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2021 Formulary Reference Guide

MAIL ORDER AVAILABLE FOR CERTAIN PRESCRIPTIONS

Understanding your formulary

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

To create the list, OptumRx® is guided by the Pharmacy and Therapeutics Committee. This group of doctors, nurses, and pharmacists reviews which medications will be covered, how well the drugs work, and overall value. They also make sure there are safe and covered options.

About this formulary Where differences between this formulary and your benefit plan exist, the benefit plan documents rule. This may not be a complete list of medications that are covered by your plan. Please review your benefit plan for full details.

How do I use my formulary?You and your doctor can use the formulary to help you choose the most cost-effective prescription medications. This guide tells you if a medication is generic or brand, and if special rules apply. Bring this list with you when you see your doctor. If your medication is not listed here, please visit your plan’s member website or call the number on your member ID card.

Some medications on your formulary have extra requirements before they can be covered. A few of the most common coverage programs are prior authorization (PA), step therapy (ST) and quantity limits (QL). We use programs like these to help make sure the medication you take is safe and effective. Check your plan documents for more information. Some Affordable Care Act (ACA) preventive medication may have coverage restrictions. If you want to learn more about these programs or to see if you take a medication in one of these programs, please visit your plan’s member website or call the number on your member ID card.

What are tiers?Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, set by your employer or plan sponsor. This is how much you will pay when you fill a prescription.

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Understanding your formulary

When does the formulary change?• Medications may move to a lower tier at any time.

• Medications may move to a higher tier or be excluded from coverage on January 1 of each year.

When a medication changes tiers, you may have to pay a different amount for that medication.

Why are some medications excluded from coverage?A medication may be excluded from coverage under your pharmacy benefit when it works the same as or similar to another prescription or over-the-counter (OTC) medication.

What if I don’t agree with a decision about an excluded medication?You or your authorized representative and your doctor can ask for a coverage request by calling the number on your member ID card.

Medication tips

What is the difference between brand-name and generic medications?Generic medications contain the same active ingredients (offers same effect) as brand-name medications, but they often cost less. Once the patent for a brand-name medication ends, the FDA can approve a generic version with the same active ingredients.

What if my doctor writes a brand-name prescription?If your doctor gives you a prescription for a brand-name medication, ask if a generic or lower-cost option could be right for you. Generic medications are usually your lowest-cost option.

Over-the-counter medicationsAn over-the-counter (OTC) medication may be the right treatment for some conditions. Talk to your doctor about available OTC options. Even though OTC medications may not be covered by your pharmacy benefit, they may cost less than a prescription medication.

What if I am taking a specialty medication?Specialty medications are used to treat complex conditions. These high-cost medications may be injected, infused or taken by mouth. Please note, not all specialty medications are listed in the formulary. Our specialty pharmacy can provide most of your specialty medications along with helpful programs and services. Call 1-855-427-4682 and have your prescriptions delivered right to your home or doctor’s office.

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Reading your formulary

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

Tier informationUsing lower tier or preferred medications can help you pay your lowest out-of-pocket cost. Your plan may have multiple or no tiers.

Drug Tier Includes Helpful Tips

Tier CM Oral Chemotherapy Oral chemotherapy drugs may have a designated copayment or coinsurance based on state laws or client preference.

Tier 1 $ Generic Use Tier 1 generic drugs instead of brand-name drugs to help reduce your out-of-pocket costs.

Tier 2 $$ Preferred Preferred brand-name drugs will generally have lower copayments than non-preferred brand-name drugs.

Tier 3 $$$ Non-Preferred Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Tier 4 $$$$ Specialty Tier 4 is generally highest in copayment and cost. These drugs are sometimes used for complex and chronic conditions and may require special monitoring and handling.

Drug list informationIn this drug list, some medications are noted with letters next to them to help you see which ones may have coverage requirements or limits. Your benefit plan decides how these medications may be covered.

M Authorized generic or cobranded product

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

PV Preventive drugs – May have coverage and no copayments when health care reform requirements are met.

PV* Preventive drugs – Available at $0 if Health Care Reform copay waiver is approved.

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

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

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Table of Contents

Analgesics ......................................................................................................................................................... 7Anesthetics ........................................................................................................................................................ 9Anti-Addiction/Substance Abuse Treatment Agents ...................................................................................10Antibacterials ...................................................................................................................................................10Anticonvulsants .............................................................................................................................................. 13Antidementia Agents ...................................................................................................................................... 14Antidepressants .............................................................................................................................................. 15Antiemetics ...................................................................................................................................................... 16Antifungals .......................................................................................................................................................16Antigout Agents .............................................................................................................................................. 17Antimigraine Agents ....................................................................................................................................... 17Antimyasthenic Agents .................................................................................................................................. 17Antimycobacterials ......................................................................................................................................... 18Antineoplastics ................................................................................................................................................18Antiparasitics ...................................................................................................................................................21Antiparkinson Agents ..................................................................................................................................... 22Antipsychotics .................................................................................................................................................22Antivirals .......................................................................................................................................................... 23Anxiolytics ....................................................................................................................................................... 25Bipolar Agents .................................................................................................................................................25Blood Glucose Monitoring ............................................................................................................................. 25Blood Glucose Regulators ............................................................................................................................. 26Blood Products/Modifiers/Volume Expanders ............................................................................................. 27Cardiovascular Agents ................................................................................................................................... 29Central Nervous System Agents ....................................................................................................................33Dental and Oral Agents ...................................................................................................................................33Dermatological Agents ................................................................................................................................... 34Electrolytes/Minerals/Metals/Vitamins .......................................................................................................... 35Gastrointestinal Agents ..................................................................................................................................38Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment ............................................................ 39Genitourinary Agents ......................................................................................................................................40Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal) ................................................................41Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) ...............................................................42Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins) ................................................... 43Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) ................................... 43Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) ................................................................ 47Hormonal Agents, Suppressant (Adrenal) ....................................................................................................47Hormonal Agents, Suppressant (Pituitary) ...................................................................................................47Hormonal Agents, Suppressant (Thyroid) .................................................................................................... 47Immunological Agents ....................................................................................................................................47Inflammatory Bowel Disease Agents ............................................................................................................ 50Metabolic Bone Disease Agents .................................................................................................................... 50Miscellaneous Therapeutic Agents ............................................................................................................... 50Ophthalmic Agents ......................................................................................................................................... 52Otic Agents ...................................................................................................................................................... 55Respiratory Tract/Pulmonary Agents ............................................................................................................55Skeletal Muscle Relaxants ..............................................................................................................................57Sleep Disorder Agents ....................................................................................................................................57

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Drug Name Drug Tier Notes

Analgesics

butalbital-acetaminophen oral capsule

1

butalbital-acetaminophen oral tablet 50-325 mg

1

butalbital-apap-caffeine 1

butalbital-aspirin-caffeine

1

duraxin 1

Nonsteroidal Anti-inflammatory Drugs

adult aspirin regimen 1 PV

aspirin adult 1 PV

aspirin adult low strength oral tablet delayed release

1 PV

aspirin childrens 1 PV

aspirin ec 1 PV

aspirin ec low dose 1 PV

aspirin ec low strength 1 PV

aspirin low dose 1 PV

aspirin oral tablet 1 PV

aspirin oral tablet delayed release

1 PV

BAYER ASPIRIN 3 PV

BAYER ASPIRIN EC LOW DOSE

3 PV

celecoxib oral 1 QL

diclofenac potassium 1

diclofenac sodium er 1

diclofenac sodium oral 1

diclofenac sodium transdermal gel 1 %

1 QL

diclofenac sodium transdermal solution

1 PA

diclofenac-misoprostol 1


diflunisal oral 1

ec-naproxen 1

etodolac 1

etodolac er 1

fenoprofen calcium oral capsule 400 mg

3

fenoprofen calcium oral tablet

3

flurbiprofen oral 1

gnp aspirin low dose 1 PV

goodsense aspirin low dose

1 PV

ibu 1

ibuprofen lysine 1

ibuprofen oral suspension

1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

1

indomethacin er 1

indomethacin oral capsule 25 mg, 50 mg

1

indomethacin sodium 1

ketoprofen er 1

ketoprofen oral capsule 50 mg, 75 mg

1

ketorolac tromethamine injection

1

ketorolac tromethamine intramuscular

1

ketorolac tromethamine oral

1 QL

meclofenamate sodium oral

1

meloxicam oral 1

nabumetone oral 1

naproxen dr 1

naproxen oral tablet 1

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

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naproxen sodium oral tablet 275 mg, 550 mg

1

oxaprozin 1

piroxicam oral 1

qc aspirin low dose oral tablet delayed release

1 PV

ST JOSEPH LOW DOSE ORAL TABLET DELAYED RELEASE

3 PV

sulindac oral 1

tolmetin sodium 1

Opioid Analgesics, Long-acting

buprenorphine transdermal

1 PA; QL

fentanyl 1 PA; QL

hydrocodone bitartrate er

1 PA; QL

hydromorphone hcl er 1 PA; QL

HYSINGLA ER 2 PA; QL

levorphanol tartrate oral tablet 2 mg

3 PA; QL

methadone hcl injection 1

methadone hcl intensol 1

methadone hcl oral concentrate

1

methadone hcl oral solution

1

methadone hcl oral tablet

1 PA

methadone hcl oral tablet soluble

1

methadose oral concentrate 10 mg/ml

1

methadose oral tablet soluble

1

methadose sugar-free 1

mitigo 1


morphine sulfate er 1 PA; QL

morphine sulfate er beads

1 PA; QL

morphine sulfate intramuscular

1

NUCYNTA ER 3 PA; QL

OXYCONTIN 2 PA; QL

oxymorphone hcl er 1 PA; QL

tramadol hcl er (biphasic)

1 QL

tramadol hcl er oral capsule extended release 24 hour 150 mg

1 PA; QL

tramadol hcl er oral tablet extended release 24 hour

1 QL

XTAMPZA ER 2 PA; QL

Opioid Analgesics, Short-acting

acetaminophen-codeine

1 QL

acetaminophen-codeine #2

1 QL


1 QL


1 QL

apap-caff-dihydrocodeine oral capsule

1 PA; QL

ascomp-codeine 1

butalbital-apap-caff-cod 1

butalbital-asa-caff-codeine

1

butorphanol tartrate injection

1

butorphanol tartrate nasal

1 QL

codeine sulfate 1 QL


8


duramorph 1

endocet 1 QL

fentanyl citrate buccal lozenge on a handle

1 PA; QL

hydrocodone-acetaminophen

1 QL

hydrocodone-ibuprofen 1 QL

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

1

hydromorphone hcl oral 1 QL

hydromorphone hcl pf 1

lorcet 1 QL

lorcet hd 1 QL

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

1 QL

morphine sulfate (pf) injection

1

morphine sulfate (pf) intravenous solution 2 mg/ml, 4 mg/ml

1

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

1

morphine sulfate oral 1 QL

oxycodone hcl oral capsule

1 QL

oxycodone hcl oral concentrate 100 mg/5ml

1 QL

oxycodone hcl oral solution

1 QL

oxycodone hcl oral tablet

1 QL


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

1 QL

oxycodone-aspirin 1 QL

oxymorphone hcl 1 QL

pentazocine-naloxone hcl

1 QL

tramadol hcl ir 1 QL

tramadol-acetaminophen

1 QL

Anesthetics

Local Anesthetics

ethyl chloride 1

glydo 1

lidocaine external ointment

1

lidocaine external patch 5 %

1

lidocaine hcl external solution

1

lidocaine hcl injection solution 2 %

1

lidocaine hcl mouth/throat

1

lidocaine hcl urethral/mucosal

1

lidocaine viscous hcl 1

lidocaine-prilocaine external cream

1

LIDOCAINE-TETRACAINE EXTERNAL CREAM 7-7 %

3


9


Anti-Addiction/Substance Abuse Treatment Agents

Alcohol Deterrents/Anti-craving

acamprosate calcium 1

disulfiram oral 1

naltrexone hcl oral 1

VIVITROL 4

Opioid Dependence Treatments

buprenorphine hcl injection

1

buprenorphine hcl sublingual

1 QL

buprenorphine hcl-naloxone hcl

1 QL

Opioid Reversal Agents

naloxone hcl injection solution

1

naloxone hcl injection solution cartridge

1

naloxone hcl injection solution prefilled syringe

1

NARCAN 2

Smoking Cessation Agents

bupropion hcl er (smoking det)

1 PV; QL

CHANTIX 3 ST; PV; QL

CHANTIX CONTINUING MONTH PAK

3 ST; PV; QL

CHANTIX STARTING MONTH PAK

3 ST; PV; QL


NICORETTE MOUTH/THROAT GUM 2 MG

3 PV; QL

nicotine polacrilex mouth/throat

1 PV; QL

nicotine step 1 1 PV; QL



NICOTROL 3 ST; PV; QL

NICOTROL NS 3 ST; PV; QL

Antibacterials

Aminoglycosides

amikacin sulfate injection

1

gentamicin in saline 1

gentamicin sulfate external

1

gentamicin sulfate injection

1

neomycin sulfate oral 1

paromomycin sulfate oral

1

streptomycin sulfate intramuscular

1

tobramycin sulfate injection

1

Antibacterials, Other

ALTABAX 3

baciim 1

bacitracin intramuscular 1

chloramphenicol sod succinate

1

clindamycin hcl oral 1

clindamycin palmitate hcl

1

clindamycin phosphate in d5w

1


10


clindamycin phosphate injection

1

clindamycin phosphate vaginal

1

colistimethate sodium (cba)

1

CORTISPORIN 3

daptomycin 1

iodine tincture external tincture 2 %

1

lincomycin hcl injection 1

linezolid in sodium chloride

1

linezolid intravenous 1

linezolid oral 1 QL

mafenide acetate external

1

methenamine hippurate 1

metronidazole in nacl 1

metronidazole oral 1

metronidazole vaginal 1

mupirocin external 1

NEO-SYNALAR EXTERNAL CREAM

3

nitrofurantoin 1

nitrofurantoin macrocrystal oral

1

nitrofurantoin monohydrate macrocrystals

1

polymyxin b sulfate injection

1

PRIMSOL 3

silver sulfadiazine external

1

tinidazole oral 1

trimethoprim oral 1


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

1

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

1

VANCOMYCIN HCL IN NACL SOLUTION 750-0.9 MG/150ML-% INTRAVENOUS

3

vancomycin hcl in nacl solution 750-0.9 mg/150ml-% intravenous

1

vancomycin hcl intravenous solution 1000 mg/200ml, 1500 mg/300ml, 2000 mg/400ml, 500 mg/100ml

1

vancomycin hcl intravenous solution reconstituted

1

vancomycin hcl oral 1

XIFAXAN 3 PA

ZYVOX INTRAVENOUS SOLUTION 200 MG/100ML

3

Beta-lactam, Cephalosporins

cefaclor 1

cefaclor er 1

cefadroxil 1

cefazolin sodium injection

1

cefazolin sodium intravenous solution reconstituted

1


11


cefazolin sodium-dextrose

1

cefdinir 1

cefditoren pivoxil 1

cefepime hcl injection 1

cefepime hcl intravenous solution

1

cefepime-dextrose 1

cefixime 1

cefotaxime sodium 1

cefotetan disodium 1

cefotetan disodium-dextrose

1

cefoxitin sodium 1

cefpodoxime proxetil 1

cefprozil 1

ceftazidime and dextrose

1

ceftazidime injection 1

ceftriaxone sodium in dextrose

1

ceftriaxone sodium injection

1

ceftriaxone sodium intravenous

1

ceftriaxone sodium-dextrose

1

cefuroxime axetil 1

cephalexin 1

tazicef injection 1

tazicef intravenous solution reconstituted

1

Beta-lactam, Other

aztreonam 1

ertapenem sodium 1

imipenem-cilastatin 1

meropenem 1


Beta-lactam, Penicillins

amoxicillin 1

amoxicillin-potassium clavulanate er

1

amoxicillin-potassium clavulanate oral

1

ampicillin 1

ampicillin sodium 1

ampicillin-sulbactam sodium

1

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

3

BICILLIN L-A 3

dicloxacillin sodium 1

nafcillin sodium injection solution reconstituted 1 gm, 2 gm

1

nafcillin sodium intravenous

1

oxacillin sodium 1

penicillin g potassium 1

penicillin g sodium 1

penicillin v potassium 1

piperacillin sod-tazobactam so intravenous solution reconstituted 2.25 (2-0.25) gm, 3.375 (3-0.375) gm, 4.5 (4-0.5) gm, 40.5 (36-4.5) gm

1

Macrolides

azithromycin intravenous

1

azithromycin oral 1

clarithromycin er 1


12


clarithromycin oral 1

DIFICID 3

erythromycin base 1

erythromycin ethylsuccinate oral

1

erythromycin oral 1

ZITHROMAX ORAL PACKET

3

Quinolones

BAXDELA ORAL 3

CIPRO ORAL SUSPENSION RECONSTITUTED

3

ciprofloxacin hcl oral 1

ciprofloxacin in d5w 1

levofloxacin in d5w 1

levofloxacin intravenous

1

levofloxacin oral 1

moxifloxacin hcl in nacl 1

moxifloxacin hcl oral 1

ofloxacin oral 1

Sulfonamides

sulfadiazine oral 1

sulfamethoxazole-trimethoprim

1

sulfatrim pediatric 1

Tetracyclines

avidoxy 1

demeclocycline hcl 1

doxy 100 1

doxycycline hyclate intravenous

1

doxycycline hyclate oral capsule

1

doxycycline hyclate oral tablet 100 mg, 20 mg

1


doxycycline monohydrate oral capsule 100 mg, 50 mg

1

doxycycline monohydrate oral suspension reconstituted

1

doxycycline monohydrate oral tablet

1

MINOCIN INTRAVENOUS

3

minocycline hcl oral 1

mondoxyne nl oral capsule 100 mg

1

morgidox oral 1

tetracycline hcl oral 1

Anticonvulsants

Anticonvulsants, Other

BRIVIACT ORAL 3 ST

EPIDIOLEX 4 PA

levetiracetam er 1

levetiracetam in nacl 1

levetiracetam intravenous

1

levetiracetam oral 1

roweepra 1

roweepra xr 1

Calcium Channel Modifying Agents

CELONTIN 3

ethosuximide oral 1

zonisamide oral 1

Gamma-aminobutyric Acid (GABA) Augmenting Agents

clobazam 1 PA

DIACOMIT 4 PA


13


diazepam rectal 1 QL

gabapentin oral 1

pentobarbital sodium injection

1

phenobarbital oral 1

phenobarbital sodium injection

1

primidone oral 1

tiagabine hcl 1

valproate sodium intravenous

1

valproic acid oral 1

Glutamate Reducing Agents

felbamate 1

FYCOMPA 3

lamotrigine er 1

lamotrigine oral tablet 1

lamotrigine oral tablet chewable

1

lamotrigine oral tablet dispersible

1

lamotrigine starter kit-blue

1

lamotrigine starter kit-green

1

lamotrigine starter kit-orange

1

subvenite 1

subvenite starter kit-blue

1

subvenite starter kit-green

1

subvenite starter kit-orange

1

topiramate er 1

topiramate oral 1


Sodium Channel Agents

BANZEL 3 PA

carbamazepine er 1

carbamazepine oral 1

DILANTIN ORAL CAPSULE 30 MG

3

epitol 1

fosphenytoin sodium 1

oxcarbazepine 1

PEGANONE 3

phenytoin infatabs 1

phenytoin oral 1

phenytoin sodium extended

1

phenytoin sodium injection

1

VIMPAT ORAL 3

Antidementia Agents

Cholinesterase Inhibitors

donepezil hcl 1

galantamine hydrobromide

1

galantamine hydrobromide er

1

rivastigmine 1

rivastigmine tartrate 1

N-methyl-D-aspartate (NMDA) Receptor Antagonist

memantine hcl er 1 QL

memantine hcl oral 1

NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR

2 QL


14


Antidepressants

Antidepressants, Other

APLENZIN 3 ST; QL

bupropion hcl er (sr) 1 QL

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

1 QL

bupropion hcl oral 1

chlordiazepoxide-amitriptyline

1

mirtazapine oral 1

olanzapine-fluoxetine hcl

1 QL

perphenazine-amitriptyline

1

Monoamine Oxidase Inhibitors

EMSAM 3 QL

MARPLAN 3

phenelzine sulfate oral 1

tranylcypromine sulfate 1

SSRI/SNRI (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors)

