CareFirst Formulary 2 (ACA Plans) 2015

Transcription

CareFirst Formulary 2
(ACA Plans)
2015
PLEASE READ: This document contains information about the drugs
we cover in this plan. This formulary is for:
• Individuals or families purchasing their own plan with an effective
date of January 1, 2014 or after, and
•M
embers of an employer group with less than 51 employees
purchasing a plan with an effective date of January 1, 2014 or after
This formulary was updated 11/01/2015. For
more recent information or other questions,
please contact CareFirst Pharmacy Services at
800-241-3371 or visit www.carefirst.com/rx.
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association.
® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.
LAST UPDATED 01/01/2014
LAST UPDATED 11/01/2015
CareFirst Formulary 2 (ACA)
Drug Name
Effective 11/01/2015
Drug Tier Requirements/Limits
5-ALPHA REDUCTASE INHIBITORS
5-ALPHA REDUCTASE INHIBITORS
AVODART CAP 0.5MG
dutasteride cap 0.5mg
finasteride tab 5mg
PROSCAR TAB 5MG
2
1
1
3
5-HT3 RECEPTOR ANTAGONISTS
5-HT3 RECEPTOR ANTAGONISTS
ANZEMET TAB 50MG
ANZEMET TAB 100MG
granisetron tab 1mg
ondansetron sol 4mg/5ml
ondansetron tab 4mg
ondansetron tab 4mg odt
ondansetron tab 8mg
ondansetron tab 8mg odt
ondansetron tab 24mg
SANCUSO DIS 3.1MG
ZOFRAN SOL 4MG/5ML
ZOFRAN TAB 4MG
ZOFRAN TAB 4MG ODT
ZOFRAN TAB 8MG
ZOFRAN TAB 8MG ODT
ZUPLENZ MIS 4MG
ZUPLENZ MIS 8MG
3
3
1
1
1
1
1
1
1
2
3
3
3
3
3
3
3
5-LIPOXYGENASE INHIBITORS
5-LIPOXYGENASE INHIBITORS
ZYFLO CR TAB 600MG
ZYFLO TAB 600MG
3
3
ABORTIFACIENT - PROGESTERONE RECEPTOR ANTAGONISTS
ABORTIFACIENT - PROGESTERONE RECEPTOR ANTAGONISTS
MIFEPREX TAB 200MG
3
ABORTIFACIENTS/CERVICAL RIPENING - PROSTAGLANDINS
ABORTIFACIENTS/CERVICAL RIPENING - PROSTAGLANDINS
CERVIDIL VAG MIS 10MG INS
PREPIDIL GEL 0.5MG/3G
PROSTIN E2 SUP 20MG
3
3
3
ACE INHIBITOR CALCIUM CHANNEL BLOCKER COMBINATIONS
ACE INHIBITOR CALCIUM CHANNEL BLOCKER COMBINATIONS
amlod/benazp
amlod/benazp
amlod/benazp
amlod/benazp
cap
cap
cap
cap
PA - Prior Authorization
2.5-10mg
5-10mg
5-20mg
5-40mg
QL - Quantity Limits
1
1
1
1
ST - Step Therapy
1
Drug Name
amlod/benazp cap 10-20mg
amlod/benazp cap 10-40mg
LOTREL CAP 2.5-10MG
LOTREL CAP 5-10MG
LOTREL CAP 5-20MG
LOTREL CAP 10-20MG
LOTREL CAP 10-40MG
PRESTALIA TAB 3.5-2.5
PRESTALIA TAB 7-5MG
PRESTALIA TAB 14-10MG
TARKA TAB 1-240 CR
TARKA TAB 2-180 CR
TARKA TAB 2-240 CR
TARKA TAB 4-240 CR
trando/verap tab 1-240 er
1
1
2
2
2
2
2
3
3
3
2
2
2
2
1
1
1
1
ACE INHIBITOR-NUTRITIONAL SUPPLEMENT COMBINATIONS
ACE INHIBITOR-NUTRITIONAL SUPPLEMENT COMBINATIONS
LYTENSOPRIL PAK KIT
3
ACE INHIBITORS
ACE INHIBITORS
ACCUPRIL TAB 5MG
ACCUPRIL TAB 10MG
ACCUPRIL TAB 20MG
ACCUPRIL TAB 40MG
ACEON TAB 4MG
ACEON TAB 8MG
ALTACE CAP 1.25MG
ALTACE CAP 2.5MG
ALTACE CAP 5MG
ALTACE CAP 10MG
benazepril tab 5mg
benazepril tab 10mg
benazepril tab 20mg
benazepril tab 40mg
captopril tab 12.5mg
captopril tab 25mg
captopril tab 50mg
captopril tab 100mg
enalapril tab 2.5mg
enalapril tab 5mg
enalapril tab 10mg
3
3
3
3
3
3
3
3
3
3
1
1
1
1
1
1
1
1
1
1
1
ST - Step Therapy
2
Drug Name
enalapril tab 20mg
EPANED SOL 1MG/ML
fosinopril tab 10mg
fosinopril tab 20mg
fosinopril tab 40mg
lisinopril tab 2.5mg
lisinopril tab 5mg
lisinopril tab 10mg
lisinopril tab 20mg
lisinopril tab 30mg
lisinopril tab 40mg
LOTENSIN TAB 10MG
LOTENSIN TAB 20MG
LOTENSIN TAB 40MG
MAVIK TAB 1MG
MAVIK TAB 2MG
MAVIK TAB 4MG
moexipril tab 7.5mg
moexipril tab 15mg
perindopril tab 2mg
perindopril tab 4mg
perindopril tab 8mg
PRINIVIL TAB 5MG
PRINIVIL TAB 10MG
PRINIVIL TAB 20MG
quinapril tab 5mg
quinapril tab 10mg
quinapril tab 20mg
quinapril tab 40mg
ramipril cap 1.25mg
ramipril cap 2.5mg
ramipril cap 5mg
ramipril cap 10mg
trandolapril tab 1mg
VASOTEC TAB 2.5MG
VASOTEC TAB 5MG
VASOTEC TAB 10MG
VASOTEC TAB 20MG
ZESTRIL TAB 2.5MG
ZESTRIL TAB 30MG
ZESTRIL TAB 40MG
ACE INHIBITORS
1
3
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
1
1
1
1
1
3
3
3
1
1
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
THIAZIDE/THIAZIDE-LIKE
ST - Step Therapy
3
Drug Name
ACE INHIBITORS
THIAZIDE/THIAZIDE-LIKE
ACCURETIC TAB 10-12.5
ACCURETIC TAB 20-12.5
ACCURETIC TAB 20-25MG
benazep/hctz tab 5-6.25
benazep/hctz tab 20-25mg
captopr/hctz tab 25-15mg
enalapr/hctz tab 5-12.5mg
enalapr/hctz tab 10-25mg
fosinop/hctz tab 10/12.5
fosinop/hctz tab 20/12.5
lisinop/hctz tab 10-12.5
lisinop/hctz tab 20-12.5
lisinop/hctz tab 20-25mg
LOTENSIN HCT TAB 10-12.5
LOTENSIN HCT TAB 20-12.5
LOTENSIN HCT TAB 20-25MG
moexipr/hctz tab 7.5-12.5
moexipr/hctz tab 15-12.5
moexipr/hctz tab 15-25mg
qnapril/hctz tab 10-12.5
qnapril/hctz tab 20-12.5
qnapril/hctz tab 20-25mg
VASERETIC TAB 10-25MG
ZESTORETIC TAB 10-12.5
ZESTORETIC TAB 20-12.5
ZESTORETIC TAB 20-25MG
3
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
3
3
1
1
1
1
1
1
3
3
3
3
ACNE ANTIBIOTICS
ACNE ANTIBIOTICS
ACZONE GEL 5%
CLEOCIN-T GEL 1%
CLEOCIN-T LOT 1%
CLEOCIN-T PAD 1%
CLEOCIN-T SOL 1%
clindacin-p pad 1%
CLINDAGEL GEL 1%
clindamycin aer 1%
clindamycin gel 1%
clindamycin lot 1%
3
3
3
3
3
1
3
1
1
1
ST - Step Therapy
4
Drug Name
clindamycin sol 1%
ery pad 2%
ERYGEL GEL 2%
erythromycin gel 2%
erythromycin sol 2%
EVOCLIN AER 1%
KLARON LOT 10%
sulfacetamid sus 10%
1
1
3
1
1
3
3
1
ACNE COMBINATIONS
ACNE COMBINATIONS
ACANYA GEL 1.2-2.5%
AVAR AER 9.5-5%
avar cleanse emu 10-5%
AVAR LS AER 10-2%
AVAR LS LIQ 10-2%
AVAR LS PAD 10-2%
AVAR PAD 9.5-5%
avar-e green cre 10-5%
AVAR-E LS CRE 10-2%
BENZACLIN GEL 1-5%
BENZAMYCIN GEL 5-3%
BENZAMYCIN GEL PAK
bp 10-1 emu
bp cleansing emu 10-4%
CLARIFOAM EF AER 10-5%
CLINDACIN KIT PAC 1%
clindamy/ben gel 1-5%
DERMAPAK PAK PLUS
DUAC GEL 1.2-5%
EPIDUO FORTE GEL 0.3-2.5%
EPIDUO GEL 0.1-2.5%
erythromycin gel /benzoyl
INOVA 4/1 KIT ACNE CON
INOVA 8/2 KIT ACNE CON
INOVA KIT 4%
INOVA KIT 8%
neuac gel 1.2-5%
NEUAC KIT 1.2-5%
ONEXTON GEL 1.2-3.75
PLEXION CLTH PAD 9.8-4.8%
PLEXION CRE 9.8-4.8%
PLEXION LIQ 9.8-4.8%
PLEXION LOT 9.8-4.8%
prascion fc pad 10-5%
2
3
1
3
2
3
3
1
2
2
3
3
1
1
3
3
1
3
3
2
2
1
3
3
3
3
1
3
3
3
3
3
3
1
ST - Step Therapy
5
Drug Name
PRASCION RA CRE 10-5%
ROSANIL KIT
ROSULA LIQ 10-4.5%
sod sul/sulf cre 9.8-4.8%
sod sul/sulf cre 10-2%
SOD SUL/SULF EMU 10-5%
sod sul/sulf gel 10-5%
sod sul/sulf kit
sod sul/sulf liq 9-4.5%
sod sul/sulf liq 9.8-4.8%
sod sul/sulf liq 10-2%
sod sul/sulf liq wash
sod sul/sulf lot 9.8-4.8%
sod sul/sulf lot 10-5%
sod sul/sulf pad 10-4%
sod sul/sulf sus 8-4%
SOD SUL/SULF SUS 10-5%
sss 10-5 aer 10-5%
sulf/sunscrn kit 9-4.5%
SUMADAN KIT
SUMADAN WASH LIQ 9-4.5%
SUMADAN XLT KIT 9-4.5%
SUMAXIN CP KIT
SUMAXIN PAD 10-4%
SUMAXIN TS SUS 8-4%
SUMAXIN WASH LIQ 9-4%
VANOXIDE-HC LOT 5-0.5%
VELTIN GEL
ZACARE KIT KIT 4%
ZACARE KIT KIT 8%
3
3
3
1
1
2
1
1
1
1
1
1
1
1
1
1
2
1
1
3
3
3
3
3
3
3
3
3
PA
3
3
ACNE PRODUCTS
ACNE PRODUCTS
ABSORICA CAP 10MG
ABSORICA CAP 20MG
ABSORICA CAP 25MG
ABSORICA CAP 30MG
ABSORICA CAP 35MG
ABSORICA CAP 40MG
adapalene cre 0.1%
adapalene gel 0.1%
adapalene gel 0.3%
adapalene lot 0.1%
amnesteem cap 10mg
amnesteem cap 20mg
3
3
3
3
3
3
1
1
1
1
1
1
ST - Step Therapy
6
Drug Name
amnesteem cap 40mg
ATRALIN GEL 0.05%
avita cre 0.025%
avita gel 0.025%
AZELEX CRE 20%
BENZEFOAM AER 9.8%
BENZIQ GEL 5.25%
BENZIQ LS GEL 2.75%
bp foam aer 9.8%
bp wash liq 7%
bpo cloths mis 6%
BPO GEL 4%
BPO GEL 8%
claravis cap 30mg
DIFFERIN CRE 0.1%
DIFFERIN GEL 0.1%
DIFFERIN GEL 0.3%
DIFFERIN LOT 0.1%
FABIOR AER 0.1%
NUOX GEL 6-3%
RETIN-A CRE 0.1%
RETIN-A CRE 0.05%
RETIN-A CRE 0.025%
RETIN-A GEL 0.01%
RETIN-A GEL 0.025%
RETIN-A MICR GEL 0.1%
RIAX AER 5.5%
RIAX AER 9.5%
SULFOAM SHA 2%
TRETIN-X CRE 0.075%
TRETIN-X CRE 0.0375%
TRETIN-X CRE KIT 0.1%
tretinoin cre 0.1%
tretinoin cre 0.05%
tretinoin gel 0.1%
tretinoin gel 0.01%
tretinoin gel 0.04%
tretinoin gel 0.05%
ZACLIR LOT 8%
1
2
PA
1
PA
1
PA
3
3
3
3
1
1
1
3
3
1
2
2
2
2
3
PA
3
3
PA
3
PA
3
PA
3
PA
3
PA
2
PA
2
PA
2
PA
3
3
3
3
PA
3
PA
3
PA
3
PA
3
PA
1
PA
1
PA
1
PA
1
PA
1
PA
1
PA
3
ADHD AGENT - SELECTIVE ALPHA ADRENERGIC AGONISTS
ST - Step Therapy
7
Drug Name
ADHD AGENT - SELECTIVE ALPHA ADRENERGIC AGONISTS
clonidine tab 0.1mg er
guanfacine tab 1mg er
INTUNIV TAB 1MG
INTUNIV TAB 2MG
INTUNIV TAB 3MG
INTUNIV TAB 4MG
KAPVAY TAB 0.1 MG
1
1
1
1
1
3
3
3
3
3
ADHD AGENT - SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR
ADHD AGENT - SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR
STRATTERA
STRATTERA
STRATTERA
STRATTERA
STRATTERA
STRATTERA
STRATTERA
CAP
CAP
CAP
CAP
CAP
CAP
CAP
10MG
18MG
25MG
40MG
60MG
80MG
100MG
2
2
2
2
2
2
2
ADRENERGIC COMBINATIONS
ADRENERGIC COMBINATIONS
ADVAIR DISKU AER 100/50
ADVAIR HFA AER 45/21
ANORO ELLIPT AER 62.5-25
BREO ELLIPTA INH 100-25
BREO ELLIPTA INH 200-25
COMBIVENT AER RESPIMAT
DULERA AER 100-5MCG
DULERA AER 200-5MCG
ipratropium/ sol albuter
STIOLTO AER RESPIMAT
SYMBICORT AER 80-4.5
SYMBICORT AER 160-4.5
2
2
2
2
2
2
2
3
3
2
2
2
1
3
3
3
PA
PA
PA
ADRENOLYTICS-CENTRAL THIAZIDE/THIAZIDE-LIKE COMB
ADRENOLYTICS-CENTRAL THIAZIDE/THIAZIDE-LIKE COMB
clorpres tab 0.1-15mg
methyld/hctz tab 250/15
1
1
1
1
ST - Step Therapy
8
Drug Name
methyld/hctz tab 250/25
1
AGENTS FOR EXTERNAL GENITAL AND PERIANAL WARTS
AGENTS FOR EXTERNAL GENITAL AND PERIANAL WARTS
VEREGEN OIN 15%
3
AGENTS FOR GAUCHER DISEASE
AGENTS FOR GAUCHER DISEASE
CERDELGA CAP 84MG
ZAVESCA CAP 100MG
3
3
PA
PA
AGENTS FOR PHEOCHROMOCYTOMA
AGENTS FOR PHEOCHROMOCYTOMA
DEMSER CAP 250MG
DIBENZYLINE CAP 10MG
phenoxybenza cap 10mg
3
3
1
ALCOHOL DETERRENTS
ALCOHOL DETERRENTS
acampro cal tab 333mg
ANTABUSE TAB 250MG
ANTABUSE TAB 500MG
disulfiram tab 250mg
disulfiram tab 500mg
1
2
2
1
1
ALKYLATING AGENTS
ALKYLATING AGENTS
HEXALEN CAP 50MG
MYLERAN TAB 2MG
0
0
ALLERGENIC EXTRACTS
ALLERGENIC EXTRACTS
GRASTEK SUB 2800BAU
2
ALPHA 1-ADRENOCEPTOR ANTAGONISTS
ALPHA 1-ADRENOCEPTOR ANTAGONISTS
alfuzosin tab 10mg
CARDURA XL TAB 4MG
CARDURA XL TAB 8MG
FLOMAX CAP 0.4MG
RAPAFLO CAP 4MG
RAPAFLO CAP 8MG
tamsulosin cap 0.4mg
UROXATRAL TAB 10MG
1
3
3
3
2
2
1
3
ALPHA ADRENERGIC AGONIST CARBONIC ANHYDRASE INHIB COMB
ALPHA ADRENERGIC AGONIST CARBONIC ANHYDRASE INHIB
COMB
SIMBRINZA SUS 1-0.2%
2
ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)
ST - Step Therapy
9
Drug Name
ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)
mirtazapine tab 7.5mg
mirtazapine tab 15mg
mirtazapine tab 15mg odt
REMERON SLTB TAB 15MG
REMERON TAB 15MG
REMERON TAB 30MG
REMERON TAB 45MG
1
1
1
1
1
1
1
3
3
3
3
3
3
ALPHA-BETA BLOCKER-NUTRITIONAL SUPPLEMENT COMBINATIONS
ALPHA-BETA BLOCKER-NUTRITIONAL SUPPLEMENT COMBINATIONS
HYPERTENEVID PAK 12.5MG
3
ALPHA-BETA BLOCKERS
ALPHA-BETA BLOCKERS
carvedilol tab 3.125mg
carvedilol tab 25mg
COREG CR CAP 10MG
COREG CR CAP 20MG
COREG CR CAP 40MG
COREG CR CAP 80MG
COREG TAB 3.125MG
COREG TAB 6.25MG
COREG TAB 12.5MG
COREG TAB 25MG
labetalol tab 100mg
labetalol tab 200mg
labetalol tab 300mg
TRANDATE TAB 100MG
TRANDATE TAB 200MG
TRANDATE TAB 300MG
1
1
1
1
2
2
2
2
3
3
3
3
1
1
1
3
3
3
ALPHA-GLUCOSIDASE INHIBITORS
ALPHA-GLUCOSIDASE INHIBITORS
acarbose tab 25mg
acarbose tab 50mg
acarbose tab 100mg
GLYSET TAB 25MG
GLYSET TAB 50MG
1
1
1
3
3
ST - Step Therapy
10
Drug Name
GLYSET TAB 100MG
PRECOSE TAB 25MG
PRECOSE TAB 50MG
PRECOSE TAB 100MG
3
2
2
2
ALTERNATIVE MEDICINE - CI'S
ALTERNATIVE MEDICINE - CI'S
CITRUS POW BERGAMOT
3
ALTERNATIVE MEDICINE - CO'S
ALTERNATIVE MEDICINE - CO'S
QUINZYME TAB 90MG
3
ALTERNATIVE MEDICINE COMBINATIONS - FOUR INGREDIENTS
ALTERNATIVE MEDICINE COMBINATIONS - FOUR INGREDIENTS
CO-VERATROL CAP
3
AMEBICIDES
AMEBICIDES
YODOXIN TAB 210MG
YODOXIN TAB 650MG
3
3
AMINOGLYCOSIDES
AMINOGLYCOSIDES
BETHKIS NEB 300/4ML
KITABIS PAK NEB 300/5ML
neomycin tab 500mg
paromomycin cap 250mg
TOBI NEB 300/5ML
TOBI PODHALR CAP 28MG
tobramycin neb 300/5ml
4
4
1
1
4
4
4
PA
PA
PA
PA
PA
AMINOPENICILLINS
AMINOPENICILLINS
amoxicillin cap 250mg
amoxicillin cap 500mg
amoxicillin chw 125mg
amoxicillin chw 250mg
AMOXICILLIN POW TRIHYDRA
amoxicillin sus 125/5ml
amoxicillin tab 500mg
ampicillin cap 250mg
ampicillin cap 500mg
ampicillin sus 125/5ml
1
1
1
1
3
1
1
1
1
1
1
1
1
1
1
ST - Step Therapy
11
Drug Name
ampicillin sus 250/5ml
MOXATAG TAB 775MG
1
3
AMPA GLUTAMATE RECEPTOR ANTAGONISTS
AMPA GLUTAMATE RECEPTOR ANTAGONISTS
FYCOMPA
FYCOMPA
FYCOMPA
FYCOMPA
FYCOMPA
FYCOMPA
TAB
TAB
TAB
TAB
TAB
TAB
2MG
4MG
6MG
8MG
10MG
12MG
3
3
3
3
3
3
AMPHETAMINE MIXTURES
AMPHETAMINE MIXTURES
ADDERALL TAB 5MG
ADDERALL TAB 7.5MG
ADDERALL TAB 10MG
ADDERALL TAB 12.5MG
ADDERALL TAB 15MG
ADDERALL TAB 20MG
ADDERALL TAB 30MG
ADDERALL XR CAP 5MG
ADDERALL XR CAP 10MG
amphetamine cap 5mg er
amphetamine tab 5mg
amphetamine tab 7.5mg
amphetamine tab 10mg
amphetamine tab 12.5mg
3
3
3
3
3
3
3
3
3
3
3
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
PA
PA
PA
PA
PA
PA
AMPHETAMINES
AMPHETAMINES
DESOXYN TAB 5MG
DEXEDRINE CAP 5MG CR
3
3
3
3
ST - Step Therapy
12
Drug Name
dextroamphet cap 5mg er
dextroamphet sol 5mg/5ml
dextroamphet tab 5mg
dextroamphet tab 10mg
EVEKEO TAB 5MG
EVEKEO TAB 10MG
methamphetam tab 5mg
PROCENTRA SOL 5MG/5ML
VYVANSE CAP 10MG
VYVANSE CAP 20MG
VYVANSE CAP 30MG
VYVANSE CAP 40MG
VYVANSE CAP 50MG
VYVANSE CAP 60MG
VYVANSE CAP 70MG
zenzedi tab 2.5mg
zenzedi tab 7.5mg
zenzedi tab 15mg
zenzedi tab 20mg
zenzedi tab 30mg
1
1
1
1
1
1
3
3
1
3
2
2
2
2
2
2
2
1
1
1
1
1
ANABOLIC STEROIDS
ANABOLIC STEROIDS
ANADROL-50 TAB 50MG
OXANDRIN TAB 2.5MG
OXANDRIN TAB 10MG
oxandrolone tab 2.5mg
oxandrolone tab 10mg
3
3
3
1
1
ANALEPTICS
ANALEPTICS
caffeine cit sol 60mg/3ml
1
ANALGESIC COMBINATIONS
ANALGESIC COMBINATIONS
ed-flex cap
LEVACET TAB
1
3
ANALGESICS-SEDATIVES
ANALGESICS-SEDATIVES
BUPAP TAB 50-300MG
but/apap/caf cap
but/apap/caf tab
but/asa/caff cap
butal/apap tab 50-325mg
EQUAGESIC TAB 200-325
3
1
1
1
1
3
ST - Step Therapy
13
Drug Name
ESGIC TAB
FIORICET CAP
FIORINAL CAP
margesic cap
VANATOL LQ SOL
2
3
2
1
3
ANAPHYLAXIS THERAPY AGENTS
ANAPHYLAXIS THERAPY AGENTS
ADRENACLICK INJ 0.3MG
ADRENACLICK INJ 0.15MG
ADRENALIN INJ 1MG/ML
ADRENALIN INJ 30/30ML
epinephrine inj 0.3mg
epinephrine inj 0.15mg
EPIPEN-JR INJ 2-PAK
EPISNAP KIT
3
3
3
3
1
1
2
3
PA
PA
ANDROGEN BIOSYNTHESIS INHIBITORS
ANDROGEN BIOSYNTHESIS INHIBITORS
ZYTIGA TAB 250MG
0
PA
ANDROGENS
ANDROGENS
ANDRODERM DIS 2MG/24HR
ANDRODERM DIS 4MG/24HR
ANDROGEL GEL 1%(25MG)
ANDROGEL GEL 1%(50MG)
ANDROGEL GEL 1.62%
ANDROGEL GEL PUMP 1%
ANDROXY TAB 10MG
AXIRON SOL 30MG/ACT
danazol cap 50mg
danazol cap 100mg
danazol cap 200mg
FORTESTA GEL 10MG/ACT
METHITEST TAB 10MG
methyltestos cap 10mg
NATESTO GEL 5.5MG
STRIANT MIS 30MG
testosterone gel 1%(25mg)
testosterone gel 1%(50mg)
testosterone gel 10mg/act
testosterone gel pump 1%
TESTRED CAP 10MG
VOGELXO GEL 1%(50MG)
VOGELXO GEL PUMP 1%
2
2
3
3
3
3
3
2
1
1
1
2
3
1
3
3
1
1
1
1
3
3
3
PA
PA
PA
PA
PA
PA
ANESTHETICS TOPICAL ORAL
ST - Step Therapy
14
Drug Name
ANESTHETICS TOPICAL ORAL
lidocaine sol 2% visc
lidocaine sol 4% 4%
LTA 360 KIT SOL 4%
1
1
3
ANGIOTENSIN II RECEPTOR ANT-CA CHANNEL BLOCKER-THIAZIDES
ANGIOTENSIN II RECEPTOR ANT-CA CHANNEL BLOCKER-THIAZIDES
amlod/valsar tab /hctz
EXFORGEH/5- TAB 160-12.5
EXFORGEH/5- TAB 160-25
EXFORGEH/10- TAB 160-12.5
TRIBENZOR20- TAB 5-12.5MG
TRIBENZOR40- TAB 5-12.5MG
TRIBENZOR40- TAB 5-25MG
TRIBENZOR40- TAB 10-12.5
TRIBENZOR40- TAB 10-25MG
1
3
3
3
3
3
2
2
2
2
2
ANGIOTENSIN II RECEPTOR ANTAG CA CHANNEL BLOCKER COMB
ANGIOTENSIN II RECEPTOR ANTAG CA CHANNEL BLOCKER COMB
amlod/valsar tab 5-160mg
AZOR TAB 5-20MG
AZOR TAB 5-40MG
AZOR TAB 10-20MG
AZOR TAB 10-40MG
EXFORGE TAB 5-160MG
EXFORGE TAB 5-320MG
EXFORGE TAB 10-160MG
EXFORGE TAB 10-320MG
telmis/amlod tab 40-5mg
TWYNSTA TAB 40-5MG
TWYNSTA TAB 40-10MG
TWYNSTA TAB 80-5MG
TWYNSTA TAB 80-10MG
1
1
1
1
2
2
2
2
3
3
3
3
1
1
1
1
3
3
3
3
ANGIOTENSIN II RECEPTOR ANTAG THIAZIDE/THIAZIDE-LIKE
ANGIOTENSIN II RECEPTOR ANTAG THIAZIDE/THIAZIDE-LIKE
ATACAND HCT TAB 16-12.5
ATACAND HCT TAB 32-12.5
ATACAND HCT TAB 32-25MG
3
3
3
PA
PA
PA
ST - Step Therapy
15
Drug Name
AVALIDE TAB 150-12.5
AVALIDE TAB 300-12.5
BENICAR HCT TAB 20-12.5
BENICAR HCT TAB 40-12.5
BENICAR HCT TAB 40-25MG
candesa/hctz tab 16-12.5
candesa/hctz tab 32-12.5
candesa/hctz tab 32-25mg
DIOVAN HCT TAB 80/12.5
DIOVAN HCT TAB 160-12.5
DIOVAN HCT TAB 160-25MG
DIOVAN HCT TAB 320-12.5
DIOVAN HCT TAB 320-25MG
EDARBYCLOR TAB 40-12.5
EDARBYCLOR TAB 40-25MG
HYZAAR TAB 50-12.5
HYZAAR TAB 100-12.5
HYZAAR TAB 100-25
irbesar/hctz tab 150-12.5
irbesar/hctz tab 300-12.5
losartan/hct tab 50-12.5
losartan/hct tab 100-12.5
losartan/hct tab 100-25
MICARDIS HCT TAB 40/12.5
MICARDIS HCT TAB 80-25MG
MICARDIS HCT TAB 80/12.5
telmisa/hctz tab 40-12.5
telmisa/hctz tab 80-12.5
telmisa/hctz tab 80-25mg
valsart/hctz tab 80-12.5
valsart/hctz tab 160-25mg
valsart/hctz tab 320-25mg
3
3
2
2
2
1
1
1
3
PA
3
PA
3
PA
3
PA
3
PA
3
PA
3
PA
3
3
3
1
1
1
1
1
3
3
3
1
1
1
1
1
1
1
1
ANGIOTENSIN II RECEPTOR ANTAGONISTS
ANGIOTENSIN II RECEPTOR ANTAGONISTS
ATACAND TAB 4MG
ATACAND TAB 8MG
ATACAND TAB 16MG
ATACAND TAB 32MG
AVAPRO TAB 75MG
AVAPRO TAB 150MG
AVAPRO TAB 300MG
BENICAR TAB 5MG
3
3
3
3
3
3
3
2
PA
PA
PA
PA
ST - Step Therapy
16
Drug Name
BENICAR TAB 20MG
BENICAR TAB 40MG
candesartan tab 4mg
candesartan tab 8mg
candesartan tab 16mg
candesartan tab 32mg
COZAAR TAB 25MG
COZAAR TAB 50MG
COZAAR TAB 100MG
DIOVAN TAB 40MG
DIOVAN TAB 80MG
DIOVAN TAB 160MG
DIOVAN TAB 320MG
EDARBI TAB 40MG
EDARBI TAB 80MG
eprosart mes tab 600mg
irbesartan tab 75mg
irbesartan tab 150mg
irbesartan tab 300mg
losartan pot tab 25mg
MICARDIS TAB 20MG
MICARDIS TAB 40MG
MICARDIS TAB 80MG
telmisartan tab 20mg
valsartan tab 40mg
valsartan tab 80mg
valsartan tab 160mg
valsartan tab 320mg
2
2
1
1
1
1
3
3
3
3
3
3
3
3
PA
3
PA
1
1
1
1
1
1
1
3
3
3
1
1
1
1
1
1
1
ANTHELMINTICS
ANTHELMINTICS
ALBENZA TAB 200MG
BILTRICIDE TAB 600MG
ivermectin tab 3mg
STROMECTOL TAB 3MG
THIABENDAZOL POW
2
3
1
3
3
ANTI TB COMBINATIONS
ANTI TB COMBINATIONS
RIFAMATE CAP
RIFATER TAB
3
3
ANTI-CATAPLECTIC AGENTS
ST - Step Therapy
17
Drug Name
ANTI-CATAPLECTIC AGENTS
XYREM SOL 500MG/ML
3
ANTI-INFECTIVE AGENTS - MISC.
