s list of covered drugs: formular y 2015 - castiarx · touchstone health hmo, inc. 2015 formulary...

Touchstone Health’s

List of Covered Drugs: Formular y 2015

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT SOME OF THE DRUGS WE COVER IN THIS PLAN

This formulary was updated in October 27, 2015. For more recent information or other questions, please contact Touchstone Health Member Concierge at 1-888- 777-0204 or, for TTY/TDD users, 711, 8AM – 8PM, 7 Days a week (Note: Member Concierge hours are 8:00AM to 8:00PM, 7 days a week from October 15, 2014 to February 14, 2015. Hours are 8:00AM to 8:00PM, Monday through Friday from February 15, 2015 to October 14, 2015) or visit www.TouchstoneH.com.

www.TouchstoneH.com

Y0064_H3327_THPSMK_2444S Accepted

http://www.touchstoneh.com/


Touchstone Health HMO, Inc One North Lexington Ave 12th Floor White Plains, NY 10601

www.TouchstoneH.com

Prospective members should call 1-888-777-0368 or TTY/TDD 711 24 hours a day, 7 days a week

Current members should call 1-888-777-0204 or TTY/TDD 711 Hours are 8:00AM to 8:00PM, 7 days a week from October 15, 2014 to February 14, 2015. We are available for phone calls 8:00AM to 8:00PM, Monday through Friday from February 15, 2015 to October 14, 2015.

This formulary was updated in October 27, 2015. For more recent information or other questions, please contact Touchstone Health Member Concierge at 1-888- 777-0204 or, for TTY/TDD users, 711, 8AM – 8PM, 7 Days a week (Note: Member Concierge hours are 8:00AM to 8:00PM, 7 days a week from October 15, 2014 to February 14, 2015. Hours are 8:00AM to 8:00PM, Monday through Friday from February 15, 2015 to October 14, 2015) or visit www.TouchstoneH.com.

facebook.com/TouchstoneH twitter.com/touchstoneh youtube.com/touchstonehealth www.touchstoneh.com/blog


Touchstone Health HMO, Inc. is a Medicare approved HMO with a Medicare Advantage Prescription Drug contract

with the federal government and a contract with the New York Medicaid Program. Enrollment in Touchstone Health

depends on contract renewal.



http://www.touchstoneh.com/blog

I

Touchstone Health HMO, Inc.

2015 Formulary

(List of Covered Drugs)

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION

ABOUT SOME OF THE DRUGS WE COVER IN THIS PLAN

HPMS Approved Formulary File Submission ID 00015480, Version 21, Approved 10/27/2015

This formulary was updated on October 27, 2015. For more recent information or other questions,

please contact Touchstone Health Member Concierge at 1-888-777-0204 or, for TTY/TDD users, 711,

8AM –8PM, 7 Days a week (Note: Member Concierge hours are 8:00AM to 8:00PM, 7 days a week

from October15, 2014 to February 14, 2015. Hours are 8:00AM to 8:00PM, Monday through Friday

from February 15,2015 to October 14, 2015) or visit www.TouchstoneH.com.

This information is available in a different format, including CD and Spanish, and can be obtained via e-

mail. Please call Member Services at the number listed above if you need plan information in another format

or language.

Esta información está disponible en un formato diferente, incluyendo CD e español, y también

puede obtenerse a través de correo electrónico. Si necesita información del plan en otro formato o lenguaje,

por favor llame a la línea de Servicio al Miembro al número mencionado arriba.

Touchstone Health HMO, Inc. is a Medicare approved HMO with a Medicare Advantage Prescription Drug

contract with the federal government and a contract with the New York Medicaid Program. Enrollment in

Touchstone Health depends on contract renewal.



II

Note to existing members: This formulary has changed since last year. Please review this document to

make sure that it still contains the drugs you take.

When this drug list (formulary) refers to “we,” “us”, or “our,” it means Touchstone Health. When it refers to

“plan” or “our plan,” it means 2015 Touchstone Health plans.

This document includes a list of the drugs (formulary) for our plan which is current as of September

22, 2015. For an updated formulary, please contact us. Our contact information, along with the

date we last updated the formulary, appears on the front and back cover pages.

You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary,

pharmacy network, and/or copayments/coinsurance may change on January 1, 2016, and from time to time

during the year.

What is the Touchstone Health Formulary?

A formulary is a list of covered drugs selected by Touchstone Health in consultation with a team of health

care providers, which represents the prescription therapies believed to be a necessary part of a quality

treatment program. Touchstone Health will generally cover the drugs listed in our formulary as long as the

drug is medically necessary, the prescription is filled at a Touchstone Health network pharmacy, and other

plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence

of Coverage.

Can the Formulary (drug list) change?

Generally, if you are taking a drug on our 2015 formulary that was covered at the beginning of the year, we

will not discontinue or reduce coverage of the drug during the 2015 coverage year except when a new, less

expensive generic drug becomes available or when new adverse information about the safety or effectiveness

of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will

not affect members who are currently taking the drug. It will remain available at the same cost-sharing for

those members taking it for the remainder of the coverage year. We feel it is important that you have

continued access for the remainder of the coverage year to the formulary drugs that were available when you

chose our plan, except for cases in which you can save additional money or we can ensure your safety.

If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy

restrictions on a drug we must notify affected members of the change at least 60 days before the change

becomes effective, or at the time the member requests a refill of the drug, at which time the member will

receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to

be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the

drug from our formulary and provide notice to members who take the drug. The enclosed formulary is

current as of October 27, 2015. To get updated information about the drugs covered by Touchstone Health

please contact us. Our contact information appears on the front and back cover pages. Touchstone Health

will mail you addendum sheets in the event of mid-year non-maintenance formulary changes.

How do I use the Formulary?

There are two ways to find your drug within the formulary:

III

Medical Condition

The formulary begins on page 1. The drugs in this formulary are grouped into categories depending on

the type of medical conditions that they are used to treat. For example, drugs used to treat a heart

condition are listed under the category, CARDIOVASCULAR AGENTS. If you know what your drug

is used for, look for the category name in the list that begins on page 1. Then look under the category

name for your drug.

Alphabetical Listing

If you are not sure what category to look under, you should look for your drug in the Index that begins

on page 83. The Index provides an alphabetical list of all of the drugs included in this document.

Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your

drug. Next to your drug, you will see the page number where you can find coverage information.

Turn to the page listed in the Index and find the name of your drug in the first column of the list.

What are generic drugs?

Touchstone Health covers both brand name drugs and generic drugs. A generic drug is approved by the

FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less

than brand name drugs.

Are there any restrictions on my coverage?

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits

may include:

• Prior Authorization: Touchstone Health requires you or your physician to get prior authorization for

certain drugs. This means that you will need to get approval from Touchstone Health before you fill

your prescriptions. If you don’t get approval, Touchstone Health may not cover the drug.

• Quantity Limits: For certain drugs, Touchstone Health limits the amount of the drug that

Touchstone Health will cover. For example, Touchstone Health provides 30 capsules per

prescription for NEXIUM. This may be in addition to a standard one-month or three-month supply.

• Step Therapy: In some cases, Touchstone Health requires you to first try certain drugs to treat your

medical condition before we will cover another drug for that condition. For example, if Drug A and

Drug B both treat your medical condition, Touchstone Health may not cover Drug B unless you try

Drug A first. If Drug A does not work for you, Touchstone Health will then cover Drug B.

You can find out if your drug has any additional requirements or limits by looking in the formulary that

begins on page 1. You can also get more information about the restrictions applied to specific covered drugs

by visiting our Web site. We have posted on line documents that explain our prior authorization and step

therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date

we last updated the formulary, appears on the front and back cover pages.

You can ask Touchstone Health to make an exception to these restrictions or limits or for a list of other,

similar drugs that may treat your health condition. See the section, “How do I request an exception to

the Touchstone Health’s formulary?” on page IV for information about how to request an exception.

IV

What if my drug is not on the Formulary?

If your drug is not included in this formulary (list of covered drugs), you should first contact Member

Services and ask if your drug is covered. For more information, please contact us. Our contact information,

along with the date we last updated the formulary, appears on the front and back cover pages.

If you learn that Touchstone Health does not cover your drug, you have two options:

• You can ask Member Services for a list of similar drugs that are covered by Touchstone Health.

When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is

covered by Touchstone Health.

• You can ask Touchstone Health to make an exception and cover your drug. See below for

information about how to request an exception.

How do I request an exception to the Touchstone Health’s Formulary?

You can ask Touchstone Health to make an exception to our coverage rules. There are several types of

exceptions that you can ask us to make.

• You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be

covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the

drug at a lower cost-sharing level.

You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, • Touchstone Health limits the amount of the drug that we will cover. If your drug has a quantity limit,

you can ask us to waive the limit and cover a greater amount.

Generally, Touchstone Health will only approve your request for an exception if the alternative drugs

included on the plan’s formulary, the lower cost-sharing drug or additional utilization restrictions would not

be as effective in treating your condition and/or would cause you to have adverse medical effects.

You should contact us to ask us for an initial coverage decision for a formulary, or utilization restriction

exception. When you request a formulary, or utilization restriction exception you should submit a

statement from your prescriber or physician supporting your request. Generally, we must make our

decision within 72 hours of getting your prescriber’s supporting statement. You can request an expedited

(fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to

72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24

hours after we get a supporting statement from your doctor or other prescriber.

What do I do before I can talk to my doctor about changing my drugs or requesting an

exception?

As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you

may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need

a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide

if you should switch to an appropriate drug that we cover or request a formulary exception so that we will

V

cover the drug you take. While you talk to your doctor to determine the right course of action for you, we

may cover your drug in certain cases during the first 90 days you are a member of our plan.

For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will

cover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go to a

network pharmacy. After your first 30-day supply, we will not pay for these drugs, even if you have been a

member of the plan less than 90 days.

If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have

provided you with 93-day transition supply, consistent with dispensing increment, (unless you have a

prescription written for fewer days). We will cover more than one refill of these drugs for the first 90days

you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your

drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day

emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary

exception.

Other times when we will cover a temporary 30-day transition supply (unless you have a prescription

for fewer days) include:

• If you enter or leave a long-term care facility

• If you are discharged from a hospital

• If you leave a skilled nursing facility

• If you cancel hospice care

• If you are discharged from a psychiatric hospital on a special medication regimen

For more information

For more detailed information about your Touchstone Health prescription drug coverage, please review your

Evidence of Coverage and other plan materials.

If you have questions about Touchstone Health, please contact us. Our contact information, along with the

date we last updated the formulary, appears on the front and back cover pages.

If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800-

MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY/TDD users should call

1-877-486-2048. Or, visit http://www.medicare.gov.

Touchstone Health’s Formulary

The formulary that begins on the next page provides coverage information about the drugs covered by

Touchstone Health. If you have trouble finding your drug in the list, turn to the Index that begins on

page 83.

The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., CELEBREX)

and generic drugs are listed in lower-case italics (e.g., atorvastatin).

The information in the Requirements/Limits column tells you if Touchstone Health has any special

requirements for coverage of your drug.

The information in the Requirements/Limits column tells you if Touchstone Health has any special

requirements for coverage of your drug.

http://www.medicare.gov/

VI

Below is a list of abbreviations that may appear on the following pages in the Requirement/Limits column

that tells you if there are any special requirements for coverage of your drug.

ABBREVIATION

DEFINITION

DESCRIPTION

LA

LIMITED AVAILABILITY

This prescription may be available

only at certain pharmacies. For

more information consult your

Pharmacy Directory or call

Member Concierge at 1-888-777-

0204, TTY/TDD call 711,

Monday-Friday, 8AM to 8PM.

PA

PRIOR AUTHORIZATION

The Plan requires you or your

physician to get prior authorization

for certain drugs. This means that

you will need to get approval

before you fill your prescriptions.

If you don’t get approval, we may

not cover the drug.

PA*

PRIOR AUTHORIZATION

–NEW STARTS

The Plan requires you or your

physician to get prior authorization

for this drug if this drug is new for

you.

ST

STEP THERAPY

In some cases, the Plan requires

you to first try certain drugs to

treat your medical condition before

we will cover another drug for that

condition. For example, if Drug A

and Drug B both treat your

medical condition, we may not

cover Drug B unless you try Drug

A first.

QL

QUANTITY LIMIT

For certain drugs, the Plan limits

the amount of the drug that we will

cover. For example, the Plan

provides 30 capsules per

prescription for NEXIUM.

VIII

MO

MAIL ORDER

This prescription drug is available

through our mail-order service, as

well as through our retail network

pharmacies. Consider using mail

order for your long-term

(maintenance) medications (such

as high blood pressure

medications). Retail network

pharmacies may be more

appropriate for short-term

prescriptions (such as antibiotics).

B/D

MEDICARE B vs. D

This drug may be covered under

Medicare Part B or D depending

upon the circumstances.

Information may need to be

submitted describing the use and

setting of the drug to make the

determination. The co-pay or

coinsurance may vary depending

on the benefit. Please refer to our

Evidence of Coverage for more

information.

1

TIER 1

Preferred Generic drugs on the

Touchstone Health Formulary.

2

TIER 2

Non-Preferred Generic drugs on

the Touchstone Health Formulary.

3

TIER 3

Preferred Brand drugs on the


4

TIER 4

Non-Preferred Brand drugs on the


5

TIER 5

High cost oral and injectable

specialty drugs. These medications

are available to you at a

coinsurance level and are not

eligible for exceptions for payment

at a lower tier.

VIII

B/D

MEDICARE B y D

(MEDICARE B vs. D)

Este medicamento puede estar

cubierto por Medicare Parte B o D,

según las circunstancias. Es

posible que necesite presentar

información con la descripción del

uso y ubicación del medicamento

para tomar una decisión. El copago

o el coseguro pueden variar según

el beneficio. Consulte nuestra

Evidencia de Cobertura para

obtener más información.

1

NIVEL 1

Medicamentos genéricos

preferidos en el Formulario de

Touchstone Health.

2

NIVEL 2

Medicamentos genéricos no


Touchstone Health.

3

NIVEL 3

Medicamentos de marca preferidos

en el Formulario de Touchstone

Health.

4

NIVEL 4

Medicamentos de marca no


Touchstone Health.

5

NIVEL 5

Medicamentos especiales

inyectables y orales de alto costo.

Estos medicamentos están a su

disposición con un nivel de

coseguro y no son elegibles para

obtener excepciones para pagar a

un nivel de precio más bajo.

contar con aprobación previa para poder llenar sus recetas. Si no

obtiene la aprobación, es posible

que ese medicamento no sea

cubierto.

PA*

AUTORIZACIÓN PREVIA

–MEDICAMENTOS

NUEVOS (PRIOR

AUTHORIZATION –NEW

STARTS)

El plan requiere que usted o su

médico obtengan autorización

previa para este medicamento si es

nuevo para usted.

ST

TRATAMIENTO

ESCALONADO (STEP

THERAPY)

En algunos casos, el plan requiere

que primero pruebe ciertos

medicamentos para tratar su

afección médica antes de cubrir

otro medicamento para tratar esa

afección. Por ejemplo, si el

medicamento A y el medicamento

B sirven para tratar su afección

médica, es posible que no

cubramos el medicamento B a

menos que usted pruebe primero el

medicamento A.

QL

LÍMITE DE CANTIDAD

(QUANTITY LIMIT)

En el caso de ciertos

medicamentos, el Plan limita la

cantidad del medicamento que

cubrimos. Por ejemplo, el Plan

suministra 30 cápsulas de

NEXIUM por receta.

MO

PEDIDO POR CORREO

(MAIL ORDER)

Este medicamento recetado está

disponible mediante nuestro

servicio de pedido por correo y en

las farmacias de venta al público

de la red. Considere usar el pedido

por correo para solicitar

medicamentos a largo plazo (de

mantenimiento, por ejemplo,

medicamentos para la presión

arterial alta). Las farmacias de

venta al público de la red pueden

ser más adecuadas para recetas a

corto plazo (como antibióticos).

VII

VI

Para obtener más información

Para obtener información más detallada sobre su cobertura de medicamentos recetados de Touchstone

Health, revise su Evidencia de Cobertura y otros materiales del plan.

Si tiene alguna pregunta sobre Touchstone Health, comuníquese con nosotros. Nuestra información de

contacto, junto con la fecha de la última actualización del formulario, figura en la portada y la contraportada.

Si tiene preguntas generales sobre la cobertura de medicamentos recetados de Medicare, comuníquese con

Medicare al 1-800-MEDICARE (1-800-633-4227), las 24 horas del día, los 7 días de la semana. Los

usuarios de dispositivos TTY/TDD deben llamar al 1-877-486-2048. O pueden visitar http://

www.medicare.gov.

Formulario de Touchstone Health

El formulario que comienza en la próxima página brinda información sobre algunos de los medicamentos

que cubre Touchstone Health. Si tiene problemas para encontrar su medicamento en la lista, consulte el

Índice que comienza en la página 83.

En la primera columna del cuadro se encuentra el nombre del medicamento. Los medicamentos de marca se

encuentran en letra mayúscula (por ejemplo, CELEBREX) y los medicamentos genéricos se encuentran en

letra minúscula y cursiva (por ejemplo, atorvastatin).

La información que aparece en la columna de Requisitos/Límites le indica si Touchstone Health tiene algún

requisito especial para cubrir su medicamento.

La información que aparece en la columna de Requisitos/Límites le indica si Touchstone Health tiene algún

requisito especial para cubrir su medicamento.

A continuación, se incluye una lista de las abreviaturas que pueden aparecer en la columna Requisito/Límites

de las páginas siguientes, que indica si existe algún tipo de requisito especial para la cobertura de su

medicamento.

ABREVIATURA

DEFINICIÓN

DESCRIPCIÓN

LA

DISPONIBILIDAD

LIMITADA (LIMITED

AVAILABILITY)

Es posible que esta receta se

encuentre disponible solo en

ciertas farmacias. Para obtener más

información, consulte su

Directorio de farmacias o llame al

Servicio de Atención para

Miembros al1-888-777-0204, los

usuario de dispositivos TTY/TDD

deben llamar al 711, de lunes a

viernes, de 8 a. m. a 8 p. m.

PA

AUTORIZACIÓN PREVIA

(PRIOR

AUTHORIZATION)

El plan requiere que usted o su

médico obtengan autorización

previa para ciertos medicamentos.

Esto quiere decir que necesitará



V

restricciones de uso adicionales no fueran lo suficientemente eficaces para tratar su afección o le provocaran

efectos médicos adversos.

Debe comunicarse con nosotros para solicitarnos una decisión de cobertura inicial para obtener una excepción

del formulario, de las restricciones de uso. Al solicitar una excepción del formulario, de las restricciones

de uso, debe enviar una declaración realizada por su médico, o la persona que ha confeccionado su

receta, que respalde su solicitud. Por lo general, debemos tomar una decisión dentro de las 72 horas

posteriores a la recepción de la declaración de respaldo de la persona que receta el medicamento. Puede

solicitar una excepción acelerada (rápida) si usted o su médico consideran que esperar una decisión durante

72 horas podría poner en grave peligro su salud. Si le conceden su solicitud para obtener una excepción

acelerada, debemos otorgarle una decisión dentro de las 24 horas posteriores a la recepción de la declaración

de respaldo del médico o la persona que ha confeccionado su receta.

¿Qué debo hacer antes de consultar con mi médico la posibilidad de cambiar los

medicamentos o de solicitar una excepción?

Como miembro nuevo o permanente de nuestro plan, es posible que esté tomando medicamentos que no se

encuentren en nuestro formulario. O bien, usted puede estar tomando un medicamento que se encuentra en

nuestro formulario pero su capacidad para adquirirlo es limitada. Por ejemplo, es posible que necesite nuestra

autorización previa para poder abastecer su receta. Debe consultar con su médico para determinar si necesita

cambiar a un medicamento adecuado que se encuentre dentro de nuestra cobertura o si debe solicitar una

excepción del formulario para que cubramos el medicamento que toma. Mientras usted consulta con su

médico para determinar el plan de acción adecuado para usted, nosotros podemos cubrir su medicamento en

ciertos casos durante los primeros 90 días de su membresía en nuestro plan.

Para cada uno de sus medicamentos que no se encuentre en nuestro formulario o en el caso de que su

capacidad para adquirir los medicamentos sea limitada, cubriremos un suministro temporal para 30 días (a

menos que tenga una receta emitida por menos días) cuando los adquiera en una farmacia de la red. Después

de su primer suministro para 30 días, no pagaremos estos medicamentos, incluso si usted ha sido miembro

del plan durante menos de 90 días.

Si usted es residente de un centro de atención de cuidados a largo plazo, le permitiremos que vuelva a

abastecer su receta hasta que le hayamos proporcionado un suministro de transición para 93 días, conforme

al incremento de suministro, (a menos que cuente con una receta emitida por menos días). Cubriremos más

de un reabastecimiento de estos medicamentos para los primeros 90 días de su membresía en nuestro plan. Si

necesita un medicamento que no se encuentra en nuestro formulario o si su capacidad para adquirirlo es

limitada, pero hace más de 90 días que es miembro de nuestro plan, cubriremos un suministro de emergencia

para 31 días de ese medicamento (a menos que tenga una receta por menos días) mientras solicita una

excepción del formulario.

Otras circunstancias en las que cubriremos un suministro temporal de transición de 30 días (salvo que tenga

una receta

por menos días) son las siguientes:

• si ingresa en un centro de cuidados a largo plazo o se va de uno

• si le dan de alta de un hospital

• si se va de un centro de enfermería especializada

• si cancela la atención paliativa

• si le dan de alta en un hospital psiquiátrico con un régimen de medicación especial.

IV

ciertos medicamentos cubiertos si visita nuestro sitio web. Hemos publicado documentos en línea que

explican nuestra autorización previa y las restricciones de terapias escalonadas. Puede pedirnos que le

enviemos una copia. Nuestra información de contacto, junto con la fecha de la última actualización del

formulario, figura en la portada y la contraportada.

Puede solicitar a Touchstone Health que haga una excepción de estas restricciones o límites o solicitar una

lista de otros medicamentos similares que pueden tratar su enfermedad. Consulte la sección, “¿Cómo solicito

una excepción del formulario de Touchstone Health?” en la página IV para obtener más información sobre

cómo solicitar una excepción.

¿Qué sucede si mi medicamento no se encuentra en el formulario?

Si su medicamento no está incluido en este formulario (lista de medicamentos cubiertos), debe comunicarse

primero con el Servicio para Miembros para preguntar si su medicamento está cubierto. Para obtener más

información, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última

actualización del formulario, figura en la portada y la contraportada.

Si confirmara que Touchstone Health no cubre el medicamento que necesita, tiene dos opciones:

Puede solicitar al Servicio para Miembros que le brinde una lista de medicamentos similares

cubiertos por Touchstone Health. Cuando reciba la lista, muéstresela a su médico y pídale que le

recete un medicamento similar que esté cubierto por Touchstone Health.

Puede solicitarle a Touchstone Health que haga una excepción y cubra el medicamento que necesita.

Consulte a continuación para obtener información acerca de cómo solicitar una excepción.

¿Cuál es el procedimiento para solicitar una excepción al formulario de Touchstone

Health?

Puede pedirle a Touchstone Health que haga una excepción en nuestras regulaciones de cobertura. Existen

varios tipos de excepciones diferentes que puede solicitar.

Puede solicitarnos que cubramos un medicamento aunque no se encuentre en nuestro formulario. Si

es aprobado, dicho medicamento será cubierto a un nivel predeterminado de costo compartido, y

usted no podrá solicitarnos que le suministremos el medicamento a un nivel inferior de costo

compartido.

Puede solicitarnos que no apliquemos las restricciones o límites de la cobertura a su medicamento.

Por ejemplo, en el caso de ciertos medicamentos, Touchstone Health limita la cantidad de

medicamento que cubre. Si se aplica un límite de cantidad a su medicamento, puede solicitarnos que

no apliquemos el límite y que cubramos una mayor cantidad.

Por lo general, Touchstone Health solo aprobará su solicitud para una excepción si los medicamentos

alternativos incluidos en el formulario del plan, el medicamento con menor costo compartido o las

III

¿Cómo utilizo el formulario?

Existen dos formas de buscar su medicamento en el formulario: Afección médica

El formulario comienza en la página 1. En este formulario, los medicamentos se agrupan en categorías

según el tipo de afecciones médicas que tratan. Por ejemplo, los medicamentos que se utilizan para el

tratamiento de afecciones cardíacas se encuentran en la categoría AGENTES CARDIOVASCULARES.

Si sabe para qué se utiliza el medicamento, busque el nombre de la categoría en la lista que comienza en

la página 1. Luego, busque el medicamento dentro de esa categoría.

Lista en orden alfabético

Si no está seguro en qué categoría se encuentra, debe buscar el medicamento en el Índice que comienza

en la página 83. El Índice proporciona un listado alfabético de todos los medicamentos que se incluyen

en este documento. En el índice figuran tanto los medicamentos de marca como los genéricos. Busque

en el Índice y encuentre su medicamento. Al lado del medicamento, verá el número de página donde

puede encontrar información sobre la cobertura. Consulte la página enumerada en el Índice y encuentre

el nombre de su medicamento en la primera columna de la lista.

¿Qué son los medicamentos genéricos?

Touchstone Health tiene cobertura de medicamentos de marca y genéricos. Un medicamento genérico es

un medicamento aprobado por la FDA por tener los mismos ingredientes activos que el medicamento de

marca. Generalmente, los medicamentos genéricos cuestan menos que los medicamentos de marca.

¿Existen restricciones en mi cobertura?

Existen algunos requisitos o límites adicionales en la cobertura de algunos medicamentos cubiertos. Estos

requisitos y límites pueden incluir lo siguiente:

Autorización previa: Touchstone Health requiere que usted o su médico obtengan autorización

previa para ciertos medicamentos. Esto quiere decir que necesitará contar con la aprobación previa por parte de Touchstone Health antes de llenar sus recetas. Si no obtiene la aprobación, es posible que Touchstone Health no cubra el medicamento.

Límites de cantidad: Para ciertos medicamentos, Touchstone Health limita la cantidad de

medicamento que cubre. Por ejemplo, Touchstone Health suministra 30 cápsulas de NEXIUM por

receta. Esto puede ser además del suministro estándar para un mes o tres meses.

Terapia escalonada: En algunos casos, Touchstone Health requiere que usted pruebe primero ciertos

medicamentos para tratar su afección médica antes de cubrir otro medicamento diferente para tratar

dicha afección. Por ejemplo, si el medicamento A y el medicamento B sirven para tratar su afección

médica, es posible que Touchstone Health no cubra el medicamento B a menos que usted primero

pruebe el medicamento A. Si el medicamento A no le funcionara bien, Touchstone Health cubrirá el

medicamento B.

Para saber si existen requisitos o límites adicionales para su medicamento, consulte el formulario que

comienza en la página 1. También puede obtener información acerca de las restricciones que se aplican a

II

Cada vez que en esta lista de medicamentos (formulario) se hace referencia a "nosotros", "nos" o "nuestros",

significa Touchstone Health. Cada vez que se hace referencia a "plan" o "planes", significa planes 2015 de

Touchstone Health.

Este documento incluye una lista de los medicamentos (formulario) de nuestro plan que entra en vigencia a

partir del 27 de octubre de 2015. Para obtener un formulario actualizado, comuníquese con nosotros.

Nuestra información de contacto, junto con la fecha de la última actualización del formulario, figura en la

portada y la contraportada.

Por lo general, debe utilizar las farmacias de la red para acceder al beneficio de medicamentos recetados. Los

beneficios, el formulario, la red de farmacias y los copagos/el coseguro podrán cambiar el 1 de enero de

2016 y de vez en cuando durante el año.

¿Cuál es el formulario de Touchstone Health?

Un formulario es una lista de medicamentos cubiertos seleccionados por Touchstone Health en colaboración

con un grupo de proveedores de atención médica, que representa las terapias recetadas que se consideran

necesarias como parte de un programa de tratamiento de calidad. Por lo general, Touchstone Health cubrirá

los medicamentos que figuran en nuestro formulario siempre y cuando el medicamento sea médicamente

necesario, la receta se llene en una farmacia de la red de Touchstone Health y se cumplan las otras reglas del

plan. Consulte su Evidencia de cobertura para obtener más información sobre cómo comprar sus

medicamentos recetados.

¿Puede cambiar el formulario (lista de medicamentos)?

Por lo general, si usted está tomando un medicamento que se encuentra en nuestro formulario 2015 y que

estaba cubierto al comienzo del año, no se suspenderá ni se reducirá la cobertura del medicamento durante el

año 2015, excepto que aparezca un nuevo medicamento genérico más económico o que se divulgue nueva

información adversa sobre la seguridad o efectividad de un medicamento. Otros tipos de cambios en el

formulario, como la eliminación de un medicamento del formulario, no afectarán a los miembros que

actualmente tomen ese medicamento. El medicamento seguirá estando disponible con el mismo costo

compartido para esos miembros que deban tomarlo durante el resto del año de cobertura. Consideramos que

es importante que usted tenga acceso continuo durante el resto del año de cobertura a los medicamentos del

formulario que estaban disponibles cuando seleccionó nuestro plan, excepto en los casos en que usted pueda

ahorrar dinero adicional o que podamos garantizar su seguridad.

Si eliminamos medicamentos de nuestro formulario o agregamos requisitos de autorización previa, límites

de cantidad o restricciones de terapias escalonadas para un medicamento,debemos notificar el cambio a los

miembros afectados al menos 60 días antes de que el cambio entre en vigencia o cuando el miembro vuelva

a comprar el medicamento. En este último caso, el miembro recibirá un suministro para 60 días del

medicamento. Si la Administración de Drogas y Alimentos (Food and Drug Administration, FDA) considera

que un medicamento de nuestro formulario no es seguro o el fabricante retira el medicamento del mercado,

eliminaremos inmediatamente el medicamento de nuestro formulario y notificaremos a los miembros que lo

tomen. El formulario adjunto entra en vigencia el 27 de octubre 2015. Para obtener información actualizada

sobre los medicamentos cubiertos por Touchstone Health, póngase en contacto con nosotros. Nuestra

información de contacto figura en la portada y la contraportada. Touchstone Health le enviará anexos por

correo en caso de que se produzcan cambios en el formulario que no sean de mantenimiento a mitad de año.

I

Formulario 2015

(Lista de medicamentos cubiertos)

LEA LO SIGUIENTE: ESTE DOCUMENTO CONTIENE INFORMACIÓN

SOBRE ALGUNOS DE LOS MEDICAMENTOS CUBIERTOS POR ESTE PLAN.

HPMS Approved Formulary File Submission ID 00015480 , Version Number 21, Approved 10/27/15

Este formulario fue actualizado el 27 de octubre 2015. Para obtener información más reciente o si tiene

alguna pregunta, póngase en contacto con el Servicio de Atención para Miembros de Touchstone Health al

1- 888-777-0204, o al 711 para usuarios de TTY/TDD, de 8 a. m. a 8 p. m., los 7 días de la semana (Nota:

El horario de nuestro Servicio de Atención para Miembros será de 8 a. m. a 8 p. m., los 7 días de la semana,

desde el 15 de octubre de 2014 hasta el 14 de febrero de 2015. El horario de atención será de 8 a. m. a

8 p. m., de lunes a viernes desde el 15 de febrero de 2015 hasta el 14 de octubre de 2015). También puede

visitar www.TouchstoneH.com.

Esta información está disponible en un formato diferente, incluido en CD y en inglés, y puede obtenerse a

través de correo electrónico. Si necesita información sobre el plan en otro formato o idioma, llame al

Servicio para Miembros al número antes mencionado.

This information is available in a different format, including CD and Spanish, and can be obtained via e-

mail. Please call Member Services at the number listed above if you need plan information in another format

or language.

Touchstone Health HMO, Inc. es una Organización para el Mantenimiento de la Salud aprobada por

Medicare con un contrato Medicare Advantage y de medicamentos recetados con el gobierno federal y el

programa de Medicaid del estado de Nueva York. La inscripción en Touchstone Health depende de la

renovación del contrato.

Y0064_H3327_THPSMK_2444S SP Accepted

Nota para los miembros actuales: Este formulario ha cambiado desde el año pasado. Revise este

documento para asegurarse de que sigue incluyendo los medicamentos que usted toma.


Touchstone Health HMO, Inc One North Lexington Ave 12th Floor White Plains, NY 10601

www.TouchstoneH.com

Los miembros potenciales deben llamar al 1-888-777-0368 o al TTY/TDD 711 las 24 horas del día, los 7 días de la semana

Los miembros actuales deben llamar al 1-888-777-0204 o al TTY/TDD 711 El horario de atención es de 8 a. m. a 8 p. m., los 7 días de la semana desde el 15 de octubre de 2014 hasta el 14 de febrero de 2015. Atendemos las llamadas telefónicas de 8 a. m. a 8 p. m., de lunes a viernes desde el 15 de febrero de 2015 hasta el 14 de octubre de 2015.

Este formulario fue actualizado el 27 de octubre 2015. Para obtener información más

reciente o si tiene alguna pregunta, póngase en contacto con el Servicio de Atención

para Miembros de Touchstone Health al 1-888-777-0204, o al 711 para usuarios de

TTY/TDD, de 8 a. m. a 8 p. m., los 7 días de la semana (Importante: El horario de

nuestro Servicio de Atención para Miembros será de 8 a. m. a 8 p. m., los

7 días de la semana, desde el 15 de octubre de 2014 hasta el 14 de febrero de 2015. El

horario de atención será de 8 a. m. a 8 p. m., de lunes a viernes desde el 15 de febrero

de 2015 hasta el 14 de octubre de 2015). También puede visitar

www.TouchstoneH.com.

facebook.com/TouchstoneH twitter.com/touchstoneh youtube.com/touchstonehealth www.touchstoneh.com/blog

Y0064_H3327_THPSMK_2444S SP Accepted Touchstone Health HMO, Inc. is a Medicare approved HMO with a Medicare Advantage Prescription Drug contract with the federal government and a contract with the New York Medicaid Program. Enrollment in Touchstone Health depends on contract renewal.



http://www.touchstoneh.com/blog

Touchstone Health’s

Lista de medicamentos cubiertos: Formulario 2015

LEA LO SIGUIENTE: ESTE DOCUMENTO CONTIENE INFOR- MACIÓN SOBRE ALGUNOS DE LOS MEDICAMENTOS CUBIER- TOS POR ESTE PLAN

Este formulario fue actualizado 27 de octubre 2015. Para obtener información más reciente o si tiene alguna pregunta, póngase en contacto con el Servicio de Atención

para Miembros de Touchstone Health al 1-888-777-0204 o para usuarios TTY/TDD ,

711, 8:00 a. m. a 8:00 p. m. los 7 días de la semana (Importante: El horario de nuestro

Servicio de Atención para Miembros será de 8 a. m. a 8 p. m., los 7 días de la semana,

desde el 15 de octubre de 2014 hasta el 14 de febrero de 2015. El horario de atención

será de 8 a. m. a 8 p. m., de lunes a viernes desde el 15 de febrero de 2015 hasta el 14

de octubre de 2015). También puede visitar www.TouchstoneH.com.

