2013 calpers (effective...

1PA - Prior Authorization QL - Quantity Limits NM - Not available at mail-order B/D - Coveredunder Medicare B or D LA - Limited Access * - CalPERS EGWP Effective 7.1.13 ** - ContactCare at 1-855-479-3660 to check if additional CalPERS coverage is available for drugs not listed

2013 CalPERS (Effective 7.1.13)

Drug Name DrugTier

Requirements/Limits

ANALGESICSGOUTallopurinol inj 500mg (genericof ALOPRIM)

1

allopurinol tab (generic ofZYLOPRIM)

1

colchicine w/ probenecid 1COLCRYS TAB 0.6MG 2probenecid 1ULORIC 2MISCELLANEOUSARTHROTEC 3diclofenac w/ misoprostol(generic of ARTHROTEC 50)

1

diclofenac w/ misoprostol(generic of ARTHROTEC 75)

1

DUEXIS 3VIMOVO 2NARCOTIC ANALGESICSacetaminophen w/ codeineSOLN

1

acetaminophen w/ codeineTABS

1

acetaminophen w/ codeine(generic ofTYLENOL/CODEINE #3)TABS

1

acetaminophen w/ codeine(generic ofTYLENOL/CODEINE #4)TABS

1

acetaminophen-caff-dihydrocod

1

ascomp with codeine (genericof FIORINAL/CODEINE #3)

1

butalbital-acetaminophen-caffeine w/ codeine (genericof FIORICET/CODEINE)

1

butorphanol nasal sprayQL (3 bottles / 30 days)

1 QL

butorphanol tartrate SOLN 1BUTRANS 3CAPITAL AND CODEINE 3

Drug Name DrugTier

Requirements/Limits

co-gesic (generic of LORTAB) 1hydrocodone-acetaminophen2.5-325mg

1

hydrocodone-acetaminophen5-300mg (generic of XODOL)

1

hydrocodone-acetaminophen5-325mg (generic of NORCO)

1

hydrocodone-acetaminophen5-500mg (generic ofLORTAB)

1

hydrocodone-acetaminophen7.5-300mg (generic ofXODOL)

1

hydrocodone-acetaminophen7.5-325 mg/15ml (generic ofHYCET)

1

hydrocodone-acetaminophen7.5-325mg (generic ofNORCO)

1

hydrocodone-acetaminophen7.5-500mg (generic ofLORTAB)

1

hydrocodone-acetaminophen7.5-500mg/15ml (generic ofLORTAB)

1

hydrocodone-acetaminophen7.5-650mg (generic ofANEXSIA)

1

hydrocodone-acetaminophen7.5-750mg

1

hydrocodone-acetaminophen10-300mg (generic ofXODOL)

1

hydrocodone-acetaminophen10-500mg (generic ofLORTAB)

1

hydrocodone-acetaminophen10-650mg (generic ofLORCET 10/650)

1

hydrocodone-acetaminophen10-660mg

1

hydrocodone-acetaminophen10-750mg (generic ofMAXIDONE)

1

hydrocodone-acetaminophentab 2.5-500mg

1

hydrocodone-acetaminophentab 10-325mg (generic ofNORCO)

1


Drug Name DrugTier

Requirements/Limits

hydrocodone-ibuprofen(generic of VICOPROFEN)

1

REPREXAIN 2.5/200 3reprexain 10/200 1stagesic 5/500 1SYNALGOS-DC 3ZAMICET 3ZYDONE 5/400 3ZYDONE 7.5/400 3ZYDONE 10/400 3NARCOTIC ANALGESICS, CIIABSTRAL 100mcg

QL (120 ea / 30 days)3 QL

ABSTRAL 200mcg, 300mcg,400mcg, 600mcg, 800mcg

QL (120 ea / 30 days)

3 QL NM

astramorph 1AVINZA 2codeine sulfate TABS 1DILAUDID-5 ORAL LIQD 2duramorph 1endocet 5/325 (generic ofPERCOCET)

1

endocet 7.5/325 (generic ofPERCOCET)

1

endocet 7.5/500 (generic ofPERCOCET)

1

endocet 10/325 (generic ofPERCOCET)

1

endocet 10/650 (generic ofPERCOCET)

1

endodan reformulated may2009 (generic ofPERCODAN)

1

EXALGOQL (60 ea / 30 days)

2 QL

fentanyl citrate (generic ofACTIQ) LPOP

QL (120 lpop / 30 days)

1 QL NM

fentanyl patch (generic ofDURAGESIC)

1

FENTORAQL (120 tabs / 30 days)

2 QL NM

hydromorphone hcl (genericof DILAUDID-5) LIQD

1

Drug Name DrugTier

Requirements/Limits

hydromorphone hcl (genericof DILAUDID-HP) SOLN500mg/50ml

1

hydromorphone hcl (genericof DILAUDID) TABS

1

INFUMORPH 200 3INFUMORPH 500 3KADIAN 2LAZANDA 2levorphanol tartrate TABS 1MAGNACET 3methadone hcl CONC 1methadone hcl SOLN 1methadone hcl (generic ofDOLOPHINE HCL) TABS5mg

1

methadone hcl (generic ofDOLOPHINE) TABS 10mg

1

METHADONE INJ 10MG/ML 3methadose (generic ofDOLOPHINE) TABS

1

morphine sul 20mg/ml oral sol 1MORPHINE SULFATE SOLN4mg/ml, 8mg/ml, 10mg/5ml,10mg/ml, 15mg/ml, 20mg/5ml

1

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

1

morphine sulfate TABS 1morphine sulfate ext-rel tab(generic of MS CONTIN)

1

NUCYNTA 2NUCYNTA ER 2ONSOLIS

QL (120 ea / 30 days)3 QL NM

OPANA ER (CRUSHRESISTANT

2

OXECTA 3oxycodone hcl CAPS 1oxycodone hcl CONC 1OXYCODONE HCL SOLN 1oxycodone hcl TABS 5mg,10mg, 20mg

1

oxycodone hcl (generic ofROXICODONE) TABS 15mg,30mg

1


Drug Name DrugTier

Requirements/Limits

oxycodone w/ acetaminophen2.5-325mg (generic ofPERCOCET)

1

oxycodone w/ acetaminophen5-325mg (generic ofPERCOCET)

1

oxycodone w/ acetaminophen5-500mg

1


1


1


1


1

oxycodone-aspirin (generic ofPERCODAN)

1

oxycodone-ibuprofen 1OXYCONTIN 2oxymorphone er 1oxymorphone hcl (generic ofOPANA) TABS

1

ROXICET 2ROXICET 5/500 3SUBSYS 3NON-NARCOTIC ANALGESICSCONZIP 3tramadol hcl er (generic ofULTRAM ER) TB24 100mg,200mg

1

tramadol hcl er TB24 300mg 1tramadol hcl tab 50 mg(generic of ULTRAM)

1

tramadol-acetaminophen(generic of ULTRACET)

1

NSAIDSCELEBREX 2diclofenac potassium (genericof CATAFLAM)

1

diclofenac sodium (generic ofVOLTAREN-XR) TB24

1

diclofenac sodium TBEC 1

Drug Name DrugTier

Requirements/Limits

diflunisal 1etodolac CAPS; TABS 1etodolac er 1fenoprofen calcium TABS 1flurbiprofen TABS 1ibuprofen SUSP 1ibuprofen TABS 400mg,600mg, 800mg

1

ketoprofen CAPS; CP24 1mefenamic acid (generic ofPONSTEL) CAPS

1

MELOXICAM SUSP 7.5MG/5ML

1

meloxicam tabs (generic ofMOBIC)

1

nabumetone TABS 1NALFON 3NAPRELAN 3naproxen (generic ofNAPROSYN) SUSP; TABS

1

naproxen (generic of EC-NAPROSYN) TBEC

1

naproxen sodium (generic ofANAPROX) TABS 275mg

1

naproxen sodium (generic ofANAPROX DS) TABS 550mg

1

oxaprozin (generic ofDAYPRO)

1

piroxicam (generic ofFELDENE) CAPS

1

sulindac TABS 150mg 1sulindac (generic ofCLINORIL) TABS 200mg

1

tolmetin sodium 1ZIPSOR 3ANESTHETICSLOCAL ANESTHETICSlidocaine hcl (local anesth.)(generic of XYLOCAINE-MPF)

1

ANTI-INFECTIVESANTIBACTERIALSamikacin sulfate SOLN1gm/4ml, 50mg/ml

1

amoxicillin 1


Drug Name DrugTier

Requirements/Limits

amoxicillin & pot clavulanateCHEW

1

amoxicillin & pot clavulanate(generic of AUGMENTIN)CHEW

1

amoxicillin & pot clavulanateSUSR

1

amoxicillin & pot clavulanate(generic of AUGMENTIN)SUSR

1

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

1

amoxicillin & pot clavulanateTABS

1

amoxicillin & pot clavulanate(generic of AUGMENTIN)TABS

1

amoxicillin & pot clavulanate(generic of AUGMENTIN XR)TB12

1

ampicillin 1ampicillin & sulbactam sodium 1ampicillin & sulbactam sodium(generic of UNASYN)

1

ampicillin & sulbactam sodium(generic of UNASYN BULKPACK)

1

ampicillin inj 1AVELOX 2AVELOX ABC PACK 2azithromycin (generic ofZITHROMAX) SOLR 500mg

1

azithromycin (generic ofZITHROMAX) SUSR

1

azithromycin (generic ofZITHROMAX) TABS

1

BACTOCILL IN DEXTROSE 3BICILLIN C-R 3BICILLIN L-A 3CEDAX CAPS 3cefaclor 1CEFACLOR ER 2cefadroxil 1cefazolin inj 1CEFAZOLIN/DEXTROSE 2

Drug Name DrugTier

Requirements/Limits

cefdinir 1cefepime hcl (generic ofMAXIPIME)

1

cefotaxime sodium (generic ofCLAFORAN)

1

CEFOTETAN 3CEFOXITIN SODIUM 3cefoxitin sodium 1gm, 2gm,10gm

1

cefpodoxime proxetil 1cefprozil 1ceftazidime (generic ofFORTAZ) SOLR 1gm, 2gm,6gm

1

CEFTAZIDIME/DEXTROSE 2CEFTIN SUSR 3ceftriaxone sodium SOLR1gm, 2gm, 10gm, 250mg

1

ceftriaxone sodium (generic ofROCEPHIN) SOLR 500mg

1

cefuroxime axetil (generic ofCEFTIN) TABS

1

cefuroxime sodium (generic ofZINACEF) 1.5gm, 7.5gm,750mg

1

cephalexin (generic ofKEFLEX) CAPS 250mg,500mg

1

cephalexin SUSR 1cephalexin TABS 1CIPRO SUSR 2ciprofloxacin hcl TABS100mg, 750mg

1

ciprofloxacin hcl (generic ofCIPRO) TABS 250mg,500mg

1

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

1

ciprofloxacin-ciprofloxacin hcl(generic of CIPRO XR)

1

ciprofloxacn inj 1CLAFORAN 1gm 3clarithromycin SUSR125mg/5ml

1

clarithromycin (generic ofBIAXIN) SUSR 250mg/5ml

1


Drug Name DrugTier

Requirements/Limits

clarithromycin (generic ofBIAXIN) TABS

1

clarithromycin (generic ofBIAXIN XL) TB24

1

demeclocycline hcl 1dicloxacillin sodium 1DIFICID 2 NMDORYX 3doxycycline (monohydrate)(generic of MONODOX)CAPS

1

doxycycline (monohydrate)(generic of ADOXA) TABS50mg, 75mg

1

doxycycline (monohydrate)(generic of ADOXA PAK1/150) TABS 150mg

1

doxycycline hyclate CAPS50mg

1

doxycycline hyclate (genericof VIBRAMYCIN) CAPS100mg

1

doxycycline hyclate SOLR 1doxycycline hyclate TABS 1doxycycline hyclate TBEC 1e.e.s. 1E.E.S. GRANULES 2ery-tab 250mg 1ERY-TAB 333mg, 500mg 2ERYPED 200 2ERYPED 400 2ERYTHROCINLACTOBIONATE 500mg

3

erythrocin stearate 1erythromycin base TABS 1erythromycin ethylsuccinate 1FACTIVE 3FORTAZ SOLN 3GENTAMICIN IN SALINE 0.9MG/ML

3

GENTAMICIN IN SALINE 1.4MG/ML

3

gentamicin in saline 60mg 1gentamicin in saline 80mg 1gentamicin in saline 100mg 1

Drug Name DrugTier

Requirements/Limits

gentamicin sulfate SOLN 1KEFLEX 750mg 3levofloxacin SOLN 25mg/ml 1levofloxacin (generic ofLEVAQUIN) SOLN 25mg/ml

1

levofloxacin (generic ofLEVAQUIN) TABS

1

levofloxacin in d5w (generic ofLEVAQUIN)

1

minocycline hcl (generic ofMINOCIN) CAPS 50mg,100mg

1

minocycline hcl CAPS 75mg 1minocycline hcl (generic ofDYNACIN) TABS

1

minocycline hcl (generic ofSOLODYN) TB24

1

MOXATAG 3nafcillin sodium 1gm, 10gm 1NALLPEN/DEXTROSE 3neomycin sulfate TABS 1NOROXIN 3oxacillin sodium 1gm, 10gm 1paromomycin sulfate CAPS 1PCE 3PENICILLIN G POT INDEXTROSE

2

penicillin g potassium 5mu 1PENICILLIN G PROCAINE 2penicillin g sodium 1penicillin v potassium 1piperacillin sodium-tazobactam sodium (genericof ZOSYN)

1

SOLODYN 55mg, 65mg,80mg, 105mg, 115mg

3 NM

streptomycin sulfate SOLR 1SULFADIAZINE TABS 2suprax CHEW 2SUPRAX SUS 100/5ML 2SUPRAX SUS 200/5ML 2SUPRAX SUS 500/5ML 2SUPRAX TAB 400MG 2tazicef vial (generic ofFORTAZ)

1


Drug Name DrugTier

Requirements/Limits

TEFLARO 3tetracycline hcl CAPS 1TIMENTIN SOLR 3tobramycin sulfate SOLN10mg/ml, 80mg/2ml

1

TOBRAMYCINSULFATE/SODIUM

2

VIBRAMYCIN SUSR; SYRP 2ZINACEF 1.5gm 3ZINACEF IN SOLUTION 3ZITHROMAX PACK 3ZMAX 2ZOSYN SOLN 3ANTIFUNGALSABELCET 3 NMAMBISOME 3 NMAMPHOTEC 50mg 3amphotericin b SOLR 1CANCIDAS 3 NMERAXIS 100mg 3 NMfluconazole (generic ofDIFLUCAN) SUSR; TABS

1

fluconazole in dextrose 1flucytosine (generic ofANCOBON) CAPS

1 NM

griseofulvin microsize SUSP 1griseofulvin microsize (genericof GRIFULVIN V) TABS

1

griseofulvin ultramicrosize(generic of GRIS-PEG)

1

itraconazole (generic ofSPORANOX) CAPS

1

ketoconazole TABS 1LAMISIL PACK 3MYCAMINE 3 NMNOXAFIL 3 NMnystatin TABS 1ONMEL 3SPORANOX SOLN 3 NMterbinafine tab 250mg(generic of LAMISIL)

1

VFEND SUS 40MG/ML 2 NMvoriconazole (generic ofVFEND) TABS

1 NM

Drug Name DrugTier

Requirements/Limits

VORICONAZOLE INJ 200MG 1ANTIMALARIALSatovaquone-proguanil hcl(generic of MALARONE)

1

chloroquine phosphate TABS250mg

1

chloroquine phosphate(generic of ARALEN) TABS500mg

1

COARTEM 2DARAPRIM 3mefloquine hcl 1PRIMAQUINE PHOSPHATETABS

2

QUALAQUIN 3quinine sulfate (generic ofQUALAQUIN) CAPS

1

ANTIRETROVIRAL AGENTSabacavir sulfate (generic ofZIAGEN)

1

APTIVUS 3 NMATRIPLA 2 NMCOMPLERA 3 NMCRIXIVAN 3didanosine (generic of VIDEXEC)

1

EDURANT 2 NMEMTRIVA 2EPIVIR SOL 10MG/ML 2EPZICOM 3 NMFUZEON KIT 2 NMINTELENCE 25mg 2INTELENCE 100mg, 200mg 2 NMINVIRASE CAPS 3INVIRASE TABS 3 NMISENTRESS CHEW 25mg 2ISENTRESS CHEW 100mg 2 NMISENTRESS TABS 2 NMKALETRA SOL 2 NMKALETRA TAB 100-25MG 2KALETRA TAB 200-50MG 2 NMlamivudine (generic ofEPIVIR)

1


Drug Name DrugTier

Requirements/Limits

lamivudine-zidovudine(generic of COMBIVIR)

1 NM

LEXIVA 3NEVIRAPINE SUSP 1nevirapine (generic ofVIRAMUNE) TABS

1

NORVIR 2PREZISTA SUSP 2 NMPREZISTA TABS 75mg 2PREZISTA TABS 150mg,400mg, 600mg, 800mg

2 NM

RESCRIPTOR 2RETROVIR IV INFUSION 2REYATAZ 2SELZENTRY 3 NMstavudine (generic of ZERIT) 1STRIBILD 3 NMSUSTIVA 2TRIZIVIR 3 NMTRUVADA 2 NMVIDEX PEDIATRIC 2gm 3VIRACEPT 3 NMVIRAMUNE SUSP 3VIRAMUNE XR 2VIREAD 2 NMZIAGEN SOLN 3zidovudine (generic ofRETROVIR) CAPS; SYRP

1

zidovudine TABS 1ANTITUBERCULAR AGENTSCAPASTAT SULFATE 3ethambutol hcl (generic ofMYAMBUTOL) TABS

1

isoniazid SOLN; SYRP 1isoniazid tabs 1MYCOBUTIN 2PASER D/R 3PRIFTIN 2pyrazinamide 1rifampin (generic of RIFADIN)CAPS; SOLR

1

RIFATER 3SEROMYCIN 3

Drug Name DrugTier

Requirements/Limits

SIRTURO 3 NM LATRECATOR 2ANTIVIRALSacyclovir (generic ofZOVIRAX) CAPS; SUSP;TABS

1

acyclovir sodium SOLR500mg

1

BARACLUDE 2cidofovir (generic of VISTIDE) 1EPIVIR HBV 2famciclovir (generic ofFAMVIR)

1

foscarnet sodium 1ganciclovir inj 500mg (genericof CYTOVENE)

1

HEPSERA 3 NMINCIVEK 2 NMREBETOL SOLN 2 NMRELENZA DISKHALER 2RIBAPAK 3 NMribapak mis 600/day 1 NMribasphere 1 NMribasphere 200mg (generic ofREBETOL) CAPS

1 NM

ribasphere 200mg (generic ofCOPEGUS) TABS

1 NM

ribavirin 200mg (generic ofREBETOL) CAPS

1 NM

ribavirin 200mg (generic ofCOPEGUS) TABS

1 NM

rimantadine hydrochloride(generic of FLUMADINE)

1

TAMIFLU 2TYZEKA 3 NMvalacyclovir hcl (generic ofVALTREX) TABS

1

VALCYTE 2 NMVICTRELIS 2 NMVISTIDE 3MISCELLANEOUSALBENZA 3ALINIA SUS 100MG/5M 2ALINIA TAB 500MG 2


Drug Name DrugTier

Requirements/Limits

AZACTAM 2gm 3AZACTAM IN DEXTROSE 3aztreonam (generic ofAZACTAM) 1gm

1

BILTRICIDE 2CLEOCIN IN D5W 3CLEOCIN INJ 3clindamycin hcl (generic ofCLEOCIN) CAPS

1

clindamycin palmitatehydrochloride (generic ofCLEOCIN PEDIATRICGRANULE)

1

clindamycin phosphate(generic of CLEOCINPHOSPHATE) SOLN150mg/ml

1

clindamycin phosphate in d5w(generic of CLEOCIN IND5W)

1

colistimethate sodium(generic of COLY-MYCIN M)SOLR

1

CUBICIN 3 B/D NMdapsone TABS 1DORIBAX 500mg 3FLAGYL ER 3imipenem-cilastatin (genericof PRIMAXIN IV)

1

INVANZ 3MACRODANTIN 25mg 2MEPRON 3 NMmeropenem (generic ofMERREM) 500mg

1

methenamine hippurate(generic of HIPREX)

1

metronidazole CAPS 1metronidazole (generic ofFLAGYL) TABS

1

metronidazole inj 1NEBUPENT 3nitrofurantoin (generic ofFURADANTIN) SUSP

1

nitrofurantoin macrocrystal(generic of MACRODANTIN)

1

Drug Name DrugTier

Requirements/Limits

nitrofurantoin monohyd macro(generic of MACROBID)

1

PENTAM 300 3polymyxin b sulfate SOLR 1PRIMSOL 3STROMECTOL 3sulfamethoxazole-trimethopSUSP

1

sulfamethoxazole-trimethop(generic of BACTRIM) TABS

1

sulfamethoxazole-trimethop(generic of BACTRIM DS)TABS

1

sulfamethoxazole-trimethop ivsoln

1

SYNERCID 3 NMtrimethoprim TABS 1TYGACIL 3 NMvancomycin hcl (generic ofVANCOCIN HCL) CAPS

1 NM

vancomycin hcl SOLR 10gm,500mg, 1000mg

1 B/D

VIBATIV 250mg 3XIFAXAN TAB 200MG 3 NMZYVOX SOLN 3 NMZYVOX SUSR; TABS 2 NMANTINEOPLASTIC AGENTSALKYLATING AGENTSBICNU 3BUSULFEX 3CEENU 2cyclophosphamide TABS 1dacarbazine 200mg 1EMCYT 2HEXALEN 2 NMIFEX INJ 3GM 3IFOSFAMIDE SOLR 1gm 1LEUKERAN 2melphalan hcl (generic ofALKERAN)

1 NM

MUSTARGEN 3THIOTEPA SOLR 3TREANDA 100mg 3 NMZANOSAR 3


Drug Name DrugTier

Requirements/Limits

ANTHRACYCLINESadriamycin SOLN 1daunorubicin hcl INJ 1DOXIL 3 NMdoxorubicin hcl SOLN 1EPIRUBICIN HCL SOLN50mg/25ml

1

idarubicin hcl (generic ofIDAMYCIN PFS) 10mg/10ml

1 NM

ANTIBIOTICSbleomycin sulfate 30unit 1COSMEGEN 3 NMmitomycin SOLR 20mg 1ANTIMETABOLITESALIMTA 500mg 3 NMARRANON 3CLOLAR 3cytarabine inj 20mg/ml 1CYTARABINE INJ 100MG/ML 1cytarabine inj 500mg 1DACOGEN 3 NMfluorouracil inj 1gemcitabine hcl (generic ofGEMZAR) 1gm

1 NM

mercaptopurine (generic ofPURINETHOL) TABS

1

methotrexate sodium inj 1pentostatin (generic ofNIPENT)

1 NM

TABLOID 2VIDAZA 3 NMANTIMITOTIC, TAXOIDSABRAXANE 3 NMdocetaxel CONC 80mg/4ml 1 NMDOCETAXEL SOLN80mg/8ml

3 NM

paclitaxel 300mg/50ml 1TAXOTERE 80mg/2ml,80mg/4ml

3 NM

ANTIMITOTIC, VINCA ALKALOIDSVINBLASTINE SULFATESOLR

2

vincasar 1

Drug Name DrugTier

Requirements/Limits

vincristine sulfate 1vinorelbine tartrate (generic ofNAVELBINE) 50mg/5ml

1

BIOLOGIC RESPONSE MODIFIERSAVASTIN 100mg/4ml 3 NMCAMPATH 3 NMERBITUX 100mg/50ml 3 NMERIVEDGE 3 NM LAHERCEPTIN 3 NMISTODAX 3 NMKADCYLA 3 NMONTAK 3 NMPROLEUKIN 3 NMRITUXAN 3 NMTORISEL 3 NMVECTIBIX 100mg/5ml 3 NMVELCADE 3 NMZOLINZA 2 NMHORMONAL ANTINEOPLASTIC AGENTSanastrozole (generic ofARIMIDEX) TABS

1

ARZERRA 3 NMbicalutamide (generic ofCASODEX)

1

DEPO-PROVERA INJ 400/ML 2ELIGARD 3 NMexemestane (generic ofAROMASIN)

1

FARESTON 2FASLODEX 2 NMFIRMAGON 3 NMflutamide 1letrozole (generic ofFEMARA) TABS

1

leuprolide acetate KIT 1 NMLUPRON DEPOT 3.75mg,7.5mg, 22.5mg, 30mg

2 NM

LUPRON DEPOT-PED 2 NMLYSODREN 2 NMMEGACE ES 2megestrol acetate (generic ofMEGACE ORAL) SUSP

