Kaiser Permanente Insurance Company Formulary

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Kaiser Permanente Insurance Company Formulary
Kaiser Permanente Insurance Company Formulary
For California PPO and Out-of-Area plans
PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER
WHEN YOU PARTICIPATE IN OUR PPO AND OUT-OF-AREA HEALTH INSURANCE PLANS
OFFERED BY KAISER PERMANENTE INSURANCE COMPANY.
This formulary was updated on May 5, 2015 and is effective as of May 5, 2015. For more recent
information or other questions, please call MedImpact 24 hours a day, seven days a week (closed
holidays) at 1-800-788-2949. You can also access the Kaiser Permanente Insurance Company (KPIC)
formulary on our website: kp.org/kpic
What is the Kaiser Permanente Insurance Company (KPIC) Formulary?
A formulary is a list of covered drugs. The KPIC Formulary is an open formulary of unrestricted drugs that
are covered under your KPIC health insurance plan. The formulary consists of generic and brand drugs.
Unless specifically excluded under your plan, all FDA-approved drugs are part of your plan’s open
formulary.
What drugs are covered?
KPIC will generally cover brand and generic drugs listed on the KPIC Formulary as long as the drug is
medically necessary, the prescription is filled at a MedImpact Pharmacy and other coverage rules are
followed.
What drugs are not covered?
Drugs not listed on the KPIC Formulary are not covered and can be found under the Outpatient Prescription
Drug Benefits, Limitations & Exclusions section of your Certificate of Insurance.
Are there any restrictions on the drugs covered on the KPIC Formulary?
Some covered drugs may have additional requirements or limits on coverage, such as quantity limits.
For certain drugs, KPIC may limit the amount of the drug dispensed to a certain days’ supply. Quantity
limits, if any, can be found under the Outpatient Prescription Drug Benefits, Limitations & Exclusions
section of your Certificate of Insurance.
What is a brand-name drug?
Brand-name drugs are usually manufactured and sold by the drug company that originally researched and
developed the drug. When the patent on a brand-name drug expires, other drug companies may
manufacture and sell an FDA-approved generic version of the drug with the same active ingredient(s) at
lower prices.
1
KPIC PPO/OOA Formulary - revised May 5, 2015
What is a generic drug?
A generic drug is approved by the FDA as having the same active ingredient as the brand-name
drug. Generally, generic drugs cost less than brand-name drugs.
What drugs are eligible to be mailed from the mail order pharmacy?
Most drugs can be mailed from our mail order pharmacy. Some drugs (for example, drugs that are
extremely high cost or require special handling) may not be eligible for mailing. Drugs cannot be mailed
outside the United States.
You can order refills through our mail-order service online at www.walgreensmail.com or by phone.
There is no extra charge for mail order. The appropriate cost share (according to your prescription drug
benefit) will apply.
Your prescription drug benefit may have a lower cost share if you use the mail order
pharmacy.
Please refer to your Certificate of Insurance for complete details of your prescription drug benefit or call
KPIC Customer Service at 1-800-788-0710.
KPIC Formulary
The most current KPIC Formulary list begins on page 3; it provides coverage information about
some of the drugs covered by KPIC. All dosage forms and strengths for a particular drug listed
may not be on the KPIC Formulary. Some drugs have multiple dosage forms. In such cases,
some dosages may be on the KPIC Formulary and others not.
KPIC may add or remove drugs from the KPIC Formulary during the year. These changes to the formulary
are based on new information or new drugs that become available.
The table below identifies drugs based on their drug category – generic or brand. Typically, you will pay
a generic drug copayment for generic drugs and a brand drug copayment for brand drugs as shown in
your Schedule of Coverage. However, if you request a brand name drug when a generic is prescribed,
you may be responsible for paying the brand-name copayment plus the difference in cost between the
generic drug and the brand-name drug. Please refer to your Certificate of Insurance for details.
2
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
BRAND DRUG
40PSE-4BRM
60PSE-4CPM
ACETADRYL
ACETA-GESIC
ACETAMINOPHEN PM
ACETAMINOPHEN PM XTRA
STRENGTH
ACETAMINOPHENDIPHENHYDRAMINE
ADT ROBITUSSIN COUGH-COLD-FLU
ADULT ROBITUSSIN NIGHT M-S CLD
ADULT TUSSIN CHEST CONGESTION
ADULT WAL-TUSSIN
AEROBID
AEROSPAN
AHIST
AK-DEX
ALA-HIST IR
ALAVERT
ALDEX AN
ALER-CAP
ALER-TAB
ALKA-SELTZER PLUS ALLERGY
ALL DAY ALLERGY
ALL DAY ALLERGY RELIEF
ALL DAY ALLERGY-D
ALLEGRA
ALLEGRA ALLERGY
ALLEGRA ODT
ALLEGRA-D 12 HOUR
ALLEGRA-D 24 HOUR
ALLER-CHLOR
ALLERCLEAR
ALLERCLEAR D-12HR
ALLERCLEAR D-24HR
ALLER-EASE
ALLER-FEX
ALLER-G-TIME
ALLERGY
ALLERGY & COLD PE
ALLERGY & CONGESTION
ALLERGY & CONGESTION RELIEF
ALLERGY & SINUS
ALLERGY & SINUS HEADACHE
ALLERGY 4-HOUR
ALLERGY COMPLETE-D
ALLERGY CREAM
ALLERGY D-12
ALLERGY MEDICATION
ALLERGY MEDICINE
ALLERGY PLUS-SEVERE SINUS HA
ALLERGY PLUS-SINUS HEADACHE
ALLERGY RELIEF
3
GENERIC DRUG
PSEUDOEPHEDRINE/BROMPHENIRAMIN
PSEUDOEPHED/CHLORPHENIRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
GUAIFENESIN
GUAIFENESIN
FLUNISOLIDE
FLUNISOLIDE
CHLORCYCLIZINE HCL
DEXAMETHASONE SOD PHOSPHATE
DEXBROMPHENIRAMINE MALEATE
LORATADINE
DOXYLAMINE SUCCINATE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
CETIRIZINE HCL
CETIRIZINE HCL
CETIRIZINE HCL/PSEUDOEPHEDRINE
FEXOFENADINE HCL
FEXOFENADINE HCL
FEXOFENADINE HCL
FEXOFENADINE/PSEUDOEPHEDRINE
FEXOFENADINE/PSEUDOEPHEDRINE
CHLORPHENIRAMINE MALEATE
LORATADINE
LORATADINE/PSEUDOEPHEDRINE
LORATADINE/PSEUDOEPHEDRINE
FEXOFENADINE HCL
FEXOFENADINE HCL
DIPHENHYDRAMINE HCL
CETIRIZINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
LORATADINE/PSEUDOEPHEDRINE
LORATADINE/PSEUDOEPHEDRINE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
CHLORPHENIRAMINE MALEATE
CETIRIZINE HCL/PSEUDOEPHEDRINE
DIPHENHYDRAMINE HCL
CETIRIZINE HCL/PSEUDOEPHEDRINE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
CETIRIZINE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
BRAND DRUG
ALLERGY RELIEF D
ALLERGY RELIEF D12
ALLERGY RELIEF D-24
ALLERGY RELIEF-D
ALLERGY RELIEF-NASAL DECONGEST
ALLERGY RELIEF-SINUS HEADACHE
ALLERGY SEVERE
ALLERGY-CONGESTION RELIEF
ALLERGY-CONGESTION RELIEF-D
ALLERGY-D
ALLERGY-TIME
ALLERHIST-1
ALLER-TEC
ALLER-TEC D
ALLFEN
ALVESCO
ANDEHIST
ANTIHIST
ANTIHISTAMINE
ANTIHISTAMINE ALLERGY
ANTI-ITCH
ARBINOXA
ARNUITY ELLIPTA
ASMANEX
ASMANEX HFA
ASTELIN
ASTEPRO
BANOPHEN
BECONASE AQ
BENADRYL
BENADRYL ALLERGY
BENADRYL ALLERGY PLUS COLD
BENADRYL ALLERGY PLUS SINUS
BENADRYL ITCH STOPPING
BENADRYL SEVERE ALLERGY-SINUS
BIDEX
BPM
BPM PSEUDO
BROMALINE
BROMAX
BROMPHENIRAMINE-PSEUDOEPHEDR
BROMPHENIRAMINEPSEUDOEPHEDRIN
BROMSPIRO
BROTAPP
BROVEX
BROVEX CT
BROVEX PSB
BROVEX PSE
4
GENERIC DRUG
FEXOFENADINE/PSEUDOEPHEDRINE
LORATADINE/PSEUDOEPHEDRINE
LORATADINE/PSEUDOEPHEDRINE
CETIRIZINE HCL/PSEUDOEPHEDRINE
LORATADINE/PSEUDOEPHEDRINE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
ACETAMINOPHEN/DIPHENHYDRAMINE
LORATADINE/PSEUDOEPHEDRINE
LORATADINE/PSEUDOEPHEDRINE
CETIRIZINE HCL/PSEUDOEPHEDRINE
CHLORPHENIRAMINE MALEATE
CLEMASTINE FUMARATE
CETIRIZINE HCL
CETIRIZINE HCL/PSEUDOEPHEDRINE
GUAIFENESIN
CICLESONIDE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
CARBINOXAMINE MALEATE
FLUTICASONE FUROATE
MOMETASONE FUROATE
MOMETASONE FUROATE
AZELASTINE HCL
AZELASTINE HCL
AZELASTINE HCL
DIPHENHYDRAMINE HCL
BECLOMETHASONE DIPROPIONATE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
BENADRYL COMPLETE ALLERGY
DIPHENHYDRAMINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
GUAIFENESIN
BROMPHENIRAMINE MALEATE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
PSEUDOEPHEDRINE/BROMPHENIRAMIN
BROMPHENIRAMINE MALEATE
BROMPHENIRAMINE MALEATE
BROMPHENIRAMINE TANNATE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
PSEUDOEPHEDRINE/BROMPHENIRAMIN
BROMPHENIRAMINE MALEATE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
BROMPHENIRAMINE TANNATE
BROMPHENIRAMINE TANNATE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
PSEUDOEPHEDRINE/BROMPHENIRAMIN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
BRAND DRUG
BROVEX SR
BUDESONIDE EC
CETIRI-D
CETIRIZINE-PSEUDOEPHEDRINE
CETIRIZINE-PSEUDOEPHEDRINE ER
CHEST CONGESTION
CHEST CONGESTION RELIEF
CHILD DELSYM COUGH+COLD
CHILD MUCINEX CHEST CONGESTION
CHILDREN'S ALL DAY ALLERGY
CHILDREN'S ALLEGRA ALLERGY
CHILDREN'S ALLERGY
CHILDREN'S ALLERGY COMPLETE
CHILDREN'S ALLERGY RELIEF
CHILDREN'S ALLER-TEC
CHILDREN'S BENADRYL ALLERGY
CHILDREN'S CETIRIZINE HCL
CHILDREN'S CHEST CONGESTION
CHILDREN'S CLARITIN
CHILDREN'S COLD & ALLERGY
CHILDREN'S COMPLETE ALLERGY
CHILDREN'S LORATADINE
CHILDREN'S MUCINEX
CHILDREN'S MUCUS RELIEF
CHILDREN'S WAL-DRYL ALLERGY
CHILDREN'S WAL-ZYR
CHILDREN'S ZYRTEC
CHILDREN'S ZYRTEC ALLERGY
CHILD'S BENADRYL ALLERGY
CHILDS TYLENOL COLD-ALLERGY
CHILD'S ZYRTEC ALLERGY
CHLOR HIST
CHLORPHEN-PSE
CHLORTABS
CHLOR-TRIMETON
CHLOR-TRIMETON ALLERGY
CLARINEX
CLARINEX-D 12 HOUR
CLARINEX-D 24 HOUR
CLARITIN
CLARITIN-D 12 HOUR
CLARITIN-D 24 HOUR
CLARITIN-D 24HR
COLD & ALLERGY
COLD & FLU RELIEF
COLD RELIEF
COMPLETE ALLERGY
COMPLETE ALLERGY MEDICINE
5
GENERIC DRUG
PSEUDOEPHEDRINE/BROMPHENIRAMIN
BUDESONIDE
BUDESONIDE
CARBINOXAMINE MALEATE
CETIRIZINE HCL/PSEUDOEPHEDRINE
CETIRIZINE HCL
CETIRIZINE HCL/PSEUDOEPHEDRINE
CETIRIZINE HCL/PSEUDOEPHEDRINE
GUAIFENESIN
GUAIFENESIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
GUAIFENESIN
CETIRIZINE HCL
FEXOFENADINE HCL
CETIRIZINE HCL
CETIRIZINE HCL
CETIRIZINE HCL
CETIRIZINE HCL
DIPHENHYDRAMINE HCL
CETIRIZINE HCL
GUAIFENESIN
LORATADINE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
DIPHENHYDRAMINE HCL
LORATADINE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
GUAIFENESIN
DIPHENHYDRAMINE HCL
CETIRIZINE HCL
CETIRIZINE HCL
CETIRIZINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
CETIRIZINE HCL
CHLORPHENIRAMINE MALEATE
PSEUDOEPHED/CHLORPHENIRAMINE
CHLORPHENIRAMINE MALEATE
CHLORPHENIRAMINE MALEATE
CHLORPHENIRAMINE MALEATE
DESLORATADINE
DESLORATADINE/PSEUDOEPHEDRINE
DESLORATADINE/PSEUDOEPHEDRINE
LORATADINE
LORATADINE/PSEUDOEPHEDRINE
LORATADINE/PSEUDOEPHEDRINE
P-EPHED SUL/LORATADINE
CLEMASTINE FUMARATE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
ACETAMINOPHEN/DIPHENHYDRAMINE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
BRAND DRUG
COMPOZ
COUGH & SEVERE COLD
COUGH CONTROL
COUGH SYRUP
COUGHTAB
COUGHTAB 400
CPM PSE
CPM-PSE
CUTIVATE
DAILYHIST-1
DALLERGY PSE
DAYHIST
DAYHIST ALLERGY
DECONAMINE
DELSYM COUGH+COLD
DERMA-PAX
DEXAMETHASONE SODIUM
PHOSPHATE
DEXASOL
DIABETIC SILTUSSIN DAS-NA
DIABETIC TUSSIN EX
DIABETIC TUSSIN MUCUS RELIEF
DICEL
DICOPANOL
DIPHEDRYL
DIPHEDRYL ALLERGY
DIPHEN
DIPHEN/LIDO VISC/MAALOX 1:1:1
DIPHENHIST
DIPHENHYDRAMINE-NS
DOXYTEX
DURA-TAP/PD
DYMISTA
DYTAN
DYTUSS
ED CHLORPED
ED CHLORPED JR
ED-CHLORTAN
ED-CHLOR-TAN
ELOCON
ENTOCORT EC
EXPECTORANT
EXPECTORANT COUGH SYRUP
EZ NITE SLEEP
FAST SLEEP
FENESIN IR
6
GENERIC DRUG
DIPHENHYDRAMINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
PSEUDOEPHED/CHLORPHENIRAMINE
PSEUDOEPHED/CHLORPHENIRAMINE
CROMOLYN SODIUM
FLUTICASONE PROPIONATE
CYPROHEPTADINE HCL
CLEMASTINE FUMARATE
PSEUDOEPHEDRINE/CPM/METHYLSCOP
CLEMASTINE FUMARATE
CLEMASTINE FUMARATE
PSEUDOEPHED/CHLORPHENIRAMINE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRAMINE HCL
DESLORATADINE
DEXAMETHASONE SOD PHOSPHATE
DEXAMETHASONE SOD PHOSPHATE
DEXCHLORPHENIRAMINE MALEATE
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
PSEUDOEPHED/CHLORPHENIRAMINE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE/LIDO/MAALOX
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE IN 0.9 % NACL
DOXYLAMINE SUCCINATE
PSEUDOEPHEDRINE HCL/CHLOR-MAL
AZELASTINE/FLUTICASONE
DIPHENHYDRAMINE TANNATE
DIPHENHYDRAMINE HCL
CHLORPHENIRAMINE MALEATE
CHLORPHENIRAMINE MALEATE
CHLORPHENIRAMINE MALEATE
CHLORPHENIRAMINE TANNATE
MOMETASONE FUROATE
BUDESONIDE
GUAIFENESIN
GUAIFENESIN
DIPHENHYDRAMINE HCL
DOXYLAMINE SUCCINATE
GUAIFENESIN
FEXOFENADINE HCL
FEXOFENADINE/PSEUDOEPHEDRINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
BRAND DRUG
FEXOFENADINE-PSE ER
FLONASE
FLONASE ALLERGY RELIEF
FLOVENT DISKUS
FLOVENT HFA
FLU & SEVERE COLD
FLU & SORE THROAT RELIEF
FLU RELIEF THERAPY
FLU RELIEF THERAPY NIGHTTIME
FLU-SEVERE COLD & COUGH
FLU-SEVERE COLD & COUGH RELIEF
GANIDIN NR
GASTROCROM
GENAHIST
GENAPHED PLUS
GERI-TUSSIN
G-FENESIN
GG 200 NR
GRASTEK
GUAIFENESIN SYRUP
GUAIFENESIN ER
GUAIFENESIN NR
HEADACHE PM
HEADACHE PM FORMULA
HISTEX
HISTEX PD
HUMIBID E
HYDROXYZINE PAMOATE
INTENSE COLD & FLU
IOPHEN NR
ITCH RELIEF
J-TAN D PD
J-TAN PD
KARBINAL ER
KENALOG
KENALOG-10
KENALOG-40
KIDS-EEZE CHEST RELIEF
LIQUITUSS GG
LODRANE
LODRANE 24
LODRANE 24D
LODRANE D
LOHIST 12D
LOHIST 12HR
LOHIST-D
LOHIST-PD
LOHIST-PSB
7
GENERIC DRUG
FEXOFENADINE/PSEUDOEPHEDRINE
FLUTICASONE PROPIONATE
FLUTICASONE PROPIONATE
FLUTICASONE PROPIONATE
FLUTICASONE PROPIONATE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
FLUNISOLIDE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
FLUTICASONE PROPIONATE
GUAIFENESIN
CROMOLYN SODIUM
DIPHENHYDRAMINE HCL
PSEUDOEPHED/CHLORPHENIRAMINE
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
GRASS POLLEN-TIMOTHY, STD
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
TRIPROLIDINE HCL
TRIPROLIDINE HCL
GUAIFENESIN
HYDROXYZINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
GUAIFENESIN
DIPHENHYDRAMINE HCL
PSEUDOEPHEDRINE/BROMPHENIRAMIN
BROMPHENIRAMINE MALEATE
CARBINOXAMINE MALEATE
TRIAMCINOLONE ACETONIDE
TRIAMCINOLONE ACETONIDE
TRIAMCINOLONE ACETONIDE
GUAIFENESIN
LEVOCETIRIZINE DIHYDROCHLORIDE
GUAIFENESIN
PSEUDOEPHEDRINE/BROMPHENIRAMIN
BROMPHENIRAMINE MALEATE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
PSEUDOEPHEDRINE/BROMPHENIRAMIN
PSEUDOEPHEDRINE/BROMPHENIRAMIN
BROMPHENIRAMINE MALEATE
PSEUDOEPHED/CHLORPHENIRAMINE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
PSEUDOEPHEDRINE/BROMPHENIRAMIN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
BRAND DRUG
LORADAMED
LORATA-D
LORATADINE ALLERGY
LORATADINE D
LORATA-DINE D
LORATADINE HIVES RELIEF
LORATADINE-D
MAPAP PM
MAXICHLOR PSE
MEDIFIN EXPECTORANT
MEDIFIN EXPECTORANT MUCUS RLF
MEDI-PHEDRYL
MEDI-SLEEP
MEDI-TABS
MEDI-TABS PM
MEDI-TUSSIN
MUCINEX
MUCINEX ALLERGY
MUCINEX FAST-MAX NITE COLD-FLU
MUCOSA
MUCUS ER
MUCUS RELIEF
MUCUS RELIEF CHEST
MUCUS-ER
MYCI CHLOR-TAN
NARAMIN
NASACORT
NASACORT AQ
NASAL ALLERGY SPRAY
NASALCROM
NASONEX
NEUTRAHIST
NIGHTTIME SLEEP AID
NIGHTTIME SLEEP GEL
NIGHTTIME SLEEP-AID
NON-ASPIRIN PM
NON-ASPIRIN PM EX-STRENGTH
NON-ASPIRIN SLEEP AID
NON-DROWSY ALLERGY
NYTOL
NYTOL QUICKCAPS
OMNARIS
ONETAB ALLERGY & SINUS
ONETAB COLD & FLU
OPTIVAR
ORALAIR
ORALONE
ORGAN-I NR
ORGANIDIN NR
ORMIR
8
GENERIC DRUG
LORATADINE
LORATADINE/PSEUDOEPHEDRINE
LORATADINE
LORATADINE/PSEUDOEPHEDRINE
LORATADINE/PSEUDOEPHEDRINE
LORATADINE
LORATADINE/PSEUDOEPHEDRINE
ACETAMINOPHEN/DIPHENHYDRAMINE
PSEUDOEPHED/CHLORPHENIRAMINE
GUAIFENESIN
GUAIFENESIN
DIPHENHYDRAMINE HCL
DOXYLAMINE SUCCINATE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
GUAIFENESIN
MOMETASONE FUROATE
GUAIFENESIN
FEXOFENADINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
CHLORPHENIRAMINE TANNATE
DIPHENHYDRAMINE HCL
TRIAMCINOLONE ACETONIDE
TRIAMCINOLONE ACETONIDE
CROMOLYN SODIUM
CROMOLYN SODIUM
MOMETASONE FUROATE
PSEUDOEPHED/CHLORPHENIRAMINE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DOXYLAMINE SUCCINATE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
LORATADINE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
OLOPATADINE HCL
CICLESONIDE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
AZELASTINE HCL
GR POL-ORC/SW VER/RYE/KENT/TIM
TRIAMCINOLONE ACETONIDE
GUAIFENESIN
GUAIFENESIN
DIPHENHYDRAMINE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
BRAND DRUG
PAIN & SLEEP
PAIN RELIEF PM
PAIN RELIEVER
PAIN RELIEVER PM
PALGIC
PATADAY
PATANASE
PATANOL
PAZEO
PEDIATRIC COUGH-COLD
PEDIAVENT
PERCOGESIC EXTRA STRENGTH
PHARBECHLOR
PHARBEDRYL
PHENADOZ
PHENERGAN
PM PAIN RELIEF
PROMETHAZINE HCL-0.9% NACL
PROMETHEGAN
PSE BPM
PSEUDO PLUS COLD & ALLERGY
PULMICORT
PULMICORT FLEXHALER
Q-DRYL
QNASL
QNASL CHILDREN
Q-TAPP
Q-TUSSIN
QUENALIN
QVAR
RAGWITEK
REFENESEN
RELCOF DN PSE
RELCOF PSE
RESPA-BR
RESPAHIST
REST SIMPLY
RESTFULLY SLEEP
RHINOCORT AQUA
RI-TUSSIN
ROBAFEN
ROBITUSSIN
ROBITUSSIN MUCUS-CHEST CONGEST
RYNEX PSE
SCOT-TUSSIN
SEMPREX-D
SEVERE ALLERGY
SEVERE ALLERGY-SINUS HEADACHE
SEVERE COLD
SEVERE COLD PE
SEVERE COLD-SINUS RELIEF PE
9
GENERIC DRUG
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
CARBINOXAMINE MALEATE
OLOPATADINE HCL
OLOPATADINE HCL
OLOPATADINE HCL
OLOPATADINE HCL
GUAIFENESIN
DEXBROMPHENIRAMINE MALEATE
ACETAMINOPHEN/DIPHENHYDRAMINE
CHLORPHENIRAMINE MALEATE
DIPHENHYDRAMINE HCL
PROMETHAZINE HCL
PROMETHAZINE HCL
ACETAMINOPHEN/DIPHENHYDRAMINE
PROMETHAZINE HCL
PROMETHAZINE HCL IN 0.9 % NACL
PROMETHAZINE HCL
PSEUDOEPHEDRINE/BROMPHENIRAMIN
PSEUDOEPHED/CHLORPHENIRAMINE
BUDESONIDE
BUDESONIDE
DIPHENHYDRAMINE HCL
BECLOMETHASONE DIPROPIONATE
BECLOMETHASONE DIPROPIONATE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
GUAIFENESIN
DIPHENHYDRAMINE HCL
BECLOMETHASONE DIPROPIONATE
WEED POLLEN-SHORT RAGWEED
GUAIFENESIN
PSEUDOEPHEDRINE/CPM/METHYLSCOP
PSEUDOEPHEDRINE/CPM/METHYLSCOP
BROMPHENIRAMINE MALEATE
PSEUDOEPHEDRINE/BROMPHENIRAMIN
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
BUDESONIDE
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
PSEUDOEPHEDRINE/BROMPHENIRAMIN
GUAIFENESIN
PSEUDOEPHEDRINE HCL/ACRIVAS
ACETAMINOPHEN/DIPHENHYDRAMINE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
BRAND DRUG
SILADRYL
SILDEC
SILPHEN
SILTUSSIN DAS
SILTUSSIN SA
SIMPLY SLEEP
SINUS & ALLERGY
SLEEP AID
SLEEP II
SLEEP TABLET
SLEEP TABS
SLEEP TIME
SLEEP-AID
SLEEP-EZE 3
SLEEPGELS
SLEEPING
SOMINEX
SOMINEX MAX STRENGTH
SUDAFED PE NIGHTTIME COLD
SUDAFED PE SEVERE COLD
SUDAHIST
SUDAL 12
SUDOGEST COLD & ALLERGY
SUDOGEST SINUS & ALLERGY
SUPREME ANTACID
SYNAGIS PER DIEM
TAB TUSSIN
TAVIST ND
TAVIST-1
THERAFLU
THERAFLU SEVERE COLD & COUGH
THERAFLU WARMING RELIEF
TIME-HIST QD
TL-HIST PD
TOBRAMYCIN 300MG IN SALINE NS
TRIACTIN
TRIACTING COLD AND ALLERGY
TRIACTING ORANGE
TRIAMINIC
TRIAMINIC COLD & ALLERGY
TRIANEX
TRICHOPHYTON
TRIDERM
TRIESENCE
TRIPOHIST
TUSSIN
TUSSIN CHEST CONGESTION
TUSSIN HONEY
TUSSIN MUCUS-CHEST CONGESTION
TYLENOL PM EXTRA STRENGTH
10
GENERIC DRUG
DIPHENHYDRAMINE HCL
PSEUDOEPHEDRINE/BROMPHENIRAMIN
DIPHENHYDRAMINE HCL
GUAIFENESIN
GUAIFENESIN
DIPHENHYDRAMINE HCL
PSEUDOEPHED/CHLORPHENIRAMINE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
PSEUDOEPHED/CHLORPHENIRAMINE
P-EPD TAN/CHLOR-TAN
PSEUDOEPHED/CHLORPHENIRAMINE
PSEUDOEPHED/CHLORPHENIRAMINE
CALCIUM CARB/MAGNESIUM HYDROX
GUAIFENESIN
LORATADINE
CLEMASTINE FUMARATE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
PSEUDOEPHEDRINE/CPM/METHYLSCOP
PSEUDOEPHEDRINE/BROMPHENIRAMIN
TOBRAMYCIN SO4
GUAIFENESIN
PSEUDOEPHED/CHLORPHENIRAMINE
PSEUDOEPHED/CHLORPHENIRAMINE
TRIAMCINOLONE ACETONIDE
DIPHENHYDRAMINE HCL
PSEUDOEPHED/CHLORPHENIRAMINE
TRIAMCINOLONE ACETONIDE
TRICHOPHYTON ALLERGENIC EXT
TRIAMCINOLONE ACETONIDE
TRIAMCINOLONE ACETONIDE/PF
TRIPROLIDINE HCL
TRIPROLIDINE HCL
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
GUAIFENESIN
ACETAMINOPHEN/DIPHENHYDRAMINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ALLERGY
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
BRAND DRUG
TYLENOL SEVERE ALLERGY
UCERIS
ULTRA SLEEP
UNISOM
UNISOM SLEEP AID
UNISOM SLEEPMELTS
VALU-DRYL
VALU-DRYL ALLERGY MEDICINE
VALU-TAPP
VANAHIST PD
VAZOL
VERAMYST
VICKS QLEARQUIL ALLERGY
VICKS QLEARQUIL NIGHTTIME
VISRX
VISTARIL
WAL-DRYL
WAL-DRYL ALLERGY
WAL-DRYL SEVERE ALLERGY-SINUS
WAL-FEX ALLERGY
WAL-FEX D 12 HOUR
WAL-FEX D 24 HOUR
WAL-FINATE
WAL-FINATE-D
WAL-FLU NIGHT SEVERE COLD
WAL-FLU SEVERE COLD & COUGH
WAL-ITIN
WAL-ITIN ALLER-MELTS
WAL-ITIN D
WAL-ITIN D 12 HOUR
WAL-NADOL PM
WAL-PHED
WAL-PHED PE
WAL-PHED PE NIGHTTIME COLD
WAL-SLEEP Z
WAL-SOM
WAL-TAP
WAL-TUSSIN
WAL-VERT
WAL-ZYR
WAL-ZYR D
XYZAL
ZETONNA
Z-SLEEP
ZYRTEC
ZYRTEC-D
ZZZQUIL
8 HOUR
8 HOUR PAIN RELIEF
8 HOUR PAIN RELIEVER
ACEPHEN
ACETADRINK
11
GENERIC DRUG
ACETAMINOPHEN/DIPHENHYDRAMINE
BUDESONIDE
DOXYLAMINE SUCCINATE
DIPHENHYDRAMINE HCL
DOXYLAMINE SUCCINATE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
PSEUDOEPHEDRINE/BROMPHENIRAMIN
TRIPROLIDINE HCL
BROMPHENIRAMINE MALEATE
FLUTICASONE FUROATE
LORATADINE
DIPHENHYDRAMINE HCL
PSEUDOEPHEDRINE/CPM/METHYLSCOP
HYDROXYZINE PAMOATE
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
DIPHENHYDRA/PHENYLEPH/ACETAMIN
FEXOFENADINE HCL
FEXOFENADINE/PSEUDOEPHEDRINE
FEXOFENADINE/PSEUDOEPHEDRINE
CHLORPHENIRAMINE MALEATE
PSEUDOEPHED/CHLORPHENIRAMINE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
LORATADINE
LORATADINE
LORATADINE/PSEUDOEPHEDRINE
LORATADINE/PSEUDOEPHEDRINE
ACETAMINOPHEN/DIPHENHYDRAMINE
PSEUDOEPHED/CHLORPHENIRAMINE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DIPHENHYDRAMINE HCL
DIPHENHYDRAMINE HCL
PSEUDOEPHEDRINE/BROMPHENIRAMIN
GUAIFENESIN
LORATADINE
CETIRIZINE HCL
CETIRIZINE HCL/PSEUDOEPHEDRINE
LEVOCETIRIZINE DIHYDROCHLORIDE
CICLESONIDE
DIPHENHYDRAMINE HCL
CETIRIZINE HCL
CETIRIZINE HCL/PSEUDOEPHEDRINE
DIPHENHYDRAMINE HCL
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
BRAND DRUG
ACETAMINOPHEN 8 HOUR
ACETAMINOPHEN ER
ACETAMINOPHEN ES
ACETAMINOPHEN EXTRA STRENGTH
ACETAMINOPHEN PAIN RELIEF
AKYNZEO
ALOXI
AMBIZINE
ANTI-NAUSEA
ANTIVERT
ANZEMET
APHEN
ARTHRITIS PAIN
ARTHRITIS PAIN RELIEF
ARTHRITIS PAIN RELIEVER
ASPIRIN FREE
ATHENOL
BETATEMP
BONINE
CESAMET
CHILD NON-ASPIRIN
CHILD PAIN REL-FEVER REDUCER
CHILD PAIN RELIEF
CHILD TRIAMINIC FEVER REDUCER
CHILDREN'S ACETAMINOPHEN
CHILDREN'S EASY-MELTS
CHILDREN'S FEVER REDUCER
CHILDREN'S FEVER REDUCING
CHILDREN'S MAPAP
CHILDREN'S MEDI-TABS
CHILDREN'S NON-ASPIRIN
CHILDREN'S PAIN & FEVER
CHILDREN'S PAIN RELIEF
CHILDREN'S PAIN RELIEVER
CHILDREN'S Q-PAP
CHILDREN'S SILAPAP
CHILDREN'S TACTINAL
CHILDREN'S TYLENOL
CHILDREN'S TYLENOL MELTAWAYS
CHILD'S ACCUDIAL ACETAMINOPHEN
COMPAZINE
COMPRO
CYCLIVERT
DICLEGIS
DRAMAMINE
DRAMAMINE LESS DROWSY
DRIMINATE
ED-APAP
12
GENERIC DRUG
ACETAMINOPHEN 500MG
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
NETUPITANT/PALONOSETRON HCL
PALONOSETRON HCL
MECLIZINE HCL
PHOSP ACID/DEXTROSE/FRUCTOSE
MECLIZINE HCL
DOLASETRON MESYLATE
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
MECLIZINE HCL
NABILONE
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
COLA SYRUP
PROCHLORPERAZINE MALEATE
PROCHLORPERAZINE MALEATE
CYCLIZINE HCL
DOXYLAMINE/PYRIDOXINE HCL
DIMENHYDRINATE
DIMENHYDRINATE
MECLIZINE HCL
DIMENHYDRINATE
DRONABINOL
ACETAMINOPHEN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
BRAND DRUG
EMEND
EMETROL
EXTENDED PAIN RELIEF
EXTRA STRENGTH NON-ASPIRIN
FEVER REDUCER & PAIN RELIEVER
FEVERALL
FORMULA EM
GENEBS
GRANISOL
INFANT FEVER-PAIN RELIEVER
INFANT PAIN & FEVER
INFANT PAIN RELIEF
INFANT TRIAMINIC FEVER REDUCER
INFANTAIRE
INFANT'S ACETAMINOPHEN
INFANTS' MAPAP
INFANT'S NON-ASPIRIN
INFANTS' NON-ASPIRIN
INFANTS' PAIN & FEVER
INFANT'S PAIN RELIEF
INFANTS' PAIN RELIEF
INFANTS PAIN RELIEVER
INFANT'S PAIN RELIEVER
INFANTS' PAIN RELIEVER
INFANTS TYLENOL
INFANTS' TYLENOL
ISOPTO HYOSCINE
JR ACETAMINOPHEN
JR. STR NON-ASPIRIN
JR. STR NON-ASPIRIN PAIN
JR. STRENGTH PAIN RELIEVER
JR. TYLENOL MELTAWAYS
JUNIOR MAPAP
JUNIOR PAIN RELIEVER
KYTRIL
LITTLE FEVERS
LITTLE REMEDIES FEVER & PAIN
MAPAP
MAPAP ARTHRITIS PAIN
MAPAP INFANT
MARINOL
MASOPHEN
MEDI-MECLIZINE
MEDI-TABS EXTRA STRENGTH
MEDI-TABS PAIN RELIEVER
MOTION RELIEF
MOTION SICKNESS
MOTION SICKNESS II
MOTION SICKNESS RELIEF
MOTION SICKNESS RELIEF II
13
GENERIC DRUG
APREPITANT
PHOSP ACID/DEXTROSE/FRUCTOSE
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
PHOSP ACID/DEXTROSE/FRUCTOSE
ACETAMINOPHEN
GRANISETRON HCL
GRANISETRON HCL
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
SCOPOLAMINE HYDROBROMIDE
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
GRANISETRON HCL
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
DRONABINOL
ACETAMINOPHEN
MECLIZINE HCL
MECLIZINE HCL
ACETAMINOPHEN
ACETAMINOPHEN
MECLIZINE HCL
DIMENHYDRINATE
MECLIZINE HCL
DIMENHYDRINATE
MECLIZINE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
ANTIEMESIS/ANTIVERTIGO
BRAND DRUG
MOTION-TIME
NAUSATROL INSTYDOSE
NAUSEA CONTROL
NAUSEA RELIEF
NAUZENE
NON-ASPIRIN
NON-ASPIRIN 8 HOUR
NON-ASPIRIN EXTRA STRENGTH
NON-ASPIRIN JR STRENGTH
NON-ASPIRIN PAIN RELIEF
NORTEMP
OFIRMEV
ONDANSETRON HCL IN DEXTROSE
ONDANSETRON HCL-D5W
ONDANSETRON HCL-NS
ONDANSETRON IN SODIUM
CHLORIDE
ONDANSETRON ODT
PAIN & FEVER
PAIN RELIEF
PAIN RELIEF ADULT
PAIN RELIEF COOL ICE
PAIN RELIEF EXTRA STRENGTH
PAIN RELIEVER JUNIOR STRENGTH
PEDIACARE FEVER REDUCER
PHARBETOL
Q-PAP
Q-PAP EXTRA STRENGTH
SANCUSO
SCOPACE
SILAPAP
TACTINAL
TIGAN
TRANSDERM-SCOP
TRAVEL SICKNESS
TRIAMINIC FEVER REDUCER
TYLENOL
TYLENOL 8 HOUR
TYLENOL ARTHRITIS
TYLENOL EXTRA STRENGTH
TYLENOL EXTRA STRENGTH ARTHRIT
TYLENOL SORE THROAT
TYLOPHEN
VERTICALM
WAL-DRAM
ZOFRAN
ZOFRAN ODT
ZUPLENZ
14
GENERIC DRUG
MECLIZINE HCL
PHOSP ACID/DEXTROSE/FRUCTOSE
PHOSP ACID/DEXTROSE/FRUCTOSE
PHOSP ACID/DEXTROSE/FRUCTOSE
DEXTROSE/FRUCTOSE/SODIUM CIT
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ONDANSETRON HCL
ONDANSETRON HCL/D5W/PF
ONDANSETRON HCL IN D5W
ONDANSETRON HCL IN 0.9 % NACL
ONDANSETRON IN 0.9 % NACL/PF
ONDANSETRON
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
PROCHLORPERAZINE EDISYLATE
PROCHLORPERAZINE MALEATE
ACETAMINOPHEN
ACETAMINOPHEN
GRANISETRON
SCOPOLAMINE HYDROBROMIDE
SCOPOLAMINE HYDROBROMIDE
ACETAMINOPHEN
ACETAMINOPHEN
TRIMETHOBENZAMIDE HCL
SCOPOLAMINE
DIMENHYDRINATE
ACETAMINOPHEN
TRIMETHOBENZAMIDE HCL
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
ACETAMINOPHEN
MECLIZINE HCL
DIMENHYDRINATE
ONDANSETRON HCL
ONDANSETRON
ONDANSETRON
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
BRAND DRUG
ACCOLATE
ACCUNEB
ADRENACLICK
ADRENALIN
ADRENALIN CHLORIDE
ADVAIR DISKUS
ADVAIR HFA
AEROBID-M
ALERTNESS AID
ALOCRIL
ANORO ELLIPTA
ARCAPTA NEOHALER
ASTHMANEFRIN REFILL
ASTHMANEFRIN STARTER KIT
ATROVENT
ATROVENT HFA
AUVI-Q
AWAKE
BREO ELLIPTA
BRONCHIAL MIST
BRONCOMAR-1
BRONKAID DUAL ACTION
BROVANA
CAFCIT
CAFFEINE AND SODIUM BENZOATE
CAFFEINE CITRATE
COMBIVENT
COMBIVENT RESPIMAT
COPD
DALIRESP
DIFIL-G 400
DILEX-G 200
DILEX-G 400
DOPAMINE HCL IN 5% DEXTROSE
DULERA
DUONEB
DY-G LIQUID
DYLIX
DYPHYLLINE GG
ED-BRON G
ELIXOPHYLLIN
EPINEPHRINE HCL-0.9% NACL
EPINEPHRINE HCL-D5W
EPINEPHRINE HCL-NS
EPINEPHRINE-D5W
EPIPEN
EPIPEN 2-PAK
EPIPEN JR
15
GENERIC DRUG
ZAFIRLUKAST
ALBUTEROL SULFATE
EPINEPHRINE
EPINEPHRINE
EPINEPHRINE
FLUTICASONE/SALMETEROL
FLUTICASONE/SALMETEROL
FLUNISOLIDE/MENTHOL
ALBUTEROL SULFATE
CAFFEINE
NEDOCROMIL SODIUM
AMINOPHYLLINE
UMECLIDINIUM BRM/VILANTEROL TR
INDACATEROL MALEATE
RACEPINEPHRINE HCL
RACEPINEPHRINE HCL
IPRATROPIUM BROMIDE
IPRATROPIUM BROMIDE
EPINEPHRINE
CAFFEINE
FLUTICASONE/VILANTEROL
EPINEPHRINE
GUAIFEN/THEOP ANHYD/P-EPHED
EPHEDRINE SULFATE/GUAIFENESIN
ARFORMOTEROL TARTRATE
CAFFEINE CITRATED
CAFFEINE/SODIUM BENZOATE
CAFFEINE CITRATED
IPRATROPIUM/ALBUTEROL SULFATE
IPRATROPIUM/ALBUTEROL SULFATE
GUAIFENESIN/DYPHYLLINE
ROFLUMILAST
GUAIFENESIN/DYPHYLLINE
GUAIFENESIN/DYPHYLLINE
GUAIFENESIN/DYPHYLLINE
DOPAMINE HCL
DOPAMINE HCL/D5W
MOMETASONE/FORMOTEROL
IPRATROPIUM/ALBUTEROL SULFATE
GUAIFENESIN/DYPHYLLINE
DYPHYLLINE
GUAIFENESIN/DYPHYLLINE
GUAIFENESIN/THEOPHYLLINE
THEOPHYLLINE ANHYDROUS
EPINEPHRINE
EPINEPHRINE HCL IN 0.9 % NACL
EPINEPHRINE HCL/D5W
EPINEPHRINE IN 0.9% NACL/PF
EPINEPHRINE HCL/D5W
EPINEPHRINE
EPINEPHRINE
EPINEPHRINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
ASTHMA
BRAND DRUG
EPIPEN JR 2-PAK
FORADIL
INCRUSE ELLIPTA
IPRATROPIUM-ALBUTEROL
ISUPREL
JAY-PHYL
LEVALBUTEROL CONCENTRATE
LEVOPHED BITARTRATE
LUFYLLIN
LUFYLLIN-GG
MAXAIR AUTOHALER
NO DOZ
NOREPINEPHRINE BITAR-0.9% NACL
NOREPINEPHRINE BITARTRATE-D5W
NOREPINEPHRINE BITARTRATE-NS
PERFOROMIST
PILL SPLITTER
PRIMATENE MIST
PROAIR HFA
PROAIR RESPICLICK
PROVENTIL HFA
RACEPINEPHRINE
S2 RACEPINEPHRINE
SEREVENT DISKUS
SINGULAIR
SPIRIVA
SPIRIVA RESPIMAT
STAY AWAKE
STRIVERDI RESPIMAT
SYMBICORT
THEO-24
THEOCHRON
THEOPHYLLINE
THEOPHYLLINE IN 5% DEXTROSE
TUDORZA PRESSAIR
TWINJECT
VENTOLIN HFA
VIVARIN
VOSPIRE ER
XOLAIR
XOPENEX
XOPENEX CONCENTRATE
XOPENEX HFA
16
GENERIC DRUG
EPINEPHRINE
FORMOTEROL FUMARATE
UMECLIDINIUM BROMIDE
IPRATROPIUM BROMIDE
IPRATROPIUM/ALBUTEROL SULFATE
ISOPROTERENOL HCL
ISOPROTERENOL HCL
GUAIFENESIN/DYPHYLLINE
LEVALBUTEROL HCL
LEVALBUTEROL HCL
NOREPINEPHRINE BITARTRATE
DYPHYLLINE
GUAIFENESIN/DYPHYLLINE
PIRBUTEROL ACETATE
METAPROTERENOL SULFATE
MONTELUKAST SODIUM
CAFFEINE
NOREPI BIT IN 0.9 % NACL/PF
NOREPINEPHRINE BITARTRATE
NOREPINEPHRINE BITARTRATE/D5W
NOREPINEPHRINE BIT/0.9 % NACL
FORMOTEROL FUMARATE
MISCELLANEOUS MEDICAL SUPPLY
EPINEPHRINE
ALBUTEROL SULFATE
ALBUTEROL SULFATE
ALBUTEROL SULFATE
RACEPINEPHRINE HCL
RACEPINEPHRINE HCL
SALMETEROL XINAFOATE
MONTELUKAST SODIUM
TIOTROPIUM BROMIDE
TIOTROPIUM BROMIDE
CAFFEINE
OLODATEROL HCL
BUDESONIDE/FORMOTEROL FUMARATE
TERBUTALINE SULFATE
THEOPHYLLINE ANHYDROUS
THEOPHYLLINE ANHYDROUS
THEOPHYLLINE ANHYDROUS
THEOPHYLLINE ANHYDROUS
THEOPHYLLINE/D5W
THERMOMETER PROBE COVERS
ACLIDINIUM BROMIDE
EPINEPHRINE
ALBUTEROL SULFATE
CAFFEINE
ALBUTEROL SULFATE
OMALIZUMAB
LEVALBUTEROL HCL
LEVALBUTEROL HCL
LEVALBUTEROL TARTRATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ASTHMA
ASTHMA
ASTHMA
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
AUTONOMIC NERVOUS SYSTEM DISORDERS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BRAND DRUG
ZYFLO
ZYFLO CR
ARICEPT
ARICEPT ODT
BLOXIVERZ
DONEPEZIL HCL ODT
ENLON
ENLON-PLUS
EXELON
GALANTAMINE HYDROBROMIDE
MESTINON
MYTELASE
NAMENDA
NAMENDA XR
NEOSTIGMINE METHYLSULFATE
PROSTIGMIN
RAZADYNE
RAZADYNE ER
REGONOL
RIVASTIGMINE
AMITRIPTYLINE-CHLORDIAZEPOXIDE
AMITRIPTYLINE-PERPHENAZINE
ANAFRANIL
APLENZIN
BRINTELLIX
BRISDELLE
BUDEPRION SR
BUDEPRION XL
BUPROPION HCL SR
BUPROPION XL
CELEXA
CHLORDIAZEPOXIDE-AMITRIPTYLINE
CITALOPRAM HBR
CYMBALTA
DESVENLAFAXINE ER
DESVENLAFAXINE FUMARATE ER
EFFEXOR
EFFEXOR XR
FETZIMA
17
GENERIC DRUG
ZAFIRLUKAST
ZILEUTON
ZILEUTON
DONEPEZIL HCL
DONEPEZIL HCL
NEOSTIGMINE METHYLSULFATE
DONEPEZIL HCL
DONEPEZIL HCL
EDROPHONIUM CHLORIDE
EDROPHONIUM CHLORIDE/ATROPINE
RIVASTIGMINE
GALANTAMINE HBR
GALANTAMINE HBR
PYRIDOSTIGMINE BROMIDE
AMBENONIUM CHLORIDE
MEMANTINE HCL
MEMANTINE HCL
PHYSOSTIGMINE SALICYLATE
NEOSTIGMINE BROMIDE
PYRIDOSTIGMINE BROMIDE
GALANTAMINE HBR
GALANTAMINE HBR
PYRIDOSTIGMINE BROMIDE
RIVASTIGMINE TARTRATE
AMITRIPTYLINE HCL
AMITRIP HCL/CHLORDIAZEPOXIDE
PERPHENAZINE/AMITRIPTYLINE HCL
AMOXAPINE
CLOMIPRAMINE HCL
BUPROPION HBR
VORTIOXETINE HYDROBROMIDE
PAROXETINE MESYLATE
BUPROPION HCL
BUPROPION HCL
BUPROPION HCL
BUPROPION HCL
BUPROPION HCL
CITALOPRAM HYDROBROMIDE
AMITRIP HCL/CHLORDIAZEPOXIDE
CITALOPRAM HYDROBROMIDE
CLOMIPRAMINE HCL
DULOXETINE HCL
DESIPRAMINE HCL
DESVENLAFAXINE
DESVENLAFAXINE FUMARATE
DOXEPIN HCL
DULOXETINE HCL
VENLAFAXINE HCL
VENLAFAXINE HCL
ESCITALOPRAM OXALATE
LEVOMILNACIPRAN HYDROCHLORIDE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BEHAVIORAL HEALTH - ANTIDEPRESSANTS
BRAND DRUG
FLUOXETINE DR
FLUOXETINE HCL
GENERIC DRUG
FLUOXETINE HCL
FLUVOXAMINE MALEATE ER
FORFIVO XL
KHEDEZLA
LEXAPRO
LUVOX CR
MARPLAN
NARDIL
NORPRAMIN
OLEPTRO ER
PAMELOR
PARNATE
PAXIL
PAXIL CR
PERPHENAZINE-AMITRIPTYLINE
PEXEVA
PRISTIQ ER
PROZAC
PROZAC WEEKLY
PRUDOXIN
REMERON
SARAFEM
SELFEMRA
SILENOR
SURMONTIL
TOFRANIL
TOFRANIL-PM
VENLAFAXINE HCL ER
VIIBRYD
VIVACTIL
WELLBUTRIN
WELLBUTRIN SR
WELLBUTRIN XL
ZOLOFT
ZONALON
18
FLUVOXAMINE MALEATE
FLUVOXAMINE MALEATE
BUPROPION HCL
IMIPRAMINE HCL
IMIPRAMINE PAMOATE
DESVENLAFAXINE
ESCITALOPRAM OXALATE
FLUVOXAMINE MALEATE
MAPROTILINE HCL
ISOCARBOXAZID
MIRTAZAPINE
PHENELZINE SULFATE
NEFAZODONE HCL
DESIPRAMINE HCL
NORTRIPTYLINE HCL
TRAZODONE HCL
NORTRIPTYLINE HCL
TRANYLCYPROMINE SULFATE
PAROXETINE HCL
PAROXETINE HCL
PAROXETINE HCL
PERPHENAZINE/AMITRIPTYLINE HCL
PAROXETINE MESYLATE
PHENELZINE SULFATE
DESVENLAFAXINE SUCCINATE
PROTRIPTYLINE HCL
FLUOXETINE HCL
FLUOXETINE HCL
DOXEPIN HCL
MIRTAZAPINE
FLUOXETINE HCL
FLUOXETINE HCL
SERTRALINE HCL
DOXEPIN HCL
ST. JOHN'S WORT
TRIMIPRAMINE MALEATE
IMIPRAMINE HCL
IMIPRAMINE PAMOATE
TRANYLCYPROMINE SULFATE
TRAZODONE HCL
TRIMIPRAMINE MALEATE
VENLAFAXINE HCL
VENLAFAXINE HCL
VILAZODONE HYDROCHLORIDE
PROTRIPTYLINE HCL
BUPROPION HCL
BUPROPION HCL
BUPROPION HCL
SERTRALINE HCL
DOXEPIN HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BRAND DRUG
ABILIFY
ABILIFY DISCMELT
ABILIFY MAINTENA
ADASUVE
ADDERALL
ADDERALL XR
ALPRAZOLAM ER
ALPRAZOLAM INTENSOL
ALPRAZOLAM ODT
ALPRAZOLAM XR
AMBIEN
AMBIEN CR
AMMONIA AROMATIC
AMMONIA INHALANT
AMPHETAMINE SALT COMBO
AMYTAL SODIUM
ANTABUSE
ATIVAN
BELSOMRA
BUTISOL SODIUM
CAMPRAL
CARBAMAZEPINE ER
CARBAMAZEPINE XR
CARBATROL
CATAPRES
CATAPRES-TTS 1
CATAPRES-TTS 2
CATAPRES-TTS 3
CLONIDINE HCL ER
CLOZAPINE ODT
CLOZARIL
COLACE
COLACE CLEAR
COL-RITE
CONCERTA
DAYTRANA
DEPADE
DESOXYN
DEXEDRINE
19
GENERIC DRUG
ARIPIPRAZOLE
ARIPIPRAZOLE
ARIPIPRAZOLE
ACAMPROSATE CALCIUM
LOXAPINE
DEXTROAMPHETAMINE/AMPHETAMINE
DEXTROAMPHETAMINE/AMPHETAMINE
ALPRAZOLAM
ALPRAZOLAM
ALPRAZOLAM
ALPRAZOLAM
ALPRAZOLAM
ZOLPIDEM TARTRATE
ZOLPIDEM TARTRATE
AMMONIA
AMMONIA
DEXTROAMPHETAMINE/AMPHETAMINE
AMOBARBITAL SODIUM
DISULFIRAM
LORAZEPAM
SUVOREXANT
BUSPIRONE HCL
BUTABARBITAL SODIUM
ACAMPROSATE CALCIUM
CARBAMAZEPINE
CARBAMAZEPINE
CARBAMAZEPINE
CARBAMAZEPINE
CLONIDINE HCL
CLONIDINE
CLONIDINE
CLONIDINE
CHLORAL HYDRATE
CHLORDIAZEPOXIDE HCL
CHLORPROMAZINE HCL
CLONIDINE
CLONIDINE HCL
CLONIDINE HCL
CLORAZEPATE DIPOTASSIUM
CLOZAPINE
CLOZAPINE
CLOZAPINE
DOCUSATE SODIUM
DOCUSATE SODIUM
DOCUSATE SODIUM
METHYLPHENIDATE HCL
METHYLPHENIDATE
NALTREXONE HCL
METHAMPHETAMINE HCL
DEXTROAMPHETAMINE SULFATE
DEXMEDETOMIDINE HCL
DEXMETHYLPHENIDATE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BRAND DRUG
DEXMETHYLPHENIDATE HCL ER
DEXTROAMPHETAMINE SULFATE ER
DEXTROAMPHETAMINE-AMPHET ER
DIASTAT
DIASTAT ACUDIAL
DIOCTO
DIOCTYL
DOC-Q-LACE
DOCU LIQUID
DOCU SOFT
DOCUPRENE
DOCUSIL
DOCUSOFT S
DOCUSOL
DOCUSOL KIDS
DOK
DOPRAM
DORAL
DSS
DULCOLAX STOOL SOFTENER
EDLUAR
EMSAM
ENEMEEZ
EPITOL
EQUETRO
EVEKEO
EVZIO
FANAPT
FAZACLO
FOCALIN
FOCALIN XR
GEODON
GUANFACINE HCL ER
HALCION
HALDOL
HALDOL DECANOATE 100
HALDOL DECANOATE 50
20
GENERIC DRUG
DEXMETHYLPHENIDATE HCL
DEXTROAMPHETAMINE SULFATE
DEXTROAMPHETAMINE SULFATE
DEXTROAMPHETAMINE/AMPHETAMINE
DIAZEPAM
DIAZEPAM
DIAZEPAM
DOCUSATE SODIUM
DOCUSATE SODIUM
DISULFIRAM
DOCUSATE SODIUM
DOCUSATE SODIUM
DOCUSATE SODIUM
DOCUSATE SODIUM
DOCUSATE SODIUM
DOCUSATE SODIUM
DOCUSATE SODIUM
DOCUSATE SODIUM
DOCUSATE SODIUM
DOXAPRAM HCL
QUAZEPAM
DOXAPRAM HCL
DROPERIDOL
DOCUSATE SODIUM
DOCUSATE SODIUM
ZOLPIDEM TARTRATE
SELEGILINE
DOCUSATE SODIUM
CARBAMAZEPINE
CARBAMAZEPINE
ESTAZOLAM
ESZOPICLONE
AMPHETAMINE SULFATE
NALOXONE HCL
ILOPERIDONE
CLOZAPINE
FLUMAZENIL
FLUPHENAZINE DECANOATE
FLUPHENAZINE HCL
FLURAZEPAM HCL
DEXMETHYLPHENIDATE HCL
DEXMETHYLPHENIDATE HCL
ZIPRASIDONE HCL
GLUTETHIMIDE
GUANFACINE HCL
GUANFACINE HCL
TRIAZOLAM
HALOPERIDOL LACTATE
HALOPERIDOL DECANOATE
HALOPERIDOL DECANOATE
HALOPERIDOL
HALOPERIDOL DECANOATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BRAND DRUG
HALOPERIDOL DECANOATE 100
HETLIOZ
INTERMEZZO
INTUNIV
INVEGA
INVEGA SUSTENNA
KAPVAY
LATUDA
LITHIUM
LITHIUM CARBONATE ER
LITHOBID
LORAZEPAM
LORAZEPAM INTENSOL
LORAZEPAM-0.9% NACL
LORAZEPAM-D5W
LOXAPINE
LOXITANE
L-TRYPTOPHAN
LUMINAL SODIUM
LUNESTA
LYDIA PINKHAM HERBAL
MEDI-DOZE
MELADOX
MELATONEX
MELATONIN
MELATONIN 1MG TAB
MELATONIN WITH VITAMIN B-6
MELATONIN-CHAMOMILE
METADATE CD
METADATE ER
METHYLIN
METHYLIN ER
METHYLPHENIDATE ER
METHYLPHENIDATE HCL CD
METHYLPHENIDATE LA
METHYLPHENIDATE SR
MIDNITE
MOBAN
NAVANE
NEMBUTAL SODIUM
NEO-FRADIN
21
GENERIC DRUG
HALOPERIDOL DECANOATE
HALOPERIDOL LACTATE
TASIMELTEON
ZOLPIDEM TARTRATE
GUANFACINE HCL
PALIPERIDONE
PALIPERIDONE PALMITATE
CLONIDINE HCL
LURASIDONE HCL
LITHIUM CITRATE
LITHIUM CARBONATE
LITHIUM CARBONATE
LITHIUM CITRATE
LITHIUM CARBONATE
LORAZEPAM
LORAZEPAM/0.9% SODIUM CHLORIDE
LORAZEPAM/D5W
LOXAPINE SUCCINATE
LOXAPINE SUCCINATE
TRYPTOPHAN
PHENOBARBITAL SODIUM
ESZOPICLONE
ETHYL ALCOHOL/HERBAL DRUGS
MELATONIN/GABA/VALERIAN
MELATONIN
MELATONIN/PYRIDOXINE HCL (B6)
CALCIUM PHOSPHATE/MELATONIN
MELATONIN
MELATONIN/PYRIDOXAL PHOSPHATE
MELATONIN/CHAMOMILE FLOWERS
MEPROBAMATE
METHYLPHENIDATE HCL
METHYLPHENIDATE HCL
METHAMPHETAMINE HCL
METHYLPHENIDATE HCL
METHYLPHENIDATE HCL
METHYLPHENIDATE HCL
METHYLPHENIDATE HCL
METHYLPHENIDATE HCL
METHYLPHENIDATE HCL
METHYLPHENIDATE HCL
MIDAZOLAM HCL
MELATONIN/HERBAL NO.233
MOLINDONE HCL
MODAFINIL
NALOXONE HCL
NALTREXONE HCL
THIOTHIXENE
PENTOBARBITAL SODIUM
NEOMYCIN SULFATE
NEOMYCIN SULFATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BRAND DRUG
NEXICLON XR
NIRAVAM
NUVIGIL
OLANZAPINE ODT
OLANZAPINE-FLUOXETINE HCL
ORAP
PEDIA-LAX STOOL SOFTENER
GENERIC DRUG
CLONIDINE HCL
ALPRAZOLAM
ARMODAFINIL
OLANZAPINE
OLANZAPINE
OLANZAPINE/FLUOXETINE HCL
PIMOZIDE
OXAZEPAM
DOCUSATE SODIUM
PENTOBARBITAL SODIUM
PERPHENAZINE
PHENOBARBITAL-NS
PHILLIPS' LAXATIVE
PRECEDEX
PROCENTRA
PROMOLAXIN
PROVIGIL
QUILLIVANT XR
RESTONE
RESTORIL
REVIA
RISPERDAL
RISPERDAL CONSTA
RISPERDAL M-TAB
RISPERIDONE ODT
RITALIN
RITALIN LA
RITALIN-SR
ROMAZICON
ROZEREM
SAPHRIS
SECONAL SODIUM
SEROQUEL
SEROQUEL XR
SILACE
SINTRALYNE-PM
SLEEP
SOF-LAX
SOMNICIN
SOMNOTE
SONATA
SORE THROAT LOZENGE
SORE THROAT SPRAY
STOOL SOFTENER
STRATTERA
SYMBYAX
TEGRETOL
22
PHENOBARBITAL
PHENOBARBITAL SODIUM
PHENOBARBITAL/0.9 % SOD CHLOR
DOCUSATE SODIUM
DEXMEDETOMIDINE HCL
DEXTROAMPHETAMINE SULFATE
DOCUSATE SODIUM
MODAFINIL
QUAZEPAM
QUETIAPINE FUMARATE
METHYLPHENIDATE HCL
MELATONIN/TRYPTOPHAN
TEMAZEPAM
NALTREXONE HCL
RISPERIDONE
RISPERIDONE MICROSPHERES
RISPERIDONE
RISPERIDONE
RISPERIDONE
METHYLPHENIDATE HCL
METHYLPHENIDATE HCL
METHYLPHENIDATE HCL
FLUMAZENIL
RAMELTEON
ASENAPINE MALEATE
SECOBARBITAL SODIUM
QUETIAPINE FUMARATE
QUETIAPINE FUMARATE
DOCUSATE SODIUM
MELATONIN/GABA/HERBAL NO.183
MELATONIN/HERBAL COMPLEX #184
DOCUSATE SODIUM
MELATON/5-HYDROXY/TRYPT/B6/MAG
CHLORAL HYDRATE
ZALEPLON
BENZOCAINE/MENTHOL
PHENOL/SODIUM PHENOLATE
DOCUSATE SODIUM
ATOMOXETINE HCL
OLANZAPINE/FLUOXETINE HCL
CARBAMAZEPINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
BEHAVIORAL HEALTH - OTHER
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
BRAND DRUG
TEGRETOL XR
TENEX
THROAT SPRAY
TRANXENE T-TAB
VACUANT
VALIUM
VANSPAR
VERSACLOZ
VIVITROL
VYVANSE
WOMENS STOOL SOFTENER
WRESTONE
XANAX
XANAX XR
XYREM
ZENZEDI
ZOLPIDEM TARTRATE ER
ZOLPIMIST
ZYPREXA
ZYPREXA RELPREVV
ZYPREXA ZYDIS
ADENOCARD
AKTEN
AMIODARONE HCL-D5W
CORDARONE
CORVERT
GLYDO
LIDAMANTLE
LIDOCAINE HCL IN 5% DEXTROSE
LIDOCAINE HCL VISCOUS
LIDOPIN
LIDORX
MULTAQ
MULTIVITAMIN AND FLUORIDE
MULTI-VITAMIN W-FLUORIDE-IRON
MULTIVITAMINS W-FLUORIDE-IRON
23
GENERIC DRUG
CARBAMAZEPINE
TEMAZEPAM
GUANFACINE HCL
THIORIDAZINE HCL
THIOTHIXENE
PHENOL/SODIUM PHENOLATE
CLORAZEPATE DIPOTASSIUM
TRIAZOLAM
TRIFLUOPERAZINE HCL
DOCUSATE SODIUM
DIAZEPAM
BUSPIRONE HCL
CLOZAPINE
NALTREXONE MICROSPHERES
LISDEXAMFETAMINE DIMESYLATE
DOCUSATE SODIUM
MELATONIN/TRYPTOPHAN
ALPRAZOLAM
ALPRAZOLAM
SODIUM OXYBATE
ZALEPLON
DEXTROAMPHETAMINE SULFATE
ZIPRASIDONE HCL
ZOLPIDEM TARTRATE
ZOLPIDEM TARTRATE
ZOLPIDEM TARTRATE
OLANZAPINE
OLANZAPINE PAMOATE
OLANZAPINE
ADENOSINE
ADENOSINE
LIDOCAINE HCL/PF
AMIODARONE HCL
AMIODARONE HCL/D5W
AMIODARONE HCL
IBUTILIDE FUMARATE
DISOPYRAMIDE PHOSPHATE
FLECAINIDE ACETATE
LIDOCAINE HCL
IBUTILIDE FUMARATE
LIDOCAINE HCL
LIDOCAINE
LIDOCAINE HCL
LIDOCAINE HCL/D5W/PF
LIDOCAINE HCL
LIDOCAINE HCL
LIDOCAINE HCL
MEXILETINE HCL
DRONEDARONE HCL
PEDI MULTIVIT NO.2 W-FLUORIDE
PEDI MV #45/FLUORIDE/IRON
PEDI MV #45/FLUORIDE/IRON
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - ARRHYTHMIA
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - CARDIAC STIMULANT
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
BRAND DRUG
NEXTERONE
NORPACE
NORPACE CR
PACERONE
PHLUORIVIT + FE
POLYVITAMIN WITH IRON-FLUORIDE
PROPAFENONE HCL ER
RADIAGUARD
RYTHMOL
RYTHMOL SR
TAMBOCOR
TIKOSYN
XOLIDO
XOLIDO XP
XYLOCAINE
XYLOCAINE IV
XYLOCAINE-MPF
DIGITEK
DIGOX
DIGOXIN
DOBUTAMINE HCL IN DEXTROSE
INAMRINONE
LANOXIN
LANOXIN PEDIATRIC
MILRINONE IN 5% DEXTROSE
SOMA
ACCUPRIL
ACCURETIC
ACEON
ADALAT CC
ADCIRCA
ADEMPAS
ADULT GLYCERIN
AFEDITAB CR
ALDACTAZIDE
ALDACTONE
ALTACE
ALTOPREV
ALUVEA
AMILORIDE-HYDROCHLOROTHIAZIDE
AMLODIPINE BESYLATE-BENAZEPRIL
24
GENERIC DRUG
AMIODARONE IN DEXTROSE,ISO-OSM
DISOPYRAMIDE PHOSPHATE
DISOPYRAMIDE PHOSPHATE
AMIODARONE HCL
MULTIVITS WITH IRON & FLUORIDE
MULTIVITS WITH IRON & FLUORIDE
PROCAINAMIDE HCL
PROPAFENONE HCL
PROPAFENONE HCL
QUINIDINE GLUCONATE
QUINIDINE SULFATE
LIDOCAINE HCL
PROPAFENONE HCL
PROPAFENONE HCL
FLECAINIDE ACETATE
DOFETILIDE
LIDOCAINE HCL
LIDOCAINE HCL
LIDOCAINE HCL
LIDOCAINE HCL/PF
LIDOCAINE HCL
CARISOPRODOL
DIGOXIN
DIGOXIN
DOBUTAMINE HCL
DOBUTAMINE HCL/D5W
INAMRINONE LACTATE
DIGOXIN
DIGOXIN
MILRINONE LACTATE/D5W
MILRINONE LACTATE
CARISOPRODOL
QUINAPRIL HCL
QUINAPRIL/HYDROCHLOROTHIAZIDE
ACEBUTOLOL HCL
PERINDOPRIL ERBUMINE
NIFEDIPINE
TADALAFIL
RIOCIGUAT
GLYCERIN
NIFEDIPINE
SPIRONOLACT/HYDROCHLOROTHIAZID
SPIRONOLACTONE
ALPROSTADIL
RAMIPRIL
LOVASTATIN
UREA
AMILORIDE HCL
AMILORIDE/HYDROCHLOROTHIAZIDE
AMLODIPINE BESYLATE
AMLODIPINE BESYLATE/BENAZEPRIL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
BRAND DRUG
AMLODIPINE-VALSARTAN
AMLODIPINE-VALSARTAN-HCTZ
AMTURNIDE
ANTI-RESIDUE SHAMPOO
AQUA CARE
AQUA GLYCOLIC
AQUANIL
ATACAND
ATACAND HCT
ATENOLOL-CHLORTHALIDONE
ATRAC-TAIN
AVALIDE
AVAPRO
AZOR
BENAZEPRIL-HYDROCHLOROTHIAZIDE
BENICAR
BENICAR HCT
BETAPACE
BETAPACE AF
BETOPTIC S
BIDIL
BISOPROLOL-HYDROCHLOROTHIAZIDE
BREVIBLOC
BYSTOLIC
CALAN
CALAN SR
CALMME
CANDESARTANHYDROCHLOROTHIAZID
CAPTOPRIL-HYDROCHLOROTHIAZIDE
CARB-O-PHILIC
CARDENE I.V.
