· drug formulary . introduction . what is a formulary? a formulary is a list of generic, brand,...
TRANSCRIPT
Effective January 2018
2018 Drug Formulary
HIOS ISSUER ID: 25768 and 80473
For members with individual and family plans
or covered through small employer groups (1–50 employees)
Core
Access PPO
Drug Formulary INTRODUCTION
What is a formulary? A formulary is a list of generic, brand, and specialty drugs. It is used by practitioners to identify drugs that offer the best overall value, considering effectiveness, safety, and cost.
How is the drug formulary developed? The formulary is developed by the Kaiser Permanente Pharmacy and Therapeutics (P&T) Committee. The P&T Committee is composed of physicians from various medical specialties, pharmacists, and a consumer member. The P&T Committee reviews and selects the most appropriate drugs in each class for the formulary based on safety, effectiveness, and cost. The P&T Committee meets quarterly to review new and existing drugs to ensure that the formulary remains responsive to the needs of members and providers.
How do I search the formulary? Drugs on the formulary are listed by therapeutic class. An alphabetical index is included at the end of this document to assist in locating specific drugs. Drugs are listed by generic name if a generic is available. If there is no generic available, drugs are listed by the brand name. Drugs are organized by class and drug formulary tier. Drugs administered in a provider’s office or in a clinic (e.g., drugs given intravenously) may not be listed on the formulary. For coverage of these drugs, refer to your Benefit Booklet.
How do I use the formulary to understand my drug coverage? Drug coverage is based on an individual’s contracted benefit. Coverage for a specific drug is subject to each member’s medical coverage agreement. Please consult your Benefit Booklet or call Member Service if you have questions about your drug coverage. Kaiser Permanente will only cover FDA-approved drugs used for non-experimental therapies. Most plans exclude experimental and investigational drugs, over-the-counter drugs, drugs used in the treatment of sexual dysfunction disorders, drugs for anticipated illnesses while traveling, or drugs used for cosmetic purposes. Please consult your Benefit Booklet for limitations and exclusions.
Medications not listed in this document are not on the formulary at the time of publication. The most current information is online at www.kp.org/wa/formulary. Non-formulary drugs are not covered unless approved by the health plan as a coverage exception. The prescriber must contact Kaiser Permanente to determine the medical necessity of the non-formulary medication. An alternative formulary medication will be recommended when clinically appropriate. If a coverage exception is not approved, the patient is responsible for the full price of the drug.
Generic drugs are substituted when available and allowed by your prescriber. When a generic is available, the brand-name drug is generally considered non-formulary and subject to a higher cost share.
The drug formulary is updated periodically and is subject to change. If a drug will be removed from the formulary, members who filled the drug in the prior three months will be notified by letter of the upcoming change. A formulary change notice will also be posted on the member website at least 45 days prior to the effective date.
Drug Formulary Tiers
Tier Description Tier P Preventative drugs and preferred contraceptives:
The Affordable Care Act (ACA) requires that preventative drugs recommended by the U.S. Preventative Services Task Force (USPSTF) are covered in full.
Tier 1 Preferred generic: Generic drugs are copies of brand name drugs in safety, effectiveness, and quality. They contain the same exact quantities of the same active ingredients and are more affordable than the brand name drug.
Tier 2 Preferred brand: Preferred brand drugs do not have a generic alternative, but were determined by the P&T Committee to have high value in their therapeutic class.
Tier 3 Non-preferred: Non-preferred drugs were determined by the P&T Committee to have higher value alternatives in preferred tiers.
Tier 4 Specialty: Specialty drugs are high-cost drugs prescribed by a physician for the treatment of complex conditions. Some specialty products are dispensed from a preferred specialty pharmacy vendor.
Tier C Oral chemotherapy: Washington State law requires that cancer drugs be covered at a comparable level when received at a doctor’s office or picked up from the pharmacy. This tier was created to ensure comparable coverage of preferred anti-cancer drugs regardless where the drug was received.
Tier M Medical benefit: These drugs are usually given at the provider’s office and are covered under the medical benefit.
What are the methods that Kaiser Permanente uses to ensure appropriate and safe use of formulary drugs?
Prior Authorization (PA) The P&T Committee determines that certain drugs should require prior authorization before they will be covered. These drugs most often have alternatives on the formulary, safety concerns, or a high potential for inappropriate use. To request coverage for prior authorization drugs, you or your prescriber must contact Kaiser Permanente. Drugs requiring prior authorization are indicated with a “PA” superscript next to the drug name.
Step Therapy (ST)
Step therapy requires you to try certain preferred drugs before receiving coverage for the drug you were prescribed. Step therapy is added by the P&T Committee. Step therapy automatically looks at your prescription history when you fill the drug you were prescribed. If you have tried the preferred drugs required by step therapy, the drug you were prescribed will automatically be covered. To request step therapy exceptions, you or your prescriber must contact Kaiser Permanente. Drugs requiring step therapy are indicated with a “ST” superscript next to the drug name.
Quantity Limit (QL) A quantity limit defines how much of a particular drug you can get during a specific time period or the maximum days supply that you can get at once. The P&T Committee determines if a drug should have a quantity limit. To request exceptions to quantity limits, your prescriber must contact Kaiser Permanente. Drugs with quantity limits are indicated with “QL” superscript next to the drug name.
Drugs Limited to Select Pharmacies Some drugs are required to be dispensed from a preferred specialty pharmacy vendor. Members with an out-of-network benefit may use other pharmacies; however, they may pay a higher cost share. Please consult your Benefit Booklet for limitations and exclusions. Drugs limited to select pharmacies are listed on the www.kp.org/wa/formulary webpage.
Covered Diabetic Supplies Some diabetic supplies may be covered at a Tier 1 cost share if they are filled as a prescription. These items are:
• Preferred blood glucose strips: o One Touch Verio o One Touch Ultra o Prodigy – prior authorization required o Contour Next – prior authorization required o Freestyle – prior authorization required
• Disposable insulin syringes and needles • Lancing devices and lancets
Preferred blood glucose meters are covered only when filled through mail order pharmacy.
Mail Order Pharmacy Service Mail order is convenient and efficiently utilizes Kaiser Permanente’s resources. This service works best for drugs that must be taken on regular basis, such as birth control pills and drugs for high blood pressure, high cholesterol, or other chronic conditions. To begin using mail order, ask your prescriber to send your prescription directly to the Mail Order Pharmacy. To transfer an existing prescription from a retail pharmacy, contact the Mail Order Pharmacy.
Address: Kaiser Permanente Mail Order Pharmacy PO Box 34383 Seattle, WA 98124-1383
Phone: 800-245-RXRX (1-800-245-7979)
Fax: 206-630-7950, or toll-free 1-800-350-1683
Preventative Medications and Preferred Contraceptives In accordance with the Affordable Care Act (ACA) requirements for preventive services, most plans cover preventative care medicines and contraceptives in full. If your plan offers ACA benefits, all prescribed FDA approved contraceptive methods from the Kaiser Permanente formulary list will be covered in full when obtained in-network. For plans with out-of-network (OON) benefits, contraceptives will be subject to the OON cost-share. The list of the preventative medications covered in full is available on the www.kp.org/wa/formulary webpage.
Please consult your Benefit Booklet under “Preventive Services” or call Member Service if you have questions about your coverage for these drugs.
If you request coverage for a non-preferred contraceptive, we will contact your provider to recommend a preferred generic or therapeutically equivalent product. If you and your provider determine that the preferred contraceptive(s) would be medically inappropriate, your provider must request a contraceptive waiver. If waiver is completed, the requested non-preferred contraceptive will be covered in full.
Excluded Prescription Products for Medications that have Over-The-Counter (OTC) Alternatives There are certain prescription products that have the same or similar products available over-the- counter (OTC) without a prescription. In certain cases, Kaiser Permanente will not cover the prescription product. The following prescription drug products are excluded from coverage: esomeprazole magnesium (Nexium) and omeprazole/sodium bicarbonate (Zegerid). Medical Benefit Injectable Drugs Some drugs are given in a non-hospital setting such as home infusion, a medical office, a physician's office, or an infusion suite. These drugs are covered under the medical benefit but may require prior authorization or a non-hospital setting. The list of medical benefit injectable drugs is available on the www.kp.org/wa/formulary webpage.
How do I get additional information? Please contact Member Service at 1-888-630-4636 with any questions or concerns regarding the information contained in this document.
The most current drug formulary is available at www.kp.org/wa/formulary.
Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ANTINEOPLASTICS, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
PROGESTERONE ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
HEMATOLOGICAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
OPIOID ANTAGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
MISCELLANEOUS AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
cefazolin inj 1gm
cephalexin sus 125/5ML
cephalexin sus 250/5ML
cephalexin CAP 250MG
January 2018
cephalexin CAP 500MG
TIER 03 NON PREFERRED
ANTI-INFECTIVES
cephalexin CAP 750MG
Cephalexin TAB 250MG
PENICILLINS
Cephalexin TAB 500MG
TIER 01 GENERIC
Daxbia CAP 333MG
amox/k clav sus 200/5ML
Keflex CAP 250MG
amox/k clav sus 250/5ML
Keflex CAP 500MG
amox/k clav sus 400/5ML
Keflex CAP 750MG
amox/k clav sus 600/5ML
SECOND GENERATION
amox/k clav TAB 250-125
TIER 01 GENERIC
amox/k clav TAB 500-125
cefprozil sus 125/5ML
amox/k clav TAB 875-125
cefprozil sus 250/5ML
amoxicillin sus 125/5ML
cefprozil TAB 250MG
amoxicillin sus 200/5ML
cefprozil TAB 500MG
amoxicillin sus 250/5ML
cefuroxime TAB 250MG
amoxicillin sus 250MG/5m
cefuroxime TAB 500MG
amoxicillin sus 400/5ML
TIER 02 PREFERRED
amoxicillin CAP 250MG
Ceftin Sus 125/5ML
amoxicillin CAP 500MG
Ceftin Sus 250/5ML
amoxicillin TAB 500MG
TIER 03 NON PREFERRED
amoxicillin TAB 875MG
cefaclor CAP 250MG
ampicillin inj 1gm
cefaclor CAP 500MG
ampicillin inj 250MG
Cefaclor ER TAB 500MG
ampicillin inj 500MG
Cefaclor Sus 125/5ML
ampicillin CAP 250MG
Cefaclor Sus 250/5ML
ampicillin CAP 500MG
Cefaclor Sus 375/5ML
dicloxacill CAP 250MG
Ceftin TAB 250MG
dicloxacill CAP 500MG
Ceftin TAB 500MG
penicilln vk sol 125/5ML
THIRD GENERATION
penicilln vk sol 250/5ML
TIER 01 GENERIC
penicilln vk TAB 250MG
cefdinir sus 125/5ML
penicilln vk TAB 500MG
cefdinir sus 250/5ML
Amox/K Clav Chw 200MG
cefdinir CAP 300MG
Amox/K Clav Chw 400MG
cefixime sus 100/5ML
Amoxicillin Chw 125MG
cefixime sus 200/5ML
Amoxicillin Chw 250MG
ceftazidime inj 1gm
Ampicillin CAP 500MG
ceftriaxone inj 1gm
Ampicillin Inj 125MG
ceftriaxone inj 2gm
Ampicillin Sus 125/5ML
ceftriaxone inj 250MG
Ampicillin Sus 250/5ML
ceftriaxone inj 500MG
Penicilln Vk Sol 125/5ML
tazicef inj 1gm
Penicilln Vk Sol 250/5ML
TIER 02 PREFERRED
TIER 02 PREFERRED
Suprax CAP 400MG
Bicillin L-a Inj 1200000
Suprax Sus 500/5ML
Bicillin L-a Inj 2400000
TIER 03 NON PREFERRED
Bicillin L-a Inj 600000
cefpodo prox sus 100/5ML
TIER 03 NON PREFERRED
cefpodo prox sus 50MG/5ML
amox-pot cla TAB ER
cefpodoxime TAB 100MG
Amoxicillin TAB 775MG
cefpodoxime TAB 200MG
Augmentin Sus ES-600
Cedax CAP 400MG
Augmentin Sus 125/5ML
Cedax Sus 180/5ML
Augmentin Sus 250/5ML
Cefditoren TAB 200MG
Augmentin TAB 500MG
Cefditoren TAB 400MG
Augmentin TAB 875MG
Ceftibuten CAP 400MG
Augmentin XR TAB 12HR
Ceftibuten Sus 180/5ML
Moxatag TAB 775MG
Fortaz Inj 1gm
Spectracef TAB 400MG
CEPHALOSPORIN
Suprax Chw 100MG
FIRST GENERATION
Suprax Chw 200MG
TIER 01 GENERIC
Suprax Sus 100/5ML
cefadroxil sus 250/5ML
Suprax Sus 200/5ML
cefadroxil sus 500/5ML
FOURTH GENERATION
cefadroxil CAP 500MG
TIER 03 NON PREFERRED
cefadroxil TAB 1gm
cefepime inj 1gm
Maxipime Inj 1gm
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 1
doxycycl HYC TAB 100MG
MACROLIDES
doxycycl HYC TAB 100MG DR
doxycycl HYC TAB 150MG DR
TIER 01 GENERIC
doxycycl HYC TAB 200MG DR
azithromycin sus 100/5ML
doxycycl HYC TAB 50MG DR
azithromycin sus 200/5ML
doxycycl HYC TAB 75MG DR
azithromycin TAB 250MG
doxycycline sus 25MG/5ML
azithromycin TAB 500MG
doxycycline TAB 150MG
azithromycin TAB 600MG
doxycycline TAB 75MG
clarithromyc sus 125/5ML
minocycline TAB 100MG
clarithromyc sus 250/5ML
minocycline TAB 135MG ERPA
clarithromyc TAB 250MG
minocycline TAB 45MG ERPA
clarithromyc TAB 500MG
minocycline TAB 50MG
Azithromycin Pow 1gm PAK
minocycline TAB 75MG
Clarithromyc Sus 125/5ML
minocycline TAB 90MG ERPA
Clarithromyc Sus 250/5ML
morgidox CAP 1X100MG
TIER 04 SPECIALTY
morgidox CAP 1X50MG
Dificid TAB 200MGQL,PA
morgidox CAP 2X100MG
TIER 03 NON PREFERRED
tetracycline CAP 250MG
clarithromyc TAB 500MG ER
tetracycline CAP 500MG
erythrom ETH sus 200/5ML
Acticlate TAB 150MG
erythromycin CAP 250MG EC
Acticlate TAB 75MG
Biaxin Sus 250/5ML
Adoxa CAP 150MG
Biaxin TAB 250MG
Adoxa PAK 1/ TAB 100MG
Biaxin TAB 500MG
Adoxa PAK 1/ TAB 150MG
E.e.s. Gran Sus 200/5ML
Adoxa PAK 2/ TAB 100MG
E.e.s. 400 TAB 400MG
Adoxa TAB 100MG
Ery-TAB Tab 250MG EC
Adoxa TAB 50MG
Ery-TAB Tab 333MG EC
Adoxa TAB 75MG
Ery-TAB Tab 500MG EC
Doryx Mpc TAB 120MG
Eryped Sus 200/5ML
Doryx TAB 200MG
Eryped Sus 400/5ML
Doryx TAB 50MG
Erythrocin TAB 250MG
Minocin CAP 100MG
Erythrom ETH TAB 400MG
Minocin CAP 50MG
Erythromycin TAB 250MG Bs
Minocin CAP 75MG
Erythromycin TAB 500MG Bs
Minocycline TAB 45MG ERPA
PCE TAB 333MG EC
Monodox CAP 100MG
PCE TAB 500MG EC
Monodox CAP 75MG
Zithromax Pow 1gm PAK
Solodyn TAB 105MGPA
Zithromax Sus 100/5ML
Solodyn TAB 115MGPA
Zithromax Sus 200/5ML
Solodyn TAB 55MGPA
Zithromax TAB Tri-PAK
Solodyn TAB 65MGPA
Zithromax TAB Z-PAK
Solodyn TAB 80MGPA
Zithromax TAB 250MG
Targadox TAB 50MG
Zithromax TAB 500MG
Tetracycline CAP 250MG
Zithromax TAB 600MG
Tetracycline CAP 500MG
Zmax Sus 2gm
Vibramycin CAP 100MG
Vibramycin Sus 25MG/5ML
TETRACYCLINES
Vibramycin Syp 50MG/5ML
TIER 01 GENERIC
avidoxy TAB 100MG
QUINOLONES
doxycyc mono CAP 100MG
TIER 01 GENERIC
doxycyc mono CAP 150MG
ciprofloxacn sus 250MG/5
doxycyc mono CAP 50MG
ciprofloxacn sus 500MG/5
doxycyc mono CAP 75MG
ciprofloxacn TAB 250MG
doxycyc mono TAB 100MG
ciprofloxacn TAB 500MG
doxycyc mono TAB 150MG
ciprofloxacn TAB 750MG
doxycyc mono TAB 50MG
levofloxacin sol 25MG/ML
doxycyc mono TAB 75MG
levofloxacin TAB 250MG
minocycline CAP 100MG
levofloxacin TAB 500MG
minocycline CAP 50MG
levofloxacin TAB 750MG
minocycline CAP 75MG
moxifloxacin TAB 400MG
mondoxyne nl CAP 100MG
Ciprofloxacn TAB 100MG
mondoxyne nl CAP 50MG
Levofloxacin Sol 25MG/ML
mondoxyne nl CAP 75MG
TIER 04 SPECIALTY
TIER 03 NON PREFERRED
Baxdela TAB 450MGQL,PA
demeclocycl TAB 150MG
TIER 03 NON PREFERRED
demeclocycl TAB 300MG
ciprofloxacn TAB 1000MG
doxycycl HYC CAP 100MG
ciprofloxacn TAB 500MG ER
doxycycl HYC CAP 50MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 2
ofloxacin TAB 400MG
griseofulvin sus 125/5ML
Avelox Abc TAB 400MG
griseofulvin TAB micr 500
Avelox TAB 400MG
griseofulvin TAB ultr 125
Cipro (10%) Sus 500MG/5
griseofulvin TAB ultr 250
Cipro (5%) Sus 250MG/5
itraconazole CAP 100MGPA
Cipro TAB 250MG
ketoconazole TAB 200MG
Cipro TAB 500MG
nystatin TAB 500000
Cipro XR TAB 1000MG
terbinafine TAB 250MG
Cipro XR TAB 500MG
voriconazole sus 40MG/MLQL,PA
Factive TAB 320MG
voriconazole TAB 200MGQL,PA
Levaquin TAB 250MG
voriconazole TAB 50MGQL,PA
Levaquin TAB 500MG
Amphotericin Inj 50MG
Levaquin TAB 750MG
TIER 02 PREFERRED
Ofloxacin TAB 300MG
Sporanox Sol 10MG/MLPA
TIER 04 SPECIALTY
AMINOGLYCOSIDES
flucytosine CAP 250MGQL
flucytosine CAP 500MGQL
TIER 01 GENERIC
Ancobon CAP 250MGQL,PA
gentamicin inj 40MG/ML
Ancobon CAP 500MGQL,PA
neomycin TAB 500MG
Cresemba CAP 186 MGQL,PA
TIER 04 SPECIALTY
Noxafil Sus 40MG/MLQL,PA
tobramycin neb 300/5MLQL,PA
Noxafil TAB 100MGQL,PA
Bethkis Neb 300/4MLQL,PA
Vfend Sus 40MG/MLQL,PA
Kitabis PAK Neb 300/5MLQL,PA
Vfend TAB 200MGQL,PA
Tobi Neb 300/5MLQL,PA
Vfend TAB 50MGQL,PA
Tobi Podhalr CAP 28MGQL,PA
TIER 03 NON PREFERRED
Tobramycin Neb 300/5MLQL,PA
bio-statin pow
TIER 03 NON PREFERRED
nystatin pow
paromomycin CAP 250MG
Bio-statin CAP 1000000
Streptomycin Inj 1gm
Bio-statin CAP 500000
Diflucan Sus 10MG/ML
SULFONAMIDES
Diflucan Sus 40MG/ML
TIER 03 NON PREFERRED
Diflucan TAB 100MG
Sulfadiazine TAB 500MG
Diflucan TAB 150MG
Diflucan TAB 200MG
ANTIMYCOBACTERIAL AGENTS
Diflucan TAB 50MG
TIER 01 GENERIC
Grifulvin V TAB 500MG
ethambutol TAB 100MG
Gris-peg TAB 125MG
ethambutol TAB 400MG
Gris-peg TAB 250MG
isoniazid TAB 100MG
Lamisil Gra 125MG
isoniazid TAB 300MG
Lamisil Gra 187.5MG
pyrazinamide TAB 500MG
Lamisil TAB 250MG
rifabutin CAP 150MG
Onmel TAB 200MGPA
rifampin CAP 150MG
Sporanox CAP PulsepakPA
rifampin CAP 300MG
Sporanox CAP 100MGPA
Isoniazid Syp 50MG/5ML
TIER 02 PREFERRED
ANTIVIRALS
Priftin TAB 150MGPA
TIER 01 GENERIC
TIER 04 SPECIALTY
abacavir sol 20MG/ML
Sirturo TAB 100MGQL,PA
abacavir TAB 300MG
TIER 03 NON PREFERRED
acyclovir sus 200/5ML
Cycloserine CAP 250MG
acyclovir CAP 200MG
Myambutol TAB 100MG
acyclovir TAB 400MG
Myambutol TAB 400MG
acyclovir TAB 800MG
Mycobutin CAP 150MG
didanosine CAP 125MG
Paser Gra 4gm
didanosine CAP 200MG
Rifadin CAP 150MG
didanosine CAP 250MG
Rifadin CAP 300MG
didanosine CAP 400MG
Rifamate CAP
entecavir TAB 0.5MGQL
Rifater TAB
entecavir TAB 1MGQL
Trecator TAB 250MG
lamivud/zido TAB 150-300
lamivudine sol 10MG/ML
ANTIFUNGALS
lamivudine TAB 100MG
TIER 01 GENERIC
lamivudine TAB 150MG
fluconazole sus 10MG/ML
lamivudine TAB 300MG
fluconazole sus 40MG/ML
lopin/riton sol 80-20/ML
fluconazole TAB 100MG
moderiba TAB 200MGQL
fluconazole TAB 150MG
nevirapine TAB 100MG
fluconazole TAB 200MG
nevirapine TAB 200MG
fluconazole TAB 50MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 3
nevirapine TAB 400MG ER
abacav/lamiv TAB /zidovudQL
oseltamivir CAP 30MG
adefov dipiv TAB 10MGQL
oseltamivir CAP 45MG
fosamprenavi TAB 700MGQL
oseltamivir CAP 75MG
valganciclov sol 50MG/MLQL,PA
ribasphere CAP 200MGQL
valganciclov TAB 450MGQL
ribasphere TAB 200MGQL
Aptivus CAP 250MGQL
ribavirin CAP 200MGQL
Aptivus SolQL,PA
ribavirin TAB 200MGQL
Atripla TABQL
rimantadine TAB 100MG
Baraclude Sol .05MG/MLQL
stavudine sol 1MG/ML
Baraclude TAB 0.5MGQL,PA
stavudine CAP 15MG
Baraclude TAB 1MGQL,PA
stavudine CAP 20MG
Complera TABQL,ST
stavudine CAP 30MG
Daklinza TAB 30MGQL,PA
stavudine CAP 40MG
Daklinza TAB 60MGQL,PA
valacyclovir TAB 1gm
Daklinza TAB 90MGQL,PA
valacyclovir TAB 500MG
Descovy TAB 200/25QL
zidovudine syp 50MG/5ML
Epclusa TAB 400-100QL,PA
zidovudine CAP 100MG
Epzicom TAB 600-300QL,PA
zidovudine TAB 300MG
Evotaz TAB 300-150QL
Nevirapine Sus 50MG/5ML
Fuzeon Inj 90MGQL,PA
TIER 02 PREFERRED
Genvoya TABQL
Crixivan CAP 200MG
Harvoni TAB 90-400MGQL,PA
Crixivan CAP 400MG
Hepsera TAB 10MGQL,PA
Edurant TAB 25MG
Lexiva Sus 50MG/MLQL
Emtriva CAP 200MG
Lexiva TAB 700MGQL
Emtriva Sol 10MG/ML
Mavyret TAB 100-40MGQL,PA
Epivir HBV Sol 5MG/MLQL
Odefsey TABQL
Intelence TAB 100MG
Olysio CAP 150MGQL,PA
Intelence TAB 200MG
Peg-intron Kit 120 RpQL
Intelence TAB 25MG
Peg-intron Kit 120mcgQL
Invirase CAP 200MG
Peg-intron Kit 150 RpQL
Invirase TAB 500MG
Peg-intron Kit 150mcgQL
Isentress Chw 100MG
Peg-intron Kit 50mcgQL
Isentress Chw 25MG
Peg-intron Kit 50mcg RpQL
Isentress HD TAB 600MG
Peg-intron Kit 80mcg RpQL
Isentress TAB 400MG
Pegasys InjQL
Kaletra TAB 100-25MG
Pegasys Inj ProclickQL
Kaletra TAB 200-50MG
Pegasys Inj 180mcg/MQL
Norvir CAP 100MG
Pegintron Kit 120mcgQL
Norvir Sol 80MG/ML
Pegintron Kit 150mcgQL
Norvir TAB 100MG
Pegintron Kit 50mcgQL
Prezista Sus 100MG/ML
Pegintron Kit 80mcgQL
Prezista TAB 150MG
Prezcobix TAB 800-150QL,PA
Prezista TAB 600MG
Reyataz CAP 150MGQL
Prezista TAB 75MG
Reyataz CAP 200MGQL
Prezista TAB 800MG
Reyataz CAP 300MGQL
Rebetol Sol 40MG/MLQL
Selzentry Sol 20MG/MLQL
Relenza Mis Diskhale
Selzentry TAB 150MGQL
Rescriptor TAB 100 MG
Selzentry TAB 25MGQL
Rescriptor TAB 200MG
Selzentry TAB 300MGQL
Sustiva CAP 200MG
Selzentry TAB 75MGQL
Sustiva CAP 50MG
Sovaldi TAB 400MGQL,PA
Sustiva TAB 600MG
Stribild TABQL,ST
Tamiflu Sus 6MG/ML
Technivie TABQL,PA
Tivicay TAB 10MG
Triumeq TABQL
Tivicay TAB 25MG
Trizivir TABQL,PA
Tivicay TAB 50MG
Truvada TAB 100-150QL
Tybost TAB 150MGPA
Truvada TAB 133-200QL
Videx Sol 2gm
Truvada TAB 167-250QL
Videx Sol 4gm
Truvada TAB 200-300QL
Viracept TAB 250MG
Tyzeka TAB 600MGQL,PA
Viracept TAB 625MG
Valcyte Sol 50MG/MLQL,PA
Viread Pow 40MG/GmQL
Valcyte TAB 450MGQL,PA
Viread TAB 150MGQL
Vemlidy TAB 25MGQL,PA
Viread TAB 200MGQL
Victrelis CAP 200MGQL,PA
Viread TAB 250MGQL
Viekira PAK TABQL,PA
Viread TAB 300MGQL
Viekira XR TABQL,PA
Ziagen Sol 20MG/ML
Vitekta TAB 150MGQL,PA
TIER 04 SPECIALTY
Vitekta TAB 85MGQL,PA
abaca/lamivu TAB 600-300QL
Vosevi TABQL,PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 4
Zepatier TAB 50-100MGQL,PA
SPECIALTY
TIER 03 NON PREFERRED
Daraprim TAB 25MGQL
famciclovir TAB 125MG
TIER 03 NON PREFERRED
famciclovir TAB 250MG
atovaq/progu TAB 250-100PA
famciclovir TAB 500MG
atovaq/progu TAB 62.5-25PA
ribavirin inh 6gm
mefloquine TAB 250MGPA
Combivir TAB 150-300
quinine sulf CAP 324MG
Copegus TAB 200MGQL
Coartem TAB 20-120MG
Epivir HBV TAB 100MG
Malarone TAB 250-100PA
Epivir Sol 10MG/ML
Malarone TAB 62.5-25PA
Epivir TAB 150MG
Plaquenil TAB 200MG
Epivir TAB 300MG
Qualaquin CAP 324MG
Famvir TAB 125MG
Famvir TAB 250MG
ANTHELMINTICS
Famvir TAB 500MG
TIER 02 PREFERRED
Flumadine TAB 100MG
Biltricide TAB 600MG
Isentress Pow 100MG
TIER 04 SPECIALTY
Kaletra Sol
Albenza TAB 200MGQL
Moderiba PAK 1200/Day
TIER 03 NON PREFERRED
Moderiba PAK 800/Day
ivermectin TAB 3MG
Moderiba TAB 1000/Day
Emverm Chw 100MG
Moderiba TAB 600/Day
Stromectol TAB 3MG
Rebetol CAP 200MGQL
Retrovir CAP 100MG
MISC. ANTI-INFECTIVES
Retrovir Syp 50MG/5ML
TIER 01 GENERIC
Reyataz Pow 50MG
clindamycin inj 150MG/ML
Ribapak PAK 1200/Day
clindamycin inj 300/2ML
Ribapak PAK 800/Day
clindamycin inj 300MG
Ribapak TAB 1000/Day
clindamycin sol 75MG/5ML
Ribapak TAB 600/Day
clindamycin CAP 150MG
Ribasphere TAB 400MG
clindamycin CAP 300MG
Ribasphere TAB 600MG
clindamycin CAP 75MG
Ribatab TAB 1000/Day
colistimeth inj 150MG
Ribatab TAB 1200/Day
dapsone TAB 100MG
Ribatab TAB 800/Day
dapsone TAB 25MG
Sitavig TAB 50MG
linezolid sus 100/5MLQL
Tamiflu CAP 30MG
linezolid TAB 600MGQL
Tamiflu CAP 45MG
metronidazol TAB 250MG
Tamiflu CAP 75MG
metronidazol TAB 500MG
Valtrex TAB 1gm
smz-tmp sus 200-40/5
Valtrex TAB 500MG
smz-tmp DS TAB 800-160
Videx EC CAP 125MG
smz-tmp TAB 400-80MG
Videx EC CAP 200MG
smz/tmp DS TAB 800-160
Videx EC CAP 250MG
sulfatrim PD sus 200-40/5
Videx EC CAP 400MG
trimethoprim TAB 100MG
Viramune Sus 50MG/5ML
vancomycin 250/5ML
Viramune TAB 200MG
TIER 02 PREFERRED
Viramune XR TAB 100MG
Alinia Sus 100/5ML
Viramune XR TAB 400MG
Alinia TAB 500MG
Virazole Inh 6gm
Primsol Sol 50MG/5ML
Zerit CAP 15MG
Trimpex Sol 50MG/5ML
Zerit CAP 20MG
TIER 04 SPECIALTY
Zerit CAP 30MG
atovaquone sus 750/5MLQL
Zerit CAP 40MG
vancomycin CAP 125MGQL
Zerit Sol 1MG/ML
vancomycin CAP 250MGQL
Ziagen TAB 300MG
Cayston Inh 75MGQL,PA
Zovirax CAP 200MG
Impavido CAP 50MGQL,PA
Zovirax Sus 200/5ML
Mepron SusQL,PA
Zovirax TAB 400MG
Sivextro TAB 200MGQL
Zovirax TAB 800MG
Vancocin HCL CAP 125MGQL,PA
Vancocin HCL CAP 250MGQL,PA
ANTIMALARIALS
Xifaxan TAB 200MGQL,PA
TIER 01 GENERIC
Xifaxan TAB 550MGQL,PA
chloroquine TAB 250MG
Zyvox Sus 100MG/5mQL,PA
chloroquine TAB 500MG
Zyvox TAB 600MGQL,PA
hydroxychlor TAB 200MG
TIER M MEDICAL COPAY
Chloroquine TAB 250MG
Invanz Inj 1gmPA
Primaquine TAB 26.3MG
TIER 03 NON PREFERRED
TIER 04
lincomycin inj 300MG/ML
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 5
metronidazol CAP 375MG
methotrexate inj 250/10ML
tinidazole TAB 250MG
methotrexate inj 50MG/2ML
tinidazole TAB 500MG
methotrexate TAB 2.5MG
Bactrim DS TAB 800-160
Carac CRE 0.5%QL
Bactrim TAB 400-80MG
Efudex CRE 5%QL,PA
Cleocin CAP 150MG
Fluoroplex CRE 1%QL
Cleocin CAP 300MG
Fluorouracil CRE 0.5%QL
Cleocin CAP 75MG
Fluorouracil Sol 2%QL
Cleocin Phos Inj 300MG
Fluorouracil Sol 5%QL
Cleocin PED Sol 75MG/5ML
Methotrexate Inj 25MG/ML
Coly-mycin M Inj 150MG
Purixan Sus 20MG/MLPA
Flagyl CAP 375MG
Tabloid TAB 40MG
Flagyl TAB 250MG
Tolak CRE 4%QL,PA
Flagyl TAB 500MG
Trexall TAB 10MGPA
Ketek TAB 300MG
Trexall TAB 15MGPA
Ketek TAB 400MG
Trexall TAB 5MGPA
Lincocin Inj 300MG/ML
Trexall TAB 7.5MGPA
Nebupent Inh 300MG
Xatmep Sol 2.5MG/MLQL,PA
Pentam 300 Inj 300MG
Xeloda TAB 150MGQL,PA
Tindamax TAB 250MG
Xeloda TAB 500MGQL,PA
Tindamax TAB 500MG
Vancomycn 25 Sol 25MG/ML
ANTIBODIES
Vancomycn 50 Sol 50MG/ML
TIER M MEDICAL COPAY
Rituxan Inj 100MGPA
ANTINEOPLASTICS, ETC.
Rituxan Inj 500MGPA
ALKYLATING AGENTS
HORMONAL AGENTS
TIER C ORAL CHEMO
TIER 01 GENERIC
melphalan TAB 2MGQL
megestrol ac sus 40MG/ML
temozolomide CAP 100MGQL
megestrol ac sus 400MG/10
temozolomide CAP 140MGQL
TIER P PREVENTIVE
temozolomide CAP 180MGQL
tamoxifen TAB 10MG
temozolomide CAP 20MGQL
tamoxifen TAB 20MG
temozolomide CAP 250MGQL
TIER C ORAL CHEMO
temozolomide CAP 5MGQL
anastrozole TAB 1MG
Alkeran TAB 2MGQL
bicalutamide TAB 50MG
Cyclophosph CAP 25MG
exemestane TAB 25MGPA
Cyclophosph CAP 50MG
flutamide CAP 125MG
Gleostine CAP 10MG
letrozole TAB 2.5MG
Gleostine CAP 100MG
leuprolide inj 1MG/0.2
Gleostine CAP 40MG
megestrol ac TAB 20MG
Gleostine CAP 5MG
megestrol ac TAB 40MG
Hexalen CAP 50MGQL,PA
nilutamide TAB 150MGPA
Leukeran TAB 2MG
Arimidex TAB 1MGPA
Lomustine CAP 10MG
Aromasin TAB 25MGPA
Lomustine CAP 100MG
Casodex TAB 50MGPA
Lomustine CAP 40MG
Eligard Inj 22.5MGPA
Myleran TAB 2MG
Eligard Inj 30MGPA
Temodar CAP 100MGQL,PA
Eligard Inj 45MGPA
Temodar CAP 140MGQL,PA
Eligard Inj 7.5MGPA
Temodar CAP 180MGQL,PA
Emcyt CAP 140MGQL,PA
Temodar CAP 20MGQL,PA
Fareston TAB 60MGPA
Temodar CAP 250MGQL,PA
Femara TAB 2.5MGPA
Temodar CAP 5MGQL,PA
Lupron Depot Inj 11.25MG
TIER 04 SPECIALTY
Lupron Depot Inj 22.5MG
Valchlor Gel 0.016%QL,PA
Lupron Depot Inj 3.75MG
Lupron Depot Inj 30MG
ANTIMETABOLITES
Lupron Depot Inj 45MG
TIER C ORAL CHEMO
Lupron Depot Inj 7.5MG
capecitabine TAB 150MGQL,PA
Lysodren TAB 500MGPA
capecitabine TAB 500MGQL,PA
Nilandron TAB 150MGPA
fluorouracil dro 2%QL
Soltamox Sol 10MG/5MLPA
fluorouracil dro 5%QL
Xtandi CAP 40MGQL,PA
fluorouracil CRE 5%QL
Zytiga TAB 250MGQL,PA
mercaptopur TAB 50MG
Zytiga TAB 500MGQL,PA
methotrexate inj 1gm
TIER M MEDICAL COPAY
methotrexate inj 1gm/40ML
Firmagon Inj 120MGPA
methotrexate inj 100/4ML
Firmagon Inj 80MGPA
methotrexate inj 200/8ML
TIER 03
methotrexate inj 25MG/ML
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 6
NON PREFERRED
Prograf CAP 5MG
Depo-provera Inj 400/MLQL
Rapamune TAB 0.5MG
Megace Oral Sus 40MG/ML
Rapamune TAB 1MG
Rapamune TAB 2MG
IMMUNOMODULATORS
Sandimmune CAP 100MG
Sandimmune CAP 25MG
TIER 01 GENERIC
Sandimmune Sol 100MG/ML
azathioprine TAB 50MG
cyclosporine sol modified
MITOTIC INHIBITORS
cyclosporine CAP 100MG
cyclosporine CAP 100MG MD
TIER C ORAL CHEMO
cyclosporine CAP 25MG
Etoposide CAP 50MG
cyclosporine CAP 25MG mod
gengraf sol 100MG/ML
ENZYME INHIBITORS
gengraf CAP 100MG
TIER C ORAL CHEMO
gengraf CAP 25MG
imatinib mes TAB 100MGQL,PA
gengraf CAP 50MG
imatinib mes TAB 400MGQL,PA
mycophenolat sus 200MG/ML
Afinitor Dis TAB 2MGQL,PA
mycophenolat CAP 250MG
Afinitor Dis TAB 3MGQL,PA
mycophenolat TAB 500MG
Afinitor Dis TAB 5MGQL,PA
mycophenolic TAB 180MG DR
Afinitor TAB 10MGQL,PA
mycophenolic TAB 360MG DR
Afinitor TAB 2.5MGQL,PA
sirolimus TAB 0.5MG
Afinitor TAB 5MGQL,PA
sirolimus TAB 1MG
Afinitor TAB 7.5MGQL,PA
sirolimus TAB 2MG
Alecensa CAP 150MGQL,PA
tacrolimus CAP 0.5MG
Alunbrig TAB 30MGQL,PA
tacrolimus CAP 1MG
Bosulif TAB 100MGQL,PA
tacrolimus CAP 5MG
Bosulif TAB 500MGQL,PA
Cyclosporine CAP 50MG Mod
Cabometyx TAB 20MGPA
TIER 02 PREFERRED
Cabometyx TAB 40MGPA
Rapamune Sol 1MG/ML
Cabometyx TAB 60MGPA
TIER C ORAL CHEMO
Caprelsa TAB 100MGQL,PA
Pomalyst CAP 1MGQL,PA
Caprelsa TAB 300MGQL,PA
Pomalyst CAP 2MGQL,PA
Cometriq Kit 100MGQL,PA
Pomalyst CAP 3MGQL,PA
Cometriq Kit 140MGQL,PA
Pomalyst CAP 4MGQL,PA
Cometriq Kit 60MGQL,PA
Revlimid CAP 10MGQL,PA
Cotellic TAB 20MGQL,PA
Revlimid CAP 15MGQL,PA
Farydak CAP 10MGQL,PA
Revlimid CAP 2.5MGQL,PA
Farydak CAP 15MGQL,PA
Revlimid CAP 20MGQL,PA
Farydak CAP 20MGQL,PA
Revlimid CAP 25MGQL,PA
Gilotrif TAB 20MGQL,PA
Revlimid CAP 5MGQL,PA
Gilotrif TAB 30MGQL,PA
Thalomid CAP 100MGQL,PA
Gilotrif TAB 40MGQL,PA
Thalomid CAP 150MGQL,PA
Gleevec TAB 100MGQL,PA
Thalomid CAP 200MGQL,PA
Gleevec TAB 400MGQL,PA
Thalomid CAP 50MGQL,PA
Ibrance CAP 100MGQL,PA
TIER 04 SPECIALTY
Ibrance CAP 125MGQL,PA
Zortress TAB 0.25MGQL,PA
Ibrance CAP 75MGQL,PA
Zortress TAB 0.5MGQL,PA
Iclusig TAB 15MGQL,PA
Zortress TAB 0.75MGQL,PA
Iclusig TAB 45MGQL,PA
TIER 03 NON PREFERRED
Idhifa TAB 100MGQL,PA
Astagraf XL CAP 0.5MG
Idhifa TAB 50MGQL,PA
Astagraf XL CAP 1MG
Imbruvica CAP 140MGQL,PA
Astagraf XL CAP 5MG
Inlyta TAB 1MGPA
Azasan TAB 100MG
Inlyta TAB 5MGPA
Azasan TAB 75 MG
Iressa TAB 250MGQL,PA
Cellcept CAP 250MG
Jakafi TAB 10MGQL,PA
Cellcept Sus 200MG/ML
Jakafi TAB 15MGQL,PA
Cellcept TAB 500MG
Jakafi TAB 20MGQL,PA
Envarsus XR TAB 0.75MG
Jakafi TAB 25MGQL,PA
Envarsus XR TAB 1MG
Jakafi TAB 5MGQL,PA
Envarsus XR TAB 4MG
Kisqali TAB 200doseQL,PA
Imuran TAB 50MG
Kisqali TAB 400doseQL,PA
Myfortic TAB 180MG
Kisqali TAB 600doseQL,PA
Myfortic TAB 360MG
Lenvima CAP 10 MGQL,PA
Neoral CAP 100MG
Lenvima CAP 14 MGQL,PA
Neoral CAP 25MG
Lenvima CAP 18 MGQL,PA
Neoral Sol 100MG/ML
Lenvima CAP 20 MGQL,PA
Prograf CAP 0.5MG
Lenvima CAP 24 MGQL,PA
Prograf CAP 1MG
Lenvima CAP 8 MGQL,PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 7
Lynparza CAP 50MGQL,PA
TIER 03 NON PREFERRED
Lynparza TAB 100MGQL,PA
Alferon N Inj 5mu/ML
Lynparza TAB 150MGQL,PA
Mekinist TAB 0.5MGQL,PA
CHEMOTHERAPY RESCUE
Mekinist TAB 2MGQL,PA
TIER 01 GENERIC
Nerlynx TAB 40MGQL,PA
mesna inj 1gm
Nexavar TAB 200MGQL,PA
TIER C ORAL CHEMO
Ninlaro CAP 2.3MGQL,PA
leucovor CA TAB 25MG
Ninlaro CAP 3MGQL,PA
leucovor CA TAB 5MG
Ninlaro CAP 4MGQL,PA
Leucovor CA TAB 10MG
Rubraca TAB 200MGQL,PA
Leucovor CA TAB 15MG
Rubraca TAB 250MGQL,PA
Mesnex TAB 400MG
Rubraca TAB 300MGQL,PA
Rydapt CAP 25MGQL,PA
ANTINEOPLASTIC COMBO
Sprycel TAB 100MGQL,PA
TIER C ORAL CHEMO
Sprycel TAB 140MGQL,PA
Kisqali 200 PAK FemaraQL,PA
Sprycel TAB 20MGQL,PA
Kisqali 400 PAK FemaraQL,PA
Sprycel TAB 50MGQL,PA
Kisqali 600 PAK FemaraQL,PA
Sprycel TAB 70MGQL,PA
Lonsurf TAB 15-6.14QL,PA
Sprycel TAB 80MGQL,PA
Lonsurf TAB 20-8.19QL,PA
Stivarga TAB 40MGQL,PA
Sutent CAP 12.5MGQL,PA
CARDIOVASCULAR DRUGS
Sutent CAP 25MGQL,PA
CARDIAC GLYCOSIDES
Sutent CAP 37.5MGQL,PA
TIER 01 GENERIC
Sutent CAP 50MGQL,PA
digitek TAB 0.125MG
Tafinlar CAP 50MGQL,PA
digitek TAB 0.25MG
Tafinlar CAP 75MGQL,PA
digox TAB 0.125MG
Tagrisso TAB 40MGQL,PA
digox TAB 0.25MG
Tagrisso TAB 80MGQL,PA
digoxin inj 0.25MG/1
Tarceva TAB 100MGQL,PA
digoxin TAB 0.125MG
Tarceva TAB 150MGQL,PA
digoxin TAB 0.25MG
Tarceva TAB 25MGQL,PA
Digoxin Sol 50mcg/ML
Tasigna CAP 150MGQL,PA
TIER 03 NON PREFERRED
Tasigna CAP 200MGQL,PA
Lanoxin Inj 0.25MG/1
Tykerb TAB 250MGQL,PA
Lanoxin PED Inj 0.1MG/ML
Votrient TAB 200MGQL,PA
Lanoxin TAB 0.0625MG
Xalkori CAP 200MGQL,PA
Lanoxin TAB 0.125MG
Xalkori CAP 250MGQL,PA
Lanoxin TAB 0.1875MG
Zejula CAP 100MGQL,PA
Lanoxin TAB 0.25MG
Zelboraf TAB 240MGQL,PA
Zolinza CAP 100MGQL,PA
ANTIANGINAL AGENTS
Zydelig TAB 100MGQL,PA
TIER 01 GENERIC
Zydelig TAB 150MGQL,PA
isosorb din TAB 10MG
Zykadia CAP 150MGQL,PA
isosorb din TAB 20MG
isosorb din TAB 30MG
TOPOISOMERASE I INHIBITOR
isosorb din TAB 5MG
TIER C ORAL CHEMO
isosorb mono TAB 10MG
Hycamtin CAP 0.25MGQL,PA
isosorb mono TAB 120MG ER
Hycamtin CAP 1MGQL,PA
isosorb mono TAB 20MG
isosorb mono TAB 30MG ER
ANTINEOPLASTICS MISC.
isosorb mono TAB 60MG ER
TIER C ORAL CHEMO
minitran dis 0.1MG/HR
bexarotene CAP 75MGQL,PA
minitran dis 0.2MG/HR
hydroxyurea CAP 500MG
minitran dis 0.4MG/HR
tretinoin CAP 10MGQL
minitran dis 0.6MG/HR
Hydrea CAP 500MGPA
nitro-time CAP 9MG CR
Intron A Inj 10muQL
nitroglycer dis 0.1MG/HR
Intron A Inj 18muQL
nitroglycer dis 0.2MG/HR
Intron A Inj 25muQL
nitroglycer dis 0.4MG/HR
Intron A Inj 50muQL
nitroglycer dis 0.6MG/HR
Matulane CAP 50MGQL
nitroglycer CAP 9MG ER
Picato Gel 0.015%QL
TIER 02 PREFERRED
Picato Gel 0.05%QL
Isordil TAB 40MG
Sylatron Kit 200mcgQL,PA
Nitro-bid Oin 2%
Sylatron Kit 300mcgQL,PA
Nitro-dur Dis 0.3MG/HR
Sylatron Kit 600mcgQL,PA
Nitro-dur Dis 0.8MG/HR
Targretin CAP 75MGQL,PA
TIER 03 NON PREFERRED
TIER 04 SPECIALTY
nitroglycrn spr 0.4MG
Actimmune Inj 2mu/0.5QL,PA
Dilatrate SR CAP 40MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 8
Gonitro Pow 400mcg
Metoprolol TAB 75MG
Isordil TAB 5MG
Propranolol Sol 20MG/5ML
Isosorb Din TAB 40MG ER
Propranolol Sol 40MG/5ML
Nitro-dur Dis 0.1MG/HR
Timolol Mal TAB 10MG
Nitro-dur Dis 0.2MG/HR
Timolol Mal TAB 20MG
Nitro-dur Dis 0.4MG/HR
Timolol Mal TAB 5MG
Nitro-dur Dis 0.6MG/HR
TIER C ORAL CHEMO
Nitroglycer Aer 400mcg
Hemangeol Sol 4.28/MLPA
Nitrolingual Spr Pumpspra
TIER 03 NON PREFERRED
Nitromist Aer 400mcg
Betapace AF TAB 120MG
Nitrostat Sub 0.3MG
Betapace AF TAB 160MG
Ranexa TAB 1000MGPA
Betapace AF TAB 80MG
Ranexa TAB 500MGPA
Betapace TAB 120MG
Betapace TAB 160MG
BETA BLOCKERS
Betapace TAB 80MG
Bystolic TAB 10MG
TIER 01 GENERIC
Bystolic TAB 2.5MG
acebutolol CAP 200MG
Bystolic TAB 20MG
acebutolol CAP 400MG
Bystolic TAB 5MG
atenolol TAB 100MG
Coreg CR CAP 10MG
atenolol TAB 25MG
Coreg CR CAP 20MG
atenolol TAB 50MG
Coreg CR CAP 40MG
betaxolol TAB 10MG
Coreg CR CAP 80MG
betaxolol TAB 20MG
Coreg TAB 12.5MG
bisoprol fum TAB 10MG
Coreg TAB 25MG
bisoprol fum TAB 5MG
Coreg TAB 3.125MG
carvedilol TAB 12.5MG
Coreg TAB 6.25MG
carvedilol TAB 25MG
Corgard TAB 20MG
carvedilol TAB 3.125MG
Corgard TAB 40MG
carvedilol TAB 6.25MG
Corgard TAB 80MG
labetalol TAB 100MG
Inderal LA CAP 120MG
labetalol TAB 200MG
Inderal LA CAP 160MG
labetalol TAB 300MG
Inderal LA CAP 60MG
metoprol suc TAB 100MG ER
Inderal LA CAP 80MG
metoprol suc TAB 200MG ER
Inderal XL CAP 120MG
metoprol suc TAB 25MG ER
Inderal XL CAP 80MG
metoprol suc TAB 50MG ER
Innopran XL CAP 120MG
metoprol TAR TAB 100MG
Innopran XL CAP 80MG
metoprol TAR TAB 25MG
Lopressor TAB 100MG
metoprol TAR TAB 50MG
Lopressor TAB 50MG
metoprolol TAB 100MG ER
Sectral CAP 200MG
metoprolol TAB 200MG ER
Sectral CAP 400MG
metoprolol TAB 25MG ER
Sotylize Sol 5MG/ML
metoprolol TAB 50MG ER
Tenormin TAB 100MG
nadolol TAB 20MG
Tenormin TAB 25MG
nadolol TAB 40MG
Tenormin TAB 50MG
nadolol TAB 80MG
Toprol XL TAB 100MG
pindolol TAB 10MG
Toprol XL TAB 200MG
pindolol TAB 5MG
Toprol XL TAB 25MG
propranolol CAP 120MG ER
Toprol XL TAB 50MG
propranolol CAP 160MG ER
Zebeta TAB 10MG
propranolol CAP 60MG ER
Zebeta TAB 5MG
propranolol CAP 80MG ER
propranolol TAB 10MG
CALCIUM CHANNEL BLOCKERS
propranolol TAB 20MG
propranolol TAB 40MG
TIER 01 GENERIC
propranolol TAB 60MG
afeditab TAB 30MG CR
propranolol TAB 80MG
afeditab TAB 60MG CR
sorine TAB 120MG
amlodipine TAB 10MG
sorine TAB 160MG
amlodipine TAB 2.5MG
sorine TAB 240MG
amlodipine TAB 5MG
sorine TAB 80MG
cartia XT CAP 120/24HR
sotalol AF TAB 120MG
cartia XT CAP 180/24HR
sotalol AF TAB 160MG
cartia XT CAP 240/24HR
sotalol AF TAB 80MG
cartia XT CAP 300/24HR
sotalol HCL TAB 120MG
dilt-XR CAP 120MG
sotalol HCL TAB 160MG
dilt-XR CAP 180MG
sotalol HCL TAB 240MG
dilt-XR CAP 240MG
sotalol HCL TAB 80MG
diltiazem CAP 120MG CD
Metoprolol TAB 37.5MG
diltiazem CAP 120MG ER
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 9
diltiazem CAP 180MG CD
verapamil CAP 100MG ER
diltiazem CAP 180MG ER
verapamil CAP 200MG ER
diltiazem CAP 240MG CD
verapamil CAP 300MG ER
diltiazem CAP 240MG ER
Adalat CC TAB 30MG ER
diltiazem CAP 300MG CD
Adalat CC TAB 60MG ER
diltiazem CAP 300MG ER
Adalat CC TAB 90MG ER
diltiazem CAP 360MG CD
Calan SR TAB 120MG
diltiazem CAP 360MG ER
Calan SR TAB 180MG
diltiazem CAP 60MG ER
Calan SR TAB 240MG
diltiazem CAP 90MG ER
Calan TAB 120MG
diltiazem TAB 120MG
Calan TAB 80MG
diltiazem TAB 30MG
Cardizem CD CAP 120MG/24
diltiazem TAB 60MG
Cardizem CD CAP 180MG/24
diltiazem TAB 90MG
Cardizem CD CAP 240MG/24
felodipine TAB 10MG ER
Cardizem CD CAP 300MG/24
felodipine TAB 2.5MG ER
Cardizem CD CAP 360MG/24
felodipine TAB 5MG ER
Cardizem LA TAB 120MG
isradipine CAP 2.5MG
Cardizem LA TAB 180MG
isradipine CAP 5MG
Cardizem LA TAB 240MG
nicardipine CAP 20MG
Cardizem LA TAB 300MG/24
nicardipine CAP 30MG
Cardizem LA TAB 360MG
nifedical XL TAB 30MG
Cardizem LA TAB 420MG/24
nifedical XL TAB 60MG
Cardizem TAB 120MG
nifedipine CAP 10MG
Cardizem TAB 30MG
nifedipine CAP 20MG
Cardizem TAB 60MG
nifedipine TAB 30MG ER
Nisoldipine TAB 20MG ER
nifedipine TAB 60MG ER
Nisoldipine TAB 25.5MG
nifedipine TAB 90MG ER
Nisoldipine TAB 30MG ER
nimodipine CAP 30MG
Nisoldipine TAB 40MG ER
verapamil CAP 120MG ER
Norvasc TAB 10MG
verapamil CAP 120MG SR
Norvasc TAB 2.5MG
verapamil CAP 180MG ER
Norvasc TAB 5MG
verapamil CAP 180MG SR
Procardia CAP 10MG
verapamil CAP 240MG ER
Procardia XL TAB 30MG CR
verapamil CAP 240MG SR
Procardia XL TAB 60MG CR
verapamil CAP 360MG SR
Procardia XL TAB 90MG CR
verapamil TAB 120MG
Sular TAB 17MG
verapamil TAB 120MG ER
Sular TAB 34MG
verapamil TAB 180MG ER
Sular TAB 8.5MG
verapamil TAB 240MG ER
Tiazac CAP 120MG/24
verapamil TAB 40MG
Tiazac CAP 180MG/24
verapamil TAB 80MG
Tiazac CAP 240MG/24
TIER 04 SPECIALTY
Tiazac CAP 300MG/24
Nymalize Sol 30/10MLQL,PA
Tiazac CAP 360MG/24
Nymalize Sol 60/20MLQL,PA
Tiazac CAP 420MG/24
TIER 03 NON PREFERRED
Verelan CAP 120MG SR
diltiazem CAP 120MG/24
Verelan CAP 180MG SR
diltiazem CAP 180MG/24
Verelan CAP 240MG SR
diltiazem CAP 240MG/24
Verelan CAP 360MG SR
diltiazem CAP 300MG/24
Verelan PM CAP 100MG ER
diltiazem CAP 360MG/24
Verelan PM CAP 200MG ER
diltiazem CAP 420MG/24
Verelan PM CAP 300MG ER
diltiazem ER TAB 180MG
diltiazem ER TAB 240MG
ANTIARRHYTHMICS
diltiazem ER TAB 300MG
TIER 01 GENERIC
diltiazem ER TAB 360MG
amiodarone TAB 200MG
diltiazem ER TAB 420MG
disopyramide CAP 100MG
matzim LA TAB 180MG/24
disopyramide CAP 150MG
matzim LA TAB 240MG/24
flecainide TAB 100MG
matzim LA TAB 300MG/24
flecainide TAB 150MG
matzim LA TAB 360MG/24
flecainide TAB 50MG
matzim LA TAB 420MG/24
mexiletine CAP 150MG
nisoldipine TAB 17MG ER
mexiletine CAP 200MG
nisoldipine TAB 34MG ER
mexiletine CAP 250MG
nisoldipine TAB 8.5MG ER
pacerone TAB 200MG
taztia XT CAP 120MG/24
propafenone TAB 150MG
taztia XT CAP 180MG/24
propafenone TAB 225MG
taztia XT CAP 240MG/24
propafenone TAB 300MG
taztia XT CAP 300MG/24
quinidine gl TAB 324MG CR
taztia XT CAP 360MG/24
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 10
quinidine gl TAB 324MG ER
ramipril CAP 2.5MG
quinidine SU TAB 300MG
ramipril CAP 5MG
Procainamide Inj 100MG/ML
trandolapril TAB 1MG
Procainamide Inj 500MG/ML
trandolapril TAB 2MG
Quinidine Gl Inj 80MG/ML
trandolapril TAB 4MG
Quinidine SU TAB 200MG
TIER 03 NON PREFERRED
Quinidine SU TAB 300MG
Accupril TAB 10MG
Quinidine SU TAB 300MG ER
Accupril TAB 20MG
TIER 02 PREFERRED
Accupril TAB 40MG
Norpace CAP 100MG CR
Accupril TAB 5MG
Norpace CAP 150MG CR
Aceon TAB 4MG
TIER 03 NON PREFERRED
Aceon TAB 8MG
amiodarone TAB 100MG
Altace CAP 1.25MG
amiodarone TAB 400MG
Altace CAP 10MG
dofetilide CAP 125mcgPA
Altace CAP 2.5MG
dofetilide CAP 250mcgPA
Altace CAP 5MG
dofetilide CAP 500mcgPA
Epaned Sol 1MG/ML
pacerone TAB 100MG
Lotensin TAB 20MG
pacerone TAB 400MG
Lotensin TAB 40MG
propafenone CAP 225MG ER
Mavik TAB 1MG
propafenone CAP 325MG ER
Mavik TAB 2MG
propafenone CAP 425MG SR
Mavik TAB 4MG
Cordarone TAB 200MG
Prinivil TAB 10MG
Multaq TAB 400MG
Prinivil TAB 20MG
Norpace CAP 100MG
Prinivil TAB 5MG
Norpace CAP 150MG
Qbrelis Sol 1MG/ML
Rythmol SR CAP 225MG
Vasotec TAB 10MG
Rythmol SR CAP 325MG
Vasotec TAB 2.5MG
Rythmol SR CAP 425MG
Vasotec TAB 20MG
Rythmol TAB 150MG
Vasotec TAB 5MG
Rythmol TAB 225MG
Zestril TAB 10MG
Tikosyn CAP 125mcgPA
Zestril TAB 2.5MG
Tikosyn CAP 250mcgPA
Zestril TAB 20MG
Tikosyn CAP 500mcgPA
Zestril TAB 30MG
Zestril TAB 40MG
ACE INHIBITORS
Zestril TAB 5MG
TIER 01 GENERIC
ANGIOTENSIN RCPTR BLOCKER
benazepril TAB 10MG
benazepril TAB 20MG
TIER 01 GENERIC
benazepril TAB 40MG
irbesartan TAB 150MG
benazepril TAB 5MG
irbesartan TAB 300MG
captopril TAB 100MG
irbesartan TAB 75MG
captopril TAB 12.5MG
losartan pot TAB 100MG
captopril TAB 25MG
losartan pot TAB 25MG
captopril TAB 50MG
losartan pot TAB 50MG
enalapril TAB 10MG
valsartan TAB 160MG
enalapril TAB 2.5MG
valsartan TAB 320MG
enalapril TAB 20MG
valsartan TAB 40MG
enalapril TAB 5MG
valsartan TAB 80MG
fosinopril TAB 10MG
TIER 03 NON PREFERRED
fosinopril TAB 20MG
candesartan TAB 16MG
fosinopril TAB 40MG
candesartan TAB 32MG
lisinopril TAB 10MG
candesartan TAB 4MG
lisinopril TAB 2.5MG
candesartan TAB 8MG
lisinopril TAB 20MG
olmesa medox TAB 20MGST
lisinopril TAB 30MG
olmesa medox TAB 40MGST
lisinopril TAB 40MG
olmesa medox TAB 5MGST
lisinopril TAB 5MG
telmisartan TAB 20MG
moexipril TAB 15MG
telmisartan TAB 40MG
moexipril TAB 7.5MG
telmisartan TAB 80MG
perindopril TAB 2MG
Atacand TAB 16MG
perindopril TAB 4MG
Atacand TAB 32MG
perindopril TAB 8MG
Atacand TAB 4MG
quinapril TAB 10MG
Atacand TAB 8MG
quinapril TAB 20MG
Avapro TAB 150MG
quinapril TAB 40MG
Avapro TAB 300MG
quinapril TAB 5MG
Avapro TAB 75MG
ramipril CAP 1.25MG
Benicar TAB 20MGST
ramipril CAP 10MG
Benicar TAB 40MGST
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 11
Benicar TAB 5MGST
Inspra TAB 50MG
Cozaar TAB 100MG
Minipress CAP 1MG
Cozaar TAB 25MG
Minipress CAP 2MG
Cozaar TAB 50MG
Minipress CAP 5MG
Diovan TAB 160MG
Reserpine TAB 0.1MG
Diovan TAB 320MG
Reserpine TAB 0.25MG
Diovan TAB 40MG
Tenex TAB 1MG
Diovan TAB 80MG
Tenex TAB 2MG
Edarbi TAB 40MGST
Edarbi TAB 80MGST
ANTIHYPERTENSIVE COMBO
Eprosart Mes TAB 600MGST
TIER 01 GENERIC
Micardis TAB 20MG
amlod/benazp CAP 10-20MG
Micardis TAB 40MG
amlod/benazp CAP 10-40MG
Micardis TAB 80MG
amlod/benazp CAP 2.5-10MG
amlod/benazp CAP 5-10MG
DIRECT RENIN INHIBITORS
amlod/benazp CAP 5-20MG
TIER 03 NON PREFERRED
amlod/benazp CAP 5-40MG
Tekturna TAB 150MGST
atenol/chlor TAB 100-25MG
Tekturna TAB 300MGST
atenol/chlor TAB 50-25MG
benazep/hctz TAB 10-12.5
ANTIHYPERTENSIVES MISC.
benazep/hctz TAB 20-12.5
benazep/hctz TAB 20-25MG
TIER 01 GENERIC
benazep/hctz TAB 5-6.25
clonidine dis 0.1/24HR
bisoprl/hctz TAB 10/6.25
clonidine dis 0.2/24HR
bisoprl/hctz TAB 2.5/6.25
clonidine dis 0.3/24HR
bisoprl/hctz TAB 5-6.25MG
clonidine TAB 0.1MG
enalapr/hctz TAB 10-25MG
clonidine TAB 0.2MG
enalapr/hctz TAB 5-12.5MG
clonidine TAB 0.3MG
fosinop/hctz TAB 10/12.5
doxazosin TAB 1MG
fosinop/hctz TAB 20/12.5
doxazosin TAB 2MG
irbesar/hctz TAB 150-12.5
doxazosin TAB 4MG
irbesar/hctz TAB 300-12.5
doxazosin TAB 8MG
lisinop/hctz TAB 10-12.5
eplerenone TAB 25MG
lisinop/hctz TAB 20-12.5
eplerenone TAB 50MG
lisinop/hctz TAB 20-25MG
guanfacine TAB 1MG
losartan/HCT TAB 100-12.5
guanfacine TAB 2MG
losartan/HCT TAB 100-25
hydralazine TAB 10MG
losartan/HCT TAB 50-12.5
hydralazine TAB 100MG
metoprl/hctz TAB 100-25MG
hydralazine TAB 25MG
metoprl/hctz TAB 100-50MG
hydralazine TAB 50MG
metoprl/hctz TAB 50-25MG
methyldopa TAB 250MG
moexipr/hctz TAB 15-12.5
methyldopa TAB 500MG
moexipr/hctz TAB 15-25MG
minoxidil TAB 10MG
moexipr/hctz TAB 7.5-12.5
minoxidil TAB 2.5MG
qnapril/hctz TAB 10-12.5
prazosin HCL CAP 1MG
qnapril/hctz TAB 20-12.5
prazosin HCL CAP 2MG
qnapril/hctz TAB 20-25MG
prazosin HCL CAP 5MG
valsart/hctz TAB 160-12.5
terazosin CAP 1MG
valsart/hctz TAB 160-25MG
terazosin CAP 10MG
valsart/hctz TAB 320-12.5
terazosin CAP 2MG
valsart/hctz TAB 320-25MG
terazosin CAP 5MG
valsart/hctz TAB 80-12.5
Phentolamine Inj 5MG
Captopr/Hctz TAB 25-15MG
TIER 04 SPECIALTY
Captopr/Hctz TAB 25-25MG
phenoxybenza CAP 10MGQL
Captopr/Hctz TAB 50-15MG
Dibenzyline CAP 10MGQL,PA
Captopr/Hctz TAB 50-25MG
Vecamyl TAB 2.5MGQL,PA
Metoprl/Hctz TAB 100-50MG
TIER 03 NON PREFERRED
Propran/Hctz TAB 40/25
Cardura TAB 1MG
Propran/Hctz TAB 80/25
Cardura TAB 2MG
TIER 03 NON PREFERRED
Cardura TAB 4MG
amlod/olmesa TAB 10-20MGST
Cardura TAB 8MG
amlod/olmesa TAB 10-40MGST
Catapres TAB 0.1MG
amlod/olmesa TAB 5-20MGST
Catapres TAB 0.2MG
amlod/olmesa TAB 5-40MGST
Catapres TAB 0.3MG
amlod/valsar TAB /hctz
Catapres-tts Dis 0.1/24HR
amlod/valsar TAB 10-160MGST
Catapres-tts Dis 0.2/24HR
amlod/valsar TAB 10-320MGST
Catapres-tts Dis 0.3/24HR
amlod/valsar TAB 5-160MGST
Demser CAP 250MG
amlod/valsar TAB 5-320MGST
Inspra TAB 25MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 12
candesa/hctz TAB 16-12.5
Lotrel CAP 5-10MG
candesa/hctz TAB 32-12.5
Lotrel CAP 5-20MG
candesa/hctz TAB 32-25MG
Methyld/Hctz TAB 250/15
nadolol/bend TAB 40-5MG
Methyld/Hctz TAB 250/25
nadolol/bend TAB 80-5MG
Metopro/Hctz TAB 100-12.5
olm MED/amlo TAB /hctzST
Metopro/Hctz TAB 25-12.5
olm MED/hctz TAB 20-12.5ST
Metopro/Hctz TAB 50-12.5
olm MED/hctz TAB 40-12.5ST
Micardis HCT TAB 40/12.5
olm MED/hctz TAB 40-25MGST
Micardis HCT TAB 80-25MG
telmis/amlod TAB 40-10MG
Micardis HCT TAB 80/12.5
telmis/amlod TAB 40-5MG
Prestalia TAB 14-10MG
telmis/amlod TAB 80-10MG
Prestalia TAB 3.5-2.5
telmis/amlod TAB 80-5MG
Prestalia TAB 7-5MG
telmisa/hctz TAB 40-12.5
Tarka TAB 1-240 CR
telmisa/hctz TAB 80-12.5
Tarka TAB 2-180 CR
telmisa/hctz TAB 80-25MG
Tarka TAB 2-240 CR
trando/verap TAB 1-240 ER
Tarka TAB 4-240 CR
trando/verap TAB 2-180 ER
Tekturna HCT TAB 150-12.5ST
trando/verap TAB 2-240 ER
Tekturna HCT TAB 150-25MGST
trando/verap TAB 4-240 ER
Tekturna HCT TAB 300-12.5ST
Accuretic TAB 10-12.5
Tekturna HCT TAB 300-25MGST
Accuretic TAB 20-12.5
Tenoretic TAB 100
Accuretic TAB 20-25MG
Tenoretic TAB 50
Atacand HCT TAB 16-12.5
Tribenzor20- TAB 5-12.5MGST
Atacand HCT TAB 32-12.5
Tribenzor40- TAB 10-12.5ST
Atacand HCT TAB 32-25MG
Tribenzor40- TAB 10-25MGST
Avalide TAB 150-12.5
Tribenzor40- TAB 5-12.5MGST
Avalide TAB 300-12.5
Tribenzor40- TAB 5-25MGST
Azor TAB 10-20MGST
Twynsta TAB 40-10MG
Azor TAB 10-40MGST
Twynsta TAB 40-5MG
Azor TAB 5-20MGST
Twynsta TAB 80-10MG
Azor TAB 5-40MGST
Twynsta TAB 80-5MG
Benicar HCT TAB 20-12.5ST
Vaseretic TAB 10-25MG
Benicar HCT TAB 40-12.5ST
Zestoretic TAB 10-12.5
Benicar HCT TAB 40-25MGST
Zestoretic TAB 20-12.5
Byvalson TAB 5-80MG
Zestoretic TAB 20-25MG
Clorpres TAB 0.1-15MG
Ziac TAB 10/6.25
Clorpres TAB 0.2-15MG
Ziac TAB 2.5/6.25
Clorpres TAB 0.3-15MG
Ziac TAB 5-6.25MG
Corzide TAB 40-5MG
Corzide TAB 80-5MG
DIURETICS
Diovan HCT TAB 160-12.5
TIER 01 GENERIC
Diovan HCT TAB 160-25MG
acetazolamid CAP 500MG ER
Diovan HCT TAB 320-12.5
acetazolamid TAB 125MG
Diovan HCT TAB 320-25MG
acetazolamid TAB 250MG
Diovan HCT TAB 80/12.5
amilor/hctz TAB 5-50
Dutoprol TAB 100-12.5
amiloride TAB 5MG
Dutoprol TAB 25-12.5
bumetanide TAB 0.5MG
Dutoprol TAB 50-12.5
bumetanide TAB 1MG
Edarbyclor TAB 40-12.5ST
bumetanide TAB 2MG
Edarbyclor TAB 40-25MGST
chlorothiaz TAB 500MG
Exforge TAB 10-160MGST
chlorthalid TAB 25MG
Exforge TAB 10-320MGST
chlorthalid TAB 50MG
Exforge TAB 5-160MGST
ethacrynic TAB acd 25MG
Exforge TAB 5-320MGST
furosemide inj 10MG/ML
Exforgeh/10- TAB 160-12.5
furosemide inj 100/10ML
Exforgeh/10- TAB 160-25
furosemide inj 20MG/2ML
Exforgeh/10- TAB 320-25
furosemide inj 40MG/4ML
Exforgeh/5- TAB 160-12.5
furosemide sol 10MG/ML
Exforgeh/5- TAB 160-25
furosemide TAB 20MG
Hyzaar TAB 100-12.5
furosemide TAB 40MG
Hyzaar TAB 100-25
furosemide TAB 80MG
Hyzaar TAB 50-12.5
hydrochlorot CAP 12.5MG
Lopress HCT TAB 50-25MG
hydrochlorot TAB 12.5MG
Lotensin HCT TAB 10-12.5
hydrochlorot TAB 25MG
Lotensin HCT TAB 20-12.5
hydrochlorot TAB 50MG
Lotensin HCT TAB 20-25MG
indapamide TAB 1.25MG
Lotrel CAP 10-20MG
indapamide TAB 2.5MG
Lotrel CAP 10-40MG
methazolamid TAB 25MG
Lotrel CAP 2.5-10MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 13
methazolamid TAB 50MG
Adrenaclick Inj 0.3MG
metolazone TAB 10MG
Adyphren Amp Kit 1MG/ML
metolazone TAB 2.5MG
Adyphren II Kit
metolazone TAB 5MG
Adyphren Kit
spirono/hctz TAB 25/25
Auvi-q Inj 0.15MG
spironolact TAB 100MG
Auvi-q Inj 0.3MG
spironolact TAB 25MG
Epinphephrin Kit Snap-v
spironolact TAB 50MG
Episnap Kit
torsemide TAB 10MG
Epy II Kit
torsemide TAB 100MG
Epy Kit
torsemide TAB 20MG
torsemide TAB 5MG
ANTIHYPERLIPIDEMICS
triamt/hctz TAB 37.5-25
TIER 01 GENERIC
triamt/hctz TAB 75-50MG
atorvastatin TAB 10MG
Chlorothiaz TAB 250MG
atorvastatin TAB 20MG
Edecrin TAB 25MG
atorvastatin TAB 40MG
Furosemide Sol 8MG/ML
atorvastatin TAB 80MG
Methyclothia TAB 5MG
cholestyram pow 4gm packets
TIER 02 PREFERRED
cholestyram pow 4gm lite packets
Aldactazide TAB 50/50
colestipol gra 5gm
Diuril Sus 250/5ML
colestipol TAB 1gm
Dyrenium CAP 100MG
ezetim/simva TAB 10-10MGPA
Dyrenium CAP 50MG
ezetim/simva TAB 10-20MGPA
TIER 04 SPECIALTY
ezetim/simva TAB 10-40MGPA
Keveyis TAB 50MGQL,PA
ezetim/simva TAB 10-80MGPA
TIER 03 NON PREFERRED
ezetimibe TAB 10MGPA
acetazolamid inj 500MG
fenofibrate CAP 130MG
triamt/hctz CAP 37.5-25
fenofibrate CAP 134MG
Aldactazide TAB 25/25
fenofibrate CAP 200MG
Aldactone TAB 100MG
fenofibrate CAP 43MG
Aldactone TAB 25MG
fenofibrate CAP 67MG
Aldactone TAB 50MG
fenofibrate TAB 160
Bumex TAB 0.5MG
fenofibrate TAB 160MG
Bumex TAB 1MG
fenofibrate TAB 54MG
Bumex TAB 2MG
gemfibrozil TAB 600MG
Demadex TAB 10MG
lovastatin TAB 10MG
Demadex TAB 20MG
lovastatin TAB 20MG
Demadex TAB 5MG
lovastatin TAB 40MG
Diamox Seque CAP 500MG CR
pravastatin TAB 10MG
Dyazide CAP 37.5-25
pravastatin TAB 20MG
Lasix TAB 20MG
pravastatin TAB 40MG
Lasix TAB 40MG
pravastatin TAB 80MG
Lasix TAB 80MG
prevalite pow 4gm
Maxzide TAB 75-50
prevalite pow 4gm pk
Maxzide-25 TAB
rosuvastatin TAB 10MG
Microzide CAP 12.5MG
rosuvastatin TAB 20MG
Neptazane TAB 25MG
rosuvastatin TAB 40MG
Neptazane TAB 50MG
rosuvastatin TAB 5MG
Triamt/Hctz CAP 50-25MG
simvastatin TAB 10MG
simvastatin TAB 20MG
VASOPRESSORS
simvastatin TAB 40MG
TIER 01 GENERIC
simvastatin TAB 5MG
epinephrine inj 0.1MG/ML
simvastatin TAB 80MG
epinephrine inj 1MG/ML
Fenofibric TAB 105MG
midodrine TAB 10MG
Fenofibric TAB 35MG
midodrine TAB 2.5MG
TIER 04 SPECIALTY
midodrine TAB 5MG
Juxtapid CAP 10MGQL,PA
Epinephrine Inj 0.15MG
Juxtapid CAP 20MGQL,PA
Epinephrine Inj 0.3MG
Juxtapid CAP 30MGQL,PA
Epinephrine Inj 1MG/ML
Juxtapid CAP 40MGQL,PA
TIER 02 PREFERRED
Juxtapid CAP 5MGQL,PA
Epipen 2-PAK Inj 0.3MG
Juxtapid CAP 60MGQL,PA
Epipen-JR Inj 2-PAK
Kynamro Inj 200MG/MLQL,PA
TIER 04 SPECIALTY
Praluent Inj 150MG/MLQL,PA
Northera CAP 100MGQL,PA
Praluent Inj 75MG/MLQL,PA
Northera CAP 200MGQL,PA
Repatha Inj 140MG/MLQL,PA
Northera CAP 300MGQL,PA
Repatha Push Inj 420/3.5QL,PA
TIER 03 NON PREFERRED
Repatha Sure Inj 140MG/MLQL,PA
Adrenaclick Inj 0.15MG
TIER 03
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 14
NON PREFERRED
Simcor TAB 500-20MG
fenofibrate TAB 120MG
Simcor TAB 500-40MG
fenofibrate TAB 145MG
Simcor TAB 750-20MG
fenofibrate TAB 40MG
Tricor TAB 145MG
fenofibrate TAB 48MG
Tricor TAB 48MG
fenofibric CAP 135MG DR
Triglide TAB 160MG
fenofibric CAP 45MG DR
Trilipix CAP 135MG
fluvastatin CAP 20MG
Trilipix CAP 45MG
fluvastatin CAP 40MG
Vascepa CAP 0.5gmPA
fluvastatin TAB 80MG ER
Vascepa CAP 1gm
niacin ER TAB 1000MG
Vytorin TAB 10-10MGPA
niacin ER TAB 500MG
Vytorin TAB 10-20MGPA
niacin ER TAB 750MG
Vytorin TAB 10-40MGPA
omega-3-acid CAP 1gm
Vytorin TAB 10-80MGPA
triklo CAP 1gm
Welchol PAK 3.75gm
Advicor TAB 1000-20
Welchol TAB 625MG
Advicor TAB 1000-40
Zetia TAB 10MGPA
Advicor TAB 500-20MG
Zocor TAB 10MG
Advicor TAB 750-20MG
Zocor TAB 20MG
Altoprev TAB 20MG ER
Zocor TAB 40MG
Altoprev TAB 40MG ER
Zocor TAB 5MG
Altoprev TAB 60MG ER
Zocor TAB 80MG
Antara CAP 30MG
Antara CAP 90MG
CARDIOVASCULAR - MISC.
Colestid FLA Gra 5/7.5gm
TIER 01 GENERIC
Colestid FLA Gra 5gm
papaverine inj 30MG/ML
Colestid Gra 5gm
Papaverine Sol 30MG/ML
Colestid Pow 5gm
TIER 02 PREFERRED
Colestid TAB 1gm
Entresto TAB 24-26MGPA
Crestor TAB 10MG
Entresto TAB 49-51MGPA
Crestor TAB 20MG
Entresto TAB 97-103MGPA
Crestor TAB 40MG
TIER 04 SPECIALTY
Crestor TAB 5MG
sildenafil TAB 20MGQL,PA
Fenofibrate CAP 150MG
Adcirca TAB 20MGQL,PA
Fenofibrate CAP 50MG
Adempas TAB 0.5MGQL,PA
Fenoglide TAB 120MG
Adempas TAB 1.5MGQL,PA
Fenoglide TAB 40MG
Adempas TAB 1MGQL,PA
Fibricor TAB 105MG
Adempas TAB 2.5MGQL,PA
Fibricor TAB 35MG
Adempas TAB 2MGQL,PA
Flolipid Sus 20MG/5ML
Letairis TAB 10MGQL,PA
Flolipid Sus 40MG/5ML
Letairis TAB 5MGQL,PA
Lescol XL TAB 80MG
Opsumit TAB 10MGQL,PA
Lipitor TAB 10MG
Orenitram TAB 0.25MGQL,PA
Lipitor TAB 20MG
Orenitram TAB 1MGQL,PA
Lipitor TAB 40MG
Orenitram TAB 2.5MGQL,PA
Lipitor TAB 80MG
Orenitram TAB 5MGQL,PA
Lipofen CAP 150MG
Revatio Sus 10MG/MLQL,PA
Lipofen CAP 50MG
Revatio TAB 20MGQL,PA
Livalo TAB 1MG
Tracleer TAB 125MGQL,PA
Livalo TAB 2MG
Tracleer TAB 62.5MGQL,PA
Livalo TAB 4MG
Tyvaso Refil Sol 0.6MG/MLQL,PA
Lofibra CAP 134MG
Tyvaso Sol 0.6MG/MLQL,PA
Lofibra CAP 200MG
Tyvaso Start Sol 0.6MG/MLQL,PA
Lofibra CAP 67MG
Uptravi TAB 1000mcgQL,PA
Lofibra TAB 160MG
Uptravi TAB 1200mcgQL,PA
Lofibra TAB 54MG
Uptravi TAB 1400mcgQL,PA
Lopid TAB 600MG
Uptravi TAB 1600mcgQL,PA
Lovaza CAP 1gm
Uptravi TAB 200/800QL,PA
Mevacor TAB 40MG
Uptravi TAB 200mcgQL,PA
Niacor TAB 500MG
Uptravi TAB 400mcgQL,PA
Niaspan TAB 1000 ER
Uptravi TAB 600mcgQL,PA
Niaspan TAB 500MG ER
Uptravi TAB 800mcgQL,PA
Niaspan TAB 750MG ER
Ventavis Sol 10mcg/MLQL,PA
Pravachol TAB 20MG
Ventavis Sol 20mcg/MLQL,PA
Pravachol TAB 40MG
TIER 03 NON PREFERRED
Pravachol TAB 80MG
amlod/atorva TAB 10-10MG
Questran Pow 4gm
amlod/atorva TAB 10-20MG
Questran Pow 4gm Lite
amlod/atorva TAB 10-40MG
Simcor TAB 1000-20
amlod/atorva TAB 10-80MG
Simcor TAB 1000-40
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 15
amlod/atorva TAB 2.5-10MG
tretinoin gel 0.1%
amlod/atorva TAB 2.5-20MG
tretinoin gel 0.1%P.M.
amlod/atorva TAB 2.5-40MG
tretinoin CRE 0.025%
amlod/atorva TAB 5-10MG
tretinoin CRE 0.05%
amlod/atorva TAB 5-20MG
tretinoin CRE 0.1%
amlod/atorva TAB 5-40MG
zenatane CAP 10MG
amlod/atorva TAB 5-80MG
zenatane CAP 20MG
Bidil TAB
zenatane CAP 30MG
Caduet TAB 10-10MG
zenatane CAP 40MG
Caduet TAB 10-20MG
Adapalene Lot 0.1%
Caduet TAB 10-40MG
Differin CRE 0.1%
Caduet TAB 10-80MG
Retin-a CRE 0.025%
Caduet TAB 2.5-10MG
Retin-a CRE 0.05%
Caduet TAB 2.5-20MG
Retin-a CRE 0.1%
Caduet TAB 2.5-40MG
Retin-a Gel 0.01%
Caduet TAB 5-10MG
Retin-a Gel 0.025%
Caduet TAB 5-20MG
Retin-a Micr Gel 0.04%
Caduet TAB 5-40MG
Retin-a Micr Gel 0.04%pmp
Caduet TAB 5-80MG
Retin-a Micr Gel 0.1%
Cialis TAB 10MGPA
Retin-a Micr Gel 0.1%P.M.