citalopram hydrobromide

1

desvenlafaxine succinate er

1 QL

escitalopram oxalate 1

FETZIMA 3 ST; QL

FETZIMA TITRATION 3 ST; QL

fluoxetine hcl (pmdd) 1

fluoxetine hcl oral capsule

1


fluoxetine hcl oral capsule delayed release

1 QL

fluoxetine hcl oral solution

1

fluoxetine hcl oral tablet 1

fluvoxamine maleate 1

fluvoxamine maleate er 1 QL

maprotiline hcl 1

nefazodone hcl 3

paroxetine hcl 1

paroxetine hcl er 1

paroxetine mesylate 1 QL

PAXIL ORAL SUSPENSION

2 ST

sertraline hcl oral 1

trazodone hcl oral 1

TRINTELLIX 3 ST; QL

venlafaxine hcl 1

venlafaxine hcl er oral capsule extended release 24 hour

1

venlafaxine hcl er oral tablet extended release 24 hour 225 mg

1

VIIBRYD 3 QL

VIIBRYD STARTER PACK

3 QL

Tricyclics

amitriptyline hcl oral 1

amoxapine 1

clomipramine hcl oral 1

desipramine hcl oral 1

doxepin hcl oral capsule

1

doxepin hcl oral concentrate

1

imipramine hcl oral 1


15


imipramine pamoate 1

nortriptyline hcl oral 1

protriptyline hcl 1

trimipramine maleate oral

1

Antiemetics

Antiemetics, Other

compro 1

dimenhydrinate injection

1

droperidol injection 1

meclizine hcl oral tablet 1

metoclopramide hcl injection

1

metoclopramide hcl oral

1

perphenazine oral 1

prochlorperazine 1

prochlorperazine edisylate injection

1

prochlorperazine maleate oral

1

scopolamine 1

Emetogenic Therapy Adjuncts

AKYNZEO ORAL 3 QL

ANZEMET 3 QL

aprepitant 1 QL

dronabinol 1 PA; QL

fosaprepitant dimeglumine

1

granisetron hcl intravenous

1

granisetron hcl oral 1 QL

ondansetron hcl injection

1

ondansetron hcl oral solution

1 QL


ondansetron hcl oral tablet 24 mg

1 QL

ondansetron hcl oral tablet 4 mg, 8 mg

1

ondansetron odt 1

palonosetron hcl 1

Antifungals

ABELCET 3

AMBISOME 3

amphotericin b intravenous

1

caspofungin acetate 1

ciclodan 1

ciclopirox 1

ciclopirox olamine external

1

clotrimazole external 1

clotrimazole mouth/throat

1

clotrimazole-betamethasone

1

CRESEMBA 3

econazole nitrate external

1

fluconazole in sodium chloride

1

fluconazole oral 1

flucytosine oral 1

griseofulvin microsize oral

1

griseofulvin ultramicrosize

1

GYNAZOLE-1 3

itraconazole oral 1 PA

KERYDIN 3 PA

ketoconazole external cream

1


16


ketoconazole external shampoo

1

ketoconazole oral 1

micafungin sodium 1

miconazole 3 vaginal suppository

1

naftifine hcl 1

nyamyc 1

nystatin external 1

nystatin mouth/throat 1

nystatin oral 1

nystatin-triamcinolone 1

nystop 1

oxiconazole nitrate 3

OXISTAT EXTERNAL LOTION

3

posaconazole 1

terbinafine hcl oral 1 QL

terconazole 1

voriconazole intravenous

1

voriconazole oral 1

Antigout Agents

allopurinol oral 1

allopurinol sodium 1

colchicine oral tablet 1

colchicine-probenecid 1

febuxostat 1 ST

probenecid 1

Antimigraine Agents

Ergot Alkaloids

dihydroergotamine mesylate injection

1 PA; QL

dihydroergotamine mesylate nasal

1 PA; QL

ergotamine-caffeine 1


Prophylactic

AIMOVIG 2 PA; QL

EMGALITY 2 PA; QL

EMGALITY (300 MG DOSE)

2 PA; QL

Serotonin (5-HT) 1b/1d Receptor Agonists

almotriptan malate 1 QL

eletriptan hydrobromide 1 QL

naratriptan hcl 1 QL

rizatriptan benzoate 1 QL

sumatriptan nasal 1 QL

sumatriptan succinate oral

1 QL

sumatriptan succinate refill

1 QL

sumatriptan succinate subcutaneous

1 QL

sumatriptan-naproxen sodium

3 QL

zolmitriptan oral 1 QL

ZOMIG NASAL 3 ST; QL

Antimyasthenic Agents

Parasympathomimetics

GUANIDINE HCL 3

neostigmine methylsulfate intravenous solution 10 mg/10ml, 5 mg/10ml

1

pyridostigmine bromide er

1

pyridostigmine bromide oral

1


17


Antimycobacterials

Antimycobacterials, Other

dapsone oral 1

rifabutin 1

Antituberculars

CAPASTAT SULFATE 3

cycloserine oral 1

ethambutol hcl oral 1

isoniazid injection 1

isoniazid oral 1

PASER 3

PRIFTIN 3

pyrazinamide oral 1

rifampin intravenous 1

rifampin oral 1

SIRTURO 3

TRECATOR 3

Antineoplastics

Alkylating Agents

BENDEKA 4 PA

busulfan 4

carboplatin 4

carmustine 4

cisplatin intravenous solution

4

cyclophosphamide injection

4

cyclophosphamide oral CM

dacarbazine 4

GLEOSTINE CM

ifosfamide 4

LEUKERAN CM

MATULANE CM

melphalan CM

melphalan hcl 4


MYLERAN CM

oxaliplatin 4

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

4

TEMODAR INTRAVENOUS

4

temozolomide CM PA

ZANOSAR 4

Antiandrogens

abiraterone acetate CM PA

bicalutamide CM

flutamide CM

nilutamide CM

XTANDI CM PA

Antiangiogenic Agents

POMALYST CM PA

REVLIMID CM PA

THALOMID CM PA

Antiestrogens/Modifiers

EMCYT CM

fulvestrant 4

SOLTAMOX CM PV*

tamoxifen citrate oral tablet 10 mg

CM

tamoxifen citrate oral tablet 20 mg

CM PV*

toremifene citrate CM

Antimetabolites

ALIMTA 4

capecitabine CM PA

cladribine 4

clofarabine 4

cytarabine 4


18


cytarabine (pf) 4

decitabine 4 PA

DROXIA 3

floxuridine injection 4

fludarabine phosphate 4

fluorouracil intravenous 4

FOLOTYN 4 PA

gemcitabine hcl 4

hydroxyurea oral CM

mercaptopurine oral CM

NIPENT 4

TABLOID CM

Antineoplastics, Other

ABRAXANE 4

adriamycin 4

ARRANON 4

arsenic trioxide intravenous

4

azacitidine 4

bleomycin sulfate 4

dactinomycin 4

daunorubicin hcl 4

dexrazoxane hcl 4

diclofenac sodium transdermal gel 3 %

1 ST; QL

docetaxel 4

doxorubicin hcl 4

doxorubicin hcl liposomal

4

epirubicin hcl 4

ETHYOL 4

FLUOROPLEX 3

FLUOROURACIL EXTERNAL CREAM 0.5 %

2


fluorouracil external cream 5 %

1

fluorouracil external solution

4

HALAVEN 4 PA

HERCEPTIN HYLECTA

4 PA

idarubicin hcl 4

irinotecan hcl 4

ISTODAX (OVERFILL) 4 PA

IXEMPRA KIT 4

leucovorin calcium injection

1

leucovorin calcium oral CM

levoleucovorin calcium 4

levoleucovorin calcium pf

4

LONSURF CM PA

MARQIBO 4

mitomycin intravenous 4

mitoxantrone hcl 4 PA

mutamycin 4

NINLARO CM PA

ONCASPAR 4

ONIVYDE 4

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

4

PICATO 3 ST

PIQRAY (200 MG DAILY DOSE)

CM PA


CM PA


CM PA

PROLEUKIN 4


19


ROZLYTREK CM PA

SYNRIBO 4 PA

teniposide 4

TOTECT 4

VELCADE 4 PA

vinblastine sulfate 4

vincristine sulfate 4

vinorelbine tartrate 4

VYXEOS 4 PA

ZALTRAP 4 PA

ZOLINZA CM PA

Aromatase Inhibitors, 3rd Generation

anastrozole oral CM PV*

exemestane CM PV*

letrozole oral CM

Enzyme Inhibitors

etoposide intravenous 4

etoposide oral CM

HYCAMTIN ORAL CM

KYPROLIS 4 PA

RUBRACA CM PA

toposar 4

topotecan hcl 4

Molecular Target Inhibitors

AFINITOR DISPERZ CM PA

BELEODAQ 4 PA

BOSULIF CM PA

CABOMETYX CM PA

CAPRELSA ORAL TABLET 100 MG

CM PA; QL

CAPRELSA ORAL TABLET 300 MG

CM PA

COMETRIQ (100 MG DAILY DOSE)

CM PA



CM PA


CM PA

COTELLIC CM PA

ERIVEDGE CM PA

erlotinib hcl oral tablet 100 mg, 150 mg

CM PA

erlotinib hcl oral tablet 25 mg

CM PA; QL

everolimus oral tablet 2.5 mg, 5 mg, 7.5 mg

CM PA; QL

FARYDAK CM PA

GILOTRIF CM PA; QL

IBRANCE CM PA

ICLUSIG ORAL TABLET 15 MG

CM PA; QL

ICLUSIG ORAL TABLET 45 MG

CM PA

imatinib mesylate CM PA

IMBRUVICA CM PA

INLYTA CM PA

JAKAFI ORAL TABLET 10 MG

CM PA; QL

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

CM PA

JEVTANA 4 PA

KOSELUGO CM PA

LENVIMA (10 MG DAILY DOSE)

CM PA


CM PA


CM PA


CM PA


CM PA


20



CM PA


CM PA


CM PA

LYNPARZA CM PA

MEKINIST CM PA

NEXAVAR CM PA

RYDAPT CM PA

SPRYCEL CM PA

STIVARGA CM PA

SUTENT CM PA

TAFINLAR CM PA

TAGRISSO ORAL TABLET 40 MG

CM PA; QL

TAGRISSO ORAL TABLET 80 MG

CM PA

TASIGNA CM PA

TURALIO CM PA

TYKERB CM PA

VENCLEXTA CM PA

VENCLEXTA STARTING PACK

CM PA

VOTRIENT CM PA

XALKORI CM PA

ZELBORAF CM PA

ZYDELIG CM PA

ZYKADIA CM PA

Monoclonal Antibody/Antibody-Drug Conjugate

ADCETRIS 4 PA

ARZERRA 4 PA

AVASTIN 4 PA

BAVENCIO 4 PA

BLINCYTO 4 PA


CYRAMZA 4 PA

DARZALEX 4 PA

EMPLICITI 4 PA

ENHERTU 4 PA

ERBITUX 4 PA

GAZYVA 4 PA

HERCEPTIN 4 PA

KADCYLA 4 PA

KANJINTI 4 PA

MVASI 4 PA

OPDIVO 4 PA

PADCEV 4 PA

PERJETA 4 PA

POLIVY 4 PA

RITUXAN 4 PA

RITUXAN HYCELA 4 PA

RUXIENCE 4 PA

TECENTRIQ 4 PA

TRAZIMERA 4 PA

UNITUXIN 4 PA

YERVOY 4 PA

ZIRABEV 4 PA

Retinoids

bexarotene CM PA

PANRETIN 3

TARGRETIN EXTERNAL

4 PA

tretinoin oral CM

Treatment Adjuncts

ELITEK 4

mesna 4

MESNEX ORAL CM

Antiparasitics

Anthelmintics

albendazole oral 1 PA


21


EMVERM 2

ivermectin oral 1

praziquantel oral 1

SKLICE 3

Antiprotozoals

ALINIA 2

atovaquone oral 1

atovaquone-proguanil hcl

1

BENZNIDAZOLE 3

chloroquine phosphate oral

1 QL

COARTEM 3

hydroxychloroquine sulfate oral

1 QL

IMPAVIDO 3

mefloquine hcl 1

pentamidine isethionate 1

primaquine phosphate 1

pyrimethamine oral 4 PA

quinine sulfate oral 1 PA

Pediculicides/Scabicides

crotan 1

lindane 3

malathion 1

permethrin external 1

spinosad 1

sulfurated lime 1

Antiparkinson Agents

Anticholinergics

benztropine mesylate 1

trihexyphenidyl hcl 1

Antiparkinson Agents, Other

amantadine hcl oral 1


entacapone 1

tolcapone 1

Dopamine Agonists

APOKYN 4 PA; QL

bromocriptine mesylate oral

3

NEUPRO 3 ST

pramipexole dihydrochloride

1

pramipexole dihydrochloride er

1

ropinirole hcl 1

ropinirole hcl er 1

Dopamine Precursors/L-Amino Acid Decarboxylase Inhibitors

carbidopa oral 1

carbidopa-levodopa 1

carbidopa-levodopa er 1

carbidopa-levodopa-entacapone

1

Monoamine Oxidase B (MAO-B) Inhibitors

rasagiline mesylate oral 1

selegiline hcl oral 1

Antipsychotics

1st Generation/Typical

chlorpromazine hcl injection

1

chlorpromazine hcl oral 1

fluphenazine decanoate injection

1

fluphenazine hcl 1

haloperidol decanoate intramuscular

1

haloperidol lactate 1


22


haloperidol oral 1

loxapine succinate 1

molindone hcl 1

pimozide 1

thioridazine hcl oral 1

thiothixene 1

trifluoperazine hcl 1

2nd Generation/Atypical

ABILIFY MAINTENA 3

aripiprazole 1 QL

FANAPT 3 ST; QL

FANAPT TITRATION PACK

3 ST; QL

INVEGA SUSTENNA 3

INVEGA TRINZA 3

LATUDA 3 QL

olanzapine intramuscular

1

olanzapine oral 1 QL

paliperidone er 1 QL

quetiapine fumarate 1 QL

quetiapine fumarate er 1 QL

REXULTI 3 QL

RISPERDAL CONSTA 3

risperidone 1 QL

SAPHRIS 2 QL

ziprasidone hcl 1 QL

ziprasidone mesylate 1

ZYPREXA RELPREVV 3

Treatment-Resistant

clozapine 1 QL

Antivirals

Anti-cytomegalovirus (CMV) Agents

cidofovir intravenous 1


ganciclovir sodium 1

valganciclovir hcl 1

Anti-hepatitis B (HBV) Agents

adefovir dipivoxil 4

BARACLUDE ORAL SOLUTION

4 QL

entecavir 4 QL

EPIVIR HBV ORAL SOLUTION

4

lamivudine oral tablet 100 mg

4

VEMLIDY 4

Anti-hepatitis C (HBV) Agents

EPCLUSA 4 PA; QL

HARVONI 4 PA; QL

MAVYRET 4 PA; QL

ZEPATIER 4 PA; QL

Anti-hepatitis C (HCV) Agents

PEGASYS 4 PA

PEGASYS PROCLICK 4 PA

ribavirin oral 4

Anti-hepatitis C (HCV) Agents, Other

INTRON A 4 PA

Antiherpetic Agents

acyclovir external 1

acyclovir oral 1

acyclovir sodium 1

DENAVIR 3

famciclovir oral 1

valacyclovir hcl oral 1 QL


23


Anti-HIV Agents, Integrase Inhibitors (INSTI)

GENVOYA 3

ISENTRESS 2

ISENTRESS HD 2

STRIBILD 3

TIVICAY 2

TIVICAY PD 2

TRIUMEQ 2

TYBOST 2

Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)

COMPLERA 2

EDURANT 2

efavirenz 1

INTELENCE 2

JULUCA 2

nevirapine 1

nevirapine er 1

ODEFSEY 3

SYMFI 2

SYMFI LO 2

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)

abacavir sulfate 1

abacavir sulfate-lamivudine

1

abacavir-lamivudine-zidovudine

1

BIKTARVY 3

CIMDUO 2

DESCOVY 3 PA; PV*


didanosine 1

EMTRIVA 2

lamivudine oral solution 1

lamivudine oral tablet 150 mg, 300 mg

1

lamivudine-zidovudine 1

RETROVIR INTRAVENOUS

2

stavudine 1

tenofovir disoproxil fumarate

1 PV*

TRUVADA 2 PV*

VIREAD ORAL POWDER

2

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG

2

zidovudine 1

Anti-HIV Agents, Other

FUZEON 2

SELZENTRY 2 PA

Anti-HIV Agents, Protease Inhibitors

APTIVUS 2

atazanavir sulfate 1

CRIXIVAN 2

EVOTAZ 2

fosamprenavir calcium 1

INVIRASE 2

KALETRA ORAL TABLET

2

LEXIVA ORAL SUSPENSION

2

lopinavir-ritonavir 1

NORVIR ORAL PACKET

2


24


NORVIR ORAL SOLUTION

2

PREZCOBIX 2

PREZISTA 2

REYATAZ ORAL PACKET

2

ritonavir 1

VIRACEPT 2

Anti-influenza Agents

oseltamivir phosphate oral

1 QL

RELENZA DISKHALER 3 QL

rimantadine hcl 1

Anxiolytics

Anxiolytics, Other

buspirone hcl oral 1

hydroxyzine hcl intramuscular

1

hydroxyzine hcl oral 1

hydroxyzine pamoate oral

1

Benzodiazepines

alprazolam er 1 QL

alprazolam intensol 1 QL

alprazolam oral tablet 1 QL

alprazolam xr 1 QL

chlordiazepoxide hcl 1 QL

clonazepam oral 1 QL

clorazepate dipotassium

1 QL

diazepam injection 1

diazepam intensol 1

diazepam intramuscular

1

diazepam oral 1

estazolam 1 QL

lorazepam injection 1


lorazepam intensol 1 QL

lorazepam oral concentrate 2 mg/ml

1 QL

lorazepam oral tablet 1 QL

oxazepam 1 QL

triazolam 1 QL

Bipolar Agents

Mood Stabilizers

divalproex sodium er 1

divalproex sodium oral 1

lithium 1

lithium carbonate er 1

lithium carbonate oral 1

Blood Glucose Monitoring

ACCU-CHEK FASTCLIX LANCET KIT

2

ACCU-CHEK MULTICLIX LANCET DEVICE KIT

2

ACCU-CHEK SOFTCLIX LANCET DEVICE KIT

2

BAYER CONTOUR LINK 2.4

2

CEQUR SIMPLICITY 2U

3

CHEMSTRIP UGK 3

CONTOUR CONTROL 2

CONTOUR NEXT CONTROL

2

CONTOUR NEXT LINK 2

CONTOUR NEXT MONITOR

2

CONTOUR NEXT TEST

2 QL

CONTOUR TEST 2 QL


25


INPEN 100-BLUE-LILLY

3

INPEN 100-BLUE-NOVO

3

INPEN 100-GRAY-LILLY

3

INPEN 100-GREY-NOVO

3

INPEN 100-PINK-LILLY

3

INPEN 100-PINK-NOVO

3

KETONE TEST 3

KETOSTIX 3

LANCETS 2

NOVOPEN ECHO 3

ONETOUCH DELICA LANCING DEV

3

ONETOUCH DELICA PLUS LANCING

3

Blood Glucose Regulators

Antidiabetic Agents

acarbose oral 1

BYDUREON 2 ST; QL

BYDUREON BCISE AUTOINJECTOR

2 ST; QL

BYETTA 10 MCG PEN 2 ST; QL

BYETTA 5 MCG PEN 2 ST; QL

FARXIGA 2 ST

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1

glipizide-metformin hcl 1

glyburide micronized 1

glyburide oral 1


glyburide-metformin 1

GLYXAMBI 2 ST

JANUMET 2 ST

JANUMET XR 2 ST

JANUVIA 2 ST

JARDIANCE 2 ST

JENTADUETO 2 ST

JENTADUETO XR 2 ST

metformin hcl er 1

metformin hcl ir 1

miglitol 1

nateglinide 1

OZEMPIC 2 ST; QL

pioglitazone hcl 1

pioglitazone hcl-glimepiride

1

pioglitazone hcl-metformin hcl

1

repaglinide 1

SYNJARDY 2 ST

SYNJARDY XR 2 ST

TRADJENTA 2 ST

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

2 ST; QL

VICTOZA 2 ST; QL

XIGDUO XR 2 ST

Glycemic Agents

diazoxide oral 1

GLUCAGON EMERGENCY KIT

2 Made by Lilly

GLUCAGON EMERGENCY KIT

2Made by Fresenius


26


Insulins

HUMALOG KWIKPEN 2

HUMALOG MIX 50/50 KWIKPEN

2

HUMALOG MIX 50/50 VIAL

2

HUMALOG MIX 75/25 KWIKPEN

2

HUMALOG MIX 75/25 VIAL

2

HUMALOG U-100 JUNIOR KWIKPEN

2

HUMALOG VIAL 2

HUMULIN 70/30 KWIKPEN

2

HUMULIN 70/30 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2

HUMULIN R U-500 KWIKPEN

2

HUMULIN R U-500 VIAL

2

HUMULIN R VIAL 2

LANTUS SOLOSTAR 2

LANTUS U-100 VIAL 2

LEVEMIR U-100 FLEXTOUCH

2

LEVEMIR U-100 VIAL 2

NOVOLIN 70/30 FLEXPEN

3

NOVOLIN 70/30 FLEXPEN RELION

3

NOVOLIN 70/30 RELION

3

NOVOLIN 70/30 VIAL 3

NOVOLIN N FLEXPEN 3

NOVOLIN N FLEXPEN RELION

3


NOVOLIN N RELION 3

NOVOLIN N VIAL 3

NOVOLIN R FLEXPEN 3

NOVOLIN R FLEXPEN RELION

3

NOVOLIN R RELION 3

NOVOLIN R VIAL 3

NOVOLOG FLEXPEN 3

NOVOLOG MIX 70/30 FLEXPEN

3

NOVOLOG MIX 70/30 VIAL

3

NOVOLOG PENFILL 3

NOVOLOG U-100 VIAL 3

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

TRESIBA 3

TRESIBA FLEXTOUCH

3

Blood Products/Modifiers/Volume Expanders

CEPROTIN 4

SOLIRIS 4 PA

Anticoagulants

acd formula a 1

anticoagulant cit dext soln a

1

argatroban 1

bivalirudin trifluoroacetate

1

ELIQUIS 2 QL

ELIQUIS DVT/PE STARTER PACK

2 QL

enoxaparin sodium 1 QL

fondaparinux sodium 1 QL


27


heparin (porcine) in nacl intravenous solution

1

heparin sod (porcine) in d5w

1

heparin sodium (porcine)

