New York - WellCare

Transcription

New York - WellCare
2015
New York
Comprehensive Formulary
List of Covered Drugs
WellCare Health Insurance Exchange Plan
Please Read: This document contains information about the drugs we cover in this plan.
NY026466_HIX_FOR_ENG
©WellCare2014NY_06_14
NY5HIXFOR60312E
What is the WellCare Health Insurance Exchange comprehensive
formulary?
A formulary is a list of covered drugs. WellCare selects the drugs by working with a team
of health care providers. The list contains the prescription and over-the-counter (OTC)
medications we believe are a necessary part of a quality treatment program. OTC drugs are
those medications you can buy without a prescription. WellCare will generally cover the drugs
listed in our formulary as long as:
1. the drug is medically necessary,
2. the prescription is filled at a WellCare network pharmacy, and
3. other plan rules are followed.
For more information on how to fill your prescriptions, please see your policy.
Can the formulary (drug list) change?
When we make certain changes to our formulary, we must notify the members who will be
affected by the changes. This includes if we:
• remove drugs from our formulary;
• add restrictions on a drug such as prior authorization, quantity limits and/or step therapy;
• move a drug to a higher cost-sharing tier.
If we make any of these changes, we must notify affected members at least 30 days before the
change goes into effect.
If the Food and Drug Administration announces that a drug on our formulary is unsafe, or a
drug manufacturer removes a drug from the market, we will immediately remove the drug from
our formulary and notify members who take the drug.
The enclosed formulary is current as of 01/01/2015. To get updated information about the
drugs covered by WellCare, please visit our website at www.wellcareplans.com or call
Customer Service at 1-855-582-6172, Monday–Friday, 8 a.m.–8 p.m. TTY users should call
1-855-582-6171.
How do I use the formulary?
There are two ways to find your drug within the formulary:
Medical Condition
The formulary begins on page 1. The drugs in this formulary are grouped into categories
depending on the type of medical conditions that they are used to treat. For example, drugs
used to treat a heart condition are listed under the category “Cardiovascular Agents.” If you
know what your drug is used for, look for the category name in the list that begins on page 1.
Then look under the category name for your drug.
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Formulary Tiers
What you pay for your prescriptions falls into one of these tiers or levels: Tier 1 (Generic Drugs): You pay the lowest cost for drugs in this level.
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Tier 2 (Preferred Drugs): You pay a slightly higher cost for drugs in this level.
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Tier 3 (Non-Preferred and Specialty Drugs): You pay the highest cost for drugs in this level.
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Alphabetical Listing
If you are not sure what category to look under, you should look for your drug in the Index
that begins on page 44. The Index provides an alphabetical list of all of the drugs included in
this document. Both brand-name drugs and generic drugs are listed in the Index. Look in the
Index and find your drug. Next to your drug, you will see the page number where you can find
coverage information. Turn to the page listed in the Index and find the name of your drug in
the first column of the list.
What are generic drugs?
WellCare covers both brand-name drugs and generic drugs. A generic drug is approved by the
FDA as having the same active ingredient as the brand-name drug. Generally, generic drugs cost
less than brand-name drugs.
Are there any restrictions on my coverage?
Some covered drugs may have additional requirements or limits on coverage. These requirements
and limits may include:
•�Prior Authorization: WellCare requires you or your physician to get prior authorization for
certain drugs. This means that you will need to get approval from us before you fill your
prescriptions. If you don’t get approval, we may not cover the drug.
•�Quantity Limits: For certain drugs, we limit the amount of the drug that we will cover. This
may be in addition to a standard one-month or three-month supply.
•�Step Therapy: In some cases, WellCare requires you to first try certain drugs to treat your
medical condition before we will cover another drug for that condition. For example, if
Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you
try Drug A first. If Drug A does not work for you, we will then cover Drug B.
You can find out if your drug has any additional requirements or limits by looking in the
formulary that begins on page 1. You can also get more information about the restrictions
applied to specific covered drugs by visiting our website at www.wellcareplans.com or contact
Customer Service at 1-855-582-6172, Monday–Friday, 8 a.m.–8 p.m. TTY users should call
1-855-582-6171.
You can ask WellCare to make an exception to these restrictions or limits, or for a list of other,
similar drugs that may treat your health condition. See the section, “How do I request an
exception to the WellCare formulary?” on the next page for information about how to request
an exception.
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What if my drug is not on the formulary?
If your drug is not included in this formulary (list of covered drugs), you should first contact
Customer Service and ask if your drug is covered. You can contact Customer Service at
1-855-582-6172, Monday–Friday, 8 a.m.–8 p.m. TTY users should call 1-855-582-6171.
If you learn that WellCare does not cover your drug, you have two options:
• You can ask Customer Service for a list of similar drugs that are covered by WellCare. When
you receive the list, show it to your doctor and ask him or her to prescribe a similar drug
that is covered by WellCare.
• You can ask WellCare to make an exception and cover your drug. See below for information about how to request an exception.
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Which vaccines do we cover?
Your prescription benefit may cover many vaccines. For details, see the Immunological Agents
section. The cost for vaccines varies, depending on the facility where you receive them. For
best coverage, use a network pharmacy.
How do I request an exception to the WellCare formulary?
You can ask WellCare to make an exception to our coverage rules. There are several types of
formulary exceptions that you can ask us to make.
Initial Coverage Decision Exception
You can ask us to cover your drug even if it is not on our formulary. If your request is approved,
the drug will be covered at a pre-determined cost-sharing level. You would not be able to ask
us to provide the drug at a lower cost-sharing level.
Utilization Restriction Exception
You can ask us to waive coverage restrictions or limits on your drug. For example, for certain
drugs, the amount of the drug that we cover is limited. If your drug has a quantity limit, you can
ask us to waive the limit and cover a greater amount. Your member contract provides you with
specific timelines on requests for exceptions.
What do I do before I can talk to my doctor about changing my drugs or
requesting an exception?
As a new or continuing member in our plan, you may be taking drugs that are not on our
formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is
limited. For example, you may need a prior authorization from us before you can fill your
prescription. You should talk to your doctor to decide if you should switch to an appropriate
drug that we cover, or request a formulary exception so that we will cover the drug you take.
While you talk to your doctor to determine the right course of action for you, we may cover
your drug in certain cases during the first 30 days you are a member of our plan.
For each of your drugs that is not on our formulary, or if your ability to get your drugs is
limited, we will cover a temporary 30-day supply (unless you have a prescription written for
fewer days) when you go to a network pharmacy.
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For more information
For more details about your WellCare prescription drug coverage, please review your contract
and other plan materials.
If you have questions about WellCare, please contact us at 1-855-582-6172, Monday–Friday,
8 a.m.–8 p.m. TTY users should call 1-855-582-6171. Or visit www.wellcareplans.com.
WellCare formulary
The comprehensive formulary that begins on page 1 provides coverage information about the
drugs covered by WellCare. If you have trouble finding your drug in the list, turn to the Index
that begins on page 44.
The information in small print next to the drug tells you if WellCare has any special
requirements for coverage of your drug.
• PA stands for Prior Authorization. Please see page II for details.
• QL stands for Quantity Limits. Please see page II for details.
• ST stands for Step Therapy. Please see page II for details.
* means that a drug may be available for up to a 30-day supply only.
This document is available in alternate languages. Please call Customer Service
at the number listed above for alternate languages available in your area.
Este documento se encuentra disponible en idiomas alternativos. Para obtener
información sobre los idiomas alternativos disponibles en su área, por favor
llame a Servicio al Cliente al número indicado más arriba.
本文件備有可選語言版本。請致電上列電話號碼,聯絡客戶服務部,索取您所在地
區提供的可選語言版本。
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Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FIFTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
AMEBICIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTIBIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTINEOPLASTIC ENZYMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANGIOGENESIS INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
RADIOPHARMACEUTICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
CELLULAR IMMUNOTHERAPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
CHEMOTHERAPY ADJUNCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
PHOSPHODIESTERASE INHBTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
CALCIUM REGULATORS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
GNRH/LHRH ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
ANTACIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
GENERAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30
MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35
MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36
ACA PREVENTIVE DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38
ASPIRIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38
FLUORIDE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40
FOLIC ACID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40
IMMUNIZATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40
IRON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41
SMOKING CESSATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
VITAMIN D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
BOWEL PREPARATION AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43
BREAST CANCER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43
Mefoxin
Zinacef IN Iso-osmotic Dextrose
Zinacef IN Iso-osmotic Diluent
THIRD GENERATION
GENERIC
cefdinir
cefotaxime sodium
cefpodoxime proxetil
ceftazidime
ceftriaxone sodium
tazicef
tazidime
Cefditoren Pivoxil
Ceftazidime
Ceftazidime/Dextrose
Ceftriaxone IN Iso-osmotic Dextrose
Ceftriaxone/Dextrose
NON PREFERRED
Cedax
Ceftibuten
Claforan
Suprax
January 2015
ANTI-INFECTIVES
PENICILLINS
GENERIC
amoxicillin
amoxicillin/clavulanate potassium
amoxicillin/clavulanate potassium ER
ampicillin
ampicillin sodium
ampicillin-sulbactam
dicloxacillin sodium
nafcillin sodium
oxacillin sodium
penicillin v potassium
penicillin G potassium
piperacillin sodium/ tazobactam sodium
piperacillin sodium/tazobactam sodium
piperacillin/tazobactam
Amoxicillin
Ampicillin
Ampicillin Sodium
Ampicillin-sulbactam
Nafcillin Sodium
Penicillin G Potassium IN Iso-osmotic Dextrose
Penicillin G Procaine
Penicillin G Sodium
Pfizerpen-G
PREFERRED
Augmentin
NON PREFERRED
Amoxicillin ER
Bactocill IN Dextrose
Bicillin C-R
Bicillin L-a
Moxatag
Timentin
CEPHALOSPORIN
FIRST GENERATION
GENERIC
cefadroxil
cefazolin sodium
cephalexin
Cefazolin Sodium
Cefazolin Sodium/Dextrose
Cephalexin
SECOND GENERATION
GENERIC
cefaclor
cefoxitin sodium
cefprozil
cefuroxime axetil
cefuroxime sodium
Cefaclor
Cefaclor ER
Cefotetan
Cefotetan/Dextrose
Cefoxitin Sodium
Cefuroxime Sodium
Cefuroxime/Dextrose
Zinacef
NON PREFERRED
Ceftin
FOURTH GENERATION
GENERIC
cefepime
Cefepime
NON PREFERRED
Maxipime
FIFTH GENERATION
NON PREFERRED
Teflaro
MACROLIDES
GENERIC
azithromycin
clarithromycin
clarithromycin ER
erythromycin
Azithromycin
E.e.s. 400
Erythromycin Base
Erythromycin Ethylsuccinate
NON PREFERRED
QL
Dificid
Ery-TAB
Erythrocin Lactobionate
PCE
Zithromax
TETRACYCLINES
GENERIC
avidoxy
demeclocycline HCL
doxy 100
doxycycline
doxycycline hyclate
doxycycline hyclate DR
doxycycline monohydrate
minocycline HCL
minocycline HCL ER
morgidox 1X100MG
morgidox 2X100MG
Minocin
Tetracycline HCL
NON PREFERRED
Alodox Convenience Kit
Ocudox
Solodyn
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
1
PA
itraconazole
ketoconazole
nystatin
QL
terbinafine HCL
voriconazole
Amphotericin B
Fluconazole IN NACL
PREFERRED
Cancidas
Lamisil
Mycamine
Noxafil
PA
Sporanox
NON PREFERRED
Abelcet
Ambisome
Amphotec
Eraxis
Terbinex
QUINOLONES
GENERIC
ciprofloxacin
ciprofloxacin ER
ciprofloxacin HCL
ciprofloxacin I.V.-IN D5W
levofloxacin
levofloxacin IN D5W
moxifloxacin HCL
ofloxacin
Ofloxacin
PREFERRED
Avelox
NON PREFERRED
Factive
Noroxin
AMINOGLYCOSIDES
GENERIC
amikacin sulfate
gentamicin sulfate
gentamicin sulfate pediatric
gentamicin sulfate/sodium chloride
gentamicin sulfate/0.9% sodium chloride
isotonic gentamicin
neomycin sulfate
paromomycin sulfate
tobramycin sulfate
Gentamicin Sulfate/0.9% Sodium Chloride
Isotonic Gentamicin
Streptomycin Sulfate
Tobramycin Sulfate/Sodium Chloride
NON PREFERRED
PA
tobramycin
QL
Tobi Podhaler
SULFONAMIDES
GENERIC
Sulfadiazine
ANTIMYCOBACTERIAL AGENTS
GENERIC
ethambutol HCL
isoniazid
pyrazinamide
rifabutin
rifampin
Isoniazid
PREFERRED
Priftin
Seromycin
Sirturo
NON PREFERRED
Capastat Sulfate
Cycloserine
Paser
Rifamate
Rifater
Trecator
ANTIFUNGALS
GENERIC
bio-statin
fluconazole
fluconazole IN dextrose
fluconazole IN NACL
flucytosine
griseofulvin microsize
griseofulvin ultramicrosize
ANTIVIRALS
GENERIC
abacavir
QL
abacavir sulfate/lamivudine/zidovudine
acyclovir
acyclovir sodium
cidofovir
didanosine
QL
famciclovir
ganciclovir
lamivudine
lamivudine/zidovudine
nevirapine
nevirapine ER
rimantadine HCL
stavudine
QL
valacyclovir HCL
zidovudine
Acyclovir Sodium
Foscarnet Sodium
PREFERRED
Aptivus
QL
Atripla
QL
Complera
Crixivan
Edurant
Emtriva
Epivir
Epivir HBV
Epzicom
QL,PA
Fuzeon
Intelence
Invirase
Isentress
Kaletra
Lexiva
Nevirapine
Norvir
Prezista
QL
Relenza Diskhaler
Rescriptor
Retrovir IV Infusion
Reyataz
PA
Selzentry
QL
Stribild
Sustiva
QL
Tamiflu
PA
Truvada
Videx Pediatric
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
2
Viracept
Viramune
Viramune XR
Viread
Ziagen
NON PREFERRED
QL,PA
adefovir dipivoxil
QL,PA
entecavir
moderiba
ribasphere
ribavirin
QL,PA
Baraclude
PA
Incivek
PA
Infergen
Moderiba
Moderiba 1200 Dose Pack
Moderiba 800 Dose Pack
PA
Olysio
PA
Peg-intron
PA
Peg-intron Redipen
PA
Peg-intron Redipen PAK 4
PA
Pegasys
PA
Pegasys Proclick
Rebetol
Ribasphere
Ribasphere Ribapak
Ribatab
PA
Sovaldi
Tivicay
QL,PA
Tyzeka
Valcyte
PA
Victrelis
Virazole
ANTIMALARIALS
GENERIC
atovaquone/proguanil HCL
chloroquine phosphate
hydroxychloroquine sulfate mefloquine HCL PA
quinine sulfate
PA
Qualaquin
PREFERRED
Coartem
Daraprim
Primaquine Phosphate
AMEBICIDES
NON PREFERRED
Yodoxin
ANTHELMINTICS
PREFERRED
Albenza
Stromectol
NON PREFERRED
Biltricide
MISC. ANTI-INFECTIVES
GENERIC
atovaquone
aztreonam
baciim
bacitracin
clindamycin palmitate HCL
clindamycin phosphate
clindamycin phosphate add-vantage
clindamycin phosphate pharmacy bulk package
clindamycin phosphate IN D5W
clindamycin HCL
colistimethate sodium
e.s.p.
imipenem/cilastatin
meropenem
metronidazole
metronidazole IN NACL 0.79%
polymyxin b sulfate
sulfamethoxazole/trimethoprim
sulfamethoxazole/trimethoprim DS
sulfatrim pediatric
tinidazole
trimethoprim
vancomycin HCL
Bacitracin
Chloramphenicol Sodium Succinate
Clindamycin Phosphate
Sulfamethoxazole/Trimethoprim
Vancomycin HCL
Vancomycin HCL IN Dextrose
PREFERRED
Alinia
Dapsone
Nebupent
Tygacil
PA
Xifaxan
QL
Zyvox
NON PREFERRED
Azactam IN Iso-osmotic Dextrose
PA
Cayston
Cubicin
Doribax
Flagyl ER
Invanz
PA
Ketek
Lincocin
Primsol
Vibativ ANTINEOPLASTICS, ETC
ALKYLATING AGENTS
GENERIC
cisplatin
ifosfamide
Cisplatin
Ifosfamide
PREFERRED
Alkeran
Gliadel Wafer
Hexalen
Ifex
Leukeran
Lomustine
Mustargen
Zanosar
NON PREFERRED
carboplatin
melphalan hydrochloride
oxaliplatin
PA
temozolomide
Bicnu
Busulfex
Carboplatin
Cyclophosphamide
Eloxatin
PA
Myleran
Temodar
Treanda
PA
Valchlor
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
3
PA
ANTIBIOTICS
GENERIC
bleomycin sulfate
idarubicin HCL
mitomycin
PREFERRED
Valstar
NON PREFERRED
adriamycin
daunorubicin HCL
doxorubicin HCL
doxorubicin HCL liposome
epirubicin HCL
lipodox
lipodox 50
PA
mitoxantrone HCL
Adriamycin
Daunoxome
Epirubicin HCL
ANTINEOPLASTIC ENZYMES
PREFERRED
Elspar
Oncaspar
NON PREFERRED
PA
Erwinaze
ANTIMETABOLITES
GENERIC
adrucil
cytarabine
cytarabine aqueous
floxuridine
fluorouracil
mercaptopurine
methotrexate
methotrexate sodium
Cytarabine
PREFERRED
Clolar
Depocyt
Tabloid
Trexall
NON PREFERRED
PA
azacitidine
PA
capecitabine
cladribine
PA
decitabine
fludarabine phosphate
gemcitabine HCL
Alimta
Arranon
Folotyn
Gemcitabine
ANGIOGENESIS INHIBITORS
NON PREFERRED
Avastin
PA
Zaltrap
ANTIBODIES
PREFERRED
Bexxar
NON PREFERRED
PA
Adcetris
PA
Arzerra
Erbitux
PA
Gazyva
PA
Herceptin
Kadcyla
PA
Perjeta
PA
Rituxan
Vectibix
PA
Yervoy
Zevalin Y-90
HORMONAL AGENTS
GENERIC
anastrozole
bicalutamide
exemestane
flutamide
letrozole
megestrol acetate
PREVENTIVE
tamoxifen citrate
PREFERRED
Depo-provera
Emcyt
Fareston
Lysodren
Nilandron
Soltamox
NON PREFERRED
PA
leuprolide acetate
QL,PA
Eligard
Faslodex
QL,PA
Firmagon
QL,PA
Lupron Depot
QL,PA
Trelstar Depot
QL,PA
Trelstar Depot Mixject
QL,PA
Trelstar LA
QL,PA
Trelstar LA Mixject
QL,PA
Trelstar Mixject
QL,PA
Vantas
QL,PA
Xtandi
QL,PA
Zoladex
PA
Zytiga
IMMUNOMODULATORS
GENERIC
azathioprine
cyclosporine
cyclosporine modified
gengraf
hecoria
mycophenolate mofetil
mycophenolic acid DR
sirolimus
tacrolimus
Cyclosporine Modified
PREFERRED
Azasan
Cellcept
Rapamune
Sandimmune
NON PREFERRED
Atgam
Cellcept Intravenous
PA
Nulojix
PA
Pomalyst
Prograf
PA
Revlimid
Simulect
PA
Thalomid
Thymoglobulin
PA
Zortress
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
4
MITOTIC INHIBITORS
GENERIC
Docetaxel
Vinblastine Sulfate
PREFERRED
Teniposide
NON PREFERRED
etoposide
paclitaxel
toposar
vincasar PFS
vincristine sulfate
vinorelbine tartrate
Abraxane
Docefrez
Etopophos
Etoposide
PA
Halaven
Ixempra Kit
PA
Jevtana
Marqibo
Paclitaxel
Taxotere
ENZYME INHIBITORS
NON PREFERRED
PA
Afinitor
PA
Afinitor Disperz
PA
Bosulif
QL,PA
Caprelsa
PA
Cometriq
PA
Gilotrif
PA
Gleevec
PA
Iclusig
PA
Imbruvica
PA
Inlyta
PA
Istodax
PA
Jakafi
PA
Kyprolis
PA
Mekinist
PA
Nexavar
PA
Sprycel
PA
Stivarga
PA
Sutent
PA
Tafinlar
PA
Tarceva
PA
Tasigna
Torisel
PA
Tykerb
PA
Velcade
PA
Votrient
PA
Xalkori
PA
Zelboraf
PA
Zolinza
TOPOISOMERASE I INHIBITOR
NON PREFERRED
irinotecan
topotecan HCL
Camptosar
Hycamtin
Irinotecan
Topotecan HCL
RADIOPHARMACEUTICALS
PREFERRED
Bexxar 131 Iodine
Metastron
Quadramet
NON PREFERRED
Xofigo
CELLULAR IMMUNOTHERAPY
PREFERRED
PA
Provenge
ANTINEOPLASTICS MISC.
GENERIC
dacarbazine
hydroxyurea
Dacarbazine
PREFERRED
Photofrin
Theracys
Tice Bcg
Trisenox
Uvadex
NON PREFERRED
tretinoin
Actimmune
Alferon N
PA
Erivedge
PA
Intron-a
PA
Intron-a W/Diluent
Matulane
Nipent
Proleukin
PA
Sylatron
PA
Synribo
PA
Targretin
CHEMOTHERAPY RESCUE
GENERIC
dexrazoxane
leucovorin calcium
mesna
Calcium Folinate
Leucovorin Calcium
PREFERRED
Fusilev
Mesnex
Totect
Voraxaze
NON PREFERRED
amifostine
CHEMOTHERAPY ADJUNCTS
PREFERRED
Kepivance
NON PREFERRED
Elitek
ANTINEOPLASTIC COMBO
GENERIC
Ifosfamide/Mesna
CARDIOVASCULAR DRUGS
PHOSPHODIESTERASE INHBTR
GENERIC
milrinone lactate
milrinone IN dextrose
CARDIAC GLYCOSIDES
GENERIC
digox
digoxin
Digoxin
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
5
ANTIANGINAL AGENTS
GENERIC
isoditrate ER
isosorbide dinitrate
isosorbide dinitrate ER
isosorbide mononitrate
isosorbide mononitrate ER
minitran
nitro-time
nitroglycerin
nitroglycerin lingual
nitroglycerin transdermal
nitroglycerin ER
nitroglycerin IN dextrose 5%
nitroglycerin IN 5% dextrose
Isosorbide Dinitrate
Nitroglycerin
Nitroglycerin IN Dextrose 5%
PREFERRED
Dilatrate SR
Nitro-bid
Nitrostat
PA
Ranexa
NON PREFERRED
Nitro-dur
Nitroglycerin Lingual
Nitromist
BETA BLOCKERS
GENERIC
acebutolol HCL
atenolol
betaxolol HCL
bisoprolol fumarate
carvedilol
esmolol HCL
labetalol HCL
metoprolol succinate ER
metoprolol tartrate
nadolol
pindolol
propranolol HCL
propranolol HCL ER
sorine
sotalol HCL
sotalol HCL (AF)
Propranolol HCL
Timolol Maleate
PREFERRED
Bystolic
Coreg CR
NON PREFERRED
Inderal XL
Innopran XL
Levatol
CALCIUM CHANNEL BLOCKERS
GENERIC
afeditab CR
amlodipine besylate
cartia XT
dilt-CD
dilt-XR
diltiazem CD
diltiazem HCL
diltiazem HCL CD
diltiazem HCL ER
diltzac
felodipine ER
matzim LA
nicardipine HCL
nifediac CC
nifedical XL
nifedipine
nifedipine ER
nimodipine
nisoldipine
taztia XT
verapamil HCL
verapamil HCL ER
verapamil HCL SR
Diltiazem HCL
Isradipine
Nisoldipine
Nisoldipine ER
Verapamil HCL
Verelan
Verelan PM
NON PREFERRED
Cardene IV
Cardizem LA
ANTIARRHYTHMICS
GENERIC
adenosine
amiodarone HCL
disopyramide phosphate
flecainide acetate
ibutilide fumarate
lidocaine HCL
lidocaine HCL IN D5W
lidocaine HCL/dextrose
mexiletine HCL
pacerone
propafenone HCL
propafenone HCL ER
quinidine gluconate CR
quinidine gluconate ER
quinidine sulfate
Amiodarone HCL
Lidocaine HCL
Procainamide HCL
Quinidine Gluconate
Quinidine Sulfate
Quinidine Sulfate ER
PREFERRED
Tikosyn
NON PREFERRED
Multaq
Nexterone
Norpace CR
ACE INHIBITORS
GENERIC
benazepril HCL
captopril
enalapril maleate
enalaprilat
fosinopril sodium
lisinopril
moexipril HCL
perindopril erbumine
quinapril HCL
ramipril
trandolapril
ANGIOTENSIN RCPTR BLOCKER
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
6
GENERIC
PA,ST
candesartan cilexetil
eprosartan mesylate
irbesartan
losartan potassium
telmisartan
valsartan
PREFERRED
Benicar
NON PREFERRED
PA,ST
Edarbi
PA,ST
Teveten
DIRECT RENIN INHIBITORS
PREFERRED
Tekturna
ANTIHYPERTENSIVES MISC.
GENERIC
clonidine HCL
doxazosin mesylate
eplerenone
fenoldopam mesylate
guanfacine HCL
hydralazine HCL
methyldopa
minoxidil
prazosin HCL
terazosin HCL
Methyldopate HCL
Phentolamine Mesylate
Reserpine
PREFERRED
Demser
Dibenzyline
ANTIHYPERTENSIVE COMBO
GENERIC
amlodipine besylate/benazepril hydrochloride
amlodipine besylate/benazepril HCL
amlodipine besylate/valsartan
atenolol/chlorthalidone
benazepril HCL/hydrochlorothiazide
bisoprolol fumarate/hydrochlorothiazide
candesartan cilexetil/hydrochlorothiazide
enalapril maleate/hydrochlorothiazide
fosinopril sodium/hydrochlorothiazide
irbesartan/hydrochlorothiazide
lisinopril/hydrochlorothiazide
losartan potassium/hydrochlorothiazide
metoprolol/hydrochlorothiazide
moexipril/hydrochlorothiazide
nadolol/bendroflumethiazide
quinapril/hydrochlorothiazide
telmisartan/amlodipine
telmisartan/hydrochloroth
telmisartan/hydrochlorothiazide
valsartan/hydrochlorothiazide
Captopril/Hydrochlorothiazide
Methyldopa/Hydrochlorothiazide
Propranolol/Hydrochlorothiazide
PREFERRED
Amturnide
Azor
Benicar HCT
Exforge HCT
Tarka
Tekamlo
Tekturna HCT
Tribenzor
NON PREFERRED
PA,ST
Edarbyclor
PA,ST
Teveten HCT
DIURETICS
GENERIC
acetazolamide
acetazolamide sodium
acetazolamide ER
amiloride HCL
amiloride/hydrochlorothiazide
bumetanide
chlorothiazide
chlorothiazide sodium
furosemide
hydrochlorothiazide
indapamide
mannitol
methazolamide
metolazone
osmitrol viaflex
spironolactone
spironolactone/hydrochlorothiazide
torsemide
triamterene/hydrochlorothiazide
Acetazolamide
Chlorothiazide
Chlorthalidone
Furosemide
Methyclothiazide
Torsemide
Triamterene/Hydrochlorothiazide
NON PREFERRED
Dyrenium
Edecrin
Sodium Edecrin
VASOPRESSORS
GENERIC
dobutamine HCL
dobutamine HCL/D5W
dobutamine/dextrose 5%
dopamine HCL
dopamine HCL-dextrose 5%
dopamine HCL/dextrose 5%
dopamine/D5W
ephedrine sulfate
midodrine HCL
norepinephrine bitartrate
phenylephrine HCL
Dobutamine/Dextrose 5%
Dopamine HCL
Epinephrine
Levophed
Phenylephrine HCL
PREFERRED
Auvi-q
Epipen 2-PAK
Epipen-JR 2-PAK
ANTIHYPERLIPIDEMICS
GENERIC
atorvastatin calcium
cholestyramine
cholestyramine light
colestipol HCL
colestipol HCL for oral suspension
fenofibrate
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
7
fenofibrate micronized
fenofibric acid DR
fluvastatin
gemfibrozil
lovastatin
micronized colestipol HCL
niacin ER
omega-3-acid ethyl esters
pravastatin sodium
prevalite
simvastatin
Niacor
PREFERRED
Crestor
Fenofibrate
Lipofen
Liptruzet
Simcor
Vascepa
Vytorin
Welchol
Zetia
NON PREFERRED
Altoprev
Fenofibric Acid
Fenoglide
Fibricor
QL,PA
Juxtapid
QL,PA
Kynamro
Livalo
Triglide
CARDIOVASCULAR - MISC.
GENERIC
amlodipine besylate/atorvastatin calcium
cardioplegic
isoxsuprine HCL
papaverine HCL
Isoxsuprine HCL
PREFERRED
QL
Caverject
QL
Caverject Impulse
QL
Cialis
QL
Edex
QL
Muse
QL
Viagra
NON PREFERRED
epoprostenol sodium
QL,PA
sildenafil
QL,PA
sildenafil citrate
QL,PA
Adcirca
QL,PA
Adempas
Bidil
QL,PA
Letairis
QL,PA
Opsumit
PA
Remodulin
QL,PA
Revatio
QL,PA
Tracleer
QL,PA
Tyvaso
QL,PA
Tyvaso Refill
QL,PA
Tyvaso Starter
PA
Veletri
QL,PA
Ventavis
DERMATOLOGICALS
ACNE PRODUCTS
GENERIC
PA
adapalene
amnesteem
avar cleanser
avar-e emollient
avar-e green
PA
avita
benzepro
benzepro SHORT contact
benziq wash
benzoyl peroxide
benzoyl peroxide wash acne treatment pack
benzoyl peroxide SHORT contact
bp cleansing wash
bp foam
bp wash
bp 10-1
cerisa wash
claravis
claris clarifying wash
clearplex x
clindacin etz pledgets
clindacin-p
clindamax
clindamycin phosphate
clindamycin/benzoyl peroxide
ery
erythromycin
erythromycin/benzoyl peroxide
lavoclen-4 acne wash kit
lavoclen-8 acne wash kit
myorisan
neuac
oscion cleanser
pr benzoyl peroxide wash
prascion
prascion fc
prascion ra with sunscreens
rosanil cleanser
se bpo wash
se bpo 3% foaming cloths
se bpo 6% foaming cloths
se bpo 9% foaming cloths
se 10-5 ss
sodium sulfacetamide
sodium sulfacetamide/sulfur
sodium sulfacetamide/sulfur cleanser
sodium sulfacetamide/sulfur cleansing cloths
sodium sulfacetamide/sulfur green
sodium sulfacetamide/sulfur w/sunscreen
sodium sulfacetamide/sulfur wash
sss 10-5
sss 10%-5%
sulfacetamide sodium
sulfacetamide sodium/sulfur cleanser
sulfacleanse 8/4
PA
tretinoin
PA
tretinoin microsphere
PA
tretinoin microsphere P.M.
virti-sulf
zenatane
zencia
Bpo
Bpo Creamy Wash Complete Pack
Bpo 3% Foaming Cloths
Bpo 6% Foaming Cloths
Bpo 9% Foaming Cloths
Lavoclen-4 Creamy Wash
Lavoclen-8 Creamy Wash
Se Bpo 7-5.5 Wash Kit
Sodium Sulfacetamide/Sulfur
Sodium Sulfacetamide/Sulfur Cleanser IN Urea
Sodium Sulfacetamide/Sulfur IN Urea
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
8
Zaclir Cleansing
PREFERRED
Acanya
PA
Atralin
PA
Differin
PA
Epiduo
PA
Ziana
NON PREFERRED
Absorica
Azelex
Claravis
PA
Tretin-x
PA
Veltin
Zovirax
ANTI-INFLAMMATORY AGENTS
GENERIC
QL,PA
diclofenac sodium
PREFERRED
QL
Voltaren
NON PREFERRED
QL,PA
Flector
ANTIPRURITICS
NON PREFERRED
Prudoxin
Zonalon
ROSACEA AGENTS
GENERIC
metronidazole
rosadan
PREFERRED
Finacea
Oracea
ANTIBIOTICS - TOPICAL
GENERIC
mupirocin
mupirocin calcium
Centany
Gentamicin Sulfate
NON PREFERRED
Altabax
Cortisporin
ANTIFUNGALS - TOPICAL
GENERIC
ciclodan
ciclopirox
ciclopirox nail lacquer
ciclopirox olamine
ciclopirox treatment
clotrimazole
clotrimazole/betamethasone dipropionate
dermazene
econazole nitrate
exoderm
hydrocortisone/iodoquinol
ketoconazole
ketodan
nyamyc
nystatin
nystatin/triamcinolone
nystop
pedi-dri
versiclear
Ciclopirox Topical Solution Kit
NON PREFERRED
Cnl8 Nail Kit
Ertaczo
Exelderm
Mentax
Naftin
Oxistat
Pedipirox-4 Nail
Xolegel
ANTIVIRALS - TOPICAL
GENERIC
acyclovir
PREFERRED
Denavir
ANTIPSORIATICS
GENERIC
acitretin
calcipotriene
calcitrene
methoxsalen
Dritho-creme HP
PREFERRED
QL,PA
Tazorac
8-mop
NON PREFERRED
Calcitriol
PA
Stelara
Vectical
ANTISEBORRHEIC AGENTS
GENERIC
seb-prev wash
selenium sulfide
sodium sulfacetamide
sodium sulfacetamide wash
Glycolic Acid
Glycolic Acid 70% High Purity
Seb-prev
Selenium Sulfide
Sodium Sulfacetamide/Urea
NON PREFERRED
Ovace Plus
CORTICOSTEROIDS - TOPICAL
GENERIC
ala cort
alclometasone dipropionate
alphatrex
amcinonide
apexicon
augmented betamethasone dipropionate
betamethasone dipropionate
betamethasone valerate
QL,PA
calcipotriene/betamethasone dipropionate
clobetasol propionate
clobetasol propionate e
clobetasol propionate emollient
clodan
cormax scalp application
cortalo
desonide
desoximetasone
diflorasone diacetate
fluocinolone acetonide
fluocinolone acetonide body
fluocinolone acetonide scalp
fluocinonide
fluocinonide emollient base
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
9
fluocinonide-e
fluticasone propionate
halac
halobetasol propionate
halonate PAC
hydrocortisone
hydrocortisone acetate/aloe
hydrocortisone acetate/pramoxine
hydrocortisone butyrate
hydrocortisone butyrate (lipid)
hydrocortisone butyrate (lipophilic)
hydrocortisone valerate
hydrocortisone IN absorbase
lokara
mometasone furoate
prednicarbate
scalacort
triamcinolone acetonide
triderm
Amcinonide
Apexicon E
Desoximetasone
Diflorasone Diacetate
Synalar
Triamcinolone Acetonide
Trianex
U-cort
PREFERRED
Pramosone
Pramosone E
QL,PA
Taclonex
Tucks Anti-itch
NON PREFERRED
Capex
Clobex
Clocortolone Pivalate
Clocortolone Pivalate P.M.
Cloderm
Cloderm P.M.
Cordran
Cordran Tape
Dermasorb Ta
Desonate
Desowen Cream/Cetaphil Lotion
Desowen Lotion/Cetaphil Cream
Desowen Ointment/Cetaphil Lotion
Halog
Kenalog
Locoid
Pediaderm HC
Pediaderm Ta
Texacort
Ultravate PAC
Verdeso
IMMUNOMODULATING AGENTS
GENERIC
imiquimod
PREFERRED
Elidel
Protopic
NON PREFERRED
Zyclara
Zyclara P.M.
DERMATOLOGICALS - MISC.
GENERIC
acticin
alphaquin HP
ammonium lactate
cerovel
diclofenac sodium
episone CRE
finasteride
fluorouracil
glydo
grafco silver nitrate applicator
hydroquinone
hydroquinone time release
hygel
hypercare
laclotion
lactic acid
lactic acid e
lactic acid w/vitamin e
latrix
lidocaine
lidocaine HCL
lidocaine HCL jelly
lidocaine/prilocaine
lindane
mafenide acetate
malathion
melpaque HP
melquin HP
nava-sc
nuquin HP
permethrin
podofilox
pramox gel
rea LO 39
rea LO 40
remergent HQ
remeven
salacyn
salicylic acid
salicylic acid cream
salicylic acid lotion
salicylic acid wart remover
silver sulfadiazine
skin bleaching
skin bleaching/sunscreen
sodium hyaluronate
ssd
thermazene
tropazone
u-kera e
umecta mousse
urea
urea hydrating
urea nail
urea topical
urea IN zinc undecylenate/lactic acid vehicle
urea 40% nail film
urea-c40
x-viate
Arzol Silver Nitrate App Licators
Coal TAR
Salvax
Silver Nitrate
TL hydroquinone
PREFERRED
Carac
Condylox
Oxsoralen
PA
Regranex
Sulfamylon
NON PREFERRED
Avage
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
10
Eurax
Fluoroplex
Natroba
Panretin
Picato
Refissa
Renova
Renova P.M.