Cialis TAB 2.5MGPA
Sod SUL/Sulf Emu 10-5%
Cialis TAB 20MGPA
Sod SUL/Sulf Lot 10-5%
Cialis TAB 5MGPA
TIER 02 PREFERRED
Corlanor TAB 5MGPA
Azelex CRE 20%
Corlanor TAB 7.5MGPA
Differin Lot 0.1%
Orenitram TAB 0.125MGPA
TIER 03 NON PREFERRED
adapal/ben p gel 0.1-2.5%
DERMATOLOGICALS
avar-e emoll CRE 10-5%
avar-e green CRE 10-5%
ACNE PRODUCTS
benzepro mis 6%
TIER 01 GENERIC
bp 10-1 emu
adapalene gel pmp 0.3%
bpo cloths mis 6%
adapalene gel 0.1%
cerisa wash emu 10-1%
adapalene gel 0.3%
clearplex X gel 10%
adapalene CRE 0.1%
clindamy/ben gel 1.2-5%
amnesteem CAP 10MG
clindamycin aer 1%
amnesteem CAP 20MG
clindamycin gel tretinoi
amnesteem CAP 40MG
ery pad 2%
avar cleanse emu 10-5%
erythromycin pad 2%
avita gel 0.025%
neuac gel 1.2-5%
avita CRE 0.025%
oscion clnsr lot 6%
claravis CAP 10MG
sod SUL/sulf liq wash
claravis CAP 20MG
sod SUL/sulf liq 10-2%
claravis CAP 30MG
sod SUL/sulf liq 9.8-4.8%
claravis CAP 40MG
sod SUL/sulf liq 9-4.5%
clindacin mis etz 1%
sod SUL/sulf lot 9.8-4.8%
clindacin-p pad 1%
sod SUL/sulf pad 10-4%
clindamy/ben gel 1-5%
sod SUL/sulf sus 8-4%
clindamycin gel 1%
sod SUL/sulf CRE 10-2%
clindamycin lot 1%
sod SUL/sulf CRE 10-5%
clindamycin lot 10MG/ML
sod SUL/sulf CRE 9.8-4.8%
clindamycin mis 1%
sss CRE 10%-5%
clindamycin pad 1%
sulfacleanse sus 8-4%
clindamycin sol 1%
tretinoin gel 0.05%
ery/benzoyl gel 5-3%
zencia liq 9-4%
erythromycin gel 2%
Absorica CAP 10MG
erythromycin sol 2%
Absorica CAP 20MG
myorisan CAP 10MG
Absorica CAP 25MG
myorisan CAP 20MG
Absorica CAP 30MG
myorisan CAP 30MG
Absorica CAP 35MG
myorisan CAP 40MG
Absorica CAP 40MG
rosanil emu cleanser
Acanya Gel 1.2-2.5%
sod SUL/sulf emu 10-5%
Aczone Gel 5%
sod SUL/sulf lot 10-5%
Aczone Gel 7.5%
sulfacetamid lot 10%
Atralin Gel 0.05%
sulfacetamid sus 10%
Avar Aer 9.5-5%
tretinoin gel 0.01%
Avar LS Aer 10-2%
tretinoin gel 0.025%
Avar LS Liq 10-2%
tretinoin gel 0.04%
Avar LS Pad 10-2%PA
tretinoin gel 0.04%pmp
Avar Pad 9.5-5%PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 16
Avar-e LS CRE 10-2%
ANTIBIOTICS - TOPICAL
Benzaclin Gel 1-5%
TIER 01 GENERIC
Benzaclin Gel 1-5%P.M.
gentamicin CRE 0.1%
Benzamycin Gel 5-3%
mupirocin oin 2%
Benziq Gel 5.25%
mupirocin CA CRE 2%
Benziq LS Gel 2.75%
mupirocin CRE 2%
Bp Cleansing Emu 10-4%
Gentamicin Oin 0.1%
Clarifoam EF Aer 10-5%
TIER 02 PREFERRED
Cleocin-t Gel 1%
Cortisporin Oin 1%
Cleocin-t Lot 1%
TIER 03 NON PREFERRED
Cleocin-t Pad 1%
Altabax Oin 1%
Cleocin-t Sol 1%
Bactroban CRE 2%
Clindagel Gel 1%
Bactroban Oin 2%
Differin Gel 0.1%
Centany Oin 2%
Differin Gel 0.3%
Cortisporin CRE 0.5%
Duac Gel 1.2-5%
Neo-synalar CRE
Epiduo Forte Gel 0.3-2.5%
Epiduo Gel 0.1-2.5%
ANTIFUNGALS - TOPICAL
Erygel Gel 2%
TIER 01 GENERIC
Evoclin Aer 1%
ciclodan sol 8%
Fabior Aer 0.1%
ciclodan CRE 0.77%
Klaron Lot 10%
ciclopirox gel 0.77%
Onexton Gel 1.2-3.75
ciclopirox sol 8%
Plexion Clth Pad 9.8-4.8%
ciclopirox sus 0.77%
Plexion CRE 9.8-4.8%
ciclopirox CRE 0.77%
Plexion Liq 9.8-4.8%
clotrim/beta lot diprop
Plexion Lot 9.8-4.8%
clotrim/beta CRE diprop
Retin-a Micr Gel 0.08%
clotrim/beta CRE 1-0.05%
Rosula Liq 10-4.5%
ketoconazole sha 2%
Rosula Pad 10-5%
ketoconazole CRE 2%
Sod SUL/Sulf Gel 10-5%
nyamyc pow 100000
Sod SUL/Sulf Sus 10-5%
nyata pow 100000
Sss 10-5 Aer 10-5%
nystat/triam oin
Sumadan Wash Liq 9-4.5%
nystat/triam CRE
Sumaxin Pad 10-4%
nystatin oin 100000
Sumaxin Ts Sus 8-4%
nystatin pow 100000
Sumaxin Wash Liq 9-4%
nystatin CRE 100000
SUL sod/sulf liq 10-2%
nystop pow 100000
SUL sod/sulf pad 10-4%
TIER 03 NON PREFERRED
Tretin-x CRE 0.0375%
ciclopirox sha 1%
Tretin-x CRE 0.075%
clotrimazole sol 1%
Vanoxide-HC Lot 5-0.5%
clotrimazole CRE 1%
Veltin Gel
econazole CRE 1%
Zaclir Lot 8%
ketoconazole aer 2%
Ziana Gel
ketodan aer 2%
naftifine CRE HCL 1%
ROSACEA AGENTS
naftifine CRE HCL 2%
TIER 01 GENERIC
oxiconazole CRE nitrate
metronidazol gel 0.75%
Ecoza Aer 1%
metronidazol CRE 0.75%
Ertaczo CRE 2%
rosadan gel 0.75%
Exelderm CRE 1%
rosadan CRE 0.75%
Exelderm Sol 1%
TIER 02 PREFERRED
Exoderm Lot 25-1%
Finacea Aer 15%
Extina Aer 2%
Finacea Gel 15%
Halotin CRE 1%
TIER 03 NON PREFERRED
Jublia Sol 10%PA
metronidazol gel 1%
Kerydin Sol 5%PA
metronidazol lot 0.75%
Loprox CRE 0.77%
Doxycycline CAP 40MG
Loprox Kit 0.77%
Metrocream CRE 0.75%
Loprox Sha 1%
Metrogel Gel 1%
Loprox Sus 0.77%
Metrolotion Lot 0.75%
Lotrisone CRE
Metronidazole 0.75% Jelly
Luzu CRE 1%
Mirvaso Gel 0.33%
Naftin CRE 1%
Noritate CRE 1%
Naftin CRE 2%
Oracea CAP 40MGPA
Naftin Gel 1%
Rhofade CRE 1%PA
Naftin Gel 2%
Rosadan Kit 0.75%
Nizoral Sha 2%
Soolantra CRE 1%
Oxistat CRE 1%
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 17
Oxistat Lot 1%
ANTISEBORRHEIC AGENTS
Penlac Sol 8%
TIER 01 GENERIC
Vusion Oin
selenium SUL lot 2.5%
Xolegel Gel 2%
sod sulfacet sha 10%
Selenium SUL Sha 2.25%
ANTIVIRALS - TOPICAL
TIER 03 NON PREFERRED
TIER 03 NON PREFERRED
seb-prev liq wash
acyclovir oin 5%
selenium SUL sha 2.25%
Denavir CRE 1%
sod sulfacet gel 10%
Xerese CRE 5-1%
sodium SULFA liq 10% wash
Zovirax CRE 5%
Loutrex CRE
Ovace Plus Aer 9.8%
ANTI-INFLAMMATORY AGENTS
Ovace Plus CRE 10%
Ovace Plus Gel 10% Wash
TIER 03 NON PREFERRED
Ovace Plus Liq 10% Wash
diclofenac gel 1%
Ovace Plus Sha 10%
diclofenac sol 1.5%
Ovace Wash Liq 10%
klofensaid sol II
Promiseb CRE
Diclofenac CRE Sodium
Selrx Sha 2.3%
Flector Dis 1.3%
Sodium SULFA Liq 10% Wash
Pennsaid Sol 2%
Tersi Foam Aer 2.25%
Rexaphenac CRE 1%
Voltaren Gel 1%
CORTICOSTEROIDS - TOPICAL
ANTIPRURITICS
TIER 01 GENERIC
ala-cort CRE 2.5%
TIER 03 NON PREFERRED
alphatrex gel 0.05%
Doxepin HCL CRE 5%
aug betamet gel 0.05%
Prudoxin CRE 5%
aug betamet lot 0.05%
Zonalon CRE 5%
aug betamet oin 0.05%
aug betamet CRE 0.05%
ANTIPSORIATICS
beta diprop gel 0.05%
TIER 01 GENERIC
betameth dip lot 0.05%
calcipotrien oin 0.005%
betameth dip oin 0.05%
calcipotrien sol 0.005%
betameth dip CRE 0.05%
calcipotrien CRE 0.005%
betameth val aer 0.12%
calcitrene oin 0.005%
betameth val lot 0.1%
tazarotene CRE 0.1%
betameth val oin 0.1%
Dritho-creme CRE HP 1%
betameth val CRE 0.1%
Tazorac CRE 0.1%
clobetasol gel 0.05%
Vectical Oin 3mcg/Gm
clobetasol sol 0.05%
TIER 02 PREFERRED
cormax scalp sol 0.05%
Tazorac CRE 0.05%
desonide lot 0.05%
Tazorac Gel 0.05%
desonide oin 0.05%
Tazorac Gel 0.1%
desonide CRE 0.05%
TIER 04 SPECIALTY
desoximetas gel 0.05%
acitretin CAP 10MGQL
desoximetas oin 0.05%
acitretin CAP 17.5MGQL
desoximetas oin 0.25%
acitretin CAP 25MGQL
desoximetas CRE 0.05%
methoxsalen CAP 10MGQL
desoximetas CRE 0.25%
Cosentyx Inj 150MG/MLQL,PA
fluocin acet oil body
Cosentyx Inj 300doseQL,PA
fluocin acet oil scalp
Cosentyx Pen Inj 150MG/MLQL,PA
fluocin acet oil 0.01% sc
Cosentyx Pen Inj 300doseQL,PA
fluocin acet oil 0.01%bdy
Oxsoralen-ul CAP 10MGQL,PA
fluocin acet oin 0.025%
Siliq Inj 210/1.5QL,PA
fluocin acet sol 0.01%
Soriatane CAP 10MGQL,PA
fluocin acet CRE 0.01%
Soriatane CAP 17.5MGQL,PA
fluocin acet CRE 0.025%
Soriatane CAP 25MGQL,PA
fluocinonide gel 0.05%
Stelara Inj 45MG/0.5QL,PA
fluocinonide oin 0.05%
Stelara Inj 90MG/MLQL,PA
fluocinonide sol 0.05%
Taltz Inj 80MG/MLQL,PA
fluocinonide CRE e 0.05%
Tremfya Inj 100MG/MLQL,PA
fluocinonide CRE 0.05%
8-mop CAP 10MGQL,PA
halobetasol oin 0.05%
TIER 03 NON PREFERRED
halobetasol CRE 0.05%
Calcitriol Oin 3mcg/Gm
hydrocort lot 2.5%
Dovonex CRE 0.005%
hydrocort oin 1%
Sorilux Aer 0.005%
hydrocort oin 2.5%
Zithranol Sha 1%
hydrocort CRE 2.5%
Zithranol-rr CRE 1.2%
hydrocort/ab oin 1%
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 18
hydrosortiso oin absorbas
Clobex Sha 0.05%
lokara lot 0.05%
Clobex Spr 0.05%
mometasone oin 0.1%
Clocortolone CRE Piv 0.1%
mometasone sol 0.1%
Cloderm CRE 0.1%
mometasone CRE 0.1%
Cloderm CRE 0.1% Pmp
triamcinolon lot 0.025%
Cordran CRE 0.05%
triamcinolon lot 0.1%
Cordran Lot 0.05%
triamcinolon oin 0.025%
Cordran Oin 0.05%
triamcinolon oin 0.1%
Cutivate CRE 0.05%
triamcinolon oin 0.5%
Cutivate Lot 0.05%
triamcinolon CRE 0.025%
Derma-smooth Oil /FS Body
triamcinolon CRE 0.1%
Derma-smooth Oil /FS Sclp
triamcinolon CRE 0.5%
Dermasorb HC Kit 2%
triderm CRE 0.1%
Dermatop CRE 0.1%
triderm CRE 0.5%
Dermatop Oin 0.1%
Desowen CRE 0.05%
Desonate Gel 0.05%
Desowen Lot 0.05%
Diflorasone CRE 0.05%
HC butyrate oin 0.1%
Diflorasone Oin 0.05%
HC butyrate sol 0.1%
Diprolene AF CRE 0.05%
HC butyrate CRE 0.1%
Diprolene Lot 0.05%
HC pramoxine CRE 2.5-1% (topical)
Diprolene Oin 0.05%
HC valerate oin 0.2%
Elocon CRE 0.1%
HC valerate CRE 0.2%
Elocon Lot 0.1%
Synalar CRE 0.025%
Elocon Oin 0.1%
Synalar Oin 0.025%
Enstilar Aer
Tridesilon CRE 0.05%
Epifoam Aer 1%
TIER 02 PREFERRED
Halog CRE 0.1%
Capex Sha 0.01%
Halog Oin 0.1%
Cordran 24X3 Tap 4mcg/CM
Kenalog Aer Spray
Cordran 80X3 Tap 4mcg/CM
Locoid CRE 0.1%
Pramosone CRE 1-1%
Locoid Lipo CRE 0.1%
Pramosone Lot 1%
Locoid Lot 0.1%
Pramosone Lot 2.5%
Locoid Oin 0.1%
TIER 04 SPECIALTY
Locoid Sol 0.1%
calcipotrien oin betamethQL,PA
Luxiq Aer 0.12%
Taclonex OinQL,PA
Micort-HC CRE 2.5%
Ultravate Lot 0.05%QL,PA
Novacort Gel
TIER 03 NON PREFERRED
Nucort Lot 2%
ala-cort CRE 1%
Olux Aer 0.05%
alclometason oin 0.05%
Olux-e Aer 0.05%
alclometason CRE 0.05%
Pandel CRE 0.1%
clobetasol aer 0.05%
Pediaderm HC Kit
clobetasol e CRE 0.05%ST
Pramosone CRE 1-2.5%
clobetasol lot 0.05%
Psorcon CRE 0.05%
clobetasol oin 0.05%ST
Sernivo Spr
clobetasol sha 0.05%
Synalar Sol 0.01%
clobetasol spr 0.05%
Taclonex Sus
clobetasol CRE 0.05%ST
Temovate CRE 0.05%ST
clodan sha 0.05%
Temovate E CRE 0.05%emlST
fluocinonide CRE 0.1%
Temovate Gel 0.05%
flurandrenol lot 0.05%
Temovate Oin 0.05%ST
flurandrenol oin 0.05%
Temovate Sol 0.05%
flurandrenol CRE 0.05%
Texacort Sol 2.5%
fluticasone lot 0.05%
Topicort CRE 0.05%
fluticasone oin 0.005%
Topicort CRE 0.25%
fluticasone CRE 0.05%
Topicort Gel 0.05%
hydrocort CRE 1%
Topicort Oin 0.05%
nolix lot 0.05%
Topicort Oin 0.25%
prednicarbat oin 0.1%
Topicort Spr 0.25%
prednicarbat CRE 0.1%
Trianex Oin 0.05%
scalacort lot 2%
Ultravate CRE 0.05%
triamcinolon aer spray
Ultravate Oin 0.05%
Aclovate CRE 0.05%
Vanos CRE 0.1%
Adv Allergy Kit Collecti
Verdeso Aer 0.05%
Ala Scalp Lot 2%
Westcort Oin 0.2%
Amcinonide CRE 0.1%
Amcinonide Lot 0.1%
IMMUNOMODULATING AGENTS
Amcinonide Oin 0.1%
TIER 01 GENERIC
Apexicon E CRE 0.05%
tacrolimus oin 0.03%
Clobex Lot 0.05%
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 19
tacrolimus oin 0.1%
lidocaine CRE 3%
TIER 02 PREFERRED
lidopin CRE 3%
Elidel CRE 1%
lindane lot 1%
TIER C ORAL CHEMO
lindane sha 1%
imiquimod CRE 5%
lorenza pad 4-1%
Aldara CRE 5%
malathion lot 0.5%
TIER 03 NON PREFERRED
migryl mis 0.0375-5
Protopic Oin 0.03%
pramox gel 1%
Protopic Oin 0.1%
rea LO 39 CRE 39%
Zyclara CRE 3.75%
releevia ML pad 4-1%
Zyclara P.M. CRE 2.5%
remeven CRE 50%
Zyclara P.M. CRE 3.75%
salacyn lot 6%
salacyn CRE 6%
DERMATOLOGICALS - MISC.
salicylic ac gel 6%
salicylic ac liq 26%
TIER 01 GENERIC
salicylic ac liq 27.5%
agoneaze kit 2.5-2.5%
salicylic ac lot 6%
anodyne lpt kit 2.5-2.5%
salicylic ac sha 6%
dermacinrx kit prizopak
salicylic ac CRE 6%
empricaine kit 2.5-2.5%
salicylic aer 6%
glydo gel 2%
salisol fort sol 26%
leva set kit
salitech lot forte
leva set kit 2.5-2.5%
synvexia pad 4-1%
lido bdk kit
umecta mouss aer 40%
lido-prilo kit 2.5-2.5%
ure-k CRE 50%
lido/prilocn kit 2.5-2.5%
ure-39 CRE 39%
lido/prilocn CRE 2.5-2.5%
urea gel 40%
lidocaine gel 2%
urea hydrati aer 35%
lidocaine gel 2% jelly
urea nail gel 45%
lidocaine pad 5%
urea CRE 39%
lidocaine-pr CRE
urea CRE 45%
lidopril kit 2.5-2.5%
urea CRE 47%
lidopril XR kit 2.5-2.5%
urea CRE 50%
liprozonepak kit 2.5-2.5%
urea 40% sus nail
livixil PAK kit 2.5-2.5%
xyphex mis
medolor PAK kit 2.5-2.5%
zeruvia pad 4-1%
permethrin CRE 5%
Acuicyn Liq
podofilox sol 0.5%
Adazin CRE
prilolid kit 2.5-2.5%
Aluvea CRE 39%
priloxx LP kit 2.5-2.5%
Anacaine Oin
rea LO 40 CRE 40%
Anastia Lot 2.75%
relador PAK kit plus
Astero Gel 4%
relador PAK kit 2.5-2.5%
Atopiclair CRE
urea CRE 40%
Avenova Sol Neutrox
LP lite PAK kit 2.5-2.5%
Avenova Sol 0.01%
TIER 02 PREFERRED
Bensal HP Oin
Condylox Gel 0.5%
Cem-urea Sol 45%
Drysol Sol 20%
Ceracade Emu
Eurax CRE 10%
Condylox Sol 0.5%
Eurax Lot 10%
Dexeryl CRE
Ulesfia Lot 5%
Eha Lot 4%
TIER 03 NON PREFERRED
Eletone CRE
ammonium lac lot 12%
Eletone CRE Twinpack
ammonium lac CRE 12%
Elimite CRE 5%
anodynz mis 0.0375-5
Emla CRE 2.5-2.5%
ceramax CRE
Emulsion SB Emu
cidaleaze CRE 3%
Entty Emu Spray
ethyl chlor aer spray
Epiceram Emu
geri-hydrola lot 5%
Ethyl Chlor Aer Fine Pin
geri-hydrola CRE 12%
Ethyl Chlor Aer Fn Strm
hyaluronate gel 0.2%
Ethyl Chlor Aer Mist
lac-hydrin lot five
Ethyl Chlor Aer MED Jet
lactic acid lot 10%
Ethyl Chlor Aer MED Strm
lactic acid CRE /vit e
Ethyl Chlor Aer Spray
lactic acid CRE e
Flexin Pad .0375-5%
lidenza pad 4-1%
Gebauers Spr Aer /Stretch
lidocaine oin PAK 5%
Hydro 35 Aer
lidocaine oin 5%
Hydro 40 Aer Foam
lidocaine sol 4%
Hylatopic Aer Plus
lidocaine CRE 3.88%
Hylatopic CRE Plus
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 20
Hylira Gel 0.2%
Urea Topical Sus 40%
Hylira Lot 0.1%
Urevaz CRE 44%
HPR Aer
Utopic CRE 41%
HPR Plus Aer
Veregen Oin 15%
HPR Plus CRE
Virasal Liq 27.5%
Kamdoy Emu
Xeralux CRE
Keralac CRE 47%
Xylocaine Sol 4%
Keralyt Gel 6%
Lac-hydrin CRE 12%
ENDOCRINE AND METABOLIC
Lac-hydrin Lot 12%
CORTICOSTEROIDS
Ldo Plus Gel 4%
TIER 01 GENERIC
Levatio Pad 0.3-5%
deltasone TAB 20MG
Lido-k Lot 3%
dexameth PHO inj 10MG/ML
Lidocaine Lot 3%
dexameth PHO inj 120MG/30
Lidoderm Dis 5%
dexameth PHO inj 20MG/5ML
Lidorx Gel 3%
dexameth PHO inj 4MG/ML
Lidothol Pad 4.5-5%
dexamethason elx 0.5/5ML
Lidotral CRE 3.88%
dexamethason TAB 0.5MG
Lidotrex Gel 2%
dexamethason TAB 0.75MG
Lidovin CRE 3.95%
dexamethason TAB 1.5MG
Lidozol CRE 3.75%
dexamethason TAB 4MG
Lindane Lot 1%
dexamethason TAB 6MG
Lindane Sha 1%
fludrocort TAB 0.1MG
Lycelle Gel
hydrocort TAB 10MG
Medi-patch Pad RX
hydrocort TAB 20MG
Menthocin Pad Lidocain
hydrocort TAB 5MG
Mentholix Spr 4-1%
methylpr ace inj 40MG/ML
Natroba Sus 0.9%
methylpr ace inj 80MG/ML
Neosalus Aer
methylpr ss inj 125MG
Neosalus CP CRE
methylpred TAB 16MG
Neosalus CRE
methylpred TAB 32MG
Neuvaxin Pad 0.0375-5
methylpred TAB 4MG
Nivatopic CRE Plus
methylpred TAB 8MG
Noble Mystiq CRE Emu-lac
pred sod PHO sol 5MG/5ML
Numbonex Lot 2.75%
prednisolone sol 15MG/5ML
Ovide Lot 0.5%
prednisolone syp 15MG/5ML
Oxsoralen Lot 1%
prednisone TAB 1MG
Pain Ease Aer Mist
prednisone TAB 10MG
Pain Ease Aer MD Strm
prednisone TAB 2.5MG
Pain Relief Pad Patch
prednisone TAB 20MG
Permavan Pad
prednisone TAB 5MG
Phlag Spr
Cortisone Ac TAB 25MG
Podocon Sol 25%
Dexameth PHO Inj 10MG/ML
Presera Aer
Dexamethason Sol 0.5/5ML
Pro:12 Aer Mousse
Dexamethason TAB 1MG
Pruclair CRE
Dexamethason TAB 2MG
Prumyx CRE
Prednisolone Sol 25MG/5ML
Pyrogall Acd Oin
Prednisone PAK 10MG
Releevia Mc Pad .0375-5%
Prednisone PAK 5MG
Releevia Pad .0375-5%
Prednisone Sol 5MG/5ML
Remaxazon Pad
Prednisone TAB 50MG
Renovo Pad 0.0375-5
TIER 02 PREFERRED
Rynoderm CRE 37.5%
Depo-medrol Inj 20MG/ML
Salex Sha 6%
Dexamethason CON 1MG/ML
Salitech Lot 5%
Medrol TAB 2MG
Salvax Aer 6%
Solu-cortef Inj 100MG
Sklice Lot 0.5%
TIER 04 SPECIALTY
Soothee Pad
Emflaza Sus 22.75/MLQL,PA
Spinosad Sus 0.9%
Emflaza TAB 18MGQL,PA
Synera Dis 70-70MG
Emflaza TAB 30MGQL,PA
Synerderm Emu
Emflaza TAB 36MGQL,PA
Tetramex Spr 2-1-3%
Emflaza TAB 6MGQL,PA
Tetrix CRE
Entocort EC CAP 3MG DRQL,PA
Tranzarel Gel 4%
Uceris TAB 9MGQL,PA
Umecta Emu
TIER 03 NON PREFERRED
Umecta Nail Sus Film
beta-phos/ac inj 3-3MG/ML
Umecta PD Emu 40-0.3%
budesonide CAP 3MG DRQL,PA
Uramaxin CRE 45%
prednisolone sol 10MG/5ML
Uramaxin Gel 45%
prednisolone sol 20MG/5ML
Uramaxin GT Gel 45%
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 21
prednisolone TAB 10MG odt
Androxy TAB 10MG
prednisolone TAB 15MG odt
Axiron Sol 30MG/ActQL,PA
prednisolone TAB 30MG odt
Depo-testost Inj 100MG/MLPA
Celestone Inj Soluspan
Fortesta Gel 10MG/ActQL,PA
Cortef TAB 10MG
Methitest TAB 10MGPA
Cortef TAB 20MG
Natesto Gel 5.5MGQL,PA
Cortef TAB 5MG
Oxandrin TAB 10MG
Depo-medrol Inj 40MG/ML
Oxandrin TAB 2.5MG
Depo-medrol Inj 80MG/ML
Striant Mis 30MGQL,PA
Dex LA 16 Inj 16MG/ML
Testim Gel 1%(50MG)QL,PA
Dexpak PAK 10 Day
Testone Cik Kit 200MG/ML
Dexpak PAK 13 Day
Testosterone Gel 10MG/ActQL,PA
Dexpak PAK 6 Day
Vogelxo Gel P.M. 1%QL,PA
Kenalog-10 Inj 10MG/ML
Vogelxo Gel 1%(50MG)QL,PA
Kenalog-40 Inj 40MG/ML
Locort PAK 11-day
ESTROGENS
Locort PAK 7-day
TIER 01 GENERIC
Medrol TAB 16MG
estrad val inj 20MG/MLPA
Medrol TAB 32MG
estrad val inj 200MG/5PA
Medrol TAB 4MG
estradiol dis 0.025MG weeklyPA
Medrol TAB 8MG
estradiol dis 0.0375MG weeklyPA
Millipred DP PAK 5MG
estradiol dis 0.05MG weeklyPA
Millipred Sol 10MG/5ML
estradiol dis 0.06MG weeklyPA
Millipred TAB 5MG
estradiol dis 0.075MG weeklyPA
Orapred Odt TAB 10MG
estradiol dis 0.1MG weeklyPA
Orapred Odt TAB 15MG
estradiol TAB 0.5MGPA
Orapred Odt TAB 30MG
estradiol TAB 1MGPA
Pediapred Sol 6.7/5ML
estradiol TAB 2MGPA
Prednisone CON 5MG/ML
Climara Dis 0.025MGPA
Rayos TAB 1MGPA
Climara Dis 0.0375MGPA
Rayos TAB 2MGPA
Climara Dis 0.05MGPA
Rayos TAB 5MGPA
Climara Dis 0.06MGPA
Solu-medrol Inj 125MG
Climara Dis 0.075MGPA
Veripred 20 Sol 20MG/5ML
Climara Dis 0.1MGPA
Zodex PAK 12-day
Estropipate TAB 0.75MGPA
Zodex PAK 6 Day
Estropipate TAB 1.5MGPA
Zonacort PAK 11 Day
Estropipate TAB 3MGPA
Zonacort PAK 7 Day
TIER 02 PREFERRED
Delestrogen Inj 10MG/MLPA
ANDROGENS-ANABOLIC
Depo-estradi Inj 5MG/MLPA
TIER 01 GENERIC
TIER 03 NON PREFERRED
danazol CAP 100MG
amabelz TAB 0.5-0.1PA
danazol CAP 200MG
amabelz TAB 1-0.5MGPA
danazol CAP 50MG
covaryx HS TABPA
testost cyp inj 100MG/MLPA
covaryx TAB 1.25-2.5PA
testost cyp inj 200MG/MLPA
eemt HS TABPA
testost enan inj 200MG/MLPA
eemt TAB 1.25-2.5PA
testosterone gel P.M. 1%QL,PA
est estrogen TAB mtestPA
testosterone gel 1%(25MG)QL,PA
est estrogen TAB mtest HSPA
testosterone gel 1%(50MG)QL,PA
estra/noreth TAB 0.5-0.1PA
Depo-testost Inj 200MG/MLPA
estra/noreth TAB 1-0.5MGPA
Testosterone Gel P.M. 1%QL,PA
estrog/mtest TAB 1.25-2.5PA
Testosterone Gel 1%(25MG)QL,PA
fyavolv TAB 0.5-2.5PA
Testosterone Gel 1%(50MG)QL,PA
fyavolv TAB 1-5PA
QL,PA
jevantique l TAB 0.5-2.5PA
TIER 04 SPECIALTY
jinteli TAB 1MG-5mcgPA
Anadrol-50 TAB 50MGQL,PA
lopreeza TAB 0.5-0.1PA
Android CAP 10MGQL,PA
lopreeza TAB 1-0.5MGPA
Testred CAP 10MGQL,PA
mimvey LO TAB 0.5-0.1PA
TIER 03 NON PREFERRED
mimvey TAB 1-0.5MGPA
methyltestos CAP 10MGQL,PA
noreth/ethin TAB 0.5-2.5PA
oxandrolone TAB 10MG
noreth/ethin TAB 1MG-5mcgPA
oxandrolone TAB 2.5MG
Activella TAB 0.5-0.1PA
testosterone sol 30MG/actQL
Activella TAB 1-0.5MGPA
Androderm Dis 2MG/24HRQL,PA
Alora Dis 0.025MGPA
Androderm Dis 4MG/24HRQL,PA
Alora Dis 0.05MGPA
Androgel Gel 1.62%QL,PA
Alora Dis 0.075MGPA
Androgel Gel 1%(25MG)QL,PA
Alora Dis 0.1MGPA
Androgel Gel 1%(50MG)QL,PA
Angeliq TAB 0.25-0.5PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 22
Angeliq TAB 0.5-1MGPA
camila TAB 0.35MG
Climara Pro Dis WeeklyPA
camrese LO TAB
Combipatch Dis .05/.14PA
camrese TAB
Combipatch Dis .05/.25PA
caziant PAK
Delestrogen Inj 20MG/MLPA
chateal TAB 0.15/30
Delestrogen Inj 40MG/MLPA
cryselle-28 TAB 28 TABS
Divigel Gel 0.25MGPA
cyclafem TAB 1/35
Divigel Gel 0.5MGPA
cyclafem TAB 7/7/7
Divigel Gel 1MG/GmPA
cyred TAB
Duavee TAB 0.45-20PA
dasetta TAB 1/35
Elestrin Gel 0.06%PA
dasetta TAB 7/7/7
Enjuvia TAB 0.3MGPA
daysee TAB
Enjuvia TAB 0.45MGPA
deblitane TAB 0.35MG
Enjuvia TAB 0.625MGPA
delyla TAB 0.1-0.02
Enjuvia TAB 0.9MGPA
deso/ethinyl TAB estradio
Estrace TAB 0.5MGPA
drospir/ethi TAB 3-0.03MG
Estrace TAB 1MGPA
drospire/ETH TAB estr/lev
Estrace TAB 2MGPA
drospirenone TAB ethy est
Estrogel GelPA
econtra EZ TAB 1.5MG
Evamist Spr 1.53MGPA
elinest TAB
Femhrt TAB 0.5-2.5PA
emoquette TAB
Menest TAB 0.3MGPA
enpresse-28 TAB
Menest TAB 0.625MGPA
enskyce TAB
Menest TAB 1.25MGPA
errin TAB 0.35MG
Menest TAB 2.5MGPA
estarylla TAB 0.25-35
Menostar Dis 14mcgPA
ethy ETH est TAB 1-35
Minivelle Dis 0.025MGPA
ethynodiol TAB 1-50
Minivelle Dis 0.0375MGPA
fallback TAB 1.5MG
Minivelle Dis 0.05MGPA
falmina TAB
Minivelle Dis 0.075MGPA
fayosim TAB
Minivelle Dis 0.1MGPA
femynor TAB 0.25-35
Prefest TABPA
gianvi TAB 3-0.02MG
Premarin TAB 0.3MGPA,ST
gildagia TAB 0.4-35
Premarin TAB 0.45MGPA,ST
gildess FE TAB 1.5/30
Premarin TAB 0.625MGPA,ST
gildess FE TAB 1/20
Premarin TAB 0.9MGPA,ST
gildess TAB 1.5/30
Premarin TAB 1.25MGPA,ST
gildess TAB 1/20
Premphase TABPA
gildess 24 TAB FE 1/20
Prempro TAB .625-2.5PA
heather TAB 0.35MG
Prempro TAB 0.3-1.5PA
introvale TAB
Prempro TAB 0.45-1.5PA
isibloom TAB 0.15-30
Prempro TAB 0.625-5PA
jencycla TAB 0.35MG
Vivelle-dot Dis 0.025MGPA
jolessa TAB
Vivelle-dot Dis 0.0375MGPA
jolivette TAB 0.35MG
Vivelle-dot Dis 0.05MGPA
juleber TAB
Vivelle-dot Dis 0.075MGPA
junel FE TAB 1.5/30
Vivelle-dot Dis 0.1MGPA
junel FE TAB 1/20
junel FE 24 TAB 1/20
CONTRACEPTIVES
junel 1.5/30 TAB
junel 1/20 TAB
TIER P PREVENTIVE
kaitlib FE chw
aftera TAB 1.5MG
kariva TAB 28 day
altavera TAB
kelnor TAB 1/35
alyacen TAB 1/35
kimidess TAB
alyacen TAB 7/7/7
kurvelo TAB 0.15/30
amethia LO TAB
larin FE TAB 1.5/30
amethia TAB
larin FE TAB 1/20
amethyst TAB 90-20mcg
larin TAB 1.5/30
apri TAB
larin TAB 1/20
aranelle TAB
larin 24 TAB FE 1/20
ashlyna TAB
larissia TAB
aubra TAB 0.1-0.02
layolis FE chw
aviane TAB
leena TAB
azurette TAB 28 day
lessina TAB
balziva TAB
levonest TAB
bekyree TAB
levonor/ethi TAB
blisovi FE TAB 1.5/30
levonor/ethi TAB estradio
blisovi FE TAB 1/20
levonor/ethi TAB 0.1-0.02
blisovi 24 TAB FE 1/20
levonorgestr TAB 1.5MG
briellyn TAB
levora-28 TAB 0.15/30
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 23
lillow TAB 0.15/30
tri-LO- TAB sprintec
lomedia 24 TAB FE
trinessa LO TAB
loryna TAB 3-0.02MG
trinessa TAB
low-ogestrel TAB
trivora-28 TAB
lutera TAB
velivet PAK
lyza TAB 0.35MG
vestura TAB 3-0.02MG
marlissa TAB 0.15/30
vienva TAB 0.1-20
medroxypr ac inj 150MG/MLQL
viorele TAB
melodetta chw 24 FE
vyfemla TAB 0.4-35
mibelas 24 chw FE
wera TAB 0.5/35
micrgstin 24 TAB FE 1/20
wymzya FE chw 0.4MG-35
microgestin TAB FE 1/20
zarah TAB 3-0.03MG
microgestin TAB FE1.5/30
zenchent FE chw 0.4MG-35
microgestin TAB 1.5/30
zenchent TAB
microgestin TAB 1/20
zovia 1/35e TAB
mono-linyah TAB 0.25-35
zovia 1/50e TAB
mononessa TAB
Depo-sq Prov Inj 104QL
my way TAB 1.5MG
Ella TAB 30MG
myzilra TAB
Kyleena Iud 19.5MG
necon TAB 0.5/35
Levo-ETH Est TAB 90-20mcg
necon TAB 1/35
Liletta Iud 52MG
necon TAB 10/11-28
LO Loestrin TAB
necon TAB 7/7/7
Mirena Iud System
next choice TAB 1.5MG
Natazia TAB
nikki TAB 3-0.02MG
Necon TAB 1/50-28
nora-be TAB 0.35MG
Nexplanon Imp 68MG
nore/ETH/fer chw 0.4MG-35
Norinyl TAB 1+50-28
noreth/ethin chw FE
Nuvaring Mis
noreth/ethin chw FE 1/20
Ogestrel TAB
noreth/ethin TAB FE 1/20
Paragard Iud T380a
noreth/ethin TAB 1/20
Plan B TAB 1.5MG
norethindron TAB 0.35MG
Safyral TAB
norgest/ethi TAB estradio
Skyla Iud 13.5MG
norgest/ethi TAB 0.25/35
Taytulla CAP
norlyda TAB 0.35MG
Xulane Dis 150-35
norlyroc TAB 0.35MG
TIER 03 NON PREFERRED
nortrel TAB 0.5/35
Beyaz TAB
nortrel TAB 1/35
Brevicon TAB 0.5/35PA
nortrel TAB 7/7/7
Cyclessa PAK
ocella TAB 3-0.03MG
Depo-provera Inj 150MG/MLQL
opcicon TAB 1.5MG
Desogen-28 TAB
option 2 TAB 1.5MG
Estrostep FE TAB
orsythia TAB
Femcon FE Chw
philith TAB 0.4-35
Generess FE Chw
pimtrea TAB
Loestrin FE TAB 1.5/30
pirmella TAB 1/35
Loestrin FE TAB 1/20
pirmella TAB 7/7/7
Loestrin TAB 1/20-21
portia-28 TAB
Loestrin 21 TAB 1.5/30
previfem TAB
Loseasonique TAB
quasense TAB
Mircette TAB 28 Day
rajani TAB
Modicon TAB 0.5/35PA
react TAB 1.5MG
Nor-QD TAB 0.35MG
reclipsen TAB
Norinyl TAB 1/35
rivelsa TAB
Ortho Micron TAB 0.35MG
setlakin TAB
Ortho Tri- TAB Cyclen
sharobel TAB 0.35MG
Ortho Tri- TAB Cycln LO
sprintec 28 TAB 28 day
Ortho-cyclen TAB 0.25/35
sronyx TAB
Ortho-novum TAB 1/35
syeda TAB 3-0.03MG
Ortho-novum TAB 7/7/7
take action TAB 1.5MG
Ovcon-35 TAB
tarina FE TAB 1/20
Quartette TAB
tilia FE TAB
Seasonique TAB
tri femynor TAB
Tri-norinyl TAB 28
tri-estaryll TAB
Yasmin 28 TAB 3-0.03MG
tri-legest TAB FE
Yaz TAB 3-0.02MG
tri-linyah TAB
tri-previfem TAB
PROGESTINS
tri-sprintec TAB
TIER 01 GENERIC
tri-LO TAB estaryll
medroxypr ac TAB 10MG
tri-LO- TAB marzia
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 24
medroxypr ac TAB 2.5MG
NON PREFERRED
medroxypr ac TAB 5MG
Adlyxin Inj 10/20mcgPA
norethin ace TAB 5MG
Adlyxin Inj 20mcgPA
progesterone inj 50MG/ML
Bydureon Inj 2MGST
progesterone CAP 100MG
Bydureon Pen Inj 2MGST
progesterone CAP 200MG
Byetta Inj 10mcgST
TIER 03 NON PREFERRED
Byetta Inj 5mcgST
megestrol sus 625MG/5m
Tanzeum Inj 30MGST
Aygestin TAB 5MG
Tanzeum Inj 50MGST
Megace ES Sus 625/5ML
Trulicity Inj 0.75/0.5ST
Prometrium CAP 100MG
Trulicity Inj 1.5/0.5ST
Prometrium CAP 200MG
Victoza Inj 18MG/3MLST
Provera TAB 10MG
SULFONYLUREAS
Provera TAB 2.5MG
TIER 01 GENERIC
Provera TAB 5MG
glimepiride TAB 1MG
glimepiride TAB 2MG
ANTIDIABETIC AGENTS
glimepiride TAB 4MG
glipizide ER TAB 10MG
INSULIN
glipizide ER TAB 2.5MG
TIER 01 GENERIC
glipizide ER TAB 5MG
Humulin Inj 70/30
glipizide TAB 10MG
Humulin Inj 70/30kwp
glipizide TAB 5MG
Humulin N Inj U-100
glipizide XL TAB 10MG
Humulin N Inj U-100kwp
glipizide XL TAB 2.5MG
Humulin R Inj U-100
glipizide XL TAB 5MG
Humulin R Inj U-500
glyburide TAB 1.25MG
TIER 02 PREFERRED
glyburide TAB 2.5MG
Humalog Inj 100/ML
glyburide TAB 5MG
Humalog JR Inj 100/ML
Tolazamide TAB 250MG
Humalog Kwik Inj 100/ML
Tolazamide TAB 500MG
Humalog Kwik Inj 200/ML
Tolbutamide TAB 500MG
Lantus Inj Solostar
TIER 03 NON PREFERRED
Lantus Inj 100/ML
glyburid mcr TAB 1.5MG
Levemir InjPA
glyburid mcr TAB 3MG
Levemir Inj FlextoucPA
glyburid mcr TAB 6MG
TIER 03 NON PREFERRED
Amaryl TAB 1MG
Afrezza Pow 12 UnitPA
Amaryl TAB 2MG
Afrezza Pow 4&8 UnitPA
Amaryl TAB 4MG
Afrezza Pow 4/8/12unPA
Chlorpropam TAB 100MG
Afrezza Pow 4unitPA
Chlorpropam TAB 250MG
Afrezza Pow 8 UnitPA
Diabeta TAB 1.25MG
Afrezza Pow 8&12unitPA
Diabeta TAB 2.5MG
Apidra Inj Solostar
Diabeta TAB 5MG
Apidra Inj U-100
Glucotrol TAB 10MG
Basaglar Inj 100unitPA
Glucotrol TAB 5MG
Fiasp Flex Inj Touch
Glucotrol XL TAB 10MG
Fiasp Inj 100/ML
Glucotrol XL TAB 2.5MG
Humalog Mix Inj 50/50
Glucotrol XL TAB 5MG
Humalog Mix Inj 50/50kwp
Glynase TAB 1.5MG
Humalog Mix Inj 75/25kwp
Glynase TAB 3MG
Humalog Mix Sus 75/25
Glynase TAB 6MG
Novolin Inj 70/30ST
BIGUANIDES
Novolin N Inj RelionST
TIER 01 GENERIC
Novolin N Inj U-100ST
metformin TAB 1000MG
Novolin R Inj RelionST
metformin TAB 500MG
Novolin R Inj U-100ST
metformin TAB 500MG ER
Novolin70/30 Inj RelionST
metformin TAB 750MG ER
Novolog Inj Flexpen
metformin TAB 850MG
Novolog Inj Penfill
TIER 02 PREFERRED
Novolog Inj 100/ML
Riomet Sol
Novolog Mix Inj Flexpen
Riomet Sol 500/5ML
Novolog Mix Inj 70/30
TIER 03 NON PREFERRED
Toujeo Solo Inj 300iu/MLPA
metformin ER TAB 1000MG
Tresiba Flex Inj 100unitPA
metformin TAB 1000 ERPA
Tresiba Flex Inj 200unitPA
Fortamet TAB 1000MG
AMYLIN ANALOGS
Fortamet TAB 500MG
TIER 03 NON PREFERRED
Glucophage TAB 1000MG
Symlinpen 60 Inj 1000mcg
Glucophage TAB 500MG
Symlnpen 120 Inj 1000mcg
Glucophage TAB 500MG XR
INCRETIN MIMETIC AGENTS
Glucophage TAB 750MG XR
TIER 03
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 25
Glucophage TAB 850MG
ANTIDIABETIC COMBINATIONS
Glumetza TAB 1000MGPA
TIER 03 NON PREFERRED
Glumetza TAB 500MGPA
glip/metform TAB 2.5-250m
MEGLITINIDE ANALOGUES
glip/metform TAB 2.5-500m
TIER 03 NON PREFERRED
glip/metform TAB 5-500MG
nateglinide TAB 120MG
glyb/metform TAB 1.25-250
nateglinide TAB 60MG
glyb/metform TAB 2.5-500
repaglinide TAB 0.5MG
glyb/metform TAB 5-500MG
repaglinide TAB 1MG
pioglit/glim TAB 30-2MG
repaglinide TAB 2MG
pioglit/glim TAB 30-4MG
Prandin TAB 0.5MG
pioglita/met TAB 15-500MG
Prandin TAB 1MG
pioglita/met TAB 15-850MG
Prandin TAB 2MG
Actoplus Met TAB XR
Starlix TAB 120MG
Actoplus Met TAB 15-500MG
Starlix TAB 60MG
Actoplus Met TAB 15-850MG
DIABETIC OTHER
Alog/Pioglit TAB 12.5-15PA
TIER 02 PREFERRED
Alog/Pioglit TAB 12.5-30PA
Glucagen Inj Hypokit
Alog/Pioglit TAB 12.5-45PA
Glucagon Kit 1MG
Alog/Pioglit TAB 25-15MGPA
Jardiance TAB 10MGQL,PA
Alog/Pioglit TAB 25-30MGPA
Jardiance TAB 25MGQL,PA
Alog/Pioglit TAB 25-45MGPA
Proglycem Sus 50MG/ML
Alogliptin/ TAB MetformPA
TIER 04 SPECIALTY
Duetact TAB 30-2MG
Korlym TAB 300MGQL,PA
Duetact TAB 30-4MG
TIER 03 NON PREFERRED
Glucovance TAB 2.5-500
Cycloset TAB 0.8MGST
Glucovance TAB 5-500MG
Farxiga TAB 10MGPA
Glyxambi TAB 10-5 MGST
Farxiga TAB 5MGPA
Glyxambi TAB 25-5 MGST
Invokana TAB 100MGPA
Invokamet TAB 150-1000PA
Invokana TAB 300MGPA
Invokamet TAB 150-500PA
ALPHA-GLUCOSIDASE INHIBIT
Invokamet TAB 50-1000PA
TIER 01 GENERIC
Invokamet TAB 50-500MGPA
acarbose TAB 100MG
Invokamet XR TAB 150-1000PA
acarbose TAB 25MG
Invokamet XR TAB 150-500PA
acarbose TAB 50MG
Invokamet XR TAB 50-1000PA
TIER 03 NON PREFERRED
Invokamet XR TAB 50-500MGPA
miglitol TAB 100MG
Janumet TAB 50-1000PA
miglitol TAB 25MG
Janumet TAB 50-500MGPA
miglitol TAB 50MG
Janumet XR TAB 100-1000PA
Glyset TAB 100MG
Janumet XR TAB 50-1000PA
Glyset TAB 25MG
Janumet XR TAB 50-500MGPA
Glyset TAB 50MG
Jentadueto TAB XRST
Precose TAB 100MG
Jentadueto TAB 2.5-1000ST
Precose TAB 25MG
Jentadueto TAB 2.5-500ST
Precose TAB 50MG
Jentadueto TAB 2.5-850ST
DPP-4 INHIBITORS
Kazano 12.5- TAB 1000MGPA
TIER 03 NON PREFERRED
Kazano 12.5- TAB 500MGPA
Alogliptin TAB 12.5MGPA
Kombiglyz XR TAB 2.5-1000PA
Alogliptin TAB 25MGPA
Kombiglyz XR TAB 5-1000MGPA
Alogliptin TAB 6.25MGPA
Kombiglyz XR TAB 5-500MGPA
Januvia TAB 100MGPA
Oseni TAB 12.5-15PA
Januvia TAB 25MGPA
Oseni TAB 12.5-30PA
Januvia TAB 50MGPA
Oseni TAB 12.5-45PA
Nesina TAB 12.5MGPA
Oseni TAB 25-15MGPA
Nesina TAB 25MGPA
Oseni TAB 25-30MGPA
Nesina TAB 6.25MGPA
Oseni TAB 25-45MGPA
Onglyza TAB 2.5MGPA
Prandimet TAB 1-500MG
Onglyza TAB 5MGPA
Prandimet TAB 2-500MG
Tradjenta TAB 5MGST
Repaglinide TAB 1-500MG
INSULIN SENSITIZING AGENT
Repaglinide TAB 2-500MG
TIER 03 NON PREFERRED
Soliqua Inj 100/33PA
pioglitazone TAB 15MG
Synjardy TABQL,PA
pioglitazone TAB 30MG
Synjardy TAB 12.5-500QL,PA
pioglitazone TAB 45MG
Synjardy TAB 5-1000MGQL,PA
Actos TAB 15MG
Synjardy TAB 5-500MGQL,PA
Actos TAB 30MG
Synjardy XR TABPA
Actos TAB 45MG
Synjardy XR TAB 10-1000PA
Avandia TAB 2MG
Synjardy XR TAB 25-1000PA
Avandia TAB 4MG
Synjardy XR TAB 5-1000MGPA
Avandia TAB 8MG
Xigduo XR TAB 10-1000PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 26
Xigduo XR TAB 10-500MGPA
TIER 03 NON PREFERRED
Xigduo XR TAB 5-1000MGPA
Lupaneta Kit 11.25-5PA
Xigduo XR TAB 5-500MGPA
Lupaneta Kit 3.75-5PA
Xultophy Inj 100/3.6PA
Lupr Dep-PED Inj 3m 30MG
Synarel Sol 2MG/MLQL
BISPHOSPHONATES
GROWTH HORMONES
TIER 01 GENERIC
alendronate TAB 10MG
TIER 04 SPECIALTY
alendronate TAB 35MG
Genotropin Inj 0.2MGQL,PA
alendronate TAB 5MG
Genotropin Inj 0.4MGQL,PA
alendronate TAB 70MG
Genotropin Inj 0.6MGQL,PA
risedronate TAB 150MGST
Genotropin Inj 0.8MGQL,PA
risedronate TAB 30MGST
Genotropin Inj 1.2MGQL,PA
risedronate TAB 35MG
Genotropin Inj 1.4MGQL,PA
risedronate TAB 5MGST
Genotropin Inj 1.6MGQL,PA
Alendronate Sol 70/75ML
Genotropin Inj 1.8MGQL,PA
Alendronate TAB 40MG
Genotropin Inj 1MGQL,PA
Etidron Disd TAB 200MG
Genotropin Inj 12MGQL,PA
Etidron Disd TAB 400MG
Genotropin Inj 2MGQL,PA
TIER M MEDICAL COPAY
Genotropin Inj 5MGQL,PA
zoledronic inj 4MG/5MLPA
Humatrope Inj 12MGQL,PA
Zoledronic Inj 4MGPA
Humatrope Inj 24MGQL,PA
TIER 03 NON PREFERRED
Humatrope Inj 5MGQL,PA
ibandronate TAB 150MG
Humatrope Inj 6MGQL,PA
risedron sod TAB 35MG DRST
Norditropin Inj 10/1.5MLQL,PA
Actonel TAB 150MGST
Norditropin Inj 15/1.5MLQL,PA
Actonel TAB 30MGST
Norditropin Inj 30/3MLQL,PA
Actonel TAB 35MG
Norditropin Inj 5/1.5MLQL,PA
Actonel TAB 5MGST
Nutropin AQ Inj Nuspin 5QL,PA
Atelvia TABST
Nutropin AQ Inj 10MG/2MLQL,PA
Binosto TAB 70MG
Nutropin AQ Inj 20MG/2MLQL,PA
Boniva TAB 150MG
Omnitrope Inj 10/1.5MLQL,PA
Fosamax + D TAB 70-2800
Omnitrope Inj 5.8MGQL,PA
Fosamax + D TAB 70-5600
Omnitrope Inj 5/1.5MLQL,PA
Fosamax TAB 70MG
Saizen Inj 5MGQL,PA
Saizen Inj 8.8MGQL,PA
CALCITONINS
Saizenprep Inj 8.8MGQL,PA
Serostim Inj 4MGQL,PA
TIER 03 NON PREFERRED
Serostim Inj 5MGQL,PA
calcitonin spr 200/act
Serostim Inj 6MGQL,PA
Fortical Spr 200/Act
Zomacton Inj 10MGQL,PA
Miacalcin Inj 200/ML
Zomacton Inj 5MGQL,PA
Miacalcin Spr 200/Act
Zorbtive Inj 8.8MGQL,PA
PARATHYROID HORMONE
GHRH
TIER 04 SPECIALTY
TIER 04 SPECIALTY
Forteo Sol 600/2.4QL,PA
Egrifta Sol 1MGQL,PA
Natpara Inj 100mcgQL,PA
Natpara Inj 25mcgQL,PA
SOMATOMEDINS
Natpara Inj 50mcgQL,PA
Natpara Inj 75mcgQL,PA
TIER 04 SPECIALTY
Tymlos InjPA
Increlex Inj 40MG/4MLQL,PA
RANK LIGAND INHIBITORS
SOMATOSTATIC AGENTS
TIER M MEDICAL COPAY
TIER 01 GENERIC
Prolia Sol 60MG/MLPA
octreotide inj 100mcg
Xgeva InjPA
octreotide inj 1000mcg
octreotide inj 200mcg
HORMONE RECEPTOR MDLTR
octreotide inj 50mcg/ML
octreotide inj 500mcg
TIER 01 GENERIC
TIER 04 SPECIALTY
raloxifene TAB 60MGPA
Sandostatin Kit Lar 10MGQL
TIER 03 NON PREFERRED
Sandostatin Kit Lar 20MGQL
Evista TAB 60MGPA
Sandostatin Kit Lar 30MGQL
Osphena TAB 60MGPA
Signifor Inj 0.3MG/MLQL,PA
Signifor Inj 0.6MG/MLQL,PA
LHRH/GNRH AGONIST
Signifor Inj 0.9MG/MLQL,PA
TIER 02 PREFERRED
Somatuline Inj 120/.5MLQL,PA
Lupr Dep-PED Inj 11.25MG
Somatuline Inj 60/0.2MLQL,PA
Lupr Dep-PED Inj 15MG
Somatuline Inj 90/0.3MLQL,PA
Lupr Dep-PED Inj 7.5MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 27
TIER M MEDICAL COPAY
Nityr TAB 10MGQL,PA
Signifor Lar Inj 20MGPA
Nityr TAB 2MGQL,PA
Signifor Lar Inj 40MGPA
Nityr TAB 5MGQL,PA
Signifor Lar Inj 60MGPA
Orfadin CAP 10MGQL,PA
TIER 03 NON PREFERRED
Orfadin CAP 2MGQL,PA
Sandostatin Inj 100mcg
Orfadin CAP 20MGQL,PA
Sandostatin Inj 1000mcg
Orfadin CAP 5MGQL,PA
Sandostatin Inj 200mcg
Orfadin Sus 4MG/MLQL,PA
Sandostatin Inj 50mcg/ML
Ravicti Liq 1.1gm/MLQL,PA
Sandostatin Inj 500mcg
Sensipar TAB 30MGQL,ST
Sensipar TAB 60MGQL,ST
GH RECEPTOR ANTAGONISTS
Sensipar TAB 90MGQL,ST
Strensiq Inj 18/0.45QL,PA
TIER 04 SPECIALTY
Strensiq Inj 28/0.7MLQL,PA
Somavert Inj 10MGQL,PA
Strensiq Inj 40MG/MLQL,PA
Somavert Inj 15MGQL,PA
Strensiq Inj 80/0.8MLQL,PA
Somavert Inj 20MGQL,PA
TIER M MEDICAL COPAY
Somavert Inj 25MGQL,PA
Fabrazyme Inj 35MGPA
Somavert Inj 30MGQL,PA
Fabrazyme Inj 5MGPA
Lumizyme Inj 50MGPA
POSTERIOR PITUITARY
TIER 03 NON PREFERRED
TIER 01 GENERIC
doxercalcif CAP 0.5mcg
desmopressin inj 4mcg/ML
doxercalcif CAP 1mcg
desmopressin sol 0.01%
doxercalcif CAP 2.5mcg
desmopressin spr 0.01%
paricalcitol CAP 1 mcg
desmopressin TAB 0.1MG
paricalcitol CAP 2 mcg
desmopressin TAB 0.2MG
paricalcitol CAP 4 mcg
TIER 02 PREFERRED
Carnitor Sol 1gm/10ML
Stimate Sol 1.5MG/ML
Carnitor SF Sol 1gm/10ML
TIER 03 NON PREFERRED
Carnitor TAB 330MG
Ddavp Inj 4mcg/ML
Cystadane Pow
Ddavp Sol 0.01%
Hectorol CAP 0.5mcg
Ddavp Spr 0.01%
Hectorol CAP 1mcg
Ddavp TAB 0.1MG
Hectorol CAP 2.5mcg
Ddavp TAB 0.2MG
Rayaldee CAP 30mcgPA
Rocaltrol CAP 0.25mcg
CORTICOTROPIN
Rocaltrol CAP 0.5mcg
TIER 04 SPECIALTY
Rocaltrol Sol 1mcg/ML
H.p. Acthar Inj 80unitQL,PA
Zemplar CAP 1mcg
Zemplar CAP 2mcg
PROLACTIN INHIBITORS
TIER 01 GENERIC
THYROID AGENTS
cabergoline TAB 0.5MG
TIER 01 GENERIC
levothyroxin TAB 100mcg
VASOPRESSIN ANTAGONISTS
levothyroxin TAB 112mcg
TIER 04 SPECIALTY
levothyroxin TAB 125mcg
Samsca TAB 15MGQL,PA
levothyroxin TAB 137mcg
Samsca TAB 30MGQL,PA
levothyroxin TAB 150mcg
levothyroxin TAB 175mcg
PROGESTERONE ANTAGONISTS
levothyroxin TAB 200mcg
TIER 03 NON PREFERRED
levothyroxin TAB 25mcg
Mifeprex TAB 200MG
levothyroxin TAB 300mcg
levothyroxin TAB 50mcg
METABOLIC MODIFIERS
levothyroxin TAB 75mcg
TIER 01 GENERIC
levothyroxin TAB 88mcg
calcitriol sol 1mcg/ML
levothyroxine TAB 0.075MG
calcitriol CAP 0.25mcg
liothyronine TAB 25mcg
calcitriol CAP 0.5mcg
liothyronine TAB 5mcg
levocarnitin sol 1gm/10ML
liothyronine TAB 50mcg
levocarnitin TAB 330MG
methimazole TAB 10MG
TIER 04 SPECIALTY
methimazole TAB 5MG
phenylbutyra pow sodiumQL,PA
propylthiour TAB 50MG
sodium pheny TAB 500MGQL
TIER 03 NON PREFERRED
Buphenyl PowQL,PA
levo-t TAB 100mcg
Buphenyl TAB 500MGQL,PA
levo-t TAB 112mcg
Carbaglu TAB 200MGQL,PA
levo-t TAB 125mcg
Kuvan Pow 100MGQL,PA
levo-t TAB 137mcg
Kuvan Pow 500MGQL,PA
levo-t TAB 150mcg
Kuvan TAB 100MGQL,PA
levo-t TAB 175mcg
Myalept Inj 11.3MGQL,PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 28
levo-t TAB 200 mcg
Synthroid TAB 125mcg
levo-t TAB 25mcg
Synthroid TAB 137mcg
levo-t TAB 300 mcg
Synthroid TAB 150mcg
levo-t TAB 50mcg
Synthroid TAB 175mcg
levo-t TAB 75mcg
Synthroid TAB 200mcg
levo-t TAB 88mcg
Synthroid TAB 25mcg
levo/liothyr TAB 30MG
Synthroid TAB 300mcg
levo/liothyr TAB 60MG
Synthroid TAB 50mcg
levo/liothyr TAB 90MG
Synthroid TAB 75mcg
levoxyl TAB 100mcg
Synthroid TAB 88mcg
levoxyl TAB 112mcg
Tapazole TAB 10MG
levoxyl TAB 125mcg
Tapazole TAB 5MG
levoxyl TAB 137mcg
Thyrolar-1 TAB 60MG
levoxyl TAB 150mcg
Thyrolar-1/2 TAB 30MG
levoxyl TAB 175mcg
Thyrolar-1/4 TAB 15MG
levoxyl TAB 200mcg
Thyrolar-2 TAB 120MG
levoxyl TAB 25mcg
Thyrolar-3 TAB 180MG
levoxyl TAB 50mcg
Tirosint CAP 100mcg
levoxyl TAB 75mcg
Tirosint CAP 112mcg
levoxyl TAB 88mcg
Tirosint CAP 125mcg
unith direct TAB 100mcg
Tirosint CAP 13mcg
unith direct TAB 112mcg
Tirosint CAP 137mcg
unith direct TAB 125mcg
Tirosint CAP 150mcg
unith direct TAB 150mcg
Tirosint CAP 25mcg
unith direct TAB 175mcg
Tirosint CAP 50mcg
unith direct TAB 200mcg
Tirosint CAP 75mcg
unith direct TAB 25mcg
Tirosint CAP 88mcg
unith direct TAB 300mcg
Westhroid TAB 130MG
unith direct TAB 50mcg
Westhroid TAB 195MG
unith direct TAB 75mcg
Westhroid TAB 32.5MG
unith direct TAB 88mcg
Westhroid TAB 65MG
unithroid TAB 100mcg
Westhroid TAB 97.5MG
unithroid TAB 112mcg
Wp Thyroid TAB 113.75MG
unithroid TAB 125mcg
Wp Thyroid TAB 130MG
unithroid TAB 137mcg
Wp Thyroid TAB 16.25MG
unithroid TAB 150mcg
Wp Thyroid TAB 32.5MG
unithroid TAB 175mcg
Wp Thyroid TAB 48.75MG
unithroid TAB 200mcg
Wp Thyroid TAB 65MG
unithroid TAB 25mcg
Wp Thyroid TAB 81.25MG
unithroid TAB 300mcg
Wp Thyroid TAB 97.5MG
unithroid TAB 50mcg
unithroid TAB 75mcg
GASTROINTESTINAL
unithroid TAB 88mcg
LAXATIVES
Armour Thyro TAB 120MG
TIER 01 GENERIC
Armour Thyro TAB 180MG
constulose sol 10gm/15
Armour Thyro TAB 240MG
lactulose sol 10gm/15
Armour Thyro TAB 300MG
lactulose sol 20gm/30
Cytomel TAB 25mcg
TIER P PREVENTIVE
Cytomel TAB 5mcg
alophen TAB 5MG EC
Cytomel TAB 50mcg
bisacodyl TAB 5MG EC
Nature Throi TAB 162.5MG
carters TAB 5MG EC
Nature-throi TAB 113.75MG
citroma sol cherry
Nature-throi TAB 130MG
citroma sol lemon
Nature-throi TAB 146.25MG
clearlax pow
Nature-throi TAB 16.25MG
correct TAB 5MG EC
Nature-throi TAB 195MG
correctol TAB 5MG EC
Nature-throi TAB 260MG
ducodyl TAB 5MG EC
Nature-throi TAB 32.5MG
dulcolax pow balance
Nature-throi TAB 325MG
eq clearlax pow
Nature-throi TAB 48.75MG
eql clearlax pow
Nature-throi TAB 65MG
eql gentle TAB laxative
Nature-throi TAB 81.25MG
eql laxative TAB 5MG EC
Nature-throi TAB 97.5MG
feenamint TAB 5MG EC
NP thyroid TAB 120MG
feminine LAX TAB 5MG EC
NP thyroid TAB 15MG
fleet laxati TAB 5MG EC
NP thyroid TAB 30MG
gavilax pow
NP thyroid TAB 60MG
gavilyte-c sol
NP thyroid TAB 90MG
gavilyte-n sol flav pk
Synthroid TAB 100mcg
gavilyte-G sol
Synthroid TAB 112mcg
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 29
gentle laxat TAB 5MG EC
Motofen TAB 1-0.025
gentlelax pow
Mytesi TAB 125MG
glycolax pow 3350 NF
Paregoric Tin 2MG/5ML
gnp bisa-LAX TAB 5MG EC
gnp clearlax pow
ULCER DRUGS
gnp laxative TAB 5MG EC
TIER 01 GENERIC
kp bisacodyl TAB 5MG EC
chlord/clidi CAP 5-2.5MG
laxaclear pow
cimetidine sol 300/5ML
laxative pol pow glycol
cimetidine TAB 200MG
laxative TAB 5MG EC
cimetidine TAB 300MG
natura-LAX pow 3350 NF
cimetidine TAB 400MG
peg 3350 pow
cimetidine TAB 800MG
peg 3350 sol electrol
dicyclomine sol 10MG/5ML
peg-3350 sol electrol
dicyclomine CAP 10MG
peg-3350/KCL sol /sodium
dicyclomine TAB 20MG
pegylax pow
famotidine sus 40MG/5ML
peg3350 pow
famotidine TAB 20MG
polyeth GLYC pow 3350 NF
famotidine TAB 40MG
polyeth GLYC pow 3350-grx
glycopyrrol inj 0.2MG/ML
powderlax pow
glycopyrrol inj 0.4/2ML
qc laxative TAB 5MG EC
glycopyrrol inj 1MG/5ML
ra laxative pow
glycopyrrol inj 4MG/20ML
ra laxative TAB 5MG EC
glycopyrrol TAB 1MG
sm clearlax pow
glycopyrrol TAB 2MG
sm gentle TAB laxative
lansoprazole CAP 15MG DR
sm laxative TAB 5MG EC
lansoprazole CAP 30MG DRST
smooth LAX pow
misoprostol TAB 100mcg
stim laxat TAB 5MG EC
misoprostol TAB 200mcg
sw clearlax pow
omeprazole CAP 10MG
trilyte sol
omeprazole CAP 20MG
vercolate TAB 5MG EC
omeprazole CAP 40MG
womans laxat TAB 5MG EC
pantoprazole TAB 20MG
womens laxat TAB 5MG EC
pantoprazole TAB 40MG
CVS c-LAX TAB 5MG
rabeprazole TAB 20MGST
CVS purelax pow
ranitidine syp 15MG/ML
CVS purelax pow 3350
ranitidine syp 150/10ML
EX-LAX ultra TAB 5MG EC
ranitidine syp 75MG/5ML
HM clearlax pow
ranitidine TAB 150MG
HM laxative TAB 5MG
ranitidine TAB 300MG
HM laxative TAB 5MG EC
sucralfate TAB 1gm
MAG citrate sol
Bella/Opium Sup 16.2-30
MAG citrate sol cherry
Bella/Opium Sup 16.2-60
MAG citrate sol grape
Librax CAP 5-2.5MG
MAG citrate sol lemon
Propanthelin TAB 15MG
SB bisacodyl TAB 5MG EC
TIER 02 PREFERRED
TIER 03 NON PREFERRED
Carafate Sus 1gm/10ML
gavilyte-h kit
Pylera CAP
peg-prep kit
TIER 03 NON PREFERRED
Colyte/Flavr Sol Packs
dicyclomine inj 10MG/ML
CVS senna plus tablet
ed-spaz TAB 0.125MG
Golytely Sol
esomepra MAG CAP 20MG DRPA
Golytely Sol Pineappl
hyoscyamine dro 0.125/ML
Kristalose PAK 10gm
hyoscyamine elx 0.125/5
Kristalose PAK 20gm
hyoscyamine sub 0.125MG
Moviprep Sol
hyoscyamine TAB 0.125MG
Nulytely Sol Flav Pks
hyoscyamine TAB 0.375 ER
Osmoprep TAB 1.5gm
hyoscyamine TAB 0.375 SR
Prepopik PAK
hyosyne dro 0.125/ML
Suprep Bowel Sol Prep Kit
hyosyne elx 0.125/5
lansopr/amox mis /clarith
ANTIDIARRHEALS
methscopolam TAB 2.5MG
TIER 01 GENERIC
methscopolam TAB 5MG
diphen/atrop TAB 2.5MG
nizatidine CAP 150MG
loperamide CAP 2MG
nizatidine CAP 300MG
opium tin 10MG/ML
nulev TAB 0.125MG
Diphen/Atrop Liq 2.5/5
omeppi CAP 20-1100PA
TIER 03 NON PREFERRED
omeppi CAP 40-1100PA
Fulyzaq TAB 125MG
omepra/bicar pow 20-1680PA
Lomotil TAB 2.5MG
omepra/bicar pow 40-1680PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 30
omepra/bicar CAP 20-1100PA
dronabinol CAP 2.5MG
omepra/bicar CAP 40-1100PA
dronabinol CAP 5MG
oscimin sub 0.125MG
ondansetron inj 4MG/2ML
oscimin SR TAB 0.375MG
ondansetron inj 40/20ML
oscimin TAB 0.125MG
ondansetron sol 4MG/5ML
ranitidine CAP 150MG
ondansetron TAB 24MG
ranitidine CAP 300MG
ondansetron TAB 4MG
symax-SL sub 0.125MG
ondansetron TAB 4MG odt
symax-SR TAB 0.375MG
ondansetron TAB 8MG
Aciphex Spr CAP 10MGPA
ondansetron TAB 8MG odt
Aciphex Spr CAP 5MGPA
scopolamine dis 1MG/3day
Aciphex TAB 20MGST
Dimenhydrin Inj 50MG/ML
Anaspaz TAB 0.125MG
Transderm-sc Dis 1.5MG
Bentyl CAP 10MG
TIER M MEDICAL COPAY
Bentyl Inj 10MG/ML
Aloxi Inj 0.25MG/5PA
Bentyl TAB 20MG
TIER 03 NON PREFERRED
Cantil TAB 25MG
aprepitant CAP 40MG
Carafate TAB 1gm
granisetron TAB 1MGPA
Cuvposa Sol 1MG/5ML
meclizine TAB 12.5MG
Cytotec TAB 100mcg
meclizine TAB 25MG
Cytotec TAB 200mcg
trimethobenz CAP 300MG
Dexilant CAP 30MG DRPA
Akynzeo CAP 300-0.5
Dexilant CAP 60MG DRPA
Anzemet TAB 100MG
Esomeprazole CAP 24.65MGPA
Anzemet TAB 50MG
Esomeprazole CAP 49.3MGPA
Cesamet CAP 1MG
First-omepra Sus 2MG/ML
Diclegis TAB 10-10MG
Lansoprazole Sus 3MG/ML
Emend CAP 125MG
Levbid TAB 0.375 ER
Emend CAP 40MG
Levsin Inj 0.5MG/ML
Emend CAP 80MG
Levsin TAB 0.125MG
Emend Sus 125MG
Levsin/SL Sub 0.125MG
Emend Tripac PAK 80 & 125
Nizatidine Sol 15MG/ML
Marinol CAP 10MG
Omeclamox- Mis PAK
Marinol CAP 2.5MG
Omeprazole + Sus Syrspend
Marinol CAP 5MG
Pamine Forte TAB 5MG
Sancuso Dis 3.1MGPA
Pamine TAB 2.5MG
Tigan CAP 300MG
Pepcid Sus 40MG/5ML
Tigan Inj 100MG/ML
Pepcid TAB 20MG
Varubi TAB 90MGPA
Pepcid TAB 40MG
Zofran Sol 4MG/5ML
Prevacid CAP 15MG DR
Zofran TAB 4MG
Prevacid CAP 30MG DRST
Zofran TAB 4MG Odt
Prevacid TAB 15MG Stb
Zofran TAB 8MG
Prevacid TAB 30MG Stb
Zofran TAB 8MG Odt
Prevpac Mis
Zuplenz Mis 4MG
Prilosec CAP 10MG
Zuplenz Mis 8MG
Prilosec CAP 20MG
Prilosec CAP 40MG
DIGESTIVE AIDS
Prilosec Pow 10MG
TIER 01 GENERIC
Prilosec Pow 2.5MG
Pancrelipase CAP 5000unit
Protonix PAK
TIER 02 PREFERRED
Protonix TAB 20MG
Creon CAP 12000unt
Protonix TAB 40MG
Creon CAP 24000unt
Robinul Fort TAB 2MG
Creon CAP 3000unit
Robinul Inj 0.2MG/ML
Creon CAP 36000unt
Robinul TAB 1MG
Creon CAP 6000unit
Symax Duotab TAB
Pepsin Pow
Zantac TAB 150MG
Zenpep CAP 10000unt
Zantac TAB 300MG
Zenpep CAP 15000unt
Zegerid CAP 20-1100PA
Zenpep CAP 20000unt
Zegerid CAP 40-1100PA
Zenpep CAP 25000unt
Zegerid Pow 20-1680PA
Zenpep CAP 3000unit
Zegerid Pow 40-1680PA
Zenpep CAP 40000unt
Zenpep CAP 5000unit
ANTIEMETICS
TIER 04 SPECIALTY
TIER 01 GENERIC
Sucraid Sol 8500/MLQL,PA
aprepitant CAP 125MG
TIER 03 NON PREFERRED
aprepitant CAP 80MG
Pancreaze CAP
aprepitant PAK 80 & 125
Pancreaze CAP 10500unt
dronabinol CAP 10MG
Pancreaze CAP 16800unt
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 31
Pancreaze CAP 21000unt
Dipentum CAP 250MGQL,ST
Pancreaze CAP 4200unit
Fosrenol Chw 1000MGQL,PA
Pertzye CAP
Fosrenol Chw 500MGQL,PA
Ultresa CAP 13800unt
Fosrenol Chw 750MGQL,PA
Ultresa CAP 20700unt
Gattex Kit 5MGQL,PA
Ultresa CAP 23000unt
Lotronex TAB 0.5MGQL,PA
Viokace TAB
Lotronex TAB 1MGQL,PA
Viokace TAB 20880
Ocaliva TAB 10MGQL,PA
Ocaliva TAB 5MGQL,PA
GASTROINTESTINAL - MISC.
Relistor TAB 150MGQL,PA
Velphoro Chw 500MGQL,PA
TIER 01 GENERIC
Viberzi TAB 100MGQL,PA
balsalazide CAP 750MG
Viberzi TAB 75MGQL,PA
calc acetate CAP 667MG
Xermelo TAB 250MGQL,PA
calc acetate TAB 667MG
TIER M MEDICAL COPAY
colocort ene 100MG
Inflectra Inj 100MGPA
enulose sol 10gm/15
Remicade Inj 100MGPA
generlac sol 10gm/15
TIER 03 NON PREFERRED
hydrocort ene 100MG
anucort-HC sup 25MG
hydrocortiso CRE 2.5%
anusol-HC sup 25MG
lactulose sol 10gm/15
cromolyn sod CON 100/5ML
mesalamine ene 4gm
hemmorex-HC sup 25MG
mesalamine TAB 1.2gmST
hemmorex-HC sup 30MG
metoclopram inj 10MG/2ML
hydrocort ac sup 25MG
metoclopram inj 5MG/ML
hydrocort ac sup 30MG
metoclopram sol 10/10ML
hydrocort CRE 1%
metoclopram sol 5MG/5ML
lidocaine/HC kit 3%-0.5%
metoclopram TAB 10MG
lidocaine/HC kit 3%-1%
metoclopram TAB 5MG
lidocaine/HC CRE 3%-0.5%
procto-MED CRE HC 2.5%
mesalamine kit 4gm
proctosol HC CRE 2.5%
procto-PAK CRE 1%
proctozone CRE -HC 2.5%
Actigall CAP 300MG
sevelamer pow 0.8gm
Amitiza CAP 24mcgQL,PA
sevelamer pow 2.4gm
Amitiza CAP 8mcgQL,PA
sevelamer TAB 800MG
Analpram-HC CRE 1-1%
sulfasalazin TAB 500MG
Analpram-HC Lot 2.5%
sulfasalazin TAB 500MG DR
Anusol-HC CRE 2.5%
ursodiol CAP 300MG
Apriso CAP 0.375gmST
ursodiol TAB 250MG
Azulfidine TAB 500MG
ursodiol TAB 500MG
Azulfidine TAB 500MG En
Lialda TAB 1.2gmST
Colazal CAP 750MG
Mesalamine TAB 800MG DRST
Cortenema Ene 100MG
Renvela PAK 2.4gm
Delzicol CAP 400MGST
Renvela TAB 800MG
Eliphos TAB 667MG
TIER 02 PREFERRED
Entereg CAP 12MG
Asacol HD TAB 800MGST
Fosrenol Pow 1000MG
Canasa Sup 1000MG
Fosrenol Pow 750MG
Cortifoam Aer 90MG
Gastrocrom CON 100/5ML
Pentasa CAP 250MG CRST
Giazo TAB 1.1gm
Pentasa CAP 500MG CRST
Lido-hydro Gel 2.8-0.55
Proctofoam Aer HC 1%
Linzess CAP 145mcgQL,PA
Rectiv Oin 0.4%
Linzess CAP 290mcgQL,PA
Relistor Inj 12/0.6ML
Linzess CAP 72mcgQL,PA
Relistor Inj 8/0.4ML
Metoclopram TAB 5MG Odt
Renagel TAB 400MG
Metocloprami TAB 10MG Odt
Renagel TAB 800MG
Metozolv Odt TAB 5MG
Renvela PAK 0.8gm
Movantik TAB 12.5MGQL,PA
TIER 04 SPECIALTY
Movantik TAB 25MGQL,PA
alosetron TAB 0.5MGQL,PA
Phoslyra Sol
alosetron TAB 1MGQL,PA
Procort CRE
lanthanum chw 1000MGQL
Proctocort CRE 1%
lanthanum chw 500MGQL
Proctocort Sup 30MG
lanthanum chw 750MGQL
Reglan TAB 10MG
Auryxia TAB 210MGQL,PA
Reglan TAB 5MG
Chenodal TAB 250MGQL,PA
Rowasa Kit 4gm
Cholbam CAP 250MGQL,PA
Sfrowasa Ene 4gm
Cholbam CAP 50MGQL,PA
Trulance TAB 3MGPA
Cimzia KitQL,PA
Uceris Aer 2MG/Act
Cimzia Kit StarterQL,PA
Urso Forte TAB 500MG
Cimzia Prefl Kit 200MG/MLQL,PA
Urso 250 TAB 250MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 32
NON PREFERRED
GENITOURINARY
darifenacin TAB 15MGST
darifenacin TAB 7.5MGST
URINARY ANTI-INFECTIVES
Detrol LA CAP 2MG
TIER 01 GENERIC
Detrol LA CAP 4MG
methenam hip TAB 1gm
Detrol TAB 1MG
nitrofur mac CAP 100MG
Detrol TAB 2MG
nitrofur mac CAP 25MG
Ditropan XL TAB 10MG
nitrofur mac CAP 50MG
Ditropan XL TAB 15MG
nitrofurantn sus 25MG/5ML
Ditropan XL TAB 5MG
nitrofurantn CAP 100MG
Enablex TAB 15MGPA
TIER 03 NON PREFERRED
Enablex TAB 7.5MGPA
azuphen mb CAP 120MG
Gelnique Gel 10%ST
hyolev mb TAB 81MG
Gelnique Gel 10% P.M.ST
hyophen TAB
Gelnique Gel 3%ST
indiomin mb CAP 120MG
Myrbetriq TAB 25MGST
me/naphos/mb TAB hyo 1
Myrbetriq TAB 50MGST
methenam man TAB 1gm
Oxytrol Dis 3.9MG/24
methenam man TAB 1000MG
Toviaz TAB 4MGST
phosphasal TAB
Toviaz TAB 8MGST
ur n-c TAB
Urecholine TAB 10MG
uramit mb CAP 118MG
Urecholine TAB 25MG
urelle TAB
Urecholine TAB 5MG
uretron d/s TAB
Urecholine TAB 50MG
uribel CAP 118MG
Vesicare TAB 10MGST
urin d/s TAB
Vesicare TAB 5MGST
uro-blue TAB 81.6MG
uro-l TAB 81MG
VAGINAL PRODUCTS
uro-mp CAP 118MG
TIER 01 GENERIC
uro-458 TAB
clindamycin CRE 2% vag
uroav-b CAP
estradiol TAB 10mcg
uroav-81 TAB
metronidazol gel 0.75%vag
urolet mb TAB
vandazole gel 0.75%
urophen mb TAB 81.6MG
yuvafem TAB 10mcg
uryl TAB
TIER 02 PREFERRED
ustell CAP
Estrace Vag CRE 0.1MG/Gm
uta CAP 120MG
Estring Mis 2MG
uticap CAP
Femring Mis 0.05/24h
utira-c TAB
Femring Mis 0.1MG/24
utrona-c TAB
Premarin Vag CRE 0.625MG
Furadantin Sus 25MG/5ML
TIER P PREVENTIVE
Hiprex TAB 1gm
vcf vaginal aer contracp
Macrobid CAP 100MG
vcf vaginal gel contrace
Macrodantin CAP 100MG
Conceptrol Gel 4%
Macrodantin CAP 25MG
Encare Sup 100MG
Macrodantin CAP 50MG
Gynol II Gel 3%
Methenam Man TAB 500MG
Shur-seal Gel 2%
Monurol PAK Granules
Today Sponge Mis
Urimar-t TAB
Vcf Vaginal Aer Contracp
Urogesic- TAB Blue
Vcf Vaginal Mis Contracp
TIER 03 NON PREFERRED
URINARY ANTISPASMODICS
terconazole sup 80MG
TIER 01 GENERIC
terconazole CRE 0.4%
bethanechol TAB 10MG
terconazole CRE 0.8%
bethanechol TAB 25MG
zazole sup 80MG
bethanechol TAB 5MG
zazole CRE 0.8%
bethanechol TAB 50MG
Avc CRE 15%
flavoxate TAB 100MG
Cleocin CRE 2% Vag
oxybutynin syp 5MG/5ML
Cleocin Sup 100MG
oxybutynin TAB 10MG ER
Clindesse CRE 2%
oxybutynin TAB 15MG ER
Crinone Gel 4% Vag
oxybutynin TAB 5MG
Crinone Gel 8% Vag
oxybutynin TAB 5MG ER
Endometrin Sup 100MG
tolterodine CAP 2MG ER
Fem PH Gel
tolterodine CAP 4MG ER
Gynazole-1 CRE 2%
tolterodine TAB 1MG
Intrarosa Sup 6.5MGPA
tolterodine TAB 2MG
Metrogel-vag Gel 0.75%
trospium chl CAP 60MG ER
Miconazole 3 Sup 200MG
trospium CL TAB 20MG
Nuvessa Gel 1.3%
TIER 03
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 33
Progesterone Sup VGS 100
Uroxatral TAB 10MG
Progesterone Sup VGS 200
Progesterone Sup VGS 25
HEMATOLOGICAL AGENTS
Progesterone Sup VGS 400
HEMATOPOIETIC AGENTS
Progesterone Sup VGS 50
TIER 01 GENERIC
Relagard Gel
cyanocobalam inj 1000mcg
Terazol 3 CRE 0.8%
TIER 02 PREFERRED
Terazol 7 CRE 0.4%
Epogen Inj 10000/MLQL,PA
Vagifem TAB 10mcg
Epogen Inj 2000/MLQL,PA
Epogen Inj 20000/MLQL,PA
GENITOURINARY - MISC.