1

heparin sodium (porcine) pf

1

jantoven 1

PRADAXA 2 QL

SAVAYSA 3 QL

THROMBATE III 4

warfarin sodium oral 1

XARELTO 2 QL

XARELTO STARTER PACK

2 QL

ZONTIVITY 3

Blood Formation Modifiers

ADAKVEO 4 PA

anagrelide hcl 1

ARANESP (ALBUMIN FREE)

4 PA

MOZOBIL 4 PA; QL

NEULASTA 4 PA

NEULASTA ONPRO 4 PA

NIVESTYM 4 PA

PROMACTA 4 PA

REBLOZYL 4 PA

RETACRIT 4 PA

Hemostasis Agents

ADVATE 4

aminocaproic acid intravenous

1

aminocaproic acid oral 1

BENEFIX 4


COAGADEX 4

CORIFACT 4

ELOCTATE 4

FEIBA 4

HEMLIBRA 4

HEMOFIL M 4

HUMATE-P 4

KOATE 4

KOATE-DVI 4

KOGENATE FS 4

KOVALTRY 4

NOVOSEVEN RT 4

NUWIQ 4

OBIZUR 4

PROFILNINE 4

PROFILNINE SD 4

protamine sulfate intravenous

1

RECOMBINATE 4

RIASTAP 4

RIXUBIS 4

tranexamic acid oral 1

VONVENDI 4

XYNTHA 4

XYNTHA SOLOFUSE 4

Platelet Modifying Agents

aspirin-dipyridamole er 1

BRILINTA 2

CABLIVI 4 PA; QL

cilostazol 1

clopidogrel bisulfate oral

1

dipyridamole oral 1

eptifibatide 1

prasugrel hcl 1


28


Cardiovascular Agents

Alpha-adrenergic Agonists

clonidine 1

clonidine hcl oral 1

guanfacine hcl 1

methyldopa 1

methyldopa-hydrochlorothiazide

1

midodrine hcl 1

Alpha-adrenergic Blocking Agents

doxazosin mesylate oral

1

phenoxybenzamine hcl oral

1

phentolamine mesylate injection

1

prazosin hcl oral 1

Angiotensin II Receptor Antagonists

amlodipine besylate-valsartan

1

amlodipine-olmesartan 1

amlodipine-valsartan-hctz

1

candesartan cilexetil 1

candesartan cilexetil-hctz

1

irbesartan 1

irbesartan-hydrochlorothiazide

1

losartan potassium oral 1

losartan potassium-hctz 1

olmesartan medoxomil oral

1


olmesartan medoxomil-hctz

1

olmesartan-amlodipine-hctz

1

telmisartan 1

telmisartan-amlodipine 1

telmisartan-hctz 1

valsartan 1

valsartan-hydrochlorothiazide

1

Angiotensin-converting Enzyme (ACE) Inhibitors

amlodipine besylate-benazepril hcl

1

benazepril hcl oral 1

benazepril-hydrochlorothiazide

1

captopril oral 1

captopril-hydrochlorothiazide

1

enalapril maleate oral 1

enalaprilat 1

enalapril-hydrochlorothiazide

1

fosinopril sodium 1

fosinopril sodium-hctz 1

lisinopril oral 1

lisinopril-hydrochlorothiazide

1

moexipril hcl 1

perindopril erbumine 1

quinapril hcl 1

quinapril-hydrochlorothiazide

1

ramipril 1

trandolapril 1


29


trandolapril-verapamil hcl er

1

Antiarrhythmics

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

1

amiodarone hcl 1

disopyramide phosphate

1

dofetilide 1

flecainide acetate 1

ibutilide fumarate 1

lidocaine hcl (cardiac) 1

lidocaine hcl (cardiac) pf

1

lidocaine in d5w intravenous solution 4-5 mg/ml-%, 8-5 mg/ml-%

1

mexiletine hcl oral 1

procainamide hcl injection

1

propafenone hcl 1

propafenone hcl er 1

quinidine gluconate er 1

quinidine sulfate 1

sorine 1

sotalol hcl (af) 1

sotalol hcl oral 1

Beta-adrenergic Blocking Agents

acebutolol hcl oral 1

atenolol oral 1

atenolol-chlorthalidone 1

betaxolol hcl oral 1

bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide

1


BYSTOLIC 2

carvedilol 1

carvedilol phosphate er 1

esmolol hcl intravenous solution 100 mg/10ml

1

esmolol hcl-sodium chloride

1

labetalol hcl intravenous solution

1

labetalol hcl oral 1

metoprolol succinate er 1

metoprolol tartrate intravenous

1

metoprolol tartrate intravenous solution cartridge 5 mg/5ml

1

metoprolol tartrate oral 1

metoprolol-hydrochlorothiazide

1

pindolol 1

propranolol hcl er 1

propranolol hcl intravenous

1

propranolol hcl oral 1

propranolol-hctz 1

timolol maleate oral 1

Calcium Channel Blocking Agents

amlodipine besylate oral

1

cartia xt 1

diltiazem hcl er beads 1

diltiazem hcl er coated beads

1

diltiazem hcl er oral capsule extended release 12 hour

1


30


diltiazem hcl intravenous

1

diltiazem hcl oral 1

dilt-xr 1

felodipine er 1

matzim la 1

nicardipine hcl intravenous

1

nifedipine er 1

nifedipine er osmotic release

1

nimodipine oral 1

nisoldipine er 1

taztia xt 1

tiadylt er 1

verapamil hcl er 1

verapamil hcl intravenous

1

verapamil hcl oral 1

Cardiovascular Agents, Other

aliskiren fumarate 1

alprostadil injection 1

amiloride-hydrochlorothiazide

1

amlodipine-atorvastatin 1

CORLANOR 3 PA; QL

DEMSER 3

digitek 1

digox 1

digoxin injection 1

digoxin oral 1

dobutamine hcl 1

dobutamine in d5w 1

dopamine hcl intravenous

1

dopamine in d5w 1


ENTRESTO 2 QL

ephedrine sulfate intravenous solution

1

epinephrine injection solution prefilled syringe

1

epinephrine pf 1

metyrosine 1

milrinone lactate 1

milrinone lactate in dextrose

1

norepinephrine bitartrate intravenous

1

pentoxifylline er 1

phenylephrine hcl intravenous solution

1

ranolazine er 1

spironolactone-hctz 1

triamterene-hctz 1

VYNDAMAX 4 PA; QL

Diuretics, Carbonic Anhydrase Inhibitors

acetazolamide er 1

acetazolamide oral 1

acetazolamide sodium 1

methazolamide oral 1

Diuretics, Loop

bumetanide 1

ethacrynate sodium 1

ethacrynic acid 1

furosemide injection 1

furosemide oral 1

torsemide 1

Diuretics, Potassium-sparing

amiloride hcl oral 1

eplerenone 1


31


spironolactone oral 1

triamterene oral 1

Diuretics, Thiazide

chlorthalidone 1

hydrochlorothiazide oral

1

indapamide 1

metolazone 1

Dyslipidemics, Fibric Acid Derivatives

fenofibrate micronized 1

fenofibrate oral capsule 1

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

1

fenofibric acid oral capsule delayed release

1

gemfibrozil oral 1

Dyslipidemics, HMG CoA Reductase Inhibitors

atorvastatin calcium oral tablet 10 mg, 20 mg

1 PV*

atorvastatin calcium oral tablet 40 mg, 80 mg

1

LIVALO 3 ST

lovastatin 1 PV

pravastatin sodium 1

rosuvastatin calcium 1

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg

1 PV*

simvastatin oral tablet 80 mg

1

Dyslipidemics, Other

cholestyramine light 1


cholestyramine oral 1

colesevelam hcl 1

colestipol hcl 1

ezetimibe 1

ezetimibe-simvastatin 1

NEXLETOL 2 PA; QL

NEXLIZET 2 PA; QL

niacin er (antihyperlipidemic)

1

omega-3-acid ethyl esters

1 PA

PRALUENT 2 PA; QL

prevalite 1

REPATHA 2 PA; QL

REPATHA PUSHTRONEX SYSTEM

2 PA; QL

REPATHA SURECLICK

2 PA; QL

Vasodilators, Direct-acting Arterial

hydralazine hcl injection

1

hydralazine hcl oral 1

minoxidil oral 1

Vasodilators, Direct-acting Arterial/Venous

DILATRATE-SR 3

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

1

isosorbide mononitrate 1

isosorbide mononitrate er

1

NITRO-BID 3

nitroglycerin 1

nitroglycerin in d5w 1


32


NITROMIST 3

nitroprusside sodium 1

RECTIV 3

Central Nervous System Agents

Attention Deficit Hyperactivity Disorder Agents, Amphetamines

amphetamine sulfate 1 PA; QL

amphetamine-dextroamphetamine

1 PA; QL

amphetamine-dextroamphetamine er

1 PA; QL

dextroamphetamine sulfate

1 PA; QL

dextroamphetamine sulfate er

1 PA; QL

VYVANSE 2 PA; QL

Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines

atomoxetine hcl 1 QL

clonidine hcl er 1

DAYTRANA 3 ST; PA; QL

dexmethylphenidate hcl 1 PA; QL

dexmethylphenidate hcl er

1 PA; QL

guanfacine hcl er 1

metadate er 1 PA; QL

methylphenidate hcl er 1 PA; QL

methylphenidate hcl er (cd)

1 PA; QL

methylphenidate hcl er (la)

1 PA; QL

methylphenidate hcl oral

1 PA; QL

QUILLIVANT XR 3 ST; PA; QL


relexxii 1 PA; QL

Central Nervous System, Other

caffeine citrate 1

GRALISE 3 ST; QL

riluzole 1 PA; QL

tetrabenazine 4 PA

Fibromyalgia Agents

duloxetine hcl oral 1 QL

pregabalin oral 1 QL

SAVELLA 3 ST; QL

SAVELLA TITRATION PACK

3 ST; QL

Multiple Sclerosis Agents

AVONEX PEN 4 PA; QL

AVONEX PREFILLED 4 PA; QL

BAFIERTAM 4 PA; QL

BETASERON 4 PA; QL

COPAXONE 4 PA; QL

dalfampridine er 4 PA; QL

GILENYA 4 PA; QL

glatiramer acetate 4 PA; QL

glatopa 4 PA; QL

MAYZENT 4 PA; QL

MAYZENT STARTER PACK

4 PA; QL

TECFIDERA 4 PA; QL

TYSABRI 4 PA; QL

Dental and Oral Agents

cavarest 1

cevimeline hcl 1

chlorhexidine gluconate mouth/throat

1

CLINPRO 5000 3


33


DEBACTEROL 3

DENTA 5000 PLUS 3

DENTAGEL 3

easygel 1

FLUORIDEX 3

fluoridex daily renewal 1

FLUORIDEX ENHANCED WHITENING

3

FLUORIDEX SENSITIVITY RELIEF

3

neutral sodium fluoride 1

oralone 1

paroex 1

periogard 1

pilocarpine hcl oral 1

prevident mouth/throat 1

sodium fluoride 5000 plus

1

sodium fluoride 5000 ppm

1

sodium fluoride 5000 sensitive

1

sodium fluoride dental 1

triamcinolone acetonide mouth/throat

1

Dermatological Agents

acitretin 1

adapalene external cream

1 PA

adapalene external gel 1 PA

adapalene-benzoyl peroxide

1

ammonium lactate external

1

amnesteem 1 PA

azelaic acid external 1


AZELEX 3

benzoyl peroxide-erythromycin

1

calcipotriene external cream

1

calcipotriene external ointment

1

calcipotriene external solution

1

calcipotriene-betameth diprop external suspension

1 QL

calcitriol external 1

claravis 1 PA

clindacin etz external swab

1

clindacin-p 1

clindamycin phosphate-benzoyl peroxide

1

clindamycin phosphate external

1

clindamycin-tretinoin 1

coal tar external 1

CONDYLOX 3

dapsone external gel 5 %

1

doxepin hcl external 3

DUPIXENT 4 PA; QL

EPIDUO FORTE 3

ery 1

erythromycin external 1

imiquimod external 1

isotretinoin oral 1 PA

lactic acid e 1

lactic acid external 1

methoxsalen rapid 1

metronidazole external 1


34


MIRVASO 2

myorisan 1 PA

neuac external gel 1

pimecrolimus 1

podofilox external 1

REGRANEX 3 PA

rosadan external cream 1

rosadan external gel 1

SANTYL 3

selenium sulfide external lotion

1

STELARA INTRAVENOUS

4 PA

STELARA SUBCUTANEOUS

4 PA; QL

sulfacetamide sodium (acne)

1

tacrolimus external ointment

1

TALTZ 4 PA

tazarotene external 1

TAZORAC EXTERNAL CREAM 0.05 %

3

TAZORAC EXTERNAL GEL

3

TREMFYA 4 PA

tretinoin external 1 PA

tretinoin microsphere 1 PA

tretinoin microsphere pump

1 PA

zenatane 1 PA

Electrolytes/Minerals/Metals/Vitamins

Electrolyte/Mineral Replacement

calcium chloride 1

calcium gluconate intravenous

1


CARBAGLU 4

chromic chloride intravenous

1

corvita 150 1

dextrose in lactated ringers

1

dextrose intravenous 1

dextrose-nacl 1

dextrose-sodium chloride

1

effer-k oral tablet effervescent 25 meq

1

ferocon 1

ferotrinsic 1

ferraplus 90 1

ferrocite plus 1

fluoritab 1 PV

foltrin 1

hemocyte-f 1

hemocyte-plus 1

iodine strong oral 1

kcl in dextrose-nacl 1

kcl-lactated ringers-d5w 1

klor-con 1

klor-con 10 1

klor-con m10 1

KLOR-CON M15 3

klor-con m20 1

klor-con sprinkle 1

klor-con/ef 1

k-prime 1

k-tan plus 1

lactated ringers intravenous

1

levocarnitine oral solution

1


35


levocarnitine oral tablet 1

levocarnitine sf 1

ludent 1 PV

magnesium chloride injection

1

magnesium sulfate in d5w

1

magnesium sulfate injection

1

magnesium sulfate intravenous solution 2 gm/50ml, 20 gm/500ml, 4 gm/100ml, 4 gm/50ml, 40 gm/1000ml

1

na ferric gluc cplx in sucrose

1

nafrinse 1 PV

nafrinse drops 1 PV

nutrilipid 1

phosphorous 1

phospho-trin 250 neutral

1

polysaccharide iron forte

1

pot bicarb-pot chloride 1

potassium acetate intravenous

1

potassium bicarbonate oral

1

potassium chloride crys er

1

potassium chloride er 1

potassium chloride in dextrose

1

potassium chloride in nacl

1

potassium chloride intravenous

1


potassium chloride oral 1

potassium citrate er 1

potassium phosphates(71 meq k)

1

purevit dualfe plus 1

ringers 1

se-tan plus 1

sod citrate-citric acid 1

sodium acetate intravenous

1

sodium bicarbonate intravenous

1

sodium chloride (pf) 1

sodium chloride injection

1

sodium chloride intravenous

1

sodium fluoride oral 1 PV

sodium phosphates 1

tl-hem 150 1

trigels-f forte 1

virt-phos 250 neutral 1

Electrolyte/Mineral/Metal Modifiers

CHEMET 3

clovique 4 PA

deferasirox 1 PA

kionex 1

sodium polystyrene sulfonate

1

sps 1

trientine hcl 4 PA

VELTASSA 3

Phosphate Binders

calcium acetate (phos binder)