ANTI-INFECTIVE AGENTS - MISC.
CAYSTON INH 75MG
FLAGYL CAP 375MG
FLAGYL ER TAB 750MG
FLAGYL TAB 250MG
FLAGYL TAB 500MG
metronidazol cap 375mg
metronidazol tab 250mg
metronidazol tab 500mg
PRIMSOL SOL 50MG/5ML
TINDAMAX TAB 250MG
TINDAMAX TAB 500MG
tinidazole tab 250mg
tinidazole tab 500mg
trimethoprim tab 100mg
VANCOCIN HCL CAP 125MG
VANCOCIN HCL CAP 250MG
vancomycin cap 125mg
vancomycin cap 250mg
VANCOMYCN 25 SOL 25MG/ML
VANCOMYCN 50 SOL 50MG/ML
XIFAXAN TAB 200MG
XIFAXAN TAB 550MG
3
3
3
3
3
1
1
1
3
2
2
1
1
1
2
2
1
1
3
3
3
2
PA
PA
PA
ANTI-INFECTIVE MISC. - COMBINATIONS
ANTI-INFECTIVE MISC. - COMBINATIONS
BACTRIM DS TAB 800-160
BACTRIM TAB 400-80MG
smz-tmp sus 200-40/5
smz-tmp tab 400-80mg
smz/tmp ds tab 800-160
2
2
1
1
1
ANTI-INFECTIVES - THROAT
ANTI-INFECTIVES - THROAT
clotrimazole tro 10mg
nystatin sus 100000
ORAVIG TAB 50MG
1
1
3
ANTI-INFLAMMATORY AGENTS
ANTI-INFLAMMATORY AGENTS
cromolyn sod neb 20mg/2ml
1
ANTI-INFLAMMATORY AGENTS - TOPICAL
ANTI-INFLAMMATORY AGENTS - TOPICAL
ST - Step Therapy
18
Drug Name
diclofenac sol 1.5%
FLECTOR DIS 1.3%
PENNSAID SOL 2%
VOLTAREN GEL 1%
1
3
PA
3
PA
2
ANTI-INFLAMMATORY COMBINATIONS - TOPICAL
ANTI-INFLAMMATORY COMBINATIONS - TOPICAL
DERMACINRX PAK LEXITRAL
DIPENTOCAINE CRE 5-5-2%
DSG PAK PAK
EMVOREN CRE
NAPROPAX MIS
NOVOCLAIR CRE
3
3
3
3
3
3
ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES
ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES
HUMIRA INJ 10MG/0.2
HUMIRA KIT 20MG/0.4
HUMIRA KIT 40MG/0.8
HUMIRA PEN INJ 40MG/0.8
SIMPONI INJ 50/0.5ML
SIMPONI INJ 100MG/ML
4
4
4
4
4
4
PA
PA
PA
PA
PA
PA
ANTIADRENALS
ANTIADRENALS
LYSODREN TAB 500MG
0
ANTIADRENERGICS - CENTRALLY ACTING
ANTIADRENERGICS - CENTRALLY ACTING
CATAPRES TAB 0.1MG
CATAPRES TAB 0.2MG
CATAPRES TAB 0.3MG
CATAPRES-TTS DIS 0.1/24HR
clonidine dis 0.1/24hr
clonidine tab 0.1mg
clonidine tab 0.2mg
clonidine tab 0.3mg
guanfacine tab 1mg
guanfacine tab 2mg
methyldopa tab 250mg
methyldopa tab 500mg
TENEX TAB 1MG
TENEX TAB 2MG
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
2
2
ST - Step Therapy
19
Drug Name
ANTIADRENERGICS - PERIPHERALLY ACTING
ANTIADRENERGICS - PERIPHERALLY ACTING
CARDURA TAB 1MG
CARDURA TAB 2MG
CARDURA TAB 4MG
CARDURA TAB 8MG
doxazosin tab 1mg
doxazosin tab 2mg
doxazosin tab 4mg
doxazosin tab 8mg
MINIPRESS CAP 1MG
MINIPRESS CAP 2MG
MINIPRESS CAP 5MG
prazosin hcl cap 1mg
terazosin cap 1mg
terazosin cap 2mg
terazosin cap 5mg
terazosin cap 10mg
3
3
3
3
1
1
1
1
3
3
3
1
1
1
1
1
1
1
ANTIANDROGENS
ANTIANDROGENS
bicalutamide tab 50mg
CASODEX TAB 50MG
flutamide cap 125mg
NILANDRON TAB 150MG
XTANDI CAP 40MG
0
0
0
0
0
PA
ANTIANGINALS-OTHER
ANTIANGINALS-OTHER
RANEXA TAB 500MG
RANEXA TAB 1000MG
2
2
ANTIANXIETY AGENTS - MISC.
ANTIANXIETY AGENTS - MISC.
buspirone tab 5mg
buspirone tab 7.5mg
buspirone tab 10mg
buspirone tab 15mg
buspirone tab 30mg
hydroxyz hcl syp 10mg/5ml
hydroxyz hcl tab 10mg
hydroxyz pam cap 25mg
1
1
1
1
1
1
1
1
1
1
1
ST - Step Therapy
20
Drug Name
meprobamate tab 200mg
meprobamate tab 400mg
VISTARIL CAP 25MG
VISTARIL CAP 50MG
1
1
1
3
3
ANTIARRHYTHMICS TYPE I-A
ANTIARRHYTHMICS TYPE I-A
disopyramide cap 100mg
disopyramide cap 150mg
NORPACE CAP 100MG
NORPACE CAP 100MG CR
NORPACE CAP 150MG
NORPACE CAP 150MG CR
quinidine gl tab 324mg cr
quinidine su tab 200mg
quinidine su tab 300mg
quinidine su tab 300mg er
1
1
2
2
2
2
1
1
1
1
ANTIARRHYTHMICS TYPE I-B
ANTIARRHYTHMICS TYPE I-B
mexiletine cap 150mg
1
1
1
ANTIARRHYTHMICS TYPE I-C
ANTIARRHYTHMICS TYPE I-C
flecainide tab 50mg
flecainide tab 100mg
flecainide tab 150mg
propafenone cap 225mg er
propafenone cap 325mg er
propafenone cap 425mg sr
propafenone tab 150mg
RYTHMOL SR CAP 225MG
RYTHMOL TAB 150MG
RYTHMOL TAB 225MG
1
1
1
1
1
1
1
1
1
2
2
2
2
2
ANTIARRHYTHMICS TYPE III
ANTIARRHYTHMICS TYPE III
amiodarone tab 200mg
CORDARONE TAB 200MG
MULTAQ TAB 400MG
pacerone tab 100mg
1
2
3
1
ST - Step Therapy
21
Drug Name
pacerone tab 400mg
TIKOSYN CAP 125MCG
TIKOSYN CAP 250MCG
TIKOSYN CAP 500MCG
1
4
PA
4
PA
4
PA
ANTIBIOTIC STEROID COMBINATIONS - TOPICAL
ANTIBIOTIC STEROID COMBINATIONS - TOPICAL
CORTISPORIN CRE 0.5%
CORTISPORIN OIN 1%
NEO-SYNALAR CRE
NEO-SYNALAR KIT
3
3
3
3
ANTIBIOTICS - TOPICAL
ANTIBIOTICS - TOPICAL
ALTABAX OIN 1%
BACITRACIN POW ZINC USP
BACTROBAN CRE 2%
BACTROBAN OIN 2%
CENTANY AT KIT 2%
CENTANY OIN 2%
gentamicin cre 0.1%
gentamicin oin 0.1%
mupirocin ca cre 2%
mupirocin oin 2%
3
3
2
2
3
3
1
1
1
1
ANTICHOLINERGIC COMBINATIONS
ANTICHOLINERGIC COMBINATIONS
BELLA/OPIUM SUP 16.2-30
BELLA/OPIUM SUP 16.2-60
chlord/clidi cap 5-2.5mg
DONNATAL ELX
DONNATAL TAB 16.2MG
DONNATAL TAB EXTENTAB
GASTRINEX NF CAP
LIBRAX CAP 5-2.5MG
PAMINE FQ KIT
3
3
1
3
3
3
3
3
3
ANTICONVULSANT - MISC. NUTRITIONAL SUPPLEMENT COMB
ANTICONVULSANT - MISC. NUTRITIONAL SUPPLEMENT COMB
THERAPENTIN PAK -90
3
ANTICONVULSANTS - BENZODIAZEPINES
ANTICONVULSANTS - BENZODIAZEPINES
clonazep
clonazep
clonazep
clonazep
clonazep
odt
odt
odt
odt
odt
tab
tab
tab
tab
tab
0.5mg
0.25mg
0.125mg
1mg
2mg
1
1
1
1
1
ST - Step Therapy
22
Drug Name
clonazepam tab 0.5mg
clonazepam tab 1mg
clonazepam tab 2mg
DIASTAT ACDL GEL 5-10MG
DIASTAT ACDL GEL 12.5-20
DIASTAT PED GEL 2.5M GEL
diazepam gel 2.5mg
diazepam gel 10mg
diazepam gel 20mg
KLONOPIN TAB 0.5MG
KLONOPIN TAB 1MG
KLONOPIN TAB 2MG
ONFI SUS 2.5MG/ML
ONFI TAB 10MG
ONFI TAB 20MG
1
1
1
3
3
3
1
1
1
2
2
2
3
3
3
ANTICONVULSANTS - MISC.
ANTICONVULSANTS - MISC.
APTIOM TAB 200MG
APTIOM TAB 400MG
APTIOM TAB 600MG
APTIOM TAB 800MG
BANZEL SUS 40MG/ML
BANZEL TAB 200MG
BANZEL TAB 400MG
carbamazepin cap 100mg er
carbamazepin chw 100mg
carbamazepin sus 100/5ml
carbamazepin tab 200mg er
carbamazepin tab 400mg er
CARBATROL CAP 100MG
CARBATROL CAP 200MG
CARBATROL CAP 300MG
epitol tab 200mg
FANATREX SUS 25MG/ML
gabapentin cap 100mg
gabapentin sol 250/5ml
gabapentin tab 600mg
gabapentin tab 800mg
KEPPRA SOL 100MG/ML
KEPPRA TAB 250MG
3
3
3
3
3
3
3
1
1
1
1
1
1
1
3
3
3
1
3
1
1
1
1
1
1
3
3
ST - Step Therapy
23
Drug Name
KEPPRA TAB 500MG
KEPPRA TAB 750MG
KEPPRA TAB 1000MG
KEPPRA XR TAB 500MG
KEPPRA XR TAB 750MG
LAMICTAL CHW 2MG
LAMICTAL CHW 5MG
LAMICTAL CHW 25MG
LAMICTAL KIT START 35
LAMICTAL ODT KIT
LAMICTAL ODT TAB 25MG
LAMICTAL TAB 25MG
LAMICTAL TAB 100MG
LAMICTAL TAB 150MG
LAMICTAL TAB 200MG
LAMICTAL XR KIT
LAMICTAL XR TAB 25MG
lamotrigine chw 5mg
lamotrigine chw 25mg
lamotrigine tab 25mg
lamotrigine tab 25mg er
lamotrigine tab 25mg odt
lamotrigine tab 50mg odt
levetiraceta sol 100mg/ml
levetiraceta tab 250mg
levetiraceta tab 500mg er
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
ST - Step Therapy
24
Drug Name
levetiraceta tab 750mg er
LYRICA CAP 25MG
LYRICA CAP 50MG
LYRICA CAP 75MG
LYRICA CAP 100MG
LYRICA CAP 150MG
LYRICA CAP 200MG
LYRICA CAP 225MG
LYRICA CAP 300MG
LYRICA SOL 20MG/ML
MYSOLINE TAB 50MG
MYSOLINE TAB 250MG
NEURONTIN CAP 100MG
NEURONTIN CAP 300MG
NEURONTIN CAP 400MG
NEURONTIN SOL 250/5ML
NEURONTIN TAB 600MG
NEURONTIN TAB 800MG
oxcarbazepin sus 300mg/5m
oxcarbazepin tab 150mg
OXTELLAR XR TAB 150MG
POTIGA TAB 50MG
POTIGA TAB 200MG
POTIGA TAB 300MG
POTIGA TAB 400MG
primidone tab 50mg
primidone tab 250mg
QUDEXY XR CAP 25/24HR
TEGRETOL SUS 100/5ML
TEGRETOL TAB 200MG
TEGRETOL-XR TAB 100MG
TOPAMAX SPR CAP 15MG
TOPAMAX SPR CAP 25MG
1
1
1
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
1
1
1
1
3
3
3
3
3
3
3
1
1
3
3
3
3
3
3
3
3
3
3
3
3
ST - Step Therapy
25
Drug Name
TOPAMAX TAB 25MG
TOPAMAX TAB 50MG
TOPAMAX TAB 100MG
TOPAMAX TAB 200MG
topiramate cap 15mg
topiramate cap 25mg
topiramate cap er 25mg
topiramate tab 25mg
topiramate tab 50mg
topiramate tab 100mg
topiramate tab 200mg
TRILEPTAL SUS 300MG/5M
TRILEPTAL TAB 150MG
TRILEPTAL TAB 300MG
TRILEPTAL TAB 600MG
TROKENDI XR CAP 25MG
VIMPAT SOL 10MG/ML
VIMPAT TAB 50MG
VIMPAT TAB 100MG
VIMPAT TAB 150MG
VIMPAT TAB 200MG
ZONEGRAN CAP 25MG
ZONEGRAN CAP 100MG
zonisamide cap 25mg
zonisamide cap 50mg
zonisamide cap 100mg
3
3
3
3
1
1
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
2
2
2
2
2
3
3
1
1
1
ANTIDEMENTIA AGENT COMBINATIONS
ANTIDEMENTIA AGENT COMBINATIONS
NAMZARIC CAP 14-10MG
NAMZARIC CAP 28-10MG
3
3
ANTIDEPRESSANT MISC-NUTRITIONAL SUPPLEMENT COMBINATIONS
ANTIDEPRESSANT MISC-NUTRITIONAL SUPPLEMENT
COMBINATIONS
APPBUTAMONE PAK
3
ANTIDEPRESSANTS - MISC.
ANTIDEPRESSANTS - MISC.
APLENZIN TAB 174MG
3
ST - Step Therapy
26
Drug Name
APLENZIN TAB 348MG
APLENZIN TAB 522MG
bupropion tab 75mg
bupropion tab 100mg
bupropion tab 100mg sr
bupropn hcl tab 150mg xl
bupropn hcl tab 300mg xl
FORFIVO XL TAB 450MG
maprotiline tab 25mg
WELLBUTRIN TAB 75MG
WELLBUTRIN TAB 100MG
WELLBUTRIN TAB 100MG SR
WELLBUTRIN TAB XL 150MG
WELLBUTRIN TAB XL 300MG
3
3
1
1
1
1
1
1
1
3
1
1
1
3
3
3
3
3
3
3
ANTIDIABETIC - AMYLIN ANALOGS
ANTIDIABETIC - AMYLIN ANALOGS
SYMLINPEN 60 INJ 1000MCG
SYMLNPEN 120 INJ 1000MCG
2
2
ANTIDIARRHEAL - CHLORIDE CHANNEL ANTAGONISTS
ANTIDIARRHEAL - CHLORIDE CHANNEL ANTAGONISTS
FULYZAQ TAB 125MG
3
ANTIDIARRHEAL COMBINATIONS
ANTIDIARRHEAL COMBINATIONS
RESTORA RX CAP 60-1.25
RESTORA SPRI PAK 15-0.25
3
3
ANTIDOTES
ANTIDOTES
RADIOGARDASE CAP 0.5GM
3
ANTIDOTES - CHELATING AGENTS
ANTIDOTES - CHELATING AGENTS
CA-DTPA SOL 1000MG
CHEMET CAP 100MG
EXJADE TAB 125MG
EXJADE TAB 250MG
EXJADE TAB 500MG
FERRIPROX TAB 500MG
JADENU TAB 90MG
3
3
4
4
4
3
3
PA
PA
PA
PA
PA
ST - Step Therapy
27
Drug Name
JADENU TAB 180MG
JADENU TAB 360MG
ZN-DTPA SOL 1000MG
3
PA
3
PA
3
ANTIEMETIC COMBINATIONS
ANTIEMETIC COMBINATIONS
AKYNZEO CAP
DICLEGIS TAB 10-10MG
3
2
ANTIEMETICS - ANTICHOLINERGIC
ANTIEMETICS - ANTICHOLINERGIC
TIGAN CAP 300MG
TRANSDERM-SC DIS 1MG
trimethobenz cap 300mg
3
3
1
ANTIEMETICS - MISCELLANEOUS
ANTIEMETICS - MISCELLANEOUS
CESAMET CAP 1MG
dronabinol cap 2.5mg
dronabinol cap 5mg
dronabinol cap 10mg
MARINOL CAP 2.5MG
MARINOL CAP 5MG
MARINOL CAP 10MG
3
1
1
1
3
3
3
ANTIESTROGENS
ANTIESTROGENS
FARESTON TAB 60MG
SOLTAMOX SOL 10MG/5ML
tamoxifen tab 10mg
tamoxifen tab 20mg
0
3
0
0
ANTIFUNGALS
ANTIFUNGALS
ANCOBON CAP 250MG
ANCOBON CAP 500MG
BIO-STATIN CAP 500000
BIO-STATIN CAP 1000000
flucytosine cap 250mg
flucytosine cap 500mg
GRIFULVIN V TAB 500MG
GRIS-PEG TAB 125MG
GRIS-PEG TAB 250MG
griseofulvin sus 125/5ml
griseofulvin tab micr 500
griseofulvin tab ultr 125
griseofulvin tab ultr 250
LAMISIL GRA 125MG
3
3
3
3
1
1
3
2
2
1
1
1
1
3
ST - Step Therapy
28
Drug Name
LAMISIL GRA 187.5MG
LAMISIL TAB 250MG
nystatin pow
nystatin tab 500000
terbinafine tab 250mg
3
3
1
1
1
ANTIFUNGALS - TOPICAL
ANTIFUNGALS - TOPICAL
CICLODAN CRE KIT 0.77%
CICLODAN SOL KIT 8%
ciclopirox cre 0.77%
ciclopirox gel 0.77%
ciclopirox kit 8%
ciclopirox sha 1%
ciclopirox sol 8%
ciclopirox sus 0.77%
CNL8 NAIL KIT
HALOTIN CRE 1%
LOPROX SHA 1%
naftifine cre hcl 1%
NAFTIN CRE 1%
NAFTIN CRE 2%
NAFTIN GEL 1%
NAFTIN GEL 2%
nystatin cre 100000
nystatin oin 100000
nystop pow 100000
PEDIADERM AF KIT COMPLETE
PENLAC SOL 8%
3
3
1
1
1
1
1
1
3
3
3
1
2
2
2
2
1
1
1
3
3
ANTIFUNGALS - TOPICAL COMBINATIONS
ANTIFUNGALS - TOPICAL COMBINATIONS
ALA-QUIN CRE 3-0.5%
ALCORTIN A GEL
ALOQUIN GEL 1.25-1%
clotrim/beta cre diprop
clotrim/beta lot diprop
DERMASORB AF KIT 3-0.5%
exoderm lot 25-1%
hydrocort cre iodoquin
hydrocort/ cre iodoquin
LOTRISONE CRE
nystat/triam cre
nystat/triam oin
PEDIPAK PAK
VUSION OIN
3
3
3
1
1
3
3
1
1
3
1
1
3
3
ST - Step Therapy
29
Drug Name
VYTONE CRE 1-1.9%
XOLEGEL DUO/ KIT XOLEX
XOLEGEL KIT COREPAK
3
3
3
ANTIHISTAMINE-STEROID
ANTIHISTAMINE-STEROID
DYMISTA SPR 137-50
3
PA
ANTIHISTAMINE-TOPICAL COMBINATIONS
ANTIHISTAMINE-TOPICAL COMBINATIONS
ALLO-PAX CRE 5-5%
NAZIREX CRE
3
3
ANTIHISTAMINES - ALKYLAMINES
ANTIHISTAMINES - ALKYLAMINES
brompheniram chw 12mg
RESPA-BR TAB 11MG
1
3
ANTIHISTAMINES - ETHANOLAMINES
ANTIHISTAMINES - ETHANOLAMINES
carbinoxamin sol 4mg/5ml
carbinoxamin tab 4mg
clemastine tab 2.68mg
KARBINAL ER SUS 4MG/5ML
1
1
1
3
ANTIHISTAMINES - NON-SEDATING
ANTIHISTAMINES - NON-SEDATING
all day allg cap 10mg
all day allg sol 5mg/5ml
ALLEGRA ALRG TAB 60MG
aller-ease tab 60mg
aller-tec tab 10mg
allergy relf syp 5mg/5ml
cetirizine tab 5mg
CLARINEX RDT TAB 2.5MG
CLARINEX RDT TAB 5MG
CLARINEX SYP 0.5MG/ML
CLARINEX TAB 5MG
desloratadin tab 2.5 odt
desloratadin tab 5mg
desloratadin tab 5mg odt
levocetirizi sol 2.5/5ml
levocetirizi tab 5mg
wal-zyr chw 5mg
wal-zyr chw 10mg
XYZAL SOL
XYZAL TAB 5MG
ZYRTEC ALLGY CAP 10MG
1
1
3
1
1
1
1
3
3
3
3
1
1
1
1
1
1
1
2
2
3
ST - Step Therapy
30
Drug Name
ZYRTEC ALLGY
ZYRTEC CHILD
ZYRTEC CHILD
ZYRTEC CHILD
ZYRTEC CHILD
TAB 10MG
CHW ALG 5MG
CHW ALG 10MG
SYP 1MG/ML
TAB 10MG
2
2
2
2
3
ANTIHISTAMINES - PHENOTHIAZINES
ANTIHISTAMINES - PHENOTHIAZINES
phenadoz sup 12.5mg
phenadoz sup 25mg
promethazine syp 6.25/5ml
promethazine tab 12.5mg
promethazine tab 25mg
promethazine tab 50mg
promethegan sup 50mg
1
1
1
1
1
1
1
ANTIHISTAMINES - PIPERIDINES
ANTIHISTAMINES - PIPERIDINES
cyproheptad syp 2mg/5ml
cyproheptad tab 4mg
1
1
ANTIHYPERLIPIDEMICS - MISC.
ANTIHYPERLIPIDEMICS - MISC.
KYNAMRO INJ 200MG/ML
LOVAZA CAP 1GM
omega-3-acid cap 1gm
VASCEPA CAP 1GM
4
3
1
3
PA
PA
PA
PA
ANTIHYPERLIPIDEMICS MISC. COMBINATIONS
ANTIHYPERLIPIDEMICS MISC. COMBINATIONS
OMEGA-3/D-3 KIT WELLNESS
3
ANTIHYPERTENSIVES - MISC.
ANTIHYPERTENSIVES - MISC.
VECAMYL TAB 2.5MG
3
ANTILEPROTICS
ANTILEPROTICS
THALOMID
THALOMID
THALOMID
THALOMID
CAP
CAP
CAP
CAP
50MG
100MG
150MG
200MG
0
0
0
0
PA
PA
PA
PA
ANTIMALARIAL COMBINATIONS
ANTIMALARIAL COMBINATIONS
atovaq/progu tab 62.5-25
atovaq/progu tab 250-100
COARTEM TAB 20-120MG
MALARONE TAB 62.5-25
MALARONE TAB 250-100
1
1
2
2
2
ST - Step Therapy
31
Drug Name
ANTIMALARIALS
ANTIMALARIALS
ARALEN TAB 500MG
chloroquine tab 250mg
chloroquine tab 500mg
DARAPRIM TAB 25MG
hydroxychlor tab 200mg
mefloquine tab 250mg
PLAQUENIL TAB 200MG
PRIMAQUINE TAB 26.3MG
QUALAQUIN CAP 324MG
quinine sulf cap 324mg
quinine sulf tab 260mg
2
1
1
3
1
1
2
3
3
1
1
ANTIMANIC AGENTS
ANTIMANIC AGENTS
lithium carb cap 150mg
lithium carb tab 300mg
lithium carb tab 300mg er
lithium carb tab 450mg er
LITHIUM SOL 8MEQ/5ML
LITHOBID TAB 300MG CR
1
1
1
1
1
1
3
3
ANTIMETABOLITES
ANTIMETABOLITES
azacitidine inj 100mg
capecitabine tab 150mg
capecitabine tab 500mg
mercaptopur tab 50mg
methotrexate inj 25mg/ml
methotrexate tab 2.5mg
PURIXAN SUS 20MG/ML
TABLOID TAB 40MG
TREXALL TAB 5MG
TREXALL TAB 7.5MG
TREXALL TAB 10MG
TREXALL TAB 15MG
VIDAZA INJ 100MG
XELODA TAB 150MG
XELODA TAB 500MG
4
0
0
0
1
0
0
0
0
0
0
0
4
0
0
PA
PA
PA
PA
PA
PA
ANTIMYASTHENIC/CHOLINERGIC AGENTS
ANTIMYASTHENIC/CHOLINERGIC AGENTS
GUANIDINE TAB 125MG
MESTINON SYP 60MG/5ML
3
2
ST - Step Therapy
32
Drug Name
MESTINON TAB 60MG
MESTINON TAB TIMESPAN
pyridostigm tab 60mg
pyridostigmi tab 180mg
2
2
1
1
ANTIMYCOBACTERIAL AGENTS
ANTIMYCOBACTERIAL AGENTS
cycloserine cap 250mg
ethambutol tab 100mg
ethambutol tab 400mg
isoniazid syp 50mg/5ml
isoniazid tab 100mg
isoniazid tab 300mg
MYAMBUTOL TAB 100MG
MYAMBUTOL TAB 400MG
MYCOBUTIN CAP 150MG
PASER GRA 4GM
PRIFTIN TAB 150MG
pyrazinamide tab 500mg
rifabutin cap 150mg
RIFADIN CAP 150MG
RIFADIN CAP 300MG
rifampin cap 150mg
rifampin cap 300mg
SIRTURO TAB 100MG
TRECATOR TAB 250MG
1
1
1
1
1
1
2
2
3
3
3
1
1
2
2
1
1
3
3
ANTINEOPLASTIC - BRAF KINASE INHIBITORS
ANTINEOPLASTIC - BRAF KINASE INHIBITORS
TAFINLAR CAP 50MG
TAFINLAR CAP 75MG
ZELBORAF TAB 240MG
0
0
0
PA
PA
PA
ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS
ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS
ERIVEDGE CAP 150MG
ODOMZO CAP 200MG
0
3
PA
ANTINEOPLASTIC - HISTONE DEACETYLASE INHIBITORS
ANTINEOPLASTIC - HISTONE DEACETYLASE INHIBITORS
FARYDAK CAP 10MG
FARYDAK CAP 15MG
FARYDAK CAP 20MG
ZOLINZA CAP 100MG
0
0
0
0
PA
PA
PA
PA
ANTINEOPLASTIC - IMMUNOMODULATORS
ANTINEOPLASTIC - IMMUNOMODULATORS
POMALYST CAP 1MG
0
PA
ST - Step Therapy
33
Drug Name
POMALYST CAP 2MG
POMALYST CAP 3MG
POMALYST CAP 4MG
0
PA
0
PA
0
PA
ANTINEOPLASTIC - MEK INHIBITORS
ANTINEOPLASTIC - MEK INHIBITORS
MEKINIST TAB 0.5MG
MEKINIST TAB 2MG
0
0
PA
PA
ANTINEOPLASTIC - MTOR KINASE INHIBITORS
ANTINEOPLASTIC - MTOR KINASE INHIBITORS
AFINITOR
AFINITOR
AFINITOR
AFINITOR
AFINITOR
AFINITOR
AFINITOR
DIS TAB 2MG
DIS TAB 3MG
DIS TAB 5MG
TAB 2.5MG
TAB 5MG
TAB 7.5MG
TAB 10MG
0
0
0
0
0
0
0
PA
PA
PA
PA
PA
PA
PA
ANTINEOPLASTIC - MULTIKINASE INHIBITORS
ANTINEOPLASTIC - MULTIKINASE INHIBITORS
NEXAVAR TAB 200MG
STIVARGA TAB 40MG
SUTENT CAP 12.5MG
SUTENT CAP 25MG
SUTENT CAP 37.5MG
SUTENT CAP 50MG
0
0
0
0
0
0
PA
PA
PA
PA
PA
PA
ANTINEOPLASTIC - TYROSINE KINASE INHIBITORS
ANTINEOPLASTIC - TYROSINE KINASE INHIBITORS
BOSULIF TAB 100MG
BOSULIF TAB 500MG
CAPRELSA TAB 100MG
CAPRELSA TAB 300MG
COMETRIQ KIT 60MG
COMETRIQ KIT 100MG
COMETRIQ KIT 140MG
GILOTRIF TAB 20MG
GILOTRIF TAB 30MG
GILOTRIF TAB 40MG
GLEEVEC TAB 100MG
GLEEVEC TAB 400MG
ICLUSIG TAB 15MG
ICLUSIG TAB 45MG
IMBRUVICA CAP 140MG
INLYTA TAB 1MG
INLYTA TAB 5MG
IRESSA TAB 250MG
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
3
ST - Step Therapy
34
Drug Name
LENVIMA CAP 10MG
LENVIMA CAP 14MG
LENVIMA CAP 20MG
LENVIMA CAP 24MG
SPRYCEL TAB 20MG
SPRYCEL TAB 50MG
SPRYCEL TAB 70MG
SPRYCEL TAB 80MG
SPRYCEL TAB 100MG
SPRYCEL TAB 140MG
TARCEVA TAB 25MG
TARCEVA TAB 100MG
TARCEVA TAB 150MG
TASIGNA CAP 150MG
TASIGNA CAP 200MG
TYKERB TAB 250MG
VOTRIENT TAB 200MG
XALKORI CAP 200MG
XALKORI CAP 250MG
ZYKADIA CAP 150MG
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
ANTINEOPLASTIC ALKYLATING AGENTS - TOPICAL
ANTINEOPLASTIC ALKYLATING AGENTS - TOPICAL
VALCHLOR GEL 0.016%
3
PA
ANTINEOPLASTIC ANTIMETABOLITES - TOPICAL
ANTINEOPLASTIC ANTIMETABOLITES - TOPICAL
CARAC CRE 0.5%
EFUDEX CRE 5%
FLUOROPLEX CRE 1%
fluorouracil cre 0.5%
fluorouracil cre 5%
fluorouracil dro 2%
fluorouracil dro 5%
TOLAK CRE 4%
3
3
3
1
1
1
1
3
ANTINEOPLASTIC COMBINATIONS
ANTINEOPLASTIC COMBINATIONS
LONSURF TAB 15-6.14
LONSURF TAB 20-8.19
3
3
ANTINEOPLASTIC OR PREMALIGNANT LESION AGENT - COMB
ANTINEOPLASTIC OR PREMALIGNANT LESION AGENT - COMB
HYALUCIL-0.5 CRE
HYALUCIL-4 CRE
3
3
ANTINEOPLASTIC OR PREMALIGNANT LESIONS - TOPICAL MISC.