Epogen Inj 3000/MLQL,PA
TIER 01 GENERIC
Epogen Inj 4000/MLQL,PA
acetic acid sol 0.25%irr
Procrit Inj 10000/MLQL,PA
alfuzosin TAB 10MG ER
Procrit Inj 2000/MLQL,PA
argyl saline sol 0.9%
Procrit Inj 20000/MLQL,PA
curity salin sol 0.9% irr
Procrit Inj 3000/MLQL,PA
cytra k gra crystals
Procrit Inj 4000/MLQL,PA
finasteride TAB 5MG
Procrit Inj 40000/MLQL,PA
k citrate sol citr acd
TIER P PREVENTIVE
k/NA citrate sol citr acd
carbonyl TAB FE 45MG
phenazo TAB 200MG
ezfe 200 CAP 200MG
phenazopyrid TAB 100MG
fa-8 CAP 800mcg
phenazopyrid TAB 200MG
fa-8 TAB 0.8MG
pot citrate TAB 1080MG
feosol TAB 65MG
pot citrate TAB 1620MG
fer-iron dro 15MG/ML
pot citrate TAB 540MG ER
ferate TAB 27MG
pot citrate- PAK CIT acid
fergon TAB 27MG
sod citrate sol citr acd
ferosul elx 220/5ML
sodium chlor sol 0.9% irr
ferrex 150 CAP 150MG
tamsulosin CAP 0.4MG
ferric x-150 CAP 150MG
taron gra crystals
ferro-bob TAB 325MG
tricitrates sol
ferrocite TAB 324MG
virtrate-k sol 1100-334
ferrotabs TAB
virtrate-2 sol
ferrous dro 15MG/ML
virtrate-2 sol 500-334
ferrous fum TAB 324MG
virtrate-3 sol
ferrous gluc TAB 225MG
TIER 02 PREFERRED
ferrous gluc TAB 240MG
Cystagon CAP 150MGPA
ferrous gluc TAB 324MG
Cystagon CAP 50MGPA
ferrous sulf dro 15MG/ML
Elmiron CAP 100MG
ferrous sulf elx 220/5ML
Oracit Sol
ferrous sulf TAB 325MG
TIER 04 SPECIALTY
ferrous sulf TAB 325MG fc
Procysbi CAP 25MGQL,PA
ferrous sulf TAB 325MG EC
Procysbi CAP 75MGQL,PA
ferrous sulf TAB 5gr
Thiola TAB 100MGQL,PA
ferrousul TAB 325MG
TIER 03 NON PREFERRED
folic acid CAP 800mcg
dutast/tamsu CAP 0.5-0.4
folic acid TAB 1MG
dutasteride CAP 0.5MG
folic acid TAB 1000mcg
neo/poly GU sol 40/ML IR
folic acid TAB 400mcg
Avodart CAP 0.5MG
folic acid TAB 800mcg
Cardura XL TAB 4MG
gnp iron TAB 325MG
Cardura XL TAB 8MG
gnp iron TAB 45MG
Flomax CAP 0.4MG
gnp iron TAB 65MG
Jalyn CAP
hgh-pot iron TAB 325MG
K-phos TAB NO 2
high potency TAB iron
Lithostat TAB 250MG
high potency TAB FE 27MG
Neosporin GU Sol 40/ML IR
iferex 150 CAP
Proscar TAB 5MG
iron slow TAB 45MG
Pyridium TAB 100MG
iron supplem TAB therapy
Pyridium TAB 200MG
iron supplem TAB 325MG
Rapaflo CAP 4MG
iron supplmt dro 15MG/ML
Rapaflo CAP 8MG
iron TAB 27MG
Renacidin Sol
iron TAB 325MG
Renacidin Sol Irr
iron TAB 45MG
Rimso-50 Sol 50%
iron TAB 50MG ER
Shohls Sol Modified
iron TAB 65MG
Urocit-k 10 TAB
myferon 150 CAP 150MG
Urocit-k 15 TAB
nat-rul iron TAB 325MG
Urocit-k 5 TAB
nu-iron 150 CAP 150MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 34
pedia iron dro 15MG/ML
TIER 04 SPECIALTY
poly-iron CAP 150MG
Cerdelga CAP 84MGQL,PA
px iron TAB 200MG
Endari Pow 5gmQL,PA
px iron TAB 27MG
Granix Inj 300/0.5QL,PA
ra iron TAB 27MG
Granix Inj 480/0.8QL,PA
ra iron TAB 325MG
Neulasta Inj 6MG/0.6mQL,PA
ra iron TAB 65MG
Neulasta Kit 6MG/0.6mQL,PA
slow iron TAB 160MG CR
Neupogen Inj 300/0.5QL
slow iron TAB 50MG
Neupogen Inj 300mcgQL
slow rel FE TAB 160MG CR
Neupogen Inj 480/0.8QL
slow release TAB iron 45
Neupogen Inj 480mcgQL
slow release TAB 143MG
Promacta TAB 12.5MGQL,PA
slow release TAB 45MG
Promacta TAB 25MGQL,PA
slow release TAB 47.5MG
Promacta TAB 50MGQL,PA
slow FE TAB 45MG
Promacta TAB 75MGQL,PA
slow-release TAB FE 45MG
Zarxio Inj 300/0.5QL
sm folic acd TAB 400mcg
Zarxio Inj 480/0.8QL
sm iron slow TAB 160MG CR
Zavesca CAP 100MGQL,PA
sm iron TAB
TIER M MEDICAL COPAY
sm iron TAB 325MG
Vpriv Inj 400unitPA
sm iron TAB 45MG
TIER 03 NON PREFERRED
wee care sus 15/1.25
Aranesp Inj 10mcgPA
yl folic aci TAB 400mcg
Aranesp Inj 100mcgPA
CVS iron TAB 27MG
Aranesp Inj 150mcgPA
CVS iron TAB 325MG
Aranesp Inj 200mcgPA
Elite Iron TAB 15MG
Aranesp Inj 25mcgPA
Femiron TAB
Aranesp Inj 300mcgPA
Feosol TAB 200MG
Aranesp Inj 40mcgPA
Feosol TAB 45MG
Aranesp Inj 500mcgPA
Fer-IN-sol Dro 15MG/ML
Aranesp Inj 60mcgPA
Fergon TAB 27MG
Mircera Inj 100mcgPA
Ferretts FE Chw 18MG
Mircera Inj 200mcgPA
Ferretts IPS Sol
Mircera Inj 50mcgPA
Ferretts TAB 325MG
Mircera Inj 75mcgPA
Ferrimin 150 TAB
Mircera Sol 150/0.3PA
Ferrous Fum TAB 29MG
Mircera Sol 30/0.3MLPA
Ferrous Gluc TAB 225MG
Ferrous Gluc TAB 324MG
ANTICOAGULANTS
Ferrous Sulf Syp 300/5ML
TIER 01 GENERIC
Ferrous Sulf TAB 140MG
enoxaparin inj 100MG/MLQL
Ferrous Sulf TAB 324MG EC
enoxaparin inj 120/0.8QL
Folic Acid Inj 5MG/ML
enoxaparin inj 150MG/MLQL
FE sulfate TAB 27MG
enoxaparin inj 30/0.3MLQL
FE Aspartate TAB
enoxaparin inj 300/3MLQL
FE TABS TAB 325MG EC
enoxaparin inj 40/0.4MLQL
Hemocyte TAB 324MG
enoxaparin inj 60/0.6MLQL
HM iron TAB 45MG
enoxaparin inj 80/0.8MLQL
HM iron TAB 65MG
heparin sod inj 1000/ML
Icar Peds Sus Grape
heparin sod inj 10000/ML
Iron Chews Chw Pediatri
heparin sod inj 5000/ML
Iron Chw Pediatri
heparin sod inj 5000/0.5
Iron High CAP Potency
jantoven TAB 1MG
Iron TAB 18MG
jantoven TAB 10MG
Iron TAB 18MG CR
jantoven TAB 2.5MG
Iron TAB 28MG
jantoven TAB 2MG
Iron Up Liq
jantoven TAB 3MG
Mykidz Iron Sus 15/1.5ML
jantoven TAB 4MG
Novaferrum CAP 50MG
jantoven TAB 5MG
Novaferrum Dro 15MG/ML
jantoven TAB 6MG
Perfect Iron TAB 25MG
jantoven TAB 7.5MG
Pic 200 CAP
warfarin TAB 1MG
Profe CAP 180MG
warfarin TAB 10MG
Proferrin ES TAB 12 MG
warfarin TAB 2.5MG
Slow FE TAB 142MG
warfarin TAB 2MG
Slow FE TAB 45MG
warfarin TAB 3MG
Slow Rel FE TAB 143MG CR
warfarin TAB 4MG
TIER C ORAL CHEMO
warfarin TAB 5MG
Droxia CAP 200MG
warfarin TAB 6MG
Droxia CAP 300MG
warfarin TAB 7.5MG
Droxia CAP 400MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 35
Lovenox Inj 100MG/MLQL
dipyridamole TAB 75MG
Lovenox Inj 120/0.8QL
pentoxifylli TAB 400MG ER
Lovenox Inj 150MG/MLQL
prasugrel TAB 10MGPA
Lovenox Inj 30/0.3MLQL
prasugrel TAB 5MGPA
Lovenox Inj 300/3MLQL
TIER 02 PREFERRED
Lovenox Inj 40/0.4MLQL
Brilinta TAB 60MGPA
Lovenox Inj 60/0.6MLQL
Brilinta TAB 90MGPA
Lovenox Inj 80/0.8MLQL
Effient TAB 10MGPA
TIER 02 PREFERRED
Effient TAB 5MGPA
Pradaxa CAP 110MG
TIER 04 SPECIALTY
Pradaxa CAP 150MG
Berinert Inj 500unitQL,PA
Pradaxa CAP 75MG
Cinryze Sol 500 UnitQL,PA
TIER 04 SPECIALTY
Firazyr Inj 30MG/3MLQL,PA
fondaparinux inj 10/0.8MLQL
Haegarda Inj 2000unitQL,PA
fondaparinux inj 2.5/0.5QL
Haegarda Inj 3000unitQL,PA
fondaparinux inj 5/0.4MLQL
Ruconest Inj 2100unitQL,PA
fondaparinux inj 7.5/0.6QL
TIER 03 NON PREFERRED
Arixtra Inj 10/0.8MLQL,PA
Aggrenox CAP 25-200MG
Arixtra Inj 2.5/0.5QL,PA
Agrylin CAP 0.5MG
Arixtra Inj 5/0.4MLQL,PA
Durlaza CAP 162.5MG
Arixtra Inj 7.5/0.6QL,PA
Persantine TAB 25MG
TIER 03 NON PREFERRED
Persantine TAB 50MG
Coumadin TAB 1MG
Persantine TAB 75MG
Coumadin TAB 10MG
Plavix TAB 300MG
Coumadin TAB 2.5MG
Plavix TAB 75MG
Coumadin TAB 2MG
Pletal TAB 100MG
Coumadin TAB 3MG
Pletal TAB 50MG
Coumadin TAB 4MG
Yosprala TAB 325-40MG
Coumadin TAB 5MG
Yosprala TAB 81-40MG
Coumadin TAB 6MG
Zontivity TAB 2.08MG
Coumadin TAB 7.5MG
Eliquis TAB 2.5MGPA
MOUTH/THROAT/DENTAL AGENT
Eliquis TAB 5MGPA
Fragmin Inj 10000/MLQL,PA
TIER 01 GENERIC
Fragmin Inj 12500untQL,PA
clotrimazole loz 10MG
Fragmin Inj 15000untQL,PA
clotrimazole tro 10MG
Fragmin Inj 18000untQL,PA
lidocaine sol 2% visc
Fragmin Inj 2500/0.2QL,PA
nystatin sus 100000
Fragmin Inj 5000/0.2QL,PA
oralone dent pst 0.1%
Fragmin Inj 7500/0.3QL,PA
pilocarpine TAB 5MG
Fragmin Inj 95000untQL,PA
triamcinolon pst den 0.1%
Savaysa TAB 15MGPA
TIER 03 NON PREFERRED
Savaysa TAB 30MGPA
cevimeline CAP 30MG
Savaysa TAB 60MGPA
chlorhex glu sol 0.12%PA
Xarelto Star TAB 15/20MGPA
paroex sol 0.12%PA
Xarelto TAB 10MGPA
periogard sol 0.12%PA
Xarelto TAB 15MGPA
pilocarpine TAB 7.5MG
Xarelto TAB 20MGPA
Aquoral Aer
Aquoral Spr
HEMOSTATICS
Bocasal Pow
TIER 01 GENERIC
Caphosol Sol
tranex acid TAB 650MGQL
Debacterol Sol 30-50%
TIER 03 NON PREFERRED
Evoxac CAP 30MG
Amicar Sol 0.25/ML
First-mouthw Sus Blm
Amicar TAB 1000MG
Lidocaine Sol 4%
Amicar TAB 500MG
Neutrasal Pow
Lysteda TAB 650MGQL
Numoisyn Liq
Numoisyn Loz
HEMATOLOGICAL - MISC.
Oravig TAB 50MG
TIER 01 GENERIC
Salagen TAB 5MG
anagrelide CAP 0.5MG
Salagen TAB 7.5MG
anagrelide CAP 1MG
Salivamax Pow
asa/dipyrida CAP 25-200MG
Salivate RX Pow
cilostazol TAB 100MG
cilostazol TAB 50MG
NEUROLOGY, CNS, PSYCH
clopidogrel TAB 300MG
ANTIANXIETY AGENTS
clopidogrel TAB 75MG
TIER 01 GENERIC
dipyridamole TAB 25MG
alprazolam TAB 0.25MG
dipyridamole TAB 50MG
alprazolam TAB 0.5MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 36
alprazolam TAB 0.5MG ER
alprazolam TAB 0.5MG XR
ANTIDEPRESSANTS
alprazolam TAB 1MG
TIER 01 GENERIC
alprazolam TAB 1MG ER
amitriptylin TAB 10MG
alprazolam TAB 1MG XR
amitriptylin TAB 100MG
alprazolam TAB 2MG
amitriptylin TAB 150MG
alprazolam TAB 2MG ER
amitriptylin TAB 25MG
alprazolam TAB 2MG XR
amitriptylin TAB 50MG
alprazolam TAB 3MG ER
amitriptylin TAB 75MG
alprazolam TAB 3MG XR
bupropion TAB 100MG
buspirone TAB 10MG
bupropion TAB 100MG ER
buspirone TAB 15MG
bupropion TAB 100MG SR
buspirone TAB 30MG
bupropion TAB 150MG ER
buspirone TAB 5MG
bupropion TAB 150MG SR
chlordiazep CAP 10MG
bupropion TAB 200MG ER
chlordiazep CAP 25MG
bupropion TAB 200MG SR
chlordiazep CAP 5MG
bupropion TAB 75MG
cloraz dipot TAB 15MG
bupropn HCL TAB 150MG XL
cloraz dipot TAB 3.75MG
bupropn HCL TAB 300MG XL
cloraz dipot TAB 7.5MG
citalopram sol 10MG/5ML
diazepam TAB 10MG
citalopram TAB 10MG
diazepam TAB 2MG
citalopram TAB 20MG
diazepam TAB 5MG
citalopram TAB 40MG
hydroxyz pam CAP 25MG
clomipramine CAP 25MG
hydroxyz pam CAP 50MG
clomipramine CAP 50MG
hydroxyz HCL syp 10MG/5ML
clomipramine CAP 75MG
hydroxyz HCL TAB 10MG
desipramine TAB 10MG
hydroxyz HCL TAB 25MG
desipramine TAB 100MG
hydroxyz HCL TAB 50MG
desipramine TAB 150MG
lorazepam inj 2MG/ML
desipramine TAB 25MG
lorazepam CON 2MG/ML
desipramine TAB 50MG
lorazepam TAB 0.5MG
desipramine TAB 75MG
lorazepam TAB 1MG
doxepin HCL CAP 10MG
lorazepam TAB 2MG
doxepin HCL CAP 100MG
oxazepam CAP 10MG
doxepin HCL CAP 150MG
oxazepam CAP 15MG
doxepin HCL CAP 25MG
oxazepam CAP 30MG
doxepin HCL CAP 50MG
Diazepam Inj 10MG/2ML
doxepin HCL CAP 75MG
Diazepam Inj 5MG/ML
doxepin HCL CON 10MG/ML
Diazepam Sol 1MG/ML
duloxetine CAP 20MG
Hydroxyz Pam CAP 100MG
duloxetine CAP 30MG
TIER 03 NON PREFERRED
duloxetine CAP 60MG
alprazolam TAB 0.25 odt
escitalopram sol 5MG/5ML
alprazolam TAB 0.5MG od
escitalopram TAB 10MG
alprazolam TAB 1MG odt
escitalopram TAB 20MG
alprazolam TAB 2MG odt
escitalopram TAB 5MG
buspirone TAB 7.5MG
fluoxetine sol 20MG/5ML
diazepam CON 5MG/ML
fluoxetine CAP 10MG
meprobamate TAB 200MG
fluoxetine CAP 20MG
meprobamate TAB 400MG
fluoxetine CAP 40MG
Alprazolam CON 1 MG/ML
fluoxetine TAB 10MG
Ativan Inj 2MG/ML
fluoxetine TAB 20MG
Ativan TAB 0.5MG
fluvoxamine TAB 100MG
Ativan TAB 1MG
fluvoxamine TAB 25MG
Ativan TAB 2MG
fluvoxamine TAB 50MG
Tranxene T TAB 3.75MG
imipram HCL TAB 10MG
Tranxene T TAB 7.5MG
imipram HCL TAB 25MG
Valium TAB 10MG
imipram HCL TAB 50MG
Valium TAB 2MG
mirtazapine TAB 15MG
Valium TAB 5MG
mirtazapine TAB 15MG odt
Vistaril CAP 25MG
mirtazapine TAB 30MG
Vistaril CAP 50MG
mirtazapine TAB 30MG odt
Xanax TAB 0.25MG
mirtazapine TAB 45MG
Xanax TAB 0.5MG
mirtazapine TAB 45MG odt
Xanax TAB 1MG
mirtazapine TAB 7.5MG
Xanax TAB 2MG
nortriptylin CAP 10MG
Xanax XR TAB 0.5MG
nortriptylin CAP 25MG
Xanax XR TAB 1MG
nortriptylin CAP 50MG
Xanax XR TAB 2MG
nortriptylin CAP 75MG
Xanax XR TAB 3MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 37
paroxetine TAB 10MG
Celexa TAB 10MG
paroxetine TAB 20MG
Celexa TAB 20MG
paroxetine TAB 30MG
Celexa TAB 40MG
paroxetine TAB 40MG
Cymbalta CAP 20MG
phenelzine TAB 15MG
Cymbalta CAP 30MG
protriptylin TAB 10MG
Cymbalta CAP 60MG
protriptylin TAB 5MG
Desvenlafax TAB 100MG ERPA
sertraline CON 20MG/ML
Desvenlafax TAB 50MG ERPA
sertraline TAB 100MG
Duloxetine CAP 40MG
sertraline TAB 25MG
Effexor XR CAP 150MG
sertraline TAB 50MG
Effexor XR CAP 37.5MG
tranylcyprom TAB 10MG
Effexor XR CAP 75MG
trazodone TAB 100MG
Elavil TAB 25MG
trazodone TAB 150MG
Fetzima CAP TitratioPA
trazodone TAB 300MG
Fetzima CAP 120MGST
trazodone TAB 50MG
Fetzima CAP 20MGST
venlafaxine CAP 150MG ER
Fetzima CAP 40MGST
venlafaxine CAP 37.5 ER
Fetzima CAP 80MGST
venlafaxine CAP 75MG ER
Fluoxetine CAP 90MG DR
venlafaxine TAB 100MG
Forfivo XL TAB 450MGST
venlafaxine TAB 25MG
Khedezla TAB 100MG ERPA
venlafaxine TAB 37.5MG
Khedezla TAB 50MG ERPA
venlafaxine TAB 50MG
Lexapro Sol 5MG/5ML
venlafaxine TAB 75MG
Lexapro TAB 10MG
Amoxapine TAB 100MG
Lexapro TAB 20MG
Amoxapine TAB 150MG
Lexapro TAB 5MG
Amoxapine TAB 25MG
Marplan TAB 10MG
Amoxapine TAB 50MG
Nardil TAB 15MG
Fluoxetine TAB 60MG
Nefazodone TAB 100MG
Maprotiline TAB 25MG
Nefazodone TAB 150MG
Maprotiline TAB 50MG
Nefazodone TAB 200MG
Maprotiline TAB 75MG
Norpramin TAB 10MG
Nortriptylin Sol 10MG/5ML
Norpramin TAB 100MG
TIER 02 PREFERRED
Norpramin TAB 150MG
Paxil Sus 10MG/5ML
Norpramin TAB 25MG
TIER 04 SPECIALTY
Norpramin TAB 50MG
Emsam Dis 12MG/24hQL,PA
Norpramin TAB 75MG
Emsam Dis 6MG/24HRQL,PA
Pamelor CAP 10MG
Emsam Dis 9MG/24HRQL,PA
Pamelor CAP 25MG
TIER 03 NON PREFERRED
Pamelor CAP 50MG
desvenlafax TAB 100MG ERPA
Pamelor CAP 75MG
desvenlafax TAB 25MG ERPA
Parnate TAB 10MG
desvenlafax TAB 50MG ERPA
Paxil CR TAB 12.5MG
fluvoxamine CAP 100MG ER
Paxil CR TAB 25MG
fluvoxamine CAP 150MG ER
Paxil CR TAB 37.5MG
imipram pam CAP 100MG
Paxil TAB 10MG
imipram pam CAP 125MG
Paxil TAB 20MG
imipram pam CAP 150MG
Paxil TAB 30MG
imipram pam CAP 75MG
Paxil TAB 40MG
nefazodone TAB 250MG
Pexeva TAB 10MG
nefazodone TAB 50MG
Pexeva TAB 20MG
paroxetin ER TAB 12.5MG
Pexeva TAB 30MG
paroxetin ER TAB 37.5MG
Pexeva TAB 40MG
paroxetine TAB 25MG ER
Pristiq TAB 100MGPA
trimipramine CAP 100MG
Pristiq TAB 25MGPA
trimipramine CAP 25MG
Pristiq TAB 50MGPA
trimipramine CAP 50MG
Prozac CAP 10MG
venlafaxine TAB 150MG ER
Prozac CAP 20MG
venlafaxine TAB 225MG ER
Prozac CAP 40MG
venlafaxine TAB 37.5 ER
Prozac Weekl CAP 90MG
venlafaxine TAB 75MG ER
Remeron Sltb TAB 15MG
Anafranil CAP 25MG
Remeron Sltb TAB 30MG
Anafranil CAP 50MG
Remeron Sltb TAB 45MG
Anafranil CAP 75MG
Remeron TAB 15MG
Aplenzin TAB 174MG
Remeron TAB 30MG
Aplenzin TAB 348MG
Remeron TAB 45MG
Aplenzin TAB 522MG
Surmontil CAP 100MG
Brintellix TAB 10MGST
Surmontil CAP 25MG
Brintellix TAB 20MGST
Surmontil CAP 50MG
Brintellix TAB 5MGST
Tofranil TAB 10MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 38
Tofranil TAB 25MG
lithium CARB TAB 300MG ER
Tofranil TAB 50MG
lithium CARB TAB 450MG ER
Tofranil-PM CAP 100MG
loxapine CAP 10MG
Tofranil-PM CAP 125MG
loxapine CAP 25MG
Tofranil-PM CAP 150MG
loxapine CAP 5MG
Tofranil-PM CAP 75MG
loxapine CAP 50MG
Trintellix TAB 10MGST
olanzapine TAB 10MG
Trintellix TAB 20MGST
olanzapine TAB 15MG
Trintellix TAB 5MGST
olanzapine TAB 2.5MG
Venlafaxine TAB 150MG ER
olanzapine TAB 20MG
Venlafaxine TAB 225MG ER
olanzapine TAB 5MG
Venlafaxine TAB 37.5 ER
olanzapine TAB 7.5MG
Venlafaxine TAB 75MG ER
perphenazine TAB 16MG
Viibryd Kit Starter
perphenazine TAB 2MG
Viibryd TAB 10MGST
perphenazine TAB 4MG
Viibryd TAB 20MGST
perphenazine TAB 8MG
Viibryd TAB 40MGST
prochlorper inj 10MG/2ML
Wellbutrin TAB XL 150MG
prochlorper sup 25MG
Wellbutrin TAB XL 300MG
prochlorper TAB 10MG
Wellbutrin TAB 100MG
prochlorper TAB 5MG
Wellbutrin TAB 100MG SR
quetiapine TAB 100MG
Wellbutrin TAB 150MG SR
quetiapine TAB 200MG
Wellbutrin TAB 200MG SR
quetiapine TAB 25MG
Wellbutrin TAB 75MG
quetiapine TAB 300MG
Zoloft CON 20MG/ML
quetiapine TAB 400MG
Zoloft TAB 100MG
quetiapine TAB 50MG
Zoloft TAB 25MG
risperidone sol 1MG/ML
Zoloft TAB 50MG
risperidone TAB 0.25MG
risperidone TAB 0.5MG
ANTIPSYCHOTICS
risperidone TAB 1MG
risperidone TAB 2MG
TIER 01 GENERIC
risperidone TAB 3MG
aripiprazole sol 1MG/MLPA
risperidone TAB 4MG
aripiprazole TAB 10MGPA
thiothixene CAP 1MG
aripiprazole TAB 15MGPA
thiothixene CAP 10MG
aripiprazole TAB 2MGPA
thiothixene CAP 2MG
aripiprazole TAB 20MGPA
thiothixene CAP 5MG
aripiprazole TAB 30MGPA
trifluoperaz TAB 1MG
aripiprazole TAB 5MGPA
trifluoperaz TAB 10MG
chlorpromaz TAB 10MG
trifluoperaz TAB 2MG
chlorpromaz TAB 100MG
trifluoperaz TAB 5MG
chlorpromaz TAB 200MG
ziprasidone CAP 20MG
chlorpromaz TAB 25MG
ziprasidone CAP 40MG
chlorpromaz TAB 50MG
ziprasidone CAP 60MG
clozapine TAB 100MG
ziprasidone CAP 80MG
clozapine TAB 200MG
Chlorpromaz Inj 25MG/ML
clozapine TAB 25MG
Chlorpromaz Inj 50MG/2ML
clozapine TAB 50MG
Fluphenazine CON 5MG/ML
compro sup 25MG
Fluphenazine Elx 2.5/5ML
fluphenaz DE inj 25MG/ML
Fluphenazine Inj 2.5MG/ML
fluphenazine TAB 1MG
Lithium CARB CAP 150MG
fluphenazine TAB 10MG
Lithium CARB CAP 600MG
fluphenazine TAB 2.5MG
Lithium Sol 8meq/5ML
fluphenazine TAB 5MG
TIER 02 PREFERRED
haloper lac inj 5MG/ML
Risperdal Inj 12.5MG
haloper DEC inj 100MG/ML
Risperdal Inj 25MG
haloper DEC inj 50MG/ML
Risperdal Inj 37.5MG
haloperidol inj 5MG/ML
Risperdal Inj 50MG
haloperidol inj 50/10ML
TIER 04 SPECIALTY
haloperidol CON 2MG/ML
Abilify Main Inj 300MGQL,PA
haloperidol TAB 0.5MG
Abilify Main Inj 400MGQL,PA
haloperidol TAB 1MG
Aristada Inj 1064MGQL,ST
haloperidol TAB 10MG
Aristada Inj 441MG/1.QL,ST
haloperidol TAB 2MG
Aristada Inj 662MG/2QL,ST
haloperidol TAB 20MG
Aristada Inj 882MG/3QL,ST
haloperidol TAB 5MG
Invega Sust Inj 117/0.75QL,PA
lithium CARB CAP 150MG
Invega Sust Inj 156MG/MLQL,PA
lithium CARB CAP 300MG
Invega Sust Inj 234/1.5QL,PA
lithium CARB CAP 600MG
Invega Sust Inj 39/0.25QL,PA
lithium CARB TAB 300MG
Invega Sust Inj 78/0.5MLQL,PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 39
Invega Trinz Inj 273MGQL,PA
Fazaclo TAB 25MG Odt
Invega Trinz Inj 410MGQL,PA
Geodon CAP 20MG
Invega Trinz Inj 546MGQL,PA
Geodon CAP 40MG
Invega Trinz Inj 819MGQL,PA
Geodon CAP 60MG
Latuda TAB 120MGQL,ST
Geodon CAP 80MG
Latuda TAB 20MGQL,ST
Geodon Inj 20MG
Latuda TAB 40MGQL,ST
Haldol Decan Inj 100MG/ML
Latuda TAB 60MGQL,ST
Haldol Decan Inj 50MG/ML
Latuda TAB 80MGQL,ST
Haldol Inj 5MG/ML
Nuplazid TAB 17MGQL,PA
Invega TAB 1.5MGST
Vraylar CAP 1.5-3MGQL,PA
Invega TAB 3MGST
Vraylar CAP 1.5MGQL,PA
Invega TAB 6MGST
Vraylar CAP 3MGQL,PA
Invega TAB 9MGST
Vraylar CAP 4.5MGQL,PA
Lithobid TAB 300MG CR
Vraylar CAP 6MGQL,PA
Molindone TAB HCL 10MG
TIER 03 NON PREFERRED
Molindone TAB HCL 25MG
aripiprazole TAB 10MG odtPA
Molindone TAB HCL 5MG
aripiprazole TAB 15MG odtPA
Rexulti TAB 0.25MGPA
clozapine TAB 100/odt
Rexulti TAB 0.5MGPA
clozapine TAB 25MG odt
Rexulti TAB 1MGPA
olanzapine inj 10MG
Rexulti TAB 2MGPA
olanzapine TAB 10MG odt
Rexulti TAB 3MGPA
olanzapine TAB 15MG odt
Rexulti TAB 4MGPA
olanzapine TAB 20MG odt
Risperdal M TAB 0.5MG
olanzapine TAB 5MG odt
Risperdal M TAB 1MG
paliperidone TAB ER 1.5MGST
Risperdal M TAB 2MG
paliperidone TAB ER 3MGST
Risperdal M TAB 3MG
paliperidone TAB ER 6MGST
Risperdal M TAB 4MG
paliperidone TAB ER 9MGST
Risperdal Sol 1MG/ML
quetiapine TAB 150MG ERST
Risperdal TAB 0.25MG
quetiapine TAB 200MG ERST
Risperdal TAB 0.5MG
quetiapine TAB 300MG ERST
Risperdal TAB 1MG
quetiapine TAB 400MG ERST
Risperdal TAB 2MG
quetiapine TAB 50MG ERST
Risperdal TAB 3MG
risperidone TAB 0.25 odt
Risperdal TAB 4MG
risperidone TAB 0.5MG od
Saphris Sub 10MGST
risperidone TAB 1MG odt
Saphris Sub 2.5MGST
risperidone TAB 2MG odt
Saphris Sub 5MGST
risperidone TAB 3MG odt
Seroquel TAB 100MG
risperidone TAB 4MG odt
Seroquel TAB 200MG
thioridazine TAB 10MG
Seroquel TAB 25MG
thioridazine TAB 100MG
Seroquel TAB 300MG
thioridazine TAB 25MG
Seroquel TAB 400MG
thioridazine TAB 50MG
Seroquel TAB 50MG
Abilify TAB 10MGPA
Seroquel XR TAB 150MGST
Abilify TAB 15MGPA
Seroquel XR TAB 200MGST
Abilify TAB 2MGPA
Seroquel XR TAB 300MGST
Abilify TAB 20MGPA
Seroquel XR TAB 400MGST
Abilify TAB 30MGPA
Seroquel XR TAB 50MGST
Abilify TAB 5MGPA
Versacloz Sus 50MG/ML
Clozapine TAB 12.5/Odt
Zyprexa Inj 10MG
Clozapine TAB 150/Odt
Zyprexa Relp Inj 210MGST
Clozapine TAB 200/Odt
Zyprexa Relp Inj 300MGST
Clozaril TAB 100MG
Zyprexa Relp Inj 405MGST
Clozaril TAB 25MG
Zyprexa TAB 10MG
Equetro CAP 100MG
Zyprexa TAB 15MG
Equetro CAP 200MG
Zyprexa TAB 2.5MG
Equetro CAP 300MG
Zyprexa TAB 20MG
Fanapt PAKST
Zyprexa TAB 5MG
Fanapt TAB 1MGST
Zyprexa TAB 7.5MG
Fanapt TAB 10MGST
Zyprexa Zydi TAB 10MG
Fanapt TAB 12MGST
Zyprexa Zydi TAB 15MG
Fanapt TAB 2MGST
Zyprexa Zydi TAB 20MG
Fanapt TAB 4MGST
Zyprexa Zydi TAB 5MG
Fanapt TAB 6MGST
Fanapt TAB 8MGST
HYPNOTICS
Fazaclo TAB 100 Odt
TIER 01 GENERIC
Fazaclo TAB 12.5 Odt
eszopiclone TAB 1MG
Fazaclo TAB 150 Odt
eszopiclone TAB 2MG
Fazaclo TAB 200 Odt
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 40
eszopiclone TAB 3MG
Temazepam 7.5MG CAPS
midazolam inj 10MG/2ML
Zolpimist Spr 5MG
midazolam inj 5MG/ML
phenobarb elx 20MG/5ML
ADHD, NARCOLEPSY, ETC.
phenobarb sol 20MG/5ML
TIER 01 GENERIC
phenobarb TAB 16.2MG
amphet/dextr CAP 10MG ER
phenobarb TAB 32.4MG
amphet/dextr CAP 15MG ERQL
phenobarb TAB 64.8MG
amphet/dextr CAP 20MG ERQL
phenobarb TAB 97.2MG
amphet/dextr CAP 25MG ERQL
temazepam CAP 15MG
amphet/dextr CAP 30MG ERQL
temazepam CAP 30MG
amphet/dextr CAP 5MG ERQL
temazepam CAP 7.5MG
amphet/dextr TAB 10MG
triazolam TAB 0.25MG
amphet/dextr TAB 12.5MG
zaleplon CAP 10MG
amphet/dextr TAB 15MG
zaleplon CAP 5MG
amphet/dextr TAB 20MG
zolpidem TAB 10MG
amphet/dextr TAB 30MG
zolpidem TAB 5MG
amphet/dextr TAB 5MG
Flurazepam CAP 15MG
amphet/dextr TAB 7.5MG
Flurazepam CAP 30MG
atomoxetine CAP 10MGST
Phenobarb Inj 130MG/ML
atomoxetine CAP 100MGST
Phenobarb TAB 100MG
atomoxetine CAP 18MGST
Phenobarb TAB 15MG
atomoxetine CAP 25MGST
Phenobarb TAB 30MG
atomoxetine CAP 40MGST
Phenobarb TAB 60MG
atomoxetine CAP 60MGST
Triazolam TAB 0.125MG
atomoxetine CAP 80MGST
TIER 02 PREFERRED
caffeine CIT sol 20MG/ML
Seconal CAP 100MG
caffeine CIT sol 60MG/3ML
Seconal Sod CAP 100MG
dexedrine TAB 10MG
TIER 04 SPECIALTY
dexedrine TAB 5MG
Hetlioz CAP 20MGQL,PA
dexmethylph TAB 10MG
TIER 03 NON PREFERRED
dexmethylph TAB 2.5MG
estazolam TAB 1MG
dexmethylph TAB 5MG
estazolam TAB 2MG
dextroamphet CAP 10MG ERQL
midazolam syp 2MG/ML
dextroamphet CAP 15MG ERQL
pentobarb inj 1000/20
dextroamphet CAP 5MG ERQL
temazepam CAP 22.5MG
dextroamphet TAB 10MG
zolpidem ER TAB 12.5MG
dextroamphet TAB 5MG
zolpidem ER TAB 6.25MG
guanfacine TAB 1MG ER
zolpidem TAR sub 1.75MG
guanfacine TAB 2MG ER
zolpidem TAR sub 3.5MG
guanfacine TAB 3MG ER
Ambien CR TAB 12.5MG
guanfacine TAB 4MG ER
Ambien CR TAB 6.25MG
metadate TAB 20MG ERQL
Ambien TAB 10MG
methylphenid CAP 10MGQL
Ambien TAB 5MG
methylphenid CAP 20MGQL
Amytal Sod Inj 500MG
methylphenid CAP 20MG ERQL,ST
Belsomra TAB 10MGPA
methylphenid CAP 30MGQL
Belsomra TAB 15MGPA
methylphenid CAP 30MG ERQL,ST
Belsomra TAB 20MGPA
methylphenid CAP 40MGQL
Belsomra TAB 5MGPA
methylphenid CAP 40MG ERQL,ST
Butisol Sod TAB 30MG
methylphenid CAP 50MGQL
Doral TAB 15MG
methylphenid CAP 60MGQL
Edluar Sub 10MG
methylphenid TAB 10MG
Edluar Sub 5MG
methylphenid TAB 10MG ERQL
Halcion TAB 0.25MG
methylphenid TAB 18MG ERQL
Intermezzo Sub 1.75MG
methylphenid TAB 20MG
Intermezzo Sub 3.5MG
methylphenid TAB 20MG ERQL
Lunesta TAB 1MG
methylphenid TAB 27MG ERQL
Lunesta TAB 2MG
methylphenid TAB 36MG ERQL
Lunesta TAB 3MG
methylphenid TAB 5MG
Nembutal Sod Inj 50MG/ML
methylphenid TAB 54MG ERQL
Quazepam TAB 15MG
modafinil TAB 100MGPA
Restoril CAP 15MG
modafinil TAB 200MGPA
Restoril CAP 22.5MG
zenzedi TAB 10MG
Restoril CAP 30MG
zenzedi TAB 5MG
Restoril CAP 7.5MG
Adderall XR CAP 10MG
Rozerem TAB 8MG
Adderall XR CAP 15MGQL
Silenor TAB 3MG
Adderall XR CAP 20MGQL
Silenor TAB 6MG
Adderall XR CAP 25MGQL
Sonata CAP 10MG
Adderall XR CAP 30MGQL
Sonata CAP 5MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 41
Adderall XR CAP 5MGQL
Focalin XR CAP 5MGQL,ST
Concerta TAB 18MGQL
Intuniv TAB 1MG
Concerta TAB 27MGQL
Intuniv TAB 2MG
Concerta TAB 36MGQL
Intuniv TAB 3MG
Concerta TAB 54MGQL
Intuniv TAB 4MG
Methylphenid CAP 60MG LAQL,ST
Kapvay TAB 0.1 MG
Methylphenid TAB 18MG ERQL
Metadate CD CAP 10MGQL
Methylphenid TAB 27MG ERQL
Metadate CD CAP 20MGQL
Methylphenid TAB 36MG ERQL
Metadate CD CAP 30MGQL
Methylphenid TAB 54MG ERQL
Metadate CD CAP 40MGQL
TIER 03 NON PREFERRED
Metadate CD CAP 50MGQL
armodafinil TAB 150MGPA
Metadate CD CAP 60MGQL
armodafinil TAB 200MGPA
Methlphenida Chw 2.5MG
armodafinil TAB 250MGPA
Methylin Chw 10MG
armodafinil TAB 50MGPA
Methylin Chw 2.5MG
clonidine TAB 0.1MG ER
Methylin Chw 5MG
dexmethylph CAP 15MG ERQL,ST
Methylphenid Chw 10MG
dexmethylph CAP 30MG ERQL,ST
Methylphenid Chw 5MG
dexmethylph CAP 40MG ERQL,ST
Mydayis CAP 12.5MGPA
dexmethylphe CAP ER 25MGQL,ST
Mydayis CAP 25MGPA
dexmethylphe CAP ER 35MGQL,ST
Mydayis CAP 37.5MGPA
dexmethylphe CAP 10MG ERQL,ST
Mydayis CAP 50MGPA
dexmethylphe CAP 20MG ERQL,ST
Nuvigil TAB 150MGPA
dexmethylphe CAP 5MG ERQL,ST
Nuvigil TAB 200MGPA
dextroamphet sol 5MG/5ML
Nuvigil TAB 250MGPA
methamphetam TAB 5MG
Nuvigil TAB 50MGPA
Adderall TAB 10MG
Procentra Sol 5MG/5ML
Adderall TAB 12.5MG
Provigil TAB 100MGPA
Adderall TAB 15MG
Provigil TAB 200MGPA
Adderall TAB 20MG
Quillichew Chw 20MG ERPA
Adderall TAB 30MG
Quillichew Chw 30MG ERPA
Adderall TAB 5MG
Quillichew Chw 40MG ERPA
Adderall TAB 7.5MG
Quillivant Sus 25MG/5MLQL,ST
Adzenys XR TAB 12.5MGPA
Ritalin LA CAP 10MGQL,ST
Adzenys XR TAB 15.7 MGPA
Ritalin LA CAP 20MGQL,ST
Adzenys XR TAB 18.8MGPA
Ritalin LA CAP 30MGQL,ST
Adzenys XR TAB 3.1MGPA
Ritalin LA CAP 40MGQL,ST
Adzenys XR TAB 6.3MGPA
Ritalin LA CAP 60MGQL,ST
Adzenys XR TAB 9.4MGPA
Ritalin TAB 10MG
Aptensio XR CAP 10MGQL,ST
Ritalin TAB 20MG
Aptensio XR CAP 15MGQL,ST
Ritalin TAB 5MG
Aptensio XR CAP 20MGQL,ST
Strattera CAP 10MGST
Aptensio XR CAP 30MGQL,ST
Strattera CAP 100MGST
Aptensio XR CAP 40MGQL,ST
Strattera CAP 18MGST
Aptensio XR CAP 50MGQL,ST
Strattera CAP 25MGST
Aptensio XR CAP 60MGQL,ST
Strattera CAP 40MGST
Cotempla TAB 17.3MGPA
Strattera CAP 60MGST
Cotempla TAB 25.9MGPA
Strattera CAP 80MGST
Cotempla TAB 8.6MGPA
Vyvanse Chw 10MGQL,PA
Daytrana Dis 10MG/9HRQL,ST
Vyvanse Chw 20MGQL,PA
Daytrana Dis 15MG/9HRQL,ST
Vyvanse Chw 30MGQL,PA
Daytrana Dis 20MG/9HRQL,ST
Vyvanse Chw 40MGQL,PA
Daytrana Dis 30MG/9HRQL,ST
Vyvanse Chw 50MGQL,PA
Desoxyn TAB 5MG
Vyvanse Chw 60MGQL,PA
Dexedrine CAP 10MG CRQL
Vyvanse CAP 10MGQL,PA
Dexedrine CAP 15MG CRQL
Vyvanse CAP 20MGQL,PA
Dexedrine CAP 5MG CRQL
Vyvanse CAP 30MGQL,PA
Dyanavel XR Sus 2.5MG/MLST
Vyvanse CAP 40MGQL,PA
Evekeo TAB 10MGPA
Vyvanse CAP 50MGQL,PA
Evekeo TAB 5MGPA
Vyvanse CAP 60MGQL,PA
Focalin TAB 10MG
Vyvanse CAP 70MGQL,PA
Focalin TAB 2.5MG
Zenzedi TAB 15MG
Focalin TAB 5MG
Zenzedi TAB 2.5MG
Focalin XR CAP 10MGQL,ST
Zenzedi TAB 20MG
Focalin XR CAP 15MGQL,ST
Zenzedi TAB 30MG
Focalin XR CAP 20MGQL,ST
Zenzedi TAB 7.5MG
Focalin XR CAP 25MGQL,ST
Focalin XR CAP 30MGQL,ST
ANTICONVULSANTS
Focalin XR CAP 35MGQL,ST
TIER 01
Focalin XR CAP 40MGQL,ST
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 42
GENERIC
zonisamide CAP 25MG
carbamazepin chw 100MG
zonisamide CAP 50MG
carbamazepin sus 100/5ML
Diastat PED Gel 2.5m Gel
carbamazepin CAP 100MG ER
Diazepam Gel 10MG
carbamazepin CAP 200MG ER
Diazepam Gel 2.5MG
carbamazepin CAP 300MG ER
Diazepam Gel 20MG
carbamazepin TAB 100mger
TIER 02 PREFERRED
carbamazepin TAB 200MG
Celontin CAP 300MG
carbamazepin TAB 200MG ER
Dilantin CAP 30MG
carbamazepin TAB 400MG ER
TIER 04 SPECIALTY
clonazep odt TAB 0.125MG
felbamate sus 600/5MLQL,PA
clonazep odt TAB 0.25MG
felbamate TAB 400MGQL,PA
clonazep odt TAB 0.5MG
felbamate TAB 600MGQL,PA
clonazep odt TAB 1MG
vigabatrin PAK 500MGQL
clonazep odt TAB 2MG
Aptiom TAB 200MGQL,PA
clonazepam TAB 0.5MG
Aptiom TAB 400MGQL,PA
clonazepam TAB 1MG
Aptiom TAB 600MGQL,PA
clonazepam TAB 2MG
Aptiom TAB 800MGQL,PA
divalproex CAP 125MG
Banzel Sus 40MG/MLQL,PA
divalproex TAB 125MG DR
Banzel TAB 200MGQL,PA
divalproex TAB 250MG DR
Banzel TAB 400MGQL,PA
divalproex TAB 250MG ER
Briviact Sol 10MG/MLQL,PA
divalproex TAB 500MG DR
Briviact TAB 10MGQL,PA
divalproex TAB 500MG ER
Briviact TAB 100MGQL,PA
epitol TAB 200MG
Briviact TAB 25MGQL,PA
ethosuximide sol 250/5ML
Briviact TAB 50MGQL,PA
ethosuximide CAP 250MG
Briviact TAB 75MGQL,PA
gabapentin sol 250/5ML
Felbatol Sus 600/5MLQL,PA
gabapentin sol 300/6ML
Felbatol TAB 400MGQL,PA
gabapentin CAP 100MG
Felbatol TAB 600MGQL,PA
gabapentin CAP 300MG
Mysoline TAB 250MGQL
gabapentin CAP 400MG
Mysoline TAB 50MGQL
gabapentin TAB 600MG
Onfi Sus 2.5MG/MLQL,PA
gabapentin TAB 800MG
Onfi TAB 10MGQL,PA
lamotrigine chw 25MG
Onfi TAB 20MGQL,PA
lamotrigine chw 5MG
Sabril Pow 500MGQL
lamotrigine TAB 100MG
Sabril TAB 500MGQL,PA
lamotrigine TAB 150MG
Vimpat TAB 100MGQL,PA
lamotrigine TAB 200MG
Vimpat TAB 150MGQL,PA
lamotrigine TAB 25MG
Vimpat TAB 200MGQL,PA
levetiraceta sol 100MG/ML
Vimpat TAB 50MGQL,PA
levetiraceta sol 500/5ML
TIER 03 NON PREFERRED
levetiraceta TAB 1000MG
lamotrig odt kit 25/50MG
levetiraceta TAB 250MG
lamotrig odt kit 50/100MG
levetiraceta TAB 500MG
lamotrig odt TAB 100MG
levetiraceta TAB 500MG ER
lamotrigine kit odt
levetiraceta TAB 750MG
lamotrigine kit start 35
levetiraceta TAB 750MG ER
lamotrigine kit start 49
oxcarbazepin sus 300MG/5m
lamotrigine kit start 98
oxcarbazepin TAB 150MG
lamotrigine TAB 100MG ER
oxcarbazepin TAB 300MG
lamotrigine TAB 200MG ER
oxcarbazepin TAB 600MG
lamotrigine TAB 25MG odt
phenytoin chw 50MG
lamotrigine TAB 25MG ER
phenytoin inj 50MG/ML
lamotrigine TAB 250MG ER
phenytoin sus 125/5ML
lamotrigine TAB 300MG ER
phenytoin EX CAP 100MG
lamotrigine TAB 50MG odt
primidone TAB 250MGQL
lamotrigine TAB 50MG ER
primidone TAB 50MGQL
phenytoin EX CAP 200MG
roweepra TAB 1000MG
phenytoin EX CAP 300MG
roweepra TAB 500MG
tiagabine TAB 2MG
roweepra TAB 750MG
tiagabine TAB 4MG
topiramate CAP 15MG
Carbatrol CAP 100MG
topiramate CAP 25MG
Carbatrol CAP 200MG
topiramate TAB 100MG
Carbatrol CAP 300MG
topiramate TAB 200MG
Depakene CAP 250MG
topiramate TAB 25MG
Depakene Sol 250/5ML
topiramate TAB 50MG
Depakote ER TAB 250MG
valproic acd sol 250/5ML
Depakote ER TAB 500MG
valproic acd CAP 250MG
Depakote Spr CAP 125MG
zonisamide CAP 100MG
Depakote TAB 125MG DR
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 43
Depakote TAB 250MG DR
Potiga TAB 200MG
Depakote TAB 500MG DR
Potiga TAB 300MG
Diastat Acdl Gel 12.5-20
Potiga TAB 400MG
Diastat Acdl Gel 5-10MG
Potiga TAB 50MG
Dilantin Chw 50MG
Qudexy XR CAP 100/24HRPA
Dilantin CAP 100MG
Qudexy XR CAP 150/24HRPA
Dilantin-125 Sus 125/5ML
Qudexy XR CAP 200/24HRPA
Fycompa Sus 0.5MG/MLST
Qudexy XR CAP 25/24HRPA
Fycompa TAB 10MGQL,ST
Qudexy XR CAP 50/24HRPA
Fycompa TAB 12MGQL,ST
Spritam TAB 1000MG
Fycompa TAB 2MGQL,ST
Spritam TAB 250MG
Fycompa TAB 4MGQL,ST
Spritam TAB 500MG
Fycompa TAB 6MGQL,ST
Spritam TAB 750MG
Fycompa TAB 8MGQL,ST
Tegretol Sus 100/5ML
Gabitril TAB 12MG
Tegretol TAB 200MG
Gabitril TAB 16MG
Tegretol-XR TAB 100MG
Gabitril TAB 2MG
Tegretol-XR TAB 200MG
Gabitril TAB 4MG
Tegretol-XR TAB 400MG
Keppra Sol 100MG/ML
Topamax Spr CAP 15MG
Keppra TAB 1000MG
Topamax Spr CAP 25MG
Keppra TAB 250MG
Topamax TAB 100MG
Keppra TAB 500MG
Topamax TAB 200MG
Keppra TAB 750MG
Topamax TAB 25MG
Keppra XR TAB 500MG
Topamax TAB 50MG
Keppra XR TAB 750MG
Topiramate CAP ER 100MG
Klonopin TAB 0.5MG
Topiramate CAP ER 150MG
Klonopin TAB 1MG
Topiramate CAP ER 200MG
Klonopin TAB 2MG
Topiramate CAP ER 25MG
Lamictal Chw 25MG
Topiramate CAP ER 50MG
Lamictal Chw 5MG
Trileptal Sus 300MG/5m
Lamictal Kit Start 35
Trileptal TAB 150MG
Lamictal Kit Start 49
Trileptal TAB 300MG
Lamictal Kit Start 98
Trileptal TAB 600MG
Lamictal Odt Kit
Trokendi XR CAP 100MGPA
Lamictal Odt TAB 100MG
Trokendi XR CAP 200MGPA
Lamictal Odt TAB 200MG
Trokendi XR CAP 25MGPA
Lamictal Odt TAB 25MG
Trokendi XR CAP 50MGPA
Lamictal Odt TAB 50MG
Vimpat Sol 10MG/ML
Lamictal TAB 100MG
Zarontin CAP 250MG
Lamictal TAB 150MG
Zarontin Sol 250/5ML
Lamictal TAB 200MG
Zonegran CAP 100MG
Lamictal TAB 25MG
Zonegran CAP 25MG
Lamictal XR Kit
Lamictal XR TAB 100MG
ANTIPARKINSON AGENTS
Lamictal XR TAB 200MG
TIER 01 GENERIC
Lamictal XR TAB 25MG
amantadine syp 50MG/5ML
Lamictal XR TAB 250MG
amantadine CAP 100MG
Lamictal XR TAB 300MG
amantadine TAB 100MG
Lamictal XR TAB 50MG
benztropine inj 1MG/ML
Lyrica CAP 100MGQL,PA
benztropine TAB 0.5MG
Lyrica CAP 150MGQL,PA
benztropine TAB 1MG
Lyrica CAP 200MGQL,PA
benztropine TAB 2MG
Lyrica CAP 225MGQL,PA
bromocriptin CAP 5MG
Lyrica CAP 25MGQL,PA
bromocriptin TAB 2.5MG
Lyrica CAP 300MGQL,PA
carbidopa TAB 25MG
Lyrica CAP 50MGQL,PA
entacapone TAB 200MG
Lyrica CAP 75MGQL,PA
pramipexole TAB 0.125MG
Lyrica Sol 20MG/MLQL,PA
pramipexole TAB 0.25MG
Neurontin CAP 100MG
pramipexole TAB 0.5MG
Neurontin CAP 300MG
pramipexole TAB 0.75MG
Neurontin CAP 400MG
pramipexole TAB 1.5MG
Neurontin Sol 250/5ML
pramipexole TAB 1MG
Neurontin TAB 600MG
rasagiline TAB 0.5MGPA
Neurontin TAB 800MG
rasagiline TAB 1MGPA
Oxtellar XR TAB 150MG
ropinirole TAB 0.25MG
Oxtellar XR TAB 300MG
ropinirole TAB 0.5MG
Oxtellar XR TAB 600MG
ropinirole TAB 1MG
Peganone TAB 250MG
ropinirole TAB 2MG
Phenytek CAP 200MG
ropinirole TAB 3MG
Phenytek CAP 300MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 44
ropinirole TAB 4MG
Requip TAB 3MG
ropinirole TAB 5MG
Requip TAB 4MG
selegiline CAP 5MG
Requip TAB 5MG
selegiline TAB 5MG
Requip XL TAB 12MG
trihexyphen elx 0.4MG/ML
Requip XL TAB 2MG
trihexyphen TAB 2MG
Requip XL TAB 4MG
trihexyphen TAB 5MG
Requip XL TAB 6MG
CARB/levo ER TAB 25-100MG
Requip XL TAB 8MG
CARB/levo ER TAB 50-200MG
Rytary CAP 145MGPA
CARB/levo TAB 10-100MG
Rytary CAP 195MGPA
CARB/levo TAB 25-100MG
Rytary CAP 245MGPA
CARB/levo TAB 25-250MG
Rytary CAP 95MGPA
CARB/Levo 50 TAB /Entacap
Sinemet CR TAB 25-100MG
CARB/Levo 75 TAB /Entacap
Sinemet CR TAB 50-200MG
CARB/Levo100 TAB /Entacap
Sinemet TAB 10-100MG
CARB/Levo125 TAB /Entacap
Sinemet TAB 25-100MG
CARB/Levo150 TAB /Entacap
Sinemet TAB 25-250MG
CARB/Levo200 TAB /Entacap
Stalevo 100 TAB
TIER 04 SPECIALTY
Stalevo 125 TAB
tolcapone TAB 100MGQL,PA
Stalevo 150 TAB
Apokyn Inj 10MG/MLQL,PA
Stalevo 200 TAB
Duopa Sus 4.63-20QL,PA
Stalevo 50 TAB
Gocovri CAP 137MGQL,PA
Stalevo 75 TAB
Gocovri CAP 68.5MGQL,PA
Xadago TAB 100MGPA
Tasmar TAB 100MGQL,PA
Xadago TAB 50MGPA
Zelapar TAB 1.25MGQL,PA
TIER 03 NON PREFERRED
NEUROLOGY, PSYCH - MISC.
pramipexole TAB 0.375 ER
TIER 01 GENERIC
pramipexole TAB 0.75 ER
acampro CAL TAB 333MG
pramipexole TAB 1.5MG ER
disulfiram TAB 250MG
pramipexole TAB 2.25 ER
disulfiram TAB 500MG
pramipexole TAB 3.75 ER
donepezil TAB 10MG
pramipexole TAB 3MG ER
donepezil TAB 5MG
pramipexole TAB 4.5MG ER
galantamine CAP 16MG ER
ropinirole TAB 12MG ER
galantamine CAP 24MG ER
ropinirole TAB 2MG ER
galantamine CAP 8MG ER
ropinirole TAB 4MG ER
galantamine TAB 12MG
ropinirole TAB 6MG ER
galantamine TAB 4MG
ropinirole TAB 8MG ER
galantamine TAB 8MG
Azilect TAB 0.5MGPA
memantine TAB HCL 10MG
Azilect TAB 1MGPA
memantine TAB HCL 5MG
Cogentin Inj 1MG/ML
pimozide TAB 1MG
Comtan TAB 200MG
pimozide TAB 2MG
Eldepryl CAP 5MG
rivastigmine CAP 1.5MG
Lodosyn TAB 25MG
rivastigmine CAP 3MG
Mirapex ER TAB 0.375MG
rivastigmine CAP 4.5MG
Mirapex ER TAB 0.75MG
rivastigmine CAP 6MG
Mirapex ER TAB 1.5MG
Fluoxetine CAP 10MG
Mirapex ER TAB 2.25MG
Fluoxetine CAP 20MG
Mirapex ER TAB 3.75MG
Galantamine Sol 4MG/ML
Mirapex ER TAB 3MG
Perphen/Amit TAB 2-10MG
Mirapex ER TAB 4.5MG
Perphen/Amit TAB 2-25MG
Mirapex TAB 0.125MG
Perphen/Amit TAB 4-10MG
Mirapex TAB 0.25MG
Perphen/Amit TAB 4-25MG
Mirapex TAB 0.5MG
Perphen/Amit TAB 4-50MG
Mirapex TAB 0.75MG
TIER P PREVENTIVE
Mirapex TAB 1.5MG
buproban TAB 150MG
Mirapex TAB 1MG
bupropion TAB 150MG
Neupro Dis 1MG/24HR
eq nicotine dis 14MG/24h
Neupro Dis 2MG/24HR
eq nicotine dis 21MG/24h
Neupro Dis 3MG/24HR
eq nicotine dis 7MG/24HR
Neupro Dis 4MG/24HR
eq nicotine gum 2mgfruit
Neupro Dis 6MG/24HR
eq nicotine gum 2MG cinn
Neupro Dis 8MG/24HR
eq nicotine gum 2MG mint
Parlodel CAP 5MG
eq nicotine gum 2MG orig
Parlodel TAB 2.5MG
eq nicotine gum 4mgfruit
Requip TAB 0.25MG
eq nicotine gum 4MG cinn
Requip TAB 0.5MG
eq nicotine gum 4MG mint
Requip TAB 1MG
eq nicotine gum 4MG orig
Requip TAB 2MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 45
eq nicotine gum 4MG ref
nicotine pol loz 4MG cinn
eq nicotine gum 4MG strt
nicotine pol loz 4MG mint
eq nicotine loz 2MG cher
nicotine TD dis 14MG/24h
eq nicotine loz 2MG cinn
nicotine TD dis 21MG/24h
eq nicotine loz 2MG mint
nicotine TD dis 7MG/24HR
eq nicotine loz 4MG chry
qc nicotine gum 4MG
eq nicotine loz 4MG mint
ra nicotine dis 14MG/24h
eql nicotine dis 14MG/24h
ra nicotine dis 21MG/24h
eql nicotine dis 21MG/24h
ra nicotine dis 7MG/24HR
eql nicotine dis 7MG/24HR
ra nicotine gum 2mgfruit
eql nicotine gum 2MG
ra nicotine gum 2MG
eql nicotine gum 2MG ref
ra nicotine gum 2MG cinn
eql nicotine gum 2MG strt
ra nicotine gum 2MG mint
eql nicotine gum 4MG
ra nicotine gum 4MG
eql nicotine gum 4MG ref
ra nicotine gum 4MG frut
eql nicotine gum 4MG strt
ra nicotine gum 4MG mint
eql nicotine loz 2MG
ra nicotine loz 2MG mint
eql nicotine loz 2MG mint
ra nicotine loz 4MG mint
eql nicotine loz 4MG chry
sm nicotine dis 14MG/24h
eql nicotine loz 4MG mint
sm nicotine dis 21MG
gnp nicotine dis 21MG/24h
sm nicotine dis 21MG/24h
gnp nicotine dis 7MG/24HR
sm nicotine dis 7MG/24HR
gnp nicotine gum 2MG mint
sm nicotine gum 2MG
gnp nicotine gum 2MG orig
sm nicotine gum 2MG mint
gnp nicotine gum 4MG mint
sm nicotine gum 4MG
gnp nicotine gum 4MG orig
sm nicotine gum 4MG mint
gnp nicotine loz mini 2MG
sm nicotine loz 2MG mint
gnp nicotine loz 2MG mint
sm nicotine loz 4MG mint
gnp nicotine loz 4MG mint
stop smoking gum 2MG mint
kls quit2 gum 2MG
stop smoking gum 2MG orig
kls quit2 loz 2MG
stop smoking gum 4MG
kls quit4 gum 4MG
stop smoking loz 2MG
kls quit4 loz 4MG
stop smoking loz 2MG mint
nicorelief gum 2MG mint
stop smoking loz 4MG mint
nicorelief gum 2MG orig
sw nicotine gum 2MG mint
nicorelief gum 4MG mint
sw nicotine gum 4MG
nicorelief gum 4MG orig
sw nicotine loz 2MG mint
nicotine dis step 1
sw nicotine loz 4MG mint
nicotine dis step 2
tgt nicotine dis 14MG/24h
nicotine dis step 3
tgt nicotine dis 21MG/24h
nicotine dis 14MG/24h
tgt nicotine dis 7MG/24HR
nicotine dis 21MG/24h
tgt nicotine gum 2mgfruit
nicotine dis 7MG/24HR
tgt nicotine gum 2MG mint
nicotine gum 2mgfruit
tgt nicotine gum 2MG orig
nicotine gum 2MG
tgt nicotine gum 4MG
nicotine gum 4MG
tgt nicotine gum 4MG mint
nicotine loz mini 2MG
tgt nicotine gum 4MG orig
nicotine loz 2MG chry
tgt nicotine loz 2MG chry
nicotine loz 2MG mint
tgt nicotine loz 2MG mint
nicotine loz 4MG chry
tgt nicotine loz 4MG chry
nicotine loz 4MG cinn
tgt nicotine loz 4MG mint
nicotine loz 4MG mint
thrive gum 2MG mint
nicotine pol gum 2mgfruit
Chantix PAK 0.5& 1MG
nicotine pol gum 2MG
Chantix PAK 1MG
nicotine pol gum 2MG cinn
Chantix TAB 0.5MG
nicotine pol gum 2MG mint
Chantix TAB 1MG
nicotine pol gum 2MG orig
Commit Loz 2MG
nicotine pol gum 2MG ref
Commit Loz 4MG
nicotine pol gum 2MG strt
Commit Loz 4MG Chry
nicotine pol gum 4mgfruit
CVS nicotine dis 14MG/24h
nicotine pol gum 4MG
CVS nicotine dis 7MG/24HR
nicotine pol gum 4MG cinn
CVS nicotine gum 2mgfruit
nicotine pol gum 4MG mint
CVS nicotine gum 2MG cinn
nicotine pol gum 4MG orig
CVS nicotine gum 2MG mint
nicotine pol gum 4MG ref
CVS nicotine gum 2MG orig
nicotine pol gum 4MG strt
CVS nicotine gum 4mgfruit
nicotine pol loz 2MG chry
CVS nicotine gum 4MG cinn
nicotine pol loz 2MG cinn
CVS nicotine gum 4MG mint
nicotine pol loz 2MG mint
CVS nicotine gum 4MG orig
nicotine pol loz 4MG chry
CVS nicotine loz 2MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 46
CVS nicotine loz 2MG mint
Tecfidera Mis StarterQL,PA
CVS nicotine loz 4MG mint
Xenazine TAB 12.5MGQL,PA
CVS nts dis step 1
Xenazine TAB 25MGQL,PA
HM nicotine dis 14MG/24h
Xyrem Sol 500MG/MLQL,PA
HM nicotine dis 21MG/24h
Zinbryta Inj 150MG/MLQL,PA
HM nicotine gum 2MG mint
TIER M MEDICAL COPAY
HM nicotine gum 4MG mint
Tysabri Inj 300/15MLPA
HM nicotine loz 2MG mint
TIER 03 NON PREFERRED
HM nicotine loz 4MG mint
donepezil TAB HCL 23MG
Nicoderm CQ Dis 14MG/24h
donepezil TAB 10MG odt
Nicoderm CQ Dis 21MG/24h
donepezil TAB 5MG odt
Nicoderm CQ Dis 7MG/24HR
fluoxetine TAB 10MG
Nicorette Gum 2mgfruit
fluoxetine TAB 20MG
Nicorette Gum 2MG
memant titra PAK 5-10MG
Nicorette Gum 2MG Cinn
memantine HC sol 2MG/ML
Nicorette Gum 2MG Mint
olanza/fluox CAP 12-25MG
Nicorette Gum 2MG Orig
olanza/fluox CAP 12-50MG
Nicorette Gum 4mgfruit
olanza/fluox CAP 3-25MG
Nicorette Gum 4MG
olanza/fluox CAP 6-25MG
Nicorette Gum 4MG Cinn
olanza/fluox CAP 6-50MG
Nicorette Gum 4MG Mint
paroxetine CAP 7.5MG
Nicorette Gum 4MG Orig
rivastigmine dis 13.3/24
Nicorette Loz 2MG Chry
rivastigmine dis 4.6MG/24
Nicorette Loz 2MG Mint
rivastigmine dis 9.5MG/24
Nicorette Loz 2MG Orig
Addyi TAB 100MGQL,PA
Nicorette Loz 4MG Chry
Antabuse TAB 250MG
Nicorette Loz 4MG Mint
Antabuse TAB 500MG
Nicorette Loz 4MG Orig
Aricept TAB 10MG
Nicorette ST Gum 2MG
Aricept TAB 23MG
Nicorette ST Gum 2MG Mint
Aricept TAB 5MG
Nicorette ST Gum 2MG Orig
Brisdelle CAP 7.5MG
Nicorette ST Gum 4MG Mint
Cdp/Amitrip TAB 10-25MG
Nicorette ST Gum 4MG Orig
Cdp/Amitrip TAB 5-12.5MG
Nicotine SYS Kit Transder
Ergoloid Mes TAB 1MG Oral
Nicotrol Inh
Exelon CAP 1.5MG
Nicotrol Ns Spr 10MG/ML
Exelon CAP 3MG
SR nicotine gum 2MG
Exelon CAP 4.5MG
TIER 04 SPECIALTY
Exelon CAP 6MG
glatiramer inj 20MG/MLQL
Exelon Dis 13.3/24
glatiramer inj 40MG/MLQL
Exelon Dis 4.6MG/24
glatopa inj 20MG/MLQL
Exelon Dis 9.5MG/24
tetrabenazin TAB 12.5MGQL,PA
Gralise Star Mis 300/600
tetrabenazin TAB 25MGQL,PA
Gralise TAB 300MG
Ampyra TAB 10MGQL,PA
Gralise TAB 600MG
Aubagio TAB 14MGQL,PA
Horizant TAB 300MG
Aubagio TAB 7MGQL,PA
Horizant TAB 600MG
Austedo TAB 12MGQL,PA
Namenda Sol 10MG/5ML
Austedo TAB 6MGQL,PA
Namenda TAB 10MG
Austedo TAB 9MGQL,PA
Namenda TAB 5-10MG
Avonex Kit 30mcgQL,PA
Namenda TAB 5MG
Avonex Pen Kit 30mcgQL,PA
Namenda XR CAP TitratioPA
Avonex Prefl Kit 30mcgQL,PA
Namenda XR CAP 14MGPA
Betaseron Inj 0.3MGQL,PA
Namenda XR CAP 21MGPA
Copaxone Inj 20MG/MLQL,PA
Namenda XR CAP 28MGPA
Copaxone Inj 40MG/MLQL,PA
Namenda XR CAP 7MGPA
Extavia Inj 0.3MGQL
Namzaric CAP
Gilenya CAP 0.5MGQL,PA
Namzaric CAP 14-10MG
Ingrezza CAP 40MGQL,PA
Namzaric CAP 21-10MG
Plegridy InjQL,PA
Namzaric CAP 28-10MG
Plegridy Inj PenQL,PA
Namzaric CAP 7-10MG
Plegridy Inj StarterQL,PA
Nuedexta CAP 20-10MG
Plegridy Pen Inj StarterQL,PA
Orap TAB 1MG
Rebif Inj 22/0.5QL
Orap TAB 2MG
Rebif Inj 44/0.5QL
Razadyne ER CAP 16MG
Rebif Rebido Inj TitratnQL
Razadyne ER CAP 24MG
Rebif Rebido Inj 22/0.5QL
Razadyne ER CAP 8MG
Rebif Rebido Inj 44/0.5QL
Razadyne TAB 12MG
Rebif Titrtn Inj PackQL
Razadyne TAB 4MG
Tecfidera CAP 120MGQL,PA
Razadyne TAB 8MG
Tecfidera CAP 240MGQL,PA
Sarafem TAB 10MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 47
Sarafem TAB 20MG
Zanaflex TAB 4MG
Savella Mis Titr PAKST
Savella TAB 100MGST
ANTIMYASTHENIC AGENTS
Savella TAB 12.5MGST
TIER 01 GENERIC
Savella TAB 25MGST
pyridostigm TAB 60MG
Savella TAB 50MGST
pyridostigmi TAB ER 180MG
Symbyax CAP 12-25MG
TIER 02 PREFERRED
Symbyax CAP 12-50MG
Mestinon Syp 60MG/5ML
Symbyax CAP 3-25MG
TIER 03 NON PREFERRED
Symbyax CAP 6-25MG
Enlon Inj 150/15ML
Symbyax CAP 6-50MG
Guanidine TAB 125MG
Zyban TAB 150MG SR
Mestinon TAB Timespan
Mestinon TAB 60MG
NEUROMUSCULAR AGENTS
TIER 01 GENERIC
OPHTHALMOLOGY AND OTIC
riluzole TAB 50MGQL
ANTI-INFECTIVES
TIER 04 SPECIALTY
TIER 01 GENERIC
Rilutek TAB 50MGQL,PA
ak-poly-bac oin op
bacit/polymy oin op
MUSCULOSKELETAL AGENTS
ciprofloxacn sol 0.3% op
TIER 01 GENERIC
erythromycin oin op
baclofen TAB 10MG
erythromycin oin 5MG/gm
baclofen TAB 20MG
gatifloxacin sol 0.5%
cyclobenzapr TAB 10MG
gentak oin 0.3% op
cyclobenzapr TAB 5MG
gentamicin oin 0.3% op
dantrolene CAP 100MG
gentamicin sol 0.3% op
dantrolene CAP 25MG
ilotycin oin op
dantrolene CAP 50MG
moxifloxacin sol 0.5%
methocarbam inj 100MG/ML
neo/poly/gra sol op
methocarbam inj 1000MG
ofloxacin dro 0.3% op
methocarbam TAB 500MG
polycin oin op
methocarbam TAB 750MG
polymyxin b/ sol trimethp
orphenadrine TAB 100MG ER
sod sulfacet sol 10% op
tizanidine TAB 2MG
sulfacet sod sol 10% op
tizanidine TAB 4MG
tobramycin sol 0.3% op
TIER 03 NON PREFERRED
trifluridine sol 1% op
carisopr/asa TAB 200-325PA
trimethoprim sol polymyxn
carisoprodol TAB asa/codPA
Bacitracin Oin Op
carisoprodol TAB 250MGPA
Gentak Oin 0.3% Op
carisoprodol TAB 350MGPA
Sulfacet Sod Oin 10% Op
chlorzoxazon TAB 500MG
TIER 02 PREFERRED
cyclobenzapr TAB 7.5MG
Ciloxan Oin 0.3% Op
metaxall TAB 800MG
Moxeza Sol 0.5%
metaxalone TAB 800MG
Natacyn Sus 5% Op
orphenadrine inj 30MG/ML
Tobrex Oin 0.3% Op
tizanidine CAP 2MG
TIER 03 NON PREFERRED
tizanidine CAP 4MG
levofloxacin sol 0.5%
tizanidine CAP 6MG
neo-polycin oin op
Amrix CAP 15MG
neo/bac/poly oin op
Amrix CAP 30MG
Azasite Sol 1%
Chlorzoxazon TAB 250MG
Besivance Sus 0.6%
Dantrium CAP 25MG
Betadine Sol 5% Op
Dantrium CAP 50MG
Bleph-10 Sol 10% Op
Fexmid TAB 7.5MG
Cefuroxime Inj 10MG/ML
First-baclof Sus 1
Ciloxan Sol 0.3% Op
First-baclof Sus 5 Kit
Neosporin Sol Op
Lorzone TAB 375MG
Ocuflox Dro 0.3% Op
Lorzone TAB 750MG
Polytrim Sol Op
Metaxalone TAB 400MG
Tobrex Sol 0.3% Op
Parafon Fort TAB 500MG
Vigamox Dro 0.5%
Robaxin Inj 100MG/ML
Viroptic Sol 1% Op
Robaxin TAB 500MG
Zirgan Gel 0.15%
Robaxin-750 TAB 750MG
Zymaxid Sol 0.5%
Skelaxin TAB 800MG
Soma TAB 250MGPA
ARTIFICIAL TEAR/LUBRICANT
Soma TAB 350MGPA
TIER 02 PREFERRED
Zanaflex CAP 2MG
Lacrisert Mis 5MG Op
Zanaflex CAP 4MG
Zanaflex CAP 6MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 48
BETA-BLOCKERS
Zylet Sus 0.5-0.3%
TIER 01 GENERIC
PROSTAGLANDINS
betaxolol sol 0.5% op
carteolol sol 1% op
TIER 01 GENERIC
dorzol/timol sol 22.3-6.8
latanoprost sol 0.005%
levobunolol sol 0.5% op
Bimatoprost Sol 0.03%
timolol gel sol 0.25% op
Travoprost Dro 0.004%
timolol gel sol 0.5% op
TIER 02 PREFERRED
timolol mal sol 0.25% op
Lumigan Sol 0.01%
timolol mal sol 0.5% op
Travatan Z Dro 0.004%
Metipranolol Sol 0.3% Oph
TIER 03 NON PREFERRED
TIER 02 PREFERRED
Rescula Sol 0.15%
Betoptic-s Sus 0.25% Op
Xalatan Sol 0.005%
TIER 03 NON PREFERRED
Zioptan Dro 0.0015%
Betagan Sol 0.5% Op
Betimol Sol 0.25%
CYCLOPLEGIC MYDRIATICS
Betimol Sol 0.5%
TIER 01 GENERIC
Combigan Sol 0.2/0.5%
cyclopentol sol 1% op
Cosopt PF Sol
cyclopentol sol 2% op
Cosopt Sol 22.3-6.8
cyclopentola sol 0.5%
Istalol Sol 0.5% Op
homatropaire sol 5% op
Timoptic Ocu Sol 0.25% Op
homatropine sol 5% op
Timoptic Ocu Sol 0.5% Op
Atropine SUL Oin 1% Op
Timoptic Sol 0.25% Op
Atropine SUL Sol 1% Op
Timoptic Sol 0.5% Op
TIER 03 NON PREFERRED
Timoptic-xe Sol 0.25% Op
Cyclogyl Sol 0.5% Op
Timoptic-xe Sol 0.5% Op
Cyclogyl Sol 1% Op
Cyclogyl Sol 2% Op
OPHTHALMIC STEROIDS
Cyclomydril Sol Op
TIER 01 GENERIC
fluoromethol sus 0.1% op
DECONGESTANTS
neo-polycin oin HC 1%op
TIER 01 GENERIC
neo/poly/bac oin /HC 1%op
altafrin sol 10% op
neo/poly/dex oin 0.1% op
altafrin sol 2.5% op
neo/poly/dex sus 0.1% op
phenylephrin sol 10% op
prednisolone sus 1% op
phenylephrin sol 2.5% op
sulf/pred NA sol op
TIER 03 NON PREFERRED
tobra/dexame sus 0.3-0.1%
Naphazoline Sol 0.1% Op
Dexameth PHO Sol 0.1% Op
TIER 02 PREFERRED
MIOTICS
Blephamide Oin S.o.p.
TIER 01 GENERIC
Blephamide Sus Op
pilocarpine sol 1% op
Durezol Emu 0.05%
pilocarpine sol 2% op
FML Forte Sus 0.25% Op
pilocarpine sol 4% op
FML Oin 0.1% Op
TIER 03 NON PREFERRED
Pred Mild Sus 0.12% Op
Isopto Carp Sol 1% Op
Pred-G S.o.p Oin Op
Isopto Carp Sol 2% Op
Pred-G Sus Op
Isopto Carp Sol 4% Op
Tobradex Oin 0.3-0.1%
Phospholine Sol 0.125%op
Vexol Sus 1% Op
TIER 03 NON PREFERRED
ADRENERGIC AGENTS
Alrex Sus 0.2%
TIER 01 GENERIC
Flarex Sus 0.1% Op
brimonidine sol 0.2% op
FML Liquiflm Sus 0.1% Op
TIER 03 NON PREFERRED
Lotemax Gel 0.5%
apraclonidin sol 0.5% op
Lotemax Oin 0.5%
brimonidine sol 0.15%
Lotemax Sus 0.5%
Alphagan P Sol 0.1%
Maxidex Sus 0.1% Op
Alphagan P Sol 0.15%
Maxitrol Oin 0.1% Op
Iopidine Sol 0.5% Op
Maxitrol Sus 0.1% Op
Iopidine Sol 1% Op
Neo/Poly/HC Sus Op
Simbrinza Sus 1-0.2%
Omnipred Sus 1% Op
Pred Forte Sus 1% Op
IMMUNOMODULATORS
Pred Sod PHO Sol 1% Op
TIER 02 PREFERRED
Predni/Moxi/ Sol Bromfena
Restasis Emu 0.05%PA
Predni/Moxi/ Sol Ketorola
Restasis Mul Emu 0.05%PA
Prednisolone Sol Moxiflox
Tobradex Sus 0.3-0.1%
LOCAL ANESTHETICS
Tobradex ST Sus 0.3-0.05
TIER 03
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 49
NON PREFERRED
Floxin Sol 0.3%
altacaine sol 0.5% op
HC/acet acid sol otic
proparacaine sol 0.5% op
Otovel Dro
tetcaine sol 0.5% op
Pramotic Dro 1-0.1%
tetracaine sol 0.5% op
tetravisc sol forte
OXYTOCICS
tetravisc sol 0.5% op
Akten Gel 3.5%
TIER 01 GENERIC
Alcaine Sol 0.5% Op
methylergon inj 0.2MG/ML
methylergon TAB 0.2MG
OPHTHALMICS - MISC.