1


36


calcium acetate oral tablet 667 mg

1

FOSRENOL ORAL PACKET

3

lanthanum carbonate 1

PHOSLYRA 3

sevelamer carbonate 1

sevelamer hcl 1

Vitamins

adc/f (0.5mg/ml) 1

airavite 1

b-6 folic acid 1

biocel 1

bp vit 3 1

b-plex 1

b-plex plus 1

cod liver oil oral oil 1

cyanocobalamin injection solution 1000 mcg/ml

1

ergocalciferol oral capsule

1

fabb 1

fa-vitamin b-6-vitamin b-12

1

folbee 1

folbee plus 1

folic acid injection 1

folic acid oral tablet 1 mg

1

folic acid oral tablet 400 mcg, 800 mcg

1 PV

folplex 2.2 1

hydroxocobalamin acetate

1

lysiplex plus oral tablet 1

multi prenatal 1 PV


multi-vit/iron/fluoride 1

multi-vitamin/fluoride 1

multivitamin/fluoride oral solution

1

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

1

multivitamin/fluoride/iron

1

multi-vitamin/fluoride/iron

1

multivitamins/fluoride 1

mvc-fluoride 1

NASCOBAL 3

nephronex oral tablet 1

nufol 1

nutrifac zx 1

ONE VITE WOMENS 3 PV

ONE-A-DAY WOMENS PRENATAL 1

3 PV

phytonadione injection 1

phytonadione oral 1

pnv prenatal plus multivit+dha

1

prenatal multi +dha 1 PV

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

1 PV

prenatal oral tablet 27-1 mg

1

prenatal plus iron 1

pyridoxine hcl injection 1

thiamine hcl injection 1

triphrocaps 1

tri-vitamin/fluoride 1

tri-vite/fluoride 1

v-c forte 1

virt-caps 1


37


virt-gard 1

vita s forte 1

vitacel 1

vita-min 1

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

1

vitamin k1 injection 1

vitamins acd-fluoride 1

vp-pnv-dha 1

vp-vite rx 1

westab one 1

Gastrointestinal Agents

Antispasmodics, Gastrointestinal

atropine sulfate injection solution 8 mg/20ml

1

atropine sulfate injection solution prefilled syringe 0.5 mg/5ml

1

CUVPOSA 3

dicyclomine hcl intramuscular

1

dicyclomine hcl oral 1

ed-spaz 1

glycopyrrolate injection solution

1

glycopyrrolate oral tablet 1 mg, 2 mg

1

glycopyrrolate pf 1

hyoscyamine sulfate oral

1

hyoscyamine sulfate sl 1

hyoscyamine sulfate sublingual

1


methscopolamine bromide oral

3

oscimin 1

Gastrointestinal Agents, Other

amoxicill-clarithro-lansopraz

1

cromolyn sodium oral 1

diphenoxylate-atropine 1

GATTEX 4 PA

loperamide hcl oral capsule

1

MOTOFEN 3

OMECLAMOX-PAK 2

PYLERA 2

sodium bicarbonate oral powder

1

SYMPROIC 2 ST; QL

ursodiol oral 1

Histamine2 (H2) Receptor Antagonists

cimetidine hcl 1

cimetidine oral 1

famotidine intravenous 1

famotidine oral suspension reconstituted

1

famotidine oral tablet 20 mg, 40 mg

1

famotidine premixed 1

nizatidine 1

Irritable Bowel Syndrome Agents

alosetron hcl 1 PA

LINZESS 2 ST; QL

Laxatives

bisacodyl ec 1 PV; QL


38


cascara sagrada oral fluid extract

1

citroma 1 PV; QL

clearlax 1 PV; QL

CLENPIQ 3

constulose 1

enulose 1

gavilax oral powder 1 PV; QL

gavilyte-c 1 PV; QL

gavilyte-g 1 PV; QL

gavilyte-h 1

gavilyte-n with flavor pack

1 PV; QL

generlac 1

gentle laxative oral 1 PV; QL

glycolax 1 PV; QL

lactulose encephalopathy

1

lactulose oral solution 1

magnesium citrate oral solution

1 PV; QL

mineral oil heavy oral 1

peg 3350-kcl-na bicarb-nacl

1 PV; QL

peg-3350/electrolytes 1 PV; QL

qc magnesium citrate 1 PV; QL

SUPREP BOWEL PREP KIT

3

trilyte 1 PV; QL

Protectants

misoprostol oral 1

sucralfate oral 1

Proton Pump Inhibitors

DEXILANT 2 QL

esomeprazole sodium 1


lansoprazole oral capsule delayed release

1 QL

lansoprazole oral tablet delayed release dispersible 15 mg

1 QL

omeprazole oral capsule delayed release

1 QL

pantoprazole sodium intravenous

1 QL

pantoprazole sodium oral tablet delayed release

1 QL

rabeprazole sodium oral tablet delayed release

1 QL

Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment

ALDURAZYME 4 PA

CERDELGA 4 PA

CHOLBAM 4 PA

CREON 2

CYSTAGON 4

ELAPRASE 4 PA

FABRAZYME 4 PA

KANUMA 4 PA

KUVAN 4 PA

LUMIZYME 4 PA

MEPSEVII 4 PA

miglustat 4 PA

MYALEPT 4 PA

NAGLAZYME 4 PA

nitisinone 4 PA

ORFADIN ORAL CAPSULE 20 MG

4 PA


39


ORFADIN ORAL SUSPENSION

4 PA

PROLASTIN-C 4 PA

RAVICTI 4 PA

REVCOVI 4 PA

sod benz-sod phenylacet

1

sodium phenylbutyrate oral

4

STRENSIQ 4 PA

SUCRAID 4

TEGSEDI 4 PA

VIMIZIM 4 PA

ZEMAIRA 4 PA

ZENPEP 2

Genitourinary Agents

Antispasmodics, Urinary

darifenacin hydrobromide er

1

flavoxate hcl 1

GELNIQUE 3 ST

MYRBETRIQ 2

oxybutynin chloride er 1

oxybutynin chloride oral 1

solifenacin succinate 1

tolterodine tartrate 1

tolterodine tartrate er 1

TOVIAZ 3

trospium chloride 1

trospium chloride er 1

Benign Prostatic Hypertrophy Agents

alfuzosin hcl er 1

dutasteride oral 1

dutasteride-tamsulosin hcl

1


finasteride oral tablet 5 mg

1

silodosin 1

tadalafil oral tablet 2.5 mg, 5 mg

1 PA; QL

tamsulosin hcl 1

terazosin hcl 1

Genitourinary Agents, Other

acetic acid irrigation 1

aminoacetic acid 1

argyle sterile saline 1

bethanechol chloride oral

1

curity sterile saline 1

ELMIRON 2

ENCARE 1 PV; QL

glycine irrigation 1

glycine urologic 1

neomycin-polymyxin b gu

1

OPTIONS CONCEPTROL

3 PV; QL

penicillamine oral capsule

4 PA

penicillamine oral tablet 4

phenazo oral tablet 200 mg

1

phenazopyridine hcl oral tablet 100 mg, 200 mg

1

RENACIDIN 3

sodium chloride irrigation

1

sorbitol irrigation solution 3.3 %

1

sorbitol-mannitol 1

TODAY SPONGE 3 PV; QL


40


VCF VAGINAL CONTRACEPTIVE VAGINAL FILM

3 PV; QL

vcf vaginal contraceptive vaginal gel

1 PV; QL

Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal)

ala-cort 1

alclometasone dipropionate

1

amcinonide external lotion

1

beser external lotion 1

betamethasone dipropionate aug

1

betamethasone dipropionate external

1

betamethasone sod phos & acet injection suspension 6 (3-3) mg/ml

1

betamethasone valerate external

1

clobetasol prop emollient base

1

clobetasol propionate e 1

clobetasol propionate emulsion

1

clobetasol propionate external

1

clocortolone pivalate 1

clodan external shampoo

1

cortisone acetate oral 1


DEPO-MEDROL INJECTION SUSPENSION 20 MG/ML

3

desonide external cream

1

desonide external lotion 1

desonide external ointment

1

desoximetasone external cream 0.25 %

1

desoximetasone external gel

1

desoximetasone external liquid

1

desoximetasone external ointment 0.25 %

1

dexamethasone intensol

1

dexamethasone oral 1

dexamethasone sod phosphate pf

1

dexamethasone sodium phosphate injection

1

fludrocortisone acetate oral

1

fluocinolone acetonide body

1

fluocinolone acetonide external

1

fluocinolone acetonide scalp

1

fluocinonide emulsified base

1

fluocinonide external 1

fluticasone propionate external

1

halcinonide 3


41


halobetasol propionate external cream

1

halobetasol propionate external ointment

1

hydrocortisone butyrate external cream

1

hydrocortisone butyrate external ointment

1

hydrocortisone butyrate external solution

1

hydrocortisone external cream 1 %, 2.5 %

1

hydrocortisone external lotion 2.5 %

1

hydrocortisone external ointment 1 %, 2.5 %

1

hydrocortisone oral 1

hydrocortisone valerate 1

methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml

1

methylprednisolone oral

1

methylprednisolone sodium succ

1

mometasone furoate external

1

prednicarbate 1

prednisolone oral solution

1

prednisolone sodium phosphate oral

1

prednisone intensol 1

prednisone oral 1

SOLU-CORTEF INJECTION SOLUTION RECONSTITUTED 1000 MG

3


TEXACORT 3

tovet external foam 1

triamcinolone acetonide external cream

1

triamcinolone acetonide external lotion

1

triamcinolone acetonide external ointment

1

triamcinolone acetonide injection suspension 40 mg/ml

1

triderm 1

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary)

ACTHAR 4 PA

cabergoline 1

chorionic gonadotropin intramuscular

4 PA

desmopressin ace spray refrig

1

desmopressin acetate injection

1

desmopressin acetate oral

1

desmopressin acetate spray

1

INCRELEX 4 PA

NORDITROPIN FLEXPRO

4 PA

novarel intramuscular solution reconstituted 10000 unit

4 PA

NUTROPIN AQ NUSPIN 10

4 PA


4 PA


4 PA


42


oxytocin injection 1

pregnyl 4 PA

Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins)

KORLYM 4 PA; QL

mifepristone 1

Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers)

Androgens

ANADROL-50 3 PA

danazol oral 1

INTRAROSA 3

METHITEST 3 PA

oxandrolone oral 1 PA; QL

testosterone cypionate intramuscular

1 PA

testosterone enanthate intramuscular

1 PA

testosterone transdermal gel 1.62 %, 12.5 mg/act (1%), 20.25 mg/1.25gm (1.62%), 20.25 mg/act (1.62%), 25 mg/2.5gm (1%), 40.5 mg/2.5gm (1.62%), 50 mg/5gm (1%)

1 PA

testosterone transdermal solution

1 PA

Estrogens

afirmelle 1 PV

altavera 1 PV

alyacen 1/35 1 PV

alyacen 7/7/7 1 PV

amabelz 1


amethia 1 PV; QL

amethia lo 1 PV; QL

amethyst 1 PV

apri 1 PV

aranelle 1 PV

ashlyna 1 PV; QL

aubra 1 PV

aubra eq 1 PV

aurovela 1.5/30 1 PV

aurovela 1/20 1 PV

aurovela 24 fe 1 PV

aurovela fe 1.5/30 1 PV

aurovela fe 1/20 1 PV

aviane 1 PV

ayuna 1 PV

azurette 1 PV

balziva 1 PV

bekyree 1 PV

BIJUVA 3

blisovi 24 fe 1 PV

blisovi fe 1.5/30 1 PV

blisovi fe 1/20 1 PV

briellyn 1 PV

camrese 1 PV; QL

camrese lo 1 PV; QL

caziant 1 PV

charlotte 24 fe 1 PV

chateal 1 PV

chateal eq 1 PV

COMBIPATCH 3

cryselle-28 1 PV

cyclafem 1/35 1 PV

cyclafem 7/7/7 1 PV

cyred 1 PV

cyred eq 1 PV


43


dasetta 1/35 1 PV

dasetta 7/7/7 1 PV

daysee 1 PV; QL

delyla 1 PV

desogestrel-ethinyl estradiol

1 PV

DIVIGEL 3

dotti 1

drospiren-eth estrad-levomefol

1 PV

drospirenone-ethinyl estradiol

1 PV

DUAVEE 2

elinest 1 PV

eluryng 1 PV

emoquette 1 PV

enpresse-28 1 PV

enskyce 1 PV

estarylla 1 PV

estradiol oral 1

estradiol transdermal 1

estradiol vaginal 1

estradiol valerate intramuscular

1

estradiol-norethindrone acet

1

ethynodiol diac-eth estradiol

1 PV

etonogestrel-ethinyl estradiol

1 PV

EVAMIST 3

falmina 1 PV

fayosim 1 PV; QL

femynor 1 PV

fyavolv 1

gianvi 1 PV

hailey 1.5/30 1 PV


hailey 24 fe 1 PV

hailey fe 1.5/30 1 PV

hailey fe 1/20 1 PV

introvale 1 PV; QL

isibloom 1 PV

jaimiess 1 PV; QL

jasmiel 1 PV

jinteli 1

jolessa 1 PV; QL

juleber 1 PV

junel 1.5/30 1 PV

junel 1/20 1 PV

junel fe 1.5/30 1 PV

junel fe 1/20 1 PV

junel fe 24 1 PV

kaitlib fe 1 PV

kalliga 1 PV

kariva 1 PV

kelnor 1/35 1 PV

kelnor 1/50 1 PV

kurvelo 1 PV

larin 1.5/30 1 PV

larin 1/20 1 PV

larin 24 fe 1 PV

larin fe 1.5/30 1 PV

larin fe 1/20 1 PV

larissia 1 PV

layolis fe 1 PV

leena 1 PV

lessina 1 PV

levonest 1 PV

levonorgest-eth est & eth est

1 PV; QL

levonorgest-eth estrad 91-day

1 PV; QL


44


levonorgestrel-ethinyl estrad

1 PV

levonorg-eth estrad triphasic

1 PV

levora 0.15/30 (28) 1 PV

lillow 1 PV

lojaimiess 1 PV; QL

lopreeza 1

loryna 1 PV

low-ogestrel 1 PV

lo-zumandimine 1 PV

lutera 1 PV

marlissa 1 PV

melodetta 24 fe 1 PV

MENEST 2

mibelas 24 fe 1 PV

microgestin 1.5/30 1 PV

microgestin 1/20 1 PV

microgestin fe 1.5/30 1 PV

microgestin fe 1/20 1 PV

mili 1 PV

mimvey 1

mono-linyah 1 PV

NATAZIA 2 PV

necon 0.5/35 (28) 1 PV

nikki 1 PV

norethin ace-eth estrad-fe

1 PV

norethindrone acet-ethinyl est

1 PV

norethindrone-eth estradiol

1

norethin-eth estradiol-fe 1 PV

norgestimate-eth estradiol

1 PV

norgestimate-ethinyl estradiol triphasic

1 PV


nortrel 0.5/35 (28) 1 PV

nortrel 1/35 (21) 1 PV

nortrel 1/35 (28) 1 PV

nortrel 7/7/7 1 PV

ocella 1 PV

orsythia 1 PV

philith 1 PV

pimtrea 1 PV

pirmella 1/35 1 PV

pirmella 7/7/7 1 PV

portia-28 1 PV

PREMARIN ORAL 2

PREMPHASE 2

PREMPRO 2

previfem 1 PV

reclipsen 1 PV

rivelsa 1 PV; QL

setlakin 1 PV; QL

simliya 1 PV

simpesse 1 PV; QL

sprintec 28 1 PV

sronyx 1 PV

syeda 1 PV

tarina 24 fe 1 PV

tarina fe 1/20 1 PV

tarina fe 1/20 eq 1 PV

tilia fe 1 PV

tri femynor 1 PV

tri-estarylla 1 PV

tri-legest fe 1 PV

tri-linyah 1 PV

tri-lo-estarylla 1 PV

tri-lo-marzia 1 PV

tri-lo-mili 1 PV

tri-lo-sprintec 1 PV


45


tri-mili 1 PV

tri-previfem 1 PV

tri-sprintec 1 PV

trivora (28) 1 PV

tri-vylibra 1 PV

tri-vylibra lo 1 PV

tydemy 1 PV

velivet 1 PV

vienva 1 PV

viorele 1 PV

volnea 1 PV

vyfemla 1 PV

vylibra 1 PV

wera 1 PV

wymzya fe 1 PV

xulane 1 PV

yuvafem 1

zarah 1 PV

zovia 1/35e (28) 1 PV

zumandimine 1 PV

Progestins

camila 1 PV

deblitane 1 PV

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

3

DEPO-SUBQ PROVERA 104

3 QL

ELLA 3 PV

errin 1 PV

heather 1 PV

hydroxyprogesterone caproate intramuscular oil

4 PA

incassia 1 PV


jencycla 1 PV

KYLEENA 3 PV

levonorgestrel 1 PV

LILETTA (52 MG) 3 PV

lyza 1 PV

MAKENA SUBCUTANEOUS

4 PA

medroxyprogesterone acetate intramuscular

1 PV; QL

medroxyprogesterone acetate oral

1

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

CM

megestrol acetate oral suspension 625 mg/5ml

1

megestrol acetate oral tablet

CM

MIRENA (52 MG) 3 PV

NEXPLANON 3 PV

nora-be 1 PV

norethindrone acetate oral

1

norethindrone oral 1 PV

norlyda 1 PV

norlyroc 1 PV

preventeza 1 PV

progesterone intramuscular

1

progesterone micronized oral

1

sharobel 1 PV

SKYLA 3 PV

tulana 1 PV

Selective Estrogen Receptor Modifying Agents

OSPHENA 3


46


raloxifene hcl 1 PV*

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid)

euthyrox 1

levo-t 1

levothyroxine sodium intravenous

1

levothyroxine sodium oral

1

levoxyl 1

liothyronine sodium intravenous

1

liothyronine sodium oral 1

np thyroid 1

unithroid 1

Hormonal Agents, Suppressant (Adrenal)

LYSODREN CM

Hormonal Agents, Suppressant (Pituitary)

leuprolide acetate injection

4 PA

LUPRON DEPOT (1-MONTH)

4 PA

LUPRON DEPOT (3-MONTH)

4 PA

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG

4 PA

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG

4 PA

LUPRON DEPOT-PED (1-MONTH)

4 PA


LUPRON DEPOT-PED (3-MONTH)

4 PA

octreotide acetate 4 PA

SIGNIFOR 4 PA; QL

SOMATULINE DEPOT 4 PA

SOMAVERT 4 PA

SYNAREL 2

Hormonal Agents, Suppressant (Thyroid)

Antithyroid Agents

methimazole oral 1

propylthiouracil oral 1

Immunological Agents

Angioedema Agents

BERINERT 4 PA; QL

CINRYZE 4 PA

icatibant acetate 4 PA

Immune Suppressants

AZASAN 3

azathioprine oral 1

azathioprine sodium 1

CIMZIA 4 PA

CIMZIA PREFILLED KIT

4 PA

CIMZIA STARTER KIT 4 PA

cyclosporine intravenous

1

cyclosporine modified 1

cyclosporine oral 1

ENBREL MINI 4 PA

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

4 PA


47


ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED

4 PA

ENBREL SURECLICK 4 PA

everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 mg

1 PA

gengraf 1

HUMIRA 4 PA

HUMIRA PEDIATRIC CROHNS START

4 PA

HUMIRA PEN 4 PA

HUMIRA PEN-CD/UC/HS STARTER

4 PA

HUMIRA PEN-PS/UV/ADOL HS START

4 PA

INFLECTRA 4 PA

KINERET 4 PA

methotrexate oral CM

methotrexate sodium (pf)

1

methotrexate sodium injection

1

methotrexate sodium oral

CM

mycophenolate mofetil 1

mycophenolate mofetil hcl

1

mycophenolate sodium 1

ORENCIA 4 PA

ORENCIA CLICKJECT 4 PA

PROGRAF INTRAVENOUS

3

RENFLEXIS 4 PA

SANDIMMUNE ORAL SOLUTION

2

SIMPONI 4 PA


SIMPONI ARIA 4 PA

sirolimus oral 1

SKYRIZI (150 MG DOSE)

4 PA

tacrolimus oral 1

temsirolimus 4

TREXALL CM

XELJANZ 4 PA

XELJANZ XR 4 PA

ZORTRESS ORAL TABLET 1 MG

3 PA

Immunizing Agents, Passive

BIVIGAM 4 PA

CARIMUNE NF 4 PA

CUVITRU 4 PA

CYTOGAM 4 PA

FLEBOGAMMA DIF 4 PA

GAMASTAN 4 PA

GAMASTAN S/D INTRAMUSCULAR INJECTABLE

4 PA

GAMMAGARD 4 PA

GAMMAGARD S/D LESS IGA

4 PA

GAMMAKED 4 PA

GAMMAPLEX 4 PA

GAMUNEX-C 4 PA

HEPAGAM B 4

HIZENTRA 4 PA

HYPERHEP B S/D 4

HYPERRHO S/D 4

MICRHOGAM ULTRA-FILTERED PLUS

4

NABI-HB 4

OCTAGAM 4 PA

PRIVIGEN 4 PA


48


RHOGAM ULTRA-FILTERED PLUS

4

RHOPHYLAC 4

THYMOGLOBULIN 3

WINRHO SDF 4

Immunomodulators

ACTEMRA 4 PA

ACTEMRA ACTPEN 4 PA

ACTIMMUNE 4 PA

ALFERON N 4

GAMIFANT 4 PA

HYQVIA 4 PA

ILARIS 4 PA; QL

leflunomide oral 1

OTEZLA 4 PA

RINVOQ 4 PA

SYNAGIS 4 PA

ULTOMIRIS 4 PA

XOLAIR 4 PA

Vaccines

ACTHIB 2 PV

ADACEL 2 PV

AFLURIA QUADRIVALENT

2 PV

BEXSERO 2 PV

BOOSTRIX 2 PV

DAPTACEL 2 PV

DIPHTHERIA-TETANUS TOXOIDS DT

2 PV

ENGERIX-B 2 PV

FLUAD 2 PV

FLUAD QUADRIVALENT

2 PV

FLUARIX QUADRIVALENT

2 PV


FLUBLOK QUADRIVALENT

2 PV

FLUCELVAX QUADRIVALENT

2 PV

FLULAVAL QUADRIVALENT

2 PV

FLUMIST QUADRIVALENT

2 PV

FLUZONE HIGH-DOSE QUADRIVALENT

2 PV

FLUZONE QUADRIVALENT

2 PV

GARDASIL 9 2 PV

HAVRIX 2 PV

HEPLISAV-B 2 PV

HIBERIX 2 PV

INFANRIX 2 PV

IPOL 2 PV

KINRIX 2 PV

MENACTRA 2 PV

MENVEO 2 PV

M-M-R II 2 PV

PEDIARIX 2 PV

PEDVAX HIB 2 PV

PENTACEL 2 PV

PNEUMOVAX 23 2 PV

PREVNAR 13 2 PV

PROQUAD 2 PV

QUADRACEL 2 PV

RECOMBIVAX HB 2 PV

ROTARIX 2 PV

ROTATEQ 2 PV

SHINGRIX 2 PV

TDVAX 2 PV

TENIVAC 2 PV

TRUMENBA 2 PV


49


TWINRIX 2 PV

VAQTA 2 PV

VARIVAX 2 PV

Inflammatory Bowel Disease Agents

Aminosalicylates

balsalazide disodium 1

DIPENTUM 3

mesalamine er 1

mesalamine oral capsule delayed release

1

mesalamine oral tablet delayed release 1.2 gm

1

mesalamine rectal 1

mesalamine-cleanser 1

PENTASA 3

Glucocorticoids

budesonide er 1

budesonide oral 1

CORTIFOAM 3

hydrocortisone (perianal)