1

megestrol acetate TABS 1


Drug Name DrugTier

Requirements/Limits

NILANDRON 2SOLTAMOX 3tamoxifen citrate TABS 1TRELSTAR DEPOT MIXJECT 2 NMTRELSTAR LA MIXJECT 2 NMTRELSTAR MIXJECT 2 NMXTANDI 3 NM LAZYTIGA 3 NMKINASE INHIBITORSAFINITOR 2 NMAFINITOR DISPERZ 3 NMBOSULIF TAB 100MG 3 NMBOSULIF TAB 500MG 3 NMCAPRELSA 3 NM LACOMETRIQ 3 NMGLEEVEC 2 NMICLUSIG 3 NMINLYTA 3 NM LAIRESSA 3 NMJAKAFI TAB 5MG 3 NM LAJAKAFI TAB 10MG 3 NM LAJAKAFI TAB 15MG 3 NM LAJAKAFI TAB 20MG 3 NM LAJAKAFI TAB 25MG 3 NM LANEXAVAR 2 NM LASPRYCEL 2 NMSTIVARGA 3 NM LASUTENT 2 NMTARCEVA 2 NMTASIGNA 2 NMTYKERB 2 NM LAVOTRIENT 2 NMXALKORI 3 NM LAZELBORAF 3 NM LAMISCELLANEOUSDROXIA 2ELSPAR 3 NMHALAVEN 3 NMhydroxyurea (generic ofHYDREA) CAPS

1

IRINOTECAN 100mg/5ml 3 NMIXEMPRA KIT 45mg 3 NM

Drug Name DrugTier

Requirements/Limits

MATULANE 2 NMmitoxantrone hcl 1 NMPOMALYST 3 NM LASYLATRON 2 NMTARGRETIN CAPS 2 NMTRETINOIN CAPS 3 NMTRISENOX 3 NMUVADEX 3NUCLEOSIDE ANALOGScladribine 1 NMfludarabine phosphate SOLN 1FLUDARABINE PHOSPHATESOLR

1

PLATINUM COORDINATION COMPLEXcarboplatin SOLN150mg/15ml

1

cisplatin SOLN 100mg/100ml 1ELOXATIN 100mg/20ml 3 NMOXALIPLATIN SOLN100mg/20ml

3 NM

PROTECTIVE AGENTSamifostine crystalline (genericof ETHYOL)

1 NM

dexrazoxane (generic ofZINECARD) 500mg

1 NM

ELITEK 1.5mg 3 NMKEPIVANCE 3 NMleucovor ca inj 1leucovorin calcium TABS 1mesna (generic of MESNEX) 1MESNEX TABS 3 NMTOPOISOMERASE INHIBITORSETOPOPHOS 3etoposide SOLN 1toposar 1topotecan hcl (generic ofHYCAMTIN) SOLR

1 NM

CARDIOVASCULARACE INHIBITOR COMBINATIONSamlodipine besylate-benazepril hcl (generic ofLOTREL)

1


Drug Name DrugTier

Requirements/Limits

benazepril &hydrochlorothiazide

1

benazepril &hydrochlorothiazide (genericof LOTENSIN HCT)

1

captopril &hydrochlorothiazide

1

enalapril maleate &hydrochlorothiazide

1

enalapril maleate &hydrochlorothiazide (genericof VASERETIC)

1

fosinopril sodium &hydrochlorothiazide

1

lisinopril &hydrochlorothiazide (genericof PRINZIDE)

1

lisinopril &hydrochlorothiazide (genericof ZESTORETIC)

1

moexipril-hydrochlorothiazide(generic of UNIRETIC)

1

quinapril-hydrochlorothiazide(generic of ACCURETIC)

1

TARKA 2ACE INHIBITORSbenazepril hcl TABS 5mg 1benazepril hcl (generic ofLOTENSIN) TABS 10mg,20mg, 40mg

1

captopril TABS 1enalapril maleate (generic ofVASOTEC) TABS

1

fosinopril sodium 1lisinopril (generic of ZESTRIL)TABS 2.5mg, 30mg, 40mg

1

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

1

moexipril hcl (generic ofUNIVASC)

1

perindopril erbumine 2mg 1perindopril erbumine (genericof ACEON) 4mg, 8mg

1

quinapril hcl (generic ofACCUPRIL)

1

ramipril (generic of ALTACE) 1

Drug Name DrugTier

Requirements/Limits

trandolapril (generic ofMAVIK)

1

ADRENOLYTICS, CENTRALclonidine hcl (generic ofCATAPRES-TTS-1) PTWK.1mg/24hr

1

clonidine hcl (generic ofCATAPRES-TTS-2) PTWK.2mg/24hr

1

clonidine hcl (generic ofCATAPRES-TTS-3) PTWK.3mg/24hr

1

clonidine hcl (generic ofCATAPRES) TABS

1

guanfacine hcl (generic ofTENEX)

1

ALDOSTERONE RECEPTORANTAGONISTSeplerenone (generic ofINSPRA)

1

spironolactone (generic ofALDACTONE) TABS

1

ALPHA BLOCKERSdoxazosin mesylate (genericof CARDURA)

1

prazosin hcl (generic ofMINIPRESS)

1

terazosin hcl 1ANGIOTENSIN II RECEPTORANTAGONIST COMBINATIONSATACAND HCT 3AZOR 2BENICAR HCT 2candesartan cilexetil-hydrochlorothiazide (genericof ATACAND HCT)

1

EDARBYCLOR 3EXFORGE 2EXFORGE HCT 5-160-12.5MG

2

EXFORGE HCT 5-160-25MG 2EXFORGE HCT 10-160-12.5MG

2

EXFORGE HCT 10-160-25MG

2


Drug Name DrugTier

Requirements/Limits

EXFORGE HCT 10-320-25MG

2

irbesartan-hydrochlorothiazide(generic of AVALIDE)

1

losartan potassium &hydrochlorothiazide (genericof HYZAAR)

1

MICARDIS HCT 2TEVETEN HCT 3TRIBENZOR 2TWYNSTA 3valsartan-hydrochlorothiazide(generic of DIOVAN HCT)

1

ANGIOTENSIN II RECEPTORANTAGONISTSATACAND 3BENICAR 2DIOVAN 2EDARBI 3eprosartan mesylate (genericof TEVETEN)

1

irbesartan (generic ofAVAPRO)

1

losartan potassium (generic ofCOZAAR)

1

MICARDIS 2TEVETEN 400mg 3ANTIARRHYTHMICSamiodarone hcl (generic ofCORDARONE) TABS 200mg

1

amiodarone hcl (generic ofPACERONE) TABS 400mg

1

amiodarone inj 50mg/ml 1disopyramide phosphate(generic of NORPACE)

1

flecainide acetate (generic ofTAMBOCOR)

1

mexiletine hcl 1MULTAQ 3NORPACE CR 2PACERONE 100mg 2pacerone (generic ofCORDARONE) 200mg

1

propafenone hcl (generic ofRYTHMOL SR) CP12

1

Drug Name DrugTier

Requirements/Limits

propafenone hcl (generic ofRYTHMOL) TABS 150mg,225mg

1

propafenone hcl TABS300mg

1

quinidine gluconate er 1quinidine sulfate 1sorine (generic ofBETAPACE) 80mg, 120mg,160mg

1

sorine 240mg 1sotalol hcl (generic ofBETAPACE) 80mg, 160mg

1

sotalol hcl 240mg 1sotalol hcl (afib/afl) (generic ofBETAPACE AF)

1

TIKOSYN 2 NMANTILIPEMICS, HMG-CoA REDUCTASEINHIBITORSALTOPREV 3atorvastatin tab 10mg(generic of LIPITOR)

1

atorvastatin tab 20mg(generic of LIPITOR)

1


1


1

CRESTOR 2fluvastatin sodium (generic ofLESCOL)

1

LESCOL XL 2LIVALO 3lovastatin 10mg 1lovastatin (generic ofMEVACOR) 20mg, 40mg

1

pravastatin sodium 10mg 1pravastatin sodium (generic ofPRAVACHOL) 20mg, 40mg,80mg

1

simvastatin (generic ofZOCOR) TABS

1

simvastatin tab 80mg (genericof ZOCOR)

1

ANTILIPEMICS, MISCELLANEOUSADVICOR 3


Drug Name DrugTier

Requirements/Limits

ANTARA 2cholestyramine (generic ofQUESTRAN)

1

cholestyramine light (genericof QUESTRAN LIGHT)

1

colestipol hcl (generic ofCOLESTID)

1

fenofibrate (generic ofTRICOR) 48mg, 145mg

1

fenofibrate (generic ofLOFIBRA) 54mg, 160mg

1

fenofibrate micronized(generic of ANTARA) 43mg,130mg

1

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

1

FENOGLIDE 3gemfibrozil (generic of LOPID)TABS

1

LIPOFEN 2LOVAZA 2niacor 1NIASPAN 2prevalite (generic ofQUESTRAN LIGHT)

1

SIMCOR 2TRIGLIDE 3TRILIPIX 2VASCEPA 3VYTORIN 2WELCHOL 2ZETIA 2BETA-BLOCKER/DIURETICCOMBINATIONSatenolol & chlorthalidone(generic of TENORETIC 50)

1

atenolol & chlorthalidone(generic of TENORETIC 100)

1

bisoprolol &hydrochlorothiazide (genericof ZIAC)

1

metoprolol &hydrochlorothiazide

1

Drug Name DrugTier

Requirements/Limits

metoprolol &hydrochlorothiazide (genericof LOPRESSOR HCT)

1

nadolol & bendroflumethiazide(generic of CORZIDE)

1

propranolol &hydrochlorothiazide

1

BETA-BLOCKERSacebutolol hcl (generic ofSECTRAL) CAPS

1

atenolol (generic ofTENORMIN) TABS

1

betaxolol hcl (generic ofKERLONE)

1

bisoprolol fumarate (genericof ZEBETA)

1

BYSTOLIC 2carvedilol (generic ofCOREG)

1

COREG CR 2labetalol hcl SOLN 1labetalol hcl (generic ofTRANDATE) TABS

1

LEVATOL 3metoprolol succinate (genericof TOPROL XL)

1

metoprolol tartrate (generic ofLOPRESSOR) SOLN

1

metoprolol tartrate TABS25mg

1

metoprolol tartrate (generic ofLOPRESSOR) TABS 50mg,100mg

1

nadolol (generic ofCORGARD) TABS

1

pindolol 1propranolol hcl TABS 1propranolol hcl er (generic ofINDERAL LA)

1

propranolol inj 1mg/ml 1propranolol sol 1propranolol tab 1timolol maleate TABS 1CALCIUM CHANNELBLOCKER/ANTILIPEMIC COMBINATIONS


Drug Name DrugTier

Requirements/Limits

AMLODIPINEBESYLATE/ATORV

1

CALCIUM CHANNEL BLOCKERSafeditab cr (generic ofADALAT CC)

1

amlodipine besylate (genericof NORVASC) TABS

1

CARDIZEM LA 120mg 3cartia (generic of CARDIZEMCD)

1

COVERA-HS 3dilt (generic of CARDIZEMCD) 120mg, 300mg

1

dilt 180mg 1dilt (generic of DILACOR XR)240mg

1

diltiazem hcl CP12 1diltiazem hcl SOLN50mg/10ml

1

DILTIAZEM HCL SOLR 3diltiazem hcl (generic ofCARDIZEM) TABS

1

diltiazem hcl coated beads(generic of CARDIZEM CD)

1

diltiazem hcl extended releasebeads (generic of TIAZAC)

1

DYNACIRC CR 3felodipine 1isradipine 1matzim (generic ofCARDIZEM LA)

1

nicardipine hcl CAPS 1nifediac (generic of ADALATCC)

1

nifediac cc tab (generic ofADALAT CC)

1

nifedical (generic ofPROCARDIA XL)

1

nifedipine (generic of ADALATCC) TB24

1

nifedipine er (generic ofPROCARDIA XL)

1

nimodipine (generic ofNIMOTOP) CAPS

1

nisoldipine (generic ofSULAR) 8.5mg, 17mg, 34mg

1

Drug Name DrugTier

Requirements/Limits

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

1

taztia (generic of TIAZAC) 1verapamil hcl (generic ofVERELAN PM) CP24 100mg,200mg, 300mg

1

verapamil hcl (generic ofVERELAN) CP24 120mg,180mg, 240mg

1

verapamil hcl SOLN 1verapamil hcl TABS 40mg 1verapamil hcl (generic ofCALAN) TABS 80mg, 120mg

1

verapamil hcl (generic ofCALAN SR) TBCR

1

DIGITALIS GLYCOSIDESdigoxin (generic of LANOXIN)TABS

1

digoxin inj (generic ofLANOXIN)

1

DIGOXIN SOL 50MCG/ML 1LANOXIN PEDIATRIC 3LANOXIN TAB 2DIRECT RENININHIBITORS/COMBINATIONSAMTURNIDE 2TEKAMLO 2TEKTURNA 2TEKTURNA HCT TAB 150-12.5MG

2

TEKTURNA HCT TAB 150-25MG

2

TEKTURNA HCT TAB 300-12.5MG

2

TEKTURNA HCT TAB 300-25MG

2

DIURETICSacetazolamide (generic ofDIAMOX) CP12

1

acetazolamide TABS 1acetazolamide sodium 1ALDACTAZIDE 3amiloride &hydrochlorothiazide

1

amiloride hcl 1


Drug Name DrugTier

Requirements/Limits

bumetanide SOLN; TABS 1chlorothiazide 1chlorthalidone 25mg, 50mg 1DIURIL SUS 250/5ML 2DYRENIUM 3EDECRIN 3furosemide SOLN 1furosemide (generic of LASIX)TABS

1

furosemide inj 1FUROSEMIDE ORAL SOLN 8MG/ML

2

hydrochlorothiazide (genericof MICROZIDE) CAPS

1

hydrochlorothiazide TABS 1indapamide TABS 1methazolamide (generic ofNEPTAZANE) TABS

1

methyclothiazide 1metolazone (generic ofZAROXOLYN) 2.5mg, 5mg

1

metolazone 10mg 1spironolactone &hydrochlorothiazide (genericof ALDACTAZIDE)

1

THALITONE 2TORSEMIDE INJ 20MG/2ML 3torsemide tabs (generic ofDEMADEX)

1

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

1

triamterene &hydrochlorothiazide cap 50-25mg

1

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

1

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

1

MISCELLANEOUSBIDIL 2clorpres 0.1/15 1clorpres 0.2/15 1

Drug Name DrugTier

Requirements/Limits

clorpres 0.3/15 1DEMSER 3 NMDIBENZYLINE 3hydralazine hcl SOLN; TABS 1methyldopa 1methyldopa &hydrochlorothiazide

1

midodrine hcl 1minoxidil TABS 1RANEXA 2NITRATESDILATRATE SR 3ISORDIL TITRADOSE 40mg 2isosorbide dinitrate SUBL 1isosorbide dinitrate (generic ofISORDIL TITRADOSE) TABS5mg

1

isosorbide dinitrate TABS10mg, 20mg, 30mg

1

isosorbide dinitrate TBCR 1isosorbide dinitrate sl tab 5mg

1

isosorbide mononitrate TABS 1isosorbide mononitrate(generic of IMDUR) TB24

1

minitran (generic of NITRO-DUR)

1

NITRO-BID 2NITRO-DUR 0.3MG/HR 2NITRO-DUR 0.8MG/HR 2NITROGLYCERIN LINGUALAERS

1

nitroglycerin patches 1NITROLINGUALPUMPSPRAY

2

NITROMIST 2NITROSTAT 2PULMONARY ARTERIAL HYPERTENSIONADCIRCA 2 NM PALETAIRIS 2 NM LAREMODULIN 2 NM LAsildenafil citrate (pulmonaryhypertension) (generic ofREVATIO)

1 NM PA


Drug Name DrugTier

Requirements/Limits

TRACLEER 2 NM LAVENTAVIS 2 NMCENTRAL NERVOUS SYSTEMANTIANXIETYalprazolam CONC 1alprazolam (generic ofXANAX) TABS

1

buspirone hcl TABS 1fluvoxamine maleate 1fluvoxamine maleate er(generic of LUVOX CR)

1

fluvoxamine tab 100mg 1lorazepam CONC 1lorazepam (generic ofATIVAN) SOLN; TABS

1

LUVOX CR 3ANTICONVULSANTSBANZEL 3carbamazepine CHEW 1carbamazepine (generic ofCARBATROL) CP12

1

carbamazepine (generic ofTEGRETOL) SUSP; TABS

1

carbamazepine (generic ofTEGRETOL-XR) TB12

1

CELONTIN 3clonazepam (generic ofKLONOPIN) TABS

1

clonazepam TBDP 1clorazepate dipotassium(generic of TRANXENE T)

1

diazepam SOLN 1diazepam (generic ofVALIUM) TABS

1

diazepam gel 1DIAZEPAM INTENSOL 1DILANTIN 2divalproex sodium (generic ofDEPAKOTE SPRINKLES)CPSP

1

divalproex sodium (generic ofDEPAKOTE ER) TB24

1

divalproex sodium (generic ofDEPAKOTE) TBEC

1

epitol (generic of TEGRETOL) 1

Drug Name DrugTier

Requirements/Limits

ethosuximide (generic ofZARONTIN) CAPS; SOLN

1

felbamate (generic ofFELBATOL)

1

gabapentin cap 100mg(generic of NEURONTIN)

1


1


1

gabapentin sol 250/5ml(generic of NEURONTIN)

1

gabapentin tab 600mg(generic of NEURONTIN)

1

gabapentin tab 800mg(generic of NEURONTIN)

1

GABITRIL 12mg, 16mg 2LAMICTAL ODT TBDP 2LAMICTAL STARTER 2LAMICTAL XR KIT 2LAMICTAL XR TB24 25mg,50mg, 100mg, 200mg, 250mg

2

lamotrigine (generic ofLAMICTAL CHEWABLEDISPERS) CHEW

1

lamotrigine (generic ofLAMICTAL) TABS

1

lamotrigine er (generic ofLAMICTAL XR)

1

levetiracetam (generic ofKEPPRA) SOLN; TABS

1

levetiracetam (generic ofKEPPRA XR) TB24

1

LYRICA CAP 25MG 2LYRICA CAP 50MG 2LYRICA CAP 75MG 2LYRICA CAP 100MG 2LYRICA CAP 150MG 2LYRICA CAP 200MG 2LYRICA CAP 225MG 2LYRICA CAP 300MG 2LYRICA SOL 20MG/ML 2ONFI 3oxcarbazepine (generic ofTRILEPTAL)

1

PEGANONE 3


Drug Name DrugTier

Requirements/Limits

phenobarbital ELIX; TABS 1phenobarbital sodium 1PHENYTEK 3phenytoin (generic ofDILANTIN INFATABS)CHEW

1

phenytoin (generic ofDILANTIN) SUSP

1

phenytoin inj 50mg/ml 1phenytoin sodium extended(generic of DILANTIN)100mg

1

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

1

POTIGA 3primidone (generic ofMYSOLINE) TABS

1

SABRIL 2 NM LASTAVZOR 3TEGRETOL CHEW 2TEGRETOL SUSP; TABS 3TEGRETOL XR TAB 100MG 2TEGRETOL-XR 3tiagabine tab 2mg (generic ofGABITRIL)

1

tiagabine tab 4mg (generic ofGABITRIL)

1

topiramate (generic ofTOPAMAX SPRINKLE)CPSP

1

topiramate (generic ofTOPAMAX) TABS

1

TRILEPTAL SUSP 3valproate sodium (generic ofDEPACON) SOLN

1

valproate sodium (generic ofDEPAKENE) SYRP

1

valproic acid (generic ofDEPAKENE) CAPS

1

VIMPAT 2zonisamide (generic ofZONEGRAN) 25mg, 100mg

1

zonisamide 50mg 1ANTIDEMENTIAARICEPT 23mg 2

Drug Name DrugTier

Requirements/Limits

donepezil hydrochloride(generic of ARICEPT) TABS

1

donepezil hydrochloride(generic of ARICEPT ODT)TBDP

1

EXELON PATCHES 2EXELON SOLN 3galantamine hydrobromide(generic of RAZADYNE ER)CP24

1

galantamine hydrobromide(generic of RAZADYNE)SOLN; TABS

1

NAMENDA 2NAMENDA TITRATION PAK 2rivastigmine tartrate (genericof EXELON)

1

ANTIDEPRESSANTSamitriptyline hcl TABS 1AMOXAPINE 2APLENZIN 3budeprion (generic ofWELLBUTRIN SR)

1

bupropion hcl (generic ofWELLBUTRIN) TABS

1

bupropion hcl sr (generic ofWELLBUTRIN SR)

1

bupropion hcl xl (generic ofWELLBUTRIN XL)

1

citalopram hydrobromideSOLN

1

citalopram hydrobromide(generic of CELEXA) TABS

1

clomipramine hcl (generic ofANAFRANIL) CAPS

1

CYMBALTA 2desipramine hcl (generic ofNORPRAMIN) TABS

1

doxepin hcl CAPS; CONC 1EMSAM 3escitalopram oxalate (genericof LEXAPRO)

1

fluoxetine hcl (generic ofPROZAC) CAPS

1

fluoxetine hcl (generic ofPROZAC WEEKLY) CPDR

1


Drug Name DrugTier

Requirements/Limits

fluoxetine hcl SOLN 1fluoxetine hcl TABS 10mg,20mg

1

FLUOXETINE HCL TABS60mg

2

FORFIVO XL 3imipramine hcl (generic ofTOFRANIL) TABS

1

imipramine pamoate (genericof TOFRANIL-PM)

1

maprotiline hcl 1MARPLAN 2mirtazapine TABS 7.5mg 1mirtazapine (generic ofREMERON) TABS 15mg,30mg, 45mg

1

mirtazapine (generic ofREMERON SOLTAB) TBDP

1

nefazodone hcl 1nortriptyline hcl (generic ofPAMELOR) CAPS

1

nortriptyline hcl SOLN 1OLEPTRO 3paroxetine er tab (generic ofPAXIL CR)

1

paroxetine hcl (generic ofPAXIL)

1

PAXIL SUSP 3PEXEVA 3phenelzine sulfate (generic ofNARDIL) TABS

1

PRISTIQ 2protriptyline hcl (generic ofVIVACTIL)

1

sertraline hcl (generic ofZOLOFT) CONC; TABS

1

tranylcypromine sulfate(generic of PARNATE)

1

trazodone hcl TABS 1trimipramine maleate (genericof SURMONTIL)

1

venlafaxine cap er (generic ofEFFEXOR XR)

1

venlafaxine hcl 1venlafaxine tab 1

Drug Name DrugTier

Requirements/Limits

venlafaxine tab er (generic ofVENLAFAXINE HCL ER)

1

VIIBRYD 2ANTIPARKINSONIAN AGENTSamantadine hcl CAPS;SYRP; TABS

1

APOKYN 2 NM LAAZILECT 2benztropine mesylate (genericof COGENTIN) SOLN

1

benztropine mesylate TABS 1bromocriptine mesylateCAPS

1

bromocriptine mesylate(generic of PARLODEL)TABS

1

carbidopa-levodopa (genericof SINEMET) TABS

1

carbidopa-levodopa (genericof SINEMET CR) TBCR

1

carbidopa-levodopa (genericof PARCOPA) TBDP

1

CARBIDOPA/LEVODOPA/ENTACA

1

COMTAN 3entacapone (generic ofCOMTAN)

1

LODOSYN 3MIRAPEX ER 3NEUPRO 2pramipexole dihydrochloride.75mg

1

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

1

ropinirole hydrochloride(generic of REQUIP) TABS

1

ropinirole hydrochloride(generic of REQUIP XL)TB24

1

selegiline hcl (generic ofELDEPRYL) CAPS

1

selegiline hcl TABS 1STALEVO 2trihexyphenidyl hcl 1


Drug Name DrugTier

Requirements/Limits

ZELAPAR 3ANTIPSYCHOTICSABILIFY 2ABILIFY DISCMELT 2ABILIFY MAINTENA 3 NMABILIFY SOL 1MG/ML 2ABILIFY TABS 2CHLORPROMAZ INJ25MG/ML

3

chlorpromazine hcl TABS 1clozapine (generic ofCLOZARIL) 25mg, 100mg

1

clozapine 50mg, 200mg 1CLOZAPINE ODT 1FANAPT 3FANAPT TITRATION PACK 3FAZACLO 3fluphenazine decanoateSOLN

1

fluphenazine hcl 1GEODON INJ 3haloperidol TABS 1haloperidol decanoate(generic of HALDOLDECANOATE 50) SOLN50mg/ml

1

haloperidol decanoate(generic of HALDOLDECANOATE 100) SOLN100mg/ml

1

haloperidol lactate CONC 1haloperidol lactate (generic ofHALDOL) SOLN

1

INVEGA 3INVEGA SUSTENNA39mg/0.25ml, 78mg/0.5ml

3

INVEGA SUSTENNA117mg/0.75ml, 156mg/ml,234mg/1.5ml

3 NM

LATUDA 2loxapine succinate (generic ofLOXITANE) CAPS

1

olanzapine (generic ofZYPREXA)

1

olanzapine inj 10mg (genericof ZYPREXA)

1

Drug Name DrugTier

Requirements/Limits

olanzapine odt (generic ofZYPREXA ZYDIS)

1

ORAP 2perphenazine TABS 1quetiapine fumarate (genericof SEROQUEL)

1

RISPERDAL CONSTA12.5mg, 25mg

2

RISPERDAL CONSTA37.5mg, 50mg

2 NM

risperidone (generic ofRISPERDAL)

1

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

1

risperidone odt .25mg 1SAPHRIS 3SEROQUEL XR 2thioridazine hcl TABS 1thiothixene 1trifluoperazine hcl 1ziprasidone hcl (generic ofGEODON)