Methergine TAB 0.2MG
TIER 01 GENERIC
TIER 02 PREFERRED
azelastine dro 0.05%
Cervidil Vag Mis 10MG INS
cromolyn sod sol 4% op
Prepidil Gel 0.5MG/3G
diclofenac sol 0.1% op
Prostin E2 Sup 20MG
dorzolamide sol 2% op
flurbiprofen sol 0.03% op
PAIN MANAGEMENT
ketorolac sol 0.4%
ANALGESICS - NONNARCOTIC
ketorolac sol 0.5%
TIER 01 GENERIC
olopatadine dro 0.1%
but/apap/caf TAB
Flurbiprofen Sol 0.03% Op
but/asa/caff CAP
TIER 02 PREFERRED
cho MAG tris liq 500/5ML
Alomide Sol 0.1% Op
diflunisal TAB 500MG
Azopt Sus 1% Op
salsalate TAB 500MG
Xiidra Dro 5%PA
salsalate TAB 750MG
TIER 04 SPECIALTY
TIER P PREVENTIVE
Cystaran Sol 0.44%QL,PA
asa low dose TAB 81MG EC
TIER 03 NON PREFERRED
aspir-low TAB 81MG EC
bromfenac sol 0.09% op
aspir-81 TAB 81MG EC
epinastine dro 0.05%
aspirin adlt TAB 81MG
olopatadine sol 0.2%
aspirin chil chw 81MGQL
Acular LS Sol 0.4%
aspirin chld chw 81MGQL
Acular Sol 0.5% Op
aspirin chw 81MGQL
Acuvail Sol 0.45%
aspirin low chw 81MGQL
Alocril Sol 2%
aspirin low TAB 81MG
Bepreve Dro 1.5%
aspirin low TAB 81MG EC
Bromfenac Sol 0.09% Op
aspirin TAB 325MGQL
Bromsite Dro 0.075%
aspirin TAB 325MG ECQL
Elestat Dro 0.05%
aspirin TAB 5gr ECQL
Emadine Sol 0.05% Op
aspirin TAB 81MG
Ilevro Dro 0.3% Op
aspirin TAB 81MG EC
Lastacaft Sol 0.25%
aspirin 81 TAB 81MG EC
Nevanac Sus 0.1%
aspirin-81 chw 81MGQL
Ocufen Sol 0.03% Op
aspirtab TAB 324MG ECQL
Pataday Sol 0.2%
bayer adv TAB 325MGQL
Patanol Sol 0.1% Op
bayer asa TAB 325MGQL
Pazeo Dro 0.7%
bayer low chw 81MGQL
Prolensa Sol 0.07%
bayer low TAB 81MG EC
Trusopt Sol 2% Op
child asa chw 81MGQL
child asa LS chw 81MGQL
OTIC AGENTS
ecotrin low TAB 81MG EC
TIER 01 GENERIC
ecotrin TAB 325MGQL
acetic acid sol 2% otic
ecpirin TAB 325MG ECQL
neo/poly/HC sol 1% otic
enteric asa TAB 325MGQL
neo/poly/HC sus 1% otic
eq aspirin TAB 325MGQL
ofloxacin dro 0.3%otic
eq aspirin TAB 325MG ECQL
TIER 02 PREFERRED
eq child asa chw 81MGQL
Cipro HC Sus Otic
eql aspirin chw 81MGQL
Ciprodex Sus 0.3-0.1%
eql aspirin TAB 325MGQL
TIER 03 NON PREFERRED
eql aspirin TAB 325MG ECQL
acetasol HC sol otic
eql aspirin TAB 81MG EC
fluocin acet oil ear0.01%
eql chld asa chw 81MGQL
fluocin acet oil 0.01%
gnp aspirin chw 81MGQL
Ace Acd/Alum Sol 2% Otic
gnp aspirin TAB 325MGQL
Cetraxal Sol 0.2%
gnp aspirin TAB 325MG ECQL
Ciprofloxacn Sol 0.2%
gnp aspirin TAB 81MG EC
Coly-mycin S Sus Otic
kls aspirin TAB 325MG ECQL
Cortisporin Sus -tc Otic
kls aspirin TAB 81MG EC
Dermotic Oil 0.01%
kp aspirin TAB 81MG EC
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 50
miniprin low TAB 81MG EC
buprenorphin sub 2MG
norwich asa TAB 325MGQL
buprenorphin sub 8MG
px aspirin chw 81MGQL
butorphanol inj 2MG/ML
px aspirin TAB 325MGQL
codeine sulf TAB 15MGQL
px aspirin TAB 325MG ECQL
codeine sulf TAB 30MGQL
px aspirin TAB 81MG EC
codeine sulf TAB 60MGQL
qc aspirin TAB 325MGQL
endocet TAB 10-325MG
qc aspirin TAB 325MG ECQL
endocet TAB 2.5-325
qc child asa chw 81MGQL
endocet TAB 5-325MG
ra aspirin chw 81MGQL
endocet TAB 7.5-325
ra aspirin TAB 325MGQL
fentanyl dis 100mcg/hQL,PA
ra aspirin TAB 325MG ECQL
fentanyl dis 12mcg/HRQL,PA
ra aspirin TAB 81MG EC
fentanyl dis 25mcg/HRQL,PA
ra child asa chw 81MGQL
fentanyl dis 50mcg/HRQL,PA
sm aspirin chw 81MGQL
fentanyl dis 75mcg/HRQL,PA
sm aspirin TAB 325MGQL
hydroco/apap sol 7.5-325QL
sm aspirin TAB 325MG ECQL
hydroco/apap TAB 10-325MGQL
sm aspirin TAB 81MG EC
hydroco/apap TAB 5-325MGQL
sm child asa chw 81MGQL
hydroco/apap TAB 7.5-325QL
st joseph chw low 81MGQL
hydromorphon inj 1MG/ML
tgt aspirin chw childQL
hydromorphon inj 2MG/ML
tgt aspirin chw 81MGQL
hydromorphon inj 4MG/ML
tgt aspirin TAB 325MGQL
hydromorphon liq 1MG/ML
tgt aspirin TAB 81MG
hydromorphon TAB 2MGQL
tgt aspirin TAB 81MG EC
hydromorphon TAB 4MGQL
Aspirin TAB 81MGQL
hydromorphon TAB 8MGQL
CVS aspirin TAB 325MGQL
lorcet plus TAB 7.5-325QL
CVS aspirin TAB 325MG ECQL
lorcet HD TAB 10-325MGQL
CVS aspirin TAB 81MG EC
lorcet TAB 5-325MGQL
CVS chld asa chw 81MGQL
lortab TAB 10-325MGQL
Ecotrin TAB 325MG ECQL
lortab TAB 5-325MGQL
HM aspirin chw 81MGQL
lortab TAB 7.5-325QL
HM aspirin TAB 325MGQL
meperidine inj 100MG/ML
MM aspirin TAB 325MGQL
methadone sol 10MG/5MLQL,ST
SB aspirin TAB 325MGQL
methadone sol 5MG/5MLQL,ST
SB aspirin TAB 325MG ECQL
methadone CON 10MG/MLQL,ST
SB child asa chw 81MGQL
methadone TAB 10MGQL,ST
TIER 03 NON PREFERRED
methadone TAB 40MGQL,ST
bupap TAB 50-300MG
methadone TAB 5MGQL,ST
but/apap/caf CAP
methadose TAB 40MGQL,ST
butal/apap TAB 50-325MG
morphine SUL sol 10MG/5ML
butalb/aceta TAB 50-300MG
morphine SUL sol 100/5ML
capacet CAP
morphine SUL sol 20MG/5ML
esgic CAP
morphine SUL TAB 100MG ER
margesic CAP
morphine SUL TAB 15MG ER
marten-TAB tab 50-325MG
morphine SUL TAB 200MG ERQL,ST
phrenilin CAP forte
morphine SUL TAB 30MG ER
zebutal CAP
morphine SUL TAB 60MG ER
Allzital TAB 25-325MG
oxycod/apap TAB 10-325MG
Disalcid TAB 500MG
oxycod/apap TAB 2.5-325
Disalcid TAB 750MG
oxycod/apap TAB 5-325MG
Duraxin CAP
oxycod/apap TAB 7.5-325
Esgic TAB
oxycod/asa TABQL
Fioricet CAP
oxycodone sol 5MG/5ML
Fiorinal CAP
oxycodone CON 100/5ML
Levacet TAB
oxycodone CON 20MG/ML
Tencon TAB 50-325MG
oxycodone TAB 10MG
Vanatol LQ Sol
oxycodone TAB 15MGQL
Vanatol S Sol
oxycodone TAB 20MGQL
oxycodone TAB 30MGQL
ANALGESICS - OPIOID
oxycodone TAB 5MGQL
tramadl/apap TAB 37.5-325QL
TIER 01 GENERIC
tramadol HCL TAB 50MGQL
apap/codeine sol 120-12/5QL
Butorphanol Inj 1MG/ML
apap/codeine TAB 300-15MGQL
Codeine Sulf TAB 15MGQL
apap/codeine TAB 300-30MGQL
Codeine Sulf TAB 30MGQL
apap/codeine TAB 300-60MGQL
Codeine Sulf TAB 60MGQL
bupren/nalox sub 2-0.5MG
Hydromorphon Sup 3MG
bupren/nalox sub 8-2MG
Levorphanol TAB 2MGQL
buprenorphin inj 0.3MG/ML
Methadone Sol 10MG/5MLQL,ST
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 51
Methadone Sol 5MG/5MLQL,ST
hydrocod/ibu TAB 10-200MGQL
Morphine SUL Inj 10/0.7ML
hydrocod/ibu TAB 2.5-200QL
Morphine SUL Sup 10MG
hydrocod/ibu TAB 5-200MGQL
Morphine SUL Sup 20MG
hydrocod/ibu TAB 7.5-200QL
Morphine SUL Sup 30MG
hydrocodone sol 10-325MGQL
Morphine SUL Sup 5MG
hydromorphon TAB 12MG ERQL,ST
Morphine SUL TAB 15MGQL
hydromorphon TAB 16MG ERQL,ST
Morphine SUL TAB 30MGQL
hydromorphon TAB 32MG ERQL,ST
Oxycodone TAB 10MG ERQL,ST
hydromorphon TAB 8MG ERQL,ST
Oxycodone TAB 20MG ERQL,ST
ibudone TAB 5-200MGQL
Oxycodone TAB 40MG ERQL,ST
meperidine TAB 100MGQL
Oxycodone TAB 60MG ERQL,ST
meperidine TAB 50MGQL
Oxycodone TAB 80MG ERQL,ST
morphine SUL CAP 10MG ERQL,PA
TIER 02 PREFERRED
morphine SUL CAP 100MG ERQL,PA
Oxycontin TAB 10MG CRQL,ST
morphine SUL CAP 20MG ERQL,PA
Oxycontin TAB 15MG CRQL,ST
morphine SUL CAP 30MG ERQL,PA
Oxycontin TAB 20MG CRQL,ST
morphine SUL CAP 50MG ERQL,PA
Oxycontin TAB 30MG CRQL,ST
morphine SUL CAP 60MG ERQL,PA
Oxycontin TAB 40MG CRQL,ST
morphine SUL CAP 80MG ERQL,PA
Oxycontin TAB 60MG CRQL,ST
oxycodone CAP 5MGQL
Oxycontin TAB 80MG CRQL,ST
oxymorphone TAB HCL 10MGQL
TIER 04 SPECIALTY
oxymorphone TAB HCL 5MGQL
fentanyl ot loz 1200mcgQL,PA
oxymorphone TAB 10MG ERQL,ST
fentanyl ot loz 1600mcgQL,PA
oxymorphone TAB 15MG ERQL,ST
fentanyl ot loz 200mcgQL,PA
oxymorphone TAB 20MG ERQL,ST
fentanyl ot loz 400mcgQL,PA
oxymorphone TAB 30MG ERQL,ST
fentanyl ot loz 600mcgQL,PA
oxymorphone TAB 40MG ERQL,ST
fentanyl ot loz 800mcgQL,PA
oxymorphone TAB 5MG ERQL,ST
Abstral Sub 100mcgQL,PA
oxymorphone TAB 7.5MG ERQL,ST
Abstral Sub 200mcgQL,PA
pentaz/nalox TAB 50-0.5MG
Abstral Sub 300mcgQL,PA
reprexain TAB 10-200MGQL
Abstral Sub 400mcgQL,PA
tramadol HCL TAB 100MG ERQL,ST
Abstral Sub 600mcgQL,PA
tramadol HCL TAB 200MG ERQL,ST
Abstral Sub 800mcgQL,PA
tramadol HCL TAB 300MG ERQL,ST
Actiq Loz 1200mcgQL,PA
verdrocet TAB 2.5-325QL
Actiq Loz 1600mcgQL,PA
vicodin ES TAB 7.5-300QL
Actiq Loz 200mcgQL,PA
vicodin HP TAB 10-300MGQL
Actiq Loz 400mcgQL,PA
vicodin TAB 5-300MGQL
Actiq Loz 600mcgQL,PA
xylon TAB 10-200MGQL
Actiq Loz 800mcgQL,PA
Alfentanil Inj 500/ML
Fentora TAB 100mcgQL,PA
Apap-caffein CAP DihydrocQL
Fentora TAB 200mcgQL,PA
Apap/Caffein TAB DihydrocQL
Fentora TAB 400mcgQL,PA
Arymo ER TAB 15MGPA
Fentora TAB 600mcgQL,PA
Arymo ER TAB 30MGPA
Fentora TAB 800mcgQL,PA
Arymo ER TAB 60MGPA
Lazanda Spr 100mcgQL,PA
Belbuca Mis 150mcgQL,PA
Lazanda Spr 300mcgQL,PA
Belbuca Mis 300mcgQL,PA
Lazanda Spr 400mcgQL,PA
Belbuca Mis 450mcgQL,PA
Subsys Spr 100mcgQL,PA
Belbuca Mis 600mcgQL,PA
Subsys Spr 1200mcgQL,PA
Belbuca Mis 75mcgQL,PA
Subsys Spr 1600mcgQL,PA
Belbuca Mis 750mcgQL,PA
Subsys Spr 200mcgQL,PA
Belbuca Mis 900mcgQL,PA
Subsys Spr 400mcgQL,PA
Bunavail Mis 2.1-0.3
Subsys Spr 600mcgQL,PA
Bunavail Mis 4.2-0.7
Subsys Spr 800mcgQL,PA
Bunavail Mis 6.3-1MG
Xtampza ER CAP 13.5MGQL,PA
Buprenex Inj 0.3MG/ML
Xtampza ER CAP 18MGQL,PA
Buprenorphin Dis 10mcg/HRQL,PA
Xtampza ER CAP 27MGQL,PA
Buprenorphin Dis 15mcg/HRQL,PA
Xtampza ER CAP 36MGQL,PA
Buprenorphin Dis 20mcg/HRQL,PA
Xtampza ER CAP 9MGQL,PA
Buprenorphin Dis 5mcg/HRQL,PA
TIER 03 NON PREFERRED
Buprenorphin Dis 7.5/HRQL,PA
alfentanil inj 500/ML
Butrans Dis 10mcg/HRQL,PA
ascomp/cod CAP 30MGQL
Butrans Dis 15mcg/HRQL,PA
but/apap/caf CAP codeineQL
Butrans Dis 20mcg/HRQL,PA
but/asa/caf/ CAP cod 30MGQL
Butrans Dis 5mcg/HRQL,PA
butorphanol sol 10MG/ML
Butrans Dis 7.5/HRQL,PA
hydroco/apap TAB 10-300MGQL
Capital/Cod Sus 120-12/5QL
hydroco/apap TAB 2.5-325QL
Conzip CAP 100MGQL,ST
hydroco/apap TAB 5-300MGQL
Conzip CAP 200MGQL,ST
hydroco/apap TAB 7.5-300QL
Conzip CAP 300MGQL,ST
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 52
Demerol Inj 100MG/ML
MS Contin TAB 60MG ER
Demerol TAB 100MGQL
Norco TAB 10-325MGQL
Demerol TAB 50MGQL
Norco TAB 5-325MGQL
Dihydrocod/ CAP Asa/CaffQL
Norco TAB 7.5-325QL
Dilaudid Inj 1MG/ML
Nucynta ER TAB 100MGQL,ST
Dilaudid Inj 2MG/ML
Nucynta ER TAB 150MGQL,ST
Dilaudid Inj 4MG/ML
Nucynta ER TAB 200MGQL,ST
Dilaudid Liq 1MG/ML
Nucynta ER TAB 250MGQL,ST
Dilaudid TAB 2MGQL
Nucynta ER TAB 50MGQL,ST
Dilaudid TAB 4MGQL
Nucynta TAB 100MG
Dilaudid TAB 8MGQL
Nucynta TAB 50MG
Dolophine TAB 10MGQL,ST
Nucynta TAB 75MG
Dolophine TAB 5MGQL,ST
Opana ER TAB 10MGQL,ST
Duragesic Dis 100mcg/HQL,PA
Opana ER TAB 15MGQL,ST
Duragesic Dis 12mcg/HRQL,PA
Opana ER TAB 20MGQL,ST
Duragesic Dis 25mcg/HRQL,PA
Opana ER TAB 30MGQL,ST
Duragesic Dis 50mcg/HRQL,PA
Opana ER TAB 40MGQL,ST
Duragesic Dis 75mcg/HRQL,PA
Opana ER TAB 5MGQL,ST
Embeda CAP 100-4MGPA
Opana ER TAB 7.5MGQL,ST
Embeda CAP 20-0.8MGPA
Opana TAB 10MGQL
Embeda CAP 30-1.2MGPA
Opana TAB 5MGQL
Embeda CAP 50-2MGPA
Oxaydo TAB 5MG
Embeda CAP 60-2.4MGPA
Oxaydo TAB 7.5MG
Embeda CAP 80-3.2MGPA
Oxycod/Ibu TAB 5-400MGQL
Exalgo TAB 12MGQL,ST
Oxycodone TAB 15MG ERQL,ST
Exalgo TAB 16MGQL,ST
Oxycodone TAB 30MG ERQL,ST
Exalgo TAB 32MGQL,ST
Oxycodone/ Sol ApapQL
Exalgo TAB 8MGQL,ST
Oxymorphone TAB 10MG ERQL,ST
Fentanyl Dis 37.5mcgQL,PA
Oxymorphone TAB 15MG ERQL,ST
Fentanyl Dis 62.5mcgQL,PA
Oxymorphone TAB 20MG ERQL,ST
Fentanyl Dis 87.5mcgQL,PA
Oxymorphone TAB 30MG ERQL,ST
Fioricet CAP CodeineQL
Oxymorphone TAB 40MG ERQL,ST
Fiorinal/Cod CAP 30MGQL
Oxymorphone TAB 5MG ERQL,ST
Hycet Sol 7.5-325QL
Oxymorphone TAB 7.5MG ERQL,ST
Hysingla ER TAB 100 MGQL,PA
Percocet TAB 10-325MG
Hysingla ER TAB 120 MGQL,PA
Percocet TAB 2.5-325
Hysingla ER TAB 20 MGQL,PA
Percocet TAB 5-325MG
Hysingla ER TAB 30 MGQL,PA
Percocet TAB 7.5-325
Hysingla ER TAB 40 MGQL,PA
Primlev TAB 10-300MGQL
Hysingla ER TAB 60 MGQL,PA
Primlev TAB 5-300MGQL
Hysingla ER TAB 80 MGQL,PA
Primlev TAB 7.5-300QL
Ibudone TAB 10-200MGQL
Reprexain TAB 5-200MGQL
Ionsys Pad 40mcg/Ac
Roxicodone TAB 15MGQL
Kadian CAP 10MG ERQL,PA
Roxicodone TAB 30MGQL
Kadian CAP 100MG ERQL,PA
Roxicodone TAB 5MGQL
Kadian CAP 20MG ERQL,PA
Suboxone Mis 12-3MG
Kadian CAP 200MG ERQL,PA
Suboxone Mis 2-0.5MG
Kadian CAP 30MG ERQL,PA
Suboxone Mis 4-1MG
Kadian CAP 40MG ERQL,PA
Suboxone Mis 8-2MG
Kadian CAP 50MG ERQL,PA
Synalgos-dc CAPQL
Kadian CAP 60MG ERQL,PA
Tramadol HCL CAP ER 100MGQL,ST
Kadian CAP 80MG ERQL,PA
Tramadol HCL CAP ER 200MGQL,ST
Lortab Elx 10-300MGQL
Tramadol HCL CAP ER 300MGQL,ST
Methadone Inj 10MG/MLST
Tramadol HCL CAP 150MG ERQL,ST
Methadose CON 10MG/MLQL,ST
Tylenol/Cod TAB #3QL
Methadose SF CON 10MG/MLQL,ST
Tylenol/Cod TAB #4QL
Morphabond TAB 100MG ERPA
Ultracet TAB 37.5-325QL
Morphabond TAB 15MG ERPA
Ultram ER TAB 100MGQL,ST
Morphabond TAB 30MG ERPA
Ultram ER TAB 200MGQL,ST
Morphabond TAB 60MG ERPA
Ultram ER TAB 300MGQL,ST
Morphine SUL CAP 120MG ERQL,ST
Ultram TAB 50MGQL
Morphine SUL CAP 30MG ERQL,ST
Vicoprofen TAB 7.5-200QL
Morphine SUL CAP 45MG ERQL,ST
Xartemis XR TAB 7.5-325QL,ST
Morphine SUL CAP 60MG ERQL,ST
Xodol TAB 10-300MGQL
Morphine SUL CAP 75MG ERQL,ST
Xodol TAB 5-300MGQL
Morphine SUL CAP 90MG ERQL,ST
Xodol TAB 7.5-300QL
MS Contin TAB 100MG ER
Zohydro ER CAP 10MGQL,PA
MS Contin TAB 15MG ER
Zohydro ER CAP 15MGQL,PA
MS Contin TAB 200MG ERQL,ST
Zohydro ER CAP 20MGQL,PA
MS Contin TAB 30MG ER
Zohydro ER CAP 30MGQL,PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 53
Zohydro ER CAP 40MGQL,PA
Rasuvo Inj 12.5MGPA
Zohydro ER CAP 50MGQL,PA
Rasuvo Inj 15MGPA
Zubsolv Sub 0.7-0.18
Rasuvo Inj 17.5MGPA
Zubsolv Sub 1.4-0.36
Rasuvo Inj 20MGPA
Zubsolv Sub 11.4-2.9
Rasuvo Inj 22.5MGPA
Zubsolv Sub 2.9-0.71
Rasuvo Inj 25MGPA
Zubsolv Sub 5.7-1.4
Rasuvo Inj 27.5MGPA
Zubsolv Sub 8.6-2.1
Rasuvo Inj 30MGPA
Rasuvo Inj 7.5MGPA
OPIOID ANTAGONIST
TIER 04 SPECIALTY
Actemra Inj 162/0.9QL,PA
TIER 01 GENERIC
Arcalyst Inj 220MGQL,PA
naloxone inj 0.4MG/ML
Duexis TAB 800-26.6QL,PA
naltrexone TAB 50MG
Enbrel Inj 25/0.5MLQL,PA
Naloxone Inj 0.4MG/ML
Enbrel Inj 25MGQL,PA
Naloxone Inj 1MG/ML
Enbrel Inj 50MG/MLQL,PA
TIER 02 PREFERRED
Enbrel Srclk Inj 50MG/MLQL,PA
Narcan Spr
Humira Inj 10MG/0.2QL,PA
TIER 04 SPECIALTY
Humira Kit 20MG/0.4QL,PA
Evzio InjQL,PA
Humira Kit 40MG/0.8QL,PA
Evzio Inj 2/0.4MLQL,PA
Humira Pedia Inj CrohnsQL,PA
Vivitrol Inj 380MGQL,PA
Humira Pen Inj CrohnsQL,PA
TIER 03 NON PREFERRED
Humira Pen Inj PsoriasiQL,PA
Revia TAB 50MG
Humira Pen Inj 40MG/0.8QL,PA
Kevzara Inj 150/1.14QL,PA
ANTI-INFLAMMATORY
Kevzara Inj 200/1.14QL,PA
TIER 01 GENERIC
Kineret InjQL,PA
diclofen pot TAB 50MG
Orencia Clck Inj 125MG/MLQL,PA
diclofenac TAB 100MG ER
Orencia Inj 125MG/MLQL,PA
diclofenac TAB 25MG DR
Orencia Inj 50/0.4QL,PA
diclofenac TAB 50MG DR
Orencia Inj 87.5/0.7QL,PA
diclofenac TAB 75MG DR
Otezla TAB 10/20/30QL,PA
etodolac CAP 200MG
Otezla TAB 30MGQL,PA
etodolac CAP 300MG
Ridaura CAP 3MGQL,PA
etodolac TAB 400MG
Simponi Inj 100MG/MLQL,PA
etodolac TAB 500MG
Simponi Inj 50/0.5MLQL,PA
flurbiprofen TAB 100MG
Vimovo TAB 375-20MGQL,PA
flurbiprofen TAB 50MG
Vimovo TAB 500-20MGQL,PA
ibuprofen TAB 400MG
Xeljanz TAB 5MGQL,PA
ibuprofen TAB 600MG
Xeljanz XR TAB 11MGQL,PA
ibuprofen TAB 800MG
TIER M MEDICAL COPAY
indomethacin CAP 25MG
Orencia Inj 250MGPA
indomethacin CAP 50MG
TIER 03 NON PREFERRED
ketorolac inj 15MG/ML
celecoxib CAP 100MGST
ketorolac inj 30MG/ML
celecoxib CAP 200MGST
ketorolac inj 60MG/2ML
celecoxib CAP 400MGST
leflunomide TAB 10MG
celecoxib CAP 50MGST
leflunomide TAB 20MG
diclo/misopr TAB 50-0.2MG
meloxicam TAB 15MG
diclo/misopr TAB 75-0.2MG
meloxicam TAB 7.5MG
etodolac ER TAB 400MG
nabumetone TAB 500MG
etodolac ER TAB 500MG
nabumetone TAB 750MG
etodolac ER TAB 600MG
naproxen sod TAB 275MG
fenoprofen TAB 600MG
naproxen sod TAB 550MG
ibuprofen sus 100/5ML
naproxen sus 125/5ML
indomethacin CAP 75MG ER
naproxen TAB 250MG
ketoprofen CAP 50MG
naproxen TAB 375MG
ketoprofen CAP 75MG
naproxen TAB 500MG
ketorolac TAB 10MG
piroxicam CAP 10MG
mefenam acid CAP 250MG
piroxicam CAP 20MG
naproxen sod TAB 375MG
sulindac TAB 150MG
naproxen sod TAB 375MG CR
sulindac TAB 200MG
naproxen sod TAB 500MG CR
tolmetin sod CAP 400MG
naproxen DR TAB 375MG
Meclofen Sod CAP 100MG
naproxen DR TAB 500MG
Meclofen Sod CAP 50MG
oxaprozin TAB 600MG
Naproxen Sus 125/5ML
profeno TAB 600MG
Tolmetin Sod CAP 400MG
Anaprox DS TAB 550MG
Tolmetin Sod TAB 200MG
Arava TAB 10MG
TIER 02 PREFERRED
Arava TAB 20MG
Rasuvo Inj 10MGPA
Arthrotec 50 TAB
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 54
Arthrotec 75 TAB
PREFERRED
Celebrex CAP 100MGST
Ergomar Sub 2MG
Celebrex CAP 200MGST
Migergot Sup 2/100
Celebrex CAP 400MGST
TIER 04 SPECIALTY
Celebrex CAP 50MGST
dihydroergot inj 1MG/MLQL
Daypro TAB 600MG
D.h.e. 45 Inj 1MG/MLQL,PA
EC-naprosyn TAB 375MG
Dihydroergot Spr 4MG/MLQL
EC-naprosyn TAB 500MG
Migranal Spr 4MG/MLQL
Feldene CAP 10MG
TIER 03 NON PREFERRED
Feldene CAP 20MG
almotrip mal TAB 12.5MGQL,ST
Fenoprofen CAP 200MG
almotrip mal TAB 6.25MGQL,ST
Fenoprofen CAP 400MG
almotriptan TAB 12.5MGQL,ST
Fenortho CAP 200MG
almotriptan TAB 6.25MGQL,ST
Fenortho CAP 400MG
eletriptan TAB 20MGQL,ST
Indocin Sup 50MG
eletriptan TAB 40MGQL,ST
Indocin Sus 25MG/5ML
frovatriptan TAB 2.5MGQL,ST
Ketoprofen CAP 200MG ER
Amerge TAB 1MGQL
Lodine TAB 400MG
Amerge TAB 2.5MGQL
Meloxicam Sus 7.5/5ML
Axert TAB 12.5MGQL,ST
Mobic Sus 7.5/5ML
Axert TAB 6.25MGQL,ST
Mobic TAB 15MG
Cafergot TAB 1-100MG
Mobic TAB 7.5MG
Cambia Pow 50MG
Nalfon CAP 400MG
Frova TAB 2.5MGQL,ST
Naprelan TAB 375MG CR
Imitrex Inj 4MG/0.5QL
Naprelan TAB 500MG CR
Imitrex Inj 6MG/0.5
Naprelan TAB 750MG CR
Imitrex Spr 20MG/ActQL
Naprosyn Sus 125/5ML
Imitrex Spr 5MG/ActQL
Naprosyn TAB 500MG
Imitrex TAB 100MGQL
Otrexup Inj 10MGPA
Imitrex TAB 25MGQL
Otrexup Inj 12.5/0.4PA
Imitrex TAB 50MGQL
Otrexup Inj 15MGPA
Maxalt TAB 10MGQL
Otrexup Inj 17.5/0.4PA
Maxalt TAB 5MGQL
Otrexup Inj 20MGPA
Maxalt-MLT TAB 10MGQL
Otrexup Inj 22.5/0.4PA
Maxalt-MLT TAB 5MGQL
Otrexup Inj 25MGPA
Relpax TAB 20MGQL,ST
Otrexup Inj 7.5/0.4PA
Relpax TAB 40MGQL,ST
Ponstel CAP 250MG
Sumavel Dose Inj 4MG/0.5QL
Rheumatrex TAB 2.5MG
Sumavel Dose Inj 6MG/0.5QL
Sprix Spr 15.75MG
Treximet TAB 10-60MGPA
Tivorbex CAP 20MG
Treximet TAB 85-500MGQL,ST
Tivorbex CAP 40MG
Zecuity Pad 6.5MG/4hQL,ST
Tolmetin Sod TAB 600MG
Zembrace Sym Inj 3/0.5ML
Vivlodex CAP 10MG
Zomig Spr 2.5MGQL
Vivlodex CAP 5MG
Zomig Spr 5MGQL
Zipsor CAP 25MGPA
Zomig TAB 2.5MGQL
Zorvolex CAP 18MG
Zomig TAB 5MGQL
Zorvolex CAP 35MG
Zomig ZMT TAB 2.5 MGQL
Zomig ZMT TAB 5MGQL
MIGRAINE PRODUCTS
GOUT AGENTS
TIER 01 GENERIC
ergot/caffen TAB 1-100MG
TIER 01 GENERIC
naratriptan TAB 1MGQL
allopurinol TAB 100MG
naratriptan TAB 2.5MGQL
allopurinol TAB 300MG
rizatriptan TAB 10MGQL
proben/colch TAB 500-0.5
rizatriptan TAB 10MG odtQL
probenecid TAB 500MG
rizatriptan TAB 5MGQL
Colchicine CAP 0.6MG
rizatriptan TAB 5MG odtQL
Colchicine TAB 0.6MG
sumatriptan inj 4MG/0.5QL
TIER 02 PREFERRED
sumatriptan inj 6MG/0.5QL
Colcrys TAB 0.6MG
sumatriptan spr 20MG/actQL
TIER 03 NON PREFERRED
sumatriptan spr 5MG/actQL
Duzallo TAB 200-200PA
sumatriptan TAB 100MGQL
Duzallo TAB 200-300PA
sumatriptan TAB 25MGQL
Mitigare CAP 0.6MG
sumatriptan TAB 50MGQL
Uloric TAB 40MGPA
zolmitriptan TAB 2.5 MGQL
Uloric TAB 80MGPA
zolmitriptan TAB 2.5MG orally disintegratingQL
Zurampic TAB 200MGPA
zolmitriptan TAB 5MGQL
Zyloprim TAB 100MG
Sumatriptan Inj 6MG/0.5QL
Zyloprim TAB 300MG
TIER 02
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 55
LOCAL ANESTHETICS-INJ
fluticasone spr 50mcg
ipratropium spr 0.03%
TIER 01 GENERIC
ipratropium spr 0.06%
lidocaine inj 1%
Flunisolide Spr 0.025%
lidocaine inj 2%
TIER 03 NON PREFERRED
TIER 03 NON PREFERRED
budesonide sus 32mcg
lido/epi 1%- inj 1:100000
mometasone spr 50mcg
Lidocain HCL Inj 10MG/ML
olopatadine spr 0.6%
Xylo/Epi 1%- Inj 1:100000
triamcinolon aer 55mcg/ac
Xylocaine Inj -mpf 2%
Adrenalin Sol 1:1000
Xylocaine Inj 1%
Astepro Spr 0.15%
Xylocaine Inj 2%
Atrovent Nas Sol 0.03%
Atrovent Nas Sol 0.06%
RESPIRATORY, ALLERGY, ETC
Azenase PAK Mis 137-50
ANTIHISTAMINES
Bactroban Oin Nasal 2%
TIER 01 GENERIC
Beconase AQ Sus 0.042%
arbinoxa sol 4MG/5ML
Dymista Spr 137-50
arbinoxa TAB 4MG
Nasonex Spr 50mcg/Ac
carbinoxamin sol 4MG/5ML
Omnaris Spr
carbinoxamin TAB 4MG
Patanase Spr 0.6%
clemastine TAB 2.68MG
Qnasl Aer 80mcg
cyproheptad syp 2MG/5ML
Qnasl Child Spr 40mcg
cyproheptad TAB 4MG
Rhinocort Sus Aqua
desloratadin TAB 5MG
Ticalast Kit 137/50
diphenhydram inj 50MG/ML
Tyzine PED Dro 0.05%
levocetirizi sol 2.5/5ML
Veramyst Spr 27.5mcg
levocetirizi TAB 5MG
Zetonna Aer 37mcg
pharbedryl CAP 50MG
phenadoz sup 12.5MG
COUGH/COLD/ALLERGY
phenadoz sup 25MG
TIER 01 GENERIC
phenergan sup 12.5MG
acetylcyst sol 10%
phenergan sup 25MG
acetylcyst sol 20%
phenergan sup 50MG
benzonatate CAP 100MG
promethazine sol 6.25/5ML
benzonatate CAP 200MG
promethazine sup 12.5MG
hydroc/homat TAB 5-1.5MG
promethazine sup 25MG
hydrocod/hom syp 5-1.5/5
promethazine sup 50MG
hydromet syp 5-1.5/5
promethazine syp 6.25/5ML
nebusal neb 3%
promethazine TAB 12.5MG
prometh VC sol plain
promethazine TAB 25MG
prometh VC/ syp codeine
promethazine TAB 50MG
prometh/cod syp 6.25-10
promethegan sup 12.5MG
prometh/PE syp 6.25-5/5
promethegan sup 25MG
prometh/PE/ syp codeine
promethegan sup 50MG
promethazine syp DM
Clemastine TAB 2.68MG
pulmosal neb 7%
Desloratadin TAB 2.5 Odt
sod chloride neb 0.9%
Desloratadin TAB 5MG Odt
sodium chlor neb 3%
TIER 03 NON PREFERRED
sodium chlor neb 7%
bpm TAB 6MG
tussigon TAB 5-1.5MG
cetirizine syp 1MG/ML
TIER 03 NON PREFERRED
diphenhydram elx 12.5/5ML
benzonatate CAP 150MG
promethazine inj 25MG/ML
biotuss liq
promethazine inj 50MG/ML
bpm pseudo TAB 6-45MG
Brompheniram Chw 12MG
brom/PSE/DM syp
Clarinex Syp 0.5MG/ML
bromfed DM syp
Clarinex TAB 5MG
hydr/CPM/PSE liq 5-4-60MG
Karbinal ER Sus 4MG/5ML
hydro/chlor/ liq 5-4-60MG
Phener Fort Syp 25MG/5ML
sodium chlor neb 10%
Phenergan Inj 25MG/ML
Carbaphen 12 Liq
Phenergan Inj 50MG/ML
Carbaphen 12 Sus PED
Respa-BR TAB 11MG
Clarinex-d TAB 2.5-120
Ryvent TAB 6MG
Flowtuss Sol 2.5-200
Xyzal Sol
Hycofenix Sol
Xyzal Sol 2.5/5ML
Hyper-sal Neb 7%
Xyzal TAB 5MG
Hypersal Neb 3.5%
Hypersal Neb 7%
NASAL AGENTS
HYD pol/CPM sus 10-8/5ML
TIER 01 GENERIC
Lexuss 210 Liq 2-10/5ML
azelastine spr 0.1%
Nebusal Neb 6%
azelastine spr 0.15%
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 56
Nortuss-EX Liq 200-20/5
Dulera Aer 100-5mcgPA
Obredon Sol 2.5-200
Dulera Aer 200-5mcgPA
Panatuss Dxp Liq
Flovent Disk Aer 100mcgPA
PE/Guaifenes Dro 1.5-20MG
Flovent Disk Aer 250mcgPA
Relhist Chw
Flovent Disk Aer 50mcgPA
Rezira Sol 60-5/5ML
Flovent HFA Aer 110mcgPA
Semprex-d CAP 8-60MG
Flovent HFA Aer 220mcgPA
Tessalon Per CAP 100MG
Flovent HFA Aer 44mcg
Tussicaps CAP 10-8MG
Qvar Aer 40mcg
Tussicaps CAP 5-4MG
Qvar Aer 80mcg
Tussionex Sus 10-8/5ML
Serevent Dis Aer 50mcgST
Tuzistra XR Sus
Spiriva Aer 1.25mcgST
Vituz Sol 5-4MG
Spiriva CAP Handihlr
Zonatuss CAP 150MG
Spiriva Spr 2.5mcg
Zutripro Liq 60-4-5MG
Stiolto Aer 2.5-2.5
Striverdi Aer 2.5mcg
ANTIASTHMATIC/COPD AGENTS
Ventolin HFA AerQL
TIER 04 SPECIALTY
TIER 01 GENERIC
zileuton ER TAB 600MGQL,PA
albuterol neb 0.083%
Zyflo CR TAB 600MGQL,PA
albuterol neb 0.5%
Zyflo TAB 600MGQL,PA
albuterol neb 0.63MG/3
TIER 03 NON PREFERRED
albuterol neb 1.25MG/3
albuterol TAB 4MG ER
albuterol syp 2MG/5ML
albuterol TAB 8MG ER
albuterol TAB 2MG
difil-G fort liq 100-100
albuterol TAB 4MG
isoproteren inj 0.2MG/ML
budesonide sus 0.25MG/2
levalbuterol neb 0.31MG
budesonide sus 0.5MG/2
levalbuterol neb 0.63MG
budesonide sus 1MG/2ML
levalbuterol neb 1.25/0.5
ipratropium sol 0.02%inh
levalbuterol neb 1.25MG
ipratropium/ sol albuter
terbutaline inj 1MG/ML
montelukast chw 4MG
zafirlukast TAB 10MG
montelukast chw 5MG
zafirlukast TAB 20MG
montelukast gra 4MG
Accolate TAB 10MG
montelukast TAB 10MG
Accolate TAB 20MG
terbutaline TAB 2.5MG
Aerospan Aer 80mcg
terbutaline TAB 5MG
Airduo Respi Inh 113-14PA
theochron TAB 100MG CR
Airduo Respi Inh 232-14PA
theochron TAB 200MG CR
Airduo Respi Inh 55-14PA
theochron TAB 300MG CR
Alvesco Aer 160mcg
theophylline sol 80/15ML
Alvesco Aer 80mcg
theophylline TAB 100MG CR
Anoro Ellipt Aer 62.5-25PA
theophylline TAB 100MG ER
Arcapta CAP 75mcg
theophylline TAB 200MG CR
Armonair Aer 113/ActPA
theophylline TAB 200MG ER
Armonair Aer 232/ActPA
theophylline TAB 300MG ER
Armonair Aer 55/ActPA
theophylline TAB 400MG ER
Arnuity Elpt Inh 100mcg
theophylline TAB 450MG ER
Arnuity Elpt Inh 200mcg
theophylline TAB 600MG ER
Bevespi Aer 9-4.8mcgPA
Cromolyn Sod Neb 20MG/2ML
Breo Ellipta Inh 100-25PA
Metaproteren Syp 10MG/5ML
Breo Ellipta Inh 200-25PA
Metaproteren TAB 10MG
Brovana Neb 15mcgPA
Metaproteren TAB 20MG
Daliresp TAB 500mcg
TIER 02 PREFERRED
Elixophyllin Elx 80/15ML
Advair Disku Aer 100/50ST
Fluticasone Inh SalmeterPA
Advair Disku Aer 250/50ST
Foradil CAP Aerolize
Advair Disku Aer 500/50ST
Incruse Elpt Inh 62.5mcgPA
Advair HFA Aer 115/21ST
Isuprel Inj 0.2MG/ML
Advair HFA Aer 230/21ST
Levalbuterol Aer 45/ActQL
Advair HFA Aer 45/21ST
Perforomist Neb 20mcg
Asmanex HFA Aer 100 McgST
Proair HFA AerQL
Asmanex HFA Aer 200 McgST
Proair Respi AerQL
Asmanex 120 Aer 220mcgST
Proventil Aer HFAQL
Asmanex 14 Aer 220mcgST
Pulmicort Inh 180mcg
Asmanex 30 Aer 110mcgST
Pulmicort Inh 90mcg
Asmanex 30 Aer 220mcgST
Pulmicort Sus 0.25MG/2
Asmanex 60 Aer 220mcgST
Pulmicort Sus 0.5MG/2
Asmanex 7 Aer 110mcgST
Pulmicort Sus 1MG/2ML
Atrovent HFA Aer 17mcg
Seebri Neoha CAP 15.6mcgPA
Combivent Aer 20-100
Singulair Chw 4MG
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 57
Singulair Chw 5MG
Comvax Inj
Singulair Gra 4MG
Engerix-b Inj 10/0.5ML
Singulair TAB 10MG
Engerix-b Inj 20mcg/ML
Symbicort Aer 160-4.5PA
EZ Flu Shot Inj PF 14-15
Symbicort Aer 80-4.5PA
EZ Flu Shot Inj 2015-16
Theo-24 CAP 100MG CR
EZ Flu Shot Kit 2015-16
Theo-24 CAP 200MG CR
EZ Flu Shot Kit 2016-17
Theo-24 CAP 300MG CR
Fluad Inj 2016-17
Theo-24 CAP 400MG ER
Fluad Inj 2017-18
Tudorza Pres Aer 400/Act
Fluarix Quad Inj 2015-16
Utibron CAP NeohalerPA
Fluarix Quad Inj 2016-17
Vospire ER TAB 4MG
Fluarix Quad Inj 2017-18
Vospire ER TAB 8MG
Flublok Sol 2015-16
Xopenex CONC Neb 1.25/0.5
Flublok Sol 2016-17
Xopenex HFA AerQL
Flublok Sol 2017-18
Xopenex Neb 0.31MG
Flucelvax Inj 2015-16
Xopenex Neb 0.63MG
Fluclvx Quad Inj 2016-17
Xopenex Neb 1.25/3ML
Fluclvx Quad Inj 2017-18
Flulaval Qua Inj 2014-15
RESPIRATORY AGENTS - MISC
Flulaval Qua Inj 2015-16
Flulaval Qua Inj 2016-17
TIER 02 PREFERRED
Flulaval Qua Inj 2017-18
Survanta Inh
Flumist Quad Sus 2015-16
TIER 04 SPECIALTY
Flumist Quad Sus 2016-17
Esbriet CAP 267MGQL,PA
Flumist Quad Sus 2017-18
Esbriet TAB 267MGQL,PA
Fluvirin Inj 2015-16
Esbriet TAB 801MGQL,PA
Fluvirin Inj 2016-17
Kalydeco PAK 50MGQL,PA
Fluvirin Inj 2017-18
Kalydeco PAK 75MGQL,PA
Fluzone HD Inj PF 15-16
Kalydeco TAB 150MGQL,PA
Fluzone HD Inj PF 16-17
Ofev CAP 100MGQL,PA
Fluzone HD Inj PF 17-18
Ofev CAP 150MGQL,PA
Fluzone Quad Inj 15-16
Orkambi TAB 100-125QL,PA
Fluzone Quad Inj 2015-16
Orkambi TAB 200-125QL,PA
Fluzone Quad Inj 2016-17
Pulmozyme Sol 1MG/MLQL
Fluzone Quad Inj 2017-18
TIER 03 NON PREFERRED
Fluzone Splt Inj 2015-16
Curosurf Sus 120/1.5
Gardasil Inj
Curosurf Sus 240/3ML
Gardasil 9 Inj
Infasurf Sus 35MG/ML
Havrix Inj 1440unit
Havrix Inj 720unit
TOXOIDS
Hiberix Sol 10mcg
Influenza Firus Vaccine
TIER P PREVENTIVE
Ipol Inj Inactive
Adacel Inj
M-m-r II Inj
Boostrix Inj
Menactra Inj
Daptacel Inj
Menhibrix Inj
Dip/Tet PED Inj 25-5lfu
Menomune Inj A/C/Y/W
Infanrix Inj
Menveo Inj
Kinrix Inj
Pedvax HIB Inj
Pediarix Inj 0.5ML
Pneumovax 23 Inj 25/0.5
Pentacel Inj
Prevnar 13 Inj
Quadracel Inj
Proquad Inj
Tenivac Inj 5-2LF
Recombiva HB Inj 10mcg/ML
Tet/Dip Tox Inj 2-2 LF
Recombiva HB Inj 5mcg/0.5
Recombiva-HB Inj 40mcg/ML
VACCINES
Rotarix Sus
Rotateq Sol
TIER P PREVENTIVE
Trumenba Inj
Acthib Inj
Twinrix Inj
Afluria Inj PF 15-16
Vaqta Inj 25/0.5ML
Afluria Inj PF 16-17
Vaqta Inj 50unt/ML
Afluria Inj PF 17-18
Varivax Inj
Afluria Inj 2015-16
Zostavax Inj
Afluria Inj 2016-17
TIER 03 NON PREFERRED
Afluria Inj 2017-18
Biothrax Inj
Afluria Quad Inj PF 16-17
Afluria Quad Inj PF 17-18
VITAMINS
Afluria Quad Inj 2017-18
VITAMINS
Bexsero Inj
TIER 01
Cervarix Inj
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 58
GENERIC
vitamin d3 chw 1000unit
phytonadione inj 1MG/0.5
vitamin d3 chw 2000unit
vitamin d CAP 50000unt
vitamin d3 chw 400unit
vitamin k1 inj 1MG/0.5
vitamin d3 chw 5000unit
Vitamin K1 Inj 10MG/ML
vitamin d3 dro 400unit
TIER 02 PREFERRED
vitamin d3 dro 5000unit
Mephyton TAB 5MG
vitamin d3 CAP 1000unit
TIER P PREVENTIVE
vitamin d3 CAP 10000unt
bio-d-mulsio liq 2000unit
vitamin d3 CAP 2000unit
bio-d-mulsio liq 400unit
vitamin d3 CAP 400unit
cvd d3 chw 1000unit
vitamin d3 CAP 5000unit
d 1000 chw 1000unit
vitamin d3 CAP 50000unt
d 1000 CAP 1000unit
vitamin d3 TAB 1000unit
d 1000 TAB 1000unit
vitamin d3 TAB 2000unit
d 400 chw 400unit
vitamin d3 TAB 400unit
d 400 TAB 400unit
vitamin d3 TAB 5000unit
d-vita liq 400unit
vitamin d3 TAB 50000uni
d-3 gummy chw 400unit
vitamin d3 TAB 50000unt
d-400 TAB 400unit
Baby Ddrops Liq 400unit
decara CAP 50000unt
Baby Super Dro Daily D3
delta d3 TAB 400unit
Baby Vit D Dro 400/.028
dialyvite d CAP 5000unit
CVS d3 chw 1000 unt
d3 adult chw 1000unit
CVS d3 CAP 1000unit
d3 kids chw 400unit
CVS d3 CAP 2000unit
d3 max ST dro 5000unit
CVS d3 CAP 400unit
d3 maximum CAP 5000unit
CVS d3 CAP 5000unit
d3 super str CAP 2000unit
D-VI-sol Liq 400unit
d3 CAP 1000unit
Daily D3 Dro 1000unit
d3 CAP 10000
Ddrops Boost Liq 600/.028
d3 CAP 2000unit
Ddrops Liq
d3 CAP 400unit
Ddrops Liq 1000unit
d3 TAB 1000unit
Ddrops Liq 2000unit
d3 TAB 2000unit
Decara CAP 25000unt
d3 TAB 400unit
D3 Dots TAB 2000unit
d3 2000 TAB 2000unit
HM vit d3 CAP 2000unit
d3-1000 CAP 1000unit
HM vitamin d TAB 1000unit
d3-50 CAP 50000unt
Optimal D3 M CAP
eql vitamin CAP d3
PA vitamin CAP 2000unit
gnp d chw 2000unit
Replesta Nx Waf 14000unt
gnp d CAP 1000unit
Replesta Waf 14000unt
gnp vit d TAB 1000unit
Replesta Waf 50000unt
gnp vit d TAB 5000unit
Super Daily Dro D3
gnp vit d3 TAB 1000unit
Thera-d TAB 4000unit
just d liq 400unit
Upspringbaby Dro Vit D3
optimal-d CAP 50000unt
Vit D3 Drops Liq 400unit
opurity vit chw d 5000un
Vitamelts D TAB 1000 Iu
pedia d-vite dro 400unit
Vitamin D3 Chw 5000unit
ra vitamin CAP 2000unit
Vitamin D3 CAP 4000unit
sm vitamin d TAB 400unit
Vitamin D3 Liq 1000unit
thera-d sprt TAB 2000unit
Vitamin D3 Liq 1200unit
thera-d TAB 2000unit
Vitamin D3 Spr 1000unit
vit d child chw 1000unit
Vitamin D3 TAB 10000unt
vit d gummie chw 400unit
Vitamin D3 TAB 3000unit
vit d3 gumm chw 1000unit
Vitamin D3 TAB 5000unit
vitajoy daly chw d 1000iu
vitamin d chw 1000unit
TIER 03 NON PREFERRED
vitamin d chw 400unit
Drisdol CAP 50000unt
vitamin d dro 400unit
vitamin d CAP 1000unit
MULTIVITAMINS
vitamin d CAP 2000unit
TIER P PREVENTIVE
vitamin d CAP 400unit
sm prenatal TAB vitamins
vitamin d TAB 1000unit
Atabex Chw Prenatal
vitamin d TAB 2000unit
Be Well PAK Rounded
vitamin d TAB 400unit
Brainstrong Mis Prenatal
vitamin d TAB 5000iu
Cadeau DHA CAP
vitamin d-3 CAP 1000unit
Centrum Spec PAK Prenatal
vitamin d-3 CAP 2000unit
CL Prenatal TAB 28-0.8MG
vitamin d-3 TAB 1000unit
CVS Prenatal Chw Gummy
vitamin d-3 TAB 2000unit
CVS Prenatal TAB
vitamin d-3 TAB 5000unit
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 59
Enfamil Mis Expecta
Acura Contrl Sol High
Eql Prenatal TAB Formula
Acura Contrl Sol Low
Gnp Daily Mis Prenatal
Acura Contrl Sol Normal
Gnp Prenatal TAB 28-0.8MG
Adj Lancing Mis Device
Goodsense TAB 28-0.8MG
Adv Lancing Mis Device
HM One Daily Mis Prenatal
Adv Travel Mis Lanc 28G
HM Prenatal TAB
Advance Liq Control
Kp Prenatal TAB Multivit
Advance Liq Intuitio
Multi Prenat TAB
Advance Norm Liq Control
One A Day CAP Prenatal
Advcate Safe Mis Lanc 26G
One A Day Mis Prenatal
Advocate Liq High
One A Day PAK Prenatal
Advocate Liq Low
One-a-day PAK Prenatal
Advocate Mis Lanc Dev
Perry Prenat CAP
Advocate Mis Lanc 30G
Pre-natal TAB Formula
Advocate Mis Lancets
Prenat Multi CAP +dha
Advocate+ Sol Redi-cod
Prenatal CAP Formula
Agamatrix Mis 33G
Prenatal CAP Omega-3
Agamatrix Sol High
Prenatal Mul CAP +dha
Agamatrix Sol Norm/Hgh
Prenatal MV Mis + DHA
Agamatrix Sol Normal
Prenatal One TAB Daily
Altrnate Sit Mis Device
Prenatal TAB
Aqua Lance Mis Lanc Dev
Prenatal TAB Complete
Assure Cmfrt Mis 28G
Prenatal TAB Formula
Assure Cmfrt Mis 30G
Prenatal TAB Forte
Assure Dose Sol Norm/Hgh
Prenatal TAB Iron
Assure Dose Sol Normal
Prenatal TAB Low Iron
Assure II Liq Level 1
Prenatal TAB Multivit
Assure II Liq Level1/2
Prenatal TAB Plus DHA
Assure Lance Mis Low Flow
Prenatal TAB Vitamins
Assure Lance Mis Micro
Prenatal TAB 27-0.8MG
Assure Lance Mis Safe 25G
Prenatal TAB 28-0.8MG
Assure Lance Mis Safe 30G
Prenatal Vit TAB Minerals
Assure Lance Mis 21G
Prenatal Vit TAB 28-0.8MG
Assure Mis Lancets
Prenatal/FE TAB
Assure Plus Mis High 18G
Prenatl Mult CAP + DHA
Assure Plus Mis Low 25G
Prentat Mult CAP Plus DHA
Assure Plus Mis Mcro 28G
Px Prenatal TAB Multivit
Assure Plus Mis Norm 21G
Qc Prenatal TAB 28-0.8MG
Assure Plus Mis Pediatri
Ra One Daily Mis
Assure Prism Sol Level1/2
Ra Prenatal TAB Formula
Assure Pro Liq Level1/2
Ra Prenatal TAB 28-0.8MG
Assure 3 Liq Control
Right Step TAB Prenatal
Assure 4 Liq Level1/2
Similac Pren PAK Early Sh
Aurora Lance Mis Thin 23G
Sm One Daily Mis Prenatal
Aurora Lance Mis 30G
Sm Prenatal TAB Vitamins
Auto Lancet Mis
Stuart One CAP
Auto-lancet Mis
Your Life CAP Prenatal
Auto-lancet Mis Mini
Autolet Impr Mis Lanc Dev
MEDICAL DEVICES
Autolet II Kit Clinisaf
Autolet Lanc Mis Device
DIABETIC SUPPLIES
Autolet Lite Kit
TIER 01 GENERIC
Autolet Lite Kit Clinisaf
lancet carry mis case
Autolet Lite Kit Starter
lancets mis 23G
Autolet Mini Mis
Accu-chek Kit Fastclix
Autolet Plat Mis 1.8MM
Accu-chek Kit Mlticlix
Autolet Plat Mis 2.4MM
Accu-chek Kit Softclix
Autolet Plat Mis 3.0MM
Accu-chek Liq Act/Gluc
Autolet Plus Mis
Accu-chek Liq Guide
Autolet Plus Mis Lanc Dev
Accu-chek Liq Smart
Autoshield Mis 29X3/16"
Accu-chek Mis Mlticlix
Autoshield Mis 29X5/16"
Accu-chek Sol
Autoshield Mis 30GX3/16
Accu-chek Sol Compact
AF Lancets Mis Thin
Accutrend Sol Glucose
AT Last Mis Lancets
Acti-lance Mis Lite 28G
AT Last Sol Control
Acti-lance Mis Spec 17G
Bayer Breeze Liq High Cnt
Acti-lance Mis Univ 23G
Bayer Breeze Liq Low Cntl
Acti-lance Mis 28G
Bayer Breeze Liq Norm Cnt
Active 1ST Mis Lanc 30G
Bayer Breeze Mis 2 TestQL,PA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 60
Bayer Micrlt Mis Lanc Dvc
Cool Control Sol A
Bayer Micrlt Mis Lancets
Cool Control Sol B
Bullseye Mis Lancets
CVS Lancets Mis Original
Bullseye Mis Mini Lnc
CVS Lancets Mis Thin 26G
BD Lancet Mis Device
CVS Lancets Mis Thin 30G
BD Lancet UF Mis 30G
CVS Lancets Mis Thin 33G
BD Lancet UF Mis 33G
CVS Lancets Mis 21G
BD Microtain Mis Lancets
CVS Lancets Mis 30G
BD Pen Needl Mis 29GX1/2"
CVS Lancets Mis 33G
BD Pen Needl Mis 31GX3/16
CVS Lancing Mis Device
BD Pen Needl Mis 31GX5/16
Diastar Easy Mis Lancets
BD Pen Needl Mis 32GX4MM
Diastar Mis Lancets
BD U-500 Mis 31GX6MM
Diatrue Cont Sol Level 1
BD Ultra-fin Mis 32GX6MM
Diatrue Cont Sol Level 2
Cardiocom Mis Lancing
Diatrue Cont Sol Level 3
Carefine Mis 31GX8MM
Droplet Lanc Mis Device
Carefine Mis 32GX4MM
Droplet Lanc Mis 30G
Carefine Mis 32GX5MM
Duo-care Liq Level1/2
Carefine Mis 32GX6MM
E-z Ject Mis Lanc 21G
Careone Adv Mis Lancing
E-z Ject Mis Lancets
Careone Lanc Mis Thin 23G
E-z Ject Mis Thin 26G
Careone Lanc Mis 28G
E-z Ject Mis 21G
Caresens Sol Control
E-z Ject Mis 21G Colr
Caretouch Mis Ejector
E-z Ject Mis 30G
Caretouch Mis Twist 28
E-z Ject Mis 32G Colr
Caretouch Mis Twist 30
E-ZJECT Lanc Mis 33G
Caretouch Mis Twist 33
Easy Comfort Mis Lanc/30G
Caretouch Mis 31GX5MM
Easy Comfort Mis 30G
Caretouch Mis 31GX6MM
Easy Comfort Mis 31GX1/4"
Caretouch Mis 31GX8MM
Easy Comfort Mis 31GX3/16
Caretouch Mis 32GX4MM
Easy Comfort Mis 31GX5/16
Caretouch Mis 32GX5MM
Easy Comfort Mis 32GX5/32
Cleanlet 28G Mis Lancets
Easy Mini Mis
Clever Check Mis
Easy Mini Mis Eject
Clever Check Mis 30G
Easy Plus II Sol High
Clevr Choice Liq High
Easy Plus II Sol Low
Clevr Choice Liq Low
Easy Talk Sol High
Clickfine Mis 31GX1/4"
Easy Talk Sol Low
Clickfine Mis 31GX5/16
Easy Talk Sol Normal
Clickfine Mis 32GX5/32
Easy Touch Mis
Closercare Mis
Easy Touch Mis Lanc/21G
Coaguchek Mis Lancets
Easy Touch Mis Lanc/23G
Comfort Assu Mis Lanc 28G
Easy Touch Mis Lanc/26G
Comfort Assu Mis Lanc 33G
Easy Touch Mis Lanc/28G
Comfort EZ Mis 29GX12MM
Easy Touch Mis Lanc/30G
Comfort EZ Mis 31GX5MM
Easy Touch Mis Lanc/32G
Comfort EZ Mis 31GX6MM
Easy Touch Mis Lanc/33G
Comfort EZ Mis 31GX8MM
Easy Touch Mis 29GX1/2"
Comfort EZ Mis 32GX4MM
Easy Touch Mis 31GX1/4"
Comfort EZ Mis 32GX5MM
Easy Touch Mis 31GX3/16
Comfort EZ Mis 32GX6MM
Easy Touch Mis 31GX5/16
Comfort EZ Mis 32GX8MM
Easy Touch Mis 32GX1/4"
Comfort EZ Mis 33GX4MM
Easy Touch Mis 32GX3/16
Comfort EZ Mis 33GX5MM
Easy Touch Mis 32GX5/32
Comfort EZ Mis 33GX6MM
Easy Touch Mis 32GX5MM
Comfort EZ Mis 33GX8MM
Easy Touch Mis 32GX6MM
Comfort Mis Lancets
Easy Touch Sol Control
Comfortouch Mis Lancet
Easy Touch Sol High/Low
Contour Liq High Cnt
Easy Trak Sol High
Contour Liq Low Cntl
Easy Trak Sol Low
Contour Liq Norm Cnt
Easy Trak Sol Normal
Contour Sol Next
Easygluco Sol High
Contour Tes NextQL,PA
Easygluco Sol Low
Control High Sol Unistrip
Easygluco Sol Normal
Control Low Sol Unistrip
Easygluco Sol Plus
Control Norm Sol Easy Stp
Easymax Sol High
Control Sol Liq High/Low
Easymax Sol Low
Control Sol Liq HI/Mid/L
Easymax Sol Norm/Low
Control Sol Liq Mid
Easymax Sol Normal
Control Sol Normal
Easymax 15 Sol Level 1
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 61
Easymax 15 Sol Level 2
Gluc Control Sol Level 1
Easymax 15 Sol Level1-2
Gluc Control Sol Level 2
Easystep Hgh Sol Control
Gluc Control Sol Mid
Easystep Low Sol Control
Gluc Control Sol Normal
Easytest II Mis Lancets
Glucocard Liq Level 1
Easytest Mis Lancets
Glucocard Sol Normal
Element Cont Liq Normal
Glucocard Sol Shine
Element Liq High
Glucocard 01 Liq Norm/Hgh
Element Liq Low
Glucocard 01 Sol Normal
Elemnt Compa Sol Level 2
Glucocom Mis 28G
Elemnt Compa Sol Level 3
Glucocom Mis 30G
Embrace Cntr Liq High
Glucocom Mis 33G
Embrace Evo Liq Level 1
Glucocom Tes High CON
Embrace Evo Liq Level 2
Glucocom Tes Norm CON
Embrace Lanc Mis Thin 30G
Glucolet 2 Mis Lancing
Embrace Pro Liq Glucose
Glucose Cont Liq High/Low
Embrace Sol Low
Glucose Cont Sol High
Eql Lancets Mis Thin 26G
Glucose Cont Sol Normal
Eql Lancets Mis Thin 30G
Glucose Cont Sol Precisio
Eql Lancets Mis 21G Colr
Glucosource Mis Lanc Dev
Eql Lancets Mis 33G Colr
Glucosource Mis Lancets
Evencar Mini Sol Normal
Gmate Contro Sol Level 2
Evencare G2 Sol Low/High
Gmate Lancet Mis 30G
Evencare G3 Sol Low/High
Gmate Lancin Mis Device
Evencare Sol Liq Low/High
Gnp Lancets Mis
Evolution Sol Normal
Gnp Lancets Mis Micro
EZ Smart Mis Lancets
Gnp Lancets Mis Sup Thin
EZ-lets 21G Mis Lancets
Gnp Lancets Mis Thin
EZ-lets 23G Mis Lancets
Gnp Lancets Mis Thin 26G
EZ-lets 26G Mis Lancets
Gnp Lancets Mis 21G
EZ-lets 28G Mis Lancets
Goodsense Mis Lanc Dvc
EZ-lets 30G Mis Lancets
Goodsense Mis Lanc 30G
Fastclix Mis Lancets
Haemolance Mis High FLO
Fifty50 Mis Lanc Dev
Haemolance Mis Low Flow
Fifty50 Mis 31GX3/16
Haemolance Mis Plus
Fifty50 Mis 31GX5/16
Haemolance Mis Plus Low
Fifty50 Mis 31GX5MM
Haemolance Mis Plus Max
Fifty50 Pen Mis 31GX8MM
Haemolance Mis Plus PED
Fifty50 Pen Mis 32GX4MM
Haemolance Mis Retract
Fifty50 Pen Mis 32GX6MM
Healthpro Sol High/Low
Fifty50 Safe Mis Lancets
Hlthy Accnts Mis Lanc 30G
Fifty50 Sol 2.0
Hypolance Kit Lancing
Fine 30 Mis
HC Lancing Mis Device
Fingerstix Mis Lancets
Incontrol Mis Lanc Dev
Fora Control Sol High
Incontrol Mis Lanc 28G
Fora Control Sol Low
Incontrol Mis Lanc 30G
Fora Control Sol Normal
Incontrol Mis Lanc 33G
Fora Lancets Mis 30G
Incontrol Mis 29GX12MM
Fora Mis Lancets
Infinity Sol High CON
Fora Mis Lancing
Infinity Sol Low CON
Foracare Gdh Sol High
Infinity Sol Norm CON
Foracare Gdh Sol Low
Insulin Pen Mis 29GX12MM
Foracare Gdh Sol Normal
Insulin Pen Mis 31GX4MM
Fortiscare Sol Cntl HI
Insulin Pen Mis 31GX8MM
Fortiscare Sol Cntl Low
Insulin Syrg Mis 0.3/28G
Fortiscare Sol Cntl Nml
Insulin Syrg Mis 0.3/29G
Freestyle Liq Control
Insulin Syrg Mis 0.3/30G
Freestyle Mis Lancets
Insulin Syrg Mis 0.3/31G
Freestyle Mis Unistick
Insulin Syrg Mis 0.5/27G
Freestyle TesQL,PA
Insulin Syrg Mis 0.5/28G
Gentle-let Mis Lancets
Insulin Syrg Mis 0.5/29G
Gentle-let Mis Platform
Insulin Syrg Mis 0.5/30G
Gentle-let Mis 26G
Insulin Syrg Mis 0.5/31G
Gentle-let Mis 28G
Insulin Syrg Mis 1ML
Ge100 Contrl Sol Normal
Insulin Syrg Mis 1ML/25G
Global Lanc Mis Device
Insulin Syrg Mis 1ML/26G
Global 28G Mis Lancets
Insulin Syrg Mis 1ML/27G
Global 30G Mis Lancets
Insulin Syrg Mis 1ML/28G
Gluc Control Liq Normal
Insulin Syrg Mis 1ML/29G
Gluc Control Sol
Insulin Syrg Mis 1ML/30G
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 62
Insulin Syrg Mis 1ML/31G
Lancets Ultr Mis Thin 28G
Insulin Syrg Mis 1MLX30G
Lancets Ultr Mis Thin 30G
Insulin Syrg Mis 2/27.5G
Lancing Devi Mis
Insulin Syrg Mis 27GX1/2"
Lancing Devi Mis Adjust
Insulin Syrg Mis 28GX1/2"
Lancing Devi Mis 25G
Insulin Syrg Mis 29GX1/2"
Lancing Devi Mis 30G
Insulin Syrg Mis 30GX1/2"
Lancing Mis Device
Insulin Syrg Mis 30GX5/16
Lancing Pen Mis
Insulin Syrg Mis 30GX8MM
Lanzo Mis Lancing
Insulin Syrg Mis 31GX5/16
Lb Lancet Mis 28G
Insulin Syrg Mis 31GX8MM
Lb Lancing Mis Device
Insulin SYR Mis 0.3/31G
Lifescan Mis Unistik2
Insulin SYR Mis 0.5/31G
Lite Touch Mis Lanc Dev
Insulin SYR Mis 1ML/31G
Lite Touch Mis Lanc Pen
Insulin SYR Mis 31GX6MM
Lite Touch Mis Lancets
Insupen Mis 29GX12MM
Litetouch Mis Lancets
Insupen Mis 31GX5MM
Litetouch Mis 29GX12.7
Insupen Mis 31GX8MM
Litetouch Mis 31GX8MM
Insupen Mis 32GX4MM
Longs Lancet Mis Standard
Insupen Mis 33GX4MM
Longs Lancet Mis Thin
Insupen Sens Mis 32GX6MM
Longs Lancet Mis Ultra Th
Insupen Sens Mis 32GX8MM
Maxima Sol Control
Insupen Ultr Mis 29GX12MM
Medichoice Mis Lancet
Insupen Ultr Mis 30GX8MM
Medisense Liq Gluc-ket
Insupen Ultr Mis 31GX6MM
Medisense Liq Gluc/Ket
Insupen Ultr Mis 31GX8MM
Medlance Mis Extr 21G
IN Control Mis 31GX5MM
Medlance Mis Lite 25G
IN Control Mis 31GX6MM
Medlance Mis Plus
IN Control Mis 31GX8MM
Medlance Mis Plus 30G
IN Touch Lan Mis Device
Medlance Mis Unv 21G
IN Touch Lan Mis 30G
Medlance Mis 30G Plus
IN Touch Sol Glucose
Medlance Pls Mis Extr 21G
Kinney Mis Lancets
Medlance Pls Mis Lite 25G
Kinney Thin Mis Lancets
Medlance Pls Mis Univ 21G
Kroger Lance Mis
Medlance Pls Mis 0.8MM
Kroger Lance Mis Thin
Meijer Lance Mis Color
Kroger Lance Mis Thin 30G
Meijer Lance Mis Univ 21G
Lancet Alter Mis Site 26G
Meijer Lance Mis Univ 30G
Lancet Auto Mis Injector
Meijer Lance Mis Universa
Lancet Carry Mis Case
Meijer Mis Lancets
Lancet Devic Mis Adjust
Micro Thin Mis Lanc 33G
Lancet Micro Mis Thin 33G
Microdot CON Sol High/Low
Lancet Stand Mis 21G
Microlet Mis Lancets
Lancet Super Mis Thin 30G
Microlet Mis Next
Lancet Ultra Mis Fine
Microtainer Mis Lancet
Lancet Ultra Mis Thin 28G
Mini Lancing Mis Device
Lancet Ultra Mis Thin 30G
Monojector Mis End CAPS
Lancet Ultra Mis 28G
Monolet Mis Lancets
Lancet With Mis Ejector
Monolet Opd Mis Lancets
Lancets Micr Mis Thin 33G
Monolettor Mis Lancets
Lancets Mis
Multi-lancet Kit Device
Lancets Mis Colored
Multi-lancet Mis Device
Lancets Mis Orange
Myglucohealt Mis Lanc 30G
Lancets Mis Original
Myglucohealt Sol LO/Nl/HI
Lancets Mis Thin
MM Pentips Mis 29GX12MM
Lancets Mis Thin 26G
MM Pentips Mis 31GX5MM
Lancets Mis Thin 30G
MM Pentips Mis 31GX8MM
Lancets Mis 21G
MM Pentips Mis 32GX4MM
Lancets Mis 21G Colr
Neutek 2tek Sol Control
Lancets Mis 23G
Nexgen Tes Norm CON
Lancets Mis 26G
Nova Max Glu Liq /Ket CON
Lancets Mis 28G
Nova Safety Mis Lanc 23G
Lancets Mis 30G
Nova Safety Mis Lanc 28G
Lancets Mis 31G
Nova Sure Mis Lancets
Lancets Mis 33G
Nova Sureflx Mis Lanc Dev
Lancets Supr Mis Thin 28G
Novofine Aut Mis 30GX8MM
Lancets Thin Mis
Novofine Mis 30GX8MM
Lancets Thin Mis 26G
Novofine Mis 32GX6MM
Lancets Thin Mis 30G
Novofine Pls Mis 32GX4MM
Lancets Ultr Mis Thin
Novotwist Mis 30GX8MM
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 63
Novotwist Mis 32GX5MM
Prodigy NO Tes CodingQL,PA
On Call Expr Sol Glucose
Prodigy Sol High
On Call Lanc Mis Device
Prodigy Sol Low
On Call Mis Lancets
Pss Safe Lan Mis
On Call Plus Mis Lanc Dev
Pss Sel Lanc Mis
On Call Plus Mis Lancets
Pss Sel Plat Mis
On Call Plus Sol Control
Px Lancets Mis Ult Thin
On Call Vivd Sol Control
Px Lancets Mis 28G
On-the-go Mis Lanc 30G
PC Lancets Mis 30G
Onetouch Fp Mis Lancets
Qc Lancets Mis 28G
Onetouch Mis Combo
Qc Lancets Mis 30G
Onetouch Mis Lanc Dev
Qc Lancing Mis Device
Onetouch Mis Lancets
Quicktek Liq Solution
Onetouch Mis 30G
Quintet Cont Sol Hgh/Norm
Onetouch Sol Ult Cont
Ra E-ZJECT Mis Thin 26G
Onetouch Sol Verio
Ra E-ZJECT Mis Thin 28G
Onetouch Sol Verio-HI
Ra E-ZJECT Mis Ult Thin
Onetouch Tes UltraQL
Ra E-ZJECT Mis 28G
Onetouch Tes Ultra BLQL
Ra E-ZJECT Mis 33G
Onetouch Tes VerioQL
Ra Pen Needl Mis 31GX3/16
Onetouch Us Mis Lancets
Rapid-safe Mis Lancing
Optumrx Cont Sol Level1/2
Readylance Mis 21G
Pen Needle Mis 29GX1/2"
Readylance Mis 23G
Pen Needle Mis 32GX4MM
Readylance Mis 26G
Pen Needles Mis 29GX1/2"
Readylance Mis 28G
Pen Needles Mis 29GX10MM
Readylance Mis 30G
Pen Needles Mis 29GX12.7
Reality Mis Lancets
Pen Needles Mis 29GX12MM
Reality Trig Mis Lancets
Pen Needles Mis 30GX5/16
Refuah Plus Sol Control
Pen Needles Mis 30GX5MM
Relion Kit Lancing
Pen Needles Mis 30GX8MM
Relion Lance Mis Stnd 21G
Pen Needles Mis 31GX1/4"
Relion Lance Mis Thin 26G
Pen Needles Mis 31GX3/16
Relion Lance Mis Thin 30G
Pen Needles Mis 31GX5/16
Relion Lanci Mis Device
Pen Needles Mis 31GX5MM
Relion Micro Mis Thin 33G
Pen Needles Mis 31GX6MM
Relion Pen Mis 29GX12MM
Pen Needles Mis 31GX8MM
Relion Pen Mis 31GX6MM
Pen Needles Mis 32GX4MM
Relion Pen Mis 31GX8MM
Pen Needles Mis 32GX5/32
Relion Pen Mis 32GX4MM
Pen Needles Mis 32GX5MM
Relion Thin Mis Lancets
Pen Needles Mis 32GX6MM
Relion Ultra Mis Thin
Pen Needles Mis 32GX8MM
Relion Ultra Mis Thin Pls
Pen Needles Mis 33GX4MM
Relion Ultra Mis Thin 32G
Penlet II Kit Blood
Rightest Alt Mis Adaptor
Penlet II Mis Repl CAP
Rightest Liq High CON
Pentips Mis 29GX12MM
Rightest Liq Norm CON
Pentips Mis 31GX5MM
Rightest Mis Gl300
Pentips Mis 31GX6MM
Rightest Mis GD500
Pentips Mis 31GX8MM
Safe-t-lance Mis HI Flow
Pentips Mis 32GX4MM
Safe-t-lance Mis Low Flow
Perfect 28G Mis Lancets
Safe-t-lance Mis Nor Flow
Perfect 30G Mis Lancets
Safe-t-lance Mis 21G
Pharmacy Cou Mis Lancets
Safe-t-lance Mis 25G
Pocketchem Sol EZ
Safe-t-pro Mis Lancets
Precision Liq Control
Safe-t-pro Mis Plus
Precision Liq Gluc/Ket
Safety Let Mis Lancets
Precision Liq Nrml/Mid
Safety Mis Lancets
Precision Mis 28g(t)
Safety Seal Mis 28G
Precision Mis 28G
Safety Seal Mis 30G
Pressure Act Mis Lancet
Safety 21G Mis Lancets
Pressure Act Mis Lancets
Safety 28G Mis Lancets
Pro Comfort Mis Lancets
Saps Health Mis Twist
Pro Comfort Mis 31G
Sapscare Mis Twist
Pro Comfort Mis 31GX8MM
Select-lite Kit Dev/Lanc
Pro Comfort Mis 32GX4MM
Select-lite Mis Lanc Dev
Pro Comfort Mis 32GX5MM
Shopko Lanc Mis Device
Pro Comfort Mis 32GX6MM
Side Button Mis Safety
Prodigy Mis Lanc Dev
Simple Diag Mis Lancing
Prodigy Mis 26G
Single-let Mis 23G
Prodigy Mis 28G
Sm Lancets Mis Thin 26G
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 64
Sm Lancets Mis Thin 30G
Tgt Lancing Mis Device
Sm Lancets Mis 21G
Thin Lancets Mis
Sm Lancets Mis 33G
Thin Lancets Mis 26G
Sm Truedraw Mis Lanc Dev
Thin Lancets Mis 30G
Smart Sense Mis Lanc 21G
Thinlets GP Mis 26G
Smart Sense Mis Lanc 26G
Thinlets Mis 28g(t)
Smart Sense Mis Lanc 30G
Tier Uni Pls Mis 31GX8MM
Smart Sense Mis Lanc 33G
Topcare Mis Lanc 33G
Smartest Mis Lancets
Travel Lance Mis Adv 28G
Smartest Sol Control
Travel Lance Mis 30G
Soft Touch Mis Lancets
True Metrix Sol Level 1
Softclix Mis Lancets
True Metrix Sol Level 2
Solus V2 Mis Lanc Dev
True Metrix Sol Level 3
Solus V2 Mis Lanc 28G
Truecontrol Liq Level 0
Solus V2 Mis Lanc 30G
Truecontrol Liq Level 1
Solus V2 Sol High
Truedraw Mis Lanc Dev
Solus V2 Sol Low
Truetest Liq Level 1
Sterilance Mis TL 28G
Truetest Liq Level 2
Sterilance Mis TL 30G
Truetest Liq Level 3
Sterilance Mis TL 32G
Truplus Lanc Mis 26G
Sterilance Mis 1.8MM
Truplus Lanc Mis 28G
Super Thin Mis Lanc 28G
Truplus Lanc Mis 30G
Super Thin Mis Lancet
Truplus Lanc Mis 33G
Super Thin Mis Lancets
Ulti-lance Mis CLR Tip
Supreme II Liq High/Low
Ulticare Pen Mis 31GX5MM
Sure Comfort Mis Lanc Pen
Ultilet Insu Mis 30X12.7
Sure Comfort Mis Lanc 18G
Ultilet Insu Mis 31GX6MM
Sure Comfort Mis Lanc 21G
Ultilet Mis Lancets
Sure Comfort Mis Lanc 23G
Ultilet Mis Safety
Sure Comfort Mis Lanc 30G
Ultilet Mis 26G
Sure Comfort Mis Lancets
Ultilet Mis 28G
Sure Comfort Mis 0.5/31G
Ultilet Mis 30G
Sure Comfort Mis 29GX1/2"
Ultilet Mis 33G
Sure Comfort Mis 30GX5/16
Ultilet Pen Mis 29GX12.7
Sure Comfort Mis 31GX3/16
Ultilet Pen Mis 31GX5MM
Sure Comfort Mis 31GX5/16
Ultilet Pen Mis 31GX8MM
Sure Comfort Mis 31GX6MM
Ultilet Pen Mis 32GX4MM
Sure Comfort Mis 32GX5/32
Ultilet Safe Mis 21G
Sure Comfort Mis 32GX6MM
Ultra Thin Mis Lanc 26G
Sure-fine Mis 29GX1/2"
Ultra Thin Mis Lanc 28G
Sure-fine Mis 31GX3/16
Ultra Thin Mis Lanc 30G
Sure-fine Mis 31GX5/16
Ultra Thin Mis Lancets
Sure-lance Mis Lancets
Ultra Thin Mis 28G
Sure-lance Mis 26G
Ultra Thin Mis 30G
Sure-pen Mis
Ultra Thin Mis 31G
Sure-touch Mis Unv Lanc
Ultra Thin Mis 33G
Sureflex Mis Lancets
Ultralance Mis 1.8MM
Surelite Mis Lancets
Ultratrk Pro Sol
Surestep Glu Sol
Ultratrk Pro Sol High/Low
Surestep Glu Sol High/Low
Ultratrk Ult Sol High/Low
Surestep Pro Tes High CON
Unfine Pntp Mis 32GX4MM
Surestep Pro Tes Low CON
Unifine Pntp Mis 29GX1/2"
Surestep Pro Tes Norm CON
Unifine Pntp Mis 29GX12MM
Surestep Sol Control
Unifine Pntp Mis 31GX3/16
Syringe Mis 0.5/30G
Unifine Pntp Mis 31GX5/16
Syringe 0.5 Mis 30G
Unifine Pntp Mis 31GX5MM
SB Lancets Mis Thin
Unifine Pntp Mis 31GX6MM
SB Lancets Mis Ultr Thn
Unifine Pntp Mis 31GX8MM
Tai Doc Sol Norm CON
Unifine Pntp Mis 32GX4MM
Techlite AST Mis Lancets
Unifine Pntp Mis 32GX5/32
Techlite Mis Lanc 30G
Unilet Cmfr Mis Tch 28G
Techlite Mis Lancets
Unilet Cmfr Mis Tch 30G
Telcare Sol Level1/2
Unilet Excel Mis 23G
Tgt Lancet Mis Alternat
Unilet EX II Mis 28G
Tgt Lancet Mis 23G
Unilet G.p Mis Supr 23G
Tgt Lancet Mis 26G
Unilet G.p. Mis 21G
Tgt Lancet Mis 28G
Unilet GP 28 Mis Ult Thin
Tgt Lancet Mis 30G
Unilet Lanc Mis 33G
Tgt Lancet Mis 33G
Unilet Lance Mis 21G
Tgt Lancing Mis Adv Dev
Unilet Lance Mis 28G
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 65
Unilet Lance Mis 33G
Breatherite Mis Spacer
Unilet Lanct Mis 28G
Breatherite Mis W/Mask
Unilet Lanct Mis 30G
Compact Spac Mis Chamber
Unilet Lanct Mis 33G
Compact Spac Mis LG Mask
Unilet Mis 21G
Compact Spac Mis MD Mask
Unilet Super Mis G.p. 23G
Compact Spac Mis Sm Mask
Unilet Super Mis 23G
E-z Spacer Mis
Unistik CZT Mis Comfort
E-z Spacer Mis Body Grd
Unistik CZT Mis Normal
Easivent Mis
Unistik II Mis Lancets
Easivent Mis Mask LG
Unistik Safe Mis Lanc 28G
Easivent Mis Mask MED
Unistik Safe Mis Lanc 30G
Easivent Mis Mask Sm
Unistik Touc Mis Lanc 21G
Flexichamber Mis
Unistik Touc Mis Lanc 23G
Flexichamber Mis Mask Lrg
Unistik Touc Mis Lanc 28G
Flexichamber Mis Mask Sm
Unistik Touc Mis Lanc 30G
Hold Chamber Mis Adlt LG
Unistik 1 Mis 2.4MM
Hold Chamber Mis Medium
Unistik 1 Mis 3.0MM
Hold Chamber Mis Small
Unistik 2 Mis
Inspirachamb Mis Large
Unistik 2 Mis Comfort
Inspirachamb Mis Medium
Unistik 2 Mis Extra
Inspirachamb Mis Mouthpce
Unistik 2 Mis Neonatal
Inspirachamb Mis Small
Unistik 2 Mis Normal
Inspirease Mis Dd Syst
Unistik 2 Mis Super
Inspirease Mis Res Bag
Unistik 2 Mis 1.8MM
Liteaire Mis
Unistik 2 Mis 2.4MM
Mask Vortex/ Mis Baby Duc
Unistik 3 Mis Comfort
Mask Vortex/ Mis Duck
Unistik 3 Mis Extra
Mask Vortex/ Mis Frog
Unistik 3 Mis Gent 30G
Mask Vortex/ Mis Lady Bug
Unistik 3 Mis Neonatal
Microchamber Mis
Unistik 3 Mis Normal
Microspacer Mis
Unistik 3 Mis Xtr 21G
Optichamber Mis Adv Lrg
Unistik 3 Mis 1.8MM
Optichamber Mis Adv MED
Universal 1 Mis Lanc 26G
Optichamber Mis Adv Sm
Universal 1 Mis Lanc 30G
Optichamber Mis Advantag
Universal 1 Mis 33G
Optichamber Mis Dia LG
Vantage Lanc Mis Device
Optichamber Mis Dia MD
Verasens Liq Level 1
Optichamber Mis Dia Sm
Victory Sol Control
Optichamber Mis Diamond
Vitalet Pro Mis
Optichamber Mis Face Mas
Vitalet Pro Mis Plus
Optihaler Mis
W&f Lancets Mis 21G
Panda Mask Mis Large
W&f Lancets Mis 26G
Panda Mask Mis Medium
1ML Syringe Mis 29G
Panda Mask Mis Pediatri
1ML Syringe Mis 30G
Panda Mask Mis Small
1ST Choice Mis Lancets
Pocket Chamb Mis
1ST Tier Uni Mis 29GX12MM
Pocket Space Mis
1ST Tier Uni Mis 31GX5MM
Riteflo Mis
1ST Tier Uni Mis 31GX6MM
Valvd Holdng Mis Chamber
1ST Tier Uni Mis 31GX8MM
Vortex Valve Mis Chamber
1ST Tier Uni Mis 32GX4MM
Watchhaler Mis
MEDICAL DEVICES - MISC
MISCELLANEOUS AGENTS
TIER 02 PREFERRED
Aerchmbr Pls Mis Flow-VU
TIER 04 SPECIALTY
Aerchmbr Pls Mis Lrg Mask
Cuprimine CAP 250MGQL,PA
Aerchmbr Pls Mis MED Mask
Depen Titra TAB 250MGQL,PA
Aerchmbr Pls Mis Sm Mask
Exjade TAB 125MGQL,PA
Aerchmbr Z- Mis Stat Pls
Exjade TAB 250MGQL,PA
Aerochamber Mis Chamber
Exjade TAB 500MGQL,PA
Aerochamber Mis Flosigna
Ferriprox TAB 500MGQL,PA
Aerochamber Mis MV
Jadenu Sprkl Gra 180MGQL,PA
Aerochamber Mis Plus
Jadenu Sprkl Gra 360MGQL,PA
Aerovent Mis Plus
Jadenu Sprkl Gra 90MGQL,PA
Arial Mis Chamber
Jadenu TAB 180MGQL,PA
Breatherite Mis
Jadenu TAB 360MGQL,PA
Breatherite Mis LG Mask
Jadenu TAB 90MGQL,PA
Breatherite Mis MED Mask
TIER 03 NON PREFERRED
Breatherite Mis Sm Mask
Chemet CAP 100MGPA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 66
Ferriprox Sol 100MG/MLPA
Effective January 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 67
Index
A
Aciphex TAB 20MG, 31
Adderall TAB 5MG, 42
acitretin CAP 10MG, 18
Adderall TAB 7.5MG, 42
abaca/lamivu TAB 600-300, 4
acitretin CAP 17.5MG, 18
Adderall XR CAP 10MG, 41
abacav/lamiv TAB /zidovud, 4
acitretin CAP 25MG, 18
Adderall XR CAP 15MG, 41
abacavir sol 20MG/ML, 3