www.TouchstoneH.com

Y0064_H3327_THPSMK_2444S SP Accepted



DRUG NAME DRUG TIER REQUIREMENTS/LIMITS

ANALGESICS Analgesics

alagesic lq sol 1

apap/codeinesol120-12/5 1 QL - 4500 per 30 days

apap/codeinetab300-15mg 1 QL - 400 per 30 days



ascomp/cod cap30mg 1 QL - 120 per 30 days

but/apap/cafcap 1

but/apap/cafcapcodeine 1 QL - 360 per 30 days

but/apap/caftab 1

but/asa/caffcap 1

butal/apap tab50-325mg 1

diclo/misoprtab50-0.2mg 1

diclo/misoprtab75-0.2mg 1

endocet tab10-325mg 1 QL - 120 per 30 days

endocet tab5-325mg 1 QL - 120 per 30 days

endocet tab7.5-325 1 QL - 120 per 30 days

hycet sol7.5-325 1 QL - 3600 per 30 days

hydroco/apapsol7.5-325 1 QL - 3600 per 30 days

hydroco/apaptab10-300mg 1 QL - 120 per 30 days




hydroco/apaptab7.5-300 1 QL - 120 per 30 days

hydroco/apaptab7.5-325 1 QL - 120 per 30 days

hydrocod/ibutab7.5-200 1 QL - 120 per 30 days

oxycod/apap tab10-325mg 1 QL - 120 per 30 days

oxycod/apap tab2.5-325 1 QL - 120 per 30 days

oxycod/apap tab5-325mg 1 QL - 120 per 30 days

oxycod/apap tab7.5-325 1 QL - 120 per 30 days

oxycod/asa tab 1 QL - 120 per 30 days

oxycod/ibu tab5-400mg 1 QL - 120 per 30 days

reprexain tab10-200mg 1 QL - 120 per 30 days

reprexain tab2.5-200 1 QL - 120 per 30 days

reprexain tab5-200mg 1 QL - 120 per 30 days

tramadl/apaptab37.5-325 1 QL - 240 per 30 days

vicodin tab5-300mg 1 QL - 120 per 30 days

vicodin es tab7.5-300 1 QL - 120 per 30 days

vicodin hp tab10-300mg 1 QL - 120 per 30 days

xodol tab10-300mg 1 QL - 120 per 30 days

xodol tab5-300mg 1 QL - 120 per 30 days

2


xodol tab7.5-300 1 QL - 120 per 30 days

zamicet sol10-325mg 1 QL - 3600 per 30 days

Nonsteroidal Anti-Inflammatory Drugs

celecoxib cap100mg 1 QL - 60 per 30 days




diclofen pottab50mg 1

diclofenac tab100mg er 1

diclofenac tab25mg dr 1



diflunisal tab500mg 1

etodolac cap200mg 1

etodolac cap300mg 1

etodolac tab400mg 1

etodolac tab500mg 1

etodolac er tab400mg 1



fenoprofen tab600mg 1

FLECTOR DIS1.3% 1 PA

flurbiprofentab100mg 1

flurbiprofentab50mg 1

ibuprofen sus100/5ml 1

ibuprofen tab400mg 1



indomethacincap25mg 1

indomethacincap50mg 1

indomethacincap75mg er 1

ketoprofen cap200mg er 1

ketoprofen cap50mg 1

ketoprofen cap75mg 1

ketorolac tab10mg 1

meclofen sodcap100mg 1

meclofen sodcap50mg 1

mefenam acidcap250mg 1

meloxicam tab15mg 1 QL - 30 per 30 days

meloxicam tab7.5mg 1 QL - 30 per 30 days

nabumetone tab500mg 1

nabumetone tab750mg 1

naproxen sus125/5ml 1

naproxen tab250mg 1

3


naproxen tab375mg 1

naproxen tab500mg 1

naproxen dr tab375mg 1

naproxen dr tab500mg 1

naproxen sodtab275mg 1

naproxen sodtab550mg 1

oxaprozin tab600mg 1

piroxicam cap10mg 1

piroxicam cap20mg 1

sulindac tab150mg 1

sulindac tab200mg 1

tolmetin sodcap400mg 1

tolmetin sodtab600mg 1

tolmetin sodtab200mg 1

Opioid Analgesics, Long-Acting

fentanyl dis100mcg/h 1 QL - 30 per 30 days

fentanyl dis12mcg/hr 1 QL - 30 per 30 days




fentanyl dis37.5mcg/hr 1 QL - 30 per 30 days



hydromorphontab12mg er 1




levorphanol tab2mg 1 QL - 120 per 30 days

METHADONE INJ10MG/ML 1 QL - 120 per 30 days; B/D

methadone sol10mg/5ml 1 QL - 600 per 30 days

methadone sol5mg/5ml 1 QL - 1200 per 30 days

methadone tab10mg 1 QL - 120 per 30 days

methadone tab5mg 1 QL - 120 per 30 days

morphine sulcap100mg er 1 QL - 60 per 30 days











4




morphine sultab100mg er 1 QL - 120 per 30 days





OXYCONTIN TAB10MG CR 1 ST; QL - 90 per 30 days







oxymorphone tab10mg er 1 QL - 90 per 30 days






oxymorphone tab7.5mg er 1 QL - 90 per 30 days

tramadol hcltab100mg er 1 QL - 30 per 30 days



Opioid Analgesics, Short-Acting

butorphanol inj1mg/ml 1 QL - 360 per 30 days

butorphanol inj2mg/ml 1 QL - 180 per 30 days

butorphanol sol10mg/ml 1 QL - 10 per 30 days

CODEINE SULFTAB15MG 1 QL - 120 per 30 days



duramorph inj0.5mg/ml 1 QL - 120 per 30 days; B/D

duramorph inj1mg/ml 1 QL - 120 per 30 days; B/D

fentanyl ot loz1200mcg 1 QL - 120 per 30 days; PA






hydromorphoninj500/50ml 1 QL - 120 per 30 days

hydromorphontab2mg 1 QL - 120 per 30 days



morphine sulsol10mg/5ml 1 QL - 1800 per 30 days

5


MORPHINE SULSOL20MG/5ML

1 QL - 900 per 30 days

morphine sulsol20mg/ml 1 QL - 180 per 30 days

morphine sultab15mg 1 QL - 120 per 30 days

morphine sultab30mg 1 QL - 120 per 30 days

nalbuphine inj10mg/ml 1 QL - 120 per 30 days; B/D

nalbuphine inj20mg/ml 1 QL - 120 per 30 days; B/D

oxycodone cap5mg 1 QL - 120 per 30 days

oxycodone con100/5ml 1 QL - 120 per 30 days

oxycodone tab10mg 1 QL - 120 per 30 days





tramadol hcltab50mg 1 QL - 240 per 30 days

ANESTHETICS Local Anesthetics lido/prilocncre2.5-2.5% 1

lidocaine gel2% jelly 1



lidocaine inj0.5% 1 B/D

lidocaine inj1% 1

lidocaine oin5% 1

lidocaine pad5% 1 QL - 90 per 30 days; PA

lidocaine sol2% visc 1

lidocaine sol4% 1

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS

Alcohol Deterrents/Anti-craving

acampro cal tab333mg 1

disulfiram tab250mg 1 MO

disulfiram tab500mg 1 MO

VIVITROL INJ380MG 1 PA

Opioid Dependence Treatments

bupren/naloxsub2-0.5mg 1 QL - 120 per 30 days; MO

bupren/naloxsub8-2mg 1 QL - 120 per 30 days; MO

buprenorphininj0.3mg/ml 1 MO

buprenorphinsub2mg 1 QL - 120 per 30 days; MO

buprenorphinsub8mg 1 QL - 120 per 30 days; MO

BUTRANS DIS10MCG/HR 1 QL - 4 per 28 days


6




SUBOXONE MIS12-3MG 1 QL - 120 per 30 days; MO

SUBOXONE MIS2-0.5MG 1 QL - 90 per 30 days; MO



Opioid Reversal Agents

naloxone inj1mg/ml 1 MO

naltrexone tab50mg 1 MO

Smoking Cessation Agents

buproban tab150mg 1 QL - 90 per 30 days; MO

bupropion tab100mg 1 QL - 120 per 30 days; MO

bupropion tab100mg sr 1 QL - 60 per 30 days; MO



bupropion tab75mg 1 QL - 180 per 30 days; MO

bupropn hcl tab150mg xl 1 MO

bupropn hcl tab300mg xl 1 MO

CHANTIX PAK0.5& 1MG 1 QL - 60 per 30 days; PA; MO

CHANTIX TAB0.5MG 1 QL - 60 per 30 days; PA; MO

CHANTIX TAB1MG 1 QL - 60 per 30 days; PA; MO

FORFIVO XL TAB450MG 1 QL - 30 per 30 days

NICOTROL NS SPR10MG/ML 1 QL - 40 per 30 days; MO

ANTIBACTERIALS Aminoglycosides gentak oin0.3% op 1

gentam/nacl inj0.9mg/ml 1

gentam/nacl inj1.4mg/ml 1

gentam/nacl inj100mg 1




gentamicin cre0.1% 1

gentamicin inj10mg/ml 1

gentamicin inj40mg/ml 1 B/D

GENTAMICIN OIN0.1% 1

gentamicin sol0.3% op 1

neomycin tab500mg 1

paromomycin cap250mg 1

streptomycininj1gm 1

tobra/nacl inj80/0.9 1 B/D

TOBRADEX OIN0.3-0.1% 1

tobramycin inj10mg/ml 1 B/D

7


tobramycin inj80mg/2ml 1 B/D

tobramycin neb300/5ml 1 PA

tobramycin sol0.3% op 1

Antibacterials

cefotetan inj10g 1

cefotetan inj1gm/10ml 1

cefotetan inj2gm/20ml 1

colistimeth inj150mg 1 B/D

neo/poly gu sol40/ml ir 1

SYNERCID INJ500MG 1 B/D

Antibacterials, Other acetic acid sol2% otic 1

baciim inj50000unt 1 B/D

bacitracin oinop 1

chloramphen inj1gm 1 B/D

clindamycin cap150mg 1

clindamycin cap300mg 1

clindamycin cre2% vag 1

clindamycin gel1% 1

clindamycin inj150mg/ml 1

clindamycin lot1% 1

clindamycin pad1% 1

clindamycin sol1% 1

CUBICIN SOL500MG 1 B/D

linezolid inj2mg/ml 1 PA

mafenide acepak5% 1

methenam hiptab1gm 1

metron/nacl inj500mg 1

metronidazolcre0.75% 1

metronidazolgel0.75% 1

metronidazolgel0.75%vag 1

metronidazollot0.75% 1

metronidazoltab250mg 1

metronidazoltab500mg 1

mupirocin cre2% 1

mupirocin oin2% 1

nitrofur maccap50mg 1

nitrofurantncap100mg 1

nitrofurantnsus25mg/5ml 1

polymyxin b inj500000 1

primsol sol50mg/5ml 1

SULFAMYLON CRE85MG/GM 1

tinidazole tab250mg 1

tinidazole tab500mg 1

8


trimethoprimtab100mg 1

TYGACIL INJ50MG 1 PA

vancomycin cap125mg 1

vancomycin cap250mg 1

vancomycin inj1000mg 1 PA

vancomycin inj10gm 1 PA

vancomycin inj500mg 1 PA

XIFAXAN TAB550MG 1

ZYVOX SUS100MG/5M 1 PA

ZYVOX TAB600MG 1 QL - 28 per 14 days; PA

Beta-lactam, Cephalosporins cefaclor cap250mg 1

cefaclor cap500mg 1

cefaclor er tab500mg 1

cefadroxil cap500mg 1

cefadroxil sus250/5ml 1

cefadroxil sus500/5ml 1

cefadroxil tab1gm 1

cefazolin inj10gm 1 B/D

cefazolin inj1gm 1 B/D

cefazolin inj1gm/50ml 1 B/D

cefazolin inj500mg 1 B/D

cefdinir cap300mg 1

cefdinir sus125/5ml 1

cefdinir sus250/5ml 1

cefepime inj1gm 1 B/D

cefepime inj2gm 1 B/D

cefotaxime inj10gm 1

cefoxitin inj10gm 1 B/D

cefoxitin inj1gm 1



cefoxitin inj2gm 1

cefpodo proxsus100/5ml 1

cefpodo proxsus50mg/5ml 1

cefpodoxime tab100mg 1

cefpodoxime tab200mg 1

cefprozil sus125/5ml 1

cefprozil sus250/5ml 1

cefprozil tab250mg 1

cefprozil tab500mg 1

ceftazidime inj1gm 1



9


ceftriaxone inj10gm 1 B/D

ceftriaxone inj1gm 1

ceftriaxone inj250mg 1 B/D

ceftriaxone inj2gm 1

ceftriaxone inj500mg 1 B/D

cefuroxime inj1.5gm 1 B/D

cefuroxime inj7.5gm 1 B/D

cefuroxime inj750mg 1 B/D

cefuroxime tab250mg 1

cefuroxime tab500mg 1

cephalexin cap250mg 1

cephalexin cap500mg 1

cephalexin sus125/5ml 1

cephalexin sus250/5ml 1

cephalexin tab250mg 1

cephalexin tab500mg 1

SUPRAX CAP400MG 1

suprax chw100mg 1

suprax chw200mg 1

SUPRAX SUS100/5ML 1

SUPRAX SUS200/5ML 1

SUPRAX SUS500/5ML 1

SUPRAX TAB400MG 1

TEFLARO INJ400MG 1 B/D

TEFLARO INJ600MG 1 B/D

Beta-lactam, Other

AZACTAM/DEX INJ1GM 1

AZACTAM/DEX INJ2GM 1

aztreonam inj1gm 1

imipenem/cilinj250mg 1

imipenem/cilinj500mg 1

INVANZ INJ1GM 1

meropenem inj500mg 1 B/D

Beta-lactam, Penicillins amox/k clav chw200mg 1

amox/k clav chw400mg 1

amox/k clav sus200/5ml 1




amox/k clav tab250mg 1



amoxicillin cap250mg 1

10


amoxicillin cap500mg 1

amoxicillin chw125mg 1

amoxicillin chw250mg 1

amoxicillin sus125/5ml 1




amoxicillin tab500mg 1

amoxicillin tab875mg 1

amox-pot clataber 1

ampicillin cap250mg 1

ampicillin cap500mg 1

ampicillin inj10gm 1 B/D

ampicillin inj125mg 1 B/D

ampicillin inj1gm 1 B/D

ampicillin sus125/5ml 1

ampicillin sus250/5ml 1

amp-sulbactainj1.5gm 1 B/D

amp-sulbactainj15gm 1 B/D

amp-sulbactainj3gm 1 B/D

BICILLIN C-RINJ1200000 1

BICILLIN C-RINJ900/300 1

BICILLIN L-AINJ1200000 1



dicloxacill cap250mg 1

dicloxacill cap500mg 1

nafcillin inj10gm 1 B/D

nafcillin inj1gm 1 B/D

oxacillin inj10gm 1

oxacillin inj2gm 1

pen g proc inj600000 1 B/D

pen g sod inj5000000 1 B/D

PENICILL GK/INJDEX 2MU 1 B/D

PENICILL GK/INJDEX 3MU 1 B/D

penicilln gkinj5mu 1 B/D

penicilln vksol125/5ml 1

penicilln vksol250/5ml 1

penicilln vktab250mg 1

penicilln vktab500mg 1

piper/tazobainj3-0.375g 1

ZOSYN SOL2-0.25GM 1 PA

ZOSYN SOL3-0.375G 1 PA

Macrolides

11


azithromycininj500mg 1 B/D

azithromycinsus100/5ml 1 QL - 30 per 5 days

azithromycinsus200/5ml 1 QL - 90 per 5 days

azithromycintab250mg 1 QL - 6 per 5 days



clarithromycsus125/5ml 1

clarithromycsus250/5ml 1

clarithromyctab250mg 1 QL - 28 per 14 days

clarithromyctab500mg 1 QL - 28 per 14 days

clarithromyctab500mg er 1 QL - 28 per 14 days

DIFICID TAB200MG 1 PA

ery pad2% 1

ery-tab tab250mg ec 1



ERYTHROCIN INJ500MG 1 B/D

erythrocin tab250mg 1

ERYTHROM ETHTAB400MG 1

erythromycingel2% 1

erythromycinoinop 1

erythromycinsol2% 1

erythromycintab250mg bs 1

erythromycintab500mg bs 1

ZMAX SUS2GM 1 QL - 60 per 30 days

Quinolones AVELOX INJ 1 B/D

CILOXAN OIN0.3% OP 1

ciprofloxacninj400mg 1

ciprofloxacnsol0.3% op 1

ciprofloxacnsus250mg/5 1

ciprofloxacnsus500mg/5 1

ciprofloxacntab1000mg 1




ciprofloxacntab500mg er 1


gatifloxacinsol0.5% 1

levofloxacinsol0.5% 1

levofloxacinsol25mg/ml 1

levofloxacintab250mg 1 QL - 14 per 14 days



12


moxifloxacintab400mg 1 QL - 10 per 10 days

ofloxacin dro0.3% op 1

ofloxacin dro0.3%otic 1

ofloxacin tab200mg 1



VIGAMOX DRO0.5% 1

Sulfonamides

silver sulfacre1% 1

smz/tmp ds tab800-160 1

smz-tmp inj400-80/5 1 B/D

smz-tmp sus200-40/5 1

smz-tmp tab400-80mg 1

sod sulfacetsol10% op 1

ssd cre1% 1

sulfacet sodoin10% op 1

sulfacetamidsus10% 1

sulfadiazinetab500mg 1

Tetracyclines

demeclocycl tab150mg 1

demeclocycl tab300mg 1

doxycyc monotab150mg 1



doxycycl hyccap100mg 1

doxycycl hyccap50mg 1

doxycycl hyctab100mg 1

minocycline cap100mg 1



minocycline tab100mg 1

minocycline tab135mg er 1





ANTICONVULSANTS Anticonvulsants, Other

APTIOM TAB200MG 1 QL - 180 per 30 days; MO




LEVETIRACETAINJ10MG/ML 1 MO

13




levetiracetasol100mg/ml 1 MO

levetiracetatab1000mg 1 MO



levetiracetatab500mg er 1 QL - 180 per 30 days; MO


levetiracetatab750mg er 1 QL - 120 per 30 days; MO

levetiracetminj500/5ml 1 MO

POTIGA TAB200MG 1 QL - 180 per 30 days; MO




Calcium Channel Modifying Agents CELONTIN CAP300MG 1 MO

ethosuximidecap250mg 1 MO

ethosuximidesol250/5ml 1 MO

LYRICA CAP100MG 1 MO




LYRICA CAP25MG 1 MO


LYRICA CAP50MG 1 MO

LYRICA CAP75MG 1 MO

LYRICA SOL20MG/ML 1 MO

zonisamide cap100mg 1 MO



Gamma-aminobutyric Acid (GABA) Augmenting Agents clonazep odttab0.125mg 1

clonazep odttab0.25mg 1

clonazep odttab0.5mg 1

clonazep odttab1mg 1

clonazep odttab2mg 1

clonazepam tab0.5mg 1

clonazepam tab1mg 1

clonazepam tab2mg 1

cloraz dipottab15mg 1 QL - 90 per 30 days

cloraz dipottab3.75mg 1 QL - 90 per 30 days

cloraz dipottab7.5mg 1 QL - 90 per 30 days

DIASTAT ACDLGEL12.5-20 1

DIASTAT ACDLGEL5-10MG 1

14


DIASTAT PED GEL2.5M GEL 1

diazepam con5mg/ml 1 QL - 240 per 30 days

DIAZEPAM GEL10MG 1

DIAZEPAM GEL2.5MG 1

DIAZEPAM GEL20MG 1

diazepam sol1mg/ml 1 QL - 1200 per 30 days

diazepam tab10mg 1 QL - 180 per 30 days



divalproex cap125mg 1 MO

divalproex tab125mg dr 1 MO


divalproex tab250mg er 1 MO


divalproex tab500mg er 1 MO

FYCOMPA TAB10MG 1 QL - 30 per 30 days






gabapentin cap100mg 1 QL - 360 per 30 days; MO



gabapentin sol250/5ml 1 MO

gabapentin tab600mg 1 QL - 180 per 30 days; MO

gabapentin tab800mg 1 QL - 120 per 30 days; MO

GABITRIL TAB12MG 1 MO

GABITRIL TAB16MG 1 MO

lorazepam con2mg/ml 1

lorazepam tab0.5mg 1

lorazepam tab1mg 1

lorazepam tab2mg 1

ONFI SUS2.5MG/ML 1

ONFI TAB10MG 1 QL - 60 per 30 days

phenobarb elx20mg/5ml 1 QL - 1500 per 30 days

PHENOBARB TAB100MG 1

PHENOBARB TAB15MG 1

phenobarb tab16.2mg 1 QL - 360 per 30 days

PHENOBARB TAB30MG 1 QL - 195 per 30 days

phenobarb tab32.4mg 1 QL - 180 per 30 days

PHENOBARB TAB60MG 1

PHENOBARB TAB64.8MG 1 QL - 90 per 30 days

PHENOBARB TAB97.2MG 1 QL - 60 per 30 days

15


primidone tab250mg 1 MO

primidone tab50mg 1 MO

SABRIL POW500MG 1 QL - 180 per 30 days; LA

SABRIL TAB500MG 1 QL - 180 per 30 days; LA

tiagabine tab2mg 1 MO

tiagabine tab4mg 1 MO

valproate inj100mg/ml 1 MO

valproic acdcap250mg 1 MO

valproic acdsyp250/5ml 1 MO

Glutamate Reducing Agents felbamate sus600/5ml 1 MO

felbamate tab400mg 1 MO

felbamate tab600mg 1 MO

lamotrigine chw25mg 1 MO

lamotrigine chw5mg 1 MO

lamotrigine tab100mg 1 MO

lamotrigine tab100mg er 1 MO









lamotrigine tabodt25mg 1 MO




topiramate cap15mg 1 MO

topiramate cap25mg 1 MO

topiramate tab100mg 1 MO




TROKENDI XR CAP100MG 1 MO




Sodium Channel Agents BANZEL SUS40MG/ML 1 QL - 2400 per 30 days; MO

BANZEL TAB200MG 1 QL - 240 per 30 days; MO

BANZEL TAB400MG 1 QL - 240 per 30 days

carbamazepincap100mg er 1 MO

16




carbamazepinchw100mg 1 MO

carbamazepinsus100/5ml 1 MO

carbamazepintab200mg 1 MO

carbamazepintab200mg er 1 MO

carbamazepintab400mg er 1 MO

DILANTIN CAP30MG 1 MO

epitol tab200mg 1

EQUETRO CAP100MG 1 MO



fosphenytoininj100/2ml 1 B/D; MO

oxcarbazepinsus300mg/5m 1 MO

oxcarbazepintab150mg 1 MO



OXTELLAR XR TAB150MG 1 QL - 480 per 30 days; MO



PEGANONE TAB250MG 1 MO

phenytoin chw50mg 1 MO

phenytoin inj50mg/ml 1 B/D; MO

phenytoin sus125/5ml 1 MO

phenytoin excap100mg 1 MO



TEGRETOL-XR TAB100MG 1 MO

VIMPAT INJ200MG/20 1 QL - 1200 per 30 days; MO

VIMPAT SOL10MG/ML 1 QL - 1200 per 30 days; MO

VIMPAT TAB100MG 1 QL - 60 per 30 days; MO




ANTIDEMENTIA AGENTS Antidementia Agents, Other

ergoloid mestab1mg oral 1

Cholinesterase Inhibitors donepezil tab10mg 1 QL - 30 per 30 days; MO

donepezil tab10mg odt 1 QL - 30 per 30 days; MO

donepezil tab5mg 1 QL - 30 per 30 days; MO

donepezil tab5mg odt 1 QL - 30 per 30 days; MO

donepezil tabhcl 23mg 1 QL - 30 per 30 days; MO

17


EXELON DIS13.3/24 1 MO

EXELON DIS4.6MG/24 1 MO

EXELON DIS9.5MG/24 1 MO

galantamine cap16mg er 1 QL - 30 per 30 days; MO



galantamine sol4mg/ml 1 QL - 180 per 30 days; MO

galantamine tab12mg 1 MO



rivastigminecap1.5mg 1 QL - 60 per 30 days; MO

rivastigminecap3mg 1 QL - 60 per 30 days; MO

rivastigminecap4.5mg 1 QL - 60 per 30 days; MO

rivastigminecap6mg 1 QL - 60 per 30 days; MO

N-methyl-D-aspartate (NMDA) Receptor Antagonist NAMENDA SOL10MG/5ML 1 QL - 360 per 30 days; MO

NAMENDA XR CAP14MG 1 QL - 30 per 30 days; MO




NAMENDA XR CAPTITRATIO 1 QL - 30 per 30 days; MO

ANTIDEPRESSANTS Antidepressants olanza/fluoxcap12-25mg 1 QL - 30 per 30 days; MO

olanza/fluoxcap12-50mg 1 QL - 30 per 30 days; MO




perphen/amittab2-10mg 1 MO





Antidepressants, Other

ABILIFY INJ9.75MG 1 B/D; MO

ABILIFY SOL1MG/ML 1 QL - 900 per 30 days; MO

ABILIFY TAB10MG 1 QL - 90 per 30 days; MO






ABILIFY DISCTAB10MG 1 QL - 90 per 30 days; MO

18


ABILIFY DISCTAB15MG 1 QL - 60 per 30 days; MO

ABILIFY MAININJ300MG 1 MO

ABILIFY MAININJ400MG 1 MO

mirtazapine tab15mg 1 QL - 30 per 30 days; MO

mirtazapine tab15mg odt 1 QL - 30 per 30 days; MO





mirtazapine tab7.5mg 1 QL - 30 per 30 days; MO

quetiapine tab100mg 1 QL - 240 per 30 days; MO






REXULTI TAB0.25MG 1 QL - 480 per 30 days; MO

REXULTI TAB0.5MG 1 QL - 240 per 30 days; MO

REXULTI TAB1MG 1 QL - 120 per 30 days; MO




SEROQUEL XR TAB150MG 1 QL - 30 per 30 days; MO





Monoamine Oxidase Inhibitors EMSAM DIS12MG/24H 1 QL - 30 per 30 days; MO

EMSAM DIS6MG/24HR 1 QL - 30 per 30 days; MO

EMSAM DIS9MG/24HR 1 QL - 30 per 30 days; MO

MARPLAN TAB10MG 1 MO

phenelzine tab15mg 1 MO

tranylcypromtab10mg 1 MO

SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors) BRINTELLIX TAB10MG 1 QL - 60 per 30 days; MO

BRINTELLIX TAB20MG 1 QL - 30 per 30 days; MO

BRINTELLIX TAB5MG 1 QL - 120 per 30 days; MO

citalopram sol10mg/5ml 1 MO

citalopram tab10mg 1 QL - 30 per 30 days; MO



DESVENLAFAX TAB100MG ER 1 QL - 120 per 30 days; MO

19


DESVENLAFAX TAB50MG ER 1 QL - 240 per 30 days; MO

duloxetine cap20mg 1 QL - 180 per 30 days; MO




escitalopramsol5mg/5ml 1 QL - 620 per 30 days; MO

escitalopramtab10mg 1 QL - 60 per 30 days; MO



FETZIMA CAP120MG 1 QL - 30 per 30 days; MO




FETZIMA CAPTITRATIO 1 QL - 28 per 28 days; MO

fluoxetine cap10mg 1 QL - 30 per 30 days; MO

fluoxetine cap20mg 1 MO

fluoxetine cap40mg 1 QL - 60 per 30 days; MO

fluoxetine sol20mg/5ml 1 MO

fluoxetine tab10mg 1 QL - 30 per 30 days; MO

fluoxetine tab20mg 1 MO

fluvoxamine cap100mg er 1 QL - 60 per 30 days; MO

fluvoxamine cap150mg er 1 QL - 60 per 30 days; MO

fluvoxamine tab100mg 1 QL - 90 per 30 days; MO



irenka cap40mg 1 QL - 90 per 30 days; MO

KHEDEZLA TAB100MG ER 1 QL - 120 per 30 days; MO

KHEDEZLA TAB50MG ER 1 QL - 240 per 30 days; MO

maprotiline tab25mg 1 MO



nefazodone tab100mg 1 MO





paroxetin ertab12.5mg 1 QL - 150 per 30 days; MO

paroxetin ertab37.5mg 1 QL - 60 per 30 days; MO

paroxetine tab10mg 1 QL - 90 per 30 days; MO


paroxetine tab25mg er 1 QL - 90 per 30 days; MO



PAXIL SUS10MG/5ML 1 MO

20


PRISTIQ TAB100MG 1 QL - 30 per 30 days; MO



sertraline con20mg/ml 1 QL - 300 per 30 days; MO

sertraline tab100mg 1 QL - 60 per 30 days; MO



trazodone tab100mg 1 MO




venlafaxine cap150mg er 1 QL - 60 per 30 days; MO

venlafaxine cap37.5mg 1 QL - 180 per 30 days; MO

venlafaxine cap75mg er 1 QL - 90 per 30 days; MO

venlafaxine tab100mg 1 QL - 90 per 30 days; MO

venlafaxine tab150mg er 1 QL - 60 per 30 days; MO

VENLAFAXINE TAB225MG ER 1 QL - 30 per 30 days; MO


venlafaxine tab37.5 er 1 QL - 180 per 30 days; MO

venlafaxine tab37.5mg 1 QL - 180 per 30 days; MO



venlafaxine tab75mg er 1 QL - 90 per 30 days; MO

VIIBRYD KIT 1 MO

VIIBRYD TAB10MG 1 QL - 120 per 30 days; MO



Tricyclics amitriptylintab100mg 1 MO

amitriptylintab10mg 1 MO





amoxapine tab100mg 1 MO




clomipraminecap25mg 1 MO



desipramine tab100mg 1 MO



21





doxepin hcl cap100mg 1 MO






doxepin hcl con10mg/ml 1 MO

imipram hcl tab10mg 1 MO



imipram pam cap100mg 1 MO




nortriptylincap10mg 1 MO




nortriptylinsol10mg/5ml 1 MO

protriptylintab10mg 1 MO

protriptylintab5mg 1 MO

SURMONTIL CAP100MG 1

SURMONTIL CAP25MG 1

SURMONTIL CAP50MG 1

ANTIEMETICS Antiemetics, Other chlorpromaz inj25mg/ml 1 MO

chlorpromaz tab100mg 1 MO





compro sup25mg 1

diphenhydraminj50mg/ml 1 B/D; MO

meclizine tab12.5mg 1 MO

meclizine tab25mg 1 MO

metoclopram inj5mg/ml 1 B/D; MO

metoclopram sol5mg/5ml 1 MO

metoclopram tab10mg 1 MO

metoclopram tab5mg 1 MO

22


perphenazinetab16mg 1 MO




phenadoz sup12.5mg 1

phenadoz sup25mg 1

prochlorper inj5mg/ml 1 MO

prochlorper sup25mg 1 MO

prochlorper tab10mg 1 MO

prochlorper tab5mg 1 MO

promethegan sup50mg 1 MO

TRANSDERM-SCDIS1.5MG 1 QL - 24 per 30 days

Emetogenic Therapy Adjuncts ALOXI INJ0.25MG/5 1 QL - 150 per 30 days; PA; MO

ANZEMET INJ20MG/ML 1 QL - 50 per 30 days; PA; MO

ANZEMET TAB100MG 1 QL - 30 per 30 days; PA; MO

ANZEMET TAB50MG 1 QL - 30 per 30 days; PA; MO

dronabinol cap10mg 1

dronabinol cap2.5mg 1 MO

dronabinol cap5mg 1 MO

EMEND CAP125MG 1 QL - 30 per 30 days; B/D; MO



EMEND PAK80 & 125 1 QL - 3 per 3 days; B/D; MO

granisetron inj0.1mg/ml 1 B/D; MO

granisetron inj1mg/ml 1 B/D; MO

granisetron tab1mg 1 QL - 30 per 30 days; B/D; MO

ondansetron inj4mg/2ml 1 B/D; MO

ondansetron sol4mg/5ml 1 QL - 150 per 5 days; B/D; MO

ondansetron tab24mg 1 QL - 60 per 30 days; B/D; MO


ondansetron tab4mg odt 1 QL - 12 per 5 days; B/D; MO


ondansetron tab8mg odt 1 QL - 12 per 5 days; B/D; MO

SANCUSO DIS3.1MG 1 QL - 1 per 7 days; MO

ANTIFUNGALS Antifungals ABELCET INJ5MG/ML 1 PA

AMBISOME INJ50MG 1 B/D

amphotericininj50mg 1 PA; MO

CANCIDAS INJ50MG 1 B/D

CANCIDAS INJ70MG 1 B/D

ciclopirox cre0.77% 1 MO

23


ciclopirox gel0.77% 1 MO

ciclopirox sha1% 1 MO

ciclopirox sol8% 1 MO

ciclopirox sus0.77% 1 MO

clotrimazolecre1% 1 MO

clotrimazolesol1% 1 MO

clotrimazoletro10mg 1 MO

econazole cre1% 1 MO

ERAXIS INJ100MG 1 PA; MO

EXELDERM CRE1% 1 MO

EXELDERM SOL1% 1 MO

fluconazole sus10mg/ml 1 MO

fluconazole sus40mg/ml 1 MO

fluconazole tab100mg 1 MO

fluconazole tab150mg 1 QL - 2 per 7 days; MO



fluconazole/injdex 400 1 MO

flucytosine cap250mg 1 MO

flucytosine cap500mg 1 MO

griseofulvinsus125/5ml 1 MO

itraconazolecap100mg 1 MO

ketoconazolecre2% 1 MO

ketoconazolesha2% 1 MO

ketoconazoletab200mg 1 MO

miconazole 3sup200mg 1 QL - 3 per 3 days; MO

NOXAFIL SUS40MG/ML 1

NOXAFIL TAB100MG 1

nyamyc pow100000 1

nystat/triamcre 1 MO

nystat/triamoin 1 MO

nystatin cre100000 1 MO

nystatin oin100000 1 MO

nystatin pow100000 1 MO

nystatin sus100000 1 MO

nystatin tab500000 1 MO

nystop pow100000 1 MO

pedi-dri pow100000 1

terbinafine tab250mg 1 MO

terconazole cre0.4% 1 QL - 45 per 7 days; MO

terconazole sup80mg 1 QL - 3 per 3 days; MO

voriconazoleinj200mg 1 PA; MO

voriconazolesus40mg/ml 1 PA

voriconazoletab200mg 1 PA

24


voriconazoletab50mg 1 PA

zazole cre0.4% 1 MO

ANTIGOUT AGENTS Antigout Agents allopurinol tab100mg 1 MO

allopurinol tab300mg 1 MO

COLCRYS TAB0.6MG 1 QL - 120 per 30 days; MO

proben/colchtab500-0.5 1 MO

probenecid tab500mg 1 MO

ANTIMIGRAINE AGENTS Antimigraine Agents

migergot sup2/100 1

Ergot Alkaloids

dihydroergotinj1mg/ml 1 MO

OTEZLA TAB10/20/30 1 QL - 60 per 30 days

OTEZLA TAB30MG 1 QL - 60 per 30 days

Prophylactic timolol mal tab10mg 1 MO

timolol mal tab20mg 1 MO

timolol mal tab5mg 1 MO

Serotonin (5-HT) 1b/1d Receptor Agonists naratriptan tab1mg 1 QL - 9 per 30 days; MO

