2016 aetna premier plus four tier open formulary · here are some reasons why: • as brand-name...

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2016 Aetna Pharmacy Drug GuideFour Tier Open Aetna Premier Plus Planwww.aetna.com

©2016 Aetna Inc.05.05.341.1 L (1/16)

www.aetna.com/formulary

Do you have questions? Call the toll-free number on your member ID card. Or visit www.aetna.com/formulary for the most up-to-date information.

Dear Member:

We are pleased to provide you with a copy of our 2016 Aetna Pharmacy drug guide that includes information about your pharmacy benefits plan. Take this guide with you when you see your doctor if you want to talk about what medicines are covered under your plan and what they may cost.

Many commonly prescribed drugs are listed in this guide. Note: this is not a complete list of drugs covered under your plan. We list only the most commonly prescribed medicines as thousands of drugs are covered by your plan.

Want to learn more your plan’s drug coverage? Just visit www.aetna.com and log in to Aetna Navigator®, your secure member website. Then take these simple steps:

1. Select “Aetna Pharmacy” at the top of the page.

2. In the “Coverage & Benefits” section, select “Pharmacy”. Then, “View your pharmacy plan details.”

What pharmacy benefits plan do I have?

You are enrolled in the Aetna Four Tier Open Premier Plus formulary plan.

Here’s what that means to you:

Think of tier as a level. Four Tier means you could pay four different amounts, depending on the drug you take.

A formulary is a list of generic and brand-name drugs that your plan covers. An open formulary means your plan covers most prescription drugs. But it may not cover some others.

What can I expect to pay?

With this health benefits and health insurance plan, the amount you pay depends on the drug your doctor prescribes. It’s either a flat fee or a percent of the prescription’s price. Each drug your plan covers falls under a different level or tier. The lower the tier, the lower the price. The higher the tier, the higher the price.

What you pay falls into one of these tiers or levels:

Tier One: You pay the lowest cost for drugs in this level. Your plan may include an additional benefit where some Tier 1 drugs would be provided at an even lower cost to you. These are considered Value Drugs/Tier 1a and include generics and some over-the-counter brand and generic products. These would be available at the lowest cost share indicated in your plan materials.

Tier Two: You pay a slightly higher cost for drugs in this level.

Tier Three: You pay the highest cost for drugs in this level.

Tier Four: You pay a higher cost for specialty drugs in this level. Specialty drugs may be injected, infused or taken by mouth.

To find your exact costs

Check your Plan Design and Benefits summary in your enrollment kit.

Your pharmacy benefits plan may include a program that encourages you to choose a generic drug over a brand-name drug to help reduce what you pay. This means that if you fill a brand-name drug when a generic is available, that in addition to your standard copay or coinsurance, you must also pay the difference in cost between the brand-name and generic drug.

For a summary of your pharmacy benefits plan, including out-of-pocket costs, visit www.aetna.com and log in to Aetna Navigator. Or call the toll-free number on your member ID card.


Where can I find more formulary information?

You and your doctor can search for a drug, find out if it’s covered and see what tier it’s in. You can also see if there are alternatives that cost less. Tell your doctor that you pay more for tier four drugs so he or she can consider this when writing a prescription.

Visit www.aetna.com/formulary. You arrive at a page that says “Find a Medication.” This is where you can learn more about the types of drug coverage reviews required for your medicine(s); things like precertification, step therapy or quantity limits. You will arrive at a menu page where you can view various drug lists, including your Aetna Pharmacy drug guide and more.

How is the formulary developed?

Aetna’s Pharmacy and Therapeutics (P&T) Committee meets regularly to review new drugs and new information about drugs that are already on the market. It reviews available information concerning safety, effectiveness and current use in therapy. The P&T Committee reviews scientific evidence, including relevant findings of federal government agencies, pharmaceutical manufacturers, medical professional associations, national commissions and peer-reviewed journals.

Our P&T Committee includes licensed pharmacists and doctors, including those who are currently in practice and others who are Aetna employees. All committee members must tell us if they are in a situation that can create a conflict of interest or if they have a financial stake that might affect their decisions.

Once the P&T Committee completes its clinical review, we also consider overall value (including cost and manufacturer rebate arrangements) and other factors before adding or removing a drug from the formulary. The Aetna Pharmacy drug guide shows you recent changes to the guide. For example, it could show what drugs started requiring coverage reviews like precertification, step therapy or quantity limits. Or which drugs no longer do. The P&T Committee can make recommendations to change the tier level of a drug or to place it on our Formulary Exclusions List, designating it as a drug that is no longer covered.

Why is the formulary subject to change?

We may add or remove drugs for certain reasons. We might also move a drug from one coverage tier to another.

Here are some reasons why:

• As brand-name drugs lose their patents and generic versions become available, the brand-name may be covered at a higher out-of-pocket cost while the generic may be covered at a lower out-of-pocket cost.

• The U.S. Food and Drug Administration (FDA) approves many new drugs throughout the year.

• Drugs can be withdrawn from the market or may become available without a prescription. Over-the-counter (OTC) drugs are not generally covered under a prescription plan, unless required by law.

Our website, www.aetna.com/formulary, reflects the most up-to-date formulary information – so please visit it often.

Why do some drugs require prior authorization or precertification?

This drug coverage review encourages appropriate and cost- effective use of prescription drugs by allowing coverage only when certain conditions are met.

Reasons for precertification include:

• Compliance with dosing guidelines

• Avoiding duplicate therapies

• Helping health care providers check that a drug is being used based on generally accepted medical criteria

The precertification program is based on current medical findings, FDA-approved manufacturer labeling information, and cost and manufacturer rebate arrangements.

If your plan requires precertification, you will find a list of drugs that are subject to precertification with this guide. Please keep in mind that:

• Your doctor must contact Aetna to request approval of coverage for these drugs.

• If we approve the request, we will notify your doctor. The drug will then be covered at the applicable out-of-pocket cost under your plan. You will also be notified of approvals where the state requires notification to members.

If the request is denied, you and your doctor will be notified. You can still purchase the drug, but for the full price.


Why do some drugs have quantity limits?

This drug coverage review limits coverage of quantities for certain drugs. These limits help your doctor and pharmacist check that your prescribed drug is used correctly and safely.

We use medical guidelines and FDA-approved recommendations from drug makers to set these coverage limits. The quantity limit program includes:

• Dose Efficiency Edits – Limit coverage of prescriptions to one dose per day for drugs that are approved for once-daily dosing.

• Maximum Daily Dose – A message is sent to the pharmacy if a prescription is less than the minimum or higher than the maximum allowed dose.

• Quantity Limits Over Time – Limit coverage of prescriptions to a specific number of units in a defined amount of time.

What is step therapy?

This drug coverage review promotes the appropriate use of equally effective but lower-cost drugs first. These lower-cost drugs are FDA-approved and treat the same condition as the corresponding step therapy drugs.

What is therapeutic duplication?

Therapeutic duplication means that two or more drugs of the same type are prescribed at the same time. This can occur when two doctors prescribe similar drugs or when your doctor switches from one drug to another drug in the same class without cancelling the first prescription.

It is rare that you should ever need two drugs from the same class to treat a medical condition. Since serious side effects may occur, we help bring such duplications to your pharmacist’s and doctor’s attention.

Learn more about drug coverage reviews

If you have a medical need for a drug that requires precertification, quantity limits or step therapy, your doctor can ask for a medical exception. The list of drugs requiring precertification, quantity limits or step therapy is subject to change. Find the most up-to-date information at www.aetna.com/formulary.

You may be able to save with generic drugs

Generic drugs are approved by FDA and proven to be just as safe and effective as brand-name drugs. They contain the same active ingredients in the same amounts as the brand-name drugs. The difference is that generics may be a different color, shape or size.

When appropriate, your doctor may decide to prescribe, or allow substitution with, a generic drug. Please talk to your doctor to find out if a generic is right for you.

Saving on prescriptions

Here are some other tips to pay less out of pocket for your prescription drugs:

• Ask your doctor to consider prescribing drugs that are on the Pharmacy Drug (formulary) Guide.

• Ask your doctor to consider prescribing generic drugs instead of brand-name drugs.

• Check to see if your plan includes our mail-order pharmacy service. Depending upon your plan, mail order may save you money. See Aetna Rx Home Delivery in this guide for details.

• Remind your doctor to check your plan to make sure you get maximum coverage.

What is Aetna Rx Home Delivery?

Check your plan documents to see if your plan includes our Aetna Rx Home Delivery mail order pharmacy. It fills prescriptions for maintenance medicine. This type of medicine is used regularly, to treat conditions like arthritis, asthma, diabetes or high cholesterol. If you need this type of drug, you can get up to a 90-day supply, or the maximum supply allowed by your plan, and free delivery right to your mailbox.

You also get:

• Quick, confidential service

• Free standard shipping

• Pharmacists who check all prescriptions for accuracy and can answer questions any time

It’s easy and fast to order – choose one of these ways:

1. CourtesyStartsm – Fill your new mail order prescription online at www.aetna.com. Click “Order Medications Online” and “Request a New Prescription”. Or, call us toll-free at 1-888-RX AETNA (1-888-792-3862) or TDD: 1-800-823-6373. We will contact your doctor to try and get a new prescription for you. You may need to schedule a visit with your doctor before he or she will write a new prescription.

2. Mail – Get a new 90-day prescription from your doctor. Mail it to us with a completed order form. Access the order form online. Log in to www.aetna.com, then click “Aetna Pharmacy.”

3. Fax – Ask your doctor to fax your new prescription, with your completed order form to 1-877-270-3317. Make sure your doctor includes your member ID number, your date of birth and your mailing address on the fax cover sheet. Only a doctor may fax a prescription.

If your prescription is for a controlled medicine, a written prescription from your doctor may be needed.

Generally, if your order is complete, you will receive your medicine within 10-14 days from when Aetna Rx Home Delivery receives your order. You can request expedited delivery for an additional charge.


What is Aetna Specialty Pharmacy?

Aetna Specialty Pharmacy is Aetna’s in-house specialty pharmacy. It can fill your prescription specialty medicine. These types of drugs may be injected, infused or taken by mouth. Specialty medicine often needs special storage and handling. It must be delivered quickly. And a nurse or pharmacist should monitor you during your treatment. Use Aetna Specialty Pharmacy to get this medicine sent right to your mailbox. You also get:

• Free delivery that is reliable, secure and sent anywhere you choose

• Extra help when you need it – like injection training and side effect monitoring

• Refill reminders

• Proactive outreach to confirm your refills

• Free standard supplies

• Nurses and pharmacists to help 24 hours a day, every day

It’s easy and fast to order – choose one of these ways:

• Fax – Your doctor can fax your prescription to 1-866-FAX-ASRX (1-866-329-2779).

• Mail – You or your doctor can mail your prescription order to: Aetna Specialty Pharmacy, 503 Sunport Lane, Orlando, FL 32809. If you mail in your own prescription, please send it along with a completed Patient Profile Form. Find the form at www.AetnaSpecialtyRx.com by clicking on “Specialty pharmacy: How to enroll.”

• Phone – Your doctor can also call and speak to one of our registered pharmacists at 1-866-782-ASRX (1-866-782-2779) during normal business hours of 8 a.m. until 7 p.m. ET.

To transfer an existing prescription order and have it filled by Aetna Specialty Pharmacy, call toll-free at 1-866-353-1892.

Please note that if your prescription drug benefits plan changes, the information herein may no longer apply. A copayment is a flat fee. Coinsurance is a percentage of the rate that Aetna negotiates with the plan sponsor for covered prescriptions except as required by law to be otherwise. Some drugs on the Preferred Drug List are subject to manufacturer rebates. Coinsurance is calculated before any rebates are subtracted. That means it may be possible for your cost of a preferred drug to be higher than your cost of a non-preferred drug.Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through specialty pharmacy prescription fulfillment.Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna’s Pharmacy Drug (formulary) Guide. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Information is subject to change. For more information about Aetna plans, refer to www.aetna.com.The drugs on the Pharmacy Drug (formulary) Guide, Formulary Exclusions, Precertification, Quantity Limit and Step Therapy Lists are subject to change. The quantity limits and step therapy drug coverage review programs are not available in all service areas. For example, step therapy programs do not apply to fully-insured members in Indiana. Step therapy does not apply to fully-insured members in New Jersey. However, these programs are available to self-funded plans. In accordance with state law, commercial fully-insured members in Louisiana and Texas (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added or removed from the Pharmacy Drug (formulary) Guide, Precertification, Quantity Limits or Step-Therapy Lists during the plan year will continue to have those medications covered at the same benefit level until their plan’s renewal date. In Texas, precertification approval is known as “pre-service utilization review.” It is not “verification” as defined by Texas law.In accordance with state law, fully-insured Commercial California HMO members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-therapy Lists will continue to have those medications covered, for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee’s medical condition. In accordance with state law, fully-insured Commercial Connecticut PPO members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-therapy Lists will continue to have those medications covered for as long as the treating physician prescribes them, provided the drug is medically necessary and more medically beneficial than other covered drugs. Nothing in this section shall preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions.This material is for information only. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is subject to change. For more information about Aetna plans, refer to www.aetna.com.

www.aetna.com

©2016 Aetna Inc.05.05.341.1 L (1/16)

Need more information? Visit www.aetna.com/formulary or call the appropriate toll-free number on your member ID card.

2016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary

Table of Contents

Table of Contents

*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS* ..................................................................................................................................... 3*ALTERNATIVE MEDICINES* ......................................................................................................................................................................................................................................................... 6*AMEBICIDES* ............................................................................................................................................................................................................................................................................................................. 6*AMINOGLYCOSIDES* ................................................................................................................................................................................................................................................................................. 6*ANALGESICS - ANTI-INFLAMMATORY* .............................................................................................................................................................................................................. 6*ANALGESICS - NONNARCOTIC* ....................................................................................................................................................................................................................................... 10*ANALGESICS - OPIOID* ...................................................................................................................................................................................................................................................................... 11*ANDROGENS-ANABOLIC* ............................................................................................................................................................................................................................................................. 15*ANORECTAL AGENTS* ........................................................................................................................................................................................................................................................................ 15*ANTHELMINTICS* ......................................................................................................................................................................................................................................................................................... 16*ANTIANGINAL AGENTS* ................................................................................................................................................................................................................................................................. 16*ANTIANXIETY AGENTS* .................................................................................................................................................................................................................................................................. 17*ANTIARRHYTHMICS* ............................................................................................................................................................................................................................................................................. 18*ANTIASTHMATIC AND BRONCHODILATOR AGENTS* ....................................................................................................................................................... 19*ANTICOAGULANTS* ................................................................................................................................................................................................................................................................................. 21*ANTICONVULSANTS* ............................................................................................................................................................................................................................................................................ 22*ANTIDEPRESSANTS* ................................................................................................................................................................................................................................................................................ 25*ANTIDIABETICS* ............................................................................................................................................................................................................................................................................................. 28*ANTIDIARRHEALS* .................................................................................................................................................................................................................................................................................... 34*ANTIDOTES* ............................................................................................................................................................................................................................................................................................................. 34*ANTIEMETICS* ..................................................................................................................................................................................................................................................................................................... 34*ANTIFUNGALS* .................................................................................................................................................................................................................................................................................................. 35*ANTIHISTAMINES* ...................................................................................................................................................................................................................................................................................... 36*ANTIHYPERLIPIDEMICS* ................................................................................................................................................................................................................................................................ 37*ANTIHYPERTENSIVES* ....................................................................................................................................................................................................................................................................... 40*ANTI-INFECTIVE AGENTS - MISC.* ............................................................................................................................................................................................................................. 44*ANTIMALARIALS* ........................................................................................................................................................................................................................................................................................ 46*ANTIMYASTHENIC/CHOLINERGIC AGENTS* ........................................................................................................................................................................................ 46*ANTIMYCOBACTERIAL AGENTS* ................................................................................................................................................................................................................................ 46*ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES* ............................................................................................................................................................. 47*ANTIPARKINSON AGENTS* ....................................................................................................................................................................................................................................................... 52*ANTIPSYCHOTICS/ANTIMANIC AGENTS* .................................................................................................................................................................................................... 54*ANTISEPTICS & DISINFECTANTS* ................................................................................................................................................................................................................................ 55*ANTIVIRALS* .......................................................................................................................................................................................................................................................................................................... 56*ASSORTED CLASSES* ............................................................................................................................................................................................................................................................................ 60*BETA BLOCKERS* ......................................................................................................................................................................................................................................................................................... 62*BIOLOGICALS MISC* ............................................................................................................................................................................................................................................................................... 63*CALCIUM CHANNEL BLOCKERS* ................................................................................................................................................................................................................................. 63*CARDIOTONICS* .............................................................................................................................................................................................................................................................................................. 65*CARDIOVASCULAR AGENTS - MISC.* .................................................................................................................................................................................................................. 65*CEPHALOSPORINS* .................................................................................................................................................................................................................................................................................... 66*CHEMICALS* ............................................................................................................................................................................................................................................................................................................ 67*CONTRACEPTIVES* .................................................................................................................................................................................................................................................................................... 67*CORTICOSTEROIDS* ................................................................................................................................................................................................................................................................................ 73*COUGH/COLD/ALLERGY* .............................................................................................................................................................................................................................................................. 74*DERMATOLOGICALS* ........................................................................................................................................................................................................................................................................... 77

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Table of Contents

*DIAGNOSTIC PRODUCTS* ............................................................................................................................................................................................................................................................. 92*DIGESTIVE AIDS* ........................................................................................................................................................................................................................................................................................... 99*DIURETICS* ................................................................................................................................................................................................................................................................................................................ 99*ENDOCRINE AND METABOLIC AGENTS - MISC.* ...................................................................................................................................................................... 100*ESTROGENS* ........................................................................................................................................................................................................................................................................................................ 106*FLUOROQUINOLONES* .................................................................................................................................................................................................................................................................. 107*GASTROINTESTINAL AGENTS - MISC.* ......................................................................................................................................................................................................... 107*GENERAL ANESTHETICS* ......................................................................................................................................................................................................................................................... 110*GENITOURINARY AGENTS - MISCELLANEOUS* ......................................................................................................................................................................... 110*GOUT AGENTS* .............................................................................................................................................................................................................................................................................................. 112*HEMATOLOGICAL AGENTS - MISC.* ................................................................................................................................................................................................................... 112*HEMATOPOIETIC AGENTS* ................................................................................................................................................................................................................................................... 115*HEMOSTATICS* .............................................................................................................................................................................................................................................................................................. 118*HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS* ...................................................................................................................................................... 119*LAXATIVES* ......................................................................................................................................................................................................................................................................................................... 120*MACROLIDES* .................................................................................................................................................................................................................................................................................................. 121*MEDICAL DEVICES AND SUPPLIES* .................................................................................................................................................................................................................... 122*MIGRAINE PRODUCTS* .................................................................................................................................................................................................................................................................. 148*MINERALS & ELECTROLYTES* ...................................................................................................................................................................................................................................... 149*MOUTH/THROAT/DENTAL AGENTS* .................................................................................................................................................................................................................. 151*MULTIVITAMINS* ..................................................................................................................................................................................................................................................................................... 152*MUSCULOSKELETAL THERAPY AGENTS* .............................................................................................................................................................................................. 160*NASAL AGENTS - SYSTEMIC AND TOPICAL* .................................................................................................................................................................................... 161*NEUROMUSCULAR AGENTS* ............................................................................................................................................................................................................................................ 162*OPHTHALMIC AGENTS* ................................................................................................................................................................................................................................................................ 163*OTIC AGENTS* .................................................................................................................................................................................................................................................................................................. 170*OXYTOCICS* ........................................................................................................................................................................................................................................................................................................ 171*PASSIVE IMMUNIZING AGENTS* ................................................................................................................................................................................................................................ 171*PENICILLINS* ..................................................................................................................................................................................................................................................................................................... 172*PHARMACEUTICAL ADJUVANTS* ........................................................................................................................................................................................................................... 173*PROGESTINS* ..................................................................................................................................................................................................................................................................................................... 173*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.* .............................................................................................................. 173*RESPIRATORY AGENTS - MISC.* ................................................................................................................................................................................................................................. 177*TETRACYCLINES* ..................................................................................................................................................................................................................................................................................... 178*THYROID AGENTS* ................................................................................................................................................................................................................................................................................ 178*ULCER DRUGS* .............................................................................................................................................................................................................................................................................................. 179*URINARY ANTI-INFECTIVES* ............................................................................................................................................................................................................................................ 182*URINARY ANTISPASMODICS* .......................................................................................................................................................................................................................................... 183*VAGINAL PRODUCTS* ...................................................................................................................................................................................................................................................................... 183*VASOPRESSORS* ......................................................................................................................................................................................................................................................................................... 185*VITAMINS* ............................................................................................................................................................................................................................................................................................................... 185

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2016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary

lowercase italics = Generic drugsUPPERCASE = Brand name drugs

Drug StatusCE = Copay Exception: Available to some members at no cost with a prescription from your provider when obtained at an in-network pharmacy. Certain limitations may apply.Tier 1 = GenericTier 2 = Preferred BrandTier 3 = Non Preferred Brand Tier 4 = Tier 4

Drug Details# = Brand-name drug expected to become available generically in the near future. After the generic drug becomes available, the brand-name drug may be covered at a higher non-preferred copay and/or added to the Formulary Exclusion List. The brand-name drug may also be subject to precertification and/or step-therapy.AL = Age LimitLGC = Lowest Generic Copay AppliesPA = Prior Authorization AppliesQL = Quantity Limit AppliesSelect OTC = Select OTC Program if your pharmacy plan includes this program you may have coverage for products noted with a doctors prescription. Please see your plan benefit information for specific coverage details.ST = Step Therapy Applies

Drug Name Drug Status Drug Details

*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*

*AMPHETAMINES**-*AMPHETAMINE MIXTURES***

ADDERALL ORAL TABLET 10 MG, 12.5 MG, 15 MG, 20 MG, 30 MG, 5 MG, 7.5 MG

Tier 3 PA; QL

ADDERALL XR Tier 3 PA; QL

amphetamine-dextroamphet er Tier 1 QL

amphetamine-dextroamphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg

Tier 1 QL

2016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)

3


*AMPHETAMINES**-*AMPHETAMINES***

DESOXYN Tier 3 PA; QL

DEXEDRINE ORAL CAPSULE EXTENDED RELEASE 24 HOUR

Tier 3 PA; QL

DEXEDRINE ORAL TABLET Tier 1 QL

dextroamphetamine sulfate er Tier 1 QL

dextroamphetamine sulfate oral solution Tier 1 QL

dextroamphetamine sulfate oral tablet Tier 1 PA; QL

EVEKEO Tier 3 PA; QL

methamphetamine hcl Tier 1 QL

PROCENTRA Tier 3 PA; QL

VYVANSE ORAL CAPSULE 10 MG Tier 2

VYVANSE ORAL CAPSULE 20 MG, 30 MG, 40 MG, 50 MG, 60 MG, 70 MG

Tier 2 QL

ZENZEDI ORAL TABLET 10 MG, 5 MG Tier 1 QL

ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG

Tier 3 PA; QL

*ANALEPTICS**-*ANALEPTICS***

CAFCIT ORAL Tier 3

caffeine citrate oral Tier 1

*ANTI-OBESITY AGENTS**-*ANTI-OBESITY AGENT COMBINATIONS**

CONTRAVE Tier 2

*ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS**-*ADHD AGENT - SELECTIVE ALPHA ADRENERGIC AGONISTS***

clonidine hcl er Tier 1 QL

guanfacine hcl er oral tablet extended release 24 hr* 1 mg

Tier 1 PA; QL

INTUNIV Tier 3 PA; #; QL; AL

KAPVAY ORAL TABLET EXTENDED RELEASE 12 HR*

Tier 3 PA; QL; AL

2016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)4


*ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS**-*ADHD AGENT - SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR***

STRATTERA ORAL CAPSULE 10 MG, 100 MG, 18 MG, 25 MG, 40 MG, 60 MG, 80 MG

Tier 2 QL

*STIMULANTS - MISC.**-*STIMULANTS - MISC.***

APTENSIO XR Tier 3 QL

CONCERTA ORAL TABLET EXTENDEDRELEASE* 18 MG, 27 MG, 36 MG, 54 MG

Tier 3 PA; QL

DAYTRANA Tier 3 PA; #; QL

dexmethylphenidate hcl Tier 1 QL

dexmethylphenidate hcl er Tier 1 QL

FOCALIN Tier 3 PA; QL

FOCALIN XR Tier 3 PA; #; QL

METADATE CD Tier 3 PA; QL

METADATE ER Tier 1 QL

METHYLIN ORAL SOLUTION 10 MG/5ML, 5 MG/5ML

Tier 3 PA; QL

METHYLIN ORAL TABLET CHEWABLE Tier 3 PA; QL

methylphenidate hcl er (cd) Tier 1 QL

methylphenidate hcl er (la) oral capsule extended release 24 hour 20 mg, 30 mg, 40 mg

Tier 1 QL

methylphenidate hcl er oral tablet extendedrelease* 18 mg, 20 mg, 27 mg, 36 mg, 54 mg

Tier 1 QL

methylphenidate hcl oral solution 10 mg/5ml, 5 mg/5ml

Tier 1 QL

methylphenidate hcl oral tablet Tier 1

methylphenidate hcl oral tablet chewable Tier 1 QL

modafinil Tier 1

NUVIGIL Tier 3

PROVIGIL Tier 3

QUILLIVANT XR Tier 3 PA; QL

RITALIN Tier 3 PA; QL

RITALIN LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 20 MG, 30 MG, 40 MG

Tier 3 PA; QL


5


RITALIN LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 60 MG

Tier 3 QL

RITALIN SR Tier 3 PA; QL

*ALTERNATIVE MEDICINES*

*ALTERNATIVE MEDICINE - C'S**-*ALTERNATIVE MEDICINE - CO'S***

QUINZYME Tier 3

*AMEBICIDES*

*AMEBICIDES**-*AMEBICIDES***

YODOXIN Tier 2

*AMINOGLYCOSIDES*

*AMINOGLYCOSIDES**-*AMINOGLYCOSIDES***

BETHKIS Tier 4

neo-fradin Tier 3

neomycin sulfate oral Tier 1

paromomycin sulfate oral Tier 1

TOBI Tier 4

TOBI PODHALER Tier 4

tobramycin inhalation Tier 4

*ANALGESICS - ANTI-INFLAMMATORY*

*ANTIRHEUMATIC - ENZYME INHIBITORS**-*ANTIRHEUMATIC - JANUS KINASE (JAK) INHIBITORS***

XELJANZ Tier 4 PA; QL

*ANTIRHEUMATIC ANTIMETABOLITES**-*ANTIRHEUMATIC ANTIMETABOLITES***

OTREXUP Tier 4

RASUVO Tier 4

RHEUMATREX Tier 3

*ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES**-*ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES***

HUMIRA Tier 4 PA

HUMIRA PEDIATRIC CROHNS START Tier 4 PA

HUMIRA PEN Tier 4 PA

HUMIRA PEN-CROHNS STARTER Tier 4 PA



HUMIRA PEN-PSORIASIS STARTER Tier 4 PA

SIMPONI Tier 4 PA; QL

SIMPONI ARIA Tier 4 PA

*GOLD COMPOUNDS**-*GOLD COMPOUNDS***

RIDAURA Tier 3

*INTERLEUKIN-1 BLOCKERS**-*INTERLEUKIN-1 BLOCKERS***

ARCALYST Tier 4 PA

*INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA)**-*INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA)***

KINERET Tier 4 PA

*INTERLEUKIN-1BETA BLOCKERS**-*INTERLEUKIN-1BETA BLOCKERS***

ILARIS Tier 4 PA

*INTERLEUKIN-6 RECEPTOR INHIBITORS**-*INTERLEUKIN-6 RECEPTOR INHIBITORS***

ACTEMRA Tier 4 PA

*NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)**-*CYCLOOXYGENASE 2 (COX-2) INHIBITORS***

CELEBREX Tier 3 #

celecoxib oral Tier 1

*NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)**-*NONSTEROIDAL ANTI-INFLAMMATORY AGENT COMBINATIONS***

ARTHROTEC Tier 3

diclofenac-misoprostol Tier 1

DUEXIS Tier 3

VIMOVO Tier 2


7


*NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)**-*NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)***

ANAPROX Tier 3

ANAPROX DS Tier 3

CATAFLAM Tier 3

DAYPRO Tier 3

diclofenac potassium Tier 1

diclofenac sodium er Tier 1

diclofenac sodium oral tablet delayed release 25 mg, 50 mg

Tier 1

diclofenac sodium oral tablet delayed release 75 mg

Tier 1 LGC

EC-NAPROSYN Tier 3

etodolac er Tier 1

etodolac oral Tier 1

FELDENE Tier 3

fenoprofen calcium oral capsule Tier 1

flurbiprofen oral Tier 1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg Tier 1 LGC

INDOCIN Tier 3

INDOCIN ORAL Tier 2

indomethacin er Tier 1

indomethacin oral Tier 1

ketoprofen er Tier 1

ketoprofen oral Tier 1

ketorolac tromethamine oral Tier 1

mefenamic acid oral Tier 1

MELOXICAM COMFORT PAC Tier 3

meloxicam oral tablet Tier 1 LGC

MOBIC Tier 3

nabumetone oral Tier 1

NALFON ORAL CAPSULE 400 MG Tier 3

NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HR* 375 MG, 500 MG, 750 MG

Tier 3

NAPROSYN Tier 3

naproxen dr Tier 12016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)8


naproxen oral suspension Tier 1

naproxen oral tablet Tier 1 LGC

naproxen sodium er Tier 1

naproxen sodium oral tablet 275 mg Tier 1

naproxen sodium oral tablet 550 mg Tier 1 LGC

oxaprozin Tier 1

piroxicam oral Tier 1

PONSTEL Tier 3

SPRIX Tier 3

sulindac oral Tier 1

TIVORBEX Tier 3

tolmetin sodium oral capsule Tier 1

tolmetin sodium oral tablet 200 mg Tier 1

VOLTAREN-XR Tier 3

ZIPSOR Tier 3

ZORVOLEX Tier 3

*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS**-*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS***

OTEZLA Tier 4 PA

*PYRIMIDINE SYNTHESIS INHIBITORS**-*PYRIMIDINE SYNTHESIS INHIBITORS***

leflunomide oral Tier 1

*SELECTIVE COSTIMULATION MODULATORS**-*SELECTIVE COSTIMULATION MODULATORS***

ORENCIA INTRAVENOUS* Tier 4 PA

ORENCIA SUBCUTANEOUS* Tier 4 PA; QL

*SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS**-*SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS***

ENBREL SUBCUTANEOUS* 25 MG/0.5ML, 50 MG/ML

Tier 4 PA; QL

ENBREL SUBCUTANEOUS* KIT Tier 4 PA; QL

ENBREL SURECLICK Tier 4 PA; QL


9


*ANALGESICS - NONNARCOTIC*

*ANALGESIC COMBINATIONS**-*ANALGESIC COMBINATIONS***

duraxin Tier 1

ED-FLEX Tier 1

*ANALGESIC COMBINATIONS**-*ANALGESICS-SEDATIVES***

ALAGESIC LQ Tier 3

BUPAP ORAL TABLET 50-300 MG Tier 3

butalbital-acetaminophen Tier 1

butalbital-apap-caffeine oral capsule Tier 1

butalbital-apap-caffeine oral tablet 50-325-40 mg Tier 1

butalbital-asa-caffeine Tier 1

CAPACET Tier 1

EQUAGESIC Tier 3

ESGIC ORAL TABLET Tier 3

FIORICET ORAL CAPSULE Tier 3

FIORINAL Tier 3

margesic Tier 1

marten-tab Tier 1

TENCON ORAL TABLET 50-325 MG Tier 1

ZEBUTAL ORAL CAPSULE 50-325-40 MG Tier 1

*ANALGESICS-PEPTIDE CHANNEL BLOCKERS**-*SELECTIVE N-TYPE NEURONAL CALCIUM CHANNEL BLOCKERS***

PRIALT Tier 4

*SALICYLATES**-*SALICYLATE COMBINATIONS***

choline & mag trisalicylate oral tablet 1000 mg Tier 1

choline-mag trisalicylate Tier 1

*SALICYLATES**-*SALICYLATES***

aspirin oral tablet 325 mg CE

aspirin oral tablet chewable CE

aspirin oral tablet delayed release 325 mg, 81 mg CE

diflunisal oral Tier 1

MINIPRIN LOW DOSE CE



MST 600 Tier 3

salsalate oral Tier 1

ST JOSEPH ASPIRIN ORAL TABLET DELAYED RELEASE

CE

*ANALGESICS - OPIOID*

*OPIOID AGONISTS**-*OPIOID AGONISTS***

ABSTRAL Tier 3 PA; QL

ACTIQ Tier 3 PA; QL

AVINZA Tier 3

DEMEROL ORAL Tier 3

DILAUDID ORAL Tier 3

DOLOPHINE ORAL TABLET 5 MG Tier 3

DURAGESIC-100 Tier 3 QL





EMBEDA Tier 3 QL

EXALGO Tier 3

fentanyl Tier 1 QL

fentanyl citrate buccal Tier 1 PA; QL

FENTORA Tier 3 PA; QL

hydromorphone hcl oral Tier 1

HYSINGLA ER Tier 2 QL

KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 100 MG, 20 MG, 200 MG, 30 MG, 40 MG, 50 MG, 60 MG, 80 MG

Tier 3

LAZANDA Tier 3 PA; QL

levorphanol tartrate oral Tier 1

meperidine hcl oral tablet Tier 1

meperitab Tier 1

METHADONE HCL INTENSOL Tier 1

methadone hcl oral Tier 1

METHADOSE ORAL CONCENTRATE Tier 3

METHADOSE ORAL TABLET Tier 1

METHADOSE ORAL TABLET SOLUBLE Tier 1

METHADOSE SUGAR-FREE Tier 3


11


morphine sulfate er Tier 1

MS CONTIN Tier 3

NUCYNTA Tier 2 QL

NUCYNTA ER Tier 2 QL

OPANA ER ORAL Tier 3

OPANA ORAL Tier 3

oxycodone hcl er Tier 1 QL

oxycodone hcl oral capsule Tier 1

oxycodone hcl oral concentrate 100 mg/5ml Tier 1

oxycodone hcl oral solution Tier 1

oxycodone hcl oral tablet Tier 1

OXYCONTIN Tier 2 QL

oxymorphone hcl Tier 1

oxymorphone hcl er Tier 1

ROXICODONE Tier 3

SUBSYS SUBLINGUAL LIQUID† 100 MCG, 1200 (600 X 2) MCG, 1600 (800 X 2) MCG, 200 MCG, 400 MCG, 600 MCG, 800 MCG

Tier 3 PA; QL

tramadol hcl er (biphasic) Tier 1

tramadol hcl er oral capsule extended release 24 hour 100 mg, 200 mg, 300 mg

Tier 1

tramadol hcl er oral tablet extended release 24 hr*

Tier 1

tramadol hcl oral Tier 1

ULTRAM Tier 3

ULTRAM ER Tier 3

ZOHYDRO ER Tier 3

*OPIOID COMBINATIONS**-*CODEINE COMBINATIONS***

acetaminophen-codeine Tier 1

acetaminophen-codeine #2 Tier 1



ASCOMP-CODEINE Tier 1

butalbital compound/codeine Tier 1

butalbital-apap-caff-cod Tier 1

butalbital-asa-caff-codeine Tier 1

CAPITAL/CODEINE Tier 2



FIORICET/CODEINE ORAL CAPSULE 50-300-40-30 MG

Tier 3

FIORINAL/CODEINE #3 Tier 3

TYLENOL WITH CODEINE #3 Tier 3

TYLENOL WITH CODEINE #4 Tier 3

*OPIOID COMBINATIONS**-*DIHYDROCODEINE COMBINATIONS***

apap-caff-dihydrocodeine oral capsule Tier 1

SYNALGOS-DC Tier 3

TREZIX ORAL CAPSULE 320.5-30-16 MG Tier 3

*OPIOID COMBINATIONS**-*HYDROCODONE COMBINATIONS***

HYCET Tier 3

hydrocodone-acetaminophen oral solution2.5-108 mg/5ml, 5-217 mg/10ml, 7.5-325 mg/15ml

Tier 1

hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg

Tier 1

hydrocodone-ibuprofen Tier 1

IBUDONE ORAL TABLET 10-200 MG Tier 3

IBUDONE ORAL TABLET 5-200 MG Tier 1

LORCET Tier 1

LORCET HD Tier 1

LORTAB ORAL ELIXIR Tier 3

LORTAB ORAL TABLET 10-325 MG, 5-325 MG, 7.5-325 MG

Tier 1

LORTAB ORAL TABLET 10-500 MG, 5-500 MG, 7.5-500 MG

Tier 3

NORCO Tier 3

REPREXAIN ORAL TABLET 10-200 MG Tier 1

REPREXAIN ORAL TABLET 2.5-200 MG, 5-200 MG

Tier 3

VICODIN ES ORAL TABLET 7.5-300 MG Tier 1

VICODIN HP ORAL TABLET 10-300 MG Tier 1

VICODIN ORAL TABLET 5-300 MG Tier 1

VICOPROFEN Tier 3

XODOL Tier 3


13


*OPIOID COMBINATIONS**-*OPIOID COMBINATIONS***

ENDOCET ORAL TABLET 10-325 MG, 5-325 MG, 7.5-325 MG

Tier 1

ENDODAN Tier 1

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

Tier 1

oxycodone-aspirin Tier 1

oxycodone-ibuprofen Tier 1 QL

PERCOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG

Tier 3

PERCODAN Tier 3

PRIMLEV Tier 3

ROXICET ORAL SOLUTION Tier 2

ROXICET ORAL TABLET Tier 1

XARTEMIS XR Tier 3

*OPIOID COMBINATIONS**-*TRAMADOL COMBINATIONS***

tramadol-acetaminophen Tier 1

ULTRACET Tier 3

*OPIOID PARTIAL AGONISTS**-*OPIOID PARTIAL AGONISTS***

BUNAVAIL BUCCAL FILM 2.1-0.3 MG, 4.2-0.7 MG, 6.3-1 MG

Tier 3 PA; QL

buprenorphine hcl sublingual tablet sublingual 2 mg, 8 mg

Tier 1 PA; QL

buprenorphine hcl-naloxone hcl Tier 1 PA; QL

butorphanol tartrate nasal Tier 1 QL

BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HR, 15 MCG/HR, 20 MCG/HR, 5 MCG/HR, 7.5 MCG/HR

Tier 2 QL

SUBOXONE SUBLINGUAL FILM 12-3 MG, 2-0.5 MG, 4-1 MG, 8-2 MG

Tier 3 PA; QL

SUBOXONE SUBLINGUAL TABLET SUBLINGUAL

Tier 3 PA; QL

ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 1.4-0.36 MG, 11.4-2.9 MG, 2.9-0.71 MG, 5.7-1.4 MG, 8.6-2.1 MG

Tier 3 PA; QL



*ANDROGENS-ANABOLIC*

*ANABOLIC STEROIDS**-*ANABOLIC STEROIDS***

ANADROL-50 Tier 3

OXANDRIN Tier 3

oxandrolone oral Tier 1

*ANDROGENS**-*ANDROGENS***

ANDRODERM TRANSDERMAL PATCH 24 HR 2 MG/24HR, 4 MG/24HR

Tier 3 #

ANDROGEL PUMP TRANSDERMAL 12.5 MG/ACT (1%)

Tier 2 #

ANDROGEL PUMP TRANSDERMAL 20.25 MG/ACT (1.62%)

Tier 2

ANDROGEL TRANSDERMAL 20.25 MG/1.25GM (1.62%), 40.5 MG/2.5GM (1.62%)

Tier 2

ANDROGEL TRANSDERMAL 25 MG/2.5GM (1%), 50 MG/5GM (1%)

Tier 2 #

ANDROID Tier 2

ANDROXY Tier 1

AXIRON Tier 3

danazol oral Tier 1

FORTESTA Tier 3

methitest Tier 2

NATESTO Tier 3

STRIANT Tier 3

TESTIM Tier 3

testosterone cypionate intramuscular* Tier 1

testosterone enanthate intramuscular* Tier 1

testosterone transdermal 10 mg/act (2%), 12.5 mg/act (1%), 50 mg/5gm (1%)

Tier 1

testosterone transdermal 25 mg/2.5gm (1%) Tier 3

VOGELXO Tier 3

VOGELXO PUMP Tier 3

*ANORECTAL AGENTS*

*INTRARECTAL STEROIDS**-*INTRARECTAL STEROIDS***

COLOCORT Tier 1

CORTENEMA Tier 3


15


CORTIFOAM Tier 3

hydrocortisone enema Tier 1

*RECTAL COMBINATIONS**-*RECTAL ANESTHETIC/STEROIDS***

ANALPRAM-HC LOTION 1-2.5 % Tier 3

hydrocortisone ace-pramoxine cream 1-1 % Tier 1

LIDAZONE HC Tier 1

lidocaine-hydrocortisone ace cream Tier 1

lidocaine-hydrocortisone ace kit 3-0.5 %, 3-1 %, 3-2.5 %

Tier 1

pramcort Tier 1

PROCORT Tier 3

PROCTOFOAM HC Tier 3

*RECTAL STEROIDS**-*RECTAL STEROIDS***

ANUSOL-HC CREAM Tier 3

PROCTOCARE-HC Tier 1

PROCTO-PAK Tier 1

PROCTOSOL HC Tier 1

PROCTOZONE-HC Tier 1

*VASODILATING AGENTS**-*NITRATE VASODILATING AGENTS***

RECTIV Tier 3

*ANTHELMINTICS*

*ANTHELMINTICS**-*ANTHELMINTICS***

ALBENZA Tier 3

BILTRICIDE Tier 2

ivermectin oral Tier 1

STROMECTOL Tier 3

*ANTIANGINAL AGENTS*

*ANTIANGINALS-OTHER**-*ANTIANGINALS-OTHER***

RANEXA Tier 2

*NITRATES**-*NITRATES***

DILATRATE-SR Tier 3

IMDUR Tier 3

isoditrate er Tier 1



ISORDIL TITRADOSE Tier 3

isosorbide dinitrate er Tier 1

isosorbide dinitrate oral Tier 1

isosorbide dinitrate sublingual tablet sublingual 5 mg

Tier 1

isosorbide mononitrate Tier 1

isosorbide mononitrate er Tier 1

MINITRAN Tier 1

NITRO-BID Tier 3

NITRO-DUR Tier 3

nitroglycerin er oral capsule extended release* 9 mg

Tier 1

nitroglycerin transdermal Tier 1

nitroglycerin translingual Tier 1

NITROLINGUAL Tier 3

NITROMIST Tier 3

NITROSTAT Tier 2

NITRO-TIME ORAL CAPSULE EXTENDED RELEASE* 9 MG

Tier 1

*ANTIANXIETY AGENTS*

*ANTIANXIETY AGENTS - MISC.**-*ANTIANXIETY AGENTS - MISC.***

buspirone hcl oral tablet 10 mg, 5 mg Tier 1 LGC

buspirone hcl oral tablet 15 mg, 30 mg, 7.5 mg Tier 1

hydroxyzine hcl oral solution Tier 1

hydroxyzine hcl oral syrup Tier 1 LGC

hydroxyzine hcl oral tablet Tier 1

hydroxyzine pamoate Tier 1

hydroxyzine pamoate oral capsule 25 mg, 50 mg Tier 1

meprobamate Tier 1

VISTARIL Tier 3

*BENZODIAZEPINES**-*BENZODIAZEPINES***

alprazolam er Tier 1

ALPRAZOLAM INTENSOL Tier 3

alprazolam oral Tier 1

alprazolam xr Tier 1


17


ATIVAN ORAL Tier 3

chlordiazepoxide hcl Tier 1

clorazepate dipotassium Tier 1

DIAZEPAM INTENSOL Tier 3

diazepam oral solution Tier 1

diazepam oral tablet Tier 1

LORAZEPAM INTENSOL Tier 3

lorazepam oral tablet Tier 1

NIRAVAM ORAL TABLET DISPERSIBLE 0.25 MG

Tier 3

oxazepam Tier 1

TRANXENE-T Tier 3

VALIUM Tier 3

XANAX Tier 3

XANAX XR Tier 3

*ANTIARRHYTHMICS*

*ANTIARRHYTHMICS TYPE I-A**-*ANTIARRHYTHMICS TYPE I-A***

disopyramide phosphate oral Tier 1

NORPACE Tier 3

NORPACE CR Tier 3

quinidine gluconate er Tier 1

quinidine sulfate oral Tier 1

*ANTIARRHYTHMICS TYPE I-B**-*ANTIARRHYTHMICS TYPE I-B***

mexiletine hcl oral Tier 1

*ANTIARRHYTHMICS TYPE I-C**-*ANTIARRHYTHMICS TYPE I-C***

flecainide acetate Tier 1

propafenone hcl Tier 1

propafenone hcl er Tier 1

RYTHMOL Tier 3

RYTHMOL SR Tier 3

*ANTIARRHYTHMICS TYPE III**-*ANTIARRHYTHMICS TYPE III***

amiodarone hcl oral Tier 1

CORDARONE Tier 3

MULTAQ Tier 2



PACERONE Tier 1

TIKOSYN Tier 3

*ANTIASTHMATIC AND BRONCHODILATOR AGENTS*

*ANTIASTHMATIC - MONOCLONAL ANTIBODIES**-*ANTI-IGE MONOCLONAL ANTIBODIES***

XOLAIR Tier 4 PA

*ANTI-INFLAMMATORY AGENTS**-*ANTI-INFLAMMATORY AGENTS***

cromolyn sodium inhalation Tier 1

*ASTHMA AND BRONCHODILATOR AGENT COMBINATIONS**-*XANTHINE-EXPECTORANTS***

DIFIL-G FORTE Tier 1

*BRONCHODILATORS - ANTICHOLINERGICS**-*BRONCHODILATORS - ANTICHOLINERGICS***

ATROVENT HFA Tier 3

INCRUSE ELLIPTA Tier 2

ipratropium bromide inhalation Tier 1

SPIRIVA HANDIHALER Tier 2

SPIRIVA RESPIMAT INHALATION AEROSOL, SOLUTION 2.5 MCG/ACT

Tier 2

TUDORZA PRESSAIR Tier 3

*LEUKOTRIENE MODULATORS**-*5-LIPOXYGENASE INHIBITORS***

ZYFLO Tier 3

ZYFLO CR Tier 3

*LEUKOTRIENE MODULATORS**-*LEUKOTRIENE RECEPTOR ANTAGONISTS***

ACCOLATE Tier 3

montelukast sodium oral Tier 1

SINGULAIR Tier 3

zafirlukast Tier 1


19


*SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS**-*SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS***

DALIRESP Tier 3

*STEROID INHALANTS**-*STEROID INHALANTS***

AEROSPAN Tier 3

ALVESCO Tier 3

ARNUITY ELLIPTA Tier 3

ASMANEX 120 METERED DOSES Tier 2





ASMANEX HFA Tier 2

budesonide inhalation Tier 1

FLOVENT DISKUS Tier 2

FLOVENT HFA Tier 2

PULMICORT Tier 3

PULMICORT FLEXHALER Tier 3

QVAR Tier 2

*SYMPATHOMIMETICS**-*ADRENERGIC COMBINATIONS***

ADVAIR DISKUS Tier 2

ADVAIR HFA Tier 2

ANORO ELLIPTA Tier 2

BREO ELLIPTA INHALATION AEROSOL POWDER, BREATH ACTIVATED 100-25 MCG/INH

Tier 2

BREO ELLIPTA INHALATION AEROSOL POWDER, BREATH ACTIVATED 200-25 MCG/INH

Tier 3

COMBIVENT RESPIMAT Tier 2

DULERA Tier 2

ipratropium-albuterol Tier 1

STIOLTO RESPIMAT Tier 2 QL

SYMBICORT Tier 2



*SYMPATHOMIMETICS**-*BETA ADRENERGICS***

albuterol sulfate er Tier 1

albuterol sulfate inhalation Tier 1

albuterol sulfate oral Tier 1

ARCAPTA NEOHALER Tier 3

BROVANA Tier 3

FORADIL AEROLIZER Tier 2

levalbuterol hcl inhalation Tier 1

metaproterenol sulfate oral Tier 1

PERFOROMIST Tier 3

PROAIR HFA Tier 2

PROAIR RESPICLICK Tier 2

PROVENTIL HFA Tier 3

SEREVENT DISKUS Tier 2

STRIVERDI RESPIMAT Tier 3

terbutaline sulfate oral Tier 1

VENTOLIN HFA Tier 2

VOSPIRE ER Tier 3

XOPENEX Tier 3

XOPENEX CONCENTRATE Tier 3

XOPENEX HFA Tier 3

*XANTHINES**-*XANTHINES***

ELIXOPHYLLIN Tier 3

LUFYLLIN Tier 3

THEO-24 Tier 2

THEOCHRON Tier 1

theophylline er Tier 1

theophylline oral solution Tier 1

*ANTICOAGULANTS*

*COUMARIN ANTICOAGULANTS**-*COUMARIN ANTICOAGULANTS***

COUMADIN ORAL Tier 3

JANTOVEN Tier 1

warfarin sodium oral Tier 1 LGC


21


*DIRECT FACTOR XA INHIBITORS**-*DIRECT FACTOR XA INHIBITORS***

ELIQUIS Tier 2

SAVAYSA Tier 3

XARELTO Tier 2

XARELTO STARTER PACK Tier 2

*HEPARINS AND HEPARINOID-LIKE AGENTS**-*LOW MOLECULAR WEIGHT HEPARINS***

enoxaparin sodium Tier 1

FRAGMIN Tier 3

LOVENOX Tier 3

*HEPARINS AND HEPARINOID-LIKE AGENTS**-*SYNTHETIC HEPARINOID-LIKE AGENTS***

ARIXTRA Tier 3

fondaparinux sodium Tier 1

*IN VITRO ANTICOAGULANTS**-*IN VITRO ANTICOAGULANTS***

acd formula a Tier 3

acd formula b Tier 3

acd-a Tier 3

ACD-A NOCLOT-50 Tier 3

anticoagulant cit dext soln a Tier 3

ANTICOAGULANT COMPOUND Tier 3

*THROMBIN INHIBITORS**-*THROMBIN INHIBITORS - HIRUDIN TYPE***

IPRIVASK Tier 3

*THROMBIN INHIBITORS**-*THROMBIN INHIBITORS - SELECTIVE DIRECT & REVERSIBLE***

PRADAXA Tier 2

*ANTICONVULSANTS*

*AMPA GLUTAMATE RECEPTOR ANTAGONISTS**-*AMPA GLUTAMATE RECEPTOR ANTAGONISTS***

FYCOMPA Tier 3



*ANTICONVULSANTS - BENZODIAZEPINES**-*ANTICONVULSANTS - BENZODIAZEPINES***

clonazepam oral Tier 1

DIASTAT ACUDIAL Tier 2

DIASTAT PEDIATRIC Tier 2

KLONOPIN Tier 3

ONFI Tier 3

*ANTICONVULSANTS - MISC.**-*ANTICONVULSANTS - MISC.***

APTIOM Tier 3

BANZEL Tier 3

carbamazepine er Tier 1

carbamazepine oral Tier 1

CARBATROL Tier 2

EPITOL Tier 1 LGC

gabapentin oral Tier 1

KEPPRA Tier 3

KEPPRA XR Tier 3

LAMICTAL Tier 3

LAMICTAL ODT Tier 3

LAMICTAL STARTER Tier 3

LAMICTAL XR Tier 3

lamotrigine er Tier 1

lamotrigine oral Tier 1

levetiracetam er Tier 1

levetiracetam oral Tier 1

LYRICA Tier 2

MYSOLINE Tier 3

NEURONTIN Tier 3

oxcarbazepine Tier 1

OXTELLAR XR Tier 3

POTIGA Tier 3

primidone oral Tier 1

QUDEXY XR Tier 3

TEGRETOL Tier 2

TEGRETOL-XR Tier 3

TOPAMAX Tier 32016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)

23


TOPAMAX SPRINKLE Tier 3

TOPIRAGEN Tier 1

topiramate oral Tier 1

TRILEPTAL Tier 3

TROKENDI XR Tier 3

VIMPAT ORAL Tier 3

ZONEGRAN Tier 3

zonisamide oral Tier 1

*CARBAMATES**-*CARBAMATES***

felbamate Tier 1

FELBATOL Tier 3

*GABA MODULATORS**-*GABA MODULATORS***

GABITRIL Tier 3

SABRIL Tier 4 PA

tiagabine hcl Tier 1

*HYDANTOINS**-*HYDANTOINS***

DILANTIN Tier 2

DILANTIN INFATABS Tier 2

PEGANONE Tier 3

PHENYTEK Tier 2

PHENYTOIN INFATABS Tier 1

phenytoin oral Tier 1

phenytoin sodium extended Tier 1

*SUCCINIMIDES**-*SUCCINIMIDES***

CELONTIN Tier 2

ethosuximide oral Tier 1

ZARONTIN Tier 3

*VALPROIC ACID**-*VALPROIC ACID***

DEPAKENE Tier 3

DEPAKOTE Tier 3

DEPAKOTE ER Tier 3

DEPAKOTE SPRINKLES Tier 3

divalproex sodium Tier 1

divalproex sodium er Tier 1

STAVZOR Tier 3

valproic acid oral Tier 1



*ANTIDEPRESSANTS*

*ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)**-*ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)***

mirtazapine oral tablet 15 mg, 30 mg, 45 mg Tier 1

mirtazapine oral tablet dispersible Tier 1

REMERON Tier 3

REMERON SOLTAB Tier 3

*ANTIDEPRESSANT COMBINATIONS**-*TRICYCLIC AGENTS-NUTRITIONAL SUPPLEMENT COMBINATIONS***

SENTRAVIL PM-25 Tier 3

*ANTIDEPRESSANTS - MISC.**-*ANTIDEPRESSANTS - MISC.***

APLENZIN Tier 3

BUDEPRION SR ORAL TABLET EXTENDED RELEASE 12 HR* 150 MG

Tier 1

BUDEPRION XL Tier 1

bupropion hcl er (sr) Tier 1

bupropion hcl er (xl) Tier 1

bupropion hcl oral Tier 1

FORFIVO XL Tier 3

WELLBUTRIN Tier 3

WELLBUTRIN SR Tier 3

WELLBUTRIN XL Tier 2

*MONOAMINE OXIDASE INHIBITORS (MAOIS)**-*MONOAMINE OXIDASE INHIBITORS (MAOIS)***

EMSAM Tier 3

MARPLAN Tier 3

NARDIL Tier 3

PARNATE Tier 3

phenelzine sulfate oral Tier 1

tranylcypromine sulfate Tier 1


25


*SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)**-*SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)***

CELEXA Tier 3

citalopram hydrobromide oral solution Tier 1

citalopram hydrobromide oral tablet Tier 1 LGC

escitalopram oxalate Tier 1

fluoxetine hcl oral capsule Tier 1 LGC

fluoxetine hcl oral capsule delayed release Tier 1

fluoxetine hcl oral solution Tier 1

fluoxetine hcl oral tablet 10 mg Tier 1 LGC

fluoxetine hcl oral tablet 20 mg Tier 1

fluoxetine hcl oral tablet 60 mg Tier 3

fluvoxamine maleate Tier 1

fluvoxamine maleate er Tier 1

LEXAPRO Tier 3

LUVOX CR Tier 3

paroxetine hcl Tier 1 LGC

paroxetine hcl er Tier 1

PAXIL Tier 3

PAXIL CR Tier 3

PEXEVA Tier 3

PROZAC Tier 3

PROZAC WEEKLY Tier 3

sertraline hcl oral concentrate Tier 1

sertraline hcl oral tablet Tier 1 LGC

ZOLOFT Tier 3

*SEROTONIN MODULATORS**-*SEROTONIN MODULATORS***

BRINTELLIX Tier 3

nefazodone hcl oral tablet 250 mg Tier 3

nefazodone hcl oral tablet 50 mg Tier 1

OLEPTRO Tier 3

trazodone hcl oral Tier 1

VIIBRYD Tier 3

VIIBRYD STARTER PACK Tier 3



*SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)**-*SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)***

CYMBALTA Tier 3

desvenlafaxine er Tier 3

duloxetine hcl oral Tier 1

EFFEXOR XR Tier 3

FETZIMA Tier 3

FETZIMA TITRATION Tier 3

IRENKA Tier 3

KHEDEZLA Tier 3

PRISTIQ Tier 3

venlafaxine hcl Tier 1

venlafaxine hcl er oral capsule extended release 24 hour

Tier 1

venlafaxine hcl er oral tablet extended release 24 hr*

Tier 3

*TRICYCLIC AGENTS**-*TRICYCLIC AGENTS***

amitriptyline hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg, 75 mg

Tier 1 LGC

amitriptyline hcl oral tablet 150 mg Tier 1

ANAFRANIL Tier 3

clomipramine hcl oral Tier 1

desipramine hcl oral Tier 1

doxepin hcl oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg

Tier 1

doxepin hcl oral concentrate Tier 1

imipramine hcl oral Tier 1

imipramine pamoate Tier 1

NORPRAMIN Tier 3

nortriptyline hcl oral capsule 10 mg, 25 mg Tier 1 LGC

nortriptyline hcl oral capsule 50 mg, 75 mg Tier 1

PAMELOR Tier 3

protriptyline hcl Tier 1

SURMONTIL Tier 3

TOFRANIL Tier 3

TOFRANIL-PM Tier 3


27


VIVACTIL Tier 3

*ANTIDIABETICS*

*ALPHA-GLUCOSIDASE INHIBITORS**-*ALPHA-GLUCOSIDASE INHIBITORS***

acarbose Tier 1

GLYSET Tier 3

PRECOSE Tier 3

*ANTIDIABETIC - AMYLIN ANALOGS**-*ANTIDIABETIC - AMYLIN ANALOGS***

SYMLINPEN 120 Tier 2

SYMLINPEN 60 Tier 2

*ANTIDIABETIC COMBINATIONS**-*DIPEPTIDYL PEPTIDASE-4 INHIBITOR-BIGUANIDE COMBINATIONS***

JANUMET Tier 2

JANUMET XR Tier 2

JENTADUETO Tier 2

KAZANO Tier 3

KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HR* 2.5-1000 MG

Tier 2 QL

KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HR* 5-1000 MG, 5-500 MG

Tier 2

*ANTIDIABETIC COMBINATIONS**-*DPP-4 INHIBITOR-THIAZOLIDINEDIONE COMBINATIONS***

OSENI Tier 3

*ANTIDIABETIC COMBINATIONS**-*MEGLITINIDE-BIGUANIDE COMBINATIONS***

PRANDIMET Tier 3

*ANTIDIABETIC COMBINATIONS**-*SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS***

GLYXAMBI Tier 2



*ANTIDIABETIC COMBINATIONS**-*SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB***