CARDENE SR
CARDIZEM
CARDIZEM CD
CARDIZEM LA
CARDURA
CARDURA XL
CARMOL
CARMOL 10
CARMOL 20
CARMOL 40
CARTIA XT
25
GENERIC DRUG
AMLODIPINE/VALSARTAN
AMLODIPINE/VALSARTAN/HCTHIAZID
AMMONIUM CHLORIDE
ALISKIREN/AMLODIPIN/HCTHIAZIDE
GLYCERIN
UREA
GLYCERIN
SKIN CLEANSER COMB NO.15
CANDESARTAN CILEXETIL
CANDESARTAN/HYDROCHLOROTHIAZID
ATENOLOL
ATENOLOL/CHLORTHALIDONE
UREA
IRBESARTAN/HYDROCHLOROTHIAZIDE
IRBESARTAN
AMLODIPINE BES/OLMESARTAN MED
BENAZEPRIL HCL
BENAZEPRIL/HYDROCHLOROTHIAZIDE
OLMESARTAN MEDOXOMIL
OLMESARTAN/HYDROCHLOROTHIAZIDE
SOTALOL HCL
SOTALOL HCL
BETAXOLOL HCL
BETAXOLOL HCL
ISOSORB DINIT/HYDRALAZINE HCL
BISOPROLOL FUMARATE
BISOPROLOL FUMARATE/HCTZ
ESMOLOL HCL
BUMETANIDE
NEBIVOLOL HCL
VERAPAMIL HCL
VERAPAMIL HCL
HERBAL DRUGS
CANDESARTAN CILEXETIL
CANDESARTAN/HYDROCHLOROTHIAZID
CAPTOPRIL
CAPTOPRIL/HYDROCHLOROTHIAZIDE
UREA
NICARDIPINE HCL
NICARDIPINE HCL
DILTIAZEM HCL
DILTIAZEM HCL
DILTIAZEM HCL
DOXAZOSIN MESYLATE
DOXAZOSIN MESYLATE
UREA
UREA
UREA
UREA
CARTEOLOL HCL
DILTIAZEM HCL
CARVEDILOL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
BRAND DRUG
CEM-UREA
CEROVEL
CHILD SUPPOSITORY
CLEVIPREX
CLORPRES
COLON HERBAL CLEANSER
COREG
COREG CR
CORGARD
CORLOPAM
CORN HUSKERS
CORZIDE
COVERA-HS
COZAAR
DEMADEX
DEMSER
DIBENZYLINE
DILACOR XR
DILT-CD
DILTIA XT
DILTIAZEM 12HR ER
DILTIAZEM 24HR CD
DILTIAZEM 24HR ER
DILTIAZEM ER
DILTIAZEM HCL-NS
DILTIAZEM-D5W
DILT-XR
DILTZAC ER
DIOVAN
DIOVAN HCT
DIURETIC SOFTGEL
DIUREX MAX
DIURIL
DIURIL SODIUM
DUTOPROL
DYAZIDE
DYNACIRC CR
DYRENIUM
EDARBI
EDARBYCLOR
EDECRIN
ENALAPRILAT
ENALAPRIL-HYDROCHLOROTHIAZIDE
ENDOCET
EPANED
26
GENERIC DRUG
UREA
UREA
GLYCERIN
CHLOROTHIAZIDE
CHLOROTHIAZIDE SODIUM
CHLORTHALIDONE
CLEVIDIPINE BUTYRATE
CLONIDINE HCL/CHLORTHALIDONE
HERBAL DRUGS
CARVEDILOL
CARVEDILOL PHOSPHATE
NADOLOL
FENOLDOPAM MESYLATE
GLYCERIN
NADOLOL/BENDROFLUMETHIAZIDE
VERAPAMIL HCL
LOSARTAN POTASSIUM
TORSEMIDE
METYROSINE
PHENOXYBENZAMINE HCL
DILTIAZEM HCL
DILTIAZEM HCL
DILTIAZEM HCL
DILTIAZEM HCL
DILTIAZEM HCL
DILTIAZEM HCL
DILTIAZEM HCL
DILTIAZEM HCL
DILTIAZEM HCL IN 0.9% NACL
DILTIAZEM HCL/D5W
DILTIAZEM HCL
DILTIAZEM HCL
VALSARTAN
VALSARTAN/HYDROCHLOROTHIAZIDE
PAMABROM
PAMABROM
CHLOROTHIAZIDE
CHLOROTHIAZIDE SODIUM
DOXAZOSIN MESYLATE
METOPROLOL SUCCINATE/HCTZ
TRIAMTERENE/HYDROCHLOROTHIAZID
ISRADIPINE
TRIAMTERENE
AZILSARTAN MEDOXOMIL
AZILSARTAN MED/CHLORTHALIDONE
ETHACRYNIC ACID
ENALAPRIL MALEATE
ENALAPRILAT DIHYDRATE
ENALAPRIL/HYDROCHLOROTHIAZIDE
OXYCODONE HCL/ACETAMINOPHEN
ENALAPRIL MALEATE
EPLERENONE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
BRAND DRUG
EPOPROSTENOL SODIUM
EXFORGE
EXFORGE HCT
FELODIPINE ER
FLOLAN
FOSINOPRIL-HYDROCHLOROTHIAZIDE
FRAGARIA VITIS
FUROSEMIDE-0.9 % NACL
FUROSEMIDE-0.9% NACL
GLYCERIN
GLYCERIN AND ROSE WATER
GORDO-UREA
GORMEL
GORMEL 10
HEALON PF
HEEL BALM
HEMANGEOL
HYDRALAZINE W/HCTZ
HYDRO 35
HYDRO 40
HYTRIN
HYZAAR
INDERAL LA
INDERAL XL
INFANT GLYCERIN
INNOPRAN XL
INSPRA
INTROL
IRBESARTAN-HYDROCHLOROTHIAZIDE
ISOPTIN SR
ISTALOL
KERAFOAM
KERALAC
KERLONE
KEROL
LASIX
LETAIRIS
LEVATOL
LISINOPRIL-HYDROCHLOROTHIAZIDE
27
GENERIC DRUG
EPOPROSTENOL SODIUM (GLYCINE)
EPROSARTAN MESYLATE
ESMOLOL HCL
AMLODIPINE/VALSARTAN
AMLODIPINE/VALSARTAN/HCTHIAZID
FELODIPINE
FENOLDOPAM MESYLATE
EPOPROSTENOL SODIUM (GLYCINE)
FOSINOPRIL SODIUM
FOSINOPRIL/HYDROCHLOROTHIAZIDE
HERBAL DRUGS
FUROSEMIDE
FUROSEMIDE IN 0.9 % NACL
FUROSEMIDE IN 0.9 % NACL
GLYCERIN
UREA
UREA
UREA
GUANABENZ ACETATE
UREA
PROPRANOLOL HCL
HYDRALAZINE HCL
HYDRALAZINE/HYDROCHLOROTHIAZID
UREA
UREA
HYDROCHLOROTHIAZIDE
TERAZOSIN HCL
LOSARTAN/HYDROCHLOROTHIAZIDE
INDAPAMIDE
PROPRANOLOL HCL
PROPRANOLOL HCL
GLYCERIN
PROPRANOLOL HCL
EPLERENONE
GLYCERIN
IRBESARTAN
IRBESARTAN/HYDROCHLOROTHIAZIDE
VERAPAMIL HCL
ISRADIPINE
TIMOLOL MALEATE
UREA
UREA
BETAXOLOL HCL
UREA
LABETALOL HCL
FUROSEMIDE
AMBRISENTAN
PENBUTOLOL SULFATE
LISINOPRIL
LISINOPRIL/HYDROCHLOROTHIAZIDE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
BRAND DRUG
LOPRESSOR
LOPRESSOR HCT
LOSARTAN-HYDROCHLOROTHIAZIDE
LOTENSIN
LOTENSIN HCT
LOTREL
MAGNACET
MATZIM LA
MAVIK
MAXIMUM ENERGY
MAXZIDE
MAXZIDE-25 MG
METHYLDOPAHYDROCHLOROTHIAZIDE
METOPROLOL TARTRATE
METOPROLOLHYDROCHLOROTHIAZIDE
MEVACOR
MICARDIS
MICARDIS HCT
MICROZIDE
MIDAMOR
MINIPRESS
MOEXIPRIL-HYDROCHLOROTHIAZIDE
NADOLOL-BENDROFLUMETHIAZIDE
NICARDIPINE HCL-D5W
NIFEDIAC CC
NIFEDICAL XL
NIFEDIPINE ER
NITROPRESS
NORVASC
NORWEGIAN FORMULA
NUTRAPLUS
NYMALIZE
OASIS
OPSUMIT
ORENITRAM ER
OSMITROL
OXYCODONE-ACETAMINOPHEN
28
GENERIC DRUG
METOPROLOL TARTRATE
METOPROLOL/HYDROCHLOROTHIAZIDE
LOSARTAN POTASSIUM
LOSARTAN/HYDROCHLOROTHIAZIDE
BENAZEPRIL HCL
BENAZEPRIL/HYDROCHLOROTHIAZIDE
AMLODIPINE BESYLATE/BENAZEPRIL
LOVASTATIN
OXYCODONE HCL/ACETAMINOPHEN
MANNITOL
DILTIAZEM HCL
TRANDOLAPRIL
HERBAL DRUGS
TRIAMTERENE/HYDROCHLOROTHIAZID
TRIAMTERENE/HYDROCHLOROTHIAZID
METHYCLOTHIAZIDE
METHYLDOPA
METHYLDOPA/HYDROCHLOROTHIAZIDE
METHYLDOPATE HCL
METOLAZONE
METOPROLOL SUCCINATE
METOPROLOL/HYDROCHLOROTHIAZIDE
LOVASTATIN
TELMISARTAN
TELMISARTAN/HYDROCHLOROTHIAZID
HYDROCHLOROTHIAZIDE
AMILORIDE HCL
PRAZOSIN HCL
MINOXIDIL
MOEXIPRIL HCL
MOEXIPRIL/HYDROCHLOROTHIAZIDE
NADOLOL
NADOLOL/BENDROFLUMETHIAZIDE
NICARDIPINE HCL
NICARDIPINE IN D5W
NIFEDIPINE
NIFEDIPINE
NIFEDIPINE
NIFEDIPINE
NIMODIPINE
NISOLDIPINE
NITROPRUSSIDE SODIUM
AMLODIPINE BESYLATE
GLYCERIN
UREA
NIMODIPINE
GLYCERIN
MACITENTAN
TREPROSTINIL DIOLAMINE
MANNITOL
OXYCODONE HCL/ACETAMINOPHEN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
BRAND DRUG
PEDIA-LAX
PERCOCET
PERMED HAIR SHAMPOO
PHENTOLAMINE MESYLATE
PRIMLEV
PRINIVIL
PRINZIDE
PROCARDIA
PROCARDIA XL
PROGLYCEM
PROPRANOLOL HCL ER
PROPRANOLOLHYDROCHLOROTHIAZID
PROSTIN VR PEDIATRIC
QUINAPRIL-HYDROCHLOROTHIAZIDE
RAINBATH
REA LO 30
REA LO 39
REA LO 40
REMEVEN
REMODULIN
RESECTISOL
RE-U40
REVATIO
ROXICET
SANI-SUPP
SECTRAL
SILDENAFIL
SODIUM DIURIL
SODIUM EDECRIN
SORINE
SOTALOL
SOTALOL AF
SOTALOL HCL
SOTYLIZE
SPIRONOLACTONE-HCTZ
SULAR
SUPER ENERGY
SUPPOSITORY
TARKA
TAZTIA XT
TEKAMLO
TEKTURNA
TEKTURNA HCT
29
GENERIC DRUG
GLYCERIN
OXYCODONE HCL/ACETAMINOPHEN
PERINDOPRIL ERBUMINE
GLYCERIN
PINDOLOL
PRAZOSIN HCL
OXYCODONE HCL/ACETAMINOPHEN
LISINOPRIL
LISINOPRIL/HYDROCHLOROTHIAZIDE
NIFEDIPINE
NIFEDIPINE
DIAZOXIDE
PROPRANOLOL HCL
PROPRANOLOL HCL
PROPRANOLOL/HYDROCHLOROTHIAZID
ALPROSTADIL
QUINAPRIL HCL
QUINAPRIL/HYDROCHLOROTHIAZIDE
GLYCERIN
RAMIPRIL
UREA
UREA
UREA
UREA
TREPROSTINIL SODIUM
MANNITOL
RESERPINE
UREA
SILDENAFIL CITRATE
OXYCODONE HCL/ACETAMINOPHEN
GLYCERIN
ACEBUTOLOL HCL
SILDENAFIL CITRATE
CHLOROTHIAZIDE SODIUM
ETHACRYNATE SODIUM
SOTALOL HCL
SOTALOL HCL
SOTALOL HCL
SOTALOL HCL
SPIRONOLACTONE
SPIRONOLACT/HYDROCHLOROTHIAZID
NISOLDIPINE
HERBAL DRUGS
GLYCERIN
TRANDOLAPRIL/VERAPAMIL HCL
DILTIAZEM HCL
ALISKIREN/AMLODIPINE BESYLATE
ALISKIREN HEMIFUMARATE
ALISKIREN/HYDROCHLOROTHIAZIDE
TELMISARTAN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
BRAND DRUG
TELMISARTAN-AMLODIPINE
TELMISARTANHYDROCHLOROTHIAZID
TENORETIC 100
TENORETIC 50
TENORMIN
TEVETEN
TEVETEN HCT
THALITONE
TIAZAC
TIMOPTIC
TIMOPTIC-XE
TL 45% UREA
TOPROL XL
TRACLEER
TRANDATE
TRANDOLAPRIL-VERAPAMIL
TRANDOLAPRIL-VERAPAMIL ER
TRIAMTERENE W/HCTZ
TRIAMTERENE-HCTZ
TRIAMTERENEHYDROCHLOROTHIAZID
TRIBENZOR
TWYNSTA
TYLOX
TYVASO
U40
ULTRA MIDE 25
UMECTA
UMECTA PD
UNIRETIC
UNIVASC
URAMAXIN
URAMAXIN GT
UREA 40
UREACIN-10
UREACIN-20
UTOPIC
VALSARTAN-HYDROCHLOROTHIAZIDE
VALTURNA
VASERETIC
VASOTEC
VECAMYL
VELETRI
VENTAVIS
VERAPAMIL ER
VERAPAMIL ER PM
30
GENERIC DRUG
TELMISARTAN/AMLODIPINE
TELMISARTAN/HYDROCHLOROTHIAZID
ATENOLOL/CHLORTHALIDONE
ATENOLOL/CHLORTHALIDONE
ATENOLOL
TERAZOSIN HCL
EPROSARTAN MESYLATE
EPROSARTAN/HYDROCHLOROTHIAZIDE
CHLORTHALIDONE
DILTIAZEM HCL
TIMOLOL MALEATE
TIMOLOL MALEATE
TIMOLOL MALEATE
UREA
METOPROLOL SUCCINATE
TORSEMIDE
BOSENTAN
LABETALOL HCL
TRANDOLAPRIL
TRANDOLAPRIL/VERAPAMIL HCL
TRANDOLAPRIL/VERAPAMIL HCL
TRIAMTERENE/HYDROCHLOROTHIAZID
TRIAMTERENE/HYDROCHLOROTHIAZID
TRIAMTERENE/HYDROCHLOROTHIAZID
OLMESARTAN/AMLODIPIN/HCTHIAZID
TELMISARTAN/AMLODIPINE
OXYCODONE HCL/ACETAMINOPHEN
TREPROSTINIL
UREA
UREA
UREA
UREA
MOEXIPRIL/HYDROCHLOROTHIAZIDE
MOEXIPRIL HCL
UREA
UREA
UREA
UREA
UREA
UREA
UREA
VALSARTAN
VALSARTAN/HYDROCHLOROTHIAZIDE
ALISKIREN/VALSARTAN
ENALAPRIL/HYDROCHLOROTHIAZIDE
ENALAPRIL MALEATE
MECAMYLAMINE HCL
EPOPROSTENOL SODIUM (ARGININE)
ILOPROST TROMETHAMINE
VERAPAMIL HCL
VERAPAMIL HCL
VERAPAMIL HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - HYPERTENSION
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
BRAND DRUG
VERAPAMIL SR
VERELAN
VERELAN PM
WIBI
XARTEMIS XR
XOLOX
X-VIATE
ZAROXOLYN
ZEBETA
ZESTORETIC
ZESTRIL
ZIAC
ADVICOR
ALGAL OMEGA-3 DHA
ALGAL-900 DHA
ALMEBEX PLUS B-12
ANTARA
ATABEX DHA
CARDIO OMEGA BENEFITS
CARDIOSTAT
CARDIOSTEROL
CHOLEST CARE
CHOLESTEROL FIGHTER
CHOLESTYRAMINE
CHOLESTYRAMINE LIGHT
CHOLINOID
CHONDROITIN SULFATE
COLESTID
COROMEGA
COROMEGA GO PAK
COROMEGA GO-PAK
COROMEGA PRENATAL OMEGA BABY
CRESTOR
DHA
DHA ALGAL-900
DHA COMPLETE
DHA PRENATAL
DRY EYE OMEGA BENEFITS
ENDUR-ACIN
EPA-DHA 720
EXPECTA LIPIL
FENOGLIDE
FIBRICOR
FISH OIL
FISH OIL + D3
FISH OIL + VITAMIN D-3
FISH OIL CONCENTRATE
FISH OIL HIGH POTENCY
31
GENERIC DRUG
VERAPAMIL HCL
VERAPAMIL HCL
VERAPAMIL HCL
GLYCERIN
OXYCODONE HCL/ACETAMINOPHEN
OXYCODONE HCL/ACETAMINOPHEN
UREA
METOLAZONE
BISOPROLOL FUMARATE
LISINOPRIL/HYDROCHLOROTHIAZIDE
LISINOPRIL
BISOPROLOL FUMARATE/HCTZ
NIACIN/LOVASTATIN
DOCOSAHEXANOIC ACID
DOCOSAHEXANOIC ACID
CHOLINE BIT/B COMP/B12/NIACIN
FENOFIBRATE,MICRONIZED
DOCOSAHEXANOIC ACID/EPA
ATORVASTATIN CALCIUM
OMEGA-3S/DHA/EPA/FISH OIL/D3
OMEGA-3/DHA/EPA/FISH OIL
PHYTOSTEROL/OM-3/DHA/EPA/FISH
PHYTOSTEROL COMBINATION NO.1
LECI/SITOSTEROLS/NIA/BETN/CHIT
CHOLESTYRAMINE (WITH SUGAR)
CHOLESTYRAMINE/ASPARTAME
INOSI/CHOLINE BIT/VIT BCOMP&C
CHONDROITIN SULFATE A
COLESTIPOL HCL
COLESTIPOL HCL
FISH OIL/OMEGA-3/VIT C/VIT E
OMEGA-3/DHA/EPA/FISH OIL
FISH OIL/OMEGA-3/VIT C/VIT E
OMEGA-3/DHA/EPA/FISH OIL
ROSUVASTATIN CALCIUM
DOCOSAHEXANOIC ACID
DOCOSAHEXANOIC ACID
DOCOSAHEXANOIC ACID
DOCOSAHEXANOIC ACID
OMEGA-3S/DHA/EPA/FISH OIL/D3
NIACIN
OMEGA-3/DHA/EPA/FISH OIL
DOCOSAHEXANOIC ACID
FENOFIBRATE
FENOFIBRIC ACID
FENOFIBRATE
FENOFIBRIC ACID
DOCOSAHEXANOIC ACID/EPA
OMEGA-3S/DHA/EPA/FISH OIL/D3
OMEGA3/DHA/EPA/FISH OIL/VIT D3
OMEGA-3 FATTY ACIDS
OMEGA-3/DHA/EPA/FISH OIL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
BRAND DRUG
FISH OIL OMEGA-3
FISH OIL PEARLS
FISH OIL ULTRA
FISH OIL WITH KRILL
FISH OIL-OMEGA-3-VIT D
FISH OIL-PHYTOSTEROLS
FISH OIL-VIT D3
FISH-FLAX-BORAGE OIL
FISH-FLAX-BORAGE OILS
FLAXSEED-FISH-BORAGE OIL
FLEX OMEGA BENEFITS
FORTIFIED CHROMIUM PICOLINATE
GRAM-O-LECI
JUXTAPID
KYNAMRO
LESCOL
LESCOL XL
LIPICHOL 540
LIPITOR
LIPOCHOL
LIPOCHOL PLUS
LIPOFEN
LIPOGEN
LIPOTRIAD
LIPTRUZET
LIVALO
LOFIBRA
LOPID
LOVAZA
MAREPA
MAXEPA
MEGAKRILL
MEGARED PLANT-OMEGA-3
NIACIN ER
NIACIN FLUSH FREE
NIACIN FLUSH-FREE
NIACIN INOSITOL
NIACIN SR 250MG
NIACOR
NIASPAN
NICOMIDE-T
NO FLUSH NIACIN
OCEAN BLUE OMEGA-3
OCEAN BLUE OMEGA-3 + D3
OMEGA 3
OMEGA 3 FISH OIL
OMEGA 3 LIQUID
32
GENERIC DRUG
OMEGA-3 FATTY ACIDS/FISH OIL
OMEGA-3 FATTY ACIDS/FISH OIL
OMEGA-3/DHA/EPA/FISH OIL
KRILL OIL/OMEGA-3/DHA/EPA
OMEGA-3S/DHA/EPA/FISH OIL/D3
PHYTOSTEROL/OM-3/DHA/EPA/FISH
OMEGA3/DHA/EPA/FISH OIL/VIT D3
FISH,SAF,FLX,BRG OILS/O3,6,9#2
FSH/FLX/PRM/BLK/BOR/OM3,6,9 #6
FLAXSEED OIL
FISH OIL/BORAGE/FLAX/OM3,6,9#1
OMEGA3/DHA/EPA/FISH OIL/VIT D3
FLUVASTATIN SODIUM
LECITHIN/INOSI/CHOL/CAL/CHROM
GEMFIBROZIL
LECITHIN
LOMITAPIDE MESYLATE
KRILL OIL
MIPOMERSEN SODIUM
LECITHIN
FLUVASTATIN SODIUM
FLUVASTATIN SODIUM
OM3/DHA/EPA/LIPIDS/ASTAX/KRILL
ATORVASTATIN CALCIUM
METHIONINE/INOSI/CHOL/LYS/B12
METHIONINE/INOSITOL/CHOLINE/FA
FENOFIBRATE
INOSITOL/CHOLINE/VIT B COMP
ANTIOX#13/MIN/FA/LUTEIN/ZEAXAN
EZETIMIBE/ATORVASTATIN CALCIUM
PITAVASTATIN CALCIUM
FENOFIBRATE
GEMFIBROZIL
OMEGA-3 ACID ETHYL ESTERS
DOCOSAHEXANOIC ACID/EPA/VIT E
OMEGA-3 FATTY ACIDS
KRILL/OMEGA-3/DHA/EPA/LIPIDS
OMEGA-3 FATTY ACIDS/DHA/EPA
NIACIN
NIACIN (INOSITOL NIACINATE)
NIACIN (INOSITOL NIACINATE)
NIACIN (INOSITOL NIACINATE)
NIACIN
NIACIN
NIACIN
NIACINAMIDE
NIACIN (INOSITOL NIACINATE)
OMEGA-3S/DHA/EPA/FISH OIL
OMEGA-3S/DHA/EPA/FISH OIL/D3
OMEGA-3 FATTY ACIDS/FISH OIL
OMEGA-3 FATTY ACIDS
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
CARDIOVASCULAR DISEASE - LIPID IRREGULARITY
BRAND DRUG
OMEGA 3-6-9
OMEGA 3-6-9 COMPLEX
OMEGA 3-6-9 FATTY ACIDS
OMEGA 3-FISH-FLAX-BORAGE OIL
OMEGA ESSENTIALS
OMEGA ESSENTIALS BASIC
OMEGA POWER
OMEGA-3
OMEGA-3 + VITAMIN D3
OMEGA-3 2100
OMEGA-3 FISH OIL
OMEGA-3 IQ CHILDREN'S
OMEGA-3 KRILL OIL
OMEGA-3+ VITAMIN D3
OMEGA-3-FISH OIL-VIT D3
POLICOSANOL-GARLIC-NIACIN
PRAVACHOL
PRENATAL DHA
PREVALITE
QUESTRAN
QUESTRAN LIGHT
RESTORA
SALMON OIL
SALMON OIL-1000
SEA OMEGA + D
SEA-OMEGA 30
SEA-OMEGA 50
SIMCOR
SLO-NIACIN
SUPER DHA GEMS
SUPER EPA
SUPER OMEGA-3
SUPER TWIN EPA-DHA
THEROMEGA
THEROMEGA SPORT
TRICOR
TRIGLIDE
TRILIPIX
TRIPLE OMEGA
TRIPLE OMEGA 3-6-9
VASCAZEN
VASCEPA
VAYAROL
VITAMIN-D + OMEGA-3
VYTORIN
WELCHOL
ZETIA
ZOCOR
ZYNCOL
33
GENERIC DRUG
FISH OIL/BORAGE/FLAX/OM3,6,9#1
FISH OIL/BORAGE/FLAX/OM3,6,9#1
FSH/FLX/PRM/BLK/BOR/OM3,6,9 #5
FISH OIL/BORAGE/FLAX/OM3,6,9#1
OMEGA-3S/DHA/EPA/FISH OIL/D3
OMEGA-3S/DHA/EPA/FISH OIL
OMEGA-3S/DHA/EPA/FISH OIL
OMEGA-3 FATTY ACIDS
OMEGA 3/DHA/EPA/OTHER OM3/D3
OMEGA-3/DHA/EPA/DPA/FISH OIL
OMEGA-3 ACID ETHYL ESTERS
OMEGA-3 FATTY ACIDS/FISH OIL
OMEGA-3S/DHA/EPA/FISH OIL
KRILL OIL/OMEGA-3/DHA/EPA
OMEGA3/DHA/EPA/FISH OIL/VIT D3
OMEGA3/DHA/EPA/FISH OIL/VIT D3
POLICOS/INOSITOL NIAC/GARLIC
PRAVASTATIN SODIUM
PRAVASTATIN SODIUM
DOCOSAHEXANOIC ACID
CHOLESTYRAMINE/ASPARTAME
CHOLESTYRAMINE (WITH SUGAR)
CHOLESTYRAMINE/ASPARTAME
OM-3/DHA/EPA/FISH OIL/L. CASEI
SALMON OIL/OMEGA-3 FATTY ACIDS
SALMON OIL/OMEGA-3 FATTY ACIDS
OMEGA3/DHA/EPA/FISH OIL/VIT D3
OMEGA-3 FATTY ACIDS/FISH OIL
OMEGA-3/DHA/EPA/FISH OIL
NIACIN/SIMVASTATIN
SIMVASTATIN
NIACIN
OMEGA-3/DHA/EPA/FISH OIL
OMEGA-3 FATTY ACIDS/VITAMIN E
FSH/FLX/PRM/BLK/BOR/OM3,6,9 #5
OMEGA-3 FATTY ACIDS
OMEGA-3/DHA/EPA/FISH OIL
OMEGA-3/DHA/EPA/FISH OIL
FENOFIBRATE NANOCRYSTALLIZED
FENOFIBRATE NANOCRYSTALLIZED
FENOFIBRIC ACID (CHOLINE)
FISH OIL/BORAGE/FLAX/OM3,6,9#1
FISH OIL/BORAGE/FLAX/OM3,6,9#1
OMEGA-3S/DHA/EPA/FISH OIL
ICOSAPENT ETHYL
PHYTOSTEROL/OM-3/DHA/EPA/FISH
OMEGA-3S/DHA/EPA/FISH OIL/D3
EZETIMIBE/SIMVASTATIN
COLESEVELAM HCL
EZETIMIBE
SIMVASTATIN
POLICOSANOL COMBINATION NO.3
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS
CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS
CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS
CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS
CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS
CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS
CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CARDIOVASCULAR DISEASE - VASODILATION
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
BRAND DRUG
AMLODIPINE-ATORVASTATIN
CADUET
JUVISYNC
NORTHERA
PROAMATINE
RANEXA
DILATRATE-SR
IMDUR
ISMO
ISOCHRON
ISODITRATE
ISORDIL
ISORDIL TITRADOSE
ISOSORBIDE MONONITRATE ER
MINITRAN
MONOKET
NITRO-BID
NITRO-DUR
NITROGLYCERIN IN D5W
NITROGLYCERIN PATCH
NITROLINGUAL
NITROMIST
NITRONAL
NITROSTAT
NITRO-TIME
PERSANTINE
RECTIV
AFTERA
ALTAVERA
ALYACEN
AMETHIA
AMETHIA LO
AMETHYST
APRI
ARANELLE
ASHLYNA
AUBRA
AVIANE
AZURETTE
BALZIVA
BEYAZ
BREVICON
34
GENERIC DRUG
AMLODIPINE/ATORVASTATIN
AMLODIPINE/ATORVASTATIN
SITAGLIPTIN/SIMVASTATIN
MIDODRINE HCL
DROXIDOPA
MIDODRINE HCL
RANOLAZINE
AMYL NITRITE
ISOSORBIDE DINITRATE
DIPYRIDAMOLE
ERGOLOID MESYLATES
ISOSORBIDE MONONITRATE
ISOSORBIDE MONONITRATE
ISOSORBIDE DINITRATE
ISOSORBIDE DINITRATE
ISOSORBIDE DINITRATE
ISOSORBIDE DINITRATE
ISOSORBIDE DINITRATE
ISOSORBIDE MONONITRATE
ISOSORBIDE MONONITRATE
ISOXSUPRINE HCL
NITROGLYCERIN
ISOSORBIDE MONONITRATE
NITROGLYCERIN
NITROGLYCERIN
NITROGLYCERIN
NITROGLYCERIN/D5W
NITROGLYCERIN
NITROGLYCERIN
NITROGLYCERIN
NITROGLYCERIN
NITROGLYCERIN
NITROGLYCERIN
NYLIDRIN HCL
PAPAVERINE HCL
DIPYRIDAMOLE
NITROGLYCERIN
LEVONORGESTREL
LEVONORGESTREL-ETHIN ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
L-NORGEST-ETH ESTR/ETHIN ESTRA
L-NORGEST-ETH ESTR/ETHIN ESTRA
LEVONORGESTREL-ETHIN ESTRADIOL
DESOGESTREL-ETHINYL ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
L-NORGEST-ETH ESTR/ETHIN ESTRA
LEVONORGESTREL-ETHIN ESTRADIOL
LEVONORGESTREL-ETHIN ESTRADIOL
DESOG-E.ESTRADIOL/E.ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
DROSPIR/ETH ESTRA/LEVOMEFOL CA
NORETHINDRONE-ETHINYL ESTRAD
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
BRAND DRUG
BRIELLYN
CAMILA
CAMRESE
CAMRESE LO
CAZIANT
CERVIDIL
CESIA
CHATEAL
CONCEPTROL
CRYSELLE
CYCLAFEM
CYCLESSA
DASETTA
DAYSEE
DEBLITANE
DELYLA
DEMULEN 1-50-28
DEPO-PROVERA
DESOGEN
DESOGESTR-ETH ESTRAD ETH ESTRA
DROSPIRENONE-ETHINYL ESTRADIOL
ECONTRA EZ
ELINEST
ELLA
EMOQUETTE
ENCARE
ENPRESSE
ENSKYCE
ERRIN
ESTARYLLA
ESTROSTEP FE
FALLBACK SOLO
FALMINA
FEMCON FE
GENERESS FE
GIANVI
GILDAGIA
GILDESS
GILDESS 24 FE
GILDESS FE
GYNOL II
GYNOL II EXTRA STRENGTH
HEATHER
HEMABATE
INTROVALE
JENCYCLA
JOLESSA
JOLIVETTE
JUNEL
JUNEL FE
KARIVA
35
GENERIC DRUG
NORETHINDRONE-ETHINYL ESTRAD
NORETHINDRONE
L-NORGEST-ETH ESTR/ETHIN ESTRA
L-NORGEST-ETH ESTR/ETHIN ESTRA
DESOGESTREL-ETHINYL ESTRADIOL
DINOPROSTONE
DESOGESTREL-ETHINYL ESTRADIOL
LEVONORGESTREL-ETHIN ESTRADIOL
NONOXYNOL 9
NORGESTREL-ETHINYL ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
DESOGESTREL-ETHINYL ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
L-NORGEST-ETH ESTR/ETHIN ESTRA
NORETHINDRONE
LEVONORGESTREL-ETHIN ESTRADIOL
ETHYNODIOL D-ETHINYL ESTRADIOL
MEDROXYPROGESTERONE ACETATE
DESOGESTREL-ETHINYL ESTRADIOL
DESOGESTREL-ETHINYL ESTRADIOL
DESOG-E.ESTRADIOL/E.ESTRADIOL
ETHINYL ESTRADIOL/DROSPIRENONE
LEVONORGESTREL
NORGESTREL-ETHINYL ESTRADIOL
ULIPRISTAL ACETATE
DESOGESTREL-ETHINYL ESTRADIOL
NONOXYNOL 9
LEVONORGESTREL-ETHIN ESTRADIOL
DESOGESTREL-ETHINYL ESTRADIOL
NORETHINDRONE
NORGESTIMATE-ETHINYL ESTRADIOL
NORETHINDRONE-E.ESTRADIOL-IRON
LEVONORGESTREL
LEVONORGESTREL-ETHIN ESTRADIOL
NORETH-ETHINYL ESTRADIOL/IRON
NORETH-ETHINYL ESTRADIOL/IRON
ETHINYL ESTRADIOL/DROSPIRENONE
NORETHINDRONE-ETHINYL ESTRAD
NORETHINDRONE AC-ETH ESTRADIOL
NORETHINDRONE-E.ESTRADIOL-IRON
NORETHINDRONE-E.ESTRADIOL-IRON
NONOXYNOL 9
NONOXYNOL 9
NORETHINDRONE
CARBOPROST TROMETHAMINE
LEVONORGESTREL-ETHIN ESTRADIOL
NORETHINDRONE
LEVONORGESTREL-ETHIN ESTRADIOL
NORETHINDRONE
NORETHINDRONE AC-ETH ESTRADIOL
NORETHINDRONE-E.ESTRADIOL-IRON
DESOG-E.ESTRADIOL/E.ESTRADIOL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
BRAND DRUG
KELNOR 1-35
KURVELO
LARIN
LARIN FE
LAYOLIS FE
LEENA
LESSINA
LEVONEST
LEVONORGESTREL-ETH ESTRADIOL
LEVONORG-ETH ESTRAD ETH ESTRAD
LEVORA-28
LO LOESTRIN FE
LO MINASTRIN FE
LOESTRIN
LOESTRIN 24 FE
LOESTRIN FE
LOMEDIA 24 FE
LO-OVRAL-28
LO-OVRAL-8
LORYNA
LOSEASONIQUE
LOW-OGESTREL
LUTERA
LYBREL
LYZA
MARLISSA
MEDROXYPROGESTERONE ACETATE
METHERGINE
MICROGESTIN
MICROGESTIN FE
MICRONOR
MINASTRIN 24 FE
MIRCETTE
MODICON
MONO-LINYAH
MONONESSA
MY WAY
MYZILRA
NATAZIA
NECON
NEXT CHOICE
NEXT CHOICE ONE DOSE
NIKKI
NORA-BE
NORDETTE-28
NORDETTE-8
NORETHINDRONE-ETHIN ESTRADIOL
NORETHINDRON-ETHINYL ESTRADIOL
NORETHIN-ETH ESTRA FERROUS FUM
36
GENERIC DRUG
ETHYNODIOL D-ETHINYL ESTRADIOL
LEVONORGESTREL-ETHIN ESTRADIOL
NORETHINDRONE AC-ETH ESTRADIOL
NORETHINDRONE-E.ESTRADIOL-IRON
NORETH-ETHINYL ESTRADIOL/IRON
NORETHINDRONE-ETHINYL ESTRAD
LEVONORGESTREL-ETHIN ESTRADIOL
LEVONORGESTREL-ETHIN ESTRADIOL
LEVONORGESTREL
LEVONORGESTREL-ETHIN ESTRADIOL
L-NORGEST-ETH ESTR/ETHIN ESTRA
LEVONORGESTREL-ETHIN ESTRADIOL
NORETHINDRONE-E.ESTRADIOL-IRON
NORETHINDRONE-E.ESTRADIOL-IRON
NORETHINDRONE AC-ETH ESTRADIOL
NORETHINDRONE-E.ESTRADIOL-IRON
NORETHINDRONE-E.ESTRADIOL-IRON
NORETHINDRONE-E.ESTRADIOL-IRON
NORGESTREL-ETHINYL ESTRADIOL
NORGESTREL-ETHINYL ESTRADIOL
ETHINYL ESTRADIOL/DROSPIRENONE
L-NORGEST-ETH ESTR/ETHIN ESTRA
NORGESTREL-ETHINYL ESTRADIOL
LEVONORGESTREL-ETHIN ESTRADIOL
LEVONORGESTREL-ETHIN ESTRADIOL
NORETHINDRONE
LEVONORGESTREL-ETHIN ESTRADIOL
MEDROXYPROGESTERONE ACET
METHYLERGONOVINE MALEATE
METHYLERGONOVINE MALEATE
NORETHINDRONE AC-ETH ESTRADIOL
NORETHINDRONE-E.ESTRADIOL-IRON
NORETHINDRONE
NORETHINDRONE-E.ESTRADIOL-IRON
DESOG-E.ESTRADIOL/E.ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
NORGESTIMATE-ETHINYL ESTRADIOL
NORGESTIMATE-ETHINYL ESTRADIOL
LEVONORGESTREL
LEVONORGESTREL-ETHIN ESTRADIOL
ESTRADIOL VALERATE/DIENOGEST
NORETHINDRONE-ETHINYL ESTRAD
LEVONORGESTREL
LEVONORGESTREL
ETHINYL ESTRADIOL/DROSPIRENONE
NORETHINDRONE
LEVONORGESTREL-ETHIN ESTRADIOL
LEVONORGESTREL-ETHIN ESTRADIOL
NORETHINDRONE
NORETH-ETHINYL ESTRADIOL/IRON
NORETHINDRONE AC-ETH ESTRADIOL
NORETH-ETHINYL ESTRADIOL/IRON
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
BRAND DRUG
NORGESTREL-ETHINY ESTRA
NORINYL 1+35
NORINYL 1+50
NORLYROC
NOR-Q-D
NORTREL
OCELLA
OGESTREL
OPCICON ONE-STEP
ORSYTHIA
ORTHO MICRONOR
ORTHO TRI-CYCLEN
ORTHO TRI-CYCLEN LO
ORTHO-CEPT
ORTHO-CYCLEN
ORTHO-NOVUM
OVCON-35
OVCON-50
OXYTOCIN
OXYTOCIN-0.9% NACL
OXYTOCIN-D5-1/2NS
OXYTOCIN-D5-1/4NS
OXYTOCIN-D5-NS
OXYTOCIN-D5W
OXYTOCIN-D5W-LACTATED RINGERS
OXYTOCIN-LACTATED RINGERS
PHILITH
PIMTREA
PIRMELLA
PITOCIN
PLAN B
PLAN B ONE-STEP
PORTIA
PREPIDIL
PREVIFEM
PROSTIN E2 VAGINAL SUPPOSITORY
PROVERA
QUARTETTE
QUASENSE
RECLIPSEN
SAFYRAL
SEASONALE
SEASONIQUE
SHAROBEL
SOLIA
SPRINTEC
SRONYX
SYEDA
TAKE ACTION
TARINA FE
TILIA FE
37
GENERIC DRUG
NORGESTIMATE-ETHINYL ESTRADIOL
NORGESTREL-ETHINYL ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
NORETHINDRONE-MESTRANOL
NORETHINDRONE
NORETHINDRONE
NORETHINDRONE-ETHINYL ESTRAD
ETHINYL ESTRADIOL/DROSPIRENONE
NORGESTREL-ETHINYL ESTRADIOL
LEVONORGESTREL
LEVONORGESTREL-ETHIN ESTRADIOL
NORETHINDRONE
NORGESTIMATE-ETHINYL ESTRADIOL
NORGESTIMATE-ETHINYL ESTRADIOL
DESOGESTREL-ETHINYL ESTRADIOL
NORGESTIMATE-ETHINYL ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
NORETHINDRONE-ETHINYL ESTRAD
NORETHINDRONE-ETHINYL ESTRAD
OXYTOCIN/0.9 % SODIUM CHLORIDE
OXYTOCIN/D5W-0.45% SODIUM CL
OXYTOCIN/D5W-0.2% SODIUM CL
OXYTOCIN/D5W-0.9% SODIUM CL
OXYTOCIN/DEXTROSE 5%
OXYTOCIN/D5LR
OXYTOCIN/RINGERS LACTATE
NORETHINDRONE-ETHINYL ESTRAD
DESOG-E.ESTRADIOL/E.ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
OXYTOCIN
LEVONORGESTREL
LEVONORGESTREL
LEVONORGESTREL-ETHIN ESTRADIOL
DINOPROSTONE
NORGESTIMATE-ETHINYL ESTRADIOL
DINOPROSTONE
MEDROXYPROGESTERONE ACETATE
L-NORGEST-ETH ESTR/ETHIN ESTRA
LEVONORGESTREL-ETHIN ESTRADIOL
DESOGESTREL-ETHINYL ESTRADIOL
DROSPIR/ETH ESTRA/LEVOMEFOL CA
LEVONORGESTREL-ETHIN ESTRADIOL
L-NORGEST-ETH ESTR/ETHIN ESTRA
NORETHINDRONE
DESOGESTREL-ETHINYL ESTRADIOL
NORGESTIMATE-ETHINYL ESTRADIOL
LEVONORGESTREL-ETHIN ESTRADIOL
ETHINYL ESTRADIOL/DROSPIRENONE
LEVONORGESTREL
NORETHINDRONE-E.ESTRADIOL-IRON
NORETHINDRONE-E.ESTRADIOL-IRON
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
CONTRACEPTION/OXYTOCICS
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
TODAY CONTRACEPTIVE SPONGE
TRI-ESTARYLLA
TRI-LEGEST FE
TRI-LINYAH
TRINESSA
TRI-NORINYL
TRI-PREVIFEM
TRI-SPRINTEC
TRIVORA-28
VCF
VELIVET
VESTURA
VIORELE
VYFEMLA
WERA
WYMZYA FE
YASMIN 28
YAZ
ZARAH
ZENCHENT
ZENCHENT FE
ZEOSA
ZOVIA 1-35E
ZOVIA 1-50E
10PEH-400GFN
10PEH-400GFN-20DM
10PEH-4CPM
10PEH-4CPM-20DM
12 HOUR COLD RELIEF
12 HOUR DECONGESTANT
12 HOUR NASAL RELIEF
12 HOUR NASAL SPRAY
12 HOUR RELIEF
12.5CPD-100GFN-30PSE
12.5CPD-120GFN-5PEH
12.5CPD-1DCPM-30PSE
15DM-100GFN-5PEH
15DM-5PEH-2CPM
20DM-100GFN-10PEH
20DM-4CPM
25CPD-200GFN
25DPH-7.5PEH
2CPM-15DM-5PEH
30PSE-150GFN-15DM
30PSE-3BRM-15DM
3BRM-15DM-30PSE
3BRM-30DM-50PSE
4 WAY
40PSE-400GFN
40PSE-400GFN-20DM
40PSE-4BRM-20DM
50PSE-3BRM-30DM
38
GENERIC DRUG
NONOXYNOL 9
NORGESTIMATE-ETHINYL ESTRADIOL
NORETHINDRONE-E.ESTRADIOL-IRON
NORGESTIMATE-ETHINYL ESTRADIOL
NORGESTIMATE-ETHINYL ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
NORGESTIMATE-ETHINYL ESTRADIOL
NORGESTIMATE-ETHINYL ESTRADIOL
LEVONORGESTREL-ETHIN ESTRADIOL
NONOXYNOL 9
DESOGESTREL-ETHINYL ESTRADIOL
ETHINYL ESTRADIOL/DROSPIRENONE
DESOG-E.ESTRADIOL/E.ESTRADIOL
NORETHINDRONE-ETHINYL ESTRAD
NORETHINDRONE-ETHINYL ESTRAD
NORETH-ETHINYL ESTRADIOL/IRON
ETHINYL ESTRADIOL/DROSPIRENONE
ETHINYL ESTRADIOL/DROSPIRENONE
ETHINYL ESTRADIOL/DROSPIRENONE
NORETHINDRONE-ETHINYL ESTRAD
NORETH-ETHINYL ESTRADIOL/IRON
NORETH-ETHINYL ESTRADIOL/IRON
ETHYNODIOL D-ETHINYL ESTRADIOL
ETHYNODIOL D-ETHINYL ESTRADIOL
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/D-METHORPHAN HB/PE
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PSEUDOEPHEDRINE HCL
PSEUDOEPHEDRINE HCL
OXYMETAZOLINE HCL
OXYMETAZOLINE HCL
PSEUDOEPHEDRINE/DEXBROMPHENIR
PSEUDOEPH/CHLOPHEDIANOL/GG
PHENYLEPHRINE/CHLOPHEDIANOL/GG
D-CHLORPHENIRA/PSE/CHLOPHEDIAN
GUAIFENESIN/D-METHORPHAN HB/PE
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFENESIN/D-METHORPHAN HB/PE
DEXTROMETHORPHAN HBR/CHLOR-MAL
CHLOPHEDIANOL HCL/GUAIFENESIN
PHENYLEPHRINE/DIPHENHYDRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
D-METHORPHAN HB/P-EPD HCL/BPM
D-METHORPHAN HB/P-EPD HCL/BPM
D-METHORPHAN HB/P-EPD HCL/BPM
PHENYLEPHRINE HCL
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/DM/PSEUDOEPHEDRINE
D-METHORPHAN HB/P-EPD HCL/BPM
D-METHORPHAN HB/P-EPD HCL/BPM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
60PSE-400GFN
60PSE-400GFN-20DM
60PSE-4CPM-20DM
7.5PEH-4BRM-15DM
ABATUSS DMX
ABROPERNOL
ABSORBINE PAIN RELIEVING
ACCUHIST
ACCUHIST PDX
ACTA-TABS
ACTA-TABS PE
ACTIFED COLD & ALLERGY
ACTIFED COLD & SINUS
ACUFLEX
ADLT WAL-TUSSIN COUGH-COLD CF
ADT ROBITUSSIN NIGHT NASAL RLF
ADT ROBITUSSIN PEAK CLD DM MAX
ADULT COUGH FORMULA DM MAX
ADULT NASAL DECONGESTANT
ADULT ROBITUSSIN
ADULT ROBITUSSIN COUGH-COLD D
ADULT ROBITUSSIN LINGERING CLD
ADULT ROBITUSSIN M-S COLD
ADULT ROBITUSSIN NASAL RELIEF
ADULT ROBITUSSIN PEAK COLD
ADULT ROBITUSSIN PEAK COLD M-S
ADULT TUSSIN COUGH CONGEST DM
ADULT TUSSIN DM
ADULT TUSSIN MULTI-SYMP COLD
ADULT WAL-TUSSIN DM
ADULT WAL-TUSSIN DM MAX
ADVANCED FORMULA EYE DROPS
ADVIL
ADVIL ALLERGY-CONGESTION RLF
ADVIL COLD & SINUS
ADVIL CONGESTION RELIEF
ADVIL PM
AEROHIST
AEROHIST PLUS
AEROKID
AFRIN
AIRACOF
ALACOL DM
ALA-HIST AC
ALAHIST DHC
ALA-HIST DM
ALAHIST LQ
ALA-HIST PE
ALBATUSSIN
ALBATUSSIN NN
ALBATUSSIN-NN
39
GENERIC DRUG
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/DM/PSEUDOEPHEDRINE
D-METHORPHAN HB/P-EPHED HCL/CP
BROMPHENIRAM/PHENYLEPHRINE/DM
DEXCHLORPHENIR/PSEUDOEPHED/DM
HOMEOPATHIC DRUGS
MENTHOL
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
P-EPHED HCL/TRIPROLIDINE HCL
PHENYLEPHRINE/CHLORPHENIRAMINE
PHENYLEPHRINE/CHLORPHENIRAMINE
P-EPHED HCL/ACETAMINOPHN/CP
ACETAMINOPHEN/PHENYLTOLX
GUAIFENESIN/D-METHORPHAN HB/PE
PHENYLEPHRINE/ACETAMINOPHEN/CP
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
PSEUDOEPHEDRINE HCL
DEXTROMETHORPHAN HBR
GUAIFENESIN/DM/PSEUDOEPHEDRINE
DEXTROMETHORPHAN HBR
GUAIFENESIN/D-METHORPHAN HB/PE
PHENYLEPHRINE HCL/ACETAMINOPHN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
TETRAHYDRZ/DEXT 70/PEG 400/PVP
CHLORPHEN/PSEUDOEPH/IBUPROFEN
CHLORPHEN/PHENYLEPH/IBUPROFEN
IBUPROFEN/PSEUDOEPHEDRINE HCL
IBUPROFEN/PHENYLEPHRINE HCL
IBUPROFEN/DIPHENHYDRAMINE CIT
CHLORPHENIRAMINE/METHSCOPOLAMN
CHLOR-MAL/PHENYLEPH/METHSCOP
CHLOR-MAL/PHENYLEPH/METHSCOP
OXYMETAZOLINE HCL
AFRIN NASAL SPRAY
DIPHENHYDRAMIN/PE/CODEINE PHOS
BROMPHENIRAM/PHENYLEPHRINE/DM
PHENYLEPHRINE HCL/CODEINE
PHENYLEPHRINE HCL/DIHYDROCO BT
BROMPHENIRAM/PHENYLEPHRINE/DM
PHENYLEPHRINE/DIPHENHYDRAMINE
DEXBROMPHENIRAMIN/PHENYLEPHRIN
PYRILAMINE/PE/DEXTROMETHORPHAN
POT GUAIACO/DM HB/PE/PYRIL
PHENYLEPHRINE/CARBETAPENTAN/GG
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
ALDEX D
ALDEX DM
ALDEX GS
ALDEX GS DM
ALDEX-CT
ALERSULE
ALERTNESS
ALERTRIS-HEEL
ALEVE COLD & SINUS
ALEVE PM
ALEVE SINUS & HEADACHE
ALEVE-D SINUS & COLD
ALEVE-D SINUS & HEADACHE
ALI-FLEX
ALKA-SELTZER PLUS ALLERG-COUGH
ALKA-SELTZER PLUS COLD
ALKA-SELTZER PLUS COLD+FLU
ALKA-SELTZER PLUS COLD-COUGH
ALKA-SELTZER PLUS DAY
ALKA-SELTZER PLUS DAY & NIGHT
ALKA-SELTZER PLUS FLU
ALKA-SELTZER PLUS MUCUS-CONGES
ALKA-SELTZER PLUS NIGHT
ALKA-SELTZER PLUS SINUS-COUGH
ALKA-SELTZER PLUS-D
ALL DAY PAIN RELIEF
ALLANHIST PDX
ALLANTAN
ALLANVAN-DM
ALLANVAN-S
ALLERFED COLD & ALLERGY
ALLERFRIM
ALLERGY & CONGEST RELIEF
ALLERGY & SINUS RELIEF
ALLERGY MULTI-SYMPTOM
ALLERGY PLUS SINUS
ALLERGY RELIEF MULTI-SYMPTOM
ALLERGY SINUS HEADACHE
ALLERGY SINUS PE
ALLERGY SINUS-D
ALLERSOL
ALLERX 10
ALLERX 30
ALLERX DF
ALLERX DF 30
ALLERX PE
ALLERX-D
ALLFEN CD
ALLFEN CDX
ALLFEN DM
ALL-NITE
ALL-NITE COLD-FLU RELIEF
40
GENERIC DRUG
PHENYLEPHRINE/PYRILAMINE
PYRILAMINE/PE/DEXTROMETHORPHAN
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/DM/PSEUDOEPHEDRINE
PHENYLEPHRINE/DIPHENHYDRAMINE
PHENYLEPHRINE/CHLORPHENIRAMINE
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
NAPROXEN SODIUM/P-EPHED HCL
NAPROXEN NA-DIPHENHYDRAMIN HCL
NAPROXEN SODIUM/P-EPHED HCL
NAPROXEN SODIUM/P-EPHED HCL
NAPROXEN SODIUM/P-EPHED HCL
ACETAMINOPHEN/PHENYLTOLX
DM/PE/ACETAMINOPHEN/DOXYLAMINE
CHLORPHENIR/PHENYLEPH/ASPIRIN
DM/P-EPHED/ACETAMINOPH/DOXYLAM
CHLORPHEN/PHENYLEPH/DM/ASPIRIN
D-METHORPHAN/PE/ACETAMINOPHEN
DM/PE/ACETAMINOPHEN/DOXYLAMINE
DM HB/PE/ACETAMINOPHEN/CHLORPH
GUAIFENESIN/DEXTROMETHORPHAN
DM/PE/ACETAMINOPHEN/DOXYLAMINE
D-METHORPHAN/PE/ACETAMINOPHEN
DM HB/PSEUDOEPHED/ACETAMIN/CP
NAPROXEN SODIUM/P-EPHED HCL
D-METHORPHAN HB/P-EPD HCL/BPM
PHENYLEPHRINE/CHLOR-TAN
DM-PE-PYRILAMINE TANNATES
PHENYLEPHRINE/PYRILAMINE TAN
PHENYLEPHRINE/CHLORPHENIRAMINE
PSEUDOEPHEDRINE/TRIPROLIDINE
PSEUDOEPHED/DIPHENHYDRAMINE
PHENYLEPHRINE/DIPHENHYDRAMINE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
PHENYLEPHRINE/DIPHENHYDRAMINE
PHENYLEPHRINE/ACETAMINOPHEN/CP
PSEUDOEPHED/ACETAMINOPH/DIPHEN
PHENYLEPHRINE/ACETAMINOPHEN/CP
P-EPHED HCL/ACETAMINOPHEN/CP
NAPHAZOLINE HCL
PSEUDOEPHEDRIN/METHSCOP/CPM/PE
PSEUDOEPHEDRIN/METHSCOP/CPM/PE
CHLORPHENIRAMINE/METHSCOPOLAMN
CHLORPHENIRAMINE/METHSCOPOLAMN
CHLOR-MAL/PHENYLEPH/METHSCOP
PSEUDOEPHEDRINE/METHYLSCOPOLAM
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/DEXTROMETHORPHAN
D-METHORPHAN/ACETAMIN/DOXYLAMN
D-METHORPHAN/ACETAMIN/DOXYLAMN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
ALTAFRIN
ALTAZINE
ALTIPRES
ALTIPRES PEDIATRIC
ALTIPRES-B
AMBIFED
AMBIFED CD
AMBIFED CDX
AMBIFED DM
AMBIFED-G
AMBIFED-G CD
AMBIFED-G CDX
AMBIFED-G DM
AMBITUSSIN AC
ANAPLEX DM
ANDEHIST-DM
ANEFRIN
ANTITUSSIVE DM
ANU-MED
AP-HIST DM
APIS COMPOSITUM
APRODINE
AQUANAZ
AQUASOL E
AQUAVIT-E
ARCTIC RELIEF
ARNICA
ARSURANEEL
ARTHRITIS
ASPERCREME HEAT
ASPERCREME MAX
ASTHMA
ATUSS DS
AURUMHEEL
BABEE-COF
BACK
BALACALL DM
BALAMINE DM
BARIJODEEL
BELLADONNA COMPOSITUM
BENADRYL-D ALLERGY-SINUS
BENGAY
BENGAY ULTRA STRENGTH
BENGAY VANISHING SCENT
BENZEDREX
BERRI-FREEZ
BICLORA
BICLORA-D
BIO T PRES
BIO T PRES PEDIATRIC
BIO T PRES-B
41
GENERIC DRUG
PHENYLEPHRINE HCL
TETRAHYDROZOLINE HCL
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
BROMPHENIRAM/PHENYLEPHRINE/DM
GUAIFENESIN/PSEUDOEPHEDRNE HCL
P-EPHED HCL/CODEINE/GUAIFEN
P-EPHED HCL/CODEINE/GUAIFEN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
P-EPHED HCL/CODEINE/GUAIFEN
P-EPHED HCL/CODEINE/GUAIFEN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/CODEINE PHOSPHATE
D-METHORPHAN HB/P-EPD HCL/BPM
D-METHORPHAN HB/P-EPD HCL/BPM
OXYMETAZOLINE HCL
GUAIFENESIN/DEXTROMETHORPHAN
PHENYLEPHRINE HCL
BROMPHENIRAM/PHENYLEPHRINE/DM
HOMEOPATHIC DRUGS
PSEUDOEPHEDRINE/TRIPROLIDINE
GUAIFENESIN/D-METHORPHAN HB/PE
VITAMIN E
VITAMIN E
MENTHOL/CAMPHOR
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
MENTHOL
MENTHOL
HOMEOPATHIC DRUGS
D-METHORP TAN/P-EPHED TAN/CP
HOMEOPATHIC DRUGS
TERP HYDRATE/COCILL/SODIUM CIT
HOMEOPATHIC DRUGS
BROMPHENIRAM/PHENYLEPHRINE/DM
DM/PHENYLEPH/CHLORPHENIRAMINE
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
PHENYLEPHRINE/DIPHENHYDRAMINE
MENTHOL
MENTHOL
MENTHOL
PROPYLHEXEDRINE
BENZONATATE
MENTHOL
CHLORCYCLIZINE/CHLOPHEDIANOL
CHLORCYCLIZ/PSE/CHLOPHEDIANOL
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
BROMPHENIRAM/PHENYLEPHRINE/DM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
BIO-B KIDS
BIOBRON DX
BIOBRON SF
BIOCOTRON
BIOCOTRON-D
BIODESP DM
BIO-DTUSS DMX
BIOFLEXOR
BIOFREEZE
BIOGESIC
BIOGIL
BIOGTUSS NF
BIONATUSS DXP
BIONEL
BIONEL PEDIATRIC
BIOREGESIC
BIOSPEC DMX
BIO-S-PRES DX
BIOTUSS
BIOTUSS PEDIATRIC
BIPHENOX TENSION HEADACHE
BLEEDING
BLUE GEL
BONE
BP 8
BP 8 COUGH
BPM PE
BPM PE DM
BPM-DM-PHEN
BPM-PHENYLEPH-DM
BPM-PSE-DM
BROHIST D
BROMALINE DM
BROMAX D
BROMAXEFED DM RF
BROMFED DM
BROMHIST-DM
BROMHIST-PDX
BROMPHENEX DM
BROMPHENIRAMINE-PHENYLEPHRINE
BROMPHENIRAMINE-PSEUDOEPHEDDM
BROM-PHENYL-DEX
BROMPLEX DM
BROM-PSE-DM
BRONCHALIS-HEEL
BRONCHIAL ASTHMA RELIEF
BRONCHITIS
BRONCOTRON
BRONCOTRON PED
BRONCOTRON-D
BRONCOTRON-S
42
GENERIC DRUG
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
D-METHORPHAN HB/P-EPD HCL/BPM
MENTHOL
MENTHOL
ACETAMINOPHEN/PHENYLTOLX
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
D-METHORPHAN/PE/DEXBROMPHENIR
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
ACETAMINOPHEN/PHENYLTOLX
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
ACETAMINOPHEN/PHENYLTOLX
HOMEOPATHIC DRUGS
MENTHOL
BLUE ICE GEL
HOMEOPATHIC DRUGS
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
PHENYLEPHRINE/BROMPHENIRAMINE
BROMPHENIRAM/PHENYLEPHRINE/DM
BROMPHENIRAM/PHENYLEPHRINE/DM
BROMPHENIRAM/PHENYLEPHRINE/DM
D-METHORPHAN HB/P-EPD HCL/BPM
PHENYLEPHRINE/BROMPHENIRAMINE
D-METHORPHAN HB/P-EPD HCL/BPM
PHENYLEPHRINE/BROMPHENIRAMINE
D-METHORPHAN HB/P-EPD HCL/BPM
D-METHORPHAN HB/P-EPD HCL/BPM
GUAIFEN/DM HB/P-EPHEDRINE/BPM
GUAIFEN/D-METHORPHAN HB/PE/BPM
D-METHORPHAN HB/P-EPD HCL/BPM
PHENYLEPHRINE/BROMPHENIRAMIN
D-METHORPHAN HB/P-EPD HCL/BPM
BROMPHENIRAM/PHENYLEPHRINE/DM
D-METHORPHAN HB/P-EPD HCL/BPM
D-METHORPHAN HB/P-EPD HCL/BPM
HOMEOPATHIC DRUGS
GUAIFENESIN/EPHEDRINE HCL
HOMEOPATHIC DRUGS
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
BRONKIDS
BRONTUSS DX
BRONTUSS SF
BROTAPP DM
BROVEX ADT
BROVEX CB
BROVEX CBX
BROVEX PB
BROVEX PB C
BROVEX PB CX
BROVEX PB DM
BROVEX PD
BROVEX PEB
BROVEX PEB DM
BROVEX PSB DM
BROVEX PSE DM
BRYANCONEEL
BUCKLEY'S COUGH MIXTURE
CAFGESIC FORTE
CALCOHEEL
CALENDULA
CALMING
CANTHARIS COMPOSITUM
CAPCOF
CAPMIST DM
CAPRON DM
CARBAPHEN 12
CARBAPHEN 12 PED
CARBAPHEN CH
CARBAPHEN PED CH
CARBATUSS
CARBATUSS-CL
CARBA-XP
CARBO-COMPOSITUM
CARDEC
CARDEC DM
CCP CAFFEINE FREE
CENHIST
CENTERGY
CENTERGY DM
CENTUSS DM
CENTUSSIN DHC
CEPACOL SORETHROAT-COUGH
CERON
CERON-DM
CERTUSS-D
CHAMOMILLA
CHELIDONIUM
CHERACOL D
CHERATUSSIN AC
CHERATUSSIN DAC
CHERRY MENTHOL
43
GENERIC DRUG
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
D-METHORPHAN HB/P-EPD HCL/BPM
PHENYLEPHRINE/BROMPHENIRAMIN
BROMPHENIRAMINE/CODEINE PHOS
BROMPHENIRAMINE/CODEINE PHOS
PHENYLEPHRINE/BROMPHENIRAMINE
BROMPHENIRAMINE/PE/CODEINE
BROMPHENIRAMINE/PE/CODEINE
BROMPHENIRAM/PHENYLEPHRINE/DM
P-EPD TAN/BROMPHENIRAMIN
PHENYLEPHRINE/BROMPHENIRAMINE
BROMPHENIRAM/PHENYLEPHRINE/DM
D-METHORPHAN HB/P-EPD HCL/BPM
D-METHORPHAN HB/P-EPD HCL/BPM
HOMEOPATHIC DRUGS
DEXTROMETHORPHAN HBR
MG SAL/ACETAMINOPHN/P-TLOX/CAF
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
CHLORPHENIRAMINE/PE/CODEINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
PYRILAMINE/DEXTROMETHORPHAN HB
CHLORPHENIR/PHENYLEPH/CARBETAP
CHLORPHENIR/PHENYLEPH/CARBETAP
CHLORPHENIRAM/PE/CHLOPHEDIANOL
CHLORPHENIRAM/PE/CHLOPHEDIANOL
PHENYLEPHRINE/CARBETAPENTAN/GG
POT GUAIACOLSUL/CARBETAPENT/PE
GUAIFENESIN/CARBETAPENTANE CIT
HOMEOPATHIC DRUGS
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFEN/PHENYLEPH/ACETAMINOPHN
PHENYLEPHRINE/BROMPHENIRAMINE
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
BROMPHENIRAM/PHENYLEPHRINE/DM
BROMPHENIRAM/PE/DIHYDROCODEINE
DEXTROMETHORPHAN HBR/B-CAINE
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PSEUDOEPH/CHLOPHEDIANOL/GG
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/CODEINE PHOSPHATE
P-EPHED HCL/CODEINE/GUAIFEN
EUCALYPTUS OIL/MENTHOL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
CHEST
CHEST CONGESTION & PAIN RELIEF
CHEST CONGESTION & SINUS
CHEST CONGESTION PLUS COUGH
CHEST CONGESTION RELIEF D
CHEST CONGESTION RELIEF DM
CHEST CONGESTION RELIEF PE
CHEST CONGESTION-COUGH RELIEF
CHEST CONGESTION-PAIN RLF PE
CHEST-SINUS CONGESTION RELIEF
CHILD ALLERGY & SINUS D
CHILD BENADRYL-D ALLERGY-SINUS
CHILD CHEST CONGESTION + COUGH
CHILD COUGH & SORE THROAT
CHILD DELSYM COUGH+CHEST DM
CHILD DELSYM COUGH-COLD NIGHT
CHILD DELSYM NIGHTTIME C-C
CHILD DOMETUSS-DA
CHILD MUCINEX M-S COLD DAY-NTE
CHILD MUCUS RELIEF COUGH
CHILD MULTI-SYMPTOM COLD-FEVER
CHILD NIGHT TIME COLD & COUGH
CHILD NIGHT TIME COUGH-COLD
CHILD PLUS COUGH-RUNNY NOSE
CHILD SORE THROAT LOZENGE
CHILD TRIACTING COLD-COUGH
