifater TAB
Trecator TAB 250MG
QL,PA
Sirturo TAB 100MG
ANTIFUNGALS
TIER 01
GENERIC
amphotericin inj 50MG
3
TIER 02
TIER 03
TIER 04
TIER 05
fluconazole sus 10MG/ML
fluconazole sus 40MG/ML
fluconazole TAB 100MG
flucytosine CAP 250MG
flucytosine CAP 500MG
griseofulvin sus 125/5ML
griseofulvin TAB micr 500
griseofulvin TAB ultr 125
griseofulvin TAB ultr 250
PA
itraconazole CAP 100MG
ketoconazole TAB 200MG
nystatin TAB 500000
terbinafine TAB 250MG
PREFERRED
PA
Sporanox Sol 10MG/ML
NON PREFERRED
bio-statin pow
nystatin pow
Ancobon CAP 250MG
Ancobon CAP 500MG
Bio-statin CAP 1000000
Bio-statin CAP 500000
Diflucan Sus 10MG/ML
Diflucan Sus 40MG/ML
Diflucan TAB 100MG
Diflucan TAB 150MG
Diflucan TAB 200MG
Diflucan TAB 50MG
Grifulvin V TAB 500MG
Gris-peg TAB 125MG
Gris-peg TAB 250MG
Lamisil Gra 125MG
Lamisil Gra 187.5MG
Lamisil TAB 250MG
Noxafil Sus 40MG/ML
Noxafil TAB 100MG
PA
Onmel TAB 200MG
PA
Sporanox CAP Pulsepak
PA
Sporanox CAP 100MG
SPECIALTY
PA
voriconazole sus 40MG/ML
PA
voriconazole TAB 200MG
PA
voriconazole TAB 50MG
QL,PA
Cresemba CAP 186 MG
PA
voriconazole inj 200MG
PA
Vfend IV Inj 200MG
PA
Vfend Sus 40MG/ML
PA
Vfend TAB 200MG
PA
Vfend TAB 50MG
ANTIVIRALS
TIER 01
GENERIC
abacavir TAB 300MG
acyclovir sus 200/5ML
acyclovir CAP 200MG
acyclovir TAB 400MG
acyclovir TAB 800MG
QL
adefov dipiv TAB 10MG
didanosine CAP 125MG
QL
entecavir TAB 0.5MG
QL
entecavir TAB 1MG
lamivud/zido TAB 150-300
TIER 02
lamivudine sol 10MG/ML
lamivudine TAB 100MG
QL
moderiba TAB 200MG
nevirapine sus 50MG/5ML
nevirapine TAB 200MG
nevirapine TAB 400MG ER
QL
ribasphere CAP 200MG
QL
ribasphere TAB 200MG
QL
ribavirin CAP 200MG
QL
ribavirin TAB 200MG
rimantadine TAB 100MG
stavudine sol 1MG/ML
stavudine CAP 15MG
stavudine CAP 20MG
stavudine CAP 30MG
stavudine CAP 40MG
valacyclovir TAB 1gm
valacyclovir TAB 500MG
zidovudine syp 50MG/5ML
zidovudine CAP 100MG
zidovudine TAB 300MG
PREFERRED
QL
Baraclude Sol .05MG/ML
Crixivan CAP 200MG
Crixivan CAP 400MG
ST
Edurant TAB 25MG
Emtriva CAP 200MG
Emtriva Sol 10MG/ML
QL
Epivir HBV Sol 5MG/ML
Intelence TAB 100MG
Intelence TAB 200MG
Intelence TAB 25MG
Invirase CAP 200MG
Invirase TAB 500MG
Isentress Chw 100MG
Isentress Chw 25MG
Isentress TAB 400MG
Kaletra Sol
Kaletra TAB 100-25MG
Kaletra TAB 200-50MG
Norvir CAP 100MG
Norvir Sol 80MG/ML
Norvir TAB 100MG
Prezista TAB 150MG
Prezista TAB 600MG
Prezista TAB 75MG
QL
Rebetol Sol 40MG/ML
Relenza Mis Diskhale
Rescriptor TAB 100 MG
Rescriptor TAB 200MG
Sustiva CAP 200MG
Sustiva CAP 50MG
Sustiva TAB 600MG
Tamiflu CAP 30MG
Tamiflu CAP 45MG
Tamiflu CAP 75MG
Tamiflu Sus 6MG/ML
Tivicay TAB 50MG
PA
Tybost TAB 150MG
Videx Sol 2gm
Videx Sol 4gm
Viracept TAB 250MG
Viracept TAB 625MG
QL
Viread Pow 40MG/Gm
QL
Viread TAB 150MG
QL
Viread TAB 200MG
QL
Viread TAB 250MG
QL
Viread TAB 300MG
4
TIER 03
TIER 04
Ziagen Sol 20MG/ML
NON PREFERRED
famciclovir TAB 125MG
nevirapine TAB 100MG
QL
ribapak PAK 1200/day
QL
ribapak PAK 800/day
QL
QL
QL
ribatab PAK 1000/day
QL
ribatab TAB 1200/day
QL
ribatab TAB 800/day
QL
Baraclude TAB 0.5MG
QL
Baraclude TAB 1MG
Combivir TAB 150-300
QL
Copegus TAB 200MG
Daklinza TAB 90MG
Epivir HBV TAB 100MG
Epivir Sol 10MG/ML
Epivir TAB 150MG
Epivir TAB 300MG
QL
Evotaz TAB 300-150
Famvir TAB 125MG
Famvir TAB 250MG
Famvir TAB 500MG
Flumadine TAB 100MG
QL
Hepsera TAB 10MG
QL,PA
Incivek TAB 375MG
Isentress Pow 100MG
QL
Moderiba PAK 1000/Day
QL
QL
QL
QL
Rebetol CAP 200MG
Retrovir CAP 100MG
Retrovir Syp 50MG/5ML
QL
Ribapak PAK 1000/Day
QL
Ribapak PAK 600/Day
Sitavig TAB 50MG
PA
Technivie TAB
Valtrex TAB 1gm
Valtrex TAB 500MG
QL,PA
Victrelis CAP 200MG
Videx EC CAP 125MG
Videx EC CAP 200MG
Videx EC CAP 250MG
Videx EC CAP 400MG
Viramune Sus 50MG/5ML
Viramune TAB 200MG
Viramune XR TAB 100MG
Viramune XR TAB 400MG
Virazole Inh 6gm
QL,PA
Vitekta TAB 85MG
Zerit CAP 15MG
Zerit CAP 20MG
Zerit CAP 30MG
Zerit CAP 40MG
Zerit Sol 1MG/ML
Ziagen TAB 300MG
Zovirax CAP 200MG
Zovirax Sus 200/5ML
Zovirax TAB 400MG
Zovirax TAB 800MG
SPECIALTY
QL
abacav/lamiv TAB /zidovud
QL
valganciclov sol 50MG/ML
QL
valganciclov TAB 450MG
QL
Aptivus CAP 250MG
QL
Atripla TAB
QL
TIER 05
Complera TAB
QL
Descovy TAB 200/25
QL,PA
Epzicom TAB 600-300
Genvoya TAB
QL,PA
Harvoni TAB 90-400MG
QL
Lexiva Sus 50MG/ML
QL
Lexiva TAB 700MG
QL
Odefsey TAB
QL
Peg-intron Kit 120 Rp
QL
Peg-intron Kit 120mcg
QL
Peg-intron Kit 150 Rp
QL
QL
QL
Peg-intron Kit 50mcg Rp
QL
QL
Peg-intron Kit 80mcg Rp
QL
Pegasys Inj
QL
Pegasys Inj Proclick
QL
Pegasys Inj 180mcg/M
QL
Pegintron Kit 120mcg
QL
Pegintron Kit 150mcg
QL
Pegintron Kit 50mcg
QL
Pegintron Kit 80mcg
QL,PA
Prezcobix TAB 800-150
QL
Prezista Sus 100MG/ML
QL
Prezista TAB 800MG
QL
Reyataz CAP 150MG
QL
Reyataz CAP 200MG
QL
Reyataz CAP 300MG
QL
Reyataz Pow 50MG
QL
Selzentry TAB 150MG
QL
Selzentry TAB 300MG
QL,PA
Sovaldi TAB 400MG
QL,ST
Stribild TAB
Tivicay TAB 10MG
Tivicay TAB 25MG
Truvada TAB 100-150
Truvada TAB 133-200
Truvada TAB 167-250
QL
Truvada TAB 200-300
QL
Valcyte Sol 50MG/ML
QL
Aptivus Sol
PA
Daklinza TAB 30MG
PA
Daklinza TAB 60MG
QL,PA
Epclusa TAB 400-100
QL
Fuzeon Inj 90MG
QL,PA
Olysio CAP 150MG
QL,PA
Triumeq TAB
QL
Trizivir TAB
QL
Tyzeka TAB 600MG
QL
Valcyte TAB 450MG
QL,PA
Viekira PAK TAB
QL,PA
Viekira XR TAB
QL,PA
Vitekta TAB 150MG
QL,PA
Zepatier TAB 50-100MG
ANTIMALARIALS
TIER 01
TIER 02
TIER 03
GENERIC
chloroquine TAB 250MG
chloroquine TAB 500MG
hydroxychlor TAB 200MG
primaquine TAB 26.3MG
PREFERRED
Daraprim TAB 25MG
NON PREFERRED
qualaquin CAP 324MG
quinine sulf CAP 324MG
Aralen TAB 500MG
5
Coartem TAB 20-120MG
Plaquenil TAB 200MG
Qualaquin CAP 324MG
AMEBICIDES
TIER 02
PREFERRED
Yodoxin TAB 650MG
ANTHELMINTICS
TIER 02
TIER 03
PREFERRED
Albenza TAB 200MG
Biltricide TAB 600MG
NON PREFERRED
ivermectin TAB 3MG
Emverm Chw 100MG
Stromectol TAB 3MG
MISC. ANTI-INFECTIVES
TIER 01
TIER 02
TIER 03
GENERIC
clindamycin inj 150MG/ML
clindamycin inj 300/2ML
clindamycin inj 300MG
clindamycin inj 9gm/60ML
clindamycin inj 9000/60
clindamycin sol 75MG/5ML
clindamycin CAP 150MG
colistimeth inj 150MG
dapsone TAB 100MG
dapsone TAB 25MG
linezolid sus 100/5ML
metronidazol TAB 250MG
metronidazol TAB 500MG
smz-tmp sus 200-40/5
smz-tmp DS TAB 800-160
smz-tmp TAB 400-80MG
smz/tmp DS TAB 800-160
sulfatrim PD sus 200-40/5
trimethoprim TAB 100MG
vancomycin CAP 125MG
vancomycin CAP 250MG
vancomycin 250/5ML
PREFERRED
Alinia Sus 100/5ML
Alinia TAB 500MG
Invanz Inj 1gm
Nebupent Inh 300MG
Primsol Sol 50MG/5ML
Zyvox Sus 100MG/5m
NON PREFERRED
aztreonam inj 1gm
aztreonam inj 2gm
baciim inj 50000unt
bacitracin inj 50000unt
lincomycin inj lidocain
lincomycin inj 300MG/ML
metronidazol CAP 375MG
polymyxin b inj 500000
tinidazole TAB 250MG
tinidazole TAB 500MG
Azactam Inj 1gm
Azactam Inj 2gm
Bactrim DS TAB 800-160
Bactrim TAB 400-80MG
TIER 04
TIER 05
Cleocin CAP 150MG
Cleocin CAP 300MG
Cleocin CAP 75MG
Cleocin Phos Inj 300MG
Cleocin Phos Inj 9gm/60ML
Cleocin PED Sol 75MG/5ML
Coly-mycin M Inj 150MG
Flagyl CAP 375MG
Flagyl ER TAB 750MG
Flagyl TAB 250MG
Flagyl TAB 500MG
PA
Impavido CAP 50MG
Ketek TAB 300MG
Ketek TAB 400MG
Lincocin Inj 300MG/ML
Pentam 300 Inj 300MG
Tindamax TAB 250MG
Tindamax TAB 500MG
Vancocin HCL CAP 125MG
Vancocin HCL CAP 250MG
Vancomycn 25 Sol 25MG/ML
Vancomycn 50 Sol 50MG/ML
SPECIALTY
atovaquone sus 750/5ML
linezolid TAB 600MG
QL
Sivextro TAB 200MG
QL,PA
Cayston Inh 75MG
Mepron Sus
QL,PA
Xifaxan TAB 200MG
QL,PA
Xifaxan TAB 550MG
Zyvox TAB 600MG
ANTINEOPLASTICS, ETC.
ALKYLATING AGENTS
TIER 01
TIER 02
TIER 03
TIER 05
GENERIC
cyclophosph CAP 25MG
cyclophosph CAP 50MG
lomustine CAP 10MG
lomustine CAP 100MG
lomustine CAP 40MG
QL
temozolomide CAP 100MG
QL
QL
QL
QL
QL
PREFERRED
QL
Alkeran TAB 2MG
Leukeran TAB 2MG
QL
Myleran TAB 2MG
NON PREFERRED
QL
thiotepa inj 15MG
Gleostine CAP 10MG
Gleostine CAP 100MG
Gleostine CAP 40MG
QL
Gleostine CAP 5MG
QL
Hexalen CAP 50MG
QL
Temodar CAP 100MG
QL
Temodar CAP 140MG
QL
Temodar CAP 180MG
QL
Temodar CAP 20MG
QL
Temodar CAP 250MG
QL
Temodar CAP 5MG
QL,PA
Valchlor Gel 0.016%
6
ANTIBIOTICS
TIER 03
IMMUNOMODULATORS
NON PREFERRED
Bleo 15k Inj
TIER 01
ANTIMETABOLITES
TIER 01
TIER 02
TIER 03
GENERIC
QL,PA
capecitabine TAB 150MG
QL,PA
capecitabine TAB 500MG
mercaptopur TAB 50MG
methotrexate inj 1gm
methotrexate inj 1gm/40ML
methotrexate inj 100/4ML
methotrexate inj 25MG/ML
methotrexate inj 50MG/2ML
methotrexate TAB 2.5MG
PREFERRED
Tabloid TAB 40MG
NON PREFERRED
Purinethol TAB 50MG
PA
Purixan Sus 20MG/ML
Trexall TAB 10MG
Trexall TAB 15MG
Trexall TAB 5MG
Trexall TAB 7.5MG
QL,PA
Xeloda TAB 150MG
QL,PA
Xeloda TAB 500MG
TIER 02
HORMONAL AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
anastrozole TAB 1MG
bicalutamide TAB 50MG
flutamide CAP 125MG
letrozole TAB 2.5MG
leuprolide inj 1MG/0.2
megestrol ac sus 40MG/ML
megestrol ac sus 400MG/10
megestrol ac TAB 20MG
megestrol ac TAB 40MG
tamoxifen TAB 10MG
tamoxifen TAB 20MG
PREFERRED
Lupron Depot Inj 11.25MG
Lupron Depot Inj 30MG
Lupron Depot Inj 45MG
QL,PA
Xtandi CAP 40MG
QL,PA
Zytiga TAB 250MG
NON PREFERRED
exemestane TAB 25MG
nilutamide TAB 150MG
Arimidex TAB 1MG
Aromasin TAB 25MG
Casodex TAB 50MG
QL
Depo-provera Inj 400/ML
Eligard Inj 22.5MG
Eligard Inj 30MG
Eligard Inj 45MG
Eligard Inj 7.5MG
QL
Emcyt CAP 140MG
Fareston TAB 60MG
Femara TAB 2.5MG
PA
Lysodren TAB 500MG
Megace Oral Sus 40MG/ML
Nilandron TAB 150MG
Soltamox Sol 10MG/5ML
TIER 03
GENERIC
azathioprine TAB 50MG
cyclosporine sol modified
cyclosporine CAP 100MG
cyclosporine CAP 100MG MD
cyclosporine CAP 25MG
cyclosporine CAP 25MG mod
cyclosporine CAP 50MG mod
gengraf sol 100MG/ML
gengraf CAP 100MG
gengraf CAP 25MG
gengraf CAP 50MG
hecoria CAP 0.5MG
hecoria CAP 1MG
hecoria CAP 5MG
mycophenolat sus 200MG/ML
mycophenolat CAP 250MG
mycophenolat TAB 500MG
mycophenolic TAB 180MG DR
mycophenolic TAB 360MG DR
sirolimus TAB 0.5MG
sirolimus TAB 1MG
sirolimus TAB 2MG
tacrolimus CAP 0.5MG
tacrolimus CAP 1MG
tacrolimus CAP 5MG
PREFERRED
Rapamune Sol 1MG/ML
QL,PA
Revlimid CAP 10MG
QL,PA
Revlimid CAP 15MG
QL,PA
Revlimid CAP 2.5MG
QL,PA
Revlimid CAP 20MG
QL,PA
Revlimid CAP 25MG
QL,PA
Revlimid CAP 5MG
QL,PA
Thalomid CAP 100MG
QL,PA
Thalomid CAP 150MG
QL,PA
Thalomid CAP 200MG
QL,PA
Thalomid CAP 50MG
NON PREFERRED
azathioprine inj 100MG
Astagraf XL CAP 0.5MG
Astagraf XL CAP 1MG
Astagraf XL CAP 5MG
Azasan TAB 100MG
Azasan TAB 75 MG
Cellcept CAP 250MG
Cellcept Sus 200MG/ML
Cellcept TAB 500MG
Envarsus XR TAB 0.75MG
Envarsus XR TAB 1MG
Envarsus XR TAB 4MG
Imuran TAB 50MG
Myfortic TAB 180MG
Myfortic TAB 360MG
Neoral CAP 100MG
Neoral CAP 25MG
Neoral Sol 100MG/ML
QL,PA
Pomalyst CAP 1MG
QL,PA
Pomalyst CAP 2MG
QL,PA
Pomalyst CAP 3MG
QL,PA
Pomalyst CAP 4MG
Prograf CAP 0.5MG
Prograf CAP 1MG
Prograf CAP 5MG
Rapamune TAB 0.5MG
Rapamune TAB 1MG
Rapamune TAB 2MG
Sandimmune CAP 100MG
7
TIER 05
QL,PA
Sandimmune CAP 25MG
Sandimmune Sol 100MG/ML
QL
Zortress TAB 0.25MG
QL
Zortress TAB 0.5MG
QL
Zortress TAB 0.75MG
MITOTIC INHIBITORS
TIER 01
GENERIC
QL
etoposide CAP 50MG
ENZYME INHIBITORS
TIER 01
TIER 02
TIER 03
GENERIC
QL,PA
imatinib mes TAB 100MG
QL,PA
imatinib mes TAB 400MG
QL,PA
Gleevec TAB 100MG
QL,PA
Gleevec TAB 400MG
PREFERRED
QL,PA
Afinitor Dis TAB 2MG
QL,PA
QL,PA
QL,PA
Afinitor TAB 10MG
QL,PA
Afinitor TAB 2.5MG
QL,PA
Afinitor TAB 5MG
QL,PA
Afinitor TAB 7.5MG
QL,PA
Gilotrif TAB 20MG
QL,PA
Gilotrif TAB 30MG
QL,PA
Gilotrif TAB 40MG
QL,PA
Imbruvica CAP 140MG
QL,PA
Iressa TAB 250MG
QL,PA
Mekinist TAB 0.5MG
QL,PA
Mekinist TAB 2MG
QL,PA
Nexavar TAB 200MG
QL,PA
Sprycel TAB 100MG
QL,PA
Sprycel TAB 140MG
QL,PA
Sprycel TAB 20MG
QL,PA
Sprycel TAB 50MG
QL,PA
Sprycel TAB 70MG
QL,PA
Sprycel TAB 80MG
QL,PA
Sutent CAP 12.5MG
QL,PA
Sutent CAP 25MG
QL,PA
Sutent CAP 37.5MG
QL,PA
Sutent CAP 50MG
QL,PA
Tafinlar CAP 50MG
QL,PA
Tafinlar CAP 75MG
QL,PA
Tarceva TAB 100MG
QL,PA
Tarceva TAB 150MG
QL,PA
Tarceva TAB 25MG
QL,PA
Tykerb TAB 250MG
QL,PA
Votrient TAB 200MG
NON PREFERRED
QL,PA
Bosulif TAB 100MG
QL,PA
Bosulif TAB 500MG
PA
Cabometyx TAB 20MG
PA
Cabometyx TAB 40MG
PA
Cabometyx TAB 60MG
QL,PA
Caprelsa TAB 100MG
QL,PA
Caprelsa TAB 300MG
QL,PA
Cometriq Kit 100MG
QL,PA
Cometriq Kit 140MG
QL,PA
Cometriq Kit 60MG
QL,PA
Farydak CAP 10MG
QL,PA
Farydak CAP 15MG
QL,PA
Farydak CAP 20MG
QL,PA
Ibrance CAP 100MG
QL,PA
Ibrance CAP 125MG
QL,PA
Ibrance CAP 75MG
QL,PA
Iclusig TAB 15MG
QL,PA
Iclusig TAB 45MG
TIER 04
TIER 05
Inlyta TAB 1MG
QL,PA
Inlyta TAB 5MG
QL,PA
Jakafi TAB 10MG
QL,PA
Jakafi TAB 15MG
QL,PA
Jakafi TAB 20MG
QL,PA
Jakafi TAB 25MG
QL,PA
Jakafi TAB 5MG
Lenvima CAP 18 MG
Lenvima CAP 8 MG
QL,PA
Stivarga TAB 40MG
QL,PA
Tasigna CAP 150MG
QL,PA
Tasigna CAP 200MG
QL,PA
Xalkori CAP 200MG
QL,PA
Xalkori CAP 250MG
QL,PA
Zelboraf TAB 240MG
QL,PA
Zolinza CAP 100MG
SPECIALTY
QL,PA
Zydelig TAB 100MG
QL,PA
Zydelig TAB 150MG
QL,PA
Alecensa CAP 150MG
QL,PA
Cotellic TAB 20MG
QL,PA
Lenvima CAP 10 MG
QL,PA
Lenvima CAP 14 MG
QL,PA
Lenvima CAP 20 MG
QL,PA
Lenvima CAP 24 MG
QL,PA
Lynparza CAP 50MG
QL,PA
Ninlaro CAP 2.3MG
QL,PA
Ninlaro CAP 3MG
QL,PA
Ninlaro CAP 4MG
QL,PA
Tagrisso TAB 40MG
QL,PA
Tagrisso TAB 80MG
QL,PA
Zykadia CAP 150MG
TOPOISOMERASE I INHIBITOR
TIER 03
NON PREFERRED
QL
Hycamtin CAP 0.25MG
QL
Hycamtin CAP 1MG
ANTINEOPLASTICS MISC.
TIER 01
TIER 02
TIER 03
TIER 04
TIER 05
GENERIC
hydroxyurea CAP 500MG
QL
tretinoin CAP 10MG
PREFERRED
QL
Matulane CAP 50MG
NON PREFERRED
QL,PA
bexarotene CAP 75MG
Alferon N Inj 5mu/ML
Hydrea CAP 500MG
QL,PA
Targretin CAP 75MG
QL
Uvadex Inj 20mcg/ML
SPECIALTY
QL
Intron A Inj 10mu
QL
Intron A Inj 18mu
QL
Intron A Inj 25mu
QL
Intron A Inj 50mu
QL
Actimmune Inj 2mu/0.5
QL
Sylatron Kit 200mcg
QL
Sylatron Kit 300mcg
QL
Sylatron Kit 600mcg
CHEMOTHERAPY RESCUE
TIER 01
GENERIC
leucovor CA TAB 10MG
leucovor CA TAB 5MG
mesna inj 1gm
8
TIER 02
TIER 03
PREFERRED
Mesnex TAB 400MG
NON PREFERRED
leucovor CA inj 100MG
leucovorin inj calcium
TIER 03
ANTINEOPLASTIC COMBO
TIER 05
QL,PA
Lonsurf TAB 15-6.14
QL,PA
Lonsurf TAB 20-8.19
CARDIOVASCULAR DRUGS
CARDIAC GLYCOSIDES
TIER 01
TIER 03
GENERIC
digitek TAB 0.125MG
digitek TAB 0.25MG
digox TAB 0.125MG
digox TAB 0.25MG
digoxin inj 0.25MG/1
digoxin sol 50mcg/ML
digoxin TAB 0.125MG
digoxin TAB 0.25MG
NON PREFERRED
lanoxin TAB 0.25MG
Lanoxin Inj 0.25MG/1
Lanoxin PED Inj 0.1MG/ML
Lanoxin TAB 0.0625MG
Lanoxin TAB 0.125MG
Lanoxin TAB 0.1875MG
Lanoxin TAB 0.25MG
ANTIANGINAL AGENTS
TIER 01
TIER 02
GENERIC
isosorb din TAB 10MG
isosorb din TAB 5MG
isosorb mono TAB 10MG
isosorb mono TAB 120MG ER
isosorb mono TAB 20MG
minitran dis 0.1MG/HR
nitro-time CAP 2.5MG CR
nitro-time CAP 6.5MG CR
nitro-time CAP 9MG CR
nitroglycer dis 0.1MG/HR
nitroglycer CAP 2.5MG ER
nitroglycer CAP 6.5MG ER
nitroglycer CAP 9MG ER
nitroglyceri sub 0.6MG
nitroglycern sub 0.3MG
nitroglycern sub 0.4MG
PREFERRED
Isordil TAB 40MG
Nitro-bid Oin 2%
Nitro-dur Dis 0.3MG/HR
Nitrostat Sub 0.3MG
Nitrostat Sub 0.4MG
Nitrostat Sub 0.6MG
NON PREFERRED
isosorb din TAB 40MG ER
nitroglycer aer 400mcg
nitroglycrn spr lingual
nitroglycrn spr 0.4MG
Dilatrate SR CAP 40MG
Imdur TAB 120MG ER
Imdur TAB 30MG ER
Imdur TAB 60MG ER
Isordil TAB 5MG
Nitrolingual Spr Pumpspra
Nitromist Aer 400mcg
Ranexa TAB 1000MG
Ranexa TAB 500MG
BETA BLOCKERS
TIER 01
GENERIC
acebutolol CAP 200MG
acebutolol CAP 400MG
atenolol TAB 100MG
atenolol TAB 25MG
atenolol TAB 50MG
betaxolol TAB 10MG
betaxolol TAB 20MG
bisoprol fum TAB 10MG
bisoprol fum TAB 5MG
carvedilol TAB 12.5MG
carvedilol TAB 25MG
labetalol TAB 100MG
labetalol TAB 200MG
labetalol TAB 300MG
metoprol TAR TAB 100MG
metoprolol TAB 100MG ER
metoprolol TAB 37.5MG
metoprolol TAB 75MG
nadolol TAB 20MG
nadolol TAB 40MG
nadolol TAB 80MG
pindolol TAB 10MG
pindolol TAB 5MG
propranolol sol 20MG/5ML
propranolol sol 40MG/5ML
propranolol CAP 120MG ER
propranolol TAB 10MG
sorine TAB 120MG
sorine TAB 160MG
sorine TAB 240MG
sorine TAB 80MG
sotalol AF TAB 120MG
sotalol AF TAB 160MG
9
TIER 03
sotalol AF TAB 80MG
sotalol HCL TAB 120MG
timolol mal TAB 10MG
timolol mal TAB 20MG
timolol mal TAB 5MG
NON PREFERRED
Betapace AF TAB 120MG
Betapace TAB 120MG
Betapace TAB 160MG
Betapace TAB 80MG
Bystolic TAB 10MG
Bystolic TAB 2.5MG
Bystolic TAB 20MG
Bystolic TAB 5MG
Coreg CR CAP 10MG
Coreg CR CAP 20MG
Coreg CR CAP 40MG
Coreg CR CAP 80MG
Coreg TAB 12.5MG
Coreg TAB 25MG
Coreg TAB 3.125MG
Coreg TAB 6.25MG
Corgard TAB 20MG
Corgard TAB 40MG
Corgard TAB 80MG
PA
Hemangeol Sol 4.28/ML
Inderal LA CAP 120MG
Inderal LA CAP 160MG
Inderal LA CAP 60MG
Inderal LA CAP 80MG
Inderal XL CAP 120MG
Inderal XL CAP 80MG
Innopran XL CAP 120MG
Innopran XL CAP 80MG
Kerlone TAB 10MG
Kerlone TAB 20MG
Levatol TAB 20MG
Lopressor TAB 100MG
Lopressor TAB 50MG
Sectral CAP 200MG
Sectral CAP 400MG
Sotylize Sol 5MG/ML
Tenormin TAB 100MG
Tenormin TAB 25MG
Tenormin TAB 50MG
Toprol XL TAB 100MG
Toprol XL TAB 200MG
Toprol XL TAB 25MG
Toprol XL TAB 50MG
Trandate TAB 100MG
Trandate TAB 200MG
Trandate TAB 300MG
Zebeta TAB 10MG
Zebeta TAB 5MG
CALCIUM CHANNEL BLOCKERS
TIER 01
GENERIC
amlodipine TAB 10MG
amlodipine TAB 2.5MG
amlodipine TAB 5MG
cartia XT CAP 120/24HR
TIER 03
dilt-XR CAP 120MG
dilt-XR CAP 180MG
dilt-XR CAP 240MG
diltiazem CAP 120MG CD
diltiazem CAP 120MG ER
diltiazem TAB 120MG
diltiazem TAB 30MG
diltiazem TAB 60MG
diltiazem TAB 90MG
felodipine TAB 10MG ER
felodipine TAB 2.5MG ER
felodipine TAB 5MG ER
isradipine CAP 2.5MG
isradipine CAP 5MG
nicardipine CAP 20MG
nicardipine CAP 30MG
nifedical XL TAB 30MG
nifedical XL TAB 60MG
nifedipine CAP 10MG
nifedipine CAP 20MG
nimodipine CAP 30MG
verapamil CAP 120MG ER
verapamil CAP 120MG SR
verapamil TAB 120MG
verapamil TAB 120MG ER
verapamil TAB 40MG
verapamil TAB 80MG
NON PREFERRED
afeditab TAB 30MG CR
afeditab TAB 60MG CR
diltiazem CAP 120MG/24
diltiazem ER TAB 180MG
matzim LA TAB 180MG/24
nifedipine TAB 30MG ER
nisoldipine TAB 17MG ER
nisoldipine TAB 20MG
nisoldipine TAB 25.5MG
10
TIER 05
nisoldipine TAB 34MG ER
nisoldipine TAB 8.5MG ER
taztia XT CAP 120MG/24
verelan CAP 120MG SR
verelan PM CAP 100MG ER
Adalat CC TAB 30MG ER
Calan SR TAB 120MG
Calan SR TAB 180MG
Calan SR TAB 240MG
Calan TAB 120MG
Calan TAB 80MG
Cardizem CD CAP 120MG/24
Cardizem LA TAB 120MG
Cardizem LA TAB 300MG/24
Cardizem LA TAB 420MG/24
Cardizem TAB 120MG
Cardizem TAB 30MG
Cardizem TAB 60MG
Norvasc TAB 10MG
Norvasc TAB 2.5MG
Norvasc TAB 5MG
Procardia CAP 10MG
Procardia XL TAB 30MG CR
Sular TAB 17MG
Sular TAB 34MG
Sular TAB 8.5MG
Tiazac CAP 120MG/24
Tiazac CAP 180MG/24
Tiazac CAP 240MG/24
Tiazac CAP 300MG/24
Tiazac CAP 360MG/24
Tiazac CAP 420MG/24
QL
Nymalize Sol 60/20ML
ANTIARRHYTHMICS
TIER 01
GENERIC
amiodarone TAB 200MG
disopyramide CAP 100MG
disopyramide CAP 150MG
flecainide TAB 100MG
flecainide TAB 150MG
flecainide TAB 50MG
mexiletine CAP 150MG
TIER 02
TIER 03
pacerone TAB 200MG
procainamide inj 100MG/ML
procainamide inj 500MG/ML
propafenone TAB 150MG
quinidine gl inj 80MG/ML
quinidine gl TAB 324MG CR
quinidine gl TAB 324MG ER
quinidine SU TAB 200MG
quinidine SU TAB 300MG
quinidine SU TAB 300MG ER
PREFERRED
Norpace CAP 100MG CR
Norpace CAP 150MG CR
NON PREFERRED
dofetilide CAP 125mcg
pacerone TAB 100MG
pacerone TAB 400MG
propafenone CAP 225MG ER
propafenone CAP 325MG ER
propafenone CAP 425MG SR
Cordarone TAB 200MG
Multaq TAB 400MG
Norpace CAP 100MG
Norpace CAP 150MG
Rythmol SR CAP 225MG
Rythmol TAB 150MG
Rythmol TAB 225MG
Tikosyn CAP 125mcg
Tikosyn CAP 250mcg
Tikosyn CAP 500mcg
ACE INHIBITORS
TIER 01
GENERIC
benazepril TAB 10MG
benazepril TAB 20MG
benazepril TAB 40MG
benazepril TAB 5MG
captopril TAB 100MG
captopril TAB 12.5MG
captopril TAB 25MG
captopril TAB 50MG
enalapril TAB 10MG
enalapril TAB 2.5MG
enalapril TAB 20MG
enalapril TAB 5MG
fosinopril TAB 10MG
fosinopril TAB 20MG
fosinopril TAB 40MG
lisinopril TAB 10MG
lisinopril TAB 2.5MG
lisinopril TAB 20MG
lisinopril TAB 30MG
lisinopril TAB 40MG
lisinopril TAB 5MG
moexipril TAB 15MG
moexipril TAB 7.5MG
perindopril TAB 2MG
perindopril TAB 4MG
perindopril TAB 8MG
quinapril TAB 10MG
11
TIER 03
quinapril TAB 20MG
quinapril TAB 40MG
quinapril TAB 5MG
ramipril CAP 1.25MG
ramipril CAP 10MG
ramipril CAP 2.5MG
ramipril CAP 5MG
trandolapril TAB 1MG
NON PREFERRED
Accupril TAB 10MG
Accupril TAB 20MG
Accupril TAB 40MG
Accupril TAB 5MG
Aceon TAB 4MG
Aceon TAB 8MG
Altace CAP 1.25MG
Altace CAP 10MG
Altace CAP 2.5MG
Altace CAP 5MG
Epaned Sol 1MG/ML
Lotensin TAB 10MG
Lotensin TAB 20MG
Lotensin TAB 40MG
Mavik TAB 1MG
Mavik TAB 2MG
Mavik TAB 4MG
Prinivil TAB 10MG
Prinivil TAB 20MG
Prinivil TAB 5MG
Qbrelis Sol 1MG/ML
Univasc TAB 15MG
Univasc TAB 7.5MG
Vasotec TAB 10MG
Vasotec TAB 2.5MG
Vasotec TAB 20MG
Vasotec TAB 5MG
Zestril TAB 10MG
Zestril TAB 2.5MG
Zestril TAB 20MG
Zestril TAB 30MG
Zestril TAB 40MG
Zestril TAB 5MG
Atacand TAB 8MG
Avapro TAB 150MG
Avapro TAB 300MG
Avapro TAB 75MG
ST
Benicar TAB 20MG
ST
Benicar TAB 40MG
ST
Benicar TAB 5MG
Cozaar TAB 100MG
Cozaar TAB 25MG
Cozaar TAB 50MG
Diovan TAB 160MG
Diovan TAB 320MG
Diovan TAB 40MG
Diovan TAB 80MG
ST
Edarbi TAB 40MG
ST
Edarbi TAB 80MG
Micardis TAB 20MG
Micardis TAB 40MG
Micardis TAB 80MG
ST
Teveten TAB 600MG
DIRECT RENIN INHIBITORS
TIER 03
ANTIHYPERTENSIVES MISC.
TIER 01
ANGIOTENSIN RCPTR BLOCKER
TIER 01
TIER 03
GENERIC
irbesartan TAB 150MG
irbesartan TAB 300MG
irbesartan TAB 75MG
losartan pot TAB 100MG
valsartan TAB 160MG
valsartan TAB 320MG
valsartan TAB 40MG
valsartan TAB 80MG
NON PREFERRED
candesartan TAB 16MG
candesartan TAB 32MG
candesartan TAB 4MG
candesartan TAB 8MG
ST
eprosart mes TAB 600MG
telmisartan TAB 20MG
Atacand TAB 16MG
Atacand TAB 32MG
Atacand TAB 4MG
NON PREFERRED
ST
Tekturna TAB 150MG
ST
Tekturna TAB 300MG
TIER 03
GENERIC
clonidine dis 0.1/24HR
clonidine TAB 0.1MG
clonidine TAB 0.2MG
clonidine TAB 0.3MG
doxazosin TAB 1MG
doxazosin TAB 2MG
doxazosin TAB 4MG
doxazosin TAB 8MG
eplerenone TAB 25MG
eplerenone TAB 50MG
guanfacine TAB 1MG
guanfacine TAB 2MG
hydralazine inj 20MG/ML
hydralazine TAB 10MG
methyldopa TAB 250MG
methyldopa TAB 500MG
minoxidil TAB 10MG
minoxidil TAB 2.5MG
phenoxybenza CAP 10MG
phentolamine inj mesylate
phentolamine inj 5MG
prazosin HCL CAP 1MG
terazosin CAP 1MG
terazosin CAP 10MG
terazosin CAP 2MG
terazosin CAP 5MG
NON PREFERRED
reserpine TAB 0.1MG
reserpine TAB 0.25MG
Cardura TAB 1MG
Cardura TAB 2MG
Cardura TAB 4MG
Cardura TAB 8MG
Catapres TAB 0.1MG
12
TIER 05
Catapres TAB 0.2MG
Catapres TAB 0.3MG
Catapres-tts Dis 0.1/24HR
Demser CAP 250MG
Inspra TAB 25MG
Inspra TAB 50MG
Minipress CAP 1MG
Minipress CAP 2MG
Minipress CAP 5MG
Tenex TAB 1MG
Tenex TAB 2MG
Dibenzyline CAP 10MG
Vecamyl TAB 2.5MG
ANTIHYPERTENSIVE COMBO
TIER 01
TIER 03
GENERIC
amlod/benazp CAP 10-20MG
amlod/benazp CAP 2.5-10MG
atenol/chlor TAB 100-25MG
atenol/chlor TAB 50-25MG
benazep/hctz TAB 10-12.5
benazep/hctz TAB 20-25MG
bisoprl/hctz TAB 10/6.25
bisoprl/hctz TAB 2.5/6.25
bisoprl/hctz TAB 5-6.25MG
captopr/hctz TAB 25-15MG
enalapr/hctz TAB 10-25MG
enalapr/hctz TAB 5-12.5MG
fosinop/hctz TAB 10/12.5
fosinop/hctz TAB 20/12.5
irbesar/hctz TAB 150-12.5
irbesar/hctz TAB 300-12.5
lisinop/hctz TAB 10-12.5
lisinop/hctz TAB 20-12.5
lisinop/hctz TAB 20-25MG
losartan/HCT TAB 100-12.5
losartan/HCT TAB 100-25
losartan/HCT TAB 50-12.5
metoprl/hctz TAB 100-25MG
moexipr/hctz TAB 15-12.5
moexipr/hctz TAB 15-25MG
moexipr/hctz TAB 7.5-12.5
propran/hctz TAB 40/25
propran/hctz TAB 80/25
qnapril/hctz TAB 10-12.5
qnapril/hctz TAB 20-12.5
qnapril/hctz TAB 20-25MG
valsart/hctz TAB 160-12.5
valsart/hctz TAB 160-25MG
valsart/hctz TAB 320-25MG
NON PREFERRED
amlod/valsar TAB /hctz
ST
amlod/valsar TAB 10-160MG
ST
ST
ST
candesa/hctz TAB 16-12.5
candesa/hctz TAB 32-12.5
candesa/hctz TAB 32-25MG
methyld/hctz TAB 250/15
methyld/hctz TAB 250/25
nadolol/bend TAB 40-5MG
nadolol/bend TAB 80-5MG
telmis/amlod TAB 40-10MG
telmisa/hctz TAB 40-12.5
telmisa/hctz TAB 80-12.5
telmisa/hctz TAB 80-25MG
trando/verap TAB 1-240 CR
trando/verap TAB 1-240 ER
Accuretic TAB 10-12.5
Accuretic TAB 20-12.5
Accuretic TAB 20-25MG
ST
Amturnide150 TAB -5-12.5
ST
ST
Amturnide300 TAB -10-25MG
ST
ST
Amturnide300 TAB -5-25MG
Atacand HCT TAB 16-12.5
Atacand HCT TAB 32-12.5
Atacand HCT TAB 32-25MG
Avalide TAB 150-12.5
Avalide TAB 300-12.5
ST
Azor TAB 10-20MG
ST
Azor TAB 10-40MG
ST
Azor TAB 5-20MG
ST
Azor TAB 5-40MG
ST
Benicar HCT TAB 20-12.5
ST
Benicar HCT TAB 40-12.5
ST
Benicar HCT TAB 40-25MG
Byvalson TAB 5-80MG
Clorpres TAB 0.1-15MG
Corzide TAB 40-5MG
Corzide TAB 80-5MG
Diovan HCT TAB 160-12.5
Diovan HCT TAB 160-25MG
Diovan HCT TAB 320-12.5
Diovan HCT TAB 320-25MG
Diovan HCT TAB 80/12.5
Dutoprol TAB 100-12.5
ST
Edarbyclor TAB 40-12.5
ST
Edarbyclor TAB 40-25MG
ST
Exforge TAB 10-160MG
ST
Exforge TAB 10-320MG
ST
Exforge TAB 5-160MG
ST
Exforge TAB 5-320MG
Exforgeh/10- TAB 160-12.5
Exforgeh/10- TAB 160-25
Exforgeh/5- TAB 160-12.5
13
Hyzaar TAB 100-12.5
Hyzaar TAB 100-25
Hyzaar TAB 50-12.5
Lopress HCT TAB 100-25MG
Lopress HCT TAB 50-25MG
Lotensin HCT TAB 10-12.5
Lotensin HCT TAB 20-12.5
Lotensin HCT TAB 20-25MG
Lotrel CAP 10-20MG
Lotrel CAP 10-40MG
Lotrel CAP 2.5-10MG
Lotrel CAP 5-10MG
Lotrel CAP 5-20MG
Lotrel CAP 5-40MG
Micardis HCT TAB 40/12.5
Micardis HCT TAB 80-25MG
Micardis HCT TAB 80/12.5
Prestalia TAB 14-10MG
Prestalia TAB 3.5-2.5
Prestalia TAB 7-5MG
Tarka TAB 1-240 CR
Tarka TAB 2-180 CR
Tarka TAB 2-240 CR
Tarka TAB 4-240 CR
ST
Tekamlo TAB 150-10MG
ST
Tekamlo TAB 150-5MG
ST
Tekamlo TAB 300-10MG
ST
Tekamlo TAB 300-5MG
ST
Tekturna HCT TAB 150-12.5
ST
Tekturna HCT TAB 150-25MG
ST
Tekturna HCT TAB 300-12.5
ST
Tekturna HCT TAB 300-25MG
Tenoretic TAB 100
Tenoretic TAB 50
ST
Teveten HCT TAB 600-25MG
ST
Tribenzor20- TAB 5-12.5MG
ST
Tribenzor40- TAB 10-12.5
ST
Tribenzor40- TAB 10-25MG
ST
Tribenzor40- TAB 5-12.5MG
ST
Tribenzor40- TAB 5-25MG
Twynsta TAB 40-10MG
Twynsta TAB 40-5MG
Twynsta TAB 80-10MG
Twynsta TAB 80-5MG
Uniretic TAB 15-12.5
Vaseretic TAB 10-25MG
Zestoretic TAB 10-12.5
Zestoretic TAB 20-12.5
Zestoretic TAB 20-25MG
Ziac TAB 10/6.25
Ziac TAB 2.5/6.25
Ziac TAB 5-6.25MG
TIER 02
TIER 03
DIURETICS
TIER 01
GENERIC
acetazolamid CAP 500MG ER
acetazolamid TAB 125MG
acetazolamid TAB 250MG
amilor/hctz TAB 5-50
amiloride TAB 5MG
bumetanide inj 0.25/ML
bumetanide TAB 0.5MG
bumetanide TAB 1MG
bumetanide TAB 2MG
chlorothiaz TAB 250MG
chlorothiaz TAB 500MG
chlorthalid TAB 100MG
ethacrynic TAB acd 25MG
furosemide inj 10MG/ML
furosemide inj 100/10ML
furosemide inj 20MG/2ML
furosemide inj 40MG/4ML
furosemide sol 10MG/ML
furosemide sol 8MG/ML
furosemide TAB 20MG
furosemide TAB 40MG
furosemide TAB 80MG
hydrochlorot CAP 12.5MG
hydrochlorot TAB 12.5MG
hydrochlorot TAB 25MG
hydrochlorot TAB 50MG
indapamide TAB 1.25MG
indapamide TAB 2.5MG
methazolamid TAB 25MG
methazolamid TAB 50MG
methyclothia TAB 5MG
metolazone TAB 10MG
metolazone TAB 2.5MG
metolazone TAB 5MG
spirono/hctz TAB 25/25
spironolact TAB 100MG
torsemide TAB 10MG
torsemide TAB 100MG
torsemide TAB 20MG
torsemide TAB 5MG
triamt/hctz TAB 37.5-25
triamt/hctz TAB 75-50MG
Edecrin TAB 25MG
PREFERRED
Aldactazide TAB 50/50
Diuril Sus 250/5ML
Dyrenium CAP 100MG
Dyrenium CAP 50MG
NON PREFERRED
acetazolamid inj 500MG
triamt/hctz CAP 37.5-25
triamt/hctz CAP 50-25MG
Aldactazide TAB 25/25
Aldactone TAB 100MG
Aldactone TAB 25MG
Aldactone TAB 50MG
Bumex TAB 0.5MG
Bumex TAB 1MG
Bumex TAB 2MG
Demadex TAB 10MG
Demadex TAB 100MG
Demadex TAB 20MG
Demadex TAB 5MG
Diamox Seque CAP 500MG CR
Dyazide CAP 37.5-25
QL,PA
Keveyis TAB 50MG
Lasix TAB 20MG
Lasix TAB 40MG
Lasix TAB 80MG
Maxzide TAB 75-50
Maxzide-25 TAB
Microzide CAP 12.5MG
Neptazane TAB 25MG
Neptazane TAB 50MG
Zaroxolyn TAB 2.5MG
Zaroxolyn TAB 5MG
VASOPRESSORS
TIER 01
14
TIER 02
TIER 03
TIER 05
GENERIC
epinephrine inj 0.15MG
epinephrine inj 0.3MG
midodrine TAB 10MG
midodrine TAB 2.5MG
midodrine TAB 5MG
PREFERRED
Epipen 2-PAK Inj 0.3MG
Epipen-JR Inj 2-PAK
NON PREFERRED
ephedrine SU inj 50MG/ML
phenylephrin inj 10MG/ML
Adrenaclick Inj 0.15MG
Adrenaclick Inj 0.3MG
Adrenalin Inj 1MG/ML
Adrenalin Inj 30/30ML
Auvi-q Inj 0.15MG
Auvi-q Inj 0.3MG
Episnap Kit
QL,PA
Northera CAP 100MG
QL,PA
Northera CAP 200MG
QL,PA
Northera CAP 300MG
ANTIHYPERLIPIDEMICS
TIER 01
TIER 02
GENERIC
atorvastatin TAB 10MG
cholestyram pow 4gm
cholestyram pow 4gm lite
colestipol gra 5gm
colestipol TAB 1gm
fenofibrate CAP 130MG
fenofibrate TAB 160MG
fenofibric TAB 105MG
fenofibric TAB 35MG
gemfibrozil TAB 600MG
lovastatin TAB 10MG
lovastatin TAB 20MG
lovastatin TAB 40MG
pravastatin TAB 10MG
prevalite pow 4gm
prevalite pow 4gm pk
rosuvastatin TAB 10MG
simvastatin TAB 10MG
simvastatin TAB 5MG
Crestor TAB 10MG
Crestor TAB 20MG
Crestor TAB 40MG
Crestor TAB 5MG
PREFERRED
PA
Zetia TAB 10MG
TIER 03
NON PREFERRED
fenofibric CAP 135MG DR
fenofibric CAP 45MG DR
fluvastatin CAP 20MG
fluvastatin CAP 40MG
fluvastatin TAB 80MG ER
niacin ER TAB 1000MG
niacin ER TAB 500MG
niacin ER TAB 750MG
niacin TAB 500MG ER
niacor TAB 500MG
omega-3-acid CAP 1gm
Advicor TAB 1000-20
Advicor TAB 1000-40
Advicor TAB 500-20MG
Advicor TAB 750-20MG
Altoprev TAB 20MG ER
Antara CAP 30MG
Antara CAP 90MG
Atorva/Coq10 PAK 20-100MG
Colestid FLA Gra 5/7.5gm
Colestid FLA Gra 5gm
Colestid Gra 5gm
Colestid Pow 5gm
Colestid TAB 1gm
Fenoglide TAB 120MG
Fenoglide TAB 40MG
Fibricor TAB 105MG
Fibricor TAB 35MG
QL,PA
Juxtapid CAP 30MG
QL,PA
Juxtapid CAP 40MG
QL,PA
Juxtapid CAP 60MG
Lescol CAP 20MG
Lescol CAP 40MG
Lescol XL TAB 80MG
Lipitor TAB 10MG
Lipitor TAB 20MG
Lipitor TAB 40MG
Lipitor TAB 80MG
Lipofen CAP 150MG
Lipofen CAP 50MG
Livalo TAB 1MG
Livalo TAB 2MG
Livalo TAB 4MG
Lofibra CAP 134MG
Lofibra CAP 200MG
Lofibra CAP 67MG
Lofibra TAB 160MG
Lofibra TAB 54MG
Lopid TAB 600MG
Lovaza CAP 1gm
Mevacor TAB 40MG
Niaspan TAB 1000 ER
Niaspan TAB 500MG ER
Niaspan TAB 750MG ER
Omega-3/D-3 Kit Wellness
QL,PA
Praluent Inj 150MG/ML
QL,PA
Praluent Inj 75MG/ML
Pravachol TAB 20MG
Pravachol TAB 40MG
Pravachol TAB 80MG
Questran Pow 4gm
15
TIER 05
Questran Pow 4gm Lite
PA
Repatha Inj 140MG/ML
Repatha Push Inj 420/3.5
PA
Repatha Sure Inj 140MG/ML
Simcor TAB 1000-20
Simcor TAB 1000-40
Simcor TAB 500-20MG
Simcor TAB 500-40MG
Simcor TAB 750-20MG
Sure Result Kit O3d3 SYS
Tricor TAB 145MG
Tricor TAB 48MG
Triglide TAB 160MG
Trilipix CAP 135MG
Trilipix CAP 45MG
Vascepa CAP 1gm
PA
Vytorin TAB 10-10MG
PA
Vytorin TAB 10-20MG
PA
Vytorin TAB 10-40MG
PA
Vytorin TAB 10-80MG
Welchol PAK 3.75gm
Welchol TAB 625MG
Zocor TAB 10MG
Zocor TAB 20MG
Zocor TAB 40MG
Zocor TAB 5MG
Zocor TAB 80MG
QL,PA
Juxtapid CAP 10MG
QL,PA
Juxtapid CAP 20MG
QL,PA
Juxtapid CAP 5MG
QL,PA
Kynamro Inj 200MG/ML
QL,PA
TIER 04
TIER 05
CARDIOVASCULAR - MISC.
TIER 01
TIER 02
TIER 03
GENERIC
papaverine inj 30MG/ML
papaverine sol 30MG/ML
PREFERRED
PA
Entresto TAB 24-26MG
PA
PA
NON PREFERRED
amlod/atorva TAB 10-10MG
amlod/atorva TAB 2.5-10MG
isoxsuprine TAB HCL 20MG
isoxsuprine TAB 10MG
Bidil TAB
Caduet TAB 10-10MG
Caduet TAB 10-20MG
Caduet TAB 10-40MG
Caduet TAB 10-80MG
Caduet TAB 2.5-10MG
Caduet TAB 2.5-20MG
Caduet TAB 2.5-40MG
Caduet TAB 5-10MG
Caduet TAB 5-20MG
Caduet TAB 5-40MG
Caduet TAB 5-80MG
PA
Corlanor TAB 5MG
PA
Corlanor TAB 7.5MG
Orenitram TAB 0.125MG
PA
Revatio Sus 10MG/ML
SPECIALTY
PA
sildenafil TAB 20MG
QL,PA
Letairis TAB 10MG
QL,PA
Letairis TAB 5MG
QL,PA
Opsumit TAB 10MG
QL,PA
Tracleer TAB 125MG
QL,PA
Tracleer TAB 62.5MG
QL,PA
Tyvaso Refil Sol 0.6MG/ML
QL,PA
Tyvaso Sol 0.6MG/ML
QL,PA
Tyvaso Start Sol 0.6MG/ML
QL,PA
Uptravi TAB 1000mcg
QL,PA
Uptravi TAB 1200mcg
QL,PA
Uptravi TAB 1400mcg
QL,PA
Uptravi TAB 1600mcg
QL,PA
Uptravi TAB 200/800
QL,PA
Uptravi TAB 200mcg
QL,PA
Uptravi TAB 400mcg
QL,PA
Uptravi TAB 600mcg
QL,PA
Uptravi TAB 800mcg
QL,PA
Ventavis Sol 10mcg/ML
QL,PA
Ventavis Sol 20mcg/ML
QL,PA
Adcirca TAB 20MG
QL,PA
Adempas TAB 0.5MG
QL,PA
Adempas TAB 1.5MG
QL,PA
Adempas TAB 1MG
QL,PA
Adempas TAB 2.5MG
QL,PA
Adempas TAB 2MG
QL,PA
Orenitram TAB 0.25MG
QL,PA
Orenitram TAB 1MG
QL,PA
Orenitram TAB 2.5MG
PA
Revatio TAB 20MG
DERMATOLOGICALS
ACNE PRODUCTS
TIER 01
GENERIC
adapalene gel pmp 0.3%
adapalene gel 0.1%
adapalene gel 0.3%
adapalene lot 0.1%
adapalene CRE 0.1%
amnesteem CAP 10MG
amnesteem CAP 20MG
amnesteem CAP 40MG
avar cleanse emu 10-5%
avita gel 0.025%
avita CRE 0.025%
claravis CAP 10MG
claravis CAP 20MG
claravis CAP 30MG
claravis CAP 40MG
clindacin mis etz 1%
clindacin-p pad 1%
clindamax gel 1%
clindamy/ben gel 1-5%
clindamycin gel 1%
clindamycin lot 1%
clindamycin lot 10MG/ML
clindamycin pad 1%
clindamycin sol 1%
erythromycin gel /benzoyl
erythromycin gel 2%
erythromycin sol 2%
myorisan CAP 10MG
myorisan CAP 20MG
myorisan CAP 30MG
myorisan CAP 40MG
16
TIER 02
TIER 03
prascion emu
rosanil emu cleanser
sod SUL/sulf emu 10-5%
sod SUL/sulf lot 10-5%
sulfacetamid lot 10%
sulfacetamid sus 10%
tretinoin gel 0.01%
tretinoin gel 0.025%
tretinoin gel 0.04%
tretinoin gel 0.04%pmp
tretinoin gel 0.1%
tretinoin gel 0.1%P.M.
tretinoin CRE 0.025%
tretinoin CRE 0.05%
tretinoin CRE 0.1%
zenatane CAP 10MG
zenatane CAP 20MG
zenatane CAP 30MG
zenatane CAP 40MG
Differin CRE 0.1%
Differin Gel 0.1%
Retin-a CRE 0.025%
Retin-a CRE 0.05%
Retin-a CRE 0.1%
Retin-a Gel 0.01%
Retin-a Gel 0.025%
Retin-a Micr Gel 0.04%
Retin-a Micr Gel 0.04%pmp
Retin-a Micr Gel 0.1%
Retin-a Micr Gel 0.1%P.M.
PREFERRED
Azelex CRE 20%
Differin Lot 0.1%
NON PREFERRED
avar-e emoll CRE 10-5%
avar-e green CRE 10-5%
benzepro mis 6%
bp cleansing emu 10-4%
bp 10-1 emu
bpo cloths mis 3%
bpo cloths mis 6%
bpo cloths mis 9%
bpo gel 4%
bpo gel 8%
cerisa wash emu 10-1%
claris wash emu 10-4%
clearplex X gel 10%
clindamy/ben gel 1.2-5%
clindamycin aer 1%
clindamycin gel tretinoi
ery pad 2%
erythromycin pad 2%
neuac gel 1.2-5%
oscion clnsr lot 6%
prascion ra CRE 10-5%
rosula pad 10-5%
sod SUL/sulf gel 10-5%
sod SUL/sulf kit
sod SUL/sulf liq wash
sod SUL/sulf liq 10-2%
sod SUL/sulf liq 9.8-4.8%
sod SUL/sulf liq 9-4.5%
sod SUL/sulf lot 9.8-4.8%
sod SUL/sulf pad 10-4%
sod SUL/sulf pad 10-5%
sod SUL/sulf sus 10-5%
sod SUL/sulf sus 8-4%
sod SUL/sulf CRE 10-2%
sod SUL/sulf CRE 10-5%
sod SUL/sulf CRE 9.8-4.8%
ss 10-2 sol 10-2%
sss CRE 10%-5%
sss 10-5 aer 10-5%
sulfacleanse sus 8-4%
tretinoin gel 0.05%
virti-sulf CRE 10-5%
zaclir lot 8%
zencia liq 9-4%
Absorica CAP 10MG
Absorica CAP 20MG
Absorica CAP 25MG
Absorica CAP 30MG
Absorica CAP 35MG
Absorica CAP 40MG
Acanya Gel 1.2-2.5%
Aczone Gel 5%
Akne-mycin Oin 2%
Atralin Gel 0.05%
Avar Aer 9.5-5%
Avar LS Aer 10-2%
Avar LS Liq 10-2%
Avar-e LS CRE 10-2%
Benzaclin Gel 1-5%
Benzaclin Gel 1-5%P.M.
Benzamycin Gel PAK
Benzamycin Gel 5-3%
Benziq Gel 5.25%
Benziq LS Gel 2.75%
Clarifoam EF Aer 10-5%
Cleocin-t Gel 1%
Cleocin-t Lot 1%
Cleocin-t Pad 1%
Cleocin-t Sol 1%
Clindacin Kit Etz 1%
Clindacin Kit PAC 1%
Clindagel Gel 1%
Dermapak PAK Plus
Differin Gel 0.3%
Duac Gel 1.2-5%
Epiduo Forte Gel 0.3-2.5%
Epiduo Gel 0.1-2.5%
Erygel Gel 2%
Evoclin Aer 1%
Fabior Aer 0.1%
Inova Kit 4%
Inova Kit 8%
Inova 4/1 Kit Acne CON
Inova 8/2 Kit Acne CON
Klaron Lot 10%
Nuox Gel 6-3%
Onexton Gel 1.2-3.75
Plexion Clth Pad 9.8-4.8%
Plexion CRE 9.8-4.8%
Plexion Liq 9.8-4.8%
Plexion Lot 9.8-4.8%
Rosanil Kit
Rosula Liq 10-4.5%
Sulfoam Sha 2%
Sumadan Kit
Sumadan Wash Liq 9-4.5%
Sumaxin CP Kit
Sumaxin Pad 10-4%
Sumaxin Ts Sus 8-4%
Sumaxin Wash Liq 9-4%
SUL sod/sulf liq 10-2%
SUL sod/sulf pad 10-4%
Tretin-x CRE 0.0375%
Vanoxide-HC Lot 5-0.5%
Veltin Gel
Zacare Kit Kit 4%
17
Zacare Kit Kit 8%
Ziana Gel
clotrimazole CRE 1%
dermazene CRE 1%
econazole CRE 1%
exoderm lot 25-1%
hydrocort/ CRE iodoquin
ketoconazole aer 2%
ketodan aer 2%
naftifine CRE HCL 1%
naftifine CRE HCL 2%
oxiconazole CRE nitrate
Ala-quin CRE 3-0.5%
Alcortin A Gel
Alcortin A Gel 1-2-1%
Aloquin Gel 1.25-1%
Cnl8 Nail Kit
Dermacinrx PAK Therazol
Dermasorb AF Kit 3-0.5%
Ecoza Aer 1%
Ertaczo CRE 2%
Exelderm CRE 1%
Exelderm Sol 1%
Extina Aer 2%
Halotin CRE 1%
Jublia Sol 10%
Kerydin Sol 5%
Loprox CRE 0.77%
Loprox Sha 1%
Lotrisone CRE
Luzu CRE 1%
Naftin CRE 1%
Naftin CRE 2%
Naftin Gel 1%
Naftin Gel 2%
Nizoral Sha 2%
Oxistat CRE 1%
Oxistat Lot 1%
Pediaderm AF Kit Complete
Pedipak PAK
Penlac Sol 8%
Vusion Oin
Xolegel Duo/ Kit Head&shd
Xolegel Duo/ Kit Xolex
Xolegel Gel 2%
Xolegel Kit Corepak
ROSACEA AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
metronidazol gel 0.75%
metronidazol CRE 0.75%
rosadan gel 0.75%
rosadan CRE 0.75%
PREFERRED
Finacea Aer 15%
Finacea Gel 15%
NON PREFERRED
metronidazol gel 1%
metronidazol lot 0.75%
Metrocream CRE 0.75%
Metrogel Gel 1%
Metrolotion Lot 0.75%
Metronidazole 0.75% Jelly
Mirvaso Gel 0.33%
Noritate CRE 1%
PA
Oracea CAP 40MG
Rosadan Kit 0.75%
Soolantra CRE 1%
ANTIBIOTICS - TOPICAL
TIER 01
TIER 02
TIER 03
GENERIC
gentamicin oin 0.1%
gentamicin CRE 0.1%
mupirocin oin 2%
mupirocin CA CRE 2%
mupirocin CRE 2%
PREFERRED
Cortisporin Oin 1%
NON PREFERRED
centany oin 2%
Altabax Oin 1%
Bactroban CRE 2%
Bactroban Oin 2%
Centany AT Kit 2%
Cortisporin CRE 0.5%
Neo-synalar CRE
Neo-synalar Kit
ANTIFUNGALS - TOPICAL
TIER 01
TIER 03
GENERIC
ciclodan sol 8%
ciclodan CRE 0.77%
ciclopirox gel 0.77%
ciclopirox sol 8%
ciclopirox sus 0.77%
ciclopirox CRE 0.77%
clotrim/beta lot diprop
clotrim/beta CRE diprop
clotrim/beta CRE 1-0.05%
ketoconazole sha 2%
ketoconazole CRE 2%
nyamyc pow 100000
nystat/triam oin
nystat/triam CRE
nystatin oin 100000
nystatin pow 100000
nystatin CRE 100000
nystop pow 100000
NON PREFERRED
ciclopirox kit 8%
ciclopirox sha 1%
clotrimazole sol 1%
ANTIVIRALS - TOPICAL
TIER 03
NON PREFERRED
acyclovir oin 5%
Denavir CRE 1%
Lidovir Oin 4-4%
Xerese CRE 5-1%
Zovirax CRE 5%
Zovirax Oin 5%
ANTI-INFLAMMATORY AGENTS
TIER 03
NON PREFERRED
diclofenac gel 1%
diclofenac sol 1.5%
diclofenac CRE sodium
diclofex dc mis
diclotral PAK
klofensaid sol II
sure result mis dss pack
xelitral PAK
Active-prep CRE Kit I
Dermacinrx PAK Lexitral
Dsg PAK Pak
Flector Dis 1.3%
Napropax Mis
18
Naproxenpax Mis
Pennsaid Sol 1.5%
Pennsaid Sol 2%
Rexaphenac CRE 1%
Voltaren Gel 1%
ANTIPRURITICS
TIER 03
NON PREFERRED
doxepin HCL CRE 5%
prudoxin CRE 5%
Prudoxin CRE 5%
Zonalon CRE 5%
ANTIPSORIATICS
TIER 01
TIER 02
TIER 03
TIER 04
TIER 05
GENERIC
acitretin CAP 10MG
acitretin CAP 17.5MG
acitretin CAP 25MG
calcipotrien oin 0.005%
calcipotrien sol 0.005%
calcipotrien CRE 0.005%
calcitrene oin 0.005%
dritho-creme CRE HP 1%
Vectical Oin 3mcg/Gm
PREFERRED
Tazorac CRE 0.05%
Tazorac CRE 0.1%
Tazorac Gel 0.05%
Tazorac Gel 0.1%
NON PREFERRED
calcitriol oin 3mcg/gm
Dovonex CRE 0.005%
Soriatane CAP 10MG
Soriatane CAP 17.5MG
Soriatane CAP 25MG
Sorilux Aer 0.005%
Zithranol Sha 1%
Zithranol-rr CRE 1.2%
SPECIALTY
QL
methoxsalen CAP 10MG
QL,PA
Cosentyx Inj 150MG/ML
QL,PA
Cosentyx Pen Inj 150MG/ML
QL,PA
Stelara Inj 45MG/0.5
QL,PA
Stelara Inj 90MG/ML
QL
Oxsoralen-ul CAP 10MG
QL,PA
Taltz Inj 80MG/ML
QL,PA
8-mop CAP 10MG
ANTISEBORRHEIC AGENTS
TIER 01
TIER 03
GENERIC
selenium SUL lot 2.5%
sod sulfacet sha 10%
NON PREFERRED
seb-prev liq wash
selenium SUL sha 2.25%
sod sulfacet gel 10%
sodium SULFA liq 10% wash
Loutrex CRE
Ovace Plus Aer 9.8%
Ovace Plus CRE 10%
Ovace Plus Gel 10% Wash
Ovace Plus Liq 10% Wash
Ovace Plus Sha 10%
Ovace Wash Liq 10%
Promiseb CRE
Selrx Sha 2.3%
Sodium SULFA Liq 10% Wash
Tersi Foam Aer 2.25%
TL Triseb CRE
CORTICOSTEROIDS - TOPICAL
TIER 01
GENERIC
alphatrex gel 0.05%
aug betamet gel 0.05%
aug betamet lot 0.05%
aug betamet oin 0.05%
aug betamet CRE 0.05%
betameth dip lot 0.05%
betameth dip oin 0.05%
betameth dip CRE 0.05%
betameth val aer 0.12%
betameth val lot 0.1%
betameth val oin 0.1%
betameth val CRE 0.1%
clobetasol gel 0.05%
clobetasol sol 0.05%
cormax scalp sol 0.05%
desonide lot 0.05%
desonide oin 0.05%
desonide CRE 0.05%
desoximetas gel 0.05%
desoximetas oin 0.05%
desoximetas oin 0.25%
desoximetas CRE 0.05%
desoximetas CRE 0.25%
fluocin acet oil body
fluocin acet oil scalp
fluocin acet oil 0.01% sc
fluocin acet oil 0.01%bdy
fluocin acet oin 0.025%
fluocin acet sol 0.01%
fluocin acet CRE 0.01%
fluocin acet CRE 0.025%
fluocinonide gel 0.05%
fluocinonide oin 0.05%
fluocinonide sol 0.05%
fluocinonide CRE -e 0.05%
fluocinonide CRE 0.05%
halobetasol oin 0.05%
halobetasol CRE 0.05%
hydrocort lot 2.5%
hydrocort oin 1%
hydrocort oin 2.5%
hydrocort CRE 2.5%
hydrocort/ab oin 1%
lokara lot 0.05%
mometasone oin 0.1%
mometasone sol 0.1%
mometasone CRE 0.1%
synalar oin 0.025%
synalar CRE 0.025%
triamcinolon lot 0.025%
triamcinolon lot 0.1%
triamcinolon oin 0.025%
triamcinolon CRE 0.025%
triderm CRE 0.1%
Desowen CRE 0.05%
Desowen Lot 0.05%
HC butyrate oin 0.1%
HC butyrate sol 0.1%
HC butyrate CRE 0.1%
HC pramoxine CRE 2.5-1%
HC valerate oin 0.2%
19
TIER 02
TIER 03
HC valerate CRE 0.2%
PREFERRED
Capex Sha 0.01%
Cordran 24X3 Tap 4mcg/CM
Cordran 80X3 Tap 4mcg/CM
Pramosone CRE 1-1%
Pramosone CRE 1%
Pramosone Lot 1%
Pramosone Lot 2.5%
Pramosone Oin 1%
Pramosone Oin 2.5%
NON PREFERRED
ala cort CRE 1%
alclometason oin 0.05%
alclometason CRE 0.05%
amcinonide lot 0.1%
amcinonide oin 0.1%
amcinonide CRE 0.1%
apexicon e CRE 0.05%
calcipotrien oin betameth
clobetasol aer 0.05%
ST
clobetasol e CRE 0.05%
clobetasol lot 0.05%
ST
clobetasol oin 0.05%
clobetasol sha 0.05%
clobetasol spr 0.05%
ST
clobetasol CRE 0.05%
clocortolone CRE piv 0.1%
clodan sha 0.05%
diflorasone oin 0.05%
diflorasone CRE 0.05%
fluocinonide CRE 0.1%
flurandrenol CRE 0.05%
fluticasone lot 0.05%
fluticasone oin 0.005%
fluticasone CRE 0.05%
halac kit
hydrocort CRE 1%
prednicarbat oin 0.1%
prednicarbat CRE 0.1%
scalacort lot 2%
triamcinolon aer spray
trianex oin 0.05%
Aclovate CRE 0.05%
Adv Allergy Kit Collecti
Ala Scalp Lot 2%
Apexicon E CRE 0.05%
Clobex Lot 0.05%
Clobex Sha 0.05%
Clobex Spr 0.05%
Clodan Kit 0.05%
Cloderm CRE 0.1%
Cloderm CRE 0.1% Pmp
Cordran CRE 0.05%
Cordran Lot 0.05%
Cordran Oin 0.05%
Cortane-b Lot
Cutivate CRE 0.05%
Cutivate Lot 0.05%
Derma-smooth Oil /FS Body
Derma-smooth Oil /FS Sclp
Dermasorb HC Kit 2%
Dermasorb Ta Kit 0.1%
Dermatop CRE 0.1%
Dermatop Oin 0.1%
Dermazone Mis
Desonate Gel 0.05%
Diprolene AF CRE 0.05%
Diprolene Lot 0.05%
Diprolene Oin 0.05%
Elocon CRE 0.1%
Elocon Lot 0.1%
Elocon Oin 0.1%
Enstilar Aer
Epifoam Aer 1%
Halog CRE 0.1%
Halog Oin 0.1%
HC ac/aloe gel 2%
Kenalog Aer Spray
Locoid CRE 0.1%
Locoid Lipo CRE 0.1%
Locoid Lot 0.1%
Locoid Oin 0.1%
Locoid Sol 0.1%
Luxiq Aer 0.12%
Novacort Gel
Noxipak PAK
Nucort Lot 2%
Nuzon Gel 2%
Olux Aer 0.05%
Olux-e Aer 0.05%
Pandel CRE 0.1%
Pediaderm HC Kit
Pediaderm Ta Kit
Pramosone CRE 1-2.5%
Pramosone E CRE 1-2.5%
Psorcon CRE 0.05%
Scalacort DK Kit
Sernivo Spr
Silazone PAK Pharmapa
Silazone-II PAK
Synalar Kit 0.025%
Synalar Sol 0.01%
Synalar Ts Kit 0.01%
Taclonex Oin
Taclonex Sus
ST
Temovate CRE 0.05%
ST
Temovate E CRE 0.05%eml
Temovate Gel 0.05%
ST
Temovate Oin 0.05%
Temovate Sol 0.05%
Texacort Sol 2.5%
Topicort CRE 0.05%
Topicort CRE 0.25%
Topicort Gel 0.05%
Topicort Oin 0.05%
Topicort Oin 0.25%
Topicort Spr 0.25%
Triamsil PAK Combipak
Triamsil PAK Multipak
Trianex Oin 0.05%
Ultravate CRE 0.05%
Ultravate Lot 0.05%
Ultravate Oin 0.05%
Ultravate X Kit 0.05-10%
Vanos CRE 0.1%
Verdeso Aer 0.05%
Westcort Oin 0.2%
Whytederm Kit Trilasil
Whytederm TD Kit PAK
Xilapak Kit
IMMUNOMODULATING AGENTS
TIER 01
TIER 02
GENERIC
imiquimod CRE 5%
tacrolimus oin 0.03%
tacrolimus oin 0.1%
PREFERRED
Elidel CRE 1%
20
TIER 03
NON PREFERRED
Aldara CRE 5%
Protopic Oin 0.03%
Protopic Oin 0.1%
Zyclara CRE 3.75%
Zyclara P.M. CRE 2.5%
Zyclara P.M. CRE 3.75%
DERMATOLOGICALS - MISC.