ANTINEOPLASTIC OR PREMALIGNANT LESIONS - TOPICAL MISC.
ST - Step Therapy
35
Drug Name
PICATO GEL 0.05%
PICATO GEL 0.015%
2
2
ANTINEOPLASTIC OR PREMALIGNANT LESIONS - TOPICAL NSAID'S
ANTINEOPLASTIC OR PREMALIGNANT LESIONS - TOPICAL NSAID'S
diclofenac gel 3%
SOLARAZE GEL 3% W/W
1
3
ANTINEOPLASTIC RETINOIDS - TOPICAL
ANTINEOPLASTIC RETINOIDS - TOPICAL
PANRETIN GEL 0.1%
3
ANTINEOPLASTICS MISC.
ANTINEOPLASTICS MISC.
ACTIMMUNE INJ 2MU/0.5
HYDREA CAP 500MG
hydroxyurea cap 500mg
INTRON A INJ 10MU
INTRON A INJ 18MU
INTRON A INJ 25MU
INTRON A INJ 50MU
MATULANE CAP 50MG
SYLATRON KIT 200MCG
SYLATRON KIT 300MCG
SYLATRON KIT 600MCG
4
0
0
4
4
4
4
0
4
4
4
PA
PA
PA
PA
PA
PA
PA
PA
ANTIPARKINSON ANTICHOLINERGICS
ANTIPARKINSON ANTICHOLINERGICS
benztropine tab 0.5mg
benztropine tab 1mg
benztropine tab 2mg
trihexyphen elx 0.4mg/ml
trihexyphen tab 2mg
trihexyphen tab 5mg
1
1
1
1
1
1
ANTIPARKINSON DOPAMINERGICS
ANTIPARKINSON DOPAMINERGICS
amantadine cap 100mg
amantadine syp 50mg/5ml
amantadine tab 100mg
bromocriptin cap 5mg
bromocriptin tab 2.5mg
PARLODEL CAP 5MG
1
1
1
1
1
2
ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS
ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS
AZILECT TAB 0.5MG
AZILECT TAB 1MG
ELDEPRYL CAP 5MG
2
2
3
ST - Step Therapy
36
Drug Name
selegiline cap 5mg
selegiline tab 5mg
ZELAPAR TAB 1.25MG
1
1
2
ANTIPERISTALTIC AGENTS
ANTIPERISTALTIC AGENTS
diphen/atrop liq 2.5/5
diphen/atrop tab 2.5mg
LOMOTIL TAB 2.5MG
MOTOFEN TAB
opium tin 1%
opium tinct tin 2mg/5ml
1
1
2
3
1
1
ANTIPROTOZOAL AGENTS
ANTIPROTOZOAL AGENTS
ALINIA SUS 100/5ML
ALINIA TAB 500MG
atovaquone sus 750/5ml
MEPRON SUS
2
2
1
3
ANTIPRURITICS - TOPICAL
ANTIPRURITICS - TOPICAL
prudoxin cre 5%
ZONALON CRE 5%
1
3
ANTIPSORIATICS
ANTIPSORIATICS
calcipotrien cre 0.005%
calcipotrien oin 0.005%
calcipotrien sol 0.005%
calcitriol oin 3mcg/gm
DOVONEX CRE 0.005%
DRITHO-CREME CRE HP 1%
SORILUX AER 0.005%
TAZORAC CRE 0.1%
TAZORAC CRE 0.05%
TAZORAC GEL 0.1%
TAZORAC GEL 0.05%
VECTICAL OIN 3MCG/GM
ZITHRANOL SHA 1%
ZITHRANOL-RR CRE 1.2%
1
1
1
1
3
3
2
2
2
2
2
3
3
3
PA
PA
PA
PA
ANTIPSORIATICS - SYSTEMIC
ANTIPSORIATICS - SYSTEMIC
acitretin cap 10mg
acitretin cap 17.5mg
acitretin cap 25mg
COSENTYX INJ 150MG/ML
1
1
1
3
PA
ST - Step Therapy
37
Drug Name
COSENTYX PEN INJ 150MG/ML
methoxsalen cap 10mg
8-MOP CAP 10MG
OXSORALEN-UL CAP 10MG
SORIATANE CAP 10MG
SORIATANE CAP 17.5MG
SORIATANE CAP 25MG
STELARA INJ 45MG/0.5
STELARA INJ 90MG/ML
3
PA
1
3
3
3
3
3
4
PA
4
PA
ANTIPSYCHOTICS - MISC.
ANTIPSYCHOTICS - MISC.
EQUETRO CAP 100MG
EQUETRO CAP 200MG
EQUETRO CAP 300MG
GEODON CAP 20MG
GEODON CAP 40MG
GEODON CAP 60MG
GEODON CAP 80MG
LATUDA TAB 20MG
LATUDA TAB 40MG
LATUDA TAB 60MG
LATUDA TAB 80MG
LATUDA TAB 120MG
ziprasidone cap 20mg
3
3
3
3
3
3
3
2
2
2
2
2
1
1
1
1
ANTIRETROVIRAL COMBINATIONS
ANTIRETROVIRAL COMBINATIONS
abacav/lamiv tab /zidovud
ATRIPLA TAB
COMBIVIR TAB 150-300
COMPLERA TAB
EPZICOM TAB 600-300
EVOTAZ TAB 300-150
KALETRA SOL
KALETRA TAB 100-25MG
KALETRA TAB 200-50MG
lamivud/zido tab 150-300
PREZCOBIX TAB 800-150
STRIBILD TAB
TRIUMEQ TAB
TRIZIVIR TAB
TRUVADA TAB 200-300
1
2
3
2
2
2
2
2
2
1
2
2
2
3
2
ST - Step Therapy
38
Drug Name
ANTIRETROVIRALS - CCR5 ANTAGONISTS (ENTRY INHIBITOR)
ANTIRETROVIRALS - CCR5 ANTAGONISTS (ENTRY INHIBITOR)
SELZENTRY TAB 150MG
SELZENTRY TAB 300MG
3
3
ANTIRETROVIRALS - FUSION INHIBITORS
ANTIRETROVIRALS - FUSION INHIBITORS
FUZEON INJ 90MG
4
PA
ANTIRETROVIRALS - INTEGRASE INHIBITORS
ANTIRETROVIRALS - INTEGRASE INHIBITORS
ISENTRESS CHW 25MG
ISENTRESS CHW 100MG
ISENTRESS POW 100MG
ISENTRESS TAB 400MG
TIVICAY TAB 50MG
VITEKTA TAB 85MG
VITEKTA TAB 150MG
2
2
2
2
2
3
3
ANTIRETROVIRALS - PROTEASE INHIBITORS
ANTIRETROVIRALS - PROTEASE INHIBITORS
APTIVUS CAP 250MG
APTIVUS SOL
CRIXIVAN CAP 200MG
CRIXIVAN CAP 400MG
INVIRASE CAP 200MG
INVIRASE TAB 500MG
LEXIVA SUS 50MG/ML
LEXIVA TAB 700MG
NORVIR CAP 100MG
NORVIR SOL 80MG/ML
NORVIR TAB 100MG
PREZISTA SUS 100MG/ML
PREZISTA TAB 75MG
PREZISTA TAB 150MG
PREZISTA TAB 600MG
PREZISTA TAB 800MG
REYATAZ CAP 150MG
REYATAZ CAP 200MG
REYATAZ CAP 300MG
REYATAZ POW 50MG
VIRACEPT TAB 250MG
VIRACEPT TAB 625MG
3
3
3
3
3
3
3
3
2
2
2
2
2
2
2
2
2
2
2
2
3
3
ANTIRETROVIRALS - RTI-NON-NUCLEOSIDE ANALOGUES
ANTIRETROVIRALS - RTI-NON-NUCLEOSIDE ANALOGUES
EDURANT TAB 25MG
2
ST - Step Therapy
39
Drug Name
INTELENCE TAB 25MG
INTELENCE TAB 100MG
INTELENCE TAB 200MG
nevirapine sus 50mg/5ml
nevirapine tab 200mg
nevirapine tab 400mg er
RESCRIPTOR TAB 100 MG
RESCRIPTOR TAB 200MG
SUSTIVA CAP 50MG
SUSTIVA CAP 200MG
SUSTIVA TAB 600MG
VIRAMUNE SUS 50MG/5ML
VIRAMUNE TAB 200MG
VIRAMUNE XR TAB 100MG
VIRAMUNE XR TAB 400MG
2
2
2
1
1
1
2
2
2
2
2
2
2
2
2
ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PURINES
ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PURINES
abacavir tab 300mg
didanosine cap 125mg
VIDEX EC CAP 125MG
VIDEX EC CAP 200MG
VIDEX EC CAP 250MG
VIDEX EC CAP 400MG
VIDEX SOL 2GM
VIDEX SOL 4GM
ZIAGEN SOL 20MG/ML
ZIAGEN TAB 300MG
1
1
1
1
1
2
2
2
2
3
3
3
3
ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PYRIMIDINES
ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PYRIMIDINES
EMTRIVA CAP 200MG
EMTRIVA SOL 10MG/ML
EPIVIR SOL 10MG/ML
EPIVIR TAB 150MG
EPIVIR TAB 300MG
lamivudine sol 10mg/ml
lamivudine tab 150mg
2
2
3
3
3
1
1
1
ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-THYMIDINES
ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-THYMIDINES
RETROVIR CAP 100MG
RETROVIR SYP 50MG/5ML
2
2
ST - Step Therapy
40
Drug Name
stavudine cap 15mg
stavudine cap 20mg
stavudine cap 30mg
stavudine cap 40mg
stavudine sol 1mg/ml
ZERIT CAP 15MG
ZERIT CAP 20MG
ZERIT CAP 30MG
ZERIT CAP 40MG
ZERIT SOL 1MG/ML
zidovudine cap 100mg
zidovudine syp 50mg/5ml
zidovudine tab 300mg
1
1
1
1
1
2
2
2
2
2
1
1
1
ANTIRETROVIRALS - RTI-NUCLEOTIDE ANALOGUES
ANTIRETROVIRALS - RTI-NUCLEOTIDE ANALOGUES
VIREAD
VIREAD
VIREAD
VIREAD
VIREAD
POW 40MG/GM
TAB 150MG
TAB 200MG
TAB 250MG
TAB 300MG
2
2
2
2
2
ANTIRETROVIRALS ADJUVANTS
ANTIRETROVIRALS ADJUVANTS
TYBOST TAB 150MG
3
ANTIRHEUMATIC - JANUS KINASE (JAK) INHIBITORS
ANTIRHEUMATIC - JANUS KINASE (JAK) INHIBITORS
XELJANZ TAB 5MG
4
PA
4
4
4
4
4
4
4
4
4
4
4
4
4
4
0
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
ANTIRHEUMATIC ANTIMETABOLITES
ANTIRHEUMATIC ANTIMETABOLITES
OTREXUP INJ 7.5/0.4
OTREXUP INJ 10MG
OTREXUP INJ 15MG
OTREXUP INJ 20MG
OTREXUP INJ 25MG
RASUVO INJ 7.5MG
RASUVO INJ 10MG
RASUVO INJ 12.5MG
RASUVO INJ 15MG
RASUVO INJ 17.5MG
RASUVO INJ 22.5MG
RASUVO INJ 25MG
RASUVO INJ 27.5MG
RASUVO INJ 30MG
RHEUMATREX TAB 2.5MG
ST - Step Therapy
41
Drug Name
ANTISEBORRHEIC COMBINATIONS
ANTISEBORRHEIC COMBINATIONS
PROMISEB KIT COMPLETE
SELENIUM SUL SHA 2.25%
SELRX SHA 2.3%
SODIUM SULFA LIQ 10% WASH
3
1
3
3
ANTISEBORRHEIC PRODUCTS
ANTISEBORRHEIC PRODUCTS
OVACE PLUS AER 9.8%
OVACE PLUS CRE 10%
OVACE PLUS GEL 10% WASH
OVACE PLUS LOT 9.8%
OVACE PLUS SHA 10%
OVACE WASH LIQ 10%
selenium sul lot 2.5%
sod sulfacet gel 10%
sod sulfacet sha 10%
sodium sulfa liq 10% wash 10%
TERSI FOAM AER 2.25%
3
3
3
3
3
3
1
1
1
1
3
ANTISEPTIC COMBINATIONS - MOUTH/THROAT
ANTISEPTIC COMBINATIONS - MOUTH/THROAT
DEBACTEROL SOL 30-50%
3
ANTISEPTICS DISINFECTANTS
ANTISEPTICS DISINFECTANTS
forma-ray sol 20%
formadon sol
GLUTARALDEHY SOL 25%
hydrogen per sol 30%
KERR TRIPLE MIS DYE SWAB
triple dye liq
1
1
3
1
3
1
ANTISEPTICS - MOUTH/THROAT
ANTISEPTICS - MOUTH/THROAT
chlorhex glu sol 0.12%
PERIDEX SOL 0.12%
1
3
ANTISPASMODICS
ANTISPASMODICS
BENTYL CAP 10MG
BENTYL TAB 20MG
dicyclomine cap 10mg
dicyclomine sol 10mg/5ml
dicyclomine tab 20mg
2
2
1
1
1
ANTITHYROID AGENTS
ANTITHYROID AGENTS
ST - Step Therapy
42
Drug Name
methimazole tab 5mg
methimazole tab 10mg
propylthiour tab 50mg
TAPAZOLE TAB 5MG
TAPAZOLE TAB 10MG
1
1
1
2
2
ANTITUSSIVE - NONNARCOTIC
ANTITUSSIVE - NONNARCOTIC
benzonatate cap 100mg
TESSALON PER CAP 100MG
ZONATUSS CAP 150MG
1
1
1
2
3
ANTITUSSIVE - OPIOID
ANTITUSSIVE - OPIOID
hydroc/homat tab 5-1.5mg
hydrocod/hom syp 5-1.5/5
1
1
ANTITUSSIVE-EXPECTORANT
ANTITUSSIVE-EXPECTORANT
FLOWTUSS SOL 2.5-200
gg/codeine sol 100-10/5
NORTUSS-EX LIQ 200-20/5
3
3
3
ANTITUSSIVE-EXPECTORANTS-ANTIHISTAMINE
ANTITUSSIVE-EXPECTORANTS-ANTIHISTAMINE
TUSNEL CAP
3
ANTITUSSIVE-EXPECTORANTS-DECONGESTANT
ANTITUSSIVE-EXPECTORANTS-DECONGESTANT
GILTUSS LIQ PED-C
HYCOFENIX SOL
SUTTAR-SF SYP
TGQ 30/ SYP 150/15
3
3
3
3
ANTIVIRAL TOPICAL COMBINATIONS
ANTIVIRAL TOPICAL COMBINATIONS
XERESE CRE 5-1%
3
ANTIVIRALS - TOPICAL
ANTIVIRALS - TOPICAL
acyclovir oin 5%
DENAVIR CRE 1%
ZOVIRAX CRE 5%
ZOVIRAX OIN 5%
1
2
3
3
APPLICATORS,COTTON BALLS,ETC
APPLICATORS,COTTON BALLS,ETC
ALCOHOL SWAB PAD
0
ST - Step Therapy
43
Drug Name
AROMATASE INHIBITORS
AROMATASE INHIBITORS
anastrozole tab 1mg
ARIMIDEX TAB 1MG
AROMASIN TAB 25MG
exemestane tab 25mg
FEMARA TAB 2.5MG
letrozole tab 2.5mg
0
0
0
0
0
0
ARTIFICIAL TEAR INSERTS
ARTIFICIAL TEAR INSERTS
LACRISERT MIS 5MG OP
3
ASTRINGENTS
ASTRINGENTS
XERAC-AC SOL 6.25%
3
AZITHROMYCIN
AZITHROMYCIN
azithromycin pow 1gm pak
azithromycin sus 100/5ml
azithromycin sus 200/5ml
azithromycin tab 250mg
ZITHROMAX POW 1GM PAK
ZITHROMAX SUS 100/5ML
ZITHROMAX SUS 200/5ML
ZITHROMAX TAB 250MG
ZITHROMAX TAB 500MG
ZITHROMAX TAB 600MG
ZMAX SUS 2GM
1
1
1
1
1
1
3
3
3
3
3
3
3
BARBITURATE HYPNOTICS
BARBITURATE HYPNOTICS
BUTISOL SOD TAB 30MG
BUTISOL SOD TAB 50MG
phenobarb elx 20mg/5ml
phenobarb tab 15mg
phenobarb tab 16.2mg
phenobarb tab 30mg
phenobarb tab 60mg
phenobarb tab 100mg
SECONAL CAP 100MG
3
3
1
1
1
1
1
1
1
1
1
3
ST - Step Therapy
44
Drug Name
BASES
BASES
NA HYDROXIDE SOL 10%
POT HYDROXID SOL 5%
3
3
BELLADONNA ALKALOIDS
BELLADONNA ALKALOIDS
ANASPAZ TAB 0.125MG
ed-spaz tab 0.125mg
hyoscyamine dro 0.125/ml
hyoscyamine elx 0.125/5
hyoscyamine sub 0.125mg
hyoscyamine tab 0.125mg
hyoscyamine tab 0.375 er
LEVBID TAB 0.375 ER
LEVSIN TAB 0.125MG
LEVSIN/SL SUB 0.125MG
SYMAX DUOTAB TAB
2
1
1
1
1
1
1
2
2
2
3
BENZATHIAZOLES
BENZATHIAZOLES
RILUTEK TAB 50MG
riluzole tab 50mg
3
1
BENZISOXAZOLES
BENZISOXAZOLES
FANAPT PAK
FANAPT TAB 1MG
FANAPT TAB 2MG
FANAPT TAB 4MG
FANAPT TAB 6MG
FANAPT TAB 8MG
FANAPT TAB 10MG
FANAPT TAB 12MG
INVEGA TAB 1.5MG
INVEGA TAB 3MG
INVEGA TAB 6MG
INVEGA TAB 9MG
paliperidone tab er 1.5mg
paliperidone tab er 3mg
RISPERDAL M TAB 0.5MG
RISPERDAL M TAB 1MG
RISPERDAL M TAB 2MG
RISPERDAL M TAB 3MG
RISPERDAL M TAB 4MG
3
3
3
3
3
3
3
3
3
3
3
3
1
1
1
1
3
3
3
3
3
ST - Step Therapy
45
Drug Name
RISPERDAL SOL 1MG/ML
RISPERDAL TAB 0.5MG
RISPERDAL TAB 0.25MG
RISPERDAL TAB 1MG
RISPERDAL TAB 2MG
RISPERDAL TAB 3MG
RISPERDAL TAB 4MG
risperidone sol 1mg/ml
risperidone tab 0.5mg
risperidone tab 0.5mg od
risperidone tab 0.25 odt
risperidone tab 0.25mg
risperidone tab 1mg
risperidone tab 1mg odt
risperidone tab 2mg
risperidone tab 3mg
risperidone tab 4mg
3
3
3
3
3
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
BENZODIAZEPINE HYPNOTIC-NUTRITIONAL SUPPLEMENT COMB
BENZODIAZEPINE HYPNOTIC-NUTRITIONAL SUPPLEMENT COMB
STRAZEPAM PAK
3
BENZODIAZEPINE HYPNOTICS
BENZODIAZEPINE HYPNOTICS
DORAL TAB 15MG
estazolam tab 1mg
estazolam tab 2mg
flurazepam cap 15mg
flurazepam cap 30mg
HALCION TAB 0.25MG
quazepam tab 15mg
RESTORIL CAP 7.5MG
RESTORIL CAP 15MG
RESTORIL CAP 22.5MG
RESTORIL CAP 30MG
temazepam cap 7.5mg
temazepam cap 15mg
temazepam cap 22.5mg
temazepam cap 30mg
triazolam tab 0.25mg
triazolam tab 0.125mg
3
1
1
1
1
3
1
3
3
3
3
1
1
1
1
1
1
BENZODIAZEPINE-NUTRITIONAL SUPPLEMENT COMBINATIONS
BENZODIAZEPINE-NUTRITIONAL SUPPLEMENT COMBINATIONS
ST - Step Therapy
46
Drug Name
GABAVALE-5 PAK
GABAZOLAMINE PAK
GABAZOLAMINE PAK 0.5MG
3
3
3
BENZODIAZEPINES
BENZODIAZEPINES
ALPRAZOLAM CON 1 MG/ML
alprazolam tab 0.5mg
alprazolam tab 0.5mg er
alprazolam tab 0.5mg od
alprazolam tab 0.25 odt
alprazolam tab 0.25mg
alprazolam tab 1mg
alprazolam tab 1mg er
alprazolam tab 1mg odt
alprazolam tab 2mg
alprazolam tab 2mg odt
ATIVAN TAB 0.5MG
ATIVAN TAB 1MG
ATIVAN TAB 2MG
chlordiazep cap 5mg
chlordiazep cap 10mg
chlordiazep cap 25mg
cloraz dipot tab 3.75mg
cloraz dipot tab 7.5mg
cloraz dipot tab 15mg
diazepam con 5mg/ml
diazepam sol 1mg/ml
diazepam tab 2mg
diazepam tab 5mg
diazepam tab 10mg
lorazepam con 2mg/ml
lorazepam tab 0.5mg
lorazepam tab 1mg
lorazepam tab 2mg
NIRAVAM TAB 0.25MG
oxazepam cap 10mg
oxazepam cap 15mg
oxazepam cap 30mg
TRANXENE T TAB 3.75MG
TRANXENE T TAB 7.5MG
TRANXENE T TAB 15MG
VALIUM TAB 2MG
3
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
1
1
1
3
3
3
2
ST - Step Therapy
47
Drug Name
VALIUM TAB 5MG
VALIUM TAB 10MG
XANAX TAB 0.5MG
XANAX TAB 0.25MG
XANAX TAB 1MG
XANAX TAB 2MG
XANAX XR TAB 0.5MG
XANAX XR TAB 1MG
XANAX XR TAB 2MG
XANAX XR TAB 3MG
2
2
2
2
2
2
3
3
3
3
BENZODIAZEPINES TRICYCLIC AGENTS
BENZODIAZEPINES TRICYCLIC AGENTS
cdp/amitrip tab 5-12.5mg
cdp/amitrip tab 10-25mg
1
1
BETA ADRENERGICS
BETA ADRENERGICS
albuterol neb 0.5%
albuterol neb 0.63mg/3
albuterol neb 0.083%
albuterol neb 1.25mg/3
albuterol syp 2mg/5ml
albuterol tab 2mg
albuterol tab 4mg
albuterol tab 4mg er
albuterol tab 8mg er
ARCAPTA CAP 75MCG
BROVANA NEB 15MCG
FORADIL CAP AEROLIZE
levalbuterol neb 0.31mg
levalbuterol neb 1.25/0.5
metaproteren syp 10mg/5ml
metaproteren tab 10mg
metaproteren tab 20mg
PERFOROMIST NEB 20MCG
PROAIR RESPI AER
PROVENTIL AER HFA
SEREVENT DIS AER 50MCG
STRIVERDI AER RESPIMAT
terbutaline tab 2.5mg
terbutaline tab 5mg
VOSPIRE ER TAB 4MG
VOSPIRE ER TAB 8MG
1
1
1
1
1
1
1
1
1
2
3
2
1
1
1
1
1
1
1
2
3
3
2
3
1
1
2
2
PA
ST - Step Therapy
48
Drug Name
XOPENEX CONC NEB 1.25/0.5
XOPENEX HFA AER
XOPENEX NEB 0.31MG
XOPENEX NEB 0.63MG
XOPENEX NEB 1.25/3ML
3
3
PA
3
3
3
BETA BLOCKER DIURETIC COMBINATIONS
BETA BLOCKER DIURETIC COMBINATIONS
atenol/chlor tab 50-25mg
atenol/chlor tab 100-25mg
bisoprl/hctz tab 2.5/6.25
bisoprl/hctz tab 5-6.25mg
bisoprl/hctz tab 10/6.25
CORZIDE TAB 40-5MG
CORZIDE TAB 80-5MG
DUTOPROL TAB 25-12.5
LOPRESS HCT TAB 50-25MG
LOPRESS HCT TAB 100-25MG
metoprl/hctz tab 50-25mg
nadolol/bend tab 40-5mg
nadolol/bend tab 80-5mg
propran/hctz tab 40/25
propran/hctz tab 80/25
TENORETIC TAB 50
TENORETIC TAB 100
ZIAC TAB 2.5/6.25
ZIAC TAB 5-6.25MG
ZIAC TAB 10/6.25
1
1
1
1
1
3
3
3
3
3
2
2
1
1
1
1
1
1
1
2
2
2
2
2
BETA BLOCKER-NUTRITIONAL SUPPLEMENT COMBINATIONS
BETA BLOCKER-NUTRITIONAL SUPPLEMENT COMBINATIONS
HYPERTENSOLO PAK
3
BETA BLOCKERS CARDIO-SELECTIVE
BETA BLOCKERS CARDIO-SELECTIVE
acebutolol cap 200mg
acebutolol cap 400mg
atenolol tab 25mg
atenolol tab 50mg
atenolol tab 100mg
betaxolol tab 10mg
betaxolol tab 20mg
bisoprol fum tab 5mg
1
1
1
1
1
1
1
1
ST - Step Therapy
49
Drug Name
bisoprol fum tab 10mg
BYSTOLIC TAB 2.5MG
BYSTOLIC TAB 5MG
BYSTOLIC TAB 10MG
BYSTOLIC TAB 20MG
KERLONE TAB 10MG
KERLONE TAB 20MG
LOPRESSOR TAB 50MG
LOPRESSOR TAB 100MG
metoprol tar tab 25mg
metoprolol tab 25mg er
SECTRAL CAP 200MG
SECTRAL CAP 400MG
TENORMIN TAB 25MG
TENORMIN TAB 50MG
TENORMIN TAB 100MG
TOPROL XL TAB 25MG
TOPROL XL TAB 50MG
TOPROL XL TAB 100MG
TOPROL XL TAB 200MG
ZEBETA TAB 5MG
ZEBETA TAB 10MG
1
2
2
2
2
3
3
3
3
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
3
3
BETA BLOCKERS NON-SELECTIVE
BETA BLOCKERS NON-SELECTIVE
BETAPACE AF TAB 80MG
BETAPACE TAB 80MG
BETAPACE TAB 120MG
BETAPACE TAB 160MG
CORGARD TAB 20MG
CORGARD TAB 40MG
CORGARD TAB 80MG
HEMANGEOL SOL 4.28/ML
INDERAL LA CAP 60MG
INDERAL LA CAP 80MG
INDERAL LA CAP 120MG
INDERAL LA CAP 160MG
INNOPRAN XL CAP 80MG
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
ST - Step Therapy
50
Drug Name
INNOPRAN XL CAP 120MG
LEVATOL TAB 20MG
nadolol tab 20mg
nadolol tab 40mg
nadolol tab 80mg
pindolol tab 5mg
pindolol tab 10mg
propranolol cap 60mg er
propranolol sol 20mg/5ml
propranolol sol 40mg/5ml
propranolol tab 10mg
sotalol af tab 80mg
sotalol af tab 120mg
sotalol af tab 160mg
sotalol hcl tab 80mg
SOTYLIZE SOL 5MG/ML
timolol mal tab 5mg
timolol mal tab 10mg
timolol mal tab 20mg
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
1
1
1
BETA-BLOCKERS - OPHTHALMIC
BETA-BLOCKERS - OPHTHALMIC
BETAGAN SOL 0.5% OP
betaxolol sol 0.5% op
BETIMOL SOL 0.5%
BETIMOL SOL 0.25%
BETOPTIC-S SUS 0.25% OP
carteolol sol 1% op
ISTALOL SOL 0.5% OP
levobunolol sol 0.5% op
levobunolol sol 0.25% op
metipranolol sol 0.3% oph
timolol gel sol 0.5% op
timolol gel sol 0.25% op
timolol mal sol 0.5% op
3
1
2
2
2
1
3
1
1
1
1
1
1
ST - Step Therapy
51
Drug Name
timolol mal sol 0.25% op
TIMOPTIC OCU SOL 0.5% OP
TIMOPTIC OCU SOL 0.25% OP
TIMOPTIC SOL 0.5% OP
TIMOPTIC SOL 0.25% OP
TIMOPTIC-XE SOL 0.5% OP
TIMOPTIC-XE SOL 0.25% OP
1
3
3
3
3
3
3
BETA-BLOCKERS - OPHTHALMIC COMBINATIONS
BETA-BLOCKERS - OPHTHALMIC COMBINATIONS
COMBIGAN SOL 0.2/0.5%