Sklice
Spinosad
Synera
PA
Targretin
Tretinoin Emollient
Ulesfia
PA
Valchlor
Veregen
ENDOCRINE AND METABOLIC
CORTICOSTEROIDS
GENERIC
a-methapred
baycadron
betamethasone sodium phosphate/betamethasone
acetate
budesonide
dexamethasone
dexamethasone sodium phosphate
fludrocortisone acetate
hydrocortisone
methylprednisolone
methylprednisolone acetate
methylprednisolone dose pack
methylprednisolone sodiumsuccinate
prednisolone
prednisolone sodium phosphate
prednisone
A-hydrocort
Cortisone Acetate
Dexamethasone
Dexamethasone Sodium Phosphate
Prednisolone Sodium Phosphate
Prednisone
PREFERRED
Uceris
NON PREFERRED
Depo-medrol
Dexamethasone Intensol
Dexpak 10 Day
Dexpak 13 Day
Dexpak 6 Day
Millipred
Millipred DP
Orapred Odt
Prednisone Intensol
Rayos
Solu-cortef
Veripred 20
ANDROGENS-ANABOLIC
GENERIC
danazol
QL,PA
oxandrolone
PA
testosterone cypionate
testosterone enanthate
PA,ST
Testosterone P.M.
PREFERRED
Androgel
Androgel P.M.
Androxy
Axiron
Methitest
NON PREFERRED
PA
Anadrol-50
PA,ST
Androderm
PA,ST
Fortesta
PA,ST
Striant
PA,ST
Testosterone
PA,ST
Vogelxo
PA,ST
Vogelxo P.M.
ESTROGENS
GENERIC
covaryx
covaryx HS
eemt
eemt HS
esterified estrogens/methltestosterone
esterified estrogens/methyltestosterone
esterified estrogens/methyltestosterone DS
esterified estrogens/methyltestosterone HS
estradiol
estradiol valerate
estradiol/norethindrone acetate
estropipate
methyltestosterone/esterified estrogens
methyltestosterone/esterified estrogens HS
mimvey
mimvey LO
ortho-est
Estropipate
Jinteli
PREFERRED
Cenestin
Combipatch
Enjuvia
Evamist
Minivelle
Premarin
Premphase
Prempro
Vivelle-dot
NON PREFERRED
Alora
Estrogel
Menest
CONTRACEPTIVES
GENERIC
Amethyst
Necon 1/50-28
Necon 10/11-28
Ogestrel
Zovia 1/50e
PREVENTIVE
altavera
alyacen 1/35
alyacen 7/7/7
QL
amethia
QL
amethia LO
apri
aranelle
aubra
aviane
azurette
balziva
briellyn
camila
QL
camrese
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
11
QL
camrese LO
caziant
cesia
chateal
cryselle-28
cyclafem 1/35
cyclafem 7/7/7
dasetta 1/35
dasetta 7/7/7
QL
daysee
deblitane
delyla
desogestrel/ethinyl estradiol
drospirenone/ethinyl estradiol
elinest
emoquette
enpresse-28
enskyce
errin
estarylla
falmina
gianvi
gildagia
gildess FE 1.5/30
gildess FE 1/20
gildess 1.5/30
gildess 1/20
heather
QL
introvale
jencycla
QL
jolessa
jolivette
junel FE 1.5/30
junel FE 1/20
junel 1.5/30
junel 1/20
kariva
kelnor 1/35
kurvelo
larin FE 1.5/30
larin FE 1/20
larin 1.5/30
larin 1/20
leena
lessina
levonest
QL
levonorgestrel
QL
levonorgestrel and ethinyl estradiol
levonorgestrel/ethinyl estradiol
levora 0.15/30-28
loryna
low-ogestrel
lutera
lyza
marlissa
QL
medroxyprogesterone acetate
microgestin FE
microgestin FE 1.5/30
microgestin 1.5/30
microgestin 1/20
mono-linyah
mononessa
QL
my way
myzilra
necon 0.5/35-28
necon 1/35
necon 7/7/7
QL
next choice one dose
nikki
nora-be
norethindrone
norethindrone acetate/ethinyl estradiol
norethindrone acetate/ethinyl estradiol/ferrous fumarate
norgestimate/ethinyl estradiol
norlyroc
nortrel 0.5/35 (28)
nortrel 1/35
nortrel 7/7/7
ocella
orsythia
philith
pimtrea
pirmella 1/35
pirmella 7/7/7
portia-28
previfem
QL
quasense
reclipsen
sharobel
solia
sprintec 28
sronyx
syeda
tilia FE
tri-estarylla
tri-legest FE
tri-linyah
tri-previfem
tri-sprintec
trinessa
trivora-28
velivet
vestura
viorele
vyfemla
wera
wymzya FE
xulane
zarah
zenchent
zenchent FE
zovia 1/35e
PREFERRED
Beyaz
Loestrin 24 FE
Lomedia 24 FE
LO Loestrin FE
Minastrin 24 FE
Safyral
PREVENTIVE
Natazia
QL
Nuvaring
NON PREFERRED
QL
Depo-subq Provera 104
QL
Ella
PREVENTIVE
Implanon
Mirena
Nexplanon
Paragard Intrauterine Copper Contraceptive T380a
Skyla
PROGESTINS
GENERIC
medroxyprogesterone acetate
norethindrone acetate
progesterone
NON PREFERRED
PA
Makena
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
12
GENERIC
nateglinide
repaglinide
ANTIDIABETIC AGENTS
INSULIN
PREFERRED
Lantus
Lantus Solostar
Novolin N
Novolin N Relion
Novolin R
Novolin R Relion
Novolin 70/30
Novolin 70/30 Relion
Novolog
Novolog Flexpen
Novolog Mix 70/30
Novolog Mix 70/30 Prefilled Flexpen
Novolog Penfill
NON PREFERRED
PA,ST
Apidra
PA,ST
Apidra Solostar
PA,ST
Humalog
PA,ST
Humalog Kwikpen
PA,ST
Humalog Mix 50/50
PA,ST
Humalog Mix 50/50 Kwikpen
PA,ST
Humalog Mix 75/25
PA,ST
Humalog Mix 75/25 Kwikpen
PA,ST
Humulin N
PA,ST
Humulin N Kwikpen
PA,ST
Humulin N U-100 Pen
PA,ST
Humulin R
PA,ST
Humulin R U-500 (concentrated)
PA,ST
Humulin 70/30
PA,ST
Humulin 70/30 Kwikpen
PA,ST
Humulin 70/30 Pen
PA,ST
Levemir
PA,ST
Levemir Flexpen
PA,ST
Levemir Flextouch
DIABETIC OTHER
PREFERRED
Glucagen
Glucagen Hypokit
Glucagon Emergency Kit
PA
Invokana
Proglycem
NON PREFERRED
Cycloset
ALPHA-GLUCOSIDASE INHIBIT
GENERIC
acarbose
NON PREFERRED
Glyset
DPP-4 INHIBITORS
PREFERRED
Januvia
Onglyza
NON PREFERRED
Tradjenta
INSULIN SENSITIZING AGENT
GENERIC
pioglitazone HCL
NON PREFERRED
Avandia
ANTIDIABETIC COMBINATIONS
GENERIC
glipizide/metformin HCL
glyburide/metformin HCL
pioglitazone HCL-glimepiride
pioglitazone HCL/metformin HCL
PREFERRED
Actoplus Met XR
Janumet
Janumet XR
Juvisync
Kombiglyze XR
Prandimet
NON PREFERRED
Jentadueto
AMYLIN ANALOGS
PREFERRED
PA
Symlinpen 120
PA
Symlinpen 60
INCRETIN MIMETIC AGENTS
PREFERRED
Bydureon
Byetta
Victoza
BISPHOSPHONATES
GENERIC
alendronate sodium
QL
ibandronate sodium
QL,PA,ST
risedronate sodium
Alendronate Sodium
Etidronate Disodium
PREFERRED
QL
Fosamax Plus D
NON PREFERRED
pamidronate disodium
PA
zoledronic acid
PA,ST
Actonel
QL,PA,ST
Atelvia
QL
Binosto
Pamidronate Disodium
PA
Zoledronic Acid
PA
Zometa
SULFONYLUREAS
GENERIC
glimepiride
glipizide
glipizide ER
glipizide XL
glyburide
glyburide micronized
tolazamide
Chlorpropamide
Tolazamide
Tolbutamide
NON PREFERRED
Diabeta
Glyburide
BIGUANIDES
GENERIC
metformin HCL
metformin HCL ER
PREFERRED
Riomet
NON PREFERRED
Glumetza
CALCITONINS
GENERIC
QL
calcitonin salmon
QL
calcitonin-salmon
QL
Fortical
MEGLITINIDE ANALOGUES
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
13
NON PREFERRED
Miacalcin
GHRH
NON PREFERRED
QL,PA
Egrifta
PARATHYROID HORMONE
NON PREFERRED
QL
Forteo
SOMATOMEDINS
NON PREFERRED
PA
Increlex
RANK LIGAND INHIBITORS
NON PREFERRED
QL,PA
Prolia
PA
Xgeva
CALCIUM REGULATORS - MISC
NON PREFERRED
Ganite
SOMATOSTATIC AGENTS
NON PREFERRED
PA
octreotide acetate
PA
Sandostatin Lar Depot
QL,PA
Signifor
PA
Somatuline Depot
GH RECEPTOR ANTAGONISTS
HORMONE RECEPTOR MDLTR
GENERIC
raloxifene hydrochloride
NON PREFERRED
PA
Somavert
POSTERIOR PITUITARY
FERTILITY REGULATORS
GENERIC
clomiphene citrate
serophene
NON PREFERRED
QL
chorionic gonadotropin
QL
novarel
QL
pregnyl w/diluent benzyl alcohol/NACL
QL
Bravelle
QL
Follistim AQ
QL
Gonal-f
QL
Gonal-f RFF
QL
Gonal-f RFF Pen
QL
Gonal-f RFF Rediject
Menopur
QL
Ovidrel
QL
Repronex
LHRH/GNRH AGONIST
NON PREFERRED
QL,PA
Lupron Depot-PED
QL,PA
Supprelin LA
Synarel
GNRH/LHRH ANTAGONISTS
NON PREFERRED
QL
Cetrotide
QL
Ganirelix Acetate
GROWTH HORMONES
NON PREFERRED
PA
Genotropin
PA
Genotropin Miniquick
PA
Humatrope
PA
Humatrope Combo Pack
PA
Norditropin Cartridge
PA
Norditropin Flexpro
PA
Norditropin Nordiflex Pen
PA
Nutropin
PA
Nutropin AQ Nuspin 10
PA
Nutropin AQ Nuspin 20
PA
Nutropin AQ Nuspin 5
PA
Nutropin AQ Pen
PA
Omnitrope
PA
Saizen
PA
Saizen Click.easy
PA
Serostim
PA
Tev-tropin
PA
Zorbtive
GENERIC
desmopressin acetate
vasopressin
NON PREFERRED
Stimate
CORTICOTROPIN
NON PREFERRED
PA
H.p. Acthar
PROLACTIN INHIBITORS
GENERIC
cabergoline
VASOPRESSIN ANTAGONISTS
NON PREFERRED
QL
Samsca
METABOLIC MODIFIERS
GENERIC
calcitriol
doxercalciferol
levocarnitine
paricalcitol
sodium phenylbutyrate
PREFERRED
Buphenyl
PA
Sensipar
NON PREFERRED
PA
Aldurazyme
PA
Carbaglu
Cystadane
PA
Elaprase
PA
Fabrazyme
Hectorol
PA
Kuvan
PA
Lumizyme
PA
Myalept
PA
Myozyme
PA
Naglazyme
Orfadin
PA
Ravicti
PA
Vimizim
Zemplar
THYROID AGENTS
GENERIC
levothroid
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
14
levothyroxine sodium
levoxyl
liothyronine sodium
methimazole
propylthiouracil
unithroid
unithroid direct
Levothyroxine Sodium
Nature-throid
NP thyroid
NP thyroid 30
NP thyroid 60
NP thyroid 90
Westhroid
PREFERRED
Armour Thyroid
NON PREFERRED
Thyrolar-1
Thyrolar-1/2
Thyrolar-1/4
Thyrolar-2
Thyrolar-3
ULCER DRUGS
GENERIC
atropine sulfate
belladonna alkaloids/phenobarbital
chlordiazepoxide HCL/clidinium bromide
cimetidine
cimetidine HCL
dicyclomine HCL
ed-spaz
esomeprazole sodium
famotidine
glycopyrrolate
hyomax-SL
hyoscyamine sulfate
hyoscyamine sulfate odt
hyoscyamine sulfate ER
hyoscyamine sulfate SR
hyosyne
QL
lansoprazole
lansoprazole/amoxicillin/clarithromycin
me-PB-hyos
methscopolamine bromide
misoprostol
nizatidine
nulev
QL
omeprazole
QL
omeprazole/sodium bicarbonate
oscimin
oscimin SR
QL
pantoprazole sodium
QL,PA,ST
rabeprazole sodium
ranitidine HCL
sucralfate
symax fastabs
symax-SL
symax-SR
Atropine Sulfate
Belladonna & Opium
Belladonna Alkaloids & Opium
Dicyclomine HCL
Famotidine
Famotidine Premixed
Gastrinex NF
Propantheline Bromide
Scopolamine Hydrobromide
PREFERRED
Carafate
QL
Nexium
Pylera
NON PREFERRED
QL,PA,ST
Aciphex Sprinkle
Atropen
Cantil
Cuvposa
QL,PA,ST
Dexilant
Donnatal
Donnatal Extentabs
QL,PA,ST
Esomeprazole Strontium
First-lansoprazole
Helidac
Omeclamox-PAK
QL,PA,ST
Prevacid Solutab
QL,PA,ST
Prilosec
QL,PA,ST
Zegerid
GASTROINTESTINAL
LAXATIVES
GENERIC
constulose
lactulose
pegylax
polyethylene glycol 3350
Cascara Sagrada
Mineral Oil Heavy
PREVENTIVE
gavilyte-c
gavilyte-n/flavor pack
gavilyte-G
peg 3350/electrolytes
peg-3350/electrolytes
peg-3350/NACL/NA bicarbonate/KCL
trilyte PREFERRED
Halflytely Bowel Prep/Flavor Packs
Moviprep
Suclear
Suprep Bowel Prep
NON PREFERRED
Colyte-flavor Packs
Golytely
Kristalose
Osmoprep Prepopik ANTIDIARRHEALS
GENERIC
diphenoxylate/atropine
lofene
lonox
loperamide HCL
opium
opium tincture
Diphenoxylate/Atropine
Opium Tincture (paregoric)
NON PREFERRED
Motofen
ANTIEMETICS
ANTACIDS
GENERIC
Sodium Bicarbonate
GENERIC
QL,PA
dronabinol
QL
granisetron HCL
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
15
meclizine HCL
QL
ondansetron odt
QL
ondansetron HCL
trimethobenzamide HCL
univert
Dimenhydrinate
PREFERRED
Aloxi
QL
Emend
QL
Sancuso
Transderm-scop
NON PREFERRED
QL
Anzemet
QL,PA
Cesamet
QL
Granisol
QL
Zuplenz
DIGESTIVE AIDS
PREFERRED
Creon
Pancrelipase
Viokace
NON PREFERRED
PA,ST
Pertzye
Sucraid PA,ST
Ultresa
PA,ST
Zenpep
GASTROINTESTINAL - MISC.
GENERIC
ana-lex
anucort-HC
balsalazide disodium
calcium acetate
colocort
cromolyn sodium
enulose
generlac
grx hicort 25
hemril-30
hydrocort ene 100MG
hydrocortisone
hydrocortisone acetate
hydrocortisone acetate/lidocaine HCL
hydrocortisone acetate/pramoxine
hydrocortisone acetate/pramoxine HCL
lactulose
lidazone HC
lidocaine HCL/hydrocortisone acetate
mesalamine
metoclopramide HCL
pramcort
procto-PAK
proctocream HC
proctosol HC
proctozone-HC
rectacort-HC
sulfasalazine
sulfazine
sulfazine EC
ursodiol
Dexpanthenol
Lidocaine HCL-hydrocortisone Acetate With Aloe
PREFERRED
QL
Amitiza
Analpram Advanced
Analpram-HC
Asacol HD
Canasa
Chenodal
Cortifoam
Delzicol
Fosrenol
Lialda
QL
Linzess
Lotronex
Pentasa
Proctofoam HC
Rectiv
PA
Relistor
Renvela
Sevelamer Carbonate
NON PREFERRED
Apriso
PA
Cimzia
PA
Cimzia Starter Kit
Dipentum
PA
Gattex
Giazo
Phoslyra
PA
Remicade
Renagel GENITOURINARY
URINARY ANTI-INFECTIVES
GENERIC
hyophen
methenamine hippurate
methenamine mandelate
nitrofurantoin
nitrofurantoin macrocrystals
nitrofurantoin monohydrate
nitrofurantoin monohydrate/macrocrystals
phosphasal
ur n-c
uretron d/s
urin d/s
uryl
ustell
uta
uticap
utira-c
utrona-c
Methenamine Mandelate
Urimar-t
NON PREFERRED
Monurol
URINARY ANTISPASMODICS
GENERIC
bethanechol chloride
flavoxate HCL
oxybutynin chloride
oxybutynin chloride ER
tolterodine tartrate
tolterodine tartrate ER
trospium chloride
trospium chloride ER
PREFERRED
Gelnique
Myrbetriq
QL
Oxytrol
QL
Oxytrol For Women
Toviaz
Vesicare
NON PREFERRED
PA,ST
Enablex
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
16
VAGINAL PRODUCTS
GENERIC
clindamycin phosphate
metronidazole vaginal
miconazole 3 combo pack
terconazole
vandazole
zazole
Miconazole 3
PREFERRED
Clindesse
Endometrin
Estrace
QL
Estring
Vagifem
NON PREFERRED
Avc
Cleocin
Crinone
Gynazole-1
PREVENTIVE
Encare
Options Conceptrol Vaginal Contraceptive
Options Gynol II Vaginal Contraceptive
Shur-seal
Today Sponge
Vcf Vaginal Contraceptive Film
Vcf Vaginal Contraceptive Foam
GENITOURINARY - MISC.
GENERIC
acetic acid 0.25%
alfuzosin HCL ER
aminoacetic acid
argyle sterile saline 100ML
citric acid/sodium citrate
curity sterile saline
cytra k crystals
cytra-2
finasteride
glycine
hydrochloric acid
neomycin/polymyxin b sulfates
phenazo
phenazopyridine HCL
potassium citrate ER
potassium citrate-citric acid crystals
sodium chloride
sodium chloride 0.9%
tamsulosin HCL
taron-crystals
Cytra-k
Cytra-3
Sorbitol
Sorbitol-mannitol
Tricitrates
PREFERRED
Elmiron
Rapaflo
Renacidin
NON PREFERRED
Avodart
Cardura XL
Cystagon
Oracit
PA
Procysbi
HEMATOLOGICAL
HEMATOPOIETIC AGENTS
GENERIC
airavite
corvita 150
cyanocobalamin
dexferrum
fabb
ferocon
ferotrinsic
ferrocite plus
ferrogels forte
folbee
folcaps
folic acid
folic acid/vitamin b-6/vitamin b-12
folplex 2.2
foltrin
hematinic plus vitamins/minerals
hematinic/folic acid
hematogen
hematogen forte
hemocyte-f
hemocyte-plus
iferex 150 forte
infed
mi-omega NF
myferon 150 forte
nufol
poly-iron 150 forte
polysaccharide iron forte
purevit dualfe plus
se-tan plus
tricon
trigels-f forte
virt-vite
B-6 Folic Acid
Bp Vit 3
Ed Cyte F
Ferraplus 90
Folic Acid
FE c plus
Hematogen Fa
Hydroxocobalamin
Multigen
Multigen Folic
Multigen Plus
Tandem F
TL gard RX
TL icon
TL-fol 500
TL-hem 150
PREVENTIVE
bprotected pedia iron
eq slow-release iron
eql folic acid
eql iron supplement therapy
eql slow release iron
ezfe 200
fa-8
feosol
fer-iron
ferate
ferosul
ferretts
ferrex 150
ferro-bob
ferrocite
ferrotabs
ferrous drops
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
17
ferrous fumarate 324
ferrous gluconate
ferrous sulfate
ferrousul
ferus
gnp folic acid
gnp iron
gnp slow release iron
high potency iron
iferex 150
iron
iron chews pediatric
iron slow release
iron supplement
iron supplement childrens
kp ferrous gluconate
kp ferrous sulfate
kp folic acid
meijer ferrous sulfate
myferon 150
nu-iron 150
poly-iron 150
px folic acid
px iron
qc ferrous sulfate
ra folic acid
ra high potency iron
ra iron
ra slow release iron
slow iron
slow release iron
sm folic acid
sm iron
sm iron slow release
th folic acid
th iron
th slow release iron
wee care
yl folic acid
CVS folic acid
CVS iron
FE gluconate
FE TABS
HM folic acid
HM iron
HM iron slow release
PREFERRED
Droxia
Feraheme
Ferrex 150 Forte Plus
Ferrex 28
Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C
Threon/Suc
Nascobal
Venofer
NON PREFERRED
sodium ferric gluconate complex/sucrose
PA
Aranesp Albumin Free
PA
Cerezyme
PA
Elelyso
PA
Epogen
Foltrate
PA
Leukine
QL,PA
Mozobil
PA
Neulasta
PA
Neumega
PA
Neupogen
PA
Nplate
PA
Omontys
PA
Procrit
QL,PA
Promacta
PA
Vpriv
PA
Zavesca
PREVENTIVE
CVS Slow Release Iron
Elite Iron
Fa-8
Femiron
Feosol
Ferretts Chewable Iron
Ferretts IPS
Ferrimin 150
Ferro-sequels
Ferrous Fumarate
Ferrous Gluconate
Ferrous Sulfate
FE Aspartate
High Potency Iron
Iron
Iron Up
Mykidz Iron 10
Novaferrum Pediatric Drops
Perfect Iron
Profe
Proferrin ES
Slow Release Iron
Sm Slow Release Iron
ANTICOAGULANTS
GENERIC
argatroban
QL
enoxaparin sodium
QL
fondaparinux sodium
hep flush-10
heparin lock
heparin lock flush
heparin lock flush for flushing vascular access devices
heparin lock flush/NACL for flushing vascular access
devices
heparin sodium
heparin sodium dcu
heparin sodium lock flush
heparin sodium/sodium chloride 0.9% premix
heparin sodium/D5W
heparin sodium/NACL 0.9%
jantoven
monoject pharma grade flush syringe/heparin lock
monoject prefill advanced heparin lock flush
sash kit for flushing vascular access devices
warfarin sodium
Acd Formula A
Acd Formula B
Acd-a Noclot-50
Anticoagulant Citrate Dextrose Solution A
Anticoagulant Sodium Citrate
Argatroban
Heparin Lock Flush
Heparin Sodium
Heparin Sodium/D5W
Heparin Sodium/NACL 0.45%
Heparin Sodium/Sodium Chloride 0.9%
PREFERRED
QL
Eliquis
QL
Pradaxa
QL
Xarelto
NON PREFERRED
QL
Fragmin
HEMOSTATICS
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
18
GENERIC
aminocaproic acid
tranexamic acid
Aminocaproic Acid
HEMATOLOGICAL - MISC.
GENERIC
albuked 25
albuked 5
albumin human
albumin-zlb
albuminar-25
albuminar-5
alburx
albutein
anagrelide hydrochloride
buminate
cilostazol
clopidogrel
dipyridamole
flexbumin
hetastarch 6%/NACL
human albumin grifols
kedbumin
pentoxifylline ER
plasbumin-25
plasbumin-5
ticlopidine HCL
LMD 10% Dextrose 5%
LMD 10% Sodium Chloride 0.9%
Protamine Sulfate
PREFERRED
Aggrenox
Brilinta
Effient
NON PREFERRED
Advate
Aggrastat
Alphanate/Von Willebrand Factor Complex/Human
Alphanine SD
Bebulin
Bebulin VH
Benefix
Berinert
Ceprotin
Cinryze
Corifact
Feiba NF
Firazyr
Helixate FS
Hemofil M
Humate-p
Integrilin
Kalbitor
Koate-dvi
Kogenate FS
Kogenate FS Bio-set
Monoclate-p
Mononine
Novoseven
Novoseven Rt
Profilnine SD
Recombinate
Riastap
Rixubis
PA
Soliris
Thrombate Iii W/10 ML Sterile Water
Thrombate Iii W/20 ML Sterile Water
Tretten
Wilate
Xyntha
Xyntha Solofuse
MOUTH/THROAT/DENTAL AGENT
GENERIC
cavarest
cavirinse
cevimeline HCL
chlorhexidine gluconate
chlorhexidine gluconate oral rinse
clinpro 5000
clotrimazole
controlrx
denta 5000 plus
dentagel
easygel
fluoridex daily defense
fluoridex daily defense enhanced whitening
fluoridex daily defense sensitivity relief
karigel
karigel-n
lidocaine viscous
lidocaine HCL
lidocaine HCL viscous
neutragard advanced
neutral sodium fluoride
nystatin
oralone
paroex
perio MED
periogard
phos-flur
pilocarpine hydrochloride
pilocarpine HCL
stannous fluoride oral rinse
topex topical anesthetic
triamcinolone acetonide
triamcinolone IN orabase
Aquoral
Numoisyn
SF
SF 5000 plus
NON PREFERRED
Oravig
NEUROLOGY, CNS, PSYCH
ANTIANXIETY AGENTS
GENERIC
alprazolam
alprazolam odt
alprazolam ER
alprazolam XR
buspirone HCL
chlordiazepoxide HCL
clorazepate dipotassium
diazepam
droperidol
gene-xene TAB 15MG
gene-xene TAB 3.75MG
gene-xene TAB 7.5MG
hydroxyzine pamoate
hydroxyzine HCL
lorazepam
meprobamate
oxazepam
Diazepam
Hydroxyzine HCL
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
19
QL
Hydroxyzine Pamoate olanzapine
QL
olanzapine odt
perphenazine
prochlorperazine
prochlorperazine edisylate
prochlorperazine maleate
QL
quetiapine fumarate
QL
risperidone
QL
risperidone odt
QL
risperidone M-TAB
thioridazine HCL
thiothixene
trifluoperazine HCL
QL
ziprasidone HCL
Chlorpromazine HCL
Fluphenazine HCL
Lithium
Lithium Carbonate
PREFERRED
QL
Abilify
QL
Abilify Discmelt
Abilify Maintena
QL
Latuda
Risperdal Consta
QL
Seroquel XR
NON PREFERRED
QL
Clozapine Odt
QL,PA,ST
Fanapt
QL,PA,ST
Fanapt Titration Pack
QL
Fazaclo
Geodon
QL,PA,ST
Invega
Invega Sustenna
QL,PA,ST
Saphris
ANTIDEPRESSANTS
GENERIC
amitriptyline HCL
QL
budeprion SR
bupropion HCL
QL
bupropion HCL ER
QL
bupropion HCL SR
QL
bupropion HCL XL
citalopram hydrobromide
clomipramine HCL
desipramine HCL
doxepin HCL
QL
duloxetine HCL
escitalopram oxalate
QL
fluoxetine DR
fluoxetine HCL
fluvoxamine maleate
QL
fluvoxamine maleate ER
imipramine pamoate
imipramine HCL
mirtazapine
mirtazapine odt
nefazodone HCL
nortriptyline HCL
paroxetine HCL
paroxetine HCL ER
phenelzine sulfate
protriptyline HCL
sertraline HCL
tranylcypromine sulfate
trazodone HCL
trimipramine maleate
QL
venlafaxine HCL
QL
venlafaxine HCL ER
Amoxapine
QL
Desvenlafaxine ER
Doxepin HCL
Fluoxetine HCL
Maprotiline HCL
Nefazodone HCL
Nortriptyline HCL
Venlafaxine HCL ER
PREFERRED
Pristiq
NON PREFERRED
QL
Aplenzin
QL,PA
Emsam
QL
Forfivo XL
Marplan
Paxil
QL
Viibryd
ANTIPSYCHOTICS
GENERIC
chlorpromazine HCL
QL
clozapine
compazine
compro
fluphenazine decanoate
fluphenazine HCL
haloperidol
haloperidol decanoate
haloperidol lactate
lithium carbonate
lithium carbonate ER
loxapine
loxapine succinate
HYPNOTICS
GENERIC
dexmedetomidine HCL
estazolam
QL
eszopiclone
flurazepam HCL
midazolam HCL
phenobarbital
temazepam
triazolam
QL
zaleplon
QL
zolpidem tartrate
QL
zolpidem tartrate ER
Flurazepam HCL
Phenobarbital
Phenobarbital Sodium
Quazepam
PREFERRED
QL
Rozerem
NON PREFERRED
QL,PA
Hetlioz
QL
Intermezzo
QL
Silenor
ADHD, NARCOLEPSY, ETC.
GENERIC
QL
amphetamine/dextroamphetamine
PA
benzphetamine HCL
caffeine citrate
clonidine HCL ER
QL
dexedrine
QL
dexmethylphenidate HCL
QL
dexmethylphenidate HCL ER
QL
dextroamphetamine sulfate
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
20
QL
dextroamphetamine sulfate ER
PA
diethylpropion HCL
PA
diethylpropion HCL ER
doxapram HCL
QL
metadate ER
QL
methamphetamine HCL
methylphenidate hydrochloride
QL
methylphenidate HCL
QL
methylphenidate HCL CD
QL
methylphenidate HCL ER
QL
methylphenidate HCL SR
QL,PA
modafinil
PA
phendimetrazine tartrate
PA
phentermine HCL
QL
zenzedi
Caffeine/Sodium Benzoate
PA
Diethylpropion HCL
QL
Methylphenidate HCL ER
PA
Phendimetrazine Tartrate ER
QL
Procentra
PREFERRED
QL
Daytrana
Intuniv
QL,PA
Nuvigil
QL
Quillivant XR
QL
Strattera
QL
Vyvanse
NON PREFERRED
QL
Focalin XR
Kapvay Dose Pack
PA
Xenical
ANTICONVULSANTS
GENERIC
carbamazepine
carbamazepine ER
clonazepam
clonazepam odt
divalproex sodium
divalproex sodium DR
divalproex sodium ER
epitol
ethosuximide
felbamate
fosphenytoin sodium
gabapentin
lamotrigine
lamotrigine ER
levetiracetam
levetiracetam ER
oxcarbazepine
phenytoin
phenytoin infatabs
phenytoin sodium
phenytoin sodium extended
primidone
tiagabine hydrochloride
topiragen
topiramate
valproate sodium
valproic acid
zonisamide
Levetiracetam
PREFERRED
Banzel
Celontin
Diazepam
Dilantin
Fycompa
Gabitril
QL
Lyrica
Onfi
Peganone
Potiga
Tegretol-XR
Vimpat
NON PREFERRED
Diastat Pediatric
Lamictal
Lamictal Odt
PA
Sabril
Stavzor
ANTIPARKINSON AGENTS
GENERIC
amantadine HCL
benztropine mesylate
bromocriptine mesylate
carbidopa
carbidopa/levodopa
carbidopa/levodopa odt
carbidopa/levodopa ER
entacapone
pramipexole dihydrochloride
ropinirole ER
ropinirole HCL
selegiline HCL
trihexyphenidyl HCL
Amantadine HCL
Carbidopa/Levodopa/Entacapone
PREFERRED
Azilect
Mirapex ER
NON PREFERRED
PA
Apokyn
Neupro
Tasmar
NEUROLOGY, PSYCH - MISC.
GENERIC
acamprosate calcium DR
disulfiram
donepezil HCL
ergoloid mesylates
fluoxetine
galantamine
galantamine hydrobromide
olanzapine/fluoxetine
rivastigmine tartrate
Chlordiazepoxide/Amitriptyline
Perphenazine/Amitriptyline
PREVENTIVE
QL
buproban
QL
bupropion HCL SR
QL
eq nicotine
QL
eq nicotine gum refill
QL
eq nicotine gum starter
QL
eq nicotine polacrilex
QL
eq nicotine step 3
QL
eql nicotine
QL
eql nicotine polacrilex
QL
eql nicotine polacrilex refill
QL
eql nicotine polacrilex starter
QL
gnp nicotine polacrilex
QL
kls quit2
QL
kls quit4
QL
nicorelief
QL
nicotine
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
21
QL
nicotine polacrilex
QL
nicotine polacrilex refill
QL
nicotine polacrilex starter kit
QL
nicotine step 1
QL
nicotine step 2
QL
nicotine step 3
QL
nicotine transdermal system
QL
px stop smoking aid
QL
ra mini nicotine
QL
ra nicotine
QL
ra nicotine polacrilex
QL
ra nicotine transdermal system step 3
QL
sm nicotine
QL
sm nicotine polacrilex
QL
sw nicotine polacrilex
QL
tgt nicotine gum
QL
tgt nicotine polacrilex
QL
tgt nicotine step one
QL
tgt nicotine step three
QL
tgt nicotine step two
QL
thrive
QL
CVS nicotine
QL
CVS nicotine polacrilex
QL
CVS nicotine polacrilex starter
QL
CVS nicotine transdermal system
QL
CVS nts step 1
QL
HM nicotine polacrilex
QL
HM nicotine transdermal system
QL
HM nicotine transdermal system step 3
QL
SR nicotine gum
PREFERRED
Exelon
QL,PA
Gralise
QL,PA
Gralise Starter
Namenda
Namenda Titration PAK
QL
Namenda XR
QL
Namenda XR Titration Pack
Nuedexta
QL
Savella
PREVENTIVE
QL
Chantix
QL
Chantix Continuing Month PAK
QL
Chantix Starting Month PAK
QL
Nicotine Transdermal System
NON PREFERRED
QL,PA
Ampyra
QL,PA
Aubagio
QL,PA
Avonex
QL,PA
Avonex Pen
QL,PA
Betaseron
QL,PA
Copaxone
QL,PA
Extavia
QL,PA
Gilenya
QL,PA
Horizant
Orap
QL,PA
Rebif
QL,PA
Rebif Rebidose
QL,PA
Rebif Rebidose Titration Pack
QL,PA
Rebif Titration Pack
QL,PA
Tecfidera
QL,PA
Tecfidera Starter Pack
QL,PA
Tysabri
PA
Xenazine
QL,PA
Xyrem
PREVENTIVE
QL
Nicotrol Inhaler
QL
Nicotrol Ns
NEUROMUSCULAR AGENTS
GENERIC
atracurium besylate
cisatracurium besylate
pancuronium bromide
QL,PA
riluzole
rocuronium bromide
vecuronium bromide
NON PREFERRED
PA
Botox
PA
Dysport
PA
Myobloc
PA
Xeomin
MUSCULOSKELETAL AGENTS
GENERIC
baclofen
carisoprodol
carisoprodol/aspirin
carisoprodol/aspirin/codeine
chlorzoxazone
cyclobenzaprine HCL
dantrolene sodium
metaxalone
methocarbamol
orphenadrine citrate
orphenadrine citrate ER
orphenadrine/asa/caffeine
revonto
tizanidine HCL
Carisoprodol
Enovarx-cyclobenzaprine HCL
PREFERRED
Gablofen
Lioresal Intrathecal
NON PREFERRED
PA
Euflexxa
PA
Hyalgan
Lorzone
PA
Orthovisc
PA
Supartz
PA
Synvisc
PA
Synvisc One
ANTIMYASTHENIC AGENTS
GENERIC
neostigmine methylsulfate
pyridostigmine bromide
Guanidine HCL
Regonol
PREFERRED
Mestinon
Mestinon Timespan
Prostigmin
OPHTHALMOLOGY AND OTIC
ANTI-INFECTIVES
GENERIC
ak-poly-bac
bacitracin/polymyxin b
ciprofloxacin HCL
erythromycin
garamycin
gatifloxacin
gentak
gentamicin sulfate
ilotycin
levofloxacin
neo-polycin
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
22
neomycin/bacitracin/polymyxin
neomycin/polymyxin/bacitracin zinc
neomycin/polymyxin/gramicidin
ofloxacin
polycin
polycin b
polymyxin b sulfate/trimethoprim sulfate
romycin
sodium sulfacetamide
sulfacetamide sodium
tobramycin sulfate
trifluridine
trimethoprim sulfate/polymyxin b sulfate
Bacitracin
Sulfacetamide Sodium
PREFERRED
Besivance
Moxeza
Natacyn
Vigamox
NON PREFERRED
Azasite
Ciloxan
Tobrex
Zirgan
NON PREFERRED
Blephamide S.o.p.