CHILD TRIAMINIC COLD & ALLERGY
CHILD TRIAMINIC COUGH-CONGEST
CHILD TRIAMINIC COUGH-SORE THR
CHILD TRIAMINIC M-S FEVER-COLD
CHILD TRIAMINIC-D MT-SYM COLD
CHILD TYLENOL PLUS COUGH-RUNNY
CHILD TYLENOL PLUS COUGH-SORE
CHILD WAL-TAP COLD-ALLERGY
CHILDREN PLUS MULTI-SYMPT COLD
CHILDREN TRIAMINIC COLD-COUGH
CHILDREN WAL-TUSSIN
CHILDREN'S COLD & COUGH
CHILDREN'S COLD & COUGH DM
CHILDREN'S COLD & COUGH RELIEF
CHILDRENS COUGH
CHILDREN'S COUGH
CHILDREN'S COUGH & RUNNY NOSE
CHILDREN'S COUGH-RUNNY NOSE
CHILDREN'S DIBROMM DM
CHILDREN'S DIMETAPP COLD-FLU
CHILDREN'S FLU RELIEF
CHILDREN'S MAPAP COUGH-SINUS
CHILDREN'S MOTRIN COLD
CHILDREN'S MULTI-SYMPTOM COLD
CHILDREN'S PLUS COLD
CHILDREN'S PLUS FLU
44
GENERIC DRUG
HOMEOPATHIC DRUGS
GUAIFENESIN/ACETAMINOPHEN
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFEN/PHENYLEPH/ACETAMINOPHN
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/DIPHENHYDRAMINE
PHENYLEPHRINE/DIPHENHYDRAMINE
GUAIFENESIN/DEXTROMETHORPHAN
D-METHORPHAN HB/ACETAMINOPHEN
GUAIFENESIN/DEXTROMETHORPHAN
PHENYLEPHRINE/DIPHENHYDRAMINE
PHENYLEPHRINE/DIPHENHYDRAMINE
PHENYLEPHRINE/CHLORPHENIRAMINE
DIPHENHYDRAM/PE/DM/ACETAMIN/GG
GUAIFENESIN/DEXTROMETHORPHAN
PHENYLEPHRINE/DM/ACETAMINOP/GG
PHENYLEPHRINE/DIPHENHYDRAMINE
PHENYLEPHRINE/DIPHENHYDRAMINE
DEXTROMETHORPHN/ACETAMINOPH/CP
HEXYLRESORCINOL
DEXTROMETHORPHAN/PHENYLEPHRINE
PHENYLEPHRINE/BROMPHENIRAMINE
GUAIFENESIN/DEXTROMETHORPHAN
D-METHORPHAN HB/ACETAMINOPHEN
DM HB/PE/ACETAMINOPHEN/CHLORPH
D-METHORPHAN HB/P-EPHED HCL/CP
DEXTROMETHORPHN/ACETAMINOPH/CP
D-METHORPHAN HB/ACETAMINOPHEN
PHENYLEPHRINE/BROMPHENIRAMINE
DM HB/PE/ACETAMINOPHEN/CHLORPH
DIPHENHYDRAMINE/PHENYLEPHR/DM
DEXTROMETHORPHAN HBR
BROMPHENIRAM/PHENYLEPHRINE/DM
BROMPHENIRAM/PHENYLEPHRINE/DM
DEXTROMETHORPHAN HBR/CHLOR-MAL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHN/ACETAMINOPH/CP
DEXTROMETHORPHAN HBR/CHLOR-MAL
BROMPHENIRAM/PHENYLEPHRINE/DM
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM HB/PE/ACETAMINOPHEN/CHLORPH
DEXTROMETHORPHN/ACETAMINOPH/CP
IBUPROFEN/PSEUDOEPHEDRINE HCL
GUAIFENESIN/D-METHORPHAN HB/PE
PHENYLEPHRINE/ACETAMINOPHEN/CP
DM HB/PE/ACETAMINOPHEN/CHLORPH
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
CHILDREN'S PLUS M-S COLD
CHILDRENS PLUS M-S COLD
CHILDRENS PLUS M-S COLD RELIEF
CHILDREN'S SILFEDRINE
CHILDREN'S SUDAFED
CHILDREN'S SUDAFED PE
CHILDREN'S SUDO GEST
CHILDREN'S TRIAMINIC
CHILDREN'S TYLENOL PLUS
CHILDRENS TYLENOL PLUS COLD
CHILDRENS TYLENOL PLUS FLU
CHILDRN COLD-COUGH-SORE THROAT
CHILDS ALLERGY
CHILD'S DIBROMM COLD-ALLERGY
CHILD'S MUCUS RELIEF M-S COLD
CHILDS PLUS COLD & ALLERGY
CHILD'S SUDAFED PE COUGH-COLD
CHILDS TRIACTING COLD & COUGH
CHILDS TYLENOL PLUS COLD-COUGH
CHLO HIST
CHLO TUSS
CHLO TUSS EX
CHLORASEPTIC TOTAL
CHLORDEX GP
CHLOR-MES D
CHLORPHEN-DEX-PSE
CHLORPHEN-PSE-DM TANNATE
CHLOR-PHENYLEPHRINE
CLOFERA
CO-APAP
COCCULUS COMPOSITUM
CODAL-DM
CODAR AR
CODAR D
CODAR GF
CODEINE-GUAIFENESIN
CODITUSS DM
COLD
COLD & ALLERGY PE
COLD & ALLERGY RELIEF
COLD & COUGH
COLD & COUGH DM
COLD & COUGH NIGHTTIME
COLD & FLU BP
COLD & FLU RELIEF PLUS
COLD & FLU SEVERE
COLD & HOT EXTRA STRENGTH
COLD & HOT PAIN RELIEF
COLD & HOT PATCHES PAIN RELIEF
COLD & SINUS
COLD & SINUS PAIN RELIEF
COLD & SINUS RELIEF
45
GENERIC DRUG
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM HB/PE/ACETAMINOPHEN/CHLORPH
PSEUDOEPHEDRINE HCL
PSEUDOEPHEDRINE HCL
PHENYLEPHRINE HCL
PSEUDOEPHEDRINE HCL
XYLOMETAZOLINE HCL
PHENYLEPHRINE HCL/ACETAMINOPHN
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM HB/PE/ACETAMINOPHEN/CHLORPH
PHENYLEPHRINE/DM/ACETAMINOP/GG
D-METHORPHAN HB/P-EPHED HCL/CP
PHENYLEPHRINE/BROMPHENIRAMINE
GUAIFENESIN/D-METHORPHAN HB/PE
DIPHENHYDRA/PHENYLEPH/ACETAMIN
DEXTROMETHORPHAN/PHENYLEPHRINE
PHENYLEPHRINE/DIPHENHYDRAMINE
D-METHORPHAN/PE/ACETAMINOPHEN
D-BROMP MAL/CHLOPHEDIANOL HCL
DEXBROMPHEN/PHENYLEPH/CHLOPHED
CHLOPHEDIANOL HCL/GUAIFENESIN
DEXTROMETH/BENZOCAINE/MENTHOL
GUAIFEN/D-METHORPHAN HB/PE/CP
CHLOR-MAL/PHENYLEPH/METHSCOP
D-METHORPHAN HB/P-EPHED HCL/CP
D-METHORP TAN/P-EPHED TAN/CP
PHENYLEPHRINE/CHLORPHENIRAMINE
PSEUDOEPHEDRINE/CHLOPHEDIANOL
DM HB/PSEUDOEPHED/ACETAMIN/CP
HOMEOPATHIC DRUGS
PYRILAMINE/PE/DEXTROMETHORPHAN
CHLORPHENIRAMINE/CODEINE PHOS
PSEUDOEPHEDRINE HCL/CODEINE
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/CODEINE PHOSPHATE
PYRILAMINE/PE/DEXTROMETHORPHAN
HOMEOPATHIC DRUGS
PHENYLEPHRINE/CHLORPHENIRAMINE
PHENYLEPHRINE/CHLORPHENIRAMINE
BROMPHENIRAM/PHENYLEPHRINE/DM
BROMPHENIRAM/PHENYLEPHRINE/DM
PHENYLEPHRINE/DIPHENHYDRAMINE
ACETAMINOPHEN/CHLORPHENIRAMINE
DM/PE/ACETAMINOPHEN/DOXYLAMINE
PHENYLEPHRINE/DM/ACETAMINOP/GG
MENTHOL
MENTHOL
MENTHOL
GUAIFEN/PHENYLEPH/ACETAMINOPHN
IBUPROFEN/PSEUDOEPHEDRINE HCL
IBUPROFEN/PSEUDOEPHEDRINE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
COLD AND COUGH
COLD AND COUGH CHILDRENS
COLD HEAD CONGESTION
COLD MULTI-SYMPTOM
COLD MULTI-SYMPTOM DAYTIME
COLD MULTI-SYMPTOM NIGHTTIME
COLD MULTI-SYMPTOM SEVERE
COLD RELIEF HEAD CONGESTION
COLD RELIEF MULTI-SYMPTOM
COLD RELIEF PLUS
COLD RELIEVER
COLD SEVERE CONGESTION
COLD-COUGH SINUS RELIEF PE
COLD-FLU RELIEF
COLDONYL
COMPLETE SINUS RELIEF
COMTREX COLD & COUGH
COMTREX COLD-COUGH DAY-NIGHT
COMTREX COLD-COUGH NIGHTTIME
COMTREX DEEP CHEST COLD
COMTREX FLU THERAPY
COMTREX SEVERE COLD-SINUS
CONEX
CONGESTAC
CONGEST-EZE
CONGEST-EZE PE
CONGESTION RELIEF
CONSTIPATION
CONTAC
CONTAC COLD-FLU
CONTAC COLD-FLU NIGHT
CONTAC D COLD
CONTRAGESIC
COOL & HEAT
COOL GEL
COOL 'N HEAT
CORFEN-DM
CORICIDIN
CORICIDIN HBP
CORICIDIN HBP COLD-MULTI SYMPT
CORYZA-DM
CORZALL
CORZALL PLUS
CORZALL-PE
COTAB A
COTAB AX
COTABFLU
COUGH
COUGH & COLD
COUGH & COLD BP
COUGH & COLD MUCUS RELIEF CF
46
GENERIC DRUG
BROMPHENIRAM/PHENYLEPHRINE/DM
D-METHORPHAN HB/P-EPD HCL/BPM
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM HB/PE/ACETAMINOPHEN/CHLORPH
PHENYLEPHRINE/DM/ACETAMINOP/GG
DM/PE/ACETAMINOPHEN/DOXYLAMINE
PHENYLEPHRINE/DM/ACETAMINOP/GG
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM HB/PE/ACETAMINOPHEN/CHLORPH
CHLORPHENIR/PHENYLEPH/ASPIRIN
PHENYLEPHRINE/ACETAMINOPHEN/CP
PHENYLEPHRINE/DM/ACETAMINOP/GG
PHENYLEPHRINE/DM/ACETAMINOP/GG
DM/PE/ACETAMINOPHEN/DOXYLAMINE
GUAIFEN/PHENYLEPH/ACETAMINOPHN
COMPLETE ALLERGY & SINUS
PHENYLEPH/ACETAMIN/DEXBROMPHEN
DM HB/PSEUDOEPHED/ACETAMIN/CP
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM HB/PE/ACETAMINOPHEN/CHLORPH
GUAIFENESIN/ACETAMINOPHEN
PHENYLEPHRINE/ACETAMINOPHEN/CP
PHENYLEPHRINE/ACETAMINOPHEN/CP
P-EPHED HCL/D-BROMP MAL
GUAIFENESIN/P-EPHED HCL
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/PHENYLEPHRINE HCL
IBUPROFEN/PHENYLEPHRINE HCL
HOMEOPATHIC DRUGS
DM/P-EPHED/ACETAMINOPHN/DIPHEN
PHENYLEPHRINE HCL/ACETAMINOPHN
D-METHORPHAN/ACETAMIN/DOXYLAMN
PHENYLEPHRINE HCL
ACETAMINOPHEN/PHENYLTOLX
MENTHOL
MENTHOL
MENTHOL
DM/PHENYLEPH/CHLORPHENIRAMINE
ACETAMINOPHEN/CHLORPHENIRAMINE
ACETAMINOPHEN/CHLORPHENIRAMINE
D-METHORPHAN/ACETAMIN/DOXYLAMN
DM/PHENYLEPH/PYRIL/DEXCHLROPHE
CARBETAPENTANE/PSEUDOEPHEDRINE
PYRIL MAL/P-EPHED HCL/CARBPNTN
DEXCHLORPHENIRAM-PE-CARBETAPEN
CHLORPHENIRAMINE/CODEINE PHOS
CHLORPHENIRAMINE/CODEINE PHOS
CHLOR-MAL/CODEINE/ACETAMINOPHN
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHAN HBR/CHLOR-MAL
DEXTROMETHORPHAN HBR/CHLOR-MAL
GUAIFENESIN/D-METHORPHAN HB/PE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
COUGH & COLD PE
COUGH & RUNNY NOSE
COUGH & SORE THROAT
COUGH AND COLD MULTI-SYMPTOM
COUGH CONTROL CF
COUGH CONTROL DM
COUGH CONTROL DM MAX
COUGH DM ER
COUGH DROPS
COUGH FORMULA DM
COUGH RELIEF
COUGH SUPPRESSANT
COUGH SUPPRESSANT/EXPECTORANT
COUGH SYRUP DM
COUGH-HEAD CONGESTION RELIEF
C-PHEN DM
C-PHEN DROPS
C-PHEN SYRUP
CPM 8-PE 20-MSC 1.25
CPM-PE
CPM-PE-DM
CPM-PSE DM
CPM-PYR-PE
CRALONIN
CREOMULSION
CREO-TERPIN
CRUROHEEL
C-TAN D
C-TANNA 12
C-TANNA 12D
DALLERGY
DALLERGY DM
DALLERGY PE
DALLERGY-JR
DAY TIME
DAY TIME COLD-FLU
DAY TIME COLD-FLU RELIEF
DAY TIME COUGH
DAY TIME PE
DAYTIME
DAY-TIME
DAYTIME & NIGHTTIME COLD
DAYTIME & NITETIME SINUS
DAYTIME COLD & COUGH
DAYTIME COLD & FLU
DAYTIME COLD & FLU RELIEF
DAYTIME COLD MULTI-SYMPTOM
DAYTIME COLD-FLU
DAYTIME COLD-FLU RELIEF
DAYTIME COUGH
DAYTIME MUCUS RELIEF DM
DAYTIME SINUS
47
GENERIC DRUG
PHENYLEPHRINE/DM/ACETAMINOP/GG
DEXTROMETHORPHAN HBR/CHLOR-MAL
DEXTROMETHORPHAN HBR/B-CAINE
PSEUDOEPH/DM/GUAIFEN/ACETAMIN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHAN POLISTIREX
EUCALYPTUS OIL/MENTHOL
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHAN HBR
DEXTROMETHORPHAN HBR
GUAIFENESIN/D-METHORPHAN HB
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPHRINE/CHLORPHENIRAMINE
PHENYLEPHRINE/CHLORPHENIRAMINE
CHLOR-MAL/PHENYLEPH/METHSCOP
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
D-METHORPHAN HB/P-EPHED HCL/CP
PHENYLEPHRINE/PYRILAMINE MA/CP
HOMEOPATHIC DRUGS
DEXTROMETHORPHAN HBR
GUAIFENESIN/DEXTROMETHORPHAN
HOMEOPATHIC DRUGS
PHENYLEPHRINE/BROMPHENIRAMIN
CAR-B-PEN TA/CHLOR-TAN
CAR-B-PEN TA/PHENYLEPHRINE/PYR
CHLORCYCLIZINE/PHENYLEPHRINE
D-METHORPHAN HB/P-EPD HCL/BPM
CHLOR-MAL/PHENYLEPH/METHSCOP
PHENYLEPHRINE/CHLORPHENIRAMINE
D-METHORPHAN/PE/ACETAMINOPHEN
D-METHORPHAN/PE/ACETAMINOPHEN
D-METHORPHAN/PE/ACETAMINOPHEN
DEXTROMETHORPHAN HBR
D-METHORPHAN/PE/ACETAMINOPHEN
DM/PSEUDOEPHED/ACETAMINOPHEN
DM/PSEUDOEPHED/ACETAMINOPHEN
DM HB/PE/ACETAMINOPHEN/CHLORPH
PHENYLEPHRINE/ACETAMIN/DOXYLAM
D-METHORPHAN HB/ACETAMINOPHEN
D-METHORPHAN/PE/ACETAMINOPHEN
DM/PSEUDOEPHED/ACETAMINOPHEN
D-METHORPHAN/PE/ACETAMINOPHEN
DM/PSEUDOEPHED/ACETAMINOPHEN
D-METHORPHAN/PE/ACETAMINOPHEN
DEXTROMETHORPHAN HBR
GUAIFENESIN/DEXTROMETHORPHAN
PHENYLEPHRINE HCL/ACETAMINOPHN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
DAYTIME SINUS RELIEF
DAYTIMECOLD
DAYTIME-NIGHTTIME
DAYTIME-NIGHTTIME COLD-FLU
DAYTIME-NIGHTTIME COUGH
DAYTIME-NITETIME
DCP
DE-CHLOR DM
DE-CHLOR DR
DECON-A
DECONEX
DECONEX DM
DECONEX DMX
DECONEX IR
DECON-G
DECONGESTANT
DECONGESTANT INHALER
DECOREL FORTE PLUS
DEHISTINE
DELSYM
DELSYM COUGH & COLD
DELSYM COUGH+CHEST CONGEST DM
DELSYM COUGH+SOOTHING ACTION
DELSYM MULTI-SYMPTOM
DELSYM NIGHTTIME COUGH-COLD
DELSYM NIGHTTIME MULTISYMPTOM
DELTUSS DMX
DELTUSS DP
DESGEN
DESGEN DM
DESPEC
DESPEC DM
DESPEC NR
DESPEC-DM
DESPEC-EXP
DESPEC-PDC
DESPEC-TAB
DEX PC
DEXPHEN M
DEXPHEN W-C
DEX-TUSS
DHM-PE
DIABETIC SILTUSSIN-DM
DIABETIC SILTUSSIN-DM MAX STR
DIABETIC TUSSIN
DIABETIC TUSSIN DM
DIABETIC TUSSIN MAX-STRENGTH
DIABETIC TUSSIN NIGHTTIME
DIARRHEA
DICEL CD
DICEL DM
48
GENERIC DRUG
PHENYLEPHRINE HCL/ACETAMINOPHN
D-METHORPHAN/PE/ACETAMINOPHEN
DM/PE/ACETAMINOPHEN/DOXYLAMINE
DM/PE/ACETAMINOPHEN/DOXYLAMINE
DEXTROMETHORPHAN HB/DOXYLAMINE
DM/PE/ACETAMINOPHEN/DOXYLAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPHRINE/BROMPHENIRAMINE
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFEN/PHENYLEPHRINE/BPM
PSEUDOEPHEDRINE HCL
L-DESOXYEPHEDRINE
PHENYLEPHRINE/DM/ACETAMINOP/GG
CHLOR-MAL/PHENYLEPH/METHSCOP
DEXTROMETHORPHAN POLISTIREX
D-METHORPHAN/ACETAMIN/DOXYLAMN
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHAN HBR/MENTHOL
DM/PE/ACETAMINOPHEN/DOXYLAMINE
PHENYLEPHRINE/DIPHENHYDRAMINE
D-METHORPHAN/ACETAMIN/DOXYLAMN
DEXCHLORPHENIR/PSEUDOEPHED/DM
PSEUDOEPHEDRINE/DEXCHLORPHENIR
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFEN/P-EPHED HCL/DIHY-COD
PHENYLEPHRINE/DHCODEINE BT/CP
GUAIFENESIN/PSEUDOEPHEDRNE HCL
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPH/DEXCHLOR/METHSCOPOL
DEXCHLORPHEN/PHENYLEPH/CODEINE
DEXTROMETHORPHAN POLISTIREX
GUAIFENESIN/CODEINE PHOSPHATE
PHENYLEPHRINE/DIPHENHYDRAMINE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
MENTHOL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHOR/ACETAMIN/DIPHEN
HOMEOPATHIC DRUGS
BROMPHENIRAM-PSE-CHLOPHEDIANOL
D-METHORP TAN/P-EPHED TAN/CP
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
DIHYDROCODEINE-BPM-PE
DIHYDRO-CP
DIHYDRO-GP
DIHYDRO-PE
DIMAPHEN
DIMAPHEN DM
DIMETANE-DX
DIMETAPP
DIMETAPP COLD & CONGESTION
DIMETAPP DM
DIMETAPP LONG-ACTING
DM MAX
DM-CHLORPHEN-PHENYLEPHRINE
DM-CPM-PE-GG
DM-PE-CPM
DM-PHENYLEPHRINE-CHLORPHEN
DM-PSE-BPM
DOLOGEN
DOLOGEN 325
DOLOGESIC
DOLOREX
DOMETUSS G
DOMETUSS-DMX
DONATUSS DC
DONATUSS XP
DONATUSSIN
DONATUSSIN DM
DOUBLE TUSSIN DM
DRISTAN
DRISTAN COLD
DRIXORAL
DROPERTEEL
DRYMAX
DRYMAX AF
DUODENOHEEL
DUONATE-12
DURABAC FORTE
DURAFLU
DURAVENT DM
DURAVENT PE
ECHINACEA PC
ED A-HIST
ED A-HIST DM
ED A-HIST PSE
ED BRON GP
ED CHLORPED D
ED-A-HIST DM
EFFERVESCENT COLD RELIEF
EFFERVESCENT COLD RELIEF PLUS
ENDACOF
ENDACOF AC
ENDACOF-C
49
GENERIC DRUG
BROMPHENIRAM/PE/DIHYDROCODEINE
P-EPHED HCL/DHCODEINE BT/CP
GUAIFEN/P-EPHED HCL/DIHY-COD
PHENYLEPHRINE/DHCODEINE BT/CP
PHENYLEPHRINE/BROMPHENIRAMINE
BROMPHENIRAM/PHENYLEPHRINE/DM
D-METHORPHAN HB/P-EPD HCL/BPM
BROMPHENIRAM/PHENYLEPHRINE/DM
PHENYLEPHRINE/DIPHENHYDRAMINE
D-METHORPHAN HB/P-EPD HCL/BPM
DEXTROMETHORPHAN HBR/CHLOR-MAL
GUAIFENESIN/DEXTROMETHORPHAN
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFEN/D-METHORPHAN HB/PE/CP
DM/PHENYLEPH/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
D-METHORPHAN HB/P-EPD HCL/BPM
ACETAMINOPHEN/D-BROMPHENIRAMIN
ACETAMINOPHEN/D-BROMPHENIRAMIN
ACETAMINOPHEN/PHENYLTOLX
ACETAMINOPHEN/PHENYLTOLX
PHENYLEPHRINE/DM/ACETAMINOP/GG
GUAIFENESIN/D-METHORPHAN HB/PE
PHENYLEPH/DIHYDROCODEINE/GUAIF
GUAIFENESIN/DM/PSEUDOEPHEDRINE
DM/PHENYLEPH/CHLORPHENIRAMINE
DM TAN/PE TAN/DEXCHLORPHEN TAN
GUAIFENESIN/DEXTROMETHORPHAN
OXYMETAZOLINE HCL
PHENYLEPHRINE/ACETAMINOPHEN/CP
PSEUDOEPHEDRINE/DEXBROMPHENIR
HOMEOPATHIC DRUGS
PSEUDOEPHEDRINE/CPM/METHYLSCOP
CHLORPHENIR/PSE/CHLOPHEDIANOL
HOMEOPATHIC DRUGS
PHENYLEPHRINE/PYRIL TAN
MG SAL/ACETAMINOPHN/P-TLOX/CAF
PSEUDOEPH/DM/GUAIFEN/ACETAMIN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/PHENYLEPHRINE HCL
HOMEOPATHIC DRUGS
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PSEUDOEPHEDRINE/TRIPROLIDINE
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPHRINE/ACETAMINOPHEN/CP
PHENYLEPHRINE/ACETAMINOPHEN/CP
DM/PHENYLEPH/CHLORPHENIRAMINE
BROMPHENIRAMINE/CODEINE PHOS
CHLORPHENIRAMINE/CODEINE PHOS
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
ENDACOF-DC
ENDACOF-DM
ENDACOF-PD
ENDACON
ENDAL CD
ENTEX LQ
ENTEX PAC
ENTEX T
ENTRE-B
ENTRE-COUGH
ENTRE-COUGH TANNATE
ENTRE-HIST PSE
ENTRE-S
ENZYME
EPHEDRINE SULFATE-0.9% NACL
EPHRINE NOSE DROPS
ESOCOR P
ESSENTIAL DAILY
EXACTUSS
EXACTUSS TR
EXALL
EXALL-D
EXAPHEN
EXAPHEN CH
EXAPHEX TR
EXCEDRIN BACK & BODY
EXCEDRIN PM
EXCEDRIN SINUS HEADACHE
EXECLEAR-C
EXECLEAR-DM
EXEFEN DMX
EXEFEN IR
EXEFEN-IR
EXHAUSTION
EXPECTORANT DM
EXPECTORANT MAX STRENGTH
EXPECTUSS
EXTRA ACTION COUGH
EYE DROPS
FAST ACTING NASAL
FEMININE
FENESIN DM IR
FENESIN PE IR
FLANAX
FLEX GEL
FLEXALL
FLEXTRA-650
FLEXTRA-DS
FLU
FLU & SORE THROAT
FLU BP
50
GENERIC DRUG
PSEUDOEPHEDRINE HCL/CODEINE
BROMPHENIRAM/PHENYLEPHRINE/DM
D-METHORPHAN HB/P-EPD HCL/BPM
GUAIFENESIN/D-METHORPHAN HB/PE
CHLORPHENIRAMINE/PE/CODEINE
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
PHENYLEPHRINE/BROMPHENIRAMIN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
PSEUDOEPHEDRINE/TRIPROLIDINE
D-METHORP TAN/P-EPHED TAN/CP
HOMEOPATHIC DRUGS
EPHEDRINE SULFATE
EPHEDRINE SULFATE IN 0.9% NACL
PHENYLEPHRINE HCL
D-METHORPHAN HB/P-EPHED HCL/CP
MULTIVIT WITH CALCIUM,IRON,MIN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/CARBETAPENTANE CIT
PSEUDOEPHED/CARBETAPENTANE/GG
PHENYLEPHRINE/CHLORPHENIRAMINE
CHLORPHENIRAM/PE/CHLOPHEDIANOL
GUAIFENESIN/PHENYLEPHRINE HCL
ASPIRIN/ACETAMINOPHEN/CAL CARB
ACETAMINOPHEN/DP-HYDRAMINE
PHENYLEPHRINE HCL/ACETAMINOPHN
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/PSEUDOEPHEDRNE HCL
HOMEOPATHIC DRUGS
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHAN/PSEUDOEPHED
GUAIFENESIN/CARBETAPENTANE CIT
GUAIFENESIN/DEXTROMETHORPHAN
TETRAHYDROZOLINE HCL
PHENYLEPHRINE HCL
HOMEOPATHIC DRUGS
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PHENYLEPHRINE HCL
MENTHOL
MENTHOL
MENTHOL/ALOE VERA EXTRACT
ACETAMINOPHEN/PHENYLTOLX
ACETAMINOPHEN/PHENYLTOLX
DEXTROMETHORPHN/ACETAMINOPH/CP
PHENYLEPHRINE/ACETAMINOPHN/PNM
DEXTROMETHORPHN/ACETAMINOPH/CP
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
FLU FORMULA
FLU RELIEF BP
FLU RELIEF THERAPY DAYTIME
FLU RLF THERAPY COLD & CHEST
FLU-SEVERE COLD-CONGESTION
FLU-SEVERE COLD-COUGH
FLUTABS
FOOT POWDER
FORMULA E
FRUIT FROSTERS
GANI-TUSS NR
GANI-TUSS-DM NR
GASTRICUMEEL
G-BRONCO-D
G-DOLOGEN
GENAC
GENAPHED
GENTEX 30
G-FENESIN DM
GILPHEX TR
GILTUSS
GILTUSS PED-C
GILTUSS PEDIATRIC
GILTUSS TR
GOLD BOND FOOT
GOLD BOND MEDICATED FOOT
GOLD BOND PAIN RELIEVING
GOODY'S PM
GORDON'S VITE E
GORDO-VITE E
G-P-TUSS DXP
GRIPP-HEEL
G-SUPRESS DX
G-TRON
G-TRON PED
G-TUSICOF
GUAIATUSSIN AC
GUAICON DMS
GUAIFEN-DEXTROMPSEUDOEPHEDRIN
GUAIFENESIN AC
GUAIFENESIN DAC
GUAIFENESIN DM
GUAIFENESIN DM NR
GUAIFENESIN-CODEINE
GUAIFENESIN-DEXTROMETHORPHAN
GUAIFENESIN-PHENYLEPHRINE
GUAIFENESIN-PHENYLEPHRINE HCL
GUIADRINE DX
GUIATEX PE
GUIATUSS DM
G-ZYNCOF
HAIR AND SKIN
51
GENERIC DRUG
DM/PE/ACETAMINOPH/DIPHENHYDRAM
DEXTROMETHORPHN/ACETAMINOPH/CP
D-METHORPHAN/PE/ACETAMINOPHEN
GUAIFEN/PHENYLEPH/ACETAMINOPHN
DM HB/PSEUDOEPHED/ACETAMIN/CP
D-METHORPHAN/PE/ACETAMINOPHEN
PSEUDOEPH/DM/GUAIFEN/ACETAMIN
MENTHOL
VITAMIN E
PECTIN
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/DEXTROMETHORPHAN
HOMEOPATHIC DRUGS
GUAIFENESIN/D-METHORPHAN HB/PE
ACETAMINOPHEN/D-BROMPHENIRAMIN
PSEUDOEPHEDRINE/TRIPROLIDINE
PSEUDOEPHEDRINE HCL
PHENYLEPHRINE/CARBETAPENTAN/GG
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/D-METHORPHAN HB/PE
PHENYLEPHRINE/CODEINE/GUAIFEN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
MENTHOL
MENTHOL
MENTHOL
ACETAMINOPHEN/DP-HYDRAMINE
VITAMIN E
VITAMIN E
D-METHORPHAN/PE/DEXBROMPHENIR
HOMEOPATHIC DRUGS
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/CODEINE PHOSPHATE
P-EPHED HCL/CODEINE/GUAIFEN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
HOMEOPATHIC DRUGS
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
HALLS
HAYFEVER
HEAD CONGESTION
HEAD CONGESTION & COLD RELIEF
HEAD CONGESTION COLD RELIEF
HEADACHE
HEADACHE II
HEADACHE RELIEF PM
HEMORRHOID RELIEF
HEMORRHOID SOLUBLE TABLET
HEMORRHOID SUPPOSITORY
HEMORRHOIDAL SUPPOSITORY
HEPEEL
HERBAL
HISTEX SR
HISTEX-DM
HISTEX-PE
HIST-PSE
HOLD
HONEY LEMON
HOT STEAM
HYCODAN
HYDROCOD-CPM-PSEUDOEPHEDRINE
HYDROCODONE BIT-HOMATROPINE
MB
HYDROCODONE
BT-HOMATROPINE
MBR
HYDROCODONE COMPOUND
HYDROCODONE-CHLORPHENIRAMNE
ER
HYDROCODONE-HOMATROPINE MBR
HYDROMET
HYDRO-TUSSIN DHC
IBUPROFEN COLD
IBUPROFEN COLD & SINUS
IBUPROFEN COLD-SINUS
IBUPROFEN PM
IBUPROFEN-DIPHENHYDRAMINE HCL
ICE BLUE DROPS
ICE BLUE GEL
ICE GEL
ICY HOT
ICY HOT NATURALS
ICY HOT NO MESS
ICY HOT PAIN RELIEVING
INDAMIX DM
INFANT NON-ASA COLD
INFANTS' COLD
INFECTION
INFLAMMATION
INJURY
INTENSE COUGH
INTENSE COUGH RELIEVER
INTESTINE
IOPHEN DM-NR
52
GENERIC DRUG
MENTHOL
HOMEOPATHIC DRUGS
DM HB/PE/ACETAMINOPHEN/CHLORPH
PHENYLEPHRINE/DM/ACETAMINOP/GG
DM HB/PE/ACETAMINOPHEN/CHLORPH
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
ACETAMINOPHEN/DP-HYDRAMINE
PHENYLEPHRINE HCL
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
PHENYLEPHRINE HCL
HOMEOPATHIC DRUGS
MENTHOL
PHENYLEPHRINE/CHLORPHENIRAMINE
TRIPROLIDINE/PHENYLEPHRINE/DM
PHENYLEPHRINE/TRIPROLIDINE
PSEUDOEPHEDRINE/TRIPROLIDINE
DEXTROMETHORPHAN HBR
EUCALYPTUS OIL/MENTHOL
CAMPHOR/EUCALYPT/MENTH/BENZOIN
HYDROCODONE BIT/HOMATROP ME-BR
PSEUDOEPHED/HYDROCODONE/CPM
HYDROCODONE BIT/HOMATROP ME-BR
HYDROCODONE BIT/HOMATROP ME-BR
HYDROCODONE BIT/HOMATROP ME-BR
HYDROCODONE/CHLORPHEN P-STIREX
HYDROCODONE BIT/HOMATROP ME-BR
HYDROCODONE BIT/HOMATROP ME-BR
P-EPHED HCL/DHCODEINE BT/CP
IBUPROFEN/PSEUDOEPHEDRINE HCL
IBUPROFEN/PSEUDOEPHEDRINE HCL
IBUPROFEN/PSEUDOEPHEDRINE HCL
IBUPROFEN/DIPHENHYDRAMINE CIT
IBUPROFEN/DIPHENHYDRAMINE HCL
EUCALYPTUS OIL/MENTHOL
MENTHOL
MENTHOL
MENTHOL
MENTHOL
MENTHOL
MENTHOL
D-METHORP TAN/P-EPD TAN/D-CP
DM/PSEUDOEPHED/ACETAMINOPHEN
DM/PSEUDOEPHED/ACETAMINOPHEN
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
HOMEOPATHIC DRUGS
GUAIFENESIN/DEXTROMETHORPHAN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
IOPHEN-C NR
J-COF DHC
J-MAX
J-MAX DHC
J-TAN D
KIDKARE
KLIMAKTHEEL
K-TAN
LAGESIC
LAMIOFLUR
LEG CRAMPS WITH QUININE
LEXUSS 210
LIGHTHEADED
LIQUIBID D-R
LIQUIBID PD-R
LITHIUMEEL
LITTLE NOSES
LITTLE REMEDIES COUGH-IMMUNE
LITTLE REMEDIES HONEY COUGH
LIVETAN DM
LOHIST
LOHIST PEB DM
LOHIST-DM
LOHIST-PEB
LOHIST-PSB-DM
LONG ACTING NASAL DECONGESTANT
LONG ACTING NASAL SPRAY
LORTUSS DM
LORTUSS EX
LORTUSS LQ
LUSAIR
LUSONAL
MAPAP COLD FORMULA
MAPAP SINUS
MAPAP SINUS MAX-STRENGTH
MAR-COF BP
MAR-COF CG
MASCULINE
MAXICHLOR DM
MAXICHLOR PEH
MAXICHLOR PEH DM
MAXICHLOR PSE DM
MAXIFED
MAXIFED CD
MAXIFED CDX
MAXIFED DM
MAXIFED DMX
MAXIFED-G
MAXIFED-G CD
MAXIFED-G CDX
MAXIFLU CD
MAXIFLU CDX
53
GENERIC DRUG
GUAIFENESIN/CODEINE PHOSPHATE
BROMPHENRM/PSEUDOEPH/DIHYDROCD
GUAIFENESIN/PHENYLEPHRINE HCL
DIHYDROCODEINE/GUAIFENESIN
PHENYLEPHRINE/BROMPHENIRAMIN
D-METHORPHAN HB/P-EPHED HCL/CP
HOMEOPATHIC DRUGS
PHENYLEPHRINE/PYRILAMINE TAN
ACETAMINOPHEN/PHENYLTOLX
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
CHLORPHENIRAMINE/CODEINE PHOS
HOMEOPATHIC DRUGS
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/PHENYLEPHRINE HCL
HOMEOPATHIC DRUGS
PHENYLEPHRINE HCL
ELDERBERRY FRUIT/HONEY
HONEY
DM/PHENYLEPH/DIPHENHYDRAM TANN
PHENYLEPHRINE/CHLORPHENIRAMINE
BROMPHENIRAM/PHENYLEPHRINE/DM
BROMPHENIRAM/PHENYLEPHRINE/DM
PHENYLEPHRINE/BROMPHENIRAMINE
D-METHORPHAN HB/P-EPD HCL/BPM
PSEUDOEPHEDRINE HCL
OXYMETAZOLINE HCL
DOXYLAMINE/PSEUDOEPHEDRINE/DM
P-EPHED HCL/CODEINE/GUAIFEN
DOXYLAMINE/PSEUDOEPHEDRINE HCL
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE HCL
D-METHORPHAN/PE/ACETAMINOPHEN
PHENYLEPHRINE HCL/ACETAMINOPHN
P-EPHED HCL/ACETAMINOPHEN
BROMPHENIRA/PSEUDOEPHED/CODEIN
GUAIFENESIN/CODEINE PHOSPHATE
HOMEOPATHIC DRUGS
DEXTROMETHORPHAN HBR/CHLOR-MAL
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
D-METHORPHAN HB/P-EPHED HCL/CP
GUAIFENESIN/PSEUDOEPHEDRNE HCL
P-EPHED HCL/CODEINE/GUAIFEN
P-EPHED HCL/CODEINE/GUAIFEN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
P-EPHED HCL/CODEINE/GUAIFEN
P-EPHED HCL/CODEINE/GUAIFEN
P/EPHED/CODEINE/ACETAMINOPH/GG
P/EPHED/CODEINE/ACETAMINOPH/GG
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
MAXIFLU DM
MAXIMUM DAILY MULTIVITAMIN
MAXIPHEN
MAXIPHEN CD
MAXIPHEN CDX
MAXIPHEN DM
MAXIPHEN DMX
M-CLEAR
M-CLEAR WC
MEDENT-PEI
MEDI-BROM
MEDICATED BODY POWDER
MEDICATED FOOT
MEDICIDIN-D
MEDIFIN CP
MEDIHONEY
MEDIKOFF
MEDI-PHEDRINE
MEDI-PHENYL
MEDI-TUSSIN DM
MEDI-TUSSIN DM DIABETIC
M-END DM
M-END DMX
M-END MAX D
M-END PE
M-END WC
MENSTRUAL
MENSTRUAL COMPLETE
MENSTRUAL PAIN RELIEF
MENSTRUAL RELIEF
MENTHOL COUGH DROPS
MENTHOL DROPS
MERCURIS-HEEL
MESEHIST DM
MESEHIST WC
MIDOL
MIDOL COMPLETE
MIDOL PM
MINERAL FREEZ
MOLYBDAN COMPOSITUM
MOTRIN PM
MUCAPHED
MUCINEX COLD & SINUS
MUCINEX COLD-FLU & SORE THROAT
MUCINEX COUGH
MUCINEX D
MUCINEX DM
MUCINEX FAST-MAX COLD-FLU
MUCINEX FAST-MAX COLD-SINUS
MUCINEX FAST-MAX CONGESTCOUGH
MUCINEX FAST-MAX DAY-NITE COLD
MUCINEX FAST-MAX DM MAX
54
GENERIC DRUG
PSEUDOEPH/DM/GUAIFEN/ACETAMIN
MULTIVIT WITH CALCIUM,IRON,MIN
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/CODEINE/GUAIFEN
PHENYLEPHRINE/CODEINE/GUAIFEN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/PHENYLEPHRINE HCL
D-METHORPHAN HB/P-EPD HCL/BPM
MENTHOL
MENTHOL
PHENYLEPHRINE/ACETAMINOPHEN/CP
GUAIFENESIN/ACETAMINOPHEN
HONEY
EUCALYPTUS OIL/MENTHOL
PSEUDOEPHEDRINE HCL
PHENYLEPHRINE HCL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
D-METHORPHAN HB/P-EPHED HCL/CP
DEXBROMPHEN/PSEUDOEPHEDRINE/DM
DEXBROMPHENIRAMINE/PSE/CODEINE
BROMPHENIRAMINE/PE/CODEINE
BROMPHENIRA/PSEUDOEPHED/CODEIN
HOMEOPATHIC DRUGS
ACETAMINOPHN/PYRIL MAL/CAFFEIN
ACETAMINOPHEN/PYRILAM/PAMABROM
ACETAMINOPHN/PYRIL MAL/CAFFEIN
EUCALYPTUS OIL/MENTHOL
EUCALYPTUS OIL/MENTHOL
HOMEOPATHIC DRUGS
D-METHORPHAN HB/P-EPHED HCL/CP
BROMPHENIRA/PSEUDOEPHED/CODEIN
ACETAMINOPHN/PYRIL MAL/CAFFEIN
ACETAMINOPHN/PYRIL MAL/CAFFEIN
ACETAMINOPHEN/DP-HYDRAMINE
MENTHOL
HOMEOPATHIC DRUGS
IBUPROFEN/DIPHENHYDRAMINE CIT
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFEN/PHENYLEPH/ACETAMINOPHN
PHENYLEPHRINE/DM/ACETAMINOP/GG
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/DEXTROMETHORPHAN
PHENYLEPHRINE/DM/ACETAMINOP/GG
GUAIFEN/PHENYLEPH/ACETAMINOPHN
GUAIFENESIN/D-METHORPHAN HB/PE
DIPHENHYDRAM/PE/DM/ACETAMIN/GG
GUAIFENESIN/DEXTROMETHORPHAN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
MUCINEX FAST-MAX SEVERE COLD
MUCINEX SINUS-MAX
MUCINEX SINUS-MAX DAY-NIGHT
MUCOSA DM
MUCUS AND COUGH RELIEF
MUCUS DM
MUCUS DM MAX
MUCUS RELIEF COLD & SINUS
MUCUS RELIEF CONGEST-COUGH
MUCUS RELIEF COUGH
MUCUS RELIEF D
MUCUS RELIEF DM
MUCUS RELIEF DM MAX
MUCUS RELIEF PE
MUCUS RELIEF PLUS
MUCUS RELIEF SEV CONGEST-COLD
MUCUS RELIEF SINUS
MUCUS RLF COLD-FLU-SORE THROAT
MUCUS RLF SEVERE SINUS CONGEST
MULIMEN
MULTIPLE VITAMINS FOR WOMEN
MULTI-SYMPTOM ALLERGY RELIEF
MULTI-SYMPTOM COLD
MULTI-SYMPTOM COLD-COUGH
MULTIVITAMINS W-CALCIUM-IRON
MUSCLE & JOINT
MYCI-GC
MYDFRIN
MYHIST-DM
MYHIST-PD
MYTUSSIN AC
MYTUSSIN DAC
NALDECON DX
NALDEX
NALEX AC
NARIZ
NASAL & SINUS DECONGESTANT
NASAL DECON (PSEUDOEPHEDRINE)
NASAL DECONGESTANT
NASAL DECONGESTANT INHALER
NASAL DECONGESTANT PE
NASAL DECONGESTANT-ANTIHIST
NASAL DECONGEST-ANTIHISTAMINE
NASAL FOUR
NASAL MIST
NASAL RELIEF
NASAL SPRAY
NASAL SPRAY EXTRA MOISTURIZING
NASAL SPRAY ORIGINAL
NASAL SPRAY SINUS
NASAL SPRAY X-MOIST
55
GENERIC DRUG
PHENYLEPHRINE/DM/ACETAMINOP/GG
GUAIFEN/PHENYLEPH/ACETAMINOPHN
DIPHENHYD/PE/ACETAMINOPHEN/GG
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFEN/PHENYLEPH/ACETAMINOPHN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/DM/ACETAMINOP/GG
PHENYLEPHRINE/DM/ACETAMINOP/GG
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/DM/ACETAMINOP/GG
GUAIFEN/PHENYLEPH/ACETAMINOPHN
HOMEOPATHIC DRUGS
MULTIVIT WITH CALCIUM,IRON,MIN
PHENYLEPHRINE/ACETAMINOPHEN/CP
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM HB/PSEUDOEPHED/ACETAMIN/CP
MULTIVIT WITH CALCIUM,IRON,MIN
MENTHOL
GUAIFENESIN/CODEINE PHOSPHATE
PHENYLEPHRINE HCL
PYRILAMINE/PE/DEXTROMETHORPHAN
PHENYLEPHRINE/PYRILAMINE MA/CP
GUAIFENESIN/CODEINE PHOSPHATE
P-EPHED HCL/CODEINE/GUAIFEN
GUAIFENESIN/DEXTROMETHORPHAN
DEXCHLORPHENIR/PHENYLEPHRINE
BROMPHENIRAMINE/CODEINE PHOS
NAPHAZOLINE HCL
GUAIFENESIN/PHENYLEPHRINE HCL
PSEUDOEPHEDRINE HCL
PSEUDOEPHEDRINE HCL
OXYMETAZOLINE HCL
LEVMETAMFETAMINE
PHENYLEPHRINE HCL
PSEUDOEPHEDRINE/TRIPROLIDINE
PSEUDOEPHEDRINE/TRIPROLIDINE
PHENYLEPHRINE HCL
OXYMETAZOLINE HCL
OXYMETAZOLINE HCL
OXYMETAZOLINE HCL
OXYMETAZOLINE HCL
OXYMETAZOLINE HCL
OXYMETAZOLINE HCL
OXYMETAZOLINE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
NASOHIST
NASOHIST DM
NASOPEN
NASOPEN PE
NASOPEN-CH
NASOTUSS
NATURAL HERB
NATURAL HERB COUGH DROPS
NAUSEA
NEO AC
NEO DM
NEOFRIN
NEO-SYNEPHRINE
NEO-SYNEPHRINE 12 HOUR
NEO-TUSS
NEOTUSS PLUS
NEOTUSS-D
NERVOHEEL
NEURALGIA
NEUTRAHIST PDX
NEXAFED
NEXAFED SINUS PRESSURE-PAIN
NICOTINE GUM
NIGHT TIME
NIGHT TIME COLD
NIGHT TIME COLD & FLU
NIGHT TIME COLD-FLU
NIGHT TIME COLD-FLU RELIEF
NIGHT TIME COUGH
NIGHT TIME COUGH & SORE THROAT
NIGHT TIME FORMULA
NIGHT-TIME
NIGHTTIME COLD
NIGHTTIME COLD & FLU
NIGHTTIME COLD-FLU
NIGHTTIME COLD-FLU RELIEF
NIGHTTIME COUGH
NIGHTTIME COUGH & SORE THROAT
NIGHTTIME COUGH RELIEF
NIGHTTIME COUGH-COLD
NIGHTTIME D COLD-FLU RELIEF
NIGHTTIME SINUS
NINJACOF
NINJACOF-A
NINJACOF-XG
NITE TIME
NITE TIME COLD & FLU
NITE TIME COLD-FLU
NITE TIME COLD-FLU RELIEF
NITE TIME COUGH
NITE TIME-D COLD-FLU
NITETIME
56
GENERIC DRUG
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
CHLORCYCLIZINE/PSEUDOEPHEDRINE
THONZYLAMINE/PHENYLEPHRINE
CHLORCYCLIZINE/PHENYLEPHRINE
CHLORCYCLIZ/PHENYLEPH/CODEINE
MENTHOL
MENTHOL/HERBAL COMPLEX NO. 141
HOMEOPATHIC DRUGS
PYRIL MAL/PSEUDOEPHED/CODEINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPHRINE HCL
PHENYLEPHRINE HCL
OXYMETAZOLINE HCL
GUAIFENESIN/DEXTROMETHORPHAN
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFENESIN/DM/P-EPHED/CHLORPH
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
D-METHORPHAN HB/P-EPHED HCL/CP
PSEUDOEPHEDRINE HCL
PSEUDOEPHEDRINE/ACETAMINOPHEN
NICOTINE POLACRILEX
DM/P-EPHED/ACETAMINOPH/DOXYLAM
DM/P-EPHED/ACETAMINOPH/DOXYLAM
D-METHORPHAN/ACETAMIN/DOXYLAMN
DM/P-EPHED/ACETAMINOPH/DOXYLAM
DM/P-EPHED/ACETAMINOPH/DOXYLAM
DEXTROMETHORPHAN HB/DOXYLAMINE
D-METHORPHAN/ACETAMIN/DOXYLAMN
DM/P-EPHED/ACETAMINOPH/DOXYLAM
DM/P-EPHED/ACETAMINOPH/DOXYLAM
DM HB/PE/ACETAMINOPHEN/CHLORPH
D-METHORPHAN/ACETAMIN/DOXYLAMN
D-METHORPHAN/ACETAMIN/DOXYLAMN
D-METHORPHAN/ACETAMIN/DOXYLAMN
DEXTROMETHORPHAN HB/DOXYLAMINE
D-METHORPHAN/ACETAMIN/DOXYLAMN
DEXTROMETHORPHAN HB/DOXYLAMINE
PHENYLEPHRINE/DIPHENHYDRAMINE
DM/P-EPHED/ACETAMINOPH/DOXYLAM
PHENYLEPHRINE/ACETAMIN/DOXYLAM
PYRILAMINE/CHLOPHEDIANOL
PYRILAM/CHLOPHED/ACETAMINOPHEN
GUAIFENESIN/CODEINE PHOSPHATE
DM/P-EPHED/ACETAMINOPH/DOXYLAM
D-METHORPHAN/ACETAMIN/DOXYLAMN
DM/P-EPHED/ACETAMINOPH/DOXYLAM
D-METHORPHAN/ACETAMIN/DOXYLAMN
DEXTROMETHORPHAN HB/DOXYLAMINE
DM/P-EPHED/ACETAMINOPH/DOXYLAM
D-METHORPHAN/ACETAMIN/DOXYLAMN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
NITE-TIME
NITETIME COLD & FLU
NITE-TIME COLD & FLU
NITE-TIME COLD-FLU RELIEF
NITETIME COUGH
NITETIME MULTI-SYMPTOM
NIVA-HIST DM
NIVANEX DMX
NO DRIP
NO DRIP NASAL RELIEF
NOHIST
NOHIST DMX
NOHIST-DM
NOHIST-LQ
NOHIST-PDX
NON ASPIRIN SINUS
NON-ASPIRIN ALLERGY SINUS PM
NON-ASPIRIN ALLERGY-SINUS
NON-ASPIRIN CHILD'S COLD
NON-ASPIRIN FLU
NON-ASPIRIN SEVERE CONGESTION
NON-ASPIRIN SINUS
NON-DROWSY SINUS
NON-DRYING SINUS
NON-DRYING SINUS PE
NON-PSEUDO COLD RELIEF
NON-PSEUDO SINUS PAIN & PRESSU
NOREL AD
NOREL CS
NOREL SR
NORTUSS-D.E.
NORTUSS-DE
NORTUSS-EX
NOSE DROPS
NOSE SPRAY
NOTUSS AC
NOTUSS DC
NOTUSS-NX
NOTUSS-NXD
NOTUSS-PE
NOVAGESIC
NRS-NASAL RELIEF
NU-COPD
NUPRIN
NU-WAY
NYQUIL D
OBREDON
OCULOHEEL
ONE DAILY MAXIMUM
ONE DAILY WITH CALCIUM-IRON
ONE DAILY WOMEN'S
ONE-A-DAY WOMEN'S
57
GENERIC DRUG
D-METHORPHAN/ACETAMIN/DOXYLAMN
D-METHORPHAN/ACETAMIN/DOXYLAMN
D-METHORPHAN/ACETAMIN/DOXYLAMN
DM/PE/ACETAMINOPHEN/DOXYLAMINE
DEXTROMETHORPHAN HB/DOXYLAMINE
D-METHORPHAN/ACETAMIN/DOXYLAMN
BROMPHENIRAM/PHENYLEPHRINE/DM
GUAIFENESIN/D-METHORPHAN HB/PE
OXYMETAZOLINE HCL
OXYMETAZOLINE HCL
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPHRINE HCL/ACETAMINOPHN
PSEUDOEPHED/ACETAMINOPH/DIPHEN
P-EPHED HCL/ACETAMINOPHEN/CP
P-EPHED HCL/ACETAMINOPHEN/CP
DM/PSEUDOEPHED/ACETAMINOPHEN
PHENYLEPHRINE/DM/ACETAMINOP/GG
PSEUDOEPHEDRINE/ACETAMINOPHEN
PSEUDOEPHEDRINE/ACETAMINOPHEN
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/DM/ACETAMINOP/GG
PHENYLEPHRINE HCL/ACETAMINOPHN
PHENYLEPHRINE/ACETAMINOPHEN/CP
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPH/ACETAMINOP/P-TLOX/CP
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
PHENYLEPHRINE HCL
OXYMETAZOLINE HCL
CHLORPHENIRAMINE/CODEINE PHOS
PSEUDOEPHEDRINE HCL/CODEINE
CHLORCYCLIZINE/CODEINE
CHLORCYCLI/PSEUDOEPHED/CODEINE
PHENYLEPHRINE HCL/CODEINE
ACETAMINOPHEN/PHENYLTOLX
OXYMETAZOLINE HCL
GUAIFENESIN/PHENYLEPHRINE HCL
MENTHOL
PHENYLEPHRINE HCL
DM/P-EPHED/ACETAMINOPH/DOXYLAM
GUAIFENESIN/HYDROCODONE
HOMEOPATHIC DRUGS
FOLIC ACID/MV,FE,OTHER MIN
MULTIVIT WITH CALCIUM,IRON,MIN
MULTIVIT WITH CALCIUM,IRON,MIN
MULTIVITS,CA,MINERALS/IRON/FA
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
ONETAB CONGESTION & COUGH
ONSET FORTE
OPTI-CLEAR
ORGANIX
ORIGINAL NASAL SPRAY
ORNEX
ORNEX MAX-STRENGTH
OSTEOHEEL
P CHLOR
PAEONIA-HEEL
PAIN MEDICINE P.M.
PAIN PADS
PAIN RELIEF ALLERGY
PAIN RELIEF COLD
PAIN RELIEF COLD & COUGH
PAIN RELIEF SINUS PE
PAIN RELIEVER ALLERGY SINUS
PAIN RELIEVER COLD
PAIN RELIEVER FLU
PAIN RELIEVER SINUS
PAIN RELIEVING
PAIN RELIEVING GEL
PAIN RELIEVING PATCH
PAMPRIN MULTI-SYMPTOM
PANATUSS DXP
PANATUSS DXP PEDIATRIC
PANATUSS PED
PANCREAS
PANMIST S
PBM ALLERGY
PDM GG
PE HCL-CPM-MSN
PECGEN DMX
PECGEN PSE
PE-CP-K GUAIACOL
PE-CPM-MSN
PECTUS-HEEL
PEDIA RELIEF
PEDIA RELIEF COUGH-COLD
PEDIA RELIEF INFANT
PEDIACARE ALLERGY & COLD
PEDIACARE COUGH-COLD
PEDIACARE DECONGESTANT
PEDIACARE MULTI-SYMPTOM COLD
PEDIAHIST DM
PEDIATEX PS
PEDIATEX TD
PEDIATEX TDM
PE-GG
PE-HIST DM
PERCOGESIC
PERSPIRATION
58
GENERIC DRUG
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/ACETAMINOPHEN/CP
TETRAHYDROZOLINE HCL
MENTHOL/PECTIN
OXYMETAZOLINE HCL
PSEUDOEPHEDRINE/ACETAMINOPHEN
PSEUDOEPHEDRINE/ACETAMINOPHEN
HOMEOPATHIC DRUGS
GUAIFEN/PHENYLEPHR/CHLORPHENIR
HOMEOPATHIC DRUGS
ACETAMINOPHEN/DP-HYDRAMINE
MENTHOL
PHENYLEPHRINE/ACETAMINOPHEN/CP
PHENYLEPHRINE/DM/ACETAMINOP/GG
D-METHORPHAN HB/ACETAMINOPHEN
PHENYLEPHRINE HCL/ACETAMINOPHN
P-EPHED HCL/ACETAMINOPHEN/CP
DM HB/PSEUDOEPHED/ACETAMIN/CP
DM/PSEUDOEPHED/ACETAMINOPHEN
PSEUDOEPHEDRINE/ACETAMINOPHEN
MENTHOL
MENTHOL
MENTHOL
ACETAMINOPHEN/PYRILAM/PAMABROM
D-METHORPHAN/PE/DEXBROMPHENIR
D-METHORPHAN/PE/DEXBROMPHENIR
D-CHLORPHENIRA/PSE/CHLOPHEDIAN
HOMEOPATHIC DRUGS
GUAIFENESIN/PSEUDOEPHEDRNE HCL
D-METHORPHAN HB/P-EPD HCL/BPM
GUAIFENESIN/D-METHORPHAN HB/PE
CHLOR-MAL/PHENYLEPH/METHSCOP
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
POT GUAIACOLSUL/CARBETAPENT/PE
CHLOR-MAL/PHENYLEPH/METHSCOP
HOMEOPATHIC DRUGS
DEXTROMETHORPHAN/PSEUDOEPHED
D-METHORPHAN HB/P-EPHED HCL/CP
PSEUDOEPHEDRINE HCL
PHENYLEPHRINE/DIPHENHYDRAMINE
D-METHORPHAN HB/P-EPHED HCL/CP
PHENYLEPHRINE HCL
DEXTROMETHORPHAN/PHENYLEPHRINE
D-METHORPHAN HB/P-EPD HCL/BPM
PSEUDOEPHED & TRIPROLID POLIST
PSEUDOEPHEDRINE/TRIPROLIDINE
TRIPROLIDINE/PSEUDOEPHEDRIN/DM
GUAIFENESIN/PHENYLEPHRINE HCL
DM/PHENYLEPH/CHLORPHENIRAMINE
ACETAMINOPHEN/DIPHENHYDRAMINE
HOMEOPATHIC DRUGS
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
PHENABID
PHENABID DM
PHENAGESIC
PHENAGIL
PHENAGIL CH
PHENA-PLUS
PHENA-S
PHENCARB GG
PHENFLU CD
PHENFLU CDX
PHENFLU DM
PHENYLEPH-CHLORPHEN PEDIATRIC
PHENYLEPHRINE HCL-0.9% NACL
PHENYLEPHRINE HCL-D5W
PHENYLEPHRINE-GUAIFENESIN
PHENYLEPHRINE-PYRILAMINE
PHENYLGESIC
PHENYLHISTINE DH
PHENYLTOLOXAMINE PE CPM
PLURATUSS
PM PAIN RELIEVER
PMS MAXIMUM STRENGTH
PMS MULTI SYMPTOM
POLY HIST CB
POLY HIST DHC
POLY HIST DM
POLY HIST FORTE
POLY HIST NC
POLY HIST PD
POLY TAN DM
POLY-650
POLY-HIST DM
POLY-HIST PD
POLY-TUSSIN
POLY-TUSSIN AC
POLY-TUSSIN D
POLY-TUSSIN DHC
POLY-TUSSIN DM
POLY-TUSSIN EX
POLY-VENT DM
POLY-VENT IR
POLY-VENT PLUS
POPULUS COMPOSITUM
PRE-MENSTRUAL RELIEF
PREMSYN PMS
PRES GEN
PRES GEN PEDIATRIC
PRESGEN B
PRESSURE & PAIN
PRIMATENE ASTHMA
PRO-CHLO
59
GENERIC DRUG
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
ACETAMINOPHEN/PHENYLTOLX
PHENYLEPHRINE/CHLORPHENIRAMINE
CHLORPHENIRAM/PE/CHLOPHEDIANOL
PHENYLEPHRINE/PYRILAMINE MA/CP
PHENYLEPHRINE/PYRILAMINE MA/CP
PHENYLEPHRINE/CARBETAPENTAN/GG
PE-CODEINE-ACETAMINOPHEN-GUAIF
PE-CODEINE-ACETAMINOPHEN-GUAIF
PHENYLEPHRINE/DM/ACETAMINOP/GG
PHENYLEPHRINE/CHLOR-TAN
PHENYLEPHRINE HCL
PHENYLEPHRINE HCL IN 0.9% NACL
PHENYLEPHRINE HCL/D5W/PF
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/PYRILAMINE
ACETAMINOPHEN/PHENYLTOLX
P-EPHED HCL/COD/CHLORPHENIR
PHENYLEPHRINE/P-TLOX CI/CP
BROMPHENIRAMINE/PE/CODEINE
ACETAMINOPHEN/DP-HYDRAMINE
ACETAMINOPHEN/PYRILAM/PAMABROM
ACETAMINOPHEN/PYRILAM/PAMABROM
GUAIFENESIN/CARBETAPENTANE CIT
PYRILAM/PHENYLE/DIHYDROCODEINE
PYRILAMINE/PE/DEXTROMETHORPHAN
DOXYLAMINE/PHENYLEPHRINE HCL
PSEUDOEPHED/CODEINE/TRIPROLIDN
PHENYLEPHRINE/PYRILAMINE MA/CP
DM TAN/PE TAN/PYRIL/D-BROM TAN
ACETAMINOPHEN/PHENYLTOLX
THONZYLAMINE/PHENYLEPHRINE/DM
THONZYLAMINE/CHLOPHEDIANOL
CHLORCYCLIZINE/CODEINE
BROMPHENIRAMINE/PE/CODEINE
CHLORCYCLI/PSEUDOEPHED/CODEINE
BROMPHENIRAM/PE/DIHYDROCODEINE
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPH/DIHYDROCODEINE/GUAIF
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFEN/PSEUDOEPHED/ACETAMINOP
HOMEOPATHIC DRUGS
ACETAMINOPHEN/PYRILAM/PAMABROM
ACETAMINOPHEN/PYRILAM/PAMABROM
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
BROMPHENIRAM/PHENYLEPHRINE/DM
PHENYLEPHRINE HCL/ACETAMINOPHN
GUAIFENESIN/EPHEDRINE HCL
PYRILAMINE/PE/CHLOPHEDIANOL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
PRO-CLEAR AC
PRO-CLEAR CAPS
PROLEX DMX
PROMETHAZINE VC
PROMETHAZINE VC-CODEINE
PROMETHAZINE-CODEINE
PROMETHAZINE-DM
PROMETHAZINE-PHENYLEPHRINE
PRO-RED AC
PROTID
PSE BROM
PSEUDO COUGH
PSEUDO DM GG
PSEUDOEPHEDRINE ER
PSEUDOEPHEDRINE GG
PSEUDOEPHEDRINE-CODEINE
PSEUDOGEST
PSORINOHEEL
PULMARI-GP
PYRICHLOR PE
PYRIL D
PYRIL DM
PYRILAMINE-PHENYLEPHRINE
PYRIL-CHLOR-PHEN
PYRIL-PHENYLEPH-DM
PYRROXATE COLD & CONGEST
QFLEX
Q-TAPP DM
Q-TUSSIN DM
QUADTANN
RECOFEN D
RECTACAINE
REDNESS RELIEF
REDNESS RELIEVER
REDNESS RELIEVER EYE DROPS
REFENESEN DM
REFENESEN PE
RELAGESIC
RELCOF C
RELCOF CPM
RELCOF DN PE
RELCOF PE
RELHIST
REME HIST DM
REME TUSSIN DM
RESCON
RESCON-DM
RESCON-GG
RESCON-JR.
RESCON-MX
RESPA A.R.