COSOPT PF SOL
COSOPT SOL 22.3-6.8
dorzol/timol sol 22.3-6.8
2
2
3
1
BIGUANIDE-NUTRITIONAL SUPPLEMENT COMBINATIONS
BIGUANIDE-NUTRITIONAL SUPPLEMENT COMBINATIONS
APPFORMIN PAK
3
BIGUANIDES
BIGUANIDES
FORTAMET TAB 500MG
FORTAMET TAB 1000MG
GLUCOPHAGE TAB 500MG
GLUCOPHAGE TAB 500MG XR
GLUCOPHAGE TAB 750MG XR
GLUMETZA TAB 500MG
GLUMETZA TAB 1000MG
metformin er tab 1000mg
metformin tab 500mg
metformin tab 500mg er
metformin tab 750mg er
metformin tab 850mg
metformin tab 1000mg
RIOMET SOL
3
3
3
3
3
3
3
3
3
1
1
1
1
1
1
3
PA
PA
PA
PA
PA
BILE ACID SEQUESTRANTS
BILE ACID SEQUESTRANTS
cholestyram pow 4gm
cholestyram pow 4gm lite
COLESTID GRA 5GM
COLESTID POW 5GM
COLESTID TAB 1GM
colestipol gra 5gm
colestipol tab 1gm
QUESTRAN POW 4GM
1
1
3
3
3
1
1
3
ST - Step Therapy
52
Drug Name
QUESTRAN POW 4GM LITE
WELCHOL PAK 3.75GM
WELCHOL TAB 625MG
3
2
2
BILE ACID SYNTHESIS DISORDER AGENTS
BILE ACID SYNTHESIS DISORDER AGENTS
CHOLBAM CAP 50MG
CHOLBAM CAP 250MG
3
3
BIPHASIC CONTRACEPTIVES - ORAL
BIPHASIC CONTRACEPTIVES - ORAL
deso/ethinyl tab estradio
LO LOESTRIN TAB
MIRCETTE TAB 28 DAY
NECON TAB 10/11-28
0
0
2
0
BISPHOSPHONATES
BISPHOSPHONATES
ACTONEL TAB 5MG
ACTONEL TAB 30MG
ACTONEL TAB 35MG
ACTONEL TAB 150MG
alendronate sol 70/75ml
alendronate tab 5mg
alendronate tab 10mg
ATELVIA TAB
BINOSTO TAB 70MG
BONIVA TAB 150MG
etidron disd tab 200mg
etidron disd tab 400mg
FOSAMAX + D TAB 70-2800
FOSAMAX + D TAB 70-5600
FOSAMAX TAB 70MG
ibandronate tab 150mg
risedron sod tab 35mg dr
risedronate tab 5mg
risedronate tab 30mg
2
2
2
2
1
1
1
1
1
1
2
3
3
1
1
3
3
3
1
1
1
1
1
1
BOWEL EVACUANT COMBINATIONS
BOWEL EVACUANT COMBINATIONS
COLYTE/FLAVR SOL PACKS
gavilyte-c sol
gavilyte-h kit
3
1
0
ST - Step Therapy
53
Drug Name
GOLYTELY SOL
MOVIPREP SOL
NULYTELY SOL FLAV PKS
PCP 100 KIT
peg-3350 sol electrol
peg-3350/kcl sol /sodium
PREPOPIK PAK
SUPREP BOWEL SOL PREP
3
0
3
3
1
1
0
0
BRADYKININ B2 RECEPTOR ANTAGONISTS
BRADYKININ B2 RECEPTOR ANTAGONISTS
FIRAZYR INJ 30MG/3ML
4
PA
BRONCHODILATORS - ANTICHOLINERGICS
BRONCHODILATORS - ANTICHOLINERGICS
ATROVENT HFA AER 17MCG
INCRUSE ELPT INH 62.5MCG
ipratropium sol 0.02%inh
SPIRIVA AER RESPIMAT
SPIRIVA CAP HANDIHLR
SPIRIVA SPR RESPIMAT
TUDORZA PRES AER 400/ACT
3
3
1
2
2
2
3
BURN PRODUCTS
BURN PRODUCTS
SILVADENE CRE 1%
silver sulfa cre 1%
SULFAMYLON CRE 85MG/GM
SULFAMYLON PAK 5%
2
1
3
3
BUTYROPHENONES
BUTYROPHENONES
haloperidol
haloperidol
haloperidol
haloperidol
haloperidol
haloperidol
haloperidol
con 2mg/ml
tab 0.5mg
tab 1mg
tab 2mg
tab 5mg
tab 10mg
tab 20mg
1
1
1
1
1
1
1
C1 INHIBITORS
C1 INHIBITORS
BERINERT INJ 500UNIT
CINRYZE SOL 500 UNIT
RUCONEST INJ 2100UNIT
4
3
3
PA
PA
PA
4
PA
CALCIMIMETIC AGENTS
CALCIMIMETIC AGENTS
SENSIPAR TAB 30MG
ST - Step Therapy
54
Drug Name
SENSIPAR TAB 60MG
SENSIPAR TAB 90MG
4
PA
4
PA
CALCITONINS
CALCITONINS
calcitonin spr 200/act
FORTICAL SPR 200/ACT
MIACALCIN INJ 200/ML
MIACALCIN SPR 200/ACT
1
3
2
3
CALCIUM CHANNEL BLOCKER HMG COA REDUCTASE INHIBIT COMB
CALCIUM CHANNEL BLOCKER HMG COA REDUCTASE INHIBIT COMB
amlod/atorva tab 2.5-10mg
amlod/atorva tab 5-10mg
CADUET TAB 2.5-10MG
CADUET TAB 2.5-20MG
CADUET TAB 2.5-40MG
CADUET TAB 5-10MG
CADUET TAB 5-20MG
CADUET TAB 5-40MG
CADUET TAB 5-80MG
CADUET TAB 10-10MG
CADUET TAB 10-20MG
CADUET TAB 10-40MG
CADUET TAB 10-80MG
1
1
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
3
3
CALCIUM CHANNEL BLOCKER-NUTRITIONAL SUPPLEMENT COMB
CALCIUM CHANNEL BLOCKER-NUTRITIONAL SUPPLEMENT COMB
HYPERTENIPIN PAK 2.5MG
3
CALCIUM CHANNEL BLOCKERS
CALCIUM CHANNEL BLOCKERS
ADALAT CC TAB 30MG ER
amlodipine tab 2.5mg
amlodipine tab 5mg
amlodipine tab 10mg
CALAN SR TAB 120MG
3
3
3
1
1
1
3
ST - Step Therapy
55
Drug Name
CALAN SR TAB 180MG
CALAN SR TAB 240MG
CALAN TAB 80MG
CALAN TAB 120MG
CARDIZEM CD CAP 120MG/24
CARDIZEM LA TAB 120MG
CARDIZEM LA TAB 300MG/24
CARDIZEM LA TAB 420MG/24
CARDIZEM TAB 30MG
CARDIZEM TAB 60MG
CARDIZEM TAB 120MG
diltiazem cap 60mg er
diltiazem cap 120mg/24
diltiazem tab 30mg
diltiazem tab 60mg
diltiazem tab 90mg
diltiazem tab 120mg
felodipine tab 2.5mg er
felodipine tab 5mg er
felodipine tab 10mg er
isradipine cap 2.5mg
isradipine cap 5mg
matzim la tab 180mg/24
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
ST - Step Therapy
56
Drug Name
nicardipine cap 20mg
nicardipine cap 30mg
nifediac cc tab 60mg er
nifedical xl tab 30mg
nifedical xl tab 60mg
nifedipine cap 10mg
nifedipine cap 20mg
nifedipine tab 30mg er
nifedipine tab 90mg er
nimodipine cap 30mg
nisoldipine tab 8.5mg er
nisoldipine tab 17mg er
nisoldipine tab 20mg
nisoldipine tab 25.5mg
nisoldipine tab 34mg er
NORVASC TAB 2.5MG
NORVASC TAB 5MG
NORVASC TAB 10MG
NYMALIZE SOL 60/20ML
PROCARDIA CAP 10MG
PROCARDIA XL TAB 30MG CR
SULAR TAB 8.5MG
SULAR TAB 17MG
SULAR TAB 34MG
TIAZAC CAP 120MG/24
TIAZAC CAP 180MG/24
TIAZAC CAP 240MG/24
TIAZAC CAP 300MG/24
TIAZAC CAP 360MG/24
TIAZAC CAP 420MG/24
verapamil cap 100mg er
verapamil cap 360mg sr
verapamil tab 40mg
verapamil tab 80mg
verapamil tab 120mg
verapamil tab 120mg er
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
PA
3
PA
3
PA
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
1
1
1
1
1
1
1
1
1
1
ST - Step Therapy
57
Drug Name
VERELAN CAP 120MG SR
VERELAN PM CAP 100MG ER
1
1
3
3
3
3
3
3
3
CARBAMATES
CARBAMATES
felbamate sus 600/5ml
felbamate tab 400mg
felbamate tab 600mg
FELBATOL SUS 600/5ML
FELBATOL TAB 400MG
FELBATOL TAB 600MG
1
1
1
3
3
3
CARBONIC ANHYDRASE INHIBITORS
CARBONIC ANHYDRASE INHIBITORS
acetazolamid cap 500mg er
acetazolamid tab 125mg
acetazolamid tab 250mg
DIAMOX SEQUE CAP 500MG CR
KEVEYIS TAB 50MG
methazolamid tab 25mg
methazolamid tab 50mg
NEPTAZANE TAB 25MG
NEPTAZANE TAB 50MG
1
1
1
2
3
1
1
3
3
CARDIAC GLYCOSIDES
CARDIAC GLYCOSIDES
digoxin sol 50mcg/ml
digoxin tab 0.25mg
digoxin tab 0.125mg
LANOXIN TAB 0.25MG
LANOXIN TAB 0.125MG
LANOXIN TAB 0.0625MG
LANOXIN TAB 0.1875MG
1
1
1
2
2
2
2
CARNITINE REPLENISHER - AGENTS
CARNITINE REPLENISHER - AGENTS
CARNITOR SOL 1GM/10ML
CARNITOR TAB 330MG
levocarnitin sol 1gm/10ml
levocarnitin tab 330mg
2
2
1
1
ST - Step Therapy
58
Drug Name
CAUTERIZING AGENT COMBINATIONS
CAUTERIZING AGENT COMBINATIONS
ARZOL SILVER MIS NITR APP
grafco silvr mis nit appl
3
1
CAUTERIZING AGENTS
CAUTERIZING AGENTS
SILVER NITRA OIN 10%
SILVER NITRA SOL 0.5%
SILVER NITRA SOL 10%
TRI-CHLOR LIQ 80%
3
3
3
3
3
3
CENTRAL MUSCLE RELAXANTS
CENTRAL MUSCLE RELAXANTS
AMRIX CAP 15MG
AMRIX CAP 30MG
baclofen tab 10mg
baclofen tab 20mg
carisoprodol tab 250mg
carisoprodol tab 350mg
chlorzoxazon tab 500mg
cyclobenzapr tab 5mg
cyclobenzapr tab 7.5mg
cyclobenzapr tab 10mg
FEXMID TAB 7.5MG
LORZONE TAB 375MG
LORZONE TAB 750MG
metaxalone tab 400mg
metaxalone tab 800mg
methocarbam tab 500mg
methocarbam tab 750mg
orphenadrine tab 100mg er
PARAFON FORT TAB 500MG
ROBAXIN TAB 500MG
ROBAXIN-750 TAB 750MG
SKELAXIN TAB 800MG
SOMA TAB 250MG
SOMA TAB 350MG
TABRADOL SUS 1MG/ML
tizanidine cap 2mg
tizanidine cap 4mg
tizanidine cap 6mg
tizanidine tab 2mg
tizanidine tab 4mg
3
3
1
1
1
1
1
1
1
1
3
3
3
1
1
1
1
1
2
2
2
2
3
3
3
1
1
1
1
1
PA
PA
ST - Step Therapy
59
Drug Name
ZANAFLEX CAP
ZANAFLEX CAP
ZANAFLEX CAP
ZANAFLEX TAB
2MG
4MG
6MG
4MG
3
3
3
2
CENTRAL/PERIPHERAL COMT INHIBITORS
CENTRAL/PERIPHERAL COMT INHIBITORS
TASMAR TAB 100MG
tolcapone tab 100mg
3
1
CEPHALOSPORINS - 1ST GENERATION
CEPHALOSPORINS - 1ST GENERATION
cefadroxil cap 500mg
cefadroxil sus 250/5ml
cefadroxil sus 500/5ml
cefadroxil tab 1gm
cephalexin cap 250mg
cephalexin sus 125/5ml
cephalexin sus 250/5ml
cephalexin tab 250mg
cephalexin tab 500mg
KEFLEX CAP 250MG
KEFLEX CAP 500MG
KEFLEX CAP 750MG
1
1
1
1
1
1
1
1
1
1
1
3
3
3
CEPHALOSPORINS - 2ND GENERATION
CEPHALOSPORINS - 2ND GENERATION
cefaclor cap 250mg
cefaclor cap 500mg
CEFACLOR ER TAB 500MG
cefaclor sus 125/5ml
cefprozil sus 125/5ml
cefprozil sus 250/5ml
cefprozil tab 250mg
cefprozil tab 500mg
CEFTIN SUS 125/5ML
CEFTIN SUS 250/5ML
CEFTIN TAB 250MG
CEFTIN TAB 500MG
cefuroxime tab 250mg
cefuroxime tab 500mg
1
1
3
1
1
1
1
1
1
1
3
3
3
3
1
1
CEPHALOSPORINS - 3RD GENERATION
CEPHALOSPORINS - 3RD GENERATION
ST - Step Therapy
60
Drug Name
CEDAX CAP 400MG
CEDAX SUS 90MG/5ML
CEDAX SUS 180/5ML
cefdinir cap 300mg
cefdinir sus 125/5ml
cefdinir sus 250/5ml
cefditoren tab 200mg
cefditoren tab 400mg
cefixime sus 100/5ml
cefixime sus 200/5ml
cefpodo prox sus 50mg/5ml
cefpodo prox sus 100/5ml
cefpodoxime tab 100mg
cefpodoxime tab 200mg
ceftibuten cap 400mg
ceftibuten sus 180/5ml
SPECTRACEF TAB 200MG
SPECTRACEF TAB 400MG
SUPRAX CAP 400MG
SUPRAX CHW 100MG
SUPRAX CHW 200MG
SUPRAX SUS 100/5ML
SUPRAX SUS 200/5ML
SUPRAX SUS 500/5ML
3
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
3
3
2
2
2
2
2
2
CERVICAL CAPS
CERVICAL CAPS
FEMCAP MIS 26MM
FEMCAP MIS 30MM
PRENTIF MIS 22MM
PRENTIF MIS 25MM
PRENTIF MIS 28MM
PRENTIF MIS 31MM
PRENTIF MIS FITTING
0
0
0
0
0
0
0
CFTR POTENTIATORS
CFTR POTENTIATORS
KALYDECO PAK 50MG
KALYDECO PAK 75MG
KALYDECO TAB 150MG
4
4
4
PA
PA
PA
CHELATING AGENTS
CHELATING AGENTS
CUPRIMINE CAP 250MG
DEPEN TITRA TAB 250MG
SYPRINE CAP 250MG
3
3
3
CHLORINE ANTISEPTICS
ST - Step Therapy
61
Drug Name
CHLORINE ANTISEPTICS
ANASEPT SPR
BENZALKONIUM SOL 50%
CHLORHEX GLU SOL 20%
3
3
3
CHOLINOMIMETICS - ACHE INHIBITORS
CHOLINOMIMETICS - ACHE INHIBITORS
ARICEPT TAB 5MG
ARICEPT TAB 10MG
ARICEPT TAB 23MG
donepezil tab 5mg
donepezil tab 5mg odt
donepezil tab 10mg
donepezil tab 10mg odt
donepezil tab hcl 23mg
EXELON CAP 1.5MG
EXELON CAP 3MG
EXELON CAP 4.5MG
EXELON CAP 6MG
EXELON DIS 4.6MG/24
EXELON DIS 9.5MG/24
EXELON DIS 13.3/24
galantamine cap 8mg er
galantamine sol 4mg/ml
galantamine tab 4mg
galantamine tab 8mg
galantamine tab 12mg
RAZADYNE ER CAP 8MG
RAZADYNE ER CAP 16MG
RAZADYNE ER CAP 24MG
RAZADYNE TAB 4MG
RAZADYNE TAB 8MG
RAZADYNE TAB 12MG
rivastigmine cap 1.5mg
rivastigmine cap 3mg
rivastigmine cap 4.5mg
rivastigmine cap 6mg
rivastigmine dis 4.6mg/24
rivastigmine dis 9.5mg/24
rivastigmine dis 13.3/24
3
3
3
1
1
1
1
1
3
3
3
3
2
2
2
1
1
1
1
1
1
1
3
3
3
3
3
3
1
1
1
1
1
1
1
CITRATES
CITRATES
citric acid/ sol sod citr
1
ST - Step Therapy
62
Drug Name
cytra-3 syp
k citrate sol citr acd
ORACIT SOL
pot citrate tab 540mg er
pot citrate tab 1080mg
pot citrate tab 1620mg
SHOHLS SOL MODIFIED
taron gra crystals
tricitrates sol
UROCIT-K 5 TAB
UROCIT-K 10 TAB
UROCIT-K 15 TAB
1
1
3
1
1
1
3
1
1
2
2
2
CLARITHROMYCIN
CLARITHROMYCIN
BIAXIN SUS 250/5ML
BIAXIN TAB 250MG
BIAXIN TAB 500MG
clarithromyc sus 125/5ml
clarithromyc sus 250/5ml
clarithromyc tab 250mg
clarithromyc tab 500mg
clarithromyc tab 500mg er
3
3
3
1
1
1
1
1
CMV AGENTS
CMV AGENTS
VALCYTE SOL 50MG/ML
VALCYTE TAB 450MG
valganciclov tab 450mg
2
2
1
COBALAMINS
COBALAMINS
NASCOBAL SPR 500MCG
3
CODEINE COMBINATIONS
CODEINE COMBINATIONS
apap/codeine sol 120-12/5
apap/codeine tab 300-15mg
but/apap/caf cap codeine
but/asa/caf/ cap cod 30mg
CAPITAL/COD SUS 120-12/5
FIORICET CAP CODEINE
FIORINAL/COD CAP 30MG
TYLENOL/COD TAB #3
TYLENOL/COD TAB #4
1
1
1
1
1
1
3
3
3
3
3
ST - Step Therapy
63
Drug Name
CODEINE-NUTRITIONAL SUPPLEMENT COMBINATIONS
CODEINE-NUTRITIONAL SUPPLEMENT COMBINATIONS
THERACODEINE PAK -300
3
COLORING AGENTS
COLORING AGENTS
FOOD COLOR LIQ BLUE
3
COMBINATION CONTRACEPTIVES - ORAL
COMBINATION CONTRACEPTIVES - ORAL
apri tab
balziva tab
BEYAZ TAB
cryselle-28 tab 28 tabs
DESOGEN-28 TAB
drospir/ethi tab 3-0.03mg
FALESSA KIT
FEMCON FE CHW
GENERESS FE CHW
gianvi tab 3-0.02mg
junel 1.5/30 tab
junel fe 24 tab 1/20
junel fe tab 1.5/30
kelnor tab 1/35
levonor/ethi tab 0.1-0.02
levonor/ethi tab estradio
LOESTRIN 21 TAB 1.5/30
LOESTRIN FE TAB 1.5/30
LOESTRIN FE TAB 1/20
LOESTRIN TAB 1/20-21
MINASTRIN 24 CHW FE
MODICON TAB 0.5/35
necon tab 1/50-28
noreth/ethin chw fe
noreth/ethin tab 1/20
noreth/ethin tab fe 1/20
NORINYL TAB 1+50-28
nortrel tab 0.5/35
nortrel tab 1/35
ogestrel tab
ORTHO-CYCLEN TAB 0.25/35
ORTHO-NOVUM TAB 1/35
OVCON-35 TAB
SAFYRAL TAB
sprintec 28 tab 28 day
YASMIN 28 TAB 3-0.03MG
0
0
0
0
3
0
0
3
3
0
0
0
0
0
0
0
3
3
3
3
0
3
0
0
0
0
3
0
0
0
3
3
3
0
0
3
ST - Step Therapy
64
Drug Name
YAZ TAB 3-0.02MG
zenchent fe chw 0.4mg-35
zovia 1/50e tab
3
0
0
COMBINATION CONTRACEPTIVES - TRANSDERMAL
COMBINATION CONTRACEPTIVES - TRANSDERMAL
xulane dis 150-35
0
COMBINATION CONTRACEPTIVES - VAGINAL
COMBINATION CONTRACEPTIVES - VAGINAL
NUVARING MIS
0
CONDOMS - FEMALE
CONDOMS - FEMALE
FC FEMALE MIS CONDOM
0
CONTINUOUS CONTRACEPTIVES - ORAL
CONTINUOUS CONTRACEPTIVES - ORAL
amethyst tab 90-20mcg
0
CORTICOSTEROIDS - TOPICAL
CORTICOSTEROIDS - TOPICAL
ACLOVATE CRE 0.05%
ADV ALLERGY KIT COLLECTI
ALA SCALP LOT 2%
alclometason cre 0.05%
alclometason oin 0.05%
alphatrex gel 0.05%
amcinonide cre 0.1%
amcinonide lot 0.1%
AMCINONIDE OIN 0.1%
APEXICON E CRE 0.05%
aug betamet cre 0.05%
aug betamet lot 0.05%
aug betamet oin 0.05%
betameth dip cre 0.05%
betameth dip lot 0.05%
betameth dip oin 0.05%
betameth val aer 0.12%
betameth val cre 0.1%
betameth val lot 0.1%
betameth val oin 0.1%
CAPEX SHA 0.01%
clobetasol aer 0.05%
clobetasol cre 0.05%
clobetasol e cre 0.05%
clobetasol gel 0.05%
clobetasol lot 0.05%
2
3
3
1
1
1
1
1
3
3
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
PA
ST - Step Therapy
65
Drug Name
clobetasol oin 0.05%
clobetasol sha 0.05%
clobetasol spr 0.05%
CLOBEX LOT 0.05%
CLOBEX SHA 0.05%
CLOBEX SPR 0.05%
clocortolone cre piv 0.1%
CLODERM CRE 0.1% PMP
CORDRAN 24X3 TAP 4MCG/CM
CORDRAN CRE 0.05%
CORDRAN LOT 0.05%
CORDRAN OIN 0.05%
cormax scalp sol 0.05%
CUTIVATE CRE 0.05%
CUTIVATE LOT 0.05%
DERMA-SMOOTH OIL /FS BODY
DERMA-SMOOTH OIL /FS SCLP
DERMASORB HC KIT 2%
DERMASORB TA KIT 0.1%
DERMATOP CRE 0.1%
DERMATOP OIN 0.1%
DESONATE GEL 0.05%
desonide cre 0.05%
desonide lot 0.05%
desonide oin 0.05%
DESOWEN CRE 0.05%
DESOWEN LOT 0.05%
DESOWEN OIN 0.05%
desoximetas cre 0.05%
desoximetas cre 0.25%
desoximetas gel 0.05%
desoximetas oin 0.05%
desoximetas oin 0.25%
diflorasone cre 0.05%
diflorasone oin 0.05%
DIPROLENE AF CRE 0.05%
DIPROLENE LOT 0.05%
DIPROLENE OIN 0.05%
ELOCON CRE 0.1%
ELOCON LOT 0.1%
ELOCON OIN 0.1%
fluocin acet cre 0.01%
fluocin acet cre 0.025%
fluocin acet oil 0.01% sc
fluocin acet oil body
1
1
1
2
2
3
1
2
3
3
3
3
1
3
3
2
2
3
3
3
3
3
1
1
1
2
2
2
1
1
1
1
1
1
1
3
3
2
3
3
2
1
1
1
1
ST - Step Therapy
66
Drug Name
fluocin acet oin 0.025%
fluocin acet sol 0.01%
fluocinonide cre 0.1%
fluocinonide cre 0.05%
fluocinonide cre -e 0.05%
fluocinonide gel 0.05%
fluocinonide oin 0.05%
fluocinonide sol 0.05%
fluticasone cre 0.05%
fluticasone lot 0.05%
fluticasone oin 0.005%
halobetasol cre 0.05%
halobetasol oin 0.05%
HALOG CRE 0.1%
HALOG OIN 0.1%
hc butyrate cre 0.1%
hc butyrate oin 0.1%
hc butyrate sol 0.1%
hc valerate cre 0.2%
hc valerate oin 0.2%
hydrocort cre 2.5%
hydrocort lot 2.5%
hydrocort oin 2.5%
KENALOG AER SPRAY
LOCOID CRE 0.1%
LOCOID LIPO CRE 0.1%
LOCOID LOT 0.1%
LOCOID OIN 0.1%
LOCOID SOL 0.1%
LUXIQ AER 0.12%
mometasone cre 0.1%
mometasone oin 0.1%
mometasone sol 0.1%
NUCORT LOT 2%
OLUX AER 0.05%
OLUX-E AER 0.05%
PANDEL CRE 0.1%
PEDIADERM HC KIT
prednicarbat cre 0.1%
prednicarbat oin 0.1%
PSORCON CRE 0.05%
scalacort lot 2%
SYNALAR CRE 0.025%
SYNALAR OIN 0.025%
SYNALAR SOL 0.01%
1
1
1
1
1
1
1
1
1
1
1
1
1
3
3
1
1
1
1
1
1
1
1
3
3
3
2
2
2
3
1
1
1
3
3
3
PA
3
3
1
1
3
1
3
3
2
ST - Step Therapy
67
Drug Name
TEMOVATE CRE 0.05%
TEMOVATE E CRE 0.05%EML
TEMOVATE GEL 0.05%
TEMOVATE OIN 0.05%
TEMOVATE SOL 0.05%
TEXACORT SOL 2.5%
TOPICORT CRE 0.05%
TOPICORT CRE 0.25%
TOPICORT GEL 0.05%
TOPICORT OIN 0.05%
TOPICORT OIN 0.25%
TOPICORT SPR 0.25%
triamcinolon aer spray
triamcinolon cre 0.1%
triamcinolon lot 0.1%
triamcinolon lot 0.025%
triamcinolon oin 0.1%
TRIANEX OIN 0.05%
ULTRAVATE CRE 0.05%
ULTRAVATE OIN 0.05%
VANOS CRE 0.1%
VERDESO AER 0.05%
WESTCORT OIN 0.2%
2
2
2
2
3
2
3
3
2
2
2
3
1
1
1
1
1
1
1
1
1
3
2
2
3
3
2
CORTICOTROPIN
CORTICOTROPIN
H.P. ACTHAR INJ 80UNIT
4
PA
COUMARIN ANTICOAGULANTS
COUMARIN ANTICOAGULANTS
COUMADIN TAB 1MG
COUMADIN TAB 2.5MG
COUMADIN TAB 2MG
COUMADIN TAB 3MG
COUMADIN TAB 4MG
COUMADIN TAB 5MG
COUMADIN TAB 6MG
COUMADIN TAB 7.5MG
COUMADIN TAB 10MG
warfarin sod tab 10mg
warfarin tab 1mg
warfarin tab 2.5mg
3
3
3
3
3
3
3
3
3
1
1
1
ST - Step Therapy
68
Drug Name
warfarin tab
warfarin tab
warfarin tab
warfarin tab
warfarin tab
warfarin tab
1
1
1
1
1
1
2mg
3mg
4mg
5mg
6mg
7.5mg
CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS
CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS
IBRANCE CAP 75MG
IBRANCE CAP 100MG
IBRANCE CAP 125MG
0
0
0
PA
PA
PA
CYCLOOXYGENASE 2 (COX-2) INHIBITORS
CYCLOOXYGENASE 2 (COX-2) INHIBITORS
CELEBREX CAP 50MG
CELEBREX CAP 100MG