Durezol
Flarex
Ozurdex
Vexol
PROSTAGLANDINS
GENERIC
QL
latanoprost
PREFERRED
QL
Lumigan
QL
Travatan Z
QL
Travoprost
NON PREFERRED
QL
Zioptan
CYCLOPLEGIC MYDRIATICS
GENERIC
atropine sulfate
atropine-care
cyclopentolate HCL
homatropaire
homatropine HBR
mydral
tropicamide
Atropine Sulfate
ARTIFICIAL TEAR/LUBRICANT
NON PREFERRED
Lacrisert
DECONGESTANTS
GENERIC
altafrin
neofrin
phenylephrine HCL
Naphazoline HCL
BETA-BLOCKERS
GENERIC
betaxolol HCL
carteolol HCL
dorzolamide HCL/timolol maleate
levobunolol HCL
timolol maleate
timolol maleate ophthalmic gel forming
Istalol
Levobunolol HCL
Metipranolol
PREFERRED
Combigan
NON PREFERRED
Betimol
Betoptic-s
OPHTHALMIC STEROIDS
GENERIC
dexamethasone sodium phosphate
fluorometholone
neo-polycin HC
neomycin/polymyxin/bacitracin/hydrocortisone
neomycin/polymyxin/dexamethasone
poly-dex
prednisolone acetate
sulfacetamide sodium/prednisolone sodium phosphate
tobramycin/dexamethasone
Neomycin/Polymyxin/Hydrocortisone
Prednisolone Sodium Phosphate
PREFERRED
Alrex
FML
Lotemax
Pred Mild
Retisert
Tobradex
Tobradex ST
Zylet
MIOTICS
GENERIC
pilocarpine HCL
PREFERRED
Phospholine Iodide
Pilopine HS
NON PREFERRED
Isopto Carbachol
ADRENERGIC AGENTS
GENERIC
apraclonidine
brimonidine tartrate
PREFERRED
Alphagan P
NON PREFERRED
Iopidine
IMMUNOMODULATORS
PREFERRED
QL,PA
Restasis
LOCAL ANESTHETICS
GENERIC
altacaine
parcaine
proparacaine HCL
tetcaine
tetracaine HCL
tetravisc
tetravisc forte
OPHTHALMICS - MISC.
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
23
GENERIC
ak-fluor
akorn balanced salt solution
altafluor
azelastine HCL
balanced salt
balanced salt solution
bio GLO
bromfenac
bss
cromolyn sodium
diclofenac sodium
dorzolamide HCL
epinastine HCL
flucaine
fluor-i-strips a.t.
fluorescein-benoxinate
fluorescein/proparacaine
fluorets
flurbiprofen sodium
flurox
ful-GLO
green GLO lissamine greenophthalmic strips
ketorolac tromethamine
lissamine green
ocucoat viscoadherent
Ak-fluor
PREFERRED
Bepreve
QL
Bromday
QL
Ilevro
QL
Nevanac
Pataday
Patanol
QL
Prolensa
NON PREFERRED
Acuvail
Alocril
Alomide
Azopt
QL,PA
Cystaran
Emadine
Eylea
Jetrea
Lastacaft
Lucentis
Macugen
Visudyne
OTIC AGENTS
GENERIC
acetasol HC
acetic acid
aero otic HC
antipyrine/benzocaine
aurax
aurodex
cortic-nd
cyotic
exotic-HC
fluocinolone acetonide
fluocinolone acetonide ear drops
hydrocortisone/acetic acid
neomycin/polymyxin/hydrocortisone
neomycin/polymyxin/HC
ofloxacin
otic care
oticin
oto-end 10
otomax-HC
pramoxine-HC
Acetic Acid/Aluminum Acetate
Antipyrine/Benzocaine
Ciprofloxacin
Myoxin
Otozin
PREFERRED
Ciprodex
NON PREFERRED
Cipro HC
Coly-mycin S
Cortisporin-tc
OXYTOCICS
GENERIC
methylergonovine maleate
oxytocin
PAIN MANAGEMENT
ANALGESICS - NONNARCOTIC
GENERIC
ali-flex
biogesic
butal/asa/caff
butalbital/acetaminophen
butalbital/acetaminophen/caffeine
butalbital/apap/caffeine
butalbital/asa/caffeine
capacet
choline magnesium trisalicylate
clonidine HCL
diflunisal
dologesic
dolorex
duraxin
ed-flex
esgic
margesic
marten-TAB
repan
salsalate
tencon
zebutal
zflex
Alpain
Bupap
Butalbital/Aspirin/Caffeine
Mst 600
Rhinoflex-650
Tencon
Zgesic
PREVENTIVE
adult aspirin EC low strength
aspir-low
aspir-81
aspirin
aspirin adult low strength
aspirin childrens
aspirin enteric coated adult low strength
aspirin low dose
aspirin low strength
aspirin EC
aspirin EC low dose
aspirin EC LO-dose
aspirin 81
aspirtab
bayer advanced aspirin regular strength
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
24
bayer aspirin
bayer aspirin regimen
bayer aspirin EC low dose
bayer chewable low dose
bayer low dose
childrens aspirin
childrens aspirin low strength
ecotrin low strength
ecpirin
enteric coated aspirin
eq adult aspirin low strength
eq aspirin
eq aspirin adult low dose
eq aspirin low dose
eq aspirin EC
eq childrens aspirin
eql adult aspirin low strength
eql aspirin
eql aspirin low dose
eql aspirin EC
eql childrens aspirin
gnp adult aspirin low strength
gnp aspirin
gnp aspirin low dose
goodsense aspirin low dose
halfprin
kls aspirin low dose
kls aspirin EC
kp aspirin
meijer aspirin EC
miniprin low dose
norwich aspirin
px aspirin
px enteric aspirin
qc aspirin
qc aspirin low dose
qc childrens aspirin
ra aspirin
ra aspirin adult low dose
ra aspirin adult low strength
ra aspirin childrens
ra aspirin EC
ra aspirin EC adult low strength
ra childrens aspirin
sm aspirin
sm aspirin adult low strength
sm aspirin enteric coated
sm aspirin low dose
sm aspirin EC low strength
sm childrens aspirin
st joseph aspirin
tgt aspirin
tgt aspirin low dose
tgt childrens aspirin
tgt enteric-coated aspirin
th aspirin
th aspirin low dose
th enteric aspirin
CVS aspirin
CVS aspirin adult low dose
CVS aspirin adult low strength
CVS aspirin child
CVS aspirin low dose
CVS aspirin low strength
CVS aspirin EC
CVS childrens aspirin
CVS enteric aspirin
EC-81 aspirin
HM aspirin
HM aspirin EC
HM aspirin EC low dose
MM aspirin
SB aspirin
SB aspirin EC
SB childrens aspirin
SB low dose asa EC
1/2halfprin
NON PREFERRED
Prialt
PREVENTIVE
Adult Aspirin Low Strength
Aspirin Low Dose
Medi-seltzer
ANALGESICS - OPIOID
GENERIC
acetaminophen/codeine
acetaminophen/codeine #2
acetaminophen/codeine #3
acetaminophen/codeine #4
acetaminophen/codeine phosphate
alfentanil
ascomp/codeine
astramorph
QL,PA
buprenorphine HCL
QL,PA
buprenorphine HCL/naloxone HCL
butalbital/acetaminophen/caffeine/codeine
butalbital/aspirin/caffeine/codeine
QL
butorphanol tartrate
codeine sulfate
duramorph
endocet
endodan
QL
fentanyl
fentanyl citrate
QL,PA
fentanyl citrate oral transmucosal
hydrocodone bitartrate/acetaminophen
hydrocodone/acetaminophen
hydrocodone/ibuprofen
hydrogesic
hydromorphone HCL
QL
hydromorphone HCL ER
ibudone
lorcet
lorcet plus
lorcet HD
lortab
meperidine HCL
meperitab
methadone HCL
methadone HCL intensol
methadose
morphine sulfate
QL
morphine sulfate ER
nalbuphine HCL
oxycodone HCL
oxycodone/acetaminophen
oxycodone/aspirin
oxycodone/ibuprofen
oxymorphone hydrochloride
QL
oxymorphone hydrochloride ER
pentazocine/acetaminophen
pentazocine/naloxone HCL
reprexain
roxicet
stagesic
sufentanil citrate
QL
tramadol hydrochloride/acetaminophen
QL
tramadol HCL
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
25
QL
tramadol HCL ER
verdrocet
vicodin
vicodin ES
vicodin HP
xylon
zamicet
Acetaminophen/Caffeine/Dihydrocodeine Bitartrate
Aspirin-caffeine-dihydrocodeine
Codeine Sulfate
CO-gesic
Hydrocodone Bitartrate/Acetaminophen
Hydrocodone/Acetaminophen
Hydromorphone HCL
Hydromorphone HCL Dosette
Levorphanol Tartrate
Meperidine HCL
Methadone HCL
Methadose
Methadose Sugar-free
Morphine Sulfate
Morphine Sulfate Add-vantage
Oxycodone HCL
QL
Tramadol HCL ER
Trezix
PREFERRED
QL,PA
Butrans
QL,PA
Lazanda
QL
Nucynta
QL
Nucynta ER
QL
Opana ER (crush Resistant)
QL
Oxycodone HCL ER
QL
Oxycontin
QL,PA
Suboxone
NON PREFERRED
QL,PA
Abstral
QL
Conzip
Depodur
QL
Exalgo
QL,PA
Fentora
QL
Hydromorphone HCL ER
Infumorph 200
Infumorph 500
QL
Kadian
Oxecta
Rybix Odt
QL,PA
Subsys
Talwin
ANTI-INFLAMMATORY
GENERIC
diclofenac potassium
diclofenac sodium DR
diclofenac sodium ER
diclofenac sodium/misoprostol
etodolac
etodolac ER
flurbiprofen
ibuprofen
indomethacin
indomethacin sodium
indomethacin ER
ketoprofen
QL
ketorolac tromethamine
leflunomide
mefenamic acid
meloxicam
nabumetone
naproxen
naproxen sodium
naproxen DR
oxaprozin
piroxicam
sulindac
tolmetin sodium
Fenoprofen Calcium
Indomethacin
Ketoprofen ER
Ketorolac Tromethamine
Meclofenamate Sodium
Meloxicam
Tolmetin Sodium
PREFERRED
QL,PA
Celebrex
Ridaura
NON PREFERRED
PA
Actemra
PA
Arcalyst
PA
Enbrel
Enbrel Sureclick
PA
Humira
PA
Humira Pen
PA
Humira Pen-crohns Diseasestarter
PA
Humira Pen-psoriasis Starter
PA
Ilaris
PA
Kineret
Nalfon
Naprelan
PA
Orencia
Rheumatrex
PA
Simponi
PA
Simponi Aria
QL
Sprix
QL
Vimovo
PA
Xeljanz
MIGRAINE PRODUCTS
GENERIC
dihydroergotamine mesylate
isometheptene mucate/caffeine/acetaminophen
isometheptene/dichloralphenazone/acetaminophen
migragesic ida
QL
naratriptan HCL
nodolor
QL
rizatriptan benzoate
QL
rizatriptan benzoate odt
QL
sumatriptan succinate
QL
sumatriptan succinate refill
QL
zolmitriptan
QL
zolmitriptan odt
QL
Dihydroergotamine Mesylate
Isometheptene/Caffeine/Acetaminophen
Migralam
QL
Sumatriptan
QL
Sumatriptan Succinate
PREFERRED
QL
Relpax
NON PREFERRED
QL,PA,ST
Alsuma
QL,PA,ST
Axert
Cafergot
Ergomar
QL,PA,ST
Frova
QL,PA,ST
Sumavel Dosepro
QL,PA,ST
Treximet
QL,PA,ST
Zomig
QL,PA,ST
Zomig Nasal Spray
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
26
GOUT AGENTS
GENERIC
allopurinol
probenecid
probenecid/colchicine
PREFERRED
Colcrys
Uloric
NON PREFERRED
PA
Krystexxa
LOCAL ANESTHETICS-INJ
GENERIC
bupivacaine spinal
bupivacaine HCL
bupivacaine/epinephrine
chloroprocaine HCL
lidocaine HCL
lidocaine/epinephrine
polocaine
polocaine-mpf
ropivacaine
ropivacaine HCL
sensorcaine
sensorcaine-mpf
sensorcaine-mpf spinal
sensorcaine-mpf/epinephrine
sensorcaine/epinephrine
xylocaine dental
BD Pudendal/Local Block Tray 1% Lidocaine
Lidocaine HCL/Dextrose
Mepivacaine HCL
Tetracaine HCL
GENERAL ANESTHETICS
GENERIC
compound 347
etomidate
fresenius propoven
isoflurane
ketamine HCL
propofol
sevoflurane
sojourn
terrell
RESPIRATORY, ALLERGY, ETC
ANTIHISTAMINES
GENERIC
arbinoxa
bpm
carbinoxamine maleate
cetirizine HCL
clemastine fumarate
cyproheptadine HCL
desloratadine
desloratadine odt
diphenhydramine HCL
levocetirizine dihydrochloride
phenadoz
phenergan
promethazine HCL
promethazine HCL plain
promethegan
Brompheniramine Tannate
Clemastine Fumarate
Dexchlorpheniramine Maleate
Respa-BR
NON PREFERRED
Clarinex
NASAL AGENTS
GENERIC
QL
azelastine HCL
QL,PA,ST
budesonide
QL
flunisolide
QL
fluticasone propionate
QL
ipratropium bromide
QL
triamcinolone acetonide
QL
Flunisolide
PREFERRED
QL
Dymista
QL
Nasonex
NON PREFERRED
Bactroban Nasal
QL,PA,ST
Beconase AQ
QL,PA,ST
Omnaris
QL
Patanase
QL,PA,ST
Qnasl
Tyzine
Tyzine Pediatric Nasal Drops
QL,PA,ST
Veramyst
QL,PA,ST
Zetonna
COUGH/COLD/ALLERGY
GENERIC
acetylcysteine
benzonatate
biotuss
biotuss pediatric
bpm pseudo
bromfed DM
bromphen/pseudoephedrine HCL/dextromethorphan HBR
giltuss pediatric
hydrocodone bitartrate/chlorpheniramine maleate/PSE
hydrocodone bitartrate/homatropine methylbromide
hydrocodone polistirex/chlorpheniramine polistirex
hydrocodone/homatropine
hydromet
nebusal
nortuss-DE
phenylephrine/guaifenesin
promethazine VC
promethazine VC/codeine
promethazine-DM
promethazine/codeine
promethazine/dextromethorphan
pulmosal
sodium chloride
tgq 7.5PEH/4BRM/15DM
tussafed EX
tussigon
Albatussin NN
Dextromethorphan HBR/Chlorpheniramine/Phenylephrine
HCL
Giltuss TR
Nortuss-EX
Promethazine VC Plain
Promethazine VC/Codeine
Rescon-JR
Tgq 15DM/5PEH/2CPM
Tgq 30PSE/150GFN/15DM
Tgq 30PSE/3BRM/15DM
Tgq 50PSE/3BRM/30DM
PREFERRED
Tussicaps
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
27
NON PREFERRED
Clarinex-d 12 HOUR
Clarinex-d 24 HOUR
Rezira
ANTIASTHMATIC/COPD AGENTS
GENERIC
albuterol sulfate
albuterol sulfate ER
albuterol TAB 4MG
aminophylline
budesonide
cromolyn sodium
difil-G forte
epinephrine HCL
QL
ipratropium bromide
QL
ipratropium bromide/albuterol sulfate
QL
levalbuterol
QL
levalbuterol HCL
montelukast sodium
terbutaline sulfate
theochron
theophylline
theophylline CR
theophylline ER
theophylline/D5W
PA
zafirlukast
Metaproterenol Sulfate
Theophylline/D5W
PREFERRED
QL
Arcapta Neohaler
QL
Asmanex Twisthaler 120 Metered Doses
QL
Asmanex Twisthaler 14 Metered Doses
QL
Asmanex Twisthaler 30 Me Tered Doses
QL
Asmanex Twisthaler 30 Metered Doses
QL
Asmanex Twisthaler 60 Metered Doses
QL
Asmanex Twisthaler 7 Metered Doses
QL
Atrovent HFA
Combivent
QL
Combivent Respimat
Daliresp
QL
Dulera
QL
Foradil Aerolizer
QL
Perforomist
QL
Proair HFA
QL
Pulmicort
QL
Pulmicort Flexhaler
QL
Qvar
QL
Serevent Diskus
QL
Spiriva Handihaler
QL
Symbicort
QL
Tudorza Pressair
NON PREFERRED
QL,PA,ST
Advair Diskus
QL,PA,ST
Advair HFA
QL,PA,ST
Alvesco
QL,PA,ST
Breo Ellipta
QL
Brovana
Elixophyllin
QL,PA,ST
Flovent Diskus
QL,PA,ST
Flovent HFA
Lufyllin
QL
Maxair Autohaler
QL
Proventil HFA
Theo-24
QL
Ventolin HFA
PA
Xolair
QL
Xopenex HFA
PA
Zyflo
PA
Zyflo CR
RESPIRATORY AGENTS - MISC
NON PREFERRED
PA
Aralast NP
PA
Glassia
PA
Kalydeco
PA
Prolastin-c
PA
Pulmozyme
PA
Zemaira
TOXOIDS
PREFERRED
Tetanus Toxoid Adsorbed
PREVENTIVE
Adacel
Boostrix
Daptacel
Diphtheria/Tetanus Toxoids Adsorbed Pediatric
Infanrix
Kinrix
Pediarix
Pentacel
Tenivac
Tetanus/Diphtheria Toxoids-adsorbed Adult
VACCINES
GENERIC
Bcg Vaccine
PREFERRED
Biothrax
Imovax Rabies (h.d.c.v.)
Ixiaro
Menhibrix
Rabavert
Typhim VI
Vivotif Berna
Yf-vax
PREVENTIVE
Acthib
Afluria PF 2012-2013
Afluria PF 2013-2014
Afluria PF 2014-2015
Afluria 2012-2013
Afluria 2013-2014
Afluria 2014-2015
Cervarix
Comvax
Engerix-b
Fluarix Quadrivalent 2013-2014
Fluarix Quadrivalent 2014-2015
Fluarix 2012-2013
Fluarix 2013-2014
Fluarix 2014-2015
Flublok 2013-2014
Flublok 2014-2015
Flucelvax 2012-2013
Flucelvax 2013-2014
Flucelvax 2014-2015
Flulaval Quadrivalent 2013-2014
Flulaval Quadrivalent 2014-2015
Flulaval 2012-2013
Flulaval 2013-2014
Flulaval 2014-2015
Flumist Nasal Vaccine 2012-2013
Flumist Quadrivalent
Fluvirin PF 2012-2013
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
28
Fluvirin PF 2013-2014
Fluvirin PF 2014-2015
Fluvirin 2012-2013
Fluvirin 2013-2014
Fluvirin 2014-2015
Fluzone High-dose PF 2012-2013
Fluzone High-dose PF 2013-2014
Fluzone High-dose PF 2014-2015
Fluzone Intradermal
Fluzone Pediatric PF 2012-2013
Fluzone Pediatric PF 2013-2014
Fluzone PF 2012-2013
Fluzone PF 2013-2014
Fluzone PF 2014-2015
Fluzone Quadrivalent 2013-2014
Fluzone Quadrivalent 2014-2015
Fluzone Split 2012-2013
Fluzone Split 2013-2014
Fluzone Split 2014-2015
Gardasil
Havrix
Hiberix
Influenza A (h1n1) Monovalent 2009
Ipol Inactivated IPV
M-m-r II W/Diluent 10 Dose
Medical Provider EZ Flu Shot PF 2012-2013
Medical Provider EZ Flu Shot PF 2013-2014
Medical Provider EZ Flu Shot PF 2014-2015
Medical Provider EZ Flu Shot 2013-2014
Medical Provider EZ Flu Shot 2014-2015
Menactra
Menomune-a/C/Y/W-135
Menveo
Pedvax HIB
Physicians EZ Use Flu Kit 2012-2013
Pneumovax 23
Pneumovax 23/1 Dose
Pneumovax 23/5 Dose
Prevnar 13
Proquad
Recombivax HB
Rotarix
Rotateq
Twinrix
Vaqta
Varivax
Zostavax
VITAMINS
VITAMINS
GENERIC
ascor l nc
ascor l 500
ascorbic acid
ergocalciferol
mega-c/a plus
ortho-CS 250
phytonadione
thiamine HCL
vitamin c 222MG
vitamin d
vitamin k1
Aminobenzoate Potassium
Pyridoxine HCL
Vitamin K1
Wheat Germ
PREVENTIVE
aqueous vitamin d infants
bio-d-mulsion
bio-d-mulsion forte
bprotected pedia d-vite
d 1000
d 10000
d 2000
d 400
d 5000
d-vita
d-1000
d-1000 extra strength
d-2000 maximum strength
d-3-5
d-400
d-5000
d-5000 maximum strength
decara
delta d3
dialyvite vitamin d 5000
d2000 ultra strength
d3
d3 adult
d3 high potency
d3 kids
d3 maximum strength
d3 super strength
d3 ultra strength
d3-1000
d3-50
eql childrens vitamin d gummies
eql vitamin d-3
eql vitamin d3
gnp vitamin d
gnp vitamin d maximum strength
gnp vitamin d super strength
gnp vitamin d3 extra strength
healthy kids vitamin d3
just d
kp vitamin d
maximum d3
nat-rul vitamin d
optimal-d
optimal-d pack
opurity vitamin d
pronutrients vitamin d3
ra vitamin d-3
sm vitamin d
sm vitamin d3
th vitamin d3
thera-d rapid repletion
thera-d 2000
vitamin d high potency
vitamin d 400
vitamin d-1000
vitamin d-1000 maximum strength
vitamin d-3
vitamin d-400
vitamin d3
vitamin d3 adult gummies
vitamin d3 high potency
vitamin d3 maximum strength
vitamin d3 super strength
CVS childrens vitamin d for bone health
CVS vitamin d
CVS vitamin d infants
CVS vitamin d 5000 high-potency
CVS vitamin d3
HM vitamin d
HM vitamin d3
PA vitamin d-3
PA vitamin d-3 gummy
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
29
PREFERRED
Mephyton
NON PREFERRED
Potaba
PREVENTIVE
CVS Vitamin D3
Ddrops
Decara
Dialyvite Vitamin D3 Max
D3
D3 Dots
HM Vitamin D3
Replesta
Replesta Childrens
Replesta Nx
Sm Vitamin D3 Maximum Strength
Super Daily D3
Thera-d 4000
Vitamelts Vitamin D
Vitamin D
Vitamin D3
Vitamin D3 400
Wellesse Vitamin D3
MULTIVITAMINS
GENERIC
b-complex
b-complex 100
b-plex
b-plex plus
biocel
choice-TABS
corvita
corvite free
dialyvite
escavite LQ
folbee plus
folbee plus cz
infuvite
infuvite adult
infuvite pediatric
lysiplex plus
mult-vitamin/fluoride
multi vitamin/fluoride
multi-vit/fluoride
multi-vit/iron/fluoride
multi-vitamin/fluoride
multi-vitamin/fluoride/iron
multivitamin with fluoride
multivitamin/fluoride
multivitamins/fluoride
mynephrocaps
nephronex
niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper
nutrifac ZX
rena-vite RX
renal
renalpren
reno CAPS
strovite plus
tri-vit/fluoride
tri-vitamin/fluoride
triphrocaps
triple-vitamin/fluoride
urosex
v-c forte
vic-forte
virt-vite plus
virt-CAPS
vita s forte
vita-min
vitacel
vitamax pediatric
vitamin b-complex 100
vitamins a/c/d/fluoride
vol-care RX
Bp Folinatal Plus B
Bp Multinatal Plus
Cavan-EC Sod DHA
Cod Liver Oil
Complete Natal DHA
Completenate
CO-natal Fa
Elite-OB
Folbecal
Inatal Advance
Inatal GT
Inatal Ultra
M-vit
Macnatal CN DHA
Mynatal Advance
Mynatal Plus
Mynatal Ultracaplet
Mynatal-z
Mynate 90 Plus
MVC-fluoride
Neurodep
Obstetrix EC
OB-natal One
Pr Natal 400
Pr Natal 400 EC
Pr Natal 430
Pr Natal 430 EC
Prenaissance Plus
Prenaplus
Prenatabs Fa
Prenatabs RX
Prenatal Ad
Prenatal Low Iron
Prenatal 19
Prenatal-u
PNV-select
PNV-DHA
Quflora Pediatric
Se-natal 19
Se-tan DHA
Seton Et-EC
Setonet
Strovite Forte
Taron-prex
Tri-vit/Fluoride/Iron
Triadvance
Tricare
Trinatal RX 1
Trinate
Ultimatecare One
Ultimatecare One NF
Ultra TABS
Vinate C
Vinate Care
Vinate GT
Vinate IC
Vinate II
Vinate M
Vinate One
Vinate Pn Care
Vinate Ultra
Vitafol-OB
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
30
PREVENTIVE
nat-rul prenatal vitamins
sm prenatal vitamins
NON PREFERRED
AP-zel
Bacmin
M.v.i. Adult
M.v.i. Pediatric
M.v.i.-12 Without Vitamin K Neevo DHA Nicadan
Nicazel
Nicazel Forte
Nutricap
Prefera OB
Prefera OB + DHA
Preferaob One
Req 49+
Siderol
Strovite One
Tri-zel
Vinate DHA RF
Vp-zel
PREVENTIVE
Atabex Prenatal
Brainstrong Prenatal
Centrum Specialist Prenatal
Classic Prenatal
CVS Prenatal
CVS Prenatal Gummy/DHA/Folic Acid
CVS Prenatal Multi+dha
Enfamil Expecta
Eql Prenatal Formula
Gnp Daily Prenatal
Gnp Prenatal
Gnp Prenatal Vitamins
Goodsense Prenatal Vitamins
Healthy Mama Be Well Rounded
HM One Daily Prenatal Combo
HM Prenatal
Kp Prenatal Multivitamins
Mission Prenatal
Mission Prenatal HP
Multi Prenatal
One A Day Womens Prenatal/DHA
One-a-day Womens Prenatal
Perry Prenatal
Pre-natal Formula
Prenatal Prenatal And Iron
Prenatal Complete
Prenatal Formula
Prenatal Forte
Prenatal Multi +dha
Prenatal Multivitamin + DHA
Prenatal One Daily
Prenatal Plus DHA
Prenatal Vitamins
Prenatal/Omega-3/Folic Acid/Iron
Px Prenatal Multivitamins
PA Prenatal Formula
Qc Prenatal
Ra One Daily
Ra Prenatal
Ra Prenatal Formula/Folicacid
Right Step Prenatal
Similac Prenatal Early Shield
Sm One Daily Prenatal
Sm Prenatal Vitamins
Stuart One
Stuart Prenatal
Stuart Prenatal + DHA
Th Prenatal Vitamins
Your Life Multi Prenatal
MEDICAL DEVICES
DIABETIC SUPPLIES
PREFERRED
Accu-chek Combo QL
Accu-chek Fastclix Lancets
QL
Accu-chek Multiclix Lancets
Accu-chek Rapid-d Infusion Set/24"/10MM
Accu-chek Rapid-d Infusion Set/24"/6MM
Accu-chek Rapid-d Infusion Set/24"/8MM
Accu-chek Rapid-d Infusion Set/31"/10MM
Accu-chek Rapid-d Infusion Set/31"/6MM
Accu-chek Rapid-d Infusion Set/31"/8MM
Accu-chek Rapid-d Infusion Set/43"/10MM
Accu-chek Rapid-d Infusion Set/43"/6MM
Accu-chek Rapid-d Infusion Set/43"/8MM
QL
Accu-chek Safe-t-pro Lancets
QL
Accu-chek Safe-t-pro Pluslancets
QL
Accu-chek Soft Touch Lancets
QL
Accu-chek Softclix Lancets
Accu-chek Spirit Adapter Kit
Accu-chek Spirit Battery Kit
Accu-chek Spirit Insulin P.M. Kit
QL
Acti-lance Lancets 28G
QL
Acti-lance Lite Safety Lancets 28G
QL
Acti-lance Special Safety Lancets 17G
QL
Acti-lance Special Safetylancets 17G
QL
Acti-lance Universal Safety Lancets 23G
QL
Advocate Lancets
QL
Advocate Safety Lancets
QL
Agamatrix Ultra-thin Lancets 33G
QL
Assure Comfort Lancets Ultra Thin 28G
QL
Assure Comfort Lancets Ultra Thin 30G
QL
Assure Haemolance Plus High Flow 18G
QL
Assure Haemolance Plus Low Flow 25G
QL
Assure Haemolance Plus Micro Flow 28G
QL
Assure Haemolance Plus Normal Flow 21G
QL
Assure Haemolance Plus Pediatric Blade
QL
Assure Lance Lancets
QL
Assure Lancets
QL
Aurora Lancet Super Thin 30G
QL
Aurora Lancet Thin 23G
QL
AF Lancets Super Thin
QL
AT Last Lancets
QL
Bayer Microlet Lancets
QL
Bullseye Mini Safety Lancets
QL
Bullseye Safety Lancets
QL
BD Insulin Syringe LUER-LOK/U-100/1ML
QL
BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2"
QL
BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2"
QL
BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8"
QL
BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2"
QL
BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2"
QL
BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2"
QL
BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8"
QL
BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2"
BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X
QL
5/16"
QL
BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2"
QL
BD Insulin Syringe Safetyglide/1ML/29G X 1/2"
QL
BD Insulin Syringe Slip Tip/U-100/1ML
QL
BD Insulin Syringe U-40/1ML/25G X 5/8"
QL
BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16"
BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X
QL
5/16"
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
31
QL
BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16"
QL
BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2"
QL
BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2"
QL
BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2"
QL
BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2"
QL
BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2"
QL
BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16"
QL
BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2"
QL
BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16"
QL
BD Insulin Syringe Ultrafine/1ML/30G X 1/2"
QL
BD Insulin Syringe Ultrafine/1ML/31G X 5/16"
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X
QL
1"
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X
QL
5/8"
BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X
QL
1/2"
QL
BD Insulin Syringe/U-100/0.5ML/30G X 1/2"
QL
BD Insulin Syringe/U-100/1ML/27G X 1/2"
QL
BD Insulin Syringe/U-100/1ML/28G X 1/2"
QL
BD Insulin Syringe/U-100/2ML/27.5G X 5/8"
QL
BD Insulin Syringe/U-100/2ML/29G X 1/2"
QL
BD Lancet Ultrafine 30G
QL
BD Lancet Ultrafine 33G
BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X
QL
1/2"
QL
BD Microtainer Lancets
QL
BD Pen Needle/Mini/Ultrafine/31G X 3/16"
QL
BD Pen Needle/Nano/Ultra Fine/32G X 4MM
QL
BD Pen Needle/SHORT/Ultrafine/31G X 5/16"
QL
BD Pen Needle/Ultrafine/29G X 12.7MM
QL
BD Pen Needle/Ultrafine/29GX1/2" 12.7MM
QL
BD Pen Needles SHORT/Ultrafine/31G X 5/16"
QL
Careone Lancet Thin
QL
Careone Lancet Ultra Thin
QL
Cleanlet Lancets 28G
QL
Clever Chek Lancets Ultrathin
QL
Clever Chek Lancets Ultrathin 30G
QL
Coaguchek Lancets
QL
Comfort Assured Lancets Micro Thin 33G
QL
Comfort Assured Lancets Super Thin 28G
QL
Comfort Lancets
QL
CVS Lancets Micro Thin 33G
QL
CVS Lancets Original
QL
CVS Lancets Thin
QL
CVS Lancets Thin 26G
QL
CVS Lancets Ultra Thin 30G
QL
CVS Lancets 21G
QL
CVS Ultra Thin Lancets
QL
Diastar Easy Test II Lancets 30G
QL
Diastar Easy Test Lancets30G
QL
Droplet Lancets Ultra Thin 30G
QL
Drug Mart Lancets Thin
QL
Drug Mart Lancets Ultra Thin
QL
Drug Mart On-the-go Lancets Gentle 30G
QL
Drug Mart Unilet Lancets Super Thin 30G
QL
Drug Mart Unilet Lancets Ultra Thin 28G
QL
Duane Reade Lancet Alternate Site 26G
QL
Duane Reade Lancet Super Thin 30G
QL
Duane Reade Lancet Ultra Thin 28G
QL
E-z Ject Lancets
QL
E-z Ject Lancets Color
QL
E-z Ject Lancets Super Thin
QL
E-z Ject Lancets Super Thin 30G
QL
E-z Ject Lancets Thin 26G
QL
E-z Ject Lancets 21G
QL
E-ZJECT Lancets Micro-thin 33G
QL
Easy Comfort Lancets
QL
Easy Touch Lancets
QL
Easy Touch Lancets 21G/Pressure Activated
QL
Easy Touch Lancets 23G/Pressure Activated
QL
Easy Touch Lancets 26G/Pressure Activated
QL
Easy Touch Lancets 28G/Pressure Activated
QL
Easy Touch Lancets 28G/Twist
QL
Easy Touch Lancets 30G/Pressure Activated
QL
Easy Touch Lancets 30G/Twist
QL
Easy Touch Lancets 32G/Pressure Activated
QL
Easy Touch Lancets 32G/Twist
QL
Easy Touch Lancets 33G/Twist
QL
Easy Touch Safety Lancets21G/Pressure Activated
QL
Easy Touch Safety Lancets23G/Pressure Activated
QL
Easy Touch Safety Lancets26G/Button Activated
QL
Easy Touch Safety Lancets26G/Pressure Activated
QL
Easy Touch Safety Lancets28G/Button Activated
QL
Easy Touch Safety Lancets28G/Pressure Activated
QL
Easy Twist & CAP Lancets
QL
Easytest II Lancets
QL
Easytest Lancets
QL
Embrace Lancets Ultra Thin 30G
QL
Eql Color Lancets Micro Thin 33G
QL
Eql Color Lancets 21G
QL
Eql Super Thin Lancets 30G
QL
Eql Thin Lancets 26G
QL
EZ Smart Blood Glucose Lancets
QL
EZ-lets Lancets 21G
QL
EZ-lets Lancets 23G
QL
EZ-lets Lancets 26G Super-soft
QL
EZ-lets Lancets 28G Ultra-soft
QL
EZ-lets Lancets 30G
QL
Fasttake Test Strips
QL
Fifty50 Safety Seal Lancets 30G
QL
Fifty50 Safety Seal Lancets 32G
QL
Fine 30
QL
Fingerstix Lancets
QL
Fora Lancets
QL
Freds Pharmacy Unilet Lancets Super Thin 30G
QL
Freds Pharmacy Unilet Lancets Ultra Thin 28G
QL
Freestyle Lancets
QL
Freestyle Unistick II Lancets
QL
Gentle-let GP Lancets
QL
Gentle-let Lancets General Purpose Style/Fine Point
QL
Gentle-let Lancets General Purpose Style/Medium Point
QL
Gentle-let Lancets Safety Style/Fine Point
QL
Gentle-let Lancets Safety Style/Medium Point
QL
Global Inject Ease Lancets 28G
QL
Global Inject Ease Lancets 30G
QL
Glucocom Lancets 28G
QL
Glucocom Lancets 30G
QL
Glucocom Lancets 33G
QL
Glucosource Lancets
QL
Gmate Lancets 30G
QL
Gnp Lancets
QL
Gnp Lancets Micro Thin 33G
QL
Gnp Lancets Super Thin 30G
QL
Gnp Lancets Thin
QL
Gnp Lancets Thin 26G
QL
Gnp Lancets 21G
QL
Gnp Micro Thin Lancets 33G
QL
Gnp Super Thin Lancets/30G
QL
H&h Thinlet Lancets 26G
QL
H&h Thinlet Super Thin Lancets 30G
QL
H-e-b Incontrol Lancets Super Thin 30G
QL
H-e-b Incontrol Lancets Ultra Thin 28G
QL
Haemolance
QL
Haemolance Low Flow Lancets
QL
Haemolance Plus
QL
Haemolance Plus High Flow
QL
Haemolance Plus Low Flow
QL
Haemolance Plus Max Flow
QL
Haemolance Plus Pediatric Flow
QL
Healthwise Lancets 30G
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
32
QL
Healthy Accents Unilet Lancets Super Thin 30G
QL
Hy-vee Lancets
QL
Hy-vee Thin Lancets
QL
HM Lancets Micro Thin 33G
QL
HM Lancets Ultra Thin 30G
QL
Kinney Lancets
QL
Kinney Thin Lancets
QL
Kroger Lancets
QL
Kroger Lancets Micro Thin33G
QL
Kroger Lancets Super Thin
QL
Kroger Lancets Thin
QL
Kroger Lancets Thin 26G
QL
Kroger Lancets Ultrathin 30G
QL
Kroger Lancets 21G
QL
Lady Lite Lancets
QL
Lancets
QL
Lancets Bullseye Safety
QL
Lancets Micro Thin 33G
QL
Lancets Safety Seal 21G
QL
Lancets Safety Seal 26G
QL
Lancets Safety Seal 28G
QL
Lancets Safety Seal 30G
QL
Lancets Super Thin 28G
QL
Lancets Thin
QL
Lancets Twist Top
QL
Lancets Ultra Fine
QL
Lancets Ultra Thin
QL
Lancets Ultra Thin 30G
QL
Lancets 26G Twist Top
QL
Lancets 28G
QL
Lancets 30G
QL
Lancets 30G Twist Top
QL
Lancets 31G Twist Top
QL
Leader Lancets Colored
QL
Leader Super Thin Lancet
QL
Leader Thin Lancets
QL
Liberty Blood Glucose Meter
QL
Liberty Blood Glucose Monitor
Liberty Control Solution High
Liberty Control Solution Normal
Liberty Glucose Control Level 1
Liberty Glucose Control Level 2
Liberty Glucose Control Mid
Liberty Glucose Control Normal
Liberty Mini Lancing Device
QL
Liberty Next Generation Blood Glucose Monitor
QL
Liberty Next Generation Blood Glucose Test Strips
QL
Liberty Test Strips
QL
Lifescan Unistik II Lancets
QL
Lifescan Unistik 2 Deep Penetration
QL
Lite Touch Lancets
QL
Litetouch Lancets Micro Thin 33G
QL
Live Better Lancet Super Thin 30G
QL
Live Better Lancet Ultra Thin 28G
QL
Longs Lancets Standard
QL
Longs Lancets Thin
QL
Longs Lancets Ultra Thin
QL
Medi-lance Lancets
QL
Medichoice Pre-set Safety Lancet Dual Use
QL
Medichoice Pre-set Safety Lancet Low Flow
QL
Medichoice Pre-set Safety Lancet Medium Flow
QL
Medichoice Pre-set Safety Lancet Moderate Flow
QL
Medichoice Safety Lancet Extra
QL
Medichoice Safety Lancet Normal
QL
Medicine Shoppe Lancets
QL
Medicine Shoppe Lancets Thin
QL
Medisense Thin Lancets
QL
Medlance Plus Extra Lancets 21G
QL
Medlance Plus Lancets
QL
Medlance Plus Lancets Lite 25G
QL
Medlance Plus Lite Lancets 25G
QL
Medlance Plus Special Lancets 0.8MM
QL
Medlance Plus Superlite 30G
QL
Medlance Plus Superlite 30G/Comfort Max
QL
Medlance Plus Universal Lancets 21G
QL
Medlance Plus/Lite 25G
QL
Medlance/Extra
QL
Medlance/Lite
QL
Medlance/Universal
QL
Meijer Color Lancets Universal 33G
QL
Meijer Lancets
QL
Meijer Lancets Thin
QL
Meijer Lancets Universal 33G
QL
Meijer Super Thin Lancets
QL
Microlet Lancets
QL
Microtainer Safety Flow Lancet/Sterile/Single-use
QL
Monolet Lancets
QL
Monolet Opd Lancets
QL
Monolettor Safety Lancets
QL
Myglucohealth Mgh Softlance Lancets 30G
QL
Netgroup Lancets
QL
Nova Safety Lancets 23G
QL
Nova Safety Lancets 28G
QL
Nova Sureflex Lancets
QL
Novofine Autocover 30GX8MM
QL
Novofine 30GX8MM
QL
Novofine 32GX6MM
QL
Novotwist 30GX8MM
QL
Novotwist 32GX5MM
QL
On Call Lancets
QL
On Call Plus Lancets
QL
Onetouch Basic System
QL
Onetouch Basic/Profile Test Strips
QL
Onetouch Club Lancets Fine Point
QL
Onetouch Combo Pack
QL
Onetouch Delica Lancets Extra Fine 33G
QL
Onetouch Delica Lancets Fine 30G
Onetouch Delica Lancing Device
QL
Onetouch Finepoint Lancets
QL
Onetouch Lancets
Onetouch Ping Insulin P.M.