INVOKAMET Tier 2

SYNJARDY Tier 2

XIGDUO XR Tier 3

*ANTIDIABETIC COMBINATIONS**-*SULFONYLUREA-BIGUANIDE COMBINATIONS***

glipizide-metformin hcl Tier 1

GLUCOVANCE Tier 3

glyburide-metformin Tier 1

*ANTIDIABETIC COMBINATIONS**-*SULFONYLUREA-THIAZOLIDINEDIONE COMBINATIONS***

AVANDARYL ORAL TABLET 4-1 MG, 4-2 MG, 4-4 MG, 8-4 MG

Tier 3

DUETACT Tier 3

pioglitazone hcl-glimepiride Tier 1

*ANTIDIABETIC COMBINATIONS**-*THIAZOLIDINEDIONE-BIGUANIDE COMBINATIONS***

ACTOPLUS MET Tier 3

ACTOPLUS MET XR Tier 3

AVANDAMET ORAL TABLET 2-1000 MG, 2-500 MG, 4-500 MG

Tier 3

pioglitazone hcl-metformin hcl Tier 1

*BIGUANIDES**-*BIGUANIDES***

GLUCOPHAGE Tier 3

GLUCOPHAGE XR Tier 3

GLUMETZA Tier 3

metformin hcl er (osm) Tier 1

metformin hcl er oral tablet extended release 24 hr* 500 mg

Tier 1 LGC

metformin hcl er oral tablet extended release 24 hr* 750 mg

Tier 1

metformin hcl oral Tier 1 LGC

RIOMET Tier 3


29


*DIABETIC OTHER**-*DIABETIC OTHER - COMBINATIONS***

cvs glucose oral tablet chewable 4-6 gm-mg Tier 3

DEX4 NATURALS Tier 3

DEX4 ORAL TABLET CHEWABLE 4-6 GM-MG

Tier 3

DEX4 POUCH PACK Tier 3

drug mart glucose Tier 3

glucose oral tablet chewable 4-6 gm-mg Tier 3

gnp glucose oral tablet chewable 4-6 gm-mg Tier 3

hm glucose Tier 3

hy-vee glucose Tier 3

kroger glucose Tier 3

leader glucose Tier 3

longs glucose Tier 3

meijer glucose Tier 3

preferred plus glucose Tier 3

px glucose Tier 3

ra glucose oral tablet chewable Tier 3

RELION GLUCOSE ORAL TABLET CHEWABLE

Tier 3

sm glucose oral tablet chewable 4-6 gm-mg Tier 3

SMART SENSE GLUCOSE Tier 3

tgt glucose oral tablet chewable 4-6 gm-mg Tier 3

up & up glucose Tier 3

value plus glucose oral tablet chewable Tier 3

walgreens glucose oral tablet chewable 4-6 gm-mg

Tier 3

*DIABETIC OTHER**-*DIABETIC OTHER***

BD GLUCOSE Tier 3

cvs glucose bits Tier 3

cvs glucose oral Tier 1

cvs glucose oral tablet chewable 4 gm Tier 3

cvs glucose shot oral liquid† 15 gm/59ml Tier 1

DEX4 GLUCOSE ORAL Tier 1

DEX4 GLUCOSE ORAL LIQUID† Tier 3

DEX4 ORAL TABLET CHEWABLE 1 GM Tier 3



DEX4 QUICK DISSOLVE GLUCOSE Tier 3

GLUCAGEN HYPOKIT Tier 3

GLUCAGON EMERGENCY Tier 2

GLUCO BURST ORAL Tier 1

glucose oral Tier 1

glucose oral tablet chewable 4 gm Tier 3

GLUTOSE 15 Tier 1

GLUTOSE 45 Tier 1

gnp glucose oral tablet chewable 4 gm Tier 3

gnp quick dissolve glucose Tier 3

leader quick dissolve glucose Tier 3

ms quick dissolve glucose Tier 3

PROGLYCEM Tier 3

ra glucose oral Tier 1

RELION GLUCOSE DRINK Tier 1

RELION GLUCOSE ORAL Tier 1

sm glucose oral tablet chewable 4 gm Tier 3

value plus glucose oral Tier 1

walgreens glucose oral tablet chewable 4 gm Tier 3

*DIABETIC OTHER**-*PROGESTERONE RECEPTOR ANTAGONISTS***

KORLYM Tier 4 PA; QL

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

JANUVIA Tier 2

NESINA Tier 3

ONGLYZA Tier 2

TRADJENTA Tier 2

*DOPAMINE RECEPTOR AGONISTS - ANTIDIABETIC**-*DOPAMINE RECEPTOR AGONISTS - ERGOT DERIVATIVES***

CYCLOSET Tier 3

*INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)**-*INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)***

BYDUREON Tier 3


31


BYETTA 10 MCG PEN Tier 3

BYETTA 5 MCG PEN Tier 3

TANZEUM Tier 3

TRULICITY Tier 2

VICTOZA Tier 2

*INSULIN SENSITIZING AGENTS**-*THIAZOLIDINEDIONES***

ACTOS Tier 3

AVANDIA Tier 3

pioglitazone hcl Tier 1

*INSULIN**-*HUMAN INSULIN***

AFREZZA Tier 3

APIDRA Tier 3

APIDRA SOLOSTAR Tier 3

HUMALOG KWIKPEN Tier 2

HUMALOG MIX 50/50 Tier 2

HUMALOG MIX 50/50 KWIKPEN Tier 2

HUMALOG MIX 75/25 Tier 2

HUMALOG MIX 75/25 KWIKPEN Tier 2

HUMULIN 70/30 KWIKPEN Tier 2

HUMULIN N KWIKPEN Tier 2

HUMULIN R U-500 (CONCENTRATED) Tier 2

LANTUS Tier 2

LANTUS SOLOSTAR Tier 2

LEVEMIR Tier 2

LEVEMIR FLEXPEN Tier 2

NOVOLIN 70/30 Tier 3

NOVOLIN 70/30 RELION Tier 3

NOVOLIN N Tier 3

NOVOLIN N RELION Tier 3

NOVOLIN R Tier 3

NOVOLIN R RELION Tier 3

NOVOLOG Tier 2

NOVOLOG FLEXPEN Tier 2

NOVOLOG MIX 70/30 Tier 2

NOVOLOG MIX 70/30 FLEXPEN Tier 2

TOUJEO SOLOSTAR Tier 2



*MEGLITINIDE ANALOGUES**-*MEGLITINIDE ANALOGUES***

nateglinide Tier 1

PRANDIN Tier 3

repaglinide Tier 1

STARLIX Tier 3

*SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS**-*SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS***

FARXIGA Tier 3

INVOKANA Tier 2

JARDIANCE Tier 2 QL

*SULFONYLUREAS**-*SULFONYLUREAS***

AMARYL Tier 3

chlorpropamide oral tablet 100 mg Tier 1 LGC

DIABETA Tier 3

glimepiride Tier 1 LGC

glipizide er oral tablet extended release 24 hr* 10 mg, 5 mg

Tier 1 LGC

glipizide er oral tablet extended release 24 hr*2.5 mg

Tier 1

glipizide oral Tier 1 LGC

GLIPIZIDE XL Tier 1

GLUCOTROL Tier 3

GLUCOTROL XL Tier 3

glyburide micronized oral tablet 1.5 mg Tier 1

glyburide micronized oral tablet 3 mg, 6 mg Tier 1 LGC

glyburide oral tablet 1.25 mg Tier 1

glyburide oral tablet 2.5 mg, 5 mg Tier 1 LGC

GLYNASE Tier 3

tolazamide oral tablet 250 mg Tier 1


33


*ANTIDIARRHEALS*

*ANTIDIARRHEAL - CHLORIDE CHANNEL ANTAGONISTS**-*ANTIDIARRHEAL - CHLORIDE CHANNEL ANTAGONISTS***

FULYZAQ Tier 3

*ANTIPERISTALTIC AGENTS**-*ANTIPERISTALTIC AGENTS***

diphenatol Tier 1

diphenoxylate-atropine oral tablet Tier 1

lofene Tier 1

LOMOTIL Tier 3

LONOX Tier 1

MOTOFEN Tier 3

opium Tier 1

*ANTIDOTES*

*ANTIDOTES - CHELATING AGENTS**-*ANTIDOTES - CHELATING AGENTS***

CHEMET Tier 2

EXJADE Tier 4 PA

FERRIPROX Tier 4 PA

JADENU Tier 4 PA

*ANTIDOTES**-*ANTIDOTES***

deferoxamine mesylate Tier 4

DESFERAL Tier 4

RADIOGARDASE Tier 2

*OPIOID ANTAGONISTS**-*OPIOID ANTAGONISTS***

EVZIO Tier 2 PA

naltrexone hcl oral Tier 1

REVIA Tier 3

VIVITROL Tier 4

*ANTIEMETICS*

*5-HT3 RECEPTOR ANTAGONISTS**-*5-HT3 RECEPTOR ANTAGONISTS***

ANZEMET ORAL Tier 3



granisetron hcl oral Tier 1

GRANISOL Tier 3

ondansetron Tier 1

ondansetron hcl oral Tier 1

SANCUSO Tier 3

ZOFRAN ODT Tier 3

ZOFRAN ORAL Tier 3

ZUPLENZ Tier 3

*ANTIEMETICS - ANTICHOLINERGIC**-*ANTIEMETICS - ANTICHOLINERGIC***

TIGAN ORAL Tier 3

trimethobenzamide hcl oral Tier 1

*ANTIEMETICS - MISCELLANEOUS**-*ANTIEMETIC COMBINATIONS***

AKYNZEO Tier 3

DICLEGIS Tier 3

*ANTIEMETICS - MISCELLANEOUS**-*ANTIEMETICS - MISCELLANEOUS***

CESAMET Tier 3

dronabinol Tier 1

MARINOL Tier 3

*SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS**-*SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS***

EMEND ORAL Tier 2 #

*ANTIFUNGALS*

*ANTIFUNGALS**-*ANTIFUNGALS***

bio-statin oral capsule Tier 3

bio-statin oral powder Tier 1

flucytosine oral Tier 1

GRIFULVIN V Tier 3

griseofulvin microsize oral Tier 1

griseofulvin ultramicrosize Tier 1

GRIS-PEG Tier 3


35


LAMISIL Tier 3

nystatin oral Tier 1

terbinafine hcl oral Tier 1

*IMIDAZOLE-RELATED ANTIFUNGALS**-*IMIDAZOLES***

ketoconazole oral Tier 1

*IMIDAZOLE-RELATED ANTIFUNGALS**-*TRIAZOLES***

CRESEMBA ORAL Tier 3

DIFLUCAN Tier 3

fluconazole oral Tier 1

itraconazole oral Tier 1

NOXAFIL Tier 3

ONMEL Tier 3

SPORANOX Tier 3

SPORANOX PULSEPAK Tier 3

VFEND Tier 3

voriconazole oral Tier 1

*ANTIHISTAMINES*

*ANTIHISTAMINES - ALKYLAMINES**-*ANTIHISTAMINES - ALKYLAMINES***

ED-CHLOR-TAN Tier 3

RESPA-BR Tier 3

*ANTIHISTAMINES - ETHANOLAMINES**-*ANTIHISTAMINES - ETHANOLAMINES***

ARBINOXA Tier 1

carbinoxamine maleate oral Tier 1

clemastine fumarate oral tablet 2.68 mg Tier 1

DOXYTEX Tier 3

KARBINAL ER Tier 3

*ANTIHISTAMINES - NON-SEDATING**-*ANTIHISTAMINES - NON-SEDATING***

ALAVERT ORAL TABLET DISPERSIBLE Tier 1 Select OTC

ALLEGRA ALLERGY Tier 1 Select OTC

ALLEGRA ALLERGY CHILDRENS Tier 1 Select OTC

cetirizine hcl oral tablet 10 mg Tier 1 Select OTC



cetirizine hcl oral tablet chewable Tier 1 Select OTC

childrens loratadine Tier 1 Select OTC

CLARINEX Tier 3

CLARINEX REDITABS Tier 3

CLARITIN ORAL TABLET Tier 1 Select OTC

CLARITIN ORAL TABLET CHEWABLE Tier 1 Select OTC

desloratadine Tier 1

fexofenadine hcl childrens Tier 1 Select OTC

fexofenadine hcl oral Tier 1 Select OTC

kp cetirizine hcl oral tablet 5 mg Tier 1 LGC

levocetirizine dihydrochloride oral Tier 1

loratadine allergy relief Tier 1 Select OTC

loratadine childrens Tier 1 Select OTC

loratadine oral tablet Tier 1 LGC; Select OTC

WAL-ITIN ORAL SYRUP Tier 1 LGC

XYZAL Tier 3

ZYRTEC ALLERGY ORAL TABLET Tier 1 Select OTC

*ANTIHISTAMINES - PHENOTHIAZINES**-*ANTIHISTAMINES - PHENOTHIAZINES***

PHENADOZ Tier 1 AL

promethazine hcl oral Tier 1 AL

promethazine hcl suppository 12.5 mg, 25 mg Tier 1 AL

PROMETHEGAN SUPPOSITORY 12.5 MG, 25 MG

Tier 1 AL

PROMETHEGAN SUPPOSITORY 50 MG Tier 3 AL

*ANTIHISTAMINES - PIPERIDINES**-*ANTIHISTAMINES - PIPERIDINES***

cyproheptadine hcl oral Tier 1

*ANTIHYPERLIPIDEMICS*

*ANTIHYPERLIPIDEMICS - COMBINATIONS**-*INTEST CHOLEST ABSORP INHIB-HMG COA REDUCTASE INHIB COMB***

LIPTRUZET Tier 2

VYTORIN Tier 3


37


*ANTIHYPERLIPIDEMICS - MISC.**-*ANTIHYPERLIPIDEMICS - MISC.***

KYNAMRO Tier 4 PA

LOVAZA Tier 3

omega-3-acid ethyl esters Tier 1

VASCEPA Tier 2

*BILE ACID SEQUESTRANTS**-*BILE ACID SEQUESTRANTS***

cholestyramine light Tier 1

cholestyramine oral Tier 1

COLESTID FLAVORED ORAL PACKET Tier 3

COLESTID ORAL PACKET Tier 3

COLESTID ORAL TABLET Tier 3

colestipol hcl Tier 1

micronized colestipol hcl Tier 1

PREVALITE Tier 1

QUESTRAN Tier 3

QUESTRAN LIGHT ORAL POWDER Tier 3

WELCHOL Tier 3 #

*FIBRIC ACID DERIVATIVES**-*FIBRIC ACID DERIVATIVES***

ANTARA ORAL CAPSULE 30 MG, 90 MG Tier 3

fenofibrate micronized Tier 1

fenofibrate oral tablet 120 mg, 145 mg, 160 mg, 48 mg, 54 mg

Tier 1

fenofibric acid oral capsule delayed release Tier 1

FENOGLIDE Tier 3 #

FIBRICOR Tier 3

gemfibrozil oral Tier 1 LGC

LIPOFEN Tier 3 #

LOFIBRA Tier 3

LOPID Tier 3

TRICOR Tier 3

TRIGLIDE ORAL TABLET 160 MG Tier 3

TRILIPIX Tier 3



*HMG COA REDUCTASE INHIBITORS**-*HMG COA REDUCTASE INHIBITOR COMBINATIONS***

ADVICOR Tier 3

SIMCOR Tier 3

*HMG COA REDUCTASE INHIBITORS**-*HMG COA REDUCTASE INHIBITORS***

ALTOPREV Tier 3

atorvastatin calcium oral Tier 1

CRESTOR Tier 2

fluvastatin sodium Tier 1

fluvastatin sodium er Tier 1

LESCOL Tier 3

LESCOL XL Tier 3

LIPITOR Tier 3

LIVALO Tier 3

lovastatin Tier 1 LGC

MEVACOR Tier 3

PRAVACHOL Tier 3

pravastatin sodium Tier 1 LGC

simvastatin oral Tier 1 LGC

ZOCOR Tier 3

*INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS**-*INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS***

ZETIA Tier 2

*MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN (MTP) INHIBITORS**-*MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN INHIBITORS***

JUXTAPID ORAL CAPSULE 10 MG, 20 MG, 5 MG

Tier 4 PA; QL

JUXTAPID ORAL CAPSULE 30 MG, 40 MG, 60 MG

Tier 4 PA


39


*NICOTINIC ACID DERIVATIVES**-*NICOTINIC ACID DERIVATIVES***

niacin er (antihyperlipidemic) Tier 1

NIACOR Tier 3

NIASPAN Tier 3

*PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 INHIBITORS**-*PCSK9 INHIBITORS***

PRALUENT Tier 4 PA

REPATHA Tier 4 PA

REPATHA SURECLICK Tier 4 PA

*ANTIHYPERTENSIVES*

*ACE INHIBITORS**-*ACE INHIBITORS***

ACCUPRIL Tier 3

ACEON ORAL TABLET 4 MG, 8 MG Tier 3

ALTACE Tier 3

benazepril hcl oral Tier 1 LGC

captopril oral Tier 1 LGC

enalapril maleate oral Tier 1 LGC

EPANED Tier 3 AL

fosinopril sodium Tier 1

lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg Tier 1 LGC

lisinopril oral tablet 30 mg, 40 mg Tier 1

LOTENSIN Tier 3

MAVIK Tier 3

moexipril hcl Tier 1

perindopril erbumine Tier 1

PRINIVIL Tier 3

quinapril hcl Tier 1

ramipril Tier 1

trandolapril Tier 1

UNIVASC Tier 3

VASOTEC Tier 3

ZESTRIL Tier 3



*AGENTS FOR PHEOCHROMOCYTOMA**-*AGENTS FOR PHEOCHROMOCYTOMA***

DEMSER Tier 3

DIBENZYLINE Tier 2

phenoxybenzamine hcl oral Tier 1

*ANGIOTENSIN II RECEPTOR ANTAGONISTS**-*ANGIOTENSIN II RECEPTOR ANTAGONISTS***

ATACAND Tier 3

AVAPRO Tier 3

BENICAR Tier 3

candesartan cilexetil Tier 1

COZAAR ORAL TABLET 25 MG, 50 MG Tier 3

DIOVAN Tier 3

EDARBI Tier 3

eprosartan mesylate Tier 1

irbesartan Tier 1

losartan potassium Tier 1 LGC

TEVETEN ORAL TABLET 600 MG Tier 3

*ANTIADRENERGIC ANTIHYPERTENSIVES**-*ANTIADRENERGICS - CENTRALLY ACTING***

CATAPRES Tier 3

CATAPRES-TTS-1 Tier 3



clonidine hcl oral Tier 1 LGC

clonidine hcl transdermal Tier 1

guanfacine hcl oral Tier 1

methyldopa oral Tier 1

TENEX Tier 3

*ANTIADRENERGIC ANTIHYPERTENSIVES**-*ANTIADRENERGICS - PERIPHERALLY ACTING***

CARDURA Tier 3

doxazosin mesylate Tier 1 LGC

MINIPRESS Tier 3

prazosin hcl oral Tier 1 LGC


41


terazosin hcl oral Tier 1 LGC

*ANTIHYPERTENSIVE COMBINATIONS**-*ACE INHIBITOR & CALCIUM CHANNEL BLOCKER COMBINATIONS***

amlodipine besy-benazepril hcl Tier 1

LOTREL Tier 3

PRESTALIA Tier 3

TARKA Tier 3 #

trandolapril-verapamil hcl er Tier 1

*ANTIHYPERTENSIVE COMBINATIONS**-*ACE INHIBITORS & THIAZIDE/THIAZIDE-LIKE***

ACCURETIC Tier 3

benazepril-hydrochlorothiazide Tier 1 LGC

enalapril-hydrochlorothiazide Tier 1 LGC

fosinopril sodium-hctz Tier 1

lisinopril-hydrochlorothiazide Tier 1 LGC

LOTENSIN HCT Tier 3

moexipril-hydrochlorothiazide Tier 1

quinapril-hydrochlorothiazide Tier 1

UNIRETIC ORAL TABLET 15-12.5 MG Tier 3

VASERETIC Tier 3

ZESTORETIC Tier 3

*ANTIHYPERTENSIVE COMBINATIONS**-*ADRENOLYTICS-CENTRAL & THIAZIDE/THIAZIDE-LIKE COMB***

CLORPRES Tier 3

*ANTIHYPERTENSIVE COMBINATIONS**-*ANGIOTENSIN II RECEPTOR ANTAG & CA CHANNEL BLOCKER COMB***

amlodipine besylate-valsartan Tier 1

AZOR Tier 3

EXFORGE Tier 2 #



*ANTIHYPERTENSIVE COMBINATIONS**-*ANGIOTENSIN II RECEPTOR ANTAG & THIAZIDE/THIAZIDE-LIKE***

ATACAND HCT Tier 3

AVALIDE Tier 3

BENICAR HCT Tier 3

candesartan cilexetil-hctz Tier 1

DIOVAN HCT Tier 3

EDARBYCLOR Tier 3

HYZAAR Tier 3

irbesartan-hydrochlorothiazide Tier 1

losartan potassium-hctz Tier 1 LGC

TEVETEN HCT Tier 3 #

valsartan-hydrochlorothiazide Tier 1

*ANTIHYPERTENSIVE COMBINATIONS**-*ANGIOTENSIN II RECEPTOR ANT-CA CHANNEL BLOCKER-THIAZIDES***

amlodipine-valsartan-hctz Tier 1

EXFORGE HCT Tier 2 #

TRIBENZOR Tier 3

*ANTIHYPERTENSIVE COMBINATIONS**-*BETA BLOCKER & DIURETIC COMBINATIONS***

atenolol-chlorthalidone Tier 1 LGC

bisoprolol-hydrochlorothiazide Tier 1 LGC

CORZIDE Tier 3

DUTOPROL Tier 3

LOPRESSOR HCT Tier 3

metoprolol-hydrochlorothiazide Tier 1

nadolol-bendroflumethiazide Tier 1

TENORETIC 100 Tier 3

TENORETIC 50 Tier 3

ZIAC Tier 3


43


*ANTIHYPERTENSIVE COMBINATIONS**-*DIRECT RENIN INHIBITORS & CALCIUM CHANNEL BLOCKER COMB***

TEKAMLO Tier 3

*ANTIHYPERTENSIVE COMBINATIONS**-*DIRECT RENIN INHIBITORS & THIAZIDE/THIAZIDE-LIKE COMB***

TEKTURNA HCT Tier 3

*ANTIHYPERTENSIVE COMBINATIONS**-*DIRECT RENIN INHIBITORS-CA CHANNEL BLOCKER-THIAZIDE COMB***

AMTURNIDE Tier 3

*ANTIHYPERTENSIVES - MISC.**-*ANTIHYPERTENSIVES - MISC.***

VECAMYL Tier 4 PA; QL

*DIRECT RENIN INHIBITORS**-*DIRECT RENIN INHIBITORS***

TEKTURNA Tier 3

*SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)**-*SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)***

eplerenone Tier 1

INSPRA Tier 3

*VASODILATORS**-*VASODILATORS***

hydralazine hcl oral tablet 10 mg, 100 mg, 50 mg Tier 1

hydralazine hcl oral tablet 25 mg Tier 1 LGC

minoxidil oral Tier 1

*ANTI-INFECTIVE AGENTS - MISC.*

*ANTI-INFECTIVE AGENTS - MISC.**-*ANTI-INFECTIVE AGENTS - MISC.***

CAYSTON Tier 4

colistimethate sodium injection Tier 4

COLY-MYCIN M Tier 4

FIRST-VANCOMYCIN 25 Tier 3

FIRST-VANCOMYCIN 50 Tier 3



FLAGYL ER Tier 3

FLAGYL ORAL TABLET Tier 3

metronidazole oral tablet Tier 1

NEBUPENT Tier 2

PRIMSOL Tier 3

TINDAMAX Tier 3

tinidazole oral Tier 1

trimethoprim oral Tier 1

VANCOCIN HCL Tier 3

vancomycin hcl oral Tier 1

XIFAXAN Tier 3

*ANTI-INFECTIVE MISC. - COMBINATIONS**-*ANTI-INFECTIVE MISC. - COMBINATIONS***

BACTRIM Tier 3

BACTRIM DS Tier 3

smz-tmp ds Tier 1

sulfamethoxazole-trimethoprim oral suspension200-40 mg/5ml

Tier 1

sulfamethoxazole-trimethoprim oral tablet 400-80 mg

Tier 1 LGC

SULFATRIM PEDIATRIC Tier 1

*ANTIPROTOZOAL AGENTS**-*ANTIPROTOZOAL AGENTS***

ALINIA Tier 3

MEPRON Tier 3

*KETOLIDES**-*KETOLIDES***

KETEK Tier 3

*LINCOSAMIDES**-*LINCOSAMIDES***

CLEOCIN ORAL CAPSULE 150 MG, 300 MG Tier 3

CLEOCIN ORAL SOLUTION RECONSTITUTED

Tier 3

clindamycin hcl oral Tier 1

clindamycin palmitate hcl Tier 1

*OXAZOLIDINONES**-*OXAZOLIDINONES***

linezolid oral Tier 1

SIVEXTRO ORAL Tier 3


45


ZYVOX ORAL SUSPENSION RECONSTITUTED

Tier 2

ZYVOX ORAL TABLET Tier 2 #

*ANTIMALARIALS*

*ANTIMALARIAL COMBINATIONS**-*ANTIMALARIAL COMBINATIONS***

atovaquone-proguanil hcl oral tablet 250-100 mg Tier 1

COARTEM Tier 3

MALARONE Tier 3

*ANTIMALARIALS**-*ANTIMALARIALS***

ARALEN Tier 3

chloroquine phosphate oral Tier 1

DARAPRIM Tier 2

hydroxychloroquine sulfate oral Tier 1

mefloquine hcl Tier 1

PLAQUENIL Tier 3

QUALAQUIN Tier 3

quinine sulfate oral Tier 1

*ANTIMYASTHENIC/CHOLINERGIC AGENTS*

*ANTIMYASTHENIC/CHOLINERGIC AGENTS**-*ANTIMYASTHENIC/CHOLINERGIC AGENTS***

MESTINON ORAL SYRUP Tier 2

MESTINON ORAL TABLET Tier 3

MESTINON ORAL TABLET EXTENDEDRELEASE*

Tier 2

pyridostigmine bromide er Tier 1

pyridostigmine bromide oral Tier 1

*ANTIMYCOBACTERIAL AGENTS*

*ANTI TB COMBINATIONS**-*ANTI TB COMBINATIONS***

RIFAMATE Tier 3

RIFATER Tier 3



*ANTIMYCOBACTERIAL AGENTS**-*ANTIMYCOBACTERIAL AGENTS***

ethambutol hcl oral Tier 1

isoniazid oral tablet Tier 1

MYAMBUTOL Tier 3

PASER Tier 3

PRIFTIN Tier 3

pyrazinamide oral Tier 1

RIFADIN ORAL Tier 3

rifampin oral Tier 1

SIRTURO Tier 4 PA; QL

TRECATOR Tier 3

*ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*

*ALKYLATING AGENTS**-*ALKYLATING AGENTS***

HEXALEN Tier 2

MYLERAN Tier 2

*ALKYLATING AGENTS**-*IMIDAZOTETRAZINES***

TEMODAR ORAL Tier 4 PA; QL

temozolomide Tier 4 PA

*ALKYLATING AGENTS**-*NITROGEN MUSTARDS***

ALKERAN ORAL Tier 2

cyclophosphamide oral capsule Tier 1

LEUKERAN Tier 2

*ALKYLATING AGENTS**-*NITROSOUREAS***

GLEOSTINE Tier 3

lomustine Tier 1

*ANTIMETABOLITES**-*ANTIMETABOLITES***

capecitabine Tier 4 PA

mercaptopurine oral Tier 1

methotrexate oral Tier 1

PURINETHOL Tier 3

PURIXAN Tier 4 PA


47


TABLOID Tier 2

TREXALL Tier 3

XELODA Tier 4 PA; QL

*ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS**-*ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS***

ERIVEDGE Tier 4 PA; QL

*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*ANDROGEN BIOSYNTHESIS INHIBITORS***

ZYTIGA Tier 4 PA; QL

*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*ANTIADRENALS***

LYSODREN Tier 3

*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*ANTIANDROGENS***

bicalutamide Tier 1

CASODEX Tier 3

flutamide Tier 1

NILANDRON Tier 2

XTANDI Tier 4 PA; QL

*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*ANTIESTROGENS***

FARESTON Tier 3

SOLTAMOX Tier 3

tamoxifen citrate oral CE

*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*AROMATASE INHIBITORS***

anastrozole oral Tier 1

ARIMIDEX Tier 3

AROMASIN Tier 3

exemestane Tier 1

FEMARA Tier 3

letrozole oral Tier 1



*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*ESTROGEN RECEPTOR ANTAGONIST***

FASLODEX Tier 4 PA

*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*ESTROGENS-ANTINEOPLASTIC***

EMCYT Tier 2

*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*GONADOTROPIN RELEASING HORMONE (GNRH) ANTAGONISTS***

FIRMAGON Tier 4 PA

*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*LHRH ANALOGS***

ELIGARD Tier 4 PA

leuprolide acetate injection Tier 4 PA

LUPRON DEPOT Tier 4 PA

TRELSTAR Tier 4 PA

TRELSTAR MIXJECT Tier 4 PA; #

VANTAS Tier 4 PA

ZOLADEX Tier 4 PA

*ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS**-*PROGESTINS-ANTINEOPLASTIC***

MEGACE ORAL Tier 3

megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml, 800 mg/20ml

Tier 1

megestrol acetate oral tablet Tier 1

*ANTINEOPLASTIC - IMMUNOMODULATORS**-*ANTINEOPLASTIC - IMMUNOMODULATORS***

POMALYST Tier 4 PA; QL

*ANTINEOPLASTIC ENZYME INHIBITORS**-*ANTINEOPLASTIC - BRAF KINASE INHIBITORS***

TAFINLAR Tier 4 PA; QL

ZELBORAF Tier 4 PA; QL


49


*ANTINEOPLASTIC ENZYME INHIBITORS**-*ANTINEOPLASTIC - HISTONE DEACETYLASE INHIBITORS***

FARYDAK Tier 4 PA; QL

ZOLINZA Tier 4 PA; QL

*ANTINEOPLASTIC ENZYME INHIBITORS**-*ANTINEOPLASTIC - MEK INHIBITORS***

MEKINIST Tier 4 PA; QL

*ANTINEOPLASTIC ENZYME INHIBITORS**-*ANTINEOPLASTIC - MTOR KINASE INHIBITORS***

AFINITOR Tier 4 PA; QL

AFINITOR DISPERZ Tier 4 PA; QL

*ANTINEOPLASTIC ENZYME INHIBITORS**-*ANTINEOPLASTIC - MULTIKINASE INHIBITORS***

NEXAVAR Tier 4 PA; QL

STIVARGA Tier 4 PA; QL

SUTENT Tier 4 PA; QL

*ANTINEOPLASTIC ENZYME INHIBITORS**-*ANTINEOPLASTIC - TYROSINE KINASE INHIBITORS***

BOSULIF Tier 4 PA; QL

CAPRELSA Tier 4 PA; QL

COMETRIQ (100 MG DAILY DOSE) Tier 4 PA; QL



GILOTRIF Tier 4 PA; QL

GLEEVEC Tier 4 PA; QL

ICLUSIG Tier 4 PA; QL

IMBRUVICA Tier 4 PA; QL

INLYTA Tier 4 PA; QL

IRESSA Tier 4 PA

LENVIMA 10 MG DAILY DOSE Tier 4 PA; QL




SPRYCEL Tier 4 PA; QL



TARCEVA Tier 4 PA; QL

TASIGNA Tier 4 PA; QL

TYKERB Tier 4 PA; QL

VOTRIENT Tier 4 PA; QL

XALKORI Tier 4 PA; QL

ZYKADIA Tier 4 PA

*ANTINEOPLASTIC ENZYME INHIBITORS**-*CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS***

IBRANCE Tier 4 PA; QL

*ANTINEOPLASTIC ENZYME INHIBITORS**-*JANUS ASSOCIATED KINASE (JAK) INHIBITORS***

JAKAFI Tier 4 PA; QL

*ANTINEOPLASTIC ENZYME INHIBITORS**-*PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS***

ZYDELIG Tier 4 PA

*ANTINEOPLASTIC ENZYME INHIBITORS**-*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS**

LYNPARZA Tier 4 PA; QL

*ANTINEOPLASTICS MISC.**-*ANTINEOPLASTICS MISC.***

ACTIMMUNE Tier 4 PA

ALFERON N Tier 4

hydroxyurea oral Tier 1

INTRON A Tier 4 PA

MATULANE Tier 2

SYLATRON SUBCUTANEOUS* KIT 200 MCG, 300 MCG, 4 X 200 MCG, 4 X 300 MCG, 600 MCG

Tier 4 PA

*ANTINEOPLASTICS MISC.**-*RETINOIDS***

tretinoin oral Tier 4

*ANTINEOPLASTICS MISC.**-*SELECTIVE RETINOID X RECEPTOR AGONISTS***

bexarotene Tier 4

TARGRETIN ORAL Tier 4 #


51


*CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS**-*FOLIC ACID ANTAGONISTS RESCUE AGENTS***

leucovorin calcium oral tablet 25 mg, 5 mg Tier 1

*CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS**-*URINARY TRACT PROTECTIVE AGENTS***

MESNEX ORAL Tier 3

*MITOTIC INHIBITORS**-*MITOTIC INHIBITORS***

etoposide oral Tier 1

*TOPOISOMERASE I INHIBITORS**-*TOPOISOMERASE I INHIBITORS***

HYCAMTIN ORAL Tier 4 PA; QL

*ANTIPARKINSON AGENTS*

*ANTIPARKINSON ADJUVANTS**-*DECARBOXYLASE INHIBITORS***

carbidopa oral Tier 1

*ANTIPARKINSON ANTICHOLINERGICS**-*ANTIPARKINSON ANTICHOLINERGICS***

benztropine mesylate oral Tier 1 LGC

trihexyphenidyl hcl oral elixir Tier 1

trihexyphenidyl hcl oral tablet 2 mg Tier 1 LGC

trihexyphenidyl hcl oral tablet 5 mg Tier 1

*ANTIPARKINSON COMT INHIBITORS**-*CENTRAL/PERIPHERAL COMT INHIBITORS***

TASMAR Tier 3

tolcapone Tier 1

*ANTIPARKINSON COMT INHIBITORS**-*PERIPHERAL COMT INHIBITORS***

COMTAN Tier 3

entacapone Tier 1

*ANTIPARKINSON DOPAMINERGICS**-*ANTIPARKINSON DOPAMINERGICS***

amantadine hcl oral capsule Tier 1



amantadine hcl oral syrup Tier 1

bromocriptine mesylate oral Tier 1

PARLODEL ORAL CAPSULE Tier 3

*ANTIPARKINSON DOPAMINERGICS**-*LEVODOPA COMBINATIONS***

carbidopa-levodopa Tier 1

carbidopa-levodopa er Tier 1

carbidopa-levodopa-entacapone Tier 1

RYTARY Tier 3

SINEMET Tier 3

SINEMET CR Tier 3

STALEVO 100 Tier 3

STALEVO 125 Tier 3

STALEVO 150 Tier 3

STALEVO 200 Tier 3

STALEVO 50 Tier 3

STALEVO 75 Tier 3

*ANTIPARKINSON DOPAMINERGICS**-*NONERGOLINE DOPAMINE RECEPTOR AGONISTS***

MIRAPEX Tier 3

MIRAPEX ER Tier 3

NEUPRO Tier 3

pramipexole dihydrochloride Tier 1

pramipexole dihydrochloride er Tier 1

REQUIP Tier 3

REQUIP XL Tier 3

ropinirole hcl Tier 1

ropinirole hcl er Tier 1

*ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS**-*ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS***

AZILECT Tier 2

ELDEPRYL Tier 3

selegiline hcl oral Tier 1

ZELAPAR Tier 3


53


*ANTIPSYCHOTICS/ANTIMANIC AGENTS*

*ANTIMANIC AGENTS**-*ANTIMANIC AGENTS***

lithium carbonate er Tier 1

lithium carbonate oral Tier 1

LITHOBID Tier 3

*ANTIPSYCHOTICS - MISC.**-*ANTIPSYCHOTICS - MISC.***

EQUETRO Tier 3

GEODON ORAL Tier 3

LATUDA Tier 2

ziprasidone hcl Tier 1

*BENZISOXAZOLES**-*BENZISOXAZOLES***

FANAPT Tier 3

FANAPT TITRATION PACK Tier 3

INVEGA Tier 3

RISPERDAL Tier 3

RISPERDAL M-TAB Tier 3

risperidone Tier 1

RISPERIDONE M-TAB Tier 1

*BUTYROPHENONES**-*BUTYROPHENONES***

haloperidol lactate oral Tier 1

haloperidol oral Tier 1

*DIBENZAPINES**-*DIBENZODIAZEPINES***

clozapine oral tablet Tier 1

clozapine oral tablet dispersible 150 mg, 200 mg Tier 1

CLOZARIL Tier 3

FAZACLO Tier 3 #

VERSACLOZ Tier 3

*DIBENZAPINES**-*DIBENZO-OXEPINO PYRROLES***

SAPHRIS Tier 3

*DIBENZAPINES**-*DIBENZOTHIAZEPINES***

quetiapine fumarate Tier 1



SEROQUEL Tier 3

SEROQUEL XR Tier 2

*DIBENZAPINES**-*DIBENZOXAZEPINES***

loxapine succinate oral Tier 1

*DIBENZAPINES**-*THIENBENZODIAZEPINES***

olanzapine oral Tier 1

ZYPREXA ORAL Tier 3

ZYPREXA ZYDIS Tier 3

*PHENOTHIAZINES**-*PHENOTHIAZINES***

chlorpromazine hcl oral Tier 1

COMPAZINE Tier 1

COMPRO Tier 1

fluphenazine hcl oral tablet Tier 1

perphenazine oral Tier 1

prochlorperazine Tier 1

prochlorperazine maleate oral Tier 1

thioridazine hcl oral Tier 1

trifluoperazine hcl oral Tier 1

*QUINOLINONE DERIVATIVES**-*QUINOLINONE DERIVATIVES***

ABILIFY DISCMELT Tier 3 #

ABILIFY MAINTENA Tier 3

ABILIFY ORAL SOLUTION Tier 3

ABILIFY ORAL TABLET Tier 3 #

aripiprazole oral solution Tier 1

aripiprazole oral tablet Tier 1

REXULTI Tier 3

*THIOXANTHENES**-*THIOXANTHENES***

thiothixene oral Tier 1

*ANTISEPTICS & DISINFECTANTS*

*ANTISEPTIC COMBINATIONS**-*ANTISEPTIC COMBINATIONS***

BUCALSEP EXTERNAL SOLUTION Tier 3


55


*ANTISEPTICS & DISINFECTANTS**-*ANTISEPTICS & DISINFECTANTS***

FORMADON Tier 1

formaldehyde external solution 10 % Tier 1

FORMA-RAY Tier 3

KERR TRIPLE DYE SWABS Tier 3

*ANTIVIRALS*

*ANTIRETROVIRALS**-*ANTIRETROVIRAL COMBINATIONS***

abacavir-lamivudine-zidovudine Tier 1

ATRIPLA Tier 2 #

COMBIVIR Tier 3

COMPLERA Tier 2

EPZICOM Tier 3

EVOTAZ Tier 3

KALETRA Tier 2

lamivudine-zidovudine Tier 1

PREZCOBIX Tier 2

STRIBILD Tier 3

TRIUMEQ Tier 2

TRIZIVIR Tier 3

TRUVADA Tier 2 PA

*ANTIRETROVIRALS**-*ANTIRETROVIRALS - CCR5 ANTAGONISTS (ENTRY INHIBITOR)***

SELZENTRY Tier 3

*ANTIRETROVIRALS**-*ANTIRETROVIRALS - FUSION INHIBITORS***

FUZEON SUBCUTANEOUS* KIT Tier 4 PA

FUZEON SUBCUTANEOUS* SOLUTION RECONSTITUTED

Tier 4 PA; #

*ANTIRETROVIRALS**-*ANTIRETROVIRALS - INTEGRASE INHIBITORS***

ISENTRESS Tier 2

TIVICAY Tier 2

VITEKTA Tier 2



*ANTIRETROVIRALS**-*ANTIRETROVIRALS - PROTEASE INHIBITORS***

APTIVUS Tier 2

CRIXIVAN Tier 3

INVIRASE Tier 3

LEXIVA Tier 2

NORVIR Tier 2

PREZISTA Tier 2

REYATAZ Tier 2

VIRACEPT Tier 3 #

*ANTIRETROVIRALS**-*ANTIRETROVIRALS - RTI-NON-NUCLEOSIDE ANALOGUES***

EDURANT Tier 3

INTELENCE Tier 3

nevirapine Tier 1

nevirapine er Tier 1

RESCRIPTOR Tier 3

SUSTIVA Tier 2

VIRAMUNE Tier 3

VIRAMUNE XR Tier 3

*ANTIRETROVIRALS**-*ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PURINES***

abacavir sulfate Tier 1

didanosine Tier 1

VIDEX Tier 2

VIDEX EC Tier 3

ZIAGEN ORAL SOLUTION Tier 2

ZIAGEN ORAL TABLET Tier 3

*ANTIRETROVIRALS**-*ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PYRIMIDINES***

EMTRIVA Tier 2

EPIVIR Tier 3

lamivudine oral solution Tier 1

lamivudine oral tablet 150 mg, 300 mg Tier 1


57


*ANTIRETROVIRALS**-*ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-THYMIDINES***

RETROVIR ORAL Tier 3

stavudine Tier 1

ZERIT Tier 3

zidovudine Tier 1

*ANTIRETROVIRALS**-*ANTIRETROVIRALS - RTI-NUCLEOTIDE ANALOGUES***

VIREAD Tier 2

*ANTIRETROVIRALS**-*ANTIRETROVIRALS ADJUVANTS***

TYBOST Tier 3

*CMV AGENTS**-*CMV AGENTS***

cidofovir intravenous* Tier 4

CYTOVENE Tier 4

FOSCAVIR Tier 4

ganciclovir sodium Tier 4

VALCYTE Tier 4 PA

valganciclovir hcl Tier 4 PA; QL

VISTIDE Tier 4

*HEPATITIS AGENTS**-*HEPATITIS B AGENTS***

adefovir dipivoxil Tier 4

BARACLUDE Tier 4 #

entecavir Tier 4 QL

EPIVIR HBV Tier 3

HEPSERA Tier 4

lamivudine oral tablet 100 mg Tier 1

TYZEKA Tier 4

*HEPATITIS AGENTS**-*HEPATITIS C AGENT - COMBINATIONS***

HARVONI Tier 4 PA; QL

TECHNIVIE Tier 4 PA

VIEKIRA PAK Tier 4 PA

*HEPATITIS AGENTS**-*HEPATITIS C AGENTS***

COPEGUS Tier 4

DAKLINZA Tier 4 PA2016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)58


INFERGEN Tier 4 PA

moderiba Tier 4

MODERIBA 1200 DOSE PACK Tier 4

MODERIBA 800 DOSE PACK Tier 4

OLYSIO Tier 4 PA; QL

PEGASYS Tier 4 PA

PEGASYS PROCLICK Tier 4 PA

PEGINTRON Tier 4 PA

PEG-INTRON Tier 4 PA

PEG-INTRON REDIPEN Tier 4 PA

PEG-INTRON REDIPEN PAK 4 Tier 4 PA

REBETOL Tier 4

ribasphere Tier 4

ribasphere ribapak Tier 4

ribatab Tier 4

ribavirin oral Tier 4

SOVALDI Tier 4 PA; QL

VICTRELIS Tier 4 PA; QL

*HERPES AGENTS**-*HERPES AGENTS - PURINE ANALOGUES***

acyclovir oral capsule Tier 1 LGC

acyclovir oral suspension Tier 1

acyclovir oral tablet 400 mg Tier 1 LGC

acyclovir oral tablet 800 mg Tier 1

valacyclovir hcl oral Tier 1

VALTREX Tier 3

ZOVIRAX ORAL CAPSULE Tier 3

ZOVIRAX ORAL SUSPENSION Tier 3

ZOVIRAX ORAL TABLET 800 MG Tier 3

*HERPES AGENTS**-*HERPES AGENTS - THYMIDINE ANALOGUES***

famciclovir oral Tier 1

FAMVIR Tier 3

*INFLUENZA AGENTS**-*INFLUENZA AGENTS***

FLUMADINE Tier 3

rimantadine hcl Tier 1


59


*INFLUENZA AGENTS**-*NEURAMINIDASE INHIBITORS***

RELENZA DISKHALER Tier 3 #

TAMIFLU ORAL CAPSULE Tier 3

TAMIFLU ORAL SUSPENSION RECONSTITUTED 6 MG/ML

Tier 3

*RESPIRATORY SYNCYTIAL VIRUS (RSV) AGENTS**-*RSV AGENTS - NUCLEOSIDE ANALOGUES***

VIRAZOLE Tier 3

*ASSORTED CLASSES*

*CHELATING AGENTS**-*CHELATING AGENTS***

CUPRIMINE Tier 3

DEPEN TITRATABS Tier 2

SYPRINE Tier 3

*ENZYMES**-*ENZYMES***

XIAFLEX Tier 4

*IMMUNOMODULATORS**-*ANTILEPROTICS***

THALOMID Tier 4 PA

*IMMUNOMODULATORS**-*IMMUNOMODULATORS FOR MYELODYSPLASTIC SYNDROMES***

REVLIMID Tier 4 PA

*IMMUNOSUPPRESSIVE AGENTS**-*CYCLOSPORINE ANALOGS***

cyclosporine intravenous* Tier 4

cyclosporine modified Tier 4

cyclosporine oral Tier 4

gengraf Tier 4

NEORAL Tier 4

SANDIMMUNE Tier 4

*IMMUNOSUPPRESSIVE AGENTS**-*IMMUNE GLOBULIN IMMUNOSUPPRESSANTS***

ATGAM Tier 4

THYMOGLOBULIN Tier 4



*IMMUNOSUPPRESSIVE AGENTS**-*INOSINE MONOPHOSPHATE DEHYDROGENASE INHIBITORS***

CELLCEPT Tier 4

mycophenolate mofetil Tier 4

mycophenolic acid Tier 4

MYFORTIC Tier 4

*IMMUNOSUPPRESSIVE AGENTS**-*MACROLIDE IMMUNOSUPPRESSANTS***

ASTAGRAF XL Tier 4

HECORIA Tier 4

PROGRAF Tier 4

RAPAMUNE ORAL SOLUTION Tier 4

RAPAMUNE ORAL TABLET 0.5 MG Tier 4

RAPAMUNE ORAL TABLET 1 MG, 2 MG Tier 4 #

sirolimus oral Tier 4

tacrolimus oral Tier 4

ZORTRESS Tier 4

*IMMUNOSUPPRESSIVE AGENTS**-*MONOCLONAL ANTIBODIES***

SIMULECT Tier 4

*IMMUNOSUPPRESSIVE AGENTS**-*PURINE ANALOGS***

AZASAN Tier 3

azathioprine oral Tier 1

IMURAN Tier 3

*IMMUNOSUPPRESSIVE AGENTS**-*SELECTIVE T-CELL COSTIMULATION BLOCKERS***

NULOJIX Tier 4

*IRRIGATION SOLUTIONS**-*IRRIGATION SOLUTIONS***

ARGYLE STERILE WATER Tier 1

lactated ringers irrigation Tier 1

PHYSIOLYTE Tier 1

PHYSIOSOL IRRIGATION Tier 1


61


ringers irrigation Tier 1

sterile water for irrigation Tier 1

TIS-U-SOL Tier 1

*POTASSIUM REMOVING RESINS**-*POTASSIUM REMOVING RESINS***

kalexate Tier 1

KAYEXALATE Tier 3

KIONEX Tier 1

sodium polystyrene sulfonate oral Tier 1

sodium polystyrene sulfonate suspension Tier 1

SPS Tier 3

*SYSTEMIC LUPUS ERYTHEMATOSUS AGENTS**-*B-LYMPHOCYTE STIMULATOR (BLYS)-SPECIFIC INHIBITORS***

BENLYSTA Tier 4 PA

*BETA BLOCKERS*

*ALPHA-BETA BLOCKERS**-*ALPHA-BETA BLOCKERS***

carvedilol Tier 1 LGC

COREG Tier 3

COREG CR Tier 3

labetalol hcl oral Tier 1

TRANDATE Tier 3

*BETA BLOCKERS CARDIO-SELECTIVE**-*BETA BLOCKERS CARDIO-SELECTIVE***

acebutolol hcl oral Tier 1

atenolol oral Tier 1 LGC

betaxolol hcl oral Tier 1

bisoprolol fumarate Tier 1 LGC

BYSTOLIC Tier 2

KERLONE Tier 3

LOPRESSOR ORAL Tier 3

metoprolol succinate er Tier 1

metoprolol tartrate oral Tier 1 LGC

SECTRAL Tier 3



TENORMIN Tier 3

TOPROL XL Tier 3

ZEBETA Tier 3

*BETA BLOCKERS NON-SELECTIVE**-*BETA BLOCKERS NON-SELECTIVE***

BETAPACE Tier 3

BETAPACE AF Tier 3

CORGARD Tier 3

INDERAL LA Tier 3

INDERAL XL Tier 3

LEVATOL Tier 3

nadolol oral Tier 1

propranolol hcl er Tier 1

propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 80 mg

Tier 1 LGC

propranolol hcl oral tablet 60 mg Tier 1

SORINE Tier 1

sotalol hcl (af) oral tablet 120 mg Tier 1 LGC

sotalol hcl (af) oral tablet 160 mg, 80 mg Tier 1

sotalol hcl oral tablet 120 mg, 80 mg Tier 1 LGC

sotalol hcl oral tablet 160 mg, 240 mg Tier 1

SOTYLIZE Tier 3

*BIOLOGICALS MISC*

*BIOLOGICALS MISC**-*BIOLOGICALS MISC***

ADAGEN Tier 4

*CALCIUM CHANNEL BLOCKERS*

*CALCIUM CHANNEL BLOCKERS**-*CALCIUM CHANNEL BLOCKERS***

ADALAT CC Tier 3

AFEDITAB CR Tier 1

amlodipine besylate oral Tier 1 LGC

CALAN Tier 3

CALAN SR Tier 3

CARDIZEM CD Tier 3

CARDIZEM LA Tier 3


63


CARDIZEM ORAL TABLET 120 MG, 30 MG, 60 MG

Tier 3

CARTIA XT Tier 1

diltiazem hcl cd Tier 1

diltiazem hcl er Tier 1

diltiazem hcl er beads Tier 1

diltiazem hcl er coated beads Tier 1

diltiazem hcl oral Tier 1 LGC

dilt-xr Tier 1

felodipine er Tier 1

ISOPTIN SR Tier 3

MATZIM LA Tier 1

nicardipine hcl oral Tier 1

NIFEDIAC CC Tier 1

NIFEDICAL XL Tier 1

nifedipine er Tier 1

nifedipine er osmotic release Tier 1

nifedipine oral Tier 1

nimodipine oral Tier 1

nisoldipine er oral tablet extended release 24 hr*17 mg, 34 mg, 8.5 mg

Tier 1

NORVASC Tier 3

NYMALIZE Tier 3

PROCARDIA Tier 3

PROCARDIA XL Tier 3

SULAR ORAL TABLET EXTENDED RELEASE 24 HR* 17 MG, 34 MG, 8.5 MG

Tier 3

TAZTIA XT Tier 1

TIAZAC Tier 3

verapamil hcl er oral capsule extended release 24 hour

Tier 1

verapamil hcl er oral tablet extendedrelease* 120 mg

Tier 1 LGC

verapamil hcl er oral tablet extendedrelease* 180 mg, 240 mg

Tier 1

verapamil hcl oral Tier 1 LGC

VERELAN Tier 3

VERELAN PM Tier 3



*CARDIOTONICS*

*CARDIAC GLYCOSIDES**-*CARDIAC GLYCOSIDES***

DIGOX Tier 1

digoxin oral tablet Tier 1 LGC

LANOXIN ORAL Tier 3

*CARDIOVASCULAR AGENTS - MISC.*

*CARDIOVASCULAR AGENTS MISC. - COMBINATIONS**-*NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB***

ENTRESTO Tier 3

*CARDIOVASCULAR AGENTS MISC. - COMBINATIONS**-*NITRATE & VASODILATOR COMBINATIONS***

BIDIL Tier 3

*IMPOTENCE AGENTS**-*PROSTAGLANDIN - IMPOTENCE AGENTS***

CAVERJECT Tier 3 #

CAVERJECT IMPULSE Tier 3 #

EDEX Tier 3

MUSE Tier 3

*PROSTAGLANDIN VASODILATORS**-*PROSTAGLANDIN VASODILATORS***

epoprostenol sodium Tier 4 PA

FLOLAN Tier 4 PA

ORENITRAM Tier 4 PA

REMODULIN Tier 4 PA

TYVASO Tier 4 PA

TYVASO REFILL Tier 4 PA

TYVASO STARTER Tier 4 PA

VELETRI Tier 4 PA

VENTAVIS Tier 4 PA


65


*PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS**-*PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS***

LETAIRIS Tier 4 PA

OPSUMIT Tier 4 PA; QL

TRACLEER Tier 4 PA; #

*PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS**-*PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS***

ADCIRCA Tier 4 PA; QL

REVATIO INTRAVENOUS* Tier 4 PA

REVATIO ORAL SUSPENSION RECONSTITUTED

Tier 4 PA; QL

REVATIO ORAL TABLET Tier 4 PA; QL

sildenafil citrate oral Tier 4 PA

*PULMONARY HYPERTENSION - SOL GUANYLATE CYCLASE STIMULATOR**-*PULM HYPERTEN-SOLUBLE GUANYLATE CYCLASE STIMULATOR (SGC)***

ADEMPAS Tier 4 PA; QL

*SINUS NODE INHIBITORS*-*SINUS NODE INHIBITORS**

CORLANOR Tier 3

*CEPHALOSPORINS*

*CEPHALOSPORINS - 1ST GENERATION**-*CEPHALOSPORINS - 1ST GENERATION***

cefadroxil Tier 1

cephalexin oral capsule Tier 1

cephalexin oral suspension reconstituted Tier 1

KEFLEX Tier 3

*CEPHALOSPORINS - 2ND GENERATION**-*CEPHALOSPORINS - 2ND GENERATION***

cefaclor oral capsule Tier 1

cefprozil Tier 1



CEFTIN ORAL SUSPENSION RECONSTITUTED 250 MG/5ML

Tier 3

CEFTIN ORAL TABLET Tier 3

cefuroxime axetil Tier 1

*CEPHALOSPORINS - 3RD GENERATION**-*CEPHALOSPORINS - 3RD GENERATION***

CEDAX Tier 3

cefdinir Tier 1

cefixime Tier 1

cefpodoxime proxetil Tier 1

SPECTRACEF Tier 3

SUPRAX ORAL CAPSULE Tier 3

SUPRAX ORAL SUSPENSION RECONSTITUTED

Tier 3

SUPRAX ORAL TABLET CHEWABLE Tier 3

*CHEMICALS*

*BULK CHEMICALS - E'S**-*BULK CHEMICALS - ET'S***

ethosuximide Tier 1

*BULK CHEMICALS - H'S**-*BULK CHEMICALS - HY'S***

hydroxyzine hcl Tier 1

*CONTRACEPTIVES*

*COMBINATION CONTRACEPTIVES - ORAL**-*BIPHASIC CONTRACEPTIVES - ORAL***

AZURETTE CE QL

desogestrel-ethinyl estradiol oral tablet0.15-0.02/0.01 mg (21/5)

Tier 1

KARIVA CE QL

LO LOESTRIN FE Tier 3

MIRCETTE Tier 3

NECON 10/11 (28) CE QL

PIMTREA Tier 1

viorele CE


67


*COMBINATION CONTRACEPTIVES - ORAL**-*COMBINATION CONTRACEPTIVES - ORAL***

ALTAVERA CE QL

alyacen 1/35 CE QL

APRI CE QL

AUBRA Tier 1

AVIANE CE QL

BALZIVA CE QL

BEYAZ Tier 3

BREVICON (28) Tier 3

briellyn CE QL

CHATEAL CE QL

CRYSELLE-28 CE QL

CYCLAFEM 1/35 CE QL

DASETTA 1/35 CE QL

DESOGEN Tier 3

desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg

Tier 1

drospirenone-ethinyl estradiol oral tablet 3-0.03 mg

Tier 1

ELINEST CE QL

EMOQUETTE CE QL

ENSKYCE Tier 1

ESTARYLLA Tier 1

FALMINA CE QL

FEMCON FE Tier 3

GENERESS FE Tier 3 #

GIANVI Tier 1

GILDAGIA CE QL

GILDESS 1.5/30 CE

GILDESS 1/20 CE

GILDESS 24 FE CE

GILDESS FE 1.5/30 CE QL

GILDESS FE 1/20 CE QL

JUNEL 1.5/30 CE QL

JUNEL 1/20 CE QL

JUNEL FE 1.5/30 CE QL



JUNEL FE 1/20 CE QL

KELNOR 1/35 CE QL

KURVELO CE QL

LARIN 1/20 Tier 1

LARIN FE 1.5/30 Tier 1

LARIN FE 1/20 Tier 1

LESSINA CE QL

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg

Tier 1

levonorgestrel-ethinyl estrad oral tablet 0.15-30 mg-mcg

CE QL

LEVORA 0.15/30 (28) CE QL

LOESTRIN 1.5/30 (21) Tier 3

LOESTRIN 1/20 (21) Tier 3

LOESTRIN FE 1.5/30 Tier 3

LOESTRIN FE 1/20 Tier 3

LORYNA Tier 1

LOW-OGESTREL CE QL

LUTERA CE QL

marlissa CE QL

MICROGESTIN 1.5/30 CE QL

MICROGESTIN 1/20 CE QL

MICROGESTIN FE 1.5/30 CE QL

MICROGESTIN FE 1/20 CE QL

MINASTRIN 24 FE Tier 3

MODICON (28) Tier 3

MONO-LINYAH Tier 1

MONONESSA Tier 1

NECON 0.5/35 (28) CE QL

NECON 1/35 (28) CE QL

NECON 1/50 (28) Tier 3

norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg(24)

Tier 1

norgestimate-eth estradiol Tier 1

norgestrel-ethinyl estradiol CE QL

NORINYL 1+35 (28) Tier 3

NORINYL 1+50 (28) Tier 3

NORTREL 0.5/35 (28) CE QL2016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)