naratriptan tab2.5mg 1 QL - 9 per 30 days; MO

rizatriptan tab10mg 1 MO

rizatriptan tab10mg odt 1 MO

rizatriptan tab5mg 1 MO

rizatriptan tab5mg odt 1 MO

sumatriptan inj6mg/0.5 1 MO

sumatriptan inj6mg/0.5 1 QL - 6 per 30 days; MO

sumatriptan tab100mg 1 QL - 9 per 30 days; MO



zolmitriptantab2.5 mg 1 QL - 6 per 30 days; MO

zolmitriptantab5mg 1 QL - 6 per 30 days; MO

ANTIMYASTHENIC AGENTS Parasympathomimetics GUANIDINE TAB125MG 1 MO

MESTINON SYP60MG/5ML 1 MO

MESTINON TABTIMESPAN 1 MO

pyridostigm tab60mg 1 MO

ANTIMYCOBACTERIALS Antimycobacterials, Other

25


dapsone tab100mg 1 MO

dapsone tab25mg 1 MO

rifabutin cap150mg 1 MO

Antituberculars CAPASTAT SULINJ1GM 1 B/D; MO

ethambutol tab100mg 1 MO

ethambutol tab400mg 1 MO

isoniazid inj100mg/ml 1 MO

isoniazid syp50mg/5ml 1 MO

isoniazid tab100mg 1 MO

isoniazid tab300mg 1 MO

paser gra4gm 1

PRIFTIN TAB150MG 1 MO

pyrazinamidetab500mg 1

rifampin cap150mg 1 MO

rifampin cap300mg 1 MO

rifampin inj600 mg 1 B/D; MO

RIFATER TAB 1 MO

SIRTURO TAB100MG 1

TRECATOR TAB250MG 1 MO

ANTINEOPLASTICS Alkylating Agents

CYCLOPHOSPH CAP25MG 1 B/D

CYCLOPHOSPH CAP50MG 1 B/D

cyclophosph tab25mg 1 B/D

cyclophosph tab50mg 1 B/D

HEXALEN CAP50MG 1

LEUKERAN TAB2MG 1

MATULANE CAP50MG 1

MUSTARGEN INJ10MG 1 PA*

OPDIVO INJ40MG/4ML 1 B/D

TREANDA INJ45/0.5ML 1 B/D

Antiandrogens

bicalutamidetab50mg 1 QL - 30 per 30 days

flutamide cap125mg 1

NILANDRON TAB150MG 1

XTANDI CAP40MG 1 QL - 120 per 30 days; LA

ZYTIGA TAB250MG 1 QL - 120 per 30 days; LA

Antiangiogenic Agents

POMALYST CAP1MG 1

POMALYST CAP2MG 1

POMALYST CAP3MG 1

POMALYST CAP4MG 1

26


REVLIMID CAP10MG 1 LA


REVLIMID CAP2.5MG 1 LA




THALOMID CAP100MG 1

THALOMID CAP150MG 1

THALOMID CAP200MG 1

THALOMID CAP50MG 1

Antiestrogens/Modifiers

EMCYT CAP140MG 1

FARESTON TAB60MG 1

SOLTAMOX SOL10MG/5ML 1

tamoxifen tab10mg 1

tamoxifen tab20mg 1

Antimetabolites

DROXIA CAP200MG 1

DROXIA CAP300MG 1

DROXIA CAP400MG 1

hydroxyurea cap500mg 1

mercaptopur tab50mg 1

PURIXAN SUS20MG/ML 1

TABLOID TAB40MG 1

Antineoplastics

ALIMTA INJ500MG 1 B/D

amifostine inj500mg 1 B/D

ARRANON INJ5MG/ML 1

AVASTIN INJ400/16ML 1 B/D

AVASTIN INJ 1 B/D

azacitidine inj100mg 1 B/D

CYRAMZA INJ100/10ML 1 B/D

CYRAMZA INJ500/50ML 1 B/D

DAUNOXOME INJ2MG/ML 1 B/D

decitabine inj50mg 1 B/D

DOCEFREZ INJ20MG 1 B/D

DOCEFREZ INJ80MG 1 B/D

DOCETAXEL INJ80MG/4ML 1 B/D

ELITEK INJ1.5MG 1 B/D

FASLODEX INJ250MG 1 PA*

FARYDAK CAP10MG 1 QL - 6 per 21 days



FUSILEV INJ50MG 1 B/D

27


gemcitabine inj1gm 1 B/D

GLEOSTINE CAP100MG 1

GLEOSTINE CAP10MG 1

GLEOSTINE CAP40MG 1

HALAVEN INJ1MG/2ML 1 B/D

HERCEPTIN INJ440MG 1 B/D

IBRANCE CAP100MG 1 QL - 30 per 30 days



ISTODAX INJ10MG 1 B/D

JEVTANA INJ60/1.5ML 1 B/D

KEYTRUDA INJ100MG/4ML 1 B/D

KEYTRUDA SOL50MG 1 B/D

LOMUSTINE CAP100MG 1

LOMUSTINE CAP10MG 1

LOMUSTINE CAP40MG 1

MESNEX TAB400MG 1

PERJETA INJ420/14ML 1 B/D

PROLEUKIN INJ22MU 1 B/D

SYNRIBO INJ3.5MG 1 B/D

THIOTEPA INJ15MG 1 B/D

VELCADE INJ3.5MG 1 B/D

YERVOY INJ50MG 1 B/D

ZALTRAP INJ100/4ML 1 B/D

Antineoplastics, Other

adrucil inj500/10ml 1 B/D

ERWINAZE INJ10000UNT 1 B/D

leucovor ca inj100mg 1 B/D

leucovor ca inj350mg 1 B/D

leucovor ca tab10mg 1




mitoxantron inj2mg/ml 1 B/D

ONCASPAR INJ750/ML 1 B/D

ZOLINZA CAP100MG 1

Aromatase Inhibitors, 3P

rdP Generation

anastrozole tab1mg 1 QL - 30 per 30 days

exemestane tab25mg 1

letrozole tab2.5mg 1

Enzyme Inhibitors

ETOPOPHOS INJ100MG 1 B/D

etoposide inj20mg/ml 1 B/D

toposar inj1gm/50ml 1 B/D

28


topotecan inj4mg 1 B/D

Molecular Target Inhibitors AFINITOR TAB10MG 1 QL - 60 per 30 days

AFINITOR TAB2.5MG 1 QL - 60 per 30 days

AFINITOR TAB5MG 1 QL - 60 per 30 days

AFINITOR TAB7.5MG 1 QL - 60 per 30 days

AFINITOR DISTAB2MG 1 QL - 150 per 30 days



BELEODAQ INJ500MG 1 B/D

BOSULIF TAB100MG 1 QL - 120 per 30 days

BOSULIF TAB500MG 1 QL - 30 per 30 days

CAPRELSA TAB100MG 1 QL - 60 per 30 days; LA

CAPRELSA TAB300MG 1 QL - 30 per 30 days; LA

COMETRIQ KIT100MG 1 QL - 56 per 28 days



ERIVEDGE CAP150MG 1

GILOTRIF TAB20MG 1 QL - 30 per 30 days



GLEEVEC TAB100MG 1 QL - 90 per 30 days

GLEEVEC TAB400MG 1 QL - 60 per 30 days

ICLUSIG TAB15MG 1 QL - 90 per 30 days

ICLUSIG TAB45MG 1 QL - 30 per 30 days

IMBRUVICA CAP140MG 1 QL - 120 per 30 days

INLYTA TAB1MG 1

INLYTA TAB5MG 1

LENVIMA CAP10MG 1 QL - 30 per 30 days




JAKAFI TAB10MG 1 QL - 60 per 30 days; LA





LYNPARZA CAP50MG 1 QL - 480 per 30 days

MEKINIST TAB0.5MG 1 QL - 120 per 30 days

MEKINIST TAB2MG 1 QL - 30 per 30 days

NEXAVAR TAB200MG 1 QL - 120 per 30 days; LA

SPRYCEL TAB100MG 1

SPRYCEL TAB140MG 1

SPRYCEL TAB20MG 1

29


SPRYCEL TAB50MG 1

SPRYCEL TAB70MG 1

SPRYCEL TAB80MG 1

STIVARGA TAB40MG 1 QL - 84 per 28 days; LA

SUTENT CAP12.5MG 1

SUTENT CAP25MG 1

SUTENT CAP37.5MG 1

SUTENT CAP50MG 1

TAFINLAR CAP50MG 1 QL - 180 per 30 days

TAFINLAR CAP75MG 1 QL - 120 per 30 days

TARCEVA TAB100MG 1

TARCEVA TAB150MG 1

TARCEVA TAB25MG 1

TASIGNA CAP150MG 1

TASIGNA CAP200MG 1

TYKERB TAB250MG 1 LA

VOTRIENT TAB200MG 1

XALKORI CAP200MG 1 QL - 60 per 30 days; LA

XALKORI CAP250MG 1 QL - 60 per 30 days; LA

ZELBORAF TAB240MG 1 QL - 240 per 30 days; LA

ZYDELIG TAB100MG 1 QL - 90 per 30 days

ZYDELIG TAB150MG 1 QL - 60 per 30 days

ZYKADIA CAP150MG 1 QL - 150 per 30 days

Monoclonal Antibodies

ARZERRA CON100/5ML 1

KADCYLA INJ100MG 1 B/D

RITUXAN INJ500MG 1 B/D

Retinoids bexarotene cap75mg 1

PANRETIN GEL0.1% 1

TARGRETIN CAP75MG 1

TARGRETIN GEL1% 1 QL - 60 per 30 days

tretinoin cap10mg 1

ANTIPARASITICS Anthelminthics ALBENZA TAB200MG 1 MO

BILTRICIDE TAB600MG 1 MO

ivermectin tab3mg 1 MO

Antiprotozoals ALINIA SUS100/5ML 1 MO

ALINIA TAB500MG 1 MO

atovaq/progutab62.5-25 1 MO

atovaq/progutab250-100 1 MO

30


atovaquone sus750/5ml 1 MO

chloroquine tab250mg 1 MO

chloroquine tab500mg 1 MO

COARTEM TAB20-120MG 1

DARAPRIM TAB25MG 1 MO

hydroxychlortab200mg 1 MO

mefloquine tab250mg 1 MO

NEBUPENT INH300MG 1 B/D; MO

PENTAM 300 INJ300MG 1 PA; MO

PRIMAQUINE TAB26.3MG 1 MO

quinine sulfcap324mg 1

Pediculicides/Scabicides lindane lot1% 1 MO

lindane sha1% 1 MO

malathion lot0.5% 1 MO

permethrin cre5% 1 MO

ANTIPARKINSON AGENTS Anticholinergics

benztropine inj1mg/ml 1 MO

benztropine tab0.5mg 1 MO

benztropine tab1mg 1 MO

benztropine tab2mg 1 MO

trihexyphen elx0.4mg/ml 1 MO

trihexyphen tab2mg 1 MO

trihexyphen tab5mg 1 MO

Antiparkinson Agents, Other amantadine cap100mg 1 MO

amantadine syp50mg/5ml 1 MO

amantadine tab100mg 1 MO

TASMAR TAB100MG 1 MO

Dopamine Agonists

APOKYN INJ10MG/ML 1 LA; PA

bromocriptincap5mg 1 MO

bromocriptintab2.5mg 1 MO

NEUPRO DIS1MG/24HR 1 QL - 30 per 30 days






pramipexole tab0.125mg 1 QL - 90 per 30 days; MO



31




pramipexole tab1mg 1 QL - 90 per 30 days; MO

pramipexole tab0.75mg er 1 MO

pramipexole tab1.5mg er 1 MO

ropinirole tab0.25mg 1 MO

ropinirole tab0.5mg 1 MO

ropinirole tab1mg 1 MO





Dopamine Precursors/L-Amino Acid Decarboxylase Inhibitors

carb/levo tab10-100mg 1 MO



carb/levo ertab25-100mg 1 MO

carb/levo ertab50-200mg 1 MO

carbidopa tab25mg 1 MO

Monoamine Oxidase B (MAO-B) Inhibitors

AZILECT TAB0.5MG 1 MO

AZILECT TAB1MG 1 MO

selegiline cap5mg 1 MO

selegiline tab5mg 1 MO

ANTIPSYCHOTICS 1st Generation/Typical fluphenaz deinj25mg/ml 1 MO

fluphenazinecon5mg/ml 1 MO

fluphenazineelx2.5/5ml 1 MO

fluphenazineinj2.5mg/ml 1 MO

fluphenazinetab10mg 1 MO


fluphenazinetab2.5mg 1 MO


haloper dec inj100mg/ml 1 B/D; MO

haloper dec inj50mg/ml 1 B/D; MO

haloper lac inj5mg/ml 1 MO

haloperidol con2mg/ml 1 MO

haloperidol tab0.5mg 1 MO

haloperidol tab10mg 1 MO

32






loxapine cap10mg 1 MO




ORAP TAB1MG 1 MO

ORAP TAB2MG 1 MO

thioridazinetab100mg 1 MO




thiothixene cap10mg 1 MO




trifluoperaztab10mg 1 MO




2nd Generation/Atypical FANAPT PAK 1 QL - 60 per 30 days; MO

FANAPT TAB10MG 1 QL - 90 per 30 days; MO







GEODON INJ20MG 1 MO

INVEGA TAB1.5MG 1 QL - 240 per 30 days; MO

INVEGA TAB3MG 1 QL - 120 per 30 days; MO



INVEGA SUST INJ117/0.75 1

INVEGA SUST INJ156MG/ML 1

INVEGA SUST INJ234/1.5 1

INVEGA SUST INJ39/0.25 1 MO

INVEGA SUST INJ78/0.5ML 1 MO

LATUDA TAB120MG 1 QL - 30 per 30 days; MO



33




olanzapine inj10mg 1 QL - 30 per 30 days; B/D; MO

olanzapine tab10mg 1 QL - 60 per 30 days; MO

olanzapine tab10mg odt 1 QL - 60 per 30 days; MO



olanzapine tab2.5mg 1 QL - 240 per 30 days; MO





olanzapine tab7.5mg 1 QL - 90 per 30 days; MO

RISPERDAL INJ12.5MG 1 MO

RISPERDAL INJ25MG 1 MO

RISPERDAL INJ37.5MG 1

RISPERDAL INJ50MG 1

risperidone sol1mg/ml 1 QL - 480 per 30 days; MO

risperidone tab0.25 odt 1 QL - 1920 per 30 days; MO

risperidone tab0.25mg 1 QL - 1920 per 30 days; MO

risperidone tab0.5mg 1 QL - 960 per 30 days; MO

risperidone tab0.5mg od 1 QL - 960 per 30 days; MO

risperidone tab1mg 1 QL - 480 per 30 days; MO

risperidone tab1mg odt 1 QL - 480 per 30 days; MO







SAPHRIS SUB10MG 1 QL - 60 per 30 days; MO

SAPHRIS SUB5MG 1 QL - 120 per 30 days; MO

ziprasidone cap20mg 1 QL - 240 per 30 days; MO




ZYPREXA RELPINJ210MG 1

Treatment Resistent

clozapine tab100mg 1 QL - 120 per 30 days; MO




FAZACLO TAB100/ODT 1 QL - 270 per 30 days; MO

FAZACLO TAB12.5/ODT 1 QL - 90 per 30 days; MO

34


FAZACLO TAB150MG 1 QL - 180 per 30 days; MO

FAZACLO TAB200MG 1 QL - 120 per 30 days; MO

FAZACLO TAB25MG ODT 1 QL - 270 per 30 days; MO

VERSACLOZ SUS50MG/ML 1 QL - 540 per 30 days

ANTISPASTICITY AGENTS Antispasticity Agents baclofen tab10mg 1 MO

baclofen tab20mg 1 MO

dantrolene cap100mg 1 MO



tizanidine tab2mg 1 MO

tizanidine tab4mg 1 MO

ANTIVIRALS Anti-cytomegalovirus (CMV) Agents adefov dipivtab10mg 1

cidofovir inj75mg/ml 1

foscarnet inj24mg/ml 1

ganciclovir inj500mg 1

VALCYTE SOL50MG/ML 1

valganciclovtab450mg 1

ZIRGAN GEL0.15% 1

Anti-hepatitis B (HBV) Agents

BARACLUDE SOL.05MG/ML 1 QL - 600 per 30 days; PA

entecavir tab0.5mg 1 QL - 30 per 30 days; PA

entecavir tab1mg 1 QL - 30 per 30 days; PA

EPIVIR HBV SOL5MG/ML 1

INTRON-A INJ10MU 1

INTRON-A INJ18MU 1

INTRON-A INJ50MU 1

lamivudine tab100mg 1

PEGASYS INJ 1 QL - 2 per 28 days; PA

PEGASYS INJ180MCG/M 1

PEGASYS INJPROCLICK 1

PEGASYS INJPROCLICK 1 QL - 2 per 28 days; PA

PEG-INTRON KIT120 RP 1 QL - 4 per 28 days; PA

PEG-INTRON KIT120MCG 1 QL - 4 per 28 days; PA

PEG-INTRON KIT150 RP 1 QL - 4 per 28 days; PA



PEG-INTRON KIT50MCG RP 1 QL - 4 per 28 days; PA


PEG-INTRON KIT80MCG RP 1 QL - 4 per 28 days; PA

35


REBETOL SOL40MG/ML 1

ribapak pak1000/day 1



ribasphere cap200mg 1

ribasphere tab200mg 1



ribavirin cap200mg 1

ribavirin tab200mg 1

SYLATRON KIT296MCG 1 QL - 5 per 28 days



TYZEKA TAB600MG 1

Anti-hepatitis C (HCV) Agents

HARVONI TAB90-400MG 1 QL - 28 per 28 days; PA

INCIVEK TAB375MG 1

OLYSIO CAP150MG 1 QL - 30 per 30 days; PA

SOVALDI TAB400MG 1 QL - 30 per 30 days; PA

VIEKIRA PAK TAB 1 QL - 112 per 28 days; PA

Antiherpetic Agents acyclovir cap200mg 1

acyclovir oin5% 1

acyclovir sus200/5ml 1

acyclovir tab400mg 1

acyclovir tab800mg 1

acyclovir nainj500mg 1

DENAVIR CRE1% 1 QL - 1.5 per 28 days

famciclovir tab125mg 1 QL - 21 per 10 days



trifluridinesol1% op 1

valacyclovirtab1gm 1

valacyclovirtab500mg 1

ZOVIRAX CRE5% 1 QL - 10 per 30 days

Anti-HIV Agents, Integrase Inhibitors (INSTI)

ISENTRESS CHW100MG 1

ISENTRESS CHW25MG 1

ISENTRESS POW100MG 1

ISENTRESS TAB400MG 1

STRIBILD TAB 1 QL - 30 per 30 days

Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) COMPLERA TAB 1

EDURANT TAB25MG 1 QL - 30 per 30 days

36


INTELENCE TAB100MG 1 QL - 120 per 30 days

INTELENCE TAB200MG 1

INTELENCE TAB25MG 1

NEVIRAPINE SUS50MG/5ML 1

nevirapine tab200mg 1

nevirapine tab400mg er 1

RESCRIPTOR TAB100 MG 1

RESCRIPTOR TAB200MG 1

SUSTIVA CAP200MG 1

SUSTIVA CAP50MG 1

SUSTIVA TAB600MG 1

TYBOST TAB150MG 1 QL - 30 per 30 days

VIRAMUNE SUS50MG/5ML 1

VIRAMUNE XR TAB100MG 1

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI) abacav/lamivtab/zidovud 1

abacavir tab300mg 1

didanosine cap125mg 1




EMTRIVA CAP200MG 1

EMTRIVA SOL10MG/ML 1

EPIVIR SOL10MG/ML 1

EPZICOM TAB600-300 1

EVOTAZ TAB300-150 1 QL - 30 per 30 days

lamivud/zidotab150-300 1

lamivudine sol10mg/ml 1



PREZCOBIX TAB800-150 1 QL - 30 per 30 days

RETROVIR INJ10MG/ML 1

stavudine cap15mg 1

stavudine cap20mg 1

stavudine cap30mg 1

stavudine cap40mg 1

stavudine sol1mg/ml 1

TRIUMEQ TAB 1 QL - 60 per 30 days

TRUVADA TAB200-300 1

VIDEX SOL2GM 1

VIREAD POW40MG/GM 1

VIREAD TAB150MG 1

VIREAD TAB200MG 1

37


VIREAD TAB250MG 1

VIREAD TAB300MG 1

ZIAGEN SOL20MG/ML 1

zidovudine cap100mg 1

zidovudine syp50mg/5ml 1

zidovudine tab300mg 1

Anti-HIV Agents, Other FUZEON INJ90MG 1

SELZENTRY TAB150MG 1

SELZENTRY TAB300MG 1

TIVICAY TAB50MG 1 QL - 60 per 30 days

VITEKTA TAB85MG 1 QL - 30 per 30 days

VITEKTA TAB150MG 1 QL - 30 per 30 days

Anti-HIV Agents, Protease Inhibitors APTIVUS CAP250MG 1

APTIVUS SOL 1 QL - 300 per 30 days

CRIXIVAN CAP200MG 1

CRIXIVAN CAP400MG 1

INVIRASE CAP200MG 1

INVIRASE TAB500MG 1

KALETRA SOL 1

KALETRA TAB100-25MG 1

KALETRA TAB200-50MG 1

LEXIVA SUS50MG/ML 1

LEXIVA TAB700MG 1

NORVIR CAP100MG 1

NORVIR SOL80MG/ML 1

NORVIR TAB100MG 1

PREZISTA SUS100MG/ML 1

PREZISTA TAB150MG 1

PREZISTA TAB600MG 1

PREZISTA TAB75MG 1

PREZISTA TAB800MG 1

REYATAZ CAP150MG 1

REYATAZ CAP200MG 1

REYATAZ CAP300MG 1

REYATAZ POW50MG 1

VIRACEPT TAB250MG 1

VIRACEPT TAB625MG 1

Anti-influenza Agents RELENZA MISDISKHALE 1 QL - 60 per 180 days

rimantadine tab100mg 1

TAMIFLU CAP30MG 1 QL - 84 per 180 days

38




TAMIFLU SUS6MG/ML 1 QL - 900 per 180 days

Antivirals

ATRIPLA TAB 1

VIRAZOLE INH6GM 1

ANXIOLYTICS Anxiolytics, Other buspirone tab10mg 1

buspirone tab15mg 1

buspirone tab30mg 1

buspirone tab5mg 1

buspirone tab7.5mg 1

hydroxyz hclinj25mg/ml 1 B/D

hydroxyz hclinj50mg/ml 1

meprobamate tab200mg 1

meprobamate tab400mg 1

Benzodiazepines

alprazolam con1 mg/ml 1

alprazolam tab0.25 odt 1

alprazolam tab0.25mg 1

alprazolam tab0.5mg 1

alprazolam tab0.5mg er 1

alprazolam tab0.5mg od 1

alprazolam tab1mg 1

alprazolam tab1mg er 1

alprazolam tab1mg odt 1

alprazolam tab2mg 1


alprazolam tab2mg odt 1


chlordiazep cap10mg 1



BIPOLAR AGENTS Mood Stabilizers

lithium carbcap150mg 1 MO



lithium carbtab300mg 1 MO

lithium carbtab300mg er 1 MO

lithium carbtab450mg er 1 MO

LITHIUM CITRSOL8MEQ/5ML 1 MO

39


BLOOD GLUCOSE REGULATORS Antidiabetic Agents acarbose tab100mg 1 MO

acarbose tab25mg 1 MO

acarbose tab50mg 1 MO

BYDUREON INJ 1 MO

BYETTA INJ10MCG 1 ST; QL - 2.4 per 30 days; MO

BYETTA INJ5MCG 1 ST; QL - 2.4 per 30 days; MO

CYCLOSET TAB0.8MG 1 QL - 180 per 30 days

glimepiride tab1mg 1 QL - 60 per 30 days; MO



glipizide tab10mg 1 QL - 120 per 30 days; MO

glipizide tab5mg 1 QL - 240 per 30 days; MO

glipizide ertab10mg 1 QL - 60 per 30 days; MO

glipizide ertab2.5mg 1 QL - 240 per 30 days; MO

glipizide ertab5mg 1 QL - 120 per 30 days; MO

glyburid mcrtab1.5mg 1 QL - 150 per 30 days; MO

glyburid mcrtab3mg 1 QL - 90 per 30 days; MO

glyburid mcrtab6mg 1 QL - 60 per 30 days; MO

glyburide tab1.25mg 1 QL - 480 per 30 days; MO

glyburide tab2.5mg 1 QL - 240 per 30 days; MO

glyburide tab5mg 1 QL - 120 per 30 days; MO

JANUVIA TAB100MG 1 QL - 30 per 30 days; MO



metformin tab1000mg 1 QL - 90 per 30 days; MO


metformin tab500mg er 1 QL - 120 per 30 days; MO

metformin tab750mg er 1 QL - 90 per 30 days; MO


metformin ertab1000mg 1 MO

nateglinide tab120mg 1 QL - 90 per 30 days; MO

nateglinide tab60mg 1 QL - 90 per 30 days; MO

ONGLYZA TAB2.5MG 1 ST; QL - 30 per 30 days; MO

ONGLYZA TAB5MG 1 ST; QL - 30 per 30 days; MO

pioglitazonetab15mg 1 QL - 30 per 30 days; MO



repaglinide tab0.5mg 1 QL - 120 per 30 days; MO

repaglinide tab1mg 1 QL - 120 per 30 days; MO

repaglinide tab2mg 1 QL - 240 per 30 days; MO

SYMLINPEN 60INJ1000MCG 1 QL - 10.8 per 30 days; MO

40


SYMLNPEN 120INJ1000MCG 1 QL - 10.8 per 30 days; MO

tolazamide tab250mg 1 MO

tolazamide tab500mg 1 MO

tolbutamide tab500mg 1 MO

VICTOZA INJ18MG/3ML 1 QL - 9 per 30 days; MO

WELCHOL PAK3.75GM 1

WELCHOL TAB625MG 1

Blood Glucose Regulators glip/metformtab2.5-250m 1 QL - 240 per 30 days; MO

glip/metformtab2.5-500m 1 QL - 120 per 30 days; MO

glip/metformtab5-500mg 1 QL - 120 per 30 days; MO

glyb/metformtab1.25-250 1 QL - 240 per 30 days; MO

glyb/metformtab2.5-500 1 QL - 120 per 30 days; MO

glyb/metformtab5-500mg 1 QL - 120 per 30 days; MO

JANUMET TAB50-1000 1 ST; QL - 60 per 30 days; MO

JANUMET TAB50-500MG 1 ST; QL - 60 per 30 days; MO

JANUMET XR TAB100-1000 1 QL - 60 per 30 days; MO

JANUMET XR TAB50-1000 1 QL - 60 per 30 days; MO

JANUMET XR TAB50-500MG 1 QL - 60 per 30 days; MO

pioglit/glimtab30-2mg 1 MO

pioglit/glimtab30-4mg 1 MO

pioglita/mettab15-500mg 1 QL - 90 per 30 days; MO

pioglita/mettab15-850mg 1 QL - 90 per 30 days; MO

PRANDIMET TAB1-500MG 1 QL - 150 per 30 days; MO

PRANDIMET TAB2-500MG 1 QL - 150 per 30 days; MO

Glycemic Agents GLUCAGEN INJHYPOKIT 1 QL - 30 per 30 days; MO

GLUCAGON KIT1MG 1 QL - 2 per 30 days; MO

PROGLYCEM SUS50MG/ML 1 MO

Insulins APIDRA INJSOLOSTAR 1 QL - 30 per 30 days; MO

APIDRA INJU-100 1 QL - 30 per 30 days; MO

HUMALOG INJ100/ML 1 MO

HUMALOG INJ100/ML 1 MO

HUMALOG KWIKINJ100/ML 1 MO

HUMALOG KWIKINJ200/ML 1 MO

HUMALOG MIX INJ50/50 1 QL - 30 per 30 days; MO

HUMALOG MIX INJ50/50KWP 1 QL - 30 per 30 days; MO

HUMALOG MIX INJ75/25KWP 1 QL - 30 per 30 days; MO

HUMALOG MIX SUS75/25 1 QL - 30 per 30 days; MO

HUMULIN INJ70/30 1 QL - 30 per 30 days; MO

HUMULIN N INJU-100 1 QL - 30 per 30 days; MO

HUMULIN N PNINJU-100 1 QL - 30 per 30 days; MO

HUMULIN PEN INJ70/30 1 QL - 30 per 30 days; MO

41


HUMULIN R INJU-100 1 QL - 30 per 30 days; MO

HUMULIN R INJU-500 1 QL - 30 per 30 days; MO

LANTUS INJ100/ML 1 QL - 30 per 30 days; MO

LANTUS INJSOLOSTAR 1 QL - 30 per 30 days; MO

LEVEMIR INJ 1 QL - 30 per 30 days; MO

LEVEMIR INJFLEXPEN 1 QL - 30 per 30 days; MO

NOVOLIN INJ70/30 1 QL - 30 per 30 days; MO

NOVOLIN N INJU-100 1 QL - 30 per 30 days; MO

NOVOLIN R INJU-100 1 QL - 30 per 30 days; MO

NOVOLOG INJ100/ML 1 QL - 30 per 30 days; MO

NOVOLOG INJPENFILL 1 QL - 30 per 30 days; MO

NOVOLOG MIX INJ70/30 1 QL - 30 per 30 days; MO

NOVOLOG MIX INJFLEXPEN 1 QL - 30 per 30 days; MO

BLOOD PRODUCTS/MODIFIERS/VOLUME EXPANDERS

Anticoagulants COUMADIN INJ5 MG 1 B/D; MO

COUMADIN TAB10MG 1 MO


COUMADIN TAB2.5MG 1 MO






COUMADIN TAB7.5MG 1 MO

enoxaparin inj100mg/ml 1 QL - 28 per 30 days

enoxaparin inj120/0.8 1 QL - 22.4 per 30 days

enoxaparin inj150mg/ml 1 QL - 28 per 30 days

enoxaparin inj30/0.3ml 1 QL - 8.4 per 30 days; MO

enoxaparin inj300/3ml 1 MO




fondaparinuxsol10/0.8 1 QL - 24 per 30 days; PA; MO

fondaparinuxsol2.5/0.5 1 QL - 15 per 30 days; PA; MO



FRAGMIN INJ10000/ML 1 QL - 20 per 30 days; PA

FRAGMIN INJ12500UNT 1 QL - 20 per 30 days; PA



FRAGMIN INJ2500/0.2 1 QL - 20 per 30 days; PA; MO

42


FRAGMIN INJ25000/ML 1 QL - 20 per 30 days; PA; MO

FRAGMIN INJ5000/0.2 1 QL - 20 per 30 days; PA; MO

FRAGMIN INJ7500/0.3 1 QL - 20 per 30 days; PA

hep sod/d5w inj20000unt 1 B/D; MO



hep sod/naclinj1000unit 1 B/D; MO

heparin sod inj1000/ml 1 B/D; MO




jantoven tab10mg 1

jantoven tab1mg 1

jantoven tab2.5mg 1

jantoven tab2mg 1

jantoven tab3mg 1

jantoven tab4mg 1

jantoven tab5mg 1

jantoven tab6mg 1

jantoven tab7.5mg 1

PRADAXA CAP150MG 1 QL - 60 per 30 days; MO

PRADAXA CAP75MG 1 QL - 60 per 30 days; MO

warfarin tab10mg 1 MO


warfarin tab2.5mg 1 MO






warfarin tab7.5mg 1 MO

XARELTO STARTAB15/20MG 1 QL - 51 per 30 days; MO

XARELTO TAB10MG 1 QL - 30 per 30 days; MO



Blood Formation Modifiers anagrelide cap0.5mg 1 MO

anagrelide cap1mg 1 MO

ARANESP INJ100MCG 1 QL - 4 per 28 days; PA; MO


ARANESP INJ150MCG 1 QL - 1.2 per 28 days; PA


ARANESP INJ200MCG 1 QL - 4 per 28 days; PA

ARANESP INJ25MCG 1 QL - 1.68 per 28 days; PA; MO

43










EPOGEN INJ10000/ML 1 PA; MO

EPOGEN INJ2000/ML 1 QL - 12 per 28 days; PA; MO

EPOGEN INJ20000/ML 1 PA; MO



LEUKINE INJ250MCG 1 PA

methylergon tab0.2mg 1 MO

MOZOBIL INJ 1 B/D

NEULASTA INJ6MG/0.6M 1 QL - 2 per 30 days; PA

NEUPOGEN INJ300/0.5 1 PA

NEUPOGEN INJ480/0.8 1 PA

NEUPOGEN INJ480MCG 1 PA

PROCRIT INJ10000/ML 1 PA; MO

PROCRIT INJ2000/ML 1 QL - 12 per 28 days; PA; MO

PROCRIT INJ20000/ML 1 PA



PROCRIT INJ40000/ML 1 PA

PROMACTA TAB12.5MG 1 QL - 90 per 30 days; LA; PA

PROMACTA TAB25MG 1 QL - 90 per 30 days; LA; PA

PROMACTA TAB50MG 1 QL - 90 per 30 days; LA; PA

PROMACTA TAB75MG 1 QL - 90 per 30 days; LA

Blood Products/Modifiers/Volume Expanders

NEUMEGA INJ5MG 1 QL - 21 per 21 days; PA

Coagulants tranex acid inj100mg/ml 1 B/D; MO

tranex acid tab650mg 1

Platelet Modifying Agents AGGRENOX CAP25-200MG 1 MO

BRILINTA TAB90MG 1 QL - 60 per 30 days; MO

cilostazol tab100mg 1 MO

cilostazol tab50mg 1 MO

clopidogrel tab300mg 1 QL - 30 per 30 days; MO

clopidogrel tab75mg 1 QL - 30 per 30 days; MO

EFFIENT TAB10MG 1 QL - 30 per 30 days; MO

EFFIENT TAB5MG 1 QL - 30 per 30 days; MO

44


ticlopidine tab250mg 1 MO

CARDIOVASCULAR AGENTS Alpha-adrenergic Agonists clonidine dis0.1/24hr 1 QL - 4 per 28 days; MO

clonidine dis0.2/24hr 1 QL - 4 per 28 days; MO

clonidine dis0.3/24hr 1 QL - 4 per 28 days; MO

clonidine tab0.1mg 1 MO

clonidine tab0.1mg er 1 MO



guanfacine tab1mg 1 MO

guanfacine tab2mg 1 MO

methyldopa tab250mg 1 MO

methyldopa tab500mg 1 MO

methyldopateinj250/5ml 1 B/D; MO

midodrine tab10mg 1 MO

midodrine tab2.5mg 1 MO

midodrine tab5mg 1 MO

Alpha-adrenergic Blocking Agents doxazosin tab1mg 1 QL - 30 per 30 days; MO

doxazosin tab2mg 1 QL - 30 per 30 days; MO



prazosin hclcap1mg 1 MO



terazosin cap10mg 1 QL - 60 per 30 days; MO




Angiotensin II Receptor Antagonists

candesartan tab16mg 1 QL - 30 per 30 days; MO




eprosart mestab600mg 1 MO

irbesartan tab150mg 1 QL - 30 per 30 days; MO



losartan pottab100mg 1 QL - 30 per 30 days; MO



telmisartan tab20mg 1 QL - 30 per 30 days; MO

45




valsartan tab80mg 1 QL - 30 per 30 days; MO




Angiotensin-converting Enzyme (ACE) Inhibitors

benazepril tab10mg 1 MO




captopril tab100mg 1 MO

captopril tab12.5mg 1 MO



enalapril tab10mg 1 MO

enalapril tab2.5mg 1 MO



fosinopril tab10mg 1 MO



lisinopril tab10mg 1 MO

lisinopril tab2.5mg 1 MO





moexipril tab15mg 1 MO

moexipril tab7.5mg 1 MO

perindopril tab2mg 1 MO



quinapril tab10mg 1 MO




ramipril cap1.25mg 1 QL - 30 per 30 days; MO

ramipril cap10mg 1 QL - 60 per 30 days; MO

ramipril cap2.5mg 1 QL - 30 per 30 days; MO

ramipril cap5mg 1 QL - 30 per 30 days; MO

trandolapriltab1mg 1 MO



46


Antiarrhythmics amiodarone inj50mg/ml 1 B/D; MO

amiodarone tab200mg 1 MO

amiodarone tab400mg 1 MO

flecainide tab100mg 1 MO



mexiletine cap150mg 1 MO



MULTAQ TAB400MG 1 QL - 60 per 30 days; MO

pacerone tab100mg 1

pacerone tab200mg 1

pacerone tab400mg 1

procainamideinj100mg/ml 1 B/D; MO

procainamideinj500mg/ml 1 MO

propafenone tab150mg 1 MO



QUINIDINE GLINJ80MG/ML 1 MO

quinidine gltab324mg cr 1 MO

quinidine sutab200mg 1 MO

quinidine sutab300mg 1 MO

quinidine sutab300mg er 1 MO

sorine tab120mg 1

sorine tab160mg 1

sorine tab240mg 1

sorine tab80mg 1

sotalol af tab120mg 1 MO

sotalol hcl tab160mg 1 MO



TIKOSYN CAP125MCG 1 MO



Beta-adrenergic Blocking Agents acebutolol cap200mg 1 MO

acebutolol cap400mg 1 MO

atenolol tab100mg 1 MO



betaxolol tab10mg 1 MO

betaxolol tab20mg 1 MO

bisoprol fumtab10mg 1 MO

47


bisoprol fumtab5mg 1 MO

carvedilol tab12.5mg 1 QL - 60 per 30 days; MO

carvedilol tab25mg 1 QL - 60 per 30 days; MO



labetalol inj5mg/ml 1 B/D; MO

labetalol tab100mg 1 MO



metoprol tartab100mg 1 MO



metoprolol inj1mg/ml 1 B/D; MO

metoprolol tab100mg er 1 QL - 30 per 30 days; MO




nadolol tab20mg 1 MO



pindolol tab10mg 1 MO

pindolol tab5mg 1 MO

propranolol cap120mg er 1 MO




propranolol inj1mg/ml 1 B/D; MO

propranolol sol20mg/5ml 1 MO

propranolol sol40mg/5ml 1 MO

propranolol tab10mg 1 MO





Calcium Channel Blocking Agents afeditab tab30mg cr 1

afeditab tab60mg cr 1

amlodipine tab10mg 1 QL - 30 per 30 days; MO

amlodipine tab2.5mg 1 QL - 30 per 30 days; MO

amlodipine tab5mg 1 QL - 30 per 30 days; MO

cartia xt cap120/24hr 1 MO




48


diltiazem cap120mg cd 1 MO

diltiazem cap120mg er 1 MO

diltiazem cap180mg/24 1 MO

diltiazem cap240mg cd 1 MO






diltiazem inj100mg 1 B/D; MO

diltiazem inj50/10ml 1 B/D; MO

diltiazem tab120mg 1 MO




dilt-xr cap120mg 1 MO



felodipine tab10mg er 1 MO

felodipine tab2.5mg er 1 MO

felodipine tab5mg er 1 MO

isradipine cap2.5mg 1 MO

isradipine cap5mg 1 MO

nicardipine cap20mg 1 MO

nicardipine cap30mg 1 MO

nicardipine inj25/10ml 1 MO

nifedical xltab30mg 1 MO

nifedical xltab60mg 1 MO

nifedipine tab30mg er 1 MO



nimodipine cap30mg 1 MO

nisoldipine tab17mg er 1 MO

nisoldipine tab20mg 1 MO

nisoldipine tab25.5mg 1 MO


nisoldipine tab34mg er 1 MO


nisoldipine tab8.5mg er 1 MO

taztia xt cap120mg/24 1 MO





49


verapamil cap100mg er 1 MO






verapamil cap360mg sr 1 MO

verapamil inj2.5mg/ml 1 B/D; MO

verapamil tab120mg 1 MO

verapamil tab120mg er 1 MO





Cardiovascular Agents

amilor/hctz tab5-50 1 MO

amlod/atorvatab10-10mg 1 QL - 30 per 30 days; MO




amlod/atorvatab2.5-10mg 1 QL - 30 per 30 days; MO







amlod/benazpcap10-20mg 1 QL - 30 per 30 days; MO


amlod/benazpcap2.5-10mg 1 QL - 30 per 30 days; MO




amlod/valsartab10-160mg 1 QL - 30 per 30 days; MO




amlod/valsartab/hctz 5-160-12.5mg

1 QL - 30 per 30 days; MO

amlod/valsartab/hctz 5-160-25mg


amlod/valsartab/hctz 10-160-12.5mg


amlod/valsartab/hctz 10-160- 1 QL - 30 per 30 days; MO

50


25mg

amlod/valsartab/hctz 10-320-25mg


AMTURNIDE150TAB-5-12.5 1 QL - 30 per 30 days; MO


AMTURNIDE300TAB-10-25MG 1 QL - 30 per 30 days; MO


AMTURNIDE300TAB-5-25MG 1 QL - 30 per 30 days; MO

atenol/chlortab100-25mg 1 MO

atenol/chlortab50-25mg 1 MO

benazep/hctztab10-12.5 1 MO


benazep/hctztab20-25mg 1 MO


bisoprl/hctztab10/6.25 1 MO

bisoprl/hctztab2.5/6.25 1 MO

bisoprl/hctztab5-6.25mg 1 MO

candesa/hctztab16-12.5 1

candesa/hctztab32-12.5 1

candesa/hctztab32-25mg 1

captopr/hctztab25-15mg 1 MO




clorpres tab0.1-15mg 1



DEMSER CAP250MG 1 QL - 480 per 30 days; MO

enalapr/hctztab10-25mg 1 MO

enalapr/hctztab5-12.5mg 1 MO

EXFORGEH/10-TAB160-12.5 1 QL - 30 per 30 days

EXFORGEH/10-TAB160-25 1 QL - 30 per 30 days

EXFORGEH/10-TAB320-25 1 QL - 30 per 30 days

EXFORGEH/5- TAB160-12.5 1 QL - 30 per 30 days

EXFORGEH/5- TAB160-25 1 QL - 30 per 30 days

fosinop/hctztab10/12.5 1 MO

fosinop/hctztab20/12.5 1 MO

irbesar/hctztab150-12.5 1 QL - 30 per 30 days; MO

irbesar/hctztab300-12.5 1 QL - 30 per 30 days; MO

lisinop/hctztab10-12.5 1 MO

lisinop/hctztab20-12.5 1 MO

lisinop/hctztab20-25mg 1 MO

losartan/hcttab100-12.5 1 QL - 30 per 30 days; MO

losartan/hcttab100-25 1 QL - 30 per 30 days; MO

51


losartan/hcttab50-12.5 1 QL - 30 per 30 days; MO

methyld/hctztab250/15 1 MO

methyld/hctztab250/25 1 MO

metoprl/hctztab100-25mg 1 MO



moexipr/hctztab15-12.5 1 MO

moexipr/hctztab15-25mg 1 MO

moexipr/hctztab7.5-12.5 1 MO

nadolol/bendtab40-5mg 1 MO

nadolol/bendtab80-5mg 1 MO

propran/hctztab40/25 1 MO

propran/hctztab80/25 1 MO

qnapril/hctztab10-12.5 1 MO

qnapril/hctztab20-12.5 1 MO

qnapril/hctztab20-25mg 1 MO

RESERPINE TAB0.1MG 1 MO

RESERPINE TAB0.25MG 1 MO

SIMCOR TAB1000-20 1 QL - 60 per 30 days; MO

SIMCOR TAB1000-40 1 QL - 60 per 30 days; MO

SIMCOR TAB500-20MG 1 QL - 60 per 30 days; MO



spirono/hctztab25/25 1 MO

TEKAMLO TAB150-10MG 1 ST; QL - 30 per 30 days; MO




TEKTURNA HCTTAB150-12.5 1 ST; QL - 30 per 30 days; MO

TEKTURNA HCTTAB150-25MG 1 ST; QL - 30 per 30 days; MO

TEKTURNA HCTTAB300-12.5 1 ST; QL - 30 per 30 days; MO

TEKTURNA HCTTAB300-25MG 1 ST; QL - 30 per 30 days; MO

telmis/amlodtab40-10mg 1 MO




telmisa/hctztab40-12.5 1 QL - 30 per 30 days; MO

telmisa/hctztab80-12.5 1 QL - 30 per 30 days; MO

telmisa/hctztab80-25mg 1 QL - 30 per 30 days; MO

triamt/hctz cap37.5-25 1 MO

triamt/hctz tab37.5-25 1 MO

triamt/hctz tab75-50mg 1 MO

valsart/hctztab160-12.5 1 MO

valsart/hctztab160-25mg 1 MO

52



valsart/hctztab320-25mg 1 MO


VYTORIN TAB10-10MG 1 ST; QL - 30 per 30 days; MO




Cardiovascular Agents, Other

digoxin inj0.25mg/1 1 MO

DIGOXIN SOL50MCG/ML 1 MO

digoxin tab0.125mg 1 MO

digoxin tab0.25mg 1 MO

pentoxifyllitab400mg er 1 MO

RANEXA TAB1000MG 1 QL - 120 per 30 days; MO

RANEXA TAB500MG 1 QL - 120 per 30 days; MO

TEKTURNA TAB150MG 1 QL - 30 per 30 days; MO

TEKTURNA TAB300MG 1 QL - 30 per 30 days; MO

Diuretics, Carbonic Anhydrase Inhibitors acetazolamidcap500mg er 1 MO

acetazolamidinj500mg 1 MO

acetazolamidtab125mg 1 MO

acetazolamidtab250mg 1 MO

methazolamidtab25mg 1 MO

methazolamidtab50mg 1 MO

Diuretics, Loop

bumetanide inj0.25/ml 1 MO

bumetanide tab0.5mg 1 MO

bumetanide tab1mg 1 MO

bumetanide tab2mg 1 MO

furosemide inj10mg/ml 1 B/D; MO

furosemide sol10mg/ml 1 MO

furosemide sol8mg/ml 1 MO

furosemide tab20mg 1 MO



torsemide tab100mg 1 MO




Diuretics, Potassium-sparing

amiloride tab5mg 1 MO

eplerenone tab25mg 1 MO

eplerenone tab50mg 1 MO

spironolact tab100mg 1 MO

53




Diuretics, Thiazide

chlorothiaz inj500mg 1 MO

chlorothiaz tab250mg 1 MO

chlorothiaz tab500mg 1 MO

chlorthalid tab25mg 1 MO

chlorthalid tab50mg 1 MO

hydrochlorotcap12.5mg 1 MO

hydrochlorottab12.5mg 1 MO

hydrochlorottab25mg 1 MO

hydrochlorottab50mg 1 MO

indapamide tab1.25mg 1 MO

indapamide tab2.5mg 1 MO

methyclothiatab5mg 1 MO

metolazone tab10mg 1 MO

metolazone tab2.5mg 1 MO

metolazone tab5mg 1 MO

Dyslipidemics, Fibric Acid Derivatives fenofibrate cap134mg 1 QL - 30 per 30 days; MO

fenofibrate cap200mg 1 QL - 30 per 30 days; MO

fenofibrate cap67mg 1 QL - 30 per 30 days; MO

fenofibrate tab145mg 1 QL - 30 per 30 days; MO




fenofibric cap135mg dr 1 QL - 30 per 30 days; MO

fenofibric cap45mg dr 1 QL - 30 per 30 days; MO

gemfibrozil tab600mg 1 MO

Dyslipidemics, HMG CoA Reductase Inhibitors

atorvastatintab10mg 1 QL - 30 per 30 days; MO




CRESTOR TAB10MG 1 QL - 30 per 30 days; MO




fluvastatin cap20mg 1 QL - 60 per 30 days; MO

fluvastatin cap40mg 1 QL - 60 per 30 days; MO

lovastatin tab10mg 1 QL - 30 per 30 days; MO



pravastatin tab10mg 1 QL - 30 per 30 days; MO

54





simvastatin tab10mg 1 QL - 30 per 30 days; MO





Dyslipidemics, Other

cholestyram pow4gm lite 1 QL - 30 per 30 days; MO

colestipol gra5gm 1 QL - 30 per 30 days; MO

colestipol tab1gm 1 QL - 30 per 30 days; MO

LOVAZA CAP1GM 1 QL - 30 per 30 days; MO

niacin er tab1000mg 1 QL - 60 per 30 days; MO



niacor tab500mg 1 MO

omega-3-acidcap1gm 1 MO

prevalite pow4gm 1 MO

questran pow4gm 1 MO

ZETIA TAB10MG 1 QL - 30 per 30 days; MO

Vasodilators, Direct-acting Arterial hydralazine inj20mg/ml 1 B/D; MO

hydralazine tab100mg 1 MO




minoxidil tab10mg 1 MO

minoxidil tab2.5mg 1 MO

Vasodilators, Direct-acting Arterial/Venous

isosorb din tab10mg 1 MO



isosorb din tab40mg er 1 MO


isosorb monotab10mg 1 MO

isosorb monotab120mg er 1 MO

isosorb monotab20mg 1 MO



NITRO-DUR DIS0.3MG/HR 1 MO

NITRO-DUR DIS0.8MG/HR 1 MO

nitroglycer dis0.1mg/hr 1 MO


55



nitroglycer inj5mg/ml 1 B/D; MO

nitroglyceridis0.6mg/hr 1 MO

nitroglycrn spr0.4mg 1 MO

NITROMIST AER400MCG 1 MO

NITROSTAT SUB0.3MG 1 MO



CENTRAL NERVOUS SYSTEM AGENTS Attention Deficit Hyperactivity Disorder Agents, Amphetamines amphetamine tab10mg 1 MO

amphetamine tab12.5mg 1 MO

amphetamine tab15mg 1 MO




amphetamine tab7.5mg 1 MO

VYVANSE CAP20MG 1 MO






Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines dexmethylph cap15mg er 1 MO

dexmethylph cap30mg er 1 MO

dexmethylph cap40mg er 1 MO

dexmethylph tab10mg 1 QL - 90 per 30 days; MO

dexmethylph tab2.5mg 1 QL - 90 per 30 days; MO

dexmethylph tab5mg 1 QL - 90 per 30 days; MO

guanfacine tab1mg er 1 MO




methylphenidcap20mg er 1 QL - 60 per 30 days; MO



methylphenidtab10mg 1 MO


methylphenidtab20mg er 1 MO




56




STRATTERA CAP100MG 1 QL - 60 per 30 days; MO







Central Nervous System, Other

NUEDEXTA CAP20-10MG 1 QL - 60 per 30 days; MO

riluzole tab50mg 1 MO

XENAZINE TAB12.5MG 1 LA; PA

XENAZINE TAB25MG 1 LA; PA

Multiple Sclerosis Agents

AVONEX KIT30MCG 1 QL - 4 per 28 days; PA

AVONEX PEN KIT30MCG 1 QL - 4 per 28 days; PA

AVONEX PREFLKIT30MCG 1 QL - 4 per 28 days; PA

BETASERON INJ0.3MG 1 QL - 15 per 30 days; PA

COPAXONE INJ40MG/ML 1

COPAXONE KIT20MG/ML 1

EXTAVIA INJ0.3MG 1 QL - 15 per 30 days

GILENYA CAP0.5MG 1 PA

PLEGRIDY INJPEN 1 QL - 1 per 28 days; PA

PLEGRIDY INJ 1 QL - 1 per 28 days; PA

PLEGRIDY PENINJSTARTER 1 QL - 1 per 28 days; PA

REBIF INJ22/0.5 1 QL - 12 per 30 days; PA

REBIF INJ44/0.5 1 QL - 12 per 30 days; PA

REBIF TITRTNSOLPACK 1 QL - 6 per 30 days; PA

TYSABRI INJ300/15ML 1 LA; PA

DENTAL AND ORAL AGENTS Dental and Oral Agents cevimeline cap30mg 1 MO

chlorhex glusol0.12% 1 MO

doxycycline tab20mg 1 MO

KEPIVANCE INJ6.25MG 1 LA; B/D

periogard sol0.12% 1 MO

pilocarpine tab5mg 1 MO

pilocarpine tab7.5mg 1 MO

triamcin/orapst0.1% 1 MO

DERMATOLOGICAL AGENTS Dermatological Agents 8-MOP CAP10MG 1 PA; MO

57


acitretin cap10mg 1 QL - 60 per 30 days; MO

acitretin cap17.5mg 1 QL - 60 per 30 days; MO

acitretin cap25mg 1 QL - 60 per 30 days; MO

adapalene cre0.1% 1 MO

adapalene gel0.1% 1 MO

adapalene gel0.3% 1 MO

ammonium laccre12% 1 MO

ammonium laclot12% 1 MO

amnesteem cap10mg 1 MO



calcipotriencre0.005% 1 QL - 120 per 30 days

calcipotrienoin0.005% 1 MO

calcipotrienoinbetameth 1 MO

calcipotriensol0.005% 1 MO

claravis cap10mg 1 MO




clindamy/bengel1-5% 1 MO

clotrim/betacrediprop 1 MO

clotrim/betalotdiprop 1 MO

diclofenac gel3% 1 QL - 100 per 30 days; PA; MO

diclofenac sol1.5% 1

ELIDEL CRE1% 1 ST; QL - 30 per 30 days; PA; MO

erythromycingel/benzoyl 1 MO

fluorouracilcre5% 1 MO

imiquimod cre5% 1 MO

methoxsalen cap10mg 1 PA

myorisan cap10mg 1

myorisan cap20mg 1

myorisan cap40mg 1

neuac gel1.2-5% 1

ORACEA CAP40MG 1

OXSORALEN-ULCAP10MG 1 PA*

podofilox sol0.5% 1 MO

SANTYL OIN250/GM 1 QL - 30 per 30 days; MO

selenium sullot2.5% 1 MO

STELARA INJ45MG/0.5 1 PA

STELARA INJ90MG/ML 1 PA

tacrolimus oin0.03% 1 QL - 30 per 30 days; MO

tacrolimus oin0.1% 1 QL - 30 per 30 days; MO

TAZORAC CRE0.05% 1 MO

TAZORAC CRE0.1% 1 MO

58


TAZORAC GEL0.05% 1 MO

TAZORAC GEL0.1% 1 MO

tretinoin cre0.025% 1

tretinoin cre0.05% 1

tretinoin cre0.1% 1

tretinoin gel0.01% 1



tretinoin gel0.1% 1

tretin-x crekit0.05% 1

VALCHLOR GEL0.016% 1

zenatane cap10mg 1

zenatane cap20mg 1

zenatane cap30mg 1

zenatane cap40mg 1

DIABETES SUPPLIES

Diabetes Supplies ALCOHOL PAD 1 MO

GAUZE PAD2"X2" 1 MO

INSULIN SYRGMIS0.3/31G 1 MO



INSULIN SYRGMIS1ML/29G 1 MO

PEN NEEDLES MIS31GX8MM 1 MO

ENZYME REPLACEMENTS/MODIFIERS Enzyme Replacements/Modifiers ADAGEN INJ250/ML 1 LA; PA