RESPA C&C IR
60
GENERIC DRUG
CODEINE PHOSPHATE/PYRIL MAL
GUAIFENESIN/CODEINE PHOSPHATE
POT GUAIACO/D-METHORPHAN HB
PHENYLEPHRINE HCL/PROMETH HCL
PROMETHAZINE/PHENYLEPH/CODEINE
PROMETHAZINE HCL/CODEINE
D-METHORPHAN HB/PROMETH HCL
PHENYLEPHRINE HCL/PROMETH HCL
DEXCHLORPHEN/PHENYLEPH/CODEINE
PHENYLEPHRINE/ACETAMINOPHEN/CP
D-METHORPHAN HB/P-EPD HCL/BPM
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
PSEUDOEPHEDRINE HCL
GUAIFENESIN/PSEUDOEPHEDRNE HCL
PSEUDOEPHEDRINE HCL/CODEINE
PSEUDOEPHEDRINE HCL
HOMEOPATHIC DRUGS
GUAIFENESIN/CARBETAPENTANE CIT
PHENYLEPHRINE/PYRILAMINE MA/CP
PHENYLEPHRINE/PYRILAMINE
PYRILAMINE/PE/DEXTROMETHORPHAN
PHENYLEPHRINE/PYRILAMINE
PHENYLEPHRINE/PYRILAMINE MA/CP
PYRILAMINE/PE/DEXTROMETHORPHAN
PHENYLEPHRINE HCL/ACETAMINOPHN
ACETAMINOPHEN/PHENYLTOLX
D-METHORPHAN HB/P-EPD HCL/BPM
GUAIFENESIN/DEXTROMETHORPHAN
CAR-B-PEN TA/EPHED TAN/PE/CP
GUAIFENESIN/DEXTROMETHORPHAN
PHENYLEPHRINE HCL
NAPHAZOLINE HCL/PEG 300
TETRAHYDROZOLINE HCL
NAPHAZOLINE HCL/PEG 300
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PHENYLEPHRINE HCL
ACETAMINOPHEN/PHENYLTOLX
GUAIFENESIN/CODEINE PHOSPHATE
CHLORPHENIRAMINE/METHSCOPOLAMN
CHLOR-MAL/PHENYLEPH/METHSCOP
CHLOR-MAL/PHENYLEPH/METHSCOP
PHENYLEPHRINE/BROMPHENIRAMIN
PYRILAMINE/PE/DEXTROMETHORPHAN
DM/PHENYLEPH/CHLORPHENIRAMINE
CHLOR-MAL/PHENYLEPH/METHSCOP
D-METHORPHAN HB/P-EPHED HCL/CP
GUAIFENESIN/PHENYLEPHRINE HCL
DEXCHLORPHENIR/PHENYLEPHRINE
DEXCHLORPHENIR/PHENYLEPHRINE
P-EPHED HCL/CHLOR-MAL/BELL ALK
DM/PE/ACETAMINOPH/DIPHENHYDRAM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
RESPAHIST-II
RESPAIRE-30
RESPERAL-DM
RESPIVENT DF
RESPIVENT DF 30
RESPIVENT-D
REZIRA
RHEUMA-HEEL
RHINOFLEX
RHINOFLEX-650
RICOLA
RITIFED
RI-TUSSIN DM
ROBAFEN AC
ROBAFEN CF
ROBAFEN COUGH
ROBAFEN DM COUGH
ROBAFEN DM MAX
ROBAFEN-DM
ROBAFEN-DM CLEAR
ROBITUSSIN COLD-FLU DAY
ROBITUSSIN COLD-FLU NIGHT
ROBITUSSIN COUGH & COLD
ROBITUSSIN COUGH & COLD CF
ROBITUSSIN COUGH & COLD CF MAX
ROBITUSSIN COUGH-CHEST-CONG
DM
ROBITUSSIN COUGH-COLD
ROBITUSSIN DM MAX
ROBITUSSIN DM TO GO
ROBITUSSIN LONG-ACTING
ROBITUSSIN NIGHTTIME COUGH DM
ROBITUSSIN PEDIATRIC
ROBITUSSIN PEDIATRIC COUGH
ROBITUSSIN-COUGH-CHEST-CONG
ROBITUSSIN-DM COUGH
RONDEC-DM
R-TANNA
R-TANNA PEDIATRIC
RU-HIST D
RU-HIST FORTE
RU-HIST-D
RU-TUSS
RU-TUSS DM
RYCONTUSS
RYDEX
RYDEX DM
RYDEX G
RYMED
RYNA-12
RYNA-12 S
RYNA-12X
61
GENERIC DRUG
PHENYLEPHRINE/BROMPHENIRAMINE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
D-METHORPHAN HB/P-EPD HCL/BPM
CHLORPHENIRAMINE/METHSCOPOLAMN
CHLORPHENIRAMINE/METHSCOPOLAMN
PSEUDOEPHEDRINE/METHYLSCOPOLAM
P-EPHED HCL/HYDROCODONE
HOMEOPATHIC DRUGS
ACETAMINOPHEN/PHENYLTOLX
ACETAMINOPHEN/PHENYLTOLX
MENTHOL
PSEUDOEPHEDRINE/TRIPROLIDINE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/D-METHORPHAN HB/PE
DEXTROMETHORPHAN HBR
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
ROBITUSSIN CF
D-METHORPHAN/PE/ACETAMINOPHEN
D-METHORPHAN/ACETAMIN/DOXYLAMN
PHENYLEPHRINE/DIPHENHYDRAMINE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHAN HBR/CHLOR-MAL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHAN HBR/CHLOR-MAL
DEXTROMETHORPHAN HB/DOXYLAMINE
DEXTROMETHORPHAN/PSEUDOEPHED
DEXTROMETHORPHAN HBR
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
D-METHORPHAN HB/P-EPD HCL/BPM
PHENYLEPHRINE/CHLOR-TAN
PHENYLEPHRINE/CHLOR-TAN
PHENYLEPHRINE/BROMPHENIRAMINE
PHENYLEPHRINE/PYRILAMINE MA/CP
PHENYLEPHRINE/PYRILAMINE
P-EPHED HCL/CHLOR-MAL/BELL ALK
GUAIFENESIN/DM/PSEUDOEPHEDRINE
DM/PHENYLEPH/CHLORPHENIRAMINE
BROMPHENIRA/PSEUDOEPHED/CODEIN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
DEXCHLORPHENIR/PHENYLEPHRINE
PHENYLEPHRINE/PYRILAMINE TAN
PHENYLEPHRINE/PYRILAMINE TAN
GUAIFEN/PHENYLEPHRINE/PYRIL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
RYNATAN
RYNATAN PEDIATRIC
RYNATUSS
RYNEX DM
RYNEX PE
RYNEZE
S.T.37
SABAL-HOMACCORD
SAFETUSSIN CD
SAFETUSSIN DM
SAFETUSSIN PM
SALONSIP AQUA-PATCH
SCOT-TUSSIN DM
SCOT-TUSSIN DM COUGH CHASER
SCOT-TUSSIN SENIOR
SEPASOOTHE
SERADEX
SERADEX-LA
SEVERE COLD & FLU
SEVERE COLD CONGESTION
SEVERE COLD MULTI-SYMPTOM
SEVERE COLD-FLU NIGHTTIME
SEVERE CONGESTION
SEVERE CONGESTION & COUGH MAX
SEVERE SINUS
SEVERE SINUS CONGESTION
SILAFED
SILDEC PE-DM
SILDEC-DM
SILDEC-PE
SILPHEN DM
SILTUSSIN DM
SILTUSSIN DM DAS COUGH FORMULA
SIMUC-DM
SINA-12X
SINUS
SINUS & ALLERGY PE
SINUS & COLD-D
SINUS 12-HOUR
SINUS CONGESTION & PAIN
SINUS CONGESTION-PAIN
SINUS CONGESTION-PAIN RELIEF
SINUS DAYTIME-NIGHTTIME
SINUS DECONGESTANT
SINUS FORMULA
SINUS HEADACHE
SINUS HEADACHE DEGONGESTANT
SINUS HEADACHE PE
SINUS MAXIMUM STRENGTH
SINUS NASAL
SINUS NASAL SPRAY
SINUS NIGHTTIME
62
GENERIC DRUG
PHENYLEPHRINE/CHLOR-TAN
PHENYLEPHRINE/CHLOR-TAN
CAR-B-PEN TA/EPHED TAN/PE/CP
BROMPHENIRAM/PHENYLEPHRINE/DM
PHENYLEPHRINE/BROMPHENIRAMINE
CHLORPHENIRAMINE/METHSCOPOLAMN
HEXYLRESORCINOL
HOMEOPATHIC DRUGS
DEXTROMETHORPHAN/PHENYLEPHRINE
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHAN HB/DOXYLAMINE
MENTHOL
DEXTROMETHORPHAN HBR/CHLOR-MAL
DEXTROMETHORPHAN HBR
GUAIFENESIN/DEXTROMETHORPHAN
HEXYLRESORCINOL/MENTHOL
BROMPHENIRAMIN/PE/CARBETAPENT
PHENYLEPHRINE/BROMPHENIRAMINE
DOXYLAM/PE/DM/ACETAMINOPHEN/GG
PSEUDOEPH/DM/GUAIFEN/ACETAMIN
PHENYLEPHRINE/DM/ACETAMINOP/GG
DM/PE/ACETAMINOPHEN/DOXYLAMINE
OXYMETAZOLINE HCL
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFEN/PHENYLEPH/ACETAMINOPHN
GUAIFEN/PSEUDOEPHED/ACETAMINOP
PSEUDOEPHEDRINE/TRIPROLIDINE
DM/PHENYLEPH/CHLORPHENIRAMINE
D-METHORPHAN HB/P-EPD HCL/BPM
PHENYLEPHRINE/CHLORPHENIRAMINE
DEXTROMETHORPHAN HBR
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/PHENYLEPHRINE TANN
HOMEOPATHIC DRUGS
PHENYLEPHRINE/CHLORPHENIRAMINE
NAPROXEN SODIUM/P-EPHED HCL
PSEUDOEPHEDRINE HCL
GUAIFEN/PHENYLEPH/ACETAMINOPHN
PHENYLEPHRINE HCL/ACETAMINOPHN
GUAIFEN/PHENYLEPH/ACETAMINOPHN
PHENYLEPHRINE/ACETAMIN/DOXYLAM
PHENYLEPHRINE HCL
PHENYLEPHRINE HCL/ACETAMINOPHN
PSEUDOEPHEDRINE/ACETAMINOPHEN
PSEUDOEPHEDRINE/ACETAMINOPHEN
PHENYLEPHRINE HCL/ACETAMINOPHN
PHENYLEPHRINE HCL/ACETAMINOPHN
OXYMETAZOLINE HCL
OXYMETAZOLINE HCL
PHENYLEPHRINE/TRIPROLIDINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
SINUS PAIN RELIEF
SINUS PRESSURE-CONG RELIEF PE
SINUS RELIEF
SINUS RELIEF CONGESTION & PAIN
SINUS RELIEF NASAL SPRAY
SINUS RELIEF-CONGESTION & PAIN
SINUTAB SINUS
SINUTROL PE
SKIN
SOMBRA COOL THERAPY
SONAHIST
SONAHIST DM
SORBUGEN NR
SORBUTUSS
SORE MUSCLE RUB
SORE THROAT & COUGH
SORE THROAT RELIEF
SPASCUPREEL
SPASM-PAIN
SPIGELIA COMPOSITUM
SPIGELON
STAFLEX
STAHIST
STAHIST AD
STATUSS GREEN
STERILE EYE DROPS
STOMACH
STOPAIN
STRAMONIUM
STRUMEEL
SUDAFED
SUDAFED 12 HOUR
SUDAFED 12 HR PRESSURE-PAIN
SUDAFED 12 HR SINUS-PAIN
SUDAFED 12-HOUR
SUDAFED 24-HOUR
SUDAFED OM
SUDAFED PE
SUDAFED PE COLD & COUGH
SUDAFED PE NON-DRYING SINUS
SUDAFED PE PRESSURE+PAIN+COLD
SUDAFED PE PRESSURE+PAIN+COUGH
SUDAFED PE SINUS & ALLERGY
SUDAFED PE SINUS HEADACHE
SUDAFED SINUS
SUDAFED TRIPLE ACTION
SUDAL-12
SUDATEX G
SUDATEX-DM
SUDOGEST
SUDOGEST PE
63
GENERIC DRUG
PHENYLEPHRINE HCL/ACETAMINOPHN
PHENYLEPHRINE HCL
OXYMETAZOLINE HCL
PHENYLEPHRINE/ACETAMINOPHEN/CP
OXYMETAZOLINE HCL
PHENYLEPHRINE/ACETAMINOPHEN/CP
PHENYLEPHRINE HCL/ACETAMINOPHN
PHENYLEPHRINE/ACETAMINOPHEN/CP
HOMEOPATHIC DRUGS
MENTHOL
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFEN/D-METHORPHAN HB/K CIT
MENTHOL
DEXTROMETHORPHAN HBR/B-CAINE
SORE THROAT LOZENGES
PECTIN
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
ACETAMINOPHEN/PHENYLTOLX
CPM/P-EPHED/ATROP/HYOS/SCOP HB
CHLORCYCLIZINE/PSEUDOEPHEDRINE
CHLORCYCLI/PSEUDOEPHED/CODEINE
TETRAHYDROZOLINE HCL
HOMEOPATHIC DRUGS
MENTHOL
HOMEOPATHIC DRUGS
HOMEOPATHIC DRUGS
PSEUDOEPHEDRINE HCL
PSEUDOEPHEDRINE HCL
NAPROXEN SODIUM/P-EPHED HCL
NAPROXEN SODIUM/P-EPHED HCL
PSEUDOEPHEDRINE HCL
PSEUDOEPHEDRINE HCL
OXYMETAZOLINE HCL
PHENYLEPHRINE HCL
PHENYLEPHRINE/DM/ACETAMINOP/GG
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/DM/ACETAMINOP/GG
D-METHORPHAN/PE/ACETAMINOPHEN
PHENYLEPHRINE/CHLORPHENIRAMINE
PHENYLEPHRINE HCL/ACETAMINOPHN
P-EPHED HCL/ACETAMINOPHEN
GUAIFEN/PSEUDOEPHED/ACETAMINOP
PSEUDOEPHED PL/CHLORPHEN POLAC
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/DM/PSEUDOEPHEDRINE
PSEUDOEPHEDRINE HCL
PHENYLEPHRINE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
SULFUR-HEEL
SUPER TROCHE DM
SUPHEDRIN
SUPHEDRIN 12-HOUR
SUPHEDRINE
SUPHEDRINE 12-HOUR
SUPHEDRINE PE
SUPHEDRINE SINUS CONGESTION
SUPRESS A
SUPRESS DM
SUPRESS-DX
SUPRESS-PE
SYZYGIUM COMPOSITUM
TAB A VITE
TAB TUSSIN DM
TANABID
TANABID SR
TAVIST
TEKRAL
TENAR DM
TENAR PSE
TENSION HEADACHE RELIEVER
TESSALON
TESSALON PERLE
TG 10PEH-380GFN
TG 10PEH-380GFN-15DM
TG 45PSE-400GFN
TG 45PSE-400GFN-15DM
THERAFLU COLD & COUGH
THERAFLU COLD-SORE THROAT
THERAFLU DAY-NGT COLD & COUGH
THERAFLU FLU-CHEST CONGESTION
THERAFLU MAX-D SEVERE COLD-FLU
THERAFLU MULTI-SYMPTOM COLD
THERAFLU SINUS & COLD
THERAPEUTIC BLUE GEL
THERAPEUTIC M
THERAPEUTIC MINERAL ICE
THROAT
THROAT DROPS
THROAT LOZENGE
TL-DEX DM
TL-DMX
TL-HIST CD
TL-HIST CM
TL-HIST DM
TRAUMEEL
TREXBROM
TRIACTING COLD & COUGH
TRIACTING COUGH & RUNNY NOSE
TRIACTING COUGH & SORE THROAT
TRIACTING EXPECTORANT
64
GENERIC DRUG
HOMEOPATHIC DRUGS
DEXTROMETHORPHAN HBR/B-CAINE
PSEUDOEPHEDRINE HCL
PSEUDOEPHEDRINE HCL
PSEUDOEPHEDRINE HCL
PSEUDOEPHEDRINE HCL
DIPHENHYDRAM/PE/DM/ACETAMIN/GG
PSEUDOEPHEDRINE HCL
D-METHORPHAN/PE/DEXBROMPHENIR
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/PHENYLEPHRINE HCL
HOMEOPATHIC DRUGS
MULTIVIT WITH CALCIUM,IRON,MIN
GUAIFENESIN/DEXTROMETHORPHAN
PHENYLEPHRINE/BROMPHENIRAMIN
PHENYLEPHRINE/BROMPHENIRAMINE
PSEUDOEPHEDRINE/ACETAMINOPHEN
PSEUDOEPHED/DIPHENHYDRAMINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
ACETAMINOPHEN/PHENYLTOLX
BENZONATATE
BENZONATATE
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/DM/PSEUDOEPHEDRINE
DEXTROMETHORPHAN/PE/PHENIRAMIN
PHENYLEPHRINE/ACETAMINOPHN/PNM
DM/PE/ACETAMINOPH/DIPHENHYDRAM
GUAIFENESIN/ACETAMINOPHEN
PSEUDOEPH/DM/GUAIFEN/ACETAMIN
D-METHORPHAN/PE/ACETAMINOPHEN
PHENYLEPHRINE/ACETAMINOPHN/PNM
MENTHOL
MULTIVIT WITH CALCIUM,IRON,MIN
MENTHOL
HOMEOPATHIC DRUGS
PECTIN
BENZOCAINE/CETYLPYRIDINIUM CHL
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/PHENYLEPHRINE HCL
BROMPHENIRAMINE/PE/CODEINE
CHLORPHENIRAMINE/CODEINE PHOS
BROMPHENIRAM/PHENYLEPHRINE/DM
HOMEOPATHIC DRUGS
BROMPHENIRAMIN/PE/CARBETAPENT
DEXTROMETHORPHAN/PHENYLEPHRINE
DEXTROMETHORPHAN HBR/CHLOR-MAL
D-METHORPHAN HB/ACETAMINOPHEN
GUAIFENESIN/PSEUDOEPHEDRNE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
TRIACTING M-SYM COLD-COUGH
TRIACTING NIGHT TIME
TRIAMINIC COLD & COUGH
TRIAMINIC COLD-ALLERGY PE
TRIAMINIC COLD-COUGH-FEVER
TRIAMINIC DAYTIME COLD-COUGH
TRIAMINIC NIGHT TIME
TRIAMINIC NIGHTTIME COLD-COUGH
TRIAMINIC-D
TRIAMINICIN
TRICODE AR
TRICODE GF
TRICODENE
TRI-DEX PE
TRIGOFEN
TRIGOFEN DM
TRIONATE
TRIP-PSE
TRIPTIFED
TRISPEC DEX
TRISPEC DMX
TRISPEC PSE
TRITAL DM
TRYMINE CD
TRYMINE CG
TRYMINE D
TUSDEC-DM
TUSICOF
TUSNEL
TUSNEL C
TUSNEL DIABETIC
TUSNEL PED-C
TUSNEL PEDIATRIC
TUSNEL-A
TUSNEL-DM PEDIATRIC
TUSSAFED EX
TUSSANIL
TUSSI PRES-B
TUSSI-12
TUSSI-12 S
TUSSI-12D
TUSSI-12D S
TUSSICAPS
TUSSIGON
TUSSIN CF
TUSSIN CF MAX
TUSSIN COLD SEVERE CONGESTION
TUSSIN COLD-CONGESTION
TUSSIN COUGH
TUSSIN COUGH DM
TUSSIN COUGH-CHEST CONGESTION
TUSSIN COUGH-COLD-FLU
65
GENERIC DRUG
D-METHORPHAN HB/P-EPHED HCL/CP
DEXTROMETHORPHAN HBR/CHLOR-MAL
DEXTROMETHORPHAN/PHENYLEPHRINE
PHENYLEPHRINE/CHLORPHENIRAMINE
DM HB/PSEUDOEPHED/ACETAMIN/CP
DEXTROMETHORPHAN/PHENYLEPHRINE
D-METHORPHAN HB/P-EPHED HCL/CP
PHENYLEPHRINE/DIPHENHYDRAMINE
D-METHORPHAN HB/P-EPHED HCL/CP
P-EPHED HCL/ACETAMINOPHEN/CP
CHLORPHEN/PSEUDOEPHED/CODEINE
P-EPHED HCL/CODEINE/GUAIFEN
AMMON CHL/DM/CP/SODIUM CIT
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
CAR-B-PEN TA/CHLOR-TAN
PSEUDOEPHEDRINE/TRIPROLIDINE
PSEUDOEPHEDRINE/TRIPROLIDINE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
DM/PHENYLEPH/CHLORPHENIRAMINE
TRIPROLIDINE/PSEUDOEPHED/CHLOP
GUAIFENESIN/CODEINE PHOSPHATE
PSEUDOEPHEDRINE/TRIPROLIDINE
BROMPHENIRAM/PHENYLEPHRINE/DM
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
P-EPHED HCL/CODEINE/GUAIFEN
GUAIFENESIN/DEXTROMETHORPHAN
P-EPHED HCL/CODEINE/GUAIFEN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
PSEUDOEPH/DM/GUAIFEN/ACETAMIN
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/D-METHORPHAN HB/PE
PHENYLEPHRINE/CHLORPHENIRAMINE
BROMPHENIRAM/PHENYLEPHRINE/DM
CAR-B-PEN TA/CHLOR-TAN
CAR-B-PEN TA/CHLOR-TAN
CAR-B-PEN TA/PHENYLEPHRINE/PYR
CAR-B-PEN TA/PHENYLEPHRINE/PYR
HYDROCODONE/CHLORPHEN P-STIREX
HYDROCODONE BIT/HOMATROP ME-BR
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/PSEUDOEPHEDRNE HCL
GUAIFENESIN/DM/PSEUDOEPHEDRINE
DEXTROMETHORPHAN HBR
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
DM HB/PE/ACETAMINOPHEN/CHLORPH
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
TUSSIN DM
TUSSIN DM CLEAR
TUSSIN DM COUGH
TUSSIN DM COUGH & CHEST
TUSSIN DM COUGH-CHEST CONGEST
TUSSIN DM MAX
TUSSIN MAXIMUM STRENGTH
TUSSIN PE
TUSSINMAX
TUSSIONEX
TUSSI-PRES
TUSSI-PRES B
TUSSI-PRES PE
TUSSI-PRES PEDIATRIC
TUSSLIN
TUSSO-C
TUSSO-DMR
TUSSO-ZMR
TYLENOL ALLERGY M-S NIGHTTIME
TYLENOL ALLERGY MULTI-SYMPTOM
TYLENOL COLD
TYLENOL COLD & FLU SEVERE
TYLENOL COLD HEAD CONGEST SEVR
TYLENOL COLD HEAD CONGESTION
TYLENOL COLD MULTI-SYMPTOM
TYLENOL COLD MULTI-SYMPTOMS
TYLENOL COLD SEVERE CONGESTION
TYLENOL COLD-FLU SEVERE
TYLENOL SINUS
TYLENOL SINUS CONGESTION-PAIN
TYLENOL WARMING COLD M-S
TYZINE
ULTIMATE TEEN
ULTRA CAP
ULTRA DM FREE & CLEAR
ULTRA FLU
ULTRA TUSS
ULTREX
VALU-TAPP DECONGESTANT
VANACOF
VANACOF APE
VANACOF CD
VANACOF DM
VANACOF DX
VANACOF G
VANACOF GPE
VANACOF-8
VANACOF-PE
VANATAB DX
VAPOR INHALER
VAPORIZING STEAM
VARICOSE
66
GENERIC DRUG
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
GUAIFENESIN/DEXTROMETHORPHAN
DEXTROMETHORPHAN HBR
GUAIFENESIN/PHENYLEPHRINE HCL
DEXTROMETHORPHAN HBR
HYDROCODONE/CHLORPHEN P-STIREX
GUAIFENESIN/D-METHORPHAN HB/PE
BROMPHENIRAM/PHENYLEPHRINE/DM
GUAIFENESIN/PHENYLEPHRINE HCL
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/CODEINE PHOSPHATE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/CARBETAPENTANE CIT
DIPHENHYDRA/PHENYLEPH/ACETAMIN
PE/ACETAMIN/DIPHENHYDRAMIN/CPM
DM HB/PE/ACETAMINOPHEN/CHLORPH
PHENYLEPHRINE/DM/ACETAMINOP/GG
GUAIFEN/PHENYLEPH/ACETAMINOPHN
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM HB/PE/ACETAMINOPHEN/CHLORPH
DM/PE/ACETAMINOPHEN/DOXYLAMINE
PSEUDOEPH/DM/GUAIFEN/ACETAMIN
PHENYLEPHRINE/DM/ACETAMINOP/GG
GUAIFEN/PSEUDOEPHED/ACETAMINOP
GUAIFEN/PHENYLEPH/ACETAMINOPHN
DM/PE/ACETAMINOPHEN/DOXYLAMINE
TETRAHYDROZOLINE HCL
MULTIVIT WITH CALCIUM,IRON,MIN
DM HB/PSEUDOEPHED/ACETAMIN/CP
GUAIFENESIN/DEXTROMETHORPHAN
DM HB/PSEUDOEPHED/ACETAMIN/CP
GUAIFENESIN/DEXTROMETHORPHAN
DM HB/PSEUDOEPHED/ACETAMIN/CP
PSEUDOEPHEDRINE HCL
D-CHLORPHENIRA/PSE/CHLOPHEDIAN
THONZYLAMINE/PHENYL/CHLOPHED
DEXCHLORPHEN/PHENYLEPH/CODEINE
GUAIFENESIN/D-METHORPHAN HB/PE
PSEUDOEPH/CHLOPHEDIANOL/GG
CHLOPHEDIANOL HCL/GUAIFENESIN
PHENYLEPHRINE/CHLOPHEDIANOL/GG
PYRILAMINE/CHLOPHEDIANOL
CHLORCYCLIZIN-PE-CHLOPHEDIANOL
PSEUDOEPH/CHLOPHEDIANOL/GG
LEVMETAMFETAMINE
CAMPHOR/EUCALYPTUS/MENTHOL
HOMEOPATHIC DRUGS
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
VASO
VAZCULEP
VAZOBID
VAZOBID-PD
VAZOTAB
VAZOTAN
V-COF
VERTIGOHEEL
V-HIST
VICKS 44
VICKS 44 CUSTOM CARE
VICKS CHILDREN'S NYQUIL
VICKS COUGH DROPS
VICKS DAYQUIL
VICKS DAYQUIL COUGH
VICKS DAYQUIL MUCUS CONTROL
VICKS DAYQUIL SEVERE COLD-FLU
VICKS DAYQUIL SINEX
VICKS DAYQUIL-NYQUIL
VICKS DAYQUIL-NYQUIL COLD-FLU
VICKS DAYQUIL-NYQUIL SEVERE
VICKS INHALER
VICKS NATURE FUSION
VICKS NATURE FUSION COUGH
VICKS NYQUIL
VICKS NYQUIL COLD & FLU
VICKS NYQUIL COUGH
VICKS NYQUIL SEVERE COLD-FLU
VICKS NYQUIL SINEX
VICKS QLEARQUIL
VICKS QLEARQUIL DAYTIME
VICKS SINEX
VICKS VAPODROPS
VICKS VAPOSTEAM
VIRACON
VIRAVAN-P
VIRAVAN-PDM
VIRDEC
VIRDEC DM
VIRTUSSIN AC
VIRTUSSIN DAC
VISINE
VISINE LONG LASTING
VISTRA 650
VITAMIN E
VITAMIN E NATURAL BLEND
VITEC
VITUZ
WAL-ACT D COLD & ALLERGY
WAL-DRYL-D ALLERY & SINUS
WAL-FLU COLD & SORE THROAT
67
GENERIC DRUG
PSEUDOEPHEDRINE/CPM/METHYLSCOP
PHENYLEPHRINE HCL
PHENYLEPHRINE/BROMPHENIRAMIN
PHENYLEPHRINE/BROMPHENIRAMINE
PHENYLEPHRINE/BROMPHENIRAMIN
BROMPHEN/PHENYLEPH/CARBET TANN
BROMPHENIRAMIN/PE/CARBETAPENT
HOMEOPATHIC DRUGS
PHENYLEPHRINE/BROMPHENIRAMINE
DEXTROMETHORPHAN HBR
DEXTROMETHORPHAN HBR
DEXTROMETHORPHAN HBR/CHLOR-MAL
MENTHOL
D-METHORPHAN/PE/ACETAMINOPHEN
DEXTROMETHORPHAN HBR
GUAIFENESIN/DEXTROMETHORPHAN
PHENYLEPHRINE/DM/ACETAMINOP/GG
PHENYLEPHRINE HCL/ACETAMINOPHN
DM/PE/ACETAMINOPHEN/DOXYLAMINE
DM/PE/ACETAMINOPHEN/DOXYLAMINE
DOXYLAM/PE/DM/ACETAMINOPHEN/GG
L-DESOXYEPHEDRINE
D-METHORPHAN/ACETAMIN/DOXYLAMN
DEXTROMETHORPHAN HBR
D-METHORPHAN/ACETAMIN/DOXYLAMN
DEXTROMETHORPHN/ACETAMINOPH/CP
DEXTROMETHORPHAN HB/DOXYLAMINE
DM/PE/ACETAMINOPHEN/DOXYLAMINE
PHENYLEPHRINE/ACETAMIN/DOXYLAM
OXYMETAZOLINE HCL
PHENYLEPHRINE HCL/ACETAMINOPHN
OXYMETAZOLINE HCL
MENTHOL
CAMPHOR/EUCALYPT/MENTH/BENZOIN
HOMEOPATHIC DRUGS
PSEUDOEPHED TAN/PYRILAMINE TAN
DM,P-EPHED,PYRILAMINE TANNATES
PHENYLEPHRINE/CHLORPHENIRAMINE
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFENESIN/CODEINE PHOSPHATE
P-EPHED HCL/CODEINE/GUAIFEN
TETRAHYDROZOLINE HCL
OXYMETAZOLINE HCL
ACETAMINOPHEN/PHENYLTOLX
VITAMIN E ACETATE
VITAMIN E MIXED
VITAMIN E
HYDROCODONE/CHLORPHENIRAMINE
PSEUDOEPHEDRINE/TRIPROLIDINE
PHENYLEPHRINE/DIPHENHYDRAMINE
PHENYLEPHRINE/ACETAMINOPHN/PNM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
BRAND DRUG
WAL-FLU NIGHT TIME
WAL-FLU SEVERE COLD
WAL-FLU SEVERE COLD-COUGH
WAL-FOUR
WAL-PHED 12 HOUR
WAL-PHED PE COLD-COUGH
WAL-PHED PE SINUS & ALLERGY
WAL-PHED PE TRIPLE RELIEF
WAL-PROFEN
WAL-PROFEN D
WAL-TAP DM
WAL-TUSSIN COUGH
WAL-TUSSIN COUGH & COLD CF
WAL-TUSSIN DM
WOMEN'S DAILY FORMULA
WOMEN'S DAILY MULTIVITAMIN
WOMEN'S ONE DAILY
Y-COF DM
Y-COF DMX
YODEFAN-NF
YPSILOHEEL
Z-COF 12DM
Z-COF 8 DM
Z-COF I
Z-DEX
Z-DEX 12D
Z-DEX SYRUP
ZEEL
ZEPHREX-D
ZFLEX
ZGESIC
ZIM'S MAX-FREEZE
ZODEN
ZODEN DM
ZODEN PD
ZODRYL AC 25
ZODRYL AC 30
ZODRYL AC 35
ZODRYL AC 40
ZODRYL AC 50
ZODRYL AC 60
ZODRYL AC 80
ZODRYL DAC 25
ZODRYL DAC 30
ZODRYL DAC 35
ZODRYL DAC 40
ZODRYL DAC 50
ZODRYL DAC 60
ZODRYL DAC 80
ZODRYL DEC 25
ZODRYL DEC 30
ZODRYL DEC 35
68
GENERIC DRUG
PHENYLEPHRINE/ACETAMINOPHN/PNM
PHENYLEPHRINE HCL/ACETAMINOPHN
D-METHORPHAN/PE/ACETAMINOPHEN
PHENYLEPHRINE HCL
PSEUDOEPHEDRINE HCL
PHENYLEPHRINE/DM/ACETAMINOP/GG
PHENYLEPHRINE/CHLORPHENIRAMINE
GUAIFEN/PHENYLEPH/ACETAMINOPHN
IBUPROFEN/PSEUDOEPHEDRINE HCL
IBUPROFEN/PSEUDOEPHEDRINE HCL
BROMPHENIRAM/PHENYLEPHRINE/DM
DEXTROMETHORPHAN HBR
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/DEXTROMETHORPHAN
MULTIVIT WITH CALCIUM,IRON,MIN
MULTIVIT WITH CALCIUM,IRON,MIN
MULTIVIT WITH CALCIUM,IRON,MIN
D-METHORPHAN/PE/DEXBROMPHENIR
BROMPHENIRAM/PHENYLEPHRINE/DM
POTASSIUM GUAIACOLSULFONATE
HOMEOPATHIC DRUGS
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/DM/PSEUDOEPHEDRINE
GUAIFENESIN/D-METHORPHAN HB/PE
DM/PHENYLEPH/CHLORPHENIRAMINE
GUAIFENESIN/D-METHORPHAN HB/PE
HOMEOPATHIC DRUGS
PSEUDOEPHEDRINE HCL
ACETAMINOPHEN/PHENYLTOLX
ACETAMINOPHEN/PHENYLTOLX
MENTHOL
GUAIFENESIN/PHENYLEPHRINE HCL
DM/PHENYLEPH/CHLORPHENIRAMINE
PHENYLEPHRINE/DIPHENHYDRAMINE
CHLORPHENIRAMINE/CODEINE PHOS
CHLORPHENIRAMINE/CODEINE PHOS
CHLORPHENIRAMINE/CODEINE PHOS
CHLORPHENIRAMINE/CODEINE PHOS
CHLORPHENIRAMINE/CODEINE PHOS
CHLORPHENIRAMINE/CODEINE PHOS
CHLORPHENIRAMINE/CODEINE PHOS
CHLORPHEN/PSEUDOEPHED/CODEINE
CHLORPHEN/PSEUDOEPHED/CODEINE
CHLORPHEN/PSEUDOEPHED/CODEINE
CHLORPHEN/PSEUDOEPHED/CODEINE
CHLORPHEN/PSEUDOEPHED/CODEINE
CHLORPHEN/PSEUDOEPHED/CODEINE
CHLORPHEN/PSEUDOEPHED/CODEINE
P-EPHED HCL/CODEINE/GUAIFEN
P-EPHED HCL/CODEINE/GUAIFEN
P-EPHED HCL/CODEINE/GUAIFEN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
COUGH AND COLD
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
BRAND DRUG
ZODRYL DEC 40
ZODRYL DEC 50
ZODRYL DEC 60
ZODRYL DEC 80
ZONATUSS
ZOTEX
ZOTEX 12
ZOTEX-12D
ZOTEX-C
ZOTEX-D
ZOTEX-EX
ZOTEX-GP
ZOTEX-PE
Z-TUSS AC
Z-TUSS DM
Z-TUSS E
ZUTRIPRO
ZYNCOF
10 WASH
A.E.R
A.E.R TRAVELER
ABSORICA
ACANYA
ACNE CARE
ACZONE
ALA-QUIN
ALC-FREE
ALCOHOL,DEHYDRATED
ALCORTIN A
ALOQUIN
ALPHAGAN P
ALUM POWDER
A-MANTLE
AMERIWASH
AMNESTEEM
ANTIBACTERIAL
ANTIBACTERIAL CLEANSING
ANTI-BACTERIAL CLEANSING
ANTIBACTERIAL LIQUID SOAP
ANTIBACTERIAL WIPES
ANTIBIOTIC
ANTISEPTIC
ANTISEPTIC BIO-HAND
ANTISEPTIC CLEANSER
ANTISEPTIC PERINEAL WASH II
ANTISEPTIC SKIN CLEANSER
ANTISEPTIC SOLUTION
ANTISEPTIC WOUND-SKIN
APOP
ASC LOTIONIZED CLEANSER
69
GENERIC DRUG
P-EPHED HCL/CODEINE/GUAIFEN
P-EPHED HCL/CODEINE/GUAIFEN
P-EPHED HCL/CODEINE/GUAIFEN
P-EPHED HCL/CODEINE/GUAIFEN
BENZONATATE
GUAIFENESIN/D-METHORPHAN HB/PE
DM-PE-PYRILAMINE TANNATES
DM/PHENYLEPH/CHLORPHENIRAMINE
PYRIL MA/PE/CODEINE PHOS
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/D-METHORPHAN HB/PE
GUAIFENESIN/PHENYLEPHRINE HCL
PHENYLEPHRINE/BROMPHENIRAMINE
CHLORPHENIRAMINE/CODEINE PHOS
GUAIFENESIN/D-METHORPHAN HB/PE
P-EPHED HCL/CODEINE/GUAIFEN
PSEUDOEPHED/HYDROCODONE/CPM
GUAIFENESIN/DEXTROMETHORPHAN
SULFACETAMIDE SODIUM
GLYCERIN/WITCH HAZEL
GLYCERIN/WITCH HAZEL
ISOTRETINOIN
CLINDAMYCIN PHOS/BENZOYL PEROX
WITCH HAZEL LEAF/ALCOHOL
DAPSONE
ADAPALENE
CLIOQUINOL/HYDROCORTISONE
BENZALKONIUM CHLORIDE
ETHYL ALCOHOL
HYDROCORTISONE/IODOQUIN/ALOE#2
IODOQUINOL/ALOE POLYSACCHAR #1
BRIMONIDINE TARTRATE
AMMONIUM ALUM
ALUMINUM ACETATE
ALUMINUM ACETATE
TRICLOSAN
ISOTRETINOIN
TRICLOSAN
TRICLOSAN
BENZETHONIUM CHLORIDE
TRICLOSAN
BENZALKONIUM CHLORIDE
BACITRACIN ZINC
POVIDONE-IODINE
ETHYL ALCOHOL
EUCALYPT/MENTH/CAMPH/PEP/W-H
BENZETHONIUM CHLORIDE
CHLORHEXIDINE GLUCONATE
POVIDONE-IODINE
BENZETHONIUM CHLORIDE
SULFACETAMIDE SODIUM/BAKUCHIOL
TRICLOSAN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
BRAND DRUG
AZELEX
BABY WASH
BACIIM
GENERIC DRUG
AZELAIC ACID
SKIN CLEANSER
BACITRACIN
BACITRACIN
BACITRACIN ZINC
BACITRACIN
ETHYL ALCOHOL/BAY OIL
METHYLBENZETHONIUM CHLORIDE
BENZETHONIUM CHLORIDE
BENZOYL PEROXIDE/HYDROCORTISON
CLINDAMYCIN PHOS/BENZOYL PEROX
BENZALKONIUM CHLORIDE
BENZALKONIUM CHLORIDE
BACITRAYCIN PLUS
BAY RUM
BEDSIDE-CARE
BEDSIDE-CARE PERINEAL
BENCORT
BENZACLIN
BENZ-ALL
BENZOIN
BETADINE
BETASEPT
BLEPH-10
BODI LINE
BODI WHIRL BATH
CALMOSEPTINE
CA-REZZ
CETAKLENZ
CLARAVIS
CLINDAMYCIN PHOS-BENZOYL PEROX
CLINDAMYCIN-BENZOYL PEROXIDE
COLD SORE
COLD SORE TREATMENT
CURE CHROME
DERMA CIDOL 2000
DERMAFIX
DERMASORB AF
DERMAZENE
DIFFERIN
DUAC
DUAC CS
DYNAHEX
EPI-CLENZ
EPIDUO
EXODERM
EYE WASH
E-Z SCRUB PREOPERATIVE
FABIOR
FINACEA
FINACEA PLUS
FIRST AID ANTISEPTIC
FLAGYL
FLAGYL ER
FORMADON
70
POVIDONE-IODINE
CHLORHEXIDINE GLUCONATE
SULFACETAMIDE SODIUM
ETHYL ALCOHOL
SKIN CLEANSER
BRIMONIDINE TARTRATE
MENTHOL/ZINC OXIDE
TRICLOSAN
SKIN CLEANSER
CHLORHEXIDINE GLUCONATE
ISOTRETINOIN
CLINDAMYCIN PHOS/BENZOYL PEROX
CLINDAMYCIN PHOS/BENZOYL PEROX
TANNIC ACID
BENZALKONIUM CHLORIDE
BENZALKONIUM CHLORIDE
DAPSONE
CHLOROXYLENOL
SOD CHLORIDE/B-6/ZINC ACET/ALC
CLIOQUINOL/HC/EMOLLIENT CMB#88
HYDROCORTISONE/IODOQUINOL
ADAPALENE
CLINDAMYCIN PHOS/BENZOYL PEROX
CLINDAMYCIN/BENZOYL PRX/SKN #5
CHLORHEXIDIN/ISOPROPYL ALCOHOL
ETHYL ALCOHOL
ADAPALENE/BENZOYL PEROXIDE
ETHYL ALCOHOL
SODIUM THIOSULFATE/SAL ACID
SOD BORATE/BORIC AC/WATER/NACL
POVIDONE-IODINE
TAZAROTENE
AZELAIC ACID
AZELAIC ACID/CERAMIDE 1,3,6-11
POVIDONE-IODINE
METRONIDAZOLE
METRONIDAZOLE
FORMALDEHYDE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
BRAND DRUG
FORMALAZ
FORMA-RAY
GELRITE
GEL-STAT
GENTLE RAIN
GENTLE SKIN CLEANSER
GERM DEFENSE
GOLD BOND QUICK SPRAY
GORDOMATIC
GRX DYNE
HAND SANITIZER
HAND SOAP
HEMORRHOID PAD
HEMORRHOIDAL HYGIENE
HEMORRHOIDAL PADS
HIBICLENS
HIBISTAT TOWELETTE
HOSPITAL ANTISEPTIC
HURRISEPT
HYDROCORTISONE-IODOQUINOL
HYDRO-IODOQUINOL 2-1
HYGIENIC CLEANSING PADS
IODEX
IODIDES
IODINE STRONG
IODOFLEX
IODOSORB
KENDALL ANTIMICROBIAL
KLARON
LAZERFORMALYDE
LID SCRUB COMPLIANCE
LOBANA BODY
LUGOL'S
MEDI PADS
MEDICATED CLEANSING CLOTHS
MEDICATED DOUCHE
MEDICATED HEMORRHOID
MEDICATED PADS
MEDICATED WIPES
MEDIWASH
MERCUROCHROME
MERTHIOLATE
METROCREAM
METROGEL
METROGEL-VAGINAL
METROLOTION
MICROKLENZ
MIRVASO
71
GENERIC DRUG
FORMALDEHYDE
FORMALDEHYDE
FORMALDEHYDE
ETHYL ALCOHOL
ETHYL ALCOHOL
TRICLOSAN
PARAB/CET ALC/STRYL ALC/PG/SLS
ETHYL ALCOHOL
BENZETHONIUM CHLORIDE/MENTHOL
ALUM/SALICYLIC ACID/TALC/BENT
POVIDONE-IODINE
ETHYL ALCOHOL
TRICLOSAN
GLYCERIN/WITCH HAZEL LEAF
WITCH HAZEL
GLYCERIN/WITCH HAZEL LEAF
CHLORHEXIDINE GLUCONATE
CHLORHEXIDINE GLUCONATE
POVIDONE-IODINE
ETHYL ALCOHOL
HYDROCORTISONE/IODOQUINOL
HYDROGEN PEROXIDE
HYDROCORTISONE/ALOE POL/IODOQU
GLYCERIN/WITCH HAZEL LEAF
POVIDONE-IODINE
AMMONIUM IODIDE/POTASSIUM IOD
IODINE/POTASSIUM IODIDE
CADEXOMER IODINE
CADEXOMER IODINE
IVERMECTIN
BENZALKONIUM CHLORIDE
SULFACETAMIDE SODIUM
FORMALDEHYDE
EYELID CLEANSER COMB NO.4
CHLOROXYLENOL
IODINE/POTASSIUM IODIDE
GLYCERIN/WITCH HAZEL LEAF
WITCH HAZEL LEAF
POVIDONE-IODINE
SKIN CLEANSER
GLYCERIN/WITCH HAZEL LEAF
GLYCERIN/ALOE VERA/WITCH HAZEL
SOD BORATE/BORIC AC/WATER/NACL
MERBROMIN
BENZALKONIUM CHLORIDE
METRONIDAZOLE
METRONIDAZOLE
METRONIDAZOLE
METRONIDAZOLE
METRONIDAZOLE
BENZETHONIUM CHLORIDE
BRIMONIDINE TARTRATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
BRAND DRUG
MYORISAN
NEOSPORIN
NEUAC
NORITATE
NORMLGEL AG
NUVESSA
ONEXTON
ORAL CLEANSER
OVACE
OVACE PLUS
OVACE PLUS WASH
OXYZAL WET DRESSING
PAROEX
PEDI-WHIRL
PERIANAL CLEANSING
PERICLEAN
PERIDEX
PERIGIENE
PERINEAL SKIN CLEANSER
PERIOGARD
PERI-WASH
PEROXIDE SORE MOUTH CLEANSER
PEROXYL DENTAL RINSE
PEROXYL ORAL CLEANSER
PETERSON'S OINTMENT
PHENEEN
PHISOHEX
PRE-MOISTENED HEMORRHOIDAL
PRE-MOISTENED MEDICATED WIPES
PREPARATION H
PREPARATION H TOTABLES
PURELL
PURELL PURIFYING ESSENTIAL
RASH RELIEF ANTIBACTERIAL
REMEDY
RENEWAL ANTIBACTERIAL LIQ SOAP
REVITADERM
ROSADAN
SAF-CLENS AF
SALINE WOUND WASH
SANIPADS WITH ALOE
SARNA SENSITIVE
SCRUB CARE POVIDONE IODINE
SEB-PREV
SECURA
SECURA MOISTURIZING
SILVER GEL
SILVER-SEPT
SILVRSTAT
SKIN CARE
72
GENERIC DRUG
ISOTRETINOIN
BENZALKONIUM CHLORIDE
CLINDAMYCIN PHOS/BENZOYL PEROX
METRONIDAZOLE
SILVER CARBONATE
METRONIDAZOLE
CLINDAMYCIN PHOS/BENZOYL PEROX
HYDROGEN PEROXIDE
SULFACETAMIDE SODIUM
SULFACETAMIDE SODIUM
SULFACETAMIDE SODIUM
BENZALK CHL/OXYQUINOLINE
CHLORHEXIDINE GLUCONATE
BENZALKONIUM CHLORIDE
SKIN CLEANSER
CHLOROXYLENOL
CHLORHEXIDINE GLUCONATE
CHLOROXYLENOL
BENZETHONIUM CHLORIDE
CHLORHEXIDINE GLUCONATE
POVIDONE-IODINE
HYDROGEN PEROXIDE
HYDROGEN PEROXIDE
HYDROGEN PEROXIDE
TANNIC ACID/ZINC OXIDE/PHENOL
BENZALKONIUM CHLORIDE
HEXACHLOROPHENE
GLYCERIN/WITCH HAZEL LEAF
WITCH HAZEL LEAF
WITCH HAZEL
WITCH HAZEL
ETHYL ALCOHOL
ETHYL ALCOHOL
BACITRACIN/DIMETHICONE/ZINC
BENZALKONIUM CHLORIDE
TRICLOSAN
BENZALKONIUM CHLORIDE
METRONIDAZOLE
SKIN CLEANSER
BENZETHONIUM CHLORIDE
GLYCERIN/ALOE VERA/WITCH HAZEL
TRICLOSAN
POVIDONE-IODINE
SULFACETAMIDE SODIUM
BENZETHONIUM CHLORIDE
BENZETHONIUM CHLORIDE
SILVER CHLORIDE
SILVER NITRATE
SILVER NITRATE APPLICATOR
SILVER
SILVER
CAMPHOR/GLYCERIN/ALCOHOL/WATER
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ACNE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
BRAND DRUG
SKIN SHIELD
SKLICE
SODIUM SULFACETAMIDE
SOOLANTRA
SOTRET
SPECTRO-JEL
SPRAY & FOAM
SPROAM ALL-BODY
STROMECTOL
STYPTOCAINE
SULFAC
SULFAMIDE
SULFO LO
SUMMER'S EVE DOUCHE
SWEEN PREP
TAZORAC
TERSASEPTIC
TINCTURE IODINE
TINCTURE MERTHIOLATE
TUCKS
TUCKS TAKE-ALONGS
VANDAZOLE
VANOXIDE-HC
VELTIN
VERSICLEAR
VITAZOL
VYTONE
Z-CLINZ
ZENATANE
ZIANA
3 DAY VAGINAL
3-DAY VAGINAL CREAM
4-N-1
ABREVA
ACTICIN
ADVANCED HEALING
AF
AKNE-MYCIN
AK-POLY-BAC
ALEVAZOL
ALINIA
ALOE VESTA SKIN CONDITIONER 2
ALTABAX
AMERIGEL BARRIER
AMERIGEL PREVENTIVE BARRIER
AMPHOTERICIN 100MG/STERIL H2O
ANTIBIOTIC + PAIN RELIEF
ANTIBIOTIC EAR SOLUTION
73
GENERIC DRUG
BENZETHONIUM CHLORIDE
IVERMECTIN
SULFACETAMIDE SODIUM
IVERMECTIN
ISOTRETINOIN
ME-BENZ/PHENOL
BENZETHONIUM CHLORIDE
BENZETHONIUM CHLORIDE
IVERMECTIN
ALUMINUM SULFATE
SULFACETAMIDE SODIUM
SULFACETAMIDE SODIUM
SULFACETAMIDE SODIUM
SULFUR
POVIDONE-IODINE
CHLOROXYLENOL
TAZAROTENE
TRICLOSAN
IODINE/SODIUM IODIDE
BENZALKONIUM CHLORIDE
WITCH HAZEL
WITCH HAZEL
METRONIDAZOLE
BENZOYL PEROXIDE/HYDROCORTISON
CLINDAMYCIN/TRETINOIN
SODIUM THIOSULFATE/SAL ACID
METRONIDAZOLE
HYDROCORTISONE/IODOQUINOL/ALOE
WITCH HAZEL
SKIN CLEANSER
ISOTRETINOIN
CLINDAMYCIN/TRETINOIN
MICONAZOLE NITRATE
CLOTRIMAZOLE
DIMETHICONE
DOCOSANOL
PERMETHRIN
ACYCLOVIR
DIMETHICONE
TOLNAFTATE
ERYTHROMYCIN BASE
BACITRACIN/POLYMYXIN B SULFATE
CLOTRIMAZOLE
NITAZOXANIDE
DIMETHICONE
RETAPAMULIN
DIMETHICONE
DIMETHICONE
AMPHOTERICIN
AMPHOTERICIN B
NEOMY SULF/POLYMYX B SULF/PRAM
NEOMYCIN/POLYMYXIN B SULF/HC
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
BRAND DRUG
ANTIBIOTIC PLUS
ANTIBIOTIC-PRAMOXINE
ANTIFUNGAL
ANTI-FUNGAL
ANTIFUNGAL CREAM
ANTI-FUNGAL CREAM
ATHLETE'S FOOT
ATHLETE'S FOOT AF
ATHLETE'S FOOT CREAM
ATHLETE'S FOOT SPRAY
ATHLETIC FOOT CREAM
AVAR
AVAR LS
AVAR-E
AVAR-E GREEN
AVAR-E LS
AVAR-E LS CREAM
AZOLEN TINCTURE
BACITRACIN WITH PAIN RELIEF
BACITRACIN-POLYMYXIN
BACTROBAN
BACTROBAN NASAL
BAZA ANTIFUNGAL
BAZA CLEANSE & PROTECT
BAZA CREAM HOSPITAL CARE PACK
BEDDING SPRAY
BENSAL HP
BENZAMYCIN
BENZAMYCINPAK
BOUDREAUXS
BP 10-1
BREEZEE MIST
CAVILON DURABLE BARRIER
CENTANY
CENTANY AT
CERISA
CICLODAN
CLARIFOAM EF
CLARIS
CLEANSING WASH
CLENIA
CLEOCIN
CLEOCIN PHOSPHATE
CLEOCIN T
CLINDACIN ETZ
CLINDACIN P
CLINDACIN PAC
CLINDA-DERM
CLINDAGEL
74
GENERIC DRUG
NEOMY SULF/POLYMYX B SULF/PRAM
NEOMY SULF/POLYMYX B SULF/PRAM
CLOTRIMAZOLE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
CLOTRIMAZOLE
TERBINAFINE HCL
TOLNAFTATE
MICONAZOLE NITRATE
CLOTRIMAZOLE
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
MICONAZOLE NITRATE
BACITRACIN/LIDOCAINE
BACITRACIN/POLYMYXIN B SULFATE
MUPIROCIN
MUPIROCIN CALCIUM
MICONAZOLE NITRATE
DIMETHICONE
MICONAZOLE/LANOLIN/SKIN CLN
PERMETHRIN
BENZOIC ACID/SALICYLIC ACID
ERYTHROMYCIN/BENZOYL PEROXIDE
ERYTHROMYCIN/BENZOYL PEROXIDE
DIMETHICONE
SULFACETAMIDE SODIUM/SULFUR
UNDECYLENIC ACID/AL CL-HYDRATE
CALCIUM CITRATE
DIMETHICONE
MUPIROCIN
MUPIROCIN
SULFACETAMIDE SODIUM/SULFUR
CICLOPIROX
CICLOPIROX
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SOD/SULFUR/UREA
SULFACETAMIDE SOD/SULFUR/UREA
SULFACETAMIDE SODIUM/SULFUR
CLINDAMYCIN PHOSPHATE
CLINDAMYCIN PHOSPHATE
CLINDAMYCIN PHOSPHATE
CLINDAMYCIN PHOS/SKIN CLNSR 19
CLINDAMYCIN PHOSPHATE
CLINDAMYCIN PHOS/SKIN CLNSR 19
CLINDAMYCIN PHOSPHATE
CLINDAMYCIN PHOSPHATE
CLINDAMYCIN PHOSPHATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
BRAND DRUG
CLINDAREACH
CLINDESSE
CLINDETS
CLOTRIM ANTIFUNGAL
CLOTRIMAZOLE 3
CLOTRIMAZOLE AF
CLOTRIMAZOLE-3
CLOTRIMAZOLE-7
CLOTRIMAZOLE-BETAMETHASONE
CNL 8
COMPLETE LICE TREATMENT
COOL BOTTOMS
CORTISPORIN
CORTOMYCIN
CRITIC-AID
CRUEX
DENAVIR
DERMAFUNGAL
DESENEX
DOUBLE ANTIBIOTIC
ECOZA
ELIMITE
ELON DUAL DEFENSE
EMGEL
E-MYCIN
ERTACZO
ERY
ERYGEL
ERY-TAB
ERYTHROCIN STEARATE
ERYTHROMYCIN
ERYTHROMYCIN-BENZOYL PEROXIDE
EURAX
EVOCLIN
EXELDERM
EXTINA
FIRST AID
FIRST AID ABX PAIN RELIEF
FIRST AID ANTIBIOTIC
FOOT & SNEAKER
FUNGI CURE
FUNGI-GUARD
FUNGI-NAIL
FUNGOID & HC
FUNGOID TINCTURE
FUNGOID-D
GARAMYCIN
GENTAK
75
GENERIC DRUG
CLINDAMYCIN PHOSPHATE
CLINDAMYCIN PHOSPHATE
CLINDAMYCIN PHOSPHATE
CLOTRIMAZOLE
CLOTRIMAZOLE
CLOTRIMAZOLE
CLOTRIMAZOLE
CLOTRIMAZOLE FOOT CREAM
CLOTRIMAZOLE
CLOTRIMAZOLE
CLOTRIMAZOLE/BETAMETHASONE DIP
CICLOPIROX/NAIL LACQUER REMOVR
PIP BUTOX/PYRETHRINS/PERMETH
DIMETHICONE
NEOMY SULF/POLYMYX B SULF/HC
NEOMYCIN/POLYMYXIN B SULF/HC
MICONAZOLE NITRATE
CLOTRIMAZOLE
PENCICLOVIR
MICONAZOLE NITRATE
CLOTRIMAZOLE
BACITRACIN ZINC/POLYMYX B SULF
ECONAZOLE NITRATE
ECONAZOLE NITRATE
PERMETHRIN
UNDECYLENIC ACID
ERYTHROMYCIN BASE/ETHANOL
ERYTHROMYCIN BASE
SERTACONAZOLE NITRATE
ERYTHROMYCIN BASE/ETHANOL
ERYTHROMYCIN BASE/ETHANOL
ERYTHROMYCIN BASE
ERYTHROMYCIN STEARATE
ERYTHROMYCIN BASE
ERYTHROMYCIN/BENZOYL PEROXIDE
CROTAMITON
CLINDAMYCIN PHOSPHATE
SULCONAZOLE NITRATE
KETOCONAZOLE
NEOMYCIN/BACITRAC ZN/POLYMYXIN
NEOMY SULF/POLYMYX B SULF/PRAM
NEOMY SULF/BACITRAC ZN/POLY
TOLNAFTATE
CLOTRIMAZOLE
TOLNAFTATE
ACETIC ACID/RESOR/SAL ACID
MICONAZOLE NITRATE/HC
MICONAZOLE NITRATE
TOLNAFTATE
GENTAMICIN SULFATE
GENTAMICIN SULFATE
GENTAMICIN SULFATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
BRAND DRUG
GENTASOL
GORDOCHOM
GYNE-LOTRIMIN
GYNE-LOTRIMIN-7
HALOTIN
HONGO CURA
HOUSEHOLD LICE CONTROL
ILOTYCIN
INZO ANTIFUNGAL
JOCK ITCH
JOCK ITCH RELIEF
JUBLIA
KENDALL MOISTURE BARRIER
KENDALL MOISTURIZING
KERYDIN
KETOCON
KETOCON + PLUS
KETODAN
KURIC
LAMISIL
LAMISIL AF
LAMISIL AF DEFENSE
LAMISIL AT
LICE BEDDING
LICE COMPLETE KIT 1-2-3
LICE CREAM RINSE
LICE EGG REMOVER
LICE KILLING
LICE PYRINYL SHAMPOO
LICE SHAMPOO
LICE SOLUTION
LICE TREATMENT
LICEMD
LICIDE
LIDOVIR
LOPROX
LOTRIMIN
LOTRIMIN AF
LOTRIMIN ULTRA
LOTRISONE
LUZU
LYCELLE
MEDERMA PM
MEDI-FIRST ANTI-FUNGAL
MENTAX
MICADERM
MICATIN
MICONAZOLE 1
76
GENERIC DRUG
GENTAMICIN SULFATE
UNDECYLENIC ACID/CHLOROXYLENOL
CLOTRIMAZOLE
CLOTRIMAZOLE
HALOPROGIN
UNDECYLENIC ACID
PIPERONYL BUTOXIDE/PYRETHRINS
ERYTHROMYCIN BASE
MICONAZOLE NITRATE
CLOTRIMAZOLE
CLOTRIMAZOLE
EFINACONAZOLE
DIMETHICONE
DIMETHICONE
TAVABOROLE
KETOCONAZOLE/HYDROCORTISONE
KETOCONAZOLE/HYDROCORTISONE
KETOCONAZOLE
KETOCONAZOLE
KETOCONAZOLE
TERBINAFINE HCL
TOLNAFTATE
TOLNAFTATE
TERBINAFINE
PERMETHRIN
PIP BUTOX/PYRETHRINS/PERMETH
PERMETHRIN
POTASS HYD/GLYCO/PQ10/HE-CELL
PERMETHRIN
PIPERONYL BUTOXIDE/PYRETHRINS
PIPERONYL BUTOXIDE/PYRETHRINS
PIP BUTOX/PYRETHRINS/PERMETH
PERMETHRIN
DIMETHICONE
PIPERONYL BUTOXIDE/PYRETHRINS
ACYCLOVIR/LIDOCAINE HCL
LINDANE
CICLOPIROX
CLOTRIMAZOLE
CLOTRIMAZOLE
BUTENAFINE HCL
CLOTRIMAZOLE/BETAMETHASONE DIP
LULICONAZOLE
CITRIC/CITRONELLYL/HYDROX/METH
MAFENIDE ACETATE
MALATHION
DIMETHICONE
TOLNAFTATE
BUTENAFINE HCL
MICONAZOLE NITRATE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
BRAND DRUG
MICONAZOLE 3
MICONAZOLE 7
MICONAZORB AF
MICRO-GUARD
MIRANEL AF
MITRAZOL
MOISTURE GUARD
MOISTURIZING SKIN PROTECTANT
MONISTAT 1
MONISTAT 3
MONISTAT 7
MONISTAT DUAL-PAK
MONISTAT SOOTHING CARE
MONISTAT-DERM
MULTI ANTIBIOTIC PLUS
MYCELEX
MYCO NAIL
MYCO NAIL A
MYCOSTATIN
NAFTIN
NATROBA
NATURAL COLD SORE
NEOMYCIN-BACITRACIN-POLYMYXIN
NEOMYCIN-POLYMYXIN B
NEOMYCIN-POLYMYXIN-HC
NEOMYCIN-POLYMYXIN-HYDROCORT
NEO-POLYCIN
NEOSPORIN + PAIN RELIEF
NEOSPORIN G.U. IRRIGANT
NEOSPORIN PLUS
NEUTRAPHOR
NIX
NIZORAL
NIZORAL A-D
NORMLSHIELD
NUZOLE
NYAMYC
NYSTATIN-TRIAMCINOLONE
NYSTOP
ODOR CONTROL FOOT-SNEAKER
ONE STEP PERINEAL
OVIDE
OXISTAT
PCE
PEDIADERM AF
PEDICULICIDE 11
PEDI-DRI
PEDIPIROX-4
PENLAC
77
GENERIC DRUG
MICONAZOLE NITRATE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
DIMETHICONE
DIMETHICONE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
DIMETHICONE
MICONAZOLE NITRATE
NEOMY SULF/POLYMYX B SULF/PRAM
MUPIROCIN
CLOTRIMAZOLE
TRIACETIN
UNDECYLENIC ACID
NYSTATIN
NAFTIFINE HCL
SPINOSAD
DIMETHICONE
NEOMY SULF/BACITRA/POLYMYXIN B
NEOMY SULF/POLYMYXIN B SULFATE
NEOMYCIN/POLYMYXIN B SULF/HC
NEOMYCIN/POLYMYXIN B SULF/HC
NEOMY SULF/BACITRA/POLYMYXIN B
NEOMY SULF/POLYMYX B SULF/PRAM
NEOMY SULF/POLYMYXIN B SULFATE
NEOMY SULF/POLYMYX B SULF/PRAM
DIMETHICONE
PERMETHRIN
KETOCONAZOLE
KETOCONAZOLE
DIMETHICONE
MICONAZOLE NITRATE
NYSTATIN
NYSTATIN
NYSTATIN/TRIAMCIN
NYSTATIN
TOLNAFTATE
DIMETHICONE
MALATHION
OXICONAZOLE NITRATE
ERYTHROMYCIN BASE
NYSTATIN/EMOLLIENT COMBO NO.54
PIPERONYL BUTOXIDE/PYRETHRINS
NYSTATIN
CICLOPIROX/NAIL LACQ/FT DEOD#4
CICLOPIROX
PERMETHRIN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
BRAND DRUG
PLEXION
PLEXION SCT
PODACTIN
POLY BACITRACIN
POLYCIN
POLYSPORIN
PRASCION
PRASCION FC
PRASCION RA
PRASCION TS
PROCOMYCIN
PROSHIELD GLOVE
PROSHIELD PLUS
PYRETHRIN LICE TREATMENT
PYRINEX
Q-NAFTATE
RASH RELIEF ANTIFUNGAL
REMEDY 4-IN-1 CLEANSING
REMEDY ANTIFUNGAL
REMEDY CLEANSING BODY
REMEDY DIMETHICONE
REMEDY NUTRASHIELD
REMEDY PHYTOPLEX ANTIFUNGAL
REMEDY SKIN REPAIR
RESTORE CLEANSER & MOISTURIZER
RESTORE DIMETHICREME
RID
RINGWORM
ROMYCIN
ROSAC
ROSADERM
ROSANIL
ROSULA
ROSULA CLK
SE 10-5 SS
SECURA ANTIFUNGAL
SECURA DIMETHICONE
SILVADENE
SITAVIG
SOD SULFACETAMIDE-SULFUR WASH
SODIUM SULFACETAMIDE-SULFUR
SODIUM SULFA-SULFUR-MERATAN
SOOTHE & COOL
SOOTHE & COOL INZO BARRIER
SPECTAZOLE
SS 10-2
SSD
SSD AF
SSS 10-4
SSS 10-5
78
GENERIC DRUG
SULFACETAMIDE SODIUM/SULFUR
SULFACET SOD/SULFUR/WITCH HAZ
TOLNAFTATE
BACITRACIN ZINC/POLYMYX B SULF
BACITRACIN/POLYMYXIN B SULFATE
BACITRACIN/POLYMYXIN B SULFATE
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
SULFACETM NA/AVOBENZONE/SULFUR
SULFACETAMIDE SODIUM/SULFUR
NEOMY SULF/BACITRA/POLYMY/LIDO
DIMETHICONE
DIMETHICONE
PIPERONYL BUTOXIDE/PYRETHRINS
PIPERONYL BUTOXIDE/PYRETHRINS
TOLNAFTATE
MICONAZOLE NIT/DIMETH/ZINC OX
DIMETHICONE
MICONAZOLE NITRATE
DIMETHICONE
DIMETHICONE
DIMETHICONE
MICONAZOLE NITRATE
DIMETHICONE
DIMETHICONE
DIMETHICONE
PERMETHRIN
CLOTRIMAZOLE
ERYTHROMYCIN BASE
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMD/SULFR/SKNCLNSR10
SULFACETAMD/SULFR/SKNCLNSR10
SULFACETAMIDE SOD/SULFUR/UREA
SULFACET SOD/SULF/UREA/MERA/TI
SULFACET SOD/SULFUR/WITCH HAZ
MICONAZOLE NITRATE
DIMETHICONE
SILVER SULFADIAZINE
SILVER SULFADIAZINE
ACYCLOVIR
SULFACETAMIDE SOD/SULFUR/UREA
SULFACETAMIDE SOD/SULFUR/UREA
SULFACET SOD/SULF/UREA/MERA/TI
TOLNAFTATE/ZNOX/CHLOROXYLENOL
DIMETHICONE
ECONAZOLE NITRATE
SPINOSAD
SULFACETAMIDE SODIUM/SULFUR
SILVER SULFADIAZINE
SILVER SULFADIAZINE
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFECTIVE
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
BRAND DRUG
STOP LICE
SULFACETAMIDE SODIUM-SULFUR
SULFACLEANSE 8-4
SULFAMYLON
SULZEE
SUMADAN
SUMADAN XLT
SUMAXIN
SUMAXIN CP
SUMAXIN TS
SWEEN 24
TERBINAFINE
TERBINAFINE HYDROCHLORIDE
THERASEAL
THERMAZENE
TINACTIN
TOPISULF
TRI-BIOZENE
TRIPLE ANTIBIOTIC
TRIPLE ANTIBIOTIC EXTRA
TRIPLE ANTIBIOTIC PLUS
TRIPLE ANTIBIOTIC-PAIN RELIEF
TRIPLE DYE
TRIPLE PASTE AF
ULESFIA
ULTRATHON
UNDELENIC
VAGISTAT-3
VANIPLY
VEREGEN
VIRTI-SULF
VUSION
WAL-SPORIN
XERESE
XOLEGEL
ZEASORB
ZEASORB-AF
ZENCIA
ZETACET
ZILACTIN
ZILACTIN-L
ZOVIRAX
ACLOVATE
ALA-CORT
ALA-SCALP
79
GENERIC DRUG
PERMETHRIN
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
MAFENIDE ACETATE
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
SULFACT SOD/SULUR/AVOB/OTN/OCT
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE/SULFUR/CLEANSR23
SULFACETAMIDE SODIUM/SULFUR
DIMETHICONE
TERBINAFINE HCL
TERBINAFINE HCL
TERBINAFINE HCL
TETRACYCLINE HCL
DIMETHICONE
SILVER SULFADIAZINE
TOLNAFTATE
TOLNAFTATE FOOT CREAM
SULFACETAMIDE SODIUM/SULFUR
TRIACETIN
NEOMYCN/BACI ZN/PMYX BS/PRAMOX
NEOMY SULF/BACITRA/POLYMYXIN B
NEOMYCN/BACI ZN/PMYX BS/PRAMOX
TRIPLE ANTIBIOTIC OINTMENT
TRIPLE ANTIBIOTIC OINTMENT PLU
NEOMYCN/BACI ZN/PMYX BS/PRAMOX
NEOMYCN/BACI ZN/PMYX BS/PRAMOX
GENTIAN VIOL/BRLNT GRN/PROFLAV
MICONAZOLE NITRATE
BENZYL ALCOHOL
DIETHYLTOLUAMIDE
UNDECYLENIC ACID
MICONAZOLE NITRATE
DIMETHICONE
SINECATECHINS
SULFACETAMIDE SODIUM/SULFUR
MICONAZOLE NITRATE/ZINC OX/PET
BACITRACIN ZINC/POLYMYX B SULF
ACYCLOVIR/HYDROCORTISONE
KETOCONAZOLE
MICONAZOLE NITRATE
MICONAZOLE NITRATE
SULFACETAMIDE SODIUM/SULFUR
SULFACETAMIDE SODIUM/SULFUR
BENZYL ALCOHOL
BENZYL ALCOHOL
ACYCLOVIR
ALCLOMETASONE DIPROPIONATE
HYDROCORTISONE
HYDROCORTISONE
ALCLOMETASONE DIPROPIONATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
BRAND DRUG
ANTI-ITCH CREME
ANTI-ITCH PLUS
ANTI-ITCH SPRAY
ANUCORT-HC
ANUSOL-HC
APEXICON
APEXICON E
AQUA GLYCOLIC HC
AQUANIL HC
AVEENO
BAYCADRON
BETA HC
BETA-VAL
CAPEX SHAMPOO
CARMOL HC
CELESTONE
CLOBETASOL EMOLLIENT
CLOBETASOL EMULSION
CLOBEX
CLODAN
CLODERM
COLOCORT
CORDRAN
CORDRAN SP
CORMAX
CORTAID
CORTALO
CORTEF
CORTENEMA
CORTICOOL 1% GEL
CORTIFOAM
CORTISONE
CORTISONE + COOLING RELIEF
CORTIZONE 10
CORTIZONE-10
CORTIZONE-10 PLUS
DEPO-MEDROL
DERMAREST ECZEMA
DERMA-SMOOTHE-FS
DERMASORB HC
DERMASORB TA
DERMATOP
DESONATE
DESONIL
DESONIL + PLUS
DESOWEN
80
GENERIC DRUG
AMCINONIDE
HYDROCORTISONE/ALOE/VIT.E/A&D
HYDROCORTISONE/ALOE/VIT.E/A&D
HYDROCORTISONE
HYDROCORTISONE ACETATE
HYDROCORTISONE
DIFLORASONE DIACETATE
DIFLORASONE DIACETATE/EMOLL
HYDROCORTISONE/SKIN CLNSR #25
HYDROCORTISONE
HYDROCORTISONE/OATMEAL/ALOE/E
DEXAMETHASONE
HYDROCORTISONE
BETAMETHASONE DIPROPIONATE
BETAMETHASONE VALERATE
BETAMETHASONE VALERATE
FLUOCINOLONE ACETONIDE
HYDROCORTISONE ACETATE/UREA
BETAMETHASONE
CLOBETASOL PROPIONATE/EMOLL
CLOBETASOL PROPIONATE/EMOLL
CLOBETASOL PROPIONATE
CLOBETASOL PROPIONATE
CLOCORTOLONE PIVALATE
CLOBETASOL PROPIONATE
CLOCORTOLONE PIVALATE
HYDROCORTISONE
FLURANDRENOLIDE
FLURANDRENOLIDE
CLOBETASOL PROPIONATE
HYDROCORTISONE
HYDROCORTISONE ACETATE/ALOE V
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE ACETATE
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE
METHYLPREDNISOLONE ACETATE
HYDROCORTISONE
FLUOCINOLONE ACETONIDE
HYDROCORTISONE/SKIN CLNSR #35
TRIAMCINOLONE/EMOLLIENT CMB#86
PREDNICARBATE
DESONIDE
DESONIDE
DESONIDE/EMOLLIENT COMBO NO.3
DESONIDE/EMOLLIENT COMBO NO.3
DESONIDE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
BRAND DRUG
DEXAMETHASONE INTENSOL
DEXPAK
DICLOFENAC SODIUM ER
DIPROLENE
DIPROLENE AF
DIPROSONE
ECZEMA ANTI-ITCH
FIRST-HYDROCORTISONE
FLECTOR
FLUOCINONIDE EMOLLIENT
FLUOCINONIDE-E
GLUCOSAMINE-MSM
GRX HICORT 25
HALAC
HALOG
HALONATE
HALONATE PAC
HC-1% HEMORRHOID
HEMORRHOIDAL HC
HEMRIL
HYDRO SKIN
HYDROCORTISONE
HYDROCORTISONE PLUS
HYDROCORTISONE PLUS 12
HYDROCORTISONE WITH ALOE
HYDROCORTISONE-ALOE
HYDROCREAM
HYDROSKIN
ILUVIEN
ITCH-X
ITCH-X HC
LOCOID
LOCOID LIPOCREAM
LUXIQ
MAXIDEX
MEDI-CORTISONE
MEDI-HOSE PANTY SZ 1
MEDI-HOSE PANTY SZ 2
MEDI-HOSE PANTY SZ 3
MEDI-HOSE PANTY SZ 4
MEDI-HOSE PANTY SZ 5
81
GENERIC DRUG
DESOXIMETASONE
DEXAMETHASONE
DEXAMETHASONE
DEXAMETHASONE
DICLOFENAC SODIUM
DICLOFENAC SODIUM
DIFLORASONE DIACETATE
BETAMETHASONE/PROPYLENE GLYC
BETAMETHASONE/PROPYLENE GLYC
BETAMETHASONE DIPROPIONATE
HYDROCORTISONE
HYDROCORTISONE
DICLOFENAC EPOLAMINE
FLUOCINOLONE ACETONIDE
FLUOCINONIDE
FLUOCINONIDE/EMOLLIENT BASE
FLUOCINONIDE/EMOLLIENT BASE
GLUCOSAMINE SULFATE/MSM
HYDROCORTISONE ACETATE
HALOBETASOL/AMMONIUM LACTATE
HALOBETASOL PROPIONATE
HALCINONIDE
HALOBETASOL/AMMONIUM LACTATE
HALOBETASOL/AMMONIUM LACTATE
HYDROCORTISONE ACETATE
HYDROCORTISONE ACETATE
HYDROCORTISONE ACETATE
HYDROCORTISONE
HC/MINERAL OIL/PETROLAT,WHT
HYDROCORTISONE ACETATE
HYDROCORTISONE BUTYRATE
HYDROCORTISONE CREAM
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE VALERATE
HYDROCORTISONE ACETATE/ALOE V
HYDROCORTISONE ACETATE/ALOE V
HYDROCORTISONE
HYDROCORTISONE
FLUOCINOLONE ACETONIDE
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE BUTYRATE
HYDROCORTISONE BUTYRATE/EMOLL
BETAMETHASONE VALERATE
DEXAMETHASONE
HYDROCORTISONE ACETATE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
BRAND DRUG
MEDI-HOSE PANTY SZ 6
MEDI-HOSE PANTY SZ 7
MEDI-HOSE PKG SIZE 1
MEDI-HOSE PKG SIZE 2
MEDI-HOSE PKG SIZE 3
MEDI-HOSE PKG SIZE 4
MEDI-HOSE PKG SIZE 5
MEDI-HOSE PKG SIZE 6
MEDI-HOSE PKG SIZE 7
MEDI-HOSE THIGH HIGH SZ 1
MEDI-HOSE THIGH HIGH SZ 2
MEDI-HOSE THIGH HIGH SZ 3
MEDI-HOSE THIGH HIGH SZ 4
MEDI-HOSE THIGH HIGH SZ 5
MEDI-HOSE THIGH HIGH SZ 6
MEDI-HOSE THIGH HIGH SZ 7
MOMEXIN
MSM WITH GLUCOSAMINE
NEO-SYNALAR
NOBLE FORMULA HC
NUCORT
NU-DERM TOLEREEN
NUZON
OLUX
OLUX-E
OLUX-OLUX-E
OZURDEX
PANDEL
PEDIADERM HC
PEDIADERM TA
PENNSAID
PROCTOCARE-HC
PROCTOCORT
PROCTOCREAM-HC
PROCTO-PAK
PROCTOSOL-HC
PROCTOZONE-HC
PSORCON
RECORT PLUS
RECTACORT-HC
RECTASOL-HC
RETISERT
SCALACORT
SCALACORT DK
SCALP RELIEF
SCALPICIN
SOLARAZE
SOOTHING CARE
SYNALAR
SYNALAR TS
82
GENERIC DRUG
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
DO NOT GIVE OUT CODE
METHYLPREDNISOLONE ACETATE
MOMETASONE FUROAT/AMMONIUM
LAC
GLUCOSAMINE SULFATE/MSM
NEOMYCIN SULFATE/FLUOCINOLONE
HYDROCORTISONE
HYDROCORTISONE ACETATE/ALOE V
HYDROCORTISONE
HYDROCORTISONE ACETATE/ALOE V
CLOBETASOL PROPIONATE
CLOBETASOL PROPIONATE/EMOLL
CLOBETASOL PROPIONATE/EMOLL
DEXAMETHASONE
HYDROCORTISONE PROBUTATE
HYDROCORTISONE/EMOL NO.45
TRIAMCINOLONE/EMOLLIENT CMB#45
DICLOFENAC SODIUM
PREDNICARBATE
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE
HYDROCORTISONE
DIFLORASONE DIACETATE
HYDROCORTISONE
HYDROCORTISONE ACETATE
HYDROCORTISONE ACETATE
FLUOCINOLONE ACETONIDE
HYDROCORTISONE
HYDROCORT/SAL ACID/SULF/SHMP#1
HYDROCORTISONE
HYDROCORTISONE
DICLOFENAC SODIUM
HYDROCORTISONE
FLUOCINOLONE ACETONIDE
FLUOCINOLONE/SKIN CLNSR28
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIINFLAMMATORY
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
BRAND DRUG
TEMOVATE
TEMOVATE EMOLLIENT
TEXACORT
TOPICORT
U-CORT
ULTRAVATE
ULTRAVATE PAC
ULTRAVATE X
VANOS
VERDESO
VOLTAREN
VOLTAREN-XR
WESTCORT
ZEMA-PAK
ALEVICYN
ALLEGRA INTENSIVE RELIEF
ALLERGY RELIEF SPRAY
AMLACTIN
ANTI ITCH
AVEENO ANTI-ITCH
BANOPHEN ANTI-ITCH
BENADRYL ITCH RELIEF
BIOFREEZE-ILEX
CALACLEAR
CALADRYL
CALADRYL CLEAR
CALAGEL
CALAGESIC
CALAHIST CLEAR
CALAMINE MEDICATED
CALAMINE-ANTIHISTAMINE
CALDYPHEN
CALDYPHEN CLEAR
CALLERGY CLEAR
CALOHIST
DERMAGESIC
DERMASARRA
DIPHENHIST WITH ZINC ACETATE
FREEZE IT
GOLD BOND
HC DERMA-PAX
IVY WASH
MEN-PHOR
POISON IVY
POISON IVY ANTI-ITCH
POISON IVY TREATMENT
POLAR FREEZE
PRAMEGEL ANTI-ITCH
PRAMOX
PRAX
PROCTOFOAM
SARNA
83
GENERIC DRUG
CLOBETASOL PROPIONATE
CLOBETASOL PROPIONATE/EMOLL
HYDROCORTISONE
DESOXIMETASONE
HYDROCORTISONE ACETATE/UREA
HALOBETASOL PROPIONATE
HALOBETASOL/AMMONIUM LACTATE
HALOBETASOL/LACTIC ACID
FLUOCINONIDE
DESONIDE
DICLOFENAC SODIUM
DICLOFENAC SODIUM
HYDROCORTISONE VALERATE
DEXAMETHASONE
NA MG FL/NA PHO/NACL/HA/NA HYP
DIPHENHYDRAMINE HCL/ALLANTOIN
DIPHENHYDRAMINE HCL/ZINC ACET
PRAMOXINE HCL/AMMONIUM LACTATE
DIPHENHYDRAMINE HCL/ZINC ACETI
PRAMOX HCL/CAMPH/OATMEAL/CALA
DIPHENHYDRAMINE HCL/ZINC ACET
DIPHENHYDRAMINE HCL/ZINC ACET
MENTHOL/CAMPHOR
PRAMOXINE HCL/CAMPH/ZINC ACET
PRAMOXINE HCL/CALAMINE
PRAMOXINE HCL/ZINC ACETATE
DIPHENHYDRAMIN/BENZETHON/ZINC
PRAMOXINE HCL/CALAMINE
PRAMOXINE HCL/CAMPH/ZINC ACET
PRAMOXINE HCL/CALAMINE
PRAMOXINE HCL/CALAMINE
DIPHENHYDRAMINE HCL/CALAMINE
PRAMOXINE HCL/CAMPH/ZINC ACET
PRAMOXINE HCL/CAMPH/ZINC ACET
DIPHENHYDRAMINE HCL/CALAMINE
PYRIL MAL/BENZOCAINE/ZNOX
MENTHOL/CAMPHOR
DIPHENHYDRAMINE HCL/ZINC ACET
MENTHOL/CAMPHO/YERB MAT/ALOE/E
PRAMOXINE HCL/MENTHOL
DIPHENHYDRAMINE HCL/HC
PRAMOXINE HCL
MENTHOL/CAMPHOR
SKIN CLEANSER COMB NO.22
SKIN CLEANSER COMB NO.13
MENTHOL/CAMPHOR/BENZYL ALCOHOL
MENTHOL/CAMPHOR
PRAMOXINE HCL/MENTHOL
PRAMOXINE HCL
PRAMOXINE HCL
PRAMOXINE HCL
MENTHOL/CAMPHOR
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - ANTIPRURITIC DRUGS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
SARNA ULTRA
SENSITIVE ANTI-ITCH
SOLARHIST
SPORTS RUB PAIN RELIEVING
TIGER BALM
VAGISIL
ZANFEL
Z-XTRA
1ST RELIEF
2 IN 1 DANDRUFF SHAMPOO
A&D
A+D
A+D ZINC OXIDE
ABSORBASE
ABSORBINE JR.
