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San Francisco Health Plan Medicare/Medi-Cal Formulary AS OF May 2020
SAN FRANCISCO HEALTH PLAN
Medicare/ Medi-Cal Formulary
A s of May 2020
San Francisco Health Plan Medicare/Medi-Cal Formulary AS OF May 2020
San Francisco Health Plan Medicare/Medi-Cal Formulary The San Francisco Health Plan (SFHP), with the direction from the Pharmacy and Therapeutics Committee (P&T), has developed a formulary to be used by members, clinicians, and pharmacists. The P&T Committee is composed of the SFHP Chief Medical Officer, the SFHP Pharmacy Director, physicians from various medical specialties and clinics, and community clinical pharmacists. The P&T meets quarterly to review formulary changes based on quality of care considerations and sound pharmacoeconomic principles.
The formulary is a list of drug products designed to reflect the most appropriate, high quality and cost-effective drug therapies. The formulary is updated regularly and is subject to change without notice.
The formulary requires the continuous support of all our providers and pharmacists. Please contact us at (415) 547-7818 x 7085 option 3 or [email protected] if you have any questions regarding theformulary. The SFHP formulary can be easily accessed online from our website athttp://www.sfhp.org/providers/formulary/sfhp-formulary/.
Request for Addition or Deletion of a Drug to the Formulary SFHP providers may request evaluation of drugs for addition to or deletion from the Formulary by submitting the Formulary Modification Request Form available on our website at http://www.sfhp.org/providers/formulary/prior-authorization-requests/.
Request for Non-Preferred Medications Non-preferred or non-formulary medications may be authorized when there is clinical justification for doing so. Providers can submit a prior authorization (PA) request in one of three different ways:
1. Online: Submit using the Online Pharmacy Prior Authorization Request Form.2. Fax: Download a Prior Authorization Request Form and fax to 1(855) 811-9331 for both
standard and urgent requests. Urgent requests should be clearly labeled “URGENT” at the topof the prior authorization request form.
3. Phone: Pharmacy Benefits Manager (PBM) PerformRx at (888) 989-0091 to submit a verbalrequest.
The Prior Authorization Request Form and the Online Pharmacy Prior Authorization Request Form can be accessed from our website at http://www.sfhp.org/providers/formulary/prior-authorization-requests/.
San Francisco Health Plan Medicare/Medi-Cal Formulary AS OF May 2020
Brand Medication Policy SFHP has a mandatory generic policy and requires generic substitution when an equivalent AB-rated generic product is available. Dispensing of brand name medications when generic equivalent is available is allowed only in certain cases:
• Pharmacy bills brand medication as DAW 5 (i.e. billed as a generic product).• Pharmacy bills brand medication as DAW 8 (i.e. generic formulation is not currently available).• Pharmacy is dispensing one (1) of the following narrow therapeutic index drugs/classes: Dilantin
(phenytoin), thyroid hormones, coumarin type anticoagulants.• For all other brand name medication requests, prior authorization with documentation that two
(2) generic medications from different manufacturers were tried and did not meet the medicalneeds of the member.
All brand name medication prior authorization requests are reviewed by an SFHP pharmacist or Medical Director. In all other cases, a prior authorization (PA) request should be submitted using the instructions above. Detailed PA criteria for brand name medication requests can be found at http://www.sfhp.org/files/providers/formulary/Prior_Auth_Criteria.pdf under “Brand Medication Requests” section.
Medicare/Medi-Cal Formulary Provisions Medicare/Medi-Cal formulary is designed for members with both Medicare and Medi-Cal coverage (dual-eligibles). Medicare/Medi-Cal formulary only covers the following products:
• Medications excluded by Medicare Part D and covered by SFHP Medi-Cal formulary• Supplies excluded by Medicare Part B and covered by SFHP Medi-Cal formulary
Day Supply Policy SFHP standard day supply policy is 30 day supply for brand and 90 day supply for generic medications. Exceptions can be made to the 90 day supply policy for specific generic medications. Refills are allowed when 75% of the medication has been used.
Formulary Restrictions (DUR edits) Standard formulary restrictions applicable to SFHP formularies are medication quantity and age limitations. All formulary restrictions are based on FDA approved indications, standards of practice and safety and abuse potential considerations.
Therapeutic Interchange Policy Per American College of Clinical Pharmacy (AACP), therapeutic interchange is defined as the dispensing of a drug that is therapeutically equivalent to but chemically different from the drug originally prescribed by a physician or other authorized prescriber. SFHP follows ACCP’s definition of therapeutic interchange and will only employ therapeutic interchange with prescriber’s approval. Criteria for
San Francisco Health Plan Medicare/Medi-Cal Formulary AS OF May 2020
consideration in therapeutic interchange include availability of agents within a therapeutic class, therapeutic equivalence, safety data, and costs.
Home Blood Pressure Monitors Effective 2/6/16, Omron Series 3, 5, and 10 home blood pressure monitors are covered as a pharmacy benefit for a quantity of 1 monitor per member every 5 years.
Formulary Document Details The SFHP formulary document is listed by drug class and includes the following information: drug name, dosage form, drug tier, quantity limit and prior authorization, or step therapy requirements. Brand products are listed in all uppercase letters and generic products are listed in all lowercase letters. Tier 1 drugs are formulary and will pay at the point of sale, if quantity limits and age limitations are met (see “Formulary Restrictions” above). Tier 2 drugs may require a Prior Authorization (see “Request for Non-Preferred Medications” above).
**Some medications may be listed as both Tier 1 and Tier 2 due to a particular strength being formulary and another strength of the same medication requiring a prior authorization.
If you are hearing impaired, please call the TDD/TYY line at 1(415) 547-7830, toll-free at 1(888) 883-7347 or through the California Relay Service at 711. You may request this document in alternative formats like Braille, large size print, and audio. To request other formats, or for help with reading this document and other SFHP materials, please call Customer Service at 1(415) 547-7800 or toll-free at 1(800) 288-5555.
1
Drug Generic drugs = lowercase italics
Brand name drugs = UPPERCASE
Tier T1= Formulary, Generic T2= Formulary, Brand T3= Formulary, Prior Authorization or Step Therapy T4= Specialty Pharmacy, Prior Authorization T5= Non-Formulary, Carve Out, or Obtain through the Medical Benefit
Notes AL= Age Limit PA= Prior Authorization QL= Quantity Limit ST= Step Therapy
Drug Tier Notes
Antihistamine Drugs
Ethanolamine Derivatives
carbinoxamine maleate oral liquid T5
carbinoxamine maleate oral tablet 4 mg T5
CHILDREN'S ALLERGY (DIPHENHYD) ORAL ELIXIR
T1
clemastine oral syrup T5
dimenhydrinate oral T1
DIPHENHIST ORAL TABLET 50 MG T1
diphenhydramine hcl oral capsule T1
diphenhydramine hcl oral tablet 25 mg T1
Q-DRYL ORAL LIQUID T1
First Gen. Antihist. Derivatives, Misc. cyproheptadine T5
First Generation Antihistamines
carbinoxamine maleate oral liquid T5
carbinoxamine maleate oral tablet 4 mg T5
CHILDREN'S ALLERGY (DIPHENHYD) ORAL ELIXIR
T1
chlorpheniramine maleate oral tablet T1
chlorpheniramine maleate oral tablet extended release
T1
clemastine oral syrup T5
cyproheptadine T5
dexchlorpheniramine maleate oral syrup T5
2
Drug Tier Notes
dimenhydrinate oral T1
DIPHENHIST ORAL TABLET 50 MG T1
diphenhydramine hcl oral capsule T1
diphenhydramine hcl oral tablet 25 mg T1
ED-CHLORPED T5
Q-DRYL ORAL LIQUID T1
Phenothiazine Derivatives
promethazine oral T1 AL
promethazine rectal suppository 12.5 mg, 25 mg T1 AL
PROMETHAZINE VC T1 AL
Piperazine Derivatives
hydroxyzine hcl intramuscular T5
hydroxyzine hcl oral solution 10 mg/5 ml T5
hydroxyzine hcl oral tablet T5
hydroxyzine pamoate T5
meclizine oral tablet 12.5 mg, 25 mg T1
meclizine oral tablet,chewable T1
Propylamine Derivatives
APRODINE T1 AL
chlorpheniramine maleate oral tablet T1
chlorpheniramine maleate oral tablet extended release
T1
dexchlorpheniramine maleate oral syrup T5
ED A-HIST (NEW DOSING) T5
ED-CHLORPED T5
KIDKARE COUGH/COLD T1 AL
PHENABID T5
Second Generation Antihistamines
ALAVERT T1
cetirizine oral tablet T1
cetirizine oral tablet,chewable T1
CHILDREN'S ALLEGRA ALLERGY ORAL TABLET,DISINTEGRATING
T1
CHILD'S ALL DAY ALLERGY(CETIR) T1
3
Drug Tier Notes
CLARINEX ORAL SYRUP T5
CLARINEX-D 12 HOUR T5
desloratadine oral tablet T5
fexofenadine oral suspension T1
fexofenadine oral tablet 180 mg, 60 mg T1
levocetirizine T5
loratadine oral solution T1
loratadine oral tablet T1
LORATADINE-D T1 AL
SEMPREX-D T5
Anti-Infective Agents
1St Generation Cephalosporin Antibiotics
cefadroxil oral capsule T5
cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml
T5
cefadroxil oral tablet T5
cefazolin injection recon soln 100 gram, 300 g T5
cephalexin oral capsule 250 mg, 500 mg T5
cephalexin oral suspension for reconstitution T5
cephalexin oral tablet T5
KEFLEX ORAL CAPSULE 750 MG T5
2Nd Generation Cephalosporin Antibiotics
cefaclor oral capsule T5
cefotetan T5
cefoxitin T5
cefoxitin in dextrose, iso-osm T5
cefprozil T5
CEFTIN ORAL SUSPENSION FOR RECONSTITUTION
T5
CEFTIN ORAL TABLET 250 MG, 500 MG T5
cefuroxime sodium injection T5
cefuroxime sodium intravenous recon soln 7.5 gram
T5
cefuroxime-dextrose (iso-osm) T5
4
Drug Tier Notes
MEFOXIN IN DEXTROSE (ISO-OSM) T5
ZINACEF IN STERILE WATER T5
ZINACEF INTRAVENOUS RECON SOLN 750 MG
T5
3Rd Generation Cephalosporin Antibiotics
CEDAX T5
cefdinir T5
cefditoren pivoxil oral tablet 200 mg T5
cefotaxime T5
cefpodoxime T5
ceftriaxone in dextrose,iso-os T5
CLAFORAN INTRAVENOUS RECON SOLN T5
FORTAZ IN DEXTROSE 5 % T5
FORTAZ INTRAVENOUS T5
SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML, 200 MG/5 ML
T5
SUPRAX ORAL TABLET T5
4Th Generation Cephalosporin Antibiotics
cefepime in dextrose,iso-osm intravenous piggyback 1 gram/50 ml
T5
cefepime injection T5
5Th Generation Cephalosporin Antibiotics
TEFLARO T5
Adamantane Antivirals
amantadine hcl T5
rimantadine T5
Allylamine Antifungals
LAMISIL T5
TERBINEX T5
Amebicides
FLAGYL ER T5
FLAGYL ORAL CAPSULE T5
HELIDAC T5
5
Drug Tier Notes
METRO I.V. T5
metronidazole in nacl (iso-os) T5
metronidazole oral tablet T5
paromomycin T5
PYLERA T5
YODOXIN T5
Aminoglycoside Antibiotics
gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 100 mg/50 ml, 60 mg/50 ml, 70 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml, 90 mg/100 ml
T5
gentamicin sulfate (pf) intravenous solution 80 mg/8 ml
T5
NEO-FRADIN T5
neomycin T5
paromomycin T5
tobramycin in 0.225 % nacl T5
tobramycin in 0.9 % nacl T5
Aminopenicillin Antibiotics
amoxicillin oral capsule T5
amoxicillin oral suspension for reconstitution T5
amoxicillin oral tablet T5
amoxicillin oral tablet,chewable 125 mg, 250 mg T5
amoxicillin-pot clavulanate T5
ampicillin T5
ampicillin sodium intravenous T5
ampicillin-sulbactam T5
AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 125-31.25 MG/5 ML
T5
MOXATAG T5
OMECLAMOX-PAK T5
PREVPAC T5
UNASYN INJECTION RECON SOLN 15 GRAM
T5
Anthelmintics
6
Drug Tier Notes
ALBENZA T5
BILTRICIDE T5
PIN-X ORAL SUSPENSION T5
STROMECTOL T5
Antifungals, Miscellaneous
GRIFULVIN V ORAL TABLET T5
griseofulvin microsize oral suspension T5
GRIS-PEG (ULTRAMICROSIZE) T5
SSKI T5
THYROSHIELD T5
Antimalarials
ARALEN T5
chloroquine phosphate oral tablet 250 mg T5
COARTEM T5
DARAPRIM T5
HELIDAC T5
hydroxychloroquine T5
MALARONE T5
MALARONE PEDIATRIC T5
mefloquine T5
primaquine T5
PYLERA T5
QUALAQUIN T5
quinidine gluconate T5
quinidine sulfate T5
Antimycobacterials, Miscellaneous
dapsone oral T5
Antiprotozoals, Miscellaneous
ALINIA T5
atovaquone T5
dapsone oral T5
FLAGYL ER T5
FLAGYL ORAL CAPSULE T5
7
Drug Tier Notes
HELIDAC T5
METRO I.V. T5
metronidazole in nacl (iso-os) T5
metronidazole oral tablet T5
NEBUPENT T5
PENTAM T5
PYLERA T5
tinidazole T5
Antituberculosis Agents
AVELOX T5
AVELOX IN NACL (ISO-OSMOTIC) T5
BIAXIN ORAL SUSPENSION FOR RECONSTITUTION 250 MG/5 ML
T5
BIAXIN ORAL TABLET T5
CAPASTAT T5
CIPRO ORAL SUSPENSION,MICROCAPSULE RECON
T5
ciprofloxacin (mixture) T5
ciprofloxacin hcl oral T5
ciprofloxacin in 5 % dextrose T5
ciprofloxacin lactate intravenous solution 400 mg/40 ml
T5
clarithromycin oral suspension for reconstitution 125 mg/5 ml
T5
cycloserine T5
ethambutol T5
isoniazid oral T5
LEVAQUIN IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK 250 MG/50 ML, 500 MG/100 ML
T5
levofloxacin in d5w intravenous piggyback 250 mg/50 ml, 750 mg/150 ml
T5
levofloxacin intravenous T5
levofloxacin oral T5
MYCOBUTIN T5
PASER T5
8
Drug Tier Notes
pretomanid T5
PRIFTIN T5
pyrazinamide T5
RIFADIN T5
RIFAMATE T5
RIFATER T5
TRECATOR T5
Antivirals, Miscellaneous
foscarnet T5
Azole Antifungals
fluconazole T5
fluconazole in dextrose(iso-o) T5
fluconazole in nacl (iso-osm) intravenous piggyback 200 mg/100 ml, 400 mg/200 ml
T5
itraconazole oral capsule T5
ketoconazole oral T5
NOXAFIL ORAL SUSPENSION T5
SPORANOX ORAL SOLUTION T5
VFEND ORAL SUSPENSION FOR RECONSTITUTION
T5
voriconazole intravenous T5
voriconazole oral tablet T5
Bacitracin Antibiotics
BACIIM T5
Carbapenem Antibiotics
DORIBAX T5
imipenem-cilastatin T5
INVANZ T5
meropenem T5
Cephamycin Antibiotics
cefotetan T5
cefoxitin T5
cefoxitin in dextrose, iso-osm T5
MEFOXIN IN DEXTROSE (ISO-OSM) T5
9
Drug Tier Notes
Chloramphenicol Antibiotics
chloramphenicol sod succinate T5
Cyclic Lipopeptide Antibiotics
CUBICIN T5
Echinocandin Antifungals
CANCIDAS T5
ERAXIS(WATER DILUENT) T5
MYCAMINE T5
Erythromycin Antibiotics
E.E.S. 400 ORAL TABLET T5
E.E.S. GRANULES T5
ERYPED 400 T5
ERY-TAB T5
ERYTHROCIN T5
ERYTHROCIN (AS STEARATE) ORAL TABLET 250 MG
T5
erythromycin oral capsule,delayed release(dr/ec) T5
erythromycin oral tablet T5
erythromycin-sulfisoxazole T5
PCE T5
Extended-Spectrum Penicillins
piperacillin-tazobactam intravenous recon soln 3.375 gram, 4.5 gram, 40.5 gram
T5
TIMENTIN T5
ZOSYN IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK 2.25 GRAM/50 ML, 3.375 GRAM/50 ML
T5
Glycopeptide Antibiotics
VANCOCIN T5
vancomycin in dextrose 5 % intravenous piggyback 1 gram/200 ml
T5
vancomycin intravenous recon soln 750 mg T5
VIBATIV INTRAVENOUS RECON SOLN 750 MG
T5
Glycylcycline Antibiotics
10
Drug Tier Notes
TYGACIL T5
Hcv Protease Inhibitor Antivirals
INCIVEK T5
VICTRELIS T5
Hiv Entry And Fusion Inhibitors
FUZEON SUBCUTANEOUS KIT T5
SELZENTRY ORAL TABLET 150 MG, 300 MG T5
Hiv Integrase Inhibitor Antiretrovirals
ISENTRESS ORAL TABLET T5
Hiv Nonnucleoside Rev.Transcrip. Inhib.
ATRIPLA T5
INTELENCE T5
nevirapine oral tablet extended release 24 hr 400 mg
T5
RESCRIPTOR T5
SUSTIVA T5
VIRAMUNE T5
Hiv Nucleoside, Nucleotide Rt Inhibitors
abacavir oral tablet T5
abacavir-lamivudine-zidovudine T5
ATRIPLA T5
didanosine T5
EMTRIVA T5
EPIVIR HBV ORAL SOLUTION T5
EPIVIR ORAL SOLUTION T5
EPZICOM T5
lamivudine oral tablet T5
lamivudine-zidovudine T5
RETROVIR INTRAVENOUS T5
stavudine T5
TRUVADA ORAL TABLET 200-300 MG T5
VIDEX 2 GRAM PEDIATRIC T5
VIDEX 4 GRAM PEDIATRIC T5
VIREAD ORAL TABLET 300 MG T5
11
Drug Tier Notes
ZIAGEN ORAL SOLUTION T5
zidovudine T5
Hiv Protease Inhibitor Antiretrovirals
APTIVUS T5
APTIVUS (WITH VITAMIN E) T5
CRIXIVAN ORAL CAPSULE 200 MG, 400 MG T5
INVIRASE T5
KALETRA T5
LEXIVA T5
NORVIR ORAL CAPSULE T5
NORVIR ORAL SOLUTION T5
NORVIR ORAL TABLET T5
PREZISTA ORAL TABLET 150 MG, 400 MG, 600 MG, 75 MG
T5
REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG
T5
VIRACEPT ORAL TABLET T5
Interferon Antivirals
ALFERON N T5
INFERGEN SUBCUTANEOUS SOLUTION 15 MCG/0.5 ML
T5
INTRON A INJECTION T5
PEGASYS CONVENIENCE PACK T5
PEGINTRON T5
Ketolide Antibiotics
KETEK T5
Lincomycin Antibiotics
CLEOCIN HCL ORAL CAPSULE 75 MG T5
CLEOCIN IN 5 % DEXTROSE T5
CLEOCIN PEDIATRIC T5
clindamycin hcl oral capsule 150 mg, 300 mg T5
LINCOCIN T5
Macrolide Antibiotics
E.E.S. 400 ORAL TABLET T5
12
Drug Tier Notes
E.E.S. GRANULES T5
ERYPED 400 T5
ERY-TAB T5
ERYTHROCIN T5
ERYTHROCIN (AS STEARATE) ORAL TABLET 250 MG
T5
erythromycin oral capsule,delayed release(dr/ec) T5
erythromycin oral tablet T5
PCE T5
Monobactam Antibiotics
AZACTAM IN DEXTROSE (ISO-OSM) T5
aztreonam T5
CAYSTON T5
Monoclonal Antibody Antivirals
SYNAGIS T5
Natural Penicillin Antibiotics
BICILLIN C-R T5
penicillin g pot in dextrose T5
penicillin g sodium T5
penicillin v potassium T5
Neuraminidase Inhibitor Antivirals
RELENZA DISKHALER T5
TAMIFLU ORAL CAPSULE T5
Nucleoside And Nucleotide Antivirals
acyclovir oral capsule T5
acyclovir oral suspension 200 mg/5 ml T5
acyclovir oral tablet T5
acyclovir sodium T5
adefovir T5
BARACLUDE T5
COPEGUS T5
CYTOVENE T5
famciclovir T5
REBETOL T5
13
Drug Tier Notes
TYZEKA T5
valacyclovir T5
VALCYTE T5
VIRAZOLE T5
VISTIDE T5
Other Macrolide Antibiotics
azithromycin T5
BIAXIN ORAL SUSPENSION FOR RECONSTITUTION 250 MG/5 ML
T5
BIAXIN ORAL TABLET T5
clarithromycin oral suspension for reconstitution 125 mg/5 ml
T5
OMECLAMOX-PAK T5
PREVPAC T5
ZMAX T5
Other Misc. Antibacterial Agents
HELIDAC T5
PYLERA T5
Oxazolidinone Antibiotics
ZYVOX INTRAVENOUS PIGGYBACK 200 MG/100 ML
T5
ZYVOX ORAL T5
Penicillinase-Resistant Penicillins
dicloxacillin T5
nafcillin in dextrose iso-osm intravenous piggyback 1 gram/50 ml
T5
oxacillin in dextrose(iso-osm) T5
oxacillin injection recon soln 10 gram T5
oxacillin intravenous T5
Polyene Antifungals
ABELCET T5
AMBISOME T5
AMPHOTEC T5
amphotericin b T5
nystatin oral powder 50 million unit T5
14
Drug Tier Notes
nystatin oral suspension T5
nystatin oral tablet T5
Polymyxin Antibiotics
colistin (colistimethate na) T5
polymyxin b sulfate T5
Quinolone Antibiotics
AVELOX T5
AVELOX IN NACL (ISO-OSMOTIC) T5
CIPRO ORAL SUSPENSION,MICROCAPSULE RECON
T5
ciprofloxacin (mixture) T5
ciprofloxacin hcl oral T5
ciprofloxacin in 5 % dextrose T5
ciprofloxacin lactate intravenous solution 400 mg/40 ml
T5
FACTIVE T5
LEVAQUIN IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK 250 MG/50 ML, 500 MG/100 ML
T5
levofloxacin in d5w intravenous piggyback 250 mg/50 ml, 750 mg/150 ml
T5
levofloxacin intravenous T5
levofloxacin oral T5
NOROXIN T5
ofloxacin oral T5
Rifamycin Antibiotics
MYCOBUTIN T5
PRIFTIN T5
RIFADIN T5
RIFAMATE T5
RIFATER T5
XIFAXAN T5
Streptogramin Antibiotics
SYNERCID T5
Sulfonamide Antibiotics (Systemic)
15
Drug Tier Notes
AZULFIDINE T5
AZULFIDINE EN-TABS T5
BACTRIM T5
BACTRIM DS T5
erythromycin-sulfisoxazole T5
sulfadiazine T5
sulfamethoxazole-trimethoprim intravenous T5
sulfamethoxazole-trimethoprim oral suspension T5
Tetracycline Antibiotics
ALODOX T5
AVIDOXY DK T5
demeclocycline T5
doxycycline hyclate intravenous T5
doxycycline hyclate oral capsule T5
doxycycline hyclate oral tablet 100 mg T5
doxycycline hyclate oral tablet,delayed release (dr/ec) 100 mg, 150 mg, 75 mg
T5
doxycycline monohydrate oral capsule T5
doxycycline monohydrate oral tablet T5
HELIDAC T5
MINOCIN INTRAVENOUS T5
MINOCIN KIT WITH WIPES T5
minocycline oral capsule T5
minocycline oral tablet T5
minocycline oral tablet extended release 24 hr 135 mg, 45 mg, 90 mg
T5
ORACEA T5
PYLERA T5
SOLODYN ORAL TABLET EXTENDED RELEASE 24 HR 105 MG, 115 MG, 55 MG, 65 MG, 80 MG
T5
tetracycline T5
VIBRAMYCIN ORAL SUSPENSION FOR RECONSTITUTION
T5
VIBRAMYCIN ORAL SYRUP T5
16
Drug Tier Notes
Urinary Anti-Infectives
FURADANTIN T5
HIPREX T5
MACRODANTIN ORAL CAPSULE 25 MG T5
MONUROL T5
nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg
T5
nitrofurantoin monohyd/m-cryst T5
trimethoprim T5
Antineoplastic Agents
Antineoplastic Agents
ABRAXANE T5
ADRIAMYCIN INTRAVENOUS RECON SOLN T5
ADRIAMYCIN INTRAVENOUS SOLUTION 10 MG/5 ML
T5
ADRUCIL INTRAVENOUS SOLUTION 500 MG/10 ML
T5
AFINITOR DISPERZ T5
AFINITOR ORAL TABLET 10 MG, 2.5 MG, 5 MG
T5
ALFERON N T5
ALIMTA T5
ALKERAN T5
anastrozole T5
AROMASIN T5
ARRANON T5
ARZERRA INTRAVENOUS SOLUTION 1,000 MG/50 ML
T5
AVASTIN T5
BEXXAR DOSIMETRIC T5
bicalutamide T5
BICNU T5
bleomycin T5
CARAC T5
carboplatin T5
17
Drug Tier Notes
cisplatin intravenous solution T5
cladribine T5
CLOLAR T5
COMETRIQ T5
COSMEGEN T5
cyclophosphamide intravenous T5
cyclophosphamide oral tablet T5
cytarabine T5
cytarabine (pf) injection recon soln T5
cytarabine (pf) injection solution 2 gram/20 ml (100 mg/ml), 20 mg/ml
T5
dacarbazine T5
DACOGEN T5
daunorubicin T5
DAUNOXOME T5
DEPOCYT (PF) T5
diclofenac sodium topical gel 3 % T5
docetaxel intravenous solution 20 mg/2 ml (final), 80 mg/8 ml (final)
T5
DROXIA T5
EFUDEX TOPICAL CREAM T5
ELIGARD T5
ELIGARD (3 MONTH) T5
ELIGARD (4 MONTH) T5
ELIGARD (6 MONTH) T5
ELOXATIN T5
ELSPAR T5
EMCYT T5
epirubicin intravenous recon soln 50 mg T5
epirubicin intravenous solution 50 mg/25 ml T5
ERBITUX T5
ERIVEDGE T5
ETOPOPHOS T5
etoposide T5
18
Drug Tier Notes
FARESTON T5
FASLODEX T5
FIRMAGON T5
floxuridine T5
fludarabine T5
FLUOROPLEX T5
fluorouracil intravenous T5
fluorouracil topical solution T5
flutamide T5
FOLOTYN INTRAVENOUS SOLUTION 20 MG/ML (1 ML)
T5
gemcitabine intravenous recon soln 1 gram, 200 mg
T5
GLEEVEC T5
HALAVEN T5
HERCEPTIN INTRAVENOUS RECON SOLN 440 MG
T5
HEXALEN T5
HYCAMTIN ORAL T5
HYDREA T5
IDAMYCIN PFS T5
IFEX T5
ifosfamide intravenous solution 1 gram/20 ml T5
ifosfamide-mesna intravenous kit 1-1 gram T5
INTRON A INJECTION T5
irinotecan intravenous solution 100 mg/5 ml, 40 mg/2 ml
T5
ISTODAX T5
IXEMPRA T5
JEVTANA T5
letrozole T5
LEUKERAN T5
leuprolide subcutaneous kit T5
LIPODOX T5
lomustine T5
19
Drug Tier Notes
LUPRON DEPOT T5
LUPRON DEPOT (3 MONTH) T5
LUPRON DEPOT (4 MONTH) T5
LUPRON DEPOT-PED T5
LYSODREN T5
MATULANE T5
MEGACE ES T5
megestrol oral suspension 400 mg/10 ml (40 mg/ml)
T5
megestrol oral tablet T5
melphalan hcl T5
mercaptopurine T5
methotrexate sodium T5
methotrexate sodium (pf) T5
mitomycin intravenous T5
mitoxantrone T5
MUSTARGEN T5
MYLERAN T5
NEXAVAR T5
NILANDRON T5
ONCASPAR T5
ONTAK T5
oxaliplatin intravenous recon soln 100 mg T5
paclitaxel T5
PANRETIN T5
pentostatin T5
PHOTOFRIN T5
POMALYST T5
PROLEUKIN T5
REVLIMID ORAL CAPSULE 10 MG, 15 MG, 25 MG, 5 MG
T5
RHEUMATREX T5
RITUXAN T5
SPRYCEL T5
20
Drug Tier Notes
SUPPRELIN LA T5
SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 50 MG
T5
TABLOID T5
tamoxifen T5
TARCEVA T5
TARGRETIN T5
TASIGNA ORAL CAPSULE 150 MG, 200 MG T5
TAXOTERE INTRAVENOUS SOLUTION 20 MG/ML (1 ML), 80 MG/4 ML (20 MG/ML)
T5
TEMODAR T5
THERACYS T5
thiotepa injection recon soln 15 mg T5
TICE BCG T5
topotecan intravenous recon soln T5
TORISEL T5
TREANDA INTRAVENOUS RECON SOLN 100 MG
T5
TRELSTAR INTRAMUSCULAR SYRINGE T5
tretinoin (chemotherapy) T5
TREXALL T5
TRISENOX INTRAVENOUS SOLUTION 1 MG/ML
T5
TYKERB T5
VALCHLOR T5
VALSTAR T5
VANTAS T5
VECTIBIX T5
VELCADE T5
VIDAZA T5
vinblastine T5
VINCASAR PFS INTRAVENOUS SOLUTION 1 MG/ML
T5
vinorelbine T5
VOTRIENT T5
21
Drug Tier Notes
VUMON T5
XELODA T5
ZALTRAP T5
ZANOSAR T5
ZEVALIN (Y-90) T5
ZOLADEX T5
ZOLINZA T5
Antitoxins,Immune Glob,Toxoids,Vaccines
Allergenic Extracts (Therapeutic)
HONEY BEE TREATMENT T5
Antitoxins And Immune Globulins
CARIMUNE NF NANOFILTERED T5
CROFAB T5
DIGIFAB T5
FLEBOGAMMA DIF INTRAVENOUS SOLUTION 10 %
T5
GAMASTAN S/D T5
GAMMAGARD LIQUID T5
GAMMAGARD S/D INTRAVENOUS RECON SOLN 2.5 GRAM
T5
GAMMAGARD S-D (IGA < 1 MCG/ML) T5
GAMUNEX-C INJECTION SOLUTION 1 GRAM/10 ML (10 %), 10 GRAM/100 ML (10 %), 2.5 GRAM/25 ML (10 %), 20 GRAM/200 ML (10 %), 5 GRAM/50 ML (10 %)
T5
HEPAGAM B INJECTION SOLUTION GREATR THAN 312 UNIT/ML (5 ML)
T5
HIZENTRA SUBCUTANEOUS SOLUTION 1 GRAM/5 ML (20 %), 10 GRAM/50 ML (20 %)
T5
HYPERHEP B S-D NEONATAL T5
HYPERRAB S/D (PF) T5
HYPERRHO S/D T5
HYPERTET S/D (PF) T5
RHOPHYLAC T5
WINRHO SDF T5
Toxoids
22
Drug Tier Notes
ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SYRINGE
T5
BOOSTRIX TDAP INTRAMUSCULAR SYRINGE
T5
DAPTACEL (DTAP PEDIATRIC) (PF) T5
INFANRIX (DTAP) (PF) INTRAMUSCULAR SYRINGE
T5
PEDIARIX (PF) T5
tetanus toxoid,adsorbed (pf) T5
tetanus-diphtheria toxoids-td T5
Vaccines
ACTHIB (PF) T5
BIOTHRAX T5
CERVARIX VACCINE (PF) T5
COMVAX (PF) T5
ENGERIX-B (PF) T5
ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SUSPENSION
T5
FLUBLOK 2013-2014 (PF) T5
FLUCELVAX 2013-2014 (PF) T5
FLULAVAL QUAD 2013-2014 T5
FLUMIST 2012-2013 T5
FLUVIRIN 2012-2013 T5
FLUVIRIN 2012-2013 (PF) T5
FLUVIRIN 2013-2014 T5
FLUVIRIN 2013-2014 (PF) T5
FLUZONE HIGH-DOSE 2012-13 (PF) T5
GARDASIL (PF) INTRAMUSCULAR SYRINGE
T5
HAVRIX (PF) INTRAMUSCULAR SUSPENSION 720 ELISA UNIT/0.5 ML
T5
HAVRIX (PF) INTRAMUSCULAR SYRINGE 1,440 ELISA UNIT/ML
T5
IMOVAX RABIES VACCINE (PF) T5
IPOL T5
IXIARO (PF) T5
23
Drug Tier Notes
KINRIX (PF) INTRAMUSCULAR SUSPENSION
T5
MENACTRA (PF) INTRAMUSCULAR SYRINGE
T5
MENHIBRIX (PF) T5
MENOMUNE - A/C/Y/W-135 (PF) T5
MENVEO A-C-Y-W-135-DIP (PF) T5
M-M-R II (PF) T5
PEDIARIX (PF) T5
PEDVAX HIB (PF) T5
PENTACEL (PF) INTRAMUSCULAR KIT 15 LF UNIT-20 MCG-5 LF/0.5 ML
T5
PNEUMOVAX-23 INJECTION SOLUTION T5
PREVNAR 13 (PF) T5
PROQUAD (PF) T5
RABAVERT (PF) T5
RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 40 MCG/ML, 5 MCG/0.5 ML
T5
RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10 MCG/ML
T5
ROTARIX T5
ROTATEQ VACCINE T5
SINGLE USE EZ FLU 2013-14 (PF) INTRAMUSCULAR SYRINGE KIT 45 MCG (15 MCG X 3)/0.5 ML
T5
THERACYS T5
TICE BCG T5
TWINRIX (PF) INTRAMUSCULAR SYRINGE T5
TYPHIM VI INTRAMUSCULAR SYRINGE T5
VAQTA (PF) INTRAMUSCULAR SUSPENSION 25 UNIT/0.5 ML
T5
VAQTA (PF) INTRAMUSCULAR SYRINGE 50 UNIT/ML
T5
VARIVAX (PF) T5
VIVOTIF BERNA VACCINE T5
YF-VAX (PF) T5
ZOSTAVAX (PF) T5
24
Drug Tier Notes
Autonomic Drugs
Alpha- And Beta-Adrenergic Agonists
ADRENALIN INJECTION SOLUTION 1 MG/ML
T5
APRODINE T1 AL
bupivacaine-epinephrine (pf) T5
CHILDREN'S SILFEDRINE T1 AL
CLARINEX-D 12 HOUR T5
CONGEST-EZE T1
ephedrine sulfate injection solution T5
ephedrine sulfate oral T5
epinephrine injection syringe 0.1 mg/ml T5
EPIPEN 2-PAK T5
EPIPEN JR 2-PAK T5
KIDKARE COUGH/COLD T1 AL
lidocaine-epinephrine (pf) T5
lidocaine-epinephrine injection solution 0.5 %-1:200,000, 1 %-1:100,000, 2 %-1:100,000
T5
LORATADINE-D T1 AL
NASAL DECONGESTANT (PSEUDOEPH) ORAL LIQUID
T1 AL
norepinephrine bitartrate T5
pseudoephedrine hcl oral tablet T1 AL
pseudoephedrine hcl oral tablet extended release T1 AL
pseudoephedrine-guaifenesin oral tablet extended release 12 hr 60-600 mg
T1 AL
racepinephrine T5
REZIRA T5
SEMPREX-D T5
SENSORCAINE-EPINEPHRINE T5
SENSORCAINE-MPF/EPINEPHRINE INJECTION SOLUTION 0.75 %-1:200,000
T5
SUDAFED 24 HOUR T1
SUDOGEST 12-HOUR T1 AL
SUDOGEST ORAL TABLET 60 MG T1 AL
25
Drug Tier Notes