69


NORTREL 1/35 (21) CE QL

NORTREL 1/35 (28) CE QL

OCELLA Tier 1

ORSYTHIA CE QL

ORTHO-CEPT (28) Tier 3

ORTHO-CYCLEN (28) Tier 3

ORTHO-NOVUM 1/35 (28) Tier 3

OVCON-35 (28) Tier 3

PHILITH CE QL

PIRMELLA 1/35 Tier 1

PORTIA-28 CE QL

PREVIFEM Tier 1

RECLIPSEN CE QL

SAFYRAL Tier 3

SOLIA Tier 1

SPRINTEC 28 Tier 1

SRONYX CE QL

SYEDA Tier 1

VESTURA Tier 1

VYFEMLA Tier 1

WERA CE QL

WYMZYA FE CE

YASMIN 28 Tier 3

YAZ Tier 3

ZARAH Tier 1

ZENCHENT CE QL

ZENCHENT FE CE

ZEOSA CE

ZOVIA 1/35E (28) CE QL

ZOVIA 1/50E (28) CE QL

*COMBINATION CONTRACEPTIVES - ORAL**-*CONTINUOUS CONTRACEPTIVES - ORAL***

AMETHYST Tier 1

*COMBINATION CONTRACEPTIVES - ORAL**-*EXTENDED-CYCLE CONTRACEPTIVES - ORAL***

AMETHIA Tier 1



AMETHIA LO Tier 1

CAMRESE Tier 1

CAMRESE LO Tier 1

DAYSEE Tier 1

INTROVALE Tier 1

JOLESSA Tier 1

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

Tier 1

LOSEASONIQUE Tier 3

QUARTETTE Tier 3

QUASENSE Tier 1

SEASONIQUE Tier 3

*COMBINATION CONTRACEPTIVES - ORAL**-*FOUR PHASE CONTRACEPTIVES - ORAL***

NATAZIA Tier 3

*COMBINATION CONTRACEPTIVES - ORAL**-*TRIPHASIC CONTRACEPTIVES - ORAL***

alyacen 7/7/7 Tier 1

ARANELLE CE QL

CAZIANT CE QL

CESIA CE

CYCLAFEM 7/7/7 Tier 1

CYCLESSA Tier 3

DASETTA 7/7/7 Tier 1

ENPRESSE-28 CE QL

ESTROSTEP FE Tier 3

LEENA CE QL

LEVONEST CE QL

MYZILRA CE

NECON 7/7/7 Tier 1

norgestim-eth estrad triphasic Tier 1

NORTREL 7/7/7 Tier 1

ORTHO TRI-CYCLEN (28) Tier 3

ORTHO TRI-CYCLEN LO Tier 3 #

ORTHO-NOVUM 7/7/7 (28) Tier 3

PIRMELLA 7/7/7 Tier 1


71


TILIA FE CE QL

TRI-ESTARYLLA Tier 1

TRI-LEGEST FE CE QL

TRI-LINYAH Tier 1

TRINESSA (28) Tier 1

TRI-NORINYL (28) Tier 3

TRI-PREVIFEM Tier 1

TRI-SPRINTEC Tier 1

TRIVORA (28) CE QL

VELIVET CE QL

*COMBINATION CONTRACEPTIVES - TRANSDERMAL**-*COMBINATION CONTRACEPTIVES - TRANSDERMAL***

ORTHO EVRA Tier 3

XULANE CE

*COMBINATION CONTRACEPTIVES - VAGINAL**-*COMBINATION CONTRACEPTIVES - VAGINAL***

NUVARING Tier 2

*COPPER CONTRACEPTIVES - IUD**-*COPPER CONTRACEPTIVES - IUD***

PARAGARD INTRAUTERINE COPPER CE

*EMERGENCY CONTRACEPTIVES**-*EMERGENCY CONTRACEPTIVES***

ELLA CE QL

levonorgestrel oral tablet 0.75 mg CE

NEXT CHOICE CE

NEXT CHOICE ONE DOSE CE

*PROGESTIN CONTRACEPTIVES - IMPLANTS**-*PROGESTIN CONTRACEPTIVES - IMPLANTS***

IMPLANON CE

NEXPLANON CE

*PROGESTIN CONTRACEPTIVES - INJECTABLE**-*PROGESTIN CONTRACEPTIVES - INJECTABLE***

DEPO-PROVERA INTRAMUSCULAR* SUSPENSION 150 MG/ML

Tier 3



DEPO-SUBQ PROVERA 104 Tier 3

medroxyprogesterone acetate intramuscular* CE

*PROGESTIN CONTRACEPTIVES - IUD**-*PROGESTIN CONTRACEPTIVES - IUD***

LILETTA CE

MIRENA CE #

SKYLA Tier 3

*PROGESTIN CONTRACEPTIVES - ORAL**-*PROGESTIN CONTRACEPTIVES - ORAL***

CAMILA Tier 1

ERRIN Tier 1

HEATHER Tier 1

JENCYCLA Tier 1

JOLIVETTE Tier 1

LYZA Tier 1

NORA-BE Tier 1

norethindrone oral Tier 1

NOR-QD Tier 3

ORTHO MICRONOR Tier 3

*CORTICOSTEROIDS*

*GLUCOCORTICOSTEROIDS**-*GLUCOCORTICOSTEROIDS***

BAYCADRON Tier 1

budesonide er Tier 1

CORTEF Tier 3

DEXAMETHASONE INTENSOL Tier 3

dexamethasone oral elixir Tier 1

dexamethasone oral tablet 0.5 mg, 0.75 mg, 1.5 mg, 4 mg, 6 mg

Tier 1

DEXPAK 10 DAY Tier 3

DEXPAK 13 DAY Tier 3

DEXPAK 6 DAY Tier 3

ENTOCORT EC Tier 3

FLO-PRED Tier 3

hydrocortisone oral Tier 1

MEDROL (PAK) Tier 3


73


MEDROL ORAL TABLET 16 MG, 2 MG, 32 MG, 4 MG

Tier 3

methylprednisolone (pak) Tier 1

methylprednisolone oral Tier 1

MILLIPRED Tier 3

MILLIPRED DP Tier 3

MILLIPRED DP 12-DAY Tier 3

ORAPRED ODT Tier 3

PEDIAPRED Tier 3

prednisolone oral Tier 1

prednisolone sodium phosphate oral solution 15 mg/5ml, 6.7 (5 base) mg/5ml

Tier 1

prednisolone sodium phosphate oral tablet dispersible

Tier 1

prednisone (pak) Tier 1 LGC

PREDNISONE INTENSOL Tier 3

prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg

Tier 1 LGC

PRELONE Tier 3

RAYOS Tier 3

UCERIS ORAL Tier 3

VERIPRED 20 Tier 3

*MINERALOCORTICOIDS**-*MINERALOCORTICOIDS***

fludrocortisone acetate oral Tier 1

*COUGH/COLD/ALLERGY*

*ANTITUSSIVES**-*ANTITUSSIVE - NONNARCOTIC***

benzonatate Tier 1

TESSALON PERLES Tier 3

ZONATUSS Tier 3

*ANTITUSSIVES**-*ANTITUSSIVE - OPIOID***

hydrocodone-homatropine Tier 1

hydromet Tier 1

TUSSIGON Tier 1



*COUGH/COLD/ALLERGY COMBINATIONS**-*ANTITUSSIVE-EXPECTORANT***

cheratussin ac oral syrup Tier 1

guaiatussin ac Tier 1

guaifenesin ac Tier 1

guaifenesin-codeine Tier 1

iophen c-nr Tier 1

m-clear wc Tier 1

nortuss-ex Tier 3

OBREDON Tier 3

relcof c Tier 1

virtussin a/c Tier 1

*COUGH/COLD/ALLERGY COMBINATIONS**-*ANTITUSSIVE-EXPECTORANTS-DECONGESTANT***

EXACTUSS Tier 3

GILTUSS Tier 3

GILTUSS PED-C Tier 3

GILTUSS TR Tier 3

HYCOFENIX Tier 3

tgq 30pse/150gfn/15dm Tier 3

*COUGH/COLD/ALLERGY COMBINATIONS**-*DECONGESTANT & ANTIHISTAMINE***

ALAVERT ALLERGY/SINUS Tier 1 Select OTC

cetirizine-pseudoephedrine er Tier 1 Select OTC

CLARINEX-D 12 HOUR Tier 3

CLARITIN-D 12 HOUR Tier 1 Select OTC

CLARITIN-D 24 HOUR Tier 1 Select OTC

DECON-A ORAL ELIXIR Tier 3

fexofenadine-pseudoephed er oral tablet extended release 24 hr*

Tier 1 Select OTC

loratadine-d 12hr Tier 1 Select OTC

loratadine-d 24hr Tier 1 Select OTC

RELHIST Tier 3

RESCON-JR Tier 3

RESCON-MX Tier 3

SEMPREX-D Tier 32016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)

75


ZYRTEC-D ALLERGY & CONGESTION Tier 1 Select OTC

*COUGH/COLD/ALLERGY COMBINATIONS**-*DECONGESTANT W/ EXPECTORANT***

GILPHEX TR Tier 3

*COUGH/COLD/ALLERGY COMBINATIONS**-*NON-NARC ANTITUSSIVE-ANTIHISTAMINE***

promethazine-dm Tier 1 AL

*COUGH/COLD/ALLERGY COMBINATIONS**-*NON-NARC ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE***

BROMFED DM Tier 1

CARBAPHEN 12 Tier 3

CARBAPHEN 12 PED Tier 3

NEOTUSS PLUS Tier 3

PEDIATEX TDM Tier 3

pseudoeph-bromphen-dm oral syrup Tier 1

tgq 30pse/3brm/15dm Tier 3

*COUGH/COLD/ALLERGY COMBINATIONS**-*OPIOID ANTITUSSIVE-ANTIHISTAMINE***

hydrocod polst-cpm polst er Tier 1

promethazine-codeine Tier 1 AL

TUSSICAPS Tier 3

TUSSIONEX PENNKINETIC ER Tier 3

TUZISTRA XR Tier 3

VITUZ Tier 3

*COUGH/COLD/ALLERGY COMBINATIONS**-*OPIOID ANTITUSSIVE-DECONGESTANT***

REZIRA Tier 3

*COUGH/COLD/ALLERGY COMBINATIONS**-*OPIOID ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE***

CPB WC Tier 3

HISTEX-AC Tier 3

phenylhistine dh Tier 3



TRICODE AR Tier 3

*MISC. RESPIRATORY INHALANTS**-*MISC. RESPIRATORY INHALANTS***

HYPERSAL INHALATION NEBULIZATION SOLUTION 3.5 %

Tier 3

NEBUSAL INHALATION NEBULIZATION SOLUTION 3 %

Tier 1

NEBUSAL INHALATION NEBULIZATION SOLUTION 6 %

Tier 3

PULMOSAL Tier 1

sodium chloride inhalation nebulization solution10 %, 3 %, 7 %

Tier 1

*MUCOLYTICS**-*MUCOLYTICS***

acetylcysteine inhalation Tier 1

*DERMATOLOGICALS*

*ACNE PRODUCTS**-*ACNE ANTIBIOTICS***

ACZONE Tier 3

AKNE-MYCIN Tier 3

CLEOCIN-T Tier 3

CLINDACIN ETZ EXTERNAL SWAB Tier 1

CLINDACIN-P Tier 1

CLINDAGEL Tier 3

CLINDAMAX Tier 1

clindamycin phosphate external Tier 1

ery Tier 1

ERYGEL Tier 3

erythromycin external pad Tier 1

erythromycin external solution Tier 1

EVOCLIN Tier 3

KLARON Tier 3

sulfacetamide sodium (acne) Tier 1

sulfacetamide sodium external suspension Tier 1

*ACNE PRODUCTS**-*ACNE COMBINATIONS***

ACANYA Tier 3

AVAR CLEANSER Tier 1

AVAR EXTERNAL PAD Tier 3


77


AVAR LS CLEANSER Tier 3

AVAR LS EXTERNAL PAD Tier 3

AVAR-E EMOLLIENT Tier 1

AVAR-E GREEN Tier 1

AVAR-E LS Tier 3

BENZAMYCIN Tier 3

BENZAMYCINPAK Tier 3

benzoyl peroxide-erythromycin Tier 1

bp 10-1 Tier 1

bp cleansing wash Tier 1

CERISA WASH Tier 1

CLARIS CLARIFYING WASH Tier 1

clindamycin phos-benzoyl perox Tier 1

DUAC Tier 3

EPIDUO Tier 2 AL

EPIDUO FORTE Tier 2

ONEXTON Tier 3

PLEXION Tier 3

PLEXION CLEANSER EXTERNAL LIQUID† Tier 3

PLEXION CLEANSING CLOTH EXTERNAL PAD

Tier 3

PRASCION Tier 1

PRASCION FC Tier 1

PRASCION RA Tier 1

ROSANIL CLEANSER Tier 1

sss 10-5 Tier 1

sulfacetamide sodium-sulfur external cream Tier 1

sulfacetamide sodium-sulfur external emulsion Tier 1

sulfacetamide sodium-sulfur external foam Tier 1

sulfacetamide sodium-sulfur external liquid† Tier 1

sulfacetamide sodium-sulfur external lotion Tier 1

sulfacetamide sodium-sulfur external pad Tier 1

sulfacetamide sodium-sulfur external suspension8-4 %

Tier 1

SULFACLEANSE 8/4 Tier 1

VANOXIDE-HC Tier 3

virti-sulf Tier 1



ZENCIA Tier 1

ZIANA Tier 2

*ACNE PRODUCTS**-*ACNE PRODUCTS***

ABSORICA Tier 3 PA

adapalene external 0.1 % Tier 1 AL

adapalene external 0.3 % Tier 1

adapalene external cream Tier 1 AL

adapalene external lotion Tier 1

AMNESTEEM Tier 1 PA

ATRALIN Tier 3 #; AL

AVITA Tier 1 AL

AZELEX Tier 3

BENZEPRO Tier 1

BENZEPRO SHORT CONTACT Tier 1

BENZIQ Tier 3

BENZIQ LS Tier 3

benzoyl peroxide external foam Tier 1

benzoyl peroxide short contact Tier 1

bp foam Tier 1

bpo Tier 3

bpo foaming cloths Tier 3

CLARAVIS Tier 1 PA

DIFFERIN EXTERNAL 0.1 % Tier 3 AL

DIFFERIN EXTERNAL 0.3 % Tier 2

DIFFERIN EXTERNAL CREAM Tier 3 AL

DIFFERIN EXTERNAL LOTION Tier 3 AL

FABIOR Tier 3 AL

MYORISAN ORAL CAPSULE 10 MG, 20 MG, 40 MG

Tier 1 PA

NUOX Tier 3

RETIN-A Tier 3 AL

RETIN-A MICRO Tier 3 AL

RETIN-A MICRO PUMP EXTERNAL 0.04 %, 0.1 %

Tier 3 AL

RIAX Tier 3

SULFOAM Tier 3

tretinoin external 0.01 %, 0.025 % Tier 1 AL2016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)

79


tretinoin external 0.05 % Tier 1

tretinoin external cream Tier 1 AL

tretinoin microsphere Tier 1 AL

tretinoin microsphere pump Tier 1 AL

TRETIN-X EXTERNAL CREAM Tier 3 AL

zaclir cleansing Tier 3

ZENATANE ORAL CAPSULE 10 MG, 20 MG, 40 MG

Tier 1 PA

*AGENTS FOR EXTERNAL GENITAL AND PERIANAL WARTS**-*AGENTS FOR EXTERNAL GENITAL AND PERIANAL WARTS***

VEREGEN Tier 3

*ANTIBIOTICS - TOPICAL**-*ANTIBIOTIC STEROID COMBINATIONS - TOPICAL***

CORTISPORIN EXTERNAL Tier 2

*ANTIBIOTICS - TOPICAL**-*ANTIBIOTICS - TOPICAL***

ALTABAX Tier 3

BACTROBAN Tier 3

CENTANY Tier 3

gentamicin sulfate external Tier 1 LGC

mupirocin calcium Tier 1

mupirocin external Tier 1

*ANTIFUNGALS - TOPICAL**-*ANTIFUNGALS - TOPICAL COMBINATIONS***

clotrimazole-betamethasone Tier 1

DERMAZENE Tier 1

EXODERM EXTERNAL LOTION Tier 1

hydrocortisone-iodoquinol Tier 1

LOTRISONE Tier 3

nystatin-triamcinolone Tier 1

VERSICLEAR Tier 1

VUSION Tier 3

VYTONE Tier 3



*ANTIFUNGALS - TOPICAL**-*ANTIFUNGALS - TOPICAL***

CICLODAN Tier 1

ciclopirox Tier 1

ciclopirox olamine external Tier 1

CNL8 NAIL Tier 3

HALOTIN Tier 3

LOPROX EXTERNAL SHAMPOO Tier 3

naftifine hcl Tier 1

NAFTIN Tier 3

NYAMYC Tier 1

nystatin external cream Tier 1

nystatin external ointment Tier 1

nystatin external powder 100000 unit/gm Tier 1

NYSTOP Tier 1

PENLAC Tier 3

*ANTIFUNGALS - TOPICAL**-*IMIDAZOLE-RELATED ANTIFUNGALS - TOPICAL***

antifungal external cream 2 % Tier 1

baza antifungal Tier 1

CARRINGTON ANTIFUNGAL Tier 1

econazole nitrate external Tier 1

ECOZA Tier 3

ERTACZO Tier 3

EXELDERM Tier 3

EXTINA Tier 3

JUBLIA Tier 3

ketoconazole external cream Tier 1

ketoconazole external shampoo Tier 1

KETODAN EXTERNAL FOAM Tier 1

kp miconazole nitrate Tier 1

LUZU Tier 3

micaderm Tier 1

MICATIN Tier 3

miconazole nitrate external cream Tier 1

MICRO GUARD EXTERNAL CREAM Tier 1


81


NEOSPORIN AF Tier 1

NIZORAL Tier 3

OXISTAT Tier 3

podactin external cream Tier 1

ra antifungal external cream Tier 1

REMEDY ANTIFUNGAL EXTERNAL CREAM

Tier 1

SECURA ANTIFUNGAL Tier 1

SECURA ANTIFUNGAL EXTRA THICK Tier 1

sm antifungal miconazole Tier 1

SOOTHE & COOL INZO ANTIFUNGAL Tier 1

XOLEGEL Tier 3

*ANTIFUNGALS - TOPICAL**-*OXABOROLE-RELATED ANTIFUNGALS - TOPICAL***

KERYDIN Tier 3

*ANTI-INFLAMMATORY AGENTS - TOPICAL**-*ANTI-INFLAMMATORY AGENTS - TOPICAL***

FLECTOR Tier 2

PENNSAID Tier 3

VOLTAREN TRANSDERMAL Tier 2

*ANTI-INFLAMMATORY AGENTS - TOPICAL**-*ANTI-INFLAMMATORY COMBINATIONS - TOPICAL***

aif #2 drug preparation kit Tier 3

*ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL**-*ANTINEOPLASTIC ALKYLATING AGENTS - TOPICAL***

VALCHLOR Tier 4 PA

*ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL**-*ANTINEOPLASTIC ANTIMETABOLITES - TOPICAL***

CARAC Tier 3

EFUDEX Tier 3

FLUOROPLEX Tier 3

fluorouracil external Tier 1



*ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL**-*ANTINEOPLASTIC OR PREMALIGNANT LESIONS - TOPICAL MISC.***

PICATO Tier 2

*ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL**-*ANTINEOPLASTIC OR PREMALIGNANT LESIONS - TOPICAL NSAID'S***

diclofenac sodium transdermal Tier 1

SOLARAZE Tier 3

*ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL**-*ANTINEOPLASTIC RETINOIDS - TOPICAL***

PANRETIN Tier 2

*ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL**-*PHOTODYNAMIC THERAPY AGENTS - TOPICAL***

LEVULAN KERASTICK Tier 3

*ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL**-*TOPICAL SELECTIVE RETINOID X RECEPTOR AGONISTS***

TARGRETIN EXTERNAL Tier 4

*ANTIPRURITICS - TOPICAL**-*ANTIPRURITICS - TOPICAL***

PRUDOXIN Tier 1

ZONALON Tier 3

*ANTIPSORIATICS**-*ANTIPSORIATICS - SYSTEMIC***

8-MOP Tier 3

acitretin Tier 1

COSENTYX Tier 4 PA

COSENTYX SENSOREADY PEN Tier 4 PA

OXSORALEN ULTRA Tier 3

SORIATANE Tier 3

STELARA Tier 4 PA


83


*ANTIPSORIATICS**-*ANTIPSORIATICS***

calcipotriene external Tier 1

CALCITRENE Tier 1

DOVONEX EXTERNAL CREAM Tier 3

DRITHO-CREME HP Tier 3

SORILUX Tier 3

TAZORAC Tier 2 AL

VECTICAL Tier 3

ZITHRANOL Tier 3

ZITHRANOL-RR Tier 3

*ANTISEBORRHEIC PRODUCTS**-*ANTISEBORRHEIC COMBINATIONS***

SELRX Tier 3

sodium sulfacetamide wash Tier 3

*ANTISEBORRHEIC PRODUCTS**-*ANTISEBORRHEIC PRODUCTS***

OVACE PLUS EXTERNAL CREAM Tier 3

OVACE PLUS EXTERNAL SHAMPOO Tier 3

OVACE PLUS WASH Tier 3

OVACE WASH Tier 3

RE 10 WASH Tier 1

SEB-PREV WASH Tier 1

selenium sulfide external lotion Tier 1

sodium sulfacetamide Tier 1

sulfacetamide sodium external Tier 1

sulfacetamide sodium external liquid† Tier 1

TERSI Tier 3

*ANTIVIRALS - TOPICAL**-*ANTIVIRAL TOPICAL COMBINATIONS***

XERESE Tier 3

*ANTIVIRALS - TOPICAL**-*ANTIVIRALS - TOPICAL***

ABREVA Tier 1 Select OTC

acyclovir external Tier 1

DENAVIR Tier 3

ZOVIRAX EXTERNAL Tier 32016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)84


*BURN PRODUCTS**-*BURN PRODUCTS***

mafenide acetate external Tier 1

SILVADENE Tier 3

silver sulfadiazine external Tier 1

SSD Tier 1

SULFAMYLON Tier 3

THERMAZENE Tier 1

*CAUTERIZING AGENTS**-*CAUTERIZING AGENT COMBINATIONS***

grafco silver nit applicator Tier 1

*CAUTERIZING AGENTS**-*CAUTERIZING AGENTS***

TRI-CHLOR Tier 3

*CORTICOSTEROIDS - TOPICAL**-*CORTICOSTEROIDS - TOPICAL***

ACLOVATE Tier 3

alclometasone dipropionate Tier 1

alphatrex Tier 1

amcinonide external cream Tier 1

APEXICON Tier 1

APEXICON E Tier 3

betamethasone dipropionate aug Tier 1

betamethasone dipropionate external Tier 1

betamethasone valerate external Tier 1

CAPEX Tier 3

clobetasol propionate e Tier 1

clobetasol propionate emulsion Tier 1

clobetasol propionate external Tier 1

clobetasol propionate external cream Tier 1

clobetasol propionate external foam Tier 1

clobetasol propionate external lotion Tier 1

clobetasol propionate external ointment Tier 1

clobetasol propionate external shampoo Tier 1

clobetasol propionate external solution Tier 1

CLOBEX Tier 3


85


CLOBEX SPRAY Tier 2

CORDRAN EXTERNAL LOTION Tier 3

CORDRAN EXTERNAL TAPE Tier 3

CORMAX SCALP APPLICATION Tier 1

CUTIVATE Tier 3

DERMA-SMOOTHE/FS BODY Tier 3

DERMA-SMOOTHE/FS SCALP Tier 3

DERMATOP EXTERNAL CREAM Tier 3

DESONATE Tier 3

desonide external Tier 1

DESOWEN Tier 3

desoximetasone external Tier 1

desoximetasone external cream 0.25 % Tier 1

desoximetasone external ointment 0.25 % Tier 1

diflorasone diacetate external ointment Tier 1

DIPROLENE Tier 3

DIPROLENE AF Tier 3

ELOCON Tier 3

fluocinolone acetonide body Tier 1

fluocinolone acetonide external Tier 1

fluocinolone acetonide scalp Tier 1

fluocinonide external Tier 1

fluocinonide external cream 0.05 % Tier 1 LGC

fluocinonide external ointment Tier 1

fluocinonide external solution Tier 1

fluocinonide-e Tier 1 LGC

fluticasone propionate external Tier 1

halobetasol propionate Tier 1

HALOG Tier 3

hydrocortisone butyr lipo base Tier 1

hydrocortisone butyrate external Tier 1

hydrocortisone external cream 2.5 % Tier 1

hydrocortisone external lotion 2.5 % Tier 1

hydrocortisone external ointment 2.5 % Tier 1

hydrocortisone valerate Tier 1

KENALOG EXTERNAL Tier 3

LOCOID Tier 3



LOCOID LIPOCREAM Tier 3

LOKARA Tier 1

LUXIQ Tier 3

mometasone furoate external Tier 1

NUCORT Tier 3

OLUX Tier 3

OLUX-E Tier 3

PANDEL Tier 3

prednicarbate Tier 1

scalacort Tier 1

SYNALAR Tier 3

TEMOVATE Tier 3

TEMOVATE E Tier 3

TEXACORT Tier 3

TOPICORT Tier 3

TOPICORT SPRAY Tier 3

triamcinolone acetonide external aerosol, solution

Tier 1

triamcinolone acetonide external cream Tier 1 LGC

triamcinolone acetonide external lotion Tier 1

triamcinolone acetonide external ointment Tier 1 LGC

TRIANEX Tier 3

TRIDERM Tier 1

ULTRAVATE Tier 3

VERDESO Tier 3

WESTCORT Tier 3

*CORTICOSTEROIDS - TOPICAL**-*STEROID-LOCAL ANESTHETIC COMBINATIONS***

CORTANE-B EXTERNAL Tier 3

EPIFOAM Tier 3

hydrocortisone ace-pramoxine external Tier 1

PRAMOSONE EXTERNAL CREAM 1-1 % Tier 3

PRAMOSONE EXTERNAL LOTION Tier 3

*CORTICOSTEROIDS - TOPICAL**-*TOPICAL STEROID COMBINATIONS***

CORTALO Tier 1


87


hydrocortisone acetate-aloe external Tier 1

TACLONEX Tier 3

*EMOLLIENT/KERATOLYTIC AGENTS**-*EMOLLIENT/KERATOLYTIC AGENTS***

ALUVEA Tier 3

CEM-UREA Tier 3

CEROVEL Tier 1

DERMASORB XM Tier 3

GORDONS UREA EXTERNAL OINTMENT 40 %

Tier 3

KERAFOAM Tier 3

KERAFOAM 42 Tier 3

KERALAC Tier 3

REMEVEN Tier 1

U-KERA E Tier 1

UMECTA EXTERNAL EMULSION Tier 3

urea external Tier 1

urea external cream 39 %, 40 %, 45 %, 50 % Tier 1

urea external lotion 40 %, 45 % Tier 1

urea external suspension 40 % Tier 1

urea nail external Tier 1

urea nail film Tier 1

urea-c40 Tier 1

UTOPIC Tier 3

X-VIATE Tier 1

*EMOLLIENT/KERATOLYTIC AGENTS**-*EMOLLIENT/KERATOLYTIC COMBINATIONS***

LATRIX Tier 1

UMECTA PD Tier 3

URAMAXIN EXTERNAL FOAM Tier 3

urea external emulsion Tier 1

urea external suspension 50 % Tier 1

urea hydrating Tier 1

urea in zn undecyl-lactic acid Tier 1

urea nail external kit Tier 3

urea nail external stick Tier 3



*EMOLLIENTS**-*EMOLLIENTS***

hygel Tier 1

HYLIRA EXTERNAL LOTION Tier 3

lactic acid external Tier 1

sodium hyaluronate external Tier 1

*ENZYMES - TOPICAL**-*ENZYMES - TOPICAL***

SANTYL Tier 3

VASOLEX Tier 1

*IMMUNOMODULATING AGENTS - TOPICAL**-*IMMUNOMODULATORS IMIDAZOQUINOLINAMINES - TOPICAL***

ALDARA Tier 3

imiquimod external Tier 1

ZYCLARA Tier 3

ZYCLARA PUMP Tier 3

*IMMUNOSUPPRESSIVE AGENTS - TOPICAL**-*MACROLIDE IMMUNOSUPPRESSANTS - TOPICAL***

ELIDEL Tier 2

PROTOPIC Tier 2 #

tacrolimus external Tier 1 QL

*KERATOLYTIC/ANTIMITOTIC AGENTS**-*KERATOLYTIC AND/OR ANTIMITOTIC COMBINATIONS***

bensal hp Tier 3

GORDOFILM Tier 3

SALKERA Tier 3

SALVAX DUO PLUS Tier 3

*KERATOLYTIC/ANTIMITOTIC AGENTS**-*KERATOLYTIC/ANTIMITOTIC AGENTS***

CONDYLOX Tier 3

podocon Tier 3

podofilox external Tier 1

SALACYN Tier 1

salicylic acid external cream Tier 1

salicylic acid external foam Tier 1


89


salicylic acid external liquid† 27.5 % Tier 1

salicylic acid external lotion Tier 1

salicylic acid external shampoo Tier 1

salicylic acid external solution 28.5 % Tier 1

salicylic acid wart remover Tier 1

*LOCAL ANESTHETICS - TOPICAL**-*LOCAL ANESTHETICS - TOPICAL***

ANACAINE Tier 3

lidocaine external ointment Tier 1

lidocaine external patch Tier 1

lidocaine hcl external cream Tier 1

lidocaine hcl external solution Tier 1

LIDODERM Tier 3

lidopin external cream 3 % Tier 3

lidorx Tier 3

QUTENZA Tier 3

QUTENZA (2 PATCH) Tier 3

XYLOCAINE EXTERNAL Tier 3

*LOCAL ANESTHETICS - TOPICAL**-*TOPICAL ANESTHETIC COMBINATIONS***

EMLA Tier 3

lidocaine-prilocaine external cream Tier 1

PLIAGLIS Tier 3

SYNERA Tier 3

*LOCAL ANESTHETICS - TOPICAL**-*TOPICAL ANESTHETIC GASSES***

GEBAUERS PAIN EASE Tier 3

GEBAUERS SPRAY AND STRETCH Tier 3

*MISC. TOPICAL**-*ASTRINGENTS***

XERAC AC Tier 3

*MISC. TOPICAL**-*MISC. TOPICAL***

HYPERCARE Tier 1

*PIGMENTING-DEPIGMENTING AGENTS**-*PIGMENTING AGENTS***

OXSORALEN Tier 2



*ROSACEA AGENTS**-*ROSACEA AGENTS***

doxycycline Tier 1

FINACEA Tier 3

METROCREAM Tier 3

METROGEL Tier 3

METROLOTION Tier 3

metronidazole external Tier 1

MIRVASO Tier 3

NORITATE Tier 3

ORACEA Tier 2 AL

ROSADAN EXTERNAL Tier 1

ROSADAN EXTERNAL CREAM Tier 1

SOOLANTRA Tier 3

*SCABICIDES & PEDICULICIDES**-*SCABICIDES & PEDICULICIDES***

ACTICIN Tier 1

ELIMITE Tier 3

EURAX Tier 3

lindane external Tier 1

malathion external Tier 1

NATROBA Tier 3

OVIDE Tier 3

permethrin external cream Tier 1

SKLICE Tier 3

ULESFIA Tier 3

*WOUND CARE PRODUCTS**-*WOUND CARE - GROWTH FACTOR AGENTS***

REGRANEX Tier 3

*WOUND CARE PRODUCTS**-*WOUND CARE COMBINATIONS***

REGENECARE Tier 3

*WOUND CARE PRODUCTS**-*WOUND CLEANSERS/DECUBITUS ULCER THERAPY***

lavare wound wash Tier 3


91


*DIAGNOSTIC PRODUCTS*

*DIAGNOSTIC BIOLOGICALS**-*MULTIPLE SKIN TESTS***

T.R.U.E. TEST Tier 3

*DIAGNOSTIC DRUGS**-*DIAGNOSTIC DRUGS***

ARIDOL Tier 3

METOPIRONE Tier 3

PROVOCHOLINE Tier 3

THYROGEN Tier 4

*DIAGNOSTIC PRODUCTS, MISC.**-*DIAGNOSTIC PRODUCTS, MISC.***

HYSKON Tier 3

*DIAGNOSTIC TESTS**-*DIAGNOSTIC TESTS***

ACCU-CHEK ACTIVE Tier 3

ACCU-CHEK AVIVA IN VITRO STRIP Tier 3

ACCU-CHEK AVIVA PLUS IN VITRO Tier 3

ACCU-CHEK COMFORT CURVE IN VITRO STRIP

Tier 3

ACCU-CHEK COMPACT Tier 3

ACCU-CHEK COMPACT PLUS Tier 3

ACCU-CHEK COMPACT TEST DRUM Tier 3

ACCU-CHEK SMARTVIEW Tier 3

ACCUTREND GLUCOSE Tier 3

ACETEST Tier 3

active-medicated spec collect Tier 3

ACURA BLOOD GLUCOSE TEST Tier 3

ADVANCE INTUITION TEST Tier 3

ADVANCE MICRO-DRAW TEST Tier 3

ADVOCATE REDI-CODE IN VITRO Tier 3

ADVOCATE REDI-CODE+ TEST Tier 3

ADVOCATE TEST Tier 3

AGAMATRIX AMP TEST Tier 3

AGAMATRIX JAZZ TEST Tier 3

AGAMATRIX KEYNOTE TEST Tier 3

AGAMATRIX PRESTO TEST Tier 32016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)92


ALBUSTIX Tier 3

ASCENSIA AUTODISC TEST Tier 3

ASSURE 3 TEST Tier 3

ASSURE 4 TEST Tier 3

ASSURE II Tier 3

ASSURE II CHECK Tier 3

ASSURE PLATINUM Tier 3

ASSURE PRO TEST Tier 3

AT LAST TEST Tier 3

BAYER BREEZE 2 TEST Tier 3

BAYER CONTOUR NEXT TEST Tier 3

BAYER CONTOUR TEST Tier 3

BD TEST Tier 3

BG STAR TEST Tier 3

BIOSCANNER GLUCOSE TEST Tier 3

blood glucose test Tier 3

CAREONE BLOOD GLUCOSE TEST Tier 3

CARESENS N GLUCOSE TEST Tier 3

CHEK-STIX CONTROL Tier 3

CHEMSTRIP K Tier 3

CHEMSTRIP MICRAL Tier 3

CLEVER CHEK AUTO-CODE TEST Tier 3

CLEVER CHEK AUTO-CODE VOICE IN VITRO

Tier 3

CLEVER CHEK TEST Tier 3

CLEVER CHOICE AUTO-CODE TEST Tier 3

CLEVER CHOICE MICRO TEST Tier 3

CLINISTIX Tier 3

CLINITEST Tier 3

CONTROL AST Tier 3

CONTROL TEST Tier 3

DIASTIX Tier 3

diatrue plus test Tier 3

DUO-CARE TEST Tier 3

easy plus blood glucose test Tier 3

easy plus ii glucose test Tier 3

EASY STEP TEST Tier 3


93


easy talk blood glucose test Tier 3

EASY TOUCH TEST Tier 3

easy trak blood glucose test Tier 3

EASYGLUCO IN VITRO Tier 3

EASYMAX 15 TEST Tier 3

EASYMAX TEST Tier 3

easyplus blood glucose test Tier 3

EASYPRO BLOOD GLUCOSE TEST Tier 3

EASYPRO PLUS IN VITRO Tier 3

element compact test Tier 3

ELEMENT TEST Tier 3

EMBRACE BLOOD GLUCOSE TEST Tier 3

EMBRACE EVO BLOOD GLUCOSE TEST Tier 3

EMBRACE PRO GLUCOSE TEST Tier 3

EQL TRUETEST TEST Tier 3

EQL TRUETRACK TEST Tier 3

EVENCARE + BLOOD GLUCOSE TEST Tier 3

EVENCARE BLOOD GLUCOSE TEST Tier 3

EVENCARE G2 TEST Tier 3

EVENCARE G3 TEST Tier 3

EVOLUTION AUTOCODE IN VITRO Tier 3

EXACTECH R-S-G TEST Tier 3

EXACTECH TEST Tier 3

EZ SMART BLOOD GLUCOSE TEST Tier 3

EZ SMART PLUS GLUCOSE TEST Tier 3

FIFTY50 GLUCOSE TEST 2.0 Tier 3

FORA D10 BLOOD GLUCOSE TEST Tier 3

FORA D15G BLOOD GLUCOSE TEST Tier 3

FORA D20 BLOOD GLUCOSE TEST Tier 3

FORA G20 BLOOD GLUCOSE TEST Tier 3

FORA G30A BLOOD GLUCOSE TEST Tier 3

FORA GD20 TEST Tier 3

FORA V10 BLOOD GLUCOSE TEST Tier 3



FORA V30A BLOOD GLUCOSE TEST Tier 3

FORACARE GD40 TEST Tier 3



FORACARE PREMIUM V10 TEST Tier 3

FORACARE TEST N GO TEST Tier 3

FREESTYLE INSULINX TEST Tier 2

FREESTYLE LITE TEST Tier 2

FREESTYLE TEST Tier 2

ge100 blood glucose test Tier 3

GLUCO PERFECT 3 TEST Tier 3

GLUCOCARD 01 SENSOR PLUS Tier 3

GLUCOCARD EXPRESSION TEST Tier 3

GLUCOCARD SHINE TEST Tier 3 QL

GLUCOCARD VITAL TEST Tier 3

GLUCOCARD X-SENSOR Tier 3

GLUCOCOM TEST Tier 3

GLUCONAVII BLOOD GLUCOSE TEST Tier 3

GMATE BLOOD GLUCOSE TEST Tier 3

INFINITY BLOOD GLUCOSE TEST Tier 3

KETOCARE Tier 3

KETOSTIX Tier 3

kroger blood glucose test Tier 3

kroger premium glucose test Tier 3

kroger test Tier 3

LIBERTY NEXT GENERATION TEST Tier 3

liberty test Tier 3

MAXIMA BLOOD GLUCOSE TEST Tier 3

meijer blood glucose test Tier 3

meijer premium glucose test Tier 3

MEIJER TRUETEST TEST Tier 3

MEIJER TRUETRACK TEST Tier 3

MICRO-BUMINTEST Tier 3

MICRODOT TEST Tier 3

MYGLUCOHEALTH TEST Tier 3

NEUTEK 2TEK TEST Tier 3

NEXGEN TEST Tier 3

NOVA MAX GLUCOSE TEST Tier 3

ON CALL EXPRESS BLOOD GLUCOSE Tier 3

ON CALL PLUS BLOOD GLUCOSE Tier 3

ON CALL VIVID BLOOD GLUCOSE Tier 3


95


ONETOUCH ULTRA BLUE Tier 2

ONETOUCH VERIO IN VITRO STRIP Tier 2

OPTIUM TEST Tier 3

OPTIUMEZ TEST Tier 3

OPTUMRX BLOOD GLUCOSE TEST Tier 3

PHARMACIST CHOICE AUTOCODE Tier 3

POCKETCHEM EZ TEST Tier 3

PRECISION PCX Tier 2

PRECISION PCX PLUS TEST Tier 2

PRECISION POINT OF CARE TEST Tier 2

PRECISION QID TEST Tier 2

PRECISION SOF-TACT TEST Tier 2

PRECISION XTRA BLOOD GLUCOSE Tier 2

PRODIGY NO CODING BLOOD GLUC Tier 3

PTS PANELS GLUCOSE TEST Tier 3

QUICKTEK TEST Tier 3

QUINTET AC BLOOD GLUCOSE TEST Tier 3

QUINTET BLOOD GLUCOSE TEST Tier 3

RA TRUETEST TEST Tier 3

REFUAH PLUS BLOOD GLUCOSE TEST Tier 3

RELION BLOOD GLUCOSE TEST Tier 3

RELION CONFIRM/MICRO TEST Tier 3

RELION KETONE Tier 3

RELION PRIME TEST Tier 3

RELION ULTIMA TEST Tier 3

REVEAL BLOOD GLUCOSE TEST Tier 3

REXALL BLOOD GLUCOSE TEST Tier 3

RIGHTEST GS100 BLOOD GLUCOSE Tier 3



SMART DIABETES XPRES TEST Tier 3

SMART SENSE PREMIUM TEST Tier 3

SMART SENSE VALUE TEST Tier 3

SMARTEST BLOOD GLUCOSE TEST Tier 3

SOLUS V2 TEST Tier 3

SUPREME TEST Tier 3

SURE EDGE TEST Tier 3



SURECHEK BLOOD GLUCOSE TEST Tier 3

SURESTEP PRO TEST Tier 3

SURE-TEST EASYPLUS MINI TEST Tier 3

TELCARE BLOOD GLUCOSE TEST Tier 3

tgt blood glucose test Tier 3

TRUETEST TEST Tier 3

TRUETRACK TEST Tier 3

ULTIMA TEST Tier 3

ULTRATRAK PRO TEST Tier 3

ULTRATRAK ULTIMATE TEST Tier 3

UNISTRIP1 GENERIC Tier 3

VICTORY AGM-4000 TEST Tier 3

VOCAL POINT BLOOD GLUCOSE TEST Tier 3

WAVESENSE PRESTO Tier 3

*DIAGNOSTIC TESTS**-*MULTIPLE URINE TESTS***

CHEMSTRIP 10 MD Tier 3

CHEMSTRIP 10/SG Tier 3

CHEMSTRIP 2 GP Tier 3

CHEMSTRIP 5 OB Tier 3

CHEMSTRIP 7 Tier 3

CHEMSTRIP 9 Tier 3

CHEMSTRIP UGK Tier 3

COMBISTIX Tier 3

CVS KETONE CARE Tier 3

HEMA-COMBISTIX Tier 3

KETO-DIASTIX Tier 3

LABSTIX Tier 3

MULTISTIX Tier 3

MULTISTIX 10 SG Tier 3

MULTISTIX 5 Tier 3

MULTISTIX 7 Tier 3

MULTISTIX 8 Tier 3

MULTISTIX 9 Tier 3

MULTISTIX 9 SG Tier 3

URISTIX Tier 3

URISTIX 4 Tier 3


97


*RADIOGRAPHIC CONTRAST MEDIA**-*RADIOGRAPHIC CONTRAST MEDIA - BARIUM***

BAR-TEST Tier 3

DIGIBAR 190 Tier 3

ENTERO VU Tier 3

E-Z-CAT DRY Tier 3

E-Z-DISK Tier 3

E-Z-DOSE Tier 3

E-Z-HD Tier 3

E-Z-PAQUE Tier 3

E-Z-PASTE Tier 3

LIQUID E-Z-PAQUE Tier 3

LIQUID POLIBAR Tier 3

LIQUID POLIBAR PLUS Tier 3

MAXIBAR Tier 3

POLIBAR ACB Tier 3

READI-CAT Tier 3

READI-CAT 2 Tier 3

SITZMARKS Tier 3

TAGITOL V Tier 3

VARIBAR HONEY Tier 3

VARIBAR NECTAR Tier 3

VARIBAR PUDDING Tier 3

VARIBAR THIN HONEY Tier 3

VARIBAR THIN LIQUID Tier 3

VOLUMEN Tier 3

*RADIOGRAPHIC CONTRAST MEDIA**-*RADIOGRAPHIC CONTRAST MEDIA - IODINATED***

CYSTO-CONRAY II Tier 3

CYSTOGRAFIN-DILUTE Tier 3

GASTROGRAFIN Tier 3

MD-GASTROVIEW Tier 1

*RADIOGRAPHIC CONTRAST MEDIA**-*RADIOGRAPHIC CONTRAST MEDIA - IRON OXIDE***

GASTROMARK Tier 3



*DIGESTIVE AIDS*

*DIGESTIVE ENZYMES**-*DIGESTIVE ENZYMES***

CREON Tier 2

PANCREAZE Tier 3

PERTZYE Tier 3

SUCRAID Tier 4

ULTRESA Tier 3

VIOKACE Tier 3

ZENPEP Tier 2

*DIURETICS*

*CARBONIC ANHYDRASE INHIBITORS**-*CARBONIC ANHYDRASE INHIBITORS***

acetazolamide er Tier 1

acetazolamide oral tablet 250 mg Tier 1

DIAMOX SEQUELS Tier 3

KEVEYIS Tier 4 PA

methazolamide oral Tier 1

NEPTAZANE Tier 3

*DIURETIC COMBINATIONS**-*DIURETIC COMBINATIONS***

ALDACTAZIDE Tier 3

amiloride-hydrochlorothiazide Tier 1 LGC

DYAZIDE Tier 3

MAXZIDE Tier 3

MAXZIDE-25 Tier 3

spironolactone-hctz Tier 1

triamterene-hctz oral capsule 37.5-25 mg Tier 1 LGC

triamterene-hctz oral tablet Tier 1 LGC

*LOOP DIURETICS**-*LOOP DIURETICS***

bumetanide oral tablet 0.5 mg, 1 mg Tier 1 LGC

bumetanide oral tablet 2 mg Tier 1

DEMADEX Tier 3

EDECRIN Tier 3

furosemide oral solution 10 mg/ml, 40 mg/4ml Tier 1


99


furosemide oral tablet Tier 1 LGC

LASIX Tier 3

torsemide oral Tier 1

*OSMOTIC DIURETICS**-*OSMOTIC DIURETICS***

INTROL Tier 3

*POTASSIUM SPARING DIURETICS**-*POTASSIUM SPARING DIURETICS***

ALDACTONE Tier 3

amiloride hcl oral Tier 1

DYRENIUM Tier 3

spironolactone oral tablet 100 mg, 50 mg Tier 1

spironolactone oral tablet 25 mg Tier 1 LGC

*THIAZIDES AND THIAZIDE-LIKE DIURETICS**-*THIAZIDES AND THIAZIDE-LIKE DIURETICS***

chlorothiazide oral tablet 500 mg Tier 1

chlorthalidone oral tablet 25 mg, 50 mg Tier 1 LGC

DIURIL Tier 3

hydrochlorothiazide oral capsule Tier 1 LGC

hydrochlorothiazide oral tablet 12.5 mg Tier 1

hydrochlorothiazide oral tablet 25 mg, 50 mg Tier 1 LGC

indapamide oral Tier 1

metolazone Tier 1

MICROZIDE Tier 3

ZAROXOLYN Tier 3

*ENDOCRINE AND METABOLIC AGENTS - MISC.*

*BONE DENSITY REGULATORS**-*BISPHOSPHONATES***

ACTONEL Tier 3 #

alendronate sodium oral solution Tier 1

alendronate sodium oral tablet 10 mg, 35 mg, 5 mg

Tier 1

alendronate sodium oral tablet 70 mg Tier 1 LGC

ATELVIA Tier 2

BINOSTO Tier 3



BONIVA INTRAVENOUS* Tier 4 PA

BONIVA ORAL Tier 3

FOSAMAX Tier 3

FOSAMAX PLUS D Tier 3

ibandronate sodium intravenous* Tier 4 PA

ibandronate sodium oral Tier 1

pamidronate disodium Tier 4 PA

RECLAST Tier 4 PA

risedronate sodium Tier 1

zoledronic acid Tier 4 PA

ZOMETA Tier 4 PA

*BONE DENSITY REGULATORS**-*CALCITONINS***

calcitonin (salmon) Tier 1

MIACALCIN Tier 3

*BONE DENSITY REGULATORS**-*PARATHYROID HORMONE AND DERIVATIVES***

FORTEO Tier 4 PA

NATPARA Tier 4 PA

*BONE DENSITY REGULATORS**-*RANK LIGAND (RANKL) INHIBITORS***

PROLIA Tier 4 PA

XGEVA Tier 4 PA

*CORTICOTROPIN**-*CORTICOTROPIN***

HP ACTHAR Tier 4 PA

*FERTILITY REGULATORS**-*OVULATION STIMULANTS-GONADOTROPINS***

BRAVELLE Tier 4 PA

chorionic gonadotropin intramuscular* Tier 4 PA

FOLLISTIM AQ Tier 4 PA

GONAL-F Tier 4 PA

GONAL-F RFF Tier 4 PA

GONAL-F RFF PEN Tier 4 PA

GONAL-F RFF REDIJECT Tier 4 PA

MENOPUR Tier 4 PA

novarel Tier 4 PA2016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)

101


OVIDREL Tier 4 PA

pregnyl Tier 4 PA

REPRONEX Tier 4 PA

*FERTILITY REGULATORS**-*OVULATION STIMULANTS-SYNTHETIC***

clomiphene citrate oral Tier 1

SEROPHENE Tier 1

*GNRH/LHRH ANTAGONISTS**-*GNRH/LHRH ANTAGONISTS***

CETROTIDE Tier 4 PA

ganirelix acetate Tier 4 PA

*GROWTH HORMONE RECEPTOR ANTAGONISTS**-*GROWTH HORMONE RECEPTOR ANTAGONISTS***

SOMAVERT Tier 4 PA

*GROWTH HORMONES**-*GROWTH HORMONES***

GENOTROPIN Tier 4 PA

GENOTROPIN MINIQUICK Tier 4 PA

HUMATROPE Tier 4 PA

NORDITROPIN FLEXPRO SUBCUTANEOUS* SOLUTION 10 MG/1.5ML, 15 MG/1.5ML, 5 MG/1.5ML

Tier 4 PA

NORDITROPIN NORDIFLEX PEN Tier 4 PA

NUTROPIN Tier 4 PA

NUTROPIN AQ Tier 4 PA

NUTROPIN AQ NUSPIN 10 Tier 4 PA



NUTROPIN AQ PEN Tier 4 PA

OMNITROPE Tier 4 PA

SAIZEN Tier 4 PA

SAIZEN CLICK.EASY Tier 4 PA

SEROSTIM Tier 4 PA

TEV-TROPIN Tier 4 PA

ZOMACTON Tier 4 PA

ZORBTIVE Tier 4 PA



*HORMONE RECEPTOR MODULATORS**-*SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)***

EVISTA Tier 3

raloxifene hcl CE

*INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS)**-*INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS)***

INCRELEX Tier 4 PA

*LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS**-*LHRH/GNRH AGONIST ANALOG COMBINATIONS***

LUPANETA PACK Tier 4 PA

*LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS**-*LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS***

LUPRON DEPOT-PED Tier 4 PA

SUPPRELIN LA Tier 4 PA

SYNAREL Tier 4 PA

*METABOLIC MODIFIERS**-*CALCIMIMETIC AGENTS***

SENSIPAR Tier 4 PA

*METABOLIC MODIFIERS**-*CARNITINE REPLENISHER - AGENTS***

CARNITOR ORAL Tier 3

CARNITOR SF Tier 3

levocarnitine oral solution Tier 1

levocarnitine oral tablet Tier 1

*METABOLIC MODIFIERS**-*FABRY DISEASE - AGENTS***

FABRAZYME Tier 4 PA

*METABOLIC MODIFIERS**-*GAA DEFICIENCY TREATMENT - AGENTS***

LUMIZYME Tier 4 PA


103


MYOZYME Tier 4 PA

*METABOLIC MODIFIERS**-*HEREDITARY TYROSINEMIA TYPE 1 (HT-1) TREATMENT - AGENTS***

ORFADIN Tier 4 PA

*METABOLIC MODIFIERS**-*HOMOCYSTINURIA TREATMENT - AGENTS***

CYSTADANE Tier 4 PA

*METABOLIC MODIFIERS**-*HYPERAMMONEMIA TREATMENT - AGENTS***

CARBAGLU Tier 4 PA

*METABOLIC MODIFIERS**-*HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS***

calcitriol oral Tier 1

doxercalciferol oral Tier 4

HECTOROL Tier 4

paricalcitol Tier 4

ROCALTROL Tier 3

ZEMPLAR Tier 4

*METABOLIC MODIFIERS**-*LEPTIN ANALOGUES***

MYALEPT Tier 4 PA

*METABOLIC MODIFIERS**-*MUCOPOLYSACCHARIDOSIS I (MPS I) - AGENTS***

ALDURAZYME Tier 4 PA

*METABOLIC MODIFIERS**-*MUCOPOLYSACCHARIDOSIS II (MPS II) - AGENTS***

ELAPRASE Tier 4 PA

*METABOLIC MODIFIERS**-*MUCOPOLYSACCHARIDOSIS IV (MPS IV) - AGENTS***

VIMIZIM Tier 4 PA



*METABOLIC MODIFIERS**-*MUCOPOLYSACCHARIDOSIS VI (MPS VI) - AGENTS***

NAGLAZYME Tier 4 PA

*METABOLIC MODIFIERS**-*PHENYLKETONURIA TREATMENT - AGENTS***

KUVAN Tier 4 PA

*METABOLIC MODIFIERS**-*UREA CYCLE DISORDER - AGENTS***

AMMONUL Tier 4

BUPHENYL Tier 4 PA

RAVICTI Tier 4 PA

sodium phenylbutyrate oral Tier 4 PA

*POSTERIOR PITUITARY HORMONES**-*VASOPRESSIN***

DDAVP NASAL Tier 3 AL

DDAVP ORAL Tier 3

desmopressin ace rhinal tube Tier 1 AL

desmopressin ace spray refrig Tier 1 AL

desmopressin acetate oral Tier 1

desmopressin acetate spray Tier 1 AL

STIMATE Tier 3 PA; AL

*PROLACTIN INHIBITORS**-*DOPAMINE RECEPTOR AGONISTS***

cabergoline Tier 1

*SOMATOSTATIC AGENTS**-*SOMATOSTATIC AGENTS***

octreotide acetate Tier 4 PA

SANDOSTATIN Tier 4 PA

SANDOSTATIN LAR DEPOT Tier 4 PA

SIGNIFOR Tier 4 PA; QL

SIGNIFOR LAR Tier 4 PA; QL

SOMATULINE DEPOT Tier 4 PA

*VASOPRESSIN RECEPTOR ANTAGONISTS**-*SELECTIVE VASOPRESSIN V2-RECEPTOR ANTAGONISTS***

SAMSCA Tier 4 PA


105


*ESTROGENS*

*ESTROGEN COMBINATIONS**-*ESTROGEN & PROGESTIN***

ACTIVELLA Tier 3

ANGELIQ Tier 3

CLIMARA PRO Tier 3 #

COMBIPATCH Tier 3 #

estradiol-norethindrone acet Tier 1

FEMHRT LOW DOSE Tier 3

MIMVEY Tier 1

norethindrone-eth estradiol oral tablet 0.5-2.5 mg-mcg

Tier 1

PREFEST Tier 3

PREMPHASE Tier 2

PREMPRO Tier 2

*ESTROGEN COMBINATIONS**-*ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB***

DUAVEE Tier 2

*ESTROGENS**-*ESTROGENS***

ALORA Tier 3

CENESTIN ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG

Tier 3

CLIMARA Tier 3

DIVIGEL Tier 3

ELESTRIN Tier 3

ENJUVIA Tier 3

ESTRACE ORAL Tier 3

estradiol oral Tier 1 LGC

estradiol transdermal patch weekly Tier 1

ESTRASORB Tier 3 #

ESTROGEL Tier 3

estropipate oral tablet 0.75 mg, 1.5 mg Tier 1 LGC

EVAMIST Tier 3

MENEST Tier 3

MENOSTAR Tier 3

MINIVELLE Tier 32016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)106


ORTHO-EST 0.625 Tier 1

ORTHO-EST 1.25 Tier 1

PREMARIN ORAL Tier 2

VIVELLE-DOT Tier 2

*FLUOROQUINOLONES*

*FLUOROQUINOLONES**-*FLUOROQUINOLONES***

CIPRO ORAL SUSPENSION RECONSTITUTED

Tier 3 AL

CIPRO ORAL TABLET 250 MG, 500 MG Tier 3 AL

CIPRO XR Tier 3 AL

ciprofloxacin hcl oral Tier 1 AL

ciprofloxacin-ciproflox hcl er Tier 1 AL

FACTIVE Tier 3 #; AL

LEVAQUIN ORAL Tier 3 AL

levofloxacin oral Tier 1 AL

NOROXIN Tier 3 AL

ofloxacin oral tablet 400 mg Tier 1 AL

*GASTROINTESTINAL AGENTS - MISC.*

*BILE ACID SYNTHESIS DISORDER AGENTS**-*BILE ACID SYNTHESIS DISORDER AGENTS***

CHOLBAM Tier 4 PA

*GALLSTONE SOLUBILIZING AGENTS**-*GALLSTONE SOLUBILIZING AGENTS***

ACTIGALL Tier 3

CHENODAL Tier 3

URSO 250 Tier 3

URSO FORTE Tier 3

ursodiol oral Tier 1

*GASTROINTESTINAL ANTIALLERGY AGENTS**-*GASTROINTESTINAL ANTIALLERGY AGENTS***

cromolyn sodium oral Tier 1

GASTROCROM Tier 3


107


*GASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS**-*GASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS***