Onetouch Ping Meter Remote
QL
Onetouch Profile System
Onetouch Suresoft Lancing Device/18G
Onetouch Suresoft Lancing Device/21G
Onetouch Suresoft Lancing Device/28G
QL
Onetouch Ultra Blue
Onetouch Ultra Control
QL
Onetouch Ultra Mini
QL
Onetouch Ultra System Kit
QL
Onetouch Ultra 2
QL
Onetouch Ultralink System (hex)
QL
Onetouch Ultralink System (DEC)
QL
Onetouch Ultrasmart
QL
Onetouch Ultrasoft Lancets
Onetouch Verio Control Solution High
QL
Onetouch Verio IQ Blood Glucose Monitoring System
Onetouch Verio Mid Control Solution
QL
Onetouch Verio Sync Bloodglucose Monitoring System
QL
Onetouch Verio Test Strips
QL
Pen Needles 29G X 12MM
QL
Pen Needles 29GX1/2"
QL
Pen Needles 30GX5/16"
QL
Pen Needles 31G X 1/4" SHORT
QL
Pen Needles 31G X 3/16"
QL
Pen Needles 31G X 6MM
QL
Pen Needles 31GX5/16"
QL
Perfect Lancets 30G
QL
Perfect Pressure Activated Safety Lancets 28G
QL
Pharmacist Choice Ultra Thin Lancets
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
33
QL
Pharmacist Choice Ultra Thin Lancets 28G
QL
Pharmacist Choice Ultra Thin Lancets 30G
QL
Pharmacist Choice Ultra Thin Lancets 31G
QL
Pharmacist Choice Ultra Thin Lancets 33G
QL
Pharmacy Counter Lancets
QL
Precision Thin Lancets
QL
Precision Thins GP Lancet
QL
Precision Ultra Lancet
QL
Preferred Plus Lancets Colored 21G
QL
Preferred Plus Lancets Super Thin 30G
QL
Preferred Plus Lancets Thin 26G
QL
Prodigy Autocode Blood Glucose Monitoring System
QL
Prodigy Autocode Blood Glucose Monitoring/Talking
QL
Prodigy Autocode Pro Blood Glucose Monitoring System
QL
Prodigy NO Coding Blood Glucose Test Strips
QL
Prodigy Pocket Blood Glucose Meter Kit
QL
Prodigy Pocket Pro Blood Glucose Monitoring System
QL
Prodigy Pressure Activated Safety Lancets
QL
Prodigy Twist Top Lancets
QL
Prodigy Voice Blood Glucose Meter Kit
QL
Prodigy Voicepro Blood Glucose Monitoring System
QL
Pss Select GP Lancets
QL
Pss Select Safety Lancets
QL
Px Lancets
QL
Px Lancets Ultra Thin
QL
Qc Lancets
QL
Qc Lancets Super Thin
QL
Qc Lancets Thin
QL
Qc Lancets Ultra Thin
QL
Ra E-ZJECT Color Lancets Micro-thin 33G
QL
Ra E-ZJECT Lancets Thin 26G
QL
Ra E-ZJECT Lancets Thin 28G
QL
Ra E-ZJECT Lancets Ultra Thin 30G
QL
Ra E-ZJECT Lancets 28G
QL
Reality Lancets
QL
Reality Trigger Lancets
QL
Relion Lancets
QL
Relion Lancets Micro-thin33G
QL
Relion Lancets Standard 21G
QL
Relion Lancets Thin 26G
QL
Relion Lancets Ultra-thin30G
QL
Relion Thin Lancets
QL
Relion Ultra Thin Lancets
QL
Relion Ultra Thin Lancets30G
QL
Relion Ultra Thin Plus Lancets 32G
QL
Relion Ultra Thin Plus Lancets 33G
QL
Renew Advanced Lancing Cartridge Refills
QL
Rexall Lancets Ultra Thin
QL
Rightest Gl300 Lancets
QL
Safe-t-lance Low Flow 25G
QL
Safe-t-lance Normal Flow 21G
QL
Safe-t-lance Plus Safety Lancet High Flow
QL
Safe-t-lance Plus Safety Lancet Low Flow
QL
Safe-t-lance Plus Safety Lancet Normal Flow
QL
Safety Lancet 2MM
QL
Safety Lancet 21G/Pressure Activated
QL
Safety Lancet 28G/Pressure Activated
QL
Safety Lancets
QL
Safety Lancets 21G
QL
Safety Lancets 28G
QL
Safety Let Lancets
QL
Safety Seal Lancets 28G
QL
Safety Seal Lancets 30G
QL
Sapscare Twist Top Lancets 30G
QL
Shopko On-the-go Comfort Lancets 30G
QL
Shopko Unilet Lancets Super Thin 30G
QL
Shopko Unilet Lancets Ultra Thin 28G
QL
Single-let
QL
Sm Lancets 21G
QL
Sm Micro Thin Lancets 33G
QL
Sm Super Thin Lancets
QL
Sm Super Thin Lancets 30G
QL
Sm Thin Lancets 26G
QL
Smart Diabetes Vantage Universal Lancets 30G
QL
Smart Sense Color Lancets Universal 33G
QL
Smart Sense Standard Lancets Universal 21G
QL
Smart Sense Super Thin Lancets Universal 30G
QL
Smart Sense Thin Lancets Universal 26G
QL
Smartest Lancets 28G
QL
Solus V2 Pressure Activated Safety Lancets 28G
QL
Solus V2 Twist Lancets 30G
QL
Sterilance TL
QL
Super Thin Lancets
QL
Sure Comfort Lancets 28G
QL
Sure Comfort Lancets 30G
QL
Sure-lance Flat Lancets
QL
Sure-lance Lancets 26G
QL
Sure-lance Thin Lancets 28G
QL
Sure-lance Ultra Thin Lancets
QL
Sure-touch Lancets Universal
QL
Surelite Lancets
QL
Surestep Pro Test Strips
QL
Surestep Test Strips
QL
SB Lancets Thin
QL
SB Lancets Ultra Thin
QL
Techlite AST Lancets
QL
Techlite Lancets
QL
Techlite Lancets 30G
QL
Tgt Lancet Alternate Site
QL
Tgt Lancet Micro Thin 33G
QL
Tgt Lancet Super Thin 30G
QL
Tgt Lancet Thin 23G
QL
Tgt Lancet Thin 26G
QL
Tgt Lancet Ultra Thin 28G
QL
Tgt Lancet Ultra Thin 30G
QL
Thinlets GP Lancets
QL
Thinlets Lancet
QL
Todays Health Super Thin Lancets 30G
QL
Todays Health Ultra Thin Lancets 28G
QL
Trueplus Lancets 26G
QL
Trueplus Lancets 28G
QL
Trueplus Lancets 28G Super Thin
QL
Trueplus Lancets 30G
QL
Trueplus Lancets 30G Ultra Thin
QL
Trueplus Lancets 33G
QL
Trueplus Lancets 33G Micro Thin
QL
Trueplus Safety Lancets 28G
QL
Ulticare Thin Lancets 30G
QL
Ultilet Basic Lancets 30G
QL
Ultilet Classic Lancets
QL
Ultilet Lancets
QL
Ultilet Lancets 33G
QL
Ultilet Safety Lancets 23G
QL
Ultra Thin Lancets 28G
QL
Ultra Thin Lancets 30G
QL
Ultra-thin II Auto Lancet
QL
Ultra-thin II Lancets 28G
QL
Ultra-thin II Lancets 30G
QL
Ultra-thin II Safety Autolancets 26G
QL
Unilet Comfortouch Lancet
QL
Unilet Excelite
QL
Unilet Excelite II
QL
Unilet G.p. Lancet
QL
Unilet G.p. Superlite Lancet
QL
Unilet GP 28 Ultra Thin
QL
Unilet Lancet
QL
Unilet Superlite Lancet
QL
Unistik 3 Gentle
QL
Universal 1 Lancets Thin 26G
QL
Universal 1 Lancets Ultra Thin 30G
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
34
V-go 20
V-go 30
V-go 40
QL
Value Plus Lancets Standard 21G
QL
Value Plus Lancets Super Thin 30G
QL
Value Plus Lancets Thin 26G
QL
Valumark Lancet Super Thin 30G
QL
Valumark Lancet Ultra Thin 28G
QL
Vida Mia Unilet Lancets Super Thin 30G
QL
Vida Mia Unilet Lancets Ultra Thin 28G
QL
Vitalet Pro Lancets
QL
Vitalet Pro Plus Lancets
QL
W&f Lancets Colored 21G
QL
W&f Lancets 26G
QL
Walgreens Advanced Travellancets 28G
QL
Walgreens Comfort Assuredlancets Micro Thin/33G
QL
Walgreens Comfort Assuredlancets Super Thin/28G
QL
Walgreens Lancets
QL
Walgreens Thin Lancets
QL
Walgreens Ultra Thin Lancets
QL
1ST Choice Lancets Super Thin
QL
1ST Choice Lancets Thin
QL
1ST Choice Lancets Ultra Thin
QL
1ST Tier Unilet Comfortouch Lancets 28G
QL
1ST Tier Unilet Comfortouch Lancets 30G
NON PREFERRED
Accu-chek Active Glucose Control Solution
QL
Accu-chek Active Strips
QL
Accu-chek Aviva
QL
Accu-chek Aviva Plus
Accu-chek Comfort Curve Linearity Solution
QL
Accu-chek Comfort Curve Test Strips
Accu-chek Compact Blue Control Solution (2 Levels)
QL
Accu-chek Compact Plus
QL
Accu-chek Compact Plus Care Kit
Accu-chek Compact Plus Clear Control Solution (2 Levels)
QL
Accu-chek Compact Test Drum
Accu-chek Fastclix Lancetdevice Kit
Accu-chek Instant Glucosecontrol Solution (2 Levels)
Accu-chek Multiclix Lanc Et Device Kit
QL
Accu-chek Nano Smartview
Accu-chek Smartview Control
QL
Accu-chek Smartview Strips
Accu-chek Softclix Lancetdevice Kit
QL
Accu-chek Voicemate
MEDICAL DEVICES - MISC
PREFERRED
QL
Aerochamber Mini Aerosol Chamber
QL
Aerochamber MV
QL
Aerochamber Plus Flow VU
QL
Aerochamber Plus Flow-VU
QL
Aerochamber Plus Flow-VU/Large Mask
QL
Aerochamber Plus Flow-VU/Mask
QL
Aerochamber Plus Flow-VU/Medium Mask
QL
Aerochamber Plus Flow-VU/Small Mask
Aerochamber Z-stat Plus Valved Holding Chamber W/Flow
QL
VU
QL
Aerochamber Z-stat Plus/Flowsignal
QL
Aerochamber Z-stat Plus/Large Mask
QL
Aerochamber Z-stat Plus/Medium Mask
QL
Aerochamber Z-stat Plus/Small Mask
QL
Aerochamber/Flowsignal
Alcoh-glove Contoured Wipe
Alcoh-wipe 12" X 12"
Alcohol Pads
Alcohol Prep Pads
Alcohol Swabs
Alcohol Wipes
QL
Arial Chamber
QL
Breatherite
QL
Breatherite Collapsible Adult Spacer W/Mask
QL
Breatherite Collapsible Child Spacer W/Mask
QL
Breatherite Collapsible Infant Spacer W/Mask
QL
Breatherite Collapsible Small Child Spacer W/Mask
QL
Breatherite Collapsible Spacer W/ Neonate Mask
QL
Breatherite Rigid Spacer W/Mask
QL
Breatherite W/Large Mask
QL
Breatherite W/Medium Mask
QL
Breatherite W/Small Mask
BD Swabs Single Use
BD Swabs Single Use Butterfly
Curity Alcohol Preps/Medium 2 Ply
Curity Alcohol Swabs
CVS Alcohol Prep Swabs
CVS Alcohol Swabs
Detachable Face Mask
QL
E-z Spacer
QL
E-z Spacer The Body Guards Pack
QL
Easivent
QL
Easivent/Mask-large
QL
Easivent/Mask-medium
QL
Easivent/Mask-small
Easy Touch Alcohol Prep Pads/Medium
Fifty50 Alcohol Prep Pads
Global Alcohol Prep Ease Pads
Gnp Alcohol Swabs
Healthwise Alcohol Prep Pads
Inspirease Bags
QL
Inspirease Drug Delivery System
Inspirease Mouthpiece
Inspirease Reservoir Bags
QL
Liteaire
Mask Vortex/Baby Whirl Duckling
Mask Vortex/Child/Frog
Mask Vortex/Spinner The Duck
Mask Vortex/Toddler/Lady Bug
Meijer Alcohol Swabs Extra-thick
QL
Microchamber
QL
Microspacer
QL
Nessi Spacer/Large Mask
QL
Nessi Spacer/Mouthpiece
QL
Nessi Spacer/Small/MED Mask
QL
Optichamber Advantage
QL
Optichamber Diamond
QL
Optichamber Diamond/Largeface Mask
QL
Optichamber Diamond/Medium Face Mask
QL
Optichamber Diamond/Smallface Mask
Optichamber Valved Holding Chamber
Optichamber/Mask
QL
Optihaler
QL
Optihaler MDI Drug Delivery System
Panda Mask Large
Panda Mask Medium
Panda Mask Small
Pediatric Panda Mask
Pharmacist Choice Alcoholprep Pads
QL
Pocket Chamber
QL
Pocket Spacer
Qc Alcohol Swabs
Ra Alcohol Swabs
Reality Swabs
Relion Alcohol Swabs
QL
Riteflo
Saps Care Alcohol Prep Pads
Shopko Alcohol Swabs
Sm Alcohol Prep Pads
Sure Comfort Alcohol Prep Pads
Sure-prep Alcohol Prep Pads
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
35
SB Alcohol Prep Pads
Tgt Alcohol Swabs
Ultilet Alcohol Swab
Ultilet Alcohol Swabs
QL
Valved Holding Chamber
QL
Vortex Valved Holding Chamber
QL
Watchhaler
Webcol Alcohol Prep Large 1 Ply
Webcol Alcohol Prep Large 2 Ply
Webcol Alcohol Prep Medium 2 Ply
MISCELLANEOUS
GENERIC
acetylcysteine
adenosine
alprostadil
amino acids
aminosyn II 8.5%/electrolytes
aminosyn 8.5%/electrolytes
aminosyn-hf
argyle sterile water 100ML
calcium chloride
calcium gluconate
chloromag
chromium chloride
clinisol SF 15%
cosyntropin
cysteine HCL
deferoxamine mesylate
dehydrated alcohol
delflex-lm/1.5% dextrose
delflex-LC/1.5% dextrose
dextrose 10%
dextrose 10% flex container
dextrose 2.5%/sodium chloride 0.45%
dextrose 2.5%/NACL 0.45%
dextrose 30%
dextrose 30% partial fill
dextrose 5%
dextrose 5% viaflex
dextrose 5%/lactated ringers
dextrose 5%/potassium chloride 0.15%
dextrose 5%/ringers
dextrose 5%/sodium chloride 0.2%
dextrose 5%/sodium chloride 0.33%
dextrose 5%/sodium chloride 0.45%
dextrose 5%/sodium chloride 0.9%
dextrose 5%/NACL 0.2%
dextrose 5%/NACL 0.33%
dextrose 5%/NACL 0.45%
dextrose 5%/NACL 0.9%
dextrose 50%
dextrose 70%
dipyridamole
effer-k
effervescent pot chloride
effervescent potassium
effervescent potassium/chloride
flumazenil
folastin
folbic
fomepizole
formadon
formaldehyde
hepatamine
hepatasol
indigo carmine
indocyanine green
intralipid
isolyte-m/dextrose 5%
isosulfan blue
k-effervescent
k-prime
k-vescent
kendall sodium chloride flush
kionex
klor-CON
klor-CON m10
klor-CON m20
klor-CON 10
klor-CON 8
klor-CON/EF
l-cysteine HCL
lactated ringers
lactated ringers dextrose 5% viaflex
lactated ringers irrigation
lactated ringers viaflex
lanolin
liposyn iii
magnesium chloride
magnesium sulfate
methylene blue
monoject pharma grade flush syringe
monoject sodium chloride flush
morrhuate sodium
multitrace-4 concentrate
multitrace-5 concentrate
n-acetyl-l-cysteine
naloxone HCL
naltrexone HCL
normal saline flush
normal saline flush for flushing vascular access devices
normal saline i.v. flush
normosol-m IN D5W
nutrilyte
nutrilyte II
phospha 250 neutral
physiolyte
physiosol irrigation
potassium acetate
potassium bicarbonate
potassium chloride
potassium chloride CR
potassium chloride ER
potassium chloride SR
potassium chloride 0.15% /NACL 0.45% viaflex
potassium chloride 0.15% w/NACL 0.9% viaflex
potassium chloride 0.15% D5W/NACL 0.33%
potassium chloride 0.15% D5W/NACL 0.45%
potassium chloride 0.15% D5W/NACL 0.45% viaflex
potassium chloride 0.15% NACL 0.9%
potassium chloride 0.15%/D5W
potassium chloride 0.22% D5W/NACL 0.45%
potassium chloride 0.224%/D5W/NACL 0.45%
potassium chloride 0.224%D5W/NACL 0.45% viaflex
potassium chloride 0.3%/D5W
potassium chloride 0.3%/NACL 0.9%/viaflex
potassium phosphate
potassium phosphates
premasol
ringers injection
ringers irrigation
saline flush
saline flush zr/sterile field
scleromate sodium morrhuate
sodium acetate
sodium bicarbonate
sodium bicarbonate partial fill
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
36
sodium chloride
sodium chloride bacteriostatic
sodium chloride flush
sodium chloride pab
sodium chloride 0.45%
sodium chloride 0.45% viaflex
sodium phosphate
sodium polystyrene sulfonate
sodium thiosulfate
sterile diluent for epoprostenol sodium
sterile water for injection
sterile water irrigation
sterile water irrigation plastic bottle
sterile water irrigation w/hanger
swabflush saline flush
tis-u-sol
tpn electrolytes
virt-phos 250 neutral
virt-vite forte
vp-precip
zinc sulfate
Ammonium Molybdate
Antivenin Latrodectus Mactans
Antivenin Micrurus Fulvius
BD posiflush
Calcium-folic Acid Plus D
Chromium Chloride
Clinimix E 4.25%/Dextrose 25%
Clinimix 4.25%/Dextrose 10%
Clinimix 4.25%/Dextrose 20%
Clinimix 4.25%/Dextrose 25%
Copper Sulfate
Copper Trace Metal
Cysteine HCL
Dextrose 10%/NACL 0.2%
Dextrose 10%/NACL 0.225%
Dextrose 10%/NACL 0.45%
Dextrose 20%
Dextrose 25%
Dextrose 40%
Dextrose 5% /Electrolyte #48 Viaflex
Dextrose 5%/NACL 0.225%
Dextrose 5%/NACL 0.3%
Freamine Iii
Hyperlyte-CR
Imogam Rabies-ht
KCL 0.075%/D5W/NACL 0.45%
KCL 0.15%/D5W/ NACL 0.3%
KCL 0.15%/D5W/Lr
KCL 0.15%/D5W/NACL 0.2%
KCL 0.15%/D5W/NACL 0.225%
KCL 0.15%/D5W/NACL 0.45%
KCL 0.15%/D5W/NACL 0.9%
KCL 0.3%/D5W/Lr IV Lac Ring
KCL 0.3%/D5W/NACL 0.45%
KCL 0.3%/D5W/NACL 0.9%
L-methyl-b6-b12
L-methylfolate
L-methylfolate Calcium
L-methylfolate CA/ME-CBL/NAC
L-methylfolate CA/P-5-P.M.-CBL
Lecithin
Lozi-flur
Magnesium Sulfate
Magnesium Sulfate IN D5W
Multitrace-4
Multitrace-4 Neonatal
Multitrace-5
MD-gastroview
Normosol -r
Normosol-r IN D5W
Potassium Acetate
Potassium Chloride
Potassium Chloride ER
Potassium Chloride 0.15% /NACL 0.45% Viaflex
Potassium Chloride 0.15%/NACL 0.9%
Potassium Chloride 0.3%/ NACL 0.9%
Saccharin Sodium
Selenium
Sodium Chloride
Sodium Fluoride
Sodium Lactate
Sodium Saccharin Dihydrate
Tryptophan
Vp-gstn
Zinc Sulfate
Zinc Trace Metal
PREVENTIVE
fluor-a-day
fluoride
fluoritab
flura-drops
karidium
ludent
nafrinse
nafrinse drops
sodium fluoride
PREFERRED
Chemet
Chemstrip-k
Cuprimine
Fluor-a-day
Hyperrab S/D
Hyperrho S/D
Hyperrho S/D Mini-dose
K-phos
NON PREFERRED
PA
Adagen
PA
Benlysta
PA
Bivigam
Botox Cosmetic
PA
Carimune Nanofiltered
Cerefolin
Cyanocobalamin/Levomefolate Calcium/Pyridoxine HCL
PA
Cytogam
Depen Titratabs
Effer-k
PA
Exjade
PA
Ferriprox
PA
Flebogamma
PA
Flebogamma Dif
Fluorabon
Flura-drops
Folbic RF
Foltx
Galzin
PA
Gamastan S/D
PA
Gammagard Liquid
PA
Gammagard S/D
PA
Gammagard S/D Iga Less Than 1mcg/ML
PA
Gammaked
PA
Gammaplex
PA
Gamunex-c
Hepagam B
PA
Hizentra
Hyperhep B S/D
Isolyte-s
Klor-CON M15
L-methyl-mc
Lmthf/Pyridoxine HCL/Cyanocobalamin
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
37
Magnebind 400
Metafolbic
Nabi-HB
PA
Octagam
Phisohex
Plasma-lyte A
Plasma-lyte-148
PA
Privigen
Rhophylac
PA
Synagis
Syprine
QL,PA
Thyrogen
Vayacog
Vayarin
Vayarol
Vita-respa
Vivitrol
Winrho SDF
PA
Xiaflex
ACA PREVENTIVE DRUGS
ASPIRIN
PREVENTIVE
adult aspirin EC low strength
aspir-low
aspir-81
aspirin
aspirin adult low strength
aspirin childrens
aspirin enteric coated adult low strength
aspirin low dose
aspirin low strength
aspirin EC
aspirin EC low dose
aspirin EC LO-dose
aspirin 81
aspirtab
bayer advanced aspirin regular strength
bayer aspirin
bayer aspirin regimen
bayer aspirin EC low dose
bayer chewable low dose
bayer low dose
childrens aspirin
childrens aspirin low strength
ecotrin low strength
ecpirin
enteric coated aspirin
eq adult aspirin low strength
eq aspirin
eq aspirin adult low dose
eq aspirin low dose
eq aspirin EC
eq childrens aspirin
eql adult aspirin low strength
eql aspirin
eql aspirin low dose
eql aspirin EC
eql childrens aspirin
gnp adult aspirin low strength
gnp aspirin
gnp aspirin low dose
goodsense aspirin low dose
halfprin
kls aspirin low dose
kls aspirin EC
kp aspirin
meijer aspirin EC
miniprin low dose
norwich aspirin
px aspirin
px enteric aspirin
qc aspirin
qc aspirin low dose
qc childrens aspirin
ra aspirin
ra aspirin adult low dose
ra aspirin adult low strength
ra aspirin childrens
ra aspirin EC
ra aspirin EC adult low strength
ra childrens aspirin
sm aspirin
sm aspirin adult low strength
sm aspirin enteric coated
sm aspirin low dose
sm aspirin EC low strength
sm childrens aspirin
st joseph aspirin
tgt aspirin
tgt aspirin low dose
tgt childrens aspirin
tgt enteric-coated aspirin
th aspirin
th aspirin low dose
th enteric aspirin
CVS aspirin
CVS aspirin adult low dose
CVS aspirin adult low strength
CVS aspirin child
CVS aspirin low dose
CVS aspirin low strength
CVS aspirin EC
CVS childrens aspirin
CVS enteric aspirin
EC-81 aspirin
HM aspirin
HM aspirin EC
HM aspirin EC low dose
MM aspirin
SB aspirin
SB aspirin EC
SB childrens aspirin
SB low dose asa EC
1/2halfprin
PREVENTIVE
Adult Aspirin Low Strength
Aspirin Low Dose
Medi-seltzer
CONTRACEPTIVES
GENERIC
Amethyst
Necon 1/50-28
Necon 10/11-28
Ogestrel
Zovia 1/50e
PREVENTIVE
altavera
alyacen 1/35
alyacen 7/7/7
QL
amethia
QL
amethia LO
apri
aranelle
aubra
aviane
azurette
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
38
balziva
briellyn
camila
QL
camrese
QL
camrese LO
caziant
cesia
chateal
cryselle-28
cyclafem 1/35
cyclafem 7/7/7
dasetta 1/35
dasetta 7/7/7
QL
daysee
deblitane
delyla
desogestrel/ethinyl estradiol
drospirenone/ethinyl estradiol
elinest
emoquette
enpresse-28
enskyce
errin
estarylla
falmina
gianvi
gildagia
gildess FE 1.5/30
gildess FE 1/20
gildess 1.5/30
gildess 1/20
heather
QL
introvale
jencycla
QL
jolessa
jolivette
junel FE 1.5/30
junel FE 1/20
junel 1.5/30
junel 1/20
kariva
kelnor 1/35
kurvelo
larin FE 1.5/30
larin FE 1/20
larin 1.5/30
larin 1/20
leena
lessina
levonest
QL
levonorgestrel
QL
levonorgestrel and ethinyl estradiol
levonorgestrel/ethinyl estradiol
levora 0.15/30-28
loryna
low-ogestrel
lutera
lyza
marlissa
QL
medroxyprogesterone acetate
microgestin FE
microgestin FE 1.5/30
microgestin 1.5/30
microgestin 1/20
mono-linyah
mononessa
QL
my way
myzilra
necon 0.5/35-28
necon 1/35
necon 7/7/7
QL
next choice one dose
nikki
nora-be
norethindrone
norethindrone acetate/ethinyl estradiol
norethindrone acetate/ethinyl estradiol/ferrous fumarate
norgestimate/ethinyl estradiol
norlyroc
nortrel 0.5/35 (28)
nortrel 1/35
nortrel 7/7/7
ocella
orsythia
philith
pimtrea
pirmella 1/35
pirmella 7/7/7
portia-28
previfem
QL
quasense
reclipsen
sharobel
solia
sprintec 28
sronyx
syeda
tilia FE
tri-estarylla
tri-legest FE
tri-linyah
tri-previfem
tri-sprintec
trinessa
trivora-28
velivet
vestura
viorele
vyfemla
wera
wymzya FE
xulane
zarah
zenchent
zenchent FE
zovia 1/35e
PREFERRED
Beyaz
Loestrin 24 FE
Lomedia 24 FE
LO Loestrin FE
Minastrin 24 FE
Safyral
PREVENTIVE
Natazia
QL
Nuvaring
NON PREFERRED
QL
Depo-subq Provera 104
PREVENTIVE
Encare
Fc Female Condom
Fc2 Female Condom
Femcap
Implanon
Mirena
Nexplanon
Omniflex Diaphragm
Options Conceptrol Vaginal Contraceptive
Options Gynol II Vaginal Contraceptive
Ortho Diaphragm All-flex/65MM
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
39
Ortho Diaphragm All-flex/70MM
Ortho Diaphragm All-flex/75MM
Ortho Diaphragm All-flex/80MM
Ortho Diaphragm Coil Spring Kit 100
Ortho Diaphragm Coil Spring Kit 105
Ortho Diaphragm Coil Spring Kit 50
Ortho Diaphragm Flat Spring Kit 55
Ortho Diaphragm Flat Spring Kit 60
Ortho Diaphragm Flat Spring Kit 65
Ortho Diaphragm Flat Spring Kit 70
Ortho Diaphragm Flat Spring Kit 75
Ortho Diaphragm Flat Spring Kit 80
Ortho Diaphragm Flat Spring Kit 85
Ortho Diaphragm Flat Spring Kit 90
Ortho Diaphragm Flat Spring Kit 95
Prentif Cavity-rim Cervical CAP
Prentif Fitting Set
Shur-seal
Skyla
Vcf Vaginal Contraceptive Film
Vcf Vaginal Contraceptive Foam
Wide-seal Silicone Diaphragm Kit 60
Wide-seal Silicone Diaphragm Kit 65
Wide-seal Silicone Diaphragm Kit 70
Wide-seal Silicone Diaphragm Kit 75
Wide-seal Silicone Diaphragm Kit 80
Wide-seal Silicone Diaphragm Kit 85
Wide-seal Silicone Diaphragm Kit 90
Wide-seal Silicone Diaphragm Kit 95
FLUORIDE
GENERIC
Lozi-flur
Sodium Fluoride
PREVENTIVE
fluor-a-day
fluoride
fluoritab
flura-drops
karidium
ludent
nafrinse
nafrinse drops
sodium fluoride
PREFERRED
Fluor-a-day
NON PREFERRED
Fluorabon
Flura-drops
FOLIC ACID
GENERIC
M-vit
Prenaplus
Prenatal Low Iron
Tricare
PREVENTIVE
eql folic acid
fa-8
folic acid
gnp folic acid
kp folic acid
nat-rul prenatal vitamins
px folic acid
ra folic acid
sm folic acid
sm prenatal vitamins
th folic acid
yl folic acid
CVS folic acid
HM folic acid
PREVENTIVE
Atabex Prenatal
Classic Prenatal
CVS Prenatal
Eql Prenatal Formula
Fa-8
Gnp Daily Prenatal
Gnp Prenatal
Gnp Prenatal Vitamins
Goodsense Prenatal Vitamins
HM One Daily Prenatal Combo
HM Prenatal
Kp Prenatal Multivitamins
Mission Prenatal
Mission Prenatal HP
Multi Prenatal
One-a-day Womens Prenatal
Perry Prenatal
Pre-natal Formula
Prenatal
Prenatal And Iron
Prenatal Complete
Prenatal Formula
Prenatal Forte
Prenatal Multi +dha
Prenatal One Daily
Prenatal Vitamins
Px Prenatal Multivitamins
PA Prenatal Formula
Qc Prenatal
Ra One Daily
Ra Prenatal
Ra Prenatal Formula/Folicacid
Right Step Prenatal
Sm One Daily Prenatal
Sm Prenatal Vitamins
Stuart Prenatal
Stuart Prenatal + DHA
Th Prenatal Vitamins
IMMUNIZATIONS
PREVENTIVE
Acthib
Adacel
Afluria PF 2012-2013
Afluria PF 2013-2014
Afluria PF 2014-2015
Afluria 2012-2013
Afluria 2013-2014
Afluria 2014-2015
Boostrix
Cervarix
Comvax
Daptacel
Diphtheria/Tetanus Toxoids Adsorbed Pediatric
Engerix-b
Fluarix Quadrivalent 2013-2014
Fluarix Quadrivalent 2014-2015
Fluarix 2012-2013
Fluarix 2013-2014
Fluarix 2014-2015
Flublok 2013-2014
Flublok 2014-2015
Flucelvax 2012-2013
Flucelvax 2013-2014
Flucelvax 2014-2015
Flulaval Quadrivalent 2013-2014
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
40
Flulaval Quadrivalent 2014-2015
Flulaval 2012-2013
Flulaval 2013-2014
Flulaval 2014-2015
Flumist Nasal Vaccine 2012-2013
Flumist Quadrivalent
Fluvirin PF 2012-2013
Fluvirin PF 2013-2014
Fluvirin PF 2014-2015
Fluvirin 2012-2013
Fluvirin 2013-2014
Fluvirin 2014-2015
Fluzone High-dose PF 2012-2013
Fluzone High-dose PF 2013-2014
Fluzone High-dose PF 2014-2015
Fluzone Intradermal
Fluzone Pediatric PF 2012-2013
Fluzone Pediatric PF 2013-2014
Fluzone PF 2012-2013
Fluzone PF 2013-2014
Fluzone PF 2014-2015
Fluzone Quadrivalent 2013-2014
Fluzone Quadrivalent 2014-2015
Fluzone Split 2012-2013
Fluzone Split 2013-2014
Fluzone Split 2014-2015
Gardasil
Havrix
Hiberix
Infanrix
Influenza A (h1n1) Monovalent 2009
Ipol Inactivated IPV
Kinrix
M-m-r II W/Diluent 10 Dose
Medical Provider EZ Flu Shot PF 2012-2013
Medical Provider EZ Flu Shot PF 2013-2014
Medical Provider EZ Flu Shot PF 2014-2015
Medical Provider EZ Flu Shot 2013-2014
Medical Provider EZ Flu Shot 2014-2015
Menactra
Menomune-a/C/Y/W-135
Menveo
Pediarix
Pedvax HIB
Pentacel
Physicians EZ Use Flu Kit 2012-2013
Pneumovax 23
Pneumovax 23/1 Dose
Pneumovax 23/5 Dose
Prevnar 13
Proquad
Recombivax HB
Rotarix
Rotateq
Tenivac
Tetanus/Diphtheria Toxoids-adsorbed Adult
Twinrix
Vaqta
Varivax
Zostavax
IRON
PREVENTIVE
bprotected pedia iron
eq slow-release iron
eql iron supplement therapy
eql slow release iron
ezfe 200
feosol
fer-iron
ferate
ferosul
ferretts
ferrex 150
ferro-bob
ferrocite
ferrotabs
ferrous drops
ferrous fumarate 324
ferrous gluconate
ferrous sulfate
ferrousul
ferus
gnp iron
gnp slow release iron
high potency iron
iferex 150
iron
iron chews pediatric
iron slow release
iron supplement
iron supplement childrens
kp ferrous gluconate
kp ferrous sulfate
meijer ferrous sulfate
myferon 150
nu-iron 150
poly-iron 150
px iron
qc ferrous sulfate
ra high potency iron
ra iron
ra slow release iron
slow iron
slow release iron
sm iron
sm iron slow release
th iron
th slow release iron
wee care
CVS iron
FE gluconate
FE TABS
HM iron
HM iron slow release
PREVENTIVE
CVS Slow Release Iron
Elite Iron
Femiron
Feosol
Ferretts IPS
Ferrimin 150
Ferro-sequels
Ferrous Fumarate
Ferrous Gluconate
Ferrous Sulfate
FE Aspartate
High Potency Iron
Iron
Iron Up
Mykidz Iron 10
Novaferrum Pediatric Drops
Perfect Iron
Profe
Proferrin ES
Slow Release Iron
Sm Slow Release Iron
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
41
SMOKING CESSATION
PREVENTIVE
QL
buproban
QL
bupropion HCL SR
QL
eq nicotine
QL
eq nicotine gum refill
QL
eq nicotine gum starter
QL
eq nicotine polacrilex
QL
eq nicotine step 3
QL
eql nicotine
QL
eql nicotine polacrilex
QL
eql nicotine polacrilex refill
QL
eql nicotine polacrilex starter
QL
gnp nicotine polacrilex
QL
kls quit2
QL
kls quit4
QL
nicorelief
QL
nicotine
QL
nicotine polacrilex
QL
nicotine polacrilex refill
QL
nicotine polacrilex starter kit
QL
nicotine step 1
QL
nicotine step 2
QL