1

hydrocortisone ace-pramoxine external cream 1-1 %

1

hydrocortisone rectal 1

procto-med hc 1

procto-pak 1

proctosol hc 1

proctozone-hc 1

Sulfonamides

sulfasalazine oral 1

Metabolic Bone Disease Agents

alendronate sodium oral solution

1


alendronate sodium oral tablet 10 mg, 5 mg

1

alendronate sodium oral tablet 35 mg, 70 mg

1 QL

calcitonin (salmon) 1 QL

calcitriol intravenous 1

calcitriol oral 1

cinacalcet hcl 1 PA

doxercalciferol intravenous

1

FORTEO 4 PA

ibandronate sodium 1 QL

MIACALCIN INJECTION

3

pamidronate disodium 4

paricalcitol 1

PROLIA 4 PA; QL

RAYALDEE 3

risedronate sodium oral tablet 150 mg, 35 mg

1 QL

risedronate sodium oral tablet 30 mg, 5 mg

1

risedronate sodium oral tablet delayed release

1 QL

XGEVA 4 PA

zoledronic acid 4

Miscellaneous Therapeutic Agents

albumin human 1

albumin-zlb 1

alburx 1

ALCOHOL PREP PADS PAD

3

ALCOHOL PREP PADS PAD 70 %

3

argyle sterile water 1

bal in oil 1


50


BD AUTOSHIELD DUO PEN NEEDLES

2

BD ULTRA-FINE INSULIN SYRINGES

2

BD ULTRA-FINE PEN NEEDLES

2

BD VEO INSULIN SYR U/F 1/2UNIT

2

benzalkonium chloride external solution

1

BOTOX 4PA; Non-Cosmetic

BREATHE EASE LARGE

2

BREATHE EASE MEDIUM

2

BREATHE EASE SMALL

2

BREATHERITE 2

CAYA 3 PV; QL

CLEVER CHOICE HOLDING CHAMBER

2

COMPACT SPACE CHAMBER/LG MASK

2

COMPACT SPACE CHAMBER/MED MASK

2

COMPACT SPACE CHAMBER/SM MASK

2

deferoxamine mesylate 1

dexmedetomidine hcl in nacl

1

dexmedetomidine hcl intravenous solution 200 mcg/2ml

1

DROPLET MICRON 2

EASIVENT 2

ergoloid mesylates oral 3

FC FEMALE CONDOM 3 PV; QL


FC2 FEMALE CONDOM

3 PV; QL

FEMCAP 3 PV; QL

FLEXICHAMBER ADULT MASK/SMALL

2

FLEXICHAMBER CHILD MASK/LARGE

2

FLEXICHAMBER CHILD MASK/SMALL

2

flumazenil intravenous 1

fomepizole 1

heparin lock flush 1

heparin sodium lock flush

1

hetastarch-nacl 1

INSPIREASE RESERVOIR BAGS

2

INSULIN PEN NEEDLES

2

INSULIN SYRINGES 2

J-TIP KIT W/VIAL ADAPTERS

3

kedbumin 1

lactated ringers irrigation

1

MASK VORTEX 2

MAXICOMFORT SYR 27G X 1/2"

2

methergine 1 QL

methylergonovine maleate oral

1 QL

MICROCHAMBER DEVICE

2

monoject flush syringe 1

monoject sodium chloride flush

1

n-acetyl-l-cysteine oral 1

normal saline flush 1


51


NOVOFINE AUTOCOVER PEN NEEDLE

2

NOVOFINE PEN NEEDLE

2

NOVOFINE PLUS PEN NEEDLE

2

NOVOTWIST PEN NEEDLE

2

NOZIN NASAL SANITIZER POPSWAB

3

PANDA MASK LARGE 2

PANDA MASK MEDIUM

2

PANDA MASK SMALL 2

PARAGARD INTRAUTERINE COPPER

3 PV

PEDIATRIC PANDA MASK

2

POCKET SPACER 2

pralidoxime chloride intramuscular

1

PRO COMFORT SPACER ADULT

2

PRO COMFORT SPACER CHILD

2

PRO COMFORT SPACER INFANT

2

PROCARE SPACER/ADULT MASK

2

PROCARE SPACER/CHILD MASK

2

ringers irrigation 1

saline flush 1

saline flush zr 1

sodium chloride flush 1


sodium nitrite intravenous

1

sodium thiosulfate intravenous

1

sterile water for irrigation

1

swabflush saline flush 1

THYROGEN 4 PA

VISTOGARD 3

water for irrigation, sterile

1

WIDE-SEAL DIAPHRAGM 60

3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL

XIAFLEX 4 PA

Ophthalmic Agents

Aminoglycosides

gentak 1

gentamicin sulfate ophthalmic

1

neomycin-polymyxin-gramicidin

1

TOBRADEX OPHTHALMIC OINTMENT

3

TOBRADEX ST 3


52


tobramycin ophthalmic 1

tobramycin-dexamethasone

1

TOBREX OPHTHALMIC OINTMENT

3

Antibacterials, Other

ak-poly-bac 1

bacitracin ophthalmic 1

bacitracin-polymyxin b ophthalmic

1

bacitra-neomycin-polymyxin-hc

1

neomycin-bacitracin zn-polymyx

1

neomycin-polymyxin-dexameth ophthalmic ointment

1

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

1

neomycin-polymyxin-hc ophthalmic

1

neo-polycin 1

neo-polycin hc 1

polycin 1

polymyxin b-trimethoprim

1

Anti-cytomegalovirus (CMV) Agents

ZIRGAN 3

Antifungals

NATACYN 2

Antiherpetic Agents

trifluridine 1

Macrolides

AZASITE 3


erythromycin ophthalmic

1

Ophthalmic Agents, Other

atropine sulfate ophthalmic ointment

1

atropine sulfate ophthalmic solution 1 %

1

cyclopentolate hcl ophthalmic

1

CYSTARAN 4 PA; QL

homatropaire 1

RESTASIS 2 PA

RESTASIS MULTIDOSE

2 PA

sulfacetamide-prednisolone ophthalmic solution

1

XIIDRA 2 PA

Ophthalmic Anti-allergy Agents

ALOCRIL 3

ALOMIDE 3

altafrin 1

azelastine hcl ophthalmic

1

BEPREVE 3 ST

cromolyn sodium ophthalmic

1

epinastine hcl 1

LASTACAFT 3 ST

olopatadine hcl ophthalmic

1

phenylephrine hcl ophthalmic

1

ZERVIATE 3 ST


53


Ophthalmic Antiglaucoma Agents

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 %

2

apraclonidine hcl 1

AZOPT 2

betaxolol hcl ophthalmic

1

BETIMOL 3

brimonidine tartrate ophthalmic

1

carteolol hcl 1

COMBIGAN 2

dorzolamide hcl ophthalmic

1

dorzolamide hcl-timolol mal

1

dorzolamide hcl-timolol mal pf

1

IOPIDINE 3

levobunolol hcl 1

PHOSPHOLINE IODIDE

2

pilocarpine hcl ophthalmic

1

RHOPRESSA 2 QL

ROCKLATAN 2 QL

SIMBRINZA 2

timolol maleate ophthalmic

1

Ophthalmic Anti-inflammatories

bromfenac sodium (once-daily)

1 QL

dexamethasone sodium phosphate ophthalmic

1


diclofenac sodium ophthalmic

1

DUREZOL 3

FLAREX 3

fluorometholone 1

flurbiprofen sodium 1

FML 2

ILEVRO 3 QL

ketorolac tromethamine ophthalmic

1

loteprednol etabonate 1

prednisolone acetate ophthalmic

1

prednisolone sodium phosphate ophthalmic

1

PROLENSA 2 QL

Ophthalmic Prostaglandin and Prostamide Analogs

bimatoprost ophthalmic 1 QL

latanoprost ophthalmic 1

LUMIGAN 2 QL

travoprost (bak free) 1 QL

ZIOPTAN 3 QL

Quinolones

BESIVANCE 3

ciprofloxacin hcl ophthalmic

1

gatifloxacin ophthalmic 1

levofloxacin ophthalmic 1

moxifloxacin hcl (2x day)

1

moxifloxacin hcl ophthalmic

1

ofloxacin ophthalmic 1


54


Sulfonamides

sulfacetamide sodium ophthalmic

1

Otic Agents

acetic acid otic 1

CIPRO HC 3

CIPRODEX 2

ciprofloxacin hcl otic 1 ST

flac 1

fluocinolone acetonide otic

1

hydrocortisone-acetic acid

1

neomycin-polymyxin-hc otic

1

ofloxacin otic 1

Respiratory Tract/Pulmonary Agents

Antihistamines

azelastine hcl nasal 1 QL

brompheniramine tannate

1

carbinoxamine maleate oral solution

1

carbinoxamine maleate oral tablet 4 mg

1

cetirizine hcl oral solution

1

clemastine fumarate oral tablet 2.68 mg

1

cyproheptadine hcl oral 1

desloratadine 1

dexchlorpheniramine maleate oral

3

diphenhydramine hcl injection

1


diphenhydramine hcl oral elixir

1

levocetirizine dihydrochloride oral

1

olopatadine hcl nasal 1 QL

promethazine hcl injection

1

promethazine hcl oral 1

promethazine hcl rectal 1

promethegan 1

ryvent 1

Anti-inflammatories, Inhaled Corticosteroids

ADVAIR HFA 2 QL

ARNUITY ELLIPTA 2 QL

BREO ELLIPTA 2 QL

budesonide inhalation 1 QL

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL

flunisolide nasal 1 QL

fluticasone propionate nasal

1

fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

1 QL

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

1 QL

mometasone furoate nasal

1 QL


55


PULMICORT FLEXHALER

2 QL

SYMBICORT 2 QL

wixela inhub 1 QL

Antileukotrienes

montelukast sodium oral

1

zafirlukast 1

zileuton er 3 ST

Bronchodilators, Anticholinergic

ANORO ELLIPTA 2 QL

ATROVENT HFA 3 QL

INCRUSE ELLIPTA 2 QL

ipratropium bromide inhalation

1 QL

ipratropium bromide nasal

1

SPIRIVA HANDIHALER

2 QL

SPIRIVA RESPIMAT 2 QL

STIOLTO RESPIMAT 2 QL

TRELEGY ELLIPTA 2 QL

Bronchodilators, Sympathomimetic

albuterol sulfate hfa 1 QL

albuterol sulfate inhalation

1 QL

albuterol sulfate oral syrup

3

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

3 QL

BROVANA 3 QL

epinephrine injection solution

1


epinephrine injection solution auto-injector

1

isoproterenol hcl injection

1

levalbuterol hcl inhalation

1 QL

PERFOROMIST 3 QL

SEREVENT DISKUS 2 QL

VENTOLIN HFA 2 QL

Cystic Fibrosis Agents

BETHKIS 4

KALYDECO 4 PA

ORKAMBI 4 PA; QL

PULMOZYME 4 PA

tobramycin inhalation 4

Mast Cell Stabilizers

cromolyn sodium inhalation

1

Phosphodiesterase Inhibitors, Airways Disease

aminophylline intravenous

1

DALIRESP ORAL TABLET 500 MCG

3 PA

difil-g forte 1

ELIXOPHYLLIN 2

THEO-24 3

theophylline 1

theophylline er 1

theophylline in d5w 1

Pulmonary Antihypertensives

ADEMPAS 4 PA; QL

alyq 4 PA; QL

ambrisentan 4 PA; QL


56


bosentan 4 PA; QL

epoprostenol sodium 4 PA

OPSUMIT 4 PA; QL

ORENITRAM 4 PA

sildenafil citrate intravenous

4 PA

sildenafil citrate oral suspension reconstituted

4 PA; QL

sildenafil citrate oral tablet 20 mg

4 PA; QL

tadalafil (pah) 4 PA; QL

TRACLEER 32 MG 4 PA; QL

treprostinil 4 PA

TYVASO 4 PA; QL

TYVASO REFILL 4 PA; QL

TYVASO STARTER 4 PA; QL

UPTRAVI 4 PA; QL

VELETRI 4 PA

VENTAVIS 4 PA; QL

Pulmonary Fibrosis Agents

OFEV 4 PA

Respiratory Tract Agents, Other

acetylcysteine inhalation

1

acetylcysteine intravenous

1

azelastine-fluticasone 1 QL

benzonatate 1

COMBIVENT RESPIMAT

2 QL

hydrocodone-homatropine

1 PA; QL

hydromet 1 PA; QL

ipratropium-albuterol 1 QL


nebusal inhalation nebulization solution 3 %

1

NUCALA 4 PA; QL

pulmosal 1

sodium chloride inhalation

1

TUZISTRA XR 3 PA; QL

Skeletal Muscle Relaxants

baclofen intrathecal 1

baclofen oral 1

carisoprodol oral 1

chlorzoxazone oral tablet 500 mg

1

cyclobenzaprine hcl oral

1

dantrolene sodium intravenous

1

metaxalone 1

methocarbamol injection

1

methocarbamol oral 1

orphenadrine citrate er 1

orphenadrine citrate injection

1

revonto 1

tizanidine hcl oral 1

Sleep Disorder Agents

GABA Receptor Modulators

eszopiclone 1 QL

temazepam 1 QL

zaleplon 1 QL

zolpidem tartrate er 1 QL

zolpidem tartrate oral 1 QL


57


Sleep Disorders, Other

armodafinil 1 PA; QL

BELSOMRA 3 ST; QL

doxepin hcl oral tablet 1 QL

HETLIOZ 4 PA; QL

modafinil 1 PA; QL

ramelteon 1 QL

SUNOSI 2 PA; QL


58

Index of Drugs

abacavir sulfate.........................24abacavir sulfate-lamivudine...... 24abacavir-lamivudine-zidovudine.................................24ABELCET..................................16ABILIFY MAINTENA................. 23abiraterone acetate................... 18ABRAXANE.............................. 19acamprosate calcium................ 10acarbose................................... 26ACCU-CHEK FASTCLIX LANCET KIT............................. 25ACCU-CHEK MULTICLIX LANCET DEVICE KIT...............25ACCU-CHEK SOFTCLIX LANCET DEVICE KIT...............25acd formula a............................ 27acebutolol hcl............................ 30acetaminophen-codeine..............8acetaminophen-codeine #2.........8acetaminophen-codeine #3.........8acetaminophen-codeine #4.........8acetazolamide...........................31acetazolamide er.......................31acetazolamide sodium.............. 31acetic acid........................... 40, 55acetylcysteine........................... 57acitretin..................................... 34ACTEMRA................................ 49ACTEMRA ACTPEN.................49ACTHAR................................... 42ACTHIB.....................................49ACTIMMUNE............................ 49acyclovir.................................... 23acyclovir sodium....................... 23ADACEL....................................49ADAKVEO.................................28adapalene................................. 34adapalene-benzoyl peroxide.....34adc/f (0.5mg/ml)........................ 37ADCETRIS................................21adefovir dipivoxil ....................... 23ADEMPAS................................ 56adenosine................................. 30adriamycin.................................19adult aspirin regimen...................7ADVAIR HFA............................ 55ADVATE....................................28AFINITOR DISPERZ.................20afirmelle.................................... 43AFLURIA QUADRIVALENT......49AIMOVIG...................................17airavite...................................... 37

ak-poly-bac............................... 53AKYNZEO.................................16ala-cort...................................... 41albendazole...............................21albumin human......................... 50albumin-zlb................................50alburx........................................ 50albuterol sulfate.........................56albuterol sulfate hfa...................56alclometasone dipropionate...... 41ALCOHOL PREP PADS........... 50ALDURAZYME......................... 39alendronate sodium.................. 50ALFERON N............................. 49alfuzosin hcl er.......................... 40ALIMTA..................................... 18ALINIA.......................................22aliskiren fumarate......................31allopurinol..................................17allopurinol sodium..................... 17almotriptan malate.................... 17ALOCRIL...................................53ALOMIDE..................................53alosetron hcl..............................38ALPHAGAN P........................... 54alprazolam................................ 25alprazolam er............................ 25alprazolam intensol................... 25alprazolam xr............................ 25alprostadil ..................................31ALTABAX..................................10altafrin....................................... 53altavera..................................... 43alyacen 1/35..............................43alyacen 7/7/7.............................43alyq........................................... 56amabelz.................................... 43amantadine hcl..........................22AMBISOME...............................16ambrisentan.............................. 56amcinonide................................41amethia..................................... 43amethia lo................................. 43amethyst................................... 43amikacin sulfate........................ 10amiloride hcl..............................31amiloride-hydrochlorothiazide... 31aminoacetic acid....................... 40aminocaproic acid..................... 28aminophylline............................ 56amiodarone hcl......................... 30amitriptyline hcl......................... 15amlodipine besylate.................. 30

amlodipine besylate-benazepril hcl............................................. 29amlodipine besylate-valsartan.. 29amlodipine-atorvastatin.............31amlodipine-olmesartan..............29amlodipine-valsartan-hctz......... 29ammonium lactate.....................34amnesteem............................... 34amoxapine................................ 15amoxicill-clarithro-lansopraz..... 38amoxicillin................................. 12amoxicillin-potassium clavulanate................................12amoxicillin-potassium clavulanate er............................12amphetamine sulfate.................33amphetamine-dextroamphetamine.................. 33amphetamine-dextroamphetamine er.............. 33amphotericin b.......................... 16ampicillin................................... 12ampicillin sodium.......................12ampicillin-sulbactam sodium..... 12ANADROL-50........................... 43anagrelide hcl............................28anastrozole............................... 20ANORO ELLIPTA..................... 56anticoagulant cit dext soln a......27ANZEMET.................................16apap-caff-dihydrocodeine........... 8APLENZIN................................ 15APOKYN................................... 22apraclonidine hcl....................... 54aprepitant.................................. 16apri............................................ 43APTIVUS...................................24aranelle..................................... 43ARANESP (ALBUMIN FREE)...28argatroban.................................27argyle sterile saline................... 40argyle sterile water....................50aripiprazole............................... 23armodafinil ................................ 58ARNUITY ELLIPTA...................55ARRANON................................ 19arsenic trioxide..........................19ARZERRA.................................21ascomp-codeine..........................8ashlyna......................................43aspirin......................................... 7aspirin adult.................................7aspirin adult low strength............ 7

59

aspirin childrens.......................... 7aspirin ec.....................................7aspirin ec low dose..................... 7aspirin ec low strength................ 7aspirin low dose.......................... 7aspirin-dipyridamole er..............28atazanavir sulfate......................24atenolol..................................... 30atenolol-chlorthalidone..............30atomoxetine hcl.........................33atorvastatin calcium.................. 32atovaquone............................... 22atovaquone-proguanil hcl..........22atropine sulfate................... 38, 53ATROVENT HFA...................... 56aubra.........................................43aubra eq....................................43AUGMENTIN............................ 12aurovela 1.5/30......................... 43aurovela 1/20............................ 43aurovela 24 fe........................... 43aurovela fe 1.5/30..................... 43aurovela fe 1/20........................ 43AUVI-Q......................................56AVASTIN...................................21aviane....................................... 43avidoxy......................................13AVONEX PEN...........................33AVONEX PREFILLED.............. 33ayuna........................................ 43azacitidine................................. 19AZASAN....................................47AZASITE................................... 53azathioprine.............................. 47azathioprine sodium..................47azelaic acid............................... 34azelastine hcl...................... 53, 55azelastine-fluticasone............... 57AZELEX.................................... 34azithromycin..............................12AZOPT...................................... 54aztreonam................................. 12azurette..................................... 43b-6 folic acid..............................37baciim........................................10bacitracin.............................10, 53bacitracin-polymyxin b.............. 53bacitra-neomycin-polymyxin-hc 53baclofen.................................... 57BAFIERTAM............................. 33bal in oil .....................................50balsalazide disodium.................50balziva.......................................43