ACNE & BLACKHEAD TERMINATOR
ACNE CLEANSER
ACNE CLEANSING BAR
ACNE CLEARING SYSTEM
ACNE CONTROL CLEANSER
ACNE CREAM
ACNE FOAMING FACE WASH
ACNE FOAMING WASH
ACNE MEDICATION
ACNE PADS
ACNE SPOT TREATMENT
ACNE TREATMENT
ACNE TREATMENT PACK
ACNECLEAR
ACNOMEL
ADAZIN
ADRUCIL
ADVANCED EYE RELIEF
ADVANCED RECOVERY
ADVANCED WOUND
AFLEXERYL-LC
AFLEXERYL-MC
AIR SALONPAS
AKWA TEARS
AL-12
ALA SEB
ALA SEB T
ALA-DERM
ALCIS
ALCOHOL PADS WITH BENZOCAINE
ALCOHOL SWABS WITH BENZOCAINE
ALEVEER
ALICLEN
ALIVIO
ALLCLENZ
ALOE BURN RELIEF
84
GENERIC DRUG
PRAMOXINE/MENTHOL/PETROLATUM
PRAMOXINE HCL
PRAMOXINE HCL/DIPHENHYDRAMINE
MENTHOL/CAMPHOR
MENTHOL/CAMPHOR
PRAMOXINE HCL
SKIN CLEANSER COMBINATION NO.8
PYRIL MAL/BENZOCAINE/ZNOX
LIDOCAINE/MENTHOL
PYRITHIONE ZINC
VITAMINS A AND D
VITS A & D/WHITE PET/LANOLIN
DIMETHIC/ZINC OX/VIT A&D/ALOE
MINERAL OIL/PETROLATUM,WHITE
THYMOL/MENTHOL
ACETIC ACID
BENZOYL PEROXIDE
SALICYLIC ACID
BENZOYL PEROXIDE
BENZ PEROX MICRO/SKIN CLNSR#24
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
SALICYLIC ACID
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
RESORCINOL/SULFUR
LIDOCAINE/BENZOCAIN/ME-SAL/CAP
FLUOROURACIL
GLYCERIN/PROPYLENE GLYCOL
GLYCERIN/DIMETHICONE
POLOXAMER 188/SORBITOL/UREA
LIDOCAINE HCL/MENTHOL
CAPSAICIN/MENTHOL
METHYL SALICYLATE/MENTH/CAMPH
LANOLIN/MIN OIL/PETROLAT,WHT
AMMONIUM LACTATE
SALICYLIC ACID/SULFUR
SALICYLIC ACID/COAL TAR/SULFUR
EMOLLIENT BASE
TROLAMINE SALICYLATE
ISOPROPYL ALCOHOL/BENZOCAINE
ISOPROPYL ALCOHOL/BENZOCAINE
CAPSAICIN/MENTHOL
SALICYLIC ACID
CAPSAICIN/MENTHOL
POLOXAMER 188/SORBITOL SOLN
LIDOCAINE/ALOE VERA
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
ALOE GRANDE
ALOE VERA
ALOE VERA BURN RELIEF
ALOE VERA PAIN RELIEVING
ALOE VERA-LIDOCAINE
ALOE VESTA CLEANSING
ALOE-LIDOCAINE
ALPHA KERI OIL
ALPHABATH
ALPHASOFT
ALTACAINE
ALTALUBE
ALTAMIST
ALTERNAGEL
AMERICAINE
AMERICERIN
AMERIGEL
AMERIGEL PREMIUM CARE
AMERIGEL WOUND WASH
AMERIPHOR
AMERISTORE
AMLACTIN XL
AMVISC
AMVISC PLUS
ANACAINE
ANALGESIC
ANALGESIC BALM
ANALGESIC CREME
ANALPRAM HC
ANAMANTLE HC
ANAMANTLE HC FORTE
ANANA FORTE
ANASEPT
ANASEPT SKIN-WOUND CLEANSER
ANBESOL
ANECREAM
ANECREAM5
ANESTAFOAM
ANESTHETIC ORAL GEL
ANTI MONKEY BUTT
ANTI-DANDRUFF
ANTI-DANDRUFF WITH MENTHOL
ANTISEPTIC & ANESTHETIC
ANTISEPTIC MOUTH CLEANSER
ANTI-SNORE
AQUA LACTEN
AQUAMED
AQUAPHOR
AQUAPHOR WITH NATURAL HEALING
ARCTIC HEAT
85
GENERIC DRUG
VIT A PALM/VIT E ACETATE/ALOE
LIDOCAINE/ALOE VERA
LIDOCAINE/MENTHOL/ALOE VERA
LIDOCAINE/ALOE VERA
ALOE VERA/COLLAGEN
LIDOCAINE/ALOE VERA
LANOLIN/MINERAL OIL/PEG
LANOLIN/MINERAL OIL
LANOLIN/MIN OIL/PEG/CASTOR OIL
TETRACAINE HCL
MINERAL OIL/PETROLATUM,WHITE
SODIUM CHLORIDE
ALUMINUM HYDROXIDE
BENZOCAINE
PETROLATUM,WHITE
ZINC ACETATE/MEADOWSWEET/OAK
ZINC OXIDE
SOD CHLORIDE/POT CHL/CAL/OAK
MINERAL OIL/HYDROPHIL PETROLAT
PETROLATUM,WHITE/WATER
SOD LACTATE/AMM LACT/POT LACT
AMMONIUM LACTATE
HYALURONATE SODIUM
HYALURONATE SODIUM
BENZOCAINE
METHYL SALICYLATE/MENTHOL
METHYL SALICYLATE/MENTHOL
TROLAMINE SALICYLATE
HYDROCORTISONE/PRAMOXINE
LIDOCAINE/HYDROCORTISONE AC
LIDOCAINE/HYDROCORTISONE AC
BROMELAINS
SODIUM HYPOCHLORITE
SODIUM HYPOCHLORITE
BENZOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
BENZOCAINE
TALC/CALAMINE
COAL TAR
SELENIUM SULFIDE/MENTHOL
ANTI-ITCH CREAM
LIDOCAINE HCL/BENZALK CHL
CARBAMIDE PEROXIDE
ETOH/EUC OIL/MENTH/PEP/WINTERG
LACTIC ACID/UREA
ALCOHOL/PROPYLENE GLYCOL
MINERAL OIL/HYDROPHIL PETROLAT
PETROLATUM,WHITE
METHYL SALICYLATE/MENTHOL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
ARTHRICREAM
ARTHRICREAM RUB
ARTHRICREME
ARTHRITIS HOT PAIN RELIEF
ARTHRITIS RELIEF
ARTIFICIAL TEARS
ASPERCREME
ASPER-FLEX
ASTRINGENT SOLUTION
ATOPICLAIR
ATRAPRO CP
ATRAPRO DERMAL SPRAY
ATRAPRO HYDROGEL
AURAPHENE-B
AURO
AURSTAT
AVEENO BABY
AVEENO BATH
AVEENO CLEAR COMPLEXION
AVEENO DAILY MOISTURIZING
AVEENO INTENSE RELIEF
AVEENO MOISTURIZING CREAM
AVO CREAM
AVOSIL
AYR
AYR SALINE
B.F.I
BABY ANTI MONKEY BUTT
BABY AYR SALINE
BABY CHEST RUB
BABY DARLINGS
BABY OIL
BABY POWDER PURE CORNSTARCH
BABY SHAMPOO
BABY TEETHING GEL
BABY TEETHING PAIN MEDICINE
BACTINE
BALMEX
BALNEOL
BALNEOL FOR HER
BALNETAR
BANALG
BASLE
BATH OIL
BAZA CLEAR
BAZA PROTECT
BENGAY ARTHRITIS FORMULA
BENGAY GREASELESS
BENOXYL-CR ADVANCED
BENPROX
BENZAC AC
BENZAC W 5
86
GENERIC DRUG
TROLAMINE SALICYLATE
TROLAMINE SALICYLATE/ALOE VERA
TROLAMINE SALICYLATE
METHYL SALICYLATE/MENTHOL
TROLAMINE SALICYLATE
GLYCERIN/PROPYLENE GLYCOL
TROLAMINE SALICYLATE
TROLAMINE SALICYLATE
CALCIUM ACETATE/ALUMINUM SULF
VITE AC/GRAPE/HYALURONIC ACID
EMOLLIENT COMBO NO.47 & NO.60
ELECT WTR/SOD CH/SOD HY/HYP AC
EMOLLIENT COMBINATION NO.60
CARBAMIDE PEROXIDE
CARBAMIDE PEROXIDE
EM#53/NAMGF/CYC/PHOS/NAHC/NACL
COLLOIDAL OATMEAL
COLLOIDAL OATMEAL
SALICYLIC ACID
DIMETHICONE/COLLOIDAL OATMEAL
GLY/DIMETH/PETROLAT,WHT/WATER
COLLOIDAL OATMEAL
EMOLLIENT COMBINATION NO.10
SODIUM SALICYLATE/OINT,PEG/BHT
SODIUM CHLORIDE
SODIUM CHLORIDE
BISMUTH FORMIC IODIDE
CALAMINE/CORN STARCH
SODIUM CHLORIDE
EUC OIL/ALOE/LAV&ROSEM OILS/PT
COLLOIDAL OATMEAL
LANOLIN/MINERAL OIL
CORN STARCH
SOAP
BENZOCAINE
BENZOCAINE
LIDOCAINE HCL/BENZALK CHL
BALSAM PERU/ZINC OXIDE
MINERAL OIL/LAN OIL/PROP GLY
MINERAL OIL/LAN OIL/PROP GLY
COAL TAR/LANOLIN
EUCALYPTUS/ME-SAL/MENTHOL/CAMP
HYDROPHILIC CREAM
LANOLIN/MINERAL OIL
COD LIVER/VIT A&D/PETROLAT,WHT
DIMETHICONE/ZINC OXIDE
METHYL SALICYLATE/MENTHOL
METHYL SALICYLATE/MENTHOL
BENZOYL PEROXIDE
BENZOYL PEROXIDE/ALOE VERA
BENZOYL PEROXIDE
BENZOYL PEROXIDE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
BENZAC W WASH
BENZASHAVE
BENZEFOAM
BENZEFOAM ULTRA
BENZEPRO
BENZIQ
BENZIQ LS
BENZODENT
BENZOIN TINCTURE
BENZ-O-STHETIC
BENZOTIC
BENZ-PROTECT
BETA CARE
BETA MED
BETA XMA
BETASAL
BETATAR SHAMPOO
BIAFINE
BIONECT
BIO-THERM
BI-ZETS
BLISTEX
BLOOD CLOTTING
BODI KLEEN
BODI LINE ANTISEPTIC SOAP
BODI PROTECT
BODI WHIRL OIL
BODY LOTION
BODY OIL
BODY POWDER MEDICATED
BOIL EASE
BOIL RELIEF
BORAX
BORO-PACKS
BP
BP FOAM
BP WASH
BP WASH ACNE TREATMENT
BP-50% UREA
BPO
BPO-10
BPO-5
BREATHE RIGHT
BREATHE RIGHT SNORE RELIEF
BREVOXYL-4
BREVOXYL-8
BROMI-LOTION
BROMI-TALC
BROMI-TALC PLUS
87
GENERIC DRUG
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE/ALOE VERA
BENZOYL PEROXIDE/ALOE VERA
BENZOCAINE
BENZOIN COMPOUND
BENZOIN
BENZOCAINE
BENZOCAINE
BENZOYL PEROXIDE
BENZOIN COMPOUND
CETYL ALC/STEARYL ALC/PG/SLS
PYRITHIONE ZINC
ALOE VERA/DIMETHICONE
SALICYLIC ACID
COAL TAR
EMOLLIENT COMBINATION NO.10
HYALURONATE SODIUM
CAPSAICIN/ME-SALICYLATE/MENTH
BENZOCAINE
DIMETHICONE/OXYBENZONE/OCTINOX
LIDOCAINE/BENZETHON CL
ALOE V/CL-XYLENOL/PHENOXYETH
SOAP
EMOLLIENT COMBINATION NO. 4
EMOLLIENT COMBINATION NO. 5
CETYL ALCOHOL
CETYL ALCOHOL
MENTHOL/ZINC OXIDE
BENZOCAINE
BENZOCAINE
SODIUM BORATE
CALCIUM ACETATE/ALUMINUM SULF
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
UREA/LACTIC AC/ZN UNDECYLENATE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
ETOH/EUC OIL/MENTH/PEP/WINTERG
ALC/MENT/EUGN/PEP/WINT/GLY/ANS
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BROMELAINS
ALUMINUM CHLORIDE
AMMONIUM ALUM/TALC/BENTONITE
AMMONIUM ALUM/TALC/BENTONITE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
BUMM BALM
BURN
BURN JEL PLUS
BURN RELIEF
BURN RELIEF W-ALOE
CALAMINE PHENOLATED
CALDESENE
CALICYLIC
CALLUS REMOVER
CALLUS REMOVERS
CALMODROX
CALMOL 4
CALMOL-4
CALYPXO
CAM
CAMPHO-PHENIQUE
CAMPHOR & PHENOL
CANK-OXIDE
CAPSAICIN HOT PATCH
CAPSICUM HOT PATCH
CAPTRACIN
CAPZASIN
CAPZASIN-HP
CAPZASIN-P
CARAC
CARBAMOXIDE
CARB-O-LAC HP
CARB-O-LAC5
CARB-O-LAN10
CARB-O-LAN20
CARB-O-SAL5
CARLESTA
CARMOL SCALP
CARRAFOAM SKIN CARE
CARRAKLENZ
CARRASYN V
CARRINGTON MOISTURE BARRIER
CASTBLAST
CASTELLANI PAINT
CASTELLANI PAINT MODIFIED
CASTIVA COOLING
CASTIVA WARMING
CASTOR OIL
CAVILON MOISTURIZING BODY
CELACYN
CEPACOL FIZZLERS
CEPACOL SENSATIONS COOLING
CEPACOL SENSATIONS HYDRA
CEPACOL SORE THROAT
CERAVE
CERAVE PM
88
GENERIC DRUG
ZINC OXIDE
BENZOCAINE/MENTH/BENZETHONIUM
LIDOCAINE HCL/VIT E/TEA TREE
LIDOCAINE/ALOE VERA
LIDOCAINE/ALOE VERA
CALAMINE/PHENOL LIQUID
ZINC OXIDE/CORN STARCH
SALICYLIC ACID
SALICYLIC ACID
SALICYLIC ACID
MENTHOL/ZINC OXIDE
COCOA BUTTER/ZINC OXIDE
ZINC OXIDE
METHYL SALICYLATE/MENTHOL
CETYL ALCOHOL/STEARYL ALCOHOL
CAMPHOR/PHENOL
CAMPHOR/PHENOL
CARBAMIDE PEROXIDE
CAPSAICIN
CAPSAICIN
CAPSAICIN/MENTHOL
CAPSAICIN
CAPSAICIN
CAPSAICIN
FLUOROURACIL
CARBAMIDE PEROXIDE
AMMONIUM LACTATE/UREA
AMMONIUM LACTATE/UREA
EMOLLIENT COMBINATION NO.50
EMOLLIENT COMBINATION NO.50
SAL ACID/UREA/PETROLATUM,WHITE
DIMETHICONE/ZINC OXIDE
SULFACETAMIDE SODIUM/UREA
POT SORBATE/VIT E/MO/ALO VER
ALOE VERA/NA LAURYL SO4
TROMETHAM/PANTOT AC/PVP/CARBOM
PETROLATUM,WHITE
TRICHLOROMONOFLUOROMETHANE
PHENOL
PHENOL
MENTH/ME-SALICYL IN CASTOR OIL
CAPSAICIN IN CASTOR OIL
EMOLLIENT COMBINATION NO.93
EMOLLIENT COMBINATION NO.60
BENZOCAINE
BENZOCAINE/MENTHOL
BENZOCAINE
BENZOCAINE/MENTHOL
CEPHALEXIN
CERAMIDES 1,3,6-11
CERAMIDE 1,3,6-11/B3/HYALUR AC
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
CERTAIN
CETACAINE
CETACAINE ANESTHETIC
CETACAINE MEDICAL KIT E
CETA-KLENZ
CETAPHIL RESTORADERM
CETYLCIDE II
CHAMOSYN
CHAP EX
CHEMET
CHERACOL
CHEST RUB
CHILDREN'S SALINE
CHILDREN'S SALINE NASAL SPRAY
CHILD'S BENADRYL ITCH COOLING
CHLORASEPTIC
CHLORASEPTIC MAX
CHLORASEPTIC SORE THROAT
CIRCUDERM
CITRA PH
CLEAN & CLEAR ADVANTAGE
CLEANSE & TREAT PLUS
CLEANSE AND TREAT
CLEANSING PADS
CLEANSING SKIN CREAM
CLEAR AWAY
CLEARASIL DAILY CLEAR
CLINAC BPO
CLOVERINE
COCOA BUTTER
COCONUT OIL
COCONUT OIL CREAM
COLD & HOT
COLD AND HOT PAIN-RELIEF
COMFORT SHIELD
COMPLEX 15
COMPOUND BENZOIN
COMPOUND BENZOIN TINCTURE
COMPOUND W
CONDYLOX
CONSTANT CLENS
CONTI
COOL HEAT CREAM
COOLING BURN
CORN & CALLUS REMOVER
CORN REMOVER
CORN-CALLUS REMOVER
CRITIC-AID CLEAR
89
GENERIC DRUG
ALUMINUM CHLORIDE
TETRACAINE/BENZOCAINE/BUTAMBEN
TETRACAINE/BENZOCAINE/BUTAMBEN
TETRACAINE/BENZOCAINE/BUTAMBEN
PARAB/CET ALC/STRYL ALC/PG/SLS
EMOLLIENT COMBINATION NO.62
CETYL ALCOHOL
ALK DIMETHYL ETHYL/BENZ AMCHL
MENTHOL/ZINC OX/ALOE/CHAM OIL
VITAMIN E/OCTINOXATE
SUCCIMER
PHENOL
EUCALYPTUS OIL/MENTHOL/CAMPHOR
SODIUM CHLORIDE
SODIUM CHLORIDE
CAMPHOR
PHENOL
BENZOCAINE/MENTHOL
BENZOCAINE/MENTHOL
BALSAM PERU/CASTOR OIL
SODIUM CITRATE
SALICYLIC ACID
SALICYLIC AC/BENZ PEROX/EMOLL
SALICYLIC ACID/BENZOYL PEROXID
SALICYLIC ACID
MENTHOL/CAMPHOR/PHENOL
SALICYLIC ACID
BENZOYL PEROXIDE
BENZOYL PEROXIDE
PETROLATUM,WHITE
COCAINE HCL
EMOLLIENT COMBINATION NO.75
EMOLLIENT COMBINATION NO.61
METHYL SALICYLATE/MENTHOL
METHYL SALICYLATE/MENTHOL
COLLOIDAL OATMEAL
ALOE VERA/DIMETHICONE/CHLORHEX
LECITHIN/GLYCERIN/DIMETHICONE
BENZOIN/ALOE VERA/STORAX/TOLU
BENZOIN COMPOUND
SALICYLIC ACID
PODOFILOX
NAPH,MB-DB/K PH,MBDB/ZINC/UREA
SOAP
METHYL SALICYLATE/MENTHOL
BENZOCAINE/TRICLOSAN
SALICY AC/HYDROCOL DR/FM BNDGE
SALICYLIC ACID
CORN STARCH
SALICYLIC ACID
VIT E ACETATE/DMC/ZNOX/PET,WH
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
CUTAR
DAILY CARE ALCOHOL FREE STRIDE
DAILY FACE WASH
DAILY MOISTURIZING LOTION
DAKIN'S
DANDREX
DANDRUFF SHAMPOO
DEBROX
DEEP BLUE
DEEP SEA
DELAZINC
DELOS
DEL-RAY SPECIAL SHAMPOO
DENDRACIN
DENDRACIN NEURODENDRAXCIN
DENT-O-KAIN
DERMABASE
DERMACERIN
DERMACLOUD
DERMADAILY
DERMADROX
DERMAFLEX
DERMAMED
DERMANAIL
DERMAPHOR
DERMAPLEX
DERMAREST PSORIASIS
DERMASEPTIN
DERMASORB XM
DERMAVANTAGE
DERMAZINC
DERMEND
DERMOPLAST
DESITIN
DESITIN CLEAR
DESQUAM-X
DEXTRAN 70 IN DEXTROSE 10%
DHS CONDITIONING RINSE
DHS SAL
DHS TAR
DHS TAR GEL
DHS ZINC
DIABETIDERM
DIAPER RASH
DIAPER RASH OINTMENT
DIAPER RASH PASTE
DIAPER RASH RELIEF
DIAPER RELIEF
DI-DAK-SOL
DISP DOUCHE EXTRA CLNS V&W
DML
90
GENERIC DRUG
COAL TAR
SALICYLIC ACID
SALICYLIC ACID
DIMETHICONE/COLLOIDAL OATMEAL
SODIUM HYPOCHLORITE
SELENIUM SULFIDE
PYRITHIONE ZINC
CARBAMIDE PEROXIDE
MSM/ALO VER/EMU OIL/HRB66
SODIUM CHLORIDE
ZINC OXIDE
BENZOYL PEROXIDE
SODIUM LAURYL SULFATE
CAPSAICIN/ME-SALICYLATE/MENTH
CAPSAICIN/ME-SALICYLATE/MENTH
BENZOCAINE
EMOLLIENT BASE
MINERAL OIL/PETROLATUM,WHITE
COLD CREAM/ZINC OXIDE/STAR/LAN
MO/ALO V/PET,WH/CETYL ALC/H2O
ALUMINUM HYDROXIDE
LIDOCAINE
ALUMINUM HYDROXIDE
MANDELIC AC/1,3-BUTANEDIOL/IPA
MINERAL OIL/HYDROPHIL PETROLAT
EMOLLIENT #56/HYALURONIC ACID
SALICYLIC ACID
MENTHOL/ZINC OXIDE
UREA/EMOLLIENT CMB NO.18
LANOLIN/MINERAL OIL
PYRITHIONE ZINC
EMOLLIENT COMBINATION NO.77
BENZOCAINE/BENZETHON CL
COD LIVER OIL/ZINC OXIDE
VITS A & D/WHITE PET/LANOLIN
BENZOYL PEROXIDE
DEXPANTHENOL
DEXTRAN 70/DEXTROSE 10 %-WATER
PANTOTHENIC ACID
SALICYLIC ACID
COAL TAR
COAL TAR
PYRITHIONE ZINC
EMOLLIENT BASE
ZINC OXIDE
COD LIVER OIL/ZINC OXIDE
COD LIVER OIL/ZINC OXIDE
ZINC OXIDE
COD LIVER OIL/ZINC OXIDE
SODIUM HYPOCHLORITE
ACETIC ACID
GLY/BENZYL ALC/PETROLAT,WHT
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
DML FACIAL MOISTURIZER
DML FORTE
DOBELL'S
DOLORACIN-L-RX
DOMEBORO
DR SCHOLL'S CLEAR AWAY
DR. SCHOLL'S FOOT POWDER
DR. SMITH'S ADULT BARRIER
DR. SMITH'S DIAPER
DR. SMITH'S DIAPER RASH
DR. SMITH'S RASH-N-ALL
DR. SMITH'S RASH-SKIN
DRAW OUT SALVE
DROXY
DRY SKIN BATH OIL
DRY SKIN CARE
DRY SKIN CREAM
DRY SKIN FORMULA BAR
DRY SKIN LOTION
DRY SKIN THERAPY
DRY SKIN THERAPY PLUS
DRY SKIN TREATMENT
DRYSOL
DUAL ACTION
DUOFILM
DURAFLEX
DURASAL
EAR DROPS
EAR SYSTEM
EAR WAX DROPS
EAR WAX REMOVAL
EARWAX TREATMENT
ECZEMA
ECZEMA RELIEF
EFFACLAR DUO
EFUDEX
ELENZAPATCH
ELETONE
ELON
ELTA
ELTA LITE TAR
ELTA SEAL MOISTURE BARRIER
ELTA TAR
EMLA
EMOLLIA
EMOLLIENT
EMU-LAC
EMULSION SB
ENDOXCIN
EPICERAM
EPIDERM
EPIFOAM
91
GENERIC DRUG
OXYBENZONE/SUNSCREEN/HYALUR AC
PANTOT AC/GLYCERIN/PET HY-PHL
SODIUM BORATE
LIDOCAIN/ME-SALICYL/CAPS/MENTH
CALCIUM ACETATE/ALUMINUM SULF
SALICYLIC ACID
SAL ACID/METHYL SALICYLATE/TLC
ZINC OXIDE
ZINC OXIDE
ZINC OXIDE
LAN/MIN OIL/ZNOX/PETROLAT,WHT
PETROLATUM,WHITE/LANOLIN
MIN OIL/ICHTHAM/SOAP/PET,WH
EMOLLIENT BASE
LANOLIN/MINERAL OIL
SOD CHLORIDE/LAN/MO/PET,WH
MINERAL OIL/PETROLATUM,WHITE
SOAP
GLYCERIN/MINERAL OIL
LANOLIN ALCOHOL/MO/W.PET/CERES
EMOLLIENT COMBINATION NO. 1
PETROLATUM,WHITE
ALUMINUM CHLORIDE
BENZOYL PEROXIDE
SALICYLIC ACID
ME-SAL/GLUCOS/MSM/CAY/MEN/ALOE
SALICYLIC ACID
CARBAMIDE PEROXIDE
CARBAMIDE PEROXIDE
CARBAMIDE PEROXIDE
CARBAMIDE PEROXIDE
CARBAMIDE PEROXIDE
COLLOIDAL OATMEAL
COLLOIDAL OATMEAL
BENZOYL PEROXIDE MICRONIZED
FLUOROURACIL
LIDOCAINE HCL/MENTHOL
EMOLLIENT COMBINATION NO. 25
OXYQUINOLINE/EMOLLIENT BASE
EMOLLIENT
COAL TAR
ZINC OXIDE
COAL TAR
LIDOCAINE/PRILOCAINE
EMOLLIENT COMBINATION NO.39
EMOLLIENT BASE
AMMONIUM LACTATE/EMU OIL
EMOLLIENT COMBINATION NO.32
LIDOCAINE HCL/MENTHOL
EMOLLIENT COMBINATION NO.32
METHYL SALICYLATE/MENTHOL
HYDROCORTISONE/PRAMOXINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
EUCERIN
EUCERIN CALMING BODY WASH
EUCERIN ECZEMA RELIEF
EUCERIN INTENSIVE REPAIR
EUCERIN PROFESSIONAL REPAIR
EUCERIN SKIN CALMING
EUFLEXXA
EXACTACAIN
EXCEL AP
EXCEL-GEL
EXFOLIATING MOISTURIZER
EXOTEN-C
EXTRA CLEANSING DOUCHE
EYE CREAM
EYESCRUB
FACIAL CARE
FACIAL CLEANSER
FAST CLEARING SPOT
FEMININE CARE DOUCHE
FEMININE MOIST & LUBRICATING
FINGER CREAM
FINGERS SKIN
FIRST-AID
FLANDERS BUTTOCKS OINTMENT
FLUOROPLEX
FOAM INCONTINENCE KIT
FOOT MOISTURIZER
FOOT SOFTENER
FOR STY RELIEF
FORDUSTIN
FREEZONE
FRESH FOAMING
GALZIN
GEBAUER'S 114
GEL-ONE
GENADUR
GENTEAL PM
GENTLE CREAM
GENTLE MOISTURIZING LOTION
GERI PROTECT
GERI RINSE-FREE
GERI-HYDROLAC
GERI-SHAMPOO
GERI-SOFT
GLYCERIN-ROSE WATER
GLYCINE SOYA PROTEIN
GLY-OXIDE
92
GENERIC DRUG
ETHYL CHLORIDE
EUCALYPTUS OIL
LANOLIN ALCOHOL/MO/W.PET/CERES
COLLOIDAL OATMEAL
EMOLLIENT COMBINATION NO.72
EMOLLIENT COMBINATION NO.96
EMOLLIENT COMBINATION NO.69
HYALURONATE SODIUM
TETRACAINE/BENZOCAINE/BUTAMBEN
POVIDONE-IODINE/ISOPROPYL ALC
PANTOTHENIC ACID/ALOE VERA
SAL ACID/UREA/PETROLATUM,WHITE
CAPSAICIN/ME-SALICYLATE/MENTH
ACETIC ACID
PANTOT AC/MO/PET H-PH/SORB SOL
EDETATE DISODIUM/PEG
EMOLLIENT BASE
EMOLLIENT BASE
SALICYLIC ACID
ACETIC ACID
CHLORHEX GL/GLYCERIN/HE-CELL
FINASTERIDE
EMOLLIENT BASE
EMOLLIENT BASE
LIDOCAINE HCL/BENZALK CHL
BALSAM PERU/ZINC OXIDE
FLUOROURACIL
FLUOROURACIL
POT SORBATE/VIT E/MO/ALO VER
SAL ACID/UREA/PETROLATUM,WHITE
SAL ACID/UREA/PETROLATUM,WHITE
MINERAL OIL/PETROLATUM,WHITE
NA BICARB/MEBENZ/STARCH/SILICA
SALICYLIC ACID/COLLODION, FLEX
GLYCERIN/SOAP/WATER
ZINC ACETATE
DICHLOROTETRAFLUOROETHANE
HYALURONATE SOD, CROSS-LINKED
BIO/CARB/EQUIS/ETHAN/CHIT/MSM
MINERAL OIL/PETROLATUM,WHITE
VITAMIN E/VIT A&D/ZINC OXIDE
VIT E ACETATE/GLY/DIMETH/WATER
LAN/MIN OIL/ZNOX/PETROLAT,WHT
SOAP
AMMONIUM LACTATE
SOAP
MINERAL OIL/PETROLAT,WHT/WATER
GLUTARALDEHYDE
GLYCERIN
SOY PROTEIN
CARBAMIDE PEROXIDE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
GOLD BOND ULTIMATE
GOLD BOND ULTIMATE DIABETIC
GOLD BOND ULTIMATE HEALING
GORDOBALM
GORDOFILM
GORDOGESIC
GORDON'S NO. FIVE
GORDON'S VITE A
GORDO-VITE A
GRANULEX
GREASELESS
GRX RINSE-FREE
GRX VITAMIN E
H.E.A.R.
HC PRAM
H-CHLOR 12
HEALON5
HEALTHY SCALP SHAMPOO
HEMORRHOIDAL-ANALGESIC
HERPECIN L
HIGH POTENCY CAPSAICIN
HPA LANOLIN
HPR
HPR PLUS
HPR PLUS-MB HYDROGEL
HURRICAINE
HURRICAINE ONE
HYALGAN
HYDRASYN25
HYDRATING HEALING
HYDRISALIC
HYDRISINOL
HYDROCERIN
HYDROCERIN PLUS
HYDROCORTISONE-PRAMOXINE
HYDROCORTISONE-PRAMOXINE HCL
HYDROCREAM BASE
HYDRO-LAN
HYDROLATUM
HYDROPHOR
HYGEL
HYGIENE 1
HYLASE
HYLATOPIC
HYLATOPIC PLUS
HYLATOPIC PLUS-AURSTAT
HYLENEX
HYLIRA
HYPERCARE
HYPER-HEAL
HYSEPT
ILEX
93
GENERIC DRUG
EMOLLIENT COMBINATION NO.31
DIMETHICONE/PETR/VIT A,C,E/ALO
DIMETHICONE/PETR/VIT A,C,E/ALO
ME-SALICYLATE/ACET/ISOPROPANOL
SALICYLIC ACID/COLLODION, FLEX
METHYL SALICYLATE
FOOT DEODORANT COMB. NO.3
VITAMIN A
VITAMIN A
TRYPSIN/BALSAM PERU/CASTOR OIL
EUCALYPTUS OIL/MENTHOL/CAMPHOR
SOAP
EMOLLIENT COMBINATION NO.49
CARBAMIDE PEROXIDE
HYDROCORTISONE/PRAMOXINE
SODIUM HYPOCHLORITE
HYALURONATE SODIUM
SALICYLIC ACID
DIBUCAINE
DMC/OXYBEN/OCTNX/OCT SAL/MERAD
CAPSAICIN
MODIFIED LANOLIN
EMOLLIENT COMBINATION NO.44
EMOLLIENT COMBINATION NO.53
EMOL53/NAMGFS/HA/NAHYPOCHLORIT
BENZOCAINE
BENZOCAINE
HYALURONATE SODIUM
UREA/ALPHA HYDROXY ACIDS
MINERAL OIL/HYDROPHIL PETROLAT
SALICYLIC ACID
VEGETABLE OIL/CASTOR OIL
MINERAL OIL/I-PROP MYR/WATER
EMOLLIENT COMBINATION NO.34
HYDROCORTISONE/PRAMOXINE
HYDROCORTISONE/PRAMOXINE
EMOLLIENT BASE
EMOLLIENT COMBINATION NO.51
PETROLATUM,WHITE
PETROLATUM,WHITE
HYALURONATE SODIUM
EDETATE SOD/PEG/SOD LAURYL SUL
HYALURONATE SODIUM/HE-CELL/PEG
EMOLLIENT COMBINATION NO.44
EMOLLIENT COMBINATION NO.53
EMOL53/NAMGFS/HA/NAHYPOCHLORIT
HYALURONIDASE, HUMAN RECOMB.
HYALURONATE SODIUM
ALUMINUM CHLORIDE
ALOE/LAC AC/CERAMIDES 3,3B,6,1
SODIUM HYPOCHLORITE
ZINC/PETROLATUM,WHITE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
ILOPAN INJECTION
IMPRUV
INCONTINENCE SKIN CARE
INCONTINENCE SKIN CARE KIT
INOVA
INOVA 4-1
INOVA 8-2
INSTANT BITE & STING RELIEF
INSTANT PAIN RELIEF
INTENSE TOOTHACHE PAIN RELIEF
INVISIBLE ACNE
IODEX WITH METHYL SALICYLATE
IONAX SCRUB
IONIL
IONIL PLUS
IONIL T
IONIL T PLUS
ISOPROPYL-WINTERGREEN
JOHNSON'S BABY POWDER
KEFLEX
KELO-COTE
KENDALL SOOTHING
KERA TEK
KERADAN
KERALYT
KERALYT SCALP
KERI
KERI ADVANCED MOISTURE THERAPY
KERI ORIGINAL MOISTURE THERAPY
KERI SENSITIVE SKIN
KERODEX 51
KERODEX 71
KEROL AD
KEROL ZX
K-Y
K-Y LUBRICATING JELLY
LAC-HYDRIN
LAC-HYDRIN FIVE
LAC-HYDRIN TWELVE
LACLOTION
LACTATED RINGERS
LACTINOL HX
LADY ANTI MONKEY BUTT
LAMISILK
LANACANE ANTI-ITCH
LANACANE FIRST AID
LANACANE WITH ALOE
LANOLIN GRX
LANOLOR DRY SKIN
94
GENERIC DRUG
DEXPANTHENOL
MINERAL OIL/I-PROP MYR/WATER
MIN OIL/ALO VER/PET,WH/SLS
MIN OIL/ALO VER/PET,WH/SLS
BENZOYL PEROXIDE/VIT E MIX
SALICYLIC AC/BENZOYL PER/VIT E
SALICYLIC AC/BENZOYL PER/VIT E
BENZOCAINE
CAMPHOR/PHENOL
BENZOCAINE
BENZOYL PEROXIDE
IODINE/METHYL SALICYLATE
SOAP
SALICYLIC ACID/BENZALK CHL
SALICYLIC ACID
COAL TAR
COAL TAR
ISOPROPYL ALCOHOL
METHYL SALICYLATE/ISOPROPANOL
TALC
CEPHALEXIN
POLYDIMETHYLSILOXANES/SILICON
ZINC OXIDE
METHYL SALICYLATE/MENTHOL
EMOLLIENT COMBINATION NO.65
SALICYLIC ACID
SALICYLIC ACID
EMOLLIENT COMBINATION NO. 19
EMOLLIENT COMBINATION NO. 22
EMOLLIENT COMBINATION NO. 20
EMOLLIENT COMBINATION NO. 14
EMOLLIENT COMBINATION NO.78
HYDROPHILIC CREAM
UREA/LACTIC AC/ZN UNDECYLENATE
UREA/LACTIC AC/ZN UNDECYLENATE
CHLORHEX GL/GLYCERIN/HE-CELL
CHLORHEX GL/GLYCERIN/HE-CELL
AMMONIUM LACTATE
AMMONIUM LACTATE
AMMONIUM LACTATE
AMMONIUM LACTATE
RINGERS SOLUTION,LACTATED
LACTIC ACID
LACTIC ACID
CALAMINE/CORN STARCH
CORN/LUFFA CYLINDRICA
BENZOCAINE/BENZETHON CL
BENZOCAINE/BENZETHON CL
BENZOCAINE/BENZETHON CL
LANOLIN
LANOLIN
LANOLIN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
LAN-O-SOOTHE
LANTISEPTIC
LATRIX
LATRIX XM
LAVOCLEN-4
LAVOCLEN-8
LAZER
LC-4
LC-5
LENZAGEL
LENZAPATCH
LIDALL
LIDAMANTLE HC
LIDOCAINE HCL-EPINEPHRINE
LIDOCAINE-HYDROCORTISONE
LIDOCAINE-PRILOCAINE
LIDOCORT
LIDOCREAM
LIDODERM
LIDODEXTRAPINE
LIDOPATCH
LIDOPRO
LIDOVEX
LIGHT NIGHT CREAM
LIMENCIN
LIP BALM MEDICATED
LIP MOISTURIZER
LIP-GUARD
LIQUA-GEL
LIQUID BANDAGE
LIQUID CORN & CALLUS REMOVER
LIQUIMAT
LITTLE REMEDIES
LITTLE REMEDIES STUFFY NOSE
L-LYSINE
LMX 4
LMX 4 PLUS
LMX 5
LOBANA BATH OIL
LOBANA PERI-GARDE
LORENZA
LOUTREX
LOZENGES
LUBRICANT EYE
LUBRICANT PM
LUBRICATING GEL
LUBRICATING JELLY
LUBRICATING MOISTURE LOTION
LUBRICATING SKIN
LUBRIDERM ADVANCED THERAPY
LUBRIDERM DAILY MOISTURE
95
GENERIC DRUG
LANOLIN
LANOLIN
UREA/LACTIC ACID/SALICYL ACID
UREA/LACTIC AC/ZN UNDECYLENATE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
VIT A PALM/VITAMIN E ACETATE
LIDOCAINE
LIDOCAINE
LIDOCAINE HCL/MENTHOL
LIDOCAINE HCL/MENTHOL
LIDOCAINE/MENTHOL
LIDOCAINE/HYDROCORTISONE AC
LIDOCAINE HCL/EPINEPHRINE
HYDROCORTISONE/LIDOCAINE/ALOE
LIDOCAINE/PRILOCAINE
HYDROCORTISONE/LIDOCAINE/ALOE
LIDOCAINE
LIDOCAINE
LIDOCAINE HCL/MENTHOL
LIDOCAINE/MENTHOL
LIDOCAIN/ME-SALICYL/CAPS/MENTH
LIDOCAINE
EMOLLIENT BASE
LIDOCAINE/MENTHOL
LIP BALM
VITAMIN E/MENTH/CAMPH/OCTINOX
BENZOPHENONE
MENTHOL/CAMPHOR/ALLANTOIN/PHE
GLYCERIN/BORIC ACID
DYCLONINE HCL/BENZETHONIUM CL
SALICYLIC ACID
SULFUR/ALCOHOL
SODIUM CHLORIDE
SODIUM CHLORIDE
EMOLLIENT COMBINATION NO. 24
LIDOCAINE
LIDOCAINE/TRANSPARENT DRESSING
LIDOCAINE
MINERAL OIL
VITAMIN E/VIT A&D/CL-XYLENOL
LIDOCAINE/MENTHOL
EMOLLIENT COMBINATION NO.85
BENZOCAINE/MENTHOL
GLYCERIN/PROPYLENE GLYCOL
MINERAL OIL/PETROLATUM,WHITE
CHLORHEX GL/GLYCERIN/HE-CELL
CHLORHEX GL/GLYCERIN/HE-CELL
EMOLLIENT
SOD CHLORIDE/LAN/MO/PET,WH
EMOLLIENT COMBINATION NO.71
EMOLLIENT COMBINATION NO.92
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
LUBRIDERM SENSITIVE SKIN
LUBRIDERM SKIN NOURISHING
LUBRISILK
LUBRI-SKIN
LUBRISOFT
M9
MAC
MAPO
MARLEX LIQUID SOAP
MASSENGILL DISPOSABLE DOUCHE
MAXILUBE
MB HYDROGEL
MECHOLYL
MEDERMA
MEDERMA FOR KIDS
MEDICATED BODY
MEDICATED CHEST RUB
MEDICATED CLEANSING
MEDICATED HEAT PATCH
MEDICATED LIP BALM
MEDI-DERM
MEDI-DERM-L
MEDI-DERM-L-RX
MEDI-FIRST BURN
MEDI-PATCH
MEDIPLAST CORN-CALLUS-WART
MEDI-RUB
MEDROX
MENTHODERM
MERCUROCLEAR
METED
METHAGUAL
MEXSANA
MG217 MEDICATED TAR
MG217 PSORIASIS
MG217 SAL-ACID
MIADERM
MIMYX
MINERIN
MINERIN LOTION
MOBISYL
MOISTURE BARRIER
MOISTURE EYES
MOISTURIZING CREAM
MOISTURIZING LOTION
MOISTURIZING THERAPY
MONOCETE EZ
MOSCO CALLUS-CORN REMOVER
MOSCO CORN REMOVER
96
GENERIC DRUG
GLY/MIN OIL/PETROLAT,WHT/WATER
GLY/DIMETH/URE/PET,WH/CET ALC
GLY/MIN OIL/PETROLAT,WHT/WATER
SOD CHLORIDE/LAN/MO/PET,WH
MINERAL OIL/PETROLAT,WHT/WATER
SODIUM CITRATE
CAPSAICIN/MENTHOL
MAGNESIUM SULFATE
MINERAL OIL
SOAP
ACETIC ACID
CHLORHEX GL/GLYCERIN/HE-CELL
EM#53/NAMGF/CYC/PHOS/NAHC/NACL
METHACHOLINE/METHYL SALICYLATE
ALLANTOIN/ONION/PEG/WATER
ALLANTOIN/ONION/PEG/WATER
MENTHOL/ZINC OXIDE
MEDICATED CALLUS REMOVER
EUCALYPT/MEN/CAMP/TURP/PET,WH
SALICYLIC ACID
CAPSAICIN
MENTHOL/CAMPHOR/PHEN/SALICYLIC
CAPSAICIN/ME-SALICYLATE/MENTH
LIDOCAIN/ME-SALICYL/CAPS/MENTH
LIDOCAIN/ME-SALICYL/CAPS/MENTH
LIDOCAINE HCL/BENZALK CHL
LIDOCAIN/ME-SALICYL/CAPS/MENTH
SALICYLIC ACID
EUCALYPT/MEN/CAMP/TURP/PET,WH
CAPSAICIN/MENTHOL
METHYL SALICYLATE/MENTHOL
LIDOCAINE HCL/BENZALK CHL
SALICYLIC ACID/SULFUR
ME-SALICYLATE/GUAIA/PET,WH
METHYL SALICYLATE
ZINC OXIDE
COAL TAR
COAL TAR
SALICYLIC ACID
EMOLLIENT COMBINATION NO.63
EMOLLIENT COMBINATION NO.35
MINERAL OIL/PETROLATUM,WHITE
MINERAL OIL/I-PROP MYR/WATER
TROLAMINE SALICYLATE
MINERAL OIL/PETROLATUM,WHITE
GLYCERIN/PROPYLENE GLYCOL
GLY/DIMETH/PETROLAT,WHT/WATER
MINERAL OIL/I-PROP MYR/WATER
MINERAL OIL/PETROLATUM,WHITE
MONOCHLOROACETIC ACID
SALICYLIC ACID
SALICYLIC ACID
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
MOSCO-CAIN
MOUTH CLEANSER
MOUTH SORE
MULTI-PURPOSE MOISTURE BARRIER
MUPPET BABY POWDER
MURINE EAR WAX REMOVAL SYSTEM
MUSCLE RELIEF
MUSCLE RUB
MUSCLE RUB ULTRA STRENGTH
MUSTARGEN
MYOFLEX
NAIL SCRUB
NASADROPS
NASAL MOIST
NASAL MOISTURIZING
NATURAL CARE GEL
NATURAL OATMEAL BATH
TREATMENT
NATURAL PAIN RELIEVING
NEOBENZ MICRO
NEOBENZ MICRO SD
NEOSALUS
NEOSALUS CP
NEOSPORIN MOISTURIZING CREAM
NEOSPORIN NEO TO GO
NEUVAXIN
NEW SKIN
NEW TEROCIN
NIVATOPIC PLUS
NIVEA
NIVEA ORIGINAL
NIVEA SOFT
NO FUNGUS
NOBLE FORMULA
NOBLE FORMULA S
NOMLANDS
NORMLGEL
NOURIVA REPAIR
NOVACORT
NULLO
NUOX
NUPERCAINAL
NUPRIN ARTHRITIS PATCH
NUTRADERM
NUTRADERM 30
NUVAIL
OATMEAL BATH
OATMEAL MOISTURIZING
OC8
OCEAN
ODOR-EATERS
OILATUM
97
GENERIC DRUG
BENZOCAINE
CARBAMIDE PEROXIDE
BENZOCAINE
MENTHOL/ZINC OX/ALOE/CHAM OIL
TALC
CARBAMIDE PEROXIDE
CAPSAICIN
METHYL SALICYLATE/MENTH/CAMPH
METHYL SALICYLATE/MENTH/CAMPH
MECHLORETHAMINE HCL
TROLAMINE SALICYLATE
CALCIUM CARBONATE/NA HYPOCHLOR
SODIUM CHLORIDE
SODIUM CHLORIDE
SODIUM CHLORIDE
ALOE/DEXPANTHENOL/HYALURON AC
COLLOIDAL OATMEAL
MENTHOL/CAMPHOR/IRR CNTR-IRTN1
BENZOYL PEROXIDE MICROSPHERES
BENZOYL PEROXIDE MICROSPHERES
EMOLLIENT COMBINATION NO.38
EMOLLIENT COMBINATION NO.47
COLLOIDAL OATMEAL
PRAMOXINE HCL/BENZALKONIUM CHL
CAPSAICIN/MENTHOL
BENZETHONIUM CHLORIDE
CAPSAICIN/ME-SALICYLATE/MENTH
EMOLLIENT COMBINATION NO.53
EMOLLIENT COMBINATION NO.66
EMOLLIENT COMBINATION NO.68
EMOLLIENT COMBINATION NO.67
TEA TREE OIL
PYRITHIONE ZINC
SALICYLIC ACID/PYRITHIONE ZINC
RESORCINOL/CALAMINE
SODIUM CHLORIDE
MINERAL OIL/PETROLATUM,WHITE
HYDROCORTISONE/PRAMOXINE/ALOE
CHLOROPHYLLIN COPPER COMPLEX
BENZOYL PEROXIDE/SULFUR
DIBUCAINE
CAPSICUM OLEORESIN
MINERAL OIL
GLY/DIMETH/URE/PET,WH/CET ALC
POLY-UREAURETHANE
COLLOIDAL OATMEAL
DIMETHICONE/COLLOIDAL OATMEAL
BENZOYL PEROXIDE
GLYCERIN/HYALURONATE SODIUM
OCEAN SALINE NASAL SPRAY
FOOT DEODORANT COMB. NO.2
SOAP
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
OIL-FREE ACNE WASH
ONE-STEP PLANTAR WART REMOVER
ONE-STEP WART REMOVER
ON-THE-SPOT
OPTASE
ORA RELIEF
ORABASE
ORA-BLEND
ORAL ANALGESIC
ORAL ANESTHETIC
ORAL ANESTHETIC PASTE
ORAL CLEANSING
ORAL PAIN RELIEF
ORAL PAIN RELIEVER
ORAL RELIEF
ORAMAGIC PLUS
ORIGINAL ABSORBINE JR.
ORIGINAL FORMULA
ORIGINAL OINTMENT
ORTHO-NESIC
ORTHOVISC
OSCION
OSTIDERM
OUTGRO
OXALIS
OXIPOR VHC
P&S
PACNEX
PACNEX HP
PACNEX LP
PACNEX MX
PAIN EASE
PAIN RELIEF ANESTHETIC
PAIN RELIEF SWABS-BENZOCAINE
PAIN RELIEVING OINTMENT
PAIN RELIEVING RUB
PAIN-RELIEF
PANOXYL
PANOXYL 5
PANOXYL-4
PANOXYL-8
PANRETIN
PARAFFIN WAX
PAZOL XS
PC TAR
PCCA EMOLLIENT
PEDIATRIC OINTMENT
PEDI-BORO SOAK
PELEVERUS
PELEVERUS CLEAR
98
GENERIC DRUG
SALICYLIC ACID
OLIVE OIL
SALICYLIC ACID
SALICYLIC ACID
BENZOYL PEROXIDE
TRYPSIN/BALSAM PERU/CASTOR OIL
PHENOL
BENZOCAINE
COMPOUNDING VEHICLE SUSP NO.2
BENZOCAINE
BENZOCAINE
BENZOCAINE
CARBAMIDE PEROXIDE
BENZOCAINE
BENZOCAINE
PHENOL
BENZOCAINE
THYMOL/MENTHOL
SOAP
CAMPHOR
CAPSAICIN/CAMPHOR/MENTHOL
HYALURONATE SODIUM
BENZOYL PEROXIDE
ALUMINUM CHLOROHYDRATE
BENZOCAINE
OXALIC ACID
COAL TAR
PHENOL/SODIUM CHLORIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
NORFLURANE/HFC 245FA
BENZOCAINE
ISOPROPYL ALCOHOL/BENZOCAINE
BENZOCAINE
METHYL SALICYLATE/MENTH/CAMPH
METHYL SALICYLATE/MENTH/CAMPH
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
BENZOYL PEROXIDE
ALITRETINOIN
PANTOTHENIC ACID
PARAFFIN
SALICYLIC ACID/COAL TAR/SULFUR
COAL TAR
EMOLLIENT BASE
COD LIVER OIL/ZINC OXIDE
CALCIUM ACETATE/ALUMINUM SULF
ZINC ACETATE
ZINC ACETATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
PELEVERUS GOLD
PENETRAN + PLUS
PEN-KERA
PENTRAVAN
PERANEX HC
PERIGUARD
PERINEAL CLEANSING FOAM
PERISHIELD
PERNOX
PERNOX SCRUB CLEANSER
PERSA-GEL
PERSONAL LUBRICANT
PERSONAL LUBRICATING JELLY
PETROLATUM
PETROLEUM JELLY
PFCB
PHARMABASE BARRIER
PHARMABASE NATURAL
PHARMACIST PAIN RELIEF
PHARMACIST'S CREME
PHENASEPTIC
PHENOL EZ
PHISODAN
PHYSIOLYTE
PHYSIOSOL
PICATO
PINEAPPLE EXTRACT
PINNACAINE
PLANTAR WART REMOVER
PLIAGLIS
PODOCON-25
PODODERM
POISON IVY RELIEF
POLAR FROST
PONARIS NASAL EMOLLIENT
PONTOCAINE
PORE UNCLOGGING
PR BENZOYL PEROXIDE
PR CREAM
PRAMCORT
PRAMOSONE
PRAMOSONE E
PRE-ATTACHED LTA KIT
PRECISE PAIN RELIEVING
PREPSITE
PRESERA
PRETTY FEET & HANDS
PROCORT
PROCTOFOAM-HC
99
GENERIC DRUG
ZINC ACETATE
AMMONIA SOLUTION, STRONG/MSM
EMOLLIENT COMBINATION NO.58
CREAM BASE NO.126
LIDOCAINE/HYDROCORTISONE AC
VIT A/VITAMIN D3/E/ALOE V/ZNOX
POT SORBATE/VIT E/ALOE V/UREA
ZINC OXIDE
SALICYLIC ACID/SULFUR
SALICYLIC ACID/SULFUR
BENZOYL PEROXIDE
CHLORHEX GL/GLYCERIN/HE-CELL
CHLORHEX GL/GLYCERIN/HE-CELL
MINERAL OIL/HYDROPHIL PETROLAT
PETROLATUM,WHITE
EMOLLIENT BASE
ZINC OXIDE
CREAM BASE NO.110
CAPSAICIN/ME-SALICYLATE/MENTH
CAPSIC OLEO/ME-SALICYLATE/MEN
PHENOL
PHENOL
PHENOL LIQUID
SODIUM SALICYLATE/SULFUR
PHYSIOLOGICAL IRRIG SOL CMB #1
PHYSIOLOGICAL IRRIG SOL CMB #1
INGENOL MEBUTATE
BROMELAINS
BENZOCAINE
SALICYLIC ACID
LIDOCAINE/TETRACAINE
PODOPHYLLUM RESIN
PODOPHYLLUM RESIN
PODOFILOX
BENZOCAINE
MENTHOL/ALOE VERA EXTRACT
EUCALYPTUS/PEPPERMINT OIL
TETRACAINE
SALICYLIC ACID
POTASSIUM HYDROXIDE
BENZOYL PEROXIDE MICROSPHERES
PROTECT CMB2/CERAMIDE 1,3,6-11
HYDROCORTISONE/PRAMOXINE
HYDROCORTISONE/PRAMOXINE
HYDROCORTISONE/PRAMOXINE/EMOLL
LIDOCAINE HCL
METHYL SALICYLATE/MENTHOL
POLOXAMER
EMOLLIENT COMBINATION NO.80
EMOLLIENT BASE
HYDROCORTISONE/PRAMOXINE
HYDROCORTISONE/PRAMOXINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
PRODERM
PROMISEB
PROMISEB COMPLETE
PROSCAR
PROSHIELD FOAM & SPRAY
PROSHIELD SKIN CARE
PROSHIELD SPRAY
PROTECTIVE
PROTECTIVE OINTMENT
PROTEIN
PROVENZA
PROVISC
PRUCLAIR
PRUMYX
PRUTECT
PRUVEL
PSORIASIN
PSORIASIS MEDICATED
PURALUBE
PUROXCIN
QROXIN
QUSAMINE-ST
QUTENZA
RADIAPLEXRX
RAPID CLEAR
RASH RELIEF CLEAR
RASH RELIEF-SILVER
RASH RELIEF-ZINC OXIDE
RECEDO
RECIPHEXAMINE
RECTICARE
REFRESH LACRI-LUBE
REFRESH P.M.
REGENECARE
REGENECARE HA
RELYYKS
RELYYT
REMEDY CALAZIME
REMEDY CLEAR-AID
REMEDY PHYTOPLEX Z-GUARD
REMEDY WITH PHYTOPLEX Z-GUARD
RENEWAL
RENEWAL DAILY MOISTURE LOTION
RENEWAL HEALING
RENEWAL MOISTURIZING CREAM
RENOVO
RESINOL
RESOURCE THICKENUP
RESTORE MOISTURE BARRIER
RESTORE SKIN CONDITIONING
REVINA
REZAMID
100
GENERIC DRUG
BALSAM PERU/CASTOR OIL
EMOLLIENT COMBINATION NO.43
EMOLLIENT #43/SKIN CLEANSER#27
FINASTERIDE
SKIN CLEANSER COMB NO.34
POLOXAMER/GLYCERIN/DIMETH/H2O
SKIN CLEANSER COMB NO.34
TALC/ZINC OXIDE
PETROLATUM,WHITE
PROTEIN SUPPLEMENT
LIDOCAINE HCL/MENTHOL
HYALURONATE SODIUM
VITE AC/GRAPE/HYALURONIC ACID
EMOLLIENT COMBINATION NO.35
EMOLLIENT COMBINATION NO.10
EMOLLIENT COMBINATION NO. 25
COAL TAR
SALICYLIC ACID
MINERAL OIL/PETROLATUM,WHITE
LIDOCAINE HCL/MENTHOL
CAPSAICIN/MENTHOL
SALICYLIC ACID
CAPSAICIN/SKIN CLEANSER
HYALURON SOD/ALLANTOIN/ALOE XT
SALICYLIC ACID
DIMETHICONE/PETROLATUM,WHITE
DIMETHICONE/ZINC OXIDE/SILVER
DIMETHICONE/ZINC OXIDE
POLYDIMETHYLSILOXANES/SILICON
LIDOCAINE HCL/MENTHOL
LIDOCAINE
MINERAL OIL/PETROLATUM,WHITE
MINERAL OIL/PETROLATUM,WHITE
LIDOCAINE HCL/COLLAGEN
LIDOCAINE/HYALUR AC/ALOE/COLL
LIDOCAINE/MENTHOL
CAPSAICIN/MENTHOL
CALAMINE/MENTHOL/PETROLAT/ZINC
PETROLATUM,WHITE
ZINC OXIDE/PETROLATUM,WHITE
PETROLATUM,WHITE
COLLOIDAL OATMEAL
DIMETHICONE/COLLOIDAL OATMEAL
PETROLATUM,WHITE
CERAMIDES 1,3,6-11
CAPSAICIN/MENTHOL
RESOR/CALA/ZNOX/PET,WH/LAN
CORN STARCH
VIT A PALM/VIT D2/E/B-O/PET,WH
EMOLLIENT COMBINATION NO.36
TRYPSIN/BALSAM PERU/CASTOR OIL
RESORCINOL/SULFUR
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
RHINARIS
RIAX
RINGERS INJECTION
RINGERS IRRIGATION
RINNOVI
RISABAL-PH
RISAMINE
ROBATHOL
ROLL ON DEODORANT
ROSULA NS
SA
SA 6%
SALACTIC FILM
SALACYN
SALEX
SALINE MIST
SALINE NASAL GEL
SALINE NASAL MIST
SALINE NASAL SPRAY
SALINE NOSE SPRAY
SALJET SALINE
SALJET SALINE RINSE
SALKERA
SALONPAS
SALONPAS-HOT
SAL-PLANT
SALVAX
SALVAX DUO PLUS
SANTYL
SARATOGA
SASTID
SAYMAN SALVE
SCALP ITCH-DANDRUFF RELIEF
SCALP TREATMENT
SCAR
SCAR GEL
SCAR RELIEF
SCAR TREATMENT
SCLEROSOL
SCYTERA
SE BPO
SEA SOFT
SEA-CLENS
SEBASORB
SEBEX
SEBULEX SHAMPOO
SECURA EXTRA PROTECTIVE
SECURA PROTECTIVE
SELECT BRAND DISPOSABLE DOUCHE
SELRX
101
GENERIC DRUG
SODIUM CHLORIDE
BENZOYL PEROXIDE
RINGERS SOLUTION
RINGERS SOLUTION
UREA/EMOL/BAK CL/PVP/GRP SD XT
MINERAL OIL/PETROLATUM,WHITE
MENTHOL/ZINC OXIDE
COTTONSEED OIL
ALUMINUM CHLORIDE
SULFACETAMIDE SODIUM/UREA
SALICYLIC ACID/CERAMIDE CMB #1
SALICYLIC ACID
SALICYLIC ACID/COLLODION, FLEX
SALICYLIC ACID
SALICYLIC ACID
SALICYLIC ACID
SODIUM CHLORIDE
SODIUM CHLORIDE/ALOE VERA
SODIUM CHLORIDE
SODIUM CHLORIDE
SODIUM CHLORIDE
SODIUM CHLORIDE
SODIUM CHLORIDE
SALICYLIC ACID/AMMON LACT/ALOE
CAPSAICIN/MENTHOL
CAPSAICIN
SALICYLIC ACID
SALICYLIC ACID
SALICYLIC ACID/UREA
COLLAGENASE CLOSTRIDIUM HIST.
EUCALYPT/ZNOX/BORIC AC/PET,WH
SALICYLIC ACID/SULFUR
ZINC OXIDE/PETROLATUM,WHITE
SALICYLIC ACID
SULFACETAMIDE SODIUM/UREA
ALLANTOIN/ONION/PEG/WATER
ALLANTOIN/ONION/PEG/WATER
ALLANTOIN/ONION/PEG/WATER
SILICONE ADHESIVE
TALC
COAL TAR
BENZOYL PEROXIDE
SODIUM CHLORIDE
NACL IRRIGAT/DECYL GLUCOSIDE
SALICYLIC ACID/SULFUR
SALICYLIC ACID/SULFUR
SALICYLIC ACID/SULFUR
ZINC OXIDE
PETROLATUM,WHITE
ACETIC ACID
SELENIUM SULFIDE
SELENIUM SULFIDE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
SELSEB
SELSUN BLUE
SELSUN BLUE NATURALS
SENSI-CARE
SENSI-CARE MOISTURIZING 2
SENSITIVE SKIN MOISTURE
SEPTI-SOFT
SEVERE DRY
SHIELD SKIN
SHUR-CLENS
SILICONE DISC
SILICONE ROLL
SILICONE SCAR
SILICONE SHEET
SILICONE TAPE
SILK SKIN
SILVERA
SIMPLY SALINE
SINELEE
SINUS WASH SALT
SKARJEL
SKEETER STIK
SKIN BALM
SKIN CARE LOTION
SKIN PROTECTANT
SKIN RELIEF MOISTURE
SKIN REPAIR
SKIN SCREEN
SKIN TREATMENT
SODIUM HYALURONATE
SOLAICE
SOLARCAINE
SOLARCAINE ALOE EXTRA
SONAFINE
SOOTHE & COOL BODY LOTION
SOOTHE & COOL BODY POWDER
SOOTHE & COOL MEDSEPTIC
SOOTHE & COOL MOIST BARRIER
SOOTHE & COOL PERINEAL WASH
SOOTHE & COOL SKIN CREAM
SOOTHE & COOL SKIN PASTE
SOOTHE LUBRICANT
SOOTHING BATH TREATMENT
SORBITOL
SORBITOL-MANNITOL
SORE THROAT
SOY PRO PROTEIN
SPECIAL CARE LOTION
SPORTS PAIN RELIEF
SPORTSCREME
102
GENERIC DRUG
SELENIUM SULFIDE
SELENIUM SULFIDE
SALICYLIC ACID
ALOE VERA/COLLAGEN
DIMETHICONE/PETROLATUM,WHITE
GLYCERIN/DIMETHICONE
SOAP
MINERAL OIL/HYDROPHIL PETROLAT
ISOPROPANOL/ETHYLCELLULOSE
POLOXAMER
SILICONES/ADHESIVE TAPE
SILICONES/ADHESIVE TAPE
ALOE/LA/CERAMIDE/SILICONE&TAPE
SILICONES/ADHESIVE TAPE
SILICONES/ADHESIVE TAPE
LANOLIN/MINERAL OIL
LIDOCAINE/CAPSAICIN/MENTHOL
SODIUM CHLORIDE
CAPSAICIN/MENTHOL
SODIUM CHLORIDE
EMOLLIENT COMBINATION NO.74
BENZOCAINE/MENTHOL
PANTOTHENIC ACID/ALOE VERA
GLYCERIN/MINERAL OIL
ZINC OXIDE
DIMETHICONE/COLLOIDAL OATMEAL
VIT A/VITE AC/ALOE V/EMU OIL
SILICONE/LAN/ISOPROPANOL/PGLY
AMMONIUM LACTATE
SODIUM CHLORIDE
SODIUM CITRATE
HYALURONATE SODIUM
CAPSAICIN/MENTHOL
BENZOCAINE/TRICLOSAN
LIDOCAINE/ALOE VERA
EMOLLIENT COMBINATION NO.10
GLYCERIN/LAN/MIN OIL/ALOE VERA
CORN STARCH
LANOLIN
PETROLATUM/VIT A&D/ALOE VERA
LANOLIN/ALOE VERA/PROP GLY
VITAMINS A AND D/ALOE VERA
ZINC OXIDE/PETROLATUM,WHITE
GLYCERIN/PROPYLENE GLYCOL
COLLOIDAL OATMEAL
SORBITOL SOLUTION
MANNITOL/SORBITOL SOLUTION
BENZOCAINE/MENTHOL
SOY PROTEIN
GLYCERIN/MINERAL OIL
TROLAMINE SALICYLATE
TROLAMINE SALICYLATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
SPRAY AND STRETCH
SPRAYZOIN
STAPHASEPTIC
STERILE TALC
STERILUBE
STICK DEODORANT
STUDIO 35 MOISTURIZING SKIN
SUMMER'S EVE DISPOSABLE DOUCHE
SUMMER'S EVE INTIM CLN CLOTH
SUPARTZ
SUPER DUPER DIAPER DOO
SUPER TROCHE PLUS
SUPERSOFT
SURGEL
SURGILUBE
SWEEN CREAM
SWEET OIL
SYNERA
SYNVEXIA
SYNVEXIA TC
SYSTANE
T+PLUS
TAR DISTILLATE
TAR OIL
TAR SHAMPOO
TARGRETIN
TARSUM GEL-SHAMPOO
TEA TREE OIL
TEARS AGAIN
TEARS NATURALE PM
TEARS RENEWED
TENDER CARE LANOLIN
TERA-GEL TAR
TEROCIN
TERSI FOAM
TETCAINE
TETRAVISC
TETRAVISC FORTE
TETRIX
T-GEL
THERA BATH
THERA-DERM
THERAFLU VAPOR PATCH
THERA-GEL
THERA-GESIC
THERA-GESIC PLUS
THERA-P HAND AND BODY LOTION
THERAPEUTIC
THERAPEUTIC GEL
THERAPEUTIC MOISTURIZING
103
GENERIC DRUG
NORFLURANE/HFC 245FA
BENZOIN
LIDOCAINE HCL/BENZETHONIUM CL
TALC
MINERAL OIL/PETROLATUM,WHITE
ALUMINUM CHLOROHYDRATE
GLY/DIMETH/PETROLAT,WHT/WATER
ACETIC ACID
LANOLIN/PROPYLENE GLYCOL/PEG
HYALURONATE SODIUM
PETROLATUM,WHITE/LANOLIN
BENZOCAINE
PETROLATUM,WHITE/WATER
MINERAL OIL
SURGICAL LUBRICANT
VITAMINS A AND D
OLIVE OIL
LIDOCAINE/TETRACAINE
LIDOCAINE HCL/MENTHOL
LIDOCAINE HCL/MENTHOL
MINERAL OIL/PETROLATUM,WHITE
COAL TAR
TALC
COAL TAR
COAL TAR
COAL TAR
BEXAROTENE
SALICYLIC ACID/COAL TAR
LANOLIN/MIN OIL/PETROLAT,WHT
MINERAL OIL/PETROLATUM,WHITE
MINERAL OIL/PETROLATUM,WHITE
LANOLIN
COAL TAR
CAPSAICIN/ME-SALICYLATE/MENTH
SELENIUM SULFIDE
TETRACAINE HCL
TETRACAINE HCL
TETRACAINE HCL
TETRACAINE HCL
PROTECT CMB2/CERAMIDE 1,3,6-11
COAL TAR
LANOLIN/MINERAL OIL
LANOLIN/MINERAL OIL
EUCALYPTUS/MENTHOL/CAMPHOR
COAL TAR
METHYL SALICYLATE/MENTHOL
METHYL SALICYLATE/MENTHOL
LANOLIN/MINERAL OIL
SALICYLIC ACID
COAL TAR
MINERAL OIL/PETROLATUM,WHITE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
THERAPEUTIC SHAMPOO
THERAPEUTIC T+PLUS
THERA-SAL
TINCTURE OF BENZOIN
TL 4.25% BPO MX
TL TRISEB
TL-CERMIDE
TOPICAINE
TOPICAINE 5
TOPICAL LIGHT MINERAL OIL
TRANSANOSIL
TRANS-VER-SAL
TRIAD
TRIAZ
TRIPLE CREAM
TRIPLE PASTE
TRIXAICIN
TRIXAICIN HP
TROCAINE
TROPAZONE
TRU-MICIN
T-SAL
TUGABOOS BABY OIL
ULCEREASE
ULTRA FRESH PM
ULTRA SALINE
ULTRA STRENGTH RUB
ULTRA THERAPY PAIN RELIEF
ULTRACIN
ULTRAMINO
ULTRASAL-ER
ULTRASONE
UNGUENTINE
UNIDERM MOISTURIZER
UNI-SALVE
UNI-WASH SKIN CLEANSER
UNSCENTED COLD CREAM
UREA 50
VAGICAINE
VAGICREAM
VAGINAL ITCH CREAM
VALCHLOR
VANICREAM
VANICREAM DIAPER RASH
VANICREAM LITE
VANOXIDE HC
VAPORIZING RUB
VAPORX BALM
VASELINE WHITE PETROLEUM
VASHE WOUND THERAPY
104
GENERIC DRUG
COAL TAR
SALICYLIC ACID
SALICYLIC ACID
BENZOIN
BENZOYL PEROXIDE
EMOLLIENT COMBINATION NO.43
EMOLLIENT COMBINATION NO.32
LIDOCAINE
LIDOCAINE
MINERAL OIL
CAPSAICIN/ME-SALICYLATE/MENTH
SALICYLIC ACID
HYDROPHILIC CREAM
BENZOYL PEROXIDE
EMOLLIENT COMBINATION NO.55
ZINC OXIDE
CAPSAICIN
CAPSAICIN
BENZOCAINE
TROLAMINE SALICYLATE
EMOLLIENT COMBINATION NO.48
TROLAMINE SALICYLATE
SALICYLIC ACID
MINERAL OIL
TURPENTINE OIL
PHENOL
LANOLIN/MIN OIL/PETROLAT,WHT
SODIUM CHLORIDE
METHYL SALICYLATE/MENTH/CAMPH
CAPSAICIN/ME-SALICYLATE/MENTH
CAPSAICIN/ME-SALICYLATE/MENTH
SOY PROTEIN
SALICYLIC ACID
EMOLLIENT COMBINATION NO.39
ZINC OX/CAMPHOR/PHENOL/TAN AC
LANOLIN
PETROLATUM,WHITE
SOAP
COLD CREAM
UREA/LACTIC AC/ZN UNDECYLENATE
BENZOCA/RES/ALOE/VIT E/VIT A&D
B-CAINE/BENZALK CL/ALOE/VIT E
BENZOCAINE/RESORCINOL
MECHLORETHAMINE HCL
EMOLLIENT BASE
DIMETHICONE/ZINC OXIDE
PETROLATUM,WHITE/WATER
BENZ PEROX/HC/SKIN CLNSR NO.14
EUCALYPTUS OIL/MENTHOL/CAMPHOR
EUCALYPTUS OIL/MENTHOL/CAMPHOR
PETROLATUM,WHITE
SODIUM CHLOR/HYPOCHLOROUS ACID
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
BRAND DRUG
VASOLEX
VEHICLE-N
VEHICLE-N MILD
VELMA
VELVACHOL
VENCEDOR-15
VENELEX
VEXA
VIASPAN BELZER-UW
VICKS BABYRUB
VICKS VAPORUB
VIRASAL
VITAMIN A & D
VITAMIN A & D GRX
VITAMIN A AND D
VITAMIN E & A
VITAMIN E & C
VITAMIN E & D
VITAMIN E & K
VITAMIN E PLUS
VITAMIN E WITH VIT A&D
VITAQUICK
VITA-RAY
VITRASE
VOSOL
WART REMOVER
WART STICK
WATER
WHITE PETROLATUM
WHITE PETROLEUM
WINTERGREEN OIL
WOUND WASH SALINE
XCLAIR
XENADERM
XERAC AC
XIAFLEX
XOTEN
XOTEN-C
X-SEB T PEARL
X-SEB T PLUS
XTRACARE
XYLOCAINE WITH EPINEPHRINE
XYLOCAINE-MPF WITH EPINEPHRINE
YODORA
ZACARE
ZACLIR
ZENIEVA
ZERUVIA
ZIKS
ZILACTIN-B
ZINC OXIDE DIAPER CREAM
105
GENERIC DRUG
TRYPSIN/BALSAM PERU/CASTOR OIL
ALC/ISOPROPANOL/PROP GLY/WATER
ALC/ISOPROPANOL/PROP GLY/WATER
LIDOCAINE/METHYL SAL/MENTHOL
MO/PET,WH/CET/ST ALC/SLS/CHOL
BENZOCAINE
BALSAM PERU/CASTOR OIL
LIDOCAINE/ALLANTOIN/PETROLATUM
ORGAN PRESERVATION SOLN-BELZER
EUC OIL/ALOE/LAV&ROSEM OILS/PT
EUCALYPT/MEN/CAMPH/TURP/PET,WH
SALICYLIC ACID
VITAMIN A
PETROLATUM,WHITE/LANOLIN
VITS A & D/WHITE PET/LANOLIN
VITAMINS A AND D
VIT A/VIT E AC/SAFFLOWER OIL
ASCORB PALM/VIT E ACETATE/B5
VIT D3/VIT E AC/SAFFLOWER OIL
VIT E AC/VIT K/SAFFLOWER OIL
VIT E ACETATE/E13/LAN/COCOA
VITAMIN E, VITAMIN A,AND VIT D
CORN STARCH
VIT A PALM/VIT E ACETATE/ALOE
HYALURONIDASE,OVINE
ACETIC ACID
SALICYLIC ACID
SALICYLIC ACID
WATER FOR IRRIGATION,STERILE
PETROLATUM,WHITE
PETROLATUM,WHITE
METHYL SALICYLATE
SODIUM CHLORIDE
HYALURO/DL-E AC/E12/ALLAN/SHEA
TRYPSIN/BALSAM PERU/CASTOR OIL
ALUMINUM CHLORIDE
COLLAGENASE CLOSTRIDIUM HIST.