Aclovate CRE 0.05%, 19
Adderall XR CAP 20MG, 41
abacavir TAB 300MG, 3
Actemra Inj 162/0.9, 54
Adderall XR CAP 25MG, 41
Abilify Main Inj 300MG, 39
Acthib Inj, 58
Adderall XR CAP 30MG, 41
Abilify Main Inj 400MG, 39
Acti-lance Mis 28G, 60
Adderall XR CAP 5MG, 42
Abilify TAB 10MG, 40
Acti-lance Mis Lite 28G, 60
Addyi TAB 100MG, 47
Abilify TAB 15MG, 40
Acti-lance Mis Spec 17G, 60
adefov dipiv TAB 10MG, 4
Abilify TAB 20MG, 40
Acti-lance Mis Univ 23G, 60
Adempas TAB 0.5MG, 15
Abilify TAB 2MG, 40
Acticlate TAB 150MG, 2
Adempas TAB 1.5MG, 15
Abilify TAB 30MG, 40
Acticlate TAB 75MG, 2
Adempas TAB 1MG, 15
Abilify TAB 5MG, 40
Actigall CAP 300MG, 32
Adempas TAB 2.5MG, 15
Absorica CAP 10MG, 16
Actimmune Inj 2mu/0.5, 8
Adempas TAB 2MG, 15
Absorica CAP 20MG, 16
Actiq Loz 1200mcg, 52
Adj Lancing Mis Device, 60
Absorica CAP 25MG, 16
Actiq Loz 1600mcg, 52
Adlyxin Inj 10/20mcg, 25
Absorica CAP 30MG, 16
Actiq Loz 200mcg, 52
Adlyxin Inj 20mcg, 25
Absorica CAP 35MG, 16
Actiq Loz 400mcg, 52
Adoxa CAP 150MG, 2
Absorica CAP 40MG, 16
Actiq Loz 600mcg, 52
Adoxa PAK 1/ TAB 100MG, 2
Abstral Sub 100mcg, 52
Actiq Loz 800mcg, 52
Adoxa PAK 1/ TAB 150MG, 2
Abstral Sub 200mcg, 52
Active 1ST Mis Lanc 30G, 60
Adoxa PAK 2/ TAB 100MG, 2
Abstral Sub 300mcg, 52
Activella TAB 0.5-0.1, 22
Adoxa TAB 100MG, 2
Abstral Sub 400mcg, 52
Activella TAB 1-0.5MG, 22
Adoxa TAB 50MG, 2
Abstral Sub 600mcg, 52
Actonel TAB 150MG, 27
Adoxa TAB 75MG, 2
Abstral Sub 800mcg, 52
Actonel TAB 30MG, 27
Adrenaclick Inj 0.15MG, 14
acampro CAL TAB 333MG, 45
Actonel TAB 35MG, 27
Adrenaclick Inj 0.3MG, 14
Acanya Gel 1.2-2.5%, 16
Actonel TAB 5MG, 27
Adrenalin Sol 1:1000, 56
acarbose TAB 100MG, 26
Actoplus Met TAB 15-500MG, 26
Adv Allergy Kit Collecti, 19
acarbose TAB 25MG, 26
Actoplus Met TAB 15-850MG, 26
Adv Lancing Mis Device, 60
acarbose TAB 50MG, 26
Actoplus Met TAB XR, 26
Adv Travel Mis Lanc 28G, 60
Accolate TAB 10MG, 57
Actos TAB 15MG, 26
Advair Disku Aer 100/50, 57
Accolate TAB 20MG, 57
Actos TAB 30MG, 26
Advair Disku Aer 250/50, 57
Accu-chek Kit Fastclix, 60
Actos TAB 45MG, 26
Advair Disku Aer 500/50, 57
Accu-chek Kit Mlticlix, 60
Acuicyn Liq, 20
Advair HFA Aer 115/21, 57
Accu-chek Kit Softclix, 60
Acular LS Sol 0.4%, 50
Advair HFA Aer 230/21, 57
Accu-chek Liq Act/Gluc, 60
Acular Sol 0.5% Op, 50
Advair HFA Aer 45/21, 57
Accu-chek Liq Guide, 60
Acura Contrl Sol High, 60
Advance Liq Control, 60
Accu-chek Liq Smart, 60
Acura Contrl Sol Low, 60
Advance Liq Intuitio, 60
Accu-chek Mis Mlticlix, 60
Acura Contrl Sol Normal, 60
Advance Norm Liq Control, 60
Accu-chek Sol, 60
Acuvail Sol 0.45%, 50
Advcate Safe Mis Lanc 26G, 60
Accu-chek Sol Compact, 60
acyclovir CAP 200MG, 3
Advicor TAB 1000-20, 15
Accupril TAB 10MG, 11
acyclovir oin 5%, 18
Advicor TAB 1000-40, 15
Accupril TAB 20MG, 11
acyclovir sus 200/5ML, 3
Advicor TAB 500-20MG, 15
Accupril TAB 40MG, 11
acyclovir TAB 400MG, 3
Advicor TAB 750-20MG, 15
Accupril TAB 5MG, 11
acyclovir TAB 800MG, 3
Advocate Liq High, 60
Accuretic TAB 10-12.5, 13
Aczone Gel 5%, 16
Advocate Liq Low, 60
Accuretic TAB 20-12.5, 13
Aczone Gel 7.5%, 16
Advocate Mis Lanc 30G, 60
Accuretic TAB 20-25MG, 13
Adacel Inj, 58
Advocate Mis Lanc Dev, 60
Accutrend Sol Glucose, 60
Adalat CC TAB 30MG ER, 10
Advocate Mis Lancets, 60
Ace Acd/Alum Sol 2% Otic, 50
Adalat CC TAB 60MG ER, 10
Advocate+ Sol Redi-cod, 60
acebutolol CAP 200MG, 9
Adalat CC TAB 90MG ER, 10
Adyphren Amp Kit 1MG/ML, 14
acebutolol CAP 400MG, 9
adapal/ben p gel 0.1-2.5%, 16
Adyphren II Kit, 14
Aceon TAB 4MG, 11
adapalene CRE 0.1%, 16
Adyphren Kit, 14
Aceon TAB 8MG, 11
adapalene gel 0.1%, 16
Adzenys XR TAB 12.5MG, 42
acetasol HC sol otic, 50
adapalene gel 0.3%, 16
Adzenys XR TAB 15.7 MG, 42
acetazolamid CAP 500MG ER, 13
adapalene gel pmp 0.3%, 16
Adzenys XR TAB 18.8MG, 42
acetazolamid inj 500MG, 14
Adapalene Lot 0.1%, 16
Adzenys XR TAB 3.1MG, 42
acetazolamid TAB 125MG, 13
Adazin CRE, 20
Adzenys XR TAB 6.3MG, 42
acetazolamid TAB 250MG, 13
Adcirca TAB 20MG, 15
Adzenys XR TAB 9.4MG, 42
acetic acid sol 0.25%irr, 34
Adderall TAB 10MG, 42
Aerchmbr Pls Mis Flow-VU, 66
acetic acid sol 2% otic, 50
Adderall TAB 12.5MG, 42
Aerchmbr Pls Mis Lrg Mask, 66
acetylcyst sol 10%, 56
Adderall TAB 15MG, 42
Aerchmbr Pls Mis MED Mask, 66
acetylcyst sol 20%, 56
Adderall TAB 20MG, 42
Aerchmbr Pls Mis Sm Mask, 66
Aciphex Spr CAP 10MG, 31
Adderall TAB 30MG, 42
Aerchmbr Z- Mis Stat Pls, 66
Aciphex Spr CAP 5MG, 31
Aerochamber Mis Chamber, 66
Alendronate Sol 70/75ML, 27
altafrin sol 2.5% op, 49
Aerochamber Mis Flosigna, 66
alendronate TAB 10MG, 27
altavera TAB, 23
Aerochamber Mis MV, 66
alendronate TAB 35MG, 27
Altoprev TAB 20MG ER, 15
Aerochamber Mis Plus, 66
Alendronate TAB 40MG, 27
Altoprev TAB 40MG ER, 15
Aerospan Aer 80mcg, 57
alendronate TAB 5MG, 27
Altoprev TAB 60MG ER, 15
Aerovent Mis Plus, 66
alendronate TAB 70MG, 27
Altrnate Sit Mis Device, 60
AF Lancets Mis Thin, 60
alfentanil inj 500/ML, 52
Alunbrig TAB 30MG, 7
afeditab TAB 30MG CR, 9
Alfentanil Inj 500/ML, 52
Aluvea CRE 39%, 20
afeditab TAB 60MG CR, 9
Alferon N Inj 5mu/ML, 8
Alvesco Aer 160mcg, 57
Afinitor Dis TAB 2MG, 7
alfuzosin TAB 10MG ER, 34
Alvesco Aer 80mcg, 57
Afinitor Dis TAB 3MG, 7
Alinia Sus 100/5ML, 5
alyacen TAB 1/35, 23
Afinitor Dis TAB 5MG, 7
Alinia TAB 500MG, 5
alyacen TAB 7/7/7, 23
Afinitor TAB 10MG, 7
Alkeran TAB 2MG, 6
amabelz TAB 0.5-0.1, 22
Afinitor TAB 2.5MG, 7
allopurinol TAB 100MG, 55
amabelz TAB 1-0.5MG, 22
Afinitor TAB 5MG, 7
allopurinol TAB 300MG, 55
amantadine CAP 100MG, 44
Afinitor TAB 7.5MG, 7
Allzital TAB 25-325MG, 51
amantadine syp 50MG/5ML, 44
Afluria Inj 2015-16, 58
almotrip mal TAB 12.5MG, 55
amantadine TAB 100MG, 44
Afluria Inj 2016-17, 58
almotrip mal TAB 6.25MG, 55
Amaryl TAB 1MG, 25
Afluria Inj 2017-18, 58
almotriptan TAB 12.5MG, 55
Amaryl TAB 2MG, 25
Afluria Inj PF 15-16, 58
almotriptan TAB 6.25MG, 55
Amaryl TAB 4MG, 25
Afluria Inj PF 16-17, 58
Alocril Sol 2%, 50
Ambien CR TAB 12.5MG, 41
Afluria Inj PF 17-18, 58
Alog/Pioglit TAB 12.5-15, 26
Ambien CR TAB 6.25MG, 41
Afluria Quad Inj 2017-18, 58
Alog/Pioglit TAB 12.5-30, 26
Ambien TAB 10MG, 41
Afluria Quad Inj PF 16-17, 58
Alog/Pioglit TAB 12.5-45, 26
Ambien TAB 5MG, 41
Afluria Quad Inj PF 17-18, 58
Alog/Pioglit TAB 25-15MG, 26
Amcinonide CRE 0.1%, 19
Afrezza Pow 12 Unit, 25
Alog/Pioglit TAB 25-30MG, 26
Amcinonide Lot 0.1%, 19
Afrezza Pow 4&8 Unit, 25
Alog/Pioglit TAB 25-45MG, 26
Amcinonide Oin 0.1%, 19
Afrezza Pow 4/8/12un, 25
Alogliptin TAB 12.5MG, 26
Amerge TAB 1MG, 55
Afrezza Pow 4unit, 25
Alogliptin TAB 25MG, 26
Amerge TAB 2.5MG, 55
Afrezza Pow 8 Unit, 25
Alogliptin TAB 6.25MG, 26
amethia LO TAB, 23
Afrezza Pow 8&12unit, 25
Alogliptin/ TAB Metform, 26
amethia TAB, 23
aftera TAB 1.5MG, 23
Alomide Sol 0.1% Op, 50
amethyst TAB 90-20mcg, 23
Agamatrix Mis 33G, 60
alophen TAB 5MG EC, 29
Amicar Sol 0.25/ML, 36
Agamatrix Sol High, 60
Alora Dis 0.025MG, 22
Amicar TAB 1000MG, 36
Agamatrix Sol Norm/Hgh, 60
Alora Dis 0.05MG, 22
Amicar TAB 500MG, 36
Agamatrix Sol Normal, 60
Alora Dis 0.075MG, 22
amilor/hctz TAB 5-50, 13
Aggrenox CAP 25-200MG, 36
Alora Dis 0.1MG, 22
amiloride TAB 5MG, 13
agoneaze kit 2.5-2.5%, 20
alosetron TAB 0.5MG, 32
amiodarone TAB 100MG, 11
Agrylin CAP 0.5MG, 36
alosetron TAB 1MG, 32
amiodarone TAB 200MG, 10
Airduo Respi Inh 113-14, 57
Aloxi Inj 0.25MG/5, 31
amiodarone TAB 400MG, 11
Airduo Respi Inh 232-14, 57
Alphagan P Sol 0.1%, 49
Amitiza CAP 24mcg, 32
Airduo Respi Inh 55-14, 57
Alphagan P Sol 0.15%, 49
Amitiza CAP 8mcg, 32
ak-poly-bac oin op, 48
alphatrex gel 0.05%, 18
amitriptylin TAB 100MG, 37
Akten Gel 3.5%, 50
Alprazolam CON 1 MG/ML, 37
amitriptylin TAB 10MG, 37
Akynzeo CAP 300-0.5, 31
alprazolam TAB 0.25 odt, 37
amitriptylin TAB 150MG, 37
Ala Scalp Lot 2%, 19
alprazolam TAB 0.25MG, 36
amitriptylin TAB 25MG, 37
ala-cort CRE 1%, 19
alprazolam TAB 0.5MG, 36
amitriptylin TAB 50MG, 37
ala-cort CRE 2.5%, 18
alprazolam TAB 0.5MG ER, 37
amitriptylin TAB 75MG, 37
Albenza TAB 200MG, 5
alprazolam TAB 0.5MG od, 37
amlod/atorva TAB 10-10MG, 15
albuterol neb 0.083%, 57
alprazolam TAB 0.5MG XR, 37
amlod/atorva TAB 10-20MG, 15
albuterol neb 0.5%, 57
alprazolam TAB 1MG, 37
amlod/atorva TAB 10-40MG, 15
albuterol neb 0.63MG/3, 57
alprazolam TAB 1MG ER, 37
amlod/atorva TAB 10-80MG, 15
albuterol neb 1.25MG/3, 57
alprazolam TAB 1MG odt, 37
amlod/atorva TAB 2.5-10MG, 16
albuterol syp 2MG/5ML, 57
alprazolam TAB 1MG XR, 37
amlod/atorva TAB 2.5-20MG, 16
albuterol TAB 2MG, 57
alprazolam TAB 2MG, 37
amlod/atorva TAB 2.5-40MG, 16
albuterol TAB 4MG, 57
alprazolam TAB 2MG ER, 37
amlod/atorva TAB 5-10MG, 16
albuterol TAB 4MG ER, 57
alprazolam TAB 2MG odt, 37
amlod/atorva TAB 5-20MG, 16
albuterol TAB 8MG ER, 57
alprazolam TAB 2MG XR, 37
amlod/atorva TAB 5-40MG, 16
Alcaine Sol 0.5% Op, 50
alprazolam TAB 3MG ER, 37
amlod/atorva TAB 5-80MG, 16
alclometason CRE 0.05%, 19
alprazolam TAB 3MG XR, 37
amlod/benazp CAP 10-20MG, 12
alclometason oin 0.05%, 19
Alrex Sus 0.2%, 49
amlod/benazp CAP 10-40MG, 12
Aldactazide TAB 25/25, 14
Altabax Oin 1%, 17
amlod/benazp CAP 2.5-10MG, 12
Aldactazide TAB 50/50, 14
altacaine sol 0.5% op, 50
amlod/benazp CAP 5-10MG, 12
Aldactone TAB 100MG, 14
Altace CAP 1.25MG, 11
amlod/benazp CAP 5-20MG, 12
Aldactone TAB 25MG, 14
Altace CAP 10MG, 11
amlod/benazp CAP 5-40MG, 12
Aldactone TAB 50MG, 14
Altace CAP 2.5MG, 11
amlod/olmesa TAB 10-20MG, 12
Aldara CRE 5%, 20
Altace CAP 5MG, 11
amlod/olmesa TAB 10-40MG, 12
Alecensa CAP 150MG, 7
altafrin sol 10% op, 49
amlod/olmesa TAB 5-20MG, 12
amlod/olmesa TAB 5-40MG, 12
Anadrol-50 TAB 50MG, 22
Aqua Lance Mis Lanc Dev, 60
amlod/valsar TAB /hctz, 12
Anafranil CAP 25MG, 38
Aquoral Aer, 36
amlod/valsar TAB 10-160MG, 12
Anafranil CAP 50MG, 38
Aquoral Spr, 36
amlod/valsar TAB 10-320MG, 12
Anafranil CAP 75MG, 38
aranelle TAB, 23
amlod/valsar TAB 5-160MG, 12
anagrelide CAP 0.5MG, 36
Aranesp Inj 100mcg, 35
amlod/valsar TAB 5-320MG, 12
anagrelide CAP 1MG, 36
Aranesp Inj 10mcg, 35
amlodipine TAB 10MG, 9
Analpram-HC CRE 1-1%, 32
Aranesp Inj 150mcg, 35
amlodipine TAB 2.5MG, 9
Analpram-HC Lot 2.5%, 32
Aranesp Inj 200mcg, 35
amlodipine TAB 5MG, 9
Anaprox DS TAB 550MG, 54
Aranesp Inj 25mcg, 35
ammonium lac CRE 12%, 20
Anaspaz TAB 0.125MG, 31
Aranesp Inj 300mcg, 35
ammonium lac lot 12%, 20
Anastia Lot 2.75%, 20
Aranesp Inj 40mcg, 35
amnesteem CAP 10MG, 16
anastrozole TAB 1MG, 6
Aranesp Inj 500mcg, 35
amnesteem CAP 20MG, 16
Ancobon CAP 250MG, 3
Aranesp Inj 60mcg, 35
amnesteem CAP 40MG, 16
Ancobon CAP 500MG, 3
Arava TAB 10MG, 54
amox-pot cla TAB ER, 1
Androderm Dis 2MG/24HR, 22
Arava TAB 20MG, 54
Amox/K Clav Chw 200MG, 1
Androderm Dis 4MG/24HR, 22
arbinoxa sol 4MG/5ML, 56
Amox/K Clav Chw 400MG, 1
Androgel Gel 1%(25MG), 22
arbinoxa TAB 4MG, 56
amox/k clav sus 200/5ML, 1
Androgel Gel 1%(50MG), 22
Arcalyst Inj 220MG, 54
amox/k clav sus 250/5ML, 1
Androgel Gel 1.62%, 22
Arcapta CAP 75mcg, 57
amox/k clav sus 400/5ML, 1
Android CAP 10MG, 22
argyl saline sol 0.9%, 34
amox/k clav sus 600/5ML, 1
Androxy TAB 10MG, 22
Arial Mis Chamber, 66
amox/k clav TAB 250-125, 1
Angeliq TAB 0.25-0.5, 22
Aricept TAB 10MG, 47
amox/k clav TAB 500-125, 1
Angeliq TAB 0.5-1MG, 23
Aricept TAB 23MG, 47
amox/k clav TAB 875-125, 1
anodyne lpt kit 2.5-2.5%, 20
Aricept TAB 5MG, 47
Amoxapine TAB 100MG, 38
anodynz mis 0.0375-5, 20
Arimidex TAB 1MG, 6
Amoxapine TAB 150MG, 38
Anoro Ellipt Aer 62.5-25, 57
aripiprazole sol 1MG/ML, 39
Amoxapine TAB 25MG, 38
Antabuse TAB 250MG, 47
aripiprazole TAB 10MG, 39
Amoxapine TAB 50MG, 38
Antabuse TAB 500MG, 47
aripiprazole TAB 10MG odt, 40
amoxicillin CAP 250MG, 1
Antara CAP 30MG, 15
aripiprazole TAB 15MG, 39
amoxicillin CAP 500MG, 1
Antara CAP 90MG, 15
aripiprazole TAB 15MG odt, 40
Amoxicillin Chw 125MG, 1
anucort-HC sup 25MG, 32
aripiprazole TAB 20MG, 39
Amoxicillin Chw 250MG, 1
Anusol-HC CRE 2.5%, 32
aripiprazole TAB 2MG, 39
amoxicillin sus 125/5ML, 1
anusol-HC sup 25MG, 32
aripiprazole TAB 30MG, 39
amoxicillin sus 200/5ML, 1
Anzemet TAB 100MG, 31
aripiprazole TAB 5MG, 39
amoxicillin sus 250/5ML, 1
Anzemet TAB 50MG, 31
Aristada Inj 1064MG, 39
amoxicillin sus 250MG/5m, 1
Apap-caffein CAP Dihydroc, 52
Aristada Inj 441MG/1., 39
amoxicillin sus 400/5ML, 1
Apap/Caffein TAB Dihydroc, 52
Aristada Inj 662MG/2, 39
amoxicillin TAB 500MG, 1
apap/codeine sol 120-12/5, 51
Aristada Inj 882MG/3, 39
Amoxicillin TAB 775MG, 1
apap/codeine TAB 300-15MG, 51
Arixtra Inj 10/0.8ML, 36
amoxicillin TAB 875MG, 1
apap/codeine TAB 300-30MG, 51
Arixtra Inj 2.5/0.5, 36
amphet/dextr CAP 10MG ER, 41
apap/codeine TAB 300-60MG, 51
Arixtra Inj 5/0.4ML, 36
amphet/dextr CAP 15MG ER, 41
Apexicon E CRE 0.05%, 19
Arixtra Inj 7.5/0.6, 36
amphet/dextr CAP 20MG ER, 41
Apidra Inj Solostar, 25
armodafinil TAB 150MG, 42
amphet/dextr CAP 25MG ER, 41
Apidra Inj U-100, 25
armodafinil TAB 200MG, 42
amphet/dextr CAP 30MG ER, 41
Aplenzin TAB 174MG, 38
armodafinil TAB 250MG, 42
amphet/dextr CAP 5MG ER, 41
Aplenzin TAB 348MG, 38
armodafinil TAB 50MG, 42
amphet/dextr TAB 10MG, 41
Aplenzin TAB 522MG, 38
Armonair Aer 113/Act, 57
amphet/dextr TAB 12.5MG, 41
Apokyn Inj 10MG/ML, 45
Armonair Aer 232/Act, 57
amphet/dextr TAB 15MG, 41
apraclonidin sol 0.5% op, 49
Armonair Aer 55/Act, 57
amphet/dextr TAB 20MG, 41
aprepitant CAP 125MG, 31
Armour Thyro TAB 120MG, 29
amphet/dextr TAB 30MG, 41
aprepitant CAP 40MG, 31
Armour Thyro TAB 180MG, 29
amphet/dextr TAB 5MG, 41
aprepitant CAP 80MG, 31
Armour Thyro TAB 240MG, 29
amphet/dextr TAB 7.5MG, 41
aprepitant PAK 80 & 125, 31
Armour Thyro TAB 300MG, 29
Amphotericin Inj 50MG, 3
apri TAB, 23
Arnuity Elpt Inh 100mcg, 57
ampicillin CAP 250MG, 1
Apriso CAP 0.375gm, 32
Arnuity Elpt Inh 200mcg, 57
ampicillin CAP 500MG, 1
Aptensio XR CAP 10MG, 42
Aromasin TAB 25MG, 6
Ampicillin CAP 500MG, 1
Aptensio XR CAP 15MG, 42
Arthrotec 50 TAB, 54
Ampicillin Inj 125MG, 1
Aptensio XR CAP 20MG, 42
Arthrotec 75 TAB, 55
ampicillin inj 1gm, 1
Aptensio XR CAP 30MG, 42
Arymo ER TAB 15MG, 52
ampicillin inj 250MG, 1
Aptensio XR CAP 40MG, 42
Arymo ER TAB 30MG, 52
ampicillin inj 500MG, 1
Aptensio XR CAP 50MG, 42
Arymo ER TAB 60MG, 52
Ampicillin Sus 125/5ML, 1
Aptensio XR CAP 60MG, 42
asa low dose TAB 81MG EC, 50
Ampicillin Sus 250/5ML, 1
Aptiom TAB 200MG, 43
asa/dipyrida CAP 25-200MG, 36
Ampyra TAB 10MG, 47
Aptiom TAB 400MG, 43
Asacol HD TAB 800MG, 32
Amrix CAP 15MG, 48
Aptiom TAB 600MG, 43
ascomp/cod CAP 30MG, 52
Amrix CAP 30MG, 48
Aptiom TAB 800MG, 43
ashlyna TAB, 23
Amytal Sod Inj 500MG, 41
Aptivus CAP 250MG, 4
Asmanex 120 Aer 220mcg, 57
Anacaine Oin, 20
Aptivus Sol, 4
Asmanex 14 Aer 220mcg, 57
Asmanex 30 Aer 110mcg, 57
Ativan TAB 1MG, 37
Avapro TAB 150MG, 11
Asmanex 30 Aer 220mcg, 57
Ativan TAB 2MG, 37
Avapro TAB 300MG, 11
Asmanex 60 Aer 220mcg, 57
atomoxetine CAP 100MG, 41
Avapro TAB 75MG, 11
Asmanex 7 Aer 110mcg, 57
atomoxetine CAP 10MG, 41
Avar Aer 9.5-5%, 16
Asmanex HFA Aer 100 Mcg, 57
atomoxetine CAP 18MG, 41
avar cleanse emu 10-5%, 16
Asmanex HFA Aer 200 Mcg, 57
atomoxetine CAP 25MG, 41
Avar LS Aer 10-2%, 16
aspir-81 TAB 81MG EC, 50
atomoxetine CAP 40MG, 41
Avar LS Liq 10-2%, 16
aspir-low TAB 81MG EC, 50
atomoxetine CAP 60MG, 41
Avar LS Pad 10-2%, 16
aspirin 81 TAB 81MG EC, 50
atomoxetine CAP 80MG, 41
Avar Pad 9.5-5%, 16
aspirin adlt TAB 81MG, 50
Atopiclair CRE, 20
avar-e emoll CRE 10-5%, 16
aspirin chil chw 81MG, 50
atorvastatin TAB 10MG, 14
avar-e green CRE 10-5%, 16
aspirin chld chw 81MG, 50
atorvastatin TAB 20MG, 14
Avar-e LS CRE 10-2%, 17
aspirin chw 81MG, 50
atorvastatin TAB 40MG, 14
Avc CRE 15%, 33
aspirin low chw 81MG, 50
atorvastatin TAB 80MG, 14
Avelox Abc TAB 400MG, 3
aspirin low TAB 81MG, 50
atovaq/progu TAB 250-100, 5
Avelox TAB 400MG, 3
aspirin low TAB 81MG EC, 50
atovaq/progu TAB 62.5-25, 5
Avenova Sol 0.01%, 20
aspirin TAB 325MG, 50
atovaquone sus 750/5ML, 5
Avenova Sol Neutrox, 20
aspirin TAB 325MG EC, 50
Atralin Gel 0.05%, 16
aviane TAB, 23
aspirin TAB 5gr EC, 50
Atripla TAB, 4
avidoxy TAB 100MG, 2
aspirin TAB 81MG, 50
Atropine SUL Oin 1% Op, 49
avita CRE 0.025%, 16
Aspirin TAB 81MG, 51
Atropine SUL Sol 1% Op, 49
avita gel 0.025%, 16
aspirin TAB 81MG EC, 50
Atrovent HFA Aer 17mcg, 57
Avodart CAP 0.5MG, 34
aspirin-81 chw 81MG, 50
Atrovent Nas Sol 0.03%, 56
Avonex Kit 30mcg, 47
aspirtab TAB 324MG EC, 50
Atrovent Nas Sol 0.06%, 56
Avonex Pen Kit 30mcg, 47
Assure 3 Liq Control, 60
Aubagio TAB 14MG, 47
Avonex Prefl Kit 30mcg, 47
Assure 4 Liq Level1/2, 60
Aubagio TAB 7MG, 47
Axert TAB 12.5MG, 55
Assure Cmfrt Mis 28G, 60
aubra TAB 0.1-0.02, 23
Axert TAB 6.25MG, 55
Assure Cmfrt Mis 30G, 60
aug betamet CRE 0.05%, 18
Axiron Sol 30MG/Act, 22
Assure Dose Sol Norm/Hgh, 60
aug betamet gel 0.05%, 18
Aygestin TAB 5MG, 25
Assure Dose Sol Normal, 60
aug betamet lot 0.05%, 18
Azasan TAB 100MG, 7
Assure II Liq Level 1, 60
aug betamet oin 0.05%, 18
Azasan TAB 75 MG, 7
Assure II Liq Level1/2, 60
Augmentin Sus 125/5ML, 1
Azasite Sol 1%, 48
Assure Lance Mis 21G, 60
Augmentin Sus 250/5ML, 1
azathioprine TAB 50MG, 7
Assure Lance Mis Low Flow, 60
Augmentin Sus ES-600, 1
azelastine dro 0.05%, 50
Assure Lance Mis Micro, 60
Augmentin TAB 500MG, 1
azelastine spr 0.1%, 56
Assure Lance Mis Safe 25G, 60
Augmentin TAB 875MG, 1
azelastine spr 0.15%, 56
Assure Lance Mis Safe 30G, 60
Augmentin XR TAB 12HR, 1
Azelex CRE 20%, 16
Assure Mis Lancets, 60
Aurora Lance Mis 30G, 60
Azenase PAK Mis 137-50, 56
Assure Plus Mis High 18G, 60
Aurora Lance Mis Thin 23G, 60
Azilect TAB 0.5MG, 45
Assure Plus Mis Low 25G, 60
Auryxia TAB 210MG, 32
Azilect TAB 1MG, 45
Assure Plus Mis Mcro 28G, 60
Austedo TAB 12MG, 47
Azithromycin Pow 1gm PAK, 2
Assure Plus Mis Norm 21G, 60
Austedo TAB 6MG, 47
azithromycin sus 100/5ML, 2
Assure Plus Mis Pediatri, 60
Austedo TAB 9MG, 47
azithromycin sus 200/5ML, 2
Assure Prism Sol Level1/2, 60
Auto Lancet Mis, 60
azithromycin TAB 250MG, 2
Assure Pro Liq Level1/2, 60
Auto-lancet Mis, 60
azithromycin TAB 500MG, 2
Astagraf XL CAP 0.5MG, 7
Auto-lancet Mis Mini, 60
azithromycin TAB 600MG, 2
Astagraf XL CAP 1MG, 7
Autolet II Kit Clinisaf, 60
Azopt Sus 1% Op, 50
Astagraf XL CAP 5MG, 7
Autolet Impr Mis Lanc Dev, 60
Azor TAB 10-20MG, 13
Astepro Spr 0.15%, 56
Autolet Lanc Mis Device, 60
Azor TAB 10-40MG, 13
Astero Gel 4%, 20
Autolet Lite Kit, 60
Azor TAB 5-20MG, 13
AT Last Mis Lancets, 60
Autolet Lite Kit Clinisaf, 60
Azor TAB 5-40MG, 13
AT Last Sol Control, 60
Autolet Lite Kit Starter, 60
Azulfidine TAB 500MG, 32
Atabex Chw Prenatal, 59
Autolet Mini Mis, 60
Azulfidine TAB 500MG En, 32
Atacand HCT TAB 16-12.5, 13
Autolet Plat Mis 1.8MM, 60
azuphen mb CAP 120MG, 33
Atacand HCT TAB 32-12.5, 13
Autolet Plat Mis 2.4MM, 60
azurette TAB 28 day, 23
Atacand HCT TAB 32-25MG, 13
Autolet Plat Mis 3.0MM, 60
B
Atacand TAB 16MG, 11
Autolet Plus Mis, 60
Baby Ddrops Liq 400unit, 59
Atacand TAB 32MG, 11
Autolet Plus Mis Lanc Dev, 60
Baby Super Dro Daily D3, 59
Atacand TAB 4MG, 11
Autoshield Mis 29X3/16", 60
Baby Vit D Dro 400/.028, 59
Atacand TAB 8MG, 11
Autoshield Mis 29X5/16", 60
bacit/polymy oin op, 48
Atelvia TAB, 27
Autoshield Mis 30GX3/16, 60
Bacitracin Oin Op, 48
atenol/chlor TAB 100-25MG, 12
Auvi-q Inj 0.15MG, 14
baclofen TAB 10MG, 48
atenol/chlor TAB 50-25MG, 12
Auvi-q Inj 0.3MG, 14
baclofen TAB 20MG, 48
atenolol TAB 100MG, 9
Avalide TAB 150-12.5, 13
Bactrim DS TAB 800-160, 6
atenolol TAB 25MG, 9
Avalide TAB 300-12.5, 13
Bactrim TAB 400-80MG, 6
atenolol TAB 50MG, 9
Avandia TAB 2MG, 26
Bactroban CRE 2%, 17
Ativan Inj 2MG/ML, 37
Avandia TAB 4MG, 26
Bactroban Oin 2%, 17
Ativan TAB 0.5MG, 37
Avandia TAB 8MG, 26
Bactroban Oin Nasal 2%, 56
balsalazide CAP 750MG, 32
Benziq Gel 5.25%, 17
bisoprol fum TAB 5MG, 9
balziva TAB, 23
Benziq LS Gel 2.75%, 17
Bleph-10 Sol 10% Op, 48
Banzel Sus 40MG/ML, 43
benzonatate CAP 100MG, 56
Blephamide Oin S.o.p., 49
Banzel TAB 200MG, 43
benzonatate CAP 150MG, 56
Blephamide Sus Op, 49
Banzel TAB 400MG, 43
benzonatate CAP 200MG, 56
blisovi 24 TAB FE 1/20, 23
Baraclude Sol .05MG/ML, 4
benztropine inj 1MG/ML, 44
blisovi FE TAB 1.5/30, 23
Baraclude TAB 0.5MG, 4
benztropine TAB 0.5MG, 44
blisovi FE TAB 1/20, 23
Baraclude TAB 1MG, 4
benztropine TAB 1MG, 44
Bocasal Pow, 36
Basaglar Inj 100unit, 25
benztropine TAB 2MG, 44
Boniva TAB 150MG, 27
Baxdela TAB 450MG, 2
Bepreve Dro 1.5%, 50
Boostrix Inj, 58
bayer adv TAB 325MG, 50
Berinert Inj 500unit, 36
Bosulif TAB 100MG, 7
bayer asa TAB 325MG, 50
Besivance Sus 0.6%, 48
Bosulif TAB 500MG, 7
Bayer Breeze Liq High Cnt, 60
beta diprop gel 0.05%, 18
bp 10-1 emu, 16
Bayer Breeze Liq Low Cntl, 60
beta-phos/ac inj 3-3MG/ML, 21
Bp Cleansing Emu 10-4%, 17
Bayer Breeze Liq Norm Cnt, 60
Betadine Sol 5% Op, 48
bpm pseudo TAB 6-45MG, 56
Bayer Breeze Mis 2 Test, 60
Betagan Sol 0.5% Op, 49
bpm TAB 6MG, 56
bayer low chw 81MG, 50
betameth dip CRE 0.05%, 18
bpo cloths mis 6%, 16
bayer low TAB 81MG EC, 50
betameth dip lot 0.05%, 18
Brainstrong Mis Prenatal, 59
Bayer Micrlt Mis Lanc Dvc, 61
betameth dip oin 0.05%, 18
Breatherite Mis, 66
Bayer Micrlt Mis Lancets, 61
betameth val aer 0.12%, 18
Breatherite Mis LG Mask, 66
BD Lancet Mis Device, 61
betameth val CRE 0.1%, 18
Breatherite Mis MED Mask, 66
BD Lancet UF Mis 30G, 61
betameth val lot 0.1%, 18
Breatherite Mis Sm Mask, 66
BD Lancet UF Mis 33G, 61
betameth val oin 0.1%, 18
Breatherite Mis Spacer, 66
BD Microtain Mis Lancets, 61
Betapace AF TAB 120MG, 9
Breatherite Mis W/Mask, 66
BD Pen Needl Mis 29GX1/2", 61
Betapace AF TAB 160MG, 9
Breo Ellipta Inh 100-25, 57
BD Pen Needl Mis 31GX3/16, 61
Betapace AF TAB 80MG, 9
Breo Ellipta Inh 200-25, 57
BD Pen Needl Mis 31GX5/16, 61
Betapace TAB 120MG, 9
Brevicon TAB 0.5/35, 24
BD Pen Needl Mis 32GX4MM, 61
Betapace TAB 160MG, 9
briellyn TAB, 23
BD U-500 Mis 31GX6MM, 61
Betapace TAB 80MG, 9
Brilinta TAB 60MG, 36
BD Ultra-fin Mis 32GX6MM, 61
Betaseron Inj 0.3MG, 47
Brilinta TAB 90MG, 36
Be Well PAK Rounded, 59
betaxolol sol 0.5% op, 49
brimonidine sol 0.15%, 49
Beconase AQ Sus 0.042%, 56
betaxolol TAB 10MG, 9
brimonidine sol 0.2% op, 49
bekyree TAB, 23
betaxolol TAB 20MG, 9
Brintellix TAB 10MG, 38
Belbuca Mis 150mcg, 52
bethanechol TAB 10MG, 33
Brintellix TAB 20MG, 38
Belbuca Mis 300mcg, 52
bethanechol TAB 25MG, 33
Brintellix TAB 5MG, 38
Belbuca Mis 450mcg, 52
bethanechol TAB 50MG, 33
Brisdelle CAP 7.5MG, 47
Belbuca Mis 600mcg, 52
bethanechol TAB 5MG, 33
Briviact Sol 10MG/ML, 43
Belbuca Mis 750mcg, 52
Bethkis Neb 300/4ML, 3
Briviact TAB 100MG, 43
Belbuca Mis 75mcg, 52
Betimol Sol 0.25%, 49
Briviact TAB 10MG, 43
Belbuca Mis 900mcg, 52
Betimol Sol 0.5%, 49
Briviact TAB 25MG, 43
Bella/Opium Sup 16.2-30, 30
Betoptic-s Sus 0.25% Op, 49
Briviact TAB 50MG, 43
Bella/Opium Sup 16.2-60, 30
Bevespi Aer 9-4.8mcg, 57
Briviact TAB 75MG, 43
Belsomra TAB 10MG, 41
bexarotene CAP 75MG, 8
brom/PSE/DM syp, 56
Belsomra TAB 15MG, 41
Bexsero Inj, 58
bromfed DM syp, 56
Belsomra TAB 20MG, 41
Beyaz TAB, 24
bromfenac sol 0.09% op, 50
Belsomra TAB 5MG, 41
Biaxin Sus 250/5ML, 2
Bromfenac Sol 0.09% Op, 50
benazep/hctz TAB 10-12.5, 12
Biaxin TAB 250MG, 2
bromocriptin CAP 5MG, 44
benazep/hctz TAB 20-12.5, 12
Biaxin TAB 500MG, 2
bromocriptin TAB 2.5MG, 44
benazep/hctz TAB 20-25MG, 12
bicalutamide TAB 50MG, 6
Brompheniram Chw 12MG, 56
benazep/hctz TAB 5-6.25, 12
Bicillin L-a Inj 1200000, 1
Bromsite Dro 0.075%, 50
benazepril TAB 10MG, 11
Bicillin L-a Inj 2400000, 1
Brovana Neb 15mcg, 57
benazepril TAB 20MG, 11
Bicillin L-a Inj 600000, 1
budesonide CAP 3MG DR, 21
benazepril TAB 40MG, 11
Bidil TAB, 16
budesonide sus 0.25MG/2, 57
benazepril TAB 5MG, 11
Biltricide TAB 600MG, 5
budesonide sus 0.5MG/2, 57
Benicar HCT TAB 20-12.5, 13
Bimatoprost Sol 0.03%, 49
budesonide sus 1MG/2ML, 57
Benicar HCT TAB 40-12.5, 13
Binosto TAB 70MG, 27
budesonide sus 32mcg, 56
Benicar HCT TAB 40-25MG, 13
bio-d-mulsio liq 2000unit, 59
Bullseye Mis Lancets, 61
Benicar TAB 20MG, 11
bio-d-mulsio liq 400unit, 59
Bullseye Mis Mini Lnc, 61
Benicar TAB 40MG, 11
Bio-statin CAP 1000000, 3
bumetanide TAB 0.5MG, 13
Benicar TAB 5MG, 12
Bio-statin CAP 500000, 3
bumetanide TAB 1MG, 13
Bensal HP Oin, 20
bio-statin pow, 3
bumetanide TAB 2MG, 13
Bentyl CAP 10MG, 31
Biothrax Inj, 58
Bumex TAB 0.5MG, 14
Bentyl Inj 10MG/ML, 31
biotuss liq, 56
Bumex TAB 1MG, 14
Bentyl TAB 20MG, 31
bisacodyl TAB 5MG EC, 29
Bumex TAB 2MG, 14
Benzaclin Gel 1-5%, 17
bisoprl/hctz TAB 10/6.25, 12
Bunavail Mis 2.1-0.3, 52
Benzaclin Gel 1-5%P.M., 17
bisoprl/hctz TAB 2.5/6.25, 12
Bunavail Mis 4.2-0.7, 52
Benzamycin Gel 5-3%, 17
bisoprl/hctz TAB 5-6.25MG, 12
Bunavail Mis 6.3-1MG, 52
benzepro mis 6%, 16
bisoprol fum TAB 10MG, 9
bupap TAB 50-300MG, 51
Buphenyl Pow, 28
Caduet TAB 5-10MG, 16
carbamazepin CAP 100MG ER, 43
Buphenyl TAB 500MG, 28
Caduet TAB 5-20MG, 16
carbamazepin CAP 200MG ER, 43
bupren/nalox sub 2-0.5MG, 51
Caduet TAB 5-40MG, 16
carbamazepin CAP 300MG ER, 43
bupren/nalox sub 8-2MG, 51
Caduet TAB 5-80MG, 16
carbamazepin chw 100MG, 43
Buprenex Inj 0.3MG/ML, 52
Cafergot TAB 1-100MG, 55
carbamazepin sus 100/5ML, 43
Buprenorphin Dis 10mcg/HR, 52
caffeine CIT sol 20MG/ML, 41
carbamazepin TAB 100mger, 43
Buprenorphin Dis 15mcg/HR, 52
caffeine CIT sol 60MG/3ML, 41
carbamazepin TAB 200MG, 43
Buprenorphin Dis 20mcg/HR, 52
Calan SR TAB 120MG, 10
carbamazepin TAB 200MG ER, 43
Buprenorphin Dis 5mcg/HR, 52
Calan SR TAB 180MG, 10
carbamazepin TAB 400MG ER, 43
Buprenorphin Dis 7.5/HR, 52
Calan SR TAB 240MG, 10
Carbaphen 12 Liq, 56
buprenorphin inj 0.3MG/ML, 51
Calan TAB 120MG, 10
Carbaphen 12 Sus PED, 56
buprenorphin sub 2MG, 51
Calan TAB 80MG, 10
Carbatrol CAP 100MG, 43
buprenorphin sub 8MG, 51
calc acetate CAP 667MG, 32
Carbatrol CAP 200MG, 43
buproban TAB 150MG, 45
calc acetate TAB 667MG, 32
Carbatrol CAP 300MG, 43
bupropion TAB 100MG, 37
calcipotrien CRE 0.005%, 18
carbidopa TAB 25MG, 44
bupropion TAB 100MG ER, 37
calcipotrien oin 0.005%, 18
carbinoxamin sol 4MG/5ML, 56
bupropion TAB 100MG SR, 37
calcipotrien oin betameth, 19
carbinoxamin TAB 4MG, 56
bupropion TAB 150MG, 45
calcipotrien sol 0.005%, 18
carbonyl TAB FE 45MG, 34
bupropion TAB 150MG ER, 37
calcitonin spr 200/act, 27
Cardiocom Mis Lancing, 61
bupropion TAB 150MG SR, 37
calcitrene oin 0.005%, 18
Cardizem CD CAP 120MG/24, 10
bupropion TAB 200MG ER, 37
calcitriol CAP 0.25mcg, 28
Cardizem CD CAP 180MG/24, 10
bupropion TAB 200MG SR, 37
calcitriol CAP 0.5mcg, 28
Cardizem CD CAP 240MG/24, 10
bupropion TAB 75MG, 37
Calcitriol Oin 3mcg/Gm, 18
Cardizem CD CAP 300MG/24, 10
bupropn HCL TAB 150MG XL, 37
calcitriol sol 1mcg/ML, 28
Cardizem CD CAP 360MG/24, 10
bupropn HCL TAB 300MG XL, 37
Cambia Pow 50MG, 55
Cardizem LA TAB 120MG, 10
buspirone TAB 10MG, 37
camila TAB 0.35MG, 23
Cardizem LA TAB 180MG, 10
buspirone TAB 15MG, 37
camrese LO TAB, 23
Cardizem LA TAB 240MG, 10
buspirone TAB 30MG, 37
camrese TAB, 23
Cardizem LA TAB 300MG/24, 10
buspirone TAB 5MG, 37
Canasa Sup 1000MG, 32
Cardizem LA TAB 360MG, 10
buspirone TAB 7.5MG, 37
candesa/hctz TAB 16-12.5, 13
Cardizem LA TAB 420MG/24, 10
but/apap/caf CAP, 51
candesa/hctz TAB 32-12.5, 13
Cardizem TAB 120MG, 10
but/apap/caf CAP codeine, 52
candesa/hctz TAB 32-25MG, 13
Cardizem TAB 30MG, 10
but/apap/caf TAB, 50
candesartan TAB 16MG, 11
Cardizem TAB 60MG, 10
but/asa/caf/ CAP cod 30MG, 52
candesartan TAB 32MG, 11
Cardura TAB 1MG, 12
but/asa/caff CAP, 50
candesartan TAB 4MG, 11
Cardura TAB 2MG, 12
butal/apap TAB 50-325MG, 51
candesartan TAB 8MG, 11
Cardura TAB 4MG, 12
butalb/aceta TAB 50-300MG, 51
Cantil TAB 25MG, 31
Cardura TAB 8MG, 12
Butisol Sod TAB 30MG, 41
capacet CAP, 51
Cardura XL TAB 4MG, 34
Butorphanol Inj 1MG/ML, 51
capecitabine TAB 150MG, 6
Cardura XL TAB 8MG, 34
butorphanol inj 2MG/ML, 51
capecitabine TAB 500MG, 6
Carefine Mis 31GX8MM, 61
butorphanol sol 10MG/ML, 52
Capex Sha 0.01%, 19
Carefine Mis 32GX4MM, 61
Butrans Dis 10mcg/HR, 52
Caphosol Sol, 36
Carefine Mis 32GX5MM, 61
Butrans Dis 15mcg/HR, 52
Capital/Cod Sus 120-12/5, 52
Carefine Mis 32GX6MM, 61
Butrans Dis 20mcg/HR, 52
Caprelsa TAB 100MG, 7
Careone Adv Mis Lancing, 61
Butrans Dis 5mcg/HR, 52
Caprelsa TAB 300MG, 7
Careone Lanc Mis 28G, 61
Butrans Dis 7.5/HR, 52
Captopr/Hctz TAB 25-15MG, 12
Careone Lanc Mis Thin 23G, 61
Bydureon Inj 2MG, 25
Captopr/Hctz TAB 25-25MG, 12
Caresens Sol Control, 61
Bydureon Pen Inj 2MG, 25
Captopr/Hctz TAB 50-15MG, 12
Caretouch Mis 31GX5MM, 61
Byetta Inj 10mcg, 25
Captopr/Hctz TAB 50-25MG, 12
Caretouch Mis 31GX6MM, 61
Byetta Inj 5mcg, 25
captopril TAB 100MG, 11
Caretouch Mis 31GX8MM, 61
Bystolic TAB 10MG, 9
captopril TAB 12.5MG, 11
Caretouch Mis 32GX4MM, 61
Bystolic TAB 2.5MG, 9
captopril TAB 25MG, 11
Caretouch Mis 32GX5MM, 61
Bystolic TAB 20MG, 9
captopril TAB 50MG, 11
Caretouch Mis Ejector, 61
Bystolic TAB 5MG, 9
Carac CRE 0.5%, 6
Caretouch Mis Twist 28, 61
Byvalson TAB 5-80MG, 13
Carafate Sus 1gm/10ML, 30
Caretouch Mis Twist 30, 61
C
Carafate TAB 1gm, 31
Caretouch Mis Twist 33, 61
CARB/Levo 50 TAB /Entacap, 45
carisopr/asa TAB 200-325, 48
cabergoline TAB 0.5MG, 28
CARB/Levo 75 TAB /Entacap, 45
carisoprodol TAB 250MG, 48
Cabometyx TAB 20MG, 7
CARB/levo ER TAB 25-100MG, 45
carisoprodol TAB 350MG, 48
Cabometyx TAB 40MG, 7
CARB/levo ER TAB 50-200MG, 45
carisoprodol TAB asa/cod, 48
Cabometyx TAB 60MG, 7
CARB/levo TAB 10-100MG, 45
Carnitor SF Sol 1gm/10ML, 28
Cadeau DHA CAP, 59
CARB/levo TAB 25-100MG, 45
Carnitor Sol 1gm/10ML, 28
Caduet TAB 10-10MG, 16
CARB/levo TAB 25-250MG, 45
Carnitor TAB 330MG, 28
Caduet TAB 10-20MG, 16
CARB/Levo100 TAB /Entacap, 45
carteolol sol 1% op, 49
Caduet TAB 10-40MG, 16
CARB/Levo125 TAB /Entacap, 45
carters TAB 5MG EC, 29
Caduet TAB 10-80MG, 16
CARB/Levo150 TAB /Entacap, 45
cartia XT CAP 120/24HR, 9
Caduet TAB 2.5-10MG, 16
CARB/Levo200 TAB /Entacap, 45
cartia XT CAP 180/24HR, 9
Caduet TAB 2.5-20MG, 16
Carbaglu TAB 200MG, 28
cartia XT CAP 240/24HR, 9
Caduet TAB 2.5-40MG, 16
cartia XT CAP 300/24HR, 9
Celexa TAB 10MG, 38
ciclodan CRE 0.77%, 17
carvedilol TAB 12.5MG, 9
Celexa TAB 20MG, 38
ciclodan sol 8%, 17
carvedilol TAB 25MG, 9
Celexa TAB 40MG, 38
ciclopirox CRE 0.77%, 17
carvedilol TAB 3.125MG, 9
Cellcept CAP 250MG, 7
ciclopirox gel 0.77%, 17
carvedilol TAB 6.25MG, 9
Cellcept Sus 200MG/ML, 7
ciclopirox sha 1%, 17
Casodex TAB 50MG, 6
Cellcept TAB 500MG, 7
ciclopirox sol 8%, 17
Catapres TAB 0.1MG, 12
Celontin CAP 300MG, 43
ciclopirox sus 0.77%, 17
Catapres TAB 0.2MG, 12
Cem-urea Sol 45%, 20
cidaleaze CRE 3%, 20
Catapres TAB 0.3MG, 12
Centany Oin 2%, 17
cilostazol TAB 100MG, 36
Catapres-tts Dis 0.1/24HR, 12
Centrum Spec PAK Prenatal, 59
cilostazol TAB 50MG, 36
Catapres-tts Dis 0.2/24HR, 12
cephalexin CAP 250MG, 1
Ciloxan Oin 0.3% Op, 48
Catapres-tts Dis 0.3/24HR, 12
cephalexin CAP 500MG, 1
Ciloxan Sol 0.3% Op, 48
Cayston Inh 75MG, 5
cephalexin CAP 750MG, 1
cimetidine sol 300/5ML, 30
caziant PAK, 23
cephalexin sus 125/5ML, 1
cimetidine TAB 200MG, 30
Cdp/Amitrip TAB 10-25MG, 47
cephalexin sus 250/5ML, 1
cimetidine TAB 300MG, 30
Cdp/Amitrip TAB 5-12.5MG, 47
Cephalexin TAB 250MG, 1
cimetidine TAB 400MG, 30
Cedax CAP 400MG, 1
Cephalexin TAB 500MG, 1
cimetidine TAB 800MG, 30
Cedax Sus 180/5ML, 1
Ceracade Emu, 20
Cimzia Kit, 32
cefaclor CAP 250MG, 1
ceramax CRE, 20
Cimzia Kit Starter, 32
cefaclor CAP 500MG, 1
Cerdelga CAP 84MG, 35
Cimzia Prefl Kit 200MG/ML, 32
Cefaclor ER TAB 500MG, 1
cerisa wash emu 10-1%, 16
Cinryze Sol 500 Unit, 36
Cefaclor Sus 125/5ML, 1
Cervarix Inj, 58
Cipro (10%) Sus 500MG/5, 3
Cefaclor Sus 250/5ML, 1
Cervidil Vag Mis 10MG INS, 50
Cipro (5%) Sus 250MG/5, 3
Cefaclor Sus 375/5ML, 1
Cesamet CAP 1MG, 31
Cipro HC Sus Otic, 50
cefadroxil CAP 500MG, 1
cetirizine syp 1MG/ML, 56
Cipro TAB 250MG, 3
cefadroxil sus 250/5ML, 1
Cetraxal Sol 0.2%, 50
Cipro TAB 500MG, 3
cefadroxil sus 500/5ML, 1
cevimeline CAP 30MG, 36
Cipro XR TAB 1000MG, 3
cefadroxil TAB 1gm, 1
Chantix PAK 0.5& 1MG, 46
Cipro XR TAB 500MG, 3
cefazolin inj 1gm, 1
Chantix PAK 1MG, 46
Ciprodex Sus 0.3-0.1%, 50
cefdinir CAP 300MG, 1
Chantix TAB 0.5MG, 46
Ciprofloxacn Sol 0.2%, 50
cefdinir sus 125/5ML, 1
Chantix TAB 1MG, 46
ciprofloxacn sol 0.3% op, 48
cefdinir sus 250/5ML, 1
chateal TAB 0.15/30, 23
ciprofloxacn sus 250MG/5, 2
Cefditoren TAB 200MG, 1
Chemet CAP 100MG, 66
ciprofloxacn sus 500MG/5, 2
Cefditoren TAB 400MG, 1
Chenodal TAB 250MG, 32
ciprofloxacn TAB 1000MG, 2
cefepime inj 1gm, 1
child asa chw 81MG, 50
Ciprofloxacn TAB 100MG, 2
cefixime sus 100/5ML, 1
child asa LS chw 81MG, 50
ciprofloxacn TAB 250MG, 2
cefixime sus 200/5ML, 1
chlord/clidi CAP 5-2.5MG, 30
ciprofloxacn TAB 500MG, 2
cefpodo prox sus 100/5ML, 1
chlordiazep CAP 10MG, 37
ciprofloxacn TAB 500MG ER, 2
cefpodo prox sus 50MG/5ML, 1
chlordiazep CAP 25MG, 37
ciprofloxacn TAB 750MG, 2
cefpodoxime TAB 100MG, 1
chlordiazep CAP 5MG, 37
citalopram sol 10MG/5ML, 37
cefpodoxime TAB 200MG, 1
chlorhex glu sol 0.12%, 36
citalopram TAB 10MG, 37
cefprozil sus 125/5ML, 1
chloroquine TAB 250MG, 5
citalopram TAB 20MG, 37
cefprozil sus 250/5ML, 1
Chloroquine TAB 250MG, 5
citalopram TAB 40MG, 37
cefprozil TAB 250MG, 1
chloroquine TAB 500MG, 5
citroma sol cherry, 29
cefprozil TAB 500MG, 1
Chlorothiaz TAB 250MG, 14
citroma sol lemon, 29
ceftazidime inj 1gm, 1
chlorothiaz TAB 500MG, 13
CL Prenatal TAB 28-0.8MG, 59
Ceftibuten CAP 400MG, 1
Chlorpromaz Inj 25MG/ML, 39
claravis CAP 10MG, 16
Ceftibuten Sus 180/5ML, 1
Chlorpromaz Inj 50MG/2ML, 39
claravis CAP 20MG, 16
Ceftin Sus 125/5ML, 1
chlorpromaz TAB 100MG, 39
claravis CAP 30MG, 16
Ceftin Sus 250/5ML, 1
chlorpromaz TAB 10MG, 39
claravis CAP 40MG, 16
Ceftin TAB 250MG, 1
chlorpromaz TAB 200MG, 39
Clarifoam EF Aer 10-5%, 17
Ceftin TAB 500MG, 1
chlorpromaz TAB 25MG, 39
Clarinex Syp 0.5MG/ML, 56
ceftriaxone inj 1gm, 1
chlorpromaz TAB 50MG, 39
Clarinex TAB 5MG, 56
ceftriaxone inj 250MG, 1
Chlorpropam TAB 100MG, 25
Clarinex-d TAB 2.5-120, 56
ceftriaxone inj 2gm, 1
Chlorpropam TAB 250MG, 25
clarithromyc sus 125/5ML, 2
ceftriaxone inj 500MG, 1
chlorthalid TAB 25MG, 13
Clarithromyc Sus 125/5ML, 2
Cefuroxime Inj 10MG/ML, 48
chlorthalid TAB 50MG, 13
clarithromyc sus 250/5ML, 2
cefuroxime TAB 250MG, 1
Chlorzoxazon TAB 250MG, 48
Clarithromyc Sus 250/5ML, 2
cefuroxime TAB 500MG, 1
chlorzoxazon TAB 500MG, 48
clarithromyc TAB 250MG, 2
Celebrex CAP 100MG, 55
cho MAG tris liq 500/5ML, 50
clarithromyc TAB 500MG, 2
Celebrex CAP 200MG, 55
Cholbam CAP 250MG, 32
clarithromyc TAB 500MG ER, 2
Celebrex CAP 400MG, 55
Cholbam CAP 50MG, 32
Cleanlet 28G Mis Lancets, 61
Celebrex CAP 50MG, 55
cholestyram pow 4gm, 14
clearlax pow, 29
celecoxib CAP 100MG, 54
cholestyram pow 4gm lite, 14
clearplex X gel 10%, 16
celecoxib CAP 200MG, 54
Cialis TAB 10MG, 16
clemastine TAB 2.68MG, 56
celecoxib CAP 400MG, 54
Cialis TAB 2.5MG, 16
Clemastine TAB 2.68MG, 56
celecoxib CAP 50MG, 54
Cialis TAB 20MG, 16
Cleocin CAP 150MG, 6
Celestone Inj Soluspan, 22
Cialis TAB 5MG, 16
Cleocin CAP 300MG, 6
Cleocin CAP 75MG, 6
clonazep odt TAB 2MG, 43
Cometriq Kit 100MG, 7
Cleocin CRE 2% Vag, 33
clonazepam TAB 0.5MG, 43
Cometriq Kit 140MG, 7
Cleocin PED Sol 75MG/5ML, 6
clonazepam TAB 1MG, 43
Cometriq Kit 60MG, 7
Cleocin Phos Inj 300MG, 6
clonazepam TAB 2MG, 43
Comfort Assu Mis Lanc 28G, 61
Cleocin Sup 100MG, 33
clonidine dis 0.1/24HR, 12
Comfort Assu Mis Lanc 33G, 61
Cleocin-t Gel 1%, 17
clonidine dis 0.2/24HR, 12
Comfort EZ Mis 29GX12MM, 61
Cleocin-t Lot 1%, 17
clonidine dis 0.3/24HR, 12
Comfort EZ Mis 31GX5MM, 61
Cleocin-t Pad 1%, 17
clonidine TAB 0.1MG, 12
Comfort EZ Mis 31GX6MM, 61
Cleocin-t Sol 1%, 17
clonidine TAB 0.1MG ER, 42
Comfort EZ Mis 31GX8MM, 61
Clever Check Mis, 61
clonidine TAB 0.2MG, 12
Comfort EZ Mis 32GX4MM, 61
Clever Check Mis 30G, 61
clonidine TAB 0.3MG, 12
Comfort EZ Mis 32GX5MM, 61
Clevr Choice Liq High, 61
clopidogrel TAB 300MG, 36
Comfort EZ Mis 32GX6MM, 61
Clevr Choice Liq Low, 61
clopidogrel TAB 75MG, 36
Comfort EZ Mis 32GX8MM, 61
Clickfine Mis 31GX1/4", 61
cloraz dipot TAB 15MG, 37
Comfort EZ Mis 33GX4MM, 61
Clickfine Mis 31GX5/16, 61
cloraz dipot TAB 3.75MG, 37
Comfort EZ Mis 33GX5MM, 61
Clickfine Mis 32GX5/32, 61
cloraz dipot TAB 7.5MG, 37
Comfort EZ Mis 33GX6MM, 61
Climara Dis 0.025MG, 22
Clorpres TAB 0.1-15MG, 13
Comfort EZ Mis 33GX8MM, 61
Climara Dis 0.0375MG, 22
Clorpres TAB 0.2-15MG, 13
Comfort Mis Lancets, 61
Climara Dis 0.05MG, 22
Clorpres TAB 0.3-15MG, 13
Comfortouch Mis Lancet, 61
Climara Dis 0.06MG, 22
Closercare Mis, 61
Commit Loz 2MG, 46
Climara Dis 0.075MG, 22
clotrim/beta CRE 1-0.05%, 17
Commit Loz 4MG, 46
Climara Dis 0.1MG, 22
clotrim/beta CRE diprop, 17
Commit Loz 4MG Chry, 46
Climara Pro Dis Weekly, 23
clotrim/beta lot diprop, 17
Compact Spac Mis Chamber, 66
clindacin mis etz 1%, 16
clotrimazole CRE 1%, 17
Compact Spac Mis LG Mask, 66
clindacin-p pad 1%, 16
clotrimazole loz 10MG, 36
Compact Spac Mis MD Mask, 66
Clindagel Gel 1%, 17
clotrimazole sol 1%, 17
Compact Spac Mis Sm Mask, 66
clindamy/ben gel 1-5%, 16
clotrimazole tro 10MG, 36
Complera TAB, 4
clindamy/ben gel 1.2-5%, 16
clozapine TAB 100/odt, 40
compro sup 25MG, 39
clindamycin aer 1%, 16
clozapine TAB 100MG, 39
Comtan TAB 200MG, 45
clindamycin CAP 150MG, 5
Clozapine TAB 12.5/Odt, 40
Comvax Inj, 58
clindamycin CAP 300MG, 5
Clozapine TAB 150/Odt, 40
Conceptrol Gel 4%, 33
clindamycin CAP 75MG, 5
Clozapine TAB 200/Odt, 40
Concerta TAB 18MG, 42
clindamycin CRE 2% vag, 33
clozapine TAB 200MG, 39
Concerta TAB 27MG, 42
clindamycin gel 1%, 16
clozapine TAB 25MG, 39
Concerta TAB 36MG, 42
clindamycin gel tretinoi, 16
clozapine TAB 25MG odt, 40
Concerta TAB 54MG, 42
clindamycin inj 150MG/ML, 5
clozapine TAB 50MG, 39
Condylox Gel 0.5%, 20
clindamycin inj 300/2ML, 5
Clozaril TAB 100MG, 40
Condylox Sol 0.5%, 20
clindamycin inj 300MG, 5
Clozaril TAB 25MG, 40
constulose sol 10gm/15, 29
clindamycin lot 1%, 16
Coaguchek Mis Lancets, 61
Contour Liq High Cnt, 61
clindamycin lot 10MG/ML, 16
Coartem TAB 20-120MG, 5
Contour Liq Low Cntl, 61
clindamycin mis 1%, 16
codeine sulf TAB 15MG, 51
Contour Liq Norm Cnt, 61
clindamycin pad 1%, 16
Codeine Sulf TAB 15MG, 51
Contour Sol Next, 61
clindamycin sol 1%, 16
codeine sulf TAB 30MG, 51
Contour Tes Next, 61
clindamycin sol 75MG/5ML, 5
Codeine Sulf TAB 30MG, 51
Control High Sol Unistrip, 61
Clindesse CRE 2%, 33
codeine sulf TAB 60MG, 51
Control Low Sol Unistrip, 61
clobetasol aer 0.05%, 19
Codeine Sulf TAB 60MG, 51
Control Norm Sol Easy Stp, 61
clobetasol CRE 0.05%, 19
Cogentin Inj 1MG/ML, 45
Control Sol Liq HI/Mid/L, 61
clobetasol e CRE 0.05%, 19
Colazal CAP 750MG, 32
Control Sol Liq High/Low, 61
clobetasol gel 0.05%, 18
Colchicine CAP 0.6MG, 55
Control Sol Liq Mid, 61
clobetasol lot 0.05%, 19
Colchicine TAB 0.6MG, 55
Control Sol Normal, 61
clobetasol oin 0.05%, 19
Colcrys TAB 0.6MG, 55
Conzip CAP 100MG, 52
clobetasol sha 0.05%, 19
Colestid FLA Gra 5/7.5gm, 15
Conzip CAP 200MG, 52
clobetasol sol 0.05%, 18
Colestid FLA Gra 5gm, 15
Conzip CAP 300MG, 52
clobetasol spr 0.05%, 19
Colestid Gra 5gm, 15
Cool Control Sol A, 61
Clobex Lot 0.05%, 19
Colestid Pow 5gm, 15
Cool Control Sol B, 61
Clobex Sha 0.05%, 19
Colestid TAB 1gm, 15
Copaxone Inj 20MG/ML, 47
Clobex Spr 0.05%, 19
colestipol gra 5gm, 14
Copaxone Inj 40MG/ML, 47
Clocortolone CRE Piv 0.1%, 19
colestipol TAB 1gm, 14
Copegus TAB 200MG, 5
clodan sha 0.05%, 19
colistimeth inj 150MG, 5
Cordarone TAB 200MG, 11
Cloderm CRE 0.1%, 19
colocort ene 100MG, 32
Cordran 24X3 Tap 4mcg/CM, 19
Cloderm CRE 0.1% Pmp, 19
Coly-mycin M Inj 150MG, 6
Cordran 80X3 Tap 4mcg/CM, 19
clomipramine CAP 25MG, 37
Coly-mycin S Sus Otic, 50
Cordran CRE 0.05%, 19
clomipramine CAP 50MG, 37
Colyte/Flavr Sol Packs, 30
Cordran Lot 0.05%, 19
clomipramine CAP 75MG, 37
Combigan Sol 0.2/0.5%, 49
Cordran Oin 0.05%, 19
clonazep odt TAB 0.125MG, 43
Combipatch Dis .05/.14, 23
Coreg CR CAP 10MG, 9
clonazep odt TAB 0.25MG, 43
Combipatch Dis .05/.25, 23
Coreg CR CAP 20MG, 9
clonazep odt TAB 0.5MG, 43
Combivent Aer 20-100, 57
Coreg CR CAP 40MG, 9
clonazep odt TAB 1MG, 43
Combivir TAB 150-300, 5
Coreg CR CAP 80MG, 9
Coreg TAB 12.5MG, 9
Curosurf Sus 240/3ML, 58
Cymbalta CAP 20MG, 38
Coreg TAB 25MG, 9
Cutivate CRE 0.05%, 19
Cymbalta CAP 30MG, 38
Coreg TAB 3.125MG, 9
Cutivate Lot 0.05%, 19
Cymbalta CAP 60MG, 38
Coreg TAB 6.25MG, 9
Cuvposa Sol 1MG/5ML, 31
cyproheptad syp 2MG/5ML, 56
Corgard TAB 20MG, 9
cvd d3 chw 1000unit, 59
cyproheptad TAB 4MG, 56
Corgard TAB 40MG, 9
CVS aspirin TAB 325MG, 51
cyred TAB, 23
Corgard TAB 80MG, 9
CVS aspirin TAB 325MG EC, 51
Cystadane Pow, 28
Corlanor TAB 5MG, 16
CVS aspirin TAB 81MG EC, 51
Cystagon CAP 150MG, 34
Corlanor TAB 7.5MG, 16
CVS c-LAX TAB 5MG, 30
Cystagon CAP 50MG, 34
cormax scalp sol 0.05%, 18
CVS chld asa chw 81MG, 51
Cystaran Sol 0.44%, 50
correct TAB 5MG EC, 29
CVS d3 CAP 1000unit, 59
Cytomel TAB 25mcg, 29
correctol TAB 5MG EC, 29
CVS d3 CAP 2000unit, 59
Cytomel TAB 50mcg, 29
Cortef TAB 10MG, 22
CVS d3 CAP 400unit, 59
Cytomel TAB 5mcg, 29
Cortef TAB 20MG, 22
CVS d3 CAP 5000unit, 59
Cytotec TAB 100mcg, 31
Cortef TAB 5MG, 22
CVS d3 chw 1000 unt, 59
Cytotec TAB 200mcg, 31
Cortenema Ene 100MG, 32
CVS iron TAB 27MG, 35
cytra k gra crystals, 34
Cortifoam Aer 90MG, 32
CVS iron TAB 325MG, 35
D
Cortisone Ac TAB 25MG, 21
CVS Lancets Mis 21G, 61
d 1000 CAP 1000unit, 59
Cortisporin CRE 0.5%, 17
CVS Lancets Mis 30G, 61
d 1000 chw 1000unit, 59
Cortisporin Oin 1%, 17
CVS Lancets Mis 33G, 61
d 1000 TAB 1000unit, 59
Cortisporin Sus -tc Otic, 50
CVS Lancets Mis Original, 61
d 400 chw 400unit, 59
Corzide TAB 40-5MG, 13
CVS Lancets Mis Thin 26G, 61
d 400 TAB 400unit, 59
Corzide TAB 80-5MG, 13
CVS Lancets Mis Thin 30G, 61
d-3 gummy chw 400unit, 59
Cosentyx Inj 150MG/ML, 18
CVS Lancets Mis Thin 33G, 61
d-400 TAB 400unit, 59
Cosentyx Inj 300dose, 18
CVS Lancing Mis Device, 61
D-VI-sol Liq 400unit, 59
Cosentyx Pen Inj 150MG/ML, 18
CVS nicotine dis 14MG/24h, 46
d-vita liq 400unit, 59
Cosentyx Pen Inj 300dose, 18
CVS nicotine dis 7MG/24HR, 46
D.h.e. 45 Inj 1MG/ML, 55
Cosopt PF Sol, 49
CVS nicotine gum 2MG cinn, 46
d3 2000 TAB 2000unit, 59
Cosopt Sol 22.3-6.8, 49
CVS nicotine gum 2MG mint, 46
d3 adult chw 1000unit, 59
Cotellic TAB 20MG, 7
CVS nicotine gum 2MG orig, 46
d3 CAP 10000, 59
Cotempla TAB 17.3MG, 42
CVS nicotine gum 2mgfruit, 46
d3 CAP 1000unit, 59
Cotempla TAB 25.9MG, 42
CVS nicotine gum 4MG cinn, 46
d3 CAP 2000unit, 59
Cotempla TAB 8.6MG, 42
CVS nicotine gum 4MG mint, 46
d3 CAP 400unit, 59
Coumadin TAB 10MG, 36
CVS nicotine gum 4MG orig, 46
D3 Dots TAB 2000unit, 59
Coumadin TAB 1MG, 36
CVS nicotine gum 4mgfruit, 46
d3 kids chw 400unit, 59
Coumadin TAB 2.5MG, 36
CVS nicotine loz 2MG, 46
d3 max ST dro 5000unit, 59
Coumadin TAB 2MG, 36
CVS nicotine loz 2MG mint, 47
d3 maximum CAP 5000unit, 59
Coumadin TAB 3MG, 36
CVS nicotine loz 4MG mint, 47
d3 super str CAP 2000unit, 59
Coumadin TAB 4MG, 36
CVS nts dis step 1, 47
d3 TAB 1000unit, 59
Coumadin TAB 5MG, 36
CVS Prenatal Chw Gummy, 59
d3 TAB 2000unit, 59
Coumadin TAB 6MG, 36
CVS Prenatal TAB, 59
d3 TAB 400unit, 59
Coumadin TAB 7.5MG, 36
CVS purelax pow, 30
d3-1000 CAP 1000unit, 59
covaryx HS TAB, 22
CVS purelax pow 3350, 30
d3-50 CAP 50000unt, 59
covaryx TAB 1.25-2.5, 22
CVS senna plus tablet, 30
Daily D3 Dro 1000unit, 59
Cozaar TAB 100MG, 12
cyanocobalam inj 1000mcg, 34
Daklinza TAB 30MG, 4
Cozaar TAB 25MG, 12
cyclafem TAB 1/35, 23
Daklinza TAB 60MG, 4
Cozaar TAB 50MG, 12
cyclafem TAB 7/7/7, 23
Daklinza TAB 90MG, 4
Creon CAP 12000unt, 31
Cyclessa PAK, 24
Daliresp TAB 500mcg, 57
Creon CAP 24000unt, 31
cyclobenzapr TAB 10MG, 48
danazol CAP 100MG, 22
Creon CAP 3000unit, 31
cyclobenzapr TAB 5MG, 48
danazol CAP 200MG, 22
Creon CAP 36000unt, 31
cyclobenzapr TAB 7.5MG, 48
danazol CAP 50MG, 22
Creon CAP 6000unit, 31
Cyclogyl Sol 0.5% Op, 49
Dantrium CAP 25MG, 48
Cresemba CAP 186 MG, 3
Cyclogyl Sol 1% Op, 49
Dantrium CAP 50MG, 48
Crestor TAB 10MG, 15
Cyclogyl Sol 2% Op, 49
dantrolene CAP 100MG, 48
Crestor TAB 20MG, 15
Cyclomydril Sol Op, 49
dantrolene CAP 25MG, 48
Crestor TAB 40MG, 15
cyclopentol sol 1% op, 49
dantrolene CAP 50MG, 48
Crestor TAB 5MG, 15
cyclopentol sol 2% op, 49
dapsone TAB 100MG, 5
Crinone Gel 4% Vag, 33
cyclopentola sol 0.5%, 49
dapsone TAB 25MG, 5
Crinone Gel 8% Vag, 33
Cyclophosph CAP 25MG, 6
Daptacel Inj, 58
Crixivan CAP 200MG, 4
Cyclophosph CAP 50MG, 6
Daraprim TAB 25MG, 5
Crixivan CAP 400MG, 4
Cycloserine CAP 250MG, 3
darifenacin TAB 15MG, 33
cromolyn sod CON 100/5ML, 32
Cycloset TAB 0.8MG, 26
darifenacin TAB 7.5MG, 33
Cromolyn Sod Neb 20MG/2ML, 57
cyclosporine CAP 100MG, 7
dasetta TAB 1/35, 23
cromolyn sod sol 4% op, 50
cyclosporine CAP 100MG MD, 7
dasetta TAB 7/7/7, 23
cryselle-28 TAB 28 TABS, 23
cyclosporine CAP 25MG, 7
Daxbia CAP 333MG, 1
Cuprimine CAP 250MG, 66
cyclosporine CAP 25MG mod, 7
Daypro TAB 600MG, 55
curity salin sol 0.9% irr, 34
Cyclosporine CAP 50MG Mod, 7
daysee TAB, 23
Curosurf Sus 120/1.5, 58
cyclosporine sol modified, 7
Daytrana Dis 10MG/9HR, 42
Daytrana Dis 15MG/9HR, 42
desmopressin inj 4mcg/ML, 28
dextroamphet CAP 15MG ER, 41
Daytrana Dis 20MG/9HR, 42
desmopressin sol 0.01%, 28
dextroamphet CAP 5MG ER, 41
Daytrana Dis 30MG/9HR, 42
desmopressin spr 0.01%, 28
dextroamphet sol 5MG/5ML, 42
Ddavp Inj 4mcg/ML, 28
desmopressin TAB 0.1MG, 28
dextroamphet TAB 10MG, 41
Ddavp Sol 0.01%, 28
desmopressin TAB 0.2MG, 28
dextroamphet TAB 5MG, 41
Ddavp Spr 0.01%, 28
deso/ethinyl TAB estradio, 23
Diabeta TAB 1.25MG, 25
Ddavp TAB 0.1MG, 28
Desogen-28 TAB, 24
Diabeta TAB 2.5MG, 25
Ddavp TAB 0.2MG, 28
Desonate Gel 0.05%, 19
Diabeta TAB 5MG, 25
Ddrops Boost Liq 600/.028, 59
desonide CRE 0.05%, 18
dialyvite d CAP 5000unit, 59
Ddrops Liq, 59
desonide lot 0.05%, 18
Diamox Seque CAP 500MG CR, 14
Ddrops Liq 1000unit, 59
desonide oin 0.05%, 18
Diastar Easy Mis Lancets, 61
Ddrops Liq 2000unit, 59
Desowen CRE 0.05%, 19
Diastar Mis Lancets, 61
Debacterol Sol 30-50%, 36
Desowen Lot 0.05%, 19
Diastat Acdl Gel 12.5-20, 44
deblitane TAB 0.35MG, 23
desoximetas CRE 0.05%, 18
Diastat Acdl Gel 5-10MG, 44
Decara CAP 25000unt, 59
desoximetas CRE 0.25%, 18
Diastat PED Gel 2.5m Gel, 43
decara CAP 50000unt, 59
desoximetas gel 0.05%, 18
Diatrue Cont Sol Level 1, 61
Delestrogen Inj 10MG/ML, 22
desoximetas oin 0.05%, 18
Diatrue Cont Sol Level 2, 61
Delestrogen Inj 20MG/ML, 23
desoximetas oin 0.25%, 18
Diatrue Cont Sol Level 3, 61
Delestrogen Inj 40MG/ML, 23
Desoxyn TAB 5MG, 42
diazepam CON 5MG/ML, 37
delta d3 TAB 400unit, 59
desvenlafax TAB 100MG ER, 38
Diazepam Gel 10MG, 43
deltasone TAB 20MG, 21
Desvenlafax TAB 100MG ER, 38
Diazepam Gel 2.5MG, 43
delyla TAB 0.1-0.02, 23
desvenlafax TAB 25MG ER, 38
Diazepam Gel 20MG, 43
Delzicol CAP 400MG, 32
desvenlafax TAB 50MG ER, 38
Diazepam Inj 10MG/2ML, 37
Demadex TAB 10MG, 14
Desvenlafax TAB 50MG ER, 38
Diazepam Inj 5MG/ML, 37
Demadex TAB 20MG, 14
Detrol LA CAP 2MG, 33
Diazepam Sol 1MG/ML, 37
Demadex TAB 5MG, 14
Detrol LA CAP 4MG, 33
diazepam TAB 10MG, 37
demeclocycl TAB 150MG, 2
Detrol TAB 1MG, 33
diazepam TAB 2MG, 37
demeclocycl TAB 300MG, 2
Detrol TAB 2MG, 33
diazepam TAB 5MG, 37
Demerol Inj 100MG/ML, 53
Dex LA 16 Inj 16MG/ML, 22
Dibenzyline CAP 10MG, 12
Demerol TAB 100MG, 53
dexameth PHO inj 10MG/ML, 21
Diclegis TAB 10-10MG, 31
Demerol TAB 50MG, 53
Dexameth PHO Inj 10MG/ML, 21
diclo/misopr TAB 50-0.2MG, 54
Demser CAP 250MG, 12
dexameth PHO inj 120MG/30, 21
diclo/misopr TAB 75-0.2MG, 54
Denavir CRE 1%, 18
dexameth PHO inj 20MG/5ML, 21
diclofen pot TAB 50MG, 54
Depakene CAP 250MG, 43
dexameth PHO inj 4MG/ML, 21
Diclofenac CRE Sodium, 18
Depakene Sol 250/5ML, 43
Dexameth PHO Sol 0.1% Op, 49
diclofenac gel 1%, 18
Depakote ER TAB 250MG, 43
Dexamethason CON 1MG/ML, 21
diclofenac sol 0.1% op, 50
Depakote ER TAB 500MG, 43
dexamethason elx 0.5/5ML, 21
diclofenac sol 1.5%, 18
Depakote Spr CAP 125MG, 43
Dexamethason Sol 0.5/5ML, 21
diclofenac TAB 100MG ER, 54
Depakote TAB 125MG DR, 43
dexamethason TAB 0.5MG, 21
diclofenac TAB 25MG DR, 54
Depakote TAB 250MG DR, 44
dexamethason TAB 0.75MG, 21
diclofenac TAB 50MG DR, 54
Depakote TAB 500MG DR, 44
dexamethason TAB 1.5MG, 21
diclofenac TAB 75MG DR, 54
Depen Titra TAB 250MG, 66
Dexamethason TAB 1MG, 21
dicloxacill CAP 250MG, 1
Depo-estradi Inj 5MG/ML, 22
Dexamethason TAB 2MG, 21
dicloxacill CAP 500MG, 1
Depo-medrol Inj 20MG/ML, 21
dexamethason TAB 4MG, 21
dicyclomine CAP 10MG, 30
Depo-medrol Inj 40MG/ML, 22
dexamethason TAB 6MG, 21
dicyclomine inj 10MG/ML, 30
Depo-medrol Inj 80MG/ML, 22
Dexedrine CAP 10MG CR, 42
dicyclomine sol 10MG/5ML, 30
Depo-provera Inj 150MG/ML, 24
Dexedrine CAP 15MG CR, 42
dicyclomine TAB 20MG, 30
Depo-provera Inj 400/ML, 7
Dexedrine CAP 5MG CR, 42
didanosine CAP 125MG, 3
Depo-sq Prov Inj 104, 24
dexedrine TAB 10MG, 41
didanosine CAP 200MG, 3
Depo-testost Inj 100MG/ML, 22
dexedrine TAB 5MG, 41
didanosine CAP 250MG, 3
Depo-testost Inj 200MG/ML, 22
Dexeryl CRE, 20
didanosine CAP 400MG, 3
Derma-smooth Oil /FS Body, 19
Dexilant CAP 30MG DR, 31
Differin CRE 0.1%, 16
Derma-smooth Oil /FS Sclp, 19
Dexilant CAP 60MG DR, 31
Differin Gel 0.1%, 17
dermacinrx kit prizopak, 20
dexmethylph CAP 15MG ER, 42
Differin Gel 0.3%, 17
Dermasorb HC Kit 2%, 19
dexmethylph CAP 30MG ER, 42
Differin Lot 0.1%, 16
Dermatop CRE 0.1%, 19
dexmethylph CAP 40MG ER, 42
Dificid TAB 200MG, 2
Dermatop Oin 0.1%, 19
dexmethylph TAB 10MG, 41
difil-G fort liq 100-100, 57
Dermotic Oil 0.01%, 50
dexmethylph TAB 2.5MG, 41
Diflorasone CRE 0.05%, 19
Descovy TAB 200/25, 4
dexmethylph TAB 5MG, 41
Diflorasone Oin 0.05%, 19
desipramine TAB 100MG, 37
dexmethylphe CAP 10MG ER, 42
Diflucan Sus 10MG/ML, 3
desipramine TAB 10MG, 37
dexmethylphe CAP 20MG ER, 42
Diflucan Sus 40MG/ML, 3
desipramine TAB 150MG, 37
dexmethylphe CAP 5MG ER, 42
Diflucan TAB 100MG, 3
desipramine TAB 25MG, 37
dexmethylphe CAP ER 25MG, 42
Diflucan TAB 150MG, 3
desipramine TAB 50MG, 37
dexmethylphe CAP ER 35MG, 42
Diflucan TAB 200MG, 3
desipramine TAB 75MG, 37
Dexpak PAK 10 Day, 22
Diflucan TAB 50MG, 3
Desloratadin TAB 2.5 Odt, 56
Dexpak PAK 13 Day, 22
diflunisal TAB 500MG, 50
desloratadin TAB 5MG, 56
Dexpak PAK 6 Day, 22
digitek TAB 0.125MG, 8
Desloratadin TAB 5MG Odt, 56
dextroamphet CAP 10MG ER, 41
digitek TAB 0.25MG, 8
digox TAB 0.125MG, 8
Diprolene Lot 0.05%, 19
doxycycl HYC TAB 150MG DR, 2
digox TAB 0.25MG, 8
Diprolene Oin 0.05%, 19
doxycycl HYC TAB 200MG DR, 2
digoxin inj 0.25MG/1, 8
dipyridamole TAB 25MG, 36
doxycycl HYC TAB 50MG DR, 2
Digoxin Sol 50mcg/ML, 8
dipyridamole TAB 50MG, 36
doxycycl HYC TAB 75MG DR, 2
digoxin TAB 0.125MG, 8
dipyridamole TAB 75MG, 36
Doxycycline CAP 40MG, 17
digoxin TAB 0.25MG, 8
Disalcid TAB 500MG, 51
doxycycline sus 25MG/5ML, 2
Dihydrocod/ CAP Asa/Caff, 53
Disalcid TAB 750MG, 51
doxycycline TAB 150MG, 2
dihydroergot inj 1MG/ML, 55
disopyramide CAP 100MG, 10
doxycycline TAB 75MG, 2
Dihydroergot Spr 4MG/ML, 55
disopyramide CAP 150MG, 10
Drisdol CAP 50000unt, 59
Dilantin CAP 100MG, 44
disulfiram TAB 250MG, 45
Dritho-creme CRE HP 1%, 18
Dilantin CAP 30MG, 43
disulfiram TAB 500MG, 45
dronabinol CAP 10MG, 31
Dilantin Chw 50MG, 44
Ditropan XL TAB 10MG, 33
dronabinol CAP 2.5MG, 31
Dilantin-125 Sus 125/5ML, 44
Ditropan XL TAB 15MG, 33
dronabinol CAP 5MG, 31
Dilatrate SR CAP 40MG, 8
Ditropan XL TAB 5MG, 33
Droplet Lanc Mis 30G, 61
Dilaudid Inj 1MG/ML, 53
Diuril Sus 250/5ML, 14
Droplet Lanc Mis Device, 61
Dilaudid Inj 2MG/ML, 53
divalproex CAP 125MG, 43
drospir/ethi TAB 3-0.03MG, 23
Dilaudid Inj 4MG/ML, 53
divalproex TAB 125MG DR, 43
drospire/ETH TAB estr/lev, 23
Dilaudid Liq 1MG/ML, 53
divalproex TAB 250MG DR, 43
drospirenone TAB ethy est, 23
Dilaudid TAB 2MG, 53
divalproex TAB 250MG ER, 43
Droxia CAP 200MG, 35
Dilaudid TAB 4MG, 53
divalproex TAB 500MG DR, 43
Droxia CAP 300MG, 35
Dilaudid TAB 8MG, 53
divalproex TAB 500MG ER, 43
Droxia CAP 400MG, 35
dilt-XR CAP 120MG, 9
Divigel Gel 0.25MG, 23
Drysol Sol 20%, 20
dilt-XR CAP 180MG, 9
Divigel Gel 0.5MG, 23
Duac Gel 1.2-5%, 17
dilt-XR CAP 240MG, 9
Divigel Gel 1MG/Gm, 23
Duavee TAB 0.45-20, 23
diltiazem CAP 120MG CD, 9
dofetilide CAP 125mcg, 11
ducodyl TAB 5MG EC, 29
diltiazem CAP 120MG ER, 9
dofetilide CAP 250mcg, 11
Duetact TAB 30-2MG, 26
diltiazem CAP 120MG/24, 10
dofetilide CAP 500mcg, 11
Duetact TAB 30-4MG, 26
diltiazem CAP 180MG CD, 10
Dolophine TAB 10MG, 53
Duexis TAB 800-26.6, 54
diltiazem CAP 180MG ER, 10
Dolophine TAB 5MG, 53
dulcolax pow balance, 29
diltiazem CAP 180MG/24, 10
donepezil TAB 10MG, 45
Dulera Aer 100-5mcg, 57
diltiazem CAP 240MG CD, 10
donepezil TAB 10MG odt, 47
Dulera Aer 200-5mcg, 57
diltiazem CAP 240MG ER, 10
donepezil TAB 5MG, 45
duloxetine CAP 20MG, 37
diltiazem CAP 240MG/24, 10
donepezil TAB 5MG odt, 47
duloxetine CAP 30MG, 37
diltiazem CAP 300MG CD, 10
donepezil TAB HCL 23MG, 47
Duloxetine CAP 40MG, 38
diltiazem CAP 300MG ER, 10
Doral TAB 15MG, 41
duloxetine CAP 60MG, 37
diltiazem CAP 300MG/24, 10
Doryx Mpc TAB 120MG, 2
Duo-care Liq Level1/2, 61
diltiazem CAP 360MG CD, 10
Doryx TAB 200MG, 2
Duopa Sus 4.63-20, 45
diltiazem CAP 360MG ER, 10
Doryx TAB 50MG, 2
Duragesic Dis 100mcg/H, 53
diltiazem CAP 360MG/24, 10
dorzol/timol sol 22.3-6.8, 49
Duragesic Dis 12mcg/HR, 53
diltiazem CAP 420MG/24, 10
dorzolamide sol 2% op, 50
Duragesic Dis 25mcg/HR, 53
diltiazem CAP 60MG ER, 10
Dovonex CRE 0.005%, 18
Duragesic Dis 50mcg/HR, 53
diltiazem CAP 90MG ER, 10
doxazosin TAB 1MG, 12
Duragesic Dis 75mcg/HR, 53
diltiazem ER TAB 180MG, 10
doxazosin TAB 2MG, 12
Duraxin CAP, 51
diltiazem ER TAB 240MG, 10
doxazosin TAB 4MG, 12
Durezol Emu 0.05%, 49
diltiazem ER TAB 300MG, 10
doxazosin TAB 8MG, 12
Durlaza CAP 162.5MG, 36
diltiazem ER TAB 360MG, 10
doxepin HCL CAP 100MG, 37
dutast/tamsu CAP 0.5-0.4, 34
diltiazem ER TAB 420MG, 10
doxepin HCL CAP 10MG, 37
dutasteride CAP 0.5MG, 34
diltiazem TAB 120MG, 10
doxepin HCL CAP 150MG, 37
Dutoprol TAB 100-12.5, 13
diltiazem TAB 30MG, 10