ALDURAZYME INJ2.9MG/5M 1 LA; PA

CEREZYME INJ400UNIT 1 LA; PA

CREON CAP12000UNT 1 MO


CREON CAP6000UNIT 1 MO

CYSTADANE POW 1

CYSTAGON CAP150MG 1 LA; MO

CYSTAGON CAP50MG 1 LA; MO

ELAPRASE INJ6MG/3ML 1 LA; PA

FABRAZYME INJ35MG 1 LA; PA

KUVAN TAB100MG 1 LA; PA

MYOZYME INJ50MG 1 LA; PA

NAGLAZYME INJ1MG/ML 1 LA; PA

ZAVESCA CAP100MG 1 LA

ZENPEP CAP10000UNT 1 MO


59




ZENPEP CAP5000UNIT 1 MO

GASTROINTESTINAL AGENTS Antispasmodics, Gastrointestinal atropine sulinj0.1mg/ml 1 B/D; MO

CANTIL TAB25MG 1 MO

dicyclomine cap10mg 1 MO

dicyclomine sol10mg/5ml 1 MO

dicyclomine tab20mg 1 MO

glycopyrrol inj0.2mg/ml 1 MO

glycopyrrol tab1mg 1 MO

glycopyrrol tab2mg 1 MO

methscopolamtab2.5mg 1 MO

methscopolamtab5mg 1 MO

Gastrointestinal Agents

CREON CAP3000UNIT 1 MO


gavilyte-c sol 1 MO

gavilyte-g sol 1 MO

gavilyte-n solflav pk 1 MO

lansopr/amoxmis/clarith 1 QL - 112 per 14 days; MO

trilyte sol 1 MO


ZENPEP CAP3000UNIT 1 MO

Gastrointestinal Agents, Other GENOTROPIN INJ12MG 1 PA; MO

loperamide cap2mg 1 MO

MOVANTIK TAB12.5MG 1 QL - 30 per 30 days; MO

MOVANTIK TAB25MG 1 QL - 30 per 30 days; MO

NUTROPIN AQ INJNUSPIN 5 1 PA

RELISTOR INJ12/0.6ML 1 MO

RELISTOR INJ8/0.4ML 1 MO

RELISTOR KIT12/0.6ML 1 MO

SEROSTIM INJ4MG 1 LA; PA



ursodiol cap300mg 1 MO

ursodiol tab250mg 1 MO

ursodiol tab500mg 1 MO

ZORBTIVE INJ8.8MG 1 LA; PA

Histamine2 (H2) Receptor Antagonists cimetidine sol300/5ml 1 MO

60


cimetidine tab200mg 1 MO




famotidine inj10mg/ml 1 B/D; MO

famotidine inj20mg/50m 1 B/D; MO

famotidine sus40mg/5ml 1 MO

famotidine tab20mg 1 MO

famotidine tab40mg 1 MO

nizatidine cap150mg 1 MO

nizatidine cap300mg 1 MO

nizatidine sol15mg/ml 1 MO

ranitidine cap150mg 1 MO

ranitidine cap300mg 1 MO

ranitidine inj150/6ml 1 B/D; MO

ranitidine syp15mg/ml 1 MO

ranitidine tab150mg 1 MO

ranitidine tab300mg 1 MO

Irritable Bowel Syndrome Agents AMITIZA CAP24MCG 1 QL - 60 per 30 days; MO

AMITIZA CAP8MCG 1 QL - 60 per 30 days; MO

LOTRONEX TAB0.5MG 1 QL - 60 per 30 days

LOTRONEX TAB1MG 1 QL - 60 per 30 days

Laxatives

constulose sol10gm/15 1 MO

enulose sol10gm/15 1 MO

generlac sol10gm/15 1 MO

lactulose sol10gm/15 1 MO

polyeth glycpow3350 nf 1 MO

Protectants

misoprostol tab100mcg 1 MO

misoprostol tab200mcg 1 MO

sucralfate tab1gm 1 MO

Proton Pump Inhibitors

esomepra magcap20mg dr 1 QL - 60 per 30 days; MO

esomeprazoleinj20mg 1 B/D; MO

esomeprazoleinj40mg 1 B/D; MO

lansoprazolecap15mg dr 1 QL - 30 per 30 days; MO

lansoprazolecap30mg dr 1 QL - 30 per 30 days; MO

NEXIUM I.V. INJ20MG 1 B/D; MO

NEXIUM I.V. INJ40MG 1 B/D; MO

omeprazole cap10mg 1 QL - 60 per 30 days; MO


61



pantoprazoleinj40mg 1 MO

pantoprazoletab20mg 1 QL - 30 per 30 days; MO

pantoprazoletab40mg 1 QL - 30 per 30 days; MO

rabeprazole tab20mg 1 QL - 30 per 30 days; MO

GENITOURINARY AGENTS Antispasmodics, Urinary ENABLEX TAB15MG 1 ST; QL - 30 per 30 days; MO

ENABLEX TAB7.5MG 1 ST; QL - 30 per 30 days; MO

flavoxate tab100mg 1 MO

oxybutynin syp5mg/5ml 1 MO

oxybutynin tab10mg er 1 QL - 90 per 30 days; MO


oxybutynin tab5mg 1 MO


OXYTROL DIS3.9MG/24 1 ST; QL - 8 per 28 days; MO

tolterodine cap2mg er 1 QL - 30 per 30 days; MO

tolterodine cap4mg er 1 QL - 30 per 30 days; MO

tolterodine tab1mg 1 QL - 60 per 30 days; MO

tolterodine tab2mg 1 QL - 60 per 30 days; MO

TOVIAZ TAB4MG 1 ST; QL - 30 per 30 days; MO

TOVIAZ TAB8MG 1 ST; QL - 30 per 30 days; MO

trospium cl tab20mg 1 QL - 60 per 30 days; MO

Benign Prostatic Hypertrophy Agents alfuzosin tab10mg 1 MO

AVODART CAP0.5MG 1 ST; QL - 30 per 30 days; MO

finasteride tab5mg 1 QL - 30 per 30 days; MO

tamsulosin cap0.4mg 1 QL - 60 per 30 days; MO

Genitourinary Agents, Other

bethanechol tab10mg 1 MO




DEPEN TITRA TAB250MG 1 MO

Phosphate Binders calc acetatecap667mg 1 MO

eliphos tab667mg 1 MO

FOSRENOL CHW1000MG 1 MO



RENAGEL TAB400MG 1 MO

RENAGEL TAB800MG 1 MO

RENVELA PAK0.8GM 1 MO

62


RENVELA PAK2.4GM 1 MO

RENVELA TAB800MG 1 MO

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (Adrenal)

Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal)

ala cort cre1% 1 MO

alclometasoncre0.05% 1 MO

alclometasonoin0.05% 1 MO

amcinonide cre0.1% 1 MO

amcinonide lot0.1% 1 MO

amcinonide oin0.1% 1 MO

aug betamet cre0.05% 1 MO

aug betamet gel0.05% 1 MO

aug betamet lot0.05% 1 MO

aug betamet oin0.05% 1 MO

betameth dipcre0.05% 1 MO

betameth diplot0.05% 1 MO

betameth dipoin0.05% 1 MO

betameth valaer0.12% 1 MO

betameth valcre0.1% 1 MO

betameth vallot0.1% 1 MO

betameth valoin0.1% 1 MO

budesonide cap3mg/24hr 1 MO

CAPEX SHA0.01% 1 MO

clobetasol gel0.05% 1 MO

clobetasol oin0.05% 1 MO

clobetasol sol0.05% 1 MO

clobetasol spr0.05% 1 MO

clobetasol ecre0.05% 1 MO

colocort ene100mg 1 MO

cortisone actab25mg 1 MO

desonide cre0.05% 1 MO

desonide lot0.05% 1 MO

desonide oin0.05% 1 MO

desoximetas cre0.05% 1 MO

desoximetas cre0.25% 1 MO

desoximetas gel0.05% 1 MO

desoximetas oin0.25% 1 MO

dexameth phoinj120mg/30 1 B/D; MO

dexamethasoncon1mg/ml 1 MO

dexamethasonelx0.5/5ml 1 MO

dexamethasontab0.5mg 1 MO


63



dexamethasontab1mg 1 MO




diflorasone cre0.05% 1 MO

diflorasone oin0.05% 1 MO

fludrocort tab0.1mg 1 MO

fluocin acetcre0.01% 1 MO

fluocin acetcre0.025% 1 MO

fluocin acetoin0.025% 1 MO

fluocin acetsol0.01% 1 MO

fluocinonidecre0.1% 1 MO

fluocinonidecre-e 0.05% 1 MO

fluocinonidegel0.05% 1 MO

fluocinonideoin0.05% 1 MO

fluocinonidesol0.05% 1 MO

fluticasone cre0.05% 1 MO

fluticasone oin0.005% 1 MO

halobetasol cre0.05% 1 MO

halobetasol oin0.05% 1 MO

HALOG CRE0.1% 1 MO

HALOG OIN0.1% 1 MO

hc butyrate cre0.1% 1 MO

hc valerate cre0.2% 1 MO

hc valerate oin0.2% 1 MO

hydrocort cre1% 1 MO

hydrocort cre2.5% 1 MO

hydrocort ene100mg 1 MO

hydrocort lot2.5% 1 MO

hydrocort oin1% 1 MO

hydrocort oin2.5% 1 MO

hydrocort tab10mg 1 MO



lokara lot0.05% 1 MO

methylpr aceinj40mg/ml 1 B/D; MO

methylpr aceinj80mg/ml 1 B/D; MO

methylpr ss inj125mg 1 B/D; MO

methylpr ss inj40mg 1 B/D; MO

methylpred pak4mg 1 MO

methylpred tab16mg 1 MO



64



mometasone cre0.1% 1 MO

mometasone oin0.1% 1 MO

mometasone sol0.1% 1 MO

pred sod phosol5mg/5ml 1 MO

prednicarbatcre0.1% 1 MO

prednicarbatoin0.1% 1 MO

prednisolonesol15mg/5ml 1 MO

prednisolonetab10mg odt 1 MO



prednisone con5mg/ml 1 MO

prednisone sol5mg/5ml 1 MO

prednisone tab10mg 1 MO


prednisone tab2.5mg 1 MO




procto-pak cre1% 1 MO

proctozone cre-hc 2.5% 1 MO

triamcinoloncre0.025% 1 MO



triamcinolonlot0.025% 1 MO

triamcinolonlot0.1% 1 MO

triamcinolonoin0.025% 1 MO



triamcinolonspr55mcg/ac 1 QL - 33 per 30 days; MO

triderm cre0.1% 1 MO

u-cort cre1% 1 MO

veripred 20 sol20mg/5ml 1 MO

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (PITUITARY)

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) desmopressininj4mcg/ml 1 B/D; MO

desmopressinspr0.01% 1 MO

desmopressintab0.1mg 1 MO

desmopressintab0.2mg 1 MO

GENOTROPIN INJ0.2MG 1 PA; MO


65








GENOTROPIN INJ1MG 1 PA; MO

GENOTROPIN INJ2MG 1 PA; MO

GENOTROPIN INJ5MG 1 PA

HUMATROPE INJ12MG 1 PA




INCRELEX INJ40MG/4ML 1 LA; PA

NORDITROPIN INJ10/1.5ML 1 PA



NUTROPIN AQ INJ10MG/2ML 1 PA

NUTROPIN AQ INJ20MG/2ML 1 PA

OMNITROPE INJ10/1.5ML 1 PA

OMNITROPE INJ5.8MG 1 PA

OMNITROPE INJ5/1.5ML 1 PA

SAIZEN INJ5MG 1 PA

SAIZEN INJ8.8MG 1 PA

STIMATE SOL1.5MG/ML 1 MO

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (SEX HORMONES/MODIFIERS)

Androgens

ANDROGEL GEL1%(50MG) 1 QL - 300 per 30 days; MO

ANDROGEL GEL1.62% 1 MO

ANDROGEL GELPUMP 1% 1 QL - 300 per 30 days; MO

ANDROXY TAB10MG 1 MO

AXIRON SOL30MG/ACT 1 MO

danazol cap100mg 1 MO



testost cyp inj100mg/ml 1 B/D; MO

testost cyp inj200mg/ml 1 B/D; MO

testost enaninj200mg/ml 1 B/D; MO

Estrogens ALORA DIS0.025MG 1 QL - 8 per 28 days; MO

ALORA DIS0.05MG 1 QL - 8 per 28 days; MO

66




estrace vag cre0.1mg/gm 1 MO

estrad val inj20mg/ml 1 MO

estradiol dis0.025mg 1 QL - 4 per 28 days; MO











estradiol tab0.5mg 1 MO

estradiol tab1mg 1 MO

estradiol tab2mg 1 MO

ESTRING MIS2MG 1 QL - 1 per 90 days; MO

menest tab0.3mg 1 MO




PREMARIN INJ25MG 1 B/D; MO

PREMARIN TAB0.3MG 1 MO





PREMARIN VAGCRE0.625MG 1 MO

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

apri tab 1 MO

aranelle tab 1 MO

aubra tab0.1-0.02 1 MO

aviane tab 1 MO

balziva tab 1 MO

cryselle-28 tab28 tabs 1 MO

delyla tab0.1-0.02 1 MO

DUAVEE TAB0.45-20 1 MO

enpresse-28 tab 1 MO

estra/norethtab1-0.5mg 1 MO

falmina tab 1 MO

gildess tab1.5/30 1 MO

jinteli tab1mg-5mcg 1 MO

67


junel 1.5/30tab 1 MO

junel 1/20 tab 1 MO

junel fe tab1.5/30 1 MO

junel fe tab1/20 1 MO

kariva tab28 day 1 MO

kelnor tab1/35 1 MO

larin tab1.5/30 1 MO

lessina tab 1 MO

levora-28 tab0.15/30 1 MO

lomedia 24 tabfe 1 MO

low-ogestreltab 1 MO

lutera tab 1 MO

microgestin tab1.5/30 1 MO

microgestin tab1/20 1 MO

microgestin tabfe 1/20 1 MO

microgestin tabfe1.5/30 1 MO

necon tab0.5/35 1 MO

necon tab1/35 1 MO

necon tab10/11-28 1 MO

nortrel tab0.5/35 1 MO

nortrel tab1/35 1 MO

nortrel tab1/35 1 MO

nortrel tab7/7/7 1 MO

NUVARING MIS 1 MO

ogestrel tab 1 MO

ORTHO EVRA DISWEEK 1 MO

oxandrolone tab10mg 1 MO

oxandrolone tab2.5mg 1 MO

portia-28 tab 1 MO

PREFEST TAB 1 MO

PREMPHASE TAB 1 MO

PREMPRO TAB.625-2.5 1 MO

PREMPRO TAB0.3-1.5 1 MO

PREMPRO TAB0.45-1.5 1 MO

PREMPRO TAB0.625-5 1 MO

previfem tab 1 MO

quasense tab 1 MO

reclipsen tab 1 MO

sprintec 28 tab28 day 1 MO

sronyx tab 1 MO

tri-legest tabfe 1 MO

tri-previfemtab 1 MO

tri-sprintectab 1 MO

trivora-28 tab 1 MO

68


velivet pak 1 MO

xulane dis150-35 1 MO

zovia 1/35e tab 1 MO

zovia 1/50e tab 1 MO

Progesterone Agonists/Antagonists

ELLA TAB30MG 1 MO

Progestins

camila tab0.35mg 1 MO

CRINONE GEL8% VAG 1 MO

DEPO-PROVERAINJ150MG/ML 1 QL - 1 per 90 days; MO

DEPO-PROVERAINJ400/ML 1 MO

errin tab0.35mg 1 MO

medroxypr acinj150mg/ml 1 QL - 1 per 90 days; MO

medroxypr actab10mg 1 MO

medroxypr actab2.5mg 1 MO

medroxypr actab5mg 1 MO

MEGACE ES SUS625/5ML 1 MO

megestrol acsus40mg/ml 1 MO

megestrol actab20mg 1 MO

megestrol actab40mg 1 MO

norethin acetab5mg 1 MO

Selective Estrogen Receptor Modifying Agents raloxifene tab60mg 1 MO

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (THYROID)

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) levothyroxintab100mcg 1 MO

levothyroxintab112mcg 1 MO











liothyronineinj10mcg/ml 1 MO

liothyroninetab25mcg 1 MO



69


SYNTHROID TAB100MCG 1 MO












HORMONAL AGENTS, SUPPRESSANT (ADRENAL) Hormonal Agents, Suppressant (Adrenal) LYSODREN TAB500MG 1 MO

HORMONAL AGENTS, SUPPRESSANT (PARATHYROID)

Hormonal Agents, Suppressant (Parathyroid) SENSIPAR TAB30MG 1 MO

SENSIPAR TAB60MG 1

SENSIPAR TAB90MG 1

HORMONAL AGENTS, SUPPRESSANT (PITUITARY) Hormonal Agents, Suppressant (Pituitary) cabergoline tab0.5mg 1 MO

FIRMAGON INJ120MG 1

leuprolide inj1mg/0.2 1 MO

LUPR DEP-PEDINJ11.25MG 1 PA

LUPR DEP-PEDINJ15MG 1 PA

LUPRON DEPOTINJ11.25MG 1 PA; MO



LUPRON DEPOTINJ30MG 1 PA; MO

LUPRON DEPOTINJ45MG 1 B/D

LUPRON DEPOTINJ7.5MG 1

octreotide inj1000mcg 1 PA

octreotide inj100mcg 1 PA; MO

octreotide inj200mcg 1 PA; MO

octreotide inj500mcg 1 PA

octreotide inj50mcg/ml 1 PA; MO

SANDOSTATIN KITLAR 10MG 1 PA



70


SOMATULINE INJ120/.5ML 1

SOMATULINE INJ60/0.2ML 1

SOMATULINE INJ90/0.3ML 1

SOMAVERT INJ10MG 1 LA; PA





SYNAREL SOL2MG/ML 1 PA

TRELSTAR DEPINJ3.75MG 1

TRELSTAR LA INJ11.25MG 1

TRELSTAR MIXINJ22.5MG 1

HORMONAL AGENTS, SUPPRESSANT (THYROID) Antithyroid Agents

methimazole tab10mg 1 MO

methimazole tab5mg 1 MO

propylthiourtab50mg 1 MO

IMMUNOLOGICAL AGENTS Angioedema (HAE) Agents

CINRYZE SOL500 UNIT 1 LA; B/D

FIRAZYR INJ30MG/3ML 1 QL - 9 per 30 days; PA

Immune Suppressants ASTAGRAF XL CAP0.5MG 1 B/D; MO

ASTAGRAF XL CAP1MG 1 B/D; MO

ASTAGRAF XL CAP5MG 1 B/D; MO

azasan tab100mg 1 B/D

azasan tab75 mg 1 B/D

azathioprinetab50mg 1 B/D

CELLCEPT SUS200MG/ML 1 B/D

CELLCEPT IV INJ500MG 1 B/D

CIMZIA KIT 1 PA

CIMZIA PREFLKIT200MG/ML 1 PA

cyclosporinecap100mg 1 B/D

cyclosporinecap100mg md 1 B/D

cyclosporinecap25mg 1 B/D

cyclosporinecap25mg mod 1 B/D

cyclosporinecap50mg mod 1 B/D

cyclosporineinj50mg/ml 1 B/D

cyclosporinesolmodified 1 B/D

ENBREL INJ25/0.5ML 1 QL - 8 per 28 days; PA

ENBREL INJ25MG 1 QL - 16 per 28 days; PA

ENBREL INJ50MG/ML 1 QL - 8 per 28 days; PA

ENBREL SRCLKINJ50MG/ML 1 QL - 8 per 28 days; PA

71


gengraf cap100mg 1 B/D

gengraf cap25mg 1 B/D

gengraf sol100mg/ml 1 B/D

HUMIRA INJ10MG/0.2 1 QL - 6 per 28 days; PA

HUMIRA KIT20MG/0.4 1 QL - 8 per 28 days; PA

HUMIRA KIT40MG/0.8 1 QL - 8 per 28 days; PA

HUMIRA PEN KITCROHNS 1 QL - 8 per 28 days; PA

KINERET INJ 1 PA

methotrexateinj1gm 1 B/D

methotrexateinj25mg/ml 1 B/D

methotrexatetab2.5mg 1

mycophenolatcap250mg 1 B/D

mycophenolattab500mg 1 B/D

mycophenolatsus200mg/ml 1 B/D

mycophenolictab180mg dr 1 B/D

mycophenolictab360mg dr 1 B/D

ORENCIA INJ125MG/ML 1 PA

ORENCIA INJ250MG 1 PA

OTREXUP INJ10MG 1 B/D




OTREXUP INJ7.5/0.4MG 1 B/D

PROGRAF INJ5MG/ML 1 B/D

RAPAMUNE SOL1MG/ML 1 B/D

RAPAMUNE TAB1MG 1 B/D

RAPAMUNE TAB2MG 1 B/D

REMICADE INJ100MG 1 PA

RHEUMATREX TAB2.5MG 1

SIMPONI INJ50MG 1 PA

sirolimus tab0.5mg 1 B/D

sirolimus tab1mg 1 B/D

sirolimus tab2mg 1 B/D

tacrolimus cap0.5mg 1 B/D

tacrolimus cap1mg 1 B/D

tacrolimus cap5mg 1 B/D

TORISEL SOL25MG/ML 1

trexall tab10mg 1

trexall tab15mg 1

trexall tab5mg 1

trexall tab7.5mg 1

ZORTRESS TAB0.25MG 1 QL - 60 per 30 days; B/D



72


Immunizing Agents, Passive CARIMUNE NF INJ3GM 1 PA

GAMASTAN S/DINJ 1 PA

GAMMAGARD INJ2.5GM/25 1 PA

HYPERRAB S/DINJ150/ML 1

PRIVIGEN INJ20GRAMS 1 B/D

THYMOGLOBULNINJ25MG 1 PA

VARIZIG INJ125UNIT 1

Immunological Agents

NULOJIX INJ250MG 1 B/D

SIMULECT INJ20MG 1 B/D

SYNAGIS INJ50MG 1 LA

Immunomodulators

ACTEMRA INJ200/10ML 1 PA

ACTIMMUNE INJ2MU/0.5 1 LA; B/D

ARCALYST INJ220MG 1 LA; PA

ILARIS INJ180MG 1 LA; B/D

leflunomide tab10mg 1 QL - 30 per 30 days

leflunomide tab20mg 1 QL - 30 per 30 days

RIDAURA CAP3MG 1

Vaccines ACTHIB INJ 1

ADACEL INJ 1

BEXSERO INJ 1

BOOSTRIX INJ 1

BOOSTRIX INJ 1

CERVARIX INJ 1

COMVAX INJ 1

DAPTACEL INJ 1

DIP/TET PED INJ25-5LFU 1

ENGERIX-B INJ10/0.5ML 1 B/D

ENGERIX-B INJ10/0.5ML 1 B/D

ENGERIX-B INJ20MCG/ML 1 B/D

GARDASIL INJ 1 PA

HAVRIX INJ1440UNIT 1

HAVRIX INJ720UNIT 1

IMOVAX RABIEINJ2.5/ML 1

INFANRIX INJ 1

IPOL INJINACTIVE 1

IXIARO INJ 1

MENACTRA INJ 1

MENOMUNE INJA/C/Y/W 1

MENVEO INJ 1

73


M-M-R II INJLIVE 1

PEDVAX HIB INJ 1

PROQUAD INJ 1

QUADRACEL INJ

RABAVERT INJ 1

RECOMBIVA HBINJ5MCG/0.5ML

1 B/D

RECOMBIVA HBINJ10MCG/ML 1 B/D

RECOMBIVA-HBINJ40MCG/ML 1 B/D

ROTARIX SUS 1

ROTATEQ SOL 1

TET/DIP TOX INJ2-2 LF 1

TETANUS TOX INJ5LF ADS 1

TRUMENBA INJ 1

TWINRIX INJ 1

TYPHIM VI INJ 1

VAQTA INJ25/0.5ML 1

VAQTA INJ50UNT/ML 1

VARIVAX INJ 1

YF-VAX INJ 1

ZOSTAVAX INJ 1 PA

INFLAMMATORY BOWEL DISEASE AGENTS Aminosalicylates ASACOL HD TAB800MG 1 MO

balsalazide cap750mg 1 MO

CANASA SUP1000MG 1 MO

DELZICOL CAP400MG 1 MO

DIPENTUM CAP250MG 1 MO

mesalamine kit4gm 1 MO

PENTASA CAP250MG CR 1 MO

PENTASA CAP500MG CR 1 MO

Sulfonamides sulfasalazintab500mg 1 MO

sulfazine ectab500mg 1 MO

METABOLIC BONE DISEASE AGENTS Metabolic Bone Disease Agents alendronate sol70/75ml 1

alendronate tab10mg 1 QL - 120 per 30 days; MO





calcitonin spr200/act 1 MO

74


calcitriol cap0.25mcg 1 MO

calcitriol cap0.5mcg 1 MO

calcitriol inj1mcg/ml 1 B/D; MO

calcitriol sol1mcg/ml 1 MO

doxercalcif cap0.5mcg 1 MO

doxercalcif cap1mcg 1 MO

doxercalcif cap2.5mcg 1 MO

etidron disdtab200mg 1 MO

etidron disdtab400mg 1 MO

FORTEO SOL600/2.4 1 PA

FORTICAL SPR200/ACT 1 MO

ibandronate inj3mg/3ml 1 QL - 1 per 30 days; MO

ibandronate tab150mg 1 QL - 1 per 30 days; MO

MIACALCIN INJ200/ML 1 PA; MO

pamidronate inj30/10ml 1 B/D; MO

pamidronate inj6mg/ml 1 B/D; MO

pamidronate inj90/10ml 1 B/D; MO

paricalcitolcap1 mcg 1 PA; MO



paricalcitolinj2mcg/ml 1 PA; MO

paricalcitolinj5mcg/ml 1 PA; MO

PROLIA SOL60MG/ML 1 B/D; MO

risedronate tab150mg 1 QL - 5 per 30 days

XGEVA INJ 1

ZEMPLAR INJ2MCG/ML 1 PA; MO

ZEMPLAR INJ5MCG/ML 1 PA; MO

zoledronic inj4mg/5ml 1 B/D; MO

zoledronic inj5/100ml 1 B/D; MO

OPHTHALMIC AGENTS Ophthalmic Agents bacit/polymyoinop 1 MO

blephamide oins.o.p. 1 MO

BLEPHAMIDE SUSOP 1 MO

dorzol/timolsol2-0.5%op 1 MO

neo/bac/polyoinop 1 MO

neo/poly/bacoin/hc 1%op 1 MO

neo/poly/dexoin0.1% op 1 MO

neo/poly/dexsus0.1% op 1 MO

neo/poly/grasolop 1 MO

neo/poly/hc susop 1 MO

polymyxin b/soltrimethp 1 MO

prednisolonesus1% op 1 MO

75


PRED-G SUSOP 1 MO

PRED-G S.O.POINOP 1 MO

proparacainesol0.5% op 1 MO

sulf/pred nasolop 1 MO

tobra/dexamesus0.3-0.1% 1 MO

Ophthalmic Agents, Other

naphazoline sol0.1% op 1 MO

RESTASIS EMU0.05% 1 QL - 60 per 30 days; MO

Ophthalmic Anti-allergy Agents ALOCRIL SOL2% 1 MO

ALOMIDE SOL0.1% OP 1 MO

azelastine dro0.05% 1 MO

cromolyn sodsol4% op 1 MO

epinastine dro0.05% 1 MO

PATANOL SOL0.1% OP 1 MO

Ophthalmic Antiglaucoma Agents ALPHAGAN P SOL0.1% 1 MO

apraclonidinsol0.5% op 1 MO

AZOPT SUS1% OP 1 MO

betaxolol sol0.5% op 1 MO

BETOPTIC-S SUS0.25% OP 1 MO

brimonidine sol0.15% 1 MO

brimonidine sol0.2% op 1 MO

carteolol sol1% op 1 MO

dorzolamide sol2% op 1 MO

IOPIDINE SOL1% OP 1 MO

levobunolol sol0.5% op 1 MO

metipranololsol0.3% oph 1 MO

pilocarpine sol4% op 1 MO

PHOSPHOLINE SOL0.125%OP 1 MO

timolol gel sol0.25% op 1 MO

timolol gel sol0.5% op 1 MO

timolol mal sol0.25% op 1 MO

timolol mal sol0.5% op 1 MO

Ophthalmic Anti-inflammatories ALREX SUS0.2% 1 MO

bromfenac sol0.09% 1 MO

dexameth phosol0.1% op 1 MO

diclofenac sol0.1% op 1 MO

FLAREX SUS0.1% OP 1 MO

fluorometholsus0.1% op 1 MO

flurbiprofensol0.03% op 1 MO

FML OIN0.1% OP 1 MO

FML FORTE SUS0.25% OP 1 MO

76


ketorolac sol0.4% 1 MO

ketorolac sol0.5% 1 MO

LOTEMAX SUS0.5% 1 MO

MAXIDEX SUS0.1% OP 1 MO

NEVANAC SUS0.1% 1 MO

PRED MILD SUS0.12% OP 1 MO

pred sod phosol1% op 1 MO

VEXOL SUS1% OP 1 MO

Ophthalmic Prostaglandin and Prostamide Analogs latanoprost sol0.005% 1 QL - 5 per 30 days; MO

LUMIGAN SOL0.01% 1 QL - 7.5 per 30 days; MO

travoprost dro0.004% 1 MO

OTIC AGENTS Otic Agents acetasol hc solotic 1 MO

CIPRO HC SUSOTIC 1 MO

CIPRODEX SUS0.3-0.1% 1 MO

COLY-MYCIN SSUSOTIC 1 MO

hc/acet acidsolotic 1 MO

neo/poly/hc sol1% otic 1 MO

neo/poly/hc sus1% otic 1 MO

RESPIRATORY TRACT/PULMONARY AGENTS Antihistamines ASTEPRO SPR0.15% 1 QL - 60 per 30 days; MO

azelastine spr0.1% 1 QL - 30 per 30 days; MO

azelastine spr0.15% 1 QL - 60 per 30 days; MO

carbinoxaminsol4mg/5ml 1 MO

carbinoxamintab4mg 1 MO

cetirizine syp5mg/5ml 1 MO

clemastine tab2.68mg 1 MO

cyproheptad syp2mg/5ml 1 MO

cyproheptad tab4mg 1 MO

desloratadintab5mg 1 QL - 30 per 30 days; MO

levocetirizisol2.5/5ml 1 MO

levocetirizitab5mg 1 QL - 30 per 30 days; MO

olopatadine spr0.6% 1

Anti-inflammatories, Inhaled Corticosteroids

ASMANEX 120 AER220MCG 1 QL - 2 per 30 days; MO




BECONASE AQ SUS0.042% 1 QL - 50 per 30 days; MO

budesonide sus32mcg 1 QL - 17.20 per 30 days; MO

77


FLOVENT DISKAER100MCG 1 QL - 120 per 30 days; MO



FLOVENT HFA AER110MCG 1 QL - 24 per 30 days; MO

FLOVENT HFA AER220MCG 1 QL - 24 per 30 days; MO

FLOVENT HFA AER44MCG 1 QL - 21.2 per 30 days; MO

flunisolide spr0.025% 1 QL - 50 per 30 days; MO

fluticasone spr50mcg 1 QL - 16 per 30 days; MO

PULMICORT INH180MCG 1 QL - 2 per 30 days; MO

PULMICORT INH90MCG 1 QL - 2 per 30 days; MO

PULMICORT SUS0.25MG/2 1 B/D; MO

PULMICORT SUS0.5MG/2 1 B/D; MO

PULMICORT SUS1MG/2ML 1 B/D; MO

QVAR AER40MCG 1 QL - 21.9 per 30 days; MO

QVAR AER80MCG 1 QL - 21.9 per 30 days; MO

RHINOCORT SUSAQUA 1 QL - 17.2 per 30 days; MO

VERAMYST SPR27.5MCG 1 QL - 20 per 30 days; MO

Antileukotrienes montelukast chw4mg 1 QL - 30 per 30 days; MO

montelukast chw5mg 1 QL - 30 per 30 days; MO

montelukast gra4mg 1 MO

montelukast tab10mg 1 QL - 30 per 30 days; MO

zafirlukast tab10mg 1 QL - 60 per 30 days; MO

zafirlukast tab20mg 1 QL - 60 per 30 days; MO

ZYFLO CR TAB600MG 1 QL - 120 per 30 days; MO

Bronchodilators, Anticholinergic ATROVENT HFAAER17MCG 1 QL - 25.8 per 30 days; MO

INCRUSE ELPTINH62.5MCG 1 QL - 30 per 30 days; MO

ipratropium sol0.02%inh 1 B/D; MO

ipratropium spr0.03% 1 QL - 30 per 30 days; MO

ipratropium spr0.06% 1 QL - 30 per 30 days; MO

SPIRIVA CAPHANDIHLR 1 QL - 90 per 30 days; MO

Bronchodilators, Sympathomimetic albuterol neb0.083% 1 B/D; MO

albuterol neb0.5% 1 B/D; MO

albuterol neb0.63mg/3 1 B/D; MO

albuterol neb1.25mg/3 1 B/D; MO

albuterol syp2mg/5ml 1 MO

albuterol tab2mg 1 MO

albuterol tab4mg 1 MO

albuterol tab4mg er 1 MO

albuterol tab8mg er 1 MO

ARCAPTA CAP75MCG 1 QL - 30 per 30 days; MO

EPIPEN 2-PAKINJ0.3MG 1 QL - 1 per 30 days; MO

78


EPIPEN-JR INJ2-PAK 1 QL - 1 per 30 days; MO

FORADIL CAPAEROLIZE 1 QL - 60 per 30 days; MO

metaproterensyp10mg/5ml 1 MO

metaproterentab10mg 1 MO

metaproterentab20mg 1 MO

PROAIR HFA AER 1 QL - 17 per 30 days; MO

PROVENTIL AERHFA 1 QL - 13.4 per 30 days; MO

SEREVENT DISAER50MCG 1 QL - 60 per 30 days; MO

terbutaline inj1mg/ml 1 B/D; MO

terbutaline tab2.5mg 1 MO

terbutaline tab5mg 1 MO

VENTOLIN HFAAER 1 QL - 36 per 30 days; MO

vospire er tab4mg 1 MO

vospire er tab8mg 1 MO

Cystic Fibrosis Agents CAYSTON INH75MG 1 LA

TOBI PODHALRCAP28MG 1

Mast Cell Stabilizers

cromolyn sodcon100/5ml 1 MO

cromolyn sodneb20mg/2ml 1 B/D; MO

Phosphodiesterase Inhibitors, Airways Disease

DALIRESP TAB500MCG 1 QL - 30 per 30 days; MO

lufyllin tab200mg 1 MO

lufyllin tab400mg 1 MO

theophyllinetab100mg cr 1 MO

theophyllinetab200mg cr 1 MO

theophyllinetab300mg er 1 MO




Pulmonary Antihypertensives

ADCIRCA TAB20MG 1 QL - 60 per 30 days; PA

LETAIRIS TAB10MG 1 LA; PA

LETAIRIS TAB5MG 1 LA; PA

REMODULIN INJ10MG/ML 1 LA; PA


REMODULIN INJ2.5MG/ML 1 LA; PA


sildenafil tab20mg 1 QL - 90 per 30 days; PA; MO

TRACLEER TAB125MG 1 LA; PA

TRACLEER TAB62.5MG 1 LA; PA

Respiratory Tract Agents, Other acetylcyst sol10% 1 B/D; MO

acetylcyst sol20% 1 B/D; MO

79


ADVAIR DISKUAER100/50 1 QL - 60 per 30 days; MO



ADVAIR HFA AER115/21 1 QL - 12 per 30 days; MO



ANORO ELLIPTAER62.5-25 1 MO

ARALAST NP INJ400MG 1 LA; PA*

BREO ELLIPTAINH100-25 1 QL - 60 per 30 days; MO

BREO ELLIPTAINH200-25 1 QL - 60 per 30 days; MO

SYMBICORT AER160-4.5 1 QL - 10.2 per 30 days; MO

SYMBICORT AER80-4.5 1 QL - 10.2 per 30 days; MO

tyzine ped dro0.05% 1 MO

ZEMAIRA INJ1000MG 1 LA; PA

Respiratory Tract/Pulmonary Agents COMBIVENT AERRESPIMAT 1 QL - 4 per 20 days; MO