AMITIZA Tier 2

*GASTROINTESTINAL STIMULANTS**-*GASTROINTESTINAL STIMULANTS***

metoclopramide hcl oral solution 10 mg/10ml Tier 1

metoclopramide hcl oral solution 5 mg/5ml Tier 1 LGC

metoclopramide hcl oral tablet 10 mg Tier 1 LGC

metoclopramide hcl oral tablet 5 mg Tier 1

metoclopramide hcl oral tablet dispersible Tier 1

METOZOLV ODT ORAL TABLET DISPERSIBLE 5 MG

Tier 3

REGLAN ORAL Tier 3

*INFLAMMATORY BOWEL AGENTS**-*INFLAMMATORY BOWEL AGENTS***

APRISO Tier 2

ASACOL HD Tier 2 #

AZULFIDINE Tier 3

AZULFIDINE EN-TABS Tier 3

balsalazide disodium Tier 1

CANASA Tier 2

COLAZAL Tier 3

DELZICOL Tier 2

DIPENTUM Tier 3

GIAZO Tier 3

LIALDA Tier 2

mesalamine enema Tier 1

PENTASA Tier 2

SFROWASA Tier 3

sulfasalazine oral Tier 1

SULFAZINE Tier 1

SULFAZINE EC Tier 1



*INFLAMMATORY BOWEL AGENTS**-*INTEGRIN RECEPTOR ANTAGONISTS***

ENTYVIO Tier 4 PA

*INFLAMMATORY BOWEL AGENTS**-*TUMOR NECROSIS FACTOR ALPHA BLOCKERS***

CIMZIA Tier 4 PA; QL

CIMZIA PREFILLED Tier 4 PA; QL

CIMZIA STARTER KIT Tier 4 PA; QL

REMICADE Tier 4 PA

*INTESTINAL ACIDIFIERS**-*INTESTINAL ACIDIFIERS***

enulose Tier 1 LGC

generlac Tier 1

lactulose encephalopathy Tier 1

*IRRITABLE BOWEL SYNDROME (IBS) AGENTS**-*IBS AGENT - GUANYLATE CYCLASE-C (GC-C) AGONISTS***

LINZESS Tier 2

*IRRITABLE BOWEL SYNDROME (IBS) AGENTS**-*IBS AGENT - SELECTIVE 5-HT3 RECEPTOR ANTAGONISTS***

alosetron hcl Tier 1

LOTRONEX Tier 3

*PERIPHERAL OPIOID RECEPTOR ANTAGONISTS**-*PERIPHERAL OPIOID RECEPTOR ANTAGONISTS***

MOVANTIK Tier 3

RELISTOR Tier 2

*PHOSPHATE BINDER AGENTS**-*PHOSPHATE BINDER AGENTS***

AURYXIA Tier 3

calcium acetate (phos binder) Tier 1

calcium acetate oral capsule Tier 1

ELIPHOS Tier 3

FOSRENOL Tier 2

PHOSLO Tier 3


109


PHOSLYRA Tier 2

RENAGEL Tier 3 #

RENVELA Tier 2

VELPHORO Tier 3

*SHORT BOWEL SYNDROME (SBS) AGENTS**-*GLUCAGON-LIKE PEPTIDE-2 (GLP-2) ANALOGS***

GATTEX Tier 4 PA

*GENERAL ANESTHETICS*

*VOLATILE ANESTHETICS**-*VOLATILE ANESTHETICS***

FORANE Tier 3

isoflurane Tier 1

sevoflurane Tier 1

SOJOURN Tier 1

SUPRANE Tier 3

TERRELL Tier 1

ULTANE Tier 3

*GENITOURINARY AGENTS - MISCELLANEOUS*

*ACIDIFIERS**-*PHOSPHATES***

K-PHOS NO 2 Tier 3

*ALKALINIZERS**-*CITRATES***

citric acid-sodium citrate Tier 1

cytra k crystals Tier 1

cytra-2 Tier 1

CYTRA-3 Tier 3

cytra-k Tier 3

ORACIT Tier 3

potassium citrate-citric acid oral packet Tier 1

potassium citrate-citric acid oral solution Tier 3

TARON-CRYSTALS Tier 1

UROCIT-K 10 Tier 3

UROCIT-K 5 Tier 3

*CYSTINOSIS AGENTS**-*CYSTINOSIS AGENTS***

CYSTAGON Tier 3



PROCYSBI ORAL CAPSULE DELAYED RELEASE 25 MG, 75 MG

Tier 4 PA; QL

*GENITOURINARY IRRIGANTS**-*ANTI-INFECTIVE GENITOURINARY IRRIGANTS***

neomycin-polymyxin b gu Tier 1

NEOSPORIN GU IRRIGANT Tier 3

*GENITOURINARY IRRIGANTS**-*GENITOURINARY IRRIGANTS***

acetic acid irrigation Tier 1

aminoacetic acid Tier 1

ARGYLE STERILE SALINE Tier 1

CURITY STERILE SALINE Tier 1

glycine irrigation Tier 1

glycine urologic Tier 1

RENACIDIN Tier 3

RESECTISOL Tier 3

sodium chloride irrigation Tier 1

*INTERSTITIAL CYSTITIS AGENTS**-*INTERSTITIAL CYSTITIS AGENTS***

ELMIRON Tier 2

*PROSTATIC HYPERTROPHY AGENTS**-*5-ALPHA REDUCTASE INHIBITORS***

AVODART Tier 2 #

finasteride oral tablet 5 mg Tier 1

PROSCAR Tier 3

*PROSTATIC HYPERTROPHY AGENTS**-*ALPHA 1-ADRENOCEPTOR ANTAGONISTS***

alfuzosin hcl er Tier 1

CARDURA XL Tier 3

FLOMAX Tier 3

RAPAFLO Tier 2

tamsulosin hcl Tier 1 LGC

UROXATRAL Tier 3


111


*PROSTATIC HYPERTROPHY AGENTS**-*PROSTATIC HYPERTROPHY AGENT COMBINATIONS***

JALYN Tier 2 #

*URINARY ANALGESICS**-*URINARY ANALGESICS***

PHENAZO ORAL TABLET 200 MG Tier 1

phenazopyridine hcl oral tablet 100 mg Tier 1 LGC

phenazopyridine hcl oral tablet 200 mg Tier 1

*URINARY STONE AGENTS**-*URINARY STONE AGENTS***

LITHOSTAT Tier 3

THIOLA Tier 3

*GOUT AGENTS*

*GOUT AGENT COMBINATIONS**-*GOUT AGENT COMBINATIONS***

colchicine-probenecid Tier 1

*GOUT AGENTS**-*GOUT AGENTS***

allopurinol oral Tier 1 LGC

colchicine oral tablet Tier 1

COLCRYS Tier 2

KRYSTEXXA Tier 4 PA

MITIGARE Tier 3

ULORIC Tier 3

ZYLOPRIM Tier 3

*URICOSURICS**-*URICOSURICS***

probenecid oral Tier 1

*HEMATOLOGICAL AGENTS - MISC.*

*ANTIHEMOPHILIC PRODUCTS**-*ANTIHEMOPHILIC PRODUCTS***

ADVATE Tier 4 PA

ALPHANATE/VWF COMPLEX/HUMAN Tier 4 PA

ALPHANINE SD Tier 4 PA

ALPROLIX Tier 4 PA

BEBULIN Tier 4 PA

BEBULIN VH Tier 4 PA

BENEFIX Tier 4 PA



CORIFACT Tier 4 PA

ELOCTATE Tier 4 PA

FEIBA Tier 4 PA

FEIBA NF Tier 4 PA

FEIBA VH IMMUNO Tier 4 PA

HELIXATE FS Tier 4 PA

HEMOFIL M Tier 4 PA

HUMATE-P Tier 4 PA

IXINITY INTRAVENOUS* SOLUTION RECONSTITUTED 1500 UNIT

Tier 4 PA

KCENTRA INTRAVENOUS* KIT 500 UNIT Tier 3

KOATE-DVI Tier 4 PA

KOGENATE FS Tier 4 PA

KOGENATE FS BIO-SET Tier 4 PA

MONOCLATE-P Tier 4 PA

MONONINE Tier 4 PA

NOVOEIGHT Tier 4 PA

NOVOSEVEN RT Tier 4 PA

PROFILNINE SD Tier 4 PA

RECOMBINATE Tier 4 PA

RIASTAP Tier 4 PA

RIXUBIS Tier 4 PA

TRETTEN Tier 4 PA

WILATE INTRAVENOUS* SOLUTION RECONSTITUTED 1000-1000 UNIT, 500-500 UNIT

Tier 4 PA

XYNTHA Tier 4 PA

XYNTHA SOLOFUSE Tier 4 PA

*BRADYKININ B2 RECEPTOR ANTAGONISTS**-*BRADYKININ B2 RECEPTOR ANTAGONISTS***

FIRAZYR Tier 4 PA

*COMPLEMENT INHIBITORS**-*C1 INHIBITORS***

BERINERT Tier 4 PA

CINRYZE Tier 4 PA

RUCONEST Tier 4 PA


113


*COMPLEMENT INHIBITORS**-*COMPLEMENT INHIBITORS***

SOLIRIS Tier 4 PA

*HEMATORHEOLOGIC AGENTS**-*HEMATORHEOLOGIC AGENTS***

pentoxifylline er Tier 1

*PLASMA KALLIKREIN INHIBITORS**-*PLASMA KALLIKREIN INHIBITORS***

KALBITOR Tier 4 PA

*PLATELET AGGREGATION INHIBITORS**-*DIRECT-ACTING P2Y12 INHIBITORS***

BRILINTA Tier 2

*PLATELET AGGREGATION INHIBITORS**-*PHOSPHODIESTERASE III INHIBITORS***

cilostazol Tier 1

PLETAL Tier 3

*PLATELET AGGREGATION INHIBITORS**-*PLATELET AGGREGATION INHIBITOR COMBINATIONS***

AGGRENOX Tier 2 #

aspirin-dipyridamole er Tier 1

*PLATELET AGGREGATION INHIBITORS**-*PLATELET AGGREGATION INHIBITORS***

dipyridamole oral Tier 1

PERSANTINE Tier 3

*PLATELET AGGREGATION INHIBITORS**-*QUINAZOLINE AGENTS***

AGRYLIN Tier 3

anagrelide hcl Tier 1

*PLATELET AGGREGATION INHIBITORS**-*THIENOPYRIDINE DERIVATIVES***

clopidogrel bisulfate Tier 1



EFFIENT Tier 2

PLAVIX Tier 3

ticlopidine hcl Tier 1

*HEMATOPOIETIC AGENTS*

*AGENTS FOR GAUCHER DISEASE**-*AGENTS FOR GAUCHER DISEASE***

CERDELGA Tier 4 PA; QL

CEREZYME INTRAVENOUS* SOLUTION RECONSTITUTED 200 UNIT

Tier 4

CEREZYME INTRAVENOUS* SOLUTION RECONSTITUTED 400 UNIT

Tier 4 PA

ELELYSO Tier 4 PA

VPRIV Tier 4 PA

ZAVESCA Tier 4 PA; #

*AGENTS FOR SICKLE CELL ANEMIA**-*CYTOTOXIC AGENTS***

DROXIA Tier 3

*COBALAMINS**-*COBALAMINS***

NASCOBAL Tier 3

*FOLIC ACID/FOLATES**-*FOLIC ACID/FOLATES***

folic acid oral tablet 1 mg CE LGC

folic acid oral tablet 400 mcg, 800 mcg CE

*HEMATOPOIETIC GROWTH FACTORS**-*ERYTHROPOIESIS-STIMULATING AGENTS (ESAS)***

ARANESP (ALBUMIN FREE) INJECTION SOLUTION

Tier 4 PA

EPOGEN Tier 4 PA

OMONTYS Tier 4 PA

PROCRIT Tier 4 PA

*HEMATOPOIETIC GROWTH FACTORS**-*GRANULOCYTE COLONY-STIMULATING FACTORS (G-CSF)***

GRANIX Tier 4 PA

NEUPOGEN INJECTION SOLUTION Tier 4 PA

ZARXIO Tier 4 PA


115


*HEMATOPOIETIC GROWTH FACTORS**-*GRANULOCYTE/MACROPHAGE COLONY-STIMULATING FACTOR(GM-CSF)***

LEUKINE Tier 4 PA

*HEMATOPOIETIC GROWTH FACTORS**-*INTERLEUKINS***

NEUMEGA Tier 4 PA

*HEMATOPOIETIC GROWTH FACTORS**-*THROMBOPOIETIN (TPO) RECEPTOR AGONISTS***

NPLATE Tier 4 PA

PROMACTA Tier 4 PA

*HEMATOPOIETIC MIXTURES**-*COBALAMIN COMBINATIONS***

neurin-sl Tier 3

*HEMATOPOIETIC MIXTURES**-*FOLIC ACID/FOLATE COMBINATIONS***

AIRAVITE Tier 1

ANIMI-3 Tier 3

ANIMI-3/VITAMIN D Tier 3

bp vit 3 Tier 3

CENFOL Tier 3

DIVISTA Tier 3

fabb Tier 1

fa-cyanocobalamin-pyridoxine Tier 1

fa-vitamin b-6-vitamin b-12 Tier 1

folbee Tier 1

folplex 2.2 Tier 1

NUFOL Tier 1

PRE-FOLIC Tier 3

revesta Tier 3

tl gard rx Tier 1

virt-vite Tier 1

*HEMATOPOIETIC MIXTURES**-*IRON COMBINATIONS***

active fe Tier 3

ALBAFORT INTRAMUSCULAR* SOLUTION Tier 3



CENTRATEX Tier 3

CORVITA 150 Tier 1

ED CYTE F Tier 3

FERIVA Tier 3

FERIVAFA Tier 3

ferocon Tier 1

ferotrinsic Tier 1

ferrex 150 forte Tier 1

FERREX 150 FORTE PLUS Tier 3

FERROCITE PLUS Tier 1

FERROGELS FORTE Tier 1

FERRO-PLEX HEMATINIC Tier 3

FERROTRIN Tier 3

FOLIVANE-PLUS Tier 3

foltrin Tier 1

FUSION PLUS Tier 3

hematinic plus complex Tier 1

hematinic plus vit/minerals Tier 1

HEMATOGEN FA Tier 3

HEMATOGEN FORTE Tier 1

HEMOCYTE PLUS Tier 3

hemocyte-plus Tier 1

IFEREX 150 FORTE Tier 1

INTEGRA PLUS Tier 3

IROSPAN 24/6 Tier 3

MAXARON FORTE ORAL TABLET Tier 3

MULTIGEN Tier 3

MULTIGEN FOLIC Tier 3

MULTIGEN PLUS Tier 3

myferon 150 forte Tier 1

NEPHRON FA Tier 3

NOVAFERRUM Tier 3

poly-iron 150 forte Tier 1

polysaccharide iron forte Tier 1

PROTECTIRON Tier 3

purefe plus Tier 3

purevit dualfe plus Tier 1


117


se-tan plus Tier 1

taron forte Tier 3

tl icon Tier 1

TRICON Tier 1

trigels-f forte Tier 1

*HEMATOPOIETIC MIXTURES**-*IRON W/ FOLIC ACID***

FOLIVANE-F Tier 3

hematinic/folic acid Tier 1

HEMOCYTE-F ORAL TABLET Tier 1

INTEGRA F Tier 3

PROFERRIN-FORTE Tier 3

TANDEM F Tier 3

*HEMATOPOIETIC MIXTURES**-*IRON-B12-FOLATE***

BIFERARX Tier 3

fe 90 plus Tier 3

FERRALET 90 Tier 3

ferraplus 90 Tier 3

FERREX 28 Tier 3

hemetab Tier 3

NATALVIRT FLT Tier 3

*IRON**-*IRON***

FER-IN-SOL CE

fer-iron CE

FERRLECIT Tier 4

ferrous sulfate oral solution CE

na ferric gluc cplx in sucrose Tier 4

VENOFER Tier 4

*HEMOSTATICS*

*HEMOSTATICS - SYSTEMIC**-*HEMOSTATICS - SYSTEMIC***

AMICAR Tier 3

aminocaproic acid oral syrup Tier 1

aminocaproic acid oral tablet 500 mg Tier 1

LYSTEDA Tier 3

tranexamic acid oral Tier 1



*HEMOSTATICS - TOPICAL**-*HEMOSTATIC COMBINATIONS - TOPICAL***

ARTISS Tier 3

EVICEL Tier 3

TISSEEL VH Tier 3

TISSEEL VHSD Tier 3

*HEMOSTATICS - TOPICAL**-*HEMOSTATICS - TOPICAL***

monsels ferric subsulfate Tier 3

*HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS*

*BARBITURATE HYPNOTICS**-*BARBITURATE HYPNOTICS***

BUTISOL SODIUM Tier 3

phenobarbital oral elixir Tier 1

phenobarbital oral solution Tier 1

phenobarbital oral tablet 16.2 mg, 32.4 mg Tier 1

SECONAL Tier 3

*HYPNOTICS - TRICYCLIC AGENTS**-*HYPNOTICS - TRICYCLIC AGENTS***

SILENOR Tier 3

*NON-BARBITURATE HYPNOTICS**-*BENZODIAZEPINE HYPNOTICS***

DORAL Tier 3

estazolam Tier 1

flurazepam hcl Tier 1

HALCION Tier 3

midazolam hcl oral Tier 1

RESTORIL Tier 3

temazepam Tier 1

triazolam Tier 1

*NON-BARBITURATE HYPNOTICS**-*NON-BENZODIAZEPINE - GABA-RECEPTOR MODULATORS***

AMBIEN Tier 3


119


AMBIEN CR Tier 3

EDLUAR Tier 3

eszopiclone Tier 1

INTERMEZZO Tier 3

LUNESTA Tier 3

SONATA Tier 3

zaleplon Tier 1

zolpidem tartrate Tier 1

zolpidem tartrate er Tier 1

ZOLPIMIST Tier 3

*OREXIN RECEPTOR ANTAGONISTS**-*OREXIN RECEPTOR ANTAGONISTS***

BELSOMRA Tier 3

*SELECTIVE MELATONIN RECEPTOR AGONISTS**-*SELECTIVE MELATONIN RECEPTOR AGONISTS***

HETLIOZ Tier 4 PA

ROZEREM Tier 3

*LAXATIVES*

*LAXATIVE COMBINATIONS**-*BOWEL EVACUANT COMBINATIONS***

COLYTE WITH FLAVOR PACKS ORAL SOLUTION RECONSTITUTED 227.1 GM

Tier 3

GAVILYTE-C Tier 1

GAVILYTE-G Tier 1

GAVILYTE-N WITH FLAVOR PACK Tier 1

GOLYTELY Tier 3

MOVIPREP Tier 2

NULYTELY WITH FLAVOR PACKS Tier 3

peg 3350/electrolytes Tier 1

peg 3350-kcl-na bicarb-nacl Tier 1

peg-3350/electrolytes Tier 1

PREPOPIK Tier 3

SUCLEAR Tier 3

SUPREP BOWEL PREP Tier 2

TRILYTE Tier 1



*LAXATIVES - MISCELLANEOUS**-*LAXATIVES - MISCELLANEOUS***

CLEARLAX ORAL POWDER Tier 1 LGC

constulose Tier 1

gavilax oral packet CE

KRISTALOSE Tier 3

lactulose oral solution 10 gm/15ml Tier 1 LGC

lactulose oral solution 20 gm/30ml Tier 1

MIRALAX ORAL POWDER Tier 1 Select OTC

polyethylene glycol 3350 oral powder Tier 1 Select OTC

*SALINE LAXATIVES**-*SALINE LAXATIVE MIXTURES***

OSMOPREP Tier 3

*MACROLIDES*

*AZITHROMYCIN**-*AZITHROMYCIN***

azithromycin oral suspension reconstituted Tier 1

azithromycin oral tablet Tier 1

ZITHROMAX ORAL Tier 3

ZITHROMAX TRI-PAK Tier 3

ZITHROMAX Z-PAK Tier 3

ZMAX Tier 3

*CLARITHROMYCIN**-*CLARITHROMYCIN***

BIAXIN Tier 3

BIAXIN XL Tier 3

BIAXIN XL PAC Tier 3

clarithromycin er Tier 1

clarithromycin oral Tier 1

*ERYTHROMYCINS**-*ERYTHROMYCINS***

E.E.S. 400 Tier 3

E.E.S. GRANULES Tier 3

ERYPED 200 Tier 3

ERYPED 400 Tier 3

ERY-TAB Tier 3

ERYTHROCIN STEARATE Tier 3


121


erythromycin base oral capsule delayed release particles

Tier 1

PCE Tier 3

*FIDAXOMICIN**-*FIDAXOMICIN***

DIFICID Tier 3

*MEDICAL DEVICES AND SUPPLIES*

*CONTRACEPTIVES**-*CERVICAL CAPS***

FEMCAP CE

PRENTIF CAVITY-RIM CERV CAP Tier 3

PRENTIF FITTING SET Tier 3

*CONTRACEPTIVES**-*CONDOMS - FEMALE***

FC FEMALE CONDOM CE

FC2 FEMALE CONDOM Tier 3

*CONTRACEPTIVES**-*DIAPHRAGMS***

OMNIFLEX DIAPHRAGM Tier 3

ORTHO DIAPHRAGM COIL Tier 3

ORTHO DIAPHRAGM FLAT Tier 3

WIDE-SEAL DIAPHRAGM 60 CE








*DIABETIC SUPPLIES**-*GLUCOSE MONITORING TEST SUPPLIES***

1st choice lancets super thin Tier 1

1st choice lancets thin Tier 1

1st choice lancets ultra thin Tier 1

1st tier unilet comfortouch Tier 3

ACCU-CHEK ACTIVE GLUCOSE CONT Tier 3

ACCU-CHEK AVIVA IN VITRO SOLUTION Tier 3

ACCU-CHEK COMFORT CURVE IN VITRO SOLUTION

Tier 3

ACCU-CHEK COMFORT CURVE LINEAR Tier 3



ACCU-CHEK COMPACT BLUE CONTROL Tier 3

ACCU-CHEK COMPACT PLUS CONTROL Tier 3

ACCU-CHEK FASTCLIX LANCET Tier 3

ACCU-CHEK FASTCLIX LANCETS Tier 3

ACCU-CHEK INSTANT CONTROL Tier 3

ACCU-CHEK MULTICLIX LANCET DEV Tier 3

ACCU-CHEK MULTICLIX LANCETS Tier 3

ACCU-CHEK SAFE-T PRO LANCETS Tier 3

ACCU-CHEK SMARTVIEW CONTROL Tier 3

ACCU-CHEK SOFT TOUCH LANCETS Tier 3

ACCU-CHEK SOFTCLIX LANCET DEV Tier 3

ACCU-CHEK SOFTCLIX LANCETS Tier 3

ACCUTREND GLUCOSE CONTROL Tier 3

acti-lance 28g Tier 3

acti-lance lite lancets 28g Tier 1

acti-lance special lancets 17g Tier 1

acti-lance universal 23g Tier 3

ACURA CONTROL Tier 3

adjustable lancing device Tier 3

ADVANCE INTUITION CONTROL Tier 3

ADVANCE MICRO-DRAW CONTROL Tier 3

ADVANCE MICRO-DRAW NORMAL Tier 3

ADVOCATE CONTROL SOLUTION Tier 3

ADVOCATE LANCETS Tier 3

ADVOCATE LANCING DEVICE Tier 3

ADVOCATE RAPID-SAFE LANCING Tier 3

ADVOCATE REDI-CODE+ CONTROL Tier 3

ADVOCATE SAFETY LANCETS Tier 3

af lancets super thin Tier 1

AGAMATRIX CONTROL Tier 3

AGAMATRIX ULTRA-THIN LANCETS Tier 3

alternate site lancing device Tier 3

aqua lance adjustable lancing Tier 3

ASCENSIA AUTODISC CONTROL Tier 3

ASCENSIA AUTODISC CONTROLS Tier 3

ASSURE 3 CONTROL Tier 3

ASSURE 4 CONTROL LEVEL 1 & 2 Tier 3


123


assure comfort lancets 28g Tier 1

assure comfort lancets 30g Tier 1

ASSURE DOSE CONTROL Tier 3

ASSURE DOSE NORM/HIGH CONTROL Tier 3

ASSURE HAEMOLANCE PLUS HIGH Tier 3

ASSURE HAEMOLANCE PLUS LOW Tier 3

ASSURE HAEMOLANCE PLUS MICRO Tier 3

ASSURE HAEMOLANCE PLUS NORMAL Tier 3

ASSURE HAEMOLANCE PLUS PED Tier 3

ASSURE II CONTROL Tier 3

ASSURE II CONTROL LEVEL 1 & 2 Tier 3

ASSURE LANCE LANCETS Tier 3

ASSURE LANCETS Tier 3

ASSURE PRO CONTROL LEVEL 1 & 2 Tier 3

AT LAST CONTROL Tier 3

AT LAST LANCETS Tier 3

aurora lancet super thin 30g Tier 3

aurora lancet thin 23g Tier 3

AUTO-LANCET Tier 3

AUTO-LANCET MINI Tier 3

AUTOLET II CLINISAFE Tier 3

AUTOLET IMPRESSION Tier 3

AUTOLET LANCING DEVICE Tier 3

AUTOLET LITE CLINISAFE Tier 3

AUTOLET LITE STARTER PACK Tier 3

AUTOLET MINI Tier 3

AUTOLET PLATFORMS Tier 3

BAYER BREEZE 2 CONTROL Tier 3

BAYER CONTOUR Tier 3

BAYER CONTOUR NEXT CONTROL Tier 3

BAYER MICROLET 2 LANCING DEVIC Tier 3

BAYER MICROLET LANCETS Tier 3

BD LANCET DEVICE Tier 3

BD LANCET ULTRAFINE 30G Tier 3

BD LANCET ULTRAFINE 33G Tier 3

BD MICROTAINER LANCETS Tier 3

BD ULTRA-FINE LANCETS Tier 3



bullseye mini safety lancets Tier 1

BULLSEYE SAFETY LANCETS Tier 3

CARDIOCOM LANCING DEVICE Tier 3

careone advanced lancing dev Tier 3

careone lancet thin 23g Tier 3

careone lancet ultra thin 28g Tier 3

CARESENS CONTROL A Tier 3

CLEANLET LANCETS 28G Tier 3

CLEVER CHEK LANCETS Tier 3

CLEVER CHOICE GLUCOSE CONTROL Tier 3

CLOSERCARE Tier 3

COAGUCHEK LANCETS Tier 3

comfort assured lancets 28g Tier 1

comfort assured lancets 33g Tier 1

comfort lancets Tier 1

control Tier 3

cvs lancets 21g Tier 1

cvs lancets micro thin 33g Tier 1

cvs lancets original Tier 1

cvs lancets thin Tier 1

cvs lancets thin 26g Tier 1

cvs lancets ultra thin 30g Tier 1

cvs lancing device Tier 3

cvs ultra thin lancets Tier 1

DIASTAR EASY TEST II LANCETS Tier 3

DIASTAR EASY TEST LANCETS Tier 3

diatrue control level 1 Tier 3



DROPLET LANCETS ULTRA THIN 30G Tier 3

DROPLET LANCING DEVICE Tier 3

drug mart lancets thin 26g Tier 1

drug mart lancets ultra thin Tier 1

DRUG MART LANCING DEVICE Tier 3

DRUG MART ON-THE-GO LANCET 30G Tier 3

DRUG MART UNILET LANCETS 28G Tier 3

DRUG MART UNILET LANCETS 30G Tier 3


125


duane reade lancet altern site Tier 3

duane reade lancet super thin Tier 3

duane reade lancet ultra thin Tier 3

DUO-CARE CONTROL SOLUTION Tier 3

easy comfort lancets Tier 1

easy mini lancing device Tier 3

easy plus ii control Tier 3

EASY STEP CONTROL Tier 3

easy talk control Tier 3

EASY TOUCH CONTROL HIGH & LOW Tier 3

EASY TOUCH LANCETS 21G Tier 3




EASY TOUCH LANCETS 28G/TWIST Tier 3






EASY TOUCH LANCING DEVICE Tier 3

EASY TOUCH SAFETY LANCETS 21G Tier 3




easy trak control Tier 3

EASY TWIST & CAP LANCETS Tier 3

EASYGLUCO CONTROL Tier 3

EASYMAX 15 LEVEL 1 CONTROL Tier 3

EASYMAX 15 LEVEL 2 CONTROL Tier 3

EASYMAX CONTROL Tier 3

EASYTEST II LANCETS Tier 3

EASYTEST LANCETS Tier 3

element compact control 2 Tier 3

element compact control 3 Tier 3

ELEMENT CONTROL Tier 3

EMBRACE CONTROL Tier 3



eql color lancets 21g Tier 1

eql color lancets micro 33g Tier 1

eql super thin lancets 30g Tier 1

eql thin lancets 26g Tier 1

EVENCARE CONTROL LOW/HIGH Tier 3

EVENCARE G2 LOW/HIGH CONTROL Tier 3

EVENCARE G3 LOW/HIGH CONTROL Tier 3

EVOLUTION CONTROL Tier 3

E-Z JECT LANCET MICRO-THIN 33G Tier 3

E-Z JECT LANCET SUPER THIN 30G Tier 3

E-Z JECT LANCETS Tier 3

E-Z JECT LANCETS 21G Tier 3

E-Z JECT LANCETS THIN 26G Tier 3

EZ SMART BLOOD GLUCOSE LANCETS Tier 3

EZ-LETS LANCETS 21G Tier 3





FIFTY50 CONTROL 2.0 Tier 3

FIFTY50 LANCING DEVICE Tier 3

FIFTY50 SAFETY SEAL LANCETS Tier 3

FINE 30 Tier 3

FINGERSTIX LANCETS Tier 3

FORA CONTROL Tier 3

FORA LANCETS Tier 3

FORA LANCING DEVICE Tier 3

FORACARE GDH CONTROL Tier 3

freds pharmacy autolet lancing Tier 3

freds pharmacy unilet lanc 28g Tier 3

freds pharmacy unilet lanc 30g Tier 3

FREESTYLE CONTROL SOLUTION Tier 3

FREESTYLE LANCETS Tier 3

FREESTYLE UNISTICK II LANCETS Tier 3

ge100 control Tier 3

GENTLE-LET GP LANCETS Tier 3

GENTLE-LET LANCETS Tier 3


127


GENTLE-LET PLATFORMS Tier 3

global inject ease lancets 28g Tier 1

global inject ease lancets 30g Tier 1

global lancing device Tier 3

GLUCOCARD 01 CONTROL Tier 3

GLUCOCARD EXPRESSION CONTROL Tier 3

GLUCOCARD SHINE Tier 3

GLUCOCARD SHINE CONTROL Tier 3

GLUCOCARD X-SENSOR CONTROL Tier 3

GLUCOCOM CONTROL Tier 3

GLUCOCOM LANCETS 28G Tier 3



GLUCOLET 2 AUTOMATIC LANCING Tier 3

glucose control Tier 3

GLUCOSOURCE LANCET DEVICE Tier 3

GLUCOSOURCE LANCETS Tier 3

GMATE CONTROL LEVEL 2 Tier 3

gnp lancets Tier 1

gnp lancets 21g Tier 1

gnp lancets micro thin 33g Tier 1

gnp lancets super thin 30g Tier 1

gnp lancets thin Tier 1

gnp lancets thin 26g Tier 1

gnp micro thin lancets 33g Tier 1

gnp super thin lancets 30g Tier 1

H&H THINLET LANCETS 26G Tier 3

H&H THINLET LANCETS 30G Tier 3

HAEMOLANCE Tier 3

HAEMOLANCE LOW FLOW LANCETS Tier 3

HAEMOLANCE PLUS Tier 3

HAEMOLANCE PLUS HIGH FLOW Tier 3

HAEMOLANCE PLUS LOW FLOW Tier 3

HAEMOLANCE PLUS MAX FLOW Tier 3

HAEMOLANCE PLUS PEDIATRIC FLOW Tier 3

HEALTH CARE LANCING DEVICE Tier 3

healthwise lancets 30g Tier 1



healthwise lancing pen Tier 3

healthy accents lancing device Tier 3

healthy accents unilet lancets Tier 1

h-e-b incontrol adv lancing Tier 3

h-e-b incontrol lancets 28g Tier 1

h-e-b incontrol lancets 30g Tier 1

hm lancets micro thin 33g Tier 1

hm lancets ultra thin 30g Tier 1

HYPOLANCE AST LANCING Tier 3

HY-VEE LANCETS Tier 3

hy-vee thin lancets Tier 1

INFINITY CONTROL Tier 3

kinney lancets Tier 1

kinney thin lancets Tier 1

kroger lancets Tier 1

kroger lancets 21g Tier 1

kroger lancets micro thin 33g Tier 1

kroger lancets super thin Tier 1

kroger lancets thin Tier 1

kroger lancets thin 26g Tier 1

kroger lancets ultrathin 30g Tier 1

kroger lancing device Tier 3

lady lite lancets Tier 1

lancet device Tier 3

lancets Tier 1

lancets 28g Tier 1

lancets 30g Tier 1

lancets micro thin 33g Tier 1

lancets super thin 28g Tier 1

lancets thin Tier 1

LANCETS ULTRA FINE Tier 3

LANCETS ULTRA THIN Tier 3

lancets ultra thin 30g Tier 1

lancing device Tier 3

leader advanced lancing device Tier 3

LIBERTY GLUCOSE CONTROL Tier 3

LIBERTY GLUCOSE CONTROL MID Tier 3


129


LIBERTY MINI LANCING DEVICE Tier 3

LIFESCAN UNISTIK 2 Tier 3

LIFESCAN UNISTIK II LANCETS Tier 3

lite touch lancets Tier 1

LITE TOUCH LANCING DEVICE Tier 3

LITE TOUCH LANCING PEN Tier 3

LITETOUCH LANCETS Tier 3

live better adv lancing device Tier 3

live better lancet super thin Tier 3

live better lancet ultra thin Tier 3

longs lancets standard Tier 1

longs lancets thin Tier 1

longs lancets ultra thin Tier 1

major comfort lancets Tier 1

MAXIMA CONTROL Tier 3

medichoice safety lancet Tier 3

medichoice safety lancet extra Tier 3

medichoice safety lancet norm Tier 3

medicine shoppe lancets Tier 1

medicine shoppe lancets thin Tier 1

medi-lance lancets Tier 1

MEDISENSE GLUCOSE KETONE CONTR Tier 3

MEDISENSE HI/MID/LOW CONTROL Tier 3

MEDISENSE HIGH/LOW CONTROL Tier 3

MEDISENSE MID CONTROL Tier 3

MEDISENSE THIN LANCETS Tier 3

MEDLANCE EXTRA 21G Tier 3

MEDLANCE LITE 25G Tier 3

MEDLANCE PLUS EXTRA 21G Tier 3

MEDLANCE PLUS LANCETS Tier 3

MEDLANCE PLUS LITE 25G Tier 3

MEDLANCE PLUS SPECIAL 0.8MM Tier 3

MEDLANCE PLUS SUPERLITE 30G Tier 3

MEDLANCE PLUS UNIVERSAL 21G Tier 3

MEDLANCE UNIVERSAL 21G Tier 3

MEIJER LANCETS Tier 3

MEIJER LANCETS THIN Tier 3



MEIJER LANCETS UNIVERSAL 21G Tier 3



MEIJER SUPER THIN LANCETS Tier 3

MICRODOT CONTROL HIGH/LOW Tier 3

MICROLET LANCETS Tier 3

MICROTAINER SAFETY FLOW LANCET Tier 3

mini lancing device Tier 3

MONOJECTOR END CAPS Tier 3

MONOJECTOR OPD END CAPS Tier 3

MONOLET LANCETS Tier 3

MONOLET OPD LANCETS Tier 3

MONOLETTOR SAFETY LANCETS Tier 3

multi-lancet device Tier 3

MYGLUCOHEALTH CONTROL Tier 3

MYGLUCOHEALTH LANCETS 30G Tier 3

NETGROUP LANCETS Tier 3

NEUTEK 2TEK CONTROL Tier 3

NEXGEN CONTROL Tier 3

NOVA MAX PLUS GLU/KET CONTROL Tier 3

NOVA SAFETY LANCETS 23G Tier 3

NOVA SAFETY LANCETS 28G Tier 3

NOVA SUREFLEX LANCETS Tier 3

NOVA SUREFLEX LANCING DEVICE Tier 3

ON CALL EXPRESS GLUCOSE CONTR Tier 3

ON CALL LANCETS Tier 3

ON CALL LANCING DEVICE Tier 3

ON CALL PLUS GLUCOSE CONTROL Tier 3

ON CALL PLUS LANCETS Tier 3

ON CALL PLUS LANCING DEVICE Tier 3

ON CALL VIVID GLUCOSE CONTROL Tier 3

ONETOUCH CLUB LANCETS FINE PT Tier 3

ONETOUCH COMBO PACK Tier 3

ONETOUCH DELICA LANCETS 33G Tier 3

ONETOUCH DELICA LANCETS FINE Tier 3

ONETOUCH DELICA LANCING DEV Tier 3

ONETOUCH FINEPOINT LANCETS Tier 3


131


ONETOUCH LANCETS Tier 3

ONETOUCH SURESOFT LANCING DEV Tier 3

ONETOUCH ULTRA CONTROL Tier 3

ONETOUCH ULTRASOFT LANCETS Tier 3

ONETOUCH VERIO IN VITRO SOLUTION Tier 3

OPTUMRX GLUCOSE CONTROL Tier 3

pc lancets super thin 30g Tier 1

PENLET II BLOOD SAMPLER Tier 3

PENLET II REPLACEMENT CAP Tier 3

PERFECT LANCETS 28G Tier 3

PERFECT LANCETS 30G Tier 3

PHARMACIST CHOICE LANCETS Tier 1

PHARMACY COUNTER LANCETS Tier 3

POCKETCHEM EZ CONTROL Tier 3

PRECISION GLUCOSE CONTROL Tier 3

PRECISION GLUCOSE CONTROL SOLN Tier 3

PRECISION GLUCOSE KETONE CONTR Tier 3

PRECISION GLUCOSE/KETONE CONTR Tier 3

PRECISION THIN LANCETS Tier 3

PRECISION THINS GP LANCETS Tier 3

PRECISION ULTRA LANCET Tier 3

preferred plus lancets colored Tier 1

preferred plus lancets thin Tier 1

PRODIGY CONTROL SOLUTION Tier 3

PRODIGY LANCETS 28G Tier 3

PRODIGY LANCING DEVICE Tier 3

PRODIGY TWIST TOP LANCETS 28G Tier 3

PSS SELECT GP LANCETS Tier 3

PSS SELECT PLATFORMS Tier 3

PSS SELECT SAFETY LANCETS Tier 3

px advanced lancing device Tier 3

px lancet auto injector Tier 3

px lancets Tier 1

px lancets ultra thin Tier 1

qc advanced lancing device Tier 3

qc lancets super thin 30g Tier 1

qc lancets ultra thin Tier 1



QUICKTEK CONTROL SOLUTION Tier 3

QUINTET CONTROL HIGH/NORMAL Tier 3

RA E-ZJECT COLOR LANCETS 33G Tier 3

RA E-ZJECT LANCETS 28G Tier 3

RA E-ZJECT LANCETS THIN 26G Tier 3

RA E-ZJECT LANCETS THIN 28G Tier 3

RA E-ZJECT LANCETS ULTRA THIN Tier 3

ra lancing device Tier 3

reality lancets Tier 1

reality trigger lancets Tier 1

REFUAH PLUS GLUCOSE CONTROL Tier 3

RELION LANCETS MICRO-THIN 33G Tier 3

RELION LANCETS STANDARD 21G Tier 3

RELION LANCETS THIN 26G Tier 3

RELION LANCETS ULTRA-THIN 30G Tier 3

RELION LANCING DEVICE Tier 3

RELION ULTRA THIN LANCETS 30G Tier 3

RELION ULTRA THIN PLUS LANCETS Tier 3

RENEW ADV CARTRIDGE REFILLS Tier 3

RENEW ADVANCED LANCING DEVICE Tier 3

REXALL LANCETS ULTRA THIN 30G Tier 3

RIGHTEST ALTERNATE SITE ADAPT Tier 3

RIGHTEST GC300 CONTROL Tier 3

RIGHTEST GD500 LANCING DEVICE Tier 3

RIGHTEST GL300 LANCETS Tier 3

SAFE-T-LANCE Tier 3

SAFE-T-LANCE PLUS Tier 3

safety lancet 21g/pressure act Tier 3

safety lancet 28g/pressure act Tier 3

SAFETY LANCETS Tier 3

SAFETY LANCETS 21G Tier 3

safety lancets 28g Tier 1

SAFETY LET LANCETS Tier 3

SAFETY SEAL LANCETS Tier 3

sb lancets thin Tier 1

sb lancets ultra thin Tier 1

select-lite device/lancets Tier 1


133


select-lite lancing device Tier 3

SHOPKO AUTOLET LANCING DEVICE Tier 3

SHOPKO ON-THE-GO LANCETS 30G Tier 3

SHOPKO UNILET LANCETS 28G Tier 3

SHOPKO UNILET LANCETS 30G Tier 3

SIMPLE DIAGNOSTICS LANCING DEV Tier 3

SINGLE-LET Tier 3

sm lancets 21g Tier 1

sm lancets 33g Tier 1

sm super thin lancets 30g Tier 1

sm thin lancets 26g Tier 1

SMART DIABETES VANTAGE LANCETS Tier 3

SMART DIABETES VANTAGE LANCING Tier 3

SMART SENSE COLOR LANCETS 33G Tier 3

SMART SENSE STANDARD LANCETS Tier 3

SMART SENSE SUPER THIN LANCETS Tier 3

SMART SENSE THIN LANCETS 26G Tier 3

SMARTEST CONTROL MEDIUM Tier 3

SMARTEST LANCETS 28G Tier 3

SOLARTEK GLUCOSE CONTROL Tier 3

SOLUS V2 CONTROL Tier 3

SOLUS V2 LANCETS 28G Tier 3

SOLUS V2 LANCING DEVICE Tier 3

SOLUS V2 TWIST LANCETS 30G Tier 3

STERILANCE PA Tier 3

STERILANCE TL Tier 3

super thin lancets Tier 1

supreme ii high/low control Tier 3

sure comfort lancets 28g Tier 1

sure comfort lancets 30g Tier 1

sure comfort lancing pen Tier 3

SURE-LANCE FLAT LANCETS Tier 3

SURE-LANCE LANCETS 26G Tier 3

SURE-LANCE THIN LANCETS 28G Tier 3

SURE-LANCE ULTRA THIN LANCETS Tier 3

SURELITE LANCETS Tier 3

SURE-PEN Tier 3



SURESTEP GLUCOSE CONTROL Tier 3

SURESTEP PRO HIGH GLUCOSE Tier 3

SURESTEP PRO LOW GLUCOSE Tier 3

SURESTEP PRO NORMAL GLUCOSE Tier 3

SURE-TOUCH LANCETS UNIVERSAL Tier 3

TAI DOC CONTROL Tier 3

TECHLITE AST LANCETS Tier 3

TECHLITE LANCETS Tier 3

TECHLITE LANCETS 30G Tier 3

TELCARE GLUCOSE CONTROL Tier 3

tgt advanced lancing device Tier 3

tgt lancet alternate site Tier 3

tgt lancet micro thin 33g Tier 3

tgt lancet super thin 30g Tier 3

tgt lancet thin 23g Tier 3

tgt lancet thin 26g Tier 3

tgt lancet ultra thin 28g Tier 3

tgt lancet ultra thin 30g Tier 3

tgt lancing device Tier 3

THINLETS GP LANCETS Tier 3

THINLETS LANCET Tier 3

todays health lancing device Tier 3

todays health thin lancets 28g Tier 1

todays health thin lancets 30g Tier 1

TRUECONTROL GLUCOSE CONT LEV 0 Tier 3

TRUECONTROL GLUCOSE CONT LEV 1 Tier 3

TRUEDRAW LANCING DEVICE Tier 3

TRUEPLUS LANCETS 26G Tier 3




TRUEPLUS SAFETY LANCETS 28G Tier 3

TRUETEST CONTROL LEVEL 1 Tier 3



ULTICARE THIN LANCETS 30G Tier 3

ULTI-LANCE AUTOMATIC Tier 3


135


ULTILET CLASSIC LANCETS Tier 3

ULTILET LANCETS Tier 3

ULTILET SAFETY LANCETS 23G Tier 3

ultra thin lancets 28g Tier 1

ultra thin lancets 30g Tier 1

ULTRALANCE Tier 3

ULTRA-THIN II AUTO LANCET Tier 3

ULTRA-THIN II LANCETS Tier 3

ULTRATRAK PRO CONTROL Tier 3

ULTRATRAK ULTIMATE CONTROL Tier 3

UNILET COMFORTOUCH LANCET Tier 3

UNILET EXCELITE Tier 3

UNILET EXCELITE II Tier 3

UNILET G.P. LANCET Tier 3

UNILET G.P. SUPERLITE LANCET Tier 3

UNILET GP 28 ULTRA THIN Tier 3

UNILET LANCET Tier 3

UNILET SUPERLITE LANCET Tier 3

UNISTIK 1 Tier 3

UNISTIK 2 Tier 3

UNISTIK 2 COMFORT Tier 3

UNISTIK 2 EXTRA Tier 3

UNISTIK 2 NEONATAL Tier 3

UNISTIK 2 NORMAL Tier 3

UNISTIK 2 SUPER Tier 3

UNISTIK 3 Tier 3

UNISTIK 3 COMFORT Tier 3

UNISTIK 3 EXTRA Tier 3

UNISTIK 3 GENTLE Tier 3

UNISTIK 3 NEONATAL Tier 3

UNISTIK 3 NORMAL Tier 3

UNISTIK CZT COMFORT Tier 3

UNISTIK CZT NORMAL Tier 3

UNISTRIP CONTROL Tier 3

UNIVERSAL 1 LANCETS THIN 26G Tier 3

UNIVERSAL 1 LANCETS ULTRA THIN Tier 3

value plus lancet standard 21g Tier 3



value plus lancets super thin Tier 1

value plus lancets thin 26g Tier 1

value plus lancing device Tier 3

valumark lancet super thin 30g Tier 3

valumark lancet ultra thin 28g Tier 3

VICTORY CONTROL LEVEL 1/2 Tier 3

VIDA MIA AUTOLET LANCING DEV Tier 3

VIDA MIA UNILET LANCETS 28G Tier 3

VIDA MIA UNILET LANCETS 30G Tier 3

VITALET PRO LANCETS Tier 3

VITALET PRO PLUS LANCETS Tier 3

W&F LANCETS 26G Tier 3

W&F LANCETS COLORED 21G Tier 3

walgreens adv travel lancets Tier 1

WALGREENS LANCETS Tier 3

walgreens lancets micro thin Tier 1

walgreens lancets super thin Tier 1

WALGREENS THIN LANCETS Tier 3

WALGREENS ULTRA THIN LANCETS Tier 3

XPRES CONTROL Tier 3

*MISC. DEVICES**-*APPLICATORS,COTTON BALLS,ETC***

ALCOH-GLOVE CONTOURED WIPE Tier 3

alcohol pads Tier 3

alcohol prep Tier 3

alcohol swabs Tier 3

alcohol wipes Tier 3

BD SWAB SINGLE USE REGULAR Tier 3

BD SWABS SINGLE USE BUTTERFLY Tier 3

CURITY ALCOHOL PREPS Tier 3

CURITY ALCOHOL SWABS Tier 3

cvs alcohol prep swabs Tier 3

cvs alcohol swabs Tier 3

EASY TOUCH ALCOHOL PREP MEDIUM Tier 3

FIFTY50 ALCOHOL PREP Tier 3

global alcohol prep ease Tier 3


137


gnp alcohol swabs Tier 3

healthwise alcohol prep Tier 3

meijer alcohol swabs Tier 3

PHARMACIST CHOICE ALCOHOL Tier 3

qc alcohol swabs Tier 3

ra alcohol swabs Tier 3

reality swabs Tier 3

RELION ALCOHOL SWABS Tier 3

sb alcohol prep Tier 3

SHOPKO ALCOHOL SWABS Tier 3

sm alcohol prep Tier 3

sure comfort alcohol prep Tier 3

SURE-PREP ALCOHOL PREP Tier 3

tgt alcohol swabs Tier 3

WEBCOL ALCOHOL PREP LARGE Tier 3

WEBCOL ALCOHOL PREP MEDIUM Tier 3

*PARENTERAL THERAPY SUPPLIES**-*NEEDLES & SYRINGES***

1st tier unifine pentips Tier 3

1st tier unifine pentips plus Tier 3

ADVOCATE INSULIN PEN NEEDLES 31G X 5 MM , 31G X 8 MM

Tier 3

ADVOCATE INSULIN SYRINGE Tier 3

ASSURE ID INSULIN SAFETY SYR Tier 3

aurora pen needles Tier 3

aurora unifine pentips Tier 3

AUTOJECT 2 Tier 3

BD AUTOSHIELD 29G X 12MM Tier 3

BD AUTOSHIELD 29G X 5MM , 29G X 8MM Tier 2

BD AUTOSHIELD DUO Tier 2

BD INSULIN SYR ULTRAFINE II Tier 3

BD INSULIN SYRINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML, 26G X 1/2" 1 ML, 27.5G X 5/8" 2 ML, 27G X 1/2" 1 ML, 29G X 1/2" 2 ML

Tier 2

BD INSULIN SYRINGE 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 31G X 5/16" 0.3 ML, U-100 1 ML

Tier 3

BD INSULIN SYRINGE HALF-UNIT Tier 3



BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML, 28G X 1/2" 0.3 ML

Tier 2

BD INSULIN SYRINGE MICROFINE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML

Tier 3

BD INSULIN SYRINGE U-40 Tier 2

BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML

Tier 3

BD INSULIN SYRINGE ULTRAFINE 30G X 1/2" 0.3 ML, 30G X 1/2" 1 ML, 31G X 15/64" 0.3 ML, 31G X 15/64" 0.5 ML, 31G X 15/64" 1 ML

Tier 2

BD INTEGRA INSULIN SYRINGE Tier 3

BD INTEGRA SYRINGE 25G X 1" 1 ML Tier 2

BD PEN Tier 2

BD PEN MINI Tier 2

BD PEN NEEDLE MINI U/F Tier 2

BD PEN NEEDLE NANO U/F Tier 2

BD PEN NEEDLE SHORT U/F Tier 2

BD PEN NEEDLE ULTRAFINE Tier 2

BD SAFETYGLIDE INSULIN SYRINGE 30G X 5/16" 0.5 ML

Tier 3

BD SAFETY-LOK INSULIN SYRINGE Tier 3

careone unifine pentips Tier 3

careone unifine pentips plus Tier 3

clickfine pen needles Tier 3

COMFORT EZ INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML

Tier 3

COMFORT EZ INSULIN SYRINGE 30G X 1/2" 0.3 ML, 30G X 1/2" 1 ML

Tier 2

COMFORT EZ PEN NEEDLES 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM

Tier 3

CORNWALL METAL PIPETTING Tier 3

cvs insulin syringe 30g x 1/2" 0.3 ml Tier 2

drug mart unifine pentips Tier 3

duane reade unifine pentips Tier 3


139


easy comfort insulin syringe 30g x 1/2" 1 ml Tier 2

easy comfort pen needles 31g x 5 mm , 31g x 8 mm

Tier 3

EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.5 ML

Tier 3

EASY TOUCH INSULIN SAFETY SYR 30G X 1/2" 1 ML

Tier 2

EASY TOUCH INSULIN SYRINGE 27G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 1 ML

Tier 2

EASY TOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML

Tier 3

EASY TOUCH PEN NEEDLES 29G X 12MM , 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 5 MM , 32G X 6 MM

Tier 3

elite-thin insulin syringe 28g x 5/16" 0.5 ml, 28g x 5/16" 1 ml, 29g x 5/16" 0.5 ml, 29g x 5/16" 1 ml

Tier 3

eql short pen needle Tier 3

eql ultra short pen needle Tier 3

FIFTY50 PEN NEEDLES Tier 3

FIFTY50 SUPERIOR COMFORT SYR Tier 3

freds pharmacy unifine pentip+ Tier 3

freds pharmacy unifine pentips Tier 3

FREESTYLE PRECISION INS SYR Tier 3

global ease inject pen needles Tier 3

global inject ease insulin syr 30g x 1/2" 0.3 ml, 30g x 1/2" 1 ml

Tier 2

GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.3 ML, 30G X 1/2" 1 ML

Tier 2

GLUCOPRO INSULIN SYRINGE 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML

Tier 3

gnp clickfine pen needles Tier 3

healthwise mini pen needles Tier 3

healthwise pen needles Tier 3

healthwise short pen needles Tier 3

healthwise unifine pentips Tier 3



healthy accents unifine pentip Tier 3

h-e-b incontrol pen needles Tier 3

HUMATROPEN FOR 12MG Tier 3



inject-ease Tier 3

INJECT-EASE AUTOMATIC INJECTOR Tier 3

insupen pen needles 32g x 4 mm Tier 3

INSUPEN SENSITIVE Tier 3

INSUPEN ULTRAFIN Tier 3

J-TIP KIT W/VIAL ADAPTERS Tier 3

kmart valu insulin syringe 29g Tier 3

kmart valu insulin syringe 30g Tier 3

kroger pen needles Tier 3

LEADER UNIFINE PENTIPS Tier 3

LEADER UNIFINE PENTIPS PLUS Tier 3

LITE TOUCH PEN NEEDLES Tier 3

LITETOUCH INSULIN SYRINGE Tier 3

LITETOUCH PEN NEEDLES Tier 3

live better pen needles Tier 3

MAGELLAN INSULIN SAFETY SYR Tier 3

MAXI-COMFORT INSULIN SYRINGE Tier 3

medicine shoppe pen needles Tier 3

meijer pen needles Tier 3

MONOJECT INSULIN SYRINGE 25G X 5/8" 1 ML, 27G X 1/2" 1 ML

Tier 2

MONOJECT INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 1 ML, U-100 1 ML

Tier 3

MONOJECT ULTRA COMFORT SYRINGE Tier 3

MOORE MONO INSULIN SYRINGE Tier 3

NORDIPEN 5 INJECTION DEVICE Tier 3

NORDIPEN DELIVERY SYSTEM Tier 3

NOVOFINE Tier 3

NOVOFINE AUTOCOVER Tier 3

NOVOTWIST Tier 3


141


OMNITROPE PEN 10 INJ DEVICE Tier 3

OMNITROPE PEN 5 INJ DEVICE Tier 4 PA

pc unifine pentips Tier 3

pca injector Tier 3

pen needles Tier 3

pen needles 1/2" Tier 3



plastic adapter Tier 3

PRECISION SUREDOSE PLUS SYR Tier 3

PRECISION SURE-DOSE SYRINGE Tier 3

preferred plus unifine pentips Tier 3

PRODIGY INSULIN PEN NEEDLES Tier 3

PRODIGY INSULIN SYRINGE Tier 3

PRODIGY MINI PEN NEEDLES Tier 3

PRODIGY SHORT PEN NEEDLES Tier 3

px extra short pen needles Tier 3

px insulin syringe 30g x 1/2" 0.3 ml, 30g x 1/2" 1 ml

Tier 2

px pen needle Tier 3

px shortlength pen needles Tier 3

qc insulin syringe 29g 0.3 ml, 29g 0.5 ml, 29g 1 ml, 30g 0.5 ml, 30g 1 ml

Tier 3

qc pen needles Tier 3

qc unifine pentips Tier 3

ra pen needles Tier 3

RELION INSULIN SYRINGE Tier 3

RELI-ON INSULIN SYRINGE Tier 3

RELION MINI PEN NEEDLES Tier 3

RELION PEN NEEDLES Tier 3

RELION SHORT PEN NEEDLES Tier 3

SAFESNAP INSULIN SYRINGE Tier 3

SAFETY-GLIDE SYRINGE Tier 3

SHOPKO UNIFINE PENTIPS Tier 3

sure comfort insulin syringe 30g x 1/2" 0.3 ml, 30g x 1/2" 1 ml

Tier 2

sure comfort pen needles 29g x 12.7mm , 30g x 8 mm , 31g x 5 mm , 31g x 8 mm , 32g x 4 mm

Tier 3



SURE-FINE PEN NEEDLES Tier 3

SURE-JECT INSULIN SYRINGE Tier 3

TERUMO INSULIN SYRINGE 27G X 1/2" 1 ML

Tier 2

TERUMO INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 3/8" 0.3 ML, 30G X 3/8" 0.5 ML, 30G X 3/8" 1 ML

Tier 3

TERUMO SURGUARD INSULIN SYR Tier 3

THINPRO INSULIN SYRINGE Tier 3

todays health mini pen needles Tier 3

todays health pen needles Tier 3

todays health short pen needle Tier 3

topcare clickfine pen needles Tier 3

TRUEPLUS INSULIN SYRINGE Tier 3

ULTICARE INSULIN SAFETY SYR Tier 3

ULTICARE INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML

Tier 3

ULTICARE INSULIN SYRINGE 30G X 1/2" 0.3 ML, 30G X 1/2" 1 ML

Tier 2

ULTICARE MICRO PEN NEEDLES Tier 3

ULTICARE MINI PEN NEEDLES Tier 3

ULTICARE PEN NEEDLES Tier 3

ULTICARE SHORT PEN NEEDLES Tier 3

ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML

Tier 3

ULTRA-THIN II INS SYR SHORT Tier 3

ULTRA-THIN II INSULIN SYRINGE Tier 3

ULTRA-THIN II MINI PEN NEEDLE Tier 3

ULTRA-THIN II PEN NEEDLE SHORT Tier 3

ULTRA-THIN II PEN NEEDLES Tier 3

UNIFINE PENTIPS Tier 3

unifine pentips plus 32g x 4 mm Tier 3

valumark pen needles Tier 3


143


VANISHPOINT INSULIN SYRINGE 29G X 1/2" 1 ML

Tier 3

VIDA MIA UNIFINE PENTIPS Tier 3

V-R MONO INSULIN SYRINGE Tier 3

wegmans unifine pentips plus Tier 3

*RESPIRATORY THERAPY SUPPLIES**-*PEAK FLOW METERS***

AIRZONE PEAK FLOW METER Tier 3

ASSESS FULL RANGE PEAK METER Tier 3

ASSESS LOW RANGE PEAK METER Tier 3

ASSESS PEAK FLOW METER Tier 3

ASTHMA CHECK METER-ZONE SYSTEM Tier 3

ASTHMAMENTOR Tier 3

MICROLIFE DIGITAL PEAK FLOW Tier 3

MINI WRIGHT PEAK FLOW METER Tier 3

PEAK AIR PEAK FLOW METER Tier 3

PERSONAL BEST FULL RANGE Tier 3

PERSONAL BEST LOW RANGE Tier 3

PIKO 1 Tier 3

POCKET PEAK FLOW METER Tier 3

POCKETPEAK PEAK FLOW METER Tier 3

TRUZONE PEAK FLOW METER Tier 3

*RESPIRATORY THERAPY SUPPLIES**-*RESPIRATORY THERAPY SUPPLIES***

ACE AEROSOL CLOUD ENHANCER Tier 3

ACTIVITY POUCH Tier 3

ADAPTER PED DISPOSABLE Tier 3

adult aerosol mask Tier 3

adult mask Tier 3

adult mask large Tier 3

AEROTRACH PLUS Tier 3

AIRS PEDIATRIC AEROSOL MASK Tier 3

ALL FLOW 1000 PFT FILTER Tier 3

BUBBLES THE FISH II PEDI MASK Tier 3

co monitor replacement pieces Tier 3

cone mask Tier 3

earloop mask Tier 3



EFLOW SCF AEROSOL HEAD Tier 3

ELITE DC AUTO ADAPTER Tier 3

filter air pp Tier 3

full kit nebulizer set Tier 3

HEALTHY LIVING FILTERS Tier 3

HEALTHY LIVING MASKS Tier 3

HEALTHY LIVING REPLACEMENT KIT Tier 3

INNOSPIRE REPLACEMENT FILTER Tier 3

KOKO PEAK PRO MOUTHPIECE Tier 3

LITETOUCH MASK LARGE Tier 3

LITETOUCH MASK MEDIUM Tier 3

LITETOUCH MASK SMALL Tier 3

MICROELITE BATTERY Tier 3

MICROELITE FILTER REPLACEMENTS Tier 3

MINIELITE FILTER REPLACEMENTS Tier 3

MINIELITE RECHARGEABLE BATTERY Tier 3

nebulizer air tube/plugs Tier 3

nebulizer mask pediatric Tier 3

nose clip Tier 3

ONE FLOW TESTER Tier 3

PARI ALTERA NEBULIZER HANDSET Tier 3

PARI BABY CONVERSION KIT Tier 3

PARI ERAPID NEBULIZER HANDSET Tier 3

PARI EXPIRATORY FILTER SET Tier 3

PARI MASK SET Tier 3

PARI SOFT PLASTIC ADULT MASK Tier 3

PARI SOFT PLASTIC PED MASK Tier 3

pediatric aerosol mask Tier 3

pediatric mouthpiece Tier 3

PFLEX Tier 3

pillow mask/adult Tier 3

pillow mask/child Tier 3

pillow mask/pediatric Tier 3

replacement air filter Tier 3

replacement filters Tier 3

SAMI THE SEAL FILTERS Tier 3

SIDESTREAM ADULT FACE MASK Tier 3


145


SIDESTREAM PEDIATRIC FACE MASK Tier 3

SIDESTREAM PLS ADULT FACE MASK Tier 3

silicone mask/adult Tier 3

silicone mask/infant Tier 3

silicone mask/pediatric Tier 3

THRESHOLD IMT Tier 3

tubing/wing tip Tier 3

WINDMILL TRAINER Tier 3

*RESPIRATORY THERAPY SUPPLIES**-*SPACER/AEROSOL-HOLDING CHAMBERS & SUPPLIES***

AEROCHAMBER MINI CHAMBER Tier 3

AEROCHAMBER MV Tier 3

AEROCHAMBER PLUS Tier 3

AEROCHAMBER PLUS FLO-VU Tier 3

AEROCHAMBER PLUS FLO-VU LARGE Tier 3

AEROCHAMBER PLUS FLO-VU MEDIUM Tier 3

AEROCHAMBER PLUS FLO-VU SMALL Tier 3

AEROCHAMBER PLUS FLO-VU W/MASK Tier 3

AEROCHAMBER PLUS FLOW VU Tier 3

AEROCHAMBER PLUS W/MASK Tier 3

AEROCHAMBER PLUS W/MASK SMALL Tier 3

AEROCHAMBER W/FLOWSIGNAL Tier 3

AEROCHAMBER Z-STAT PLUS Tier 3

AEROCHAMBER Z-STAT PLUS CHAMBR Tier 3

AEROCHAMBER Z-STAT PLUS/LARGE Tier 3

AEROCHAMBER Z-STAT PLUS/MEDIUM Tier 3

AEROCHAMBER Z-STAT PLUS/SMALL Tier 3

ARIAL CHAMBER Tier 3

BREATHERITE Tier 3

BREATHERITE COLL SPACER ADULT Tier 3

BREATHERITE COLL SPACER CHILD Tier 3

BREATHERITE COLL SPACER INFANT Tier 3

BREATHERITE RIGID SPACER/MASK Tier 3

BREATHERITE SPACER NEONATE Tier 3

BREATHERITE SPACER SMALL CHILD Tier 3

BREATHERITE/LARGE MASK Tier 3



BREATHERITE/MEDIUM MASK Tier 3

BREATHERITE/SMALL MASK Tier 3

EASIVENT Tier 3

EASIVENT MASK LARGE Tier 3

EASIVENT MASK MEDIUM Tier 3

EASIVENT MASK SMALL Tier 3

E-Z SPACER Tier 3

E-Z SPACER THE BODY GUARDS PK Tier 3

INSPIREASE Tier 3

INSPIREASE BAGS Tier 3

INSPIREASE MOUTHPIECE Tier 3

INSPIREASE RESERVOIR BAGS Tier 3

LITEAIRE Tier 3

MASK VORTEX Tier 3

MICROCHAMBER Tier 3

MICROSPACER Tier 3

NESSI SPACER WITH MASK LARGE Tier 3

NESSI SPACER WITH MASK SM/MED Tier 3

NESSI SPACER WITH MOUTHPIECE Tier 3

OPTICHAMBER ADVANTAGE Tier 3

OPTICHAMBER ADVANTAGE-LG MASK Tier 3

OPTICHAMBER ADVANTAGE-MED MASK Tier 3

OPTICHAMBER ADVANTAGE-SM MASK Tier 3

OPTICHAMBER DIAMOND Tier 3

OPTICHAMBER DIAMOND-LG MASK Tier 3

OPTICHAMBER DIAMOND-MD MASK Tier 3

OPTICHAMBER DIAMOND-SM MASK Tier 3

OPTICHAMBER FACE MASK-LARGE Tier 3

OPTICHAMBER FACE MASK-MEDIUM Tier 3

OPTICHAMBER FACE MASK-SMALL Tier 3

OPTIHALER Tier 3

PANDA MASK LARGE Tier 3

PANDA MASK MEDIUM Tier 3

PANDA MASK SMALL Tier 3

PEDIATRIC PANDA MASK Tier 3

POCKET CHAMBER Tier 3

POCKET SPACER Tier 3


147


RITEFLO Tier 3

valved holding chamber Tier 3

VORTEX VALVED HOLDING CHAMBER Tier 3

WATCHHALER Tier 3

*MIGRAINE PRODUCTS*

*MIGRAINE COMBINATIONS**-*ERGOT COMBINATIONS***

CAFERGOT Tier 3

MIGERGOT Tier 3

*MIGRAINE COMBINATIONS**-*MIGRAINE COMBINATIONS***

MIGRALAM Tier 3

*MIGRAINE COMBINATIONS**-*SELECTIVE SEROTONIN AGONIST-NSAID COMBINATIONS***

TREXIMET Tier 3

*MIGRAINE PRODUCTS - NSAIDS**-*MIGRAINE PRODUCTS - NSAIDS***

CAMBIA Tier 3

*MIGRAINE PRODUCTS**-*MIGRAINE PRODUCTS***

D.H.E. 45 Tier 3

dihydroergotamine mesylate injection Tier 1

ERGOMAR Tier 3

MIGRAL Tier 3

MIGRANAL Tier 3

*SEROTONIN AGONISTS**-*SELECTIVE SEROTONIN AGONISTS 5-HT(1)***

almotriptan malate Tier 1

ALSUMA Tier 3

AMERGE Tier 3

AXERT Tier 3 #

FROVA Tier 3 #

IMITREX Tier 3

IMITREX STATDOSE SYSTEM Tier 3

MAXALT Tier 3



MAXALT-MLT Tier 3

naratriptan hcl Tier 1

RELPAX Tier 3

rizatriptan benzoate Tier 1

sumatriptan succinate oral Tier 1

SUMAVEL DOSEPRO Tier 3

ZECUITY Tier 3

zolmitriptan oral Tier 1

ZOMIG Tier 3

ZOMIG ZMT Tier 3

*MINERALS & ELECTROLYTES*

*CALCIUM**-*CALCIUM COMBINATIONS***

CALCIFOL Tier 3

calcium-folic acid plus d Tier 3

*FLUORIDE**-*FLUORIDE COMBINATIONS***

FLUOR-A-DAY ORAL TABLET CHEWABLE Tier 3

*FLUORIDE**-*FLUORIDE***

FLUORABON CE

FLUOR-A-DAY ORAL SOLUTION Tier 1

fluoritab oral solution Tier 1

fluoritab oral tablet chewable 0.55 (0.25 f) mg Tier 1

fluoritab oral tablet chewable 1.1 (0.5 f) mg, 2.2 (1 f) mg

CE

FLURA-DROPS ORAL SOLUTION 0.275 (0.125 F) MG/DROP

Tier 1

FLURA-DROPS ORAL SOLUTION 0.55 (0.25 F) MG/DROP

CE

KARIDIUM Tier 1

LOZI-FLUR Tier 3

LUDENT CE

NAFRINSE Tier 1

NAFRINSE DROPS Tier 1

sodium fluoride oral solution CE

sodium fluoride oral tablet 2.2 (1 f) mg CE

sodium fluoride oral tablet chewable 0.55 (0.25 f) mg

CE LGC


149


sodium fluoride oral tablet chewable 1.1 (0.5 f) mg, 2.2 (1 f) mg

CE

*IODINE PRODUCTS**-*IODINE PRODUCTS***

SSKI Tier 3

*PHOSPHATE**-*PHOSPHATE***

K-PHOS Tier 3

PHOSPHA 250 NEUTRAL Tier 1

*POTASSIUM**-*POTASSIUM COMBINATIONS***

EFFER-K ORAL TABLET EFFERVESCENT 10 MEQ, 20 MEQ

Tier 3

effervescent pot chloride Tier 1

pot bicarb-pot chloride Tier 1

*POTASSIUM**-*POTASSIUM***

EFFER-K ORAL TABLET EFFERVESCENT 25 MEQ

Tier 1

k-effervescent Tier 1

KLOR-CON 10 Tier 1 LGC

KLOR-CON M10 Tier 1

KLOR-CON M15 Tier 3

KLOR-CON M20 Tier 1

KLOR-CON ORAL PACKET 20 MEQ Tier 1

KLOR-CON ORAL PACKET 25 MEQ Tier 3

KLOR-CON ORAL TABLET EXTENDEDRELEASE*

Tier 1 LGC

KLOR-CON/EF Tier 1

K-PRIME Tier 1

k-vescent Tier 1

MICRO-K Tier 3

potassium bicarbonate oral Tier 1

potassium chloride crys er oral tablet extendedrelease* 10 meq

Tier 1 LGC

potassium chloride crys er oral tablet extendedrelease* 20 meq

Tier 1

potassium chloride er oral capsule extended release* 10 meq

Tier 1 LGC

potassium chloride er oral capsule extended release* 8 meq

Tier 1



potassium chloride er oral tablet extendedrelease* 10 meq, 8 meq

Tier 1

potassium chloride oral packet Tier 1

potassium chloride oral solution 20 meq/15ml (10%)