METHYL SALICYLATE/MENTHOL
CAPSAICIN/ME-SALICYLATE/MENTH
SALICYLIC ACID/COAL TAR
COAL TAR
GLY/LAN/ME-BENZ/NA LAURYL SO4
LIDOCAINE HCL/EPINEPHRINE
LIDOCAINE HCL/EPINEPHRINE/PF
BENZ AC/SAL ACID/ZNOX/BORIC AC
BENZOYL PEROXIDE/HYALURONT SOD
BENZOYL PEROXIDE
EMOLLIENT COMBINATION NO.35
LIDOCAINE HCL/MENTHOL
CAPSAICIN/ME-SALICYLATE/MENTH
BENZOCAINE
DIMETHIC/ZINC OX/VIT A&D/ALOE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - MISCELLANEOUS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PIGMENTATION DISORDERS
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
BRAND DRUG
ZINC-OXYDE PLUS
ZNP BAR
ZODERM
ZOSTRIX
ZOSTRIX DIABETIC
ZOSTRIX HIGH POTENCY
ZOSTRIX HP
Z-PRAM
8-MOP
ACLARO
ACLARO PD
BABY SUNBLOCK
C-CLARIFYING SERUM
CETAPHIL DAILY MOISTURIZING SP
CETAPHIL DERMACONTROL
CHILDREN'S SUNBLOCK
C-THERAPY NIGHT CREAM
EPIQUIN MICRO
ESOTERICA FADE CREAM
EUCERIN DAILY PROTECTION
KERI AGE DEFY & PROTECT
LUBRIDERM
LUSTRA-AF
NU-DERM SUNFADER
OIL-FREE MOISTURE
OXSORALEN
OXSORALEN-ULTRA
RADIADERM R1-R2
RADIADERM R2
SUNBLOCK
SUNSCREEN
TOTAL BLOCK
TRI-LUMA
TROPICAL STYLE
UVADEX
ACUWASH
AMEVIVE
ASTAGRAF XL
BETAMIDE
BODI LUX
BOYOL
CALCIJEX
CALCIPOTRIENE-BETAMETHASONE DP
CALCITRENE
CARRASYN GEL
106
GENERIC DRUG
MENTHOL/ZINC OXIDE
PYRITHIONE ZINC
BENZOYL PEROXIDE/UREA
CAPSAICIN
CAPSAICIN
CAPSAICIN
CAPSAICIN
HYDROCORT/PRAMOXN/SKN CLNSR#16
METHOXSALEN
HYDROQUINONE/AVOBENZ/OCTINOX
HYDROQUINONE/AVOBENZ/OCTINOX
OXYBENZONE/OCTINOXATE/OCTOCRYL
HYDROQUINONE/ASCORBIC ACID
OXYBENZONE/PADIMATE O
AVOBENZONE/OCTOCRYL/OCTYL SAL
OXYBEN/HOMOSAL/CINOX/SUNSCREEN
COPPERTONE SUNBLOCK SPF15
COPPERTONE SUNBLOCK SPF30
COPPERTONE SUNBLOCK SPF40
COPPERTONE SUNBLOCK SPF50
HYDROQUINONE/VIT C/VIT E ACET
HYDROQUINONE MICROSPHERES
HYDROQUINONE/OXYBENZONE/PADIMA
ENS/OCTIN/OCT SAL/TIT DIO/ZNOX
OXYBENZONE/OCTINOXATE
OXYBENZONE/OCTINOX/OCTYL SAL
VIT E AC/AVOBNZ/OCTINOX/H-QUIN
OXYBENZONE/OCTINOX/H-QUINONE
OXYBENZONE/OCTINOXATE
METHOXSALEN
METHOXSALEN, RAPID
AVOBENZ/HOMOSAL/OCTIN/OCT/EM52
AVOBENZ/HOMOSAL/OCTINOX/OCTOCR
OXYBENZONE/OCTINOXATE
OXYBENZONE/PADIMATE O
TIO2/ZNOX/OXYBEN/OCTNX/O-CRYL
FLUOCINOLONE/TRETINOIN/H-QUIN
PADIMATE O/OCTINOXATE
METHOXSALEN
ACITRETIN
SKIN CLEANSER COMB NO.19
ALEFACEPT
TACROLIMUS
UREA/HYDROPHILIC CREAM
SKIN CLEANSER COMBINATION NO.2
ICHTHAMMOL
CALCITRIOL
CALCIPOTRIENE
CALCIPOTRIENE/BETAMETHASONE
CALCIPOTRIENE
CALCITRIOL
ALLANTOIN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DERMATOLOGY - PSORIASIS/ECZEMA
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
BRAND DRUG
CARRASYN SPRAY GEL
CLOBETA
CLOBETA + PLUS
COSENTYX (2 SYRINGES)
COSENTYX PEN
COSENTYX PEN (2 PENS)
COSENTYX SYRINGE
CUTEMOL EMOLLIENT
D.R. SENSITIVE SKIN
DOVONEX
DRITHOCREME HP
DRITHO-SCALP
ELIDEL
FLEXITOL
HECORIA
JOHNSON'S FOOT
PROGRAF
PROTOPIC
PYROGALLIC ACID
REHYLA
REMEDY 4-IN-1 BODY
RESTORE SKIN CLEANSER
RESTORE WOUND CLEANSER
ROCALTROL
SORBOLENE
SORIATANE
SORILUX
TACLONEX
TACLONEX SCALP
TENA
TOETAL FRESH
TRI-CHLOR
TRIPLE HELIX COLLAGEN
UNICARE MOISTURIZING
VECTICAL
ZITHRANOL
ZITHRANOL-RR
ACTOPLUS MET
ACTOPLUS MET XR
ACTOS
AFREZZA
AMARYL
APIDRA
APIDRA SOLOSTAR
AVANDAMET
AVANDARYL
AVANDIA
107
GENERIC DRUG
ALLANTOIN
CLOBETASOL PROPIONATE/COAL TAR
CLOBETASOL PROPIONATE/COAL TAR
SECUKINUMAB
SECUKINUMAB
SECUKINUMAB
SECUKINUMAB
ALLANTOIN
URE/CETYL ALC/STEARYL ALC/PG
CALCIPOTRIENE
ANTHRALIN
ANTHRALIN
PIMECROLIMUS
UREA/ALLANTOIN/VIT E ACETATE
GREEN SOAP
TACROLIMUS
FOOT CLEANSER COMBINATION NO.1
TACROLIMUS
TACROLIMUS
PYROGALLOL
SKIN CLEANSER COMBINATION #23
ALLANTOIN
SKIN CLEANSER COMB NO.20
SKIN CLEANSER COMB NO.21
CALCITRIOL
GLY/MIN OIL/PET,WH/CTS/H2O
ACITRETIN
CALCIPOTRIENE
CALCIPOTRIENE/BETAMETHASONE
CALCIPOTRIENE/BETAMETHASONE
TACROLIMUS
SOAP/EMOLLIENT BASE
UREA/CAMPHOR/MENTHOL/EUCALYPTL
TRICHLOROACETIC ACID
TRICHLOROACETIC ACID
COLLAGEN,BOVINE
ALLANTOIN
CALCITRIOL
ANTHRALIN MICRONIZED
ANTHRALIN
ACARBOSE
PIOGLITAZONE HCL/METFORMIN HCL
PIOGLITAZONE HCL/METFORMIN HCL
PIOGLITAZONE HCL
INSULIN REGULAR, HUMAN
GLIMEPIRIDE
INSULIN GLULISINE
INSULIN GLULISINE
ROSIGLITAZONE/METFORMIN HCL
ROSIGLITAZONE/GLIMEPIRIDE
ROSIGLITAZONE MALEATE
BROMOCRIPTINE MESYLATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
BRAND DRUG
BYDUREON
BYDUREON PEN
BYETTA
CYCLOSET
DEX4 GLUCOSE
DEX4 GLUCOSE BITS
DIABETA
DUETACT
ENFAMIL
FARXIGA
FORTAMET
GERBER GOOD START
GLIPIZIDE ER
GLIPIZIDE XL
GLIPIZIDE-METFORMIN
GLUCAGEN
GLUCAGON EMERGENCY KIT
GLUCO BURST
GLUCO SHOT
GLUCOPHAGE
GLUCOPHAGE XR
GLUCOSE
GLUCOSE BITS
GLUCOSE GEL
GLUCOTROL
GLUCOTROL XL
GLUCOVANCE
GLUMETZA
GLUTOL
GLUTOSE 15
GLUTOSE 45
GLYBURIDE MICRONIZED
GLYBURIDE-METFORMIN HCL
GLYNASE
GLYSET
GLYXAMBI
HUMALOG
HUMALOG MIX 50-50
HUMALOG MIX 75-25
HUMULIN 70/30 KWIKPEN
HUMULIN 70-30
HUMULIN N
HUMULIN N KWIKPEN
HUMULIN R
INSTA-GLUCOSE
INVOKAMET
INVOKANA
JANUMET
108
GENERIC DRUG
EXENATIDE MICROSPHERES
EXENATIDE MICROSPHERES
EXENATIDE
CHLORPROPAMIDE
BROMOCRIPTINE MESYLATE
DEXTROSE
DEXTROSE
GLYBURIDE
PIOGLITAZONE HCL/GLIMEPIRIDE
DEXTROSE
DAPAGLIFLOZIN PROPANEDIOL
METFORMIN HCL
DEXTROSE
GLIMEPIRIDE
GLIPIZIDE
GLIPIZIDE
GLIPIZIDE
GLIPIZIDE/METFORMIN HCL
GLUCAGON,HUMAN RECOMBINANT
GLUCAGON,HUMAN RECOMBINANT
DEXTROSE
DEXTROSE
METFORMIN HCL
METFORMIN HCL
DEXTROSE
DEXTROSE
DEXTROSE
GLIPIZIDE
GLIPIZIDE
GLYBURIDE/METFORMIN HCL
METFORMIN HCL
DEXTROSE
DEXTROSE
DEXTROSE
GLYBURIDE
GLYBURIDE,MICRONIZED
GLYBURIDE/METFORMIN HCL
GLYBURIDE,MICRONIZED
MIGLITOL
EMPAGLIFLOZIN/LINAGLIPTIN
INSULIN LISPRO
INSULIN NPL/INSULIN LISPRO
INSULIN NPL/INSULIN LISPRO
INSULIN NPH HUM/REG INSULIN HM
INSULIN NPH HUM/REG INSULIN HM
INSULIN NPH HUMAN ISOPHANE
INSULIN NPH HUMAN ISOPHANE
INSULIN REGULAR, HUMAN
DEXTROSE/DEXTRIN/MALTOSE
CANAGLIFLOZIN/METFORMIN HCL
CANAGLIFLOZIN
SITAGLIPTIN PHOS/METFORMIN HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
DIABETES
BRAND DRUG
JANUMET XR
JANUVIA
JARDIANCE
JENTADUETO
KAZANO
KOMBIGLYZE XR
KORLYM
LANTUS
LANTUS SOLOSTAR
LEVEMIR
LEVEMIR FLEXPEN
LEVEMIR FLEXTOUCH
METAGLIP
METFORMIN HCL ER
MIFEPREX
NESINA
NOVOLIN 70-30
NOVOLIN N
NOVOLIN R
NOVOLOG
NOVOLOG FLEXPEN
NOVOLOG MIX 70-30
NOVOLOG MIX 70-30 FLEXPEN
ONGLYZA
OSENI
PARLODEL
PIOGLITAZONE-GLIMEPIRIDE
PIOGLITAZONE-METFORMIN
PRANDIMET
PRANDIN
PRECOSE
REGRANEX
RELION
RIOMET
ROCK CANDY
STARLIX
SYMLIN
SYMLINPEN 120
SYMLINPEN 60
TANZEUM
TOUJEO SOLOSTAR
TRADJENTA
TRUEPLUS GLUCOSE
TRULICITY
ULTILET
VICTOZA 2-PAK
109
GENERIC DRUG
SITAGLIPTIN PHOS/METFORMIN HCL
SITAGLIPTIN PHOSPHATE
EMPAGLIFLOZIN
LINAGLIPTIN/METFORMIN HCL
ALOGLIPTIN BENZ/METFORMIN HCL
SAXAGLIPTIN HCL/METFORMIN HCL
MIFEPRISTONE
INSULIN GLARGINE,HUM.REC.ANLOG
INSULIN GLARGINE,HUM.REC.ANLOG
INSULIN DETEMIR
INSULIN DETEMIR
INSULIN DETEMIR
GLIPIZIDE/METFORMIN HCL
METFORMIN HCL
METFORMIN HCL
MIFEPRISTONE
NATEGLINIDE
ALOGLIPTIN BENZOATE
INSULIN NPH HUM/REG INSULIN HM
INSULIN NPH HUMAN ISOPHANE
INSULIN REGULAR, HUMAN
INSULIN ASPART
INSULIN ASPART
INSULN ASP PRT/INSULIN ASPART
INSULN ASP PRT/INSULIN ASPART
SAXAGLIPTIN HCL
ALOGLIPTIN BENZ/PIOGLITAZONE
BROMOCRIPTINE MESYLATE
PIOGLITAZONE HCL
PIOGLITAZONE HCL/GLIMEPIRIDE
PIOGLITAZONE HCL/METFORMIN HCL
REPAGLINIDE/METFORMIN HCL
REPAGLINIDE
ACARBOSE
BECAPLERMIN
DEXTROSE/VITAMIN D3
REPAGLINIDE
METFORMIN HCL
DEXTROSE
NATEGLINIDE
PRAMLINTIDE ACETATE
PRAMLINTIDE ACETATE
PRAMLINTIDE ACETATE
ALBIGLUTIDE
TOLAZAMIDE
TOLBUTAMIDE
INSULIN GLARGINE,HUM.REC.ANLOG
LINAGLIPTIN
DEXTROSE/VITAMIN D3
DULAGLUTIDE
DEXTROSE
LIRAGLUTIDE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
DIABETES
DIABETES
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
BRAND DRUG
VICTOZA 3-PAK
XIGDUO XR
ACETASOL HC
ACETIC ACID-ALUMINUM
AERO OTIC HC
ANTIPYRINE-BENZOCAINE
AURALGAN
AURAX
AURODEX
AUROGUARD
BOROFAIR
CETRAXAL
CHLOROXYLENOL-PRAMOXINE HCL
CHLORPHENYLCAINE
CILOXAN
CIPRO
CIPRO HC
CIPRODEX
CLEARCANAL
COLY-MYCIN S
CORTAMOX
CORTANE-B
CORTISPORIN-TC
CRESYLATE
DERMOTIC
EAR DROPS FOR SWIMMERS
EAR DRY
EAR DRYING AGENT
EAR WAX CLEANSING
EARACHE RELIEF
EARSOL-HC
EXOTIC-HC
FLOXIN
HYDROCORTISONE-ACETIC ACID
MINERAL OIL LIGHT
MIN-O-EAR
MURINE EARIGATE
MYOXIN
NEOTIC
OCUFLOX
OTIC CARE
OTIC EDGE
OTICIN
OTICIN HC
OTO-END 10
OTOGESIC
OTOMAX-HC
OTOZIN
110
GENERIC DRUG
LIRAGLUTIDE
DAPAGLIFLOZIN/METFORMIN HCL
ACETIC ACID/HYDROCORTISONE
ACETIC ACID/ALUMINUM ACETATE
HC/PRAMOXINE HCL/CHLOROXYLENOL
ANTIPYRINE/BENZOCAINE
AA/ANTIPYRN/BCAINE/POLICO#1/AL
ANTIPYRINE/BENZOCAINE
ANTIPYRINE/BENZOCAINE
ANTIPYRINE/BENZOCAINE
ACETIC ACID/ALUMINUM ACETATE
CIPROFLOXACIN HCL
CHLOROXYLENOL/PRAMOXINE HCL
PHENYLEPHRINE/ANTIPY/B-CAINE
CIPROFLOXACIN HCL
CIPROFLOXACIN HCL
CIPROFLOXACIN/HYDROCORTISONE
CIPROFLOXACIN HCL/DEXAMETH
CIPROFLOXACIN HCL
CARBAMIDE PEROXIDE/NACL/NAHCO3
NEOMY SULF/COLIST SUL/HC/THONZ
HC/PRAMOXINE HCL/CHLOROXYLENOL
HC/PRAMOX HCL/CL-XYLENOL/WATER
NEOMY SULF/COLIST SUL/HC/THONZ
CRESYL ACETATE
FLUOCINOLONE ACETONIDE OIL
ISOPROPYL ALCOHOL/GLYCERIN
ISOPROPYL ALCOHOL/GLYCERIN
ISOPROPYL ALCOHOL/GLYCERIN
CARBAMIDE PEROXIDE/SEA WATER
SULF/HG/HOMEOPATHIC/CHAM FLW
HYDROCORTISONE/YERBA SANTA
HC/PRAMOXINE HCL/CHLOROXYLENOL
OFLOXACIN
FLUOCINOLONE ACETONIDE OIL
ACETIC ACID/HYDROCORTISONE
MINERAL OIL
MINERAL OIL
MINERAL OIL
SEA WATER
CHLOROXYLENOL/BENZOC/HYDROCORT
ANTIPYRINE/BENZOCAIN/GLY/ZINC
OFLOXACIN
OFLOXACIN
ANTIPYRINE/BENZOCAINE
AA/ANTPY/BCAINE/POLICO/AL ACET
CHLOROXYLENOL/PRAMOXINE HCL
HC/PRAMOXINE HCL/CHLOROXYLENOL
HC/PRAMOXINE HCL/CHLOROXYLENOL
PHENYLEPHRINE/ANTIPY/B-CAINE
HC/PRAMOXINE HCL/CHLOROXYLENOL
ANTIPYRINE/BENZOCAIN/GLY/ZINC
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
EAR - GENERAL DISORDERS
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
BRAND DRUG
PR OTIC SOLUTION
PRAMOTIC
PRAMOXINE-HC
PROQUIN XR
SWIM EAR
TREAGAN OTIC
TRIOXIN
VOSOL HC
ZINOTIC
ZINOTIC ES
AURYXIA
BUFFERED SALT
CALPHRON
CERALYTE-50
CERALYTE-70
CERALYTE-90
CERAORS 75
CERASPORT
CERASPORT EX1
DELFLEX WITH 1.5% DEXTROSE
DELFLEX WITH 2.5% DEXTROSE
DELFLEX WITH 4.25% DEXTROSE
DEXTROSE 10%-ELECTROLYTE 48
DEXTROSE 5%-0.2% NACL-KCL
DEXTROSE 5%-0.225% NACL-KCL
DEXTROSE 5%-0.3% NACL-KCL
DEXTROSE 5%-0.33% NACL-KCL
DEXTROSE 5%-0.45% NACL-KCL
DEXTROSE 5%-1/2NS-KCL
DEXTROSE 5%-1/3NS-KCL
DEXTROSE 5%-1/4NS-KCL
DEXTROSE 5%-ELECTROLYTE #48
DEXTROSE 5%-NS-KCL
DEXTROSE 5%-POTASSIUM CHLORIDE
DIANEAL PD-2 W/3.5% DEXTROSE
DIANEAL PD-2 W-1.5% DEXTROSE
DIANEAL PD-2 W-2.5% DEXTROSE
DIANEAL PD-2 W-4.25% DEXTROSE
DIANEAL WITH 1.5% DEXTROSE
DIANEAL WITH 2.5% DEXTROSE
DIANEAL WITH 4.25% DEXTROSE
DRIPDROP
EFFER-K
ELIPHOS
ENFALYTE
ENFAMIL ENFALYTE
EPIKLOR
FOSRENOL
GERIAIDE
GLYCOPHOS
HYPERLYTE CR
111
GENERIC DRUG
AA/ANTPY/BCAINE/POLICO/AL ACET
CHLOROXYLENOL/PRAMOXINE HCL
HC/PRAMOX HCL/CL-XYLENOL/WATER
CIPROFLOXACIN HCL
ISOPROPYL ALCOHOL/GLYCERIN
AA/ANTIPYRN/BCAINE/POLICO#1/AL
CHLOROXYLENOL/BENZOC/HYDROCORT
ACETIC ACID/HYDROCORTISONE
CHLOROXYLENOL/GLYC/PRAMOX/ZINC
CHLOROXYLENOL/GLYC/PRAMOX/ZINC
FERRIC CITRATE
SODIUM CL/POTASSIUM CHLORIDE
CALCIUM ACETATE
CALCIUM ACETATE
NACL/POT CHL/SOD CIT/RICE SYR
NACL/POT CHL/SOD CIT/RICE SYR
SODIUM/CHLORIDE/POTASS/CITRATE
NACL/POT CHL/SOD CIT/RICE SYR
NACL/POT CHL/SOD CIT/RICE SYR
NACL/POT CHL/SOD CIT/RICE SYR
PERIT. DIALYSIS#19 & DEX 1.5 %
PERIT. DIALYSIS 7 & DEX 2.5 %
PERIT. DIALYSIS 8 & DEX 4.25 %
ELECTROLYTE-48 SOLUTION/D10W
POTASSIUM CHLORIDE/D5-0.2%NACL
POTASSIUM CHLORIDE/D5-0.2%NACL
POTASSIUM CHLORIDE/D5-0.3%NACL
POTASSIUM CHLORIDE/D5-0.3%NACL
POTASSIUM CHLORIDE/D5-0.45NACL
POTASSIUM CHLORIDE/D5-0.45NACL
POTASSIUM CHLORIDE/D5-0.3%NACL
POTASSIUM CHLORIDE/D5-0.2%NACL
ELECTROLYTE-48 SOLUTION/D5W
POTASSIUM CHLORIDE/D5-0.9%NACL
POTASSIUM CHLORIDE IN D5W
DIALYSIS SOLUTIONS
PERIT. DIALYSIS#4 & DEXT 1.5 %
PERIT. DIALYSIS 13 & DEX 2.5 %
PERIT. DIALYSIS 3 & DEX 4.25 %
PERIT. DIALYSIS#6 & DEX 1.5 %
PERIT. DIALYSIS 7 & DEX 2.5 %
PERIT. DIALYSIS 8 & DEX 4.25 %
NA/K/CL/CITRATE/ZN/MG/CARBOHYD
POTASSIUM BICARBONATE/CIT AC
CALCIUM ACETATE
ELECTROLYTE,ORAL
ELECTROLYTE,ORAL
POTASSIUM CHLORIDE
LANTHANUM CARBONATE
NACL/POT CHLORIDE/SOD CIT/MV
SODIUM GLYCEROPHOSPHATE
SODIUM/K+/MAG/CA/CHLOR/ACETATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
BRAND DRUG
INPERSOL WITH 1.5% DEXTROSE
INPERSOL WITH 4.25% DEXTROSE
IONOSOL B WITH DEXTROSE 5%
IONOSOL MB-DEXTROSE 5%
ISOLYTE H WITH DEXTROSE
ISOLYTE M WITH DEXTROSE
ISOLYTE P WITH DEXTROSE
ISOLYTE S
K EFFERVESCENT
KALEXATE
KAOCHLOR-EFF
KAON-CL 10
KAYEXALATE
KENDALL 0.9% NACL WITH CAP
KIONEX
KLOR-CON
KLOR-CON 10
KLOR-CON 8
KLOR-CON M10
KLOR-CON M15
KLOR-CON M20
KLOR-CON-EF
K-PRIME
K-SOL
K-TAB
K-TAB ER
MAGNEBIND 300
MAGNEBIND 400 RX
MARLEXATE
MEDI-LYTE
MICRO-K
MOI-STIR
MONOJECT 0.9% SODIUM CHLORIDE
MONOJECT PREFILL
MONOJECT PREFILL ADVANCED
MOUTHKOTE
NEUT
NORMAL SALINE FLUSH
NORMOSOL-M AND DEXTROSE
NORMOSOL-R
NORMOSOL-R AND DEXTROSE
NORMOSOL-R PH 7.4
NUTRILYTE
NUTRILYTE II
ORALYTE
PEDIALYTE
PEDIALYTE ADVANCED CARE
PEDIALYTE ELECTROLYTE SINGLES
PEDIA-POP
PEDIATRIC ELECTROLYTE
PEDIATRIC FREEZER POPS
PEDIAVANCE
112
GENERIC DRUG
DIALYSIS SOLUTIONS
DIALYSIS SOLUTIONS
ELECTROLYTE-B SOLUTION/D5W
ELECTROLYTE-MB SOLUTION/D5W
ELECTROLYTE-H SOLUTION/D5W
ELECTROLYTE-M SOLUTION/D5W
ELECTROLYTE-P SOLUTION/D5W
ELECTROLYTE-S (PH 7.4)
POTASSIUM BICARBONATE/CIT AC
SODIUM POLYSTYRENE SULFONATE
POTASSIUM CHLORIDE/POT BICARB
POTASSIUM CHLORIDE
SODIUM POLYSTYRENE SULFONATE
0.9 % SODIUM CHLORIDE
SODIUM POLYSTYRENE SULFONATE
POTASSIUM CHLORIDE
POTASSIUM CHLORIDE
POTASSIUM CHLORIDE
POTASSIUM CHLORIDE
POTASSIUM CHLORIDE
POTASSIUM CHLORIDE
POTASSIUM BICARBONATE/CIT AC
POTASSIUM BICARBONATE/CIT AC
POTASSIUM CHLORIDE
POTASSIUM CHLORIDE
POTASSIUM CHLORIDE
CALCIUM CARBONATE/MAG CARB
CALCIUM CARBONATE/MAG CARB/FA
SODIUM POLYSTYRENE SULFONATE
POT CHLORIDE/CAL PHOS/MAG
POTASSIUM CHLORIDE
LYTES/CARBOXYMETHYLCELLULOSE
0.9 % SODIUM CHLORIDE
0.9 % SODIUM CHLORIDE
0.9 % SODIUM CHLORIDE
LYTES/YERBA SANTA
SODIUM BICARBONATE
0.9 % SODIUM CHLORIDE
ELECTROLYTE-M SOLUTION/D5W
ELECTROLYTE-R SOLUTION
ELECTROLYTE-R SOLUTION/D5W
ELECTROLYTE-R (PH 7.4)
SOD/POT/MAG/CAL/CHLO/ACE/GLUC
SODIUM/K+/MAG/CA/CHLOR/ACETATE
ELECTROLYTE,ORAL
ELECTROLYTE,ORAL
ELECTROLYTE,ORAL
ELECTROLYTE,ORAL
SOD CIT/POT CL/POT CIT/CALC CL
ELECTROLYTE,ORAL
ELECTROLYTE,ORAL
SOD/POTASS/CHLOR/ZINC/DEX/FRUC
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ELECTROLYTE REGULATION
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
BRAND DRUG
PHOSLO
PHOSLYRA
PHOS-NAK
PLASMA-LYTE 148
PLASMA-LYTE 56 IN DEXTROSE
PLASMA-LYTE A PH 7.4
POSIFLUSH SALINE
POTASSIUM CHL-NORMAL SALINE
POTASSIUM CHLORIDE
POTASSIUM CHLORIDE IN D5LR
POTASSIUM CHLORIDE-NACL
POTASSIUM CHLORIDE-NS
POTASSIUM CL-LIDOCAINE-NS
POTASSIUM PHOS-D5W
POTASSIUM PHOS-NS
POTASSIUM PHOSPHATE
POTASSIUM PHOSPHATE-NS
QUIC-K
RENAGEL
RENVELA
SAFE WASH
SALINE FLUSH
SAMSCA
SODIUM BICARBONATE-D5W
SODIUM PHOSPHATE
SODIUM PHOSPHATE-NS
SPS
STERILE SALINE
SWABFLUSH
SYREX
THAM
THERMOTABS
TPN ELECTROLYTES
TPN ELECTROLYTES II
VAPRISOL
VELPHORO
BRAVELLE
CHORIONIC GONADOTROPIN
CLOMID
CRINONE
ENDOMETRIN
FIRST-PROGESTERONE VGS 100
FIRST-PROGESTERONE VGS 200
113
GENERIC DRUG
CALCIUM ACETATE
CALCIUM ACETATE
NAPH,MB-DB/K PH,MBDB
ELECTROLYTE-148 SOLUTION
ELECTROLYTE-56 SOLUTION/D5W
ELECTROLYTE-A SOLUTION
0.9 % SODIUM CHLORIDE
POTASSIUM
POTASSIUM ACETATE
POTASSIUM CHLORIDE IN 0.9%NACL
POT CHLORIDE/POT BICARB/CIT AC
POTASSIUM CHLORIDE IN LR-D5
POTASSIUM CHLORIDE-0.45% NACL
POTASSIUM CHLORIDE IN 0.9%NACL
POTASSIUM CL/LIDO/0.9 % NACL
POTASSIUM PHOSPHATE/D5W
POTASSIUM PHOS IN 0.9 % NACL
POTASSIUM PHOS,M-BASIC-D-BASIC
POTASSIUM PHOS IN 0.9 % NACL
POTASSIUM BICARBONATE
SEVELAMER HCL
SEVELAMER CARBONATE
0.9 % SODIUM CHLORIDE
0.9 % SODIUM CHLORIDE
TOLVAPTAN
SEVELAMER CARBONATE
SODIUM ACETATE
SODIUM BICARB IN STERILE WATER
SODIUM BICARBONATE
SODIUM BICARBONATE IN D5W
SODIUM LACTATE
SODIUM PHOS,M-BASIC-D-BASIC
SODIUM PHOSPHATE IN 0.9 % NACL
SODIUM POLYSTYRENE SULFONATE
SODIUM POLYSTYRENE SULFONATE
0.9 % SODIUM CHLORIDE
0.9 % SODIUM CHLORIDE
0.9 % SODIUM CHLORIDE
TROMETHAMINE
SODIUM CL/POTASSIUM CHLORIDE
SODIUM/K+/MAG/CA/CHLOR/ACETATE
SODIUM/K+/MAG/CA/CHLOR/ACETATE
CONIVAPTAN HCL/D5W
SUCROFERRIC OXYHYDROXIDE
UROFOLLITROPIN
CHORIONIC GONADOTROPIN, HUMAN
CLOMIPHENE CITRATE
CLOMIPHENE CITRATE
PROGESTERONE,MICRONIZED
PROGESTERONE,MICRONIZED
PROGESTERONE
PROGESTERONE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - FERTILITY
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
BRAND DRUG
FIRST-PROGESTERONE VGS 25
FIRST-PROGESTERONE VGS 400
FIRST-PROGESTERONE VGS 50
FOLLISTIM AQ
GONAL-F
GONAL-F RFF
GONAL-F RFF REDI-JECT
LUVERIS
MENOPUR
NOVAREL
OVIDREL
PREGNYL
PROCHIEVE
PROGESTERONE IN OIL
PROGESTERONE SUPPOSITORY
PROMETRIUM
REPRONEX
SEROPHENE
ACTHREL
ACTONEL
AREDIA
ATELVIA
BINOSTO
BONIVA
CALCITONIN-SALMON
CETROTIDE
DDAVP
DESMOPRESSIN ACETATE
DIDRONEL
DUMMY LUPRON
EGRIFTA
ELIGARD
EVISTA
FORTEO
FORTICAL
FOSAMAX
FOSAMAX PLUS D
GANIRELIX ACETATE
GANITE
GENOTROPIN
H.P. ACTHAR
HECTOROL
HUMATROPE
INCRELEX
114
GENERIC DRUG
PROGESTERONE
PROGESTERONE
PROGESTERONE
FOLLITROPIN BETA,RECOMB
FOLLITROPIN ALFA, RECOMB
FOLLITROPIN ALFA, RECOMB
FOLLITROPIN ALFA, RECOMB
LUTROPIN ALFA
MENOTROPINS
CHORIONIC GONADOTROPIN, HUMAN
CHORIOGONADOTROPIN ALFA
CHORIONIC GONADOTROPIN, HUMAN
PROGESTERONE,MICRONIZED
PROGESTERONE
PROGESTERONE
PROGESTERONE,MICRONIZED
PROGESTERONE,MICRONIZED
MENOTROPINS
CLOMIPHENE CITRATE
CORTICORELIN OVINE TRIFLUTATE
RISEDRONATE SODIUM
ALENDRONATE SODIUM
PAMIDRONATE DISODIUM
RISEDRONATE SODIUM
ALENDRONATE SODIUM
IBANDRONATE SODIUM
CABERGOLINE
CALCITONIN,SALMON,SYNTHETIC
CETRORELIX ACETATE
DANAZOL
DESMOPRESSIN (NONREFRIGERATED)
DESMOPRESSIN (NONREFRIGERATED)
ETIDRONATE DISODIUM
DOXERCALCIFEROL
LEUPROLIDE ACETATE
TESAMORELIN ACETATE
LEUPROLIDE ACETATE
ETIDRONATE DISODIUM
RALOXIFENE HCL
TERIPARATIDE
CALCITONIN,SALMON,SYNTHETIC
ALENDRONATE SODIUM
ALENDRONATE SODIUM/VITAMIN D3
GALLIUM NITRATE
SOMATROPIN
CORTICOTROPIN
DOXERCALCIFEROL
SOMATROPIN
IBANDRONATE SODIUM
MECASERMIN
LEUPROLIDE ACETATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - OTHER
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
BRAND DRUG
LUPRON DEPOT
LUPRON DEPOT-PED
MIACALCIN
MYALEPT
NATPARA
NORDITROPIN
NORDITROPIN FLEXPRO
NORDITROPIN NORDIFLEX
NUTROPIN
NUTROPIN AQ
NUTROPIN AQ NUSPIN
OMNITROPE
OSPHENA
PARICALCITOL
PITRESSIN
PROLIA
RECLAST
SAIZEN
SENSIPAR
SEROSTIM
SKELID
SOMAVERT
STIMATE
SUPPRELIN LA
SYNAREL
TEV-TROPIN
TRELSTAR
TRELSTAR DEPOT
TRELSTAR LA
VANTAS
VASOPRESSIN-D5W
VASOPRESSIN-NS
VASOSTRICT
XGEVA
ZEMPLAR
ZOLADEX
ZOMETA
ZORBTIVE
ARMOUR THYROID
CYTOMEL
IODOPEN
IOSAT
LEVOTHROID
LEVOTHYROXINE 12.5MCG/1ML SUSP
LEVOXYL
115
GENERIC DRUG
LEUPROLIDE ACETATE
LEUPROLIDE ACETATE
CALCITONIN,SALMON,SYNTHETIC
METRELEPTIN
PARATHYROID HORMONE
SOMATROPIN
SOMATROPIN
SOMATROPIN
SOMATROPIN
SOMATROPIN
SOMATROPIN
SOMATROPIN
OSPEMIFENE
PAMIDRONATE DISODIUM
VASOPRESSIN
DENOSUMAB
RALOXIFENE HCL
ZOLEDRONIC ACID/MANNITOL&WATER
RISEDRONATE SODIUM
SOMATROPIN
CINACALCET HCL
SOMATROPIN
TILUDRONATE DISODIUM
PEGVISOMANT
DESMOPRESSIN ACETATE
HISTRELIN AC
NAFARELIN ACETATE
SOMATROPIN
TRIPTORELIN PAMOATE
TRIPTORELIN PAMOATE
TRIPTORELIN PAMOATE
HISTRELIN AC
VASOPRESSIN
VASOPRESSIN IN D5W
VASOPRESSIN IN 0.9 % NACL
VASOPRESSIN
DENOSUMAB
PARICALCITOL
GOSERELIN ACETATE
ZOLEDRONIC ACID
ZOLEDRONIC ACID
SOMATROPIN
THYROID,PORK
LIOTHYRONINE SODIUM
SODIUM IODIDE
POTASSIUM IODIDE
LEVOTHYROXINE SODIUM
LEVOTHYROXINE
LEVOTHYROXINE SODIUM
LEVOTHYROXINE SODIUM
LIOTHYRONINE SODIUM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
ENDOCRINE DISORDER - THYROID
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
BRAND DRUG
NATURE-THROID
NP THYROID
SSKI
STRONG IODINE
SYNTHROID
TAPAZOLE
THYROLAR-1
THYROLAR-1/2
THYROLAR-1/4
THYROLAR-2
THYROLAR-3
THYROSAFE
THYROSHIELD
TIROSINT
TRIOSTAT
UNITHROID
WESTHROID
WESTHROID-P
WP THYROID
ACULAR
ACULAR LS
ACUVAIL
ADVANCED EYE RELIEF REDNESS
AK-TROL
ALAMAST
ALAWAY
ALCAINE
ALLERGY EYE
ALLERGY EYE DROPS
ALODOX
ALOMIDE
ALREX
ALTACHLORE
ALTAFLUOR
ANTIHISTAMINE EYE DROPS
AVELOX
AVELOX ABC PACK
AVENOVA
AZASITE
BEPREVE
BESIVANCE
BLEPHAMIDE
BLEPHAMIDE S.O.P.
BROMDAY
CELLUGEL
CHILDREN'S ALAWAY
CLEAR EYES COMPLETE
CLEAR EYES ITCHY EYE RELIEF
116
GENERIC DRUG
METHIMAZOLE
THYROID,PORK
THYROID,PORK
PROPYLTHIOURACIL
POTASSIUM IODIDE
POTASSIUM IODIDE/IODINE
LEVOTHYROXINE SODIUM
METHIMAZOLE
LIOTRIX
LIOTRIX
LIOTRIX
LIOTRIX
LIOTRIX
POTASSIUM IODIDE
POTASSIUM IODIDE
LEVOTHYROXINE SODIUM
LIOTHYRONINE SODIUM
LEVOTHYROXINE SODIUM
THYROID,PORK
THYROID,PORK
THYROID,PORK
KETOROLAC TROMETHAMINE
KETOROLAC TROMETHAMINE
KETOROLAC TROMETHAMINE/PF
NAPHAZOLINE HCL/HYPROMELLOSE
NEO/POLYMYX B SULF/DEXAMETH
PEMIROLAST POTASSIUM
KETOTIFEN FUMARATE
PROPARACAINE HCL
KETOTIFEN FUMARATE
KETOTIFEN FUMARATE
DOXYCYCLINE/EYELID CLNS NO.2&3
LODOXAMIDE TROMETHAMINE
LOTEPREDNOL ETABONATE
SODIUM CHLORIDE
BENOXINATE HCL/FLUORESCEIN NA
KETOTIFEN FUMARATE
MOXIFLOXACIN HCL
MOXIFLOXACIN HCL
HYPOCHLOROUS ACID/SODIUM CHLOR
AZITHROMYCIN
AZITHROMYCIN
BEPOTASTINE BESILATE
BESIFLOXACIN HCL
SULFACETM NA/PREDNISOL AC
SULFACETM NA/PREDNISOL AC
BROMFENAC SODIUM
BROMFENAC SODIUM
HYPROMELLOSE
KETOTIFEN FUMARATE
NAPHAZO HCL/HPM/PS 80/ZN SULF
NAPHAZOLINE HCL/ZN SULF/GLY
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
BRAND DRUG
CLEAR EYES REDNESS RELIEF
DEXASPORIN
DISCOVISC
DUOVISC
DUREZOL
ELESTAT
EMADINE
EQ GENTLE
EYE ALLERGY RELIEF
EYE DROPS ADVANCED RELIEF
EYE DROPS ALLERGY RELIEF
EYE DROPS REDNESS RELIEF
EYE ITCH RELIEF
FLAREX
FLO-PRED
FLUCAINE
FLUORESCEIN-BENOXINATE
FLUORESCEIN-PROPARACAINE
FLUORESCEIN-PROPARACAINE HCL
FLURESS
FLUROX
FML
FML FORTE
FML S.O.P.
GENTEAL MILD
GENTEAL MILD TO MODERATE
GENTEAL SEVERE
GONAK
GONIOSOFT
GONIOTAIRE
GONIOVISC
ILEVRO
IQUIX
ISOPTO TEARS
ITCHY EYE
JETREA
LASTACAFT
LEVAQUIN
LOTEMAX
LUBRICANT EYE DROPS
LUBRICANT REDNESS EYE DROPS
LUBRICANT REDNESS RELIEVER
MAXIMUM REDNESS RELIEF
MAXITROL
117
GENERIC DRUG
NAPHAZOLINE HCL/GLYCERIN
CYCLOSPORINE
NEO/POLYMYX B SULF/DEXAMETH
CHONDR SULF A SOD/HYALURONATE
CHONDR SULF A SOD/HYALURONATE
DIFLUPREDNATE
EPINASTINE HCL
EMEDASTINE DIFUMARATE
EPINASTINE HCL
HYPROMELLOSE
NAPHAZOLINE HCL/PHENIRAMINE
TETRAHYDRZ/DEXT 70/PEG 400/PVP
TETRAHYDROZOLINE HCL/ZN SULF
NAPHAZOLINE HCL/GLYCERIN
KETOTIFEN FUMARATE
FLUOROMETHOLONE ACETATE
PREDNISOLONE ACETATE
PROPARACAINE/FLUORESCEIN SOD
BENOXINATE HCL/FLUORESCEIN NA
PROPARACAINE/FLUORESCEIN SOD
PROPARACAINE/FLUORESCEIN SOD
FLUOROMETHOLONE
FLURBIPROFEN SODIUM
BENOXINATE HCL/FLUORESCEIN NA
BENOXINATE HCL/FLUORESCEIN NA
FLUOROMETHOLONE
FLUOROMETHOLONE
FLUOROMETHOLONE
GANCICLOVIR
GATIFLOXACIN
HYPROMELLOSE
HYPROMELLOSE
HYPROMELLOSE
HYPROMELLOSE
HYPROMELLOSE
HYPROMELLOSE
HYPROMELLOSE
NEPAFENAC
LEVOFLOXACIN
HYPROMELLOSE
KETOTIFEN FUMARATE
OCRIPLASMIN/PF
KETOROLAC TROMETHAMINE
ALCAFTADINE
LEVOFLOXACIN
LEVOFLOXACIN
LOTEPREDNOL ETABONATE
HYPROMELLOSE
NAPHAZOLINE HCL/HYPROMELLOSE
TETRAHYDROZOLINE HCL/PEG
NAPHAZOLINE HCL/HYPROMELLOSE
NEO/POLYMYX B SULF/DEXAMETH
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
BRAND DRUG
METHADEX
MILLIPRED
MOXEZA
MURO-128
NAPHAZOLINE HCL W/ANTAZOLINE
NAPHCON-A
NATACYN
NEBCIN
NEOCIDIN
NEOMYCIN-BACITRACIN-POLY-HC
NEOMYCIN-POLYMYXIN-DEXAMETH
NEOMYCIN-POLYMYXIN-GRAMICIDIN
NEO-POLYCIN HC
NEVANAC
NOROXIN
OCUCOAT
OCUDOX
OCUFEN
OCUTRICIN
OMNIPRED
OPCON-A
ORAPRED
ORAPRED ODT
PARCAINE
PEDIAPRED
POLY-DEX
POLYMYXIN B SUL-TRIMETHOPRIM
POLY-PRED
POLYTRIM
PRED FORTE
PRED MILD
PRED-G
PREDNISOL
PREDNISOLONE SODIUM PHOSPHATE
PROLENSA
PURE & GENTLE EYE DROPS
QUIXIN
REDNESS LUBRICANT EYE DROPS
REFRESH
RELIEF DROPS
RELIEF EYE DROPS
RESTASIS
SANDIMMUNE
SOCHLOR
SPRIX
SULFACETAMIDE-PREDNISOLONE
SYSTANE GEL
TOBRADEX
118
GENERIC DRUG
NEO/POLYMYX B SULF/DEXAMETH
PREDNISOLONE SOD PHOSPHATE
MOXIFLOXACIN HCL
MOXIFLOXACIN HCL
SODIUM CHLORIDE
NAPHAZOLINE HCL/ANTAZOLINE
NAPHAZOLINE HCL/PHENIRAMINE
NATAMYCIN
TOBRAMYCIN SULFATE
NEOMYCIN/POLYMYXN B/GRAMICIDIN
NEOMY SULF/BACITRAC ZN/POLY/HC
NEO/POLYMYX B SULF/DEXAMETH
NEOMYCIN/POLYMYXN B/GRAMICIDIN
NEOMY SULF/BACITRAC ZN/POLY/HC
NEPAFENAC
NORFLOXACIN
HYPROMELLOSE
DOXY/EYELID CLNS #3/EYE EML #1
FLURBIPROFEN SODIUM
NEOMYCIN/POLYMYXN B/GRAMICIDIN
PREDNISOLONE ACETATE
NAPHAZOLINE HCL/PHENIRAMINE
PREDNISOLONE SOD PHOSPHATE
PREDNISOLONE SOD PHOSPHATE
PROPARACAINE HCL
PREDNISOLONE SOD PHOSPHATE
NEO/POLYMYX B SULF/DEXAMETH
POLYMYXIN B SULF/TRIMETHOPRIM
NEOMY SULF/POLYMYX B SULF/PRED
POLYMYXIN B SULF/TRIMETHOPRIM
PREDNISOLONE ACETATE
PREDNISOLONE ACETATE
GENTAMICIN/PREDNISOL AC
PREDNISOLONE SOD PHOSPHATE
PREDNISOLONE ACETATE
PREDNISOLONE SOD PHOSPHATE
PREDNISOLONE SOD PHOSPHATE
BROMFENAC SODIUM
PROPARACAINE HCL
HYPROMELLOSE
LEVOFLOXACIN
NAPHAZOLINE HCL/PEG 300
KETOTIFEN FUMARATE
TETRAHYDROZOLINE HCL/ZN SULF
TETRAHYDROZOLINE HCL/ZN SULF
CYCLOSPORINE
CYCLOSPORINE
SODIUM CHLORIDE
KETOROLAC TROMETHAMINE
SULFACETAMIDE/PREDNISOLONE SP
HYPROMELLOSE
TOBRAMYCIN/DEXAMETHASONE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GENERAL DISORDERS
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
BRAND DRUG
TOBRADEX ST
TOBRAMYCIN-DEXAMETHASONE
TOBRASOL
TOBREX
TORADOL
TRIPLE ANTIBIOTIC HC
VERIPRED 20
VEXOL
VIGAMOX
VIROPTIC
VISCOAT
VISINE ADVANCED
VISINE ALLERGY RELIEF
VISINE TOTALITY
VISINE-A
VITRASERT
XIBROM
ZADITOR
ZIRGAN
ZITHROMAX
ZITHROMAX TRI-PAK
ZMAX
ZYLET
ZYMAR
ZYMAXID
ZYRTEC ITCHY EYE
AK-PENTOLATE
ATROPEN
ATROPINE CARE
AZOPT
BETAGAN
BETIMOL
COMBIGAN
COSOPT
COSOPT PF
CYCLOGYL
CYCLOMYDRIL
CYLATE
DIAMOX SEQUELS
DORZOLAMIDE-TIMOLOL
HOMATROPAIRE
HOMATROPINE
HOMATROPINE HYDROBROMIDE
IOPIDINE
119
GENERIC DRUG
TOBRAMYCIN/DEXAMETHASONE
TOBRAMYCIN SULFATE
TOBRAMYCIN/DEXAMETHASONE
TOBRAMYCIN
TOBRAMYCIN
KETOROLAC TROMETHAMINE
TRIFLURIDINE
NEOMY SULF/BACITRAC ZN/POLY/HC
PREDNISOLONE SOD PHOSPHATE
RIMEXOLONE
MOXIFLOXACIN HCL
TRIFLURIDINE
CHONDR SULF A SOD/HYALURONATE
TETRAHYDRZ/DEXT 70/PEG 400/PVP
TETRAHYDROZOLINE HCL/ZN SULF
TETRAHYD/ZN/PEG 400/HYPROM/GLY
NAPHAZOLINE HCL/PHENIRAMINE
GANCICLOVIR
BROMFENAC SODIUM
KETOTIFEN FUMARATE
GANCICLOVIR
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
TOBRAMYCIN/LOTEPRED ETAB
GATIFLOXACIN
GATIFLOXACIN
KETOTIFEN FUMARATE
ACETAZOLAMIDE
ACETAZOLAMIDE SODIUM
CYCLOPENTOLATE HCL
APRACLONIDINE HCL
ATROPINE SULFATE
ATROPINE SULFATE
ATROPINE SULFATE
BRINZOLAMIDE
LEVOBUNOLOL HCL
TIMOLOL
BRIMONIDINE TARTRATE/TIMOLOL
DORZOLAMIDE HCL/TIMOLOL MALEAT
DORZOLAMIDE/TIMOLOL/PF
CYCLOPENTOLATE HCL
CYCLOPENTOLATE/PHENYLEPHRINE
CYCLOPENTOLATE HCL
CYCLOPENTOLATE HCL
ACETAZOLAMIDE
DORZOLAMIDE HCL
DORZOLAMIDE HCL/TIMOLOL MALEAT
HOMATROPINE HBR
HOMATROPINE HBR
HOMATROPINE HBR
APRACLONIDINE HCL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - GLAUCOMA
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
BRAND DRUG
ISOPTO ATROPINE
ISOPTO CARBACHOL
ISOPTO CARPINE
ISOPTO HOMATROPINE
LUMIGAN
MIOCHOL-E
MIOSTAT
MITOSOL
MYDRAL
MYDRIACYL
NEPTAZANE
OPTIPRANOLOL
PAREMYD
PHOSPHOLINE IODIDE
PILOPINE HS
RESCULA
SALAGEN
SAL-TROPINE
SIMBRINZA
TIMOPTIC OCUDOSE
TRAVATAN
TRAVATAN Z
TRAVOPROST
TRUSOPT
XALATAN
ZIOPTAN
AKORN BALANCED SALT
AKWA TEARS RENEWED
AQUASOL A
ARTIFICIAL TEARS LUBRICATION G
B-12
B-12 DOTS
BALANCED SALT
BION TEARS
BSS
BSS PLUS
CAPSULE #000
COLLYRIUM
COSAMIN DS
CYANOCOBALAMIN INJECTION
CYSTARAN
DRY EYE RELIEF
DRY EYES
ENUCLENE
120
GENERIC DRUG
ATROPINE SULFATE
CARBACHOL
PILOCARPINE HCL
HOMATROPINE HBR
LATANOPROST
LEVOBUNOLOL HCL
BIMATOPROST
METHAZOLAMIDE
METIPRANOLOL
ACETYLCHOLINE CHLORIDE
CARBACHOL
MITOMYCIN
MITOMYCIN
TROPICAMIDE
TROPICAMIDE
METHAZOLAMIDE
METIPRANOLOL
HYDROXYAMPHETAMINE/TROPICAMIDE
ECHOTHIOPHATE IODIDE
PILOCARPINE HCL
PILOCARPINE HCL
UNOPROSTONE ISOPROPYL
PILOCARPINE HCL
ATROPINE SULFATE
BRINZOLAMIDE/BRIMONIDINE TART
TIMOLOL MALEATE/PF
TRAVOPROST (BENZALKONIUM)
TRAVOPROST
TRAVOPROST (BENZALKONIUM)
TROPICAMIDE
DORZOLAMIDE HCL
LATANOPROST
TAFLUPROST/PF
BALANCED SALT IRRIG SOLN NO.2
DEXTRAN 70/HYPROMELLOSE
VITAMIN A PALMITATE
POLYVINYL ALCOHOL
CYANOCOBALAMIN (VITAMIN B-12)
B-12 1000MCG
CYANOCOBALAMIN (VITAMIN B-12)
BALANCED SALT IRRIG SOLN NO.2
DEXTRAN 70/HYPROMELLOSE/PF
BALANCED SALT IRRIG SOLN NO.2
BALANCED SALT IRRIG SOLN NO.1
GELATIN CAPSULES (EMPTY)
SOD BORATE/BORIC AC/WATER/NACL
GLUCOSAMINE/CHONDRO SU A
CYANOCOBALAMIN (VITAMIN B-12)
CYSTEAMINE HCL
PEG 400/HYPROMELLOSE/GLYCERIN
PETROLAT,WHT/MIN OIL/SOD CHL
TYLOXAPOL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
BRAND DRUG
EQ REVIVE PLUS
EYE DROP TEARS
EYE IRRIGATING SOLUTION
EYE-STREAM
EYLEA
FRESHKOTE
GELFILM
GEL-JET GELATIN
GENTEAL
GENTLE LUBRICANT EYE
GLUCOSAMINE-CHONDROITIN
HYPOTEARS
IRRIGATING OPHTH SOLUTION
IRRIGATING SOLUTION
LACRISERT
LIQUID B12
LIQUID B-12
LIQUITEARS
LUBRICANT DRY EYE RELIEF
LUBRICATING EYE DROPS
LUBRICATING PLUS
LUBRIFRESH PM
LUCENTIS
MACUGEN
MEDI-WASH
MOISTURIZING LUBRICANT
MUROCEL
NASCOBAL
NATURAL BALANCE TEARS
NATURAL TEARS
NATURE'S TEARS
NIGHTTIME RELIEF
OCUSOFT BABY
OCUSOFT LID SCRUB
OCUSOFT LID SCRUB PLUS
OSTEO BI-FLEX
PHYSICIANS EZ USE B-12
RAPID B-12 ENERGY
REFRESH CELLUVISC
REFRESH CLASSIC
REFRESH CONTACTS
REFRESH LIQUIGEL
REFRESH OPTIVE
REFRESH OPTIVE ADVANCED
REFRESH OPTIVE SENSITIVE
REFRESH PLUS
REFRESH TEARS
RETAINE CMC
121
GENERIC DRUG
CARBOXYMETHYLCELLULOSE SODIUM
PEG 400/HYPROMELLOSE/GLYCERIN
SOD BORATE/BORIC AC/WATER/NACL
BALANCED SALT SOLN NON-SURG #3
AFLIBERCEPT
EYE LUBRICANT COMBINATION NO.1
GELATIN
GELATIN
GELATIN
CARBOXYMETHYLCELL/HYPROMELLOSE
HYPROMELLOSE/PF
GLUCOSAMINE CHONDROITI COMPLEX
GLUCOSAMINE/CHONDRO SU A
POLYETHYLENE GLYCOL/POLYVINYL
NA PHOS,M-B/SODIUM CHLORIDE
SODIUM/POTASSIUM/SOD CHL
HYDROXYPROPYL CELLULOSE
CYANOCOBALAMIN (VITAMIN B-12)
CYANOCOBALAMIN (VITAMIN B-12)
POLYVINYL ALCOHOL
CARBOXYMETHYLCELLULOSE SODIUM
CARBOXYMETHYLCELLULOS/GLYCERIN
CARBOXYMETHYLCELLULOSE SODIUM
MINERAL OIL/PETROLATUM,WHITE
RANIBIZUMAB
PEGAPTANIB SODIUM
SOD BORATE/BORIC AC/WATER/NACL
CARBOXYMETHYLCELLULOSE SODIUM
METHYLCELLULOSE
CYANOCOBALAMIN (VITAMIN B-12)
HYPROMELLOSE
DEXTRAN 70/HYPROMELLOSE/PF
HYPROMELLOSE
PETROLAT,WHT/MIN OIL/SOD CHL
EYELID CLEANSER COMBINATION #3
EYELID CLEANSER COMB NO.7
EYELID CLEANSER COMBINATION #3
GLUC/CHON-MSM#1/C/MANG/BOS/BOR
CYANOCOBALAMIN (VITAMIN B-12)
POLYSORBATE 20
POLYSORBATE 80
CYANOCOBALAMIN (VITAMIN B-12)
CARBOXYMETHYLCELLULOSE SODIUM
POLYVINYL ALCOHOL/POVIDONE/PF
CARBOXYMETHYLCELLULOSE SODIUM
CARBOXYMETHYLCELLULOSE SODIUM
CARBOXYMETHYLCELLULOS/GLYCERIN
CARBOXYMETHYL/GLY/POLY80/PF
CARBOXYMETHYLCELL/GLYCERIN/PF
CARBOXYMETHYLCELLULOSE SODIUM
CARBOXYMETHYLCELLULOSE SODIUM
CARBOXYMETHYLCELLULOSE SODIUM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
EYE - MISCELLANEOUS
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
FLUID REPLACEMENT
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
BRAND DRUG
RETAINE HPMC
RETAINE MGD
RETAINE PM
REVIVE PLUS
SOOTHE HYDRATION
SOOTHE XP
STERILE EYE WASH
STERILE LUBRICANT
STERILID
SYSTANE BALANCE
SYSTANE LIQUID GEL
SYSTANE ULTRA
TEARFAIR
TEARS AGAIN ADVANCED
TEARS AGAIN MC
TEARS NATURALE
TEARS NATURALE FORTE
TEARS NATURALE FREE
TEARS NATURALE-II
TEARS PURE
THERA TEARS
ULTRA FRESH
ULTRA LUBRICANT EYE
VISUDYNE
VITAMELTS ENERGY
VITAMIN B-12
VIVA-DROPS
ZALTRAP
ATP
DEXTROSE 10%-0.2% NACL
DEXTROSE 10%-0.45% NACL
DEXTROSE 10%-0.9% NACL
DEXTROSE 10%-1/4NS
DEXTROSE 2.5%-0.45% NACL
DEXTROSE 5%-0.2% NACL
DEXTROSE 5%-0.225% NACL
DEXTROSE 5%-0.3% NACL
DEXTROSE 5%-0.33% NACL
DEXTROSE 5%-0.45% NACL
DEXTROSE 5%-0.9% NACL
DEXTROSE IN LACTATED RINGERS
DEXTROSE IN RINGERS INJECTION
DEXTROSE IN WATER
DEXTROSE WITH SODIUM CHLORIDE
ALOPRIM
COLCRYS
ELITEK
KRYSTEXXA
122
GENERIC DRUG
HYPROMELLOSE/PF
LIGHT MINERAL OIL/MIN OIL/PF
MINERAL OIL/PETROLATUM,WHITE
CARBOXYMETHYLCELLULOSE SODIUM
POVIDONE
MINERAL OIL, LIGHT/MINERAL OIL
SOD BORATE/BORIC AC/WATER/NACL
CARBOXYMETHYLCELLULOSE SODIUM
EYELID CLEANSER COMBINATION #1
PROPYLENE GLYCOL
PROPYLENE GLYCOL/PEG 400
PROPYLENE GLYCOL/PEG 400
POLYVINYL ALCOHOL
EYELID EMOLLIENT COMB NO.1
DEXTRAN 70/HYPROMELLOSE
DEXTRAN 70/HYPROMELLOSE
DEXTRAN/HYPROMELLOSE/GLYCERIN
DEXTRAN 70/HYPROMELLOSE/PF
DEXTRAN 70/HYPROMELLOSE
DEXTRAN 70/HYPROMELLOSE
CARBOXYMETHYLCELLULOSE SODIUM
CARBOXYMETHYLCELLULOSE SODIUM
PROPYLENE GLYCOL/PEG 400
VERTEPORFIN
CYANOCOBALAMIN (VITAMIN B-12)
VITAMIN B12
CYANOCOBALAMIN (VITAMIN B-12)
POLYSORBATE 80/PF
ZIV-AFLIBERCEPT
ADENOSINE TRIPHOSPHATE
DEXTROSE 10 % AND 0.2 % NACL
DEXTROSE 10 % AND 0.45 % NACL
DEXTROSE 10 % AND 0.9 % NACL
DEXTROSE 10 % AND 0.2 % NACL
DEXTROSE 2.5 % AND 0.45 % NACL
DEXTROSE 5 %-0.2 % NACL
DEXTROSE 5 %-0.2 % NACL
DEXTROSE 5 % AND 0.3 % NACL
DEXTROSE 5 % AND 0.3 % NACL
DEXTROSE 5 %-0.45 % NACL
DEXTROSE 5 % AND 0.9 % NACL
DEXTROSE 5%-LACTATED RINGERS
DEXTROSE 5% IN RINGERS
DEXTROSE 10 % IN WATER
DEXTROSE 2.5 % AND 0.45 % NACL
ALLOPURINOL
ALLOPURINOL SODIUM
ALLOPURINOL SODIUM
COLCHICINE
COLCHICINE
RASBURICASE
PEGLOTICASE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
GOUT AND RELATED DISEASES
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
BRAND DRUG
MITIGARE
PROBENECID-COLCHICINE
ULORIC
ZYLOPRIM
ACD
ACD-A
ACTIVASE
ADVATE
ADVATE H
ADVATE L
ADVATE M
ADVATE SH
ADVATE UH
AGGRASTAT
AGGRENOX
AGRYLIN
ALBUKED-25
ALBUKED-5
ALBUMIN (HUMAN)
ALBUMINAR-25
ALBUMINAR-5
ALBURX
ALBUTEIN
ALPHANATE
ALPHANINE SD
ALPROLIX
AMICAR
ANGIOMAX
ARANESP
ARGATROBAN
ARGATROBAN-SODIUM CHLORIDE
ARIXTRA
ASTRINGYN
ATRYN
AVITENE
BEBULIN
BEBULIN VH IMMUNO
BENEFIX
BIOCLATE
BRILINTA
BUMINATE
CATHFLO ACTIVASE
CEPROTIN
CITRATE PHOSPHATE DEXTROSE
CLOPIDOGREL
CORIFACT
COUMADIN
CYKLOKAPRON
123
GENERIC DRUG
COLCHICINE
PROBENECID
COLCHICINE/PROBENECID
FEBUXOSTAT
ALLOPURINOL
DEXTROSE/SOD CITRATE/CITRIC AC
CITRATE DEXTROSE SOLUTION
ALTEPLASE
ANTIHEMOPH.FVIII,FULL LENGTH
ANTIHEMOPH.FVIII,FULL LENGTH
ANTIHEMOPH.FVIII,FULL LENGTH
ANTIHEMOPH.FVIII,FULL LENGTH
ANTIHEMOPH.FVIII,FULL LENGTH
ANTIHEMOPH.FVIII,FULL LENGTH
TIROFIBAN-0.9% SODIUM CHLORIDE
ASPIRIN/DIPYRIDAMOLE
ANAGRELIDE HCL
ALBUMIN HUMAN
ALBUMIN HUMAN
ALBUMIN HUMAN
ALBUMIN HUMAN
ALBUMIN HUMAN
ALBUMIN HUMAN
ALBUMIN HUMAN
ANTIHEMOPHILIC FACTOR/VWF
FACTOR IX
FACTOR IX REC, FC FUSION PROTN
AMINOCAPROIC ACID
AMINOCAPROIC ACID
ANAGRELIDE HCL
BIVALIRUDIN
DARBEPOETIN ALFA IN POLYSORBAT
ARGATROBAN IN 0.9 % SOD CHLOR
FONDAPARINUX SODIUM
FERRIC SUBSULFATE
ANTITHROMBIN III, HUMAN RECOMB
MICROFIBRILLAR COLLAGEN
FACTOR IX COMPLEX (PCC) COMB.6
FACTOR IX COMPLEX (PCC) COMB.6
FACTOR IX HUMAN RECOMBINANT
ANTIHEMOPHILIC FACTOR, HUM REC
TICAGRELOR
ALBUMIN HUMAN
ALTEPLASE
PROTEIN C CONCENTRATE, HUMAN
CILOSTAZOL
CITRATE PHOSPHATE DEXTROS SOLN
CLOPIDOGREL BISULFATE
FACTOR XIII
WARFARIN SODIUM
TRANEXAMIC ACID
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
BRAND DRUG
DEXTRAN 70 IN DEXTROSE 5%
DROXIA
EFFIENT
ELIQUIS
ELOCTATE
ENDO-AVITENE
EPOGEN
EVICEL
FEIBA NF
FEIBA VH IMMUNO
FLEXBUMIN
FRAGMIN
GELFOAM
GELFOAM COMPRESSED
GRANIX
HELIXATE FS
HEMOFIL M
HEPARIN FLUSH
HEPARIN LOCK
HEPARIN SODIUM
HEPARIN SODIUM IN 0.45% NACL
HEPARIN SODIUM IN 0.9% NACL
HEPARIN SODIUM IN 5% DEXTROSE
HEPARIN SODIUM-0.9% NACL
HEPARIN SODIUM-D5W
HEPARIN SODIUM-NS
HESPAN
HETASTARCH IN NS
HEXTEND LACTATED ELECTROLYTE
HUMATE-P
HYDREA
INNOHEP
INTEGRILIN
IPRIVASK
JANTOVEN
KCENTRA
KEDBUMIN
KOATE-DVI
KOGENATE FS
LEUKINE
LMD 10% WITH 0.9% SOD CHLORIDE
LMD 10% WITH 5% DEXTROSE
LOVENOX
LYSTEDA
MEPHYTON
MIRCERA
MONOCLATE-P
MONONINE
MONSEL'S
124
GENERIC DRUG
DEXTRAN 70/D5W
HYDROXYUREA
PRASUGREL HCL
APIXABAN
ANTIHEMOPH.FVIII REC,FC FUSION
MICROFIBRILLAR COLLAGEN
ENOXAPARIN SODIUM
EPOETIN ALFA
THROMBIN(HUM PLAS)/FIBRINOG/CA
ANTI-INHIBITOR COAGULANT COMP.
ANTI-INHIBITOR COAGULANT COMP.
ALBUMIN HUMAN
FONDAPARINUX SODIUM
DALTEPARIN SODIUM,PORCINE
GELATIN SPONGE,ABSORBABLE
GELATIN SPONGE,ABSORBABLE
TBO-FILGRASTIM
ANTIHEMOPH.FVIII,FULL LENGTH
ANTIHEMOPHILIC FACTOR, HUMAN
HEPARIN SOD,PORCINE-0.9 % NACL
HEPARIN SODIUM,PORCINE
HEPARIN SODIUM,PORCINE
HEPARIN SOD,PORK IN 0.45% NACL
HEPARIN SODIUM,PORCINE/NS/PF
HEPARIN SODIUM,PORCINE/D5W
HEPARIN SOD,PORCINE-0.9 % NACL
HEPARIN (PORCINE) IN D5W/PF
HEPARIN SOD,PORCINE-0.9 % NACL
HETASTARCH IN 0.9 % NACL
HETASTARCH IN 0.9 % NACL
HETASTARCH/E-LYTES,LACTATE
ANTIHEMOPHILIC FACTOR/VWF
HYDROXYUREA
HYDROXYUREA
TINZAPARIN SODIUM,PORCINE
EPTIFIBATIDE
DESIRUDIN
WARFARIN SODIUM
HUMAN PROTHROMBIN COMPLX(PCC)
ALBUMIN HUMAN
ANTIHEMOPHILIC FACTOR, HUMAN
ANTIHEMOPH.FVIII,FULL LENGTH
SARGRAMOSTIM
DEXTRAN 40 IN 0.9 % NACL
DEXTRAN 40/D5W
ENOXAPARIN SODIUM
TRANEXAMIC ACID
PHYTONADIONE
METHOXY PEG-EPOETIN BETA
ANTIHEMOPHILIC FACTOR, HUMAN
FACTOR IX
FERRIC SUBSULFATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
BRAND DRUG
NEULASTA
NEUMEGA
NEUPOGEN
NOVOEIGHT
NOVOSEVEN
NOVOSEVEN RT
NPLATE
OBIZUR
OCTAPLAS
OMONTYS
OXYCEL
PANHEMATIN
PLASBUMIN-25
PLASBUMIN-5
PLASMANATE
PLAVIX
PLETAL
PRADAXA
PROCRIT
PROFILNINE
PROFILNINE SD
PROMACTA
RECOMBINATE
RECOTHROM
REFLUDAN
REOPRO
RETAVASE
RIASTAP
RIXUBIS
SAVAYSA
SOLIRIS
SURGICEL
SURGICEL NU-KNIT
SURGIFOAM
SYRINGE AVITENE
TACHOSIL
THROMBATE III
THROMBIN-JMI
TISSEEL VHSD
TNKASE
TRENTAL
TRETTEN
TRICITRASOL
VITAMIN K1
VITAMIN K2
VOLUVEN
125
GENERIC DRUG
PEGFILGRASTIM
OPRELVEKIN
FILGRASTIM
ANTIHEMOPH.FVIII,B-DOM TRUNCAT
COAGULATION FACTOR VIIA,RECOMB
COAGULATION FACTOR VIIA,RECOMB
ROMIPLOSTIM
ANTIHEMOPHILIC FVIII,REC PORC
PLASMA HUMAN, BLOOD GROUP A
PEGINESATIDE
CELLULOSE,OXIDIZED
HEMIN
PENTOXIFYLLINE
PHYTONADIONE
ALBUMIN HUMAN
ALBUMIN HUMAN
PLASMA PROTEIN FRACTION
CLOPIDOGREL BISULFATE
CILOSTAZOL
DABIGATRAN ETEXILATE MESYLATE
EPOETIN ALFA
FACTOR IX COMPLEX (PCC) COMB.4
FACTOR IX COMPLEX (PCC) COMB.4
ELTROMBOPAG OLAMINE
PROTAMINE SULFATE
ANTIHEMOPHILIC FACTOR, HUM REC
THROMBIN (RECOMBINANT)
LEPIRUDIN,RECOMBINANT
ABCIXIMAB
RETEPLASE
FIBRINOGEN
FACTOR IX HUMAN RECOMBINANT
EDOXABAN TOSYLATE
ECULIZUMAB
CELLULOSE,OXIDIZED
CELLULOSE,OXIDIZED
GELATIN SPONGE,ABSORBABLE
MICROFIBRILLAR COLLAGEN
FIBRINOGEN/THROMBIN (HUM PLAS)
ANTITHROMBIN III (HUM PLAS)
THROMBIN (BOVINE)
TICLOPIDINE HCL
THROMBIN(HUM PLAS)/FIB/APRO/CA
TENECTEPLASE
TRANEXAMIC ACID
PENTOXIFYLLINE
FACTOR XIII A-SUBUNIT,RECOMB
SODIUM CITRATE DIHYDRATE
PHYTONADIONE
HES 130/0.4 IN 0.9 % NACL
WARFARIN SODIUM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HEMATOLOGICAL DISORDERS
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
BRAND DRUG
WILATE
XARELTO
XYNTHA
XYNTHA SOLOFUSE
ZONTIVITY
ABD PADS 5X9"
ACTIVELLA
ADAPTIC 3X8"
ADHESIVE REM UNISOLVE 402300
ALORA
ANADROL-50
ANDRODERM
ANDROGEL
ANDROID
ANDROXY
ANGELIQ
AVEED
AXIRON
AYGESTIN
CATH TRAY W/10CC SYR & 3PVI
CENESTIN
CLIMARA
CLIMARA PRO
COMBIPATCH
COVARYX
COVARYX H.S.
DELATESTRYL
DELESTROGEN
DEPO-ESTRADIOL
DEPO-TESTOSTERONE
DHEA
DHEA 25
DIGNITY EXTRA PAD 26950
DIVIGEL
DUAVEE
EEMT
EEMT H.S.