CELEBREX CAP 200MG
CELEBREX CAP 400MG
celecoxib cap 50mg
celecoxib cap 100mg
celecoxib cap 200mg
celecoxib cap 400mg
3
3
3
3
1
1
1
1
CYCLOPLEGIC MYDRIATIC COMBINATIONS
CYCLOPLEGIC MYDRIATIC COMBINATIONS
CYCLOMYDRIL SOL OP
3
CYCLOPLEGIC MYDRIATICS
CYCLOPLEGIC MYDRIATICS
ATROPINE SUL OIN 1% OP
atropine sul sol 1% op
CYCLOGYL SOL 0.5% OP
CYCLOGYL SOL 1% OP
CYCLOGYL SOL 2% OP
cyclopentol sol 1% op
cyclopentol sol 2% op
homatropine sol 5% op
ISO HOMATROP SOL 2% OP
ISO HOMATROP SOL 5% OP
ISO HYOSCINE SOL 0.25% OP
MYDRIACYL SOL 1% OP
tropicamide sol 0.5% op
tropicamide sol 1% op
3
1
3
3
3
1
1
1
3
3
3
3
1
1
CYCLOSPORINE ANALOGS
CYCLOSPORINE ANALOGS
cyclosporine cap 25mg
1
ST - Step Therapy
69
Drug Name
cyclosporine cap 50mg mod
cyclosporine cap 100mg
gengraf cap 25mg
gengraf cap 100mg
gengraf sol 100mg/ml
NEORAL CAP 25MG
NEORAL CAP 100MG
NEORAL SOL 100MG/ML
SANDIMMUNE CAP 25MG
SANDIMMUNE CAP 100MG
SANDIMMUNE SOL 100MG/ML
1
1
1
1
1
2
2
2
2
2
2
CYSTIC FIBROSIS AGENT - COMBINATIONS
CYSTIC FIBROSIS AGENT - COMBINATIONS
ORKAMBI TAB 200-125
4
CYSTINOSIS AGENTS
CYSTINOSIS AGENTS
CYSTAGON CAP 50MG
CYSTAGON CAP 150MG
PROCYSBI CAP 25MG
PROCYSBI CAP 75MG
4
4
3
3
PA
PA
PA
PA
CYTOTOXIC AGENTS
CYTOTOXIC AGENTS
DROXIA CAP 200MG
DROXIA CAP 300MG
DROXIA CAP 400MG
0
0
0
DECARBOXYLASE INHIBITORS
DECARBOXYLASE INHIBITORS
carbidopa tab 25mg
LODOSYN TAB 25MG
1
3
DECONGESTANT ANTIHISTAMINE
DECONGESTANT ANTIHISTAMINE
CLARINEX-D TAB 2.5-120
DECON-A ELX 2-5MG/5M
prometh vc syp plain
RELHIST CHW
RESCON-MX TAB
SEMPREX-D CAP 8-60MG
3
3
1
3
3
3
DECONGESTANT-ANTIHISTAMINE W/ EXPECTORANT
DECONGESTANT-ANTIHISTAMINE W/ EXPECTORANT
DECON-G DRO 2-1-40MG
3
DENTAL DESENSITIZING PRODUCTS
DENTAL DESENSITIZING PRODUCTS
HURRISEAL SOL
3
ST - Step Therapy
70
Drug Name
DENTAL PRODUCTS - COMBINATIONS
DENTAL PRODUCTS - COMBINATIONS
fluoridex dd pst sensitiv
FLUORIDEX GEL SENSITIV
NAFRINSE SOL DAILY
PRVDNT 5000 PST ENAML PR
1
3
3
3
DEPIGMENTING COMBINATIONS
DEPIGMENTING COMBINATIONS
CLARYS CRE
3
DIABETIC OTHER
DIABETIC OTHER
GLUCAGEN INJ HYPOKIT
GLUCAGON KIT 1MG
PROGLYCEM SUS 50MG/ML
2
2
3
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
ACCU-CHEK TES ACTIVE
ACCU-CHEK TES AVIVA
ACCU-CHEK TES AVIVA PL
ACCU-CHEK TES COMFORT
ACCU-CHEK TES COMPACT
ACCU-CHEK TES DRUM
ACCU-CHEK TES SMART
ACCUTREND TES GLUCOSE
ACETEST TAB TABLETS
ACURA TES BLD GLUC
ADVANCE TES INTUITIO
ADVANCE TES MICRO-DW
ADVOCATE TES
ADVOCATE TES REDI-COD
ADVOCATE TES REDICODE
AGAMATRIX TES AMP
AGAMATRIX TES JAZZ
AGAMATRIX TES KEYNOTE
AGAMATRIX TES PRESTO
ALBUSTIX TES
ASSURE 3 TES
ASSURE 4 TES
ASSURE II TES
ASSURE II TES CHECK
ASSURE PRISM TES MULTI
ASSURE PRO TES
ASSURE TES PLATINUM
AT LAST TES
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
ST - Step Therapy
71
Drug Name
AUTOCODE TES BLD GLUC
BAYER BREEZE MIS 2 TEST
BAYER CONTOR TES BLD GLUC
BAYER CONTOR TES NEXT
BG STAR TES BLD GLUC
BIOSCANNER TES GLUCOSE
BLOOD GLUCOS TES
BLOOD GLUCOS TES PREMIUM
BLOOD GLUCOS TES STRIPS
CARESENS N TES
CLEVER CHEK TES
CLEVER CHEK TES AUTO CD
CLEVER CHEK TES VOICE
CLEVER CHOIC TES MICRO
CLEVR CHOICE TES AUTO-CD
CLINITEST TAB CHLD RES
CONFIRM/MICR TES GLUCOSE
CONTROL AST TES
CONTROL TES
CVS ADVANCED TES GLUCOSE
DIASTIX TES STRIPS
DIATRUE PLUS TES STRIPS
DUO-CARE TES
EASY PLUS II TES BLD GLUC
EASY PLUS TES BLD GLUC
EASY STEP TES
EASY TALK TES BLD GLUC
EASY TOUCH TES STRIPS
EASY TRAK TES BLD GLUC
EASYGLUCO TES
EASYGLUCO TES PLUS
EASYMAX 15 TES
EASYMAX TES
EASYPLUS TES BLD GLUC
EASYPRO PLUS TES
EASYPRO TES BLD GLUC
ELEMENT TES
ELEMNT COMPA TES STRIPS
EMBRACE EVO TES
EMBRACE PRO TES
EMBRACE TES BLD GLUC
EQL TRUETEST TES BLD GLUC
EVENCARE + TES BLD GLUC
EVENCARE G2 TES
EVENCARE G3 TES
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
0
PA
0
PA
0
PA
0
PA
0
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
ST - Step Therapy
72
Drug Name
EVENCARE TES BLD GLUC
EVENCARE TES MINI
EVOLUTION TES AUTOCODE
EXACTECH TES
EXACTECH TES R-S-G
EZ SMART PLS TES BLD GLUC
EZ SMART TES BLD GLUC
FIFTY50 GLUC TES 2.0
FORA D10 TES BLD GLUC
FORA D15G TES BLD GLUC
FORA D20 TES BLD GLUC
FORA G20 TES BLD GLUC
FORA G30A TES BLD GLUC
FORA GD20 TES BLD GLUC
FORA GD50 TES
FORA V10 TES BLD GLUC
FORA V30A TES BLD GLUC
FORACARE TES GD40
FORACARE TES PREM V10
FORACARE TES TST N GO
FREESTYLE TES
FREESTYLE TES INSULINX
FREESTYLE TES LITE
GE100 BLOOD TES GLUCOSE
GHT TEST TES STRIPS
GLUCO PERFEC TES 3
GLUCOCARD 01 TES PLUS
GLUCOCARD 01 TES SENSOR
GLUCOCARD TES EXPRESSI
GLUCOCARD TES SHINE
GLUCOCARD TES VITAL
GLUCOCARD TES X-SENSOR
GLUCOCOM TES
GLUCONAVII TES STRIPS
GMATE BLOOD TES GLUCOSE
HEALTHPRO TES STRIPS
IN TOUCH TES BLOOD
INFINITY TES BLD GLUC
KROGER BLOOD TES GLUCOSE
KROGER TES
LIBERTY NEXT TES GEN
LIBERTY TES
MAXIMA BLOOD TES GLUCOSE
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
ST - Step Therapy
73
Drug Name
MEIJER BLOOD TES GLUCOSE
MEIJER TES TRUETEST
MEIJER TES TRUETRAC
MICRO-BUMIN KIT
MICRODOT TES
MYGLUCOHEALT TES BLD GLUC
NEUTEK 2TEK TES STRIPS
NEXGEN TES
NITRATEST TES PAPER
NOVA MAX TES GLUCOSE
ON CALL PLUS TES BLD GLUC
ON CALL TES EXPRESS
ON CALL VIVD TES BLD GLUC
ONETOUCH TES ULTRA BL
ONETOUCH TES VERIO
OPTIUM TES
OPTIUMEZ TES
OPTUMRX TES BLD GLUC
POCKETCHEM TES EZ
PRECISION PT TES OF CARE
PRECISION TES PCX
PRECISION TES PCX PLUS
PRECISION TES QID
PRECISION TES SOF-TACT
PRECISION TES XTRA
PRODIGY NO TES CODING
PTS PANELS TES GLUCOSE
PTS PANELS TES KETONE
QUICKTEK TES
QUINTET AC TES BLD GLUC
QUINTET TES BLD GLUC
RA TRUETEST TES
REFUAH PLUS TES BLD GLUC
RELION BLOOD TES GLUCOSE
RELION KETON TES
RELION PRIME TES
RELION PRIME TES GLUCOSE
RELION TES ULTIMA
REVEAL TES BLD GLUC
RIGHTEST TES GS100
RIGHTEST TES GS300
RIGHTEST TES GS550
SMART SENSE TES TEST
SMARTEST TES BLD GLUC
SOLUS V2 TES AUDIBLE
0
PA
0
PA
0
PA
3
0
PA
0
PA
0
PA
0
PA
3
0
PA
0
PA
0
PA
0
PA
0
0
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
ST - Step Therapy
74
Drug Name
SUPREME TES
SURE EDGE TES
SURE-TEST TES EASYPLUS
SURECHEK TES BLD GLUC
TELCARE TES BLD GLUC
TRUE METRIX TES
TRUE METRIX TES GLUCOSE
TRUETEST TES
TRUETEST TES BLD GLUC
TRUETRACK TES
TRUETRACK TES BLD GLUC
ULTIMA TES
ULTRATRAK TES ULTIMATE
ULTRATRK PRO TES
UNISTRIP1 TES GENERIC
VICTORY TES AGM-4000
VOCAL POINT TES BLD GLUC
WAVESENSE TES PRESTO
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
0
PA
DIAPHRAGMS
DIAPHRAGMS
CAYA DPR
OMNIFLEX DPR
ORTHO COIL DPR KIT 50
ORTHO FLAT DPR KIT 55
WIDE-SEAL DPR KIT 60
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
DIBENZO-OXEPINO PYRROLES
DIBENZO-OXEPINO PYRROLES
ST - Step Therapy
75
Drug Name
SAPHRIS SUB 2.5MG
SAPHRIS SUB 5MG
SAPHRIS SUB 10MG
3
3
3
DIBENZODIAZEPINES
DIBENZODIAZEPINES
clozapine tab 12.5/odt
clozapine tab 25mg
clozapine tab 25mg odt
clozapine tab 50mg
clozapine tab 100/odt
clozapine tab 100mg
clozapine tab 200mg
CLOZARIL TAB 25MG
CLOZARIL TAB 100MG
FAZACLO TAB 12.5/ODT
FAZACLO TAB 25MG ODT
FAZACLO TAB 100/ODT
FAZACLO TAB 150MG
FAZACLO TAB 200MG
VERSACLOZ SUS 50MG/ML
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
DIBENZOTHIAZEPINES
DIBENZOTHIAZEPINES
quetiapine tab 25mg
quetiapine tab 50mg
quetiapine tab 100mg
SEROQUEL TAB 25MG
SEROQUEL TAB 50MG
SEROQUEL TAB 100MG
SEROQUEL TAB 200MG
SEROQUEL TAB 300MG
SEROQUEL TAB 400MG
SEROQUEL XR TAB 50MG
1
1
1
1
1
1
3
3
3
3
3
3
2
2
2
2
2
DIBENZOXAZEPINES
DIBENZOXAZEPINES
ADASUVE INH 10MG
3
ST - Step Therapy
76
Drug Name
loxapine cap
loxapine cap
loxapine cap
loxapine cap
1
1
1
1
5mg
10mg
25mg
50mg
DIGESTIVE ENZYMES
DIGESTIVE ENZYMES
CREON CAP 3000UNIT
CREON CAP 6000UNIT
CREON CAP 12000UNT
CREON CAP 24000UNT
CREON CAP 36000UNT
PANCREAZE CAP 4200UNIT
PANCREAZE CAP 10500UNT
pancrelipase cap 5000unit
PERTZYE CAP
SUCRAID SOL 8500/ML
ULTRESA CAP 13800UNT
VIOKACE TAB
VIOKACE TAB 20880
ZENPEP CAP 3000UNIT
ZENPEP CAP 5000UNIT
ZENPEP CAP 10000UNT
ZENPEP CAP 15000UNT
ZENPEP CAP 20000UNT
ZENPEP CAP 25000UNT
ZENPEP CAP 40000UNT
2
2
2
2
2
3
3
3
3
1
3
3
2
2
2
2
2
2
2
2
2
2
2
2
DIHYDROCODEINE COMBINATIONS
DIHYDROCODEINE COMBINATIONS
apap-caffein cap dihydroc
dihydrocod/ cap asa/caff
SYNALGOS-DC CAP
TREZIX CAP
1
1
3
3
DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS
DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS
JANUVIA TAB 25MG
JANUVIA TAB 50MG
JANUVIA TAB 100MG
NESINA TAB 6.25MG
NESINA TAB 12.5MG
NESINA TAB 25MG
2
2
2
3
3
3
PA
PA
PA
ST - Step Therapy
77
Drug Name
ONGLYZA TAB 2.5MG
ONGLYZA TAB 5MG
TRADJENTA TAB 5MG
3
PA
3
PA
2
DIPEPTIDYL PEPTIDASE-4 INHIBITOR-BIGUANIDE COMBINATIONS
DIPEPTIDYL PEPTIDASE-4 INHIBITOR-BIGUANIDE COMBINATIONS
JANUMET TAB 50-500MG
JANUMET TAB 50-1000
JANUMET XR TAB 50-500MG
JANUMET XR TAB 50-1000
JANUMET XR TAB 100-1000
JENTADUETO TAB 2.5-500
KAZANO 12.5- TAB 500MG
KAZANO 12.5- TAB 1000MG
KOMBIGLYZE TAB 2.5-1000
KOMBIGLYZE TAB 5-500MG
KOMBIGLYZE TAB 5-1000MG
2
2
2
2
2
2
2
2
3
3
3
3
3
PA
PA
PA
PA
PA
DIRECT FACTOR XA INHIBITORS
DIRECT FACTOR XA INHIBITORS
ELIQUIS TAB 2.5MG
ELIQUIS TAB 5MG
SAVAYSA TAB 15MG
SAVAYSA TAB 30MG
SAVAYSA TAB 60MG
XARELTO STAR TAB 15/20MG
XARELTO TAB 10MG
XARELTO TAB 15MG
XARELTO TAB 20MG
2
2
3
3
3
2
2
2
2
DIRECT MUSCLE RELAXANTS
DIRECT MUSCLE RELAXANTS
DANTRIUM CAP 25MG
DANTRIUM CAP 50MG
dantrolene cap 25mg
dantrolene cap 50mg
dantrolene cap 100mg
2
2
1
1
1
DIRECT RENIN INHIBITORS
DIRECT RENIN INHIBITORS
TEKTURNA TAB 150MG
TEKTURNA TAB 300MG
2
2
DIRECT RENIN INHIBITORS THIAZIDE/THIAZIDE-LIKE COMB
DIRECT RENIN INHIBITORS THIAZIDE/THIAZIDE-LIKE COMB
TEKTURNA HCT TAB 150-12.5
2
ST - Step Therapy
78
Drug Name
TEKTURNA HCT TAB 150-25MG
TEKTURNA HCT TAB 300-12.5
TEKTURNA HCT TAB 300-25MG
2
2
2
DIRECT-ACTING P2Y12 INHIBITORS
DIRECT-ACTING P2Y12 INHIBITORS
BRILINTA TAB 60MG
BRILINTA TAB 90MG
KENGREAL SOL 50MG
2
2
3
DIURETIC COMBINATIONS
DIURETIC COMBINATIONS
ALDACTAZIDE TAB 25/25
ALDACTAZIDE TAB 50/50
amilor/hctz tab 5-50
DYAZIDE CAP 37.5-25
MAXZIDE TAB 75-50
MAXZIDE-25 TAB
spirono/hctz tab 25/25
triamt/hctz cap 37.5-25
triamt/hctz cap 50-25mg
triamt/hctz tab 37.5-25
triamt/hctz tab 75-50mg
3
3
1
3
3
3
1
1
1
1
1
DOPAMINE RECEPTOR AGONISTS
DOPAMINE RECEPTOR AGONISTS
cabergoline tab 0.5mg
1
DOPAMINE RECEPTOR AGONISTS - ERGOT DERIVATIVES
DOPAMINE RECEPTOR AGONISTS - ERGOT DERIVATIVES
CYCLOSET TAB 0.8MG
3
DPP-4 INHIBITOR-THIAZOLIDINEDIONE COMBINATIONS
DPP-4 INHIBITOR-THIAZOLIDINEDIONE COMBINATIONS
OSENI
OSENI
OSENI
OSENI
OSENI
OSENI
TAB
TAB
TAB
TAB
TAB
TAB
12.5-15
12.5-30
12.5-45
25-15MG
25-30MG
25-45MG
3
3
3
3
3
3
PA
PA
PA
PA
PA
PA
DRY MOUTH AGENTS AND ARTIFICIAL SALIVA
DRY MOUTH AGENTS AND ARTIFICIAL SALIVA
AQUORAL AER
NEUTRASAL POW
3
3
EMERGENCY CONTRACEPTIVES
EMERGENCY CONTRACEPTIVES
ELLA TAB 30MG
levonorgestr tab 1.5mg
0
0
ST - Step Therapy
79
Drug Name
EMOLLIENT/KERATOLYTIC AGENTS
EMOLLIENT/KERATOLYTIC AGENTS
ALUVEA CRE 39%
CEM-UREA SOL 45%
DERMASORB XM KIT 39%
GORDONS UREA OIN 40%
HYDRO 40 AER FOAM
KERAFOAM 42 AER 42%
KERAFOAM AER 30%
KERALAC CRE 47%
rea lo 39 cre 39%
rea lo 40 cre 40%
rea lo 40 lot 40%
UMECTA EMU
umecta mouss aer 40%
UMECTA NAIL SUS FILM
URAMAXIN CRE 45%
URAMAXIN GEL 45%
URAMAXIN GT KIT 45%
URAMAXIN LOT 45%
urea 40% sus nail
urea cre 45%
urea cre 47%
urea cre 50%
urea gel 40%
urea lot 45%
urea nail gel 45%
UREVAZ CRE 44%
UTOPIC CRE 41%
3
3
3
3
3
3
3
3
1
1
1
3
1
3
3
3
3
3
1
1
1
1
1
1
1
3
3
EMOLLIENT/KERATOLYTIC COMBINATIONS
EMOLLIENT/KERATOLYTIC COMBINATIONS
HYDRO 35 AER
LATRIX XM EMU 45%
UMECTA PD EMU 40-0.3%
UMECTA PD SUS 40-0.3%
URAMAXIN AER 20%
urea emu 50%
urea hydrati aer 35%
UREA NAIL KIT
UREA NAIL MIS 50%
urea sus 50%
3
3
3
3
3
1
1
3
3
1
EMOLLIENTS
EMOLLIENTS
HPR PLUS MB KIT HYDROGEL
3
ST - Step Therapy
80
Drug Name
hygel gel 0.2%
HYLIRA GEL 0.2%
HYLIRA LOT 0.1%
lactic acid lot 10%
1
3
3
1
ENZYMES - TOPICAL
ENZYMES - TOPICAL
GRANULEX AER
OPTASE GEL
SANTYL OIN 250/GM
tbc aer
XENADERM OIN
3
3
3
1
3
ERGOT COMBINATIONS
ERGOT COMBINATIONS
CAFERGOT TAB 1-100MG
migergot sup 2/100
3
1
ERYTHROMYCINS
ERYTHROMYCINS
e.e.s. 400 tab 400mg
ERY-TAB TAB 250MG EC
ERYPED SUS 200/5ML
ERYPED SUS 400/5ML
erythrocin tab 250mg
erythromycin cap 250mg ec
erythromycin tab 250mg bs
erythromycin tab 500mg bs
PCE TAB 333MG EC
PCE TAB 500MG EC
1
3
3
3
3
3
1
1
1
1
3
3
ERYTHROPOIESIS-STIMULATING AGENTS (ESAS)
ERYTHROPOIESIS-STIMULATING AGENTS (ESAS)
ARANESP INJ 10MCG
ARANESP INJ 25MCG
ARANESP INJ 40MCG
ARANESP INJ 60MCG
ARANESP INJ 100MCG
ARANESP INJ 150MCG
ARANESP INJ 200MCG
ARANESP INJ 300MCG
ARANESP INJ 500MCG
EPOGEN INJ 2000/ML
EPOGEN INJ 3000/ML
EPOGEN INJ 4000/ML
EPOGEN INJ 10000/ML
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
ST - Step Therapy
81
Drug Name
EPOGEN INJ 20000/ML
MIRCERA INJ 50MCG
MIRCERA INJ 75MCG
MIRCERA INJ 100MCG
MIRCERA INJ 200MCG
PROCRIT INJ 40000/ML
4
PA
3
3
3
3
4
PA
ESTROGEN ANDROGEN
ESTROGEN ANDROGEN
covaryx hs tab
covaryx tab 1.25-2.5
1
1
ESTROGEN PROGESTIN
ESTROGEN PROGESTIN
ACTIVELLA TAB 0.5-0.1
ACTIVELLA TAB 1-0.5MG
ANGELIQ TAB 0.5-1MG
ANGELIQ TAB 0.25-0.5
BIEST/PROGES CRE
CLIMARA PRO DIS WEEKLY
COMBIPATCH DIS .05/.14
COMBIPATCH DIS .05/.25
FEMHRT TAB 0.5-2.5
jinteli tab 1mg-5mcg
mimvey lo tab 0.5-0.1
mimvey tab 1-0.5mg
noreth/ethin tab 0.5-2.5
PREFEST TAB
PREMPHASE TAB
PREMPRO TAB 0.3-1.5
PREMPRO TAB 0.45-1.5
PREMPRO TAB 0.625-5
PREMPRO TAB .625-2.5
3
3
3
3
3
3
3
3
3
1
1
1
1
3
2
2
2
2
2
ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB
ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB
DUAVEE TAB 0.45-20
2
ESTROGENS
ESTROGENS
ALORA DIS 0.1MG
ALORA DIS 0.05MG
ALORA DIS 0.025MG
ALORA DIS 0.075MG
CLIMARA DIS 0.1MG
CLIMARA DIS 0.05MG
CLIMARA DIS 0.06MG
CLIMARA DIS 0.025MG
3
3
3
3
3
3
3
3
ST - Step Therapy
82
Drug Name
CLIMARA DIS 0.075MG
CLIMARA DIS 0.0375MG
DIVIGEL GEL 0.5MG
DIVIGEL GEL 0.25MG
DIVIGEL GEL 1MG/GM
ELESTRIN GEL 0.06%
ENJUVIA TAB 0.3MG
ENJUVIA TAB 0.9MG
ENJUVIA TAB 0.45MG
ENJUVIA TAB 0.625MG
ENJUVIA TAB 1.25MG
ESTRACE TAB 0.5MG
ESTRACE TAB 1MG
ESTRACE TAB 2MG
estradiol dis 0.1mg
estradiol dis 0.05mg
ESTRADIOL MIS 6MG
ESTRADIOL MIS 10MG
ESTRADIOL MIS 12.5MG
ESTRADIOL MIS 25MG
estradiol tab 0.5mg
estradiol tab 1mg
estradiol tab 2mg
ESTROGEL GEL
estropipate tab 0.75mg
estropipate tab 1.5mg
estropipate tab 3mg
EVAMIST SPR 1.53MG
MENEST TAB 0.3MG
MENEST TAB 0.625MG
MENEST TAB 1.25MG
MENEST TAB 2.5MG
MENOSTAR DIS 14MCG
MINIVELLE DIS 0.0375MG
PREMARIN TAB 0.3MG
PREMARIN TAB 0.9MG
PREMARIN TAB 0.45MG
PREMARIN TAB 0.625MG
PREMARIN TAB 1.25MG
VIVELLE-DOT DIS 0.1MG
3
3
2
2
2
3
3
3
3
3
3
3
3
3
1
1
1
1
1
1
3
3
3
3
1
1
1
3
1
1
1
2
3
3
3
3
3
2
2
2
2
2
2
3
3
ST - Step Therapy
83
Drug Name
3
3
3
ESTROGENS-ANTINEOPLASTIC
ESTROGENS-ANTINEOPLASTIC
EMCYT CAP 140MG
0
EXTENDED-CYCLE CONTRACEPTIVES - ORAL
EXTENDED-CYCLE CONTRACEPTIVES - ORAL
camrese lo tab
camrese tab
levonor/ethi tab estradio
QUARTETTE TAB
0
0
0
0
EYELID CLEANSERS LUBRICANTS
EYELID CLEANSERS LUBRICANTS
ACUICYN LIQ
3
FIBRIC ACID DERIVATIVES
FIBRIC ACID DERIVATIVES
ANTARA CAP 30MG
ANTARA CAP 90MG
fenofibrate cap 43mg
fenofibrate tab 40mg
fenofibric cap 45mg dr
fenofibric cap 135mg dr
fenofibric tab 35mg
fenofibric tab 105mg
FENOGLIDE TAB 40MG
FENOGLIDE TAB 120MG
FIBRICOR TAB 35MG
FIBRICOR TAB 105MG
gemfibrozil tab 600mg
LIPOFEN CAP 50MG
LIPOFEN CAP 150MG
LOFIBRA CAP 67MG
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
3
3
3
1
3
3
3
ST - Step Therapy
84
Drug Name
LOFIBRA CAP 134MG
LOFIBRA CAP 200MG
LOFIBRA TAB 54MG
LOFIBRA TAB 160MG
LOPID TAB 600MG
TRICOR TAB 48MG
TRICOR TAB 145MG
TRIGLIDE TAB 160MG
TRILIPIX CAP 45MG
TRILIPIX CAP 135MG
3
3
3
3
3
3
PA
3
PA
3
3
3
FIBROMYALGIA AGENT - SNRIS
FIBROMYALGIA AGENT - SNRIS
SAVELLA
SAVELLA
SAVELLA
SAVELLA
SAVELLA
MIS
TAB
TAB
TAB
TAB
TITR PAK
12.5MG
25MG
50MG
100MG
2
2
2
2
2
FIDAXOMICIN
FIDAXOMICIN
DIFICID TAB 200MG
2
FIXED OILS
FIXED OILS
LINSEED OIL RAW
MACADAMIA OIL NUT OIL
3
3
FLUORIDE
FLUORIDE
FLUORABON DRO
fluoritab chw 0.5mg f
fluoritab chw 0.25mg f
fluoritab chw 1mg f
flura-drops dro 0.25mg f
karidium dro 0.125mg
LOZI-FLUR LOZ 1MG F
LURIDE CHW 0.5MG F
LURIDE CHW 0.25MG F
LURIDE CHW 1MG F
LURIDE DRO 0.5MG/ML
sod fluoride dro 0.5mg/ml
sod fluoride tab 0.5mg f
sod fluoride tab 1mg f
0
0
0
1
0
0
3
0
0
2
0
0
0
1
FLUORIDE COMBINATIONS
FLUORIDE COMBINATIONS
FLORIVA DRO 0.25MG
3
ST - Step Therapy
85
Drug Name
FLUOR-A-DAY CHW 0.5MG F
FLUOR-A-DAY CHW 0.25MG F
FLUOR-A-DAY CHW 1MG F
2
2
2
FLUORIDE DENTAL PRODUCTS
FLUORIDE DENTAL PRODUCTS
clinpro 5000 pst 1.1%
controlrx cre 1.1%
NAFRINSE DLY SOL /NEUTRAL
NAFRINSE WK SOL 0.2%
phos-flur gel 1.1%
PREVDNT 5000 PST 1.1%
PREVIDENT CRE 5000 PLS
PREVIDENT GEL 1.1%
1
1
3
3
1
3
3
3
FLUOROQUINOLONES
FLUOROQUINOLONES
AVELOX TAB 400MG