PULMOZYME SOL1MG/ML 1 PA

XOLAIR SOL150MG 1 LA; PA

SKELETAL MUSCLE RELAXANTS Skeletal Muscle Relaxants cyclobenzaprtab10mg 1 MO

cyclobenzaprtab5mg 1 MO

orphenadrineinj30mg/ml 1 B/D; MO

SLEEP DISORDER AGENTS GABA Receptor Modulators eszopiclone tab1mg 1 QL - 30 per 30 days

eszopiclone tab2mg 1 QL - 30 per 30 days

eszopiclone tab3mg 1 QL - 30 per 30 days

zaleplon cap10mg 1 QL - 60 per 30 days;

zaleplon cap5mg 1 QL - 30 per 30 days;

zolpidem tab10mg 1 QL - 30 per 30 days;

zolpidem tab5mg 1 QL - 30 per 30 days;

zolpidem er tab12.5mg 1 QL - 30 per 30 days;

zolpidem er tab6.25mg 1 QL - 30 per 30 days;

Sleep Disorders, Other

NUVIGIL TAB150MG 1 PA




ROZEREM TAB8MG 1 ST; QL - 30 per 30 days

XYREM SOL500MG/ML 1 LA; PA

80


THERAPEUTIC NUTRIENTS/MINERALS/ELECTROLYTES

Therapeutic Nutrients/Minerals/Electrolytes

AMINOSYN INJ8.5/LYTE 1 B/D

AMINOSYN II INJ10% 1 B/D

AMINOSYN II INJ7% 1 B/D

AMINOSYN II INJ8.5% 1 B/D

AMINOSYN II INJ8.5/LYTE 1 B/D

AMINOSYN M INJ3.5% 1 B/D

AMINOSYN-HBCINJ7% 1 B/D

AMINOSYN-PF INJ10% 1 B/D

AMINOSYN-PF INJ7% 1 B/D

D10W/NACL INJ0.2% 1 B/D


d2.5w/nacl inj0.45% 1 B/D

d5w/lr inj 1 B/D

d5w/nacl inj0.2% 1 B/D





dextrose inj10% 1 B/D

dextrose inj5% 1 B/D

fomepizole inj1gm/ml 1 B/D

intralipid inj20% 1 B/D

kcl/d5w inj0.15% 1 B/D

kcl/d5w inj0.3% 1 B/D

kcl/d5w/lr inj0.15% 1 B/D

kcl/d5w/naclinj.075/.45 1 B/D

kcl/d5w/naclinj.15/.33% 1 B/D

kcl/d5w/naclinj.15/.45% 1 B/D

kcl/d5w/naclinj.22/.45 1 B/D

KCL/D5W/NACLINJ0.15/0.2 1 B/D

kcl/d5w/naclinj0.15/0.2 1 B/D



kcl/d5w/naclinj0.3/0.9% 1 B/D

lactated rininj 1 B/D

lactated rinsolirrigat 1

levocarnitininj200mg/ml 1 B/D

levocarnitinsol1gm/10ml 1

levocarnitintab330mg 1

ringers inj 1 B/D

81


ringers irr sol 1

SOD LACTATE INJ5MEQ/ML 1 B/D

TPN ELECTROLINJ 1 B/D

TRAVASOL INJ10% 1 B/D

TROPHAMINE INJ10% 1 B/D

Electrolyte/Mineral Modifiers

CHEMET CAP100MG 1

EXJADE TAB125MG 1 LA; PA



kionex pow 1

sod poly sulsus15gm/60 1

SYPRINE CAP250MG 1

Electrolyte/Mineral Replacement

ammonium chlinj5meq/ml 1 B/D

fluoride chw1mg f 1

kcl in nacl inj 1 B/D

klor-con 10 tab10meq er 1


klor-con m15tab 1

klor-con m20tab20meq er 1

magnesium suinj50% 1 B/D

PHYSIOSOL SOLIRRIGAT 1

pot chloridecap10meq er 1


pot chlorideinj2meq/ml 1 B/D

pot citrate tab1080mg 1



pot cl microtab10meq er 1


sod chlorideinj0.45% 1 B/D


sod chlorideinj2.5/ml 1 B/D

sod chlorideinj3% 1 B/D


sodium chlorsol0.9% irr 1

ammonium chlinj5meq/ml 1 B/D

kcl in nacl inj 1 B/D



klor-con m15tab 1

klor-con m20tab20meq er 1

magnesium suinj50% 1 B/D

82


PHYSIOSOL SOLIRRIGAT 1



pot chlorideinj2meq/ml 1 B/D







sod chlorideinj2.5/ml 1 B/D



sodium chlorsol0.9% irr 1

83

Index of Drugs UTherapeutic Classes and Categories Therapeutic Categories are listed in Bold Therapeutic Classes are also listed in Bold 1st Generation/Typical ..................... 31 2nd Generation/Atypical .................. 32 8-MOP CAP10MG ........................ 56 abacav/lamivtab/zidovud .................... 36 abacavir tab300mg .......................... 36 ABELCET INJ5MG/ML ................... 22 ABILIFY INJ9.75MG ....................... 17 ABILIFY SOL1MG/ML .................... 17 ABILIFY TAB10MG ........................ 17 ABILIFY TAB15MG ........................ 17 ABILIFY TAB20MG ........................ 17 ABILIFY TAB2MG .......................... 17 ABILIFY TAB30MG ........................ 17 ABILIFY TAB5MG .......................... 17 ABILIFY DISCTAB10MG .................... 17 ABILIFY DISCTAB15MG .................... 18 ABILIFY MAININJ300MG ................... 18 ABILIFY MAININJ400MG ................... 18 acampro cal tab333mg ......................... 5 acarbose tab100mg ......................... 39 acarbose tab25mg........................... 39 acarbose tab50mg........................... 39 acebutolol cap200mg ........................ 46 acebutolol cap400mg ........................ 46 acetasol hc solotic .............................. 76 acetazolamidcap500mg er ................. 52 acetazolamidinj500mg ........................ 52 acetazolamidtab125mg ...................... 52 acetazolamidtab250mg ...................... 52 acetic acid sol2% otic ........................... 7 acetylcyst sol10% .............................. 78 acetylcyst sol20% .............................. 78 acitretin cap10mg ............................. 57 acitretin cap17.5mg .......................... 57 acitretin cap25mg ............................. 57 ACTEMRA INJ200/10ML ............... 72 ACTHIB INJ ................................... 72 ACTIMMUNE INJ2MU/0.5 ................ 72 acyclovir cap200mg .......................... 35 acyclovir oin5% ................................ 35

acyclovir sus200/5ml ........................ 35 acyclovir tab400mg .......................... 35 acyclovir tab800mg .......................... 35 acyclovir nainj500mg .......................... 35 ADACEL INJ ................................. 72 ADAGEN INJ250/ML ..................... 58 adapalene cre0.1% .......................... 57 adapalene gel0.1%........................... 57 adapalene gel0.3%........................... 57 ADCIRCA TAB20MG ..................... 78 adefov dipivtab10mg .......................... 34 adrucil inj500/10ml ............................. 27 ADVAIR DISKUAER100/50 ................ 79 ADVAIR DISKUAER250/50 ................ 79 ADVAIR DISKUAER500/50 ................ 79 ADVAIR HFA AER115/21 ................. 79 ADVAIR HFA AER230/21 ................. 79 ADVAIR HFA AER45/21 ................... 79 afeditab tab30mg cr ......................... 47 afeditab tab60mg cr ......................... 47 AFINITOR TAB10MG ...................... 28 AFINITOR TAB2.5MG ..................... 28 AFINITOR TAB5MG ........................ 28 AFINITOR TAB7.5MG ..................... 28 AFINITOR DISTAB2MG ..................... 28 AFINITOR DISTAB3MG ..................... 28 AFINITOR DISTAB5MG ..................... 28 AGGRENOX CAP25-200MG .......... 43 ala cort cre1% ................................. 62 alagesic lq sol ....................................... 1 ALBENZA TAB200MG ................... 29 albuterol neb0.083% ........................ 77 albuterol neb0.5% ............................ 77 albuterol neb0.63mg/3 ...................... 77 albuterol neb1.25mg/3 ...................... 77 albuterol syp2mg/5ml ....................... 77 albuterol tab2mg .............................. 77 albuterol tab4mg .............................. 77 albuterol tab4mg er .......................... 77 albuterol tab8mg er .......................... 77

84

alclometasoncre0.05% ....................... 62 alclometasonoin0.05% ....................... 62 ALCOHOL PAD .............................. 58 Alcohol Deterrents/Anti-craving ....... 5 ALDURAZYME INJ2.9MG/5M ........... 58 alendronate sol70/75ml ...................... 73 alendronate tab10mg ......................... 73 alendronate tab35mg ......................... 73 alendronate tab40mg ......................... 73 alendronate tab5mg ........................... 73 alendronate tab70mg ......................... 73 alfuzosin tab10mg ............................ 61 ALIMTA INJ500MG ....................... 26 ALINIA SUS100/5ML ..................... 29 ALINIA TAB500MG ....................... 29 Alkylating Agents ............................. 25 allopurinol tab100mg .......................... 24 allopurinol tab300mg .......................... 24 ALOCRIL SOL2%........................... 75 ALOMIDE SOL0.1% OP ................. 75 ALORA DIS0.025MG ................... 65 ALORA DIS0.05MG ..................... 65 ALORA DIS0.075MG ................... 66 ALORA DIS0.1MG ....................... 66 ALOXI INJ0.25MG/5 ..................... 22 Alpha-adrenergic Agonists ............. 44 Alpha-adrenergic Blocking Agents . 44 ALPHAGAN P SOL0.1% ................... 75 alprazolam con1 mg/ml ..................... 38 alprazolam tab0.25 odt ...................... 38 alprazolam tab0.25mg ....................... 38 alprazolam tab0.5mg ......................... 38 alprazolam tab0.5mg er ..................... 38 alprazolam tab0.5mg od .................... 38 alprazolam tab1mg ............................ 38 alprazolam tab1mg er ........................ 38 alprazolam tab1mg odt ...................... 38 alprazolam tab2mg ............................ 38 alprazolam tab2mg er ........................ 38 alprazolam tab2mg odt ...................... 38 alprazolam tab3mg er ........................ 38 ALREX SUS0.2% ......................... 75 amantadine cap100mg ...................... 30 amantadine syp50mg/5ml ................. 30 amantadine tab100mg ....................... 30 AMBISOME INJ50MG ..................... 22

amcinonide cre0.1% .......................... 62 amcinonide lot0.1% ........................... 62 amcinonide oin0.1% .......................... 62 amifostine inj500mg .......................... 26 amilor/hctz tab5-50 ............................. 49 amiloride tab5mg .............................. 52 Aminoglycosides................................ 6 Aminosalicylates .............................. 73 AMINOSYN INJ8.5/LYTE ................ 80 AMINOSYN II INJ10% ........................ 80 AMINOSYN II INJ7% .......................... 80 AMINOSYN II INJ8.5% ....................... 80 AMINOSYN II INJ8.5/LYTE ................ 80 AMINOSYN M INJ3.5% ..................... 80 AMINOSYN-HBCINJ7% ..................... 80 AMINOSYN-PF INJ10% ..................... 80 AMINOSYN-PF INJ7% ....................... 80 amiodarone inj50mg/ml ..................... 46 amiodarone tab200mg ...................... 46 amiodarone tab400mg ...................... 46 AMITIZA CAP24MCG .................... 60 AMITIZA CAP8MCG ...................... 60 amitriptylintab100mg .......................... 20 amitriptylintab10mg ............................ 20 amitriptylintab150mg .......................... 20 amitriptylintab25mg ............................ 20 amitriptylintab50mg ............................ 20 amitriptylintab75mg ............................ 20 amlod/atorvatab10-10mg ................... 49 amlod/atorvatab10-20mg ................... 49 amlod/atorvatab10-40mg ................... 49 amlod/atorvatab10-80mg ................... 49 amlod/atorvatab2.5-10mg .................. 49 amlod/atorvatab2.5-20mg .................. 49 amlod/atorvatab2.5-40mg .................. 49 amlod/atorvatab5-10mg ..................... 49 amlod/atorvatab5-20mg ..................... 49 amlod/atorvatab5-40mg ..................... 49 amlod/atorvatab5-80mg ..................... 49 amlod/benazpcap10-20mg ................. 49 amlod/benazpcap10-40mg ................. 49 amlod/benazpcap2.5-10mg ................ 49 amlod/benazpcap5-10mg ................... 49 amlod/benazpcap5-20mg ................... 49 amlod/benazpcap5-40mg ................... 49 amlod/valsartab/hctz 10-160-12.5mg . 49

85

amlod/valsartab/hctz 10-160-25mg .... 49 amlod/valsartab/hctz 10-320-25mg .... 50 amlod/valsartab/hctz 5-160-12.5mg ... 49 amlod/valsartab/hctz 5-160-25mg ...... 49 amlod/valsartab10-160mg .................. 49 amlod/valsartab10-320mg .................. 49 amlod/valsartab5-160mg .................... 49 amlod/valsartab5-320mg .................... 49 amlodipine tab10mg .......................... 47 amlodipine tab2.5mg ......................... 47 amlodipine tab5mg ............................ 47 ammonium chlinj5meq/ml ................... 81 ammonium laccre12% ........................ 57 ammonium laclot12% ......................... 57 amnesteem cap10mg ....................... 57 amnesteem cap20mg ....................... 57 amnesteem cap40mg ....................... 57 amox/k clav chw200mg ........................ 9 amox/k clav chw400mg ........................ 9 amox/k clav sus200/5ml ....................... 9 amox/k clav sus250/5ml ....................... 9 amox/k clav sus400/5ml ....................... 9 amox/k clav sus600/5ml ....................... 9 amox/k clav tab250mg ......................... 9 amox/k clav tab500mg ......................... 9 amox/k clav tab875mg ......................... 9 amoxapine tab100mg ....................... 20 amoxapine tab150mg ....................... 20 amoxapine tab25mg ......................... 20 amoxapine tab50mg ......................... 20 amoxicillin cap250mg ........................... 9 amoxicillin cap500mg ......................... 10 amoxicillin chw125mg ........................ 10 amoxicillin chw250mg ........................ 10 amoxicillin sus125/5ml ....................... 10 amoxicillin sus200/5ml ....................... 10 amoxicillin sus250/5ml ....................... 10 amoxicillin sus400/5ml ....................... 10 amoxicillin tab500mg .......................... 10 amoxicillin tab875mg .......................... 10 amox-pot clataber............................... 10 amphetamine tab10mg ....................... 55 amphetamine tab12.5mg .................... 55 amphetamine tab15mg ....................... 55 amphetamine tab20mg ....................... 55 amphetamine tab30mg ....................... 55

amphetamine tab5mg ......................... 55 amphetamine tab7.5mg ...................... 55 amphotericininj50mg .......................... 22 ampicillin cap250mg .......................... 10 ampicillin cap500mg .......................... 10 ampicillin inj10gm .............................. 10 ampicillin inj125mg ............................ 10 ampicillin inj1gm ................................ 10 ampicillin sus125/5ml ........................ 10 ampicillin sus250/5ml ........................ 10 amp-sulbactainj1.5gm ........................ 10 amp-sulbactainj15gm ......................... 10 amp-sulbactainj3gm ........................... 10 AMTURNIDE150TAB-5-12.5 .............. 50 AMTURNIDE300TAB-10-12.5 ............ 50 AMTURNIDE300TAB-10-25MG ......... 50 AMTURNIDE300TAB-5-12.5 .............. 50 AMTURNIDE300TAB-5-25MG ........... 50 anagrelide cap0.5mg ......................... 42 anagrelide cap1mg ............................ 42 Analgesics .......................................... 1 ANALGESICS ...................................... 1 anastrozole tab1mg ............................ 27 ANDROGEL GEL1%(50MG) ........... 65 ANDROGEL GEL1.62% .................. 65 ANDROGEL GELPUMP1% ............... 65 Androgens ........................................ 65 ANDROXY TAB10MG .................... 65 ANESTHETICS .................................... 5 Angioedema (HAE) Agents .............. 70 Angiotensin II Receptor Antagonists

........................................................ 44 Angiotensin-converting Enzyme

(ACE) Inhibitors ............................ 45 ANORO ELLIPTAER62.5-25 .............. 79 Anthelminthics ................................. 29 ANTI-ADDICTION/SUBSTANCE

ABUSE TREATMENT AGENTS ...... 5 Antiandrogens .................................. 25 Antiangiogenic Agents .................... 25 Antiarrhythmics ................................ 46 Antibacterials ..................................... 7 ANTIBACTERIALS .............................. 6 Antibacterials, Other .......................... 7 Anticholinergics ............................... 30 Anticoagulants ................................. 41

86

ANTICONVULSANTS ........................ 12 Anticonvulsants, Other .................... 12 Anti-cytomegalovirus (CMV) Agents

........................................................ 34 ANTIDEMENTIA AGENTS ................ 16 Antidementia Agents, Other ............ 16 Antidepressants ............................... 17 ANTIDEPRESSANTS ........................ 17 Antidepressants, Other .................... 17 Antidiabetic Agents .......................... 39 ANTIEMETICS ................................... 21 Antiemetics, Other ........................... 21 Antiestrogens/Modifiers .................. 26 Antifungals ....................................... 22 ANTIFUNGALS ................................. 22 Antigout Agents ............................... 24 ANTIGOUT AGENTS ......................... 24 Anti-hepatitis B (HBV) Agents ......... 34 Anti-hepatitis C (HCV) Agents ......... 35 Antiherpetic Agents ......................... 35 Antihistamines ................................. 76 Anti-HIV Agents, Integrase Inhibitors

(INSTI) ............................................ 35 Anti-HIV Agents, Non-nucleoside

Reverse Transcriptase Inhibitors (NNRTI) .......................................... 35

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI) ............................ 36

Anti-HIV Agents, Other .................... 37 Anti-HIV Agents, Protease Inhibitors

........................................................ 37 Anti-inflammatories, Inhaled

Corticosteroids ............................. 76 Anti-influenza Agents ...................... 37 Antileukotrienes ............................... 77 Antimetabolites ................................ 26 Antimigraine Agents ........................ 24 ANTI-MIGRAINE AGENTS ................ 24 ANTIMYASTHENIC AGENTS ........... 24 ANTIMYCOBACTERIALS ................. 24 Antimycobacterials, Other ............... 24 Antineoplastics ................................ 26 ANTINEOPLASTICS ......................... 25 Antineoplastics, Other ..................... 27 ANTIPARASITICS ............................. 29

ANTIPARKINSON AGENTS ............. 30 Antiparkinson Agents, Other .......... 30 Antiprotozoals .................................. 29 ANTIPSYCHOTICS ............................ 31 Antispasmodics, Gastrointestinal .. 59 Antispasmodics, Urinary ................. 61 Antispasticity Agents ....................... 34 ANTISPASTICITY AGENTS .............. 34 Antithyroid Agents ........................... 70 Antituberculars ................................. 25 Antivirals ........................................... 38 ANTIVIRALS ...................................... 34 ANXIOLYTICS ................................... 38 Anxiolytics, Other............................. 38 ANZEMET INJ20MG/ML ................ 22 ANZEMET TAB100MG .................. 22 ANZEMET TAB50MG .................... 22 apap/codeinesol120-12/5 ..................... 1 apap/codeinetab300-15mg ................... 1 apap/codeinetab300-30mg ................... 1 apap/codeinetab300-60mg ................... 1 APIDRA INJSOLOSTAR ............... 40 APIDRA INJU-100 ......................... 40 APOKYN INJ10MG/ML ................. 30 apraclonidinsol0.5% op ...................... 75 apri tab ........................................ 66 APTIOM TAB200MG ..................... 12 APTIOM TAB400MG ..................... 12 APTIOM TAB600MG ..................... 12 APTIOM TAB800MG ..................... 12 APTIVUS CAP250MG .................... 37 APTIVUS SOL ................................ 37 ARALAST NP INJ400MG .................. 79 aranelle tab ..................................... 66 ARANESP INJ100MCG ................. 42 ARANESP INJ150MCG ................. 42 ARANESP INJ200MCG ................. 42 ARANESP INJ25MCG ............. 42, 43 ARANESP INJ300MCG ................. 43 ARANESP INJ40MCG ................... 43 ARANESP INJ500MCG ................. 43 ARANESP INJ60MCG ................... 43 ARCALYST INJ220MG ................... 72 ARCAPTA CAP75MCG .................. 77 Aromatase Inhibitors, 3rd Generation

........................................................ 27

87

ARRANON INJ5MG/ML ................. 26 ARZERRA CON100/5ML ............... 29 ASACOL HD TAB800MG ................. 73 ascomp/cod cap30mg ......................... 1 ASMANEX 120 AER220MCG ............ 76 ASMANEX 30 AER110MCG ............. 76 ASMANEX 30 AER220MCG ............. 76 ASMANEX 60 AER220MCG ............. 76 ASTAGRAF XL CAP0.5MG ............... 70 ASTAGRAF XL CAP1MG .................. 70 ASTAGRAF XL CAP5MG .................. 70 ASTEPRO SPR0.15% .................... 76 atenol/chlortab100-25mg .................... 50 atenol/chlortab50-25mg ...................... 50 atenolol tab100mg ........................... 46 atenolol tab25mg ............................. 46 atenolol tab50mg ............................. 46 atorvastatintab10mg ........................... 53 atorvastatintab20mg ........................... 53 atorvastatintab40mg ........................... 53 atorvastatintab80mg ........................... 53 atovaq/progutab250-100 .................... 29 atovaq/progutab62.5-25 ..................... 29 atovaquone sus750/5ml .................... 30 ATRIPLA TAB ................................ 38 atropine sulinj0.1mg/ml ...................... 59 ATROVENT HFAAER17MCG ............ 77 Attention Deficit Hyperactivity

Disorder Agents, Amphetamines 55 Attention Deficit Hyperactivity

Disorder Agents, Non-amphetamines............................... 55

aubra tab0.1-0.02 ............................... 66 aug betamet cre0.05% ....................... 62 aug betamet gel0.05% ....................... 62 aug betamet lot0.05% ........................ 62 aug betamet oin0.05% ....................... 62 AVASTIN INJ ................................. 26 AVASTIN INJ400/16ML .................. 26 AVELOX INJ ................................. 11 aviane tab ...................................... 66 AVODART CAP0.5MG ................... 61 AVONEX KIT30MCG .................... 56 AVONEX PEN KIT30MCG ................. 56 AVONEX PREFLKIT30MCG .............. 56 AXIRON SOL30MG/ACT .............. 65

azacitidine inj100mg ........................... 26 AZACTAM/DEX INJ1GM ...................... 9 AZACTAM/DEX INJ2GM ...................... 9 azasan tab100mg .......................... 70 azasan tab75 mg ........................... 70 azathioprinetab50mg .......................... 70 azelastine dro0.05% .......................... 75 azelastine spr0.1% ............................ 76 azelastine spr0.15% .......................... 76 AZILECT TAB0.5MG ...................... 31 AZILECT TAB1MG ......................... 31 azithromycininj500mg ......................... 11 azithromycinsus100/5ml ..................... 11 azithromycinsus200/5ml ..................... 11 azithromycintab250mg ....................... 11 azithromycintab500mg ....................... 11 azithromycintab600mg ....................... 11 AZOPT SUS1% OP ...................... 75 aztreonam inj1gm ............................... 9 baciim inj50000unt .......................... 7 bacit/polymyoinop .............................. 74 bacitracin oinop ................................... 7 baclofen tab10mg ............................ 34 baclofen tab20mg ............................ 34 balsalazide cap750mg ........................ 73 balziva tab ...................................... 66 BANZEL SUS40MG/ML ................ 15 BANZEL TAB200MG ..................... 15 BANZEL TAB400MG ..................... 15 BARACLUDE SOL.05MG/ML .......... 34 BECONASE AQ SUS0.042% ............. 76 BELEODAQ INJ500MG ..................... 28 benazep/hctztab10-12.5 ..................... 50 benazep/hctztab20-12.5 ..................... 50 benazep/hctztab20-25mg ................... 50 benazep/hctztab5-6.25 ....................... 50 benazepril tab10mg ........................... 45 benazepril tab20mg ........................... 45 benazepril tab40mg ........................... 45 benazepril tab5mg ............................. 45 Benign Prostatic Hypertrophy Agents

........................................................ 61 Benzodiazepines .............................. 38 benztropine inj1mg/ml ........................ 30 benztropine tab0.5mg ......................... 30 benztropine tab1mg............................ 30

88

benztropine tab2mg............................ 30 Beta-adrenergic Blocking Agents ... 46 Beta-lactam, Cephalosporins ............ 8 Beta-lactam, Other ............................. 9 Beta-lactam, Penicillins ..................... 9 betameth dipcre0.05% ....................... 62 betameth diplot0.05% ......................... 62 betameth dipoin0.05% ........................ 62 betameth valaer0.12% ....................... 62 betameth valcre0.1% .......................... 62 betameth vallot0.1% ........................... 62 betameth valoin0.1% .......................... 62 BETASERON INJ0.3MG .................. 56 betaxolol sol0.5% op ........................ 75 betaxolol tab10mg ............................ 46 betaxolol tab20mg ............................ 46 bethanechol tab10mg ......................... 61 bethanechol tab25mg ......................... 61 bethanechol tab50mg ......................... 61 bethanechol tab5mg ........................... 61 BETOPTIC-S SUS0.25% OP ............ 75 bexarotene cap75mg.......................... 29 BEXSERO INJ ................................ 72 bicalutamidetab50mg ......................... 25 BICILLIN C-RINJ1200000 .................. 10 BICILLIN C-RINJ900/300 ................... 10 BICILLIN L-AINJ1200000 ................... 10 BICILLIN L-AINJ2400000 ................... 10 BICILLIN L-AINJ600000 ..................... 10 BILTRICIDE TAB600MG ................... 29 BIPOLAR AGENTS ........................... 38 bisoprl/hctztab10/6.25 ........................ 50 bisoprl/hctztab2.5/6.25 ....................... 50 bisoprl/hctztab5-6.25mg ..................... 50 bisoprol fumtab10mg .......................... 46 bisoprol fumtab5mg ............................ 47 blephamide oins.o.p. ......................... 74 BLEPHAMIDE SUSOP ...................... 74 Blood Formation Modifiers .............. 42 Blood Glucose Regulators .............. 40 BLOOD GLUCOSE REGULATORS .. 39 BLOOD PRODUCTS/MODIFIERS/

VOLUME EXPANDERS ................. 41 Blood Products/Modifiers/Volume

Expanders ..................................... 43 BOOSTRIX INJ ............................... 72

BOSULIF TAB100MG .................... 28 BOSULIF TAB500MG .................... 28 BREO ELLIPTAINH100-25 ................ 79 BREO ELLIPTAINH200-25 ................ 79 BRILINTA TAB90MG ...................... 43 brimonidine sol0.15% ......................... 75 brimonidine sol0.2% op ...................... 75 BRINTELLIX TAB10MG .................... 18 BRINTELLIX TAB20MG .................... 18 BRINTELLIX TAB5MG ...................... 18 bromfenac sol0.09% ......................... 75 bromocriptincap5mg ........................... 30 bromocriptintab2.5mg ......................... 30 Bronchodilators, Anticholinergic .... 77 Bronchodilators, Sympathomimetic

........................................................ 77 budesonide cap3mg/24hr .................. 62 budesonide sus32mcg ...................... 76 bumetanide inj0.25/ml ....................... 52 bumetanide tab0.5mg ........................ 52 bumetanide tab1mg........................... 52 bumetanide tab2mg........................... 52 bupren/naloxsub2-0.5mg ...................... 5 bupren/naloxsub8-2mg ......................... 5 buprenorphininj0.3mg/ml ...................... 5 buprenorphinsub2mg ........................... 5 buprenorphinsub8mg ........................... 5 buproban tab150mg .......................... 6 bupropion tab100mg .......................... 6 bupropion tab100mg sr ...................... 6 bupropion tab150mg sr ...................... 6 bupropion tab200mg sr ...................... 6 bupropion tab75mg ............................ 6 bupropn hcl tab150mg xl ...................... 6 bupropn hcl tab300mg xl ...................... 6 buspirone tab10mg........................... 38 buspirone tab15mg........................... 38 buspirone tab30mg........................... 38 buspirone tab5mg............................. 38 buspirone tab7.5mg.......................... 38 but/apap/cafcap .................................... 1 but/apap/cafcapcodeine ....................... 1 but/apap/caftab .................................... 1 but/asa/caffcap ..................................... 1 butal/apap tab50-325mg ..................... 1 butorphanol inj1mg/ml .......................... 4

89

butorphanol inj2mg/ml .......................... 4 butorphanol sol10mg/ml ....................... 4 BUTRANS DIS10MCG/HR ............... 5 BUTRANS DIS15MCG/HR ............... 5 BUTRANS DIS20MCG/HR ............... 6 BUTRANS DIS5MCG/HR ................. 6 BYDUREON INJ.............................. 39 BYETTA INJ10MCG ...................... 39 BYETTA INJ5MCG ........................ 39 cabergoline tab0.5mg ......................... 69 calc acetatecap667mg ....................... 61 calcipotriencre0.005% ........................ 57 calcipotrienoin0.005% ........................ 57 calcipotrienoinbetameth ..................... 57 calcipotriensol0.005% ........................ 57 calcitonin spr200/act .......................... 73 calcitriol cap0.25mcg ......................... 74 calcitriol cap0.5mcg ........................... 74 calcitriol inj1mcg/ml ........................... 74 calcitriol sol1mcg/ml .......................... 74 Calcium Channel Blocking Agents . 47 Calcium Channel Modifying Agents 13 camila tab0.35mg .......................... 68 CANASA SUP1000MG ................. 73 CANCIDAS INJ50MG ...................... 22 CANCIDAS INJ70MG ...................... 22 candesa/hctztab16-12.5 ..................... 50 candesa/hctztab32-12.5 ..................... 50 candesa/hctztab32-25mg ................... 50 candesartan tab16mg ......................... 44 candesartan tab32mg ......................... 44 candesartan tab4mg........................... 44 candesartan tab8mg........................... 44 CANTIL TAB25MG ........................ 59 CAPASTAT SULINJ1GM ................... 25 CAPEX SHA0.01% ....................... 62 CAPRELSA TAB100MG ................. 28 CAPRELSA TAB300MG ................. 28 captopr/hctztab25-15mg ..................... 50 captopr/hctztab25-25mg ..................... 50 captopr/hctztab50-15mg ..................... 50 captopr/hctztab50-25mg ..................... 50 captopril tab100mg ........................... 45 captopril tab12.5mg .......................... 45 captopril tab25mg ............................. 45 captopril tab50mg ............................. 45

carb/levo tab10-100mg ..................... 31 carb/levo tab25-100mg ..................... 31 carb/levo tab25-250mg ..................... 31 carb/levo ertab25-100mg ................... 31 carb/levo ertab50-200mg ................... 31 carbamazepincap100mg er ................ 15 carbamazepincap200mg er ................ 16 carbamazepincap300mg er ................ 16 carbamazepinchw100mg ................... 16 carbamazepinsus100/5ml .................. 16 carbamazepintab200mg ..................... 16 carbamazepintab200mg er ................. 16 carbamazepintab400mg er ................. 16 carbidopa tab25mg........................... 31 carbinoxaminsol4mg/5ml .................... 76 carbinoxamintab4mg .......................... 76 Cardiovascular Agents .................... 49 CARDIOVASCULAR AGENTS ......... 44 Cardiovascular Agents, Other ......... 52 CARIMUNE NF INJ3GM .................... 72 carteolol sol1% op ............................ 75 cartia xt cap120/24hr ........................ 47 cartia xt cap180/24hr ........................ 47 cartia xt cap240/24hr ........................ 47 cartia xt cap300/24hr ........................ 47 carvedilol tab12.5mg ......................... 47 carvedilol tab25mg ............................ 47 carvedilol tab3.125mg ....................... 47 carvedilol tab6.25mg ......................... 47 CAYSTON INH75MG ..................... 78 cefaclor cap250mg ............................ 8 cefaclor cap500mg ............................ 8 cefaclor er tab500mg ............................ 8 cefadroxil cap500mg ........................... 8 cefadroxil sus250/5ml .......................... 8 cefadroxil sus500/5ml .......................... 8 cefadroxil tab1gm ................................ 8 cefazolin inj10gm................................ 8 cefazolin inj1gm ................................. 8 cefazolin inj1gm/50ml ......................... 8 cefazolin inj500mg.............................. 8 cefdinir cap300mg ............................. 8 cefdinir sus125/5ml ........................... 8 cefdinir sus250/5ml ........................... 8 cefepime inj1gm ................................ 8 cefepime inj2gm ................................ 8

90

cefotaxime inj10gm ............................. 8 cefotetan inj10g .................................. 7 cefotetan inj1gm/10ml ........................ 7 cefotetan inj2gm/20ml ........................ 7 cefoxitin inj10gm................................. 8 cefoxitin inj1gm .................................. 8 cefoxitin inj2gm .................................. 8 cefpodo proxsus100/5ml ...................... 8 cefpodo proxsus50mg/5ml ................... 8 cefpodoxime tab100mg ........................ 8 cefpodoxime tab200mg ........................ 8 cefprozil sus125/5ml ........................... 8 cefprozil sus250/5ml ........................... 8 cefprozil tab250mg ............................. 8 cefprozil tab500mg ............................. 8 ceftazidime inj1gm................................ 8 ceftazidime inj2gm................................ 8 ceftazidime inj6gm................................ 8 ceftriaxone inj10gm .............................. 9 ceftriaxone inj1gm ................................ 9 ceftriaxone inj250mg ............................ 9 ceftriaxone inj2gm ................................ 9 ceftriaxone inj500mg ............................ 9 cefuroxime inj1.5gm ............................ 9 cefuroxime inj7.5gm ............................ 9 cefuroxime inj750mg ........................... 9 cefuroxime tab250mg .......................... 9 cefuroxime tab500mg .......................... 9 celecoxib cap100mg............................. 2 celecoxib cap200mg............................. 2 celecoxib cap400mg............................. 2 celecoxib cap50mg............................... 2 CELLCEPT SUS200MG/ML ............ 70 CELLCEPT IV INJ500MG .................. 70 CELONTIN CAP300MG .................. 13 CENTRAL NERVOUS SYSTEM

AGENTS ......................................... 55 Central Nervous System, Other ...... 56 cephalexin cap250mg ......................... 9 cephalexin cap500mg ......................... 9 cephalexin sus125/5ml ........................ 9 cephalexin sus250/5ml ........................ 9 cephalexin tab250mg .......................... 9 cephalexin tab500mg .......................... 9 CEREZYME INJ400UNIT ................ 58 CERVARIX INJ................................ 72

cetirizine syp5mg/5ml ........................ 76 cevimeline cap30mg .......................... 56 CHANTIX PAK0.5& 1MG ................. 6 CHANTIX TAB0.5MG ....................... 6 CHANTIX TAB1MG .......................... 6 CHEMET CAP100MG ................... 81 chloramphen inj1gm ............................. 7 chlordiazep cap10mg ......................... 38 chlordiazep cap25mg ......................... 38 chlordiazep cap5mg ........................... 38 chlorhex glusol0.12% ......................... 56 chloroquine tab250mg ........................ 30 chloroquine tab500mg ........................ 30 chlorothiaz inj500mg .......................... 53 chlorothiaz tab250mg ......................... 53 chlorothiaz tab500mg ......................... 53 chlorpromaz inj25mg/ml ..................... 21 chlorpromaz tab100mg ....................... 21 chlorpromaz tab10mg ......................... 21 chlorpromaz tab200mg ....................... 21 chlorpromaz tab25mg ......................... 21 chlorpromaz tab50mg ......................... 21 chlorthalid tab25mg ............................ 53 chlorthalid tab50mg ............................ 53 cholestyram pow4gm lite .................... 54 Cholinesterase Inhibitors ................ 16 ciclopirox cre0.77% ........................... 22 ciclopirox gel0.77% ........................... 23 ciclopirox sha1% ............................... 23 ciclopirox sol8% ................................ 23 ciclopirox sus0.77%........................... 23 cidofovir inj75mg/ml .......................... 34 cilostazol tab100mg........................... 43 cilostazol tab50mg............................. 43 CILOXAN OIN0.3% OP .................. 11 cimetidine sol300/5ml ........................ 59 cimetidine tab200mg ......................... 60 cimetidine tab300mg ......................... 60 cimetidine tab400mg ......................... 60 cimetidine tab800mg ......................... 60 CIMZIA KIT ................................... 70 CIMZIA PREFLKIT200MG/ML ........... 70 CINRYZE SOL500 UNIT ................ 70 CIPRO HC SUSOTIC ...................... 76 CIPRODEX SUS0.3-0.1% ............... 76 ciprofloxacninj400mg .......................... 11

91

ciprofloxacnsol0.3% op ...................... 11 ciprofloxacnsus250mg/5 ..................... 11 ciprofloxacnsus500mg/5 ..................... 11 ciprofloxacntab1000mg ...................... 11 ciprofloxacntab100mg ........................ 11 ciprofloxacntab250mg ........................ 11 ciprofloxacntab500mg ........................ 11 ciprofloxacntab500mg er .................... 11 ciprofloxacntab750mg ........................ 11 citalopram sol10mg/5ml .................... 18 citalopram tab10mg ........................... 18 citalopram tab20mg ........................... 18 citalopram tab40mg ........................... 18 claravis cap10mg ............................ 57 claravis cap20mg ............................ 57 claravis cap30mg ............................ 57 claravis cap40mg ............................ 57 clarithromycsus125/5ml ...................... 11 clarithromycsus250/5ml ...................... 11 clarithromyctab250mg ........................ 11 clarithromyctab500mg ........................ 11 clarithromyctab500mg er .................... 11 clemastine tab2.68mg ....................... 76 clindamy/bengel1-5% ......................... 57 clindamycin cap150mg ......................... 7 clindamycin cap300mg ......................... 7 clindamycin cre2% vag ......................... 7 clindamycin gel1%................................ 7 clindamycin inj150mg/ml ...................... 7 clindamycin lot1%................................. 7 clindamycin pad1% .............................. 7 clindamycin sol1% ................................ 7 clobetasol gel0.05% .......................... 62 clobetasol oin0.05% .......................... 62 clobetasol sol0.05% .......................... 62 clobetasol spr0.05% .......................... 62 clobetasol ecre0.05% ......................... 62 clomipraminecap25mg ....................... 20 clomipraminecap50mg ....................... 20 clomipraminecap75mg ....................... 20 clonazep odttab0.125mg .................... 13 clonazep odttab0.25mg ...................... 13 clonazep odttab0.5mg ........................ 13 clonazep odttab1mg ........................... 13 clonazep odttab2mg ........................... 13 clonazepam tab0.5mg ....................... 13

clonazepam tab1mg .......................... 13 clonazepam tab2mg .......................... 13 clonidine dis0.1/24hr ........................ 44 clonidine dis0.2/24hr ........................ 44 clonidine dis0.3/24hr ........................ 44 clonidine tab0.1mg ........................... 44 clonidine tab0.1mg er ....................... 44 clonidine tab0.2mg ........................... 44 clonidine tab0.3mg ........................... 44 clopidogrel tab300mg ......................... 43 clopidogrel tab75mg ........................... 43 cloraz dipottab15mg ........................... 13 cloraz dipottab3.75mg ........................ 13 cloraz dipottab7.5mg .......................... 13 clorpres tab0.1-15mg ...................... 50 clorpres tab0.2-15mg ...................... 50 clorpres tab0.3-15mg ...................... 50 clotrim/betacrediprop .......................... 57 clotrim/betalotdiprop ........................... 57 clotrimazolecre1% .............................. 23 clotrimazolesol1% .............................. 23 clotrimazoletro10mg ........................... 23 clozapine tab100mg ......................... 33 clozapine tab200mg ......................... 33 clozapine tab25mg ........................... 33 clozapine tab50mg ........................... 33 Coagulants ........................................ 43 COARTEM TAB20-120MG ............ 30 CODEINE SULFTAB15MG .................. 4 CODEINE SULFTAB30MG .................. 4 CODEINE SULFTAB60MG .................. 4 COLCRYS TAB0.6MG ................... 24 colestipol gra5gm .............................. 54 colestipol tab1gm .............................. 54 colistimeth inj150mg ............................. 7 colocort ene100mg .......................... 62 COLY-MYCIN SSUSOTIC ................. 76 COMBIVENT AERRESPIMAT ......... 79 COMETRIQ KIT100MG ................... 28 COMETRIQ KIT140MG ................... 28 COMETRIQ KIT60MG ..................... 28 COMPLERA TAB ............................ 35 compro sup25mg........................... 21 COMVAX INJ ................................ 72 constulose sol10gm/15 ...................... 60 COPAXONE INJ40MG/ML .............. 56