nicotine step 3
QL
nicotine transdermal system
QL
px stop smoking aid
QL
ra mini nicotine
QL
ra nicotine
QL
ra nicotine polacrilex
QL
ra nicotine transdermal system step 3
QL
sm nicotine
QL
sm nicotine polacrilex
QL
sw nicotine polacrilex
QL
tgt nicotine gum
QL
tgt nicotine polacrilex
QL
tgt nicotine step one
QL
tgt nicotine step three
QL
tgt nicotine step two
QL
thrive
QL
CVS nicotine
QL
CVS nicotine polacrilex
QL
CVS nicotine polacrilex starter
QL
CVS nicotine transdermal system
QL
CVS nts step 1
QL
HM nicotine polacrilex
QL
HM nicotine transdermal system
QL
HM nicotine transdermal system step 3
QL
SR nicotine gum
PREVENTIVE
QL
Chantix
QL
Chantix Continuing Month PAK
QL
Chantix Starting Month PAK
QL
Nicotine Transdermal System
PREVENTIVE
QL
Nicotrol Inhaler
QL
Nicotrol Ns
VITAMIN D
PREVENTIVE
aqueous vitamin d infants
bio-d-mulsion
bio-d-mulsion forte
bprotected pedia d-vite
d 1000
d 10000
d 2000
d 400
d 5000
d-vita
d-1000
d-1000 extra strength
d-2000 maximum strength
d-3-5
d-400
d-5000
d-5000 maximum strength
decara
delta d3
dialyvite vitamin d 5000
d2000 ultra strength
d3
d3 adult
d3 high potency
d3 kids
d3 maximum strength
d3 super strength
d3 ultra strength
d3-1000
d3-50
eql childrens vitamin d gummies
eql vitamin d-3
eql vitamin d3
gnp vitamin d
gnp vitamin d maximum strength
gnp vitamin d super strength
gnp vitamin d3 extra strength
healthy kids vitamin d3
just d
kp vitamin d
maximum d3
nat-rul vitamin d
optimal-d
optimal-d pack
opurity vitamin d
pronutrients vitamin d3
ra vitamin d-3
sm vitamin d
sm vitamin d3
th vitamin d3
thera-d rapid repletion
thera-d 2000
vitamin d
vitamin d high potency
vitamin d 400
vitamin d-1000
vitamin d-1000 maximum strength
vitamin d-3
vitamin d-400
vitamin d3
vitamin d3 adult gummies
vitamin d3 high potency
vitamin d3 maximum strength
vitamin d3 super strength
CVS childrens vitamin d for bone health
CVS vitamin d
CVS vitamin d infants
CVS vitamin d 5000 high-potency
CVS vitamin d3
HM vitamin d
HM vitamin d3
PA vitamin d-3
PA vitamin d-3 gummy
PREVENTIVE
CVS Vitamin D3
Ddrops
Decara
Dialyvite Vitamin D3 Max
D3
D3 Dots
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
42
HM Vitamin D3
Replesta
Replesta Childrens
Replesta Nx
Sm Vitamin D3 Maximum Strength
Super Daily D3
Thera-d 4000
Vitamelts Vitamin D
Vitamin D
Vitamin D3
Vitamin D3 400
Wellesse Vitamin D3
BOWEL PREPARATION AGENTS
PREVENTIVE
gavilyte-c
gavilyte-n/flavor pack
gavilyte-G
peg 3350/electrolytes
peg-3350/electrolytes
peg-3350/NACL/NA bicarbonate/KCL
trilyte
NON PREFERRED
Colyte-flavor Packs
Golytely
BREAST CANCER
PREVENTIVE
tamoxifen citrate
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
43
Index
A
A-hydrocort, 11
a-methapred, 11
abacavir, 2
abacavir sulfate/lamivudine/zidovudine, 2
Abelcet, 2
Abilify, 20
Abilify Discmelt, 20
Abilify Maintena, 20
Abraxane, 5
Absorica, 9
Abstral, 26
acamprosate calcium DR, 21
Acanya, 9
acarbose, 13
Accu-chek Active Glucose Control Solution, 35
Accu-chek Active Strips, 35
Accu-chek Aviva, 35
Accu-chek Aviva Plus, 35
Accu-chek Combo, 31
Accu-chek Comfort Curve Linearity Solution, 35
Accu-chek Comfort Curve Test Strips, 35
Accu-chek Compact Blue Control Solution (2 Levels), 35
Accu-chek Compact Plus, 35
Accu-chek Compact Plus Care Kit, 35
Accu-chek Compact Plus Clear Control
Solution (2 Levels), 35
Accu-chek Compact Test Drum, 35
Accu-chek Fastclix Lancetdevice Kit, 35
Accu-chek Fastclix Lancets, 31
Accu-chek Instant Glucosecontrol Solution (2 Levels), 35
Accu-chek Multiclix Lanc Et Device Kit,
35
Accu-chek Multiclix Lancets, 31
Accu-chek Nano Smartview, 35
Accu-chek Rapid-d Infusion Set/24"/10MM, 31
Accu-chek Rapid-d Infusion Set/24"/6MM, 31
Accu-chek Rapid-d Infusion Set/24"/8MM, 31
Accu-chek Rapid-d Infusion Set/31"/10MM, 31
Accu-chek Rapid-d Infusion Set/31"/6MM, 31
Accu-chek Rapid-d Infusion Set/31"/8MM, 31
Accu-chek Rapid-d Infusion Set/43"/10MM, 31
Accu-chek Rapid-d Infusion Set/43"/6MM, 31
Accu-chek Rapid-d Infusion Set/43"/8MM, 31
Accu-chek Safe-t-pro Lancets, 31
Accu-chek Safe-t-pro Pluslancets, 31
Accu-chek Smartview Control, 35
Accu-chek Smartview Strips, 35
Accu-chek Soft Touch Lancets, 31
Accu-chek Softclix Lancetdevice Kit, 35
Accu-chek Softclix Lancets, 31
Accu-chek Spirit Adapter Kit, 31
Accu-chek Spirit Battery Kit, 31
Accu-chek Spirit Insulin P.M. Kit, 31
Accu-chek Voicemate, 35
Acd Formula A, 18
Acd Formula B, 18
Acd-a Noclot-50, 18
acebutolol HCL, 6
Acetaminophen/Caffeine/Dihydrocodeine
Bitartrate, 26
acetaminophen/codeine, 25
acetaminophen/codeine #2, 25
acetaminophen/codeine #3, 25
acetaminophen/codeine #4, 25
acetaminophen/codeine phosphate, 25
acetasol HC, 24
acetazolamide, 7
Acetazolamide, 7
acetazolamide ER, 7
acetazolamide sodium, 7
acetic acid, 24
acetic acid 0.25%, 17
Acetic Acid/Aluminum Acetate, 24
acetylcysteine, 27, 36
Aciphex Sprinkle, 15
acitretin, 9
Actemra, 26
Acthib, 28, 40
Acti-lance Lancets 28G, 31
Acti-lance Lite Safety Lancets 28G, 31
Acti-lance Special Safety Lancets 17G, 31
Acti-lance Special Safetylancets 17G, 31
Acti-lance Universal Safety Lancets 23G,
31
acticin, 10
Actimmune, 5
Actonel, 13
Actoplus Met XR, 13
Acuvail, 24
acyclovir, 2, 9
acyclovir sodium, 2
Acyclovir Sodium, 2
Adacel, 28, 40
Adagen, 37
adapalene, 8
Adcetris, 4
Adcirca, 8
adefovir dipivoxil, 3
Adempas, 8
adenosine, 6, 36
adriamycin, 4
Adriamycin, 4
adrucil, 4
adult aspirin EC low strength, 24, 38
Adult Aspirin Low Strength, 25, 38
Advair Diskus, 28
Advair HFA, 28
Advate, 19
Advocate Lancets, 31
Advocate Safety Lancets, 31
aero otic HC, 24
Aerochamber Mini Aerosol Chamber, 35
Aerochamber MV, 35
Aerochamber Plus Flow VU, 35
Aerochamber Plus Flow-VU, 35
Aerochamber Plus Flow-VU/Large Mask, 35
Aerochamber Plus Flow-VU/Mask, 35
Aerochamber Plus Flow-VU/Medium
Mask, 35
Aerochamber Plus Flow-VU/Small Mask, 35
Aerochamber Z-stat Plus Valved Holding
Chamber W/Flow VU, 35
Aerochamber Z-stat Plus/Flowsignal, 35
Aerochamber Z-stat Plus/Large Mask, 35
Aerochamber Z-stat Plus/Medium Mask, 35
Aerochamber Z-stat Plus/Small Mask, 35
Aerochamber/Flowsignal, 35
AF Lancets Super Thin, 31
afeditab CR, 6
Afinitor, 5
Afinitor Disperz, 5
Afluria 2012-2013, 28, 40
Afluria 2013-2014, 28, 40
Afluria 2014-2015, 28, 40
Afluria PF 2012-2013, 28, 40
Afluria PF 2013-2014, 28, 40
Afluria PF 2014-2015, 28, 40
Agamatrix Ultra-thin Lancets 33G, 31
Aggrastat, 19
Aggrenox, 19
airavite, 17
ak-fluor, 24
Ak-fluor, 24
ak-poly-bac, 22
akorn balanced salt solution, 24
ala cort, 9
Albatussin NN, 27
Albenza, 3
albuked 25, 19
albuked 5, 19
albumin human, 19
albumin-zlb, 19
albuminar-25, 19
albuminar-5, 19
alburx, 19
albutein, 19
albuterol sulfate, 28
albuterol sulfate ER, 28
albuterol TAB 4MG, 28
alclometasone dipropionate, 9
Alcoh-glove Contoured Wipe, 35
Alcoh-wipe 12" X 12", 35
Alcohol Pads, 35
Alcohol Prep Pads, 35
Alcohol Swabs, 35
Alcohol Wipes, 35
Aldurazyme, 14
alendronate sodium, 13
Alendronate Sodium, 13
alfentanil, 25
Alferon N, 5
alfuzosin HCL ER, 17
ali-flex, 24
Alimta, 4
Alinia, 3
Alkeran, 3
allopurinol, 27
44
Alocril, 24
amoxicillin/clavulanate potassium ER, 1
Asmanex Twisthaler 30 Me Tered Doses, Alodox Convenience Kit, 1
amphetamine/dextroamphetamine, 20
28
Alomide, 24
Amphotec, 2
Asmanex Twisthaler 30 Metered Doses, Alora, 11
Amphotericin B, 2
28
Aloxi, 16
ampicillin, 1
Asmanex Twisthaler 60 Metered Doses, Alpain, 24
Ampicillin, 1
28
Alphagan P, 23
ampicillin sodium, 1
Asmanex Twisthaler 7 Metered Doses, Alphanate/Von Willebrand Factor
Ampicillin Sodium, 1
28
ampicillin-sulbactam, 1
aspir-81, 24, 38
Complex/Human, 19
Alphanine SD, 19
Ampicillin-sulbactam, 1
aspir-low, 24, 38
alphaquin HP, 10
Ampyra, 22
aspirin, 24, 38
alphatrex, 9
Amturnide, 7
aspirin 81, 24, 38
alprazolam, 19
ana-lex, 16
aspirin adult low strength, 24, 38
alprazolam ER, 19
Anadrol-50, 11
aspirin childrens, 24, 38
alprazolam odt, 19
anagrelide hydrochloride, 19
aspirin EC, 24, 38
alprazolam XR, 19
Analpram Advanced, 16
aspirin EC LO-dose, 24, 38
alprostadil, 36
Analpram-HC, 16
aspirin EC low dose, 24, 38
Alrex, 23
anastrozole, 4
aspirin enteric coated adult low strength,
Alsuma, 26
Androderm, 11
24, 38
Altabax, 9
Androgel, 11
aspirin low dose, 24, 38
altacaine, 23
Androgel P.M., 11
Aspirin Low Dose, 25, 38
altafluor, 24
Androxy, 11
aspirin low strength, 24, 38
altafrin, 23
Anticoagulant Citrate Dextrose Solution
Aspirin-caffeine-dihydrocodeine, 26
altavera, 11, 38
aspirtab, 24, 38
A, 18
Altoprev, 8
Anticoagulant Sodium Citrate, 18
Assure Comfort Lancets Ultra Thin 28G, Alvesco, 28
antipyrine/benzocaine, 24
31
alyacen 1/35, 11, 38
Antipyrine/Benzocaine, 24
Assure Comfort Lancets Ultra Thin 30G, alyacen 7/7/7, 11, 38
Antivenin Latrodectus Mactans, 37
31
amantadine HCL, 21
Antivenin Micrurus Fulvius, 37
Assure Haemolance Plus High Flow 18G, Amantadine HCL, 21
anucort-HC, 16
31
Ambisome, 2
Anzemet, 16
Assure Haemolance Plus Low Flow 25G,
amcinonide, 9
AP-zel, 31
31
Amcinonide, 10
apexicon, 9
Assure Haemolance Plus Micro Flow amethia, 11, 38
Apexicon E, 10
28G, 31
amethia LO, 11, 38
Apidra, 13
Assure Haemolance Plus Normal Flow
Amethyst, 11, 38
Apidra Solostar, 13
21G, 31
amifostine, 5
Aplenzin, 20
Assure Haemolance Plus Pediatric Blade, amikacin sulfate, 2
Apokyn, 21
31
amiloride HCL, 7
apraclonidine, 23
Assure Lance Lancets, 31
amiloride/hydrochlorothiazide, 7
apri, 11, 38
Assure Lancets, 31
amino acids, 36
Apriso, 16
astramorph, 25
aminoacetic acid, 17
Aptivus, 2
AT Last Lancets, 31
Aminobenzoate Potassium, 29
aqueous vitamin d infants, 29, 42
Atabex Prenatal, 31, 40
aminocaproic acid, 19
Aquoral, 19
Atelvia, 13
Aminocaproic Acid, 19
Aralast NP, 28
atenolol, 6
aminophylline, 28
aranelle, 11, 38
atenolol/chlorthalidone, 7
aminosyn 8.5%/electrolytes, 36
Aranesp Albumin Free, 18
Atgam, 4
aminosyn II 8.5%/electrolytes, 36
arbinoxa, 27
atorvastatin calcium, 7
aminosyn-hf, 36
Arcalyst, 26
atovaquone, 3
amiodarone HCL, 6
Arcapta Neohaler, 28
atovaquone/proguanil HCL, 3
Amiodarone HCL, 6
argatroban, 18
atracurium besylate, 22
Amitiza, 16
Argatroban, 18
Atralin, 9
amitriptyline HCL, 20
argyle sterile saline 100ML, 17
Atripla, 2
amlodipine besylate, 6
argyle sterile water 100ML, 36
Atropen, 15
amlodipine besylate/atorvastatin calcium, Arial Chamber, 35
atropine sulfate, 15, 23
Armour Thyroid, 15
Atropine Sulfate, 15, 23
8
amlodipine besylate/benazepril HCL, 7
Arranon, 4
atropine-care, 23
amlodipine besylate/benazepril Arzerra, 4
Atrovent HFA, 28
Arzol Silver Nitrate App Licators, 10
Aubagio, 22
hydrochloride, 7
amlodipine besylate/valsartan, 7
Asacol HD, 16
aubra, 11, 38
ammonium lactate, 10
ascomp/codeine, 25
augmented betamethasone dipropionate, Ammonium Molybdate, 37
ascor l 500, 29
9
amnesteem, 8
ascor l nc, 29
Augmentin, 1
Amoxapine, 20
ascorbic acid, 29
aurax, 24
amoxicillin, 1
Asmanex Twisthaler 120 Metered Doses, aurodex, 24
Amoxicillin, 1
Aurora Lancet Super Thin 30G, 31
28
Amoxicillin ER, 1
Asmanex Twisthaler 14 Metered Doses, Aurora Lancet Thin 23G, 31
amoxicillin/clavulanate potassium, 1
Auvi-q, 7
28
45
Avage, 10
Avandia, 13
avar cleanser, 8
avar-e emollient, 8
avar-e green, 8
Avastin, 4
Avc, 17
Avelox, 2
aviane, 11, 38
avidoxy, 1
avita, 8
Avodart, 17
Avonex, 22
Avonex Pen, 22
Axert, 26
Axiron, 11
azacitidine, 4
Azactam IN Iso-osmotic Dextrose, 3
Azasan, 4
Azasite, 23
azathioprine, 4
azelastine HCL, 24, 27
Azelex, 9
Azilect, 21
azithromycin, 1
Azithromycin, 1
Azopt, 24
Azor, 7
aztreonam, 3
azurette, 11, 38
BD Insulin Syringe Microfine IV/U100/1ML/28G X 1/2", 31
BD Insulin Syringe Microfine/U100/0.3ML/28G X 1/2", 31
BD Insulin Syringe Microfine/U100/0.5ML/28G X 1/2", 31
BD Insulin Syringe Microfine/U100/1ML/27G X 5/8", 31
BD Insulin Syringe Microfine/U100/1ML/28G X 1/2", 31
BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2", 31
BD Insulin Syringe Safetyglide/1ML/29G X 1/2", 31
BD Insulin Syringe Safetyglide/U100/0.3ML/31G X 5/16", 31
BD Insulin Syringe Slip Tip/U-100/1ML, 31
BD Insulin Syringe U-40/1ML/25G X 5/8", 31
BD Insulin Syringe Ultrafine Halfunit/0.3ML/31G X 5/16", 31
BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16", 31
BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16", 32
BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2", 32
BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16", 32
BD Insulin Syringe Ultrafine/0.5ML/30G X B
1/2", 32
B-6 Folic Acid, 17
BD Insulin Syringe Ultrafine/0.5ML/31G X b-complex, 30
5/16", 32
b-complex 100, 30
BD Insulin Syringe Ultrafine/1ML/30G X
b-plex, 30
1/2", 32
b-plex plus, 30
BD Insulin Syringe Ultrafine/1ML/31G X
baciim, 3
5/16", 32
bacitracin, 3
BD Insulin Syringe Ultrafine/UBacitracin, 3, 23
100/0.3ML/29G X 1/2", 32
bacitracin/polymyxin b, 22
BD Insulin Syringe Ultrafine/Ubaclofen, 22
100/0.5ML/29G X 1/2", 32
Bacmin, 31
BD Insulin Syringe Ultrafine/UBactocill IN Dextrose, 1
100/1ML/29G X 1/2", 32
Bactroban Nasal, 27
BD Insulin Syringe Ultrafine/Ubalanced salt, 24
100/1ML/30G X 1/2", 32
balanced salt solution, 24
BD Insulin Syringe/Detachable Needle/Ubalsalazide disodium, 16
100/1ML/25G X 1", 32
balziva, 11, 39
BD Insulin Syringe/Detachable Needle/UBanzel, 21
100/1ML/25G X 5/8", 32
Baraclude, 3
BD Insulin Syringe/Detachable Needle/Ubaycadron, 11
100/1ML/26G X 1/2", 32
bayer advanced aspirin regular strength, BD Insulin Syringe/U-100/0.5ML/30G X 24, 38
1/2", 32
bayer aspirin, 25, 38
BD Insulin Syringe/U-100/1ML/27G X bayer aspirin EC low dose, 25, 38
1/2", 32
bayer aspirin regimen, 25, 38
BD Insulin Syringe/U-100/1ML/28G X bayer chewable low dose, 25, 38
1/2", 32
bayer low dose, 25, 38
BD Insulin Syringe/U-100/2ML/27.5G X Bayer Microlet Lancets, 31
5/8", 32
Bcg Vaccine, 28
BD Insulin Syringe/U-100/2ML/29G X BD Insulin Syringe LUER-LOK/U1/2", 32
100/1ML, 31
BD Lancet Ultrafine 30G, 32
BD Insulin Syringe Microfine IV/UBD Lancet Ultrafine 33G, 32
100/0.3ML/28G X 1/2", 31
BD LO-dose Insulin Syringe Microfine BD Insulin Syringe Microfine IV/UIV/0.5ML/28G X 1/2", 32
100/0.5ML/28G X 1/2", 31
BD Microtainer Lancets, 32
BD Insulin Syringe Microfine IV/UBD Pen Needle/Mini/Ultrafine/31G X 100/1ML/27G X 5/8", 31
3/16", 32
BD Pen Needle/Nano/Ultra Fine/32G X 4MM, 32
BD Pen Needle/SHORT/Ultrafine/31G X 5/16", 32
BD Pen Needle/Ultrafine/29G X 12.7MM, 32
BD Pen Needle/Ultrafine/29GX1/2" 12.7MM, 32
BD Pen Needles SHORT/Ultrafine/31G X
5/16", 32
BD posiflush, 37
BD Pudendal/Local Block Tray 1% Lidocaine, 27
BD Swabs Single Use, 35
BD Swabs Single Use Butterfly, 35
Bebulin, 19
Bebulin VH, 19
Beconase AQ, 27
Belladonna & Opium, 15
Belladonna Alkaloids & Opium, 15
belladonna alkaloids/phenobarbital, 15
benazepril HCL, 6
benazepril HCL/hydrochlorothiazide, 7
Benefix, 19
Benicar, 7
Benicar HCT, 7
Benlysta, 37
benzepro, 8
benzepro SHORT contact, 8
benziq wash, 8
benzonatate, 27
benzoyl peroxide, 8
benzoyl peroxide SHORT contact, 8
benzoyl peroxide wash acne treatment pack, 8
benzphetamine HCL, 20
benztropine mesylate, 21
Bepreve, 24
Berinert, 19
Besivance, 23
betamethasone dipropionate, 9
betamethasone sodium phosphate/betamethasone acetate, 11
betamethasone valerate, 9
Betaseron, 22
betaxolol HCL, 6, 23
bethanechol chloride, 16
Betimol, 23
Betoptic-s, 23
Bexxar, 4
Bexxar 131 Iodine, 5
Beyaz, 12, 39
bicalutamide, 4
Bicillin C-R, 1
Bicillin L-a, 1
Bicnu, 3
Bidil, 8
Biltricide, 3
Binosto, 13
bio GLO, 24
bio-d-mulsion, 29, 42
bio-d-mulsion forte, 29, 42
bio-statin, 2
biocel, 30
biogesic, 24
Biothrax, 28
biotuss, 27
46
biotuss pediatric, 27
carbinoxamine maleate, 27
buprenorphine HCL, 25
bisoprolol fumarate, 6
carboplatin, 3
buprenorphine HCL/naloxone HCL, 25
bisoprolol fumarate/hydrochlorothiazide, buproban, 21, 42
Carboplatin, 3
Cardene IV, 6
bupropion HCL, 20
7
Bivigam, 37
cardioplegic, 8
bupropion HCL ER, 20
bleomycin sulfate, 4
Cardizem LA, 6
bupropion HCL SR, 20, 21, 42
Blephamide S.o.p., 23
Cardura XL, 17
bupropion HCL XL, 20
Boostrix, 28, 40
Careone Lancet Thin, 32
buspirone HCL, 19
Bosulif, 5
Careone Lancet Ultra Thin, 32
Busulfex, 3
Botox, 22
Carimune Nanofiltered, 37
butal/asa/caff, 24
Botox Cosmetic, 37
carisoprodol, 22
butalbital/acetaminophen, 24
bp 10-1, 8
Carisoprodol, 22
butalbital/acetaminophen/caffeine, 24
bp cleansing wash, 8
butalbital/acetaminophen/caffeine/codein
carisoprodol/aspirin, 22
bp foam, 8
carisoprodol/aspirin/codeine, 22
e, 25
Bp Folinatal Plus B, 30
carteolol HCL, 23
butalbital/apap/caffeine, 24
Bp Multinatal Plus, 30
cartia XT, 6
butalbital/asa/caffeine, 24
Bp Vit 3, 17
carvedilol, 6
Butalbital/Aspirin/Caffeine, 24
bp wash, 8
Cascara Sagrada, 15
butalbital/aspirin/caffeine/codeine, 25
bpm, 27
Cavan-EC Sod DHA, 30
butorphanol tartrate, 25
bpm pseudo, 27
cavarest, 19
Butrans, 26
Bpo, 8
Caverject, 8
Bydureon, 13
Caverject Impulse, 8
Bpo 3% Foaming Cloths, 8
Byetta, 13
cavirinse, 19
Bpo 6% Foaming Cloths, 8
Bystolic, 6
Cayston, 3
Bpo 9% Foaming Cloths, 8
C
caziant, 12, 39
Bpo Creamy Wash Complete Pack, 8
cabergoline, 14
Cedax, 1
bprotected pedia d-vite, 29, 42
Cafergot, 26
cefaclor, 1
bprotected pedia iron, 17, 41
caffeine citrate, 20
Cefaclor, 1
Brainstrong Prenatal, 31
Caffeine/Sodium Benzoate, 21
Cefaclor ER, 1
Bravelle, 14
calcipotriene, 9
cefadroxil, 1
Breatherite, 35
calcipotriene/betamethasone cefazolin sodium, 1
Breatherite Collapsible Adult Spacer
dipropionate, 9
Cefazolin Sodium, 1
W/Mask, 35
calcitonin salmon, 13
Breatherite Collapsible Child Spacer
Cefazolin Sodium/Dextrose, 1
calcitonin-salmon, 13
cefdinir, 1
W/Mask, 35
calcitrene, 9
Breatherite Collapsible Infant Spacer
Cefditoren Pivoxil, 1
Calcitriol, 9
cefepime, 1
W/Mask, 35
calcitriol, 14
Cefepime, 1
Breatherite Collapsible Small Child calcium acetate, 16
cefotaxime sodium, 1
Spacer W/Mask, 35
calcium chloride, 36
Cefotetan, 1
Breatherite Collapsible Spacer W/ Calcium Folinate, 5
Cefotetan/Dextrose, 1
Neonate Mask, 35
calcium gluconate, 36
cefoxitin sodium, 1
Breatherite Rigid Spacer W/Mask, 35
Calcium-folic Acid Plus D, 37
Cefoxitin Sodium, 1
Breatherite W/Large Mask, 35
camila, 11, 39
cefpodoxime proxetil, 1
Breatherite W/Medium Mask, 35
Camptosar, 5
cefprozil, 1
Breatherite W/Small Mask, 35
camrese, 11, 39
ceftazidime, 1
Breo Ellipta, 28
camrese LO, 12, 39
Ceftazidime, 1
briellyn, 11, 39
Canasa, 16
Ceftazidime/Dextrose, 1
Brilinta, 19
Cancidas, 2
Ceftibuten, 1
brimonidine tartrate, 23
candesartan cilexetil, 7
Ceftin, 1
Bromday, 24
candesartan cilexetil/hydrochlorothiazide, Ceftriaxone IN Iso-osmotic Dextrose, 1
bromfed DM, 27
7
ceftriaxone sodium, 1
bromfenac, 24
Cantil, 15
Ceftriaxone/Dextrose, 1
bromocriptine mesylate, 21
capacet, 24
bromphen/pseudoephedrine cefuroxime axetil, 1
Capastat Sulfate, 2
cefuroxime sodium, 1
HCL/dextromethorphan HBR, 27
capecitabine, 4
Brompheniramine Tannate, 27
Cefuroxime Sodium, 1
Capex, 10
Brovana, 28
Cefuroxime/Dextrose, 1
Caprelsa, 5
bss, 24
Celebrex, 26
captopril, 6
budeprion SR, 20
Cellcept, 4
Captopril/Hydrochlorothiazide, 7
Cellcept Intravenous, 4
budesonide, 11, 27, 28
Carac, 10
Celontin, 21
Bullseye Mini Safety Lancets, 31
Carafate, 15
Cenestin, 11
Bullseye Safety Lancets, 31
Carbaglu, 14
Centany, 9
bumetanide, 7
carbamazepine, 21
Centrum Specialist Prenatal, 31
buminate, 19
carbamazepine ER, 21
cephalexin, 1
Bupap, 24
carbidopa, 21
Cephalexin, 1
Buphenyl, 14
carbidopa/levodopa, 21
Ceprotin, 19
bupivacaine HCL, 27
carbidopa/levodopa ER, 21
Cerefolin, 37
bupivacaine spinal, 27
carbidopa/levodopa odt, 21
Cerezyme, 18
bupivacaine/epinephrine, 27
Carbidopa/Levodopa/Entacapone, 21
47
cerisa wash, 8
cerovel, 10
Cervarix, 28, 40
Cesamet, 16
cesia, 12, 39
cetirizine HCL, 27
Cetrotide, 14
cevimeline HCL, 19
Chantix, 22, 42
Chantix Continuing Month PAK, 22, 42
Chantix Starting Month PAK, 22, 42
chateal, 12, 39
Chemet, 37
Chemstrip-k, 37
Chenodal, 16
childrens aspirin, 25, 38
childrens aspirin low strength, 25, 38
Chloramphenicol Sodium Succinate, 3
chlordiazepoxide HCL, 19
chlordiazepoxide HCL/clidinium bromide,
15
Chlordiazepoxide/Amitriptyline, 21
chlorhexidine gluconate, 19
chlorhexidine gluconate oral rinse, 19
chloromag, 36
chloroprocaine HCL, 27
chloroquine phosphate, 3
chlorothiazide, 7
Chlorothiazide, 7
chlorothiazide sodium, 7
chlorpromazine HCL, 20
Chlorpromazine HCL, 20
Chlorpropamide, 13
Chlorthalidone, 7
chlorzoxazone, 22
choice-TABS, 30
cholestyramine, 7
cholestyramine light, 7
choline magnesium trisalicylate, 24
chorionic gonadotropin, 14
chromium chloride, 36
Chromium Chloride, 37
Cialis, 8
ciclodan, 9
ciclopirox, 9
ciclopirox nail lacquer, 9
ciclopirox olamine, 9
Ciclopirox Topical Solution Kit, 9
ciclopirox treatment, 9
cidofovir, 2
cilostazol, 19
Ciloxan, 23
cimetidine, 15
cimetidine HCL, 15
Cimzia, 16
Cimzia Starter Kit, 16
Cinryze, 19
Cipro HC, 24
Ciprodex, 24
ciprofloxacin, 2
Ciprofloxacin, 24
ciprofloxacin ER, 2
ciprofloxacin HCL, 2, 22
ciprofloxacin I.V.-IN D5W, 2
cisatracurium besylate, 22
cisplatin, 3
Cisplatin, 3
citalopram hydrobromide, 20
citric acid/sodium citrate, 17
cladribine, 4
Claforan, 1
claravis, 8
Claravis, 9
Clarinex, 27
Clarinex-d 12 HOUR, 28
Clarinex-d 24 HOUR, 28
claris clarifying wash, 8
clarithromycin, 1
clarithromycin ER, 1
Classic Prenatal, 31, 40
Cleanlet Lancets 28G, 32
clearplex x, 8
clemastine fumarate, 27
Clemastine Fumarate, 27
Cleocin, 17
Clever Chek Lancets Ultrathin, 32
Clever Chek Lancets Ultrathin 30G, 32
clindacin etz pledgets, 8
clindacin-p, 8
clindamax, 8
clindamycin HCL, 3
clindamycin palmitate HCL, 3
clindamycin phosphate, 3, 8, 17
Clindamycin Phosphate, 3
clindamycin phosphate add-vantage, 3
clindamycin phosphate IN D5W, 3
clindamycin phosphate pharmacy bulk package, 3
clindamycin/benzoyl peroxide, 8
Clindesse, 17
Clinimix 4.25%/Dextrose 10%, 37
Clinimix 4.25%/Dextrose 20%, 37
Clinimix 4.25%/Dextrose 25%, 37
Clinimix E 4.25%/Dextrose 25%, 37
clinisol SF 15%, 36
clinpro 5000, 19
clobetasol propionate, 9
clobetasol propionate e, 9
clobetasol propionate emollient, 9
Clobex, 10
Clocortolone Pivalate, 10
Clocortolone Pivalate P.M., 10
clodan, 9
Cloderm, 10
Cloderm P.M., 10
Clolar, 4
clomiphene citrate, 14
clomipramine HCL, 20
clonazepam, 21
clonazepam odt, 21
clonidine HCL, 7, 24
clonidine HCL ER, 20
clopidogrel, 19
clorazepate dipotassium, 19
clotrimazole, 9, 19
clotrimazole/betamethasone dipropionate, 9
clozapine, 20
Clozapine Odt, 20
Cnl8 Nail Kit, 9
CO-gesic, 26
CO-natal Fa, 30
Coaguchek Lancets, 32
Coal TAR, 10
Coartem, 3
Cod Liver Oil, 30
codeine sulfate, 25
Codeine Sulfate, 26
Colcrys, 27
colestipol HCL, 7
colestipol HCL for oral suspension, 7
colistimethate sodium, 3
colocort, 16
Coly-mycin S, 24
Colyte-flavor Packs, 15, 43
Combigan, 23
Combipatch, 11
Combivent, 28
Combivent Respimat, 28
Cometriq, 5
Comfort Assured Lancets Micro Thin 33G, 32
Comfort Assured Lancets Super Thin
28G, 32
Comfort Lancets, 32
compazine, 20
Complera, 2
Complete Natal DHA, 30
Completenate, 30
compound 347, 27
compro, 20
Comvax, 28, 40
Condylox, 10
constulose, 15
controlrx, 19
Conzip, 26
Copaxone, 22
Copper Sulfate, 37
Copper Trace Metal, 37
Cordran, 10
Cordran Tape, 10
Coreg CR, 6
Corifact, 19
cormax scalp application, 9
cortalo, 9
cortic-nd, 24
Cortifoam, 16
Cortisone Acetate, 11
Cortisporin, 9
Cortisporin-tc, 24
corvita, 30
corvita 150, 17
corvite free, 30
cosyntropin, 36
covaryx, 11
covaryx HS, 11
Creon, 16
Crestor, 8
Crinone, 17
Crixivan, 2
cromolyn sodium, 16, 24, 28
cryselle-28, 12, 39
Cubicin, 3
Cuprimine, 37
Curity Alcohol Preps/Medium 2 Ply, 35
Curity Alcohol Swabs, 35
curity sterile saline, 17
Cuvposa, 15
CVS Alcohol Prep Swabs, 35
CVS Alcohol Swabs, 35
CVS aspirin, 25, 38
CVS aspirin adult low dose, 25, 38
CVS aspirin adult low strength, 25, 38
CVS aspirin child, 25, 38
CVS aspirin EC, 25, 38
CVS aspirin low dose, 25, 38
CVS aspirin low strength, 25, 38
CVS childrens aspirin, 25, 38
CVS childrens vitamin d for bone health,
29, 42
CVS enteric aspirin, 25, 38
CVS folic acid, 18, 40
CVS iron, 18, 41
CVS Lancets 21G, 32
CVS Lancets Micro Thin 33G, 32
CVS Lancets Original, 32
CVS Lancets Thin, 32
CVS Lancets Thin 26G, 32
CVS Lancets Ultra Thin 30G, 32
CVS nicotine, 22, 42
CVS nicotine polacrilex, 22, 42
CVS nicotine polacrilex starter, 22, 42
CVS nicotine transdermal system, 22, 42
CVS nts step 1, 22, 42
CVS Prenatal, 31, 40
CVS Prenatal Gummy/DHA/Folic Acid,
31
CVS Prenatal Multi+dha, 31
CVS Slow Release Iron, 18, 41
CVS Ultra Thin Lancets, 32
CVS vitamin d, 29, 42
CVS vitamin d 5000 high-potency, 29, 42
CVS vitamin d infants, 29, 42
CVS vitamin d3, 29, 42
CVS Vitamin D3, 30, 42
cyanocobalamin, 17
Cyanocobalamin/Levomefolate
Calcium/Pyridoxine HCL, 37
cyclafem 1/35, 12, 39
cyclafem 7/7/7, 12, 39
cyclobenzaprine HCL, 22
cyclopentolate HCL, 23
Cyclophosphamide, 3
Cycloserine, 2
Cycloset, 13
cyclosporine, 4
cyclosporine modified, 4
Cyclosporine Modified, 4
cyotic, 24
cyproheptadine HCL, 27
Cystadane, 14
Cystagon, 17
Cystaran, 24
cysteine HCL, 36
Cysteine HCL, 37
cytarabine, 4
Cytarabine, 4
cytarabine aqueous, 4
Cytogam, 37
cytra k crystals, 17
cytra-2, 17
Cytra-3, 17
Cytra-k, 17
D
d 1000, 29, 42
d 10000, 29, 42
d 2000, 29, 42
d 400, 29, 42