CIPRO (5%) SUS 250MG/5
CIPRO (10%) SUS 500MG/5
CIPRO TAB 250MG
CIPRO TAB 500MG
CIPRO XR TAB 500MG
CIPRO XR TAB 1000MG
ciprofloxacn sus 250mg/5
ciprofloxacn sus 500mg/5
ciprofloxacn tab 100mg
ciprofloxacn tab 500mg er
FACTIVE TAB 320MG
LEVAQUIN TAB 250MG
LEVAQUIN TAB 500MG
LEVAQUIN TAB 750MG
levofloxacin sol 25mg/ml
levofloxacin tab 250mg
moxifloxacin tab 400mg
ofloxacin tab 400mg
3
3
3
3
3
3
3
1
1
1
1
1
1
1
1
3
3
3
3
1
1
1
1
1
1
FOLIC ACID ANTAGONISTS RESCUE AGENTS
FOLIC ACID ANTAGONISTS RESCUE AGENTS
leucovor ca tab 5mg
leucovor ca tab 10mg
0
0
ST - Step Therapy
86
Drug Name
LEVOLEUCOVOR SOL 250MG/25
0
0
3
FOLIC ACID/FOLATE COMBINATIONS
FOLIC ACID/FOLATE COMBINATIONS
ZAVARA CAP 1MG-5750
3
FOLIC ACID/FOLATES
FOLIC ACID/FOLATES
folic acid tab 1mg
folic acid tab 400mcg
folic acid tab 800mcg
1
0
0
FOUR PHASE CONTRACEPTIVES - ORAL
FOUR PHASE CONTRACEPTIVES - ORAL
NATAZIA TAB
0
GABA MODULATORS
GABA MODULATORS
GABITRIL TAB 2MG
GABITRIL TAB 4MG
GABITRIL TAB 12MG
GABITRIL TAB 16MG
SABRIL POW 500MG
SABRIL TAB 500MG
tiagabine tab 2mg
tiagabine tab 4mg
2
2
2
2
4
4
1
1
PA
PA
GABA RECEPTOR MODULATOR-NUTRITIONAL SUPPLEMENT COMB
GABA RECEPTOR MODULATOR-NUTRITIONAL SUPPLEMENT COMB
SENTRAZOLPID PAK PM-5
3
GALLSTONE SOLUBILIZING AGENTS
GALLSTONE SOLUBILIZING AGENTS
ACTIGALL CAP 300MG
CHENODAL TAB 250MG
URSO 250 TAB 250MG
URSO FORTE TAB 500MG
ursodiol cap 300mg
ursodiol tab 250mg
ursodiol tab 500mg
2
3
2
2
1
1
1
GASTROINTESTINAL ANTIALLERGY AGENTS
GASTROINTESTINAL ANTIALLERGY AGENTS
cromolyn sod con 100/5ml
GASTROCROM CON 100/5ML
1
3
GASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS
GASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS
AMITIZA CAP 8MCG
2
ST - Step Therapy
87
Drug Name
AMITIZA CAP 24MCG
2
GASTROINTESTINAL STIMULANTS
GASTROINTESTINAL STIMULANTS
metoclopram sol 5mg/5ml
metoclopram tab 5mg
metoclopram tab 5mg odt
metoclopram tab 10mg
METOZOLV ODT TAB 5MG
REGLAN TAB 5MG
REGLAN TAB 10MG
1
1
1
1
3
3
3
GLUCAGON-LIKE PEPTIDE-2 (GLP-2) ANALOGS
GLUCAGON-LIKE PEPTIDE-2 (GLP-2) ANALOGS
GATTEX KIT 5MG
4
PA
GLUCOCORTICOSTEROIDS
GLUCOCORTICOSTEROIDS
budesonide cap 3mg/24hr
CORTEF TAB 5MG
CORTEF TAB 10MG
CORTEF TAB 20MG
cortisone ac tab 25mg
DEXAMETHASON CON 1MG/ML
dexamethason elx 0.5/5ml
dexamethason sol 0.5/5ml
dexamethason tab 0.5mg
dexamethason tab 1mg
DEXPAK PAK 10 DAY
ENTOCORT EC CAP 3MG/24HR
FLO-PRED SUS
hydrocort tab 5mg
hydrocort tab 10mg
hydrocort tab 20mg
MEDROL PAK 4MG
MEDROL TAB 2MG
MEDROL TAB 4MG
MEDROL TAB 8MG
MEDROL TAB 16MG
MEDROL TAB 32MG
methylpred pak 4mg
methylpred tab 4mg
1
3
3
3
1
3
1
1
1
1
1
1
1
1
1
2
3
3
1
1
1
3
3
3
3
3
3
1
1
ST - Step Therapy
88
Drug Name
methylpred tab 8mg
methylpred tab 16mg
methylpred tab 32mg
MILLIPRED DP PAK 5MG
MILLIPRED SOL 10MG/5ML
MILLIPRED TAB 5MG
ORAPRED ODT TAB 10MG
PEDIAPRED SOL 6.7/5ML
pred sod pho sol 5mg/5ml
prednisolone sol 15mg/5ml
prednisolone sol 25mg/5ml
prednisolone tab 10mg odt
PREDNISONE CON 5MG/ML
prednisone pak 5mg
prednisone pak 10mg
prednisone sol 5mg/5ml
prednisone tab 1mg
prednisone tab 2.5mg
prednisone tab 5mg
prednisone tab 10mg
prednisone tab 20mg
prednisone tab 50mg
PRO-C-DURE 5 KIT 40MG/ML
PRO-C-DURE 6 KIT 40MG/ML
RAYOS TAB 1MG
RAYOS TAB 2MG
RAYOS TAB 5MG
UCERIS TAB 9MG
VERIPRED 20 SOL 20MG/5ML
1
1
1
3
3
3
2
2
2
3
1
1
1
1
1
1
3
1
1
1
1
1
1
1
1
1
3
3
3
PA
3
PA
3
PA
2
3
GLUCOSE MONITOR BLOOD PRESSURE MONITOR COMBINATIONS
GLUCOSE MONITOR BLOOD PRESSURE MONITOR COMBINATIONS
DUO-CARE MIS
3
GLUCOSE MONITOR CHOLESTEROL MONITOR COMBINATIONS
GLUCOSE MONITOR CHOLESTEROL MONITOR COMBINATIONS
ACCUTREND MIS PLUS
3
GLUCOSE MONITORING TEST SUPPLIES
GLUCOSE MONITORING TEST SUPPLIES
AT LAST KIT GLUCOSE
AUTODISC LIQ LOW/HIGH
AUTOLET LITE KIT STARTER
3
0
0
ST - Step Therapy
89
Drug Name
BAYER BREEZE KIT 2 SYSTEM
BAYER BREEZE LIQ HIGH CNT
BAYER BREEZE LIQ LOW CNTL
BAYER BREEZE LIQ NORM CNT
BD MAGNIGUID MIS MAGNIFIR
BLUESTAR MIS
BREEZE 2 MIS SYSTEM
DIASCREEN 10 MIS
FINGERSTIX MIS LANCETS
G4 SENSOR KIT
GLUCOLET 2 MIS LANCING
GUARDIAN RT MIS REPLACE
MONOJECTOR MIS END CAPS
SIDEKICK KIT SYSTEM
SOF-SENSOR MIS
SUPREME II MIS PADDLES
URIN-TEK KIT
0
PA
0
3
3
0
3
3
0
0
2
0
3
0
3
3
3
3
GLUCOSE/KETONE MONITORING TEST SUPPLIES
GLUCOSE/KETONE MONITORING TEST SUPPLIES
CARDIO CHEK MIS KIT
3
GNRH/LHRH ANTAGONISTS
GNRH/LHRH ANTAGONISTS
CETROTIDE KIT 0.25MG
GANIRELIX AC INJ
2
2
PA
PA
GOLD COMPOUNDS
GOLD COMPOUNDS
RIDAURA CAP 3MG
3
GOUT AGENT COMBINATIONS
GOUT AGENT COMBINATIONS
proben/colch tab 500-0.5
1
GOUT AGENTS
GOUT AGENTS
allopurinol tab 100mg
allopurinol tab 300mg
colchicine cap 0.6mg
colchicine tab 0.6mg
COLCRYS TAB 0.6MG
MITIGARE CAP 0.6MG
ULORIC TAB 40MG
ULORIC TAB 80MG
ZYLOPRIM TAB 100MG
ZYLOPRIM TAB 300MG
1
1
1
1
2
3
2
2
3
3
GRANULOCYTE COLONY-STIMULATING FACTORS (G-CSF)
ST - Step Therapy
90
Drug Name
GRANULOCYTE COLONY-STIMULATING FACTORS (G-CSF)
GRANIX INJ 300/0.5
GRANIX INJ 480/0.8
NEULASTA INJ 6MG/0.6M
NEULASTA KIT 6MG/0.6M
NEUPOGEN INJ 300/0.5
NEUPOGEN INJ 300MCG
NEUPOGEN INJ 480/0.8
NEUPOGEN INJ 480MCG
ZARXIO INJ 300/0.5
ZARXIO INJ 480/0.8
3
3
4
4
4
4
4
4
4
4
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
GRANULOCYTE/MACROPHAGE COLONY-STIMULATING
FACTOR(GM-CSF)
GRANULOCYTE/MACROPHAGE COLONY-STIMULATING
FACTOR(GM-CSF)
LEUKINE INJ 250MCG
4
PA
GROWTH HORMONE RECEPTOR ANTAGONISTS
GROWTH HORMONE RECEPTOR ANTAGONISTS
SOMAVERT
SOMAVERT
SOMAVERT
SOMAVERT
SOMAVERT
INJ
INJ
INJ
INJ
INJ
10MG
15MG
20MG
25MG
30MG
4
4
4
4
4
PA
PA
PA
PA
PA
GROWTH HORMONE RELEASING HORMONES (GHRH)
GROWTH HORMONE RELEASING HORMONES (GHRH)
EGRIFTA SOL 1MG
EGRIFTA SOL 2MG
4
4
PA
PA
4
4
4
4
4
4
4
4
4
4
4
4
4
4
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
GROWTH HORMONES
GROWTH HORMONES
GENOTROPIN INJ 0.2MG
GENOTROPIN INJ 1MG
GENOTROPIN INJ 2MG
GENOTROPIN INJ 5MG
GENOTROPIN INJ 12MG
HUMATROPE INJ 5MG
HUMATROPE INJ 6MG
ST - Step Therapy
91
Drug Name
HUMATROPE INJ 12MG
HUMATROPE INJ 24MG
NORDITROPIN INJ 5/1.5ML
NORDITROPIN INJ 30/3ML
NUTROPIN AQ INJ 10MG/2ML
NUTROPIN AQ INJ 20MG/2ML
NUTROPIN AQ INJ NUSPIN 5
OMNITROPE INJ 5.8MG
SAIZEN INJ 5MG
SAIZEN INJ 8.8MG
SEROSTIM INJ 4MG
SEROSTIM INJ 5MG
SEROSTIM INJ 6MG
ZOMACTON INJ 10MG
ZORBTIVE INJ 8.8MG
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
H-2 ANTAGONIST-NUTRITIONAL SUPPLEMENT COMBINATIONS
H-2 ANTAGONIST-NUTRITIONAL SUPPLEMENT COMBINATIONS
SENTRADINE PAK
3
H-2 ANTAGONISTS
H-2 ANTAGONISTS
AXID CAP 300MG
cimetidine sol 300/5ml
cimetidine tab 300mg
famotidine sus 40mg/5ml
famotidine tab 40mg
nizatidine cap 150mg
nizatidine cap 300mg
nizatidine sol 15mg/ml
PEPCID SUS 40MG/5ML
PEPCID TAB 40MG
ranitidine cap 300mg
ranitidine syp 75mg/5ml
ranitidine tab 300mg
ZANTAC TAB 300MG
3
1
1
1
1
1
1
1
1
1
3
3
1
1
1
3
HEMATORHEOLOGIC AGENTS
HEMATORHEOLOGIC AGENTS
pentoxifylli tab 400mg er
1
HEMOSTATICS - SYSTEMIC
HEMOSTATICS - SYSTEMIC
AMICAR TAB 500MG
3
ST - Step Therapy
92
Drug Name
AMICAR TAB 1000MG
LYSTEDA TAB 650MG
3
3
HEPATITIS B AGENTS
HEPATITIS B AGENTS
adefov dipiv tab 10mg
BARACLUDE SOL .05MG/ML
BARACLUDE TAB 0.5MG
BARACLUDE TAB 1MG
entecavir tab 0.5mg
entecavir tab 1mg
EPIVIR HBV SOL 5MG/ML
EPIVIR HBV TAB 100MG
HEPSERA TAB 10MG
TYZEKA TAB 600MG
1
2
2
2
1
1
2
2
3
1
3
HEPATITIS C AGENT - COMBINATIONS
HEPATITIS C AGENT - COMBINATIONS
HARVONI TAB 90-400MG
TECHNIVIE TAB
VIEKIRA PAK TAB
4
4
4
PA
PA
PA
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
HEPATITIS C AGENTS
HEPATITIS C AGENTS
COPEGUS TAB 200MG
DAKLINZA TAB 30MG
DAKLINZA TAB 60MG
MODERIBA PAK 600/DAY
moderiba tab 200mg
OLYSIO CAP 150MG
PEG-INTRON KIT 50MCG RP
PEG-INTRON KIT 80MCG
PEG-INTRON KIT 120 RP
PEG-INTRON KIT 150MCG
PEGASYS INJ
PEGASYS INJ 180MCG/M
PEGASYS INJ PROCLICK
REBETOL CAP 200MG
REBETOL SOL 40MG/ML
ribasphere tab 400mg
ribasphere tab 600mg
ribavirin cap 200mg
SOVALDI TAB 400MG
ST - Step Therapy
93
Drug Name
VICTRELIS CAP 200MG
4
PA
HEREDITARY TYROSINEMIA TYPE 1 (HT-1) TREATMENT - AGENTS
HEREDITARY TYROSINEMIA TYPE 1 (HT-1) TREATMENT - AGENTS
ORFADIN CAP 2MG
ORFADIN CAP 5MG
ORFADIN CAP 10MG
3
3
3
PA
PA
PA
HERPES AGENTS - PURINE ANALOGUES
HERPES AGENTS - PURINE ANALOGUES
acyclovir cap 200mg
acyclovir sus 200/5ml
acyclovir tab 400mg
acyclovir tab 800mg
SITAVIG TAB 50MG
valacyclovir tab 1gm
valacyclovir tab 500mg
VALTREX TAB 1GM
VALTREX TAB 500MG
ZOVIRAX CAP 200MG
ZOVIRAX SUS 200/5ML
ZOVIRAX TAB 400MG
ZOVIRAX TAB 800MG
1
1
1
1
3
1
1
3
3
3
3
3
3
PA
PA
HERPES AGENTS - THYMIDINE ANALOGUES
HERPES AGENTS - THYMIDINE ANALOGUES
famciclovir tab 125mg
FAMVIR TAB 125MG
FAMVIR TAB 250MG
FAMVIR TAB 500MG
1
1
1
3
3
3
HMG COA REDUCTASE INHIBITOR COMBINATIONS
HMG COA REDUCTASE INHIBITOR COMBINATIONS
ADVICOR TAB 500-20MG
ADVICOR TAB 750-20MG
ADVICOR TAB 1000-20
ADVICOR TAB 1000-40
ATORVA/COQ10 PAK 20-100MG
SIMCOR TAB 500-20MG
SIMCOR TAB 500-40MG
SIMCOR TAB 750-20MG
SIMCOR TAB 1000-20
SIMCOR TAB 1000-40
3
3
3
3
3
2
2
2
2
2
PA
PA
PA
PA
HMG COA REDUCTASE INHIBITORS
HMG COA REDUCTASE INHIBITORS
ST - Step Therapy
94
Drug Name
ALTOPREV TAB 20MG ER
atorvastatin tab 10mg
CRESTOR TAB 5MG
CRESTOR TAB 10MG
CRESTOR TAB 20MG
CRESTOR TAB 40MG
fluvastatin cap 20mg
fluvastatin cap 40mg
fluvastatin tab 80mg er
LESCOL XL TAB 80MG
LIPITOR TAB 10MG
LIPITOR TAB 20MG
LIPITOR TAB 40MG
LIPITOR TAB 80MG
LIVALO TAB 1MG
LIVALO TAB 2MG
LIVALO TAB 4MG
lovastatin tab 10mg
lovastatin tab 20mg
lovastatin tab 40mg
MEVACOR TAB 40MG
PRAVACHOL TAB 20MG
PRAVACHOL TAB 40MG
PRAVACHOL TAB 80MG
pravastatin tab 10mg
simvastatin tab 5mg
simvastatin tab 10mg
ZOCOR TAB 5MG
ZOCOR TAB 10MG
ZOCOR TAB 20MG
ZOCOR TAB 40MG
ZOCOR TAB 80MG
3
PA
3
PA
3
PA
1
1
1
1
2
2
2
2
1
1
1
3
PA
3
PA
3
PA
3
PA
3
3
PA
3
PA
3
PA
1
1
1
3
3
3
3
1
1
1
1
1
1
1
1
1
3
3
3
3
3
HOMOCYSTINURIA TREATMENT - AGENTS
ST - Step Therapy
95
Drug Name
HOMOCYSTINURIA TREATMENT - AGENTS
CYSTADANE POW
3
HUMAN INSULIN
HUMAN INSULIN
AFREZZA POW 4& 8UNIT
AFREZZA POW 4UNIT
AFREZZA POW 8&12UNIT
APIDRA INJ SOLOSTAR
APIDRA INJ U-100
HUMALOG INJ 100/ML
HUMALOG KWIK INJ 100/ML
HUMALOG KWIK INJ 200/ML
HUMALOG MIX INJ 50/50
HUMALOG MIX INJ 50/50KWP
HUMALOG MIX INJ 75/25KWP
HUMALOG MIX SUS 75/25
HUMULIN INJ 70/30KWP
HUMULIN N INJ U-100KWP
HUMULIN R INJ U-500
LANTUS INJ 100/ML
LANTUS INJ SOLOSTAR
LEVEMIR INJ
LEVEMIR INJ FLEXTOUC
NOVOLIN INJ 70/30
NOVOLIN N INJ U-100
NOVOLIN R INJ U-100
NOVOLOG INJ 100/ML
NOVOLOG INJ FLEXPEN
NOVOLOG INJ PENFILL
NOVOLOG MIX INJ 70/30
NOVOLOG MIX INJ FLEXPEN
TOUJEO SOLO INJ 300IU/ML
3
3
3
3
3
3
3
3
3
3
3
3
3
3
2
2
2
2
2
2
2
2
2
2
2
2
2
2
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
HYDANTOINS
HYDANTOINS
DILANTIN CAP 30MG
DILANTIN CAP 100MG
DILANTIN CHW 50MG
DILANTIN-125 SUS 125/5ML
PEGANONE TAB 250MG
PHENYTEK CAP 200MG
PHENYTEK CAP 300MG
phenytoin chw 50mg
phenytoin ex cap 100mg
phenytoin sus 125/5ml
3
3
3
3
3
3
3
1
1
1
ST - Step Therapy
96
Drug Name
HYDROCODONE COMBINATIONS
HYDROCODONE COMBINATIONS
HYCET SOL 7.5-325
hydroco/apap sol 7.5-325
hydroco/apap sol 10-325mg
hydroco/apap tab 2.5-325
hydroco/apap tab 5-325mg
hydroco/apap tab 7.5-325
hydroco/apap tab 10-325mg
hydrocod/ibu tab 2.5-200
hydrocod/ibu tab 7.5-200
ibudone tab 5-200mg
ibudone tab 10-200mg
LORTAB ELX 10-300MG
NORCO TAB 5-325MG
NORCO TAB 7.5-325
NORCO TAB 10-325MG
REPREXAIN TAB 2.5-200
REPREXAIN TAB 5-200MG
vicodin es tab 7.5-300
vicodin hp tab 10-300mg
vicodin tab 5-300mg
VICOPROFEN TAB 7.5-200
XODOL TAB 5-300MG
XODOL TAB 7.5-300
XODOL TAB 10-300MG
3
1
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
1
1
1
3
3
3
3
HYDROCODONE-NUTRITIONAL SUPPLEMENT COMBINATIONS
HYDROCODONE-NUTRITIONAL SUPPLEMENT COMBINATIONS
THERACODOPHN PAK -325
3
HYDROLYTIC ENZYMES
HYDROLYTIC ENZYMES
PULMOZYME SOL 1MG/ML
4
PA
HYPERAMMONEMIA TREATMENT - AGENTS
HYPERAMMONEMIA TREATMENT - AGENTS
CARBAGLU TAB 200MG
3
PA
HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS
HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS
calcitriol cap 0.5mcg
calcitriol cap 0.25mcg
calcitriol sol 1mcg/ml
doxercalcif cap 0.5mcg
doxercalcif cap 1mcg
doxercalcif cap 2.5mcg
1
1
1
1
1
1
ST - Step Therapy
97
Drug Name
HECTOROL CAP 0.5MCG
HECTOROL CAP 1MCG
HECTOROL CAP 2.5MCG
paricalcitol cap 1 mcg
ROCALTROL CAP 0.5MCG
ROCALTROL CAP 0.25MCG
ROCALTROL SOL 1MCG/ML
ZEMPLAR CAP 1MCG
ZEMPLAR CAP 2MCG
2
2
2
1
1
1
2
2
2
2
2
HYPNOTICS - TRICYCLIC AGENTS
HYPNOTICS - TRICYCLIC AGENTS
SILENOR TAB 3MG
SILENOR TAB 6MG
2
2
IBS AGENT - GUANYLATE CYCLASE-C (GC-C) AGONISTS
IBS AGENT - GUANYLATE CYCLASE-C (GC-C) AGONISTS
LINZESS CAP 145MCG
LINZESS CAP 290MCG
2
2
IBS AGENT - SELECTIVE 5-HT3 RECEPTOR ANTAGONISTS
IBS AGENT - SELECTIVE 5-HT3 RECEPTOR ANTAGONISTS
alosetron tab 0.5mg
alosetron tab 1mg
LOTRONEX TAB 0.5MG
LOTRONEX TAB 1MG
1
1
2
2
IMIDAZOLE-RELATED ANTIFUNGALS
IMIDAZOLE-RELATED ANTIFUNGALS
GYNAZOLE-1 CRE 2%
miconazole 3 sup 200mg
TERAZOL 3 CRE 0.8%
TERAZOL 7 CRE 0.4%
terconazole cre 0.4%
zazole cre 0.8%
zazole sup 80mg
3
1
2
2
1
1
1
IMIDAZOLE-RELATED ANTIFUNGALS - TOPICAL
IMIDAZOLE-RELATED ANTIFUNGALS - TOPICAL
CLOTRIMAZOLE CRY
econazole cre 1%
ECOZA AER 1%
ERTACZO CRE 2%
EXELDERM CRE 1%
EXELDERM SOL 1%
EXTINA AER 2%
3
1
3
3
3
3
3
ST - Step Therapy
98
Drug Name
JUBLIA SOL 10%
ketoconazole cre 2%
ketoconazole sha 2%
ketodan aer 2%
KETODAN KIT 2%
LUZU CRE 1%
NIZORAL SHA 2%
OXISTAT CRE 1%
OXISTAT LOT 1%
XOLEGEL GEL 2%
2
1
1
1
3
2
3
3
3
3
IMIDAZOLES
IMIDAZOLES
ketoconazole tab 200mg
MICONAZOLE POW
1
3
IMIDAZOTETRAZINES
IMIDAZOTETRAZINES
TEMODAR CAP 5MG
TEMODAR CAP 20MG
TEMODAR CAP 100MG
TEMODAR CAP 140MG
TEMODAR CAP 180MG
TEMODAR CAP 250MG
TEMODAR INJ 100MG
temozolomide cap 5mg
0
0
0
0
0
0
4
0
0
0
0
0
0
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
IMMUNOMODULATORS FOR MYELODYSPLASTIC SYNDROMES
IMMUNOMODULATORS FOR MYELODYSPLASTIC SYNDROMES
REVLIMID
REVLIMID
REVLIMID
REVLIMID
REVLIMID
REVLIMID
CAP
CAP
CAP
CAP
CAP
CAP
2.5MG
5MG
10MG
15MG
20MG
25MG
0
0
0
0
0
0
PA
PA
PA
PA
PA
PA
IMMUNOMODULATORS IMIDAZOQUINOLINAMINES - TOPICAL
IMMUNOMODULATORS IMIDAZOQUINOLINAMINES - TOPICAL
ALDARA CRE 5%
imiquimod cre 5%
ZYCLARA CRE 3.75%
ZYCLARA PUMP CRE 2.5%
3
1
2
2
ST - Step Therapy
99
Drug Name
IN VITRO ANTICOAGULANTS
IN VITRO ANTICOAGULANTS
ACD FORMULA SOL A
ACD FORMULA SOL B
ANTICOAG CPD SOL
ANTICOAGULNT SOL SOD CITR
TRICITRASOL CON
3
3
3
3
3
INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)
INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)
BYDUREON INJ
BYETTA INJ 5MCG
BYETTA INJ 10MCG
TANZEUM INJ 30MG
TANZEUM INJ 50MG
TRULICITY INJ 0.75/0.5
TRULICITY INJ 1.5/0.5
VICTOZA INJ 18MG/3ML
2
3
3
3
3
3
3
2
PA
PA
INFLAMMATORY BOWEL AGENTS
INFLAMMATORY BOWEL AGENTS
APRISO CAP 0.375GM
ASACOL HD TAB 800MG
AZULFIDINE TAB 500MG
AZULFIDINE TAB 500MG EN
balsalazide cap 750mg
CANASA SUP 1000MG
COLAZAL CAP 750MG
DELZICOL CAP 400MG
DIPENTUM CAP 250MG
GIAZO TAB 1.1GM
LIALDA TAB 1.2GM
mesalamine ene 4gm
mesalamine kit 4gm
PENTASA CAP 250MG CR
PENTASA CAP 500MG CR
ROWASA KIT 4GM
SFROWASA ENE 4GM
sulfasalazin tab 500mg
sulfazine ec tab 500mg
2
3
3
3
1
2
3
3
3
3
2
1
1
2
2
3
3
1
1
PA
PA
INFLUENZA AGENTS
INFLUENZA AGENTS
FLUMADINE TAB 100MG
rimantadine tab 100mg
3
1
INFLUENZA AGENTS-NUTRITIONAL SUPPLEMENT COMBINATIONS
ST - Step Therapy
100
Drug Name
INFLUENZA AGENTS-NUTRITIONAL SUPPLEMENT COMBINATIONS
RIMANTALIST PAK
3
INOSINE MONOPHOSPHATE DEHYDROGENASE INHIBITORS
INOSINE MONOPHOSPHATE DEHYDROGENASE INHIBITORS
CELLCEPT CAP 250MG
CELLCEPT SUS 200MG/ML
CELLCEPT TAB 500MG
mycophenolat cap 250mg
mycophenolat sus 200mg/ml
mycophenolat tab 500mg
mycophenolic tab 180mg dr
mycophenolic tab 360mg dr
MYFORTIC TAB 180MG
MYFORTIC TAB 360MG
2
2
2
1
1
1
1
1
2
2
INSULIN ADMINISTRATION SUPPLIES
INSULIN ADMINISTRATION SUPPLIES
ACCU-CHEK KIT SPIRIT
ACCU-CHEK MIS BATTERY
3ML CARTRIDG MIS PLASTIC
H-TRON PLUS MIS INS PUMP
OMNIPOD KIT STARTER
OMNIPOD MIS
PUMP INSULIN MIS BOOK #2
0
3
3
3
3
3
3
INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS)
INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS)
INCRELEX INJ 40MG/4ML
4
PA
4
PA
INTERLEUKIN-1 BLOCKERS
INTERLEUKIN-1 BLOCKERS
ARCALYST INJ 220MG
INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA)
INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA)
KINERET INJ
4
PA
INTERLEUKIN-6 RECEPTOR INHIBITORS
INTERLEUKIN-6 RECEPTOR INHIBITORS
ACTEMRA INJ 162/0.9
4
PA
INTERSTITIAL CYSTITIS AGENTS
INTERSTITIAL CYSTITIS AGENTS
ELMIRON CAP 100MG
3
INTEST CHOLEST ABSORP INHIB-HMG COA REDUCTASE INHIB COMB
INTEST CHOLEST ABSORP INHIB-HMG COA REDUCTASE INHIB COMB
VYTORIN TAB 10-10MG
VYTORIN TAB 10-20MG
2
2
ST - Step Therapy
101
Drug Name
VYTORIN TAB 10-40MG
VYTORIN TAB 10-80MG
2
2