XYLOCAINE-MPF/EPINEPHRINE INJECTION SOLUTION 1 %-1:200,000
T5
Alpha-Adrenergic Agonists
clonidine T5
clonidine (pf) T5
clonidine hcl oral tablet T5
CLORPRES T5
ED A-HIST (NEW DOSING) T5
methyldopa T5
methyldopate T5
midodrine T5
NEO-SYNEPHRINE (PHENYLEPHRINE) INJECTION
T5
PHENABID T5
PROMETHAZINE VC T1 AL
Antimuscarinics/Antispasmodics
ANASPAZ T5
ANORO ELLIPTA T5
ATROPEN INTRAMUSCULAR PEN INJECTOR 0.5 MG/0.7 ML, 1 MG/0.7 ML, 2 MG/0.7 ML
T5
atropine injection syringe 0.1 mg/ml T5
ATROVENT HFA T5
belladonna tincture (bulk) T5
BENTYL INTRAMUSCULAR T5
BENTYL ORAL CAPSULE T5
BENTYL ORAL TABLET T5
CANTIL T5
chlordiazepoxide-clidinium T5
COMBIVENT T5
CUVPOSA T5
dicyclomine oral solution T5
diphenoxylate-atropine oral tablet T5
glycopyrrolate oral tablet 1 mg, 2 mg T5
hyoscyamine sulfate oral drops T5
26
Drug Tier Notes
hyoscyamine sulfate oral elixir T5
hyoscyamine sulfate oral tablet T5
hyoscyamine sulfate oral tablet extended release 12 hr
T1
hyoscyamine sulfate sublingual T1
ipratropium bromide inhalation T5
ipratropium-albuterol T5
LEVSIN INJECTION T5
methscopolamine T5
phenobarb-hyoscy-atropine-scop oral tablet T5
propantheline T5
scopolamine hbr T5
SPIRIVA WITH HANDIHALER T5
SYMAX DUOTAB T5
Antiparkinsonian Agents
benztropine T5
trihexyphenidyl T5
Autonomic Drugs, Miscellaneous
CHANTIX CONTINUING MONTH BOX T5
CHANTIX ORAL TABLET 0.5 MG T5
CHANTIX STARTING MONTH BOX T5
nicotine (polacrilex) buccal gum 2 mg T1 QL (360 EA per 30 days)
nicotine (polacrilex) buccal gum 4 mg T1 QL (360 QY per 30 DYs)
nicotine (polacrilex) buccal lozenge T1 QL (360 EA per 30 days)
nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr
T1 QL (30 QY per 30 DYs)
NICOTROL T5
NICOTROL NS T5
Centrally Acting Skeletal Muscle Relaxnt
AMRIX T5
carisoprodol oral tablet 250 mg T5
carisoprodol-aspirin T5
carisoprodol-aspirin-codeine T5
chlorzoxazone oral tablet 500 mg T5
27
Drug Tier Notes
cyclobenzaprine oral tablet T5
metaxalone oral tablet 800 mg T5
methocarbamol oral T5
ROBAXIN INJECTION T5
tizanidine T5
Direct-Acting Skeletal Muscle Relaxants
REVONTO T5
Gaba-Derivative Skeletal Muscle Relaxant
baclofen oral tablet 10 mg, 20 mg T5
GABLOFEN INTRATHECAL SOLUTION 40,000 MCG/20ML (2,000 MCG/ML)
T5
LIORESAL T5
Neuromuscular Blocking Agents
ANECTINE T5
Non-Sel. Beta-Adrenergic Blocking Agents
BYSTOLIC T5
carvedilol T5
COREG CR T5
INNOPRAN XL T5
labetalol intravenous syringe 20 mg/4 ml (5 mg/ml)
T5
labetalol oral T5
nadolol T5
nadolol-bendroflumethiazide T5
pindolol T5
propranolol oral T5
propranolol-hydrochlorothiazid T5
sotalol T5
Non-Sel.Alpha-1-Adrenergic Blocking Agts
doxazosin T5
prazosin T5
terazosin T5
Non-Sel.Alpha-Adrenergic Blocking Agents
CAFERGOT T5
28
Drug Tier Notes
D.H.E.45 T5
DIBENZYLINE T5
ergoloid T5
ERGOMAR T5
MIGRANAL T5
phentolamine injection recon soln T5
Non-Selective Beta-Adrenergic Agonists
ISUPREL T5
Parasympathomimetic (Cholinergic Agents)
bethanechol chloride T5
donepezil T5
EVOXAC T5
EXELON ORAL SOLUTION T5
EXELON TRANSDERMAL PATCH 24 HOUR 4.6 MG/24 HR, 9.5 MG/24 HR
T5
galantamine T5
guanidine T5
MESTINON ORAL T5
MESTINON TIMESPAN T5
neostigmine methylsulfate injection T5
physostigmine salicylate T5
pilocarpine hcl oral T5
PROSTIGMIN T5
REGONOL T5
rivastigmine tartrate T5
Selective Alpha-1-Adrenergic Block.Agent
carvedilol T5
COREG CR T5
FLOMAX T5
JALYN T5
labetalol intravenous syringe 20 mg/4 ml (5 mg/ml)
T5
labetalol oral T5
RAPAFLO T5
29
Drug Tier Notes
UROXATRAL T5
Selective Beta-1-Adrenergic Agonists
dobutamine in d5w intravenous parenteral solution 1,000 mg/250 ml (4,000 mcg/ml), 250 mg/250 ml (1 mg/ml), 500 mg/250 ml (2,000 mcg/ml)
T5
dobutamine intravenous solution 250 mg/20 ml (12.5 mg/ml)
T5
dopamine in 5 % dextrose intravenous solution 200 mg/250 ml (800 mcg/ml), 800 mg/250 ml (3,200 mcg/ml)
T5
dopamine intravenous solution 200 mg/5 ml (40 mg/ml), 800 mg/10 ml (80 mg/ml), 800 mg/5 ml (160 mg/ml)
T5
Selective Beta-2-Adrenergic Agonists
ADVAIR DISKUS T5
ADVAIR HFA T5
albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 2.5 mg/0.5 ml
T5
albuterol sulfate oral syrup T5
albuterol sulfate oral tablet T5
ANORO ELLIPTA T5
BROVANA T5
budesonide-formoterol T5
COMBIVENT T5
DULERA INHALATION HFA AEROSOL INHALER 100-5 MCG/ACTUATION, 200-5 MCG/ACTUATION
T5
FORADIL AEROLIZER T5
ipratropium-albuterol T5
levalbuterol hcl inhalation solution for nebulization 1.25 mg/0.5 ml
T5
MAXAIR AUTOHALER T5
metaproterenol T5
PERFOROMIST T5
PROAIR HFA T5
SEREVENT DISKUS T5
30
Drug Tier Notes
terbutaline T5
XOPENEX T5
XOPENEX HFA T5
Selective Beta-Adrenergic Blocking Agent
atenolol T5
atenolol-chlorthalidone T5
bisoprolol fumarate T5
bisoprolol-hydrochlorothiazide T5
metoprolol succinate T5
metoprolol ta-hydrochlorothiaz T5
metoprolol tartrate intravenous solution T5
metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg
T5
Skeletal Muscle Relaxants, Miscellaneous
BOTOX T5
BOTOX COSMETIC T5
DYSPORT T5
MYOBLOC INTRAMUSCULAR SOLUTION 10,000 UNIT/2 ML
T5
orphenadrine citrate injection T5
ORPHENADRINE COMPOUND-DS T5
XEOMIN INTRAMUSCULAR RECON SOLN 100 UNIT, 50 UNIT
T5
Blood Derivatives
Blood Derivatives
ALBUMINAR 25 % T5
ALBUMINAR 5 % T5
Blood Formation, Coagulation, Thrombosis
Anticoagulants
TRICITRASOL T5
Anticoagulants, Miscellaneous
ACD-A T5
anticoag citrate phos dextrose T5
CEPROTIN (BLUE BAR) T5
31
Drug Tier Notes
CEPROTIN (GREEN BAR) T5
fondaparinux T5
THROMBATE III T5
Antiheparin Agents
protamine T5
Coumarin Derivatives
COUMADIN INTRAVENOUS T5
warfarin T5
Direct Factor Xa Inhibitors
fondaparinux T5
Direct Thrombin Inhibitors
ANGIOMAX T5
argatroban T5
IPRIVASK T5
PRADAXA ORAL CAPSULE 150 MG, 75 MG T5
Hematopoietic Agents
ARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML
T5
ARANESP (IN POLYSORBATE) INJECTION SYRINGE 100 MCG/0.5 ML, 150 MCG/0.3 ML, 200 MCG/0.4 ML, 25 MCG/0.42 ML, 40 MCG/0.4 ML, 60 MCG/0.3 ML
T5
EPOGEN INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML
T5
GRANIX SUBCUTANEOUS SYRINGE T5
LEUKINE INJECTION RECON SOLN T5
MOZOBIL T5
NEUMEGA T5
NEUPOGEN T5
NPLATE SUBCUTANEOUS RECON SOLN 250 MCG, 500 MCG
T5
PROCRIT INJECTION SOLUTION 40,000 UNIT/ML
T5
32
Drug Tier Notes
PROMACTA ORAL TABLET 25 MG, 50 MG, 75 MG
T5
Hemorrheologic Agents
pentoxifylline T5
Hemostatics
ADVATE INTRAVENOUS RECON SOLN 1,000 (+/-) UNIT, 1,500 (+/-) UNIT, 2,000 (+/-) UNIT, 250 (+/-) UNIT, 3,000 (+/-) UNIT, 500 (+/-) UNIT
T5
ALPHANATE INTRAVENOUS RECON SOLN 1,000 (400 VWF) UNIT/10 ML, 1,500 (600 VWF) UNIT/10 ML, 250 (100 VWF) UNIT/5 ML, 500 (200 VWF) UNIT/5 ML
T5
ALPHANINE SD INTRAVENOUS RECON SOLN 1,000 (+/-) UNIT, 500 (+/-) UNIT
T5
aminocaproic acid intravenous T5
BENEFIX INTRAVENOUS RECON SOLN 1,000 UNIT, 2,000 UNIT, 250 UNIT, 500 UNIT
T5
CYKLOKAPRON T5
DDAVP INJECTION T5
DDAVP NASAL SOLUTION T5
DDAVP ORAL T5
desmopressin nasal spray,non-aerosol T5
FEIBA NF INTRAVENOUS RECON SOLN 1,750-3,250 UNIT
T5
HELIXATE FS T5
HEMOFIL M HIGH T5
HEMOFIL M LOW T5
HEMOFIL M MID T5
HEMOFIL M SUPER HIGH T5
HUMATE-P T5
KOATE-DVI INTRAVENOUS KIT T5
KOATE-DVI INTRAVENOUS RECON SOLN 1,000 (+/-) UNIT, 250 (+/-) UNIT
T5
LYSTEDA T5
MONOCLATE-P INTRAVENOUS RECON SOLN 1,000 (+/-) UNIT
T5
NOVOSEVEN RT T5
33
Drug Tier Notes
PROFILNINE INTRAVENOUS RECON SOLN 500 (+/-) UNIT
T5
RECOMBINATE T5
RECOTHROM SPRAY KIT T5
RECOTHROM TOPICAL RECON SOLN 5,000 UNIT
T5
RIASTAP T5
RIXUBIS T5
STIMATE T5
THROMBIN-JMI NASAL T5
THROMBIN-JMI TOPICAL RECON SOLN T5
THROMBIN-JMI TOPICAL SPRAY,NON-AEROSOL
T5
XYNTHA T5
XYNTHA SOLOFUSE INTRAVENOUS SYRINGE 3,000 (+/-) UNIT
T5
Heparins
enoxaparin T5
FRAGMIN SUBCUTANEOUS SYRINGE 10,000 ANTI-XA UNIT/ML, 12,500 ANTI-XA UNIT/0.5 ML, 2,500 ANTI-XA UNIT/0.2 ML
T5
heparin (porcine) in 5 % dex intravenous parenteral solution 20,000 unit/500 ml (40 unit/ml)
T5
heparin (porcine) injection solution 10,000 unit/ml, 20,000 unit/ml
T5
heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/250 ml, 25,000 unit/500 ml
T5
heparin, porcine (pf) intravenous solution 25,000 unit/10 ml
T5
Iron Preparations
ATABEX EC T5
BAL-CARE DHA T5
BAL-CARE DHA ESSENTIAL T5
CAVAN-EC SOD DHA T5
CENTRUM COMPLETE T1
34
Drug Tier Notes
CLASSIC PRENATAL T2
COMPLETENATE T5
CONCEPT DHA T5
CONCEPT OB T5
DUET DHA BALANCED ORAL COMBO PACK 26 MG IRON- 1 MG-278 MG
T5
DUET DHA EC-OM 3 T5
DUET DHA WITH OMEGA-3 T5
ELITE-OB 400 T5
EXTRA-VIRT PLUS DHA T5
EZFE FORTE T1 QL (30 QY per 30 DYs)
ferrous fumarate oral tablet 324 mg (106 mg iron) T1
ferrous gluconate oral tablet 240 mg (27 mg iron), 324 mg (38 mg iron), 325 mg (36 mg iron)
T1
ferrous sulfate oral drops T1
ferrous sulfate oral elixir T1
ferrous sulfate oral liquid T1
ferrous sulfate oral solution T1
ferrous sulfate oral tablet 325 mg (65 mg iron) T1
ferrous sulfate oral tablet extended release T1
ferrous sulfate oral tablet,delayed release (dr/ec) T1
FLINTSTONES COMPLETE (IRON) ORAL TABLET,CHEWABLE 18 MG IRON
T2
FOLCAL DHA T5
FOLIVANE-PRX DHA NF T5
GESTICARE DHA T5
IROSPAN 24/6 T5
KPN ORAL TABLET 9 MG IRON- 267 MCG T2 QL (30 QY per 30 DYs)
LEVOMEFOLATEPNV T5
L-METHYLFOLATE PNV DHA T5
NATACHEW (FE BIS-GLYCINATE) T5
NATAFORT (NEW FORMULA 2011) T5
NATELLE ONE T5
OB COMPLETE 400 T5
OB COMPLETE ONE T5
35
Drug Tier Notes
OB COMPLETE ORAL TABLET T5
OB COMPLETE PREMIER T5
OBSTETRIX EC T5
OBTREX T5
ONE DAILY MULTI-VIT W-MINERAL ORAL TABLET
T1
PAIRE OB PLUS DHA T5
PNV FOLIC ACID + IRON T5
POLY-VI-SOL WITH IRON T2
POLYVITAMIN WITH IRON T1
POLY-VITAMIN WITH IRON T1
PREFERA-OB ONE T5
PRENA1 T5
PRENA1 PLUS T5
PRENAISSANCE 90 DHA T5
PRENATA T5
PRENATABS FA T5
PRENATABS RX T5
PRENATAL VITAMIN ORAL TABLET 27 MG IRON- 0.8 MG
T1
PRENATE DHA T5
PRENATE ELITE T5
PRENATE ESSENTIAL T5
PRENATE MINI T5
PREQUE 10 T5
PUREFE OB PLUS T5
SELECT-OB (FOLIC ACID) T5
SE-TAN DHA T5
SETONET T5
SETONET-EC T5
TARON-BC T5
THERA-M ORAL TABLET , 9 MG IRON-400 MCG
T1
THEREMS-M T2
TRIADVANCE T5
36
Drug Tier Notes
TRINATE T5
TRIVEEN-DUO DHA T5
TRIVEEN-ONE T5
TRIVEEN-PRX RNF T5
TRIVEEN-TEN T5
TRI-VI-SOL WITH IRON T2
ULTIMATECARE ONE NF T5
VINATE AZ T5
VINATE DHA T5
VINATE M T5
VINATE ONE T5
VIRT-BAL DHA T5
VIRT-PN T5
VIRT-PN DHA T5
VIRT-SELECT T5
VITAFOL-PLUS T5
VITASPIRE T5
VIVA DHA T5
VP-CH PLUS T5
VP-CH-PNV T5
VP-ERA OB PLUS T5
VP-PNV-DHA T5
ZATEAN-CH T5
ZATEAN-PN PLUS T5
Platelet-Aggregation Inhibitors
AGGRASTAT IN SODIUM CHLORIDE INTRAVENOUS SOLUTION 5 MG/100 ML (50 MCG/ML)
T5
AGGRENOX T5
ASCRIPTIN T1
aspirin oral tablet T1
aspirin oral tablet,chewable T1
aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg
T1
aspirin rectal suppository 600 mg T1
37
Drug Tier Notes
BAYER PLUS EXTRA STRENGTH T1
cilostazol T5
clopidogrel T5
dipyridamole T5
EFFERVESCENT ANTACID T1
EFFIENT T5
HALFPRIN T2
INTEGRILIN T5
MIGRAINE FORMULA T1
REOPRO T5
SYNALGOS-DC T5
ticlopidine T5
TRI-BUFFERED ASPIRIN T1
Platelet-Reducing Agents
AGRYLIN T5
anagrelide oral capsule 1 mg T5
Thrombolytic Agents
ACTIVASE INTRAVENOUS RECON SOLN 50 MG
T5
ASCRIPTIN T1
aspirin oral tablet T1
aspirin oral tablet,chewable T1
aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg
T1
aspirin rectal suppository 600 mg T1
BAYER PLUS EXTRA STRENGTH T1
EFFERVESCENT ANTACID T1
HALFPRIN T2
MIGRAINE FORMULA T1
RETAVASE INTRAVENOUS KIT T5
SYNALGOS-DC T5
TRI-BUFFERED ASPIRIN T1
Cardiovascular Drugs
Alpha-Adrenergic Blocking Agents
38
Drug Tier Notes
carvedilol T5
COREG CR T5
doxazosin T5
labetalol intravenous syringe 20 mg/4 ml (5 mg/ml)
T5
labetalol oral T5
prazosin T5
terazosin T5
Alpha-Adrenergic Blocking Agt.(Hypoten)
doxazosin T5
labetalol intravenous syringe 20 mg/4 ml (5 mg/ml)
T5
labetalol oral T5
prazosin T5
terazosin T5
Angiotensin Ii Receptor Antagon.(Hypotn)
AVAPRO T5
AZOR T5
DIOVAN T5
EXFORGE T5
EXFORGE HCT T5
irbesartan-hydrochlorothiazide T5
losartan T5
losartan-hydrochlorothiazide T5
olmesartan T5
telmisartan T5
telmisartan-amlodipine T5
TEVETEN HCT T5
TRIBENZOR T5
valsartan-hydrochlorothiazide T5
Angiotensin Ii Receptor Antagonists
AVAPRO T5
AZOR T5
DIOVAN T5
39
Drug Tier Notes
EXFORGE T5
EXFORGE HCT T5
irbesartan-hydrochlorothiazide T5
losartan T5
losartan-hydrochlorothiazide T5
olmesartan T5
telmisartan T5
telmisartan-amlodipine T5
TEVETEN HCT T5
TRIBENZOR T5
valsartan-hydrochlorothiazide T5
Angiotensin-Convert.Enzyme Inhib(Hypotn)
amlodipine-benazepril T5
benazepril T5
benazepril-hydrochlorothiazide T5
captopril T5
captopril-hydrochlorothiazide T5
enalapril maleate T5
enalaprilat intravenous solution T5
enalapril-hydrochlorothiazide T5
fosinopril T5
fosinopril-hydrochlorothiazide T5
lisinopril T5
lisinopril-hydrochlorothiazide T5
moexipril T5
moexipril-hydrochlorothiazide T5
quinapril T5
quinapril-hydrochlorothiazide T5
ramipril T5
TARKA T5
Angiotensin-Converting Enzyme Inhibitors
amlodipine-benazepril T5
benazepril T5
benazepril-hydrochlorothiazide T5
40
Drug Tier Notes
captopril T5
captopril-hydrochlorothiazide T5
enalapril maleate T5
enalaprilat intravenous solution T5
enalapril-hydrochlorothiazide T5
fosinopril T5
fosinopril-hydrochlorothiazide T5
lisinopril T5
lisinopril-hydrochlorothiazide T5
moexipril T5
moexipril-hydrochlorothiazide T5
quinapril T5
quinapril-hydrochlorothiazide T5
ramipril T5
TARKA T5
Antiarrhythmic Agents
ADENOCARD T5
Antiarrhythmics, Miscellaneous
digoxin injection solution T5
digoxin oral solution 50 mcg/ml (0.05 mg/ml) T5
digoxin oral tablet T5
LANOXIN PEDIATRIC T5
magnesium sulfate in d5w intravenous piggyback 1 gram/100 ml
T5
magnesium sulfate in water intravenous parenteral solution 20 gram/500 ml (4 %)
T5
magnesium sulfate in water intravenous piggyback 4 gram/50 ml (8 %)
T5
magnesium sulfate injection syringe T5
Antilipemic Agents, Miscellaneous
FISH OIL ORAL CAPSULE 340-1,000 MG T1 QL (120 QY per 30 DYs)
JUXTAPID ORAL CAPSULE 10 MG, 20 MG T5
LOVAZA T5
niacin oral capsule, extended release 250 mg, 500 mg
T1
41
Drug Tier Notes
niacin oral tablet 100 mg, 500 mg T1
niacin oral tablet extended release 500 mg T1
NIACOR T5
NIASPAN EXTENDED-RELEASE T5
omega-3 fatty acids-fish oil oral capsule 300-1,000 mg
T1 QL (120 QY per 30 DYs)
Beta-Adrenergic Blocking Agents
atenolol T5
atenolol-chlorthalidone T5
bisoprolol fumarate T5
bisoprolol-hydrochlorothiazide T5
BYSTOLIC T5
carvedilol T5
COREG CR T5
INNOPRAN XL T5
labetalol intravenous syringe 20 mg/4 ml (5 mg/ml)
T5
labetalol oral T5
LEVATOL T5
metoprolol succinate T5
metoprolol ta-hydrochlorothiaz T5
metoprolol tartrate intravenous solution T5
metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg
T5
nadolol T5
nadolol-bendroflumethiazide T5
pindolol T5
propranolol oral T5
propranolol-hydrochlorothiazid T5
sotalol T5
Beta-Adrenergic Blocking Agt.(Hypoten)
atenolol T5
atenolol-chlorthalidone T5
bisoprolol fumarate T5
bisoprolol-hydrochlorothiazide T5
42
Drug Tier Notes
INNOPRAN XL T5
labetalol intravenous syringe 20 mg/4 ml (5 mg/ml)
T5
labetalol oral T5
metoprolol succinate T5
metoprolol ta-hydrochlorothiaz T5
metoprolol tartrate intravenous solution T5
metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg
T5
nadolol T5
nadolol-bendroflumethiazide T5
pindolol T5
propranolol oral T5
propranolol-hydrochlorothiazid T5
sotalol T5
Bile Acid Sequestrants
cholestyramine (with sugar) T5
CHOLESTYRAMINE LIGHT T5
COLESTID FLAVORED ORAL PACKET T5
COLESTID ORAL TABLET T5
colestipol oral granules T5
WELCHOL T5
Calcium-Channel Block.Agt,Misc(Hypoten)
diltiazem hcl intravenous T5
diltiazem hcl oral capsule,ext.rel 24h degradable T5
diltiazem hcl oral capsule,extended release 12 hr T5
diltiazem hcl oral capsule,extended release 24 hr T5
diltiazem hcl oral capsule,extended release 24hr T5
diltiazem hcl oral tablet T5
TARKA T5
verapamil intravenous solution T5
verapamil oral T5
Calcium-Channel Blocking Agents
amlodipine T5
43
Drug Tier Notes
amlodipine-benazepril T5
AMTURNIDE T5
AZOR T5
CADUET T5
CARDENE SR T5
CLEVIPREX INTRAVENOUS EMULSION 25 MG/50 ML
T5
diltiazem hcl intravenous T5
diltiazem hcl oral capsule,ext.rel 24h degradable T5
diltiazem hcl oral capsule,extended release 12 hr T5
diltiazem hcl oral capsule,extended release 24 hr T5
diltiazem hcl oral capsule,extended release 24hr T5
diltiazem hcl oral tablet T5
EXFORGE T5
EXFORGE HCT T5
felodipine T5
isradipine T5
nicardipine intravenous solution T5
nicardipine oral T5
NIFEDICAL XL T5
nifedipine oral capsule T5
nifedipine oral tablet extended release T5
nifedipine oral tablet extended release 24hr 90 mg T5
nimodipine T5
nisoldipine oral tablet extended release 24 hr 20 mg, 30 mg, 40 mg
T5
TARKA T5
TEKAMLO T5
telmisartan-amlodipine T5
TRIBENZOR T5
verapamil intravenous solution T5
verapamil oral T5
Calcium-Channel Blocking Agents(Hypoten)
diltiazem hcl intravenous T5
44
Drug Tier Notes
diltiazem hcl oral capsule,ext.rel 24h degradable T5
diltiazem hcl oral capsule,extended release 12 hr T5
diltiazem hcl oral capsule,extended release 24 hr T5
diltiazem hcl oral capsule,extended release 24hr T5
diltiazem hcl oral tablet T5
verapamil intravenous solution T5
verapamil oral T5
Calcium-Channel Blocking Agents, Misc.
diltiazem hcl intravenous T5
diltiazem hcl oral capsule,ext.rel 24h degradable T5
diltiazem hcl oral capsule,extended release 12 hr T5
diltiazem hcl oral capsule,extended release 24 hr T5
diltiazem hcl oral capsule,extended release 24hr T5
diltiazem hcl oral tablet T5
TARKA T5
verapamil intravenous solution T5
verapamil oral T5
Carbonic Anhydrase Inhibitors(Hypoten)
acetazolamide T5
acetazolamide sodium T5
Cardiac Drugs, Miscellaneous
RANEXA T5
Cardiotonic Agents
digoxin injection solution T5
digoxin oral solution 50 mcg/ml (0.05 mg/ml) T5
digoxin oral tablet T5
dobutamine in d5w intravenous parenteral solution 1,000 mg/250 ml (4,000 mcg/ml), 250 mg/250 ml (1 mg/ml), 500 mg/250 ml (2,000 mcg/ml)
T5
dobutamine intravenous solution 250 mg/20 ml (12.5 mg/ml)
T5
dopamine in 5 % dextrose intravenous solution 200 mg/250 ml (800 mcg/ml), 800 mg/250 ml (3,200 mcg/ml)
T5
45
Drug Tier Notes
dopamine intravenous solution 200 mg/5 ml (40 mg/ml), 800 mg/10 ml (80 mg/ml), 800 mg/5 ml (160 mg/ml)
T5
LANOXIN PEDIATRIC T5
milrinone T5
milrinone in 5 % dextrose intravenous piggyback 40 mg/200 ml (200 mcg/ml)
T5
Central Alpha-Agonists
clonidine T5
clonidine (pf) T5
clonidine hcl oral tablet T5
CLORPRES T5
guanfacine oral tablet T5
INTUNIV ER T5
methyldopa T5
methyldopate T5
Cholesterol Absorption Inhibitors
VYTORIN 10-10 T5
VYTORIN 10-20 T5
VYTORIN 10-40 T5
VYTORIN 10-80 T5
ZETIA T5
Class Ia Antiarrhythmics
disopyramide phosphate oral capsule T5
NORPACE CR T5
procainamide injection T5
quinidine gluconate T5
quinidine sulfate T5
Class Ib Antiarrhythmics
DILANTIN T5
lidocaine (pf) intravenous syringe T5
mexiletine T5
phenytoin oral suspension 125 mg/5 ml T5
phenytoin oral tablet,chewable T5
46
Drug Tier Notes
phenytoin sodium extended T5
phenytoin sodium intravenous solution T5
Class Ic Antiarrhythmics
flecainide T5
propafenone T5
Class Ii Antiarrhythmics
atenolol T5
atenolol-chlorthalidone T5
bisoprolol fumarate T5
bisoprolol-hydrochlorothiazide T5
carvedilol T5
COREG CR T5
INNOPRAN XL T5
labetalol intravenous syringe 20 mg/4 ml (5 mg/ml)
T5
labetalol oral T5
metoprolol succinate T5
metoprolol ta-hydrochlorothiaz T5
metoprolol tartrate intravenous solution T5
metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg
T5
nadolol T5
nadolol-bendroflumethiazide T5
pindolol T5
propranolol oral T5
propranolol-hydrochlorothiazid T5
sotalol T5
Class Iii Antiarrhythmics
amiodarone intravenous solution T5
amiodarone oral tablet 200 mg, 400 mg T5
CORVERT T5
MULTAQ T5
PACERONE ORAL TABLET 100 MG T5
sotalol T5
47
Drug Tier Notes
TIKOSYN T5
Class Iv Antiarrhythmics
ADENOCARD T5
ADENOSCAN T5
diltiazem hcl intravenous T5
diltiazem hcl oral capsule,ext.rel 24h degradable T5
diltiazem hcl oral capsule,extended release 12 hr T5
diltiazem hcl oral capsule,extended release 24 hr T5
diltiazem hcl oral capsule,extended release 24hr T5
diltiazem hcl oral tablet T5
verapamil intravenous solution T5
verapamil oral T5
Dihydropyridines
amlodipine T5
amlodipine-benazepril T5
AMTURNIDE T5
AZOR T5
CADUET T5
CARDENE SR T5
CLEVIPREX INTRAVENOUS EMULSION 25 MG/50 ML
T5
EXFORGE T5
EXFORGE HCT T5
felodipine T5
isradipine T5
nicardipine intravenous solution T5
nicardipine oral T5
NIFEDICAL XL T5
nifedipine oral capsule T5
nifedipine oral tablet extended release T5
nifedipine oral tablet extended release 24hr 90 mg T5
nimodipine T5
nisoldipine oral tablet extended release 24 hr 20 mg, 30 mg, 40 mg
T5
48
Drug Tier Notes
TEKAMLO T5
telmisartan-amlodipine T5
TRIBENZOR T5
Dihydropyridines (Antihypertensive)
amlodipine T5
amlodipine-benazepril T5
AMTURNIDE T5
AZOR T5
CADUET T5
CARDENE SR T5
CLEVIPREX INTRAVENOUS EMULSION 25 MG/50 ML
T5
EXFORGE T5
EXFORGE HCT T5
felodipine T5
isradipine T5
nicardipine intravenous solution T5
nicardipine oral T5
NIFEDICAL XL T5
nifedipine oral capsule T5
nifedipine oral tablet extended release T5
nifedipine oral tablet extended release 24hr 90 mg T5
nimodipine T5
nisoldipine oral tablet extended release 24 hr 20 mg, 30 mg, 40 mg
T5
TEKAMLO T5
telmisartan-amlodipine T5
TRIBENZOR T5
Direct Vasodilators
BIDIL T5
hydralazine T5
minoxidil oral T5
Diuretics, Miscellaneous (Hypotensive)
ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML T5
49
Drug Tier Notes
THEO-24 T5
THEOCHRON T5
theophylline oral tablet extended release T5
Fibric Acid Derivatives
ANTARA ORAL CAPSULE 43 MG T5
fenofibrate micronized oral capsule 130 mg, 134 mg, 200 mg, 67 mg
T5
fenofibrate oral tablet 160 mg, 54 mg T5
fenofibric acid T5
fenofibric acid (choline) T5
FENOGLIDE T5
gemfibrozil T5
LIPOFEN T5
TRICOR T5
Hmg-Coa Reductase Inhibitors
ADVICOR T5
ALTOPREV T5
atorvastatin T5
CADUET T5
CRESTOR T5
fluvastatin oral capsule T5
LESCOL XL T5
LIVALO T5
lovastatin T5
pravastatin T5
SIMCOR T5
simvastatin oral tablet T5
VYTORIN 10-10 T5
VYTORIN 10-20 T5
VYTORIN 10-40 T5
VYTORIN 10-80 T5
Hypotensive Agents, Miscellaneous
amlodipine T5
amlodipine-benazepril T5
50
Drug Tier Notes
AZOR T5
CARDENE SR T5
carvedilol T5
CLEVIPREX INTRAVENOUS EMULSION 25 MG/50 ML
T5
COREG CR T5
CORLOPAM T5
DIBENZYLINE T5
doxazosin T5
EXFORGE T5
felodipine T5
INNOPRAN XL T5
isradipine T5
nicardipine intravenous solution T5
nicardipine oral T5
NIFEDICAL XL T5
nifedipine oral capsule T5
nifedipine oral tablet extended release T5
nifedipine oral tablet extended release 24hr 90 mg T5
nimodipine T5
nisoldipine oral tablet extended release 24 hr 20 mg, 30 mg, 40 mg
T5
phentolamine injection recon soln T5
pindolol T5
propranolol oral T5
sotalol T5
terazosin T5
Loop Diuretics (Hypotensive Agents)
bumetanide T5
DEMADEX T5
furosemide injection syringe T5
furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml)
T5
furosemide oral tablet T5
SODIUM EDECRIN T5
51
Drug Tier Notes
torsemide intravenous solution 20 mg/2 ml (10 mg/ml)
T5
Mineralocorticoid (Aldosterone) Antagnts
ALDACTAZIDE ORAL TABLET 25-25 MG T5
eplerenone T5
spironolactone T5
Mineralocorticoid(Aldoster.)Antag(Hypot)
ALDACTAZIDE ORAL TABLET 25-25 MG T5
eplerenone T5
spironolactone T5
Nitrates And Nitrites
amyl nitrite inhalation solution 0.3 ml T5
BIDIL T5
DILATRATE-SR T5
IMDUR T5
ISORDIL T5
isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg
T5
isosorbide dinitrate oral tablet extended release T5
isosorbide mononitrate oral tablet T5
NITRO-BID T5
NITRO-DUR TRANSDERMAL PATCH 24 HOUR 0.3 MG/HR, 0.8 MG/HR
T5
nitroglycerin in 5 % dextrose intravenous solution 100 mg/250 ml (400 mcg/ml), 50 mg/250 ml (200 mcg/ml)
T5
nitroglycerin intravenous T5
nitroglycerin oral T5
nitroglycerin transdermal patch 24 hour T5
NITROLINGUAL T5
NITROMIST T5
NITROSTAT T5
Osmotic Diuretics (Hypotensive Agents)
mannitol 10 % T5
mannitol 20 % T5
52
Drug Tier Notes
mannitol 25 % intravenous solution T5
mannitol 5 % T5
Peripheral Adrenergic Inhibitors
reserpine T5
Phosphodiesterase Type 5 Inhibitors
ADCIRCA T5
CIALIS T5
cilostazol T5
LEVITRA T5
REVATIO INTRAVENOUS T5
REVATIO ORAL TABLET T5
STAXYN T5
STENDRA T5
VIAGRA T5
Potassium-Sparing Diuretics (Hypoten)
ALDACTAZIDE ORAL TABLET 25-25 MG T5
amiloride T5
amiloride-hydrochlorothiazide T5
DYRENIUM T5
eplerenone T5
spironolactone T5
triamterene-hydrochlorothiazid oral capsule 37.5-25 mg
T5
triamterene-hydrochlorothiazid oral tablet T5
Renin Inhibitors
AMTURNIDE T5
TEKAMLO T5
TEKTURNA T5
TEKTURNA HCT T5
Sclerosing Agents
ETHAMOLIN T5
morrhuate sodium T5
SOTRADECOL T5
53
Drug Tier Notes
Thiazide Diuretics(Hypotensive Agents)
ALDACTAZIDE ORAL TABLET 25-25 MG T5
amiloride-hydrochlorothiazide T5
AMTURNIDE T5
benazepril-hydrochlorothiazide T5
bisoprolol-hydrochlorothiazide T5
captopril-hydrochlorothiazide T5
chlorothiazide T5
chlorothiazide sodium T5
DIURIL T5
enalapril-hydrochlorothiazide T5
EXFORGE HCT T5
fosinopril-hydrochlorothiazide T5
hydrochlorothiazide T5
irbesartan-hydrochlorothiazide T5
lisinopril-hydrochlorothiazide T5
losartan-hydrochlorothiazide T5
methyclothiazide T5
metoprolol ta-hydrochlorothiaz T5
moexipril-hydrochlorothiazide T5
nadolol-bendroflumethiazide T5
propranolol-hydrochlorothiazid T5
quinapril-hydrochlorothiazide T5
TEKTURNA HCT T5
TEVETEN HCT T5
triamterene-hydrochlorothiazid oral capsule 37.5-25 mg
T5
triamterene-hydrochlorothiazid oral tablet T5
TRIBENZOR T5
valsartan-hydrochlorothiazide T5
Thiazide-Like Diuretics(Hypotensive Agt)
atenolol-chlorthalidone T5
chlorthalidone oral tablet 25 mg, 50 mg T5
CLORPRES T5
54
Drug Tier Notes
indapamide T5
metolazone T5
Vasodilating Agents, Miscellaneous
AGGRENOX T5
alprostadil T5
ambrisentan T5
amlodipine T5
amlodipine-benazepril T5
AMTURNIDE T5
AZOR T5
CADUET T5
CARDENE SR T5
CAVERJECT IMPULSE T5
CAVERJECT INTRACAVERNOSAL RECON SOLN
T5
CLEVIPREX INTRAVENOUS EMULSION 25 MG/50 ML
T5
diltiazem hcl intravenous T5
diltiazem hcl oral capsule,ext.rel 24h degradable T5
diltiazem hcl oral capsule,extended release 12 hr T5
diltiazem hcl oral capsule,extended release 24 hr T5
diltiazem hcl oral capsule,extended release 24hr T5
diltiazem hcl oral tablet T5
dipyridamole T5
EDEX INTRACAVERNOSAL KIT 40 MCG T5
epoprostenol (glycine) T5
EXFORGE T5
felodipine T5
isradipine T5
MUSE T5
NATRECOR T5
nicardipine intravenous solution T5
nicardipine oral T5
NIFEDICAL XL T5
55
Drug Tier Notes
nifedipine oral capsule T5
nifedipine oral tablet extended release T5
nifedipine oral tablet extended release 24hr 90 mg T5
nimodipine T5
nisoldipine oral tablet extended release 24 hr 20 mg, 30 mg, 40 mg
T5
papaverine injection solution T5
REMODULIN T5
TARKA T5
TEKAMLO T5
telmisartan-amlodipine T5
TRACLEER ORAL TABLET T5
TRIBENZOR T5
TYVASO T5
VENTAVIS T5
verapamil intravenous solution T5
verapamil oral T5
Cellular And Gene Therapy
Cellular And Gene Therapy
PROVENGE T5
Cellular Therapy
PROVENGE T5
Central Nervous System Agents
Adamantanes (Cns)
amantadine hcl T5
Amphetamines
benzphetamine oral tablet 50 mg T5
DESOXYN T5
dextroamphetamine oral capsule, extended release T5
dextroamphetamine oral tablet T5
dextroamphetamine-amphetamine oral capsule,extended release 24hr
T5
PROCENTRA T5
56
Drug Tier Notes
VYVANSE ORAL CAPSULE 20 MG, 30 MG, 40 MG, 50 MG, 60 MG, 70 MG
T5
Analgesics And Antipyretics, Misc.