TIER 01
TIER 02
TIER 03
GENERIC
dermacinrx kit prizopak
glydo gel 2%
hypercare sol 20%
leva set kit
lido/prilocn kit 2.5-2.5%
lido/prilocn CRE 2.5-2.5%
lidocaine gel 2%
lidocaine gel 2% jelly
lidocaine pad 5%
lidocaine-pr CRE
lidopril kit 2.5-2.5%
lidopril XR kit 2.5-2.5%
livixil PAK kit 2.5-2.5%
permethrin CRE 5%
podofilox sol 0.5%
rea LO 40 CRE 40%
relador PAK kit plus
relador PAK kit 2.5-2.5%
urea CRE 40%
x-viate CRE 40%
CARB-o-philc CRE /40
LP lite PAK kit 2.5-2.5%
PREFERRED
Condylox Gel 0.5%
Drysol Sol 20%
Eurax CRE 10%
Eurax Lot 10%
Ulesfia Lot 5%
NON PREFERRED
ammonium lac lot 12%
ammonium lac CRE 12%
anodynz mis 0.0375-5
avalin-RX pad 4-1%
cem-urea sol 45%
ceramax CRE
cerovel gel 40%
cerovel lot 40%
cidaleaze CRE 3%
cocaine HCL sol 4%
elenzapatch dis 4-1%
ethyl chlor aer fine pin
ethyl chlor aer fn strm
ethyl chlor aer mist
ethyl chlor aer spray
ethyl chlor aer MED jet
ethyl chlor aer MED strm
hyaluronate gel 0.2%
k2k pain rel pad 4-4%
lactic acid lot 10%
lactic acid CRE /vit e
lactic acid CRE e
latrix sus 50%
lidenza pad 4-1%
lidocaine lot 3%
lidocaine oin PAK 5%
lidocaine oin 5%
lidocaine sol 4%
lidocaine CRE 3%
lidodextrapi pad 4-1%
lidopin CRE 3%
lindane lot 1%
lindane sha 1%
lorenza pad 4-1%
malathion lot 0.5%
migryl mis 0.0375-5
podocon sol 25%
pramox gel 1%
provenza pad 4-1%
pyrogall acd oin
rea LO 39 CRE 39%
rea LO 40 lot 40%
reciphexamin dis 4-1%
releevia ML pad 4-1%
remeven CRE 50%
salacyn lot 6%
salacyn CRE 6%
salicylic ac aer 6%
salicylic ac gel 6%
salicylic ac kit 6%
salicylic ac kit 6% cream
salicylic ac kit 6% lotn
salicylic ac liq 26%
salicylic ac liq 27.5%
salicylic ac lot 6%
salicylic ac sha 6%
salicylic ac CRE 6%
salicylic aer 6%
salvax aer 6%
spinosad sus 0.9%
synvexia pad 4-1%
tetrix CRE
umecta mouss aer 40%
uramaxin aer 20%
ure-k CRE 50%
urea gel 40%
urea hydrati aer 35%
urea lot 40%
urea lot 45%
urea nail gel 45%
urea nail kit
urea sus 50%
urea topical sus 40%
urea CRE 39%
urea CRE 45%
urea CRE 47%
urea CRE 50%
urea 40% sus nail
urea-c40 lot 40%
x-viate gel 40%
x-viate lot 40%
xyphex mis
zeruvia pad 4-1%
Accucaine Inj 1%
Acuicyn Liq
Adazin CRE
Aluvea CRE 39%
Anacaine Oin
Astero Gel 4%
Atendia Pad 4-3%
Atopiclair CRE
Avenova Sol Neutrox
Avenova Sol 0.01%
Bensal HP Oin
Captracin Pad .0375-5%
Ceracade Emu
Cetacaine Aer
Condylox Sol 0.5%
CARB-o-philc gel 40%
Dermacinrx Kit Combopak
21
Dermacinrx Kit Pharmapa
Dermacinrx PAK
Dermacinrx PAK Duopatch
Dermacinrx PAK Phn
Dermacinrx PAK Zrm
Dermasorb XM Kit 39%
Dermazyl PAK 5%
Eletone CRE
Eletone CRE Twinpack
Elimite CRE 5%
Emla CRE 2.5-2.5%
Emulsion SB Emu
Entty Emu Spray
Epiceram Emu
Flexin Pad .0375-5%
Gebauers Spr Aer /Stretch
Gordons Urea Oin 40%
Hydro 35 Aer
Hydro 40 Aer Foam
Hylatopic Aer
Hylatopic Aer Plus
Hylatopic CRE Plus
Hylira Gel 0.2%
Hylira Lot 0.1%
HPR Aer
HPR Plus Aer
HPR Plus CRE
Kerafoam Aer 30%
Kerafoam 42 Aer 42%
Keralac CRE 47%
Keralyt Gel 6%
Keralyt Kit Scalp 6%
Lac-hydrin CRE 12%
Lac-hydrin Lot 12%
Ldo Plus Gel 4%
Levatio Pad 0.3-5%
Lido-k Lot 3%
Lidocin Gel 3%
Lidoderm Dis 5%
Lidorx Gel 3%
Lidothol Pad 4.5-5%
Lidotral CRE 3.88%
Lidovin CRE 3.95%
Lidozol CRE 3.75%
Lycelle Gel
Mac Patch Pad .0375-5%
Medi-patch Pad RX
Megrix Mis
Mentho-caine Kit 5-8%
Menthocin Pad Lidocain
Mentholix Spr 4-1%
Natroba Sus 0.9%
Neosalus Aer
Neosalus CP CRE
Neosalus CRE
Neuvaxin Pad 0.0375-5
Nivatopic CRE Plus
Ovide Lot 0.5%
Oxsoralen Lot 1%
Pain Ease Aer Mist
Pain Ease Aer MD Strm
Pain Relief Pad Patch
Permavan Pad
Presera Aer
Prozena Pad 4%
Pruclair CRE
Prumyx CRE
Qroxin Pad
Qutenza Kit 8% 1-pch
Qutenza Kit 8% 2-pch
Releevia Mc Pad .0375-5%
Releevia Pad .0375-5%
Remaxazon Pad
Renovo Pad 0.0375-5
Rynoderm CRE 37.5%
Salex Cream Kit 6%
Salex Lotion Kit 6%
Salex Sha 6%
Salkera Aer 6%
Salvax Aer 6%
Salvax Duo Kit Plus
Sinelee Pad 0.0375-5
Sklice Lot 0.5%
Solupak PAK
Soothee Pad
Synera Dis 70-70MG
Tetramex Spr 2-1-3%
Tropazone Lot
Umecta Emu
Umecta Nail Sus Film
Umecta PD Emu 40-0.3%
Umecta PD Sus 40-0.3%
Umecta Sus 40%
Uramaxin CRE 45%
Uramaxin Gel 45%
Uramaxin GT Gel 45%
Uramaxin Lot 45%
Urea Nail Mis 50%
Urevaz CRE 44%
Utopic CRE 41%
Veregen Oin 15%
Virasal Liq 27.5%
Xeralux CRE
Xylocaine Sol 4%
ENDOCRINE AND METABOLIC
CORTICOSTEROIDS
TIER 01
GENERIC
a-hydrocort inj 100MG
baycadron elx 0.5/5ML
cortisone ac TAB 25MG
deltasone TAB 20MG
dexameth PHO inj 10MG/ML
dexameth PHO inj 120MG/30
dexameth PHO inj 20MG/5ML
dexameth PHO inj 4MG/ML
dexamethason elx 0.5/5ML
dexamethason sol 0.5/5ML
dexamethason TAB 0.5MG
dexamethason TAB 1MG
fludrocort TAB 0.1MG
hydrocort TAB 10MG
hydrocort TAB 20MG
hydrocort TAB 5MG
methylpr ace inj 40MG/ML
methylpr ace inj 80MG/ML
methylpr ss inj 1000MG
methylpred TAB 16MG
methylpred TAB 32MG
methylpred TAB 4MG
methylpred TAB 8MG
pred sod PHO sol 5MG/5ML
22
TIER 02
TIER 03
prednisolone sol 15MG/5ML
prednisolone sol 25MG/5ML
prednisolone syp 15MG/5ML
prednisone sol 5MG/5ML
prednisone PAK 10MG
prednisone PAK 5MG
prednisone TAB 1MG
prednisone TAB 10MG
prednisone TAB 2.5MG
prednisone TAB 20MG
prednisone TAB 5MG
prednisone TAB 50MG
PREFERRED
Depo-medrol Inj 20MG/ML
Dexamethason CON 1MG/ML
Medrol TAB 2MG
Solu-medrol Inj 2gm
NON PREFERRED
beta-phos/ac inj 3-3MG/ML
betameth SP inj 24MG/2ML
methylp/lido inj 40-10/ML
methylp/lido inj 80-10/ML
methylprd PF inj 160/2ML
methylprd PF inj 40MG/ML
methylprd PF inj 80MG/ML
methylpredni inj 100MG/ML
prednisolone TAB 10MG odt
triamcinolon inj 40MG/ML
triamcinolon inj 80MG/2ML
triamcn/lido inj 40MG-1%
Active Injec Inj Dl
Active Injec Inj M-1
Active Injec Kit Blm-1
Active Injec Kit Bm
Active Injec Kit D
Active Injec Kit Dlm
Active Injec Kit Km
Active Injec Kit Lm-dep-1
Aristospan Inj 20MG/ML
Beta 1 Kit Kit 30MG/5ML
Betalido Kit
Betaloan Sui Inj 3-3MG/ML
Betameth Com Inj 7MG/ML
Betameth PF Inj 12MG/2ML
Bt Injection Kit 40-0.5%
Bupivilog Kit
Celestone Inj Soluspan
Cortef TAB 10MG
Cortef TAB 20MG
Cortef TAB 5MG
Dex Combo Inj 8-4MG/ML
Dex LA 16 Inj 16MG/ML
Dex LA 8 Inj 8MG/ML
Dexlido Kit
Dexlido-m Kit
Dexpak PAK 10 Day
Dexpak PAK 13 Day
Dexpak PAK 6 Day
Doubledex Kit
Dyural-l Kit
Dyural-lm Kit
Dyural-40 Kit
Dyural-80 Kit
Kenalog-10 Inj 10MG/ML
TIER 05
Kenalog-40 Inj 40MG/ML
Lidolog Kit
LT Injection Kit
Marbeta-l Kit
Marbeta-25 Kit
Mardex-25 Kit
Medrol TAB 16MG
Medrol TAB 32MG
Medrol TAB 4MG
Medrol TAB 8MG
Medroloan II Kit 40MG/ML
Medroloan Kit 40MG/ML
Millipred DP PAK 5MG
Millipred Sol 10MG/5ML
Millipred TAB 5MG
Mlk F1 Kit
Mlk F2 Kit
Mlk F3 Kit
Mlk F4 Kit
Mlp A-1 Kit
Multi- Kit Specialt
Orapred Odt TAB 10MG
Pediapred Sol 6.7/5ML
Prednisone CON 5MG/ML
Pro-c-dure 5 Kit 40MG/ML
Pro-c-dure 6 Kit 40MG/ML
Rayos TAB 1MG
Rayos TAB 2MG
Rayos TAB 5MG
Solu-cortef Inj 100MG
Solu-medrol Inj 1gm
Solu-medrol Inj 125MG
Triloan II Kit 40MG/ML
Triloan Suik Kit 40MG/ML
Veripred 20 Sol 20MG/5ML
budesonide CAP 3MG DR
Entocort EC CAP 3MG DR
QL
Uceris TAB 9MG
ANDROGENS-ANABOLIC
TIER 01
TIER 03
GENERIC
danazol CAP 100MG
danazol CAP 200MG
danazol CAP 50MG
PA
testost cyp inj 100MG/ML
PA
testost cyp inj 200MG/ML
PA
testost enan inj 200MG/ML
QL,PA
testosterone gel P.M. 1%
QL,PA
testosterone gel 1%(25MG)
QL,PA
testosterone gel 1%(50MG)
testosterone inj 250MG/ML
PA
Depo-testost Inj 200MG/ML
NON PREFERRED
PA
methyltestos CAP 10MG
oxandrolone TAB 10MG
oxandrolone TAB 2.5MG
QL,PA
testosterone gel 10MG/act
Anadrol-50 TAB 50MG
QL,PA
Androderm Dis 2MG/24HR
QL,PA
Androderm Dis 4MG/24HR
QL,PA
Androgel Gel P.M. 1%
23
QL,PA
Androgel Gel 1.62%
QL,PA
Androgel Gel 1%(25MG)
QL,PA
Androgel Gel 1%(50MG)
PA
Android CAP 10MG
Androxy TAB 10MG
QL,PA
Axiron Sol 30MG/Act
PA
Depo-testost Inj 100MG/ML
QL
First-testos CRE Mc 2%
QL,PA
Fortesta Gel 10MG/Act
PA
Methitest TAB 10MG
QL,PA
Natesto Gel 5.5MG
Oxandrin TAB 10MG
Oxandrin TAB 2.5MG
QL,PA
Striant Mis 30MG
Test Eo-pro- Inj Cyp 220
QL,PA
Testim Gel 1%(50MG)
Testone Cik Kit 200MG/ML
PA
Testred CAP 10MG
noreth/ethin TAB 1MG-5mcg
Activella TAB 0.5-0.1
Activella TAB 1-0.5MG
Alora Dis 0.025MG
Alora Dis 0.05MG
Alora Dis 0.075MG
Alora Dis 0.1MG
Angeliq TAB 0.25-0.5
Angeliq TAB 0.5-1MG
Climara Pro Dis Weekly
Combipatch Dis .05/.14
Combipatch Dis .05/.25
Delestrogen Inj 20MG/ML
Divigel Gel 0.25MG
Divigel Gel 0.5MG
Divigel Gel 1MG/Gm
Duavee TAB 0.45-20
Elestrin Gel 0.06%
Enjuvia TAB 0.3MG
Enjuvia TAB 0.45MG
Enjuvia TAB 0.625MG
Enjuvia TAB 0.9MG
Enjuvia TAB 1.25MG
Estrace TAB 0.5MG
Estrace TAB 1MG
Estrace TAB 2MG
Estrogel Gel
Evamist Spr 1.53MG
Femhrt TAB 0.5-2.5
Menest TAB 0.3MG
Menest TAB 0.625MG
Menest TAB 1.25MG
Menest TAB 2.5MG
Minivelle Dis 0.025 MG
Minivelle Dis 0.0375MG
Minivelle Dis 0.1MG
Prefest TAB
Premarin Inj 25MG
Premarin TAB 0.3MG
Premarin TAB 0.45MG
Premarin TAB 0.625MG
Premarin TAB 0.9MG
Premarin TAB 1.25MG
Premphase TAB
Prempro TAB .625-2.5
Prempro TAB 0.3-1.5
Prempro TAB 0.45-1.5
Prempro TAB 0.625-5
Vivelle-dot Dis 0.025MG
ESTROGENS
TIER 01
TIER 02
TIER 03
GENERIC
covaryx HS TAB
covaryx TAB 1.25-2.5
eemt HS TAB
eemt TAB 1.25-2.5
est estrogen TAB mtest
est estrogen TAB mtest HS
estrad val inj 20MG/ML
estrad val inj 200MG/5
estrad val inj 40MG/ML
estradiol dis 0.025MG
estradiol dis 0.1MG
estradiol TAB 0.5MG
estradiol TAB 1MG
estradiol TAB 2MG
estrog/mtest TAB 1.25-2.5
estropipate TAB 0.75MG
estropipate TAB 1.5MG
estropipate TAB 3MG
ortho-est TAB 0.625
ortho-est TAB 1.25
Climara Dis 0.025MG
Climara Dis 0.0375MG
Climara Dis 0.05MG
Climara Dis 0.06MG
Climara Dis 0.075MG
Climara Dis 0.1MG
PREFERRED
Depo-estradi Inj 5MG/ML
Menostar Dis 14mcg
NON PREFERRED
amabelz TAB 0.5-0.1
amabelz TAB 1-0.5MG
estra/noreth TAB 0.5-0.1
estra/noreth TAB 1-0.5MG
fyavolv TAB 0.5-2.5
fyavolv TAB 1-5
jevantique l TAB 0.5-2.5
jinteli TAB 1MG-5mcg
lopreeza TAB 0.5-0.1
lopreeza TAB 1-0.5MG
mimvey LO TAB 0.5-0.1
mimvey TAB 1-0.5MG
noreth/ethin TAB 0.5-2.5
CONTRACEPTIVES
TIER 01
GENERIC
aftera TAB 1.5MG
altavera TAB
alyacen TAB 1/35
alyacen TAB 7/7/7
apri TAB
aranelle TAB
aubra TAB 0.1-0.02
aviane TAB
balziva TAB
blisovi FE TAB 1.5/30
24
blisovi FE TAB 1/20
briellyn TAB
camila TAB 0.35MG
caziant PAK
chateal TAB 0.15/30
cryselle-28 TAB 28 TABS
cyclafem TAB 1/35
cyclafem TAB 7/7/7
cyred TAB
dasetta TAB 1/35
dasetta TAB 7/7/7
deblitane TAB 0.35MG
delyla TAB 0.1-0.02
drospir/ethi TAB 3-0.03MG
econtra EZ TAB 1.5MG
elinest TAB
emoquette TAB
enpresse-28 TAB
enskyce TAB
errin TAB 0.35MG
estarylla TAB 0.25-35
fallback TAB 1.5MG
falmina TAB
gildagia TAB 0.4-35
gildess FE TAB 1.5/30
gildess FE TAB 1/20
gildess TAB 1.5/30
gildess TAB 1/20
heather TAB 0.35MG
jencycla TAB 0.35MG
jolivette TAB 0.35MG
juleber TAB
junel FE TAB 1.5/30
junel FE TAB 1/20
junel 1.5/30 TAB
junel 1/20 TAB
kelnor TAB 1/35
kurvelo TAB 0.15/30
larin FE TAB 1.5/30
larin FE TAB 1/20
larin TAB 1.5/30
larin TAB 1/20
larissia TAB
leena TAB
lessina TAB
levonest TAB
levonor/ethi TAB
levonor/ethi TAB estradio
levonor/ethi TAB 0.1-0.02
levonorgestr TAB 0.75MG
levonorgestr TAB 1.5MG
levora-28 TAB 0.15/30
low-ogestrel TAB
lutera TAB
lyza TAB 0.35MG
marlissa TAB 0.15/30
QL
medroxypr ac inj 150MG/ML
microgestin TAB FE 1/20
microgestin TAB FE1.5/30
microgestin TAB 1.5/30
microgestin TAB 1/20
mono-linyah TAB 0.25-35
mononessa TAB
my way TAB 1.5MG
myzilra TAB
necon TAB 0.5/35
necon TAB 1/35
necon TAB 1/50-28
necon TAB 10/11-28
necon TAB 7/7/7
TIER 02
TIER 03
next choice TAB 1.5MG
nora-be TAB 0.35MG
noreth/ethin TAB FE 1/20
noreth/ethin TAB 1/20
norethindron TAB 0.35MG
norgest/ethi TAB estradio
norgest/ethi TAB 0.25/35
norlyroc TAB 0.35MG
nortrel TAB 0.5/35
nortrel TAB 1/35
nortrel TAB 7/7/7
ocella TAB 3-0.03MG
ogestrel TAB
opcicon TAB 1.5MG
orsythia TAB
philith TAB 0.4-35
pirmella TAB 1/35
pirmella TAB 7/7/7
portia-28 TAB
previfem TAB
react TAB 1.5MG
reclipsen TAB
sharobel TAB 0.35MG
sprintec 28 TAB 28 day
sronyx TAB
syeda TAB 3-0.03MG
take action TAB 1.5MG
tarina FE TAB 1/20
tri-estaryll TAB
tri-linyah TAB
tri-previfem TAB
tri-sprintec TAB
tri-LO TAB estaryll
tri-LO- TAB marzia
tri-LO- TAB sprintec
trinessa LO TAB
trinessa TAB
trivora-28 TAB
velivet PAK
vienva TAB 0.1-20
vyfemla TAB 0.4-35
wera TAB 0.5/35
xulane dis 150-35
zarah TAB 3-0.03MG
zenchent TAB
zovia 1/35e TAB
zovia 1/50e TAB
Plan B TAB 1.5MG
PREFERRED
Ella TAB 30MG
Mirena Iud System
Nuvaring Mis
Paragard Iud T380a
Skyla Iud 13.5MG
NON PREFERRED
amethia LO TAB
QL
amethia TAB
amethyst TAB 90-20mcg
QL
ashlyna TAB
azurette TAB 28 day
bekyree TAB
blisovi 24 TAB FE 1/20
camrese LO TAB
QL
camrese TAB
QL
daysee TAB
deso/ethinyl TAB estradio
drospirenone TAB ethy est
gianvi TAB 3-0.02MG
gildess 24 TAB FE 1/20
introvale TAB
25
TIER 05
jolessa TAB
junel FE 24 TAB 1/20
kaitlib FE chw
kariva TAB 28 day
kimidess TAB
larin 24 TAB FE 1/20
layolis FE chw
levo-ETH est TAB 90-20mcg
lomedia 24 TAB FE
loryna TAB 3-0.02MG
micrgstin 24 TAB FE 1/20
nikki TAB 3-0.02MG
noreth/ethin chw FE
pimtrea TAB
quasense TAB
setlakin TAB
tilia FE TAB
tri-legest TAB FE
vestura TAB 3-0.02MG
viorele TAB
wymzya FE chw 0.4MG-35
zenchent FE chw 0.4MG-35
Beyaz TAB
Cyclessa PAK
QL
Depo-provera Inj 150MG/ML
QL
Depo-sq Prov Inj 104
Desogen-28 TAB
Estrostep FE TAB
Falessa Kit
Femcon FE Chw
Generess FE Chw
Liletta Iud 52MG
Loestrin FE TAB 1.5/30
Loestrin FE TAB 1/20
Loestrin TAB 1/20-21
Loestrin 21 TAB 1.5/30
Loseasonique TAB
LO Loestrin TAB
Minastrin 24 Chw FE
Mircette TAB 28 Day
Natazia TAB
Nor-QD TAB 0.35MG
Norinyl TAB 1+50-28
Norinyl TAB 1/35
Ortho Evra Dis Week
Ortho Micron TAB 0.35MG
Ortho Tri- TAB Cyclen
Ortho Tri- TAB Cycln LO
Ortho-cept TAB 28
Ortho-cyclen TAB 0.25/35
Ortho-novum TAB 1/35
Ortho-novum TAB 7/7/7
Ovcon-35 TAB
Quartette TAB
Safyral TAB
QL
Seasonique TAB
Tri-norinyl TAB 28
Yasmin 28 TAB 3-0.03MG
Yaz TAB 3-0.02MG
Brevicon TAB 0.5/35
Modicon TAB 0.5/35
ANTIDIABETIC AGENTS
INSULIN
TIER 01
TIER 02
TIER 03
GENERIC
Humulin Inj 70/30
Humulin Inj 70/30kwp
Humulin N Inj U-100
Humulin N Inj U-100kwp
Humulin R Inj U-100
Humulin R Inj U-500
PREFERRED
Humalog Inj 100/ML
Humalog Kwik Inj 100/ML
PA
Lantus Inj Solostar
PA
Lantus Inj 100/ML
PA
Levemir Inj
PA
Levemir Inj Flexpen
PA
Levemir Inj Flextouc
NON PREFERRED
PA
Afrezza Pow
PA
Afrezza Pow 4& 8unit
PA
Afrezza Pow 4unit
PA
Afrezza Pow 8&12unit
Apidra Inj Solostar
Apidra Inj U-100
Humalog Kwik Inj 200/ML
Humalog Mix Inj 50/50
Humalog Mix Inj 50/50kwp
Humalog Mix Inj 75/25kwp
Humalog Mix Sus 75/25
Novolin Inj 70/30
Novolin N Inj Relion
Novolin N Inj U-100
Novolin R Inj Relion
Novolin R Inj U-100
Novolin70/30 Inj Relion
Novolog Inj Flexpen
Novolog Inj Penfill
Novolog Inj 100/ML
Novolog Mix Inj Flexpen
Novolog Mix Inj 70/30
PA
Toujeo Solo Inj 300iu/ML
PA
Tresiba Flex Inj 100unit
PA
Tresiba Flex Inj 200unit
AMYLIN ANALOGS
NON PREFERRED
TIER 03
Symlinpen 60 Inj 1000mcg
Symlnpen 120 Inj 1000mcg
INCRETIN MIMETIC AGENTS
NON PREFERRED
TIER 03
ST
PROGESTINS
TIER 01
TIER 03
progesterone inj 50MG/ML
progesterone CAP 100MG
progesterone CAP 200MG
NON PREFERRED
medroxyprog inj lidocain
megestrol sus 625MG/5m
Aygestin TAB 5MG
Megace ES Sus 625/5ML
Prometrium CAP 100MG
Prometrium CAP 200MG
Provera TAB 10MG
Provera TAB 2.5MG
Provera TAB 5MG
GENERIC
medroxypr ac TAB 10MG
medroxypr ac TAB 2.5MG
medroxypr ac TAB 5MG
norethin ace TAB 5MG
Bydureon Inj
ST
Bydureon Inj 2MG
ST
Bydureon Pen Inj 2MG
ST
Byetta Inj 10mcg
ST
Byetta Inj 5mcg
ST
Tanzeum Inj 30MG
ST
Tanzeum Inj 50MG
26
Trulicity Inj 0.75/0.5
Trulicity Inj 1.5/0.5
ST
Victoza Inj 18MG/3ML
repaglinide TAB 2MG
Prandin TAB 0.5MG
Prandin TAB 1MG
Prandin TAB 2MG
Starlix TAB 120MG
Starlix TAB 60MG
SULFONYLUREAS
GENERIC
TIER 01
TIER 02
TIER 03
BIGUANIDES
TIER 01
TIER 02
TIER 03
glimepiride TAB 1MG
glimepiride TAB 2MG
glimepiride TAB 4MG
glipizide ER TAB 10MG
glipizide ER TAB 2.5MG
glipizide ER TAB 5MG
glipizide TAB 10MG
glipizide TAB 5MG
glipizide XL TAB 10MG
glipizide XL TAB 2.5MG
glipizide XL TAB 5MG
glyburide TAB 1.25MG
glyburide TAB 2.5MG
glyburide TAB 5MG
tolazamide TAB 250MG
tolazamide TAB 500MG
tolbutamide TAB 500MG
PREFERRED
Diabeta TAB 1.25MG
Diabeta TAB 2.5MG
Diabeta TAB 5MG
NON PREFERRED
chlorpropam TAB 100MG
chlorpropam TAB 250MG
glyburid mcr TAB 1.5MG
glyburid mcr TAB 3MG
glyburid mcr TAB 6MG
Amaryl TAB 1MG
Amaryl TAB 2MG
Amaryl TAB 4MG
Glucotrol TAB 10MG
Glucotrol TAB 5MG
Glucotrol XL TAB 10MG
Glucotrol XL TAB 2.5MG
Glucotrol XL TAB 5MG
Glynase TAB 1.5MG
Glynase TAB 3MG
Glynase TAB 6MG
GENERIC
metformin TAB 1000MG
metformin TAB 500MG
metformin TAB 500MG ER
metformin TAB 750MG ER
metformin TAB 850MG
PREFERRED
Riomet Sol
Riomet Sol 500/5ML
NON PREFERRED
metformin ER TAB 1000MG
Fortamet TAB 1000MG
Fortamet TAB 500MG
Glucophage TAB 1000MG
Glucophage TAB 500MG XR
Glucophage TAB 750MG XR
PA
Glumetza TAB 1000MG
PA
Glumetza TAB 500MG
MEGLITINIDE ANALOGUES
NON PREFERRED
TIER 03
nateglinide TAB 120MG
nateglinide TAB 60MG
repaglinide TAB 0.5MG
repaglinide TAB 1MG
DIABETIC OTHER
PREFERRED
TIER 02
TIER 03
TIER 05
Glucagen Inj Hypokit
Glucagon Kit 1MG
QL,PA
Jardiance TAB 10MG
QL,PA
Jardiance TAB 25MG
Proglycem Sus 50MG/ML
NON PREFERRED
PA
Farxiga TAB 10MG
PA
Farxiga TAB 5MG
PA
Invokana TAB 100MG
PA
Invokana TAB 300MG
QL,PA
Korlym TAB 300MG
ALPHA-GLUCOSIDASE INHIBIT
GENERIC
TIER 01
TIER 03
acarbose TAB 100MG
acarbose TAB 25MG
acarbose TAB 50MG
NON PREFERRED
miglitol TAB 100MG
miglitol TAB 25MG
miglitol TAB 50MG
Glyset TAB 100MG
Glyset TAB 25MG
Glyset TAB 50MG
Precose TAB 100MG
Precose TAB 25MG
Precose TAB 50MG
DPP-4 INHIBITORS
NON PREFERRED
TIER 03
PA
alogliptin TAB 12.5MG
PA
alogliptin TAB 25MG
PA
alogliptin TAB 6.25MG
PA
Januvia TAB 100MG
PA
Januvia TAB 25MG
PA
Januvia TAB 50MG
PA
Nesina TAB 12.5MG
PA
Nesina TAB 25MG
PA
Nesina TAB 6.25MG
PA
Onglyza TAB 2.5MG
PA
Onglyza TAB 5MG
ST
Tradjenta TAB 5MG
INSULIN SENSITIZING AGENT
NON PREFERRED
TIER 03
pioglitazone TAB 15MG
Actos TAB 15MG
Actos TAB 30MG
Actos TAB 45MG
Avandia TAB 2MG
Avandia TAB 4MG
Avandia TAB 8MG
ANTIDIABETIC COMBINATIONS
NON PREFERRED
TIER 03
PA
alog/pioglip TAB 12.5-15
PA
alog/pioglip TAB 12.5-30
PA
alog/pioglit TAB 12.5-45
PA
alog/pioglit TAB 25-15MG
PA
PA
PA
alogliptin/ TAB metform
glip/metform TAB 2.5-250m
27
glip/metform TAB 2.5-500m
glip/metform TAB 5-500MG
glyb/metform TAB 1.25-250
glyb/metform TAB 2.5-500
glyb/metform TAB 5-500MG
pioglit/glim TAB 30-2MG
pioglit/glim TAB 30-4MG
pioglita/met TAB 15-500MG
pioglita/met TAB 15-850MG
repaglinide TAB 1-500MG
repaglinide TAB 2-500MG
Actoplus Met TAB XR
Actoplus Met TAB 15-500MG
Actoplus Met TAB 15-850MG
Avandamet TAB 2-1000MG
Avandaryl TAB 4-1MG
Avandaryl TAB 4-2MG
Avandaryl TAB 4-4MG
Avandaryl TAB 8-4MG
Duetact TAB 30-2MG
Duetact TAB 30-4MG
Glucovance TAB 1.25-250
Glucovance TAB 2.5-500
Glucovance TAB 5-500MG
ST
Glyxambi TAB 10-5 MG
ST
Glyxambi TAB 25-5 MG
Invokamet TAB 150-1000
Invokamet TAB 50-500MG
PA
Janumet TAB 50-1000
PA
Janumet TAB 50-500MG
PA
Janumet XR TAB 100-1000
PA
Janumet XR TAB 50-1000
PA
Janumet XR TAB 50-500MG
Jentadueto TAB XR
ST
Jentadueto TAB 2.5-1000
ST
ST
PA
Kazano 12.5- TAB 1000MG
PA
Kazano 12.5- TAB 500MG
PA
Kombiglyze TAB 2.5-1000
PA
Kombiglyze TAB 5-1000MG
PA
Kombiglyze TAB 5-500MG
PA
Oseni TAB 12.5-15
PA
Oseni TAB 12.5-30
PA
Oseni TAB 12.5-45
PA
Oseni TAB 25-15MG
PA
Oseni TAB 25-30MG
PA
Oseni TAB 25-45MG
Prandimet TAB 1-500MG
Prandimet TAB 2-500MG
QL,PA
Synjardy TAB
QL,PA
Synjardy TAB 12.5-500
QL,PA
Synjardy TAB 5-1000MG
QL,PA
Synjardy TAB 5-500MG
PA
Xigduo XR TAB 10-1000
PA
Xigduo XR TAB 10-500MG
PA
PA
BISPHOSPHONATES
TIER 01
GENERIC
alendronate sol 70/75ML
alendronate TAB 10MG
TIER 03
alendronate TAB 5MG
etidron disd TAB 200MG
etidron disd TAB 400MG
ST
risedronate TAB 150MG
ST
ST
ST
risedronate TAB 5MG
NON PREFERRED
ibandronate TAB 150MG
ST
risedron sod TAB 35MG DR
ST
Actonel TAB 150MG
ST
Actonel TAB 30MG
ST
Actonel TAB 35MG
ST
Actonel TAB 5MG
ST
Atelvia TAB
Binosto TAB 70MG
Boniva TAB 150MG
Fosamax + D TAB 70-2800
Fosamax + D TAB 70-5600
Fosamax TAB 70MG
CALCITONINS
TIER 01
TIER 03
GENERIC
fortical spr 200/act
NON PREFERRED
calcitonin spr 200/act
Miacalcin Inj 200/ML
Miacalcin Spr 200/Act
PARATHYROID HORMONE
TIER 03
TIER 05
NON PREFERRED
QL
Natpara Inj 100mcg
QL
Natpara Inj 25mcg
QL
Natpara Inj 50mcg
QL
Natpara Inj 75mcg
QL
Forteo Sol 600/2.4
HORMONE RECEPTOR MDLTR
TIER 01
TIER 03
GENERIC
PA
raloxifene TAB 60MG
NON PREFERRED
PA
Evista TAB 60MG
PA
Osphena TAB 60MG
LHRH/GNRH AGONIST
TIER 02
TIER 03
PREFERRED
Lupr Dep-PED Inj 11.25MG
Lupr Dep-PED Inj 15MG
Lupr Dep-PED Inj 30MG
Lupr Dep-PED Inj 7.5MG
NON PREFERRED
QL
Synarel Sol 2MG/ML
GROWTH HORMONES
TIER 03
TIER 04
TIER 05
NON PREFERRED
QL,PA
Genotropin Inj 2MG
QL,PA
Zomacton Inj 10MG
SPECIALTY
QL,PA
Omnitrope Inj 10/1.5ML
QL,PA
Omnitrope Inj 5.8MG
QL,PA
Omnitrope Inj 5/1.5ML
QL,PA
Genotropin Inj 0.2MG
QL,PA
QL,PA
QL,PA
QL,PA
28
QL,PA
QL,PA
QL,PA
QL,PA
Genotropin Inj 1MG
QL,PA
Genotropin Inj 12MG
QL,PA
Genotropin Inj 5MG
QL,PA
Humatrope Inj 12MG
QL,PA
Humatrope Inj 24MG
QL,PA
Humatrope Inj 5MG
QL,PA
Humatrope Inj 6MG
QL,PA
Norditropin Inj 10/1.5ML
QL,PA
QL,PA
Norditropin Inj 30/3ML
QL,PA
QL,PA
Nutropin AQ Inj Nuspin 5
QL,PA
Nutropin AQ Inj 10MG/2ML
QL,PA
Nutropin AQ Inj 20MG/2ML
QL,PA
Saizen Inj 5MG
QL,PA
Saizen Inj 8.8MG
QL,PA
Serostim Inj 4MG
QL,PA
Serostim Inj 5MG
QL,PA
Serostim Inj 6MG
QL,PA
Tev-tropin Inj 5MG
QL,PA
Zomacton Inj 5MG
QL,PA
Zorbtive Inj 8.8MG
POSTERIOR PITUITARY
QL
Egrifta Sol 1MG
QL
Egrifta Sol 2MG
VASOPRESSIN ANTAGONISTS
TIER 01
TIER 02
TIER 03
CORTICOTROPIN
TIER 04
SOMATOMEDINS
TIER 05
QL,PA
Increlex Inj 40MG/4ML
SOMATOSTATIC AGENTS
TIER 01
TIER 02
TIER 03
TIER 05
GENERIC
octreotide inj 100mcg
octreotide inj 50mcg/ML
PREFERRED
QL
Sandostatin Kit Lar 10MG
QL
QL
NON PREFERRED
Sandostatin Inj 100mcg
Sandostatin Inj 50mcg/ML
QL,PA
Signifor Inj 0.3MG/ML
QL,PA
QL,PA
PA
Somatuline Inj 120/.5ML
PA
Somatuline Inj 60/0.2ML
PA
Somatuline Inj 90/0.3ML
GH RECEPTOR ANTAGONISTS
TIER 05
QL,PA
Somavert Inj 10MG
QL,PA
Somavert Inj 15MG
QL,PA
Somavert Inj 20MG
QL,PA
Somavert Inj 25MG
QL,PA
Somavert Inj 30MG
SPECIALTY
QL,PA
H.p. Acthar Inj 80unit
PROLACTIN INHIBITORS
TIER 01
GHRH
TIER 05
GENERIC
desmopressin inj 4mcg/ML
desmopressin sol 0.01%
desmopressin spr 0.01%
desmopressin TAB 0.1MG
desmopressin TAB 0.2MG
vasopressin inj 10/0.5ML
vasopressin inj 20unt/ML
PREFERRED
Stimate Sol 1.5MG/ML
NON PREFERRED
Ddavp Inj 4mcg/ML
Ddavp Sol 0.01%
Ddavp Spr 0.01%
Ddavp TAB 0.1MG
Ddavp TAB 0.2MG
Pitressin Inj 20unt/ML
TIER 03
TIER 05
GENERIC
cabergoline TAB 0.5MG
NON PREFERRED
QL,PA
Samsca TAB 30MG
QL,PA
Samsca TAB 15MG
PROGESTERONE ANTAGONISTS
TIER 03
NON PREFERRED
Mifeprex TAB 200MG
METABOLIC MODIFIERS
TIER 01
TIER 03
GENERIC
calcitriol sol 1mcg/ML
calcitriol CAP 0.25mcg
calcitriol CAP 0.5mcg
levocarnitin sol 1gm/10ML
levocarnitin TAB 330MG
NON PREFERRED
doxercalcif CAP 0.5mcg
doxercalcif CAP 1mcg
doxercalcif CAP 2.5mcg
paricalcitol CAP 1 mcg
Carnitor Sol 1gm/10ML
Carnitor SF Sol 1gm/10ML
Carnitor TAB 330MG
Cystadane Pow
Hectorol CAP 0.5mcg
Hectorol CAP 1mcg
Hectorol CAP 2.5mcg
Kuvan Pow 500MG
Rocaltrol CAP 0.25mcg
Rocaltrol CAP 0.5mcg
Rocaltrol Sol 1mcg/ML
ST
Sensipar TAB 30MG
ST
Sensipar TAB 60MG
ST
Sensipar TAB 90MG
PA
Strensiq Inj 18/0.45
PA
Strensiq Inj 28/0.7ML
PA
Strensiq Inj 40MG/ML
PA
Strensiq Inj 80/0.8ML
29
TIER 05
Zemplar CAP 1mcg
Zemplar CAP 2mcg
QL
phenylbutyra pow sodium
QL
Buphenyl Pow
QL
Buphenyl TAB 500MG
QL,PA
Carbaglu TAB 200MG
QL
Kuvan Pow 100MG
QL,PA
Kuvan TAB 100MG
QL,PA
Myalept Inj 11.3MG
QL
Orfadin CAP 10MG
QL
Orfadin CAP 2MG
Orfadin CAP 20MG
QL
Orfadin CAP 5MG
QL,PA
Ravicti Liq 1.1gm/ML
THYROID AGENTS
TIER 01
TIER 03
GENERIC
levothyroxin TAB 100mcg
levothyroxine TAB 0.075MG
liothyronine TAB 25mcg
methimazole TAB 10MG
methimazole TAB 5MG
propylthiour TAB 50MG
NON PREFERRED
levo-t TAB 100mcg
levo-t TAB 112mcg
levo-t TAB 125mcg
levo-t TAB 137mcg
levo-t TAB 150mcg
levo-t TAB 175mcg
levo-t TAB 200 mcg
levo-t TAB 25mcg
levo-t TAB 300 mcg
levo-t TAB 50mcg
levo-t TAB 75mcg
levo-t TAB 88mcg
levoxyl TAB 100mcg
levoxyl TAB 112mcg
levoxyl TAB 125mcg
levoxyl TAB 137mcg
levoxyl TAB 150mcg
levoxyl TAB 175mcg
levoxyl TAB 200mcg
levoxyl TAB 25mcg
levoxyl TAB 50mcg
levoxyl TAB 75mcg
levoxyl TAB 88mcg
nature-throi TAB 130MG
nature-throi TAB 16.25MG
nature-throi TAB 32.5MG
unith direct TAB 100mcg
unithroid TAB 100mcg
unithroid TAB 25mcg
unithroid TAB 50mcg
unithroid TAB 75mcg
unithroid TAB 88mcg
westhroid TAB 130MG
westhroid TAB 32.5MG
westhroid TAB 65MG
Armour Thyro TAB 120MG
Cytomel TAB 25mcg
Cytomel TAB 5mcg
Cytomel TAB 50mcg
Nature Throi TAB 162.5MG
Nature-throi TAB 113.75MG
Nature-throi TAB 260MG
Nature-throi TAB 325MG
NP thyroid TAB 30MG
NP thyroid TAB 60MG
NP thyroid TAB 90MG
Synthroid TAB 100mcg
Synthroid TAB 25mcg
Synthroid TAB 50mcg
Synthroid TAB 75mcg
Synthroid TAB 88mcg
Tapazole TAB 10MG
Tapazole TAB 5MG
Thyrolar-1 TAB 60MG
Thyrolar-1/2 TAB 30MG
Thyrolar-1/4 TAB 15MG
Thyrolar-2 TAB 120MG
Thyrolar-3 TAB 180MG
Tirosint CAP 100mcg
Tirosint CAP 112mcg
Tirosint CAP 125mcg
Tirosint CAP 13mcg
Tirosint CAP 137mcg
Tirosint CAP 150mcg
30
Tirosint CAP 25mcg
Tirosint CAP 50mcg
Tirosint CAP 75mcg
Tirosint CAP 88mcg
Westhroid TAB 113.75MG
Westhroid TAB 195MG
Westhroid TAB 260MG
Westhroid TAB 325MG
Wp Thyroid TAB 113.75MG
Wp Thyroid TAB 130MG
Wp Thyroid TAB 65MG
Restora Spri PAK 15-0.25
ULCER DRUGS
TIER 01
GASTROINTESTINAL
LAXATIVES
TIER 01
TIER 03
GENERIC
constulose sol 10gm/15
gavilyte-c sol
lactulose sol 10gm/15
peg 3350 sol electrol
polyeth GLYC pow 3350 NF
NON PREFERRED
gavilyte-h kit
gavilyte-n sol flav pk
gavilyte-G sol
peg-prep kit
peg-3350 sol electrol
peg-3350/KCL sol /sodium
pegylax pow
trilyte sol
Colyte/Flavr Sol Packs
CVS senna plus tablet
Gialax Kit
Golytely Sol
Golytely Sol Pineappl
Kristalose PAK 10gm
Kristalose PAK 20gm
Moviprep Sol
Nulytely Sol Flav Pks
Osmoprep TAB 1.5gm
Pcp 100 Kit
Prepopik PAK
Suclear Kit
Suprep Bowel Sol Prep
ANTIDIARRHEALS
TIER 01
TIER 03
GENERIC
diphen/atrop liq 2.5/5
diphen/atrop TAB 2.5MG
lofene TAB 2.5MG
loperamide CAP 2MG
opium tin 1%
NON PREFERRED
paregoric tin 2MG/5ML
Fulyzaq TAB 125MG
Lomotil TAB 2.5MG
Motofen TAB 1-0.025
Mytesi TAB 125MG
TIER 02
TIER 03
GENERIC
bella/opium sup 16.2-30
bella/opium sup 16.2-60
chlord/clidi CAP 5-2.5MG
cimetidine sol 300/5ML
cimetidine TAB 200MG
dicyclomine sol 10MG/5ML
dicyclomine CAP 10MG
dicyclomine TAB 20MG
famotidine sus 40MG/5ML
famotidine TAB 20MG
famotidine TAB 40MG
glycopyrrol inj 0.2MG/ML
glycopyrrol inj 0.4/2ML
glycopyrrol inj 1MG/5ML
glycopyrrol inj 4MG/20ML
glycopyrrol TAB 1MG
glycopyrrol TAB 2MG
ST
lansoprazole CAP 15MG DR
ST
lansoprazole CAP 30MG DR
misoprostol TAB 100mcg
misoprostol TAB 200mcg
omeprazole CAP 10MG
omeprazole CAP 20MG
omeprazole CAP 40MG
pantoprazole TAB 20MG
pantoprazole TAB 40MG
propanthelin TAB 15MG
ST
rabeprazole TAB 20MG
ranitidine inj 150/6ML
ranitidine inj 50MG/2ML
ranitidine syp 15MG/ML
ranitidine syp 150/10ML
ranitidine syp 75MG/5ML
ranitidine TAB 150MG
ranitidine TAB 300MG
sucralfate TAB 1gm
PREFERRED
Carafate Sus 1gm/10ML
Pylera CAP
NON PREFERRED
atropine SUL inj 0.05MG/1
atropine SUL inj 0.1MG/ML
atropine SUL inj 0.4/0.5
atropine SUL inj 0.4MG/ML
atropine SUL inj 1MG/ML
b-donna TAB 16.2MG
dicyclomine inj 10MG/ML
ed-spaz TAB 0.125MG
PA
esomeprazole CAP 49.3MG
gastrinex NF CAP
hyoscyamine dro 0.125/ML
hyoscyamine elx 0.125/5
hyoscyamine sub 0.125MG
hyoscyamine TAB 0.125MG
hyoscyamine TAB 0.375 ER
hyoscyamine TAB 0.375 SR
hyosyne dro 0.125/ML
hyosyne elx 0.125/5
lansopr/amox mis /clarith
methscopolam TAB 2.5MG
methscopolam TAB 5MG
nizatidine sol 15MG/ML
31
nizatidine CAP 150MG
nizatidine CAP 300MG
nulev TAB 0.125MG
omepra/bicar pow 20-1680
omepra/bicar pow 40-1680
PA
omepra/bicar CAP 20-1100
PA
omepra/bicar CAP 40-1100
oscimin sub 0.125MG
oscimin SR TAB 0.375MG
oscimin TAB 0.125MG
phenohytro TAB
ranitidine CAP 150MG
ranitidine CAP 300MG
scopolamine inj 0.4MG/ML
symax-SL sub 0.125MG
symax-SR TAB 0.375MG
PA
Aciphex Spr CAP 10MG
PA
Aciphex Spr CAP 5MG
ST
Aciphex TAB 20MG
Anaspaz TAB 0.125MG
Atropen Inj 0.25MG
Atropen Inj 0.5MG
Atropen Inj 1MG
Atropen Inj 2MG
Bentyl CAP 10MG
Bentyl Inj 10MG/ML
Bentyl TAB 20MG
Cantil TAB 25MG
Carafate TAB 1gm
Cuvposa Sol 1MG/5ML
Cytotec TAB 100mcg
Cytotec TAB 200mcg
PA
Dexilant CAP 30MG DR
PA
Dexilant CAP 60MG DR
Donnatal Elx
Donnatal Elx Grape
Donnatal Elx Mint
Donnatal TAB
Donnatal TAB Extentab
Donnatal TAB 16.2MG
First-omepra Sus 2MG/ML
Lansoprazole Sus 3MG/ML
Levbid TAB 0.375 ER
Levsin Inj 0.5MG/ML
Levsin TAB 0.125MG
Levsin/SL Sub 0.125MG
Librax CAP 5-2.5MG
Omeclamox- Mis PAK
Omeprazole + Sus Syrspend
Pamine Forte TAB 5MG
Pamine FQ Kit
Pamine TAB 2.5MG
Pepcid Sus 40MG/5ML
Pepcid TAB 20MG
Pepcid TAB 40MG
ST
Prevacid CAP 15MG DR
ST
Prevacid CAP 30MG DR
Prevacid TAB 15MG Stb
Prevacid TAB 30MG Stb
Prevpac Mis
Prilosec CAP 10MG
Prilosec CAP 20MG
Prilosec CAP 40MG
Prilosec Pow 10MG
Prilosec Pow 2.5MG
Protonix PAK
Protonix TAB 20MG
Protonix TAB 40MG
Robinul Fort TAB 2MG
Robinul Inj 0.2MG/ML
Robinul Inj 0.4/2ML
Robinul TAB 1MG
Symax Duotab TAB
Zantac Inj 25MG/ML
Zantac Inj 50MG/2ML
Zantac TAB 150MG
Zantac TAB 300MG
PA
Zegerid CAP 20-1100
PA
Zegerid CAP 40-1100
PA
Zegerid Pow 20-1680
PA
Zegerid Pow 40-1680
ANTIEMETICS
TIER 01
TIER 02
TIER 03
GENERIC
dimenhydrin inj 50MG/ML
dronabinol CAP 10MG
dronabinol CAP 2.5MG
dronabinol CAP 5MG
ondansetron inj 4MG/2ML
ondansetron inj 40/20ML
ondansetron sol 4MG/5ML
ondansetron TAB 24MG
ondansetron TAB 4MG
ondansetron TAB 4MG odt
ondansetron TAB 8MG
ondansetron TAB 8MG odt
PREFERRED
Emend CAP 125MG
Emend CAP 80MG
Emend PAK 80 & 125
NON PREFERRED
granisetron TAB 1MG
meclizine TAB 12.5MG
meclizine TAB 25MG
trimethobenz CAP 300MG
Akynzeo CAP
Anzemet TAB 100MG
Anzemet TAB 50MG
Cesamet CAP 1MG
Diclegis TAB 10-10MG
Emend CAP 40MG
Emend Sus 125MG
Granisol Sol 2MG/10ML
Marinol CAP 10MG
Marinol CAP 2.5MG
Marinol CAP 5MG
Sancuso Dis 3.1MG
Tigan CAP 300MG
Tigan Inj 100MG/ML
Transderm-sc Dis 1MG
QL,PA
Varubi TAB 90MG
Zofran Inj 40/20ML
Zofran Sol 4MG/5ML
Zofran TAB 4MG
Zofran TAB 4MG Odt
Zofran TAB 8MG
Zofran TAB 8MG Odt
Zuplenz Mis 4MG
Zuplenz Mis 8MG
DIGESTIVE AIDS
TIER 01
TIER 02
GENERIC
pancrelipase CAP 5000unit
PREFERRED
Creon CAP 12000unt
Creon CAP 24000unt
Creon CAP 3000unit
Creon CAP 36000unt
Creon CAP 6000unit
32
TIER 03
TIER 05
Zenpep CAP 10000unt
Zenpep CAP 15000unt
Zenpep CAP 20000unt
Zenpep CAP 25000unt
Zenpep CAP 3000unit
Zenpep CAP 40000unt
Zenpep CAP 5000unit
NON PREFERRED
Pancreaze CAP 10500unt
Pancreaze CAP 4200unit
Pertzye CAP
Ultresa CAP 13800unt
Viokace TAB
Viokace TAB 20880
Sucraid Sol 8500/ML
GASTROINTESTINAL - MISC.
TIER 01
TIER 02
TIER 03
GENERIC
balsalazide CAP 750MG
calc acetate CAP 667MG
calc acetate TAB 667MG
colocort ene 100MG
enulose sol 10gm/15
generlac sol 10gm/15
hydrocort ene 100MG
hydrocortiso CRE 2.5%
mesalamine ene 4gm
ST
mesalamine TAB 800MG DR
metoclopram inj 10MG/2ML
metoclopram inj 5MG/ML
metoclopram sol 10/10ML
metoclopram sol 5MG/5ML
metoclopram TAB 10MG
metoclopram TAB 5MG
procto-MED CRE HC 2.5%
proctosol HC CRE 2.5%
proctozone CRE -HC 2.5%
sevelamer TAB 800MG
sulfasalazin TAB 500MG
sulfasalazin TAB 500MG DR
ursodiol CAP 300MG
ursodiol TAB 250MG
ursodiol TAB 500MG
PREFERRED
ST
Asacol HD TAB 800MG
Canasa Sup 1000MG
Cortifoam Aer 90MG
Lialda TAB 1.2gm
Pentasa CAP 250MG CR
Pentasa CAP 500MG CR
Proctofoam Aer HC 1%
Rectiv Oin 0.4%
Relistor Inj 12/0.6ML
Relistor Inj 8/0.4ML
Relistor Kit 12/0.6ML
Renagel TAB 400MG
Renagel TAB 800MG
Renvela PAK 0.8gm
Renvela PAK 2.4gm
Renvela TAB 800MG
NON PREFERRED
alosetron TAB 0.5MG
alosetron TAB 1MG
anucort-HC sup 25MG
anusol-HC sup 25MG
cromolyn sod CON 100/5ML
dexpanthenol inj 250MG/ML
grx hicort sup 25MG
hemmorex-HC sup 25MG
hemmorex-HC sup 30MG
hydrocort ac sup 25MG
hydrocort ac sup 30MG
hydrocort CRE 1%
lidazone CRE
lido-hydro gel 2.8-0.55
lidocaine/HC kit 3%-0.5%
lidocaine/HC kit 3%-1%
lidocaine/HC CRE 3%-0.5%
mesalamine kit 4gm
metoclopram TAB 5MG odt
metocloprami TAB 10MG odt
pramcort CRE 1-1%
procto-PAK CRE 1%
rectacort-HC sup 25MG
Actigall CAP 300MG
QL,PA
Amitiza CAP 24mcg
QL,PA
Amitiza CAP 8mcg
Analpram HC CRE 2.5-1%
Analpram-HC CRE Singles
Analpram-HC CRE 1-1%
Analpram-HC CRE 1-2.5%
Analpram-HC Lot 2.5%
Analprm Sngl CRE HC 2.5-1
Anusol-HC CRE 2.5%
Apriso CAP 0.375gm
Azulfidine TAB 500MG
Azulfidine TAB 500MG En
PA
Cholbam CAP 250MG
PA
Cholbam CAP 50MG
Colazal CAP 750MG
Cortenema Ene 100MG
Delzicol CAP 400MG
Dipentum CAP 250MG
Eliphos TAB 667MG
Entereg CAP 12MG
Fosrenol Chw 1000MG
Fosrenol Chw 500MG
Fosrenol Chw 750MG
Fosrenol Pow 1000MG
Fosrenol Pow 750MG
Gastrocrom CON 100/5ML
Giazo TAB 1.1gm
HC pramoxine CRE 1-1%
HC pramoxine CRE 2.5-1%
QL,PA
Linzess CAP 145mcg
QL,PA
Linzess CAP 290mcg
Lotronex TAB 0.5MG
Lotronex TAB 1MG
Metozolv Odt TAB 5MG
QL,PA
Movantik TAB 12.5MG
QL,PA
Movantik TAB 25MG
Phoslo CAP 667MG
Phoslyra Sol
Procort CRE
Proctocort CRE 1%
Proctocort Sup 30MG
Reglan TAB 10MG
Reglan TAB 5MG
PA
Relistor TAB 150MG
Rowasa Kit 4gm
Sfrowasa Ene 4gm
Uceris Aer 2MG/Act
Urso Forte TAB 500MG
33
TIER 05
Urso 250 TAB 250MG
PA
Viberzi TAB 100MG
PA
Viberzi TAB 75MG
PA
auryxia TAB 210MG
Chenodal TAB 250MG
QL,PA
Cimzia Kit
QL,PA
Cimzia Kit Starter
QL,PA
Cimzia Prefl Kit 200MG/ML
QL,PA
Gattex Kit 5MG
QL,PA
Ocaliva TAB 10MG
QL,PA
Ocaliva TAB 5MG
QL,PA
Velphoro Chw 500MG
TIER 03
GENITOURINARY
URINARY ANTI-INFECTIVES
TIER 01
TIER 03
GENERIC
methenam hip TAB 1gm
nitrofur mac CAP 100MG
nitrofurantn sus 25MG/5ML
nitrofurantn CAP 100MG
NON PREFERRED
azuphen mb CAP 120MG
hyolev mb TAB 81MG
hyophen TAB
me/naphos/mb TAB hyo 1
methenam man TAB 1gm
methenam man TAB 1000MG
methenam man TAB 500MG
uramit mb CAP 118MG
urelle TAB
uribel CAP 118MG
urimar-t TAB
uro-blue TAB 81.6MG
uro-l TAB 81MG
uro-mp CAP 118MG
uro-458 TAB
uroav-b CAP
uroav-81 TAB
urolet mb TAB
urophen mb TAB 81.6MG
uryl TAB
ustell CAP
uta CAP 120MG
uticap CAP
Furadantin Sus 25MG/5ML
Hiprex TAB 1gm
Macrobid CAP 100MG
Macrodantin CAP 100MG
Monurol PAK Granules
Uretron D/S TAB
Urogesic- TAB Blue
URINARY ANTISPASMODICS
TIER 01
GENERIC
bethanechol TAB 10MG
bethanechol TAB 5MG
flavoxate TAB 100MG
oxybutynin syp 5MG/5ML
oxybutynin TAB 10MG ER
oxybutynin TAB 5MG
tolterodine CAP 2MG ER
tolterodine CAP 4MG ER
tolterodine TAB 1MG
tolterodine TAB 2MG
trospium chl CAP 60MG ER
trospium CL TAB 20MG
NON PREFERRED
ST
darifenacin TAB 15MG
ST
darifenacin TAB 7.5MG
Detrol LA CAP 2MG
Detrol LA CAP 4MG
Detrol TAB 1MG
Detrol TAB 2MG
Ditropan XL TAB 10MG
Ditropan XL TAB 15MG
Ditropan XL TAB 5MG
ST
Enablex TAB 15MG
ST
Enablex TAB 7.5MG
ST
Gelnique Gel 10%
ST
Gelnique Gel 3%
ST
Myrbetriq TAB 25MG
ST
Myrbetriq TAB 50MG
ST
Oxytrol Dis 3.9MG/24
ST
Toviaz TAB 4MG
ST
Toviaz TAB 8MG
Urecholine TAB 10MG
Urecholine TAB 25MG
Urecholine TAB 5MG
Urecholine TAB 50MG
ST
Vesicare TAB 10MG
ST
Vesicare TAB 5MG
VAGINAL PRODUCTS
TIER 01
TIER 02
TIER 03
GENERIC
clindamycin CRE 2% vag
metronidazol gel 0.75%vag
vandazole gel 0.75%
PREFERRED
Estrace Vag CRE 0.1MG/Gm
Estring Mis 2MG
Premarin Vag CRE 0.625MG
Vagifem TAB 10mcg
NON PREFERRED
miconazole 3 sup 200MG
terconazole sup 80MG
terconazole CRE 0.4%
terconazole CRE 0.8%
zazole sup 80MG
zazole CRE 0.8%
Avc CRE 15%
Cleocin CRE 2% Vag
Cleocin Sup 100MG
Clindesse CRE 2%
Crinone Gel 4% Vag
Crinone Gel 8% Vag
Endometrin Sup 100MG
Fem PH Gel
Femring Mis 0.05/24h
Femring Mis 0.1MG/24
Gynazole-1 CRE 2%
Metrogel-vag Gel 0.75%
Nuvessa Gel 1.3%
Progesterone Sup VGS 100
Relagard Gel
Terazol 3 CRE 0.8%
34
Terazol 7 CRE 0.4%
HEMATOPOIETIC AGENTS
TIER 01
GENITOURINARY - MISC.
TIER 01
TIER 02
TIER 03
TIER 05
GENERIC
acetic acid sol 0.25%irr
alfuzosin TAB 10MG ER
argyl saline sol 0.9%
citric acid/ sol sod citr
curity salin sol 0.9% irr
cytra k gra crystals
cytra-k sol
cytra-2 sol
cytra-3 syp
finasteride TAB 5MG
k citrate sol citr acd
phenazo TAB 200MG
phenazopyrid TAB 100MG
phenazopyrid TAB 200MG
pot citrate TAB 1080MG
pot citrate TAB 1620MG
pot citrate TAB 540MG ER
sod citrate sol citr acd
sodium chlor sol 0.9% irr
tamsulosin CAP 0.4MG
virtrate-k sol
virtrate-k sol 1100-334
virtrate-2 sol
virtrate-2 sol 500-334
virtrate-3 sol
PREFERRED
PA
Cystagon CAP 150MG
PA
Cystagon CAP 50MG
Elmiron CAP 100MG
Oracit Sol
NON PREFERRED
dutast/tamsu CAP 0.5-0.4
dutasteride CAP 0.5MG
k/NA citrate sol citr acd
neo/poly GU sol 40/ML IR
pot citrate- PAK CIT acid
taron gra crystals
tricitrates sol
Avodart CAP 0.5MG
Cardura XL TAB 4MG
Cardura XL TAB 8MG
Flomax CAP 0.4MG
Jalyn CAP
K-phos TAB NO 2
Lithostat TAB 250MG
Neosporin GU Sol 40/ML IR
Proscar TAB 5MG
Pyridium TAB 100MG
Pyridium TAB 200MG
Rapaflo CAP 4MG
Rapaflo CAP 8MG
Renacidin Sol
Renacidin Sol Irr
Rimso-50 Sol 50%
Shohls Sol Modified
Thiola TAB 100MG
Urocit-k 10 TAB
Urocit-k 15 TAB
Urocit-k 5 TAB
Uroxatral TAB 10MG
QL,PA
Procysbi CAP 25MG
QL,PA
Procysbi CAP 75MG
HEMATOLOGICAL AGENTS
TIER 02
TIER 03
GENERIC
cyanocobalam inj 1000mcg
folic acid inj 5MG/ML
folic acid TAB 1MG
folic acid TAB 1000mcg
PREFERRED
Droxia CAP 200MG
Droxia CAP 300MG
Droxia CAP 400MG
QL,PA
Epogen Inj 2000/ML
QL,PA
Procrit Inj 2000/ML
NON PREFERRED
corvita 150 TAB
ferocon CAP
ferotrinsic CAP
ferraplus 90 TAB
ferrex 150 CAP forte
ferrex 150 CAP forte pl
ferrex 28 TAB
ferrocite TAB plus
ferrogels fo CAP forte
foltrin CAP
hematinic pl TAB vit/min
hematogen fa CAP
hematogen CAP
hematogen CAP forte
hematron liq
hemax TAB
iferex 150 CAP forte
multigen pls TAB
multigen TAB
multigen TAB folic
myferon 150 CAP forte
poly-iron CAP 150 fort
purevit dual CAP FE plus
se-tan plus CAP
tandem f CAP
tricon CAP
trigels-f CAP forte
QL,PA
Aranesp Inj 10mcg
QL,PA
Aranesp Inj 200mcg
Biferarx TAB
Corvite FE TAB
Corvite 150 TAB
Feraheme Inj 510/17ML
Ferralet 90 TAB
Folivane-f CAP
Folivane-pls CAP
Folixapure TAB 1-5000
Fusion PAK Sprinkle
FE succ/ac-c CAP thre/b12
FE 90 Plus TAB
Hematron-AF TAB
Hemetab TAB
Hemocyte Pls CAP
Integra F CAP
Integra Plus CAP
Irospan 24/6 Mis
Maxaron TAB Forte
QL,PA
Mircera Inj 100mcg
QL,PA
Mircera Inj 200mcg
QL,PA
Mircera Inj 50mcg
QL,PA
Mircera Inj 75mcg
MV FE/c/b12/ TAB fa/succ
MV FE/c/b12/ TAB CA/succ
Nascobal Spr 500mcg
Natalvirt TAB Flt
Nephron Fa TAB
35
TIER 04
TIER 05
Novaferrum Sol
Noxifol-d TAB
QL
Omontys Inj 10MG/ML
QL
Omontys Inj 20MG/2ML
Proferrin- TAB Forte
Purefolix TAB 1-5000
Roxifol-d TAB 1-500
Tandem Plus CAP
Taron Forte CAP
Triferic Sol
TL icon CAP
TL-hem 150 TAB
SPECIALTY
QL,PA
Cerdelga CAP 84MG
QL,PA
Epogen Inj 10000/ML
QL,PA
Epogen Inj 20000/ML
QL,PA
Epogen Inj 3000/ML
QL,PA
Epogen Inj 4000/ML
QL
Neupogen Inj 300/0.5
QL
Neupogen Inj 300mcg
QL
Neupogen Inj 480/0.8
QL
Neupogen Inj 480mcg
QL,PA
Procrit Inj 10000/ML
QL,PA
QL,PA
Procrit Inj 3000/ML
QL,PA
Procrit Inj 4000/ML
QL,PA
QL
Zarxio Inj 300/0.5
QL
Zarxio Inj 480/0.8
QL,PA
Aranesp Inj 100mcg
QL,PA
Aranesp Inj 150mcg
QL,PA
Aranesp Inj 25mcg
QL,PA
Aranesp Inj 300mcg
QL,PA
Aranesp Inj 40mcg
QL,PA
Aranesp Inj 500mcg
QL,PA
Aranesp Inj 60mcg
QL,PA
Neulasta Inj 6MG/0.6m
QL,PA
Neulasta Kit 6MG/0.6m
QL
Neumega Inj 5MG
QL,PA
Promacta TAB 12.5MG
QL,PA
Promacta TAB 25MG
QL,PA
Promacta TAB 50MG
QL,PA
Promacta TAB 75MG
QL,PA
Zavesca CAP 100MG
TIER 03
ANTICOAGULANTS
TIER 01
GENERIC
QL
enoxaparin inj 100MG/ML
QL
enoxaparin inj 120/0.8
QL
enoxaparin inj 150MG/ML
QL
enoxaparin inj 30/0.3ML
QL
enoxaparin inj 300/3ML
QL
QL
QL
hep sod/NACL inj 1000unit
hep sod/NACL inj 12500unt
hep sod/NACL inj 2unit/ML
hep sod/NACL inj 2000unit
hep sod/NACL inj 25000unt
heparin sod inj 1000/ML
heparin sod inj 5000/0.5
jantoven TAB 1MG
jantoven TAB 10MG
TIER 04
TIER 05
jantoven TAB 2.5MG
jantoven TAB 2MG
jantoven TAB 3MG
jantoven TAB 4MG
jantoven TAB 5MG
jantoven TAB 6MG
jantoven TAB 7.5MG
warfarin sod TAB 10MG
warfarin TAB 1MG
warfarin TAB 10MG
warfarin TAB 2.5MG
warfarin TAB 2MG
warfarin TAB 3MG
warfarin TAB 4MG
warfarin TAB 5MG
warfarin TAB 6MG
warfarin TAB 7.5MG
QL
Lovenox Inj 100MG/ML
QL
Lovenox Inj 120/0.8
QL
Lovenox Inj 150MG/ML
QL
Lovenox Inj 30/0.3ML
QL
Lovenox Inj 300/3ML
QL
QL
QL
NON PREFERRED
Coumadin TAB 1MG
Coumadin TAB 10MG
Coumadin TAB 2.5MG
Coumadin TAB 2MG
Coumadin TAB 3MG
Coumadin TAB 4MG
Coumadin TAB 5MG
Coumadin TAB 6MG
Coumadin TAB 7.5MG
PA
Eliquis TAB 2.5MG
PA
Eliquis TAB 5MG
QL
Fragmin Inj 25000/ML
QL
Fragmin Inj 7500/0.3
QL,PA
Fragmin Inj 95000unt
Iprivask Inj 15MG
PA
Pradaxa CAP 110MG
PA
Pradaxa CAP 150MG
PA
Pradaxa CAP 75MG
PA
Savaysa TAB 15MG
PA
Savaysa TAB 30MG
PA
Savaysa TAB 60MG
PA
Xarelto Star TAB 15/20MG
PA
Xarelto TAB 10MG
PA
Xarelto TAB 15MG
PA
Xarelto TAB 20MG
SPECIALTY
QL
fondaparinux inj 10/0.8ML
QL
fondaparinux inj 2.5/0.5
QL
fondaparinux inj 5/0.4ML
QL
fondaparinux inj 7.5/0.6
QL
Arixtra Inj 10/0.8ML
QL
Arixtra Inj 2.5/0.5
QL
Arixtra Inj 5/0.4ML
QL
Arixtra Inj 7.5/0.6
QL
Fragmin Inj 10000/ML
QL
QL
QL
QL
QL
36
HEMOSTATICS
TIER 01
TIER 02
TIER 03
GENERIC
aminocapr ac syp 25%
aminocapr ac TAB 500MG
QL
tranex acid TAB 650MG
PREFERRED
Thrombin-jmi Kit 20000unt
NON PREFERRED
aminocapr ac TAB 1000MG
Amicar Sol 0.25/ML
Amicar TAB 1000MG
Amicar TAB 500MG
Artiss Sol 10ML
Artiss Sol 2ML
Artiss Sol 4ML
Astringyn Sol 259MG/Gm
Evicel Kit 2ML
Evicel Kit 5ML
Evithrom Sol 800-1200
QL
Lysteda TAB 650MG
Monsels Ferr Sol Subsulf
Recothrom Sol 20000unt
Recothrom Sol 5000unit
Thrombin Kit 5000unit
Thrombin-jmi Kit 5000unit
Thrombin-jmi Sol 20000unt
Thrombin-jmi Sol 5000unit
Thrombogen Kit 10000unt
Thrombogen Sol 1000unit
Thrombogen Sol 10000unt
Tisseel Kit
Tisseel Sol
Tisseel VH Kit 10ML
Tisseel VH Kit 2ML
Tisseel VH Kit 4ML
TIER 05
MOUTH/THROAT/DENTAL AGENT
TIER 01
TIER 03
HEMATOLOGICAL - MISC.