1

ATTENTION DEFICIT HYPERACTIVITYDISORDERamphetamine-dextroamphetamine (genericof ADDERALL XR) CP24

1

amphetamine-dextroamphetamine (genericof ADDERALL) TABS

1

DAYTRANA 2INTUNIV 2metadate 1METADATE CD 3METHYLIN CHEW TAB 2methylphenidate hcl (genericof RITALIN LA) CP24

1

methylphenidate hcl (genericof METADATE CD) CPCR

1

methylphenidate hcl (genericof METHYLIN) SOLN

1

methylphenidate hcl (genericof RITALIN) TABS

1

methylphenidate hcl TBCR 1


Drug Name DrugTier

Requirements/Limits

METHYLPHENIDATE HCLER 18mg, 27mg, 36mg,54mg

1

QUILLIVANT XR 2RITALIN 3RITALIN LA 10mg 2STRATTERA 2VYVANSE 2HYPNOTICSEDLUAR SUB 5MG 3EDLUAR SUB 10MG 3INTERMEZZO SUB 1.75MG 3INTERMEZZO SUB 3.5MG 3LUNESTA TAB 1MG 2LUNESTA TAB 2MG 2LUNESTA TAB 3MG 2ROZEREM TAB 8MG 3SILENOR 2zaleplon cap 5mg (generic ofSONATA)

1

zaleplon cap 10mg (generic ofSONATA)

1

zolpidem er tab 6.25mg(generic of AMBIEN CR)

1

zolpidem er tab 12.5mg(generic of AMBIEN CR)

1

zolpidem tab 5mg (generic ofAMBIEN)

1

zolpidem tab 10mg (generic ofAMBIEN)

1

ZOLPIMIST SPR 5MG 3MIGRAINEALSUMA INJ 6MG/0.5 3AXERT TAB 6.25MG 3AXERT TAB 12.5MG 3dihydroergotamine mesylate(generic of D.H.E. 45) 1mg/ml

1

DIHYDROERGOTAMINEMESYLATE 4mg/ml

1

ergomar 1ergotamine w/ caffeine 1FROVA TAB 2.5MG 3MAXALT TAB 5MG 3MAXALT TAB 10MG 3

Drug Name DrugTier

Requirements/Limits

MAXALT-MLT TAB 5MG 3MAXALT-MLT TAB 10MG 3MIGERGOT 2MIGRANAL SPR 4MG/ML 2 NMnaratriptan tab 1mg (genericof AMERGE)

1

naratriptan tab 2.5mg (genericof AMERGE)

1

RELPAX TAB 20MG 2RELPAX TAB 40MG 2rizatriptan benzoate odt(generic of MAXALT-MLT)

1

rizatriptan benzoate tabs(generic of MAXALT)

1

SUMATRIPTAN INJ 4MG/0.5 1sumatriptan inj 6mg/0.5(generic of IMITREX)

1

sumatriptan spr 5mg/act 1sumatriptan spr 20mg/act 1sumatriptan tab 25mg(generic of IMITREX)

1

sumatriptan tab 50mg(generic of IMITREX)

1

sumatriptan tab 100mg(generic of IMITREX)

1

SUMAVEL DOSE INJ6MG/0.5

2

TREXIMET TAB 85-500MG 2ZOMIG SPR 5MG 2ZOMIG TAB 2.5MG 2ZOMIG TAB 5MG 2ZOMIG ZMT TAB 2.5 MG 2ZOMIG ZMT TAB 5MG 2MISCELLANEOUSEQUETRO 3GRALISE STARTER 2GRALISE TAB 300MG 2GRALISE TAB 600MG 2HORIZANT 3lithium carbonate CAPS 1LITHIUM CARBONATETABS

1

lithium carbonate (generic ofLITHOBID) TBCR 300mg

1


Drug Name DrugTier

Requirements/Limits

lithium carbonate TBCR450mg

1

LITHIUM CITRATE 2MESTINON SYRUP 2MESTINON TIMESPAN 2MYTELASE 3NUEDEXTA CAP 20-10MG 2pyridostigmine bromide(generic of MESTINON)TABS

1

REGONOL 2RILUTEK 3 NMSAVELLA 2SAVELLA TITRATION PACK 2XENAZINE 2 NM LAMULTIPLE SCLEROSIS AGENTSAMPYRA 3 NM LAAUBAGIO 3 NMAVONEX KIT 30MCG 2 NMAVONEX PREFL KIT 30MCG 2 NMBETASERON INJ 0.3MG 2 NMCOPAXONE KIT 20MG/ML 2 NMEXTAVIA INJ 0.3MG 2 NMGILENYA 3 NMREBIF INJ 22/0.5 3 NMREBIF INJ 44/0.5 3 NMREBIF TITRTN SOL PACK 3 NMTECFIDERA 3 NMTECFIDERA STARTERPACK

3 NM

TYSABRI 3 NM LAMUSCULOSKELETAL THERAPY AGENTSbaclofen TABS 1chlorzoxazone (generic ofPARAFON FORTE DSC)TABS

1

cyclobenzapr cap 15mg er 1cyclobenzapr cap 30mg er 1cyclobenzapr tab 5mg(generic of FLEXERIL)

1

cyclobenzapr tab 7.5mg(generic of FEXMID)

1

cyclobenzapr tab 10mg(generic of FLEXERIL)

1

Drug Name DrugTier

Requirements/Limits

dantrolene sodium (generic ofDANTRIUM) CAPS

1

methocarbamol (generic ofROBAXIN) TABS 500mg

1

methocarbamol (generic ofROBAXIN-750) TABS 750mg

1

tizanidine hcl (generic ofZANAFLEX) CAPS

1

tizanidine tabs 2mg 1tizanidine tabs (generic ofZANAFLEX) 4mg

1

NARCOLEPSY/CATAPLEXYmodafinil (generic ofPROVIGIL)

1 NM

NUVIGIL 2XYREM 2 NM LAPSYCHOTHERAPEUTIC-MISCbuprenorphine hcl SUBL 1buprenorphine-naloxone subl(generic of SUBOXONE)

1

buproban (generic of ZYBAN) 1CAMPRAL 2CHANTIX PAK 0.5& 1MG 2CHANTIX TAB 0.5MG 2CHANTIX TAB 1MG 2disulfiram (generic ofANTABUSE) TABS

1

naloxone hcl SOLN 1naltrexone hcl (generic ofREVIA) TABS

1

NICOTROL INH 3NICOTROL NS SPR10MG/ML

3

perphenazine-amitriptyline 1SARAFEM 3SUBOXONE FILM 2-0.5MG 3SUBOXONE FILM 4-1MG 3SUBOXONE FILM 8-2MG 3SUBOXONE FILM 12-3MG 3SUBOXONE SUB 2-0.5MG 3SUBOXONE SUB 8-2MG 3VIVITROL 3 NMENDOCRINE AND METABOLICANDROGENS


Drug Name DrugTier

Requirements/Limits

ANDRODERM DIS2MG/24HR

2

ANDRODERM DIS4MG/24HR

2

ANDROGEL GEL 1%(25MG) 2ANDROGEL GEL 1%(50MG) 2ANDROGEL GEL 1.62% 2ANDROGEL GEL PUMP 1% 2ANDROXY 2AXIRON SOL 30MG/ACT 2FORTESTA GEL 10MG/ACT 2oxandrolone (generic ofOXANDRIN) TABS

1

STRIANT MIS 30MG 3TESTIM GEL 1%(50MG) 3testosterone cypionate(generic of DEPO-TESTOSTERONE) OIL

1

testosterone enanthate(generic of DELATESTRYL)OIL

1

ANTIDIABETICS, INJECTABLEALCOHOL PREPS PADS 2APIDRA 2APIDRA SOLOSTAR 2BYDUREON INJ 2BYETTA 3GAUZE PADS 2X2 2HUMALOG 3HUMALOG KWIKPEN 3HUMALOG MIX 50/50 3HUMALOG MIX 50/50KWIKPEN

3

HUMALOG MIX 75/25 3HUMALOG MIX 75/25KWIKPEN

3

HUMULIN 70/30 3HUMULIN 70/30 PEN 3HUMULIN N 3HUMULIN N U-100 PEN 3HUMULIN R 3HUMULIN R U-500(CONCENTRATE)

2

INSULIN PEN NEEDLES 2

Drug Name DrugTier

Requirements/Limits

INSULIN SAFETY NEEDLES 2INSULIN SYRINGES 2LANTUS 2LANTUS SOLOSTAR 2LEVEMIR 2LEVEMIR FLEXPEN 2NOVOLIN 70/30 2NOVOLIN N 2NOVOLIN R 2NOVOLOG 2NOVOLOG FLEXPEN 2NOVOLOG MIX 70/30 2NOVOLOG MIX 70/30PREFILL

2

SYMLINPEN 60 2SYMLINPEN 120 2VICTOZA INJ 18MG/3ML 2ANTIDIABETICS, ORALacarbose (generic ofPRECOSE)

1

ACTOPLUS MET TAB XR 3glimepiride tab 1mg (genericof AMARYL)

1

glimepiride tab 2mg (genericof AMARYL)

1

glimepiride tab 4mg (genericof AMARYL)

1

glip/metform tab 2.5-250m(generic of METAGLIP)

1

glip/metform tab 2.5-500m 1glip/metform tab 5-500mg 1glipizide er tab 2.5mg (genericof GLUCOTROL XL)

1

glipizide er tab 5mg (genericof GLUCOTROL XL)

1

glipizide er tab 10mg (genericof GLUCOTROL XL)

1

glipizide tab 5mg (generic ofGLUCOTROL)

1

glipizide tab 10mg (generic ofGLUCOTROL)

1

GLUMETZA TAB 500MG 3GLUMETZA TAB 1000MG 3glyb/metform tab 1.25-250(generic of GLUCOVANCE)

1


Drug Name DrugTier

Requirements/Limits

glyb/metform tab 2.5-500(generic of GLUCOVANCE)

1

glyb/metform tab 5-500mg(generic of GLUCOVANCE)

1

glyburid mcr tab 1.5mg(generic of GLYNASE)

1

glyburid mcr tab 3mg (genericof GLYNASE)

1

glyburid mcr tab 6mg (genericof GLYNASE)

1

glyburide tab 1.25mg 1glyburide tab 2.5mg 1glyburide tab 5mg 1GLYSET 3JANUMET TAB 50-500MG 2JANUMET TAB 50-1000 2JANUMET XR TAB 50-500MG

2

JANUMET XR TAB 50-1000 2JANUMET XR TAB 100-1000 2JANUVIA TAB 25MG 2JANUVIA TAB 50MG 2JANUVIA TAB 100MG 2JENTADUETO TAB 2.5-500 2JENTADUETO TAB 2.5-850 2JENTADUETO TAB 2.5-1000 2JUVISYNC TAB 50-10MG 2JUVISYNC TAB 50-20MG 2JUVISYNC TAB 50-40MG 2JUVISYNC TAB 100-10MG 2JUVISYNC TAB 100-20MG 2JUVISYNC TAB 100-40MG 2KAZANO 3KOMBIGLYZE TAB 2.5-1000 3KOMBIGLYZE TAB 5-500MG 3KOMBIGLYZE TAB 5-1000MG

3

metformin er tab 1000mg(generic of FORTAMET)

1

metformin tab 500mg (genericof GLUCOPHAGE)

1

metformin tab 500mg er(generic of FORTAMET)500mg

1

Drug Name DrugTier

Requirements/Limits

metformin tab 500mg er(generic of GLUCOPHAGEXR) 500mg

1

metformin tab 750mg er(generic of GLUCOPHAGEXR)

1

metformin tab 850mg (genericof GLUCOPHAGE)

1

metformin tab 1000mg(generic of GLUCOPHAGE)

1

nateglinide tab 60mg (genericof STARLIX)

1

nateglinide tab 120mg(generic of STARLIX)

1

NESINA 3ONGLYZA TAB 2.5MG 3ONGLYZA TAB 5MG 3OSENI TAB 12.5-15MG 3OSENI TAB 12.5-30MG 3OSENI TAB 12.5-45MG 3OSENI TAB 25-15MG 3OSENI TAB 25-30MG 3OSENI TAB 25-45MG 3pioglit/glim tab 30-2mg(generic of DUETACT)

1

pioglit/glim tab 30-4mg(generic of DUETACT)

1

pioglita/met tab 15-500mg(generic of ACTOPLUS MET)

1

pioglita/met tab 15-850mg(generic of ACTOPLUS MET)

1

pioglitazone tab 15mg(generic of ACTOS)

1


1


1

PRANDIMET TAB 1-500MG 3PRANDIMET TAB 2-500MG 3PRANDIN TAB 0.5MG 2PRANDIN TAB 1MG 2PRANDIN TAB 2MG 2RIOMET SOL 2TRADJENTA TAB 5MG 2BISPHOSPHONATES


Drug Name DrugTier

Requirements/Limits

ACTONEL 2alendronate sodium tabs5mg, 10mg, 35mg, 40mg

1

alendronate sodium tabs(generic of FOSAMAX) 70mg

1

alendronate sol 70/75ml 1ATELVIA 2BINOSTO 3BONIVA INJ 3MG/3ML 3 B/DFOSAMAX PLUS D 3ibandronate sodium (genericof BONIVA)

1 B/D

PAMIDRONATE DISODIUMSOLN 6mg/ml

3 B/D

pamidronate disodium SOLN30mg/10ml, 90mg/10ml

1 B/D

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

1 B/D NM

ZOMETA 3 B/D NMCALCITONINScalcitonin (salmon) nasalspray (generic ofMIACALCIN)

1

fortical 2MIACALCIN INJ 200U/ML 2 B/DCALCIUM RECEPTOR ANTAGONISTSSENSIPAR 2 NMCHELATING AGENTSCHEMET 3EXJADE 3 NM LAFERRIPROX 3 NMkionex (generic ofKAYEXALATE)

1

sodium polystyrene sulfonate 1SYPRINE 3 NMCONTRACEPTIVESamethia 91 day (generic ofSEASONIQUE)

1

amethyst 28 day 1apri 28 day (generic ofDESOGEN)

1

aranelle 28 (generic of TRI-NORINYL 28)

1

aviane 28 1

Drug Name DrugTier

Requirements/Limits

balziva 28 day (generic ofOVCON-35)

1

BEYAZ 2briellyn 28 day (generic ofOVCON-35)

1

camila 28 day (generic ofNOR-QD)

1

cryselle 28 1cyclafem 1/35 28 day (genericof NORINYL 1+35)

1

cyclafem 7/7/7 28 day(generic of ORTHO-NOVUM7/7/7)

1

DEPO-SUBQ PROVERA 104 3drospirenone-ethinyl estradiol(generic of YASMIN 28)

1

ELLA 2emoquette (generic ofDESOGEN)

1

enpresse 28 day 1errin 28 day (generic ofORTHO MICRONOR)

1

GENERESS FE 3gianvi 28-day (generic ofYAZ)

1

gildagia (generic of OVCON-35)

1

introvale 91 day 1jolivette 28 day (generic ofORTHO MICRONOR)

1

junel 1.5/30 21 day (generic ofLOESTRIN 1.5/30-21)

1

junel 1/20 21 day (generic ofLOESTRIN 1/20-21)

1

junel fe 1.5/30 28 day (genericof LOESTRIN FE 1.5/30)

1

junel fe 1/20 28 day (genericof LOESTRIN FE 1/20)

1

kariva 28 day (generic ofMIRCETTE)

1

kelnor 1/35 28 day 1leena 28 day (generic of TRI-NORINYL 28)

1

lessina 28 day 1levonest 28 day 1


Drug Name DrugTier

Requirements/Limits

levonorgestrel (emergencyoc) (generic of PLAN B ONE-STEP)

1

levonorgestrel-ethinylestradiol (91-day)

1

levora 0.15/30 28 day 1LO LOESTRIN FE 2LOESTRIN 24 FE 2loryna 28 day (generic ofYAZ)

1

low-ogestrel 28 day 1lutera 28 day 1marlissa 28 day 1medroxyprogesterone acetate(contraceptive) (generic ofDEPO-PROVERACONTRACEPTIV)

1

microgestin 1.5/30 21 day(generic of LOESTRIN 1.5/30-21)

1

microgestin 1/20 21 day(generic of LOESTRIN 1/20-21)

1

microgestin fe 1.5/30 28 day(generic of LOESTRIN FE1.5/30)

1

microgestin fe 1/20 28 day(generic of LOESTRIN FE1/20)

1

mononessa 28 day (generic ofORTHO-CYCLEN)

1

myzilra 1necon 0.5/35 28 day (genericof BREVICON-28)

1

necon 1/35 28 day (generic ofNORINYL 1+35)

1

necon 7/7/7 28 day (genericof ORTHO-NOVUM 7/7/7)

1

NECON 10/11 28 DAY 3next choice (generic of PLANB)

1

nora-be 28 day (generic ofNOR-QD)

1

nortrel 0.5/35 28 day (genericof BREVICON-28)

1

nortrel 1/35 21 day (generic ofNORINYL 1+35)

1

Drug Name DrugTier

Requirements/Limits

nortrel 1/35 28 day (generic ofNORINYL 1+35)

1

nortrel 7/7/7 28 day (genericof ORTHO-NOVUM 7/7/7)

1

NUVARING 2ocella 28 day (generic ofYASMIN 28)

1

ogestrel 28 day 1orsythia 28 day 1ORTHO EVRA 2ORTHO TRI-CYCLEN LO 2OVCON-50 28 3philith (generic of OVCON-35) 1portia 28 day 1previfem 28 day (generic ofORTHO-CYCLEN)

1

quasense 91 day 1reclipsen 28 day (generic ofDESOGEN)

1

SOLIA 1sprintec 28 day (generic ofORTHO-CYCLEN)

1

sronyx 28 day 1tri-legest 28 (generic ofESTROSTEP FE)

1

tri-previfem 28 day (generic ofORTHO TRI-CYCLEN)

1

tri-sprintec 28 day (generic ofORTHO TRI-CYCLEN)

1

trinessa 28 day (generic ofORTHO TRI-CYCLEN)

1

trivora 28 day 1velivet 28 day (generic ofCYCLESSA)

1

vestura (generic of YAZ) 1viorele (generic ofMIRCETTE)

1

zenchent fe 28 day (generic ofFEMCON FE)

1

zovia 1/35e 28 day 1zovia 1/50e 28 day 1ENDOMETRIOSISdanazol CAPS 1SYNAREL 2 NMENZYME REPLACEMENTS


Drug Name DrugTier

Requirements/Limits

ADAGEN 3 NM LAALDURAZYME 3 NM LABUPHENYL 3 NMBUPHENYL TAB 500MG 3 NMCARBAGLU 3 NM LACEREZYME 200unit 3 NMCYSTADANE 3 NMCYSTAGON 2 NMELAPRASE 3 NMELELYSO 3 NMFABRAZYME 35mg 3 NMKUVAN 2 NMlevocarnitine (metabolicmodifiers) (generic ofCARNITOR)

1 B/D

LUMIZYME 3 NMMYOZYME 3 NMNAGLAZYME 3 NM LAORFADIN 3 NM LAsodium phenylbutyrate(generic of BUPHENYL)

1 NM

VPRIV 3 NMZAVESCA 3 NM LAESTROGEN/PROGESTINSCLIMARA PRO 3COMBIPATCH 2estradiol & norethindroneacetate (generic ofACTIVELLA)

1

FEMHRT LOW DOSE 3jinteli 1PREFEST 3PREMPHASE 2PREMPRO 2ESTROGENSALORA 3DELESTROGEN 10mg/ml 3DEPO-ESTRADIOL 3DIVIGEL 1mg/gm 2ELESTRIN 3ESTRACE CREA 3estradiol (generic ofCLIMARA) PTWK

1

Drug Name DrugTier

Requirements/Limits

estradiol (generic ofESTRACE) TABS

1

estradiol valerate OIL10mg/ml

1

estradiol valerate (generic ofDELESTROGEN) OIL20mg/ml, 40mg/ml

1

ESTRING 3estropipate TABS 1EVAMIST 2FEMRING 3FEMTRACE 3MENEST 2MENOSTAR 3MINIVELLE 3PREMARIN 2PREMARIN CREAM 2PREMARIN INJ 3VAGIFEM 2VIVELLE-DOT 2GLUCOCORTICOIDSa-hydrocort 1CELESTONE 3cortisone acetate TABS 1DEPO-MEDROL 20mg/ml 3dexamethasone ELIX; TABS 1DEXAMETHASONEINTENSOL

3

dexamethasone sodiumphosphate

1

DEXPAK TAPERPAK 13 DAY 2FLO-PRED 3fludrocortisone acetate TABS 1hydrocortisone (generic ofCORTEF) TABS

1

methylprednisolone (genericof MEDROL DOSEPAK)TABS 4mg

1

methylprednisolone (genericof MEDROL) TABS 4mg,8mg, 16mg, 32mg

1

methylprednisolone acetate(generic of DEPO-MEDROL)

1

methylprednisolone sod succ(generic of SOLU-MEDROL)

1


Drug Name DrugTier

Requirements/Limits

MILLIPRED 3ORAPRED ODT 15mg, 30mg 2prednisolone sodiumphosphate (generic ofPEDIAPRED) 5mg/5ml

1

prednisolone sodiumphosphate (generic ofORAPRED) 15mg/5ml

1

prednisolone sodiumphosphate 25mg/5ml

1

prednisone SOLN; TABS 1PREDNISONE INTENSOL 2RAYOS 3SOLU-CORTEF 250MG 2SOLU-MEDROL 2gm 3VERIPRED 3GLUCOSE ELEVATING AGENTSGLUCAGEN HYPOKIT 2GLUCAGON EMERGENCYKIT

2

PROGLYCEM 3 NMHUMAN GROWTH HORMONESGENOTROPIN 3 NMGENOTROPIN MINIQUICK 3 NMHUMATROPE 2 NMHUMATROPE COMBO PACK 2 NMNORDITROPIN FLEXPRO 2 NMNORDITROPIN NORDIFLEXPEN

2 NM

NUTROPIN 3 NMNUTROPIN AQ NUSPIN 5 3 NMNUTROPIN AQ PEN 3 NMOMNITROPE SOLN 3OMNITROPE SOLR 3 NMSAIZEN 3 NMSAIZEN CLICK.EASY 3 NMSEROSTIM 3 NMTEV-TROPIN 3 NMZORBTIVE 3 NMMISCELLANEOUScabergoline 1chorionic gonadotropin SOLR 1 NMEGRIFTA 3 NM

Drug Name DrugTier

Requirements/Limits

INCRELEX 3 NM LAmethylergonovine maleate(generic of METHERGINE)TABS

1

novarel 1 NMoctreotide acetate (generic ofSANDOSTATIN)

1 NM

pregnyl 1 NMPROLIA 3 NMSAMSCA 3 NMSANDOSTATIN LAR DEPOT 3 NMSIGNIFOR 3 NMSOMATULINE DEPOT 3 NMSOMAVERT 3 NM LAXGEVA 3 NMPARATHYROID HORMONESFORTEO 2 NMPHOSPHATE BINDER AGENTScalcium acetate (phosphatebinder) (generic of PHOSLO)CAPS

1

calcium acetate (phosphatebinder) (generic of ELIPHOS)TABS

1

FOSRENOL 2PHOSLO 2PHOSLYRA 2RENAGEL 3RENVELA 2PROGESTINSCRINONE 2ENDOMETRIN 2medroxyprogesterone acetate(generic of PROVERA)

1

norethindrone acetate(generic of AYGESTIN)TABS

1

progesterone micronized(generic of PROMETRIUM)CAPS

1

SELECTIVE ESTROGEN RECEPTORMODULATORSEVISTA 2THYROID AGENTS


Drug Name DrugTier

Requirements/Limits

levothroid (generic ofSYNTHROID)

1

levothyroxine sodium (genericof SYNTHROID) TABS

1

levoxyl (generic ofSYNTHROID)

1

liothyronine sodium (genericof TRIOSTAT) SOLN

1

liothyronine sodium (genericof CYTOMEL) TABS

1

methimazole (generic ofTAPAZOLE) TABS

1

propylthiouracil TABS 1SYNTHROID 2TIROSINT 3unithroid (generic ofSYNTHROID)

1

VASOPRESSINSdesmopressin acetate(generic of DDAVP) TABS

1

desmopressin acetate spray(generic of DDAVP)

1

desmopressin acetate sprayrefrigerated

1

desmopressin inj (generic ofDDAVP)

1

DESMOPRESSIN SOLN0.01%

1

STIMATE 3 NMGASTROINTESTINALANTIEMETICSALOXI 3 NMANTIVERT 50mg 3CESAMET CAP 1MG 3compro 1dronabinol cap 2.5mg(generic of MARINOL)

1

dronabinol cap 5mg (genericof MARINOL)

1

dronabinol cap 10mg (genericof MARINOL)