acetaminophen oral drops 100 mg/ml T1
acetaminophen oral liquid 500 mg/5 ml T1
acetaminophen oral tablet 500 mg T1
acetaminophen-codeine oral solution 120-12 mg/5 ml
T5
acetaminophen-codeine oral tablet T5
butalbital-acetaminop-caf-cod oral capsule 50-325-40-30 mg
T5
butalbital-acetaminophen-caff oral capsule 50-325-40 mg
T5
butalbital-acetaminophen-caff oral tablet 50-325-40 mg
T5
CHILDREN'S NON-ASPIRIN ORAL TABLET,CHEWABLE
T1
CHILDREN'S PAIN RELIEF ORAL SUSPENSION
T1
clonidine (pf) T5
ENDOCET ORAL TABLET 10-325 MG, 5-325 MG, 7.5-325 MG
T5
FEVERALL RECTAL SUPPOSITORY 325 MG, 650 MG
T1
FEVERALL RECTAL SUPPOSITORY 80 MG T2
gabapentin oral capsule T5
gabapentin oral solution 250 mg/5 ml T5
gabapentin oral tablet 600 mg, 800 mg T5
hydrocodone-acetaminophen oral solution 7.5-325 mg/15 ml, 7.5-500 mg/15 ml
T5
hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg
T5
LYRICA ORAL CAPSULE T5
MAGNACET T5
MAPAP (ACETAMINOPHEN) ORAL LIQUID 160 MG/5 ML
T1
MIGRAINE FORMULA T1
57
Drug Tier Notes
oxycodone-acetaminophen oral tablet 2.5-325 mg T5
PRIALT T5
PRIMLEV T5
Q-PAP ORAL LIQUID T1
ROXICET ORAL SOLUTION T5
TENSION HEADACHE RELIEF T1
tramadol-acetaminophen T5
XOLOX T5
ZAMICET T5
ZYDONE T5
Anticholinergic Agents (Cns)
benztropine T5
trihexyphenidyl T5
Anticonvulsants, Miscellaneous
APTIOM T5
BANZEL T5
carbamazepine oral capsule, er multiphase 12 hr T5
carbamazepine oral suspension 100 mg/5 ml T5
carbamazepine oral tablet T5
carbamazepine oral tablet extended release 12 hr 200 mg, 400 mg
T5
carbamazepine oral tablet,chewable T5
DEPACON T5
DEPAKENE T5
DEPAKOTE T5
DEPAKOTE ER T5
DEPAKOTE SPRINKLES T5
EQUETRO T5
felbamate T5
FYCOMPA ORAL TABLET T5
gabapentin oral capsule T5
gabapentin oral solution 250 mg/5 ml T5
gabapentin oral tablet 600 mg, 800 mg T5
GABITRIL ORAL TABLET 12 MG, 16 MG T5
58
Drug Tier Notes
LAMICTAL ODT T5
LAMICTAL ODT STARTER (BLUE) T5
LAMICTAL ODT STARTER (GREEN) T5
LAMICTAL ODT STARTER (ORANGE) T5
LAMICTAL STARTER (BLUE) KIT T5
LAMICTAL STARTER (GREEN) KIT T5
LAMICTAL STARTER (ORANGE) KIT T5
LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24HR 100 MG, 200 MG, 25 MG, 50 MG
T5
LAMICTAL XR STARTER (BLUE) T5
LAMICTAL XR STARTER (GREEN) T5
LAMICTAL XR STARTER (ORANGE) T5
lamotrigine oral tablet T5
lamotrigine oral tablet, chewable dispersible T5
levetiracetam intravenous T5
levetiracetam oral solution 100 mg/ml T5
levetiracetam oral tablet T5
levetiracetam oral tablet extended release 24 hr T5
LYRICA ORAL CAPSULE T5
magnesium sulfate in d5w intravenous piggyback 1 gram/100 ml
T5
magnesium sulfate in water intravenous parenteral solution 20 gram/500 ml (4 %)
T5
magnesium sulfate in water intravenous piggyback 4 gram/50 ml (8 %)
T5
magnesium sulfate injection syringe T5
oxcarbazepine T5
OXTELLAR XR T5
SABRIL T5
STAVZOR T5
TEGRETOL XR ORAL TABLET EXTENDED RELEASE 12 HR 100 MG
T5
tiagabine oral tablet 2 mg, 4 mg T5
topiramate oral capsule, sprinkle T5
topiramate oral tablet T5
59
Drug Tier Notes
VIMPAT INTRAVENOUS T5
VIMPAT ORAL SOLUTION T5
VIMPAT ORAL TABLET T5
ZONEGRAN ORAL CAPSULE 100 MG, 25 MG T5
zonisamide oral capsule 50 mg T5
Antidepressants, Miscellaneous
APLENZIN T5
BUDEPRION SR ORAL TABLET SUSTAINED-RELEASE 12 HR 150 MG
T5
BUPROBAN T5
bupropion hcl oral tablet T5
bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg
T5
bupropion hcl oral tablet sustained-release 12 hr 100 mg, 200 mg
T5
mirtazapine T5
Antimanic Agents
ABILIFY T5
ABILIFY DISCMELT T5
ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON
T5
carbamazepine oral capsule, er multiphase 12 hr T5
carbamazepine oral suspension 100 mg/5 ml T5
carbamazepine oral tablet T5
carbamazepine oral tablet extended release 12 hr 200 mg, 400 mg
T5
carbamazepine oral tablet,chewable T5
DEPACON T5
DEPAKENE T5
DEPAKOTE T5
DEPAKOTE ER T5
DEPAKOTE SPRINKLES T5
EQUETRO T5
GEODON INTRAMUSCULAR T5
LAMICTAL ODT T5
60
Drug Tier Notes
LAMICTAL ODT STARTER (BLUE) T5
LAMICTAL ODT STARTER (GREEN) T5
LAMICTAL ODT STARTER (ORANGE) T5
LAMICTAL STARTER (BLUE) KIT T5
LAMICTAL STARTER (GREEN) KIT T5
LAMICTAL STARTER (ORANGE) KIT T5
lamotrigine oral tablet T5
lamotrigine oral tablet, chewable dispersible T5
lithium carbonate T5
lithium citrate oral solution 8 meq/5 ml T5
olanzapine T5
quetiapine oral tablet T5
RISPERDAL CONSTA T5
risperidone oral solution T5
risperidone oral tablet T5
risperidone oral tablet,disintegrating T5
SAPHRIS SUBLINGUAL TABLET 10 MG, 5 MG
T5
SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR
T5
STAVZOR T5
TEGRETOL XR ORAL TABLET EXTENDED RELEASE 12 HR 100 MG
T5
ziprasidone hcl T5
ZYPREXA RELPREVV T5
Antimigraine Agents, Miscellaneous
ASCOMP WITH CODEINE T5
ASCRIPTIN T1
aspirin oral tablet T1
aspirin oral tablet,chewable T1
aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg
T1
aspirin rectal suppository 600 mg T1
BAYER PLUS EXTRA STRENGTH T1
61
Drug Tier Notes
butalbital-acetaminop-caf-cod oral capsule 50-325-40-30 mg
T5
butalbital-acetaminophen-caff oral capsule 50-325-40 mg
T5
butalbital-acetaminophen-caff oral tablet 50-325-40 mg
T5
CAFERGOT T5
CAMBIA T5
D.H.E.45 T5
DEPACON T5
DEPAKENE T5
DEPAKOTE T5
DEPAKOTE ER T5
DEPAKOTE SPRINKLES T5
EFFERVESCENT ANTACID T1
ERGOMAR T5
HALFPRIN T2
INNOPRAN XL T5
MIGRAINE FORMULA T1
MIGRANAL T5
propranolol oral T5
STAVZOR T5
SYNALGOS-DC T5
tramadol-acetaminophen T5
TRI-BUFFERED ASPIRIN T1
Antipsychotics, Miscellaneous
loxapine succinate T5
ORAP T5
Anxiolytics,Sedatives,And Hypnotics,Misc
buspirone T5
droperidol injection solution T5
EDLUAR T5
eszopiclone T5
hydroxyzine hcl intramuscular T5
hydroxyzine hcl oral solution 10 mg/5 ml T5
62
Drug Tier Notes
hydroxyzine hcl oral tablet T5
hydroxyzine pamoate T5
meprobamate T5
promethazine oral T1 AL
promethazine rectal suppository 12.5 mg, 25 mg T1 AL
propofol intravenous emulsion T5
ROZEREM T5
SONATA T5
zolpidem oral T5
ZOLPIMIST T5
Atypical Antipsychotics
ABILIFY T5
ABILIFY DISCMELT T5
ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON
T5
clozapine oral tablet T5
FANAPT T5
FAZACLO T5
GEODON INTRAMUSCULAR T5
INVEGA T5
INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML
T5
LATUDA ORAL TABLET 40 MG, 60 MG, 80 MG
T5
olanzapine T5
olanzapine-fluoxetine T5
quetiapine oral tablet T5
RISPERDAL CONSTA T5
risperidone oral solution T5
risperidone oral tablet T5
risperidone oral tablet,disintegrating T5
SAPHRIS SUBLINGUAL TABLET 10 MG, 5 MG
T5
SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR
T5
63
Drug Tier Notes
ziprasidone hcl T5
ZYPREXA RELPREVV T5
Barbiturates (Anticonvulsants)
BREVITAL INJECTION RECON SOLN 2.5 GRAM, 500 MG
T5
phenobarb-hyoscy-atropine-scop oral tablet T5
primidone T5
Barbiturates (Anxiolytic, Sedative/Hyp)
ASCOMP WITH CODEINE T5
butalbital-acetaminop-caf-cod oral capsule 50-325-40-30 mg
T5
butalbital-acetaminophen-caff oral capsule 50-325-40 mg
T5
butalbital-acetaminophen-caff oral tablet 50-325-40 mg
T5
phenobarb-hyoscy-atropine-scop oral tablet T5
Barbiturates (General Anesthetics)
BREVITAL INJECTION RECON SOLN 2.5 GRAM, 500 MG
T5
Benzodiazepines (Anticonvulsants)
clonazepam T5
clorazepate dipotassium T5
DIASTAT T5
DIASTAT ACUDIAL T5
DIAZEPAM INTENSOL T5
diazepam oral solution 5 mg/5 ml (1 mg/ml) T5
diazepam oral tablet T5
lorazepam injection solution 4 mg/ml T5
lorazepam injection syringe T5
lorazepam oral T5
ONFI T5
Benzodiazepines (Anxiolytic,Sedativ/Hyp)
alprazolam T5
ALPRAZOLAM INTENSOL T5
amitriptyline-chlordiazepoxide T5
64
Drug Tier Notes
chlordiazepoxide hcl T5
chlordiazepoxide-clidinium T5
clonazepam T5
clorazepate dipotassium T5
DIASTAT T5
DIASTAT ACUDIAL T5
DIAZEPAM INTENSOL T5
diazepam oral solution 5 mg/5 ml (1 mg/ml) T5
diazepam oral tablet T5
DORAL T5
estazolam T5
flurazepam T5
lorazepam injection solution 4 mg/ml T5
lorazepam injection syringe T5
lorazepam oral T5
midazolam (pf) injection cartridge T5
midazolam oral syrup 2 mg/ml T5
ONFI T5
temazepam T5
triazolam T5
Butyrophenones
haloperidol T5
haloperidol decanoate T5
haloperidol lactate injection T5
haloperidol lactate oral T5
Catechol-O-Methyltransferase(Comt)Inhib.
COMTAN T5
STALEVO 100 T5
STALEVO 125 T5
STALEVO 150 T5
STALEVO 200 T5
STALEVO 50 T5
STALEVO 75 T5
TASMAR ORAL TABLET 100 MG T5
65
Drug Tier Notes
Central Nervous System Agents, Misc.
CAMPRAL T5
flumazenil T5
guanfacine oral tablet T5
INTUNIV ER T5
LODOSYN T5
NAMENDA T5
NAMENDA TITRATION PAK T5
NUEDEXTA T5
RILUTEK T5
STRATTERA T5
XENAZINE T5
XYREM T5
Cyclooxygenase-2 (Cox-2) Inhibitors
CELEBREX T5
Dopamine Precursors
carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg
T5
carbidopa-levodopa oral tablet extended release T5
carbidopa-levodopa oral tablet,disintegrating T5
STALEVO 100 T5
STALEVO 125 T5
STALEVO 150 T5
STALEVO 200 T5
STALEVO 50 T5
STALEVO 75 T5
Ergot-Deriv. Dopamine Receptor Agonists
bromocriptine T5
cabergoline T5
CYCLOSET T5
Fibromyalgia Agents
duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg
T5
LYRICA ORAL CAPSULE T5
66
Drug Tier Notes
SAVELLA T5
General Anesthetics, Miscellaneous
AMIDATE INTRAVENOUS SOLUTION T5
ketamine injection T5
propofol intravenous emulsion T5
Hydantoins
DILANTIN T5
fosphenytoin injection solution 100 mg pe/2 ml T5
PEGANONE T5
phenytoin oral suspension 125 mg/5 ml T5
phenytoin oral tablet,chewable T5
phenytoin sodium extended T5
phenytoin sodium intravenous solution T5
Monoamine Oxidase B Inhibitors
AZILECT T5
ELDEPRYL T5
EMSAM T5
selegiline hcl oral tablet T5
ZELAPAR T5
Monoamine Oxidase Inhibitors
AZILECT T5
ELDEPRYL T5
EMSAM T5
MARPLAN T5
NARDIL T5
selegiline hcl oral tablet T5
tranylcypromine T5
ZELAPAR T5
Nonergot-Deriv.Dopamine Receptor Agonist
APOKYN T5
MIRAPEX ER ORAL TABLET EXTENDED RELEASE 24 HR 0.375 MG, 0.75 MG, 1.5 MG, 3 MG, 4.5 MG
T5
pramipexole oral tablet T5
67
Drug Tier Notes
ropinirole T5
Opiate Agonists
ABSTRAL T5
acetaminophen-codeine oral solution 120-12 mg/5 ml
T5
acetaminophen-codeine oral tablet T5
alfentanil T5
ASCOMP WITH CODEINE T5
AVINZA T5
butalbital-acetaminop-caf-cod oral capsule 50-325-40-30 mg
T5
carisoprodol-aspirin-codeine T5
codeine sulfate oral tablet T5
DEMEROL (PF) INJECTION SOLUTION 100 MG/ML
T5
DEMEROL (PF) INJECTION SYRINGE 25 MG/ML, 75 MG/ML
T5
DEMEROL ORAL TABLET 50 MG T5
DEPODUR (PF) EPIDURAL SUSPENSION 10 MG/ML
T5
DILAUDID-HP (PF) INJECTION RECON SOLN T5
DISKETS T5
DOLOPHINE ORAL T5
ENDOCET ORAL TABLET 10-325 MG, 5-325 MG, 7.5-325 MG
T5
ENDODAN T5
EXALGO ER ORAL TABLET EXTENDED RELEASE 24 HR 12 MG, 16 MG, 8 MG
T5
fentanyl citrate (pf) injection solution T5
fentanyl citrate buccal lozenge on a handle T5
fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr
T5
FENTORA T5
hydrocodone-acetaminophen oral solution 7.5-325 mg/15 ml, 7.5-500 mg/15 ml
T5
68
Drug Tier Notes
hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg
T5
hydrocodone-ibuprofen oral tablet 2.5-200 mg, 5-200 mg, 7.5-200 mg
T5
hydromorphone (pf) injection solution 1 mg/ml, 2 mg/ml, 4 mg/ml
T5
hydromorphone oral liquid T5
hydromorphone oral tablet T5
hydromorphone rectal T5
ibuprofen-oxycodone T5
KADIAN ORAL CAPSULE,EXTEND.RELEASE PELLETS 10 MG, 200 MG
T5
levorphanol tartrate oral tablet 2 mg T5
MAGNACET T5
meperidine (pf) injection solution 50 mg/ml T5
meperidine injection cartridge T5
meperidine oral solution T5
meperidine oral tablet 100 mg T5
methadone injection solution T5
methadone oral concentrate T5
methadone oral solution T5
morphine injection solution 5 mg/ml T5
morphine injection syringe 15 mg/ml T5
morphine oral capsule,extend.release pellets 100 mg, 20 mg, 30 mg, 50 mg, 60 mg, 80 mg
T5
morphine oral tablet T5
morphine oral tablet extended release T5
NUCYNTA T5
opium tincture T5
oxycodone oral capsule T5
oxycodone oral tablet T5
oxycodone-acetaminophen oral tablet 2.5-325 mg T5
OXYCONTIN ORAL TABLET EXTENDED RELEASE 12 HR
T5
oxymorphone oral tablet T5
69
Drug Tier Notes
oxymorphone oral tablet extended release 12 hr 15 mg, 7.5 mg
T5
PRIMLEV T5
REPREXAIN ORAL TABLET 10-200 MG T5
REZIRA T5
ROXICET ORAL SOLUTION T5
SUFENTA T5
SYNALGOS-DC T5
tramadol oral tablet 50 mg T5
tramadol oral tablet extended release 24 hr T5
tramadol oral tablet, er multiphase 24 hr T5
tramadol-acetaminophen T5
TREZIX ORAL CAPSULE 356.4-30-16 MG T5
ULTIVA T5
XOLOX T5
ZAMICET T5
ZYDONE T5
Opiate Antagonists
naloxone injection solution T5
naloxone injection syringe T5
naltrexone T5
VIVITROL T5
Opiate Partial Agonists
BUPRENEX T5
buprenorphine hcl sublingual T5
buprenorphine-naloxone sublingual tablet T5
butorphanol tartrate T5
BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HOUR, 20 MCG/HOUR, 5 MCG/HOUR
T5
nalbuphine T5
pentazocine-naloxone T5
SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 8-2 MG
T5
TALWIN T5
70
Drug Tier Notes
ZUBSOLV SUBLINGUAL TABLET 1.4-0.36 MG, 5.7-1.4 MG
T5
Other Nonsteroidal Anti-Inflam. Agents
ARTHROTEC 50 T5
ARTHROTEC 75 T5
CALDOLOR INTRAVENOUS RECON SOLN 400 MG/4 ML (100 MG/ML)
T5
CAMBIA T5
CATAFLAM T5
CLINORIL T5
diclofenac sodium oral T5
diflunisal T5
etodolac T5
FELDENE T5
fenoprofen oral tablet T5
FLECTOR T5
flurbiprofen T5
hydrocodone-ibuprofen oral tablet 2.5-200 mg, 5-200 mg, 7.5-200 mg
T5
IBUPROFEN JR STRENGTH T1
ibuprofen oral capsule T5
ibuprofen oral suspension T1
ibuprofen oral tablet 100 mg, 200 mg T1
ibuprofen oral tablet 400 mg, 600 mg, 800 mg T5
ibuprofen-oxycodone T5
INDOCIN T5
indomethacin oral T5
INFANT'S IBUPROFEN T5
ketoprofen oral capsule 50 mg, 75 mg T5
ketoprofen oral capsule,ext rel. pellets 24 hr 200 mg
T5
ketorolac injection cartridge T5
ketorolac injection solution 30 mg/ml (1 ml) T5
ketorolac oral T5
meclofenamate T5
71
Drug Tier Notes
mefenamic acid T5
meloxicam T5
nabumetone T5
NALFON ORAL CAPSULE 400 MG T5
NAPRELAN CR T5
naproxen T5
naproxen sodium oral tablet 220 mg T1
naproxen sodium oral tablet 275 mg, 550 mg T5
NEOPROFEN (IBUPROFEN LYSN)(PF) T5
oxaprozin T5
PENNSAID TOPICAL DROPS T5
REPREXAIN ORAL TABLET 10-200 MG T5
sulindac oral tablet 150 mg T5
tolmetin T5
TREXIMET ORAL TABLET 85-500 MG T5
VIMOVO T5
VOLTAREN TOPICAL T5
ZIPSOR T5
ZORVOLEX T5
Phenothiazines
chlorpromazine T5
COMPRO T5
fluphenazine decanoate T5
fluphenazine hcl T5
perphenazine T5
perphenazine-amitriptyline T5
prochlorperazine edisylate injection solution 5 mg/ml
T5
prochlorperazine maleate T5
thioridazine T5
trifluoperazine T5
Respiratory And Cns Stimulants
ASCOMP WITH CODEINE T5
72
Drug Tier Notes
butalbital-acetaminop-caf-cod oral capsule 50-325-40-30 mg
T5
butalbital-acetaminophen-caff oral capsule 50-325-40 mg
T5
butalbital-acetaminophen-caff oral tablet 50-325-40 mg
T5
CONCERTA T5
DAYTRANA T5
dexmethylphenidate oral capsule,er biphasic 50-50 15 mg, 30 mg, 40 mg
T5
dexmethylphenidate oral tablet T5
FOCALIN XR ORAL CAPSULE,ER BIPHASIC 50-50 10 MG, 20 MG, 5 MG
T5
METADATE ER T5
METHYLIN ORAL TABLET,CHEWABLE T5
methylphenidate hcl oral capsule, er biphasic 30-70
T5
methylphenidate hcl oral capsule,er biphasic 50-50 20 mg, 30 mg, 40 mg
T5
methylphenidate hcl oral solution T5
methylphenidate hcl oral tablet T5
methylphenidate hcl oral tablet extended release 10 mg
T5
MIGRAINE FORMULA T1
QUILLIVANT XR T5
RITALIN LA ORAL CAPSULE,ER BIPHASIC 50-50 10 MG
T5
SYNALGOS-DC T5
TENSION HEADACHE RELIEF T1
Salicylates
AGGRENOX T5
ASCOMP WITH CODEINE T5
ASCRIPTIN T1
ASPER-FLEX T1
aspirin oral tablet T1
aspirin oral tablet,chewable T1
73
Drug Tier Notes
aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg
T1
aspirin rectal suppository 600 mg T1
BAYER PLUS EXTRA STRENGTH T1
carisoprodol-aspirin T5
carisoprodol-aspirin-codeine T5
choline,magnesium salicylate T5
EFFERVESCENT ANTACID T1
ENDODAN T5
HALFPRIN T2
MIGRAINE FORMULA T1
MUSCLE RUB (WITH CAMPHOR) T1
ORPHENADRINE COMPOUND-DS T5
SALONPAS TOPICAL ADHESIVE PATCH,MEDICATED
T1 QL (40 QY per 30 DYs); AL
salsalate T5
SYNALGOS-DC T5
THERA-GESIC TOPICAL CREAM 15-1 % T5
TRI-BUFFERED ASPIRIN T1
ULTRACIN T T1
Sel.Serotonin,Norepi Reuptake Inhibitor
duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg
T5
PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 100 MG, 50 MG
T5
SAVELLA T5
venlafaxine T5
Selective Serotonin Agonists
ALSUMA T5
AMERGE T5
AXERT T5
FROVA T5
IMITREX NASAL T5
MAXALT T5
MAXALT-MLT T5
74
Drug Tier Notes
RELPAX T5
sumatriptan succinate oral T5
sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml
T5
sumatriptan succinate subcutaneous pen injector 4 mg/0.5 ml
T5
sumatriptan succinate subcutaneous solution T5
SUMAVEL DOSEPRO SUBCUTANEOUS NEEDLE-FREE INJECTOR 6 MG/0.5 ML
T5
TREXIMET ORAL TABLET 85-500 MG T5
ZOMIG NASAL SPRAY,NON-AEROSOL 5 MG T5
ZOMIG ORAL T5
ZOMIG ZMT T5
Selective-Serotonin Reuptake Inhibitors
citalopram T5
escitalopram oxalate T5
fluoxetine oral capsule T5
fluoxetine oral capsule,delayed release(dr/ec) T5
fluoxetine oral solution T5
fluoxetine oral tablet 10 mg, 20 mg T5
fluvoxamine oral tablet T5
LUVOX CR T5
olanzapine-fluoxetine T5
paroxetine hcl oral tablet T5
paroxetine hcl oral tablet extended release 24 hr T5
PAXIL ORAL SUSPENSION T5
PEXEVA T5
SARAFEM ORAL TABLET 10 MG, 20 MG T5
sertraline T5
Serotonin Modulators
nefazodone T5
trazodone T5
VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)-20 MG (7)-40 MG (16)
T5
Succinimides
75
Drug Tier Notes
CELONTIN ORAL CAPSULE 300 MG T5
ethosuximide T5
Thioxanthenes
thiothixene T5
Tricyclics, Other Norepi-Ru Inhibitors
amitriptyline T5
amitriptyline-chlordiazepoxide T5
amoxapine T5
ANAFRANIL T5
desipramine T5
doxepin oral capsule T5
doxepin oral concentrate T5
imipramine hcl T5
imipramine pamoate T5
maprotiline T5
nortriptyline oral capsule T5
perphenazine-amitriptyline T5
protriptyline T5
SILENOR T5
SURMONTIL T5
Vesicular Monoamine Transport2 Inhibitor
XENAZINE T5
Wakefulness-Promoting Agents
NUVIGIL T5
PROVIGIL T5
Contraceptives (E.G. Foams, Devices)
Contraceptives (E.G. Foams, Devices)
AIMSCO LATEX CONDOM T1
CONDOMS-PREM LUBRICATED T1
GYNOL II T1
TODAY CONTRACEPTIVE SPONGE T2
VAGINAL CONTRACEPTIVE FILM T2
VAGINAL CONTRACEPTIVE FOAM T1
76
Drug Tier Notes
Devices
Devices
AMVISC T5
AMVISC PLUS T5
BIOTENE DRY MOUTH ORAL RINSE T2
BLOOD PRESSURE KIT T1 QL (1 EA per 5 yrs)
blood pressure kit med and lrg T1 QL (1 EA per 5 yrs)
blood pressure monitor T1 QL (1 EA per 5 yrs)
EUFLEXXA T5
HYPER-SAL INHALATION SOLUTION FOR NEBULIZATION 7 %
T5
ORTHOVISC T5
PROVISC T5
sodium chloride inhalation solution for nebulization 0.9 %, 10 %, 3 %
T5
SUPARTZ T5
SYNVISC T5
VISCOAT T5
Diagnostic Agents
Adrenocortical Insufficiency
ACTHAR H.P. T5
ACTHREL T5
CORTROSYN T5
cosyntropin intravenous T5
Allergenic Extracts (Diagnostic)
HONEY BEE TREATMENT T5
Diabetes Mellitus
TRUETEST TEST STRIPS T5
TRUETRACK TEST T5
Diagnostic Agents
GASTROMARK T5
Drug Hypersensitivity
PRE-PEN T5
77
Drug Tier Notes
Ketones
ACETEST T1
Kidney Function
mannitol 10 % T5
mannitol 20 % T5
mannitol 25 % intravenous solution T5
mannitol 5 % T5
Myasthenia Gravis
ENLON T5
ENLON-PLUS T5
neostigmine methylsulfate injection T5
Ocular Disorders
ALTAFLUOR T5
FLUORETS T5
MEMBRANEBLUE T5
Pituitary Function
ACTHREL T5
R-GENE 10 T5
Roentgenography And Other Imaging Agents
ENTERO VU ORAL PACKET T5
ESOPHO-CAT T5
E-Z-CAT DRY T5
E-Z-HD BARIUM T5
E-Z-PAQUE T5
GASTROGRAFIN T5
ISOVUE-300 T5
ISOVUE-M 300 T5
LIQUID E-Z PAQUE T5
LIQUID POLIBAR T5
MAXIBAR T5
MULTIHANCE T5
OMNIPAQUE 240 T5
OMNIPAQUE 300 T5
78
Drug Tier Notes
PROHANCE INTRAVENOUS SOLUTION T5
READI-CAT T5
READI-CAT 2 ORAL SUSPENSION 2.1 % (W/V), 2.0 % (W/W)
T5
TAGITOL V T5
VARIBAR THIN LIQUID T5
VISIPAQUE INTRAVENOUS SOLUTION 270 MG IODINE/ML
T5
VOLUMEN T5
Sugar
CLINITEST REAGENT T1
Electrolytic, Caloric, And Water Balance
Acidifying Agents
ammonium chloride T5
Alkalinizing Agents
CYTRA K CRYSTALS T5
EFFERVESCENT ANTACID T1
NEUT T5
potassium citrate oral tablet extended release 10 meq (1,080 mg), 5 meq (540 mg)
T5
sodium bicarbonate intravenous syringe 10 meq/10 ml (8.4 %), 4.2 % (0.5 meq/ml), 7.5 % (0.9 meq/ml)
T5
sodium citrate-citric acid T1 QL (120 ML per 1 day)
sodium lactate T5
TRICITRASOL T5
Ammonia Detoxicants
AMMONUL T5
BUPHENYL ORAL TABLET T5
CARBAGLU T5
KRISTALOSE T5
lactulose oral solution 10 gram/15 ml T5
LITHOSTAT T5
Caloric Agents
AMINOSYN 10 % T5
79
Drug Tier Notes
AMINOSYN 3.5 % T5
AMINOSYN 7 % T5
AMINOSYN 7 % WITH ELECTROLYTES T5
AMINOSYN 8.5 %-ELECTROLYTES T5
AMINOSYN II 15 % T5
AMINOSYN II 5%/DEXTROSE 25% T5
AMINOSYN II 8.5 % T5
AMINOSYN M 3.5 % T5
AMINOSYN-RF 5.2 % T5
BOOST ORAL LIQUID T3 PA
CLINIMIX 5%/D15W SULFITE FREE T5
CLINIMIX 5%/D25W SULFITE-FREE T5
CLINIMIX 2.75%/D5W SULFIT FREE T5
CLINIMIX 4.25%/D10W SULF FREE T5
CLINIMIX 4.25%/D5W SULFIT FREE T5
CLINIMIX 4.25%-D20W SULF-FREE T5
CLINIMIX 5%-D20W(SULFITE-FREE) T5
CLINIMIX E 2.75%/D10W SUL FREE T5
CLINIMIX E 2.75%/D5W SULF FREE T5
CLINIMIX E 4.25%/D25W SUL FREE T5
CLINIMIX E 4.25%/D5W SULF FREE T5
CLINIMIX E 5%/D15W SULFIT FREE T5
CLINIMIX E 5%/D20W SULFIT FREE T5
CLINIMIX E 5%/D25W SULFIT FREE T5
d10 %-0.45 % sodium chloride T5
d2.5 %-0.45 % sodium chloride T5
d5 % and 0.9 % sodium chloride T5
d5 %-0.45 % sodium chloride T5
dextrose 10 % and 0.2 % nacl T5
dextrose 10 % in water (d10w) T5
dextrose 25 % in water (d25w) T5
dextrose 30 % in water (d30w) T5
dextrose 40 % in water (d40w) T5
80
Drug Tier Notes
dextrose 5 % in water (d5w) intravenous parenteral solution
T5
dextrose 5%-0.2 % sod chloride T5
dextrose 5%-0.3 % sod.chloride T5
dextrose 50 % in water (d50w) intravenous parenteral solution
T5
dextrose 70 % in water (d70w) T5
ENFAMIL GLUCOSE T5
ENSURE MUSCLE HEALTH ORAL LIQUID 0.05-1.05 GRAM-KCAL/ML
T3 PA
ENSURE PLUS T3 PA
FREAMINE HBC 6.9 % T5
FREAMINE III 3 %-ELECTROLYTES T5
glucose oral tablet,chewable 4 gram T1
INTRALIPID INTRAVENOUS EMULSION 20 %, 30 %
T5
NEPHRAMINE 5.4 % T5
NEPRO CARB STEADY T3 PA
NUTRAMIGEN WITH ENFLORA LGG T3 PA
PEDIASURE ORAL LIQUID 0.03-1 GRAM-KCAL/ML
T3 PA
PKU 2 T3 PA
PKU TRIO T3 PA
POLYCOSE T5
PREMASOL 6 % T5
PROSOL 20 % T5
SIMILAC ALIMENTUM T3 PA
SIMILAC EXPERT CARE NEOSURE T3 PA
Carbonic Anhydrase Inhibitors
acetazolamide T5
acetazolamide sodium T5
Diuretics, Miscellaneous
ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML T5
THEO-24 T5
THEOCHRON T5
81
Drug Tier Notes
theophylline oral tablet extended release T5
Irrigating Solutions
acetic acid irrigation T5
DELFLEX-LC/1.5% DEXTROSE T5
DELFLEX-LC/2.5% DEXTROSE T5
DELFLEX-LC/4.25% DEXTROSE T5
DIANEAL LOW CALCIUM/1.5% DEX T5
DIANEAL PD-2 WITH 2.5 % DEX T5
DIANEAL PD-2 WITH 4.25 % DEX T5
DIANEAL WITH 2.5 % DEXTROSE T5
GLYCINE UROLOGIC T5
lactated ringers irrigation T5
PHYSIOLYTE T5
RENACIDIN IRRIGATION SOLUTION 6.602-0.198 GRAM/100 ML
T5
RESECTISOL T5
RIMSO-50 T5
ringer's irrigation T5
STERILE SALINE IRRIGATION T5
water for irrigation, sterile T5
Loop Diuretics
bumetanide T5
DEMADEX T5
furosemide injection syringe T5
furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml)
T5
furosemide oral tablet T5
SODIUM EDECRIN T5
torsemide intravenous solution 20 mg/2 ml (10 mg/ml)
T5
Osmotic Diuretics
mannitol 10 % T5
mannitol 20 % T5
mannitol 25 % intravenous solution T5
82
Drug Tier Notes
mannitol 5 % T5
Phosphate-Removing Agents
calcium acetate(phosphat bind) T5
FOSRENOL ORAL TABLET,CHEWABLE T5
RENAGEL T5
RENVELA ORAL POWDER IN PACKET T5
sevelamer carbonate oral tablet T5
Potassium-Removing Agents
KIONEX T5
KIONEX (WITH SORBITOL) T5
Potassium-Sparing Diuretics
ALDACTAZIDE ORAL TABLET 25-25 MG T5
amiloride T5
amiloride-hydrochlorothiazide T5
DYRENIUM T5
spironolactone T5
triamterene-hydrochlorothiazid oral capsule 37.5-25 mg
T5
triamterene-hydrochlorothiazid oral tablet T5
Replacement Preparations
ANTACID EXTRA-STRENGTH ORAL TABLET,CHEWABLE 168 MG CALCIUM (420 MG), 200 MG CALCIUM (500 MG)
T1
ATABEX EC T5
BAL-CARE DHA T5
B-NEXA T5
CALCI-CHEW T1
CALCI-MIX T2
CALCIONATE T2
CALCIUM 500 WITH D T1
CALCIUM 600 T1
CALCIUM 600 WITH VITAMIN D3 ORAL CAPSULE 600 MG(1,500MG) -400 UNIT
T1
CALCIUM ANTACID ORAL TABLET,CHEWABLE 300 MG (750 MG)
T1
83
Drug Tier Notes
CALCIUM ANTACID ULTRA MAX ST T1
calcium carbonate oral suspension T1
calcium carbonate oral tablet 260 mg calcium (648 mg), 500 mg calcium (1,250 mg)
T1
calcium carbonate-vitamin d2 T1
calcium carbonate-vitamin d3 oral tablet 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit
T1
calcium citrate-vitamin d3 oral tablet 200-125 mg-unit
T1
calcium gluconate oral tablet 45 mg (500 mg) T1
calcium lactate oral tablet 650 mg, 84 mg (648 mg)
T1
dextrose 5 % in ringer's T5
dextrose 5 %-lactated ringers T5
EFFER-K T5
electrolyte-48 in d5w T5
FLORICAL T5
FOLBECAL T5
FOLCAL DHA T5
HESPAN 6 % IN NS T5
HEXTEND T5
HYPERLYTE CR T5
HYPER-SAL INHALATION SOLUTION FOR NEBULIZATION 7 %
T5
IONOSOL-B IN D5W T5
IONOSOL-MB IN D5W T5
ISOLYTE M IN 5 % DEXTROSE T5
ISOLYTE S PH 7.4 T5
ISOLYTE-P IN 5 % DEXTROSE T5
ISOLYTE-S T5
KLOR-CON T5
KLOR-CON 8 T5
KLOR-CON M10 T5
KLOR-CON M15 T5
KLOR-CON M20 T5
84
Drug Tier Notes
KLOR-CON/25 T5
lactated ringers intravenous T5
LEVOMEFOLATEPNV T5
L-METHYLFOLATE PNV DHA T5
MACNATAL CN DHA T5
magnesium oral tablet 200 mg T1
MAGONATE T1
MARNATAL-F T5
MONOCAL T5
MYNATAL ORAL CAPSULE T5
MYNATAL PLUS T5
NATALVIRT CA T5
NATALVIT T5
NATELLE ONE T5
NORMOSOL-R T5
NORMOSOL-R IN 5 % DEXTROSE T5
NORMOSOL-R PH 7.4 T5
NUTRILYTE II T5
OB COMPLETE ONE T5
OB COMPLETE PREMIER T5
O-CAL PRENATAL T5
OS-CAL 500 + D3 ORAL TABLET 500 MG(1,250MG) -200 UNIT
T1
OYSCO 500/D ORAL TABLET,CHEWABLE T1
OYSTER SHELL + D3 T1
OYSTER SHELL CALCIUM-VIT D2 ORAL TABLET 250 (625)-125 MG-UNIT
T1
PARVA-CAL 500 T2
PEDIATRIC ELECTROLYTE ORAL SOLUTION
T1
PHOS-NAK T2
PLASMA-LYTE 148 T5
PLASMA-LYTE A T5
PLASMA-LYTE-56 IN 5 % DEXTROSE T5
potassium acetate T5
85
Drug Tier Notes
potassium bicarb and chloride T5
potassium chlorid-d5-0.45%nacl T5
potassium chloride in 0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l
T5
potassium chloride in 5 % dex intravenous parenteral solution 20 meq/l, 40 meq/l
T5
potassium chloride in lr-d5 T5
potassium chloride in water intravenous piggyback
T5
potassium chloride intravenous T5
potassium chloride oral liquid T5
potassium chloride oral tablet extended release 10 meq
T5
potassium chloride oral tablet extended release 20 meq
T1
potassium chloride-0.45 % nacl T5
potassium chloride-d5-0.2%nacl intravenous parenteral solution 20 meq/l
T5
potassium chloride-d5-0.3%nacl intravenous parenteral solution 20 meq/l
T5
potassium chloride-d5-0.9%nacl T5
potassium gluconate oral tablet 2.5 meq, 550 mg (90 mg)
T5
potassium phosphate m-/d-basic intravenous solution 3 mmol/ml
T5
PR NATAL 430 EC T5
PRENAISSANCE 90 DHA T5
PRENATABS FA T5
PRENATABS RX T5
PRENATAL LOW IRON T5
PRENATAL PLUS WITH IRON (CA) T5
PRENATAL VITAMIN ORAL TABLET 27 MG IRON- 0.8 MG
T1
PRENATAL VITAMIN PLUS LOW IRON T5
PROTECT NATAL T5
ringer's intravenous T5
RISACAL-D T1
86
Drug Tier Notes
SETONET T5
SETONET-EC T5
sodium acetate T5
sodium chloride 0.45 % intravenous parenteral solution
T5
sodium chloride 0.9 % intravenous parenteral solution
T5
sodium chloride 3 % T5
sodium chloride 5 % T5
sodium chloride inhalation solution for nebulization 0.9 %, 10 %, 3 %
T5
sodium chloride intravenous T5
sodium chloride oral T1
sodium phosphate T5
TARON-BC T5
THERA-M ORAL TABLET 9 MG IRON-400 MCG
T1
TRIADVANCE T5
TRINATAL ULTRA T5
TRINATE T5
TRIVEEN-DUO DHA T5
TRIVEEN-ONE T5
TRIVEEN-PRX RNF T5
ULTIMATECARE ONE NF T5
VENATAL COMPLETE DHA T5
VINATE AZ T5
VINATE DHA T5
VINATE ONE T5
VIRT-BAL DHA T5
VIRT-SELECT T5
VOLUVEN 6 % T5
VP-GGR-B6 T5
ZATEAN-CH T5
ZATEAN-PN PLUS T5
zinc gluconate oral T1
87
Drug Tier Notes
zinc sulfate oral T1
ZINC-15 T2
Thiazide Diuretics
ALDACTAZIDE ORAL TABLET 25-25 MG T5
amiloride-hydrochlorothiazide T5
AMTURNIDE T5
benazepril-hydrochlorothiazide T5
bisoprolol-hydrochlorothiazide T5
captopril-hydrochlorothiazide T5
chlorothiazide T5
chlorothiazide sodium T5
DIURIL T5
enalapril-hydrochlorothiazide T5
EXFORGE HCT T5
fosinopril-hydrochlorothiazide T5
hydrochlorothiazide T5
irbesartan-hydrochlorothiazide T5
lisinopril-hydrochlorothiazide T5
losartan-hydrochlorothiazide T5
methyclothiazide T5
metoprolol ta-hydrochlorothiaz T5
moexipril-hydrochlorothiazide T5
nadolol-bendroflumethiazide T5
propranolol-hydrochlorothiazid T5
quinapril-hydrochlorothiazide T5
TEKTURNA HCT T5
TEVETEN HCT T5
triamterene-hydrochlorothiazid oral capsule 37.5-25 mg
T5
triamterene-hydrochlorothiazid oral tablet T5
TRIBENZOR T5
valsartan-hydrochlorothiazide T5
Thiazide-Like Diuretics
atenolol-chlorthalidone T5
88
Drug Tier Notes
chlorthalidone oral tablet 25 mg, 50 mg T5
CLORPRES T5
indapamide T5
metolazone T5
Uricosuric Agents
probenecid T5
Vasopressin Antagonists
SAMSCA T5
Enzymes
Enzymes
ACTIVASE INTRAVENOUS RECON SOLN 50 MG
T5
ADAGEN T5
ALDURAZYME T5
CEREZYME T5
ELAPRASE T5
ELELYSO T5
ELITEK T5
FABRAZYME T5
HYLENEX T5
LUMIZYME T5
NAGLAZYME T5
PULMOZYME T5
RETAVASE INTRAVENOUS KIT T5
VITRASE T5
VPRIV T5
XIAFLEX T5
Eye, Ear, Nose And Throat (Eent) Preps.