doxepin HCL CAP 25MG, 37
Dutoprol TAB 25-12.5, 13
diltiazem TAB 60MG, 10
doxepin HCL CAP 50MG, 37
Dutoprol TAB 50-12.5, 13
diltiazem TAB 90MG, 10
doxepin HCL CAP 75MG, 37
Duzallo TAB 200-200, 55
Dimenhydrin Inj 50MG/ML, 31
doxepin HCL CON 10MG/ML, 37
Duzallo TAB 200-300, 55
Diovan HCT TAB 160-12.5, 13
Doxepin HCL CRE 5%, 18
Dyanavel XR Sus 2.5MG/ML, 42
Diovan HCT TAB 160-25MG, 13
doxercalcif CAP 0.5mcg, 28
Dyazide CAP 37.5-25, 14
Diovan HCT TAB 320-12.5, 13
doxercalcif CAP 1mcg, 28
Dymista Spr 137-50, 56
Diovan HCT TAB 320-25MG, 13
doxercalcif CAP 2.5mcg, 28
Dyrenium CAP 100MG, 14
Diovan HCT TAB 80/12.5, 13
doxycyc mono CAP 100MG, 2
Dyrenium CAP 50MG, 14
Diovan TAB 160MG, 12
doxycyc mono CAP 150MG, 2
E
Diovan TAB 320MG, 12
doxycyc mono CAP 50MG, 2
E-z Ject Mis 21G, 61
Diovan TAB 40MG, 12
doxycyc mono CAP 75MG, 2
E-z Ject Mis 21G Colr, 61
Diovan TAB 80MG, 12
doxycyc mono TAB 100MG, 2
E-z Ject Mis 30G, 61
Dip/Tet PED Inj 25-5lfu, 58
doxycyc mono TAB 150MG, 2
E-z Ject Mis 32G Colr, 61
Dipentum CAP 250MG, 32
doxycyc mono TAB 50MG, 2
E-z Ject Mis Lanc 21G, 61
Diphen/Atrop Liq 2.5/5, 30
doxycyc mono TAB 75MG, 2
E-z Ject Mis Lancets, 61
diphen/atrop TAB 2.5MG, 30
doxycycl HYC CAP 100MG, 2
E-z Ject Mis Thin 26G, 61
diphenhydram elx 12.5/5ML, 56
doxycycl HYC CAP 50MG, 2
E-z Spacer Mis, 66
diphenhydram inj 50MG/ML, 56
doxycycl HYC TAB 100MG, 2
E-z Spacer Mis Body Grd, 66
Diprolene AF CRE 0.05%, 19
doxycycl HYC TAB 100MG DR, 2
E-ZJECT Lanc Mis 33G, 61
E.e.s. 400 TAB 400MG, 2
Edarbyclor TAB 40-12.5, 13
Emflaza TAB 36MG, 21
E.e.s. Gran Sus 200/5ML, 2
Edarbyclor TAB 40-25MG, 13
Emflaza TAB 6MG, 21
Easivent Mis, 66
Edecrin TAB 25MG, 14
Emla CRE 2.5-2.5%, 20
Easivent Mis Mask LG, 66
Edluar Sub 10MG, 41
emoquette TAB, 23
Easivent Mis Mask MED, 66
Edluar Sub 5MG, 41
empricaine kit 2.5-2.5%, 20
Easivent Mis Mask Sm, 66
Edurant TAB 25MG, 4
Emsam Dis 12MG/24h, 38
Easy Comfort Mis 30G, 61
eemt HS TAB, 22
Emsam Dis 6MG/24HR, 38
Easy Comfort Mis 31GX1/4", 61
eemt TAB 1.25-2.5, 22
Emsam Dis 9MG/24HR, 38
Easy Comfort Mis 31GX3/16, 61
Effexor XR CAP 150MG, 38
Emtriva CAP 200MG, 4
Easy Comfort Mis 31GX5/16, 61
Effexor XR CAP 37.5MG, 38
Emtriva Sol 10MG/ML, 4
Easy Comfort Mis 32GX5/32, 61
Effexor XR CAP 75MG, 38
Emulsion SB Emu, 20
Easy Comfort Mis Lanc/30G, 61
Effient TAB 10MG, 36
Emverm Chw 100MG, 5
Easy Mini Mis, 61
Effient TAB 5MG, 36
Enablex TAB 15MG, 33
Easy Mini Mis Eject, 61
Efudex CRE 5%, 6
Enablex TAB 7.5MG, 33
Easy Plus II Sol High, 61
Egrifta Sol 1MG, 27
enalapr/hctz TAB 10-25MG, 12
Easy Plus II Sol Low, 61
Eha Lot 4%, 20
enalapr/hctz TAB 5-12.5MG, 12
Easy Talk Sol High, 61
Elavil TAB 25MG, 38
enalapril TAB 10MG, 11
Easy Talk Sol Low, 61
Eldepryl CAP 5MG, 45
enalapril TAB 2.5MG, 11
Easy Talk Sol Normal, 61
Element Cont Liq Normal, 62
enalapril TAB 20MG, 11
Easy Touch Mis, 61
Element Liq High, 62
enalapril TAB 5MG, 11
Easy Touch Mis 29GX1/2", 61
Element Liq Low, 62
Enbrel Inj 25/0.5ML, 54
Easy Touch Mis 31GX1/4", 61
Elemnt Compa Sol Level 2, 62
Enbrel Inj 25MG, 54
Easy Touch Mis 31GX3/16, 61
Elemnt Compa Sol Level 3, 62
Enbrel Inj 50MG/ML, 54
Easy Touch Mis 31GX5/16, 61
Elestat Dro 0.05%, 50
Enbrel Srclk Inj 50MG/ML, 54
Easy Touch Mis 32GX1/4", 61
Elestrin Gel 0.06%, 23
Encare Sup 100MG, 33
Easy Touch Mis 32GX3/16, 61
Eletone CRE, 20
Endari Pow 5gm, 35
Easy Touch Mis 32GX5/32, 61
Eletone CRE Twinpack, 20
endocet TAB 10-325MG, 51
Easy Touch Mis 32GX5MM, 61
eletriptan TAB 20MG, 55
endocet TAB 2.5-325, 51
Easy Touch Mis 32GX6MM, 61
eletriptan TAB 40MG, 55
endocet TAB 5-325MG, 51
Easy Touch Mis Lanc/21G, 61
Elidel CRE 1%, 20
endocet TAB 7.5-325, 51
Easy Touch Mis Lanc/23G, 61
Eligard Inj 22.5MG, 6
Endometrin Sup 100MG, 33
Easy Touch Mis Lanc/26G, 61
Eligard Inj 30MG, 6
Enfamil Mis Expecta, 60
Easy Touch Mis Lanc/28G, 61
Eligard Inj 45MG, 6
Engerix-b Inj 10/0.5ML, 58
Easy Touch Mis Lanc/30G, 61
Eligard Inj 7.5MG, 6
Engerix-b Inj 20mcg/ML, 58
Easy Touch Mis Lanc/32G, 61
Elimite CRE 5%, 20
Enjuvia TAB 0.3MG, 23
Easy Touch Mis Lanc/33G, 61
elinest TAB, 23
Enjuvia TAB 0.45MG, 23
Easy Touch Sol Control, 61
Eliphos TAB 667MG, 32
Enjuvia TAB 0.625MG, 23
Easy Touch Sol High/Low, 61
Eliquis TAB 2.5MG, 36
Enjuvia TAB 0.9MG, 23
Easy Trak Sol High, 61
Eliquis TAB 5MG, 36
Enlon Inj 150/15ML, 48
Easy Trak Sol Low, 61
Elite Iron TAB 15MG, 35
enoxaparin inj 100MG/ML, 35
Easy Trak Sol Normal, 61
Elixophyllin Elx 80/15ML, 57
enoxaparin inj 120/0.8, 35
Easygluco Sol High, 61
Ella TAB 30MG, 24
enoxaparin inj 150MG/ML, 35
Easygluco Sol Low, 61
Elmiron CAP 100MG, 34
enoxaparin inj 30/0.3ML, 35
Easygluco Sol Normal, 61
Elocon CRE 0.1%, 19
enoxaparin inj 300/3ML, 35
Easygluco Sol Plus, 61
Elocon Lot 0.1%, 19
enoxaparin inj 40/0.4ML, 35
Easymax 15 Sol Level 1, 61
Elocon Oin 0.1%, 19
enoxaparin inj 60/0.6ML, 35
Easymax 15 Sol Level 2, 62
Emadine Sol 0.05% Op, 50
enoxaparin inj 80/0.8ML, 35
Easymax 15 Sol Level1-2, 62
Embeda CAP 100-4MG, 53
enpresse-28 TAB, 23
Easymax Sol High, 61
Embeda CAP 20-0.8MG, 53
enskyce TAB, 23
Easymax Sol Low, 61
Embeda CAP 30-1.2MG, 53
Enstilar Aer, 19
Easymax Sol Norm/Low, 61
Embeda CAP 50-2MG, 53
entacapone TAB 200MG, 44
Easymax Sol Normal, 61
Embeda CAP 60-2.4MG, 53
entecavir TAB 0.5MG, 3
Easystep Hgh Sol Control, 62
Embeda CAP 80-3.2MG, 53
entecavir TAB 1MG, 3
Easystep Low Sol Control, 62
Embrace Cntr Liq High, 62
Entereg CAP 12MG, 32
Easytest II Mis Lancets, 62
Embrace Evo Liq Level 1, 62
enteric asa TAB 325MG, 50
Easytest Mis Lancets, 62
Embrace Evo Liq Level 2, 62
Entocort EC CAP 3MG DR, 21
EC-naprosyn TAB 375MG, 55
Embrace Lanc Mis Thin 30G, 62
Entresto TAB 24-26MG, 15
EC-naprosyn TAB 500MG, 55
Embrace Pro Liq Glucose, 62
Entresto TAB 49-51MG, 15
econazole CRE 1%, 17
Embrace Sol Low, 62
Entresto TAB 97-103MG, 15
econtra EZ TAB 1.5MG, 23
Emcyt CAP 140MG, 6
Entty Emu Spray, 20
ecotrin low TAB 81MG EC, 50
Emend CAP 125MG, 31
enulose sol 10gm/15, 32
ecotrin TAB 325MG, 50
Emend CAP 40MG, 31
Envarsus XR TAB 0.75MG, 7
Ecotrin TAB 325MG EC, 51
Emend CAP 80MG, 31
Envarsus XR TAB 1MG, 7
Ecoza Aer 1%, 17
Emend Sus 125MG, 31
Envarsus XR TAB 4MG, 7
ecpirin TAB 325MG EC, 50
Emend Tripac PAK 80 & 125, 31
Epaned Sol 1MG/ML, 11
ed-spaz TAB 0.125MG, 30
Emflaza Sus 22.75/ML, 21
Epclusa TAB 400-100, 4
Edarbi TAB 40MG, 12
Emflaza TAB 18MG, 21
Epiceram Emu, 20
Edarbi TAB 80MG, 12
Emflaza TAB 30MG, 21
Epiduo Forte Gel 0.3-2.5%, 17
Epiduo Gel 0.1-2.5%, 17
eql nicotine gum 2MG strt, 46
estradiol TAB 0.5MG, 22
Epifoam Aer 1%, 19
eql nicotine gum 4MG, 46
estradiol TAB 10mcg, 33
epinastine dro 0.05%, 50
eql nicotine gum 4MG ref, 46
estradiol TAB 1MG, 22
Epinephrine Inj 0.15MG, 14
eql nicotine gum 4MG strt, 46
estradiol TAB 2MG, 22
epinephrine inj 0.1MG/ML, 14
eql nicotine loz 2MG, 46
Estring Mis 2MG, 33
Epinephrine Inj 0.3MG, 14
eql nicotine loz 2MG mint, 46
estrog/mtest TAB 1.25-2.5, 22
epinephrine inj 1MG/ML, 14
eql nicotine loz 4MG chry, 46
Estrogel Gel, 23
Epinephrine Inj 1MG/ML, 14
eql nicotine loz 4MG mint, 46
Estropipate TAB 0.75MG, 22
Epinphephrin Kit Snap-v, 14
Eql Prenatal TAB Formula, 60
Estropipate TAB 1.5MG, 22
Epipen 2-PAK Inj 0.3MG, 14
eql vitamin CAP d3, 59
Estropipate TAB 3MG, 22
Epipen-JR Inj 2-PAK, 14
Equetro CAP 100MG, 40
Estrostep FE TAB, 24
Episnap Kit, 14
Equetro CAP 200MG, 40
eszopiclone TAB 1MG, 40
epitol TAB 200MG, 43
Equetro CAP 300MG, 40
eszopiclone TAB 2MG, 40
Epivir HBV Sol 5MG/ML, 4
Ergoloid Mes TAB 1MG Oral, 47
eszopiclone TAB 3MG, 41
Epivir HBV TAB 100MG, 5
Ergomar Sub 2MG, 55
ethacrynic TAB acd 25MG, 13
Epivir Sol 10MG/ML, 5
ergot/caffen TAB 1-100MG, 55
ethambutol TAB 100MG, 3
Epivir TAB 150MG, 5
errin TAB 0.35MG, 23
ethambutol TAB 400MG, 3
Epivir TAB 300MG, 5
Ertaczo CRE 2%, 17
ethosuximide CAP 250MG, 43
eplerenone TAB 25MG, 12
ery pad 2%, 16
ethosuximide sol 250/5ML, 43
eplerenone TAB 50MG, 12
Ery-TAB Tab 250MG EC, 2
ethy ETH est TAB 1-35, 23
Epogen Inj 10000/ML, 34
Ery-TAB Tab 333MG EC, 2
Ethyl Chlor Aer Fine Pin, 20
Epogen Inj 2000/ML, 34
Ery-TAB Tab 500MG EC, 2
Ethyl Chlor Aer Fn Strm, 20
Epogen Inj 20000/ML, 34
ery/benzoyl gel 5-3%, 16
Ethyl Chlor Aer MED Jet, 20
Epogen Inj 3000/ML, 34
Erygel Gel 2%, 17
Ethyl Chlor Aer MED Strm, 20
Epogen Inj 4000/ML, 34
Eryped Sus 200/5ML, 2
Ethyl Chlor Aer Mist, 20
Eprosart Mes TAB 600MG, 12
Eryped Sus 400/5ML, 2
ethyl chlor aer spray, 20
Epy II Kit, 14
Erythrocin TAB 250MG, 2
Ethyl Chlor Aer Spray, 20
Epy Kit, 14
erythrom ETH sus 200/5ML, 2
ethynodiol TAB 1-50, 23
Epzicom TAB 600-300, 4
Erythrom ETH TAB 400MG, 2
Etidron Disd TAB 200MG, 27
eq aspirin TAB 325MG, 50
erythromycin CAP 250MG EC, 2
Etidron Disd TAB 400MG, 27
eq aspirin TAB 325MG EC, 50
erythromycin gel 2%, 16
etodolac CAP 200MG, 54
eq child asa chw 81MG, 50
erythromycin oin 5MG/gm, 48
etodolac CAP 300MG, 54
eq clearlax pow, 29
erythromycin oin op, 48
etodolac ER TAB 400MG, 54
eq nicotine dis 14MG/24h, 45
erythromycin pad 2%, 16
etodolac ER TAB 500MG, 54
eq nicotine dis 21MG/24h, 45
erythromycin sol 2%, 16
etodolac ER TAB 600MG, 54
eq nicotine dis 7MG/24HR, 45
Erythromycin TAB 250MG Bs, 2
etodolac TAB 400MG, 54
eq nicotine gum 2MG cinn, 45
Erythromycin TAB 500MG Bs, 2
etodolac TAB 500MG, 54
eq nicotine gum 2MG mint, 45
Esbriet CAP 267MG, 58
Etoposide CAP 50MG, 7
eq nicotine gum 2MG orig, 45
Esbriet TAB 267MG, 58
Eurax CRE 10%, 20
eq nicotine gum 2mgfruit, 45
Esbriet TAB 801MG, 58
Eurax Lot 10%, 20
eq nicotine gum 4MG cinn, 45
escitalopram sol 5MG/5ML, 37
Evamist Spr 1.53MG, 23
eq nicotine gum 4MG mint, 45
escitalopram TAB 10MG, 37
Evekeo TAB 10MG, 42
eq nicotine gum 4MG orig, 45
escitalopram TAB 20MG, 37
Evekeo TAB 5MG, 42
eq nicotine gum 4MG ref, 46
escitalopram TAB 5MG, 37
Evencar Mini Sol Normal, 62
eq nicotine gum 4MG strt, 46
esgic CAP, 51
Evencare G2 Sol Low/High, 62
eq nicotine gum 4mgfruit, 45
Esgic TAB, 51
Evencare G3 Sol Low/High, 62
eq nicotine loz 2MG cher, 46
esomepra MAG CAP 20MG DR, 30
Evencare Sol Liq Low/High, 62
eq nicotine loz 2MG cinn, 46
Esomeprazole CAP 24.65MG, 31
Evista TAB 60MG, 27
eq nicotine loz 2MG mint, 46
Esomeprazole CAP 49.3MG, 31
Evoclin Aer 1%, 17
eq nicotine loz 4MG chry, 46
est estrogen TAB mtest, 22
Evolution Sol Normal, 62
eq nicotine loz 4MG mint, 46
est estrogen TAB mtest HS, 22
Evotaz TAB 300-150, 4
eql aspirin chw 81MG, 50
estarylla TAB 0.25-35, 23
Evoxac CAP 30MG, 36
eql aspirin TAB 325MG, 50
estazolam TAB 1MG, 41
Evzio Inj, 54
eql aspirin TAB 325MG EC, 50
estazolam TAB 2MG, 41
Evzio Inj 2/0.4ML, 54
eql aspirin TAB 81MG EC, 50
estra/noreth TAB 0.5-0.1, 22
EX-LAX ultra TAB 5MG EC, 30
eql chld asa chw 81MG, 50
estra/noreth TAB 1-0.5MG, 22
Exalgo TAB 12MG, 53
eql clearlax pow, 29
Estrace TAB 0.5MG, 23
Exalgo TAB 16MG, 53
eql gentle TAB laxative, 29
Estrace TAB 1MG, 23
Exalgo TAB 32MG, 53
Eql Lancets Mis 21G Colr, 62
Estrace TAB 2MG, 23
Exalgo TAB 8MG, 53
Eql Lancets Mis 33G Colr, 62
Estrace Vag CRE 0.1MG/Gm, 33
Exelderm CRE 1%, 17
Eql Lancets Mis Thin 26G, 62
estrad val inj 200MG/5, 22
Exelderm Sol 1%, 17
Eql Lancets Mis Thin 30G, 62
estrad val inj 20MG/ML, 22
Exelon CAP 1.5MG, 47
eql laxative TAB 5MG EC, 29
estradiol dis 0.025MG, 22
Exelon CAP 3MG, 47
eql nicotine dis 14MG/24h, 46
estradiol dis 0.0375MG, 22
Exelon CAP 4.5MG, 47
eql nicotine dis 21MG/24h, 46
estradiol dis 0.05MG, 22
Exelon CAP 6MG, 47
eql nicotine dis 7MG/24HR, 46
estradiol dis 0.06MG, 22
Exelon Dis 13.3/24, 47
eql nicotine gum 2MG, 46
estradiol dis 0.075MG, 22
Exelon Dis 4.6MG/24, 47
eql nicotine gum 2MG ref, 46
estradiol dis 0.1MG, 22
Exelon Dis 9.5MG/24, 47
exemestane TAB 25MG, 6
Fazaclo TAB 150 Odt, 40
Fentora TAB 400mcg, 52
Exforge TAB 10-160MG, 13
Fazaclo TAB 200 Odt, 40
Fentora TAB 600mcg, 52
Exforge TAB 10-320MG, 13
Fazaclo TAB 25MG Odt, 40
Fentora TAB 800mcg, 52
Exforge TAB 5-160MG, 13
FE Aspartate TAB, 35
Feosol TAB 200MG, 35
Exforge TAB 5-320MG, 13
FE sulfate TAB 27MG, 35
Feosol TAB 45MG, 35
Exforgeh/10- TAB 160-12.5, 13
FE TABS TAB 325MG EC, 35
feosol TAB 65MG, 34
Exforgeh/10- TAB 160-25, 13
feenamint TAB 5MG EC, 29
Fer-IN-sol Dro 15MG/ML, 35
Exforgeh/10- TAB 320-25, 13
felbamate sus 600/5ML, 43
fer-iron dro 15MG/ML, 34
Exforgeh/5- TAB 160-12.5, 13
felbamate TAB 400MG, 43
ferate TAB 27MG, 34
Exforgeh/5- TAB 160-25, 13
felbamate TAB 600MG, 43
fergon TAB 27MG, 34
Exjade TAB 125MG, 66
Felbatol Sus 600/5ML, 43
Fergon TAB 27MG, 35
Exjade TAB 250MG, 66
Felbatol TAB 400MG, 43
ferosul elx 220/5ML, 34
Exjade TAB 500MG, 66
Felbatol TAB 600MG, 43
Ferretts FE Chw 18MG, 35
Exoderm Lot 25-1%, 17
Feldene CAP 10MG, 55
Ferretts IPS Sol, 35
Extavia Inj 0.3MG, 47
Feldene CAP 20MG, 55
Ferretts TAB 325MG, 35
Extina Aer 2%, 17
felodipine TAB 10MG ER, 10
ferrex 150 CAP 150MG, 34
EZ Flu Shot Inj 2015-16, 58
felodipine TAB 2.5MG ER, 10
ferric x-150 CAP 150MG, 34
EZ Flu Shot Inj PF 14-15, 58
felodipine TAB 5MG ER, 10
Ferrimin 150 TAB, 35
EZ Flu Shot Kit 2015-16, 58
Fem PH Gel, 33
Ferriprox Sol 100MG/ML, 67
EZ Flu Shot Kit 2016-17, 58
Femara TAB 2.5MG, 6
Ferriprox TAB 500MG, 66
EZ Smart Mis Lancets, 62
Femcon FE Chw, 24
ferro-bob TAB 325MG, 34
EZ-lets 21G Mis Lancets, 62
Femhrt TAB 0.5-2.5, 23
ferrocite TAB 324MG, 34
EZ-lets 23G Mis Lancets, 62
feminine LAX TAB 5MG EC, 29
ferrotabs TAB, 34
EZ-lets 26G Mis Lancets, 62
Femiron TAB, 35
ferrous dro 15MG/ML, 34
EZ-lets 28G Mis Lancets, 62
Femring Mis 0.05/24h, 33
Ferrous Fum TAB 29MG, 35
EZ-lets 30G Mis Lancets, 62
Femring Mis 0.1MG/24, 33
ferrous fum TAB 324MG, 34
ezetim/simva TAB 10-10MG, 14
femynor TAB 0.25-35, 23
ferrous gluc TAB 225MG, 34
ezetim/simva TAB 10-20MG, 14
fenofibrate CAP 130MG, 14
Ferrous Gluc TAB 225MG, 35
ezetim/simva TAB 10-40MG, 14
fenofibrate CAP 134MG, 14
ferrous gluc TAB 240MG, 34
ezetim/simva TAB 10-80MG, 14
Fenofibrate CAP 150MG, 15
ferrous gluc TAB 324MG, 34
ezetimibe TAB 10MG, 14
fenofibrate CAP 200MG, 14
Ferrous Gluc TAB 324MG, 35
ezfe 200 CAP 200MG, 34
fenofibrate CAP 43MG, 14
ferrous sulf dro 15MG/ML, 34
F
Fenofibrate CAP 50MG, 15
ferrous sulf elx 220/5ML, 34
fenofibrate CAP 67MG, 14
Ferrous Sulf Syp 300/5ML, 35
fa-8 CAP 800mcg, 34
fenofibrate TAB 120MG, 15
Ferrous Sulf TAB 140MG, 35
fa-8 TAB 0.8MG, 34
fenofibrate TAB 145MG, 15
Ferrous Sulf TAB 324MG EC, 35
Fabior Aer 0.1%, 17
fenofibrate TAB 160, 14
ferrous sulf TAB 325MG, 34
Fabrazyme Inj 35MG, 28
fenofibrate TAB 160MG, 14
ferrous sulf TAB 325MG EC, 34
Fabrazyme Inj 5MG, 28
fenofibrate TAB 40MG, 15
ferrous sulf TAB 325MG fc, 34
Factive TAB 320MG, 3
fenofibrate TAB 48MG, 15
ferrous sulf TAB 5gr, 34
fallback TAB 1.5MG, 23
fenofibrate TAB 54MG, 14
ferrousul TAB 325MG, 34
falmina TAB, 23
fenofibric CAP 135MG DR, 15
Fetzima CAP 120MG, 38
famciclovir TAB 125MG, 5
fenofibric CAP 45MG DR, 15
Fetzima CAP 20MG, 38
famciclovir TAB 250MG, 5
Fenofibric TAB 105MG, 14
Fetzima CAP 40MG, 38
famciclovir TAB 500MG, 5
Fenofibric TAB 35MG, 14
Fetzima CAP 80MG, 38
famotidine sus 40MG/5ML, 30
Fenoglide TAB 120MG, 15
Fetzima CAP Titratio, 38
famotidine TAB 20MG, 30
Fenoglide TAB 40MG, 15
Fexmid TAB 7.5MG, 48
famotidine TAB 40MG, 30
Fenoprofen CAP 200MG, 55
Fiasp Flex Inj Touch, 25
Famvir TAB 125MG, 5
Fenoprofen CAP 400MG, 55
Fiasp Inj 100/ML, 25
Famvir TAB 250MG, 5
fenoprofen TAB 600MG, 54
Fibricor TAB 105MG, 15
Famvir TAB 500MG, 5
Fenortho CAP 200MG, 55
Fibricor TAB 35MG, 15
Fanapt PAK, 40
Fenortho CAP 400MG, 55
Fifty50 Mis 31GX3/16, 62
Fanapt TAB 10MG, 40
fentanyl dis 100mcg/h, 51
Fifty50 Mis 31GX5/16, 62
Fanapt TAB 12MG, 40
fentanyl dis 12mcg/HR, 51
Fifty50 Mis 31GX5MM, 62
Fanapt TAB 1MG, 40
fentanyl dis 25mcg/HR, 51
Fifty50 Mis Lanc Dev, 62
Fanapt TAB 2MG, 40
Fentanyl Dis 37.5mcg, 53
Fifty50 Pen Mis 31GX8MM, 62
Fanapt TAB 4MG, 40
fentanyl dis 50mcg/HR, 51
Fifty50 Pen Mis 32GX4MM, 62
Fanapt TAB 6MG, 40
Fentanyl Dis 62.5mcg, 53
Fifty50 Pen Mis 32GX6MM, 62
Fanapt TAB 8MG, 40
fentanyl dis 75mcg/HR, 51
Fifty50 Safe Mis Lancets, 62
Fareston TAB 60MG, 6
Fentanyl Dis 87.5mcg, 53
Fifty50 Sol 2.0, 62
Farxiga TAB 10MG, 26
fentanyl ot loz 1200mcg, 52
Finacea Aer 15%, 17
Farxiga TAB 5MG, 26
fentanyl ot loz 1600mcg, 52
Finacea Gel 15%, 17
Farydak CAP 10MG, 7
fentanyl ot loz 200mcg, 52
finasteride TAB 5MG, 34
Farydak CAP 15MG, 7
fentanyl ot loz 400mcg, 52
Fine 30 Mis, 62
Farydak CAP 20MG, 7
fentanyl ot loz 600mcg, 52
Fingerstix Mis Lancets, 62
Fastclix Mis Lancets, 62
fentanyl ot loz 800mcg, 52
Fioricet CAP, 51
fayosim TAB, 23
Fentora TAB 100mcg, 52
Fioricet CAP Codeine, 53
Fazaclo TAB 100 Odt, 40
Fentora TAB 200mcg, 52
Fiorinal CAP, 51
Fazaclo TAB 12.5 Odt, 40
Fiorinal/Cod CAP 30MG, 53
fluocin acet oil ear0.01%, 50
Fluzone Quad Inj 2017-18, 58
Firazyr Inj 30MG/3ML, 36
fluocin acet oil scalp, 18
Fluzone Splt Inj 2015-16, 58
Firmagon Inj 120MG, 6
fluocin acet oin 0.025%, 18
FML Forte Sus 0.25% Op, 49
Firmagon Inj 80MG, 6
fluocin acet sol 0.01%, 18
FML Liquiflm Sus 0.1% Op, 49
First-baclof Sus 1, 48
fluocinonide CRE 0.05%, 18
FML Oin 0.1% Op, 49
First-baclof Sus 5 Kit, 48
fluocinonide CRE 0.1%, 19
Focalin TAB 10MG, 42
First-mouthw Sus Blm, 36
fluocinonide CRE e 0.05%, 18
Focalin TAB 2.5MG, 42
First-omepra Sus 2MG/ML, 31
fluocinonide gel 0.05%, 18
Focalin TAB 5MG, 42
Flagyl CAP 375MG, 6
fluocinonide oin 0.05%, 18
Focalin XR CAP 10MG, 42
Flagyl TAB 250MG, 6
fluocinonide sol 0.05%, 18
Focalin XR CAP 15MG, 42
Flagyl TAB 500MG, 6
fluoromethol sus 0.1% op, 49
Focalin XR CAP 20MG, 42
Flarex Sus 0.1% Op, 49
Fluoroplex CRE 1%, 6
Focalin XR CAP 25MG, 42
flavoxate TAB 100MG, 33
Fluorouracil CRE 0.5%, 6
Focalin XR CAP 30MG, 42
flecainide TAB 100MG, 10
fluorouracil CRE 5%, 6
Focalin XR CAP 35MG, 42
flecainide TAB 150MG, 10
fluorouracil dro 2%, 6
Focalin XR CAP 40MG, 42
flecainide TAB 50MG, 10
fluorouracil dro 5%, 6
Focalin XR CAP 5MG, 42
Flector Dis 1.3%, 18
Fluorouracil Sol 2%, 6
folic acid CAP 800mcg, 34
fleet laxati TAB 5MG EC, 29
Fluorouracil Sol 5%, 6
Folic Acid Inj 5MG/ML, 35
Flexichamber Mis, 66
fluoxetine CAP 10MG, 37
folic acid TAB 1000mcg, 34
Flexichamber Mis Mask Lrg, 66
Fluoxetine CAP 10MG, 45
folic acid TAB 1MG, 34
Flexichamber Mis Mask Sm, 66
fluoxetine CAP 20MG, 37
folic acid TAB 400mcg, 34
Flexin Pad .0375-5%, 20
Fluoxetine CAP 20MG, 45
folic acid TAB 800mcg, 34
Flolipid Sus 20MG/5ML, 15
fluoxetine CAP 40MG, 37
fondaparinux inj 10/0.8ML, 36
Flolipid Sus 40MG/5ML, 15
Fluoxetine CAP 90MG DR, 38
fondaparinux inj 2.5/0.5, 36
Flomax CAP 0.4MG, 34
fluoxetine sol 20MG/5ML, 37
fondaparinux inj 5/0.4ML, 36
Flovent Disk Aer 100mcg, 57
fluoxetine TAB 10MG, 37, 47
fondaparinux inj 7.5/0.6, 36
Flovent Disk Aer 250mcg, 57
fluoxetine TAB 20MG, 37, 47
Fora Control Sol High, 62
Flovent Disk Aer 50mcg, 57
Fluoxetine TAB 60MG, 38
Fora Control Sol Low, 62
Flovent HFA Aer 110mcg, 57
fluphenaz DE inj 25MG/ML, 39
Fora Control Sol Normal, 62
Flovent HFA Aer 220mcg, 57
Fluphenazine CON 5MG/ML, 39
Fora Lancets Mis 30G, 62
Flovent HFA Aer 44mcg, 57
Fluphenazine Elx 2.5/5ML, 39
Fora Mis Lancets, 62
Flowtuss Sol 2.5-200, 56
Fluphenazine Inj 2.5MG/ML, 39
Fora Mis Lancing, 62
Floxin Sol 0.3%, 50
fluphenazine TAB 10MG, 39
Foracare Gdh Sol High, 62
Fluad Inj 2016-17, 58
fluphenazine TAB 1MG, 39
Foracare Gdh Sol Low, 62
Fluad Inj 2017-18, 58
fluphenazine TAB 2.5MG, 39
Foracare Gdh Sol Normal, 62
Fluarix Quad Inj 2015-16, 58
fluphenazine TAB 5MG, 39
Foradil CAP Aerolize, 57
Fluarix Quad Inj 2016-17, 58
flurandrenol CRE 0.05%, 19
Forfivo XL TAB 450MG, 38
Fluarix Quad Inj 2017-18, 58
flurandrenol lot 0.05%, 19
Fortamet TAB 1000MG, 25
Flublok Sol 2015-16, 58
flurandrenol oin 0.05%, 19
Fortamet TAB 500MG, 25
Flublok Sol 2016-17, 58
Flurazepam CAP 15MG, 41
Fortaz Inj 1gm, 1
Flublok Sol 2017-18, 58
Flurazepam CAP 30MG, 41
Forteo Sol 600/2.4, 27
Flucelvax Inj 2015-16, 58
flurbiprofen sol 0.03% op, 50
Fortesta Gel 10MG/Act, 22
Fluclvx Quad Inj 2016-17, 58
Flurbiprofen Sol 0.03% Op, 50
Fortical Spr 200/Act, 27
Fluclvx Quad Inj 2017-18, 58
flurbiprofen TAB 100MG, 54
Fortiscare Sol Cntl HI, 62
fluconazole sus 10MG/ML, 3
flurbiprofen TAB 50MG, 54
Fortiscare Sol Cntl Low, 62
fluconazole sus 40MG/ML, 3
flutamide CAP 125MG, 6
Fortiscare Sol Cntl Nml, 62
fluconazole TAB 100MG, 3
fluticasone CRE 0.05%, 19
Fosamax + D TAB 70-2800, 27
fluconazole TAB 150MG, 3
Fluticasone Inh Salmeter, 57
Fosamax + D TAB 70-5600, 27
fluconazole TAB 200MG, 3
fluticasone lot 0.05%, 19
Fosamax TAB 70MG, 27
fluconazole TAB 50MG, 3
fluticasone oin 0.005%, 19
fosamprenavi TAB 700MG, 4
flucytosine CAP 250MG, 3
fluticasone spr 50mcg, 56
fosinop/hctz TAB 10/12.5, 12
flucytosine CAP 500MG, 3
fluvastatin CAP 20MG, 15
fosinop/hctz TAB 20/12.5, 12
fludrocort TAB 0.1MG, 21
fluvastatin CAP 40MG, 15
fosinopril TAB 10MG, 11
Flulaval Qua Inj 2014-15, 58
fluvastatin TAB 80MG ER, 15
fosinopril TAB 20MG, 11
Flulaval Qua Inj 2015-16, 58
Fluvirin Inj 2015-16, 58
fosinopril TAB 40MG, 11
Flulaval Qua Inj 2016-17, 58
Fluvirin Inj 2016-17, 58
Fosrenol Chw 1000MG, 32
Flulaval Qua Inj 2017-18, 58
Fluvirin Inj 2017-18, 58
Fosrenol Chw 500MG, 32
Flumadine TAB 100MG, 5
fluvoxamine CAP 100MG ER, 38
Fosrenol Chw 750MG, 32
Flumist Quad Sus 2015-16, 58
fluvoxamine CAP 150MG ER, 38
Fosrenol Pow 1000MG, 32
Flumist Quad Sus 2016-17, 58
fluvoxamine TAB 100MG, 37
Fosrenol Pow 750MG, 32
Flumist Quad Sus 2017-18, 58
fluvoxamine TAB 25MG, 37
Fragmin Inj 10000/ML, 36
Flunisolide Spr 0.025%, 56
fluvoxamine TAB 50MG, 37
Fragmin Inj 12500unt, 36
fluocin acet CRE 0.01%, 18
Fluzone HD Inj PF 15-16, 58
Fragmin Inj 15000unt, 36
fluocin acet CRE 0.025%, 18
Fluzone HD Inj PF 16-17, 58
Fragmin Inj 18000unt, 36
fluocin acet oil 0.01%, 50
Fluzone HD Inj PF 17-18, 58
Fragmin Inj 2500/0.2, 36
fluocin acet oil 0.01% sc, 18
Fluzone Quad Inj 15-16, 58
Fragmin Inj 5000/0.2, 36
fluocin acet oil 0.01%bdy, 18
Fluzone Quad Inj 2015-16, 58
Fragmin Inj 7500/0.3, 36
fluocin acet oil body, 18
Fluzone Quad Inj 2016-17, 58
Fragmin Inj 95000unt, 36
Freestyle Liq Control, 62
Genotropin Inj 0.2MG, 27
Global 28G Mis Lancets, 62
Freestyle Mis Lancets, 62
Genotropin Inj 0.4MG, 27
Global 30G Mis Lancets, 62
Freestyle Mis Unistick, 62
Genotropin Inj 0.6MG, 27
Global Lanc Mis Device, 62
Freestyle Tes, 62
Genotropin Inj 0.8MG, 27
Gluc Control Liq Normal, 62
Frova TAB 2.5MG, 55
Genotropin Inj 1.2MG, 27
Gluc Control Sol, 62
frovatriptan TAB 2.5MG, 55
Genotropin Inj 1.4MG, 27
Gluc Control Sol Level 1, 62
Fulyzaq TAB 125MG, 30
Genotropin Inj 1.6MG, 27
Gluc Control Sol Level 2, 62
Furadantin Sus 25MG/5ML, 33
Genotropin Inj 1.8MG, 27
Gluc Control Sol Mid, 62
furosemide inj 100/10ML, 13
Genotropin Inj 12MG, 27
Gluc Control Sol Normal, 62
furosemide inj 10MG/ML, 13
Genotropin Inj 1MG, 27
Glucagen Inj Hypokit, 26
furosemide inj 20MG/2ML, 13
Genotropin Inj 2MG, 27
Glucagon Kit 1MG, 26
furosemide inj 40MG/4ML, 13
Genotropin Inj 5MG, 27
Glucocard 01 Liq Norm/Hgh, 62
furosemide sol 10MG/ML, 13
gentak oin 0.3% op, 48
Glucocard 01 Sol Normal, 62
Furosemide Sol 8MG/ML, 14
Gentak Oin 0.3% Op, 48
Glucocard Liq Level 1, 62
furosemide TAB 20MG, 13
gentamicin CRE 0.1%, 17
Glucocard Sol Normal, 62
furosemide TAB 40MG, 13
gentamicin inj 40MG/ML, 3
Glucocard Sol Shine, 62
furosemide TAB 80MG, 13
Gentamicin Oin 0.1%, 17
Glucocom Mis 28G, 62
Fuzeon Inj 90MG, 4
gentamicin oin 0.3% op, 48
Glucocom Mis 30G, 62
fyavolv TAB 0.5-2.5, 22
gentamicin sol 0.3% op, 48
Glucocom Mis 33G, 62
fyavolv TAB 1-5, 22
gentle laxat TAB 5MG EC, 30
Glucocom Tes High CON, 62
Fycompa Sus 0.5MG/ML, 44
Gentle-let Mis 26G, 62
Glucocom Tes Norm CON, 62
Fycompa TAB 10MG, 44
Gentle-let Mis 28G, 62
Glucolet 2 Mis Lancing, 62
Fycompa TAB 12MG, 44
Gentle-let Mis Lancets, 62
Glucophage TAB 1000MG, 25
Fycompa TAB 2MG, 44
Gentle-let Mis Platform, 62
Glucophage TAB 500MG, 25
Fycompa TAB 4MG, 44
gentlelax pow, 30
Glucophage TAB 500MG XR, 25
Fycompa TAB 6MG, 44
Genvoya TAB, 4
Glucophage TAB 750MG XR, 25
Fycompa TAB 8MG, 44
Geodon CAP 20MG, 40
Glucophage TAB 850MG, 26
G
Geodon CAP 40MG, 40
Glucose Cont Liq High/Low, 62
Geodon CAP 60MG, 40
Glucose Cont Sol High, 62
gabapentin CAP 100MG, 43
Geodon CAP 80MG, 40
Glucose Cont Sol Normal, 62
gabapentin CAP 300MG, 43
Geodon Inj 20MG, 40
Glucose Cont Sol Precisio, 62
gabapentin CAP 400MG, 43
geri-hydrola CRE 12%, 20
Glucosource Mis Lanc Dev, 62
gabapentin sol 250/5ML, 43
geri-hydrola lot 5%, 20
Glucosource Mis Lancets, 62
gabapentin sol 300/6ML, 43
gianvi TAB 3-0.02MG, 23
Glucotrol TAB 10MG, 25
gabapentin TAB 600MG, 43
Giazo TAB 1.1gm, 32
Glucotrol TAB 5MG, 25
gabapentin TAB 800MG, 43
gildagia TAB 0.4-35, 23
Glucotrol XL TAB 10MG, 25
Gabitril TAB 12MG, 44
gildess 24 TAB FE 1/20, 23
Glucotrol XL TAB 2.5MG, 25
Gabitril TAB 16MG, 44
gildess FE TAB 1.5/30, 23
Glucotrol XL TAB 5MG, 25
Gabitril TAB 2MG, 44
gildess FE TAB 1/20, 23
Glucovance TAB 2.5-500, 26
Gabitril TAB 4MG, 44
gildess TAB 1.5/30, 23
Glucovance TAB 5-500MG, 26
galantamine CAP 16MG ER, 45
gildess TAB 1/20, 23
Glumetza TAB 1000MG, 26
galantamine CAP 24MG ER, 45
Gilenya CAP 0.5MG, 47
Glumetza TAB 500MG, 26
galantamine CAP 8MG ER, 45
Gilotrif TAB 20MG, 7
glyb/metform TAB 1.25-250, 26
Galantamine Sol 4MG/ML, 45
Gilotrif TAB 30MG, 7
glyb/metform TAB 2.5-500, 26
galantamine TAB 12MG, 45
Gilotrif TAB 40MG, 7
glyb/metform TAB 5-500MG, 26
galantamine TAB 4MG, 45
glatiramer inj 20MG/ML, 47
glyburid mcr TAB 1.5MG, 25
galantamine TAB 8MG, 45
glatiramer inj 40MG/ML, 47
glyburid mcr TAB 3MG, 25
Gardasil 9 Inj, 58
glatopa inj 20MG/ML, 47
glyburid mcr TAB 6MG, 25
Gardasil Inj, 58
Gleevec TAB 100MG, 7
glyburide TAB 1.25MG, 25
Gastrocrom CON 100/5ML, 32
Gleevec TAB 400MG, 7
glyburide TAB 2.5MG, 25
gatifloxacin sol 0.5%, 48
Gleostine CAP 100MG, 6
glyburide TAB 5MG, 25
Gattex Kit 5MG, 32
Gleostine CAP 10MG, 6
glycolax pow 3350 NF, 30
gavilax pow, 29
Gleostine CAP 40MG, 6
glycopyrrol inj 0.2MG/ML, 30
gavilyte-c sol, 29
Gleostine CAP 5MG, 6
glycopyrrol inj 0.4/2ML, 30
gavilyte-G sol, 29
glimepiride TAB 1MG, 25
glycopyrrol inj 1MG/5ML, 30
gavilyte-h kit, 30
glimepiride TAB 2MG, 25
glycopyrrol inj 4MG/20ML, 30
gavilyte-n sol flav pk, 29
glimepiride TAB 4MG, 25
glycopyrrol TAB 1MG, 30
Ge100 Contrl Sol Normal, 62
glip/metform TAB 2.5-250m, 26
glycopyrrol TAB 2MG, 30
Gebauers Spr Aer /Stretch, 20
glip/metform TAB 2.5-500m, 26
glydo gel 2%, 20
Gelnique Gel 10%, 33
glip/metform TAB 5-500MG, 26
Glynase TAB 1.5MG, 25
Gelnique Gel 10% P.M., 33
glipizide ER TAB 10MG, 25
Glynase TAB 3MG, 25
Gelnique Gel 3%, 33
glipizide ER TAB 2.5MG, 25
Glynase TAB 6MG, 25
gemfibrozil TAB 600MG, 14
glipizide ER TAB 5MG, 25
Glyset TAB 100MG, 26
Generess FE Chw, 24
glipizide TAB 10MG, 25
Glyset TAB 25MG, 26
generlac sol 10gm/15, 32
glipizide TAB 5MG, 25
Glyset TAB 50MG, 26
gengraf CAP 100MG, 7
glipizide XL TAB 10MG, 25
Glyxambi TAB 10-5 MG, 26
gengraf CAP 25MG, 7
glipizide XL TAB 2.5MG, 25
Glyxambi TAB 25-5 MG, 26
gengraf CAP 50MG, 7
glipizide XL TAB 5MG, 25
Gmate Contro Sol Level 2, 62
gengraf sol 100MG/ML, 7
Gmate Lancet Mis 30G, 62
Haemolance Mis High FLO, 62
HM nicotine dis 14MG/24h, 47
Gmate Lancin Mis Device, 62
Haemolance Mis Low Flow, 62
HM nicotine dis 21MG/24h, 47
gnp aspirin chw 81MG, 50
Haemolance Mis Plus, 62
HM nicotine gum 2MG mint, 47
gnp aspirin TAB 325MG, 50
Haemolance Mis Plus Low, 62
HM nicotine gum 4MG mint, 47
gnp aspirin TAB 325MG EC, 50
Haemolance Mis Plus Max, 62
HM nicotine loz 2MG mint, 47
gnp aspirin TAB 81MG EC, 50
Haemolance Mis Plus PED, 62
HM nicotine loz 4MG mint, 47
gnp bisa-LAX TAB 5MG EC, 30
Haemolance Mis Retract, 62
HM One Daily Mis Prenatal, 60
gnp clearlax pow, 30
Halcion TAB 0.25MG, 41
HM Prenatal TAB, 60
gnp d CAP 1000unit, 59
Haldol Decan Inj 100MG/ML, 40
HM vit d3 CAP 2000unit, 59
gnp d chw 2000unit, 59
Haldol Decan Inj 50MG/ML, 40
HM vitamin d TAB 1000unit, 59
Gnp Daily Mis Prenatal, 60
Haldol Inj 5MG/ML, 40
Hold Chamber Mis Adlt LG, 66
gnp iron TAB 325MG, 34
halobetasol CRE 0.05%, 18
Hold Chamber Mis Medium, 66
gnp iron TAB 45MG, 34
halobetasol oin 0.05%, 18
Hold Chamber Mis Small, 66
gnp iron TAB 65MG, 34
Halog CRE 0.1%, 19
homatropaire sol 5% op, 49
Gnp Lancets Mis, 62
Halog Oin 0.1%, 19
homatropine sol 5% op, 49
Gnp Lancets Mis 21G, 62
haloper DEC inj 100MG/ML, 39
Horizant TAB 300MG, 47
Gnp Lancets Mis Micro, 62
haloper DEC inj 50MG/ML, 39
Horizant TAB 600MG, 47
Gnp Lancets Mis Sup Thin, 62
haloper lac inj 5MG/ML, 39
HPR Aer, 21
Gnp Lancets Mis Thin, 62
haloperidol CON 2MG/ML, 39
HPR Plus Aer, 21
Gnp Lancets Mis Thin 26G, 62
haloperidol inj 50/10ML, 39
HPR Plus CRE, 21
gnp laxative TAB 5MG EC, 30
haloperidol inj 5MG/ML, 39
Humalog Inj 100/ML, 25
gnp nicotine dis 21MG/24h, 46
haloperidol TAB 0.5MG, 39
Humalog JR Inj 100/ML, 25
gnp nicotine dis 7MG/24HR, 46
haloperidol TAB 10MG, 39
Humalog Kwik Inj 100/ML, 25
gnp nicotine gum 2MG mint, 46
haloperidol TAB 1MG, 39
Humalog Kwik Inj 200/ML, 25
gnp nicotine gum 2MG orig, 46
haloperidol TAB 20MG, 39
Humalog Mix Inj 50/50, 25
gnp nicotine gum 4MG mint, 46
haloperidol TAB 2MG, 39
Humalog Mix Inj 50/50kwp, 25
gnp nicotine gum 4MG orig, 46
haloperidol TAB 5MG, 39
Humalog Mix Inj 75/25kwp, 25
gnp nicotine loz 2MG mint, 46
Halotin CRE 1%, 17
Humalog Mix Sus 75/25, 25
gnp nicotine loz 4MG mint, 46
Harvoni TAB 90-400MG, 4
Humatrope Inj 12MG, 27
gnp nicotine loz mini 2MG, 46
Havrix Inj 1440unit, 58
Humatrope Inj 24MG, 27
Gnp Prenatal TAB 28-0.8MG, 60
Havrix Inj 720unit, 58
Humatrope Inj 5MG, 27
gnp vit d TAB 1000unit, 59
HC butyrate CRE 0.1%, 19
Humatrope Inj 6MG, 27
gnp vit d TAB 5000unit, 59
HC butyrate oin 0.1%, 19
Humira Inj 10MG/0.2, 54
gnp vit d3 TAB 1000unit, 59
HC butyrate sol 0.1%, 19
Humira Kit 20MG/0.4, 54
Gocovri CAP 137MG, 45
HC Lancing Mis Device, 62
Humira Kit 40MG/0.8, 54
Gocovri CAP 68.5MG, 45
HC pramoxine CRE 2.5-1%, 19
Humira Pedia Inj Crohns, 54
Golytely Sol, 30
HC valerate CRE 0.2%, 19
Humira Pen Inj 40MG/0.8, 54
Golytely Sol Pineappl, 30
HC valerate oin 0.2%, 19
Humira Pen Inj Crohns, 54
Gonitro Pow 400mcg, 9
HC/acet acid sol otic, 50
Humira Pen Inj Psoriasi, 54
Goodsense Mis Lanc 30G, 62
Healthpro Sol High/Low, 62
Humulin Inj 70/30, 25
Goodsense Mis Lanc Dvc, 62
heather TAB 0.35MG, 23
Humulin Inj 70/30kwp, 25
Goodsense TAB 28-0.8MG, 60
Hectorol CAP 0.5mcg, 28
Humulin N Inj U-100, 25
Gralise Star Mis 300/600, 47
Hectorol CAP 1mcg, 28
Humulin N Inj U-100kwp, 25
Gralise TAB 300MG, 47
Hectorol CAP 2.5mcg, 28
Humulin R Inj U-100, 25
Gralise TAB 600MG, 47
Hemangeol Sol 4.28/ML, 9
Humulin R Inj U-500, 25
granisetron TAB 1MG, 31
hemmorex-HC sup 25MG, 32
hyaluronate gel 0.2%, 20
Granix Inj 300/0.5, 35
hemmorex-HC sup 30MG, 32
Hycamtin CAP 0.25MG, 8
Granix Inj 480/0.8, 35
Hemocyte TAB 324MG, 35
Hycamtin CAP 1MG, 8
Grifulvin V TAB 500MG, 3
heparin sod inj 1000/ML, 35
Hycet Sol 7.5-325, 53
Gris-peg TAB 125MG, 3
heparin sod inj 10000/ML, 35
Hycofenix Sol, 56
Gris-peg TAB 250MG, 3
heparin sod inj 5000/0.5, 35
HYD pol/CPM sus 10-8/5ML, 56
griseofulvin sus 125/5ML, 3
heparin sod inj 5000/ML, 35
hydr/CPM/PSE liq 5-4-60MG, 56
griseofulvin TAB micr 500, 3
Hepsera TAB 10MG, 4
hydralazine TAB 100MG, 12
griseofulvin TAB ultr 125, 3
Hetlioz CAP 20MG, 41
hydralazine TAB 10MG, 12
griseofulvin TAB ultr 250, 3
Hexalen CAP 50MG, 6
hydralazine TAB 25MG, 12
guanfacine TAB 1MG, 12
hgh-pot iron TAB 325MG, 34
hydralazine TAB 50MG, 12
guanfacine TAB 1MG ER, 41
Hiberix Sol 10mcg, 58
Hydrea CAP 500MG, 8
guanfacine TAB 2MG, 12
high potency TAB FE 27MG, 34
Hydro 35 Aer, 20
guanfacine TAB 2MG ER, 41
high potency TAB iron, 34
Hydro 40 Aer Foam, 20
guanfacine TAB 3MG ER, 41
Hiprex TAB 1gm, 33
hydro/chlor/ liq 5-4-60MG, 56
guanfacine TAB 4MG ER, 41
Hlthy Accnts Mis Lanc 30G, 62
hydroc/homat TAB 5-1.5MG, 56
Guanidine TAB 125MG, 48
HM aspirin chw 81MG, 51
hydrochlorot CAP 12.5MG, 13
Gynazole-1 CRE 2%, 33
HM aspirin TAB 325MG, 51
hydrochlorot TAB 12.5MG, 13
Gynol II Gel 3%, 33
HM clearlax pow, 30
hydrochlorot TAB 25MG, 13
H
HM iron TAB 45MG, 35
hydrochlorot TAB 50MG, 13
HM iron TAB 65MG, 35
hydroco/apap sol 7.5-325, 51
H.p. Acthar Inj 80unit, 28
HM laxative TAB 5MG, 30
hydroco/apap TAB 10-300MG, 52
Haegarda Inj 2000unit, 36
HM laxative TAB 5MG EC, 30
hydroco/apap TAB 10-325MG, 51
Haegarda Inj 3000unit, 36
hydroco/apap TAB 2.5-325, 52
Hysingla ER TAB 30 MG, 53
Indocin Sup 50MG, 55
hydroco/apap TAB 5-300MG, 52
Hysingla ER TAB 40 MG, 53
Indocin Sus 25MG/5ML, 55
hydroco/apap TAB 5-325MG, 51
Hysingla ER TAB 60 MG, 53
indomethacin CAP 25MG, 54
hydroco/apap TAB 7.5-300, 52
Hysingla ER TAB 80 MG, 53
indomethacin CAP 50MG, 54
hydroco/apap TAB 7.5-325, 51
Hyzaar TAB 100-12.5, 13
indomethacin CAP 75MG ER, 54
hydrocod/hom syp 5-1.5/5, 56
Hyzaar TAB 100-25, 13
Infanrix Inj, 58
hydrocod/ibu TAB 10-200MG, 52
Hyzaar TAB 50-12.5, 13
Infasurf Sus 35MG/ML, 58
hydrocod/ibu TAB 2.5-200, 52
I
Infinity Sol High CON, 62
hydrocod/ibu TAB 5-200MG, 52
Infinity Sol Low CON, 62
ibandronate TAB 150MG, 27
hydrocod/ibu TAB 7.5-200, 52
Infinity Sol Norm CON, 62
Ibrance CAP 100MG, 7
hydrocodone sol 10-325MG, 52
Inflectra Inj 100MG, 32
Ibrance CAP 125MG, 7
hydrocort ac sup 25MG, 32
Influenza Firus Vaccine, 58
Ibrance CAP 75MG, 7
hydrocort ac sup 30MG, 32
Ingrezza CAP 40MG, 47
Ibudone TAB 10-200MG, 53
hydrocort CRE 1%, 19, 32
Inlyta TAB 1MG, 7
ibudone TAB 5-200MG, 52
hydrocort CRE 2.5%, 18
Inlyta TAB 5MG, 7
ibuprofen sus 100/5ML, 54
hydrocort ene 100MG, 32
Innopran XL CAP 120MG, 9
ibuprofen TAB 400MG, 54
hydrocort lot 2.5%, 18
Innopran XL CAP 80MG, 9
ibuprofen TAB 600MG, 54
hydrocort oin 1%, 18
Inspirachamb Mis Large, 66
ibuprofen TAB 800MG, 54
hydrocort oin 2.5%, 18
Inspirachamb Mis Medium, 66
Icar Peds Sus Grape, 35
hydrocort TAB 10MG, 21
Inspirachamb Mis Mouthpce, 66
Iclusig TAB 15MG, 7
hydrocort TAB 20MG, 21
Inspirachamb Mis Small, 66
Iclusig TAB 45MG, 7
hydrocort TAB 5MG, 21
Inspirease Mis Dd Syst, 66
Idhifa TAB 100MG, 7
hydrocort/ab oin 1%, 18
Inspirease Mis Res Bag, 66
Idhifa TAB 50MG, 7
hydrocortiso CRE 2.5%, 32
Inspra TAB 25MG, 12
iferex 150 CAP, 34
hydromet syp 5-1.5/5, 56
Inspra TAB 50MG, 12
Ilevro Dro 0.3% Op, 50
hydromorphon inj 1MG/ML, 51
Insulin Pen Mis 29GX12MM, 62
ilotycin oin op, 48
hydromorphon inj 2MG/ML, 51
Insulin Pen Mis 31GX4MM, 62
imatinib mes TAB 100MG, 7
hydromorphon inj 4MG/ML, 51
Insulin Pen Mis 31GX8MM, 62
imatinib mes TAB 400MG, 7
hydromorphon liq 1MG/ML, 51
Insulin SYR Mis 0.3/31G, 63
Imbruvica CAP 140MG, 7
Hydromorphon Sup 3MG, 51
Insulin SYR Mis 0.5/31G, 63
imipram HCL TAB 10MG, 37
hydromorphon TAB 12MG ER, 52
Insulin SYR Mis 1ML/31G, 63
imipram HCL TAB 25MG, 37
hydromorphon TAB 16MG ER, 52
Insulin SYR Mis 31GX6MM, 63
imipram HCL TAB 50MG, 37
hydromorphon TAB 2MG, 51
Insulin Syrg Mis 0.3/28G, 62
imipram pam CAP 100MG, 38
hydromorphon TAB 32MG ER, 52
Insulin Syrg Mis 0.3/29G, 62
imipram pam CAP 125MG, 38
hydromorphon TAB 4MG, 51
Insulin Syrg Mis 0.3/30G, 62
imipram pam CAP 150MG, 38
hydromorphon TAB 8MG, 51
Insulin Syrg Mis 0.3/31G, 62
imipram pam CAP 75MG, 38
hydromorphon TAB 8MG ER, 52
Insulin Syrg Mis 0.5/27G, 62
imiquimod CRE 5%, 20
hydrosortiso oin absorbas, 19
Insulin Syrg Mis 0.5/28G, 62
Imitrex Inj 4MG/0.5, 55
hydroxychlor TAB 200MG, 5
Insulin Syrg Mis 0.5/29G, 62
Imitrex Inj 6MG/0.5, 55
hydroxyurea CAP 500MG, 8
Insulin Syrg Mis 0.5/30G, 62
Imitrex Spr 20MG/Act, 55
hydroxyz HCL syp 10MG/5ML, 37
Insulin Syrg Mis 0.5/31G, 62
Imitrex Spr 5MG/Act, 55
hydroxyz HCL TAB 10MG, 37
Insulin Syrg Mis 1ML, 62
Imitrex TAB 100MG, 55
hydroxyz HCL TAB 25MG, 37
Insulin Syrg Mis 1ML/25G, 62
Imitrex TAB 25MG, 55
hydroxyz HCL TAB 50MG, 37
Insulin Syrg Mis 1ML/26G, 62
Imitrex TAB 50MG, 55
Hydroxyz Pam CAP 100MG, 37
Insulin Syrg Mis 1ML/27G, 62
Impavido CAP 50MG, 5
hydroxyz pam CAP 25MG, 37
Insulin Syrg Mis 1ML/28G, 62
Imuran TAB 50MG, 7
hydroxyz pam CAP 50MG, 37
Insulin Syrg Mis 1ML/29G, 62
IN Control Mis 31GX5MM, 63
Hylatopic Aer Plus, 20
Insulin Syrg Mis 1ML/30G, 62
IN Control Mis 31GX6MM, 63
Hylatopic CRE Plus, 20
Insulin Syrg Mis 1ML/31G, 63
IN Control Mis 31GX8MM, 63
Hylira Gel 0.2%, 21
Insulin Syrg Mis 1MLX30G, 63
IN Touch Lan Mis 30G, 63
Hylira Lot 0.1%, 21
Insulin Syrg Mis 2/27.5G, 63
IN Touch Lan Mis Device, 63
hyolev mb TAB 81MG, 33
Insulin Syrg Mis 27GX1/2", 63
IN Touch Sol Glucose, 63
hyophen TAB, 33
Insulin Syrg Mis 28GX1/2", 63
Incontrol Mis 29GX12MM, 62
hyoscyamine dro 0.125/ML, 30
Insulin Syrg Mis 29GX1/2", 63
Incontrol Mis Lanc 28G, 62
hyoscyamine elx 0.125/5, 30
Insulin Syrg Mis 30GX1/2", 63
Incontrol Mis Lanc 30G, 62
hyoscyamine sub 0.125MG, 30
Insulin Syrg Mis 30GX5/16, 63
Incontrol Mis Lanc 33G, 62
hyoscyamine TAB 0.125MG, 30
Insulin Syrg Mis 30GX8MM, 63
Incontrol Mis Lanc Dev, 62
hyoscyamine TAB 0.375 ER, 30
Insulin Syrg Mis 31GX5/16, 63
Increlex Inj 40MG/4ML, 27
hyoscyamine TAB 0.375 SR, 30
Insulin Syrg Mis 31GX8MM, 63
Incruse Elpt Inh 62.5mcg, 57
hyosyne dro 0.125/ML, 30
Insupen Mis 29GX12MM, 63
indapamide TAB 1.25MG, 13
hyosyne elx 0.125/5, 30
Insupen Mis 31GX5MM, 63
indapamide TAB 2.5MG, 13
Hyper-sal Neb 7%, 56
Insupen Mis 31GX8MM, 63
Inderal LA CAP 120MG, 9
Hypersal Neb 3.5%, 56
Insupen Mis 32GX4MM, 63
Inderal LA CAP 160MG, 9
Hypersal Neb 7%, 56
Insupen Mis 33GX4MM, 63
Inderal LA CAP 60MG, 9
Hypolance Kit Lancing, 62
Insupen Sens Mis 32GX6MM, 63
Inderal LA CAP 80MG, 9
Hysingla ER TAB 100 MG, 53
Insupen Sens Mis 32GX8MM, 63
Inderal XL CAP 120MG, 9
Hysingla ER TAB 120 MG, 53
Insupen Ultr Mis 29GX12MM, 63
Inderal XL CAP 80MG, 9
Hysingla ER TAB 20 MG, 53
Insupen Ultr Mis 30GX8MM, 63
indiomin mb CAP 120MG, 33
Insupen Ultr Mis 31GX6MM, 63
iron TAB 325MG, 34
jencycla TAB 0.35MG, 23
Insupen Ultr Mis 31GX8MM, 63
iron TAB 45MG, 34
Jentadueto TAB 2.5-1000, 26
Intelence TAB 100MG, 4
iron TAB 50MG ER, 34
Jentadueto TAB 2.5-500, 26
Intelence TAB 200MG, 4
iron TAB 65MG, 34
Jentadueto TAB 2.5-850, 26
Intelence TAB 25MG, 4
Iron Up Liq, 35
Jentadueto TAB XR, 26
Intermezzo Sub 1.75MG, 41
Isentress Chw 100MG, 4
jevantique l TAB 0.5-2.5, 22
Intermezzo Sub 3.5MG, 41
Isentress Chw 25MG, 4
jinteli TAB 1MG-5mcg, 22
Intrarosa Sup 6.5MG, 33
Isentress HD TAB 600MG, 4
jolessa TAB, 23
Intron A Inj 10mu, 8
Isentress Pow 100MG, 5
jolivette TAB 0.35MG, 23
Intron A Inj 18mu, 8
Isentress TAB 400MG, 4
Jublia Sol 10%, 17
Intron A Inj 25mu, 8
isibloom TAB 0.15-30, 23
juleber TAB, 23
Intron A Inj 50mu, 8
Isoniazid Syp 50MG/5ML, 3
junel 1.5/30 TAB, 23
introvale TAB, 23
isoniazid TAB 100MG, 3
junel 1/20 TAB, 23
Intuniv TAB 1MG, 42
isoniazid TAB 300MG, 3
junel FE 24 TAB 1/20, 23
Intuniv TAB 2MG, 42
isoproteren inj 0.2MG/ML, 57
junel FE TAB 1.5/30, 23
Intuniv TAB 3MG, 42
Isopto Carp Sol 1% Op, 49
junel FE TAB 1/20, 23
Intuniv TAB 4MG, 42
Isopto Carp Sol 2% Op, 49
just d liq 400unit, 59
Invanz Inj 1gm, 5
Isopto Carp Sol 4% Op, 49
Juxtapid CAP 10MG, 14
Invega Sust Inj 117/0.75, 39
Isordil TAB 40MG, 8
Juxtapid CAP 20MG, 14
Invega Sust Inj 156MG/ML, 39
Isordil TAB 5MG, 9
Juxtapid CAP 30MG, 14
Invega Sust Inj 234/1.5, 39
isosorb din TAB 10MG, 8
Juxtapid CAP 40MG, 14
Invega Sust Inj 39/0.25, 39
isosorb din TAB 20MG, 8
Juxtapid CAP 5MG, 14
Invega Sust Inj 78/0.5ML, 39
isosorb din TAB 30MG, 8
Juxtapid CAP 60MG, 14
Invega TAB 1.5MG, 40
Isosorb Din TAB 40MG ER, 9
K
Invega TAB 3MG, 40
isosorb din TAB 5MG, 8
k citrate sol citr acd, 34
Invega TAB 6MG, 40
isosorb mono TAB 10MG, 8
K-phos TAB NO 2, 34
Invega TAB 9MG, 40
isosorb mono TAB 120MG ER, 8
k/NA citrate sol citr acd, 34
Invega Trinz Inj 273MG, 40
isosorb mono TAB 20MG, 8
Kadian CAP 100MG ER, 53
Invega Trinz Inj 410MG, 40
isosorb mono TAB 30MG ER, 8
Kadian CAP 10MG ER, 53
Invega Trinz Inj 546MG, 40
isosorb mono TAB 60MG ER, 8
Kadian CAP 200MG ER, 53
Invega Trinz Inj 819MG, 40
isradipine CAP 2.5MG, 10
Kadian CAP 20MG ER, 53
Invirase CAP 200MG, 4
isradipine CAP 5MG, 10
Kadian CAP 30MG ER, 53
Invirase TAB 500MG, 4
Istalol Sol 0.5% Op, 49
Kadian CAP 40MG ER, 53
Invokamet TAB 150-1000, 26
Isuprel Inj 0.2MG/ML, 57
Kadian CAP 50MG ER, 53
Invokamet TAB 150-500, 26
itraconazole CAP 100MG, 3
Kadian CAP 60MG ER, 53
Invokamet TAB 50-1000, 26
ivermectin TAB 3MG, 5
Kadian CAP 80MG ER, 53
Invokamet TAB 50-500MG, 26
J
kaitlib FE chw, 23
Invokamet XR TAB 150-1000, 26
Jadenu Sprkl Gra 180MG, 66
Kaletra Sol, 5
Invokamet XR TAB 150-500, 26
Jadenu Sprkl Gra 360MG, 66
Kaletra TAB 100-25MG, 4
Invokamet XR TAB 50-1000, 26
Jadenu Sprkl Gra 90MG, 66
Kaletra TAB 200-50MG, 4
Invokamet XR TAB 50-500MG, 26
Jadenu TAB 180MG, 66
Kalydeco PAK 50MG, 58
Invokana TAB 100MG, 26
Jadenu TAB 360MG, 66
Kalydeco PAK 75MG, 58
Invokana TAB 300MG, 26
Jadenu TAB 90MG, 66
Kalydeco TAB 150MG, 58
Ionsys Pad 40mcg/Ac, 53
Jakafi TAB 10MG, 7
Kamdoy Emu, 21
Iopidine Sol 0.5% Op, 49
Jakafi TAB 15MG, 7
Kapvay TAB 0.1 MG, 42
Iopidine Sol 1% Op, 49
Jakafi TAB 20MG, 7
Karbinal ER Sus 4MG/5ML, 56
Ipol Inj Inactive, 58
Jakafi TAB 25MG, 7
kariva TAB 28 day, 23
ipratropium sol 0.02%inh, 57
Jakafi TAB 5MG, 7
Kazano 12.5- TAB 1000MG, 26
ipratropium spr 0.03%, 56
Jalyn CAP, 34
Kazano 12.5- TAB 500MG, 26
ipratropium spr 0.06%, 56
jantoven TAB 10MG, 35
Keflex CAP 250MG, 1
ipratropium/ sol albuter, 57
jantoven TAB 1MG, 35
Keflex CAP 500MG, 1
irbesar/hctz TAB 150-12.5, 12
jantoven TAB 2.5MG, 35
Keflex CAP 750MG, 1
irbesar/hctz TAB 300-12.5, 12
jantoven TAB 2MG, 35
kelnor TAB 1/35, 23
irbesartan TAB 150MG, 11
jantoven TAB 3MG, 35
Kenalog Aer Spray, 19
irbesartan TAB 300MG, 11
jantoven TAB 4MG, 35
Kenalog-10 Inj 10MG/ML, 22
irbesartan TAB 75MG, 11
jantoven TAB 5MG, 35
Kenalog-40 Inj 40MG/ML, 22
Iressa TAB 250MG, 7
jantoven TAB 6MG, 35
Keppra Sol 100MG/ML, 44
Iron Chews Chw Pediatri, 35
jantoven TAB 7.5MG, 35
Keppra TAB 1000MG, 44
Iron Chw Pediatri, 35
Janumet TAB 50-1000, 26
Keppra TAB 250MG, 44
Iron High CAP Potency, 35
Janumet TAB 50-500MG, 26
Keppra TAB 500MG, 44
iron slow TAB 45MG, 34
Janumet XR TAB 100-1000, 26
Keppra TAB 750MG, 44
iron supplem TAB 325MG, 34
Janumet XR TAB 50-1000, 26
Keppra XR TAB 500MG, 44
iron supplem TAB therapy, 34
Janumet XR TAB 50-500MG, 26
Keppra XR TAB 750MG, 44
iron supplmt dro 15MG/ML, 34
Januvia TAB 100MG, 26
Keralac CRE 47%, 21
Iron TAB 18MG, 35
Januvia TAB 25MG, 26
Keralyt Gel 6%, 21
Iron TAB 18MG CR, 35
Januvia TAB 50MG, 26
Kerydin Sol 5%, 17
iron TAB 27MG, 34
Jardiance TAB 10MG, 26
Ketek TAB 300MG, 6
Iron TAB 28MG, 35
Jardiance TAB 25MG, 26
Ketek TAB 400MG, 6
ketoconazole aer 2%, 17
lactic acid CRE /vit e, 20
Lancets Micr Mis Thin 33G, 63
ketoconazole CRE 2%, 17
lactic acid CRE e, 20
Lancets Mis, 63
ketoconazole sha 2%, 17
lactic acid lot 10%, 20
Lancets Mis 21G, 63
ketoconazole TAB 200MG, 3
lactulose sol 10gm/15, 29, 32
Lancets Mis 21G Colr, 63
ketodan aer 2%, 17
lactulose sol 20gm/30, 29
lancets mis 23G, 60
Ketoprofen CAP 200MG ER, 55
Lamictal Chw 25MG, 44
Lancets Mis 23G, 63
ketoprofen CAP 50MG, 54
Lamictal Chw 5MG, 44
Lancets Mis 26G, 63
ketoprofen CAP 75MG, 54
Lamictal Kit Start 35, 44
Lancets Mis 28G, 63
ketorolac inj 15MG/ML, 54
Lamictal Kit Start 49, 44
Lancets Mis 30G, 63
ketorolac inj 30MG/ML, 54
Lamictal Kit Start 98, 44
Lancets Mis 31G, 63
ketorolac inj 60MG/2ML, 54
Lamictal Odt Kit, 44
Lancets Mis 33G, 63
ketorolac sol 0.4%, 50
Lamictal Odt TAB 100MG, 44
Lancets Mis Colored, 63
ketorolac sol 0.5%, 50
Lamictal Odt TAB 200MG, 44
Lancets Mis Orange, 63
ketorolac TAB 10MG, 54
Lamictal Odt TAB 25MG, 44
Lancets Mis Original, 63
Keveyis TAB 50MG, 14
Lamictal Odt TAB 50MG, 44
Lancets Mis Thin, 63
Kevzara Inj 150/1.14, 54
Lamictal TAB 100MG, 44
Lancets Mis Thin 26G, 63
Kevzara Inj 200/1.14, 54
Lamictal TAB 150MG, 44
Lancets Mis Thin 30G, 63
Khedezla TAB 100MG ER, 38
Lamictal TAB 200MG, 44
Lancets Supr Mis Thin 28G, 63
Khedezla TAB 50MG ER, 38
Lamictal TAB 25MG, 44
Lancets Thin Mis, 63
kimidess TAB, 23
Lamictal XR Kit, 44
Lancets Thin Mis 26G, 63
Kineret Inj, 54
Lamictal XR TAB 100MG, 44
Lancets Thin Mis 30G, 63
Kinney Mis Lancets, 63
Lamictal XR TAB 200MG, 44
Lancets Ultr Mis Thin, 63
Kinney Thin Mis Lancets, 63
Lamictal XR TAB 250MG, 44
Lancets Ultr Mis Thin 28G, 63
Kinrix Inj, 58
Lamictal XR TAB 25MG, 44
Lancets Ultr Mis Thin 30G, 63
Kisqali 200 PAK Femara, 8
Lamictal XR TAB 300MG, 44
Lancing Devi Mis, 63
Kisqali 400 PAK Femara, 8
Lamictal XR TAB 50MG, 44
Lancing Devi Mis 25G, 63
Kisqali 600 PAK Femara, 8
Lamisil Gra 125MG, 3
Lancing Devi Mis 30G, 63
Kisqali TAB 200dose, 7
Lamisil Gra 187.5MG, 3
Lancing Devi Mis Adjust, 63
Kisqali TAB 400dose, 7
Lamisil TAB 250MG, 3
Lancing Mis Device, 63
Kisqali TAB 600dose, 7
lamivud/zido TAB 150-300, 3
Lancing Pen Mis, 63
Kitabis PAK Neb 300/5ML, 3
lamivudine sol 10MG/ML, 3
Lanoxin Inj 0.25MG/1, 8
Klaron Lot 10%, 17
lamivudine TAB 100MG, 3
Lanoxin PED Inj 0.1MG/ML, 8
klofensaid sol II, 18
lamivudine TAB 150MG, 3
Lanoxin TAB 0.0625MG, 8
Klonopin TAB 0.5MG, 44
lamivudine TAB 300MG, 3
Lanoxin TAB 0.125MG, 8
Klonopin TAB 1MG, 44
lamotrig odt kit 25/50MG, 43
Lanoxin TAB 0.1875MG, 8
Klonopin TAB 2MG, 44
lamotrig odt kit 50/100MG, 43
Lanoxin TAB 0.25MG, 8
kls aspirin TAB 325MG EC, 50
lamotrig odt TAB 100MG, 43
lansopr/amox mis /clarith, 30
kls aspirin TAB 81MG EC, 50
lamotrigine chw 25MG, 43
lansoprazole CAP 15MG DR, 30
kls quit2 gum 2MG, 46
lamotrigine chw 5MG, 43
lansoprazole CAP 30MG DR, 30
kls quit2 loz 2MG, 46
lamotrigine kit odt, 43
Lansoprazole Sus 3MG/ML, 31
kls quit4 gum 4MG, 46
lamotrigine kit start 35, 43
lanthanum chw 1000MG, 32
kls quit4 loz 4MG, 46
lamotrigine kit start 49, 43
lanthanum chw 500MG, 32
Kombiglyz XR TAB 2.5-1000, 26
lamotrigine kit start 98, 43
lanthanum chw 750MG, 32
Kombiglyz XR TAB 5-1000MG, 26
lamotrigine TAB 100MG, 43
Lantus Inj 100/ML, 25
Kombiglyz XR TAB 5-500MG, 26
lamotrigine TAB 100MG ER, 43
Lantus Inj Solostar, 25
Korlym TAB 300MG, 26
lamotrigine TAB 150MG, 43
Lanzo Mis Lancing, 63
kp aspirin TAB 81MG EC, 50
lamotrigine TAB 200MG, 43
larin 24 TAB FE 1/20, 23
kp bisacodyl TAB 5MG EC, 30
lamotrigine TAB 200MG ER, 43
larin FE TAB 1.5/30, 23
Kp Prenatal TAB Multivit, 60
lamotrigine TAB 250MG ER, 43
larin FE TAB 1/20, 23
Kristalose PAK 10gm, 30
lamotrigine TAB 25MG, 43
larin TAB 1.5/30, 23
Kristalose PAK 20gm, 30
lamotrigine TAB 25MG ER, 43
larin TAB 1/20, 23
Kroger Lance Mis, 63
lamotrigine TAB 25MG odt, 43
larissia TAB, 23
Kroger Lance Mis Thin, 63
lamotrigine TAB 300MG ER, 43
Lasix TAB 20MG, 14
Kroger Lance Mis Thin 30G, 63
lamotrigine TAB 50MG ER, 43
Lasix TAB 40MG, 14
kurvelo TAB 0.15/30, 23
lamotrigine TAB 50MG odt, 43
Lasix TAB 80MG, 14
Kuvan Pow 100MG, 28
Lancet Alter Mis Site 26G, 63
Lastacaft Sol 0.25%, 50
Kuvan Pow 500MG, 28
Lancet Auto Mis Injector, 63
latanoprost sol 0.005%, 49
Kuvan TAB 100MG, 28
lancet carry mis case, 60
Latuda TAB 120MG, 40
Kyleena Iud 19.5MG, 24
Lancet Carry Mis Case, 63
Latuda TAB 20MG, 40
Kynamro Inj 200MG/ML, 14
Lancet Devic Mis Adjust, 63
Latuda TAB 40MG, 40
L
Lancet Micro Mis Thin 33G, 63
Latuda TAB 60MG, 40
Lancet Stand Mis 21G, 63
Latuda TAB 80MG, 40
labetalol TAB 100MG, 9
Lancet Super Mis Thin 30G, 63
laxaclear pow, 30
labetalol TAB 200MG, 9
Lancet Ultra Mis 28G, 63
laxative pol pow glycol, 30
labetalol TAB 300MG, 9
Lancet Ultra Mis Fine, 63
laxative TAB 5MG EC, 30
Lac-hydrin CRE 12%, 21
Lancet Ultra Mis Thin 28G, 63
layolis FE chw, 23
Lac-hydrin Lot 12%, 21
Lancet Ultra Mis Thin 30G, 63
Lazanda Spr 100mcg, 52
lac-hydrin lot five, 20
Lancet With Mis Ejector, 63
Lazanda Spr 300mcg, 52
Lacrisert Mis 5MG Op, 48
Lazanda Spr 400mcg, 52
levofloxacin sol 0.5%, 48
lidocaine sol 2% visc, 36
Lb Lancet Mis 28G, 63
levofloxacin sol 25MG/ML, 2
lidocaine sol 4%, 20
Lb Lancing Mis Device, 63
Levofloxacin Sol 25MG/ML, 2
Lidocaine Sol 4%, 36
Ldo Plus Gel 4%, 21
levofloxacin TAB 250MG, 2
lidocaine-pr CRE, 20
leena TAB, 23
levofloxacin TAB 500MG, 2
lidocaine/HC CRE 3%-0.5%, 32
leflunomide TAB 10MG, 54
levofloxacin TAB 750MG, 2
lidocaine/HC kit 3%-0.5%, 32
leflunomide TAB 20MG, 54
levonest TAB, 23
lidocaine/HC kit 3%-1%, 32
Lenvima CAP 10 MG, 7
levonor/ethi TAB, 23
Lidoderm Dis 5%, 21
Lenvima CAP 14 MG, 7
levonor/ethi TAB 0.1-0.02, 23
lidopin CRE 3%, 20
Lenvima CAP 18 MG, 7
levonor/ethi TAB estradio, 23
lidopril kit 2.5-2.5%, 20
Lenvima CAP 20 MG, 7
levonorgestr TAB 1.5MG, 23
lidopril XR kit 2.5-2.5%, 20
Lenvima CAP 24 MG, 7
levora-28 TAB 0.15/30, 23
Lidorx Gel 3%, 21
Lenvima CAP 8 MG, 7
Levorphanol TAB 2MG, 51
Lidothol Pad 4.5-5%, 21
Lescol XL TAB 80MG, 15
levothyroxin TAB 100mcg, 28
Lidotral CRE 3.88%, 21
lessina TAB, 23
levothyroxin TAB 112mcg, 28
Lidotrex Gel 2%, 21
Letairis TAB 10MG, 15
levothyroxin TAB 125mcg, 28
Lidovin CRE 3.95%, 21
Letairis TAB 5MG, 15
levothyroxin TAB 137mcg, 28
Lidozol CRE 3.75%, 21
letrozole TAB 2.5MG, 6
levothyroxin TAB 150mcg, 28
Lifescan Mis Unistik2, 63
Leucovor CA TAB 10MG, 8
levothyroxin TAB 175mcg, 28
Liletta Iud 52MG, 24
Leucovor CA TAB 15MG, 8
levothyroxin TAB 200mcg, 28
lillow TAB 0.15/30, 24
leucovor CA TAB 25MG, 8
levothyroxin TAB 25mcg, 28
Lincocin Inj 300MG/ML, 6
leucovor CA TAB 5MG, 8
levothyroxin TAB 300mcg, 28
lincomycin inj 300MG/ML, 5
Leukeran TAB 2MG, 6
levothyroxin TAB 50mcg, 28
lindane lot 1%, 20
leuprolide inj 1MG/0.2, 6
levothyroxin TAB 75mcg, 28
Lindane Lot 1%, 21
leva set kit, 20
levothyroxin TAB 88mcg, 28
lindane sha 1%, 20
leva set kit 2.5-2.5%, 20
levothyroxine TAB 0.075MG, 28
Lindane Sha 1%, 21
Levacet TAB, 51
levoxyl TAB 100mcg, 29
linezolid sus 100/5ML, 5
Levalbuterol Aer 45/Act, 57
levoxyl TAB 112mcg, 29
linezolid TAB 600MG, 5
levalbuterol neb 0.31MG, 57
levoxyl TAB 125mcg, 29
Linzess CAP 145mcg, 32
levalbuterol neb 0.63MG, 57
levoxyl TAB 137mcg, 29
Linzess CAP 290mcg, 32
levalbuterol neb 1.25/0.5, 57
levoxyl TAB 150mcg, 29
Linzess CAP 72mcg, 32
levalbuterol neb 1.25MG, 57
levoxyl TAB 175mcg, 29
liothyronine TAB 25mcg, 28
Levaquin TAB 250MG, 3
levoxyl TAB 200mcg, 29
liothyronine TAB 50mcg, 28
Levaquin TAB 500MG, 3
levoxyl TAB 25mcg, 29
liothyronine TAB 5mcg, 28
Levaquin TAB 750MG, 3
levoxyl TAB 50mcg, 29
Lipitor TAB 10MG, 15
Levatio Pad 0.3-5%, 21
levoxyl TAB 75mcg, 29
Lipitor TAB 20MG, 15
Levbid TAB 0.375 ER, 31
levoxyl TAB 88mcg, 29
Lipitor TAB 40MG, 15
Levemir Inj, 25
Levsin Inj 0.5MG/ML, 31
Lipitor TAB 80MG, 15
Levemir Inj Flextouc, 25
Levsin TAB 0.125MG, 31
Lipofen CAP 150MG, 15
levetiraceta sol 100MG/ML, 43
Levsin/SL Sub 0.125MG, 31
Lipofen CAP 50MG, 15
levetiraceta sol 500/5ML, 43
Lexapro Sol 5MG/5ML, 38
liprozonepak kit 2.5-2.5%, 20
levetiraceta TAB 1000MG, 43
Lexapro TAB 10MG, 38
lisinop/hctz TAB 10-12.5, 12
levetiraceta TAB 250MG, 43
Lexapro TAB 20MG, 38
lisinop/hctz TAB 20-12.5, 12
levetiraceta TAB 500MG, 43
Lexapro TAB 5MG, 38
lisinop/hctz TAB 20-25MG, 12
levetiraceta TAB 500MG ER, 43
Lexiva Sus 50MG/ML, 4
lisinopril TAB 10MG, 11
levetiraceta TAB 750MG, 43
Lexiva TAB 700MG, 4
lisinopril TAB 2.5MG, 11
levetiraceta TAB 750MG ER, 43
Lexuss 210 Liq 2-10/5ML, 56
lisinopril TAB 20MG, 11
Levo-ETH Est TAB 90-20mcg, 24
Lialda TAB 1.2gm, 32
lisinopril TAB 30MG, 11
levo-t TAB 100mcg, 28
Librax CAP 5-2.5MG, 30
lisinopril TAB 40MG, 11
levo-t TAB 112mcg, 28
lidenza pad 4-1%, 20
lisinopril TAB 5MG, 11
levo-t TAB 125mcg, 28
lido bdk kit, 20
Lite Touch Mis Lanc Dev, 63
levo-t TAB 137mcg, 28
Lido-hydro Gel 2.8-0.55, 32
Lite Touch Mis Lanc Pen, 63
levo-t TAB 150mcg, 28
Lido-k Lot 3%, 21
Lite Touch Mis Lancets, 63
levo-t TAB 175mcg, 28
lido-prilo kit 2.5-2.5%, 20
Liteaire Mis, 66
levo-t TAB 200 mcg, 29
lido/epi 1%- inj 1:100000, 56
Litetouch Mis 29GX12.7, 63
levo-t TAB 25mcg, 29
lido/prilocn CRE 2.5-2.5%, 20
Litetouch Mis 31GX8MM, 63
levo-t TAB 300 mcg, 29
lido/prilocn kit 2.5-2.5%, 20
Litetouch Mis Lancets, 63
levo-t TAB 50mcg, 29
Lidocain HCL Inj 10MG/ML, 56
lithium CARB CAP 150MG, 39
levo-t TAB 75mcg, 29
lidocaine CRE 3%, 20
Lithium CARB CAP 150MG, 39
levo-t TAB 88mcg, 29
lidocaine CRE 3.88%, 20
lithium CARB CAP 300MG, 39
levo/liothyr TAB 30MG, 29
lidocaine gel 2%, 20
lithium CARB CAP 600MG, 39
levo/liothyr TAB 60MG, 29
lidocaine gel 2% jelly, 20
Lithium CARB CAP 600MG, 39
levo/liothyr TAB 90MG, 29
lidocaine inj 1%, 56
lithium CARB TAB 300MG, 39
levobunolol sol 0.5% op, 49
lidocaine inj 2%, 56
lithium CARB TAB 300MG ER, 39
levocarnitin sol 1gm/10ML, 28
Lidocaine Lot 3%, 21
lithium CARB TAB 450MG ER, 39
levocarnitin TAB 330MG, 28
lidocaine oin 5%, 20
Lithium Sol 8meq/5ML, 39
levocetirizi sol 2.5/5ML, 56
lidocaine oin PAK 5%, 20
Lithobid TAB 300MG CR, 40
levocetirizi TAB 5MG, 56
lidocaine pad 5%, 20
Lithostat TAB 250MG, 34
Livalo TAB 1MG, 15
Loseasonique TAB, 24
Lyrica Sol 20MG/ML, 44
Livalo TAB 2MG, 15
Lotemax Gel 0.5%, 49
Lysodren TAB 500MG, 6
Livalo TAB 4MG, 15
Lotemax Oin 0.5%, 49
Lysteda TAB 650MG, 36
livixil PAK kit 2.5-2.5%, 20
Lotemax Sus 0.5%, 49
lyza TAB 0.35MG, 24
LO Loestrin TAB, 24
Lotensin HCT TAB 10-12.5, 13
M
Locoid CRE 0.1%, 19
Lotensin HCT TAB 20-12.5, 13
M-m-r II Inj, 58
Locoid Lipo CRE 0.1%, 19
Lotensin HCT TAB 20-25MG, 13
Macrobid CAP 100MG, 33
Locoid Lot 0.1%, 19
Lotensin TAB 20MG, 11
Macrodantin CAP 100MG, 33
Locoid Oin 0.1%, 19
Lotensin TAB 40MG, 11
Macrodantin CAP 25MG, 33
Locoid Sol 0.1%, 19
Lotrel CAP 10-20MG, 13
Macrodantin CAP 50MG, 33
Locort PAK 11-day, 22
Lotrel CAP 10-40MG, 13
MAG citrate sol, 30
Locort PAK 7-day, 22
Lotrel CAP 2.5-10MG, 13
MAG citrate sol cherry, 30
Lodine TAB 400MG, 55
Lotrel CAP 5-10MG, 13
MAG citrate sol grape, 30
Lodosyn TAB 25MG, 45
Lotrel CAP 5-20MG, 13
MAG citrate sol lemon, 30
Loestrin 21 TAB 1.5/30, 24
Lotrisone CRE, 17
Malarone TAB 250-100, 5
Loestrin FE TAB 1.5/30, 24
Lotronex TAB 0.5MG, 32
Malarone TAB 62.5-25, 5
Loestrin FE TAB 1/20, 24
Lotronex TAB 1MG, 32
malathion lot 0.5%, 20
Loestrin TAB 1/20-21, 24
Loutrex CRE, 18
Maprotiline TAB 25MG, 38
Lofibra CAP 134MG, 15
lovastatin TAB 10MG, 14
Maprotiline TAB 50MG, 38
Lofibra CAP 200MG, 15
lovastatin TAB 20MG, 14
Maprotiline TAB 75MG, 38
Lofibra CAP 67MG, 15
lovastatin TAB 40MG, 14
margesic CAP, 51
Lofibra TAB 160MG, 15
Lovaza CAP 1gm, 15
Marinol CAP 10MG, 31
Lofibra TAB 54MG, 15