Tier 1 LGC

*ZINC**-*ZINC***

GALZIN Tier 3

*MOUTH/THROAT/DENTAL AGENTS*

*ANESTHETICS TOPICAL ORAL**-*ANESTHETICS TOPICAL ORAL***

lidocaine viscous Tier 1

*ANTI-INFECTIVES - THROAT**-*ANTI-INFECTIVES - THROAT***

clotrimazole mouth/throat Tier 1

nystatin mouth/throat Tier 1

ORAVIG Tier 3

*ANTISEPTICS - MOUTH/THROAT**-*ANTISEPTIC COMBINATIONS - MOUTH/THROAT***

DEBACTEROL Tier 3

*ANTISEPTICS - MOUTH/THROAT**-*ANTISEPTICS - MOUTH/THROAT***

chlorhexidine gluconate mouth/throat Tier 1

PERIDEX Tier 3

PERIOGARD Tier 1

*DENTAL PRODUCTS**-*DENTAL PRODUCTS - COMBINATIONS***

FLUORIDEX SENSITIVITY RELIEF DENTAL Tier 3

FLUORIDEX SENSITIVITY RELIEF DENTAL PASTE

Tier 1

NAFRINSE DAILY ACIDULATED Tier 3

*DENTAL PRODUCTS**-*FLUORIDE DENTAL PRODUCTS***

CAVAREST Tier 1

CLINPRO 5000 Tier 1

CONTROLRX Tier 1

DENTA 5000 PLUS Tier 1


151


DENTAGEL Tier 1

dentall 1100 plus Tier 1

FLUORIDEX DAILY DEFENSE Tier 1

FLUORIDEX ENHANCED WHITENING Tier 1

KARIGEL Tier 1

KARIGEL-N Tier 1

NAFRINSE DAILY/NEUTRAL Tier 3

NAFRINSE WEEKLY Tier 3

NEUTRAGARD ADVANCED Tier 1

PERIOMED Tier 1

PHOS-FLUR Tier 1

PREVIDENT 5000 BOOSTER Tier 3

PREVIDENT 5000 BOOSTER PLUS Tier 3

sf Tier 1

sf 5000 plus Tier 1

stannous fluoride mouth/throat Tier 1

*STEROIDS - MOUTH/THROAT**-*STEROIDS - MOUTH/THROAT***

ORALONE Tier 1

triamcinolone acetonide mouth/throat Tier 1

*THROAT PRODUCTS - MISC.**-*SALIVA STIMULANTS***

cevimeline hcl Tier 1

EVOXAC Tier 3

pilocarpine hcl oral Tier 1

SALAGEN Tier 3

*MULTIVITAMINS*

*B-COMPLEX W/ FOLIC ACID**-*B-COMPLEX W/ C & FOLIC ACID***

DIALYVITE Tier 1

folbee plus Tier 1

mynephrocaps Tier 1

NEPHROCAPS Tier 3

NEPHRONEX ORAL TABLET Tier 1

RENAL ORAL CAPSULE Tier 1

rena-vite rx Tier 1



reno caps Tier 1

triphrocaps Tier 1

virt-caps Tier 1

virt-vite plus Tier 1

vol-care rx Tier 1

*B-COMPLEX W/ FOLIC ACID**-*B-COMPLEX W/ C-BIOTIN-D & FOLIC ACID***

NEPHROCAPS QT Tier 3

*B-COMPLEX W/ FOLIC ACID**-*B-COMPLEX W/ C-BIOTIN-D-ZINC & FOLIC ACID***

VITAL-D RX Tier 3

*B-COMPLEX W/ FOLIC ACID**-*B-COMPLEX W/ C-BIOTIN-E & FOLIC ACID***

RENATABS Tier 3

*B-COMPLEX W/ FOLIC ACID**-*B-COMPLEX W/ C-BIOTIN-E-FOLIC ACID & IRON***

RENATABS WITH IRON Tier 3

*B-COMPLEX W/ FOLIC ACID**-*B-COMPLEX W/ C-BIOTIN-E-MINERALS & FOLIC ACID***

DIALYVITE 3000 Tier 3

DIALYVITE 5000 Tier 3

*B-COMPLEX W/ FOLIC ACID**-*B-COMPLEX W/ C-BIOTIN-MINERALS & FOLIC ACID***

FOLBEE PLUS CZ Tier 1

*B-COMPLEX W/ FOLIC ACID**-*B-COMPLEX W/ C-ZN & FOLIC ACID***

DIALYVITE/ZINC Tier 3

NEPHPLEX RX Tier 3

*B-COMPLEX W/ FOLIC ACID**-*B-COMPLEX W/ LYSINE-MIN-FE & FOLIC ACID***

NUTRIVIT Tier 3


153


*MULTIPLE VITAMINS W/ CALCIUM**-*MULTIPLE VITAMINS W/ CALCIUM***

advanced am/pm Tier 3

*MULTIPLE VITAMINS W/ MINERALS & CALCIUM-FOLIC ACID**-*MULTIPLE VITAMINS W/ MINERALS & CALCIUM-FOLIC ACID***

FOLGARD OS Tier 3

TL G-FOL OS Tier 3

*MULTIPLE VITAMINS W/ MINERALS**-*MULTIPLE VITAMINS W/ MINERALS & FOLIC ACID***

CORVITA Tier 1

DIALYVITE SUPREME D Tier 3

OCUVEL Tier 3

STROVITE FORTE ORAL SYRUP Tier 2

SUPERVITE EC Tier 3

SYNAGEX Tier 3

SYNATEK Tier 3

UDAMIN SP Tier 3

*PED MULTI VITAMINS W/FL & FE**-*PED MULTI VITAMINS W/FL & FE***

ESCAVITE Tier 3

multi-vit/fluoride/iron Tier 3

multi-vitamin/fluoride/iron Tier 3

POLY-VI-FLOR/IRON Tier 3

tl-fluorivite Tier 3

*PED MULTI VITAMINS W/FL & FE**-*PED VITAMINS ACD FLUORIDE & IRON***

MYKIDZ IRON FL Tier 3

tri-vit/fluoride/iron Tier 3

*PED MV W/ FLUORIDE**-*PED MV W/ FLUORIDE***

multi vit/fl Tier 1

multi vita-bets/fluoride oral tablet chewable 0.25 mg

Tier 1

multi vitamin/fluoride Tier 1



multiple vitamins/fluoride Tier 1

multi-vit/fluoride Tier 1

multivitamin/fluoride Tier 1

multi-vitamin/fluoride oral solution Tier 1

multi-vitamin/fluoride oral tablet chewable 0.5 mg

Tier 1

multivitamins/fluoride Tier 1

multi-vitamins/fluoride oral solution Tier 1

multi-vits/fluoride Tier 1

mult-vitamin/fluoride Tier 1

MVC-FLUORIDE Tier 1

POLY-VI-FLOR Tier 3

polyvitamin/fluoride Tier 1

poly-vitamin/fluoride oral solution 0.5 mg/ml Tier 1

QUFLORA PEDIATRIC ORAL SOLUTION Tier 3

QUFLORA PEDIATRIC ORAL TABLET CHEWABLE

Tier 1

*PED MV W/ FLUORIDE**-*PED VITAMINS ACD & FA W/ FLUORIDE***

TRI-VI-FLOR Tier 3

tri-vi-floro Tier 3

*PED MV W/ FLUORIDE**-*PED VITAMINS ACD W/ FLUORIDE***

triple-vitamin/fluoride Tier 1

tri-vit/fluoride Tier 1

tri-vitamin/fluoride Tier 1

vitamins acd-fluoride Tier 1

*PRENATAL VITAMINS**-*PRENATAL MV & MIN W/FE-FA***

ATABEX EC Tier 3

ATABEX ORAL TABLET Tier 3

BAL-CARE DHA Tier 3

CITRANATAL B-CALM Tier 3

CITRANATAL RX Tier 3

c-nate dha Tier 3

completenate Tier 3

CO-NATAL FA Tier 3

CONCEPT DHA Tier 3


155


CONCEPT OB Tier 3

DUET DHA 400 Tier 3

DUET DHA 400EC Tier 3

DUET DHA 430 Tier 3

DUET DHA 430EC Tier 3

DUET DHA BALANCED ORAL 25-1 & 267 MG

Tier 3

ELITE-OB Tier 3

FOLCAPS OMEGA 3 Tier 3

FOLIVANE-OB Tier 3

hemenatal ob Tier 3

hemenatal ob + dha Tier 3

INATAL ADVANCE Tier 3

INATAL GT Tier 3

INATAL ULTRA Tier 3

MARNATAL-F Tier 3

MYNATAL Tier 3

MYNATAL ADVANCE Tier 3

NATACHEW Tier 3

NATALVIT Tier 3

NATELLE ONE Tier 3

NEEVO DHA ORAL CAPSULE 27-1.13 MG Tier 3

NESTABS Tier 3

NESTABS DHA Tier 3

OB COMPLETE Tier 3

OB COMPLETE 400 Tier 3

OB COMPLETE ONE Tier 3

OB COMPLETE PETITE Tier 3

OB COMPLETE PREMIER Tier 3

OB COMPLETE/DHA Tier 3

O-CAL PRENATAL Tier 3

pnv fe fum/docusate/folic acid Tier 3

pnv-omega Tier 3

pnv-select Tier 3

pnv-total Tier 3

PREFERA OB Tier 3

PREFERA OB + DHA Tier 3



prena1 pearl Tier 3

prenaissance harmony dha Tier 3

PRENATA Tier 3

prenatabs fa Tier 3

PRENATABS RX Tier 3

prenatal 19 Tier 3

PRENATAL AD Tier 3

PRENATAL MULTIVITAMIN-ULTRA Tier 3

prenatal plus iron Tier 3

PRENATAL-U Tier 3

PRENATE ELITE ORAL TABLET 26-0.6-0.4 MG

Tier 3

PROVIDA OB Tier 3

purefe ob plus Tier 3

relnate dha Tier 3

SELECT-OB ORAL TABLET CHEWABLE 29-1 MG

Tier 3

se-natal 19 Tier 3

TARON-BC Tier 3

TARON-C DHA Tier 3

tl-care dha Tier 3

triadvance Tier 3

TRICARE PRENATAL COMPLEAT Tier 3

TRICARE PRENATAL DHA ONE Tier 3

trinatal gt Tier 3

TRINATE Tier 3

tri-tabs dha Tier 3

ultra tabs Tier 3

vena-bal dha Tier 3

venatal-fa Tier 3

VINACAL B Tier 3

VINATE AZ EXTRA Tier 3

VINATE CALCIUM Tier 3

VINATE DHA RF Tier 3

VINATE IC Tier 3

VINATE II Tier 3

VINATE M Tier 3


157


virt-pn Tier 3

virt-pn plus Tier 3

VITAFOL-NANO Tier 3

VITAFOL-OB Tier 3

VITAPEARL Tier 3

VITA-PREN Tier 3

VIVA DHA Tier 3

vol-nate Tier 3

vol-tab rx Tier 3

vp-heme ob Tier 3

vp-heme ob + dha Tier 3

vp-pnv-dha Tier 3

ZATEAN-PN Tier 3

ZATEAN-PN PLUS Tier 3

*PRENATAL VITAMINS**-*PRENATAL MV & MIN W/FE-FA-CA-OMEGA 3 FISH OIL***

NESTABS ABC Tier 3

PR NATAL 400 Tier 3

TRIVEEN-DUO DHA Tier 3

*PRENATAL VITAMINS**-*PRENATAL MV & MIN W/FE-FA-DHA***

active ob Tier 3

CITRANATAL 90 DHA Tier 3

CITRANATAL DHA Tier 3

CITRANATAL HARMONY ORAL CAPSULE 27-1-260 MG

Tier 3

CRNATAL Tier 3

extra-virt plus dha Tier 3

folcal dha Tier 3

FOLIVANE-PRX DHA NF Tier 3

GESTICARE DHA Tier 3

infanate balance Tier 3

levomefolate dha Tier 3

MACNATAL CN DHA Tier 3

NATALVIRT 90 DHA Tier 3

NATALVIRT CA Tier 3

NEXA PLUS Tier 3



PAIRE OB Tier 3

pnv ob+dha Tier 3

pnv-dha Tier 3

pnv-dha+docusate Tier 3

PREFERAOB ONE Tier 3

PREFOL-DHA Tier 3

prena1 plus/quatrefolic Tier 3

prena1/quatrefolic oral capsule Tier 3

prenaissance Tier 3

prenaissance 90 dha Tier 3

prenaissance balance Tier 3

prenaissance dha Tier 3

prenaissance plus Tier 3

prenaissance promise Tier 3

PRENATE DHA ORAL CAPSULE 28-0.6-0.4-300 MG

Tier 3

PRENATE ENHANCE Tier 3

PRENATE MINI Tier 3

PRENATE RESTORE Tier 3

PREQUE 10 ORAL TABLET 15-25-0.5-50 MG Tier 3

R-NATAL OB Tier 3

SELECT-OB+DHA Tier 3

TARON-PREX Tier 3

tl-select Tier 3

TRIVEEN-PRX RNF Tier 3

VEMAVITE-PRX 2 Tier 3

virt-pn dha Tier 3

virt-select Tier 3

VITAFOL FE+ Tier 3

VITAFOL ULTRA Tier 3

VITAFOL-OB+DHA Tier 3

VITAFOL-ONE Tier 3

VITAMEDMD ONE RX/QUATREFOLIC Tier 3

VITAMEDMD PLUS RX/QUATREFOLIC Tier 3

vp-ch plus Tier 3

vp-ch-pnv Tier 3

vp-heme one Tier 3


159


ZATEAN-CH Tier 3

ZATEAN-PN DHA Tier 3

*PRENATAL VITAMINS**-*PRENATAL MV & MINERALS W/FA WITHOUT IRON***

PRENATE Tier 3

*PRENATAL VITAMINS**-*PRENATAL VITAMINS***

focalgin-b Tier 3

prenaissance next Tier 3

prenaissance next-b Tier 3

PRENATE AM Tier 3

vp-ggr-b6 prenatal Tier 3

*VITAMIN MIXTURES**-*NIACINAMIDE W/ ZINC-COPPER & FOLIC ACID***

NICOMIDE Tier 3

*MUSCULOSKELETAL THERAPY AGENTS*

*CENTRAL MUSCLE RELAXANTS**-*CENTRAL MUSCLE RELAXANTS***

AMRIX Tier 3

baclofen oral tablet 10 mg Tier 1 LGC

baclofen oral tablet 20 mg Tier 1

carisoprodol oral tablet 350 mg Tier 1

chlorzoxazone oral Tier 1

cyclobenzaprine hcl oral tablet 10 mg, 5 mg Tier 1 LGC

cyclobenzaprine hcl oral tablet 7.5 mg Tier 1

FEXMID Tier 3

LORZONE Tier 3

metaxalone Tier 1

methocarbamol oral Tier 1

orphenadrine citrate er Tier 1

PARAFON FORTE DSC Tier 3

ROBAXIN ORAL Tier 3

ROBAXIN-750 Tier 3

SKELAXIN Tier 3

SOMA Tier 3

tizanidine hcl oral Tier 12016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)160


ZANAFLEX Tier 3

*DIRECT MUSCLE RELAXANTS**-*DIRECT MUSCLE RELAXANTS***

DANTRIUM ORAL CAPSULE 25 MG, 50 MG Tier 3

dantrolene sodium oral Tier 1

*MUSCLE RELAXANT COMBINATIONS**-*MUSCLE RELAXANT COMBINATIONS***

carisoprodol-aspirin Tier 1

carisoprodol-aspirin-codeine Tier 1

orphenadrine-aspirin-caffeine oral tablet25-385-30 mg

Tier 1

*MUSCLE RELAXANT COMBINATIONS**-*MUSCLE RELAXANT-NUTRITIONAL SUPPLEMENT COMBINATIONS***

THERABENZAPRINE-90-5 Tier 3

*VISCOSUPPLEMENTS**-*VISCOSUPPLEMENTS***

EUFLEXXA Tier 4 PA

GEL-ONE Tier 4 PA

HYALGAN Tier 4 PA

MONOVISC Tier 4 PA

ORTHOVISC Tier 4 PA

SUPARTZ Tier 4 PA

SYNVISC Tier 4 PA

SYNVISC ONE Tier 4 PA

*NASAL AGENTS - SYSTEMIC AND TOPICAL*

*NASAL AGENT COMBINATIONS**-*ANTIHISTAMINE-STEROID***

DYMISTA Tier 3

*NASAL ANTIALLERGY**-*NASAL ANTIHISTAMINES***

ASTEPRO Tier 3

azelastine hcl nasal Tier 1

olopatadine hcl Tier 1

PATANASE Tier 3


161


*NASAL ANTICHOLINERGICS**-*NASAL ANTICHOLINERGICS***

ATROVENT Tier 3

ipratropium bromide nasal Tier 1

*NASAL ANTI-INFECTIVES**-*NASAL ANTIBIOTICS***

BACTROBAN NASAL Tier 3

*NASAL STEROIDS**-*NASAL STEROIDS***

BECONASE AQ Tier 3

budesonide nasal Tier 1

FLONASE Tier 3

FLONASE ALLERGY RELIEF Tier 1 Select OTC

flunisolide nasal solution 25 mcg/act (0.025%) Tier 1

fluticasone propionate nasal Tier 1

NASACORT ALLERGY 24HR Tier 1 Select OTC

NASONEX Tier 2

OMNARIS Tier 3

QNASL Tier 3

QNASL CHILDRENS Tier 3

RHINOCORT AQUA Tier 3

VERAMYST Tier 3

ZETONNA Tier 3

*SYMPATHOMIMETIC DECONGESTANTS**-*TOPICAL DECONGESTANTS***

ADRENALIN NASAL Tier 3

TYZINE Tier 3

*NEUROMUSCULAR AGENTS*

*ALS AGENTS**-*BENZATHIAZOLES***

RILUTEK Tier 3

riluzole Tier 1

*NEUROMUSCULAR BLOCKING AGENT - NEUROTOXINS**-*NEUROMUSCULAR BLOCKING AGENT - NEUROTOXINS***

BOTOX Tier 4 PA

DYSPORT Tier 4 PA

XEOMIN Tier 4 PA



*OPHTHALMIC AGENTS*

*ARTIFICIAL TEARS AND LUBRICANTS**-*ARTIFICIAL TEAR INSERTS***

LACRISERT Tier 3

*BETA-BLOCKERS - OPHTHALMIC**-*BETA-BLOCKERS - OPHTHALMIC COMBINATIONS***

COMBIGAN Tier 2

COSOPT Tier 3

COSOPT PF Tier 3

dorzolamide hcl-timolol mal Tier 1

*BETA-BLOCKERS - OPHTHALMIC**-*BETA-BLOCKERS - OPHTHALMIC***

BETAGAN Tier 3

betaxolol hcl ophthalmic Tier 1

BETIMOL Tier 2

BETOPTIC-S Tier 2

carteolol hcl Tier 1

ISTALOL Tier 3

levobunolol hcl ophthalmic solution 0.5 % Tier 1

metipranolol Tier 1

timolol maleate ophthalmic Tier 1

TIMOPTIC Tier 3

TIMOPTIC OCUDOSE Tier 3

TIMOPTIC-XE Tier 3

*CYCLOPLEGIC MYDRIATICS**-*CYCLOPLEGIC MYDRIATIC COMBINATIONS***

CYCLOMYDRIL Tier 3

*CYCLOPLEGIC MYDRIATICS**-*CYCLOPLEGIC MYDRIATICS***

atropine sulfate ophthalmic solution Tier 1

atropine-care Tier 1

CYCLOGYL OPHTHALMIC SOLUTION 0.5 %, 2 %

Tier 3

cyclopentolate hcl ophthalmic Tier 1


163


HOMATROPAIRE Tier 1

homatropine hbr ophthalmic Tier 1

ISOPTO HOMATROPINE OPHTHALMIC SOLUTION 2 %

Tier 3

ISOPTO HYOSCINE Tier 3

mydral Tier 1

MYDRIACYL Tier 3

tropicamide ophthalmic Tier 1

*MIOTICS**-*MIOTICS - CHOLINESTERASE INHIBITORS***

PHOSPHOLINE IODIDE Tier 2

*MIOTICS**-*MIOTICS - DIRECT ACTING***

ISOPTO CARBACHOL Tier 2

pilocarpine hcl ophthalmic Tier 1

*OPHTHALMIC - ANGIOGENESIS INHIBITORS**-*VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) ANTAGONISTS***

EYLEA Tier 4 PA

LUCENTIS Tier 4 PA

MACUGEN Tier 4 PA

*OPHTHALMIC ADRENERGIC AGENTS**-*ALPHA ADRENERGIC AGONIST & CARBONIC ANHYDRASE INHIB COMB***

SIMBRINZA Tier 3

*OPHTHALMIC ADRENERGIC AGENTS**-*OPHTHALMIC SELECTIVE ALPHA ADRENERGIC AGONISTS***

ALPHAGAN P Tier 2

apraclonidine hcl Tier 1

brimonidine tartrate ophthalmic Tier 1

IOPIDINE Tier 3

*OPHTHALMIC ANTI-INFECTIVES**-*OPHTHALMIC ANTIBIOTICS***

AZASITE Tier 2

BESIVANCE Tier 3

CILOXAN Tier 3



ciprofloxacin hcl ophthalmic Tier 1

erythromycin ophthalmic Tier 1

GARAMYCIN OPHTHALMIC SOLUTION Tier 3

gatifloxacin Tier 1

GENTAK Tier 1

gentamicin sulfate ophthalmic Tier 1

ILOTYCIN Tier 1

levofloxacin ophthalmic Tier 1

MITOSOL Tier 3

MOXEZA Tier 3

OCUFLOX Tier 3

ofloxacin ophthalmic Tier 1

romycin Tier 1

tobramycin ophthalmic Tier 1

TOBREX Tier 3

VIGAMOX Tier 3

ZYMAXID Tier 3

*OPHTHALMIC ANTI-INFECTIVES**-*OPHTHALMIC ANTIFUNGAL***

NATACYN Tier 3

*OPHTHALMIC ANTI-INFECTIVES**-*OPHTHALMIC ANTI-INFECTIVE COMBINATIONS***

ak-poly-bac Tier 1

bacitracin-polymyxin b ophthalmic Tier 1

neomycin-bacitracin zn-polymyx Tier 1

neomycin-polymyxin-gramicidin Tier 1

NEO-POLYCIN Tier 1

NEOSPORIN Tier 3

POLYCIN Tier 1

polycin b Tier 1

polymyxin b-trimethoprim Tier 1

POLYTRIM Tier 3

triple antibiotic ophthalmic Tier 1


165


*OPHTHALMIC ANTI-INFECTIVES**-*OPHTHALMIC ANTISEPTICS***

BETADINE OPHTHALMIC PREP Tier 3

*OPHTHALMIC ANTI-INFECTIVES**-*OPHTHALMIC ANTIVIRALS***

trifluridine ophthalmic Tier 1

VIROPTIC Tier 3

ZIRGAN Tier 3

*OPHTHALMIC ANTI-INFECTIVES**-*OPHTHALMIC SULFONAMIDES***

sulfacetamide sodium ophthalmic solution Tier 1

*OPHTHALMIC DECONGESTANTS**-*OPHTHALMIC DECONGESTANTS***

ALTAFRIN Tier 1

NEOFRIN Tier 1

phenylephrine hcl ophthalmic solution 10 %, 2.5 %

Tier 1

*OPHTHALMIC IMMUNOMODULATORS**-*OPHTHALMIC IMMUNOMODULATORS***

RESTASIS Tier 2

*OPHTHALMIC LOCAL ANESTHETICS**-*OPHTHALMIC LOCAL ANESTHETICS***

AKTEN Tier 3

ALCAINE Tier 3

ALTACAINE Tier 1

parcaine Tier 1

proparacaine hcl ophthalmic Tier 1

TETCAINE Tier 1

tetracaine hcl ophthalmic Tier 1

TETRAVISC Tier 1

TETRAVISC FORTE Tier 1



*OPHTHALMIC PHOTODYNAMIC THERAPY AGENTS**-*OPHTHALMIC PHOTODYNAMIC THERAPY AGENTS***

VISUDYNE Tier 4 PA

*OPHTHALMIC STEROIDS**-*OPHTHALMIC STEROID COMBINATIONS***

bacitra-neomycin-polymyxin-hc Tier 1

BLEPHAMIDE Tier 3

BLEPHAMIDE S.O.P. Tier 3

MAXITROL Tier 3

neomycin-polymyxin-dexameth Tier 1

NEO-POLYCIN HC Tier 1

poly-dex Tier 1

PRED-G Tier 3

PRED-G S.O.P. Tier 3

sulfacetamide-prednisolone ophthalmic solution Tier 1

TOBRADEX Tier 3

TOBRADEX ST Tier 3

tobramycin-dexamethasone Tier 1

ZYLET Tier 3

*OPHTHALMIC STEROIDS**-*OPHTHALMIC STEROIDS***

ALREX Tier 2

dexamethasone sodium phosphate ophthalmic Tier 1

DUREZOL Tier 2

FLAREX Tier 3

fluorometholone ophthalmic Tier 1

FML Tier 3

FML FORTE Tier 3

FML LIQUIFILM Tier 3

LOTEMAX OPHTHALMIC Tier 2

LOTEMAX OPHTHALMIC OINTMENT Tier 3

LOTEMAX OPHTHALMIC SUSPENSION Tier 2

MAXIDEX Tier 3

OMNIPRED Tier 3

OZURDEX Tier 4 PA


167


PRED FORTE Tier 3

PRED MILD Tier 3

prednisolone acetate ophthalmic Tier 1

prednisolone sodium phosphate ophthalmic Tier 1

VEXOL Tier 3

*OPHTHALMIC SURGICAL AIDS**-*OPHTHALMIC SURGICAL AIDS***

GELFILM OPHTHALMIC Tier 3

*OPHTHALMICS - MISC.**-*OPHTHALMIC ANTIALLERGIC***

ALAWAY Tier 1 Select OTC

ALAWAY CHILDRENS ALLERGY Tier 1 Select OTC

ALOCRIL Tier 3

ALOMIDE Tier 3

azelastine hcl ophthalmic Tier 1

BEPREVE Tier 3

cromolyn sodium ophthalmic Tier 1

ELESTAT Tier 3

EMADINE Tier 3

epinastine hcl Tier 1

LASTACAFT Tier 3

OPTIVAR Tier 3

PATADAY Tier 3

PATANOL Tier 3 #

PAZEO Tier 3

ZADITOR Tier 1 LGC; Select OTC

*OPHTHALMICS - MISC.**-*OPHTHALMIC CARBONIC ANHYDRASE INHIBITORS***

AZOPT Tier 2

dorzolamide hcl Tier 1

TRUSOPT Tier 3

*OPHTHALMICS - MISC.**-*OPHTHALMIC DIAGNOSTIC PRODUCTS***

ALTAFLUOR Tier 1

BIO GLO Tier 1



FLUCAINE Tier 1

fluorescein-benoxinate Tier 1

FLUOR-I-STRIPS A.T. Tier 1

FLURA-SAFE Tier 3

FLUROX Tier 1

FUL-GLO OPHTHALMIC STRIP 0.6 MG Tier 3

FUL-GLO OPHTHALMIC STRIP 1 MG Tier 1

PAREMYD Tier 3

proparacaine-fluorescein Tier 1

ROSE GLO Tier 3

*OPHTHALMICS - MISC.**-*OPHTHALMIC ENZYMES***

JETREA Tier 4 PA

*OPHTHALMICS - MISC.**-*OPHTHALMIC NONSTEROIDAL ANTI-INFLAMMATORY AGENTS***

ACULAR Tier 3

ACULAR LS Tier 3

ACUVAIL Tier 3

diclofenac sodium ophthalmic Tier 1

flurbiprofen sodium Tier 1

ILEVRO Tier 3

ketorolac tromethamine ophthalmic Tier 1

NEVANAC Tier 3

OCUFEN Tier 3

PROLENSA Tier 3

*OPHTHALMICS - MISC.**-*OPHTHALMICS - CYSTINOSIS AGENTS**

CYSTARAN Tier 4 PA

*PROSTAGLANDINS - OPHTHALMIC**-*PROSTAGLANDINS - OPHTHALMIC***

bimatoprost ophthalmic Tier 1

latanoprost ophthalmic Tier 1

LUMIGAN OPHTHALMIC SOLUTION 0.01 % Tier 2

RESCULA Tier 3

TRAVATAN Z Tier 2

travoprost Tier 12016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)

169


XALATAN Tier 3

ZIOPTAN Tier 3

*OTIC AGENTS*

*OTIC AGENTS - MISCELLANEOUS**-*OTIC AGENTS - MISCELLANEOUS***

acetic acid otic Tier 1

CRESYLATE Tier 3

*OTIC ANALGESICS**-*OTIC ANALGESICS***

pinnacaine otic Tier 3

*OTIC ANTI-INFECTIVES**-*OTIC ANTI-INFECTIVES***

CETRAXAL Tier 3

ofloxacin otic Tier 1

*OTIC COMBINATIONS**-*OTIC ANALGESIC COMBINATIONS***

antipyrine-benzocaine Tier 1

AURODEX Tier 1

MYOXIN Tier 3

otic care Tier 1

oticin Tier 1

OTOZIN Tier 3

*OTIC COMBINATIONS**-*OTIC STEROID-ANTI-INFECTIVE COMBINATIONS***

antibiotic ear Tier 1

CIPRO HC Tier 3 #

CIPRODEX Tier 2

COLY-MYCIN S Tier 3

CORTISPORIN OTIC Tier 3

CORTISPORIN-TC Tier 3

neomycin-polymyxin-hc otic Tier 1

*OTIC STEROIDS**-*OTIC STEROIDS***

ACETASOL HC Tier 1

DERMOTIC Tier 3

fluocinolone acetonide otic Tier 1

hydrocortisone-acetic acid Tier 1

VOSOL HC Tier 32016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)170


*OXYTOCICS*

*ABORTIFACIENTS/AGENTS FOR CERVICAL RIPENING**-*ABORTIFACIENTS/CERVICAL RIPENING - PROSTAGLANDINS***

CERVIDIL Tier 3

PREPIDIL Tier 3

PROSTIN E2 Tier 3

*OXYTOCICS**-*OXYTOCICS***

methylergonovine maleate oral Tier 1

*PASSIVE IMMUNIZING AGENTS*

*IMMUNE SERUMS**-*IMMUNE SERUMS***

BIVIGAM Tier 4 PA

CARIMUNE NF INTRAVENOUS* SOLUTION RECONSTITUTED 12 GM, 6 GM

Tier 4 PA

CYTOGAM Tier 4

FLEBOGAMMA Tier 4 PA

FLEBOGAMMA DIF Tier 4 PA

GAMASTAN S/D Tier 4

GAMMAGARD Tier 4 PA

GAMMAGARD S/D INTRAVENOUS* SOLUTION RECONSTITUTED 10 GM, 5 GM

Tier 4 PA

GAMMAGARD S/D INTRAVENOUS* SOLUTION RECONSTITUTED 2.5 GM

Tier 4

GAMMAGARD S/D LESS IGA Tier 4

GAMMAKED Tier 4 PA

GAMMAPLEX Tier 4 PA

GAMUNEX-C Tier 4 PA

HEPAGAM B Tier 4

HIZENTRA Tier 4 PA

HYPERHEP B S/D Tier 4

HYPERRAB S/D Tier 4

HYPERRHO S/D Tier 4

HYPERTET S/D Tier 4

IMOGAM RABIES-HT Tier 4

MICRHOGAM ULTRA-FILTERED PLUS Tier 4

NABI-HB Tier 4

OCTAGAM Tier 4 PA2016 Aetna Pharmacy Drug Guide - Four Tier Open Premier Plus Formulary(Updated 11/01/15)

171


PRIVIGEN Tier 4 PA

RHOGAM ULTRA-FILTERED PLUS Tier 4

RHOPHYLAC Tier 4

WINRHO SDF Tier 4

*MONOCLONAL ANTIBODIES**-*ANTIVIRAL MONOCLONAL ANTIBODIES***

SYNAGIS Tier 4 PA

*PASSIVE IMMUNIZING AGENTS - COMBINATIONS**-*PASSIVE IMMUNIZING AGENTS - COMBINATIONS***

HYQVIA Tier 4 PA

*PENICILLINS*

*AMINOPENICILLINS**-*AMINOPENICILLINS***

amoxicillin oral capsule Tier 1

amoxicillin oral suspension reconstituted Tier 1

amoxicillin oral tablet Tier 1

ampicillin oral capsule Tier 1

MOXATAG Tier 3

*NATURAL PENICILLINS**-*NATURAL PENICILLINS***

penicillin v potassium Tier 1

*PENICILLIN COMBINATIONS**-*PENICILLIN COMBINATIONS***

amoxicillin-pot clavulanate er Tier 1

amoxicillin-pot clavulanate oral Tier 1

AUGMENTIN ES-600 Tier 3

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

Tier 2

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 250-62.5 MG/5ML

Tier 3

AUGMENTIN ORAL TABLET Tier 3

AUGMENTIN XR Tier 3

*PENICILLINASE-RESISTANT PENICILLINS**-*PENICILLINASE-RESISTANT PENICILLINS***

dicloxacillin sodium Tier 1



*PHARMACEUTICAL ADJUVANTS*

*LIQUID VEHICLES**-*ORAL VEHICLES***

PCCA ACACIA SYRUP BASE Tier 3

*SEMI SOLID VEHICLES**-*SEMI SOLID VEHICLES***

polyethylene glycol 3350 powder Tier 1 LGC

*PROGESTINS*

*PROGESTINS**-*PROGESTINS***

AYGESTIN Tier 3

MAKENA Tier 4 PA

medroxyprogesterone acetate oral Tier 1 LGC

MEGACE ES Tier 3

megestrol acetate oral suspension 625 mg/5ml Tier 1

norethindrone acetate oral Tier 1

progesterone intramuscular* Tier 1

progesterone micronized oral Tier 1

PROMETRIUM Tier 3

PROVERA Tier 3

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*

*AGENTS FOR CHEMICAL DEPENDENCY**-*ALCOHOL DETERRENTS***

acamprosate calcium Tier 1

ANTABUSE Tier 3

CAMPRAL Tier 3

disulfiram oral Tier 1

*ANTI-CATAPLECTIC AGENTS**-*ANTI-CATAPLECTIC AGENTS***

XYREM Tier 4 PA

*ANTIDEMENTIA AGENTS**-*ANTIDEMENTIA AGENT COMBINATIONS***

NAMZARIC Tier 2


173


*ANTIDEMENTIA AGENTS**-*CHOLINOMIMETICS - ACHE INHIBITORS***

ARICEPT Tier 3

ARICEPT ODT ORAL TABLET DISPERSIBLE 10 MG

Tier 3

donepezil hcl Tier 1

EXELON ORAL CAPSULE Tier 3

EXELON TRANSDERMAL Tier 2

galantamine hydrobromide Tier 1

galantamine hydrobromide er Tier 1

RAZADYNE Tier 3

RAZADYNE ER Tier 3

rivastigmine Tier 1

rivastigmine tartrate Tier 1

*ANTIDEMENTIA AGENTS**-*N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONISTS***

memantine hcl oral tablet Tier 1

NAMENDA Tier 2 #

NAMENDA TITRATION PAK Tier 2 #

NAMENDA XR Tier 2 #

NAMENDA XR TITRATION PACK Tier 2 #

*COMBINATION PSYCHOTHERAPEUTICS**-*THIENBENZODIAZEPINES & SSRIS***

olanzapine-fluoxetine hcl Tier 1

SYMBYAX Tier 3

*FIBROMYALGIA AGENTS**-*FIBROMYALGIA AGENT - SNRIS***

SAVELLA Tier 2

SAVELLA TITRATION PACK Tier 2

*MOVEMENT DISORDER DRUG THERAPY**-*MOVEMENT DISORDER DRUG THERAPY***

tetrabenazine Tier 4 PA

XENAZINE ORAL TABLET 12.5 MG, 25 MG Tier 4 PA; #; QL



*MULTIPLE SCLEROSIS AGENTS**-*MS AGENTS - PYRIMIDINE SYNTHESIS INHIBITORS***

AUBAGIO Tier 4 PA; QL

*MULTIPLE SCLEROSIS AGENTS**-*MULTIPLE SCLEROSIS AGENTS - INTERFERONS***

AVONEX Tier 4 PA; QL

BETASERON Tier 4 PA; QL

EXTAVIA Tier 4 PA; QL

PLEGRIDY Tier 4 PA; QL

PLEGRIDY STARTER PACK Tier 4 PA; QL

*MULTIPLE SCLEROSIS AGENTS**-*MULTIPLE SCLEROSIS AGENTS - MONOCLONAL ANTIBODIES***

LEMTRADA Tier 4 PA; QL

TYSABRI Tier 4 PA

*MULTIPLE SCLEROSIS AGENTS**-*MULTIPLE SCLEROSIS AGENTS - NRF2 PATHWAY ACTIVATORS***

TECFIDERA ORAL Tier 4 PA; QL

TECFIDERA ORAL CAPSULE DELAYED RELEASE 120 MG, 240 MG

Tier 4 PA; QL

*MULTIPLE SCLEROSIS AGENTS**-*MULTIPLE SCLEROSIS AGENTS - POTASSIUM CHANNEL BLOCKERS***

AMPYRA Tier 4 PA; QL

*MULTIPLE SCLEROSIS AGENTS**-*MULTIPLE SCLEROSIS AGENTS***

COPAXONE Tier 4 PA

GLATOPA Tier 4 PA

*MULTIPLE SCLEROSIS AGENTS**-*SPHINGOSINE 1-PHOSPHATE (S1P) RECEPTOR MODULATORS***

GILENYA Tier 4 PA; QL


175


*POSTHERPETIC NEURALGIA (PHN) AGENTS**-*POSTHERPETIC NEURALGIA (PHN) AGENTS***

GRALISE Tier 3

GRALISE STARTER Tier 3

*PREMENSTRUAL DYSPHORIC DISORDER (PMDD) AGENTS**-*PREMENSTRUAL DYSPHORIC DISORDER (PMDD) AGENTS - SSRIS***

fluoxetine hcl (pmdd) Tier 1

SARAFEM Tier 1

*PSEUDOBULBAR AFFECT (PBA) AGENTS**-*PSEUDOBULBAR AFFECT AGENT COMBINATIONS***

NUEDEXTA Tier 2

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.**-*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.***

ORAP Tier 3

*RESTLESS LEG SYNDROME (RLS) AGENTS**-*RESTLESS LEG SYNDROME (RLS) AGENTS***

HORIZANT Tier 3

*SMOKING DETERRENTS**-*SMOKING DETERRENTS***

BUPROBAN CE

bupropion hcl er (smoking det) CE

CHANTIX CE

CHANTIX CONTINUING MONTH PAK CE

CHANTIX STARTING MONTH PAK CE

NICODERM CQ CE

NICORETTE Tier 3

NICORETTE MINI Tier 3

NICORETTE STARTER KIT Tier 3

nicotine CE

nicotine polacrilex mouth/throat CE

NICOTROL CE

NICOTROL NS CE



ZYBAN Tier 3

*VASOMOTOR SYMPTOM AGENTS**-*VASOMOTOR SYMPTOM AGENTS - SSRIS***

BRISDELLE Tier 3

*RESPIRATORY AGENTS - MISC.*

*ALPHA-PROTEINASE INHIBITOR (HUMAN)**-*ALPHA-PROTEINASE INHIBITOR (HUMAN)***

ARALAST NP Tier 4 PA

GLASSIA Tier 4 PA

PROLASTIN-C Tier 4 PA

ZEMAIRA Tier 4 PA

*CYSTIC FIBROSIS AGENTS**-*CFTR POTENTIATORS***

KALYDECO ORAL PACKET Tier 4 PA

KALYDECO ORAL TABLET Tier 4 PA; QL

*CYSTIC FIBROSIS AGENTS**-*CYSTIC FIBROSIS AGENT - COMBINATIONS***

ORKAMBI Tier 4 PA

*CYSTIC FIBROSIS AGENTS**-*HYDROLYTIC ENZYMES***

PULMOZYME Tier 4 PA

*PLEURAL SCLEROSING AGENTS**-*PLEURAL SCLEROSING AGENTS***

SCLEROSOL INTRAPLEURAL Tier 3

STERILE TALC POWDER Tier 3

*PULMONARY FIBROSIS AGENTS**-*PULMONARY FIBROSIS AGENTS - KINASE INHIBITORS***

OFEV Tier 4 PA; QL

*PULMONARY FIBROSIS AGENTS**-*PULMONARY FIBROSIS AGENTS***

ESBRIET Tier 4 PA; QL

*RESPIRATORY AGENTS - MISC.**-*RESPIRATORY AGENTS - MISC.***

CUROSURF Tier 3


177


INFASURF Tier 3

*TETRACYCLINES*

*TETRACYCLINE COMBINATIONS**-*TETRACYCLINE COMBINATIONS***

NICAZELDOXY 30 Tier 3

NICAZELDOXY 60 Tier 3

*TETRACYCLINES**-*TETRACYCLINES***

ACTICLATE Tier 3

ADOXA Tier 3 AL

ADOXA PAK 1/100 Tier 3 AL



avidoxy Tier 1 AL

demeclocycline hcl oral Tier 1 AL

DORYX ORAL TABLET DELAYED RELEASE 150 MG, 200 MG

Tier 3 AL

DORYX ORAL TABLET DELAYED RELEASE 50 MG

Tier 3

doxycycline hyclate oral capsule Tier 1 LGC; AL

doxycycline hyclate oral tablet 100 mg Tier 1 LGC; AL

doxycycline hyclate oral tablet 20 mg Tier 1 AL

doxycycline hyclate oral tablet delayed release Tier 1 AL

doxycycline monohydrate Tier 1 AL

MINOCIN ORAL CAPSULE 100 MG, 50 MG Tier 3 AL

minocycline hcl er Tier 1 AL

minocycline hcl oral Tier 1 AL

MONODOX ORAL CAPSULE 100 MG, 75 MG Tier 3 AL

MORGIDOX ORAL Tier 1 AL

SOLODYN Tier 3 AL

TARGADOX Tier 3

tetracycline hcl oral Tier 1 LGC

VIBRAMYCIN Tier 3 AL

*THYROID AGENTS*

*ANTITHYROID AGENTS**-*ANTITHYROID AGENTS***

methimazole oral Tier 1



propylthiouracil oral Tier 1

TAPAZOLE Tier 3

*THYROID HORMONES**-*THYROID HORMONES***

ARMOUR THYROID ORAL TABLET 120 MG, 15 MG, 180 MG, 240 MG, 300 MG

Tier 3

CYTOMEL Tier 3

levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg

Tier 1 LGC

levothyroxine sodium oral tablet 300 mcg Tier 1

LEVOXYL Tier 1

liothyronine sodium oral Tier 1

NATURE-THROID Tier 3

np thyroid Tier 1

SYNTHROID Tier 3

THYROLAR-1 Tier 3

THYROLAR-1/2 Tier 3

THYROLAR-1/4 Tier 3

THYROLAR-2 Tier 3

THYROLAR-3 Tier 3

TIROSINT Tier 3

UNITHROID Tier 1

UNITHROID DIRECT Tier 1

WESTHROID Tier 3

WP THYROID ORAL TABLET 113.75 MG, 130 MG, 16.25 MG, 32.5 MG, 48.75 MG, 65 MG, 97.5 MG

Tier 3

*ULCER DRUGS*

*ANTISPASMODICS**-*ANTICHOLINERGIC COMBINATIONS***

GASTRINEX NF Tier 3

*ANTISPASMODICS**-*ANTISPASMODICS***

BENTYL ORAL CAPSULE Tier 3

BENTYL ORAL TABLET Tier 3

dicyclomine hcl oral capsule Tier 1 LGC

dicyclomine hcl oral tablet Tier 1 LGC


179


*ANTISPASMODICS**-*BELLADONNA ALKALOIDS***

ed-spaz Tier 1

HYOMAX-SL Tier 1

hyoscyamine sulfate er Tier 1

hyoscyamine sulfate oral Tier 1

hyoscyamine sulfate sublingual Tier 1

hyosyne Tier 1

NULEV Tier 1

oscimin Tier 1

oscimin sr Tier 1

SYMAX DUOTAB Tier 3

SYMAX FASTABS Tier 1

SYMAX-SL Tier 1

SYMAX-SR Tier 1

*ANTISPASMODICS**-*QUATERNARY ANTICHOLINERGICS***

CANTIL Tier 3

CUVPOSA Tier 3

GLYCATE Tier 3

glycopyrrolate oral Tier 1

methscopolamine bromide oral Tier 1

PAMINE Tier 3

PAMINE FORTE Tier 3

ROBINUL ORAL Tier 3

ROBINUL-FORTE Tier 3

*H-2 ANTAGONISTS**-*H-2 ANTAGONISTS***

acid reducer maximum strength oral tablet 20 mg Tier 1 LGC

AXID ORAL CAPSULE 300 MG Tier 3

AXID ORAL SOLUTION Tier 3

cimetidine hcl Tier 1

cimetidine oral tablet 300 mg, 400 mg Tier 1

cimetidine oral tablet 800 mg Tier 1 LGC

famotidine oral suspension reconstituted Tier 1

famotidine oral tablet 40 mg Tier 1 LGC

nizatidine Tier 1



PEPCID ORAL SUSPENSION RECONSTITUTED

Tier 3

PEPCID ORAL TABLET 40 MG Tier 3

ranitidine hcl oral capsule 300 mg Tier 1

ranitidine hcl oral syrup Tier 1

ranitidine hcl oral tablet 300 mg Tier 1 LGC

*MISC. ANTI-ULCER**-*MISC. ANTI-ULCER***

CARAFATE Tier 3

sucralfate oral tablet Tier 1

*PROTON PUMP INHIBITORS**-*PROTON PUMP INHIBITORS***

ACIPHEX Tier 3

DEXILANT Tier 2

esomeprazole magnesium Tier 1

esomeprazole strontium oral capsule delayed release 49.3 mg

Tier 3

kp omeprazole magnesium Tier 1 LGC

lansoprazole oral capsule delayed release 15 mg Tier 1 Select OTC

lansoprazole oral capsule delayed release 30 mg Tier 1

NEXIUM 24HR Tier 1 Select OTC

NEXIUM ORAL CAPSULE DELAYED RELEASE 20 MG

Tier 2 #

NEXIUM ORAL CAPSULE DELAYED RELEASE 40 MG

Tier 3 #

NEXIUM ORAL PACKET Tier 3 #

omeprazole oral capsule delayed release 10 mg, 40 mg

Tier 1

omeprazole oral capsule delayed release 20 mg Tier 1 LGC

omeprazole oral tablet delayed release Tier 1 Select OTC

pantoprazole sodium oral Tier 1

PREVACID 24HR Tier 1 Select OTC

PREVACID ORAL CAPSULE DELAYED RELEASE 30 MG

Tier 3

PREVACID SOLUTAB Tier 3

PRILOSEC Tier 3

PRILOSEC OTC Tier 1 LGC; Select OTC

PROTONIX ORAL Tier 3


181


rabeprazole sodium Tier 1

*ULCER DRUGS - PROSTAGLANDINS**-*ULCER DRUGS - PROSTAGLANDINS***

CYTOTEC Tier 3

misoprostol oral Tier 1

*ULCER THERAPY COMBINATIONS**-*PROTON PUMP INHIBITOR-ANTACID COMBINATIONS***

omeprazole-sodium bicarbonate oral capsule40-1100 mg

Tier 1

ZEGERID ORAL CAPSULE 40-1100 MG Tier 3

ZEGERID ORAL PACKET Tier 3

ZEGERID OTC Tier 1 Select OTC

*ULCER THERAPY COMBINATIONS**-*ULCER ANTI-INFECTIVE W/ BISMUTH COMBINATIONS***

PYLERA Tier 2

*ULCER THERAPY COMBINATIONS**-*ULCER ANTI-INFECTIVE W/ PROTON PUMP INHIBITORS***

amoxicill-clarithro-lansopraz Tier 1

OMECLAMOX-PAK Tier 2

PREVPAC Tier 3

*URINARY ANTI-INFECTIVES*

*URINARY ANTI-INFECTIVES**-*URINARY ANTI-INFECTIVES***

FURADANTIN Tier 3

HIPREX Tier 3

MACROBID Tier 3

MACRODANTIN Tier 3

methenamine hippurate Tier 1

methenamine mandelate oral tablet 1 gm Tier 1

MONUROL Tier 3

nitrofurantoin Tier 1



nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg

Tier 1

nitrofurantoin monohyd macro Tier 1

UREX Tier 3

*URINARY ANTISPASMODICS*

*URINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC)**-*URINARY ANTISPASMODIC - ANTIMUSCARINIC (ANTICHOLINERGIC)***

DETROL Tier 3

DETROL LA Tier 3

DITROPAN XL Tier 3

ENABLEX Tier 3

GELNIQUE TRANSDERMAL 3 (28) % (MG/ACT)

Tier 3

oxybutynin chloride oral tablet Tier 1 LGC

OXYTROL FOR WOMEN Tier 1 #; Select OTC

TOVIAZ Tier 3

*URINARY ANTISPASMODICS - BETA-3 ADRENERGIC AGONISTS**-*URINARY ANTISPASMODICS - BETA-3 ADRENERGIC AGONISTS***

MYRBETRIQ Tier 2

*URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS**-*URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS***

bethanechol chloride oral tablet 25 mg Tier 1

*VAGINAL PRODUCTS*

*MISCELLANEOUS VAGINAL PRODUCTS**-*MISCELLANEOUS VAGINAL COMBINATIONS***

FEM PH Tier 3

RELAGARD Tier 3

*SPERMICIDES**-*SPERMICIDES***

ENCARE Tier 3

OPTIONS CONCEPTROL Tier 3

OPTIONS GYNOL II CONTRACEPTIVE Tier 3

SHUR-SEAL CONTRACEPTIVE Tier 3


183


TODAY SPONGE CE

VCF VAGINAL CONTRACEPTIVE VAGINAL FILM

CE

VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM

Tier 3

*VAGINAL ANTI-INFECTIVES**-*IMIDAZOLE-RELATED ANTIFUNGALS***

GYNAZOLE-1 Tier 3

TERAZOL 3 VAGINAL CREAM Tier 3

TERAZOL 7 Tier 3

terconazole Tier 1

ZAZOLE Tier 1

*VAGINAL ANTI-INFECTIVES**-*VAGINAL ANTI-INFECTIVES***

AVC VAGINAL Tier 3

CLEOCIN VAGINAL Tier 3

clindamycin phosphate vaginal Tier 1

CLINDESSE Tier 3

METROGEL-VAGINAL Tier 3

metronidazole vaginal Tier 1

NUVESSA Tier 3

VANDAZOLE Tier 1

*VAGINAL ESTROGENS**-*VAGINAL ESTROGENS***

ESTRACE VAGINAL Tier 3

ESTRING Tier 3

FEMRING Tier 3 #

PREMARIN VAGINAL Tier 2

VAGIFEM Tier 3

*VAGINAL PROGESTINS**-*VAGINAL PROGESTINS***

CRINONE Tier 2

ENDOMETRIN Tier 2

FIRST-PROGESTERONE VGS 100 Tier 3







*VASOPRESSORS*

*ANAPHYLAXIS THERAPY AGENTS**-*ANAPHYLAXIS THERAPY AGENTS***

ADRENACLICK Tier 3

AUVI-Q Tier 2

EPIPEN JR 2-PAK Tier 2 #

*NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS**-*NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS***

NORTHERA ORAL CAPSULE 100 MG, 200 MG, 300 MG

Tier 4 PA; QL

*VASOPRESSORS**-*VASOPRESSORS***

midodrine hcl Tier 1

*VITAMINS*

*OIL SOLUBLE VITAMINS**-*VITAMIN D***

delta d3 CE

DRISDOL ORAL CAPSULE Tier 3

D-VI-SOL CE

D-VITA CE

ergocalciferol oral capsule Tier 1

vitamin d (ergocalciferol) Tier 1

vitamin d2 oral tablet 400 unit CE

vitamin d3 oral capsule 1000 unit, 400 unit CE

vitamin d3 oral liquid† 400 unit/ml CE

vitamin d3 oral tablet 1000 unit, 400 unit CE

vitamin d3 oral tablet chewable 400 unit CE

*OIL SOLUBLE VITAMINS**-*VITAMIN K***

MEPHYTON Tier 2

*WATER SOLUBLE VITAMINS**-*VITAMIN B-3***

ENDUR-ACIN Tier 1

eql niacin Tier 1

gnp niacin Tier 1


185


gnp niacin tr Tier 1

hm niacin Tier 1

niacin er Tier 1

niacin oral tablet Tier 1

niacin-50 Tier 1

px niacin Tier 1

ra niacin Tier 1

ra no flush niacin Tier 1

SLO-NIACIN ORAL TABLET EXTENDEDRELEASE* 250 MG

Tier 1

SLO-NIACIN ORAL TABLET EXTENDEDRELEASE* 500 MG, 750 MG

Tier 3

sm niacin cr Tier 1


Index

Index

1st choice lancets super thin ....... 1221st choice lancets thin ........................... 1221st choice lancets ultra thin ......... 1221st tier unifine pentips .......................... 1381st tier unifine pentips plus ........... 1381st tier unilet comfortouch ............. 1228-MOP .............................................................................. 83abacavir sulfate ................................................... 57abacavir-lamivudine-zidovudine....................................................................................................... 56ABILIFY ....................................................................... 55ABILIFY DISCMELT ............................. 55ABILIFY MAINTENA .......................... 55ABREVA ..................................................................... 84ABSORICA .............................................................. 79ABSTRAL .................................................................. 11acamprosate calcium .............................. 173ACANYA .................................................................... 77acarbose ......................................................................... 28ACCOLATE ............................................................ 19ACCU-CHEK ACTIVE ........................ 92ACCU-CHEK ACTIVE GLUCOSE CONT ...................................... 122ACCU-CHEK AVIVA ............ 92, 122ACCU-CHEK AVIVA PLUS ...... 92ACCU-CHEK COMFORT CURVE ........................................................... 92, 122ACCU-CHEK COMFORT CURVE LINEAR ........................................ 122ACCU-CHEK COMPACT ............... 92ACCU-CHEK COMPACT BLUE CONTROL ............................................................. 123ACCU-CHEK COMPACT PLUS....................................................................................................... 92ACCU-CHEK COMPACT PLUS CONTROL ............................................................. 123ACCU-CHEK COMPACT TEST DRUM .............................................................................. 92ACCU-CHEK FASTCLIX LANCET ................................................................... 123ACCU-CHEK FASTCLIX LANCETS .............................................................. 123ACCU-CHEK INSTANT CONTROL ............................................................. 123ACCU-CHEK MULTICLIX LANCET DEV ................................................ 123ACCU-CHEK MULTICLIX LANCETS .............................................................. 123ACCU-CHEK SAFE-T PRO LANCETS .............................................................. 123ACCU-CHEK SMARTVIEW ..... 92

Index

ACCU-CHEK SMARTVIEW CONTROL ............................................................. 123ACCU-CHEK SOFT TOUCH LANCETS .............................................................. 123ACCU-CHEK SOFTCLIX LANCET DEV ................................................ 123ACCU-CHEK SOFTCLIX LANCETS .............................................................. 123ACCUPRIL ............................................................... 40ACCURETIC ......................................................... 42ACCUTREND GLUCOSE ............... 92ACCUTREND GLUCOSE CONTROL ............................................................. 123acd formula a ......................................................... 22acd formula b ......................................................... 22acd-a .................................................................................... 22ACD-A NOCLOT-50 ................................ 22ACE AEROSOL CLOUD ENHANCER ....................................................... 144acebutolol hcl ......................................................... 62ACEON ........................................................................... 40acetaminophen-codeine .......................... 12acetaminophen-codeine #2 ................ 12acetaminophen-codeine #3 ................ 12acetaminophen-codeine #4 ................ 12ACETASOL HC ........................................... 170acetazolamide ........................................................ 99acetazolamide er ............................................... 99ACETEST ................................................................... 92acetic acid ............................................... 111, 170acetylcysteine ......................................................... 77acid reducer maximum strength................................................................................................... 180ACIPHEX ................................................................ 181acitretin ........................................................................... 83ACLOVATE ........................................................... 85ACTEMRA ................................................................... 7ACTICIN ...................................................................... 91ACTICLATE ...................................................... 178ACTIGALL .......................................................... 107acti-lance 28g .................................................... 123acti-lance lite lancets 28g ............... 123acti-lance special lancets 17g ... 123acti-lance universal 23g ..................... 123ACTIMMUNE ..................................................... 51ACTIQ .............................................................................. 11active fe ....................................................................... 116active ob ..................................................................... 158ACTIVELLA ..................................................... 106active-medicated spec collect ........ 92ACTIVITY POUCH ............................... 144

Index

ACTONEL ............................................................. 100ACTOPLUS MET .......................................... 29ACTOPLUS MET XR ............................. 29ACTOS ............................................................................ 32ACULAR ................................................................. 169ACULAR LS ...................................................... 169ACURA BLOOD GLUCOSE TEST ................................................................................... 92ACURA CONTROL ............................... 123ACUVAIL .............................................................. 169acyclovir ............................................................. 59, 84ACZONE ...................................................................... 77ADAGEN ..................................................................... 63ADALAT CC ......................................................... 63adapalene ..................................................................... 79ADAPTER PED DISPOSABLE................................................................................................... 144ADCIRCA .................................................................. 66ADDERALL ............................................................... 3ADDERALL XR .................................................. 3adefovir dipivoxil .............................................. 58ADEMPAS ................................................................ 66adjustable lancing device ................. 123ADOXA ..................................................................... 178ADOXA PAK 1/100 ............................... 178ADOXA PAK 1/150 ............................... 178ADOXA PAK 2/100 ............................... 178ADRENACLICK ......................................... 185ADRENALIN .................................................... 162adult aerosol mask ..................................... 144adult mask ............................................................... 144adult mask large ............................................. 144ADVAIR DISKUS ........................................ 20ADVAIR HFA ..................................................... 20ADVANCE INTUITION CONTROL ............................................................. 123ADVANCE INTUITION TEST....................................................................................................... 92ADVANCE MICRO-DRAW CONTROL ............................................................. 123ADVANCE MICRO-DRAW NORMAL ................................................................ 123ADVANCE MICRO-DRAW TEST ................................................................................... 92advanced am/pm ............................................ 154ADVATE ................................................................. 112ADVICOR .................................................................. 39ADVOCATE CONTROL SOLUTION .......................................................... 123ADVOCATE INSULIN PEN NEEDLES ............................................................... 138