Alpha-Adrenergic Agonists (Eent)
ALPHAGAN P T5
brimonidine ophthalmic (eye) drops 0.2 % T5
COMBIGAN T5
Antiallergic Agents
89
Drug Tier Notes
ALOCRIL T5
ASTELIN T5
ASTEPRO NASAL SPRAY,NON-AEROSOL T5
azelastine ophthalmic (eye) T5
BEPREVE T5
cromolyn nasal T1 AL
cromolyn ophthalmic (eye) T5
ELESTAT T5
ketotifen fumarate T1
LASTACAFT T5
PATADAY OPHTHALMIC (EYE) DROPS 0.2 % T5
PATANASE T5
PATANOL T5
Antibacterials (Eent)
AK-POLY-BAC T5
ALODOX T5
bacitracin ophthalmic (eye) T5
BACTROBAN NASAL T5
BESIVANCE T5
BLEPH-10 T5
BLEPHAMIDE T5
BLEPHAMIDE S.O.P. T5
CILOXAN T5
CIPRO HC T5
CIPRODEX T5
COLY-MYCIN S T5
doxycycline hyclate oral tablet 20 mg T5
erythromycin ophthalmic (eye) T5
GARAMYCIN OPHTHALMIC (EYE) OINTMENT
T5
GENTAK OPHTHALMIC (EYE) DROPS T5
levofloxacin ophthalmic (eye) T5
MAXITROL T5
neomycin-bacitracin-poly-hc T5
90
Drug Tier Notes
neomycin-bacitracin-polymyxin T5
neomycin-polymyxin-gramicidin T5
neomycin-polymyxin-hc T5
OCUFLOX T5
ofloxacin otic (ear) T5
polymyxin b sulf-trimethoprim T5
PRED-G T5
PRED-G S.O.P. T5
sulfacetamide-prednisolone T5
TOBRADEX T5
TOBRADEX ST T5
tobramycin T5
TOBREX OPHTHALMIC (EYE) OINTMENT T5
ZYLET T5
ZYMAXID T5
Antifungals (Eent)
NATACYN T5
Antivirals (Eent)
trifluridine T5
ZIRGAN T5
Beta-Adrenergic Blocking Agents (Eent)
BETAGAN OPHTHALMIC (EYE) DROPS 0.5 % T5
betaxolol ophthalmic (eye) T5
carteolol T5
COMBIGAN T5
COSOPT T5
ISTALOL T5
levobunolol ophthalmic (eye) drops 0.25 % T5
metipranolol T5
timolol maleate ophthalmic (eye) drops T5
timolol maleate ophthalmic (eye) gel forming solution
T5
Carbonic Anhydrase Inhibitors (Eent)
acetazolamide T5
91
Drug Tier Notes
acetazolamide sodium T5
COSOPT T5
dorzolamide T5
Corticosteroids (Eent)
ACETASOL HC T5
AERO OTIC HC T5
CIPRO HC T5
CIPRODEX T5
CORTANE-B AQUEOUS T5
DERMOTIC OIL T5
dexamethasone sodium phosphate ophthalmic (eye)
T5
DUREZOL T5
FLAREX T5
FLONASE T5
flunisolide nasal spray,non-aerosol 25 mcg (0.025 %)
T5
fluorometholone T5
FML S.O.P. T5
ILUVIEN T5
MAXITROL T5
neomycin-bacitracin-poly-hc T5
neomycin-polymyxin-hc ophthalmic (eye) T5
OMNARIS T5
OMNIPRED T5
OZURDEX T5
PRED MILD T5
PRED-G T5
PRED-G S.O.P. T5
prednisolone sodium phosphate ophthalmic (eye) T5
RETISERT T5
RHINOCORT ALLERGY T2 QL (8.43 ML per 30 days)
RHINOCORT AQUA T5
TOBRADEX T5
92
Drug Tier Notes
TOBRADEX ST T5
triamcinolone acetonide nasal T1 QL (16.9 ML per 30 days)
VERAMYST T5
VEXOL T5
ZYLET T5
Eent Anti-Infectives, Miscellaneous
ACETASOL HC T5
acetic acid otic (ear) T5
acetic acid-aluminum acetate T5
BETADINE OPHTHALMIC PREP T5
chlorhexidine gluconate mucous membrane T5
EAR WAX DROPS T1
OTICIN T5
Eent Anti-Inflammatory Agents, Misc.
RESTASIS T5
Eent Drugs, Miscellaneous
ALODOX T5
ALTALUBE T1
ARTIFICIAL TEARS (POLYVIN ALC) T1
ARTIFICIAL TEARS(DEXT70-HYPRO) OPHTHALMIC (EYE) DROPS
T1
BABY AYR SALINE T2
DEEP SEA NASAL T1 QL (90 QY per 30 DYs)
ENUCLENE T5
EYLEA INTRAVITREAL SOLUTION T5
HYPOTEARS T1
IOPIDINE OPHTHALMIC (EYE) DROPPERETTE
T5
ipratropium bromide nasal spray,non-aerosol 0.03 %
T1 QL (30 ML per 30 days)
ipratropium bromide nasal spray,non-aerosol 42 mcg (0.06 %)
T1 QL (15 ML per 30 days)
ISOPTO TEARS T2
JETREA (PF) INTRAVITREAL SOLUTION 0.5 MG/0.2 ML
T5
93
Drug Tier Notes
LACRISERT T5
LUBRICANT EYE OPHTHALMIC (EYE) OINTMENT 83-15 %
T1
LUCENTIS INTRAVITREAL SOLUTION T5
MACUGEN T5
MURO 128 OPHTHALMIC (EYE) DROPS 2 % T1
NATURE'S TEARS (HYPROMELLOSE) T1
PURE AND GENTLE EYE T1
REFRESH LIQUIGEL T2
sodium chloride ophthalmic (eye) T1
TEARS NATURALE FREE (PF) T1
THERATEARS OPHTHALMIC (EYE) DROPPERETTE,GEL
T1
THERATEARS OPHTHALMIC (EYE) DROPS T2
ULTRA FRESH T1
VISUDYNE T5
Eent Nonsteroidal Anti-Inflam. Agents
ACULAR T5
ACULAR LS T5
ACUVAIL (PF) T5
BROMDAY T5
bromfenac T5
diclofenac sodium ophthalmic (eye) T5
flurbiprofen sodium T5
NEVANAC T5
Local Anesthetics (Eent)
AKTEN (PF) T5
ALCAINE T5
ALTAFLUOR T5
cocaine T5
lidocaine hcl mucous membrane jelly T5
lidocaine hcl mucous membrane solution 4 % (40 mg/ml)
T5
LIDOCAINE VISCOUS T5
OTICIN T5
94
Drug Tier Notes
OTOZIN T5
PINNACAINE T5
TETCAINE T5
Miotics
ISOPTO CARBACHOL T5
PHOSPHOLINE IODIDE T5
pilocarpine hcl ophthalmic (eye) drops 1 %, 2 %, 4 %
T5
PILOPINE HS T5
Mydriatics
atropine ophthalmic (eye) drops T5
atropine ophthalmic (eye) ointment T5
CYCLOGYL OPHTHALMIC (EYE) DROPS 0.5 %, 2 %
T5
CYCLOMYDRIL T5
cyclopentolate ophthalmic (eye) drops 1 % T5
HOMATROPAIRE T5
ISOPTO HOMATROPINE OPHTHALMIC (EYE) DROPS 2 %
T5
ISOPTO HYOSCINE T5
tropicamide ophthalmic (eye) drops 1 % T5
Prostaglandin Analogs
latanoprost T5
LUMIGAN OPHTHALMIC (EYE) DROPS 0.01 %
T5
Vasoconstrictors
EYE ALLERGY RELIEF T1
naphazoline T5
phenylephrine hcl ophthalmic (eye) T5
TYZINE NASAL DROPS T5
Gastrointestinal Drugs
5-Ht3 Receptor Antagonists
ANZEMET INTRAVENOUS SOLUTION 100 MG/5 ML
T5
granisetron (pf) intravenous solution 100 mcg/ml T5
95
Drug Tier Notes
granisetron hcl intravenous solution 1 mg/ml (1 ml)
T5
granisetron hcl oral T5
GRANISOL T5
ondansetron T5
ondansetron hcl T5
ondansetron hcl (pf) injection solution T5
ZUPLENZ T5
Antacids And Adsorbents
aluminum hydroxide gel oral suspension 320 mg/5 ml
T1
alum-mag hydroxide-simeth oral suspension 200-200-20 mg/5 ml
T1
ANTACID ANTI-GAS ORAL SUSPENSION 400-400-40 MG/5 ML
T1
ANTACID EXTRA-STRENGTH ORAL TABLET,CHEWABLE 168 MG CALCIUM (420 MG), 200 MG CALCIUM (500 MG)
T1
CALCIUM ANTACID ORAL TABLET,CHEWABLE 300 MG (750 MG)
T1
CALCIUM ANTACID ULTRA MAX ST T1
calcium carbonate oral tablet 260 mg calcium (648 mg)
T1
EFFERVESCENT ANTACID T1
GAVISCON EXTRA STRENGTH ORAL SUSPENSION
T2
MAG-AL T2
magnesium oxide oral tablet 250 mg magnesium, 400 mg (241.3 mg magnesium)
T1
PEPTIC RELIEF ORAL TABLET,CHEWABLE T1
PINK BISMUTH ORAL SUSPENSION 262 MG/15 ML
T1
PINK BISMUTH ORAL TABLET T1
ROLAIDS T2
ROLAIDS EXTRA STRENGTH T2
sodium bicarbonate oral T1
STOMACH RELIEF MAX STRENGTH T1
96
Drug Tier Notes
Antidiarrhea Agents
ANTI-DIARRHEAL (LOPERAMIDE) ORAL TABLET
T1 QL (30 EA per 30 days)
diphenoxylate-atropine oral tablet T5
FULYZAQ T5
loperamide oral capsule T5
loperamide oral liquid 1 mg/5 ml T1 QL (150 ML per 30 days)
MOTOFEN T5
opium tincture T5
PEPTIC RELIEF ORAL TABLET,CHEWABLE T1
PINK BISMUTH ORAL SUSPENSION 262 MG/15 ML
T1
PINK BISMUTH ORAL TABLET T1
STOMACH RELIEF MAX STRENGTH T1
Antiemetics, Miscellaneous
ANTI-NAUSEA T1
CESAMET T5
dronabinol T5
TRANSDERM-SCOP T5
Antiflatulents
alum-mag hydroxide-simeth oral suspension 200-200-20 mg/5 ml
T1
ANTACID ANTI-GAS ORAL SUSPENSION 400-400-40 MG/5 ML
T1
BICARSIM T2
BICARSIM FORTE T1
simethicone oral capsule 180 mg T1
simethicone oral drops,suspension T1
simethicone oral tablet,chewable T1
Antihistamines (Gi Drugs)
COMPRO T5
dimenhydrinate oral T1
meclizine oral tablet 12.5 mg, 25 mg T1
meclizine oral tablet,chewable T1
97
Drug Tier Notes
prochlorperazine edisylate injection solution 5 mg/ml
T5
prochlorperazine maleate T5
TIGAN INTRAMUSCULAR T5
TIGAN ORAL CAPSULE 300 MG T5
Anti-Inflammatory Agents (Gi Drugs)
APRISO T5
ASACOL HD T5
AZULFIDINE T5
AZULFIDINE EN-TABS T5
balsalazide T5
CANASA T5
DELZICOL ORAL CAPSULE,DELAYED RELEASE(DR/EC)
T5
DIPENTUM T5
LIALDA T5
LOTRONEX T5
mesalamine rectal enema T5
mesalamine with cleansing wipe T5
SFROWASA T5
Antiulcer Agents And Acid Suppress.,Misc
HELIDAC T5
PYLERA T5
Cathartics And Laxatives
AMITIZA T5
ATABEX EC T5
bisacodyl T1
COLYTE WITH FLAVOR PACKS ORAL RECON SOLN 227.1-21.5-6.36 GRAM
T5
COMPLETE-RF PRENATAL T5
DAILY FIBER (PSYLLIUM-SUCROSE) ORAL POWDER 3.4 GRAM/12 GRAM
T1
docusate sodium oral capsule T1
docusate sodium oral tablet T1
ENEMA DISPOSABLE T1
98
Drug Tier Notes
FIBER SMOOTH T1
FOLCAL DHA T5
FOLIVANE-PRX DHA NF T5
GAVILYTE-G T5
GAVILYTE-N T5
GERI-MUCIL (ASPARTAME) T1
glycerin (adult) T1
glycerin (child) T1
GOLYTELY ORAL POWDER IN PACKET T5
HALFLYTELY-BISACODYL W-FLAV PK T5
karaya gum (bulk) T1
KONSYL (SUGAR) ORAL POWDER IN PACKET
T1
LAXATIVE (BISACODYL) ORAL TABLET T1
LO-SO PREP T5
MACNATAL CN DHA T5
magnesium citrate oral solution T1
MILK OF MAGNESIA T1
MINERAL OIL LAXATIVE T1
MOVIPREP T5
OBSTETRIX EC T5
OBTREX T5
OSMOPREP T5
peg 3350-electrolytes oral recon soln 240-22.72-6.72 -5.84 gram
T5
polyethylene glycol 3350 T1 QL (527 QY per 30 DYs)
PRENAISSANCE 90 DHA T5
PREQUE 10 T5
psyllium husk oral powder T1
SENNA ORAL SYRUP 8.8 MG/5 ML T1
SENNA ORAL TABLET T1
sennosides-docusate sodium T1
SILACE ORAL SYRUP T1
STOOL SOFTENER ORAL CAPSULE 50 MG T1
99
Drug Tier Notes
SUPREP BOWEL PREP KIT T5
TRICARE PRENATAL DHA ONE(DSS) T5
TRINATAL ULTRA T5
TRIVEEN-PRX RNF T5
VIRT-SELECT T5
VP-CH PLUS T5
ZATEAN-CH T5
Cholelitholytic Agents
CHENODAL T5
URSO FORTE T5
ursodiol oral capsule T5
ursodiol oral tablet 250 mg T5
Digestants
CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,000-38,000 -60,000 UNIT, 24,000-76,000 -120,000 UNIT, 6,000-19,000 -30,000 UNIT
T5
lactase T1
PANCRELIPASE 5000 T5
ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,000-34,000 -55,000 UNIT, 15,000-51,000 -82,000 UNIT, 20,000-68,000 -109,000 UNIT
T5
Emetics
ipecac T1
Gi Drugs, Miscellaneous
ALLI T2
CIMZIA T5
CIMZIA POWDER FOR RECONST T5
CIMZIA STARTER KIT T5
CULTURELLE KIDS PROBIOTICS ORAL POWDER IN PACKET
T2
CULTURELLE ORAL CAPSULE, SPRINKLE T2
ENTEREG T5
HUMIRA PEN T5
100
Drug Tier Notes
HUMIRA SUBCUTANEOUS SYRINGE KIT 20 MG/0.4 ML
T5
PROBIOTIC (S.BOULARDII) T1
RELISTOR SUBCUTANEOUS KIT T5
RELISTOR SUBCUTANEOUS SOLUTION T5
REMICADE T5
SIMPONI SUBCUTANEOUS PEN INJECTOR T5
VSL#3 ORAL CAPSULE T3 PA
XENICAL T5
Histamine H2-Antagonists
ACID REDUCER (FAMOTIDINE) ORAL TABLET 20 MG
T1
AXID ORAL SOLUTION T5
cimetidine hcl T5
cimetidine oral tablet 200 mg T1
cimetidine oral tablet 300 mg, 400 mg, 800 mg T5
famotidine (pf)-nacl (iso-os) T5
famotidine intravenous solution T5
famotidine oral suspension T5
famotidine oral tablet 10 mg T1
famotidine oral tablet 40 mg T5
nizatidine oral capsule T5
ranitidine hcl injection solution 25 mg/ml T5
ranitidine hcl oral capsule T5
ranitidine hcl oral syrup T5
ranitidine hcl oral tablet 150 mg, 75 mg T1
ranitidine hcl oral tablet 300 mg T5
Neurokinin-1 Receptor Antagonists
EMEND ORAL CAPSULE T5
EMEND ORAL CAPSULE,DOSE PACK T5
Prokinetic Agents
metoclopramide hcl injection solution T5
metoclopramide hcl oral solution T5
metoclopramide hcl oral tablet T5
101
Drug Tier Notes
METOZOLV ODT ORAL TABLET,DISINTEGRATING 5 MG
T5
Prostaglandins
ARTHROTEC 50 T5
ARTHROTEC 75 T5
misoprostol T5
Protectants
CARAFATE ORAL SUSPENSION T5
sucralfate oral tablet T5
Proton-Pump Inhibitors
ACIPHEX T5
ACIPHEX SPRINKLE T5
DEXILANT T5
lansoprazole oral capsule,delayed release(dr/ec) T5
NEXIUM T5
NEXIUM IV T5
NEXIUM PACKET ORAL GRANULES DR FOR SUSP IN PACKET 10 MG, 20 MG, 40 MG
T5
OMECLAMOX-PAK T5
omeprazole oral capsule,delayed release(dr/ec) T5
omeprazole oral tablet,delayed release (dr/ec) T5
omeprazole-sodium bicarbonate oral capsule T5
pantoprazole T5
PREVACID SOLUTAB T5
PREVPAC T5
PRILOSEC ORAL SUSP,DELAYED RELEASE FOR RECON
T5
PROTONIX ORAL GRANULES DR FOR SUSP IN PACKET
T5
VIMOVO T5
ZEGERID ORAL PACKET 20-1,680 MG T5
Gold Compounds
Gold Compounds
RIDAURA T5
102
Drug Tier Notes
Heavy Metal Antagonists
Heavy Metal Antagonists
CHEMET T5
CUPRIMINE T5
deferoxamine T5
DEPEN TITRATABS T5
EXJADE T5
SYPRINE T5
Hormones And Synthetic Substitutes
Adrenals
ADVAIR DISKUS T5
ADVAIR HFA T5
A-HYDROCORT T5
ALVESCO T5
A-METHAPRED T5
ARISTOSPAN INTRA-ARTICULAR T5
ARISTOSPAN INTRALESIONAL T5
ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 110 MCG/ ACTUATION (30), 220 MCG/ ACTUATION (14)
T5
BAYCADRON T5
betamethasone acet,sod phos T5
budesonide-formoterol T5
CELESTONE T5
CORTEF T5
cortisone T5
DEPO-MEDROL INJECTION SUSPENSION 20 MG/ML
T5
DEXAMETHASONE INTENSOL T5
dexamethasone oral solution T5
dexamethasone oral tablet T5
dexamethasone sodium phosphate injection solution
T5
DEXPAK 10 DAY T5
103
Drug Tier Notes
DULERA INHALATION HFA AEROSOL INHALER 100-5 MCG/ACTUATION, 200-5 MCG/ACTUATION
T5
ENTOCORT EC T5
FLOVENT DISKUS T5
FLOVENT HFA T5
fludrocortisone T5
KENALOG INJECTION T5
MEDROL ORAL TABLET 2 MG T5
methylprednisolone T5
methylprednisolone acetate T5
methylprednisolone sodium succ intravenous recon soln 1,000 mg
T5
MILLIPRED T5
MILLIPRED DP ORAL TABLETS,DOSE PACK 5 MG (21 TABS)
T5
ORAPRED ODT T5
prednisolone oral solution 15 mg/5 ml T5
prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml)
T5
prednisone T5
PREDNISONE INTENSOL T5
PULMICORT FLEXHALER T5
PULMICORT INHALATION SUSPENSION FOR NEBULIZATION 1 MG/2 ML
T5
QVAR T5
SOLU-CORTEF ACT-O-VIAL (PF) INJECTION RECON SOLN 1,000 MG/8 ML, 250 MG/2 ML, 500 MG/4 ML
T5
SOLU-MEDROL INTRAVENOUS RECON SOLN 2 GRAM
T5
VERIPRED 20 T5
Alpha-Glucosidase Inhibitors
acarbose T5
GLYSET T5
Amylinomimetics
104
Drug Tier Notes
SYMLINPEN 120 T5
Androgens
ANADROL-50 T5
ANDRODERM T5
ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP
T5
ANDROGEL TRANSDERMAL GEL IN PACKET 1 % (25 MG/2.5GRAM), 1.62 % (20.25 MG/1.25 GRAM), 1.62 % (40.5 MG/2.5 GRAM)
T5
ANDROID T5
ANDROXY T5
AXIRON T5
COVARYX T5
COVARYX H.S. T5
danazol T5
DEPO-TESTOSTERONE T5
FORTESTA T5
METHITEST T5
OXANDRIN T5
STRIANT T5
TESTOPEL T5
testosterone enanthate T5
Antidiabetic Agents, Miscellaneous
WELCHOL T5
Antiestrogens
anastrozole T5
AROMASIN T5
letrozole T5
Antigonadtropins
CETROTIDE SUBCUTANEOUS KIT 0.25 MG T5
FIRMAGON T5
ganirelix T5
Antihypoglycemic Agents, Miscellaneous
PROGLYCEM T5
105
Drug Tier Notes
Antiparathyroid Agents
calcitonin (salmon) T5
MIACALCIN INJECTION T5
SENSIPAR T5
Antithyroid Agents
IODOPEN T5
methimazole oral tablet 10 mg, 5 mg T5
propylthiouracil T5
SSKI T5
THYROSHIELD T5
Biguanides
ACTOPLUS MET XR T5
AVANDAMET T5
glipizide-metformin T5
GLUMETZA T5
glyburide-metformin T5
JANUMET T5
JENTADUETO T5
KOMBIGLYZE XR T5
metformin oral tablet T5
metformin oral tablet extended release 24 hr T5
metformin oral tablet extended release 24hr T5
PRANDIMET T5
Contraceptives
ALTAVERA (28) T5
AMETHYST (28) T5
APRI T5
ARANELLE (28) T5
AVIANE T5
AZURETTE (28) T5
BALZIVA (28) T5
BEYAZ T5
BREVICON (28) T5
106
Drug Tier Notes
CAMILA T5
CAZIANT (28) T5
CRYSELLE (28) T5
CYCLAFEM 1/35 (28) T5
CYCLAFEM 7/7/7 (28) T5
ELLA T5
ENPRESSE T5
ESTROSTEP FE-28 T5
FEMCON FE T5
GIANVI (28) T5
GILDESS FE 1.5/30 (28) T5
GILDESS FE 1/20 (28) T5
IMPLANON T5
INTROVALE T5
JUNEL 1.5/30 (21) T5
JUNEL 1/20 (21) T5
KELNOR 1/35 (28) T5
levonorgestrel oral tablet 0.75 mg T5
LO LOESTRIN FE T5
LOSEASONIQUE T5
MIRENA T5
MONONESSA (28) T5
NATAZIA T5
NECON 1/50 (28) T5
NECON 10/11 (28) T5
NEXT CHOICE ONE DOSE T5
NUVARING T5
OCELLA T5
OGESTREL (28) T5
ORTHO TRI-CYCLEN (28) T5
ORTHO TRI-CYCLEN LO (28) T5
SAFYRAL T5
SEASONIQUE T5
XULANE T5
107
Drug Tier Notes
ZOVIA 1/50E (28) T5
Dipeptidyl Peptidase-4(Dpp-4) Inhibitors
JANUMET T5
JANUVIA T5
JENTADUETO T5
KOMBIGLYZE XR T5
ONGLYZA T5
Estrogen Agonist-Antagonists
EVISTA T5
FARESTON T5
tamoxifen T5
Estrogens
ACTIVELLA T5
ALORA T5
ANGELIQ ORAL TABLET 0.5-1 MG T5
CENESTIN T5
CLIMARA PRO T5
COMBIPATCH T5
COVARYX T5
COVARYX H.S. T5
DEPO-ESTRADIOL T5
DIVIGEL TRANSDERMAL GEL IN PACKET 0.25 MG/0.25 GRAM (0.1 %)
T5
ELESTRIN T5
ENJUVIA T5
ESTRACE VAGINAL T5
estradiol oral T5
estradiol transdermal patch weekly T5
estradiol vaginal tablet T5
estradiol valerate T5
ESTRASORB T5
ESTRING T5
ESTROGEL T5
estropipate T5
108
Drug Tier Notes
EVAMIST T5
FEMHRT LOW DOSE T5
FEMRING T5
JINTELI T5
MENEST T5
MENOSTAR T5
PREFEST T5
PREMARIN T5
PREMPHASE T5
PREMPRO T5
VIVELLE-DOT TRANSDERMAL PATCH SEMIWEEKLY 0.0375 MG/24 HR
T5
Glycogenolytic Agents
GLUCAGEN HYPOKIT T5
GLUCAGON EMERGENCY KIT (HUMAN) T5
Gonadotropins
BRAVELLE T5
chorionic gonadotropin, human intramuscular T5
ELIGARD T5
ELIGARD (3 MONTH) T5
ELIGARD (4 MONTH) T5
ELIGARD (6 MONTH) T5
FOLLISTIM AQ T5
GONAL-F T5
GONAL-F RFF T5
GONAL-F RFF PEN SUBCUTANEOUS PEN INJECTOR 300/0.5 UNIT/ML
T5
leuprolide subcutaneous kit T5
LUPRON DEPOT T5
LUPRON DEPOT (3 MONTH) T5
LUPRON DEPOT (4 MONTH) T5
LUPRON DEPOT-PED T5
MENOPUR T5
OVIDREL T5
109
Drug Tier Notes
REPRONEX T5
SUPPRELIN LA T5
SYNAREL T5
TRELSTAR INTRAMUSCULAR SYRINGE T5
VANTAS T5
ZOLADEX T5
Gonadotropins And Antigonadotropins
BRAVELLE T5
chorionic gonadotropin, human intramuscular T5
ELIGARD T5
ELIGARD (3 MONTH) T5
ELIGARD (4 MONTH) T5
ELIGARD (6 MONTH) T5
FOLLISTIM AQ T5
GONAL-F T5
GONAL-F RFF T5
GONAL-F RFF PEN SUBCUTANEOUS PEN INJECTOR 300/0.5 UNIT/ML
T5
leuprolide subcutaneous kit T5
LUPRON DEPOT T5
LUPRON DEPOT (3 MONTH) T5
LUPRON DEPOT (4 MONTH) T5
LUPRON DEPOT-PED T5
MENOPUR T5
OVIDREL T5
REPRONEX T5
SUPPRELIN LA T5
SYNAREL T5
VANTAS T5
ZOLADEX T5
Incretin Mimetics
BYETTA T5
VICTOZA 2-PAK T5
Insulins
110
Drug Tier Notes
APIDRA SOLOSTAR U-100 INSULIN T5
APIDRA U-100 INSULIN T5
HUMALOG MIX 50-50 KWIKPEN T5
HUMALOG MIX 75-25 KWIKPEN T5
HUMALOG U-100 INSULIN SUBCUTANEOUS CARTRIDGE
T5
HUMULIN 70/30 INSULIN PEN T5
HUMULIN N PEN T5
HUMULIN R REGULAR U-100 INSULN T5
HUMULIN R U-500 (CONC) INSULIN T5
LANTUS SOLOSTAR U-100 INSULIN T5
LEVEMIR U-100 INSULIN T5
NOVOLOG MIX 70-30FLEXPEN U-100 T5
NOVOLOG PENFILL U-100 INSULIN T5
Intermediate-Acting Insulins
HUMALOG MIX 50-50 KWIKPEN T5
HUMALOG MIX 75-25 KWIKPEN T5
HUMULIN 70/30 INSULIN PEN T5
HUMULIN N PEN T5
NOVOLOG MIX 70-30FLEXPEN U-100 T5
Long-Acting Insulins
LANTUS SOLOSTAR U-100 INSULIN T5
LEVEMIR U-100 INSULIN T5
Meglitinides
nateglinide T5
PRANDIMET T5
PRANDIN ORAL TABLET 0.5 MG T5
repaglinide oral tablet 1 mg, 2 mg T5
Parathyroid Agents
FORTEO T5
Parathyroid And Antiparathyroid Agents
calcitonin (salmon) T5
FORTEO T5
MIACALCIN INJECTION T5
111
Drug Tier Notes
Pituitary
ACTHAR H.P. T5
DDAVP T5
desmopressin nasal spray,non-aerosol T5
GENOTROPIN T5
GENOTROPIN MINIQUICK T5
HUMATROPE T5
NORDITROPIN FLEXPRO SUBCUTANEOUS PEN INJECTOR 10 MG/1.5 ML (6.7 MG/ML), 15 MG/1.5 ML (10 MG/ML)
T5
NORDITROPIN NORDIFLEX T5
NUTROPIN T5
NUTROPIN AQ NUSPIN SUBCUTANEOUS PEN INJECTOR 10 MG/2 ML (5 MG/ML), 5 MG/2 ML (2.5 MG/ML)
T5
NUTROPIN AQ SUBCUTANEOUS CARTRIDGE 20 MG/2 ML (10 MG/ML)
T5
OMNITROPE SUBCUTANEOUS CARTRIDGE 5 MG/1.5 ML (3.3 MG/ML)
T5
OMNITROPE SUBCUTANEOUS RECON SOLN
T5
PITRESSIN T5
SAIZEN CLICK.EASY T5
SAIZEN SUBCUTANEOUS RECON SOLN 5 MG
T5
SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG, 5 MG, 6 MG
T5
STIMATE T5
ZORBTIVE T5
Progestins
ACTIVELLA T5
ANGELIQ ORAL TABLET 0.5-1 MG T5
AYGESTIN T5
COMBIPATCH T5
CRINONE T5
DEPO-PROVERA INTRAMUSCULAR SUSPENSION
T5
112
Drug Tier Notes
DEPO-SUBQ PROVERA 104 T5
ENDOMETRIN T5
FEMHRT LOW DOSE T5
JINTELI T5
MAKENA INTRAMUSCULAR OIL 250 MG/ML
T5
medroxyprogesterone oral T5
MEGACE ES T5
megestrol oral suspension 400 mg/10 ml (40 mg/ml)
T5
megestrol oral tablet T5
progesterone T5
PROMETRIUM T5
Rapid-Acting Insulins
APIDRA SOLOSTAR U-100 INSULIN T5
APIDRA U-100 INSULIN T5
HUMALOG MIX 50-50 KWIKPEN T5
HUMALOG MIX 75-25 KWIKPEN T5
HUMALOG U-100 INSULIN SUBCUTANEOUS CARTRIDGE
T5
NOVOLOG MIX 70-30FLEXPEN U-100 T5
NOVOLOG PENFILL U-100 INSULIN T5
Short-Acting Insulins
HUMULIN 70/30 INSULIN PEN T5
HUMULIN R REGULAR U-100 INSULN T5
HUMULIN R U-500 (CONC) INSULIN T5
Somatostatin Agonists
octreotide acetate injection solution T5
SANDOSTATIN LAR DEPOT INTRAMUSCULAR KIT
T5
SOMATULINE DEPOT T5
Somatotropin Agonists
INCRELEX T5
Somatotropin Antagonists
113
Drug Tier Notes
SOMAVERT SUBCUTANEOUS RECON SOLN 10 MG, 15 MG, 20 MG
T5
Sulfonylureas
AVANDARYL T5
chlorpropamide T5
DIABETA T5
DUETACT T5
glimepiride T5
glipizide T5
glipizide-metformin T5
glyburide micronized T5
glyburide-metformin T5
tolazamide T5
Thiazolidinediones
ACTOPLUS MET XR T5
AVANDAMET T5
AVANDARYL T5
AVANDIA T5
DUETACT T5
pioglitazone T5
Thyroid Agents
ARMOUR THYROID T5
CYTOMEL T5
levothyroxine oral T5
liothyronine intravenous T5
NATURE-THROID ORAL TABLET 130 MG, 16.25 MG, 195 MG, 260 MG, 32.5 MG, 325 MG, 65 MG, 97.5 MG
T5
THYROLAR-1 T5
THYROLAR-1/2 T5
THYROLAR-1/4 T5
THYROLAR-2 T5
THYROLAR-3 T5
114
Drug Tier Notes
TIROSINT ORAL CAPSULE 100 MCG, 112 MCG, 125 MCG, 13 MCG, 137 MCG, 150 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG
T5
Local Anesthetics (Parenteral)
Local Anesthetics (Parenteral)
bupivacaine T5
bupivacaine (pf) injection solution T5
bupivacaine-dextrose-water(pf) T5
bupivacaine-epinephrine (pf) T5
CARBOCAINE (PF) T5
CARBOCAINE INJECTION SOLUTION T5
chloroprocaine (pf) T5
lidocaine (pf) in d7.5w T5
lidocaine (pf) injection solution T5
lidocaine hcl injection solution 10 mg/ml (1 %), 5 mg/ml (0.5 %)
T5
lidocaine-epinephrine (pf) T5
lidocaine-epinephrine injection solution 0.5 %-1:200,000, 1 %-1:100,000, 2 %-1:100,000
T5
NAROPIN (PF) T5
NESACAINE INJECTION SOLUTION 10 MG/ML (1 %)
T5
PONTOCAINE (PF) T5
SENSORCAINE-EPINEPHRINE T5
SENSORCAINE-MPF/EPINEPHRINE INJECTION SOLUTION 0.75 %-1:200,000
T5
XYLOCAINE-MPF/EPINEPHRINE INJECTION SOLUTION 1 %-1:200,000
T5
Miscellaneous Therapeutic Agents
5-Alpha-Reductase Inhibitors
AVODART T5
finasteride oral tablet 5 mg T5
JALYN T5
Alcohol Deterrents
disulfiram T5
115
Drug Tier Notes
naltrexone T5
VIVITROL T5
Antidotes
amyl nitrite inhalation solution 0.3 ml T5
ATROPEN INTRAMUSCULAR PEN INJECTOR 0.5 MG/0.7 ML, 1 MG/0.7 ML, 2 MG/0.7 ML
T5
CHEMET T5
CROFAB T5
deferoxamine T5
DIGIFAB T5
flumazenil T5
fomepizole T5
FOSRENOL ORAL TABLET,CHEWABLE T5
FUSILEV T5
GLUCAGEN HYPOKIT T5
GLUCAGON EMERGENCY KIT (HUMAN) T5
KIONEX T5
KIONEX (WITH SORBITOL) T5
leucovorin calcium injection recon soln T5
leucovorin calcium injection solution 500 mg/50 ml
T5
leucovorin calcium oral T5
magnesium sulfate in d5w intravenous piggyback 1 gram/100 ml
T5
magnesium sulfate in water intravenous parenteral solution 20 gram/500 ml (4 %)
T5
magnesium sulfate in water intravenous piggyback 4 gram/50 ml (8 %)
T5
magnesium sulfate injection syringe T5
MEPHYTON T2
methylene blue (antidote) T5
naloxone injection solution T5
naloxone injection syringe T5
physostigmine salicylate T5
protamine T5
116
Drug Tier Notes
PROTOPAM CHLORIDE T5
RENAGEL T5
RENVELA ORAL POWDER IN PACKET T5
sevelamer carbonate oral tablet T5
sodium thiosulfate intravenous solution 1 gram/10 ml (100 mg/ml), 12.5 gram/50 ml (250 mg/ml)
T5
SSKI T5
THYROSHIELD T5
Antigout Agents
allopurinol T5
allopurinol sodium T5
COLCRYS T5
INDOCIN T5
indomethacin oral T5
KRYSTEXXA T5
NAPRELAN CR T5
naproxen T5
naproxen sodium oral tablet 220 mg T1
naproxen sodium oral tablet 275 mg, 550 mg T5