1 NM

EMEND CAP 40MG 2EMEND CAP 80MG 2EMEND CAP 125MG 2EMEND PAK 80 & 125 2

Drug Name DrugTier

Requirements/Limits

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

1

granisetron hcl TABS 1GRANISOL 2meclizine hcl (generic ofANTIVERT) TABS

1

metoclopramide hcl SOLN 1metoclopramide hcl (genericof REGLAN) TABS

1

METOZOLV ODT 3ondansetron hcl (generic ofZOFRAN) TABS 4mg, 8mg

1

ondansetron hcl TABS 24mg 1ondansetron hcl inj 4mg/2ml 1ondansetron hcl inj (generic ofZOFRAN) 40mg/20ml

1

ondansetron hcl oral soln(generic of ZOFRAN)

1

ondansetron odt (generic ofZOFRAN ODT)

1

phenadoz 1prochlorperazine 1prochlorperazine edisylate 1prochlorperazine maleateTABS

1

promethazine hcl SUPP;SYRP; TABS

1

promethazine hcl inj (genericof PHENERGAN)

1

promethegan 1SANCUSO DIS 3.1MG 2TRANSDERM-SC DIS 1.5MG 2ANTISPASMODICSatropine sulfate SOLN.05mg/ml, .1mg/ml

1

BENTYL SOLN 3CANTIL 3CUVPOSA 3dicyclomine hcl (generic ofBENTYL) CAPS; TABS

1

dicyclomine hcl SOLN 1glycopyrrolate (generic ofROBINUL) SOLN 4mg/20ml

1

glycopyrrolate (generic ofROBINUL) TABS 1mg

1


Drug Name DrugTier

Requirements/Limits

glycopyrrolate (generic ofROBINUL FORTE) TABS2mg

1

methscopolamine bromide(generic of PAMINE) TABS2.5mg

1

methscopolamine bromide(generic of PAMINE FORTE)TABS 5mg

1

H2-RECEPTOR ANTAGONISTScimetidine TABS 1cimetidine inj 150mg/ml 1cimetidine sol 300/5ml 1famotidine SOLN 1famotidine (generic ofPEPCID) SUSR

1

famotidine (generic ofPEPCID) TABS 20mg, 40mg

1

nizatidine CAPS 150mg 1nizatidine (generic of AXID)CAPS 300mg

1

nizatidine (generic of AXID)SOLN

1

ranitidine hcl CAPS 1ranitidine hcl (generic ofZANTAC) SOLN 150mg/6ml

1

ranitidine hcl (generic ofZANTAC) SYRP

1

ranitidine hcl (generic ofZANTAC) TABS 150mg,300mg

1

ZANTAC SOLN 3ZANTAC TBEF 3INFLAMMATORY BOWEL DISEASEAPRISO 2ASACOL 2ASACOL HD 2balsalazide disodium (genericof COLAZAL)

1

budesonide (generic ofENTOCORT EC) CP24

1 NM

CANASA 2CIMZIA 3 NMCIMZIA STARTER KIT 3 NMcolocort (generic ofCORTENEMA)

1

Drug Name DrugTier

Requirements/Limits

DELZICOL 3DIPENTUM 2 NMGIAZO 3hydrocortisone (intrarectal)(generic of CORTENEMA)

1

LIALDA 2mesalamine enema (genericof ROWASA)

1

PENTASA 2SFROWASA 2sulfasalazine dr (generic ofAZULFIDINE EN-TABS)

1

sulfasalazine ir (generic ofAZULFIDINE)

1

UCERIS 3LAXATIVESconstulose 1enulose 1gaviltye-g (generic ofGOLYTELY)

1

gavilyte-c (generic ofCOLYTE-FLAVOR PACKS)

1

gavilyte-n (generic ofNULYTELY/FLAVOR PACKS)

1

generlac 1GOLYTELY 2HALFLYTELY BOWELPREP/FLA

3

kristalose 2lactulose SOLN 1MOVIPREP 2OSMOPREP 3polyethylene glycol 3350POWD

1

PREPOPIK 3RELISTOR KIT 2SUCLEAR 3SUPREP BOWEL PREP 2trilyte (generic ofNULYTELY/FLAVOR PACKS)

1

VISICOL 3MISCELLANEOUSAMITIZA 2CARAFATE SUSP 2


Drug Name DrugTier

Requirements/Limits

chenodal 1 NMcromolyn sodium(mastocytosis) (generic ofGASTROCROM)

1

diphenoxylate w/ atropineLIQD

1

diphenoxylate w/ atropine(generic of LOMOTIL) TABS

1

GATTEX 3 NM LAHELIDAC 3LINZESS 3loperamide hcl CAPS 1LOTRONEX 2 NMmisoprostol (generic ofCYTOTEC)

1

OMECLAMOX-PAK 3PREVPAC MIS 2PYLERA 2SUCRAID 3sucralfate (generic ofCARAFATE) TABS

1

ursodiol (generic ofACTIGALL) CAPS

1

ursodiol (generic of URSO250) TABS 250mg

1

ursodiol (generic of URSOFORTE) TABS 500mg

1

XIFAXAN TAB 550MG 2 NMPANCREATIC ENZYMESCREON 2PANCREAZE 3PERTZYE 3ULTRESA 2VIOKACE 2ZENPEP 2PROTON PUMP INHIBITORSACIPHEX TAB 20MG 3DEXILANT 2lansoprazole cap 15mg dr(generic of PREVACID)

1

lansoprazole cap 30mg dr(generic of PREVACID)

1

NEXIUM 2NEXIUM I.V. 3

Drug Name DrugTier

Requirements/Limits

omeprazole cap 10mg(generic of PRILOSEC)

1


1


1

pantoprazole sodium inj(generic of PROTONIX)

1

pantoprazole tab 20mg(generic of PROTONIX)

1

pantoprazole tab 40mg(generic of PROTONIX)

1

PREVACID TAB 15MG STB 3PREVACID TAB 30MG STB 3PROTONIX INJ 3PROTONIX PAK 3ZEGERID POW 20-1680 3ZEGERID POW 40-1680 3GENITOURINARYBENIGN PROSTATIC HYPERPLASIAalfuzosin hcl (generic ofUROXATRAL)

1

AVODART 2CARDURA XL 3finasteride (generic ofPROSCAR) TABS 5mg

1

JALYN 2RAPAFLO 2tamsulosin hcl (generic ofFLOMAX)

1

MISCELLANEOUSbethanechol chloride (genericof URECHOLINE) TABS

1

ELMIRON 2potassium citrate (alkalinizer)(generic of UROCIT-K 5)540mg

1

potassium citrate (alkalinizer)(generic of UROCIT-K 10)1080mg

1

UROCIT-K 15 2URINARY ANTISPASMODICSDETROL LA 2ENABLEX 3GELNIQUE 2


Drug Name DrugTier

Requirements/Limits

MYRBETRIQ 3oxybutynin chloride SYRP;TABS

1

oxybutynin chloride (genericof DITROPAN XL) TB24

1

OXYTROL 3SANCTURA XR 3tolterodine tartrate (generic ofDETROL)

1

TOVIAZ 2trospium cl cap 60mg er(generic of SANCTURA XR)

1

trospium cl tab 20mg (genericof SANCTURA)

1

VESICARE 2VAGINAL ANTI-INFECTIVESCLEOCIN VAG SUPP 100MG 2clindamycin cre 2% vag(generic of CLEOCIN)

1

metronidazole vaginal(generic of METROGEL-VAGINAL)

1

miconazole nitrate vaginal 1terconazole vaginal (genericof TERAZOL 7) CREA .4%

1

terconazole vaginal (genericof TERAZOL 3) CREA .8%

1

terconazole vaginal (genericof TERAZOL 3) SUPP

1

vandazole 1zazole (generic of TERAZOL7) .4%

1

zazole .8% 1HEMATOLOGICANTICOAGULANTSCOUMADIN 3COUMADIN INJ 3ELIQUIS 2enoxaparin sodium (generic ofLOVENOX) 30mg/0.3ml,40mg/0.4ml, 60mg/0.6ml,80mg/0.8ml

1

enoxaparin sodium (generic ofLOVENOX) 100mg/ml,120mg/0.8ml, 150mg/ml,300mg/3ml

1 NM

Drug Name DrugTier

Requirements/Limits

fondaparinux sodium (genericof ARIXTRA) 2.5mg/0.5ml

1

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

1 NM

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

2

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

2 NM

HEP SOD/NACL INJ 25000 2heparin (porcine) in sodiumchloride (generic of HEPARINSODIUM/SODIUM CHL)

1

heparin (porcine) in sodiumchloride 100u/ml

2

heparin sod (porcine) in d5w 1HEPARIN SODIUM SOLN2000unit/ml

2 B/D

heparin sodium (porcine) 1 B/Djantoven (generic ofCOUMADIN)

1

PRADAXA 2warfarin sodium (generic ofCOUMADIN)

1

XARELTO 2HEMATOPOIETIC GROWTH FACTORSARANESP ALBUMIN FREE25mcg/0.42ml, 25mcg/ml,40mcg/0.4ml, 40mcg/ml,60mcg/0.3ml, 60mcg/ml,100mcg/0.5ml, 100mcg/ml,150mcg/0.3ml, 200mcg/0.4ml,200mcg/ml, 300mcg/0.6ml,300mcg/ml, 500mcg/ml

2 B/D NM

EPOGEN 2 B/D NMLEUKINE 3 NMMOZOBIL 2 NMNEULASTA 2 NMNEUMEGA 3 NMNEUPOGEN 300mcg/0.5ml,480mcg/0.8ml, 480mcg/1.6ml

2 NM

PROCRIT 2 B/D NMMISCELLANEOUS


Drug Name DrugTier

Requirements/Limits

anagrelide hcl 1mg 1anagrelide hcl (generic ofAGRYLIN) .5mg

1

cilostazol (generic of PLETAL) 1pentoxifylline (generic ofTRENTAL) TBCR

1

PROMACTA 2 NM LAtranexamic acid (generic ofCYKLOKAPRON) SOLN

1

PLATELET AGGREGATION INHIBITORSAGGRENOX 2BRILINTA 2clopidogrel bisulfate (genericof PLAVIX)

1

dipyridamole (generic ofPERSANTINE) TABS

1

EFFIENT 2IMMUNOLOGIC AGENTSDISEASE-MODIFYING ANTI-RHEUMATICDRUGS (DMARDS)ACTEMRA 200mg/10ml 3 NMENBREL 2 NMHUMIRA 2 NMhydroxychloroquine sulfate(generic of PLAQUENIL)

1

KINERET 3 NMleflunomide (generic ofARAVA) TABS

1

methotrexate sodium tabs 1ORENCIA 3 NMREMICADE 3 NMRHEUMATREX 2SIMPONI 50mg/0.5ml 3 NMTREXALL 2XELJANZ 3 NMIMMUNOGLOBULINSCARIMUNE NANOFILTERED3gm

3 NM

FLEBOGAMMA .5gm/10ml 3 NMGAMASTAN S/D 2 NMGAMMAGARD LIQUID 3 NMGAMMAKED 1gm/10ml 3 NMGAMMAPLEX 10gm/200ml 3 NM

Drug Name DrugTier

Requirements/Limits

GAMUNEX-C 1gm/10ml 3 NMHIZENTRA 1gm/5ml 3 NMOCTAGAM 1gm/20ml 3 NMPRIVIGEN 20gm/200ml 3 NMIMMUNOMODULATORSACTIMMUNE 3 NM LAARCALYST 3 NMINFERGEN 15mcg/0.5ml 2 NMINTRON-A KIT 3mu/0.2ml,5mu/0.2ml

2 NM

INTRON-A KIT 10mu/0.2ml 2INTRON-A SOLN6000000unit/ml

2 NM

INTRON-A W/DILUENT10mu

2 NM

PEG-INTRON 2 NMPEG-INTRON REDIPEN 2 NMPEGASYS KIT 2 NMPEGASYS SOLN 180mcg/ml 2 NMPEGASYS PROCLICK135mcg/0.5ml

2 NM

REVLIMID 2.5mg, 5mg,10mg, 15mg, 25mg

2 NM LA

THALOMID 2 NMIMMUNOSUPPRESSANTSATGAM 3AZASAN 2azathioprine (generic ofIMURAN) TABS

1

azathioprine inj 100mg 1CELLCEPT SUSR 2 NMCELLCEPT INTRAVENOUS 3cyclosporine (generic ofSANDIMMUNE) CAPS;SOLN

1

cyclosporine modified (formicroemulsion) (generic ofNEORAL) CAPS 25mg,100mg

1

cyclosporine modified (formicroemulsion) CAPS 50mg

1

cyclosporine modified (formicroemulsion) (generic ofNEORAL) SOLN

1

gengraf (generic of NEORAL) 1


Drug Name DrugTier

Requirements/Limits

mycophenolate mofetil(generic of CELLCEPT)

1

MYFORTIC 180mg 2MYFORTIC 360mg 2 NMNEORAL 2NULOJIX 3 NMPROGRAF CAPS 5mg 2 NMPROGRAF CAPS .5mg, 1mg 2PROGRAF SOLN 3RAPAMUNE SOLN 2 NMRAPAMUNE TABS 1mg,2mg

2 NM

RAPAMUNE TABS .5mg 2SANDIMMUNE CAPS 2SANDIMMUNE SOLN100mg/ml

2

SIMULECT 20mg 3tacrolimus (generic ofPROGRAF) CAPS 5mg

1 NM

tacrolimus (generic ofPROGRAF) CAPS .5mg,1mg

1

THYMOGLOBULIN 3ZORTRESS 3 NMVACCINESACTHIB 2ADACEL 2BOOSTRIX 2CERVARIX 2COMVAX 2DAPTACEL 2DECAVAC 2DIPHTHERIA/TETANUSTOXOID

2

ENGERIX-B SUSP 2GARDASIL 2HAVRIX 2IMOVAX RABIES (H.D.C.V.) 2INFANRIX 2IPOL INACTIVATED IPV 2IXIARO 2M-M-R II W/DILUENT 10 DOS 2MENACTRA 2

Drug Name DrugTier

Requirements/Limits

MENHIBRIX 2MENOMUNE-A/C/Y/W-135 2MENVEO 2PEDVAX HIB 2PROQUAD 2RABAVERT 2RECOMBIVAX HB 10mcg/ml,40mcg/ml

2

ROTATEQ 2SYNAGIS 50mg/0.5ml 3 NMTETANUS TOXOIDADSORBED

2

TETANUS/DIPHTHERIATOXOID

2

TWINRIX 2TYPHIM VI 2VAQTA 25unit/0.5ml 2VARIVAX 2YF-VAX 2ZOSTAVAX 2NUTRITIONAL/SUPPLEMENTSELECTROLYTESAMMONIUM CHLORIDESOLN

3

klor-con TBCR 8meq,10meq, 20meq

1

KLOR-CON TBCR 15meq 3MAGNESIUM SULFATESOLN 40mg/ml, 80mg/ml

2

magnesium sulfate SOLN50%

1

MAGNESIUM SULFATE IND5W

2

parenteral electrolytes 1potassium chloride caps er(generic of MICRO-K)

1

potassium chloridemicroencapsulated crystals cr

1

SOD FLUORIDE 2.2MG TAB 1sodium chloride SOLN2.5meq/ml

1

IV NUTRITIONamino acid infusion 1AMINOSYN 3


Drug Name DrugTier

Requirements/Limits

aminosyn 8.5 % withelectrolytes, sulfite-free

1

AMINOSYN II 3aminosyn ii 8.5 % withelectrolytes, sulfite-free

1

AMINOSYN M 3AMINOSYN-HBC 3AMINOSYN-PF 3AMINOSYN-PF 7% 3CLINIMIX 2.75%/DEXTROSE5%

3

CLINIMIX 4.25%/DEXTROSE5%

3


3


3


3

CLINIMIX 5%/DEXTROSE15%

3


3


3

CLINIMIX E2.75%/DEXTROSE 5%

3


3


3


3

CLINIMIX E 5%/DEXTROSE15%

3


3


3

clinisol 15 1FREAMINE III 3% 3freamine iii 8.5 1hepatamine 8 1HEPATASOL INJ 8% 1intralipid (generic of LIPOSYNII)

1

Drug Name DrugTier

Requirements/Limits

INTRALIPID INJ 30% 2NEPHRAMINE 3PREMASOL 3PROCALAMINE 3PROSOL 3TRAVASOL 3TROPHAMINE 3IV REPLACEMENT SOLUTIONSdextrose SOLN 1dextrose 2.5%/nacl 0.45% 1DEXTROSE 5%/ELECTROLYTE

2

dextrose 10% w/ sodiumchloride 0.2%

3

dextrose in lactated ringers 1dextrose w/ sodium chloride 1IONOSOL-B/DEXTROSE 5% 3IONOSOL-MB/DEXTROSE5%

3

isolyte m 1ISOLYTE P 3ISOLYTE S 3ISOLYTE S IN 5 %DEXTROSE

3

ISOLYTE-H/DEXTROSE 5% 2KCL 0.3%/D5W/NACL 0.9% 2KCL 0.15%/D5W/LR 3KCL 0.15%/D5W/NACL0.225%

2

KCL/NACL INJ 0.3-0.9 1lactated ringer's 1normosol-m 1NORMOSOL-R 3normosol-r in 5 % dextrose 3PLASMA-LYTE A 3PLASMA-LYTE-56/D5W 3PLASMA-LYTE-148 3potassium chloride SOLN.4meq/ml, 2meq/ml,10meq/100ml, 10meq/50ml,30meq/100ml

1

potassium chloride 30 meq/l(0.224%) in dextrose 5% inj

1


Drug Name DrugTier

Requirements/Limits

potassium chloride indextrose

1

potassium chloride indextrose & sodium chloride

1

potassium chloride in nacl 1ringer's 1sodium chloride SOLN .45%,.9%, 3%, 5%

1

VITAMINScalcitriol (generic ofROCALTROL) CAPS

1 B/D

calcitriol SOLN 1mcg/ml 1 B/Dcalcitriol (generic ofROCALTROL) SOLN1mcg/ml

1 B/D

HECTOROL CAPS 2 B/DHECTOROL SOLN 3 B/DPRENATAL VITAMINS 1ZEMPLAR CAPS 2 B/DZEMPLAR SOLN 3 B/DOPHTHALMICANTI-INFECTIVE/ANTI-INFLAMMATORYbacitracin-poly-neomycin-hc 1BLEPHAMIDE OINT 2BLEPHAMIDE SUSP 3neomycin-polymy-dexameth(generic of MAXITROL)

1

neomycin-polymyxin-hc(ophth)

1

sulfacetamide sod-prednisolone

1

TOBRADEX OINT 2TOBRADEX ST 2tobramycin-dexamethasone(generic of TOBRADEX)

1

ZYLET 2ANTI-INFECTIVESAZASITE 2bacitracin (ophthalmic) 1bacitracin-polymyxin b (ophth) 1BESIVANCE 2CILOXAN OINT 2ciprofloxacin hcl (ophth)(generic of CILOXAN)

1

Drug Name DrugTier

Requirements/Limits

erythromycin (ophth) 1gentak 1gentamicin sulfate (ophth)(generic of GARAMYCIN)

1

levofloxacin (ophth) 1MOXEZA 2NATACYN 2neomycin-bacitracin zn-polymyxin

1

neomycin-polymy-gramicid(generic of NEOSPORIN)

1

ofloxacin (ophth) (generic ofOCUFLOX)

1

polymyxin b-trimethoprim(generic of POLYTRIM)

1

sulfacetamide sodium (ophth)OINT

1

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

1

tobramycin sulfate (ophth)(generic of TOBREX)

1

TOBREX OINT 0.3% 2trifluridine (generic ofVIROPTIC) SOLN

1

VIGAMOX 2ZIRGAN 3ZYMAXID 3ANTI-INFLAMMATORIESACUVAIL 3ALREX 2BROMDAY 2bromfenac sodium (ophth) 1dexamethasone sodiumphosphate (ophth)

1

diclofenac sodium (ophth) 1DUREZOL 2FLAREX 3FLUOROMETHOLONESUSP

1

flurbiprofen sodium (genericof OCUFEN)

1

FML 2FML FORTE 2ILEVRO 2


Drug Name DrugTier

Requirements/Limits

ketorolac tromethamine(ophth) (generic of ACULARLS) .4%

1

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

1

LOTEMAX 2MAXIDEX 3NEVANAC 2PRED MILD 2PRED-G 3PRED-G S.O.P. 3prednisolone acetate (ophth)(generic of OMNIPRED)

1

PREDNISOLONE SODIUMPHOSP SOLN

2

VEXOL 3ANTIALLERGICSALOCRIL 3ALOMIDE 3azelastine hcl (ophth) (genericof OPTIVAR)

1

BEPREVE 2cromolyn sodium (ophth) 1EMADINE 3epinastine hcl (ophth) (genericof ELESTAT)

1

LASTACAFT 2PATADAY 2PATANOL 2ANTIGLAUCOMAALPHAGAN P 2AZOPT 2betaxolol hcl (ophth) 1BETIMOL 2BETOPTIC-S 2brimonidine tartrate .2% 1BRIMONIDINE TARTRATE.15%

1

carteolol hcl (ophth) 1COMBIGAN 2COSOPT PF 3dorzolamide hcl (generic ofTRUSOPT)

1

Drug Name DrugTier

Requirements/Limits

dorzolamide hcl-timololmaleate (generic of COSOPT)

1

ISOPTO CARPINE 3ISTALOL 2latanoprost sol 0.005%(generic of XALATAN)

1

levobunolol hcl (generic ofBETAGAN) .5%

1

LEVOBUNOLOL HCL .25% 1LUMIGAN SOL 0.01% 2LUMIGAN SOL 0.03% 2metipranolol (generic ofOPTIPRANOLOL)

1

PHOSPHOLINE IODIDE 3PILOCARPINE HCL SOLN 1PILOPINE HS 2timolol maleate (ophth)(generic of TIMOPTIC)

1

timolol maleate gel (generic ofTIMOPTIC-XE)

1

TIMOPTIC OCUDOSE 3TRAVATAN Z DRO 0.004% 2ZIOPTAN DRO 0.0015% 2MISCELLANEOUSak-con 1BOTOX 100unit 3 NMLACRISERT 3PROLENSA 2proparacaine hcl (generic ofALCAINE) SOLN

1

RESTASIS 2tropicamide (generic ofMYDRIACYL) SOLN 1%

1

tropicamide SOLN .5% 1XEOMIN 50unit 3RESPIRATORYANTICHOLINERGIC/BETA AGONISTCOMBINATIONSCOMBIVENT AER 3COMBIVENT AERRESPIMAT

2

ipratropium-albuterol (genericof DUONEB)

1

ANTICHOLINERGICS


Drug Name DrugTier

Requirements/Limits

ATROVENT HFA AER17MCG

3

ipratropium bromide (nasal)(generic of ATROVENT)

1

ipratropium sol inhal 1SPIRIVA CAP HANDIHLR 2TUDORZA PRES AER400/ACT

3

ANTIHISTAMINE/DECONGESTANTCOMBINATIONSCLARINEX-D 12 HOUR 3CLARINEX-D 24 HOUR 3SEMPREX-D 3ANTIHISTAMINESASTEPRO SPR 0.15% 2azelastine spr 0.1% (genericof ASTELIN)

1

carbinoxamine maleate(generic of PALGIC)

1

cetirizine syrup 1CLARINEX SYRP 3CLARINEX REDITABS 3cyproheptadine hcl SYRP;TABS

1

desloratadine (generic ofCLARINEX) TABS

1

desloratadine (generic ofCLARINEX REDITABS)TBDP

1

diphenhydram inj 50mg/ml 1hydroxyzine hcl SOLN; TABS 1hydroxyzine hcl inj 1hydroxyzine pamoate (genericof VISTARIL) CAPS 25mg,50mg

1

hydroxyzine pamoate CAPS100mg

1

levocetirizine dihydrochloride(generic of XYZAL)

1

levocetirizine tab 5 mg(generic of XYZAL)

1

PATANASE 2BETA AGONISTS

Drug Name DrugTier

Requirements/Limits

albuterol sulfate (generic ofACCUNEB) NEBU.63mg/3ml, 1.25mg/3ml

1

albuterol sulfate NEBU.083%, .5%

1

albuterol sulfate SYRP 1albuterol sulfate TABS 1albuterol sulfate (generic ofVOSPIRE ER) TB12

1

ARCAPTA CAP 75MCG 2BROVANA 3FORADIL CAP AEROLIZE 2levalbuterol hcl (generic ofXOPENEX CONCENTRATE)NEBU 1.25mg/0.5ml

1

levalbuterol hcl (generic ofXOPENEX) NEBU.31mg/3ml, .63mg/3ml,1.25mg/3ml

1

PERFOROMIST 2PROAIR HFA AER 2PROVENTIL AER HFA 2SEREVENT DIS AER 50MCG 2terbutaline sulfate SOLN;TABS

1

VENTOLIN HFA AER 3XOPENEX 3XOPENEX HFA AER 2LEUKOTRIENE RECEPTORANTAGONISTSmontelukast sodium (genericof SINGULAIR) CHEW;PACK; TABS

1

zafirlukast (generic ofACCOLATE)

1

ZYFLO CR 3MAST CELL STABILIZERScromolyn sodium NEBU 1MISCELLANEOUSacetylcysteine SOLN 10%,20%