Lovenox Inj 100MG/ML, 36
Marinol CAP 2.5MG, 31
lokara lot 0.05%, 19
Lovenox Inj 120/0.8, 36
Marinol CAP 5MG, 31
lomedia 24 TAB FE, 24
Lovenox Inj 150MG/ML, 36
marlissa TAB 0.15/30, 24
Lomotil TAB 2.5MG, 30
Lovenox Inj 30/0.3ML, 36
Marplan TAB 10MG, 38
Lomustine CAP 100MG, 6
Lovenox Inj 300/3ML, 36
marten-TAB tab 50-325MG, 51
Lomustine CAP 10MG, 6
Lovenox Inj 40/0.4ML, 36
Mask Vortex/ Mis Baby Duc, 66
Lomustine CAP 40MG, 6
Lovenox Inj 60/0.6ML, 36
Mask Vortex/ Mis Duck, 66
Longs Lancet Mis Standard, 63
Lovenox Inj 80/0.8ML, 36
Mask Vortex/ Mis Frog, 66
Longs Lancet Mis Thin, 63
low-ogestrel TAB, 24
Mask Vortex/ Mis Lady Bug, 66
Longs Lancet Mis Ultra Th, 63
loxapine CAP 10MG, 39
Matulane CAP 50MG, 8
Lonsurf TAB 15-6.14, 8
loxapine CAP 25MG, 39
matzim LA TAB 180MG/24, 10
Lonsurf TAB 20-8.19, 8
loxapine CAP 50MG, 39
matzim LA TAB 240MG/24, 10
loperamide CAP 2MG, 30
loxapine CAP 5MG, 39
matzim LA TAB 300MG/24, 10
Lopid TAB 600MG, 15
LP lite PAK kit 2.5-2.5%, 20
matzim LA TAB 360MG/24, 10
lopin/riton sol 80-20/ML, 3
Lumigan Sol 0.01%, 49
matzim LA TAB 420MG/24, 10
lopreeza TAB 0.5-0.1, 22
Lumizyme Inj 50MG, 28
Mavik TAB 1MG, 11
lopreeza TAB 1-0.5MG, 22
Lunesta TAB 1MG, 41
Mavik TAB 2MG, 11
Lopress HCT TAB 50-25MG, 13
Lunesta TAB 2MG, 41
Mavik TAB 4MG, 11
Lopressor TAB 100MG, 9
Lunesta TAB 3MG, 41
Mavyret TAB 100-40MG, 4
Lopressor TAB 50MG, 9
Lupaneta Kit 11.25-5, 27
Maxalt TAB 10MG, 55
Loprox CRE 0.77%, 17
Lupaneta Kit 3.75-5, 27
Maxalt TAB 5MG, 55
Loprox Kit 0.77%, 17
Lupr Dep-PED Inj 11.25MG, 27
Maxalt-MLT TAB 10MG, 55
Loprox Sha 1%, 17
Lupr Dep-PED Inj 15MG, 27
Maxalt-MLT TAB 5MG, 55
Loprox Sus 0.77%, 17
Lupr Dep-PED Inj 3m 30MG, 27
Maxidex Sus 0.1% Op, 49
lorazepam CON 2MG/ML, 37
Lupr Dep-PED Inj 7.5MG, 27
Maxima Sol Control, 63
lorazepam inj 2MG/ML, 37
Lupron Depot Inj 11.25MG, 6
Maxipime Inj 1gm, 1
lorazepam TAB 0.5MG, 37
Lupron Depot Inj 22.5MG, 6
Maxitrol Oin 0.1% Op, 49
lorazepam TAB 1MG, 37
Lupron Depot Inj 3.75MG, 6
Maxitrol Sus 0.1% Op, 49
lorazepam TAB 2MG, 37
Lupron Depot Inj 30MG, 6
Maxzide TAB 75-50, 14
lorcet HD TAB 10-325MG, 51
Lupron Depot Inj 45MG, 6
Maxzide-25 TAB, 14
lorcet plus TAB 7.5-325, 51
Lupron Depot Inj 7.5MG, 6
me/naphos/mb TAB hyo 1, 33
lorcet TAB 5-325MG, 51
lutera TAB, 24
meclizine TAB 12.5MG, 31
lorenza pad 4-1%, 20
Luxiq Aer 0.12%, 19
meclizine TAB 25MG, 31
Lortab Elx 10-300MG, 53
Luzu CRE 1%, 17
Meclofen Sod CAP 100MG, 54
lortab TAB 10-325MG, 51
Lycelle Gel, 21
Meclofen Sod CAP 50MG, 54
lortab TAB 5-325MG, 51
Lynparza CAP 50MG, 8
Medi-patch Pad RX, 21
lortab TAB 7.5-325, 51
Lynparza TAB 100MG, 8
Medichoice Mis Lancet, 63
loryna TAB 3-0.02MG, 24
Lynparza TAB 150MG, 8
Medisense Liq Gluc-ket, 63
Lorzone TAB 375MG, 48
Lyrica CAP 100MG, 44
Medisense Liq Gluc/Ket, 63
Lorzone TAB 750MG, 48
Lyrica CAP 150MG, 44
Medlance Mis 30G Plus, 63
losartan pot TAB 100MG, 11
Lyrica CAP 200MG, 44
Medlance Mis Extr 21G, 63
losartan pot TAB 25MG, 11
Lyrica CAP 225MG, 44
Medlance Mis Lite 25G, 63
losartan pot TAB 50MG, 11
Lyrica CAP 25MG, 44
Medlance Mis Plus, 63
losartan/HCT TAB 100-12.5, 12
Lyrica CAP 300MG, 44
Medlance Mis Plus 30G, 63
losartan/HCT TAB 100-25, 12
Lyrica CAP 50MG, 44
Medlance Mis Unv 21G, 63
losartan/HCT TAB 50-12.5, 12
Lyrica CAP 75MG, 44
Medlance Pls Mis 0.8MM, 63
Medlance Pls Mis Extr 21G, 63
Metadate CD CAP 30MG, 42
methylphenid CAP 10MG, 41
Medlance Pls Mis Lite 25G, 63
Metadate CD CAP 40MG, 42
methylphenid CAP 20MG, 41
Medlance Pls Mis Univ 21G, 63
Metadate CD CAP 50MG, 42
methylphenid CAP 20MG ER, 41
medolor PAK kit 2.5-2.5%, 20
Metadate CD CAP 60MG, 42
methylphenid CAP 30MG, 41
Medrol TAB 16MG, 22
metadate TAB 20MG ER, 41
methylphenid CAP 30MG ER, 41
Medrol TAB 2MG, 21
Metaproteren Syp 10MG/5ML, 57
methylphenid CAP 40MG, 41
Medrol TAB 32MG, 22
Metaproteren TAB 10MG, 57
methylphenid CAP 40MG ER, 41
Medrol TAB 4MG, 22
Metaproteren TAB 20MG, 57
methylphenid CAP 50MG, 41
Medrol TAB 8MG, 22
metaxall TAB 800MG, 48
methylphenid CAP 60MG, 41
medroxypr ac inj 150MG/ML, 24
Metaxalone TAB 400MG, 48
Methylphenid CAP 60MG LA, 42
medroxypr ac TAB 10MG, 24
metaxalone TAB 800MG, 48
Methylphenid Chw 10MG, 42
medroxypr ac TAB 2.5MG, 25
metformin ER TAB 1000MG, 25
Methylphenid Chw 5MG, 42
medroxypr ac TAB 5MG, 25
metformin TAB 1000 ER, 25
methylphenid TAB 10MG, 41
mefenam acid CAP 250MG, 54
metformin TAB 1000MG, 25
methylphenid TAB 10MG ER, 41
mefloquine TAB 250MG, 5
metformin TAB 500MG, 25
methylphenid TAB 18MG ER, 41
Megace ES Sus 625/5ML, 25
metformin TAB 500MG ER, 25
Methylphenid TAB 18MG ER, 42
Megace Oral Sus 40MG/ML, 7
metformin TAB 750MG ER, 25
methylphenid TAB 20MG, 41
megestrol ac sus 400MG/10, 6
metformin TAB 850MG, 25
methylphenid TAB 20MG ER, 41
megestrol ac sus 40MG/ML, 6
methadone CON 10MG/ML, 51
methylphenid TAB 27MG ER, 41
megestrol ac TAB 20MG, 6
Methadone Inj 10MG/ML, 53
Methylphenid TAB 27MG ER, 42
megestrol ac TAB 40MG, 6
methadone sol 10MG/5ML, 51
methylphenid TAB 36MG ER, 41
megestrol sus 625MG/5m, 25
Methadone Sol 10MG/5ML, 51
Methylphenid TAB 36MG ER, 42
Meijer Lance Mis Color, 63
methadone sol 5MG/5ML, 51
methylphenid TAB 54MG ER, 41
Meijer Lance Mis Univ 21G, 63
Methadone Sol 5MG/5ML, 52
Methylphenid TAB 54MG ER, 42
Meijer Lance Mis Univ 30G, 63
methadone TAB 10MG, 51
methylphenid TAB 5MG, 41
Meijer Lance Mis Universa, 63
methadone TAB 40MG, 51
methylpr ace inj 40MG/ML, 21
Meijer Mis Lancets, 63
methadone TAB 5MG, 51
methylpr ace inj 80MG/ML, 21
Mekinist TAB 0.5MG, 8
Methadose CON 10MG/ML, 53
methylpr ss inj 125MG, 21
Mekinist TAB 2MG, 8
Methadose SF CON 10MG/ML, 53
methylpred TAB 16MG, 21
melodetta chw 24 FE, 24
methadose TAB 40MG, 51
methylpred TAB 32MG, 21
Meloxicam Sus 7.5/5ML, 55
methamphetam TAB 5MG, 42
methylpred TAB 4MG, 21
meloxicam TAB 15MG, 54
methazolamid TAB 25MG, 13
methylpred TAB 8MG, 21
meloxicam TAB 7.5MG, 54
methazolamid TAB 50MG, 14
methyltestos CAP 10MG, 22
melphalan TAB 2MG, 6
methenam hip TAB 1gm, 33
Metipranolol Sol 0.3% Oph, 49
memant titra PAK 5-10MG, 47
methenam man TAB 1000MG, 33
metoclopram inj 10MG/2ML, 32
memantine HC sol 2MG/ML, 47
methenam man TAB 1gm, 33
metoclopram inj 5MG/ML, 32
memantine TAB HCL 10MG, 45
Methenam Man TAB 500MG, 33
metoclopram sol 10/10ML, 32
memantine TAB HCL 5MG, 45
Methergine TAB 0.2MG, 50
metoclopram sol 5MG/5ML, 32
Menactra Inj, 58
methimazole TAB 10MG, 28
metoclopram TAB 10MG, 32
Menest TAB 0.3MG, 23
methimazole TAB 5MG, 28
metoclopram TAB 5MG, 32
Menest TAB 0.625MG, 23
Methitest TAB 10MG, 22
Metoclopram TAB 5MG Odt, 32
Menest TAB 1.25MG, 23
Methlphenida Chw 2.5MG, 42
Metocloprami TAB 10MG Odt, 32
Menest TAB 2.5MG, 23
methocarbam inj 1000MG, 48
metolazone TAB 10MG, 14
Menhibrix Inj, 58
methocarbam inj 100MG/ML, 48
metolazone TAB 2.5MG, 14
Menomune Inj A/C/Y/W, 58
methocarbam TAB 500MG, 48
metolazone TAB 5MG, 14
Menostar Dis 14mcg, 23
methocarbam TAB 750MG, 48
metoprl/hctz TAB 100-25MG, 12
Menthocin Pad Lidocain, 21
methotrexate inj 100/4ML, 6
metoprl/hctz TAB 100-50MG, 12
Mentholix Spr 4-1%, 21
methotrexate inj 1gm, 6
Metoprl/Hctz TAB 100-50MG, 12
Menveo Inj, 58
methotrexate inj 1gm/40ML, 6
metoprl/hctz TAB 50-25MG, 12
meperidine inj 100MG/ML, 51
methotrexate inj 200/8ML, 6
Metopro/Hctz TAB 100-12.5, 13
meperidine TAB 100MG, 52
methotrexate inj 250/10ML, 6
Metopro/Hctz TAB 25-12.5, 13
meperidine TAB 50MG, 52
methotrexate inj 25MG/ML, 6
Metopro/Hctz TAB 50-12.5, 13
Mephyton TAB 5MG, 59
Methotrexate Inj 25MG/ML, 6
metoprol suc TAB 100MG ER, 9
meprobamate TAB 200MG, 37
methotrexate inj 50MG/2ML, 6
metoprol suc TAB 200MG ER, 9
meprobamate TAB 400MG, 37
methotrexate TAB 2.5MG, 6
metoprol suc TAB 25MG ER, 9
Mepron Sus, 5
methoxsalen CAP 10MG, 18
metoprol suc TAB 50MG ER, 9
mercaptopur TAB 50MG, 6
methscopolam TAB 2.5MG, 30
metoprol TAR TAB 100MG, 9
mesalamine ene 4gm, 32
methscopolam TAB 5MG, 30
metoprol TAR TAB 25MG, 9
mesalamine kit 4gm, 32
Methyclothia TAB 5MG, 14
metoprol TAR TAB 50MG, 9
mesalamine TAB 1.2gm, 32
Methyld/Hctz TAB 250/15, 13
metoprolol TAB 100MG ER, 9
Mesalamine TAB 800MG DR, 32
Methyld/Hctz TAB 250/25, 13
metoprolol TAB 200MG ER, 9
mesna inj 1gm, 8
methyldopa TAB 250MG, 12
metoprolol TAB 25MG ER, 9
Mesnex TAB 400MG, 8
methyldopa TAB 500MG, 12
Metoprolol TAB 37.5MG, 9
Mestinon Syp 60MG/5ML, 48
methylergon inj 0.2MG/ML, 50
metoprolol TAB 50MG ER, 9
Mestinon TAB 60MG, 48
methylergon TAB 0.2MG, 50
Metoprolol TAB 75MG, 9
Mestinon TAB Timespan, 48
Methylin Chw 10MG, 42
Metozolv Odt TAB 5MG, 32
Metadate CD CAP 10MG, 42
Methylin Chw 2.5MG, 42
Metrocream CRE 0.75%, 17
Metadate CD CAP 20MG, 42
Methylin Chw 5MG, 42
Metrogel Gel 1%, 17
Metrogel-vag Gel 0.75%, 33
Minivelle Dis 0.05MG, 23
moexipr/hctz TAB 7.5-12.5, 12
Metrolotion Lot 0.75%, 17
Minivelle Dis 0.075MG, 23
moexipril TAB 15MG, 11
metronidazol CAP 375MG, 6
Minivelle Dis 0.1MG, 23
moexipril TAB 7.5MG, 11
metronidazol CRE 0.75%, 17
Minocin CAP 100MG, 2
Molindone TAB HCL 10MG, 40
metronidazol gel 0.75%, 17
Minocin CAP 50MG, 2
Molindone TAB HCL 25MG, 40
metronidazol gel 0.75%vag, 33
Minocin CAP 75MG, 2
Molindone TAB HCL 5MG, 40
metronidazol gel 1%, 17
minocycline CAP 100MG, 2
mometasone CRE 0.1%, 19
metronidazol lot 0.75%, 17
minocycline CAP 50MG, 2
mometasone oin 0.1%, 19
metronidazol TAB 250MG, 5
minocycline CAP 75MG, 2
mometasone sol 0.1%, 19
metronidazol TAB 500MG, 5
minocycline TAB 100MG, 2
mometasone spr 50mcg, 56
Metronidazole 0.75% Jelly, 17
minocycline TAB 135MG ER, 2
mondoxyne nl CAP 100MG, 2
Mevacor TAB 40MG, 15
minocycline TAB 45MG ER, 2
mondoxyne nl CAP 50MG, 2
mexiletine CAP 150MG, 10
Minocycline TAB 45MG ER, 2
mondoxyne nl CAP 75MG, 2
mexiletine CAP 200MG, 10
minocycline TAB 50MG, 2
mono-linyah TAB 0.25-35, 24
mexiletine CAP 250MG, 10
minocycline TAB 75MG, 2
Monodox CAP 100MG, 2
Miacalcin Inj 200/ML, 27
minocycline TAB 90MG ER, 2
Monodox CAP 75MG, 2
Miacalcin Spr 200/Act, 27
minoxidil TAB 10MG, 12
Monojector Mis End CAPS, 63
mibelas 24 chw FE, 24
minoxidil TAB 2.5MG, 12
Monolet Mis Lancets, 63
Micardis HCT TAB 40/12.5, 13
Mirapex ER TAB 0.375MG, 45
Monolet Opd Mis Lancets, 63
Micardis HCT TAB 80-25MG, 13
Mirapex ER TAB 0.75MG, 45
Monolettor Mis Lancets, 63
Micardis HCT TAB 80/12.5, 13
Mirapex ER TAB 1.5MG, 45
mononessa TAB, 24
Micardis TAB 20MG, 12
Mirapex ER TAB 2.25MG, 45
montelukast chw 4MG, 57
Micardis TAB 40MG, 12
Mirapex ER TAB 3.75MG, 45
montelukast chw 5MG, 57
Micardis TAB 80MG, 12
Mirapex ER TAB 3MG, 45
montelukast gra 4MG, 57
Miconazole 3 Sup 200MG, 33
Mirapex ER TAB 4.5MG, 45
montelukast TAB 10MG, 57
Micort-HC CRE 2.5%, 19
Mirapex TAB 0.125MG, 45
Monurol PAK Granules, 33
micrgstin 24 TAB FE 1/20, 24
Mirapex TAB 0.25MG, 45
morgidox CAP 1X100MG, 2
Micro Thin Mis Lanc 33G, 63
Mirapex TAB 0.5MG, 45
morgidox CAP 1X50MG, 2
Microchamber Mis, 66
Mirapex TAB 0.75MG, 45
morgidox CAP 2X100MG, 2
Microdot CON Sol High/Low, 63
Mirapex TAB 1.5MG, 45
Morphabond TAB 100MG ER, 53
microgestin TAB 1.5/30, 24
Mirapex TAB 1MG, 45
Morphabond TAB 15MG ER, 53
microgestin TAB 1/20, 24
Mircera Inj 100mcg, 35
Morphabond TAB 30MG ER, 53
microgestin TAB FE 1/20, 24
Mircera Inj 200mcg, 35
Morphabond TAB 60MG ER, 53
microgestin TAB FE1.5/30, 24
Mircera Inj 50mcg, 35
morphine SUL CAP 100MG ER, 52
Microlet Mis Lancets, 63
Mircera Inj 75mcg, 35
morphine SUL CAP 10MG ER, 52
Microlet Mis Next, 63
Mircera Sol 150/0.3, 35
Morphine SUL CAP 120MG ER, 53
Microspacer Mis, 66
Mircera Sol 30/0.3ML, 35
morphine SUL CAP 20MG ER, 52
Microtainer Mis Lancet, 63
Mircette TAB 28 Day, 24
morphine SUL CAP 30MG ER, 52
Microzide CAP 12.5MG, 14
Mirena Iud System, 24
Morphine SUL CAP 30MG ER, 53
midazolam inj 10MG/2ML, 41
mirtazapine TAB 15MG, 37
Morphine SUL CAP 45MG ER, 53
midazolam inj 5MG/ML, 41
mirtazapine TAB 15MG odt, 37
morphine SUL CAP 50MG ER, 52
midazolam syp 2MG/ML, 41
mirtazapine TAB 30MG, 37
morphine SUL CAP 60MG ER, 52
midodrine TAB 10MG, 14
mirtazapine TAB 30MG odt, 37
Morphine SUL CAP 60MG ER, 53
midodrine TAB 2.5MG, 14
mirtazapine TAB 45MG, 37
Morphine SUL CAP 75MG ER, 53
midodrine TAB 5MG, 14
mirtazapine TAB 45MG odt, 37
morphine SUL CAP 80MG ER, 52
Mifeprex TAB 200MG, 28
mirtazapine TAB 7.5MG, 37
Morphine SUL CAP 90MG ER, 53
Migergot Sup 2/100, 55
Mirvaso Gel 0.33%, 17
Morphine SUL Inj 10/0.7ML, 52
miglitol TAB 100MG, 26
misoprostol TAB 100mcg, 30
morphine SUL sol 100/5ML, 51
miglitol TAB 25MG, 26
misoprostol TAB 200mcg, 30
morphine SUL sol 10MG/5ML, 51
miglitol TAB 50MG, 26
Mitigare CAP 0.6MG, 55
morphine SUL sol 20MG/5ML, 51
Migranal Spr 4MG/ML, 55
MM aspirin TAB 325MG, 51
Morphine SUL Sup 10MG, 52
migryl mis 0.0375-5, 20
MM Pentips Mis 29GX12MM, 63
Morphine SUL Sup 20MG, 52
Millipred DP PAK 5MG, 22
MM Pentips Mis 31GX5MM, 63
Morphine SUL Sup 30MG, 52
Millipred Sol 10MG/5ML, 22
MM Pentips Mis 31GX8MM, 63
Morphine SUL Sup 5MG, 52
Millipred TAB 5MG, 22
MM Pentips Mis 32GX4MM, 63
morphine SUL TAB 100MG ER, 51
mimvey LO TAB 0.5-0.1, 22
Mobic Sus 7.5/5ML, 55
Morphine SUL TAB 15MG, 52
mimvey TAB 1-0.5MG, 22
Mobic TAB 15MG, 55
morphine SUL TAB 15MG ER, 51
Mini Lancing Mis Device, 63
Mobic TAB 7.5MG, 55
morphine SUL TAB 200MG ER, 51
Minipress CAP 1MG, 12
modafinil TAB 100MG, 41
Morphine SUL TAB 30MG, 52
Minipress CAP 2MG, 12
modafinil TAB 200MG, 41
morphine SUL TAB 30MG ER, 51
Minipress CAP 5MG, 12
Moderiba PAK 1200/Day, 5
morphine SUL TAB 60MG ER, 51
miniprin low TAB 81MG EC, 51
Moderiba PAK 800/Day, 5
Motofen TAB 1-0.025, 30
minitran dis 0.1MG/HR, 8
Moderiba TAB 1000/Day, 5
Movantik TAB 12.5MG, 32
minitran dis 0.2MG/HR, 8
moderiba TAB 200MG, 3
Movantik TAB 25MG, 32
minitran dis 0.4MG/HR, 8
Moderiba TAB 600/Day, 5
Moviprep Sol, 30
minitran dis 0.6MG/HR, 8
Modicon TAB 0.5/35, 24
Moxatag TAB 775MG, 1
Minivelle Dis 0.025MG, 23
moexipr/hctz TAB 15-12.5, 12
Moxeza Sol 0.5%, 48
Minivelle Dis 0.0375MG, 23
moexipr/hctz TAB 15-25MG, 12
moxifloxacin sol 0.5%, 48
moxifloxacin TAB 400MG, 2
Namenda XR CAP 21MG, 47
nefazodone TAB 250MG, 38
MS Contin TAB 100MG ER, 53
Namenda XR CAP 28MG, 47
nefazodone TAB 50MG, 38
MS Contin TAB 15MG ER, 53
Namenda XR CAP 7MG, 47
Nembutal Sod Inj 50MG/ML, 41
MS Contin TAB 200MG ER, 53
Namenda XR CAP Titratio, 47
neo-polycin oin HC 1%op, 49
MS Contin TAB 30MG ER, 53
Namzaric CAP, 47
neo-polycin oin op, 48
MS Contin TAB 60MG ER, 53
Namzaric CAP 14-10MG, 47
Neo-synalar CRE, 17
Multaq TAB 400MG, 11
Namzaric CAP 21-10MG, 47
neo/bac/poly oin op, 48
Multi Prenat TAB, 60
Namzaric CAP 28-10MG, 47
neo/poly GU sol 40/ML IR, 34
Multi-lancet Kit Device, 63
Namzaric CAP 7-10MG, 47
neo/poly/bac oin /HC 1%op, 49
Multi-lancet Mis Device, 63
Naphazoline Sol 0.1% Op, 49
neo/poly/dex oin 0.1% op, 49
mupirocin CA CRE 2%, 17
Naprelan TAB 375MG CR, 55
neo/poly/dex sus 0.1% op, 49
mupirocin CRE 2%, 17
Naprelan TAB 500MG CR, 55
neo/poly/gra sol op, 48
mupirocin oin 2%, 17
Naprelan TAB 750MG CR, 55
neo/poly/HC sol 1% otic, 50
my way TAB 1.5MG, 24
Naprosyn Sus 125/5ML, 55
neo/poly/HC sus 1% otic, 50
Myalept Inj 11.3MG, 28
Naprosyn TAB 500MG, 55
Neo/Poly/HC Sus Op, 49
Myambutol TAB 100MG, 3
naproxen DR TAB 375MG, 54
neomycin TAB 500MG, 3
Myambutol TAB 400MG, 3
naproxen DR TAB 500MG, 54
Neoral CAP 100MG, 7
Mycobutin CAP 150MG, 3
naproxen sod TAB 275MG, 54
Neoral CAP 25MG, 7
mycophenolat CAP 250MG, 7
naproxen sod TAB 375MG, 54
Neoral Sol 100MG/ML, 7
mycophenolat sus 200MG/ML, 7
naproxen sod TAB 375MG CR, 54
Neosalus Aer, 21
mycophenolat TAB 500MG, 7
naproxen sod TAB 500MG CR, 54
Neosalus CP CRE, 21
mycophenolic TAB 180MG DR, 7
naproxen sod TAB 550MG, 54
Neosalus CRE, 21
mycophenolic TAB 360MG DR, 7
naproxen sus 125/5ML, 54
Neosporin GU Sol 40/ML IR, 34
Mydayis CAP 12.5MG, 42
Naproxen Sus 125/5ML, 54
Neosporin Sol Op, 48
Mydayis CAP 25MG, 42
naproxen TAB 250MG, 54
Neptazane TAB 25MG, 14
Mydayis CAP 37.5MG, 42
naproxen TAB 375MG, 54
Neptazane TAB 50MG, 14
Mydayis CAP 50MG, 42
naproxen TAB 500MG, 54
Nerlynx TAB 40MG, 8
myferon 150 CAP 150MG, 34
naratriptan TAB 1MG, 55
Nesina TAB 12.5MG, 26
Myfortic TAB 180MG, 7
naratriptan TAB 2.5MG, 55
Nesina TAB 25MG, 26
Myfortic TAB 360MG, 7
Narcan Spr, 54
Nesina TAB 6.25MG, 26
Myglucohealt Mis Lanc 30G, 63
Nardil TAB 15MG, 38
neuac gel 1.2-5%, 16
Myglucohealt Sol LO/Nl/HI, 63
Nasonex Spr 50mcg/Ac, 56
Neulasta Inj 6MG/0.6m, 35
Mykidz Iron Sus 15/1.5ML, 35
nat-rul iron TAB 325MG, 34
Neulasta Kit 6MG/0.6m, 35
Myleran TAB 2MG, 6
Natacyn Sus 5% Op, 48
Neupogen Inj 300/0.5, 35
myorisan CAP 10MG, 16
Natazia TAB, 24
Neupogen Inj 300mcg, 35
myorisan CAP 20MG, 16
nateglinide TAB 120MG, 26
Neupogen Inj 480/0.8, 35
myorisan CAP 30MG, 16
nateglinide TAB 60MG, 26
Neupogen Inj 480mcg, 35
myorisan CAP 40MG, 16
Natesto Gel 5.5MG, 22
Neupro Dis 1MG/24HR, 45
Myrbetriq TAB 25MG, 33
Natpara Inj 100mcg, 27
Neupro Dis 2MG/24HR, 45
Myrbetriq TAB 50MG, 33
Natpara Inj 25mcg, 27
Neupro Dis 3MG/24HR, 45
Mysoline TAB 250MG, 43
Natpara Inj 50mcg, 27
Neupro Dis 4MG/24HR, 45
Mysoline TAB 50MG, 43
Natpara Inj 75mcg, 27
Neupro Dis 6MG/24HR, 45
Mytesi TAB 125MG, 30
Natroba Sus 0.9%, 21
Neupro Dis 8MG/24HR, 45
myzilra TAB, 24
natura-LAX pow 3350 NF, 30
Neurontin CAP 100MG, 44
N
Nature Throi TAB 162.5MG, 29
Neurontin CAP 300MG, 44
Nature-throi TAB 113.75MG, 29
Neurontin CAP 400MG, 44
nabumetone TAB 500MG, 54
Nature-throi TAB 130MG, 29
Neurontin Sol 250/5ML, 44
nabumetone TAB 750MG, 54
Nature-throi TAB 146.25MG, 29
Neurontin TAB 600MG, 44
nadolol TAB 20MG, 9
Nature-throi TAB 16.25MG, 29
Neurontin TAB 800MG, 44
nadolol TAB 40MG, 9
Nature-throi TAB 195MG, 29
Neutek 2tek Sol Control, 63
nadolol TAB 80MG, 9
Nature-throi TAB 260MG, 29
Neutrasal Pow, 36
nadolol/bend TAB 40-5MG, 13
Nature-throi TAB 32.5MG, 29
Neuvaxin Pad 0.0375-5, 21
nadolol/bend TAB 80-5MG, 13
Nature-throi TAB 325MG, 29
Nevanac Sus 0.1%, 50
naftifine CRE HCL 1%, 17
Nature-throi TAB 48.75MG, 29
Nevirapine Sus 50MG/5ML, 4
naftifine CRE HCL 2%, 17
Nature-throi TAB 65MG, 29
nevirapine TAB 100MG, 3
Naftin CRE 1%, 17
Nature-throi TAB 81.25MG, 29
nevirapine TAB 200MG, 3
Naftin CRE 2%, 17
Nature-throi TAB 97.5MG, 29
nevirapine TAB 400MG ER, 4
Naftin Gel 1%, 17
Nebupent Inh 300MG, 6
Nexavar TAB 200MG, 8
Naftin Gel 2%, 17
nebusal neb 3%, 56
Nexgen Tes Norm CON, 63
Nalfon CAP 400MG, 55
Nebusal Neb 6%, 56
Nexplanon Imp 68MG, 24
naloxone inj 0.4MG/ML, 54
necon TAB 0.5/35, 24
next choice TAB 1.5MG, 24
Naloxone Inj 0.4MG/ML, 54
necon TAB 1/35, 24
niacin ER TAB 1000MG, 15
Naloxone Inj 1MG/ML, 54
Necon TAB 1/50-28, 24
niacin ER TAB 500MG, 15
naltrexone TAB 50MG, 54
necon TAB 10/11-28, 24
niacin ER TAB 750MG, 15
Namenda Sol 10MG/5ML, 47
necon TAB 7/7/7, 24
Niacor TAB 500MG, 15
Namenda TAB 10MG, 47
Nefazodone TAB 100MG, 38
Niaspan TAB 1000 ER, 15
Namenda TAB 5-10MG, 47
Nefazodone TAB 150MG, 38
Niaspan TAB 500MG ER, 15
Namenda TAB 5MG, 47
Nefazodone TAB 200MG, 38
Niaspan TAB 750MG ER, 15
Namenda XR CAP 14MG, 47
nicardipine CAP 20MG, 10
nicotine TD dis 7MG/24HR, 46
noreth/ethin chw FE 1/20, 24
nicardipine CAP 30MG, 10
Nicotrol Inh, 47
noreth/ethin TAB 0.5-2.5, 22
Nicoderm CQ Dis 14MG/24h, 47
Nicotrol Ns Spr 10MG/ML, 47
noreth/ethin TAB 1/20, 24
Nicoderm CQ Dis 21MG/24h, 47
nifedical XL TAB 30MG, 10
noreth/ethin TAB 1MG-5mcg, 22
Nicoderm CQ Dis 7MG/24HR, 47
nifedical XL TAB 60MG, 10
noreth/ethin TAB FE 1/20, 24
nicorelief gum 2MG mint, 46
nifedipine CAP 10MG, 10
norethin ace TAB 5MG, 25
nicorelief gum 2MG orig, 46
nifedipine CAP 20MG, 10
norethindron TAB 0.35MG, 24
nicorelief gum 4MG mint, 46
nifedipine TAB 30MG ER, 10
norgest/ethi TAB 0.25/35, 24
nicorelief gum 4MG orig, 46
nifedipine TAB 60MG ER, 10
norgest/ethi TAB estradio, 24
Nicorette Gum 2MG, 47
nifedipine TAB 90MG ER, 10
Norinyl TAB 1+50-28, 24
Nicorette Gum 2MG Cinn, 47
nikki TAB 3-0.02MG, 24
Norinyl TAB 1/35, 24
Nicorette Gum 2MG Mint, 47
Nilandron TAB 150MG, 6
Noritate CRE 1%, 17
Nicorette Gum 2MG Orig, 47
nilutamide TAB 150MG, 6
norlyda TAB 0.35MG, 24
Nicorette Gum 2mgfruit, 47
nimodipine CAP 30MG, 10
norlyroc TAB 0.35MG, 24
Nicorette Gum 4MG, 47
Ninlaro CAP 2.3MG, 8
Norpace CAP 100MG, 11
Nicorette Gum 4MG Cinn, 47
Ninlaro CAP 3MG, 8
Norpace CAP 100MG CR, 11
Nicorette Gum 4MG Mint, 47
Ninlaro CAP 4MG, 8
Norpace CAP 150MG, 11
Nicorette Gum 4MG Orig, 47
nisoldipine TAB 17MG ER, 10
Norpace CAP 150MG CR, 11
Nicorette Gum 4mgfruit, 47
Nisoldipine TAB 20MG ER, 10
Norpramin TAB 100MG, 38
Nicorette Loz 2MG Chry, 47
Nisoldipine TAB 25.5MG, 10
Norpramin TAB 10MG, 38
Nicorette Loz 2MG Mint, 47
Nisoldipine TAB 30MG ER, 10
Norpramin TAB 150MG, 38
Nicorette Loz 2MG Orig, 47
nisoldipine TAB 34MG ER, 10
Norpramin TAB 25MG, 38
Nicorette Loz 4MG Chry, 47
Nisoldipine TAB 40MG ER, 10
Norpramin TAB 50MG, 38
Nicorette Loz 4MG Mint, 47
nisoldipine TAB 8.5MG ER, 10
Norpramin TAB 75MG, 38
Nicorette Loz 4MG Orig, 47
Nitro-bid Oin 2%, 8
Northera CAP 100MG, 14
Nicorette ST Gum 2MG, 47
Nitro-dur Dis 0.1MG/HR, 9
Northera CAP 200MG, 14
Nicorette ST Gum 2MG Mint, 47
Nitro-dur Dis 0.2MG/HR, 9
Northera CAP 300MG, 14
Nicorette ST Gum 2MG Orig, 47
Nitro-dur Dis 0.3MG/HR, 8
nortrel TAB 0.5/35, 24
Nicorette ST Gum 4MG Mint, 47
Nitro-dur Dis 0.4MG/HR, 9
nortrel TAB 1/35, 24
Nicorette ST Gum 4MG Orig, 47
Nitro-dur Dis 0.6MG/HR, 9
nortrel TAB 7/7/7, 24
nicotine dis 14MG/24h, 46
Nitro-dur Dis 0.8MG/HR, 8
nortriptylin CAP 10MG, 37
nicotine dis 21MG/24h, 46
nitro-time CAP 9MG CR, 8
nortriptylin CAP 25MG, 37
nicotine dis 7MG/24HR, 46
nitrofur mac CAP 100MG, 33
nortriptylin CAP 50MG, 37
nicotine dis step 1, 46
nitrofur mac CAP 25MG, 33
nortriptylin CAP 75MG, 37
nicotine dis step 2, 46
nitrofur mac CAP 50MG, 33
Nortriptylin Sol 10MG/5ML, 38
nicotine dis step 3, 46
nitrofurantn CAP 100MG, 33
Nortuss-EX Liq 200-20/5, 57
nicotine gum 2MG, 46
nitrofurantn sus 25MG/5ML, 33
Norvasc TAB 10MG, 10
nicotine gum 2mgfruit, 46
Nitroglycer Aer 400mcg, 9
Norvasc TAB 2.5MG, 10
nicotine gum 4MG, 46
nitroglycer CAP 9MG ER, 8
Norvasc TAB 5MG, 10
nicotine loz 2MG chry, 46
nitroglycer dis 0.1MG/HR, 8
Norvir CAP 100MG, 4
nicotine loz 2MG mint, 46
nitroglycer dis 0.2MG/HR, 8
Norvir Sol 80MG/ML, 4
nicotine loz 4MG chry, 46
nitroglycer dis 0.4MG/HR, 8
Norvir TAB 100MG, 4
nicotine loz 4MG cinn, 46
nitroglycer dis 0.6MG/HR, 8
norwich asa TAB 325MG, 51
nicotine loz 4MG mint, 46
nitroglycrn spr 0.4MG, 8
Nova Max Glu Liq /Ket CON, 63
nicotine loz mini 2MG, 46
Nitrolingual Spr Pumpspra, 9
Nova Safety Mis Lanc 23G, 63
nicotine pol gum 2MG, 46
Nitromist Aer 400mcg, 9
Nova Safety Mis Lanc 28G, 63
nicotine pol gum 2MG cinn, 46
Nitrostat Sub 0.3MG, 9
Nova Sure Mis Lancets, 63
nicotine pol gum 2MG mint, 46
Nityr TAB 10MG, 28
Nova Sureflx Mis Lanc Dev, 63
nicotine pol gum 2MG orig, 46
Nityr TAB 2MG, 28
Novacort Gel, 19
nicotine pol gum 2MG ref, 46
Nityr TAB 5MG, 28
Novaferrum CAP 50MG, 35
nicotine pol gum 2MG strt, 46
Nivatopic CRE Plus, 21
Novaferrum Dro 15MG/ML, 35
nicotine pol gum 2mgfruit, 46
nizatidine CAP 150MG, 30
Novofine Aut Mis 30GX8MM, 63
nicotine pol gum 4MG, 46
nizatidine CAP 300MG, 30
Novofine Mis 30GX8MM, 63
nicotine pol gum 4MG cinn, 46
Nizatidine Sol 15MG/ML, 31
Novofine Mis 32GX6MM, 63
nicotine pol gum 4MG mint, 46
Nizoral Sha 2%, 17
Novofine Pls Mis 32GX4MM, 63
nicotine pol gum 4MG orig, 46
Noble Mystiq CRE Emu-lac, 21
Novolin Inj 70/30, 25
nicotine pol gum 4MG ref, 46
nolix lot 0.05%, 19
Novolin N Inj Relion, 25
nicotine pol gum 4MG strt, 46
Nor-QD TAB 0.35MG, 24
Novolin N Inj U-100, 25
nicotine pol gum 4mgfruit, 46
nora-be TAB 0.35MG, 24
Novolin R Inj Relion, 25
nicotine pol loz 2MG chry, 46
Norco TAB 10-325MG, 53
Novolin R Inj U-100, 25
nicotine pol loz 2MG cinn, 46
Norco TAB 5-325MG, 53
Novolin70/30 Inj Relion, 25
nicotine pol loz 2MG mint, 46
Norco TAB 7.5-325, 53
Novolog Inj 100/ML, 25
nicotine pol loz 4MG chry, 46
Norditropin Inj 10/1.5ML, 27
Novolog Inj Flexpen, 25
nicotine pol loz 4MG cinn, 46
Norditropin Inj 15/1.5ML, 27
Novolog Inj Penfill, 25
nicotine pol loz 4MG mint, 46
Norditropin Inj 30/3ML, 27
Novolog Mix Inj 70/30, 25
Nicotine SYS Kit Transder, 47
Norditropin Inj 5/1.5ML, 27
Novolog Mix Inj Flexpen, 25
nicotine TD dis 14MG/24h, 46
nore/ETH/fer chw 0.4MG-35, 24
Novotwist Mis 30GX8MM, 63
nicotine TD dis 21MG/24h, 46
noreth/ethin chw FE, 24
Novotwist Mis 32GX5MM, 64
Noxafil Sus 40MG/ML, 3
olanza/fluox CAP 3-25MG, 47
Onetouch Mis Lancets, 64
Noxafil TAB 100MG, 3
olanza/fluox CAP 6-25MG, 47
Onetouch Sol Ult Cont, 64
NP thyroid TAB 120MG, 29
olanza/fluox CAP 6-50MG, 47
Onetouch Sol Verio, 64
NP thyroid TAB 15MG, 29
olanzapine inj 10MG, 40
Onetouch Sol Verio-HI, 64
NP thyroid TAB 30MG, 29
olanzapine TAB 10MG, 39
Onetouch Tes Ultra, 64
NP thyroid TAB 60MG, 29
olanzapine TAB 10MG odt, 40
Onetouch Tes Ultra BL, 64
NP thyroid TAB 90MG, 29
olanzapine TAB 15MG, 39
Onetouch Tes Verio, 64
nu-iron 150 CAP 150MG, 34
olanzapine TAB 15MG odt, 40
Onetouch Us Mis Lancets, 64
Nucort Lot 2%, 19
olanzapine TAB 2.5MG, 39
Onexton Gel 1.2-3.75, 17
Nucynta ER TAB 100MG, 53
olanzapine TAB 20MG, 39
Onfi Sus 2.5MG/ML, 43
Nucynta ER TAB 150MG, 53
olanzapine TAB 20MG odt, 40
Onfi TAB 10MG, 43
Nucynta ER TAB 200MG, 53
olanzapine TAB 5MG, 39
Onfi TAB 20MG, 43
Nucynta ER TAB 250MG, 53
olanzapine TAB 5MG odt, 40
Onglyza TAB 2.5MG, 26
Nucynta ER TAB 50MG, 53
olanzapine TAB 7.5MG, 39
Onglyza TAB 5MG, 26
Nucynta TAB 100MG, 53
olm MED/amlo TAB /hctz, 13
Onmel TAB 200MG, 3
Nucynta TAB 50MG, 53
olm MED/hctz TAB 20-12.5, 13
Opana ER TAB 10MG, 53
Nucynta TAB 75MG, 53
olm MED/hctz TAB 40-12.5, 13
Opana ER TAB 15MG, 53
Nuedexta CAP 20-10MG, 47
olm MED/hctz TAB 40-25MG, 13
Opana ER TAB 20MG, 53
nulev TAB 0.125MG, 30
olmesa medox TAB 20MG, 11
Opana ER TAB 30MG, 53
Nulytely Sol Flav Pks, 30
olmesa medox TAB 40MG, 11
Opana ER TAB 40MG, 53
Numbonex Lot 2.75%, 21
olmesa medox TAB 5MG, 11
Opana ER TAB 5MG, 53
Numoisyn Liq, 36
olopatadine dro 0.1%, 50
Opana ER TAB 7.5MG, 53
Numoisyn Loz, 36
olopatadine sol 0.2%, 50
Opana TAB 10MG, 53
Nuplazid TAB 17MG, 40
olopatadine spr 0.6%, 56
Opana TAB 5MG, 53
Nutropin AQ Inj 10MG/2ML, 27
Olux Aer 0.05%, 19
opcicon TAB 1.5MG, 24
Nutropin AQ Inj 20MG/2ML, 27
Olux-e Aer 0.05%, 19
opium tin 10MG/ML, 30
Nutropin AQ Inj Nuspin 5, 27
Olysio CAP 150MG, 4
Opsumit TAB 10MG, 15
Nuvaring Mis, 24
Omeclamox- Mis PAK, 31
Optichamber Mis Adv Lrg, 66
Nuvessa Gel 1.3%, 33
omega-3-acid CAP 1gm, 15
Optichamber Mis Adv MED, 66
Nuvigil TAB 150MG, 42
omeppi CAP 20-1100, 30
Optichamber Mis Adv Sm, 66
Nuvigil TAB 200MG, 42
omeppi CAP 40-1100, 30
Optichamber Mis Advantag, 66
Nuvigil TAB 250MG, 42
omepra/bicar CAP 20-1100, 31
Optichamber Mis Dia LG, 66
Nuvigil TAB 50MG, 42
omepra/bicar CAP 40-1100, 31
Optichamber Mis Dia MD, 66
nyamyc pow 100000, 17
omepra/bicar pow 20-1680, 30
Optichamber Mis Dia Sm, 66
nyata pow 100000, 17
omepra/bicar pow 40-1680, 30
Optichamber Mis Diamond, 66
Nymalize Sol 30/10ML, 10
Omeprazole + Sus Syrspend, 31
Optichamber Mis Face Mas, 66
Nymalize Sol 60/20ML, 10
omeprazole CAP 10MG, 30
Optihaler Mis, 66
nystat/triam CRE, 17
omeprazole CAP 20MG, 30
Optimal D3 M CAP, 59
nystat/triam oin, 17
omeprazole CAP 40MG, 30
optimal-d CAP 50000unt, 59
nystatin CRE 100000, 17
Omnaris Spr, 56
option 2 TAB 1.5MG, 24
nystatin oin 100000, 17
Omnipred Sus 1% Op, 49
Optumrx Cont Sol Level1/2, 64
nystatin pow, 3
Omnitrope Inj 10/1.5ML, 27
opurity vit chw d 5000un, 59
nystatin pow 100000, 17
Omnitrope Inj 5.8MG, 27
Oracea CAP 40MG, 17
nystatin sus 100000, 36
Omnitrope Inj 5/1.5ML, 27
Oracit Sol, 34
nystatin TAB 500000, 3
On Call Expr Sol Glucose, 64
oralone dent pst 0.1%, 36
nystop pow 100000, 17
On Call Lanc Mis Device, 64
Orap TAB 1MG, 47
O
On Call Mis Lancets, 64
Orap TAB 2MG, 47
On Call Plus Mis Lanc Dev, 64
Orapred Odt TAB 10MG, 22
Obredon Sol 2.5-200, 57
On Call Plus Mis Lancets, 64
Orapred Odt TAB 15MG, 22
Ocaliva TAB 10MG, 32
On Call Plus Sol Control, 64
Orapred Odt TAB 30MG, 22
Ocaliva TAB 5MG, 32
On Call Vivd Sol Control, 64
Oravig TAB 50MG, 36
ocella TAB 3-0.03MG, 24
On-the-go Mis Lanc 30G, 64
Orencia Clck Inj 125MG/ML, 54
octreotide inj 1000mcg, 27
ondansetron inj 40/20ML, 31
Orencia Inj 125MG/ML, 54
octreotide inj 100mcg, 27
ondansetron inj 4MG/2ML, 31
Orencia Inj 250MG, 54
octreotide inj 200mcg, 27
ondansetron sol 4MG/5ML, 31
Orencia Inj 50/0.4, 54
octreotide inj 500mcg, 27
ondansetron TAB 24MG, 31
Orencia Inj 87.5/0.7, 54
octreotide inj 50mcg/ML, 27
ondansetron TAB 4MG, 31
Orenitram TAB 0.125MG, 16
Ocufen Sol 0.03% Op, 50
ondansetron TAB 4MG odt, 31
Orenitram TAB 0.25MG, 15
Ocuflox Dro 0.3% Op, 48
ondansetron TAB 8MG, 31
Orenitram TAB 1MG, 15
Odefsey TAB, 4
ondansetron TAB 8MG odt, 31
Orenitram TAB 2.5MG, 15
Ofev CAP 100MG, 58
One A Day CAP Prenatal, 60
Orenitram TAB 5MG, 15
Ofev CAP 150MG, 58
One A Day Mis Prenatal, 60
Orfadin CAP 10MG, 28
ofloxacin dro 0.3% op, 48
One A Day PAK Prenatal, 60
Orfadin CAP 20MG, 28
ofloxacin dro 0.3%otic, 50
One-a-day PAK Prenatal, 60
Orfadin CAP 2MG, 28
Ofloxacin TAB 300MG, 3
Onetouch Fp Mis Lancets, 64
Orfadin CAP 5MG, 28
ofloxacin TAB 400MG, 3
Onetouch Mis 30G, 64
Orfadin Sus 4MG/ML, 28
Ogestrel TAB, 24
Onetouch Mis Combo, 64
Orkambi TAB 100-125, 58
olanza/fluox CAP 12-25MG, 47
Onetouch Mis Lanc Dev, 64
Orkambi TAB 200-125, 58
olanza/fluox CAP 12-50MG, 47
orphenadrine inj 30MG/ML, 48
oxybutynin TAB 5MG, 33
Pancreaze CAP, 31
orphenadrine TAB 100MG ER, 48
oxybutynin TAB 5MG ER, 33
Pancreaze CAP 10500unt, 31
orsythia TAB, 24
oxycod/apap TAB 10-325MG, 51
Pancreaze CAP 16800unt, 31
Ortho Micron TAB 0.35MG, 24
oxycod/apap TAB 2.5-325, 51
Pancreaze CAP 21000unt, 32
Ortho Tri- TAB Cyclen, 24
oxycod/apap TAB 5-325MG, 51
Pancreaze CAP 4200unit, 32
Ortho Tri- TAB Cycln LO, 24
oxycod/apap TAB 7.5-325, 51
Pancrelipase CAP 5000unit, 31
Ortho-cyclen TAB 0.25/35, 24
oxycod/asa TAB, 51
Panda Mask Mis Large, 66
Ortho-novum TAB 1/35, 24
Oxycod/Ibu TAB 5-400MG, 53
Panda Mask Mis Medium, 66
Ortho-novum TAB 7/7/7, 24
oxycodone CAP 5MG, 52
Panda Mask Mis Pediatri, 66
oscimin SR TAB 0.375MG, 31
oxycodone CON 100/5ML, 51
Panda Mask Mis Small, 66
oscimin sub 0.125MG, 31
oxycodone CON 20MG/ML, 51
Pandel CRE 0.1%, 19
oscimin TAB 0.125MG, 31
oxycodone sol 5MG/5ML, 51
pantoprazole TAB 20MG, 30
oscion clnsr lot 6%, 16
oxycodone TAB 10MG, 51
pantoprazole TAB 40MG, 30
oseltamivir CAP 30MG, 4
Oxycodone TAB 10MG ER, 52
papaverine inj 30MG/ML, 15
oseltamivir CAP 45MG, 4
oxycodone TAB 15MG, 51
Papaverine Sol 30MG/ML, 15
oseltamivir CAP 75MG, 4
Oxycodone TAB 15MG ER, 53
Parafon Fort TAB 500MG, 48
Oseni TAB 12.5-15, 26
oxycodone TAB 20MG, 51
Paragard Iud T380a, 24
Oseni TAB 12.5-30, 26
Oxycodone TAB 20MG ER, 52
Paregoric Tin 2MG/5ML, 30
Oseni TAB 12.5-45, 26
oxycodone TAB 30MG, 51
paricalcitol CAP 1 mcg, 28
Oseni TAB 25-15MG, 26
Oxycodone TAB 30MG ER, 53
paricalcitol CAP 2 mcg, 28
Oseni TAB 25-30MG, 26
Oxycodone TAB 40MG ER, 52
paricalcitol CAP 4 mcg, 28
Oseni TAB 25-45MG, 26
oxycodone TAB 5MG, 51
Parlodel CAP 5MG, 45
Osmoprep TAB 1.5gm, 30
Oxycodone TAB 60MG ER, 52
Parlodel TAB 2.5MG, 45
Osphena TAB 60MG, 27
Oxycodone TAB 80MG ER, 52
Parnate TAB 10MG, 38
Otezla TAB 10/20/30, 54
Oxycodone/ Sol Apap, 53
paroex sol 0.12%, 36
Otezla TAB 30MG, 54
Oxycontin TAB 10MG CR, 52
paromomycin CAP 250MG, 3
Otovel Dro, 50
Oxycontin TAB 15MG CR, 52
paroxetin ER TAB 12.5MG, 38
Otrexup Inj 10MG, 55
Oxycontin TAB 20MG CR, 52
paroxetin ER TAB 37.5MG, 38
Otrexup Inj 12.5/0.4, 55
Oxycontin TAB 30MG CR, 52
paroxetine CAP 7.5MG, 47
Otrexup Inj 15MG, 55
Oxycontin TAB 40MG CR, 52
paroxetine TAB 10MG, 38
Otrexup Inj 17.5/0.4, 55
Oxycontin TAB 60MG CR, 52
paroxetine TAB 20MG, 38
Otrexup Inj 20MG, 55
Oxycontin TAB 80MG CR, 52
paroxetine TAB 25MG ER, 38
Otrexup Inj 22.5/0.4, 55
oxymorphone TAB 10MG ER, 52
paroxetine TAB 30MG, 38
Otrexup Inj 25MG, 55
Oxymorphone TAB 10MG ER, 53
paroxetine TAB 40MG, 38
Otrexup Inj 7.5/0.4, 55
oxymorphone TAB 15MG ER, 52
Paser Gra 4gm, 3
Ovace Plus Aer 9.8%, 18
Oxymorphone TAB 15MG ER, 53
Pataday Sol 0.2%, 50
Ovace Plus CRE 10%, 18
oxymorphone TAB 20MG ER, 52
Patanase Spr 0.6%, 56
Ovace Plus Gel 10% Wash, 18
Oxymorphone TAB 20MG ER, 53
Patanol Sol 0.1% Op, 50
Ovace Plus Liq 10% Wash, 18
oxymorphone TAB 30MG ER, 52
Paxil CR TAB 12.5MG, 38
Ovace Plus Sha 10%, 18
Oxymorphone TAB 30MG ER, 53
Paxil CR TAB 25MG, 38
Ovace Wash Liq 10%, 18
oxymorphone TAB 40MG ER, 52
Paxil CR TAB 37.5MG, 38
Ovcon-35 TAB, 24
Oxymorphone TAB 40MG ER, 53
Paxil Sus 10MG/5ML, 38
Ovide Lot 0.5%, 21
oxymorphone TAB 5MG ER, 52
Paxil TAB 10MG, 38
Oxandrin TAB 10MG, 22
Oxymorphone TAB 5MG ER, 53
Paxil TAB 20MG, 38
Oxandrin TAB 2.5MG, 22
oxymorphone TAB 7.5MG ER, 52
Paxil TAB 30MG, 38
oxandrolone TAB 10MG, 22
Oxymorphone TAB 7.5MG ER, 53
Paxil TAB 40MG, 38
oxandrolone TAB 2.5MG, 22
oxymorphone TAB HCL 10MG, 52
Pazeo Dro 0.7%, 50
oxaprozin TAB 600MG, 54
oxymorphone TAB HCL 5MG, 52
PC Lancets Mis 30G, 64
Oxaydo TAB 5MG, 53
Oxytrol Dis 3.9MG/24, 33
PCE TAB 333MG EC, 2
Oxaydo TAB 7.5MG, 53
P
PCE TAB 500MG EC, 2
oxazepam CAP 10MG, 37
PE/Guaifenes Dro 1.5-20MG, 57
PA vitamin CAP 2000unit, 59
oxazepam CAP 15MG, 37
pedia d-vite dro 400unit, 59
pacerone TAB 100MG, 11
oxazepam CAP 30MG, 37
pedia iron dro 15MG/ML, 35
pacerone TAB 200MG, 10
oxcarbazepin sus 300MG/5m, 43
Pediaderm HC Kit, 19
pacerone TAB 400MG, 11
oxcarbazepin TAB 150MG, 43
Pediapred Sol 6.7/5ML, 22
Pain Ease Aer MD Strm, 21
oxcarbazepin TAB 300MG, 43
Pediarix Inj 0.5ML, 58
Pain Ease Aer Mist, 21
oxcarbazepin TAB 600MG, 43
Pedvax HIB Inj, 58
Pain Relief Pad Patch, 21
oxiconazole CRE nitrate, 17
peg 3350 pow, 30
paliperidone TAB ER 1.5MG, 40
Oxistat CRE 1%, 17
peg 3350 sol electrol, 30
paliperidone TAB ER 3MG, 40
Oxistat Lot 1%, 18
peg-3350 sol electrol, 30
paliperidone TAB ER 6MG, 40
Oxsoralen Lot 1%, 21
peg-3350/KCL sol /sodium, 30
paliperidone TAB ER 9MG, 40
Oxsoralen-ul CAP 10MG, 18
Peg-intron Kit 120 Rp, 4
Pamelor CAP 10MG, 38
Oxtellar XR TAB 150MG, 44
Peg-intron Kit 120mcg, 4
Pamelor CAP 25MG, 38
Oxtellar XR TAB 300MG, 44
Peg-intron Kit 150 Rp, 4
Pamelor CAP 50MG, 38
Oxtellar XR TAB 600MG, 44
Peg-intron Kit 150mcg, 4
Pamelor CAP 75MG, 38
oxybutynin syp 5MG/5ML, 33
Peg-intron Kit 50mcg, 4
Pamine Forte TAB 5MG, 31
oxybutynin TAB 10MG ER, 33
Peg-intron Kit 50mcg Rp, 4
Pamine TAB 2.5MG, 31
oxybutynin TAB 15MG ER, 33
Peg-intron Kit 80mcg Rp, 4
Panatuss Dxp Liq, 57
peg-prep kit, 30
perindopril TAB 8MG, 11
Picato Gel 0.015%, 8
peg3350 pow, 30
periogard sol 0.12%, 36
Picato Gel 0.05%, 8
Peganone TAB 250MG, 44
Permavan Pad, 21
pilocarpine sol 1% op, 49
Pegasys Inj, 4
permethrin CRE 5%, 20
pilocarpine sol 2% op, 49
Pegasys Inj 180mcg/M, 4
Perphen/Amit TAB 2-10MG, 45
pilocarpine sol 4% op, 49
Pegasys Inj Proclick, 4
Perphen/Amit TAB 2-25MG, 45
pilocarpine TAB 5MG, 36
Pegintron Kit 120mcg, 4
Perphen/Amit TAB 4-10MG, 45
pilocarpine TAB 7.5MG, 36
Pegintron Kit 150mcg, 4
Perphen/Amit TAB 4-25MG, 45
pimozide TAB 1MG, 45
Pegintron Kit 50mcg, 4
Perphen/Amit TAB 4-50MG, 45
pimozide TAB 2MG, 45
Pegintron Kit 80mcg, 4
perphenazine TAB 16MG, 39
pimtrea TAB, 24
pegylax pow, 30
perphenazine TAB 2MG, 39
pindolol TAB 10MG, 9
Pen Needle Mis 29GX1/2", 64
perphenazine TAB 4MG, 39
pindolol TAB 5MG, 9
Pen Needle Mis 32GX4MM, 64
perphenazine TAB 8MG, 39
pioglit/glim TAB 30-2MG, 26
Pen Needles Mis 29GX1/2", 64
Perry Prenat CAP, 60
pioglit/glim TAB 30-4MG, 26
Pen Needles Mis 29GX10MM, 64
Persantine TAB 25MG, 36
pioglita/met TAB 15-500MG, 26
Pen Needles Mis 29GX12.7, 64
Persantine TAB 50MG, 36
pioglita/met TAB 15-850MG, 26
Pen Needles Mis 29GX12MM, 64
Persantine TAB 75MG, 36
pioglitazone TAB 15MG, 26
Pen Needles Mis 30GX5/16, 64
Pertzye CAP, 32
pioglitazone TAB 30MG, 26
Pen Needles Mis 30GX5MM, 64
Pexeva TAB 10MG, 38
pioglitazone TAB 45MG, 26
Pen Needles Mis 30GX8MM, 64
Pexeva TAB 20MG, 38
pirmella TAB 1/35, 24
Pen Needles Mis 31GX1/4", 64
Pexeva TAB 30MG, 38
pirmella TAB 7/7/7, 24
Pen Needles Mis 31GX3/16, 64
Pexeva TAB 40MG, 38
piroxicam CAP 10MG, 54
Pen Needles Mis 31GX5/16, 64
pharbedryl CAP 50MG, 56
piroxicam CAP 20MG, 54
Pen Needles Mis 31GX5MM, 64
Pharmacy Cou Mis Lancets, 64
Plan B TAB 1.5MG, 24
Pen Needles Mis 31GX6MM, 64
phenadoz sup 12.5MG, 56
Plaquenil TAB 200MG, 5
Pen Needles Mis 31GX8MM, 64
phenadoz sup 25MG, 56
Plavix TAB 300MG, 36
Pen Needles Mis 32GX4MM, 64
phenazo TAB 200MG, 34
Plavix TAB 75MG, 36
Pen Needles Mis 32GX5/32, 64
phenazopyrid TAB 100MG, 34
Plegridy Inj, 47
Pen Needles Mis 32GX5MM, 64
phenazopyrid TAB 200MG, 34
Plegridy Inj Pen, 47
Pen Needles Mis 32GX6MM, 64
phenelzine TAB 15MG, 38
Plegridy Inj Starter, 47
Pen Needles Mis 32GX8MM, 64
Phener Fort Syp 25MG/5ML, 56
Plegridy Pen Inj Starter, 47
Pen Needles Mis 33GX4MM, 64
Phenergan Inj 25MG/ML, 56
Pletal TAB 100MG, 36
penicilln vk sol 125/5ML, 1
Phenergan Inj 50MG/ML, 56
Pletal TAB 50MG, 36
Penicilln Vk Sol 125/5ML, 1
phenergan sup 12.5MG, 56
Plexion Clth Pad 9.8-4.8%, 17
penicilln vk sol 250/5ML, 1
phenergan sup 25MG, 56
Plexion CRE 9.8-4.8%, 17
Penicilln Vk Sol 250/5ML, 1
phenergan sup 50MG, 56
Plexion Liq 9.8-4.8%, 17
penicilln vk TAB 250MG, 1
phenobarb elx 20MG/5ML, 41
Plexion Lot 9.8-4.8%, 17
penicilln vk TAB 500MG, 1
Phenobarb Inj 130MG/ML, 41
Pneumovax 23 Inj 25/0.5, 58
Penlac Sol 8%, 18
phenobarb sol 20MG/5ML, 41
Pocket Chamb Mis, 66
Penlet II Kit Blood, 64
Phenobarb TAB 100MG, 41
Pocket Space Mis, 66
Penlet II Mis Repl CAP, 64
Phenobarb TAB 15MG, 41
Pocketchem Sol EZ, 64
Pennsaid Sol 2%, 18
phenobarb TAB 16.2MG, 41
Podocon Sol 25%, 21
Pentacel Inj, 58
Phenobarb TAB 30MG, 41
podofilox sol 0.5%, 20
Pentam 300 Inj 300MG, 6
phenobarb TAB 32.4MG, 41
poly-iron CAP 150MG, 35
Pentasa CAP 250MG CR, 32
Phenobarb TAB 60MG, 41
polycin oin op, 48
Pentasa CAP 500MG CR, 32
phenobarb TAB 64.8MG, 41
polyeth GLYC pow 3350 NF, 30
pentaz/nalox TAB 50-0.5MG, 52
phenobarb TAB 97.2MG, 41
polyeth GLYC pow 3350-grx, 30
Pentips Mis 29GX12MM, 64
phenoxybenza CAP 10MG, 12
polymyxin b/ sol trimethp, 48
Pentips Mis 31GX5MM, 64
Phentolamine Inj 5MG, 12
Polytrim Sol Op, 48
Pentips Mis 31GX6MM, 64
phenylbutyra pow sodium, 28
Pomalyst CAP 1MG, 7
Pentips Mis 31GX8MM, 64
phenylephrin sol 10% op, 49
Pomalyst CAP 2MG, 7
Pentips Mis 32GX4MM, 64
phenylephrin sol 2.5% op, 49
Pomalyst CAP 3MG, 7
pentobarb inj 1000/20, 41
Phenytek CAP 200MG, 44
Pomalyst CAP 4MG, 7
pentoxifylli TAB 400MG ER, 36
Phenytek CAP 300MG, 44
Ponstel CAP 250MG, 55
Pepcid Sus 40MG/5ML, 31
phenytoin chw 50MG, 43
portia-28 TAB, 24
Pepcid TAB 20MG, 31
phenytoin EX CAP 100MG, 43
pot citrate TAB 1080MG, 34
Pepcid TAB 40MG, 31
phenytoin EX CAP 200MG, 43
pot citrate TAB 1620MG, 34
Pepsin Pow, 31
phenytoin EX CAP 300MG, 43
pot citrate TAB 540MG ER, 34
Percocet TAB 10-325MG, 53
phenytoin inj 50MG/ML, 43
pot citrate- PAK CIT acid, 34
Percocet TAB 2.5-325, 53
phenytoin sus 125/5ML, 43
Potiga TAB 200MG, 44
Percocet TAB 5-325MG, 53
philith TAB 0.4-35, 24
Potiga TAB 300MG, 44
Percocet TAB 7.5-325, 53
Phlag Spr, 21
Potiga TAB 400MG, 44
Perfect 28G Mis Lancets, 64
Phoslyra Sol, 32
Potiga TAB 50MG, 44
Perfect 30G Mis Lancets, 64
phosphasal TAB, 33
powderlax pow, 30
Perfect Iron TAB 25MG, 35
Phospholine Sol 0.125%op, 49
Pradaxa CAP 110MG, 36
Perforomist Neb 20mcg, 57
phrenilin CAP forte, 51
Pradaxa CAP 150MG, 36
perindopril TAB 2MG, 11
phytonadione inj 1MG/0.5, 59
Pradaxa CAP 75MG, 36
perindopril TAB 4MG, 11
Pic 200 CAP, 35
Praluent Inj 150MG/ML, 14
Praluent Inj 75MG/ML, 14
Prednisone PAK 5MG, 21
Prilosec CAP 20MG, 31
pramipexole TAB 0.125MG, 44
Prednisone Sol 5MG/5ML, 21
Prilosec CAP 40MG, 31
pramipexole TAB 0.25MG, 44
prednisone TAB 10MG, 21
Prilosec Pow 10MG, 31
pramipexole TAB 0.375 ER, 45
prednisone TAB 1MG, 21
Prilosec Pow 2.5MG, 31
pramipexole TAB 0.5MG, 44
prednisone TAB 2.5MG, 21
priloxx LP kit 2.5-2.5%, 20
pramipexole TAB 0.75 ER, 45
prednisone TAB 20MG, 21
Primaquine TAB 26.3MG, 5
pramipexole TAB 0.75MG, 44
Prednisone TAB 50MG, 21
primidone TAB 250MG, 43
pramipexole TAB 1.5MG, 44
prednisone TAB 5MG, 21
primidone TAB 50MG, 43
pramipexole TAB 1.5MG ER, 45
Prefest TAB, 23
Primlev TAB 10-300MG, 53
pramipexole TAB 1MG, 44
Premarin TAB 0.3MG, 23
Primlev TAB 5-300MG, 53
pramipexole TAB 2.25 ER, 45
Premarin TAB 0.45MG, 23
Primlev TAB 7.5-300, 53
pramipexole TAB 3.75 ER, 45
Premarin TAB 0.625MG, 23
Primsol Sol 50MG/5ML, 5
pramipexole TAB 3MG ER, 45
Premarin TAB 0.9MG, 23
Prinivil TAB 10MG, 11
pramipexole TAB 4.5MG ER, 45
Premarin TAB 1.25MG, 23
Prinivil TAB 20MG, 11
Pramosone CRE 1-1%, 19
Premarin Vag CRE 0.625MG, 33
Prinivil TAB 5MG, 11
Pramosone CRE 1-2.5%, 19
Premphase TAB, 23
Pristiq TAB 100MG, 38
Pramosone Lot 1%, 19
Prempro TAB .625-2.5, 23
Pristiq TAB 25MG, 38
Pramosone Lot 2.5%, 19
Prempro TAB 0.3-1.5, 23
Pristiq TAB 50MG, 38
Pramotic Dro 1-0.1%, 50
Prempro TAB 0.45-1.5, 23
Pro Comfort Mis 31G, 64
pramox gel 1%, 20
Prempro TAB 0.625-5, 23
Pro Comfort Mis 31GX8MM, 64
Prandimet TAB 1-500MG, 26
Prenat Multi CAP +dha, 60
Pro Comfort Mis 32GX4MM, 64
Prandimet TAB 2-500MG, 26
Prenatal CAP Formula, 60
Pro Comfort Mis 32GX5MM, 64
Prandin TAB 0.5MG, 26
Prenatal CAP Omega-3, 60
Pro Comfort Mis 32GX6MM, 64
Prandin TAB 1MG, 26
Prenatal Mul CAP +dha, 60
Pro Comfort Mis Lancets, 64
Prandin TAB 2MG, 26
Prenatal MV Mis + DHA, 60
Pro:12 Aer Mousse, 21
prasugrel TAB 10MG, 36
Prenatal One TAB Daily, 60
Proair HFA Aer, 57
prasugrel TAB 5MG, 36
Prenatal TAB, 60
Proair Respi Aer, 57
Pravachol TAB 20MG, 15
Prenatal TAB 27-0.8MG, 60
proben/colch TAB 500-0.5, 55
Pravachol TAB 40MG, 15
Prenatal TAB 28-0.8MG, 60
probenecid TAB 500MG, 55
Pravachol TAB 80MG, 15
Prenatal TAB Complete, 60
Procainamide Inj 100MG/ML, 11
pravastatin TAB 10MG, 14
Prenatal TAB Formula, 60
Procainamide Inj 500MG/ML, 11
pravastatin TAB 20MG, 14
Prenatal TAB Forte, 60
Procardia CAP 10MG, 10
pravastatin TAB 40MG, 14
Prenatal TAB Iron, 60
Procardia XL TAB 30MG CR, 10
pravastatin TAB 80MG, 14
Prenatal TAB Low Iron, 60
Procardia XL TAB 60MG CR, 10
prazosin HCL CAP 1MG, 12
Prenatal TAB Multivit, 60
Procardia XL TAB 90MG CR, 10
prazosin HCL CAP 2MG, 12
Prenatal TAB Plus DHA, 60
Procentra Sol 5MG/5ML, 42
prazosin HCL CAP 5MG, 12
Prenatal TAB Vitamins, 60
prochlorper inj 10MG/2ML, 39
Pre-natal TAB Formula, 60
Prenatal Vit TAB 28-0.8MG, 60
prochlorper sup 25MG, 39
Precision Liq Control, 64
Prenatal Vit TAB Minerals, 60
prochlorper TAB 10MG, 39
Precision Liq Gluc/Ket, 64
Prenatal/FE TAB, 60
prochlorper TAB 5MG, 39
Precision Liq Nrml/Mid, 64
Prenatl Mult CAP + DHA, 60
Procort CRE, 32
Precision Mis 28G, 64
Prentat Mult CAP Plus DHA, 60
Procrit Inj 10000/ML, 34
Precision Mis 28g(t), 64
Prepidil Gel 0.5MG/3G, 50
Procrit Inj 2000/ML, 34
Precose TAB 100MG, 26
Prepopik PAK, 30
Procrit Inj 20000/ML, 34
Precose TAB 25MG, 26
Presera Aer, 21
Procrit Inj 3000/ML, 34
Precose TAB 50MG, 26
Pressure Act Mis Lancet, 64
Procrit Inj 4000/ML, 34
Pred Forte Sus 1% Op, 49
Pressure Act Mis Lancets, 64
Procrit Inj 40000/ML, 34
Pred Mild Sus 0.12% Op, 49
Prestalia TAB 14-10MG, 13
procto-MED CRE HC 2.5%, 32
Pred Sod PHO Sol 1% Op, 49
Prestalia TAB 3.5-2.5, 13
procto-PAK CRE 1%, 32
pred sod PHO sol 5MG/5ML, 21
Prestalia TAB 7-5MG, 13
Proctocort CRE 1%, 32
Pred-G S.o.p Oin Op, 49
Prevacid CAP 15MG DR, 31
Proctocort Sup 30MG, 32
Pred-G Sus Op, 49
Prevacid CAP 30MG DR, 31
Proctofoam Aer HC 1%, 32
Predni/Moxi/ Sol Bromfena, 49
Prevacid TAB 15MG Stb, 31
proctosol HC CRE 2.5%, 32
Predni/Moxi/ Sol Ketorola, 49
Prevacid TAB 30MG Stb, 31
proctozone CRE -HC 2.5%, 32
prednicarbat CRE 0.1%, 19
prevalite pow 4gm, 14
Procysbi CAP 25MG, 34
prednicarbat oin 0.1%, 19
prevalite pow 4gm pk, 14
Procysbi CAP 75MG, 34
prednisolone sol 10MG/5ML, 21
previfem TAB, 24
Prodigy Mis 26G, 64
prednisolone sol 15MG/5ML, 21
Prevnar 13 Inj, 58
Prodigy Mis 28G, 64
prednisolone sol 20MG/5ML, 21
Prevpac Mis, 31
Prodigy Mis Lanc Dev, 64
Prednisolone Sol 25MG/5ML, 21
Prezcobix TAB 800-150, 4
Prodigy NO Tes Coding, 64
Prednisolone Sol Moxiflox, 49
Prezista Sus 100MG/ML, 4
Prodigy Sol High, 64
prednisolone sus 1% op, 49
Prezista TAB 150MG, 4
Prodigy Sol Low, 64
prednisolone syp 15MG/5ML, 21
Prezista TAB 600MG, 4
Profe CAP 180MG, 35
prednisolone TAB 10MG odt, 22
Prezista TAB 75MG, 4
profeno TAB 600MG, 54
prednisolone TAB 15MG odt, 22
Prezista TAB 800MG, 4
Proferrin ES TAB 12 MG, 35
prednisolone TAB 30MG odt, 22
Priftin TAB 150MG, 3
progesterone CAP 100MG, 25
Prednisone CON 5MG/ML, 22
prilolid kit 2.5-2.5%, 20
progesterone CAP 200MG, 25
Prednisone PAK 10MG, 21
Prilosec CAP 10MG, 31
progesterone inj 50MG/ML, 25
Progesterone Sup VGS 100, 34
protriptylin TAB 5MG, 38
Questran Pow 4gm, 15
Progesterone Sup VGS 200, 34
Proventil Aer HFA, 57
Questran Pow 4gm Lite, 15
Progesterone Sup VGS 25, 34
Provera TAB 10MG, 25
quetiapine TAB 100MG, 39
Progesterone Sup VGS 400, 34
Provera TAB 2.5MG, 25
quetiapine TAB 150MG ER, 40
Progesterone Sup VGS 50, 34
Provera TAB 5MG, 25
quetiapine TAB 200MG, 39
Proglycem Sus 50MG/ML, 26
Provigil TAB 100MG, 42
quetiapine TAB 200MG ER, 40
Prograf CAP 0.5MG, 7
Provigil TAB 200MG, 42
quetiapine TAB 25MG, 39
Prograf CAP 1MG, 7
Prozac CAP 10MG, 38
quetiapine TAB 300MG, 39
Prograf CAP 5MG, 7
Prozac CAP 20MG, 38
quetiapine TAB 300MG ER, 40
Prolensa Sol 0.07%, 50
Prozac CAP 40MG, 38
quetiapine TAB 400MG, 39
Prolia Sol 60MG/ML, 27
Prozac Weekl CAP 90MG, 38
quetiapine TAB 400MG ER, 40
Promacta TAB 12.5MG, 35
Pruclair CRE, 21
quetiapine TAB 50MG, 39
Promacta TAB 25MG, 35
Prudoxin CRE 5%, 18
quetiapine TAB 50MG ER, 40
Promacta TAB 50MG, 35
Prumyx CRE, 21
Quicktek Liq Solution, 64
Promacta TAB 75MG, 35
Psorcon CRE 0.05%, 19
Quillichew Chw 20MG ER, 42
prometh VC sol plain, 56
Pss Safe Lan Mis, 64
Quillichew Chw 30MG ER, 42
prometh VC/ syp codeine, 56
Pss Sel Lanc Mis, 64
Quillichew Chw 40MG ER, 42
prometh/cod syp 6.25-10, 56
Pss Sel Plat Mis, 64
Quillivant Sus 25MG/5ML, 42
prometh/PE syp 6.25-5/5, 56
Pulmicort Inh 180mcg, 57
quinapril TAB 10MG, 11
prometh/PE/ syp codeine, 56
Pulmicort Inh 90mcg, 57
quinapril TAB 20MG, 11
promethazine inj 25MG/ML, 56
Pulmicort Sus 0.25MG/2, 57
quinapril TAB 40MG, 11
promethazine inj 50MG/ML, 56
Pulmicort Sus 0.5MG/2, 57
quinapril TAB 5MG, 11
promethazine sol 6.25/5ML, 56
Pulmicort Sus 1MG/2ML, 57
Quinidine Gl Inj 80MG/ML, 11
promethazine sup 12.5MG, 56
pulmosal neb 7%, 56
quinidine gl TAB 324MG CR, 10
promethazine sup 25MG, 56
Pulmozyme Sol 1MG/ML, 58
quinidine gl TAB 324MG ER, 11
promethazine sup 50MG, 56
Purixan Sus 20MG/ML, 6
Quinidine SU TAB 200MG, 11
promethazine syp 6.25/5ML, 56
px aspirin chw 81MG, 51
quinidine SU TAB 300MG, 11
promethazine syp DM, 56
px aspirin TAB 325MG, 51
Quinidine SU TAB 300MG, 11
promethazine TAB 12.5MG, 56
px aspirin TAB 325MG EC, 51
Quinidine SU TAB 300MG ER, 11
promethazine TAB 25MG, 56
px aspirin TAB 81MG EC, 51
quinine sulf CAP 324MG, 5
promethazine TAB 50MG, 56
px iron TAB 200MG, 35
Quintet Cont Sol Hgh/Norm, 64
promethegan sup 12.5MG, 56
px iron TAB 27MG, 35
Qvar Aer 40mcg, 57
promethegan sup 25MG, 56
Px Lancets Mis 28G, 64
Qvar Aer 80mcg, 57
promethegan sup 50MG, 56
Px Lancets Mis Ult Thin, 64
R
Prometrium CAP 100MG, 25
Px Prenatal TAB Multivit, 60
ra aspirin chw 81MG, 51
Prometrium CAP 200MG, 25
Pylera CAP, 30
ra aspirin TAB 325MG, 51
Promiseb CRE, 18
pyrazinamide TAB 500MG, 3
ra aspirin TAB 325MG EC, 51
propafenone CAP 225MG ER, 11
Pyridium TAB 100MG, 34
ra aspirin TAB 81MG EC, 51
propafenone CAP 325MG ER, 11
Pyridium TAB 200MG, 34
ra child asa chw 81MG, 51
propafenone CAP 425MG SR, 11
pyridostigm TAB 60MG, 48
Ra E-ZJECT Mis 28G, 64
propafenone TAB 150MG, 10
pyridostigmi TAB ER 180MG, 48
Ra E-ZJECT Mis 33G, 64
propafenone TAB 225MG, 10
Pyrogall Acd Oin, 21
Ra E-ZJECT Mis Thin 26G, 64
propafenone TAB 300MG, 10
Q
Ra E-ZJECT Mis Thin 28G, 64
Propanthelin TAB 15MG, 30
Qbrelis Sol 1MG/ML, 11
Ra E-ZJECT Mis Ult Thin, 64
proparacaine sol 0.5% op, 50
qc aspirin TAB 325MG, 51
ra iron TAB 27MG, 35
Propran/Hctz TAB 40/25, 12
qc aspirin TAB 325MG EC, 51
ra iron TAB 325MG, 35
Propran/Hctz TAB 80/25, 12
qc child asa chw 81MG, 51
ra iron TAB 65MG, 35
propranolol CAP 120MG ER, 9
Qc Lancets Mis 28G, 64
ra laxative pow, 30
propranolol CAP 160MG ER, 9
Qc Lancets Mis 30G, 64
ra laxative TAB 5MG EC, 30
propranolol CAP 60MG ER, 9
Qc Lancing Mis Device, 64
ra nicotine dis 14MG/24h, 46
propranolol CAP 80MG ER, 9
qc laxative TAB 5MG EC, 30
ra nicotine dis 21MG/24h, 46
Propranolol Sol 20MG/5ML, 9
qc nicotine gum 4MG, 46
ra nicotine dis 7MG/24HR, 46
Propranolol Sol 40MG/5ML, 9
Qc Prenatal TAB 28-0.8MG, 60
ra nicotine gum 2MG, 46
propranolol TAB 10MG, 9
qnapril/hctz TAB 10-12.5, 12
ra nicotine gum 2MG cinn, 46
propranolol TAB 20MG, 9
qnapril/hctz TAB 20-12.5, 12
ra nicotine gum 2MG mint, 46
propranolol TAB 40MG, 9
qnapril/hctz TAB 20-25MG, 12
ra nicotine gum 2mgfruit, 46
propranolol TAB 60MG, 9
Qnasl Aer 80mcg, 56
ra nicotine gum 4MG, 46
propranolol TAB 80MG, 9
Qnasl Child Spr 40mcg, 56
ra nicotine gum 4MG frut, 46
propylthiour TAB 50MG, 28
Quadracel Inj, 58
ra nicotine gum 4MG mint, 46
Proquad Inj, 58
Qualaquin CAP 324MG, 5
ra nicotine loz 2MG mint, 46
Proscar TAB 5MG, 34
Quartette TAB, 24
ra nicotine loz 4MG mint, 46
Prostin E2 Sup 20MG, 50
quasense TAB, 24
Ra One Daily Mis, 60
Protonix PAK, 31
Quazepam TAB 15MG, 41
Ra Pen Needl Mis 31GX3/16, 64
Protonix TAB 20MG, 31
Qudexy XR CAP 100/24HR, 44
Ra Prenatal TAB 28-0.8MG, 60
Protonix TAB 40MG, 31
Qudexy XR CAP 150/24HR, 44
Ra Prenatal TAB Formula, 60
Protopic Oin 0.03%, 20
Qudexy XR CAP 200/24HR, 44
ra vitamin CAP 2000unit, 59
Protopic Oin 0.1%, 20
Qudexy XR CAP 25/24HR, 44
rabeprazole TAB 20MG, 30
protriptylin TAB 10MG, 38
Qudexy XR CAP 50/24HR, 44
rajani TAB, 24
raloxifene TAB 60MG, 27
Reglan TAB 10MG, 32
Requip XL TAB 4MG, 45
ramipril CAP 1.25MG, 11
Reglan TAB 5MG, 32
Requip XL TAB 6MG, 45
ramipril CAP 10MG, 11
relador PAK kit 2.5-2.5%, 20
Requip XL TAB 8MG, 45
ramipril CAP 2.5MG, 11
relador PAK kit plus, 20
Rescriptor TAB 100 MG, 4
ramipril CAP 5MG, 11
Relagard Gel, 34
Rescriptor TAB 200MG, 4
Ranexa TAB 1000MG, 9
Releevia Mc Pad .0375-5%, 21
Rescula Sol 0.15%, 49
Ranexa TAB 500MG, 9
releevia ML pad 4-1%, 20
Reserpine TAB 0.1MG, 12
ranitidine CAP 150MG, 31
Releevia Pad .0375-5%, 21
Reserpine TAB 0.25MG, 12
ranitidine CAP 300MG, 31
Relenza Mis Diskhale, 4
Respa-BR TAB 11MG, 56
ranitidine syp 150/10ML, 30
Relhist Chw, 57
Restasis Emu 0.05%, 49
ranitidine syp 15MG/ML, 30
Relion Kit Lancing, 64
Restasis Mul Emu 0.05%, 49
ranitidine syp 75MG/5ML, 30
Relion Lance Mis Stnd 21G, 64
Restoril CAP 15MG, 41
ranitidine TAB 150MG, 30
Relion Lance Mis Thin 26G, 64
Restoril CAP 22.5MG, 41
ranitidine TAB 300MG, 30
Relion Lance Mis Thin 30G, 64
Restoril CAP 30MG, 41
Rapaflo CAP 4MG, 34
Relion Lanci Mis Device, 64
Restoril CAP 7.5MG, 41
Rapaflo CAP 8MG, 34
Relion Micro Mis Thin 33G, 64
Retin-a CRE 0.025%, 16
Rapamune Sol 1MG/ML, 7
Relion Pen Mis 29GX12MM, 64
Retin-a CRE 0.05%, 16
Rapamune TAB 0.5MG, 7
Relion Pen Mis 31GX6MM, 64
Retin-a CRE 0.1%, 16
Rapamune TAB 1MG, 7
Relion Pen Mis 31GX8MM, 64
Retin-a Gel 0.01%, 16
Rapamune TAB 2MG, 7
Relion Pen Mis 32GX4MM, 64
Retin-a Gel 0.025%, 16
Rapid-safe Mis Lancing, 64
Relion Thin Mis Lancets, 64
Retin-a Micr Gel 0.04%, 16
rasagiline TAB 0.5MG, 44
Relion Ultra Mis Thin, 64
Retin-a Micr Gel 0.04%pmp, 16
rasagiline TAB 1MG, 44
Relion Ultra Mis Thin 32G, 64
Retin-a Micr Gel 0.08%, 17
Rasuvo Inj 10MG, 54
Relion Ultra Mis Thin Pls, 64
Retin-a Micr Gel 0.1%, 16
Rasuvo Inj 12.5MG, 54
Relistor Inj 12/0.6ML, 32
Retin-a Micr Gel 0.1%P.M., 16
Rasuvo Inj 15MG, 54
Relistor Inj 8/0.4ML, 32
Retrovir CAP 100MG, 5
Rasuvo Inj 17.5MG, 54
Relistor TAB 150MG, 32
Retrovir Syp 50MG/5ML, 5
Rasuvo Inj 20MG, 54
Relpax TAB 20MG, 55
Revatio Sus 10MG/ML, 15
Rasuvo Inj 22.5MG, 54
Relpax TAB 40MG, 55
Revatio TAB 20MG, 15
Rasuvo Inj 25MG, 54
Remaxazon Pad, 21
Revia TAB 50MG, 54
Rasuvo Inj 27.5MG, 54
Remeron Sltb TAB 15MG, 38
Revlimid CAP 10MG, 7
Rasuvo Inj 30MG, 54
Remeron Sltb TAB 30MG, 38
Revlimid CAP 15MG, 7
Rasuvo Inj 7.5MG, 54
Remeron Sltb TAB 45MG, 38
Revlimid CAP 2.5MG, 7
Ravicti Liq 1.1gm/ML, 28
Remeron TAB 15MG, 38
Revlimid CAP 20MG, 7
Rayaldee CAP 30mcg, 28
Remeron TAB 30MG, 38
Revlimid CAP 25MG, 7
Rayos TAB 1MG, 22
Remeron TAB 45MG, 38
Revlimid CAP 5MG, 7
Rayos TAB 2MG, 22
remeven CRE 50%, 20
Rexaphenac CRE 1%, 18
Rayos TAB 5MG, 22
Remicade Inj 100MG, 32
Rexulti TAB 0.25MG, 40
Razadyne ER CAP 16MG, 47
Renacidin Sol, 34
Rexulti TAB 0.5MG, 40
Razadyne ER CAP 24MG, 47
Renacidin Sol Irr, 34
Rexulti TAB 1MG, 40
Razadyne ER CAP 8MG, 47
Renagel TAB 400MG, 32
Rexulti TAB 2MG, 40
Razadyne TAB 12MG, 47
Renagel TAB 800MG, 32
Rexulti TAB 3MG, 40
Razadyne TAB 4MG, 47
Renovo Pad 0.0375-5, 21
Rexulti TAB 4MG, 40
Razadyne TAB 8MG, 47
Renvela PAK 0.8gm, 32
Reyataz CAP 150MG, 4
rea LO 39 CRE 39%, 20
Renvela PAK 2.4gm, 32
Reyataz CAP 200MG, 4
rea LO 40 CRE 40%, 20
Renvela TAB 800MG, 32
Reyataz CAP 300MG, 4
react TAB 1.5MG, 24
repaglinide TAB 0.5MG, 26
Reyataz Pow 50MG, 5
Readylance Mis 21G, 64
Repaglinide TAB 1-500MG, 26
Rezira Sol 60-5/5ML, 57
Readylance Mis 23G, 64
repaglinide TAB 1MG, 26
Rheumatrex TAB 2.5MG, 55
Readylance Mis 26G, 64
Repaglinide TAB 2-500MG, 26
Rhinocort Sus Aqua, 56
Readylance Mis 28G, 64
repaglinide TAB 2MG, 26
Rhofade CRE 1%, 17
Readylance Mis 30G, 64
Repatha Inj 140MG/ML, 14
Ribapak PAK 1200/Day, 5
Reality Mis Lancets, 64
Repatha Push Inj 420/3.5, 14
Ribapak PAK 800/Day, 5
Reality Trig Mis Lancets, 64
Repatha Sure Inj 140MG/ML, 14
Ribapak TAB 1000/Day, 5
Rebetol CAP 200MG, 5
Replesta Nx Waf 14000unt, 59
Ribapak TAB 600/Day, 5
Rebetol Sol 40MG/ML, 4
Replesta Waf 14000unt, 59
ribasphere CAP 200MG, 4
Rebif Inj 22/0.5, 47
Replesta Waf 50000unt, 59
ribasphere TAB 200MG, 4
Rebif Inj 44/0.5, 47
reprexain TAB 10-200MG, 52
Ribasphere TAB 400MG, 5
Rebif Rebido Inj 22/0.5, 47
Reprexain TAB 5-200MG, 53
Ribasphere TAB 600MG, 5