187

Index

ADVOCATE INSULIN SYRINGE ................................................................ 138ADVOCATE LANCETS ................ 123ADVOCATE LANCING DEVICE................................................................................................... 123ADVOCATE RAPID-SAFE LANCING .............................................................. 123ADVOCATE REDI-CODE ............. 92ADVOCATE REDI-CODE+ CONTROL ............................................................. 123ADVOCATE REDI-CODE+ TEST ................................................................................... 92ADVOCATE SAFETY LANCETS .............................................................. 123ADVOCATE TEST ..................................... 92AEROCHAMBER MINI CHAMBER ........................................................... 146AEROCHAMBER MV ...................... 146AEROCHAMBER PLUS ............... 146AEROCHAMBER PLUS FLO-VU ..................................................................... 146AEROCHAMBER PLUS FLO-VU LARGE ........................................ 146AEROCHAMBER PLUS FLO-VU MEDIUM .................................. 146AEROCHAMBER PLUS FLO-VU SMALL ........................................ 146AEROCHAMBER PLUS FLO-VU W/MASK .................................. 146AEROCHAMBER PLUS FLOW VU ....................................................................................... 146AEROCHAMBER PLUS W/MASK ................................................................. 146AEROCHAMBER PLUS W/MASK SMALL .................................... 146AEROCHAMBER W/FLOWSIGNAL ..................................... 146AEROCHAMBER Z-STAT PLUS................................................................................................... 146AEROCHAMBER Z-STAT PLUS CHAMBR ................................................................ 146AEROCHAMBER Z-STAT PLUS/LARGE .................................................. 146AEROCHAMBER Z-STAT PLUS/MEDIUM ........................................... 146AEROCHAMBER Z-STAT PLUS/SMALL ................................................. 146AEROSPAN ............................................................ 20AEROTRACH PLUS ............................ 144af lancets super thin ................................. 123AFEDITAB CR .................................................. 63AFINITOR ................................................................. 50AFINITOR DISPERZ ............................... 50

Index

AFREZZA .................................................................. 32AGAMATRIX AMP TEST ............. 92AGAMATRIX CONTROL .......... 123AGAMATRIX JAZZ TEST ............ 92AGAMATRIX KEYNOTE TEST....................................................................................................... 92AGAMATRIX PRESTO TEST....................................................................................................... 92AGAMATRIX ULTRA-THIN LANCETS .............................................................. 123AGGRENOX ..................................................... 114AGRYLIN .............................................................. 114aif #2 drug preparation kit ................ 82AIRAVITE ............................................................. 116AIRS PEDIATRIC AEROSOL MASK ........................................................................... 144AIRZONE PEAK FLOW METER................................................................................................... 144AKNE-MYCIN ................................................... 77ak-poly-bac ............................................................ 165AKTEN ....................................................................... 166AKYNZEO ................................................................ 35ALAGESIC LQ .................................................. 10ALAVERT ................................................................. 36ALAVERT ALLERGY/SINUS....................................................................................................... 75ALAWAY ............................................................... 168ALAWAY CHILDRENS ALLERGY ............................................................. 168ALBAFORT ........................................................ 116ALBENZA ................................................................. 16ALBUSTIX ............................................................... 93albuterol sulfate .................................................. 21albuterol sulfate er ......................................... 21ALCAINE ............................................................... 166alclometasone dipropionate ............. 85ALCOH-GLOVE CONTOURED WIPE ............................................................................... 137alcohol pads ......................................................... 137alcohol prep .......................................................... 137alcohol swabs ..................................................... 137alcohol wipes ...................................................... 137ALDACTAZIDE .............................................. 99ALDACTONE ................................................. 100ALDARA ..................................................................... 89ALDURAZYME .......................................... 104alendronate sodium ................................... 100ALFERON N .......................................................... 51alfuzosin hcl er ................................................. 111ALINIA ........................................................................... 45ALKERAN ................................................................ 47ALL FLOW 1000 PFT FILTER................................................................................................... 144

Index

ALLEGRA ALLERGY .......................... 36ALLEGRA ALLERGY CHILDRENS ......................................................... 36allopurinol .............................................................. 112almotriptan malate ..................................... 148ALOCRIL ................................................................ 168ALOMIDE ............................................................. 168ALORA ....................................................................... 106alosetron hcl ........................................................ 109ALPHAGAN P ................................................ 164ALPHANATE/VWF COMPLEX/HUMAN ............................ 112ALPHANINE SD ........................................ 112alphatrex ........................................................................ 85alprazolam .................................................................. 17alprazolam er ......................................................... 17ALPRAZOLAM INTENSOL ....... 17alprazolam xr ......................................................... 17ALPROLIX ........................................................... 112ALREX ........................................................................ 167ALSUMA ................................................................. 148ALTABAX ................................................................ 80ALTACAINE ..................................................... 166ALTACE ....................................................................... 40ALTAFLUOR ................................................... 168ALTAFRIN ........................................................... 166ALTAVERA ........................................................... 68alternate site lancing device ........ 123ALTOPREV ............................................................. 39ALUVEA ..................................................................... 88ALVESCO ................................................................. 20alyacen 1/35 ............................................................. 68alyacen 7/7/7 ........................................................... 71amantadine hcl ......................................... 52, 53AMARYL .................................................................... 33AMBIEN ................................................................... 119AMBIEN CR ...................................................... 120amcinonide ................................................................. 85AMERGE ................................................................. 148AMETHIA ................................................................. 70AMETHIA LO ..................................................... 71AMETHYST ........................................................... 70AMICAR .................................................................. 118amiloride hcl ....................................................... 100amiloride-hydrochlorothiazide .... 99aminoacetic acid ........................................... 111aminocaproic acid ...................................... 118amiodarone hcl .................................................... 18AMITIZA ................................................................. 108amitriptyline hcl ................................................. 27amlodipine besy-benazepril hcl....................................................................................................... 42amlodipine besylate ...................................... 63


Index

amlodipine besylate-valsartan ..... 42amlodipine-valsartan-hctz .................. 43AMMONUL ........................................................ 105AMNESTEEM ..................................................... 79amoxicill-clarithro-lansopraz ... 182amoxicillin .............................................................. 172amoxicillin-pot clavulanate .......... 172amoxicillin-pot clavulanate er................................................................................................... 172amphetamine-dextroamphet er ........ 3amphetamine-dextroamphetamine........................................................................................................... 3ampicillin .................................................................. 172AMPYRA ................................................................ 175AMRIX ........................................................................ 160AMTURNIDE ...................................................... 44ANACAINE ............................................................. 90ANADROL-50 ..................................................... 15ANAFRANIL ........................................................ 27anagrelide hcl .................................................... 114ANALPRAM-HC ............................................ 16ANAPROX .................................................................... 8ANAPROX DS ....................................................... 8anastrozole ................................................................. 48ANDRODERM ................................................... 15ANDROGEL .......................................................... 15ANDROGEL PUMP ................................... 15ANDROID ................................................................. 15ANDROXY .............................................................. 15ANGELIQ ............................................................... 106ANIMI-3 .................................................................... 116ANIMI-3/VITAMIN D ....................... 116ANORO ELLIPTA ....................................... 20ANTABUSE ........................................................ 173ANTARA ..................................................................... 38antibiotic ear ....................................................... 170anticoagulant cit dext soln a ........... 22ANTICOAGULANT COMPOUND ......................................................... 22antifungal ..................................................................... 81antipyrine-benzocaine ........................... 170ANUSOL-HC ........................................................ 16ANZEMET ................................................................ 34apap-caff-dihydrocodeine ................... 13APEXICON .............................................................. 85APEXICON E ....................................................... 85APIDRA ......................................................................... 32APIDRA SOLOSTAR ............................. 32APLENZIN ............................................................... 25apraclonidine hcl .......................................... 164APRI .................................................................................... 68APRISO ...................................................................... 108APTENSIO XR ....................................................... 5

Index

APTIOM ........................................................................ 23APTIVUS ..................................................................... 57aqua lance adjustable lancing................................................................................................... 123ARALAST NP ................................................. 177ARALEN ...................................................................... 46ARANELLE ............................................................ 71ARANESP (ALBUMIN FREE)................................................................................................... 115ARBINOXA ............................................................ 36ARCALYST ................................................................ 7ARCAPTA NEOHALER .................... 21ARGYLE STERILE SALINE................................................................................................... 111ARGYLE STERILE WATER ..... 61ARIAL CHAMBER ................................ 146ARICEPT ................................................................. 174ARICEPT ODT ............................................... 174ARIDOL ........................................................................ 92ARIMIDEX .............................................................. 48aripiprazole ............................................................... 55ARIXTRA ................................................................... 22ARMOUR THYROID ......................... 179ARNUITY ELLIPTA ................................ 20AROMASIN ............................................................ 48ARTHROTEC .......................................................... 7ARTISS ....................................................................... 119ASACOL HD ..................................................... 108ASCENSIA AUTODISC CONTROL ............................................................. 123ASCENSIA AUTODISC CONTROLS ........................................................ 123ASCENSIA AUTODISC TEST....................................................................................................... 93ASCOMP-CODEINE ................................ 12ASMANEX 120 METERED DOSES ............................................................................. 20ASMANEX 14 METERED DOSES ............................................................................. 20ASMANEX 30 METERED DOSES ............................................................................. 20ASMANEX 60 METERED DOSES ............................................................................. 20ASMANEX 7 METERED DOSES....................................................................................................... 20ASMANEX HFA ............................................. 20aspirin ................................................................................ 10aspirin-dipyridamole er ...................... 114ASSESS FULL RANGE PEAK METER ....................................................................... 144ASSESS LOW RANGE PEAK METER ....................................................................... 144

Index

ASSESS PEAK FLOW METER................................................................................................... 144ASSURE 3 CONTROL ...................... 123ASSURE 3 TEST ............................................ 93ASSURE 4 CONTROL LEVEL 1 & 2 ...................................................................................... 123ASSURE 4 TEST ............................................ 93assure comfort lancets 28g ............ 124assure comfort lancets 30g ............ 124ASSURE DOSE CONTROL ..... 124ASSURE DOSE NORM/HIGH CONTROL ............................................................. 124ASSURE HAEMOLANCE PLUS HIGH .............................................................................. 124ASSURE HAEMOLANCE PLUS LOW ................................................................................ 124ASSURE HAEMOLANCE PLUS MICRO ........................................................................ 124ASSURE HAEMOLANCE PLUS NORMAL ................................................................ 124ASSURE HAEMOLANCE PLUS PED ................................................................................... 124ASSURE ID INSULIN SAFETY SYR ................................................................................... 138ASSURE II ................................................................ 93ASSURE II CHECK ................................... 93ASSURE II CONTROL ..................... 124ASSURE II CONTROL LEVEL 1 & 2 ...................................................................................... 124ASSURE LANCE LANCETS................................................................................................... 124ASSURE LANCETS .............................. 124ASSURE PLATINUM ............................ 93ASSURE PRO CONTROL LEVEL 1 & 2 ..................................................... 124ASSURE PRO TEST ................................. 93ASTAGRAF XL ............................................... 61ASTEPRO ............................................................... 161ASTHMA CHECK METER-ZONE SYSTEM .............. 144ASTHMAMENTOR ............................... 144AT LAST CONTROL .......................... 124AT LAST LANCETS ............................ 124AT LAST TEST ................................................. 93ATABEX .................................................................. 155ATABEX EC ...................................................... 155ATACAND ............................................................... 41ATACAND HCT ............................................. 43ATELVIA ................................................................ 100atenolol ............................................................................ 62atenolol-chlorthalidone .......................... 43ATGAM ......................................................................... 60ATIVAN ........................................................................ 18


189

Index

atorvastatin calcium .................................... 39atovaquone-proguanil hcl ................... 46ATRALIN ................................................................... 79ATRIPLA ..................................................................... 56atropine sulfate ................................................ 163atropine-care ...................................................... 163ATROVENT ....................................................... 162ATROVENT HFA ......................................... 19AUBAGIO ............................................................. 175AUBRA .......................................................................... 68AUGMENTIN .................................................. 172AUGMENTIN ES-600 ........................ 172AUGMENTIN XR ..................................... 172AURODEX ........................................................... 170aurora lancet super thin 30g ...... 124aurora lancet thin 23g .......................... 124aurora pen needles ..................................... 138aurora unifine pentips ........................... 138AURYXIA ............................................................. 109AUTOJECT 2 .................................................... 138AUTO-LANCET .......................................... 124AUTO-LANCET MINI ...................... 124AUTOLET II CLINISAFE ........... 124AUTOLET IMPRESSION ............ 124AUTOLET LANCING DEVICE................................................................................................... 124AUTOLET LITE CLINISAFE................................................................................................... 124AUTOLET LITE STARTER PACK ............................................................................. 124AUTOLET MINI ......................................... 124AUTOLET PLATFORMS ............ 124AUVI-Q ...................................................................... 185AVALIDE ................................................................... 43AVANDAMET ................................................... 29AVANDARYL .................................................... 29AVANDIA ................................................................. 32AVAPRO ..................................................................... 41AVAR ................................................................................ 77AVAR CLEANSER .................................... 77AVAR LS .................................................................... 78AVAR LS CLEANSER ......................... 78AVAR-E EMOLLIENT ........................ 78AVAR-E GREEN ........................................... 78AVAR-E LS ............................................................. 78AVC VAGINAL ........................................... 184AVIANE ........................................................................ 68avidoxy ......................................................................... 178AVINZA ........................................................................ 11AVITA ............................................................................. 79AVODART ........................................................... 111AVONEX ................................................................. 175AXERT ........................................................................ 148

Index

AXID .............................................................................. 180AXIRON ....................................................................... 15AYGESTIN .......................................................... 173AZASAN ...................................................................... 61AZASITE ................................................................. 164azathioprine .............................................................. 61azelastine hcl ....................................... 161, 168AZELEX ....................................................................... 79AZILECT ..................................................................... 53azithromycin ......................................................... 121AZOPT ......................................................................... 168AZOR ................................................................................. 42AZULFIDINE ................................................... 108AZULFIDINE EN-TABS ............... 108AZURETTE ............................................................. 67bacitracin-polymyxin b ........................ 165bacitra-neomycin-polymyxin-hc................................................................................................... 167baclofen ....................................................................... 160BACTRIM .................................................................. 45BACTRIM DS ...................................................... 45BACTROBAN ..................................................... 80BACTROBAN NASAL .................... 162BAL-CARE DHA ....................................... 155balsalazide disodium .............................. 108BALZIVA ................................................................... 68BANZEL ....................................................................... 23BARACLUDE ..................................................... 58BAR-TEST ................................................................ 98BAYCADRON .................................................... 73BAYER BREEZE 2 CONTROL................................................................................................... 124BAYER BREEZE 2 TEST ................ 93BAYER CONTOUR ............................... 124BAYER CONTOUR NEXT CONTROL ............................................................. 124BAYER CONTOUR NEXT TEST....................................................................................................... 93BAYER CONTOUR TEST ............. 93BAYER MICROLET 2 LANCING DEVIC .................................... 124BAYER MICROLET LANCETS................................................................................................... 124baza antifungal .................................................... 81BD AUTOSHIELD ................................... 138BD AUTOSHIELD DUO ............... 138BD GLUCOSE .................................................... 30BD INSULIN SYR ULTRAFINE II ............................................................................................. 138BD INSULIN SYRINGE ................. 138BD INSULIN SYRINGE HALF-UNIT ........................................................ 138

Index

BD INSULIN SYRINGE MICROFINE ...................................................... 139BD INSULIN SYRINGE U-40................................................................................................... 139BD INSULIN SYRINGE ULTRAFINE ...................................................... 139BD INTEGRA INSULIN SYRINGE ................................................................ 139BD INTEGRA SYRINGE ............. 139BD LANCET DEVICE ...................... 124BD LANCET ULTRAFINE 30G................................................................................................... 124BD LANCET ULTRAFINE 33G................................................................................................... 124BD MICROTAINER LANCETS................................................................................................... 124BD PEN ...................................................................... 139BD PEN MINI .................................................. 139BD PEN NEEDLE MINI U/F................................................................................................... 139BD PEN NEEDLE NANO U/F................................................................................................... 139BD PEN NEEDLE SHORT U/F................................................................................................... 139BD PEN NEEDLE ULTRAFINE................................................................................................... 139BD SAFETYGLIDE INSULIN SYRINGE ................................................................ 139BD SAFETY-LOK INSULIN SYRINGE ................................................................ 139BD SWAB SINGLE USE REGULAR ............................................................. 137BD SWABS SINGLE USE BUTTERFLY .................................................... 137BD TEST ...................................................................... 93BD ULTRA-FINE LANCETS................................................................................................... 124BEBULIN ................................................................ 112BEBULIN VH .................................................. 112BECONASE AQ ........................................... 162BELSOMRA ....................................................... 120benazepril hcl ......................................................... 40benazepril-hydrochlorothiazide....................................................................................................... 42BENEFIX ................................................................. 112BENICAR ................................................................... 41BENICAR HCT ................................................. 43BENLYSTA ............................................................. 62bensal hp ....................................................................... 89BENTYL ................................................................... 179BENZAMYCIN ................................................. 78BENZAMYCINPAK ................................. 78BENZEPRO ............................................................. 79


Index

BENZEPRO SHORT CONTACT....................................................................................................... 79BENZIQ ......................................................................... 79BENZIQ LS .............................................................. 79benzonatate ................................................................ 74benzoyl peroxide ................................................ 79benzoyl peroxide short contact .... 79benzoyl peroxide-erythromycin ... 78benztropine mesylate ................................... 52BEPREVE ............................................................... 168BERINERT ........................................................... 113BESIVANCE ..................................................... 164BETADINE OPHTHALMIC PREP ............................................................................... 166BETAGAN ............................................................ 163betamethasone dipropionate ........... 85betamethasone dipropionate aug....................................................................................................... 85betamethasone valerate .......................... 85BETAPACE ............................................................. 63BETAPACE AF ................................................. 63BETASERON ................................................... 175betaxolol hcl ............................................. 62, 163bethanechol chloride ............................... 183BETHKIS ......................................................................... 6BETIMOL ............................................................... 163BETOPTIC-S ..................................................... 163bexarotene ................................................................... 51BEYAZ ............................................................................ 68BG STAR TEST ................................................ 93BIAXIN ...................................................................... 121BIAXIN XL .......................................................... 121BIAXIN XL PAC ........................................ 121bicalutamide ............................................................. 48BIDIL ................................................................................. 65BIFERARX ........................................................... 118BILTRICIDE .......................................................... 16bimatoprost ............................................................ 169BINOSTO ................................................................ 100BIO GLO .................................................................. 168BIOSCANNER GLUCOSE TEST....................................................................................................... 93bio-statin ........................................................................ 35bisoprolol fumarate ...................................... 62bisoprolol-hydrochlorothiazide....................................................................................................... 43BIVIGAM ............................................................... 171BLEPHAMIDE ............................................... 167BLEPHAMIDE S.O.P. ........................ 167blood glucose test ............................................. 93BONIVA ................................................................... 101BOSULIF ..................................................................... 50BOTOX ....................................................................... 162

Index

bp 10-1 .............................................................................. 78bp cleansing wash ........................................... 78bp foam ............................................................................ 79bp vit 3 .......................................................................... 116bpo .......................................................................................... 79bpo foaming cloths ......................................... 79BRAVELLE ......................................................... 101BREATHERITE ............................................ 146BREATHERITE COLL SPACER ADULT ....................................................................... 146BREATHERITE COLL SPACER CHILD .......................................................................... 146BREATHERITE COLL SPACER INFANT ..................................................................... 146BREATHERITE RIGID SPACER/MASK ........................................... 146BREATHERITE SPACER NEONATE ............................................................. 146BREATHERITE SPACER SMALL CHILD ............................................. 146BREATHERITE/LARGE MASK................................................................................................... 146BREATHERITE/MEDIUM MASK ........................................................................... 147BREATHERITE/SMALL MASK................................................................................................... 147BREO ELLIPTA ............................................... 20BREVICON (28) .............................................. 68briellyn ............................................................................. 68BRILINTA ............................................................. 114brimonidine tartrate ................................. 164BRINTELLIX ....................................................... 26BRISDELLE ....................................................... 177BROMFED DM ................................................. 76bromocriptine mesylate ........................... 53BROVANA ............................................................... 21BUBBLES THE FISH II PEDI MASK ........................................................................... 144BUCALSEP ............................................................. 55BUDEPRION SR ............................................. 25BUDEPRION XL ............................................ 25budesonide .................................................. 20, 162budesonide er ......................................................... 73bullseye mini safety lancets ........... 125BULLSEYE SAFETY LANCETS................................................................................................... 125bumetanide ................................................................. 99BUNAVAIL ............................................................. 14BUPAP ............................................................................ 10BUPHENYL ........................................................ 105buprenorphine hcl ........................................... 14buprenorphine hcl-naloxone hcl....................................................................................................... 14

Index

BUPROBAN ....................................................... 176bupropion hcl ......................................................... 25bupropion hcl er (smoking det)................................................................................................... 176bupropion hcl er (sr) ................................... 25bupropion hcl er (xl) ................................... 25buspirone hcl ........................................................... 17butalbital compound/codeine ......... 12butalbital-acetaminophen .................... 10butalbital-apap-caff-cod ........................ 12butalbital-apap-caffeine ......................... 10butalbital-asa-caff-codeine ............... 12butalbital-asa-caffeine ............................. 10BUTISOL SODIUM ............................... 119butorphanol tartrate .................................... 14BUTRANS ................................................................. 14BYDUREON .......................................................... 31BYETTA 10 MCG PEN ....................... 32BYETTA 5 MCG PEN ........................... 32BYSTOLIC ............................................................... 62cabergoline ............................................................ 105CAFCIT .............................................................................. 4CAFERGOT ........................................................ 148caffeine citrate .......................................................... 4CALAN ........................................................................... 63CALAN SR ............................................................... 63CALCIFOL ........................................................... 149calcipotriene ............................................................ 84calcitonin (salmon) .................................... 101CALCITRENE ..................................................... 84calcitriol ..................................................................... 104calcium acetate ................................................ 109calcium acetate (phos binder) ... 109calcium-folic acid plus d ................... 149CAMBIA .................................................................. 148CAMILA ....................................................................... 73CAMPRAL ............................................................ 173CAMRESE ................................................................ 71CAMRESE LO .................................................... 71CANASA ................................................................. 108candesartan cilexetil ................................... 41candesartan cilexetil-hctz .................... 43CANTIL ..................................................................... 180CAPACET .................................................................. 10capecitabine ............................................................. 47CAPEX ............................................................................ 85CAPITAL/CODEINE ............................... 12CAPRELSA ............................................................. 50captopril ......................................................................... 40CARAC ........................................................................... 82CARAFATE ........................................................ 181CARBAGLU ...................................................... 104carbamazepine ..................................................... 23


191

Index

carbamazepine er ............................................. 23CARBAPHEN 12 ............................................ 76CARBAPHEN 12 PED ........................... 76CARBATROL ...................................................... 23carbidopa ..................................................................... 52carbidopa-levodopa ..................................... 53carbidopa-levodopa er ............................. 53carbidopa-levodopa-entacapone....................................................................................................... 53carbinoxamine maleate ........................... 36CARDIOCOM LANCING DEVICE ..................................................................... 125CARDIZEM ............................................................. 64CARDIZEM CD ............................................... 63CARDIZEM LA ................................................ 63CARDURA ............................................................... 41CARDURA XL ............................................... 111careone advanced lancing dev................................................................................................... 125CAREONE BLOOD GLUCOSE TEST ................................................................................... 93careone lancet thin 23g ....................... 125careone lancet ultra thin 28g ..... 125careone unifine pentips ....................... 139careone unifine pentips plus ........ 139CARESENS CONTROL A .......... 125CARESENS N GLUCOSE TEST....................................................................................................... 93CARIMUNE NF ........................................... 171carisoprodol ......................................................... 160carisoprodol-aspirin ................................ 161carisoprodol-aspirin-codeine .... 161CARNITOR ......................................................... 103CARNITOR SF .............................................. 103CARRINGTON ANTIFUNGAL....................................................................................................... 81carteolol hcl .......................................................... 163CARTIA XT ............................................................ 64carvedilol ...................................................................... 62CASODEX ................................................................. 48CATAFLAM .............................................................. 8CATAPRES ............................................................. 41CATAPRES-TTS-1 ...................................... 41CATAPRES-TTS-2 ...................................... 41CATAPRES-TTS-3 ...................................... 41CAVAREST ........................................................ 151CAVERJECT ......................................................... 65CAVERJECT IMPULSE ..................... 65CAYSTON ................................................................. 44CAZIANT ................................................................... 71CEDAX ........................................................................... 67cefaclor ............................................................................ 66cefadroxil ...................................................................... 66

Index

cefdinir ............................................................................. 67cefixime ............................................................................ 67cefpodoxime proxetil ................................... 67cefprozil .......................................................................... 66CEFTIN .......................................................................... 67cefuroxime axetil ............................................... 67CELEBREX ................................................................. 7celecoxib ............................................................................ 7CELEXA ....................................................................... 26CELLCEPT ............................................................... 61CELONTIN .............................................................. 24CEM-UREA ............................................................. 88CENESTIN ............................................................ 106CENFOL ................................................................... 116CENTANY ................................................................ 80CENTRATEX ................................................... 117cephalexin .................................................................... 66CERDELGA ........................................................ 115CEREZYME ....................................................... 115CERISA WASH ................................................ 78CEROVEL ................................................................. 88CERVIDIL ............................................................. 171CESAMET ................................................................. 35CESIA ............................................................................... 71cetirizine hcl ................................................. 36, 37cetirizine-pseudoephedrine er ....... 75CETRAXAL ........................................................ 170CETROTIDE ...................................................... 102cevimeline hcl .................................................... 152CHANTIX .............................................................. 176CHANTIX CONTINUING MONTH PAK ................................................... 176CHANTIX STARTING MONTH PAK .................................................................................. 176CHATEAL ................................................................. 68CHEK-STIX CONTROL .................... 93CHEMET ..................................................................... 34CHEMSTRIP 10 MD ................................ 97CHEMSTRIP 10/SG ................................... 97CHEMSTRIP 2 GP ....................................... 97CHEMSTRIP 5 OB ...................................... 97CHEMSTRIP 7 ................................................... 97CHEMSTRIP 9 ................................................... 97CHEMSTRIP K .................................................. 93CHEMSTRIP MICRAL ........................ 93CHEMSTRIP UGK ...................................... 97CHENODAL ...................................................... 107cheratussin ac ........................................................ 75childrens loratadine ..................................... 37chlordiazepoxide hcl ................................... 18chlorhexidine gluconate ..................... 151chloroquine phosphate ............................. 46chlorothiazide .................................................... 100

Index

chlorpromazine hcl ........................................ 55chlorpropamide ................................................... 33chlorthalidone ................................................... 100chlorzoxazone .................................................... 160CHOLBAM .......................................................... 107cholestyramine ..................................................... 38cholestyramine light ..................................... 38choline & mag trisalicylate ............... 10choline-mag trisalicylate ...................... 10chorionic gonadotropin ...................... 101CICLODAN ............................................................. 81ciclopirox ...................................................................... 81ciclopirox olamine .......................................... 81cidofovir ......................................................................... 58cilostazol .................................................................... 114CILOXAN .............................................................. 164cimetidine ................................................................. 180cimetidine hcl ..................................................... 180CIMZIA ...................................................................... 109CIMZIA PREFILLED .......................... 109CIMZIA STARTER KIT ................. 109CINRYZE ................................................................ 113CIPRO ........................................................................... 107CIPRO HC .............................................................. 170CIPRO XR .............................................................. 107CIPRODEX .......................................................... 170ciprofloxacin hcl ............................ 107, 165ciprofloxacin-ciproflox hcl er .... 107citalopram hydrobromide .................... 26CITRANATAL 90 DHA .................. 158CITRANATAL B-CALM .............. 155CITRANATAL DHA ............................ 158CITRANATAL HARMONY .... 158CITRANATAL RX .................................. 155citric acid-sodium citrate ................. 110CLARAVIS .............................................................. 79CLARINEX .............................................................. 37CLARINEX REDITABS ..................... 37CLARINEX-D 12 HOUR ................... 75CLARIS CLARIFYING WASH....................................................................................................... 78clarithromycin ................................................... 121clarithromycin er .......................................... 121CLARITIN ................................................................. 37CLARITIN-D 12 HOUR ...................... 75CLARITIN-D 24 HOUR ...................... 75CLEANLET LANCETS 28G ... 125CLEARLAX ........................................................ 121clemastine fumarate ..................................... 36CLEOCIN .................................................... 45, 184CLEOCIN-T ............................................................ 77CLEVER CHEK AUTO-CODE TEST ................................................................................... 93


Index

CLEVER CHEK AUTO-CODE VOICE .............................................................................. 93CLEVER CHEK LANCETS ..... 125CLEVER CHEK TEST .......................... 93CLEVER CHOICE AUTO-CODE TEST ................................................................................... 93CLEVER CHOICE GLUCOSE CONTROL ............................................................. 125CLEVER CHOICE MICRO TEST....................................................................................................... 93clickfine pen needles ................................ 139CLIMARA ............................................................. 106CLIMARA PRO ............................................ 106CLINDACIN ETZ .......................................... 77CLINDACIN-P ................................................... 77CLINDAGEL ......................................................... 77CLINDAMAX ..................................................... 77clindamycin hcl ................................................... 45clindamycin palmitate hcl ................... 45clindamycin phos-benzoyl perox....................................................................................................... 78clindamycin phosphate ............ 77, 184CLINDESSE ....................................................... 184CLINISTIX ............................................................... 93CLINITEST .............................................................. 93CLINPRO 5000 .............................................. 151clobetasol propionate ................................ 85clobetasol propionate e ........................... 85clobetasol propionate emulsion....................................................................................................... 85CLOBEX ...................................................................... 85CLOBEX SPRAY .......................................... 86clomiphene citrate ....................................... 102clomipramine hcl .............................................. 27clonazepam ................................................................ 23clonidine hcl ............................................................. 41clonidine hcl er ........................................................ 4clopidogrel bisulfate ................................ 114clorazepate dipotassium ........................ 18CLORPRES .............................................................. 42CLOSERCARE .............................................. 125clotrimazole .......................................................... 151clotrimazole-betamethasone ............ 80clozapine ........................................................................ 54CLOZARIL ............................................................... 54c-nate dha ................................................................ 155CNL8 NAIL ............................................................. 81co monitor replacement pieces................................................................................................... 144COAGUCHEK LANCETS .......... 125COARTEM ............................................................... 46COLAZAL ............................................................. 108colchicine ................................................................. 112

Index

colchicine-probenecid ........................... 112COLCRYS ............................................................. 112COLESTID ................................................................ 38COLESTID FLAVORED ................... 38colestipol hcl ........................................................... 38colistimethate sodium ................................ 44COLOCORT ........................................................... 15COLY-MYCIN M .......................................... 44COLY-MYCIN S ......................................... 170COLYTE WITH FLAVOR PACKS ........................................................................ 120COMBIGAN ....................................................... 163COMBIPATCH .............................................. 106COMBISTIX .......................................................... 97COMBIVENT RESPIMAT ............. 20COMBIVIR .............................................................. 56COMETRIQ (100 MG DAILY DOSE) ............................................................................... 50COMETRIQ (140 MG DAILY DOSE) ............................................................................... 50COMETRIQ (60 MG DAILY DOSE) ............................................................................... 50comfort assured lancets 28g ........ 125comfort assured lancets 33g ........ 125COMFORT EZ INSULIN SYRINGE ................................................................ 139COMFORT EZ PEN NEEDLES................................................................................................... 139comfort lancets ................................................. 125COMPAZINE ........................................................ 55COMPLERA ........................................................... 56completenate ........................................................ 155COMPRO .................................................................... 55COMTAN .................................................................... 52CO-NATAL FA ............................................. 155CONCEPT DHA ........................................... 155CONCEPT OB ................................................. 156CONCERTA ............................................................... 5CONDYLOX ......................................................... 89cone mask ................................................................. 144constulose ................................................................. 121CONTRAVE ............................................................... 4control ........................................................................... 125CONTROL AST ............................................... 93CONTROL TEST ........................................... 93CONTROLRX ................................................. 151COPAXONE ....................................................... 175COPEGUS .................................................................. 58CORDARONE ..................................................... 18CORDRAN ............................................................... 86COREG ........................................................................... 62COREG CR .............................................................. 62CORGARD ............................................................... 63

Index

CORIFACT ........................................................... 113CORLANOR .......................................................... 66CORMAX SCALP APPLICATION .................................................. 86CORNWALL METAL PIPETTING .......................................................... 139CORTALO ................................................................. 87CORTANE-B ......................................................... 87CORTEF ........................................................................ 73CORTENEMA ..................................................... 15CORTIFOAM ....................................................... 16CORTISPORIN .................................. 80, 170CORTISPORIN-TC ................................. 170CORVITA ............................................................... 154CORVITA 150 ................................................. 117CORZIDE .................................................................... 43COSENTYX ............................................................ 83COSENTYX SENSOREADY PEN ....................................................................................... 83COSOPT .................................................................... 163COSOPT PF ......................................................... 163COUMADIN .......................................................... 21COZAAR ..................................................................... 41CPB WC ........................................................................ 76CREON ........................................................................... 99CRESEMBA ........................................................... 36CRESTOR .................................................................. 39CRESYLATE .................................................... 170CRINONE ............................................................... 184CRIXIVAN ............................................................... 57CRNATAL ............................................................. 158cromolyn sodium ............... 19, 107, 168CRYSELLE-28 ................................................... 68CUPRIMINE .......................................................... 60CURITY ALCOHOL PREPS ... 137CURITY ALCOHOL SWABS................................................................................................... 137CURITY STERILE SALINE .... 111CUROSURF ........................................................ 177CUTIVATE .............................................................. 86CUVPOSA ............................................................. 180cvs alcohol prep swabs ........................ 137cvs alcohol swabs ......................................... 137cvs glucose .................................................................. 30cvs glucose bits .................................................... 30cvs glucose shot .................................................. 30cvs insulin syringe ....................................... 139CVS KETONE CARE ............................. 97cvs lancets 21g ................................................. 125cvs lancets micro thin 33g .............. 125cvs lancets original .................................... 125cvs lancets thin ................................................. 125cvs lancets thin 26g ................................... 125


193

Index

cvs lancets ultra thin 30g ................. 125cvs lancing device ........................................ 125cvs ultra thin lancets ............................... 125CYCLAFEM 1/35 .......................................... 68CYCLAFEM 7/7/7 ........................................ 71CYCLESSA ............................................................. 71cyclobenzaprine hcl .................................. 160CYCLOGYL ....................................................... 163CYCLOMYDRIL ........................................ 163cyclopentolate hcl ........................................ 163cyclophosphamide ........................................... 47CYCLOSET ............................................................. 31cyclosporine ............................................................. 60cyclosporine modified ............................... 60CYMBALTA ......................................................... 27cyproheptadine hcl ......................................... 37CYSTADANE .................................................. 104CYSTAGON ....................................................... 110CYSTARAN ....................................................... 169CYSTO-CONRAY II ................................ 98CYSTOGRAFIN-DILUTE ............... 98CYTOGAM .......................................................... 171CYTOMEL ............................................................ 179CYTOTEC ............................................................. 182CYTOVENE ........................................................... 58cytra k crystals ................................................. 110cytra-2 ........................................................................... 110CYTRA-3 ................................................................. 110cytra-k ............................................................................ 110D.H.E. 45 .................................................................. 148DAKLINZA ............................................................. 58DALIRESP ................................................................ 20danazol ............................................................................. 15DANTRIUM ....................................................... 161dantrolene sodium ....................................... 161DARAPRIM ............................................................ 46DASETTA 1/35 .................................................. 68DASETTA 7/7/7 ............................................... 71DAYPRO ......................................................................... 8DAYSEE ....................................................................... 71DAYTRANA ............................................................. 5DDAVP ....................................................................... 105DEBACTEROL ............................................. 151DECON-A .................................................................. 75deferoxamine mesylate ............................. 34delta d3 ........................................................................ 185DELZICOL ........................................................... 108DEMADEX .............................................................. 99demeclocycline hcl ..................................... 178DEMEROL ................................................................ 11DEMSER ...................................................................... 41DENAVIR .................................................................. 84DENTA 5000 PLUS ................................ 151

Index

DENTAGEL ........................................................ 152dentall 1100 plus ........................................... 152DEPAKENE ............................................................ 24DEPAKOTE ............................................................ 24DEPAKOTE ER ................................................ 24DEPAKOTE SPRINKLES ............... 24DEPEN TITRATABS ............................... 60DEPO-PROVERA ......................................... 72DEPO-SUBQ PROVERA 104 .... 73DERMA-SMOOTHE/FS BODY....................................................................................................... 86DERMA-SMOOTHE/FS SCALP....................................................................................................... 86DERMASORB XM ...................................... 88DERMATOP .......................................................... 86DERMAZENE ..................................................... 80DERMOTIC ......................................................... 170DESFERAL .............................................................. 34desipramine hcl ................................................... 27desloratadine .......................................................... 37desmopressin ace rhinal tube .... 105desmopressin ace spray refrig................................................................................................... 105desmopressin acetate .............................. 105desmopressin acetate spray .......... 105DESOGEN ................................................................. 68desogestrel-ethinyl estradiol........................................................................................... 67, 68DESONATE ............................................................ 86desonide .......................................................................... 86DESOWEN ............................................................... 86desoximetasone .................................................... 86DESOXYN .................................................................... 4desvenlafaxine er .............................................. 27DETROL ................................................................... 183DETROL LA ...................................................... 183DEX4 .................................................................................. 30DEX4 GLUCOSE ........................................... 30DEX4 NATURALS ..................................... 30DEX4 POUCH PACK ............................. 30DEX4 QUICK DISSOLVE GLUCOSE ................................................................. 31dexamethasone ..................................................... 73DEXAMETHASONE INTENSOL....................................................................................................... 73dexamethasone sodium phosphate................................................................................................... 167DEXEDRINE ............................................................. 4DEXILANT .......................................................... 181dexmethylphenidate hcl ............................... 5dexmethylphenidate hcl er ...................... 5DEXPAK 10 DAY ......................................... 73DEXPAK 13 DAY ......................................... 73

Index

DEXPAK 6 DAY ............................................. 73dextroamphetamine sulfate ................... 4dextroamphetamine sulfate er ........... 4DIABETA ................................................................... 33DIALYVITE ....................................................... 152DIALYVITE 3000 ..................................... 153DIALYVITE 5000 ..................................... 153DIALYVITE SUPREME D ......... 154DIALYVITE/ZINC .................................. 153DIAMOX SEQUELS ................................ 99DIASTAR EASY TEST II LANCETS .............................................................. 125DIASTAR EASY TEST LANCETS .............................................................. 125DIASTAT ACUDIAL .............................. 23DIASTAT PEDIATRIC ........................ 23DIASTIX ...................................................................... 93diatrue control level 1 ........................... 125diatrue control level 2 ........................... 125diatrue control level 3 ........................... 125diatrue plus test ................................................... 93diazepam ........................................................................ 18DIAZEPAM INTENSOL .................... 18DIBENZYLINE ................................................. 41DICLEGIS .................................................................. 35diclofenac potassium ....................................... 8diclofenac sodium .................... 8, 83, 169diclofenac sodium er ....................................... 8diclofenac-misoprostol ................................. 7dicloxacillin sodium ................................. 172dicyclomine hcl ................................................ 179didanosine ................................................................... 57DIFFERIN .................................................................. 79DIFICID ..................................................................... 122DIFIL-G FORTE .............................................. 19diflorasone diacetate ................................... 86DIFLUCAN .............................................................. 36diflunisal ........................................................................ 10DIGIBAR 190 ....................................................... 98DIGOX ............................................................................. 65digoxin .............................................................................. 65dihydroergotamine mesylate ....... 148DILANTIN ................................................................ 24DILANTIN INFATABS ....................... 24DILATRATE-SR ............................................. 16DILAUDID ............................................................... 11diltiazem hcl ............................................................. 64diltiazem hcl cd .................................................... 64diltiazem hcl er ..................................................... 64diltiazem hcl er beads ................................ 64diltiazem hcl er coated beads ......... 64dilt-xr .................................................................................. 64DIOVAN ....................................................................... 41


Index

DIOVAN HCT ..................................................... 43DIPENTUM ......................................................... 108diphenatol .................................................................... 34diphenoxylate-atropine ............................ 34DIPROLENE .......................................................... 86DIPROLENE AF .............................................. 86dipyridamole ........................................................ 114disopyramide phosphate ........................ 18disulfiram ................................................................. 173DITROPAN XL ............................................. 183DIURIL ....................................................................... 100divalproex sodium ........................................... 24divalproex sodium er .................................. 24DIVIGEL .................................................................. 106DIVISTA .................................................................. 116DOLOPHINE ......................................................... 11donepezil hcl ........................................................ 174DORAL ....................................................................... 119DORYX ...................................................................... 178dorzolamide hcl ............................................... 168dorzolamide hcl-timolol mal ....... 163DOVONEX ............................................................... 84doxazosin mesylate ........................................ 41doxepin hcl ................................................................. 27doxercalciferol ................................................. 104doxycycline ................................................................. 91doxycycline hyclate ................................... 178doxycycline monohydrate ................ 178DOXYTEX ................................................................ 36DRISDOL ................................................................ 185DRITHO-CREME HP .............................. 84dronabinol ................................................................... 35DROPLET LANCETS ULTRA THIN 30G ............................................................... 125DROPLET LANCING DEVICE................................................................................................... 125drospirenone-ethinyl estradiol ..... 68DROXIA ................................................................... 115drug mart glucose ............................................ 30drug mart lancets thin 26g ............. 125drug mart lancets ultra thin ......... 125DRUG MART LANCING DEVICE ..................................................................... 125DRUG MART ON-THE-GO LANCET 30G ................................................... 125drug mart unifine pentips ................. 139DRUG MART UNILET LANCETS 28G ............................................... 125DRUG MART UNILET LANCETS 30G ............................................... 125DUAC ................................................................................ 78duane reade lancet altern site ... 126duane reade lancet super thin ... 126

Index

duane reade lancet ultra thin ..... 126duane reade unifine pentips ......... 139DUAVEE ................................................................. 106DUET DHA 400 ............................................ 156DUET DHA 400EC ................................. 156DUET DHA 430 ............................................ 156DUET DHA 430EC ................................. 156DUET DHA BALANCED ............ 156DUETACT ................................................................. 29DUEXIS ............................................................................. 7DULERA ...................................................................... 20duloxetine hcl ......................................................... 27DUO-CARE CONTROL SOLUTION .......................................................... 126DUO-CARE TEST ........................................ 93DURAGESIC-100 .......................................... 11DURAGESIC-12 .............................................. 11DURAGESIC-25 .............................................. 11DURAGESIC-50 .............................................. 11DURAGESIC-75 .............................................. 11duraxin ............................................................................. 10DUREZOL ............................................................. 167DUTOPROL ............................................................ 43D-VI-SOL ................................................................ 185D-VITA ....................................................................... 185DYAZIDE ................................................................... 99DYMISTA .............................................................. 161DYRENIUM ....................................................... 100DYSPORT .............................................................. 162E.E.S. 400 ................................................................ 121E.E.S. GRANULES ................................. 121earloop mask ....................................................... 144EASIVENT ........................................................... 147EASIVENT MASK LARGE ..... 147EASIVENT MASK MEDIUM................................................................................................... 147EASIVENT MASK SMALL ..... 147easy comfort insulin syringe ........ 140easy comfort lancets ................................. 126easy comfort pen needles .................. 140easy mini lancing device ................... 126easy plus blood glucose test ............. 93easy plus ii control ..................................... 126easy plus ii glucose test ........................... 93EASY STEP CONTROL ................. 126EASY STEP TEST ........................................ 93easy talk blood glucose test .............. 94easy talk control ............................................. 126EASY TOUCH ALCOHOL PREP MEDIUM ................................................................. 137EASY TOUCH CONTROL HIGH & LOW ........................................................................ 126

Index

EASY TOUCH INSULIN SAFETY SYR .................................................. 140EASY TOUCH INSULIN SYRINGE ................................................................ 140EASY TOUCH LANCETS 21G................................................................................................... 126EASY TOUCH LANCETS 23G................................................................................................... 126EASY TOUCH LANCETS 26G................................................................................................... 126EASY TOUCH LANCETS 28G................................................................................................... 126EASY TOUCH LANCETS 28G/TWIST .......................................................... 126EASY TOUCH LANCETS 30G................................................................................................... 126EASY TOUCH LANCETS 30G/TWIST .......................................................... 126EASY TOUCH LANCETS 32G................................................................................................... 126EASY TOUCH LANCETS 32G/TWIST .......................................................... 126EASY TOUCH LANCETS 33G/TWIST .......................................................... 126EASY TOUCH LANCING DEVICE ..................................................................... 126EASY TOUCH PEN NEEDLES................................................................................................... 140EASY TOUCH SAFETY LANCETS 21G ............................................... 126EASY TOUCH SAFETY LANCETS 23G ............................................... 126EASY TOUCH SAFETY LANCETS 26G ............................................... 126EASY TOUCH SAFETY LANCETS 28G ............................................... 126EASY TOUCH TEST ............................... 94easy trak blood glucose test ............. 94easy trak control ............................................ 126EASY TWIST & CAP LANCETS................................................................................................... 126EASYGLUCO ...................................................... 94EASYGLUCO CONTROL .......... 126EASYMAX 15 LEVEL 1 CONTROL ............................................................. 126EASYMAX 15 LEVEL 2 CONTROL ............................................................. 126EASYMAX 15 TEST ................................ 94EASYMAX CONTROL ................... 126EASYMAX TEST .......................................... 94easyplus blood glucose test ............... 94EASYPRO BLOOD GLUCOSE TEST ................................................................................... 94


195

Index

EASYPRO PLUS ............................................ 94EASYTEST II LANCETS ............. 126EASYTEST LANCETS .................... 126EC-NAPROSYN .................................................. 8econazole nitrate ............................................... 81ECOZA ............................................................................ 81ED CYTE F .......................................................... 117EDARBI ......................................................................... 41EDARBYCLOR ................................................ 43ED-CHLOR-TAN ........................................... 36EDECRIN .................................................................... 99EDEX ................................................................................. 65ED-FLEX ..................................................................... 10EDLUAR .................................................................. 120ed-spaz .......................................................................... 180EDURANT ................................................................ 57EFFER-K .................................................................. 150effervescent pot chloride ................... 150EFFEXOR XR ...................................................... 27EFFIENT .................................................................. 115EFLOW SCF AEROSOL HEAD................................................................................................... 145EFUDEX ....................................................................... 82ELAPRASE .......................................................... 104ELDEPRYL ............................................................. 53ELELYSO ............................................................... 115element compact control 2 ............. 126element compact control 3 ............. 126element compact test ................................... 94ELEMENT CONTROL ..................... 126ELEMENT TEST ............................................ 94ELESTAT ................................................................ 168ELESTRIN ............................................................. 106ELIDEL .......................................................................... 89ELIGARD ................................................................... 49ELIMITE ...................................................................... 91ELINEST ...................................................................... 68ELIPHOS ................................................................. 109ELIQUIS ....................................................................... 22ELITE DC AUTO ADAPTER................................................................................................... 145ELITE-OB .............................................................. 156elite-thin insulin syringe .................... 140ELIXOPHYLLIN ............................................ 21ELLA .................................................................................. 72ELMIRON .............................................................. 111ELOCON ...................................................................... 86ELOCTATE ......................................................... 113EMADINE ............................................................. 168EMBEDA ..................................................................... 11EMBRACE BLOOD GLUCOSE TEST ................................................................................... 94EMBRACE CONTROL .................... 126

Index

EMBRACE EVO BLOOD GLUCOSE TEST ............................................ 94EMBRACE PRO GLUCOSE TEST ................................................................................... 94EMCYT .......................................................................... 49EMEND .......................................................................... 35EMLA ................................................................................ 90EMOQUETTE ..................................................... 68EMSAM ......................................................................... 25EMTRIVA .................................................................. 57ENABLEX ............................................................. 183enalapril maleate .............................................. 40enalapril-hydrochlorothiazide ..... 42ENBREL ........................................................................... 9ENBREL SURECLICK ............................. 9ENCARE .................................................................. 183ENDOCET ................................................................. 14ENDODAN ............................................................... 14ENDOMETRIN ............................................. 184ENDUR-ACIN ................................................. 185ENJUVIA ................................................................. 106enoxaparin sodium ......................................... 22ENPRESSE-28 .................................................... 71ENSKYCE ................................................................. 68entacapone ................................................................. 52entecavir ......................................................................... 58ENTERO VU ......................................................... 98ENTOCORT EC ............................................... 73ENTRESTO ............................................................. 65ENTYVIO ............................................................... 109enulose .......................................................................... 109EPANED ....................................................................... 40EPIDUO ......................................................................... 78EPIDUO FORTE .............................................. 78EPIFOAM ................................................................... 87epinastine hcl ...................................................... 168EPIPEN JR 2-PAK .................................... 185EPITOL ........................................................................... 23EPIVIR ............................................................................. 57EPIVIR HBV .......................................................... 58eplerenone ................................................................... 44EPOGEN ................................................................... 115epoprostenol sodium ................................... 65eprosartan mesylate ..................................... 41EPZICOM ................................................................... 56eql color lancets 21g ............................... 127eql color lancets micro 33g .......... 127eql niacin ................................................................... 185eql short pen needle .................................. 140eql super thin lancets 30g ................ 127eql thin lancets 26g ................................... 127EQL TRUETEST TEST ........................ 94EQL TRUETRACK TEST ................ 94

Index

eql ultra short pen needle ................ 140EQUAGESIC ......................................................... 10EQUETRO ................................................................. 54ergocalciferol ..................................................... 185ERGOMAR .......................................................... 148ERIVEDGE .............................................................. 48ERRIN .............................................................................. 73ERTACZO ................................................................. 81ery ............................................................................................ 77ERYGEL ....................................................................... 77ERYPED 200 ..................................................... 121ERYPED 400 ..................................................... 121ERY-TAB ................................................................ 121ERYTHROCIN STEARATE .... 121erythromycin ............................................ 77, 165erythromycin base ....................................... 122ESBRIET .................................................................. 177ESCAVITE ............................................................ 154escitalopram oxalate ................................... 26ESGIC ............................................................................... 10esomeprazole magnesium ................ 181esomeprazole strontium ...................... 181ESTARYLLA ........................................................ 68estazolam .................................................................. 119ESTRACE ............................................... 106, 184estradiol ...................................................................... 106estradiol-norethindrone acet ...... 106ESTRASORB .................................................... 106ESTRING ................................................................. 184ESTROGEL ......................................................... 106estropipate .............................................................. 106ESTROSTEP FE ............................................... 71eszopiclone ............................................................. 120ethambutol hcl ....................................................... 47ethosuximide ................................................ 24, 67etodolac ............................................................................... 8etodolac er ...................................................................... 8etoposide ........................................................................ 52EUFLEXXA ........................................................ 161EURAX ........................................................................... 91EVAMIST ............................................................... 106EVEKEO .......................................................................... 4EVENCARE + BLOOD GLUCOSE TEST ............................................ 94EVENCARE BLOOD GLUCOSE TEST ................................................................................... 94EVENCARE CONTROL LOW/HIGH .......................................................... 127EVENCARE G2 LOW/HIGH CONTROL ............................................................. 127EVENCARE G2 TEST ........................... 94EVENCARE G3 LOW/HIGH CONTROL ............................................................. 127


Index

EVENCARE G3 TEST ........................... 94EVICEL ...................................................................... 119EVISTA ...................................................................... 103EVOCLIN ................................................................... 77EVOLUTION AUTOCODE .......... 94EVOLUTION CONTROL ............ 127EVOTAZ ...................................................................... 56EVOXAC ................................................................. 152EVZIO .............................................................................. 34EXACTECH R-S-G TEST ................ 94EXACTECH TEST ....................................... 94EXACTUSS ............................................................. 75EXALGO ..................................................................... 11EXELDERM ........................................................... 81EXELON .................................................................. 174exemestane ................................................................. 48EXFORGE ................................................................. 42EXFORGE HCT ............................................... 43EXJADE ........................................................................ 34EXODERM ............................................................... 80EXTAVIA ............................................................... 175EXTINA ......................................................................... 81extra-virt plus dha ....................................... 158EYLEA ........................................................................ 164E-Z JECT LANCET MICRO-THIN 33G ................................... 127E-Z JECT LANCET SUPER THIN 30G ............................................................... 127E-Z JECT LANCETS ............................ 127E-Z JECT LANCETS 21G ............ 127E-Z JECT LANCETS THIN 26G................................................................................................... 127EZ SMART BLOOD GLUCOSE LANCETS .............................................................. 127EZ SMART BLOOD GLUCOSE TEST ................................................................................... 94EZ SMART PLUS GLUCOSE TEST ................................................................................... 94E-Z SPACER ...................................................... 147E-Z SPACER THE BODY GUARDS PK ..................................................... 147E-Z-CAT DRY .................................................... 98E-Z-DISK ..................................................................... 98E-Z-DOSE .................................................................. 98E-Z-HD ............................................................................ 98EZ-LETS LANCETS 21G ............. 127EZ-LETS LANCETS 23G ............. 127EZ-LETS LANCETS 26G ............. 127EZ-LETS LANCETS 28G ............. 127EZ-LETS LANCETS 30G ............. 127E-Z-PAQUE ............................................................. 98E-Z-PASTE ............................................................... 98fabb .................................................................................... 116

Index

FABIOR ......................................................................... 79FABRAZYME ................................................. 103FACTIVE ................................................................. 107fa-cyanocobalamin-pyridoxine................................................................................................... 116FALMINA .................................................................. 68famciclovir .................................................................. 59famotidine ................................................................ 180FAMVIR ....................................................................... 59FANAPT ....................................................................... 54FANAPT TITRATION PACK ... 54FARESTON ............................................................. 48FARXIGA ................................................................... 33FARYDAK ................................................................ 50FASLODEX ............................................................. 49fa-vitamin b-6-vitamin b-12 ......... 116FAZACLO ................................................................. 54FC FEMALE CONDOM ................. 122FC2 FEMALE CONDOM ............. 122fe 90 plus ................................................................... 118FEIBA ........................................................................... 113FEIBA NF ............................................................... 113FEIBA VH IMMUNO ......................... 113felbamate ....................................................................... 24FELBATOL ............................................................. 24FELDENE ....................................................................... 8felodipine er .............................................................. 64FEM PH ...................................................................... 183FEMARA ..................................................................... 48FEMCAP .................................................................. 122FEMCON FE .......................................................... 68FEMHRT LOW DOSE ....................... 106FEMRING .............................................................. 184fenofibrate ................................................................... 38fenofibrate micronized .............................. 38fenofibric acid ....................................................... 38FENOGLIDE ......................................................... 38fenoprofen calcium ............................................ 8fentanyl ............................................................................. 11fentanyl citrate ...................................................... 11FENTORA ................................................................. 11FER-IN-SOL ....................................................... 118fer-iron ......................................................................... 118FERIVA ..................................................................... 117FERIVAFA ........................................................... 117ferocon .......................................................................... 117ferotrinsic ................................................................. 117FERRALET 90 ................................................ 118ferraplus 90 ........................................................... 118ferrex 150 forte ................................................ 117FERREX 150 FORTE PLUS ..... 117FERREX 28 .......................................................... 118FERRIPROX .......................................................... 34

Index

FERRLECIT ........................................................ 118FERROCITE PLUS ................................. 117FERROGELS FORTE ......................... 117FERRO-PLEX HEMATINIC ... 117FERROTRIN ...................................................... 117ferrous sulfate .................................................... 118FETZIMA .................................................................... 27FETZIMA TITRATION ....................... 27FEXMID .................................................................... 160fexofenadine hcl .................................................. 37fexofenadine hcl childrens .................. 37fexofenadine-pseudoephed er ........ 75FIBRICOR ................................................................. 38FIFTY50 ALCOHOL PREP ....... 137FIFTY50 CONTROL 2.0 ................ 127FIFTY50 GLUCOSE TEST 2.0....................................................................................................... 94FIFTY50 LANCING DEVICE................................................................................................... 127FIFTY50 PEN NEEDLES ............. 140FIFTY50 SAFETY SEAL LANCETS .............................................................. 127FIFTY50 SUPERIOR COMFORT SYR ................................................................................... 140filter air pp ............................................................. 145FINACEA .................................................................... 91finasteride ................................................................ 111FINE 30 ....................................................................... 127FINGERSTIX LANCETS .............. 127FIORICET .................................................................. 10FIORICET/CODEINE ............................. 13FIORINAL ................................................................. 10FIORINAL/CODEINE #3 .................. 13FIRAZYR ................................................................ 113FIRMAGON ............................................................ 49FIRST-PROGESTERONE VGS 100 ...................................................................................... 184FIRST-PROGESTERONE VGS 200 ...................................................................................... 184FIRST-PROGESTERONE VGS 25 .......................................................................................... 184FIRST-PROGESTERONE VGS 400 ...................................................................................... 184FIRST-PROGESTERONE VGS 50 .......................................................................................... 185FIRST-VANCOMYCIN 25 ............. 44FIRST-VANCOMYCIN 50 ............. 44FLAGYL ....................................................................... 45FLAGYL ER ........................................................... 45FLAREX ................................................................... 167FLEBOGAMMA ......................................... 171FLEBOGAMMA DIF ........................... 171flecainide acetate .............................................. 18


197

Index

FLECTOR ................................................................... 82FLOLAN ....................................................................... 65FLOMAX ................................................................. 111FLONASE .............................................................. 162FLONASE ALLERGY RELIEF................................................................................................... 162FLO-PRED ................................................................ 73FLOVENT DISKUS ................................... 20FLOVENT HFA ................................................ 20FLUCAINE ........................................................... 169fluconazole ................................................................. 36flucytosine .................................................................... 35fludrocortisone acetate ............................ 74FLUMADINE ....................................................... 59flunisolide ................................................................ 162fluocinolone acetonide ............. 86, 170fluocinolone acetonide body ............ 86fluocinolone acetonide scalp .......... 86fluocinonide .............................................................. 86fluocinonide-e ........................................................ 86FLUORABON ................................................. 149FLUOR-A-DAY ............................................ 149fluorescein-benoxinate ......................... 169FLUORIDEX DAILY DEFENSE................................................................................................... 152FLUORIDEX ENHANCED WHITENING ..................................................... 152FLUORIDEX SENSITIVITY RELIEF ....................................................................... 151FLUOR-I-STRIPS A.T. ..................... 169fluoritab ...................................................................... 149fluorometholone ............................................. 167FLUOROPLEX .................................................. 82fluorouracil ................................................................ 82fluoxetine hcl ........................................................... 26fluoxetine hcl (pmdd) .............................. 176fluphenazine hcl .................................................. 55FLURA-DROPS ............................................ 149FLURA-SAFE .................................................. 169flurazepam hcl ................................................... 119flurbiprofen .................................................................... 8flurbiprofen sodium .................................. 169FLUROX .................................................................. 169flutamide ........................................................................ 48fluticasone propionate .............. 86, 162fluvastatin sodium ........................................... 39fluvastatin sodium er ................................... 39fluvoxamine maleate .................................... 26fluvoxamine maleate er ........................... 26FML .................................................................................. 167FML FORTE ...................................................... 167FML LIQUIFILM ....................................... 167focalgin-b ................................................................. 160