1

ARALAST NP 400mg 3 NM LAAUVI-Q INJ 0.3MG 2AUVI-Q INJ 0.15MG 2CAYSTON 3 NM LA


Drug Name DrugTier

Requirements/Limits

DALIRESP 2DYMISTA SPR 137-50 3epinephrine hcl .1mg/ml 1EPIPEN 2-PAK 2EPIPEN-JR 2-PAK 2GLASSIA 3 NM LAPROLASTIN-C 3 NM LAPULMOZYME 2 NMTOBI 2 NMTWINJECT 3TYZINE 3TYZINE PEDIATRIC NASALDR

3

XOLAIR 2 NM LAZEMAIRA 3 NM LANASAL STEROIDSBECONASE AQ SUS 0.042% 3flunisolide spr 0.025% 1fluticasone spr 50mcg(generic of FLONASE)

1

NASONEX SPR 50MCG/AC 2OMNARIS SPR 3QNASL AER 80MCG 3RHINOCORT SUS AQUA 3triamcinolon spr 55mcg/ac(generic of NASACORT AQ)

1

VERAMYST SPR 27.5MCG 3ZETONNA AER 37MCG 3STEROID INHALANTSALVESCO AER 80MCG 3ALVESCO AER 160MCG 3ASMANEX 14 AER 220MCG 2ASMANEX 30 AER 110MCG 2ASMANEX 30 AER 220MCG 2ASMANEX 60 AER 220MCG 2ASMANEX 120 AER 220MCG 2budesonide (inhalation)(generic of PULMICORT)

1

FLOVENT DISK AER 50MCG 2FLOVENT DISK AER100MCG

2

FLOVENT DISK AER250MCG

2

Drug Name DrugTier

Requirements/Limits

FLOVENT HFA AER 44MCG 2FLOVENT HFA AER 110MCG 2FLOVENT HFA AER 220MCG 2PULMICORT INH 90MCG 2PULMICORT INH 180MCG 2PULMICORT INH SUSP 3QVAR AER 40MCG 2QVAR AER 80MCG 2STEROID/BETA-AGONISTCOMBINATIONSADVAIR DISKU AER 100/50 2ADVAIR DISKU AER 250/50 2ADVAIR DISKU AER 500/50 2ADVAIR HFA AER 45/21 2ADVAIR HFA AER 115/21 2ADVAIR HFA AER 230/21 2DULERA AER 100-5MCG 2DULERA AER 200-5MCG 2SYMBICORT AER 80-4.5 2SYMBICORT AER 160-4.5 2XANTHINESaminophylline inj 1ELIXOPHYLLIN 2LUFYLLIN 3THEO-24 2theophylline TB12; TB24 1TOPICALDERMATOLOGY, ACNEABSORICA 3 NMACANYA 2ACZONE 3adapalene (generic ofDIFFERIN)

1

AKNE-MYCIN 3amnesteem 1ATRALIN 2avita (generic of RETIN-A)CREA

1

avita GEL 1AZELEX 3


Drug Name DrugTier

Requirements/Limits

benzoyl peroxide-erythromycin (generic ofBENZAMYCIN)

1

claravis 1CLINDAGEL 3clindamycin phosphate(topical) (generic ofEVOCLIN) FOAM

1

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

1

clindamycin phosphate-benzoyl peroxide (generic ofBENZACLIN)

1

DIFFERIN GEL .3% 2DIFFERIN LOTN 2EPIDUO 2ery 1erythromycin (acne aid) 1myorisan 1RETIN-A MICRO 2sulfacetamide sodium (acne)(generic of KLARON)

1

TRETIN X 3tretinoin (generic of RETIN-A)CREA; GEL

1

TRETINOIN MICROSPHERE 1VELTIN 2zenatane 1ZIANA 3DERMATOLOGY, ACTINIC KERATOSISCARAC 2FLUOROPLEX 3fluorouracil (topical) (genericof EFUDEX) CREA

1

fluorouracil (topical) SOLN 1PICATO 2SOLARAZE 2DERMATOLOGY, ANTIBIOTICSALTABAX 2BACTROBAN CREA 2BACTROBAN NASAL 3CORTISPORIN CREA; OINT 3

Drug Name DrugTier

Requirements/Limits

gentamicin sulfate (topical) 1mafenide acetate (generic ofSULFAMYLON) PACK

1

mupirocin cream 2% (genericof BACTROBAN)

1

mupirocin oint 2% (generic ofBACTROBAN)

1

PHISOHEX 3silver sulfadiazine (generic ofSILVADENE) CREA

1

ssd (generic of SILVADENE) 1SULFAMYLON 3thermazene (generic ofSILVADENE)

1

DERMATOLOGY, ANTIFUNGALSciclopirox CREA; SUSP 1ciclopirox (generic ofLOPROX) GEL

1

ciclopirox shampoo 1%(generic of LOPROXSHAMPOO)

1

clotrimazole (topical) 1econazole nitrate CREA 1ERTACZO 3EXELDERM 3ketoconazole (topical)(generic of EXTINA)

1

ketoconazole cream 1MENTAX 2NAFTIN 3nyamyc 1nystatin (topical) 1nystatin pow 100000 1nystop 1OXISTAT 2pedi-dri 1DERMATOLOGY, ANTIPRURITICCORTIFOAM 2proctocream (generic ofANUSOL-HC)

1

proctozone hc (generic ofANUSOL-HC)

1

PRUDOXIN 1ZONALON 3


Drug Name DrugTier

Requirements/Limits

DERMATOLOGY, ANTIPSORIATICScalcipotriene (generic ofDOVONEX) CREA

1

calcipotriene OINT; SOLN 1CALCITRIOL OINT 18-MOP 3OXSORALEN ULTRA 2 NMSORIATANE 2 NMSORILUX 2STELARA 3 NMTAZORAC 2DERMATOLOGY, ANTISEBORRHEICSketoconazole shampoo(generic of NIZORAL)

1

selenium sulfide (generic ofSELSUN SHAMPOO) LOTN

1

DERMATOLOGY, ANTIVIRALSacyclovir topical (generic ofZOVIRAX)

1

DENAVIR 3XERESE 3ZOVIRAX CREA; OINT 3DERMATOLOGY, CORTICOSTEROIDSala-cort 1alclometasone dipropionate(generic of ACLOVATE)CREA

1

alclometasone dipropionateOINT

1

amcinonide CREA; LOTN 1AMCINONIDE OINT 3betamethasone dipropionate(topical)

1

betamethasone dipropionateaugmented (generic ofDIPROLENE AF) CREA

1

betamethasone dipropionateaugmented GEL

1

betamethasone dipropionateaugmented (generic ofDIPROLENE) LOTN; OINT

1

betamethasone valerateCREA; LOTN; OINT

1

betamethasone valerate(generic of LUXIQ) FOAM

1

Drug Name DrugTier

Requirements/Limits

CAPEX 2clobetasol propionate (genericof TEMOVATE) GEL; OINT;SOLN

1

clobetasol propionate (genericof CLOBEX) LOTN; SHAM

1

clobetasol propionateemollient base (generic ofTEMOVATE E)

1

clobetasol propionateemulsion (generic of OLUX-E)

1

CLOBEX LIQD 3CLODERM PUMP 3CORDRAN 3CORDRAN SP 3CORDRAN TAPE 3DESONATE 3desonide (generic ofDESOWEN) CREA; LOTN;OINT

1

desowen oint kit 0.05% 1desoximetasone (generic ofTOPICORT) CREA

1

desoximetasone (generic ofTOPICORT) GEL

1

DESOXIMETASONE OINT.05%

1

desoximetasone (generic ofTOPICORT) OINT .25%

1

diflorasone diacetate 1fluocinolone acetonide CREA.01%

1

fluocinolone acetonide(generic of SYNALAR) CREA.025%

1

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

1

fluocinolone acetonide(generic of SYNALAR) OINT

1

fluocinolone acetonide(generic of SYNALAR) SOLN

1

fluocinonide GEL; OINT;SOLN

1

fluocinonide emulsified base 1


Drug Name DrugTier

Requirements/Limits

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

1

halobetasol propionate(generic of ULTRAVATE)

1

HALOG 3hydrocortisone (topical) 1hydrocortisone butyrate(generic of LOCOID)

1

hydrocortisone valerateCREA

1

hydrocortisone valerate(generic of WESTCORT)OINT

1

KENALOG 3LOCOID LOTN 3LOCOID LIPOCREAM 2lokara (generic ofDESOWEN)

1

LUXIQ 3mometasone furoate (genericof ELOCON) CREA; OINT;SOLN

1

OLUX-E 3PANDEL 3prednicarbate (generic ofDERMATOP)

1

procto-pak 1TACLONEX 3TOPICORT LIQD 3TOPICORT OINT .05% 2triamcinolone acetonide(topical)

1

triderm 1u-cort (generic of CARMOL-HC)

1

VANOS 3VERDESO 3DERMATOLOGY, LOCAL ANESTHETICSlidocaine OINT 1lidocaine hcl GEL 1lidocaine hcl (generic ofXYLOCAINE) SOLN 4%

1

lidocaine-prilocaine (genericof EMLA)

1

Drug Name DrugTier

Requirements/Limits

LIDODERM 2SYNERA 3DERMATOLOGY, MISCELLANEOUS SKINAND MUCOUS MEMBRANEammonium lactate (generic ofLAC-HYDRIN) CREA; LOTN

1

CONDYLOX GEL 2ELIDEL 2FINACEA 2imiquimod (generic ofALDARA) CREA

1

laclotion (generic of LAC-HYDRIN)

1

METROGEL 2metronidazole (topical)(generic of METROCREAM)CREA

1

metronidazole (topical) GEL 1metronidazole (topical)(generic of METROLOTION)LOTN

1

ORACEA 2OXSORALEN 3PANRETIN 3 NMPENNSAID 2podofilox (generic ofCONDYLOX) SOLN

1

PROTOPIC 2RECTIV 3TARGRETIN GEL 3 NMVOLTAREN GEL 1% 2ZYCLARA 2ZYCLARA PUMP 2DERMATOLOGY, SCABICIDES ANDPEDICULIDESEURAX 3malathion (generic of OVIDE) 1permethrin (generic ofELIMITE) CREA

1

SKLICE 3ULESFIA 3DERMATOLOGY, WOUND CARE AGENTS


Drug Name DrugTier

Requirements/Limits

neomycin/polymyxin b gu(generic of NEOSPORIN GUIRRIGANT)

1

REGRANEX 3 NMSANTYL 3sodium chloride (gu irrigant) 1water for irrigation, sterile 1MOUTH/THROAT/DENTAL AGENTScevimeline hcl (generic ofEVOXAC)

1

chlorhexidine gluconate(mouth-throat) (generic ofPERIDEX)

1

clotrimazole TROC 1lidocaine hcl (mouth-throat) 1nystatin (mouth-throat) 1periogard (generic ofPERIDEX)

1

pilocarpine hcl (oral) (genericof SALAGEN)

1

triamcinolone acetonide(mouth)

1

OTICacetasol hc (generic ofVOSOL HC)

1

acetic acid (otic) 1acetic acid sol/hc (generic ofVOSOL HC)

1

CIPRO HC 2CIPRODEX 2COLY-MYCIN S 3CORTISPORIN-TC 3fluocinolone acetonide (otic)(generic of DERMOTIC)

1

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

1

neomycin-polymyxin-hc (otic)SUSP

1

ofloxacin (otic) 1

43

Index

88-MOP 40

Aa-hydrocort 26abacavir sulfate 6ABELCET 6ABILIFY 19ABILIFY DISCMELT 19ABILIFY MAINTENA 19ABILIFY SOL 1MG/ML 19ABILIFY TABS 19ABRAXANE 9ABSORICA 38ABSTRAL 2ACANYA 38acarbose 22ACCOLATE

see zafirlukast 37ACCUNEB

see albuterol sulfate 37ACCUPRIL

see quinapril hcl 11ACCURETIC

see quinapril-hydrochlorothiazide 11

acebutolol hcl 13ACEON

see perindopril erbumine 11acetaminophen w/ codeine 1acetaminophen-caff-

dihydrocod 1acetasol hc 42acetazolamide 14acetazolamide sodium 14acetic acid (otic) 42acetic acid sol/hc 42acetylcysteine 37ACIPHEX TAB 20MG 30ACLOVATE

see alclometasonedipropionate 40

ACTEMRA 32ACTHIB 33ACTIGALL

see ursodiol 30ACTIMMUNE 32ACTIQ

see fentanyl citrate 2ACTIVELLA

see estradiol &norethindrone acetate 26

ACTONEL 24ACTOPLUS MET

see pioglita/met tab 15-500mg 23

see pioglita/met tab 15-850mg 23

ACTOPLUS MET TAB XR 22ACTOS

see pioglitazone tab15mg 23



ACULARsee ketorolac tromethamine

(ophth) 36ACULAR LS

see ketorolac tromethamine(ophth) 36

ACUVAIL 35acyclovir 7acyclovir sodium 7acyclovir topical 40ACZONE 38ADACEL 33ADAGEN 26ADALAT CC

see afeditab cr 14see nifediac 14see nifediac cc tab 14see nifedipine 14

adapalene 38ADCIRCA 15ADDERALL

see amphetamine-dextroamphetamine 19

ADDERALL XRsee amphetamine-

dextroamphetamine 19ADOXA

see doxycycline(monohydrate) 5

ADOXA PAK 1/150see doxycycline

(monohydrate) 5adriamycin 9ADVAIR DISKU AER

100/50 38ADVAIR DISKU AER

250/50 38ADVAIR DISKU AER

500/50 38ADVAIR HFA AER 115/21 38ADVAIR HFA AER 230/21 38ADVAIR HFA AER 45/21 38ADVICOR 12afeditab cr 14AFINITOR 10AFINITOR DISPERZ 10AGGRENOX 32AGRYLIN

see anagrelide hcl 32ak-con 36AKNE-MYCIN 38ala-cort 40ALBENZA 7

albuterol sulfate 37ALCAINE

see proparacaine hcl 36alclometasone

dipropionate 40ALCOHOL PREPS 22ALDACTAZIDE 14

see spironolactone &hydrochlorothiazide 15

ALDACTONEsee spironolactone 11

ALDARAsee imiquimod 41

ALDURAZYME 26alendronate sodium tabs 24alendronate sol 70/75ml 24alfuzosin hcl 30ALIMTA 9ALINIA SUS 100MG/5M 7ALINIA TAB 500MG 7ALKERAN

see melphalan hcl 8allopurinol inj 500mg 1allopurinol tab 1ALOCRIL 36ALOMIDE 36ALOPRIM

see allopurinol inj 500mg 1ALORA 26ALOXI 28ALPHAGAN P 36alprazolam 16ALREX 35ALSUMA INJ 6MG/0.5 20ALTABAX 39ALTACE

see ramipril 11ALTOPREV 12ALVESCO AER 160MCG 38ALVESCO AER 80MCG 38amantadine hcl 18AMARYL

see glimepiride tab 1mg 22see glimepiride tab 2mg 22see glimepiride tab 4mg 22

AMBIENsee zolpidem tab 10mg 20see zolpidem tab 5mg 20

AMBIEN CRsee zolpidem er tab

12.5mg 20see zolpidem er tab

6.25mg 20AMBISOME 6AMCINONIDE 40amcinonide 40AMERGE

see naratriptan tab 1mg 20see naratriptan tab

2.5mg 20amethia 91 day 24

44

amethyst 28 day 24amifostine crystalline 10amikacin sulfate 3amiloride &

hydrochlorothiazide 14amiloride hcl 14amino acid infusion 33aminophylline inj 38AMINOSYN 33aminosyn 8.5 % with

electrolytes, sulfite-free 34AMINOSYN II 34aminosyn ii 8.5 % with

electrolytes, sulfite-free 34AMINOSYN M 34AMINOSYN-HBC 34AMINOSYN-PF 34AMINOSYN-PF 7% 34amiodarone hcl 12amiodarone inj 50mg/ml 12AMITIZA 29amitriptyline hcl 17amlodipine besylate 14amlodipine besylate-

benazepril hcl 10AMLODIPINE

BESYLATE/ATORV 14AMMONIUM CHLORIDE 33ammonium lactate 41amnesteem 38AMOXAPINE 17amoxicillin 3amoxicillin & pot clavulanate 4amphetamine-

dextroamphetamine 19AMPHOTEC 6amphotericin b 6ampicillin 4ampicillin & sulbactam

sodium 4ampicillin inj 4AMPYRA 21AMTURNIDE 14ANAFRANIL

see clomipramine hcl 17anagrelide hcl 32ANAPROX

see naproxen sodium 3ANAPROX DS

see naproxen sodium 3anastrozole 9ANCOBON

see flucytosine 6ANDRODERM DIS

2MG/24HR 22ANDRODERM DIS

4MG/24HR 22ANDROGEL GEL

1%(25MG) 22ANDROGEL GEL

1%(50MG) 22

ANDROGEL GEL 1.62% 22ANDROGEL GEL PUMP

1% 22ANDROXY 22ANEXSIA

see hydrocodone-acetaminophen 7.5-650mg 1

ANTABUSEsee disulfiram 21

ANTARA 13see fenofibrate

micronized 13ANTIVERT 28

see meclizine hcl 28ANUSOL-HC

see proctocream 39see proctozone hc 39

APIDRA 22APIDRA SOLOSTAR 22APLENZIN 17APOKYN 18apri 28 day 24APRISO 29APTIVUS 6ARALAST NP 37ARALEN

see chloroquinephosphate 6

aranelle 28 24ARANESP ALBUMIN

FREE 31ARAVA

see leflunomide 32ARCALYST 32ARCAPTA CAP 75MCG 37ARICEPT 17

see donepezilhydrochloride 17

ARICEPT ODTsee donepezil

hydrochloride 17ARIMIDEX

see anastrozole 9ARIXTRA

see fondaparinux sodium 31AROMASIN

see exemestane 9ARRANON 9ARTHROTEC 1ARTHROTEC 50

see diclofenac w/misoprostol 1

ARTHROTEC 75see diclofenac w/

misoprostol 1ARZERRA 9ASACOL 29ASACOL HD 29ascomp with codeine 1ASMANEX 120 AER

220MCG 38

ASMANEX 14 AER220MCG 38




ASTELINsee azelastine spr 0.1% 37

ASTEPRO SPR 0.15% 37astramorph 2ATACAND 12ATACAND HCT 11

see candesartan cilexetil-hydrochlorothiazide 11

ATELVIA 24atenolol 13atenolol & chlorthalidone 13ATGAM 32ATIVAN

see lorazepam 16atorvastatin tab 10mg 12atorvastatin tab 20mg 12atorvastatin tab 40mg 12atorvastatin tab 80mg 12atovaquone-proguanil hcl 6ATRALIN 38ATRIPLA 6atropine sulfate 28ATROVENT

see ipratropium bromide(nasal) 37

ATROVENT HFA AER17MCG 37

AUBAGIO 21AUGMENTIN

see amoxicillin & potclavulanate 4

AUGMENTIN ES-600see amoxicillin & pot

clavulanate 4AUGMENTIN XR

see amoxicillin & potclavulanate 4

AUVI-Q INJ 0.15MG 37AUVI-Q INJ 0.3MG 37AVALIDE

see irbesartan-hydrochlorothiazide 12

AVAPROsee irbesartan 12

AVASTIN 9AVELOX 4AVELOX ABC PACK 4aviane 28 24AVINZA 2avita 38AVODART 30AVONEX KIT 30MCG 21AVONEX PREFL KIT

45

30MCG 21AXERT TAB 12.5MG 20AXERT TAB 6.25MG 20AXID

see nizatidine 29AXIRON SOL 30MG/ACT 22AYGESTIN

see norethindroneacetate 27

AZACTAM 8see aztreonam 8

AZACTAM IN DEXTROSE 8AZASAN 32AZASITE 35azathioprine 32azathioprine inj 100mg 32azelastine hcl (ophth) 36azelastine spr 0.1% 37AZELEX 38AZILECT 18azithromycin 4AZOPT 36AZOR 11aztreonam 8AZULFIDINE

see sulfasalazine ir 29AZULFIDINE EN-TABS

see sulfasalazine dr 29

Bbacitracin (ophthalmic) 35bacitracin-poly-neomycin-

hc 35bacitracin-polymyxin b

(ophth) 35baclofen 21BACTOCILL IN DEXTROSE4BACTRIM

see sulfamethoxazole-trimethop 8

BACTRIM DSsee sulfamethoxazole-

trimethop 8BACTROBAN 39

see mupirocin cream 2% 39see mupirocin oint 2% 39

BACTROBAN NASAL 39balsalazide disodium 29balziva 28 day 24BANZEL 16BARACLUDE 7BECONASE AQ SUS

0.042% 38benazepril &

hydrochlorothiazide 11benazepril hcl 11BENICAR 12BENICAR HCT 11BENTYL 28

see dicyclomine hcl 28BENZACLIN

see clindamycin phosphate-benzoyl peroxide 39

BENZAMYCINsee benzoyl peroxide-

erythromycin 39benzoyl peroxide-

erythromycin 39benztropine mesylate 18BEPREVE 36BESIVANCE 35BETAGAN

see levobunolol hcl 36betamethasone dipropionate

(topical) 40betamethasone dipropionate

augmented 40betamethasone valerate 40BETAPACE

see sorine 12see sotalol hcl 12

BETAPACE AFsee sotalol hcl (afib/afl) 12

BETASERON INJ 0.3MG 21betaxolol hcl 13betaxolol hcl (ophth) 36bethanechol chloride 30BETIMOL 36BETOPTIC-S 36BEYAZ 24BIAXIN

see clarithromycin 4, 5BIAXIN XL

see clarithromycin 5bicalutamide 9BICILLIN C-R 4BICILLIN L-A 4BICNU 8BIDIL 15BILTRICIDE 8BINOSTO 24bisoprolol &

hydrochlorothiazide 13bisoprolol fumarate 13bleomycin sulfate 9BLEPH-10

see sulfacetamide sodium(ophth) 35

BLEPHAMIDE 35BONIVA

see ibandronate sodium 24BONIVA INJ 3MG/3ML 24BOOSTRIX 33BOSULIF TAB 100MG 10BOSULIF TAB 500MG 10BOTOX 36BREVICON-28

see necon 0.5/35 28 day 25see nortrel 0.5/35 28 day 25

briellyn 28 day 24BRILINTA 32BRIMONIDINE

TARTRATE 36brimonidine tartrate 36BROMDAY 35bromfenac sodium (ophth) 35bromocriptine mesylate 18BROVANA 37budeprion 17budesonide 29budesonide (inhalation) 38bumetanide 15BUPHENYL 26

see sodiumphenylbutyrate 26

BUPHENYL TAB 500MG 26buprenorphine hcl 21buprenorphine-naloxone

subl 21buproban 21bupropion hcl 17bupropion hcl sr 17bupropion hcl xl 17buspirone hcl 16BUSULFEX 8butalbital-acetaminophen-

caffeine w/ codeine 1butorphanol nasal spray 1butorphanol tartrate 1BUTRANS 1BYDUREON INJ 22BYETTA 22BYSTOLIC 13

Ccabergoline 27CALAN

see verapamil hcl 14CALAN SR

see verapamil hcl 14calcipotriene 40calcitonin (salmon) nasal

spray 24CALCITRIOL 40calcitriol 35calcium acetate (phosphate

binder) 27camila 28 day 24CAMPATH 9CAMPRAL 21CANASA 29CANCIDAS 6candesartan cilexetil-

hydrochlorothiazide 11CANTIL 28CAPASTAT SULFATE 7CAPEX 40CAPITAL AND CODEINE 1CAPRELSA 10captopril 11captopril &

hydrochlorothiazide 11

46

CARAC 39CARAFATE 29

see sucralfate 30CARBAGLU 26carbamazepine 16CARBATROL

see carbamazepine 16carbidopa-levodopa 18CARBIDOPA/LEVODOPA/E

NTACA 18carbinoxamine maleate 37carboplatin 10CARDIZEM

see diltiazem hcl 14CARDIZEM CD

see cartia 14see dilt 14see diltiazem hcl coated

beads 14CARDIZEM LA 14

see matzim 14CARDURA

see doxazosin mesylate 11CARDURA XL 30CARIMUNE

NANOFILTERED 32CARMOL-HC

see u-cort 41CARNITOR

see levocarnitine (metabolicmodifiers) 26

carteolol hcl (ophth) 36cartia 14carvedilol 13CASODEX

see bicalutamide 9CATAFLAM

see diclofenac potassium 3CATAPRES

see clonidine hcl 11CATAPRES-TTS-1



see clonidine hcl 11CAYSTON 37CEDAX 4CEENU 8cefaclor 4CEFACLOR ER 4cefadroxil 4cefazolin inj 4CEFAZOLIN/DEXTROSE 4cefdinir 4cefepime hcl 4cefotaxime sodium 4CEFOTETAN 4CEFOXITIN SODIUM 4cefoxitin sodium 4cefpodoxime proxetil 4

cefprozil 4ceftazidime 4CEFTAZIDIME/DEXTROSE 4CEFTIN 4

see cefuroxime axetil 4ceftriaxone sodium 4cefuroxime axetil 4cefuroxime sodium 4CELEBREX 3CELESTONE 26CELEXA

see citalopramhydrobromide 17

CELLCEPT 32see mycophenolate

mofetil 33CELLCEPT

INTRAVENOUS 32CELONTIN 16cephalexin 4CEREZYME 26CERVARIX 33CESAMET CAP 1MG 28cetirizine syrup 37cevimeline hcl 42CHANTIX PAK 0.5& 1MG 21CHANTIX TAB 0.5MG 21CHANTIX TAB 1MG 21CHEMET 24chenodal 30chlorhexidine gluconate