INTESTINAL ACIDIFIERS
INTESTINAL ACIDIFIERS
enulose sol 10gm/15
1
INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS
INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS
ZETIA TAB 10MG
2
INTRARECTAL STEROIDS
INTRARECTAL STEROIDS
colocort ene 100mg
CORTENEMA ENE 100MG
CORTIFOAM AER 90MG
UCERIS AER 2MG/ACT
1
3
2
3
IODINE ANTISEPTICS
IODINE ANTISEPTICS
LUGOLS SOL STRONG
3
IODINE PRODUCTS
IODINE PRODUCTS
SSKI SOL 1GM/ML
3
IRON
IRON
fer-iron dro 15mg/ml
FERRLECIT INJ 12.5MG/M
FERROUS SUL LIQ 220/5ML
ferrous sulf elx 220/5ml
FERROUS SULF SYP 300/5ML
MYKIDZ IRON SUS 15/1.5ML
TRIFERIC SOL
wee care sus 15/1.25
0
3
3
0
3
3
3
0
IRON W/ FOLIC ACID
IRON W/ FOLIC ACID
FUSION PAK SPRINKLE
3
JANUS ASSOCIATED KINASE (JAK) INHIBITORS
JANUS ASSOCIATED KINASE (JAK) INHIBITORS
JAKAFI
JAKAFI
JAKAFI
JAKAFI
JAKAFI
TAB
TAB
TAB
TAB
TAB
5MG
10MG
15MG
20MG
25MG
0
0
0
0
0
PA
PA
PA
PA
PA
KERATOLYTIC AND/OR ANTIMITOTIC COMBINATIONS
KERATOLYTIC AND/OR ANTIMITOTIC COMBINATIONS
ST - Step Therapy
102
Drug Name
BENSAL HP OIN
GORDOFILM SOL
PYROGALL ACD OIN
salicylic ac aer 6%
SALKERA AER 6%
SALVAX DUO KIT PLUS
SUPRACIL CRE
3
3
3
1
3
3
3
KERATOLYTIC/ANTIMITOTIC AGENTS
KERATOLYTIC/ANTIMITOTIC AGENTS
CONDYLOX GEL 0.5%
CONDYLOX SOL 0.5%
KERALYT GEL 6%
KERALYT KIT SCALP 6%
PODOCON SOL 25%
podofilox sol 0.5%
SALEX CREAM KIT 6%
SALEX LOTION KIT 6%
SALEX SHA 6%
salicylic ac cre 6%
salicylic ac gel 6%
salicylic ac kit 6% cream
salicylic ac kit 6% lotn
SALICYLIC AC LIQ 26%
salicylic ac liq 27.5%
salicylic ac lot 6%
salicylic ac sha 6%
salicylic ac sol 28.5%
salicylic aer 6%
SALVAX AER 6%
ULTRASAL-ER SOL 28.5%
VIRASAL LIQ 27.5%
2
2
3
3
3
1
3
3
3
1
1
1
1
3
1
1
1
1
1
3
3
3
KETOLIDES
KETOLIDES
KETEK TAB 300MG
KETEK TAB 400MG
3
3
LAXATIVES - MISCELLANEOUS
LAXATIVES - MISCELLANEOUS
KRISTALOSE PAK 10GM
KRISTALOSE PAK 20GM
lactulose sol 10gm/15
3
3
1
LEPROSTATICS
LEPROSTATICS
dapsone tab 25mg
dapsone tab 100mg
1
1
ST - Step Therapy
103
Drug Name
LEPTIN ANALOGUES
LEPTIN ANALOGUES
MYALEPT INJ 11.3MG
3
PA
LEUKOTRIENE RECEPTOR ANTAGONISTS
LEUKOTRIENE RECEPTOR ANTAGONISTS
ACCOLATE TAB 10MG
ACCOLATE TAB 20MG
montelukast chw 4mg
montelukast chw 5mg
montelukast gra 4mg
montelukast tab 10mg
SINGULAIR CHW 4MG
SINGULAIR CHW 5MG
SINGULAIR GRA 4MG
SINGULAIR TAB 10MG
zafirlukast tab 10mg
zafirlukast tab 20mg
3
3
1
1
1
1
3
3
3
3
1
1
LEVODOPA COMBINATIONS
LEVODOPA COMBINATIONS
carb/levo100 tab /entacap
carb/levo 50 tab /entacap
carb/levo 75 tab /entacap
carb/levo er tab 25-100mg
carb/levo er tab 50-200mg
carb/levo tab 10-100mg
DUOPA SUS 4.63-20
RYTARY CAP
RYTARY CAP 23.75-95
SINEMET CR TAB 25-100MG
SINEMET CR TAB 50-200MG
SINEMET TAB 10-100MG
STALEVO 50 TAB
STALEVO 75 TAB
STALEVO 100 TAB
STALEVO 125 TAB
STALEVO 150 TAB
STALEVO 200 TAB
1
1
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
3
3
3
3
3
ST - Step Therapy
104
Drug Name
LHRH ANALOGS
LHRH ANALOGS
leuprolide inj 1mg/0.2
4
PA
LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS
LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS
SYNAREL SOL 2MG/ML
3
LINCOSAMIDE COMBINATIONS
LINCOSAMIDE COMBINATIONS
CLIN-LIDO KIT
3
LINCOSAMIDES
LINCOSAMIDES
CLEOCIN CAP 75MG
CLEOCIN CAP 150MG
CLEOCIN CAP 300MG
CLEOCIN PED SOL 75MG/5ML
CLIN SINGLE KIT USE
clindamycin cap 75mg
clindamycin sol 75mg/5ml
2
2
2
2
3
1
1
1
1
LINIMENT COMBINATIONS
LINIMENT COMBINATIONS
CAMPHOMEX SPR
REMATEX CRE
SILMANIX CRE
3
3
3
LINIMENTS
LINIMENTS
TURPENTINE SOL SPIRITS
3
LOCAL ANESTHETICS - TOPICAL
LOCAL ANESTHETICS - TOPICAL
ANACAINE OIN
cocaine hcl sol 4%
cocaine hcl sol 10%
LDO PLUS GEL 4%
lidocaine oin 5%
lidocaine pad 5%
lidocaine sol 4% 4%
LIDODERM DIS 5%
LIDOVEX CRE 3.75%
LIDOVIN CRE 3.95%
LIDOZOL CRE 3.75%
PROZENA PAD 4%
QUTENZA KIT 8% 1-PCH
3
1
1
3
1
1
1
2
3
3
3
3
3
ST - Step Therapy
105
Drug Name
XYLOCAINE SOL 4%
3
LOOP DIURETICS
LOOP DIURETICS
bumetanide tab 0.5mg
bumetanide tab 1mg
bumetanide tab 2mg
DEMADEX TAB 5MG
DEMADEX TAB 10MG
DEMADEX TAB 20MG
EDECRIN TAB 25MG
FUROSEMIDE SOL 8MG/ML
furosemide sol 10mg/ml
furosemide tab 20mg
furosemide tab 40mg
furosemide tab 80mg
LASIX TAB 20MG
LASIX TAB 40MG
LASIX TAB 80MG
torsemide tab 5mg
torsemide tab 10mg
torsemide tab 20mg
torsemide tab 100mg
1
1
1
3
3
3
3
2
1
1
1
1
3
3
3
1
1
1
1
LOW MOLECULAR WEIGHT HEPARINS
LOW MOLECULAR WEIGHT HEPARINS
enoxaparin inj 30/0.3ml
enoxaparin inj 100mg/ml
enoxaparin inj 120/0.8
enoxaparin inj 150mg/ml
enoxaparin inj 300/3ml
FRAGMIN INJ 2500/0.2
FRAGMIN INJ 10000/ML
FRAGMIN INJ 12500UNT
LOVENOX INJ 30/0.3ML
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
ST - Step Therapy
106
Drug Name
LOVENOX INJ
LOVENOX INJ
LOVENOX INJ
LOVENOX INJ
2
2
2
2
100MG/ML
120/0.8
150MG/ML
300/3ML
MACROLIDE IMMUNOSUPPRESSANTS
MACROLIDE IMMUNOSUPPRESSANTS
ASTAGRAF XL CAP 0.5MG
ASTAGRAF XL CAP 1MG
ASTAGRAF XL CAP 5MG
ENVARSUS XR TAB 0.75MG
ENVARSUS XR TAB 1MG
ENVARSUS XR TAB 4MG
PROGRAF CAP 0.5MG
PROGRAF CAP 1MG
PROGRAF CAP 5MG
RAPAMUNE SOL 1MG/ML
RAPAMUNE TAB 0.5MG
RAPAMUNE TAB 1MG
RAPAMUNE TAB 2MG
sirolimus tab 0.5mg
sirolimus tab 1mg
sirolimus tab 2mg
tacrolimus cap 0.5mg
tacrolimus cap 1mg
tacrolimus cap 5mg
ZORTRESS TAB 0.5MG
ZORTRESS TAB 0.25MG
ZORTRESS TAB 0.75MG
3
3
3
3
3
3
2
2
2
2
2
2
2
1
1
1
1
1
1
3
3
3
MACROLIDE IMMUNOSUPPRESSANTS - TOPICAL
MACROLIDE IMMUNOSUPPRESSANTS - TOPICAL
ELIDEL CRE 1%
PROTOPIC OIN 0.1%
PROTOPIC OIN 0.03%
tacrolimus oin 0.1%
tacrolimus oin 0.03%
2
3
3
1
1
MEGLITINIDE ANALOGUES
MEGLITINIDE ANALOGUES
nateglinide tab 60mg
nateglinide tab 120mg
PRANDIN TAB 0.5MG
PRANDIN TAB 1MG
PRANDIN TAB 2MG
repaglinide tab 0.5mg
repaglinide tab 1mg
1
1
3
3
3
1
1
ST - Step Therapy
107
Drug Name
repaglinide tab 2mg
STARLIX TAB 60MG
STARLIX TAB 120MG
1
3
3
MEGLITINIDE-BIGUANIDE COMBINATIONS
MEGLITINIDE-BIGUANIDE COMBINATIONS
PRANDIMET TAB 1-500MG
PRANDIMET TAB 2-500MG
3
3
MEPERIDINE COMBINATIONS
MEPERIDINE COMBINATIONS
MEPER/PROMET CAP 50-25MG
3
METHENAMINE COMBOS
METHENAMINE COMBOS
UROQID #2 TAB
3
MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN INHIBITORS
MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN INHIBITORS
JUXTAPID
JUXTAPID
JUXTAPID
JUXTAPID
JUXTAPID
JUXTAPID
CAP
CAP
CAP
CAP
CAP
CAP
5MG
10MG
20MG
30MG
40MG
60MG
3
3
3
3
3
3
PA
PA
PA
PA
PA
PA
MIGRAINE COMBINATIONS
MIGRAINE COMBINATIONS
isometh/caff tab /apap
migragesic cap ida
PRODRIN TAB
1
1
3
MIGRAINE PRODUCTS
MIGRAINE PRODUCTS
D.H.E. 45 INJ 1MG/ML
dihydroergot inj 1mg/ml
dihydroergot spr 4mg/ml
ERGOMAR SUB 2MG
MIGRANAL SPR 4MG/ML
2
1
1
3
2
QL (12ea/ 25 Days)
QL (12ea/ 25 Days)
MINERALOCORTICOIDS
MINERALOCORTICOIDS
fludrocort tab 0.1mg
1
MIOTICS - CHOLINESTERASE INHIBITORS
MIOTICS - CHOLINESTERASE INHIBITORS
PHOSPHOLINE SOL 0.125%OP
3
MIOTICS - DIRECT ACTING
MIOTICS - DIRECT ACTING
ISO CARBACHO SOL 1.5% OP
3
ST - Step Therapy
108
Drug Name
ISO CARBACHO SOL 3% OP
ISOPTO CARP SOL 1% OP
pilocarpine sol 1% op
3
3
3
3
1
1
1
MISC. ANTI-ULCER
MISC. ANTI-ULCER
CARAFATE SUS 1GM/10ML
CARAFATE TAB 1GM
sucralfate tab 1gm
2
2
1
MISC. DERMATOLOGICAL PRODUCTS
MISC. DERMATOLOGICAL PRODUCTS
EMULSION SB EMU
HYLATOPIC AER
NUVAIL SOL 16%
3
3
3
MISC. DEVICES
MISC. DEVICES
BD SAFE CLIP MIS NDL CLPR
0
MISC. RESPIRATORY INHALANTS
MISC. RESPIRATORY INHALANTS
HYPER-SAL NEB 7%
HYPERSAL NEB 3.5%
NEBUSAL NEB 6%
sod chloride neb 0.9%
sodium chlor neb 3%
sodium chlor neb 7%
sodium chlor neb 10%
3
3
3
1
1
1
1
MISC. TOPICAL
MISC. TOPICAL
ARNICA TIN FLOWER
DRYSOL SOL 20%
3
3
MISC. TOPICAL COMBINATIONS
MISC. TOPICAL COMBINATIONS
DERMACINRX KIT COMBOPAK
DERMACINRX KIT PHARMAPA
3
3
MISCELLANEOUS VAGINAL COMBINATIONS
MISCELLANEOUS VAGINAL COMBINATIONS
FEM PH GEL
relagard gel
3
1
MITOTIC INHIBITORS
MITOTIC INHIBITORS
ST - Step Therapy
109
Drug Name
etoposide cap 50mg
0
MIXED ADRENERGICS
MIXED ADRENERGICS
epinephrine inj 0.1mg/ml
epinephrine inj 1mg/ml
1
1
MIXED ALLERGENIC EXTRACTS
MIXED ALLERGENIC EXTRACTS
ORALAIR SUB 300 IR
2
MONOAMINE OXIDASE INHIBITORS (MAOIS)
MONOAMINE OXIDASE INHIBITORS (MAOIS)
EMSAM DIS 6MG/24HR
EMSAM DIS 9MG/24HR
EMSAM DIS 12MG/24H
MARPLAN TAB 10MG
NARDIL TAB 15MG
PARNATE TAB 10MG
phenelzine tab 15mg
tranylcyprom tab 10mg
3
3
3
3
2
2
1
1
MOVEMENT DISORDER DRUG THERAPY
MOVEMENT DISORDER DRUG THERAPY
tetrabenazin tab 12.5mg
tetrabenazin tab 25mg
XENAZINE TAB 12.5MG
XENAZINE TAB 25MG
4
4
4
4
PA
PA
PA
PA
MS AGENTS - PYRIMIDINE SYNTHESIS INHIBITORS
MS AGENTS - PYRIMIDINE SYNTHESIS INHIBITORS
AUBAGIO TAB 7MG
AUBAGIO TAB 14MG
4
4
PA
PA
MUCOLYTICS
MUCOLYTICS
acetylcyst sol 10%
acetylcyst sol 20%
1
1
MULTIPLE SCLEROSIS AGENTS
MULTIPLE SCLEROSIS AGENTS
COPAXONE INJ 20MG/ML
COPAXONE INJ 40MG/ML
glatopa inj 20mg/ml
4
4
4
PA
PA
PA
MULTIPLE SCLEROSIS AGENTS - INTERFERONS
MULTIPLE SCLEROSIS AGENTS - INTERFERONS
AVONEX KIT 30MCG
AVONEX PEN KIT 30MCG
AVONEX PREFL KIT 30MCG
EXTAVIA INJ 0.3MG
4
PA
4
PA
4
PA
4
PA
ST - Step Therapy
110
Drug Name
PLEGRIDY INJ
PLEGRIDY INJ PEN
PLEGRIDY INJ STARTER
PLEGRIDY PEN INJ STARTER
REBIF INJ 22/0.5
REBIF INJ 44/0.5
REBIF REBIDO INJ 22/0.5
REBIF REBIDO INJ 44/0.5
REBIF REBIDO INJ TITRATN
REBIF TITRTN INJ PACK
2
PA
2
PA
2
PA
2
PA
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
MULTIPLE SCLEROSIS AGENTS - NRF2 PATHWAY ACTIVATORS
MULTIPLE SCLEROSIS AGENTS - NRF2 PATHWAY ACTIVATORS
TECFIDERA CAP 120MG
TECFIDERA CAP 240MG
TECFIDERA MIS STARTER
4
4
4
PA
PA
PA
MULTIPLE SCLEROSIS AGENTS - POTASSIUM CHANNEL BLOCKERS
MULTIPLE SCLEROSIS AGENTS - POTASSIUM CHANNEL BLOCKERS
AMPYRA TAB 10MG
4
PA
MULTIPLE URINE TESTS
MULTIPLE URINE TESTS
KETO-DIASTIX TES
MULTISTIX 10 TES SG
0
3
MUSCLE RELAXANT COMBINATIONS
MUSCLE RELAXANT COMBINATIONS
carisopr/asa tab 200-325
carisoprodol tab asa/cod
orph/asa/caf tab
1
1
1
MUSCLE RELAXANT-LINIMENTS COMBINATIONS
MUSCLE RELAXANT-LINIMENTS COMBINATIONS
FLEXEPAX MIS
3
MUSCLE RELAXANT-NUTRITIONAL SUPPLEMENT COMBINATIONS
MUSCLE RELAXANT-NUTRITIONAL SUPPLEMENT COMBINATIONS
PRAZOLAMINE PAK
THERABENZAPR PAK -90
THERABENZAPR PAK -90-5
3
3
3
N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONISTS
N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONISTS
memant titra pak 5-10mg
memantine hc sol 2mg/ml
memantine tab hcl 5mg
memantine tab hcl 10mg
NAMENDA SOL 10MG/5ML
NAMENDA TAB 5-10MG
1
1
1
1
2
2
ST - Step Therapy
111
Drug Name
NAMENDA TAB 5MG
NAMENDA TAB 10MG
NAMENDA XR CAP 7MG
NAMENDA XR CAP 14MG
NAMENDA XR CAP 21MG
NAMENDA XR CAP 28MG
NAMENDA XR CAP TITRATIO
2
2
2
2
2
2
2
NASAL ANTIBIOTICS
NASAL ANTIBIOTICS
BACTROBAN OIN NASAL 2%
3
NASAL ANTICHOLINERGICS
NASAL ANTICHOLINERGICS
ATROVENT NAS SOL 0.03%
ATROVENT NAS SOL 0.06%
ipratropium spr 0.03%
ipratropium spr 0.06%
2
2
1
1
NASAL ANTIHISTAMINES
NASAL ANTIHISTAMINES
ASTEPRO SPR 0.15%
azelastine spr 0.1%
azelastine spr 0.15%
olopatadine spr 0.6%
PATANASE SPR 0.6%
3
1
1
1
3
NASAL STEROIDS
NASAL STEROIDS
BECONASE AQ SUS 0.042%
budesonide sus 32mcg
flunisolide spr 0.025%
NASONEX SPR 50MCG/AC
OMNARIS SPR
QNASL AER 80MCG
QNASL CHILD SPR 40MCG
RHINOCORT SUS AQUA
triamcinolon aer 55mcg/ac
VERAMYST SPR 27.5MCG
ZETONNA AER 37MCG
3
1
1
2
3
3
3
3
1
3
3
PA
PA
PA
PA
PA
PA
PA
NATURAL PENICILLINS
NATURAL PENICILLINS
penicilln
penicilln
penicilln
penicilln
NEEDLES
vk
vk
vk
vk
sol 125/5ml
sol 250/5ml
tab 250mg
tab 500mg
1
1
1
1
SYRINGES
ST - Step Therapy
112
Drug Name
NEEDLES
SYRINGES
ANESTH NEEDL MIS 20GX4"
AUTOSHIELD MIS 29X3/16"
AUTOSHIELD MIS 29X5/16"
AUTOSHIELD MIS 30GX3/16
BD ECLIPSE MIS 1ML/27G
BD ECLIPSE MIS 1ML/30G
BD NEEDLE MIS 23GX1.25
BD NEEDLE MIS 30G X 1"
BD NEEDLES MIS 25GX7/8"
BLUNT CANNUL MIS 17GX1.5"
BULB IRR SYR MIS 60ML
COMFORT EZ MIS 33GX5MM
CRONO SYR MIS 10ML
CRONO SYR MIS 20ML
18G SHIELDED MIS NEEDLE
HUBER NEEDLE MIS 19GX1.25
HUBER NEEDLE MIS 19GX3/4"
HUBER NEEDLE MIS 20GX1.25
HUMAPEN MIS LUXURA
HUMATROPEN MIS FOR 6MG
HYPO NEEDLE MIS 14GX1"
HYPO NEEDLE MIS 14GX1.5"
HYPO NEEDLE MIS 16GX3/4"
HYPO NEEDLE MIS 21GX1.25
3
3
3
3
0
0
0
3
3
3
3
3
3
3
0
0
0
3
3
3
3
3
3
0
0
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
ST - Step Therapy
113
Drug Name
INSULIN PEN MIS 31GX4MM
INSULIN SYRG MIS 0.3/28G
INSULIN SYRG MIS 1ML
INSULIN SYRG MIS 1ML/25G
INSULIN SYRG MIS 2/27.5G
INSUPEN MIS 33GX4MM
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
ST - Step Therapy
114
Drug Name
INSUPEN SENS MIS 32GX8MM
J-TIP KIT KIT ADAPTERS
KLATSKIN BIO MIS 16X4"
12ML LL SYRN MIS 20GX1"
10ML LL SYRN MIS 20GX1.5"
10ML LL SYRN MIS 21GX1.5"
10ML LL SYRN MIS 23GX1.25
3ML LL SYRNG MIS 18GX1.5"
5ML LL SYRNG MIS 20GX1"
3ML LL SYRNG MIS 20GX3/4"
3ML LL SYRNG MIS 21GX1.25
6ML LUER LOK MIS 20GX1"
6ML LUER LOK MIS 21GX1.25
6ML LUER LOK MIS 22GX1.25
LUER-LOK SYR MIS 1ML/20G
MONOJECT S/P MIS 20ML/LT
MONOJECT S/P MIS 35ML/REG
NOVOFINE MIS 30GX8MM
NOVOFINE MIS 32GX6MM
NOVOFINE PLS MIS 32GX4MM
NOVOTWIST MIS 32GX5MM
PEN NEEDLES MIS 29GX12.7
PLAS ADAPT MIS 1ML
ROSENTHAL MIS
SAFETYGLIDE MIS 27GX5/8"
SAFTY NEEDLE MIS 21GX5/8"
SAFTY NEEDLE MIS 23GX5/8"
0
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
2
3
3
0
0
0
0
0
3
3
3
3
3
ST - Step Therapy
115
Drug Name
STIMEX NEEDL MIS 22GX4.25
STIMEX NEEDL MIS 22X2-1/8
SYMPATH NDL MIS 18GX6"
1ML SYR/NEED MIS 26GX5/8"
1 ML SYRIMGE MIS 18GX1"
140ML SYRING MIS LUER-LOC
2.5ML SYRING MIS TRAY PAK
6ML SYRINGE MIS 18GX1"
3ML SYRINGE MIS 20GX1.5"
1 ML SYRINGE MIS 22X1-1/2
3ML SYRINGE MIS 25GX1.25
1ML SYRINGE MIS 25GX5/8"
3ML SYRINGE MIS 27GX1.25
6ML SYRINGE MIS CANNULA
20ml syringe mis luer slp
10ML SYRINGE MIS LUER-LOK
12ML SYRINGE MIS REG LUER
3ML SYRINGE MIS REG TIP
20-25ML SYRN MIS LUER LCK
1.5 ML SYRNG MIS 22X1-1/2
TB SYRINGE MIS 0.5/28G
1ML TB SYRNG MIS 21GX1"
1ML TB SYRNG MIS 25GX5/8"
1ML TB SYRNG MIS REG LUER
TOOMEY SYRIN MIS 70ML
UNIFINE PNTP MIS 29GX12MM
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
0
ST - Step Therapy
116
Drug Name
YALE NEEDLES MIS 21GX2"
0
0
0
3
NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB
NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB
ENTRESTO TAB 24-26MG
3
3
3
PA
PA
PA
RELENZA MIS DISKHALE
2
TAMIFLU CAP 30MG
2
TAMIFLU CAP 45MG
2
TAMIFLU CAP 75MG
2
TAMIFLU SUS 6MG/ML
2
QL (40ea/ 90 Days; 1
fill/90 days)
fill/90 days)
fill/90 days)
fill/90 days)
QL (180ml/ 90 Days; 1
fill/90 days)
NEURAMINIDASE INHIBITORS
NEURAMINIDASE INHIBITORS
NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS
NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS
NORTHERA CAP 100MG
NORTHERA CAP 200MG
NORTHERA CAP 300MG
4
4
4
PA
PA
PA
NICOTINIC ACID DERIVATIVES
NICOTINIC ACID DERIVATIVES
niacin er tab 500mg
niacin er tab 750mg
niacin er tab 1000mg
niacor tab 500mg
NIASPAN TAB 500MG ER
NIASPAN TAB 750MG ER
NIASPAN TAB 1000 ER
1
1
1
1
3
3
3
NITRATE VASODILATOR COMBINATIONS
NITRATE VASODILATOR COMBINATIONS
BIDIL TAB
2
NITRATE VASODILATING AGENTS
NITRATE VASODILATING AGENTS
RECTIV OIN 0.4%
3
NITRATES
NITRATES
ST - Step Therapy
117
Drug Name
DILATRATE SR CAP 40MG
ISORDIL TAB 5MG
ISORDIL TAB 40MG
isosorb din tab 5mg
isosorb din tab 10mg
isosorb din tab 40mg er
isosorb mono tab 10mg
isosorb mono tab 20mg
isosorb mono tab 30mg er
NITRO-BID OIN 2%
NITRO-DUR DIS 0.1MG/HR
nitroglycer aer 400mcg
nitroglycer cap 2.5mg er
nitroglycer cap 6.5mg er
nitroglycer cap 9mg er
nitroglycer dis 0.1mg/hr
nitroglycrn spr 0.4mg
NITROLINGUAL SPR PUMPSPRA
NITROMIST AER 400MCG
NITRONAL SOL 1MG/ML
NITROSTAT SUB 0.3MG
NITROSTAT SUB 0.4MG
NITROSTAT SUB 0.6MG
3
2
2
1
1
1
1
1
1
1
1
1
1
3
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
2
3
3
2
2
2
NITROGEN MUSTARDS
NITROGEN MUSTARDS
ALKERAN TAB 2MG
CYCLOPHOSPH CAP 25MG
CYCLOPHOSPH CAP 50MG
LEUKERAN TAB 2MG
0
0
0
0
NITROSOUREAS
NITROSOUREAS
GLEOSTINE CAP 10MG
0
ST - Step Therapy
118
Drug Name
GLEOSTINE CAP 40MG
GLEOSTINE CAP 100MG
lomustine cap 10mg
lomustine cap 40mg
lomustine cap 100mg
0
0
0
0
0
NON-BENZODIAZEPINE - GABA-RECEPTOR MODULATORS
NON-BENZODIAZEPINE - GABA-RECEPTOR MODULATORS
AMBIEN CR TAB 6.25MG
AMBIEN CR TAB 12.5MG
AMBIEN TAB 5MG
AMBIEN TAB 10MG
EDLUAR SUB 5MG
EDLUAR SUB 10MG
eszopiclone tab 1mg
eszopiclone tab 2mg
eszopiclone tab 3mg
INTERMEZZO SUB 1.75MG
INTERMEZZO SUB 3.5MG
LUNESTA TAB 1MG
LUNESTA TAB 2MG
LUNESTA TAB 3MG
SONATA CAP 5MG
SONATA CAP 10MG
zaleplon cap 5mg
zaleplon cap 10mg
zolpidem er tab 6.25mg
zolpidem er tab 12.5mg
zolpidem tab 5mg
zolpidem tab 10mg
ZOLPIMIST SPR 5MG
3
3
3
3
3
3
1
1
1
3
3
3
3
3
3
3
1
1
1
1
1
1
3
PA
PA
PA
PA
PA
NON-NARC ANTITUSSIVE-ANTIHISTAMINE
NON-NARC ANTITUSSIVE-ANTIHISTAMINE
promethazine syp dm
1
NON-NARC ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE
NON-NARC ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE
CARBAPHEN 12 LIQ
CARBAPHEN 12 SUS PED
NEOTUSS PLUS LIQ