TIER 01
TIER 02
TIER 03
GENERIC
anagrelide CAP 0.5MG
anagrelide CAP 1MG
asa/dipyrida CAP 25-200MG
cilostazol TAB 100MG
cilostazol TAB 50MG
clopidogrel TAB 300MG
clopidogrel TAB 75MG
dipyridamole TAB 25MG
pentoxifylli TAB 400MG ER
ticlopidine TAB 250MG
PREFERRED
PA
Brilinta TAB 60MG
PA
Brilinta TAB 90MG
PA
Effient TAB 10MG
PA
Effient TAB 5MG
NON PREFERRED
Aggrenox CAP 25-200MG
Agrylin CAP 0.5MG
Durlaza CAP 162.5MG
Kinlytic Inj 250000
Persantine TAB 25MG
Persantine TAB 50MG
Persantine TAB 75MG
Plavix TAB 300MG
Plavix TAB 75MG
Pletal TAB 100MG
Pletal TAB 50MG
Zontivity TAB 2.08MG
TIER 04
SPECIALTY
QL,PA
Berinert Inj 500unit
QL,PA
Firazyr Inj 30MG/3ML
QL,PA
Cinryze Sol 500 Unit
QL,PA
Ruconest Inj 2100unit
GENERIC
clotrimazole loz 10MG
clotrimazole tro 10MG
lidocaine sol 2% visc
nystatin sus 100000
oralone pst 0.1%
pilocarpine TAB 5MG
triamcin/ora pst 0.1%
triamcinolon pst 0.1%
NON PREFERRED
cevimeline CAP 30MG
lidocaine sol 4%
numoisyn liq
pilocarpine TAB 7.5MG
Aquoral Aer
Caphosol Sol
Debacterol Sol 30-50%
Evoxac CAP 30MG
First-marys Sus Mouthwsh
First-mouthw Sus Blm
Nafrinse Sol Daily
Nafrinse Wk Sol 0.2%
Neutrasal Pow
Numoisyn Loz
Oravig TAB 50MG
Salagen TAB 5MG
Salagen TAB 7.5MG
Salivamax Pow
Salivate RX Pow
NEUROLOGY, CNS, PSYCH
ANTIANXIETY AGENTS
TIER 01
GENERIC
alprazolam TAB 0.25MG
alprazolam TAB 0.5MG
alprazolam TAB 0.5MG ER
alprazolam TAB 0.5MG XR
alprazolam TAB 1MG
alprazolam TAB 1MG ER
alprazolam TAB 1MG XR
alprazolam TAB 2MG
buspirone TAB 10MG
buspirone TAB 15MG
buspirone TAB 30MG
buspirone TAB 5MG
chlordiazep CAP 10MG
chlordiazep CAP 25MG
chlordiazep CAP 5MG
cloraz dipot TAB 15MG
cloraz dipot TAB 3.75MG
cloraz dipot TAB 7.5MG
diazepam inj 10MG/2ML
diazepam inj 5MG/ML
diazepam sol 1MG/ML
diazepam TAB 10MG
diazepam TAB 2MG
37
TIER 03
diazepam TAB 5MG
droperidol inj 2.5MG/ML
hydroxyz pam CAP 100MG
hydroxyz HCL inj 25MG/ML
hydroxyz HCL inj 50MG/ML
hydroxyz HCL sol 10MG/5ML
hydroxyz HCL syp 10MG/5ML
hydroxyz HCL TAB 10MG
lorazepam inj 2MG/ML
lorazepam inj 4MG/ML
lorazepam CON 2MG/ML
lorazepam TAB 0.5MG
lorazepam TAB 1MG
lorazepam TAB 2MG
oxazepam CAP 10MG
oxazepam CAP 15MG
oxazepam CAP 30MG
NON PREFERRED
alprazolam TAB 0.25 odt
alprazolam TAB 0.5MG od
alprazolam TAB 1MG odt
alprazolam TAB 2MG odt
buspirone TAB 7.5MG
diazepam CON 5MG/ML
meprobamate TAB 200MG
meprobamate TAB 400MG
Alprazolam CON 1 MG/ML
Ativan Inj 2MG/ML
Ativan Inj 4MG/ML
Ativan TAB 0.5MG
Ativan TAB 1MG
Ativan TAB 2MG
Tranxene T TAB 15MG
Tranxene T TAB 3.75MG
Tranxene T TAB 7.5MG
Valium TAB 10MG
Valium TAB 2MG
Valium TAB 5MG
Vistaril CAP 25MG
Vistaril CAP 50MG
Xanax TAB 0.25MG
Xanax TAB 0.5MG
Xanax TAB 1MG
Xanax TAB 2MG
Xanax XR TAB 0.5MG
Xanax XR TAB 1MG
Xanax XR TAB 2MG
Xanax XR TAB 3MG
ANTIDEPRESSANTS
TIER 01
GENERIC
amitriptylin TAB 10MG
amoxapine TAB 100MG
amoxapine TAB 150MG
amoxapine TAB 25MG
amoxapine TAB 50MG
bupropion TAB 100MG
bupropion TAB 100MG ER
bupropion TAB 100MG SR
bupropion TAB 75MG
bupropn HCL TAB 150MG XL
bupropn HCL TAB 300MG XL
citalopram sol 10MG/5ML
citalopram TAB 10MG
citalopram TAB 20MG
citalopram TAB 40MG
clomipramine CAP 25MG
desipramine TAB 10MG
doxepin HCL CAP 10MG
doxepin HCL CON 10MG/ML
duloxetine CAP 20MG
duloxetine CAP 30MG
duloxetine CAP 60MG
escitalopram sol 5MG/5ML
escitalopram TAB 10MG
fluoxetine sol 20MG/5ML
fluoxetine CAP 10MG
fluoxetine CAP 20MG
fluoxetine CAP 40MG
fluoxetine TAB 10MG
fluoxetine TAB 20MG
fluoxetine TAB 60MG
fluvoxamine TAB 100MG
imipram HCL TAB 10MG
maprotiline TAB 25MG
mirtazapine TAB 15MG
mirtazapine TAB 15MG odt
mirtazapine TAB 7.5MG
nortriptylin sol 10MG/5ML
nortriptylin CAP 10MG
paroxetine TAB 10MG
paroxetine TAB 20MG
paroxetine TAB 30MG
paroxetine TAB 40MG
phenelzine TAB 15MG
protriptylin TAB 10MG
protriptylin TAB 5MG
sertraline CON 20MG/ML
sertraline TAB 100MG
38
TIER 02
TIER 03
sertraline TAB 25MG
sertraline TAB 50MG
tranylcyprom TAB 10MG
trazodone TAB 100MG
trazodone TAB 150MG
trazodone TAB 300MG
trazodone TAB 50MG
venlafaxine CAP 150MG ER
venlafaxine CAP 37.5 ER
venlafaxine CAP 75MG ER
venlafaxine TAB 100MG
venlafaxine TAB 37.5MG
PREFERRED
Paxil Sus 10MG/5ML
NON PREFERRED
desvenlafax TAB 100MG ER
desvenlafax TAB 50MG ER
duloxetine CAP 40MG
fluoxetine CAP 90MG DR
fluvoxamine CAP 100MG ER
fluvoxamine CAP 150MG ER
imipram pam CAP 100MG
nefazodone TAB 100MG
nefazodone TAB 50MG
paroxetin ER TAB 12.5MG
paroxetin ER TAB 37.5MG
paroxetine TAB 25MG ER
trimipramine CAP 100MG
venlafaxine TAB 150MG ER
venlafaxine TAB 37.5 ER
Anafranil CAP 25MG
Anafranil CAP 50MG
Anafranil CAP 75MG
Aplenzin TAB 174MG
Aplenzin TAB 348MG
Aplenzin TAB 522MG
QL,ST
Brintellix TAB 10MG
QL,ST
Brintellix TAB 20MG
QL,ST
Brintellix TAB 5MG
Celexa TAB 10MG
Celexa TAB 20MG
Celexa TAB 40MG
Cymbalta CAP 20MG
Cymbalta CAP 30MG
Cymbalta CAP 60MG
Effexor XR CAP 150MG
Effexor XR CAP 37.5MG
Effexor XR CAP 75MG
Elavil TAB 25MG
Emsam Dis 12MG/24h
Emsam Dis 6MG/24HR
Emsam Dis 9MG/24HR
PA
Fetzima CAP Titratio
ST
Fetzima CAP 120MG
ST
Fetzima CAP 20MG
ST
Fetzima CAP 40MG
ST
Fetzima CAP 80MG
ST
Forfivo XL TAB 450MG
Irenka CAP 40MG
Khedezla TAB 100MG ER
Khedezla TAB 50MG ER
Lexapro Sol 5MG/5ML
Lexapro TAB 10MG
Lexapro TAB 20MG
Lexapro TAB 5MG
Luvox CR CAP 100MG
Marplan TAB 10MG
Nardil TAB 15MG
Norpramin TAB 10MG
Norpramin TAB 100MG
Norpramin TAB 150MG
Norpramin TAB 25MG
Norpramin TAB 50MG
Norpramin TAB 75MG
Oleptro TAB 24HR150
Oleptro TAB 24HR300
Pamelor CAP 10MG
Pamelor CAP 25MG
Pamelor CAP 50MG
Pamelor CAP 75MG
Parnate TAB 10MG
Paxil CR TAB 12.5MG
Paxil CR TAB 25MG
Paxil CR TAB 37.5MG
Paxil TAB 10MG
Paxil TAB 20MG
Paxil TAB 30MG
Paxil TAB 40MG
Pexeva TAB 10MG
Pexeva TAB 20MG
Pexeva TAB 30MG
Pexeva TAB 40MG
PA
Pristiq TAB 100MG
PA
Pristiq TAB 25MG
PA
Pristiq TAB 50MG
Prozac CAP 10MG
Prozac CAP 20MG
Prozac CAP 40MG
Prozac Weekl CAP 90MG
Remeron Sltb TAB 15MG
Remeron TAB 15MG
Remeron TAB 30MG
Remeron TAB 45MG
Surmontil CAP 100MG
Surmontil CAP 25MG
Surmontil CAP 50MG
Tofranil TAB 10MG
Tofranil TAB 25MG
Tofranil TAB 50MG
Tofranil-PM CAP 100MG
QL,ST
Trintellix TAB 10MG
QL,ST
Trintellix TAB 20MG
QL,ST
Trintellix TAB 5MG
ST
Viibryd Kit
Viibryd Kit Starter
ST
Viibryd TAB 10MG
ST
Viibryd TAB 20MG
ST
Viibryd TAB 40MG
Vivactil TAB 10MG
Vivactil TAB 5MG
Wellbutrin TAB XL 150MG
Wellbutrin TAB XL 300MG
39
Wellbutrin TAB 100MG
Wellbutrin TAB 100MG SR
Wellbutrin TAB 75MG
Zoloft CON 20MG/ML
Zoloft TAB 100MG
Zoloft TAB 25MG
Zoloft TAB 50MG
ANTIPSYCHOTICS
TIER 01
GENERIC
PA
aripiprazole sol 1MG/ML
PA
aripiprazole TAB 10MG
PA
PA
PA
PA
PA
chlorpromaz inj 25MG/ML
chlorpromaz inj 50MG/2ML
chlorpromaz TAB 10MG
clozapine TAB 100MG
clozapine TAB 200MG
clozapine TAB 25MG
clozapine TAB 50MG
compro sup 25MG
fluphenaz DE inj 25MG/ML
fluphenazine elx 2.5/5ML
fluphenazine inj 2.5MG/ML
fluphenazine CON 5MG/ML
fluphenazine TAB 1MG
fluphenazine TAB 2.5MG
haloper lac inj 5MG/ML
haloper DEC inj 100MG/ML
haloper DEC inj 50MG/ML
haloperidol CON 2MG/ML
haloperidol TAB 0.5MG
haloperidol TAB 1MG
haloperidol TAB 10MG
haloperidol TAB 2MG
haloperidol TAB 20MG
haloperidol TAB 5MG
lithium sol 8meq/5ML
lithium CARB CAP 150MG
lithium CARB TAB 300MG
lithium CARB TAB 300MG ER
lithium CARB TAB 450MG ER
loxapine CAP 10MG
loxapine CAP 25MG
loxapine CAP 5MG
loxapine CAP 50MG
olanzapine TAB 10MG
olanzapine TAB 15MG
olanzapine TAB 2.5MG
olanzapine TAB 20MG
olanzapine TAB 5MG
olanzapine TAB 7.5MG
perphenazine TAB 16MG
TIER 02
TIER 03
prochlorper inj 10MG/2ML
prochlorper sup 25MG
prochlorper TAB 10MG
prochlorper TAB 5MG
quetiapine TAB 100MG
quetiapine TAB 25MG
quetiapine TAB 50MG
risperidone sol 1MG/ML
risperidone TAB 0.25MG
risperidone TAB 0.5MG
risperidone TAB 1MG
risperidone TAB 2MG
risperidone TAB 3MG
risperidone TAB 4MG
thiothixene CAP 1MG
thiothixene CAP 10MG
thiothixene CAP 2MG
thiothixene CAP 5MG
trifluoperaz TAB 1MG
ziprasidone CAP 20MG
PREFERRED
PA
Abilify Sol 1MG/ML
Risperdal Inj 12.5MG
Risperdal Inj 25MG
Risperdal Inj 37.5MG
Risperdal Inj 50MG
NON PREFERRED
PA
aripiprazole TAB 10MG odt
PA
aripiprazole TAB 15MG odt
clozapine TAB 100/odt
clozapine TAB 12.5/odt
clozapine TAB 25MG odt
molindone TAB HCL 10MG
olanzapine inj 10MG
olanzapine TAB 10MG odt
ST
paliperidone TAB ER 1.5MG
ST
paliperidone TAB ER 3MG
ST
ST
risperidone TAB 0.25 odt
risperidone TAB 0.5MG od
risperidone TAB 1MG odt
thioridazine TAB 10MG
PA
Abilify Disc TAB 10MG
PA
Abilify Disc TAB 15MG
Abilify Inj 9.75MG
PA
Abilify TAB 10MG
40
PA
Abilify TAB 15MG
PA
Abilify TAB 2MG
PA
Abilify TAB 20MG
PA
Abilify TAB 30MG
PA
Abilify TAB 5MG
ST
Aristada Inj 441MG/1.
ST
Aristada Inj 662MG/2
ST
Aristada Inj 882MG/3
Clozaril TAB 100MG
Clozaril TAB 25MG
Equetro CAP 100MG
Equetro CAP 200MG
Equetro CAP 300MG
ST
Fanapt PAK
ST
Fanapt TAB 1MG
ST
Fanapt TAB 10MG
ST
Fanapt TAB 12MG
ST
Fanapt TAB 2MG
ST
Fanapt TAB 4MG
ST
Fanapt TAB 6MG
ST
Fanapt TAB 8MG
Fazaclo TAB 100 Odt
Fazaclo TAB 12.5 Odt
Fazaclo TAB 150 Odt
Fazaclo TAB 200 Odt
Fazaclo TAB 25MG Odt
Geodon CAP 20MG
Geodon CAP 40MG
Geodon CAP 60MG
Geodon CAP 80MG
Geodon Inj 20MG
Haldol Decan Inj 100MG/ML
Haldol Decan Inj 50MG/ML
Haldol Inj 5MG/ML
ST
Invega Trinz Inj 273MG
ST
ST
ST
ST
Invega TAB 1.5MG
ST
Invega TAB 3MG
ST
Invega TAB 6MG
ST
Invega TAB 9MG
ST
Latuda TAB 120MG
ST
Latuda TAB 20MG
ST
Latuda TAB 40MG
ST
Latuda TAB 60MG
ST
Latuda TAB 80MG
Lithobid TAB 300MG CR
PA
Rexulti TAB 0.25MG
PA
Rexulti TAB 0.5MG
PA
Rexulti TAB 1MG
PA
Rexulti TAB 2MG
PA
Rexulti TAB 3MG
PA
Rexulti TAB 4MG
Risperdal M TAB 0.5MG
Risperdal M TAB 1MG
Risperdal M TAB 2MG
Risperdal M TAB 3MG
Risperdal M TAB 4MG
Risperdal Sol 1MG/ML
Risperdal TAB 0.25MG
Risperdal TAB 0.5MG
Risperdal TAB 1MG
Risperdal TAB 2MG
Risperdal TAB 3MG
Risperdal TAB 4MG
ST
Saphris Sub 10MG
Saphris Sub 2.5MG
ST
Saphris Sub 5MG
Seroquel TAB 100MG
TIER 05
Seroquel TAB 200MG
Seroquel TAB 25MG
Seroquel TAB 300MG
Seroquel TAB 400MG
Seroquel TAB 50MG
ST
Seroquel XR TAB 150MG
ST
ST
ST
ST
Versacloz Sus 50MG/ML
Zyprexa Inj 10MG
ST
Zyprexa Relp Inj 210MG
ST
ST
Zyprexa TAB 10MG
Zyprexa TAB 15MG
Zyprexa TAB 2.5MG
Zyprexa TAB 20MG
Zyprexa TAB 5MG
Zyprexa TAB 7.5MG
Zyprexa Zydi TAB 10MG
QL,ST
Abilify Main Inj 300MG
QL,ST
Abilify Main Inj 400MG
ST
Invega Sust Inj 117/0.75
ST
Invega Sust Inj 156MG/ML
ST
ST
ST
Invega Sust Inj 78/0.5ML
QL,PA
Nuplazid TAB 17MG
QL,PA
Vraylar CAP 1.5-3MG
QL,PA
Vraylar CAP 1.5MG
QL,PA
Vraylar CAP 3MG
QL,PA
Vraylar CAP 4.5MG
QL,PA
Vraylar CAP 6MG
HYPNOTICS
TIER 01
GENERIC
eszopiclone TAB 1MG
eszopiclone TAB 2MG
eszopiclone TAB 3MG
flurazepam CAP 15MG
flurazepam CAP 30MG
phenobarb elx 20MG/5ML
phenobarb inj 130MG/ML
phenobarb inj 65MG/ML
phenobarb sol 20MG/5ML
phenobarb TAB 100MG
phenobarb TAB 15MG
phenobarb TAB 16.2MG
phenobarb TAB 30MG
phenobarb TAB 60MG
temazepam CAP 15MG
temazepam CAP 30MG
temazepam CAP 7.5MG
triazolam TAB 0.125MG
triazolam TAB 0.25MG
zaleplon CAP 10MG
zaleplon CAP 5MG
zolpidem TAB 10MG
zolpidem TAB 5MG
TIER 02
41
TIER 03
TIER 05
PREFERRED
Seconal CAP 100MG
Seconal Sod CAP 100MG
NON PREFERRED
estazolam TAB 1MG
estazolam TAB 2MG
quazepam TAB 15MG
temazepam CAP 22.5MG
zolpidem ER TAB 12.5MG
zolpidem ER TAB 6.25MG
zolpidem TAR sub 1.75MG
zolpidem TAR sub 3.5MG
Ambien CR TAB 12.5MG
Ambien CR TAB 6.25MG
Ambien TAB 10MG
Ambien TAB 5MG
Amytal Sod Inj 500MG
PA
Belsomra TAB 10MG
PA
Belsomra TAB 15MG
PA
Belsomra TAB 20MG
PA
Belsomra TAB 5MG
Butisol Sod TAB 30MG
Butisol Sod TAB 50MG
Doral TAB 15MG
Edluar Sub 10MG
Edluar Sub 5MG
Halcion TAB 0.25MG
Intermezzo Sub 1.75MG
Intermezzo Sub 3.5MG
Lunesta TAB 1MG
Lunesta TAB 2MG
Lunesta TAB 3MG
Nembutal Sod Inj 50MG/ML
Restoril CAP 15MG
Restoril CAP 22.5MG
Restoril CAP 30MG
Restoril CAP 7.5MG
Rozerem TAB 8MG
Silenor TAB 3MG
Silenor TAB 6MG
Sonata CAP 10MG
Sonata CAP 5MG
Temazepam 7.5MG CAPS
Zolpimist Spr 5MG
QL,PA
Hetlioz CAP 20MG
TIER 02
ADHD, NARCOLEPSY, ETC.
TIER 01
GENERIC
QL
amphet/dextr CAP 10MG ER
QL
QL
QL
QL
QL
amphet/dextr TAB 10MG
amphet/dextr TAB 12.5MG
amphet/dextr TAB 7.5MG
QL
amphetamine CAP 10MG ER
QL
QL
QL
QL
QL
caffeine CIT sol 20MG/ML
TIER 03
caffeine CIT sol 60MG/3ML
dexedrine TAB 10MG
dexedrine TAB 5MG
dexmethylph TAB 10MG
dexmethylph TAB 2.5MG
dexmethylph TAB 5MG
QL
dextroamphet CAP 10MG ER
QL
QL
dextroamphet TAB 10MG
dextroamphet TAB 5MG
guanfacine TAB 1MG ER
QL
metadate TAB 20MG ER
QL
methylphenid CAP 10MG
QL
QL,ST
methylphenid CAP 20MG ER
QL
QL,ST
QL
QL,ST
QL
QL
methylphenid TAB 10MG
QL
methylphenid TAB 10MG ER
QL
QL
QL
methylphenid TAB 20MG SR
QL
QL
QL
PA
modafinil TAB 100MG
PA
modafinil TAB 200MG
zenzedi TAB 10MG
zenzedi TAB 5MG
QL
Adderall XR CAP 10MG
QL
QL
QL
QL
QL
Adderall XR CAP 5MG
PREFERRED
ST
Strattera CAP 10MG
ST
Strattera CAP 100MG
ST
Strattera CAP 18MG
ST
Strattera CAP 25MG
ST
Strattera CAP 40MG
ST
Strattera CAP 60MG
ST
Strattera CAP 80MG
NON PREFERRED
PA
armodafinil TAB 150MG
PA
PA
PA
caffeine/sod inj benzoate
clonidine TAB 0.1MG ER
QL,ST
dexmethylph CAP 15MG ER
QL,ST
QL,ST
QL,ST
dexmethylphe CAP 10MG ER
QL,ST
QL,ST
dextroamphet sol 5MG/5ML
methamphetam TAB 5MG
methlphenida chw 2.5MG
methylphenid chw 10MG
42
methylphenid chw 5MG
methylphenid sol 10MG/5ML
methylphenid sol 5MG/5ML
Adderall TAB 10MG
Adderall TAB 12.5MG
Adderall TAB 15MG
Adderall TAB 20MG
Adderall TAB 30MG
Adderall TAB 5MG
Adderall TAB 7.5MG
PA
Adzenys XR TAB 12.5MG
PA
Adzenys XR TAB 15.7 MG
PA
PA
PA
PA
Aptensio XR CAP 10MG
QL
Concerta TAB 18MG
QL
Concerta TAB 27MG
QL
Concerta TAB 36MG
QL
Concerta TAB 54MG
QL,ST
Daytrana Dis 10MG/9HR
QL,ST
QL,ST
QL,ST
Desoxyn TAB 5MG
QL
Dexedrine CAP 10MG CR
QL
QL
PA
Dyanavel XR Sus 2.5MG/ML
PA
Evekeo TAB 10MG
PA
Evekeo TAB 5MG
Focalin TAB 10MG
Focalin TAB 2.5MG
Focalin TAB 5MG
QL,ST
Focalin XR CAP 10MG
QL,ST
Focalin XR CAP 15MG
QL,ST
Focalin XR CAP 20MG
QL,ST
Focalin XR CAP 25MG
QL,ST
Focalin XR CAP 30MG
QL,ST
Focalin XR CAP 35MG
QL,ST
Focalin XR CAP 40MG
QL,ST
Focalin XR CAP 5MG
Intuniv TAB 1MG
Intuniv TAB 2MG
Intuniv TAB 3MG
Intuniv TAB 4MG
Kapvay TAB 0.1 MG
QL
Metadate CD CAP 10MG
QL
QL
QL
QL
QL
Methylin Chw 10MG
Methylin Chw 2.5MG
Methylin Chw 5MG
Methylin Sol 10MG/5ML
Methylin Sol 5MG/5ML
PA
Nuvigil TAB 150MG
PA
Nuvigil TAB 200MG
PA
Nuvigil TAB 250MG
PA
Nuvigil TAB 50MG
Procentra Sol 5MG/5ML
PA
Provigil TAB 100MG
PA
Provigil TAB 200MG
PA
Quillichew Chw 20MG ER
PA
PA
QL,ST
Quillivant Sus 25MG/5ML
QL,ST
Ritalin LA CAP 10MG
QL,ST
Ritalin LA CAP 20MG
QL,ST
Ritalin LA CAP 30MG
QL,ST
Ritalin LA CAP 40MG
Ritalin LA CAP 60MG
Ritalin TAB 10MG
Ritalin TAB 20MG
QL
Ritalin TAB 20MG SR
Ritalin TAB 5MG
QL,PA
Vyvanse CAP 10MG
QL,PA
Vyvanse CAP 20MG
QL,PA
Vyvanse CAP 30MG
QL,PA
Vyvanse CAP 40MG
QL,PA
Vyvanse CAP 50MG
QL,PA
Vyvanse CAP 60MG
QL,PA
Vyvanse CAP 70MG
Zenzedi TAB 15MG
Zenzedi TAB 2.5MG
Zenzedi TAB 20MG
Zenzedi TAB 30MG
Zenzedi TAB 7.5MG
ANTICONVULSANTS
TIER 01
GENERIC
carbamazepin chw 100MG
carbamazepin sus 100/5ML
carbamazepin CAP 100MG ER
carbamazepin TAB 100mger
carbamazepin TAB 200MG
carbamazepin TAB 200MG ER
carbamazepin TAB 400MG ER
clonazep odt TAB 0.125MG
clonazep odt TAB 1MG
clonazep odt TAB 2MG
clonazepam TAB 0.5MG
clonazepam TAB 1MG
clonazepam TAB 2MG
divalproex CAP 125MG
divalproex TAB 125MG DR
divalproex TAB 250MG ER
divalproex TAB 500MG ER
epitol TAB 200MG
ethosuximide sol 250/5ML
ethosuximide CAP 250MG
fosphenytoin inj 100/2ML
fosphenytoin inj 500/10ML
gabapentin sol 250/5ML
gabapentin sol 300/6ML
gabapentin CAP 100MG
gabapentin TAB 600MG
gabapentin TAB 800MG
lamotrigine chw 25MG
lamotrigine chw 5MG
lamotrigine TAB 100MG
43
TIER 02
TIER 03
levetiraceta sol 100MG/ML
levetiraceta sol 500/5ML
levetiraceta TAB 1000MG
levetiraceta TAB 500MG ER
levetiraceta TAB 750MG ER
oxcarbazepin sus 300MG/5m
oxcarbazepin TAB 150MG
phenytoin chw 50MG
phenytoin inj 50MG/ML
phenytoin sus 125/5ML
phenytoin EX CAP 100MG
primidone TAB 250MG
primidone TAB 50MG
roweepra TAB 500MG
topiragen TAB 100MG
topiragen TAB 200MG
topiragen TAB 25MG
topiragen TAB 50MG
topiramate CAP 15MG
topiramate CAP 25MG
topiramate TAB 100MG
topiramate TAB 200MG
topiramate TAB 25MG
topiramate TAB 50MG
valproic acd sol 250/5ML
valproic acd syp 250/5ML
valproic acd CAP 250MG
zonisamide CAP 100MG
zonisamide CAP 25MG
zonisamide CAP 50MG
Diastat PED Gel 2.5m Gel
PREFERRED
Celontin CAP 300MG
Dilantin CAP 30MG
NON PREFERRED
diazepam gel 10MG
diazepam gel 2.5MG
diazepam gel 20MG
felbamate sus 600/5ML
felbamate TAB 400MG
felbamate TAB 600MG
lamotrig odt kit 25/50MG
lamotrig odt kit 50/100MG
lamotrigine kit odt
lamotrigine TAB 100MG ER
lamotrigine TAB 25MG odt
lamotrigine TAB 50MG odt
tiagabine TAB 2MG
tiagabine TAB 4MG
topiramate CAP ER 100MG
Banzel Sus 40MG/ML
Banzel TAB 200MG
Banzel TAB 400MG
Carbatrol CAP 100MG
Carbatrol CAP 200MG
Carbatrol CAP 300MG
Cerebyx Inj 100/2ML
Cerebyx Inj 500/10ML
Depakene CAP 250MG
Depakene Syp 250/5ML
Depakote ER TAB 250MG
Depakote ER TAB 500MG
Depakote Spr CAP 125MG
Depakote TAB 125MG DR
Diastat Acdl Gel 12.5-20
Diastat Acdl Gel 5-10MG
Dilantin Chw 50MG
Dilantin CAP 100MG
Dilantin-125 Sus 125/5ML
Felbatol Sus 600/5ML
Felbatol TAB 400MG
Felbatol TAB 600MG
Fycompa Sus 0.5MG/ML
QL,ST
Fycompa TAB 10MG
QL,ST
Fycompa TAB 12MG
QL,ST
Fycompa TAB 2MG
QL,ST
Fycompa TAB 4MG
QL,ST
Fycompa TAB 6MG
QL,ST
Fycompa TAB 8MG
Gabitril TAB 12MG
Gabitril TAB 16MG
Gabitril TAB 2MG
Gabitril TAB 4MG
Keppra Sol 100MG/ML
Keppra TAB 1000MG
Keppra TAB 250MG
Keppra TAB 500MG
Keppra TAB 750MG
Keppra XR TAB 500MG
Keppra XR TAB 750MG
Klonopin TAB 0.5MG
Klonopin TAB 1MG
Klonopin TAB 2MG
Lamictal Chw 2MG
Lamictal Chw 25MG
Lamictal Chw 5MG
Lamictal Kit Start 35
Lamictal Odt Kit
Lamictal Odt TAB 100MG
Lamictal TAB 100MG
Lamictal TAB 150MG
Lamictal TAB 200MG
Lamictal TAB 25MG
Lamictal XR Kit
Lamictal XR TAB 100MG
QL,PA
Lyrica CAP 100MG
QL,PA
Lyrica CAP 150MG
QL,PA
Lyrica CAP 200MG
QL,PA
Lyrica CAP 225MG
QL,PA
Lyrica CAP 25MG
44
QL,PA
TIER 05
Lyrica CAP 300MG
QL,PA
Lyrica CAP 50MG
QL,PA
Lyrica CAP 75MG
QL,PA
Lyrica Sol 20MG/ML
Mysoline TAB 250MG
Mysoline TAB 50MG
Neurontin CAP 100MG
Neurontin CAP 300MG
Neurontin CAP 400MG
Neurontin Sol 250/5ML
Neurontin TAB 600MG
Neurontin TAB 800MG
Onfi Sus 2.5MG/ML
Onfi TAB 10MG
Onfi TAB 20MG
Oxtellar XR TAB 150MG
Peganone TAB 250MG
Phenytek CAP 200MG
Phenytek CAP 300MG
Potiga TAB 200MG
Potiga TAB 300MG
Potiga TAB 400MG
Potiga TAB 50MG
PA
Qudexy XR CAP 100/24HR
PA
PA
PA
PA
Spritam TAB 1000MG
Spritam TAB 250MG
Spritam TAB 500MG
Spritam TAB 750MG
Stavzor CAP 125MG
Stavzor CAP 250MG
Stavzor CAP 500MG
Tegretol Sus 100/5ML
Tegretol TAB 200MG
Tegretol-XR TAB 100MG
Topamax Spr CAP 15MG
Topamax Spr CAP 25MG
Topamax TAB 100MG
Topamax TAB 200MG
Topamax TAB 25MG
Topamax TAB 50MG
Trileptal Sus 300MG/5m
Trileptal TAB 150MG
Trileptal TAB 300MG
Trileptal TAB 600MG
PA
Trokendi XR CAP 100MG
PA
PA
PA
Vimpat Sol 10MG/ML
Vimpat TAB 100MG
Vimpat TAB 150MG
Vimpat TAB 200MG
Vimpat TAB 50MG
Zarontin CAP 250MG
Zarontin Sol 250/5ML
Zonegran CAP 100MG
Zonegran CAP 25MG
QL,PA
Aptiom TAB 200MG
QL,PA
Aptiom TAB 400MG
QL,PA
Aptiom TAB 600MG
QL,PA
Aptiom TAB 800MG
PA
Briviact Sol 10MG/ML
PA
Briviact TAB 10MG
PA
Briviact TAB 100MG
PA
Briviact TAB 25MG
PA
Briviact TAB 50MG
PA
Briviact TAB 75MG
PA
Sabril Pow 500MG
PA
Sabril TAB 500MG
ANTIPARKINSON AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
amantadine syp 50MG/5ML
amantadine CAP 100MG
amantadine TAB 100MG
benztropine inj 1MG/ML
benztropine TAB 0.5MG
benztropine TAB 1MG
benztropine TAB 2MG
bromocriptin CAP 5MG
bromocriptin TAB 2.5MG
carbidopa TAB 25MG
entacapone TAB 200MG
pramipexole TAB 0.125MG
pramipexole TAB 1MG
ropinirole TAB 0.25MG
ropinirole TAB 0.5MG
ropinirole TAB 1MG
ropinirole TAB 2MG
ropinirole TAB 3MG
ropinirole TAB 4MG
ropinirole TAB 5MG
selegiline CAP 5MG
selegiline TAB 5MG
trihexyphen elx 0.4MG/ML
trihexyphen TAB 2MG
trihexyphen TAB 5MG
CARB/levo ER TAB 25-100MG
CARB/levo ER TAB 50-200MG
CARB/levo TAB 10-100MG
CARB/levo 50 TAB /entacap
CARB/levo 75 TAB /entacap
CARB/levo100 TAB /entacap
Lodosyn TAB 25MG
PREFERRED
PA
Azilect TAB 0.5MG
PA
Azilect TAB 1MG
NON PREFERRED
pramipexole TAB 0.75 ER
pramipexole TAB 1.5MG ER
pramipexole TAB 3MG
ropinirole TAB 12MG ER
tolcapone TAB 100MG
45
TIER 04
TIER 05
Cogentin Inj 1MG/ML
Comtan TAB 200MG
Eldepryl CAP 5MG
Mirapex ER TAB 0.375MG
Mirapex ER TAB 3MG
Mirapex TAB 0.125MG
Mirapex TAB 0.25MG
Mirapex TAB 0.5MG
Mirapex TAB 0.75MG
Mirapex TAB 1.5MG
Mirapex TAB 1MG
Neupro Dis 1MG/24HR
Neupro Dis 2MG/24HR
Neupro Dis 3MG/24HR
Neupro Dis 4MG/24HR
Neupro Dis 6MG/24HR
Neupro Dis 8MG/24HR
Parlodel CAP 5MG
Requip TAB 0.25MG
Requip TAB 0.5MG
Requip TAB 1MG
Requip TAB 2MG
Requip TAB 3MG
Requip TAB 4MG
Requip TAB 5MG
Requip XL TAB 12MG
Requip XL TAB 2MG
Requip XL TAB 4MG
Requip XL TAB 6MG
Requip XL TAB 8MG
PA
Rytary CAP 145MG
PA
Rytary CAP 195MG
PA
Rytary CAP 245MG
PA
Rytary CAP 95MG
Sinemet CR TAB 25-100MG
Sinemet CR TAB 50-200MG
Sinemet TAB 10-100MG
Stalevo 100 TAB
Stalevo 125 TAB
Stalevo 150 TAB
Stalevo 200 TAB
Stalevo 50 TAB
Stalevo 75 TAB
Tasmar TAB 100MG
Zelapar TAB 1.25MG
SPECIALTY
PA
Duopa Sus 4.63-20
QL
Apokyn Inj 10MG/ML
NEUROLOGY, PSYCH - MISC.
TIER 01
GENERIC
acampro CAL TAB 333MG
buproban TAB 150MG
bupropion TAB 150MG
disulfiram TAB 250MG
disulfiram TAB 500MG
donepezil TAB 10MG
donepezil TAB 5MG
PA
eq nicotine dis 14MG/24h
PA
eq nicotine dis 21MG/24h
PA
eq nicotine dis 7MG/24HR
PA
TIER 02
eql nicotine dis 14MG/24h
PA
eql nicotine dis 21MG/24h
PA
eql nicotine dis 7MG/24HR
fluoxetine CAP 10MG
fluoxetine CAP 20MG
galantamine sol 4MG/ML
galantamine CAP 16MG ER
galantamine TAB 12MG
galantamine TAB 4MG
galantamine TAB 8MG
memantine TAB HCL 10MG
memantine TAB HCL 5MG
PA
nicotine dis step 1
PA
nicotine dis step 2
PA
nicotine dis step 3
PA
nicotine dis 14MG/24h
PA
nicotine dis 21MG/24h
PA
nicotine dis 7MG/24HR
nicotine SYS kit transder
PA
nicotine TD dis 14MG/24h
PA
nicotine TD dis 21MG/24h
PA
nicotine TD dis 7MG/24HR
perphen/amit TAB 2-10MG
pimozide TAB 1MG
pimozide TAB 2MG
PA
ra nicotine dis 14MG/24h
PA
ra nicotine dis 21MG/24h
PA
ra nicotine dis 7MG/24HR
rivastigmine CAP 1.5MG
rivastigmine CAP 3MG
rivastigmine CAP 4.5MG
rivastigmine CAP 6MG
PA
sm nicotine dis 14MG/24h
PA
sm nicotine dis 21MG
PA
sm nicotine dis 21MG/24h
PA
sm nicotine dis 7MG/24HR
PA
tgt nicotine dis 14MG/24h
PA
tgt nicotine dis 21MG/24h
PA
tgt nicotine dis 7MG/24HR
PA
CVS nicotine dis 14MG/24h
PA
CVS nicotine dis 7MG/24HR
PA
CVS nts dis step 1
PA
HM nicotine dis 14MG/24h
PA
HM nicotine dis 21MG/24h
PREFERRED
PA
eq nicotine gum 2mgfruit
PA
eq nicotine gum 2MG cinn
PA
eq nicotine gum 2MG mint
PA
eq nicotine gum 2MG orig
PA
eq nicotine gum 4mgfruit
PA
eq nicotine gum 4MG cinn
PA
eq nicotine gum 4MG mint
PA
eq nicotine gum 4MG orig
PA
eq nicotine gum 4MG ref
PA
eq nicotine gum 4MG strt
PA
eq nicotine loz 2MG cher
PA
eq nicotine loz 2MG mint
PA
eq nicotine loz 4MG chry
PA
eq nicotine loz 4MG mint
PA
eql nicotine gum 2MG
PA
eql nicotine gum 2MG ref
PA
eql nicotine gum 2MG strt
PA
eql nicotine gum 4MG
PA
eql nicotine gum 4MG ref
46
PA
eql nicotine gum 4MG strt
PA
eql nicotine loz 2MG mint
PA
eql nicotine loz 4MG mint
PA
gnp nicotine gum 2MG mint
PA
gnp nicotine gum 2MG orig
PA
gnp nicotine gum 4MG mint
PA
gnp nicotine gum 4MG orig
PA
gnp nicotine loz mini 2MG
PA
gnp nicotine loz 2MG mint
PA
gnp nicotine loz 4MG mint
PA
kls quit2 gum 2MG
PA
kls quit2 loz 2MG
PA
kls quit4 gum 4MG
PA
kls quit4 loz 4MG
PA
nicorelief gum 2MG mint
PA
nicorelief gum 2MG orig
PA
nicorelief gum 4MG mint
PA
nicorelief gum 4MG orig
PA
nicotine gum 2mgfruit
PA
nicotine gum 4MG
PA
nicotine loz mini 2MG
PA
nicotine loz 2MG chry
PA
nicotine loz 2MG mint
PA
nicotine loz 4MG chry
PA
nicotine loz 4MG cinn
PA
nicotine loz 4MG mint
PA
nicotine pol gum 2mgfruit
PA
nicotine pol gum 2MG
PA
nicotine pol gum 2MG cinn
PA
nicotine pol gum 2MG mint
PA
nicotine pol gum 2MG orig
PA
nicotine pol gum 2MG ref
PA
nicotine pol gum 2MG strt
PA
nicotine pol gum 4mgfruit
PA
nicotine pol gum 4MG
PA
nicotine pol gum 4MG cinn
PA
nicotine pol gum 4MG mint
PA
nicotine pol gum 4MG orig
PA
nicotine pol gum 4MG ref
PA
nicotine pol gum 4MG strt
PA
nicotine pol loz 2MG chry
PA
nicotine pol loz 2MG cinn
PA
nicotine pol loz 2MG mint
PA
nicotine pol loz 4MG chry
PA
nicotine pol loz 4MG cinn
PA
nicotine pol loz 4MG mint
PA
qc nicotine gum 4MG
PA
ra nicotine gum 2mgfruit
PA
ra nicotine gum 2MG
PA
ra nicotine gum 2MG cinn
PA
ra nicotine gum 2MG mint
PA
ra nicotine gum 4MG
PA
ra nicotine gum 4MG frut
PA
ra nicotine gum 4MG mint
PA
ra nicotine loz 2MG mint
PA
ra nicotine loz 4MG mint
PA
sm nicotine gum 2MG
PA
sm nicotine gum 2MG mint
PA
sm nicotine gum 4MG
PA
sm nicotine gum 4MG mint
PA
sm nicotine loz 2MG mint
PA
sm nicotine loz 4MG mint
PA
stop smoking gum 2MG mint
PA
stop smoking gum 2MG orig
PA
stop smoking gum 4MG
PA
stop smoking loz 2MG
PA
stop smoking loz 2MG mint
PA
stop smoking loz 4MG mint
PA
sw nicotine gum 2MG mint
PA
sw nicotine gum 4MG
PA
TIER 03
sw nicotine loz 2MG mint
PA
sw nicotine loz 4MG mint
PA
tgt nicotine gum 2mgfruit
PA
tgt nicotine gum 2MG mint
PA
tgt nicotine gum 2MG orig
PA
tgt nicotine gum 4MG
PA
tgt nicotine gum 4MG mint
PA
tgt nicotine gum 4MG orig
PA
tgt nicotine loz 2MG chry
PA
tgt nicotine loz 2MG mint
PA
tgt nicotine loz 4MG chry
PA
tgt nicotine loz 4MG mint
PA
thrive gum 2MG mint
Chantix PAK 0.5& 1MG
Chantix PAK 1MG
Chantix TAB 0.5MG
Chantix TAB 1MG
PA
Commit Loz 2MG
PA
Commit Loz 4MG
PA
Commit Loz 4MG Chry
PA
CVS nicotine gum 2mgfruit
PA
CVS nicotine gum 2MG cinn
PA
CVS nicotine gum 2MG mint
PA
CVS nicotine gum 2MG orig
PA
CVS nicotine gum 4mgfruit
PA
CVS nicotine gum 4MG cinn
PA
CVS nicotine gum 4MG mint
PA
CVS nicotine gum 4MG orig
PA
CVS nicotine loz 2MG
PA
CVS nicotine loz 2MG mint
PA
CVS nicotine loz 4MG mint
PA
HM nicotine gum 2MG mint
PA
HM nicotine gum 4MG mint
PA
HM nicotine loz 2MG mint
PA
HM nicotine loz 4MG mint
PA
Nicoderm CQ Dis 14MG/24h
PA
Nicoderm CQ Dis 21MG/24h
PA
Nicoderm CQ Dis 7MG/24HR
PA
Nicorette Gum 2mgfruit
PA
Nicorette Gum 2MG Cinn
PA
Nicorette Gum 2MG Mint
PA
Nicorette Gum 2MG Orig
PA
Nicorette Gum 4mgfruit
PA
Nicorette Gum 4MG Cinn
PA
Nicorette Gum 4MG Mint
PA
Nicorette Gum 4MG Orig
PA
Nicorette Loz 2MG Chry
PA
Nicorette Loz 2MG Mint
PA
Nicorette Loz 2MG Orig
PA
Nicorette Loz 4MG Chry
PA
Nicorette Loz 4MG Mint
PA
Nicorette Loz 4MG Orig
PA
Nicorette ST Gum 2MG
PA
Nicorette ST Gum 2MG Mint
PA
Nicorette ST Gum 2MG Orig
PA
Nicorette ST Gum 4MG Mint
PA
Nicorette ST Gum 4MG Orig
PA
SR nicotine gum 2MG
NON PREFERRED
cdp/amitrip TAB 10-25MG
cdp/amitrip TAB 5-12.5MG
donepezil TAB HCL 23MG
donepezil TAB 10MG odt
donepezil TAB 5MG odt
ergoloid mes TAB 1MG oral
memant titra PAK 5-10MG
memantine HC sol 2MG/ML
olanza/fluox CAP 12-25MG
47
TIER 04
rivastigmine dis 13.3/24
rivastigmine dis 4.6MG/24
rivastigmine dis 9.5MG/24
Active-PAC/ Mis Gaba 300
Antabuse TAB 250MG
Antabuse TAB 500MG
Aricept Odt TAB 10MG
Aricept TAB 10MG
Aricept TAB 23MG
Aricept TAB 5MG
Brisdelle CAP 7.5MG
Campral TAB 333MG
Exelon CAP 1.5MG
Exelon CAP 3MG
Exelon CAP 4.5MG
Exelon CAP 6MG
Exelon Dis 13.3/24
Exelon Dis 4.6MG/24
Exelon Dis 9.5MG/24
Gralise Star Mis 300/600
Gralise TAB 300MG
Gralise TAB 600MG
Horizant TAB 300MG
Horizant TAB 600MG
Namenda Sol 10MG/5ML
PA
Namenda TAB 10MG
PA
Namenda TAB 5-10MG
PA
Namenda TAB 5MG
PA
Namenda XR CAP Titratio
PA
Namenda XR CAP 14MG
PA
Namenda XR CAP 21MG
PA
Namenda XR CAP 28MG
PA
Namenda XR CAP 7MG
Namzaric CAP 14-10MG
Namzaric CAP 7-10MG
Nuedexta CAP 20-10MG
Razadyne ER CAP 16MG
Razadyne ER CAP 24MG
Razadyne ER CAP 8MG
Razadyne Sol 4MG/ML
Razadyne TAB 12MG
Razadyne TAB 4MG
Razadyne TAB 8MG
Sarafem TAB 10MG
Sarafem TAB 20MG
ST
Savella Mis Titr PAK
ST
Savella TAB 100MG
ST
Savella TAB 12.5MG
ST
Savella TAB 25MG
ST
Savella TAB 50MG
Smartrx PAK Gaba-v
Symbyax CAP 12-25MG
Symbyax CAP 12-50MG
Symbyax CAP 3-25MG
Symbyax CAP 6-25MG
Symbyax CAP 6-50MG
SPECIALTY
QL
glatopa inj 20MG/ML
QL,PA
Avonex Kit 30mcg
QL,PA
Avonex Pen Kit 30mcg
QL,PA
Avonex Prefl Kit 30mcg
QL
Extavia Inj 0.3MG
QL,PA
Gilenya CAP 0.5MG
QL,PA
Rebif Inj 22/0.5
QL,PA
Rebif Inj 44/0.5
QL,PA
Rebif Rebido Inj Titratn
QL,PA
TIER 05
Rebif Rebido Inj 22/0.5
QL,PA
Rebif Rebido Inj 44/0.5
QL,PA
Rebif Titrtn Inj Pack
QL,PA
tetrabenazin TAB 12.5MG
QL,PA
tetrabenazin TAB 25MG
QL,PA
Ampyra TAB 10MG
QL,PA
Aubagio TAB 14MG
QL,PA
Aubagio TAB 7MG
QL,PA
Betaseron Inj 0.3MG
QL
Copaxone Inj 20MG/ML
QL,PA
Copaxone Inj 40MG/ML
Orap TAB 1MG
Orap TAB 2MG
QL,PA
Plegridy Inj
QL,PA
Plegridy Inj Pen
QL,PA
Plegridy Inj Starter
QL,PA
Plegridy Pen Inj Starter
QL,PA
Tecfidera CAP 120MG
QL,PA
Tecfidera CAP 240MG
QL,PA
Tecfidera Mis Starter
QL,PA
Xenazine TAB 12.5MG
QL,PA
Xenazine TAB 25MG
QL,PA
Xyrem Sol 500MG/ML
QL,PA
Zinbryta Inj 150MG/ML
NEUROMUSCULAR AGENTS
TIER 01
TIER 03
GENERIC
QL
riluzole TAB 50MG
NON PREFERRED
QL
Rilutek TAB 50MG
Xeomin Inj 200unit
MUSCULOSKELETAL AGENTS
TIER 01
TIER 03
GENERIC
baclofen TAB 10MG
baclofen TAB 20MG
cyclobenzapr TAB 10MG
cyclobenzapr TAB 5MG
dantrolene CAP 100MG
dantrolene CAP 25MG
dantrolene CAP 50MG
methocarbam inj 100MG/ML
methocarbam TAB 500MG
methocarbam TAB 750MG
orphenadrine TAB 100MG ER
tizanidine TAB 2MG
tizanidine TAB 4MG
NON PREFERRED
PA
carisopr/asa TAB 200-325
PA
carisoprodol TAB asa/cod
PA
carisoprodol TAB 250MG
PA
carisoprodol TAB 350MG
chlorzoxazon TAB 500MG
cyclobenzapr TAB 7.5MG
metaxall TAB 800MG
metaxalone TAB 400MG
metaxalone TAB 800MG
orphenadrine inj 30MG/ML
tizanidine CAP 2MG
tizanidine CAP 4MG
tizanidine CAP 6MG
Amrix CAP 15MG
Amrix CAP 30MG
Cyclo/Gaba PAK 10/300
Cyclobenzapr PAK Pax
Dantrium CAP 25MG
Dantrium CAP 50MG
Fexmid TAB 7.5MG
48
First-baclof Sus 1
First-baclof Sus 5 Kit
Flexepax Mis
Lorzone TAB 375MG
Lorzone TAB 750MG
Norflex Inj 30MG/ML
Parafon Fort TAB 500MG
Robaxin Inj 100MG/ML
Robaxin TAB 500MG
Robaxin-750 TAB 750MG
Skelaxin TAB 800MG
PA
Soma TAB 250MG
PA
Soma TAB 350MG
Zanaflex CAP 2MG
Zanaflex CAP 4MG
Zanaflex CAP 6MG
Zanaflex TAB 4MG
ANTIMYASTHENIC AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
neostig meth inj 0.5MG/ML
neostig meth inj 1MG/ML
pyridostigm TAB 60MG
pyridostigmi TAB 180MG
Enlon Inj 150/15ML
PREFERRED
Mestinon Syp 60MG/5ML
NON PREFERRED
guanidine TAB 125MG
Mestinon TAB Timespan
Mestinon TAB 60MG
Besivance Sus 0.6%
Betadine Sol 5% Op
Bleph-10 Sol 10% Op
Ciloxan Sol 0.3% Op
Garamycin Sol 0.3% Op
Natacyn Sus 5% Op
Neosporin Sol Op
Ocuflox Dro 0.3% Op
Polytrim Sol Op
Tobrex Sol 0.3% Op
Viroptic Sol 1% Op
Zirgan Gel 0.15%
ARTIFICIAL TEAR/LUBRICANT
TIER 02
BETA-BLOCKERS
TIER 01
TIER 02
TIER 03
OPHTHALMOLOGY AND OTIC
ANTI-INFECTIVES
TIER 01
TIER 02
TIER 03
GENERIC
ak-poly-bac oin op
bacit/polymy oin op
bacitracin oin op
ciprofloxacn sol 0.3% op
erythromycin oin op
erythromycin oin 5MG/gm
gatifloxacin sol 0.5%
gentak oin 0.3% op
gentamicin oin 0.3% op
gentamicin sol 0.3% op
ilotycin oin op
neo/poly/gra sol op
ofloxacin dro 0.3% op
polycin b oin op
polycin oin op
polymyxin b/ sol trimethp
romycin oin op
sod sulfacet sol 10% op
sulfacet sod oin 10% op
sulfacet sod sol 10% op
tobramycin sol 0.3% op
trifluridine sol 1% op
trimethoprim sol polymyxn
Zymaxid Sol 0.5%
PREFERRED
Ciloxan Oin 0.3% Op
Moxeza Sol 0.5%
Tobrex Oin 0.3% Op
Vigamox Dro 0.5%
NON PREFERRED
levofloxacin sol 0.5%
neo-polycin oin op
neo/bac/poly oin op
Azasite Sol 1%
PREFERRED
Lacrisert Mis 5MG Op
GENERIC
betaxolol sol 0.5% op
carteolol sol 1% op
dorzol/timol sol 22.3-6.8
levobunolol sol 0.5% op
metipranolol sol 0.3% oph
timolol gel sol 0.25% op
timolol gel sol 0.5% op
timolol mal sol 0.25% op
timolol mal sol 0.5% op
PREFERRED
Betoptic-s Sus 0.25% Op
NON PREFERRED
istalol sol 0.5% op
Betagan Sol 0.5% Op
Betimol Sol 0.25%
Betimol Sol 0.5%
Combigan Sol 0.2/0.5%
Cosopt PF Sol
Cosopt Sol 22.3-6.8
Istalol Sol 0.5% Op
Timoptic Ocu Sol 0.25% Op
Timoptic Ocu Sol 0.5% Op
Timoptic Sol 0.25% Op
Timoptic Sol 0.5% Op
Timoptic-xe Sol 0.25% Op
Timoptic-xe Sol 0.5% Op
OPHTHALMIC STEROIDS
TIER 01
TIER 02
GENERIC
dexameth PHO sol 0.1% op
fluoromethol sus 0.1% op
neo-polycin oin HC 1%op
neo/poly/bac oin /HC 1%op
neo/poly/dex oin 0.1% op
neo/poly/dex sus 0.1% op
poly-dex oin 0.1% op
prednisolone sus 1% op
sulf/pred NA sol op
tobra/dexame sus 0.3-0.1%
PREFERRED
Blephamide Oin S.o.p.
Blephamide Sus Op
Durezol Emu 0.05%
FML Forte Sus 0.25% Op
FML Oin 0.1% Op
Pred Mild Sus 0.12% Op
Pred-G S.o.p Oin Op
Pred-G Sus Op
Tobradex Oin 0.3-0.1%
Vexol Sus 1% Op
49
TIER 03
NON PREFERRED
neo/poly/HC sus op
pred sod PHO sol 1% op
predni/moxi/ sol bromfena
prednisolone sol moxiflox
Alrex Sus 0.2%
Flarex Sus 0.1% Op
FML Liquiflm Sus 0.1% Op
Lotemax Gel 0.5%
Lotemax Oin 0.5%
Lotemax Sus 0.5%
Maxidex Sus 0.1% Op
Maxitrol Oin 0.1% Op
Maxitrol Sus 0.1% Op
Omnipred Sus 1% Op
Pred Forte Sus 1% Op
Predni/Moxi/ Sol Ketorola
Tobradex Sus 0.3-0.1%
Tobradex ST Sus 0.3-0.05
Zylet Sus 0.5-0.3%
PROSTAGLANDINS
TIER 01
TIER 02
TIER 03
GENERIC
bimatoprost sol 0.03%
latanoprost sol 0.005%
travoprost dro 0.004%
PREFERRED
Lumigan Sol 0.01%
Travatan Z Dro 0.004%
NON PREFERRED
Rescula Sol 0.15%
Xalatan Sol 0.005%
Zioptan Dro 0.0015%
CYCLOPLEGIC MYDRIATICS
TIER 01
TIER 03
GENERIC
atropin-care sol 1% op
atropine SUL oin 1% op
atropine SUL sol 1% op
cyclopentol sol 1% op
cyclopentol sol 2% op
homatropaire sol 5% op
homatropine sol 5% op
NON PREFERRED
cyclopentola sol 0.5%
Cyclogyl Sol 0.5% Op
Cyclogyl Sol 1% Op
Cyclogyl Sol 2% Op
Cyclomydril Sol Op
Iso Atropine Sol 1% Op
Isopto Carp Sol 2% Op
Phospholine Sol 0.125%op
ADRENERGIC AGENTS
TIER 01
TIER 03
IMMUNOMODULATORS
TIER 02
TIER 03
TIER 03
TIER 01
TIER 02
TIER 03
GENERIC
altafrin sol 10% op
altafrin sol 2.5% op
neofrin sol 10% op
neofrin sol 2.5% op
phenylephrin sol 10% op
phenylephrin sol 2.5% op
NON PREFERRED
naphazoline sol 0.1% op
TIER 03
GENERIC
pilocarpine sol 1% op
NON PREFERRED
NON PREFERRED
altacaine sol 0.5% op
parcaine sol 0.5% op
proparacaine sol 0.5% op
tetcaine sol 0.5% op
tetracaine sol 0.5% op
tetravisc sol forte
tetravisc sol 0.5% op
Akten Gel 3.5%
Alcaine Sol 0.5% Op
OPHTHALMICS - MISC.