d 5000, 29, 42
d-1000, 29, 42
d-1000 extra strength, 29, 42
d-2000 maximum strength, 29, 42
d-3-5, 29, 42
d-400, 29, 42
d-5000, 29, 42
d-5000 maximum strength, 29, 42
d-vita, 29, 42
d2000 ultra strength, 29, 42
d3, 29, 42
D3, 30, 42
d3 adult, 29, 42
D3 Dots, 30, 42
d3 high potency, 29, 42
d3 kids, 29, 42
d3 maximum strength, 29, 42
d3 super strength, 29, 42
d3 ultra strength, 29, 42
d3-1000, 29, 42
d3-50, 29, 42
dacarbazine, 5
Dacarbazine, 5
Daliresp, 28
danazol, 11
dantrolene sodium, 22
Dapsone, 3
Daptacel, 28, 40
Daraprim, 3
dasetta 1/35, 12, 39
dasetta 7/7/7, 12, 39
daunorubicin HCL, 4
Daunoxome, 4
daysee, 12, 39
Daytrana, 21
Ddrops, 30, 42
deblitane, 12, 39
decara, 29, 42
Decara, 30, 42
decitabine, 4
deferoxamine mesylate, 36
dehydrated alcohol, 36
delflex-LC/1.5% dextrose, 36
delflex-lm/1.5% dextrose, 36
delta d3, 29, 42
delyla, 12, 39
Delzicol, 16
demeclocycline HCL, 1
Demser, 7
Denavir, 9
denta 5000 plus, 19
dentagel, 19
Depen Titratabs, 37
Depo-medrol, 11
Depo-provera, 4
Depo-subq Provera 104, 12, 39
Depocyt, 4
Depodur, 26
Dermasorb Ta, 10
dermazene, 9
desipramine HCL, 20
desloratadine, 27
desloratadine odt, 27
desmopressin acetate, 14
desogestrel/ethinyl estradiol, 12, 39
Desonate, 10
desonide, 9
Desowen Cream/Cetaphil Lotion, 10
Desowen Lotion/Cetaphil Cream, 10
Desowen Ointment/Cetaphil Lotion, 10
desoximetasone, 9
Desoximetasone, 10
Desvenlafaxine ER, 20
Detachable Face Mask, 35
dexamethasone, 11
Dexamethasone, 11
Dexamethasone Intensol, 11
dexamethasone sodium phosphate, 11,
23
Dexamethasone Sodium Phosphate, 11
Dexchlorpheniramine Maleate, 27
dexedrine, 20
dexferrum, 17
Dexilant, 15
dexmedetomidine HCL, 20
dexmethylphenidate HCL, 20
dexmethylphenidate HCL ER, 20
Dexpak 10 Day, 11
Dexpak 13 Day, 11
Dexpak 6 Day, 11
Dexpanthenol, 16
dexrazoxane, 5
dextroamphetamine sulfate, 20
dextroamphetamine sulfate ER, 21
Dextromethorphan
HBR/Chlorpheniramine/Phenylephrine
HCL, 27
dextrose 10%, 36
dextrose 10% flex container, 36
Dextrose 10%/NACL 0.2%, 37
Dextrose 10%/NACL 0.225%, 37
Dextrose 10%/NACL 0.45%, 37
dextrose 2.5%/NACL 0.45%, 36
dextrose 2.5%/sodium chloride 0.45%,
36
Dextrose 20%, 37
Dextrose 25%, 37
dextrose 30%, 36
dextrose 30% partial fill, 36
Dextrose 40%, 37
dextrose 5%, 36
Dextrose 5% /Electrolyte #48 Viaflex, 37
dextrose 5% viaflex, 36
dextrose 5%/lactated ringers, 36
dextrose 5%/NACL 0.2%, 36
Dextrose 5%/NACL 0.225%, 37
Dextrose 5%/NACL 0.3%, 37
dextrose 5%/NACL 0.33%, 36
dextrose 5%/NACL 0.45%, 36
dextrose 5%/NACL 0.9%, 36
dextrose 5%/potassium chloride 0.15%,
36
dextrose 5%/ringers, 36
dextrose 5%/sodium chloride 0.2%, 36
dextrose 5%/sodium chloride 0.33%, 36
dextrose 5%/sodium chloride 0.45%, 36
dextrose 5%/sodium chloride 0.9%, 36
dextrose 50%, 36
dextrose 70%, 36
Diabeta, 13
dialyvite, 30
dialyvite vitamin d 5000, 29, 42
Dialyvite Vitamin D3 Max, 30, 42
Diastar Easy Test II Lancets 30G, 32
Diastar Easy Test Lancets30G, 32
Diastat Pediatric, 21
diazepam, 19
Diazepam, 19, 21
Dibenzyline, 7
diclofenac potassium, 26
48
diclofenac sodium, 9, 10, 24
diclofenac sodium DR, 26
diclofenac sodium ER, 26
diclofenac sodium/misoprostol, 26
dicloxacillin sodium, 1
dicyclomine HCL, 15
Dicyclomine HCL, 15
didanosine, 2
diethylpropion HCL, 21
Diethylpropion HCL, 21
diethylpropion HCL ER, 21
Differin, 9
Dificid, 1
difil-G forte, 28
diflorasone diacetate, 9
Diflorasone Diacetate, 10
diflunisal, 24
digox, 5
digoxin, 5
Digoxin, 5
dihydroergotamine mesylate, 26
Dihydroergotamine Mesylate, 26
Dilantin, 21
Dilatrate SR, 6
dilt-CD, 6
dilt-XR, 6
diltiazem CD, 6
diltiazem HCL, 6
Diltiazem HCL, 6
diltiazem HCL CD, 6
diltiazem HCL ER, 6
diltzac, 6
Dimenhydrinate, 16
Dipentum, 16
diphenhydramine HCL, 27
diphenoxylate/atropine, 15
Diphenoxylate/Atropine, 15
Diphtheria/Tetanus Toxoids Adsorbed Pediatric, 28, 40
dipyridamole, 19, 36
disopyramide phosphate, 6
disulfiram, 21
divalproex sodium, 21
divalproex sodium DR, 21
divalproex sodium ER, 21
dobutamine HCL, 7
dobutamine HCL/D5W, 7
dobutamine/dextrose 5%, 7
Dobutamine/Dextrose 5%, 7
Docefrez, 5
Docetaxel, 5
dologesic, 24
dolorex, 24
donepezil HCL, 21
Donnatal, 15
Donnatal Extentabs, 15
dopamine HCL, 7
Dopamine HCL, 7
dopamine HCL-dextrose 5%, 7
dopamine HCL/dextrose 5%, 7
dopamine/D5W, 7
Doribax, 3
dorzolamide HCL, 24
dorzolamide HCL/timolol maleate, 23
doxapram HCL, 21
doxazosin mesylate, 7
doxepin HCL, 20
Doxepin HCL, 20
doxercalciferol, 14
doxorubicin HCL, 4
doxorubicin HCL liposome, 4
doxy 100, 1
doxycycline, 1
doxycycline hyclate, 1
doxycycline hyclate DR, 1
doxycycline monohydrate, 1
Dritho-creme HP, 9
dronabinol, 15
droperidol, 19
Droplet Lancets Ultra Thin 30G, 32
drospirenone/ethinyl estradiol, 12, 39
Droxia, 18
Drug Mart Lancets Thin, 32
Drug Mart Lancets Ultra Thin, 32
Drug Mart On-the-go Lancets Gentle 30G, 32
Drug Mart Unilet Lancets Super Thin 30G, 32
Drug Mart Unilet Lancets Ultra Thin 28G, 32
Duane Reade Lancet Alternate Site 26G, 32
Duane Reade Lancet Super Thin 30G, 32
Duane Reade Lancet Ultra Thin 28G, 32
Dulera, 28
duloxetine HCL, 20
duramorph, 25
duraxin, 24
Durezol, 23
Dymista, 27
Dyrenium, 7
Dysport, 22
E
E-z Ject Lancets, 32
E-z Ject Lancets 21G, 32
E-z Ject Lancets Color, 32
E-z Ject Lancets Super Thin, 32
E-z Ject Lancets Super Thin 30G, 32
E-z Ject Lancets Thin 26G, 32
E-z Spacer, 35
E-z Spacer The Body Guards Pack, 35
E-ZJECT Lancets Micro-thin 33G, 32
E.e.s. 400, 1
e.s.p., 3
Easivent, 35
Easivent/Mask-large, 35
Easivent/Mask-medium, 35
Easivent/Mask-small, 35
Easy Comfort Lancets, 32
Easy Touch Alcohol Prep Pads/Medium,
35
Easy Touch Lancets, 32
Easy Touch Lancets 21G/Pressure Activated, 32
Easy Touch Lancets 23G/Pressure Activated, 32
Easy Touch Lancets 26G/Pressure Activated, 32
Easy Touch Lancets 28G/Pressure Activated, 32
Easy Touch Lancets 28G/Twist, 32
Easy Touch Lancets 30G/Pressure Activated, 32
Easy Touch Lancets 30G/Twist, 32
Easy Touch Lancets 32G/Pressure Activated, 32
Easy Touch Lancets 32G/Twist, 32
Easy Touch Lancets 33G/Twist, 32
Easy Touch Safety Lancets21G/Pressure Activated, 32
Easy Touch Safety Lancets23G/Pressure Activated, 32
Easy Touch Safety Lancets26G/Button Activated, 32
Easy Touch Safety Lancets26G/Pressure Activated, 32
Easy Touch Safety Lancets28G/Button Activated, 32
Easy Touch Safety Lancets28G/Pressure Activated, 32
Easy Twist & CAP Lancets, 32
easygel, 19
Easytest II Lancets, 32
Easytest Lancets, 32
EC-81 aspirin, 25, 38
econazole nitrate, 9
ecotrin low strength, 25, 38
ecpirin, 25, 38
Ed Cyte F, 17
ed-flex, 24
ed-spaz, 15
Edarbi, 7
Edarbyclor, 7
Edecrin, 7
Edex, 8
Edurant, 2
eemt, 11
eemt HS, 11
effer-k, 36
Effer-k, 37
effervescent pot chloride, 36
effervescent potassium, 36
effervescent potassium/chloride, 36
Effient, 19
Egrifta, 14
Elaprase, 14
Elelyso, 18
Elidel, 10
Eligard, 4
elinest, 12, 39
Eliquis, 18
Elite Iron, 18, 41
Elite-OB, 30
Elitek, 5
Elixophyllin, 28
Ella, 12
Elmiron, 17
Eloxatin, 3
Elspar, 4
Emadine, 24
Embrace Lancets Ultra Thin 30G, 32
Emcyt, 4
Emend, 16
emoquette, 12, 39
Emsam, 20
Emtriva, 2
Enablex, 16
enalapril maleate, 6
enalapril maleate/hydrochlorothiazide, 7
enalaprilat, 6
Enbrel, 26
Enbrel Sureclick, 26
Encare, 17, 39
49
endocet, 25
endodan, 25
Endometrin, 17
Enfamil Expecta, 31
Engerix-b, 28, 40
Enjuvia, 11
Enovarx-cyclobenzaprine HCL, 22
enoxaparin sodium, 18
enpresse-28, 12, 39
enskyce, 12, 39
entacapone, 21
entecavir, 3
enteric coated aspirin, 25, 38
enulose, 16
ephedrine sulfate, 7
Epiduo, 9
epinastine HCL, 24
Epinephrine, 7
epinephrine HCL, 28
Epipen 2-PAK, 7
Epipen-JR 2-PAK, 7
epirubicin HCL, 4
Epirubicin HCL, 4
episone CRE, 10
epitol, 21
Epivir, 2
Epivir HBV, 2
eplerenone, 7
Epogen, 18
epoprostenol sodium, 8
eprosartan mesylate, 7
Epzicom, 2
eq adult aspirin low strength, 25, 38
eq aspirin, 25, 38
eq aspirin adult low dose, 25, 38
eq aspirin EC, 25, 38
eq aspirin low dose, 25, 38
eq childrens aspirin, 25, 38
eq nicotine, 21, 42
eq nicotine gum refill, 21, 42
eq nicotine gum starter, 21, 42
eq nicotine polacrilex, 21, 42
eq nicotine step 3, 21, 42
eq slow-release iron, 17, 41
eql adult aspirin low strength, 25, 38
eql aspirin, 25, 38
eql aspirin EC, 25, 38
eql aspirin low dose, 25, 38
eql childrens aspirin, 25, 38
eql childrens vitamin d gummies, 29, 42
Eql Color Lancets 21G, 32
Eql Color Lancets Micro Thin 33G, 32
eql folic acid, 17, 40
eql iron supplement therapy, 17, 41
eql nicotine, 21, 42
eql nicotine polacrilex, 21, 42
eql nicotine polacrilex refill, 21, 42
eql nicotine polacrilex starter, 21, 42
Eql Prenatal Formula, 31, 40
eql slow release iron, 17, 41
Eql Super Thin Lancets 30G, 32
Eql Thin Lancets 26G, 32
eql vitamin d-3, 29, 42
eql vitamin d3, 29, 42
Eraxis, 2
Erbitux, 4
ergocalciferol, 29
ergoloid mesylates, 21
Ergomar, 26
Erivedge, 5
errin, 12, 39
Ertaczo, 9
Erwinaze, 4
ery, 8
Ery-TAB, 1
Erythrocin Lactobionate, 1
erythromycin, 1, 8, 22
Erythromycin Base, 1
Erythromycin Ethylsuccinate, 1
erythromycin/benzoyl peroxide, 8
escavite LQ, 30
escitalopram oxalate, 20
esgic, 24
esmolol HCL, 6
esomeprazole sodium, 15
Esomeprazole Strontium, 15
estarylla, 12, 39
estazolam, 20
esterified estrogens/methltestosterone, 11
esterified estrogens/methyltestosterone, 11
esterified estrogens/methyltestosterone
DS, 11
esterified estrogens/methyltestosterone
HS, 11
Estrace, 17
estradiol, 11
estradiol valerate, 11
estradiol/norethindrone acetate, 11
Estring, 17
Estrogel, 11
estropipate, 11
Estropipate, 11
eszopiclone, 20
ethambutol HCL, 2
ethosuximide, 21
Etidronate Disodium, 13
etodolac, 26
etodolac ER, 26
etomidate, 27
Etopophos, 5
etoposide, 5
Etoposide, 5
Euflexxa, 22
Eurax, 11
Evamist, 11
Exalgo, 26
Exelderm, 9
Exelon, 22
exemestane, 4
Exforge HCT, 7
Exjade, 37
exoderm, 9
exotic-HC, 24
Extavia, 22
Eylea, 24
EZ Smart Blood Glucose Lancets, 32
EZ-lets Lancets 21G, 32
EZ-lets Lancets 23G, 32
EZ-lets Lancets 26G Super-soft, 32
EZ-lets Lancets 28G Ultra-soft, 32
EZ-lets Lancets 30G, 32
ezfe 200, 17, 41
F
fa-8, 17, 40
Fa-8, 18, 40
fabb, 17
Fabrazyme, 14
Factive, 2
falmina, 12, 39
famciclovir, 2
famotidine, 15
Famotidine, 15
Famotidine Premixed, 15
Fanapt, 20
Fanapt Titration Pack, 20
Fareston, 4
Faslodex, 4
Fasttake Test Strips, 32
Fazaclo, 20
Fc Female Condom, 39
Fc2 Female Condom, 39
FE Aspartate, 18, 41
FE c plus, 17
FE gluconate, 18, 41
FE TABS, 18, 41
Feiba NF, 19
felbamate, 21
felodipine ER, 6
Femcap, 39
Femiron, 18, 41
fenofibrate, 7
Fenofibrate, 8
fenofibrate micronized, 8
Fenofibric Acid, 8
fenofibric acid DR, 8
Fenoglide, 8
fenoldopam mesylate, 7
Fenoprofen Calcium, 26
fentanyl, 25
fentanyl citrate, 25
fentanyl citrate oral transmucosal, 25
Fentora, 26
feosol, 17, 41
Feosol, 18, 41
fer-iron, 17, 41
Feraheme, 18
ferate, 17, 41
ferocon, 17
ferosul, 17, 41
ferotrinsic, 17
Ferraplus 90, 17
ferretts, 17, 41
Ferretts Chewable Iron, 18
Ferretts IPS, 18, 41
ferrex 150, 17, 41
Ferrex 150 Forte Plus, 18
Ferrex 28, 18
Ferrimin 150, 18, 41
Ferriprox, 37
ferro-bob, 17, 41
Ferro-sequels, 18, 41
ferrocite, 17, 41
ferrocite plus, 17
ferrogels forte, 17
ferrotabs, 17, 41
ferrous drops, 17, 41
Ferrous Fumarate, 18, 41
ferrous fumarate 324, 18, 41
ferrous gluconate, 18, 41
Ferrous Gluconate, 18, 41
50
ferrous sulfate, 18, 41
Ferrous Sulfate, 18, 41
ferrousul, 18, 41
ferus, 18, 41
Fibricor, 8
Fifty50 Alcohol Prep Pads, 35
Fifty50 Safety Seal Lancets 30G, 32
Fifty50 Safety Seal Lancets 32G, 32
Finacea, 9
finasteride, 10, 17
Fine 30, 32
Fingerstix Lancets, 32
Firazyr, 19
Firmagon, 4
First-lansoprazole, 15
Flagyl ER, 3
Flarex, 23
flavoxate HCL, 16
Flebogamma, 37
Flebogamma Dif, 37
flecainide acetate, 6
Flector, 9
flexbumin, 19
Flovent Diskus, 28
Flovent HFA, 28
floxuridine, 4
Fluarix 2012-2013, 28, 40
Fluarix 2013-2014, 28, 40
Fluarix 2014-2015, 28, 40
Fluarix Quadrivalent 2013-2014, 28, 40
Fluarix Quadrivalent 2014-2015, 28, 40
Flublok 2013-2014, 28, 40
Flublok 2014-2015, 28, 40
flucaine, 24
Flucelvax 2012-2013, 28, 40
Flucelvax 2013-2014, 28, 40
Flucelvax 2014-2015, 28, 40
fluconazole, 2
fluconazole IN dextrose, 2
fluconazole IN NACL, 2
Fluconazole IN NACL, 2
flucytosine, 2
fludarabine phosphate, 4
fludrocortisone acetate, 11
Flulaval 2012-2013, 28, 41
Flulaval 2013-2014, 28, 41
Flulaval 2014-2015, 28, 41
Flulaval Quadrivalent 2013-2014, 28, 40
Flulaval Quadrivalent 2014-2015, 28, 41
flumazenil, 36
Flumist Nasal Vaccine 2012-2013, 28, 41
Flumist Quadrivalent, 28, 41
flunisolide, 27
Flunisolide, 27
fluocinolone acetonide, 9, 24
fluocinolone acetonide body, 9
fluocinolone acetonide ear drops, 24
fluocinolone acetonide scalp, 9
fluocinonide, 9
fluocinonide emollient base, 9
fluocinonide-e, 10
fluor-a-day, 37, 40
Fluor-a-day, 37, 40
fluor-i-strips a.t., 24
Fluorabon, 37, 40
fluorescein-benoxinate, 24
fluorescein/proparacaine, 24
fluorets, 24
fluoride, 37, 40
fluoridex daily defense, 19
fluoridex daily defense enhanced whitening, 19
fluoridex daily defense sensitivity relief, 19
fluoritab, 37, 40
fluorometholone, 23
Fluoroplex, 11
fluorouracil, 4, 10
fluoxetine, 21
fluoxetine DR, 20
fluoxetine HCL, 20
Fluoxetine HCL, 20
fluphenazine decanoate, 20
fluphenazine HCL, 20
Fluphenazine HCL, 20
flura-drops, 37, 40
Flura-drops, 37, 40
flurazepam HCL, 20
Flurazepam HCL, 20
flurbiprofen, 26
flurbiprofen sodium, 24
flurox, 24
flutamide, 4
fluticasone propionate, 10, 27
fluvastatin, 8
Fluvirin 2012-2013, 29, 41
Fluvirin 2013-2014, 29, 41
Fluvirin 2014-2015, 29, 41
Fluvirin PF 2012-2013, 28, 41
Fluvirin PF 2013-2014, 29, 41
Fluvirin PF 2014-2015, 29, 41
fluvoxamine maleate, 20
fluvoxamine maleate ER, 20
Fluzone High-dose PF 2012-2013, 29, 41
Fluzone High-dose PF 2013-2014, 29, 41
Fluzone High-dose PF 2014-2015, 29, 41
Fluzone Intradermal, 29, 41
Fluzone Pediatric PF 2012-2013, 29, 41
Fluzone Pediatric PF 2013-2014, 29, 41
Fluzone PF 2012-2013, 29, 41
Fluzone PF 2013-2014, 29, 41
Fluzone PF 2014-2015, 29, 41
Fluzone Quadrivalent 2013-2014, 29, 41
Fluzone Quadrivalent 2014-2015, 29, 41
Fluzone Split 2012-2013, 29, 41
Fluzone Split 2013-2014, 29, 41
Fluzone Split 2014-2015, 29, 41
FML, 23
Focalin XR, 21
folastin, 36
Folbecal, 30
folbee, 17
folbee plus, 30
folbee plus cz, 30
folbic, 36
Folbic RF, 37
folcaps, 17
folic acid, 17, 40
Folic Acid, 17
folic acid/vitamin b-6/vitamin b-12, 17
Follistim AQ, 14
Folotyn, 4
folplex 2.2, 17
Foltrate, 18
foltrin, 17
Foltx, 37
fomepizole, 36
fondaparinux sodium, 18
Fora Lancets, 32
Foradil Aerolizer, 28
Forfivo XL, 20
formadon, 36
formaldehyde, 36
Forteo, 14
Fortesta, 11
Fortical, 13
Fosamax Plus D, 13
Foscarnet Sodium, 2
fosinopril sodium, 6
fosinopril sodium/hydrochlorothiazide, 7
fosphenytoin sodium, 21
Fosrenol, 16
Fragmin, 18
Freamine Iii, 37
Freds Pharmacy Unilet Lancets Super Thin 30G, 32
Freds Pharmacy Unilet Lancets Ultra Thin 28G, 32
Freestyle Lancets, 32
Freestyle Unistick II Lancets, 32
fresenius propoven, 27
Frova, 26
ful-GLO, 24
furosemide, 7
Furosemide, 7
Fusilev, 5
Fuzeon, 2
Fycompa, 21
G
gabapentin, 21
Gabitril, 21
Gablofen, 22
galantamine, 21
galantamine hydrobromide, 21
Galzin, 37
Gamastan S/D, 37
Gammagard Liquid, 37
Gammagard S/D, 37
Gammagard S/D Iga Less Than 1mcg/ML, 37
Gammaked, 37
Gammaplex, 37
Gamunex-c, 37
ganciclovir, 2
Ganirelix Acetate, 14
Ganite, 14
garamycin, 22
Gardasil, 29, 41
Gastrinex NF, 15
gatifloxacin, 22
Gattex, 16
gavilyte-c, 15, 43
gavilyte-G, 15, 43
gavilyte-n/flavor pack, 15, 43
Gazyva, 4
Gelnique, 16
Gemcitabine, 4
gemcitabine HCL, 4
gemfibrozil, 8
gene-xene TAB 15MG, 19
gene-xene TAB 3.75MG, 19
51
gene-xene TAB 7.5MG, 19
generlac, 16
gengraf, 4
Genotropin, 14
Genotropin Miniquick, 14
gentak, 22
gentamicin sulfate, 2, 22
Gentamicin Sulfate, 9
gentamicin sulfate pediatric, 2
gentamicin sulfate/0.9% sodium chloride,
2
Gentamicin Sulfate/0.9% Sodium
Chloride, 2
gentamicin sulfate/sodium chloride, 2
Gentle-let GP Lancets, 32
Gentle-let Lancets General Purpose
Style/Fine Point, 32
Gentle-let Lancets General Purpose
Style/Medium Point, 32
Gentle-let Lancets Safety Style/Fine
Point, 32
Gentle-let Lancets Safety Style/Medium
Point, 32
Geodon, 20
gianvi, 12, 39
Giazo, 16
gildagia, 12, 39
gildess 1.5/30, 12, 39
gildess 1/20, 12, 39
gildess FE 1.5/30, 12, 39
gildess FE 1/20, 12, 39
Gilenya, 22
Gilotrif, 5
giltuss pediatric, 27
Giltuss TR, 27
Glassia, 28
Gleevec, 5
Gliadel Wafer, 3
glimepiride, 13
glipizide, 13
glipizide ER, 13
glipizide XL, 13
glipizide/metformin HCL, 13
Global Alcohol Prep Ease Pads, 35
Global Inject Ease Lancets 28G, 32
Global Inject Ease Lancets 30G, 32
Glucagen, 13
Glucagen Hypokit, 13
Glucagon Emergency Kit, 13
Glucocom Lancets 28G, 32
Glucocom Lancets 30G, 32
Glucocom Lancets 33G, 32
Glucosource Lancets, 32
Glumetza, 13
glyburide, 13
Glyburide, 13
glyburide micronized, 13
glyburide/metformin HCL, 13
glycine, 17
Glycolic Acid, 9
Glycolic Acid 70% High Purity, 9
glycopyrrolate, 15
glydo, 10
Glyset, 13
Gmate Lancets 30G, 32
gnp adult aspirin low strength, 25, 38
Gnp Alcohol Swabs, 35
gnp aspirin, 25, 38
gnp aspirin low dose, 25, 38
Gnp Daily Prenatal, 31, 40
gnp folic acid, 18, 40
gnp iron, 18, 41
Gnp Lancets, 32
Gnp Lancets 21G, 32
Gnp Lancets Micro Thin 33G, 32
Gnp Lancets Super Thin 30G, 32
Gnp Lancets Thin, 32
Gnp Lancets Thin 26G, 32
Gnp Micro Thin Lancets 33G, 32
gnp nicotine polacrilex, 21, 42
Gnp Prenatal, 31, 40
Gnp Prenatal Vitamins, 31, 40
gnp slow release iron, 18, 41
Gnp Super Thin Lancets/30G, 32
gnp vitamin d, 29, 42
gnp vitamin d maximum strength, 29, 42
gnp vitamin d super strength, 29, 42
gnp vitamin d3 extra strength, 29, 42
Golytely, 15, 43
Gonal-f, 14
Gonal-f RFF, 14
Gonal-f RFF Pen, 14
Gonal-f RFF Rediject, 14
goodsense aspirin low dose, 25, 38
Goodsense Prenatal Vitamins, 31, 40
grafco silver nitrate applicator, 10
Gralise, 22
Gralise Starter, 22
granisetron HCL, 15
Granisol, 16
green GLO lissamine greenophthalmic
strips, 24
griseofulvin microsize, 2
griseofulvin ultramicrosize, 2
grx hicort 25, 16
guanfacine HCL, 7
Guanidine HCL, 22
Gynazole-1, 17
H
H&h Thinlet Lancets 26G, 32
H&h Thinlet Super Thin Lancets 30G, 32
H-e-b Incontrol Lancets Super Thin 30G,
32
H-e-b Incontrol Lancets Ultra Thin 28G,
32
H.p. Acthar, 14
Haemolance, 32
Haemolance Low Flow Lancets, 32
Haemolance Plus, 32
Haemolance Plus High Flow, 32
Haemolance Plus Low Flow, 32
Haemolance Plus Max Flow, 32
Haemolance Plus Pediatric Flow, 32
halac, 10
Halaven, 5
Halflytely Bowel Prep/Flavor Packs, 15
halfprin, 25, 38
halobetasol propionate, 10
Halog, 10
halonate PAC, 10
haloperidol, 20
haloperidol decanoate, 20
haloperidol lactate, 20
Havrix, 29, 41
Healthwise Alcohol Prep Pads, 35
Healthwise Lancets 30G, 32
Healthy Accents Unilet Lancets Super
Thin 30G, 33
healthy kids vitamin d3, 29, 42
Healthy Mama Be Well Rounded, 31
heather, 12, 39
hecoria, 4
Hectorol, 14
Helidac, 15
Helixate FS, 19
hematinic plus vitamins/minerals, 17
hematinic/folic acid, 17
hematogen, 17
Hematogen Fa, 17
hematogen forte, 17
hemocyte-f, 17
hemocyte-plus, 17
Hemofil M, 19
hemril-30, 16
hep flush-10, 18
Hepagam B, 37
heparin lock, 18
heparin lock flush, 18
Heparin Lock Flush, 18
heparin lock flush for flushing vascular
access devices, 18
heparin lock flush/NACL for flushing
vascular access devices, 18
heparin sodium, 18
Heparin Sodium, 18
heparin sodium dcu, 18
heparin sodium lock flush, 18
heparin sodium/D5W, 18
Heparin Sodium/D5W, 18
Heparin Sodium/NACL 0.45%, 18
heparin sodium/NACL 0.9%, 18
Heparin Sodium/Sodium Chloride 0.9%,
18
heparin sodium/sodium chloride 0.9%
premix, 18
hepatamine, 36
hepatasol, 36
Herceptin, 4
hetastarch 6%/NACL, 19
Hetlioz, 20
Hexalen, 3
Hiberix, 29, 41
high potency iron, 18, 41
High Potency Iron, 18, 41
Hizentra, 37
HM aspirin, 25, 38
HM aspirin EC, 25, 38
HM aspirin EC low dose, 25, 38
HM folic acid, 18, 40
HM iron, 18, 41
HM iron slow release, 18, 41
HM Lancets Micro Thin 33G, 33
HM Lancets Ultra Thin 30G, 33
HM nicotine polacrilex, 22, 42
HM nicotine transdermal system, 22, 42
HM nicotine transdermal system step 3,
22, 42
HM One Daily Prenatal Combo, 31, 40
HM Prenatal, 31, 40
HM vitamin d, 29, 42
HM vitamin d3, 29, 42
HM Vitamin D3, 30, 43
homatropaire, 23
homatropine HBR, 23
52
Horizant, 22
Humalog, 13
Humalog Kwikpen, 13
Humalog Mix 50/50, 13
Humalog Mix 50/50 Kwikpen, 13
Humalog Mix 75/25, 13
Humalog Mix 75/25 Kwikpen, 13
human albumin grifols, 19
Humate-p, 19
Humatrope, 14
Humatrope Combo Pack, 14
Humira, 26
Humira Pen, 26
Humira Pen-crohns Diseasestarter, 26
Humira Pen-psoriasis Starter, 26
Humulin 70/30, 13
Humulin 70/30 Kwikpen, 13
Humulin 70/30 Pen, 13
Humulin N, 13
Humulin N Kwikpen, 13
Humulin N U-100 Pen, 13
Humulin R, 13
Humulin R U-500 (concentrated), 13
Hy-vee Lancets, 33
Hy-vee Thin Lancets, 33
Hyalgan, 22
Hycamtin, 5
hydralazine HCL, 7
hydrochloric acid, 17
hydrochlorothiazide, 7
hydrocodone bitartrate/acetaminophen, 25
Hydrocodone Bitartrate/Acetaminophen,
26
hydrocodone bitartrate/chlorpheniramine maleate/PSE, 27
hydrocodone bitartrate/homatropine methylbromide, 27
hydrocodone polistirex/chlorpheniramine polistirex, 27
hydrocodone/acetaminophen, 25
Hydrocodone/Acetaminophen, 26
hydrocodone/homatropine, 27
hydrocodone/ibuprofen, 25
hydrocort ene 100MG, 16
hydrocortisone, 10, 11, 16
hydrocortisone acetate, 16
hydrocortisone acetate/aloe, 10
hydrocortisone acetate/lidocaine HCL, 16
hydrocortisone acetate/pramoxine, 10, 16
hydrocortisone acetate/pramoxine HCL, 16
hydrocortisone butyrate, 10
hydrocortisone butyrate (lipid), 10
hydrocortisone butyrate (lipophilic), 10
hydrocortisone IN absorbase, 10
hydrocortisone valerate, 10
hydrocortisone/acetic acid, 24
hydrocortisone/iodoquinol, 9
hydrogesic, 25
hydromet, 27
hydromorphone HCL, 25
Hydromorphone HCL, 26
Hydromorphone HCL Dosette, 26
hydromorphone HCL ER, 25
Hydromorphone HCL ER, 26
hydroquinone, 10
infuvite pediatric, 30
Inlyta, 5
Innopran XL, 6
Inspirease Bags, 35
Inspirease Drug Delivery System, 35
Inspirease Mouthpiece, 35
Inspirease Reservoir Bags, 35
Integrilin, 19
Intelence, 2
Intermezzo, 20
intralipid, 36
Intron-a, 5
Intron-a W/Diluent, 5
introvale, 12, 39
Intuniv, 21
Invanz, 3
Invega, 20
Invega Sustenna, 20
Invirase, 2
Invokana, 13
Iopidine, 23
Ipol Inactivated IPV, 29, 41
ipratropium bromide, 27, 28
I
ipratropium bromide/albuterol sulfate, 28
ibandronate sodium, 13
irbesartan, 7
ibudone, 25
irbesartan/hydrochlorothiazide, 7
ibuprofen, 26
irinotecan, 5
ibutilide fumarate, 6
Irinotecan, 5
Iclusig, 5
iron, 18, 41
idarubicin HCL, 4
Iron, 18, 41
iferex 150, 18, 41
Iron Asp Gly/ Polysacch Compl/Ascorb iferex 150 forte, 17
CAL/B12/Fa/C Threon/Suc, 18
Ifex, 3
iron chews pediatric, 18, 41
ifosfamide, 3
iron slow release, 18, 41
Ifosfamide, 3
iron supplement, 18, 41
Ifosfamide/Mesna, 5
iron supplement childrens, 18, 41
Ilaris, 26
Iron Up, 18, 41
Ilevro, 24
Isentress, 2
ilotycin, 22
isoditrate ER, 6
Imbruvica, 5
isoflurane, 27
imipenem/cilastatin, 3
isolyte-m/dextrose 5%, 36
imipramine HCL, 20
Isolyte-s, 37
imipramine pamoate, 20
isometheptene imiquimod, 10
mucate/caffeine/acetaminophen, 26
Imogam Rabies-ht, 37
Isometheptene/Caffeine/Acetaminophen,
Imovax Rabies (h.d.c.v.), 28
26
Implanon, 12, 39
isometheptene/dichloralphenazone/aceta
Inatal Advance, 30
minophen, 26
Inatal GT, 30
isoniazid, 2
Inatal Ultra, 30
Isoniazid, 2
Incivek, 3
Isopto Carbachol, 23
Increlex, 14
isosorbide dinitrate, 6
indapamide, 7
Isosorbide Dinitrate, 6
Inderal XL, 6
isosorbide dinitrate ER, 6
indigo carmine, 36
isosorbide mononitrate, 6
indocyanine green, 36
isosorbide mononitrate ER, 6
indomethacin, 26
isosulfan blue, 36
Indomethacin, 26
isotonic gentamicin, 2
indomethacin ER, 26
Isotonic Gentamicin, 2
indomethacin sodium, 26
isoxsuprine HCL, 8
Infanrix, 28, 41
Isoxsuprine HCL, 8
infed, 17
Isradipine, 6
Infergen, 3
Istalol, 23
Influenza A (h1n1) Monovalent 2009, 29, Istodax, 5
41
itraconazole, 2
Infumorph 200, 26
Ixempra Kit, 5
Infumorph 500, 26
Ixiaro, 28
infuvite, 30
infuvite adult, 30
53
hydroquinone time release, 10
Hydroxocobalamin, 17
hydroxychloroquine sulfate, 3
hydroxyurea, 5
hydroxyzine HCL, 19
Hydroxyzine HCL, 19
hydroxyzine pamoate, 19
Hydroxyzine Pamoate, 20
hygel, 10
hyomax-SL, 15
hyophen, 16
hyoscyamine sulfate, 15
hyoscyamine sulfate ER, 15
hyoscyamine sulfate odt, 15
hyoscyamine sulfate SR, 15
hyosyne, 15
hypercare, 10
Hyperhep B S/D, 37
Hyperlyte-CR, 37
Hyperrab S/D, 37
Hyperrho S/D, 37
Hyperrho S/D Mini-dose, 37
J
Jakafi, 5
jantoven, 18
Janumet, 13
Janumet XR, 13
Januvia, 13
jencycla, 12, 39
Jentadueto, 13
Jetrea, 24
Jevtana, 5
Jinteli, 11
jolessa, 12, 39
jolivette, 12, 39
junel 1.5/30, 12, 39
junel 1/20, 12, 39
junel FE 1.5/30, 12, 39
junel FE 1/20, 12, 39
just d, 29, 42
Juvisync, 13
Juxtapid, 8
K
k-effervescent, 36
K-phos, 37
k-prime, 36
k-vescent, 36
Kadcyla, 4
Kadian, 26
Kalbitor, 19
Kaletra, 2
Kalydeco, 28
Kapvay Dose Pack, 21
karidium, 37, 40
karigel, 19
karigel-n, 19
kariva, 12, 39
KCL 0.075%/D5W/NACL 0.45%, 37
KCL 0.15%/D5W/ NACL 0.3%, 37
KCL 0.15%/D5W/Lr, 37
KCL 0.15%/D5W/NACL 0.2%, 37
KCL 0.15%/D5W/NACL 0.225%, 37
KCL 0.15%/D5W/NACL 0.45%, 37
KCL 0.15%/D5W/NACL 0.9%, 37
KCL 0.3%/D5W/Lr IV Lac Ring, 37
KCL 0.3%/D5W/NACL 0.45%, 37