probenecid T5
ULORIC T5
Bone Anabolic Agents
FORTEO T5
Bone Resorption Inhibitors
ACTONEL T5
alendronate oral tablet T5
ATELVIA T5
BONIVA INTRAVENOUS T5
calcitonin (salmon) T5
etidronate disodium T5
EVISTA T5
FOSAMAX PLUS D T5
ibandronate intravenous solution T5
ibandronate oral T5
117
Drug Tier Notes
MIACALCIN INJECTION T5
pamidronate T5
PROLIA T5
RECLAST T5
SKELID T5
XGEVA T5
ZOMETA INTRAVENOUS SOLUTION T5
Cariostatic Agents
FLUORABON T5
FLUOR-A-DAY T5
FLUOR-A-DAY (WITH XYLITOL) T5
fluoride (sodium) oral drops T5
fluoride (sodium) oral tablet,chewable 0.5 mg (1.1 mg sodium fluorid)
T5
FLUORIDEX DAILY DEFENSE DENTAL GEL T5
FLURA-DROPS T5
TRIPLE VITAMIN WITH FLUORIDE T5
Complement Inhibitors
BERINERT INTRAVENOUS KIT T5
CINRYZE T5
FIRAZYR T5
KALBITOR T5
SOLIRIS T5
Disease-Modifying Antirheumatic Agents
ACTEMRA INTRAVENOUS SOLUTION 200 MG/10 ML (20 MG/ML), 80 MG/4 ML (20 MG/ML)
T5
ACTEMRA SUBCUTANEOUS T5
ARAVA T5
AZASAN T5
azathioprine T5
azathioprine sodium T5
AZULFIDINE T5
AZULFIDINE EN-TABS T5
118
Drug Tier Notes
CIMZIA T5
CIMZIA POWDER FOR RECONST T5
CIMZIA STARTER KIT T5
CUPRIMINE T5
cyclosporine intravenous T5
cyclosporine modified T5
cyclosporine oral capsule T5
DEPEN TITRATABS T5
ENBREL SUBCUTANEOUS RECON SOLN T5
ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5 ML (0.5)
T5
HUMIRA PEN T5
HUMIRA SUBCUTANEOUS SYRINGE KIT 20 MG/0.4 ML
T5
hydroxychloroquine T5
KINERET T5
methotrexate sodium T5
methotrexate sodium (pf) T5
ORENCIA (WITH MALTOSE) T5
OTEZLA T5
OTEZLA STARTER ORAL TABLETS,DOSE PACK 10 MG (4)-20 MG (4)-30 MG(19)
T5
REMICADE T5
RHEUMATREX T5
RIDAURA T5
SANDIMMUNE ORAL SOLUTION T5
SIMPONI SUBCUTANEOUS PEN INJECTOR T5
STELARA SUBCUTANEOUS SYRINGE T5
TREXALL T5
Gonadotropin-Releasing Hormone Antagnts
CETROTIDE SUBCUTANEOUS KIT 0.25 MG T5
FIRMAGON T5
ganirelix T5
Immunomodulatory Agents
119
Drug Tier Notes
ACTEMRA INTRAVENOUS SOLUTION 200 MG/10 ML (20 MG/ML), 80 MG/4 ML (20 MG/ML)
T5
ACTEMRA SUBCUTANEOUS T5
ACTIMMUNE T5
ARAVA T5
AVONEX (WITH ALBUMIN) T5
AVONEX INTRAMUSCULAR SYRINGE KIT T5
AZASAN T5
azathioprine T5
azathioprine sodium T5
AZULFIDINE T5
AZULFIDINE EN-TABS T5
BETASERON SUBCUTANEOUS KIT T5
CIMZIA T5
CIMZIA POWDER FOR RECONST T5
CIMZIA STARTER KIT T5
COPAXONE SUBCUTANEOUS SYRINGE T5
cyclosporine intravenous T5
cyclosporine modified T5
cyclosporine oral capsule T5
ENBREL SUBCUTANEOUS RECON SOLN T5
ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5 ML (0.5)
T5
GILENYA ORAL CAPSULE 0.5 MG T5
HUMIRA PEN T5
HUMIRA SUBCUTANEOUS SYRINGE KIT 20 MG/0.4 ML
T5
hydroxychloroquine T5
INTRON A INJECTION T5
KINERET T5
methotrexate sodium T5
methotrexate sodium (pf) T5
ORENCIA (WITH MALTOSE) T5
OTEZLA T5
120
Drug Tier Notes
OTEZLA STARTER ORAL TABLETS,DOSE PACK 10 MG (4)-20 MG (4)-30 MG(19)
T5
POMALYST T5
PROLEUKIN T5
REBIF (WITH ALBUMIN) T5
REBIF REBIDOSE T5
REBIF TITRATION PACK T5
REMICADE T5
REVLIMID ORAL CAPSULE 10 MG, 15 MG, 25 MG, 5 MG
T5
RHEUMATREX T5
RIDAURA T5
SANDIMMUNE ORAL SOLUTION T5
SIMPONI SUBCUTANEOUS PEN INJECTOR T5
STELARA SUBCUTANEOUS SYRINGE T5
THALOMID T5
TREXALL T5
TYSABRI T5
Immunosuppressive Agents
ASTAGRAF XL T5
ATGAM T5
AZASAN T5
azathioprine T5
azathioprine sodium T5
BENLYSTA INTRAVENOUS T5
CELLCEPT T5
CELLCEPT INTRAVENOUS T5
cyclophosphamide intravenous T5
cyclophosphamide oral tablet T5
cyclosporine intravenous T5
cyclosporine modified T5
cyclosporine oral capsule T5
ELIDEL T5
mercaptopurine T5
121
Drug Tier Notes
methotrexate sodium T5
methotrexate sodium (pf) T5
mycophenolate sodium T5
PROGRAF INTRAVENOUS T5
PROGRAF ORAL CAPSULE T5
RAPAMUNE T5
RHEUMATREX T5
SANDIMMUNE ORAL SOLUTION T5
SIMULECT T5
THYMOGLOBULIN T5
TREXALL T5
ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG
T5
Other Miscellaneous Therapeutic Agents
acetylcysteine T5
AMPYRA T5
ARCALYST T5
BOTOX T5
BOTOX COSMETIC T5
CARNITOR INTRAVENOUS T5
CARNITOR ORAL TABLET T5
CARTICEL T5
CYSTADANE T5
CYSTAGON T5
DEMSER T5
DYSPORT T5
ethanol (ethyl alcohol) T5
HONEY BEE TREATMENT T5
KUVAN ORAL POWDER IN PACKET 100 MG T5
KUVAN ORAL TABLET,SOLUBLE T5
levocarnitine (with sugar) T5
melatonin oral liquid 5 mg/15 ml T1
melatonin oral tablet 1 mg, 3 mg, 5 mg T1
melatonin oral tablet,disintegrating 3 mg, 5 mg T1
122
Drug Tier Notes
MYOBLOC INTRAMUSCULAR SOLUTION 10,000 UNIT/2 ML
T5
octreotide acetate injection solution T5
OCUVITE LUTEIN AND ZEAXANTHIN T2
ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG
T5
PANHEMATIN INTRAVENOUS RECON SOLN 313 MG
T5
REMICADE T5
SANDOSTATIN LAR DEPOT INTRAMUSCULAR KIT
T5
SENSIPAR T5
THIOLA T5
XEOMIN INTRAMUSCULAR RECON SOLN 100 UNIT, 50 UNIT
T5
ZAVESCA T5
Protective Agents
amifostine crystalline T5
dexrazoxane hcl T5
ELMIRON T5
mesna T5
MESNEX ORAL T5
Oxytocics
Oxytocics
CERVIDIL T5
HEMABATE T5
methylergonovine T5
oxytocin injection solution T5
PREPIDIL T5
PROSTIN E2 T5
Pharmaceutical Aids
Pharmaceutical Aids
DILUENT FOR EPOPROSTENOL/FLOLA T5
PLACEBO #00 T4
water for inject, bacteriostat T5
123
Drug Tier Notes
Radioactive Agents
Radioactive Agents
METASTRON T5
QUADRAMET T5
Respiratory Tract Agents
Alpha And Beta Adrenergic Agonist(Respr)
ADRENALIN INJECTION SOLUTION 1 MG/ML
T5
APRODINE T1 AL
CHILDREN'S SILFEDRINE T1 AL
CLARINEX-D 12 HOUR T5
CONGEST-EZE T1
ephedrine sulfate injection solution T5
ephedrine sulfate oral T5
epinephrine injection syringe 0.1 mg/ml T5
EPIPEN 2-PAK T5
EPIPEN JR 2-PAK T5
KIDKARE COUGH/COLD T1 AL
LORATADINE-D T1 AL
NASAL DECONGESTANT (PSEUDOEPH) ORAL LIQUID
T1 AL
pseudoephedrine hcl oral tablet T1 AL
pseudoephedrine hcl oral tablet extended release T1 AL
pseudoephedrine-guaifenesin oral tablet extended release 12 hr 60-600 mg
T1 AL
racepinephrine T5
REZIRA T5
SEMPREX-D T5
SUDAFED 24 HOUR T1
SUDOGEST 12-HOUR T1 AL
SUDOGEST ORAL TABLET 60 MG T1 AL
Anticholinergic Agents (Respir.Tract)
ANORO ELLIPTA T5
124
Drug Tier Notes
ATROPEN INTRAMUSCULAR PEN INJECTOR 0.5 MG/0.7 ML, 1 MG/0.7 ML, 2 MG/0.7 ML
T5
atropine injection syringe 0.1 mg/ml T5
ATROVENT HFA T5
COMBIVENT T5
diphenoxylate-atropine oral tablet T5
ipratropium bromide inhalation T5
ipratropium-albuterol T5
SPIRIVA WITH HANDIHALER T5
Antitussives
ADULT ROBITUSSIN PEAK COLD DM T1 AL
ADULT TUSSIN COUGH CONGEST DM T1 AL
benzonatate oral capsule 100 mg, 200 mg T1
codeine sulfate oral tablet T5
codeine-guaifenesin T1 AL
CREO-TERPIN (DM-GUAIFENESIN) T1
dextromethorphan polistirex T1 AL
dextromethorphan-guaifenesin oral syrup T1 AL
DIABETIC TUSSIN DM ORAL LIQUID 10-200 MG/5 ML
T1 AL
KIDKARE COUGH/COLD T1 AL
NUEDEXTA T5
promethazine-dm T1 AL
REZIRA T5
SCOT-TUSSIN SENIOR T2
SYNALGOS-DC T5
VICKS 44 CUSTOM CARE DRY COUGH T2
Cystic Fibrosis (Cftr) Potentiators
KALYDECO ORAL TABLET T5
Expectorants
ADULT ROBITUSSIN PEAK COLD DM T1 AL
ADULT TUSSIN CHEST CONGESTION T1 AL
ADULT TUSSIN COUGH CONGEST DM T1 AL
125
Drug Tier Notes
codeine-guaifenesin T1 AL
CONGEST-EZE T1
CREO-TERPIN (DM-GUAIFENESIN) T1
dextromethorphan-guaifenesin oral syrup T1 AL
DIABETIC TUSSIN DM ORAL LIQUID 10-200 MG/5 ML
T1 AL
guaifenesin oral tablet 200 mg T1 AL
guaifenesin oral tablet extended release 12hr T1 AL
MUCINEX ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG
T1 AL
pseudoephedrine-guaifenesin oral tablet extended release 12 hr 60-600 mg
T1 AL
SCOT-TUSSIN SENIOR T2
SSKI T5
THYROSHIELD T5
TUSSIN ORAL LIQUID T1
First Generation Antihist.(Respir Tract)
APRODINE T1 AL
carbinoxamine maleate oral liquid T5
carbinoxamine maleate oral tablet 4 mg T5
CHILDREN'S ALLERGY (DIPHENHYD) ORAL ELIXIR
T1
chlorpheniramine maleate oral tablet T1
chlorpheniramine maleate oral tablet extended release
T1
clemastine oral syrup T5
cyproheptadine T5
dexchlorpheniramine maleate oral syrup T5
dimenhydrinate oral T1
DIPHENHIST ORAL TABLET 50 MG T1
diphenhydramine hcl oral capsule T1
diphenhydramine hcl oral tablet 25 mg T1
ED A-HIST (NEW DOSING) T5
ED-CHLORPED T5
KIDKARE COUGH/COLD T1 AL
126
Drug Tier Notes
PHENABID T5
promethazine oral T1 AL
PROMETHAZINE VC T1 AL
promethazine-dm T1 AL
Q-DRYL ORAL LIQUID T1
Leukotriene Modifiers
ACCOLATE T5
montelukast T5
ZYFLO T5
ZYFLO CR T5
Mast-Cell Stabilizers
ALOCRIL T5
cromolyn inhalation T5
cromolyn nasal T1 AL
cromolyn ophthalmic (eye) T5
cromolyn oral T5
Mucolytic Agents
acetylcysteine T5
PULMOZYME T5
Nasal Preparations (Steroids)
FLONASE T5
flunisolide nasal spray,non-aerosol 25 mcg (0.025 %)
T5
OMNARIS T5
RHINOCORT ALLERGY T2 QL (8.43 ML per 30 days)
RHINOCORT AQUA T5
triamcinolone acetonide nasal T1 QL (16.9 ML per 30 days)
VERAMYST T5
Non-Select.Beta-Adrenergic Agont(Respir)
ISUPREL T5
Orally Inhaled Preparations (Steroids)
ADVAIR DISKUS T5
ADVAIR HFA T5
127
Drug Tier Notes
ALVESCO T5
ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 110 MCG/ ACTUATION (30), 220 MCG/ ACTUATION (14)
T5
budesonide-formoterol T5
DULERA INHALATION HFA AEROSOL INHALER 100-5 MCG/ACTUATION, 200-5 MCG/ACTUATION
T5
FLOVENT DISKUS T5
FLOVENT HFA T5
PULMICORT FLEXHALER T5
PULMICORT INHALATION SUSPENSION FOR NEBULIZATION 1 MG/2 ML
T5
QVAR T5
Respiratory Tract Agents, Miscellaneous
ARALAST NP T5
GLASSIA T5
XOLAIR SUBCUTANEOUS RECON SOLN T5
Second Generation Antihist(Respir Tract)
ALAVERT T1
cetirizine oral tablet T1
cetirizine oral tablet,chewable T1
CHILDREN'S ALLEGRA ALLERGY T1
CHILD'S ALL DAY ALLERGY(CETIR) T1
CLARINEX ORAL SYRUP T5
CLARINEX-D 12 HOUR T5
desloratadine oral tablet T5
fexofenadine oral suspension T1
fexofenadine oral tablet 180 mg, 60 mg T1
levocetirizine T5
loratadine oral solution T1
loratadine oral tablet T1
LORATADINE-D T1 AL
SEMPREX-D T5
128
Drug Tier Notes
Select.Beta-2-Adrenergic Agonist(Respir)
ADVAIR DISKUS T5
ADVAIR HFA T5
albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 2.5 mg/0.5 ml
T5
albuterol sulfate oral syrup T5
albuterol sulfate oral tablet T5
ANORO ELLIPTA T5
BROVANA T5
budesonide-formoterol T5
COMBIVENT T5
DULERA INHALATION HFA AEROSOL INHALER 100-5 MCG/ACTUATION, 200-5 MCG/ACTUATION
T5
FORADIL AEROLIZER T5
ipratropium-albuterol T5
levalbuterol hcl inhalation solution for nebulization 1.25 mg/0.5 ml
T5
MAXAIR AUTOHALER T5
metaproterenol T5
PERFOROMIST T5
PROAIR HFA T5
SEREVENT DISKUS T5
terbutaline T5
XOPENEX T5
XOPENEX HFA T5
Vasodilating Agents (Respiratory Tract)
ADCIRCA T5
ambrisentan T5
epoprostenol (glycine) T5
REMODULIN T5
REVATIO INTRAVENOUS T5
REVATIO ORAL TABLET T5
TRACLEER ORAL TABLET T5
129
Drug Tier Notes
TYVASO T5
VENTAVIS T5
Xanthine Derivatives
aminophylline intravenous solution 250 mg/10 ml T5
ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML T5
LUFYLLIN T5
THEO-24 T5
THEOCHRON T5
theophylline oral tablet extended release T5
Skin And Mucous Membrane Agents
Allylamines (Skin And Mucous Membrane)
NAFTIN TOPICAL CREAM 1 % T5
NAFTIN TOPICAL GEL 1 % T5
terbinafine hcl topical T1 QL (120 GM per 30 days)
Antibacterials (Skin, Mucous Membrane)
ACZONE TOPICAL GEL T5
AKNE-MYCIN T5
ALTABAX T5
bacitracin topical ointment T1
bacitracin zinc topical ointment T1
BACTROBAN T5
BENZAMYCINPAK T5
CENTANY AT T5
clindamycin phosphate topical foam T5
clindamycin phosphate topical gel T5
clindamycin phosphate topical lotion T5
clindamycin phosphate topical solution T5
clindamycin phosphate topical swab T5
clindamycin phosphate vaginal T5
clindamycin-benzoyl peroxide topical gel T5
CORTISPORIN TOPICAL T5
ERY PADS T5
erythromycin with ethanol topical gel T5
130
Drug Tier Notes
erythromycin with ethanol topical solution T5
erythromycin-benzoyl peroxide T5
gentamicin topical T5
metronidazole topical cream T5
metronidazole topical gel T5
metronidazole topical lotion T5
metronidazole vaginal T5
neomycin-polymyxin b gu T5
NORITATE T5
ROSADAN TOPICAL KIT, CLEANSER AND GEL
T5
TRIPLE ANTIBIOTIC TOPICAL OINTMENT T1
VELTIN T5
Antifulgals (Skin, Mucous Membrane),Misc
EXODERM T5
Anti-Inflammatory Agents (Skin, Mucous)
ALA-SCALP T5
alclometasone T5
ALCORTIN A TOPICAL GEL IN PACKET T5
amcinonide T5
ANALPRAM ADVANCED T5
ANALPRAM-HC RECTAL LOTION T5
ANUSOL-HC RECTAL CREAM WITH APPLICATOR
T5
APEXICON T5
APEXICON E T5
betamethasone dipropionate T5
betamethasone valerate topical cream T5
betamethasone valerate topical lotion T5
betamethasone valerate topical ointment T5
betamethasone, augmented T5
CAPEX T5
CARMOL HC T5
clobetasol scalp T5
131
Drug Tier Notes
clobetasol topical cream T5
clobetasol topical foam T5
clobetasol topical gel T5
clobetasol topical ointment T5
clobetasol-emollient topical cream T5
CLOBEX T5
CLODERM T5
clotrimazole-betamethasone T5
COLOCORT T5
CORDRAN TAPE SMALL ROLL T5
CORDRAN TOPICAL CREAM 0.05 % T5
CORDRAN TOPICAL LOTION T5
CUTIVATE TOPICAL OINTMENT T5
DERMA-SMOOTHE/FS BODY OIL T5
DERMATOP T5
DESONATE T5
desonide T5
DESOWEN OINTMENT AND LOTION T5
desoximetasone topical cream T5
desoximetasone topical gel T5
desoximetasone topical ointment 0.25 % T5
diflorasone topical cream T5
ELOCON TOPICAL CREAM T5
ELOCON TOPICAL OINTMENT T5
EPIFOAM T5
fluocinolone and shower cap T5
fluocinolone topical cream T5
fluocinolone topical ointment T5
fluocinolone topical solution T5
fluocinonide topical cream 0.05 % T5
fluocinonide topical gel T5
fluocinonide topical ointment T5
fluocinonide topical solution T5
FLUOCINONIDE-E T5
132
Drug Tier Notes
fluticasone propionate topical cream T5
fluticasone propionate topical lotion T5
halobetasol propionate topical cream T5
halobetasol propionate topical ointment T5
HALOG T5
HALONATE T5
HC-1% HEMORRHOID T1
hydrocortisone acetate rectal suppository 25 mg T5
hydrocortisone acetate topical cream 1 % T1 QL (240 GM per 30 days)
hydrocortisone butyrate topical cream T5
hydrocortisone butyrate topical ointment T5
hydrocortisone butyrate topical solution T5
hydrocortisone topical cream 1 % T1 QL (240 QY per 30 DYs)
hydrocortisone topical cream 2.5 % T5
hydrocortisone topical lotion 1 % T1 QL (240 GM per 30 days)
hydrocortisone topical lotion 2.5 % T5
hydrocortisone topical ointment 0.5 %, 2.5 % T5
hydrocortisone topical ointment 1 % T1 QL (240 QY per 30 DYs)
hydrocortisone valerate T5
hydrocortisone-aloe vera topical cream 1 % T1 QL (240 QY per 30 DYs)
hydrocortisone-pramox-e-pram.1 rectal kit,cream and towelette 2.5 %-1 % (4 gram)-1 %
T5
hydrocortisone-pramoxine rectal cream 1-1 %, 2.5-1 %
T5
hydrocortisone-pramoxine topical T5
KENALOG TOPICAL T5
lidocaine hcl-hydrocortison ac rectal kit 3-0.5 %, 3-1 % (7 gram)
T5
lidocaine hcl-hydrocortison ac topical T5
lidocaine-hydrocortisone-aloe T5
LOCOID LIPOCREAM T5
LOCOID TOPICAL LOTION T5
LUXIQ T5
mometasone topical solution T5
NUCORT T5
133
Drug Tier Notes
OLUX-E T5
ORALONE T5
PANDEL T5
PEDIADERM HC T5
PROCTOCORT TOPICAL T5
PROCTOFOAM HC T5
RIMSO-50 T5
TACLONEX T5
TEXACORT T5
triamcinolone acetonide topical cream T5
triamcinolone acetonide topical lotion T5
triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 %
T5
TRIANEX T5
ULTRAVATE PAC T5
VANOS T5
XERESE T5
Antipruritics And Local Anesthetics
ANALPRAM ADVANCED T5
ANALPRAM-HC RECTAL LOTION T5
ANECREAM (WITH DRESSINGS) T5
ANTI-ITCH (DIPHENHYDRAMINE) TOPICAL GEL
T1
EPIFOAM T5
hydrocortisone-pramox-e-pram.1 rectal kit,cream and towelette 2.5 %-1 % (4 gram)-1 %
T5
hydrocortisone-pramoxine rectal cream 1-1 %, 2.5-1 %
T5
hydrocortisone-pramoxine topical T5
lidocaine hcl topical cream 3 % T5
lidocaine hcl topical lotion T5
lidocaine hcl-hydrocortison ac rectal kit 3-0.5 %, 3-1 % (7 gram)
T5
lidocaine hcl-hydrocortison ac topical T5
LIDOCAINE PAIN RELIEF T1
134
Drug Tier Notes
lidocaine topical cream 5 % T1
lidocaine topical ointment T5
lidocaine-hydrocortisone-aloe T5
lidocaine-prilocaine T5
LIDODERM T5
phenazopyridine oral tablet 95 mg T1
PRAMEGEL ANTI-ITCH T5
pramoxine T1
PROCTOFOAM HC T5
PRUDOXIN T5
SYNERA T5
VAGISIL TOPICAL CREAM 20-3 % T5
Antivirals (Skin And Mucous Membrane)
ABREVA T2 QL (2 QY per 30 DYs)
acyclovir topical cream T5
DENAVIR T5
XERESE T5
ZOVIRAX TOPICAL OINTMENT T5
Astringents
HEMORRHOIDAL (WITCH HAZEL) T1
Azoles (Skin And Mucous Membrane)
ALOE VESTA ANTIFUNGAL (MICON) T1
AZOLEN TINCTURE T1
clotrimazole mucous membrane T5
clotrimazole topical solution T5
clotrimazole vaginal cream T1
clotrimazole-betamethasone T5
econazole T5
ECOZA T5
ERTACZO T5
EXELDERM T5
EXTINA T5
FUNGI CURE T2
GYNE-LOTRIMIN T1
135
Drug Tier Notes
ketoconazole topical cream T5
ketoconazole topical shampoo T5
LOTRIMIN AF T1
LOTRIMIN AF POWDER T1
miconazole nitrate topical cream T1
miconazole nitrate vaginal cream T1
miconazole nitrate vaginal suppository T1
MICONAZOLE-3 VAGINAL SUPPOSITORY T5
MONISTAT 3 VAGINAL CREAM T2
NIZORAL A-D T2
OXISTAT T5
terconazole vaginal cream T5
tioconazole T1
VUSION T5
XOLEGEL T5
Basic Lotions And Liniments
GERI-HYDROLAC TOPICAL LOTION 12 % T2
GERI-HYDROLAC TOPICAL LOTION 5 % T1
LAC-HYDRIN FIVE T2
lactic acid T5
Basic Oils And Other Solvents
MINERAL OIL LIGHT T1
Basic Ointments And Protectants
ammonium lactate topical cream T1
HYDROPHOR T5
MINERIN CREME T1
Benzylamines (Skin And Mucous Membrane)
LOTRIMIN ULTRA T5
Cell Stimulants And Proliferants
ATRALIN T5
AVITA T5
KEPIVANCE T5
REGRANEX T5
136
Drug Tier Notes
RENOVA TOPICAL CREAM 0.02 % T5
RETIN-A MICRO T5
RETIN-A TOPICAL CREAM 0.05 %, 0.1 % T5
RETIN-A TOPICAL GEL 0.01 % T5
tretinoin (emollient) T5
TRETIN-X (GEL) T5
TRETIN-X CREAM KIT T5
TRETIN-X TOPICAL CREAM 0.0375 % T5
VELTIN T5
Corticosteroids (Skin, Mucous Membrane)
ALA-SCALP T5
alclometasone T5
ALCORTIN A TOPICAL GEL IN PACKET T5
amcinonide T5
ANALPRAM ADVANCED T5
ANALPRAM-HC RECTAL LOTION T5
ANUSOL-HC RECTAL CREAM WITH APPLICATOR
T5
APEXICON T5
APEXICON E T5
betamethasone dipropionate T5
betamethasone valerate topical cream T5
betamethasone valerate topical lotion T5
betamethasone valerate topical ointment T5
betamethasone, augmented T5
CAPEX T5
CARMOL HC T5
clobetasol scalp T5
clobetasol topical cream T5
clobetasol topical foam T5
clobetasol topical gel T5
clobetasol topical ointment T5
clobetasol-emollient topical cream T5
CLOBEX T5
137
Drug Tier Notes
CLODERM T5
clotrimazole-betamethasone T5
COLOCORT T5
CORDRAN TAPE SMALL ROLL T5
CORDRAN TOPICAL CREAM 0.05 % T5
CORDRAN TOPICAL LOTION T5
CORTISPORIN TOPICAL T5
CUTIVATE TOPICAL OINTMENT T5
DERMA-SMOOTHE/FS BODY OIL T5
DERMATOP T5
DESONATE T5
desonide T5
DESOWEN OINTMENT AND LOTION T5
desoximetasone topical cream T5
desoximetasone topical gel T5
desoximetasone topical ointment 0.25 % T5
diflorasone topical cream T5
ELOCON TOPICAL CREAM T5
ELOCON TOPICAL OINTMENT T5
EPIFOAM T5
fluocinolone and shower cap T5
fluocinolone topical cream T5
fluocinolone topical ointment T5
fluocinolone topical solution T5
fluocinonide topical cream 0.05 % T5
fluocinonide topical gel T5
fluocinonide topical ointment T5
fluocinonide topical solution T5
FLUOCINONIDE-E T5
fluticasone propionate topical cream T5
fluticasone propionate topical lotion T5
halobetasol propionate topical cream T5
halobetasol propionate topical ointment T5
HALOG T5
138
Drug Tier Notes
HALONATE T5
HC-1% HEMORRHOID T1
hydrocortisone acetate rectal suppository 25 mg T5
hydrocortisone acetate topical cream 1 % T1 QL (240 GM per 30 days)
hydrocortisone butyrate topical cream T5
hydrocortisone butyrate topical ointment T5
hydrocortisone butyrate topical solution T5
hydrocortisone topical cream 1 % T1 QL (240 QY per 30 DYs)
hydrocortisone topical cream 2.5 % T5
hydrocortisone topical lotion 1 % T1 QL (240 GM per 30 days)
hydrocortisone topical lotion 2.5 % T5
hydrocortisone topical ointment 0.5 %, 2.5 % T5
hydrocortisone topical ointment 1 % T1 QL (240 QY per 30 DYs)
hydrocortisone valerate T5
hydrocortisone-aloe vera topical cream 1 % T1 QL (240 QY per 30 DYs)
hydrocortisone-pramox-e-pram.1 rectal kit,cream and towelette 2.5 %-1 % (4 gram)-1 %
T5
hydrocortisone-pramoxine rectal cream 1-1 %, 2.5-1 %
T5
hydrocortisone-pramoxine topical T5
KENALOG TOPICAL T5
lidocaine hcl-hydrocortison ac rectal kit 3-0.5 %, 3-1 % (7 gram)
T5
lidocaine hcl-hydrocortison ac topical T5
lidocaine-hydrocortisone-aloe T5
LOCOID LIPOCREAM T5
LOCOID TOPICAL LOTION T5
LUXIQ T5
mometasone topical solution T5
NUCORT T5
OLUX-E T5
ORALONE T5
PANDEL T5
PEDIADERM HC T5
PROCTOCORT TOPICAL T5
139
Drug Tier Notes
PROCTOFOAM HC T5
TACLONEX T5
TEXACORT T5
triamcinolone acetonide topical cream T5
triamcinolone acetonide topical lotion T5
triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 %
T5
TRIANEX T5
ULTRAVATE PAC T5
VANOS T5
XERESE T5
Depigmenting Agents
TRI-LUMA T5
Detergents
PERIFRESH T1
Hydroxypyridones (Skin, Mucous Membrane)
ciclopirox T5
ciclopirox-vite-nail lacq remo T5
CNL 8 NAIL T5
Keratolytic Agents
ACNE MEDICATION TOPICAL LOTION 5 % T1
benzoyl peroxide topical cleanser 10 %, 4 %, 5 % T1
benzoyl peroxide topical gel 10 %, 2.5 % T1 QL (60 QY per 30 DYs)
benzoyl peroxide topical gel 5 % T1
benzoyl peroxide topical lotion 10 % T1
BP-50% UREA T5
clindamycin-benzoyl peroxide topical gel T5
GORDONS UREA T5
HYDRO 35 T5
HYDRO 40 T5
KERAFOAM T5
LATRIX XM T5
NEUTROGENA T-GEL CONDITNER(SA) T2
PRASCION RA T5
140
Drug Tier Notes
salicylic acid topical liquid 17 % T1 QL (15 QY per 30 DYs)
UMECTA NAIL FILM PEN T5
UMECTA PD T5
URAMAXIN TOPICAL CREAM T5
URAMAXIN TOPICAL FOAM T5
URAMAXIN TOPICAL GEL T5
UREA (WITH LACTIC,SALICY ACID) T5
urea topical cream 20 % T1 QL (85 QY per 30 DYs)
urea topical cream 40 %, 50 % T5
urea topical gel 40 % T5
urea topical lotion T5
WART REMOVER TOPICAL LIQUID T1 QL (14.8 QY per 30 DYs)
Keratoplastic Agents
coal tar (bulk) T5
CUTAR T2
ELTA LITE TAR T1
ELTA TAR T1
THERA-GEL T1
X-SEB T PLUS T1
Local Anti-Infectives, Miscellaneous
ALCOHOL PREP PADS T5
ALCORTIN A TOPICAL GEL IN PACKET T5
ALOQUIN T5
ANTISEPTIC WOUND-SKIN T1
DY-O-DERM T5
KLARON T5
PHISOHEX T5
PRASCION RA T5
selenium sulfide topical shampoo 2.25 %, 2.5 % T5
SILVADENE T5
SULFAMYLON T5
ULESFIA T5
Nonsteroidal Anti-Inflammat.Agents(Skin)
diclofenac sodium topical gel 3 % T5
141
Drug Tier Notes
FLECTOR T5
PENNSAID TOPICAL DROPS T5
VOLTAREN TOPICAL T5
Pigmenting Agents
8-MOP T5
OXSORALEN T5
OXSORALEN ULTRA T5
UVADEX T5
Polyenes (Skin And Mucous Membrane)
NYAMYC T5
nystatin topical cream T5
nystatin topical ointment T5
nystatin-triamcinolone T5
Scabicides And Pediculicides
ACTICIN T5
EURAX T5
lindane T5
malathion T5
NATROBA T5
permethrin topical liquid T1
PYRETHRIN LICE TREATMENT M T1
RID LICE KILLING T1
ULESFIA T5
Skin And Mucous Membrane Agents, Misc.