MIOTICS
TIER 01
PREFERRED
PA
Restasis Emu 0.05%
LOCAL ANESTHETICS
DECONGESTANTS
TIER 01
GENERIC
brimonidine sol 0.2% op
NON PREFERRED
apraclonidin sol 0.5% op
brimonidine sol 0.15%
Alphagan P Sol 0.1%
Alphagan P Sol 0.15%
Iopidine Sol 0.5% Op
Iopidine Sol 1% Op
Simbrinza Sus 1-0.2%
TIER 05
GENERIC
azelastine dro 0.05%
cromolyn sod sol 4% op
diclofenac sol 0.1% op
dorzolamide sol 2% op
flurbiprofen sol 0.03% op
ketorolac sol 0.4%
ketorolac sol 0.5%
olopatadine dro 0.1%
PREFERRED
Alomide Sol 0.1% Op
Azopt Sus 1% Op
NON PREFERRED
bromfenac sol 0.09% op
epinastine dro 0.05%
Acular LS Sol 0.4%
Acular Sol 0.5% Op
Acuvail Sol 0.45%
Alocril Sol 2%
Bepreve Dro 1.5%
Elestat Dro 0.05%
Emadine Sol 0.05% Op
Ilevro Dro 0.3% Op
Lastacaft Sol 0.25%
Nevanac Sus 0.1%
Ocufen Sol 0.03% Op
Optivar Dro 0.05%
Pataday Sol 0.2%
Patanol Sol 0.1% Op
Pazeo Dro 0.7%
Prolensa Sol 0.07%
Trusopt Sol 2% Op
Cystaran Sol 0.44%
50
OTIC AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
acetic acid sol 2% otic
antipy/benzo sol otic
neo/poly/HC sol 1% otic
neo/poly/HC sus 1% otic
ofloxacin dro 0.3%otic
PREFERRED
Cipro HC Sus Otic
Ciprodex Sus 0.3-0.1%
NON PREFERRED
ace acd/alum sol 2% otic
acetasol HC sol otic
aero otic HC sol
ciprofloxacn sol 0.2%
cortic-nd dro
cyotic dro
exotic-HC dro otic
fluocin acet oil ear0.01%
fluocin acet oil 0.01%
otic care dro
oticin dro 1-0.1%
oto-end 10 sol
otomax-HC dro
otozin dro
Cetraxal Sol 0.2%
Coly-mycin S Sus Otic
Cortane-b Dro AQ Otic
Cortane-b Dro Otic
Cortisporin Sus -tc Otic
Dermotic Oil 0.01%
Floxin Sol 0.3%
HC/acet acid sol otic
Oticin HC Dro
Otovel Dro
Pinnacaine Dro 20% Otic
Pramotic Dro 1-0.1%
Vosol HC Sol Otic
OXYTOCICS
TIER 01
TIER 02
TIER 03
GENERIC
methergine TAB 0.2MG
methylergon inj 0.2MG/ML
methylergon TAB 0.2MG
oxytocin inj 10unt/ML
PREFERRED
Cervidil Vag Mis 10MG INS
Prepidil Gel 0.5MG/3G
Prostin E2 Sup 20MG
NON PREFERRED
Hemabate Inj 250mcg
Pitocin Inj 10unt/ML
PAIN MANAGEMENT
ANALGESICS - NONNARCOTIC
TIER 01
TIER 03
GENERIC
but/apap/caf TAB
but/asa/caff CAP
cho MAG tris liq 500/5ML
diflunisal TAB 500MG
salsalate TAB 500MG
salsalate TAB 750MG
NON PREFERRED
alagesic LQ sol
but/apap/caf CAP
butal/apap TAB 50-325MG
capacet CAP
cho MAG tris TAB 1000MG
duraxin CAP
ed-flex CAP
esgic CAP
margesic CAP
marten-TAB tab 50-325MG
tencon TAB 50-325MG
vanatol LQ sol
zebutal CAP
Allzital TAB 25-325MG
Bupap TAB 50-300MG
Disalcid TAB 500MG
Disalcid TAB 750MG
Esgic TAB
Fioricet CAP
Fiorinal CAP
Levacet TAB
ANALGESICS - OPIOID
TIER 01
GENERIC
QL
apap/codeine sol 120-12/5
QL
apap/codeine TAB 300-15MG
QL
QL
bupren/nalox sub 2-0.5MG
bupren/nalox sub 8-2MG
buprenorphin inj 0.3MG/ML
buprenorphin sub 2MG
buprenorphin sub 8MG
butorphanol inj 1MG/ML
butorphanol inj 2MG/ML
codeine sulf TAB 15MG
QL
endocet TAB 10-325MG
QL
endocet TAB 2.5-325
QL
endocet TAB 5-325MG
QL
endocet TAB 7.5-325
endodan TAB
QL,PA
fentanyl dis 100mcg/h
QL,PA
fentanyl dis 12mcg/HR
QL,PA
QL,PA
QL,PA
QL
hydroco/apap sol 7.5-325
QL
hydroco/apap sol 7.5-500
QL
hydroco/apap TAB 10-325MG
QL
QL
hydroco/apap TAB 7.5-325
hydromorphon inj 1MG/ML
hydromorphon inj 50MG/5ML
hydromorphon inj 500/50ML
hydromorphon liq 1MG/ML
hydromorphon sup 3MG
hydromorphon TAB 2MG
levorphanol TAB 2MG
QL
lorcet plus TAB 7.5-325
QL
lorcet HD TAB 10-325MG
QL
lorcet TAB 5-325MG
QL
lortab TAB 10-325MG
QL
lortab TAB 5-325MG
QL
lortab TAB 7.5-325
meperidine inj 10MG/ML
51
TIER 02
TIER 03
QL
methadone sol 10MG/5ML
QL
methadone sol 5MG/5ML
QL
methadone CON 10MG/ML
QL
methadone TAB 10MG
QL
methadone TAB 5MG
morphine SUL inj 0.5MG/ML
morphine SUL inj 1MG/ML
morphine SUL inj 10/0.7ML
morphine SUL sol 10MG/5ML
morphine SUL sol 100/5ML
morphine SUL sol 20MG/5ML
morphine SUL sup 10MG
QL
morphine SUL TAB 100MG ER
morphine SUL TAB 15MG
QL
QL
morphine SUL TAB 30MG
QL
QL
QL
oxycod/apap TAB 10-325MG
QL
oxycod/apap TAB 2.5-325
QL
oxycod/apap TAB 5-325MG
QL
oxycod/apap TAB 7.5-325
oxycod/asa TAB
oxycodone sol 5MG/5ML
oxycodone CON 100/5ML
oxycodone CON 20MG/ML
oxycodone TAB 10MG
QL,ST
oxycodone TAB 10MG ER
oxycodone TAB 15MG
oxycodone TAB 20MG
QL,ST
oxycodone TAB 30MG
QL,ST
oxycodone TAB 5MG
QL,ST
QL
roxicet TAB 5-325MG
QL
tramadl/apap TAB 37.5-325
tramadol HCL TAB 50MG
Dilaudid Liq 1MG/ML
PREFERRED
Dilaudid-HP Inj 250MG
QL,ST
Oxycontin TAB 10MG CR
QL,ST
QL,ST
QL,ST
QL,ST
QL,ST
QL,ST
NON PREFERRED
alfentanil inj 500/ML
QL
apap-caffein CAP dihydroc
ascomp/cod CAP 30MG
QL
but/apap/caf CAP codeine
but/asa/caf/ CAP cod 30MG
butorphanol sol 10MG/ML
codeine sulf sol 30MG/5ML
dihydrocod/ CAP asa/caff
duramorph inj 0.5MG/ML
duramorph inj 1MG/ML
QL,PA
fentanyl dis 37.5mcg
QL,PA
QL,PA
QL
QL
QL
QL
hydrocod/ibu TAB 10-200MG
hydrocod/ibu TAB 2.5-200
hydrocod/ibu TAB 5-200MG
hydrocod/ibu TAB 7.5-200
QL
hydrocodone sol 10-325MG
QL
hydromorphon TAB 12MG ER
QL
QL
QL
ibudone TAB 5-200MG
meper/promet CAP 50-25MG
meperidine sol 50MG/5ML
meperidine TAB 100MG
meperidine TAB 50MG
methadone inj 10MG/ML
QL
methadone TAB 40MG
QL
methadose CON 10MG/ML
QL
methadose SF CON 10MG/ML
QL
methadose TAB 40MG
QL,PA
morphine SUL CAP 10MG ER
QL,PA
QL
QL,PA
QL
QL
QL,PA
QL
QL
QL,PA
QL
nalbuphine inj 10MG/ML
nalbuphine inj 20MG/ML
oxycod/ibu TAB 5-400MG
oxycodone CAP 5MG
QL,ST
QL,ST
QL,ST
QL
oxycodone/ sol apap
oxymorphone TAB HCL 10MG
oxymorphone TAB HCL 5MG
QL,ST
oxymorphone TAB 10MG ER
QL,ST
QL,ST
QL,ST
QL,ST
QL,ST
QL,ST
oxymorphone TAB 7.5MG ER
pentaz/nalox TAB 50-0.5MG
reprexain TAB 10-200MG
QL
tramadol HCL CAP ER 100MG
QL
QL
QL
tramadol HCL CAP 150MG ER
QL
tramadol HCL TAB 100MG ER
QL
QL
QL
verdrocet TAB 2.5-325
QL
vicodin ES TAB 7.5-300
QL
vicodin HP TAB 10-300MG
QL
vicodin TAB 5-300MG
xylon TAB 10-200MG
Alfenta Inj 500/ML
QL
Avinza CAP 120MG
52
QL
Avinza CAP 30MG
QL
Avinza CAP 45MG
QL
Avinza CAP 60MG
QL
Avinza CAP 75MG
QL
Avinza CAP 90MG
QL,PA
Belbuca Mis 150mcg
QL,PA
Belbuca Mis 300mcg
QL,PA
Belbuca Mis 450mcg
QL,PA
Belbuca Mis 600mcg
QL,PA
Belbuca Mis 75mcg
QL,PA
Belbuca Mis 750mcg
QL,PA
Belbuca Mis 900mcg
Bunavail Mis 2.1-0.3
Bunavail Mis 4.2-0.7
Bunavail Mis 6.3-1MG
Buprenex Inj 0.3MG/ML
QL,PA
Butrans Dis 10mcg/HR
QL,PA
QL,PA
QL,PA
Butrans Dis 5mcg/HR
QL,PA
Butrans Dis 7.5/HR
QL
Capital/Cod Sus 120-12/5
QL
Conzip CAP 100MG
QL
Conzip CAP 200MG
QL
Conzip CAP 300MG
Demerol Inj 100/2ML
Demerol Inj 100MG/ML
Demerol Inj 25MG/ML
Demerol Inj 25MG/0.5
Demerol Inj 50MG/ML
Demerol Inj 75MG/ML
Demerol Inj 75MG/1.5
Demerol TAB 100MG
Demerol TAB 50MG
Dilaudid Inj 1MG/ML
Dilaudid Inj 2MG/ML
Dilaudid Inj 4MG/ML
Dilaudid TAB 2MG
Dilaudid TAB 4MG
Dilaudid TAB 8MG
Dilaudid-HP Inj 10MG/ML
QL
Dolophine TAB 10MG
QL
Dolophine TAB 5MG
QL,PA
Duragesic Dis 100mcg/H
QL,PA
Duragesic Dis 12mcg/HR
QL,PA
QL,PA
QL,PA
PA
Embeda CAP 100-4MG
PA
Embeda CAP 20-0.8MG
PA
Embeda CAP 30-1.2MG
PA
Embeda CAP 50-2MG
PA
Embeda CAP 60-2.4MG
PA
Embeda CAP 80-3.2MG
QL
Exalgo TAB 12MG
QL
Exalgo TAB 16MG
QL
Exalgo TAB 32MG
QL
Exalgo TAB 8MG
QL
Fioricet CAP Codeine
Fiorinal/Cod CAP 30MG
QL
Hycet Sol 7.5-325
QL,PA
Hysingla ER TAB 100 MG
QL,PA
QL,PA
QL,PA
QL,PA
QL,PA
QL,PA
Ibudone TAB 10-200MG
Infumorph Inj 10MG/ML
Infumorph Inj 25MG/ML
Ionsys Pad 40mcg/Ac
QL,PA
Kadian CAP 10MG ER
QL,PA
Kadian CAP 100MG ER
QL,PA
Kadian CAP 20MG ER
QL,PA
Kadian CAP 200MG ER
QL,PA
Kadian CAP 30MG ER
QL,PA
Kadian CAP 40MG ER
QL,PA
Kadian CAP 50MG ER
QL,PA
Kadian CAP 60MG ER
QL,PA
Kadian CAP 80MG ER
Lazanda Spr 300mcg
QL
Lortab Elx 10-300MG
QL
MS Contin TAB 100MG CR
QL
QL
QL
QL
QL
Norco TAB 10-325MG
QL
Norco TAB 5-325MG
QL
Norco TAB 7.5-325
QL,ST
Nucynta ER TAB 100MG
QL,ST
QL,ST
QL,ST
QL,ST
Nucynta ER TAB 50MG
Nucynta TAB 100MG
Nucynta TAB 50MG
Nucynta TAB 75MG
QL,ST
Opana ER TAB 10MG
QL,ST
Opana ER TAB 15MG
QL,ST
Opana ER TAB 20MG
QL,ST
Opana ER TAB 30MG
QL,ST
Opana ER TAB 40MG
QL,ST
Opana ER TAB 5MG
QL,ST
Opana ER TAB 7.5MG
Opana Inj 1MG/ML
Opana TAB 10MG
Opana TAB 5MG
Oxaydo TAB 5MG
Oxaydo TAB 7.5MG
QL
Percocet TAB 10-325MG
QL
Percocet TAB 2.5-325
QL
Percocet TAB 5-325MG
QL
Percocet TAB 7.5-325
Percodan TAB
QL
Primlev TAB 10-300MG
QL
Primlev TAB 5-300MG
QL
Primlev TAB 7.5-300
Probuphine Imp Kit 74.2
Reprexain TAB 2.5-200
Reprexain TAB 5-200MG
QL
Roxicet Sol 5-325/5
Roxicodone TAB 15MG
Roxicodone TAB 30MG
Roxicodone TAB 5MG
Suboxone Mis 12-3MG
Suboxone Mis 2-0.5MG
Suboxone Mis 4-1MG
Suboxone Mis 8-2MG
Synalgos-dc CAP
Talwin Inj 30MG/ML
QL
Trezix CAP
QL
Tylenol/Cod TAB #3
QL
Tylenol/Cod TAB #4
QL
Ultracet TAB 37.5-325
QL
Ultram ER TAB 100MG
QL
Ultram ER TAB 200MG
QL
Ultram ER TAB 300MG
Ultram TAB 50MG
53
TIER 05
Vicoprofen TAB 7.5-200
QL,ST
Xartemis XR TAB 7.5-325
QL
Xodol TAB 10-300MG
QL
Xodol TAB 5-300MG
QL
Xodol TAB 7.5-300
QL
Zamicet Sol 10-325MG
QL,PA
Zohydro ER CAP 10MG
QL,PA
Zohydro ER CAP 15MG
QL,PA
Zohydro ER CAP 20MG
QL,PA
Zohydro ER CAP 30MG
QL,PA
Zohydro ER CAP 40MG
QL,PA
Zohydro ER CAP 50MG
Zubsolv Sub 1.4-0.36
Zubsolv Sub 5.7-1.4
Zubsolv Sub 8.6-2.1
QL,PA
fentanyl ot loz 1200mcg
QL,PA
QL,PA
QL,PA
QL,PA
QL,PA
QL,PA
Abstral Sub 100mcg
QL,PA
Abstral Sub 200mcg
QL,PA
Abstral Sub 300mcg
QL,PA
Abstral Sub 400mcg
QL,PA
Abstral Sub 600mcg
QL,PA
Abstral Sub 800mcg
QL,PA
Actiq Loz 1200mcg
QL,PA
Actiq Loz 1600mcg
QL,PA
Actiq Loz 200mcg
QL,PA
Actiq Loz 400mcg
QL,PA
Actiq Loz 600mcg
QL,PA
Actiq Loz 800mcg
QL,PA
Fentora TAB 100mcg
QL,PA
Fentora TAB 200mcg
QL,PA
Fentora TAB 400mcg
QL,PA
Fentora TAB 600mcg
QL,PA
Fentora TAB 800mcg
QL,PA
Lazanda Spr 100mcg
QL,PA
Lazanda Spr 400mcg
QL,PA
Subsys Spr 100mcg
QL,PA
Subsys Spr 1200mcg
QL,PA
Subsys Spr 1600mcg
QL,PA
Subsys Spr 200mcg
QL,PA
Subsys Spr 400mcg
QL,PA
Subsys Spr 600mcg
QL,PA
Subsys Spr 800mcg
PA
Xtampza ER CAP 13.5MG
PA
Xtampza ER CAP 18MG
PA
Xtampza ER CAP 27MG
PA
Xtampza ER CAP 36MG
PA
Xtampza ER CAP 9MG
ANTI-INFLAMMATORY
TIER 01
GENERIC
diclofen pot TAB 50MG
diclofenac TAB 100MG ER
diclofenac TAB 25MG DR
etodolac CAP 200MG
etodolac CAP 300MG
etodolac TAB 400MG
etodolac TAB 500MG
flurbiprofen TAB 100MG
flurbiprofen TAB 50MG
TIER 02
TIER 03
ibuprofen TAB 400MG
ibuprofen TAB 600MG
ibuprofen TAB 800MG
indomethacin CAP 25MG
indomethacin CAP 50MG
ketorolac inj 15MG/ML
ketorolac inj 30MG/ML
ketorolac inj 60MG/2ML
leflunomide TAB 10MG
leflunomide TAB 20MG
meclofen sod CAP 100MG
meclofen sod CAP 50MG
meloxicam TAB 15MG
meloxicam TAB 7.5MG
nabumetone TAB 500MG
nabumetone TAB 750MG
naproxen sod TAB 275MG
naproxen sus 125/5ML
naproxen TAB 250MG
naproxen TAB 375MG
naproxen TAB 500MG
piroxicam CAP 10MG
piroxicam CAP 20MG
sulindac TAB 150MG
sulindac TAB 200MG
tolmetin sod CAP 400MG
tolmetin sod TAB 200MG
PREFERRED
PA
Rasuvo Inj 10MG
PA
Rasuvo Inj 12.5MG
PA
Rasuvo Inj 15MG
PA
Rasuvo Inj 17.5MG
PA
Rasuvo Inj 20MG
PA
Rasuvo Inj 22.5MG
PA
Rasuvo Inj 25MG
PA
Rasuvo Inj 27.5MG
PA
Rasuvo Inj 30MG
PA
Rasuvo Inj 7.5MG
Ridaura CAP 3MG
NON PREFERRED
celecoxib CAP 100MG
celecoxib CAP 200MG
celecoxib CAP 400MG
celecoxib CAP 50MG
diclo/misopr TAB 50-0.2MG
diclo/misopr TAB 75-0.2MG
etodolac ER TAB 400MG
fenoprofen CAP 200MG
fenoprofen CAP 400MG
fenoprofen TAB 600MG
ibuprofen sus 100/5ML
indomethacin CAP 75MG ER
ketoprofen CAP 200MG ER
ketoprofen CAP 50MG
ketoprofen CAP 75MG
ketorolac TAB 10MG
mefenam acid CAP 250MG
meloxicam sus 7.5/5ML
naproxen sod TAB 375MG CR
naproxen sod TAB 500MG CR
naproxen DR TAB 375MG
naproxen DR TAB 500MG
oxaprozin TAB 600MG
tolmetin sod TAB 600MG
Active Injec Kit Ket-l
Active Injec Kit Ketmarc
54
TIER 04
Anaprox DS TAB 550MG
Arava TAB 10MG
Arava TAB 20MG
Arthrotec 50 TAB
Arthrotec 75 TAB
Capxib Kit
Cataflam TAB 50MG
Celebrex CAP 100MG
Celebrex CAP 200MG
Celebrex CAP 400MG
Celebrex CAP 50MG
Daypro TAB 600MG
Dermacinrx Kit Analgesi
Duexis TAB 800-26.6
EC-naprosyn TAB 375MG
EC-naprosyn TAB 500MG
Feldene CAP 10MG
Feldene CAP 20MG
Fenortho CAP 200MG
Fenortho CAP 400MG
Flexizol PAK Combipak
Ibu/Minrex PAK
Indocin Sup 50MG
Indocin Sus 25MG/5ML
Inflammation PAK Reductio
IC 400 Kit 400MG
IC 800 Kit 800MG
Ketorocaine Kit -l
Ketorocaine Kit -lm
Lidoxib Kit
Mobic Sus 7.5/5ML
Mobic TAB 15MG
Mobic TAB 7.5MG
Nalfon CAP 400MG
Naprelan TAB 375MG CR
Napropak PAK
Napropak PAK Cool
Naprosyn Sus 125/5ML
Naprosyn TAB 250MG
Naprosyn TAB 375MG
Naprosyn TAB 500MG
Orencia Clck Inj 125MG/ML
PA
Otrexup Inj 10MG
Otrexup Inj 12.5/0.4
PA
Otrexup Inj 15MG
PA
PA
Otrexup Inj 20MG
PA
PA
Otrexup Inj 25MG
QL,PA
Otrexup Inj 7.5/0.4
Ponstel CAP 250MG
Rheumatrex TAB 2.5MG
Sprix Spr 15.75MG
Tivorbex CAP 20MG
Tivorbex CAP 40MG
Toronova II Kit 30MG/ML
Toronova Kit 30MG/ML
Vimovo TAB 375-20MG
Vimovo TAB 500-20MG
Vivlodex CAP 10MG
Vivlodex CAP 5MG
Voltaren-XR TAB 100MG
Zipsor CAP 25MG
Zorvolex CAP 18MG
Zorvolex CAP 35MG
SPECIALTY
QL,PA
Enbrel Inj 25/0.5ML
QL,PA
Enbrel Inj 25MG
QL,PA
TIER 05
Enbrel Inj 50MG/ML
QL,PA
Enbrel Srclk Inj 50MG/ML
QL,PA
Humira Inj 10MG/0.2
QL,PA
Humira Kit 20MG/0.4
QL,PA
Humira Kit 40MG/0.8
QL,PA
Humira Pedia Inj Crohns
QL,PA
Humira Pen Inj Crohns
QL,PA
Humira Pen Inj Psoriasi
QL,PA
Humira Pen Inj 40MG/0.8
QL,PA
Orencia Inj 125MG/ML
QL,PA
Otezla TAB 10/20/30
QL,PA
Otezla TAB 30MG
QL,PA
Actemra Inj 162/0.9
QL,PA
Arcalyst Inj 220MG
QL,PA
Kineret Inj
QL,PA
Simponi Inj 100MG/ML
QL,PA
Simponi Inj 50/0.5ML
QL,PA
Xeljanz TAB 5MG
QL,PA
Xeljanz XR TAB 11MG
MIGRAINE PRODUCTS
TIER 01
TIER 02
TIER 03
GENERIC
dihydroergot inj 1MG/ML
isometh/apap CAP dichlor
QL
naratriptan TAB 1MG
QL
naratriptan TAB 2.5MG
nodolor CAP
QL
rizatriptan TAB 10MG
QL
rizatriptan TAB 10MG odt
QL
rizatriptan TAB 5MG
QL
rizatriptan TAB 5MG odt
QL
sumatriptan inj 4MG/0.5
QL
sumatriptan inj 6MG/0.5
QL
sumatriptan spr 20MG/act
QL
sumatriptan spr 5MG/act
QL
sumatriptan TAB 100MG
QL
QL
QL
zolmitriptan TAB 2.5 MG
QL
zolmitriptan TAB 2.5MG
QL
zolmitriptan TAB 5MG
PREFERRED
Cafergot TAB 1-100MG
Ergomar Sub 2MG
Migergot Sup 2/100
NON PREFERRED
QL,ST
almotrip mal TAB 12.5MG
QL,ST
almotrip mal TAB 6.25MG
QL,ST
almotriptan TAB 12.5MG
QL,ST
almotriptan TAB 6.25MG
QL,ST
frovatriptan TAB 2.5MG
isometh/caff TAB /apap
migralam CAP
QL
Alsuma Inj 6MG/0.5
QL
Amerge TAB 1MG
QL
Amerge TAB 2.5MG
QL,ST
Axert TAB 12.5MG
QL,ST
Axert TAB 6.25MG
Cambia Pow 50MG
D.h.e. 45 Inj 1MG/ML
QL,ST
Frova TAB 2.5MG
QL
Imitrex Inj 4MG/0.5
QL
Imitrex Inj 6MG/0.5
QL
Imitrex Spr 20MG/Act
QL
Imitrex Spr 5MG/Act
QL
Imitrex TAB 100MG
QL
Imitrex TAB 25MG
QL
Imitrex TAB 50MG
55
QL
TIER 04
Maxalt TAB 10MG
QL
Maxalt TAB 5MG
QL
Maxalt-MLT TAB 10MG
QL
Maxalt-MLT TAB 5MG
Migral TAB 130MG
Migranow PAK
Prodrin TAB
QL,ST
Relpax TAB 20MG
QL,ST
Relpax TAB 40MG
QL
Sumavel Dose Inj 4MG/0.5
QL
Sumavel Dose Inj 6MG/0.5
QL,ST
Treximet TAB 85-500MG
QL,ST
Zecuity Pad 6.5MG/4h
Zembrace Sym Inj 3/0.5ML
QL
Zomig Nasal Spr 5MG
QL
Zomig Spr 2.5MG
QL
Zomig TAB 2.5MG
QL
Zomig TAB 5MG
QL
Zomig ZMT TAB 2.5 MG
QL
Zomig ZMT TAB 5MG
SPECIALTY
dihydroergot spr 4MG/ML
Migranal Spr 4MG/ML
ropivacaine inj 10MG/ML
ropivacaine inj 7.5MG/ML
sensorcaine inj -mpf/epi
sensorcaine inj mpf 0.5%
sensorcaine inj mpf0.25%
sensorcaine inj mpf0.75%
sensorcaine inj 0.25%
sensorcaine inj 0.5%
sensorcaine/ inj epi 0.25
sensorcaine/ inj epi 0.5%
tetracaine inj 1%
xylocaine inj dent 2%
Active Injec Kit Lm-2
BL Injection Kit
Carbocaine Inj 1.5% PF
Carbocaine Inj 1%
Carbocaine Inj 1% PF
Carbocaine Inj 2%
Carbocaine Inj 2% PF
Exparel Inj 1.3%
Lido/Sod Bic Inj 0.5-8.4%
Lido/Sod Bic Inj 1-8.4%
Marcaine Inj 0.25%
Marcaine Inj 0.5%
Marcaine Inj 0.75%
Marcaine/Epi Inj 0.25%
Marcaine/Epi Inj 0.5%
Marlido Kit
Marlido-25 Kit
Marvona Kit 0.5%
Mld Kit
Naropin Inj 10MG/ML
Naropin Inj 2MG/ML
Naropin Inj 5MG/ML
Naropin Inj 7.5MG/ML
Nesacaine Inj -mpf 2%
Nesacaine Inj -mpf 3%
Nesacaine Inj 1%
Nesacaine Inj 2%
Sensorcaine Inj -mpf/Epi
Xylo-mpf/Epi Inj 1.5%
Xylo-mpf/Epi Inj 1%
Xylo-mpf/Epi Inj 2%
Xylo/Epi Inj 0.5%
Xylo/Epi Inj 2%
Xylo/Epi 1%- Inj 1:100000
Xylocaine Inj -mpf 1%
Xylocaine Inj Mpf 0.5%
Xylocaine Inj Mpf 1.5%
Xylocaine Inj 0.5%
Xylocaine Inj 1%
Xylocaine Inj 2%
GOUT AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
allopurinol TAB 100MG
allopurinol TAB 300MG
colchicine CAP 0.6MG
colchicine TAB 0.6MG
proben/colch TAB 500-0.5
probenecid TAB 500MG
PREFERRED
Colcrys TAB 0.6MG
NON PREFERRED
Mitigare CAP 0.6MG
Uloric TAB 40MG
Uloric TAB 80MG
PA
Zurampic TAB 200MG
Zyloprim TAB 100MG
Zyloprim TAB 300MG
LOCAL ANESTHETICS-INJ
TIER 01
TIER 03
GENERIC
lidocaine inj 0.5%
NON PREFERRED
bupivac/NACL inj 0.1-0.9%
bupivac/NACL inj 0.2-0.9%
bupivac/NACL inj 0.25-0.9
bupivacaine inj 0.25%
bupivacaine/ inj epi 0.25
bupivacaine/ inj epi 0.5%
lido/epi inj 0.5%
lido/epi inj 1.5%
lido/epi inj 2%
lido/epi 1%- inj 1:100000
lidocaine inj HCL
lidocaine inj 1.5%
lidocaine inj 1%
lidocaine inj 2%
lidocaine inj 4%
polocaine inj -mpf 1%
polocaine inj -mpf 2%
polocaine inj mpf 1.5%
polocaine inj 1%
polocaine inj 2%
RESPIRATORY, ALLERGY, ETC
ANTIHISTAMINES
TIER 01
GENERIC
arbinoxa sol 4MG/5ML
arbinoxa TAB 4MG
carbinoxamin sol 4MG/5ML
carbinoxamin TAB 4MG
clemastine syp 0.5/5ML
clemastine TAB 2.68MG
cyproheptad syp 2MG/5ML
cyproheptad TAB 4MG
desloratadin TAB 2.5 odt
desloratadin TAB 5MG
56
TIER 03
desloratadin TAB 5MG odt
diphenhydram inj 50MG/ML
levocetirizi sol 2.5/5ML
levocetirizi TAB 5MG
pharbedryl CAP 50MG
phenadoz sup 12.5MG
phenadoz sup 25MG
phenergan sup 12.5MG
phenergan sup 25MG
phenergan sup 50MG
promethazine sol 6.25/5ML
promethazine sup 12.5MG
promethazine sup 25MG
promethazine sup 50MG
promethazine syp 6.25/5ML
promethazine TAB 12.5MG
promethazine TAB 25MG
promethazine TAB 50MG
promethegan sup 12.5MG
promethegan sup 25MG
promethegan sup 50MG
NON PREFERRED
bpm TAB 6MG
brompheniram chw 12MG
brompheniram inj 10MG/ML
cetirizine syp 1MG/ML
dexchlorphen syp 2MG/5ML
diphenhydram elx 12.5/5ML
promethazine inj 25MG/ML
promethazine inj 50MG/ML
respa-BR TAB 11MG
Clarinex Syp 0.5MG/ML
Clarinex TAB 5MG
Karbinal ER Sus 4MG/5ML
Phener Fort Syp 25MG/5ML
Phenergan Inj 25MG/ML
Phenergan Inj 50MG/ML
Xyzal Sol
Xyzal Sol 2.5/5ML
Xyzal TAB 5MG
NASAL AGENTS
TIER 01
TIER 03
GENERIC
azelastine spr 0.1%
azelastine spr 0.15%
flunisolide spr 0.025%
fluticasone spr 50mcg
ipratropium spr 0.03%
ipratropium spr 0.06%
NON PREFERRED
budesonide sus 32mcg
flonase spr 0.05%
mometasone spr 50mcg
olopatadine spr 0.6%
triamcinolon aer 55mcg/ac
Adrenalin Sol 1:1000
Astepro Spr 0.15%
Atrovent Nas Sol 0.03%
Atrovent Nas Sol 0.06%
Azenase PAK Mis 137-50
Bactroban Oin Nasal 2%
Beconase AQ Sus 0.042%
Dymista Spr 137-50
Nasonex Spr 50mcg/Ac
Omnaris Spr
Patanase Spr 0.6%
Qnasl Aer 80mcg
Qnasl Child Spr 40mcg
Rhinocort Sus Aqua
Ticaspray PAK
Tyzine PED Dro 0.05%
Tyzine Sol 0.1%
Veramyst Spr 27.5mcg
Zetonna Aer 37mcg
COUGH/COLD/ALLERGY
TIER 01
TIER 03
GENERIC
acetylcyst sol 10%
acetylcyst sol 20%
benzonatate CAP 100MG
hydroc/homat TAB 5-1.5MG
hydrocod/hom syp 5-1.5/5
hydromet syp 5-1.5/5
nebusal neb 3%
prometh VC syp plain
prometh VC/ syp codeine
prometh/cod syp 6.25-10
prometh/PE syp 6.25-5/5
prometh/PE/ syp codeine
promethazine syp DM
pulmosal neb 7%
sod chloride neb 0.9%
sodium chlor neb 3%
sodium chlor neb 7%
tussigon TAB 5-1.5MG
NON PREFERRED
albatussin liq NN
biotuss liq
bpm pseudo TAB 6-45MG
brom/PSE/DM syp
bromfed DM syp
hydr/CPM/PSE liq 5-4-60MG
hydro/chlor/ liq 5-4-60MG
lexuss 210 liq 2-10/5ML
nortuss-EX liq 200-20/5
rescon-JR TAB
sodium chlor neb 10%
Albatussin CAP
Carbaphen 12 Liq
Carbaphen 12 Sus PED
Clarinex-d TAB 2.5-120
Cpb Wc Liq
Decon-G Dro 2-1-40MG
DM/CPM/PE dro
Flowtuss Sol 2.5-200
Hycofenix Sol
Hyper-sal Neb 7%
Hypersal Neb 3.5%
Hypersal Neb 7%
HYD pol/CPM sus 10-8/5ML
Nebusal Neb 6%
Obredon Sol 2.5-200
Panatuss Dxp Liq
PE/guaifenes dro 1.5-20MG
Relhist Chw
Rescon-JR TAB
Rezira Sol 60-5/5ML
Semprex-d CAP 8-60MG
Tessalon Per CAP 100MG
Tusnel CAP
Tussicaps CAP 10-8MG
Tussicaps CAP 5-4MG
Tussionex Sus 10-8/5ML
Tuzistra XR Sus
Vituz Sol 5-4MG
Zonatuss CAP 150MG
57
ST
Zutripro Liq 60-4-5MG
ANTIASTHMATIC/COPD AGENTS
TIER 01
TIER 02
GENERIC
albuterol neb 0.083%
albuterol neb 0.5%
albuterol neb 0.63MG/3
albuterol neb 1.25MG/3
albuterol syp 2MG/5ML
albuterol TAB 2MG
albuterol TAB 4MG
budesonide sus 0.25MG/2
budesonide sus 0.5MG/2
budesonide sus 1MG/2ML
cromolyn sod neb 20MG/2ML
epinephrine inj 0.1MG/ML
epinephrine inj 1MG/ML
ipratropium sol 0.02%inh
ipratropium/ sol albuter
ipratropium/ sol sulfate
metaproteren syp 10MG/5ML
metaproteren TAB 10MG
metaproteren TAB 20MG
montelukast chw 4MG
montelukast chw 5MG
montelukast gra 4MG
montelukast TAB 10MG
terbutaline TAB 2.5MG
terbutaline TAB 5MG
theochron TAB 100MG CR
theophylline sol 80/15ML
theophylline TAB 100MG CR
theophylline TAB 100MG ER
theophylline TAB 200MG CR
PREFERRED
PA
Advair Disku Aer 100/50
PA
PA
PA
Advair HFA Aer 115/21
PA
PA
ST
Asmanex HFA Aer 100 Mcg
ST
Asmanex HFA Aer 200 Mcg
ST
Asmanex 120 Aer 220mcg
ST
ST
ST
ST
ST
Atrovent HFA Aer 17mcg
Combivent Aer 20-100
ST
Dulera Aer 100-5mcg
ST
Dulera Aer 200-5mcg
PA
Flovent Disk Aer 100mcg
PA
PA
PA
Flovent HFA Aer 110mcg
PA
QL
Proair HFA Aer
Qvar Aer 40mcg
Qvar Aer 80mcg
TIER 03
Serevent Dis Aer 50mcg
QL,ST
Spiriva Aer 1.25mcg
Spiriva CAP Handihlr
Spiriva Spr Respimat
Spiriva Spr 2.5mcg
Striverdi Aer 2.5mcg
QL
Ventolin HFA Aer
NON PREFERRED
albuterol TAB 4MG ER
albuterol TAB 8MG ER
difil-G fort liq 100-100
levalbuterol neb 0.31MG
levalbuterol neb 1.25/0.5
terbutaline inj 1MG/ML
zafirlukast TAB 10MG
zafirlukast TAB 20MG
Accolate TAB 10MG
Accolate TAB 20MG
Aerospan Aer 80mcg
Alvesco Aer 160mcg
Alvesco Aer 80mcg
PA
Anoro Ellipt Aer 62.5-25
Arcapta CAP 75mcg
Arnuity Elpt Inh 100mcg
Arnuity Elpt Inh 200mcg
PA
Bevespi Aer
PA
Breo Ellipta Inh 100-25
PA
Breo Ellipta Inh 200-25
Brovana Neb 15mcg
Daliresp TAB 500mcg
Elixophyllin Elx 80/15ML
Foradil CAP Aerolize
PA
Incruse Elpt Inh 62.5mcg
Isuprel Inj 0.2MG/ML
Lufyllin TAB 200MG
Lufyllin TAB 400MG
PA
Nucala Inj 100MG
Perforomist Neb 20mcg
QL
Proair Respi Aer
QL
Proventil Aer HFA
Pulmicort Inh 180mcg
Pulmicort Inh 90mcg
Pulmicort Sus 0.25MG/2
Pulmicort Sus 0.5MG/2
Pulmicort Sus 1MG/2ML
Singulair Chw 4MG
Singulair Chw 5MG
Singulair Gra 4MG
Singulair TAB 10MG
Stiolto Aer 2.5-2.5
PA
Symbicort Aer 160-4.5
PA
Symbicort Aer 80-4.5
Theo-24 CAP 100MG CR
Theo-24 CAP 400MG ER
Tudorza Pres Aer 400/Act
PA
Utibron CAP Neohaler
Vospire ER TAB 4MG
Vospire ER TAB 8MG
Xopenex CONC Neb 1.25/0.5
QL
Xopenex HFA Aer
Xopenex Neb 0.31MG
Xopenex Neb 0.63MG
Xopenex Neb 1.25/3ML
PA
Zyflo CR TAB 600MG
Zyflo TAB 600MG
58
RESPIRATORY AGENTS - MISC
TIER 02
TIER 03
TIER 04
TIER 05
Fluad Inj 2016-17
Fluarix PF Inj 2013-14
Fluarix PF Inj 2014-15
Fluarix Quad Inj 2014-15
Flublok Sol 2014-15
Flublok Sol 2015-16
Flublok Sol 2016-17
Flucelvax Inj 2014-15
Flucelvax Inj 2015-16
Fluclvx Quad Inj 2016-17
Flulaval Inj 2014-15
Flulaval Qua Inj 2014-15
Flumist Quad Sus 2014-15
Fluvirin Inj 2014-15
Fluvirin PF Inj 2014-15
Fluvirin PF Inj 2016-17
Fluzone HD Inj PF 14-15
Fluzone Inj Intradrm
Fluzone Inj PF 14-15
Fluzone Quad Inj 14-15
Fluzone Splt Inj 2014-15
Fluzone Splt Inj 2015-16
Gardasil 9 Inj
Influenza Firus Vaccine
Menhibrix Inj
Prevnar 13 Inj
Proquad Inj
Rabavert Inj
Rotarix Sus
Rotateq Sol
Trumenba Inj
Varivax Inj
Zostavax Inj
PREFERRED
QL
Pulmozyme Sol 1MG/ML
Survanta Inh
NON PREFERRED
Curosurf Sus 80MG/ML
Infasurf Sus 35MG/ML
QL,PA
Kalydeco PAK 50MG
QL,PA
Kalydeco PAK 75MG
Surfaxin Sus 30MG/ML
SPECIALTY
QL,PA
Esbriet CAP 267MG
QL,PA
Kalydeco TAB 150MG
QL,PA
Ofev CAP 100MG
QL,PA
Ofev CAP 150MG
QL,PA
Orkambi TAB 200-125
TOXOIDS
TIER 01
TIER 02
TIER 03
GENERIC
tet/dip tox inj 2-2 LF
tetanus tox inj 5LF ads
PREFERRED
Infanrix Inj
Tenivac Inj 5-2LF
NON PREFERRED
dip/tet PED inj 25-5lfu
Adacel Inj
Boostrix Inj
Daptacel Inj
Kinrix Inj
Pediarix Inj 0.5ML
Pentacel Inj
Quadracel Inj
VACCINES
TIER 01
TIER 02
TIER 03
GENERIC
pneumovax 23 inj 25/0.5
PREFERRED
Acthib Inj
Comvax Inj
Gardasil Inj
Hiberix Sol 10mcg
M-m-r II Inj
Pedvax HIB Inj
Pneumovax 23 Inj 25/0.5
Recombiva HB Inj 10mcg/ML
Recombiva HB Inj 5mcg/0.5
Recombiva-HB Inj 40mcg/ML
NON PREFERRED
Afluria Inj PF 14-15
Afluria Inj 2014-15
Afluria Inj 2015-16
Afluria Inj 2016-17
Afluria Quad Inj PF 16-17
Bexsero Inj
Biothrax Inj
Cervarix Inj
Engerix-b Inj 10/0.5ML
Engerix-b Inj 20mcg/ML
EZ Flu Shot Inj PF 14-15
EZ Flu Shot Inj 2014-15
EZ Flu Shot Inj 2015-16
EZ Flu Shot Kit 2015-16
EZ Flu Shot Kit 2016-17
VITAMINS
VITAMINS
TIER 01
TIER 02
TIER 03
GENERIC
ergocalcifer CAP 50000unt
phytonadione inj 1MG/0.5
vitamin d CAP 50000unt
vitamin k1 inj 1MG/0.5
vitamin k1 inj 10MG/ML
PREFERRED
Mephyton TAB 5MG
NON PREFERRED
aminobez pot pow
ortho-CS 250 inj 250MG/ML
vitamin c inj 222MG/ML
Drisdol CAP 50000unt
Potaba CAP 500MG
MULTIVITAMINS
TIER 03
NON PREFERRED
b-plex plus TAB
lysiplex TAB plus
thera form/ TAB hematin
59
vp-zel TAB
Albafort Inj
AP-zel TAB
Folgard OS TAB
Nicadan TAB
TL G-FOL OS TAB
Vitafol TAB
MEDICAL DEVICES
DIABETIC SUPPLIES
TIER 01
GENERIC
adj lancing mis device
altrnate sit mis device
control sol normal
gluc control sol
gluc control sol normal
insulin syrg mis 0.3/29G
insulin syrg mis 1ML/27G
insulin syrg mis 29GX1/2"
lancet devic mis adjust
lancets mis
lancets mis orange
lancets mis 21G
lancets mis 23G
lancets mis 26G
lancets mis 28G
lancets mis 30G
lancets mis 31G
lancets mis 33G
lancets thin mis
lancing devi mis
multi-lancet mis device
pen needles mis 29GX1/2"
pen needles mis 29GX12MM
pen needles mis 30GX5/16
pen needles mis 31GX1/4"
safety 21G mis lancets
safety 28G mis lancets
super thin mis lancets
truplus lanc mis 28G
unifine pntp mis 31GX8MM
Accu-chek IN Liq Control
Accu-chek Kit Fastclix
Accu-chek Kit Mlticlix
Accu-chek Kit Softclix
Accu-chek Liq Act/Gluc
Accu-chek Liq Compact
Accu-chek Liq Smart
Accu-chek Mis Mlticlix
Accu-chek Sol
Accu-chek Sol Comfort
Accu-chek Sol Compact
Accutrend Sol Glucose
Acti-lance Mis Lite 28G
Acti-lance Mis Spec 17G
Acti-lance Mis Univ 23G
Acti-lance Mis 28G
Active 1ST Mis Lanc 30G
Acura Contrl Sol High
Acura Contrl Sol Low
Acura Contrl Sol Normal
Adj Lancing Mis Device
Adv Lancing Mis Device
Adv Travel Mis Lanc 28G
Advance Liq Control
Advance Liq Intuitio
Advance Norm Liq Control
Advcate Safe Mis Lanc 26G
Advocate Liq High
Advocate Liq Low
Advocate Mis Lanc Dev
Advocate Mis Lanc 30G
Advocate Mis Lancets
Advocate+ Sol Redi-cod
Agamatrix Mis 33G
Agamatrix Sol High
Agamatrix Sol Norm/Hgh
Agamatrix Sol Normal
Aqua Lance Mis Lanc Dev
Ascensia Liq Norm CON
Assure Cmfrt Mis 28G
Assure Cmfrt Mis 30G
Assure Dose Sol Norm/Hgh
Assure Dose Sol Normal
Assure II Liq Level 1
Assure II Liq Level1/2
Assure Lance Mis Low Flow
Assure Lance Mis Micro
Assure Lance Mis Safe 25G
Assure Lance Mis Safe 30G
Assure Lance Mis 21G
Assure Mis Lancets
Assure Plus Mis High 18G
Assure Plus Mis Low 25G
Assure Plus Mis Mcro 28G
Assure Plus Mis Norm 21G
Assure Plus Mis Pediatri
Assure Prism Sol Level1/2
Assure Pro Liq Level1/2
Assure 3 Liq Control
Assure 4 Liq Level1/2
Aurora Lance Mis Thin 23G
Aurora Lance Mis 30G
Auto Lancet Mis
Auto-lancet Mis Mini
Autodisc Liq Low/High
Autolet Impr Mis Lanc Dev
Autolet II Kit Clinisaf
Autolet Lanc Mis Device
Autolet Lite Kit Clinisaf
Autolet Mini Mis
Autolet Mis Impressi
Autoshield Mis 29X3/16"
Autoshield Mis 29X5/16"
Autoshield Mis 30GX3/16
AF Lancets Mis Thin
AT Last Mis Lancets
AT Last Sol Control
Bayer Breeze Liq High Cnt
Bayer Breeze Liq Low Cntl
Bayer Breeze Liq Norm Cnt
QL,PA
Bayer Breeze Mis 2 Test
60
Bayer Micrlt Mis Lanc Dvc
Bayer Micrlt Mis Lancets
Bullseye Mis Lancets
Bullseye Mis Mini Lnc
BD Lancet Mis Device
BD Lancet UF Mis 30G
BD Lancet UF Mis 33G
BD Microtain Mis Lancets
BD Pen Needl Mis 29GX1/2"
BD Pen Needl Mis 31GX3/16
BD Pen Needl Mis 31GX5/16
BD Pen Needl Mis 32GX4MM
Carefine Mis 31GX8MM
Careone Adv Mis Lancing
Careone Lanc Mis Thin 23G
Careone Lanc Mis 28G
Caresens Sol Control
Cleanlet 28G Mis Lancets
Clever Check Mis
Clever Check Mis 30G
Clevr Choice Liq High
Clevr Choice Liq Low
Clickfine Mis 31GX1/4"
Clickfine Mis 31GX5/16
Clickfine Mis 32GX5/32
Coaguchek Mis Lancets
Comfort Assu Mis Lanc 28G
Comfort Assu Mis Lanc 33G
Comfort EZ Mis 29GX12MM
Comfort Mis Lancets
Comfortouch Mis Lancet
Contour Liq High Cnt
Contour Liq Low Cntl
Contour Liq Norm Cnt
Contour Sol Next
QL,PA
Contour Tes Next
Control High Sol Unistrip
Control Low Sol Unistrip
Control Norm Sol Easy Stp
Control Sol Liq High/Low
Control Sol Liq HI/Mid/L
Control Sol Liq Mid
Cool Control Sol A
Cool Control Sol B
CVS Lancets Mis Original
CVS Lancets Mis Thin 26G
CVS Lancets Mis 21G
CVS Lancing Mis Device
Diastar Easy Mis Lancets
Diastar Mis Lancets
Diatrue Cont Sol Level 1
Droplet Lanc Mis Device
Droplet Lanc Mis 30G
Duo-care Liq Level1/2
E-z Ject Mis Lanc 21G
E-z Ject Mis Lancets
E-z Ject Mis Thin 26G
E-z Ject Mis 21G
E-z Ject Mis 21G Colr
E-z Ject Mis 30G
E-z Ject Mis 32G Colr
E-ZJECT Lanc Mis 33G
Easy Comfort Mis Lanc/30G
Easy Comfort Mis 30G
Easy Comfort Mis 31GX1/4"
Easy Comfort Mis 31GX3/16
Easy Mini Mis
Easy Plus II Sol High
Easy Plus II Sol Low
Easy Talk Sol High
Easy Talk Sol Low
Easy Talk Sol Normal
Easy Touch Mis
Easy Touch Mis Lanc/21G
Easy Touch Mis 29GX1/2"
Easy Touch Mis 31GX3/16
Easy Touch Mis 32GX5MM
Easy Touch Mis 32GX6MM
Easy Touch Sol Control
Easy Touch Sol High/Low
Easy Trak Sol High
Easy Trak Sol Low
Easy Trak Sol Normal
Easygluco Sol High
Easygluco Sol Low
Easygluco Sol Normal
Easygluco Sol Plus
Easymax Sol High
Easymax Sol Low
Easymax Sol Normal
Easymax 15 Sol Level 1
Easymax 15 Sol Level 2
Easystep Hgh Sol Control
Easystep Low Sol Control
Easytest II Mis Lancets
Easytest Mis Lancets
Element Cont Liq Normal
Element Liq High
Element Liq Low
Elemnt Compa Sol Level 2
Elemnt Compa Sol Level 3
Embrace Cntr Liq High
Embrace Evo Liq Level 1
Embrace Evo Liq Level 2
Embrace Lanc Mis Thin 30G
Embrace Pro Liq Glucose
Embrace Sol Low
Eql Lancets Mis Thin 26G
Eql Lancets Mis Thin 30G
61
Eql Lancets Mis 21G Colr
Eql Lancets Mis 33G Colr
Evencar Mini Sol Normal
Evencare G2 Sol Low/High
Evencare G3 Sol Low/High
Evencare Sol Liq Low/High
Evolution Sol Normal
EZ Smart Mis Lancets
EZ-lets 21G Mis Lancets
Fastclix Mis Lancets
Fifty50 Mis Lanc Dev
Fifty50 Mis 31GX3/16
Fifty50 Mis 31GX5/16
Fifty50 Mis 31GX5MM
Fifty50 Pen Mis 31GX8MM
Fifty50 Safe Mis Lancets
Fifty50 Sol 2.0
Fine 30 Mis
Fingerstix Mis Lancets
Fora Control Sol High
Fora Control Sol Low
Fora Control Sol Normal
Fora Lancets Mis 30G
Fora Mis Lancets
Fora Mis Lancing
Foracare Gdh Sol High
Foracare Gdh Sol Low
Foracare Gdh Sol Normal
Fortiscare Kit System
Fortiscare Sol Cntl HI
Fortiscare Sol Cntl Low
Fortiscare Sol Cntl Nml
Freestyle Liq Control
Freestyle Mis Lancets
Freestyle Mis Unistick
QL,PA
Freestyle Tes
Gentle-let Mis Lancets
Gentle-let Mis 26G
Gentle-let Mis 28G
Ge100 Contrl Sol Normal
Global Lanc Mis Device
Global 28G Mis Lancets
Global 30G Mis Lancets
Gluc Control Liq Normal
Gluc Control Sol Level 1
Gluc Control Sol Level 2
Gluc Control Sol Mid
Glucocard Liq Level 1
Glucocard Sol Normal
Glucocard Sol Shine
Glucocard 01 Liq Norm/Hgh
Glucocard 01 Sol Normal
Glucocom Mis 28G
Glucocom Mis 30G
Glucocom Mis 33G
Glucocom Tes High CON
Glucocom Tes Norm CON
Glucolet 2 Mis Lancing
Glucose Cont Liq High/Low
Glucose Cont Sol High
Glucose Cont Sol Normal
Glucose Cont Sol Precisio
Glucosource Mis Lanc Dev
Glucosource Mis Lancets
Gmate Contro Sol Level 2
Gmate Lancet Mis 30G
Gnp Lancets Mis
Gnp Lancets Mis Micro
Gnp Lancets Mis Sup Thin
Gnp Lancets Mis Thin
Gnp Lancets Mis Thin 26G
Gnp Lancets Mis 21G
Haemolance Mis High FLO
Haemolance Mis Low Flow
Haemolance Mis Plus
Haemolance Mis Plus Low
Haemolance Mis Plus Max
Haemolance Mis Plus PED
Haemolance Mis Retract
Healthpro Sol High/Low
Hlthy Accnts Mis Lanc 30G
Hypolance Kit Lancing
HC Lancing Mis Device
HM Lancets Mis 30G
HM Lancets Mis 33G
Incontrol Mis Lanc Dev
Incontrol Mis Lanc 28G
Incontrol Mis 29GX12MM
Infinity Sol High CON
Infinity Sol Low CON
Infinity Sol Norm CON
Insulin Pen Mis 29GX12MM
Insulin Syrg Mis 0.3/28G
Insulin Syrg Mis 1ML
Insulin Syrg Mis 1ML/25G
Insulin Syrg Mis 28GX1/2"
Insulin Syrg Mis 29GX1/2"
Insulin Syrg Mis 30GX5/16
Insulin Syrg Mis 31GX5/16
Insupen Mis 32GX4MM
Insupen Mis 33GX4MM
Insupen Sens Mis 32GX6MM
Insupen Sens Mis 32GX8MM
Insupen Ultr Mis 29GX12MM
IN Control Mis 31GX5MM
IN Touch Lan Mis 30G
IN Touch Sol Glucose
Kinney Mis Lancets
Kinney Thin Mis Lancets
Kroger Lance Mis
Kroger Lance Mis Thin
62
Kroger Lance Mis Thin 30G
Lancet Alter Mis Site 26G
Lancet Micro Mis Thin 33G
Lancet Stand Mis 21G
Lancet Super Mis Thin 30G
Lancet Ultra Mis Fine
Lancet Ultra Mis Thin 28G
Lancet Ultra Mis Thin 30G
Lancet Ultra Mis 28G
Lancets Micr Mis Thin 33G
Lancets Mis
Lancets Mis Colored
Lancets Mis Original
Lancets Mis Thin
Lancets Mis Thin 26G
Lancets Mis Thin 30G
Lancets Mis 21G
Lancets Mis 21G Colr
Lancets Mis 26G
Lancets Mis 28G
Lancets Mis 30G
Lancets Mis 33G
Lancets Supr Mis Thin 28G
Lancets Thin Mis
Lancets Thin Mis 26G
Lancets Thin Mis 30G
Lancets Ultr Mis Thin
Lancets Ultr Mis Thin 28G
Lancets Ultr Mis Thin 30G
Lancing Devi Mis
Lb Lancet Mis 28G
Lb Lancing Mis Device
Lifescan Mis Unistik2
Lite Touch Mis Lanc Dev
Lite Touch Mis Lanc Pen
Lite Touch Mis Lancets
Litetouch Mis Lancets
Litetouch Mis 29GX12.7
Litetouch Mis 31GX8MM
Longs Lancet Mis Standard
Longs Lancet Mis Thin
Longs Lancet Mis Ultra Th
Maxima Sol Control
Medichoice Mis Lancet
Medisense Liq Gluc-ket
Medisense Liq Gluc/Ket
Medlance Mis Extr 21G
Medlance Mis Lite 25G
Medlance Mis Plus
Medlance Mis Plus 30G
Medlance Mis Unv 21G
Medlance Mis 30G Plus
Medlance Pls Mis Extr 21G
Medlance Pls Mis Lite 25G
Medlance Pls Mis Univ 21G
Medlance Pls Mis 0.8MM
Meijer Lance Mis Color
Meijer Lance Mis Univ 21G
Meijer Lance Mis Univ 30G
Meijer Lance Mis Universa
Meijer Mis Lancets
Micro Thin Mis Lanc 33G
Microdot CON Sol High/Low
Microlet Mis Lancets
Microtainer Mis Lancet
Monolet Mis Lancets
Monolet Opd Mis Lancets
Monolettor Mis Lancets
Myglucohealt Mis Lanc 30G
Myglucohealt Sol LO/Nl/HI
Neutek 2tek Sol Control
Nexgen Tes Norm CON
Nova Max Glu Liq /Ket CON
Nova Safety Mis Lanc 23G
Nova Safety Mis Lanc 28G
Nova Sure Mis Lancets
Nova Sureflx Mis Lanc Dev
Novofine Aut Mis 30GX8MM
Novofine Mis 30GX8MM
Novofine Mis 32GX6MM
Novofine Pls Mis 32GX4MM
Novotwist Mis 30GX8MM
Novotwist Mis 32GX5MM
On Call Expr Sol Glucose
On Call Mis Lancets
On Call Plus Mis Lancets
On Call Plus Sol Control
On Call Vivd Sol Control
On-the-go Mis Lanc 30G
Onetouch Fp Mis Lancets
Onetouch Mis Combo
Onetouch Sol Ult Cont
Onetouch Sol Verio
Onetouch Sol Verio-HI
QL
Onetouch Tes Ultra
QL
Onetouch Tes Ultra BL
QL
Onetouch Tes Verio
Optumrx Cont Sol Level1/2
Pen Needle Mis 29GX1/2"
Pen Needle Mis 32GX4MM
Pen Needles Mis 29GX1/2"
Pen Needles Mis 29GX12.7
Pen Needles Mis 29GX12MM
Pen Needles Mis 30GX5/16
Pen Needles Mis 31GX1/4"
Pentips Mis 29GX12MM
Pentips Mis 31GX5MM
Pentips Mis 31GX6MM
Pentips Mis 31GX8MM
Pentips Mis 32GX4MM
Perfect 28G Mis Lancets
Perfect 30G Mis Lancets
Pharmacy Cou Mis Lancets
Pocketchem Sol EZ
Precision Liq Control
Precision Liq Gluc/Ket
Precision Liq Nrml/Mid
Precision Mis 28g(t)
Precision Mis 28G
Pressure Act Mis Lancet
Pressure Act Mis Lancets
Pro Comfort Mis Lancets
Prodigy Mis Lanc Dev
Prodigy Mis 26G
Prodigy Mis 28G
QL,PA
Prodigy NO Tes Coding
Prodigy Sol High
Prodigy Sol Low
Pss Safe Lan Mis
Pss Sel Lanc Mis
Px Lancets Mis Ult Thin
63
PC Lancets Mis 30G
Qc Lancets Mis 28G
Qc Lancets Mis 30G
Qc Lancing Mis Device
Quicktek Liq Solution
Quintet Cont Sol Hgh/Norm
Ra E-ZJECT Mis Thin 26G
Ra E-ZJECT Mis Thin 28G
Ra E-ZJECT Mis Ult Thin
Ra E-ZJECT Mis 28G
Ra E-ZJECT Mis 33G
Ra Pen Needl Mis 31GX3/16
Reality Mis Lancets
Reality Trig Mis Lancets
Refuah Plus Sol Control
Relion Lance Mis Stnd 21G
Relion Lance Mis Thin 26G
Relion Lance Mis Thin 30G
Relion Lanci Mis Device
Relion Micro Mis Thin 33G
Relion Pen Mis 29GX12MM
Relion Thin Mis Lancets
Relion Ultra Mis Thin
Relion Ultra Mis Thin Pls
Relion Ultra Mis Thin 32G
Renew Adv Mis Device
Renew Adv Mis Refills
Rightest Liq High CON
Rightest Liq Norm CON
Rightest Mis Gl300
Rightest Mis GD500
Safe-t-lance Mis HI Flow
Safe-t-lance Mis Low Flow
Safe-t-lance Mis Nor Flow
Safe-t-lance Mis 21G
Safe-t-lance Mis 25G
Safe-t-pro Mis Lancets
Safe-t-pro Mis Plus
Safety Let Mis Lancets
Safety Mis Lancets
Safety Seal Mis 28G
Safety Seal Mis 30G
Safety 21G Mis Lancets
Safety 28G Mis Lancets
Sapscare Mis Twist
Side Button Mis Safety
Simple Diag Mis Lancing
Single-let Mis 23G
Sm Lancets Mis Thin 26G
Sm Lancets Mis Thin 30G
Sm Lancets Mis 21G
Sm Lancets Mis 33G
Smart Sense Mis Lanc 21G
Smartest Mis Lancets
Smartest Sol Control
Soft Touch Mis Lancets
Softclix Lan Mis Device
Softclix Mis Lancets
Solus V2 Mis Lanc Dev
Solus V2 Mis Lanc 28G
Solus V2 Mis Lanc 30G
Solus V2 Sol High
Solus V2 Sol Low
Sterilance Mis TL 28G
Sterilance Mis 1.8MM
Super Thin Mis Lanc 28G
Super Thin Mis Lancet
Super Thin Mis Lancets
Supreme II Liq High/Low
Sure Comfort Mis Lanc Pen
Sure Comfort Mis Lancets
Sure Comfort Mis 29GX1/2"
Sure Comfort Mis 30GX5/16
Sure Comfort Mis 32GX6MM
Sure-fine Mis 29GX1/2"
Sure-fine Mis 31GX3/16
Sure-fine Mis 31GX5/16
Sure-lance Mis Lancets
Sure-lance Mis 26G
Sure-pen Mis
Sure-touch Mis Unv Lanc
Sureflex Mis Lancets
Surelite Mis Lancets
Surestep Glu Sol
Surestep Glu Sol High/Low
Surestep Pro Tes High CON
Surestep Pro Tes Low CON
Surestep Pro Tes Norm CON
Surestep Sol Control
SB Lancets Mis Thin
SB Lancets Mis Ultr Thn
Tai Doc Sol Norm CON
Techlite AST Mis Lancets
Techlite Mis Lanc 30G
Techlite Mis Lancets
Telcare Sol Level1/2
Tgt Lancet Mis Alternat
Tgt Lancet Mis 23G
Tgt Lancet Mis 26G
Tgt Lancet Mis 28G
Tgt Lancet Mis 30G
Tgt Lancet Mis 33G
Tgt Lancing Mis Adv Dev
Tgt Lancing Mis Device
Thin Lancets Mis
Thin Lancets Mis 26G
Thin Lancets Mis 30G
Thinlets GP Mis 26G
Thinlets Mis 28g(t)
Tier Uni Pls Mis 31GX8MM
Travel Lance Mis 30G
True Metrix Sol Level 1
Truecontrol Liq Level 0
Truecontrol Liq Level 1
Truedraw Mis Lanc Dev
Truetest Liq Level 1
Truplus Lanc Mis 26G
Ulti-lance Mis CLR Tip
Ultilet Mis Lancets
Ultilet Mis Safety
Ultilet Mis 26G
Ultilet Mis 28G
64
Ultilet Mis 30G
Ultilet Mis 33G
Ultra Thin Mis Lanc 26G
Ultra Thin Mis Lancets
Ultra Thin Mis 28G
Ultra Thin Mis 30G
Ultra Thin Mis 31G
Ultra Thin Mis 33G
Ultralance Mis 1.8MM
Ultratrk Pro Sol
Ultratrk Pro Sol High/Low
Ultratrk Ult Sol High/Low
Unfine Pntp Mis 32GX4MM
Unifine Pntp Mis 29GX1/2"
Unifine Pntp Mis 29GX12MM
Unifine Pntp Mis 31GX3/16
Unilet Cmfr Mis Tch 28G
Unilet Cmfr Mis Tch 30G
Unilet Excel Mis 23G
Unilet EX II Mis 28G
Unilet G.p Mis Supr 23G
Unilet G.p. Mis 21G
Unilet GP 28 Mis Ult Thin
Unilet Lanc Mis 33G
Unilet Lance Mis 21G
Unilet Lanct Mis 28G
Unilet Mis 21G
Unilet Super Mis G.p. 23G
Unilet Super Mis 23G
Unistik CZT Mis Comfort
Unistik CZT Mis Normal
Unistik II Mis Lancets
Unistik Safe Mis Lanc 28G
Unistik Safe Mis Lanc 30G
Unistik Touc Mis Lanc 21G
Unistik 1 Mis 2.4MM
Unistik 1 Mis 3.0MM
Unistik 2 Mis
Unistik 2 Mis Comfort
Unistik 2 Mis Extra
Unistik 2 Mis Neonatal
Unistik 2 Mis Normal
Unistik 2 Mis Super
Unistik 2 Mis 1.8MM
Unistik 3 Mis Comfort
Unistik 3 Mis Extra
Unistik 3 Mis Gent 30G
Unistik 3 Mis Neonatal
Unistik 3 Mis Normal
Universal 1 Mis Lanc 26G
Universal 1 Mis Lanc 30G
Vantage Lanc Mis Device
Vantage Lanc Mis Univ 30G
Victory Sol Control
Vitalet Pro Mis
TIER 02
TIER 03
Vitalet Pro Mis Plus
W&f Lancets Mis 21G
W&f Lancets Mis 26G
Xpres Contrl Sol Normal
1ST Choice Mis Lancets
1ST Tier Uni Mis 29GX12MM
PREFERRED
Diascreen Mis Control
Diascreen Mis 1b
Diascreen Mis 1k
Diascreen Mis 2GK
Diascreen Mis 2GP
Diascreen Mis 4nl
Diascreen Mis 4obl
Diascreen Mis 4PH
Diascreen 10 Mis
Diascreen 3 Mis
Diascreen 5 Mis
Diascreen 6 Mis
Diascreen 7 Mis
Diascreen 8 Mis
Diascreen 9 Mis
Onetouch Mis Lanc Dev
Onetouch Mis Lancets
Onetouch Mis 30G
Onetouch Us Mis Lancets
Penlet II Kit Blood
Urin-tek Mis
NON PREFERRED
Diascreen Mis 1G
MEDICAL DEVICES - MISC
TIER 02
PREFERRED
pocket chamb mis
pocket space mis
Aerchmbr Pls Mis Flow-VU
Aerchmbr Pls Mis Lrg Mask
Aerchmbr Pls Mis MED Mask
Aerchmbr Pls Mis Sm Mask
Aerchmbr Z- Mis Stat Pls
Aerochamber Mis Chamber
Aerochamber Mis Flosigna
Aerochamber Mis MV
Aerochamber Mis Plus
Aerovent Mis Plus
Arial Mis Chamber
Breatherite Mis
Breatherite Mis LG Mask
Breatherite Mis MED Mask
Breatherite Mis Sm Mask
Breatherite Mis Spacer
Breatherite Mis W/Mask
Compact Spac Mis Chamber
Compact Spac Mis LG Mask
Compact Spac Mis MD Mask
Compact Spac Mis Sm Mask
E-z Spacer Mis
Easivent Mis
Flexichamber Mis
Hold Chamber Mis Adlt LG
Inspirachamb Mis Large
Inspirachamb Mis Medium
Inspirachamb Mis Mouthpce
Inspirachamb Mis Small
Inspirease Mis Dd Syst
65
Liteaire Mis
Mask Vortex/ Mis Frog
Mask Vortex/ Mis Lady Bug
Microchamber Mis
Microspacer Mis
Nessi Spacer Mis Large
Nessi Spacer Mis Mouthpc
Nessi Spacer Mis Sm/MED
Optichamber Mis Adv Lrg
Optichamber Mis Adv MED
Optichamber Mis Adv Sm
Optichamber Mis Advantag
Optichamber Mis Dia LG
Optichamber Mis Dia MD
Optichamber Mis Dia Sm
Optichamber Mis Diamond
Optihaler Mis
Panda Mask Mis Large
Panda Mask Mis Medium
Panda Mask Mis Pediatri
Panda Mask Mis Small
Riteflo Mis
Valvd Holdng Mis Chamber
Vortex Valve Mis Chamber
Watchhaler Mis
MISCELLANEOUS AGENTS
TIER 03
TIER 05
NON PREFERRED
CA-dtpa sol 1000MG
PA
Ferriprox Sol 100MG/ML
QL,PA
Ferriprox TAB 500MG
ZN-dtpa sol 1000MG
Chemet CAP 100MG
QL,PA
Exjade TAB 125MG
QL,PA
Exjade TAB 250MG
QL,PA
Exjade TAB 500MG
QL,PA
Jadenu TAB 180MG
QL,PA
Jadenu TAB 360MG
QL,PA
Jadenu TAB 90MG
66
Index
A
a-hydrocort inj 100MG, 22
abacav/lamiv TAB /zidovud, 5
abacavir TAB 300MG, 4
Abilify Disc TAB 10MG, 40
Abilify Disc TAB 15MG, 40
Abilify Inj 9.75MG, 40
Abilify Main Inj 300MG, 41
Abilify Main Inj 400MG, 41
Abilify Sol 1MG/ML, 40
Abilify TAB 10MG, 40
Abilify TAB 2MG, 41
Abilify TAB 5MG, 41
Absorica CAP 10MG, 17
Abstral Sub 100mcg, 54
acampro CAL TAB 333MG, 46
Acanya Gel 1.2-2.5%, 17
acarbose TAB 100MG, 27
Accolate TAB 10MG, 58
Accolate TAB 20MG, 58
Accu-chek IN Liq Control, 60
Accu-chek Kit Fastclix, 60
Accu-chek Kit Mlticlix, 60
Accu-chek Kit Softclix, 60
Accu-chek Liq Act/Gluc, 60
Accu-chek Liq Compact, 60
Accu-chek Liq Smart, 60
Accu-chek Mis Mlticlix, 60
Accu-chek Sol, 60
Accu-chek Sol Comfort, 60
Accu-chek Sol Compact, 60
Accucaine Inj 1%, 21
Accupril TAB 10MG, 12
Accuretic TAB 10-12.5, 13
Accuretic TAB 20-12.5, 13
Accuretic TAB 20-25MG, 13
Accutrend Sol Glucose, 60
ace acd/alum sol 2% otic, 51
acebutolol CAP 200MG, 9
acebutolol CAP 400MG, 9
Aceon TAB 4MG, 12
Aceon TAB 8MG, 12
acetasol HC sol otic, 51
acetazolamid CAP 500MG ER, 14
acetazolamid inj 500MG, 14
acetazolamid TAB 125MG, 14