ELESTRIN
ENJUVIA
ESSIAN
ESSIAN H.S.
ESTRACE
ESTRADERM
ESTRADIOL-NORETHINDRONE ACETAT
ESTRASORB
ESTRING
ESTROGEL
ESTROGEN & METHYLTESTOSTERONE
ESTROGEN-METHYLTESTOSTERONE
126
GENERIC DRUG
ANTIHEMOPHILIC FACTOR/VWF
RIVAROXABAN
ANTIHEMOPH.FVIII,B-DOMAIN DEL
ANTIHEMOPH.FVIII,B-DOMAIN DEL
VORAPAXAR SULFATE
ESTRADIOL/NORETHINDRONE ACET
ESTRADIOL
OXYMETHOLONE
TESTOSTERONE
TESTOSTERONE
METHYLTESTOSTERONE
FLUOXYMESTERONE
DROSPIRENONE/ESTRADIOL
TESTOSTERONE UNDECANOATE
TESTOSTERONE
NORETHINDRONE ACETATE
ESTROGENS,CONJ.,SYNTHETIC A
ESTRADIOL
ESTRADIOL/LEVONORGESTREL
ESTRADIOL/NORETHINDRONE ACET
ESTROGEN,ESTER/ME-TESTOSTERONE
ESTROGEN,ESTER/ME-TESTOSTERONE
TESTOSTERONE ENANTHATE
ESTRADIOL VALERATE
ESTRADIOL CYPIONATE
TESTOSTERONE CYPIONATE
PRASTERONE (DHEA)
PRASTERONE (DHEA)
ESTRADIOL
ESTROGENS,CONJ/BAZEDOXIFENE
ESTROGEN,ESTER/ME-TESTOSTERONE
ESTROGEN,ESTER/ME-TESTOSTERONE
ESTRADIOL
ESTROGENS,CONJ.,SYNTHETIC B
ESTROGEN,ESTER/ME-TESTOSTERONE
ESTROGEN,ESTER/ME-TESTOSTERONE
ESTRADIOL
ESTRADIOL
ESTRADIOL
ESTRADIOL VALERATE
ESTRADIOL/NORETHINDRONE ACET
ESTRADIOL
ESTRADIOL
ESTRADIOL
ESTROGEN,ESTER/ME-TESTOSTERONE
ESTROGEN,ESTER/ME-TESTOSTERONE
ESTROPIPATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
BRAND DRUG
EVAMIST
FEEDING GRAVITY BAG 1000ML
FEMHRT
FEMRING
FEMTRACE
FIRST-TESTOSTERONE
FIRST-TESTOSTERONE MC
FORTESTA
HUGGIES SNUG/DRY 4161279
HYDROCOLLOID DRESSING 4X5"
HYDROFILM DRESSING
JEVANTIQUE
JINTELI
LOPREEZA
LUPANETA PACK
MAKENA
MEDIPORE WOUND DRESSING 2 X 2
MENEST
MENOSTAR
MEPILEX 4X4"
MEPILEX LITE DRESSING 4X4"
METHITEST
MIC-KEY EXTENSION SET W/2PORT
MIC-KEY G-TUBE 24FR
MIMVEY
MIMVEY LO
MINIVELLE
NATESTO
NON-ADHERENT DRESSING 3X8"
ORTHO-PREFEST
OSTOMY BELT MEDIUM HOL7300
OXANDRIN
POUCH DRAIN 413334
POUCH DRAIN NATURA 413174
PREFEST
PREMARIN
PREMPHASE
PREMPRO
PROGESTERONE CREAM
PROMOGRAN PRISMA AG MATRIX
SEASORB AG PADS
STRIANT
TEGADERM FILM 2 3/8X 2 3/4"
TESTIM
TESTOPEL
TESTRED
127
GENERIC DRUG
ESTRADIOL
NORETHINDRONE AC-ETH ESTRADIOL
ESTRADIOL ACETATE
ESTRADIOL ACETATE
TESTOSTERONE PROPIONATE
TESTOSTERONE PROPIONATE
TESTOSTERONE
NORETHINDRONE AC-ETH ESTRADIOL
NORETHINDRONE AC-ETH ESTRADIOL
ESTRADIOL/NORETHINDRONE ACET
LEUPROLIDE/NORETHINDRONE ACET
HYDROXYPROGESTERONE CAPROATE
ESTROGENS,ESTERIFIED
ESTRADIOL
METHYLTESTOSTERONE
ESTRADIOL/NORETHINDRONE ACET
ESTRADIOL/NORETHINDRONE ACET
ESTRADIOL
TESTOSTERONE
NORETHINDRONE ACETATE
ESTRADIOL/NORGESTIMATE
OXANDROLONE
OXANDROLONE
ESTRADIOL/NORGESTIMATE
ESTROGENS, CONJUGATED
ESTROGEN,CON/M-PROGEST ACET
ESTROGEN,CON/M-PROGEST ACET
PROGESTERONE 200MG
TESTOSTERONE
TESTOSTERONE
TESTOSTERONE
TESTOSTERONE
TESTOSTERONE CYPIONATE
TESTOSTERONE ENANTHATE
METHYLTESTOSTERONE
TRI-ESTROGEN-PROGESTERONE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
HORMONAL DEFICIENCY
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
BRAND DRUG
VAGIFEM
VIVELLE-DOT
VOGELXO
WAFER SUR FIT #125259
WAFER SUR FIT #125271
WAFER SUR-FIT 4X4 125265
WAFER SUR-FIT CONVATEC 411806
WAFER SUR-FIT CONVATEC 413168
WAFER SUR-FIT CONVATEC 413182
WAFER/FLANGE SENSURA 10011
ACTHIB
ADACEL TDAP
ADENOVIRUS TYPE 4
ADENOVIRUS TYPE 4 AND TYPE 7
ADENOVIRUS TYPE 7
AFLURIA
AFLURIA 2011-2012
AFLURIA 2011-2012 (PF)
AFLURIA 2012-2013
AFLURIA 2013-2014
AFLURIA 2014-2015
AGRIFLU
ATGAM
ATTENUVAX VACCINE WITH DILUENT
BCG VACCINE (TICE STRAIN)
BEXSERO
BIOTHRAX
BIVIGAM
BOOSTRIX
BOOSTRIX TDAP
BOTULISM ANTITOXIN HEPTAVALENT
CARIMUNE NF NANOFILTERED
CERVARIX
COMVAX
CYTOGAM
DAPTACEL DTAP
DECAVAC
DIPHTHERIA-TETANUS TOXOID
DIPHTHERIA-TETANUS TOXOIDS-PED
ENGERIX-B
ENGERIX-B ADULT
ENGERIX-B PEDIATRIC-ADOLESCENT
FLEBOGAMMA
FLEBOGAMMA DIF
FLUARIX
FLUARIX 2011-2012
FLUARIX 2012-2013
FLUARIX 2013-2014
FLUARIX 2014-2015
FLUARIX QUAD 2013-2014
FLUARIX QUAD 2014-2015
FLUBLOK 2012-2013
128
GENERIC DRUG
ESTRADIOL
ESTRADIOL
TESTOSTERONE
HAEMOPH B POLY CONJ-TET TOX/PF
DIPH,PERTUSS(ACELL),TET VAC/PF
ADENOVIRUS VACCINE LIVE TYPE-4
ADENOVIRUS VAC LIVE TYPE-4 & 7
ADENOVIRUS VACCINE LIVE TYPE-7
INFLUENZA TV-S 09-10 VACCINE
FLU VACCINE TVSP2011-12(9 YR+)
FLU VACCINE TS2011-12(9YR+)/PF
FLU VACCINE 2012-13 (5YR+)/PF
FLU VACC TS 2013-14 (5YR+)/PF
FLU VACCINE TS 2014-15 (5 YR+)
INFLUENZA TVS 10-11 VACCINE/PF
LYMPHOCYTE IMMUNE GLOBULIN
MEASLES VACCINE,LIVE,ATTEN/PF
BCG LIVE
MENINGOCOCCAL B VACC,4-COMP/PF
ANTHRAX VACCINE
IMMUNE GLOBULIN,GAMMA(IGG)
DIPHTH,PERTUSS(ACELL),TET VAC
DIPHTH,PERTUSS(ACELL),TET VAC
BOTULISM ANTITOXIN 7/MALTOSE
IMMUNE GLOBULIN,GAMMA(IGG)
HUMAN PAPILLOMAV VACC BIVAL/PF
HEP B VACCINE/HIB CONJ-MENG/PF
CYTOMEGALOVIRUS IMMUNE GLOBULN
DIPH,PERTUSS(ACELL),TET PED/PF
TETANUS AND DIPHTHERIA TOX/PF
TETANUS,DIPHTHERIA TOXD PED/PF
TETANUS,DIPHTHERIA TOXD PED/PF
HEPATITIS B VIRUS VACCINE/PF
HEPATITIS B VIRUS VACCINE/PF
HEPATITIS B VIRUS VACCINE/PF
IMMUNE GLOBULIN,GAMMA(IGG)
IMMUNE GLOBULIN,GAMMA(IGG)
INFLUENZA TVS 09-10 VACCINE/PF
FLU VACCINE TS2011-12(3YR+)/PF
FLU VACCINE TS2012-13(3YR+)/PF
FLU VACC TS 2013-14(36MOS+)/PF
FLU VACC TS 2014-15(36MOS+)/PF
FLU VACC QS 2013-14(36MOS+)/PF
FLU VACC QS 2014-15(36MOS+)/PF
FLU VAC TV 2012(18-49YR)RCM/PF
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
BRAND DRUG
FLUBLOK 2013-2014
FLUBLOK 2014-2015
FLUCELVAX
FLUCELVAX 2014-2015
FLULAVAL
FLULAVAL 2011-2012
FLULAVAL 2012-2013
FLULAVAL 2013-2014
FLULAVAL 2014-2015
FLULAVAL QUAD 2013-2014
FLULAVAL QUAD 2014-2015
FLUMIST
FLUMIST QUAD 2014-2015
FLUVIRIN
FLUVIRIN 2011-2012
FLUVIRIN 2012-2013
FLUVIRIN 2013-2014
FLUVIRIN 2014-2015
FLUZONE
FLUZONE 2011-2012
FLUZONE 2011-2012 (PF)
FLUZONE 2012-2013
FLUZONE 2013-2014
FLUZONE 2014-2015
FLUZONE HIGH-DOSE
FLUZONE HIGH-DOSE 2011-12 (PF)
FLUZONE HIGH-DOSE 2012-13
FLUZONE HIGH-DOSE 2013-2014
FLUZONE HIGH-DOSE 2014-2015
FLUZONE INTRADERM QUAD 2014-15
FLUZONE INTRADERMAL
FLUZONE INTRADERMAL 2012-2013
FLUZONE INTRADERMAL 2013-2014
FLUZONE INTRADERMAL 2014-2015
FLUZONE PEDI 2012-2013
FLUZONE PEDI 2013-2014
FLUZONE QUAD 2013-2014
FLUZONE QUAD 2014-2015
FLUZONE QUAD PEDI 2013-2014
FLUZONE QUAD PEDI 2014-2015
GAMASTAN S-D
GAMMAGARD LIQUID
GAMMAGARD S-D
GAMMAKED
GAMMAPLEX
GAMUNEX
GAMUNEX-C
GARDASIL
GARDASIL 9
HAVRIX
HEPAGAM B
HIZENTRA
129
GENERIC DRUG
FLU VAC TV 2013(18-49YR)RCM/PF
FLU VAC TV 2014(18 YR+)RCM/PF
FLU VACC 12-13(18+)CELL DER/PF
FLU VACC TS 14-15 (18+)CELL/PF
INFLUENZA TV-S 09-10 VACCINE
FLU VACCINE TS 2011-12(18 YR+)
FLU VACCINE TS 2012-13(18 YR+)
FLU VACC TS 2013-14(36MOS+)
FLU VACC TS 2014-15(36MOS+)/PF
FLU VACCINE QS 2013-14(36MOS+)
FLU VACC QS 2014-15(36MOS+)/PF
FLU VACCINE 2012 (2-49YRS)
FLU VACC QV LIVE 2014(2-49YRS)
INFLUENZA TV-S 10-11 VACCINE
FLU VACCINE TS 2011-12 (4 YR+)
FLU VACCINE TS 2012-13 (4 YR+)
FLU VACCINE TS 2013-14 (4 YR+)
FLU VACCINE TS 2014-15 (4 YR+)
INFLUENZA TV-S 09-10 VACCINE
FLU VACCINE TS 2011-12(6 MOS+)
FLU VACCINE 2011 (36 MOS+)/PF
FLU VACCINE 2012-13(36MOS+)/PF
FLU VACC TS 2013-14(36MOS+)/PF
FLU VACC TS 2014-15(36MOS+)/PF
INFLUENZA TVS 09-10 VACCINE/PF
INFLUENZA TVS 11-12 VACCINE/PF
FLU VACC TS 2012-13(65YR+)/PF
FLU VACC TS 2013-14 (65YR+)/PF
FLU VACC TS 2014-15 (65YR+)/PF
FLU VACC QS 2014 (18-64YRS)/PF
INFLUENZA TVS 11-12 VACCINE/PF
FLU VACCINE 2012 (18-64YRS)/PF
FLU VACC TS 2013 (18-64YRS)/PF
FLU VACC TS 2014 (18-64YRS)/PF
FLU VACCINE 2012(6-35MOS)/PF
FLU VACC TS 2013 (6-35MOS)/PF
FLU VACC QS 2013-14(36MOS+)/PF
FLU VACC QS 2014-15(36MOS+)/PF
FLU VACCINE 2013(6-35MOS)/PF
FLU VACCINE 2014(6-35MOS)/PF
IMMUNE GLOBULIN,GAMMA(IGG)
IMMUNE GLOBULIN,GAMMA(IGG)
IMMUNE GLOBULIN,GAMMA(IGG)
IMMUNE GLOB,GAM CAPRYLATE(IGG)
IMMUNE GLOBULIN,GAMMA(IGG)
IMMUNE GLOB,GAM CAPRYLATE(IGG)
IMMUNE GLOB,GAM CAPRYLATE(IGG)
HUMAN PAPILOMVIRUS VAC,QVAL/PF
HPV VACCINE 9-VALENT/PF
HEPATITIS A VIRUS VACCINE/PF
HEPATITIS B IMMUN GLOB/MALTOSE
IMMUNE GLOBULIN,GAMMA(IGG)
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
BRAND DRUG
HYPERHEP B S-D
HYPERRAB S-D
HYPERRHO S-D
HYPERTET S-D
HYQVIA
IMOGAM RABIES-HT
IMOVAX RABIES VACCINE
INFANRIX DTAP
INFANRIX PF
INFLUENZA A (H1N1) 2009
IPOL
IXIARO
JE-VAX
KINRIX
MENACTRA
MENHIBRIX
MENOMUNE-A-C-Y-W-135
MENVEO A-C-Y-W-135-DIP
MENVEO MENA COMPONENT
MENVEO MENCYW-135 COMPONENT
MERUVAX II VACCINE W-DILUENT
MICRHOGAM
MICRHOGAM ULTRA-FILTERED PLUS
M-M-R II VACCINE
MUMPSVAX VACCINE W-DILUENT
NABI-HB
OCTAGAM
PEDIARIX
PEDVAXHIB
PENTACEL
PENTACEL ACTHIB COMPONENT
PENTACEL DTAP-IPV COMPONENT
PHYSICIANS EZ USE FLU 2012-13
PNEUMOVAX 23
PREVNAR 13
PRIVIGEN
PROQUAD
QUADRACEL DTAP-IPV
RABAVERT
RECOMBIVAX HB
RHOGAM
RHOGAM ULTRA-FILTERED PLUS
RHOPHYLAC
ROTARIX
ROTATEQ
SINGLE USE EZ FLU 2012-2013
SINGLE USE EZ FLU 2013-2014
SINGLE USE EZ FLU 2014-2015
TENIVAC
TETANUS DIPHTHERIA TOXOIDS
TETANUS TOXOID ADSORBED
TETANUS-DIPHTERIA-DECAVAC
130
GENERIC DRUG
HEPATITIS B IMMUNE GLOBULIN
RABIES IMMUNE GLOBULIN/PF
RHO(D) IMMUNE GLOBULIN
TETANUS IMMUNE GLOBULIN/PF
IGG/HYALURONIDASE,RECOMBINANT
RABIES IMMUNE GLOBULIN/PF
RABIES VACC, HUMAN DIPLOID/PF
DIPH,PERTUSS(ACELL),TET PED/PF
DIPH,PERTUSS(ACELL),TET PED/PF
INFLUENZA A (H1N1)VAC 2009/PF
POLIOMYELITIS VACCINE, KILLED
JAPANESE ENCEPHALITIS VACC/PF
JAPANESE ENCEPHALITIS VACCINE
DIPH,PERTUS(ACEL),TET,POLIO/PF
MENING VAC A,C,Y,W-135 DIP/PF
MENINGOCOCCAL VAC C,Y/HIB/PF
MENINGOCOC VAC A,C,Y,W-135/PF
MENING VAC A,C,Y,W-135 DIP/PF
MENING A CONJ VACC, 1 OF 2/PF
MENING C,Y,W-135 VAC 2 OF 2/PF
RUBELLA VIRUS LIVE VACCINE/PF
RHO(D) IMMUNE GLOBULIN
RHO(D) IMMUNE GLOBULIN
MEASLES,MUMPS&RUBELLA VACC/PF
MUMPS VACCINE,LIVE/PF
HEPATITIS B IMMUNE GLOBULIN
IMMUNE GLOBULIN,G(IGG)/MALTOSE
HEP B VACCINE/DP(A)T-POLIO/PF
HAEMPH B POLYSAC CONJ-MENIN/PF
DP(A)T-POLIO/HIB CONJ-TET/PF
HAEMOPH B POLY CONJ-TET TOX/PF
DIPH,PERTUS(ACEL),TET,POLIO/PF
FLU VACCINE TS 2012-13 (4 YR+)
PNEUMOCOCCAL 23-VAL P-SAC VAC
PNEUMOC 13-VAL CONJ-DIP CRM/PF
IMMUNE GLOBULIN,GAMMA(IGG)
MEASLES,MUMPS,RUB,VARICELLA/PF
DIPH,PERTUS(ACEL),TET,POLIO/PF
RABIES VACCINE (PCEC)/PF
HEPATITIS B VIRUS VACCINE/PF
RHO(D) IMMUNE GLOBULIN
RHO(D) IMMUNE GLOBULIN
RHO(D) IMMUNE GLOBULIN
ROTAVIRUS VAC,LIVE ATT, 89-12
ROTAVIRUS VACCINE,LIVE ORAL PV
FLU VACCINE TS2012-13(4YR+)/PF
FLU VACC QS 2013-14(36MOS+)/PF
FLU VACC TS 14-15 (18+)CELL/PF
TETANUS AND DIPHTHERIA TOX/PF
TETANUS & DIPHTHERIA TOX,ADULT
TETANUS TOXOID, ADSORBED/PF
TETANUS AND DIPHTHERIA TOX/PF
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNIZATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
IMMUNOSUPPRESSION/MODULATION
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
BRAND DRUG
THERACYS
THYMOGLOBULIN
TRIHIBIT
TRIPEDIA
TRUMENBA
TWINRIX
TYPHIM VI
VAQTA
VARIVAX VACCINE
VARIZIG
VIVAGLOBIN
VIVOTIF BERNA
WINRHO SDF
YF-VAX
ZOSTAVAX
ACTIMMUNE
AFINITOR
AFINITOR DISPERZ
ALDARA
ALFERON N
AZASAN
CELLCEPT
CYCLOSPORINE MODIFIED
GENGRAF
IMURAN
INTRON A
MYCOPHENOLIC ACID
MYFORTIC
NEORAL
NULOJIX
ORTHOCLONE OKT-3
PROLEUKIN
RAPAMUNE
SIMULECT
ZORTRESS
ZYCLARA
ACTICLATE
ADOXA
AMOX TR-POTASSIUM CLAVULANATE
AMOXICILLIN ER
AMOXICILLIN-CLAVULANATE ER
AMOXIL
AMPICILLIN-SULBACTAM
ARKALIOX
131
GENERIC DRUG
BCG LIVE
LYMPHOCYTE IMMU GLOB.,RABBIT
DP(A)T PED/HIB CONJ-TET/PF
DIPH,PERTUSS(ACELL),TET PED/PF
N.MENINGITIDIS B,LIPID FHBP RC
HEPATITIS A & B VACCINE/PF
TYPHOID VACC VI CAPSULR POLYS
HEPATITIS A VIRUS VACCINE/PF
VARICELLA VACCINE LIVE/PF
VARICELLA-ZOSTER IMMUNE GLOB
IMMUNE GLOBULIN,GAMMA(IGG)
TYPHOID VACC,LIVE,ATTENUATED
RHO(D) IMMUNE GLOBULIN/MALTOSE
YELLOW FEVER VACCINE LIVE/PF
ZOSTER VACCINE LIVE/PF
INTERFERON GAMMA-1B,RECOMB.
EVEROLIMUS
EVEROLIMUS
IMIQUIMOD
INTERFERON ALFA-N3
AZATHIOPRINE
AZATHIOPRINE
AZATHIOPRINE SODIUM
MYCOPHENOLATE MOFETIL
CYCLOSPORINE, MODIFIED
CYCLOSPORINE, MODIFIED
IMIQUIMOD
AZATHIOPRINE
INTERFERON ALFA-2B,RECOMB.
MYCOPHENOLATE MOFETIL
MYCOPHENOLATE SODIUM
MYCOPHENOLATE SODIUM
CYCLOSPORINE, MODIFIED
BELATACEPT
MUROMONAB-CD3
ALDESLEUKIN
SIROLIMUS
BASILIXIMAB
SIROLIMUS
EVEROLIMUS
IMIQUIMOD
DOXYCYCLINE HYCLATE
DOXYCYCLINE MONOHYDRATE
AMOXICILLIN/POTASSIUM CLAV
AMOXICILLIN
AMOXICILLIN
AMOXICILLIN/POTASSIUM CLAV
AMOXICILLIN
AMPICILLIN SODIUM
AMPICILLIN TRIHYDRATE
AMPICILLIN SODIUM/SULBACTAM NA
SULBUTIAMINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
BRAND DRUG
AUGMENTIN
AUGMENTIN ES-600
AUGMENTIN XR
AVELOX IV
AVIDOXY
AVIDOXY DK
AVYCAZ
AZACTAM
AZACTAM-ISO-OSMOTIC DEXTROSE
AZO
AZO DINE
AZO STANDARD
AZO-GESIC
AZO-TABS
BACTRIM
BACTRIM DS
BENOXYLDOXY 30
BENOXYLDOXY 60
BIAXIN
BIAXIN XL
BICILLIN C-R
BICILLIN L-A
CAYSTON
CECLOR
CEDAX
CEFACLOR ER
CEFAZOLIN
CEFAZOLIN SODIUM-0.9% NACL
CEFEPIME
CEFEPIME-DEXTROSE
CEFOTETAN
CEFOTETAN & DEXTROSE
CEFOXITIN
CEFOXITIN SODIUM
CEFTIN
CEFTRIAXONE
CEFUROXIME
CEFUROXIME AXETIL
CIPRO I.V.
132
GENERIC DRUG
AMOXICILLIN/POTASSIUM CLAV
AMOXICILLIN/POTASSIUM CLAV
AMOXICILLIN/POTASSIUM CLAV
MOXIFLOXACIN IN NACL (ISO-OSM)
DOXYCYCLINE MONOHYDRATE
DOXYCYCLINE/SALICY/OCT/ZINC OX
CEFTAZIDIME/AVIBACTAM
AZTREONAM
AZTREONAM/DEXTROSE-WATER
PHENAZOPYRIDINE HCL
PHENAZOPYRIDINE HCL
PHENAZOPYRIDINE HCL
PHENAZOPYRIDINE HCL
PHENAZOPYRIDINE HCL
AZTREONAM
SULFAMETHOXAZOLE/TRIMETHOPRIM
SULFAMETHOXAZOLE/TRIMETHOPRIM
DOXYCYCLINE/BENZOYL PEROXIDE
DOXYCYCLINE/BENZOYL PEROXIDE
CLARITHROMYCIN
CLARITHROMYCIN
PEN G BENZ/PEN G PROCAINE
PENICILLIN G BENZATHINE
AZTREONAM LYSINE
CEFACLOR
CEFTIBUTEN
CEFACLOR
CEFACLOR
CEFADROXIL
CEFAZOLIN SODIUM/DEXTROSE,ISO
CEFAZOLIN SODIUM
CEFAZOLIN SODIUM IN 0.9 % NACL
CEFDINIR
CEFDITOREN PIVOXIL
CEFEPIME HCL/DEXTROSE, ISO-OSM
CEFEPIME HCL
CEFEPIME HCL/D5W
CEFOTAXIME SODIUM
CEFOTETAN DISODIUM
CEFOTETAN DISOD/DEXTROSE,ISO
CEFOXITIN SODIUM
CEFOXITIN SODIUM/DEXTROSE,ISO
CEFPODOXIME PROXETIL
CEFPROZIL
CEFTAZIDIME
CEFTIBUTEN
CEFUROXIME AXETIL
CEFTRIAXONE NA/DEXTROSE,ISO
CEFUROXIME AXETIL
CEFUROXIME SODIUM
CIPROFLOXACIN LACTATE/D5W
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
BRAND DRUG
CIPRO XR
CIPROFLOXACIN ER
CIPROFLOXACIN-D5W
CLAFORAN
CLARITHROMYCIN ER
CUBICIN
CYSTEX PLUS
DIFICID
DORIBAX
DORYX
DOXY 100
DOXYCYCLINE IR-DR
DYNACIN
E.E.S. 200
E.E.S. 400
ERYPED 200
ERYPED 400
ERYTHROCIN LACTOBIONATE
ERYTHROMYCIN-SULFISOXAZOLE
FACTIVE
FORTAZ
FORTAZ IN ISO-OSMOTIC DEXTROSE
FURADANTIN
HIPREX
HYOPHEN
IMIPENEM-CILASTATIN SODIUM
INVANZ
KETEK
KETEK PAK
LEVOFLOXACIN-D5W
MACROBID
MACRODANTIN
MAXIPIME
MEFOXIN
MERREM
MINOCIN
MONODOX
MONUROL
MORGIDOX
MOXATAG
133
GENERIC DRUG
CIPROFLOXACIN/CIPROFLOXA HCL
CIPROFLOXACIN
CIPROFLOXACIN/CIPROFLOXA HCL
CIPROFLOXACIN LACTATE/D5W
CEFOTAXIME SODIUM
CLARITHROMYCIN
CLARITHROMYCIN
DAPTOMYCIN
METHENAMINE/SODIUM SALICYLATE
DEMECLOCYCLINE HCL
DICLOXACILLIN SODIUM
FIDAXOMICIN
DORIPENEM
DOXYCYCLINE HYCLATE
DOXYCYCLINE HYCLATE
DOXYCYCLINE HYCLATE
DOXYCYCLINE MONOHYDRATE
DOXYCYCLINE MONOHYDRATE
MINOCYCLINE HCL
ERYTHROMYCIN ETHYLSUCCINATE
ERYTHROMYCIN ETHYLSUCCINATE
ERYTHROMYCIN ETHYLSUCCINATE
ERYTHROMYCIN ETHYLSUCCINATE
ERYTHROMYCIN LACTOBIONATE
ERYTHROMYCIN ETHYLSUCCINATE
ERY E-SUCC/SULFISOXAZOLE
GEMIFLOXACIN MESYLATE
CEFTAZIDIME
CEFTAZIDIME NA/DEXTROSE,ISO
NITROFURANTOIN
METHENAMINE HIPPURATE
METHENAM/ME BLUE/BA/SALICY/HYO
IMIPENEM/CILASTATIN SODIUM
ERTAPENEM SODIUM
TELITHROMYCIN
TELITHROMYCIN
LEVOFLOXACIN/D5W
LINEZOLID
NITROFURANTOIN MONOHYD/M-CRYST
NITROFURANTOIN MACROCRYSTAL
CEFEPIME HCL
CEFOXITIN SODIUM/D5W
MEROPENEM
MEROPENEM
METHENAMINE HIPPURATE
METHENAMINE MANDELATE
MINOCYCLINE HCL
MINOCYCLINE HCL
DOXYCYCLINE MONOHYDRATE
FOSFOMYCIN TROMETHAMINE
DOXYCYCLINE HYCLATE
AMOXICILLIN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
BRAND DRUG
NAFCILLIN
NITROFURANTOIN MONO-MACRO
NUTRIDOX
OMNICEF
ORACEA
ORAXYL
OXACILLIN
PENICILLIN G POTASS-0.9% NACL
PENICILLIN GK-ISO-OSM DEXTROSE
PENICILLIN V POTASSIUM
PERIOSTAT
PFIZERPEN
PHOSENAMINE
PHOSPHASAL
PIPERACILLIN
PIPERACILLIN-TAZOBACTAM
PRIMAXIN
PRIMAXIN I.M.
PRIMSOL
PRODIUM
PROSED-DS
PYRIDIUM
RE-AZO
ROCEPHIN
SEPTRA
SEPTRA DS
SIVEXTRO
SOLODYN
SPECTRACEF
SULFAMETHOXAZOLE-TMP DS
SULFAMETHOXAZOLETRIMETHOPRIM
SULFATRIM
SUPRAX
SYNERCID
TAZICEF
TEFLARO
TIMENTIN
TRIMOX
TYGACIL
UNASYN
UR N-C
URELLE
URETRON D-S
134
GENERIC DRUG
NAFCILLIN IN DEXTROSE,ISO-OSM
NAFCILLIN SODIUM
NITROFURANTOIN
NITROFURANTOIN MONOHYD/M-CRYST
DOXYCYCLINE/OMEGA-3 #1/EYE MSK
CEFDINIR
DOXYCYCLINE MONOHYDRATE
DOXYCYCLINE HYCLATE
OXACILLIN SODIUM/DEXTROSE,ISO
OXACILLIN SODIUM
PENICILLIN G POT IN 0.9% NACL
PENICILLIN G POTASSIUM
PENICILLIN G PROCAINE
PENICILLIN G SODIUM
PEN G POT/DEXTROSE-WATER
DOXYCYCLINE HYCLATE
PENICILLIN G POTASSIUM
PHENAZOPYRIDINE HCL
METHEN/M-BLUE/SAL/NA PHOS/HYOS
MTH/ME BLUE/SOD PHOS/PHEN/HYOS
PIPERACILLIN SODIUM
PIPERACILLIN SODIUM/TAZOBACTAM
IMIPENEM/CILASTATIN SODIUM
IMIPENEM/CILASTATIN SODIUM
TRIMETHOPRIM
PHENAZOPYRIDINE HCL
METHENAM/ME BLUE/BA/SALICY/HYO
PHENAZOPYRIDINE HCL
PHENAZOPYRIDINE HCL
CEFTRIAXONE SODIUM
SULFAMETHOXAZOLE/TRIMETHOPRIM
SULFAMETHOXAZOLE/TRIMETHOPRIM
TEDIZOLID PHOSPHATE
MINOCYCLINE HCL
CEFDITOREN PIVOXIL
SULFADIAZINE
SULFAMETHOXAZOLE/TRIMETHOPRIM
SULFAMETHOXAZOLE/TRIMETHOPRIM
SULFAMETHOXAZOLE/TRIMETHOPRIM
CEFIXIME
QUINUPRISTIN/DALFOPRISTIN
CEFTAZIDIME
CEFTAROLINE FOSAMIL ACETATE
TICARCILLIN/K CLAVULANATE
TRIMETHOPRIM
AMOXICILLIN
TIGECYCLINE
AMPICILLIN SODIUM/SULBACTAM NA
MTH/ME BLUE/SOD PHOS/PHEN/HYOS
MTH/ME BLUE/SOD PHOS/PHEN/HYOS
METHEN/M-BLUE/SAL/NA PHOS/HYOS
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - BACTERIAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
BRAND DRUG
UREX
URIBEL
URIMAR-T
URIN D.S.
URINARY PAIN RELIEF
URINARY TRACT
URISTAT
URO-BLUE
UROGESIC-BLUE
URO-L
URO-MP
URYL
USTELL
UTA
UTICAP
UTIRA-C
UTRONA-C
VANCOCIN HCL
VIBRAMYCIN
WOMAN'S WELLBEING UTI RELIEF
ZERBAXA
ZINACEF
ZINACEF ISO-OSMOTIC DEXTROSE
ZOSYN
ZYVOX
ABELCET
AMBISOME
AMPHOTEC
ANCOBON
CANCIDAS
CRESEMBA
DIFLUCAN
DIFLUCAN IN DEXTROSE
DIFLUCAN IN SALINE
ERAXIS (WATER DILUENT)
FIRST-BXN
FIRST-DUKE'S
FIRST-MARY'S
FLUCONAZOLE IN DEXTROSE
FLUCONAZOLE IN SALINE
FLUCONAZOLE-NACL
GRIFULVIN V
GRISEOFULVIN
GRIS-PEG
MYCAMINE
NOXAFIL
ONMEL
135
GENERIC DRUG
METHENAMINE HIPPURATE
MTH/ME BLUE/SOD PHOS/PHEN/HYOS
METHEN/M-BLUE/SAL/NA PHOS/HYOS
MTH/ME BLUE/SOD PHOS/PHEN/HYOS
PHENAZOPYRIDINE HCL
PHENAZOPYRIDINE HCL
PHENAZOPYRIDINE HCL
METHEN/SOD PHOS/METH BLUE/HYOS
METHEN/SOD PHOS/METH BLUE/HYOS
MTH/ME BLUE/SOD PHOS/PHEN/HYOS
MTH/ME BLUE/SOD PHOS/PHEN/HYOS
METHEN/SOD PHOS/METH BLUE/HYOS
METHEN/M-BLUE/SAL/NA PHOS/HYOS
METHEN/M-BLUE/SAL/NA PHOS/HYOS
METHEN/M-BLUE/SAL/NA PHOS/HYOS
MTH/ME BLUE/SOD PHOS/PHEN/HYOS
MTH/ME BLUE/SOD PHOS/PHEN/HYOS
VANCOMYCIN HCL
VANCOMYCIN HCL
DOXYCYCLINE CALCIUM
PHENAZOPYRIDINE HCL
CEFTOLOZANE/TAZOBACTAM
CEFUROXIME SODIUM
CEFUROXIME SODIUM/DEXTROSE,ISO
PIPERACILLIN SODIUM/TAZOBACTAM
LINEZOLID
AMPHOTERICIN B LIPID COMPLEX
AMPHOTERICIN B LIPOSOME
AMPHOTERICIN B CHOLESTERYL SUL
FLUCYTOSINE
CASPOFUNGIN ACETATE
ISAVUCONAZONIUM SULFATE
FLUCONAZOLE
FLUCONAZOLE IN DEXTROSE,ISO-OS
FLUCONAZOLE IN NACL,ISO-OSM
ANIDULAFUNGIN
NYSTATIN/LIDOCAINE/DIPHENHYD
NYSTATIN/HYDROCORTISONE/DIPHEN
NYSTATIN/TCN/HC/DIPHENHYDRAMIN
FLUCONAZOLE
FLUCONAZOLE IN DEXTROSE,ISO-OS
FLUCONAZOLE IN NACL,ISO-OSM
FLUCONAZOLE IN NACL,ISO-OSM
FLUCYTOSINE
GRISEOFULVIN, MICROSIZE
GRISEOFULVIN, MICROSIZE
GRISEOFULVIN ULTRAMICROSIZE
GRISEOFULVIN ULTRAMICROSIZE
ITRACONAZOLE
MICAFUNGIN SODIUM
POSACONAZOLE
ITRACONAZOLE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - FUNGAL
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
BRAND DRUG
ORAVIG
SPORANOX
TERBINEX
VFEND
VFEND IV
AMINOACETIC ACID
BETHKIS
CAPASTAT SULFATE
CHLORAMPHENICOL SOD SUCCINATE
CLEOCIN HCL
CLEOCIN PALMITATE
CLEOCIN PHOSPHATE IN D5W
CLINDAMYCIN PEDIATRIC
CLINDAMYCIN PHOSPHATE-D5W
COLISTIMETHATE
COLY-MYCIN M PARENTERAL
DALVANCE
GENTAMICIN SULFATE IN NS
GLYCINE
ISONARIF
KITABIS PAK
LINCOCIN
MYAMBUTOL
MYCOBUTIN
ORBACTIV
PASER
PRIFTIN
RIFADIN
RIFAMATE
RIFATER
RIMACTANE
SEROMYCIN
SIRTURO
THALOMID
TOBI
TOBI PODHALER
TOBRAMYCIN SULFATE IN NS
TRECATOR
VANCOMYCIN
136
GENERIC DRUG
MICONAZOLE
ITRACONAZOLE
TERBINAFINE/HYDROXY CHITOSAN
VORICONAZOLE
VORICONAZOLE
VORICONAZOLE
AMIKACIN SULFATE
GLYCINE UROLOGIC SOLUTION
TOBRAMYCIN
CAPREOMYCIN SULFATE
CHLORAMPHENICOL SOD SUCC
CLINDAMYCIN HCL
CLINDAMYCIN PALMITATE HCL
CLINDAMYCIN PHOSPHATE/D5W
CLINDAMYCIN HCL
CLINDAMYCIN PALMITATE HCL
CLINDAMYCIN PALMITATE HCL
CLINDAMYCIN PHOSPHATE/D5W
COLISTIN (COLISTIMETHATE NA)
COLISTIN (COLISTIMETHATE NA)
CYCLOSERINE
DALBAVANCIN HCL
ETHAMBUTOL HCL
GENTAMICIN IN NACL, ISO-OSM
GLYCINE UROLOGIC SOLUTION
RIFAMPIN/ISONIAZID
ISONIAZID
KANAMYCIN SULFATE
TOBRAMYCIN/NEBULIZER
LINCOMYCIN HCL
ETHAMBUTOL HCL
RIFABUTIN
ORITAVANCIN DIPHOSPHATE
AMINOSALICYLIC ACID
POLYMYXIN B SULFATE
RIFAPENTINE
PYRAZINAMIDE
RIFABUTIN
RIFAMPIN
RIFAMPIN/ISONIAZID
RIFAMPIN
RIFAMP/ISONIAZID/PYRAZINAMIDE
RIFAMPIN
CYCLOSERINE
BEDAQUILINE FUMARATE
STREPTOMYCIN SULFATE
THALIDOMIDE
TOBRAMYCIN IN 0.225% NACL
TOBRAMYCIN
TOBRAMYCIN/SODIUM CHLORIDE
ETHIONAMIDE
VANCOMYCIN IN DEXTROSE,ISO-OSM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - MISCELLANEOUS
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - PARASITIC
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
BRAND DRUG
VANCOMYCIN HCL-0.9% NACL
VANCOMYCIN HCL-D5W
VANCOMYCIN-0.9% NACL
VANCOMYCIN-D5W
VIBATIV
XIFAXAN
ALBENZA
ARALEN PHOSPHATE
ATOVAQUONE-PROGUANIL HCL
BILTRICIDE
COARTEM
DARAPRIM
MALARONE
MEPRON
METRO IV
NEBUPENT
PENTAM 300
PIN-X
PLAQUENIL
PRIMAQUINE
QUALAQUIN
REESE PINWORM
TINDAMAX
YODOXIN
ABACAVIR
ABACAVIR-LAMIVUDINE-ZIDOVUDINE
APTIVUS
ATRIPLA
BARACLUDE
COMBIVIR
COMPLERA
COPEGUS
CRIXIVAN
CYTOVENE
EDURANT
EMTRIVA
EPIVIR
EPIVIR HBV
EPZICOM
137
GENERIC DRUG
VANCOMYCIN/0.9% SOD CHLORIDE
VANCOMYCIN HCL/D5W
VANCOMYCIN/0.9% SOD CHLORIDE
VANCOMYCIN HCL/D5W
TELAVANCIN HCL
RIFAXIMIN
ALBENDAZOLE
CHLOROQUINE PHOSPHATE
ATOVAQUONE
ATOVAQUONE/PROGUANIL HCL
PRAZIQUANTEL
CHLOROQUINE PHOSPHATE
ARTEMETHER/LUMEFANTRINE
PYRIMETHAMINE
HYDROXYCHLOROQUINE SULFATE
ATOVAQUONE/PROGUANIL HCL
MEBENDAZOLE
MEFLOQUINE HCL
ATOVAQUONE
METRONIDAZOLE/SODIUM CHLORIDE
PENTAMIDINE ISETHIONATE
PAROMOMYCIN SULFATE
PENTAMIDINE ISETHIONATE
PYRANTEL PAMOATE
HYDROXYCHLOROQUINE SULFATE
PRIMAQUINE PHOSPHATE
QUININE SULFATE
QUININE SULFATE
PYRANTEL PAMOATE
TINIDAZOLE
TINIDAZOLE
IODOQUINOL
ABACAVIR SULFATE
ABACAVIR/LAMIVUDINE/ZIDOVUDINE
ACYCLOVIR SODIUM
ADEFOVIR DIPIVOXIL
TIPRANAVIR
EFAVIRENZ/EMTRICITAB/TENOFOVIR
ENTECAVIR
CIDOFOVIR
LAMIVUDINE/ZIDOVUDINE
EMTRICITAB/RILPIVIRINE/TENOFOV
RIBAVIRIN
INDINAVIR SULFATE
GANCICLOVIR SODIUM
DIDANOSINE
RILPIVIRINE HCL
EMTRICITABINE
ENTECAVIR
LAMIVUDINE
LAMIVUDINE
ABACAVIR SULFATE/LAMIVUDINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
BRAND DRUG
EVOTAZ
FAMVIR
FLUMADINE
FOSCAVIR
FUZEON
HARVONI
HEPSERA
INCIVEK
INFERGEN
INTELENCE
INVIRASE
ISENTRESS
KALETRA
LAMIVUDINE HBV
LAMIVUDINE-ZIDOVUDINE
LEXIVA
MODERIBA
NEVIRAPINE ER
NORVIR
OLYSIO
PEGASYS
PEGASYS PROCLICK
PEGINTRON
PEGINTRON REDIPEN
PERAMIVIR
PREZCOBIX
PREZISTA
RAPIVAB
REBETOL
RELENZA
RESCRIPTOR
RETROVIR
REYATAZ
RIBAPAK
RIBASPHERE
RIBATAB
RIBAVIRIN
SELZENTRY
SOVALDI
STRIBILD
SUSTIVA
SYLATRON
SYLATRON 4-PACK
SYNAGIS
TAMIFLU
138
GENERIC DRUG
ATAZANAVIR SULFATE/COBICISTAT
FAMCICLOVIR
FAMCICLOVIR
RIMANTADINE HCL
FOSCARNET SODIUM
FOSCARNET SODIUM
ENFUVIRTIDE
GANCICLOVIR SODIUM
LEDIPASVIR/SOFOSBUVIR
ADEFOVIR DIPIVOXIL
TELAPREVIR
INTERFERON ALFACON-1
ETRAVIRINE
SAQUINAVIR MESYLATE
RALTEGRAVIR POTASSIUM
LOPINAVIR/RITONAVIR
LAMIVUDINE
LAMIVUDINE
LAMIVUDINE/ZIDOVUDINE
FOSAMPRENAVIR CALCIUM
RIBAVIRIN
NEVIRAPINE
NEVIRAPINE
RITONAVIR
SIMEPREVIR SODIUM
PEGINTERFERON ALFA-2A
PEGINTERFERON ALFA-2A
PEGINTERFERON ALFA-2B
PEGINTERFERON ALFA-2B
PERAMIVIR/PF
DARUNAVIR/COBICISTAT
DARUNAVIR ETHANOLATE
PERAMIVIR/PF
RIBAVIRIN
ZANAMIVIR
DELAVIRDINE MESYLATE
ZIDOVUDINE
ATAZANAVIR SULFATE
RIBAVIRIN
RIBAVIRIN
RIBAVIRIN
RIMANTADINE HCL
MARAVIROC
SOFOSBUVIR
STAVUDINE
ELVITEGR/COBICIST/EMTRIC/TENOF
EFAVIRENZ
PEGINTERFERON ALFA-2B
PEGINTERFERON ALFA-2B
PALIVIZUMAB
OSELTAMIVIR PHOSPHATE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFECTIOUS DISEASE - VIRAL
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
BRAND DRUG
TIVICAY
TRIUMEQ
TRIZIVIR
TRUVADA
TYBOST
TYZEKA
VALACYCLOVIR
VALCYTE
VALTREX
VICTRELIS
VIDEX
VIDEX EC
VIEKIRA PAK
VIRACEPT
VIRAMUNE
VIRAMUNE XR
VIRAZOLE
VIREAD
VISTIDE
VITEKTA
ZERIT
ZIAGEN
ACTEMRA
ADULT LOW DOSE ASPIRIN EC
ADVIL LIQUI-GELS
ADVIL MIGRAINE
A-HYDROCORT
ALEVE
ALL DAY RELIEF
A-METHAPRED
ANAPROX
ANAPROX DS
ARAVA
ARCALYST
ARISTOSPAN
ARTHRI-FLEX
ARTHROTEC 50
ARTHROTEC 75
ASMALPRED
ASMALPRED PLUS
ASPERDRINK
ASPIR 81
ASPIRIN EC
ASPIR-LOW
ASPIR-TRIN
BAYER ADVANCED
BAYER CHEWABLE ASPIRIN
BERINERT
139
GENERIC DRUG
DOLUTEGRAVIR SODIUM
ABACAVIR/DOLUTEGRAVIR/LAMIVUDI
ABACAVIR/LAMIVUDINE/ZIDOVUDINE
EMTRICITABINE/TENOFOVIR
COBICISTAT
TELBIVUDINE
VALACYCLOVIR HCL
VALGANCICLOVIR HCL
VALGANCICLOVIR HCL
VALACYCLOVIR HCL
BOCEPREVIR
DIDANOSINE
DIDANOSINE
OMBITA/PARITAP/RITON/DASABUVIR
NELFINAVIR MESYLATE
NEVIRAPINE
NEVIRAPINE
RIBAVIRIN
TENOFOVIR DISOPROXIL FUMARATE
CIDOFOVIR
ELVITEGRAVIR
STAVUDINE
ABACAVIR SULFATE
ZIDOVUDINE
TOCILIZUMAB
ASPIRIN
IBUPROFEN
IBUPROFEN
HYDROCORTISONE SOD SUCCINATE
NAPROXEN SODIUM
NAPROXEN SODIUM
METHYLPREDNISOLONE SOD SUCC
NAPROXEN SODIUM
NAPROXEN SODIUM
LEFLUNOMIDE
RILONACEPT
TRIAMCINOLONE HEXACETONIDE
GLUC/MSM/COLL2/HYAL/ANTIARTH#3
DICLOFENAC SODIUM/MISOPROSTOL
DICLOFENAC SODIUM/MISOPROSTOL
PREDNISOLONE SOD PH/PEAK FLOW
PREDNISOLONE SOD PH/PEAK FLOW
ASPIRIN
ASPIRIN
ASPIRIN 325MG
ASPIRIN
ASPIRIN LOW 81MG
ASPIRIN
ASPIRIN
ASPIRIN
ASPIRIN
C1 ESTERASE INHIBITOR
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
BRAND DRUG
BETAMETHASONE ACETATE-SOD
PHOS
CALDOLOR
CAMBIA
CARTIVISC
CATAFLAM
CELEBREX
CHILD IBUPROFEN
CHILDREN'S ADVIL
CHILDREN'S ASPIRIN
CHILDREN'S IBUPROFEN
CHILDREN'S MEDI-PROFEN
CHILDREN'S MOTRIN
CHILDREN'S PROFEN IB
CHILDREN'S PROFENIB
CIDAFLEX
CIDATRINE
CINRYZE
CLINORIL
COMFORT PAC-IBUPROFEN
COMFORT PAC-MELOXICAM
COMFORT PAC-NAPROXEN
CONDROLITE
COSAFLEX
COSAMIN ASU
CUPRIMINE
DAYPRO
DEPEN
DEXAMETHASONE-NS
DICLOFENAC SODIUM-MISOPROSTOL
DONA
DUEXIS
EC-NAPROSYN
ECOTRIN
ECPIRIN
ENBREL
ETODOLAC ER
EZ USE JOINT-TUNNEL-TRIGGER
FELDENE
FENOPROFEN CALCIUM
FENTANYL CITRATE
FIRAZYR
FLEX ABILITY
FLEXABLE MAXIMUM STRENGTH
FLEXI JOINT
GENICIN
GLUCOSAMINE
140
GENERIC DRUG
BETAMET ACET/BETAMET NA PH
IBUPROFEN
DICLOFENAC POTASSIUM
GLUCOSAMINE/CHONDROITIN A/MSM
DICLOFENAC POTASSIUM
CELECOXIB
CELECOXIB
IBUPROFEN
IBUPROFEN
ASPIRIN
IBUPROFEN
IBUPROFEN
IBUPROFEN
IBUPROFEN
IBUPROFEN
GLUCOSAMINE HCL/CHONDR SU A NA
GLUCOSAMINE SULFATE
C1 ESTERASE INHIBITOR
SULINDAC
IBUPROFEN/IRR CNT-IRRIT CMB #2
MELOXICAM/IRR CNTR-IRR CMB #2
NAPROXEN/IRR CNTR-IRRIT CMB #2
GLUCOSAMINE/CHONDROITIN A/MSM
CORTISONE ACETATE
GLUC SU/CHONDRO SU A/VIT C/MN
GLUCOSAMINE/CONDROITIN/HRB#182
PENICILLAMINE
OXAPROZIN
PENICILLAMINE
DEXAMETHASONE IN 0.9 % NACL
DICLOFENAC POTASSIUM
DICLOFENAC SODIUM/MISOPROSTOL
GLUCOSAMINE SULFATE
IBUPROFEN/FAMOTIDINE
NAPROXEN
ASPIRIN
ASPIRIN
ETANERCEPT
ETODOLAC
ETODOLAC
TRIAMCINOLONE/LIDOCAINE
PIROXICAM
ICATIBANT ACETATE
GLUCOSAMINE SULF/CHONDROITIN A
GLUCOSAMINE/CHONDROITIN SULF A
GLUC SU/MSM/CHONDRO SU A/C/MN
FLUDROCORTISONE ACETATE
FLURBIPROFEN
GLUCOSAMINE SULFATE
GLUCOSAMINE HCL/MSM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
BRAND DRUG
GLUCOSAMINE & CHONDROITIN
GLUCOSAMINE CHONDROITIN
GLUCOSAMINE CHONDROITIN MSM
GLUCOSAMINE CHONDROITIN PLUS
GLUCOSAMINE COMPLEX
GLUCOSAMINE COMPLEX-MSM
GLUCOSAMINE MSM
GLUCOSAMINE PLUS VITAMIN D
GLUCOSAMINE RELIEF
GLUCOSAMINE SULFATE
GLUCOSAMINE/CHONDROITIN
GLUCOSAMINE/CHRONDROITIN
GLUCOSAMINE-CHONDROITIN
COMPLX
GLUCOSAMINE-CHONDROITIN-D3
GLUCOSAMINE-CHONDROITIN-MSM
GLUCOSAMINE-CHONDROITIN-VIT D3
GLUCOSAMINE-FISH OIL
GLUCOSAMINE-MSM COMPLEX
GLUCOSAMINE-VITAMIN D3
GLUCOTEN
HALFPRIN
HUMIRA
HUMIRA PEDIATRIC CROHN'S
IBU-DROPS
IBUPROFEN IB
ILARIS
INDOCIN
INFANTS IBU-DROPS
INFANTS IBUPROFEN
INFANT'S IBUPROFEN
INFANTS' IBUPROFEN
INFANTS MEDI-PROFEN
INFANT'S MOTRIN
INFANTS' MOTRIN
INFANTS PROFENIB
I-PRIN
JOINT SUPPORT
KALBITOR
KINERET
LITE COAT ASPIRIN
LO-DOSE ASPIRIN EC
LOW DOSE ASPIRIN EC
MEDI-FLEXX TABLET
MEDI-PROFEN
MEDIPROXEN
MEDROL
141
GENERIC DRUG
GLUC 2KCL/CHONDR/COLL HY/HY AC
GLUC SU/CHONDRO SU A/VIT C/MN
GLUCOSAMINE/MSM/CHONDROITIN A
GLUC/CHND/OM3/DHA/EPA/FISH/STR
GLUCOSAMINE/D3/BOSWELLIA SERRA
GLUC SU/MSM/MAGNESIUM/VIT C
GLUCOSAMINE HCL/MSM
GLUCOSAMINE HCL/VITAMIN D3
GLUCOSAMINE SULFATE 2KCL
GLUCOSAMINE HCL/CHONDRO SU A
GLUCOSAMINE 500/CHROND 400
GLU/CHON-MSM#1/D3/C/MN/BOS/BOR
GLUCOSAM/CHON-COL.CPLX/D3/C/MN
GLU/CHON-MSM#1/D3/C/MN/BOS/BOR
GLUCOSAMINE/CHONDROITIN/VIT D3
GLUC SU/OMEGA-3/VITAMIN E
GLUCOS/MSM/COLG II/C/MAN/HRB21
GLUCOSAMINE/D3/BOSWELLIA SERRA
GLUCOSAM & CHONDROIT-MV & MIN3
ASPIRIN
ADALIMUMAB
ADALIMUMAB
IBUPROFEN
IBUPROFEN
IBUPROFEN 200
IBUPROFEN
CANAKINUMAB/PF
INDOMETHACIN
INDOMETHACIN
IBUPROFEN
IBUPROFEN
IBUPROFEN
IBUPROFEN
IBUPROFEN
IBUPROFEN
IBUPROFEN
IBUPROFEN
IBUPROFEN
GLUC HCL/CSA/COLL HY/HYALUR AC
ECALLANTIDE
KETOPROFEN
ANAKINRA
LEFLUNOMIDE
ASPIRIN
ASPIRIN
ASPIRIN
MECLOFENAMATE SODIUM
GLUCOSAMINE/CHONDROITIN A/MSM
IBUPROFEN
NAPROXEN SODIUM
METHYLPREDNISOLONE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
BRAND DRUG
GENERIC DRUG
MEFENAMIC ACID
MELOXICAM
METHOTREXATE
METHOTREXATE SODIUM
MILLIPRED DP
MINIPRIN
MOBIC
MONOVISC
MOTRIN
MOTRIN IB
MSM GLUCOSAMINE COMPLEX
MSM-GLUCOSAMINE
MYOCHRYSINE
NALFON
NAPRELAN
NAPRELAN CR DOSE CARD
NAPROSYN
NAPROXEN SODIUM CR
OPTIFLEX COMPLETE
OPTIFLEX-G
ORENCIA
OTEZLA
OTREXUP
PHYSICIANS EZ USE M-PRED
PONSTEL
PREDNISONE INTENSOL
PRELONE
PROVIL
PRYFLEX
RASUVO
RAYOS
RELAFEN
RELAMINE
RHEUMATREX
RIDAURA
RUCONEST
SIMPONI
SIMPONI ARIA
SOLU-CORTEF
SOLU-MEDROL
ST JOSEPH ASPIRIN
ST. JOSEPH ASPIRIN
142
METHOTREXATE SODIUM
METHOTREXATE SODIUM/PF
METHYLPREDNISOLONE
METHYLPREDNISOLONE SOD SUCC
PREDNISOLONE
ASPIRIN
MELOXICAM
HYALURONATE SODIUM, STABILIZED
IBUPROFEN
IBUPROFEN
GLUC HCL/MSM/C/MN/WILLOW/GING
GLUCOSAMINE SULFATE/MSM
GOLD SODIUM THIOMALATE
NABUMETONE
FENOPROFEN CALCIUM
NAPROXEN SODIUM
NAPROXEN SODIUM
NAPROXEN
NAPROXEN
NAPROXEN SODIUM
NAPROXEN SODIUM
GLUCOSAM SUL NA/CHONDR SU A NA
GLUCOSAMINE SULFATE
ABATACEPT
APREMILAST
METHOTREXATE/PF
OXAPROZIN
PHENYLBUTAZONE
METHYLPREDNISOLONE/BUPIVACAINE
PIROXICAM
MEFENAMIC ACID
PREDNISOLONE
PREDNISONE
PREDNISONE
PREDNISOLONE
IBUPROFEN
GLUCOSAM SU/CHONDROITIN/AO MV5
METHOTREXATE/PF
PREDNISONE
NABUMETONE
GLUCOSAM SU/CHONDROITIN/AO MV5
METHOTREXATE SODIUM
AURANOFIN
C1 ESTERASE INHIBITOR, RECOMB
GOLIMUMAB
GOLIMUMAB
HYDROCORTISONE SOD SUCC/PF
METHYLPREDNISOLONE SOD SUCC
ASPIRIN
ASPIRIN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
INFLAMMATORY DISEASE
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
BRAND DRUG
STANBACK ANALGESIC
STELARA
SYNOVACIN
SYNVISC
SYNVISC-ONE
TREPADONE
TREPADONE-120
TREXALL
TRIPLE FLEX
TRIPLEFLEX
VEGETARIAN GLUCOSAMINE
VIMOVO
WAL-PROXEN
XELJANZ
ZIPSOR
ZORPRIN
ZORVOLEX
ARTICADENT DENTAL
BUCALSEP
BUFFERED LIDOCAINE
BUFFERED LIDOCAINE-NS
BUPIVACAINE HCL-0.9% NACL
BUPIVACAINE HCL-EPINEPHRINE
BUPIVACAINE HCL-NS
BUPIVACAINE-DEXTROSE
BUPIVACAINE-NORMAL SALINE
CARBOCAINE
CEPACOL
CEPACOL DUAL RELIEF
CEPACOL SORE THROAT + COATING
CEPACOL ULTRA
CEPASTAT
CHLOROPROCAINE HCL
CITANEST FORTE DENTAL
CITANEST PLAIN DENTAL
DNA MEDICATED COLLECTION
EXPAREL
G-BUCAL-C
LIDOCAINE HCL IN 7.5% DEXTROSE
LIDOCAINE HCL-0.9% NACL
LIDOCAINE-EPINEPHRINE
MARCAINE
MARCAINE SPINAL
MARCAINE WITH EPINEPHRINE
MARCAINE-EPINEPHRINE
NAROPIN
NESACAINE
NESACAINE-MPF
ORAGESIC
143
GENERIC DRUG
ASPIRIN
USTEKINUMAB
SULINDAC
GLUCOSAMINE SULFATE
HYLAN G-F 20
HYLAN G-F 20
TOLMETIN SODIUM
GLUCOSAM/CHONDROITIN/DIET CB13
GLUCOSAM/CHONDROITIN/DIET CB13
METHOTREXATE SODIUM
GLUCOSAMINE/MSM/CHONDROITIN A
GLUCOSAMINE/MSM/CHONDROITIN A
GLUCOSAMINE HCL
NAPROXEN/ESOMEPRAZOLE MAG
NAPROXEN SODIUM
TOFACITINIB CITRATE
DICLOFENAC POTASSIUM
ASPIRIN
DICLOFENAC SUBMICRONIZED
ARTICAINE/EPINEPHRINE BITART
B-CAINE/ZINC CL/PINE/CPYRD
LIDOCAINE WITH 8.4% SOD BICARB
LIDOCAIN/8.4% NAHCO3/0.9% NACL
BUPIVACAINE HCL
BUPIVACAINE HCL/0.9 % NACL/PF
BUPIVACAINE HCL/EPINEPHRINE
BUPIVACAINE HCL/0.9 % NACL/PF
BUPIVACAINE HCL/DEX-WATER/PF
BUPIVACAINE HCL/0.9 % NACL/PF
MEPIVACAINE HCL
MENTHOL/CETYLPYRD CL
BENZOCAINE/GLYCERIN
BENZOCAINE/PECTIN
BENZOCAINE/GLYCERIN
PHENOL
CHLOROPROCAINE HCL/PF
PRILOCAINE HCL/EPINEPHRINE BIT
PRILOCAINE HCL
LIDOCAINE HCL/GLYCERIN
BUPIVACAINE LIPOSOME/PF
MENTHOL/ZINC/BENZOCAINE/CETYLP
LIDOCAINE HCL/D7.5W/PF
LIDOCAINE HCL IN 0.9 % NACL/PF
LIDOCAINE HCL/EPINEPHRINE BIT
BUPIVACAINE HCL
BUPIVACAINE HCL/DEX-WATER/PF
BUPIVACAINE HCL/EPINEPHRINE/PF
BUPIVACAINE HCL/EPINEPHRINE
ROPIVACAINE HCL/PF
CHLOROPROCAINE HCL
CHLOROPROCAINE HCL/PF
NACL/BENZYL ALCOHOL/YERBA SANT
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOCAL ANESTHESIA
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
BRAND DRUG
ORASEP
POLOCAINE
POLOCAINE-MPF
ROPIVACAINE HCL-0.9% NACL
ROPIVACAINE HCL-NS
SENSORCAINE
SENSORCAINE WITH DEXTROSE
SENSORCAINE WITH EPINEPHRINE
SENSORCAINE-MPF
SENSORCAINE-MPF EPINEPHRINE
TOOTHACHE
ANA-LEX
ANALPRAM ADVANCED
ANALPRAM E
APRISO
ASACOL
ASACOL HD
AZULFIDINE
CANASA
CIMZIA
COLAZAL
DELZICOL
DIPENTUM
ENTYVIO
FORMULATION R
GIAZO
GRX HEMORRHOIDAL
HEMORRHOID OINTMENT
HEMORRHOIDAL
HEMORRHOIDAL COOLING GEL
HEMORRHOIDAL CREAM
HEMORRHOIDAL GEL
HEMORRHOIDAL H
HEMORRHOIDAL OINTMENT
HEMORRHOIDAL SUPPOSITORIES
HEM-PREP
HYDROCORTISONE-LIDOCAINE
LIALDA
LINZESS
MAJOR-PREP HEMORRHOIDAL
MEDICONE
PENTASA
PRAM-HCA
PREP-HEM
RECTAGEL HC
REMICADE
ROWASA
SFROWASA
SULFASALAZINE DR
144
GENERIC DRUG
BENZOCAINE/MENTH/CETYLPYRD CL
MEPIVACAINE HCL
MEPIVACAINE HCL/PF
ROPIVACAINE HCL/PF
ROPIVACAINE HCL IN 0.9%NACL/PF
ROPIVACAINE HCL IN 0.9%NACL/PF
BUPIVACAINE HCL
BUPIVACAINE HCL/DEX-WATER/PF
BUPIVACAINE HCL/EPINEPHRINE
BUPIVACAINE HCL/PF
BUPIVACAINE HCL/EPINEPHRINE/PF
BENZOCAINE/POVIDONE-IODINE/PHE
HYDROCORTISONE/LIDOCAINE/ALOE
HC/PRAMOX/DIOSMIN#1/ALO#1/PCOS
HYDROCORT/PRAMOXIN/EMOL/PRAM#1
MESALAMINE
MESALAMINE
MESALAMINE
SULFASALAZINE
BALSALAZIDE DISODIUM
MESALAMINE
CERTOLIZUMAB PEGOL
BALSALAZIDE DISODIUM
MESALAMINE
OLSALAZINE SODIUM
VEDOLIZUMAB
PHENYLEPHRINE/SHK LV/MO/PET,WH
BALSALAZIDE DISODIUM
PHENYLEPH/MINERAL OIL/PETROLAT
PHENYLEPHRINE/SHK LV/MO/PET,WH
PHENYLEPH/MINERAL OIL/PETROLAT
PHENYLEPHRINE HCL/WITCH HAZEL
PE/SHARK LIVER/GLY/PET,WH
PHENYLEPHRINE HCL/WITCH HAZEL
SHARK LIVER OIL/COCOA BUTTER
PHENYLEPH/MINERAL OIL/PETROLAT
PHENYLEPHRINE HCL/COCOA BUTTER
PE/SHARK LIVER/GLY/PET,WH
HYDROCORTISONE/LIDOCAINE/ALOE
MESALAMINE
LINACLOTIDE
PHENYLEPH/MINERAL OIL/PETROLAT
B-CAINE/MIN OIL/PETROLAT,WHT
MESALAMINE
HYDROCORT/PRAMOXN/SKN CLNSR#16
PHENYLEPHRINE/MO/SHK LV/PET,WH
HYDROCORTISONE/LIDOCAINE/ALOE
INFLIXIMAB
MESALAMINE W/CLEANSING WIPES
MESALAMINE
SULFASALAZINE
SULFASALAZINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER
GASTROINTESTINAL DISORDERS - BOWEL
INFLAMMAT
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
BRAND DRUG
SULFAZINE
SULFAZINE EC
TRONOLANE
ZYPRAM
ACTIGALL
ALOPHEN PILLS
AMITIZA
AMMONUL
ANTI-DIARRHEA
ANTIDIARRHEAL
ANTI-DIARRHEAL
ANTI-DIARRHEAL PLUS ANTI-GAS
ANTI-DIARRHEAL PLUS GAS RELIEF
BANATROL PLUS
BENEFIBER
BENEFIBER + CALCIUM SUGAR-FREE
BENEFIBER PLUS CALCIUM
BENEFIBER PLUS HEART HEALTH
BEST FIBER
BISAC-EVAC
BISA-LAX
BISCOLAX
BISMATROL
BISMUTH
BISMUTH MAXIMUM STRENGTH
BLACK DRAUGHT LAXATIVE
BLACK DRAUGHT SENNA LAXATIVE
BOOST KID ESSENTIALS-FIBER
BOOST WITH BENEFIBER
BRIGHT BEGINNINGS
BUPHENYL
CALCARB 600
CALCICARB
CALCI-CHEW
CALCI-MIX
CALCIUM
CALCIUM STOOL SOFTENER
CALCIUM WITH VITAMIN D
CAL-MINT
CALTRATE 600
CARBAGLU
CEO-TWO
CESINEX
CHENODAL
CHILDREN'S BENEFIBER
CHILDREN'S KAOPECTATE
CHILD'S FIBER SELECT GUMMIES
CHOCOLATED LAXATIVE
CHOLBAM
CITRATE OF MAGNESIA
CITROMA
CITRUCEL
145
GENERIC DRUG
SULFASALAZINE
SULFASALAZINE
PRAMOXINE HCL/ZINC OXIDE
HYDROCORT/PRAMOXN/SKN CLNSR#16
URSODIOL
BISACODYL
LUBIPROSTONE
SODIUM BENZOATE/SOD PHENYLACET
LOPERAMIDE HCL
LOPERAMIDE HCL
BISMUTH SUBSALICYLATE
LOPERAMIDE HCL/SIMETHICONE
LOPERAMIDE HCL/SIMETHICONE
BANANA FLAKES/TOS
GUAR GUM
WHEAT DEXTRIN/CA #15/ASPARTAME
CAL GLUCONATE/CAL LACTATE/GUM
WHEAT DEXTRIN/B6/FA/B12
WHEAT DEXTRIN
BISACODYL
BISACODYL
BISACODYL
BISMUTH SUBSALICYLATE
BISMUTH SUBSALICYLATE
BISMUTH SUBSALICYLATE
CASANTHRANOL
SENNOSIDES
PEDIATRIC NUTRIT,IRON,LF&FIBER
LACTOSE-REDUCED FOOD/FIBER
LACTOSE-REDUCED FOOD/FIBER
SODIUM PHENYLBUTYRATE
CALCIUM CARBONATE
CALCIUM CARBONATE
CALCIUM CARBONATE
CALCIUM CARBONATE
CALCIUM CARBONATE
DOCUSATE CALCIUM
CALCIUM CARBONATE/VITAMIN D3
CALCIUM CARBONATE
CALCIUM CARBONATE
CARGLUMIC ACID
POTASSIUM BITART/SODIUM BICARB
ALBUMEN (ALBUMIN)/TANNIC ACID
CHENODIOL
WHEAT DEXTRIN
BISMUTH SUBSALICYLATE
INULIN
SENNOSIDES
CHOLIC ACID
MAGNESIUM CITRATE
MAGNESIUM CITRATE
METHYLCELLULOSE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
BRAND DRUG
CLEAR 2 GO
CLEARLAX
CLEAR-LAX
COLOX
COLYTE WITH FLAVOR PACKETS
COLYTE WITH FLAVOR PACKS
CONSTULOSE
CORRECTIVE LAXATIVE
CORRECTOL
CURAD ENEMA
CVF
DIAMODE
DIARRHEA RELIEF
DIOTAME
DIOTAME INSTYDOSE
DIPHENOXYLATE-ATROPINE
DISPOSABLE ENEMA
DOC-Q-LAX
DOCUSATE SODIUM-SENNA
DOCUSOL PLUS
DOK PLUS
DUCODYL
DULCOLAX
DULCOLAX BALANCE
EASY FIBER
ENEMA
ENEMA DISPOSABLE
ENSURE WITH FIBER
ENTEREG
ENULOSE
EQUALACTIN
EX-LAX
EX-LAX MAXIMUM STRENGTH
EX-LAX MILK OF MAGNESIA
FAST RELIEF LAXATIVE
FEMATROL LAXATIVE
FIBER
FIBER CHOICE
FIBER FLOW
FIBER GUMMIES
FIBER LAX
FIBER LAXATIVE
FIBER PLUS
FIBER PLUS CALCIUM
FIBER SELECT GUMMIES
FIBER SMOOTH
FIBER SUPPLEMENT
FIBER TABS
FIBER THERAPY
FIBER WITH PROBIOTIC
FIBERCON
146
GENERIC DRUG
FOS/MALTODEXTRIN
POLYETHYLENE GLYCOL 3350
POLYETHYLENE GLYCOL 3350
PSYLLIUM HUSK/LAXATIVE NO.1
PEG 3350/NA SULF,BICARB,CL/KCL
PEG 3350/NA SULF,BICARB,CL/KCL
LACTULOSE
BISACODYL
BISACODYL
NA PHOS,M-B/NA PHOS,DI-BA
FIBER/MALTODEXTRIN/INULIN/FOS
LOPERAMIDE HCL
BISMUTH SUBSALICYLATE
BISMUTH SUBSALICYLATE
BISMUTH SUBSALICYLATE
DIPHENOXYLATE HCL/ATROPINE
NA PHOS,M-B/NA PHOS,DI-BA
SENNOSIDES/DOCUSATE SODIUM
DOCUSATE CALCIUM
SENNOSIDES/DOCUSATE SODIUM
DOCUSATE SODIUM/BENZOCAINE
SENNOSIDES/DOCUSATE SODIUM
BISACODYL
BISACODYL
POLYETHYLENE GLYCOL 3350
DEXTRIN
MINERAL OIL
NA PHOS,M-B/NA PHOS,DI-BA
LACTOSE-REDUCED FOOD/FIBER
ALVIMOPAN
LACTULOSE
CALCIUM POLYCARBOPHIL
BISACODYL
SENNOSIDES
MAGNESIUM HYDROXIDE
BISACODYL
BISACODYL
CALCIUM POLYCARBOPHIL
INULIN
FOS/MALTO/POLYDEXTROSE/SORB 70
INULIN
CALCIUM POLYCARBOPHIL
CALCIUM POLYCARBOPHIL
ACAC/INUL/C-LSE/CHROM/GRN TEA
PSYLLIUM HUSK/CA CARBONATE
INULIN/CHROMIUM PICOLINATE
PSYLLIUM SEED
INULIN/SORBITOL
CALCIUM POLYCARBOPHIL
CALCIUM POLYCARBOPHIL
WHEAT DEXTRIN/L.ACID/ASPARTAME
CALCIUM POLYCARBOPHIL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
BRAND DRUG
FIBER-LAX
FIBER-STAT
FIBERTAB
FIBER-TABS
FULYZAQ
GATTEX
GAVILAX
GAVILYTE-C
GAVILYTE-G
GAVILYTE-H AND BISACODYL
GAVILYTE-N
GENERLAC
GENTLE LAXATIVE
GENTLELAX
GERI-KOT
GERI-MUCIL
GLYCOLAX
GOLYTELY
HALFLYTELY-BISACODYL
HEALTHYLAX
HIGH POTENCY CALCIUM
HYDROCIL INSTANT
HYFIBER
IMODIUM MULTI-SYMPTOM RELIEF
IMPACT WITH FIBER
IMPERIM
ISOSOURCE 1.5 CAL
ISOSOURCE 1.5 CAL TUBE FEED
ISOSOURCE VHN
JEVITY 1.2 CAL