BANZEL.................................... 14BARACLUDE............................ 23BAVENCIO............................... 21BAXDELA................................. 13BAYER ASPIRIN........................ 7BAYER ASPIRIN EC LOW DOSE..........................................7BAYER CONTOUR LINK 2.4....25BD AUTOSHIELD DUO PEN NEEDLES................................. 51BD ULTRA-FINE INSULIN SYRINGES............................... 51BD ULTRA-FINE PEN NEEDLES................................. 51BD VEO INSULIN SYR U/F 1/2UNIT.....................................51bekyree..................................... 43BELEODAQ.............................. 20BELSOMRA.............................. 58benazepril hcl............................29benazepril-hydrochlorothiazide. 29BENDEKA.................................18BENEFIX...................................28benzalkonium chloride.............. 51BENZNIDAZOLE...................... 22benzonatate.............................. 57benzoyl peroxide-erythromycin. 34benztropine mesylate................22BEPREVE................................. 53BERINERT................................47beser......................................... 41BESIVANCE............................. 54betamethasone dipropionate.... 41betamethasone dipropionate aug............................................ 41betamethasone sod phos & acet........................................... 41betamethasone valerate........... 41BETASERON............................33betaxolol hcl........................ 30, 54bethanechol chloride.................40BETHKIS...................................56BETIMOL.................................. 54bexarotene................................ 21BEXSERO.................................49bicalutamide..............................18BICILLIN L-A.............................12BIJUVA..................................... 43BIKTARVY................................ 24bimatoprost............................... 54biocel.........................................37bisacodyl ec.............................. 38bisoprolol fumarate................... 30

bisoprolol-hydrochlorothiazide.. 30bivalirudin trifluoroacetate......... 27BIVIGAM................................... 48bleomycin sulfate...................... 19BLINCYTO................................ 21blisovi 24 fe............................... 43blisovi fe 1.5/30......................... 43blisovi fe 1/20............................ 43BOOSTRIX............................... 49bosentan................................... 57BOSULIF...................................20BOTOX..................................... 51bp vit 3...................................... 37b-plex........................................ 37b-plex plus.................................37BREATHE EASE LARGE......... 51BREATHE EASE MEDIUM.......51BREATHE EASE SMALL..........51BREATHERITE.........................51BREO ELLIPTA........................ 55briellyn.......................................43BRILINTA..................................28brimonidine tartrate................... 54BRIVIACT................................. 13bromfenac sodium (once-daily).54bromocriptine mesylate.............22brompheniramine tannate......... 55BROVANA................................ 56budesonide......................... 50, 55budesonide er........................... 50bumetanide............................... 31buprenorphine.............................8buprenorphine hcl..................... 10buprenorphine hcl-naloxone hcl............................................. 10bupropion hcl............................ 15bupropion hcl er (smoking det). 10bupropion hcl er (sr)..................15bupropion hcl er (xl).................. 15buspirone hcl.............................25busulfan.................................... 18butalbital-acetaminophen............7butalbital-apap-caff-cod.............. 8butalbital-apap-caffeine...............7butalbital-asa-caff-codeine..........8butalbital-aspirin-caffeine............ 7butorphanol tartrate.....................8BYDUREON..............................26BYDUREON BCISE AUTOINJECTOR...................... 26BYETTA 10 MCG PEN............. 26BYETTA 5 MCG PEN............... 26BYSTOLIC................................ 30

60

cabergoline............................... 42CABLIVI.................................... 28CABOMETYX........................... 20caffeine citrate...........................33calcipotriene..............................34calcipotriene-betameth diprop...34calcitonin (salmon).................... 50calcitriol............................... 34, 50calcium acetate......................... 37calcium acetate (phos binder)...36calcium chloride........................ 35calcium gluconate..................... 35camila........................................46camrese.................................... 43camrese lo................................ 43candesartan cilexetil ................. 29candesartan cilexetil-hctz..........29CAPASTAT SULFATE..............18capecitabine..............................18CAPRELSA...............................20captopril .................................... 29captopril-hydrochlorothiazide.... 29CARBAGLU.............................. 35carbamazepine......................... 14carbamazepine er..................... 14carbidopa.................................. 22carbidopa-levodopa.................. 22carbidopa-levodopa er.............. 22carbidopa-levodopa-entacapone............................... 22carbinoxamine maleate.............55carboplatin................................ 18CARIMUNE NF......................... 48carisoprodol.............................. 57carmustine................................ 18carteolol hcl...............................54cartia xt..................................... 30carvedilol...................................30carvedilol phosphate er.............30cascara sagrada....................... 39caspofungin acetate..................16cavarest.................................... 33CAYA........................................ 51caziant.......................................43cefaclor..................................... 11cefaclor er................................. 11cefadroxil ...................................11cefazolin sodium....................... 11cefazolin sodium-dextrose........ 12cefdinir...................................... 12cefditoren pivoxil ....................... 12cefepime hcl..............................12cefepime-dextrose.................... 12

cefixime.....................................12cefotaxime sodium.................... 12cefotetan disodium....................12cefotetan disodium-dextrose.....12cefoxitin sodium........................ 12cefpodoxime proxetil ................. 12cefprozil .....................................12ceftazidime................................12ceftazidime and dextrose.......... 12ceftriaxone sodium....................12ceftriaxone sodium in dextrose. 12ceftriaxone sodium-dextrose.....12cefuroxime axetil ....................... 12celecoxib..................................... 7CELONTIN................................13cephalexin.................................12CEPROTIN............................... 27CEQUR SIMPLICITY 2U.......... 25CERDELGA.............................. 39cetirizine hcl.............................. 55cevimeline hcl........................... 33CHANTIX.................................. 10CHANTIX CONTINUING MONTH PAK.............................10CHANTIX STARTING MONTH PAK...........................................10charlotte 24 fe........................... 43chateal...................................... 43chateal eq................................. 43CHEMET...................................36CHEMSTRIP UGK.................... 25chloramphenicol sod succinate.10chlordiazepoxide hcl................. 25chlordiazepoxide-amitriptyline...15chlorhexidine gluconate............ 33chloroquine phosphate..............22chlorpromazine hcl....................22chlorthalidone............................32chlorzoxazone...........................57CHOLBAM................................ 39cholestyramine..........................32cholestyramine light.................. 32chorionic gonadotropin..............42chromic chloride........................35ciclodan.....................................16ciclopirox................................... 16ciclopirox olamine..................... 16cidofovir.....................................23cilostazol................................... 28CIMDUO................................... 24cimetidine..................................38cimetidine hcl............................ 38CIMZIA......................................47

CIMZIA PREFILLED KIT...........47CIMZIA STARTER KIT............. 47cinacalcet hcl............................ 50CINRYZE.................................. 47CIPRO.......................................13CIPRO HC................................ 55CIPRODEX............................... 55ciprofloxacin hcl............ 13, 54, 55ciprofloxacin in d5w...................13cisplatin..................................... 18citalopram hydrobromide.......... 15citroma...................................... 39cladribine...................................18claravis......................................34clarithromycin............................13clarithromycin er........................12clearlax......................................39clemastine fumarate..................55CLENPIQ.................................. 39CLEVER CHOICE HOLDING CHAMBER................................ 51clindacin etz.............................. 34clindacin-p.................................34clindamycin hcl..........................10clindamycin palmitate hcl.......... 10clindamycin phosphate....... 11, 34clindamycin phosphate in d5w.. 10clindamycin phosphate-benzoyl peroxide.......................34clindamycin-tretinoin................. 34CLINPRO 5000......................... 33clobazam...................................13clobetasol prop emollient base. 41clobetasol propionate................41clobetasol propionate e.............41clobetasol propionate emulsion 41clocortolone pivalate................. 41clodan....................................... 41clofarabine................................ 18clomipramine hcl....................... 15clonazepam...............................25clonidine....................................29clonidine hcl.............................. 29clonidine hcl er.......................... 33clopidogrel bisulfate.................. 28clorazepate dipotassium........... 25clotrimazole...............................16clotrimazole-betamethasone.....16clovique.....................................36clozapine...................................23COAGADEX..............................28coal tar...................................... 34COARTEM................................ 22

61

cod liver oil ................................ 37codeine sulfate............................8colchicine.................................. 17colchicine-probenecid............... 17colesevelam hcl........................ 32colestipol hcl............................. 32colistimethate sodium (cba)...... 11COMBIGAN.............................. 54COMBIPATCH.......................... 43COMBIVENT RESPIMAT......... 57COMETRIQ (100 MG DAILY DOSE).......................................20COMETRIQ (140 MG DAILY DOSE).......................................20COMETRIQ (60 MG DAILY DOSE).......................................20COMPACT SPACE CHAMBER/LG MASK............... 51COMPACT SPACE CHAMBER/MED MASK............51COMPACT SPACE CHAMBER/SM MASK.............. 51COMPLERA..............................24compro...................................... 16CONDYLOX..............................34constulose.................................39CONTOUR CONTROL............. 25CONTOUR NEXT CONTROL...25CONTOUR NEXT LINK............ 25CONTOUR NEXT MONITOR... 25CONTOUR NEXT TEST........... 25CONTOUR TEST......................25COPAXONE..............................33CORIFACT................................28CORLANOR..............................31CORTIFOAM............................ 50cortisone acetate.......................41CORTISPORIN......................... 11corvita 150................................ 35COTELLIC................................ 20CREON..................................... 39CRESEMBA..............................16CRIXIVAN................................. 24cromolyn sodium...........38, 53, 56crotan........................................ 22cryselle-28.................................43curity sterile saline.................... 40CUVITRU.................................. 48CUVPOSA................................ 38cyanocobalamin........................ 37cyclafem 1/35............................43cyclafem 7/7/7...........................43cyclobenzaprine hcl.................. 57

cyclopentolate hcl..................... 53cyclophosphamide.................... 18cycloserine................................ 18cyclosporine.............................. 47cyclosporine modified............... 47cyproheptadine hcl....................55CYRAMZA................................ 21cyred......................................... 43cyred eq.................................... 43CYSTAGON..............................39CYSTARAN.............................. 53cytarabine................................. 18cytarabine (pf)........................... 19CYTOGAM................................48dacarbazine.............................. 18dactinomycin............................. 19dalfampridine er........................ 33DALIRESP................................ 56danazol..................................... 43dantrolene sodium.................... 57dapsone.............................. 18, 34DAPTACEL............................... 49daptomycin................................11darifenacin hydrobromide er..... 40DARZALEX............................... 21dasetta 1/35.............................. 44dasetta 7/7/7............................. 44daunorubicin hcl........................19daysee...................................... 44DAYTRANA.............................. 33DEBACTEROL..........................34deblitane................................... 46decitabine..................................19deferasirox................................ 36deferoxamine mesylate.............51delyla.........................................44demeclocycline hcl....................13DEMSER...................................31DENAVIR.................................. 23DENTA 5000 PLUS.................. 34DENTAGEL...............................34DEPO-MEDROL....................... 41DEPO-PROVERA..................... 46DEPO-SUBQ PROVERA 104...46DESCOVY................................ 24desipramine hcl.........................15desloratadine............................ 55desmopressin ace spray refrig..42desmopressin acetate...............42desmopressin acetate spray..... 42desogestrel-ethinyl estradiol..... 44desonide................................... 41desoximetasone........................41

desvenlafaxine succinate er......15dexamethasone........................ 41dexamethasone intensol........... 41dexamethasone sod phosphate pf............................. 41dexamethasone sodium phosphate........................... 41, 54dexchlorpheniramine maleate...55DEXILANT................................ 39dexmedetomidine hcl................ 51dexmedetomidine hcl in nacl.....51dexmethylphenidate hcl............ 33dexmethylphenidate hcl er........ 33dexrazoxane hcl........................19dextroamphetamine sulfate.......33dextroamphetamine sulfate er.. 33dextrose.................................... 35dextrose in lactated ringers.......35dextrose-nacl............................ 35dextrose-sodium chloride..........35DIACOMIT................................ 13diazepam............................ 14, 25diazepam intensol..................... 25diazoxide...................................26diclofenac potassium.................. 7diclofenac sodium........... 7, 19, 54diclofenac sodium er................... 7diclofenac-misoprostol................ 7dicloxacillin sodium................... 12dicyclomine hcl..........................38didanosine.................................24DIFICID..................................... 13difil-g forte................................. 56diflunisal...................................... 7digitek........................................31digox......................................... 31digoxin.......................................31dihydroergotamine mesylate.....17DILANTIN..................................14DILATRATE-SR........................ 32diltiazem hcl.............................. 31diltiazem hcl er.......................... 30diltiazem hcl er beads............... 30diltiazem hcl er coated beads... 30dilt-xr......................................... 31dimenhydrinate......................... 16DIPENTUM............................... 50diphenhydramine hcl.................55diphenoxylate-atropine..............38DIPHTHERIA-TETANUS TOXOIDS DT............................ 49dipyridamole..............................28disopyramide phosphate...........30

62

disulfiram...................................10divalproex sodium..................... 25divalproex sodium er.................25DIVIGEL....................................44dobutamine hcl..........................31dobutamine in d5w....................31docetaxel...................................19dofetilide....................................30donepezil hcl............................. 14dopamine hcl.............................31dopamine in d5w.......................31dorzolamide hcl.........................54dorzolamide hcl-timolol mal...... 54dorzolamide hcl-timolol mal pf.. 54dotti ........................................... 44doxazosin mesylate.................. 29doxepin hcl....................15, 34, 58doxercalciferol...........................50doxorubicin hcl.......................... 19doxorubicin hcl liposomal..........19doxy 100................................... 13doxycycline hyclate................... 13doxycycline monohydrate......... 13dronabinol................................. 16droperidol.................................. 16DROPLET MICRON................. 51drospiren-eth estrad-levomefol. 44drospirenone-ethinyl estradiol...44DROXIA.................................... 19DUAVEE................................... 44duloxetine hcl............................ 33DUPIXENT................................34duramorph...................................9duraxin........................................ 7DUREZOL.................................54dutasteride................................ 40dutasteride-tamsulosin hcl........ 40EASIVENT................................ 51easygel......................................34ec-naproxen................................ 7econazole nitrate.......................16ed-spaz..................................... 38EDURANT.................................24efavirenz................................... 24effer-k........................................35ELAPRASE............................... 39eletriptan hydrobromide............ 17elinest........................................44ELIQUIS....................................27ELIQUIS DVT/PE STARTER PACK........................................ 27ELITEK......................................21ELIXOPHYLLIN........................ 56

ELLA......................................... 46ELMIRON..................................40ELOCTATE............................... 28eluryng...................................... 44EMCYT..................................... 18EMGALITY................................17EMGALITY (300 MG DOSE).... 17emoquette................................. 44EMPLICITI................................ 21EMSAM.....................................15EMTRIVA.................................. 24EMVERM.................................. 22enalapril maleate.......................29enalaprilat................................. 29enalapril-hydrochlorothiazide.... 29ENBREL..............................47, 48ENBREL MINI........................... 47ENBREL SURECLICK.............. 48ENCARE................................... 40endocet....................................... 9ENGERIX-B.............................. 49ENHERTU.................................21enoxaparin sodium....................27enpresse-28.............................. 44enskyce.....................................44entacapone............................... 22entecavir................................... 23ENTRESTO.............................. 31enulose..................................... 39EPCLUSA................................. 23ephedrine sulfate...................... 31EPIDIOLEX............................... 13EPIDUO FORTE....................... 34epinastine hcl............................ 53epinephrine......................... 31, 56epinephrine pf........................... 31epirubicin hcl............................. 19epitol......................................... 14EPIVIR HBV..............................23eplerenone................................ 31epoprostenol sodium.................57eptifibatide.................................28ERBITUX.................................. 21ergocalciferol.............................37ergoloid mesylates.................... 51ergotamine-caffeine.................. 17ERIVEDGE............................... 20erlotinib hcl................................20errin...........................................46ertapenem sodium.................... 12ery............................................. 34erythromycin................. 13, 34, 53erythromycin base.....................13

erythromycin ethylsuccinate......13escitalopram oxalate................. 15esmolol hcl................................ 30esmolol hcl-sodium chloride......30esomeprazole sodium...............39estarylla.....................................44estazolam..................................25estradiol.................................... 44estradiol valerate.......................44estradiol-norethindrone acet..... 44eszopiclone............................... 57ethacrynate sodium...................31ethacrynic acid.......................... 31ethambutol hcl...........................18ethosuximide.............................13ethyl chloride...............................9ethynodiol diac-eth estradiol..... 44ETHYOL....................................19etodolac...................................... 7etodolac er.................................. 7etonogestrel-ethinyl estradiol.... 44etoposide.................................. 20euthyrox.................................... 47EVAMIST.................................. 44everolimus...........................20, 48EVOTAZ....................................24exemestane.............................. 20ezetimibe...................................32ezetimibe-simvastatin............... 32fabb........................................... 37FABRAZYME............................ 39falmina...................................... 44famciclovir................................. 23famotidine................................. 38famotidine premixed..................38FANAPT....................................23FANAPT TITRATION PACK..... 23FARXIGA.................................. 26FARYDAK................................. 20fa-vitamin b-6-vitamin b-12....... 37fayosim......................................44FC FEMALE CONDOM............ 51FC2 FEMALE CONDOM.......... 51febuxostat................................. 17FEIBA........................................28felbamate.................................. 14felodipine er.............................. 31FEMCAP................................... 51femynor..................................... 44fenofibrate................................. 32fenofibrate micronized...............32fenofibric acid............................32fenoprofen calcium......................7

63

fentanyl....................................... 8fentanyl citrate.............................9ferocon...................................... 35ferotrinsic.................................. 35ferraplus 90............................... 35ferrocite plus............................. 35FETZIMA...................................15FETZIMA TITRATION...............15finasteride................................. 40flac............................................ 55FLAREX.................................... 54flavoxate hcl.............................. 40FLEBOGAMMA DIF..................48flecainide acetate...................... 30FLEXICHAMBER ADULT MASK/SMALL........................... 51FLEXICHAMBER CHILD MASK/LARGE...........................51FLEXICHAMBER CHILD MASK/SMALL........................... 51FLOVENT DISKUS................... 55FLOVENT HFA......................... 55floxuridine..................................19FLUAD...................................... 49FLUAD QUADRIVALENT......... 49FLUARIX QUADRIVALENT......49FLUBLOK QUADRIVALENT.....49FLUCELVAX QUADRIVALENT...................... 49fluconazole................................16fluconazole in sodium chloride..16flucytosine................................. 16fludarabine phosphate.............. 19fludrocortisone acetate..............41FLULAVAL QUADRIVALENT... 49flumazenil ..................................51FLUMIST QUADRIVALENT......49flunisolide.................................. 55fluocinolone acetonide........ 41, 55fluocinolone acetonide body..... 41fluocinolone acetonide scalp.....41fluocinonide...............................41fluocinonide emulsified base.....41FLUORIDEX............................. 34fluoridex daily renewal.............. 34FLUORIDEX ENHANCED WHITENING............................. 34FLUORIDEX SENSITIVITY RELIEF..................................... 34fluoritab..................................... 35fluorometholone........................ 54FLUOROPLEX..........................19fluorouracil ................................ 19

FLUOROURACIL......................19fluoxetine hcl............................. 15fluoxetine hcl (pmdd).................15fluphenazine decanoate............22fluphenazine hcl........................ 22flurbiprofen.................................. 7flurbiprofen sodium................... 54flutamide................................... 18fluticasone propionate.........41, 55fluticasone-salmeterol............... 55FLUTICASONE-SALMETEROL..........................55fluvoxamine maleate................. 15fluvoxamine maleate er.............15FLUZONE HIGH-DOSE QUADRIVALENT...................... 49FLUZONE QUADRIVALENT.... 49FML...........................................54folbee........................................ 37folbee plus.................................37folic acid.................................... 37FOLOTYN................................. 19folplex 2.2..................................37foltrin......................................... 35fomepizole.................................51fondaparinux sodium.................27FORTEO................................... 50fosamprenavir calcium.............. 24fosaprepitant dimeglumine........16fosinopril sodium....................... 29fosinopril sodium-hctz............... 29fosphenytoin sodium................. 14FOSRENOL.............................. 37fulvestrant................................. 18furosemide................................ 31FUZEON................................... 24fyavolv.......................................44FYCOMPA................................ 14gabapentin................................ 14galantamine hydrobromide....... 14galantamine hydrobromide er... 14GAMASTAN..............................48GAMASTAN S/D.......................48GAMIFANT............................... 49GAMMAGARD.......................... 48GAMMAGARD S/D LESS IGA..48GAMMAKED............................. 48GAMMAPLEX........................... 48GAMUNEX-C............................ 48ganciclovir sodium.................... 23GARDASIL 9.............................49gatifloxacin................................ 54GATTEX....................................38

gavilax.......................................39gavilyte-c...................................39gavilyte-g...................................39gavilyte-h...................................39gavilyte-n with flavor pack.........39GAZYVA................................... 21GELNIQUE............................... 40gemcitabine hcl......................... 19gemfibrozil .................................32generlac.................................... 39gengraf......................................48gentak....................................... 52gentamicin in saline.................. 10gentamicin sulfate............... 10, 52gentle laxative........................... 39GENVOYA................................ 24gianvi.........................................44GILENYA.................................. 33GILOTRIF................................. 20glatiramer acetate..................... 33glatopa...................................... 33GLEOSTINE............................. 18glimepiride.................................26glipizide er.................................26glipizide ir.................................. 26glipizide xl................................. 26glipizide-metformin hcl.............. 26GLUCAGON EMERGENCY KIT............................................ 26glyburide................................... 26glyburide micronized................. 26glyburide-metformin.................. 26glycine.......................................40glycine urologic......................... 40glycolax..................................... 39glycopyrrolate............................38glycopyrrolate pf........................38glydo........................................... 9GLYXAMBI................................26gnp aspirin low dose................... 7goodsense aspirin low dose........7GRALISE.................................. 33granisetron hcl.......................... 16griseofulvin microsize................16griseofulvin ultramicrosize.........16guanfacine hcl...........................29guanfacine hcl er.......................33GUANIDINE HCL......................17GYNAZOLE-1........................... 16hailey 1.5/30..............................44hailey 24 fe................................44hailey fe 1.5/30..........................44hailey fe 1/20.............................44