92

COPAXONE KIT20MG/ML .............. 56 cortisone actab25mg .......................... 62 COUMADIN INJ5 MG ...................... 41 COUMADIN TAB10MG ................... 41 COUMADIN TAB1MG ..................... 41 COUMADIN TAB2.5MG .................. 41 COUMADIN TAB2MG ..................... 41 COUMADIN TAB3MG ..................... 41 COUMADIN TAB4MG ..................... 41 COUMADIN TAB5MG ..................... 41 COUMADIN TAB6MG ..................... 41 COUMADIN TAB7.5MG .................. 41 CREON CAP12000UNT ............... 58 CREON CAP24000UNT ............... 58 CREON CAP3000UNIT ................ 59 CREON CAP36000UNT ............... 59 CREON CAP6000UNIT ................ 58 CRESTOR TAB10MG .................... 53 CRESTOR TAB20MG .................... 53 CRESTOR TAB40MG .................... 53 CRESTOR TAB5MG ...................... 53 CRINONE GEL8% VAG ................. 68 CRIXIVAN CAP200MG ................... 37 CRIXIVAN CAP400MG ................... 37 cromolyn sodcon100/5ml ................... 78 cromolyn sodneb20mg/2ml ................ 78 cromolyn sodsol4% op ....................... 75 cryselle-28 tab28 tabs ........................ 66 CUBICIN SOL500MG ....................... 7 cyclobenzaprtab10mg ........................ 79 cyclobenzaprtab5mg .......................... 79 CYCLOPHOSPH CAP25MG .............. 25 CYCLOPHOSPH CAP50MG .............. 25 cyclophosph tab25mg ........................ 25 cyclophosph tab50mg ........................ 25 CYCLOSET TAB0.8MG .................. 39 cyclosporinecap100mg ....................... 70 cyclosporinecap100mg md ................. 70 cyclosporinecap25mg ......................... 70 cyclosporinecap25mg mod ................. 70 cyclosporinecap50mg mod ................. 70 cyclosporineinj50mg/ml ...................... 70 cyclosporinesolmodified ..................... 70 cyproheptad syp2mg/5ml ................... 76 cyproheptad tab4mg........................... 76 CYRAMZA INJ100/10ML ................... 26

CYRAMZA INJ500/50ML ................... 26 CYSTADANE POW .......................... 58 CYSTAGON CAP150MG ................ 58 CYSTAGON CAP50MG .................. 58 Cystic Fibrosis Agents .................... 78 D10W/NACL INJ0.2% ...................... 80 D10W/NACL INJ0.45% .................... 80 d2.5w/nacl inj0.45% .......................... 80 d5w/lr inj ........................................ 80 d5w/nacl inj0.2% ............................. 80 D5W/NACL INJ0.225% ................... 80 d5w/nacl inj0.33% ........................... 80 d5w/nacl inj0.45% ........................... 80 d5w/nacl inj0.9% ............................. 80 DALIRESP TAB500MCG ................ 78 danazol cap100mg ......................... 65 danazol cap200mg ......................... 65 danazol cap50mg ........................... 65 dantrolene cap100mg ........................ 34 dantrolene cap25mg.......................... 34 dantrolene cap50mg.......................... 34 dapsone tab100mg ......................... 25 dapsone tab25mg........................... 25 DAPTACEL INJ ............................... 72 DARAPRIM TAB25MG .................... 30 DAUNOXOME INJ2MG/ML ................ 26 decitabine inj50mg ............................ 26 delyla tab0.1-0.02 ............................... 66 DELZICOL CAP400MG ................... 73 demeclocycl tab150mg ....................... 12 demeclocycl tab300mg ....................... 12 DEMSER CAP250MG ................... 50 DENAVIR CRE1% .......................... 35 Dental and Oral Agents .................... 56 DENTAL AND ORAL AGENTS ......... 56 DEPEN TITRA TAB250MG ................ 61 DEPO-PROVERAINJ150MG/ML ....... 68 DEPO-PROVERAINJ400/ML ............. 68 Dermatological Agents .................... 56 DERMATOLOGICAL AGENTS ......... 56 desipramine tab100mg ....................... 20 desipramine tab10mg ......................... 20 desipramine tab150mg ....................... 20 desipramine tab25mg ......................... 21 desipramine tab50mg ......................... 21 desipramine tab75mg ......................... 21

93

desloratadintab5mg ............................ 76 desmopressininj4mcg/ml .................... 64 desmopressinspr0.01% ...................... 64 desmopressintab0.1mg ...................... 64 desmopressintab0.2mg ...................... 64 desonide cre0.05%.......................... 62 desonide lot0.05% ........................... 62 desonide oin0.05% .......................... 62 desoximetas cre0.05% ....................... 62 desoximetas cre0.25% ....................... 62 desoximetas gel0.05% ....................... 62 desoximetas oin0.25% ....................... 62 DESVENLAFAX TAB100MG ER ....... 18 DESVENLAFAX TAB50MG ER ......... 19 dexameth phoinj120mg/30 ................. 62 dexameth phosol0.1% op ................... 75 dexamethasoncon1mg/ml .................. 62 dexamethasonelx0.5/5ml ................... 62 dexamethasontab0.5mg ..................... 62 dexamethasontab0.75mg ................... 62 dexamethasontab1.5mg ..................... 63 dexamethasontab1mg ........................ 63 dexamethasontab2mg ........................ 63 dexamethasontab4mg ........................ 63 dexamethasontab6mg ........................ 63 dexmethylph cap15mg er ................... 55 dexmethylph cap30mg er ................... 55 dexmethylph cap40mg er ................... 55 dexmethylph tab10mg ........................ 55 dexmethylph tab2.5mg ....................... 55 dexmethylph tab5mg .......................... 55 dextrose inj10% ............................... 80 dextrose inj5% ................................. 80 Diabetes Supplies ............................ 58 DIASTAT ACDLGEL12.5-20 .............. 13 DIASTAT ACDLGEL5-10MG ............. 13 DIASTAT PED GEL2.5M GEL ........... 14 diazepam con5mg/ml ...................... 14 DIAZEPAM GEL10MG .................... 14 DIAZEPAM GEL2.5MG ................... 14 DIAZEPAM GEL20MG .................... 14 diazepam sol1mg/ml ....................... 14 diazepam tab10mg .......................... 14 diazepam tab2mg ............................ 14 diazepam tab5mg ............................ 14 diclo/misoprtab50-0.2mg ...................... 1

diclo/misoprtab75-0.2mg ...................... 1 diclofen pottab50mg ............................. 2 diclofenac gel3% ............................... 57 diclofenac sol0.1% op ....................... 75 diclofenac sol1.5% ............................ 57 diclofenac tab100mg er ....................... 2 diclofenac tab25mg dr ......................... 2 diclofenac tab50mg dr ......................... 2 diclofenac tab75mg dr ......................... 2 dicloxacill cap250mg .......................... 10 dicloxacill cap500mg .......................... 10 dicyclomine cap10mg ......................... 59 dicyclomine sol10mg/5ml ................... 59 dicyclomine tab20mg .......................... 59 didanosine cap125mg ....................... 36 didanosine cap200mg ....................... 36 didanosine cap250mg ....................... 36 didanosine cap400mg ....................... 36 DIFICID TAB200MG ....................... 11 diflorasone cre0.05%.......................... 63 diflorasone oin0.05% .......................... 63 diflunisal tab500mg ............................. 2 digoxin inj0.25mg/1 ........................ 52 DIGOXIN SOL50MCG/ML .............. 52 digoxin tab0.125mg ........................ 52 digoxin tab0.25mg .......................... 52 dihydroergotinj1mg/ml ........................ 24 DILANTIN CAP30MG ...................... 16 diltiazem cap120mg cd ..................... 48 diltiazem cap120mg er ..................... 48 diltiazem cap180mg/24 .................... 48 diltiazem cap240mg cd ..................... 48 diltiazem cap300mg er ..................... 48 diltiazem cap360mg/24 .................... 48 diltiazem cap420mg/24 .................... 48 diltiazem cap60mg er ....................... 48 diltiazem cap90mg er ....................... 48 diltiazem inj100mg............................ 48 diltiazem inj50/10ml .......................... 48 diltiazem tab120mg .......................... 48 diltiazem tab30mg ............................ 48 diltiazem tab60mg ............................ 48 diltiazem tab90mg ............................ 48 dilt-xr cap120mg ............................. 48 dilt-xr cap180mg ............................. 48 dilt-xr cap240mg ............................. 48

94

DIP/TET PED INJ25-5LFU ................. 72 DIPENTUM CAP250MG ................. 73 diphenhydraminj50mg/ml ................... 21 disulfiram tab250mg ............................ 5 disulfiram tab500mg ............................ 5 Diuretics, Carbonic Anhydrase

Inhibitors ....................................... 52 Diuretics, Loop ................................. 52 Diuretics, Potassium-sparing .......... 52 Diuretics, Thiazide............................ 53 divalproex cap125mg ........................ 14 divalproex tab125mg dr ..................... 14 divalproex tab250mg dr ..................... 14 divalproex tab250mg er ..................... 14 divalproex tab500mg dr ..................... 14 divalproex tab500mg er ..................... 14 DOCEFREZ INJ20MG .................... 26 DOCEFREZ INJ80MG .................... 26 DOCETAXEL INJ80MG/4ML ........... 26 donepezil tab10mg ........................... 16 donepezil tab10mg odt ..................... 16 donepezil tab5mg ............................. 16 donepezil tab5mg odt ....................... 16 donepezil tabhcl 23mg ..................... 16 Dopamine Agonists .......................... 30 Dopamine Precursors/L-Amino Acid

Decarboxylase Inhibitors ............. 31 dorzol/timolsol2-0.5%op ..................... 74 dorzolamide sol2% op ........................ 75 doxazosin tab1mg ............................ 44 doxazosin tab2mg ............................ 44 doxazosin tab4mg ............................ 44 doxazosin tab8mg ............................ 44 doxepin hcl cap100mg ....................... 21 doxepin hcl cap10mg ......................... 21 doxepin hcl cap150mg ....................... 21 doxepin hcl cap25mg ......................... 21 doxepin hcl cap50mg ......................... 21 doxepin hcl cap75mg ......................... 21 doxepin hcl con10mg/ml ..................... 21 doxercalcif cap0.5mcg ........................ 74 doxercalcif cap1mcg........................... 74 doxercalcif cap2.5mcg ........................ 74 doxycyc monotab150mg .................... 12 doxycyc monotab50mg ...................... 12 doxycyc monotab75mg ...................... 12

doxycycl hyccap100mg ...................... 12 doxycycl hyccap50mg ........................ 12 doxycycl hyctab100mg ....................... 12 doxycycline tab20mg .......................... 56 dronabinol cap10mg .......................... 22 dronabinol cap2.5mg ......................... 22 dronabinol cap5mg ............................ 22 DROXIA CAP200MG .................... 26 DROXIA CAP300MG .................... 26 DROXIA CAP400MG .................... 26 DUAVEE TAB0.45-20 ................... 66 duloxetine cap20mg .......................... 19 duloxetine cap30mg .......................... 19 duloxetine cap40mg .......................... 19 duloxetine cap60mg .......................... 19 duramorph inj0.5mg/ml ....................... 4 duramorph inj1mg/ml .......................... 4 Dyslipidemics ................................... 53 Dyslipidemics, Fibric Acid

Derivatives .................................... 53 Dyslipidemics, HMG CoA Reductase

Inhibitors ....................................... 53 Dyslipidemics, Other ........................ 54 econazole cre1% .............................. 23 EDURANT TAB25MG .................... 35 EFFIENT TAB10MG ....................... 43 EFFIENT TAB5MG ......................... 43 ELAPRASE INJ6MG/3ML ............... 58 Electrolyte/Mineral Modifiers .......... 81 Electrolyte/Mineral Replacement .... 81 ELIDEL CRE1% ............................ 57 eliphos tab667mg ........................... 61 ELITEK INJ1.5MG ......................... 26 ELLA TAB30MG .......................... 68 EMCYT CAP140MG ..................... 26 EMEND CAP125MG .................... 22 EMEND CAP40MG ...................... 22 EMEND CAP80MG ...................... 22 EMEND PAK80 & 125 .................. 22 Emetogenic Therapy Adjuncts ........ 22 EMSAM DIS12MG/24H ................ 18 EMSAM DIS6MG/24HR ............... 18 EMSAM DIS9MG/24HR ............... 18 EMTRIVA CAP200MG ................... 36 EMTRIVA SOL10MG/ML ............... 36 ENABLEX TAB15MG ..................... 61

95

ENABLEX TAB7.5MG .................... 61 enalapr/hctztab10-25mg ..................... 50 enalapr/hctztab5-12.5mg .................... 50 enalapril tab10mg ............................. 45 enalapril tab2.5mg ............................ 45 enalapril tab20mg ............................. 45 enalapril tab5mg ............................... 45 ENBREL INJ25/0.5ML ................... 70 ENBREL INJ25MG ........................ 70 ENBREL INJ50MG/ML .................. 70 ENBREL SRCLKINJ50MG/ML ........... 70 endocet tab10-325mg ...................... 1 endocet tab5-325mg ........................ 1 endocet tab7.5-325 .......................... 1 ENGERIX-B INJ10/0.5ML ................ 72 ENGERIX-B INJ20MCG/ML ............. 72 enoxaparin inj100mg/ml .................... 41 enoxaparin inj120/0.8 ........................ 41 enoxaparin inj150mg/ml .................... 41 enoxaparin inj30/0.3ml ...................... 41 enoxaparin inj300/3ml ....................... 41 enoxaparin inj40/0.4ml ...................... 41 enoxaparin inj60/0.6ml ...................... 41 enoxaparin inj80/0.8ml ...................... 41 enpresse-28 tab ................................. 66 entecavir tab0.5mg ............................. 34 entecavir tab1mg ................................ 34 enulose sol10gm/15 ....................... 60 Enzyme Inhibitors ............................ 27 Enzyme Replacements/ Modifiers... 58 ENZYME REPLACEMENTS/

MODIFIERS .................................... 58 epinastine dro0.05%.......................... 75 EPIPEN 2-PAKINJ0.3MG ................... 77 EPIPEN-JR INJ2-PAK ...................... 78 epitol tab200mg ............................. 16 EPIVIR SOL10MG/ML ................... 36 EPIVIR HBV SOL5MG/ML ................ 34 eplerenone tab25mg ......................... 52 eplerenone tab50mg ......................... 52 EPOGEN INJ10000/ML ................. 43 EPOGEN INJ2000/ML ................... 43 EPOGEN INJ20000/ML ................. 43 EPOGEN INJ3000/ML ................... 43 EPOGEN INJ4000/ML ................... 43 eprosart mestab600mg ...................... 44

EPZICOM TAB600-300 .................. 36 EQUETRO CAP100MG ................. 16 EQUETRO CAP200MG ................. 16 EQUETRO CAP300MG ................. 16 ERAXIS INJ100MG ....................... 23 ergoloid mestab1mg oral .................... 16 Ergot Alkaloids ................................. 24 ERIVEDGE CAP150MG .................. 28 errin tab0.35mg ............................ 68 ERWINAZE INJ10000UNT .............. 27 ery pad2% .................................. 11 ery-tab tab250mg ec ...................... 11 ery-tab tab333mg ec ...................... 11 ery-tab tab500mg ec ...................... 11 ERYTHROCIN INJ500MG ................ 11 erythrocin tab250mg .......................... 11 ERYTHROM ETHTAB400MG ............ 11 erythromycingel/benzoyl ..................... 57 erythromycingel2% ............................. 11 erythromycinoinop .............................. 11 erythromycinsol2% ............................. 11 erythromycintab250mg bs .................. 11 erythromycintab500mg bs .................. 11 escitalopramsol5mg/5ml ..................... 19 escitalopramtab10mg ......................... 19 escitalopramtab20mg ......................... 19 escitalopramtab5mg ........................... 19 esomepra magcap20mg dr ................ 60 esomeprazoleinj20mg ........................ 60 esomeprazoleinj40mg ........................ 60 estra/norethtab1-0.5mg ...................... 66 estrace vag cre0.1mg/gm ................... 66 estrad val inj20mg/ml ........................ 66 estradiol dis0.025mg ........................ 66 estradiol dis0.0375mg ...................... 66 estradiol dis0.05mg .......................... 66 estradiol dis0.06mg .......................... 66 estradiol dis0.075mg ........................ 66 estradiol dis0.1mg ............................ 66 estradiol tab0.5mg ............................ 66 estradiol tab1mg ............................... 66 estradiol tab2mg ............................... 66 ESTRING MIS2MG ........................ 66 Estrogens .......................................... 65 eszopiclone tab1mg ........................... 79 eszopiclone tab2mg ........................... 79

96

eszopiclone tab3mg ........................... 79 ethambutol tab100mg ........................ 25 ethambutol tab400mg ........................ 25 ethosuximidecap250mg ..................... 13 ethosuximidesol250/5ml ..................... 13 etidron disdtab200mg ......................... 74 etidron disdtab400mg ......................... 74 etodolac cap200mg ........................... 2 etodolac cap300mg ........................... 2 etodolac tab400mg ............................ 2 etodolac tab500mg ............................ 2 etodolac er tab400mg ........................... 2 etodolac er tab500mg ........................... 2 etodolac er tab600mg ........................... 2 ETOPOPHOS INJ100MG ................ 27 etoposide inj20mg/ml ....................... 27 EVOTAZ TAB300-150 ........................ 36 EXELDERM CRE1% ....................... 23 EXELDERM SOL1% ....................... 23 EXELON DIS13.3/24 ..................... 17 EXELON DIS4.6MG/24 ................. 17 EXELON DIS9.5MG/24 ................. 17 exemestane tab25mg ........................ 27 EXFORGEH/10-TAB160-12.5 ............ 50 EXFORGEH/10-TAB160-25 ............... 50 EXFORGEH/10-TAB320-25 ............... 50 EXFORGEH/5- TAB160-12.5 ............. 50 EXFORGEH/5- TAB160-25 ................ 50 EXJADE TAB125MG ..................... 81 EXJADE TAB250MG ..................... 81 EXJADE TAB500MG ..................... 81 EXTAVIA INJ0.3MG ....................... 56 FABRAZYME INJ35MG ................... 58 falmina tab .......................................... 66 famciclovir tab125mg ......................... 35 famciclovir tab250mg ......................... 35 famciclovir tab500mg ......................... 35 famotidine inj10mg/ml ....................... 60 famotidine inj20mg/50m .................... 60 famotidine sus40mg/5ml ................... 60 famotidine tab20mg ........................... 60 famotidine tab40mg ........................... 60 FANAPT PAK ................................ 32 FANAPT TAB10MG ...................... 32 FANAPT TAB12MG ...................... 32 FANAPT TAB1MG ........................ 32

FANAPT TAB2MG ........................ 32 FANAPT TAB4MG ........................ 32 FANAPT TAB6MG ........................ 32 FANAPT TAB8MG ........................ 32 FARESTON TAB60MG ................... 26 FARYDAK CAP10MG ........................ 26 FARYDAK CAP15MG ........................ 26 FARYDAK CAP20MG ........................ 26 FASLODEX INJ250MG ................... 26 FAZACLO TAB100/ODT ................ 33 FAZACLO TAB12.5/ODT ............... 33 FAZACLO TAB150MG ................... 34 FAZACLO TAB200MG ................... 34 FAZACLO TAB25MG ODT ............ 34 felbamate sus600/5ml ...................... 15 felbamate tab400mg ......................... 15 felbamate tab600mg ......................... 15 felodipine tab10mg er ........................ 48 felodipine tab2.5mg er ....................... 48 felodipine tab5mg er .......................... 48 fenofibrate cap134mg ......................... 53 fenofibrate cap200mg ......................... 53 fenofibrate cap67mg........................... 53 fenofibrate tab145mg ......................... 53 fenofibrate tab160mg ......................... 53 fenofibrate tab48mg ........................... 53 fenofibrate tab54mg ........................... 53 fenofibric cap135mg dr ...................... 53 fenofibric cap45mg dr ........................ 53 fenoprofen tab600mg .......................... 2 fentanyl dis100mcg/h ........................ 3 fentanyl dis12mcg/hr ......................... 3 fentanyl dis25mcg/hr ......................... 3 fentanyl dis37.5mcg/hr ...................... 3 fentanyl dis50mcg/hr ......................... 3 fentanyl dis62.5mcg/hr ...................... 3 fentanyl dis75mcg/hr ......................... 3 fentanyl dis87.5mcg/hr ...................... 3 fentanyl ot loz1200mcg ........................ 4 fentanyl ot loz1600mcg ........................ 4 fentanyl ot loz200mcg .......................... 4 fentanyl ot loz400mcg .......................... 4 fentanyl ot loz600mcg .......................... 4 fentanyl ot loz800mcg .......................... 4 FETZIMA CAP120MG .................... 19 FETZIMA CAP20MG ...................... 19

97

FETZIMA CAP40MG ...................... 19 FETZIMA CAP80MG ...................... 19 FETZIMA CAPTITRATIO ............... 19 finasteride tab5mg .............................. 61 FIRAZYR INJ30MG/3ML ................ 70 FIRMAGON INJ120MG ................... 69 FLAREX SUS0.1% OP .................. 75 flavoxate tab100mg .......................... 61 flecainide tab100mg .......................... 46 flecainide tab150mg .......................... 46 flecainide tab50mg ............................ 46 FLECTOR DIS1.3% ......................... 2 FLOVENT DISKAER100MCG ............ 77 FLOVENT DISKAER250MCG ............ 77 FLOVENT DISKAER50MCG .............. 77 FLOVENT HFA AER110MCG ............ 77 FLOVENT HFA AER220MCG ............ 77 FLOVENT HFA AER44MCG .............. 77 fluconazole sus10mg/ml ..................... 23 fluconazole sus40mg/ml ..................... 23 fluconazole tab100mg ........................ 23 fluconazole tab150mg ........................ 23 fluconazole tab200mg ........................ 23 fluconazole tab50mg .......................... 23 fluconazole/injdex 400 ........................ 23 flucytosine cap250mg ......................... 23 flucytosine cap500mg ......................... 23 fludrocort tab0.1mg ........................... 63 flunisolide spr0.025% ......................... 77 fluocin acetcre0.01% .......................... 63 fluocin acetcre0.025% ........................ 63 fluocin acetoin0.025% ........................ 63 fluocin acetsol0.01% .......................... 63 fluocinonidecre0.1% ........................... 63 fluocinonidecre-e 0.05% ..................... 63 fluocinonidegel0.05% ......................... 63 fluocinonideoin0.05% ......................... 63 fluocinonidesol0.05% ......................... 63 fluoride chw1mg f ............................... 81 fluorometholsus0.1% op ..................... 75 fluorouracilcre5% ............................... 57 fluoxetine cap10mg ........................... 19 fluoxetine cap20mg ........................... 19 fluoxetine cap40mg ........................... 19 fluoxetine sol20mg/5ml ...................... 19 fluoxetine tab10mg ............................ 19

fluoxetine tab20mg ............................ 19 fluphenaz deinj25mg/ml ..................... 31 fluphenazinecon5mg/ml ..................... 31 fluphenazineelx2.5/5ml ....................... 31 fluphenazineinj2.5mg/ml ..................... 31 fluphenazinetab10mg ......................... 31 fluphenazinetab1mg ........................... 31 fluphenazinetab2.5mg ........................ 31 fluphenazinetab5mg ........................... 31 flurbiprofensol0.03% op ...................... 75 flurbiprofentab100mg ........................... 2 flurbiprofentab50mg ............................. 2 flutamide cap125mg ......................... 25 fluticasone cre0.05% .......................... 63 fluticasone oin0.005% ........................ 63 fluticasone spr50mcg ......................... 77 fluvastatin cap20mg ........................... 53 fluvastatin cap40mg ........................... 53 fluvoxamine cap100mg er .................. 19 fluvoxamine cap150mg er .................. 19 fluvoxamine tab100mg ....................... 19 fluvoxamine tab25mg ......................... 19 fluvoxamine tab50mg ......................... 19 FML OIN0.1% OP ...................... 75 FML FORTE SUS0.25% OP ............ 75 fomepizole inj1gm/ml ......................... 80 fondaparinuxsol10/0.8 ........................ 41 fondaparinuxsol2.5/0.5 ....................... 41 fondaparinuxsol5.0/0.4 ....................... 41 fondaparinuxsol7.5/0.6 ....................... 41 FORADIL CAPAEROLIZE .............. 78 FORFIVO XL TAB450MG ................... 6 FORTEO SOL600/2.4 ................... 74 FORTICAL SPR200/ACT ................ 74 foscarnet inj24mg/ml ........................ 34 fosinop/hctztab10/12.5 ....................... 50 fosinop/hctztab20/12.5 ....................... 50 fosinopril tab10mg ............................. 45 fosinopril tab20mg ............................. 45 fosinopril tab40mg ............................. 45 fosphenytoininj100/2ml ....................... 16 FOSRENOL CHW1000MG ............. 61 FOSRENOL CHW500MG ............... 61 FOSRENOL CHW750MG ............... 61 FRAGMIN INJ10000/ML ................ 41 FRAGMIN INJ12500UNT ............... 41

98

FRAGMIN INJ15000UNT ............... 41 FRAGMIN INJ18000UNT ............... 41 FRAGMIN INJ2500/0.2 .................. 41 FRAGMIN INJ25000/ML ................ 42 FRAGMIN INJ5000/0.2 .................. 42 FRAGMIN INJ7500/0.3 .................. 42 furosemide inj10mg/ml ...................... 52 furosemide sol10mg/ml ..................... 52 furosemide sol8mg/ml ....................... 52 furosemide tab20mg .......................... 52 furosemide tab40mg .......................... 52 furosemide tab80mg .......................... 52 FUSILEV INJ50MG ........................ 26 FUZEON INJ90MG ....................... 37 FYCOMPA TAB10MG .................... 14 FYCOMPA TAB12MG .................... 14 FYCOMPA TAB2MG ...................... 14 FYCOMPA TAB4MG ...................... 14 FYCOMPA TAB6MG ...................... 14 FYCOMPA TAB8MG ...................... 14 GABA Receptor Modulators ............ 79 gabapentin cap100mg ....................... 14 gabapentin cap300mg ....................... 14 gabapentin cap400mg ....................... 14 gabapentin sol250/5ml ...................... 14 gabapentin tab600mg ........................ 14 gabapentin tab800mg ........................ 14 GABITRIL TAB12MG ...................... 14 GABITRIL TAB16MG ...................... 14 galantamine cap16mg er .................... 17 galantamine cap24mg er .................... 17 galantamine cap8mg er ...................... 17 galantamine sol4mg/ml ...................... 17 galantamine tab12mg ......................... 17 galantamine tab4mg ........................... 17 galantamine tab8mg ........................... 17 GAMASTAN S/DINJ ........................... 72 Gamma-aminobutyric Acid (GABA)

Augmenting Agents ...................... 13 GAMMAGARD INJ2.5GM/25 ........... 72 ganciclovir inj500mg ........................... 34 GARDASIL INJ ................................ 72 Gastrointestinal Agents ................... 59 GASTROINTESTINAL AGENTS ....... 59 Gastrointestinal Agents, Other ....... 59 gatifloxacinsol0.5%............................. 11

GAUZE PAD2............................... 58 gavilyte-c sol ..................................... 59 gavilyte-g sol ..................................... 59 gavilyte-n solflav pk ........................... 59 gemcitabine inj1gm ............................ 27 gemfibrozil tab600mg ......................... 53 generlac sol10gm/15 ....................... 60 gengraf cap100mg ......................... 71 gengraf cap25mg ........................... 71 gengraf sol100mg/ml ...................... 71 GENITOURINARY AGENTS ............. 61 Genitourinary Agents, Other ........... 61 GENOTROPIN INJ0.2MG ................. 64 GENOTROPIN INJ0.4MG ................. 64 GENOTROPIN INJ0.6MG ................. 65 GENOTROPIN INJ0.8MG ................. 65 GENOTROPIN INJ1.2MG ................. 65 GENOTROPIN INJ1.4MG ................. 65 GENOTROPIN INJ1.6MG ................. 65 GENOTROPIN INJ1.8MG ................. 65 GENOTROPIN INJ12MG .................. 59 GENOTROPIN INJ1MG .................... 65 GENOTROPIN INJ2MG .................... 65 GENOTROPIN INJ5MG .................... 65 gentak oin0.3% op ........................... 6 gentam/nacl inj0.9mg/ml ...................... 6 gentam/nacl inj1.4mg/ml ...................... 6 gentam/nacl inj100mg .......................... 6 gentam/nacl inj60mg ............................ 6 gentam/nacl inj80mg ............................ 6 gentamicin cre0.1% ............................. 6 gentamicin inj10mg/ml ......................... 6 gentamicin inj40mg/ml ......................... 6 GENTAMICIN OIN0.1% ...................... 6 gentamicin sol0.3% op ........................ 6 GEODON INJ20MG ...................... 32 gildess tab1.5/30 ................................ 66 GILENYA CAP0.5MG ..................... 56 GILOTRIF TAB20MG ...................... 28 GILOTRIF TAB30MG ...................... 28 GILOTRIF TAB40MG ...................... 28 GLEEVEC TAB100MG ................... 28 GLEEVEC TAB400MG ................... 28 GLEOSTINE CAP100MG ................. 27 GLEOSTINE CAP10MG ................... 27 GLEOSTINE CAP40MG ................... 27

99

glimepiride tab1mg ............................. 39 glimepiride tab2mg ............................. 39 glimepiride tab4mg ............................. 39 glip/metformtab2.5-250m ................... 40 glip/metformtab2.5-500m ................... 40 glip/metformtab5-500mg .................... 40 glipizide tab10mg ............................. 39 glipizide tab5mg ............................... 39 glipizide ertab10mg ............................ 39 glipizide ertab2.5mg ........................... 39 glipizide ertab5mg .............................. 39 GLUCAGEN INJHYPOKIT .............. 40 GLUCAGON KIT1MG ..................... 40 Glutamate Reducing Agents ........... 15 glyb/metformtab1.25-250 ................... 40 glyb/metformtab2.5-500 ..................... 40 glyb/metformtab5-500mg ................... 40 glyburid mcrtab1.5mg ......................... 39 glyburid mcrtab3mg ............................ 39 glyburid mcrtab6mg ............................ 39 glyburide tab1.25mg ......................... 39 glyburide tab2.5mg ........................... 39 glyburide tab5mg .............................. 39 Glycemic Agents .............................. 40 glycopyrrol inj0.2mg/ml ....................... 59 glycopyrrol tab1mg ............................. 59 glycopyrrol tab2mg ............................. 59 granisetron inj0.1mg/ml ...................... 22 granisetron inj1mg/ml ......................... 22 granisetron tab1mg ............................ 22 griseofulvinsus125/5ml ....................... 23 guanfacine tab1mg ............................ 44 guanfacine tab2mg ............................ 44 guanfacine tab1mg er ......................... 55 guanfacine tab2mg er ......................... 55 guanfacine tab3mg er ......................... 55 guanfacine tab4mg er ......................... 55 GUANIDINE TAB125MG .................. 24 HALAVEN INJ1MG/2ML ................ 27 halobetasol cre0.05% ......................... 63 halobetasol oin0.05% ......................... 63 HALOG CRE0.1% ........................ 63 HALOG OIN0.1% ......................... 63 haloper dec inj100mg/ml .................... 31 haloper dec inj50mg/ml ...................... 31 haloper lac inj5mg/ml ......................... 31

haloperidol con2mg/ml ....................... 31 haloperidol tab0.5mg .......................... 31 haloperidol tab10mg ........................... 31 haloperidol tab1mg ............................. 32 haloperidol tab20mg ........................... 32 haloperidol tab2mg ............................. 32 haloperidol tab5mg ............................. 32 HARVONI TAB90-400MG .................. 35 HAVRIX INJ1440UNIT .................. 72 HAVRIX INJ720UNIT .................... 72 hc butyrate cre0.1% ........................... 63 hc valerate cre0.2%............................ 63 hc valerate oin0.2% ............................ 63 hc/acet acidsolotic .............................. 76 hep sod/d5w inj20000unt ................... 42 hep sod/d5w inj25000unt ................... 42 hep sod/naclinj1000unit ...................... 42 heparin sod inj1000/ml ....................... 42 heparin sod inj10000/ml ..................... 42 heparin sod inj20000/ml ..................... 42 heparin sod inj5000/ml ....................... 42 HERCEPTIN INJ440MG .................. 27 HEXALEN CAP50MG .................... 25 Histamine2 (H2) Receptor

Antagonists ................................... 59 HORMONAL AGENTS, STIMULANT/

REPLACEMENT/ MODIFYING (Adrenal) ........................................ 62

HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (PITUITARY) .................................. 64

HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (SEX HORMONES/MODIFIERS) ............ 65

HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (THYROID) ..................................... 68

Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal) ........................................ 62

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) ....................................... 64

Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) ........... 66

100

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) ........................................ 68

Hormonal Agents, Suppressant (Adrenal) ........................................ 69

HORMONAL AGENTS, SUPPRESSANT (ADRENAL) ........ 69

Hormonal Agents, Suppressant (Parathyroid) ................................. 69

HORMONAL AGENTS, SUPPRESSANT (PARATHYROID) 69

Hormonal Agents, Suppressant (Pituitary) ....................................... 69

HORMONAL AGENTS, SUPPRESSANT (PITUITARY) ...... 69

HORMONAL AGENTS, SUPPRESSANTS (THYROID) ....... 70

HUMALOG INJ100/ML ................... 40 HUMALOG KWIKINJ100/ML .............. 40 HUMALOG KWIKINJ200/ML .............. 40 HUMALOG MIX INJ50/50 .................. 40 HUMALOG MIX INJ50/50KWP .......... 40 HUMALOG MIX INJ75/25KWP .......... 40 HUMALOG MIX SUS75/25 ................ 40 HUMATROPE INJ12MG .................. 65 HUMATROPE INJ24MG .................. 65 HUMATROPE INJ5MG .................... 65 HUMATROPE INJ6MG .................... 65 HUMIRA INJ10MG/0.2 .................. 71 HUMIRA KIT20MG/0.4 .................. 71 HUMIRA KIT40MG/0.8 .................. 71 HUMIRA PEN KITCROHNS .............. 71 HUMULIN INJ70/30 ........................ 40 HUMULIN N INJU-100 ..................... 40 HUMULIN N PNINJU-100 .................. 40 HUMULIN PEN INJ70/30 ................... 40 HUMULIN R INJU-100 ..................... 41 HUMULIN R INJU-500 ..................... 41 hycet sol7.5-325 ............................. 1 hydralazine inj20mg/ml ....................... 54 hydralazine tab100mg ........................ 54 hydralazine tab10mg .......................... 54 hydralazine tab25mg .......................... 54 hydralazine tab50mg .......................... 54 hydrochlorotcap12.5mg ...................... 53 hydrochlorottab12.5mg ....................... 53

hydrochlorottab25mg.......................... 53 hydrochlorottab50mg.......................... 53 hydroco/apapsol7.5-325 ....................... 1 hydroco/apaptab10-300mg .................. 1 hydroco/apaptab10-325mg .................. 1 hydroco/apaptab5-300mg .................... 1 hydroco/apaptab5-325mg .................... 1 hydroco/apaptab7.5-300 ...................... 1 hydroco/apaptab7.5-325 ...................... 1 hydrocod/ibutab7.5-200 ........................ 1 hydrocort cre1% ............................... 63 hydrocort cre2.5% ............................ 63 hydrocort ene100mg ........................ 63 hydrocort lot2.5% ............................. 63 hydrocort oin1% ............................... 63 hydrocort oin2.5% ............................ 63 hydrocort tab10mg ........................... 63 hydrocort tab20mg ........................... 63 hydrocort tab5mg ............................. 63 hydromorphoninj500/50ml .................... 4 hydromorphontab12mg er .................... 3 hydromorphontab16mg er .................... 3 hydromorphontab2mg .......................... 4 hydromorphontab32mg er .................... 3 hydromorphontab4mg .......................... 4 hydromorphontab8mg .......................... 4 hydromorphontab8mg er ...................... 3 hydroxychlortab200mg ....................... 30 hydroxyurea cap500mg ...................... 26 hydroxyz hclinj25mg/ml ...................... 38 hydroxyz hclinj50mg/ml ...................... 38 HYPERRAB S/DINJ150/ML ............... 72 ibandronate inj3mg/3ml ...................... 74 ibandronate tab150mg ....................... 74 IBRANCE CAP100MG ....................... 27 IBRANCE CAP125MG ....................... 27 IBRANCE CAP75MG ......................... 27 ibuprofen sus100/5ml ......................... 2 ibuprofen tab400mg ........................... 2 ibuprofen tab600mg ........................... 2 ibuprofen tab800mg ........................... 2 ICLUSIG TAB15MG ........................... 28 ICLUSIG TAB45MG ........................... 28 ILARIS INJ180MG ......................... 72 IMBRUVICA CAP140MG ................. 28 imipenem/cilinj250mg ........................... 9

101

imipenem/cilinj500mg ........................... 9 imipram hcl tab10mg .......................... 21 imipram hcl tab25mg .......................... 21 imipram hcl tab50mg .......................... 21 imipram pam cap100mg ..................... 21 imipram pam cap125mg ..................... 21 imipram pam cap150mg ..................... 21 imipram pam cap75mg ....................... 21 imiquimod cre5% .............................. 57 Immune Suppressants ..................... 70 Immunizing Agents, Passive ........... 72 Immunological Agents ..................... 72 IMMUNOLOGICAL AGENTS ............ 70 Immunomodulators .......................... 72 IMOVAX RABIEINJ2.5/ML ................. 72 INCIVEK TAB375MG ..................... 35 INCRELEX INJ40MG/4ML .............. 65 INCRUSE ELPTINH62.5MCG ............ 77 indapamide tab1.25mg ...................... 53 indapamide tab2.5mg ........................ 53 indomethacincap25mg ......................... 2 indomethacincap50mg ......................... 2 indomethacincap75mg er ..................... 2 INFANRIX INJ ................................. 72 INFLAMMATORY BOWEL DISEASE

AGENTS ......................................... 73 INLYTA TAB1MG .......................... 28 INLYTA TAB5MG .......................... 28 INSULIN SYRGMIS0.3/31G ............... 58 INSULIN SYRGMIS0.5/29G ............... 58 INSULIN SYRGMIS0.5/31G ............... 58 INSULIN SYRGMIS1ML/29G ............. 58 Insulins .............................................. 40 INTELENCE TAB100MG ................. 36 INTELENCE TAB200MG ................. 36 INTELENCE TAB25MG ................... 36 intralipid inj20% ................................. 80 INTRON-A INJ10MU ....................... 34 INTRON-A INJ18MU ....................... 34 INTRON-A INJ50MU ....................... 34 INVANZ INJ1GM ............................. 9 INVEGA TAB1.5MG ...................... 32 INVEGA TAB3MG ......................... 32 INVEGA TAB6MG ......................... 32 INVEGA TAB9MG ......................... 32 INVEGA SUST INJ117/0.75 ............... 32

INVEGA SUST INJ156MG/ML ........... 32 INVEGA SUST INJ234/1.5 ................. 32 INVEGA SUST INJ39/0.25 ................. 32 INVEGA SUST INJ78/0.5ML .............. 32 INVIRASE CAP200MG ................... 37 INVIRASE TAB500MG .................... 37 IOPIDINE SOL1% OP ..................... 75 IPOL INJINACTIVE ..................... 72 ipratropium sol0.02%inh ..................... 77 ipratropium spr0.03% ......................... 77 ipratropium spr0.06% ......................... 77 irbesar/hctztab150-12.5 ...................... 50 irbesar/hctztab300-12.5 ...................... 50 irbesartan tab150mg ......................... 44 irbesartan tab300mg ......................... 44 irbesartan tab75mg ........................... 44 irenka cap40mg .................................. 19 Irritable Bowel Syndrome Agents ... 60 ISENTRESS CHW100MG ................ 35 ISENTRESS CHW25MG .................. 35 ISENTRESS POW100MG ................ 35 ISENTRESS TAB400MG ................. 35 isoniazid inj100mg/ml ....................... 25 isoniazid syp50mg/5ml ..................... 25 isoniazid tab100mg .......................... 25 isoniazid tab300mg .......................... 25 isosorb din tab10mg ........................... 54 isosorb din tab20mg ........................... 54 isosorb din tab30mg ........................... 54 isosorb din tab40mg er ....................... 54 isosorb din tab5mg ............................. 54 isosorb monotab10mg ........................ 54 isosorb monotab120mg er .................. 54 isosorb monotab20mg ........................ 54 isosorb monotab30mg er .................... 54 isosorb monotab60mg er .................... 54 isradipine cap2.5mg .......................... 48 isradipine cap5mg ............................. 48 ISTODAX INJ10MG ....................... 27 itraconazolecap100mg ....................... 23 ivermectin tab3mg .............................. 29 IXIARO INJ .................................... 72 JAKAFI TAB10MG ........................ 28 JAKAFI TAB15MG ........................ 28 JAKAFI TAB20MG ........................ 28 JAKAFI TAB25MG ........................ 28