(mouth-throat) 42chloroquine phosphate 6chlorothiazide 15CHLORPROMAZ INJ

25MG/ML 19chlorpromazine hcl 19chlorthalidone 15chlorzoxazone 21cholestyramine 13cholestyramine light 13chorionic gonadotropin 27ciclopirox 39ciclopirox shampoo 1% 39cidofovir 7cilostazol 32CILOXAN

see ciprofloxacin hcl(ophth) 35

CILOXAN OINT 35cimetidine 29cimetidine inj 150mg/ml 29cimetidine sol 300/5ml 29CIMZIA 29CIMZIA STARTER KIT 29CIPRO 4

see ciprofloxacin hcl 4CIPRO HC 42CIPRO I.V.-IN D5W

see ciprofloxacin in d5w 4CIPRO XR

see ciprofloxacin-ciprofloxacin hcl 4

CIPRODEX 42ciprofloxacin hcl 4ciprofloxacin hcl (ophth) 35ciprofloxacin in d5w 4ciprofloxacin-ciprofloxacin

hcl 4ciprofloxacn inj 4cisplatin 10citalopram hydrobromide 17cladribine 10CLAFORAN 4

see cefotaxime sodium 4claravis 39CLARINEX 37

see desloratadine 37CLARINEX REDITABS 37

see desloratadine 37CLARINEX-D 12 HOUR 37CLARINEX-D 24 HOUR 37clarithromycin 4, 5CLEOCIN

see clindamycin cre 2%vag 31

see clindamycin hcl 8CLEOCIN IN D5W 8

see clindamycin phosphatein d5w 8

CLEOCIN INJ 8CLEOCIN PEDIATRIC

GRANULEsee clindamycin palmitate

hydrochloride 8CLEOCIN PHOSPHATE

see clindamycinphosphate 8

CLEOCIN VAG SUPP100MG 31

CLEOCIN-Tsee clindamycin phosphate

(topical) 39CLIMARA

see estradiol 26CLIMARA PRO 26CLINDAGEL 39clindamycin cre 2% vag 31clindamycin hcl 8clindamycin palmitate

hydrochloride 8clindamycin phosphate 8clindamycin phosphate

(topical) 39clindamycin phosphate in

d5w 8clindamycin phosphate-

benzoyl peroxide 39CLINIMIX 2.75%/DEXTROSE

5% 34CLINIMIX 4.25%/DEXTROSE

10% 34

47

CLINIMIX 4.25%/DEXTROSE20% 34



CLINIMIX 5%/DEXTROSE15% 34



CLINIMIX E2.75%/DEXTROSE10% 34

CLINIMIX E2.75%/DEXTROSE 5% 34

CLINIMIX E4.25%/DEXTROSE25% 34

CLINIMIX E4.25%/DEXTROSE 5% 34

CLINIMIX E 5%/DEXTROSE15% 34



clinisol 15 34CLINORIL

see sulindac 3clobetasol propionate 40clobetasol propionate

emollient base 40clobetasol propionate

emulsion 40CLOBEX 40

see clobetasolpropionate 40

CLODERM PUMP 40CLOLAR 9clomipramine hcl 17clonazepam 16clonidine hcl 11clopidogrel bisulfate 32clorazepate dipotassium 16clorpres 0.1/15 15clorpres 0.2/15 15clorpres 0.3/15 15clotrimazole 42clotrimazole (topical) 39clozapine 19CLOZAPINE ODT 19CLOZARIL

see clozapine 19co-gesic 1COARTEM 6codeine sulfate 2COGENTIN

see benztropinemesylate 18

COLAZAL

see balsalazide disodium 29colchicine w/ probenecid 1COLCRYS TAB 0.6MG 1COLESTID

see colestipol hcl 13colestipol hcl 13colistimethate sodium 8colocort 29COLY-MYCIN M

see colistimethate sodium 8COLY-MYCIN S 42COLYTE-FLAVOR PACKS

see gavilyte-c 29COMBIGAN 36COMBIPATCH 26COMBIVENT AER 36COMBIVENT AER

RESPIMAT 36COMBIVIR

see lamivudine-zidovudine7COMETRIQ 10COMPLERA 6compro 28COMTAN 18

see entacapone 18COMVAX 33CONDYLOX 41

see podofilox 41constulose 29CONZIP 3COPAXONE KIT 20MG/ML21COPEGUS

see ribasphere 200mg 7see ribavirin 200mg 7

CORDARONEsee amiodarone hcl 12see pacerone 12

CORDRAN 40CORDRAN SP 40CORDRAN TAPE 40COREG

see carvedilol 13COREG CR 13CORGARD

see nadolol 13CORTEF

see hydrocortisone 26CORTENEMA

see colocort 29see hydrocortisone

(intrarectal) 29CORTIFOAM 39cortisone acetate 26CORTISPORIN 39

see neomycin-polymyxin-hc(otic) 42

CORTISPORIN-TC 42CORZIDE

see nadolol &bendroflumethiazide 13

COSMEGEN 9

COSOPTsee dorzolamide hcl-timolol

maleate 36COSOPT PF 36COUMADIN 31

see jantoven 31see warfarin sodium 31

COUMADIN INJ 31COVERA-HS 14COZAAR

see losartan potassium 12CREON 30CRESTOR 12CRINONE 27CRIXIVAN 6cromolyn sodium 37cromolyn sodium

(mastocytosis) 30cromolyn sodium (ophth) 36cryselle 28 24CUBICIN 8CUTIVATE

see fluticasonepropionate 41

CUVPOSA 28cyclafem 1/35 28 day 24cyclafem 7/7/7 28 day 24CYCLESSA

see velivet 28 day 25cyclobenzapr cap 15mg er 21cyclobenzapr cap 30mg er 21cyclobenzapr tab 10mg 21cyclobenzapr tab 5mg 21cyclobenzapr tab 7.5mg 21cyclophosphamide 8cyclosporine 32cyclosporine modified (for

microemulsion) 32CYKLOKAPRON

see tranexamic acid 32CYMBALTA 17cyproheptadine hcl 37CYSTADANE 26CYSTAGON 26CYTARABINE INJ

100MG/ML 9cytarabine inj 20mg/ml 9cytarabine inj 500mg 9CYTOMEL

see liothyronine sodium 28CYTOTEC

see misoprostol 30CYTOVENE

see ganciclovir inj 500mg 7

DD.H.E. 45

see dihydroergotaminemesylate 20

dacarbazine 8DACOGEN 9

48

DALIRESP 38danazol 25DANTRIUM

see dantrolene sodium 21dantrolene sodium 21dapsone 8DAPTACEL 33DARAPRIM 6daunorubicin hcl 9DAYPRO

see oxaprozin 3DAYTRANA 19DDAVP

see desmopressinacetate 28

see desmopressin acetatespray 28

see desmopressin inj 28DECAVAC 33DELATESTRYL

see testosteroneenanthate 22

DELESTROGEN 26see estradiol valerate 26

DELZICOL 29DEMADEX

see torsemide tabs 15demeclocycline hcl 5DEMSER 15DENAVIR 40DEPACON

see valproate sodium 17DEPAKENE

see valproate sodium 17see valproic acid 17

DEPAKOTEsee divalproex sodium 16

DEPAKOTE ERsee divalproex sodium 16

DEPAKOTE SPRINKLESsee divalproex sodium 16

DEPO-ESTRADIOL 26DEPO-MEDROL 26

see methylprednisoloneacetate 26

DEPO-PROVERACONTRACEPTIV

see medroxyprogesteroneacetate (contraceptive) 25

DEPO-PROVERA INJ400/ML 9

DEPO-SUBQ PROVERA104 24

DEPO-TESTOSTERONEsee testosterone

cypionate 22DERMA-SMOOTHE/FS

BODY OILsee fluocinolone

acetonide 40DERMATOP

see prednicarbate 41

DERMOTICsee fluocinolone acetonide

(otic) 42desipramine hcl 17desloratadine 37desmopressin acetate 28desmopressin acetate

spray 28desmopressin acetate spray

refrigerated 28desmopressin inj 28DESMOPRESSIN SOLN

0.01% 28DESOGEN

see apri 28 day 24see emoquette 24see reclipsen 28 day 25

DESONATE 40desonide 40DESOWEN

see desonide 40see lokara 41

desowen oint kit 0.05% 40DESOXIMETASONE 40desoximetasone 40DETROL

see tolterodine tartrate 31DETROL LA 30dexamethasone 26DEXAMETHASONE

INTENSOL 26dexamethasone sodium

phosphate 26dexamethasone sodium

phosphate (ophth) 35DEXILANT 30DEXPAK TAPERPAK 13

DAY 26dexrazoxane 10dextrose 34dextrose 10% w/ sodium

chloride 0.2% 34dextrose 2.5%/nacl 0.45% 34DEXTROSE 5%

/ELECTROLYTE 34dextrose in lactated ringers 34dextrose w/ sodium

chloride 34DIAMOX

see acetazolamide 14diazepam 16diazepam gel 16DIAZEPAM INTENSOL 16DIBENZYLINE 15diclofenac potassium 3diclofenac sodium 3diclofenac sodium (ophth) 35diclofenac w/ misoprostol 1dicloxacillin sodium 5dicyclomine hcl 28didanosine 6

DIFFERIN 39see adapalene 38

DIFICID 5diflorasone diacetate 40DIFLUCAN

see fluconazole 6diflunisal 3digoxin 14digoxin inj 14DIGOXIN SOL 50MCG/ML 14DIHYDROERGOTAMINE

MESYLATE 20dihydroergotamine

mesylate 20DILACOR XR

see dilt 14DILANTIN 16

see phenytoin 17see phenytoin sodium

extended 17DILANTIN INFATABS

see phenytoin 17DILATRATE SR 15DILAUDID

see hydromorphone hcl 2DILAUDID-5

see hydromorphone hcl 2DILAUDID-5 ORAL LIQD 2DILAUDID-HP

see hydromorphone hcl 2dilt 14DILTIAZEM HCL 14diltiazem hcl 14diltiazem hcl coated beads 14diltiazem hcl extended

release beads 14DIOVAN 12DIOVAN HCT

see valsartan-hydrochlorothiazide 12

DIPENTUM 29diphenhydram inj 50mg/ml 37diphenoxylate w/ atropine 30DIPHTHERIA/TETANUS

TOXOID 33DIPROLENE

see betamethasonedipropionateaugmented 40

DIPROLENE AFsee betamethasone

dipropionateaugmented 40

dipyridamole 32disopyramide phosphate 12disulfiram 21DITROPAN XL

see oxybutynin chloride 31DIURIL SUS 250/5ML 15divalproex sodium 16DIVIGEL 26

49

DOCETAXEL 9docetaxel 9DOLOPHINE

see methadone hcl 2see methadose 2

DOLOPHINE HCLsee methadone hcl 2

donepezil hydrochloride 17DORIBAX 8DORYX 5dorzolamide hcl 36dorzolamide hcl-timolol

maleate 36DOVONEX

see calcipotriene 40doxazosin mesylate 11doxepin hcl 17DOXIL 9doxorubicin hcl 9doxycycline (monohydrate) 5doxycycline hyclate 5dronabinol cap 10mg 28dronabinol cap 2.5mg 28dronabinol cap 5mg 28drospirenone-ethinyl

estradiol 24DROXIA 10DUETACT

see pioglit/glim tab 30-2mg 23

see pioglit/glim tab 30-4mg 23

DUEXIS 1DULERA AER 100-5MCG 38DULERA AER 200-5MCG 38DUONEB

see ipratropium-albuterol 36DURAGESIC

see fentanyl patch 2duramorph 2DUREZOL 35DYAZIDE

see triamterene &hydrochlorothiazide cap37.5-25 mg 15

DYMISTA SPR 137-50 38DYNACIN

see minocycline hcl 5DYNACIRC CR 14DYRENIUM 15

Ee.e.s. 5E.E.S. GRANULES 5EC-NAPROSYN

see naproxen 3econazole nitrate 39EDARBI 12EDARBYCLOR 11EDECRIN 15EDLUAR SUB 10MG 20

EDLUAR SUB 5MG 20EDURANT 6EFFEXOR XR

see venlafaxine cap er 18EFFIENT 32EFUDEX

see fluorouracil (topical) 39EGRIFTA 27ELAPRASE 26ELDEPRYL

see selegiline hcl 18ELELYSO 26ELESTAT

see epinastine hcl(ophth) 36

ELESTRIN 26ELIDEL 41ELIGARD 9ELIMITE

see permethrin 41ELIPHOS

see calcium acetate(phosphate binder) 27

ELIQUIS 31ELITEK 10ELIXOPHYLLIN 38ELLA 24ELMIRON 30ELOCON

see mometasone furoate 41ELOXATIN 10ELSPAR 10EMADINE 36EMCYT 8EMEND CAP 125MG 28EMEND CAP 40MG 28EMEND CAP 80MG 28EMEND PAK 80 & 125 28EMLA

see lidocaine-prilocaine 41emoquette 24EMSAM 17EMTRIVA 6ENABLEX 30enalapril maleate 11enalapril maleate &

hydrochlorothiazide 11ENBREL 32endocet 10/325 2endocet 10/650 2endocet 5/325 2endocet 7.5/325 2endocet 7.5/500 2endodan reformulated may

2009 2ENDOMETRIN 27ENGERIX-B 33enoxaparin sodium 31enpresse 28 day 24entacapone 18ENTOCORT EC

see budesonide 29enulose 29EPIDUO 39epinastine hcl (ophth) 36epinephrine hcl 38EPIPEN 2-PAK 38EPIPEN-JR 2-PAK 38EPIRUBICIN HCL 9epitol 16EPIVIR

see lamivudine 6EPIVIR HBV 7EPIVIR SOL 10MG/ML 6eplerenone 11EPOGEN 31eprosartan mesylate 12EPZICOM 6EQUETRO 20ERAXIS 6ERBITUX 9ergomar 20ergotamine w/ caffeine 20ERIVEDGE 9errin 28 day 24ERTACZO 39ery 39ERY-TAB 5ery-tab 5ERYPED 200 5ERYPED 400 5ERYTHROCIN

LACTOBIONATE 5erythrocin stearate 5erythromycin (acne aid) 39erythromycin (ophth) 35erythromycin base 5erythromycin ethylsuccinate 5escitalopram oxalate 17ESTRACE 26

see estradiol 26estradiol 26estradiol & norethindrone

acetate 26estradiol valerate 26ESTRING 26estropipate 26ESTROSTEP FE

see tri-legest 28 25ethambutol hcl 7ethosuximide 16ETHYOL

see amifostine crystalline 10etodolac 3etodolac er 3ETOPOPHOS 10etoposide 10EURAX 41EVAMIST 26EVISTA 27EVOCLIN

50

see clindamycin phosphate(topical) 39

EVOXACsee cevimeline hcl 42

EXALGO 2EXELDERM 39EXELON

see rivastigmine tartrate 17EXELON PATCHES 17EXELON SOLN 17exemestane 9EXFORGE 11EXFORGE HCT 10-160-

12.5MG 11EXFORGE HCT 10-160-

25MG 11EXFORGE HCT 10-320-

25MG 12EXFORGE HCT 5-160-

12.5MG 11EXFORGE HCT 5-160-

25MG 11EXJADE 24EXTAVIA INJ 0.3MG 21EXTINA

see ketoconazole(topical) 39

FFABRAZYME 26FACTIVE 5famciclovir 7famotidine 29FAMVIR

see famciclovir 7FANAPT 19FANAPT TITRATION

PACK 19FARESTON 9FASLODEX 9FAZACLO 19felbamate 16FELBATOL

see felbamate 16FELDENE

see piroxicam 3felodipine 14FEMARA

see letrozole 9FEMCON FE

see zenchent fe 28 day 25FEMHRT LOW DOSE 26FEMRING 26FEMTRACE 26fenofibrate 13fenofibrate micronized 13FENOGLIDE 13fenoprofen calcium 3fentanyl citrate 2fentanyl patch 2FENTORA 2

FERRIPROX 24FEXMID

see cyclobenzapr tab7.5mg 21

FINACEA 41finasteride 30FIORICET/CODEINE

see butalbital-acetaminophen-caffeinew/ codeine 1

FIORINAL/CODEINE #3see ascomp with codeine 1

FIRMAGON 9FLAGYL

see metronidazole 8FLAGYL ER 8FLAREX 35FLEBOGAMMA 32flecainide acetate 12FLEXERIL

see cyclobenzapr tab10mg 21

see cyclobenzapr tab5mg 21

FLO-PRED 26FLOMAX

see tamsulosin hcl 30FLONASE

see fluticasone spr50mcg 38

FLOVENT DISK AER100MCG 38



FLOVENT HFA AER110MCG 38



fluconazole 6fluconazole in dextrose 6flucytosine 6FLUDARABINE

PHOSPHATE 10fludarabine phosphate 10fludrocortisone acetate 26FLUMADINE

see rimantadinehydrochloride 7

flunisolide spr 0.025% 38fluocinolone acetonide 40fluocinolone acetonide

(otic) 42fluocinonide 40fluocinonide emulsified

base 40FLUOROMETHOLONE 35FLUOROPLEX 39fluorouracil (topical) 39

fluorouracil inj 9FLUOXETINE HCL 18fluoxetine hcl 17, 18fluphenazine decanoate 19fluphenazine hcl 19flurbiprofen 3flurbiprofen sodium 35flutamide 9fluticasone propionate 41fluticasone spr 50mcg 38fluvastatin sodium 12fluvoxamine maleate 16fluvoxamine maleate er 16fluvoxamine tab 100mg 16FML 35FML FORTE 35fondaparinux sodium 31FORADIL CAP AEROLIZE 37FORFIVO XL 18FORTAMET

see metformin er tab1000mg 23

see metformin tab 500mger 23

FORTAZ 5see ceftazidime 4see tazicef vial 5

FORTEO 27FORTESTA GEL

10MG/ACT 22fortical 24FOSAMAX

see alendronate sodiumtabs 24

FOSAMAX PLUS D 24foscarnet sodium 7fosinopril sodium 11fosinopril sodium &

hydrochlorothiazide 11FOSRENOL 27FRAGMIN 31FREAMINE III 3% 34freamine iii 8.5 34FROVA TAB 2.5MG 20FURADANTIN

see nitrofurantoin 8furosemide 15furosemide inj 15FUROSEMIDE ORAL SOLN

8 MG/ML 15FUZEON 6

Ggabapentin cap 100mg 16gabapentin cap 300mg 16gabapentin cap 400mg 16gabapentin sol 250/5ml 16gabapentin tab 600mg 16gabapentin tab 800mg 16GABITRIL 16

51

see tiagabine tab 2mg 17see tiagabine tab 4mg 17

galantamine hydrobromide 17GAMASTAN S/D 32GAMMAGARD LIQUID 32GAMMAKED 32GAMMAPLEX 32GAMUNEX-C 32ganciclovir inj 500mg 7GARAMYCIN

see gentamicin sulfate(ophth) 35

GARDASIL 33GASTROCROM

see cromolyn sodium(mastocytosis) 30

GATTEX 30GAUZE PADS 2X2 22gaviltye-g 29gavilyte-c 29gavilyte-n 29GELNIQUE 30gemcitabine hcl 9gemfibrozil 13GEMZAR

see gemcitabine hcl 9GENERESS FE 24generlac 29gengraf 32GENOTROPIN 27GENOTROPIN

MINIQUICK 27gentak 35GENTAMICIN IN SALINE 0.9

MG/ML 5GENTAMICIN IN SALINE 1.4

MG/ML 5gentamicin in saline 100mg 5gentamicin in saline 60mg 5gentamicin in saline 80mg 5gentamicin sulfate 5gentamicin sulfate (ophth) 35gentamicin sulfate (topical) 39GEODON

see ziprasidone hcl 19GEODON INJ 19gianvi 28-day 24GIAZO 29gildagia 24GILENYA 21GLASSIA 38GLEEVEC 10glimepiride tab 1mg 22glimepiride tab 2mg 22glimepiride tab 4mg 22glip/metform tab 2.5-250m 22glip/metform tab 2.5-500m 22glip/metform tab 5-500mg 22glipizide er tab 10mg 22glipizide er tab 2.5mg 22

glipizide er tab 5mg 22glipizide tab 10mg 22glipizide tab 5mg 22GLUCAGEN HYPOKIT 27GLUCAGON EMERGENCY

KIT 27GLUCOPHAGE

see metformin tab1000mg 23

see metformin tab 500mg23see metformin tab 850mg23

GLUCOPHAGE XRsee metformin tab 500mg

er 23see metformin tab 750mg

er 23GLUCOTROL

see glipizide tab 10mg 22see glipizide tab 5mg 22

GLUCOTROL XLsee glipizide er tab 10mg 22see glipizide er tab

2.5mg 22see glipizide er tab 5mg 22

GLUCOVANCEsee glyb/metform tab 1.25-

250 22see glyb/metform tab 2.5-

500 23see glyb/metform tab 5-

500mg 23GLUMETZA TAB 1000MG 22GLUMETZA TAB 500MG 22glyb/metform tab 1.25-250 22glyb/metform tab 2.5-500 23glyb/metform tab 5-500mg 23glyburid mcr tab 1.5mg 23glyburid mcr tab 3mg 23glyburid mcr tab 6mg 23glyburide tab 1.25mg 23glyburide tab 2.5mg 23glyburide tab 5mg 23glycopyrrolate 28, 29GLYNASE

see glyburid mcr tab1.5mg 23

see glyburid mcr tab 3mg23see glyburid mcr tab 6mg23

GLYSET 23GOLYTELY 29

see gaviltye-g 29GRALISE STARTER 20GRALISE TAB 300MG 20GRALISE TAB 600MG 20granisetron hcl 28GRANISOL 28GRIFULVIN V

see griseofulvin microsize 6GRIS-PEG

see griseofulvinultramicrosize 6

griseofulvin microsize 6griseofulvin ultramicrosize 6guanfacine hcl 11

HHALAVEN 10HALDOL

see haloperidol lactate 19HALDOL DECANOATE 100

see haloperidoldecanoate 19

HALDOL DECANOATE 50see haloperidol

decanoate 19HALFLYTELY BOWEL

PREP/FLA 29halobetasol propionate 41HALOG 41haloperidol 19haloperidol decanoate 19haloperidol lactate 19HAVRIX 33HECTOROL 35HELIDAC 30HEP SOD/NACL INJ

25000 31heparin (porcine) in sodium

chloride 31heparin (porcine) in sodium

chloride 100u/ml 31heparin sod (porcine) in

d5w 31HEPARIN SODIUM 31heparin sodium (porcine) 31HEPARIN SODIUM/SODIUM

CHLsee heparin (porcine) in

sodium chloride 31hepatamine 8 34HEPATASOL INJ 8% 34HEPSERA 7HERCEPTIN 9HEXALEN 8HIPREX

see methenaminehippurate 8

HIZENTRA 32HORIZANT 20HUMALOG 22HUMALOG KWIKPEN 22HUMALOG MIX 50/50 22HUMALOG MIX 50/50

KWIKPEN 22HUMALOG MIX 75/25 22HUMALOG MIX 75/25

KWIKPEN 22HUMATROPE 27HUMATROPE COMBO

PACK 27HUMIRA 32HUMULIN 70/30 22

52

HUMULIN 70/30 PEN 22HUMULIN N 22HUMULIN N U-100 PEN 22HUMULIN R 22HUMULIN R U-500

(CONCENTRATE) 22HYCAMTIN

see topotecan hcl 10HYCET

see hydrocodone-acetaminophen 7.5-325mg/15ml 1

hydralazine hcl 15HYDREA

see hydroxyurea 10hydrochlorothiazide 15hydrocodone-acetaminophen

10-300mg 1hydrocodone-acetaminophen





2.5-325mg 1hydrocodone-acetaminophen





7.5-325 mg/15ml 1hydrocodone-acetaminophen



7.5-500mg/15ml 1hydrocodone-acetaminophen



tab 10-325mg 1hydrocodone-acetaminophen

tab 2.5-500mg 1hydrocodone-ibuprofen 2hydrocortisone 26hydrocortisone (intrarectal) 29hydrocortisone (topical) 41hydrocortisone butyrate 41hydrocortisone valerate 41hydromorphone hcl 2hydroxychloroquine sulfate 32hydroxyurea 10hydroxyzine hcl 37

hydroxyzine hcl inj 37hydroxyzine pamoate 37HYZAAR

see losartan potassium &hydrochlorothiazide 12

Iibandronate sodium 24ibuprofen 3ICLUSIG 10IDAMYCIN PFS

see idarubicin hcl 9idarubicin hcl 9IFEX INJ 3GM 8IFOSFAMIDE 8ILEVRO 35IMDUR

see isosorbidemononitrate 15

imipenem-cilastatin 8imipramine hcl 18imipramine pamoate 18imiquimod 41IMITREX

see sumatriptan inj6mg/0.5 20

see sumatriptan tab100mg 20



IMOVAX RABIES(H.D.C.V.) 33

IMURANsee azathioprine 32

INCIVEK 7INCRELEX 27indapamide 15INDERAL LA

see propranolol hcl er 13INFANRIX 33INFERGEN 32INFUMORPH 200 2INFUMORPH 500 2INLYTA 10INSPRA

see eplerenone 11INSULIN PEN NEEDLES 22INSULIN SAFETY

NEEDLES 22INSULIN SYRINGES 22INTELENCE 6INTERMEZZO SUB

1.75MG 20INTERMEZZO SUB 3.5MG20intralipid 34INTRALIPID INJ 30% 34INTRON-A 32INTRON-A W/DILUENT 32introvale 91 day 24