Index

FOCALIN ........................................................................ 5FOCALIN XR ........................................................... 5folbee ............................................................................... 116folbee plus ............................................................... 152FOLBEE PLUS CZ .................................. 153folcal dha .................................................................. 158FOLCAPS OMEGA 3 .......................... 156FOLGARD OS ................................................ 154folic acid .................................................................... 115FOLIVANE-F ................................................... 118FOLIVANE-OB ............................................. 156FOLIVANE-PLUS .................................... 117FOLIVANE-PRX DHA NF ......... 158FOLLISTIM AQ ........................................... 101folplex 2.2 ................................................................. 116foltrin .............................................................................. 117fondaparinux sodium .................................. 22FORA CONTROL ..................................... 127FORA D10 BLOOD GLUCOSE TEST ................................................................................... 94FORA D15G BLOOD GLUCOSE TEST ................................................................................... 94FORA D20 BLOOD GLUCOSE TEST ................................................................................... 94FORA G20 BLOOD GLUCOSE TEST ................................................................................... 94FORA G30A BLOOD GLUCOSE TEST ................................................................................... 94FORA GD20 TEST ...................................... 94FORA LANCETS ....................................... 127FORA LANCING DEVICE ........ 127FORA V10 BLOOD GLUCOSE TEST ................................................................................... 94FORA V12 BLOOD GLUCOSE TEST ................................................................................... 94FORA V20 BLOOD GLUCOSE TEST ................................................................................... 94FORA V30A BLOOD GLUCOSE TEST ................................................................................... 94FORACARE GD40 TEST ................. 94FORACARE GDH CONTROL................................................................................................... 127FORACARE PREMIUM V10 TEST ................................................................................... 95FORACARE TEST N GO TEST....................................................................................................... 95FORADIL AEROLIZER ..................... 21FORANE .................................................................. 110FORFIVO XL ....................................................... 25FORMADON ......................................................... 56formaldehyde .......................................................... 56FORMA-RAY ...................................................... 56FORTEO ................................................................... 101

Index

FORTESTA .............................................................. 15FOSAMAX ........................................................... 101FOSAMAX PLUS D .............................. 101FOSCAVIR ............................................................... 58fosinopril sodium .............................................. 40fosinopril sodium-hctz .............................. 42FOSRENOL ......................................................... 109FRAGMIN ................................................................. 22freds pharmacy autolet lancing................................................................................................... 127freds pharmacy unifine pentip+................................................................................................... 140freds pharmacy unifine pentips................................................................................................... 140freds pharmacy unilet lanc 28g................................................................................................... 127freds pharmacy unilet lanc 30g................................................................................................... 127FREESTYLE CONTROL SOLUTION .......................................................... 127FREESTYLE INSULINX TEST....................................................................................................... 95FREESTYLE LANCETS ................ 127FREESTYLE LITE TEST ................. 95FREESTYLE PRECISION INS SYR ................................................................................... 140FREESTYLE TEST ..................................... 95FREESTYLE UNISTICK II LANCETS .............................................................. 127FROVA ....................................................................... 148FUL-GLO ................................................................ 169full kit nebulizer set ................................... 145FULYZAQ ................................................................. 34FURADANTIN .............................................. 182furosemide ................................................... 99, 100FUSION PLUS ................................................ 117FUZEON ....................................................................... 56FYCOMPA ................................................................ 22gabapentin .................................................................. 23GABITRIL ................................................................. 24galantamine hydrobromide ........... 174galantamine hydrobromide er................................................................................................... 174GALZIN ..................................................................... 151GAMASTAN S/D ....................................... 171GAMMAGARD ............................................ 171GAMMAGARD S/D .............................. 171GAMMAGARD S/D LESS IGA................................................................................................... 171GAMMAKED .................................................. 171GAMMAPLEX ............................................... 171GAMUNEX-C ................................................. 171ganciclovir sodium ......................................... 58


Index

ganirelix acetate ............................................ 102GARAMYCIN ................................................. 165GASTRINEX NF ......................................... 179GASTROCROM ........................................... 107GASTROGRAFIN ......................................... 98GASTROMARK .............................................. 98gatifloxacin ............................................................ 165GATTEX .................................................................. 110gavilax ........................................................................... 121GAVILYTE-C .................................................. 120GAVILYTE-G ................................................. 120GAVILYTE-N WITH FLAVOR PACK ............................................................................. 120ge100 blood glucose test ....................... 95ge100 control ...................................................... 127GEBAUERS PAIN EASE ................. 90GEBAUERS SPRAY AND STRETCH ................................................................... 90GELFILM ................................................................ 168GELNIQUE .......................................................... 183GEL-ONE ................................................................ 161gemfibrozil .................................................................. 38GENERESS FE .................................................. 68generlac ...................................................................... 109gengraf ............................................................................. 60GENOTROPIN ............................................... 102GENOTROPIN MINIQUICK................................................................................................... 102GENTAK ................................................................. 165gentamicin sulfate ........................... 80, 165GENTLE-LET GP LANCETS................................................................................................... 127GENTLE-LET LANCETS ............ 127GENTLE-LET PLATFORMS................................................................................................... 128GEODON ..................................................................... 54GESTICARE DHA ................................... 158GIANVI .......................................................................... 68GIAZO ......................................................................... 108GILDAGIA ............................................................... 68GILDESS 1.5/30 ............................................... 68GILDESS 1/20 ..................................................... 68GILDESS 24 FE ................................................ 68GILDESS FE 1.5/30 .................................... 68GILDESS FE 1/20 .......................................... 68GILENYA ............................................................... 175GILOTRIF .................................................................. 50GILPHEX TR ........................................................ 76GILTUSS ..................................................................... 75GILTUSS PED-C ............................................ 75GILTUSS TR ......................................................... 75GLASSIA ................................................................. 177GLATOPA ............................................................. 175

Index

GLEEVEC .................................................................. 50GLEOSTINE .......................................................... 47glimepiride ................................................................. 33glipizide ........................................................................... 33glipizide er .................................................................. 33GLIPIZIDE XL ................................................... 33glipizide-metformin hcl ........................... 29global alcohol prep ease ................... 137global ease inject pen needles................................................................................................... 140global inject ease insulin syr ...... 140global inject ease lancets 28g ... 128global inject ease lancets 30g ... 128global lancing device ............................. 128GLUCAGEN HYPOKIT ..................... 31GLUCAGON EMERGENCY ...... 31GLUCO BURST ............................................... 31GLUCO PERFECT 3 TEST ........... 95GLUCOCARD 01 CONTROL................................................................................................... 128GLUCOCARD 01 SENSOR PLUS ................................................................................... 95GLUCOCARD EXPRESSION CONTROL ............................................................. 128GLUCOCARD EXPRESSION TEST ................................................................................... 95GLUCOCARD SHINE ....................... 128GLUCOCARD SHINE CONTROL ............................................................. 128GLUCOCARD SHINE TEST ...... 95GLUCOCARD VITAL TEST ..... 95GLUCOCARD X-SENSOR ........... 95GLUCOCARD X-SENSOR CONTROL ............................................................. 128GLUCOCOM CONTROL ............. 128GLUCOCOM LANCETS 28G................................................................................................... 128GLUCOCOM LANCETS 30G................................................................................................... 128GLUCOCOM LANCETS 33G................................................................................................... 128GLUCOCOM TEST ................................... 95GLUCOLET 2 AUTOMATIC LANCING .............................................................. 128GLUCONAVII BLOOD GLUCOSE TEST ............................................ 95GLUCOPHAGE ................................................ 29GLUCOPHAGE XR ................................... 29GLUCOPRO INSULIN SYRINGE................................................................................................... 140glucose .................................................................. 30, 31glucose control ................................................. 128

Index

GLUCOSOURCE LANCET DEVICE ..................................................................... 128GLUCOSOURCE LANCETS................................................................................................... 128GLUCOTROL ...................................................... 33GLUCOTROL XL ......................................... 33GLUCOVANCE ............................................... 29GLUMETZA .......................................................... 29GLUTOSE 15 ........................................................ 31GLUTOSE 45 ........................................................ 31glyburide ........................................................................ 33glyburide micronized .................................. 33glyburide-metformin .................................... 29GLYCATE ............................................................. 180glycine ........................................................................... 111glycine urologic .............................................. 111glycopyrrolate ................................................... 180GLYNASE ................................................................. 33GLYSET ........................................................................ 28GLYXAMBI ........................................................... 28GMATE BLOOD GLUCOSE TEST ................................................................................... 95GMATE CONTROL LEVEL 2................................................................................................... 128gnp alcohol swabs ....................................... 138gnp clickfine pen needles .................. 140gnp glucose .................................................... 30, 31gnp lancets .............................................................. 128gnp lancets 21g ................................................ 128gnp lancets micro thin 33g ............. 128gnp lancets super thin 30g ............. 128gnp lancets thin ............................................... 128gnp lancets thin 26g ................................. 128gnp micro thin lancets 33g ............. 128gnp niacin ................................................................ 185gnp niacin tr ......................................................... 186gnp quick dissolve glucose ................. 31gnp super thin lancets 30g ............. 128GOLYTELY ........................................................ 120GONAL-F ............................................................... 101GONAL-F RFF ............................................... 101GONAL-F RFF PEN .............................. 101GONAL-F RFF REDIJECT ........ 101GORDOFILM ....................................................... 89GORDONS UREA ........................................ 88grafco silver nit applicator ................ 85GRALISE ................................................................. 176GRALISE STARTER ........................... 176granisetron hcl ..................................................... 35GRANISOL .............................................................. 35GRANIX ................................................................... 115GRIFULVIN V ................................................... 35griseofulvin microsize ............................... 35


199

Index

griseofulvin ultramicrosize ................ 35GRIS-PEG .................................................................. 35guaiatussin ac ........................................................ 75guaifenesin ac ........................................................ 75guaifenesin-codeine ...................................... 75guanfacine hcl ....................................................... 41guanfacine hcl er .................................................. 4GYNAZOLE-1 ................................................ 184H&H THINLET LANCETS 26G................................................................................................... 128H&H THINLET LANCETS 30G................................................................................................... 128HAEMOLANCE .......................................... 128HAEMOLANCE LOW FLOW LANCETS .............................................................. 128HAEMOLANCE PLUS ..................... 128HAEMOLANCE PLUS HIGH FLOW ............................................................................ 128HAEMOLANCE PLUS LOW FLOW ............................................................................ 128HAEMOLANCE PLUS MAX FLOW ............................................................................ 128HAEMOLANCE PLUS PEDIATRIC FLOW ................................ 128HALCION .............................................................. 119halobetasol propionate ............................ 86HALOG .......................................................................... 86haloperidol ................................................................. 54haloperidol lactate ......................................... 54HALOTIN ................................................................... 81HARVONI ................................................................. 58HEALTH CARE LANCING DEVICE ..................................................................... 128healthwise alcohol prep ..................... 138healthwise lancets 30g ......................... 128healthwise lancing pen ......................... 129healthwise mini pen needles ........ 140healthwise pen needles ......................... 140healthwise short pen needles ...... 140healthwise unifine pentips ............... 140healthy accents lancing device................................................................................................... 129healthy accents unifine pentip ... 141healthy accents unilet lancets .... 129HEALTHY LIVING FILTERS................................................................................................... 145HEALTHY LIVING MASKS................................................................................................... 145HEALTHY LIVING REPLACEMENT KIT ......................... 145HEATHER ................................................................. 73h-e-b incontrol adv lancing ........... 129h-e-b incontrol lancets 28g ........... 129

Index

h-e-b incontrol lancets 30g ........... 129h-e-b incontrol pen needles ........... 141HECORIA ................................................................... 61HECTOROL ........................................................ 104HELIXATE FS ................................................ 113HEMA-COMBISTIX ................................ 97hematinic plus complex ....................... 117hematinic plus vit/minerals ........... 117hematinic/folic acid ................................... 118HEMATOGEN FA ................................... 117HEMATOGEN FORTE .................... 117hemenatal ob ....................................................... 156hemenatal ob + dha .................................. 156hemetab ....................................................................... 118HEMOCYTE PLUS ................................ 117HEMOCYTE-F ............................................... 118hemocyte-plus .................................................... 117HEMOFIL M ...................................................... 113HEPAGAM B ................................................... 171HEPSERA ................................................................... 58HETLIOZ ................................................................. 120HEXALEN ................................................................. 47HIPREX ..................................................................... 182HISTEX-AC ............................................................ 76HIZENTRA .......................................................... 171hm glucose .................................................................. 30hm lancets micro thin 33g ............... 129hm lancets ultra thin 30g .................. 129hm niacin ................................................................... 186HOMATROPAIRE ................................... 164homatropine hbr ............................................ 164HORIZANT ......................................................... 176HP ACTHAR ..................................................... 101HUMALOG KWIKPEN ....................... 32HUMALOG MIX 50/50 ........................ 32HUMALOG MIX 50/50 KWIKPEN ................................................................. 32HUMALOG MIX 75/25 ........................ 32HUMALOG MIX 75/25 KWIKPEN ................................................................. 32HUMATE-P ......................................................... 113HUMATROPE ................................................. 102HUMATROPEN FOR 12MG................................................................................................... 141HUMATROPEN FOR 24MG................................................................................................... 141HUMATROPEN FOR 6MG ...... 141HUMIRA .......................................................................... 6HUMIRA PEDIATRIC CROHNS START ................................................................................. 6HUMIRA PEN ......................................................... 6HUMIRA PEN-CROHNS STARTER ....................................................................... 6

Index

HUMIRA PEN-PSORIASIS STARTER ....................................................................... 7HUMULIN 70/30 KWIKPEN ..... 32HUMULIN N KWIKPEN .................. 32HUMULIN R U-500 (CONCENTRATED) ................................. 32HYALGAN ........................................................... 161HYCAMTIN ........................................................... 52HYCET ............................................................................ 13HYCOFENIX ........................................................ 75hydralazine hcl ..................................................... 44hydrochlorothiazide ................................. 100hydrocod polst-cpm polst er ............ 76hydrocodone-acetaminophen ......... 13hydrocodone-homatropine ................. 74hydrocodone-ibuprofen ........................... 13hydrocortisone .............................. 16, 73, 86hydrocortisone ace-pramoxine........................................................................................... 16, 87hydrocortisone acetate-aloe ............ 88hydrocortisone butyr lipo base .... 86hydrocortisone butyrate ......................... 86hydrocortisone valerate .......................... 86hydrocortisone-acetic acid ............ 170hydrocortisone-iodoquinol ................. 80hydromet ........................................................................ 74hydromorphone hcl ....................................... 11hydroxychloroquine sulfate ............... 46hydroxyurea .............................................................. 51hydroxyzine hcl ........................................ 17, 67hydroxyzine pamoate .................................. 17hygel ..................................................................................... 89HYLIRA ........................................................................ 89HYOMAX-SL .................................................. 180hyoscyamine sulfate .................................. 180hyoscyamine sulfate er ......................... 180hyosyne ......................................................................... 180HYPERCARE ....................................................... 90HYPERHEP B S/D ................................... 171HYPERRAB S/D ......................................... 171HYPERRHO S/D ......................................... 171HYPERSAL ............................................................. 77HYPERTET S/D ........................................... 171HYPOLANCE AST LANCING................................................................................................... 129HYQVIA ................................................................... 172HYSINGLA ER ................................................. 11HYSKON ..................................................................... 92hy-vee glucose ....................................................... 30HY-VEE LANCETS ............................... 129hy-vee thin lancets ...................................... 129HYZAAR ..................................................................... 43ibandronate sodium .................................. 101


Index

IBRANCE ................................................................... 51IBUDONE .................................................................. 13ibuprofen ........................................................................... 8ICLUSIG ....................................................................... 50IFEREX 150 FORTE ............................. 117ILARIS ................................................................................. 7ILEVRO ..................................................................... 169ILOTYCIN ............................................................. 165IMBRUVICA ......................................................... 50IMDUR ............................................................................ 16imipramine hcl ...................................................... 27imipramine pamoate .................................... 27imiquimod .................................................................... 89IMITREX ................................................................. 148IMITREX STATDOSE SYSTEM................................................................................................... 148IMOGAM RABIES-HT .................... 171IMPLANON ............................................................ 72IMURAN ...................................................................... 61INATAL ADVANCE ........................... 156INATAL GT ........................................................ 156INATAL ULTRA ........................................ 156INCRELEX ........................................................... 103INCRUSE ELLIPTA .................................. 19indapamide ............................................................. 100INDERAL LA ....................................................... 63INDERAL XL ....................................................... 63INDOCIN ......................................................................... 8indomethacin ............................................................... 8indomethacin er ...................................................... 8infanate balance ............................................. 158INFASURF ............................................................ 178INFERGEN ............................................................... 59INFINITY BLOOD GLUCOSE TEST ................................................................................... 95INFINITY CONTROL ........................ 129inject-ease ................................................................ 141INJECT-EASE AUTOMATIC INJECTOR ............................................................. 141INLYTA ......................................................................... 50INNOSPIRE REPLACEMENT FILTER ....................................................................... 145INSPIREASE ..................................................... 147INSPIREASE BAGS .............................. 147INSPIREASE MOUTHPIECE................................................................................................... 147INSPIREASE RESERVOIR BAGS ............................................................................. 147INSPRA .......................................................................... 44insupen pen needles .................................. 141INSUPEN SENSITIVE ...................... 141INSUPEN ULTRAFIN ....................... 141INTEGRA F ......................................................... 118

Index

INTEGRA PLUS .......................................... 117INTELENCE .......................................................... 57INTERMEZZO ............................................... 120INTROL ..................................................................... 100INTRON A ................................................................ 51INTROVALE ......................................................... 71INTUNIV ......................................................................... 4INVEGA ........................................................................ 54INVIRASE ................................................................. 57INVOKAMET ...................................................... 29INVOKANA ........................................................... 33iophen c-nr ................................................................. 75IOPIDINE ................................................................ 164ipratropium bromide ................... 19, 162ipratropium-albuterol ................................ 20IPRIVASK ................................................................. 22irbesartan ..................................................................... 41irbesartan-hydrochlorothiazide....................................................................................................... 43IRENKA ........................................................................ 27IRESSA ........................................................................... 50IROSPAN 24/6 ................................................ 117ISENTRESS ............................................................ 56isoditrate er ............................................................... 16isoflurane .................................................................. 110isoniazid ......................................................................... 47ISOPTIN SR ............................................................ 64ISOPTO CARBACHOL ................... 164ISOPTO HOMATROPINE .......... 164ISOPTO HYOSCINE ............................ 164ISORDIL TITRADOSE ........................ 17isosorbide dinitrate ....................................... 17isosorbide dinitrate er ............................... 17isosorbide mononitrate ............................ 17isosorbide mononitrate er ................... 17ISTALOL ................................................................. 163itraconazole .............................................................. 36ivermectin ..................................................................... 16IXINITY .................................................................... 113JADENU ....................................................................... 34JAKAFI ........................................................................... 51JALYN ......................................................................... 112JANTOVEN ............................................................. 21JANUMET ................................................................. 28JANUMET XR .................................................... 28JANUVIA .................................................................... 31JARDIANCE .......................................................... 33JENCYCLA ............................................................. 73JENTADUETO ................................................... 28JETREA ..................................................................... 169JOLESSA ..................................................................... 71JOLIVETTE ............................................................. 73

Index

J-TIP KIT W/VIAL ADAPTERS................................................................................................... 141JUBLIA ........................................................................... 81JUNEL 1.5/30 ........................................................ 68JUNEL 1/20 .............................................................. 68JUNEL FE 1.5/30 ............................................ 68JUNEL FE 1/20 .................................................. 69JUXTAPID ................................................................ 39KADIAN ....................................................................... 11KALBITOR .......................................................... 114KALETRA ................................................................. 56kalexate ............................................................................ 62KALYDECO ...................................................... 177KAPVAY ......................................................................... 4KARBINAL ER ................................................. 36KARIDIUM ......................................................... 149KARIGEL ............................................................... 152KARIGEL-N ....................................................... 152KARIVA ....................................................................... 67KAYEXALATE ................................................ 62KAZANO ..................................................................... 28KCENTRA ............................................................. 113k-effervescent ...................................................... 150KEFLEX ........................................................................ 66KELNOR 1/35 ...................................................... 69KENALOG ................................................................ 86KEPPRA ........................................................................ 23KEPPRA XR .......................................................... 23KERAFOAM ......................................................... 88KERAFOAM 42 ............................................... 88KERALAC ................................................................. 88KERLONE ................................................................. 62KERR TRIPLE DYE SWABS .... 56KERYDIN .................................................................. 82KETEK ............................................................................ 45KETOCARE ............................................................ 95ketoconazole ................................................. 36, 81KETODAN ................................................................ 81KETO-DIASTIX .............................................. 97ketoprofen ........................................................................ 8ketoprofen er ............................................................... 8ketorolac tromethamine .............. 8, 169KETOSTIX ............................................................... 95KEVEYIS .................................................................... 99KHEDEZLA ............................................................ 27KINERET ........................................................................ 7kinney lancets ..................................................... 129kinney thin lancets ...................................... 129KIONEX ........................................................................ 62KLARON ..................................................................... 77KLONOPIN ............................................................. 23KLOR-CON ......................................................... 150KLOR-CON 10 ............................................... 150


201

Index

KLOR-CON M10 ........................................ 150KLOR-CON M15 ........................................ 150KLOR-CON M20 ........................................ 150KLOR-CON/EF ............................................. 150kmart valu insulin syringe 29g................................................................................................... 141kmart valu insulin syringe 30g................................................................................................... 141KOATE-DVI ...................................................... 113KOGENATE FS ............................................ 113KOGENATE FS BIO-SET ........... 113KOKO PEAK PRO MOUTHPIECE ............................................... 145KOMBIGLYZE XR .................................... 28KORLYM .................................................................... 31kp cetirizine hcl ................................................... 37kp miconazole nitrate ................................. 81kp omeprazole magnesium ............. 181K-PHOS ..................................................................... 150K-PHOS NO 2 .................................................. 110K-PRIME ................................................................. 150KRISTALOSE ................................................. 121kroger blood glucose test ..................... 95kroger glucose ....................................................... 30kroger lancets .................................................... 129kroger lancets 21g ...................................... 129kroger lancets micro thin 33g ... 129kroger lancets super thin .................. 129kroger lancets thin ...................................... 129kroger lancets thin 26g ........................ 129kroger lancets ultrathin 30g ........ 129kroger lancing device ............................. 129kroger pen needles ..................................... 141kroger premium glucose test ........... 95kroger test .................................................................... 95KRYSTEXXA .................................................. 112KURVELO ................................................................ 69KUVAN ..................................................................... 105k-vescent ..................................................................... 150KYNAMRO ............................................................. 38labetalol hcl .............................................................. 62LABSTIX ..................................................................... 97LACRISERT ....................................................... 163lactated ringers ................................................... 61lactic acid ..................................................................... 89lactulose ..................................................................... 121lactulose encephalopathy ................. 109lady lite lancets ................................................ 129LAMICTAL ............................................................. 23LAMICTAL ODT ........................................... 23LAMICTAL STARTER ....................... 23LAMICTAL XR ................................................ 23LAMISIL ...................................................................... 36

Index

lamivudine ....................................................... 57, 58lamivudine-zidovudine ............................. 56lamotrigine ................................................................. 23lamotrigine er ........................................................ 23lancet device ........................................................ 129lancets ............................................................................ 129lancets 28g .............................................................. 129lancets 30g .............................................................. 129lancets micro thin 33g ........................... 129lancets super thin 28g ........................... 129lancets thin ............................................................. 129LANCETS ULTRA FINE .............. 129LANCETS ULTRA THIN ............. 129lancets ultra thin 30g .............................. 129lancing device .................................................... 129LANOXIN .................................................................. 65lansoprazole ......................................................... 181LANTUS ....................................................................... 32LANTUS SOLOSTAR ........................... 32LARIN 1/20 .............................................................. 69LARIN FE 1.5/30 ............................................ 69LARIN FE 1/20 .................................................. 69LASIX ........................................................................... 100LASTACAFT .................................................... 168latanoprost ............................................................. 169LATRIX ......................................................................... 88LATUDA ..................................................................... 54lavare wound wash ........................................ 91LAZANDA ................................................................ 11leader advanced lancing device................................................................................................... 129leader glucose ....................................................... 30leader quick dissolve glucose ........ 31LEADER UNIFINE PENTIPS................................................................................................... 141LEADER UNIFINE PENTIPS PLUS ............................................................................... 141LEENA ............................................................................ 71leflunomide ..................................................................... 9LEMTRADA ...................................................... 175LENVIMA 10 MG DAILY DOSE....................................................................................................... 50LENVIMA 14 MG DAILY DOSE....................................................................................................... 50LENVIMA 20 MG DAILY DOSE....................................................................................................... 50LENVIMA 24 MG DAILY DOSE....................................................................................................... 50LESCOL ........................................................................ 39LESCOL XL ........................................................... 39LESSINA ..................................................................... 69LETAIRIS ................................................................... 66letrozole .......................................................................... 48

Index

leucovorin calcium ......................................... 52LEUKERAN ........................................................... 47LEUKINE ................................................................ 116leuprolide acetate ............................................ 49levalbuterol hcl .................................................... 21LEVAQUIN ......................................................... 107LEVATOL ................................................................. 63LEVEMIR ................................................................... 32LEVEMIR FLEXPEN .............................. 32levetiracetam ........................................................... 23levetiracetam er .................................................. 23levobunolol hcl ................................................. 163levocarnitine ........................................................ 103levocetirizine dihydrochloride ...... 37levofloxacin ........................................... 107, 165levomefolate dha ........................................... 158LEVONEST ............................................................. 71levonorgest-eth estrad 91-day ...... 71levonorgestrel ........................................................ 72levonorgestrel-ethinyl estrad .......... 69LEVORA 0.15/30 (28) ............................ 69levorphanol tartrate ..................................... 11levothyroxine sodium .............................. 179LEVOXYL ............................................................. 179LEVULAN KERASTICK .................. 83LEXAPRO ................................................................. 26LEXIVA ......................................................................... 57LIALDA ..................................................................... 108LIBERTY GLUCOSE CONTROL................................................................................................... 129LIBERTY GLUCOSE CONTROL MID ................................................................................... 129LIBERTY MINI LANCING DEVICE ..................................................................... 130LIBERTY NEXT GENERATION TEST ................................................................................... 95liberty test .................................................................... 95LIDAZONE HC ................................................. 16lidocaine ......................................................................... 90lidocaine hcl ............................................................. 90lidocaine viscous ........................................... 151lidocaine-hydrocortisone ace ........ 16lidocaine-prilocaine ..................................... 90LIDODERM ............................................................ 90lidopin ................................................................................ 90lidorx ................................................................................... 90LIFESCAN UNISTIK 2 .................... 130LIFESCAN UNISTIK II LANCETS .............................................................. 130LILETTA ..................................................................... 73lindane .............................................................................. 91linezolid ........................................................................... 45LINZESS .................................................................. 109


Index

liothyronine sodium .................................. 179LIPITOR ........................................................................ 39LIPOFEN ..................................................................... 38LIPTRUZET ............................................................ 37LIQUID E-Z-PAQUE ............................... 98LIQUID POLIBAR ....................................... 98LIQUID POLIBAR PLUS ................. 98lisinopril ......................................................................... 40lisinopril-hydrochlorothiazide ..... 42lite touch lancets ............................................ 130LITE TOUCH LANCING DEVICE ..................................................................... 130LITE TOUCH LANCING PEN................................................................................................... 130LITE TOUCH PEN NEEDLES................................................................................................... 141LITEAIRE .............................................................. 147LITETOUCH INSULIN SYRINGE ................................................................ 141LITETOUCH LANCETS ............... 130LITETOUCH MASK LARGE................................................................................................... 145LITETOUCH MASK MEDIUM................................................................................................... 145LITETOUCH MASK SMALL................................................................................................... 145LITETOUCH PEN NEEDLES................................................................................................... 141lithium carbonate ............................................. 54lithium carbonate er ..................................... 54LITHOBID ................................................................. 54LITHOSTAT ...................................................... 112LIVALO ......................................................................... 39live better adv lancing device .... 130live better lancet super thin .......... 130live better lancet ultra thin ............. 130live better pen needles ........................... 141LO LOESTRIN FE ........................................ 67LOCOID ........................................................................ 86LOCOID LIPOCREAM ........................ 87LOESTRIN 1.5/30 (21) .......................... 69LOESTRIN 1/20 (21) ................................ 69LOESTRIN FE 1.5/30 .............................. 69LOESTRIN FE 1/20 .................................... 69lofene ................................................................................... 34LOFIBRA .................................................................... 38LOKARA ..................................................................... 87LOMOTIL .................................................................. 34lomustine ....................................................................... 47longs glucose ........................................................... 30longs lancets standard .......................... 130longs lancets thin .......................................... 130longs lancets ultra thin ........................ 130

Index

LONOX .......................................................................... 34LOPID ............................................................................... 38LOPRESSOR ......................................................... 62LOPRESSOR HCT ....................................... 43LOPROX ...................................................................... 81loratadine ..................................................................... 37loratadine allergy relief ......................... 37loratadine childrens ..................................... 37loratadine-d 12hr ............................................. 75loratadine-d 24hr ............................................. 75lorazepam ..................................................................... 18LORAZEPAM INTENSOL ............ 18LORCET ....................................................................... 13LORCET HD .......................................................... 13LORTAB ...................................................................... 13LORYNA ..................................................................... 69LORZONE ............................................................. 160losartan potassium ......................................... 41losartan potassium-hctz .......................... 43LOSEASONIQUE ......................................... 71LOTEMAX ........................................................... 167LOTENSIN ............................................................... 40LOTENSIN HCT ............................................. 42LOTREL ........................................................................ 42LOTRISONE .......................................................... 80LOTRONEX ....................................................... 109lovastatin ....................................................................... 39LOVAZA ..................................................................... 38LOVENOX ................................................................ 22LOW-OGESTREL ......................................... 69loxapine succinate ........................................... 55LOZI-FLUR ......................................................... 149LUCENTIS ............................................................ 164LUDENT .................................................................. 149LUFYLLIN ............................................................... 21LUMIGAN ............................................................. 169LUMIZYME ....................................................... 103LUNESTA .............................................................. 120LUPANETA PACK ................................. 103LUPRON DEPOT ........................................... 49LUPRON DEPOT-PED ..................... 103LUTERA ....................................................................... 69LUVOX CR .............................................................. 26LUXIQ ............................................................................. 87LUZU ................................................................................. 81LYNPARZA ............................................................ 51LYRICA ......................................................................... 23LYSODREN ............................................................ 48LYSTEDA .............................................................. 118LYZA ................................................................................. 73MACNATAL CN DHA ..................... 158MACROBID ....................................................... 182MACRODANTIN ...................................... 182

Index

MACUGEN .......................................................... 164mafenide acetate ................................................ 85MAGELLAN INSULIN SAFETY SYR ................................................................................... 141major comfort lancets ............................ 130MAKENA ............................................................... 173MALARONE ......................................................... 46malathion ...................................................................... 91margesic ......................................................................... 10MARINOL ................................................................. 35marlissa ........................................................................... 69MARNATAL-F .............................................. 156MARPLAN ............................................................... 25marten-tab ................................................................... 10MASK VORTEX ......................................... 147MATULANE ......................................................... 51MATZIM LA ......................................................... 64MAVIK ........................................................................... 40MAXALT ................................................................ 148MAXALT-MLT ............................................. 149MAXARON FORTE .............................. 117MAXIBAR ................................................................. 98MAXI-COMFORT INSULIN SYRINGE ................................................................ 141MAXIDEX ............................................................. 167MAXIMA BLOOD GLUCOSE TEST ................................................................................... 95MAXIMA CONTROL ........................ 130MAXITROL ........................................................ 167MAXZIDE ................................................................. 99MAXZIDE-25 ....................................................... 99m-clear wc ................................................................... 75MD-GASTROVIEW .................................. 98medichoice safety lancet .................... 130medichoice safety lancet extra................................................................................................... 130medichoice safety lancet norm................................................................................................... 130medicine shoppe lancets .................... 130medicine shoppe lancets thin ...... 130medicine shoppe pen needles ..... 141medi-lance lancets ...................................... 130MEDISENSE GLUCOSE KETONE CONTR ..................................... 130MEDISENSE HI/MID/LOW CONTROL ............................................................. 130MEDISENSE HIGH/LOW CONTROL ............................................................. 130MEDISENSE MID CONTROL................................................................................................... 130MEDISENSE THIN LANCETS................................................................................................... 130MEDLANCE EXTRA 21G ......... 130


203

Index

MEDLANCE LITE 25G ................... 130MEDLANCE PLUS EXTRA 21G................................................................................................... 130MEDLANCE PLUS LANCETS................................................................................................... 130MEDLANCE PLUS LITE 25G................................................................................................... 130MEDLANCE PLUS SPECIAL 0.8MM .......................................................................... 130MEDLANCE PLUS SUPERLITE 30G ..................................................................................... 130MEDLANCE PLUS UNIVERSAL 21G ..................................................................................... 130MEDLANCE UNIVERSAL 21G................................................................................................... 130MEDROL ..................................................................... 74MEDROL (PAK) ............................................. 73medroxyprogesterone acetate....................................................................................... 73, 173mefenamic acid ........................................................ 8mefloquine hcl ....................................................... 46MEGACE ES ..................................................... 173MEGACE ORAL ............................................. 49megestrol acetate .............................. 49, 173meijer alcohol swabs .............................. 138meijer blood glucose test ...................... 95meijer glucose ....................................................... 30MEIJER LANCETS ................................ 130MEIJER LANCETS THIN ........... 130MEIJER LANCETS UNIVERSAL 21G ..................................................................................... 131MEIJER LANCETS UNIVERSAL 30G ..................................................................................... 131MEIJER LANCETS UNIVERSAL 33G ..................................................................................... 131meijer pen needles ...................................... 141meijer premium glucose test ............ 95MEIJER SUPER THIN LANCETS .............................................................. 131MEIJER TRUETEST TEST ........... 95MEIJER TRUETRACK TEST ... 95MEKINIST ................................................................ 50meloxicam ........................................................................ 8MELOXICAM COMFORT PAC........................................................................................................... 8memantine hcl ................................................... 174MENEST .................................................................. 106MENOPUR ........................................................... 101MENOSTAR ...................................................... 106meperidine hcl ....................................................... 11meperitab ...................................................................... 11MEPHYTON ...................................................... 185meprobamate .......................................................... 17

Index

MEPRON ..................................................................... 45mercaptopurine ................................................... 47mesalamine ............................................................ 108MESNEX ..................................................................... 52MESTINON ............................................................. 46METADATE CD ................................................. 5METADATE ER .................................................. 5metaproterenol sulfate .............................. 21metaxalone ............................................................. 160metformin hcl .......................................................... 29metformin hcl er ................................................. 29metformin hcl er (osm) ............................. 29methadone hcl ....................................................... 11METHADONE HCL INTENSOL....................................................................................................... 11METHADOSE ..................................................... 11METHADOSE SUGAR-FREE....................................................................................................... 11methamphetamine hcl .................................... 4methazolamide ...................................................... 99methenamine hippurate ....................... 182methenamine mandelate .................... 182methimazole .......................................................... 178methitest ......................................................................... 15methocarbamol ................................................ 160methotrexate ............................................................. 47methscopolamine bromide .............. 180methyldopa ................................................................. 41methylergonovine maleate .............. 171METHYLIN ................................................................. 5methylphenidate hcl .......................................... 5methylphenidate hcl er ................................. 5methylphenidate hcl er (cd) .................. 5methylphenidate hcl er (la) ................... 5methylprednisolone ....................................... 74methylprednisolone (pak) .................... 74metipranolol ......................................................... 163metoclopramide hcl ................................... 108metolazone .............................................................. 100METOPIRONE ................................................... 92metoprolol succinate er .......................... 62metoprolol tartrate ......................................... 62metoprolol-hydrochlorothiazide....................................................................................................... 43METOZOLV ODT .................................... 108METROCREAM .............................................. 91METROGEL ........................................................... 91METROGEL-VAGINAL ................ 184METROLOTION ............................................. 91metronidazole ............................. 45, 91, 184MEVACOR .............................................................. 39mexiletine hcl .......................................................... 18MIACALCIN ..................................................... 101

Index

micaderm ...................................................................... 81MICATIN .................................................................... 81miconazole nitrate ........................................... 81MICRHOGAM ULTRA-FILTERED PLUS .......... 171MICRO GUARD .............................................. 81MICRO-BUMINTEST ............................ 95MICROCHAMBER ................................ 147MICRODOT CONTROL HIGH/LOW .......................................................... 131MICRODOT TEST ....................................... 95MICROELITE BATTERY ........... 145MICROELITE FILTER REPLACEMENTS .................................... 145MICROGESTIN 1.5/30 ......................... 69MICROGESTIN 1/20 ............................... 69MICROGESTIN FE 1.5/30 .............. 69MICROGESTIN FE 1/20 .................... 69MICRO-K ................................................................ 150MICROLET LANCETS ................... 131MICROLIFE DIGITAL PEAK FLOW ............................................................................ 144micronized colestipol hcl ...................... 38MICROSPACER .......................................... 147MICROTAINER SAFETY FLOW LANCET ................................................................... 131MICROZIDE ...................................................... 100midazolam hcl ................................................... 119midodrine hcl ...................................................... 185MIGERGOT ........................................................ 148MIGRAL ................................................................... 148MIGRALAM ...................................................... 148MIGRANAL ....................................................... 148MILLIPRED ............................................................ 74MILLIPRED DP ............................................... 74MILLIPRED DP 12-DAY ................. 74MIMVEY ................................................................. 106MINASTRIN 24 FE ..................................... 69mini lancing device .................................... 131MINI WRIGHT PEAK FLOW METER ....................................................................... 144MINIELITE FILTER REPLACEMENTS .................................... 145MINIELITE RECHARGEABLE BATTERY ............................................................. 145MINIPRESS ............................................................ 41MINIPRIN LOW DOSE ....................... 10MINITRAN .............................................................. 17MINIVELLE ....................................................... 106MINOCIN ............................................................... 178minocycline hcl ................................................ 178minocycline hcl er ....................................... 178minoxidil ........................................................................ 44


Index

MIRALAX ............................................................. 121MIRAPEX .................................................................. 53MIRAPEX ER ...................................................... 53MIRCETTE .............................................................. 67MIRENA ....................................................................... 73mirtazapine ................................................................ 25MIRVASO ................................................................. 91misoprostol ............................................................ 182MITIGARE ........................................................... 112MITOSOL ............................................................... 165MOBIC ................................................................................ 8modafinil ............................................................................ 5moderiba ........................................................................ 59MODERIBA 1200 DOSE PACK....................................................................................................... 59MODERIBA 800 DOSE PACK....................................................................................................... 59MODICON (28) ................................................. 69moexipril hcl ............................................................ 40moexipril-hydrochlorothiazide .... 42mometasone furoate ..................................... 87MONOCLATE-P ......................................... 113MONODOX ......................................................... 178MONOJECT INSULIN SYRINGE................................................................................................... 141MONOJECT ULTRA COMFORT SYRINGE ................................................................ 141MONOJECTOR END CAPS .... 131MONOJECTOR OPD END CAPS................................................................................................... 131MONOLET LANCETS ..................... 131MONOLET OPD LANCETS ... 131MONOLETTOR SAFETY LANCETS .............................................................. 131MONO-LINYAH ............................................. 69MONONESSA ..................................................... 69MONONINE ....................................................... 113MONOVISC ........................................................ 161monsels ferric subsulfate .................. 119montelukast sodium ....................................... 19MONUROL .......................................................... 182MOORE MONO INSULIN SYRINGE ................................................................ 141MORGIDOX ...................................................... 178morphine sulfate er ........................................ 12MOTOFEN ................................................................ 34MOVANTIK ....................................................... 109MOVIPREP .......................................................... 120MOXATAG ......................................................... 172MOXEZA ................................................................ 165MS CONTIN ........................................................... 12ms quick dissolve glucose .................... 31MST 600 ........................................................................ 11

Index

MULTAQ .................................................................... 18multi vit/fl ................................................................. 154multi vita-bets/fluoride ......................... 154multi vitamin/fluoride ............................ 154MULTIGEN ......................................................... 117MULTIGEN FOLIC ............................... 117MULTIGEN PLUS ................................... 117multi-lancet device ..................................... 131multiple vitamins/fluoride ............... 155MULTISTIX ........................................................... 97MULTISTIX 10 SG ..................................... 97MULTISTIX 5 ..................................................... 97MULTISTIX 7 ..................................................... 97MULTISTIX 8 ..................................................... 97MULTISTIX 9 ..................................................... 97MULTISTIX 9 SG ......................................... 97multi-vit/fluoride ............................................ 155multi-vit/fluoride/iron ............................ 154multivitamin/fluoride .............................. 155multi-vitamin/fluoride ............................ 155multi-vitamin/fluoride/iron ............ 154multivitamins/fluoride ........................... 155multi-vitamins/fluoride ........................ 155multi-vits/fluoride ........................................ 155mult-vitamin/fluoride .............................. 155mupirocin ..................................................................... 80mupirocin calcium .......................................... 80MUSE ................................................................................ 65MVC-FLUORIDE ...................................... 155MYALEPT ............................................................. 104MYAMBUTOL .................................................. 47mycophenolate mofetil .............................. 61mycophenolic acid .......................................... 61mydral ............................................................................ 164MYDRIACYL .................................................. 164myferon 150 forte ......................................... 117MYFORTIC ............................................................. 61MYGLUCOHEALTH CONTROL................................................................................................... 131MYGLUCOHEALTH LANCETS 30G ..................................................................................... 131MYGLUCOHEALTH TEST ......... 95MYKIDZ IRON FL ................................. 154MYLERAN ............................................................... 47MYNATAL .......................................................... 156MYNATAL ADVANCE ................. 156mynephrocaps .................................................... 152MYORISAN ............................................................ 79MYOXIN ................................................................. 170MYOZYME ......................................................... 104MYRBETRIQ ................................................... 183MYSOLINE ............................................................. 23MYZILRA .................................................................. 71

Index

na ferric gluc cplx in sucrose ..... 118NABI-HB ................................................................. 171nabumetone ................................................................... 8nadolol .............................................................................. 63nadolol-bendroflumethiazide ......... 43NAFRINSE ........................................................... 149NAFRINSE DAILY ACIDULATED ............................................... 151NAFRINSE DAILY/NEUTRAL................................................................................................... 152NAFRINSE DROPS ............................... 149NAFRINSE WEEKLY ....................... 152naftifine hcl ................................................................ 81NAFTIN ......................................................................... 81NAGLAZYME ................................................ 105NALFON .......................................................................... 8naltrexone hcl ........................................................ 34NAMENDA ......................................................... 174NAMENDA TITRATION PAK................................................................................................... 174NAMENDA XR ............................................ 174NAMENDA XR TITRATION PACK ............................................................................. 174NAMZARIC ........................................................ 173NAPRELAN ................................................................ 8NAPROSYN ............................................................... 8naproxen ............................................................................ 9naproxen dr ................................................................... 8naproxen sodium ................................................... 9naproxen sodium er .......................................... 9naratriptan hcl .................................................. 149NARDIL ........................................................................ 25NASACORT ALLERGY 24HR................................................................................................... 162NASCOBAL ....................................................... 115NASONEX ............................................................ 162NATACHEW ..................................................... 156NATACYN ........................................................... 165NATALVIRT 90 DHA ....................... 158NATALVIRT CA ....................................... 158NATALVIRT FLT .................................... 118NATALVIT .......................................................... 156NATAZIA ................................................................... 71nateglinide .................................................................. 33NATELLE ONE ............................................ 156NATESTO .................................................................. 15NATPARA ............................................................. 101NATROBA ................................................................ 91NATURE-THROID ................................. 179nebulizer air tube/plugs ...................... 145nebulizer mask pediatric ................... 145NEBUPENT ............................................................. 45NEBUSAL ................................................................. 77


205

Index

NECON 0.5/35 (28) ..................................... 69NECON 1/35 (28) ........................................... 69NECON 1/50 (28) ........................................... 69NECON 10/11 (28) ....................................... 67NECON 7/7/7 ........................................................ 71NEEVO DHA .................................................... 156nefazodone hcl ...................................................... 26neo-fradin ......................................................................... 6NEOFRIN ................................................................ 166neomycin sulfate .................................................... 6neomycin-bacitracin zn-polymyx................................................................................................... 165neomycin-polymyxin b gu ................ 111neomycin-polymyxin-dexameth................................................................................................... 167neomycin-polymyxin-gramicidin................................................................................................... 165neomycin-polymyxin-hc ...................... 170NEO-POLYCIN ............................................. 165NEO-POLYCIN HC ............................... 167NEORAL ...................................................................... 60NEOSPORIN ..................................................... 165NEOSPORIN AF ............................................. 82NEOSPORIN GU IRRIGANT................................................................................................... 111NEOTUSS PLUS ............................................. 76NEPHPLEX RX ............................................ 153NEPHROCAPS .............................................. 152NEPHROCAPS QT .................................. 153NEPHRON FA ................................................ 117NEPHRONEX .................................................. 152NEPTAZANE ....................................................... 99NESINA ......................................................................... 31NESSI SPACER WITH MASK LARGE ........................................................................ 147NESSI SPACER WITH MASK SM/MED ................................................................... 147NESSI SPACER WITH MOUTHPIECE ............................................... 147NESTABS ............................................................... 156NESTABS ABC ............................................ 158NESTABS DHA ........................................... 156NETGROUP LANCETS .................. 131NEUMEGA .......................................................... 116NEUPOGEN ....................................................... 115NEUPRO ...................................................................... 53neurin-sl ..................................................................... 116NEURONTIN ........................................................ 23NEUTEK 2TEK CONTROL ..... 131NEUTEK 2TEK TEST ............................ 95NEUTRAGARD ADVANCED................................................................................................... 152NEVANAC ........................................................... 169

Index

nevirapine .................................................................... 57nevirapine er ........................................................... 57NEXA PLUS ....................................................... 158NEXAVAR ............................................................... 50NEXGEN CONTROL .......................... 131NEXGEN TEST ................................................ 95NEXIUM .................................................................. 181NEXIUM 24HR ............................................. 181NEXPLANON ..................................................... 72NEXT CHOICE ................................................. 72NEXT CHOICE ONE DOSE ........ 72niacin .............................................................................. 186niacin er ...................................................................... 186niacin er (antihyperlipidemic) ...... 40niacin-50 .................................................................... 186NIACOR ........................................................................ 40NIASPAN .................................................................... 40nicardipine hcl ...................................................... 64NICAZELDOXY 30 ............................... 178NICAZELDOXY 60 ............................... 178NICODERM CQ ........................................... 176NICOMIDE .......................................................... 160NICORETTE ...................................................... 176NICORETTE MINI .................................. 176NICORETTE STARTER KIT................................................................................................... 176nicotine ......................................................................... 176nicotine polacrilex ...................................... 176NICOTROL .......................................................... 176NICOTROL NS .............................................. 176NIFEDIAC CC .................................................... 64NIFEDICAL XL ............................................... 64nifedipine ...................................................................... 64nifedipine er .............................................................. 64nifedipine er osmotic release .......... 64NILANDRON ....................................................... 48nimodipine .................................................................. 64NIRAVAM ................................................................ 18nisoldipine er .......................................................... 64NITRO-BID ............................................................. 17NITRO-DUR .......................................................... 17nitrofurantoin ..................................................... 182nitrofurantoin macrocrystal ......... 183nitrofurantoin monohyd macro................................................................................................... 183nitroglycerin ............................................................. 17nitroglycerin er .................................................... 17NITROLINGUAL .......................................... 17NITROMIST ........................................................... 17NITROSTAT .......................................................... 17NITRO-TIME ........................................................ 17nizatidine ................................................................... 180NIZORAL ................................................................... 82

Index

NORA-BE ................................................................... 73NORCO .......................................................................... 13NORDIPEN 5 INJECTION DEVICE ..................................................................... 141NORDIPEN DELIVERY SYSTEM ................................................................... 141NORDITROPIN FLEXPRO ....... 102NORDITROPIN NORDIFLEX PEN ................................................................................... 102norethin ace-eth estrad-fe ................... 69norethindrone ......................................................... 73norethindrone acetate ........................... 173norethindrone-eth estradiol .......... 106norgestimate-eth estradiol .................. 69norgestim-eth estrad triphasic ..... 71norgestrel-ethinyl estradiol ............... 69NORINYL 1+35 (28) ................................ 69NORINYL 1+50 (28) ................................ 69NORITATE .............................................................. 91NOROXIN ............................................................. 107NORPACE ................................................................. 18NORPACE CR .................................................... 18NORPRAMIN ...................................................... 27NOR-QD ....................................................................... 73NORTHERA ....................................................... 185NORTREL 0.5/35 (28) ............................ 69NORTREL 1/35 (21) .................................. 70NORTREL 1/35 (28) .................................. 70NORTREL 7/7/7 ............................................... 71nortriptyline hcl .................................................. 27nortuss-ex ..................................................................... 75NORVASC ................................................................ 64NORVIR ........................................................................ 57nose clip ...................................................................... 145NOVA MAX GLUCOSE TEST....................................................................................................... 95NOVA MAX PLUS GLU/KET CONTROL ............................................................. 131NOVA SAFETY LANCETS 23G................................................................................................... 131NOVA SAFETY LANCETS 28G................................................................................................... 131NOVA SUREFLEX LANCETS................................................................................................... 131NOVA SUREFLEX LANCING DEVICE ..................................................................... 131NOVAFERRUM .......................................... 117novarel .......................................................................... 101NOVOEIGHT ................................................... 113NOVOFINE ......................................................... 141NOVOFINE AUTOCOVER ...... 141NOVOLIN 70/30 .............................................. 32NOVOLIN 70/30 RELION .............. 32


Index

NOVOLIN N .......................................................... 32NOVOLIN N RELION ........................... 32NOVOLIN R ........................................................... 32NOVOLIN R RELION ........................... 32NOVOLOG ............................................................... 32NOVOLOG FLEXPEN .......................... 32NOVOLOG MIX 70/30 ......................... 32NOVOLOG MIX 70/30 FLEXPEN ................................................................... 32NOVOSEVEN RT ..................................... 113NOVOTWIST ................................................... 141NOXAFIL ................................................................... 36np thyroid ................................................................. 179NPLATE .................................................................... 116NUCORT ..................................................................... 87NUCYNTA ............................................................... 12NUCYNTA ER ................................................... 12NUEDEXTA ....................................................... 176NUFOL ........................................................................ 116NULEV ....................................................................... 180NULOJIX ..................................................................... 61NULYTELY WITH FLAVOR PACKS ........................................................................ 120NUOX ............................................................................... 79NUTRIVIT ............................................................. 153NUTROPIN .......................................................... 102NUTROPIN AQ ............................................ 102NUTROPIN AQ NUSPIN 10 ... 102NUTROPIN AQ NUSPIN 20 ... 102NUTROPIN AQ NUSPIN 5 ....... 102NUTROPIN AQ PEN ........................... 102NUVARING ............................................................ 72NUVESSA ............................................................. 184NUVIGIL ......................................................................... 5NYAMYC ................................................................... 81NYMALIZE ............................................................. 64nystatin ................................................. 36, 81, 151nystatin-triamcinolone ............................. 80NYSTOP ....................................................................... 81OB COMPLETE ........................................... 156OB COMPLETE 400 ............................. 156OB COMPLETE ONE ......................... 156OB COMPLETE PETITE .............. 156OB COMPLETE PREMIER ...... 156OB COMPLETE/DHA ....................... 156OBREDON ................................................................ 75O-CAL PRENATAL .............................. 156OCELLA ....................................................................... 70OCTAGAM .......................................................... 171octreotide acetate ......................................... 105OCUFEN .................................................................. 169OCUFLOX ............................................................. 165OCUVEL .................................................................. 154

Index

OFEV ............................................................................. 177ofloxacin ..................................... 107, 165, 170olanzapine ................................................................... 55olanzapine-fluoxetine hcl ................. 174OLEPTRO .................................................................. 26olopatadine hcl ................................................ 161OLUX ................................................................................ 87OLUX-E ......................................................................... 87OLYSIO ......................................................................... 59OMECLAMOX-PAK ........................... 182omega-3-acid ethyl esters .................... 38omeprazole ............................................................. 181omeprazole-sodium bicarbonate................................................................................................... 182OMNARIS ............................................................. 162OMNIFLEX DIAPHRAGM ....... 122OMNIPRED ......................................................... 167OMNITROPE .................................................... 102OMNITROPE PEN 10 INJ DEVICE ..................................................................... 142OMNITROPE PEN 5 INJ DEVICE ..................................................................... 142OMONTYS ........................................................... 115ON CALL EXPRESS BLOOD GLUCOSE ................................................................. 95ON CALL EXPRESS GLUCOSE CONTR ....................................................................... 131ON CALL LANCETS .......................... 131ON CALL LANCING DEVICE................................................................................................... 131ON CALL PLUS BLOOD GLUCOSE ................................................................. 95ON CALL PLUS GLUCOSE CONTROL ............................................................. 131ON CALL PLUS LANCETS .... 131ON CALL PLUS LANCING DEVICE ..................................................................... 131ON CALL VIVID BLOOD GLUCOSE ................................................................. 95ON CALL VIVID GLUCOSE CONTROL ............................................................. 131ondansetron .............................................................. 35ondansetron hcl ................................................... 35ONE FLOW TESTER .......................... 145ONETOUCH CLUB LANCETS FINE PT ..................................................................... 131ONETOUCH COMBO PACK................................................................................................... 131ONETOUCH DELICA LANCETS 33G ..................................................................................... 131ONETOUCH DELICA LANCETS FINE ................................................................................. 131

Index

ONETOUCH DELICA LANCING DEV .................................................................................. 131ONETOUCH FINEPOINT LANCETS .............................................................. 131ONETOUCH LANCETS ................ 132ONETOUCH SURESOFT LANCING DEV ............................................ 132ONETOUCH ULTRA BLUE ....... 96ONETOUCH ULTRA CONTROL................................................................................................... 132ONETOUCH ULTRASOFT LANCETS .............................................................. 132ONETOUCH VERIO ................ 96, 132ONEXTON ................................................................ 78ONFI .................................................................................... 23ONGLYZA ................................................................ 31ONMEL .......................................................................... 36OPANA ........................................................................... 12OPANA ER ............................................................... 12opium .................................................................................. 34OPSUMIT ................................................................... 66OPTICHAMBER ADVANTAGE................................................................................................... 147OPTICHAMBER ADVANTAGE-LG MASK .......... 147OPTICHAMBER ADVANTAGE-MED MASK ... 147OPTICHAMBER ADVANTAGE-SM MASK ......... 147OPTICHAMBER DIAMOND................................................................................................... 147OPTICHAMBER DIAMOND-LG MASK ........................................................................... 147OPTICHAMBER DIAMOND-MD MASK ........................................................................... 147OPTICHAMBER DIAMOND-SM MASK ........................................................................... 147OPTICHAMBER FACE MASK-LARGE .............................................. 147OPTICHAMBER FACE MASK-MEDIUM ....................................... 147OPTICHAMBER FACE MASK-SMALL ............................................. 147OPTIHALER ...................................................... 147OPTIONS CONCEPTROL .......... 183OPTIONS GYNOL II CONTRACEPTIVE ................................. 183OPTIUM TEST ................................................... 96OPTIUMEZ TEST ......................................... 96OPTIVAR ................................................................ 168OPTUMRX BLOOD GLUCOSE TEST ................................................................................... 96


207

Index

OPTUMRX GLUCOSE CONTROL ............................................................. 132ORACEA ..................................................................... 91ORACIT ..................................................................... 110ORALONE ............................................................ 152ORAP ............................................................................. 176ORAPRED ODT ............................................... 74ORAVIG ................................................................... 151ORENCIA ....................................................................... 9ORENITRAM ....................................................... 65ORFADIN ............................................................... 104ORKAMBI ............................................................. 177orphenadrine citrate er ....................... 160orphenadrine-aspirin-caffeine................................................................................................... 161ORSYTHIA .............................................................. 70ORTHO DIAPHRAGM COIL................................................................................................... 122ORTHO DIAPHRAGM FLAT................................................................................................... 122ORTHO EVRA ................................................... 72ORTHO MICRONOR .............................. 73ORTHO TRI-CYCLEN (28) .......... 71ORTHO TRI-CYCLEN LO ............. 71ORTHO-CEPT (28) ..................................... 70ORTHO-CYCLEN (28) ......................... 70ORTHO-EST 0.625 .................................. 107ORTHO-EST 1.25 ...................................... 107ORTHO-NOVUM 1/35 (28) .......... 70ORTHO-NOVUM 7/7/7 (28) ........ 71ORTHOVISC ..................................................... 161oscimin ......................................................................... 180oscimin sr ................................................................. 180OSENI ............................................................................... 28OSMOPREP ........................................................ 121OTEZLA ........................................................................... 9otic care ...................................................................... 170oticin ................................................................................ 170OTOZIN ..................................................................... 170OTREXUP ..................................................................... 6OVACE PLUS ..................................................... 84OVACE PLUS WASH ............................ 84OVACE WASH ................................................. 84OVCON-35 (28) ................................................ 70OVIDE ............................................................................. 91OVIDREL ............................................................... 102OXANDRIN ............................................................ 15oxandrolone .............................................................. 15oxaprozin .......................................................................... 9oxazepam ...................................................................... 18oxcarbazepine ........................................................ 23OXISTAT .................................................................... 82OXSORALEN ...................................................... 90

Index

OXSORALEN ULTRA ......................... 83OXTELLAR XR ............................................... 23oxybutynin chloride ................................... 183oxycodone hcl ........................................................ 12oxycodone hcl er ................................................ 12oxycodone-acetaminophen ................. 14oxycodone-aspirin ........................................... 14oxycodone-ibuprofen .................................. 14OXYCONTIN ....................................................... 12oxymorphone hcl ............................................... 12oxymorphone hcl er ...................................... 12OXYTROL FOR WOMEN ......... 183OZURDEX ............................................................ 167PACERONE ............................................................ 19PAIRE OB .............................................................. 159PAMELOR ................................................................ 27pamidronate disodium .......................... 101PAMINE .................................................................... 180PAMINE FORTE ........................................ 180PANCREAZE ....................................................... 99PANDA MASK LARGE ................. 147PANDA MASK MEDIUM .......... 147PANDA MASK SMALL ................. 147PANDEL ....................................................................... 87PANRETIN ............................................................... 83pantoprazole sodium ............................... 181PARAFON FORTE DSC ................ 160PARAGARD INTRAUTERINE COPPER ........................................................................ 72parcaine ...................................................................... 166PAREMYD ........................................................... 169PARI ALTERA NEBULIZER HANDSET ............................................................. 145PARI BABY CONVERSION KIT................................................................................................... 145PARI ERAPID NEBULIZER HANDSET ............................................................. 145PARI EXPIRATORY FILTER SET .................................................................................... 145PARI MASK SET ....................................... 145PARI SOFT PLASTIC ADULT MASK ........................................................................... 145PARI SOFT PLASTIC PED MASK ........................................................................... 145paricalcitol ............................................................. 104PARLODEL ............................................................. 53PARNATE ................................................................. 25paromomycin sulfate ....................................... 6paroxetine hcl ........................................................ 26paroxetine hcl er ................................................ 26PASER ............................................................................. 47PATADAY ............................................................ 168PATANASE ......................................................... 161

Index

PATANOL ............................................................. 168PAXIL ............................................................................... 26PAXIL CR .................................................................. 26PAZEO ......................................................................... 168pc lancets super thin 30g .................. 132pc unifine pentips ......................................... 142pca injector ............................................................ 142PCCA ACACIA SYRUP BASE................................................................................................... 173PCE .................................................................................... 122PEAK AIR PEAK FLOW METER................................................................................................... 144PEDIAPRED .......................................................... 74PEDIATEX TDM ........................................... 76pediatric aerosol mask ......................... 145pediatric mouthpiece ............................... 145PEDIATRIC PANDA MASK................................................................................................... 147peg 3350/electrolytes .............................. 120peg 3350-kcl-na bicarb-nacl ....... 120peg-3350/electrolytes ............................. 120PEGANONE ........................................................... 24PEGASYS ................................................................... 59PEGASYS PROCLICK ......................... 59PEGINTRON ......................................................... 59PEG-INTRON ...................................................... 59PEG-INTRON REDIPEN ................... 59PEG-INTRON REDIPEN PAK 4....................................................................................................... 59pen needles ............................................................. 142pen needles 1/2" ............................................. 142pen needles 3/16" ......................................... 142pen needles 5/16" ......................................... 142penicillin v potassium ............................ 172PENLAC ....................................................................... 81PENLET II BLOOD SAMPLER................................................................................................... 132PENLET II REPLACEMENT CAP ................................................................................... 132PENNSAID ............................................................... 82PENTASA .............................................................. 108pentoxifylline er .............................................. 114PEPCID ....................................................................... 181PERCOCET ............................................................. 14PERCODAN ........................................................... 14PERFECT LANCETS 28G .......... 132PERFECT LANCETS 30G .......... 132PERFOROMIST ............................................... 21PERIDEX ................................................................. 151perindopril erbumine .................................. 40PERIOGARD ..................................................... 151PERIOMED ......................................................... 152permethrin ................................................................... 91