102

JAKAFI TAB5MG .......................... 28 jantoven tab10mg ............................ 42 jantoven tab1mg .............................. 42 jantoven tab2.5mg ........................... 42 jantoven tab2mg .............................. 42 jantoven tab3mg .............................. 42 jantoven tab4mg .............................. 42 jantoven tab5mg .............................. 42 jantoven tab6mg .............................. 42 jantoven tab7.5mg ........................... 42 JANUMET TAB50-1000 ................. 40 JANUMET TAB50-500MG ............. 40 JANUMET XR TAB100-1000 ............ 40 JANUMET XR TAB50-1000 .............. 40 JANUMET XR TAB50-500MG .......... 40 JANUVIA TAB100MG .................... 39 JANUVIA TAB25MG ...................... 39 JANUVIA TAB50MG ...................... 39 JEVTANA INJ60/1.5ML .................. 27 jinteli tab1mg-5mcg ........................ 66 junel 1.5/30tab .................................... 67 junel 1/20 tab ..................................... 67 junel fe tab1.5/30 ............................. 67 junel fe tab1/20 ................................ 67 KADCYLA INJ100MG .................... 29 KALETRA SOL ............................... 37 KALETRA TAB100-25MG .............. 37 KALETRA TAB200-50MG .............. 37 kariva tab28 day ............................ 67 kcl in nacl inj ....................................... 81 kcl/d5w inj0.15%............................. 80 kcl/d5w inj0.3%............................... 80 kcl/d5w/lr inj0.15%............................. 80 kcl/d5w/naclinj.075/.45 ....................... 80 kcl/d5w/naclinj.15/.33% ...................... 80 kcl/d5w/naclinj.15/.45% ...................... 80 kcl/d5w/naclinj.22/.45 ......................... 80 kcl/d5w/naclinj0.15/0.2 ....................... 80 KCL/D5W/NACLINJ0.15/0.2 .............. 80 kcl/d5w/naclinj0.15/0.9 ....................... 80 kcl/d5w/naclinj0.3/0.45 ....................... 80 kcl/d5w/naclinj0.3/0.9% ...................... 80 kelnor tab1/35 ............................... 67 KEPIVANCE INJ6.25MG .................. 56 ketoconazolecre2% ............................ 23 ketoconazolesha2% ........................... 23

ketoconazoletab200mg ...................... 23 ketoprofen cap200mg er ..................... 2 ketoprofen cap50mg............................ 2 ketoprofen cap75mg............................ 2 ketorolac sol0.4% ............................. 76 ketorolac sol0.5% ............................. 76 ketorolac tab10mg ................................ 2 KEYTRUDA INJ100MG/4ML .............. 27 KEYTRUDA SOL50MG ...................... 27 KHEDEZLA TAB100MG ER ............ 19 KHEDEZLA TAB50MG ER .............. 19 KINERET INJ ................................. 71 kionex pow ......................................... 81 klor-con 10 tab10meq er .................... 81 klor-con 8 tab8meq er ....................... 81 klor-con m15tab ................................. 81 klor-con m20tab20meq er .................. 81 KUVAN TAB100MG ..................... 58 labetalol inj5mg/ml............................ 47 labetalol tab100mg ........................... 47 labetalol tab200mg ........................... 47 labetalol tab300mg ........................... 47 lactated rininj ...................................... 80 lactated rinsolirrigat ............................ 80 lactulose sol10gm/15 ........................ 60 lamivud/zidotab150-300 ..................... 36 lamivudine sol10mg/ml ...................... 36 lamivudine tab100mg ........................ 34 lamivudine tab150mg ........................ 36 lamivudine tab300mg ........................ 36 lamotrigine chw25mg ......................... 15 lamotrigine chw5mg ........................... 15 lamotrigine tab100mg ......................... 15 lamotrigine tab100mg er ..................... 15 lamotrigine tab150mg ......................... 15 lamotrigine tab200mg ......................... 15 lamotrigine tab200mg er ..................... 15 lamotrigine tab250mg er ..................... 15 lamotrigine tab25mg ........................... 15 lamotrigine tab25mg er ....................... 15 lamotrigine tab300mg er ..................... 15 lamotrigine tab50mg er ....................... 15 lamotrigine tabodt100mg .................... 15 lamotrigine tabodt200mg .................... 15 lamotrigine tabodt25mg ...................... 15 lamotrigine tabodt50mg ...................... 15

103

lansopr/amoxmis/clarith ...................... 59 lansoprazolecap15mg dr .................... 60 lansoprazolecap30mg dr .................... 60 LANTUS INJ100/ML ...................... 41 LANTUS INJSOLOSTAR .............. 41 larin tab1.5/30 .................................... 67 latanoprost sol0.005% ........................ 76 LATUDA TAB120MG .................... 32 LATUDA TAB20MG ...................... 32 LATUDA TAB40MG ...................... 32 LATUDA TAB60MG ...................... 33 LATUDA TAB80MG ...................... 33 Laxatives ........................................... 60 leflunomide tab10mg .......................... 72 leflunomide tab20mg .......................... 72 LENVIMA CAP10MG ......................... 28 LENVIMA CAP14MG ......................... 28 LENVIMA CAP20MG ......................... 28 LENVIMA CAP24MG ......................... 28 lessina tab ...................................... 67 LETAIRIS TAB10MG ....................... 78 LETAIRIS TAB5MG ......................... 78 letrozole tab2.5mg ............................ 27 leucovor ca inj100mg ......................... 27 leucovor ca inj350mg ......................... 27 leucovor ca tab10mg .......................... 27 leucovor ca tab15mg .......................... 27 leucovor ca tab25mg .......................... 27 leucovor ca tab5mg ............................ 27 LEUKERAN TAB2MG ..................... 25 LEUKINE INJ250MCG ................... 43 leuprolide inj1mg/0.2 ......................... 69 LEVEMIR INJ ................................. 41 LEVEMIR INJFLEXPEN ................. 41 LEVETIRACETAINJ10MG/ML ........... 12 LEVETIRACETAINJ15MG/ML ........... 13 LEVETIRACETAINJ5MG/ML ............. 13 levetiracetasol100mg/ml ..................... 13 levetiracetatab1000mg ....................... 13 levetiracetatab250mg ......................... 13 levetiracetatab500mg ......................... 13 levetiracetatab500mg er ..................... 13 levetiracetatab750mg ......................... 13 levetiracetatab750mg er ..................... 13 levetiracetminj500/5ml ........................ 13 levobunolol sol0.5% op ...................... 75

levocarnitininj200mg/ml ...................... 80 levocarnitinsol1gm/10ml ..................... 80 levocarnitintab330mg ......................... 80 levocetirizisol2.5/5ml .......................... 76 levocetirizitab5mg............................... 76 levofloxacinsol0.5% ............................ 11 levofloxacinsol25mg/ml ...................... 11 levofloxacintab250mg ......................... 11 levofloxacintab500mg ......................... 11 levofloxacintab750mg ......................... 11 levora-28 tab0.15/30 ........................ 67 levorphanol tab2mg .............................. 3 levothyroxintab100mcg ...................... 68 levothyroxintab112mcg ...................... 68 levothyroxintab125mcg ...................... 68 levothyroxintab137mcg ...................... 68 levothyroxintab150mcg ...................... 68 levothyroxintab175mcg ...................... 68 levothyroxintab200mcg ...................... 68 levothyroxintab25mcg ........................ 68 levothyroxintab300mcg ...................... 68 levothyroxintab50mcg ........................ 68 levothyroxintab75mcg ........................ 68 levothyroxintab88mcg ........................ 68 LEXIVA SUS50MG/ML .................. 37 LEXIVA TAB700MG ...................... 37 lido/prilocncre2.5-2.5% ......................... 5 lidocaine gel2% jelly ........................... 5 lidocaine inj0.5% ................................ 5 lidocaine inj1% ................................... 5 lidocaine oin5% .................................. 5 lidocaine pad5% ................................. 5 lidocaine sol2% visc ........................... 5 lidocaine sol4% .................................. 5 lindane lot1% .................................. 30 lindane sha1% ................................ 30 linezolid inj2mg/ml ................................ 7 liothyronineinj10mcg/ml ...................... 68 liothyroninetab25mcg ......................... 68 liothyroninetab50mcg ......................... 68 liothyroninetab5mcg ........................... 68 lisinop/hctztab10-12.5 ........................ 50 lisinop/hctztab20-12.5 ........................ 50 lisinop/hctztab20-25mg ...................... 50 lisinopril tab10mg .............................. 45 lisinopril tab2.5mg ............................. 45

104

lisinopril tab20mg .............................. 45 lisinopril tab30mg .............................. 45 lisinopril tab40mg .............................. 45 lisinopril tab5mg ................................ 45 lithium carbcap150mg ........................ 38 lithium carbcap300mg ........................ 38 lithium carbcap600mg ........................ 38 lithium carbtab300mg ......................... 38 lithium carbtab300mg er ..................... 38 lithium carbtab450mg er ..................... 38 LITHIUM CITRSOL8MEQ/5ML .......... 38 Local Anesthetics............................... 5 lokara lot0.05%.............................. 63 lomedia 24 tabfe ................................ 67 LOMUSTINE CAP100MG ................ 27 LOMUSTINE CAP10MG .................. 27 LOMUSTINE CAP40MG .................. 27 loperamide cap2mg ........................... 59 lorazepam con2mg/ml ...................... 14 lorazepam tab0.5mg ......................... 14 lorazepam tab1mg............................ 14 lorazepam tab2mg............................ 14 losartan pottab100mg ......................... 44 losartan pottab25mg........................... 44 losartan pottab50mg........................... 44 losartan/hcttab100-12.5 ...................... 50 losartan/hcttab100-25 ......................... 50 losartan/hcttab50-12.5 ........................ 51 LOTEMAX SUS0.5% ...................... 76 LOTRONEX TAB0.5MG .................. 60 LOTRONEX TAB1MG ..................... 60 lovastatin tab10mg ............................ 53 lovastatin tab20mg ............................ 53 lovastatin tab40mg ............................ 53 LOVAZA CAP1GM ........................ 54 low-ogestreltab ................................... 67 loxapine cap10mg ........................... 32 loxapine cap25mg ........................... 32 loxapine cap50mg ........................... 32 loxapine cap5mg ............................. 32 lufyllin tab200mg ............................. 78 lufyllin tab400mg ............................. 78 LUMIGAN SOL0.01% ..................... 76 LUPR DEP-PEDINJ11.25MG ............. 69 LUPR DEP-PEDINJ15MG .................. 69 LUPRON DEPOTINJ11.25MG ........... 69

LUPRON DEPOTINJ22.5MG ............. 69 LUPRON DEPOTINJ3.75MG ............. 69 LUPRON DEPOTINJ30MG ................ 69 LUPRON DEPOTINJ45MG ................ 69 LUPRON DEPOTINJ7.5MG ............... 69 lutera tab ....................................... 67 LYNPARZA CAP50MG ...................... 28 LYRICA CAP100MG ..................... 13 LYRICA CAP150MG ..................... 13 LYRICA CAP200MG ..................... 13 LYRICA CAP225MG ..................... 13 LYRICA CAP25MG ....................... 13 LYRICA CAP300MG ..................... 13 LYRICA CAP50MG ....................... 13 LYRICA CAP75MG ....................... 13 LYRICA SOL20MG/ML ................. 13 LYSODREN TAB500MG ................. 69 Macrolides ........................................ 10 mafenide acepak5% ............................. 7 magnesium suinj50% ......................... 81 malathion lot0.5% ............................. 30 maprotiline tab25mg ........................... 19 maprotiline tab50mg ........................... 19 maprotiline tab75mg ........................... 19 MARPLAN TAB10MG .................... 18 Mast Cell Stabilizers ......................... 78 MATULANE CAP50MG ................... 25 MAXIDEX SUS0.1% OP ................ 76 meclizine tab12.5mg ........................ 21 meclizine tab25mg ........................... 21 meclofen sodcap100mg ....................... 2 meclofen sodcap50mg ......................... 2 medroxypr acinj150mg/ml .................. 68 medroxypr actab10mg ........................ 68 medroxypr actab2.5mg ....................... 68 medroxypr actab5mg .......................... 68 mefenam acidcap250mg ...................... 2 mefloquine tab250mg ........................ 30 MEGACE ES SUS625/5ML .............. 68 megestrol acsus40mg/ml ................... 68 megestrol actab20mg ......................... 68 megestrol actab40mg ......................... 68 MEKINIST TAB0.5MG ..................... 28 MEKINIST TAB2MG ........................ 28 meloxicam tab15mg ........................... 2 meloxicam tab7.5mg .......................... 2

105

MENACTRA INJ .............................. 72 menest tab0.3mg........................... 66 menest tab0.625mg ....................... 66 menest tab1.25mg ......................... 66 menest tab2.5mg........................... 66 MENOMUNE INJA/C/Y/W ............... 72 MENVEO INJ ................................ 72 meprobamate tab200mg .................... 38 meprobamate tab400mg .................... 38 mercaptopur tab50mg ........................ 26 meropenem inj500mg ......................... 9 mesalamine kit4gm ........................... 73 MESNEX TAB400MG ................... 27 MESTINON SYP60MG/5ML ........... 24 MESTINON TABTIMESPAN ........... 24 Metabolic Bone Disease Agents ..... 73 METABOLIC BONE DISEASE

AGENTS ......................................... 73 metaproterensyp10mg/5ml ................. 78 metaproterentab10mg ........................ 78 metaproterentab20mg ........................ 78 metformin tab1000mg ...................... 39 metformin tab500mg ........................ 39 metformin tab500mg er .................... 39 metformin tab750mg er .................... 39 metformin tab850mg ........................ 39 metformin ertab1000mg ..................... 39 METHADONE INJ10MG/ML .............. 3 methadone sol10mg/5ml .................... 3 methadone sol5mg/5ml ...................... 3 methadone tab10mg .......................... 3 methadone tab5mg ............................ 3 methazolamidtab25mg ....................... 52 methazolamidtab50mg ....................... 52 methenam hiptab1gm ........................... 7 methimazole tab10mg ........................ 70 methimazole tab5mg .......................... 70 methotrexateinj1gm ............................ 71 methotrexateinj25mg/ml ..................... 71 methotrexatetab2.5mg ....................... 71 methoxsalen cap10mg ....................... 57 methscopolamtab2.5mg ..................... 59 methscopolamtab5mg ........................ 59 methyclothiatab5mg ........................... 53 methyld/hctztab250/15 ....................... 51 methyld/hctztab250/25 ....................... 51

methyldopa tab250mg ....................... 44 methyldopa tab500mg ....................... 44 methyldopateinj250/5ml ..................... 44 methylergon tab0.2mg ........................ 43 methylphenidcap20mg er ................... 55 methylphenidcap30mg er ................... 55 methylphenidcap40mg er ................... 55 methylphenidtab10mg ........................ 55 methylphenidtab18mg er .................... 55 methylphenidtab20mg ........................ 55 methylphenidtab20mg er .................... 55 methylphenidtab27mg er .................... 55 methylphenidtab36mg er .................... 55 methylphenidtab54mg er .................... 56 methylphenidtab5mg .......................... 56 methylpr aceinj40mg/ml ..................... 63 methylpr aceinj80mg/ml ..................... 63 methylpr ss inj125mg ......................... 63 methylpr ss inj40mg ........................... 63 methylpred pak4mg ........................... 63 methylpred tab16mg .......................... 63 methylpred tab32mg .......................... 63 methylpred tab4mg............................ 63 methylpred tab8mg............................ 64 metipranololsol0.3% oph .................... 75 metoclopram inj5mg/ml ...................... 21 metoclopram sol5mg/5ml ................... 21 metoclopram tab10mg ........................ 21 metoclopram tab5mg .......................... 21 metolazone tab10mg ......................... 53 metolazone tab2.5mg ........................ 53 metolazone tab5mg ........................... 53 metoprl/hctztab100-25mg ................... 51 metoprl/hctztab100-50mg ................... 51 metoprl/hctztab50-25mg ..................... 51 metoprol tartab100mg ........................ 47 metoprol tartab25mg .......................... 47 metoprol tartab50mg .......................... 47 metoprolol inj1mg/ml ......................... 47 metoprolol tab100mg er .................... 47 metoprolol tab200mg er .................... 47 metoprolol tab25mg er ...................... 47 metoprolol tab50mg er ...................... 47 metron/nacl inj500mg ........................... 7 metronidazolcre0.75% .......................... 7 metronidazolgel0.75% .......................... 7

106

metronidazolgel0.75%vag .................... 7 metronidazollot0.75% ........................... 7 metronidazoltab250mg ......................... 7 metronidazoltab500mg ......................... 7 mexiletine cap150mg ........................ 46 mexiletine cap200mg ........................ 46 mexiletine cap250mg ........................ 46 MIACALCIN INJ200/ML ................... 74 miconazole 3sup200mg ..................... 23 microgestin tab1.5/30 ......................... 67 microgestin tab1/20 ............................ 67 microgestin tabfe 1/20 ........................ 67 microgestin tabfe1.5/30 ...................... 67 midodrine tab10mg........................... 44 midodrine tab2.5mg .......................... 44 midodrine tab5mg............................. 44 migergot sup2/100........................... 24 minocycline cap100mg ....................... 12 minocycline cap50mg ......................... 12 minocycline cap75mg ......................... 12 minocycline tab100mg ........................ 12 minocycline tab135mg er ................... 12 minocycline tab45mg er ..................... 12 minocycline tab50mg .......................... 12 minocycline tab75mg .......................... 12 minocycline tab90mg er ..................... 12 minoxidil tab10mg ............................ 54 minoxidil tab2.5mg ........................... 54 mirtazapine tab15mg .......................... 18 mirtazapine tab15mg odt .................... 18 mirtazapine tab30mg .......................... 18 mirtazapine tab30mg odt .................... 18 mirtazapine tab45mg .......................... 18 mirtazapine tab45mg odt .................... 18 mirtazapine tab7.5mg ......................... 18 misoprostol tab100mcg ...................... 60 misoprostol tab200mcg ...................... 60 mitoxantron inj2mg/ml ........................ 27 M-M-R II INJLIVE ............................ 73 moexipr/hctztab15-12.5 ...................... 51 moexipr/hctztab15-25mg .................... 51 moexipr/hctztab7.5-12.5 ..................... 51 moexipril tab15mg ............................ 45 moexipril tab7.5mg ........................... 45 Molecular Target Inhibitors ............. 28 mometasone cre0.1% ....................... 64

mometasone oin0.1% ........................ 64 mometasone sol0.1% ........................ 64 Monoamine Oxidase B (MAO-B)

Inhibitors ....................................... 31 Monoamine Oxidase Inhibitors ....... 18 Monoclonal Antibodies .................... 29 montelukast chw4mg .......................... 77 montelukast chw5mg .......................... 77 montelukast gra4mg ........................... 77 montelukast tab10mg ......................... 77 Mood Stabilizers ............................... 38 morphine sulcap100mg er .................... 3 morphine sulcap10mg er ...................... 3 morphine sulcap120mg er .................... 3 morphine sulcap20mg er ...................... 3 morphine sulcap30mg er ...................... 3 morphine sulcap45mg er ...................... 3 morphine sulcap50mg er ...................... 3 morphine sulcap60mg er ...................... 3 morphine sulcap75mg er ...................... 3 morphine sulcap80mg er ...................... 4 morphine sulcap90mg er ...................... 4 morphine sulsol10mg/5ml .................... 4 MORPHINE SULSOL20MG/5ML ......... 5 morphine sulsol20mg/ml ...................... 5 morphine sultab100mg er ..................... 4 morphine sultab15mg ....................... 4, 5 morphine sultab15mg er ....................... 4 morphine sultab200mg er ..................... 4 morphine sultab30mg ....................... 4, 5 morphine sultab30mg er ....................... 4 morphine sultab60mg er ....................... 4 MOVANTIK TAB12.5MG .................... 59 MOVANTIK TAB25MG ....................... 59 moxifloxacintab400mg ........................ 12 MOZOBIL INJ ................................. 43 MULTAQ TAB400MG .................... 46 Multiple Sclerosis Agents ................ 56 mupirocin cre2%................................. 7 mupirocin oin2% ................................. 7 MUSTARGEN INJ10MG .................. 25 mycophenolatcap250mg .................... 71 mycophenolatsus200mg/ml ................ 71 mycophenolattab500mg ..................... 71 mycophenolictab180mg dr ................. 71 mycophenolictab360mg dr ................. 71

107

myorisan cap10mg .......................... 57 myorisan cap20mg .......................... 57 myorisan cap40mg .......................... 57 MYOZYME INJ50MG ..................... 58 nabumetone tab500mg ....................... 2 nabumetone tab750mg ....................... 2 nadolol tab20mg ............................. 47 nadolol tab40mg ............................. 47 nadolol tab80mg ............................. 47 nadolol/bendtab40-5mg ...................... 51 nadolol/bendtab80-5mg ...................... 51 nafcillin inj10gm ................................ 10 nafcillin inj1gm .................................. 10 NAGLAZYME INJ1MG/ML ............... 58 nalbuphine inj10mg/ml ........................ 5 nalbuphine inj20mg/ml ........................ 5 naloxone inj1mg/ml ........................... 6 naltrexone tab50mg............................. 6 NAMENDA SOL10MG/5ML ........... 17 NAMENDA XR CAP14MG ................ 17 NAMENDA XR CAP21MG ................ 17 NAMENDA XR CAP28MG ................ 17 NAMENDA XR CAP7MG .................. 17 NAMENDA XR CAPTITRATIO .......... 17 naphazoline sol0.1% op ..................... 75 naproxen sus125/5ml ........................ 2 naproxen tab250mg .......................... 2 naproxen tab375mg .......................... 3 naproxen tab500mg .......................... 3 naproxen dr tab375mg ......................... 3 naproxen dr tab500mg ......................... 3 naproxen sodtab275mg ........................ 3 naproxen sodtab550mg ........................ 3 naratriptan tab1mg ............................. 24 naratriptan tab2.5mg .......................... 24 nateglinide tab120mg ......................... 39 nateglinide tab60mg ........................... 39 NEBUPENT INH300MG .................. 30 necon tab0.5/35............................ 67 necon tab1/35 .............................. 67 necon tab10/11-28 ....................... 67 nefazodone tab100mg ....................... 19 nefazodone tab150mg ....................... 19 nefazodone tab200mg ....................... 19 nefazodone tab250mg ....................... 19 nefazodone tab50mg......................... 19

neo/bac/polyoinop .............................. 74 neo/poly gu sol40/ml ir ......................... 7 neo/poly/bacoin/hc 1%op ................... 74 neo/poly/dexoin0.1% op ..................... 74 neo/poly/dexsus0.1% op .................... 74 neo/poly/grasolop ............................... 74 neo/poly/hc sol1% otic ........................ 76 neo/poly/hc sus1% otic ....................... 76 neo/poly/hc susop .............................. 74 neomycin tab500mg .......................... 6 neuac gel1.2-5% ................................ 57 NEULASTA INJ6MG/0.6M .............. 43 NEUMEGA INJ5MG ....................... 43 NEUPOGEN INJ300/0.5 ................. 43 NEUPOGEN INJ480/0.8 ................. 43 NEUPOGEN INJ480MCG ............... 43 NEUPRO DIS1MG/24HR .............. 30 NEUPRO DIS2MG/24HR .............. 30 NEUPRO DIS3MG/24HR .............. 30 NEUPRO DIS4MG/24HR .............. 30 NEUPRO DIS6MG/24HR .............. 30 NEUPRO DIS8MG/24HR .............. 30 NEVANAC SUS0.1% ..................... 76 NEVIRAPINE SUS50MG/5ML .......... 36 nevirapine tab200mg ......................... 36 nevirapine tab400mg er ..................... 36 NEXAVAR TAB200MG .................. 28 NEXIUM I.V. INJ20MG ....................... 60 NEXIUM I.V. INJ40MG ....................... 60 niacin er tab1000mg ......................... 54 niacin er tab500mg ........................... 54 niacin er tab750mg ........................... 54 niacor tab500mg............................ 54 nicardipine cap20mg .......................... 48 nicardipine cap30mg .......................... 48 nicardipine inj25/10ml ......................... 48 NICOTROL NS SPR10MG/ML ............. 6 nifedical xltab30mg............................. 48 nifedical xltab60mg............................. 48 nifedipine tab30mg er ........................ 48 nifedipine tab60mg er ........................ 48 nifedipine tab90mg er ........................ 48 NILANDRON TAB150MG ................ 25 nimodipine cap30mg ......................... 48 nisoldipine tab17mg er ....................... 48 nisoldipine tab20mg ........................... 48

108

nisoldipine tab25.5mg ........................ 48 nisoldipine tab30mg ........................... 48 nisoldipine tab34mg er ....................... 48 nisoldipine tab40mg ........................... 48 nisoldipine tab8.5mg er ...................... 48 NITRO-DUR DIS0.3MG/HR ............. 54 NITRO-DUR DIS0.8MG/HR ............. 54 nitrofur maccap50mg ............................ 7 nitrofurantncap100mg .......................... 7 nitrofurantnsus25mg/5ml ...................... 7 nitroglycer dis0.1mg/hr ....................... 54 nitroglycer dis0.2mg/hr ....................... 54 nitroglycer dis0.4mg/hr ....................... 55 nitroglycer inj5mg/ml .......................... 55 nitroglyceridis0.6mg/hr ....................... 55 nitroglycrn spr0.4mg ........................... 55 NITROMIST AER400MCG ............... 55 NITROSTAT SUB0.3MG .................. 55 NITROSTAT SUB0.4MG .................. 55 NITROSTAT SUB0.6MG .................. 55 nizatidine cap150mg ......................... 60 nizatidine cap300mg ......................... 60 nizatidine sol15mg/ml ........................ 60 N-methyl-D-aspartate (NMDA)

Receptor Antagonist .................... 17 Nonsteroidal Anti-Inflammatory

Drugs ............................................... 2 NORDITROPIN INJ10/1.5ML ............. 65 NORDITROPIN INJ15/1.5ML ............. 65 NORDITROPIN INJ5/1.5ML ............... 65 norethin acetab5mg............................ 68 nortrel tab0.5/35 ............................. 67 nortrel tab1/35 ................................ 67 nortrel tab7/7/7 ............................... 67 nortriptylincap10mg ............................ 21 nortriptylincap25mg ............................ 21 nortriptylincap50mg ............................ 21 nortriptylincap75mg ............................ 21 nortriptylinsol10mg/5ml ...................... 21 NORVIR CAP100MG .................... 37 NORVIR SOL80MG/ML ................ 37 NORVIR TAB100MG ..................... 37 NOVOLIN INJ70/30 ........................ 41 NOVOLIN N INJU-100 ..................... 41 NOVOLIN R INJU-100 ..................... 41 NOVOLOG INJ100/ML ................... 41

NOVOLOG INJPENFILL ................ 41 NOVOLOG MIX INJ70/30 .................. 41 NOVOLOG MIX INJFLEXPEN ........... 41 NOXAFIL SUS40MG/ML ................ 23 NOXAFIL TAB100MG .................... 23 NUEDEXTA CAP20-10MG ............. 56 NULOJIX INJ250MG ...................... 72 NUTROPIN AQ INJ10MG/2ML .......... 65 NUTROPIN AQ INJ20MG/2ML .......... 65 NUTROPIN AQ INJNUSPIN 5 ........... 59 NUVARING MIS .............................. 67 NUVIGIL TAB150MG ..................... 79 NUVIGIL TAB200MG ..................... 79 NUVIGIL TAB250MG ..................... 79 NUVIGIL TAB50MG ....................... 79 nyamyc pow100000 ...................... 23 nystat/triamcre .................................... 23 nystat/triamoin .................................... 23 nystatin cre100000 .......................... 23 nystatin oin100000 .......................... 23 nystatin pow100000 ........................ 23 nystatin sus100000 ......................... 23 nystatin tab500000 .......................... 23 nystop pow100000 ........................ 23 octreotide inj1000mcg ....................... 69 octreotide inj100mcg ......................... 69 octreotide inj200mcg ......................... 69 octreotide inj500mcg ......................... 69 octreotide inj50mcg/ml ...................... 69 ofloxacin dro0.3% op ........................ 12 ofloxacin dro0.3%otic ....................... 12 ofloxacin tab200mg .......................... 12 ofloxacin tab300mg .......................... 12 ofloxacin tab400mg .......................... 12 ogestrel tab ..................................... 67 olanza/fluoxcap12-25mg .................... 17 olanza/fluoxcap12-50mg .................... 17 olanza/fluoxcap3-25mg ...................... 17 olanza/fluoxcap6-25mg ...................... 17 olanza/fluoxcap6-50mg ...................... 17 olanzapine inj10mg ........................... 33 olanzapine tab10mg .......................... 33 olanzapine tab10mg odt .................... 33 olanzapine tab15mg .......................... 33 olanzapine tab15mg odt .................... 33 olanzapine tab2.5mg ......................... 33

109

olanzapine tab20mg .......................... 33 olanzapine tab20mg odt .................... 33 olanzapine tab5mg ............................ 33 olanzapine tab5mg odt ...................... 33 olanzapine tab7.5mg ......................... 33 olopatadine spr0.6%........................... 76 OLYSIO CAP150MG ..................... 35 omega-3-acidcap1gm ......................... 54 omeprazole cap10mg ........................ 60 omeprazole cap20mg ........................ 60 omeprazole cap40mg ........................ 61 OMNITROPE INJ10/1.5ML .............. 65 OMNITROPE INJ5.8MG .................. 65 OMNITROPE INJ5/1.5ML ................ 65 ONCASPAR INJ750/ML .................. 27 ondansetron inj4mg/2ml ..................... 22 ondansetron sol4mg/5ml .................... 22 ondansetron tab24mg ........................ 22 ondansetron tab4mg .......................... 22 ondansetron tab4mg odt .................... 22 ondansetron tab8mg .......................... 22 ondansetron tab8mg odt .................... 22 ONFI SUS2.5MG/ML ................... 14 ONFI TAB10MG .......................... 14 ONGLYZA TAB2.5MG ................... 39 ONGLYZA TAB5MG ...................... 39 OPDIVO INJ40MG/4ML ..................... 25 Ophthalmic Agents .......................... 74 OPHTHALMIC AGENTS ................... 74 Ophthalmic Agents, Other ............... 75 Ophthalmic Anti-allergy Agents ...... 75 Ophthalmic Antiglaucoma Agents .. 75 Ophthalmic Anti-inflammatories ..... 75 Ophthalmic Prostaglandins and

Prostamide Analogs ..................... 76 Opioid Analgesics, Long-Acting ....... 3 Opioid Analgesics, Short-Acting ...... 4 Opioid Dependence Treatments ....... 5 Opioid Reversal Agents ..................... 6 ORACEA CAP40MG ..................... 57 ORAP TAB1MG .......................... 32 ORAP TAB2MG .......................... 32 ORENCIA INJ125MG/ML ............... 71 ORENCIA INJ250MG ..................... 71 orphenadrineinj30mg/ml ..................... 79 ORTHO EVRA DISWEEK ................. 67

OTEZLA TAB10/20/30 .................. 24 OTEZLA TAB30MG ....................... 24 Otic Agents ....................................... 76 OTIC AGENTS ................................... 76 OTREXUP INJ10MG .......................... 71 OTREXUP INJ15MG .......................... 71 OTREXUP INJ20MG .......................... 71 OTREXUP INJ25MG .......................... 71 OTREXUP INJ7.5/0.4MG ................... 71 oxacillin inj10gm ............................... 10 oxacillin inj2gm ................................. 10 oxandrolone tab10mg ......................... 67 oxandrolone tab2.5mg ........................ 67 oxaprozin tab600mg ........................... 3 oxcarbazepinsus300mg/5m ............... 16 oxcarbazepintab150mg ...................... 16 oxcarbazepintab300mg ...................... 16 oxcarbazepintab600mg ...................... 16 OXSORALEN-ULCAP10MG .............. 57 OXTELLAR XR TAB150MG ............... 16 OXTELLAR XR TAB300MG ............... 16 OXTELLAR XR TAB600MG ............... 16 oxybutynin syp5mg/5ml ..................... 61 oxybutynin tab10mg er ...................... 61 oxybutynin tab15mg er ...................... 61 oxybutynin tab5mg ............................ 61 oxybutynin tab5mg er ........................ 61 oxycod/apap tab10-325mg ................... 1 oxycod/apap tab2.5-325 ....................... 1 oxycod/apap tab5-325mg ..................... 1 oxycod/apap tab7.5-325 ....................... 1 oxycod/asa tab .................................... 1 oxycod/ibu tab5-400mg ....................... 1 oxycodone cap5mg ............................ 5 oxycodone con100/5ml ...................... 5 oxycodone tab10mg ........................... 5 oxycodone tab15mg ........................... 5 oxycodone tab20mg ........................... 5 oxycodone tab30mg ........................... 5 oxycodone tab5mg ............................. 5 OXYCONTIN TAB10MG CR .............. 4 OXYCONTIN TAB15MG CR .............. 4 OXYCONTIN TAB20MG CR .............. 4 OXYCONTIN TAB30MG CR .............. 4 OXYCONTIN TAB40MG CR .............. 4 OXYCONTIN TAB60MG CR .............. 4

110

OXYCONTIN TAB80MG CR .............. 4 oxymorphone tab10mg er .................... 4 oxymorphone tab15mg er .................... 4 oxymorphone tab20mg er .................... 4 oxymorphone tab30mg er .................... 4 oxymorphone tab40mg er .................... 4 oxymorphone tab5mg er ...................... 4 oxymorphone tab7.5mg er ................... 4 OXYTROL DIS3.9MG/24 ............... 61 pacerone tab100mg ........................ 46 pacerone tab200mg ........................ 46 pacerone tab400mg ........................ 46 pamidronate inj30/10ml ...................... 74 pamidronate inj6mg/ml ....................... 74 pamidronate inj90/10ml ...................... 74 PANRETIN GEL0.1% ...................... 29 pantoprazoleinj40mg .......................... 61 pantoprazoletab20mg ......................... 61 pantoprazoletab40mg ......................... 61 Parasympathomimetics ................... 24 paricalcitolcap1 mcg ........................... 74 paricalcitolcap2 mcg ........................... 74 paricalcitolcap4 mcg ........................... 74 paricalcitolinj2mcg/ml ......................... 74 paricalcitolinj5mcg/ml ......................... 74 paromomycin cap250mg ...................... 6 paroxetin ertab12.5mg ....................... 19 paroxetin ertab37.5mg ....................... 19 paroxetine tab10mg........................... 19 paroxetine tab20mg........................... 19 paroxetine tab25mg er ...................... 19 paroxetine tab30mg........................... 19 paroxetine tab40mg........................... 19 paser gra4gm ............................... 25 PATANOL SOL0.1% OP ................ 75 PAXIL SUS10MG/5ML ................. 19 Pediculicides/Scabicides ................. 30 pedi-dri pow100000 ......................... 23 PEDVAX HIB INJ .............................. 73 PEGANONE TAB250MG ................ 16 PEGASYS INJ ................................ 34 PEGASYS INJ180MCG/M ............. 34 PEGASYS INJPROCLICK ............. 34 PEG-INTRON KIT120 RP ................. 34 PEG-INTRON KIT120MCG ............... 34 PEG-INTRON KIT150 RP ................. 34

PEG-INTRON KIT150MCG ............... 34 PEG-INTRON KIT50MCG ................. 34 PEG-INTRON KIT50MCG RP ........... 34 PEG-INTRON KIT80MCG ................. 34 PEG-INTRON KIT80MCG RP ........... 34 pen g proc inj600000 ......................... 10 pen g sod inj5000000 ....................... 10 PEN NEEDLES MIS31GX8MM .......... 58 PENICILL GK/INJDEX 2MU ............... 10 PENICILL GK/INJDEX 3MU ............... 10 penicilln gkinj5mu ............................... 10 penicilln vksol125/5ml ........................ 10 penicilln vksol250/5ml ........................ 10 penicilln vktab250mg .......................... 10 penicilln vktab500mg .......................... 10 PENTAM 300 INJ300MG .................. 30 PENTASA CAP250MG CR ............ 73 PENTASA CAP500MG CR ............ 73 pentoxifyllitab400mg er ...................... 52 perindopril tab2mg.............................. 45 perindopril tab4mg.............................. 45 perindopril tab8mg.............................. 45 periogard sol0.12% .......................... 56 PERJETA INJ420/14ML ................. 27 permethrin cre5% .............................. 30 perphen/amittab2-10mg ..................... 17 perphen/amittab2-25mg ..................... 17 perphen/amittab4-10mg ..................... 17 perphen/amittab4-25mg ..................... 17 perphen/amittab4-50mg ..................... 17 perphenazinetab16mg ........................ 22 perphenazinetab2mg.......................... 22 perphenazinetab4mg.......................... 22 perphenazinetab8mg.......................... 22 phenadoz sup12.5mg ...................... 22 phenadoz sup25mg ......................... 22 phenelzine tab15mg .......................... 18 phenobarb elx20mg/5ml ................... 14 PHENOBARB TAB100MG ............... 14 PHENOBARB TAB15MG ................. 14 phenobarb tab16.2mg ...................... 14 PHENOBARB TAB30MG ................. 14 phenobarb tab32.4mg ...................... 14 PHENOBARB TAB60MG ................. 14 PHENOBARB TAB64.8MG .............. 14 PHENOBARB TAB97.2MG .............. 14

111

phenytoin chw50mg ......................... 16 phenytoin inj50mg/ml ....................... 16 phenytoin sus125/5ml ...................... 16 phenytoin excap100mg ...................... 16 phenytoin excap200mg ...................... 16 phenytoin excap300mg ...................... 16 Phosphate Binders ........................... 61 Phosphodiesterase Inhibitors,

Airways Disease ........................... 78 PHOSPHOLINE SOL0.125%OP ........ 75 PHYSIOSOL SOLIRRIGAT ........ 81, 82 pilocarpine sol4% op .......................... 75 pilocarpine tab5mg ............................. 56 pilocarpine tab7.5mg .......................... 56 pindolol tab10mg ............................. 47 pindolol tab5mg ............................... 47 pioglit/glimtab30-2mg ......................... 40 pioglit/glimtab30-4mg ......................... 40 pioglita/mettab15-500mg .................... 40 pioglita/mettab15-850mg .................... 40 pioglitazonetab15mg .......................... 39 pioglitazonetab30mg .......................... 39 pioglitazonetab45mg .......................... 39 piper/tazobainj3-0.375g ...................... 10 piroxicam cap10mg ............................ 3 piroxicam cap20mg ............................ 3 Platelet Modifying Agents ............... 43 PLEGRIDY INJ ................................... 56 PLEGRIDY INJPEN ........................... 56 PLEGRIDY PENINJSTARTER ........... 56 podofilox sol0.5% ............................. 57 polyeth glycpow3350 nf ...................... 60 polymyxin b inj500000 .......................... 7 polymyxin b/soltrimethp ...................... 74 POMALYST CAP1MG ..................... 25 POMALYST CAP2MG ..................... 25 POMALYST CAP3MG ..................... 25 POMALYST CAP4MG ..................... 25 portia-28 tab ..................................... 67 pot chloridecap10meq er .............. 81, 82 pot chloridecap8meq er ................ 81, 82 pot chlorideinj2meq/ml ................. 81, 82 pot citrate tab1080mg ................... 81, 82 pot citrate tab1620mg ......................... 81 pot citrate tab540mg..................... 81, 82 pot cl microtab10meq er ............... 81, 82

pot cl microtab20meq er ............... 81, 82 POTIGA TAB200MG ..................... 13 POTIGA TAB300MG ..................... 13 POTIGA TAB400MG ..................... 13 POTIGA TAB50MG ....................... 13 PRADAXA CAP150MG .................. 42 PRADAXA CAP75MG .................... 42 pramipexole tab0.125mg .................... 30 pramipexole tab0.25mg ...................... 30 pramipexole tab0.5mg ........................ 30 pramipexole tab0.75mg ...................... 31 pramipexole tab0.75mg er .................. 31 pramipexole tab1.5mg ........................ 31 pramipexole tab1.5mg er .................... 31 pramipexole tab1mg ........................... 31 PRANDIMET TAB1-500MG ............. 40 PRANDIMET TAB2-500MG ............. 40 pravastatin tab10mg ........................... 53 pravastatin tab20mg ........................... 54 pravastatin tab40mg ........................... 54 pravastatin tab80mg ........................... 54 prazosin hclcap1mg ........................... 44 prazosin hclcap2mg ........................... 44 prazosin hclcap5mg ........................... 44 PRED MILD SUS0.12% OP ............. 76 pred sod phosol1% op ........................ 76 pred sod phosol5mg/5ml .................... 64 PRED-G SUSOP ........................... 75 PRED-G S.O.POINOP ....................... 75 prednicarbatcre0.1% .......................... 64 prednicarbatoin0.1% .......................... 64 prednisolonesol15mg/5ml .................. 64 prednisolonesus1% op ....................... 74 prednisolonetab10mg odt ................... 64 prednisolonetab15mg odt ................... 64 prednisolonetab30mg odt ................... 64 prednisone con5mg/ml ...................... 64 prednisone sol5mg/5ml ..................... 64 prednisone tab10mg.......................... 64 prednisone tab1mg............................ 64 prednisone tab2.5mg ......................... 64 prednisone tab20mg.......................... 64 prednisone tab50mg.......................... 64 prednisone tab5mg............................ 64 PREFEST TAB ............................... 67 PREMARIN INJ25MG ..................... 66