acitretin T5
ACZONE TOPICAL GEL T5
adapalene topical cream T5
adapalene topical gel 0.1 % T5
ALOE VESTA CLEANSING T1
AVAGE T5
AZELEX T5
calcipotriene scalp T5
calcipotriene topical cream T5
142
Drug Tier Notes
calcipotriene topical ointment T5
capsaicin topical cream 0.025 % T1
CARAC T5
CETAPHIL GENTLE CLEANSER T1
CLARAVIS T5
CONDYLOX T5
diclofenac sodium topical gel 3 % T5
DIFFERIN TOPICAL GEL 0.3 % T5
DIFFERIN TOPICAL LOTION T5
EFUDEX TOPICAL CREAM T5
ELIDEL T5
ENBREL SUBCUTANEOUS RECON SOLN T5
ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5 ML (0.5)
T5
EPIDUO TOPICAL GEL T5
FINACEA TOPICAL GEL T5
FLECTOR T5
FLUOROPLEX T5
fluorouracil topical solution T5
GRX RINSE-FREE T1
HIGH POTENCY CAPSAICIN T1 QL (42.5 QY per 30 DYs)
HUMIRA PEN T5
HUMIRA SUBCUTANEOUS SYRINGE KIT 20 MG/0.4 ML
T5
imiquimod topical cream in packet T5
K-Y LUBRICATING T1
LEVULAN T5
METVIXIA T5
minocycline oral tablet extended release 24 hr 135 mg, 45 mg, 90 mg
T5
ORACEA T5
ORAL RELIEF DRY MOUTH T2
OTEZLA T5
OTEZLA STARTER ORAL TABLETS,DOSE PACK 10 MG (4)-20 MG (4)-30 MG(19)
T5
143
Drug Tier Notes
PANRETIN T5
PENNSAID TOPICAL DROPS T5
PROSHIELD SPRAY CLEANSER T1
PROTOPIC T5
QUTENZA T5
REGRANEX T5
REMICADE T5
SANTYL T5
SOLODYN ORAL TABLET EXTENDED RELEASE 24 HR 105 MG, 115 MG, 55 MG, 65 MG, 80 MG
T5
STELARA SUBCUTANEOUS SYRINGE T5
TACLONEX T5
TARGRETIN TOPICAL T5
TAZORAC T5
TRIXAICIN T1
TRIXAICIN HP T1
VALCHLOR T5
VANIQA T5
VECTICAL T5
VEREGEN T5
VOLTAREN TOPICAL T5
ZYCLARA TOPICAL CREAM IN METERED-DOSE PUMP 2.5 %
T5
ZYCLARA TOPICAL CREAM IN PACKET T5
Thiocarbamates(Skin And Mucous Membrane)
LAMISIL AF TOPICAL POWDER T1
TINACTIN TOPICAL AEROSOL POWDER T1
TINACTIN TOPICAL AEROSOL,SPRAY T2
tolnaftate topical cream T1
tolnaftate topical solution T1
Smooth Muscle Relaxants
Antimuscarinics
DITROPAN XL ORAL TABLET EXTENDED RELEASE 24HR 5 MG
T5
144
Drug Tier Notes
ENABLEX T5
flavoxate T5
GELNIQUE TRANSDERMAL GEL IN METERED-DOSE PUMP 28 MG/0.92 GRAM (3 %)
T5
oxybutynin chloride oral syrup T5
oxybutynin chloride oral tablet T5
oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg
T5
OXYTROL T5
SANCTURA T5
SANCTURA XR T5
solifenacin T5
tolterodine T5
TOVIAZ T5
Respiratory Smooth Muscle Relaxants
aminophylline intravenous solution 250 mg/10 ml T5
ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML T5
LUFYLLIN T5
THEO-24 T5
THEOCHRON T5
theophylline oral tablet extended release T5
Vitamins
Multivitamin Preparations
ANIMAL SHAPES COMPLETE ORAL TABLET,CHEWABLE
T1
APETIMAR/IRON T2
AQUADEKS ORAL TABLET,CHEWABLE T2
ATABEX EC T5
BAL-CARE DHA T5
BAL-CARE DHA ESSENTIAL T5
B-NEXA T5
CAVAN-EC SOD DHA T5
CENTRUM COMPLETE T1
CENTRUM SILVER ORAL TABLET T1
145
Drug Tier Notes
CHEWABLE-VITE T2
CITRANATAL B-CALM (FE GLUC) T5
CLASSIC PRENATAL T2
COMPLETE SENIOR ORAL TABLET T1
COMPLETENATE T5
COMPLETE-RF PRENATAL T5
CONCEPT DHA T5
CONCEPT OB T5
DAILY MULTIPLE FOR MEN 50+ T1
DAILY-VITE T1
DUET DHA BALANCED ORAL COMBO PACK 26 MG IRON- 1 MG-278 MG
T5
DUET DHA EC-OM 3 T5
DUET DHA WITH OMEGA-3 T5
ELITE OB WITH DHA T5
ELITE-OB 400 T5
EXTRA-VIRT PLUS DHA T5
EZFE FORTE T1 QL (30 QY per 30 DYs)
FLINTSTONES COMPLETE (IRON) ORAL TABLET,CHEWABLE 18 MG IRON
T2
FOLBECAL T5
FOLCAL DHA T5
FOLIVANE-PRX DHA NF T5
GESTICARE DHA T5
HEMENATAL OB T5
HEMENATAL OB + DHA T5
KPN ORAL TABLET 9 MG IRON- 267 MCG T2 QL (30 QY per 30 DYs)
LEVOMEFOLATEPNV T5
L-METHYLFOLATE PNV DHA T5
MACNATAL CN DHA T5
MACULAR VITAMIN ORAL TABLET 0.5 MG T2
MARNATAL-F T5
MULTI-DELYN T1
mv-min-folic acid-lutein T1
146
Drug Tier Notes
MYNATAL ORAL CAPSULE T5
MYNATAL PLUS T5
MYNATE 90 PLUS T5
NATACHEW (FE BIS-GLYCINATE) T5
NATAFORT (NEW FORMULA 2011) T5
NATALVIRT CA T5
NATALVIT T5
NATELLE ONE T5
OB COMPLETE 400 T5
OB COMPLETE ONE T5
OB COMPLETE ORAL TABLET T5
OB COMPLETE PREMIER T5
OBSTETRIX EC T5
OBTREX T5
O-CAL PRENATAL T5
OCUVITE WITH LUTEIN T1
ONE DAILY MULTI-VIT W-MINERAL ORAL TABLET
T1
PAIRE OB PLUS DHA T5
PNV FOLIC ACID + IRON T5
POLY-VI-SOL ORAL DROPS T2 AL
POLY-VI-SOL WITH IRON T2
POLY-VITAMIN T1
POLYVITAMIN WITH IRON T1
POLY-VITAMIN WITH IRON T1
PR NATAL 430 EC T5
PREFERA-OB ONE T5
PRENA1 T5
PRENA1 CHEW (QUATREFOLIC) T5
PRENA1 PLUS T5
PRENAISSANCE 90 DHA T5
PRENATA T5
PRENATABS FA T5
PRENATABS RX T5
147
Drug Tier Notes
PRENATAL 19 (WITH DOCUSATE) T5
PRENATAL LOW IRON T5
PRENATAL PLUS WITH IRON (CA) T5
PRENATAL VITAMIN ORAL TABLET 27 MG IRON- 0.8 MG
T1
PRENATAL VITAMIN PLUS LOW IRON T5
PRENATAL-U T5
PRENATE DHA T5
PRENATE ELITE T5
PRENATE ESSENTIAL T5
PRENATE MINI T5
PREQUE 10 T5
PROTECT NATAL T5
PUREFE OB PLUS T5
SELECT-OB (FOLIC ACID) T5
SE-TAN DHA T5
SETONET T5
SETONET-EC T5
TARON-BC T5
THERA ORAL TABLET T1
THERA-M ORAL TABLET , 9 MG IRON-400 MCG
T1
THERATRUM COMPLETE 50 PLUS/LUT T1
THEREMS-M T2
TRIADVANCE T5
TRICARE PRENATAL DHA ONE(DSS) T5
TRINATAL GT T5
TRINATAL ULTRA T5
TRINATE T5
TRIPLE VITAMIN WITH FLUORIDE T5
TRIVEEN-DUO DHA T5
TRIVEEN-ONE T5
TRIVEEN-PRX RNF T5
TRIVEEN-TEN T5
148
Drug Tier Notes
TRI-VI-SOL WITH IRON T2
TRI-VITAMIN T1
ULTIMATECARE ONE NF T5
VENATAL COMPLETE DHA T5
VINATE AZ T5
VINATE CALCIUM T5
VINATE DHA T5
VINATE IC T5
VINATE II T5
VINATE M T5
VINATE ONE T5
VINATE PN CARE T5
VIRT-BAL DHA T5
VIRT-PN T5
VIRT-PN DHA T5
VIRT-SELECT T5
VITAFOL-PLUS T5
VITALETS ORAL TABLET,CHEWABLE T1
VITAMENT T2
VITASPIRE T5
VIVA DHA T5
VP-CH PLUS T5
VP-CH-PNV T5
VP-ERA OB PLUS T5
VP-GGR-B6 T5
VP-PNV-DHA T5
ZATEAN-CH T5
ZATEAN-PN PLUS T5
Vitamin A
TRIPLE VITAMIN WITH FLUORIDE T5
TRI-VI-SOL WITH IRON T2
TRI-VITAMIN T1
vitamin a oral capsule 10,000 unit T1
Vitamin B Complex
149
Drug Tier Notes
ADVICOR T5
AQUADEKS ORAL TABLET,CHEWABLE T2
ATABEX EC T5
BAL-CARE DHA T5
BAL-CARE DHA ESSENTIAL T5
biotin oral capsule 5 mg T1
B-NEXA T5
CAVAN-EC SOD DHA T5
CENTRUM COMPLETE T1
CENTRUM SILVER ORAL TABLET T1
CITRANATAL B-CALM (FE GLUC) T5
CLASSIC PRENATAL T2
COMPLETENATE T5
COMPLETE-RF PRENATAL T5
CONCEPT DHA T5
CONCEPT OB T5
cyanocobalamin (vitamin b-12) injection T1
cyanocobalamin (vitamin b-12) oral tablet 500 mcg
T1
cyanocobalamin (vitamin b-12) oral tablet extended release 1,000 mcg
T1
DAILY MULTIPLE FOR MEN 50+ T1
DIALYVITE 800 ORAL TABLET T1
DIALYVITE 800-ULTRA D T2
DUET DHA BALANCED ORAL COMBO PACK 26 MG IRON- 1 MG-278 MG
T5
DUET DHA EC-OM 3 T5
DUET DHA WITH OMEGA-3 T5
ELITE-OB 400 T5
EXTRA-VIRT PLUS DHA T5
EZFE FORTE T1 QL (30 QY per 30 DYs)
FOLBECAL T5
FOLCAL DHA T5
folic acid injection T5
folic acid oral tablet T1
150
Drug Tier Notes
FOLIVANE-PRX DHA NF T5
GESTICARE DHA T5
HEMENATAL OB T5
HEMENATAL OB + DHA T5
IROSPAN 24/6 T5
KPN ORAL TABLET 9 MG IRON- 267 MCG T2 QL (30 QY per 30 DYs)
LEVOMEFOLATEPNV T5
L-METHYLFOLATE T1 QL (30 EA per 30 days)
L-METHYLFOLATE PNV DHA T5
MACNATAL CN DHA T5
MACULAR VITAMIN ORAL TABLET 0.5 MG T2
MARNATAL-F T5
mv-min-folic acid-lutein T1
MYNATAL ORAL CAPSULE T5
MYNATAL PLUS T5
NATACHEW (FE BIS-GLYCINATE) T5
NATAFORT (NEW FORMULA 2011) T5
NATALVIRT CA T5
NATALVIT T5
NATELLE ONE T5
NEPHROCAPS T5
OB COMPLETE 400 T5
OB COMPLETE ONE T5
OB COMPLETE ORAL TABLET T5
OB COMPLETE PREMIER T5
OBSTETRIX EC T5
OBTREX T5
O-CAL PRENATAL T5
PAIRE OB PLUS DHA T5
PNV FOLIC ACID + IRON T5
PR NATAL 430 EC T5
PREFERA-OB ONE T5
PRENA1 T5
PRENA1 CHEW (QUATREFOLIC) T5
151
Drug Tier Notes
PRENA1 PLUS T5
PRENAISSANCE 90 DHA T5
PRENATA T5
PRENATABS FA T5
PRENATABS RX T5
PRENATAL 19 (WITH DOCUSATE) T5
PRENATAL LOW IRON T5
PRENATAL PLUS WITH IRON (CA) T5
PRENATAL VITAMIN ORAL TABLET 27 MG IRON- 0.8 MG
T1
PRENATAL VITAMIN PLUS LOW IRON T5
PRENATE DHA T5
PRENATE ELITE T5
PRENATE ESSENTIAL T5
PRENATE MINI T5
PREQUE 10 T5
PROTECT NATAL T5
PUREFE OB PLUS T5
PYRI 500 T1
pyridoxine (vitamin b6) oral tablet 100 mg, 25 mg, 50 mg
T1
RENA-VITE RX T1
SELECT-OB (FOLIC ACID) T5
SE-TAN DHA T5
SETONET T5
SETONET-EC T5
SIMCOR T5
TARON-BC T5
THERA-M ORAL TABLET 9 MG IRON-400 MCG
T1
thiamine mononitrate (vit b1) T1
TRIADVANCE T5
TRICARE PRENATAL DHA ONE(DSS) T5
TRINATAL GT T5
TRINATAL ULTRA T5
152
Drug Tier Notes
TRINATE T5
TRIVEEN-DUO DHA T5
TRIVEEN-ONE T5
TRIVEEN-PRX RNF T5
TRIVEEN-TEN T5
ULTIMATECARE ONE NF T5
VENATAL COMPLETE DHA T5
VINATE AZ T5
VINATE DHA T5
VINATE M T5
VINATE ONE T5
VIRT-BAL DHA T5
VIRT-PN T5
VIRT-PN DHA T5
VIRT-SELECT T5
VITAFOL-PLUS T5
VITAMENT T2
VITAMIN B-1 ORAL TABLET 100 MG, 50 MG T1
VITAMIN B-12 ORAL TABLET 1,000 MCG T1
VITAMIN B-12 ORAL TABLET 100 MCG T1 QL (100 QY per 30 DYs)
VITAMIN B-6 ORAL TABLET 50 MG T1
VITASPIRE T5
VIVA DHA T5
VP-CH PLUS T5
VP-CH-PNV T5
VP-ERA OB PLUS T5
VP-GGR-B6 T5
VP-PNV-DHA T5
ZATEAN-CH T5
ZATEAN-PN PLUS T5
Vitamin C
ascorbic acid (vitamin c) oral tablet 250 mg, 500 mg
T1
DIALYVITE 800 ORAL TABLET T1
153
Drug Tier Notes
DIALYVITE 800-ULTRA D T2
IROSPAN 24/6 T5
NEPHROCAPS T5
TRIPLE VITAMIN WITH FLUORIDE T5
TRI-VI-SOL WITH IRON T2
TRI-VITAMIN T1
VITAMIN C ORAL TABLET 1,000 MG T1
VITAMIN C ORAL TABLET,CHEWABLE 500 MG
T1
Vitamin D
calcitriol intravenous solution 1 mcg/ml T5
calcitriol oral T5
CALCIUM 500 WITH D T1
CALCIUM 600 WITH VITAMIN D3 ORAL CAPSULE 600 MG(1,500MG) -400 UNIT
T1
calcium carbonate-vitamin d2 T1
calcium carbonate-vitamin d3 oral tablet 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit
T1
calcium citrate-vitamin d3 oral tablet 200-125 mg-unit
T1
cholecalciferol (vitamin d3) oral capsule 1,250 mcg (50,000 unit), 125 mcg (5,000 unit)
T1
cholecalciferol (vitamin d3) oral tablet 125 mcg (5,000 unit), 25 mcg (1,000 unit), 50 mcg (2,000 unit)
T1
DIALYVITE 800-ULTRA D T2
ergocalciferol (vitamin d2) oral capsule 1,250 mcg (50,000 unit)
T1
ergocalciferol (vitamin d2) oral drops T1 AL
FOSAMAX PLUS D T5
HECTOROL INTRAVENOUS SOLUTION 2 MCG/ML
T5
OS-CAL 500 + D3 ORAL TABLET 500 MG(1,250MG) -200 UNIT
T1
OYSCO 500/D ORAL TABLET,CHEWABLE T1
OYSTER SHELL + D3 T1
154
Drug Tier Notes
OYSTER SHELL CALCIUM-VIT D2 ORAL TABLET 250 (625)-125 MG-UNIT
T1
PARVA-CAL 500 T2
RISACAL-D T1
TRIPLE VITAMIN WITH FLUORIDE T5
TRI-VI-SOL WITH IRON T2
TRI-VITAMIN T1
VITAMIN D3 ORAL CAPSULE 10 MCG (400 UNIT), 25 MCG (1,000 UNIT), 50 MCG (2,000 UNIT)
T1
VITAMIN D3 ORAL TABLET 10 MCG (400 UNIT)
T1
VITAMIN D3 ORAL TABLET,CHEWABLE 10 MCG (400 UNIT)
T1
ZEMPLAR T5
Vitamin E
vitamin e (dl, acetate) oral capsule 100 unit, 400 unit
T1
vitamin e (dl, acetate) oral drops 100 unit/0.25 ml T1
Vitamin K Activity
MEPHYTON T2
155
Index
8 8-MOP ................................ 140 A abacavir ................................ 10 abacavir-lamivudine-
zidovudine ........................ 10 ABELCET ............................ 13 ABILIFY ........................ 59, 62 ABILIFY DISCMELT ... 59, 62 ABILIFY MAINTENA .. 59, 62 ABRAXANE ........................ 16 ABREVA ........................... 133 ABSTRAL ............................ 66 acarbose .............................. 103 ACCOLATE....................... 125 ACD-A ................................. 30 acetaminophen ...................... 55 acetaminophen-codeine .. 55, 66 ACETASOL HC ............ 90, 91 acetazolamide ........... 44, 80, 90 acetazolamide sodium ... 44, 80,
90 ACETEST ............................ 76 acetic acid ....................... 80, 91 acetic acid-aluminum acetate 91 acetylcysteine ............. 120, 126 ACID REDUCER
(FAMOTIDINE) .............. 99 ACIPHEX........................... 100 ACIPHEX SPRINKLE ...... 100 acitretin ............................... 141 ACNE MEDICATION ....... 139 ACTEMRA ................ 117, 118 ACTHAR H.P. ............. 76, 110 ACTHIB (PF) ....................... 22 ACTHREL ..................... 76, 77 ACTICIN ............................ 140 ACTIMMUNE ................... 118 ACTIVASE .................... 37, 87 ACTIVELLA ............. 106, 111 ACTONEL ......................... 116 ACTOPLUS MET XR 104, 113 ACULAR ............................. 93 ACULAR LS ........................ 93 ACUVAIL (PF) .................... 93 acyclovir ....................... 12, 133 acyclovir sodium .................. 12 ACZONE .................... 128, 141
ADACEL(TDAP ADOLESN/ADULT)(PF) 21
ADAGEN ............................. 88 adapalene ............................ 141 ADCIRCA .................... 51, 128 adefovir ................................. 12 ADENOCARD ............... 40, 46 ADENOSCAN ..................... 46 ADRENALIN ............... 23, 122 ADRIAMYCIN .................... 16 ADRUCIL ............................ 16 ADULT ROBITUSSIN PEAK
COLD DM .............. 123, 124 ADULT TUSSIN CHEST
CONGESTION .............. 124 ADULT TUSSIN COUGH
CONGEST DM ...... 123, 124 ADVAIR DISKUS ...... 29, 101,
126, 127 ADVAIR HFA .... 29, 101, 126,
127 ADVATE.............................. 31 ADVICOR .................... 49, 148 AERO OTIC HC .................. 90 AFINITOR ........................... 16 AFINITOR DISPERZ .......... 16 AGGRASTAT IN SODIUM
CHLORIDE ...................... 36 AGGRENOX............ 36, 53, 72 AGRYLIN ............................ 37 A-HYDROCORT ............... 102 AIMSCO LATEX CONDOM
.......................................... 75 AKNE-MYCIN .................. 128 AK-POLY-BAC ................... 89 AKTEN (PF) ........................ 93 ALA-SCALP .............. 129, 135 ALAVERT ..................... 2, 127 ALBENZA ............................. 5 ALBUMINAR 25 % ............ 30 ALBUMINAR 5 % .............. 30 albuterol sulfate ............ 29, 127 ALCAINE ............................ 93 alclometasone ............. 129, 135 ALCOHOL PREP PADS ... 140 ALCORTIN A .... 130, 135, 140 ALDACTAZIDE ..... 50, 51, 52,
81, 86 ALDURAZYME .................. 88
alendronate ......................... 116 alfentanil ............................... 66 ALFERON N .................. 11, 16 ALIMTA ............................... 16 ALINIA .................................. 6 ALKERAN ........................... 16 ALLI ..................................... 99 allopurinol ........................... 115 allopurinol sodium .............. 115 ALOCRIL ..................... 88, 125 ALODOX ................. 15, 89, 92 ALOE VESTA
ANTIFUNGAL (MICON) ........................................ 134
ALOE VESTA CLEANSING ........................................ 141
ALOQUIN .......................... 140 ALORA .............................. 107 ALPHAGAN P ..................... 88 ALPHANATE ...................... 32 ALPHANINE SD ................. 32 alprazolam ............................ 63 ALPRAZOLAM INTENSOL
.......................................... 63 alprostadil ............................. 53 ALSUMA ............................. 73 ALTABAX ......................... 129 ALTAFLUOR ................ 77, 93 ALTALUBE ......................... 92 ALTAVERA (28) ............... 105 ALTOPREV ......................... 49 aluminum hydroxide gel ....... 94 alum-mag hydroxide-simeth 95,
96 ALVESCO .................. 102, 126 amantadine hcl .................. 4, 55 AMBISOME ......................... 13 ambrisentan ................... 53, 128 amcinonide ................. 130, 135 AMERGE ............................. 73 A-METHAPRED ............... 102 AMETHYST (28) ............... 105 AMIDATE ............................ 65 amifostine crystalline .......... 122 amiloride ......................... 52, 81 amiloride-hydrochlorothiazide
.............................. 52, 82, 86 aminocaproic acid ................. 32 aminophylline ............. 128, 143
156
AMINOSYN 10 % ............... 78 AMINOSYN 3.5 % .............. 78 AMINOSYN 7 % ................. 78 AMINOSYN 7 % WITH
ELECTROLYTES ........... 78 AMINOSYN 8.5 %-
ELECTROLYTES ........... 78 AMINOSYN II 15 % ........... 78 AMINOSYN II
5%/DEXTROSE 25% ...... 78 AMINOSYN II 8.5 % .......... 78 AMINOSYN M 3.5 % ......... 78 AMINOSYN-RF 5.2 % ........ 78 amiodarone ........................... 46 AMITIZA ............................. 97 amitriptyline ......................... 74 amitriptyline-chlordiazepoxide
.................................... 63, 74 amlodipine .......... 42, 47, 49, 53 amlodipine-benazepril ... 39, 42,
47, 49, 54 ammonium chloride.............. 78 ammonium lactate .............. 135 AMMONUL ......................... 78 amoxapine ............................ 74 amoxicillin .............................. 5 amoxicillin-pot clavulanate .... 5 AMPHOTEC ........................ 13 amphotericin b ...................... 13 ampicillin ................................ 5 ampicillin sodium ................... 5 ampicillin-sulbactam .............. 5 AMPYRA ........................... 120 AMRIX................................. 26 AMTURNIDE ... 42, 47, 52, 54,
86 AMVISC .............................. 75 AMVISC PLUS ................... 75 amyl nitrite ................... 51, 114 ANADROL-50 ................... 103 ANAFRANIL ....................... 74 anagrelide ............................. 37 ANALPRAM ADVANCED
........................ 130, 133, 135 ANALPRAM-HC...... 130, 133,
135 ANASPAZ ........................... 25 anastrozole .................... 16, 104 ANDRODERM .................. 103 ANDROGEL ...................... 103 ANDROID ......................... 103
ANDROXY ........................ 103 ANECREAM (WITH
DRESSINGS) ................. 133 ANECTINE .......................... 27 ANGELIQ .................. 107, 111 ANGIOMAX ........................ 31 ANIMAL SHAPES
COMPLETE ................... 144 ANORO ELLIPTA 25, 29, 123,
127 ANTACID ANTI-GAS .. 95, 96 ANTACID EXTRA-
STRENGTH ............... 82, 95 ANTARA ............................. 48 anticoag citrate phos dextrose
.......................................... 30 ANTI-DIARRHEAL
(LOPERAMIDE).............. 95 ANTI-ITCH
(DIPHENHYDRAMINE) ........................................ 133
ANTI-NAUSEA ................... 96 ANTISEPTIC WOUND-SKIN
........................................ 140 ANUSOL-HC ............. 130, 135 ANZEMET ........................... 94 APETIMAR/IRON ............. 144 APEXICON ................ 130, 135 APEXICON E ............ 130, 136 APIDRA SOLOSTAR U-100
INSULIN ................ 109, 112 APIDRA U-100 INSULIN 109,
112 APLENZIN .......................... 58 APOKYN ............................. 66 APRI ................................... 105 APRISO ................................ 96 APRODINE ...... 2, 23, 122, 124 APTIOM ............................... 57 APTIVUS ............................. 10 APTIVUS (WITH VITAMIN
E) ...................................... 10 AQUADEKS .............. 144, 148 ARALAST NP ................... 126 ARALEN ................................ 6 ARANELLE (28) ............... 105 ARANESP (IN
POLYSORBATE) ............ 31 ARAVA ...................... 117, 118 ARCALYST ....................... 121 argatroban ............................. 31
ARISTOSPAN INTRA-ARTICULAR ................. 102
ARISTOSPAN INTRALESIONAL ........ 102
ARMOUR THYROID ........ 113 AROMASIN ................. 16, 104 ARRANON .......................... 16 ARTHROTEC 50 ......... 69, 100 ARTHROTEC 75 ......... 69, 100 ARTIFICIAL TEARS
(POLYVIN ALC) ............. 92 ARTIFICIAL
TEARS(DEXT70-HYPRO) .......................................... 92
ARZERRA ........................... 16 ASACOL HD ....................... 96 ASCOMP WITH CODEINE
.................. 60, 63, 66, 71, 72 ascorbic acid (vitamin c) .... 152 ASCRIPTIN ....... 36, 37, 60, 72 ASMANEX TWISTHALER
................................ 102, 126 ASPER-FLEX ...................... 72 aspirin ................. 36, 37, 60, 72 ASTAGRAF XL ................. 120 ASTELIN ............................. 88 ASTEPRO ............................ 88 ATABEX EC ... 33, 82, 97, 144,
148 ATELVIA ........................... 116 atenolol ..................... 29, 41, 45 atenolol-chlorthalidone .. 29, 41,
46, 53, 87 ATGAM ............................. 120 atorvastatin ........................... 49 atovaquone .............................. 6 ATRALIN ........................... 135 ATRIPLA ............................. 10 ATROPEN ............ 25, 114, 123 atropine ................... 25, 93, 123 ATROVENT HFA ........ 25, 123 AUGMENTIN ........................ 5 AVAGE .............................. 141 AVANDAMET .......... 105, 113 AVANDARYL ........... 112, 113 AVANDIA ......................... 113 AVAPRO .............................. 38 AVASTIN ............................. 16 AVELOX .......................... 7, 14 AVELOX IN NACL (ISO-
OSMOTIC) ................... 7, 14
157
AVIANE............................. 105 AVIDOXY DK .................... 15 AVINZA............................... 67 AVITA ............................... 135 AVODART ........................ 114 AVONEX ........................... 118 AVONEX (WITH ALBUMIN)
........................................ 118 AXERT................................. 73 AXID .................................. 100 AXIRON ............................ 103 AYGESTIN ........................ 111 AZACTAM IN DEXTROSE
(ISO-OSM) ....................... 12 AZASAN ............ 117, 118, 120 azathioprine ........ 117, 118, 120 azathioprine sodium .. 117, 118,
120 azelastine .............................. 88 AZELEX ............................ 141 AZILECT ............................. 66 azithromycin ......................... 12 AZOLEN TINCTURE ....... 134 AZOR ..... 38, 42, 47, 48, 49, 54 aztreonam ............................. 12 AZULFIDINE 14, 96, 117, 118 AZULFIDINE EN-TABS ... 14,
96, 117, 118 AZURETTE (28)................ 105 B BABY AYR SALINE .......... 92 BACIIM ................................. 8 bacitracin ...................... 89, 129 bacitracin zinc .................... 129 baclofen ................................ 27 BACTRIM ............................ 14 BACTRIM DS...................... 14 BACTROBAN ................... 129 BACTROBAN NASAL ....... 89 BAL-CARE DHA . 33, 82, 144,
148 BAL-CARE DHA
ESSENTIAL..... 33, 144, 148 balsalazide ............................ 96 BALZIVA (28) ................... 105 BANZEL .............................. 57 BARACLUDE ..................... 12 BAYCADRON................... 102 BAYER PLUS EXTRA
STRENGTH ... 36, 37, 60, 72 belladonna tincture (bulk) .... 25
benazepril ............................. 39 benazepril-hydrochlorothiazide
.............................. 39, 52, 86 BENEFIX ............................. 32 BENLYSTA ....................... 120 BENTYL .............................. 25 BENZAMYCINPAK ......... 129 benzonatate ......................... 123 benzoyl peroxide ................ 139 benzphetamine ...................... 55 benztropine ..................... 26, 57 BEPREVE ............................ 88 BERINERT ........................ 117 BESIVANCE........................ 89 BETADINE OPHTHALMIC
PREP ................................ 91 BETAGAN ........................... 90 betamethasone acet,sod phos
........................................ 102 betamethasone dipropionate
................................ 130, 136 betamethasone valerate...... 130,
136 betamethasone, augmented 130,
136 BETASERON .................... 118 betaxolol ............................... 90 bethanechol chloride............. 28 BEXXAR DOSIMETRIC .... 16 BEYAZ ............................... 105 BIAXIN ............................ 7, 13 bicalutamide ......................... 16 BICARSIM ........................... 96 BICARSIM FORTE ............. 96 BICILLIN C-R ..................... 12 BICNU.................................. 16 BIDIL ............................. 48, 51 BILTRICIDE .......................... 5 BIOTENE DRY MOUTH
ORAL RINSE................... 75 BIOTHRAX ......................... 22 biotin ................................... 148 bisacodyl ............................... 97 bisoprolol fumarate... 30, 41, 46 bisoprolol-hydrochlorothiazide
.................. 30, 41, 46, 52, 86 bleomycin ............................. 16 BLEPH-10 ............................ 89 BLEPHAMIDE .................... 89 BLEPHAMIDE S.O.P. ......... 89 BLOOD PRESSURE KIT .... 75
blood pressure kit med and lrg .......................................... 75
blood pressure monitor ......... 75 B-NEXA ............... 82, 144, 148 BONIVA ............................. 116 BOOST ................................. 78 BOOSTRIX TDAP ............... 21 BOTOX ........................ 30, 121 BOTOX COSMETIC ... 30, 121 BP-50% UREA ................... 139 BRAVELLE ....................... 108 BREVICON (28) ................ 105 BREVITAL .................... 62, 63 brimonidine ........................... 88 BROMDAY .......................... 93 bromfenac ............................. 93 bromocriptine ....................... 65 BROVANA .................. 29, 127 BUDEPRION SR ................. 59 budesonide-formoterol 29, 102,
126, 127 bumetanide ..................... 50, 81 BUPHENYL ......................... 78 bupivacaine ......................... 113 bupivacaine (pf) .................. 113 bupivacaine-dextrose-water(pf)
........................................ 113 bupivacaine-epinephrine (pf)
.................................. 23, 113 BUPRENEX ......................... 69 buprenorphine hcl ................. 69 buprenorphine-naloxone ....... 69 BUPROBAN ........................ 59 bupropion hcl ........................ 59 buspirone .............................. 61 butalbital-acetaminop-caf-cod
.................. 56, 60, 63, 67, 71 butalbital-acetaminophen-caff
........................ 56, 60, 63, 71 butorphanol tartrate .............. 69 BUTRANS ........................... 69 BYETTA ............................ 109 BYSTOLIC ..................... 27, 41 C cabergoline ........................... 65 CADUET ...... 42, 47, 48, 49, 54 CAFERGOT ................... 27, 60 CALCI-CHEW ..................... 82 CALCI-MIX ......................... 82 CALCIONATE ..................... 82 calcipotriene ....................... 141
158
calcitonin (salmon) .... 104, 110, 116
calcitriol .............................. 152 CALCIUM 500 WITH D .... 82,
152 CALCIUM 600 .................... 82 CALCIUM 600 WITH
VITAMIN D3 ........... 82, 152 calcium acetate(phosphat bind)
.......................................... 81 CALCIUM ANTACID .. 82, 95 CALCIUM ANTACID
ULTRA MAX ST....... 82, 95 calcium carbonate ........... 82, 95 calcium carbonate-vitamin d2
.................................. 82, 152 calcium carbonate-vitamin d3
.................................. 82, 153 calcium citrate-vitamin d3 ... 82,
153 calcium gluconate ................. 82 calcium lactate ...................... 82 CALDOLOR ........................ 69 CAMBIA ........................ 60, 69 CAMILA ............................ 105 CAMPRAL........................... 64 CANASA ............................. 97 CANCIDAS ........................... 8 CANTIL ............................... 25 CAPASTAT ........................... 7 CAPEX ....................... 130, 136 capsaicin ............................. 141 captopril ................................ 39 captopril-hydrochlorothiazide
.............................. 39, 52, 86 CARAC ........................ 16, 141 CARAFATE ....................... 100 CARBAGLU ........................ 78 carbamazepine ................ 57, 59 carbidopa-levodopa .............. 65 carbinoxamine maleate ... 1, 125 CARBOCAINE .................. 113 CARBOCAINE (PF) .......... 113 carboplatin ............................ 16 CARDENE SR .. 42, 47, 48, 49,
54 CARIMUNE NF
NANOFILTERED ........... 21 carisoprodol .......................... 26 carisoprodol-aspirin ........ 26, 72
carisoprodol-aspirin-codeine .............................. 26, 67, 72
CARMOL HC ............ 130, 136 CARNITOR........................ 121 carteolol ................................ 90 CARTICEL ........................ 121 carvedilol 27, 28, 37, 41, 46, 49 CATAFLAM ........................ 69 CAVAN-EC SOD DHA ...... 33,
144, 148 CAVERJECT ....................... 54 CAVERJECT IMPULSE ..... 54 CAYSTON ........................... 12 CAZIANT (28) ................... 105 CEDAX .................................. 3 cefaclor ................................... 3 cefadroxil ................................ 3 cefazolin ................................. 3 cefdinir.................................... 3 cefditoren pivoxil ................... 3 cefepime ................................. 4 cefepime in dextrose,iso-osm . 4 cefotaxime .............................. 4 cefotetan ............................. 3, 8 cefoxitin .............................. 3, 8 cefoxitin in dextrose, iso-osm 3,
8 cefpodoxime ........................... 4 cefprozil .................................. 3 CEFTIN .................................. 3 ceftriaxone in dextrose,iso-os . 4 cefuroxime sodium ................. 3 cefuroxime-dextrose (iso-osm)
............................................ 3 CELEBREX ......................... 65 CELESTONE ..................... 102 CELLCEPT ........................ 120 CELLCEPT INTRAVENOUS
........................................ 120 CELONTIN .......................... 74 CENESTIN ......................... 107 CENTANY AT................... 129 CENTRUM COMPLETE ... 33,
144, 148 CENTRUM SILVER . 144, 148 cephalexin ............................... 3 CEPROTIN (BLUE BAR) ... 30 CEPROTIN (GREEN BAR) 30 CEREZYME ........................ 88 CERVARIX VACCINE (PF)
.......................................... 22
CERVIDIL ......................... 122 CESAMET ........................... 96 CETAPHIL GENTLE
CLEANSER ................... 141 cetirizine ......................... 2, 127 CETROTIDE .............. 104, 118 CHANTIX ............................ 26 CHANTIX CONTINUING
MONTH BOX .................. 26 CHANTIX STARTING
MONTH BOX .................. 26 CHEMET .................... 101, 114 CHENODAL ........................ 98 CHEWABLE-VITE ........... 144 CHILDREN'S ALLEGRA
ALLERGY ................. 2, 127 CHILDREN'S ALLERGY
(DIPHENHYD) .......... 1, 125 CHILDREN'S NON-ASPIRIN
.......................................... 56 CHILDREN'S PAIN RELIEF
.......................................... 56 CHILDREN'S SILFEDRINE
.................................. 23, 122 CHILD'S ALL DAY
ALLERGY(CETIR) ... 2, 127 chloramphenicol sod succinate
............................................ 8 chlordiazepoxide hcl ............. 63 chlordiazepoxide-clidinium . 25,
63 chlorhexidine gluconate ........ 91 chloroprocaine (pf) ............. 113 chloroquine phosphate ............ 6 chlorothiazide ................. 53, 86 chlorothiazide sodium .... 53, 86 chlorpheniramine maleate . 1, 2,
125 chlorpromazine ..................... 71 chlorpropamide ................... 112 chlorthalidone ................. 53, 87 chlorzoxazone ....................... 26 cholecalciferol (vitamin d3) 153 cholestyramine (with sugar) . 42 CHOLESTYRAMINE LIGHT
.......................................... 42 choline,magnesium salicylate
.......................................... 72 chorionic gonadotropin, human
........................................ 108 CIALIS ................................. 52
159
ciclopirox ............................ 138 ciclopirox-vite-nail lacq remo
........................................ 138 cilostazol......................... 36, 52 CILOXAN ............................ 89 cimetidine ........................... 100 cimetidine hcl ..................... 100 CIMZIA ................ 99, 117, 118 CIMZIA POWDER FOR
RECONST ........ 99, 117, 118 CIMZIA STARTER KIT .... 99,
117, 119 CINRYZE........................... 117 CIPRO .............................. 7, 14 CIPRO HC...................... 89, 90 CIPRODEX .................... 89, 90 ciprofloxacin (mixture) .... 7, 14 ciprofloxacin hcl ............... 7, 14 ciprofloxacin in 5 % dextrose 7,
14 ciprofloxacin lactate ......... 7, 14 cisplatin ................................ 16 citalopram ............................. 74 CITRANATAL B-CALM (FE
GLUC) .................... 144, 148 cladribine .............................. 16 CLAFORAN .......................... 4 CLARAVIS ........................ 141 CLARINEX .................... 2, 127 CLARINEX-D 12 HOUR2, 23,
122, 127 clarithromycin .................. 7, 13 CLASSIC PRENATAL ...... 33,
144, 148 clemastine ....................... 1, 125 CLEOCIN HCL.................... 11 CLEOCIN IN 5 %
DEXTROSE ..................... 11 CLEOCIN PEDIATRIC ....... 11 CLEVIPREX 42, 47, 48, 49, 54 CLIMARA PRO ................. 107 clindamycin hcl .................... 11 clindamycin phosphate ....... 129 clindamycin-benzoyl peroxide
................................ 129, 139 CLINIMIX 5%/D15W
SULFITE FREE ............... 78 CLINIMIX 5%/D25W
SULFITE-FREE ............... 78 CLINIMIX 2.75%/D5W
SULFIT FREE.................. 79
CLINIMIX 4.25%/D10W SULF FREE ..................... 79
CLINIMIX 4.25%/D5W SULFIT FREE .................. 79
CLINIMIX 4.25%-D20W SULF-FREE ..................... 79
CLINIMIX 5%-D20W(SULFITE-FREE).. 79
CLINIMIX E 2.75%/D10W SUL FREE ........................ 79
CLINIMIX E 2.75%/D5W SULF FREE ..................... 79
CLINIMIX E 4.25%/D25W SUL FREE ........................ 79
CLINIMIX E 4.25%/D5W SULF FREE ..................... 79
CLINIMIX E 5%/D15W SULFIT FREE .................. 79
CLINIMIX E 5%/D20W SULFIT FREE .................. 79
CLINIMIX E 5%/D25W SULFIT FREE .................. 79
CLINITEST REAGENT ...... 77 CLINORIL ........................... 69 clobetasol .................... 130, 136 clobetasol-emollient ... 130, 136 CLOBEX .................... 130, 136 CLODERM ................ 130, 136 CLOLAR .............................. 16 clonazepam ........................... 63 clonidine ......................... 24, 45 clonidine (pf) ............ 24, 45, 56 clonidine hcl ................... 24, 45 clopidogrel ............................ 36 clorazepate dipotassium ....... 63 CLORPRES ........ 24, 45, 53, 87 clotrimazole ........................ 134 clotrimazole-betamethasone
........................ 130, 134, 136 clozapine ............................... 62 CNL 8 NAIL ...................... 139 coal tar (bulk) ..................... 139 COARTEM ............................ 6 cocaine .................................. 93 codeine sulfate .............. 67, 123 codeine-guaifenesin .... 123, 124 COLCRYS.......................... 115 COLESTID ........................... 42 COLESTID FLAVORED .... 42 colestipol .............................. 42 colistin (colistimethate na) ... 13
COLOCORT ............... 130, 136 COLY-MYCIN S ................. 89 COLYTE WITH FLAVOR
PACKS ............................. 97 COMBIGAN .................. 88, 90 COMBIPATCH .......... 107, 111 COMBIVENT 25, 29, 123, 127 COMETRIQ ......................... 16 COMPLETE SENIOR ........ 144 COMPLETENATE ..... 33, 144,
148 COMPLETE-RF PRENATAL
.......................... 97, 144, 148 COMPRO ....................... 71, 96 COMTAN ............................. 64 COMVAX (PF) .................... 22 CONCEPT DHA .. 33, 144, 148 CONCEPT OB ..... 33, 144, 148 CONCERTA ......................... 71 CONDOMS-PREM
LUBRICATED ................. 75 CONDYLOX ...................... 141 CONGEST-EZE ... 24, 122, 124 COPAXONE ...................... 119 COPEGUS ............................ 12 CORDRAN ................. 130, 136 CORDRAN TAPE SMALL
ROLL ...................... 130, 136 COREG CR . 27, 28, 37, 41, 46,
49 CORLOPAM ........................ 49 CORTANE-B AQUEOUS ... 90 CORTEF ............................. 102 cortisone ............................. 102 CORTISPORIN .......... 129, 136 CORTROSYN ...................... 76 CORVERT ........................... 46 COSMEGEN ........................ 16 COSOPT ............................... 90 cosyntropin ........................... 76 COUMADIN ........................ 31 COVARYX ................ 103, 107 COVARYX H.S. ........ 104, 107 CREON ................................. 99 CREO-TERPIN (DM-
GUAIFENESIN) .... 123, 124 CRESTOR ............................ 49 CRINONE .......................... 111 CRIXIVAN ........................... 10 CROFAB ...................... 21, 114 cromolyn ....................... 88, 125
160
CRYSELLE (28) ................ 105 CUBICIN ............................... 8 CULTURELLE .................... 99 CULTURELLE KIDS
PROBIOTICS................... 99 CUPRIMINE .............. 101, 117 CUTAR .............................. 139 CUTIVATE ................ 130, 136 CUVPOSA ........................... 25 cyanocobalamin (vitamin b-12)
........................................ 149 CYCLAFEM 1/35 (28) ...... 105 CYCLAFEM 7/7/7 (28) ..... 105 cyclobenzaprine .................... 26 CYCLOGYL ........................ 94 CYCLOMYDRIL................. 94 cyclopentolate....................... 94 cyclophosphamide ........ 16, 120 cycloserine .............................. 7 CYCLOSET ......................... 65 cyclosporine ....... 117, 119, 120 cyclosporine modified ....... 117,
119, 120 CYKLOKAPRON ................ 32 cyproheptadine ............... 1, 125 CYSTADANE .................... 121 CYSTAGON ...................... 121 cytarabine ............................. 17 cytarabine (pf) ...................... 17 CYTOMEL......................... 113 CYTOVENE ........................ 12 CYTRA K CRYSTALS ....... 78 D D.H.E.45 ......................... 27, 60 d10 %-0.45 % sodium chloride
.......................................... 79 d2.5 %-0.45 % sodium
chloride ............................. 79 d5 % and 0.9 % sodium
chloride ............................. 79 d5 %-0.45 % sodium chloride
.......................................... 79 dacarbazine ........................... 17 DACOGEN .......................... 17 DAILY FIBER (PSYLLIUM-
SUCROSE)....................... 97 DAILY MULTIPLE FOR
MEN 50+ ................ 144, 149 DAILY-VITE ..................... 144 danazol ............................... 104 dapsone ................................... 6
DAPTACEL (DTAP PEDIATRIC) (PF) ............ 21
DARAPRIM ........................... 6 daunorubicin ......................... 17 DAUNOXOME .................... 17 DAYTRANA........................ 71 DDAVP ........................ 32, 110 DEEP SEA NASAL ............. 92 deferoxamine .............. 101, 114 DELFLEX-LC/1.5%