Index

perphenazine ........................................................... 55PERSANTINE ................................................. 114PERSONAL BEST FULL RANGE ....................................................................... 144PERSONAL BEST LOW RANGE................................................................................................... 144PERTZYE ................................................................... 99PEXEVA ....................................................................... 26PFLEX .......................................................................... 145PHARMACIST CHOICE ALCOHOL ............................................................ 138PHARMACIST CHOICE AUTOCODE .......................................................... 96PHARMACIST CHOICE LANCETS .............................................................. 132PHARMACY COUNTER LANCETS .............................................................. 132PHENADOZ ........................................................... 37PHENAZO ............................................................. 112phenazopyridine hcl ................................. 112phenelzine sulfate ............................................. 25phenobarbital ..................................................... 119phenoxybenzamine hcl .............................. 41phenylephrine hcl ......................................... 166phenylhistine dh .................................................. 76PHENYTEK ............................................................ 24phenytoin ....................................................................... 24PHENYTOIN INFATABS ............... 24phenytoin sodium extended ............... 24PHILITH ....................................................................... 70PHOS-FLUR ....................................................... 152PHOSLO ................................................................... 109PHOSLYRA ........................................................ 110PHOSPHA 250 NEUTRAL ......... 150PHOSPHOLINE IODIDE .............. 164PHYSIOLYTE ..................................................... 61PHYSIOSOL IRRIGATION .......... 61PICATO ......................................................................... 83PIKO 1 .......................................................................... 144pillow mask/adult ......................................... 145pillow mask/child .......................................... 145pillow mask/pediatric ............................. 145pilocarpine hcl .................................. 152, 164PIMTREA ................................................................... 67pinnacaine otic ................................................. 170pioglitazone hcl ................................................... 32pioglitazone hcl-glimepiride ........... 29pioglitazone hcl-metformin hcl .... 29PIRMELLA 1/35 .............................................. 70PIRMELLA 7/7/7 ............................................ 71piroxicam .......................................................................... 9PLAQUENIL ......................................................... 46plastic adapter .................................................. 142

Index

PLAVIX ..................................................................... 115PLEGRIDY ........................................................... 175PLEGRIDY STARTER PACK................................................................................................... 175PLETAL ..................................................................... 114PLEXION .................................................................... 78PLEXION CLEANSER ......................... 78PLEXION CLEANSING CLOTH....................................................................................................... 78PLIAGLIS ................................................................... 90pnv fe fum/docusate/folic acid................................................................................................... 156pnv ob+dha ........................................................... 159pnv-dha ........................................................................ 159pnv-dha+docusate ...................................... 159pnv-omega ............................................................... 156pnv-select .................................................................. 156pnv-total ..................................................................... 156POCKET CHAMBER .......................... 147POCKET PEAK FLOW METER................................................................................................... 144POCKET SPACER ................................... 147POCKETCHEM EZ CONTROL................................................................................................... 132POCKETCHEM EZ TEST ............... 96POCKETPEAK PEAK FLOW METER ....................................................................... 144podactin .......................................................................... 82podocon ........................................................................... 89podofilox ........................................................................ 89POLIBAR ACB .................................................. 98POLYCIN ................................................................ 165polycin b ..................................................................... 165poly-dex ....................................................................... 167polyethylene glycol 3350................................................................................... 121, 173poly-iron 150 forte ..................................... 117polymyxin b-trimethoprim ............... 165polysaccharide iron forte ................. 117POLYTRIM ......................................................... 165POLY-VI-FLOR ........................................... 155POLY-VI-FLOR/IRON ..................... 154polyvitamin/fluoride ................................. 155poly-vitamin/fluoride .............................. 155POMALYST ........................................................... 49PONSTEL ....................................................................... 9PORTIA-28 ............................................................... 70pot bicarb-pot chloride ........................ 150potassium bicarbonate ......................... 150potassium chloride ..................................... 151potassium chloride crys er ............. 150potassium chloride er ............. 150, 151potassium citrate-citric acid ........ 110

Index

POTIGA ......................................................................... 23PR NATAL 400 ............................................. 158PRADAXA ................................................................ 22PRALUENT ............................................................. 40pramcort ......................................................................... 16pramipexole dihydrochloride ......... 53pramipexole dihydrochloride er....................................................................................................... 53PRAMOSONE ..................................................... 87PRANDIMET ........................................................ 28PRANDIN ................................................................... 33PRASCION ............................................................... 78PRASCION FC ................................................... 78PRASCION RA .................................................. 78PRAVACHOL ..................................................... 39pravastatin sodium ......................................... 39prazosin hcl ............................................................... 41PRECISION GLUCOSE CONTROL ............................................................. 132PRECISION GLUCOSE CONTROL SOLN ...................................... 132PRECISION GLUCOSE KETONE CONTR ..................................... 132PRECISION GLUCOSE/KETONE CONTR................................................................................................... 132PRECISION PCX ........................................... 96PRECISION PCX PLUS TEST....................................................................................................... 96PRECISION POINT OF CARE TEST ................................................................................... 96PRECISION QID TEST ........................ 96PRECISION SOF-TACT TEST....................................................................................................... 96PRECISION SUREDOSE PLUS SYR ................................................................................... 142PRECISION SURE-DOSE SYRINGE ................................................................ 142PRECISION THIN LANCETS................................................................................................... 132PRECISION THINS GP LANCETS .............................................................. 132PRECISION ULTRA LANCET................................................................................................... 132PRECISION XTRA BLOOD GLUCOSE ................................................................. 96PRECOSE ................................................................... 28PRED FORTE .................................................. 168PRED MILD ....................................................... 168PRED-G ..................................................................... 167PRED-G S.O.P. ............................................... 167prednicarbate ......................................................... 87prednisolone ............................................................. 74


209

Index

prednisolone acetate ............................... 168prednisolone sodium phosphate....................................................................................... 74, 168prednisone ................................................................... 74prednisone (pak) ................................................ 74PREDNISONE INTENSOL ........... 74PREFERA OB .................................................. 156PREFERA OB + DHA ........................ 156PREFERAOB ONE .................................. 159preferred plus glucose .............................. 30preferred plus lancets colored................................................................................................... 132preferred plus lancets thin .............. 132preferred plus unifine pentips ... 142PREFEST ................................................................. 106PREFOL-DHA ................................................. 159PRE-FOLIC .......................................................... 116pregnyl .......................................................................... 102PRELONE .................................................................. 74PREMARIN ......................................... 107, 184PREMPHASE ................................................... 106PREMPRO ............................................................. 106prena1 pearl ......................................................... 157prena1 plus/quatrefolic ....................... 159prena1/quatrefolic ...................................... 159prenaissance ........................................................ 159prenaissance 90 dha ................................ 159prenaissance balance ............................. 159prenaissance dha .......................................... 159prenaissance harmony dha ............ 157prenaissance next ......................................... 160prenaissance next-b .................................. 160prenaissance plus ......................................... 159prenaissance promise ............................ 159PRENATA ............................................................. 157prenatabs fa .......................................................... 157PRENATABS RX ...................................... 157prenatal 19 ............................................................. 157PRENATAL AD ........................................... 157PRENATAL MULTIVITAMIN-ULTRA ......... 157prenatal plus iron ........................................ 157PRENATAL-U ................................................ 157PRENATE .............................................................. 160PRENATE AM ............................................... 160PRENATE DHA ........................................... 159PRENATE ELITE ...................................... 157PRENATE ENHANCE ...................... 159PRENATE MINI .......................................... 159PRENATE RESTORE ......................... 159PRENTIF CAVITY-RIM CERV CAP ................................................................................... 122PRENTIF FITTING SET ................. 122

Index

PREPIDIL ............................................................... 171PREPOPIK ............................................................ 120PREQUE 10 ......................................................... 159PRESTALIA ........................................................... 42PREVACID .......................................................... 181PREVACID 24HR ..................................... 181PREVACID SOLUTAB ................... 181PREVALITE ........................................................... 38PREVIDENT 5000 BOOSTER................................................................................................... 152PREVIDENT 5000 BOOSTER PLUS ............................................................................... 152PREVIFEM ............................................................... 70PREVPAC .............................................................. 182PREZCOBIX .......................................................... 56PREZISTA ................................................................. 57PRIALT .......................................................................... 10PRIFTIN ........................................................................ 47PRILOSEC ............................................................ 181PRILOSEC OTC .......................................... 181primidone ..................................................................... 23PRIMLEV ................................................................... 14PRIMSOL .................................................................... 45PRINIVIL .................................................................... 40PRISTIQ ........................................................................ 27PRIVIGEN ............................................................. 172PROAIR HFA ....................................................... 21PROAIR RESPICLICK ......................... 21probenecid .............................................................. 112PROCARDIA ........................................................ 64PROCARDIA XL ........................................... 64PROCENTRA ........................................................... 4prochlorperazine ............................................... 55prochlorperazine maleate ................... 55PROCORT ................................................................. 16PROCRIT ................................................................ 115PROCTOCARE-HC .................................... 16PROCTOFOAM HC .................................. 16PROCTO-PAK .................................................... 16PROCTOSOL HC .......................................... 16PROCTOZONE-HC .................................... 16PROCYSBI ........................................................... 111PRODIGY CONTROL SOLUTION .......................................................... 132PRODIGY INSULIN PEN NEEDLES ............................................................... 142PRODIGY INSULIN SYRINGE................................................................................................... 142PRODIGY LANCETS 28G ......... 132PRODIGY LANCING DEVICE................................................................................................... 132PRODIGY MINI PEN NEEDLES................................................................................................... 142

Index

PRODIGY NO CODING BLOOD GLUC ................................................................................. 96PRODIGY SHORT PEN NEEDLES ............................................................... 142PRODIGY TWIST TOP LANCETS 28G ............................................... 132PROFERRIN-FORTE .......................... 118PROFILNINE SD ....................................... 113progesterone ........................................................ 173progesterone micronized ................... 173PROGLYCEM ..................................................... 31PROGRAF ................................................................. 61PROLASTIN-C .............................................. 177PROLENSA ......................................................... 169PROLIA ..................................................................... 101PROMACTA ...................................................... 116promethazine hcl ............................................... 37promethazine-codeine ............................... 76promethazine-dm .............................................. 76PROMETHEGAN .......................................... 37PROMETRIUM ............................................. 173propafenone hcl .................................................. 18propafenone hcl er ......................................... 18proparacaine hcl ........................................... 166proparacaine-fluorescein ................. 169propranolol hcl .................................................... 63propranolol hcl er ........................................... 63propylthiouracil .............................................. 179PROSCAR .............................................................. 111PROSTIN E2 ...................................................... 171PROTECTIRON ........................................... 117PROTONIX .......................................................... 181PROTOPIC ................................................................ 89protriptyline hcl .................................................. 27PROVENTIL HFA ........................................ 21PROVERA ............................................................. 173PROVIDA OB .................................................. 157PROVIGIL ..................................................................... 5PROVOCHOLINE ........................................ 92PROZAC ....................................................................... 26PROZAC WEEKLY ................................... 26PRUDOXIN ............................................................. 83pseudoeph-bromphen-dm ..................... 76PSS SELECT GP LANCETS ... 132PSS SELECT PLATFORMS .... 132PSS SELECT SAFETY LANCETS .............................................................. 132PTS PANELS GLUCOSE TEST....................................................................................................... 96PULMICORT ........................................................ 20PULMICORT FLEXHALER ....... 20PULMOSAL ........................................................... 77PULMOZYME ................................................ 177


Index

purefe ob plus ..................................................... 157purefe plus ............................................................... 117purevit dualfe plus ...................................... 117PURINETHOL .................................................... 47PURIXAN ................................................................... 47px advanced lancing device .......... 132px extra short pen needles .............. 142px glucose .................................................................... 30px insulin syringe ......................................... 142px lancet auto injector .......................... 132px lancets .................................................................. 132px lancets ultra thin .................................. 132px niacin ..................................................................... 186px pen needle ...................................................... 142px shortlength pen needles ............. 142PYLERA ................................................................... 182pyrazinamide ........................................................... 47pyridostigmine bromide .......................... 46pyridostigmine bromide er ................. 46qc advanced lancing device .......... 132qc alcohol swabs ........................................... 138qc insulin syringe ......................................... 142qc lancets super thin 30g .................. 132qc lancets ultra thin .................................. 132qc pen needles ................................................... 142qc unifine pentips ......................................... 142QNASL ........................................................................ 162QNASL CHILDRENS ......................... 162QUALAQUIN ...................................................... 46QUARTETTE ....................................................... 71QUASENSE ............................................................. 71QUDEXY XR ....................................................... 23QUESTRAN ............................................................ 38QUESTRAN LIGHT .................................. 38quetiapine fumarate ...................................... 54QUFLORA PEDIATRIC ................. 155QUICKTEK CONTROL SOLUTION .......................................................... 133QUICKTEK TEST ........................................ 96QUILLIVANT XR ............................................ 5quinapril hcl ............................................................. 40quinapril-hydrochlorothiazide ..... 42quinidine gluconate er .............................. 18quinidine sulfate ................................................. 18quinine sulfate ....................................................... 46QUINTET AC BLOOD GLUCOSE TEST ............................................ 96QUINTET BLOOD GLUCOSE TEST ................................................................................... 96QUINTET CONTROL HIGH/NORMAL ......................................... 133QUINZYME ................................................................ 6QUTENZA ................................................................. 90

Index

QUTENZA (2 PATCH) ......................... 90QVAR ................................................................................ 20ra alcohol swabs ............................................ 138ra antifungal ............................................................ 82RA E-ZJECT COLOR LANCETS 33G ..................................................................................... 133RA E-ZJECT LANCETS 28G................................................................................................... 133RA E-ZJECT LANCETS THIN 26G ..................................................................................... 133RA E-ZJECT LANCETS THIN 28G ..................................................................................... 133RA E-ZJECT LANCETS ULTRA THIN ............................................................................... 133ra glucose ......................................................... 30, 31ra lancing device ........................................... 133ra niacin ..................................................................... 186ra no flush niacin .......................................... 186ra pen needles .................................................... 142RA TRUETEST TEST ............................ 96rabeprazole sodium ................................... 182RADIOGARDASE ....................................... 34raloxifene hcl ...................................................... 103ramipril ............................................................................ 40RANEXA ..................................................................... 16ranitidine hcl ....................................................... 181RAPAFLO .............................................................. 111RAPAMUNE ......................................................... 61RASUVO ......................................................................... 6RAVICTI .................................................................. 105RAYOS ........................................................................... 74RAZADYNE ...................................................... 174RAZADYNE ER .......................................... 174RE 10 WASH ......................................................... 84READI-CAT ........................................................... 98READI-CAT 2 ..................................................... 98reality lancets ..................................................... 133reality swabs ........................................................ 138reality trigger lancets ............................. 133REBETOL .................................................................. 59RECLAST ............................................................... 101RECLIPSEN ............................................................ 70RECOMBINATE ......................................... 113RECTIV ......................................................................... 16REFUAH PLUS BLOOD GLUCOSE TEST ............................................ 96REFUAH PLUS GLUCOSE CONTROL ............................................................. 133REGENECARE ................................................. 91REGLAN .................................................................. 108REGRANEX ........................................................... 91RELAGARD ....................................................... 183relcof c .............................................................................. 75

Index

RELENZA DISKHALER ................... 60RELHIST ..................................................................... 75RELION ALCOHOL SWABS................................................................................................... 138RELION BLOOD GLUCOSE TEST ................................................................................... 96RELION CONFIRM/MICRO TEST ................................................................................... 96RELION GLUCOSE ...................... 30, 31RELION GLUCOSE DRINK ....... 31RELION INSULIN SYRINGE................................................................................................... 142RELI-ON INSULIN SYRINGE................................................................................................... 142RELION KETONE ....................................... 96RELION LANCETS MICRO-THIN 33G ................................... 133RELION LANCETS STANDARD 21G ..................................................................................... 133RELION LANCETS THIN 26G................................................................................................... 133RELION LANCETS ULTRA-THIN 30G .................................. 133RELION LANCING DEVICE................................................................................................... 133RELION MINI PEN NEEDLES................................................................................................... 142RELION PEN NEEDLES .............. 142RELION PRIME TEST ......................... 96RELION SHORT PEN NEEDLES................................................................................................... 142RELION ULTIMA TEST ................... 96RELION ULTRA THIN LANCETS 30G ............................................... 133RELION ULTRA THIN PLUS LANCETS .............................................................. 133RELISTOR ............................................................ 109relnate dha .............................................................. 157RELPAX ................................................................... 149REMEDY ANTIFUNGAL ............... 82REMERON ............................................................... 25REMERON SOLTAB .............................. 25REMEVEN ................................................................ 88REMICADE ......................................................... 109REMODULIN ...................................................... 65RENACIDIN ...................................................... 111RENAGEL ............................................................. 110RENAL ........................................................................ 152RENATABS ........................................................ 153RENATABS WITH IRON ............ 153rena-vite rx ............................................................. 152RENEW ADV CARTRIDGE REFILLS ................................................................... 133


211

Index

RENEW ADVANCED LANCING DEVICE ..................................................................... 133reno caps ................................................................... 153RENVELA ............................................................. 110repaglinide ................................................................. 33REPATHA ................................................................. 40REPATHA SURECLICK ................... 40replacement air filter .............................. 145replacement filters ...................................... 145REPREXAIN ......................................................... 13REPRONEX ........................................................ 102REQUIP ......................................................................... 53REQUIP XL ............................................................. 53RESCON-JR ............................................................ 75RESCON-MX ....................................................... 75RESCRIPTOR ...................................................... 57RESCULA .............................................................. 169RESECTISOL ................................................... 111RESPA-BR ................................................................ 36RESTASIS ............................................................. 166RESTORIL ............................................................ 119RETIN-A ...................................................................... 79RETIN-A MICRO .......................................... 79RETIN-A MICRO PUMP .................. 79RETROVIR .............................................................. 58REVATIO ................................................................... 66REVEAL BLOOD GLUCOSE TEST ................................................................................... 96revesta ........................................................................... 116REVIA .............................................................................. 34REVLIMID ............................................................... 60REXALL BLOOD GLUCOSE TEST ................................................................................... 96REXALL LANCETS ULTRA THIN 30G ............................................................... 133REXULTI .................................................................... 55REYATAZ ................................................................. 57REZIRA ......................................................................... 76RHEUMATREX ................................................... 6RHINOCORT AQUA ........................... 162RHOGAM ULTRA-FILTERED PLUS ............................................................................... 172RHOPHYLAC ................................................. 172RIASTAP ................................................................. 113RIAX ................................................................................... 79ribasphere .................................................................... 59ribasphere ribapak ......................................... 59ribatab ............................................................................... 59ribavirin .......................................................................... 59RIDAURA ...................................................................... 7RIFADIN ...................................................................... 47RIFAMATE ............................................................. 46rifampin ........................................................................... 47

Index

RIFATER ..................................................................... 46RIGHTEST ALTERNATE SITE ADAPT ........................................................................ 133RIGHTEST GC300 CONTROL................................................................................................... 133RIGHTEST GD500 LANCING DEVICE ..................................................................... 133RIGHTEST GL300 LANCETS................................................................................................... 133RIGHTEST GS100 BLOOD GLUCOSE ................................................................. 96RIGHTEST GS300 BLOOD GLUCOSE ................................................................. 96RIGHTEST GS550 BLOOD GLUCOSE ................................................................. 96RILUTEK ................................................................ 162riluzole .......................................................................... 162rimantadine hcl ................................................... 59ringers irrigation .............................................. 62RIOMET ........................................................................ 29risedronate sodium .................................... 101RISPERDAL ........................................................... 54RISPERDAL M-TAB ............................... 54risperidone ................................................................. 54RISPERIDONE M-TAB ....................... 54RITALIN .......................................................................... 5RITALIN LA ...................................................... 5, 6RITALIN SR ............................................................... 6RITEFLO ................................................................. 148rivastigmine .......................................................... 174rivastigmine tartrate ................................ 174RIXUBIS .................................................................. 113rizatriptan benzoate .................................. 149R-NATAL OB .................................................. 159ROBAXIN .............................................................. 160ROBAXIN-750 ............................................... 160ROBINUL ............................................................... 180ROBINUL-FORTE ................................... 180ROCALTROL .................................................. 104romycin ........................................................................ 165ropinirole hcl .......................................................... 53ropinirole hcl er ................................................. 53ROSADAN ................................................................ 91ROSANIL CLEANSER ........................ 78ROSE GLO ........................................................... 169ROXICET .................................................................... 14ROXICODONE ................................................. 12ROZEREM ............................................................ 120RUCONEST ........................................................ 113RYTARY ..................................................................... 53RYTHMOL ............................................................... 18RYTHMOL SR ................................................... 18SABRIL .......................................................................... 24

Index

SAFESNAP INSULIN SYRINGE................................................................................................... 142SAFE-T-LANCE .......................................... 133SAFE-T-LANCE PLUS .................... 133safety lancet 21g/pressure act ... 133safety lancet 28g/pressure act ... 133SAFETY LANCETS .............................. 133SAFETY LANCETS 21G .............. 133safety lancets 28g ......................................... 133SAFETY LET LANCETS ............. 133SAFETY SEAL LANCETS ........ 133SAFETY-GLIDE SYRINGE ..... 142SAFYRAL .................................................................. 70SAIZEN ...................................................................... 102SAIZEN CLICK.EASY ..................... 102SALACYN ................................................................. 89SALAGEN ............................................................. 152salicylic acid ................................................ 89, 90salicylic acid wart remover ............... 90SALKERA ................................................................. 89salsalate .......................................................................... 11SALVAX DUO PLUS ............................. 89SAMI THE SEAL FILTERS ..... 145SAMSCA ................................................................. 105SANCUSO ................................................................. 35SANDIMMUNE ............................................... 60SANDOSTATIN .......................................... 105SANDOSTATIN LAR DEPOT................................................................................................... 105SANTYL ....................................................................... 89SAPHRIS ..................................................................... 54SARAFEM ............................................................ 176SAVAYSA ................................................................. 22SAVELLA .............................................................. 174SAVELLA TITRATION PACK................................................................................................... 174sb alcohol prep ................................................. 138sb lancets thin .................................................... 133sb lancets ultra thin .................................. 133scalacort ......................................................................... 87SCLEROSOL INTRAPLEURAL................................................................................................... 177SEASONIQUE .................................................... 71SEB-PREV WASH ....................................... 84SECONAL ............................................................. 119SECTRAL ................................................................... 62SECURA ANTIFUNGAL ................. 82SECURA ANTIFUNGAL EXTRA THICK .............................................................................. 82select-lite device/lancets .................... 133select-lite lancing device ................... 134SELECT-OB ....................................................... 157SELECT-OB+DHA ................................. 159


Index

selegiline hcl ............................................................ 53selenium sulfide ................................................... 84SELRX ............................................................................. 84SELZENTRY ......................................................... 56SEMPREX-D ......................................................... 75se-natal 19 ............................................................... 157SENSIPAR ............................................................ 103SENTRAVIL PM-25 .................................. 25SEREVENT DISKUS ............................... 21SEROPHENE .................................................... 102SEROQUEL ............................................................. 55SEROQUEL XR ............................................... 55SEROSTIM ........................................................... 102sertraline hcl ........................................................... 26se-tan plus ............................................................... 118sevoflurane ............................................................. 110sf ............................................................................................. 152sf 5000 plus ............................................................ 152SFROWASA ....................................................... 108SHOPKO ALCOHOL SWABS................................................................................................... 138SHOPKO AUTOLET LANCING DEVICE ..................................................................... 134SHOPKO ON-THE-GO LANCETS 30G ............................................... 134SHOPKO UNIFINE PENTIPS................................................................................................... 142SHOPKO UNILET LANCETS 28G ..................................................................................... 134SHOPKO UNILET LANCETS 30G ..................................................................................... 134SHUR-SEAL CONTRACEPTIVE................................................................................................... 183SIDESTREAM ADULT FACE MASK ........................................................................... 145SIDESTREAM PEDIATRIC FACE MASK ..................................................... 146SIDESTREAM PLS ADULT FACE MASK ..................................................... 146SIGNIFOR ............................................................. 105SIGNIFOR LAR ........................................... 105sildenafil citrate .................................................. 66SILENOR ................................................................. 119silicone mask/adult .................................... 146silicone mask/infant .................................. 146silicone mask/pediatric ........................ 146SILVADENE ......................................................... 85silver sulfadiazine ............................................ 85SIMBRINZA ...................................................... 164SIMCOR ........................................................................ 39SIMPLE DIAGNOSTICS LANCING DEV ............................................ 134SIMPONI ......................................................................... 7

Index

SIMPONI ARIA .................................................... 7SIMULECT .............................................................. 61simvastatin .................................................................. 39SINEMET .................................................................... 53SINEMET CR ....................................................... 53SINGLE-LET ..................................................... 134SINGULAIR ........................................................... 19sirolimus ........................................................................ 61SIRTURO .................................................................... 47SITZMARKS ......................................................... 98SIVEXTRO ............................................................... 45SKELAXIN .......................................................... 160SKLICE .......................................................................... 91SKYLA ............................................................................ 73SLO-NIACIN ..................................................... 186sm alcohol prep ............................................... 138sm antifungal miconazole .................... 82sm glucose ....................................................... 30, 31sm lancets 21g ................................................... 134sm lancets 33g ................................................... 134sm niacin cr ........................................................... 186sm super thin lancets 30g ................. 134sm thin lancets 26g .................................... 134SMART DIABETES VANTAGE LANCETS .............................................................. 134SMART DIABETES VANTAGE LANCING .............................................................. 134SMART DIABETES XPRES TEST ................................................................................... 96SMART SENSE COLOR LANCETS 33G ............................................... 134SMART SENSE GLUCOSE ......... 30SMART SENSE PREMIUM TEST ................................................................................... 96SMART SENSE STANDARD LANCETS .............................................................. 134SMART SENSE SUPER THIN LANCETS .............................................................. 134SMART SENSE THIN LANCETS 26G ..................................................................................... 134SMART SENSE VALUE TEST....................................................................................................... 96SMARTEST BLOOD GLUCOSE TEST ................................................................................... 96SMARTEST CONTROL MEDIUM ................................................................. 134SMARTEST LANCETS 28G ... 134smz-tmp ds ................................................................... 45sodium chloride ................................... 77, 111sodium fluoride ................................ 149, 150sodium hyaluronate ....................................... 89sodium phenylbutyrate ......................... 105sodium polystyrene sulfonate ......... 62

Index

sodium sulfacetamide ................................. 84sodium sulfacetamide wash .............. 84SOJOURN .............................................................. 110SOLARAZE ............................................................. 83SOLARTEK GLUCOSE CONTROL ............................................................. 134SOLIA ............................................................................... 70SOLIRIS .................................................................... 114SOLODYN ............................................................ 178SOLTAMOX .......................................................... 48SOLUS V2 CONTROL ..................... 134SOLUS V2 LANCETS 28G ....... 134SOLUS V2 LANCING DEVICE................................................................................................... 134SOLUS V2 TEST ............................................ 96SOLUS V2 TWIST LANCETS 30G ..................................................................................... 134SOMA ........................................................................... 160SOMATULINE DEPOT ................... 105SOMAVERT ...................................................... 102SONATA .................................................................. 120SOOLANTRA ...................................................... 91SOOTHE & COOL INZO ANTIFUNGAL ................................................... 82SORIATANE ......................................................... 83SORILUX .................................................................... 84SORINE ......................................................................... 63sotalol hcl ..................................................................... 63sotalol hcl (af) ....................................................... 63SOTYLIZE ................................................................ 63SOVALDI ................................................................... 59SPECTRACEF .................................................... 67SPIRIVA HANDIHALER ................. 19SPIRIVA RESPIMAT .............................. 19spironolactone .................................................. 100spironolactone-hctz ....................................... 99SPORANOX ........................................................... 36SPORANOX PULSEPAK ................. 36SPRINTEC 28 ...................................................... 70SPRIX .................................................................................... 9SPRYCEL ................................................................... 50SPS ......................................................................................... 62SRONYX ..................................................................... 70SSD ........................................................................................ 85SSKI ................................................................................. 150sss 10-5 ............................................................................ 78ST JOSEPH ASPIRIN ............................. 11STALEVO 100 .................................................... 53STALEVO 125 .................................................... 53STALEVO 150 .................................................... 53STALEVO 200 .................................................... 53STALEVO 50 ........................................................ 53STALEVO 75 ........................................................ 53


213

Index

stannous fluoride .......................................... 152STARLIX ..................................................................... 33stavudine ........................................................................ 58STAVZOR ................................................................. 24STELARA .................................................................. 83STERILANCE PA ..................................... 134STERILANCE TL ...................................... 134STERILE TALC POWDER ........ 177sterile water for irrigation .................. 62STIMATE ................................................................ 105STIOLTO RESPIMAT ........................... 20STIVARGA .............................................................. 50STRATTERA ............................................................ 5STRIANT ..................................................................... 15STRIBILD .................................................................. 56STRIVERDI RESPIMAT ................... 21STROMECTOL ................................................. 16STROVITE FORTE ................................ 154SUBOXONE ........................................................... 14SUBSYS ........................................................................ 12SUCLEAR .............................................................. 120SUCRAID ................................................................... 99sucralfate .................................................................. 181SULAR ............................................................................ 64sulfacetamide sodium ..... 77, 84, 166sulfacetamide sodium (acne) .......... 77sulfacetamide sodium-sulfur ........... 78sulfacetamide-prednisolone ......... 167SULFACLEANSE 8/4 ............................. 78sulfamethoxazole-trimethoprim....................................................................................................... 45SULFAMYLON ................................................ 85sulfasalazine ........................................................ 108SULFATRIM PEDIATRIC ............. 45SULFAZINE ....................................................... 108SULFAZINE EC ........................................... 108SULFOAM ................................................................ 79sulindac ............................................................................... 9sumatriptan succinate ........................... 149SUMAVEL DOSEPRO ..................... 149SUPARTZ ............................................................... 161super thin lancets ......................................... 134SUPERVITE EC ........................................... 154SUPPRELIN LA ........................................... 103SUPRANE .............................................................. 110SUPRAX ....................................................................... 67supreme ii high/low control .......... 134SUPREME TEST ............................................ 96SUPREP BOWEL PREP ................. 120sure comfort alcohol prep ............... 138sure comfort insulin syringe ........ 142sure comfort lancets 28g ................... 134sure comfort lancets 30g ................... 134

Index

sure comfort lancing pen .................. 134sure comfort pen needles .................. 142SURE EDGE TEST ..................................... 96SURECHEK BLOOD GLUCOSE TEST ................................................................................... 97SURE-FINE PEN NEEDLES ... 143SURE-JECT INSULIN SYRINGE................................................................................................... 143SURE-LANCE FLAT LANCETS................................................................................................... 134SURE-LANCE LANCETS 26G................................................................................................... 134SURE-LANCE THIN LANCETS 28G ..................................................................................... 134SURE-LANCE ULTRA THIN LANCETS .............................................................. 134SURELITE LANCETS ....................... 134SURE-PEN ............................................................ 134SURE-PREP ALCOHOL PREP................................................................................................... 138SURESTEP GLUCOSE CONTROL ............................................................. 135SURESTEP PRO HIGH GLUCOSE ............................................................. 135SURESTEP PRO LOW GLUCOSE ............................................................. 135SURESTEP PRO NORMAL GLUCOSE ............................................................. 135SURESTEP PRO TEST ........................ 97SURE-TEST EASYPLUS MINI TEST ................................................................................... 97SURE-TOUCH LANCETS UNIVERSAL ..................................................... 135SURMONTIL ........................................................ 27SUSTIVA ..................................................................... 57SUTENT ........................................................................ 50SYEDA ............................................................................ 70SYLATRON ............................................................ 51SYMAX DUOTAB .................................. 180SYMAX FASTABS ................................ 180SYMAX-SL ......................................................... 180SYMAX-SR ......................................................... 180SYMBICORT ........................................................ 20SYMBYAX .......................................................... 174SYMLINPEN 120 ........................................... 28SYMLINPEN 60 ............................................... 28SYNAGEX ............................................................ 154SYNAGIS ................................................................ 172SYNALAR ................................................................. 87SYNALGOS-DC .............................................. 13SYNAREL ............................................................. 103SYNATEK ............................................................. 154SYNERA ...................................................................... 90

Index

SYNJARDY ............................................................. 29SYNTHROID .................................................... 179SYNVISC ................................................................ 161SYNVISC ONE .............................................. 161SYPRINE ..................................................................... 60T.R.U.E. TEST .................................................... 92TABLOID ................................................................... 48TACLONEX ........................................................... 88tacrolimus ........................................................ 61, 89TAFINLAR ............................................................... 49TAGITOL V ............................................................ 98TAI DOC CONTROL .......................... 135TAMIFLU ................................................................... 60tamoxifen citrate ................................................ 48tamsulosin hcl .................................................... 111TANDEM F .......................................................... 118TANZEUM ............................................................... 32TAPAZOLE ......................................................... 179TARCEVA ................................................................. 51TARGADOX ..................................................... 178TARGRETIN ............................................. 51, 83TARKA ........................................................................... 42taron forte ................................................................ 118TARON-BC ......................................................... 157TARON-C DHA ........................................... 157TARON-CRYSTALS ........................... 110TARON-PREX ................................................ 159TASIGNA ................................................................... 51TASMAR ..................................................................... 52TAZORAC ................................................................. 84TAZTIA XT ............................................................. 64TECFIDERA ...................................................... 175TECHLITE AST LANCETS ..... 135TECHLITE LANCETS ...................... 135TECHLITE LANCETS 30G ...... 135TECHNIVIE ............................................................ 58TEGRETOL ............................................................. 23TEGRETOL-XR ............................................... 23TEKAMLO ............................................................... 44TEKTURNA ........................................................... 44TEKTURNA HCT ......................................... 44TELCARE BLOOD GLUCOSE TEST ................................................................................... 97TELCARE GLUCOSE CONTROL ............................................................. 135temazepam .............................................................. 119TEMODAR ............................................................... 47TEMOVATE .......................................................... 87TEMOVATE E ................................................... 87temozolomide .......................................................... 47TENCON ...................................................................... 10TENEX ............................................................................ 41TENORETIC 100 ............................................ 43


Index

TENORETIC 50 ................................................ 43TENORMIN ............................................................ 63TERAZOL 3 ........................................................ 184TERAZOL 7 ........................................................ 184terazosin hcl ............................................................. 42terbinafine hcl ....................................................... 36terbutaline sulfate ............................................ 21terconazole ............................................................. 184TERRELL ............................................................... 110TERSI ................................................................................ 84TERUMO INSULIN SYRINGE................................................................................................... 143TERUMO SURGUARD INSULIN SYR ................................................................................... 143TESSALON PERLES .............................. 74TESTIM ......................................................................... 15testosterone ................................................................ 15testosterone cypionate ............................... 15testosterone enanthate .............................. 15TETCAINE ........................................................... 166tetrabenazine ....................................................... 174tetracaine hcl ...................................................... 166tetracycline hcl ................................................. 178TETRAVISC ...................................................... 166TETRAVISC FORTE ........................... 166TEVETEN .................................................................. 41TEVETEN HCT ................................................ 43TEV-TROPIN ................................................... 102TEXACORT ............................................................ 87tgq 30pse/150gfn/15dm ........................... 75tgq 30pse/3brm/15dm ................................ 76tgt advanced lancing device ......... 135tgt alcohol swabs .......................................... 138tgt blood glucose test .................................. 97tgt glucose ................................................................... 30tgt lancet alternate site ........................ 135tgt lancet micro thin 33g ................... 135tgt lancet super thin 30g .................... 135tgt lancet thin 23g ........................................ 135tgt lancet thin 26g ........................................ 135tgt lancet ultra thin 28g ...................... 135tgt lancet ultra thin 30g ...................... 135tgt lancing device ......................................... 135THALOMID ............................................................ 60THEO-24 ...................................................................... 21THEOCHRON ..................................................... 21theophylline ............................................................... 21theophylline er ...................................................... 21THERABENZAPRINE-90-5 ..... 161THERMAZENE ................................................ 85THINLETS GP LANCETS .......... 135THINLETS LANCET ........................... 135

Index

THINPRO INSULIN SYRINGE................................................................................................... 143THIOLA ..................................................................... 112thioridazine hcl .................................................... 55thiothixene ................................................................... 55THRESHOLD IMT .................................. 146THYMOGLOBULIN ................................ 60THYROGEN .......................................................... 92THYROLAR-1 ................................................ 179THYROLAR-1/2 .......................................... 179THYROLAR-1/4 .......................................... 179THYROLAR-2 ................................................ 179THYROLAR-3 ................................................ 179tiagabine hcl ............................................................ 24TIAZAC ......................................................................... 64ticlopidine hcl .................................................... 115TIGAN ............................................................................. 35TIKOSYN ................................................................... 19TILIA FE ...................................................................... 72timolol maleate ................................................ 163TIMOPTIC ............................................................. 163TIMOPTIC OCUDOSE ..................... 163TIMOPTIC-XE ............................................... 163TINDAMAX ........................................................... 45tinidazole ....................................................................... 45TIROSINT .............................................................. 179TISSEEL VH ...................................................... 119TISSEEL VHSD ........................................... 119TIS-U-SOL ................................................................ 62TIVICAY ..................................................................... 56TIVORBEX .................................................................. 9tizanidine hcl ....................................................... 160tl gard rx .................................................................... 116TL G-FOL OS ................................................... 154tl icon .............................................................................. 118tl-care dha ............................................................... 157tl-fluorivite .............................................................. 154tl-select ......................................................................... 159TOBI ........................................................................................ 6TOBI PODHALER ........................................... 6TOBRADEX ....................................................... 167TOBRADEX ST ........................................... 167tobramycin ...................................................... 6, 165tobramycin-dexamethasone .......... 167TOBREX .................................................................. 165TODAY SPONGE ..................................... 184todays health lancing device ....... 135todays health mini pen needles................................................................................................... 143todays health pen needles ................ 143todays health short pen needle................................................................................................... 143

Index

todays health thin lancets 28g................................................................................................... 135todays health thin lancets 30g................................................................................................... 135TOFRANIL ............................................................... 27TOFRANIL-PM ................................................. 27tolazamide ................................................................... 33tolcapone ....................................................................... 52tolmetin sodium ....................................................... 9TOPAMAX ............................................................... 23TOPAMAX SPRINKLE ....................... 24topcare clickfine pen needles ..... 143TOPICORT ............................................................... 87TOPICORT SPRAY ................................... 87TOPIRAGEN ......................................................... 24topiramate ................................................................... 24TOPROL XL ........................................................... 63torsemide ................................................................... 100TOUJEO SOLOSTAR ............................. 32TOVIAZ ..................................................................... 183TRACLEER ............................................................. 66TRADJENTA ........................................................ 31tramadol hcl ............................................................. 12tramadol hcl er ..................................................... 12tramadol hcl er (biphasic) .................. 12tramadol-acetaminophen ..................... 14TRANDATE ........................................................... 62trandolapril ............................................................... 40trandolapril-verapamil hcl er ........ 42tranexamic acid ............................................... 118TRANXENE-T .................................................... 18tranylcypromine sulfate .......................... 25TRAVATAN Z ............................................... 169travoprost ................................................................. 169trazodone hcl ........................................................... 26TRECATOR ............................................................ 47TRELSTAR .............................................................. 49TRELSTAR MIXJECT .......................... 49tretinoin ................................................... 51, 79, 80tretinoin microsphere ................................. 80tretinoin microsphere pump ............. 80TRETIN-X ................................................................. 80TRETTEN ............................................................... 113TREXALL .................................................................. 48TREXIMET .......................................................... 148TREZIX .......................................................................... 13triadvance ................................................................ 157triamcinolone acetonide ........ 87, 152triamterene-hctz ................................................. 99TRIANEX ................................................................... 87triazolam .................................................................... 119TRIBENZOR ......................................................... 43


215

Index

TRICARE PRENATAL COMPLEAT ....................................................... 157TRICARE PRENATAL DHA ONE .................................................................................. 157TRI-CHLOR ............................................................ 85TRICODE AR ....................................................... 77TRICON ..................................................................... 118TRICOR ......................................................................... 38TRIDERM .................................................................. 87TRI-ESTARYLLA ........................................ 72trifluoperazine hcl ........................................... 55trifluridine ............................................................... 166trigels-f forte ........................................................ 118TRIGLIDE ................................................................. 38trihexyphenidyl hcl ......................................... 52TRI-LEGEST FE .............................................. 72TRILEPTAL ............................................................ 24TRI-LINYAH ........................................................ 72TRILIPIX ..................................................................... 38TRILYTE ................................................................. 120trimethobenzamide hcl ............................. 35trimethoprim ............................................................ 45trinatal gt .................................................................. 157TRINATE ................................................................ 157TRINESSA (28) ................................................. 72TRI-NORINYL (28) ................................... 72triphrocaps ............................................................. 153triple antibiotic ................................................ 165triple-vitamin/fluoride ........................... 155TRI-PREVIFEM ............................................... 72TRI-SPRINTEC ................................................. 72tri-tabs dha ............................................................. 157TRIUMEQ .................................................................. 56TRIVEEN-DUO DHA ......................... 158TRIVEEN-PRX RNF ............................ 159TRI-VI-FLOR ................................................... 155tri-vi-floro ................................................................ 155tri-vit/fluoride .................................................... 155tri-vit/fluoride/iron ..................................... 154tri-vitamin/fluoride .................................... 155TRIVORA (28) ................................................... 72TRIZIVIR .................................................................... 56TROKENDI XR ................................................ 24tropicamide ............................................................ 164TRUECONTROL GLUCOSE CONT LEV 0 ..................................................... 135TRUECONTROL GLUCOSE CONT LEV 1 ..................................................... 135TRUEDRAW LANCING DEVICE ..................................................................... 135TRUEPLUS INSULIN SYRINGE................................................................................................... 143TRUEPLUS LANCETS 26G .... 135

Index

TRUEPLUS LANCETS 28G .... 135TRUEPLUS LANCETS 30G .... 135TRUEPLUS LANCETS 33G .... 135TRUEPLUS SAFETY LANCETS 28G ..................................................................................... 135TRUETEST CONTROL LEVEL 1................................................................................................... 135TRUETEST CONTROL LEVEL 2................................................................................................... 135TRUETEST CONTROL LEVEL 3................................................................................................... 135TRUETEST TEST ......................................... 97TRUETRACK TEST ................................. 97TRULICITY ............................................................ 32TRUSOPT ............................................................... 168TRUVADA ............................................................... 56TRUZONE PEAK FLOW METER ....................................................................... 144tubing/wing tip .................................................. 146TUDORZA PRESSAIR ......................... 19TUSSICAPS ............................................................ 76TUSSIGON ............................................................... 74TUSSIONEX PENNKINETIC ER....................................................................................................... 76TUZISTRA XR ................................................... 76TYBOST ....................................................................... 58TYKERB ...................................................................... 51TYLENOL WITH CODEINE #3....................................................................................................... 13TYLENOL WITH CODEINE #4....................................................................................................... 13TYSABRI ................................................................ 175TYVASO ...................................................................... 65TYVASO REFILL ......................................... 65TYVASO STARTER ................................ 65TYZEKA ...................................................................... 58TYZINE ..................................................................... 162UCERIS .......................................................................... 74UDAMIN SP ....................................................... 154U-KERA E ................................................................. 88ULESFIA ..................................................................... 91ULORIC ..................................................................... 112ULTANE .................................................................. 110ULTICARE INSULIN SAFETY SYR ................................................................................... 143ULTICARE INSULIN SYRINGE................................................................................................... 143ULTICARE MICRO PEN NEEDLES ............................................................... 143ULTICARE MINI PEN NEEDLES ............................................................... 143ULTICARE PEN NEEDLES .... 143

Index

ULTICARE SHORT PEN NEEDLES ............................................................... 143ULTICARE THIN LANCETS 30G ..................................................................................... 135ULTI-LANCE AUTOMATIC................................................................................................... 135ULTILET CLASSIC LANCETS................................................................................................... 136ULTILET INSULIN SYRINGE SHORT ........................................................................ 143ULTILET LANCETS ........................... 136ULTILET SAFETY LANCETS 23G ..................................................................................... 136ULTIMA TEST .................................................. 97ultra tabs ................................................................... 157ultra thin lancets 28g .............................. 136ultra thin lancets 30g .............................. 136ULTRACET ............................................................. 14ULTRALANCE ............................................. 136ULTRAM ..................................................................... 12ULTRAM ER ........................................................ 12ULTRA-THIN II AUTO LANCET................................................................................................... 136ULTRA-THIN II INS SYR SHORT ........................................................................ 143ULTRA-THIN II INSULIN SYRINGE ................................................................ 143ULTRA-THIN II LANCETS ..... 136ULTRA-THIN II MINI PEN NEEDLE ................................................................... 143ULTRA-THIN II PEN NEEDLE SHORT ........................................................................ 143ULTRA-THIN II PEN NEEDLES................................................................................................... 143ULTRATRAK PRO CONTROL................................................................................................... 136ULTRATRAK PRO TEST ............... 97ULTRATRAK ULTIMATE CONTROL ............................................................. 136ULTRATRAK ULTIMATE TEST....................................................................................................... 97ULTRAVATE ...................................................... 87ULTRESA .................................................................. 99UMECTA ..................................................................... 88UMECTA PD ........................................................ 88UNIFINE PENTIPS ................................. 143unifine pentips plus .................................... 143UNILET COMFORTOUCH LANCET ................................................................... 136UNILET EXCELITE ............................. 136UNILET EXCELITE II ...................... 136UNILET G.P. LANCET .................... 136


Index

UNILET G.P. SUPERLITE LANCET ................................................................... 136UNILET GP 28 ULTRA THIN................................................................................................... 136UNILET LANCET .................................... 136UNILET SUPERLITE LANCET................................................................................................... 136UNIRETIC ................................................................. 42UNISTIK 1 ............................................................ 136UNISTIK 2 ............................................................ 136UNISTIK 2 COMFORT .................... 136UNISTIK 2 EXTRA ................................ 136UNISTIK 2 NEONATAL ............... 136UNISTIK 2 NORMAL ........................ 136UNISTIK 2 SUPER ................................. 136UNISTIK 3 ............................................................ 136UNISTIK 3 COMFORT .................... 136UNISTIK 3 EXTRA ................................ 136UNISTIK 3 GENTLE ........................... 136UNISTIK 3 NEONATAL ............... 136UNISTIK 3 NORMAL ........................ 136UNISTIK CZT COMFORT ......... 136UNISTIK CZT NORMAL ............. 136UNISTRIP CONTROL ....................... 136UNISTRIP1 GENERIC .......................... 97UNITHROID ...................................................... 179UNITHROID DIRECT ....................... 179UNIVASC ................................................................... 40UNIVERSAL 1 LANCETS THIN 26G ..................................................................................... 136UNIVERSAL 1 LANCETS ULTRA THIN ................................................... 136up & up glucose .................................................. 30URAMAXIN .......................................................... 88urea ........................................................................................ 88urea hydrating ....................................................... 88urea in zn undecyl-lactic acid ....... 88urea nail ......................................................................... 88urea nail film ........................................................... 88urea-c40 ......................................................................... 88UREX ............................................................................. 183URISTIX ....................................................................... 97URISTIX 4 ................................................................. 97UROCIT-K 10 .................................................. 110UROCIT-K 5 ...................................................... 110UROXATRAL ................................................. 111URSO 250 ............................................................... 107URSO FORTE .................................................. 107ursodiol ........................................................................ 107UTOPIC ......................................................................... 88VAGIFEM .............................................................. 184valacyclovir hcl ................................................... 59VALCHLOR ........................................................... 82

Index

VALCYTE ................................................................. 58valganciclovir hcl ............................................ 58VALIUM ...................................................................... 18valproic acid ............................................................ 24valsartan-hydrochlorothiazide ..... 43VALTREX ................................................................. 59value plus glucose ............................... 30, 31value plus lancet standard 21g................................................................................................... 136value plus lancets super thin ....... 137value plus lancets thin 26g ............. 137value plus lancing device ................. 137valumark lancet super thin 30g................................................................................................... 137valumark lancet ultra thin 28g................................................................................................... 137valumark pen needles ............................. 143valved holding chamber ..................... 148VANCOCIN HCL .......................................... 45vancomycin hcl .................................................... 45VANDAZOLE ................................................. 184VANISHPOINT INSULIN SYRINGE ................................................................ 144VANOXIDE-HC .............................................. 78VANTAS ...................................................................... 49VARIBAR HONEY .................................... 98VARIBAR NECTAR ................................ 98VARIBAR PUDDING ............................ 98VARIBAR THIN HONEY ............... 98VARIBAR THIN LIQUID ................ 98VASCEPA .................................................................. 38VASERETIC .......................................................... 42VASOLEX ................................................................. 89VASOTEC ................................................................. 40VCF VAGINAL CONTRACEPTIVE ................................. 184VECAMYL ............................................................... 44VECTICAL ............................................................... 84VELETRI ..................................................................... 65VELIVET ..................................................................... 72VELPHORO ........................................................ 110VEMAVITE-PRX 2 ................................ 159vena-bal dha ........................................................ 157venatal-fa .................................................................. 157venlafaxine hcl ...................................................... 27venlafaxine hcl er ............................................. 27VENOFER ............................................................. 118VENTAVIS .............................................................. 65VENTOLIN HFA ............................................ 21VERAMYST ...................................................... 162verapamil hcl .......................................................... 64verapamil hcl er ................................................. 64VERDESO ................................................................. 87

Index

VEREGEN ................................................................. 80VERELAN ................................................................. 64VERELAN PM ................................................... 64VERIPRED 20 ..................................................... 74VERSACLOZ ....................................................... 54VERSICLEAR ..................................................... 80VESTURA ................................................................. 70VEXOL ....................................................................... 168VFEND ............................................................................ 36VIBRAMYCIN ............................................... 178VICODIN ..................................................................... 13VICODIN ES ......................................................... 13VICODIN HP ........................................................ 13VICOPROFEN .................................................... 13VICTORY AGM-4000 TEST ...... 97VICTORY CONTROL LEVEL 1/2 ........................................................................................ 137VICTOZA ................................................................... 32VICTRELIS ............................................................. 59VIDA MIA AUTOLET LANCING DEV ............................................ 137VIDA MIA UNIFINE PENTIPS................................................................................................... 144VIDA MIA UNILET LANCETS 28G ..................................................................................... 137VIDA MIA UNILET LANCETS 30G ..................................................................................... 137VIDEX ............................................................................. 57VIDEX EC ................................................................. 57VIEKIRA PAK ................................................... 58VIGAMOX ............................................................ 165VIIBRYD ..................................................................... 26VIIBRYD STARTER PACK ........ 26VIMIZIM ................................................................. 104VIMOVO ......................................................................... 7VIMPAT ........................................................................ 24VINACAL B ....................................................... 157VINATE AZ EXTRA ........................... 157VINATE CALCIUM .............................. 157VINATE DHA RF ..................................... 157VINATE IC ........................................................... 157VINATE II ............................................................. 157VINATE M ........................................................... 157VIOKACE .................................................................. 99viorele ................................................................................ 67VIRACEPT ............................................................... 57VIRAMUNE ........................................................... 57VIRAMUNE XR .............................................. 57VIRAZOLE .............................................................. 60VIREAD ........................................................................ 58VIROPTIC ............................................................. 166virt-caps ...................................................................... 153virti-sulf ........................................................................... 78


217

Index

virt-pn ............................................................................. 158virt-pn dha ............................................................... 159virt-pn plus ............................................................. 158virt-select .................................................................. 159virtussin a/c ............................................................... 75virt-vite ......................................................................... 116virt-vite plus .......................................................... 153VISTARIL .................................................................. 17VISTIDE ....................................................................... 58VISUDYNE ......................................................... 167VITAFOL FE+ ................................................ 159VITAFOL ULTRA ................................... 159VITAFOL-NANO ...................................... 158VITAFOL-OB .................................................. 158VITAFOL-OB+DHA ............................ 159VITAFOL-ONE ............................................. 159VITAL-D RX ..................................................... 153VITALET PRO LANCETS ......... 137VITALET PRO PLUS LANCETS................................................................................................... 137VITAMEDMD ONE RX/QUATREFOLIC ............................. 159VITAMEDMD PLUS RX/QUATREFOLIC ............................. 159vitamin d (ergocalciferol) ................ 185vitamin d2 ................................................................ 185vitamin d3 ................................................................ 185vitamins acd-fluoride .............................. 155VITAPEARL ...................................................... 158VITA-PREN ........................................................ 158VITEKTA .................................................................... 56VITUZ .............................................................................. 76VIVA DHA ........................................................... 158VIVACTIL ................................................................. 28VIVELLE-DOT ............................................. 107VIVITROL ................................................................. 34VOCAL POINT BLOOD GLUCOSE TEST ............................................ 97VOGELXO ................................................................ 15VOGELXO PUMP ........................................ 15vol-care rx ............................................................... 153vol-nate ........................................................................ 158vol-tab rx ................................................................... 158VOLTAREN ........................................................... 82VOLTAREN-XR ................................................. 9VOLUMEN .............................................................. 98voriconazole ............................................................. 36VORTEX VALVED HOLDING CHAMBER ........................................................... 148VOSOL HC ........................................................... 170VOSPIRE ER ......................................................... 21VOTRIENT .............................................................. 51vp-ch plus ................................................................. 159

Index

vp-ch-pnv .................................................................. 159vp-ggr-b6 prenatal ..................................... 160vp-heme ob ............................................................. 158vp-heme ob + dha ........................................ 158vp-heme one .......................................................... 159vp-pnv-dha .............................................................. 158VPRIV .......................................................................... 115V-R MONO INSULIN SYRINGE................................................................................................... 144VUSION ........................................................................ 80VYFEMLA ................................................................ 70VYTONE ..................................................................... 80VYTORIN .................................................................. 37VYVANSE .................................................................... 4W&F LANCETS 26G .......................... 137W&F LANCETS COLORED 21G................................................................................................... 137walgreens adv travel lancets ....... 137walgreens glucose ............................... 30, 31WALGREENS LANCETS ........... 137walgreens lancets micro thin ...... 137walgreens lancets super thin ....... 137WALGREENS THIN LANCETS................................................................................................... 137WALGREENS ULTRA THIN LANCETS .............................................................. 137WAL-ITIN ................................................................. 37warfarin sodium ................................................. 21WATCHHALER .......................................... 148WAVESENSE PRESTO ...................... 97WEBCOL ALCOHOL PREP LARGE ........................................................................ 138WEBCOL ALCOHOL PREP MEDIUM ................................................................. 138wegmans unifine pentips plus .... 144WELCHOL ............................................................... 38WELLBUTRIN .................................................. 25WELLBUTRIN SR ....................................... 25WELLBUTRIN XL ...................................... 25WERA ............................................................................... 70WESTCORT ........................................................... 87WESTHROID ................................................... 179WIDE-SEAL DIAPHRAGM 60................................................................................................... 122WIDE-SEAL DIAPHRAGM 65................................................................................................... 122WIDE-SEAL DIAPHRAGM 70................................................................................................... 122WIDE-SEAL DIAPHRAGM 75................................................................................................... 122WIDE-SEAL DIAPHRAGM 80................................................................................................... 122

Index

WIDE-SEAL DIAPHRAGM 85................................................................................................... 122WIDE-SEAL DIAPHRAGM 90................................................................................................... 122WIDE-SEAL DIAPHRAGM 95................................................................................................... 122WILATE .................................................................... 113WINDMILL TRAINER .................... 146WINRHO SDF ................................................. 172WP THYROID ................................................ 179WYMZYA FE ...................................................... 70XALATAN ............................................................ 170XALKORI .................................................................. 51XANAX ......................................................................... 18XANAX XR ............................................................ 18XARELTO ................................................................. 22XARELTO STARTER PACK .... 22XARTEMIS XR ................................................ 14XELJANZ ....................................................................... 6XELODA ..................................................................... 48XENAZINE .......................................................... 174XEOMIN .................................................................. 162XERAC AC .............................................................. 90XERESE ........................................................................ 84XGEVA ...................................................................... 101XIAFLEX .................................................................... 60XIFAXAN .................................................................. 45XIGDUO XR .......................................................... 29XODOL .......................................................................... 13XOLAIR ........................................................................ 19XOLEGEL ................................................................. 82XOPENEX ................................................................. 21XOPENEX CONCENTRATE .... 21XOPENEX HFA ............................................... 21XPRES CONTROL .................................. 137XTANDI ........................................................................ 48XULANE ..................................................................... 72X-VIATE ...................................................................... 88XYLOCAINE ........................................................ 90XYNTHA ................................................................. 113XYNTHA SOLOFUSE ...................... 113XYREM ..................................................................... 173XYZAL ........................................................................... 37YASMIN 28 ............................................................. 70YAZ ...................................................................................... 70YODOXIN ..................................................................... 6zaclir cleansing ................................................... 80ZADITOR ............................................................... 168zafirlukast .................................................................... 19zaleplon ....................................................................... 120ZANAFLEX ........................................................ 161ZARAH ........................................................................... 70ZARONTIN ............................................................. 24


Index

ZAROXOLYN ................................................. 100ZARXIO .................................................................... 115ZATEAN-CH ..................................................... 160ZATEAN-PN ..................................................... 158ZATEAN-PN DHA .................................. 160ZATEAN-PN PLUS ................................ 158ZAVESCA ............................................................. 115ZAZOLE ................................................................... 184ZEBETA ........................................................................ 63ZEBUTAL .................................................................. 10ZECUITY ................................................................ 149ZEGERID ................................................................ 182ZEGERID OTC .............................................. 182ZELAPAR .................................................................. 53ZELBORAF ............................................................. 49ZEMAIRA .............................................................. 177ZEMPLAR ............................................................. 104ZENATANE ............................................................ 80ZENCHENT ............................................................ 70ZENCHENT FE ................................................. 70ZENCIA ......................................................................... 79ZENPEP ......................................................................... 99ZENZEDI ......................................................................... 4ZEOSA ............................................................................. 70ZERIT ................................................................................ 58ZESTORETIC ...................................................... 42ZESTRIL ...................................................................... 40ZETIA ............................................................................... 39ZETONNA ............................................................. 162ZIAC .................................................................................... 43ZIAGEN ......................................................................... 57ZIANA ............................................................................. 79zidovudine .................................................................... 58ZIOPTAN ................................................................ 170ziprasidone hcl ..................................................... 54ZIPSOR ............................................................................... 9ZIRGAN .................................................................... 166ZITHRANOL ......................................................... 84ZITHRANOL-RR ........................................... 84ZITHROMAX .................................................. 121ZITHROMAX TRI-PAK ................. 121ZITHROMAX Z-PAK ......................... 121ZMAX ........................................................................... 121ZOCOR ........................................................................... 39ZOFRAN ...................................................................... 35ZOFRAN ODT .................................................... 35ZOHYDRO ER ................................................... 12ZOLADEX ................................................................. 49zoledronic acid ................................................. 101ZOLINZA .................................................................... 50zolmitriptan ........................................................... 149ZOLOFT ........................................................................ 26zolpidem tartrate ........................................... 120

Index

zolpidem tartrate er .................................. 120ZOLPIMIST ......................................................... 120ZOMACTON ..................................................... 102ZOMETA ................................................................. 101ZOMIG ........................................................................ 149ZOMIG ZMT ..................................................... 149ZONALON ................................................................ 83ZONATUSS ............................................................. 74ZONEGRAN .......................................................... 24zonisamide .................................................................. 24ZORBTIVE ........................................................... 102ZORTRESS .............................................................. 61ZORVOLEX ............................................................... 9ZOVIA 1/35E (28) ......................................... 70ZOVIA 1/50E (28) ......................................... 70ZOVIRAX ...................................................... 59, 84ZUBSOLV ................................................................. 14ZUPLENZ ................................................................... 35ZYBAN ....................................................................... 177ZYCLARA ................................................................. 89ZYCLARA PUMP ......................................... 89ZYDELIG .................................................................... 51ZYFLO ............................................................................. 19ZYFLO CR ................................................................ 19ZYKADIA .................................................................. 51ZYLET ......................................................................... 167ZYLOPRIM ......................................................... 112ZYMAXID ............................................................. 165ZYPREXA ................................................................. 55ZYPREXA ZYDIS ........................................ 55ZYRTEC ALLERGY ................................ 37ZYRTEC-D ALLERGY & CONGESTION ................................................... 76ZYTIGA ......................................................................... 48ZYVOX .......................................................................... 46


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