112

PREMARIN TAB0.3MG ................... 66 PREMARIN TAB0.45MG ................. 66 PREMARIN TAB0.625MG ............... 66 PREMARIN TAB0.9MG ................... 66 PREMARIN TAB1.25MG ................. 66 PREMARIN VAGCRE0.625MG ......... 66 PREMPHASE TAB ........................... 67 PREMPRO TAB.625-2.5 ................ 67 PREMPRO TAB0.3-1.5 .................. 67 PREMPRO TAB0.45-1.5 ................ 67 PREMPRO TAB0.625-5 ................. 67 prevalite pow4gm ............................. 54 previfem tab .................................... 67 PREZCOBIX TAB800-150 ................. 36 PREZISTA SUS100MG/ML ............. 37 PREZISTA TAB150MG ................... 37 PREZISTA TAB600MG ................... 37 PREZISTA TAB75MG ..................... 37 PREZISTA TAB800MG ................... 37 PRIFTIN TAB150MG ...................... 25 PRIMAQUINE TAB26.3MG ............... 30 primidone tab250mg ......................... 15 primidone tab50mg........................... 15 primsol sol50mg/5ml ........................ 7 PRISTIQ TAB100MG ..................... 20 PRISTIQ TAB25MG ....................... 20 PRISTIQ TAB50MG ....................... 20 PRIVIGEN INJ20GRAMS ................ 72 PROAIR HFA AER ............................ 78 proben/colchtab500-0.5 ...................... 24 probenecid tab500mg ........................ 24 procainamideinj100mg/ml .................. 46 procainamideinj500mg/ml .................. 46 prochlorper inj5mg/ml ......................... 22 prochlorper sup25mg ......................... 22 prochlorper tab10mg .......................... 22 prochlorper tab5mg ............................ 22 PROCRIT INJ10000/ML ................. 43 PROCRIT INJ2000/ML ................... 43 PROCRIT INJ20000/ML ................. 43 PROCRIT INJ3000/ML ................... 43 PROCRIT INJ4000/ML ................... 43 PROCRIT INJ40000/ML ................. 43 procto-pak cre1% .............................. 64 proctozone cre-hc 2.5% .................... 64

Progesterone Agonists/Antagonists........................................................ 68

Progestins ......................................... 68 PROGLYCEM SUS50MG/ML .......... 40 PROGRAF INJ5MG/ML ................. 71 PROLEUKIN INJ22MU ..................... 27 PROLIA SOL60MG/ML ................. 74 PROMACTA TAB12.5MG ............... 43 PROMACTA TAB25MG .................. 43 PROMACTA TAB50MG .................. 43 PROMACTA TAB75MG .................. 43 promethegan sup50mg ...................... 22 propafenone tab150mg ...................... 46 propafenone tab225mg ...................... 46 propafenone tab300mg ...................... 46 proparacainesol0.5% op ..................... 75 Prophylactic ...................................... 24 propran/hctztab40/25 ......................... 51 propran/hctztab80/25 ......................... 51 propranolol cap120mg er ................... 47 propranolol cap160mg er ................... 47 propranolol cap60mg er ..................... 47 propranolol cap80mg er ..................... 47 propranolol inj1mg/ml ......................... 47 propranolol sol20mg/5ml .................... 47 propranolol sol40mg/5ml .................... 47 propranolol tab10mg .......................... 47 propranolol tab20mg .......................... 47 propranolol tab40mg .......................... 47 propranolol tab60mg .......................... 47 propranolol tab80mg .......................... 47 propylthiourtab50mg........................... 70 PROQUAD INJ ............................... 73 Protectants ....................................... 60 Proton Pump Inhibitors ................... 60 protriptylintab10mg ............................. 21 protriptylintab5mg ............................... 21 PROVENTIL AERHFA ..................... 78 PULMICORT INH180MCG ............... 77 PULMICORT INH90MCG ................. 77 PULMICORT SUS0.25MG/2 ............ 77 PULMICORT SUS0.5MG/2 .............. 77 PULMICORT SUS1MG/2ML ............ 77 Pulmonary Antihypertensives ......... 78 PULMOZYME SOL1MG/ML ............. 79 PURIXAN SUS20MG/ML ................... 26

113

pyrazinamidetab500mg ...................... 25 pyridostigm tab60mg .......................... 24 qnapril/hctztab10-12.5 ........................ 51 qnapril/hctztab20-12.5 ........................ 51 qnapril/hctztab20-25mg ...................... 51 QUADRACEL INJ............................ 73 quasense tab ................................... 67 questran pow4gm ............................ 54 quetiapine tab100mg ......................... 18 quetiapine tab200mg ......................... 18 quetiapine tab25mg ........................... 18 quetiapine tab300mg ......................... 18 quetiapine tab400mg ......................... 18 quetiapine tab50mg ........................... 18 quinapril tab10mg ............................. 45 quinapril tab20mg ............................. 45 quinapril tab40mg ............................. 45 quinapril tab5mg ............................... 45 QUINIDINE GLINJ80MG/ML .............. 46 quinidine gltab324mg cr ..................... 46 quinidine sutab200mg ........................ 46 quinidine sutab300mg ........................ 46 quinidine sutab300mg er .................... 46 quinine sulfcap324mg ........................ 30 Quinolones ....................................... 11 QVAR AER40MCG ..................... 77 QVAR AER80MCG ..................... 77 RABAVERT INJ............................... 73 rabeprazole tab20mg ......................... 61 raloxifene tab60mg ............................ 68 ramipril cap1.25mg .......................... 45 ramipril cap10mg ............................. 45 ramipril cap2.5mg ............................ 45 ramipril cap5mg ............................... 45 RANEXA TAB1000MG .................. 52 RANEXA TAB500MG .................... 52 ranitidine cap150mg .......................... 60 ranitidine cap300mg .......................... 60 ranitidine inj150/6ml .......................... 60 ranitidine syp15mg/ml ....................... 60 ranitidine tab150mg ........................... 60 ranitidine tab300mg ........................... 60 RAPAMUNE SOL1MG/ML .............. 71 RAPAMUNE TAB1MG .................... 71 RAPAMUNE TAB2MG .................... 71 REBETOL SOL40MG/ML ............... 35

REBIF INJ22/0.5 .......................... 56 REBIF INJ44/0.5 .......................... 56 REBIF TITRTNSOLPACK .................. 56 reclipsen tab ..................................... 67 RECOMBIVA HBINJ10MCG/ML ........ 73 RECOMBIVA HBINJ5MCG/0.5ML ..... 73 RECOMBIVA-HBINJ40MCG/ML ........ 73 RELENZA MISDISKHALE .............. 37 RELISTOR INJ12/0.6ML ................. 59 RELISTOR INJ8/0.4ML ................... 59 RELISTOR KIT12/0.6ML ................. 59 REMICADE INJ100MG ................... 71 REMODULIN INJ10MG/ML .............. 78 REMODULIN INJ1MG/ML ................ 78 REMODULIN INJ2.5MG/ML ............. 78 REMODULIN INJ5MG/ML ................ 78 RENAGEL TAB400MG .................. 61 RENAGEL TAB800MG .................. 61 RENVELA PAK0.8GM .................... 61 RENVELA PAK2.4GM .................... 62 RENVELA TAB800MG ................... 62 repaglinide tab0.5mg .......................... 39 repaglinide tab1mg ............................. 39 repaglinide tab2mg ............................. 39 reprexain tab10-200mg ...................... 1 reprexain tab2.5-200 .......................... 1 reprexain tab5-200mg ........................ 1 RESCRIPTOR TAB100 MG .............. 36 RESCRIPTOR TAB200MG ............... 36 RESERPINE TAB0.1MG .................. 51 RESERPINE TAB0.25MG ................ 51 Respiratory Tract Agents, Other ..... 78 Respiratory Tract/Pulmonary Agents

........................................................ 79 RESPIRATORY TRACT/PULMONARY

AGENTS ......................................... 76 RESTASIS EMU0.05% ................... 75 Retinoids ........................................... 29 RETROVIR INJ10MG/ML ................ 36 REVLIMID CAP10MG ..................... 26 REVLIMID CAP15MG ..................... 26 REVLIMID CAP2.5MG .................... 26 REVLIMID CAP20MG ..................... 26 REVLIMID CAP25MG ..................... 26 REVLIMID CAP5MG ....................... 26 REXULTI TAB0.25MG ....................... 18

114

REXULTI TAB0.5MG ......................... 18 REXULTI TAB1MG ............................ 18 REXULTI TAB2MG ............................ 18 REXULTI TAB3MG ............................ 18 REXULTI TAB4MG ............................ 18 REYATAZ CAP150MG ................... 37 REYATAZ CAP200MG ................... 37 REYATAZ CAP300MG ................... 37 REYATAZ POW50MG ................... 37 RHEUMATREX TAB2.5MG ............... 71 RHINOCORT SUSAQUA ................. 77 ribapak pak1000/day ...................... 35 ribapak pak1200/day ...................... 35 ribapak pak800/day ........................ 35 ribasphere cap200mg ........................ 35 ribasphere tab200mg ........................ 35 ribasphere tab400mg ........................ 35 ribasphere tab600mg ........................ 35 ribavirin cap200mg ........................... 35 ribavirin tab200mg ............................ 35 RIDAURA CAP3MG ....................... 72 rifabutin cap150mg ........................... 25 rifampin cap150mg .......................... 25 rifampin cap300mg .......................... 25 rifampin inj600 mg ........................... 25 RIFATER TAB ................................ 25 riluzole tab50mg .............................. 56 rimantadine tab100mg ........................ 37 ringers inj ........................................ 80 ringers irr sol ...................................... 81 risedronate tab150mg ........................ 74 RISPERDAL INJ12.5MG .................. 33 RISPERDAL INJ25MG ..................... 33 RISPERDAL INJ37.5MG .................. 33 RISPERDAL INJ50MG ..................... 33 risperidone sol1mg/ml ........................ 33 risperidone tab0.25 odt ....................... 33 risperidone tab0.25mg ........................ 33 risperidone tab0.5mg.......................... 33 risperidone tab0.5mg od ..................... 33 risperidone tab1mg............................. 33 risperidone tab1mg odt ....................... 33 risperidone tab2mg............................. 33 risperidone tab2mg odt ....................... 33 risperidone tab3mg............................. 33 risperidone tab3mg odt ....................... 33

risperidone tab4mg............................. 33 risperidone tab4mg odt ....................... 33 RITUXAN INJ500MG ..................... 29 rivastigminecap1.5mg ........................ 17 rivastigminecap3mg ........................... 17 rivastigminecap4.5mg ........................ 17 rivastigminecap6mg ........................... 17 rizatriptan tab10mg............................. 24 rizatriptan tab10mg odt ....................... 24 rizatriptan tab5mg............................... 24 rizatriptan tab5mg odt ......................... 24 ropinirole tab0.25mg.......................... 31 ropinirole tab0.5mg............................ 31 ropinirole tab1mg .............................. 31 ropinirole tab2mg .............................. 31 ropinirole tab3mg .............................. 31 ropinirole tab4mg .............................. 31 ropinirole tab5mg .............................. 31 ROTARIX SUS ............................... 73 ROTATEQ SOL .............................. 73 ROZEREM TAB8MG ...................... 79 SABRIL POW500MG .................... 15 SABRIL TAB500MG ...................... 15 SAIZEN INJ5MG ........................... 65 SAIZEN INJ8.8MG ........................ 65 SANCUSO DIS3.1MG .................... 22 SANDOSTATIN KITLAR 10MG ......... 69 SANDOSTATIN KITLAR 20MG ......... 69 SANDOSTATIN KITLAR 30MG ......... 69 SANTYL OIN250/GM .................... 57 SAPHRIS SUB10MG ..................... 33 SAPHRIS SUB5MG ....................... 33 Selective Estrogen Receptor

Modifying Agents .......................... 68 selegiline cap5mg.............................. 31 selegiline tab5mg .............................. 31 selenium sullot2.5% ........................... 57 SELZENTRY TAB150MG ................ 37 SELZENTRY TAB300MG ................ 37 SENSIPAR TAB30MG .................... 69 SENSIPAR TAB60MG .................... 69 SENSIPAR TAB90MG .................... 69 SEREVENT DISAER50MCG ............. 78 SEROQUEL XR TAB150MG .............. 18 SEROQUEL XR TAB200MG .............. 18 SEROQUEL XR TAB300MG .............. 18

115

SEROQUEL XR TAB400MG .............. 18 SEROQUEL XR TAB50MG ................ 18 SEROSTIM INJ4MG ....................... 59 SEROSTIM INJ5MG ....................... 59 SEROSTIM INJ6MG ....................... 59 Serotonin (5-HT) 1b/1d Receptor

Agonists ........................................ 24 sertraline con20mg/ml ....................... 20 sertraline tab100mg........................... 20 sertraline tab25mg............................. 20 sertraline tab50mg............................. 20 sildenafil tab20mg ............................. 78 silver sulfacre1% ................................ 12 SIMCOR TAB1000-20 ................... 51 SIMCOR TAB1000-40 ................... 51 SIMCOR TAB500-20MG ............... 51 SIMCOR TAB500-40MG ............... 51 SIMCOR TAB750-20MG ............... 51 SIMPONI INJ50MG ........................ 71 SIMULECT INJ20MG ...................... 72 simvastatin tab10mg .......................... 54 simvastatin tab20mg .......................... 54 simvastatin tab40mg .......................... 54 simvastatin tab5mg ............................ 54 simvastatin tab80mg .......................... 54 sirolimus tab0.5mg ........................... 71 sirolimus tab1mg .............................. 71 sirolimus tab2mg .............................. 71 SIRTURO TAB100MG ................... 25 Skeletal Muscle Relaxants ............... 79 SKELETAL MUSCLE RELAXANTS . 79 SLEEP DISORDER AGENTS ............ 79 Sleep Disorders, Other .................... 79 Smoking Cessation Agents ............... 6 smz/tmp ds tab800-160 ..................... 12 smz-tmp inj400-80/5 ....................... 12 smz-tmp sus200-40/5 ..................... 12 smz-tmp tab400-80mg ................... 12 sod chlorideinj0.45% .................... 81, 82 sod chlorideinj0.9% ...................... 81, 82 sod chlorideinj2.5/ml..................... 81, 82 sod chlorideinj3% ......................... 81, 82 sod chlorideinj5% ......................... 81, 82 SOD LACTATE INJ5MEQ/ML ............ 81 sod poly sulsus15gm/60 ..................... 81 sod sulfacetsol10% op ....................... 12

Sodium Channel Inhibitors .............. 15 sodium chlorsol0.9% irr ................ 81, 82 SOLTAMOX SOL10MG/5ML .......... 26 SOMATULINE INJ120/.5ML .............. 70 SOMATULINE INJ60/0.2ML .............. 70 SOMATULINE INJ90/0.3ML .............. 70 SOMAVERT INJ10MG .................... 70 SOMAVERT INJ15MG .................... 70 SOMAVERT INJ20MG .................... 70 SOMAVERT INJ25MG .................... 70 SOMAVERT INJ30MG .................... 70 sorine tab120mg............................ 46 sorine tab160mg............................ 46 sorine tab240mg............................ 46 sorine tab80mg.............................. 46 sotalol af tab120mg ........................... 46 sotalol hcl tab160mg .......................... 46 sotalol hcl tab240mg .......................... 46 sotalol hcl tab80mg ............................ 46 SOVALDI TAB400MG .................... 35 SPIRIVA CAPHANDIHLR .............. 77 spirono/hctztab25/25 .......................... 51 spironolact tab100mg ......................... 52 spironolact tab25mg ........................... 53 spironolact tab50mg ........................... 53 sprintec 28 tab28 day ......................... 67 SPRYCEL TAB100MG ................... 28 SPRYCEL TAB140MG ................... 28 SPRYCEL TAB20MG ..................... 28 SPRYCEL TAB50MG ..................... 29 SPRYCEL TAB70MG ..................... 29 SPRYCEL TAB80MG ..................... 29 sronyx tab ...................................... 67 ssd cre1% .................................. 12 SSRIs/SNRIs (Selective Serotonin

Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors) ...................................... 18

stavudine cap15mg .......................... 36 stavudine cap20mg .......................... 36 stavudine cap30mg .......................... 36 stavudine cap40mg .......................... 36 stavudine sol1mg/ml ......................... 36 STELARA INJ45MG/0.5 ................. 57 STELARA INJ90MG/ML ................. 57 STIMATE SOL1.5MG/ML ............... 65

116

STIVARGA TAB40MG .................... 29 STRATTERA CAP100MG ................ 56 STRATTERA CAP10MG .................. 56 STRATTERA CAP18MG .................. 56 STRATTERA CAP25MG .................. 56 STRATTERA CAP40MG .................. 56 STRATTERA CAP60MG .................. 56 STRATTERA CAP80MG .................. 56 streptomycininj1gm .............................. 6 STRIBILD TAB ................................ 35 SUBOXONE MIS12-3MG .................. 6 SUBOXONE MIS2-0.5MG ................. 6 SUBOXONE MIS4-1MG .................... 6 SUBOXONE MIS8-2MG .................... 6 sucralfate tab1gm .............................. 60 sulf/pred nasolop ................................ 75 sulfacet sodoin10% op ....................... 12 sulfacetamidsus10% .......................... 12 sulfadiazinetab500mg ........................ 12 SULFAMYLON CRE85MG/GM ........... 7 sulfasalazintab500mg ......................... 73 sulfazine ectab500mg ........................ 73 Sulfonamides .............................. 12, 73 sulindac tab150mg ............................ 3 sulindac tab200mg ............................ 3 sumatriptan inj6mg/0.5 ....................... 24 sumatriptan tab100mg ........................ 24 sumatriptan tab25mg .......................... 24 sumatriptan tab50mg .......................... 24 SUPRAX CAP400MG ..................... 9 suprax chw100mg ........................... 9 suprax chw200mg ........................... 9 SUPRAX SUS100/5ML ................... 9 SUPRAX SUS200/5ML ................... 9 SUPRAX SUS500/5ML ................... 9 SUPRAX TAB400MG ...................... 9 SURMONTIL CAP100MG ................ 21 SURMONTIL CAP25MG .................. 21 SURMONTIL CAP50MG .................. 21 SUSTIVA CAP200MG .................... 36 SUSTIVA CAP50MG ...................... 36 SUSTIVA TAB600MG .................... 36 SUTENT CAP12.5MG ................... 29 SUTENT CAP25MG ...................... 29 SUTENT CAP37.5MG ................... 29 SUTENT CAP50MG ...................... 29

SYLATRON KIT296MCG ................ 35 SYLATRON KIT444MCG ................ 35 SYLATRON KIT888MCG ................ 35 SYMBICORT AER160-4.5 ............... 79 SYMBICORT AER80-4.5 ................. 79 SYMLINPEN 60INJ1000MCG ............ 39 SYMLNPEN 120INJ1000MCG ........... 40 SYNAGIS INJ50MG ....................... 72 SYNAREL SOL2MG/ML ................. 70 SYNERCID INJ500MG ...................... 7 SYNRIBO INJ3.5MG ...................... 27 SYNTHROID TAB100MCG .............. 69 SYNTHROID TAB112MCG .............. 69 SYNTHROID TAB125MCG .............. 69 SYNTHROID TAB137MCG .............. 69 SYNTHROID TAB150MCG .............. 69 SYNTHROID TAB175MCG .............. 69 SYNTHROID TAB200MCG .............. 69 SYNTHROID TAB25MCG ................ 69 SYNTHROID TAB300MCG .............. 69 SYNTHROID TAB50MCG ................ 69 SYNTHROID TAB75MCG ................ 69 SYNTHROID TAB88MCG ................ 69 SYPRINE CAP250MG ................... 81 TABLOID TAB40MG ...................... 26 tacrolimus cap0.5mg ......................... 71 tacrolimus cap1mg ............................ 71 tacrolimus cap5mg ............................ 71 tacrolimus oin0.03% ........................... 57 tacrolimus oin0.1% ............................. 57 TAFINLAR CAP50MG ..................... 29 TAFINLAR CAP75MG ..................... 29 TAMIFLU CAP30MG ...................... 37 TAMIFLU CAP45MG ...................... 38 TAMIFLU CAP75MG ...................... 38 TAMIFLU SUS6MG/ML .................. 38 tamoxifen tab10mg ........................... 26 tamoxifen tab20mg ........................... 26 tamsulosin cap0.4mg ........................ 61 TARCEVA TAB100MG ................... 29 TARCEVA TAB150MG ................... 29 TARCEVA TAB25MG ..................... 29 TARGRETIN CAP75MG .................. 29 TARGRETIN GEL1% ....................... 29 TASIGNA CAP150MG ................... 29 TASIGNA CAP200MG ................... 29

117

TASMAR TAB100MG .................... 30 TAZORAC CRE0.05% ................... 57 TAZORAC CRE0.1% ..................... 57 TAZORAC GEL0.05% .................... 58 TAZORAC GEL0.1% ...................... 58 taztia xt cap120mg/24 ...................... 48 taztia xt cap180mg/24 ...................... 48 taztia xt cap240mg/24 ...................... 48 taztia xt cap300mg/24 ...................... 48 taztia xt cap360mg/24 ...................... 48 TEFLARO INJ400MG ....................... 9 TEFLARO INJ600MG ....................... 9 TEGRETOL-XR TAB100MG .............. 16 TEKAMLO TAB150-10MG ............. 51 TEKAMLO TAB150-5MG ............... 51 TEKAMLO TAB300-10MG ............. 51 TEKAMLO TAB300-5MG ............... 51 TEKTURNA TAB150MG ................. 52 TEKTURNA TAB300MG ................. 52 TEKTURNA HCTTAB150-12.5 .......... 51 TEKTURNA HCTTAB150-25MG ........ 51 TEKTURNA HCTTAB300-12.5 .......... 51 TEKTURNA HCTTAB300-25MG ........ 51 telmis/amlodtab40-10mg .................... 51 telmis/amlodtab40-5mg ...................... 51 telmis/amlodtab80-10mg .................... 51 telmis/amlodtab80-5mg ...................... 51 telmisa/hctztab40-12.5 ....................... 51 telmisa/hctztab80-12.5 ....................... 51 telmisa/hctztab80-25mg ..................... 51 telmisartan tab20mg ........................... 44 telmisartan tab40mg ........................... 45 telmisartan tab80mg ........................... 45 terazosin cap10mg ........................... 44 terazosin cap1mg ............................. 44 terazosin cap2mg ............................. 44 terazosin cap5mg ............................. 44 terbinafine tab250mg.......................... 23 terbutaline inj1mg/ml .......................... 78 terbutaline tab2.5mg........................... 78 terbutaline tab5mg.............................. 78 terconazole cre0.4%........................... 23 terconazole sup80mg ......................... 23 testost cyp inj100mg/ml ...................... 65 testost cyp inj200mg/ml ...................... 65 testost enaninj200mg/ml .................... 65

TET/DIP TOX INJ2-2 LF .................... 73 TETANUS TOX INJ5LF ADS ............. 73 Tetracyclines .................................... 12 THALOMID CAP100MG .................. 26 THALOMID CAP150MG .................. 26 THALOMID CAP200MG .................. 26 THALOMID CAP50MG .................... 26 theophyllinetab100mg cr .................... 78 theophyllinetab200mg cr .................... 78 theophyllinetab300mg er .................... 78 theophyllinetab400mg er .................... 78 theophyllinetab450mg er .................... 78 theophyllinetab600mg er .................... 78 Therapeutic Nutrients/ Minerals/

Electrolytes ................................... 80 THERAPEUTIC

NUTRIENTS/MINERALS/ELECTROLYTES .............................................. 80

thioridazinetab100mg ......................... 32 thioridazinetab10mg ........................... 32 thioridazinetab25mg ........................... 32 thioridazinetab50mg ........................... 32 THIOTEPA INJ15MG ......................... 27 thiothixene cap10mg .......................... 32 thiothixene cap1mg ............................ 32 thiothixene cap2mg ............................ 32 thiothixene cap5mg ............................ 32 THYMOGLOBULNINJ25MG .............. 72 tiagabine tab2mg .............................. 15 tiagabine tab4mg .............................. 15 ticlopidine tab250mg .......................... 44 TIKOSYN CAP125MCG ................. 46 TIKOSYN CAP250MCG ................. 46 TIKOSYN CAP500MCG ................. 46 timolol gel sol0.25% op ...................... 75 timolol gel sol0.5% op ........................ 75 timolol mal sol0.25% op ..................... 75 timolol mal sol0.5% op ....................... 75 timolol mal tab10mg ........................... 24 timolol mal tab20mg ........................... 24 timolol mal tab5mg ............................. 24 tinidazole tab250mg ............................ 7 tinidazole tab500mg ............................ 7 TIVICAY TAB50MG ........................ 37 tizanidine tab2mg .............................. 34 tizanidine tab4mg .............................. 34

118

TOBI PODHALRCAP28MG ............... 78 tobra/dexamesus0.3-0.1% ................. 75 tobra/nacl inj80/0.9 .............................. 6 TOBRADEX OIN0.3-0.1% ................. 6 tobramycin inj10mg/ml ........................ 6 tobramycin inj80mg/2ml ...................... 7 tobramycin neb300/5ml ....................... 7 tobramycin sol0.3% op ........................ 7 tolazamide tab250mg ........................ 40 tolazamide tab500mg ........................ 40 tolbutamide tab500mg ........................ 40 tolmetin sodcap400mg ......................... 3 tolmetin sodtab200mg .......................... 3 tolmetin sodtab600mg .......................... 3 tolterodine cap2mg er ......................... 61 tolterodine cap4mg er ......................... 61 tolterodine tab1mg.............................. 61 tolterodine tab2mg.............................. 61 topiramate cap15mg .......................... 15 topiramate cap25mg .......................... 15 topiramate tab100mg ........................ 15 topiramate tab200mg ........................ 15 topiramate tab25mg .......................... 15 topiramate tab50mg .......................... 15 toposar inj1gm/50ml ....................... 27 topotecan inj4mg .............................. 28 TORISEL SOL25MG/ML ................ 71 torsemide tab100mg ......................... 52 torsemide tab10mg........................... 52 torsemide tab20mg........................... 52 torsemide tab5mg............................. 52 TOVIAZ TAB4MG .......................... 61 TOVIAZ TAB8MG .......................... 61 TPN ELECTROLINJ ........................... 81 TRACLEER TAB125MG ................. 78 TRACLEER TAB62.5MG ................ 78 tramadl/apaptab37.5-325 ..................... 1 tramadol hcltab100mg er ...................... 4 tramadol hcltab200mg er ...................... 4 tramadol hcltab300mg er ...................... 4 tramadol hcltab50mg ............................ 5 trandolapriltab1mg.............................. 45 trandolapriltab2mg.............................. 45 trandolapriltab4mg.............................. 45 tranex acid inj100mg/ml ..................... 43 tranex acid tab650mg ......................... 43

TRANSDERM-SCDIS1.5MG .............. 22 tranylcypromtab10mg ......................... 18 TRAVASOL INJ10% ........................ 81 travoprost dro0.004% ........................ 76 trazodone tab100mg ........................ 20 trazodone tab150mg ........................ 20 trazodone tab300mg ........................ 20 trazodone tab50mg .......................... 20 TREANDA INJ45/0.5ML ..................... 25 Treatment Resistent ......................... 33 TRECATOR TAB250MG ................. 25 TRELSTAR DEPINJ3.75MG .............. 70 TRELSTAR LA INJ11.25MG .............. 70 TRELSTAR MIXINJ22.5MG ............... 70 tretinoin cap10mg ............................. 29 tretinoin cre0.025% .......................... 58 tretinoin cre0.05% ............................ 58 tretinoin cre0.1% .............................. 58 tretinoin gel0.01%............................. 58 tretinoin gel0.025%........................... 58 tretinoin gel0.04%............................. 58 tretinoin gel0.1% .............................. 58 tretin-x crekit0.05%............................. 58 trexall tab10mg ............................... 71 trexall tab15mg ............................... 71 trexall tab5mg ................................. 71 trexall tab7.5mg .............................. 71 triamcin/orapst0.1%............................ 56 triamcinoloncre0.025% ....................... 64 triamcinoloncre0.1% ........................... 64 triamcinoloncre0.5% ........................... 64 triamcinolonlot0.025% ........................ 64 triamcinolonlot0.1% ............................ 64 triamcinolonoin0.025% ....................... 64 triamcinolonoin0.1% ........................... 64 triamcinolonoin0.5% ........................... 64 triamcinolonspr55mcg/ac ................... 64 triamt/hctz cap37.5-25 ........................ 51 triamt/hctz tab37.5-25 ......................... 51 triamt/hctz tab75-50mg ....................... 51 Tricyclics ........................................... 20 triderm cre0.1% .............................. 64 trifluoperaztab10mg............................ 32 trifluoperaztab1mg.............................. 32 trifluoperaztab2mg.............................. 32 trifluoperaztab5mg.............................. 32

119

trifluridinesol1% op ............................. 35 trihexyphen elx0.4mg/ml .................... 30 trihexyphen tab2mg ............................ 30 trihexyphen tab5mg ............................ 30 tri-legest tabfe ................................... 67 trilyte sol ......................................... 59 trimethoprimtab100mg ......................... 8 tri-previfemtab .................................... 67 tri-sprintectab ..................................... 67 TRIUMEQ TAB ................................... 36 trivora-28 tab ..................................... 67 TROKENDI XR CAP100MG ............... 15 TROKENDI XR CAP200MG ............... 15 TROKENDI XR CAP25MG ................. 15 TROKENDI XR CAP50MG ................. 15 TROPHAMINE INJ10% ..................... 81 trospium cl tab20mg ........................... 61 TRUMENBA INJ ............................. 73 TRUVADA TAB200-300 ................. 36 TWINRIX INJ .................................. 73 TYBOST TAB150MG ......................... 36 TYGACIL INJ50MG .......................... 8 TYKERB TAB250MG .................... 29 TYPHIM VI INJ ................................. 73 TYSABRI INJ300/15ML .................. 56 TYZEKA TAB600MG ..................... 35 tyzine ped dro0.05%.......................... 79 u-cort cre1% .................................. 64 ursodiol cap300mg .......................... 59 ursodiol tab250mg ........................... 59 ursodiol tab500mg ........................... 59 Vaccines ............................................ 72 valacyclovirtab1gm ............................. 35 valacyclovirtab500mg ......................... 35 VALCHLOR GEL0.016% .................... 58 VALCYTE SOL50MG/ML ............... 34 valganciclovtab450mg ........................ 34 valproate inj100mg/ml ...................... 15 valproic acdcap250mg ....................... 15 valproic acdsyp250/5ml ...................... 15 valsart/hctztab160-12.5 ...................... 51 valsart/hctztab160-25mg .................... 51 valsart/hctztab320-12.5 ...................... 52 valsart/hctztab320-25mg .................... 52 valsart/hctztab80-12.5 ........................ 52 valsartan tab160mg ............................ 45

valsartan tab320mg ............................ 45 valsartan tab40mg .............................. 45 valsartan tab80mg .............................. 45 vancomycin cap125mg ........................ 8 vancomycin cap250mg ........................ 8 vancomycin inj1000mg ........................ 8 vancomycin inj10gm ............................ 8 vancomycin inj500mg .......................... 8 VAQTA INJ25/0.5ML .................... 73 VAQTA INJ50UNT/ML ................. 73 VARIVAX INJ ................................. 73 VARIZIG INJ125UNIT ........................ 72 Vasodilators, Direct-acting Arterial 54 Vasodilators, Direct-acting

Arterial/Venous ............................. 54 VELCADE INJ3.5MG ..................... 27 velivet pak ...................................... 68 venlafaxine cap150mg er ................... 20 venlafaxine cap37.5mg ...................... 20 venlafaxine cap75mg er ..................... 20 venlafaxine tab100mg ........................ 20 venlafaxine tab150mg er .................... 20 VENLAFAXINE TAB225MG ER ......... 20 venlafaxine tab25mg .......................... 20 venlafaxine tab37.5 er ........................ 20 venlafaxine tab37.5mg ....................... 20 venlafaxine tab50mg .......................... 20 venlafaxine tab75mg .......................... 20 venlafaxine tab75mg er ...................... 20 VENTOLIN HFAAER .......................... 78 VERAMYST SPR27.5MCG ............. 77 verapamil cap100mg er .................... 49 verapamil cap120mg er .................... 49 verapamil cap180mg er .................... 49 verapamil cap200mg er .................... 49 verapamil cap240mg er .................... 49 verapamil cap300mg er .................... 49 verapamil cap360mg sr .................... 49 verapamil inj2.5mg/ml ...................... 49 verapamil tab120mg ......................... 49 verapamil tab120mg er ..................... 49 verapamil tab180mg er ..................... 49 verapamil tab240mg er ..................... 49 verapamil tab40mg ........................... 49 verapamil tab80mg ........................... 49 veripred 20 sol20mg/5ml .................... 64

120

VERSACLOZ SUS50MG/ML ........... 34 VEXOL SUS1% OP ...................... 76 vicodin tab5-300mg .......................... 1 vicodin es tab7.5-300 .......................... 1 vicodin hp tab10-300mg ...................... 1 VICTOZA INJ18MG/3ML ................ 40 VIDEX SOL2GM ........................... 36 VIEKIRA PAK TAB ............................. 35 VIGAMOX DRO0.5% ..................... 12 VIIBRYD KIT .................................. 20 VIIBRYD TAB10MG ....................... 20 VIIBRYD TAB20MG ....................... 20 VIIBRYD TAB40MG ....................... 20 VIMPAT INJ200MG/20 .................. 16 VIMPAT SOL10MG/ML ................. 16 VIMPAT TAB100MG ..................... 16 VIMPAT TAB150MG ..................... 16 VIMPAT TAB200MG ..................... 16 VIMPAT TAB50MG ....................... 16 VIRACEPT TAB250MG ................... 37 VIRACEPT TAB625MG ................... 37 VIRAMUNE SUS50MG/5ML ........... 36 VIRAMUNE XR TAB100MG ............... 36 VIRAZOLE INH6GM ........................ 38 VIREAD POW40MG/GM ............... 36 VIREAD TAB150MG ..................... 36 VIREAD TAB200MG ..................... 36 VIREAD TAB250MG ..................... 37 VIREAD TAB300MG ..................... 37 VITEKTA TAB150MG ......................... 37 VITEKTA TAB85MG ........................... 37 VIVITROL INJ380MG ........................ 5 voriconazoleinj200mg ......................... 23 voriconazolesus40mg/ml .................... 23 voriconazoletab200mg ....................... 23 voriconazoletab50mg ......................... 24 vospire er tab4mg.............................. 78 vospire er tab8mg.............................. 78 VOTRIENT TAB200MG .................. 29 VYTORIN TAB10-10MG ................ 52 VYTORIN TAB10-20MG ................ 52 VYTORIN TAB10-40MG ................ 52 VYTORIN TAB10-80MG ................ 52 VYVANSE CAP20MG .................... 55 VYVANSE CAP30MG .................... 55 VYVANSE CAP40MG .................... 55

VYVANSE CAP50MG .................... 55 VYVANSE CAP60MG .................... 55 VYVANSE CAP70MG .................... 55 warfarin tab10mg............................. 42 warfarin tab1mg............................... 42 warfarin tab2.5mg............................ 42 warfarin tab2mg............................... 42 warfarin tab3mg............................... 42 warfarin tab4mg............................... 42 warfarin tab5mg............................... 42 warfarin tab6mg............................... 42 warfarin tab7.5mg............................ 42 WELCHOL PAK3.75GM ................. 40 WELCHOL TAB625MG .................. 40 XALKORI CAP200MG .................... 29 XALKORI CAP250MG .................... 29 XARELTO TAB10MG ..................... 42 XARELTO TAB15MG ..................... 42 XARELTO TAB20MG ..................... 42 XARELTO STARTAB15/20MG .......... 42 XENAZINE TAB12.5MG .................. 56 XENAZINE TAB25MG ..................... 56 XGEVA INJ .................................. 74 XIFAXAN TAB550MG ...................... 8 xodol tab10-300mg ......................... 1 xodol tab5-300mg ........................... 1 xodol tab7.5-300............................. 2 XOLAIR SOL150MG ..................... 79 XTANDI CAP40MG ....................... 25 xulane dis150-35 ........................... 68 XYREM SOL500MG/ML ............... 79 YERVOY INJ50MG ....................... 27 YF-VAX INJ ................................... 73 zafirlukast tab10mg ............................ 77 zafirlukast tab20mg ............................ 77 zaleplon cap10mg ........................... 79 zaleplon cap5mg ............................. 79 ZALTRAP INJ100/4ML ................... 27 zamicet sol10-325mg ....................... 2 ZAVESCA CAP100MG .................. 58 zazole cre0.4% .............................. 24 ZELBORAF TAB240MG .................. 29 ZEMAIRA INJ1000MG ................... 79 ZEMPLAR INJ2MCG/ML ................ 74 ZEMPLAR INJ5MCG/ML ................ 74 zenatane cap10mg .......................... 58

121

zenatane cap20mg .......................... 58 zenatane cap30mg .......................... 58 zenatane cap40mg .......................... 58 ZENPEP CAP10000UNT .............. 58 ZENPEP CAP15000UNT .............. 58 ZENPEP CAP20000UNT .............. 59 ZENPEP CAP25000UNT .............. 59 ZENPEP CAP3000UNIT ............... 59 ZENPEP CAP40000UNT .............. 59 ZENPEP CAP5000UNIT ............... 59 ZETIA TAB10MG ......................... 54 ZIAGEN SOL20MG/ML ................. 37 zidovudine cap100mg ....................... 37 zidovudine syp50mg/5ml ................... 37 zidovudine tab300mg ........................ 37 ziprasidone cap20mg ......................... 33 ziprasidone cap40mg ......................... 33 ziprasidone cap60mg ......................... 33 ziprasidone cap80mg ......................... 33 ZIRGAN GEL0.15% ...................... 34 ZMAX SUS2GM .......................... 11 zoledronic inj4mg/5ml ........................ 74 zoledronic inj5/100ml ......................... 74 ZOLINZA CAP100MG .................... 27 zolmitriptantab2.5 mg ......................... 24 zolmitriptantab5mg ............................. 24

zolpidem tab10mg ........................... 79 zolpidem tab5mg ............................. 79 zolpidem er tab12.5mg ....................... 79 zolpidem er tab6.25mg ....................... 79 zonisamide cap100mg ...................... 13 zonisamide cap25mg ........................ 13 zonisamide cap50mg ........................ 13 ZORBTIVE INJ8.8MG ..................... 59 ZORTRESS TAB0.25MG ................ 71 ZORTRESS TAB0.5MG .................. 71 ZORTRESS TAB0.75MG ................ 71 ZOSTAVAX INJ ............................... 73 ZOSYN SOL2-0.25GM ................. 10 ZOSYN SOL3-0.375G .................. 10 zovia 1/35e tab ................................... 68 zovia 1/50e tab ................................... 68 ZOVIRAX CRE5% .......................... 35 ZYDELIG TAB100MG ........................ 29 ZYDELIG TAB150MG ........................ 29 ZYFLO CR TAB600MG ................... 77 ZYKADIA CAP150MG .................... 29 ZYPREXA RELPINJ210MG ............... 33 ZYTIGA TAB250MG ...................... 25 ZYVOX SUS100MG/5M ................. 8 ZYVOX TAB600MG ....................... 8

s list of covered drugs: formular y 2015 - castiarx · touchstone health hmo, inc. 2015 formulary...

Documents