DEXTROSE ..................... 80 DELFLEX-LC/2.5%
DEXTROSE ..................... 80 DELFLEX-LC/4.25%
DEXTROSE ..................... 80 DELZICOL .......................... 97 DEMADEX .................... 50, 81 demeclocycline ..................... 15 DEMEROL ........................... 67 DEMEROL (PF)................... 67 DEMSER ............................ 121 DENAVIR .......................... 133 DEPACON ............... 57, 59, 61 DEPAKENE ............. 57, 59, 61 DEPAKOTE ............. 57, 59, 61 DEPAKOTE ER ....... 57, 59, 61 DEPAKOTE SPRINKLES . 57,
59, 61 DEPEN TITRATABS 101, 117 DEPOCYT (PF) ................... 17 DEPODUR (PF) ................... 67 DEPO-ESTRADIOL .......... 107 DEPO-MEDROL ............... 102 DEPO-PROVERA.............. 111 DEPO-SUBQ PROVERA 104
........................................ 111 DEPO-TESTOSTERONE .. 104 DERMA-SMOOTHE/FS
BODY OIL ............. 130, 136 DERMATOP .............. 130, 136 DERMOTIC OIL ................. 90 desipramine .......................... 74 desloratadine ................... 2, 127 desmopressin ................ 32, 110 DESONATE ............... 130, 136 desonide ...................... 130, 136 DESOWEN OINTMENT
AND LOTION ....... 130, 136 desoximetasone .......... 131, 136 DESOXYN ........................... 55 dexamethasone ................... 102
DEXAMETHASONE INTENSOL ..................... 102
dexamethasone sodium phosphate .................. 90, 102
dexchlorpheniramine maleate 1, 2, 125
DEXILANT ........................ 101 dexmethylphenidate .............. 71 DEXPAK 10 DAY ............. 102 dexrazoxane hcl .................. 122 dextroamphetamine .............. 55 dextroamphetamine-
amphetamine ..................... 55 dextromethorphan polistirex
........................................ 124 dextromethorphan-guaifenesin
........................................ 124 dextrose 10 % and 0.2 % nacl
.......................................... 79 dextrose 10 % in water (d10w)
.......................................... 79 dextrose 25 % in water (d25w)
.......................................... 79 dextrose 30 % in water (d30w)
.......................................... 79 dextrose 40 % in water (d40w)
.......................................... 79 dextrose 5 % in ringer's ........ 82 dextrose 5 % in water (d5w) . 79 dextrose 5 %-lactated ringers82 dextrose 5%-0.2 % sod
chloride ............................. 79 dextrose 5%-0.3 %
sod.chloride ...................... 79 dextrose 50 % in water (d50w)
.......................................... 79 dextrose 70 % in water (d70w)
.......................................... 79 DIABETA ........................... 112 DIABETIC TUSSIN DM ... 124 DIALYVITE 800 ........ 149, 152 DIALYVITE 800-ULTRA D
........................ 149, 152, 153 DIANEAL LOW
CALCIUM/1.5% DEX ..... 80 DIANEAL PD-2 WITH 2.5 %
DEX .................................. 80 DIANEAL PD-2 WITH 4.25
% DEX .............................. 80 DIANEAL WITH 2.5 %
DEXTROSE ..................... 80
161
DIASTAT ............................. 63 DIASTAT ACUDIAL .......... 63 diazepam......................... 63, 64 DIAZEPAM INTENSOL ..... 63 DIBENZYLINE ............. 27, 50 diclofenac sodium ... 17, 69, 93,
140, 141 dicloxacillin .......................... 13 dicyclomine .......................... 25 didanosine............................. 10 DIFFERIN .......................... 141 diflorasone .................. 131, 136 diflunisal ............................... 70 DIGIFAB ...................... 21, 114 digoxin ............................ 40, 44 DILANTIN ..................... 45, 65 DILATRATE-SR ................. 51 DILAUDID-HP (PF) ............ 67 diltiazem hcl 42, 43, 44, 46, 47,
54 DILUENT FOR
EPOPROSTENOL/FLOLA ........................................ 122
dimenhydrinate ......... 1, 96, 125 DIOVAN .............................. 38 DIPENTUM ......................... 97 DIPHENHIST ................ 1, 125 diphenhydramine hcl ...... 1, 125 diphenoxylate-atropine .. 25, 95,
123 dipyridamole................... 36, 54 DISKETS ............................. 67 disopyramide phosphate ....... 45 disulfiram ........................... 114 DITROPAN XL ................. 143 DIURIL .......................... 53, 86 DIVIGEL ............................ 107 dobutamine ..................... 28, 44 dobutamine in d5w ......... 28, 44 docetaxel............................... 17 docusate sodium ................... 97 DOLOPHINE ....................... 67 donepezil .............................. 28 dopamine ........................ 29, 44 dopamine in 5 % dextrose ... 29,
44 DORAL ................................ 64 DORIBAX .............................. 8 dorzolamide .......................... 90 doxazosin ............ 27, 37, 38, 50 doxepin ................................. 74
doxycycline hyclate ........ 15, 89 doxycycline monohydrate .... 15 dronabinol ............................. 96 droperidol ............................. 61 DROXIA .............................. 17 DUET DHA BALANCED .. 33,
144, 149 DUET DHA EC-OM 3 33, 144,
149 DUET DHA WITH OMEGA-3
.......................... 33, 144, 149 DUETACT ................. 112, 113 DULERA ...... 29, 102, 126, 127 duloxetine ....................... 65, 73 DUREZOL ........................... 90 DY-O-DERM ..................... 140 DYRENIUM .................. 52, 82 DYSPORT .................... 30, 121 E E.E.S. 400 ......................... 9, 11 E.E.S. GRANULES.......... 9, 11 EAR WAX DROPS.............. 91 econazole ............................ 134 ECOZA ............................... 134 ED A-HIST (NEW DOSING)
.............................. 2, 24, 125 ED-CHLORPED ........ 1, 2, 125 EDEX ................................... 54 EDLUAR .............................. 61 EFFER-K .............................. 83 EFFERVESCENT ANTACID
............ 36, 37, 61, 72, 78, 95 EFFIENT .............................. 36 EFUDEX ...................... 17, 141 ELAPRASE .......................... 88 ELDEPRYL.......................... 66 electrolyte-48 in d5w ............ 83 ELELYSO ............................ 88 ELESTAT ............................. 88 ELESTRIN ......................... 107 ELIDEL ...................... 120, 141 ELIGARD .................... 17, 108 ELIGARD (3 MONTH) ...... 17,
108 ELIGARD (4 MONTH) ...... 17,
108 ELIGARD (6 MONTH) ...... 17,
108 ELITE OB WITH DHA ..... 144 ELITEK ................................ 88 ELITE-OB 400 ..... 34, 144, 149
ELIXOPHYLLIN .. 48, 80, 128, 143
ELLA .................................. 105 ELMIRON .......................... 122 ELOCON .................... 131, 136 ELOXATIN .......................... 17 ELSPAR ............................... 17 ELTA LITE TAR ............... 139 ELTA TAR ......................... 139 EMCYT ................................ 17 EMEND .............................. 100 EMSAM ............................... 66 EMTRIVA ............................ 10 ENABLEX ......................... 143 enalapril maleate ................... 39 enalaprilat ............................. 39 enalapril-hydrochlorothiazide
.............................. 39, 53, 87 ENBREL ............. 117, 119, 141 ENDOCET ..................... 56, 67 ENDODAN .................... 67, 72 ENDOMETRIN .................. 111 ENEMA DISPOSABLE ....... 97 ENFAMIL GLUCOSE ......... 79 ENGERIX-B (PF) ................ 22 ENGERIX-B PEDIATRIC
(PF) ................................... 22 ENJUVIA ........................... 107 ENLON ................................. 76 ENLON-PLUS ..................... 76 enoxaparin ............................ 33 ENPRESSE ......................... 105 ENSURE MUSCLE HEALTH
.......................................... 79 ENSURE PLUS .................... 79 ENTEREG ............................ 99 ENTERO VU ........................ 77 ENTOCORT EC ................. 102 ENUCLENE ......................... 92 ephedrine sulfate ........... 24, 122 EPIDUO ............................. 141 EPIFOAM ........... 131, 133, 137 epinephrine ................... 24, 122 EPIPEN 2-PAK ............ 24, 123 EPIPEN JR 2-PAK ....... 24, 123 epirubicin .............................. 17 EPIVIR ................................. 10 EPIVIR HBV ........................ 10 eplerenone ................. 50, 51, 52 EPOGEN .............................. 31 epoprostenol (glycine) .. 54, 128
162
EPZICOM ............................ 10 EQUETRO ..................... 57, 59 ERAXIS(WATER DILUENT)
............................................ 8 ERBITUX............................. 17 ergocalciferol (vitamin d2) . 153 ergoloid................................. 27 ERGOMAR .................... 27, 61 ERIVEDGE .......................... 17 ERTACZO ......................... 134 ERY PADS ......................... 129 ERYPED 400 ................... 9, 11 ERY-TAB......................... 9, 11 ERYTHROCIN ................ 9, 11 ERYTHROCIN (AS
STEARATE) ................ 9, 11 erythromycin .............. 9, 11, 89 erythromycin with ethanol . 129 erythromycin-benzoyl peroxide
........................................ 129 erythromycin-sulfisoxazole ... 9,
14 escitalopram oxalate ............. 74 ESOPHO-CAT ..................... 77 estazolam .............................. 64 ESTRACE .......................... 107 estradiol .............................. 107 estradiol valerate ................ 107 ESTRASORB ..................... 107 ESTRING ........................... 107 ESTROGEL ....................... 107 estropipate .......................... 107 ESTROSTEP FE-28 ........... 105 eszopiclone ........................... 61 ethambutol .............................. 7 ETHAMOLIN ...................... 52 ethanol (ethyl alcohol) ........ 121 ethosuximide ........................ 74 etidronate disodium ............ 116 etodolac ................................ 70 ETOPOPHOS ....................... 17 etoposide............................... 17 EUFLEXXA ......................... 75 EURAX .............................. 140 EVAMIST .......................... 107 EVISTA ...................... 106, 116 EVOXAC ............................. 28 EXALGO ER ....................... 67 EXELDERM ...................... 134 EXELON .............................. 28
EXFORGE... 38, 43, 47, 48, 50, 54
EXFORGE HCT 38, 43, 47, 48, 53, 87
EXJADE ............................. 101 EXODERM ........................ 129 EXTINA ............................. 134 EXTRA-VIRT PLUS DHA. 34,
144, 149 EYE ALLERGY RELIEF .... 94 EYLEA ................................. 92 E-Z-CAT DRY ..................... 77 EZFE FORTE ....... 34, 145, 149 E-Z-HD BARIUM ................ 77 E-Z-PAQUE ......................... 77 F FABRAZYME ..................... 88 FACTIVE ............................. 14 famciclovir............................ 12 famotidine ........................... 100 famotidine (pf)-nacl (iso-os)
........................................ 100 FANAPT .............................. 62 FARESTON ................. 17, 106 FASLODEX ......................... 17 FAZACLO............................ 62 FEIBA NF ............................ 32 felbamate .............................. 57 FELDENE ............................ 70 felodipine ...... 43, 47, 48, 50, 54 FEMCON FE ...................... 105 FEMHRT LOW DOSE ..... 107,
111 FEMRING .......................... 107 fenofibrate ............................ 49 fenofibrate micronized ......... 48 fenofibric acid....................... 49 fenofibric acid (choline) ....... 49 FENOGLIDE........................ 49 fenoprofen ............................ 70 fentanyl ................................. 67 fentanyl citrate ...................... 67 fentanyl citrate (pf) ............... 67 FENTORA............................ 67 ferrous fumarate ................... 34 ferrous gluconate .................. 34 ferrous sulfate ....................... 34 FEVERALL.......................... 56 fexofenadine ................... 2, 127 FIBER SMOOTH ................. 97 FINACEA ........................... 141
finasteride ........................... 114 FIRAZYR ........................... 117 FIRMAGON ......... 17, 104, 118 FISH OIL .............................. 40 FLAGYL ............................ 4, 6 FLAGYL ER ...................... 4, 6 FLAREX ............................... 91 flavoxate ............................. 143 FLEBOGAMMA DIF .......... 21 flecainide .............................. 45 FLECTOR ............ 70, 140, 141 FLINTSTONES COMPLETE
(IRON) ...................... 34, 145 FLOMAX ............................. 28 FLONASE .................... 91, 126 FLORICAL ........................... 83 FLOVENT DISKUS .. 102, 126 FLOVENT HFA ......... 102, 126 floxuridine ............................ 17 FLUBLOK 2013-2014 (PF) . 22 FLUCELVAX 2013-2014 (PF)
.......................................... 22 fluconazole ............................. 8 fluconazole in dextrose(iso-o) 8 fluconazole in nacl (iso-osm) . 8 fludarabine ............................ 17 fludrocortisone .................... 102 FLULAVAL QUAD 2013-
2014 .................................. 22 flumazenil ..................... 64, 114 FLUMIST 2012-2013 ........... 22 flunisolide ..................... 91, 126 fluocinolone ................ 131, 137 fluocinolone and shower cap
................................ 131, 137 fluocinonide ................ 131, 137 FLUOCINONIDE-E ... 131, 137 FLUORABON .................... 116 FLUOR-A-DAY ................. 116 FLUOR-A-DAY (WITH
XYLITOL) ..................... 116 FLUORETS .......................... 77 fluoride (sodium) ................ 116 FLUORIDEX DAILY
DEFENSE ....................... 117 fluorometholone ................... 91 FLUOROPLEX ............ 17, 141 fluorouracil ............. 17, 18, 142 fluoxetine .............................. 74 fluphenazine decanoate ........ 71 fluphenazine hcl .................... 71
163
FLURA-DROPS ................ 117 flurazepam ............................ 64 flurbiprofen........................... 70 flurbiprofen sodium .............. 93 flutamide............................... 18 fluticasone propionate 131, 137 fluvastatin ............................. 49 FLUVIRIN 2012-2013 ......... 22 FLUVIRIN 2012-2013 (PF) . 22 FLUVIRIN 2013-2014 ......... 22 FLUVIRIN 2013-2014 (PF) . 22 fluvoxamine .......................... 74 FLUZONE HIGH-DOSE
2012-13 (PF) .................... 22 FML S.O.P. .......................... 91 FOCALIN XR ...................... 71 FOLBECAL ......... 83, 145, 149 FOLCAL DHA 34, 83, 97, 145,
149 folic acid ............................. 149 FOLIVANE-PRX DHA NF 34,
97, 145, 149 FOLLISTIM AQ ........ 108, 109 FOLOTYN ........................... 18 fomepizole .......................... 114 fondaparinux................... 30, 31 FORADIL AEROLIZER .... 29,
127 FORTAZ ................................ 4 FORTAZ IN DEXTROSE 5 %
............................................ 4 FORTEO .................... 110, 116 FORTESTA ........................ 104 FOSAMAX PLUS D .. 116, 153 foscarnet ................................. 8 fosinopril .............................. 39 fosinopril-hydrochlorothiazide
.............................. 39, 53, 87 fosphenytoin ......................... 65 FOSRENOL ................. 81, 114 FRAGMIN ........................... 33 FREAMINE HBC 6.9 % ...... 79 FREAMINE III 3 %-
ELECTROLYTES ........... 79 FROVA ................................ 73 FULYZAQ ........................... 95 FUNGI CURE .................... 134 FURADANTIN .................... 15 furosemide ...................... 50, 81 FUSILEV ........................... 114 FUZEON ................................ 9
FYCOMPA ........................... 57 G gabapentin ...................... 56, 57 GABITRIL ........................... 57 GABLOFEN ......................... 27 galantamine .......................... 28 GAMASTAN S/D ................ 21 GAMMAGARD LIQUID .... 21 GAMMAGARD S/D ............ 21 GAMMAGARD S-D (IGA < 1
MCG/ML) ........................ 21 GAMUNEX-C...................... 21 ganirelix ...................... 104, 118 GARAMYCIN ..................... 89 GARDASIL (PF) .................. 22 GASTROGRAFIN ............... 77 GASTROMARK .................. 76 GAVILYTE-G...................... 97 GAVILYTE-N...................... 97 GAVISCON EXTRA
STRENGTH ..................... 95 GELNIQUE ........................ 143 gemcitabine .......................... 18 gemfibrozil ........................... 49 GENOTROPIN .................. 110 GENOTROPIN MINIQUICK
........................................ 110 GENTAK.............................. 89 gentamicin .......................... 129 gentamicin in nacl (iso-osm) .. 5 gentamicin sulfate (pf)............ 5 GEODON ....................... 59, 62 GERI-HYDROLAC ........... 134 GERI-MUCIL
(ASPARTAME) ............... 97 GESTICARE DHA ..... 34, 145,
149 GIANVI (28) ...................... 105 GILDESS FE 1.5/30 (28) ... 105 GILDESS FE 1/20 (28) ...... 105 GILENYA .......................... 119 GLASSIA ........................... 126 GLEEVEC ............................ 18 glimepiride.......................... 112 glipizide .............................. 112 glipizide-metformin .... 105, 112 GLUCAGEN HYPOKIT .. 108,
115 GLUCAGON EMERGENCY
KIT (HUMAN)....... 108, 115 glucose .................................. 79
GLUMETZA ...................... 105 glyburide micronized .......... 112 glyburide-metformin ... 105, 112 glycerin (adult) ..................... 97 glycerin (child) ..................... 97 GLYCINE UROLOGIC ....... 80 glycopyrrolate ....................... 25 GLYSET ............................. 103 GOLYTELY ......................... 97 GONAL-F ................... 108, 109 GONAL-F RFF .......... 108, 109 GONAL-F RFF PEN .. 108, 109 GORDONS UREA ............. 139 granisetron (pf) ..................... 94 granisetron hcl ...................... 94 GRANISOL .......................... 94 GRANIX ............................... 31 GRIFULVIN V ....................... 5 griseofulvin microsize ............ 5 GRIS-PEG
(ULTRAMICROSIZE) ....... 6 GRX RINSE-FREE ............ 142 guaifenesin .......................... 124 guanfacine ....................... 45, 64 guanidine .............................. 28 GYNE-LOTRIMIN ............ 134 GYNOL II ............................ 75 H HALAVEN ........................... 18 HALFLYTELY-BISACODYL
W-FLAV PK .................... 97 HALFPRIN ......... 36, 37, 61, 72 halobetasol propionate 131, 137 HALOG ...................... 131, 137 HALONATE .............. 131, 137 haloperidol ............................ 64 haloperidol decanoate ........... 64 haloperidol lactate ................ 64 HAVRIX (PF) ...................... 22 HC-1% HEMORRHOID ... 131,
137 HECTOROL ....................... 153 HELIDAC ......... 4, 6, 13, 15, 97 HELIXATE FS ..................... 32 HEMABATE ...................... 122 HEMENATAL OB ..... 145, 149 HEMENATAL OB + DHA
................................ 145, 149 HEMOFIL M HIGH ............. 32 HEMOFIL M LOW .............. 32 HEMOFIL M MID ............... 32
164
HEMOFIL M SUPER HIGH32 HEMORRHOIDAL (WITCH
HAZEL) ......................... 134 HEPAGAM B ...................... 21 heparin (porcine) .................. 33 heparin (porcine) in 5 % dex 33 heparin(porcine) in 0.45% nacl
.......................................... 33 heparin, porcine (pf) ............. 33 HERCEPTIN ........................ 18 HESPAN 6 % IN NS ............ 83 HEXALEN ........................... 18 HEXTEND ........................... 83 HIGH POTENCY
CAPSAICIN ................... 142 HIPREX ............................... 15 HIZENTRA .......................... 21 HOMATROPAIRE .............. 94 HONEY BEE TREATMENT
............................ 21, 76, 121 HUMALOG MIX 50-50
KWIKPEN ..... 109, 110, 112 HUMALOG MIX 75-25
KWIKPEN ..... 109, 110, 112 HUMALOG U-100 INSULIN
................................ 109, 112 HUMATE-P ......................... 32 HUMATROPE ................... 110 HUMIRA ...... 99, 117, 119, 142 HUMIRA PEN .... 99, 117, 119,
142 HUMULIN 70/30 INSULIN
PEN ................ 109, 110, 112 HUMULIN N PEN..... 109, 110 HUMULIN R REGULAR U-
100 INSULN .......... 109, 112 HUMULIN R U-500 (CONC)
INSULIN ................ 109, 112 HYCAMTIN ........................ 18 hydralazine ........................... 48 HYDREA ............................. 18 HYDRO 35 ......................... 139 HYDRO 40 ......................... 139 hydrochlorothiazide ........ 53, 87 hydrocodone-acetaminophen
.................................... 56, 67 hydrocodone-ibuprofen .. 67, 70 hydrocortisone ............ 131, 137 hydrocortisone acetate 131, 137 hydrocortisone butyrate ..... 131,
137
hydrocortisone valerate ..... 132, 137
hydrocortisone-aloe vera ... 132, 137
hydrocortisone-pramox-e-pram.1 ............. 132, 133, 137
hydrocortisone-pramoxine . 132, 133, 137, 138
hydromorphone .................... 67 hydromorphone (pf) ............. 67 HYDROPHOR ................... 135 hydroxychloroquine 6, 117, 119 hydroxyzine hcl ................ 2, 61 hydroxyzine pamoate ....... 2, 61 HYLENEX ........................... 88 hyoscyamine sulfate ............. 25 HYPERHEP B S-D
NEONATAL .................... 21 HYPERLYTE CR ................ 83 HYPERRAB S/D (PF) ......... 21 HYPERRHO S/D ................. 21 HYPER-SAL .................. 75, 83 HYPERTET S/D (PF) .......... 21 HYPOTEARS ...................... 92 I ibandronate ......................... 116 ibuprofen .............................. 70 IBUPROFEN JR STRENGTH
.......................................... 70 ibuprofen-oxycodone...... 67, 70 IDAMYCIN PFS .................. 18 IFEX ..................................... 18 ifosfamide ............................. 18 ifosfamide-mesna ................. 18 ILUVIEN .............................. 91 IMDUR ................................. 51 imipenem-cilastatin ................ 8 imipramine hcl ...................... 75 imipramine pamoate ............. 75 imiquimod .......................... 142 IMITREX ............................. 73 IMOVAX RABIES VACCINE
(PF) ................................... 22 IMPLANON ....................... 105 INCIVEK................................ 9 INCRELEX ........................ 112 indapamide ..................... 53, 87 INDOCIN ..................... 70, 115 indomethacin ................ 70, 115 INFANRIX (DTAP) (PF) ..... 21 INFANT'S IBUPROFEN ..... 70
INFERGEN .......................... 11 INNOPRAN XL 27, 41, 46, 50,
61 INTEGRILIN ....................... 37 INTELENCE ........................ 10 INTRALIPID ........................ 80 INTRON A ............. 11, 18, 119 INTROVALE ..................... 106 INTUNIV ER ................. 45, 64 INVANZ ................................. 8 INVEGA ............................... 62 INVEGA SUSTENNA ......... 62 INVIRASE ........................... 10 IODOPEN ........................... 104 IONOSOL-B IN D5W .......... 83 IONOSOL-MB IN D5W ...... 83 IOPIDINE ............................. 92 ipecac .................................... 99 IPOL ..................................... 22 ipratropium bromide ...... 25, 92,
123 ipratropium-albuterol ..... 25, 29,
123, 127 IPRIVASK ............................ 31 irbesartan-hydrochlorothiazide
.............................. 38, 53, 87 irinotecan .............................. 18 IROSPAN 24/6 ..... 34, 149, 152 ISENTRESS ......................... 10 ISOLYTE M IN 5 %
DEXTROSE ..................... 83 ISOLYTE S PH 7.4 .............. 83 ISOLYTE-P IN 5 %
DEXTROSE ..................... 83 ISOLYTE-S .......................... 83 isoniazid .................................. 7 ISOPTO CARBACHOL ...... 93 ISOPTO HOMATROPINE .. 94 ISOPTO HYOSCINE ........... 94 ISOPTO TEARS .................. 92 ISORDIL .............................. 51 isosorbide dinitrate ............... 51 isosorbide mononitrate ......... 51 ISOVUE-300 ........................ 77 ISOVUE-M 300 .................... 77 isradipine ...... 43, 47, 48, 50, 54 ISTALOL ............................. 90 ISTODAX ............................. 18 ISUPREL ...................... 27, 126 itraconazole ............................. 8 IXEMPRA ............................ 18
165
IXIARO (PF) ........................ 22 J JALYN ......................... 28, 114 JANUMET ................. 105, 106 JANUVIA........................... 106 JENTADUETO .......... 105, 106 JETREA (PF) ....................... 92 JEVTANA ............................ 18 JINTELI ..................... 107, 111 JUNEL 1.5/30 (21) ............. 106 JUNEL 1/20 (21) ................ 106 JUXTAPID ........................... 40 K KADIAN .............................. 68 KALBITOR ........................ 117 KALETRA ........................... 10 KALYDECO ...................... 124 karaya gum (bulk) ................ 97 KEFLEX................................. 3 KELNOR 1/35 (28) ............ 106 KENALOG......... 102, 132, 138 KEPIVANCE ..................... 135 KERAFOAM ..................... 139 ketamine ............................... 65 KETEK ................................. 11 ketoconazole ................... 8, 134 ketoprofen............................. 70 ketorolac ............................... 70 ketotifen fumarate ................ 88 KIDKARE COUGH/COLD .. 2,
24, 123, 124, 125 KINERET ................... 118, 119 KINRIX (PF) ........................ 22 KIONEX....................... 81, 115 KIONEX (WITH SORBITOL)
.................................. 81, 115 KLARON ........................... 140 KLOR-CON ......................... 83 KLOR-CON 8 ...................... 83 KLOR-CON M10 ................. 83 KLOR-CON M15 ................. 83 KLOR-CON M20 ................. 83 KLOR-CON/25 .................... 83 KOATE-DVI ........................ 32 KOMBIGLYZE XR ... 105, 106 KONSYL (SUGAR) ............ 98 KPN ...................... 34, 145, 149 KRISTALOSE ..................... 78 KRYSTEXXA .................... 116 KUVAN ............................. 121 K-Y LUBRICATING ......... 142
L labetalol .. 27, 28, 37, 38, 41, 46 LAC-HYDRIN FIVE ......... 135 LACRISERT ........................ 92 lactase ................................... 99 lactated ringers ............... 80, 83 lactic acid ............................ 135 lactulose ................................ 78 LAMICTAL ODT .......... 57, 59 LAMICTAL ODT STARTER
(BLUE) ....................... 57, 59 LAMICTAL ODT STARTER
(GREEN) .................... 57, 59 LAMICTAL ODT STARTER
(ORANGE) ................. 57, 59 LAMICTAL STARTER
(BLUE) KIT ............... 57, 59 LAMICTAL STARTER
(GREEN) KIT ............ 57, 59 LAMICTAL STARTER
(ORANGE) KIT ......... 57, 59 LAMICTAL XR ................... 58 LAMICTAL XR STARTER
(BLUE) ............................. 58 LAMICTAL XR STARTER
(GREEN) .......................... 58 LAMICTAL XR STARTER
(ORANGE) ....................... 58 LAMISIL ................................ 4 LAMISIL AF ...................... 143 lamivudine ............................ 10 lamivudine-zidovudine ......... 10 lamotrigine................ 58, 59, 60 LANOXIN PEDIATRIC 40, 44 lansoprazole ........................ 101 LANTUS SOLOSTAR U-100
INSULIN ................ 109, 110 LASTACAFT ....................... 88 latanoprost ............................ 94 LATRIX XM ...................... 139 LATUDA.............................. 62 LAXATIVE (BISACODYL)98 LESCOL XL......................... 49 letrozole ........................ 18, 104 leucovorin calcium ............. 115 LEUKERAN ........................ 18 LEUKINE ............................. 31 leuprolide .............. 18, 108, 109 levalbuterol hcl ............. 29, 127 LEVAQUIN IN 5 %
DEXTROSE ................. 7, 14
LEVATOL ............................ 41 LEVEMIR U-100 INSULIN
................................ 109, 110 levetiracetam ......................... 58 LEVITRA ............................. 52 levobunolol ........................... 90 levocarnitine (with sugar) ... 121 levocetirizine .................. 2, 127 levofloxacin ................ 7, 14, 89 levofloxacin in d5w .......... 7, 14 LEVOMEFOLATEPNV ..... 34,
83, 145, 149 levonorgestrel ..................... 106 levorphanol tartrate ............... 68 levothyroxine ...................... 113 LEVSIN ................................ 25 LEVULAN ......................... 142 LEXIVA ............................... 11 LIALDA ............................... 97 lidocaine ............................. 133 lidocaine (pf) in d7.5w ...... 113 lidocaine (pf) ................ 45, 113 lidocaine hcl .......... 93, 114, 133 lidocaine hcl-hydrocortison ac
........................ 132, 133, 138 LIDOCAINE PAIN RELIEF
........................................ 133 LIDOCAINE VISCOUS ...... 93 lidocaine-epinephrine ... 24, 114 lidocaine-epinephrine (pf) ... 24,
114 lidocaine-hydrocortisone-aloe
........................ 132, 133, 138 lidocaine-prilocaine ............ 133 LIDODERM ....................... 133 LINCOCIN ........................... 11 lindane ................................ 140 LIORESAL ........................... 27 liothyronine ......................... 113 LIPODOX ............................. 18 LIPOFEN .............................. 49 LIQUID E-Z PAQUE ........... 77 LIQUID POLIBAR .............. 77 lisinopril .......................... 39, 40 lisinopril-hydrochlorothiazide
........................ 39, 40, 53, 87 lithium carbonate .................. 60 lithium citrate ........................ 60 LITHOSTAT ........................ 78 LIVALO ............................... 49 L-METHYLFOLATE ........ 149
166
L-METHYLFOLATE PNV DHA ........... 34, 83, 145, 149
LO LOESTRIN FE............. 106 LOCOID ..................... 132, 138 LOCOID LIPOCREAM .... 132,
138 LODOSYN ........................... 64 lomustine .............................. 18 loperamide ............................ 95 loratadine .................... 2, 3, 127 LORATADINE-D ... 3, 24, 123,
127 lorazepam ....................... 63, 64 losartan ................................. 38 losartan-hydrochlorothiazide
.............................. 38, 53, 87 LOSEASONIQUE ............. 106 LO-SO PREP........................ 98 LOTRIMIN AF .................. 134 LOTRIMIN AF POWDER 134 LOTRIMIN ULTRA .......... 135 LOTRONEX ........................ 97 lovastatin .............................. 49 LOVAZA ............................. 40 loxapine succinate ................ 61 LUBRICANT EYE .............. 92 LUCENTIS........................... 92 LUFYLLIN ................ 128, 144 LUMIGAN ........................... 94 LUMIZYME ........................ 88 LUPRON DEPOT 18, 108, 109 LUPRON DEPOT (3
MONTH) .......... 18, 108, 109 LUPRON DEPOT (4
MONTH) .......... 18, 108, 109 LUPRON DEPOT-PED ...... 18,
108, 109 LUVOX CR.......................... 74 LUXIQ ....................... 132, 138 LYRICA ................... 56, 58, 65 LYSODREN......................... 18 LYSTEDA ............................ 32 M MACNATAL CN DHA 83, 98,
145, 149 MACRODANTIN ................ 15 MACUGEN .......................... 92 MACULAR VITAMIN..... 145,
149 MAG-AL .............................. 95 MAGNACET ................. 56, 68
magnesium............................ 83 magnesium citrate................. 98 magnesium oxide .................. 95 magnesium sulfate .. 40, 58, 115 magnesium sulfate in d5w ... 40,
58, 115 magnesium sulfate in water . 40,
58, 115 MAGONATE ....................... 83 MAKENA .......................... 111 MALARONE ......................... 6 MALARONE PEDIATRIC ... 6 malathion ............................ 141 mannitol 10 % .......... 51, 76, 81 mannitol 20 % .......... 51, 76, 81 mannitol 25 % .......... 51, 76, 81 mannitol 5 % ............ 51, 76, 81 MAPAP
(ACETAMINOPHEN) ..... 56 maprotiline............................ 75 MARNATAL-F .... 83, 145, 149 MARPLAN .......................... 66 MATULANE........................ 18 MAXAIR AUTOHALER ... 29,
128 MAXALT ............................. 73 MAXALT-MLT ................... 73 MAXIBAR ........................... 77 MAXITROL ................... 89, 91 meclizine .......................... 2, 96 meclofenamate...................... 70 MEDROL ........................... 102 medroxyprogesterone ......... 111 mefenamic acid..................... 70 mefloquine .............................. 6 MEFOXIN IN DEXTROSE
(ISO-OSM) ..................... 3, 8 MEGACE ES ............... 18, 111 megestrol ...................... 19, 111 melatonin ............................ 121 meloxicam ............................ 70 melphalan hcl ....................... 19 MEMBRANEBLUE ............ 77 MENACTRA (PF) ............... 22 MENEST ............................ 107 MENHIBRIX (PF) ............... 22 MENOMUNE - A/C/Y/W-135
(PF) ................................... 22 MENOPUR ................ 108, 109 MENOSTAR ...................... 107
MENVEO A-C-Y-W-135-DIP (PF) ................................... 22
meperidine ............................ 68 meperidine (pf) ..................... 68 MEPHYTON .............. 115, 154 meprobamate ........................ 61 mercaptopurine ............. 19, 120 meropenem ............................. 8 mesalamine ........................... 97 mesalamine with cleansing
wipe .................................. 97 mesna .................................. 122 MESNEX ............................ 122 MESTINON ......................... 28 MESTINON TIMESPAN .... 28 METADATE ER .................. 72 metaproterenol .............. 29, 128 METASTRON .................... 122 metaxalone ............................ 26 metformin ........................... 105 methadone ............................. 68 methimazole ....................... 104 METHITEST ...................... 104 methocarbamol ..................... 26 methotrexate sodium ... 19, 118,
119, 120 methotrexate sodium (pf) .... 19,
118, 119, 120 methscopolamine .................. 26 methyclothiazide ............. 53, 87 methyldopa ..................... 25, 45 methyldopate .................. 25, 45 methylene blue (antidote) ... 115 methylergonovine ............... 122 METHYLIN ......................... 72 methylphenidate hcl .............. 72 methylprednisolone ............ 102 methylprednisolone acetate 102 methylprednisolone sodium
succ ................................. 102 metipranolol .......................... 90 metoclopramide hcl ............ 100 metolazone ...................... 53, 87 metoprolol succinate . 30, 41, 46 metoprolol ta-hydrochlorothiaz
.................. 30, 41, 46, 53, 87 metoprolol tartrate ... 30, 41, 42,
46 METOZOLV ODT ............. 100 METRO I.V. ....................... 4, 6 metronidazole ............. 4, 6, 129
167
metronidazole in nacl (iso-os) ........................................ 4, 6
METVIXIA ........................ 142 mexiletine ............................. 45 MIACALCIN ..... 104, 110, 116 miconazole nitrate .............. 134 MICONAZOLE-3 .............. 134 midazolam ............................ 64 midazolam (pf) ..................... 64 midodrine ............................. 25 MIGRAINE FORMULA .... 37,
56, 61, 72 MIGRANAL .................. 27, 61 MILK OF MAGNESIA ....... 98 MILLIPRED....................... 103 MILLIPRED DP ................ 103 milrinone .............................. 44 milrinone in 5 % dextrose .... 44 MINERAL OIL LAXATIVE
.......................................... 98 MINERAL OIL LIGHT ..... 135 MINERIN CREME ............ 135 MINOCIN ............................ 15 MINOCIN KIT WITH WIPES
.......................................... 15 minocycline .................. 15, 142 minoxidil .............................. 48 MIRAPEX ER ...................... 66 MIRENA ............................ 106 mirtazapine ........................... 59 misoprostol ......................... 100 mitomycin............................. 19 mitoxantrone......................... 19 M-M-R II (PF) ...................... 22 moexipril ........................ 39, 40 moexipril-hydrochlorothiazide
........................ 39, 40, 53, 87 mometasone ................ 132, 138 MONISTAT 3 .................... 134 MONOCAL .......................... 83 MONOCLATE-P ................. 32 MONONESSA (28) ........... 106 montelukast ........................ 125 MONUROL .......................... 15 morphine............................... 68 morrhuate sodium ................. 52 MOTOFEN........................... 95 MOVIPREP .......................... 98 MOXATAG ........................... 5 MOZOBIL ............................ 31 MUCINEX ......................... 124
MULTAQ ............................. 46 MULTI-DELYN ................ 145 MULTIHANCE.................... 77 MURO 128 ........................... 92 MUSCLE RUB (WITH
CAMPHOR) ..................... 72 MUSE ................................... 54 MUSTARGEN ..................... 19 mv-min-folic acid-lutein.... 145,
149 MYCAMINE .......................... 8 MYCOBUTIN .................. 7, 14 mycophenolate sodium ....... 120 MYLERAN .......................... 19 MYNATAL .......... 83, 145, 149 MYNATAL PLUS83, 145, 149 MYNATE 90 PLUS ........... 145 MYOBLOC .................. 30, 121 N nabumetone .......................... 70 nadolol ................ 27, 41, 42, 46 nadolol-bendroflumethiazide
............ 27, 41, 42, 46, 53, 87 nafcillin in dextrose iso-osm 13 NAFTIN ............................. 128 NAGLAZYME ..................... 88 nalbuphine ............................ 69 NALFON .............................. 70 naloxone ....................... 69, 115 naltrexone ..................... 69, 114 NAMENDA.......................... 64 NAMENDA TITRATION
PAK .................................. 64 naphazoline ........................... 94 NAPRELAN CR .......... 70, 116 naproxen ....................... 70, 116 naproxen sodium .......... 70, 116 NARDIL ............................... 66 NAROPIN (PF) .................. 114 NASAL DECONGESTANT