Rebif Rebido Inj 44/0.5, 47
Requip TAB 0.25MG, 45
Ribatab TAB 1000/Day, 5
Rebif Rebido Inj Titratn, 47
Requip TAB 0.5MG, 45
Ribatab TAB 1200/Day, 5
Rebif Titrtn Inj Pack, 47
Requip TAB 1MG, 45
Ribatab TAB 800/Day, 5
reclipsen TAB, 24
Requip TAB 2MG, 45
ribavirin CAP 200MG, 4
Recombiva HB Inj 10mcg/ML, 58
Requip TAB 3MG, 45
ribavirin inh 6gm, 5
Recombiva HB Inj 5mcg/0.5, 58
Requip TAB 4MG, 45
ribavirin TAB 200MG, 4
Recombiva-HB Inj 40mcg/ML, 58
Requip TAB 5MG, 45
Ridaura CAP 3MG, 54
Rectiv Oin 0.4%, 32
Requip XL TAB 12MG, 45
rifabutin CAP 150MG, 3
Refuah Plus Sol Control, 64
Requip XL TAB 2MG, 45
Rifadin CAP 150MG, 3
Rifadin CAP 300MG, 3
rivastigmine dis 9.5MG/24, 47
Safe-t-lance Mis HI Flow, 64
Rifamate CAP, 3
rivelsa TAB, 24
Safe-t-lance Mis Low Flow, 64
rifampin CAP 150MG, 3
rizatriptan TAB 10MG, 55
Safe-t-lance Mis Nor Flow, 64
rifampin CAP 300MG, 3
rizatriptan TAB 10MG odt, 55
Safe-t-pro Mis Lancets, 64
Rifater TAB, 3
rizatriptan TAB 5MG, 55
Safe-t-pro Mis Plus, 64
Right Step TAB Prenatal, 60
rizatriptan TAB 5MG odt, 55
Safety 21G Mis Lancets, 64
Rightest Alt Mis Adaptor, 64
Robaxin Inj 100MG/ML, 48
Safety 28G Mis Lancets, 64
Rightest Liq High CON, 64
Robaxin TAB 500MG, 48
Safety Let Mis Lancets, 64
Rightest Liq Norm CON, 64
Robaxin-750 TAB 750MG, 48
Safety Mis Lancets, 64
Rightest Mis GD500, 64
Robinul Fort TAB 2MG, 31
Safety Seal Mis 28G, 64
Rightest Mis Gl300, 64
Robinul Inj 0.2MG/ML, 31
Safety Seal Mis 30G, 64
Rilutek TAB 50MG, 48
Robinul TAB 1MG, 31
Safyral TAB, 24
riluzole TAB 50MG, 48
Rocaltrol CAP 0.25mcg, 28
Saizen Inj 5MG, 27
rimantadine TAB 100MG, 4
Rocaltrol CAP 0.5mcg, 28
Saizen Inj 8.8MG, 27
Rimso-50 Sol 50%, 34
Rocaltrol Sol 1mcg/ML, 28
Saizenprep Inj 8.8MG, 27
Riomet Sol, 25
ropinirole TAB 0.25MG, 44
salacyn CRE 6%, 20
Riomet Sol 500/5ML, 25
ropinirole TAB 0.5MG, 44
salacyn lot 6%, 20
risedron sod TAB 35MG DR, 27
ropinirole TAB 12MG ER, 45
Salagen TAB 5MG, 36
risedronate TAB 150MG, 27
ropinirole TAB 1MG, 44
Salagen TAB 7.5MG, 36
risedronate TAB 30MG, 27
ropinirole TAB 2MG, 44
Salex Sha 6%, 21
risedronate TAB 35MG, 27
ropinirole TAB 2MG ER, 45
salicylic ac CRE 6%, 20
risedronate TAB 5MG, 27
ropinirole TAB 3MG, 44
salicylic ac gel 6%, 20
Risperdal Inj 12.5MG, 39
ropinirole TAB 4MG, 45
salicylic ac liq 26%, 20
Risperdal Inj 25MG, 39
ropinirole TAB 4MG ER, 45
salicylic ac liq 27.5%, 20
Risperdal Inj 37.5MG, 39
ropinirole TAB 5MG, 45
salicylic ac lot 6%, 20
Risperdal Inj 50MG, 39
ropinirole TAB 6MG ER, 45
salicylic ac sha 6%, 20
Risperdal M TAB 0.5MG, 40
ropinirole TAB 8MG ER, 45
salicylic aer 6%, 20
Risperdal M TAB 1MG, 40
rosadan CRE 0.75%, 17
salisol fort sol 26%, 20
Risperdal M TAB 2MG, 40
rosadan gel 0.75%, 17
Salitech Lot 5%, 21
Risperdal M TAB 3MG, 40
Rosadan Kit 0.75%, 17
salitech lot forte, 20
Risperdal M TAB 4MG, 40
rosanil emu cleanser, 16
Salivamax Pow, 36
Risperdal Sol 1MG/ML, 40
Rosula Liq 10-4.5%, 17
Salivate RX Pow, 36
Risperdal TAB 0.25MG, 40
Rosula Pad 10-5%, 17
salsalate TAB 500MG, 50
Risperdal TAB 0.5MG, 40
rosuvastatin TAB 10MG, 14
salsalate TAB 750MG, 50
Risperdal TAB 1MG, 40
rosuvastatin TAB 20MG, 14
Salvax Aer 6%, 21
Risperdal TAB 2MG, 40
rosuvastatin TAB 40MG, 14
Samsca TAB 15MG, 28
Risperdal TAB 3MG, 40
rosuvastatin TAB 5MG, 14
Samsca TAB 30MG, 28
Risperdal TAB 4MG, 40
Rotarix Sus, 58
Sancuso Dis 3.1MG, 31
risperidone sol 1MG/ML, 39
Rotateq Sol, 58
Sandimmune CAP 100MG, 7
risperidone TAB 0.25 odt, 40
Rowasa Kit 4gm, 32
Sandimmune CAP 25MG, 7
risperidone TAB 0.25MG, 39
roweepra TAB 1000MG, 43
Sandimmune Sol 100MG/ML, 7
risperidone TAB 0.5MG, 39
roweepra TAB 500MG, 43
Sandostatin Inj 1000mcg, 28
risperidone TAB 0.5MG od, 40
roweepra TAB 750MG, 43
Sandostatin Inj 100mcg, 28
risperidone TAB 1MG, 39
Roxicodone TAB 15MG, 53
Sandostatin Inj 200mcg, 28
risperidone TAB 1MG odt, 40
Roxicodone TAB 30MG, 53
Sandostatin Inj 500mcg, 28
risperidone TAB 2MG, 39
Roxicodone TAB 5MG, 53
Sandostatin Inj 50mcg/ML, 28
risperidone TAB 2MG odt, 40
Rozerem TAB 8MG, 41
Sandostatin Kit Lar 10MG, 27
risperidone TAB 3MG, 39
Rubraca TAB 200MG, 8
Sandostatin Kit Lar 20MG, 27
risperidone TAB 3MG odt, 40
Rubraca TAB 250MG, 8
Sandostatin Kit Lar 30MG, 27
risperidone TAB 4MG, 39
Rubraca TAB 300MG, 8
Saphris Sub 10MG, 40
risperidone TAB 4MG odt, 40
Ruconest Inj 2100unit, 36
Saphris Sub 2.5MG, 40
Ritalin LA CAP 10MG, 42
Rydapt CAP 25MG, 8
Saphris Sub 5MG, 40
Ritalin LA CAP 20MG, 42
Rynoderm CRE 37.5%, 21
Saps Health Mis Twist, 64
Ritalin LA CAP 30MG, 42
Rytary CAP 145MG, 45
Sapscare Mis Twist, 64
Ritalin LA CAP 40MG, 42
Rytary CAP 195MG, 45
Sarafem TAB 10MG, 47
Ritalin LA CAP 60MG, 42
Rytary CAP 245MG, 45
Sarafem TAB 20MG, 48
Ritalin TAB 10MG, 42
Rytary CAP 95MG, 45
Savaysa TAB 15MG, 36
Ritalin TAB 20MG, 42
Rythmol SR CAP 225MG, 11
Savaysa TAB 30MG, 36
Ritalin TAB 5MG, 42
Rythmol SR CAP 325MG, 11
Savaysa TAB 60MG, 36
Riteflo Mis, 66
Rythmol SR CAP 425MG, 11
Savella Mis Titr PAK, 48
Rituxan Inj 100MG, 6
Rythmol TAB 150MG, 11
Savella TAB 100MG, 48
Rituxan Inj 500MG, 6
Rythmol TAB 225MG, 11
Savella TAB 12.5MG, 48
rivastigmine CAP 1.5MG, 45
Ryvent TAB 6MG, 56
Savella TAB 25MG, 48
rivastigmine CAP 3MG, 45
S
Savella TAB 50MG, 48
rivastigmine CAP 4.5MG, 45
SB aspirin TAB 325MG, 51
Sabril Pow 500MG, 43
rivastigmine CAP 6MG, 45
SB aspirin TAB 325MG EC, 51
Sabril TAB 500MG, 43
rivastigmine dis 13.3/24, 47
SB bisacodyl TAB 5MG EC, 30
Safe-t-lance Mis 21G, 64
rivastigmine dis 4.6MG/24, 47
SB child asa chw 81MG, 51
Safe-t-lance Mis 25G, 64
SB Lancets Mis Thin, 65
Simbrinza Sus 1-0.2%, 49
sm nicotine gum 2MG mint, 46
SB Lancets Mis Ultr Thn, 65
Simcor TAB 1000-20, 15
sm nicotine gum 4MG, 46
scalacort lot 2%, 19
Simcor TAB 1000-40, 15
sm nicotine gum 4MG mint, 46
scopolamine dis 1MG/3day, 31
Simcor TAB 500-20MG, 15
sm nicotine loz 2MG mint, 46
Seasonique TAB, 24
Simcor TAB 500-40MG, 15
sm nicotine loz 4MG mint, 46
seb-prev liq wash, 18
Simcor TAB 750-20MG, 15
Sm One Daily Mis Prenatal, 60
Seconal CAP 100MG, 41
Similac Pren PAK Early Sh, 60
sm prenatal TAB vitamins, 59
Seconal Sod CAP 100MG, 41
Simple Diag Mis Lancing, 64
Sm Prenatal TAB Vitamins, 60
Sectral CAP 200MG, 9
Simponi Inj 100MG/ML, 54
Sm Truedraw Mis Lanc Dev, 65
Sectral CAP 400MG, 9
Simponi Inj 50/0.5ML, 54
sm vitamin d TAB 400unit, 59
Seebri Neoha CAP 15.6mcg, 57
simvastatin TAB 10MG, 14
Smart Sense Mis Lanc 21G, 65
Select-lite Kit Dev/Lanc, 64
simvastatin TAB 20MG, 14
Smart Sense Mis Lanc 26G, 65
Select-lite Mis Lanc Dev, 64
simvastatin TAB 40MG, 14
Smart Sense Mis Lanc 30G, 65
selegiline CAP 5MG, 45
simvastatin TAB 5MG, 14
Smart Sense Mis Lanc 33G, 65
selegiline TAB 5MG, 45
simvastatin TAB 80MG, 14
Smartest Mis Lancets, 65
selenium SUL lot 2.5%, 18
Sinemet CR TAB 25-100MG, 45
Smartest Sol Control, 65
Selenium SUL Sha 2.25%, 18
Sinemet CR TAB 50-200MG, 45
smooth LAX pow, 30
selenium SUL sha 2.25%, 18
Sinemet TAB 10-100MG, 45
smz-tmp DS TAB 800-160, 5
Selrx Sha 2.3%, 18
Sinemet TAB 25-100MG, 45
smz-tmp sus 200-40/5, 5
Selzentry Sol 20MG/ML, 4
Sinemet TAB 25-250MG, 45
smz-tmp TAB 400-80MG, 5
Selzentry TAB 150MG, 4
Single-let Mis 23G, 64
smz/tmp DS TAB 800-160, 5
Selzentry TAB 25MG, 4
Singulair Chw 4MG, 57
sod chloride neb 0.9%, 56
Selzentry TAB 300MG, 4
Singulair Chw 5MG, 58
sod citrate sol citr acd, 34
Selzentry TAB 75MG, 4
Singulair Gra 4MG, 58
sod SUL/sulf CRE 10-2%, 16
Semprex-d CAP 8-60MG, 57
Singulair TAB 10MG, 58
sod SUL/sulf CRE 10-5%, 16
Sensipar TAB 30MG, 28
sirolimus TAB 0.5MG, 7
sod SUL/sulf CRE 9.8-4.8%, 16
Sensipar TAB 60MG, 28
sirolimus TAB 1MG, 7
sod SUL/sulf emu 10-5%, 16
Sensipar TAB 90MG, 28
sirolimus TAB 2MG, 7
Sod SUL/Sulf Emu 10-5%, 16
Serevent Dis Aer 50mcg, 57
Sirturo TAB 100MG, 3
Sod SUL/Sulf Gel 10-5%, 17
Sernivo Spr, 19
Sitavig TAB 50MG, 5
sod SUL/sulf liq 10-2%, 16
Seroquel TAB 100MG, 40
Sivextro TAB 200MG, 5
sod SUL/sulf liq 9-4.5%, 16
Seroquel TAB 200MG, 40
Skelaxin TAB 800MG, 48
sod SUL/sulf liq 9.8-4.8%, 16
Seroquel TAB 25MG, 40
Sklice Lot 0.5%, 21
sod SUL/sulf liq wash, 16
Seroquel TAB 300MG, 40
Skyla Iud 13.5MG, 24
sod SUL/sulf lot 10-5%, 16
Seroquel TAB 400MG, 40
Slow FE TAB 142MG, 35
Sod SUL/Sulf Lot 10-5%, 16
Seroquel TAB 50MG, 40
slow FE TAB 45MG, 35
sod SUL/sulf lot 9.8-4.8%, 16
Seroquel XR TAB 150MG, 40
Slow FE TAB 45MG, 35
sod SUL/sulf pad 10-4%, 16
Seroquel XR TAB 200MG, 40
slow iron TAB 160MG CR, 35
Sod SUL/Sulf Sus 10-5%, 17
Seroquel XR TAB 300MG, 40
slow iron TAB 50MG, 35
sod SUL/sulf sus 8-4%, 16
Seroquel XR TAB 400MG, 40
Slow Rel FE TAB 143MG CR, 35
sod sulfacet gel 10%, 18
Seroquel XR TAB 50MG, 40
slow rel FE TAB 160MG CR, 35
sod sulfacet sha 10%, 18
Serostim Inj 4MG, 27
slow release TAB 143MG, 35
sod sulfacet sol 10% op, 48
Serostim Inj 5MG, 27
slow release TAB 45MG, 35
sodium chlor neb 10%, 56
Serostim Inj 6MG, 27
slow release TAB 47.5MG, 35
sodium chlor neb 3%, 56
sertraline CON 20MG/ML, 38
slow release TAB iron 45, 35
sodium chlor neb 7%, 56
sertraline TAB 100MG, 38
slow-release TAB FE 45MG, 35
sodium chlor sol 0.9% irr, 34
sertraline TAB 25MG, 38
sm aspirin chw 81MG, 51
sodium pheny TAB 500MG, 28
sertraline TAB 50MG, 38
sm aspirin TAB 325MG, 51
sodium SULFA liq 10% wash, 18
setlakin TAB, 24
sm aspirin TAB 325MG EC, 51
Sodium SULFA Liq 10% Wash, 18
sevelamer pow 0.8gm, 32
sm aspirin TAB 81MG EC, 51
Soft Touch Mis Lancets, 65
sevelamer pow 2.4gm, 32
sm child asa chw 81MG, 51
Softclix Mis Lancets, 65
sevelamer TAB 800MG, 32
sm clearlax pow, 30
Soliqua Inj 100/33, 26
Sfrowasa Ene 4gm, 32
sm folic acd TAB 400mcg, 35
Solodyn TAB 105MG, 2
sharobel TAB 0.35MG, 24
sm gentle TAB laxative, 30
Solodyn TAB 115MG, 2
Shohls Sol Modified, 34
sm iron slow TAB 160MG CR, 35
Solodyn TAB 55MG, 2
Shopko Lanc Mis Device, 64
sm iron TAB, 35
Solodyn TAB 65MG, 2
Shur-seal Gel 2%, 33
sm iron TAB 325MG, 35
Solodyn TAB 80MG, 2
Side Button Mis Safety, 64
sm iron TAB 45MG, 35
Soltamox Sol 10MG/5ML, 6
Signifor Inj 0.3MG/ML, 27
Sm Lancets Mis 21G, 65
Solu-cortef Inj 100MG, 21
Signifor Inj 0.6MG/ML, 27
Sm Lancets Mis 33G, 65
Solu-medrol Inj 125MG, 22
Signifor Inj 0.9MG/ML, 27
Sm Lancets Mis Thin 26G, 64
Solus V2 Mis Lanc 28G, 65
Signifor Lar Inj 20MG, 28
Sm Lancets Mis Thin 30G, 65
Solus V2 Mis Lanc 30G, 65
Signifor Lar Inj 40MG, 28
sm laxative TAB 5MG EC, 30
Solus V2 Mis Lanc Dev, 65
Signifor Lar Inj 60MG, 28
sm nicotine dis 14MG/24h, 46
Solus V2 Sol High, 65
sildenafil TAB 20MG, 15
sm nicotine dis 21MG, 46
Solus V2 Sol Low, 65
Silenor TAB 3MG, 41
sm nicotine dis 21MG/24h, 46
Soma TAB 250MG, 48
Silenor TAB 6MG, 41
sm nicotine dis 7MG/24HR, 46
Soma TAB 350MG, 48
Siliq Inj 210/1.5, 18
sm nicotine gum 2MG, 46
Somatuline Inj 120/.5ML, 27
Somatuline Inj 60/0.2ML, 27
stavudine CAP 40MG, 4
Sumatriptan Inj 6MG/0.5, 55
Somatuline Inj 90/0.3ML, 27
stavudine sol 1MG/ML, 4
sumatriptan spr 20MG/act, 55
Somavert Inj 10MG, 28
Stelara Inj 45MG/0.5, 18
sumatriptan spr 5MG/act, 55
Somavert Inj 15MG, 28
Stelara Inj 90MG/ML, 18
sumatriptan TAB 100MG, 55
Somavert Inj 20MG, 28
Sterilance Mis 1.8MM, 65
sumatriptan TAB 25MG, 55
Somavert Inj 25MG, 28
Sterilance Mis TL 28G, 65
sumatriptan TAB 50MG, 55
Somavert Inj 30MG, 28
Sterilance Mis TL 30G, 65
Sumavel Dose Inj 4MG/0.5, 55
Sonata CAP 10MG, 41
Sterilance Mis TL 32G, 65
Sumavel Dose Inj 6MG/0.5, 55
Sonata CAP 5MG, 41
stim laxat TAB 5MG EC, 30
Sumaxin Pad 10-4%, 17
Soolantra CRE 1%, 17
Stimate Sol 1.5MG/ML, 28
Sumaxin Ts Sus 8-4%, 17
Soothee Pad, 21
Stiolto Aer 2.5-2.5, 57
Sumaxin Wash Liq 9-4%, 17
Soriatane CAP 10MG, 18
Stivarga TAB 40MG, 8
Super Daily Dro D3, 59
Soriatane CAP 17.5MG, 18
stop smoking gum 2MG mint, 46
Super Thin Mis Lanc 28G, 65
Soriatane CAP 25MG, 18
stop smoking gum 2MG orig, 46
Super Thin Mis Lancet, 65
Sorilux Aer 0.005%, 18
stop smoking gum 4MG, 46
Super Thin Mis Lancets, 65
sorine TAB 120MG, 9
stop smoking loz 2MG, 46
Suprax CAP 400MG, 1
sorine TAB 160MG, 9
stop smoking loz 2MG mint, 46
Suprax Chw 100MG, 1
sorine TAB 240MG, 9
stop smoking loz 4MG mint, 46
Suprax Chw 200MG, 1
sorine TAB 80MG, 9
Strattera CAP 100MG, 42
Suprax Sus 100/5ML, 1
sotalol AF TAB 120MG, 9
Strattera CAP 10MG, 42
Suprax Sus 200/5ML, 1
sotalol AF TAB 160MG, 9
Strattera CAP 18MG, 42
Suprax Sus 500/5ML, 1
sotalol AF TAB 80MG, 9
Strattera CAP 25MG, 42
Supreme II Liq High/Low, 65
sotalol HCL TAB 120MG, 9
Strattera CAP 40MG, 42
Suprep Bowel Sol Prep Kit, 30
sotalol HCL TAB 160MG, 9
Strattera CAP 60MG, 42
Sure Comfort Mis 0.5/31G, 65
sotalol HCL TAB 240MG, 9
Strattera CAP 80MG, 42
Sure Comfort Mis 29GX1/2", 65
sotalol HCL TAB 80MG, 9
Strensiq Inj 18/0.45, 28
Sure Comfort Mis 30GX5/16, 65
Sotylize Sol 5MG/ML, 9
Strensiq Inj 28/0.7ML, 28
Sure Comfort Mis 31GX3/16, 65
Sovaldi TAB 400MG, 4
Strensiq Inj 40MG/ML, 28
Sure Comfort Mis 31GX5/16, 65
Spectracef TAB 400MG, 1
Strensiq Inj 80/0.8ML, 28
Sure Comfort Mis 31GX6MM, 65
Spinosad Sus 0.9%, 21
Streptomycin Inj 1gm, 3
Sure Comfort Mis 32GX5/32, 65
Spiriva Aer 1.25mcg, 57
Striant Mis 30MG, 22
Sure Comfort Mis 32GX6MM, 65
Spiriva CAP Handihlr, 57
Stribild TAB, 4
Sure Comfort Mis Lanc 18G, 65
Spiriva Spr 2.5mcg, 57
Striverdi Aer 2.5mcg, 57
Sure Comfort Mis Lanc 21G, 65
spirono/hctz TAB 25/25, 14
Stromectol TAB 3MG, 5
Sure Comfort Mis Lanc 23G, 65
spironolact TAB 100MG, 14
Stuart One CAP, 60
Sure Comfort Mis Lanc 30G, 65
spironolact TAB 25MG, 14
Suboxone Mis 12-3MG, 53
Sure Comfort Mis Lanc Pen, 65
spironolact TAB 50MG, 14
Suboxone Mis 2-0.5MG, 53
Sure Comfort Mis Lancets, 65
Sporanox CAP 100MG, 3
Suboxone Mis 4-1MG, 53
Sure-fine Mis 29GX1/2", 65
Sporanox CAP Pulsepak, 3
Suboxone Mis 8-2MG, 53
Sure-fine Mis 31GX3/16, 65
Sporanox Sol 10MG/ML, 3
Subsys Spr 100mcg, 52
Sure-fine Mis 31GX5/16, 65
sprintec 28 TAB 28 day, 24
Subsys Spr 1200mcg, 52
Sure-lance Mis 26G, 65
Spritam TAB 1000MG, 44
Subsys Spr 1600mcg, 52
Sure-lance Mis Lancets, 65
Spritam TAB 250MG, 44
Subsys Spr 200mcg, 52
Sure-pen Mis, 65
Spritam TAB 500MG, 44
Subsys Spr 400mcg, 52
Sure-touch Mis Unv Lanc, 65
Spritam TAB 750MG, 44
Subsys Spr 600mcg, 52
Sureflex Mis Lancets, 65
Sprix Spr 15.75MG, 55
Subsys Spr 800mcg, 52
Surelite Mis Lancets, 65
Sprycel TAB 100MG, 8
Sucraid Sol 8500/ML, 31
Surestep Glu Sol, 65
Sprycel TAB 140MG, 8
sucralfate TAB 1gm, 30
Surestep Glu Sol High/Low, 65
Sprycel TAB 20MG, 8
SUL sod/sulf liq 10-2%, 17
Surestep Pro Tes High CON, 65
Sprycel TAB 50MG, 8
SUL sod/sulf pad 10-4%, 17
Surestep Pro Tes Low CON, 65
Sprycel TAB 70MG, 8
Sular TAB 17MG, 10
Surestep Pro Tes Norm CON, 65
Sprycel TAB 80MG, 8
Sular TAB 34MG, 10
Surestep Sol Control, 65
SR nicotine gum 2MG, 47
Sular TAB 8.5MG, 10
Surmontil CAP 100MG, 38
sronyx TAB, 24
sulf/pred NA sol op, 49
Surmontil CAP 25MG, 38
Sss 10-5 Aer 10-5%, 17
Sulfacet Sod Oin 10% Op, 48
Surmontil CAP 50MG, 38
sss CRE 10%-5%, 16
sulfacet sod sol 10% op, 48
Survanta Inh, 58
st joseph chw low 81MG, 51
sulfacetamid lot 10%, 16
Sustiva CAP 200MG, 4
Stalevo 100 TAB, 45
sulfacetamid sus 10%, 16
Sustiva CAP 50MG, 4
Stalevo 125 TAB, 45
sulfacleanse sus 8-4%, 16
Sustiva TAB 600MG, 4
Stalevo 150 TAB, 45
Sulfadiazine TAB 500MG, 3
Sutent CAP 12.5MG, 8
Stalevo 200 TAB, 45
sulfasalazin TAB 500MG, 32
Sutent CAP 25MG, 8
Stalevo 50 TAB, 45
sulfasalazin TAB 500MG DR, 32
Sutent CAP 37.5MG, 8
Stalevo 75 TAB, 45
sulfatrim PD sus 200-40/5, 5
Sutent CAP 50MG, 8
Starlix TAB 120MG, 26
sulindac TAB 150MG, 54
sw clearlax pow, 30
Starlix TAB 60MG, 26
sulindac TAB 200MG, 54
sw nicotine gum 2MG mint, 46
stavudine CAP 15MG, 4
Sumadan Wash Liq 9-4.5%, 17
sw nicotine gum 4MG, 46
stavudine CAP 20MG, 4
sumatriptan inj 4MG/0.5, 55
sw nicotine loz 2MG mint, 46
stavudine CAP 30MG, 4
sumatriptan inj 6MG/0.5, 55
sw nicotine loz 4MG mint, 46
syeda TAB 3-0.03MG, 24
tamsulosin CAP 0.4MG, 34
Temodar CAP 20MG, 6
Sylatron Kit 200mcg, 8
Tanzeum Inj 30MG, 25
Temodar CAP 250MG, 6
Sylatron Kit 300mcg, 8
Tanzeum Inj 50MG, 25
Temodar CAP 5MG, 6
Sylatron Kit 600mcg, 8
Tapazole TAB 10MG, 29
Temovate CRE 0.05%, 19
Symax Duotab TAB, 31
Tapazole TAB 5MG, 29
Temovate E CRE 0.05%eml, 19
symax-SL sub 0.125MG, 31
Tarceva TAB 100MG, 8
Temovate Gel 0.05%, 19
symax-SR TAB 0.375MG, 31
Tarceva TAB 150MG, 8
Temovate Oin 0.05%, 19
Symbicort Aer 160-4.5, 58
Tarceva TAB 25MG, 8
Temovate Sol 0.05%, 19
Symbicort Aer 80-4.5, 58
Targadox TAB 50MG, 2
temozolomide CAP 100MG, 6
Symbyax CAP 12-25MG, 48
Targretin CAP 75MG, 8
temozolomide CAP 140MG, 6
Symbyax CAP 12-50MG, 48
tarina FE TAB 1/20, 24
temozolomide CAP 180MG, 6
Symbyax CAP 3-25MG, 48
Tarka TAB 1-240 CR, 13
temozolomide CAP 20MG, 6
Symbyax CAP 6-25MG, 48
Tarka TAB 2-180 CR, 13
temozolomide CAP 250MG, 6
Symbyax CAP 6-50MG, 48
Tarka TAB 2-240 CR, 13
temozolomide CAP 5MG, 6
Symlinpen 60 Inj 1000mcg, 25
Tarka TAB 4-240 CR, 13
Tencon TAB 50-325MG, 51
Symlnpen 120 Inj 1000mcg, 25
taron gra crystals, 34
Tenex TAB 1MG, 12
Synalar CRE 0.025%, 19
Tasigna CAP 150MG, 8
Tenex TAB 2MG, 12
Synalar Oin 0.025%, 19
Tasigna CAP 200MG, 8
Tenivac Inj 5-2LF, 58
Synalar Sol 0.01%, 19
Tasmar TAB 100MG, 45
Tenoretic TAB 100, 13
Synalgos-dc CAP, 53
Taytulla CAP, 24
Tenoretic TAB 50, 13
Synarel Sol 2MG/ML, 27
tazarotene CRE 0.1%, 18
Tenormin TAB 100MG, 9
Synera Dis 70-70MG, 21
tazicef inj 1gm, 1
Tenormin TAB 25MG, 9
Synerderm Emu, 21
Tazorac CRE 0.05%, 18
Tenormin TAB 50MG, 9
Synjardy TAB, 26
Tazorac CRE 0.1%, 18
Terazol 3 CRE 0.8%, 34
Synjardy TAB 12.5-500, 26
Tazorac Gel 0.05%, 18
Terazol 7 CRE 0.4%, 34
Synjardy TAB 5-1000MG, 26
Tazorac Gel 0.1%, 18
terazosin CAP 10MG, 12
Synjardy TAB 5-500MG, 26
taztia XT CAP 120MG/24, 10
terazosin CAP 1MG, 12
Synjardy XR TAB, 26
taztia XT CAP 180MG/24, 10
terazosin CAP 2MG, 12
Synjardy XR TAB 10-1000, 26
taztia XT CAP 240MG/24, 10
terazosin CAP 5MG, 12
Synjardy XR TAB 25-1000, 26
taztia XT CAP 300MG/24, 10
terbinafine TAB 250MG, 3
Synjardy XR TAB 5-1000MG, 26
taztia XT CAP 360MG/24, 10
terbutaline inj 1MG/ML, 57
Synthroid TAB 100mcg, 29
Tecfidera CAP 120MG, 47
terbutaline TAB 2.5MG, 57
Synthroid TAB 112mcg, 29
Tecfidera CAP 240MG, 47
terbutaline TAB 5MG, 57
Synthroid TAB 125mcg, 29
Tecfidera Mis Starter, 47
terconazole CRE 0.4%, 33
Synthroid TAB 137mcg, 29
Techlite AST Mis Lancets, 65
terconazole CRE 0.8%, 33
Synthroid TAB 150mcg, 29
Techlite Mis Lanc 30G, 65
terconazole sup 80MG, 33
Synthroid TAB 175mcg, 29
Techlite Mis Lancets, 65
Tersi Foam Aer 2.25%, 18
Synthroid TAB 200mcg, 29
Technivie TAB, 4
Tessalon Per CAP 100MG, 57
Synthroid TAB 25mcg, 29
Tegretol Sus 100/5ML, 44
Testim Gel 1%(50MG), 22
Synthroid TAB 300mcg, 29
Tegretol TAB 200MG, 44
Testone Cik Kit 200MG/ML, 22
Synthroid TAB 50mcg, 29
Tegretol-XR TAB 100MG, 44
testost cyp inj 100MG/ML, 22
Synthroid TAB 75mcg, 29
Tegretol-XR TAB 200MG, 44
testost cyp inj 200MG/ML, 22
Synthroid TAB 88mcg, 29
Tegretol-XR TAB 400MG, 44
testost enan inj 200MG/ML, 22
synvexia pad 4-1%, 20
Tekturna HCT TAB 150-12.5, 13
testosterone gel 1%(25MG), 22
Syringe 0.5 Mis 30G, 65
Tekturna HCT TAB 150-25MG, 13
Testosterone Gel 1%(25MG), 22
Syringe Mis 0.5/30G, 65
Tekturna HCT TAB 300-12.5, 13
testosterone gel 1%(50MG), 22
T
Tekturna HCT TAB 300-25MG, 13
Testosterone Gel 1%(50MG), 22
Tekturna TAB 150MG, 12
Testosterone Gel 10MG/Act, 22
Tabloid TAB 40MG, 6
Tekturna TAB 300MG, 12
testosterone gel P.M. 1%, 22
Taclonex Oin, 19
Telcare Sol Level1/2, 65
Testosterone Gel P.M. 1%, 22
Taclonex Sus, 19
telmis/amlod TAB 40-10MG, 13
testosterone sol 30MG/act, 22
tacrolimus CAP 0.5MG, 7
telmis/amlod TAB 40-5MG, 13
Testred CAP 10MG, 22
tacrolimus CAP 1MG, 7
telmis/amlod TAB 80-10MG, 13
Tet/Dip Tox Inj 2-2 LF, 58
tacrolimus CAP 5MG, 7
telmis/amlod TAB 80-5MG, 13
tetcaine sol 0.5% op, 50
tacrolimus oin 0.03%, 19
telmisa/hctz TAB 40-12.5, 13
tetrabenazin TAB 12.5MG, 47
tacrolimus oin 0.1%, 20
telmisa/hctz TAB 80-12.5, 13
tetrabenazin TAB 25MG, 47
Tafinlar CAP 50MG, 8
telmisa/hctz TAB 80-25MG, 13
tetracaine sol 0.5% op, 50
Tafinlar CAP 75MG, 8
telmisartan TAB 20MG, 11
tetracycline CAP 250MG, 2
Tagrisso TAB 40MG, 8
telmisartan TAB 40MG, 11
Tetracycline CAP 250MG, 2
Tagrisso TAB 80MG, 8
telmisartan TAB 80MG, 11
tetracycline CAP 500MG, 2
Tai Doc Sol Norm CON, 65
Temazepam 7.5MG CAPS, 41
Tetracycline CAP 500MG, 2
take action TAB 1.5MG, 24
temazepam CAP 15MG, 41
Tetramex Spr 2-1-3%, 21
Taltz Inj 80MG/ML, 18
temazepam CAP 22.5MG, 41
tetravisc sol 0.5% op, 50
Tamiflu CAP 30MG, 5
temazepam CAP 30MG, 41
tetravisc sol forte, 50
Tamiflu CAP 45MG, 5
temazepam CAP 7.5MG, 41
Tetrix CRE, 21
Tamiflu CAP 75MG, 5
Temodar CAP 100MG, 6
Texacort Sol 2.5%, 19
Tamiflu Sus 6MG/ML, 4
Temodar CAP 140MG, 6
tgt aspirin chw 81MG, 51
tamoxifen TAB 10MG, 6
Temodar CAP 180MG, 6
tgt aspirin chw child, 51
tamoxifen TAB 20MG, 6
tgt aspirin TAB 325MG, 51
tiagabine TAB 4MG, 43
Tofranil-PM CAP 125MG, 39
tgt aspirin TAB 81MG, 51
Tiazac CAP 120MG/24, 10
Tofranil-PM CAP 150MG, 39
tgt aspirin TAB 81MG EC, 51
Tiazac CAP 180MG/24, 10
Tofranil-PM CAP 75MG, 39
Tgt Lancet Mis 23G, 65
Tiazac CAP 240MG/24, 10
Tolak CRE 4%, 6
Tgt Lancet Mis 26G, 65
Tiazac CAP 300MG/24, 10
Tolazamide TAB 250MG, 25
Tgt Lancet Mis 28G, 65
Tiazac CAP 360MG/24, 10
Tolazamide TAB 500MG, 25
Tgt Lancet Mis 30G, 65
Tiazac CAP 420MG/24, 10
Tolbutamide TAB 500MG, 25
Tgt Lancet Mis 33G, 65
Ticalast Kit 137/50, 56
tolcapone TAB 100MG, 45
Tgt Lancet Mis Alternat, 65
Tier Uni Pls Mis 31GX8MM, 65
tolmetin sod CAP 400MG, 54
Tgt Lancing Mis Adv Dev, 65
Tigan CAP 300MG, 31
Tolmetin Sod CAP 400MG, 54
Tgt Lancing Mis Device, 65
Tigan Inj 100MG/ML, 31
Tolmetin Sod TAB 200MG, 54
tgt nicotine dis 14MG/24h, 46
Tikosyn CAP 125mcg, 11
Tolmetin Sod TAB 600MG, 55
tgt nicotine dis 21MG/24h, 46
Tikosyn CAP 250mcg, 11
tolterodine CAP 2MG ER, 33
tgt nicotine dis 7MG/24HR, 46
Tikosyn CAP 500mcg, 11
tolterodine CAP 4MG ER, 33
tgt nicotine gum 2MG mint, 46
tilia FE TAB, 24
tolterodine TAB 1MG, 33
tgt nicotine gum 2MG orig, 46
timolol gel sol 0.25% op, 49
tolterodine TAB 2MG, 33
tgt nicotine gum 2mgfruit, 46
timolol gel sol 0.5% op, 49
Topamax Spr CAP 15MG, 44
tgt nicotine gum 4MG, 46
timolol mal sol 0.25% op, 49
Topamax Spr CAP 25MG, 44
tgt nicotine gum 4MG mint, 46
timolol mal sol 0.5% op, 49
Topamax TAB 100MG, 44
tgt nicotine gum 4MG orig, 46
Timolol Mal TAB 10MG, 9
Topamax TAB 200MG, 44
tgt nicotine loz 2MG chry, 46
Timolol Mal TAB 20MG, 9
Topamax TAB 25MG, 44
tgt nicotine loz 2MG mint, 46
Timolol Mal TAB 5MG, 9
Topamax TAB 50MG, 44
tgt nicotine loz 4MG chry, 46
Timoptic Ocu Sol 0.25% Op, 49
Topcare Mis Lanc 33G, 65
tgt nicotine loz 4MG mint, 46
Timoptic Ocu Sol 0.5% Op, 49
Topicort CRE 0.05%, 19
Thalomid CAP 100MG, 7
Timoptic Sol 0.25% Op, 49
Topicort CRE 0.25%, 19
Thalomid CAP 150MG, 7
Timoptic Sol 0.5% Op, 49
Topicort Gel 0.05%, 19
Thalomid CAP 200MG, 7
Timoptic-xe Sol 0.25% Op, 49
Topicort Oin 0.05%, 19
Thalomid CAP 50MG, 7
Timoptic-xe Sol 0.5% Op, 49
Topicort Oin 0.25%, 19
Theo-24 CAP 100MG CR, 58
Tindamax TAB 250MG, 6
Topicort Spr 0.25%, 19
Theo-24 CAP 200MG CR, 58
Tindamax TAB 500MG, 6
topiramate CAP 15MG, 43
Theo-24 CAP 300MG CR, 58
tinidazole TAB 250MG, 6
topiramate CAP 25MG, 43
Theo-24 CAP 400MG ER, 58
tinidazole TAB 500MG, 6
Topiramate CAP ER 100MG, 44
theochron TAB 100MG CR, 57
Tirosint CAP 100mcg, 29
Topiramate CAP ER 150MG, 44
theochron TAB 200MG CR, 57
Tirosint CAP 112mcg, 29
Topiramate CAP ER 200MG, 44
theochron TAB 300MG CR, 57
Tirosint CAP 125mcg, 29
Topiramate CAP ER 25MG, 44
theophylline sol 80/15ML, 57
Tirosint CAP 137mcg, 29
Topiramate CAP ER 50MG, 44
theophylline TAB 100MG CR, 57
Tirosint CAP 13mcg, 29
topiramate TAB 100MG, 43
theophylline TAB 100MG ER, 57
Tirosint CAP 150mcg, 29
topiramate TAB 200MG, 43
theophylline TAB 200MG CR, 57
Tirosint CAP 25mcg, 29
topiramate TAB 25MG, 43
theophylline TAB 200MG ER, 57
Tirosint CAP 50mcg, 29
topiramate TAB 50MG, 43
theophylline TAB 300MG ER, 57
Tirosint CAP 75mcg, 29
Toprol XL TAB 100MG, 9
theophylline TAB 400MG ER, 57
Tirosint CAP 88mcg, 29
Toprol XL TAB 200MG, 9
theophylline TAB 450MG ER, 57
Tivicay TAB 10MG, 4
Toprol XL TAB 25MG, 9
theophylline TAB 600MG ER, 57
Tivicay TAB 25MG, 4
Toprol XL TAB 50MG, 9
thera-d sprt TAB 2000unit, 59
Tivicay TAB 50MG, 4
torsemide TAB 100MG, 14
thera-d TAB 2000unit, 59
Tivorbex CAP 20MG, 55
torsemide TAB 10MG, 14
Thera-d TAB 4000unit, 59
Tivorbex CAP 40MG, 55
torsemide TAB 20MG, 14
Thin Lancets Mis, 65
tizanidine CAP 2MG, 48
torsemide TAB 5MG, 14
Thin Lancets Mis 26G, 65
tizanidine CAP 4MG, 48
Toujeo Solo Inj 300iu/ML, 25
Thin Lancets Mis 30G, 65
tizanidine CAP 6MG, 48
Toviaz TAB 4MG, 33
Thinlets GP Mis 26G, 65
tizanidine TAB 2MG, 48
Toviaz TAB 8MG, 33
Thinlets Mis 28g(t), 65
tizanidine TAB 4MG, 48
Tracleer TAB 125MG, 15
Thiola TAB 100MG, 34
Tobi Neb 300/5ML, 3
Tracleer TAB 62.5MG, 15
thioridazine TAB 100MG, 40
Tobi Podhalr CAP 28MG, 3
Tradjenta TAB 5MG, 26
thioridazine TAB 10MG, 40
tobra/dexame sus 0.3-0.1%, 49
tramadl/apap TAB 37.5-325, 51
thioridazine TAB 25MG, 40
Tobradex Oin 0.3-0.1%, 49
Tramadol HCL CAP 150MG ER, 53
thioridazine TAB 50MG, 40
Tobradex ST Sus 0.3-0.05, 49
Tramadol HCL CAP ER 100MG, 53
thiothixene CAP 10MG, 39
Tobradex Sus 0.3-0.1%, 49
Tramadol HCL CAP ER 200MG, 53
thiothixene CAP 1MG, 39
tobramycin neb 300/5ML, 3
Tramadol HCL CAP ER 300MG, 53
thiothixene CAP 2MG, 39
Tobramycin Neb 300/5ML, 3
tramadol HCL TAB 100MG ER, 52
thiothixene CAP 5MG, 39
tobramycin sol 0.3% op, 48
tramadol HCL TAB 200MG ER, 52
thrive gum 2MG mint, 46
Tobrex Oin 0.3% Op, 48
tramadol HCL TAB 300MG ER, 52
Thyrolar-1 TAB 60MG, 29
Tobrex Sol 0.3% Op, 48
tramadol HCL TAB 50MG, 51
Thyrolar-1/2 TAB 30MG, 29
Today Sponge Mis, 33
trando/verap TAB 1-240 ER, 13
Thyrolar-1/4 TAB 15MG, 29
Tofranil TAB 10MG, 38
trando/verap TAB 2-180 ER, 13
Thyrolar-2 TAB 120MG, 29
Tofranil TAB 25MG, 39
trando/verap TAB 2-240 ER, 13
Thyrolar-3 TAB 180MG, 29
Tofranil TAB 50MG, 39
trando/verap TAB 4-240 ER, 13
tiagabine TAB 2MG, 43
Tofranil-PM CAP 100MG, 39
trandolapril TAB 1MG, 11
trandolapril TAB 2MG, 11
Tribenzor40- TAB 10-12.5, 13
Truvada TAB 167-250, 4
trandolapril TAB 4MG, 11
Tribenzor40- TAB 10-25MG, 13
Truvada TAB 200-300, 4
tranex acid TAB 650MG, 36
Tribenzor40- TAB 5-12.5MG, 13
Tudorza Pres Aer 400/Act, 58
Transderm-sc Dis 1.5MG, 31
Tribenzor40- TAB 5-25MG, 13
Tussicaps CAP 10-8MG, 57
Tranxene T TAB 3.75MG, 37
tricitrates sol, 34
Tussicaps CAP 5-4MG, 57
Tranxene T TAB 7.5MG, 37
Tricor TAB 145MG, 15
tussigon TAB 5-1.5MG, 56
tranylcyprom TAB 10MG, 38
Tricor TAB 48MG, 15
Tussionex Sus 10-8/5ML, 57
Tranzarel Gel 4%, 21
triderm CRE 0.1%, 19
Tuzistra XR Sus, 57
Travatan Z Dro 0.004%, 49
triderm CRE 0.5%, 19
Twinrix Inj, 58
Travel Lance Mis 30G, 65
Tridesilon CRE 0.05%, 19
Twynsta TAB 40-10MG, 13
Travel Lance Mis Adv 28G, 65
trifluoperaz TAB 10MG, 39
Twynsta TAB 40-5MG, 13
Travoprost Dro 0.004%, 49
trifluoperaz TAB 1MG, 39
Twynsta TAB 80-10MG, 13
trazodone TAB 100MG, 38
trifluoperaz TAB 2MG, 39
Twynsta TAB 80-5MG, 13
trazodone TAB 150MG, 38
trifluoperaz TAB 5MG, 39
Tybost TAB 150MG, 4
trazodone TAB 300MG, 38
trifluridine sol 1% op, 48
Tykerb TAB 250MG, 8
trazodone TAB 50MG, 38
Triglide TAB 160MG, 15
Tylenol/Cod TAB #3, 53
Trecator TAB 250MG, 3
trihexyphen elx 0.4MG/ML, 45
Tylenol/Cod TAB #4, 53
Tremfya Inj 100MG/ML, 18
trihexyphen TAB 2MG, 45
Tymlos Inj, 27
Tresiba Flex Inj 100unit, 25
trihexyphen TAB 5MG, 45
Tysabri Inj 300/15ML, 47
Tresiba Flex Inj 200unit, 25
triklo CAP 1gm, 15
Tyvaso Refil Sol 0.6MG/ML, 15
Tretin-x CRE 0.0375%, 17
Trileptal Sus 300MG/5m, 44
Tyvaso Sol 0.6MG/ML, 15
Tretin-x CRE 0.075%, 17
Trileptal TAB 150MG, 44
Tyvaso Start Sol 0.6MG/ML, 15
tretinoin CAP 10MG, 8
Trileptal TAB 300MG, 44
Tyzeka TAB 600MG, 4
tretinoin CRE 0.025%, 16
Trileptal TAB 600MG, 44
Tyzine PED Dro 0.05%, 56
tretinoin CRE 0.05%, 16
Trilipix CAP 135MG, 15
U
tretinoin CRE 0.1%, 16
Trilipix CAP 45MG, 15
Uceris Aer 2MG/Act, 32
tretinoin gel 0.01%, 16
trilyte sol, 30
Uceris TAB 9MG, 21
tretinoin gel 0.025%, 16
trimethobenz CAP 300MG, 31
Ulesfia Lot 5%, 20
tretinoin gel 0.04%, 16
trimethoprim sol polymyxn, 48
Uloric TAB 40MG, 55
tretinoin gel 0.04%pmp, 16
trimethoprim TAB 100MG, 5
Uloric TAB 80MG, 55
tretinoin gel 0.05%, 16
trimipramine CAP 100MG, 38
Ulti-lance Mis CLR Tip, 65
tretinoin gel 0.1%, 16
trimipramine CAP 25MG, 38
Ulticare Pen Mis 31GX5MM, 65
tretinoin gel 0.1%P.M., 16
trimipramine CAP 50MG, 38
Ultilet Insu Mis 30X12.7, 65
Trexall TAB 10MG, 6
Trimpex Sol 50MG/5ML, 5
Ultilet Insu Mis 31GX6MM, 65
Trexall TAB 15MG, 6
trinessa LO TAB, 24
Ultilet Mis 26G, 65
Trexall TAB 5MG, 6
trinessa TAB, 24
Ultilet Mis 28G, 65
Trexall TAB 7.5MG, 6
Trintellix TAB 10MG, 39
Ultilet Mis 30G, 65
Treximet TAB 10-60MG, 55
Trintellix TAB 20MG, 39
Ultilet Mis 33G, 65
Treximet TAB 85-500MG, 55
Trintellix TAB 5MG, 39
Ultilet Mis Lancets, 65
tri femynor TAB, 24
Triumeq TAB, 4
Ultilet Mis Safety, 65
tri-estaryll TAB, 24
trivora-28 TAB, 24
Ultilet Pen Mis 29GX12.7, 65
tri-legest TAB FE, 24
Trizivir TAB, 4
Ultilet Pen Mis 31GX5MM, 65
tri-linyah TAB, 24
Trokendi XR CAP 100MG, 44
Ultilet Pen Mis 31GX8MM, 65
tri-LO TAB estaryll, 24
Trokendi XR CAP 200MG, 44
Ultilet Pen Mis 32GX4MM, 65
tri-LO- TAB marzia, 24
Trokendi XR CAP 25MG, 44
Ultilet Safe Mis 21G, 65
tri-LO- TAB sprintec, 24
Trokendi XR CAP 50MG, 44
Ultra Thin Mis 28G, 65
Tri-norinyl TAB 28, 24
trospium chl CAP 60MG ER, 33
Ultra Thin Mis 30G, 65
tri-previfem TAB, 24
trospium CL TAB 20MG, 33
Ultra Thin Mis 31G, 65
tri-sprintec TAB, 24
True Metrix Sol Level 1, 65
Ultra Thin Mis 33G, 65
triamcinolon aer 55mcg/ac, 56
True Metrix Sol Level 2, 65
Ultra Thin Mis Lanc 26G, 65
triamcinolon aer spray, 19
True Metrix Sol Level 3, 65
Ultra Thin Mis Lanc 28G, 65
triamcinolon CRE 0.025%, 19
Truecontrol Liq Level 0, 65
Ultra Thin Mis Lanc 30G, 65
triamcinolon CRE 0.1%, 19
Truecontrol Liq Level 1, 65
Ultra Thin Mis Lancets, 65
triamcinolon CRE 0.5%, 19
Truedraw Mis Lanc Dev, 65
Ultracet TAB 37.5-325, 53
triamcinolon lot 0.025%, 19
Truetest Liq Level 1, 65
Ultralance Mis 1.8MM, 65
triamcinolon lot 0.1%, 19
Truetest Liq Level 2, 65
Ultram ER TAB 100MG, 53
triamcinolon oin 0.025%, 19
Truetest Liq Level 3, 65
Ultram ER TAB 200MG, 53
triamcinolon oin 0.1%, 19
Trulance TAB 3MG, 32
Ultram ER TAB 300MG, 53
triamcinolon oin 0.5%, 19
Trulicity Inj 0.75/0.5, 25
Ultram TAB 50MG, 53
triamcinolon pst den 0.1%, 36
Trulicity Inj 1.5/0.5, 25
Ultratrk Pro Sol, 65
triamt/hctz CAP 37.5-25, 14
Trumenba Inj, 58
Ultratrk Pro Sol High/Low, 65
Triamt/Hctz CAP 50-25MG, 14
Truplus Lanc Mis 26G, 65
Ultratrk Ult Sol High/Low, 65
triamt/hctz TAB 37.5-25, 14
Truplus Lanc Mis 28G, 65
Ultravate CRE 0.05%, 19
triamt/hctz TAB 75-50MG, 14
Truplus Lanc Mis 30G, 65
Ultravate Lot 0.05%, 19
Trianex Oin 0.05%, 19
Truplus Lanc Mis 33G, 65
Ultravate Oin 0.05%, 19
Triazolam TAB 0.125MG, 41
Trusopt Sol 2% Op, 50
Ultresa CAP 13800unt, 32
triazolam TAB 0.25MG, 41
Truvada TAB 100-150, 4
Ultresa CAP 20700unt, 32
Tribenzor20- TAB 5-12.5MG, 13
Truvada TAB 133-200, 4
Ultresa CAP 23000unt, 32
Umecta Emu, 21
unithroid TAB 100mcg, 29
ursodiol TAB 250MG, 32
umecta mouss aer 40%, 20
unithroid TAB 112mcg, 29
ursodiol TAB 500MG, 32
Umecta Nail Sus Film, 21
unithroid TAB 125mcg, 29
uryl TAB, 33
Umecta PD Emu 40-0.3%, 21
unithroid TAB 137mcg, 29
ustell CAP, 33
Unfine Pntp Mis 32GX4MM, 65
unithroid TAB 150mcg, 29
uta CAP 120MG, 33
Unifine Pntp Mis 29GX1/2", 65
unithroid TAB 175mcg, 29
Utibron CAP Neohaler, 58
Unifine Pntp Mis 29GX12MM, 65
unithroid TAB 200mcg, 29
uticap CAP, 33
Unifine Pntp Mis 31GX3/16, 65
unithroid TAB 25mcg, 29
utira-c TAB, 33
Unifine Pntp Mis 31GX5/16, 65
unithroid TAB 300mcg, 29
Utopic CRE 41%, 21
Unifine Pntp Mis 31GX5MM, 65
unithroid TAB 50mcg, 29
utrona-c TAB, 33
Unifine Pntp Mis 31GX6MM, 65
unithroid TAB 75mcg, 29
V
Unifine Pntp Mis 31GX8MM, 65
unithroid TAB 88mcg, 29
Vagifem TAB 10mcg, 34
Unifine Pntp Mis 32GX4MM, 65
Universal 1 Mis 33G, 66
valacyclovir TAB 1gm, 4
Unifine Pntp Mis 32GX5/32, 65
Universal 1 Mis Lanc 26G, 66
valacyclovir TAB 500MG, 4
Unilet Cmfr Mis Tch 28G, 65
Universal 1 Mis Lanc 30G, 66
Valchlor Gel 0.016%, 6
Unilet Cmfr Mis Tch 30G, 65
Upspringbaby Dro Vit D3, 59
Valcyte Sol 50MG/ML, 4
Unilet EX II Mis 28G, 65
Uptravi TAB 1000mcg, 15
Valcyte TAB 450MG, 4
Unilet Excel Mis 23G, 65
Uptravi TAB 1200mcg, 15
valganciclov sol 50MG/ML, 4
Unilet G.p Mis Supr 23G, 65
Uptravi TAB 1400mcg, 15
valganciclov TAB 450MG, 4
Unilet G.p. Mis 21G, 65
Uptravi TAB 1600mcg, 15
Valium TAB 10MG, 37
Unilet GP 28 Mis Ult Thin, 65
Uptravi TAB 200/800, 15
Valium TAB 2MG, 37
Unilet Lanc Mis 33G, 65
Uptravi TAB 200mcg, 15
Valium TAB 5MG, 37
Unilet Lance Mis 21G, 65
Uptravi TAB 400mcg, 15
valproic acd CAP 250MG, 43
Unilet Lance Mis 28G, 65
Uptravi TAB 600mcg, 15
valproic acd sol 250/5ML, 43
Unilet Lance Mis 33G, 66
Uptravi TAB 800mcg, 15
valsart/hctz TAB 160-12.5, 12
Unilet Lanct Mis 28G, 66
ur n-c TAB, 33
valsart/hctz TAB 160-25MG, 12
Unilet Lanct Mis 30G, 66
Uramaxin CRE 45%, 21
valsart/hctz TAB 320-12.5, 12
Unilet Lanct Mis 33G, 66
Uramaxin Gel 45%, 21
valsart/hctz TAB 320-25MG, 12
Unilet Mis 21G, 66
Uramaxin GT Gel 45%, 21
valsart/hctz TAB 80-12.5, 12
Unilet Super Mis 23G, 66
uramit mb CAP 118MG, 33
valsartan TAB 160MG, 11
Unilet Super Mis G.p. 23G, 66
ure-39 CRE 39%, 20
valsartan TAB 320MG, 11
Unistik 1 Mis 2.4MM, 66
ure-k CRE 50%, 20
valsartan TAB 40MG, 11
Unistik 1 Mis 3.0MM, 66
urea 40% sus nail, 20
valsartan TAB 80MG, 11
Unistik 2 Mis, 66
urea CRE 39%, 20
Valtrex TAB 1gm, 5
Unistik 2 Mis 1.8MM, 66
urea CRE 40%, 20
Valtrex TAB 500MG, 5
Unistik 2 Mis 2.4MM, 66
urea CRE 45%, 20
Valvd Holdng Mis Chamber, 66
Unistik 2 Mis Comfort, 66
urea CRE 47%, 20
Vanatol LQ Sol, 51
Unistik 2 Mis Extra, 66
urea CRE 50%, 20
Vanatol S Sol, 51
Unistik 2 Mis Neonatal, 66
urea gel 40%, 20
Vancocin HCL CAP 125MG, 5
Unistik 2 Mis Normal, 66
urea hydrati aer 35%, 20
Vancocin HCL CAP 250MG, 5
Unistik 2 Mis Super, 66
urea nail gel 45%, 20
vancomycin 250/5ML, 5
Unistik 3 Mis 1.8MM, 66
Urea Topical Sus 40%, 21
vancomycin CAP 125MG, 5
Unistik 3 Mis Comfort, 66
Urecholine TAB 10MG, 33
vancomycin CAP 250MG, 5
Unistik 3 Mis Extra, 66
Urecholine TAB 25MG, 33
Vancomycn 25 Sol 25MG/ML, 6
Unistik 3 Mis Gent 30G, 66
Urecholine TAB 50MG, 33
Vancomycn 50 Sol 50MG/ML, 6
Unistik 3 Mis Neonatal, 66
Urecholine TAB 5MG, 33
vandazole gel 0.75%, 33
Unistik 3 Mis Normal, 66
urelle TAB, 33
Vanos CRE 0.1%, 19
Unistik 3 Mis Xtr 21G, 66
uretron d/s TAB, 33
Vanoxide-HC Lot 5-0.5%, 17
Unistik CZT Mis Comfort, 66
Urevaz CRE 44%, 21
Vantage Lanc Mis Device, 66
Unistik CZT Mis Normal, 66
uribel CAP 118MG, 33
Vaqta Inj 25/0.5ML, 58
Unistik II Mis Lancets, 66
Urimar-t TAB, 33
Vaqta Inj 50unt/ML, 58
Unistik Safe Mis Lanc 28G, 66
urin d/s TAB, 33
Varivax Inj, 58
Unistik Safe Mis Lanc 30G, 66
uro-458 TAB, 33
Varubi TAB 90MG, 31
Unistik Touc Mis Lanc 21G, 66
uro-blue TAB 81.6MG, 33
Vascepa CAP 0.5gm, 15
Unistik Touc Mis Lanc 23G, 66
uro-l TAB 81MG, 33
Vascepa CAP 1gm, 15
Unistik Touc Mis Lanc 28G, 66
uro-mp CAP 118MG, 33
Vaseretic TAB 10-25MG, 13
Unistik Touc Mis Lanc 30G, 66
uroav-81 TAB, 33
Vasotec TAB 10MG, 11
unith direct TAB 100mcg, 29
uroav-b CAP, 33
Vasotec TAB 2.5MG, 11
unith direct TAB 112mcg, 29
Urocit-k 10 TAB, 34
Vasotec TAB 20MG, 11
unith direct TAB 125mcg, 29
Urocit-k 15 TAB, 34
Vasotec TAB 5MG, 11
unith direct TAB 150mcg, 29
Urocit-k 5 TAB, 34
vcf vaginal aer contracp, 33
unith direct TAB 175mcg, 29
Urogesic- TAB Blue, 33
Vcf Vaginal Aer Contracp, 33
unith direct TAB 200mcg, 29
urolet mb TAB, 33
vcf vaginal gel contrace, 33
unith direct TAB 25mcg, 29
urophen mb TAB 81.6MG, 33
Vcf Vaginal Mis Contracp, 33
unith direct TAB 300mcg, 29
Uroxatral TAB 10MG, 34
Vecamyl TAB 2.5MG, 12
unith direct TAB 50mcg, 29
Urso 250 TAB 250MG, 32
Vectical Oin 3mcg/Gm, 18
unith direct TAB 75mcg, 29
Urso Forte TAB 500MG, 32
velivet PAK, 24
unith direct TAB 88mcg, 29
ursodiol CAP 300MG, 32
Velphoro Chw 500MG, 32
Veltin Gel, 17
Victory Sol Control, 66
vitamin d-3 CAP 2000unit, 59
Vemlidy TAB 25MG, 4
Victoza Inj 18MG/3ML, 25
vitamin d-3 TAB 1000unit, 59
venlafaxine CAP 150MG ER, 38
Victrelis CAP 200MG, 4
vitamin d-3 TAB 2000unit, 59
venlafaxine CAP 37.5 ER, 38
Videx EC CAP 125MG, 5
vitamin d-3 TAB 5000unit, 59
venlafaxine CAP 75MG ER, 38
Videx EC CAP 200MG, 5
vitamin d3 CAP 10000unt, 59
venlafaxine TAB 100MG, 38
Videx EC CAP 250MG, 5
vitamin d3 CAP 1000unit, 59
venlafaxine TAB 150MG ER, 38
Videx EC CAP 400MG, 5
vitamin d3 CAP 2000unit, 59
Venlafaxine TAB 150MG ER, 39
Videx Sol 2gm, 4
Vitamin D3 CAP 4000unit, 59
venlafaxine TAB 225MG ER, 38
Videx Sol 4gm, 4
vitamin d3 CAP 400unit, 59
Venlafaxine TAB 225MG ER, 39
Viekira PAK TAB, 4
vitamin d3 CAP 50000unt, 59
venlafaxine TAB 25MG, 38
Viekira XR TAB, 4
vitamin d3 CAP 5000unit, 59
venlafaxine TAB 37.5 ER, 38
vienva TAB 0.1-20, 24
vitamin d3 chw 1000unit, 59
Venlafaxine TAB 37.5 ER, 39
vigabatrin PAK 500MG, 43
vitamin d3 chw 2000unit, 59
venlafaxine TAB 37.5MG, 38
Vigamox Dro 0.5%, 48
vitamin d3 chw 400unit, 59
venlafaxine TAB 50MG, 38
Viibryd Kit Starter, 39
vitamin d3 chw 5000unit, 59
venlafaxine TAB 75MG, 38
Viibryd TAB 10MG, 39
Vitamin D3 Chw 5000unit, 59
venlafaxine TAB 75MG ER, 38
Viibryd TAB 20MG, 39
vitamin d3 dro 400unit, 59
Venlafaxine TAB 75MG ER, 39
Viibryd TAB 40MG, 39
vitamin d3 dro 5000unit, 59
Ventavis Sol 10mcg/ML, 15
Vimovo TAB 375-20MG, 54
Vitamin D3 Liq 1000unit, 59
Ventavis Sol 20mcg/ML, 15
Vimovo TAB 500-20MG, 54
Vitamin D3 Liq 1200unit, 59
Ventolin HFA Aer, 57
Vimpat Sol 10MG/ML, 44
Vitamin D3 Spr 1000unit, 59
Veramyst Spr 27.5mcg, 56
Vimpat TAB 100MG, 43
Vitamin D3 TAB 10000unt, 59
verapamil CAP 100MG ER, 10
Vimpat TAB 150MG, 43
vitamin d3 TAB 1000unit, 59
verapamil CAP 120MG ER, 10
Vimpat TAB 200MG, 43
vitamin d3 TAB 2000unit, 59
verapamil CAP 120MG SR, 10
Vimpat TAB 50MG, 43
Vitamin D3 TAB 3000unit, 59
verapamil CAP 180MG ER, 10
Viokace TAB, 32
vitamin d3 TAB 400unit, 59
verapamil CAP 180MG SR, 10
Viokace TAB 20880, 32
vitamin d3 TAB 50000uni, 59
verapamil CAP 200MG ER, 10
viorele TAB, 24
vitamin d3 TAB 50000unt, 59
verapamil CAP 240MG ER, 10
Viracept TAB 250MG, 4
vitamin d3 TAB 5000unit, 59
verapamil CAP 240MG SR, 10
Viracept TAB 625MG, 4
Vitamin D3 TAB 5000unit, 59
verapamil CAP 300MG ER, 10
Viramune Sus 50MG/5ML, 5
Vitamin K1 Inj 10MG/ML, 59
verapamil CAP 360MG SR, 10
Viramune TAB 200MG, 5
vitamin k1 inj 1MG/0.5, 59
verapamil TAB 120MG, 10
Viramune XR TAB 100MG, 5
Vitekta TAB 150MG, 4
verapamil TAB 120MG ER, 10
Viramune XR TAB 400MG, 5
Vitekta TAB 85MG, 4
verapamil TAB 180MG ER, 10
Virasal Liq 27.5%, 21
Vituz Sol 5-4MG, 57
verapamil TAB 240MG ER, 10
Virazole Inh 6gm, 5
Vivelle-dot Dis 0.025MG, 23
verapamil TAB 40MG, 10
Viread Pow 40MG/Gm, 4
Vivelle-dot Dis 0.0375MG, 23
verapamil TAB 80MG, 10
Viread TAB 150MG, 4
Vivelle-dot Dis 0.05MG, 23
Verasens Liq Level 1, 66
Viread TAB 200MG, 4
Vivelle-dot Dis 0.075MG, 23
vercolate TAB 5MG EC, 30
Viread TAB 250MG, 4
Vivelle-dot Dis 0.1MG, 23
Verdeso Aer 0.05%, 19
Viread TAB 300MG, 4
Vivitrol Inj 380MG, 54
verdrocet TAB 2.5-325, 52
Viroptic Sol 1% Op, 48
Vivlodex CAP 10MG, 55
Veregen Oin 15%, 21
virtrate-2 sol, 34
Vivlodex CAP 5MG, 55
Verelan CAP 120MG SR, 10
virtrate-2 sol 500-334, 34
Vogelxo Gel 1%(50MG), 22
Verelan CAP 180MG SR, 10
virtrate-3 sol, 34
Vogelxo Gel P.M. 1%, 22
Verelan CAP 240MG SR, 10
virtrate-k sol 1100-334, 34
Voltaren Gel 1%, 18
Verelan CAP 360MG SR, 10
Vistaril CAP 25MG, 37
voriconazole sus 40MG/ML, 3
Verelan PM CAP 100MG ER, 10
Vistaril CAP 50MG, 37
voriconazole TAB 200MG, 3
Verelan PM CAP 200MG ER, 10
vit d child chw 1000unit, 59
voriconazole TAB 50MG, 3
Verelan PM CAP 300MG ER, 10
vit d gummie chw 400unit, 59
Vortex Valve Mis Chamber, 66
Veripred 20 Sol 20MG/5ML, 22
Vit D3 Drops Liq 400unit, 59
Vosevi TAB, 4
Versacloz Sus 50MG/ML, 40
vit d3 gumm chw 1000unit, 59
Vospire ER TAB 4MG, 58
Vesicare TAB 10MG, 33
vitajoy daly chw d 1000iu, 59
Vospire ER TAB 8MG, 58
Vesicare TAB 5MG, 33
Vitalet Pro Mis, 66
Votrient TAB 200MG, 8
vestura TAB 3-0.02MG, 24
Vitalet Pro Mis Plus, 66
Vpriv Inj 400unit, 35
Vexol Sus 1% Op, 49
Vitamelts D TAB 1000 Iu, 59
Vraylar CAP 1.5-3MG, 40
Vfend Sus 40MG/ML, 3
vitamin d CAP 1000unit, 59
Vraylar CAP 1.5MG, 40
Vfend TAB 200MG, 3
vitamin d CAP 2000unit, 59
Vraylar CAP 3MG, 40
Vfend TAB 50MG, 3
vitamin d CAP 400unit, 59
Vraylar CAP 4.5MG, 40
Viberzi TAB 100MG, 32
vitamin d CAP 50000unt, 59
Vraylar CAP 6MG, 40
Viberzi TAB 75MG, 32
vitamin d chw 1000unit, 59
Vusion Oin, 18
Vibramycin CAP 100MG, 2
vitamin d chw 400unit, 59
vyfemla TAB 0.4-35, 24
Vibramycin Sus 25MG/5ML, 2
vitamin d dro 400unit, 59
Vytorin TAB 10-10MG, 15
Vibramycin Syp 50MG/5ML, 2
vitamin d TAB 1000unit, 59
Vytorin TAB 10-20MG, 15
vicodin ES TAB 7.5-300, 52
vitamin d TAB 2000unit, 59
Vytorin TAB 10-40MG, 15
vicodin HP TAB 10-300MG, 52
vitamin d TAB 400unit, 59
Vytorin TAB 10-80MG, 15
vicodin TAB 5-300MG, 52
vitamin d TAB 5000iu, 59
Vyvanse CAP 10MG, 42
Vicoprofen TAB 7.5-200, 53
vitamin d-3 CAP 1000unit, 59
Vyvanse CAP 20MG, 42
Vyvanse CAP 30MG, 42
Xarelto TAB 10MG, 36
Zanaflex TAB 4MG, 48
Vyvanse CAP 40MG, 42
Xarelto TAB 15MG, 36
Zantac TAB 150MG, 31
Vyvanse CAP 50MG, 42
Xarelto TAB 20MG, 36
Zantac TAB 300MG, 31
Vyvanse CAP 60MG, 42
Xartemis XR TAB 7.5-325, 53
zarah TAB 3-0.03MG, 24
Vyvanse CAP 70MG, 42
Xatmep Sol 2.5MG/ML, 6
Zarontin CAP 250MG, 44
Vyvanse Chw 10MG, 42
Xeljanz TAB 5MG, 54
Zarontin Sol 250/5ML, 44
Vyvanse Chw 20MG, 42
Xeljanz XR TAB 11MG, 54
Zarxio Inj 300/0.5, 35
Vyvanse Chw 30MG, 42
Xeloda TAB 150MG, 6
Zarxio Inj 480/0.8, 35
Vyvanse Chw 40MG, 42
Xeloda TAB 500MG, 6
Zavesca CAP 100MG, 35
Vyvanse Chw 50MG, 42
Xenazine TAB 12.5MG, 47
zazole CRE 0.8%, 33
Vyvanse Chw 60MG, 42
Xenazine TAB 25MG, 47
zazole sup 80MG, 33
W
Xeralux CRE, 21
Zebeta TAB 10MG, 9
Xerese CRE 5-1%, 18
Zebeta TAB 5MG, 9
W&f Lancets Mis 21G, 66
Xermelo TAB 250MG, 32
zebutal CAP, 51
W&f Lancets Mis 26G, 66
Xgeva Inj, 27
Zecuity Pad 6.5MG/4h, 55
warfarin TAB 10MG, 35
Xifaxan TAB 200MG, 5
Zegerid CAP 20-1100, 31
warfarin TAB 1MG, 35
Xifaxan TAB 550MG, 5
Zegerid CAP 40-1100, 31
warfarin TAB 2.5MG, 35
Xigduo XR TAB 10-1000, 26
Zegerid Pow 20-1680, 31
warfarin TAB 2MG, 35
Xigduo XR TAB 10-500MG, 27
Zegerid Pow 40-1680, 31
warfarin TAB 3MG, 35
Xigduo XR TAB 5-1000MG, 27
Zejula CAP 100MG, 8
warfarin TAB 4MG, 35
Xigduo XR TAB 5-500MG, 27
Zelapar TAB 1.25MG, 45
warfarin TAB 5MG, 35
Xiidra Dro 5%, 50
Zelboraf TAB 240MG, 8
warfarin TAB 6MG, 35
Xodol TAB 10-300MG, 53
Zembrace Sym Inj 3/0.5ML, 55
warfarin TAB 7.5MG, 35
Xodol TAB 5-300MG, 53
Zemplar CAP 1mcg, 28
Watchhaler Mis, 66
Xodol TAB 7.5-300, 53
Zemplar CAP 2mcg, 28
wee care sus 15/1.25, 35
Xolegel Gel 2%, 18
zenatane CAP 10MG, 16
Welchol PAK 3.75gm, 15
Xopenex CONC Neb 1.25/0.5, 58
zenatane CAP 20MG, 16
Welchol TAB 625MG, 15
Xopenex HFA Aer, 58
zenatane CAP 30MG, 16
Wellbutrin TAB 100MG, 39
Xopenex Neb 0.31MG, 58
zenatane CAP 40MG, 16
Wellbutrin TAB 100MG SR, 39
Xopenex Neb 0.63MG, 58
zenchent FE chw 0.4MG-35, 24
Wellbutrin TAB 150MG SR, 39
Xopenex Neb 1.25/3ML, 58
zenchent TAB, 24
Wellbutrin TAB 200MG SR, 39
Xtampza ER CAP 13.5MG, 52
zencia liq 9-4%, 16
Wellbutrin TAB 75MG, 39
Xtampza ER CAP 18MG, 52
Zenpep CAP 10000unt, 31
Wellbutrin TAB XL 150MG, 39
Xtampza ER CAP 27MG, 52
Zenpep CAP 15000unt, 31
Wellbutrin TAB XL 300MG, 39
Xtampza ER CAP 36MG, 52
Zenpep CAP 20000unt, 31
wera TAB 0.5/35, 24
Xtampza ER CAP 9MG, 52
Zenpep CAP 25000unt, 31
Westcort Oin 0.2%, 19
Xtandi CAP 40MG, 6
Zenpep CAP 3000unit, 31
Westhroid TAB 130MG, 29
Xulane Dis 150-35, 24
Zenpep CAP 40000unt, 31
Westhroid TAB 195MG, 29
Xultophy Inj 100/3.6, 27
Zenpep CAP 5000unit, 31
Westhroid TAB 32.5MG, 29
Xylo/Epi 1%- Inj 1:100000, 56
zenzedi TAB 10MG, 41
Westhroid TAB 65MG, 29
Xylocaine Inj -mpf 2%, 56
Zenzedi TAB 15MG, 42
Westhroid TAB 97.5MG, 29
Xylocaine Inj 1%, 56
Zenzedi TAB 2.5MG, 42
womans laxat TAB 5MG EC, 30
Xylocaine Inj 2%, 56
Zenzedi TAB 20MG, 42
womens laxat TAB 5MG EC, 30
Xylocaine Sol 4%, 21
Zenzedi TAB 30MG, 42
Wp Thyroid TAB 113.75MG, 29
xylon TAB 10-200MG, 52
zenzedi TAB 5MG, 41
Wp Thyroid TAB 130MG, 29
xyphex mis, 20
Zenzedi TAB 7.5MG, 42
Wp Thyroid TAB 16.25MG, 29
Xyrem Sol 500MG/ML, 47
Zepatier TAB 50-100MG, 5
Wp Thyroid TAB 32.5MG, 29
Xyzal Sol, 56
Zerit CAP 15MG, 5
Wp Thyroid TAB 48.75MG, 29
Xyzal Sol 2.5/5ML, 56
Zerit CAP 20MG, 5
Wp Thyroid TAB 65MG, 29
Xyzal TAB 5MG, 56
Zerit CAP 30MG, 5
Wp Thyroid TAB 81.25MG, 29
Y
Zerit CAP 40MG, 5
Wp Thyroid TAB 97.5MG, 29
Zerit Sol 1MG/ML, 5
wymzya FE chw 0.4MG-35, 24
Yasmin 28 TAB 3-0.03MG, 24
zeruvia pad 4-1%, 20
X
Yaz TAB 3-0.02MG, 24
Zestoretic TAB 10-12.5, 13
yl folic aci TAB 400mcg, 35
Zestoretic TAB 20-12.5, 13
Xadago TAB 100MG, 45
Yosprala TAB 325-40MG, 36
Zestoretic TAB 20-25MG, 13
Xadago TAB 50MG, 45
Yosprala TAB 81-40MG, 36
Zestril TAB 10MG, 11
Xalatan Sol 0.005%, 49
Your Life CAP Prenatal, 60
Zestril TAB 2.5MG, 11
Xalkori CAP 200MG, 8
yuvafem TAB 10mcg, 33
Zestril TAB 20MG, 11
Xalkori CAP 250MG, 8
Z
Zestril TAB 30MG, 11
Xanax TAB 0.25MG, 37
Zestril TAB 40MG, 11
Xanax TAB 0.5MG, 37
Zaclir Lot 8%, 17
Zestril TAB 5MG, 11
Xanax TAB 1MG, 37
zafirlukast TAB 10MG, 57
Zetia TAB 10MG, 15
Xanax TAB 2MG, 37
zafirlukast TAB 20MG, 57
Zetonna Aer 37mcg, 56
Xanax XR TAB 0.5MG, 37
zaleplon CAP 10MG, 41
Ziac TAB 10/6.25, 13
Xanax XR TAB 1MG, 37
zaleplon CAP 5MG, 41
Ziac TAB 2.5/6.25, 13
Xanax XR TAB 2MG, 37
Zanaflex CAP 2MG, 48
Ziac TAB 5-6.25MG, 13
Xanax XR TAB 3MG, 37
Zanaflex CAP 4MG, 48
Ziagen Sol 20MG/ML, 4
Xarelto Star TAB 15/20MG, 36
Zanaflex CAP 6MG, 48
Ziagen TAB 300MG, 5
Zonacort PAK 11 Day, 22
1ST Choice Mis Lancets, 66
Ziana Gel, 17
Zonacort PAK 7 Day, 22
1ST Tier Uni Mis 29GX12MM, 66
zidovudine CAP 100MG, 4
Zonalon CRE 5%, 18
1ST Tier Uni Mis 31GX5MM, 66
zidovudine syp 50MG/5ML, 4
Zonatuss CAP 150MG, 57
1ST Tier Uni Mis 31GX6MM, 66
zidovudine TAB 300MG, 4
Zonegran CAP 100MG, 44
1ST Tier Uni Mis 31GX8MM, 66
zileuton ER TAB 600MG, 57
Zonegran CAP 25MG, 44
1ST Tier Uni Mis 32GX4MM, 66
Zinbryta Inj 150MG/ML, 47
zonisamide CAP 100MG, 43
8
Zioptan Dro 0.0015%, 49
zonisamide CAP 25MG, 43
8-mop CAP 10MG, 18
ziprasidone CAP 20MG, 39
zonisamide CAP 50MG, 43
ziprasidone CAP 40MG, 39
Zontivity TAB 2.08MG, 36
ziprasidone CAP 60MG, 39
Zorbtive Inj 8.8MG, 27
ziprasidone CAP 80MG, 39
Zortress TAB 0.25MG, 7
Zipsor CAP 25MG, 55
Zortress TAB 0.5MG, 7
Zirgan Gel 0.15%, 48
Zortress TAB 0.75MG, 7
Zithranol Sha 1%, 18
Zorvolex CAP 18MG, 55
Zithranol-rr CRE 1.2%, 18
Zorvolex CAP 35MG, 55
Zithromax Pow 1gm PAK, 2
Zostavax Inj, 58
Zithromax Sus 100/5ML, 2
zovia 1/35e TAB, 24
Zithromax Sus 200/5ML, 2
zovia 1/50e TAB, 24
Zithromax TAB 250MG, 2
Zovirax CAP 200MG, 5
Zithromax TAB 500MG, 2
Zovirax CRE 5%, 18
Zithromax TAB 600MG, 2
Zovirax Sus 200/5ML, 5
Zithromax TAB Tri-PAK, 2
Zovirax TAB 400MG, 5
Zithromax TAB Z-PAK, 2
Zovirax TAB 800MG, 5
Zmax Sus 2gm, 2
Zubsolv Sub 0.7-0.18, 54
Zocor TAB 10MG, 15
Zubsolv Sub 1.4-0.36, 54
Zocor TAB 20MG, 15
Zubsolv Sub 11.4-2.9, 54
Zocor TAB 40MG, 15
Zubsolv Sub 2.9-0.71, 54
Zocor TAB 5MG, 15
Zubsolv Sub 5.7-1.4, 54
Zocor TAB 80MG, 15
Zubsolv Sub 8.6-2.1, 54
Zodex PAK 12-day, 22
Zuplenz Mis 4MG, 31
Zodex PAK 6 Day, 22
Zuplenz Mis 8MG, 31
Zofran Sol 4MG/5ML, 31
Zurampic TAB 200MG, 55
Zofran TAB 4MG, 31
Zutripro Liq 60-4-5MG, 57
Zofran TAB 4MG Odt, 31
Zyban TAB 150MG SR, 48
Zofran TAB 8MG, 31
Zyclara CRE 3.75%, 20
Zofran TAB 8MG Odt, 31
Zyclara P.M. CRE 2.5%, 20
Zohydro ER CAP 10MG, 53
Zyclara P.M. CRE 3.75%, 20
Zohydro ER CAP 15MG, 53
Zydelig TAB 100MG, 8
Zohydro ER CAP 20MG, 53
Zydelig TAB 150MG, 8
Zohydro ER CAP 30MG, 53
Zyflo CR TAB 600MG, 57
Zohydro ER CAP 40MG, 54
Zyflo TAB 600MG, 57
Zohydro ER CAP 50MG, 54
Zykadia CAP 150MG, 8
Zoledronic Inj 4MG, 27
Zylet Sus 0.5-0.3%, 49
zoledronic inj 4MG/5ML, 27
Zyloprim TAB 100MG, 55
Zolinza CAP 100MG, 8
Zyloprim TAB 300MG, 55
zolmitriptan TAB 2.5 MG, 55
Zymaxid Sol 0.5%, 48
zolmitriptan TAB 2.5MG, 55
Zyprexa Inj 10MG, 40
zolmitriptan TAB 5MG, 55
Zyprexa Relp Inj 210MG, 40
Zoloft CON 20MG/ML, 39
Zyprexa Relp Inj 300MG, 40
Zoloft TAB 100MG, 39
Zyprexa Relp Inj 405MG, 40
Zoloft TAB 25MG, 39
Zyprexa TAB 10MG, 40
Zoloft TAB 50MG, 39
Zyprexa TAB 15MG, 40
zolpidem ER TAB 12.5MG, 41
Zyprexa TAB 2.5MG, 40
zolpidem ER TAB 6.25MG, 41
Zyprexa TAB 20MG, 40
zolpidem TAB 10MG, 41
Zyprexa TAB 5MG, 40
zolpidem TAB 5MG, 41
Zyprexa TAB 7.5MG, 40
zolpidem TAR sub 1.75MG, 41
Zyprexa Zydi TAB 10MG, 40
zolpidem TAR sub 3.5MG, 41
Zyprexa Zydi TAB 15MG, 40
Zolpimist Spr 5MG, 41
Zyprexa Zydi TAB 20MG, 40
Zomacton Inj 10MG, 27
Zyprexa Zydi TAB 5MG, 40
Zomacton Inj 5MG, 27
Zytiga TAB 250MG, 6
Zomig Spr 2.5MG, 55
Zytiga TAB 500MG, 6
Zomig Spr 5MG, 55
Zyvox Sus 100MG/5m, 5
Zomig TAB 2.5MG, 55
Zyvox TAB 600MG, 5
Zomig TAB 5MG, 55
1
Zomig ZMT TAB 2.5 MG, 55
1ML Syringe Mis 29G, 66
Zomig ZMT TAB 5MG, 55
1ML Syringe Mis 30G, 66
Kaiser Permanente Nondiscrimination Notice and Language Access Services
KAISER PERMANENTE NONDISCRIMINATION NOTICE
Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. (“Kaiser Permanente”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity. Kaiser Permanente does not exclude people or treat them differently because of race, color, national origin, age, disability, sex, sexual orientation, or gender identity.
Kaiser Permanente: Provides free aids and services to people with disabilities to communicate effectively with us, such as: • Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language is not English, such as: • Qualified interpreters • Information written in other languages
If you need these services, contact Kaiser Permanente Member Services.
If you believe that Kaiser Permanente has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity, you can file a grievance by phone, mail, fax, or email. If you need help filing a grievance, a Kaiser Permanente Member Services Representative is available to help you. Language assistance is provided free of charge. The Kaiser Permanente Civil Rights Coordinator will be notified of all grievances related to discrimination on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity.
Phone: 206-630-4636 Toll-free: 1-888-901-4636
TTY Washington Relay Service: 1-800-833-6388 or 711 TTY Idaho Relay Service: 1-800-377-3529 or 711
Fax: 206-901-6205 or toll-free 1-888-874-1765 Address: Kaiser Foundation Health Plan of Washington
Civil Rights Coordinator, Quality GNE-D1E-07 P.O. Box 9812 Renton, WA 98057-9054
Email: [email protected] You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/ lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services 200 Independence Avenue SW., Room 509F HHH Building Washington, DC 20201 1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html For Medicare Advantage Plans Only: Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.
© 2017 Kaiser Foundation Health Plan of Washington H5050_XB0001444_55_17 accepted 2017-XB-6_ACA_Notice_Taglines
LANGUAGE ACCESS SERVICES
English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-888-901-4636 (TTY: 1-800-833-6388 or 711).
Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-901-4636 (TTY: 1-800-833-6388 / 711).
中文 (Chinese):注意:如果您使用繁體中文,您可 以免費獲得語言援助服務。請致電 1-888-901-4636 (TTY: 1-800-833-6388 / 711)。
Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-901-4636 (TTY: 1-800-833-6388 / 711).
한국어(Korean): 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-888-901-4636 (TTY: 1-800-833-6388 / 711) 번으로 전화해 주십시오.
Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-901-4636 (телетайп: 1-800-833-6388 / 711).
Filipino (Tagalog): PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-901-4636 (TTY: 1-800-833-6388 / 711).
Українська (Ukrainian): УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-888-901-4636 (телетайп: 1-800-833-6388 / 711).
ភាសាខ្មែរ (Khmer)៖ របយ័ត៖ េ េបើសិនអកនិខ្យមរ, េ សជំនួខ្យផក េ យមិនគិតល គឺចនសំប់បំេ រអក។ ចូរទូ រស័ព 1-888-901-4636 (TTY: 1-800-833-6388 / 711)។ 日本語 (Japanese): 注意事項:日本語を話される場 合、無料の言語支援をご利用いただけます。 1-888-901-4636 (TTY: 1-800-833-6388 / 711) まで、 お電話にてご連絡ください。
አማርኛ (Amharic) ፥ ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-888-901-4636 (መስማት ለተሳናቸው: 1-800-833-6388 / 711).
Oromiffa (Oromo): XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-888-901-4636 (TTY: 1-800-833-6388 / 711).
ਪੰਜਾਬੀ (Punjabi) ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਿ ੇਹੋ, ਤਾਂ ਭਾਸਾ ਧ ਿੱ ਚ ਸਹਾਇਤਾ ਸੇ ਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਿ ਹੈ। 1-888-901-4636 (TTY: 1-800-833-6388 / 711) ‘ਤੇ ਕਾਲ ਕਰੋ।
تتوافر اللغوية المساعدة خدمات فإن اللغة، اذكر تتحدث كنت إذا :ملحوظة في ومعلومات مساعدة على الحصول حق لديكم :(Arabic) العربية : (6388-833-800-1 / 711) .والبكم الصم هاتف رقم 4636-901-888-1 برقم اتصل .بالمجان لك
Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-888-901-4636 (TTY: 1-800-833-6388 / 711).
ພາສາລາວ (Lao): ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ ້ າພາສາລາວ, ການບໍ ລິ ການຊ່ວຍເຫ ຼື ອດ້ານພາສາ, ໂດຍບໍ່ ເສັຽຄ່າ, ແມ່ນມີ ພ້ອມ ໃຫ້ທ່ານ. ໂທຣ 1-888-901-4636 (TTY: 1-800-833-6388 / 711).
Srpsko-hrvatski (Serbo-Croatian): OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-888-901-4636 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 1-800-833-6388 / 711).
Français (French): ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-888-901-4636 (ATS: 1-800-833-6388 / 711).
Română (Romanian): ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-888-901-4636 (TTY: 1-800-833-6388 / 711).
Adamawa (Fulfulde): MAANDO: To a waawi Adamawa, e woodi ballooji-ma to ekkitaaki wolde caahu. Noddu 1-888-901-4636 (TTY: 1-800-833-6388 / 711).
می فراهم شما برای رايگان بصورت زبانی تسهيالت کنيد، می گفتگو فارسی زبان به اگر :توجه :(Farsi) فارسی .بگيريد تماس (TTY: 1-800-833-6388 / 711) 4636-901-888-1 با .باشد
XB0001444-55-17