JEVITY 1.5 CAL
KAOLIN PECTIN
KAOPECTATE
KAO-TIN
KOLA-PECTIN DS
KONDREMUL
KONSYL
KONSYL BALANCE
KONSYL EASY MIX
KONSYL FIBER
KONSYL FORMULA-D
KONSYL-D
K-PEC
KRISTALOSE
LAX STOOL SOFTENER WITH SENNA
LAXA CLEAR
LAXACIN
LAXATIVE
LAXATIVE FEMININE
LAXATIVE MAXIMUM STRENGTH
147
GENERIC DRUG
CALCIUM POLYCARBOPHIL
FOS/MALTODEXTRIN
CALCIUM POLYCARBOPHIL
CALCIUM POLYCARBOPHIL
CROFELEMER
TEDUGLUTIDE
POLYETHYLENE GLYCOL 3350
PEG 3350/NA SULF,BICARB,CL/KCL
PEG 3350/NA SULF,BICARB,CL/KCL
BISAC/NACL/NAHCO3/KCL/PEG 3350
SODIUM CHLORIDE/NAHCO3/KCL/PEG
LACTULOSE
BISACODYL
POLYETHYLENE GLYCOL 3350
SENNOSIDES
PSYLLIUM HUSK/ASPARTAME
POLYETHYLENE GLYCOL 3350
PEG 3350/NA SULF,BICARB,CL/KCL
BISAC/NACL/NAHCO3/KCL/PEG 3350
POLYETHYLENE GLYCOL 3350
CALCIUM CARBONATE
PSYLLIUM SEED
ACACIA
IMODIUM A-D
LOPERAMIDE HCL/SIMETHICONE
NUT.TX.COMP.IMMUNE SYS/SOY FIB
LOPERAMIDE HCL
LACTOSE-REDUCED FOOD/FIBER
LACTOSE-REDUCED FOOD/FIBER
LACTOSE-REDUCED FOOD/FIBER
LACTOSE-REDUCED FOOD/FIBER
LACTOSE-REDUCED FOOD/FIBER
KAOLIN/PECTIN
ATTAPULGITE
BISMUTH SUBSALICYLATE
BISMUTH SUBSALICYLATE
MINERAL OIL/CARRAGEENAN
PSYLLIUM HUSK
PSYLLIUM HUSK/INULIN/ASPARTAME
PSYLLIUM HUSK
CALCIUM POLYCARBOPHIL
PSYLLIUM HUSK (WITH DEXTROSE)
PSYLLIUM SEED (WITH DEXTROSE)
BISMUTH SUBSALICYLATE
LACTULOSE
LACTULOSE
SENNOSIDES/DOCUSATE SODIUM
POLYETHYLENE GLYCOL 3350
SENNOSIDES/DOCUSATE SODIUM
BISACODYL
BISACODYL
SENNOSIDES
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
BRAND DRUG
LAXATIVE PEG 3350
LAXATIVE PILLS
LAXATIVE SUPPOSITORY
LAXATIVE-SENNA
LIQUAFIBER
LIQUID FIBER FLOW
LITHOSTAT
LOMOTIL
LOPERAMIDE
LO-PERAMIDE
LO-SO PREP KIT
LOTRONEX
MAALOX
MAGIC BULLET
MEDI-BISMUTH
MEDI-LAX
MEDI-LAXX
MEDI-MUCIL
MEDI-NATURAL
MEDI-NATURAL SENNA STOOL SOFT
METAFIBER
METAMUCIL
METAMUCIL FIBER SINGLES
METAMUCIL MULTIHEALTH FIBER
METAMUCIL OT
METAMUCIL PLUS CALCIUM
MILK OF MAGNESIA
MINERAL OIL ENEMA
MINERAL OIL EXTRA HEAVY
MIRALAX
MOTOFEN
MOVANTIK
MOVIPREP
NARCOSOFT
NARCOSOFT II
NATURAL CALCIUM
NATURAL DAILY FIBER
NATURAL FIBER
NATURAL FIBER LAXATIVE
NATURAL FIBER POWDER
NATURAL FIBER SUPPLEMENT
NATURAL LAXATIVE
NATURAL PSYLLIUM FIBER
NATURAL SENNA LAXATIVE
NATURAL VEGETABLE FIBER
NATURAL VEGETABLE LAXATIVE
NATURAL VEGETABLE POWDER
NULYTELY WITH FLAVOR PACKS
NUTRISOURCE FIBER
OAT BRAN
OCL
148
GENERIC DRUG
POLYETHYLENE GLYCOL 3350
SENNOSIDES
BISACODYL
SENNOSIDES
GLYCERIN/MALTODEXTRIN
FOS/MALTODEXTRIN/POLYDEXTROSE
ACETOHYDROXAMIC ACID
DIPHENOXYLATE HCL/ATROPINE
LOPERAMIDE HCL
LOPERAMIDE HCL
BISACODYL/MAGNESIUM CITRATE
ALOSETRON HCL
BISMUTH SUBSALICYLATE
BISACODYL
MAGNESIUM CITRATE
BISMUTH SUBSALICYLATE
SENNOSIDES
SENNOSIDES/DOCUSATE SODIUM
PSYLLIUM HUSK
SENNOSIDES
SENNOSIDES/DOCUSATE SODIUM
PSYLLIUM SEED
INULIN
PSYLLIUM HUSK/ASPARTAME
PSYLLIUM HUSK/ASPARTAME
PSYLLIUM SEED (WITH SUGAR)
PSYLLIUM HUSK/CA CARBONATE
MAGNESIUM HYDROXIDE
MINERAL OIL
MINERAL OIL
POLYETHYLENE GLYCOL 3350
DIFENOXIN HCL/ATROPINE SULFATE
NALOXEGOL OXALATE
PEG3350/SOD SUL/NACL/ASB/C/KCL
SENNA/PSYLL/CASC/L.ACID/HB#195
SENNA/PSYLL/CASC/L.ACID/HB#235
CALCIUM CARBONATE
PSYLLIUM HUSK (WITH SUGAR)
PSYLLIUM HUSK
PSYLLIUM HUSK (WITH SUGAR)
PSYLLIUM SEED (WITH DEXTROSE)
PSYLLIUM HUSK/ASPARTAME
SENNOSIDES
PSYLLIUM HUSK/ASPARTAME
SENNOSIDES
PSYLLIUM HUSK (WITH SUGAR)
PSYLLIUM SEED (WITH DEXTROSE)
PSYLLIUM HUSK (WITH SUGAR)
SODIUM CHLORIDE/NAHCO3/KCL/PEG
GUAR GUM
BRAN
SOD SULF/SODIUM/NAHCO3/KCL/PEG
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
BRAND DRUG
ORAL SALINE LAXATIVE
ORAL SALINE LAXATIVE KIT
OSMOPREP
OYSCO-500
OYST-CAL-500
OYSTER SHELL CALCIUM
P-COL RITE
PEDIA-LAX ENEMA
PEDIA-LAX FIBER GUMMIES
PEDIA-LAX STRIP
PEDIASURE ENTERAL WITH FIBER
PEDIASURE WITH FIBER
PEDIATRIC ENEMA
PEG 3350-ELECTROLYTE
PEG3350
PEG-3350
PEG-3350 AND ELECTROLYTES
PEG-3350 WITH FLAVOR PACKS
PEG-PREP
PEPTAMEN JUNIOR FIBER
PEPTIC RELIEF
PEP-T-MED
PEPTO-BISMOL
PEPTO-BISMOL TO-GO
PERDIEM
PERI-COLACE
PHILLIPS' MILK OF MAGNESIA
PHOSPHATE ENEMA
PHOSPHATE LAXATIVE
PINK BISMUTH
POWDERLAX
PREP KIT #3
PREPARATION CLEANSING
PREPOPIK
PROMOTE WITH FIBER
PSYLLIUM FIBER
PSYLLIUM SEED
PURELAX
RAVICTI
READY TO USE ENEMA
REGULOID
RELISTOR
RESOURCE WITH FIBER
SALINE ENEMA
SB GENTLE LAX-WOMEN
SENEXON
SENEXON-S
SENNA
149
GENERIC DRUG
OPIUM TINCTURE
NA PHOS,M-B/NA PHOS,DI-BA
NA PHOS,M-B/NA PHOS,DI-BA
NAPHOS M-B M-H/NA PHOS,DI-BA
CALCIUM CARBONATE
CALCIUM CARBONATE
OYSTER CALCIUM
CALCIUM CARBONATE
PAREGORIC
SENNOSIDES/DOCUSATE SODIUM
NA PHOS,M-B/NA PHOS,DI-BA
POLYDEXTROSE/XYLITOL
SENNOSIDES
PEDIATRIC NUTRIT,IRON,LF&FIBER
PEDIATRIC NUTRIT,IRON,LF&FIBER
NA PHOS,M-B/NA PHOS,DI-BA
PEG 3350/NA SULF,BICARB,CL/KCL
POLYETHYLENE GLYCOL 3350
SODIUM CHLORIDE/NAHCO3/KCL/PEG
PEG 3350/NA SULF,BICARB,CL/KCL
SODIUM CHLORIDE/NAHCO3/KCL/PEG
BISAC/NACL/NAHCO3/KCL/PEG 3350
NUTRIT SUPP/INULIN/FOS/FIBER
BISMUTH SUBSALICYLATE
BISMUTH SUBSALICYLATE
BISMUTH SUBSALICYLATE
BISMUTH SUBSALICYLATE
CALCIUM POLYCARBOPHIL
SENNOSIDES/DOCUSATE SODIUM
MAGNESIUM HYDROXIDE
NA PHOS,M-B/NA PHOS,DI-BA
NA PHOS,M-B/NA PHOS,DI-BA
BISMUTH SUBSALICYLATE
POLYETHYLENE GLYCOL 3350
POLYETHYLENE GLYCOL 3350
BISACODYL/NAPH,MB-DB
NA PHOS,M-B/NA PHOS,DI-BA
SOD PICOSULF/MAG OX/CITRIC AC
LACTOSE-REDUCED FOOD/FIBER
PSYLLIUM HUSK
PSYLLIUM HUSK
POLYETHYLENE GLYCOL 3350
GLYCEROL PHENYLBUTYRATE
MINERAL OIL
PSYLLIUM HUSK
METHYLNALTREXONE BROMIDE
LACTOSE-REDUCED FOOD/FIBER
NA PHOS,M-B/NA PHOS,DI-BA
BISACODYL
SENNOSIDES
SENNOSIDES/DOCUSATE SODIUM
SENNA LEAF EXTRACT
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
LOWER GASTROINTESTINAL DISORDERS - OTHER
BRAND DRUG
SENNA LAX
SENNA LAXATIVE
SENNA PLUS
SENNA PROMPT
SENNA S
SENNA SOFT
SENNA-C
SENNA-C PLUS
SENNA-DOCUSATE SODIUM
SENNA-EXTRA
SENNA-GEN
SENNALAX-S
SENNA-S
SENNO
SENNOSIDES-DOCUSATE SODIUM
SENOKOT
SENOKOT TO GO
SENOKOT-S
SENOKOTXTRA
SEN-O-TAB
SMOOTHLAX
SOL CARB
SOLUBLE FIBER
SOLUBLE FIBER THERAPY
SOOTHE
STIMULANT LAXATIVE PLUS
STOMACH RELIEF
STOMACH RELIEF ORIGINAL
STOOL SOFTENER-LAXATIVE
STOOL SOFTENER-STIMULANT LAX
SUCLEAR
SUPER CALCIUM
SUPREP
SURFAK
TOTAL FIBER
TRILYTE WITH FLAVOR PACKETS
ULTRA A-D
UNIFIBER
URSO
URSO FORTE
VACUANT PLUS
VEGETABLE LAXATIVE
VISICOL
WAL-MUCIL
WAL-MUCIL NATURAL FIBER LAX
WAL-MUCIL PLUS CALCIUM
WAL-PHOSPHATE
WEIGHT MANAGEMENT FIBER
WOMAN'S LAXATIVE
WOMEN'S GENTLE LAXATIVE
150
GENERIC DRUG
SENNOSIDES
SENNOSIDES
SENNOSIDES/DOCUSATE SODIUM
SENNOSIDES/PSYLLIUM HUSK
SENNOSIDES/DOCUSATE SODIUM
SENNOSIDES
SENNOSIDES
SENNOSIDES/DOCUSATE SODIUM
SENNOSIDES/DOCUSATE SODIUM
SENNOSIDES
SENNOSIDES
SENNOSIDES/DOCUSATE SODIUM
SENNOSIDES/DOCUSATE SODIUM
SENNOSIDES
SENNOSIDES/DOCUSATE SODIUM
SENNOSIDES
SENNOSIDES
SENNOSIDES/DOCUSATE SODIUM
SENNOSIDES
SENNOSIDES
POLYETHYLENE GLYCOL 3350
SODIUM PHENYLBUTYRATE
MALTODEXTRIN
METHYLCELLULOSE
METHYLCELLULOSE (WITH SUGAR)
BISMUTH SUBSALICYLATE
SENNOSIDES/DOCUSATE SODIUM
BISMUTH SUBSALICYLATE
BISMUTH SUBSALICYLATE
SENNOSIDES/DOCUSATE SODIUM
SENNOSIDES/DOCUSATE SODIUM
PEG 3350-BOWEL 2,TWO PART PREP
CALCIUM CARBONATE
SODIUM,POTASSIUM,&MAG SULFATES
DOCUSATE CALCIUM
WHEAT DEXTRIN
SODIUM CHLORIDE/NAHCO3/KCL/PEG
LOPERAMIDE HCL
CELLULOSE
URSODIOL
URSODIOL
URSODIOL
DOCUSATE SODIUM/BENZOCAINE
PSYLLIUM SEED
NA PHOS MONO&DIBASIC/CELLULOSE
PSYLLIUM HUSK
PSYLLIUM HUSK (WITH SUGAR)
PSYLLIUM HUSK/CA CARBONATE
NA PHOS,M-B/NA PHOS,DI-BA
INULIN/SORBITOL
BISACODYL
BISACODYL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
LOWER GASTROINTESTINAL DISORDERS - OTHER
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
MISCELLANEOUS AGENTS
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
BRAND DRUG
WOMEN'S LAXATIVE
ARALAST
ARALAST NP
EVOXAC
GLASSIA
NEXAVIR
PROLASTIN
PROLASTIN C
URECHOLINE
ZEMAIRA
ABRAXANE
ADCETRIS
ADRIAMYCIN
ALIMTA
ALKERAN
AMIFOSTINE
ARIMIDEX
AROMASIN
ARRANON
ARZERRA
AVASTIN
BELEODAQ
BEXXAR
BICNU
BLINCYTO
BOSULIF
BUSULFEX
CAMPATH
CAMPTOSAR
CAPRELSA
CASODEX
CEENU
CERUBIDINE
CLOLAR
COMETRIQ
COSMEGEN
CYCLOPHOSPHAMIDE
CYRAMZA
DACOGEN
151
GENERIC DRUG
BISACODYL
ALPHA-1-PROTEINASE INHIBITOR
ALPHA-1-PROTEINASE INHIBITOR
BETHANECHOL CHLORIDE
CEVIMELINE HCL
CEVIMELINE HCL
ALPHA-1-PROTEINASE INHIBITOR
GUANIDINE HCL
LIVER EXTRACT (BEEF-PORK)
ALPHA-1-PROTEINASE INHIBITOR
ALPHA-1-PROTEINASE INHIBITOR
BETHANECHOL CHLORIDE
ALPHA-1-PROTEINASE INHIBITOR
PACLITAXEL PROTEIN-BOUND
BRENTUXIMAB VEDOTIN
DOXORUBICIN HCL
PEMETREXED DISODIUM
MELPHALAN
AMIFOSTINE CRYSTALLINE
ANASTROZOLE
ANASTROZOLE
EXEMESTANE
NELARABINE
OFATUMUMAB
BEVACIZUMAB
AZACITIDINE
BELINOSTAT
TOSITUMOMAB (WITH MALTOSE)
BICALUTAMIDE
CARMUSTINE
BLEOMYCIN SULFATE
BLINATUMOMAB
BOSUTINIB
BUSULFAN
ALEMTUZUMAB
IRINOTECAN HCL
CAPECITABINE
VANDETANIB
CARBOPLATIN
BICALUTAMIDE
LOMUSTINE
DAUNORUBICIN HCL
CISPLATIN
CLADRIBINE
CLOFARABINE
CABOZANTINIB S-MALATE
DACTINOMYCIN
RAMUCIRUMAB
CYTARABINE
DACARBAZINE
DECITABINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
BRAND DRUG
GENERIC DRUG
DACTINOMYCIN
DAUNORUBICIN HCL
DAUNORUBICIN CITRATE LIPOSOMAL
DECITABINE
CYTARABINE LIPOSOME/PF
DEXRAZOXANE HCL
DOCETAXEL
DAUNOXOME
DEPOCYT
DEXRAZOXANE
DOCEFREZ
DOCETAXEL
DOXIL
DOXORUBICIN HCL LIPOSOME
ELLENCE
ELOXATIN
ELSPAR
EMCYT
ERBITUX
ERIVEDGE
ERWINAZE
ETHYOL
ETOPOPHOS
FARESTON
FARYDAK
FASLODEX
FEMARA
FIRMAGON
FLUDARA
FOLOTYN
FUSILEV
GAZYVA
GEMZAR
GILOTRIF
GLEEVEC
GLEOSTINE
GLIADEL
HALAVEN
HERCEPTIN
HEXALEN
HYCAMTIN
IBRANCE
ICLUSIG
IDAMYCIN PFS
IFEX
IFOSFAMIDE-MESNA
152
DOXORUBICIN HCL PEG-LIPOSOMAL
DOXORUBICIN HCL
DOXORUBICIN HCL PEG-LIPOSOMAL
EPIRUBICIN HCL
OXALIPLATIN
ASPARAGINASE
ESTRAMUSTINE PHOSPHATE SODIUM
EPIRUBICIN HCL
CETUXIMAB
VISMODEGIB
ASPARAGINASE (ERWINIA CHRYSAN)
AMIFOSTINE CRYSTALLINE
ETOPOSIDE PHOSPHATE
ETOPOSIDE
EXEMESTANE
TOREMIFENE CITRATE
PANOBINOSTAT LACTATE
FULVESTRANT
LETROZOLE
DEGARELIX ACETATE
FLOXURIDINE
FLUDARABINE PHOSPHATE
FLUDARABINE PHOSPHATE
FLUTAMIDE
PRALATREXATE
LEVOLEUCOVORIN CALCIUM
OBINUTUZUMAB
GEMCITABINE HCL
GEMCITABINE HCL
AFATINIB DIMALEATE
IMATINIB MESYLATE
LOMUSTINE
CARMUSTINE IN POLIFEPROSAN 20
ERIBULIN MESYLATE
TRASTUZUMAB
ALTRETAMINE
TOPOTECAN HCL
PALBOCICLIB
PONATINIB HCL
IDARUBICIN HCL
IDARUBICIN HCL
IFOSFAMIDE
IFOSFAMIDE
IFOSFAMIDE/MESNA
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
BRAND DRUG
IMBRUVICA
INLYTA
IRESSA
ISTODAX
IXEMPRA
JAKAFI
JEVTANA
KADCYLA
KEYTRUDA
KYPROLIS
LEMTRADA
LENVIMA
LEUKERAN
LEUSTATIN
LEVULAN
LIPODOX
LIPODOX 50
LYNPARZA
LYSODREN
MARQIBO
MATULANE
MEGACE
MEGACE ES
MEKINIST
MESNEX
METVIXIA
MYLERAN
MYLOTARG
NAVELBINE
NEXAVAR
NILANDRON
NIPENT
NOVANTRONE
OFORTA
ONCASPAR
ONTAK
ONXOL
OPDIVO
PERJETA
PHOTOFRIN
153
GENERIC DRUG
IBRUTINIB
AXITINIB
GEFITINIB
IRINOTECAN HCL
ROMIDEPSIN
IXABEPILONE
RUXOLITINIB PHOSPHATE
CABAZITAXEL
ADO-TRASTUZUMAB EMTANSINE
PEMBROLIZUMAB
CARFILZOMIB
ALEMTUZUMAB
LENVATINIB MESYLATE
LETROZOLE
LEUCOVORIN CALCIUM
CHLORAMBUCIL
CLADRIBINE
AMINOLEVULINIC ACID HCL
DOXORUBICIN HCL PEG-LIPOSOMAL
DOXORUBICIN HCL PEG-LIPOSOMAL
LOMUSTINE
OLAPARIB
MITOTANE
VINCRISTINE SULFATE LIPOSOMAL
PROCARBAZINE HCL
MEGESTROL ACETATE
MEGESTROL ACETATE
MEGESTROL ACETATE
TRAMETINIB DIMETHYL SULFOXIDE
MELPHALAN HCL
MERCAPTOPURINE
MESNA
MESNA
METHYL AMINOLEVULINATE HCL
MITOXANTRONE HCL
BUSULFAN
GEMTUZUMAB OZOGAMICIN
VINORELBINE TARTRATE
SORAFENIB TOSYLATE
NILUTAMIDE
PENTOSTATIN
MITOXANTRONE HCL
FLUDARABINE PHOSPHATE
PEGASPARGASE
DENILEUKIN DIFTITOX
PACLITAXEL
NIVOLUMAB
OXALIPLATIN
PACLITAXEL
PENTOSTATIN
PERTUZUMAB
PORFIMER SODIUM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
NEOPLASTIC DISEASE
BRAND DRUG
POMALYST
PROVENGE
PURINETHOL
PURIXAN
REVLIMID
RITUXAN
SOLTAMOX
SPRYCEL
STIVARGA
SUTENT
SYLVANT
SYNRIBO
TABLOID
TAFINLAR
TARCEVA
TASIGNA
TAXOTERE
TEMODAR
TOPOSAR
TORISEL
TOTECT
TREANDA
TRISENOX
TYKERB
VALSTAR
VANDETANIB
VECTIBIX
VELCADE
VIDAZA
VINCASAR PFS
VORAXAZE
VOTRIENT
VUMON
XALKORI
XELODA
XTANDI
YERVOY
ZANOSAR
ZELBORAF
ZEVALIN
ZINECARD
ZOLINZA
ZYDELIG
ZYKADIA
154
GENERIC DRUG
POMALIDOMIDE
SIPULEUCEL-T/LACTATED RINGERS
MERCAPTOPURINE
MERCAPTOPURINE
LENALIDOMIDE
RITUXIMAB
TAMOXIFEN CITRATE
DASATINIB
REGORAFENIB
SUNITINIB MALATE
SILTUXIMAB
OMACETAXINE MEPESUCCINATE
THIOGUANINE
DABRAFENIB MESYLATE
TAMOXIFEN CITRATE
ERLOTINIB HCL
NILOTINIB HCL
DOCETAXEL
TEMOZOLOMIDE
TEMOZOLOMIDE
TENIPOSIDE
THIOTEPA
ETOPOSIDE
TOPOTECAN HCL
TEMSIROLIMUS
DEXRAZOXANE HCL
BENDAMUSTINE HCL
ARSENIC TRIOXIDE
LAPATINIB DITOSYLATE
VALRUBICIN
PANITUMUMAB
BORTEZOMIB
AZACITIDINE
VINBLASTINE SULFATE
VINCRISTINE SULFATE
VINCRISTINE SULFATE
VINORELBINE TARTRATE
GLUCARPIDASE
PAZOPANIB HCL
TENIPOSIDE
CRIZOTINIB
CAPECITABINE
ENZALUTAMIDE
IPILIMUMAB
STREPTOZOCIN
VEMURAFENIB
KIT FOR Y-90/IBRITUMOMAB/ALBUM
DEXRAZOXANE HCL
VORINOSTAT
IDELALISIB
CERITINIB
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
NEOPLASTIC DISEASE
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
NEUROLOGICAL DISEASE - MISCELLANEOUS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
BRAND DRUG
ZYTIGA
AMPYRA
AUBAGIO
AVONEX
AVONEX ADMINISTRATION PACK
AVONEX PEN
BETASERON
COPAXONE
EXTAVIA
FANATREX
GILENYA
GRALISE
HORIZANT
NEURONTIN
NUEDEXTA
PLEGRIDY
PLEGRIDY PEN
REBIF
REBIF REBIDOSE
RILUTEK
SAVELLA
TECFIDERA
TYSABRI
XENAZINE
ACT ANTI-CAVITY MOUTH RINSE
ACT MOUTHWASH
ANTICAVITY FLUORIDE
ANTI-PLAQUE DENTAL RINSE
ANTISEPTIC MOUTH RINSE
ARESTIN
BIOTENE
BREATH SPRAY
CAVIRINSE
CITRUS ANTISEPTIC
CLINPRO 5000
CONTROL RX
DENTA 5000 PLUS
DENTAGEL
DENTAPAINE
DENTIVA
EPIFLUR
FLUORABON
FLUOR-A-DAY
FLUORIDE
FLUORIDEX DAILY DEFENSE
FLUORITAB
FLURA-DROPS
GUMSOL
KEPIVANCE
LISTERINE ANTISEPTIC
155
GENERIC DRUG
ABIRATERONE ACETATE
DALFAMPRIDINE
TERIFLUNOMIDE
INTERFERON BETA-1A
INTERFERON BETA-1A/ALBUMIN
INTERFERON BETA-1A
INTERFERON BETA-1B
GLATIRAMER ACETATE
INTERFERON BETA-1B
GABAPENTIN
GABAPENTIN
FINGOLIMOD HCL
GABAPENTIN
GABAPENTIN ENACARBIL
GABAPENTIN
DEXTROMETHORPHAN HBR/QUINIDINE
PEGINTERFERON BETA-1A
PEGINTERFERON BETA-1A
INTERFERON BETA-1A/ALBUMIN
INTERFERON BETA-1A/ALBUMIN
RILUZOLE
RILUZOLE
MILNACIPRAN HCL
DIMETHYL FUMARATE
NATALIZUMAB
TETRABENAZINE
SODIUM FLOURIDE
CETYLPYRD CL/DOMIPHEN BROMIDE
SODIUM FLUORIDE
NA PY-PH/ALC/GLY/SLS/H2O
EUCALYP/ME-SALICYLATE/MEN/THYM
MINOCYCLINE HCL MICROSPHERES
FLUORIDE TOOTHPASTE
MOUTHWASH
SODIUM FLUORIDE
EUCALYP/ME-SALICYLATE/MEN/THYM
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
BENZOCAINE/GLYCERIN/CLOVE OIL
XYLITOL/ANTISEPTIC COMBO NO.5
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
ZINC CHLORIDE/BENZOCAINE
PALIFERMIN
EUCALYP/ME-SALICYLATE/MEN/THYM
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
ORAL/PHARYNGEAL DISORDERS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER DRUGS
OTHER RESPIRATORY DISORDERS
OTHER RESPIRATORY DISORDERS
OTHER RESPIRATORY DISORDERS
OTHER RESPIRATORY DISORDERS
OTHER RESPIRATORY DISORDERS
OTHER RESPIRATORY DISORDERS
OTHER RESPIRATORY DISORDERS
OTHER RESPIRATORY DISORDERS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
BRAND DRUG
LOZI-FLUR
LUDENT FLUORIDE
MOUTH RINSE ANTISEPTIC
MOUTHRINSE
MOUTHSPRAY
NAFRINSE DAILY-NEUTRAL
PHOS-FLUR
PLAX
PREVIDENT
PREVIDENT 5000
PREVIDENT 5000 PLUS
PROTEXIN
REMESENSE
RENAF
SALESE
SF
SF 5000 PLUS
SODIPHLUOR
ZINC
ZINC + VITAMIN C
ZINC LOZENGE
ZINC-15
ZINC-220
ZINCATE
ZN-DTPA
ZOHYDRO ER
ZOLMITRIPTAN ODT
ZOMIG
ZOMIG ZMT
ZYTAZE
CUROSURF
ESBRIET
INFASURF
KALYDECO
OFEV
PULMOZYME
SURFAXIN
SURVANTA
ACETAMINOPH-CAFFDIHYDROCODEIN
ACETAMINOPHEN-BUTALBITAL
ACETAMINOPHEN-CODEINE
ADDED STRENGTH HEADACHE
ADDED STRENGTH PAIN RELIEVER
ALAGESIC
ALAGESIC LQ
ALKA-SELTZER
ALKA-SELTZER ORIGINAL
156
GENERIC DRUG
SODIUM FLUORIDE
SODIUM FLUORIDE
EUCALYP/ME-SALICYLATE/MEN/THYM
EUCALYP/ME-SALICYLATE/MEN/THYM
MOUTHWASH
SODIUM FLUORIDE
SODIUM FLUORIDE
NA PY-PH/ALC/GLY/SLS/H2O
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
MENTHOL/PEPPERMINT OIL
POTASSIUM OXALATE
SODIUM FLUORIDE
XYLITOL/ANTISEPTIC COMBO NO.6
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
SODIUM FLUORIDE
ZINC GLUCONATE
VIT C/ZINC CITRATE/HERBAL #163
ZINC CHLORIDE
ZINC GLUCONATE
ZINC GLUCONATE
ZINC SULFATE
ZINC SULFATE
ZINC SULFATE
ZINC SULFATE
PENTETATE ZINC TRISODIUM
HYDROCODONE BITARTRATE
ZOLMITRIPTAN
ZOLMITRIPTAN
ZOLMITRIPTAN
ZOLMITRIPTAN
ZINC CITRATE/PHYTASE
PORACTANT ALFA
PIRFENIDONE
CALFACTANT
IVACAFTOR
NINTEDANIB ESYLATE
DORNASE ALFA
LUCINACTANT
BERACTANT
DHCODEINE BT/ACETAMINOPHN/CAFF
BUTALBITAL/ACETAMINOPHEN
ACETAMINOPHEN WITH CODEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
BUTALB/ACETAMINOPHEN/CAFFEINE
BUTALB/ACETAMINOPHEN/CAFFEINE
ASPIRIN/SOD BICARB/CITRIC ACID
ASPIRIN/SOD BICARB/CITRIC ACID
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
BRAND DRUG
AMERGE
ANABAR
ANACIN
ANOLOR-300
ANTACID & PAIN RELIEF
ARTHRITIS BC
ASCOMP WITH CODEINE
ASCRIPTIN
ASPIRIN BUFFERED
ASPIRIN-CAFFEINE
ASPIRIN-CAFFEINE-DIHYDROCODEIN
AXERT
BACK & BODY PAIN RELIEVER
BACK PAIN-OFF
BALACET 325
BAYER BACK & BODY
BAYER MIGRAINE
BAYER PLUS
BAYER PM
BC
BC ARTHRITIS
BE-FLEX PLUS
BELLADONNA-OPIUM
BUFFERED ASPIRIN
BUFFERIN
BUNAVAIL
BUPAP
BUPRENORPHINE-NALOXONE
BUTALB-ACETAMINOPH-CAFF-CODEIN
BUTALB-CAFF-ACETAMINOPH-CODEIN
BUTALBITAL COMPOUND
BUTALBITAL COMPOUND-CODEINE
BUTALBITAL-ACETAMINOPHEN-CAFFE
BUTALBITAL-ASPIRIN-CAFFEINE
BUTRANS
CAFERGOT
CAFGESIC
CAPACET
CAPITAL W-CODEINE
CARISOPRODOL COMPOUNDCODEINE
CARISOPRODOL-ASPIRIN-CODEINE
CEPHADYN
COCET
COCET PLUS
CODEINE SULFATE
CO-GESIC
CRAMP
DARVOCET A500
DARVOCET-N 100
DARVOCET-N 50
DARVON
DEPODUR
157
GENERIC DRUG
NARATRIPTAN HCL
SAL-AMIDE/ACETAMINOPHN/P-TLOX
ASPIRIN/CAFFEINE
BUTALB/ACETAMINOPHEN/CAFFEINE
ASPIRIN/SOD BICARB/CITRIC ACID
ASPIRIN/SALICYLAMIDE/CAFFEINE
CODEINE/BUTALBITAL/ASA/CAFFEIN
ASA/CALCIUM CARB/MAG/AL HYDROX
ASPIRIN/CALCIUM CARBONATE/MAG
ASPIRIN/CAFFEINE
DIHYDROCODEINE/ASPIRIN/CAFFEIN
ALMOTRIPTAN MALATE
ASPIRIN/CAFFEINE
MG SALICYLATE/ACETAMINOPH/CAFF
PROPOXYPHENE NAP/ACETAMINOPHEN
ASPIRIN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ASA/CALCIUM CARB/MAG/AL HYDROX
ASPIRIN/DIPHENHYDRAMINE CITRAT
ASPIRIN/CAFFEINE
ASPIRIN/CAFFEINE
SAL-AMIDE/ACETAMINOPHN/P-TLOX
OPIUM/BELLADONNA ALKALOIDS
ASPIRIN/CALCIUM CARBONATE/MAG
ASPIRIN/CALCIUM CARBONATE/MAG
BUPRENORPHINE HCL/NALOXONE HCL
BUTALBITAL/ACETAMINOPHEN
BUPRENORPHINE HCL/NALOXONE HCL
BUTALBIT/ACETAMIN/CAFF/CODEINE
BUTALBIT/ACETAMIN/CAFF/CODEINE
BUTALBITAL/ASPIRIN/CAFFEINE
CODEINE/BUTALBITAL/ASA/CAFFEIN
BUTALB/ACETAMINOPHEN/CAFFEINE
BUTALBITAL/ASPIRIN/CAFFEINE
BUPRENORPHINE
ERGOTAMINE TARTRATE/CAFFEINE
SAL-AMIDE/ACETAMIN/P-TLOX/CAFF
BUTALB/ACETAMINOPHEN/CAFFEINE
ACETAMINOPHEN WITH CODEINE
CODEINE/CARISOPRODOL/ASPIRIN
CODEINE/CARISOPRODOL/ASPIRIN
BUTALBITAL/ACETAMINOPHEN
ACETAMINOPHEN WITH CODEINE
ACETAMINOPHEN WITH CODEINE
HYDROCODONE/ACETAMINOPHEN
ACETAMINOPHEN/PAMABROM
PROPOXYPHENE NAP/ACETAMINOPHEN
PROPOXYPHENE NAP/ACETAMINOPHEN
PROPOXYPHENE NAP/ACETAMINOPHEN
PROPOXYPHENE HCL
MORPHINE SULFATE LIPOSOMAL/PF
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
BRAND DRUG
DILAUDID-HP
DIUREX
DOAN'S PM BACK PAIN RELIEF
DOLGIC PLUS
DURABAC
DURACLON
DURAXIN
ED-FLEX
EFFERVESCENT ANTACID
EMBEDA
ENDODAN
EPIDRIN
ERGOTAMINE-CAFFEINE
ESGIC
ESGIC-PLUS
EXCEDRIN
EXCEDRIN EXTRA STRENGTH
EXCEDRIN MENSTRUAL COMPLETE
EXCEDRIN MIGRAINE
EXCEDRIN TENSION HEADACHE
FENTANYL CITRATE-0.9% NACL
FENTANYL CITRATE-D5W
FENTANYL CITRATE-NS
FENTANYL-BUPIVACAINE-NS
FENTANYL-ROPIVACAINE-NS
FIORICET
FIORICET WITH CODEINE
FIORINAL
FIORINAL WITH CODEINE #3
FLEXTRA PLUS
FRENADOL
FROVA
GOODY'S BODY PAIN
GOODY'S EXTRA STRENGTH
GOODY'S HEADACHE POWDER
GOODY'S MIGRAINE RELIEF
HEADACHE FORMULA
HEADACHE PAIN
HEADACHE RELIEF
HYCET
HYDROCODONE-ACETAMINOPHEN
HYDROCODONE-APAP
HYDROCODONE-IBUPROFEN
HYDROGESIC
HYDROMORPHONE HCL-D5W
HYDROMORPHONE HCL-NS
HYDROMORPHONE-BUPIVACAINE
HYDROMORPHONE-BUPIVACAINE-NS
IBUDONE
ISOMETHEPT-CAFF-ACETAMINOPHEN
ISOMETHEPT-DICHLORALP-ACETAMIN
ISOMETHEPTENE-CAFFACETAMINOPH
158
GENERIC DRUG
HYDROMORPHONE HCL/PF
MAGNESIUM SALICYLATE/CAFFEINE
MG SALICYLATE/DP-HYDRAM HCL
BUTALB/ACETAMINOPHEN/CAFFEINE
SAL-AMIDE/ACETAMIN/P-TLOX/CAFF
CLONIDINE HCL/PF
SAL-AMIDE/ACETAMINOPHN/P-TLOX
SAL-AMIDE/ACETAMINOPHN/P-TLOX
ASPIRIN/SOD BICARB/CITRIC ACID
MORPHINE SULFATE/NALTREXONE
OXYCODONE HCL/ASPIRIN
ISOMETHEPT/DICHLPHN/ACETAMINOP
ERGOTAMINE TARTRATE/CAFFEINE
BUTALB/ACETAMINOPHEN/CAFFEINE
BUTALB/ACETAMINOPHEN/CAFFEINE
ACETAMINOPHEN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ACETAMINOPHEN/CAFFEINE
FENTANYL CITRATE-0.9 % NACL/PF
FENTANYL CITRATE/D5W/PF
FENTANYL CITRATE/PF
FENTANYL/BUPIVACAINE/NS/PF
FENTANYL/ROPIVACAINE/NS/PF
BUTALB/ACETAMINOPHEN/CAFFEINE
BUTALBIT/ACETAMIN/CAFF/CODEINE
BUTALBITAL/ASPIRIN/CAFFEINE
CODEINE/BUTALBITAL/ASA/CAFFEIN
ACETAMINOPHEN/PHENYLTOLOX/CAFF
SALICYLAMIDE/ACETAMINOPHEN
FROVATRIPTAN SUCCINATE
ASPIRIN/ACETAMINOPHEN
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ASA/ACETAMINOPHN/CAFFEIN/POT
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ACETAMINOPHEN/CAFFEINE
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE BIT/ACETAMINOPHEN
HYDROCODONE/IBUPROFEN
HYDROCODONE/ACETAMINOPHEN
HYDROMORPHONE HCL IN D5W/PF
HYDROMORPHONE HCL IN 0.9% NACL
HYDROMORPHONE/BUPIV/0.9NACL/PF
HYDROMORPHONE/BUPIV/0.9NACL/PF
HYDROCODONE/IBUPROFEN
ISOMETHEPTEN/CAF/ACETAMINOPHEN
ISOMETHEPT/DICHLPHN/ACETAMINOP
ISOMETHEPTEN/CAF/ACETAMINOPHEN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
BRAND DRUG
LEVACET
LORCET
LORCET 10-650
LORCET HD
LORCET PLUS
LORTAB
MARGESIC
MARGESIC H
MARTEN-TAB
MAXALT
MAXALT MLT
MAXIDONE
MEDI-SELTZER
MEPERIDINE HCL-0.9% NACL
MEPERIDINE HCL-NS
METHADONE HCL-0.9% NACL
MIDRIN
MIGERGOT
MIGRAGESIC IDA
MIGRAINE FORMULA
MIGRAINE PAIN-RELIEVER
MIGRAINE RELIEF
MIGRALAM
MIGRATEN
MORPHINE SULFATE IN DEXTROSE
MORPHINE SULFATE-0.9% NACL
MORPHINE SULFATE-D5W
MORPHINE SULFATE-NACL,ISO-OSM
NARATRIPTAN
NODOLOR
NORCO
NUCYNTA
NUCYNTA ER
NUMORPHAN
OPANA
OPANA ER
ORBIVAN
ORBIVAN CF
OXYCODONE HCL-ASPIRIN
OXYCODONE HCL-IBUPROFEN
OXYCODONE-ASPIRIN
OXYMORPHONE HCL ER
PAIN-OFF
PAIN-RELIEVER
PAMPRIN MAX
PANLOR SS
PENTAZOCINE-ACETAMINOPHEN
PENTAZOCINE-NALOXONE HCL
PERCODAN
PHRENILIN
159
GENERIC DRUG
ASA/SALICYLAM/ACETAMINOPH/CAFF
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
BUTALB/ACETAMINOPHEN/CAFFEINE
HYDROCODONE/ACETAMINOPHEN
BUTALBITAL/ACETAMINOPHEN
RIZATRIPTAN BENZOATE
RIZATRIPTAN BENZOATE
HYDROCODONE/ACETAMINOPHEN
ASPIRIN/SOD BICARB/CITRIC ACID
MEPERIDINE HCL IN 0.9 % NACL
MEPERIDINE HCL IN 0.9 % NACL
METHADONE HCL IN 0.9 % NACL
ISOMETHEPT/DICHLPHN/ACETAMINOP
ERGOTAMINE TARTRATE/CAFFEINE
ISOMETHEPT/DICHLPHN/ACETAMINOP
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ISOMETHEPTEN/CAF/ACETAMINOPHEN
ISOMETHEPTEN/CAF/ACETAMINOPHEN
MORPHINE SULFATE/D5W/PF
MORPHINE SULFATE IN 0.9 % NACL
MORPHINE SULFATE/D5W
MORPHINE IN NACL, ISO-OSM/PF
NARATRIPTAN HCL
NARATRIPTAN HCL
ISOMETHEPT/DICHLPHN/ACETAMINOP
HYDROCODONE/ACETAMINOPHEN
TAPENTADOL HCL
TAPENTADOL HCL
OXYMORPHONE HCL
OXYMORPHONE HCL
OXYMORPHONE HCL
BUTALB/ACETAMINOPHEN/CAFFEINE
BUTALBITAL/ACETAMINOPHEN
OXYCODONE HCL/ASPIRIN
IBUPROFEN/OXYCODONE HCL
OXYCODONE HCL/OXYCODON TER/ASA
OXYMORPHONE HCL
OXYMORPHONE HCL
ASPIRIN/ACETAMINOPHEN/CAFFEINE
ACETAMINOPHEN/CAFFEINE
ASPIRIN/ACETAMINOPHEN/CAFFEINE
DHCODEINE BT/ACETAMINOPHN/CAFF
PENTAZOCINE HCL/ACETAMINOPHEN
PENTAZOCINE HCL/NALOXONE HCL
OXYCODONE HCL/ASPIRIN
BUTALBITAL/ACETAMINOPHEN
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PAIN MANAGEMENT - ANALGESICS
PARKINSONS DISEASE
BRAND DRUG
PHRENILIN FORTE
POLYGESIC
PRIALT
PRODRIN
PROMACET
PROPOXACET-N 100
PROPOXYPHENE HCLACETAMINOPHENNAPPROPOXYPHENE
ACETAMINOPHEN
RELPAX
REMIFENTANIL HCL-NS
REPAN
REPREXAIN
RIZATRIPTAN
SEDAPAP
STAGESIC
STANBACK
SUBOXONE
SUFENTANIL-BUPIVACAINE-NS
SUPER PAIN RELIEF
SYNALGOS-DC
TALWIN
TENCON
TENSION HEADACHE
TENSION HEADACHE PAIN RELIEVER
TENSION HEADACHE RELIEF
TRAMADOL HCL-ACETAMINOPHEN
TREXIMET
TREZIX
TRI-BUFFERED ASPIRIN
TYLENOL-CODEINE NO.3
TYLENOL-CODEINE NO.4
ULTRACET
VANQUISH
VERDROCET
VICODIN
VICODIN ES
VICODIN HP
VICOPROFEN
WOMEN'S ASPIRIN
WOMEN'S MENSTRUAL RELIEF
XODOL 10-300
XODOL 5-300
XODOL 7.5-300
XYLON 10
ZAMICET
ZEBUTAL
ZERLOR
ZOLVIT
ZUBSOLV
ZYDONE
ANTACID TABLET
160
GENERIC DRUG
BUTALBITAL/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
ZICONOTIDE ACETATE
ISOMETHEPTEN/CAF/ACETAMINOPHEN
BUTALBITAL/ACETAMINOPHEN
PROPOXYPHENE NAP/ACETAMINOPHEN
PROPOXYPHENE HCL
PROPOXYPHENE HCL/ACETAMINOPHEN
PROPOXYPHENE NAP/ACETAMINOPHEN
ELETRIPTAN HBR
REMIFENTANIL IN 0.9 % NACL/PF
BUTALB/ACETAMINOPHEN/CAFFEINE
HYDROCODONE/IBUPROFEN
RIZATRIPTAN BENZOATE
BUTALBITAL/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
ASPIRIN/CAFFEINE
BUPRENORPHINE HCL/NALOXONE HCL
SUFENTANIL/BUPIVACAINE/NS/PF
ASPIRIN/ACETAMINOPHEN/CAFFEINE
DIHYDROCODEINE/ASPIRIN/CAFFEIN
PENTAZOCINE LACTATE
BUTALBITAL/ACETAMINOPHEN
ACETAMINOPHEN/CAFFEINE
ACETAMINOPHEN/CAFFEINE
ACETAMINOPHEN/CAFFEINE
TRAMADOL HCL/ACETAMINOPHEN
SUMATRIPTAN SUCC/NAPROXEN SOD
DHCODEINE BT/ACETAMINOPHN/CAFF
ASPIRIN/CALCIUM CARBONATE/MAG
ACETAMINOPHEN WITH CODEINE
ACETAMINOPHEN WITH CODEINE
TRAMADOL HCL/ACETAMINOPHEN
ASA/ACETAMINOPHN/MAG/ALH/CAFF
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/IBUPROFEN
ASPIRIN/CALCIUM CARBONATE
ACETAMINOPHEN/PAMABROM
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/ACETAMINOPHEN
HYDROCODONE/IBUPROFEN
HYDROCODONE/ACETAMINOPHEN
BUTALB/ACETAMINOPHEN/CAFFEINE
DHCODEINE BT/ACETAMINOPHN/CAFF
HYDROCODONE/ACETAMINOPHEN
BUPRENORPHINE HCL/NALOXONE HCL
HYDROCODONE/ACETAMINOPHEN
MG TRISILICATE/ALH/NAHCO3/AA
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
PARKINSONS DISEASE
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
BRAND DRUG
AZILECT
CARBIDOPA-LEVODOPA
CARBIDOPA-LEVODOPA ER
CARBIDOPA-LEVODOPA-ENTACAPONE
COMTAN
DUOPA
FOAMING ANTACID
GAVISCON
MIRAPEX
MIRAPEX ER
NEUPRO
PARCOPA
PRAMIPEXOLE DIHYDROCHLORIDE
PRAMIPEXOLE ER
REQUIP
REQUIP XL
RYTARY
SINEMET 10-100
SINEMET 25-100
SINEMET 25-250
SINEMET CR
STALEVO 100
STALEVO 125
STALEVO 150
STALEVO 200
STALEVO 50
STALEVO 75
TASMAR
APTIOM
BANZEL
CELONTIN
CEREBYX
DEPAKOTE
DEPAKOTE ER
DEPAKOTE SPRINKLE
DIVALPROEX SODIUM ER
FELBATOL
FYCOMPA
GABITRIL
LEVETIRACETAM-NACL
MEBARAL
ONFI
OXTELLAR XR
PEGANONE
PHENYTEK
161
GENERIC DRUG
RASAGILINE MESYLATE
CARBIDOPA/LEVODOPA
CARBIDOPA/LEVODOPA
CARBIDOPA/LEVODOPA/ENTACAPONE
ENTACAPONE
CARBIDOPA/LEVODOPA
ENTACAPONE
MG TRISILICATE/ALH/NAHCO3/AA
MG TRISILICATE/ALH/NAHCO3/AA
PRAMIPEXOLE DI-HCL
PRAMIPEXOLE DI-HCL
ROTIGOTINE
CARBIDOPA/LEVODOPA
PRAMIPEXOLE DI-HCL
PRAMIPEXOLE DI-HCL
ROPINIROLE HCL
ROPINIROLE HCL
ROPINIROLE HCL
CARBIDOPA/LEVODOPA
CARBIDOPA/LEVODOPA
CARBIDOPA/LEVODOPA
CARBIDOPA/LEVODOPA
CARBIDOPA/LEVODOPA
CARBIDOPA/LEVODOPA/ENTACAPONE
CARBIDOPA/LEVODOPA/ENTACAPONE
CARBIDOPA/LEVODOPA/ENTACAPONE
CARBIDOPA/LEVODOPA/ENTACAPONE
CARBIDOPA/LEVODOPA/ENTACAPONE
CARBIDOPA/LEVODOPA/ENTACAPONE
TOLCAPONE
TRIHEXYPHENIDYL HCL
ESLICARBAZEPINE ACETATE
RUFINAMIDE
METHSUXIMIDE
FOSPHENYTOIN SODIUM
DIVALPROEX SODIUM
DIVALPROEX SODIUM
DIVALPROEX SODIUM
DIVALPROEX SODIUM
DIVALPROEX SODIUM
FELBAMATE
FELBAMATE
FOSPHENYTOIN SODIUM
PERAMPANEL
TIAGABINE HCL
LEVETIRACETAM IN NACL (ISO-OS)
MEPHOBARBITAL
CLOBAZAM
OXCARBAZEPINE
OXCARBAZEPINE
ETHOTOIN
PHENYTOIN SODIUM EXTENDED
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SEIZURE DISORDER
SKELETAL MUSCLE DISORDER
SKELETAL MUSCLE DISORDER
SKELETAL MUSCLE DISORDER
SKELETAL MUSCLE DISORDER
SKELETAL MUSCLE DISORDER
SKELETAL MUSCLE DISORDER
SKELETAL MUSCLE DISORDER
SKELETAL MUSCLE DISORDER
SKELETAL MUSCLE DISORDER
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
BRAND DRUG
POTIGA
SABRIL
TRILEPTAL
VIMPAT
ZONEGRAN
CARISOPRODOL COMPOUND
CARISOPRODOL-ASPIRIN
CHLORZOXAZONE
W/ACETAMINOPHEN
COMFORT PAC-CYCLOBENZAPRINE
COMFORT PAC-TIZANIDINE
ORPHENADRINE COMPOUND
ORPHENADRINE COMPOUND FORTE
SKELAXIN
ANIMAL CHEWS
ANIMAL SHAPES
ANIMAL SHAPES VITAMINS
CENTRAL-VITE HP
CEROVITE ADVANCED FORMULA
CHEWABLE MULTI VITAMIN
CHEWABLE-VITE
CHILD CHEW VITAMIN
CHILD LITTLE ANIMALS VITAMINS
CHILDREN'S CHEWABLE
CHILDREN'S CHEWABLE COMPLETE
CHILDREN'S CHEWABLE VITAMIN
CHILDREN'S MULTIVIT W-EXTRA C
CHILDREN'S MULTIVITAMINS
CHILD'S VITAMIN WITH VITAMIN C
DAILY DIET SUPPORT
DAILY MULTIPLE VITAMIN
DAILY VALUE
DAILY VITAMIN
DAILY VITAMIN FORMULA
DAILY VITE
DINO-LIFE WITH EXTRA C
ESSENTIAL ONE DAILY
EZFE 200
FERREX 150
FERUS
FLINTSTONES
FLINTSTONES WITH EXTRA C
FRUITY CHEWS
GUMMI BEAR MULTIVITAMIN
GUMMY SWIRLS
IFEREX 150
INFUVITE
INFUVITE ADULT
IRONUP
162
GENERIC DRUG
PHENYTOIN SODIUM EXTENDED
EZOGABINE
VIGABATRIN
TIAGABINE HCL
OXCARBAZEPINE
LACOSAMIDE
ZONISAMIDE
ZONISAMIDE
CARISOPRODOL/ASPIRIN
CARISOPRODOL/ASPIRIN
CHLORZOXAZONE/ACETAMINOPHEN
CYCLOBENZ HCL/IRR CNTR-IRR CB2
TIZANIDINE/IRR CNTR-IRR CMB #2
METAXALONE
ORPHENADRINE/ASPIRIN/CAFFEINE
ORPHENADRINE/ASPIRIN/CAFFEINE
METAXALONE
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN/IRON/FOLIC ACID
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
IRON POLYSACCHARIDE COMPLEX
IRON POLYSACCHARIDE COMPLEX
IRON POLYSACCHARIDE COMPLEX
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
IRON POLYSACCHARIDE COMPLEX
MVI, PEDI NO.1 WITH VIT K
MVI, ADULT NO.4 WITH VIT K
IRON POLYSACCHARIDE COMPLEX
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
BRAND DRUG
KID'S GUMMY BEAR VITAMINS
KIDS VITAMINS
KID'S VITAMINS
KID'S VITAMINS + EXTRA C
KID'S VITAMINS COMPLETE
M.V.I.-12
MEGA MULTIVITAMIN
MEN'S MULTI-VITAMIN
MULTI-DELYN
MULTIPLE VITAMINS
MULTI-VITAMIN DAILY
MULTIVITAMINS
MULTIVITAMINS HI-PO
MY FAVORITE MULTIPLE
MYFERON 150
NIFEREX
NOVAFERRUM
NOVAFERRUM 50
NU-IRON 150
ONCE DAILY
ONE DAILY ESSENTIAL
ONE DAILY MULTIVITAMIN
ONE-A-DAY ESSENTIAL
ONE-A-DAY MEN'S
PHARMACIST FAVORITE MULTI-VITE
PIC 200
POLY-IRON
POLYSACCHARIDE IRON
POLYSACCHARIDE IRON 150
POLY-VI-SOL
POLY-VITA
POLY-VITAMIN
POUCH DRAIN 401549
PRO FE
SENTRY
SPECTRAVITE ADVANCED FORMULA
STROVITE
SUPER MULTIVITAMIN
TAB-A-VITE
VIMAR
VITAMINS FOR HAIR
ZOO CHEWS
BEANO
DIGESTIVE ENZYME
DIGESTIVE ENZYMES
ENZYMATIC DIGESTANT
ENZYME DIGEST
GAS-X PREVENTION
KARBOZYME
MILCO-ZYME
MILK DIGESTANT
163
GENERIC DRUG
MULTIVITAMIN
PEDIATRIC MULTIVIT COMB 8/FA
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MVI, ADULT NO.2 WITHOUT VIT K
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
IRON POLYSACCHARIDE COMPLEX
IRON POLYSACCHARIDE COMPLEX
IRON POLYSACCHARIDE COMPLEX
IRON POLYSACCHARIDE COMPLEX
IRON POLYSACCHARIDE COMPLEX
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITS-MINERALS/FA/LYCOPENE
MULTIVITAMIN
IRON POLYSACCHARIDE COMPLEX
IRON POLYSACCHARIDE COMPLEX
IRON POLYSACCHARIDE COMPLEX
IRON POLYSACCHARIDE COMPLEX
PEDIATRIC MULTIVIT COMB NO.81
PEDIATRIC MULTIVIT COMB NO.20
MULTIVITAMIN
IRON POLYSACCHARIDE COMPLEX
MULTIVITAMIN/IRON/FOLIC ACID
MULTIVITAMIN/IRON/FOLIC ACID
VITAMIN B COMP AND VIT C NO.6
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
MULTIVITAMIN
WOMEN'S ONE A DAY MULTIVITAMIN
MULTIVITAMIN
ALPHA-D-GALACTOSIDASE
ENZYMES,DIGESTIVE
ENZYMES,DIGESTIVE
ENZYMES,DIGESTIVE
ENZYMES,DIGESTIVE
ALPHA-D-GALACTOSIDASE
PANCREATIN/POTASS/SOD BICARB
PEPSIN/GLUTAMIC ACID/BETAINE
LACTASE/RENNET
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
BRAND DRUG
MM-ZYME
SUCRAID
TOXIN CONTROL
TRI-ZYME
ANTISPASMODIC
ATROPINE SULFATE-0.9% NACL
ATROPINE SULF-NS
BELLADONNA-PHENOBARBITAL
CANTIL
CHLORDIAZEPOXIDE-CLIDINIUM
DIGEX NF
DONNATAL
GASTRINEX NF
LIBRAX
ME-PB-HYOS
PAMINE FQ
PB-HYOS
PROCHLORPERAZINE/ISOPROPAMIDE
QUADRAPAX
RE-PB HYOS
SE-DONNA PB HYOS
SERVIRA
ACID CONTROLLER COMPLETE
ACID GONE
ACID GONE ANTACID
ACID REDUCER COMPLETE
ACIPHEX
ACIPHEX SPRINKLE
ADVANCED ANTACID
ADVANCED ANTACID-ANTIGAS
ALAMAG
ALAMAG-PLUS
ALKA-SELTZER HEARTBURN
ALKA-SELTZER HEARTBURN+GAS
ALMACONE
ALMACONE-2
ANTACID & ANTIGAS
ANTACID & GAS RELIEF
ANTACID ANTI-GAS DOUBLE STR
ANTACID DOUBLE STRENGTH
ANTACID II PLUS SIMETHICONE
ANTACID II WITH SIMETHICONE
ANTACID M
ANTACID MULTI-SYMPTOM
ANTACID PLUS ANTI-GAS
ANTACID PLUS EXTRA STRENGTH
ANTACID SUPREME
ANTACID WITH SIMETHICONE
ANTACID-ANTIGAS
AXID
AXID AR
164
GENERIC DRUG
ENZYMES,DIGESTIVE
SACROSIDASE
CHARCOAL/CALCIUM CARBONATE
LIPASE/LACTASE/AMYLASE
PHENOBARB/HYOSCY/ATROPINE/SCOP
ATROPINE SULFATE IN 0.9% NACL
ATROPINE SULFATE IN 0.9% NACL
PHENOBARB/HYOSCY/ATROPINE/SCOP
MEPENZOLATE BROMIDE
CHLORDIAZEPOXIDE/CLIDINIUM BR
HYOSCYAMINE SULFATE/PHENYLTOLX
PHENOBARB/HYOSCY/ATROPINE/SCOP
HYOSCYAMINE SULFATE/PHENYLTOLX
IPECAC
CHLORDIAZEPOXIDE/CLIDINIUM BR
PHENOBARB/HYOSCY/ATROPINE/SCOP
METHSCP BR/LA/S.THM/L.PARA/BIF
PHENOBARB/HYOSCY/ATROPINE/SCOP
ISOPROPAMIDE/PROCHLORPERAZINE
PHENOBARB/HYOSCY/ATROPINE/SCOP
PHENOBARB/HYOSCY/ATROPINE/SCOP
PHENOBARB/HYOSCY/ATROPINE/SCOP
PHENOBARB/HYOSCY/ATROPINE/SCOP
FAMOTIDINE/CA CARB/MAG HYDROX
MAGNESIUM CARBONATE/AL HYDROX
MAG CARB/AL HYDROX/ALGINIC AC
FAMOTIDINE/CA CARB/MAG HYDROX
RABEPRAZOLE SODIUM
RABEPRAZOLE SODIUM
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAGNESIUM HYDROXIDE/AL HYDROX
MAG HYDROX/AL HYDROX/SIMETH
SODIUM BICARBONATE/SODIUM CIT
CALCIUM CARBONATE/SIMETHICONE
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
CALCIUM CARB/MAG HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
CALCIUM CARB/MAGNESIUM HYDROX
MAG HYDROX/AL HYDROX/SIMETH
CALCIUM CARBONATE/SIMETHICONE
NIZATIDINE
NIZATIDINE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
BRAND DRUG
CITROCARBONATE ANTACID
COMFORT GEL
COMPLETE
CYTRA-3
DEXILANT
DUAL ACTION COMPLETE
ESOMEPRAZOLE STRONTIUM
E-Z-GAS II
GAS-X WITH MAALOX
GELUSIL
GENATON
GERI-LANTA
GERI-MOX
HEARTBURN ANTACID
HELIDAC
JR MAALOX PLUS ANTIGAS
KAPIDEX
LANSOPRAZOL-AMOXICIL-CLARITHRO
LIQUID ANTACID
MAALOX MAXIMUM STRENGTH
MAALOX PLUS EXTRA STRENGTH
MAG-AL
MAG-AL PLUS
MAG-AL PLUS XS
MAG-AL ULTIMATE STRENGTH
MAGLOX
MASANTI
MEIJER ANTACID
MI ACID
MILANTEX
MINTOX
MINTOX MAXIMUM STRENGTH
MYLANTA
MYLANTA DOUBLE-STRENGTH
MYLANTA SUPREME ANTACID
MYLANTEX DOUBLE-STRENGTH
NEXIUM
NEXIUM 24HR
NEXIUM I.V.
OMECLAMOX-PAK
OMEPRAZOLE-SODIUM BICARBONATE
PEPCID COMPLETE
PHILLIPS'
POTASS CIT-SOD CIT-CITRIC ACID
PREVPAC
PROBANTHELINE W/PHENOBARBITAL
PROPANTHELINE W/PHENOBARBITAL
165
GENERIC DRUG
SODIUM BICARBONATE/SODIUM CIT
MAG HYDROX/AL HYDROX/SIMETH
FAMOTIDINE/CA CARB/MAG HYDROX
SOD/POT/K CIT/SOD CIT/CIT ACID
DEXLANSOPRAZOLE
FAMOTIDINE/CA CARB/MAG HYDROX
ESOMEPRAZOLE MAGNESIUM
ESOMEPRAZOLE SODIUM
SIMETHICONE/SOD BICARB/CIT AC
CALCIUM CARBONATE/SIMETHICONE
MAG HYDROX/AL HYDROX/SIMETH
MAG CARB/AL HYDROX/ALGINIC AC
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAGNESIUM CARBONATE/AL HYDROX
BISMUTH SAL/METRONID/TETRACYC
CALCIUM CARBONATE/SIMETHICONE
DEXLANSOPRAZOLE
LANSOPRAZOLE/AMOXICILN/CLARITH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAGNESIUM HYDROXIDE/AL HYDROX
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAGNESIUM HYDROXIDE/AL HYDROX
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
CALCIUM CARB/MAGNESIUM HYDROX
MAG HYDROX/AL HYDROX/SIMETH
CALCIUM CARB/MAGNESIUM HYDROX
MAG HYDROX/AL HYDROX/SIMETH
ESOMEPRAZOLE MAGNESIUM
ESOMEPRAZOLE MAGNESIUM
ESOMEPRAZOLE SODIUM
NIZATIDINE
OMEPRAZOLE/CLARITH/AMOXICILLIN
OMEPRAZOLE MAGNESIUM
OMEPRAZOLE/SODIUM BICARBONATE
PANTOPRAZOLE SODIUM
FAMOTIDINE/CA CARB/MAG HYDROX
MAGNESIUM HYDROXIDE
SOD/POT/K CIT/SOD CIT/CIT ACID
LANSOPRAZOLE/AMOXICILN/CLARITH
PROPANTHELINE/PHENOBARBITAL
PROPANTHELINE/PHENOBARBITAL
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
BRAND DRUG
PROTONIX
PROTONIX IV
PYLERA
RI MAG PLUS
RI-GEL
RI-GEL II
RIGINIC
RI-MAG
RI-MOX
RI-MOX PLUS
ROLAIDS
ROLAIDS MULTI-SYMPTOM
ROLAIDS PLUS ANTI-GAS
RON ACID PLUS
RON-ACID
RULOX
TITRALAC PLUS
TRICITRATES
TUMS DUAL ACTION
VIRTRATE-3
ZEGERID
ZEGERID OTC
ALFUZOSIN HCL ER
AVODART
CYSTAGON
CYTRA-2
CYTRA-K
DETROL
DETROL LA
ENABLEX
FLOMAX
JALYN
K-PHOS M.F.
K-PHOS NEUTRAL
K-PHOS NO.2
MYRBETRIQ
ORACIT
OXYTROL
OXYTROL FOR WOMEN
PHENAZOFORTE PLUS
PHENAZOPYRIDINE PLUS
PHOSPHA 250 NEUTRAL
POTASSIUM CITRATE-CITRIC ACID
PROCYSBI
PYRELLE HB
RAPAFLO
RENACIDIN
SANCTURA
SANCTURA XR
166
GENERIC DRUG
PANTOPRAZOLE SODIUM
PANTOPRAZOLE SODIUM
BISMUTH/METRONID/TETRACYCLINE
RABEPRAZOLE SODIUM
MAGALDRATE/SIMETHICONE
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
MAG CARB/AL HYDROX/ALGINIC AC
MAGALDRATE
MAG HYDROX/AL HYDROX/SIMETH
MAG HYDROX/AL HYDROX/SIMETH
CALCIUM CARB/MAG HYDROX/SIMETH
CALCIUM CARB/MAG HYDROX/SIMETH
CALCIUM CARBONATE/SIMETHICONE
MAGALDRATE/SIMETHICONE
MAGALDRATE
MAG HYDROX/AL HYDROX/SIMETH
CALCIUM CARBONATE/SIMETHICONE
SOD/POT/K & SOD CIT/C AC/SUCRO
FAMOTIDINE/CA CARB/MAG HYDROX
SOD/POT/K CIT/SOD CIT/CIT ACID
OMEPRAZOLE/SODIUM BICARBONATE
OMEPRAZOLE/SODIUM BICARBONATE
ALFUZOSIN HCL
ALFUZOSIN HCL
DUTASTERIDE
CYSTEAMINE BITARTRATE
CITRIC ACID/SODIUM CITRATE
POTASSIUM CITRATE/CITRIC ACID
TOLTERODINE TARTRATE
TOLTERODINE TARTRATE
DARIFENACIN HYDROBROMIDE
FLAVOXATE HCL
TAMSULOSIN HCL
DUTASTERIDE/TAMSULOSIN HCL
NA PHOS,M-B/K PHOS,MONOB
PHOSPHORUS #1
NA PHOS,M-B/K PHOS,MONOB
MIRABEGRON
CITRIC ACID/SODIUM CITRATE
OXYBUTYNIN
OXYBUTYNIN
PHENAZOPY HCL/HYOSCY/BUTABARB
PHENAZOPY HCL/HYOSCY/BUTABARB
PHOSPHORUS #1
POTASSIUM CITRATE/CITRIC ACID
CYSTEAMINE BITARTRATE
PHENAZOPY HCL/HYOSCY/BUTABARB
SILODOSIN
CITRIC ACID/G-LACTONE/MAG CARB
TROSPIUM CHLORIDE
TROSPIUM CHLORIDE
KPIC PPO/OOA Formulary - revised May 5, 2015
CLASSIFICATION
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
URINARY TRACT - FUNCTIONAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
VAGINAL DISORDERS
BRAND DRUG
SHOHL'S MODIFIED
SODIUM CITRATE & CITRIC ACID
TARON-CRYSTALS
THIOLA
TOLTERODINE TARTRATE ER
TOVIAZ
TROSPIUM CHLORIDE ER
UROQID-ACID NO.2
UROXATRAL
VESICARE
VIRT-PHOS 250 NEUTRAL
VIS-PHOS N
VISQID A-A
1-DAY
ACID JELLY
FEM PH
FEMININE MOIST-LUBRICATING
FEMININE WASH
FRESH SCENT DOUCHE
GYNAZOLE 1
GYNAZOLE-1
K-Y TINGLING
LONG LASTING VAGINAL
LUBRIN
NORFORMS
RELAGARD
ROMANTIC MIST DOUCHE
SAUGELLA
SILKY LUBRICATING
SUMMER'S EVE FEMININE WASH
TERAZOL 3
TERAZOL 7
TIOCONAZOLE 1
TIOCONAZOLE-1
TRIMO-SAN
TROPICAL BREEZE DOUCHE
VAGISTAT-1
167
GENERIC DRUG
CITRIC ACID/SODIUM CITRATE
CITRIC ACID/SODIUM CITRATE
TAMSULOSIN HCL
POTASSIUM CITRATE/CITRIC ACID
TIOPRONIN
TOLTERODINE TARTRATE
TOLTERODINE TARTRATE
FESOTERODINE FUMARATE
TROSPIUM CHLORIDE
TROSPIUM CHLORIDE
METHEN MAND/NAPHOS M-B M-H
ALFUZOSIN HCL
SOLIFENACIN SUCCINATE
PHOSPHORUS #1
PHOSPHORUS #1
METHEN MAND/NAPHOS M-B M-H
TIOCONAZOLE
ACETIC AC/RICINOLEIC/OXYQUINOL
ACETIC ACID/OXYQUINOLINE
GLYCERIN/MIN OIL/POLYCARBOPHIL
VAGINAL ANTISEPTICS COMBO NO.1
OCTOXYNOL 9/CITRIC ACID
BUTOCONAZOLE NITRATE
BUTOCONAZOLE NITRATE
PG/SORBITOL/CELLU/METHYLSAL/E
VAGINAL MOISTURIZER COMBO NO.2
PROP GLYCOL ALGINATE
VAGINAL DEODORANT COMB NO.1
ACETIC ACID/OXYQUINOLINE
OCTOXYNOL 9/CITRIC ACID
FEMININE HYGIENE CLEANSER NO.1
VAGINAL MOISTURIZER COMBO NO.4
VAGINAL ANTISEPTICS COMBO NO.1
TERCONAZOLE
TERCONAZOLE
TERCONAZOLE
TIOCONAZOLE
TIOCONAZOLE
OXYQUINOLINE/SOD.LAURYL SULFAT
OCTOXYNOL 9/CITRIC ACID
TIOCONAZOLE
KPIC PPO/OOA Formulary - revised May 5, 2015

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