acetazolamid TAB 250MG, 14
acetic acid sol 0.25%irr, 35
acetic acid sol 2% otic, 51
acetylcyst sol 10%, 57
acetylcyst sol 20%, 57
Aciphex Spr CAP 10MG, 32
Aciphex Spr CAP 5MG, 32
Aciphex TAB 20MG, 32
acitretin CAP 10MG, 19
acitretin CAP 17.5MG, 19
acitretin CAP 25MG, 19
Aclovate CRE 0.05%, 20
Actemra Inj 162/0.9, 55
Acthib Inj, 59
Acti-lance Mis 28G, 60
Acti-lance Mis Lite 28G, 60
Acti-lance Mis Spec 17G, 60
Acti-lance Mis Univ 23G, 60
Acticlate TAB 150MG, 3
Acticlate TAB 75MG, 3
Actigall CAP 300MG, 33
Actimmune Inj 2mu/0.5, 8
Actiq Loz 1200mcg, 54
Active 1ST Mis Lanc 30G, 60
Active Injec Inj Dl, 23
Active Injec Inj M-1, 23
Active Injec Kit Blm-1, 23
Active Injec Kit Bm, 23
Active Injec Kit D, 23
Active Injec Kit Dlm, 23
Active Injec Kit Ket-l, 54
Active Injec Kit Ketmarc, 54
Active Injec Kit Km, 23
Active Injec Kit Lm-2, 56
Active Injec Kit Lm-dep-1, 23
Active-PAC/ Mis Gaba 300, 48
Active-prep CRE Kit I, 18
Activella TAB 0.5-0.1, 24
Activella TAB 1-0.5MG, 24
Actonel TAB 150MG, 28
Actonel TAB 5MG, 28
Actoplus Met TAB 15-500MG, 28
Actoplus Met TAB 15-850MG, 28
Actoplus Met TAB XR, 28
Actos TAB 15MG, 27
Actos TAB 30MG, 27
Actos TAB 45MG, 27
Acuicyn Liq, 21
Acular LS Sol 0.4%, 50
Acular Sol 0.5% Op, 50
Acura Contrl Sol High, 60
Acura Contrl Sol Low, 60
Acura Contrl Sol Normal, 60
Acuvail Sol 0.45%, 50
acyclovir CAP 200MG, 4
acyclovir oin 5%, 18
acyclovir sus 200/5ML, 4
acyclovir TAB 400MG, 4
acyclovir TAB 800MG, 4
Aczone Gel 5%, 17
Adacel Inj, 59
Adalat CC TAB 30MG ER, 11
adapalene CRE 0.1%, 16
adapalene gel 0.1%, 16
adapalene gel 0.3%, 16
adapalene gel pmp 0.3%, 16
adapalene lot 0.1%, 16
Adazin CRE, 21
Adcirca TAB 20MG, 16
Adderall TAB 10MG, 43
Adderall TAB 12.5MG, 43
Adderall TAB 7.5MG, 43
Adderall XR CAP 10MG, 42
adefov dipiv TAB 10MG, 4
Adempas TAB 0.5MG, 16
Adempas TAB 1MG, 16
Adempas TAB 2MG, 16
adj lancing mis device, 60
Adj Lancing Mis Device, 60
Adoxa CAP 150MG, 3
Adoxa PAK 1/ TAB 100MG, 3
Adoxa TAB 100MG, 3
Adoxa TAB 50MG, 3
Adoxa TAB 75MG, 3
Adrenaclick Inj 0.15MG, 15
Adrenaclick Inj 0.3MG, 15
Adrenalin Inj 1MG/ML, 15
Adrenalin Inj 30/30ML, 15
Adrenalin Sol 1:1000, 57
Adv Allergy Kit Collecti, 20
Adv Lancing Mis Device, 60
Adv Travel Mis Lanc 28G, 60
Advair Disku Aer 100/50, 58
Advair HFA Aer 115/21, 58
Advance Liq Control, 60
Advance Liq Intuitio, 60
Advance Norm Liq Control, 60
Advcate Safe Mis Lanc 26G, 60
Advicor TAB 1000-20, 15
Advicor TAB 1000-40, 15
Advicor TAB 500-20MG, 15
Advicor TAB 750-20MG, 15
Advocate Liq High, 60
Advocate Liq Low, 60
Advocate Mis Lanc 30G, 60
Advocate Mis Lanc Dev, 60
Advocate Mis Lancets, 60
Advocate+ Sol Redi-cod, 60
Adzenys XR TAB 12.5MG, 43
Adzenys XR TAB 15.7 MG, 43
Aerchmbr Pls Mis Flow-VU, 65
Aerchmbr Pls Mis Lrg Mask, 65
Aerchmbr Pls Mis MED Mask, 65
Aerchmbr Pls Mis Sm Mask, 65
Aerchmbr Z- Mis Stat Pls, 65
aero otic HC sol, 51
Aerochamber Mis Chamber, 65
Aerochamber Mis Flosigna, 65
Aerochamber Mis MV, 65
Aerochamber Mis Plus, 65
Aerospan Aer 80mcg, 58
Aerovent Mis Plus, 65
AF Lancets Mis Thin, 60
afeditab TAB 30MG CR, 10
afeditab TAB 60MG CR, 10
Afinitor Dis TAB 2MG, 8
Afinitor TAB 10MG, 8
Afinitor TAB 2.5MG, 8
Afinitor TAB 5MG, 8
Afinitor TAB 7.5MG, 8
Afluria Inj 2014-15, 59
Afluria Inj PF 14-15, 59
Afluria Quad Inj PF 16-17, 59
Afrezza Pow, 26
Afrezza Pow 4& 8unit, 26
Afrezza Pow 4unit, 26
Afrezza Pow 8&12unit, 26
aftera TAB 1.5MG, 24
Agamatrix Mis 33G, 60
Agamatrix Sol High, 60
Agamatrix Sol Norm/Hgh, 60
Agamatrix Sol Normal, 60
Aggrenox CAP 25-200MG, 37
Agrylin CAP 0.5MG, 37
ak-poly-bac oin op, 49
Akne-mycin Oin 2%, 17
Akten Gel 3.5%, 50
Akynzeo CAP, 32
ala cort CRE 1%, 20
Ala Scalp Lot 2%, 20
Ala-quin CRE 3-0.5%, 18
alagesic LQ sol, 51
Albafort Inj, 60
Albatussin CAP, 57
albatussin liq NN, 57
Albenza TAB 200MG, 6
albuterol neb 0.083%, 58
albuterol neb 0.5%, 58
albuterol neb 0.63MG/3, 58
albuterol neb 1.25MG/3, 58
albuterol syp 2MG/5ML, 58
albuterol TAB 2MG, 58
albuterol TAB 4MG, 58
albuterol TAB 4MG ER, 58
albuterol TAB 8MG ER, 58
Alcaine Sol 0.5% Op, 50
alclometason CRE 0.05%, 20
alclometason oin 0.05%, 20
Alcortin A Gel, 18
Alcortin A Gel 1-2-1%, 18
Aldactazide TAB 25/25, 14
Aldactazide TAB 50/50, 14
Aldactone TAB 100MG, 14
Aldara CRE 5%, 21
Alecensa CAP 150MG, 8
alendronate sol 70/75ML, 28
alendronate TAB 10MG, 28
Alfenta Inj 500/ML, 52
alfentanil inj 500/ML, 52
Alferon N Inj 5mu/ML, 8
alfuzosin TAB 10MG ER, 35
Alinia Sus 100/5ML, 6
Alinia TAB 500MG, 6
Alkeran TAB 2MG, 6
allopurinol TAB 100MG, 56
allopurinol TAB 300MG, 56
Allzital TAB 25-325MG, 51
almotrip mal TAB 12.5MG, 55
almotrip mal TAB 6.25MG, 55
almotriptan TAB 12.5MG, 55
almotriptan TAB 6.25MG, 55
Alocril Sol 2%, 50
Alodox Kit 20MG, 3
alog/pioglip TAB 12.5-15, 27
alog/pioglip TAB 12.5-30, 27
alog/pioglit TAB 12.5-45, 27
alog/pioglit TAB 25-15MG, 27
alogliptin TAB 12.5MG, 27
alogliptin TAB 25MG, 27
alogliptin TAB 6.25MG, 27
alogliptin/ TAB metform, 27
Alomide Sol 0.1% Op, 50
Aloquin Gel 1.25-1%, 18
Alora Dis 0.025MG, 24
Alora Dis 0.1MG, 24
alosetron TAB 0.5MG, 33
alosetron TAB 1MG, 33
Alphagan P Sol 0.1%, 50
Alphagan P Sol 0.15%, 50
alphatrex gel 0.05%, 19
Alprazolam CON 1 MG/ML, 38
alprazolam TAB 0.25 odt, 38
alprazolam TAB 0.25MG, 37
alprazolam TAB 0.5MG, 37
alprazolam TAB 0.5MG ER, 37
alprazolam TAB 0.5MG od, 38
alprazolam TAB 0.5MG XR, 37
alprazolam TAB 1MG, 37
alprazolam TAB 1MG ER, 37
alprazolam TAB 1MG odt, 38
alprazolam TAB 1MG XR, 37
alprazolam TAB 2MG, 37
alprazolam TAB 2MG odt, 38
Alrex Sus 0.2%, 50
Alsuma Inj 6MG/0.5, 55
Altabax Oin 1%, 18
altacaine sol 0.5% op, 50
Altace CAP 1.25MG, 12
Altace CAP 10MG, 12
Altace CAP 2.5MG, 12
Altace CAP 5MG, 12
altafrin sol 10% op, 50
altafrin sol 2.5% op, 50
altavera TAB, 24
Altoprev TAB 20MG ER, 15
altrnate sit mis device, 60
Aluvea CRE 39%, 21
Alvesco Aer 160mcg, 58
Alvesco Aer 80mcg, 58
alyacen TAB 1/35, 24
alyacen TAB 7/7/7, 24
amabelz TAB 0.5-0.1, 24
amabelz TAB 1-0.5MG, 24
amantadine CAP 100MG, 45
amantadine syp 50MG/5ML, 45
amantadine TAB 100MG, 45
Amaryl TAB 1MG, 27
Amaryl TAB 2MG, 27
Amaryl TAB 4MG, 27
Ambien CR TAB 12.5MG, 42
Ambien CR TAB 6.25MG, 42
Ambien TAB 10MG, 42
Ambien TAB 5MG, 42
amcinonide CRE 0.1%, 20
amcinonide lot 0.1%, 20
amcinonide oin 0.1%, 20
Amerge TAB 1MG, 55
Amerge TAB 2.5MG, 55
amethia LO TAB, 25
amethia TAB, 25
amethyst TAB 90-20mcg, 25
Amicar Sol 0.25/ML, 37
Amicar TAB 1000MG, 37
Amicar TAB 500MG, 37
amikacin inj 1gm/4ML, 3
amikacin inj 500/2ML, 3
amilor/hctz TAB 5-50, 14
amiloride TAB 5MG, 14
aminobez pot pow, 59
aminocapr ac syp 25%, 37
aminocapr ac TAB 1000MG, 37
aminocapr ac TAB 500MG, 37
amiodarone TAB 100MG, 11
Amitiza CAP 24mcg, 33
Amitiza CAP 8mcg, 33
amitriptylin TAB 100MG, 38
amlod/atorva TAB 10-10MG, 16
amlod/atorva TAB 2.5-10MG, 16
amlod/benazp CAP 10-20MG, 13
amlod/benazp CAP 2.5-10MG, 13
amlod/valsar TAB /hctz, 13
amlod/valsar TAB 10-160MG, 13
amlodipine TAB 10MG, 10
amlodipine TAB 2.5MG, 10
amlodipine TAB 5MG, 10
ammonium lac CRE 12%, 21
ammonium lac lot 12%, 21
amnesteem CAP 10MG, 16
amox-pot cla TAB ER, 1
amox/k clav chw 200MG, 1
amox/k clav chw 400MG, 1
amox/k clav sus 200/5ML, 1
amox/k clav TAB 250-125, 1
amox/k clav TAB 500-125, 1
amox/k clav TAB 875MG, 1
amoxapine TAB 100MG, 38
amoxicillin CAP 250MG, 1
amoxicillin CAP 500MG, 1
amoxicillin chw 125MG, 1
amoxicillin chw 250MG, 1
amoxicillin sus 125/5ML, 1
amoxicillin sus 250MG/5m, 1
amoxicillin TAB 500MG, 1
amp-sulbacta inj 1-0.5gm, 1
amp-sulbacta inj 1.5gm, 1
amp-sulbacta inj 10-5gm, 1
amp-sulbacta inj 15gm, 1
amp-sulbacta inj 2-1gm, 1
amp-sulbacta inj 3gm, 1
amphet/dextr CAP 10MG ER, 42
amphet/dextr TAB 10MG, 42
amphet/dextr TAB 12.5MG, 42
amphet/dextr TAB 7.5MG, 42
amphetamine CAP 10MG ER, 42
amphotericin inj 50MG, 3
ampicillin CAP 250MG, 1
ampicillin CAP 500MG, 1
ampicillin inj 10gm, 1
ampicillin inj 125MG, 1
ampicillin sus 125/5ML, 1
ampicillin sus 250/5ML, 1
Ampyra TAB 10MG, 48
Amrix CAP 15MG, 48
Amrix CAP 30MG, 48
Amturnide150 TAB -5-12.5, 13
Amturnide300 TAB -10-25MG, 13
Amturnide300 TAB -5-25MG, 13
Amytal Sod Inj 500MG, 42
Anacaine Oin, 21
Anadrol-50 TAB 50MG, 23
Anafranil CAP 25MG, 39
anagrelide CAP 0.5MG, 37
anagrelide CAP 1MG, 37
Analpram HC CRE 2.5-1%, 33
Analpram-HC CRE 1-1%, 33
Analpram-HC CRE 1-2.5%, 33
Analpram-HC CRE Singles, 33
Analpram-HC Lot 2.5%, 33
Analprm Sngl CRE HC 2.5-1, 33
Anaprox DS TAB 550MG, 55
Anaspaz TAB 0.125MG, 32
anastrozole TAB 1MG, 7
Ancobon CAP 250MG, 4
Ancobon CAP 500MG, 4
Androderm Dis 2MG/24HR, 23
Androderm Dis 4MG/24HR, 23
Androgel Gel 1%(25MG), 24
Androgel Gel 1%(50MG), 24
Androgel Gel 1.62%, 24
Androgel Gel P.M. 1%, 23
Android CAP 10MG, 24
Androxy TAB 10MG, 24
Angeliq TAB 0.25-0.5, 24
Angeliq TAB 0.5-1MG, 24
anodynz mis 0.0375-5, 21
Anoro Ellipt Aer 62.5-25, 58
Antabuse TAB 250MG, 48
Antabuse TAB 500MG, 48
Antara CAP 30MG, 15
Antara CAP 90MG, 15
antipy/benzo sol otic, 51
anucort-HC sup 25MG, 33
Anusol-HC CRE 2.5%, 33
anusol-HC sup 25MG, 33
Anzemet TAB 100MG, 32
Anzemet TAB 50MG, 32
AP-zel TAB, 60
apap-caffein CAP dihydroc, 52
apap/codeine sol 120-12/5, 51
apap/codeine TAB 300-15MG, 51
apexicon e CRE 0.05%, 20
Apexicon E CRE 0.05%, 20
Apidra Inj Solostar, 26
Apidra Inj U-100, 26
Aplenzin TAB 174MG, 39
Apokyn Inj 10MG/ML, 46
apraclonidin sol 0.5% op, 50
apri TAB, 24
Apriso CAP 0.375gm, 33
Aptensio XR CAP 10MG, 43
Aptiom TAB 200MG, 45
Aptivus CAP 250MG, 5
Aptivus Sol, 5
Aqua Lance Mis Lanc Dev, 60
Aquoral Aer, 37
Aralen TAB 500MG, 5
aranelle TAB, 24
Aranesp Inj 100mcg, 36
Arava TAB 10MG, 55
Arava TAB 20MG, 55
arbinoxa sol 4MG/5ML, 56
arbinoxa TAB 4MG, 56
Arcalyst Inj 220MG, 55
Arcapta CAP 75mcg, 58
argyl saline sol 0.9%, 35
Arial Mis Chamber, 65
Aricept Odt TAB 10MG, 48
Aricept TAB 10MG, 48
Aricept TAB 23MG, 48
Aricept TAB 5MG, 48
Arimidex TAB 1MG, 7
aripiprazole sol 1MG/ML, 40
aripiprazole TAB 10MG, 40
aripiprazole TAB 10MG odt, 40
aripiprazole TAB 15MG odt, 40
Aristada Inj 441MG/1., 41
Aristada Inj 662MG/2, 41
Aristada Inj 882MG/3, 41
Aristospan Inj 20MG/ML, 23
Arixtra Inj 10/0.8ML, 36
Arixtra Inj 2.5/0.5, 36
Arixtra Inj 5/0.4ML, 36
Arixtra Inj 7.5/0.6, 36
armodafinil TAB 150MG, 42
Armour Thyro TAB 120MG, 30
Arnuity Elpt Inh 100mcg, 58
Arnuity Elpt Inh 200mcg, 58
Aromasin TAB 25MG, 7
Arthrotec 50 TAB, 55
Arthrotec 75 TAB, 55
Artiss Sol 10ML, 37
Artiss Sol 2ML, 37
Artiss Sol 4ML, 37
asa/dipyrida CAP 25-200MG, 37
Asacol HD TAB 800MG, 33
Ascensia Liq Norm CON, 60
ascomp/cod CAP 30MG, 52
ashlyna TAB, 25
Asmanex 120 Aer 220mcg, 58
Asmanex HFA Aer 100 Mcg, 58
Asmanex HFA Aer 200 Mcg, 58
Assure 3 Liq Control, 60
Assure 4 Liq Level1/2, 60
Assure Cmfrt Mis 28G, 60
Assure Cmfrt Mis 30G, 60
Assure Dose Sol Norm/Hgh, 60
Assure Dose Sol Normal, 60
Assure II Liq Level 1, 60
Assure II Liq Level1/2, 60
Assure Lance Mis 21G, 60
Assure Lance Mis Low Flow, 60
Assure Lance Mis Micro, 60
Assure Lance Mis Safe 25G, 60
Assure Lance Mis Safe 30G, 60
Assure Mis Lancets, 60
Assure Plus Mis High 18G, 60
Assure Plus Mis Low 25G, 60
Assure Plus Mis Mcro 28G, 60
Assure Plus Mis Norm 21G, 60
Assure Plus Mis Pediatri, 60
Assure Prism Sol Level1/2, 60
Assure Pro Liq Level1/2, 60
Astagraf XL CAP 0.5MG, 7
Astagraf XL CAP 1MG, 7
Astagraf XL CAP 5MG, 7
Astepro Spr 0.15%, 57
Astero Gel 4%, 21
Astringyn Sol 259MG/Gm, 37
AT Last Mis Lancets, 60
AT Last Sol Control, 60
Atacand HCT TAB 16-12.5, 13
Atacand HCT TAB 32-12.5, 13
Atacand HCT TAB 32-25MG, 13
Atacand TAB 16MG, 12
Atacand TAB 32MG, 12
Atacand TAB 4MG, 12
Atacand TAB 8MG, 12
Atelvia TAB, 28
Atendia Pad 4-3%, 21
atenol/chlor TAB 100-25MG, 13
atenol/chlor TAB 50-25MG, 13
atenolol TAB 100MG, 9
Ativan Inj 2MG/ML, 38
Ativan Inj 4MG/ML, 38
Ativan TAB 0.5MG, 38
Ativan TAB 1MG, 38
Ativan TAB 2MG, 38
Atopiclair CRE, 21
Atorva/Coq10 PAK 20-100MG, 15
atorvastatin TAB 10MG, 15
atovaquone sus 750/5ML, 6
Atralin Gel 0.05%, 17
Atripla TAB, 5
Atropen Inj 0.25MG, 32
Atropen Inj 0.5MG, 32
Atropen Inj 1MG, 32
Atropen Inj 2MG, 32
atropin-care sol 1% op, 50
atropine SUL inj 0.05MG/1, 31
atropine SUL inj 0.1MG/ML, 31
atropine SUL inj 0.4/0.5, 31
atropine SUL inj 0.4MG/ML, 31
atropine SUL inj 1MG/ML, 31
atropine SUL oin 1% op, 50
atropine SUL sol 1% op, 50
Atrovent HFA Aer 17mcg, 58
Atrovent Nas Sol 0.03%, 57
Atrovent Nas Sol 0.06%, 57
Aubagio TAB 14MG, 48
Aubagio TAB 7MG, 48
aubra TAB 0.1-0.02, 24
aug betamet CRE 0.05%, 19
aug betamet gel 0.05%, 19
aug betamet lot 0.05%, 19
aug betamet oin 0.05%, 19
Augmentin Sus 125/5ML, 1
Augmentin Sus 250/5ML, 1
Augmentin Sus ES-600, 1
Augmentin TAB 500MG, 1
Augmentin TAB 875MG, 1
Augmentin XR TAB 12HR, 1
Aurora Lance Mis 30G, 60
Aurora Lance Mis Thin 23G, 60
auryxia TAB 210MG, 34
Auto Lancet Mis, 60
Auto-lancet Mis Mini, 60
Autodisc Liq Low/High, 60
Autolet II Kit Clinisaf, 60
Autolet Impr Mis Lanc Dev, 60
Autolet Lanc Mis Device, 60
Autolet Lite Kit Clinisaf, 60
Autolet Mini Mis, 60
Autolet Mis Impressi, 60
Autoshield Mis 29X3/16", 60
Autoshield Mis 29X5/16", 60
Autoshield Mis 30GX3/16, 60
Auvi-q Inj 0.15MG, 15
Auvi-q Inj 0.3MG, 15
Avalide TAB 150-12.5, 13
Avalide TAB 300-12.5, 13
avalin-RX pad 4-1%, 21
Avandamet TAB 2-1000MG, 28
Avandaryl TAB 4-1MG, 28
Avandia TAB 2MG, 27
Avandia TAB 4MG, 27
Avandia TAB 8MG, 27
Avapro TAB 150MG, 12
Avapro TAB 300MG, 12
Avapro TAB 75MG, 12
Avar Aer 9.5-5%, 17
avar cleanse emu 10-5%, 16
Avar LS Aer 10-2%, 17
Avar LS Liq 10-2%, 17
avar-e emoll CRE 10-5%, 17
avar-e green CRE 10-5%, 17
Avar-e LS CRE 10-2%, 17
Avc CRE 15%, 34
Avelox Abc TAB 400MG, 3
Avelox TAB 400MG, 3
Avenova Sol 0.01%, 21
Avenova Sol Neutrox, 21
aviane TAB, 24
Avidoxy DK Kit, 3
avidoxy TAB 100MG, 2
Avinza CAP 120MG, 52
Avinza CAP 30MG, 53
Avinza CAP 45MG, 53
Avinza CAP 60MG, 53
Avinza CAP 75MG, 53
Avinza CAP 90MG, 53
avita CRE 0.025%, 16
avita gel 0.025%, 16
Avodart CAP 0.5MG, 35
Avonex Kit 30mcg, 48
Avonex Pen Kit 30mcg, 48
Avonex Prefl Kit 30mcg, 48
Axert TAB 12.5MG, 55
Axert TAB 6.25MG, 55
Axiron Sol 30MG/Act, 24
Aygestin TAB 5MG, 26
Azactam Inj 1gm, 6
Azactam Inj 2gm, 6
Azasan TAB 100MG, 7
Azasan TAB 75 MG, 7
Azasite Sol 1%, 49
azathioprine inj 100MG, 7
azathioprine TAB 50MG, 7
azelastine dro 0.05%, 50
azelastine spr 0.1%, 57
azelastine spr 0.15%, 57
Azelex CRE 20%, 17
Azenase PAK Mis 137-50, 57
Azilect TAB 0.5MG, 45
Azilect TAB 1MG, 45
azithromycin pow 1gm PAK, 2
azithromycin sus 100/5ML, 2
azithromycin sus 200/5ML, 2
azithromycin TAB 250MG, 2
Azopt Sus 1% Op, 50
Azor TAB 10-20MG, 13
Azor TAB 10-40MG, 13
Azor TAB 5-20MG, 13
Azor TAB 5-40MG, 13
aztreonam inj 1gm, 6
aztreonam inj 2gm, 6
Azulfidine TAB 500MG, 33
Azulfidine TAB 500MG En, 33
azuphen mb CAP 120MG, 34
azurette TAB 28 day, 25
B
b-donna TAB 16.2MG, 31
b-plex plus TAB, 59
baciim inj 50000unt, 6
bacit/polymy oin op, 49
bacitracin inj 50000unt, 6
bacitracin oin op, 49
baclofen TAB 10MG, 48
baclofen TAB 20MG, 48
Bactrim DS TAB 800-160, 6
Bactrim TAB 400-80MG, 6
Bactroban CRE 2%, 18
Bactroban Oin 2%, 18
Bactroban Oin Nasal 2%, 57
balsalazide CAP 750MG, 33
balziva TAB, 24
Banzel Sus 40MG/ML, 44
Banzel TAB 200MG, 44
Banzel TAB 400MG, 44
Baraclude Sol .05MG/ML, 4
Baraclude TAB 0.5MG, 5
Baraclude TAB 1MG, 5
baycadron elx 0.5/5ML, 22
Bayer Breeze Liq High Cnt, 60
Bayer Breeze Liq Low Cntl, 60
Bayer Breeze Liq Norm Cnt, 60
Bayer Breeze Mis 2 Test, 60
Bayer Micrlt Mis Lanc Dvc, 61
Bayer Micrlt Mis Lancets, 61
BD Lancet Mis Device, 61
BD Lancet UF Mis 30G, 61
BD Lancet UF Mis 33G, 61
BD Microtain Mis Lancets, 61
BD Pen Needl Mis 29GX1/2", 61
BD Pen Needl Mis 31GX3/16, 61
BD Pen Needl Mis 31GX5/16, 61
BD Pen Needl Mis 32GX4MM, 61
Beconase AQ Sus 0.042%, 57
bekyree TAB, 25
Belbuca Mis 150mcg, 53
bella/opium sup 16.2-30, 31
bella/opium sup 16.2-60, 31
Belsomra TAB 10MG, 42
benazep/hctz TAB 10-12.5, 13
benazep/hctz TAB 20-25MG, 13
benazepril TAB 10MG, 11
Benicar HCT TAB 20-12.5, 13
Benicar HCT TAB 40-12.5, 13
Benicar HCT TAB 40-25MG, 13
Benicar TAB 20MG, 12
Benicar TAB 40MG, 12
Benicar TAB 5MG, 12
Bensal HP Oin, 21
Bentyl CAP 10MG, 32
Bentyl Inj 10MG/ML, 32
Bentyl TAB 20MG, 32
Benzaclin Gel 1-5%, 17
Benzaclin Gel 1-5%P.M., 17
Benzamycin Gel 5-3%, 17
Benzamycin Gel PAK, 17
benzepro mis 6%, 17
Benziq Gel 5.25%, 17
Benziq LS Gel 2.75%, 17
benzonatate CAP 100MG, 57
benztropine inj 1MG/ML, 45
benztropine TAB 0.5MG, 45
benztropine TAB 1MG, 45
benztropine TAB 2MG, 45
Bepreve Dro 1.5%, 50
Berinert Inj 500unit, 37
Besivance Sus 0.6%, 49
Beta 1 Kit Kit 30MG/5ML, 23
beta-phos/ac inj 3-3MG/ML, 23
Betadine Sol 5% Op, 49
Betagan Sol 0.5% Op, 49
Betalido Kit, 23
Betaloan Sui Inj 3-3MG/ML, 23
Betameth Com Inj 7MG/ML, 23
betameth dip CRE 0.05%, 19
betameth dip lot 0.05%, 19
betameth dip oin 0.05%, 19
Betameth PF Inj 12MG/2ML, 23
betameth SP inj 24MG/2ML, 23
betameth val aer 0.12%, 19
betameth val CRE 0.1%, 19
betameth val lot 0.1%, 19
betameth val oin 0.1%, 19
Betapace AF TAB 120MG, 10
Betapace TAB 120MG, 10
Betaseron Inj 0.3MG, 48
betaxolol sol 0.5% op, 49
betaxolol TAB 10MG, 9
betaxolol TAB 20MG, 9
bethanechol TAB 10MG, 34
Bethkis Neb 300/4ML, 3
Betimol Sol 0.25%, 49
Betimol Sol 0.5%, 49
Betoptic-s Sus 0.25% Op, 49
Bevespi Aer, 58
bexarotene CAP 75MG, 8
Bexsero Inj, 59
Beyaz TAB, 26
Biaxin Sus 250/5ML, 2
Biaxin TAB 250MG, 2
Biaxin TAB 500MG, 2
bicalutamide TAB 50MG, 7
Bicillin C-R Inj 1200000, 1
Bicillin C-R Inj 900/300, 1
Bicillin L-a Inj 1200000, 1
Bidil TAB, 16
Biferarx TAB, 35
Biltricide TAB 600MG, 6
bimatoprost sol 0.03%, 50
Binosto TAB 70MG, 28
Bio-statin CAP 1000000, 4
Bio-statin CAP 500000, 4
bio-statin pow, 4
Biothrax Inj, 59
biotuss liq, 57
bisoprl/hctz TAB 10/6.25, 13
bisoprl/hctz TAB 2.5/6.25, 13
bisoprl/hctz TAB 5-6.25MG, 13
bisoprol fum TAB 10MG, 9
bisoprol fum TAB 5MG, 9
BL Injection Kit, 56
Bleo 15k Inj, 7
Bleph-10 Sol 10% Op, 49
Blephamide Oin S.o.p., 49
Blephamide Sus Op, 49
blisovi 24 TAB FE 1/20, 25
blisovi FE TAB 1.5/30, 24
blisovi FE TAB 1/20, 25
Boniva TAB 150MG, 28
Boostrix Inj, 59
Bosulif TAB 100MG, 8
Bosulif TAB 500MG, 8
bp 10-1 emu, 17
bp cleansing emu 10-4%, 17
bpm pseudo TAB 6-45MG, 57
bpm TAB 6MG, 57
bpo cloths mis 3%, 17
bpo gel 4%, 17
bpo gel 8%, 17
Breatherite Mis, 65
Breatherite Mis LG Mask, 65
Breatherite Mis MED Mask, 65
Breatherite Mis Sm Mask, 65
Breatherite Mis Spacer, 65
Breatherite Mis W/Mask, 65
Breo Ellipta Inh 100-25, 58
Breo Ellipta Inh 200-25, 58
Brevicon TAB 0.5/35, 26
briellyn TAB, 25
Brilinta TAB 60MG, 37
Brilinta TAB 90MG, 37
brimonidine sol 0.15%, 50
brimonidine sol 0.2% op, 50
Brintellix TAB 10MG, 39
Brisdelle CAP 7.5MG, 48
Briviact Sol 10MG/ML, 45
Briviact TAB 100MG, 45
brom/PSE/DM syp, 57
bromfed DM syp, 57
bromfenac sol 0.09% op, 50
bromocriptin CAP 5MG, 45
bromocriptin TAB 2.5MG, 45
brompheniram chw 12MG, 57
brompheniram inj 10MG/ML, 57
Brovana Neb 15mcg, 58
Bt Injection Kit 40-0.5%, 23
budesonide CAP 3MG DR, 23
budesonide sus 0.25MG/2, 58
budesonide sus 0.5MG/2, 58
budesonide sus 1MG/2ML, 58
budesonide sus 32mcg, 57
Bullseye Mis Lancets, 61
Bullseye Mis Mini Lnc, 61
bumetanide inj 0.25/ML, 14
bumetanide TAB 0.5MG, 14
bumetanide TAB 1MG, 14
bumetanide TAB 2MG, 14
Bumex TAB 0.5MG, 14
Bumex TAB 1MG, 14
Bumex TAB 2MG, 14
Bunavail Mis 2.1-0.3, 53
Bunavail Mis 4.2-0.7, 53
Bunavail Mis 6.3-1MG, 53
Bupap TAB 50-300MG, 51
Buphenyl Pow, 30
Buphenyl TAB 500MG, 30
bupivac/NACL inj 0.1-0.9%, 56
bupivac/NACL inj 0.2-0.9%, 56
bupivac/NACL inj 0.25-0.9, 56
bupivacaine inj 0.25%, 56
bupivacaine/ inj epi 0.25, 56
bupivacaine/ inj epi 0.5%, 56
Bupivilog Kit, 23
bupren/nalox sub 2-0.5MG, 51
bupren/nalox sub 8-2MG, 51
Buprenex Inj 0.3MG/ML, 53
buprenorphin inj 0.3MG/ML, 51
buprenorphin sub 2MG, 51
buprenorphin sub 8MG, 51
buproban TAB 150MG, 46
bupropion TAB 100MG, 38
bupropion TAB 100MG ER, 38
bupropion TAB 100MG SR, 38
bupropn HCL TAB 150MG XL, 38
bupropn HCL TAB 300MG XL, 38
buspirone TAB 10MG, 37
buspirone TAB 7.5MG, 38
but/apap/caf CAP, 51
but/apap/caf CAP codeine, 52
but/apap/caf TAB, 51
but/asa/caf/ CAP cod 30MG, 52
but/asa/caff CAP, 51
butal/apap TAB 50-325MG, 51
Butisol Sod TAB 30MG, 42
Butisol Sod TAB 50MG, 42
butorphanol inj 1MG/ML, 51
butorphanol inj 2MG/ML, 51
butorphanol sol 10MG/ML, 52
Butrans Dis 10mcg/HR, 53
Butrans Dis 7.5/HR, 53
Bydureon Inj, 26
Bydureon Inj 2MG, 26
Bydureon Pen Inj 2MG, 26
Byetta Inj 10mcg, 26
Byetta Inj 5mcg, 26
Bystolic TAB 10MG, 10
Bystolic TAB 2.5MG, 10
Byvalson TAB 5-80MG, 13
C
CA-dtpa sol 1000MG, 66
cabergoline TAB 0.5MG, 29
Cabometyx TAB 20MG, 8
Caduet TAB 10-10MG, 16
Caduet TAB 2.5-10MG, 16
Cafergot TAB 1-100MG, 55
caffeine CIT sol 20MG/ML, 42
caffeine CIT sol 60MG/3ML, 42
caffeine/sod inj benzoate, 42
Calan SR TAB 120MG, 11
Calan TAB 120MG, 11
Calan TAB 80MG, 11
calc acetate CAP 667MG, 33
calc acetate TAB 667MG, 33
calcipotrien CRE 0.005%, 19
calcipotrien oin 0.005%, 19
calcipotrien oin betameth, 20
calcipotrien sol 0.005%, 19
calcitonin spr 200/act, 28
calcitrene oin 0.005%, 19
calcitriol CAP 0.25mcg, 29
calcitriol CAP 0.5mcg, 29
calcitriol oin 3mcg/gm, 19
calcitriol sol 1mcg/ML, 29
Cambia Pow 50MG, 55
camila TAB 0.35MG, 25
Campral TAB 333MG, 48
camrese LO TAB, 25
camrese TAB, 25
Canasa Sup 1000MG, 33
candesa/hctz TAB 16-12.5, 13
candesa/hctz TAB 32-12.5, 13
candesa/hctz TAB 32-25MG, 13
candesartan TAB 16MG, 12
Cantil TAB 25MG, 32
capacet CAP, 51
Capastat SUL Inj 1gm, 3
capecitabine TAB 150MG, 7
capecitabine TAB 500MG, 7
Capex Sha 0.01%, 20
Caphosol Sol, 37
Capital/Cod Sus 120-12/5, 53
Caprelsa TAB 100MG, 8
Caprelsa TAB 300MG, 8
captopr/hctz TAB 25-15MG, 13
captopril TAB 100MG, 11
captopril TAB 12.5MG, 11
Captracin Pad .0375-5%, 21
Capxib Kit, 55
Carafate Sus 1gm/10ML, 31
Carafate TAB 1gm, 32
CARB-o-philc CRE /40, 21
CARB-o-philc gel 40%, 21
CARB/levo 50 TAB /entacap, 45
CARB/levo 75 TAB /entacap, 45
CARB/levo ER TAB 25-100MG, 45
CARB/levo ER TAB 50-200MG, 45
CARB/levo TAB 10-100MG, 45
CARB/levo100 TAB /entacap, 45
Carbaglu TAB 200MG, 30
carbamazepin CAP 100MG ER, 43
carbamazepin chw 100MG, 43
carbamazepin sus 100/5ML, 43
carbamazepin TAB 100mger, 43
carbamazepin TAB 200MG, 43
carbamazepin TAB 200MG ER, 43
carbamazepin TAB 400MG ER, 43
Carbaphen 12 Liq, 57
Carbaphen 12 Sus PED, 57
Carbatrol CAP 100MG, 44
carbidopa TAB 25MG, 45
carbinoxamin sol 4MG/5ML, 56
carbinoxamin TAB 4MG, 56
Carbocaine Inj 1%, 56
Carbocaine Inj 1% PF, 56
Carbocaine Inj 1.5% PF, 56
Carbocaine Inj 2%, 56
Carbocaine Inj 2% PF, 56
Cardizem CD CAP 120MG/24, 11
Cardizem LA TAB 120MG, 11
Cardizem LA TAB 300MG/24, 11
Cardizem LA TAB 420MG/24, 11
Cardizem TAB 120MG, 11
Cardura TAB 1MG, 12
Cardura TAB 2MG, 12
Cardura TAB 4MG, 12
Cardura TAB 8MG, 12
Cardura XL TAB 4MG, 35
Cardura XL TAB 8MG, 35
Carefine Mis 31GX8MM, 61
Careone Adv Mis Lancing, 61
Careone Lanc Mis 28G, 61
Careone Lanc Mis Thin 23G, 61
Caresens Sol Control, 61
carisopr/asa TAB 200-325, 48
carisoprodol TAB 250MG, 48
carisoprodol TAB 350MG, 48
carisoprodol TAB asa/cod, 48
Carnitor SF Sol 1gm/10ML, 29
Carnitor Sol 1gm/10ML, 29
Carnitor TAB 330MG, 29
carteolol sol 1% op, 49
cartia XT CAP 120/24HR, 10
carvedilol TAB 12.5MG, 9
carvedilol TAB 25MG, 9
Casodex TAB 50MG, 7
Cataflam TAB 50MG, 55
Catapres TAB 0.1MG, 12
Catapres-tts Dis 0.1/24HR, 13
Cayston Inh 75MG, 6
caziant PAK, 25
cdp/amitrip TAB 10-25MG, 47
cdp/amitrip TAB 5-12.5MG, 47
Cedax CAP 400MG, 2
Cedax Sus 180/5ML, 2
cefaclor CAP 250MG, 1
cefaclor CAP 500MG, 1
cefaclor ER TAB 500MG, 1
cefaclor sus 125/5ML, 1
cefadroxil CAP 500MG, 1
cefadroxil sus 250/5ML, 1
cefadroxil sus 500/5ML, 1
cefadroxil TAB 1gm, 1
cefazolin inj 100gm, 1
cefazolin inj 500MG, 1
cefdinir CAP 300MG, 2
cefdinir sus 125/5ML, 2
cefdinir sus 250/5ML, 2
cefditoren TAB 200MG, 2
cefditoren TAB 400MG, 2
cefepime inj 1gm, 2
cefepime inj 2gm, 2
cefixime sus 100/5ML, 2
cefixime sus 200/5ML, 2
Cefotan Inj 1gm/10ML, 1
Cefotan Inj 2gm, 1
cefotaxime inj 10gm, 2
cefotaxime inj 500MG, 2
cefotetan inj 10G, 1
cefotetan inj 1gm/10ML, 1
cefotetan inj 2gm/20ML, 1
cefoxitin inj 10gm, 1
cefpodo prox sus 100/5ML, 2
cefpodo prox sus 50MG/5ML, 2
cefpodoxime TAB 100MG, 2
cefpodoxime TAB 200MG, 2
cefprozil sus 125/5ML, 1
cefprozil sus 250/5ML, 1
cefprozil TAB 250MG, 1
cefprozil TAB 500MG, 1
ceftazidime inj 1gm, 2
ceftibuten CAP 400MG, 2
ceftibuten sus 180/5ML, 2
Ceftin Sus 125/5ML, 1
Ceftin Sus 250/5ML, 1
Ceftin TAB 250MG, 1
Ceftin TAB 500MG, 2
ceftriaxone inj 100gm, 2
ceftriaxone inj 250MG, 2
ceftriaxone inj 500MG, 2
cefuroxime inj 1.5gm, 1
cefuroxime inj 225gm, 1
cefuroxime inj 7.5gm, 1
cefuroxime inj 750MG, 1
cefuroxime TAB 250MG, 1
cefuroxime TAB 500MG, 1
Celebrex CAP 100MG, 55
celecoxib CAP 100MG, 54
Celestone Inj Soluspan, 23
Celexa TAB 10MG, 39
Celexa TAB 20MG, 39
Celexa TAB 40MG, 39
Cellcept CAP 250MG, 7
Cellcept Sus 200MG/ML, 7
Cellcept TAB 500MG, 7
Celontin CAP 300MG, 44
cem-urea sol 45%, 21
Centany AT Kit 2%, 18
centany oin 2%, 18
cephalexin CAP 250MG, 1
cephalexin sus 125/5ML, 1
cephalexin sus 250/5ML, 1
cephalexin TAB 250MG, 1
cephalexin TAB 500MG, 1
Ceracade Emu, 21
ceramax CRE, 21
Cerdelga CAP 84MG, 36
Cerebyx Inj 100/2ML, 44
Cerebyx Inj 500/10ML, 44
cerisa wash emu 10-1%, 17
cerovel gel 40%, 21
cerovel lot 40%, 21
Cervarix Inj, 59
Cervidil Vag Mis 10MG INS, 51
Cesamet CAP 1MG, 32
Cetacaine Aer, 21
cetirizine syp 1MG/ML, 57
Cetraxal Sol 0.2%, 51
cevimeline CAP 30MG, 37
Chantix PAK 0.5& 1MG, 47
Chantix PAK 1MG, 47
Chantix TAB 0.5MG, 47
Chantix TAB 1MG, 47
chateal TAB 0.15/30, 25
Chemet CAP 100MG, 66
Chenodal TAB 250MG, 34
chlord/clidi CAP 5-2.5MG, 31
chlordiazep CAP 10MG, 37
chloroquine TAB 250MG, 5
chloroquine TAB 500MG, 5
chlorothiaz TAB 250MG, 14
chlorothiaz TAB 500MG, 14
chlorpromaz inj 25MG/ML, 40
chlorpromaz inj 50MG/2ML, 40
chlorpromaz TAB 100MG, 40
chlorpropam TAB 100MG, 27
chlorpropam TAB 250MG, 27
chlorthalid TAB 100MG, 14
chlorzoxazon TAB 500MG, 48
cho MAG tris liq 500/5ML, 51
cho MAG tris TAB 1000MG, 51
Cholbam CAP 250MG, 33
Cholbam CAP 50MG, 33
cholestyram pow 4gm, 15
cholestyram pow 4gm lite, 15
ciclodan CRE 0.77%, 18
ciclodan sol 8%, 18
ciclopirox CRE 0.77%, 18
ciclopirox gel 0.77%, 18
ciclopirox kit 8%, 18
ciclopirox sha 1%, 18
ciclopirox sol 8%, 18
ciclopirox sus 0.77%, 18
cidaleaze CRE 3%, 21
cilostazol TAB 100MG, 37
cilostazol TAB 50MG, 37
Ciloxan Oin 0.3% Op, 49
Ciloxan Sol 0.3% Op, 49
cimetidine sol 300/5ML, 31
cimetidine TAB 200MG, 31
Cimzia Kit, 34
Cimzia Kit Starter, 34
Cimzia Prefl Kit 200MG/ML, 34
Cinryze Sol 500 Unit, 37
Cipro (10%) Sus 500MG/5, 3
Cipro (5%) Sus 250MG/5, 3
Cipro HC Sus Otic, 51
Cipro TAB 250MG, 3
Cipro TAB 500MG, 3
Cipro XR TAB 1000MG, 3
Cipro XR TAB 500MG, 3
Ciprodex Sus 0.3-0.1%, 51
ciprofloxacn sol 0.2%, 51
ciprofloxacn sol 0.3% op, 49
ciprofloxacn sus 250MG/5, 3
ciprofloxacn sus 500MG/5, 3
ciprofloxacn TAB 1000MG, 3
ciprofloxacn TAB 500MG ER, 3
citalopram sol 10MG/5ML, 38
citalopram TAB 10MG, 38
citric acid/ sol sod citr, 35
Claforan Inj 10gm, 2
Claforan Inj 1gm, 2
Claforan Inj 2gm, 2
Claforan Inj 500MG, 2
claravis CAP 10MG, 16
Clarifoam EF Aer 10-5%, 17
Clarinex Syp 0.5MG/ML, 57
Clarinex TAB 5MG, 57
Clarinex-d TAB 2.5-120, 57
claris wash emu 10-4%, 17
clarithromyc sus 125/5ML, 2
clarithromyc sus 250/5ML, 2
clarithromyc TAB 250MG, 2
clarithromyc TAB 500MG, 2
clarithromyc TAB 500MG ER, 2
Cleanlet 28G Mis Lancets, 61
clearplex X gel 10%, 17
clemastine syp 0.5/5ML, 56
clemastine TAB 2.68MG, 56
Cleocin CAP 150MG, 6
Cleocin CAP 300MG, 6
Cleocin CAP 75MG, 6
Cleocin CRE 2% Vag, 34
Cleocin PED Sol 75MG/5ML, 6
Cleocin Phos Inj 300MG, 6
Cleocin Phos Inj 9gm/60ML, 6
Cleocin Sup 100MG, 34
Cleocin-t Gel 1%, 17
Cleocin-t Lot 1%, 17
Cleocin-t Pad 1%, 17
Cleocin-t Sol 1%, 17
Clever Check Mis, 61
Clever Check Mis 30G, 61
Clevr Choice Liq High, 61
Clevr Choice Liq Low, 61
Clickfine Mis 31GX1/4", 61
Clickfine Mis 31GX5/16, 61
Clickfine Mis 32GX5/32, 61
Climara Dis 0.025MG, 24
Climara Pro Dis Weekly, 24
Clindacin Kit Etz 1%, 17
Clindacin Kit PAC 1%, 17
clindacin mis etz 1%, 16
clindacin-p pad 1%, 16
Clindagel Gel 1%, 17
clindamax gel 1%, 16
clindamy/ben gel 1-5%, 16
clindamy/ben gel 1.2-5%, 17
clindamycin aer 1%, 17
clindamycin CAP 150MG, 6
clindamycin CRE 2% vag, 34
clindamycin gel 1%, 16
clindamycin gel tretinoi, 17
clindamycin inj 150MG/ML, 6
clindamycin inj 300/2ML, 6
clindamycin inj 300MG, 6
clindamycin inj 9000/60, 6
clindamycin inj 9gm/60ML, 6
clindamycin lot 1%, 16
clindamycin lot 10MG/ML, 16
clindamycin pad 1%, 16
clindamycin sol 1%, 16
clindamycin sol 75MG/5ML, 6
Clindesse CRE 2%, 34
clobetasol aer 0.05%, 20
clobetasol CRE 0.05%, 20
clobetasol e CRE 0.05%, 20
clobetasol gel 0.05%, 19
clobetasol lot 0.05%, 20
clobetasol oin 0.05%, 20
clobetasol sha 0.05%, 20
clobetasol sol 0.05%, 19
clobetasol spr 0.05%, 20
Clobex Lot 0.05%, 20
Clobex Sha 0.05%, 20
Clobex Spr 0.05%, 20
clocortolone CRE piv 0.1%, 20
Clodan Kit 0.05%, 20
clodan sha 0.05%, 20
Cloderm CRE 0.1%, 20
Cloderm CRE 0.1% Pmp, 20
clomipramine CAP 25MG, 38
clonazep odt TAB 0.125MG, 43
clonazep odt TAB 1MG, 43
clonazep odt TAB 2MG, 43
clonazepam TAB 0.5MG, 43
clonazepam TAB 1MG, 43
clonazepam TAB 2MG, 43
clonidine dis 0.1/24HR, 12
clonidine TAB 0.1MG, 12
clonidine TAB 0.1MG ER, 42
clopidogrel TAB 300MG, 37
clopidogrel TAB 75MG, 37
cloraz dipot TAB 15MG, 37
cloraz dipot TAB 3.75MG, 37
cloraz dipot TAB 7.5MG, 37
Clorpres TAB 0.1-15MG, 13
clotrim/beta CRE 1-0.05%, 18
clotrim/beta CRE diprop, 18
clotrim/beta lot diprop, 18
clotrimazole CRE 1%, 18
clotrimazole loz 10MG, 37
clotrimazole sol 1%, 18
clotrimazole tro 10MG, 37
clozapine TAB 100/odt, 40
clozapine TAB 100MG, 40
clozapine TAB 12.5/odt, 40
clozapine TAB 25MG odt, 40
Clozaril TAB 100MG, 41
Clozaril TAB 25MG, 41
Cnl8 Nail Kit, 18
Coaguchek Mis Lancets, 61
Coartem TAB 20-120MG, 6
cocaine HCL sol 4%, 21
codeine sulf sol 30MG/5ML, 52
codeine sulf TAB 15MG, 51
Cogentin Inj 1MG/ML, 46
Colazal CAP 750MG, 33
colchicine CAP 0.6MG, 56
colchicine TAB 0.6MG, 56
Colcrys TAB 0.6MG, 56
Colestid FLA Gra 5/7.5gm, 15
Colestid FLA Gra 5gm, 15
Colestid Gra 5gm, 15
Colestid Pow 5gm, 15
Colestid TAB 1gm, 15
colestipol gra 5gm, 15
colestipol TAB 1gm, 15
colistimeth inj 150MG, 6
colocort ene 100MG, 33
Coly-mycin M Inj 150MG, 6
Coly-mycin S Sus Otic, 51
Colyte/Flavr Sol Packs, 31
Combigan Sol 0.2/0.5%, 49
Combipatch Dis .05/.14, 24
Combipatch Dis .05/.25, 24
Combivent Aer 20-100, 58
Combivir TAB 150-300, 5
Cometriq Kit 100MG, 8
Comfort Assu Mis Lanc 28G, 61
Comfort Assu Mis Lanc 33G, 61
Comfort EZ Mis 29GX12MM, 61
Comfort Mis Lancets, 61
Comfortouch Mis Lancet, 61
Commit Loz 2MG, 47
Commit Loz 4MG, 47
Commit Loz 4MG Chry, 47
Compact Spac Mis Chamber, 65
Compact Spac Mis LG Mask, 65
Compact Spac Mis MD Mask, 65
Compact Spac Mis Sm Mask, 65
Complera TAB, 5
compro sup 25MG, 40
Comtan TAB 200MG, 46
Comvax Inj, 59
Concerta TAB 18MG, 43
Condylox Gel 0.5%, 21
Condylox Sol 0.5%, 21
constulose sol 10gm/15, 31
Contour Liq High Cnt, 61
Contour Liq Low Cntl, 61
Contour Liq Norm Cnt, 61
Contour Sol Next, 61
Contour Tes Next, 61
Control High Sol Unistrip, 61
Control Low Sol Unistrip, 61
Control Norm Sol Easy Stp, 61
Control Sol Liq HI/Mid/L, 61
Control Sol Liq High/Low, 61
Control Sol Liq Mid, 61
control sol normal, 60
Conzip CAP 100MG, 53
Cool Control Sol A, 61
Cool Control Sol B, 61
Copaxone Inj 20MG/ML, 48
Copaxone Inj 40MG/ML, 48
Copegus TAB 200MG, 5
Cordarone TAB 200MG, 11
Cordran 24X3 Tap 4mcg/CM, 20
Cordran 80X3 Tap 4mcg/CM, 20
Cordran CRE 0.05%, 20
Cordran Lot 0.05%, 20
Cordran Oin 0.05%, 20
Coreg CR CAP 10MG, 10
Coreg TAB 12.5MG, 10
Coreg TAB 25MG, 10
Corgard TAB 20MG, 10
Corlanor TAB 5MG, 16
Corlanor TAB 7.5MG, 16
cormax scalp sol 0.05%, 19
Cortane-b Dro AQ Otic, 51
Cortane-b Dro Otic, 51
Cortane-b Lot, 20
Cortef TAB 10MG, 23
Cortef TAB 20MG, 23
Cortef TAB 5MG, 23
Cortenema Ene 100MG, 33
cortic-nd dro, 51
Cortifoam Aer 90MG, 33
cortisone ac TAB 25MG, 22
Cortisporin CRE 0.5%, 18
Cortisporin Oin 1%, 18
Cortisporin Sus -tc Otic, 51
corvita 150 TAB, 35
Corvite 150 TAB, 35
Corvite FE TAB, 35
Corzide TAB 40-5MG, 13
Corzide TAB 80-5MG, 13
Cosentyx Inj 150MG/ML, 19
Cosentyx Pen Inj 150MG/ML, 19
Cosopt PF Sol, 49
Cosopt Sol 22.3-6.8, 49
Cotellic TAB 20MG, 8
Coumadin TAB 10MG, 36
Coumadin TAB 2.5MG, 36
Coumadin TAB 7.5MG, 36
covaryx HS TAB, 24
covaryx TAB 1.25-2.5, 24
Cozaar TAB 100MG, 12
Cozaar TAB 25MG, 12
Cozaar TAB 50MG, 12
Cpb Wc Liq, 57
Creon CAP 12000unt, 32
Creon CAP 3000unit, 32
Creon CAP 6000unit, 32
Cresemba CAP 186 MG, 4
Crestor TAB 10MG, 15
Crestor TAB 5MG, 15
Crinone Gel 4% Vag, 34
Crinone Gel 8% Vag, 34
Crixivan CAP 200MG, 4
Crixivan CAP 400MG, 4
cromolyn sod CON 100/5ML, 33
cromolyn sod neb 20MG/2ML, 58
cromolyn sod sol 4% op, 50
cryselle-28 TAB 28 TABS, 25
curity salin sol 0.9% irr, 35
Curosurf Sus 80MG/ML, 59
Cutivate CRE 0.05%, 20
Cutivate Lot 0.05%, 20
Cuvposa Sol 1MG/5ML, 32
CVS Lancets Mis 21G, 61
CVS Lancets Mis Original, 61
CVS Lancets Mis Thin 26G, 61
CVS Lancing Mis Device, 61
CVS nicotine dis 14MG/24h, 46
CVS nicotine dis 7MG/24HR, 46
CVS nicotine gum 2MG cinn, 47
CVS nicotine gum 2MG mint, 47
CVS nicotine gum 2MG orig, 47
CVS nicotine gum 2mgfruit, 47
CVS nicotine gum 4MG cinn, 47
CVS nicotine gum 4MG mint, 47
CVS nicotine gum 4MG orig, 47
CVS nicotine gum 4mgfruit, 47
CVS nicotine loz 2MG, 47
CVS nicotine loz 2MG mint, 47
CVS nicotine loz 4MG mint, 47
CVS nts dis step 1, 46
CVS senna plus tablet, 31
cyanocobalam inj 1000mcg, 35
cyclafem TAB 1/35, 25
cyclafem TAB 7/7/7, 25
Cyclessa PAK, 26
Cyclo/Gaba PAK 10/300, 48
Cyclobenzapr PAK Pax, 48
cyclobenzapr TAB 10MG, 48
cyclobenzapr TAB 5MG, 48
cyclobenzapr TAB 7.5MG, 48
Cyclogyl Sol 0.5% Op, 50
Cyclogyl Sol 1% Op, 50
Cyclogyl Sol 2% Op, 50
Cyclomydril Sol Op, 50
cyclopentol sol 1% op, 50
cyclopentol sol 2% op, 50
cyclopentola sol 0.5%, 50
cyclophosph CAP 25MG, 6
cyclophosph CAP 50MG, 6
cycloserine CAP 250MG, 3
cyclosporine CAP 100MG, 7
cyclosporine CAP 100MG MD, 7
cyclosporine CAP 25MG, 7
cyclosporine CAP 25MG mod, 7
cyclosporine CAP 50MG mod, 7
cyclosporine sol modified, 7
Cymbalta CAP 20MG, 39
cyotic dro, 51
cyproheptad syp 2MG/5ML, 56
cyproheptad TAB 4MG, 56
cyred TAB, 25
Cystadane Pow, 29
Cystagon CAP 150MG, 35
Cystagon CAP 50MG, 35
Cystaran Sol 0.44%, 50
Cytomel TAB 25mcg, 30
Cytotec TAB 100mcg, 32
Cytotec TAB 200mcg, 32
cytra k gra crystals, 35
cytra-2 sol, 35
cytra-3 syp, 35
cytra-k sol, 35
D
D.h.e. 45 Inj 1MG/ML, 55
Daklinza TAB 30MG, 5
Daliresp TAB 500mcg, 58
danazol CAP 100MG, 23
Dantrium CAP 25MG, 48
Dantrium CAP 50MG, 48
dantrolene CAP 100MG, 48
dapsone TAB 100MG, 6
dapsone TAB 25MG, 6
Daptacel Inj, 59
Daraprim TAB 25MG, 5
darifenacin TAB 15MG, 34
darifenacin TAB 7.5MG, 34
dasetta TAB 1/35, 25
dasetta TAB 7/7/7, 25
Daypro TAB 600MG, 55
daysee TAB, 25
Daytrana Dis 10MG/9HR, 43
Ddavp Inj 4mcg/ML, 29
Ddavp Sol 0.01%, 29
Ddavp Spr 0.01%, 29
Ddavp TAB 0.1MG, 29
Ddavp TAB 0.2MG, 29
Debacterol Sol 30-50%, 37
deblitane TAB 0.35MG, 25
Decon-G Dro 2-1-40MG, 57
Delestrogen Inj 10MG/ML, 24
deltasone TAB 20MG, 22
delyla TAB 0.1-0.02, 25
Delzicol CAP 400MG, 33
Demadex TAB 100MG, 14
Demadex TAB 5MG, 14
demeclocycl TAB 150MG, 2
demeclocycl TAB 300MG, 2
Demerol Inj 100/2ML, 53
Demerol Inj 100MG/ML, 53
Demerol Inj 25MG/0.5, 53
Demerol Inj 75MG/1.5, 53
Demerol TAB 100MG, 53
Demerol TAB 50MG, 53
Demser CAP 250MG, 13
Denavir CRE 1%, 18
Depakene CAP 250MG, 44
Depakene Syp 250/5ML, 44
Depakote ER TAB 250MG, 44
Depakote ER TAB 500MG, 44
Depakote Spr CAP 125MG, 44
Depakote TAB 125MG DR, 44
Depo-estradi Inj 5MG/ML, 24
Depo-medrol Inj 20MG/ML, 23
Depo-provera Inj 150MG/ML, 26
Depo-provera Inj 400/ML, 7
Depo-sq Prov Inj 104, 26
Depo-testost Inj 100MG/ML, 24
Depo-testost Inj 200MG/ML, 23
Derma-smooth Oil /FS Body, 20
Derma-smooth Oil /FS Sclp, 20
Dermacinrx Kit Analgesi, 55
Dermacinrx Kit Combopak, 21
Dermacinrx Kit Pharmapa, 22
dermacinrx kit prizopak, 21
Dermacinrx PAK, 22
Dermacinrx PAK Duopatch, 22
Dermacinrx PAK Lexitral, 18
Dermacinrx PAK Phn, 22
Dermacinrx PAK Therazol, 18
Dermacinrx PAK Zrm, 22
Dermapak PAK Plus, 17
Dermasorb AF Kit 3-0.5%, 18
Dermasorb HC Kit 2%, 20
Dermasorb Ta Kit 0.1%, 20
Dermasorb XM Kit 39%, 22
Dermatop CRE 0.1%, 20
Dermatop Oin 0.1%, 20
dermazene CRE 1%, 18
Dermazone Mis, 20
Dermazyl PAK 5%, 22
Dermotic Oil 0.01%, 51
Descovy TAB 200/25, 5
desipramine TAB 100MG, 38
desloratadin TAB 2.5 odt, 56
desloratadin TAB 5MG, 56
desloratadin TAB 5MG odt, 57
desmopressin inj 4mcg/ML, 29
desmopressin sol 0.01%, 29
desmopressin spr 0.01%, 29
desmopressin TAB 0.1MG, 29
desmopressin TAB 0.2MG, 29
deso/ethinyl TAB estradio, 25
Desogen-28 TAB, 26
Desonate Gel 0.05%, 20
desonide CRE 0.05%, 19
desonide lot 0.05%, 19
desonide oin 0.05%, 19
Desowen CRE 0.05%, 19
Desowen Lot 0.05%, 19
desoximetas CRE 0.05%, 19
desoximetas CRE 0.25%, 19
desoximetas gel 0.05%, 19
desoximetas oin 0.05%, 19
desoximetas oin 0.25%, 19
Desoxyn TAB 5MG, 43
desvenlafax TAB 100MG ER, 39
desvenlafax TAB 50MG ER, 39
Detrol LA CAP 2MG, 34
Detrol LA CAP 4MG, 34
Detrol TAB 1MG, 34
Detrol TAB 2MG, 34
Dex Combo Inj 8-4MG/ML, 23
Dex LA 16 Inj 16MG/ML, 23
Dex LA 8 Inj 8MG/ML, 23
dexameth PHO inj 10MG/ML, 22
dexameth PHO inj 120MG/30, 22
dexameth PHO inj 20MG/5ML, 22
dexameth PHO inj 4MG/ML, 22
dexameth PHO sol 0.1% op, 49
Dexamethason CON 1MG/ML, 23
dexamethason elx 0.5/5ML, 22
dexamethason sol 0.5/5ML, 22
dexamethason TAB 0.5MG, 22
dexamethason TAB 1MG, 22
dexchlorphen syp 2MG/5ML, 57
Dexedrine CAP 10MG CR, 43
dexedrine TAB 10MG, 42
dexedrine TAB 5MG, 42
Dexilant CAP 30MG DR, 32
Dexilant CAP 60MG DR, 32
Dexlido Kit, 23
Dexlido-m Kit, 23
dexmethylph CAP 15MG ER, 42
dexmethylph TAB 10MG, 42
dexmethylph TAB 2.5MG, 42
dexmethylph TAB 5MG, 42
dexmethylphe CAP 10MG ER, 42
Dexpak PAK 10 Day, 23
dexpanthenol inj 250MG/ML, 33
dextroamphet CAP 10MG ER, 42
dextroamphet sol 5MG/5ML, 42
dextroamphet TAB 10MG, 42
dextroamphet TAB 5MG, 42
Diabeta TAB 1.25MG, 27
Diabeta TAB 2.5MG, 27
Diabeta TAB 5MG, 27
Diamox Seque CAP 500MG CR, 14
Diascreen 10 Mis, 65
Diascreen 3 Mis, 65
Diascreen 5 Mis, 65
Diascreen 6 Mis, 65
Diascreen 7 Mis, 65
Diascreen 8 Mis, 65
Diascreen 9 Mis, 65
Diascreen Mis 1b, 65
Diascreen Mis 1G, 65
Diascreen Mis 1k, 65
Diascreen Mis 2GK, 65
Diascreen Mis 2GP, 65
Diascreen Mis 4nl, 65
Diascreen Mis 4obl, 65
Diascreen Mis 4PH, 65
Diascreen Mis Control, 65
Diastar Easy Mis Lancets, 61
Diastar Mis Lancets, 61
Diastat Acdl Gel 12.5-20, 44
Diastat Acdl Gel 5-10MG, 44
Diastat PED Gel 2.5m Gel, 44
Diatrue Cont Sol Level 1, 61
diazepam CON 5MG/ML, 38
diazepam gel 10MG, 44
diazepam gel 2.5MG, 44
diazepam gel 20MG, 44
diazepam inj 10MG/2ML, 37
diazepam inj 5MG/ML, 37
diazepam sol 1MG/ML, 37
diazepam TAB 10MG, 37
Dibenzyline CAP 10MG, 13
Diclegis TAB 10-10MG, 32
diclo/misopr TAB 50-0.2MG, 54
diclo/misopr TAB 75-0.2MG, 54
diclofen pot TAB 50MG, 54
diclofenac CRE sodium, 18
diclofenac gel 1%, 18
diclofenac sol 0.1% op, 50
diclofenac sol 1.5%, 18
diclofenac TAB 100MG ER, 54
diclofenac TAB 25MG DR, 54
diclofex dc mis, 18
diclotral PAK, 18
dicloxacill CAP 250MG, 1
dicloxacill CAP 500MG, 1
dicyclomine CAP 10MG, 31
dicyclomine inj 10MG/ML, 31
dicyclomine sol 10MG/5ML, 31
dicyclomine TAB 20MG, 31
didanosine CAP 125MG, 4
Differin CRE 0.1%, 17
Differin Gel 0.1%, 17
Differin Gel 0.3%, 17
Differin Lot 0.1%, 17
Dificid TAB 200MG, 2
difil-G fort liq 100-100, 58
diflorasone CRE 0.05%, 20
diflorasone oin 0.05%, 20
Diflucan Sus 10MG/ML, 4
Diflucan Sus 40MG/ML, 4
Diflucan TAB 100MG, 4
diflunisal TAB 500MG, 51
digitek TAB 0.125MG, 9
digitek TAB 0.25MG, 9
digox TAB 0.125MG, 9
digox TAB 0.25MG, 9
digoxin inj 0.25MG/1, 9
digoxin sol 50mcg/ML, 9
digoxin TAB 0.125MG, 9
digoxin TAB 0.25MG, 9
dihydrocod/ CAP asa/caff, 52
dihydroergot inj 1MG/ML, 55
dihydroergot spr 4MG/ML, 56
Dilantin CAP 100MG, 44
Dilantin CAP 30MG, 44
Dilantin Chw 50MG, 44
Dilantin-125 Sus 125/5ML, 44
Dilatrate SR CAP 40MG, 9
Dilaudid Inj 1MG/ML, 53
Dilaudid Liq 1MG/ML, 52
Dilaudid TAB 2MG, 53
Dilaudid-HP Inj 10MG/ML, 53
Dilaudid-HP Inj 250MG, 52
dilt-XR CAP 120MG, 10
diltiazem CAP 120MG CD, 10
diltiazem CAP 120MG ER, 10
diltiazem CAP 120MG/24, 10
diltiazem ER TAB 180MG, 10
diltiazem TAB 120MG, 10
dimenhydrin inj 50MG/ML, 32
Diovan HCT TAB 160-12.5, 13
Diovan HCT TAB 160-25MG, 13
Diovan HCT TAB 320-12.5, 13
Diovan HCT TAB 320-25MG, 13
Diovan HCT TAB 80/12.5, 13
Diovan TAB 160MG, 12
Diovan TAB 320MG, 12
Diovan TAB 40MG, 12
Diovan TAB 80MG, 12
dip/tet PED inj 25-5lfu, 59
Dipentum CAP 250MG, 33
diphen/atrop liq 2.5/5, 31
diphen/atrop TAB 2.5MG, 31
diphenhydram elx 12.5/5ML, 57
diphenhydram inj 50MG/ML, 57
Diprolene AF CRE 0.05%, 20
Diprolene Lot 0.05%, 20
Diprolene Oin 0.05%, 20
dipyridamole TAB 25MG, 37
Disalcid TAB 500MG, 51
Disalcid TAB 750MG, 51
disopyramide CAP 100MG, 11
disopyramide CAP 150MG, 11
disulfiram TAB 250MG, 46
disulfiram TAB 500MG, 46
Ditropan XL TAB 10MG, 34
Diuril Sus 250/5ML, 14
divalproex CAP 125MG, 43
divalproex TAB 125MG DR, 43
divalproex TAB 250MG ER, 43
divalproex TAB 500MG ER, 43
Divigel Gel 0.25MG, 24
Divigel Gel 0.5MG, 24
Divigel Gel 1MG/Gm, 24
DM/CPM/PE dro, 57
dofetilide CAP 125mcg, 11
Dolophine TAB 10MG, 53
Dolophine TAB 5MG, 53
donepezil TAB 10MG, 46
donepezil TAB 10MG odt, 47
donepezil TAB 5MG, 46
donepezil TAB 5MG odt, 47
donepezil TAB HCL 23MG, 47
Donnatal Elx, 32
Donnatal Elx Grape, 32
Donnatal Elx Mint, 32
Donnatal TAB, 32
Donnatal TAB 16.2MG, 32
Donnatal TAB Extentab, 32
Doral TAB 15MG, 42
Doryx Mpc TAB 120MG, 3
Doryx TAB 200MG, 3
Doryx TAB 50MG, 3
dorzol/timol sol 22.3-6.8, 49
dorzolamide sol 2% op, 50
Doubledex Kit, 23
Dovonex CRE 0.005%, 19
doxazosin TAB 1MG, 12
doxepin HCL CAP 100MG, 38
doxepin HCL CON 10MG/ML, 38
doxepin HCL CRE 5%, 19
doxercalcif CAP 0.5mcg, 29
doxercalcif CAP 1mcg, 29
doxercalcif CAP 2.5mcg, 29
doxycyc CAP 100MG, 2
doxycyc CAP 50MG, 2
doxycyc mono CAP 100MG, 2
doxycyc mono CAP 50MG, 2
doxycyc mono TAB 100MG, 2
doxycycl HYC CAP 100MG, 2
doxycycl HYC CAP 50MG, 2
doxycycl HYC TAB 100MG, 2
doxycycl HYC TAB 100MG DR, 2
doxycycline CAP 150MG, 2
doxycycline sus 25MG/5ML, 2
Drisdol CAP 50000unt, 59
dritho-creme CRE HP 1%, 19
dronabinol CAP 10MG, 32
dronabinol CAP 2.5MG, 32
dronabinol CAP 5MG, 32
droperidol inj 2.5MG/ML, 38
Droplet Lanc Mis 30G, 61
Droplet Lanc Mis Device, 61
drospir/ethi TAB 3-0.03MG, 25
drospirenone TAB ethy est, 25
Droxia CAP 200MG, 35
Drysol Sol 20%, 21
Dsg PAK Pak, 18
Duac Gel 1.2-5%, 17
Duavee TAB 0.45-20, 24
Duetact TAB 30-2MG, 28
Duetact TAB 30-4MG, 28
Duexis TAB 800-26.6, 55
Dulera Aer 100-5mcg, 58
Dulera Aer 200-5mcg, 58
duloxetine CAP 20MG, 38