KCL 0.3%/D5W/NACL 0.9%, 37
kedbumin, 19
kelnor 1/35, 12, 39
Kenalog, 10
kendall sodium chloride flush, 36
Kepivance, 5
ketamine HCL, 27
Ketek, 3
ketoconazole, 2, 9
ketodan, 9
ketoprofen, 26
Ketoprofen ER, 26
ketorolac tromethamine, 24, 26
Ketorolac Tromethamine, 26
Kineret, 26
Kinney Lancets, 33
Kinney Thin Lancets, 33
Kinrix, 28, 41
kionex, 36
klor-CON, 36
klor-CON 10, 36
klor-CON 8, 36
klor-CON m10, 36
Klor-CON M15, 37
klor-CON m20, 36
klor-CON/EF, 36
kls aspirin EC, 25, 38
kls aspirin low dose, 25, 38
kls quit2, 21, 42
kls quit4, 21, 42
Koate-dvi, 19
Kogenate FS, 19
Kogenate FS Bio-set, 19
Kombiglyze XR, 13
kp aspirin, 25, 38
kp ferrous gluconate, 18, 41
kp ferrous sulfate, 18, 41
kp folic acid, 18, 40
Kp Prenatal Multivitamins, 31, 40
kp vitamin d, 29, 42
Kristalose, 15
Kroger Lancets, 33
Kroger Lancets 21G, 33
Kroger Lancets Micro Thin33G, 33
Kroger Lancets Super Thin, 33
Kroger Lancets Thin, 33
Kroger Lancets Thin 26G, 33
Kroger Lancets Ultrathin 30G, 33
Krystexxa, 27
kurvelo, 12, 39
Kuvan, 14
Kynamro, 8
Kyprolis, 5
L
l-cysteine HCL, 36
L-methyl-b6-b12, 37
L-methyl-mc, 37
L-methylfolate, 37
L-methylfolate CA/ME-CBL/NAC, 37
L-methylfolate CA/P-5-P.M.-CBL, 37
L-methylfolate Calcium, 37
labetalol HCL, 6
laclotion, 10
Lacrisert, 23
lactated ringers, 36
lactated ringers dextrose 5% viaflex, 36
lactated ringers irrigation, 36
lactated ringers viaflex, 36
lactic acid, 10
lactic acid e, 10
lactic acid w/vitamin e, 10
lactulose, 15, 16
Lady Lite Lancets, 33
Lamictal, 21
Lamictal Odt, 21
Lamisil, 2
lamivudine, 2
lamivudine/zidovudine, 2
lamotrigine, 21
lamotrigine ER, 21
Lancets, 33
Lancets 26G Twist Top, 33
Lancets 28G, 33
Lancets 30G, 33
Lancets 30G Twist Top, 33
Lancets 31G Twist Top, 33
Lancets Bullseye Safety, 33
Lancets Micro Thin 33G, 33
Lancets Safety Seal 21G, 33
Lancets Safety Seal 26G, 33
Lancets Safety Seal 28G, 33
Lancets Safety Seal 30G, 33
Lancets Super Thin 28G, 33
Lancets Thin, 33
Lancets Twist Top, 33
Lancets Ultra Fine, 33
Lancets Ultra Thin, 33
Lancets Ultra Thin 30G, 33
lanolin, 36
lansoprazole, 15
lansoprazole/amoxicillin/clarithromycin, 15
Lantus, 13
Lantus Solostar, 13
larin 1.5/30, 12, 39
larin 1/20, 12, 39
larin FE 1.5/30, 12, 39
larin FE 1/20, 12, 39
Lastacaft, 24
latanoprost, 23
latrix, 10
Latuda, 20
lavoclen-4 acne wash kit, 8
Lavoclen-4 Creamy Wash, 8
lavoclen-8 acne wash kit, 8
Lavoclen-8 Creamy Wash, 8
Lazanda, 26
Leader Lancets Colored, 33
Leader Super Thin Lancet, 33
Leader Thin Lancets, 33
Lecithin, 37
leena, 12, 39
leflunomide, 26
lessina, 12, 39
Letairis, 8
letrozole, 4
leucovorin calcium, 5
Leucovorin Calcium, 5
Leukeran, 3
Leukine, 18
leuprolide acetate, 4
levalbuterol, 28
levalbuterol HCL, 28
Levatol, 6
Levemir, 13
Levemir Flexpen, 13
Levemir Flextouch, 13
levetiracetam, 21
Levetiracetam, 21
levetiracetam ER, 21
levobunolol HCL, 23
Levobunolol HCL, 23
levocarnitine, 14
levocetirizine dihydrochloride, 27
levofloxacin, 2, 22
levofloxacin IN D5W, 2
levonest, 12, 39
levonorgestrel, 12, 39
levonorgestrel and ethinyl estradiol, 12, 39
levonorgestrel/ethinyl estradiol, 12, 39
Levophed, 7
levora 0.15/30-28, 12, 39
Levorphanol Tartrate, 26
levothroid, 14
levothyroxine sodium, 15
Levothyroxine Sodium, 15
levoxyl, 15
Lexiva, 2
56
Lialda, 16
Liberty Blood Glucose Meter, 33
Liberty Blood Glucose Monitor, 33
Liberty Control Solution High, 33
Liberty Control Solution Normal, 33
Liberty Glucose Control Level 1, 33
Liberty Glucose Control Level 2, 33
Liberty Glucose Control Mid, 33
Liberty Glucose Control Normal, 33
Liberty Mini Lancing Device, 33
Liberty Next Generation Blood Glucose Monitor, 33
Liberty Next Generation Blood Glucose Test Strips, 33
Liberty Test Strips, 33
lidazone HC, 16
lidocaine, 10
lidocaine HCL, 6, 10, 19, 27
Lidocaine HCL, 6
lidocaine HCL IN D5W, 6
lidocaine HCL jelly, 10
lidocaine HCL viscous, 19
Lidocaine HCL-hydrocortisone Acetate With Aloe, 16
lidocaine HCL/dextrose, 6
Lidocaine HCL/Dextrose, 27
lidocaine HCL/hydrocortisone acetate, 16
lidocaine viscous, 19
lidocaine/epinephrine, 27
lidocaine/prilocaine, 10
Lifescan Unistik 2 Deep Penetration, 33
Lifescan Unistik II Lancets, 33
Lincocin, 3
lindane, 10
Linzess, 16
Lioresal Intrathecal, 22
liothyronine sodium, 15
lipodox, 4
lipodox 50, 4
Lipofen, 8
liposyn iii, 36
Liptruzet, 8
lisinopril, 6
lisinopril/hydrochlorothiazide, 7
lissamine green, 24
Lite Touch Lancets, 33
Liteaire, 35
Litetouch Lancets Micro Thin 33G, 33
Lithium, 20
lithium carbonate, 20
Lithium Carbonate, 20
lithium carbonate ER, 20
Livalo, 8
Live Better Lancet Super Thin 30G, 33
Live Better Lancet Ultra Thin 28G, 33
LMD 10% Dextrose 5%, 19
LMD 10% Sodium Chloride 0.9%, 19
Lmthf/Pyridoxine HCL/Cyanocobalamin,
37
LO Loestrin FE, 12, 39
Locoid, 10
Loestrin 24 FE, 12, 39
lofene, 15
lokara, 10
Lomedia 24 FE, 12, 39
Lomustine, 3
Longs Lancets Standard, 33
Longs Lancets Thin, 33
Longs Lancets Ultra Thin, 33
lonox, 15
loperamide HCL, 15
lorazepam, 19
lorcet, 25
lorcet HD, 25
lorcet plus, 25
lortab, 25
loryna, 12, 39
Lorzone, 22
losartan potassium, 7
losartan potassium/hydrochlorothiazide,
7
Lotemax, 23
Lotronex, 16
lovastatin, 8
low-ogestrel, 12, 39
loxapine, 20
loxapine succinate, 20
Lozi-flur, 37, 40
Lucentis, 24
ludent, 37, 40
Lufyllin, 28
Lumigan, 23
Lumizyme, 14
Lupron Depot, 4
Lupron Depot-PED, 14
lutera, 12, 39
Lyrica, 21
lysiplex plus, 30
Lysodren, 4
lyza, 12, 39
M
M-m-r II W/Diluent 10 Dose, 29, 41
M-vit, 30, 40
M.v.i. Adult, 31
M.v.i. Pediatric, 31
M.v.i.-12 Without Vitamin K, 31
Macnatal CN DHA, 30
Macugen, 24
mafenide acetate, 10
Magnebind 400, 38
magnesium chloride, 36
magnesium sulfate, 36
Magnesium Sulfate, 37
Magnesium Sulfate IN D5W, 37
Makena, 12
malathion, 10
mannitol, 7
Maprotiline HCL, 20
margesic, 24
marlissa, 12, 39
Marplan, 20
Marqibo, 5
marten-TAB, 24
Mask Vortex/Baby Whirl Duckling, 35
Mask Vortex/Child/Frog, 35
Mask Vortex/Spinner The Duck, 35
Mask Vortex/Toddler/Lady Bug, 35
Matulane, 5
matzim LA, 6
Maxair Autohaler, 28
maximum d3, 29, 42
Maxipime, 1
MD-gastroview, 37
me-PB-hyos, 15
meclizine HCL, 16
Meclofenamate Sodium, 26
Medi-lance Lancets, 33
Medi-seltzer, 25, 38
Medical Provider EZ Flu Shot 2013-2014, 29, 41
Medical Provider EZ Flu Shot 2014-2015, 29, 41
Medical Provider EZ Flu Shot PF 20122013, 29, 41
Medical Provider EZ Flu Shot PF 20132014, 29, 41
Medical Provider EZ Flu Shot PF 20142015, 29, 41
Medichoice Pre-set Safety Lancet Dual Use, 33
Medichoice Pre-set Safety Lancet Low Flow, 33
Medichoice Pre-set Safety Lancet Medium Flow, 33
Medichoice Pre-set Safety Lancet Moderate Flow, 33
Medichoice Safety Lancet Extra, 33
Medichoice Safety Lancet Normal, 33
Medicine Shoppe Lancets, 33
Medicine Shoppe Lancets Thin, 33
Medisense Thin Lancets, 33
Medlance Plus Extra Lancets 21G, 33
Medlance Plus Lancets, 33
Medlance Plus Lancets Lite 25G, 33
Medlance Plus Lite Lancets 25G, 33
Medlance Plus Special Lancets 0.8MM, 33
Medlance Plus Superlite 30G, 33
Medlance Plus Superlite 30G/Comfort Max, 33
Medlance Plus Universal Lancets 21G, 33
Medlance Plus/Lite 25G, 33
Medlance/Extra, 33
Medlance/Lite, 33
Medlance/Universal, 33
medroxyprogesterone acetate, 12(2), 39
mefenamic acid, 26
mefloquine HCL, 3
Mefoxin, 1
mega-c/a plus, 29
megestrol acetate, 4
Meijer Alcohol Swabs Extra-thick, 35
meijer aspirin EC, 25, 38
Meijer Color Lancets Universal 33G, 33
meijer ferrous sulfate, 18, 41
Meijer Lancets, 33
Meijer Lancets Thin, 33
Meijer Lancets Universal 33G, 33
Meijer Super Thin Lancets, 33
Mekinist, 5
meloxicam, 26
Meloxicam, 26
melpaque HP, 10
melphalan hydrochloride, 3
melquin HP, 10
Menactra, 29, 41
Menest, 11
Menhibrix, 28
Menomune-a/C/Y/W-135, 29, 41
Menopur, 14
Mentax, 9
Menveo, 29, 41
meperidine HCL, 25
57
Meperidine HCL, 26
meperitab, 25
Mephyton, 30
Mepivacaine HCL, 27
meprobamate, 19
mercaptopurine, 4
meropenem, 3
mesalamine, 16
mesna, 5
Mesnex, 5
Mestinon, 22
Mestinon Timespan, 22
metadate ER, 21
Metafolbic, 38
Metaproterenol Sulfate, 28
Metastron, 5
metaxalone, 22
metformin HCL, 13
metformin HCL ER, 13
methadone HCL, 25
Methadone HCL, 26
methadone HCL intensol, 25
methadose, 25
Methadose, 26
Methadose Sugar-free, 26
methamphetamine HCL, 21
methazolamide, 7
methenamine hippurate, 16
methenamine mandelate, 16
Methenamine Mandelate, 16
methimazole, 15
Methitest, 11
methocarbamol, 22
methotrexate, 4
methotrexate sodium, 4
methoxsalen, 9
methscopolamine bromide, 15
Methyclothiazide, 7
methyldopa, 7
Methyldopa/Hydrochlorothiazide, 7
Methyldopate HCL, 7
methylene blue, 36
methylergonovine maleate, 24
methylphenidate HCL, 21
methylphenidate HCL CD, 21
methylphenidate HCL ER, 21
Methylphenidate HCL ER, 21
methylphenidate HCL SR, 21
methylphenidate hydrochloride, 21
methylprednisolone, 11
methylprednisolone acetate, 11
methylprednisolone dose pack, 11
methylprednisolone sodiumsuccinate, 11
methyltestosterone/esterified estrogens,
11
methyltestosterone/esterified estrogens
HS, 11
Metipranolol, 23
metoclopramide HCL, 16
metolazone, 7
metoprolol succinate ER, 6
metoprolol tartrate, 6
metoprolol/hydrochlorothiazide, 7
metronidazole, 3, 9
metronidazole IN NACL 0.79%, 3
metronidazole vaginal, 17
mexiletine HCL, 6
mi-omega NF, 17
Miacalcin, 14
Miconazole 3, 17
miconazole 3 combo pack, 17
Microchamber, 35
microgestin 1.5/30, 12, 39
microgestin 1/20, 12, 39
microgestin FE, 12, 39
microgestin FE 1.5/30, 12, 39
Microlet Lancets, 33
micronized colestipol HCL, 8
Microspacer, 35
Microtainer Safety Flow
Lancet/Sterile/Single-use, 33
midazolam HCL, 20
midodrine HCL, 7
migragesic ida, 26
Migralam, 26
Millipred, 11
Millipred DP, 11
milrinone IN dextrose, 5
milrinone lactate, 5
mimvey, 11
mimvey LO, 11
Minastrin 24 FE, 12, 39
Mineral Oil Heavy, 15
miniprin low dose, 25, 38
minitran, 6
Minivelle, 11
Minocin, 1
minocycline HCL, 1
minocycline HCL ER, 1
minoxidil, 7
Mirapex ER, 21
Mirena, 12, 39
mirtazapine, 20
mirtazapine odt, 20
misoprostol, 15
Mission Prenatal, 31, 40
Mission Prenatal HP, 31, 40
mitomycin, 4
mitoxantrone HCL, 4
MM aspirin, 25, 38
modafinil, 21
moderiba, 3
Moderiba, 3
Moderiba 1200 Dose Pack, 3
Moderiba 800 Dose Pack, 3
moexipril HCL, 6
moexipril/hydrochlorothiazide, 7
mometasone furoate, 10
mono-linyah, 12, 39
Monoclate-p, 19
monoject pharma grade flush syringe, 36
monoject pharma grade flush
syringe/heparin lock, 18
monoject prefill advanced heparin lock
flush, 18
monoject sodium chloride flush, 36
Monolet Lancets, 33
Monolet Opd Lancets, 33
Monolettor Safety Lancets, 33
mononessa, 12, 39
Mononine, 19
montelukast sodium, 28
Monurol, 16
morgidox 1X100MG, 1
morgidox 2X100MG, 1
morphine sulfate, 25
Morphine Sulfate, 26
Morphine Sulfate Add-vantage, 26
morphine sulfate ER, 25
morrhuate sodium, 36
Motofen, 15
Moviprep, 15
Moxatag, 1
Moxeza, 23
moxifloxacin HCL, 2
Mozobil, 18
Mst 600, 24
mult-vitamin/fluoride, 30
Multaq, 6
Multi Prenatal, 31, 40
multi vitamin/fluoride, 30
multi-vit/fluoride, 30
multi-vit/iron/fluoride, 30
multi-vitamin/fluoride, 30
multi-vitamin/fluoride/iron, 30
Multigen, 17
Multigen Folic, 17
Multigen Plus, 17
Multitrace-4, 37
multitrace-4 concentrate, 36
Multitrace-4 Neonatal, 37
Multitrace-5, 37
multitrace-5 concentrate, 36
multivitamin with fluoride, 30
multivitamin/fluoride, 30
multivitamins/fluoride, 30
mupirocin, 9
mupirocin calcium, 9
Muse, 8
Mustargen, 3
MVC-fluoride, 30
my way, 12, 39
Myalept, 14
Mycamine, 2
mycophenolate mofetil, 4
mycophenolic acid DR, 4
mydral, 23
myferon 150, 18, 41
myferon 150 forte, 17
Myglucohealth Mgh Softlance Lancets
30G, 33
Mykidz Iron 10, 18, 41
Myleran, 3
Mynatal Advance, 30
Mynatal Plus, 30
Mynatal Ultracaplet, 30
Mynatal-z, 30
Mynate 90 Plus, 30
mynephrocaps, 30
Myobloc, 22
myorisan, 8
Myoxin, 24
Myozyme, 14
Myrbetriq, 16
myzilra, 12, 39
N
n-acetyl-l-cysteine, 36
Nabi-HB, 38
nabumetone, 26
nadolol, 6
nadolol/bendroflumethiazide, 7
nafcillin sodium, 1
Nafcillin Sodium, 1
nafrinse, 37, 40
58
nafrinse drops, 37, 40
Naftin, 9
Naglazyme, 14
nalbuphine HCL, 25
Nalfon, 26
naloxone HCL, 36
naltrexone HCL, 36
Namenda, 22
Namenda Titration PAK, 22
Namenda XR, 22
Namenda XR Titration Pack, 22
Naphazoline HCL, 23
Naprelan, 26
naproxen, 26
naproxen DR, 26
naproxen sodium, 26
naratriptan HCL, 26
Nascobal, 18
Nasonex, 27
nat-rul prenatal vitamins, 31, 40
nat-rul vitamin d, 29, 42
Natacyn, 23
Natazia, 12, 39
nateglinide, 13
Natroba, 11
Nature-throid, 15
nava-sc, 10
Nebupent, 3
nebusal, 27
necon 0.5/35-28, 12, 39
necon 1/35, 12, 39
Necon 1/50-28, 11, 38
Necon 10/11-28, 11, 38
necon 7/7/7, 12, 39
Neevo DHA, 31
nefazodone HCL, 20
Nefazodone HCL, 20
neo-polycin, 22
neo-polycin HC, 23
neofrin, 23
neomycin sulfate, 2
neomycin/bacitracin/polymyxin, 23
neomycin/polymyxin b sulfates, 17
neomycin/polymyxin/bacitracin zinc, 23
neomycin/polymyxin/bacitracin/hydrocorti
sone, 23
neomycin/polymyxin/dexamethasone, 23
neomycin/polymyxin/gramicidin, 23
neomycin/polymyxin/HC, 24
Neomycin/Polymyxin/Hydrocortisone, 23
neomycin/polymyxin/hydrocortisone, 24
neostigmine methylsulfate, 22
nephronex, 30
Nessi Spacer/Large Mask, 35
Nessi Spacer/Mouthpiece, 35
Nessi Spacer/Small/MED Mask, 35
Netgroup Lancets, 33
neuac, 8
Neulasta, 18
Neumega, 18
Neupogen, 18
Neupro, 21
Neurodep, 30
neutragard advanced, 19
neutral sodium fluoride, 19
Nevanac, 24
nevirapine, 2
Nevirapine, 2
nevirapine ER, 2
Nexavar, 5
Nexium, 15
Nexplanon, 12, 39
next choice one dose, 12, 39
Nexterone, 6
niacin ER, 8
niacinamide/azelaic ac/ turmer/fa/b6/zinc
ox/copper, 30
Niacor, 8
Nicadan, 31
nicardipine HCL, 6
Nicazel, 31
Nicazel Forte, 31
nicorelief, 21, 42
nicotine, 21, 42
nicotine polacrilex, 22, 42
nicotine polacrilex refill, 22, 42
nicotine polacrilex starter kit, 22, 42
nicotine step 1, 22, 42
nicotine step 2, 22, 42
nicotine step 3, 22, 42
nicotine transdermal system, 22, 42
Nicotine Transdermal System, 22, 42
Nicotrol Inhaler, 22, 42
Nicotrol Ns, 22, 42
nifediac CC, 6
nifedical XL, 6
nifedipine, 6
nifedipine ER, 6
nikki, 12, 39
Nilandron, 4
nimodipine, 6
Nipent, 5
nisoldipine, 6
Nisoldipine, 6
Nisoldipine ER, 6
Nitro-bid, 6
Nitro-dur, 6
nitro-time, 6
nitrofurantoin, 16
nitrofurantoin macrocrystals, 16
nitrofurantoin monohydrate, 16
nitrofurantoin
monohydrate/macrocrystals, 16
nitroglycerin, 6
Nitroglycerin, 6
nitroglycerin ER, 6
nitroglycerin IN 5% dextrose, 6
nitroglycerin IN dextrose 5%, 6
Nitroglycerin IN Dextrose 5%, 6
nitroglycerin lingual, 6
Nitroglycerin Lingual, 6
nitroglycerin transdermal, 6
Nitromist, 6
Nitrostat, 6
nizatidine, 15
nodolor, 26
nora-be, 12, 39
Norditropin Cartridge, 14
Norditropin Flexpro, 14
Norditropin Nordiflex Pen, 14
norepinephrine bitartrate, 7
norethindrone, 12, 39
norethindrone acetate, 12
norethindrone acetate/ethinyl estradiol,
12, 39
norethindrone acetate/ethinyl
estradiol/ferrous fumarate, 12, 39
norgestimate/ethinyl estradiol, 12, 39
norlyroc, 12, 39
normal saline flush, 36
normal saline flush for flushing vascular
access devices, 36
normal saline i.v. flush, 36
Normosol -r, 37
normosol-m IN D5W, 36
Normosol-r IN D5W, 37
Noroxin, 2
Norpace CR, 6
nortrel 0.5/35 (28), 12, 39
nortrel 1/35, 12, 39
nortrel 7/7/7, 12, 39
nortriptyline HCL, 20
Nortriptyline HCL, 20
nortuss-DE, 27
Nortuss-EX, 27
Norvir, 2
norwich aspirin, 25, 38
Nova Safety Lancets 23G, 33
Nova Safety Lancets 28G, 33
Nova Sureflex Lancets, 33
Novaferrum Pediatric Drops, 18, 41
novarel, 14
Novofine 30GX8MM, 33
Novofine 32GX6MM, 33
Novofine Autocover 30GX8MM, 33
Novolin 70/30, 13
Novolin 70/30 Relion, 13
Novolin N, 13
Novolin N Relion, 13
Novolin R, 13
Novolin R Relion, 13
Novolog, 13
Novolog Flexpen, 13
Novolog Mix 70/30, 13
Novolog Mix 70/30 Prefilled Flexpen, 13
Novolog Penfill, 13
Novoseven, 19
Novoseven Rt, 19
Novotwist 30GX8MM, 33
Novotwist 32GX5MM, 33
Noxafil, 2
NP thyroid, 15
NP thyroid 30, 15
NP thyroid 60, 15
NP thyroid 90, 15
Nplate, 18
nu-iron 150, 18, 41
Nucynta, 26
Nucynta ER, 26
Nuedexta, 22
nufol, 17
nulev, 15
Nulojix, 4
Numoisyn, 19
nuquin HP, 10
Nutricap, 31
nutrifac ZX, 30
nutrilyte, 36
nutrilyte II, 36
Nutropin, 14
Nutropin AQ Nuspin 10, 14
Nutropin AQ Nuspin 20, 14
Nutropin AQ Nuspin 5, 14
Nutropin AQ Pen, 14
59
Nuvaring, 12, 39
Nuvigil, 21
nyamyc, 9
nystatin, 2, 9, 19
nystatin/triamcinolone, 9
nystop, 9
O
OB-natal One, 30
Obstetrix EC, 30
ocella, 12, 39
Octagam, 38
octreotide acetate, 14
ocucoat viscoadherent, 24
Ocudox, 1
ofloxacin, 2, 23, 24
Ofloxacin, 2
Ogestrel, 11, 38
olanzapine, 20
olanzapine odt, 20
olanzapine/fluoxetine, 21
Olysio, 3
Omeclamox-PAK, 15
omega-3-acid ethyl esters, 8
omeprazole, 15
omeprazole/sodium bicarbonate, 15
Omnaris, 27
Omniflex Diaphragm, 39
Omnitrope, 14
Omontys, 18
On Call Lancets, 33
On Call Plus Lancets, 33
Oncaspar, 4
ondansetron HCL, 16
ondansetron odt, 16
One A Day Womens Prenatal/DHA, 31
One-a-day Womens Prenatal, 31, 40
Onetouch Basic System, 33
Onetouch Basic/Profile Test Strips, 33
Onetouch Club Lancets Fine Point, 33
Onetouch Combo Pack, 33
Onetouch Delica Lancets Extra Fine 33G, 33
Onetouch Delica Lancets Fine 30G, 33
Onetouch Delica Lancing Device, 33
Onetouch Finepoint Lancets, 33
Onetouch Lancets, 33
Onetouch Ping Insulin P.M., 33
Onetouch Ping Meter Remote, 33
Onetouch Profile System, 33
Onetouch Suresoft Lancing Device/18G, 33
Onetouch Suresoft Lancing Device/21G, 33
Onetouch Suresoft Lancing Device/28G, 33
Onetouch Ultra 2, 33
Onetouch Ultra Blue, 33
Onetouch Ultra Control, 33
Onetouch Ultra Mini, 33
Onetouch Ultra System Kit, 33
Onetouch Ultralink System (DEC), 33
Onetouch Ultralink System (hex), 33
Onetouch Ultrasmart, 33
Onetouch Ultrasoft Lancets, 33
Onetouch Verio Control Solution High, 33
Onetouch Verio IQ Blood Glucose Monitoring System, 33
Onetouch Verio Mid Control Solution, 33
Onetouch Verio Sync Bloodglucose Monitoring System, 33
Onetouch Verio Test Strips, 33
Onfi, 21
Onglyza, 13
Opana ER (crush Resistant), 26
opium, 15
opium tincture, 15
Opium Tincture (paregoric), 15
Opsumit, 8
Optichamber Advantage, 35
Optichamber Diamond, 35
Optichamber Diamond/Largeface Mask,
35
Optichamber Diamond/Medium Face Mask, 35
Optichamber Diamond/Smallface Mask, 35
Optichamber Valved Holding Chamber, 35
Optichamber/Mask, 35
Optihaler, 35
Optihaler MDI Drug Delivery System, 35
optimal-d, 29, 42
optimal-d pack, 29, 42
Options Conceptrol Vaginal
Contraceptive, 17, 39
Options Gynol II Vaginal Contraceptive, 17, 39
opurity vitamin d, 29, 42
Oracea, 9
Oracit, 17
oralone, 19
Orap, 22
Orapred Odt, 11
Oravig, 19
Orencia, 26
Orfadin, 14
orphenadrine citrate, 22
orphenadrine citrate ER, 22
orphenadrine/asa/caffeine, 22
orsythia, 12, 39
Ortho Diaphragm All-flex/65MM, 39
Ortho Diaphragm All-flex/70MM, 40
Ortho Diaphragm All-flex/75MM, 40
Ortho Diaphragm All-flex/80MM, 40
Ortho Diaphragm Coil Spring Kit 100, 40
Ortho Diaphragm Coil Spring Kit 105, 40
Ortho Diaphragm Coil Spring Kit 50, 40
Ortho Diaphragm Flat Spring Kit 55, 40
Ortho Diaphragm Flat Spring Kit 60, 40
Ortho Diaphragm Flat Spring Kit 65, 40
Ortho Diaphragm Flat Spring Kit 70, 40
Ortho Diaphragm Flat Spring Kit 75, 40
Ortho Diaphragm Flat Spring Kit 80, 40
Ortho Diaphragm Flat Spring Kit 85, 40
Ortho Diaphragm Flat Spring Kit 90, 40
Ortho Diaphragm Flat Spring Kit 95, 40
ortho-CS 250, 29
ortho-est, 11
Orthovisc, 22
oscimin, 15
oscimin SR, 15
oscion cleanser, 8
osmitrol viaflex, 7
Osmoprep, 15
otic care, 24
oticin, 24
oto-end 10, 24
otomax-HC, 24
Otozin, 24
Ovace Plus, 9
Ovidrel, 14
oxacillin sodium, 1
oxaliplatin, 3
oxandrolone, 11
oxaprozin, 26
oxazepam, 19
oxcarbazepine, 21
Oxecta, 26
Oxistat, 9
Oxsoralen, 10
oxybutynin chloride, 16
oxybutynin chloride ER, 16
oxycodone HCL, 25
Oxycodone HCL, 26
Oxycodone HCL ER, 26
oxycodone/acetaminophen, 25
oxycodone/aspirin, 25
oxycodone/ibuprofen, 25
Oxycontin, 26
oxymorphone hydrochloride, 25
oxymorphone hydrochloride ER, 25
oxytocin, 24
Oxytrol, 16
Oxytrol For Women, 16
Ozurdex, 23
P
PA Prenatal Formula, 31, 40
PA vitamin d-3, 29, 42
PA vitamin d-3 gummy, 29, 42
pacerone, 6
paclitaxel, 5
Paclitaxel, 5
pamidronate disodium, 13
Pamidronate Disodium, 13
Pancrelipase, 16
pancuronium bromide, 22
Panda Mask Large, 35
Panda Mask Medium, 35
Panda Mask Small, 35
Panretin, 11
pantoprazole sodium, 15
papaverine HCL, 8
Paragard Intrauterine Copper Contraceptive T380a, 12
parcaine, 23
paricalcitol, 14
paroex, 19
paromomycin sulfate, 2
paroxetine HCL, 20
paroxetine HCL ER, 20
Paser, 2
Pataday, 24
Patanase, 27
Patanol, 24
Paxil, 20
PCE, 1
pedi-dri, 9
Pediaderm HC, 10
Pediaderm Ta, 10
Pediarix, 28, 41
Pediatric Panda Mask, 35
Pedipirox-4 Nail, 9
Pedvax HIB, 29, 41
60
peg 3350/electrolytes, 15, 43
peg-3350/electrolytes, 15, 43
peg-3350/NACL/NA bicarbonate/KCL, 15, 43
Peg-intron, 3
Peg-intron Redipen, 3
Peg-intron Redipen PAK 4, 3
Peganone, 21
Pegasys, 3
Pegasys Proclick, 3
pegylax, 15
Pen Needles 29G X 12MM, 33
Pen Needles 29GX1/2", 33
Pen Needles 30GX5/16", 33
Pen Needles 31G X 1/4" SHORT, 33
Pen Needles 31G X 3/16", 33
Pen Needles 31G X 6MM, 33
Pen Needles 31GX5/16", 33
penicillin G potassium, 1
Penicillin G Potassium IN Iso-osmotic Dextrose, 1
Penicillin G Procaine, 1
Penicillin G Sodium, 1
penicillin v potassium, 1
Pentacel, 28, 41
Pentasa, 16
pentazocine/acetaminophen, 25
pentazocine/naloxone HCL, 25
pentoxifylline ER, 19
Perfect Iron, 18, 41
Perfect Lancets 30G, 33
Perfect Pressure Activated Safety Lancets 28G, 33
Perforomist, 28
perindopril erbumine, 6
perio MED, 19
periogard, 19
Perjeta, 4
permethrin, 10
perphenazine, 20
Perphenazine/Amitriptyline, 21
Perry Prenatal, 31, 40
Pertzye, 16
Pfizerpen-G, 1
Pharmacist Choice Alcoholprep Pads, 35
Pharmacist Choice Ultra Thin Lancets, 33
Pharmacist Choice Ultra Thin Lancets
28G, 34
Pharmacist Choice Ultra Thin Lancets
30G, 34
Pharmacist Choice Ultra Thin Lancets
31G, 34
Pharmacist Choice Ultra Thin Lancets
33G, 34
Pharmacy Counter Lancets, 34
phenadoz, 27
phenazo, 17
phenazopyridine HCL, 17
phendimetrazine tartrate, 21
Phendimetrazine Tartrate ER, 21
phenelzine sulfate, 20
phenergan, 27
phenobarbital, 20
Phenobarbital, 20
Phenobarbital Sodium, 20
phentermine HCL, 21
Phentolamine Mesylate, 7
phenylephrine HCL, 7, 23
Phenylephrine HCL, 7
phenylephrine/guaifenesin, 27
phenytoin, 21
phenytoin infatabs, 21
phenytoin sodium, 21
phenytoin sodium extended, 21
philith, 12, 39
Phisohex, 38
phos-flur, 19
Phoslyra, 16
phospha 250 neutral, 36
phosphasal, 16
Phospholine Iodide, 23
Photofrin, 5
Physicians EZ Use Flu Kit 2012-2013, 29, 41
physiolyte, 36
physiosol irrigation, 36
phytonadione, 29
Picato, 11
pilocarpine HCL, 19, 23
pilocarpine hydrochloride, 19
Pilopine HS, 23
pimtrea, 12, 39
pindolol, 6
pioglitazone HCL, 13
pioglitazone HCL-glimepiride, 13
pioglitazone HCL/metformin HCL, 13
piperacillin sodium/ tazobactam sodium,
1
piperacillin sodium/tazobactam sodium, 1
piperacillin/tazobactam, 1
pirmella 1/35, 12, 39
pirmella 7/7/7, 12, 39
piroxicam, 26
plasbumin-25, 19
plasbumin-5, 19
Plasma-lyte A, 38
Plasma-lyte-148, 38
Pneumovax 23, 29, 41
Pneumovax 23/1 Dose, 29, 41
Pneumovax 23/5 Dose, 29, 41
PNV-DHA, 30
PNV-select, 30
Pocket Chamber, 35
Pocket Spacer, 35
podofilox, 10
polocaine, 27
polocaine-mpf, 27
poly-dex, 23
poly-iron 150, 18, 41
poly-iron 150 forte, 17
polycin, 23
polycin b, 23
polyethylene glycol 3350, 15
polymyxin b sulfate, 3
polymyxin b sulfate/trimethoprim sulfate,
23
polysaccharide iron forte, 17
Pomalyst, 4
portia-28, 12, 39
Potaba, 30
potassium acetate, 36
Potassium Acetate, 37
potassium bicarbonate, 36
potassium chloride, 36
Potassium Chloride, 37
potassium chloride 0.15% /NACL 0.45% viaflex, 36
Potassium Chloride 0.15% /NACL 0.45% Viaflex, 37
potassium chloride 0.15% D5W/NACL 0.33%, 36
potassium chloride 0.15% D5W/NACL 0.45%, 36
potassium chloride 0.15% D5W/NACL 0.45% viaflex, 36
potassium chloride 0.15% NACL 0.9%, 36
potassium chloride 0.15% w/NACL 0.9%
viaflex, 36
potassium chloride 0.15%/D5W, 36
Potassium Chloride 0.15%/NACL 0.9%, 37
potassium chloride 0.22% D5W/NACL 0.45%, 36
potassium chloride 0.224%/D5W/NACL 0.45%, 36
potassium chloride 0.224%D5W/NACL 0.45% viaflex, 36
Potassium Chloride 0.3%/ NACL 0.9%, 37
potassium chloride 0.3%/D5W, 36
potassium chloride 0.3%/NACL 0.9%/viaflex, 36
potassium chloride CR, 36
potassium chloride ER, 36
Potassium Chloride ER, 37
potassium chloride SR, 36
potassium citrate ER, 17
potassium citrate-citric acid crystals, 17
potassium phosphate, 36
potassium phosphates, 36
Potiga, 21
pr benzoyl peroxide wash, 8
Pr Natal 400, 30
Pr Natal 400 EC, 30
Pr Natal 430, 30
Pr Natal 430 EC, 30
Pradaxa, 18
pramcort, 16
pramipexole dihydrochloride, 21
Pramosone, 10
Pramosone E, 10
pramox gel, 10
pramoxine-HC, 24
Prandimet, 13
prascion, 8
prascion fc, 8
prascion ra with sunscreens, 8
pravastatin sodium, 8
prazosin HCL, 7
Pre-natal Formula, 31, 40
Precision Thin Lancets, 34
Precision Thins GP Lancet, 34
Precision Ultra Lancet, 34
Pred Mild, 23
prednicarbate, 10
prednisolone, 11
prednisolone acetate, 23
prednisolone sodium phosphate, 11
Prednisolone Sodium Phosphate, 11, 23
prednisone, 11
Prednisone, 11
Prednisone Intensol, 11
61
Prefera OB, 31
Prefera OB + DHA, 31
Preferaob One, 31
Preferred Plus Lancets Colored 21G, 34