64

HALAVEN................................. 19halcinonide................................41halobetasol propionate..............42haloperidol................................ 23haloperidol decanoate...............22haloperidol lactate.....................22HARVONI..................................23HAVRIX.....................................49heather......................................46HEMLIBRA................................28hemocyte-f................................ 35hemocyte-plus...........................35HEMOFIL M.............................. 28HEPAGAM B.............................48heparin (porcine) in nacl........... 28heparin lock flush...................... 51heparin sod (porcine) in d5w.....28heparin sodium (porcine).......... 28heparin sodium (porcine) pf...... 28heparin sodium lock flush......... 51HEPLISAV-B.............................49HERCEPTIN............................. 21HERCEPTIN HYLECTA............19hetastarch-nacl......................... 51HETLIOZ...................................58HIBERIX....................................49HIZENTRA................................ 48homatropaire.............................53HUMALOG KWIKPEN.............. 27HUMALOG MIX 50/50 KWIKPEN................................. 27HUMALOG MIX 50/50 VIAL......27HUMALOG MIX 75/25 KWIKPEN................................. 27HUMALOG MIX 75/25 VIAL......27HUMALOG U-100 JUNIOR KWIKPEN................................. 27HUMALOG VIAL....................... 27HUMATE-P............................... 28HUMIRA....................................48HUMIRA PEDIATRIC CROHNS START......................48HUMIRA PEN........................... 48HUMIRA PEN-CD/UC/HS STARTER................................. 48HUMIRA PEN-PS/UV/ADOL HS START................................ 48HUMULIN 70/30 KWIKPEN...... 27HUMULIN 70/30 VIAL...............27HUMULIN N KWIKPEN............ 27HUMULIN N VIAL..................... 27HUMULIN R U-500 KWIKPEN..27HUMULIN R U-500 VIAL.......... 27

HUMULIN R VIAL..................... 27HYCAMTIN............................... 20hydralazine hcl.......................... 32hydrochlorothiazide...................32hydrocodone bitartrate er............8hydrocodone-acetaminophen..... 9hydrocodone-homatropine........ 57hydrocodone-ibuprofen............... 9hydrocortisone.................... 42, 50hydrocortisone (perianal).......... 50hydrocortisone ace-pramoxine..50hydrocortisone butyrate............ 42hydrocortisone valerate.............42hydrocortisone-acetic acid........ 55hydromet................................... 57hydromorphone hcl..................... 9hydromorphone hcl er................. 8hydromorphone hcl pf................. 9hydroxocobalamin acetate........ 37hydroxychloroquine sulfate....... 22hydroxyprogesterone caproate. 46hydroxyurea.............................. 19hydroxyzine hcl......................... 25hydroxyzine pamoate................25hyoscyamine sulfate................. 38hyoscyamine sulfate sl..............38HYPERHEP B S/D....................48HYPERRHO S/D.......................48HYQVIA.................................... 49HYSINGLA ER............................8ibandronate sodium.................. 50IBRANCE.................................. 20ibu............................................... 7ibuprofen..................................... 7ibuprofen lysine...........................7ibutilide fumarate.......................30icatibant acetate........................47ICLUSIG....................................20idarubicin hcl............................. 19ifosfamide..................................18ILARIS.......................................49ILEVRO.....................................54imatinib mesylate...................... 20IMBRUVICA.............................. 20imipenem-cilastatin................... 12imipramine hcl...........................15imipramine pamoate................. 16imiquimod..................................34IMPAVIDO................................ 22incassia..................................... 46INCRELEX................................ 42INCRUSE ELLIPTA.................. 56indapamide............................... 32

indomethacin...............................7indomethacin er.......................... 7indomethacin sodium.................. 7INFANRIX................................. 49INFLECTRA.............................. 48INLYTA..................................... 20INPEN 100-BLUE-LILLY...........26INPEN 100-BLUE-NOVO..........26INPEN 100-GRAY-LILLY.......... 26INPEN 100-GREY-NOVO.........26INPEN 100-PINK-LILLY............26INPEN 100-PINK-NOVO...........26INSPIREASE RESERVOIR BAGS........................................ 51INSULIN PEN NEEDLES..........51INSULIN SYRINGES................ 51INTELENCE..............................24INTRAROSA............................. 43INTRON A.................................23introvale.................................... 44INVEGA SUSTENNA................23INVEGA TRINZA...................... 23INVIRASE................................. 24iodine strong............................. 35iodine tincture............................11IOPIDINE.................................. 54IPOL..........................................49ipratropium bromide.................. 56ipratropium-albuterol................. 57irbesartan.................................. 29irbesartan-hydrochlorothiazide..29irinotecan hcl.............................19ISENTRESS..............................24ISENTRESS HD....................... 24isibloom.....................................44isoniazid.................................... 18isoproterenol hcl........................56isosorbide dinitrate....................32isosorbide mononitrate..............32isosorbide mononitrate er......... 32isotretinoin.................................34ISTODAX (OVERFILL)............. 19itraconazole...............................16ivermectin..................................22IXEMPRA KIT........................... 19jaimiess..................................... 44JAKAFI......................................20jantoven.................................... 28JANUMET................................. 26JANUMET XR........................... 26JANUVIA...................................26JARDIANCE..............................26jasmiel.......................................44

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jencycla..................................... 46JENTADUETO.......................... 26JENTADUETO XR.................... 26JEVTANA..................................20jinteli ..........................................44jolessa.......................................44J-TIP KIT W/VIAL ADAPTERS. 51juleber....................................... 44JULUCA.................................... 24junel 1.5/30............................... 44junel 1/20.................................. 44junel fe 1.5/30........................... 44junel fe 1/20.............................. 44junel fe 24................................. 44KADCYLA................................. 21kaitlib fe.....................................44KALETRA..................................24kalliga........................................44KALYDECO.............................. 56KANJINTI.................................. 21KANUMA...................................39kariva........................................ 44kcl in dextrose-nacl................... 35kcl-lactated ringers-d5w............ 35kedbumin.................................. 51kelnor 1/35................................ 44kelnor 1/50................................ 44KERYDIN.................................. 16ketoconazole.......................16, 17KETONE TEST......................... 26ketoprofen................................... 7ketoprofen er...............................7ketorolac tromethamine........ 7, 54KETOSTIX................................ 26KINERET.................................. 48KINRIX...................................... 49kionex........................................36klor-con..................................... 35klor-con 10................................ 35klor-con m10............................. 35KLOR-CON M15....................... 35klor-con m20............................. 35klor-con sprinkle........................35klor-con/ef................................. 35KOATE......................................28KOATE-DVI...............................28KOGENATE FS........................ 28KORLYM...................................43KOSELUGO..............................20KOVALTRY...............................28k-prime...................................... 35k-tan plus.................................. 35kurvelo...................................... 44

KUVAN......................................39KYLEENA................................. 46KYPROLIS................................ 20labetalol hcl............................... 30lactated ringers................... 35, 51lactic acid.................................. 34lactic acid e............................... 34lactulose....................................39lactulose encephalopathy......... 39lamivudine...........................23, 24lamivudine-zidovudine.............. 24lamotrigine................................ 14lamotrigine er............................ 14lamotrigine starter kit-blue.........14lamotrigine starter kit-green...... 14lamotrigine starter kit-orange.... 14LANCETS................................. 26lansoprazole..............................39lanthanum carbonate................ 37LANTUS SOLOSTAR............... 27LANTUS U-100 VIAL................ 27larin 1.5/30................................ 44larin 1/20................................... 44larin 24 fe.................................. 44larin fe 1.5/30............................ 44larin fe 1/20............................... 44larissia.......................................44LASTACAFT............................. 53latanoprost................................ 54LATUDA....................................23layolis fe.................................... 44leena......................................... 44leflunomide................................49LENVIMA (10 MG DAILY DOSE).......................................20LENVIMA (12 MG DAILY DOSE).......................................20LENVIMA (14 MG DAILY DOSE).......................................20LENVIMA (18 MG DAILY DOSE).......................................20LENVIMA (20 MG DAILY DOSE).......................................20LENVIMA (24 MG DAILY DOSE).......................................21LENVIMA (4 MG DAILY DOSE).......................................21LENVIMA (8 MG DAILY DOSE).......................................21lessina.......................................44letrozole.................................... 20leucovorin calcium.................... 19LEUKERAN...............................18

leuprolide acetate......................47levalbuterol hcl.......................... 56LEVEMIR U-100 FLEXTOUCH.27LEVEMIR U-100 VIAL...............27levetiracetam.............................13levetiracetam er........................ 13levetiracetam in nacl................. 13levobunolol hcl.......................... 54levocarnitine........................35, 36levocarnitine sf.......................... 36levocetirizine dihydrochloride....55levofloxacin......................... 13, 54levofloxacin in d5w....................13levoleucovorin calcium..............19levoleucovorin calcium pf..........19levonest.....................................44levonorgest-eth est & eth est.... 44levonorgest-eth estrad 91-day.. 44levonorgestrel........................... 46levonorgestrel-ethinyl estrad.....45levonorg-eth estrad triphasic.....45levora 0.15/30 (28)....................45levorphanol tartrate..................... 8levo-t......................................... 47levothyroxine sodium................ 47levoxyl....................................... 47LEXIVA..................................... 24lidocaine......................................9lidocaine hcl................................ 9lidocaine hcl (cardiac)............... 30lidocaine hcl (cardiac) pf........... 30lidocaine hcl urethral/mucosal.....9lidocaine in d5w........................ 30lidocaine viscous hcl................... 9lidocaine-prilocaine..................... 9LIDOCAINE-TETRACAINE.........9LILETTA (52 MG)......................46lillow.......................................... 45lincomycin hcl............................11lindane...................................... 22linezolid..................................... 11linezolid in sodium chloride....... 11LINZESS................................... 38liothyronine sodium................... 47lisinopril ..................................... 29lisinopril-hydrochlorothiazide.....29lithium........................................25lithium carbonate.......................25lithium carbonate er.................. 25LIVALO..................................... 32lojaimiess.................................. 45LONSURF.................................19loperamide hcl...........................38

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lopinavir-ritonavir.......................24lopreeza.................................... 45lorazepam................................. 25lorazepam intensol....................25lorcet........................................... 9lorcet hd...................................... 9loryna........................................ 45losartan potassium....................29losartan potassium-hctz............ 29loteprednol etabonate............... 54lovastatin...................................32low-ogestrel...............................45loxapine succinate.................... 23lo-zumandimine.........................45ludent........................................ 36LUMIGAN..................................54LUMIZYME............................... 39LUPRON DEPOT (1-MONTH)..47LUPRON DEPOT (3-MONTH)..47LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG..47LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG..47LUPRON DEPOT-PED (1-MONTH)....................................47LUPRON DEPOT-PED (3-MONTH)....................................47lutera......................................... 45LYNPARZA............................... 21lysiplex plus...............................37LYSODREN.............................. 47lyza............................................46mafenide acetate...................... 11magnesium chloride..................36magnesium citrate.....................39magnesium sulfate....................36magnesium sulfate in d5w........ 36MAKENA...................................46malathion.................................. 22maprotiline hcl...........................15marlissa.....................................45MARPLAN.................................15MARQIBO................................. 19MASK VORTEX........................ 51MATULANE.............................. 18matzim la...................................31MAVYRET.................................23MAXICOMFORT SYR 27G X 1/2"............................................51MAYZENT.................................33MAYZENT STARTER PACK.... 33meclizine hcl............................. 16meclofenamate sodium...............7

medroxyprogesterone acetate.. 46mefloquine hcl...........................22megestrol acetate..................... 46MEKINIST................................. 21melodetta 24 fe......................... 45meloxicam...................................7melphalan................................. 18melphalan hcl............................18memantine hcl...........................14memantine hcl er...................... 14MENACTRA..............................49MENEST................................... 45MENVEO.................................. 49MEPSEVII................................. 39mercaptopurine......................... 19meropenem...............................12mesalamine...............................50mesalamine er.......................... 50mesalamine-cleanser................50mesna....................................... 21MESNEX...................................21metadate er...............................33metaxalone............................... 57metformin hcl er........................ 26metformin hcl ir ......................... 26methadone hcl............................ 8methadone hcl intensol............... 8methadose.................................. 8methadose sugar-free.................8methazolamide..........................31methenamine hippurate............ 11methergine................................ 51methimazole..............................47METHITEST..............................43methocarbamol......................... 57methotrexate............................. 48methotrexate sodium................ 48methotrexate sodium (pf).......... 48methoxsalen rapid.....................34methscopolamine bromide........38methyldopa............................... 29methyldopa-hydrochlorothiazide...................29methylergonovine maleate........51methylphenidate hcl.................. 33methylphenidate hcl er..............33methylphenidate hcl er (cd).......33methylphenidate hcl er (la)........33methylprednisolone...................42methylprednisolone acetate...... 42methylprednisolone sodium succ...........................................42metoclopramide hcl...................16

metolazone............................... 32metoprolol succinate er.............30metoprolol tartrate.....................30metoprolol-hydrochlorothiazide.30metronidazole..................... 11, 34metronidazole in nacl................ 11metyrosine................................ 31mexiletine hcl............................ 30MIACALCIN.............................. 50mibelas 24 fe.............................45micafungin sodium.................... 17miconazole 3.............................17MICRHOGAM ULTRA-FILTERED PLUS...................... 48MICROCHAMBER.................... 51microgestin 1.5/30.....................45microgestin 1/20........................45microgestin fe 1.5/30.................45microgestin fe 1/20....................45midodrine hcl.............................29mifepristone.............................. 43miglitol.......................................26miglustat....................................39mili .............................................45milrinone lactate........................31milrinone lactate in dextrose..... 31mimvey......................................45mineral oil heavy....................... 39MINOCIN.................................. 13minocycline hcl..........................13minoxidil .................................... 32MIRENA (52 MG)......................46mirtazapine............................... 15MIRVASO................................. 35misoprostol................................39mitigo.......................................... 8mitomycin..................................19mitoxantrone hcl........................19M-M-R II.................................... 49modafinil ....................................58moexipril hcl.............................. 29molindone hcl............................23mometasone furoate........... 42, 55mondoxyne nl............................13monoject flush syringe.............. 51monoject sodium chloride flush.51mono-linyah.............................. 45montelukast sodium.................. 56morgidox................................... 13morphine sulfate..................... 8, 9morphine sulfate (concentrate)... 9morphine sulfate (pf)................... 9morphine sulfate er..................... 8

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morphine sulfate er beads.......... 8MOTOFEN................................ 38moxifloxacin hcl...................13, 54moxifloxacin hcl (2x day)...........54moxifloxacin hcl in nacl............. 13MOZOBIL..................................28multi prenatal............................ 37multi-vit/iron/fluoride..................37multivitamin/fluoride.................. 37multi-vitamin/fluoride................. 37multivitamin/fluoride/iron........... 37multi-vitamin/fluoride/iron.......... 37multivitamins/fluoride................ 37mupirocin.................................. 11mutamycin.................................19MVASI.......................................21mvc-fluoride.............................. 37MYALEPT................................. 39mycophenolate mofetil .............. 48mycophenolate mofetil hcl........ 48mycophenolate sodium............. 48MYLERAN.................................18myorisan................................... 35MYRBETRIQ.............................40na ferric gluc cplx in sucrose.....36NABI-HB................................... 48nabumetone................................ 7n-acetyl-l-cysteine..................... 51nafcillin sodium......................... 12nafrinse..................................... 36nafrinse drops........................... 36naftifine hcl................................17NAGLAZYME............................39naloxone hcl..............................10naltrexone hcl............................10NAMZARIC............................... 14naproxen..................................... 7naproxen dr.................................7naproxen sodium........................ 8naratriptan hcl........................... 17NARCAN...................................10NASCOBAL.............................. 37NATACYN.................................53NATAZIA...................................45nateglinide.................................26nebusal..................................... 57necon 0.5/35 (28)......................45nefazodone hcl..........................15neomycin sulfate....................... 10neomycin-bacitracin zn-polymyx.....................................53neomycin-polymyxin b gu......... 40neomycin-polymyxin-dexameth 53

neomycin-polymyxin-gramicidin..................................52neomycin-polymyxin-hc...... 53, 55neo-polycin................................53neo-polycin hc...........................53neostigmine methylsulfate........ 17NEO-SYNALAR........................ 11nephronex................................. 37neuac........................................ 35NEULASTA............................... 28NEULASTA ONPRO.................28NEUPRO...................................22neutral sodium fluoride..............34nevirapine................................. 24nevirapine er............................. 24NEXAVAR.................................21NEXLETOL............................... 32NEXLIZET.................................32NEXPLANON............................46niacin er (antihyperlipidemic).... 32nicardipine hcl........................... 31NICORETTE............................. 10nicotine polacrilex..................... 10nicotine step 1...........................10nicotine step 2...........................10nicotine step 3...........................10NICOTROL............................... 10NICOTROL NS......................... 10nifedipine er.............................. 31nifedipine er osmotic release.... 31nikki...........................................45nilutamide..................................18nimodipine.................................31NINLARO.................................. 19NIPENT.....................................19nisoldipine er.............................31nitisinone...................................39NITRO-BID................................32nitrofurantoin............................. 11nitrofurantoin macrocrystal........11nitrofurantoin monohydrate macrocrystals............................11nitroglycerin...............................32nitroglycerin in d5w................... 32NITROMIST.............................. 33nitroprusside sodium.................33NIVESTYM................................28nizatidine...................................38nora-be......................................46NORDITROPIN FLEXPRO....... 42norepinephrine bitartrate...........31norethin ace-eth estrad-fe.........45norethindrone............................46

norethindrone acetate............... 46norethindrone acet-ethinyl est...45norethindrone-eth estradiol....... 45norethin-eth estradiol-fe............ 45norgestimate-eth estradiol........ 45norgestimate-ethinyl estradiol triphasic.....................................45norlyda...................................... 46norlyroc..................................... 46normal saline flush.................... 51nortrel 0.5/35 (28)..................... 45nortrel 1/35 (21)........................ 45nortrel 1/35 (28)........................ 45nortrel 7/7/7...............................45nortriptyline hcl..........................16NORVIR.............................. 24, 25novarel...................................... 42NOVOFINE AUTOCOVER PEN NEEDLE........................... 52NOVOFINE PEN NEEDLE....... 52NOVOFINE PLUS PEN NEEDLE....................................52NOVOLIN 70/30 FLEXPEN...... 27NOVOLIN 70/30 FLEXPEN RELION.....................................27NOVOLIN 70/30 RELION......... 27NOVOLIN 70/30 VIAL............... 27NOVOLIN N FLEXPEN.............27NOVOLIN N FLEXPEN RELION.....................................27NOVOLIN N RELION................27NOVOLIN N VIAL..................... 27NOVOLIN R FLEXPEN.............27NOVOLIN R FLEXPEN RELION.....................................27NOVOLIN R RELION................27NOVOLIN R VIAL..................... 27NOVOLOG FLEXPEN.............. 27NOVOLOG MIX 70/30 FLEXPEN..................................27NOVOLOG MIX 70/30 VIAL......27NOVOLOG PENFILL................ 27NOVOLOG U-100 VIAL............ 27NOVOPEN ECHO.....................26NOVOSEVEN RT..................... 28NOVOTWIST PEN NEEDLE.... 52NOZIN NASAL SANITIZER POPSWAB................................52np thyroid.................................. 47NUCALA................................... 57NUCYNTA ER.............................8nufol.......................................... 37nutrifac zx..................................37