Duo-care Liq Level1/2, 61
Duopa Sus 4.63-20, 46
Duragesic Dis 100mcg/H, 53
Duragesic Dis 12mcg/HR, 53
duramorph inj 0.5MG/ML, 52
duramorph inj 1MG/ML, 52
duraxin CAP, 51
Durezol Emu 0.05%, 49
Durlaza CAP 162.5MG, 37
dutast/tamsu CAP 0.5-0.4, 35
dutasteride CAP 0.5MG, 35
Dutoprol TAB 100-12.5, 13
Dyanavel XR Sus 2.5MG/ML, 43
Dyazide CAP 37.5-25, 14
Dymista Spr 137-50, 57
Dyrenium CAP 100MG, 14
Dyrenium CAP 50MG, 14
Dyural-40 Kit, 23
Dyural-80 Kit, 23
Dyural-l Kit, 23
Dyural-lm Kit, 23
E
E-z Ject Mis 21G, 61
E-z Ject Mis 21G Colr, 61
E-z Ject Mis 30G, 61
E-z Ject Mis 32G Colr, 61
E-z Ject Mis Lanc 21G, 61
E-z Ject Mis Lancets, 61
E-z Ject Mis Thin 26G, 61
E-z Spacer Mis, 65
E-ZJECT Lanc Mis 33G, 61
e.e.s. 400 TAB 400MG, 2
E.e.s. Gran Sus 200/5ML, 2
Easivent Mis, 65
Easy Comfort Mis 30G, 61
Easy Comfort Mis 31GX1/4", 61
Easy Comfort Mis 31GX3/16, 61
Easy Comfort Mis Lanc/30G, 61
Easy Mini Mis, 61
Easy Plus II Sol High, 61
Easy Plus II Sol Low, 61
Easy Talk Sol High, 61
Easy Talk Sol Low, 61
Easy Talk Sol Normal, 61
Easy Touch Mis, 61
Easy Touch Mis 29GX1/2", 61
Easy Touch Mis 31GX3/16, 61
Easy Touch Mis 32GX5MM, 61
Easy Touch Mis 32GX6MM, 61
Easy Touch Mis Lanc/21G, 61
Easy Touch Sol Control, 61
Easy Touch Sol High/Low, 61
Easy Trak Sol High, 61
Easy Trak Sol Low, 61
Easy Trak Sol Normal, 61
Easygluco Sol High, 61
Easygluco Sol Low, 61
Easygluco Sol Normal, 61
Easygluco Sol Plus, 61
Easymax 15 Sol Level 1, 61
Easymax 15 Sol Level 2, 61
Easymax Sol High, 61
Easymax Sol Low, 61
Easymax Sol Normal, 61
Easystep Hgh Sol Control, 61
Easystep Low Sol Control, 61
Easytest II Mis Lancets, 61
Easytest Mis Lancets, 61
EC-naprosyn TAB 375MG, 55
EC-naprosyn TAB 500MG, 55
econazole CRE 1%, 18
econtra EZ TAB 1.5MG, 25
Ecoza Aer 1%, 18
ed-flex CAP, 51
ed-spaz TAB 0.125MG, 31
Edarbi TAB 40MG, 12
Edarbi TAB 80MG, 12
Edarbyclor TAB 40-12.5, 13
Edarbyclor TAB 40-25MG, 13
Edecrin TAB 25MG, 14
Edluar Sub 10MG, 42
Edluar Sub 5MG, 42
Edurant TAB 25MG, 4
eemt HS TAB, 24
eemt TAB 1.25-2.5, 24
Effexor XR CAP 150MG, 39
Effexor XR CAP 37.5MG, 39
Effexor XR CAP 75MG, 39
Effient TAB 10MG, 37
Effient TAB 5MG, 37
Egrifta Sol 1MG, 29
Egrifta Sol 2MG, 29
Elavil TAB 25MG, 39
Eldepryl CAP 5MG, 46
Element Cont Liq Normal, 61
Element Liq High, 61
Element Liq Low, 61
Elemnt Compa Sol Level 2, 61
Elemnt Compa Sol Level 3, 61
elenzapatch dis 4-1%, 21
Elestat Dro 0.05%, 50
Elestrin Gel 0.06%, 24
Eletone CRE, 22
Eletone CRE Twinpack, 22
Elidel CRE 1%, 20
Eligard Inj 22.5MG, 7
Eligard Inj 30MG, 7
Eligard Inj 45MG, 7
Eligard Inj 7.5MG, 7
Elimite CRE 5%, 22
elinest TAB, 25
Eliphos TAB 667MG, 33
Eliquis TAB 2.5MG, 36
Eliquis TAB 5MG, 36
Elixophyllin Elx 80/15ML, 58
Ella TAB 30MG, 25
Elmiron CAP 100MG, 35
Elocon CRE 0.1%, 20
Elocon Lot 0.1%, 20
Elocon Oin 0.1%, 20
Emadine Sol 0.05% Op, 50
Embeda CAP 100-4MG, 53
Embeda CAP 20-0.8MG, 53
Embeda CAP 50-2MG, 53
Embrace Cntr Liq High, 61
Embrace Evo Liq Level 1, 61
Embrace Evo Liq Level 2, 61
Embrace Lanc Mis Thin 30G, 61
Embrace Pro Liq Glucose, 61
Embrace Sol Low, 61
Emcyt CAP 140MG, 7
Emend CAP 125MG, 32
Emend CAP 40MG, 32
Emend CAP 80MG, 32
Emend PAK 80 & 125, 32
Emend Sus 125MG, 32
Emla CRE 2.5-2.5%, 22
emoquette TAB, 25
Emsam Dis 12MG/24h, 39
Emsam Dis 6MG/24HR, 39
Emsam Dis 9MG/24HR, 39
Emtriva CAP 200MG, 4
Emtriva Sol 10MG/ML, 4
Emulsion SB Emu, 22
Emverm Chw 100MG, 6
Enablex TAB 15MG, 34
Enablex TAB 7.5MG, 34
enalapr/hctz TAB 10-25MG, 13
enalapr/hctz TAB 5-12.5MG, 13
enalapril TAB 10MG, 11
enalapril TAB 2.5MG, 11
Enbrel Inj 25/0.5ML, 55
Enbrel Inj 25MG, 55
Enbrel Inj 50MG/ML, 55
Enbrel Srclk Inj 50MG/ML, 55
endocet TAB 10-325MG, 51
endocet TAB 2.5-325, 51
endocet TAB 5-325MG, 51
endocet TAB 7.5-325, 51
endodan TAB, 51
Endometrin Sup 100MG, 34
Engerix-b Inj 10/0.5ML, 59
Engerix-b Inj 20mcg/ML, 59
Enjuvia TAB 0.3MG, 24
Enlon Inj 150/15ML, 49
enoxaparin inj 100MG/ML, 36
enoxaparin inj 120/0.8, 36
enoxaparin inj 150MG/ML, 36
enoxaparin inj 30/0.3ML, 36
enoxaparin inj 300/3ML, 36
enpresse-28 TAB, 25
enskyce TAB, 25
Enstilar Aer, 20
entacapone TAB 200MG, 45
entecavir TAB 0.5MG, 4
entecavir TAB 1MG, 4
Entereg CAP 12MG, 33
Entocort EC CAP 3MG DR, 23
Entresto TAB 24-26MG, 16
Entty Emu Spray, 22
enulose sol 10gm/15, 33
Envarsus XR TAB 0.75MG, 7
Envarsus XR TAB 1MG, 7
Envarsus XR TAB 4MG, 7
Epaned Sol 1MG/ML, 12
Epclusa TAB 400-100, 5
ephedrine SU inj 50MG/ML, 15
Epiceram Emu, 22
Epiduo Forte Gel 0.3-2.5%, 17
Epiduo Gel 0.1-2.5%, 17
Epifoam Aer 1%, 20
epinastine dro 0.05%, 50
epinephrine inj 0.15MG, 15
epinephrine inj 0.1MG/ML, 58
epinephrine inj 0.3MG, 15
epinephrine inj 1MG/ML, 58
Epipen 2-PAK Inj 0.3MG, 15
Epipen-JR Inj 2-PAK, 15
Episnap Kit, 15
epitol TAB 200MG, 43
Epivir HBV Sol 5MG/ML, 4
Epivir HBV TAB 100MG, 5
Epivir Sol 10MG/ML, 5
Epivir TAB 150MG, 5
Epivir TAB 300MG, 5
eplerenone TAB 25MG, 12
eplerenone TAB 50MG, 12
Epogen Inj 10000/ML, 36
eprosart mes TAB 600MG, 12
Epzicom TAB 600-300, 5
eq nicotine dis 14MG/24h, 46
eq nicotine dis 21MG/24h, 46
eq nicotine dis 7MG/24HR, 46
eq nicotine gum 2MG cinn, 46
eq nicotine gum 2MG mint, 46
eq nicotine gum 2MG orig, 46
eq nicotine gum 2mgfruit, 46
eq nicotine gum 4MG cinn, 46
eq nicotine gum 4MG mint, 46
eq nicotine gum 4MG orig, 46
eq nicotine gum 4MG ref, 46
eq nicotine gum 4MG strt, 46
eq nicotine gum 4mgfruit, 46
eq nicotine loz 2MG cher, 46
eq nicotine loz 2MG mint, 46
eq nicotine loz 4MG chry, 46
eq nicotine loz 4MG mint, 46
Eql Lancets Mis 21G Colr, 62
Eql Lancets Mis 33G Colr, 62
Eql Lancets Mis Thin 26G, 61
Eql Lancets Mis Thin 30G, 61
eql nicotine dis 14MG/24h, 46
eql nicotine dis 21MG/24h, 46
eql nicotine dis 7MG/24HR, 46
eql nicotine gum 2MG, 46
eql nicotine gum 2MG ref, 46
eql nicotine gum 2MG strt, 46
eql nicotine gum 4MG, 46
eql nicotine gum 4MG ref, 46
eql nicotine gum 4MG strt, 47
eql nicotine loz 2MG mint, 47
eql nicotine loz 4MG mint, 47
Equetro CAP 100MG, 41
ergocalcifer CAP 50000unt, 59
ergoloid mes TAB 1MG oral, 47
Ergomar Sub 2MG, 55
errin TAB 0.35MG, 25
Ertaczo CRE 2%, 18
ery pad 2%, 17
Ery-TAB Tab 250MG EC, 2
Erygel Gel 2%, 17
Eryped Sus 200/5ML, 2
Eryped Sus 400/5ML, 2
Erythrocin TAB 250MG, 2
erythrom ETH TAB 400MG, 2
erythromycin CAP 250MG EC, 2
erythromycin gel /benzoyl, 16
erythromycin gel 2%, 16
erythromycin oin 5MG/gm, 49
erythromycin oin op, 49
erythromycin pad 2%, 17
erythromycin sol 2%, 16
erythromycin TAB 250MG bs, 2
erythromycin TAB 500MG bs, 2
Esbriet CAP 267MG, 59
escitalopram sol 5MG/5ML, 38
escitalopram TAB 10MG, 38
esgic CAP, 51
Esgic TAB, 51
esomeprazole CAP 49.3MG, 31
est estrogen TAB mtest, 24
est estrogen TAB mtest HS, 24
estarylla TAB 0.25-35, 25
estazolam TAB 1MG, 42
estazolam TAB 2MG, 42
estra/noreth TAB 0.5-0.1, 24
estra/noreth TAB 1-0.5MG, 24
Estrace TAB 0.5MG, 24
Estrace TAB 1MG, 24
Estrace TAB 2MG, 24
Estrace Vag CRE 0.1MG/Gm, 34
estrad val inj 200MG/5, 24
estrad val inj 20MG/ML, 24
estrad val inj 40MG/ML, 24
estradiol dis 0.025MG, 24
estradiol TAB 0.5MG, 24
estradiol TAB 1MG, 24
estradiol TAB 2MG, 24
Estring Mis 2MG, 34
estrog/mtest TAB 1.25-2.5, 24
Estrogel Gel, 24
estropipate TAB 0.75MG, 24
estropipate TAB 1.5MG, 24
estropipate TAB 3MG, 24
Estrostep FE TAB, 26
eszopiclone TAB 1MG, 41
ethacrynic TAB acd 25MG, 14
ethambutol TAB 100MG, 3
ethambutol TAB 400MG, 3
ethosuximide CAP 250MG, 43
ethosuximide sol 250/5ML, 43
ethyl chlor aer fine pin, 21
ethyl chlor aer fn strm, 21
ethyl chlor aer MED jet, 21
ethyl chlor aer MED strm, 21
ethyl chlor aer mist, 21
ethyl chlor aer spray, 21
etidron disd TAB 200MG, 28
etidron disd TAB 400MG, 28
etodolac CAP 200MG, 54
etodolac CAP 300MG, 54
etodolac ER TAB 400MG, 54
etodolac TAB 400MG, 54
etodolac TAB 500MG, 54
etoposide CAP 50MG, 8
Eurax CRE 10%, 21
Eurax Lot 10%, 21
Evamist Spr 1.53MG, 24
Evekeo TAB 10MG, 43
Evekeo TAB 5MG, 43
Evencar Mini Sol Normal, 62
Evencare G2 Sol Low/High, 62
Evencare G3 Sol Low/High, 62
Evencare Sol Liq Low/High, 62
Evicel Kit 2ML, 37
Evicel Kit 5ML, 37
Evista TAB 60MG, 28
Evithrom Sol 800-1200, 37
Evoclin Aer 1%, 17
Evolution Sol Normal, 62
Evotaz TAB 300-150, 5
Evoxac CAP 30MG, 37
Exalgo TAB 12MG, 53
Exalgo TAB 16MG, 53
Exalgo TAB 32MG, 53
Exalgo TAB 8MG, 53
Exelderm CRE 1%, 18
Exelderm Sol 1%, 18
Exelon CAP 1.5MG, 48
Exelon CAP 3MG, 48
Exelon CAP 4.5MG, 48
Exelon CAP 6MG, 48
Exelon Dis 13.3/24, 48
Exelon Dis 4.6MG/24, 48
Exelon Dis 9.5MG/24, 48
exemestane TAB 25MG, 7
Exforge TAB 10-160MG, 13
Exforgeh/10- TAB 160-12.5, 13
Exforgeh/10- TAB 160-25, 13
Exforgeh/5- TAB 160-12.5, 13
Exjade TAB 125MG, 66
exoderm lot 25-1%, 18
exotic-HC dro otic, 51
Exparel Inj 1.3%, 56
Extavia Inj 0.3MG, 48
Extina Aer 2%, 18
EZ Flu Shot Inj 2014-15, 59
EZ Flu Shot Inj 2015-16, 59
EZ Flu Shot Inj PF 14-15, 59
EZ Flu Shot Kit 2015-16, 59
EZ Flu Shot Kit 2016-17, 59
EZ Smart Mis Lancets, 62
EZ-lets 21G Mis Lancets, 62
F
Fabior Aer 0.1%, 17
Factive TAB 320MG, 3
Falessa Kit, 26
fallback TAB 1.5MG, 25
falmina TAB, 25
famciclovir TAB 125MG, 5
famotidine sus 40MG/5ML, 31
famotidine TAB 20MG, 31
famotidine TAB 40MG, 31
Famvir TAB 125MG, 5
Famvir TAB 250MG, 5
Famvir TAB 500MG, 5
Fanapt PAK, 41
Fanapt TAB 10MG, 41
Fanapt TAB 12MG, 41
Fanapt TAB 1MG, 41
Fanapt TAB 2MG, 41
Fanapt TAB 4MG, 41
Fanapt TAB 6MG, 41
Fanapt TAB 8MG, 41
Fareston TAB 60MG, 7
Farxiga TAB 10MG, 27
Farxiga TAB 5MG, 27
Farydak CAP 10MG, 8
Farydak CAP 15MG, 8
Farydak CAP 20MG, 8
Fastclix Mis Lancets, 62
Fazaclo TAB 100 Odt, 41
Fazaclo TAB 12.5 Odt, 41
Fazaclo TAB 25MG Odt, 41
FE 90 Plus TAB, 35
FE succ/ac-c CAP thre/b12, 35
felbamate sus 600/5ML, 44
felbamate TAB 400MG, 44
felbamate TAB 600MG, 44
Felbatol Sus 600/5ML, 44
Felbatol TAB 400MG, 44
Felbatol TAB 600MG, 44
Feldene CAP 10MG, 55
Feldene CAP 20MG, 55
felodipine TAB 10MG ER, 10
felodipine TAB 2.5MG ER, 10
felodipine TAB 5MG ER, 10
Fem PH Gel, 34
Femara TAB 2.5MG, 7
Femcon FE Chw, 26
Femhrt TAB 0.5-2.5, 24
Femring Mis 0.05/24h, 34
Femring Mis 0.1MG/24, 34
fenofibrate CAP 130MG, 15
fenofibrate TAB 120MG, 15
fenofibric CAP 135MG DR, 15
fenofibric CAP 45MG DR, 15
fenofibric TAB 105MG, 15
fenofibric TAB 35MG, 15
Fenoglide TAB 120MG, 15
Fenoglide TAB 40MG, 15
fenoprofen CAP 200MG, 54
fenoprofen CAP 400MG, 54
fenoprofen TAB 600MG, 54
Fenortho CAP 200MG, 55
Fenortho CAP 400MG, 55
fentanyl dis 100mcg/h, 51
fentanyl dis 12mcg/HR, 51
fentanyl dis 37.5mcg, 52
fentanyl ot loz 1200mcg, 54
Fentora TAB 100mcg, 54
Feraheme Inj 510/17ML, 35
ferocon CAP, 35
ferotrinsic CAP, 35
Ferralet 90 TAB, 35
ferraplus 90 TAB, 35
ferrex 150 CAP forte, 35
ferrex 150 CAP forte pl, 35
ferrex 28 TAB, 35
Ferriprox Sol 100MG/ML, 66
Ferriprox TAB 500MG, 66
ferrocite TAB plus, 35
ferrogels fo CAP forte, 35
Fetzima CAP 120MG, 39
Fetzima CAP Titratio, 39
Fexmid TAB 7.5MG, 48
Fibricor TAB 105MG, 15
Fibricor TAB 35MG, 15
Fifty50 Mis 31GX3/16, 62
Fifty50 Mis 31GX5/16, 62
Fifty50 Mis 31GX5MM, 62
Fifty50 Mis Lanc Dev, 62
Fifty50 Pen Mis 31GX8MM, 62
Fifty50 Safe Mis Lancets, 62
Fifty50 Sol 2.0, 62
Finacea Aer 15%, 18
Finacea Gel 15%, 18
finasteride TAB 5MG, 35
Fine 30 Mis, 62
Fingerstix Mis Lancets, 62
Fioricet CAP, 51
Fioricet CAP Codeine, 53
Fiorinal CAP, 51
Fiorinal/Cod CAP 30MG, 53
Firazyr Inj 30MG/3ML, 37
First-baclof Sus 1, 49
First-baclof Sus 5 Kit, 49
First-marys Sus Mouthwsh, 37
First-mouthw Sus Blm, 37
First-omepra Sus 2MG/ML, 32
First-testos CRE Mc 2%, 24
Flagyl CAP 375MG, 6
Flagyl ER TAB 750MG, 6
Flagyl TAB 250MG, 6
Flagyl TAB 500MG, 6
Flarex Sus 0.1% Op, 50
flavoxate TAB 100MG, 34
flecainide TAB 100MG, 11
Flector Dis 1.3%, 18
Flexepax Mis, 49
Flexichamber Mis, 65
Flexin Pad .0375-5%, 22
Flexizol PAK Combipak, 55
Flomax CAP 0.4MG, 35
flonase spr 0.05%, 57
Flovent Disk Aer 100mcg, 58
Flovent HFA Aer 110mcg, 58
Flowtuss Sol 2.5-200, 57
Floxin Sol 0.3%, 51
Fluad Inj 2016-17, 59
Fluarix PF Inj 2013-14, 59
Fluarix PF Inj 2014-15, 59
Fluarix Quad Inj 2014-15, 59
Flublok Sol 2014-15, 59
Flucelvax Inj 2014-15, 59
Flucelvax Inj 2015-16, 59
Fluclvx Quad Inj 2016-17, 59
fluconazole sus 10MG/ML, 4
fluconazole sus 40MG/ML, 4
fluconazole TAB 100MG, 4
flucytosine CAP 250MG, 4
flucytosine CAP 500MG, 4
fludrocort TAB 0.1MG, 22
Flulaval Inj 2014-15, 59
Flulaval Qua Inj 2014-15, 59
Flumadine TAB 100MG, 5
Flumist Quad Sus 2014-15, 59
flunisolide spr 0.025%, 57
fluocin acet CRE 0.01%, 19
fluocin acet CRE 0.025%, 19
fluocin acet oil 0.01%, 51
fluocin acet oil 0.01% sc, 19
fluocin acet oil 0.01%bdy, 19
fluocin acet oil body, 19
fluocin acet oil ear0.01%, 51
fluocin acet oil scalp, 19
fluocin acet oin 0.025%, 19
fluocin acet sol 0.01%, 19
fluocinonide CRE -e 0.05%, 19
fluocinonide CRE 0.05%, 19
fluocinonide CRE 0.1%, 20
fluocinonide gel 0.05%, 19
fluocinonide oin 0.05%, 19
fluocinonide sol 0.05%, 19
fluoromethol sus 0.1% op, 49
fluoxetine CAP 10MG, 38, 46
fluoxetine CAP 20MG, 38, 46
fluoxetine CAP 40MG, 38
fluoxetine CAP 90MG DR, 39
fluoxetine sol 20MG/5ML, 38
fluoxetine TAB 10MG, 38
fluphenaz DE inj 25MG/ML, 40
fluphenazine CON 5MG/ML, 40
fluphenazine elx 2.5/5ML, 40
fluphenazine inj 2.5MG/ML, 40
fluphenazine TAB 10MG, 40
fluphenazine TAB 2.5MG, 40
flurandrenol CRE 0.05%, 20
flurazepam CAP 15MG, 41
flurazepam CAP 30MG, 41
flurbiprofen sol 0.03% op, 50
flurbiprofen TAB 100MG, 54
flurbiprofen TAB 50MG, 54
flutamide CAP 125MG, 7
fluticasone CRE 0.05%, 20
fluticasone lot 0.05%, 20
fluticasone oin 0.005%, 20
fluticasone spr 50mcg, 57
fluvastatin CAP 20MG, 15
fluvastatin CAP 40MG, 15
fluvastatin TAB 80MG ER, 15
Fluvirin Inj 2014-15, 59
Fluvirin PF Inj 2014-15, 59
Fluvirin PF Inj 2016-17, 59
fluvoxamine CAP 100MG ER, 39
fluvoxamine CAP 150MG ER, 39
fluvoxamine TAB 100MG, 38
Fluzone HD Inj PF 14-15, 59
Fluzone Inj Intradrm, 59
Fluzone Inj PF 14-15, 59
Fluzone Quad Inj 14-15, 59
Fluzone Splt Inj 2014-15, 59
Fluzone Splt Inj 2015-16, 59
FML Forte Sus 0.25% Op, 49
FML Liquiflm Sus 0.1% Op, 50
FML Oin 0.1% Op, 49
Focalin TAB 10MG, 43
Focalin TAB 2.5MG, 43
Focalin TAB 5MG, 43
Focalin XR CAP 10MG, 43
Folgard OS TAB, 60
folic acid inj 5MG/ML, 35
folic acid TAB 1000mcg, 35
folic acid TAB 1MG, 35
Folivane-f CAP, 35
Folivane-pls CAP, 35
Folixapure TAB 1-5000, 35
foltrin CAP, 35
fondaparinux inj 10/0.8ML, 36
fondaparinux inj 2.5/0.5, 36
fondaparinux inj 5/0.4ML, 36
fondaparinux inj 7.5/0.6, 36
Fora Control Sol High, 62
Fora Control Sol Low, 62
Fora Control Sol Normal, 62
Fora Lancets Mis 30G, 62
Fora Mis Lancets, 62
Fora Mis Lancing, 62
Foracare Gdh Sol High, 62
Foracare Gdh Sol Low, 62
Foracare Gdh Sol Normal, 62
Foradil CAP Aerolize, 58
Forfivo XL TAB 450MG, 39
Fortamet TAB 1000MG, 27
Fortamet TAB 500MG, 27
Fortaz Inj 1gm, 2
Fortaz Inj 2gm, 2
Fortaz Inj 500MG, 2
Fortaz Inj 6gm, 2
Forteo Sol 600/2.4, 28
Fortesta Gel 10MG/Act, 24
fortical spr 200/act, 28
Fortiscare Kit System, 62
Fortiscare Sol Cntl HI, 62
Fortiscare Sol Cntl Low, 62
Fortiscare Sol Cntl Nml, 62
Fosamax + D TAB 70-2800, 28
Fosamax + D TAB 70-5600, 28
Fosamax TAB 70MG, 28
fosinop/hctz TAB 10/12.5, 13
fosinop/hctz TAB 20/12.5, 13
fosinopril TAB 10MG, 11
fosphenytoin inj 100/2ML, 43
fosphenytoin inj 500/10ML, 43
Fosrenol Chw 1000MG, 33
Fosrenol Pow 1000MG, 33
Fosrenol Pow 750MG, 33
Fragmin Inj 10000/ML, 36
Fragmin Inj 12500unt, 36
Fragmin Inj 2500/0.2, 36
Fragmin Inj 25000/ML, 36
Freestyle Liq Control, 62
Freestyle Mis Lancets, 62
Freestyle Mis Unistick, 62
Freestyle Tes, 62
Frova TAB 2.5MG, 55
frovatriptan TAB 2.5MG, 55
Fulyzaq TAB 125MG, 31
Furadantin Sus 25MG/5ML, 34
furosemide inj 100/10ML, 14
furosemide inj 10MG/ML, 14
furosemide inj 20MG/2ML, 14
furosemide inj 40MG/4ML, 14
furosemide sol 10MG/ML, 14
furosemide sol 8MG/ML, 14
furosemide TAB 20MG, 14
Fusion PAK Sprinkle, 35
Fuzeon Inj 90MG, 5
fyavolv TAB 0.5-2.5, 24
fyavolv TAB 1-5, 24
Fycompa Sus 0.5MG/ML, 44
Fycompa TAB 10MG, 44
Fycompa TAB 12MG, 44
Fycompa TAB 2MG, 44
Fycompa TAB 4MG, 44
Fycompa TAB 6MG, 44
Fycompa TAB 8MG, 44
G
gabapentin CAP 100MG, 43
gabapentin sol 250/5ML, 43
gabapentin sol 300/6ML, 43
gabapentin TAB 600MG, 43
gabapentin TAB 800MG, 43
Gabitril TAB 12MG, 44
galantamine CAP 16MG ER, 46
galantamine sol 4MG/ML, 46
galantamine TAB 12MG, 46
Garamycin Sol 0.3% Op, 49
Gardasil 9 Inj, 59
Gardasil Inj, 59
gastrinex NF CAP, 31
Gastrocrom CON 100/5ML, 33
gatifloxacin sol 0.5%, 49
Gattex Kit 5MG, 34
gavilyte-c sol, 31
gavilyte-G sol, 31
gavilyte-h kit, 31
gavilyte-n sol flav pk, 31
Ge100 Contrl Sol Normal, 62
Gebauers Spr Aer /Stretch, 22
Gelnique Gel 10%, 34
Gelnique Gel 3%, 34
gemfibrozil TAB 600MG, 15
Generess FE Chw, 26
generlac sol 10gm/15, 33
gengraf CAP 100MG, 7
gengraf CAP 25MG, 7
gengraf CAP 50MG, 7
gengraf sol 100MG/ML, 7
Genotropin Inj 0.2MG, 28
Genotropin Inj 12MG, 29
gentak oin 0.3% op, 49
gentamicin CRE 0.1%, 18
gentamicin inj 10MG/ML, 3
gentamicin inj 40MG/ML, 3
gentamicin oin 0.1%, 18
gentamicin oin 0.3% op, 49
gentamicin sol 0.3% op, 49
Gentle-let Mis 26G, 62
Gentle-let Mis 28G, 62
Gentle-let Mis Lancets, 62
Genvoya TAB, 5
Geodon CAP 20MG, 41
Geodon CAP 40MG, 41
Geodon CAP 60MG, 41
Geodon CAP 80MG, 41
Geodon Inj 20MG, 41
Gialax Kit, 31
gianvi TAB 3-0.02MG, 25
Giazo TAB 1.1gm, 33
gildagia TAB 0.4-35, 25
gildess 24 TAB FE 1/20, 25
gildess FE TAB 1.5/30, 25
gildess FE TAB 1/20, 25
gildess TAB 1.5/30, 25
gildess TAB 1/20, 25
Gilenya CAP 0.5MG, 48
Gilotrif TAB 20MG, 8
glatopa inj 20MG/ML, 48
Gleevec TAB 100MG, 8
Gleevec TAB 400MG, 8
Gleostine CAP 100MG, 6
glimepiride TAB 1MG, 27
glip/metform TAB 2.5-250m, 27
glip/metform TAB 2.5-500m, 28
glip/metform TAB 5-500MG, 28
glipizide ER TAB 10MG, 27
glipizide ER TAB 2.5MG, 27
glipizide ER TAB 5MG, 27
glipizide TAB 10MG, 27
glipizide TAB 5MG, 27
glipizide XL TAB 10MG, 27
glipizide XL TAB 2.5MG, 27
glipizide XL TAB 5MG, 27
Global 28G Mis Lancets, 62
Global 30G Mis Lancets, 62
Global Lanc Mis Device, 62
Gluc Control Liq Normal, 62
gluc control sol, 60
Gluc Control Sol Level 1, 62
Gluc Control Sol Level 2, 62
Gluc Control Sol Mid, 62
gluc control sol normal, 60
Glucagen Inj Hypokit, 27
Glucagon Kit 1MG, 27
Glucocard 01 Liq Norm/Hgh, 62
Glucocard 01 Sol Normal, 62
Glucocard Liq Level 1, 62
Glucocard Sol Normal, 62
Glucocard Sol Shine, 62
Glucocom Mis 28G, 62
Glucocom Tes High CON, 62
Glucocom Tes Norm CON, 62
Glucolet 2 Mis Lancing, 62
Glucophage TAB 1000MG, 27
Glucophage TAB 500MG XR, 27
Glucophage TAB 750MG XR, 27
Glucose Cont Liq High/Low, 62
Glucose Cont Sol High, 62
Glucose Cont Sol Normal, 62
Glucose Cont Sol Precisio, 62
Glucosource Mis Lanc Dev, 62
Glucosource Mis Lancets, 62
Glucotrol TAB 10MG, 27
Glucotrol TAB 5MG, 27
Glucotrol XL TAB 10MG, 27
Glucotrol XL TAB 2.5MG, 27
Glucotrol XL TAB 5MG, 27
Glucovance TAB 1.25-250, 28
Glucovance TAB 2.5-500, 28
Glucovance TAB 5-500MG, 28
Glumetza TAB 1000MG, 27
Glumetza TAB 500MG, 27
glyb/metform TAB 1.25-250, 28
glyb/metform TAB 2.5-500, 28
glyb/metform TAB 5-500MG, 28
glyburid mcr TAB 1.5MG, 27
glyburid mcr TAB 3MG, 27
glyburid mcr TAB 6MG, 27
glyburide TAB 1.25MG, 27
glyburide TAB 2.5MG, 27
glyburide TAB 5MG, 27
glycopyrrol inj 0.2MG/ML, 31
glycopyrrol inj 0.4/2ML, 31
glycopyrrol inj 1MG/5ML, 31
glycopyrrol inj 4MG/20ML, 31
glycopyrrol TAB 1MG, 31
glycopyrrol TAB 2MG, 31
glydo gel 2%, 21
Glynase TAB 1.5MG, 27
Glynase TAB 3MG, 27
Glynase TAB 6MG, 27
Glyset TAB 100MG, 27
Glyset TAB 25MG, 27
Glyset TAB 50MG, 27
Glyxambi TAB 10-5 MG, 28
Glyxambi TAB 25-5 MG, 28
Gmate Contro Sol Level 2, 62
Gmate Lancet Mis 30G, 62
Gnp Lancets Mis, 62
Gnp Lancets Mis 21G, 62
Gnp Lancets Mis Micro, 62
Gnp Lancets Mis Sup Thin, 62
Gnp Lancets Mis Thin, 62
Gnp Lancets Mis Thin 26G, 62
gnp nicotine gum 2MG mint, 47
gnp nicotine gum 2MG orig, 47
gnp nicotine gum 4MG mint, 47
gnp nicotine gum 4MG orig, 47
gnp nicotine loz 2MG mint, 47
gnp nicotine loz 4MG mint, 47
gnp nicotine loz mini 2MG, 47
Golytely Sol, 31
Golytely Sol Pineappl, 31
Gordons Urea Oin 40%, 22
Gralise Star Mis 300/600, 48
Gralise TAB 300MG, 48
Gralise TAB 600MG, 48
granisetron TAB 1MG, 32
Granisol Sol 2MG/10ML, 32
Grifulvin V TAB 500MG, 4
Gris-peg TAB 125MG, 4
Gris-peg TAB 250MG, 4
griseofulvin sus 125/5ML, 4
griseofulvin TAB micr 500, 4
griseofulvin TAB ultr 125, 4
griseofulvin TAB ultr 250, 4
grx hicort sup 25MG, 33
guanfacine TAB 1MG, 12
guanfacine TAB 1MG ER, 42
guanfacine TAB 2MG, 12
guanidine TAB 125MG, 49
Gynazole-1 CRE 2%, 34
H
H.p. Acthar Inj 80unit, 29
Haemolance Mis High FLO, 62
Haemolance Mis Low Flow, 62
Haemolance Mis Plus, 62
Haemolance Mis Plus Low, 62
Haemolance Mis Plus Max, 62
Haemolance Mis Plus PED, 62
Haemolance Mis Retract, 62
halac kit, 20
Halcion TAB 0.25MG, 42
Haldol Decan Inj 100MG/ML, 41
Haldol Decan Inj 50MG/ML, 41
Haldol Inj 5MG/ML, 41
halobetasol CRE 0.05%, 19
halobetasol oin 0.05%, 19
Halog CRE 0.1%, 20
Halog Oin 0.1%, 20
haloper DEC inj 100MG/ML, 40
haloper DEC inj 50MG/ML, 40
haloper lac inj 5MG/ML, 40
haloperidol CON 2MG/ML, 40
haloperidol TAB 0.5MG, 40
haloperidol TAB 10MG, 40
Halotin CRE 1%, 18
Harvoni TAB 90-400MG, 5
HC ac/aloe gel 2%, 20
HC butyrate CRE 0.1%, 19
HC butyrate oin 0.1%, 19
HC butyrate sol 0.1%, 19
HC Lancing Mis Device, 62
HC pramoxine CRE 1-1%, 33
HC pramoxine CRE 2.5-1%, 19, 33
HC valerate CRE 0.2%, 20
HC valerate oin 0.2%, 19
HC/acet acid sol otic, 51
Healthpro Sol High/Low, 62
heather TAB 0.35MG, 25
hecoria CAP 0.5MG, 7
hecoria CAP 1MG, 7
hecoria CAP 5MG, 7
Hectorol CAP 0.5mcg, 29
Hectorol CAP 1mcg, 29
Hectorol CAP 2.5mcg, 29
Hemabate Inj 250mcg, 51
Hemangeol Sol 4.28/ML, 10
hematinic pl TAB vit/min, 35
hematogen CAP, 35
hematogen CAP forte, 35
hematogen fa CAP, 35
hematron liq, 35
Hematron-AF TAB, 35
hemax TAB, 35
Hemetab TAB, 35
hemmorex-HC sup 25MG, 33
hemmorex-HC sup 30MG, 33
Hemocyte Pls CAP, 35
hep sod/NACL inj 1000unit, 36
hep sod/NACL inj 12500unt, 36
hep sod/NACL inj 2000unit, 36
hep sod/NACL inj 25000unt, 36
hep sod/NACL inj 2unit/ML, 36
heparin sod inj 1000/ML, 36
heparin sod inj 5000/0.5, 36
Hepsera TAB 10MG, 5
Hetlioz CAP 20MG, 42
Hexalen CAP 50MG, 6
Hiberix Sol 10mcg, 59
Hiprex TAB 1gm, 34
Hlthy Accnts Mis Lanc 30G, 62
HM Lancets Mis 30G, 62
HM Lancets Mis 33G, 62
HM nicotine dis 14MG/24h, 46
HM nicotine dis 21MG/24h, 46
HM nicotine gum 2MG mint, 47
HM nicotine gum 4MG mint, 47
HM nicotine loz 2MG mint, 47
HM nicotine loz 4MG mint, 47
Hold Chamber Mis Adlt LG, 65
homatropaire sol 5% op, 50
homatropine sol 5% op, 50
Horizant TAB 300MG, 48
Horizant TAB 600MG, 48
HPR Aer, 22
HPR Plus Aer, 22
HPR Plus CRE, 22
Humalog Inj 100/ML, 26
Humalog Kwik Inj 100/ML, 26
Humalog Kwik Inj 200/ML, 26
Humalog Mix Inj 50/50, 26
Humalog Mix Inj 50/50kwp, 26
Humalog Mix Inj 75/25kwp, 26
Humalog Mix Sus 75/25, 26
Humatrope Inj 12MG, 29
Humira Inj 10MG/0.2, 55
Humira Kit 20MG/0.4, 55
Humira Kit 40MG/0.8, 55
Humira Pedia Inj Crohns, 55
Humira Pen Inj 40MG/0.8, 55
Humira Pen Inj Crohns, 55
Humira Pen Inj Psoriasi, 55
Humulin Inj 70/30, 26
Humulin Inj 70/30kwp, 26
Humulin N Inj U-100, 26
Humulin N Inj U-100kwp, 26
Humulin R Inj U-100, 26
Humulin R Inj U-500, 26
hyaluronate gel 0.2%, 21
Hycamtin CAP 0.25MG, 8
Hycamtin CAP 1MG, 8
Hycet Sol 7.5-325, 53
Hycofenix Sol, 57
HYD pol/CPM sus 10-8/5ML, 57
hydr/CPM/PSE liq 5-4-60MG, 57
hydralazine inj 20MG/ML, 12
hydralazine TAB 100MG, 12
Hydrea CAP 500MG, 8
Hydro 35 Aer, 22
Hydro 40 Aer Foam, 22
hydro/chlor/ liq 5-4-60MG, 57
hydroc/homat TAB 5-1.5MG, 57
hydrochlorot CAP 12.5MG, 14
hydrochlorot TAB 12.5MG, 14
hydrochlorot TAB 25MG, 14
hydrochlorot TAB 50MG, 14
hydroco/apap sol 7.5-325, 51
hydroco/apap sol 7.5-500, 51
hydroco/apap TAB 10-300MG, 52
hydroco/apap TAB 2.5-325, 52
hydrocod/hom syp 5-1.5/5, 57
hydrocod/ibu TAB 10-200MG, 52
hydrocod/ibu TAB 2.5-200, 52
hydrocod/ibu TAB 5-200MG, 52
hydrocod/ibu TAB 7.5-200, 52
hydrocodone sol 10-325MG, 52
hydrocort ac sup 25MG, 33
hydrocort ac sup 30MG, 33
hydrocort CRE 1%, 20, 33
hydrocort CRE 2.5%, 19
hydrocort ene 100MG, 33
hydrocort lot 2.5%, 19
hydrocort oin 1%, 19
hydrocort oin 2.5%, 19
hydrocort TAB 10MG, 22
hydrocort/ CRE iodoquin, 18
hydrocort/ab oin 1%, 19
hydrocortiso CRE 2.5%, 33
hydromet syp 5-1.5/5, 57
hydromorphon inj 10MG/ML, 51
hydromorphon inj 500/50ML, 51
hydromorphon inj 50MG/5ML, 51
hydromorphon liq 1MG/ML, 51
hydromorphon sup 3MG, 51
hydromorphon TAB 12MG ER, 52
hydromorphon TAB 2MG, 51
hydroxychlor TAB 200MG, 5
hydroxyurea CAP 500MG, 8
hydroxyz HCL inj 25MG/ML, 38
hydroxyz HCL inj 50MG/ML, 38
hydroxyz HCL sol 10MG/5ML, 38
hydroxyz HCL syp 10MG/5ML, 38
hydroxyz HCL TAB 10MG, 38
hydroxyz pam CAP 100MG, 38
Hylatopic Aer, 22
Hylatopic Aer Plus, 22
Hylatopic CRE Plus, 22
Hylira Gel 0.2%, 22
Hylira Lot 0.1%, 22
hyolev mb TAB 81MG, 34
hyophen TAB, 34
hyoscyamine dro 0.125/ML, 31
hyoscyamine elx 0.125/5, 31
hyoscyamine sub 0.125MG, 31
hyoscyamine TAB 0.125MG, 31
hyoscyamine TAB 0.375 ER, 31
hyoscyamine TAB 0.375 SR, 31
hyosyne dro 0.125/ML, 31
hyosyne elx 0.125/5, 31
Hyper-sal Neb 7%, 57
hypercare sol 20%, 21
Hypersal Neb 3.5%, 57
Hypersal Neb 7%, 57
Hypolance Kit Lancing, 62
Hysingla ER TAB 100 MG, 53
Hyzaar TAB 100-12.5, 14
Hyzaar TAB 100-25, 14
Hyzaar TAB 50-12.5, 14
I
ibandronate TAB 150MG, 28
Ibrance CAP 100MG, 8
Ibrance CAP 125MG, 8
Ibrance CAP 75MG, 8
Ibu/Minrex PAK, 55
Ibudone TAB 10-200MG, 53
ibudone TAB 5-200MG, 52
ibuprofen sus 100/5ML, 54
ibuprofen TAB 400MG, 54
IC 400 Kit 400MG, 55
IC 800 Kit 800MG, 55
Iclusig TAB 15MG, 8
Iclusig TAB 45MG, 8
iferex 150 CAP forte, 35
Ilevro Dro 0.3% Op, 50
ilotycin oin op, 49
imatinib mes TAB 100MG, 8
imatinib mes TAB 400MG, 8
Imbruvica CAP 140MG, 8
Imdur TAB 120MG ER, 9
imipram HCL TAB 10MG, 38
imipram pam CAP 100MG, 39
imiquimod CRE 5%, 20
Imitrex Inj 4MG/0.5, 55
Imitrex Inj 6MG/0.5, 55
Imitrex Spr 20MG/Act, 55
Imitrex Spr 5MG/Act, 55
Imitrex TAB 100MG, 55
Impavido CAP 50MG, 6
Imuran TAB 50MG, 7
IN Control Mis 31GX5MM, 62
IN Touch Lan Mis 30G, 62
IN Touch Sol Glucose, 62
Incivek TAB 375MG, 5
Incontrol Mis 29GX12MM, 62
Incontrol Mis Lanc 28G, 62
Incontrol Mis Lanc Dev, 62
Increlex Inj 40MG/4ML, 29
Incruse Elpt Inh 62.5mcg, 58
indapamide TAB 1.25MG, 14
indapamide TAB 2.5MG, 14
Inderal LA CAP 120MG, 10
Inderal XL CAP 120MG, 10
Inderal XL CAP 80MG, 10
Indocin Sup 50MG, 55
Indocin Sus 25MG/5ML, 55
indomethacin CAP 25MG, 54
indomethacin CAP 50MG, 54
indomethacin CAP 75MG ER, 54
Infanrix Inj, 59
Infasurf Sus 35MG/ML, 59
Infinity Sol High CON, 62
Infinity Sol Low CON, 62
Infinity Sol Norm CON, 62
Inflammation PAK Reductio, 55
Influenza Firus Vaccine, 59
Infumorph Inj 10MG/ML, 53
Infumorph Inj 25MG/ML, 53
Inlyta TAB 1MG, 8
Inlyta TAB 5MG, 8
Innopran XL CAP 120MG, 10
Innopran XL CAP 80MG, 10
Inova 4/1 Kit Acne CON, 17
Inova 8/2 Kit Acne CON, 17
Inova Kit 4%, 17
Inova Kit 8%, 17
Inspirachamb Mis Large, 65
Inspirachamb Mis Medium, 65
Inspirachamb Mis Mouthpce, 65
Inspirachamb Mis Small, 65
Inspirease Mis Dd Syst, 65
Inspra TAB 25MG, 13
Inspra TAB 50MG, 13
Insulin Pen Mis 29GX12MM, 62
Insulin Syrg Mis 0.3/28G, 62
insulin syrg mis 0.3/29G, 60
Insulin Syrg Mis 1ML, 62
Insulin Syrg Mis 1ML/25G, 62
insulin syrg mis 1ML/27G, 60
Insulin Syrg Mis 28GX1/2", 62
insulin syrg mis 29GX1/2", 60
Insulin Syrg Mis 29GX1/2", 62
Insulin Syrg Mis 30GX5/16, 62
Insulin Syrg Mis 31GX5/16, 62
Insupen Mis 32GX4MM, 62
Insupen Mis 33GX4MM, 62
Insupen Sens Mis 32GX6MM, 62
Insupen Sens Mis 32GX8MM, 62
Insupen Ultr Mis 29GX12MM, 62
Integra F CAP, 35
Integra Plus CAP, 35
Intelence TAB 100MG, 4
Intermezzo Sub 1.75MG, 42
Intermezzo Sub 3.5MG, 42
Intron A Inj 10mu, 8
introvale TAB, 25
Intuniv TAB 1MG, 43
Intuniv TAB 2MG, 43
Intuniv TAB 3MG, 43
Intuniv TAB 4MG, 43
Invanz Inj 1gm, 6
Invega Sust Inj 117/0.75, 41
Invega Sust Inj 156MG/ML, 41
Invega Sust Inj 78/0.5ML, 41
Invega TAB 1.5MG, 41
Invega TAB 3MG, 41
Invega TAB 6MG, 41
Invega TAB 9MG, 41
Invega Trinz Inj 273MG, 41
Invirase CAP 200MG, 4
Invirase TAB 500MG, 4
Invokamet TAB 150-1000, 28
Invokamet TAB 50-500MG, 28
Invokana TAB 100MG, 27
Invokana TAB 300MG, 27
Ionsys Pad 40mcg/Ac, 53
Iopidine Sol 0.5% Op, 50
Iopidine Sol 1% Op, 50
ipratropium sol 0.02%inh, 58
ipratropium spr 0.03%, 57
ipratropium spr 0.06%, 57
ipratropium/ sol albuter, 58
ipratropium/ sol sulfate, 58
Iprivask Inj 15MG, 36
irbesar/hctz TAB 150-12.5, 13
irbesar/hctz TAB 300-12.5, 13
irbesartan TAB 150MG, 12
Irenka CAP 40MG, 39
Iressa TAB 250MG, 8
Irospan 24/6 Mis, 35
Isentress Chw 100MG, 4
Isentress Chw 25MG, 4
Isentress Pow 100MG, 5
Isentress TAB 400MG, 4
Iso Atropine Sol 1% Op, 50
isometh/apap CAP dichlor, 55
isometh/caff TAB /apap, 55
isoniazid inj 100MG/ML, 3
isoniazid syp 50MG/5ML, 3
isoniazid TAB 100MG, 3
isoniazid TAB 300MG, 3
Isopto Carp Sol 1% Op, 50
Isordil TAB 40MG, 9
Isordil TAB 5MG, 9
isosorb din TAB 10MG, 9
isosorb din TAB 40MG ER, 9
isosorb mono TAB 10MG, 9
isosorb mono TAB 120MG ER, 9
isosorb mono TAB 20MG, 9
isoxsuprine TAB 10MG, 16
isoxsuprine TAB HCL 20MG, 16
isradipine CAP 2.5MG, 10
isradipine CAP 5MG, 10
istalol sol 0.5% op, 49
Istalol Sol 0.5% Op, 49
Isuprel Inj 0.2MG/ML, 58
itraconazole CAP 100MG, 4
ivermectin TAB 3MG, 6
J
Jadenu TAB 180MG, 66
Jadenu TAB 360MG, 66
Jadenu TAB 90MG, 66
Jakafi TAB 10MG, 8
Jakafi TAB 15MG, 8
Jakafi TAB 20MG, 8
Jakafi TAB 25MG, 8
Jakafi TAB 5MG, 8
Jalyn CAP, 35
jantoven TAB 10MG, 36
jantoven TAB 2.5MG, 36
jantoven TAB 7.5MG, 36
Janumet TAB 50-1000, 28
Janumet TAB 50-500MG, 28
Janumet XR TAB 100-1000, 28
Janumet XR TAB 50-1000, 28
Janumet XR TAB 50-500MG, 28
Januvia TAB 100MG, 27
Jardiance TAB 10MG, 27
Jardiance TAB 25MG, 27
jencycla TAB 0.35MG, 25
Jentadueto TAB 2.5-1000, 28
Jentadueto TAB XR, 28
jevantique l TAB 0.5-2.5, 24
jinteli TAB 1MG-5mcg, 24
jolessa TAB, 26
jolivette TAB 0.35MG, 25
Jublia Sol 10%, 18
juleber TAB, 25
junel 1.5/30 TAB, 25
junel 1/20 TAB, 25
junel FE 24 TAB 1/20, 26
junel FE TAB 1.5/30, 25
junel FE TAB 1/20, 25
Juxtapid CAP 10MG, 16
K
k citrate sol citr acd, 35
K-phos TAB NO 2, 35
k/NA citrate sol citr acd, 35
k2k pain rel pad 4-4%, 21
Kadian CAP 100MG ER, 53
kaitlib FE chw, 26
Kaletra Sol, 4
Kaletra TAB 100-25MG, 4
Kaletra TAB 200-50MG, 4
Kalydeco PAK 50MG, 59
Kalydeco PAK 75MG, 59
Kalydeco TAB 150MG, 59
Kapvay TAB 0.1 MG, 43
Karbinal ER Sus 4MG/5ML, 57
kariva TAB 28 day, 26
Kazano 12.5- TAB 1000MG, 28
Kazano 12.5- TAB 500MG, 28
Keflex CAP 250MG, 1
Keflex CAP 500MG, 1
Keflex CAP 750MG, 1
kelnor TAB 1/35, 25
Kenalog Aer Spray, 20
Kenalog-10 Inj 10MG/ML, 23
Kenalog-40 Inj 40MG/ML, 23
Keppra Sol 100MG/ML, 44
Keppra TAB 1000MG, 44
Keppra XR TAB 500MG, 44
Keppra XR TAB 750MG, 44
Kerafoam 42 Aer 42%, 22
Kerafoam Aer 30%, 22
Keralac CRE 47%, 22
Keralyt Gel 6%, 22
Keralyt Kit Scalp 6%, 22
Kerlone TAB 10MG, 10
Kerlone TAB 20MG, 10
Kerydin Sol 5%, 18
Ketek TAB 300MG, 6
Ketek TAB 400MG, 6
ketoconazole aer 2%, 18
ketoconazole CRE 2%, 18
ketoconazole sha 2%, 18
ketoconazole TAB 200MG, 4
ketodan aer 2%, 18
ketoprofen CAP 200MG ER, 54
ketoprofen CAP 50MG, 54
ketoprofen CAP 75MG, 54
Ketorocaine Kit -l, 55
Ketorocaine Kit -lm, 55
ketorolac inj 15MG/ML, 54
ketorolac inj 30MG/ML, 54
ketorolac inj 60MG/2ML, 54
ketorolac sol 0.4%, 50
ketorolac sol 0.5%, 50
ketorolac TAB 10MG, 54
Keveyis TAB 50MG, 14
Khedezla TAB 100MG ER, 39
Khedezla TAB 50MG ER, 39
kimidess TAB, 26
Kineret Inj, 55
Kinlytic Inj 250000, 37
Kinney Mis Lancets, 62
Kinney Thin Mis Lancets, 62
Kinrix Inj, 59
Kitabis PAK Neb 300/5ML, 3
Klaron Lot 10%, 17
klofensaid sol II, 18
Klonopin TAB 0.5MG, 44
Klonopin TAB 1MG, 44
Klonopin TAB 2MG, 44
kls quit2 gum 2MG, 47
kls quit2 loz 2MG, 47
kls quit4 gum 4MG, 47
kls quit4 loz 4MG, 47
Kombiglyze TAB 2.5-1000, 28
Kombiglyze TAB 5-1000MG, 28
Kombiglyze TAB 5-500MG, 28
Korlym TAB 300MG, 27
Kristalose PAK 10gm, 31
Kristalose PAK 20gm, 31
Kroger Lance Mis, 62
Kroger Lance Mis Thin, 62
Kroger Lance Mis Thin 30G, 63
kurvelo TAB 0.15/30, 25
Kuvan Pow 100MG, 30
Kuvan Pow 500MG, 29
Kuvan TAB 100MG, 30
Kynamro Inj 200MG/ML, 16
L
labetalol TAB 100MG, 9
Lac-hydrin CRE 12%, 22
Lac-hydrin Lot 12%, 22
Lacrisert Mis 5MG Op, 49
lactic acid CRE /vit e, 21
lactic acid CRE e, 21
lactic acid lot 10%, 21
lactulose sol 10gm/15, 31, 33
lactulose sol 20gm/30, 31
Lamictal Chw 25MG, 44
Lamictal Kit Start 35, 44
Lamictal Odt Kit, 44
Lamictal Odt TAB 100MG, 44
Lamictal TAB 100MG, 44
Lamictal XR Kit, 44
Lamictal XR TAB 100MG, 44
Lamisil Gra 125MG, 4
Lamisil Gra 187.5MG, 4
Lamisil TAB 250MG, 4
lamivud/zido TAB 150-300, 4
lamivudine sol 10MG/ML, 4
lamivudine TAB 100MG, 4
lamotrig odt kit 25/50MG, 44
lamotrig odt kit 50/100MG, 44
lamotrigine chw 25MG, 43
lamotrigine chw 5MG, 43
lamotrigine kit odt, 44
lamotrigine TAB 100MG, 43
lamotrigine TAB 100MG ER, 44
lamotrigine TAB 25MG odt, 44
lamotrigine TAB 50MG odt, 44
Lancet Alter Mis Site 26G, 63
lancet devic mis adjust, 60
Lancet Micro Mis Thin 33G, 63
Lancet Stand Mis 21G, 63
Lancet Super Mis Thin 30G, 63
Lancet Ultra Mis 28G, 63
Lancet Ultra Mis Fine, 63
Lancet Ultra Mis Thin 28G, 63
Lancet Ultra Mis Thin 30G, 63
Lancets Micr Mis Thin 33G, 63
lancets mis, 60
Lancets Mis, 63
lancets mis 21G, 60
Lancets Mis 21G, 63
Lancets Mis 21G Colr, 63
lancets mis 23G, 60
lancets mis 26G, 60
Lancets Mis 26G, 63
lancets mis 28G, 60
Lancets Mis 28G, 63
lancets mis 30G, 60
Lancets Mis 30G, 63
lancets mis 31G, 60
lancets mis 33G, 60
Lancets Mis 33G, 63
Lancets Mis Colored, 63
lancets mis orange, 60
Lancets Mis Original, 63
Lancets Mis Thin, 63
Lancets Mis Thin 26G, 63
Lancets Mis Thin 30G, 63
Lancets Supr Mis Thin 28G, 63
lancets thin mis, 60
Lancets Thin Mis, 63
Lancets Thin Mis 26G, 63
Lancets Thin Mis 30G, 63
Lancets Ultr Mis Thin, 63
Lancets Ultr Mis Thin 28G, 63
Lancets Ultr Mis Thin 30G, 63
lancing devi mis, 60
Lancing Devi Mis, 63
Lanoxin Inj 0.25MG/1, 9
Lanoxin PED Inj 0.1MG/ML, 9
Lanoxin TAB 0.0625MG, 9
lanoxin TAB 0.25MG, 9
lansopr/amox mis /clarith, 31
lansoprazole CAP 15MG DR, 31
lansoprazole CAP 30MG DR, 31
Lansoprazole Sus 3MG/ML, 32
Lantus Inj 100/ML, 26
Lantus Inj Solostar, 26
larin 24 TAB FE 1/20, 26
larin FE TAB 1.5/30, 25
larin FE TAB 1/20, 25
larin TAB 1.5/30, 25
larin TAB 1/20, 25
larissia TAB, 25
Lasix TAB 20MG, 14
Lasix TAB 40MG, 14
Lasix TAB 80MG, 14
Lastacaft Sol 0.25%, 50
latanoprost sol 0.005%, 50
latrix sus 50%, 21
Latuda TAB 120MG, 41
Latuda TAB 20MG, 41
Latuda TAB 40MG, 41
Latuda TAB 60MG, 41
Latuda TAB 80MG, 41
layolis FE chw, 26
Lazanda Spr 100mcg, 54
Lb Lancet Mis 28G, 63
Lb Lancing Mis Device, 63
Ldo Plus Gel 4%, 22
leena TAB, 25
leflunomide TAB 10MG, 54
leflunomide TAB 20MG, 54
Lenvima CAP 10 MG, 8
Lenvima CAP 8 MG, 8
Lescol CAP 20MG, 15
Lescol CAP 40MG, 15
Lescol XL TAB 80MG, 15
lessina TAB, 25
Letairis TAB 10MG, 16
Letairis TAB 5MG, 16
letrozole TAB 2.5MG, 7
leucovor CA inj 100MG, 9
leucovor CA TAB 10MG, 8
leucovorin inj calcium, 9
Leukeran TAB 2MG, 6
leuprolide inj 1MG/0.2, 7
leva set kit, 21
Levacet TAB, 51
levalbuterol neb 0.31MG, 58
levalbuterol neb 1.25/0.5, 58
Levaquin Sol 25MG/ML, 3
Levaquin TAB 250MG, 3
Levatio Pad 0.3-5%, 22
Levatol TAB 20MG, 10
Levbid TAB 0.375 ER, 32
Levemir Inj, 26
Levemir Inj Flexpen, 26
Levemir Inj Flextouc, 26
levetiraceta sol 100MG/ML, 44
levetiraceta sol 500/5ML, 44
levetiraceta TAB 1000MG, 44
levetiraceta TAB 500MG ER, 44
levetiraceta TAB 750MG ER, 44
levo-ETH est TAB 90-20mcg, 26
levo-t TAB 100mcg, 30
levo-t TAB 200 mcg, 30
levo-t TAB 300 mcg, 30
levobunolol sol 0.5% op, 49
levocarnitin sol 1gm/10ML, 29
levocarnitin TAB 330MG, 29
levocetirizi sol 2.5/5ML, 57
levocetirizi TAB 5MG, 57
levofloxacin sol 0.5%, 49
levofloxacin sol 25MG/ML, 3
levofloxacin TAB 250MG, 3
levonest TAB, 25
levonor/ethi TAB, 25
levonor/ethi TAB 0.1-0.02, 25
levonor/ethi TAB estradio, 25
levonorgestr TAB 0.75MG, 25
levonorgestr TAB 1.5MG, 25
levora-28 TAB 0.15/30, 25
levorphanol TAB 2MG, 51
levothyroxin TAB 100mcg, 30
levothyroxine TAB 0.075MG, 30
levoxyl TAB 100mcg, 30
Levsin Inj 0.5MG/ML, 32
Levsin TAB 0.125MG, 32
Levsin/SL Sub 0.125MG, 32
Lexapro Sol 5MG/5ML, 39
Lexapro TAB 10MG, 39
Lexapro TAB 20MG, 39
Lexapro TAB 5MG, 39
Lexiva Sus 50MG/ML, 5
Lexiva TAB 700MG, 5
lexuss 210 liq 2-10/5ML, 57
Lialda TAB 1.2gm, 33
Librax CAP 5-2.5MG, 32
lidazone CRE, 33
lidenza pad 4-1%, 21
lido-hydro gel 2.8-0.55, 33
Lido-k Lot 3%, 22
lido/epi 1%- inj 1:100000, 56
lido/epi inj 0.5%, 56
lido/epi inj 1.5%, 56
lido/epi inj 2%, 56
lido/prilocn CRE 2.5-2.5%, 21
lido/prilocn kit 2.5-2.5%, 21
Lido/Sod Bic Inj 0.5-8.4%, 56
Lido/Sod Bic Inj 1-8.4%, 56
lidocaine CRE 3%, 21
lidocaine gel 2%, 21
lidocaine gel 2% jelly, 21
lidocaine inj 0.5%, 56
lidocaine inj 1%, 56
lidocaine inj 1.5%, 56
lidocaine inj HCL, 56
lidocaine lot 3%, 21
lidocaine oin 5%, 21
lidocaine oin PAK 5%, 21
lidocaine pad 5%, 21
lidocaine sol 2% visc, 37
lidocaine sol 4%, 21, 37
lidocaine-pr CRE, 21
lidocaine/HC CRE 3%-0.5%, 33
lidocaine/HC kit 3%-0.5%, 33
lidocaine/HC kit 3%-1%, 33
Lidocin Gel 3%, 22
Lidoderm Dis 5%, 22
lidodextrapi pad 4-1%, 21
Lidolog Kit, 23
lidopin CRE 3%, 21
lidopril kit 2.5-2.5%, 21
lidopril XR kit 2.5-2.5%, 21
Lidorx Gel 3%, 22
Lidothol Pad 4.5-5%, 22
Lidotral CRE 3.88%, 22
Lidovin CRE 3.95%, 22
Lidovir Oin 4-4%, 18
Lidoxib Kit, 55
Lidozol CRE 3.75%, 22
Lifescan Mis Unistik2, 63
Liletta Iud 52MG, 26
Lincocin Inj 300MG/ML, 6
lincomycin inj 300MG/ML, 6
lincomycin inj lidocain, 6
lindane lot 1%, 21
lindane sha 1%, 21
linezolid sus 100/5ML, 6
linezolid TAB 600MG, 6
Linzess CAP 145mcg, 33
Linzess CAP 290mcg, 33
liothyronine TAB 25mcg, 30
Lipitor TAB 10MG, 15
Lipofen CAP 150MG, 15
Lipofen CAP 50MG, 15
lisinop/hctz TAB 10-12.5, 13
lisinop/hctz TAB 20-12.5, 13
lisinop/hctz TAB 20-25MG, 13
lisinopril TAB 10MG, 11
lisinopril TAB 2.5MG, 11
Lite Touch Mis Lanc Dev, 63
Lite Touch Mis Lanc Pen, 63
Lite Touch Mis Lancets, 63
Liteaire Mis, 66
Litetouch Mis 29GX12.7, 63
Litetouch Mis 31GX8MM, 63
Litetouch Mis Lancets, 63
lithium CARB CAP 150MG, 40
lithium CARB TAB 300MG, 40
lithium CARB TAB 300MG ER, 40
lithium CARB TAB 450MG ER, 40
lithium sol 8meq/5ML, 40
Lithobid TAB 300MG CR, 41
Lithostat TAB 250MG, 35
Livalo TAB 1MG, 15
Livalo TAB 2MG, 15
Livalo TAB 4MG, 15
livixil PAK kit 2.5-2.5%, 21
LO Loestrin TAB, 26
Locoid CRE 0.1%, 20
Locoid Lipo CRE 0.1%, 20
Locoid Lot 0.1%, 20
Locoid Oin 0.1%, 20
Locoid Sol 0.1%, 20
Lodosyn TAB 25MG, 45
Loestrin 21 TAB 1.5/30, 26
Loestrin FE TAB 1.5/30, 26
Loestrin FE TAB 1/20, 26
Loestrin TAB 1/20-21, 26
lofene TAB 2.5MG, 31
Lofibra CAP 134MG, 15
Lofibra TAB 160MG, 15
Lofibra TAB 54MG, 15
lokara lot 0.05%, 19
lomedia 24 TAB FE, 26
Lomotil TAB 2.5MG, 31
lomustine CAP 100MG, 6
Longs Lancet Mis Standard, 63
Longs Lancet Mis Thin, 63
Longs Lancet Mis Ultra Th, 63
Lonsurf TAB 15-6.14, 9
Lonsurf TAB 20-8.19, 9
loperamide CAP 2MG, 31
Lopid TAB 600MG, 15
lopreeza TAB 0.5-0.1, 24
lopreeza TAB 1-0.5MG, 24
Lopress HCT TAB 100-25MG, 14
Lopress HCT TAB 50-25MG, 14
Lopressor TAB 100MG, 10
Lopressor TAB 50MG, 10
Loprox CRE 0.77%, 18
Loprox Sha 1%, 18
lorazepam CON 2MG/ML, 38
lorazepam inj 2MG/ML, 38
lorazepam inj 4MG/ML, 38
lorazepam TAB 0.5MG, 38
lorazepam TAB 1MG, 38
lorazepam TAB 2MG, 38
lorcet HD TAB 10-325MG, 51
lorcet plus TAB 7.5-325, 51
lorcet TAB 5-325MG, 51
lorenza pad 4-1%, 21
Lortab Elx 10-300MG, 53
lortab TAB 10-325MG, 51
lortab TAB 5-325MG, 51
lortab TAB 7.5-325, 51
loryna TAB 3-0.02MG, 26
Lorzone TAB 375MG, 49
Lorzone TAB 750MG, 49
losartan pot TAB 100MG, 12
losartan/HCT TAB 100-12.5, 13
losartan/HCT TAB 100-25, 13
losartan/HCT TAB 50-12.5, 13
Loseasonique TAB, 26
Lotemax Gel 0.5%, 50
Lotemax Oin 0.5%, 50
Lotemax Sus 0.5%, 50
Lotensin HCT TAB 10-12.5, 14
Lotensin HCT TAB 20-12.5, 14
Lotensin HCT TAB 20-25MG, 14
Lotensin TAB 10MG, 12
Lotrel CAP 10-20MG, 14
Lotrel CAP 2.5-10MG, 14
Lotrisone CRE, 18
Lotronex TAB 0.5MG, 33
Lotronex TAB 1MG, 33
Loutrex CRE, 19
lovastatin TAB 10MG, 15
Lovaza CAP 1gm, 15
Lovenox Inj 100MG/ML, 36
Lovenox Inj 120/0.8, 36
Lovenox Inj 150MG/ML, 36
Lovenox Inj 30/0.3ML, 36
Lovenox Inj 300/3ML, 36
low-ogestrel TAB, 25
loxapine CAP 10MG, 40
LP lite PAK kit 2.5-2.5%, 21
LT Injection Kit, 23
Lufyllin TAB 200MG, 58
Lufyllin TAB 400MG, 58
Lumigan Sol 0.01%, 50
Lunesta TAB 1MG, 42
Lunesta TAB 2MG, 42
Lunesta TAB 3MG, 42
Lupr Dep-PED Inj 11.25MG, 28
Lupr Dep-PED Inj 15MG, 28
Lupr Dep-PED Inj 30MG, 28
Lupr Dep-PED Inj 7.5MG, 28
Lupron Depot Inj 11.25MG, 7
Lupron Depot Inj 30MG, 7
Lupron Depot Inj 45MG, 7
lutera TAB, 25
Luvox CR CAP 100MG, 39
Luxiq Aer 0.12%, 20
Luzu CRE 1%, 18
Lycelle Gel, 22
Lynparza CAP 50MG, 8
Lyrica CAP 100MG, 44
Lyrica CAP 25MG, 44
Lyrica CAP 50MG, 45
Lyrica CAP 75MG, 45
Lyrica Sol 20MG/ML, 45
lysiplex TAB plus, 59
Lysodren TAB 500MG, 7
Lysteda TAB 650MG, 37
lyza TAB 0.35MG, 25
M
M-m-r II Inj, 59
Mac Patch Pad .0375-5%, 22
Macrobid CAP 100MG, 34
Macrodantin CAP 100MG, 34
malathion lot 0.5%, 21
maprotiline TAB 25MG, 38
Marbeta-25 Kit, 23
Marbeta-l Kit, 23
Marcaine Inj 0.25%, 56
Marcaine/Epi Inj 0.25%, 56
Marcaine/Epi Inj 0.5%, 56
Mardex-25 Kit, 23
margesic CAP, 51
Marinol CAP 10MG, 32
Marinol CAP 2.5MG, 32
Marinol CAP 5MG, 32
Marlido Kit, 56
Marlido-25 Kit, 56
marlissa TAB 0.15/30, 25
Marplan TAB 10MG, 39
marten-TAB tab 50-325MG, 51
Marvona Kit 0.5%, 56
Mask Vortex/ Mis Frog, 66
Mask Vortex/ Mis Lady Bug, 66
Matulane CAP 50MG, 8
matzim LA TAB 180MG/24, 10
Mavik TAB 1MG, 12
Mavik TAB 2MG, 12
Mavik TAB 4MG, 12
Maxalt TAB 10MG, 56
Maxalt TAB 5MG, 56
Maxalt-MLT TAB 10MG, 56
Maxalt-MLT TAB 5MG, 56
Maxaron TAB Forte, 35
Maxidex Sus 0.1% Op, 50
Maxima Sol Control, 63
Maxipime Inj 1gm, 2
Maxipime Inj 2gm, 2
Maxitrol Oin 0.1% Op, 50
Maxitrol Sus 0.1% Op, 50
Maxzide TAB 75-50, 14
Maxzide-25 TAB, 14
me/naphos/mb TAB hyo 1, 34
meclizine TAB 12.5MG, 32
meclizine TAB 25MG, 32
meclofen sod CAP 100MG, 54
meclofen sod CAP 50MG, 54
Medi-patch Pad RX, 22
Medichoice Mis Lancet, 63
Medisense Liq Gluc-ket, 63
Medisense Liq Gluc/Ket, 63
Medlance Mis 30G Plus, 63
Medlance Mis Extr 21G, 63
Medlance Mis Lite 25G, 63
Medlance Mis Plus, 63
Medlance Mis Plus 30G, 63
Medlance Mis Unv 21G, 63
Medlance Pls Mis 0.8MM, 63
Medlance Pls Mis Extr 21G, 63
Medlance Pls Mis Lite 25G, 63
Medlance Pls Mis Univ 21G, 63
Medrol TAB 16MG, 23
Medrol TAB 2MG, 23
Medrol TAB 32MG, 23
Medrol TAB 4MG, 23
Medrol TAB 8MG, 23
Medroloan II Kit 40MG/ML, 23
Medroloan Kit 40MG/ML, 23
medroxypr ac inj 150MG/ML, 25
medroxypr ac TAB 10MG, 26
medroxypr ac TAB 2.5MG, 26
medroxypr ac TAB 5MG, 26
medroxyprog inj lidocain, 26
mefenam acid CAP 250MG, 54
Megace ES Sus 625/5ML, 26
Megace Oral Sus 40MG/ML, 7
megestrol ac sus 400MG/10, 7
megestrol ac sus 40MG/ML, 7
megestrol ac TAB 20MG, 7
megestrol ac TAB 40MG, 7
megestrol sus 625MG/5m, 26