Preferred Plus Lancets Super Thin 30G,
34
Preferred Plus Lancets Thin 26G, 34
pregnyl w/diluent benzyl alcohol/NACL, 14
Premarin, 11
premasol, 36
Premphase, 11
Prempro, 11
Prenaissance Plus, 30
Prenaplus, 30, 40
Prenatabs Fa, 30
Prenatabs RX, 30
Prenatal, 31, 40
Prenatal 19, 30
Prenatal Ad, 30
Prenatal And Iron, 31, 40
Prenatal Complete, 31, 40
Prenatal Formula, 31, 40
Prenatal Forte, 31, 40
Prenatal Low Iron, 30, 40
Prenatal Multi +dha, 31, 40
Prenatal Multivitamin + DHA, 31
Prenatal One Daily, 31, 40
Prenatal Plus DHA, 31
Prenatal Vitamins, 31, 40
Prenatal-u, 30
Prenatal/Omega-3/Folic Acid/Iron, 31
Prentif Cavity-rim Cervical CAP, 40
Prentif Fitting Set, 40
Prepopik, 15
Prevacid Solutab, 15
prevalite, 8
previfem, 12, 39
Prevnar 13, 29, 41
Prezista, 2
Prialt, 25
Priftin, 2
Prilosec, 15
Primaquine Phosphate, 3
primidone, 21
Primsol, 3
Pristiq, 20
Privigen, 38
Proair HFA, 28
probenecid, 27
probenecid/colchicine, 27
Procainamide HCL, 6
Procentra, 21
prochlorperazine, 20
prochlorperazine edisylate, 20
prochlorperazine maleate, 20
Procrit, 18
procto-PAK, 16
proctocream HC, 16
Proctofoam HC, 16
proctosol HC, 16
proctozone-HC, 16
Procysbi, 17
Prodigy Autocode Blood Glucose Monitoring System, 34
Prodigy Autocode Blood Glucose Monitoring/Talking, 34
Prodigy Autocode Pro Blood Glucose
Monitoring System, 34
px stop smoking aid, 22, 42
Prodigy NO Coding Blood Glucose Test Pylera, 15
pyrazinamide, 2
Strips, 34
Prodigy Pocket Blood Glucose Meter Kit, pyridostigmine bromide, 22
Pyridoxine HCL, 29
34
Prodigy Pocket Pro Blood Glucose Q
Monitoring System, 34
Qc Alcohol Swabs, 35
Prodigy Pressure Activated Safety qc aspirin, 25, 38
Lancets, 34
qc aspirin low dose, 25, 38
Prodigy Twist Top Lancets, 34
qc childrens aspirin, 25, 38
Prodigy Voice Blood Glucose Meter Kit, qc ferrous sulfate, 18, 41
34
Qc Lancets, 34
Prodigy Voicepro Blood Glucose Qc Lancets Super Thin, 34
Monitoring System, 34
Qc Lancets Thin, 34
Profe, 18, 41
Qc Lancets Ultra Thin, 34
Proferrin ES, 18, 41
Qc Prenatal, 31, 40
Profilnine SD, 19
Qnasl, 27
progesterone, 12
Quadramet, 5
Proglycem, 13
Qualaquin, 3
Prograf, 4
quasense, 12, 39
Prolastin-c, 28
Quazepam, 20
Prolensa, 24
quetiapine fumarate, 20
Proleukin, 5
Quflora Pediatric, 30
Prolia, 14
Quillivant XR, 21
Promacta, 18
quinapril HCL, 6
promethazine HCL, 27
quinapril/hydrochlorothiazide, 7
promethazine HCL plain, 27
Quinidine Gluconate, 6
promethazine VC, 27
quinidine gluconate CR, 6
Promethazine VC Plain, 27
quinidine gluconate ER, 6
promethazine VC/codeine, 27
quinidine sulfate, 6
Promethazine VC/Codeine, 27
Quinidine Sulfate, 6
promethazine-DM, 27
Quinidine Sulfate ER, 6
promethazine/codeine, 27
quinine sulfate, 3
promethazine/dextromethorphan, 27
Qvar, 28
promethegan, 27
R
pronutrients vitamin d3, 29, 42
propafenone HCL, 6
Ra Alcohol Swabs, 35
propafenone HCL ER, 6
ra aspirin, 25, 38
Propantheline Bromide, 15
ra aspirin adult low dose, 25, 38
proparacaine HCL, 23
ra aspirin adult low strength, 25, 38
propofol, 27
ra aspirin childrens, 25, 38
propranolol HCL, 6
ra aspirin EC, 25, 38
Propranolol HCL, 6
ra aspirin EC adult low strength, 25, 38
propranolol HCL ER, 6
ra childrens aspirin, 25, 38
Propranolol/Hydrochlorothiazide, 7
Ra E-ZJECT Color Lancets Micro-thin propylthiouracil, 15
33G, 34
Proquad, 29, 41
Ra E-ZJECT Lancets 28G, 34
Prostigmin, 22
Ra E-ZJECT Lancets Thin 26G, 34
Protamine Sulfate, 19
Ra E-ZJECT Lancets Thin 28G, 34
Protopic, 10
Ra E-ZJECT Lancets Ultra Thin 30G, 34
protriptyline HCL, 20
ra folic acid, 18, 40
Provenge, 5
ra high potency iron, 18, 41
Proventil HFA, 28
ra iron, 18, 41
Prudoxin, 9
ra mini nicotine, 22, 42
Pss Select GP Lancets, 34
ra nicotine, 22, 42
Pss Select Safety Lancets, 34
ra nicotine polacrilex, 22, 42
Pulmicort, 28
ra nicotine transdermal system step 3, Pulmicort Flexhaler, 28
22, 42
pulmosal, 27
Ra One Daily, 31, 40
Pulmozyme, 28
Ra Prenatal, 31, 40
purevit dualfe plus, 17
Ra Prenatal Formula/Folicacid, 31, 40
px aspirin, 25, 38
ra slow release iron, 18, 41
px enteric aspirin, 25, 38
ra vitamin d-3, 29, 42
px folic acid, 18, 40
Rabavert, 28
px iron, 18, 41
rabeprazole sodium, 15
Px Lancets, 34
raloxifene hydrochloride, 14
Px Lancets Ultra Thin, 34
ramipril, 6
Px Prenatal Multivitamins, 31, 40
Ranexa, 6
62
ranitidine HCL, 15
Rapaflo, 17
Rapamune, 4
Ravicti, 14
Rayos, 11
rea LO 39, 10
rea LO 40, 10
Reality Lancets, 34
Reality Swabs, 35
Reality Trigger Lancets, 34
Rebetol, 3
Rebif, 22
Rebif Rebidose, 22
Rebif Rebidose Titration Pack, 22
Rebif Titration Pack, 22
reclipsen, 12, 39
Recombinate, 19
Recombivax HB, 29, 41
rectacort-HC, 16
Rectiv, 16
Refissa, 11
Regonol, 22
Regranex, 10
Relenza Diskhaler, 2
Relion Alcohol Swabs, 35
Relion Lancets, 34
Relion Lancets Micro-thin33G, 34
Relion Lancets Standard 21G, 34
Relion Lancets Thin 26G, 34
Relion Lancets Ultra-thin30G, 34
Relion Thin Lancets, 34
Relion Ultra Thin Lancets, 34
Relion Ultra Thin Lancets30G, 34
Relion Ultra Thin Plus Lancets 32G, 34
Relion Ultra Thin Plus Lancets 33G, 34
Relistor, 16
Relpax, 26
remergent HQ, 10
remeven, 10
Remicade, 16
Remodulin, 8
rena-vite RX, 30
Renacidin, 17
Renagel, 16
renal, 30
renalpren, 30
Renew Advanced Lancing Cartridge
Refills, 34
reno CAPS, 30
Renova, 11
Renova P.M., 11
Renvela, 16
repaglinide, 13
repan, 24
Replesta, 30, 43
Replesta Childrens, 30, 43
Replesta Nx, 30, 43
reprexain, 25
Repronex, 14
Req 49+, 31
Rescon-JR, 27
Rescriptor, 2
Reserpine, 7
Respa-BR, 27
Restasis, 23
Retisert, 23
Retrovir IV Infusion, 2
Revatio, 8
Revlimid, 4
revonto, 22
Rexall Lancets Ultra Thin, 34
Reyataz, 2
Rezira, 28
Rheumatrex, 26
Rhinoflex-650, 24
Rhophylac, 38
Riastap, 19
ribasphere, 3
Ribasphere, 3
Ribasphere Ribapak, 3
Ribatab, 3
ribavirin, 3
Ridaura, 26
rifabutin, 2
Rifamate, 2
rifampin, 2
Rifater, 2
Right Step Prenatal, 31, 40
Rightest Gl300 Lancets, 34
riluzole, 22
rimantadine HCL, 2
ringers injection, 36
ringers irrigation, 36
Riomet, 13
risedronate sodium, 13
Risperdal Consta, 20
risperidone, 20
risperidone M-TAB, 20
risperidone odt, 20
Riteflo, 35
Rituxan, 4
rivastigmine tartrate, 21
Rixubis, 19
rizatriptan benzoate, 26
rizatriptan benzoate odt, 26
rocuronium bromide, 22
romycin, 23
ropinirole ER, 21
ropinirole HCL, 21
ropivacaine, 27
ropivacaine HCL, 27
rosadan, 9
rosanil cleanser, 8
Rotarix, 29, 41
Rotateq, 29, 41
roxicet, 25
Rozerem, 20
Rybix Odt, 26
S
Sabril, 21
Saccharin Sodium, 37
Safe-t-lance Low Flow 25G, 34
Safe-t-lance Normal Flow 21G, 34
Safe-t-lance Plus Safety Lancet High
Flow, 34
Safe-t-lance Plus Safety Lancet Low
Flow, 34
Safe-t-lance Plus Safety Lancet Normal
Flow, 34
Safety Lancet 21G/Pressure Activated,
34
Safety Lancet 28G/Pressure Activated,
34
Safety Lancet 2MM, 34
Safety Lancets, 34
Safety Lancets 21G, 34
Safety Lancets 28G, 34
Safety Let Lancets, 34
Safety Seal Lancets 28G, 34
Safety Seal Lancets 30G, 34
Safyral, 12, 39
Saizen, 14
Saizen Click.easy, 14
salacyn, 10
salicylic acid, 10
salicylic acid cream, 10
salicylic acid lotion, 10
salicylic acid wart remover, 10
saline flush, 36
saline flush zr/sterile field, 36
salsalate, 24
Salvax, 10
Samsca, 14
Sancuso, 16
Sandimmune, 4
Sandostatin Lar Depot, 14
Saphris, 20
Saps Care Alcohol Prep Pads, 35
Sapscare Twist Top Lancets 30G, 34
sash kit for flushing vascular access
devices, 18
Savella, 22
SB Alcohol Prep Pads, 36
SB aspirin, 25, 38
SB aspirin EC, 25, 38
SB childrens aspirin, 25, 38
SB Lancets Thin, 34
SB Lancets Ultra Thin, 34
SB low dose asa EC, 25, 38
scalacort, 10
scleromate sodium morrhuate, 36
Scopolamine Hydrobromide, 15
se 10-5 ss, 8
se bpo 3% foaming cloths, 8
se bpo 6% foaming cloths, 8
Se Bpo 7-5.5 Wash Kit, 8
se bpo 9% foaming cloths, 8
se bpo wash, 8
Se-natal 19, 30
Se-tan DHA, 30
se-tan plus, 17
Seb-prev, 9
seb-prev wash, 9
selegiline HCL, 21
Selenium, 37
selenium sulfide, 9
Selenium Sulfide, 9
Selzentry, 2
Sensipar, 14
sensorcaine, 27
sensorcaine-mpf, 27
sensorcaine-mpf spinal, 27
sensorcaine-mpf/epinephrine, 27
sensorcaine/epinephrine, 27
Serevent Diskus, 28
Seromycin, 2
serophene, 14
Seroquel XR, 20
Serostim, 14
sertraline HCL, 20
Seton Et-EC, 30
Setonet, 30
Sevelamer Carbonate, 16
sevoflurane, 27
63
SF, 19
SF 5000 plus, 19
sharobel, 12, 39
Shopko Alcohol Swabs, 35
Shopko On-the-go Comfort Lancets 30G, 34
Shopko Unilet Lancets Super Thin 30G, 34
Shopko Unilet Lancets Ultra Thin 28G, 34
Shur-seal, 17, 40
Siderol, 31
Signifor, 14
sildenafil, 8
sildenafil citrate, 8
Silenor, 20
Silver Nitrate, 10
silver sulfadiazine, 10
Simcor, 8
Similac Prenatal Early Shield, 31
Simponi, 26
Simponi Aria, 26
Simulect, 4
simvastatin, 8
Single-let, 34
sirolimus, 4
Sirturo, 2
skin bleaching, 10
skin bleaching/sunscreen, 10
Sklice, 11
Skyla, 12, 40
slow iron, 18, 41
slow release iron, 18, 41
Slow Release Iron, 18, 41
Sm Alcohol Prep Pads, 35
sm aspirin, 25, 38
sm aspirin adult low strength, 25, 38
sm aspirin EC low strength, 25, 38
sm aspirin enteric coated, 25, 38
sm aspirin low dose, 25, 38
sm childrens aspirin, 25, 38
sm folic acid, 18, 40
sm iron, 18, 41
sm iron slow release, 18, 41
Sm Lancets 21G, 34
Sm Micro Thin Lancets 33G, 34
sm nicotine, 22, 42
sm nicotine polacrilex, 22, 42
Sm One Daily Prenatal, 31, 40
sm prenatal vitamins, 31, 40
Sm Prenatal Vitamins, 31, 40
Sm Slow Release Iron, 18, 41
Sm Super Thin Lancets, 34
Sm Super Thin Lancets 30G, 34
Sm Thin Lancets 26G, 34
sm vitamin d, 29, 42
sm vitamin d3, 29, 42
Sm Vitamin D3 Maximum Strength, 30, 43
Smart Diabetes Vantage Universal Lancets 30G, 34
Smart Sense Color Lancets Universal 33G, 34
Smart Sense Standard Lancets Universal 21G, 34
Smart Sense Super Thin Lancets Universal 30G, 34
Smart Sense Thin Lancets Universal 26G, 34
Smartest Lancets 28G, 34
sodium acetate, 36
Sodium Bicarbonate, 15
sodium bicarbonate, 36
sodium bicarbonate partial fill, 36
sodium chloride, 17, 27, 37
Sodium Chloride, 37
sodium chloride 0.45%, 37
sodium chloride 0.45% viaflex, 37
sodium chloride 0.9%, 17
sodium chloride bacteriostatic, 37
sodium chloride flush, 37
sodium chloride pab, 37
Sodium Edecrin, 7
sodium ferric gluconate complex/sucrose, 18
Sodium Fluoride, 37, 40
sodium fluoride, 37, 40
sodium hyaluronate, 10
Sodium Lactate, 37
sodium phenylbutyrate, 14
sodium phosphate, 37
sodium polystyrene sulfonate, 37
Sodium Saccharin Dihydrate, 37
sodium sulfacetamide, 8, 9, 23
sodium sulfacetamide wash, 9
sodium sulfacetamide/sulfur, 8
Sodium Sulfacetamide/Sulfur, 8
sodium sulfacetamide/sulfur cleanser, 8
Sodium Sulfacetamide/Sulfur Cleanser IN Urea, 8
sodium sulfacetamide/sulfur cleansing cloths, 8
sodium sulfacetamide/sulfur green, 8
Sodium Sulfacetamide/Sulfur IN Urea, 8
sodium sulfacetamide/sulfur w/sunscreen, 8
sodium sulfacetamide/sulfur wash, 8
Sodium Sulfacetamide/Urea, 9
sodium thiosulfate, 37
sojourn, 27
solia, 12, 39
Soliris, 19
Solodyn, 1
Soltamox, 4
Solu-cortef, 11
Solus V2 Pressure Activated Safety Lancets 28G, 34
Solus V2 Twist Lancets 30G, 34
Somatuline Depot, 14
Somavert, 14
Sorbitol, 17
Sorbitol-mannitol, 17
sorine, 6
sotalol HCL, 6
sotalol HCL (AF), 6
Sovaldi, 3
Spinosad, 11
Spiriva Handihaler, 28
spironolactone, 7
spironolactone/hydrochlorothiazide, 7
Sporanox, 2
sprintec 28, 12, 39
Sprix, 26
Sprycel, 5
SR nicotine gum, 22, 42
sronyx, 12, 39
ssd, 10
sss 10%-5%, 8
sss 10-5, 8
st joseph aspirin, 25, 38
stagesic, 25
stannous fluoride oral rinse, 19
stavudine, 2
Stavzor, 21
Stelara, 9
Sterilance TL, 34
sterile diluent for epoprostenol sodium, 37
sterile water for injection, 37
sterile water irrigation, 37
sterile water irrigation plastic bottle, 37
sterile water irrigation w/hanger, 37
Stimate, 14
Stivarga, 5
Strattera, 21
Streptomycin Sulfate, 2
Striant, 11
Stribild, 2
Stromectol, 3
Strovite Forte, 30
Strovite One, 31
strovite plus, 30
Stuart One, 31
Stuart Prenatal, 31, 40
Stuart Prenatal + DHA, 31, 40
Suboxone, 26
Subsys, 26
Suclear, 15
Sucraid, 16
sucralfate, 15
sufentanil citrate, 25
sulfacetamide sodium, 8, 23
Sulfacetamide Sodium, 23
sulfacetamide sodium/prednisolone sodium phosphate, 23
sulfacetamide sodium/sulfur cleanser, 8
sulfacleanse 8/4, 8
Sulfadiazine, 2
sulfamethoxazole/trimethoprim, 3
Sulfamethoxazole/Trimethoprim, 3
sulfamethoxazole/trimethoprim DS, 3
Sulfamylon, 10
sulfasalazine, 16
sulfatrim pediatric, 3
sulfazine, 16
sulfazine EC, 16
sulindac, 26
Sumatriptan, 26
sumatriptan succinate, 26
Sumatriptan Succinate, 26
sumatriptan succinate refill, 26
Sumavel Dosepro, 26
Supartz, 22
Super Daily D3, 30, 43
Super Thin Lancets, 34
Supprelin LA, 14
Suprax, 1
Suprep Bowel Prep, 15
Sure Comfort Alcohol Prep Pads, 35
Sure Comfort Lancets 28G, 34
Sure Comfort Lancets 30G, 34
Sure-lance Flat Lancets, 34
Sure-lance Lancets 26G, 34
Sure-lance Thin Lancets 28G, 34
64
Sure-lance Ultra Thin Lancets, 34
Sure-prep Alcohol Prep Pads, 35
Sure-touch Lancets Universal, 34
Surelite Lancets, 34
Surestep Pro Test Strips, 34
Surestep Test Strips, 34
Sustiva, 2
Sutent, 5
sw nicotine polacrilex, 22, 42
swabflush saline flush, 37
syeda, 12, 39
Sylatron, 5
symax fastabs, 15
symax-SL, 15
symax-SR, 15
Symbicort, 28
Symlinpen 120, 13
Symlinpen 60, 13
Synagis, 38
Synalar, 10
Synarel, 14
Synera, 11
Synribo, 5
Synvisc, 22
Synvisc One, 22
Syprine, 38
T
Tabloid, 4
Taclonex, 10
tacrolimus, 4
Tafinlar, 5
Talwin, 26
Tamiflu, 2
tamoxifen citrate, 4, 43
tamsulosin HCL, 17
Tandem F, 17
Tarceva, 5
Targretin, 5, 11
Tarka, 7
taron-crystals, 17
Taron-prex, 30
Tasigna, 5
Tasmar, 21
Taxotere, 5
tazicef, 1
tazidime, 1
Tazorac, 9
taztia XT, 6
Tecfidera, 22
Tecfidera Starter Pack, 22
Techlite AST Lancets, 34
Techlite Lancets, 34
Techlite Lancets 30G, 34
Teflaro, 1
Tegretol-XR, 21
Tekamlo, 7
Tekturna, 7
Tekturna HCT, 7
telmisartan, 7
telmisartan/amlodipine, 7
telmisartan/hydrochloroth, 7
telmisartan/hydrochlorothiazide, 7
temazepam, 20
Temodar, 3
temozolomide, 3
tencon, 24
Tencon, 24
Teniposide, 5
Tenivac, 28, 41
terazosin HCL, 7
terbinafine HCL, 2
Terbinex, 2
terbutaline sulfate, 28
terconazole, 17
terrell, 27
Testosterone, 11
testosterone cypionate, 11
testosterone enanthate, 11
Testosterone P.M., 11
Tetanus Toxoid Adsorbed, 28
Tetanus/Diphtheria Toxoids-adsorbed Adult, 28, 41
tetcaine, 23
tetracaine HCL, 23
Tetracaine HCL, 27
Tetracycline HCL, 1
tetravisc, 23
tetravisc forte, 23
Tev-tropin, 14
Teveten, 7
Teveten HCT, 7
Texacort, 10
Tgq 15DM/5PEH/2CPM, 27
Tgq 30PSE/150GFN/15DM, 27
Tgq 30PSE/3BRM/15DM, 27
Tgq 50PSE/3BRM/30DM, 27
tgq 7.5PEH/4BRM/15DM, 27
Tgt Alcohol Swabs, 36
tgt aspirin, 25, 38
tgt aspirin low dose, 25, 38
tgt childrens aspirin, 25, 38
tgt enteric-coated aspirin, 25, 38
Tgt Lancet Alternate Site, 34
Tgt Lancet Micro Thin 33G, 34
Tgt Lancet Super Thin 30G, 34
Tgt Lancet Thin 23G, 34
Tgt Lancet Thin 26G, 34
Tgt Lancet Ultra Thin 28G, 34
Tgt Lancet Ultra Thin 30G, 34
tgt nicotine gum, 22, 42
tgt nicotine polacrilex, 22, 42
tgt nicotine step one, 22, 42
tgt nicotine step three, 22, 42
tgt nicotine step two, 22, 42
th aspirin, 25, 38
th aspirin low dose, 25, 38
th enteric aspirin, 25, 38
th folic acid, 18, 40
th iron, 18, 41
Th Prenatal Vitamins, 31, 40
th slow release iron, 18, 41
th vitamin d3, 29, 42
Thalomid, 4
Theo-24, 28
theochron, 28
theophylline, 28
theophylline CR, 28
theophylline ER, 28
theophylline/D5W, 28
Theophylline/D5W, 28
thera-d 2000, 29, 42
Thera-d 4000, 30, 43
thera-d rapid repletion, 29, 42
Theracys, 5
thermazene, 10
thiamine HCL, 29
Thinlets GP Lancets, 34
Thinlets Lancet, 34
thioridazine HCL, 20
thiothixene, 20
thrive, 22, 42
Thrombate Iii W/10 ML Sterile Water, 19
Thrombate Iii W/20 ML Sterile Water, 19
Thymoglobulin, 4
Thyrogen, 38
Thyrolar-1, 15
Thyrolar-1/2, 15
Thyrolar-1/4, 15
Thyrolar-2, 15
Thyrolar-3, 15
tiagabine hydrochloride, 21
Tice Bcg, 5
ticlopidine HCL, 19
Tikosyn, 6
tilia FE, 12, 39
Timentin, 1
Timolol Maleate, 6
timolol maleate, 23
timolol maleate ophthalmic gel forming, 23
tinidazole, 3
tis-u-sol, 37
Tivicay, 3
tizanidine HCL, 22
TL gard RX, 17
TL hydroquinone, 10
TL icon, 17
TL-fol 500, 17
TL-hem 150, 17
Tobi Podhaler, 2
Tobradex, 23
Tobradex ST, 23
tobramycin, 2
tobramycin sulfate, 2, 23
Tobramycin Sulfate/Sodium Chloride, 2
tobramycin/dexamethasone, 23
Tobrex, 23
Today Sponge, 17
Todays Health Super Thin Lancets 30G,
34
Todays Health Ultra Thin Lancets 28G, 34
tolazamide, 13
Tolazamide, 13
Tolbutamide, 13
tolmetin sodium, 26
Tolmetin Sodium, 26
tolterodine tartrate, 16
tolterodine tartrate ER, 16
topex topical anesthetic, 19
topiragen, 21
topiramate, 21
toposar, 5
topotecan HCL, 5
Topotecan HCL, 5
Torisel, 5
torsemide, 7
Torsemide, 7
Totect, 5
Toviaz, 16
tpn electrolytes, 37
Tracleer, 8
Tradjenta, 13
tramadol HCL, 25
65
tramadol HCL ER, 26
Tramadol HCL ER, 26
tramadol hydrochloride/acetaminophen,
25
trandolapril, 6
tranexamic acid, 19
Transderm-scop, 16
tranylcypromine sulfate, 20
Travatan Z, 23
Travoprost, 23
trazodone HCL, 20
Treanda, 3
Trecator, 2
Trelstar Depot, 4
Trelstar Depot Mixject, 4
Trelstar LA, 4
Trelstar LA Mixject, 4
Trelstar Mixject, 4
Tretin-x, 9
tretinoin, 5, 8
Tretinoin Emollient, 11
tretinoin microsphere, 8
tretinoin microsphere P.M., 8
Tretten, 19
Trexall, 4
Treximet, 26
Trezix, 26
tri-estarylla, 12, 39
tri-legest FE, 12, 39
tri-linyah, 12, 39
tri-previfem, 12, 39
tri-sprintec, 12, 39
tri-vit/fluoride, 30
Tri-vit/Fluoride/Iron, 30
tri-vitamin/fluoride, 30
Tri-zel, 31
Triadvance, 30
triamcinolone acetonide, 10, 19, 27
Triamcinolone Acetonide, 10
triamcinolone IN orabase, 19
triamterene/hydrochlorothiazide, 7
Triamterene/Hydrochlorothiazide, 7
Trianex, 10
triazolam, 20
Tribenzor, 7
Tricare, 30, 40
Tricitrates, 17
tricon, 17
triderm, 10
trifluoperazine HCL, 20
trifluridine, 23
trigels-f forte, 17
Triglide, 8
trihexyphenidyl HCL, 21
trilyte, 15, 43
trimethobenzamide HCL, 16
trimethoprim, 3
trimethoprim sulfate/polymyxin b sulfate,
23
trimipramine maleate, 20
Trinatal RX 1, 30
Trinate, 30
trinessa, 12, 39
triphrocaps, 30
triple-vitamin/fluoride, 30
Trisenox, 5
trivora-28, 12, 39
tropazone, 10
tropicamide, 23
trospium chloride, 16
trospium chloride ER, 16
Trueplus Lancets 26G, 34
Trueplus Lancets 28G, 34
Trueplus Lancets 28G Super Thin, 34
Trueplus Lancets 30G, 34
Trueplus Lancets 30G Ultra Thin, 34
Trueplus Lancets 33G, 34
Trueplus Lancets 33G Micro Thin, 34
Trueplus Safety Lancets 28G, 34
Truvada, 2
Tryptophan, 37
Tucks Anti-itch, 10
Tudorza Pressair, 28
tussafed EX, 27
Tussicaps, 27
tussigon, 27
Twinrix, 29, 41
Tygacil, 3
Tykerb, 5
Typhim VI, 28
Tysabri, 22
Tyvaso, 8
Tyvaso Refill, 8
Tyvaso Starter, 8
Tyzeka, 3
Tyzine, 27
Tyzine Pediatric Nasal Drops, 27
U
U-cort, 10
u-kera e, 10
Uceris, 11
Ulesfia, 11
Uloric, 27
Ulticare Thin Lancets 30G, 34
Ultilet Alcohol Swab, 36
Ultilet Alcohol Swabs, 36
Ultilet Basic Lancets 30G, 34
Ultilet Classic Lancets, 34
Ultilet Lancets, 34
Ultilet Lancets 33G, 34
Ultilet Safety Lancets 23G, 34
Ultimatecare One, 30
Ultimatecare One NF, 30
Ultra TABS, 30
Ultra Thin Lancets 28G, 34
Ultra Thin Lancets 30G, 34
Ultra-thin II Auto Lancet, 34
Ultra-thin II Lancets 28G, 34
Ultra-thin II Lancets 30G, 34
Ultra-thin II Safety Autolancets 26G, 34
Ultravate PAC, 10
Ultresa, 16
umecta mousse, 10
Unilet Comfortouch Lancet, 34
Unilet Excelite, 34
Unilet Excelite II, 34
Unilet G.p. Lancet, 34
Unilet G.p. Superlite Lancet, 34
Unilet GP 28 Ultra Thin, 34
Unilet Lancet, 34
Unilet Superlite Lancet, 34
Unistik 3 Gentle, 34
unithroid, 15
unithroid direct, 15
Universal 1 Lancets Thin 26G, 34
Universal 1 Lancets Ultra Thin 30G, 34
univert, 16
ur n-c, 16
urea, 10
urea 40% nail film, 10
urea hydrating, 10
urea IN zinc undecylenate/lactic acid
vehicle, 10
urea nail, 10
urea topical, 10
urea-c40, 10
uretron d/s, 16
Urimar-t, 16
urin d/s, 16
urosex, 30
ursodiol, 16
uryl, 16
ustell, 16
uta, 16
uticap, 16
utira-c, 16
utrona-c, 16
Uvadex, 5
V
v-c forte, 30
V-go 20, 35
V-go 30, 35
V-go 40, 35
Vagifem, 17
valacyclovir HCL, 2
Valchlor, 3, 11
Valcyte, 3
valproate sodium, 21
valproic acid, 21
valsartan, 7
valsartan/hydrochlorothiazide, 7
Valstar, 4
Value Plus Lancets Standard 21G, 35
Value Plus Lancets Super Thin 30G, 35
Value Plus Lancets Thin 26G, 35
Valumark Lancet Super Thin 30G, 35
Valumark Lancet Ultra Thin 28G, 35
Valved Holding Chamber, 36
vancomycin HCL, 3
Vancomycin HCL, 3
Vancomycin HCL IN Dextrose, 3
vandazole, 17
Vantas, 4
Vaqta, 29, 41
Varivax, 29, 41
Vascepa, 8
vasopressin, 14
Vayacog, 38
Vayarin, 38
Vayarol, 38
Vcf Vaginal Contraceptive Film, 17, 40
Vcf Vaginal Contraceptive Foam, 17, 40
Vectibix, 4
Vectical, 9
vecuronium bromide, 22
Velcade, 5
Veletri, 8
velivet, 12, 39
Veltin, 9
venlafaxine HCL, 20
venlafaxine HCL ER, 20
Venlafaxine HCL ER, 20
Venofer, 18
66
Ventavis, 8
Ventolin HFA, 28
Veramyst, 27
verapamil HCL, 6
Verapamil HCL, 6
verapamil HCL ER, 6
verapamil HCL SR, 6
Verdeso, 10
verdrocet, 26
Veregen, 11
Verelan, 6
Verelan PM, 6
Veripred 20, 11
versiclear, 9
Vesicare, 16
vestura, 12, 39
Vexol, 23
Viagra, 8
Vibativ, 3
vic-forte, 30
vicodin, 26
vicodin ES, 26
vicodin HP, 26
Victoza, 13
Victrelis, 3
Vida Mia Unilet Lancets Super Thin 30G,
35
Vida Mia Unilet Lancets Ultra Thin 28G, 35
Videx Pediatric, 2
Vigamox, 23
Viibryd, 20
Vimizim, 14
Vimovo, 26
Vimpat, 21
Vinate C, 30
Vinate Care, 30
Vinate DHA RF, 31
Vinate GT, 30
Vinate IC, 30
Vinate II, 30
Vinate M, 30
Vinate One, 30
Vinate Pn Care, 30
Vinate Ultra, 30
Vinblastine Sulfate, 5
vincasar PFS, 5
vincristine sulfate, 5
vinorelbine tartrate, 5
Viokace, 16
viorele, 12, 39
Viracept, 3
Viramune, 3
Viramune XR, 3
Virazole, 3
Viread, 3
virt-CAPS, 30
virt-phos 250 neutral, 37
virt-vite, 17
virt-vite forte, 37
virt-vite plus, 30
virti-sulf, 8
Visudyne, 24
vita s forte, 30
vita-min, 30
Vita-respa, 38
vitacel, 30
Vitafol-OB, 30
Vitalet Pro Lancets, 35
Vitalet Pro Plus Lancets, 35
vitamax pediatric, 30
Vitamelts Vitamin D, 30, 43
vitamin b-complex 100, 30
vitamin c 222MG, 29
vitamin d, 29, 42
Vitamin D, 30, 43
vitamin d 400, 29, 42
vitamin d high potency, 29, 42
vitamin d-1000, 29, 42
vitamin d-1000 maximum strength, 29, 42
vitamin d-3, 29, 42
vitamin d-400, 29, 42
vitamin d3, 29, 42
Vitamin D3, 30, 43
Vitamin D3 400, 30, 43
vitamin d3 adult gummies, 29, 42
vitamin d3 high potency, 29, 42
vitamin d3 maximum strength, 29, 42
vitamin d3 super strength, 29, 42
vitamin k1, 29
Vitamin K1, 29
vitamins a/c/d/fluoride, 30
Vivelle-dot, 11
Vivitrol, 38
Vivotif Berna, 28
Vogelxo, 11
Vogelxo P.M., 11
vol-care RX, 30
Voltaren, 9
Voraxaze, 5
voriconazole, 2
Vortex Valved Holding Chamber, 36
Votrient, 5
Vp-gstn, 37
vp-precip, 37
Vp-zel, 31
Vpriv, 18
vyfemla, 12, 39
Vytorin, 8
Vyvanse, 21
Wide-seal Silicone Diaphragm Kit 75,
Wide-seal Silicone Diaphragm Kit 80,
Wide-seal Silicone Diaphragm Kit 85,
Wide-seal Silicone Diaphragm Kit 90,
Wide-seal Silicone Diaphragm Kit 95,
Wilate, 19
Winrho SDF, 38
wymzya FE, 12, 39
40
40
40
40
40
X
x-viate, 10
Xalkori, 5
Xarelto, 18
Xeljanz, 26
Xenazine, 22
Xenical, 21
Xeomin, 22
Xgeva, 14
Xiaflex, 38
Xifaxan, 3
Xofigo, 5
Xolair, 28
Xolegel, 9
Xopenex HFA, 28
Xtandi, 4
xulane, 12, 39
xylocaine dental, 27
xylon, 26
Xyntha, 19
Xyntha Solofuse, 19
Xyrem, 22
Y
Yervoy, 4
Yf-vax, 28
yl folic acid, 18, 40
Yodoxin, 3
Your Life Multi Prenatal, 31
Z
Zaclir Cleansing, 9
zafirlukast, 28
zaleplon, 20
Zaltrap, 4
W
zamicet, 26
W&f Lancets 26G, 35
Zanosar, 3
W&f Lancets Colored 21G, 35
zarah, 12, 39
Walgreens Advanced Travellancets 28G,
Zavesca, 18
35
zazole, 17
Walgreens Comfort Assuredlancets Micro zebutal, 24
Thin/33G, 35
Zegerid, 15
Walgreens Comfort Assuredlancets
Zelboraf, 5
Super Thin/28G, 35
Zemaira, 28
Walgreens Lancets, 35
Zemplar, 14
Walgreens Thin Lancets, 35
zenatane, 8
Walgreens Ultra Thin Lancets, 35
zenchent, 12, 39
warfarin sodium, 18
zenchent FE, 12, 39
Watchhaler, 36
zencia, 8
Webcol Alcohol Prep Large 1 Ply, 36
Zenpep, 16
Webcol Alcohol Prep Large 2 Ply, 36
zenzedi, 21
Webcol Alcohol Prep Medium 2 Ply, 36
Zetia, 8
wee care, 18, 41
Zetonna, 27
Welchol, 8
Zevalin Y-90, 4
Wellesse Vitamin D3, 30, 43
zflex, 24
wera, 12, 39
Zgesic, 24
Westhroid, 15
Ziagen, 3
Wheat Germ, 29
Ziana, 9
Wide-seal Silicone Diaphragm Kit 60, 40
zidovudine, 2
Wide-seal Silicone Diaphragm Kit 65, 40
Zinacef, 1
Wide-seal Silicone Diaphragm Kit 70, 40
Zinacef IN Iso-osmotic Dextrose, 1
67
Zinacef IN Iso-osmotic Diluent, 1
zinc sulfate, 37
Zinc Sulfate, 37
Zinc Trace Metal, 37
Zioptan, 23
ziprasidone HCL, 20
Zirgan, 23
Zithromax, 1
Zoladex, 4
zoledronic acid, 13
Zoledronic Acid, 13
Zolinza, 5
zolmitriptan, 26
zolmitriptan odt, 26
zolpidem tartrate, 20
zolpidem tartrate ER, 20
Zometa, 13
Zomig, 26
Zomig Nasal Spray, 26
Zonalon, 9
zonisamide, 21
Zorbtive, 14
Zortress, 4
Zostavax, 29, 41
zovia 1/35e, 12, 39
Zovia 1/50e, 11, 38
Zovirax, 9
Zuplenz, 16
Zyclara, 10
Zyclara P.M., 10
Zyflo, 28
Zyflo CR, 28
Zylet, 23
Zytiga, 4
Zyvox, 3
1
1/2halfprin, 25, 38
1ST Choice Lancets Super Thin, 35
1ST Choice Lancets Thin, 35
1ST Choice Lancets Ultra Thin, 35
1ST Tier Unilet Comfortouch Lancets
28G, 35
1ST Tier Unilet Comfortouch Lancets
30G, 35
8
8-mop, 9
68
60312
P.O. Box 31389 | Tampa, FL 33631-3389 

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