(PSEUDOEPH) ........ 24, 123 NATACHEW (FE BIS-
GLYCINATE) .. 34, 145, 149 NATACYN .......................... 90 NATAFORT (NEW
FORMULA 2011) ... 34, 145, 150
NATALVIRT CA. 83, 145, 150 NATALVIT .......... 83, 145, 150 NATAZIA .......................... 106 nateglinide .......................... 110
NATELLE ONE .... 34, 84, 145, 150
NATRECOR ......................... 54 NATROBA ......................... 141 NATURE'S TEARS
(HYPROMELLOSE) ....... 92 NATURE-THROID ........... 113 NEBUPENT ........................... 6 NECON 1/50 (28) ............... 106 NECON 10/11 (28) ............. 106 nefazodone ............................ 74 NEO-FRADIN ........................ 5 neomycin ................................ 5 neomycin-bacitracin-poly-hc
.................................... 89, 91 neomycin-bacitracin-
polymyxin ......................... 89 neomycin-polymyxin b gu .. 129 neomycin-polymyxin-
gramicidin ......................... 89 neomycin-polymyxin-hc . 89, 91 NEOPROFEN (IBUPROFEN
LYSN)(PF) ....................... 70 neostigmine methylsulfate ... 28,
76 NEO-SYNEPHRINE
(PHENYLEPHRINE) ....... 25 NEPHRAMINE 5.4 % .......... 80 NEPHROCAPS .......... 150, 152 NEPRO CARB STEADY .... 80 NESACAINE ..................... 114 NEUMEGA .......................... 31 NEUPOGEN ......................... 31 NEUT ................................... 78 NEUTROGENA T-GEL
CONDITNER(SA) ......... 139 NEVANAC ........................... 93 nevirapine ............................. 10 NEXAVAR ........................... 19 NEXIUM ............................ 101 NEXIUM IV ....................... 101 NEXIUM PACKET ............ 101 NEXT CHOICE ONE DOSE
........................................ 106 niacin .................................... 40 NIACOR ............................... 40 NIASPAN EXTENDED-
RELEASE ......................... 40 nicardipine .... 43, 47, 48, 50, 54 nicotine ................................. 26 nicotine (polacrilex) .............. 26
168
NICOTROL .......................... 26 NICOTROL NS.................... 26 NIFEDICAL XL 43, 47, 48, 50,
54 nifedipine ...... 43, 47, 48, 50, 54 NILANDRON ...................... 19 nimodipine .... 43, 47, 48, 50, 54 nisoldipine .... 43, 47, 48, 50, 54 NITRO-BID ......................... 51 NITRO-DUR ........................ 51 nitrofurantoin macrocrystal .. 15 nitrofurantoin monohyd/m-
cryst .................................. 16 nitroglycerin ......................... 51 nitroglycerin in 5 % dextrose 51 NITROLINGUAL ................ 51 NITROMIST ........................ 51 NITROSTAT ........................ 51 nizatidine ............................ 100 NIZORAL A-D .................. 134 NORDITROPIN FLEXPRO
........................................ 110 NORDITROPIN NORDIFLEX
........................................ 110 norepinephrine bitartrate ...... 24 NORITATE ........................ 129 NORMOSOL-R ................... 84 NORMOSOL-R IN 5 %
DEXTROSE ..................... 84 NORMOSOL-R PH 7.4 ....... 84 NOROXIN ........................... 14 NORPACE CR ..................... 45 nortriptyline .......................... 75 NORVIR............................... 11 NOVOLOG MIX 70-
30FLEXPEN U-100 ...... 109, 110, 112
NOVOLOG PENFILL U-100 INSULIN ................ 110, 112
NOVOSEVEN RT ............... 32 NOXAFIL .............................. 8 NPLATE............................... 31 NUCORT ................... 132, 138 NUCYNTA .......................... 68 NUEDEXTA ................ 65, 124 NUTRAMIGEN WITH
ENFLORA LGG .............. 80 NUTRILYTE II .................... 84 NUTROPIN ........................ 110 NUTROPIN AQ ................. 111 NUTROPIN AQ NUSPIN . 111
NUVARING ....................... 106 NUVIGIL ............................. 75 NYAMYC .......................... 140 nystatin ......................... 13, 140 nystatin-triamcinolone ........ 140 O OB COMPLETE .. 34, 145, 150 OB COMPLETE 400 .. 34, 145,
150 OB COMPLETE ONE .. 34, 84,
145, 150 OB COMPLETE PREMIER
.................... 34, 84, 145, 150 OBSTETRIX EC ... 34, 98, 145,
150 OBTREX ........ 34, 98, 145, 150 O-CAL PRENATAL ... 84, 145,
150 OCELLA ............................ 106 octreotide acetate ........ 112, 121 OCUFLOX ........................... 89 OCUVITE LUTEIN AND
ZEAXANTHIN .............. 121 OCUVITE WITH LUTEIN 145 ofloxacin ......................... 14, 89 OGESTREL (28) ................ 106 olanzapine ....................... 60, 62 olanzapine-fluoxetine ..... 62, 74 olmesartan ............................ 38 OLUX-E ..................... 132, 138 OMECLAMOX-PAK ..... 5, 13,
101 omega-3 fatty acids-fish oil .. 40 omeprazole ......................... 101 omeprazole-sodium
bicarbonate ..................... 101 OMNARIS.................... 91, 126 OMNIPAQUE 240 ............... 77 OMNIPAQUE 300 ............... 77 OMNIPRED ......................... 91 OMNITROPE ..................... 111 ONCASPAR ......................... 19 ondansetron .......................... 94 ondansetron hcl..................... 94 ondansetron hcl (pf).............. 94 ONE DAILY MULTI-VIT W-
MINERAL ................ 34, 146 ONFI ............................... 63, 64 ONGLYZA ......................... 106 ONTAK ................................ 19 opium tincture................. 68, 95
ORACEA ...................... 15, 142 ORAL RELIEF DRY MOUTH
........................................ 142 ORALONE ................. 132, 138 ORAP ................................... 61 ORAPRED ODT ................ 103 ORENCIA (WITH
MALTOSE) ............ 118, 119 ORFADIN .......................... 121 orphenadrine citrate .............. 30 ORPHENADRINE
COMPOUND-DS ....... 30, 73 ORTHO TRI-CYCLEN (28)
........................................ 106 ORTHO TRI-CYCLEN LO
(28) ................................. 106 ORTHOVISC ....................... 75 OS-CAL 500 + D3........ 84, 153 OSMOPREP ......................... 98 OTEZLA ............. 118, 119, 142 OTEZLA STARTER . 118, 119,
142 OTICIN ........................... 91, 93 OTOZIN ............................... 93 OVIDREL ................... 108, 109 oxacillin ................................ 13 oxacillin in dextrose(iso-osm)
.......................................... 13 oxaliplatin ............................. 19 OXANDRIN ....................... 104 oxaprozin .............................. 70 oxcarbazepine ....................... 58 OXISTAT ........................... 134 OXSORALEN .................... 140 OXSORALEN ULTRA ...... 140 OXTELLAR XR .................. 58 oxybutynin chloride ............ 143 oxycodone ............................. 68 oxycodone-acetaminophen .. 56,
68 OXYCONTIN ...................... 68 oxymorphone ........................ 68 oxytocin .............................. 122 OXYTROL ......................... 143 OYSCO 500/D .............. 84, 153 OYSTER SHELL + D3 84, 153 OYSTER SHELL CALCIUM-
VIT D2 ...................... 84, 153 OZURDEX ........................... 91 P PACERONE ......................... 46
169
paclitaxel .............................. 19 PAIRE OB PLUS DHA ...... 34,
146, 150 pamidronate ........................ 116 PANCRELIPASE 5000 ....... 99 PANDEL .................... 132, 138 PANHEMATIN ................. 121 PANRETIN .................. 19, 142 pantoprazole ....................... 101 papaverine ............................ 54 paromomycin ...................... 4, 5 paroxetine hcl ....................... 74 PARVA-CAL 500 ........ 84, 153 PASER ................................... 7 PATADAY ........................... 88 PATANASE ......................... 88 PATANOL ........................... 88 PAXIL .................................. 74 PCE................................... 9, 11 PEDIADERM HC ...... 132, 138 PEDIARIX (PF) ............. 21, 22 PEDIASURE ........................ 80 PEDIATRIC ELECTROLYTE
.......................................... 84 PEDVAX HIB (PF) .............. 23 peg 3350-electrolytes ........... 98 PEGANONE ........................ 66 PEGASYS CONVENIENCE
PACK ............................... 11 PEGINTRON ....................... 11 penicillin g pot in dextrose ... 12 penicillin g sodium ............... 12 penicillin v potassium........... 12 PENNSAID .......... 71, 140, 142 PENTACEL (PF) ................. 23 PENTAM ............................... 6 pentazocine-naloxone ........... 69 pentostatin ............................ 19 pentoxifylline ....................... 31 PEPTIC RELIEF .................. 95 PERFOROMIST .......... 29, 128 PERIFRESH ....................... 138 permethrin .......................... 141 perphenazine......................... 71 perphenazine-amitriptyline.. 71,
75 PEXEVA .............................. 74 PHENABID .............. 2, 25, 125 phenazopyridine ................. 133 phenobarb-hyoscy-atropine-
scop....................... 26, 62, 63
phentolamine .................. 27, 50 phenylephrine hcl ................. 94 phenytoin ........................ 45, 66 phenytoin sodium ........... 45, 66 phenytoin sodium extended . 45,
66 PHISOHEX ........................ 140 PHOS-NAK .......................... 84 PHOSPHOLINE IODIDE .... 93 PHOTOFRIN........................ 19 PHYSIOLYTE ..................... 80 physostigmine salicylate...... 28,
115 pilocarpine hcl ................ 28, 93 PILOPINE HS ...................... 93 pindolol ......... 27, 41, 42, 46, 50 PINK BISMUTH ............ 95, 96 PINNACAINE...................... 93 PIN-X ..................................... 5 pioglitazone ........................ 113 piperacillin-tazobactam .......... 9 PITRESSIN ........................ 111 PKU 2 ................................... 80 PKU TRIO ............................ 80 PLACEBO #00 ................... 122 PLASMA-LYTE 148 ........... 84 PLASMA-LYTE A .............. 84 PLASMA-LYTE-56 IN 5 %
DEXTROSE ..................... 84 PNEUMOVAX-23 ............... 23 PNV FOLIC ACID + IRON 34,
146, 150 POLYCOSE ......................... 80 polyethylene glycol 3350 ..... 98 polymyxin b sulfate .............. 13 polymyxin b sulf-trimethoprim
.......................................... 89 POLY-VI-SOL ................... 146 POLY-VI-SOL WITH IRON
.................................. 35, 146 POLY-VITAMIN ............... 146 POLYVITAMIN WITH IRON
.................................. 35, 146 POLY-VITAMIN WITH
IRON ................................ 35 POLY-VITAMIN WITH
IRON .............................. 146 POMALYST ................ 19, 119 PONTOCAINE (PF) .......... 114 potassium acetate .................. 84
potassium bicarb and chloride .......................................... 84
potassium chlorid-d5-0.45%nacl ......................... 84
potassium chloride .......... 84, 85 potassium chloride in 0.9%nacl
.......................................... 84 potassium chloride in 5 % dex
.......................................... 84 potassium chloride in lr-d5 ... 84 potassium chloride in water .. 84 potassium chloride-0.45 % nacl
.......................................... 85 potassium chloride-d5-
0.2%nacl ........................... 85 potassium chloride-d5-
0.3%nacl ........................... 85 potassium chloride-d5-
0.9%nacl ........................... 85 potassium citrate ................... 78 potassium gluconate ............. 85 potassium phosphate m-/d-
basic .................................. 85 PR NATAL 430 EC ..... 85, 146,
150 PRADAXA ........................... 31 PRAMEGEL ANTI-ITCH . 133 pramipexole .......................... 66 pramoxine ........................... 133 PRANDIMET ............. 105, 110 PRANDIN .......................... 110 PRASCION RA .......... 139, 140 pravastatin ............................. 49 prazosin ..................... 27, 37, 38 PRED MILD ......................... 91 PRED-G .......................... 89, 91 PRED-G S.O.P. .............. 89, 91 prednisolone ....................... 103 prednisolone sodium phosphate
.................................. 91, 103 prednisone ........................... 103 PREDNISONE INTENSOL
........................................ 103 PREFERA-OB ONE ... 35, 146,
150 PREFEST ........................... 107 PREMARIN ....................... 107 PREMASOL 6 % ................. 80 PREMPHASE ..................... 107 PREMPRO ......................... 107 PRENA1 ............... 35, 146, 150
170
PRENA1 CHEW (QUATREFOLIC) . 146, 150
PRENA1 PLUS .... 35, 146, 150 PRENAISSANCE 90 DHA 35,
85, 98, 146, 150 PRENATA ........... 35, 146, 150 PRENATABS FA . 35, 85, 146,
150 PRENATABS RX . 35, 85, 146,
150 PRENATAL 19 (WITH
DOCUSATE) ......... 146, 150 PRENATAL LOW IRON ... 85,
146, 150 PRENATAL PLUS WITH
IRON (CA) ....... 85, 146, 150 PRENATAL VITAMIN 35, 85,
146, 150 PRENATAL VITAMIN PLUS
LOW IRON ...... 85, 146, 150 PRENATAL-U ................... 146 PRENATE DHA .. 35, 146, 150 PRENATE ELITE 35, 146, 150 PRENATE ESSENTIAL..... 35,
146, 150 PRENATE MINI .. 35, 146, 150 PRE-PEN .............................. 76 PREPIDIL .......................... 122 PREQUE 10 ... 35, 98, 146, 150 pretomanid .............................. 7 PREVACID SOLUTAB .... 101 PREVNAR 13 (PF) .............. 23 PREVPAC ................ 5, 13, 101 PREZISTA ........................... 11 PRIALT ................................ 56 PRIFTIN ........................... 7, 14 PRILOSEC ......................... 101 primaquine .............................. 6 primidone ............................. 62 PRIMLEV ...................... 56, 68 PRISTIQ ............................... 73 PROAIR HFA .............. 29, 128 probenecid .................... 87, 116 PROBIOTIC (S.BOULARDII)
.......................................... 99 procainamide ........................ 45 PROCENTRA ...................... 55 prochlorperazine edisylate... 71,
96 prochlorperazine maleate 71, 96 PROCRIT ............................. 31
PROCTOCORT.......... 132, 138 PROCTOFOAM HC . 132, 133,
138 PROFILNINE ....................... 32 progesterone ....................... 111 PROGLYCEM ................... 104 PROGRAF.......................... 120 PROHANCE ........................ 77 PROLEUKIN ............... 19, 119 PROLIA.............................. 116 PROMACTA ........................ 31 promethazine ............ 2, 61, 125 PROMETHAZINE VC ... 2, 25,
125 promethazine-dm ........ 124, 125 PROMETRIUM ................. 112 propafenone .......................... 45 propantheline ........................ 26 propofol .......................... 61, 65 propranolol .. 27, 41, 42, 46, 50,
61 propranolol-hydrochlorothiazid
............ 27, 41, 42, 46, 53, 87 propylthiouracil .................. 104 PROQUAD (PF)................... 23 PROSHIELD SPRAY
CLEANSER ................... 142 PROSOL 20 % ..................... 80 PROSTIGMIN...................... 28 PROSTIN E2 ...................... 122 protamine ...................... 30, 115 PROTECT NATAL ..... 85, 146,
151 PROTONIX ........................ 101 PROTOPAM CHLORIDE . 115 PROTOPIC ......................... 142 protriptyline .......................... 75 PROVENGE ......................... 55 PROVIGIL ........................... 75 PROVISC ............................. 76 PRUDOXIN ....................... 133 pseudoephedrine hcl ..... 24, 123 pseudoephedrine-guaifenesin
.......................... 24, 123, 124 psyllium husk ....................... 98 PULMICORT ............. 103, 126 PULMICORT FLEXHALER
................................ 103, 126 PULMOZYME ............. 88, 126 PURE AND GENTLE EYE . 92
PUREFE OB PLUS ..... 35, 146, 151
PYLERA ........... 4, 6, 13, 15, 97 pyrazinamide .......................... 7 PYRETHRIN LICE
TREATMENT M ........... 141 PYRI 500 ............................ 151 pyridoxine (vitamin b6) ...... 151 Q Q-DRYL ......................... 1, 125 Q-PAP ................................... 56 QUADRAMET ................... 122 QUALAQUIN ........................ 6 quetiapine ....................... 60, 62 QUILLIVANT XR ............... 72 quinapril .......................... 39, 40 quinapril-hydrochlorothiazide
........................ 39, 40, 53, 87 quinidine gluconate .......... 6, 45 quinidine sulfate ............... 6, 45 QUTENZA ......................... 142 QVAR ......................... 103, 126 R RABAVERT (PF) ................ 23 racepinephrine .............. 24, 123 ramipril ........................... 39, 40 RANEXA ............................. 44 ranitidine hcl ....................... 100 RAPAFLO ............................ 28 RAPAMUNE ...................... 120 READI-CAT ......................... 77 READI-CAT 2 ...................... 77 REBETOL ............................ 12 REBIF (WITH ALBUMIN)
........................................ 119 REBIF REBIDOSE ............ 119 REBIF TITRATION PACK
........................................ 119 RECLAST .......................... 116 RECOMBINATE ................. 32 RECOMBIVAX HB (PF) ..... 23 RECOTHROM ..................... 32 RECOTHROM SPRAY KIT 32 REFRESH LIQUIGEL ......... 92 REGONOL ........................... 28 REGRANEX .............. 135, 142 RELENZA DISKHALER .... 12 RELISTOR ........................... 99 RELPAX ............................... 73 REMICADE 99, 118, 119, 121,
142
171
REMODULIN .............. 54, 128 RENACIDIN ........................ 81 RENAGEL ................... 81, 115 RENA-VITE RX ................ 151 RENOVA ........................... 135 RENVELA ................... 81, 115 REOPRO .............................. 37 repaglinide .......................... 110 REPREXAIN ................. 68, 71 REPRONEX ............... 108, 109 RESCRIPTOR ...................... 10 RESECTISOL ...................... 81 reserpine ............................... 51 RESTASIS ........................... 92 RETAVASE ................... 37, 88 RETIN-A ............................ 135 RETIN-A MICRO .............. 135 RETISERT ........................... 91 RETROVIR .......................... 10 REVATIO .................... 52, 128 REVLIMID .................. 19, 119 REVONTO ........................... 26 REYATAZ ........................... 11 REZIRA ......... 24, 68, 123, 124 R-GENE 10 .......................... 77 RHEUMATREX . 19, 118, 119,
120 RHINOCORT ALLERGY .. 91,
126 RHINOCORT AQUA .. 91, 126 RHOPHYLAC ..................... 21 RIASTAP ............................. 32 RID LICE KILLING .......... 141 RIDAURA .......... 101, 118, 119 RIFADIN .......................... 7, 14 RIFAMATE ..................... 7, 14 RIFATER ......................... 7, 14 RILUTEK ............................. 65 rimantadine ............................. 4 RIMSO-50 .................... 81, 132 ringer's ............................ 81, 85 RISACAL-D................. 85, 153 RISPERDAL CONSTA . 60, 62 risperidone ...................... 60, 62 RITALIN LA........................ 72 RITUXAN ............................ 19 rivastigmine tartrate.............. 28 RIXUBIS .............................. 32 ROBAXIN ............................ 26 ROLAIDS............................. 95
ROLAIDS EXTRA STRENGTH ..................... 95
ropinirole .............................. 66 ROSADAN ......................... 129 ROTARIX ............................ 23 ROTATEQ VACCINE......... 23 ROXICET ....................... 56, 68 ROZEREM ........................... 61 S SABRIL ................................ 58 SAFYRAL .......................... 106 SAIZEN .............................. 111 SAIZEN CLICK.EASY ..... 111 salicylic acid ....................... 139 SALONPAS ......................... 73 salsalate ................................ 73 SAMSCA.............................. 87 SANCTURA ...................... 143 SANCTURA XR ................ 143 SANDIMMUNE 118, 119, 120 SANDOSTATIN LAR
DEPOT ................... 112, 121 SANTYL ............................ 142 SAPHRIS........................ 60, 62 SARAFEM ........................... 74 SAVELLA ...................... 65, 73 scopolamine hbr ................... 26 SCOT-TUSSIN SENIOR ... 124 SEASONIQUE ................... 106 SELECT-OB (FOLIC ACID)
.......................... 35, 146, 151 selegiline hcl ......................... 66 selenium sulfide .................. 140 SELZENTRY ......................... 9 SEMPREX-D ... 3, 24, 123, 127 SENNA ................................. 98 sennosides-docusate sodium. 98 SENSIPAR ................. 104, 121 SENSORCAINE-
EPINEPHRINE ........ 24, 114 SENSORCAINE-
MPF/EPINEPHRINE ...... 24, 114
SEREVENT DISKUS .. 29, 128 SEROQUEL XR............. 60, 62 SEROSTIM ........................ 111 sertraline ............................... 74 SE-TAN DHA ...... 35, 146, 151 SETONET ...... 35, 85, 147, 151 SETONET-EC 35, 85, 147, 151 sevelamer carbonate ..... 81, 115
SFROWASA ........................ 97 SILACE ................................ 98 SILENOR ............................. 75 SILVADENE ...................... 140 SIMCOR ....................... 49, 151 simethicone ........................... 96 SIMILAC ALIMENTUM .... 80 SIMILAC EXPERT CARE
NEOSURE ........................ 80 SIMPONI .............. 99, 118, 119 SIMULECT ........................ 120 simvastatin ............................ 49 SINGLE USE EZ FLU 2013-
14 (PF) .............................. 23 SKELID .............................. 116 sodium acetate ...................... 85 sodium bicarbonate ......... 78, 95 sodium chloride ........ 76, 85, 92 sodium chloride 0.45 % ........ 85 sodium chloride 0.9 % .......... 85 sodium chloride 3 % ............. 85 sodium chloride 5 % ............. 85 sodium citrate-citric acid ...... 78 SODIUM EDECRIN ...... 50, 81 sodium lactate ....................... 78 sodium phosphate ................. 86 sodium thiosulfate .............. 115 solifenacin ........................... 143 SOLIRIS ............................. 117 SOLODYN ................... 15, 142 SOLU-CORTEF ACT-O-
VIAL (PF) ...................... 103 SOLU-MEDROL ............... 103 SOMATULINE DEPOT .... 112 SOMAVERT ...................... 112 SONATA .............................. 61 sotalol ........... 27, 41, 42, 46, 50 SOTRADECOL .................... 52 SPIRIVA WITH
HANDIHALER ........ 26, 123 spironolactone ..... 50, 51, 52, 82 SPORANOX ........................... 8 SPRYCEL ............................. 19 SSKI ............... 6, 104, 115, 124 STALEVO 100 ............... 64, 65 STALEVO 125 ............... 64, 65 STALEVO 150 ............... 64, 65 STALEVO 200 ............... 64, 65 STALEVO 50 ................. 64, 65 STALEVO 75 ................. 64, 65 stavudine ............................... 10
172
STAVZOR ............... 58, 60, 61 STAXYN .............................. 52 STELARA .......... 118, 119, 142 STENDRA ........................... 52 STERILE SALINE ............... 81 STIMATE..................... 33, 111 STOMACH RELIEF MAX
STRENGTH ............... 95, 96 STOOL SOFTENER ............ 98 STRATTERA ....................... 65 STRIANT ........................... 104 STROMECTOL ..................... 5 SUBOXONE ........................ 69 sucralfate ............................ 100 SUDAFED 24 HOUR .. 24, 123 SUDOGEST ................. 24, 123 SUDOGEST 12-HOUR 24, 123 SUFENTA ............................ 68 sulfacetamide-prednisolone .. 89 sulfadiazine........................... 14 sulfamethoxazole-trimethoprim
.......................................... 15 SULFAMYLON................. 140 sulindac................................. 71 sumatriptan succinate ........... 73 SUMAVEL DOSEPRO ....... 73 SUPARTZ ............................ 76 SUPPRELIN LA .. 19, 108, 109 SUPRAX ................................ 4 SUPREP BOWEL PREP KIT
.......................................... 98 SURMONTIL....................... 75 SUSTIVA ............................. 10 SUTENT............................... 19 SYMAX DUOTAB .............. 26 SYMLINPEN 120 .............. 103 SYNAGIS............................. 12 SYNALGOS-DC ..... 37, 61, 68,
72, 73, 124 SYNAREL ................. 108, 109 SYNERA ............................ 133 SYNERCID .......................... 14 SYNVISC ............................. 76 SYPRINE ........................... 101 T TABLOID ............................ 19 TACLONEX ...... 132, 138, 142 TAGITOL V ......................... 77 TALWIN .............................. 69 TAMIFLU ............................ 12 tamoxifen ...................... 19, 106
TARCEVA ........................... 19 TARGRETIN ............... 19, 142 TARKA .. 39, 40, 42, 43, 44, 55 TARON-BC.... 35, 86, 147, 151 TASIGNA ............................ 19 TASMAR ............................. 64 TAXOTERE ......................... 20 TAZORAC ......................... 142 TEARS NATURALE FREE
(PF) ................................... 92 TEFLARO .............................. 4 TEGRETOL XR ............. 58, 60 TEKAMLO .. 43, 47, 48, 52, 55 TEKTURNA ........................ 52 TEKTURNA HCT ... 52, 53, 87 telmisartan ............................ 38 telmisartan-amlodipine .. 38, 39,
43, 47, 48, 55 temazepam ............................ 64 TEMODAR .......................... 20 TENSION HEADACHE
RELIEF ...................... 56, 72 terazosin.................... 27, 38, 50 terbinafine hcl ..................... 128 TERBINEX ............................ 4 terbutaline ..................... 29, 128 terconazole.......................... 134 TESTOPEL ........................ 104 testosterone enanthate......... 104 tetanus toxoid,adsorbed (pf) . 21 tetanus-diphtheria toxoids-td 22 TETCAINE .......................... 93 tetracycline ........................... 15 TEVETEN HCT . 38, 39, 53, 87 TEXACORT ............... 132, 138 THALOMID ....................... 119 THEO-24 ........ 48, 80, 128, 144 THEOCHRON 48, 80, 128, 144 theophylline .... 48, 80, 128, 144 THERA ............................... 147 THERACYS ................... 20, 23 THERA-GEL...................... 139 THERA-GESIC .................... 73 THERA-M ...... 35, 86, 147, 151 THERATEARS .................... 92 THERATRUM COMPLETE
50 PLUS/LUT ................ 147 THEREMS-M .............. 35, 147 thiamine mononitrate (vit b1)
........................................ 151 THIOLA ............................. 121
thioridazine ........................... 71 thiotepa ................................. 20 thiothixene ............................ 74 THROMBATE III ................ 30 THROMBIN-JMI ................. 33 THYMOGLOBULIN ......... 120 THYROLAR-1 ................... 113 THYROLAR-1/2 ................ 113 THYROLAR-1/4 ................ 113 THYROLAR-2 ................... 113 THYROLAR-3 ................... 113 THYROSHIELD ... 6, 104, 115,
124 tiagabine ............................... 58 TICE BCG ...................... 20, 23 ticlopidine ............................. 37 TIGAN .................................. 96 TIKOSYN ............................. 46 TIMENTIN ............................. 9 timolol maleate ..................... 90 TINACTIN ......................... 143 tinidazole ................................ 6 tioconazole .......................... 134 TIROSINT .......................... 113 tizanidine .............................. 26 TOBRADEX .................. 89, 91 TOBRADEX ST ............. 89, 91 tobramycin ............................ 89 tobramycin in 0.225 % nacl .... 5 tobramycin in 0.9 % nacl ........ 5 TOBREX .............................. 89 TODAY CONTRACEPTIVE
SPONGE ........................... 75 tolazamide ........................... 113 tolmetin ................................. 71 tolnaftate ............................. 143 tolterodine ........................... 143 topiramate ............................. 58 topotecan ............................... 20 TORISEL .............................. 20 torsemide ........................ 50, 81 TOVIAZ ............................. 143 TRACLEER ................. 55, 128 tramadol .......................... 68, 69 tramadol-acetaminophen56, 61,
69 TRANSDERM-SCOP .......... 96 tranylcypromine .................... 66 trazodone .............................. 74 TREANDA ........................... 20 TRECATOR ........................... 7
173
TRELSTAR .................. 20, 108 tretinoin (chemotherapy) ...... 20 tretinoin (emollient)............ 135 TRETIN-X ......................... 135 TRETIN-X (GEL) .............. 135 TRETIN-X CREAM KIT... 135 TREXALL ............ 20, 118, 120 TREXIMET .................... 71, 73 TREZIX ................................ 69 TRIADVANCE ..... 35, 86, 147,
151 triamcinolone acetonide ...... 91,
126, 132, 138 triamterene-hydrochlorothiazid
........................ 52, 53, 82, 87 TRIANEX .................. 132, 138 triazolam ............................... 64 TRIBENZOR .... 38, 39, 43, 47,
48, 53, 55, 87 TRI-BUFFERED ASPIRIN 37,
61, 73 TRICARE PRENATAL DHA
ONE(DSS) ........ 98, 147, 151 TRICITRASOL .............. 30, 78 TRICOR ............................... 49 trifluoperazine ...................... 71 trifluridine............................. 90 trihexyphenidyl............... 26, 57 TRI-LUMA ........................ 138 trimethoprim ......................... 16 TRINATAL GT.......... 147, 151 TRINATAL ULTRA..... 86, 98,
147, 151 TRINATE ....... 35, 86, 147, 151 TRIPLE ANTIBIOTIC ...... 129 TRIPLE VITAMIN WITH
FLUORIDE ... 117, 147, 148, 152, 153
TRISENOX .......................... 20 TRIVEEN-DUO DHA .. 35, 86,
147, 151 TRIVEEN-ONE .... 35, 86, 147,
151 TRIVEEN-PRX RNF .... 35, 86,
98, 147, 151 TRIVEEN-TEN .... 35, 147, 151 TRI-VI-SOL WITH IRON .. 35,
147, 148, 152, 153 TRI-VITAMIN .. 147, 148, 152,
153 TRIXAICIN ....................... 142
TRIXAICIN HP ................. 142 tropicamide ........................... 94 TRUETEST TEST STRIPS . 76 TRUETRACK TEST ........... 76 TRUVADA .......................... 10 TUSSIN .............................. 124 TWINRIX (PF)..................... 23 TYGACIL .............................. 9 TYKERB .............................. 20 TYPHIM VI ......................... 23 TYSABRI ........................... 120 TYVASO ...................... 55, 128 TYZEKA .............................. 12 TYZINE................................ 94 U ULESFIA.................... 140, 141 ULORIC ............................. 116 ULTIMATECARE ONE NF
.................... 35, 86, 147, 151 ULTIVA ............................... 69 ULTRA FRESH ................... 93 ULTRACIN T ...................... 73 ULTRAVATE PAC ... 132, 138 UMECTA NAIL FILM PEN
........................................ 139 UMECTA PD ..................... 139 UNASYN ............................... 5 URAMAXIN ...................... 139 urea ..................................... 139 UREA (WITH
LACTIC,SALICY ACID) ........................................ 139
UROXATRAL ..................... 28 URSO FORTE ...................... 98 ursodiol ........................... 98, 99 UVADEX ........................... 140 V VAGINAL
CONTRACEPTIVE FILM .......................................... 75
VAGINAL CONTRACEPTIVE FOAM .......................................... 75
VAGISIL ............................ 133 valacyclovir .......................... 12 VALCHLOR ................ 20, 142 VALCYTE ........................... 12 valsartan-hydrochlorothiazide
........................ 38, 39, 53, 87 VALSTAR............................ 20 VANCOCIN ........................... 9
vancomycin ............................. 9 vancomycin in dextrose 5 % ... 9 VANIQA ............................ 143 VANOS ...................... 132, 138 VANTAS .............. 20, 108, 109 VAQTA (PF) ........................ 23 VARIBAR THIN LIQUID ... 77 VARIVAX (PF) .................... 23 VECTIBIX ........................... 20 VECTICAL ........................ 143 VELCADE ........................... 20 VELTIN ...................... 129, 135 VENATAL COMPLETE DHA
.......................... 86, 147, 151 venlafaxine ........................... 73 VENTAVIS .................. 55, 128 VERAMYST ................ 91, 126 verapamil ...... 42, 43, 44, 47, 55 VEREGEN ......................... 143 VERIPRED 20 .................... 103 VEXOL ................................. 91 VFEND ................................... 8 VIAGRA ............................... 52 VIBATIV ................................ 9 VIBRAMYCIN .................... 15 VICKS 44 CUSTOM CARE
DRY COUGH ................ 124 VICTOZA 2-PAK .............. 109 VICTRELIS ............................ 9 VIDAZA ............................... 20 VIDEX 2 GRAM PEDIATRIC
.......................................... 10 VIDEX 4 GRAM PEDIATRIC
.......................................... 10 VIIBRYD ............................. 74 VIMOVO ...................... 71, 101 VIMPAT ............................... 58 VINATE AZ ... 36, 86, 147, 151 VINATE CALCIUM .......... 147 VINATE DHA 36, 86, 147, 151 VINATE IC ........................ 147 VINATE II .......................... 147 VINATE M ........... 36, 147, 151 VINATE ONE 36, 86, 147, 151 VINATE PN CARE ........... 147 vinblastine ............................. 20 VINCASAR PFS .................. 20 vinorelbine ............................ 20 VIRACEPT ........................... 11 VIRAMUNE ......................... 10 VIRAZOLE .......................... 12
174
VIREAD ............................... 10 VIRT-BAL DHA... 36, 86, 147,
151 VIRT-PN .............. 36, 147, 151 VIRT-PN DHA .... 36, 147, 151 VIRT-SELECT 36, 86, 98, 147,
151 VISCOAT............................. 76 VISIPAQUE ......................... 77 VISTIDE .............................. 12 VISUDYNE ......................... 93 VITAFOL-PLUS .. 36, 148, 152 VITALETS ......................... 148 VITAMENT ............... 148, 152 vitamin a ............................. 148 VITAMIN B-1.................... 152 VITAMIN B-12.................. 152 VITAMIN B-6.................... 152 VITAMIN C ....................... 152 VITAMIN D3 ..................... 153 vitamin e (dl, acetate) ......... 154 VITASPIRE ......... 36, 148, 152 VITRASE ............................. 88 VIVA DHA .......... 36, 148, 152 VIVELLE-DOT ................. 107 VIVITROL ................... 69, 114 VIVOTIF BERNA VACCINE
.......................................... 23 VOLTAREN ........ 71, 140, 143 VOLUMEN .......................... 77 VOLUVEN 6 % ................... 86 voriconazole ........................... 8 VOTRIENT .......................... 20 VP-CH PLUS . 36, 98, 148, 152 VP-CH-PNV......... 36, 148, 152 VP-ERA OB PLUS ..... 36, 148,
152 VP-GGR-B6 ......... 86, 148, 152 VP-PNV-DHA ..... 36, 148, 152 VPRIV .................................. 88 VSL#3 .................................. 99 VUMON ............................... 20 VUSION ............................. 134 VYTORIN 10-10............ 45, 49 VYTORIN 10-20............ 45, 49
VYTORIN 10-40 ............ 45, 49 VYTORIN 10-80 ............ 45, 49 VYVANSE ........................... 55 W warfarin ................................ 31 WART REMOVER ............ 139 water for inject, bacteriostat
........................................ 122 water for irrigation, sterile .... 81 WELCHOL .................. 42, 104 WINRHO SDF ..................... 21 X XELODA.............................. 20 XENAZINE .................... 65, 75 XENICAL ............................ 99 XEOMIN ...................... 30, 121 XERESE ............. 132, 133, 138 XGEVA .............................. 116 XIAFLEX ............................. 88 XIFAXAN ............................ 14 XOLAIR ............................. 126 XOLEGEL.......................... 134 XOLOX .......................... 56, 69 XOPENEX ................... 29, 128 XOPENEX HFA .......... 29, 128 X-SEB T PLUS .................. 140 XULANE............................ 106 XYLOCAINE-
MPF/EPINEPHRINE ...... 24, 114
XYNTHA ............................. 33 XYNTHA SOLOFUSE ........ 33 XYREM................................ 65 Y YF-VAX (PF) ....................... 23 YODOXIN ............................. 4 Z ZALTRAP ............................ 20 ZAMICET ...................... 57, 69 ZANOSAR ........................... 20 ZATEAN-CH .. 36, 86, 98, 148,
152 ZATEAN-PN PLUS ...... 36, 86,
148, 152 ZAVESCA.......................... 121
ZEGERID ........................... 101 ZELAPAR ............................ 66 ZEMPLAR ......................... 153 ZENPEP ............................... 99 ZETIA ................................... 45 ZEVALIN (Y-90) ................. 20 ZIAGEN ............................... 10 zidovudine ............................ 10 ZINACEF ............................... 3 ZINACEF IN STERILE
WATER .............................. 3 zinc gluconate ....................... 86 zinc sulfate ............................ 86 ZINC-15 ............................... 86 ziprasidone hcl ................ 60, 62 ZIPSOR ................................ 71 ZIRGAN ............................... 90 ZMAX .................................. 13 ZOLADEX ........... 20, 108, 109 ZOLINZA ............................. 20 zolpidem ............................... 62 ZOLPIMIST ......................... 62 ZOMETA ........................... 116 ZOMIG ................................. 73 ZOMIG ZMT ........................ 73 ZONEGRAN ........................ 58 zonisamide ............................ 58 ZORBTIVE ........................ 111 ZORTRESS ........................ 120 ZORVOLEX ......................... 71 ZOSTAVAX (PF) ................ 23 ZOSYN IN DEXTROSE (ISO-
OSM) .................................. 9 ZOVIA 1/50E (28) ............. 106 ZOVIRAX .......................... 133 ZUBSOLV ............................ 69 ZUPLENZ ............................ 94 ZYCLARA ......................... 143 ZYDONE ........................ 57, 69 ZYFLO ............................... 125 ZYFLO CR ......................... 125 ZYLET ........................... 90, 91 ZYMAXID ........................... 90 ZYPREXA RELPREVV 60, 62 ZYVOX ................................ 13