Megrix Mis, 22
Meijer Lance Mis Color, 63
Meijer Lance Mis Univ 21G, 63
Meijer Lance Mis Univ 30G, 63
Meijer Lance Mis Universa, 63
Meijer Mis Lancets, 63
Mekinist TAB 0.5MG, 8
Mekinist TAB 2MG, 8
meloxicam sus 7.5/5ML, 54
meloxicam TAB 15MG, 54
meloxicam TAB 7.5MG, 54
memant titra PAK 5-10MG, 47
memantine HC sol 2MG/ML, 47
memantine TAB HCL 10MG, 46
memantine TAB HCL 5MG, 46
Menest TAB 0.3MG, 24
Menhibrix Inj, 59
Menostar Dis 14mcg, 24
Mentho-caine Kit 5-8%, 22
Menthocin Pad Lidocain, 22
Mentholix Spr 4-1%, 22
meper/promet CAP 50-25MG, 52
meperidine inj 100MG/ML, 51
meperidine sol 50MG/5ML, 52
meperidine TAB 100MG, 52
meperidine TAB 50MG, 52
Mephyton TAB 5MG, 59
meprobamate TAB 200MG, 38
meprobamate TAB 400MG, 38
Mepron Sus, 6
mercaptopur TAB 50MG, 7
mesalamine ene 4gm, 33
mesalamine kit 4gm, 33
mesalamine TAB 800MG DR, 33
mesna inj 1gm, 8
Mesnex TAB 400MG, 9
Mestinon Syp 60MG/5ML, 49
Mestinon TAB 60MG, 49
Mestinon TAB Timespan, 49
Metadate CD CAP 10MG, 43
metadate TAB 20MG ER, 42
metaproteren syp 10MG/5ML, 58
metaproteren TAB 10MG, 58
metaproteren TAB 20MG, 58
metaxall TAB 800MG, 48
metaxalone TAB 400MG, 48
metaxalone TAB 800MG, 48
metformin ER TAB 1000MG, 27
metformin TAB 1000MG, 27
metformin TAB 500MG ER, 27
metformin TAB 750MG ER, 27
methadone CON 10MG/ML, 52
methadone inj 10MG/ML, 52
methadone sol 10MG/5ML, 52
methadone sol 5MG/5ML, 52
methadone TAB 10MG, 52
methadose CON 10MG/ML, 52
methadose SF CON 10MG/ML, 52
methadose TAB 40MG, 52
methamphetam TAB 5MG, 42
methazolamid TAB 25MG, 14
methazolamid TAB 50MG, 14
methenam hip TAB 1gm, 34
methenam man TAB 1000MG, 34
methenam man TAB 1gm, 34
methenam man TAB 500MG, 34
methergine TAB 0.2MG, 51
methimazole TAB 10MG, 30
methimazole TAB 5MG, 30
Methitest TAB 10MG, 24
methlphenida chw 2.5MG, 42
methocarbam inj 100MG/ML, 48
methocarbam TAB 500MG, 48
methocarbam TAB 750MG, 48
methotrexate inj 100/4ML, 7
methotrexate inj 1gm, 7
methotrexate inj 1gm/40ML, 7
methotrexate inj 25MG/ML, 7
methotrexate inj 50MG/2ML, 7
methotrexate TAB 2.5MG, 7
methoxsalen CAP 10MG, 19
methscopolam TAB 2.5MG, 31
methscopolam TAB 5MG, 31
methyclothia TAB 5MG, 14
methyld/hctz TAB 250/15, 13
methyld/hctz TAB 250/25, 13
methyldopa TAB 250MG, 12
methyldopa TAB 500MG, 12
methylergon inj 0.2MG/ML, 51
methylergon TAB 0.2MG, 51
Methylin Chw 10MG, 43
Methylin Chw 2.5MG, 43
Methylin Chw 5MG, 43
Methylin Sol 10MG/5ML, 43
Methylin Sol 5MG/5ML, 43
methylp/lido inj 40-10/ML, 23
methylp/lido inj 80-10/ML, 23
methylphenid CAP 10MG, 42
methylphenid CAP 20MG ER, 42
methylphenid chw 10MG, 42
methylphenid chw 5MG, 43
methylphenid sol 10MG/5ML, 43
methylphenid sol 5MG/5ML, 43
methylphenid TAB 10MG, 42
methylphenid TAB 10MG ER, 42
methylphenid TAB 20MG SR, 42
methylpr ace inj 40MG/ML, 22
methylpr ace inj 80MG/ML, 22
methylpr ss inj 1000MG, 22
methylprd PF inj 160/2ML, 23
methylprd PF inj 40MG/ML, 23
methylprd PF inj 80MG/ML, 23
methylpred TAB 16MG, 22
methylpredni inj 100MG/ML, 23
methyltestos CAP 10MG, 23
metipranolol sol 0.3% oph, 49
metoclopram inj 10MG/2ML, 33
metoclopram inj 5MG/ML, 33
metoclopram sol 10/10ML, 33
metoclopram sol 5MG/5ML, 33
metoclopram TAB 10MG, 33
metoclopram TAB 5MG, 33
metoclopram TAB 5MG odt, 33
metocloprami TAB 10MG odt, 33
metolazone TAB 10MG, 14
metolazone TAB 2.5MG, 14
metolazone TAB 5MG, 14
metoprl/hctz TAB 100-25MG, 13
metoprol TAR TAB 100MG, 9
metoprolol TAB 100MG ER, 9
metoprolol TAB 37.5MG, 9
metoprolol TAB 75MG, 9
Metozolv Odt TAB 5MG, 33
Metrocream CRE 0.75%, 18
Metrogel Gel 1%, 18
Metrogel-vag Gel 0.75%, 34
Metrolotion Lot 0.75%, 18
metronidazol CAP 375MG, 6
metronidazol CRE 0.75%, 18
metronidazol gel 0.75%, 18
metronidazol gel 0.75%vag, 34
metronidazol gel 1%, 18
metronidazol lot 0.75%, 18
metronidazol TAB 250MG, 6
metronidazol TAB 500MG, 6
Metronidazole 0.75% Jelly, 18
Mevacor TAB 40MG, 15
mexiletine CAP 150MG, 11
Miacalcin Inj 200/ML, 28
Miacalcin Spr 200/Act, 28
Micardis HCT TAB 40/12.5, 14
Micardis HCT TAB 80-25MG, 14
Micardis HCT TAB 80/12.5, 14
Micardis TAB 20MG, 12
miconazole 3 sup 200MG, 34
micrgstin 24 TAB FE 1/20, 26
Micro Thin Mis Lanc 33G, 63
Microchamber Mis, 66
Microdot CON Sol High/Low, 63
microgestin TAB 1.5/30, 25
microgestin TAB 1/20, 25
microgestin TAB FE 1/20, 25
microgestin TAB FE1.5/30, 25
Microlet Mis Lancets, 63
Microspacer Mis, 66
Microtainer Mis Lancet, 63
Microzide CAP 12.5MG, 14
midodrine TAB 10MG, 15
midodrine TAB 2.5MG, 15
midodrine TAB 5MG, 15
Mifeprex TAB 200MG, 29
Migergot Sup 2/100, 55
miglitol TAB 100MG, 27
Migral TAB 130MG, 56
migralam CAP, 55
Migranal Spr 4MG/ML, 56
Migranow PAK, 56
migryl mis 0.0375-5, 21
Millipred DP PAK 5MG, 23
Millipred Sol 10MG/5ML, 23
Millipred TAB 5MG, 23
mimvey LO TAB 0.5-0.1, 24
mimvey TAB 1-0.5MG, 24
Minastrin 24 Chw FE, 26
Minipress CAP 1MG, 13
minitran dis 0.1MG/HR, 9
Minivelle Dis 0.025 MG, 24
Minivelle Dis 0.0375MG, 24
Minocin CAP 100MG, 3
Minocin CAP 50MG, 3
minocin CAP 75MG, 2
Minocin Kit 100MG, 3
Minocin Kit 50MG, 3
minocycline CAP 100MG, 2
minocycline TAB 100MG, 2
minocycline TAB 135MG ER, 3
minoxidil TAB 10MG, 12
minoxidil TAB 2.5MG, 12
Mirapex ER TAB 0.375MG, 46
Mirapex ER TAB 3MG, 46
Mirapex TAB 0.125MG, 46
Mirapex TAB 1MG, 46
Mircera Inj 100mcg, 35
Mircette TAB 28 Day, 26
Mirena Iud System, 25
mirtazapine TAB 15MG, 38
mirtazapine TAB 15MG odt, 38
mirtazapine TAB 7.5MG, 38
Mirvaso Gel 0.33%, 18
misoprostol TAB 100mcg, 31
misoprostol TAB 200mcg, 31
Mitigare CAP 0.6MG, 56
Mld Kit, 56
Mlk F1 Kit, 23
Mlk F2 Kit, 23
Mlk F3 Kit, 23
Mlk F4 Kit, 23
Mlp A-1 Kit, 23
Mobic Sus 7.5/5ML, 55
Mobic TAB 15MG, 55
Mobic TAB 7.5MG, 55
modafinil TAB 100MG, 42
modafinil TAB 200MG, 42
Moderiba PAK 1000/Day, 5
moderiba TAB 200MG, 4
Modicon TAB 0.5/35, 26
moexipr/hctz TAB 15-12.5, 13
moexipr/hctz TAB 15-25MG, 13
moexipr/hctz TAB 7.5-12.5, 13
moexipril TAB 15MG, 11
moexipril TAB 7.5MG, 11
molindone TAB HCL 10MG, 40
mometasone CRE 0.1%, 19
mometasone oin 0.1%, 19
mometasone sol 0.1%, 19
mometasone spr 50mcg, 57
mondoxyne nl CAP 100MG, 2
mono-linyah TAB 0.25-35, 25
Monodox CAP 100MG, 3
Monodox CAP 75MG, 3
Monolet Mis Lancets, 63
Monolet Opd Mis Lancets, 63
Monolettor Mis Lancets, 63
mononessa TAB, 25
Monsels Ferr Sol Subsulf, 37
montelukast chw 4MG, 58
montelukast chw 5MG, 58
montelukast gra 4MG, 58
montelukast TAB 10MG, 58
Monurol PAK Granules, 34
morgidox CAP 1X100MG, 3
Morgidox Kit 1X100MG, 3
morphine SUL CAP 100MG ER, 52
morphine SUL inj 0.5MG/ML, 52
morphine SUL inj 10/0.7ML, 52
morphine SUL inj 10MG/ML, 52
morphine SUL sol 100/5ML, 52
morphine SUL sol 10MG/5ML, 52
morphine SUL sol 20MG/5ML, 52
morphine SUL sup 10MG, 52
morphine SUL TAB 100MG ER, 52
morphine SUL TAB 15MG, 52
morphine SUL TAB 30MG, 52
Motofen TAB 1-0.025, 31
Movantik TAB 12.5MG, 33
Movantik TAB 25MG, 33
Moviprep Sol, 31
Moxatag TAB 775MG, 1
Moxeza Sol 0.5%, 49
moxifloxacin TAB 400MG, 3
MS Contin TAB 100MG CR, 53
Multaq TAB 400MG, 11
Multi- Kit Specialt, 23
multi-lancet mis device, 60
multigen pls TAB, 35
multigen TAB, 35
multigen TAB folic, 35
mupirocin CA CRE 2%, 18
mupirocin CRE 2%, 18
mupirocin oin 2%, 18
MV FE/c/b12/ TAB CA/succ, 35
MV FE/c/b12/ TAB fa/succ, 35
my way TAB 1.5MG, 25
Myalept Inj 11.3MG, 30
Myambutol TAB 100MG, 3
Myambutol TAB 400MG, 3
Mycobutin CAP 150MG, 3
mycophenolat CAP 250MG, 7
mycophenolat sus 200MG/ML, 7
mycophenolat TAB 500MG, 7
mycophenolic TAB 180MG DR, 7
mycophenolic TAB 360MG DR, 7
myferon 150 CAP forte, 35
Myfortic TAB 180MG, 7
Myfortic TAB 360MG, 7
Myglucohealt Mis Lanc 30G, 63
Myglucohealt Sol LO/Nl/HI, 63
Myleran TAB 2MG, 6
myorisan CAP 10MG, 16
Myrbetriq TAB 25MG, 34
Myrbetriq TAB 50MG, 34
Mysoline TAB 250MG, 45
Mysoline TAB 50MG, 45
Mytesi TAB 125MG, 31
myzilra TAB, 25
N
nabumetone TAB 500MG, 54
nabumetone TAB 750MG, 54
nadolol TAB 20MG, 9
nadolol TAB 40MG, 9
nadolol TAB 80MG, 9
nadolol/bend TAB 40-5MG, 13
nadolol/bend TAB 80-5MG, 13
nafcillin inj 10gm, 1
Nafrinse Sol Daily, 37
Nafrinse Wk Sol 0.2%, 37
naftifine CRE HCL 1%, 18
naftifine CRE HCL 2%, 18
Naftin CRE 1%, 18
Naftin CRE 2%, 18
Naftin Gel 1%, 18
Naftin Gel 2%, 18
nalbuphine inj 10MG/ML, 52
nalbuphine inj 20MG/ML, 52
Nalfon CAP 400MG, 55
Namenda Sol 10MG/5ML, 48
Namenda TAB 10MG, 48
Namenda TAB 5-10MG, 48
Namenda TAB 5MG, 48
Namenda XR CAP 14MG, 48
Namenda XR CAP Titratio, 48
Namzaric CAP 14-10MG, 48
naphazoline sol 0.1% op, 50
Naprelan TAB 375MG CR, 55
Napropak PAK, 55
Napropak PAK Cool, 55
Napropax Mis, 18
Naprosyn Sus 125/5ML, 55
Naprosyn TAB 250MG, 55
naproxen DR TAB 375MG, 54
naproxen DR TAB 500MG, 54
naproxen sod TAB 275MG, 54
naproxen sod TAB 375MG CR, 54
naproxen sod TAB 500MG CR, 54
naproxen sus 125/5ML, 54
naproxen TAB 250MG, 54
Naproxenpax Mis, 19
naratriptan TAB 1MG, 55
naratriptan TAB 2.5MG, 55
Nardil TAB 15MG, 39
Naropin Inj 10MG/ML, 56
Naropin Inj 7.5MG/ML, 56
Nascobal Spr 500mcg, 35
Nasonex Spr 50mcg/Ac, 57
Natacyn Sus 5% Op, 49
Natalvirt TAB Flt, 35
Natazia TAB, 26
nateglinide TAB 120MG, 27
nateglinide TAB 60MG, 27
Natesto Gel 5.5MG, 24
Natpara Inj 100mcg, 28
Natroba Sus 0.9%, 22
Nature Throi TAB 162.5MG, 30
Nature-throi TAB 113.75MG, 30
nature-throi TAB 130MG, 30
nature-throi TAB 16.25MG, 30
Nature-throi TAB 260MG, 30
nature-throi TAB 32.5MG, 30
Nature-throi TAB 325MG, 30
Nebupent Inh 300MG, 6
nebusal neb 3%, 57
Nebusal Neb 6%, 57
necon TAB 0.5/35, 25
necon TAB 1/35, 25
necon TAB 1/50-28, 25
necon TAB 10/11-28, 25
necon TAB 7/7/7, 25
nefazodone TAB 100MG, 39
Nembutal Sod Inj 50MG/ML, 42
neo-polycin oin HC 1%op, 49
neo-polycin oin op, 49
Neo-synalar CRE, 18
Neo-synalar Kit, 18
neo/bac/poly oin op, 49
neo/poly GU sol 40/ML IR, 35
neo/poly/bac oin /HC 1%op, 49
neo/poly/dex oin 0.1% op, 49
neo/poly/dex sus 0.1% op, 49
neo/poly/gra sol op, 49
neo/poly/HC sol 1% otic, 51
neo/poly/HC sus 1% otic, 51
neo/poly/HC sus op, 50
neofrin sol 10% op, 50
neofrin sol 2.5% op, 50
neomycin TAB 500MG, 3
Neoral CAP 100MG, 7
Neoral CAP 25MG, 7
Neoral Sol 100MG/ML, 7
Neosalus Aer, 22
Neosalus CP CRE, 22
Neosalus CRE, 22
Neosporin GU Sol 40/ML IR, 35
Neosporin Sol Op, 49
neostig meth inj 0.5MG/ML, 49
neostig meth inj 1MG/ML, 49
Nephron Fa TAB, 35
Neptazane TAB 25MG, 14
Neptazane TAB 50MG, 14
Nesacaine Inj -mpf 2%, 56
Nesacaine Inj -mpf 3%, 56
Nesacaine Inj 1%, 56
Nesacaine Inj 2%, 56
Nesina TAB 12.5MG, 27
Nesina TAB 25MG, 27
Nesina TAB 6.25MG, 27
Nessi Spacer Mis Large, 66
Nessi Spacer Mis Mouthpc, 66
Nessi Spacer Mis Sm/MED, 66
neuac gel 1.2-5%, 17
Neulasta Inj 6MG/0.6m, 36
Neulasta Kit 6MG/0.6m, 36
Neumega Inj 5MG, 36
Neupogen Inj 300/0.5, 36
Neupogen Inj 300mcg, 36
Neupogen Inj 480/0.8, 36
Neupogen Inj 480mcg, 36
Neupro Dis 1MG/24HR, 46
Neurontin CAP 100MG, 45
Neurontin Sol 250/5ML, 45
Neurontin TAB 600MG, 45
Neurontin TAB 800MG, 45
Neutek 2tek Sol Control, 63
Neutrasal Pow, 37
Neuvaxin Pad 0.0375-5, 22
Nevanac Sus 0.1%, 50
nevirapine sus 50MG/5ML, 4
nevirapine TAB 100MG, 5
nevirapine TAB 200MG, 4
nevirapine TAB 400MG ER, 4
Nexavar TAB 200MG, 8
Nexgen Tes Norm CON, 63
next choice TAB 1.5MG, 25
niacin ER TAB 1000MG, 15
niacin TAB 500MG ER, 15
niacor TAB 500MG, 15
Niaspan TAB 1000 ER, 15
Niaspan TAB 500MG ER, 15
Niaspan TAB 750MG ER, 15
Nicadan TAB, 60
nicardipine CAP 20MG, 10
nicardipine CAP 30MG, 10
Nicazeldoxy Kit 30, 3
Nicazeldoxy Kit 60, 3
Nicoderm CQ Dis 14MG/24h, 47
Nicoderm CQ Dis 21MG/24h, 47
Nicoderm CQ Dis 7MG/24HR, 47
nicorelief gum 2MG mint, 47
nicorelief gum 2MG orig, 47
nicorelief gum 4MG mint, 47
nicorelief gum 4MG orig, 47
Nicorette Gum 2MG Cinn, 47
Nicorette Gum 2MG Mint, 47
Nicorette Gum 2MG Orig, 47
Nicorette Gum 2mgfruit, 47
Nicorette Gum 4MG Cinn, 47
Nicorette Gum 4MG Mint, 47
Nicorette Gum 4MG Orig, 47
Nicorette Gum 4mgfruit, 47
Nicorette Loz 2MG Chry, 47
Nicorette Loz 2MG Mint, 47
Nicorette Loz 2MG Orig, 47
Nicorette Loz 4MG Chry, 47
Nicorette Loz 4MG Mint, 47
Nicorette Loz 4MG Orig, 47
Nicorette ST Gum 2MG, 47
Nicorette ST Gum 2MG Mint, 47
Nicorette ST Gum 2MG Orig, 47
Nicorette ST Gum 4MG Mint, 47
Nicorette ST Gum 4MG Orig, 47
nicotine dis 14MG/24h, 46
nicotine dis 21MG/24h, 46
nicotine dis 7MG/24HR, 46
nicotine dis step 1, 46
nicotine gum 2mgfruit, 47
nicotine gum 4MG, 47
nicotine loz 2MG chry, 47
nicotine loz 2MG mint, 47
nicotine loz 4MG chry, 47
nicotine loz 4MG cinn, 47
nicotine loz 4MG mint, 47
nicotine loz mini 2MG, 47
nicotine pol gum 2MG, 47
nicotine pol gum 2MG cinn, 47
nicotine pol gum 2MG mint, 47
nicotine pol gum 2MG orig, 47
nicotine pol gum 2MG ref, 47
nicotine pol gum 2MG strt, 47
nicotine pol gum 2mgfruit, 47
nicotine pol gum 4MG, 47
nicotine pol gum 4MG cinn, 47
nicotine pol gum 4MG mint, 47
nicotine pol gum 4MG orig, 47
nicotine pol gum 4MG ref, 47
nicotine pol gum 4MG strt, 47
nicotine pol gum 4mgfruit, 47
nicotine pol loz 2MG chry, 47
nicotine pol loz 2MG cinn, 47
nicotine pol loz 2MG mint, 47
nicotine pol loz 4MG chry, 47
nicotine pol loz 4MG cinn, 47
nicotine pol loz 4MG mint, 47
nicotine SYS kit transder, 46
nicotine TD dis 14MG/24h, 46
nicotine TD dis 21MG/24h, 46
nicotine TD dis 7MG/24HR, 46
nifedical XL TAB 30MG, 10
nifedical XL TAB 60MG, 10
nifedipine CAP 10MG, 10
nifedipine CAP 20MG, 10
nifedipine TAB 30MG ER, 10
nikki TAB 3-0.02MG, 26
Nilandron TAB 150MG, 7
nilutamide TAB 150MG, 7
nimodipine CAP 30MG, 10
Ninlaro CAP 2.3MG, 8
Ninlaro CAP 3MG, 8
Ninlaro CAP 4MG, 8
nisoldipine TAB 17MG ER, 10
nisoldipine TAB 20MG, 10
nisoldipine TAB 25.5MG, 10
nisoldipine TAB 34MG ER, 11
nisoldipine TAB 8.5MG ER, 11
Nitro-bid Oin 2%, 9
Nitro-dur Dis 0.1MG/HR, 9
nitro-time CAP 2.5MG CR, 9
nitro-time CAP 6.5MG CR, 9
nitro-time CAP 9MG CR, 9
nitrofur mac CAP 100MG, 34
nitrofurantn CAP 100MG, 34
nitrofurantn sus 25MG/5ML, 34
nitroglycer aer 400mcg, 9
nitroglycer CAP 2.5MG ER, 9
nitroglycer CAP 6.5MG ER, 9
nitroglycer CAP 9MG ER, 9
nitroglycer dis 0.1MG/HR, 9
nitroglyceri sub 0.6MG, 9
nitroglycern sub 0.3MG, 9
nitroglycern sub 0.4MG, 9
nitroglycrn spr 0.4MG, 9
nitroglycrn spr lingual, 9
Nitrolingual Spr Pumpspra, 9
Nitromist Aer 400mcg, 9
Nitrostat Sub 0.3MG, 9
Nivatopic CRE Plus, 22
nizatidine CAP 150MG, 32
nizatidine CAP 300MG, 32
nizatidine sol 15MG/ML, 31
Nizoral Sha 2%, 18
nodolor CAP, 55
Nor-QD TAB 0.35MG, 26
nora-be TAB 0.35MG, 25
Norco TAB 10-325MG, 53
Norco TAB 5-325MG, 53
Norco TAB 7.5-325, 53
Norditropin Inj 10/1.5ML, 29
Norditropin Inj 30/3ML, 29
noreth/ethin chw FE, 26
noreth/ethin TAB 0.5-2.5, 24
noreth/ethin TAB 1/20, 25
noreth/ethin TAB 1MG-5mcg, 24
noreth/ethin TAB FE 1/20, 25
norethin ace TAB 5MG, 26
norethindron TAB 0.35MG, 25
Norflex Inj 30MG/ML, 49
norgest/ethi TAB 0.25/35, 25
norgest/ethi TAB estradio, 25
Norinyl TAB 1+50-28, 26
Norinyl TAB 1/35, 26
Noritate CRE 1%, 18
norlyroc TAB 0.35MG, 25
Noroxin TAB 400MG, 3
Norpace CAP 100MG, 11
Norpace CAP 100MG CR, 11
Norpace CAP 150MG, 11
Norpace CAP 150MG CR, 11
Norpramin TAB 100MG, 39
Northera CAP 100MG, 15
nortrel TAB 0.5/35, 25
nortrel TAB 1/35, 25
nortrel TAB 7/7/7, 25
nortriptylin CAP 10MG, 38
nortriptylin sol 10MG/5ML, 38
nortuss-EX liq 200-20/5, 57
Norvasc TAB 10MG, 11
Norvasc TAB 2.5MG, 11
Norvasc TAB 5MG, 11
Norvir CAP 100MG, 4
Norvir Sol 80MG/ML, 4
Norvir TAB 100MG, 4
Nova Max Glu Liq /Ket CON, 63
Nova Safety Mis Lanc 23G, 63
Nova Safety Mis Lanc 28G, 63
Nova Sure Mis Lancets, 63
Nova Sureflx Mis Lanc Dev, 63
Novacort Gel, 20
Novaferrum Sol, 36
Novofine Aut Mis 30GX8MM, 63
Novofine Mis 30GX8MM, 63
Novofine Mis 32GX6MM, 63
Novofine Pls Mis 32GX4MM, 63
Novolin Inj 70/30, 26
Novolin N Inj Relion, 26
Novolin N Inj U-100, 26
Novolin R Inj Relion, 26
Novolin R Inj U-100, 26
Novolin70/30 Inj Relion, 26
Novolog Inj 100/ML, 26
Novolog Inj Flexpen, 26
Novolog Inj Penfill, 26
Novolog Mix Inj 70/30, 26
Novolog Mix Inj Flexpen, 26
Novotwist Mis 30GX8MM, 63
Novotwist Mis 32GX5MM, 63
Noxafil Sus 40MG/ML, 4
Noxafil TAB 100MG, 4
Noxifol-d TAB, 36
Noxipak PAK, 20
NP thyroid TAB 30MG, 30
Nucala Inj 100MG, 58
Nucort Lot 2%, 20
Nucynta ER TAB 100MG, 53
Nucynta TAB 100MG, 53
Nuedexta CAP 20-10MG, 48
nulev TAB 0.125MG, 32
Nulytely Sol Flav Pks, 31
numoisyn liq, 37
Numoisyn Loz, 37
Nuox Gel 6-3%, 17
Nuplazid TAB 17MG, 41
Nutridox Kit, 3
Nutropin AQ Inj 10MG/2ML, 29
Nutropin AQ Inj 20MG/2ML, 29
Nutropin AQ Inj Nuspin 5, 29
Nuvaring Mis, 25
Nuvessa Gel 1.3%, 34
Nuvigil TAB 150MG, 43
Nuzon Gel 2%, 20
nyamyc pow 100000, 18
Nymalize Sol 60/20ML, 11
nystat/triam CRE, 18
nystat/triam oin, 18
nystatin CRE 100000, 18
nystatin oin 100000, 18
nystatin pow, 4
nystatin pow 100000, 18
nystatin sus 100000, 37
nystatin TAB 500000, 4
nystop pow 100000, 18
O
Obredon Sol 2.5-200, 57
Ocaliva TAB 10MG, 34
Ocaliva TAB 5MG, 34
ocella TAB 3-0.03MG, 25
octreotide inj 1000mcg, 29
octreotide inj 50mcg/ML, 29
Ocufen Sol 0.03% Op, 50
Ocuflox Dro 0.3% Op, 49
Odefsey TAB, 5
Ofev CAP 100MG, 59
Ofev CAP 150MG, 59
ofloxacin dro 0.3% op, 49
ofloxacin dro 0.3%otic, 51
ofloxacin TAB 400MG, 3
ogestrel TAB, 25
olanza/fluox CAP 12-25MG, 47
olanzapine inj 10MG, 40
olanzapine TAB 10MG, 40
olanzapine TAB 10MG odt, 40
olanzapine TAB 2.5MG, 40
olanzapine TAB 7.5MG, 40
Oleptro TAB 24HR150, 39
Oleptro TAB 24HR300, 39
olopatadine dro 0.1%, 50
olopatadine spr 0.6%, 57
Olux Aer 0.05%, 20
Olux-e Aer 0.05%, 20
Olysio CAP 150MG, 5
Omeclamox- Mis PAK, 32
omega-3-acid CAP 1gm, 15
Omega-3/D-3 Kit Wellness, 15
omepra/bicar CAP 20-1100, 32
omepra/bicar CAP 40-1100, 32
omepra/bicar pow 20-1680, 32
omepra/bicar pow 40-1680, 32
Omeprazole + Sus Syrspend, 32
omeprazole CAP 10MG, 31
Omnaris Spr, 57
Omnipred Sus 1% Op, 50
Omnitrope Inj 10/1.5ML, 28
Omnitrope Inj 5.8MG, 28
Omnitrope Inj 5/1.5ML, 28
Omontys Inj 10MG/ML, 36
Omontys Inj 20MG/2ML, 36
On Call Expr Sol Glucose, 63
On Call Mis Lancets, 63
On Call Plus Mis Lancets, 63
On Call Plus Sol Control, 63
On Call Vivd Sol Control, 63
On-the-go Mis Lanc 30G, 63
ondansetron inj 40/20ML, 32
ondansetron inj 4MG/2ML, 32
ondansetron sol 4MG/5ML, 32
ondansetron TAB 24MG, 32
ondansetron TAB 4MG odt, 32
ondansetron TAB 8MG odt, 32
Onetouch Fp Mis Lancets, 63
Onetouch Mis 30G, 65
Onetouch Mis Combo, 63
Onetouch Mis Lanc Dev, 65
Onetouch Mis Lancets, 65
Onetouch Sol Ult Cont, 63
Onetouch Sol Verio, 63
Onetouch Sol Verio-HI, 63
Onetouch Tes Ultra, 63
Onetouch Tes Ultra BL, 63
Onetouch Tes Verio, 63
Onetouch Us Mis Lancets, 65
Onexton Gel 1.2-3.75, 17
Onfi Sus 2.5MG/ML, 45
Onfi TAB 10MG, 45
Onfi TAB 20MG, 45
Onglyza TAB 2.5MG, 27
Onglyza TAB 5MG, 27
Onmel TAB 200MG, 4
Opana ER TAB 10MG, 53
Opana ER TAB 7.5MG, 53
Opana Inj 1MG/ML, 53
Opana TAB 10MG, 53
Opana TAB 5MG, 53
opcicon TAB 1.5MG, 25
opium tin 1%, 31
Opsumit TAB 10MG, 16
Optichamber Mis Adv Lrg, 66
Optichamber Mis Adv MED, 66
Optichamber Mis Adv Sm, 66
Optichamber Mis Advantag, 66
Optichamber Mis Dia LG, 66
Optichamber Mis Dia MD, 66
Optichamber Mis Dia Sm, 66
Optichamber Mis Diamond, 66
Optihaler Mis, 66
Optivar Dro 0.05%, 50
Optumrx Cont Sol Level1/2, 63
Oracea CAP 40MG, 18
Oracit Sol, 35
oralone pst 0.1%, 37
Orap TAB 1MG, 48
Orap TAB 2MG, 48
Orapred Odt TAB 10MG, 23
Oravig TAB 50MG, 37
Orencia Clck Inj 125MG/ML, 55
Orencia Inj 125MG/ML, 55
Orenitram TAB 0.125MG, 16
Orenitram TAB 1MG, 16
Orfadin CAP 10MG, 30
Orfadin CAP 20MG, 30
Orfadin CAP 2MG, 30
Orfadin CAP 5MG, 30
Orkambi TAB 200-125, 59
orphenadrine inj 30MG/ML, 48
orphenadrine TAB 100MG ER, 48
orsythia TAB, 25
Ortho Evra Dis Week, 26
Ortho Micron TAB 0.35MG, 26
Ortho Tri- TAB Cyclen, 26
Ortho Tri- TAB Cycln LO, 26
Ortho-cept TAB 28, 26
ortho-CS 250 inj 250MG/ML, 59
Ortho-cyclen TAB 0.25/35, 26
ortho-est TAB 0.625, 24
ortho-est TAB 1.25, 24
Ortho-novum TAB 1/35, 26
Ortho-novum TAB 7/7/7, 26
oscimin SR TAB 0.375MG, 32
oscimin sub 0.125MG, 32
oscimin TAB 0.125MG, 32
oscion clnsr lot 6%, 17
Oseni TAB 12.5-15, 28
Oseni TAB 12.5-30, 28
Oseni TAB 12.5-45, 28
Oseni TAB 25-15MG, 28
Osmoprep TAB 1.5gm, 31
Osphena TAB 60MG, 28
Otezla TAB 10/20/30, 55
Otezla TAB 30MG, 55
otic care dro, 51
oticin dro 1-0.1%, 51
Oticin HC Dro, 51
oto-end 10 sol, 51
otomax-HC dro, 51
Otovel Dro, 51
otozin dro, 51
Otrexup Inj 10MG, 55
Otrexup Inj 12.5/0.4, 55
Ovace Plus Aer 9.8%, 19
Ovace Plus CRE 10%, 19
Ovace Plus Gel 10% Wash, 19
Ovace Plus Liq 10% Wash, 19
Ovace Plus Sha 10%, 19
Ovace Wash Liq 10%, 19
Ovcon-35 TAB, 26
Ovide Lot 0.5%, 22
oxacillin inj 10gm, 1
Oxandrin TAB 10MG, 24
Oxandrin TAB 2.5MG, 24
oxandrolone TAB 10MG, 23
oxandrolone TAB 2.5MG, 23
oxaprozin TAB 600MG, 54
Oxaydo TAB 5MG, 53
Oxaydo TAB 7.5MG, 53
oxazepam CAP 10MG, 38
oxcarbazepin sus 300MG/5m, 44
oxcarbazepin TAB 150MG, 44
oxiconazole CRE nitrate, 18
Oxistat CRE 1%, 18
Oxistat Lot 1%, 18
Oxsoralen Lot 1%, 22
Oxsoralen-ul CAP 10MG, 19
Oxtellar XR TAB 150MG, 45
oxybutynin syp 5MG/5ML, 34
oxybutynin TAB 10MG ER, 34
oxybutynin TAB 5MG, 34
oxycod/apap TAB 10-325MG, 52
oxycod/apap TAB 2.5-325, 52
oxycod/apap TAB 5-325MG, 52
oxycod/apap TAB 7.5-325, 52
oxycod/asa TAB, 52
oxycod/ibu TAB 5-400MG, 52
oxycodone CAP 5MG, 52
oxycodone CON 100/5ML, 52
oxycodone CON 20MG/ML, 52
oxycodone sol 5MG/5ML, 52
oxycodone TAB 10MG, 52
oxycodone TAB 10MG ER, 52
oxycodone/ sol apap, 52
Oxycontin TAB 10MG CR, 52
oxymorphone TAB 10MG ER, 52
oxymorphone TAB 7.5MG ER, 52
oxymorphone TAB HCL 10MG, 52
oxymorphone TAB HCL 5MG, 52
oxytocin inj 10unt/ML, 51
Oxytrol Dis 3.9MG/24, 34
P
pacerone TAB 100MG, 11
Pain Ease Aer MD Strm, 22
Pain Ease Aer Mist, 22
Pain Relief Pad Patch, 22
paliperidone TAB ER 1.5MG, 40
paliperidone TAB ER 3MG, 40
Pamelor CAP 10MG, 39
Pamine Forte TAB 5MG, 32
Pamine FQ Kit, 32
Pamine TAB 2.5MG, 32
Panatuss Dxp Liq, 57
Pancreaze CAP 10500unt, 33
Pancreaze CAP 4200unit, 33
pancrelipase CAP 5000unit, 32
Panda Mask Mis Large, 66
Panda Mask Mis Medium, 66
Panda Mask Mis Pediatri, 66
Panda Mask Mis Small, 66
Pandel CRE 0.1%, 20
pantoprazole TAB 20MG, 31
pantoprazole TAB 40MG, 31
papaverine inj 30MG/ML, 16
papaverine sol 30MG/ML, 16
Parafon Fort TAB 500MG, 49
Paragard Iud T380a, 25
parcaine sol 0.5% op, 50
paregoric tin 2MG/5ML, 31
paricalcitol CAP 1 mcg, 29
Parlodel CAP 5MG, 46
Parnate TAB 10MG, 39
paromomycin CAP 250MG, 3
paroxetin ER TAB 12.5MG, 39
paroxetin ER TAB 37.5MG, 39
paroxetine TAB 10MG, 38
paroxetine TAB 25MG ER, 39
Paser Gra 4gm, 3
Pataday Sol 0.2%, 50
Patanase Spr 0.6%, 57
Patanol Sol 0.1% Op, 50
Paxil CR TAB 12.5MG, 39
Paxil CR TAB 25MG, 39
Paxil CR TAB 37.5MG, 39
Paxil Sus 10MG/5ML, 39
Paxil TAB 10MG, 39
Paxil TAB 20MG, 39
Paxil TAB 30MG, 39
Paxil TAB 40MG, 39
Pazeo Dro 0.7%, 50
PC Lancets Mis 30G, 64
PCE TAB 333MG EC, 2
PCE TAB 500MG EC, 2
Pcp 100 Kit, 31
PE/guaifenes dro 1.5-20MG, 57
Pediaderm AF Kit Complete, 18
Pediaderm HC Kit, 20
Pediaderm Ta Kit, 20
Pediapred Sol 6.7/5ML, 23
Pediarix Inj 0.5ML, 59
Pedipak PAK, 18
Pedvax HIB Inj, 59
peg 3350 sol electrol, 31
peg-3350 sol electrol, 31
peg-3350/KCL sol /sodium, 31
Peg-intron Kit 120 Rp, 5
Peg-intron Kit 120mcg, 5
Peg-intron Kit 150 Rp, 5
Peg-intron Kit 50mcg Rp, 5
Peg-intron Kit 80mcg Rp, 5
peg-prep kit, 31
Peganone TAB 250MG, 45
Pegasys Inj, 5
Pegasys Inj 180mcg/M, 5
Pegasys Inj Proclick, 5
Pegintron Kit 120mcg, 5
pegylax pow, 31
pen G proc inj 600000, 1
pen G sod inj 5000000, 1
Pen Needle Mis 29GX1/2", 63
Pen Needle Mis 32GX4MM, 63
pen needles mis 29GX1/2", 60
Pen Needles Mis 29GX1/2", 63
Pen Needles Mis 29GX12.7, 63
pen needles mis 29GX12MM, 60
Pen Needles Mis 29GX12MM, 63
pen needles mis 30GX5/16, 60
Pen Needles Mis 30GX5/16, 63
pen needles mis 31GX1/4", 60
Pen Needles Mis 31GX1/4", 63
penicilln GK inj 20mu, 1
penicilln GK inj 5mu, 1
penicilln vk sol 125/5ML, 1
penicilln vk sol 250/5ML, 1
penicilln vk TAB 250MG, 1
penicilln vk TAB 500MG, 1
Penlac Sol 8%, 18
Penlet II Kit Blood, 65
Pennsaid Sol 1.5%, 19
Pennsaid Sol 2%, 19
Pentacel Inj, 59
Pentam 300 Inj 300MG, 6
Pentasa CAP 250MG CR, 33
Pentasa CAP 500MG CR, 33
pentaz/nalox TAB 50-0.5MG, 52
Pentips Mis 29GX12MM, 63
pentoxifylli TAB 400MG ER, 37
Pepcid Sus 40MG/5ML, 32
Pepcid TAB 20MG, 32
Pepcid TAB 40MG, 32
Percocet TAB 10-325MG, 53
Percocet TAB 2.5-325, 53
Percocet TAB 5-325MG, 53
Percocet TAB 7.5-325, 53
Percodan TAB, 53
Perfect 28G Mis Lancets, 63
Perfect 30G Mis Lancets, 63
Perforomist Neb 20mcg, 58
perindopril TAB 2MG, 11
Permavan Pad, 22
permethrin CRE 5%, 21
perphen/amit TAB 2-10MG, 46
perphenazine TAB 16MG, 40
Persantine TAB 25MG, 37
Pertzye CAP, 33
Pexeva TAB 10MG, 39
Pexeva TAB 20MG, 39
Pexeva TAB 30MG, 39
Pexeva TAB 40MG, 39
Pfizerpen-G Inj 20mu, 1
pfizerpen-G inj 5mu, 1
Pfizerpen-G Inj 5mu, 1
pharbedryl CAP 50MG, 57
Pharmacy Cou Mis Lancets, 63
phenadoz sup 12.5MG, 57
phenadoz sup 25MG, 57
phenazo TAB 200MG, 35
phenazopyrid TAB 100MG, 35
phenazopyrid TAB 200MG, 35
phenelzine TAB 15MG, 38
Phener Fort Syp 25MG/5ML, 57
Phenergan Inj 25MG/ML, 57
Phenergan Inj 50MG/ML, 57
phenergan sup 12.5MG, 57
phenergan sup 25MG, 57
phenergan sup 50MG, 57
phenobarb elx 20MG/5ML, 41
phenobarb inj 130MG/ML, 41
phenobarb inj 65MG/ML, 41
phenobarb sol 20MG/5ML, 41
phenobarb TAB 100MG, 41
phenobarb TAB 16.2MG, 41
phenohytro TAB, 32
phenoxybenza CAP 10MG, 12
phentolamine inj 5MG, 12
phentolamine inj mesylate, 12
phenylbutyra pow sodium, 30
phenylephrin inj 10MG/ML, 15
phenylephrin sol 10% op, 50
phenylephrin sol 2.5% op, 50
Phenytek CAP 200MG, 45
Phenytek CAP 300MG, 45
phenytoin chw 50MG, 44
phenytoin EX CAP 100MG, 44
phenytoin inj 50MG/ML, 44
phenytoin sus 125/5ML, 44
philith TAB 0.4-35, 25
Phoslo CAP 667MG, 33
Phoslyra Sol, 33
Phospholine Sol 0.125%op, 50
phytonadione inj 1MG/0.5, 59
pilocarpine sol 1% op, 50
pilocarpine TAB 5MG, 37
pilocarpine TAB 7.5MG, 37
pimozide TAB 1MG, 46
pimozide TAB 2MG, 46
pimtrea TAB, 26
pindolol TAB 10MG, 9
pindolol TAB 5MG, 9
Pinnacaine Dro 20% Otic, 51
pioglit/glim TAB 30-2MG, 28
pioglit/glim TAB 30-4MG, 28
pioglita/met TAB 15-500MG, 28
pioglita/met TAB 15-850MG, 28
pioglitazone TAB 15MG, 27
pirmella TAB 1/35, 25
pirmella TAB 7/7/7, 25
piroxicam CAP 10MG, 54
piroxicam CAP 20MG, 54
Pitocin Inj 10unt/ML, 51
Pitressin Inj 20unt/ML, 29
Plan B TAB 1.5MG, 25
Plaquenil TAB 200MG, 6
Plavix TAB 300MG, 37
Plavix TAB 75MG, 37
Plegridy Inj, 48
Plegridy Inj Pen, 48
Plegridy Inj Starter, 48
Plegridy Pen Inj Starter, 48
Pletal TAB 100MG, 37
Pletal TAB 50MG, 37
Plexion Clth Pad 9.8-4.8%, 17
Plexion CRE 9.8-4.8%, 17
Plexion Liq 9.8-4.8%, 17
Plexion Lot 9.8-4.8%, 17
pneumovax 23 inj 25/0.5, 59
Pneumovax 23 Inj 25/0.5, 59
pocket chamb mis, 65
pocket space mis, 65
Pocketchem Sol EZ, 63
podocon sol 25%, 21
podofilox sol 0.5%, 21
polocaine inj -mpf 1%, 56
polocaine inj -mpf 2%, 56
polocaine inj 1%, 56
polocaine inj 2%, 56
polocaine inj mpf 1.5%, 56
poly-dex oin 0.1% op, 49
poly-iron CAP 150 fort, 35
polycin b oin op, 49
polycin oin op, 49
polyeth GLYC pow 3350 NF, 31
polymyxin b inj 500000, 6
polymyxin b/ sol trimethp, 49
Polytrim Sol Op, 49
Pomalyst CAP 1MG, 7
Pomalyst CAP 2MG, 7
Pomalyst CAP 3MG, 7
Pomalyst CAP 4MG, 7
Ponstel CAP 250MG, 55
portia-28 TAB, 25
pot citrate TAB 1080MG, 35
pot citrate TAB 1620MG, 35
pot citrate TAB 540MG ER, 35
pot citrate- PAK CIT acid, 35
Potaba CAP 500MG, 59
Potiga TAB 200MG, 45
Potiga TAB 50MG, 45
Pradaxa CAP 110MG, 36
Praluent Inj 150MG/ML, 15
Praluent Inj 75MG/ML, 15
pramcort CRE 1-1%, 33
pramipexole TAB 0.125MG, 45
pramipexole TAB 0.75 ER, 45
pramipexole TAB 1.5MG ER, 45
pramipexole TAB 1MG, 45
pramipexole TAB 3MG, 45
Pramosone CRE 1%, 20
Pramosone CRE 1-1%, 20
Pramosone CRE 1-2.5%, 20
Pramosone E CRE 1-2.5%, 20
Pramosone Lot 1%, 20
Pramosone Lot 2.5%, 20
Pramosone Oin 1%, 20
Pramosone Oin 2.5%, 20
Pramotic Dro 1-0.1%, 51
pramox gel 1%, 21
Prandimet TAB 1-500MG, 28
Prandimet TAB 2-500MG, 28
Prandin TAB 0.5MG, 27
Prandin TAB 1MG, 27
Prandin TAB 2MG, 27
prascion emu, 17
prascion ra CRE 10-5%, 17
Pravachol TAB 20MG, 15
pravastatin TAB 10MG, 15
prazosin HCL CAP 1MG, 12
Precision Liq Control, 63
Precision Liq Gluc/Ket, 63
Precision Liq Nrml/Mid, 63
Precision Mis 28G, 63
Precision Mis 28g(t), 63
Precose TAB 100MG, 27
Pred Forte Sus 1% Op, 50
Pred Mild Sus 0.12% Op, 49
pred sod PHO sol 1% op, 50
pred sod PHO sol 5MG/5ML, 22
Pred-G S.o.p Oin Op, 49
Pred-G Sus Op, 49
predni/moxi/ sol bromfena, 50
Predni/Moxi/ Sol Ketorola, 50
prednicarbat CRE 0.1%, 20
prednicarbat oin 0.1%, 20
prednisolone sol 15MG/5ML, 23
prednisolone sol 25MG/5ML, 23
prednisolone sol moxiflox, 50
prednisolone sus 1% op, 49
prednisolone syp 15MG/5ML, 23
prednisolone TAB 10MG odt, 23
Prednisone CON 5MG/ML, 23
prednisone PAK 10MG, 23
prednisone PAK 5MG, 23
prednisone sol 5MG/5ML, 23
prednisone TAB 10MG, 23
prednisone TAB 2.5MG, 23
Prefest TAB, 24
Premarin Inj 25MG, 24
Premarin TAB 0.3MG, 24
Premarin Vag CRE 0.625MG, 34
Premphase TAB, 24
Prempro TAB .625-2.5, 24
Prempro TAB 0.3-1.5, 24
Prempro TAB 0.45-1.5, 24
Prempro TAB 0.625-5, 24
Prepidil Gel 0.5MG/3G, 51
Prepopik PAK, 31
Presera Aer, 22
Pressure Act Mis Lancet, 63
Pressure Act Mis Lancets, 63
Prestalia TAB 14-10MG, 14
Prestalia TAB 3.5-2.5, 14
Prestalia TAB 7-5MG, 14
Prevacid CAP 15MG DR, 32
Prevacid CAP 30MG DR, 32
Prevacid TAB 15MG Stb, 32
Prevacid TAB 30MG Stb, 32
prevalite pow 4gm, 15
prevalite pow 4gm pk, 15
previfem TAB, 25
Prevnar 13 Inj, 59
Prevpac Mis, 32
Prezcobix TAB 800-150, 5
Prezista Sus 100MG/ML, 5
Prezista TAB 150MG, 4
Priftin TAB 150MG, 3
Prilosec CAP 10MG, 32
Prilosec Pow 10MG, 32
Prilosec Pow 2.5MG, 32
primaquine TAB 26.3MG, 5
primidone TAB 250MG, 44
primidone TAB 50MG, 44
Primlev TAB 10-300MG, 53
Primlev TAB 5-300MG, 53
Primlev TAB 7.5-300, 53
Primsol Sol 50MG/5ML, 6
Prinivil TAB 10MG, 12
Pristiq TAB 100MG, 39
Pro Comfort Mis Lancets, 63
Pro-c-dure 5 Kit 40MG/ML, 23
Pro-c-dure 6 Kit 40MG/ML, 23
Proair HFA Aer, 58
Proair Respi Aer, 58
proben/colch TAB 500-0.5, 56
probenecid TAB 500MG, 56
Probuphine Imp Kit 74.2, 53
procainamide inj 100MG/ML, 11
procainamide inj 500MG/ML, 11
Procardia CAP 10MG, 11
Procardia XL TAB 30MG CR, 11
Procentra Sol 5MG/5ML, 43
prochlorper inj 10MG/2ML, 40
prochlorper sup 25MG, 40
prochlorper TAB 10MG, 40
prochlorper TAB 5MG, 40
Procort CRE, 33
Procrit Inj 10000/ML, 36
procto-MED CRE HC 2.5%, 33
procto-PAK CRE 1%, 33
Proctocort CRE 1%, 33
Proctocort Sup 30MG, 33
Proctofoam Aer HC 1%, 33
proctosol HC CRE 2.5%, 33
proctozone CRE -HC 2.5%, 33
Procysbi CAP 25MG, 35
Procysbi CAP 75MG, 35
Prodigy Mis 26G, 63
Prodigy Mis 28G, 63
Prodigy Mis Lanc Dev, 63
Prodigy NO Tes Coding, 63
Prodigy Sol High, 63
Prodigy Sol Low, 63
Prodrin TAB, 56
Proferrin- TAB Forte, 36
progesterone CAP 100MG, 26
progesterone CAP 200MG, 26
progesterone inj 50MG/ML, 26
Progesterone Sup VGS 100, 34
Proglycem Sus 50MG/ML, 27
Prograf CAP 0.5MG, 7
Prograf CAP 1MG, 7
Prograf CAP 5MG, 7
Prolensa Sol 0.07%, 50
Promacta TAB 12.5MG, 36
Promacta TAB 25MG, 36
prometh VC syp plain, 57
prometh VC/ syp codeine, 57
prometh/cod syp 6.25-10, 57
prometh/PE syp 6.25-5/5, 57
prometh/PE/ syp codeine, 57
promethazine inj 25MG/ML, 57
promethazine inj 50MG/ML, 57
promethazine sol 6.25/5ML, 57
promethazine sup 12.5MG, 57
promethazine sup 25MG, 57
promethazine sup 50MG, 57
promethazine syp 6.25/5ML, 57
promethazine syp DM, 57
promethazine TAB 12.5MG, 57
promethazine TAB 25MG, 57
promethazine TAB 50MG, 57
promethegan sup 12.5MG, 57
promethegan sup 25MG, 57
promethegan sup 50MG, 57
Prometrium CAP 100MG, 26
Prometrium CAP 200MG, 26
Promiseb CRE, 19
propafenone CAP 225MG ER, 11
propafenone CAP 325MG ER, 11
propafenone CAP 425MG SR, 11
propafenone TAB 150MG, 11
propanthelin TAB 15MG, 31
proparacaine sol 0.5% op, 50
propran/hctz TAB 40/25, 13
propran/hctz TAB 80/25, 13
propranolol CAP 120MG ER, 9
propranolol sol 20MG/5ML, 9
propranolol sol 40MG/5ML, 9
propranolol TAB 10MG, 9
propylthiour TAB 50MG, 30
Proquad Inj, 59
Proscar TAB 5MG, 35
Prostin E2 Sup 20MG, 51
Protonix PAK, 32
Protonix TAB 20MG, 32
Protonix TAB 40MG, 32
Protopic Oin 0.03%, 21
Protopic Oin 0.1%, 21
protriptylin TAB 10MG, 38
protriptylin TAB 5MG, 38
Proventil Aer HFA, 58
provenza pad 4-1%, 21
Provera TAB 10MG, 26
Provera TAB 2.5MG, 26
Provera TAB 5MG, 26
Provigil TAB 100MG, 43
Provigil TAB 200MG, 43
Prozac CAP 10MG, 39
Prozac CAP 20MG, 39
Prozac CAP 40MG, 39
Prozac Weekl CAP 90MG, 39
Prozena Pad 4%, 22
Pruclair CRE, 22
prudoxin CRE 5%, 19
Prudoxin CRE 5%, 19
Prumyx CRE, 22
Psorcon CRE 0.05%, 20
Pss Safe Lan Mis, 63
Pss Sel Lanc Mis, 63
Pulmicort Inh 180mcg, 58
Pulmicort Inh 90mcg, 58
Pulmicort Sus 0.25MG/2, 58
Pulmicort Sus 0.5MG/2, 58
Pulmicort Sus 1MG/2ML, 58
pulmosal neb 7%, 57
Pulmozyme Sol 1MG/ML, 59
Purefolix TAB 1-5000, 36
purevit dual CAP FE plus, 35
Purinethol TAB 50MG, 7
Purixan Sus 20MG/ML, 7
Px Lancets Mis Ult Thin, 63
Pylera CAP, 31
pyrazinamide TAB 500MG, 3
Pyridium TAB 100MG, 35
Pyridium TAB 200MG, 35
pyridostigm TAB 60MG, 49
pyridostigmi TAB 180MG, 49
pyrogall acd oin, 21
Q
Qbrelis Sol 1MG/ML, 12
Qc Lancets Mis 28G, 64
Qc Lancets Mis 30G, 64
Qc Lancing Mis Device, 64
qc nicotine gum 4MG, 47
qnapril/hctz TAB 10-12.5, 13
qnapril/hctz TAB 20-12.5, 13
qnapril/hctz TAB 20-25MG, 13
Qnasl Aer 80mcg, 57
Qnasl Child Spr 40mcg, 57
Qroxin Pad, 22
Quadracel Inj, 59
qualaquin CAP 324MG, 5
Qualaquin CAP 324MG, 6
Quartette TAB, 26
quasense TAB, 26
quazepam TAB 15MG, 42
Qudexy XR CAP 100/24HR, 45
Questran Pow 4gm, 15
Questran Pow 4gm Lite, 16
quetiapine TAB 100MG, 40
Quicktek Liq Solution, 64
Quillichew Chw 20MG ER, 43
Quillivant Sus 25MG/5ML, 43
quinapril TAB 10MG, 11
quinidine gl inj 80MG/ML, 11
quinidine gl TAB 324MG CR, 11
quinidine gl TAB 324MG ER, 11
quinidine SU TAB 200MG, 11
quinidine SU TAB 300MG, 11
quinidine SU TAB 300MG ER, 11
quinine sulf CAP 324MG, 5
Quintet Cont Sol Hgh/Norm, 64
Qutenza Kit 8% 1-pch, 22
Qutenza Kit 8% 2-pch, 22
Qvar Aer 40mcg, 58
Qvar Aer 80mcg, 58
R
Ra E-ZJECT Mis 28G, 64
Ra E-ZJECT Mis 33G, 64
Ra E-ZJECT Mis Thin 26G, 64
Ra E-ZJECT Mis Thin 28G, 64
Ra E-ZJECT Mis Ult Thin, 64
ra nicotine dis 14MG/24h, 46
ra nicotine dis 21MG/24h, 46
ra nicotine dis 7MG/24HR, 46
ra nicotine gum 2MG, 47
ra nicotine gum 2MG cinn, 47
ra nicotine gum 2MG mint, 47
ra nicotine gum 2mgfruit, 47
ra nicotine gum 4MG, 47
ra nicotine gum 4MG frut, 47
ra nicotine gum 4MG mint, 47
ra nicotine loz 2MG mint, 47
ra nicotine loz 4MG mint, 47
Ra Pen Needl Mis 31GX3/16, 64
Rabavert Inj, 59
rabeprazole TAB 20MG, 31
raloxifene TAB 60MG, 28
ramipril CAP 1.25MG, 12
ramipril CAP 10MG, 12
ramipril CAP 2.5MG, 12
ramipril CAP 5MG, 12
Ranexa TAB 1000MG, 9
Ranexa TAB 500MG, 9
ranitidine CAP 150MG, 32
ranitidine CAP 300MG, 32
ranitidine inj 150/6ML, 31
ranitidine inj 50MG/2ML, 31
ranitidine syp 150/10ML, 31
ranitidine syp 15MG/ML, 31
ranitidine syp 75MG/5ML, 31
ranitidine TAB 150MG, 31
ranitidine TAB 300MG, 31
Rapaflo CAP 4MG, 35
Rapaflo CAP 8MG, 35
Rapamune Sol 1MG/ML, 7
Rapamune TAB 0.5MG, 7
Rapamune TAB 1MG, 7
Rapamune TAB 2MG, 7
Rasuvo Inj 10MG, 54
Rasuvo Inj 12.5MG, 54
Rasuvo Inj 15MG, 54
Rasuvo Inj 20MG, 54
Rasuvo Inj 25MG, 54
Rasuvo Inj 30MG, 54
Ravicti Liq 1.1gm/ML, 30
Rayos TAB 1MG, 23
Rayos TAB 2MG, 23
Rayos TAB 5MG, 23
Razadyne ER CAP 16MG, 48
Razadyne Sol 4MG/ML, 48
Razadyne TAB 12MG, 48
rea LO 39 CRE 39%, 21
rea LO 40 CRE 40%, 21
rea LO 40 lot 40%, 21
react TAB 1.5MG, 25
Reality Mis Lancets, 64
Reality Trig Mis Lancets, 64
Rebetol CAP 200MG, 5
Rebetol Sol 40MG/ML, 4
Rebif Inj 22/0.5, 48
Rebif Inj 44/0.5, 48
Rebif Rebido Inj 22/0.5, 48
Rebif Rebido Inj 44/0.5, 48
Rebif Rebido Inj Titratn, 48
Rebif Titrtn Inj Pack, 48
reciphexamin dis 4-1%, 21
reclipsen TAB, 25
Recombiva HB Inj 10mcg/ML, 59
Recombiva HB Inj 5mcg/0.5, 59
Recombiva-HB Inj 40mcg/ML, 59
Recothrom Sol 20000unt, 37
Recothrom Sol 5000unit, 37
rectacort-HC sup 25MG, 33
Rectiv Oin 0.4%, 33
Refuah Plus Sol Control, 64
Reglan TAB 10MG, 33
Reglan TAB 5MG, 33
relador PAK kit 2.5-2.5%, 21
relador PAK kit plus, 21
Relagard Gel, 34
Releevia Mc Pad .0375-5%, 22
releevia ML pad 4-1%, 21
Releevia Pad .0375-5%, 22
Relenza Mis Diskhale, 4
Relhist Chw, 57
Relion Lance Mis Stnd 21G, 64
Relion Lance Mis Thin 26G, 64
Relion Lance Mis Thin 30G, 64
Relion Lanci Mis Device, 64
Relion Micro Mis Thin 33G, 64
Relion Pen Mis 29GX12MM, 64
Relion Thin Mis Lancets, 64
Relion Ultra Mis Thin, 64
Relion Ultra Mis Thin 32G, 64
Relion Ultra Mis Thin Pls, 64
Relistor Inj 12/0.6ML, 33
Relistor Inj 8/0.4ML, 33
Relistor Kit 12/0.6ML, 33
Relistor TAB 150MG, 33
Relpax TAB 20MG, 56
Relpax TAB 40MG, 56
Remaxazon Pad, 22
Remeron Sltb TAB 15MG, 39
Remeron TAB 15MG, 39
remeven CRE 50%, 21
Renacidin Sol, 35
Renacidin Sol Irr, 35
Renagel TAB 400MG, 33
Renagel TAB 800MG, 33
Renew Adv Mis Device, 64
Renew Adv Mis Refills, 64
Renovo Pad 0.0375-5, 22
Renvela PAK 0.8gm, 33
Renvela PAK 2.4gm, 33
Renvela TAB 800MG, 33
repaglinide TAB 0.5MG, 27
repaglinide TAB 1-500MG, 28
repaglinide TAB 1MG, 27
repaglinide TAB 2-500MG, 28
repaglinide TAB 2MG, 27
Repatha Inj 140MG/ML, 16
Repatha Push Inj 420/3.5, 16
Repatha Sure Inj 140MG/ML, 16
reprexain TAB 10-200MG, 52
Reprexain TAB 2.5-200, 53
Reprexain TAB 5-200MG, 53
Requip TAB 0.25MG, 46
Requip TAB 0.5MG, 46
Requip TAB 1MG, 46
Requip TAB 2MG, 46
Requip TAB 3MG, 46
Requip TAB 4MG, 46
Requip TAB 5MG, 46
Requip XL TAB 12MG, 46
rescon-JR TAB, 57
Rescon-JR TAB, 57
Rescriptor TAB 100 MG, 4
Rescriptor TAB 200MG, 4
Rescula Sol 0.15%, 50
reserpine TAB 0.1MG, 12
reserpine TAB 0.25MG, 12
respa-BR TAB 11MG, 57
Restasis Emu 0.05%, 50
Restora Spri PAK 15-0.25, 31
Restoril CAP 15MG, 42
Restoril CAP 22.5MG, 42
Restoril CAP 30MG, 42
Restoril CAP 7.5MG, 42
Retin-a CRE 0.025%, 17
Retin-a Gel 0.01%, 17
Retin-a Gel 0.025%, 17
Retin-a Micr Gel 0.04%, 17
Retin-a Micr Gel 0.04%pmp, 17
Retin-a Micr Gel 0.1%, 17
Retin-a Micr Gel 0.1%P.M., 17
Retrovir CAP 100MG, 5
Retrovir Syp 50MG/5ML, 5
Revatio Sus 10MG/ML, 16
Revatio TAB 20MG, 16
Revlimid CAP 10MG, 7
Revlimid CAP 2.5MG, 7
Revlimid CAP 5MG, 7
Rexaphenac CRE 1%, 19
Rexulti TAB 0.25MG, 41
Rexulti TAB 0.5MG, 41
Rexulti TAB 1MG, 41
Rexulti TAB 2MG, 41
Rexulti TAB 3MG, 41
Rexulti TAB 4MG, 41
Reyataz CAP 150MG, 5
Reyataz Pow 50MG, 5
Rezira Sol 60-5/5ML, 57
Rheumatrex TAB 2.5MG, 55
Rhinocort Sus Aqua, 57
Ribapak PAK 1000/Day, 5
ribapak PAK 1200/day, 5
Ribapak PAK 600/Day, 5
ribapak PAK 800/day, 5
ribasphere CAP 200MG, 4
ribasphere TAB 200MG, 4
ribatab PAK 1000/day, 5
ribatab TAB 1200/day, 5
ribatab TAB 800/day, 5
ribavirin CAP 200MG, 4
ribavirin TAB 200MG, 4
Ridaura CAP 3MG, 54
rifabutin CAP 150MG, 3
Rifadin CAP 150MG, 3
Rifadin CAP 300MG, 3
Rifamate CAP, 3
rifampin CAP 150MG, 3
rifampin CAP 300MG, 3
Rifater TAB, 3
Rightest Liq High CON, 64
Rightest Liq Norm CON, 64
Rightest Mis GD500, 64
Rightest Mis Gl300, 64
Rilutek TAB 50MG, 48
riluzole TAB 50MG, 48
rimantadine TAB 100MG, 4
Rimso-50 Sol 50%, 35
Riomet Sol, 27
Riomet Sol 500/5ML, 27
risedron sod TAB 35MG DR, 28
risedronate TAB 150MG, 28
Risperdal Inj 12.5MG, 40
Risperdal Inj 25MG, 40
Risperdal Inj 37.5MG, 40
Risperdal Inj 50MG, 40
Risperdal M TAB 0.5MG, 41
Risperdal M TAB 1MG, 41
Risperdal Sol 1MG/ML, 41
Risperdal TAB 0.25MG, 41
Risperdal TAB 0.5MG, 41
Risperdal TAB 1MG, 41
risperidone sol 1MG/ML, 40
risperidone TAB 0.25 odt, 40
risperidone TAB 0.25MG, 40
risperidone TAB 0.5MG, 40
risperidone TAB 0.5MG od, 40
risperidone TAB 1MG, 40
risperidone TAB 1MG odt, 40
Ritalin LA CAP 10MG, 43
Ritalin TAB 10MG, 43
Ritalin TAB 20MG, 43
Ritalin TAB 20MG SR, 43
Ritalin TAB 5MG, 43
Riteflo Mis, 66
rivastigmine CAP 1.5MG, 46
rivastigmine CAP 3MG, 46
rivastigmine CAP 4.5MG, 46
rivastigmine CAP 6MG, 46
rivastigmine dis 13.3/24, 48
rivastigmine dis 4.6MG/24, 48
rivastigmine dis 9.5MG/24, 48
rizatriptan TAB 10MG, 55
rizatriptan TAB 10MG odt, 55
rizatriptan TAB 5MG, 55
rizatriptan TAB 5MG odt, 55
Robaxin Inj 100MG/ML, 49
Robaxin TAB 500MG, 49
Robaxin-750 TAB 750MG, 49
Robinul Fort TAB 2MG, 32
Robinul Inj 0.2MG/ML, 32
Robinul Inj 0.4/2ML, 32
Robinul TAB 1MG, 32
Rocaltrol CAP 0.25mcg, 29
Rocaltrol CAP 0.5mcg, 29
Rocaltrol Sol 1mcg/ML, 29
Rocephin Inj 1gm, 2
romycin oin op, 49
ropinirole TAB 0.25MG, 45
ropinirole TAB 0.5MG, 45
ropinirole TAB 12MG ER, 45
ropinirole TAB 1MG, 45
ropivacaine inj 10MG/ML, 56
ropivacaine inj 7.5MG/ML, 56
rosadan CRE 0.75%, 18
rosadan gel 0.75%, 18
Rosadan Kit 0.75%, 18
rosanil emu cleanser, 17
Rosanil Kit, 17
Rosula Liq 10-4.5%, 17
rosula pad 10-5%, 17
rosuvastatin TAB 10MG, 15
Rotarix Sus, 59
Rotateq Sol, 59
Rowasa Kit 4gm, 33
roweepra TAB 500MG, 44
Roxicet Sol 5-325/5, 53
roxicet TAB 5-325MG, 52
Roxicodone TAB 15MG, 53
Roxifol-d TAB 1-500, 36
Rozerem TAB 8MG, 42
Ruconest Inj 2100unit, 37
Rynoderm CRE 37.5%, 22
Rytary CAP 145MG, 46
Rytary CAP 95MG, 46
Rythmol SR CAP 225MG, 11
Rythmol TAB 150MG, 11
Rythmol TAB 225MG, 11
S
Sabril Pow 500MG, 45
Sabril TAB 500MG, 45
Safe-t-lance Mis 21G, 64
Safe-t-lance Mis 25G, 64
Safe-t-lance Mis HI Flow, 64
Safe-t-lance Mis Low Flow, 64
Safe-t-lance Mis Nor Flow, 64
Safe-t-pro Mis Lancets, 64
Safe-t-pro Mis Plus, 64
safety 21G mis lancets, 60
Safety 21G Mis Lancets, 64
safety 28G mis lancets, 60
Safety 28G Mis Lancets, 64
Safety Let Mis Lancets, 64
Safety Mis Lancets, 64
Safety Seal Mis 28G, 64
Safety Seal Mis 30G, 64
Safyral TAB, 26
Saizen Inj 5MG, 29
Saizen Inj 8.8MG, 29
salacyn CRE 6%, 21
salacyn lot 6%, 21
Salagen TAB 5MG, 37
Salagen TAB 7.5MG, 37
Salex Cream Kit 6%, 22
Salex Lotion Kit 6%, 22
Salex Sha 6%, 22
salicylic ac aer 6%, 21
salicylic ac CRE 6%, 21
salicylic ac gel 6%, 21
salicylic ac kit 6%, 21
salicylic ac kit 6% cream, 21
salicylic ac kit 6% lotn, 21
salicylic ac liq 26%, 21
salicylic ac liq 27.5%, 21
salicylic ac lot 6%, 21
salicylic ac sha 6%, 21
salicylic aer 6%, 21
Salivamax Pow, 37
Salivate RX Pow, 37
Salkera Aer 6%, 22
salsalate TAB 500MG, 51
salsalate TAB 750MG, 51
salvax aer 6%, 21
Salvax Aer 6%, 22
Salvax Duo Kit Plus, 22
Samsca TAB 15MG, 29
Samsca TAB 30MG, 29
Sancuso Dis 3.1MG, 32
Sandimmune CAP 100MG, 7
Sandimmune CAP 25MG, 8
Sandimmune Sol 100MG/ML, 8
Sandostatin Inj 1000mcg, 29
Sandostatin Inj 50mcg/ML, 29
Sandostatin Kit Lar 10MG, 29
Saphris Sub 10MG, 41
Saphris Sub 2.5MG, 41
Saphris Sub 5MG, 41
Sapscare Mis Twist, 64
Sarafem TAB 10MG, 48
Sarafem TAB 20MG, 48
Savaysa TAB 15MG, 36
Savella Mis Titr PAK, 48
Savella TAB 100MG, 48
Savella TAB 12.5MG, 48
SB Lancets Mis Thin, 64
SB Lancets Mis Ultr Thn, 64
Scalacort DK Kit, 20
scalacort lot 2%, 20
scopolamine inj 0.4MG/ML, 32
se-tan plus CAP, 35
Seasonique TAB, 26
seb-prev liq wash, 19
Seconal CAP 100MG, 42
Seconal Sod CAP 100MG, 42
Sectral CAP 200MG, 10
Sectral CAP 400MG, 10
selegiline CAP 5MG, 45
selegiline TAB 5MG, 45
selenium SUL lot 2.5%, 19
selenium SUL sha 2.25%, 19
Selrx Sha 2.3%, 19