INTUNIV 19INVANZ 8INVEGA 19INVEGA SUSTENNA 19INVIRASE 6IONOSOL-B/DEXTROSE

5% 34IONOSOL-MB/DEXTROSE

5% 34IPOL INACTIVATED IPV 33ipratropium bromide

(nasal) 37ipratropium sol inhal 37ipratropium-albuterol 36irbesartan 12irbesartan-

hydrochlorothiazide 12IRESSA 10IRINOTECAN 10ISENTRESS 6isolyte m 34ISOLYTE P 34ISOLYTE S 34ISOLYTE S IN 5 %

DEXTROSE 34ISOLYTE-H/DEXTROSE

5% 34isoniazid 7isoniazid tabs 7ISOPTO CARPINE 36ISORDIL TITRADOSE 15

see isosorbide dinitrate 15isosorbide dinitrate 15isosorbide dinitrate sl tab 5

mg 15isosorbide mononitrate 15isradipine 14ISTALOL 36ISTODAX 9itraconazole 6IXEMPRA KIT 10IXIARO 33

JJAKAFI TAB 10MG 10JAKAFI TAB 15MG 10JAKAFI TAB 20MG 10JAKAFI TAB 25MG 10JAKAFI TAB 5MG 10JALYN 30jantoven 31JANUMET TAB 50-1000 23JANUMET TAB 50-500MG 23JANUMET XR TAB 100-

1000 23JANUMET XR TAB 50-

1000 23JANUMET XR TAB 50-

500MG 23JANUVIA TAB 100MG 23

53

JANUVIA TAB 25MG 23JANUVIA TAB 50MG 23JENTADUETO TAB 2.5-

1000 23JENTADUETO TAB 2.5-

500 23JENTADUETO TAB 2.5-

850 23jinteli 26jolivette 28 day 24junel 1.5/30 21 day 24junel 1/20 21 day 24junel fe 1.5/30 28 day 24junel fe 1/20 28 day 24JUVISYNC TAB 100-10MG23JUVISYNC TAB 100-20MG23JUVISYNC TAB 100-40MG23JUVISYNC TAB 50-10MG 23JUVISYNC TAB 50-20MG 23JUVISYNC TAB 50-40MG 23

KKADCYLA 9KADIAN 2KALETRA SOL 6KALETRA TAB 100-25MG 6KALETRA TAB 200-50MG 6kariva 28 day 24KAYEXALATE

see kionex 24KAZANO 23KCL 0.15%/D5W/LR 34KCL 0.15%/D5W/NACL

0.225% 34KCL 0.3%/D5W/NACL

0.9% 34KCL/NACL INJ 0.3-0.9 34KEFLEX 5

see cephalexin 4kelnor 1/35 28 day 24KENALOG 41KEPIVANCE 10KEPPRA

see levetiracetam 16KEPPRA XR

see levetiracetam 16KERLONE

see betaxolol hcl 13ketoconazole 6ketoconazole (topical) 39ketoconazole cream 39ketoconazole shampoo 40ketoprofen 3ketorolac tromethamine

(ophth) 36KINERET 32kionex 24KLARON

see sulfacetamide sodium(acne) 39

KLONOPINsee clonazepam 16

KLOR-CON 33klor-con 33KOMBIGLYZE TAB 2.5-

1000 23KOMBIGLYZE TAB 5-

1000MG 23KOMBIGLYZE TAB 5-

500MG 23kristalose 29KUVAN 26

Llabetalol hcl 13LAC-HYDRIN

see ammonium lactate 41see laclotion 41

laclotion 41LACRISERT 36lactated ringer's 34lactulose 29LAMICTAL

see lamotrigine 16LAMICTAL CHEWABLE

DISPERSsee lamotrigine 16

LAMICTAL ODT 16LAMICTAL STARTER 16LAMICTAL XR 16

see lamotrigine er 16LAMISIL 6

see terbinafine tab 250mg 6lamivudine 6lamivudine-zidovudine 7lamotrigine 16lamotrigine er 16LANOXIN

see digoxin 14see digoxin inj 14

LANOXIN PEDIATRIC 14LANOXIN TAB 14lansoprazole cap 15mg dr 30lansoprazole cap 30mg dr 30LANTUS 22LANTUS SOLOSTAR 22LASIX

see furosemide 15LASTACAFT 36latanoprost sol 0.005% 36LATUDA 19LAZANDA 2leena 28 day 24leflunomide 32LESCOL

see fluvastatin sodium 12LESCOL XL 12lessina 28 day 24LETAIRIS 15letrozole 9

leucovor ca inj 10leucovorin calcium 10LEUKERAN 8LEUKINE 31leuprolide acetate 9levalbuterol hcl 37LEVAQUIN

see levofloxacin 5see levofloxacin in d5w 5

LEVATOL 13LEVEMIR 22LEVEMIR FLEXPEN 22levetiracetam 16LEVOBUNOLOL HCL 36levobunolol hcl 36levocarnitine (metabolic

modifiers) 26levocetirizine

dihydrochloride 37levocetirizine tab 5 mg 37levofloxacin 5levofloxacin (ophth) 35levofloxacin in d5w 5levonest 28 day 24levonorgestrel (emergency

oc) 25levonorgestrel-ethinyl

estradiol (91-day) 25levora 0.15/30 28 day 25levorphanol tartrate 2levothroid 28levothyroxine sodium 28levoxyl 28LEXAPRO

see escitalopram oxalate 17LEXIVA 7LIALDA 29lidocaine 41lidocaine hcl 41lidocaine hcl (local anesth.) 3lidocaine hcl (mouth-throat)42lidocaine-prilocaine 41LIDODERM 41LINZESS 30liothyronine sodium 28LIPITOR

see atorvastatin tab10mg 12




LIPOFEN 13LIPOSYN II

see intralipid 34lisinopril 11lisinopril &

hydrochlorothiazide 11LITHIUM CARBONATE 20

54

lithium carbonate 20, 21LITHIUM CITRATE 21LITHOBID

see lithium carbonate 20LIVALO 12LO LOESTRIN FE 25LOCOID 41

see hydrocortisonebutyrate 41

LOCOID LIPOCREAM 41LODOSYN 18LOESTRIN 1.5/30-21

see junel 1.5/30 21 day 24see microgestin 1.5/30 21

day 25LOESTRIN 1/20-21

see junel 1/20 21 day 24see microgestin 1/20 21

day 25LOESTRIN 24 FE 25LOESTRIN FE 1.5/30

see junel fe 1.5/30 28day 24

see microgestin fe 1.5/3028 day 25

LOESTRIN FE 1/20see junel fe 1/20 28 day 24see microgestin fe 1/20 28

day 25LOFIBRA

see fenofibrate 13see fenofibrate

micronized 13lokara 41LOMOTIL

see diphenoxylate w/atropine 30

loperamide hcl 30LOPID

see gemfibrozil 13LOPRESSOR

see metoprolol tartrate 13LOPRESSOR HCT

see metoprolol &hydrochlorothiazide 13

LOPROXsee ciclopirox 39

LOPROX SHAMPOOsee ciclopirox shampoo

1% 39lorazepam 16LORCET 10/650

see hydrocodone-acetaminophen 10-650mg 1

LORTABsee co-gesic 1see hydrocodone-

acetaminophen 10-500mg 1

see hydrocodone-acetaminophen 5-500mg1


see hydrocodone-acetaminophen 7.5-500mg/15ml 1

loryna 28 day 25losartan potassium 12losartan potassium &

hydrochlorothiazide 12LOTEMAX 36LOTENSIN

see benazepril hcl 11LOTENSIN HCT

see benazepril &hydrochlorothiazide 11

LOTRELsee amlodipine besylate-

benazepril hcl 10LOTRONEX 30lovastatin 12LOVAZA 13LOVENOX

see enoxaparin sodium 31low-ogestrel 28 day 25loxapine succinate 19LOXITANE

see loxapine succinate 19LUFYLLIN 38LUMIGAN SOL 0.01% 36LUMIGAN SOL 0.03% 36LUMIZYME 26LUNESTA TAB 1MG 20LUNESTA TAB 2MG 20LUNESTA TAB 3MG 20LUPRON DEPOT 9LUPRON DEPOT-PED 9lutera 28 day 25LUVOX CR 16

see fluvoxamine maleateer 16

LUXIQ 41see betamethasone

valerate 40LYRICA CAP 100MG 16LYRICA CAP 150MG 16LYRICA CAP 200MG 16LYRICA CAP 225MG 16LYRICA CAP 25MG 16LYRICA CAP 300MG 16LYRICA CAP 50MG 16LYRICA CAP 75MG 16LYRICA SOL 20MG/ML 16LYSODREN 9

MM-M-R II W/DILUENT 10

DOS 33MACROBID

see nitrofurantoin monohydmacro 8

MACRODANTIN 8see nitrofurantoin

macrocrystal 8mafenide acetate 39MAGNACET 2MAGNESIUM SULFATE 33magnesium sulfate 33MAGNESIUM SULFATE IN

D5W 33MALARONE

see atovaquone-proguanilhcl 6

malathion 41maprotiline hcl 18MARINOL

see dronabinol cap 10mg28see dronabinol cap

2.5mg 28see dronabinol cap 5mg 28

marlissa 28 day 25MARPLAN 18MATULANE 10matzim 14MAVIK

see trandolapril 11MAXALT

see rizatriptan benzoatetabs 20

MAXALT TAB 10MG 20MAXALT TAB 5MG 20MAXALT-MLT

see rizatriptan benzoateodt 20

MAXALT-MLT TAB 10MG 20MAXALT-MLT TAB 5MG 20MAXIDEX 36MAXIDONE


MAXIPIMEsee cefepime hcl 4

MAXITROLsee neomycin-polymy-

dexameth 35MAXZIDE

see triamterene &hydrochlorothiazide tab75-50 mg 15

MAXZIDE-25see triamterene &

hydrochlorothiazide tab37.5-25 mg 15

meclizine hcl 28MEDROL

see methylprednisolone 26MEDROL DOSEPAK

see methylprednisolone 26medroxyprogesterone

acetate 27medroxyprogesterone

acetate (contraceptive) 25

55

mefenamic acid 3mefloquine hcl 6MEGACE ES 9MEGACE ORAL

see megestrol acetate 9megestrol acetate 9MELOXICAM SUSP 7.5

MG/5ML 3meloxicam tabs 3melphalan hcl 8MENACTRA 33MENEST 26MENHIBRIX 33MENOMUNE-A/C/Y/W-13533MENOSTAR 26MENTAX 39MENVEO 33MEPRON 8mercaptopurine 9meropenem 8MERREM

see meropenem 8mesalamine enema 29mesna 10MESNEX 10

see mesna 10MESTINON

see pyridostigminebromide 21

MESTINON SYRUP 21MESTINON TIMESPAN 21metadate 19METADATE CD 19

see methylphenidate hcl 19METAGLIP

see glip/metform tab 2.5-250m 22

metformin er tab 1000mg 23metformin tab 1000mg 23metformin tab 500mg 23metformin tab 500mg er 23metformin tab 750mg er 23metformin tab 850mg 23methadone hcl 2METHADONE INJ

10MG/ML 2methadose 2methazolamide 15methenamine hippurate 8METHERGINE

see methylergonovinemaleate 27

methimazole 28methocarbamol 21methotrexate sodium inj 9methotrexate sodium tabs 32methscopolamine bromide 29methyclothiazide 15methyldopa 15methyldopa &

hydrochlorothiazide 15

methylergonovine maleate 27METHYLIN

see methylphenidate hcl 19METHYLIN CHEW TAB 19methylphenidate hcl 19METHYLPHENIDATE HCL

ER 20methylprednisolone 26methylprednisolone

acetate 26methylprednisolone sod

succ 26metipranolol 36metoclopramide hcl 28metolazone 15metoprolol &

hydrochlorothiazide 13metoprolol succinate 13metoprolol tartrate 13METOZOLV ODT 28METROCREAM

see metronidazole(topical) 41

METROGEL 41METROGEL-VAGINAL

see metronidazolevaginal 31

METROLOTIONsee metronidazole

(topical) 41metronidazole 8metronidazole (topical) 41metronidazole inj 8metronidazole vaginal 31MEVACOR

see lovastatin 12mexiletine hcl 12MIACALCIN

see calcitonin (salmon)nasal spray 24

MIACALCIN INJ 200U/ML 24MICARDIS 12MICARDIS HCT 12miconazole nitrate vaginal 31MICRO-K

see potassium chloridecaps er 33

microgestin 1.5/30 21 day 25microgestin 1/20 21 day 25microgestin fe 1.5/30 28

day 25microgestin fe 1/20 28 day 25MICROZIDE

see hydrochlorothiazide 15midodrine hcl 15MIGERGOT 20MIGRANAL SPR 4MG/ML 20MILLIPRED 27MINIPRESS

see prazosin hcl 11minitran 15

MINIVELLE 26MINOCIN

see minocycline hcl 5minocycline hcl 5minoxidil 15MIRAPEX

see pramipexoledihydrochloride 18

MIRAPEX ER 18MIRCETTE

see kariva 28 day 24see viorele 25

mirtazapine 18misoprostol 30mitomycin 9mitoxantrone hcl 10MOBIC

see meloxicam tabs 3modafinil 21moexipril hcl 11moexipril-

hydrochlorothiazide 11mometasone furoate 41MONODOX

see doxycycline(monohydrate) 5

mononessa 28 day 25montelukast sodium 37morphine sul 20mg/ml oral

sol 2MORPHINE SULFATE 2morphine sulfate 2morphine sulfate ext-rel tab 2MOVIPREP 29MOXATAG 5MOXEZA 35MOZOBIL 31MS CONTIN

see morphine sulfate ext-reltab 2

MULTAQ 12mupirocin cream 2% 39mupirocin oint 2% 39MUSTARGEN 8MYAMBUTOL

see ethambutol hcl 7MYCAMINE 6MYCOBUTIN 7mycophenolate mofetil 33MYDRIACYL

see tropicamide 36MYFORTIC 33myorisan 39MYOZYME 26MYRBETRIQ 31MYSOLINE

see primidone 17MYTELASE 21myzilra 25

N

56

nabumetone 3nadolol 13nadolol &

bendroflumethiazide 13nafcillin sodium 5NAFTIN 39NAGLAZYME 26NALFON 3NALLPEN/DEXTROSE 5naloxone hcl 21naltrexone hcl 21NAMENDA 17NAMENDA TITRATION

PAK 17NAPRELAN 3NAPROSYN

see naproxen 3naproxen 3naproxen sodium 3naratriptan tab 1mg 20naratriptan tab 2.5mg 20NARDIL

see phenelzine sulfate 18NASACORT AQ

see triamcinolon spr55mcg/ac 38

NASONEX SPR50MCG/AC 38

NATACYN 35nateglinide tab 120mg 23nateglinide tab 60mg 23NAVELBINE

see vinorelbine tartrate 9NEBUPENT 8necon 0.5/35 28 day 25necon 1/35 28 day 25NECON 10/11 28 DAY 25necon 7/7/7 28 day 25nefazodone hcl 18neomycin sulfate 5neomycin-bacitracin zn-

polymyxin 35neomycin-polymy-

dexameth 35neomycin-polymy-gramicid 35neomycin-polymyxin-hc

(ophth) 35neomycin-polymyxin-hc

(otic) 42neomycin/polymyxin b gu 42NEORAL 33

see cyclosporine modified(for microemulsion) 32

see gengraf 32NEOSPORIN

see neomycin-polymy-gramicid 35

NEOSPORIN GU IRRIGANTsee neomycin/polymyxin b

gu 42NEPHRAMINE 34

NEPTAZANEsee methazolamide 15

NESINA 23NEULASTA 31NEUMEGA 31NEUPOGEN 31NEUPRO 18NEURONTIN

see gabapentin cap100mg 16



see gabapentin sol250/5ml 16

see gabapentin tab600mg 16

see gabapentin tab800mg 16

NEVANAC 36NEVIRAPINE 7nevirapine 7NEXAVAR 10NEXIUM 30NEXIUM I.V. 30next choice 25niacor 13NIASPAN 13nicardipine hcl 14NICOTROL INH 21NICOTROL NS SPR

10MG/ML 21nifediac 14nifediac cc tab 14nifedical 14nifedipine 14nifedipine er 14NILANDRON 10nimodipine 14NIMOTOP

see nimodipine 14NIPENT

see pentostatin 9nisoldipine 14NITRO-BID 15NITRO-DUR

see minitran 15NITRO-DUR 0.3MG/HR 15NITRO-DUR 0.8MG/HR 15nitrofurantoin 8nitrofurantoin macrocrystal 8nitrofurantoin monohyd

macro 8NITROGLYCERIN

LINGUAL 15nitroglycerin patches 15NITROLINGUAL

PUMPSPRAY 15NITROMIST 15NITROSTAT 15

nizatidine 29NIZORAL

see ketoconazoleshampoo 40

NOR-QDsee camila 28 day 24see nora-be 28 day 25

nora-be 28 day 25NORCO



see hydrocodone-acetaminophen tab 10-325mg 1

NORDITROPIN FLEXPRO 27NORDITROPIN NORDIFLEX

PEN 27norethindrone acetate 27NORINYL 1+35

see cyclafem 1/35 28 day24see necon 1/35 28 day 25see nortrel 1/35 21 day 25see nortrel 1/35 28 day 25

normosol-m 34NORMOSOL-R 34normosol-r in 5 % dextrose 34NOROXIN 5NORPACE

see disopyramidephosphate 12

NORPACE CR 12NORPRAMIN

see desipramine hcl 17nortrel 0.5/35 28 day 25nortrel 1/35 21 day 25nortrel 1/35 28 day 25nortrel 7/7/7 28 day 25nortriptyline hcl 18NORVASC

see amlodipine besylate 14NORVIR 7novarel 27NOVOLIN 70/30 22NOVOLIN N 22NOVOLIN R 22NOVOLOG 22NOVOLOG FLEXPEN 22NOVOLOG MIX 70/30 22NOVOLOG MIX 70/30

PREFILL 22NOXAFIL 6NUCYNTA 2NUCYNTA ER 2NUEDEXTA CAP 20-

10MG 21NULOJIX 33NULYTELY/FLAVOR PACKS

see gavilyte-n 29

57

see trilyte 29NUTROPIN 27NUTROPIN AQ NUSPIN 5 27NUTROPIN AQ PEN 27NUVARING 25NUVIGIL 21nyamyc 39nystatin 6nystatin (mouth-throat) 42nystatin (topical) 39nystatin pow 100000 39nystop 39

Oocella 28 day 25OCTAGAM 32octreotide acetate 27OCUFEN

see flurbiprofen sodium 35OCUFLOX

see ofloxacin (ophth) 35ofloxacin (ophth) 35ofloxacin (otic) 42ogestrel 28 day 25olanzapine 19olanzapine inj 10mg 19olanzapine odt 19OLEPTRO 18OLUX-E 41

see clobetasol propionateemulsion 40

OMECLAMOX-PAK 30omeprazole cap 10mg 30omeprazole cap 20mg 30omeprazole cap 40mg 30OMNARIS SPR 38OMNIPRED

see prednisolone acetate(ophth) 36

OMNITROPE 27ondansetron hcl 28ondansetron hcl inj 28ondansetron hcl oral soln 28ondansetron odt 28ONFI 16ONGLYZA TAB 2.5MG 23ONGLYZA TAB 5MG 23ONMEL 6ONSOLIS 2ONTAK 9OPANA

see oxymorphone hcl 3OPANA ER (CRUSH

RESISTANT 2OPTIPRANOLOL

see metipranolol 36OPTIVAR

see azelastine hcl(ophth) 36

ORACEA 41

ORAP 19ORAPRED

see prednisolone sodiumphosphate 27

ORAPRED ODT 27ORENCIA 32ORFADIN 26orsythia 28 day 25ORTHO EVRA 25ORTHO MICRONOR

see errin 28 day 24see jolivette 28 day 24

ORTHO TRI-CYCLENsee tri-previfem 28 day 25see tri-sprintec 28 day 25see trinessa 28 day 25

ORTHO TRI-CYCLEN LO 25ORTHO-CYCLEN

see mononessa 28 day 25see previfem 28 day 25see sprintec 28 day 25

ORTHO-NOVUM 7/7/7see cyclafem 7/7/7 28

day 24see necon 7/7/7 28 day 25see nortrel 7/7/7 28 day 25

OSENI TAB 12.5-15MG 23OSENI TAB 12.5-30MG 23OSENI TAB 12.5-45MG 23OSENI TAB 25-15MG 23OSENI TAB 25-30MG 23OSENI TAB 25-45MG 23OSMOPREP 29OVCON-35

see balziva 28 day 24see briellyn 28 day 24see gildagia 24see philith 25

OVCON-50 28 25OVIDE

see malathion 41oxacillin sodium 5OXALIPLATIN 10OXANDRIN

see oxandrolone 22oxandrolone 22oxaprozin 3oxcarbazepine 16OXECTA 2OXISTAT 39OXSORALEN 41OXSORALEN ULTRA 40oxybutynin chloride 31OXYCODONE HCL 2oxycodone hcl 2oxycodone w/ acetaminophen

10-325mg 3oxycodone w/ acetaminophen

10-650mg 3oxycodone w/ acetaminophen

2.5-325mg 3

oxycodone w/ acetaminophen5-325mg 3

oxycodone w/ acetaminophen5-500mg 3

oxycodone w/ acetaminophen7.5-325mg 3

oxycodone w/ acetaminophen7.5-500mg 3

oxycodone-aspirin 3oxycodone-ibuprofen 3OXYCONTIN 3oxymorphone er 3oxymorphone hcl 3OXYTROL 31

PPACERONE 12

see amiodarone hcl 12pacerone 12paclitaxel 9PALGIC

see carbinoxaminemaleate 37

PAMELORsee nortriptyline hcl 18

PAMIDRONATEDISODIUM 24

pamidronate disodium 24PAMINE

see methscopolaminebromide 29

PAMINE FORTEsee methscopolamine

bromide 29PANCREAZE 30PANDEL 41PANRETIN 41pantoprazole sodium inj 30pantoprazole tab 20mg 30pantoprazole tab 40mg 30PARAFON FORTE DSC

see chlorzoxazone 21PARCOPA

see carbidopa-levodopa 18parenteral electrolytes 33PARLODEL

see bromocriptinemesylate 18

PARNATEsee tranylcypromine

sulfate 18paromomycin sulfate 5paroxetine er tab 18paroxetine hcl 18PASER D/R 7PATADAY 36PATANASE 37PATANOL 36PAXIL 18

see paroxetine hcl 18PAXIL CR

58

see paroxetine er tab 18PCE 5pedi-dri 39PEDIAPRED

see prednisolone sodiumphosphate 27

PEDVAX HIB 33PEG-INTRON 32PEG-INTRON REDIPEN 32PEGANONE 16PEGASYS 32PEGASYS PROCLICK 32PENICILLIN G POT IN

DEXTROSE 5penicillin g potassium 5PENICILLIN G PROCAINE 5penicillin g sodium 5penicillin v potassium 5PENNSAID 41PENTAM 300 8PENTASA 29pentostatin 9pentoxifylline 32PEPCID

see famotidine 29PERCOCET

see endocet 10/325 2see endocet 10/650 2see endocet 5/325 2see endocet 7.5/325 2see endocet 7.5/500 2see oxycodone w/

acetaminophen 10-325mg 3

see oxycodone w/acetaminophen 10-650mg 3

see oxycodone w/acetaminophen 2.5-325mg 3

see oxycodone w/acetaminophen 5-325mg3



PERCODANsee endodan reformulated

may 2009 2see oxycodone-aspirin 3

PERFOROMIST 37PERIDEX

see chlorhexidine gluconate(mouth-throat) 42

see periogard 42perindopril erbumine 11periogard 42permethrin 41perphenazine 19

perphenazine-amitriptyline 21PERSANTINE

see dipyridamole 32PERTZYE 30PEXEVA 18phenadoz 28phenelzine sulfate 18PHENERGAN

see promethazine hcl inj 28phenobarbital 17phenobarbital sodium 17PHENYTEK 17

see phenytoin sodiumextended 17

phenytoin 17phenytoin inj 50mg/ml 17phenytoin sodium

extended 17philith 25PHISOHEX 39PHOSLO 27

see calcium acetate(phosphate binder) 27

PHOSLYRA 27PHOSPHOLINE IODIDE 36PICATO 39PILOCARPINE HCL 36pilocarpine hcl (oral) 42PILOPINE HS 36pindolol 13pioglit/glim tab 30-2mg 23pioglit/glim tab 30-4mg 23pioglita/met tab 15-500mg 23pioglita/met tab 15-850mg 23pioglitazone tab 15mg 23pioglitazone tab 30mg 23pioglitazone tab 45mg 23piperacillin sodium-

tazobactam sodium 5piroxicam 3PLAN B

see next choice 25PLAN B ONE-STEP

see levonorgestrel(emergency oc) 25

PLAQUENILsee hydroxychloroquine

sulfate 32PLASMA-LYTE A 34PLASMA-LYTE-148 34PLASMA-LYTE-56/D5W 34PLAVIX

see clopidogrel bisulfate 32PLETAL

see cilostazol 32podofilox 41polyethylene glycol 3350 29polymyxin b sulfate 8polymyxin b-trimethoprim 35POLYTRIM

see polymyxin b-

trimethoprim 35POMALYST 10PONSTEL

see mefenamic acid 3portia 28 day 25potassium chloride 34potassium chloride 30 meq/l