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nutrilipid.....................................36NUTROPIN AQ NUSPIN 10..... 42NUTROPIN AQ NUSPIN 20..... 42NUTROPIN AQ NUSPIN 5....... 42NUWIQ......................................28nyamyc......................................17nystatin......................................17nystatin-triamcinolone............... 17nystop....................................... 17OBIZUR.................................... 28ocella.........................................45OCTAGAM................................48octreotide acetate..................... 47ODEFSEY.................................24OFEV........................................ 57ofloxacin........................13, 54, 55olanzapine.................................23olanzapine-fluoxetine hcl.......... 15olmesartan medoxomil..............29olmesartan medoxomil-hctz...... 29olmesartan-amlodipine-hctz......29olopatadine hcl....................53, 55OMECLAMOX-PAK.................. 38omega-3-acid ethyl esters.........32omeprazole............................... 39ONCASPAR..............................19ondansetron hcl........................ 16ondansetron odt........................ 16ONE VITE WOMENS................37ONE-A-DAY WOMENS PRENATAL 1............................ 37ONETOUCH DELICA LANCING DEV..........................26ONETOUCH DELICA PLUS LANCING.................................. 26ONIVYDE..................................19OPDIVO.................................... 21OPSUMIT..................................57OPTIONS CONCEPTROL........40oralone...................................... 34ORENCIA..................................48ORENCIA CLICKJECT............. 48ORENITRAM............................ 57ORFADIN............................39, 40ORKAMBI................................. 56orphenadrine citrate.................. 57orphenadrine citrate er..............57orsythia..................................... 45oscimin......................................38oseltamivir phosphate............... 25OSPHENA................................ 46OTEZLA.................................... 49oxacillin sodium.........................12

oxaliplatin.................................. 18oxandrolone.............................. 43oxaprozin.................................... 8oxazepam................................. 25oxcarbazepine...........................14oxiconazole nitrate.................... 17OXISTAT...................................17oxybutynin chloride................... 40oxybutynin chloride er............... 40oxycodone hcl............................. 9oxycodone-acetaminophen.........9oxycodone-aspirin.......................9OXYCONTIN...............................8oxymorphone hcl.........................9oxymorphone hcl er.................... 8oxytocin.....................................43OZEMPIC..................................26paclitaxel................................... 19PADCEV................................... 21paliperidone er.......................... 23palonosetron hcl........................16pamidronate disodium...............50PANDA MASK LARGE............. 52PANDA MASK MEDIUM...........52PANDA MASK SMALL..............52PANRETIN................................21pantoprazole sodium.................39PARAGARD INTRAUTERINE COPPER...................................52paraplatin.................................. 18paricalcitol................................. 50paroex....................................... 34paromomycin sulfate.................10paroxetine hcl............................15paroxetine hcl er....................... 15paroxetine mesylate..................15PASER......................................18PAXIL........................................15PEDIARIX................................. 49PEDIATRIC PANDA MASK...... 52PEDVAX HIB............................ 49peg 3350-kcl-na bicarb-nacl......39peg-3350/electrolytes................39PEGANONE..............................14PEGASYS.................................23PEGASYS PROCLICK............. 23penicillamine............................. 40penicillin g potassium................12penicillin g sodium.....................12penicillin v potassium................ 12PENTACEL............................... 49pentamidine isethionate............ 22PENTASA................................. 50

pentazocine-naloxone hcl........... 9pentobarbital sodium.................14pentoxifylline er......................... 31PERFOROMIST........................56perindopril erbumine................. 29periogard...................................34PERJETA..................................21permethrin.................................22perphenazine............................ 16perphenazine-amitriptyline........15phenazo.................................... 40phenazopyridine hcl.................. 40phenelzine sulfate..................... 15phenobarbital............................ 14phenobarbital sodium................14phenoxybenzamine hcl............. 29phentolamine mesylate............. 29phenylephrine hcl................31, 53phenytoin.................................. 14phenytoin infatabs.....................14phenytoin sodium......................14phenytoin sodium extended...... 14philith.........................................45PHOSLYRA.............................. 37PHOSPHOLINE IODIDE...........54phosphorous............................. 36phospho-trin 250 neutral........... 36phytonadione............................ 37PICATO.....................................19pilocarpine hcl..................... 34, 54pimecrolimus.............................35pimozide....................................23pimtrea...................................... 45pindolol......................................30pioglitazone hcl......................... 26pioglitazone hcl-glimepiride.......26pioglitazone hcl-metformin hcl.. 26piperacillin sod-tazobactam so..12PIQRAY (200 MG DAILY DOSE).......................................19PIQRAY (250 MG DAILY DOSE).......................................19PIQRAY (300 MG DAILY DOSE).......................................19pirmella 1/35............................. 45pirmella 7/7/7............................ 45piroxicam.....................................8PNEUMOVAX 23...................... 49pnv prenatal plus multivit+dha.. 37POCKET SPACER................... 52podofilox....................................35POLIVY..................................... 21polycin.......................................53

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polymyxin b sulfate................... 11polymyxin b-trimethoprim..........53polysaccharide iron forte...........36POMALYST.............................. 18portia-28....................................45posaconazole............................17pot bicarb-pot chloride.............. 36potassium acetate.....................36potassium bicarbonate..............36potassium chloride.................... 36potassium chloride crys er........ 36potassium chloride er................36potassium chloride in dextrose. 36potassium chloride in nacl.........36potassium citrate er...................36potassium phosphates(71 meq k)............................................... 36PRADAXA.................................28pralidoxime chloride.................. 52PRALUENT...............................32pramipexole dihydrochloride..... 22pramipexole dihydrochloride er.22prasugrel hcl............................. 28pravastatin sodium....................32praziquantel.............................. 22prazosin hcl...............................29prednicarbate............................ 42prednisolone............................. 42prednisolone acetate.................54prednisolone sodium phosphate........................... 42, 54prednisone................................ 42prednisone intensol...................42pregabalin................................. 33pregnyl...................................... 43PREMARIN............................... 45PREMPHASE........................... 45PREMPRO................................45prenatal..................................... 37prenatal multi +dha................... 37prenatal plus iron...................... 37prevalite.................................... 32preventeza................................ 46prevident................................... 34previfem.................................... 45PREVNAR 13............................49PREZCOBIX............................. 25PREZISTA................................ 25PRIFTIN.................................... 18primaquine phosphate.............. 22primidone.................................. 14PRIMSOL..................................11PRIVIGEN.................................48

PRO COMFORT SPACER ADULT...................................... 52PRO COMFORT SPACER CHILD....................................... 52PRO COMFORT SPACER INFANT..................................... 52probenecid................................ 17procainamide hcl.......................30PROCARE SPACER/ADULT MASK........................................52PROCARE SPACER/CHILD MASK........................................52prochlorperazine....................... 16prochlorperazine edisylate........ 16prochlorperazine maleate......... 16procto-med hc........................... 50procto-pak................................. 50proctosol hc...............................50proctozone-hc........................... 50PROFILNINE............................ 28PROFILNINE SD...................... 28progesterone.............................46progesterone micronized.......... 46PROGRAF................................ 48PROLASTIN-C..........................40PROLENSA.............................. 54PROLEUKIN............................. 19PROLIA.....................................50PROMACTA..............................28promethazine hcl.......................55promethegan.............................55propafenone hcl........................ 30propafenone hcl er.................... 30propranolol hcl.......................... 30propranolol hcl er...................... 30propranolol-hctz........................ 30propylthiouracil ..........................47PROQUAD................................49protamine sulfate...................... 28protriptyline hcl..........................16PULMICORT FLEXHALER.......56pulmosal....................................57PULMOZYME........................... 56purevit dualfe plus.....................36PYLERA....................................38pyrazinamide.............................18pyridostigmine bromide.............17pyridostigmine bromide er.........17pyridoxine hcl............................ 37pyrimethamine.......................... 22qc aspirin low dose..................... 8qc magnesium citrate................39QUADRACEL............................49

quetiapine fumarate.................. 23quetiapine fumarate er.............. 23QUILLIVANT XR....................... 33quinapril hcl...............................29quinapril-hydrochlorothiazide.... 29quinidine gluconate er...............30quinidine sulfate........................ 30quinine sulfate...........................22rabeprazole sodium.................. 39raloxifene hcl.............................47ramelteon.................................. 58ramipril ...................................... 29ranolazine er............................. 31rasagiline mesylate................... 22RAVICTI....................................40RAYALDEE...............................50REBLOZYL............................... 28reclipsen....................................45RECOMBINATE........................28RECOMBIVAX HB.................... 49RECTIV.....................................33REGRANEX..............................35RELENZA DISKHALER............ 25relexxii .......................................33RENACIDIN.............................. 40RENFLEXIS.............................. 48repaglinide................................ 26REPATHA................................. 32REPATHA PUSHTRONEX SYSTEM................................... 32REPATHA SURECLICK........... 32RESTASIS................................ 53RESTASIS MULTIDOSE.......... 53RETACRIT................................ 28RETROVIR............................... 24REVCOVI..................................40REVLIMID................................. 18revonto...................................... 57REXULTI...................................23REYATAZ................................. 25RHOGAM ULTRA-FILTERED PLUS.........................................49RHOPHYLAC............................49RHOPRESSA........................... 54RIASTAP...................................28ribavirin..................................... 23rifabutin..................................... 18rifampin..................................... 18riluzole.......................................33rimantadine hcl..........................25ringers....................................... 36ringers irrigation........................ 52RINVOQ....................................49

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risedronate sodium................... 50RISPERDAL CONSTA..............23risperidone................................ 23ritonavir..................................... 25RITUXAN.................................. 21RITUXAN HYCELA...................21rivastigmine...............................14rivastigmine tartrate.................. 14rivelsa........................................45RIXUBIS....................................28rizatriptan benzoate.................. 17ROCKLATAN............................ 54ropinirole hcl..............................22ropinirole hcl er......................... 22rosadan..................................... 35rosuvastatin calcium................. 32ROTARIX.................................. 49ROTATEQ.................................49roweepra................................... 13roweepra xr............................... 13ROZLYTREK............................ 20RUBRACA................................ 20RUXIENCE............................... 21RYDAPT................................... 21ryvent........................................ 55saline flush................................ 52saline flush zr............................ 52SANDIMMUNE......................... 48SANTYL.................................... 35SAPHRIS.................................. 23SAVAYSA................................. 28SAVELLA.................................. 33SAVELLA TITRATION PACK... 33scopolamine..............................16selegiline hcl............................. 22selenium sulfide........................ 35SELZENTRY.............................24SEREVENT DISKUS................ 56sertraline hcl..............................15se-tan plus................................ 36setlakin......................................45sevelamer carbonate................ 37sevelamer hcl............................37sharobel.................................... 46SHINGRIX.................................49SIGNIFOR.................................47sildenafil citrate......................... 57silodosin.................................... 40silver sulfadiazine......................11SIMBRINZA.............................. 54simliya....................................... 45simpesse...................................45SIMPONI...................................48

SIMPONI ARIA......................... 48simvastatin................................ 32sirolimus....................................48SIRTURO..................................18SKLICE..................................... 22SKYLA...................................... 46SKYRIZI (150 MG DOSE).........48sod benz-sod phenylacet.......... 40sod citrate-citric acid................. 36sodium acetate..........................36sodium bicarbonate.............36, 38sodium chloride.............36, 40, 57sodium chloride (pf).................. 36sodium chloride flush................ 52sodium fluoride....................34, 36sodium fluoride 5000 plus......... 34sodium fluoride 5000 ppm.........34sodium fluoride 5000 sensitive..34sodium nitrite.............................52sodium phenylbutyrate..............40sodium phosphates...................36sodium polystyrene sulfonate... 36sodium thiosulfate..................... 52solifenacin succinate.................40SOLIRIS....................................27SOLTAMOX.............................. 18SOLU-CORTEF........................ 42SOMATULINE DEPOT............. 47SOMAVERT..............................47sorbitol...................................... 40sorbitol-mannitol........................40sorine........................................ 30sotalol hcl.................................. 30sotalol hcl (af)............................30spinosad....................................22SPIRIVA HANDIHALER............56SPIRIVA RESPIMAT................ 56spironolactone...........................32spironolactone-hctz...................31sprintec 28................................ 45SPRYCEL................................. 21sps............................................ 36sronyx....................................... 45ST JOSEPH LOW DOSE............8stavudine...................................24STELARA..................................35sterile water for irrigation...........52STIOLTO RESPIMAT............... 56STIVARGA................................21STRENSIQ................................40streptomycin sulfate.................. 10STRIBILD..................................24subvenite...................................14

subvenite starter kit-blue...........14subvenite starter kit-green........ 14subvenite starter kit-orange...... 14SUCRAID..................................40sucralfate.................................. 39sulfacetamide sodium............... 55sulfacetamide sodium (acne).... 35sulfacetamide-prednisolone...... 53sulfadiazine............................... 13sulfamethoxazole-trimethoprim.13sulfasalazine............................. 50sulfatrim pediatric......................13sulfurated lime...........................22sulindac.......................................8sumatriptan............................... 17sumatriptan succinate............... 17sumatriptan succinate refill ....... 17sumatriptan-naproxen sodium.. 17SUNOSI.................................... 58SUPREP BOWEL PREP KIT....39SUTENT....................................21swabflush saline flush............... 52syeda........................................ 45SYMBICORT.............................56SYMFI....................................... 24SYMFI LO................................. 24SYMPROIC...............................38SYNAGIS.................................. 49SYNAREL................................. 47SYNJARDY...............................26SYNJARDY XR.........................26SYNRIBO..................................20TABLOID...................................19tacrolimus............................35, 48tadalafil ......................................40tadalafil (pah)............................ 57TAFINLAR.................................21TAGRISSO............................... 21TALTZ....................................... 35tamoxifen citrate........................18tamsulosin hcl........................... 40TARGRETIN............................. 21tarina 24 fe................................ 45tarina fe 1/20............................. 45tarina fe 1/20 eq........................ 45TASIGNA.................................. 21tazarotene................................. 35tazicef........................................12TAZORAC.................................35taztia xt......................................31TDVAX...................................... 49TECENTRIQ............................. 21TECFIDERA..............................33

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TEGSEDI.................................. 40telmisartan................................ 29telmisartan-amlodipine..............29telmisartan-hctz.........................29temazepam............................... 57TEMODAR................................ 18temozolomide............................18temsirolimus..............................48teniposide..................................20TENIVAC.................................. 49tenofovir disoproxil fumarate.....24terazosin hcl..............................40terbinafine hcl............................17terconazole............................... 17testosterone.............................. 43testosterone cypionate..............43testosterone enanthate............. 43tetrabenazine............................ 33tetracycline hcl.......................... 13TEXACORT.............................. 42THALOMID............................... 18THEO-24...................................56theophylline...............................56theophylline er...........................56theophylline in d5w................... 56thiamine hcl...............................37thioridazine hcl.......................... 23thiothixene.................................23THROMBATE III ....................... 28THYMOGLOBULIN...................49THYROGEN..............................52tiadylt er.................................... 31tiagabine hcl..............................14tilia fe.........................................45timolol maleate....................30, 54tinidazole...................................11TIVICAY.................................... 24TIVICAY PD.............................. 24tizanidine hcl............................. 57tl-hem 150................................. 36TOBRADEX.............................. 52TOBRADEX ST.........................52tobramycin.......................... 53, 56tobramycin sulfate.....................10tobramycin-dexamethasone......53TOBREX................................... 53TODAY SPONGE..................... 40tolcapone.................................. 22tolmetin sodium...........................8tolterodine tartrate.....................40tolterodine tartrate er.................40topiramate................................. 14topiramate er.............................14

toposar...................................... 20topotecan hcl.............................20toremifene citrate...................... 18torsemide.................................. 31TOTECT....................................20TOUJEO MAX SOLOSTAR...... 27TOUJEO SOLOSTAR...............27tovet.......................................... 42TOVIAZ..................................... 40TRACLEER...............................57TRADJENTA.............................26tramadol hcl er............................ 8tramadol hcl er (biphasic)............8tramadol hcl ir ............................. 9tramadol-acetaminophen............ 9trandolapril ................................ 29trandolapril-verapamil hcl er......30tranexamic acid.........................28tranylcypromine sulfate............. 15travoprost (bak free)..................54TRAZIMERA............................. 21trazodone hcl............................ 15TRECATOR.............................. 18TRELEGY ELLIPTA..................56TREMFYA.................................35treprostinil ................................. 57TRESIBA...................................27TRESIBA FLEXTOUCH............27tretinoin............................... 21, 35tretinoin microsphere................ 35tretinoin microsphere pump...... 35TREXALL.................................. 48tri femynor................................. 45triamcinolone acetonide...... 34, 42triamterene................................32triamterene-hctz........................ 31triazolam................................... 25triderm.......................................42trientine hcl................................36tri-estarylla................................ 45trifluoperazine hcl......................23trifluridine.................................. 53trigels-f forte.............................. 36trihexyphenidyl hcl.................... 22tri-legest fe................................ 45tri-linyah.................................... 45tri-lo-estarylla............................ 45tri-lo-marzia............................... 45tri-lo-mili .................................... 45tri-lo-sprintec............................. 45trilyte......................................... 39trimethoprim.............................. 11tri-mili ........................................ 46

trimipramine maleate................ 16TRINTELLIX..............................15triphrocaps................................ 37tri-previfem................................ 46tri-sprintec................................. 46TRIUMEQ................................. 24tri-vitamin/fluoride......................37tri-vite/fluoride........................... 37trivora (28).................................46tri-vylibra................................... 46tri-vylibra lo................................46trospium chloride.......................40trospium chloride er.................. 40TRULICITY............................... 26TRUMENBA..............................49TRUVADA.................................24tulana........................................ 46TURALIO.................................. 21TUZISTRA XR.......................... 57TWINRIX...................................50TYBOST....................................24tydemy...................................... 46TYKERB....................................21TYSABRI...................................33TYVASO................................... 57TYVASO REFILL...................... 57TYVASO STARTER..................57ULTOMIRIS.............................. 49unithroid.................................... 47UNITUXIN................................. 21UPTRAVI.................................. 57ursodiol..................................... 38valacyclovir hcl..........................23valganciclovir hcl.......................23valproate sodium.......................14valproic acid.............................. 14valsartan................................... 29valsartan-hydrochlorothiazide... 29vancomycin hcl......................... 11vancomycin hcl in dextrose.......11vancomycin hcl in nacl.............. 11VANCOMYCIN HCL IN NACL.. 11VAQTA......................................50VARIVAX.................................. 50v-c forte..................................... 37VCF VAGINAL CONTRACEPTIVE................... 41vcf vaginal contraceptive...........41VELCADE................................. 20VELETRI................................... 57velivet........................................46VELTASSA............................... 36VEMLIDY.................................. 23

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VENCLEXTA.............................21VENCLEXTA STARTING PACK........................................ 21venlafaxine hcl.......................... 15venlafaxine hcl er...................... 15VENTAVIS................................ 57VENTOLIN HFA........................56verapamil hcl.............................31verapamil hcl er.........................31VICTOZA.................................. 26vienva........................................46VIIBRYD....................................15VIIBRYD STARTER PACK....... 15VIMIZIM.................................... 40VIMPAT.....................................14vinblastine sulfate..................... 20vincristine sulfate...................... 20vinorelbine tartrate.................... 20viorele....................................... 46VIRACEPT................................ 25VIREAD.....................................24virt-caps.................................... 37virt-gard.....................................38virt-phos 250 neutral................. 36VISTOGARD.............................52vita s forte................................. 38vitacel........................................38vita-min..................................... 38vitamin d (ergocalciferol)...........38vitamin k1..................................38vitamins acd-fluoride................. 38VIVITROL..................................10volnea....................................... 46VONVENDI............................... 28voriconazole..............................17VOTRIENT................................21vp-pnv-dha................................ 38vp-vite rx................................... 38vyfemla......................................46vylibra........................................46VYNDAMAX..............................31VYVANSE................................. 33VYXEOS................................... 20warfarin sodium.........................28water for irrigation, sterile..........52wera.......................................... 46westab one................................38WIDE-SEAL DIAPHRAGM 60.. 52WIDE-SEAL DIAPHRAGM 65.. 52WIDE-SEAL DIAPHRAGM 70.. 52WIDE-SEAL DIAPHRAGM 75.. 52WIDE-SEAL DIAPHRAGM 80.. 52WIDE-SEAL DIAPHRAGM 85.. 52

WIDE-SEAL DIAPHRAGM 90.. 52WIDE-SEAL DIAPHRAGM 95.. 52WINRHO SDF...........................49wixela inhub.............................. 56wymzya fe................................. 46XALKORI.................................. 21XARELTO................................. 28XARELTO STARTER PACK.....28XELJANZ.................................. 48XELJANZ XR............................ 48XGEVA......................................50XIAFLEX................................... 52XIFAXAN...................................11XIGDUO XR..............................26XIIDRA...................................... 53XOLAIR.....................................49XTAMPZA ER............................. 8XTANDI.....................................18xulane....................................... 46XYNTHA................................... 28XYNTHA SOLOFUSE...............28YERVOY................................... 21yuvafem.................................... 46zafirlukast..................................56zaleplon.....................................57ZALTRAP..................................20ZANOSAR.................................18zarah......................................... 46ZELBORAF............................... 21ZEMAIRA.................................. 40zenatane................................... 35ZENPEP....................................40ZEPATIER................................ 23ZERVIATE................................ 53zidovudine.................................24zileuton er................................. 56ZIOPTAN.................................. 54ziprasidone hcl.......................... 23ziprasidone mesylate................ 23ZIRABEV...................................21ZIRGAN.................................... 53ZITHROMAX.............................13zoledronic acid.......................... 50ZOLINZA...................................20zolmitriptan................................17zolpidem tartrate....................... 57zolpidem tartrate er................... 57ZOMIG...................................... 17zonisamide................................13ZONTIVITY............................... 28ZORTRESS.............................. 48zovia 1/35e (28)........................ 46zumandimine.............................46

ZYDELIG...................................21ZYKADIA...................................21ZYPREXA RELPREVV............. 23ZYVOX......................................11

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