Selzentry TAB 150MG, 5
Selzentry TAB 300MG, 5
Semprex-d CAP 8-60MG, 57
Sensipar TAB 30MG, 29
sensorcaine inj -mpf/epi, 56
Sensorcaine Inj -mpf/Epi, 56
sensorcaine inj 0.25%, 56
sensorcaine inj 0.5%, 56
sensorcaine inj mpf 0.5%, 56
sensorcaine inj mpf0.25%, 56
sensorcaine inj mpf0.75%, 56
sensorcaine/ inj epi 0.25, 56
sensorcaine/ inj epi 0.5%, 56
Serevent Dis Aer 50mcg, 58
Sernivo Spr, 20
Seroquel TAB 100MG, 41
Seroquel XR TAB 150MG, 41
Serostim Inj 4MG, 29
sertraline CON 20MG/ML, 38
sertraline TAB 100MG, 38
setlakin TAB, 26
sevelamer TAB 800MG, 33
Sfrowasa Ene 4gm, 33
sharobel TAB 0.35MG, 25
Shohls Sol Modified, 35
Side Button Mis Safety, 64
Signifor Inj 0.3MG/ML, 29
Silazone PAK Pharmapa, 20
Silazone-II PAK, 20
sildenafil TAB 20MG, 16
Silenor TAB 3MG, 42
Silenor TAB 6MG, 42
Simbrinza Sus 1-0.2%, 50
Simcor TAB 1000-20, 16
Simcor TAB 1000-40, 16
Simcor TAB 500-20MG, 16
Simple Diag Mis Lancing, 64
Simponi Inj 100MG/ML, 55
Simponi Inj 50/0.5ML, 55
simvastatin TAB 10MG, 15
Sinelee Pad 0.0375-5, 22
Sinemet CR TAB 25-100MG, 46
Sinemet CR TAB 50-200MG, 46
Sinemet TAB 10-100MG, 46
Single-let Mis 23G, 64
Singulair Chw 4MG, 58
Singulair Chw 5MG, 58
Singulair Gra 4MG, 58
Singulair TAB 10MG, 58
sirolimus TAB 0.5MG, 7
sirolimus TAB 1MG, 7
sirolimus TAB 2MG, 7
Sirturo TAB 100MG, 3
Sitavig TAB 50MG, 5
Sivextro TAB 200MG, 6
Skelaxin TAB 800MG, 49
Sklice Lot 0.5%, 22
Skyla Iud 13.5MG, 25
Sm Lancets Mis 21G, 64
Sm Lancets Mis 33G, 64
Sm Lancets Mis Thin 26G, 64
Sm Lancets Mis Thin 30G, 64
sm nicotine dis 14MG/24h, 46
sm nicotine dis 21MG, 46
sm nicotine dis 21MG/24h, 46
sm nicotine dis 7MG/24HR, 46
sm nicotine gum 2MG, 47
sm nicotine gum 2MG mint, 47
sm nicotine gum 4MG, 47
sm nicotine gum 4MG mint, 47
sm nicotine loz 2MG mint, 47
sm nicotine loz 4MG mint, 47
Smart Sense Mis Lanc 21G, 64
Smartest Mis Lancets, 64
Smartest Sol Control, 64
Smartrx PAK Gaba-v, 48
smz-tmp DS TAB 800-160, 6
smz-tmp sus 200-40/5, 6
smz-tmp TAB 400-80MG, 6
smz/tmp DS TAB 800-160, 6
sod chloride neb 0.9%, 57
sod citrate sol citr acd, 35
sod SUL/sulf CRE 10-2%, 17
sod SUL/sulf CRE 10-5%, 17
sod SUL/sulf CRE 9.8-4.8%, 17
sod SUL/sulf emu 10-5%, 17
sod SUL/sulf gel 10-5%, 17
sod SUL/sulf kit, 17
sod SUL/sulf liq 10-2%, 17
sod SUL/sulf liq 9-4.5%, 17
sod SUL/sulf liq 9.8-4.8%, 17
sod SUL/sulf liq wash, 17
sod SUL/sulf lot 10-5%, 17
sod SUL/sulf lot 9.8-4.8%, 17
sod SUL/sulf pad 10-4%, 17
sod SUL/sulf pad 10-5%, 17
sod SUL/sulf sus 10-5%, 17
sod SUL/sulf sus 8-4%, 17
sod sulfacet gel 10%, 19
sod sulfacet sha 10%, 19
sod sulfacet sol 10% op, 49
sodium chlor neb 10%, 57
sodium chlor sol 0.9% irr, 35
sodium SULFA liq 10% wash, 19
Sodium SULFA Liq 10% Wash, 19
Soft Touch Mis Lancets, 64
Softclix Lan Mis Device, 64
Softclix Mis Lancets, 64
Solodyn TAB 105MG, 3
Solodyn TAB 115MG, 3
Solodyn TAB 55MG, 3
Solodyn TAB 65MG, 3
Solodyn TAB 80MG, 3
Soltamox Sol 10MG/5ML, 7
Solu-cortef Inj 1000MG, 23
Solu-medrol Inj 125MG, 23
Solu-medrol Inj 1gm, 23
Solu-medrol Inj 2gm, 23
Solupak PAK, 22
Solus V2 Mis Lanc 28G, 64
Solus V2 Mis Lanc 30G, 64
Solus V2 Mis Lanc Dev, 64
Solus V2 Sol High, 64
Solus V2 Sol Low, 64
Soma TAB 250MG, 49
Soma TAB 350MG, 49
Somatuline Inj 120/.5ML, 29
Somatuline Inj 60/0.2ML, 29
Somatuline Inj 90/0.3ML, 29
Somavert Inj 10MG, 29
Sonata CAP 10MG, 42
Sonata CAP 5MG, 42
Soolantra CRE 1%, 18
Soothee Pad, 22
Soriatane CAP 10MG, 19
Soriatane CAP 17.5MG, 19
Soriatane CAP 25MG, 19
Sorilux Aer 0.005%, 19
sorine TAB 120MG, 9
sorine TAB 160MG, 9
sorine TAB 240MG, 9
sorine TAB 80MG, 9
sotalol AF TAB 120MG, 9
sotalol HCL TAB 120MG, 10
Sotylize Sol 5MG/ML, 10
Sovaldi TAB 400MG, 5
Spectracef TAB 200MG, 2
Spectracef TAB 400MG, 2
spinosad sus 0.9%, 21
Spiriva Aer 1.25mcg, 58
Spiriva CAP Handihlr, 58
Spiriva Spr 2.5mcg, 58
Spiriva Spr Respimat, 58
spirono/hctz TAB 25/25, 14
spironolact TAB 100MG, 14
Sporanox CAP 100MG, 4
Sporanox CAP Pulsepak, 4
Sporanox Sol 10MG/ML, 4
sprintec 28 TAB 28 day, 25
Spritam TAB 1000MG, 45
Sprix Spr 15.75MG, 55
Sprycel TAB 100MG, 8
Sprycel TAB 140MG, 8
Sprycel TAB 20MG, 8
Sprycel TAB 50MG, 8
Sprycel TAB 70MG, 8
Sprycel TAB 80MG, 8
SR nicotine gum 2MG, 47
sronyx TAB, 25
ss 10-2 sol 10-2%, 17
sss 10-5 aer 10-5%, 17
sss CRE 10%-5%, 17
Stalevo 100 TAB, 46
Stalevo 125 TAB, 46
Stalevo 150 TAB, 46
Stalevo 200 TAB, 46
Stalevo 50 TAB, 46
Stalevo 75 TAB, 46
Starlix TAB 120MG, 27
Starlix TAB 60MG, 27
stavudine CAP 15MG, 4
stavudine sol 1MG/ML, 4
Stavzor CAP 125MG, 45
Stelara Inj 45MG/0.5, 19
Stelara Inj 90MG/ML, 19
Sterilance Mis 1.8MM, 64
Sterilance Mis TL 28G, 64
Stimate Sol 1.5MG/ML, 29
Stiolto Aer 2.5-2.5, 58
Stivarga TAB 40MG, 8
stop smoking gum 2MG mint, 47
stop smoking gum 2MG orig, 47
stop smoking gum 4MG, 47
stop smoking loz 2MG, 47
stop smoking loz 2MG mint, 47
stop smoking loz 4MG mint, 47
Strattera CAP 100MG, 42
Strensiq Inj 18/0.45, 29
Strensiq Inj 28/0.7ML, 29
Strensiq Inj 40MG/ML, 29
Strensiq Inj 80/0.8ML, 29
streptomycin inj 1gm, 3
Striant Mis 30MG, 24
Stribild TAB, 5
Striverdi Aer 2.5mcg, 58
Stromectol TAB 3MG, 6
Suboxone Mis 12-3MG, 53
Suboxone Mis 2-0.5MG, 53
Subsys Spr 100mcg, 54
Suclear Kit, 31
Sucraid Sol 8500/ML, 33
sucralfate TAB 1gm, 31
SUL sod/sulf liq 10-2%, 17
SUL sod/sulf pad 10-4%, 17
Sular TAB 17MG, 11
Sular TAB 34MG, 11
Sular TAB 8.5MG, 11
sulf/pred NA sol op, 49
sulfacet sod oin 10% op, 49
sulfacet sod sol 10% op, 49
sulfacetamid lot 10%, 17
sulfacetamid sus 10%, 17
sulfacleanse sus 8-4%, 17
sulfadiazine TAB 500MG, 3
sulfasalazin TAB 500MG, 33
sulfasalazin TAB 500MG DR, 33
sulfatrim PD sus 200-40/5, 6
Sulfoam Sha 2%, 17
sulindac TAB 150MG, 54
sulindac TAB 200MG, 54
Sumadan Kit, 17
Sumadan Wash Liq 9-4.5%, 17
sumatriptan inj 4MG/0.5, 55
sumatriptan inj 6MG/0.5, 55
sumatriptan spr 20MG/act, 55
sumatriptan spr 5MG/act, 55
sumatriptan TAB 100MG, 55
Sumavel Dose Inj 4MG/0.5, 56
Sumavel Dose Inj 6MG/0.5, 56
Sumaxin CP Kit, 17
Sumaxin Pad 10-4%, 17
Sumaxin Ts Sus 8-4%, 17
Sumaxin Wash Liq 9-4%, 17
Super Thin Mis Lanc 28G, 64
Super Thin Mis Lancet, 64
super thin mis lancets, 60
Super Thin Mis Lancets, 64
Suprax CAP 400MG, 2
Suprax Chw 100MG, 2
Suprax Chw 200MG, 2
Suprax Sus 100/5ML, 2
Supreme II Liq High/Low, 64
Suprep Bowel Sol Prep, 31
Sure Comfort Mis 29GX1/2", 64
Sure Comfort Mis 30GX5/16, 64
Sure Comfort Mis 32GX6MM, 64
Sure Comfort Mis Lanc Pen, 64
Sure Comfort Mis Lancets, 64
Sure Result Kit O3d3 SYS, 16
sure result mis dss pack, 18
Sure-fine Mis 29GX1/2", 64
Sure-fine Mis 31GX3/16, 64
Sure-fine Mis 31GX5/16, 64
Sure-lance Mis 26G, 64
Sure-lance Mis Lancets, 64
Sure-pen Mis, 64
Sure-touch Mis Unv Lanc, 64
Sureflex Mis Lancets, 64
Surelite Mis Lancets, 64
Surestep Glu Sol, 64
Surestep Glu Sol High/Low, 64
Surestep Pro Tes High CON, 64
Surestep Pro Tes Low CON, 64
Surestep Pro Tes Norm CON, 64
Surestep Sol Control, 64
Surfaxin Sus 30MG/ML, 59
Surmontil CAP 100MG, 39
Survanta Inh, 59
Sustiva CAP 200MG, 4
Sustiva CAP 50MG, 4
Sustiva TAB 600MG, 4
Sutent CAP 12.5MG, 8
Sutent CAP 25MG, 8
Sutent CAP 37.5MG, 8
Sutent CAP 50MG, 8
sw nicotine gum 2MG mint, 47
sw nicotine gum 4MG, 47
sw nicotine loz 2MG mint, 47
sw nicotine loz 4MG mint, 47
syeda TAB 3-0.03MG, 25
Sylatron Kit 200mcg, 8
Symax Duotab TAB, 32
symax-SL sub 0.125MG, 32
symax-SR TAB 0.375MG, 32
Symbicort Aer 160-4.5, 58
Symbicort Aer 80-4.5, 58
Symbyax CAP 12-25MG, 48
Symlinpen 60 Inj 1000mcg, 26
Symlnpen 120 Inj 1000mcg, 26
synalar CRE 0.025%, 19
Synalar Kit 0.025%, 20
synalar oin 0.025%, 19
Synalar Sol 0.01%, 20
Synalar Ts Kit 0.01%, 20
Synalgos-dc CAP, 53
Synarel Sol 2MG/ML, 28
Synera Dis 70-70MG, 22
Synjardy TAB, 28
Synjardy TAB 12.5-500, 28
Synjardy TAB 5-1000MG, 28
Synjardy TAB 5-500MG, 28
Synthroid TAB 100mcg, 30
synvexia pad 4-1%, 21
T
Tabloid TAB 40MG, 7
Taclonex Oin, 20
Taclonex Sus, 20
tacrolimus CAP 0.5MG, 7
tacrolimus CAP 1MG, 7
tacrolimus CAP 5MG, 7
tacrolimus oin 0.03%, 20
tacrolimus oin 0.1%, 20
Tafinlar CAP 50MG, 8
Tafinlar CAP 75MG, 8
Tagrisso TAB 40MG, 8
Tagrisso TAB 80MG, 8
Tai Doc Sol Norm CON, 64
take action TAB 1.5MG, 25
Taltz Inj 80MG/ML, 19
Talwin Inj 30MG/ML, 53
Tamiflu CAP 30MG, 4
Tamiflu CAP 45MG, 4
Tamiflu CAP 75MG, 4
Tamiflu Sus 6MG/ML, 4
tamoxifen TAB 10MG, 7
tamoxifen TAB 20MG, 7
tamsulosin CAP 0.4MG, 35
tandem f CAP, 35
Tandem Plus CAP, 36
Tanzeum Inj 30MG, 26
Tanzeum Inj 50MG, 26
Tapazole TAB 10MG, 30
Tapazole TAB 5MG, 30
Tarceva TAB 100MG, 8
Tarceva TAB 150MG, 8
Tarceva TAB 25MG, 8
Targadox TAB 50MG, 3
Targretin CAP 75MG, 8
tarina FE TAB 1/20, 25
Tarka TAB 1-240 CR, 14
Taron Forte CAP, 36
taron gra crystals, 35
Tasigna CAP 150MG, 8
Tasigna CAP 200MG, 8
Tasmar TAB 100MG, 46
tazicef inj 1gm, 2
tazicef inj 2gm, 2
tazicef inj 6gm, 2
Tazorac CRE 0.05%, 19
Tazorac CRE 0.1%, 19
Tazorac Gel 0.05%, 19
Tazorac Gel 0.1%, 19
taztia XT CAP 120MG/24, 11
Tecfidera CAP 120MG, 48
Tecfidera CAP 240MG, 48
Tecfidera Mis Starter, 48
Techlite AST Mis Lancets, 64
Techlite Mis Lanc 30G, 64
Techlite Mis Lancets, 64
Technivie TAB, 5
Tegretol Sus 100/5ML, 45
Tegretol TAB 200MG, 45
Tegretol-XR TAB 100MG, 45
Tekamlo TAB 150-10MG, 14
Tekturna HCT TAB 150-12.5, 14
Tekturna HCT TAB 150-25MG, 14
Tekturna HCT TAB 300-12.5, 14
Tekturna HCT TAB 300-25MG, 14
Tekturna TAB 150MG, 12
Tekturna TAB 300MG, 12
Telcare Sol Level1/2, 64
telmis/amlod TAB 40-10MG, 13
telmisa/hctz TAB 40-12.5, 13
telmisa/hctz TAB 80-12.5, 13
telmisa/hctz TAB 80-25MG, 13
telmisartan TAB 20MG, 12
Temazepam 7.5MG CAPS, 42
temazepam CAP 15MG, 41
temazepam CAP 22.5MG, 42
temazepam CAP 30MG, 41
temazepam CAP 7.5MG, 41
Temodar CAP 100MG, 6
Temodar CAP 20MG, 6
Temodar CAP 5MG, 6
Temovate CRE 0.05%, 20
Temovate E CRE 0.05%eml, 20
Temovate Gel 0.05%, 20
Temovate Oin 0.05%, 20
Temovate Sol 0.05%, 20
temozolomide CAP 100MG, 6
tencon TAB 50-325MG, 51
Tenex TAB 1MG, 13
Tenex TAB 2MG, 13
Tenivac Inj 5-2LF, 59
Tenoretic TAB 100, 14
Tenoretic TAB 50, 14
Tenormin TAB 100MG, 10
Terazol 3 CRE 0.8%, 34
Terazol 7 CRE 0.4%, 35
terazosin CAP 10MG, 12
terbinafine TAB 250MG, 4
terbutaline inj 1MG/ML, 58
terbutaline TAB 2.5MG, 58
terbutaline TAB 5MG, 58
terconazole CRE 0.4%, 34
terconazole CRE 0.8%, 34
terconazole sup 80MG, 34
Tersi Foam Aer 2.25%, 19
Tessalon Per CAP 100MG, 57
Test Eo-pro- Inj Cyp 220, 24
Testim Gel 1%(50MG), 24
Testone Cik Kit 200MG/ML, 24
testost cyp inj 100MG/ML, 23
testost cyp inj 200MG/ML, 23
testost enan inj 200MG/ML, 23
testosterone gel 1%(25MG), 23
testosterone gel 1%(50MG), 23
testosterone gel 10MG/act, 23
testosterone gel P.M. 1%, 23
testosterone inj 250MG/ML, 23
Testred CAP 10MG, 24
tet/dip tox inj 2-2 LF, 59
tetanus tox inj 5LF ads, 59
tetcaine sol 0.5% op, 50
tetrabenazin TAB 12.5MG, 48
tetrabenazin TAB 25MG, 48
tetracaine inj 1%, 56
tetracaine sol 0.5% op, 50
tetracycline CAP 250MG, 3
tetracycline CAP 500MG, 3
Tetramex Spr 2-1-3%, 22
tetravisc sol 0.5% op, 50
tetravisc sol forte, 50
tetrix CRE, 21
Tev-tropin Inj 5MG, 29
Teveten HCT TAB 600-25MG, 14
Teveten TAB 600MG, 12
Texacort Sol 2.5%, 20
Tgt Lancet Mis 23G, 64
Tgt Lancet Mis Alternat, 64
Tgt Lancing Mis Adv Dev, 64
Tgt Lancing Mis Device, 64
tgt nicotine dis 14MG/24h, 46
tgt nicotine dis 21MG/24h, 46
tgt nicotine dis 7MG/24HR, 46
tgt nicotine gum 2MG mint, 47
tgt nicotine gum 2MG orig, 47
tgt nicotine gum 2mgfruit, 47
tgt nicotine gum 4MG, 47
tgt nicotine gum 4MG mint, 47
tgt nicotine gum 4MG orig, 47
tgt nicotine loz 2MG chry, 47
tgt nicotine loz 2MG mint, 47
tgt nicotine loz 4MG chry, 47
tgt nicotine loz 4MG mint, 47
Thalomid CAP 100MG, 7
Theo-24 CAP 100MG CR, 58
Theo-24 CAP 400MG ER, 58
theochron TAB 100MG CR, 58
theophylline sol 80/15ML, 58
theophylline TAB 100MG CR, 58
theophylline TAB 100MG ER, 58
theophylline TAB 200MG CR, 58
thera form/ TAB hematin, 59
Thin Lancets Mis, 64
Thin Lancets Mis 26G, 64
Thin Lancets Mis 30G, 64
Thinlets GP Mis 26G, 64
Thinlets Mis 28g(t), 64
Thiola TAB 100MG, 35
thioridazine TAB 100MG, 40
thiotepa inj 15MG, 6
thiothixene CAP 10MG, 40
thrive gum 2MG mint, 47
Thrombin Kit 5000unit, 37
Thrombin-jmi Kit 20000unt, 37
Thrombin-jmi Kit 5000unit, 37
Thrombin-jmi Sol 20000unt, 37
Thrombin-jmi Sol 5000unit, 37
Thrombogen Kit 10000unt, 37
Thrombogen Sol 10000unt, 37
Thrombogen Sol 1000unit, 37
Thyrolar-1 TAB 60MG, 30
Thyrolar-1/2 TAB 30MG, 30
Thyrolar-1/4 TAB 15MG, 30
tiagabine TAB 2MG, 44
tiagabine TAB 4MG, 44
Tiazac CAP 120MG/24, 11
Ticaspray PAK, 57
ticlopidine TAB 250MG, 37
Tier Uni Pls Mis 31GX8MM, 64
Tigan CAP 300MG, 32
Tigan Inj 100MG/ML, 32
Tikosyn CAP 125mcg, 11
tilia FE TAB, 26
timolol gel sol 0.25% op, 49
timolol gel sol 0.5% op, 49
timolol mal sol 0.25% op, 49
timolol mal sol 0.5% op, 49
timolol mal TAB 10MG, 10
Timoptic Ocu Sol 0.25% Op, 49
Timoptic Ocu Sol 0.5% Op, 49
Timoptic Sol 0.25% Op, 49
Timoptic Sol 0.5% Op, 49
Timoptic-xe Sol 0.25% Op, 49
Timoptic-xe Sol 0.5% Op, 49
Tindamax TAB 250MG, 6
Tindamax TAB 500MG, 6
tinidazole TAB 250MG, 6
tinidazole TAB 500MG, 6
Tirosint CAP 100mcg, 30
Tisseel Kit, 37
Tisseel Sol, 37
Tisseel VH Kit 10ML, 37
Tivicay TAB 10MG, 5
Tivicay TAB 25MG, 5
Tivicay TAB 50MG, 4
Tivorbex CAP 20MG, 55
Tivorbex CAP 40MG, 55
tizanidine CAP 2MG, 48
tizanidine TAB 2MG, 48
tizanidine TAB 4MG, 48
TL G-FOL OS TAB, 60
TL icon CAP, 36
TL Triseb CRE, 19
TL-hem 150 TAB, 36
Tobi Neb 300/5ML, 3
Tobi Podhalr CAP 28MG, 3
tobra/dexame sus 0.3-0.1%, 49
Tobradex Oin 0.3-0.1%, 49
Tobradex ST Sus 0.3-0.05, 50
Tobradex Sus 0.3-0.1%, 50
tobramycin inj 1.2/30ML, 3
tobramycin inj 1.2gm, 3
tobramycin inj 10MG/ML, 3
tobramycin inj 40MG/ML, 3
tobramycin inj 80MG/2ML, 3
tobramycin neb 300/5ML, 3
tobramycin sol 0.3% op, 49
Tobrex Oin 0.3% Op, 49
Tobrex Sol 0.3% Op, 49
Tofranil TAB 10MG, 39
Tofranil-PM CAP 100MG, 39
tolazamide TAB 250MG, 27
tolazamide TAB 500MG, 27
tolbutamide TAB 500MG, 27
tolcapone TAB 100MG, 45
tolmetin sod CAP 400MG, 54
tolmetin sod TAB 200MG, 54
tolmetin sod TAB 600MG, 54
tolterodine CAP 2MG ER, 34
tolterodine CAP 4MG ER, 34
tolterodine TAB 1MG, 34
tolterodine TAB 2MG, 34
Topamax Spr CAP 15MG, 45
Topamax Spr CAP 25MG, 45
Topamax TAB 100MG, 45
Topicort CRE 0.05%, 20
Topicort CRE 0.25%, 20
Topicort Gel 0.05%, 20
Topicort Oin 0.05%, 20
Topicort Oin 0.25%, 20
Topicort Spr 0.25%, 20
topiragen TAB 100MG, 44
topiramate CAP 15MG, 44
topiramate CAP 25MG, 44
topiramate CAP ER 100MG, 44
topiramate TAB 100MG, 44
Toprol XL TAB 100MG, 10
Toronova II Kit 30MG/ML, 55
Toronova Kit 30MG/ML, 55
torsemide TAB 100MG, 14
Toujeo Solo Inj 300iu/ML, 26
Toviaz TAB 4MG, 34
Toviaz TAB 8MG, 34
Tracleer TAB 125MG, 16
Tracleer TAB 62.5MG, 16
Tradjenta TAB 5MG, 27
tramadl/apap TAB 37.5-325, 52
tramadol HCL CAP 150MG ER, 52
tramadol HCL CAP ER 100MG, 52
tramadol HCL TAB 100MG ER, 52
tramadol HCL TAB 50MG, 52
Trandate TAB 100MG, 10
trando/verap TAB 1-240 CR, 13
trando/verap TAB 1-240 ER, 13
trandolapril TAB 1MG, 12
tranex acid TAB 650MG, 37
Transderm-sc Dis 1MG, 32
Tranxene T TAB 15MG, 38
Tranxene T TAB 3.75MG, 38
Tranxene T TAB 7.5MG, 38
tranylcyprom TAB 10MG, 39
Travatan Z Dro 0.004%, 50
Travel Lance Mis 30G, 64
travoprost dro 0.004%, 50
trazodone TAB 100MG, 39
Trecator TAB 250MG, 3
Tresiba Flex Inj 100unit, 26
Tresiba Flex Inj 200unit, 26
Tretin-x CRE 0.0375%, 17
tretinoin CAP 10MG, 8
tretinoin CRE 0.025%, 17
tretinoin gel 0.01%, 17
tretinoin gel 0.04%pmp, 17
tretinoin gel 0.1%P.M., 17
Trexall TAB 10MG, 7
Trexall TAB 15MG, 7
Trexall TAB 5MG, 7
Trexall TAB 7.5MG, 7
Treximet TAB 85-500MG, 56
Trezix CAP, 53
tri-estaryll TAB, 25
tri-legest TAB FE, 26
tri-linyah TAB, 25
tri-LO TAB estaryll, 25
tri-LO- TAB marzia, 25
tri-LO- TAB sprintec, 25
Tri-norinyl TAB 28, 26
tri-previfem TAB, 25
tri-sprintec TAB, 25
triamcin/ora pst 0.1%, 37
triamcinolon aer 55mcg/ac, 57
triamcinolon aer spray, 20
triamcinolon CRE 0.025%, 19
triamcinolon inj 40MG/ML, 23
triamcinolon inj 80MG/2ML, 23
triamcinolon lot 0.025%, 19
triamcinolon lot 0.1%, 19
triamcinolon oin 0.025%, 19
triamcinolon pst 0.1%, 37
triamcn/lido inj 40MG-1%, 23
Triamsil PAK Combipak, 20
Triamsil PAK Multipak, 20
triamt/hctz CAP 37.5-25, 14
triamt/hctz CAP 50-25MG, 14
triamt/hctz TAB 37.5-25, 14
triamt/hctz TAB 75-50MG, 14
trianex oin 0.05%, 20
Trianex Oin 0.05%, 20
triazolam TAB 0.125MG, 41
triazolam TAB 0.25MG, 41
Tribenzor20- TAB 5-12.5MG, 14
Tribenzor40- TAB 10-12.5, 14
Tribenzor40- TAB 10-25MG, 14
Tribenzor40- TAB 5-12.5MG, 14
Tribenzor40- TAB 5-25MG, 14
tricitrates sol, 35
tricon CAP, 35
Tricor TAB 145MG, 16
Tricor TAB 48MG, 16
triderm CRE 0.1%, 19
Triferic Sol, 36
trifluoperaz TAB 10MG, 40
trifluridine sol 1% op, 49
trigels-f CAP forte, 35
Triglide TAB 160MG, 16
trihexyphen elx 0.4MG/ML, 45
trihexyphen TAB 2MG, 45
trihexyphen TAB 5MG, 45
Trileptal Sus 300MG/5m, 45
Trileptal TAB 150MG, 45
Trilipix CAP 135MG, 16
Trilipix CAP 45MG, 16
Triloan II Kit 40MG/ML, 23
Triloan Suik Kit 40MG/ML, 23
trilyte sol, 31
trimethobenz CAP 300MG, 32
trimethoprim sol polymyxn, 49
trimethoprim TAB 100MG, 6
trimipramine CAP 100MG, 39
trinessa LO TAB, 25
trinessa TAB, 25
Trintellix TAB 10MG, 39
Triumeq TAB, 5
trivora-28 TAB, 25
Trizivir TAB, 5
Trokendi XR CAP 100MG, 45
Tropazone Lot, 22
trospium chl CAP 60MG ER, 34
trospium CL TAB 20MG, 34
True Metrix Sol Level 1, 64
Truecontrol Liq Level 0, 64
Truecontrol Liq Level 1, 64
Truedraw Mis Lanc Dev, 64
Truetest Liq Level 1, 64
Trulicity Inj 0.75/0.5, 27
Trulicity Inj 1.5/0.5, 27
Trumenba Inj, 59
Truplus Lanc Mis 26G, 64
truplus lanc mis 28G, 60
Trusopt Sol 2% Op, 50
Truvada TAB 100-150, 5
Tudorza Pres Aer 400/Act, 58
Tusnel CAP, 57
Tussicaps CAP 10-8MG, 57
Tussicaps CAP 5-4MG, 57
tussigon TAB 5-1.5MG, 57
Tussionex Sus 10-8/5ML, 57
Tuzistra XR Sus, 57
Twynsta TAB 40-10MG, 14
Tybost TAB 150MG, 4
Tykerb TAB 250MG, 8
Tylenol/Cod TAB #3, 53
Tylenol/Cod TAB #4, 53
Tyvaso Refil Sol 0.6MG/ML, 16
Tyvaso Sol 0.6MG/ML, 16
Tyvaso Start Sol 0.6MG/ML, 16
Tyzeka TAB 600MG, 5
Tyzine PED Dro 0.05%, 57
Tyzine Sol 0.1%, 57
U
Uceris Aer 2MG/Act, 33
Uceris TAB 9MG, 23
Ulesfia Lot 5%, 21
Uloric TAB 40MG, 56
Uloric TAB 80MG, 56
Ulti-lance Mis CLR Tip, 64
Ultilet Mis 26G, 64
Ultilet Mis 28G, 64
Ultilet Mis 30G, 65
Ultilet Mis 33G, 65
Ultilet Mis Lancets, 64
Ultilet Mis Safety, 64
Ultra Thin Mis 28G, 65
Ultra Thin Mis Lanc 26G, 65
Ultra Thin Mis Lancets, 65
Ultracet TAB 37.5-325, 53
Ultralance Mis 1.8MM, 65
Ultram ER TAB 100MG, 53
Ultram TAB 50MG, 53
Ultratrk Pro Sol, 65
Ultratrk Pro Sol High/Low, 65
Ultratrk Ult Sol High/Low, 65
Ultravate CRE 0.05%, 20
Ultravate Lot 0.05%, 20
Ultravate Oin 0.05%, 20
Ultravate X Kit 0.05-10%, 20
Ultresa CAP 13800unt, 33
Umecta Emu, 22
umecta mouss aer 40%, 21
Umecta Nail Sus Film, 22
Umecta PD Emu 40-0.3%, 22
Umecta PD Sus 40-0.3%, 22
Umecta Sus 40%, 22
Unasyn Inj 1.5gm, 1
Unasyn Inj 15gm, 1
Unasyn Inj 3gm, 1
Unfine Pntp Mis 32GX4MM, 65
Unifine Pntp Mis 29GX1/2", 65
Unifine Pntp Mis 29GX12MM, 65
Unifine Pntp Mis 31GX3/16, 65
unifine pntp mis 31GX8MM, 60
Unilet Cmfr Mis Tch 28G, 65
Unilet Cmfr Mis Tch 30G, 65
Unilet EX II Mis 28G, 65
Unilet Excel Mis 23G, 65
Unilet G.p Mis Supr 23G, 65
Unilet G.p. Mis 21G, 65
Unilet GP 28 Mis Ult Thin, 65
Unilet Lanc Mis 33G, 65
Unilet Lance Mis 21G, 65
Unilet Lanct Mis 28G, 65
Unilet Mis 21G, 65
Unilet Super Mis 23G, 65
Unilet Super Mis G.p. 23G, 65
Uniretic TAB 15-12.5, 14
Unistik 1 Mis 2.4MM, 65
Unistik 2 Mis, 65
Unistik 2 Mis Comfort, 65
Unistik 2 Mis Extra, 65
Unistik 2 Mis Neonatal, 65
Unistik 2 Mis Normal, 65
Unistik 2 Mis Super, 65
Unistik 3 Mis Comfort, 65
Unistik 3 Mis Extra, 65
Unistik 3 Mis Gent 30G, 65
Unistik 3 Mis Neonatal, 65
Unistik 3 Mis Normal, 65
Unistik CZT Mis Comfort, 65
Unistik CZT Mis Normal, 65
Unistik II Mis Lancets, 65
Unistik Safe Mis Lanc 28G, 65
Unistik Safe Mis Lanc 30G, 65
Unistik Touc Mis Lanc 21G, 65
unith direct TAB 100mcg, 30
unithroid TAB 100mcg, 30
Univasc TAB 15MG, 12
Univasc TAB 7.5MG, 12
Universal 1 Mis Lanc 26G, 65
Universal 1 Mis Lanc 30G, 65
Uptravi TAB 1000mcg, 16
Uptravi TAB 200/800, 16
uramaxin aer 20%, 21
Uramaxin CRE 45%, 22
Uramaxin Gel 45%, 22
Uramaxin GT Gel 45%, 22
Uramaxin Lot 45%, 22
uramit mb CAP 118MG, 34
ure-k CRE 50%, 21
urea 40% sus nail, 21
urea CRE 39%, 21
urea CRE 40%, 21
urea CRE 45%, 21
urea CRE 47%, 21
urea CRE 50%, 21
urea gel 40%, 21
urea hydrati aer 35%, 21
urea lot 40%, 21
urea lot 45%, 21
urea nail gel 45%, 21
urea nail kit, 21
Urea Nail Mis 50%, 22
urea sus 50%, 21
urea topical sus 40%, 21
urea-c40 lot 40%, 21
Urecholine TAB 10MG, 34
urelle TAB, 34
Uretron D/S TAB, 34
Urevaz CRE 44%, 22
uribel CAP 118MG, 34
urimar-t TAB, 34
Urin-tek Mis, 65
uro-458 TAB, 34
uro-blue TAB 81.6MG, 34
uro-l TAB 81MG, 34
uro-mp CAP 118MG, 34
uroav-81 TAB, 34
uroav-b CAP, 34
Urocit-k 10 TAB, 35
Urocit-k 15 TAB, 35
Urocit-k 5 TAB, 35
Urogesic- TAB Blue, 34
urolet mb TAB, 34
urophen mb TAB 81.6MG, 34
Uroxatral TAB 10MG, 35
Urso 250 TAB 250MG, 34
Urso Forte TAB 500MG, 33
ursodiol CAP 300MG, 33
ursodiol TAB 250MG, 33
ursodiol TAB 500MG, 33
uryl TAB, 34
ustell CAP, 34
uta CAP 120MG, 34
Utibron CAP Neohaler, 58
uticap CAP, 34
Utopic CRE 41%, 22
Uvadex Inj 20mcg/ML, 8
V
Vagifem TAB 10mcg, 34
valacyclovir TAB 1gm, 4
valacyclovir TAB 500MG, 4
Valchlor Gel 0.016%, 6
Valcyte Sol 50MG/ML, 5
Valcyte TAB 450MG, 5
valganciclov sol 50MG/ML, 5
valganciclov TAB 450MG, 5
Valium TAB 10MG, 38
Valium TAB 2MG, 38
Valium TAB 5MG, 38
valproic acd CAP 250MG, 44
valproic acd sol 250/5ML, 44
valproic acd syp 250/5ML, 44
valsart/hctz TAB 160-12.5, 13
valsart/hctz TAB 160-25MG, 13
valsart/hctz TAB 320-25MG, 13
valsartan TAB 160MG, 12
Valtrex TAB 1gm, 5
Valtrex TAB 500MG, 5
Valvd Holdng Mis Chamber, 66
vanatol LQ sol, 51
Vancocin HCL CAP 125MG, 6
Vancocin HCL CAP 250MG, 6
vancomycin 250/5ML, 6
vancomycin CAP 125MG, 6
vancomycin CAP 250MG, 6
Vancomycn 25 Sol 25MG/ML, 6
Vancomycn 50 Sol 50MG/ML, 6
vandazole gel 0.75%, 34
Vanos CRE 0.1%, 20
Vanoxide-HC Lot 5-0.5%, 17
Vantage Lanc Mis Device, 65
Vantage Lanc Mis Univ 30G, 65
Varivax Inj, 59
Varubi TAB 90MG, 32
Vascepa CAP 1gm, 16
Vaseretic TAB 10-25MG, 14
vasopressin inj 10/0.5ML, 29
vasopressin inj 20unt/ML, 29
Vasotec TAB 10MG, 12
Vasotec TAB 2.5MG, 12
Vasotec TAB 20MG, 12
Vasotec TAB 5MG, 12
Vecamyl TAB 2.5MG, 13
Vectical Oin 3mcg/Gm, 19
velivet PAK, 25
Velphoro Chw 500MG, 34
Veltin Gel, 17
venlafaxine CAP 150MG ER, 39
venlafaxine CAP 37.5 ER, 39
venlafaxine CAP 75MG ER, 39
venlafaxine TAB 100MG, 39
venlafaxine TAB 150MG ER, 39
venlafaxine TAB 37.5 ER, 39
venlafaxine TAB 37.5MG, 39
Ventavis Sol 10mcg/ML, 16
Ventavis Sol 20mcg/ML, 16
Ventolin HFA Aer, 58
Veramyst Spr 27.5mcg, 57
verapamil CAP 100MG ER, 11
verapamil CAP 120MG SR, 10
verapamil TAB 120MG, 10
verapamil TAB 120MG ER, 10
Verdeso Aer 0.05%, 20
verdrocet TAB 2.5-325, 52
Veregen Oin 15%, 22
verelan CAP 120MG SR, 11
verelan PM CAP 100MG ER, 11
Veripred 20 Sol 20MG/5ML, 23
Versacloz Sus 50MG/ML, 41
Vesicare TAB 10MG, 34
Vesicare TAB 5MG, 34
vestura TAB 3-0.02MG, 26
Vexol Sus 1% Op, 49
Vfend IV Inj 200MG, 4
Vfend Sus 40MG/ML, 4
Vfend TAB 200MG, 4
Vfend TAB 50MG, 4
Viberzi TAB 100MG, 34
Viberzi TAB 75MG, 34
Vibramycin CAP 100MG, 3
Vibramycin Sus 25MG/5ML, 3
Vibramycin Syp 50MG/5ML, 3
vicodin ES TAB 7.5-300, 52
vicodin HP TAB 10-300MG, 52
vicodin TAB 5-300MG, 52
Vicoprofen TAB 7.5-200, 54
Victory Sol Control, 65
Victoza Inj 18MG/3ML, 27
Victrelis CAP 200MG, 5
Videx EC CAP 125MG, 5
Videx Sol 2gm, 4
Videx Sol 4gm, 4
Viekira PAK TAB, 5
Viekira XR TAB, 5
vienva TAB 0.1-20, 25
Vigamox Dro 0.5%, 49
Viibryd Kit, 39
Viibryd Kit Starter, 39
Viibryd TAB 10MG, 39
Vimovo TAB 375-20MG, 55
Vimovo TAB 500-20MG, 55
Vimpat Sol 10MG/ML, 45
Vimpat TAB 100MG, 45
Vimpat TAB 50MG, 45
Viokace TAB, 33
Viokace TAB 20880, 33
viorele TAB, 26
Viracept TAB 250MG, 4
Viracept TAB 625MG, 4
Viramune Sus 50MG/5ML, 5
Viramune TAB 200MG, 5
Viramune XR TAB 100MG, 5
Viramune XR TAB 400MG, 5
Virasal Liq 27.5%, 22
Virazole Inh 6gm, 5
Viread Pow 40MG/Gm, 4
Viread TAB 150MG, 4
Viread TAB 200MG, 4
Viread TAB 250MG, 4
Viread TAB 300MG, 4
Viroptic Sol 1% Op, 49
virti-sulf CRE 10-5%, 17
virtrate-2 sol, 35
virtrate-2 sol 500-334, 35
virtrate-3 sol, 35
virtrate-k sol, 35
virtrate-k sol 1100-334, 35
Vistaril CAP 25MG, 38
Vistaril CAP 50MG, 38
Vitafol TAB, 60
Vitalet Pro Mis, 65
Vitalet Pro Mis Plus, 65
vitamin c inj 222MG/ML, 59
vitamin d CAP 50000unt, 59
vitamin k1 inj 10MG/ML, 59
vitamin k1 inj 1MG/0.5, 59
Vitekta TAB 150MG, 5
Vitekta TAB 85MG, 5
Vituz Sol 5-4MG, 57
Vivactil TAB 10MG, 39
Vivactil TAB 5MG, 39
Vivelle-dot Dis 0.025MG, 24
Vivlodex CAP 10MG, 55
Vivlodex CAP 5MG, 55
Voltaren Gel 1%, 19
Voltaren-XR TAB 100MG, 55
voriconazole inj 200MG, 4
voriconazole sus 40MG/ML, 4
voriconazole TAB 200MG, 4
voriconazole TAB 50MG, 4
Vortex Valve Mis Chamber, 66
Vosol HC Sol Otic, 51
Vospire ER TAB 4MG, 58
Vospire ER TAB 8MG, 58
Votrient TAB 200MG, 8
vp-zel TAB, 60
Vraylar CAP 1.5-3MG, 41
Vraylar CAP 1.5MG, 41
Vraylar CAP 3MG, 41
Vraylar CAP 4.5MG, 41
Vraylar CAP 6MG, 41
Vusion Oin, 18
vyfemla TAB 0.4-35, 25
Vytorin TAB 10-10MG, 16
Vyvanse CAP 10MG, 43
W
W&f Lancets Mis 21G, 65
W&f Lancets Mis 26G, 65
warfarin sod TAB 10MG, 36
warfarin TAB 10MG, 36
warfarin TAB 2.5MG, 36
warfarin TAB 7.5MG, 36
Watchhaler Mis, 66
Welchol PAK 3.75gm, 16
Welchol TAB 625MG, 16
Wellbutrin TAB 100MG, 40
Wellbutrin TAB 100MG SR, 40
Wellbutrin TAB 75MG, 40
Wellbutrin TAB XL 150MG, 39
Wellbutrin TAB XL 300MG, 39
wera TAB 0.5/35, 25
Westcort Oin 0.2%, 20
Westhroid TAB 113.75MG, 31
westhroid TAB 130MG, 30
Westhroid TAB 195MG, 31
westhroid TAB 32.5MG, 30
westhroid TAB 65MG, 30
Whytederm Kit Trilasil, 20
Whytederm TD Kit PAK, 20
Wp Thyroid TAB 113.75MG, 31
Wp Thyroid TAB 130MG, 31
Wp Thyroid TAB 65MG, 31
wymzya FE chw 0.4MG-35, 26
X
x-viate CRE 40%, 21
x-viate gel 40%, 21
x-viate lot 40%, 21
Xalatan Sol 0.005%, 50
Xalkori CAP 200MG, 8
Xalkori CAP 250MG, 8
Xanax TAB 0.25MG, 38
Xanax TAB 0.5MG, 38
Xanax TAB 1MG, 38
Xanax TAB 2MG, 38
Xanax XR TAB 0.5MG, 38
Xanax XR TAB 1MG, 38
Xarelto Star TAB 15/20MG, 36
Xarelto TAB 10MG, 36
Xartemis XR TAB 7.5-325, 54
xelitral PAK, 18
Xeljanz TAB 5MG, 55
Xeljanz XR TAB 11MG, 55
Xeloda TAB 150MG, 7
Xeloda TAB 500MG, 7
Xenazine TAB 12.5MG, 48
Xenazine TAB 25MG, 48
Xeomin Inj 200unit, 48
Xeralux CRE, 22
Xerese CRE 5-1%, 18
Xifaxan TAB 200MG, 6
Xifaxan TAB 550MG, 6
Xigduo XR TAB 10-1000, 28
Xigduo XR TAB 10-500MG, 28
Xilapak Kit, 20
Xodol TAB 10-300MG, 54
Xodol TAB 5-300MG, 54
Xodol TAB 7.5-300, 54
Xolegel Duo/ Kit Head&shd, 18
Xolegel Duo/ Kit Xolex, 18
Xolegel Gel 2%, 18
Xolegel Kit Corepak, 18
Xopenex CONC Neb 1.25/0.5, 58
Xopenex HFA Aer, 58
Xopenex Neb 0.31MG, 58
Xopenex Neb 0.63MG, 58
Xopenex Neb 1.25/3ML, 58
Xpres Contrl Sol Normal, 65
Xtampza ER CAP 13.5MG, 54
Xtampza ER CAP 18MG, 54
Xtandi CAP 40MG, 7
xulane dis 150-35, 25
Xylo-mpf/Epi Inj 1%, 56
Xylo-mpf/Epi Inj 1.5%, 56
Xylo-mpf/Epi Inj 2%, 56
Xylo/Epi 1%- Inj 1:100000, 56
Xylo/Epi Inj 0.5%, 56
Xylo/Epi Inj 2%, 56
Xylocaine Inj -mpf 1%, 56
Xylocaine Inj 0.5%, 56
Xylocaine Inj 1%, 56
Xylocaine Inj 2%, 56
xylocaine inj dent 2%, 56
Xylocaine Inj Mpf 0.5%, 56
Xylocaine Inj Mpf 1.5%, 56
Xylocaine Sol 4%, 22
xylon TAB 10-200MG, 52
xyphex mis, 21
Xyrem Sol 500MG/ML, 48
Xyzal Sol, 57
Xyzal Sol 2.5/5ML, 57
Xyzal TAB 5MG, 57
Y
Yasmin 28 TAB 3-0.03MG, 26
Yaz TAB 3-0.02MG, 26
Yodoxin TAB 650MG, 6
Z
Zacare Kit Kit 4%, 17
Zacare Kit Kit 8%, 18
zaclir lot 8%, 17
zafirlukast TAB 10MG, 58
zafirlukast TAB 20MG, 58
zaleplon CAP 10MG, 41
zaleplon CAP 5MG, 41
Zamicet Sol 10-325MG, 54
Zanaflex CAP 2MG, 49
Zanaflex TAB 4MG, 49
Zantac Inj 25MG/ML, 32
Zantac Inj 50MG/2ML, 32
Zantac TAB 150MG, 32
Zantac TAB 300MG, 32
zarah TAB 3-0.03MG, 25
Zarontin CAP 250MG, 45
Zarontin Sol 250/5ML, 45
Zaroxolyn TAB 2.5MG, 14
Zaroxolyn TAB 5MG, 14
Zarxio Inj 300/0.5, 36
Zarxio Inj 480/0.8, 36
Zavesca CAP 100MG, 36
zazole CRE 0.8%, 34
zazole sup 80MG, 34
Zebeta TAB 10MG, 10
Zebeta TAB 5MG, 10
zebutal CAP, 51
Zecuity Pad 6.5MG/4h, 56
Zegerid CAP 20-1100, 32
Zegerid CAP 40-1100, 32
Zegerid Pow 20-1680, 32
Zegerid Pow 40-1680, 32
Zelapar TAB 1.25MG, 46
Zelboraf TAB 240MG, 8
Zembrace Sym Inj 3/0.5ML, 56
Zemplar CAP 1mcg, 30
Zemplar CAP 2mcg, 30
zenatane CAP 10MG, 17
zenchent FE chw 0.4MG-35, 26
zenchent TAB, 25
zencia liq 9-4%, 17
Zenpep CAP 10000unt, 33
Zenpep CAP 3000unit, 33
Zenpep CAP 5000unit, 33
zenzedi TAB 10MG, 42
Zenzedi TAB 15MG, 43
Zenzedi TAB 2.5MG, 43
zenzedi TAB 5MG, 42
Zenzedi TAB 7.5MG, 43
Zepatier TAB 50-100MG, 5
Zerit CAP 15MG, 5
Zerit CAP 20MG, 5
Zerit CAP 30MG, 5
Zerit CAP 40MG, 5
Zerit Sol 1MG/ML, 5
zeruvia pad 4-1%, 21
Zestoretic TAB 10-12.5, 14
Zestoretic TAB 20-12.5, 14
Zestoretic TAB 20-25MG, 14
Zestril TAB 10MG, 12
Zestril TAB 2.5MG, 12
Zestril TAB 5MG, 12
Zetia TAB 10MG, 15
Zetonna Aer 37mcg, 57
Ziac TAB 10/6.25, 14
Ziac TAB 2.5/6.25, 14
Ziac TAB 5-6.25MG, 14
Ziagen Sol 20MG/ML, 5
Ziagen TAB 300MG, 5
Ziana Gel, 18
zidovudine CAP 100MG, 4
zidovudine syp 50MG/5ML, 4
zidovudine TAB 300MG, 4
Zinacef Inj 1.5gm, 2
Zinacef Inj 7.5gm, 2
Zinacef Inj 750MG, 2
Zinbryta Inj 150MG/ML, 48
Zioptan Dro 0.0015%, 50
ziprasidone CAP 20MG, 40
Zipsor CAP 25MG, 55
Zirgan Gel 0.15%, 49
Zithranol Sha 1%, 19
Zithranol-rr CRE 1.2%, 19
Zithromax Pow 1gm PAK, 2
Zithromax Sus 100/5ML, 2
Zithromax Sus 200/5ML, 2
Zithromax TAB 250MG, 2
Zithromax TAB Tri-PAK, 2
Zithromax TAB Z-PAK, 2
Zmax Sus 2gm, 2
ZN-dtpa sol 1000MG, 66
Zocor TAB 10MG, 16
Zocor TAB 20MG, 16
Zocor TAB 40MG, 16
Zocor TAB 5MG, 16
Zocor TAB 80MG, 16
Zofran Inj 40/20ML, 32
Zofran Sol 4MG/5ML, 32
Zofran TAB 4MG, 32
Zofran TAB 4MG Odt, 32
Zofran TAB 8MG, 32
Zofran TAB 8MG Odt, 32
Zohydro ER CAP 10MG, 54
Zolinza CAP 100MG, 8
zolmitriptan TAB 2.5 MG, 55
zolmitriptan TAB 2.5MG, 55
zolmitriptan TAB 5MG, 55
Zoloft CON 20MG/ML, 40
Zoloft TAB 100MG, 40
Zoloft TAB 25MG, 40
Zoloft TAB 50MG, 40
zolpidem ER TAB 12.5MG, 42
zolpidem ER TAB 6.25MG, 42
zolpidem TAB 10MG, 41
zolpidem TAB 5MG, 41
zolpidem TAR sub 1.75MG, 42
zolpidem TAR sub 3.5MG, 42
Zolpimist Spr 5MG, 42
Zomacton Inj 10MG, 28
Zomacton Inj 5MG, 29
Zomig Nasal Spr 5MG, 56
Zomig Spr 2.5MG, 56
Zomig TAB 2.5MG, 56
Zomig TAB 5MG, 56
Zomig ZMT TAB 2.5 MG, 56
Zomig ZMT TAB 5MG, 56
Zonalon CRE 5%, 19
Zonatuss CAP 150MG, 57
Zonegran CAP 100MG, 45
Zonegran CAP 25MG, 45
zonisamide CAP 100MG, 44
Zontivity TAB 2.08MG, 37
Zorbtive Inj 8.8MG, 29
Zortress TAB 0.25MG, 8
Zorvolex CAP 18MG, 55
Zorvolex CAP 35MG, 55
Zostavax Inj, 59
zovia 1/35e TAB, 25
zovia 1/50e TAB, 25
Zovirax CAP 200MG, 5
Zovirax CRE 5%, 18
Zovirax Oin 5%, 18
Zovirax Sus 200/5ML, 5
Zovirax TAB 400MG, 5
Zovirax TAB 800MG, 5
Zubsolv Sub 1.4-0.36, 54
Zuplenz Mis 4MG, 32
Zuplenz Mis 8MG, 32
Zurampic TAB 200MG, 56
Zutripro Liq 60-4-5MG, 58
Zyclara CRE 3.75%, 21
Zyclara P.M. CRE 2.5%, 21
Zyclara P.M. CRE 3.75%, 21
Zydelig TAB 100MG, 8
Zydelig TAB 150MG, 8
Zyflo CR TAB 600MG, 58
Zyflo TAB 600MG, 58
Zykadia CAP 150MG, 8
Zylet Sus 0.5-0.3%, 50
Zyloprim TAB 100MG, 56
Zyloprim TAB 300MG, 56
Zymaxid Sol 0.5%, 49
Zyprexa Inj 10MG, 41
Zyprexa Relp Inj 210MG, 41
Zyprexa TAB 10MG, 41
Zyprexa TAB 2.5MG, 41
Zyprexa TAB 5MG, 41
Zyprexa TAB 7.5MG, 41
Zyprexa Zydi TAB 10MG, 41
Zytiga TAB 250MG, 7
Zyvox Sus 100MG/5m, 6
Zyvox TAB 600MG, 6
1
1ST Choice Mis Lancets, 65
1ST Tier Uni Mis 29GX12MM, 65
8
8-mop CAP 10MG, 19
Appendix A:
OVER-THE-COUNTER (OTC) MEDICATION
BENEFIT LIST
The medications listed below are covered only for members who have
purchased a special benefit offered through Group Health called the Overthe-Counter Pharmacy Benefit.
***Typically, if a generic product is available for a drug, the Brand Name
product may not be covered.***
Generic Product Name
ALLERGY COUGH AND COLD
***Brand Name***
Forms
Antihistamines
CHLORPHENIRAMINE
CHLOR-TRIMETON®
CLEMASTINE
TAVIST®
Tab, Liquid
Tab, Liquid
DIPHENHYDRAMINE
BENADRYL®
Cap, Liquid
LORATADINE
CLARITIN®
Tab, Liquid
Decongestants
OXYMETAZOLINE NASAL SPRAY
AFRIN®
PHENYLEPHRINE NASAL SPRAY
NEO-SYNEPHRINE®
Spray
Spray
PSEUDOEPHEDRINE
SUDAFED®
Tablet
Antihistamine/Decongestant Combinations
TRIPROLIDINE/PSEUDOEPHEDRINE
ACTIFED®
Tablet
BROMPHENIRAMINE/PSEUDOEPHEDRINE
DIMETAPP®
Liquid
GUAIFENESIN
ROBITUSSIN®
Liquid
GUAIFENESIN/DEXTROMETHORPHAN
ROBITUSSIN-DM®
Liquid
DEXTROMETHORPHAN
ROBITUSSIN COUGH®
Liquid
DEXTROMETHORPHAN EXTEND RELEASE
DELSYM®
Liquid
TYLENOL®
Tab, Chew, Supp,
Liquid
Expectorants/Cough Agents
AUTONOMICS AND CNS
Analgesics, Miscellaneous
ACETAMINOPHEN
Non-Steroidal Anti-Inflammatories
IBUPROFEN
MOTRIN®, ADVIL®
Tab, Liquid
BAYER®, ASCRIPTIN®
Tab, Supp
Salicylates
ASPIRIN
DERMATOLOGICAL/ TOPICAL AGENTS
Acne/Psoriasis, Topical
BENZOYL PEROXIDE 5%, 10%
BENZAC®
COAL TAR
Gel, Wash, Lotion
Solution
Anesthetic Agents, Topical
BENZOCAINE
HURRICAINE®
PRAMOXINE
ANUSOL®
Antifungals, Topical
Gel
Ointment
CLOTRIMAZOLE 1%
LOTRIMIN®
Cream, Solution
MICONAZOLE 2%
MICATIN®, DESENEX®
Cream, Powder
Anti-Infectives, Topical
BACITRACIN
BACIGUENT®
Ointment
BACITRACIN, POLYMIXIN B
POLYSPORIN®
Ointment
BACITRACIN, NEOMYCIN, POLYMYXIN B
NEOSPORIN®
Ointment
OATMEAL, COLLOIDAL
AVEENO® BATH POWDER
Powder
Anti-Itch, Topical
CALAMINE
CALAMINE
CAMPHOR/ MENTHOL
SARNA®
Lotion
Lotion
CAPSAICIN
ZOSTRIX®, ZOSTRIX-HP®
Cream
ABREVA®
Cream
Anti-Virals, Topical
DOCOSANOL 10%
Corticosteroids, Topical, Low Potency
HYDROCORTISONE 0.5%, 1%
CORTIZONE®
Cream, Oint,
Lotion
Keratolytics
SALICYLIC ACID 17%
DUOFILM®
Liquid
SALICYLIC ACID 40%
MEDIPLAST®
Plaster
UREA 10%, 20%
UREACIN®, CARMOL® 20
Cream, Lotion
Dermatologics, Miscellaneous
ALUMINUM ACETATE
BUROWS®
Liquid
AMMONIUM LACTATE 12%
AMLACTIN®
Cream, Lotion
HYDROGEN PEROXIDE
HYDROGEN PEROXIDE
VITAMIN A&D
A AND D® OINTMENT
WITCH HAZEL
TUCKS®
Solution, Pads
ZINC OXIDE, COD LIVER OIL & LANOLIN
DESITIN®
Oint, Paste
ZINC OXIDE 20%
BALMEX®
Ointment
Liquid
Ointment
Scabicides
PERMETHRIN
NIX®
PYRETHRINS, PIPERONYL BUTOXIDE
RID®, R & C®
Shampoo
Rinse
LANOLIN, HYDROUS
LANOLIN
Ointment
PETROLATUM, GLYCERIN,BENZYL ALC
MOISTUREL®
PETROLATUM, MINERAL OIL/WAX, ETC.
AQUAPHOR®, EUCERIN®
Ointment
DEBROX®
Solution
Skin Protectants
Lotion
EYE, EAR, NOSE AND THROAT
Otics
CARBAMIDE
Nasal Agents
CROMOLYN
NASALCROM®
Spray
Ophthalmics
ARTIFICIAL TEARS
HYOPTEARS®, PURALUBE®
CARBOXYMETHYLCELLULOSE
CELLUVISC®, REFRESH PLUS®
Drops
HYDROXYPROPYL METHYLCELLULOSE
TEARS NATURALE II®
Drops
KETOTIFEN FUMARATE 0.025%
ZADITOR®
Drops
NAPHAZOLINE/ PHENIRAMINE
OPCON-A®
Drops
POLYVINYL ALCOHOL, POVIDONE
REFRESH® PF
Drops
SODIUM CHLORIDE 5%
MURO®-128
Throat and Mouth Agents
Drops, Ointment
Drops, Ointment
CETYLPYRIDINIUM CL, BENZYL ALCOHOL
CEPACOL®
Lozenge
GASTROINTESTINAL AGENTS
Antacids/Adsorbents
CHARCOAL, ACTIVATED W/O SORBITOL
ACTIDOSE
Liquid
ALUMINUM/ MAGNESIUM
MAALOX®
Tablet, Liquid
ALUMINUM/ MAGNESIUM/ SIMETHICONE
MINTOX® PLUS, MI-ACID
Tablet, Liquid
ALUM/ MAGN/TRISILIS/ALG AC/SOD BICAR
GAVISCON®, GENATON
Tablet
ALUMINUM HYDROXIDE
ALTERNAGEL®, AMPHOGEL®
Liquid
MAGNESIUM OXIDE
MAG-OX®
Tablet
Antidiarrheals
BISMUTH SUBSALICYLATE
PEPTO BISMOL®
Tablet, Liquid
LOPERAMIDE
IMMODIUM®
Tablet, Liquid
DIMENHYDRINATE
DRAMAMINE®
Tablet, Liquid
MECLIZINE
BONINE®, ANTIVERT®
Antinauseants
Tablet
Laxatives/Cathartics
BISACODYL
DULCOLAX®
Tablet, Supp
DOCUSATE SODIUM
COLACE®
Tablet, Liquid
GLYCERIN
GLYCERIN
Liquid, Supp
MAGNESIUM CITRATE
CITRO-MAG®
Liquid
MILK OF MAGNESIA
MILK OF MAGNESIA
Liquid
MINERAL OIL
FLEET® MINERAL OIL
PSYLLIUM
METAMUCIL®
Powder
POLYETHYLENE GLYCOL
MIRALAX®
Powder
SENNA
SENOKOT®
Tablet, Liquid
Liquid
Histamine H2 Blockers
RANITIDINE
ZANTAC®
Tablet
Gastrointestinal, Miscellaneous
SIMETHICONE
MYLICON®
LACTOBACILLUS
BACID®
Tablet
SHARK LIVER OIL, COCOA BUTTER,
PHENYLEPHRINE
HEMORRHOIDAL
SUPPOSITORIES
Supp
PRILOSEC OTC
Tablet
OXYTROL® PATCH
Patch
PLAN B ONE STEP
Tablet
NIACIN
NIACIN
Tablet
NIACIN EXTENDED-RELEASE
SLO-NIACIN®
FISH OILS
SEA-OMEGA®-50
Capsule
NAC®
Capsule
Capsule
Proton Pump Inhibitors
OMEPRAZOLE
GENITOURINARY
Overactive bladder treatment
OXYBUTYNIN
HORMONES
Contraceptive
LEVONORGESTROL
LIPID LOWERING AGENTS
Non-Prescription Agents
Tablet
NUTRITIONALS AND SUPPLEMENTS
Vitamins/Dietary Supplements
ACETYLCYSTEINE
ASCORBIC ACID (VIT C)
Tablet
CYANOCOBALAMIN (VIT B12)
Tablet
CHOLECALCIFEROL (VIT D)
Tablet
FOLIC ACID
Tablet
NIACINAMIDE (VIT B3)
Tablet
PRENATAL VITAMINS W/ FOLIC ACID
Tablet
PYRIDOXINE (VIT B6)
Tablet
THIAMINE (VIT B1)
Tablet
VITAMIN A
Capsule
VITAMIN B COMPLEX
Tablet
VITAMIN B COMPLEX W/C
Tablet
VITAMIN E
Capsule
Electrolytes, Iron, & Minerals
CALCIUM CARBONATE
TUMS®
CALCIUM CITRATE
CAL-CITRATE®
Tablet
CALCIUM CITRATE w/VITAMIN D
CITRACAL®
Tablet
ELECTROLYTE ORAL
PEDIALYTE®
Liquid
FERROUS GLUCONATE
FERGON®
Tablet
FERROUS SULFATE
FER-IN-SOL®
MAGNESIUM OXIDE
URO-MAG®
SODIUM BICARBONATE
ZINC SULFATE
Chew tabs, Liquid
Tablet, Liquid
Capsule
Tablet
ZINCATE®
Capsule
BETADINE®
Douche
VAGINAL PREPARATIONS
Vaginal Anti-Infectives
POVIDONE-IODINE
Vaginal Antifungals
CLOTRIMAZOLE
MICONAZOLE
MYCELEX®-7, GYNE-LOTRIMIN®3
MONISTAT®
Cream, Vag tabs
Cream
Miscellaneous
LUBRICATING JELLY
K-Y JELLY®
JELLY
Group Health Nondiscrimination Notice
and Language Access Services
GROUP HEALTH NONDISCRIMINATION NOTICE
Group Health Cooperative and Group Health Options, Inc. (“Group Health”) comply with applicable Federal civil
rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. Group Health
does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Group Health:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
• Qualified sign language interpreters
• Written information in other formats (large print, audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language is not English, such as:
• Qualified interpreters
• Information written in other languages
If you need these services, contact the Group Health Civil Rights Coordinator.
If you believe that Group Health has failed to provide these services or discriminated in another way on the basis of
race, color, national origin, age, disability, or sex, you can file a grievance with:
Group Health Civil Rights Coordinator, Group Health Headquarters, 320 Westlake Ave. N., Suite 100, GHQ-E2N,
Seattle, WA 98109, 206-448-5819, 206-877-0645 (Fax), complianceoffice@ghc.org. You can file a grievance in
person or by mail, fax, or email. If you need help filing a grievance, the Group Health Civil Rights Coordinator is
available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human
Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human
Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800‑368‑1019,
800-537-7697 (TDD).
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
LANGUAGE ACCESS SERVICES
English: ATTENTION: If you speak English, language
assistance services, free of charge, are available to you.
Call 1-888-901-4636 (TTY: 1-800-833-6388 or 711).
Español (Spanish): ATENCIÓN: Si habla español,
tiene a su disposición servicios gratuitos de asistencia
lingüística. Llame al 1-888-901-4636
(TTY: 1-800-833-6388 / 711).
中文 (Chinese)：注意：如果您使用繁體中文，您可以
免費獲得語言援助服務。請致電 1-888-901-4636
(TTY：1-800-833-6388 / 711）。
Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng
Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành
cho bạn. Gọi số 1-888-901-4636
(TTY：1-800-833-6388 / 711).
한국어(Korean): 주의: 한국어를 사용하시는 경우,
언어 지원 서비스를 무료로 이용하실 수 있습니다.
1-888-901-4636 (TTY: 1-800-833-6388 / 711) 번으로
전화해 주십시오.
Русский (Russian): ВНИМАНИЕ: Если вы говорите
на русском языке, то вам доступны бесплатные
услуги перевода. Звоните 1-888-901-4636
(телетайп: 1-800-833-6388 / 711).
© 2016 Group Health Cooperative and Group Health Options, Inc.
2017-XB-02_ACA_Notice_Taglines
Y0033_H5050_XB0001444-02-16
Accepted 08-21-2016
Filipino (Tagalog): PAUNAWA: Kung nagsasalita ka
ng Tagalog, maaari kang gumamit ng mga serbisyo
ng tulong sa wika nang walang bayad. Tumawag sa
1-888-901-4636 (TTY: 1-800-833-6388 / 711).
Українська (Ukrainian): УВАГА! Якщо ви
розмовляєте українською мовою, ви можете
звернутися до безкоштовної служби мовної
підтримки. Телефонуйте за номером
1-888-901-4636 (телетайп: 1-800-833-6388 / 711).
ភាសាខ្មែរ (Khmer)៖ របយ័ត�៖ េប�ើសិន�អ�កនិ�យ�ែខ�រ,
ំ ួយែផ�ក� េ�យមន
េស�ជន
់ ំេរ�អ�ក។ ចូរទូ
ិ គិត�ល គឺ�ច�នសំ �បប
រស័ព1
� -888-901-4636 (TTY: 1-800-833-6388 / 711។
日本語(Japanese): 注意事項：日本語を話される場
合、無料の言語支援をご利用いただけます。
1-888-901-4636（TTY:1-800-833-6388 / 711）ま
で、お電話にてご連絡ください。
አማርኛ (Amharic)፥ ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ
የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ
ሚከተለው ቁጥር ይደውሉ 1-888-901-4636
(መስማት ለተሳናቸው: 1-800-833-6388 / 711).
Oromiffa (Oromo): XIYYEEFFANNAA: Afaan
dubbattu Oroomiffa, tajaajila gargaarsa afaanii,
kanfaltiidhaan ala, ni argama. Bilbilaa
1-888-901-4636 (TTY: 1-800-833-6388 / 711).
‫ لديكم حق الحصول على مساعدة ومعلومات في‬:)Arabic( ‫العربية‬
‫ فإن خدمات المساعدة اللغوية‬،‫ إذا كنت تتحدث اذكر اللغة‬:‫ملحوظة‬
1-888-901-4636 ‫ اتصل برقم‬.‫تتوافر لك بالمجان‬
.)711 / 1-800-833-6388 :‫(رقم هاتف الصم والبكم‬
ਪੰ ਜਾਬੀ (Punjabi) ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰ ਜਾਬੀ ਬੋਲਦੇ ਹੋ,
ਤਾਂ ਭਾਸ਼ਾ ਵਿੱ ਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ।
1-888-901-4636 (TTY: 1-800-833-6388 / 711)
‘ਤੇ ਕਾਲ ਕਰੋ।
Deutsch (German): ACHTUNG: Wenn Sie Deutsch
sprechen, stehen Ihnen kostenlos sprachliche
Hilfsdienstleistungen zur Verfügung. Rufnummer:
1-888-901-4636 (TTY: 1-800-833-6388 / 711).
້
ພາສາລາວ (Lao): ໂປດຊາບ: ຖ້າວ່າ ທ່ ານເວົາພາສາລາວ,
ການບໍ
່
ື ດ້ານພາສາ, ໂດຍບໍເສັຽຄ່າ, ແມ່ ນມີພອ້ ມໃຫ້ທ່ານ.
ລິການຊ່ວຍເຫຼອ
ໂທຣ 1-888-901-4636 (TTY: 1-800-833-6388 / 711).
Srpsko-hrvatski (Serbo-Croatian): OBAVJEŠTENJE
Ako govorite srpsko-hrvatski, usluge jezičke pomoći
dostupne su vam besplatno. Nazovite
1-888-901-4636 (TTY- Telefon za osobe sa oštećenim
govorom ili sluhom: 1-800-833-6388 / 711).
Français (French): ATTENTION: Si vous parlez
français, des services d’aide linguistique vous sont
proposés gratuitement. Appelez le 1-888-901-4636
(ATS : 1-800-833-6388 / 711).
Română (Romanian): ATENȚIE: Dacă vorbiți limba
română, vă stau la dispoziție servicii de asistență
lingvistică, gratuit. Sunați la 1-888-901-4636
(TTY: 1-800-833-6388 / 711).
Adamawa (Fulfulde): MAANDO: To a waawi
[Adamawa], e woodi ballooji-ma to ekkitaaki wolde
caahu. Noddu 1-888-901-4636
(TTY: 1-800-833-6388 / 711).
،‫ اگر به زبان فارسی گفتگو می کنید‬:‫ توجه‬:)Farsi( ‫فارسی‬
‫ با‬.‫تسهیالت زبانی بصورت رایگان برای شما فراهم می باشد‬
‫) تماس‬TTY: 1-800-833-6388 / 711( 1-888-901-4636
.‫بگیرید‬

2016 Drug Formulary - Group Health Cooperative

Transcription

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