(0.224%) in dextrose 5%inj 34

potassium chloride caps er 33potassium chloride in

dextrose 35potassium chloride in

dextrose & sodiumchloride 35

potassium chloride in nacl 35potassium chloride

microencapsulatedcrystals cr 33

potassium citrate(alkalinizer) 30

POTIGA 17PRADAXA 31pramipexole

dihydrochloride 18PRANDIMET TAB 1-

500MG 23PRANDIMET TAB 2-

500MG 23PRANDIN TAB 0.5MG 23PRANDIN TAB 1MG 23PRANDIN TAB 2MG 23PRAVACHOL

see pravastatin sodium 12pravastatin sodium 12prazosin hcl 11PRECOSE

see acarbose 22PRED MILD 36PRED-G 36PRED-G S.O.P. 36prednicarbate 41prednisolone acetate

(ophth) 36PREDNISOLONE SODIUM

PHOSP 36prednisolone sodium

phosphate 27prednisone 27PREDNISONE INTENSOL 27PREFEST 26pregnyl 27PREMARIN 26PREMARIN CREAM 26PREMARIN INJ 26PREMASOL 34PREMPHASE 26PREMPRO 26PRENATAL VITAMINS 35PREPOPIK 29PREVACID

59

see lansoprazole cap 15mgdr 30

see lansoprazole cap 30mgdr 30

PREVACID TAB 15MGSTB 30

PREVACID TAB 30MGSTB 30

prevalite 13previfem 28 day 25PREVPAC MIS 30PREZISTA 7PRIFTIN 7PRILOSEC

see omeprazole cap10mg 30



PRIMAQUINEPHOSPHATE 6

PRIMAXIN IVsee imipenem-cilastatin 8

primidone 17PRIMSOL 8PRINIVIL

see lisinopril 11PRINZIDE

see lisinopril &hydrochlorothiazide 11

PRISTIQ 18PRIVIGEN 32PROAIR HFA AER 37probenecid 1PROCALAMINE 34PROCARDIA XL

see nifedical 14see nifedipine er 14

prochlorperazine 28prochlorperazine edisylate 28prochlorperazine maleate 28PROCRIT 31procto-pak 41proctocream 39proctozone hc 39progesterone micronized 27PROGLYCEM 27PROGRAF 33

see tacrolimus 33PROLASTIN-C 38PROLENSA 36PROLEUKIN 9PROLIA 27PROMACTA 32promethazine hcl 28promethazine hcl inj 28promethegan 28PROMETRIUM

see progesteronemicronized 27

propafenone hcl 12proparacaine hcl 36propranolol &

hydrochlorothiazide 13propranolol hcl 13propranolol hcl er 13propranolol inj 1mg/ml 13propranolol sol 13propranolol tab 13propylthiouracil 28PROQUAD 33PROSCAR

see finasteride 30PROSOL 34PROTONIX

see pantoprazole sodiuminj 30

see pantoprazole tab20mg 30

see pantoprazole tab40mg 30

PROTONIX INJ 30PROTONIX PAK 30PROTOPIC 41protriptyline hcl 18PROVENTIL AER HFA 37PROVERA

see medroxyprogesteroneacetate 27

PROVIGILsee modafinil 21

PROZACsee fluoxetine hcl 17

PROZAC WEEKLYsee fluoxetine hcl 17

PRUDOXIN 39PULMICORT

see budesonide(inhalation) 38

PULMICORT INH 180MCG38PULMICORT INH 90MCG 38PULMICORT INH SUSP 38PULMOZYME 38PURINETHOL

see mercaptopurine 9PYLERA 30pyrazinamide 7pyridostigmine bromide 21

QQNASL AER 80MCG 38QUALAQUIN 6

see quinine sulfate 6quasense 91 day 25QUESTRAN

see cholestyramine 13QUESTRAN LIGHT

see cholestyramine light 13see prevalite 13

quetiapine fumarate 19QUILLIVANT XR 20

quinapril hcl 11quinapril-

hydrochlorothiazide 11quinidine gluconate er 12quinidine sulfate 12quinine sulfate 6QVAR AER 40MCG 38QVAR AER 80MCG 38

RRABAVERT 33ramipril 11RANEXA 15ranitidine hcl 29RAPAFLO 30RAPAMUNE 33RAYOS 27RAZADYNE

see galantaminehydrobromide 17

RAZADYNE ERsee galantamine

hydrobromide 17REBETOL 7

see ribasphere 200mg 7see ribavirin 200mg 7

REBIF INJ 22/0.5 21REBIF INJ 44/0.5 21REBIF TITRTN SOL PACK21reclipsen 28 day 25RECOMBIVAX HB 33RECTIV 41REGLAN

see metoclopramide hcl 28REGONOL 21REGRANEX 42RELENZA DISKHALER 7RELISTOR 29RELPAX TAB 20MG 20RELPAX TAB 40MG 20REMERON

see mirtazapine 18REMERON SOLTAB

see mirtazapine 18REMICADE 32REMODULIN 15RENAGEL 27RENVELA 27reprexain 10/200 2REPREXAIN 2.5/200 2REQUIP

see ropinirolehydrochloride 18

REQUIP XLsee ropinirole

hydrochloride 18RESCRIPTOR 7RESTASIS 36RETIN-A

see avita 38

60

see tretinoin 39RETIN-A MICRO 39RETROVIR

see zidovudine 7RETROVIR IV INFUSION 7REVATIO

see sildenafil citrate(pulmonaryhypertension) 15

REVIAsee naltrexone hcl 21

REVLIMID 32REYATAZ 7RHEUMATREX 32RHINOCORT SUS AQUA 38RIBAPAK 7ribapak mis 600/day 7ribasphere 7ribasphere 200mg 7ribavirin 200mg 7RIFADIN

see rifampin 7rifampin 7RIFATER 7RILUTEK 21rimantadine hydrochloride 7ringer's 35RIOMET SOL 23RISPERDAL

see risperidone 19RISPERDAL CONSTA 19RISPERDAL M-TAB

see risperidone odt 19risperidone 19risperidone odt 19RITALIN 20

see methylphenidate hcl 19RITALIN LA 20

see methylphenidate hcl 19RITUXAN 9rivastigmine tartrate 17rizatriptan benzoate odt 20rizatriptan benzoate tabs 20ROBAXIN

see methocarbamol 21ROBAXIN-750

see methocarbamol 21ROBINUL

see glycopyrrolate 28ROBINUL FORTE

see glycopyrrolate 29ROCALTROL

see calcitriol 35ROCEPHIN

see ceftriaxone sodium 4ropinirole hydrochloride 18ROTATEQ 33ROWASA

see mesalamine enema 29ROXICET 3ROXICET 5/500 3

ROXICODONEsee oxycodone hcl 2

ROZEREM TAB 8MG 20RYTHMOL

see propafenone hcl 12RYTHMOL SR

see propafenone hcl 12

SSABRIL 17SAIZEN 27SAIZEN CLICK.EASY 27SALAGEN

see pilocarpine hcl (oral) 42SAMSCA 27SANCTURA

see trospium cl tab 20mg 31SANCTURA XR 31

see trospium cl cap 60mger 31

SANCUSO DIS 3.1MG 28SANDIMMUNE 33

see cyclosporine 32SANDOSTATIN

see octreotide acetate 27SANDOSTATIN LAR

DEPOT 27SANTYL 42SAPHRIS 19SARAFEM 21SAVELLA 21SAVELLA TITRATION

PACK 21SEASONIQUE

see amethia 91 day 24SECTRAL

see acebutolol hcl 13selegiline hcl 18selenium sulfide 40SELSUN SHAMPOO

see selenium sulfide 40SELZENTRY 7SEMPREX-D 37SENSIPAR 24SEREVENT DIS AER

50MCG 37SEROMYCIN 7SEROQUEL

see quetiapine fumarate 19SEROQUEL XR 19SEROSTIM 27sertraline hcl 18SFROWASA 29SIGNIFOR 27sildenafil citrate (pulmonary

hypertension) 15SILENOR 20SILVADENE

see silver sulfadiazine 39see ssd 39see thermazene 39

silver sulfadiazine 39SIMCOR 13SIMPONI 32SIMULECT 33simvastatin 12simvastatin tab 80mg 12SINEMET

see carbidopa-levodopa 18SINEMET CR

see carbidopa-levodopa 18SINGULAIR

see montelukast sodium 37SIRTURO 7SKLICE 41SOD FLUORIDE 2.2MG

TAB 33sodium chloride 33, 35sodium chloride (gu

irrigant) 42sodium phenylbutyrate 26sodium polystyrene

sulfonate 24SOLARAZE 39SOLIA 25SOLODYN 5

see minocycline hcl 5SOLTAMOX 10SOLU-CORTEF 250MG 27SOLU-MEDROL 27

see methylprednisolone sodsucc 26

SOMATULINE DEPOT 27SOMAVERT 27SONATA

see zaleplon cap 10mg 20see zaleplon cap 5mg 20

SORIATANE 40SORILUX 40sorine 12sotalol hcl 12sotalol hcl (afib/afl) 12SPIRIVA CAP HANDIHLR 37spironolactone 11spironolactone &

hydrochlorothiazide 15SPORANOX 6

see itraconazole 6sprintec 28 day 25SPRYCEL 10sronyx 28 day 25ssd 39stagesic 5/500 2STALEVO 18STARLIX

see nateglinide tab120mg 23

see nateglinide tab 60mg 23stavudine 7STAVZOR 17STELARA 40STIMATE 28

61

STIVARGA 10STRATTERA 20streptomycin sulfate 5STRIANT MIS 30MG 22STRIBILD 7STROMECTOL 8SUBOXONE

see buprenorphine-naloxone subl 21

SUBOXONE FILM 12-3MG21SUBOXONE FILM 2-

0.5MG 21SUBOXONE FILM 4-1MG 21SUBOXONE FILM 8-2MG 21SUBOXONE SUB 2-0.5MG21SUBOXONE SUB 8-2MG 21SUBSYS 3SUCLEAR 29SUCRAID 30sucralfate 30SULAR

see nisoldipine 14sulfacetamide sod-

prednisolone 35sulfacetamide sodium

(acne) 39sulfacetamide sodium

(ophth) 35SULFADIAZINE 5sulfamethoxazole-trimethop 8sulfamethoxazole-trimethop

iv soln 8SULFAMYLON 39

see mafenide acetate 39sulfasalazine dr 29sulfasalazine ir 29sulindac 3SUMATRIPTAN INJ

4MG/0.5 20sumatriptan inj 6mg/0.5 20sumatriptan spr 20mg/act 20sumatriptan spr 5mg/act 20sumatriptan tab 100mg 20sumatriptan tab 25mg 20sumatriptan tab 50mg 20SUMAVEL DOSE INJ

6MG/0.5 20suprax 5SUPRAX SUS 100/5ML 5SUPRAX SUS 200/5ML 5SUPRAX SUS 500/5ML 5SUPRAX TAB 400MG 5SUPREP BOWEL PREP 29SURMONTIL

see trimipramine maleate18SUSTIVA 7SUTENT 10SYLATRON 10SYMBICORT AER 160-4.5 38SYMBICORT AER 80-4.5 38SYMLINPEN 120 22

SYMLINPEN 60 22SYNAGIS 33SYNALAR

see fluocinoloneacetonide 40

SYNALGOS-DC 2SYNAREL 25SYNERA 41SYNERCID 8SYNTHROID 28

see levothroid 28see levothyroxine sodium28see levoxyl 28see unithroid 28

SYPRINE 24

TTABLOID 9TACLONEX 41tacrolimus 33TAMBOCOR

see flecainide acetate 12TAMIFLU 7tamoxifen citrate 10tamsulosin hcl 30TAPAZOLE

see methimazole 28TARCEVA 10TARGRETIN 10, 41TARKA 11TASIGNA 10TAXOTERE 9tazicef vial 5TAZORAC 40taztia 14TECFIDERA 21TECFIDERA STARTER

PACK 21TEFLARO 6TEGRETOL 17

see carbamazepine 16see epitol 16

TEGRETOL XR TAB100MG 17

TEGRETOL-XR 17see carbamazepine 16

TEKAMLO 14TEKTURNA 14TEKTURNA HCT TAB 150-

12.5MG 14TEKTURNA HCT TAB 150-

25MG 14TEKTURNA HCT TAB 300-

12.5MG 14TEKTURNA HCT TAB 300-

25MG 14TEMOVATE

see clobetasolpropionate 40

TEMOVATE Esee clobetasol propionate

emollient base 40TENEX

see guanfacine hcl 11TENORETIC 100

see atenolol &chlorthalidone 13

TENORETIC 50see atenolol &

chlorthalidone 13TENORMIN

see atenolol 13TERAZOL 3

see terconazole vaginal 31TERAZOL 7

see terconazole vaginal 31see zazole 31

terazosin hcl 11terbinafine tab 250mg 6terbutaline sulfate 37terconazole vaginal 31TESTIM GEL 1%(50MG) 22testosterone cypionate 22testosterone enanthate 22TETANUS TOXOID

ADSORBED 33TETANUS/DIPHTHERIA

TOXOID 33tetracycline hcl 6TEV-TROPIN 27TEVETEN 12

see eprosartan mesylate 12TEVETEN HCT 12THALITONE 15THALOMID 32THEO-24 38theophylline 38thermazene 39thioridazine hcl 19THIOTEPA 8thiothixene 19THYMOGLOBULIN 33tiagabine tab 2mg 17tiagabine tab 4mg 17TIAZAC

see diltiazem hcl extendedrelease beads 14

see taztia 14TIKOSYN 12TIMENTIN 6timolol maleate 13timolol maleate (ophth) 36timolol maleate gel 36TIMOPTIC

see timolol maleate(ophth) 36

TIMOPTIC OCUDOSE 36TIMOPTIC-XE

see timolol maleate gel 36TIROSINT 28tizanidine hcl 21tizanidine tabs 21

62

TOBI 38TOBRADEX 35

see tobramycin-dexamethasone 35

TOBRADEX ST 35tobramycin sulfate 6tobramycin sulfate (ophth) 35TOBRAMYCIN

SULFATE/SODIUM 6tobramycin-

dexamethasone 35TOBREX

see tobramycin sulfate(ophth) 35

TOBREX OINT 0.3% 35TOFRANIL

see imipramine hcl 18TOFRANIL-PM

see imipramine pamoate 18tolmetin sodium 3tolterodine tartrate 31TOPAMAX

see topiramate 17TOPAMAX SPRINKLE

see topiramate 17TOPICORT 41

see desoximetasone 40topiramate 17toposar 10topotecan hcl 10TOPROL XL

see metoprolol succinate 13TORISEL 9TORSEMIDE INJ

20MG/2ML 15torsemide tabs 15TOVIAZ 31TRACLEER 16TRADJENTA TAB 5MG 23tramadol hcl er 3tramadol hcl tab 50 mg 3tramadol-acetaminophen 3TRANDATE

see labetalol hcl 13trandolapril 11tranexamic acid 32TRANSDERM-SC DIS

1.5MG 28TRANXENE T

see clorazepatedipotassium 16

tranylcypromine sulfate 18TRAVASOL 34TRAVATAN Z DRO

0.004% 36trazodone hcl 18TREANDA 8TRECATOR 7TRELSTAR DEPOT

MIXJECT 10TRELSTAR LA MIXJECT 10

TRELSTAR MIXJECT 10TRENTAL

see pentoxifylline 32TRETIN X 39TRETINOIN 10tretinoin 39TRETINOIN

MICROSPHERE 39TREXALL 32TREXIMET TAB 85-

500MG 20tri-legest 28 25TRI-NORINYL 28

see aranelle 28 24see leena 28 day 24

tri-previfem 28 day 25tri-sprintec 28 day 25triamcinolon spr 55mcg/ac 38triamcinolone acetonide

(mouth) 42triamcinolone acetonide

(topical) 41triamterene &

hydrochlorothiazide cap37.5-25 mg 15

triamterene &hydrochlorothiazide cap50-25 mg 15

triamterene &hydrochlorothiazide tab37.5-25 mg 15

triamterene &hydrochlorothiazide tab75-50 mg 15

TRIBENZOR 12TRICOR

see fenofibrate 13triderm 41trifluoperazine hcl 19trifluridine 35TRIGLIDE 13trihexyphenidyl hcl 18TRILEPTAL 17

see oxcarbazepine 16TRILIPIX 13trilyte 29trimethoprim 8trimipramine maleate 18trinessa 28 day 25TRIOSTAT

see liothyronine sodium 28TRISENOX 10trivora 28 day 25TRIZIVIR 7TROPHAMINE 34tropicamide 36trospium cl cap 60mg er 31trospium cl tab 20mg 31TRUSOPT

see dorzolamide hcl 36TRUVADA 7

TUDORZA PRES AER400/ACT 37

TWINJECT 38TWINRIX 33TWYNSTA 12TYGACIL 8TYKERB 10TYLENOL/CODEINE #3

see acetaminophen w/codeine 1

TYLENOL/CODEINE #4see acetaminophen w/

codeine 1TYPHIM VI 33TYSABRI 21TYZEKA 7TYZINE 38TYZINE PEDIATRIC NASAL

DR 38

Uu-cort 41UCERIS 29ULESFIA 41ULORIC 1ULTRACET

see tramadol-acetaminophen 3

ULTRAMsee tramadol hcl tab 50

mg 3ULTRAM ER

see tramadol hcl er 3ULTRAVATE

see halobetasolpropionate 41

ULTRESA 30UNASYN

see ampicillin & sulbactamsodium 4

UNASYN BULK PACKsee ampicillin & sulbactam

sodium 4UNIRETIC

see moexipril-hydrochlorothiazide 11

unithroid 28UNIVASC

see moexipril hcl 11URECHOLINE

see bethanechol chloride 30UROCIT-K 10

see potassium citrate(alkalinizer) 30

UROCIT-K 15 30UROCIT-K 5

see potassium citrate(alkalinizer) 30

UROXATRALsee alfuzosin hcl 30

URSO 250see ursodiol 30

63

URSO FORTEsee ursodiol 30

ursodiol 30UVADEX 10

VVAGIFEM 26valacyclovir hcl 7VALCYTE 7VALIUM

see diazepam 16valproate sodium 17valproic acid 17valsartan-

hydrochlorothiazide 12VALTREX

see valacyclovir hcl 7VANCOCIN HCL

see vancomycin hcl 8vancomycin hcl 8vandazole 31VANOS 41VAQTA 33VARIVAX 33VASCEPA 13VASERETIC

see enalapril maleate &hydrochlorothiazide 11

VASOTECsee enalapril maleate 11

VECTIBIX 9VELCADE 9velivet 28 day 25VELTIN 39venlafaxine cap er 18venlafaxine hcl 18VENLAFAXINE HCL ER

see venlafaxine tab er 18venlafaxine tab 18venlafaxine tab er 18VENTAVIS 16VENTOLIN HFA AER 37VERAMYST SPR

27.5MCG 38verapamil hcl 14VERDESO 41VERELAN

see verapamil hcl 14VERELAN PM

see verapamil hcl 14VERIPRED 27VESICARE 31vestura 25VEXOL 36VFEND

see voriconazole 6VFEND SUS 40MG/ML 6VIBATIV 8VIBRAMYCIN 6

see doxycycline hyclate 5VICOPROFEN

see hydrocodone-ibuprofen 2

VICTOZA INJ 18MG/3ML 22VICTRELIS 7VIDAZA 9VIDEX EC

see didanosine 6VIDEX PEDIATRIC 7VIGAMOX 35VIIBRYD 18VIMOVO 1VIMPAT 17VINBLASTINE SULFATE 9vincasar 9vincristine sulfate 9vinorelbine tartrate 9VIOKACE 30viorele 25VIRACEPT 7VIRAMUNE 7

see nevirapine 7VIRAMUNE XR 7VIREAD 7VIROPTIC

see trifluridine 35VISICOL 29VISTARIL

see hydroxyzinepamoate 37

VISTIDE 7see cidofovir 7

VIVACTILsee protriptyline hcl 18

VIVELLE-DOT 26VIVITROL 21VOLTAREN GEL 1% 41VOLTAREN-XR

see diclofenac sodium 3voriconazole 6VORICONAZOLE INJ

200MG 6VOSOL HC

see acetasol hc 42see acetic acid sol/hc 42

VOSPIRE ERsee albuterol sulfate 37

VOTRIENT 10VPRIV 26VYTORIN 13VYVANSE 20

Wwarfarin sodium 31water for irrigation, sterile 42WELCHOL 13WELLBUTRIN

see bupropion hcl 17WELLBUTRIN SR

see budeprion 17see bupropion hcl sr 17

WELLBUTRIN XLsee bupropion hcl xl 17

WESTCORTsee hydrocortisone

valerate 41

XXALATAN

see latanoprost sol0.005% 36

XALKORI 10XANAX

see alprazolam 16XARELTO 31XELJANZ 32XENAZINE 21XEOMIN 36XERESE 40XGEVA 27XIFAXAN TAB 200MG 8XIFAXAN TAB 550MG 30XODOL




XOLAIR 38XOPENEX 37

see levalbuterol hcl 37XOPENEX CONCENTRATE

see levalbuterol hcl 37XOPENEX HFA AER 37XTANDI 10XYLOCAINE

see lidocaine hcl 41XYLOCAINE-MPF

see lidocaine hcl (localanesth.) 3

XYREM 21XYZAL

see levocetirizinedihydrochloride 37

see levocetirizine tab 5mg 37

YYASMIN 28

see drospirenone-ethinylestradiol 24

see ocella 28 day 25YAZ

see gianvi 28-day 24see loryna 28 day 25see vestura 25

YF-VAX 33

Z

64

zafirlukast 37zaleplon cap 10mg 20zaleplon cap 5mg 20ZAMICET 2ZANAFLEX

see tizanidine hcl 21see tizanidine tabs 21

ZANOSAR 8ZANTAC 29

see ranitidine hcl 29ZARONTIN

see ethosuximide 16ZAROXOLYN

see metolazone 15ZAVESCA 26zazole 31ZEBETA

see bisoprolol fumarate 13ZEGERID POW 20-1680 30ZEGERID POW 40-1680 30ZELAPAR 19ZELBORAF 10ZEMAIRA 38ZEMPLAR 35zenatane 39zenchent fe 28 day 25ZENPEP 30ZERIT

see stavudine 7ZESTORETIC

see lisinopril &hydrochlorothiazide 11

ZESTRILsee lisinopril 11

ZETIA 13ZETONNA AER 37MCG 38ZIAC

see bisoprolol &hydrochlorothiazide 13

ZIAGEN 7see abacavir sulfate 6

ZIANA 39zidovudine 7ZINACEF 6

see cefuroxime sodium 4ZINACEF IN SOLUTION 6ZINECARD

see dexrazoxane 10ZIOPTAN DRO 0.0015% 36ziprasidone hcl 19ZIPSOR 3ZIRGAN 35ZITHROMAX 6

see azithromycin 4ZMAX 6ZOCOR

see simvastatin 12see simvastatin tab 80mg12

ZOFRANsee ondansetron hcl 28see ondansetron hcl inj 28

see ondansetron hcl oralsoln 28

ZOFRAN ODTsee ondansetron odt 28

zoledronic acid inj 4mg/5ml24ZOLINZA 9ZOLOFT

see sertraline hcl 18zolpidem er tab 12.5mg 20zolpidem er tab 6.25mg 20zolpidem tab 10mg 20zolpidem tab 5mg 20ZOLPIMIST SPR 5MG 20ZOMETA 24

see zoledronic acid inj4mg/5ml 24

ZOMIG SPR 5MG 20ZOMIG TAB 2.5MG 20ZOMIG TAB 5MG 20ZOMIG ZMT TAB 2.5 MG 20ZOMIG ZMT TAB 5MG 20ZONALON 39ZONEGRAN

see zonisamide 17zonisamide 17ZORBTIVE 27ZORTRESS 33ZOSTAVAX 33ZOSYN 6

see piperacillin sodium-tazobactam sodium 5

zovia 1/35e 28 day 25zovia 1/50e 28 day 25ZOVIRAX 40

see acyclovir 7see acyclovir topical 40

ZYBANsee buproban 21

ZYCLARA 41ZYCLARA PUMP 41ZYDONE 10/400 2ZYDONE 5/400 2ZYDONE 7.5/400 2ZYFLO CR 37ZYLET 35ZYLOPRIM

see allopurinol tab 1ZYMAXID 35ZYPREXA

see olanzapine 19see olanzapine inj 10mg 19

ZYPREXA ZYDISsee olanzapine odt 19

ZYTIGA 10ZYVOX 8

2013 calpers (effective...

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