PEDIATEX TDM SUS
TGQ 15DM/5PE SYP H/2CPM
TGQ 30/PSE/3 SYP BRM/15DM
3
3
3
3
3
3
NONERGOLINE DOPAMINE RECEPTOR AGONISTS
NONERGOLINE DOPAMINE RECEPTOR AGONISTS
APOKYN INJ 10MG/ML
4
PA
ST - Step Therapy
119
Drug Name
MIRAPEX ER TAB 0.75MG
MIRAPEX ER TAB 3MG
MIRAPEX TAB 0.5MG
MIRAPEX TAB 0.25MG
MIRAPEX TAB 0.75MG
MIRAPEX TAB 0.125MG
MIRAPEX TAB 1.5MG
MIRAPEX TAB 1MG
NEUPRO DIS 1MG/24HR
NEUPRO DIS 2MG/24HR
NEUPRO DIS 3MG/24HR
NEUPRO DIS 4MG/24HR
NEUPRO DIS 6MG/24HR
NEUPRO DIS 8MG/24HR
pramipexole tab 0.5mg
pramipexole tab 0.75 er
pramipexole tab 1.5mg er
pramipexole tab 1mg
pramipexole tab 3mg
REQUIP TAB 0.5MG
REQUIP TAB 0.25MG
REQUIP TAB 1MG
REQUIP TAB 2MG
REQUIP TAB 3MG
REQUIP TAB 4MG
REQUIP TAB 5MG
REQUIP XL TAB 2MG
REQUIP XL TAB 4MG
REQUIP XL TAB 6MG
REQUIP XL TAB 8MG
REQUIP XL TAB 12MG
ropinirole tab 0.5mg
ropinirole tab 0.25mg
ropinirole tab 1mg
2
2
2
2
2
2
2
3
3
3
3
3
3
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
3
3
3
1
1
1
ST - Step Therapy
120
Drug Name
ropinirole tab
ropinirole tab
ropinirole tab
ropinirole tab
ropinirole tab
ropinirole tab
ropinirole tab
ropinirole tab
ropinirole tab
2mg
2mg er
3mg
4mg
4mg er
5mg
6mg er
8mg er
12mg er
1
1
1
1
1
1
1
1
1
NONSTEROIDAL ANTI-INFLAMMATORY AGENT COMBINATIONS
NONSTEROIDAL ANTI-INFLAMMATORY AGENT COMBINATIONS
ARTHROTEC 50 TAB
ARTHROTEC 75 TAB
DERMA SILKRX PAK DICLOPAK
DERMACINRX KIT ANALGESI
DERMACINRX PAK INFLAMMA
diclo/misopr tab 50-0.2mg
diclo/misopr tab 75-0.2mg
DUEXIS TAB 800-26.6
FLEXIZOL PAK COMBIPAK
IC 400 KIT 400MG
IC 800 KIT 800MG
NAPROPAK PAK
NAPROPAK PAK COOL
VIMOVO TAB 375-20MG
VIMOVO TAB 500-20MG
3
3
3
3
3
1
1
3
3
3
3
3
3
3
3
PA
PA
PA
PA
PA
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)
advil jr st tab 100mg
ADVIL MIGRAI CAP 200MG
ADVIL TAB 200MG
ALEVE CAP 220MG
ALEVE TAB 220MG
all day pain tab 220mg
ANAPROX DS TAB 550MG
ANAPROX TAB 275MG
CHILD MOTRIN CHW 50MG
DAYPRO TAB 600MG
diclofen pot tab 50mg
diclofenac tab 25mg dr
diclofenac tab 100mg er
EC-NAPROSYN TAB 375MG
1
3
3
3
3
1
2
2
3
2
1
1
1
1
1
3
ST - Step Therapy
121
Drug Name
EC-NAPROSYN TAB 500MG
etodolac cap 200mg
etodolac cap 300mg
etodolac er tab 400mg
etodolac tab 400mg
etodolac tab 500mg
FELDENE CAP 10MG
FELDENE CAP 20MG
fenoprofen cap 400mg
fenoprofen tab 600mg
flurbiprofen tab 50mg
flurbiprofen tab 100mg
ibuprofen dro 50/1.25
ibuprofen jr chw 100mg
ibuprofen sus 100/5ml
ibuprofen tab 400mg
ibuprofen tab 600mg
ibuprofen tab 800mg
INDOCIN SUP 50MG
INDOCIN SUS 25MG/5ML
indomethacin cap 25mg
indomethacin cap 50mg
indomethacin cap 75mg er
ketoprofen cap 50mg
ketoprofen cap 75mg
ketoprofen cap 200mg er
ketorolac tab 10mg
meclofen sod cap 50mg
meclofen sod cap 100mg
mefenam acid cap 250mg
meloxicam sus 7.5/5ml
meloxicam tab 7.5mg
meloxicam tab 15mg
MOBIC SUS 7.5/5ML
MOBIC TAB 7.5MG
MOBIC TAB 15MG
MOTRIN CHILD SUS 100/5ML
motrin ib tab 200mg
MOTRIN INFAN DRO 50/1.25
MOTRIN JR ST CHW 100MG
MOTRIN JR ST TAB 100MG
nabumetone tab 500mg
nabumetone tab 750mg
3
1
1
1
1
1
1
1
3
3
1
1
1
1
1
1
1
1
1
1
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
3
1
3
3
3
1
1
ST - Step Therapy
122
Drug Name
NALFON CAP 400MG
NAPRELAN TAB 375MG CR
NAPROSYN TAB 250MG
NAPROSYN TAB 375MG
NAPROSYN TAB 500MG
naproxen dr tab 375mg
naproxen dr tab 500mg
NAPROXEN POW SODIUM
naproxen sod cap 220mg
naproxen sod tab 275mg
naproxen sod tab 375mg cr
naproxen sod tab 500mg cr
naproxen sod tab 550mg
naproxen sus 125/5ml
naproxen tab 250mg
naproxen tab 375mg
naproxen tab 500mg
NEOPROFEN SOL 10MG/ML
oxaprozin tab 600mg
piroxicam cap 10mg
piroxicam cap 20mg
PONSTEL CAP 250MG
SPRIX SPR 15.75MG
sulindac tab 150mg
sulindac tab 200mg
TIVORBEX CAP 20MG
TIVORBEX CAP 40MG
tolmetin sod cap 400mg
tolmetin sod tab 200mg
tolmetin sod tab 600mg
wal-profen cap 200mg
ZIPSOR CAP 25MG
ZORVOLEX CAP 18MG
ZORVOLEX CAP 35MG
3
3
PA
3
3
2
2
2
1
1
3
1
1
1
1
1
1
1
1
1
3
1
1
1
3
3
1
1
3
3
1
1
1
1
3
3
3
NSAID-DIETARY MANAGEMENT COMBINATIONS
NSAID-DIETARY MANAGEMENT COMBINATIONS
PRASTERA KIT
THERAFELDAMI PAK
THERAPROFEN PAK 800MG
THERAPROFEN PAK -90
THERAPROXEN PAK 500MG
THERAPROXEN PAK -90
3
3
3
3
3
3
ST - Step Therapy
123
Drug Name
TREPADICLOFE PAK 25MG
TREPOXICAM PAK 7.5MG
3
3
NSAID-VITAMINS AND/OR MINERALS COMBINATIONS
NSAID-VITAMINS AND/OR MINERALS COMBINATIONS
IBU/MINREX PAK
3
NUTRITIONAL SUPPLEMENTS
NUTRITIONAL SUPPLEMENTS
PROMACTIN AA SUS PLUS
3
OPHTHALMIC ANTI-INFECTIVE COMBINATIONS
OPHTHALMIC ANTI-INFECTIVE COMBINATIONS
neo-polycin oin op
neo/poly/gra sol op
NEOSPORIN SOL OP
polycin oin op
POLYTRIM SOL OP
trimethoprim sol polymyxn
1
1
3
1
3
1
OPHTHALMIC ANTIALLERGIC
OPHTHALMIC ANTIALLERGIC
ALOCRIL SOL 2%
ALOMIDE SOL 0.1% OP
azelastine dro 0.05%
BEPREVE DRO 1.5%
cromolyn sod sol 4% op
ELESTAT DRO 0.05%
EMADINE SOL 0.05% OP
epinastine dro 0.05%
LASTACAFT SOL 0.25%
PATADAY SOL 0.2%
PATANOL SOL 0.1% OP
PAZEO DRO 0.7%
3
3
1
3
1
3
3
1
3
2
2
3
PA
OPHTHALMIC ANTIBIOTICS
OPHTHALMIC ANTIBIOTICS
AZASITE SOL 1%
bacitracin oin op
BESIVANCE SUS 0.6%
CILOXAN OIN 0.3% OP
CILOXAN SOL 0.3% OP
ciprofloxacn sol 0.3% op
GARAMYCIN SOL 0.3% OP
gatifloxacin sol 0.5%
gentamicin oin 0.3% op
gentamicin sol 0.3% op
ilotycin oin op
3
1
2
3
3
1
3
1
1
1
1
ST - Step Therapy
124
Drug Name
levofloxacin sol 0.5%
MITOSOL KIT 0.2MG
MOXEZA SOL 0.5%
OCUFLOX DRO 0.3% OP
ofloxacin dro 0.3% op
tobramycin sol 0.3% op
TOBREX OIN 0.3% OP
TOBREX SOL 0.3% OP
VIGAMOX DRO 0.5%
ZYMAXID SOL 0.5%
1
3
2
3
1
1
3
3
2
3
OPHTHALMIC ANTIFUNGAL
OPHTHALMIC ANTIFUNGAL
NATACYN SUS 5% OP
3
OPHTHALMIC ANTISEPTICS
OPHTHALMIC ANTISEPTICS
BETADINE SOL 5% OP
3
OPHTHALMIC ANTIVIRALS
OPHTHALMIC ANTIVIRALS
trifluridine sol 1% op
VIROPTIC SOL 1% OP
ZIRGAN GEL 0.15%
1
2
3
OPHTHALMIC CARBONIC ANHYDRASE INHIBITORS
OPHTHALMIC CARBONIC ANHYDRASE INHIBITORS
AZOPT SUS 1% OP
dorzolamide sol 2% op
TRUSOPT SOL 2% OP
2
1
3
OPHTHALMIC DECONGESTANTS
OPHTHALMIC DECONGESTANTS
naphazoline sol 0.1% op
phenylephrin sol 2.5% op
phenylephrin sol 10% op
1
1
1
OPHTHALMIC IMMUNOMODULATORS
OPHTHALMIC IMMUNOMODULATORS
RESTASIS EMU 0.05%
2
OPHTHALMIC LOCAL ANESTHETICS
OPHTHALMIC LOCAL ANESTHETICS
AKTEN GEL 3.5%
ALCAINE SOL 0.5% OP
proparacaine sol 0.5% op
tetracaine sol 0.5% op
3
3
1
1
OPHTHALMIC NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
OPHTHALMIC NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
ACULAR LS SOL 0.4%
3
ST - Step Therapy
125
Drug Name
ACULAR SOL 0.5% OP
ACUVAIL SOL 0.45%
bromfenac sol 0.09% op
diclofenac sol 0.1% op
flurbiprofen sol 0.03% op
ILEVRO DRO 0.3% OP
ketorolac sol 0.4%
ketorolac sol 0.5%
NEVANAC SUS 0.1%
OCUFEN SOL 0.03% OP
PROLENSA SOL 0.07%
3
3
1
1
1
3
1
1
3
3
2
OPHTHALMIC SELECTIVE ALPHA ADRENERGIC AGONISTS
OPHTHALMIC SELECTIVE ALPHA ADRENERGIC AGONISTS
ALPHAGAN P SOL 0.1%
ALPHAGAN P SOL 0.15%
apraclonidin sol 0.5% op
brimonidine sol 0.2% op
brimonidine sol 0.15%
IOPIDINE SOL 0.5% OP
IOPIDINE SOL 1% OP
2
2
1
1
1
3
3
OPHTHALMIC STEROID COMBINATIONS
OPHTHALMIC STEROID COMBINATIONS
BLEPHAMIDE OIN S.O.P.
BLEPHAMIDE SUS OP
MAXITROL OIN 0.1% OP
MAXITROL SUS 0.1% OP
neo-polycin oin hc 1%op
neo/poly/dex oin 0.1% op
neo/poly/dex sus 0.1% op
neo/poly/hc sus op
PRED-G S.O.P OIN OP
PRED-G SUS OP
sulf/pred na sol op
tobra/dexame sus 0.3-0.1%
TOBRADEX OIN 0.3-0.1%
TOBRADEX ST SUS 0.3-0.05
TOBRADEX SUS 0.3-0.1%
ZYLET SUS 0.5-0.3%
3
3
3
3
1
1
1
1
3
3
1
1
2
2
3
2
OPHTHALMIC STEROIDS
OPHTHALMIC STEROIDS
ALREX SUS 0.2%
dexameth pho sol 0.1% op
DUREZOL EMU 0.05%
FLAREX SUS 0.1% OP
2
1
2
3
ST - Step Therapy
126
Drug Name
fluoromethol sus 0.1% op
FML FORTE SUS 0.25% OP
FML LIQUIFLM SUS 0.1% OP
FML OIN 0.1% OP
LOTEMAX GEL 0.5%
LOTEMAX OIN 0.5%
LOTEMAX SUS 0.5%
MAXIDEX SUS 0.1% OP
OMNIPRED SUS 1% OP
PRED MILD SUS 0.12% OP
PRED SOD PHO SOL 1% OP
prednisolone sus 1% op
VEXOL SUS 1% OP
1
3
3
3
2
2
2
3
3
3
3
1
3
OPHTHALMIC SULFONAMIDES
OPHTHALMIC SULFONAMIDES
BLEPH-10 SOL 10% OP
sulfacet sod oin 10% op
sulfacet sod sol 10% op
3
1
1
OPHTHALMIC SURGICAL AIDS
OPHTHALMIC SURGICAL AIDS
GELFILM MIS OP
3
OPHTHALMICS - CYSTINOSIS AGENTS
OPHTHALMICS - CYSTINOSIS AGENTS
CYSTARAN SOL 0.44%
3
PA
OPIOID AGONISTS
OPIOID AGONISTS
ABSTRAL SUB 100MCG
ABSTRAL SUB 200MCG
ABSTRAL SUB 300MCG
ABSTRAL SUB 400MCG
ABSTRAL SUB 600MCG
ABSTRAL SUB 800MCG
ACTIQ LOZ 200MCG
ACTIQ LOZ 400MCG
ACTIQ LOZ 600MCG
ACTIQ LOZ 800MCG
ACTIQ LOZ 1200MCG
ACTIQ LOZ 1600MCG
codeine sulf tab 15mg
CONZIP CAP 100MG
CONZIP CAP 200MG
CONZIP CAP 300MG
2
PA
2
PA
2
PA
2
PA
2
PA
2
PA
3
PA
3
PA
3
PA
3
PA
3
PA
3
PA
1
1
1
3
3
3
ST - Step Therapy
127
Drug Name
DEMEROL TAB 50MG
DEMEROL TAB 100MG
DILAUDID LIQ 1MG/ML
DILAUDID TAB 2MG
DILAUDID TAB 4MG
DILAUDID TAB 8MG
DOLOPHINE TAB 5MG
DOLOPHINE TAB 10MG
DURAGESIC DIS 12MCG/HR
DURAGESIC DIS 100MCG/H
EMBEDA CAP 20-0.8MG
EMBEDA CAP 30-1.2MG
EMBEDA CAP 50-2MG
EMBEDA CAP 60-2.4MG
EMBEDA CAP 80-3.2MG
EMBEDA CAP 100-4MG
EXALGO TAB 8MG
EXALGO TAB 12MG
EXALGO TAB 16MG
EXALGO TAB 32MG
fentanyl dis 12mcg/hr
FENTANYL DIS 37.5MCG
fentanyl dis 100mcg/h
fentanyl ot loz 200mcg
FENTORA TAB 100MCG
FENTORA TAB 200MCG
FENTORA TAB 400MCG
FENTORA TAB 600MCG
FENTORA TAB 800MCG
hydromorphon liq 1mg/ml
HYDROMORPHON SUP 3MG
hydromorphon tab 2mg
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
1
3
1
3
1
3
1
1
PA
1
PA
1
PA
1
PA
1
PA
1
PA
2
PA
2
PA
2
PA
2
PA
2
PA
1
3
1
ST - Step Therapy
128
Drug Name
hydromorphon tab 8mg er
HYSINGLA ER TAB 20 MG
IONSYS PAD 40MCG/AC
KADIAN CAP 10MG ER
KADIAN CAP 20MG ER
KADIAN CAP 30MG ER
KADIAN CAP 40MG ER
KADIAN CAP 50MG ER
KADIAN CAP 60MG ER
KADIAN CAP 80MG ER
KADIAN CAP 100MG ER
KADIAN CAP 200MG ER
LAZANDA SPR 100MCG
LAZANDA SPR 400MCG
levorphanol tab 2mg
meperidine sol 50mg/5ml
meperidine tab 50mg
meperidine tab 100mg
methadone con 10mg/ml
methadone sol 5mg/5ml
methadone sol 10mg/5ml
methadone tab 5mg
methadone tab 10mg
methadone tab 40mg
METHADOSE CON 10MG/ML
morphine sul cap 10mg er
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
PA
3
PA
1
1
1
1
1
1
1
1
1
1
3
1
1
1
1
1
1
1
1
1
ST - Step Therapy
129
Drug Name
morphine sul sol 10mg/5ml
morphine sul sol 20mg/5ml
morphine sul sol 100/5ml
morphine sul sup 5mg
MORPHINE SUL SUP 30MG
morphine sul tab 15mg
morphine sul tab 15mg er
morphine sul tab 30mg
MS CONTIN TAB 15MG CR
NUCYNTA ER TAB 50MG
NUCYNTA ER TAB 100MG
NUCYNTA TAB 50MG
NUCYNTA TAB 75MG
NUCYNTA TAB 100MG
OPANA ER TAB 5MG
OPANA ER TAB 7.5MG
OPANA ER TAB 10MG
OPANA ER TAB 15MG
OPANA ER TAB 20MG
OPANA ER TAB 30MG
OPANA ER TAB 40MG
OPANA TAB 5MG
OPANA TAB 10MG
OXAYDO TAB 5MG
OXAYDO TAB 7.5MG
oxycodone cap 5mg
oxycodone con 100/5ml
oxycodone sol 5mg/5ml
oxycodone tab 5mg
oxycodone tab 10mg
1
1
1
1
1
1
1
1
3
1
1
1
1
1
1
1
3
3
3
3
3
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
1
1
1
1
1
ST - Step Therapy
130
Drug Name
oxycodone tab 10mg er
oxycodone tab 15mg
oxycodone tab 20mg
oxycodone tab 30mg
OXYCONTIN TAB 10MG CR
oxymorphone tab 5mg er
oxymorphone tab 7.5mg er
oxymorphone tab hcl 5mg
oxymorphone tab hcl 10mg
ROXICODONE TAB 5MG
ROXICODONE TAB 15MG
ROXICODONE TAB 30MG
SUBSYS SPR 100MCG
SUBSYS SPR 200MCG
SUBSYS SPR 400MCG
SUBSYS SPR 600MCG
SUBSYS SPR 800MCG
SUBSYS SPR 1200MCG
SUBSYS SPR 1600MCG
TRAMADOL HCL CAP 150MG ER
tramadol hcl cap er 100mg
tramadol hcl tab 50mg
tramadol hcl tab 100mg er
ULTRAM ER TAB 100MG
ULTRAM ER TAB 200MG
ULTRAM ER TAB 300MG
ULTRAM TAB 50MG
1
QL (120 tabs/25 days)
1
1
1
1
1
1
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
3
3
3
2
PA
2
PA
2
PA
2
PA
2
PA
2
PA
2
PA
3
1
1
1
1
1
1
1
3
3
3
2
ST - Step Therapy
131
Drug Name
ZOHYDRO ER
ZOHYDRO ER
ZOHYDRO ER
ZOHYDRO ER
ZOHYDRO ER
ZOHYDRO ER
CAP
CAP
CAP
CAP
CAP
CAP
10MG
15MG
20MG
30MG
40MG
50MG
3
3
3
3
3
3
OPIOID ANTAGONISTS
OPIOID ANTAGONISTS
naltrexone tab 50mg
REVIA TAB 50MG
1
2
OPIOID ANTITUSSIVE-ANTIHISTAMINE
OPIOID ANTITUSSIVE-ANTIHISTAMINE
CODAR AR LIQ 2-8/5ML
hyd pol/cpm liq 10-8/5ml
prometh/cod syp 6.25-10
TUSSICAPS CAP 5-4MG
TUSSICAPS CAP 10-8MG
TUSSIONEX SUS 10-8/5ML
TUZISTRA XR SUS
VITUZ SOL 5-4MG
3
1
3
3
3
3
3
3
OPIOID ANTITUSSIVE-DECONGESTANT
OPIOID ANTITUSSIVE-DECONGESTANT
REZIRA SOL 60-5/5ML
3
OPIOID ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE
OPIOID ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE
hydro/chlor/ liq 5-4-60mg
prometh vc/ syp codeine
ZUTRIPRO LIQ 60-4-5MG
1
3
3
OPIOID COMBINATIONS
OPIOID COMBINATIONS
oxycod/apap tab 2.5-325
oxycod/apap tab 5-325mg
oxycod/apap tab 7.5-325
oxycod/apap tab 10-325mg
oxycod/asa tab
oxycod/ibu tab 5-400mg
PERCOCET TAB 2.5-325
PERCOCET TAB 5-325MG
PERCOCET TAB 7.5-325
PERCOCET TAB 10-325MG
PERCODAN TAB
PRIMLEV TAB 5-300MG
PRIMLEV TAB 7.5-300
1
1
1
1
1
1
3
3
3
3
3
3
3
ST - Step Therapy
132
Drug Name
PRIMLEV TAB 10-300MG
ROXICET SOL 5-325/5
XARTEMIS XR TAB 7.5-325
3
2
3
OPIOID PARTIAL AGONISTS
OPIOID PARTIAL AGONISTS
BUNAVAIL MIS 2.1-0.3
BUNAVAIL MIS 4.2-0.7
BUNAVAIL MIS 6.3-1MG
bupren/nalox sub 2-0.5mg
bupren/nalox sub 8-2mg
buprenorphin sub 2mg
buprenorphin sub 8mg
butorphanol sol 10mg/ml
3
3
3
1
1
1
1
1
BUTRANS DIS 5MCG/HR
BUTRANS DIS 7.5/HR
BUTRANS DIS 10MCG/HR
pentaz/nalox tab 50-0.5mg
SUBOXONE MIS 2-0.5MG
SUBOXONE MIS 4-1MG
SUBOXONE MIS 8-2MG
SUBOXONE MIS 12-3MG
ZUBSOLV SUB 1.4-0.36
ZUBSOLV SUB 5.7-1.4
ZUBSOLV SUB 8.6-2.1
2
2
2
2
2
1
3
3
3
3
2
2
2
2
2
QL (2 btls (6ml)/ 25
Days)
PA
PA
PA
PA
ORAL VEHICLES
ORAL VEHICLES
PCCA ACACIA SYP BASE
3
OREXIN RECEPTOR ANTAGONISTS
OREXIN RECEPTOR ANTAGONISTS
BELSOMRA
BELSOMRA
BELSOMRA
BELSOMRA
TAB
TAB
TAB
TAB
5MG
10MG
15MG
20MG
3
3
3
3
ORGAN PRESERVATION SOLUTIONS
ORGAN PRESERVATION SOLUTIONS
VIASPAN SOL
3
OTIC AGENTS - MISCELLANEOUS
OTIC AGENTS - MISCELLANEOUS
ST - Step Therapy
133
Drug Name
ace acd/alum sol 2% otic
acetic acid sol 2% otic
1
1
OTIC ANTI-INFECTIVES
OTIC ANTI-INFECTIVES
CETRAXAL SOL 0.2%
ciprofloxacn sol 0.2%
ofloxacin dro 0.3%otic
3
1
1
OTIC STEROID-ANTI-INFECTIVE COMBINATIONS
OTIC STEROID-ANTI-INFECTIVE COMBINATIONS
CIPRO HC SUS OTIC
CIPRODEX SUS 0.3-0.1%
COLY-MYCIN S SUS OTIC
CORTISPORIN SOL 1% OTIC
neo/poly/hc sol 1% otic
neo/poly/hc sus 1% otic
3
2
3
3
1
1
OTIC STEROIDS
OTIC STEROIDS
acetasol hc sol otic
DERMOTIC OIL 0.01%
fluocin acet oil ear0.01%
1
3
1
OVULATION STIMULANTS-GONADOTROPINS
OVULATION STIMULANTS-GONADOTROPINS
BRAVELLE INJ 75UNIT
FOLLISTIM AQ INJ 75UNIT
GONAL-F INJ 450UNIT
GONAL-F INJ 1050UNIT
GONAL-F RFF INJ 75UNIT
GONAL-F RFF INJ 300
GONAL-F RFF INJ 450
GONAL-F RFF INJ 900
MENOPUR INJ 75UNIT
OVIDREL INJ
pregnyl inj 10000unt
REPRONEX INJ 75UNIT
3
2
2
2
2
3
3
3
3
3
3
3
2
1
3
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
OVULATION STIMULANTS-SYNTHETIC
OVULATION STIMULANTS-SYNTHETIC
clomiphene tab 50mg
1
OXABOROLE-RELATED ANTIFUNGALS - TOPICAL
OXABOROLE-RELATED ANTIFUNGALS - TOPICAL
KERYDIN SOL 5%
3
ST - Step Therapy
134
Drug Name
OXAZOLIDINONES
OXAZOLIDINONES
linezolid tab 600mg
SIVEXTRO TAB 200MG
ZYVOX SUS 100MG/5M
ZYVOX TAB 600MG
1
2
3
3
OXYTOCICS
OXYTOCICS
methylergon tab 0.2mg
1
PABA
PABA
aminobez pot pow
POTABA CAP 500MG
POTABA TAB 500MG
POTASSIUM P- POW AMINOBEN
1
3
3
3
PARATHYROID HORMONE AND DERIVATIVES
PARATHYROID HORMONE AND DERIVATIVES
FORTEO SOL 600/2.4
NATPARA INJ 25MCG
NATPARA INJ 50MCG
NATPARA INJ 75MCG
NATPARA INJ 100MCG
4
4
4
4
4
PA
PA
PA
PA
PA
PARENTERAL VEHICLES
PARENTERAL VEHICLES
HSA DILUENT SOL STERILE
SALINE/PHENO SOL
sterile dilu sol epopros
STERILE DILU SOL FLOLAN
3
3
1
3
PCSK9 INHIBITORS
PCSK9 INHIBITORS
PRALUENT INJ 75MG/ML
PRALUENT INJ 150MG/ML
REPATHA INJ 140MG/ML
REPATHA SURE INJ 140MG/ML
4
4
4
4
PA
PA
PA
PA
PED MV W/ FLUORIDE
PED MV W/ FLUORIDE
POLY-VI-FLOR MIS FS 0.5MG
POLY-VI-FLOR MIS FS 0.25
3
3
PEDIATRIC MULTIPLE VITAMINS W/FLUORIDE-IRON-ZINC
PEDIATRIC MULTIPLE VITAMINS W/FLUORIDE-IRON-ZINC
TEXAVITE LQ LIQ
3
PENICILLIN COMBINATIONS
ST - Step Therapy
135
Drug Name
PENICILLIN COMBINATIONS
amox-pot cla tab er
amox/k clav chw 200mg
amox/k clav chw 400mg
amox/k clav sus 200/5ml
amox/k clav tab 250mg
AUGMENTIN SUS 125/5ML
AUGMENTIN SUS 250/5ML
AUGMENTIN SUS ES-600
AUGMENTIN TAB 500MG
AUGMENTIN TAB 875MG
AUGMENTIN XR TAB 12HR
1
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
PENICILLINASE-RESISTANT PENICILLINS
PENICILLINASE-RESISTANT PENICILLINS
dicloxacill cap 250mg
dicloxacill cap 500mg
1
1
PERIPHERAL COMT INHIBITORS
PERIPHERAL COMT INHIBITORS
COMTAN TAB 200MG
entacapone tab 200mg
3
1
PERIPHERAL OPIOID RECEPTOR ANTAGONISTS
PERIPHERAL OPIOID RECEPTOR ANTAGONISTS
ENTEREG CAP 12MG
MOVANTIK TAB 12.5MG
MOVANTIK TAB 25MG
RELISTOR INJ 8/0.4ML
RELISTOR INJ 12/0.6ML
3
2
2
2
2
PERIPHERAL VASODILATORS
PERIPHERAL VASODILATORS
isoxsuprine tab 10mg
isoxsuprine tab hcl 20mg
1
1
PHENOTHIAZINES
PHENOTHIAZINES
chlorpromaz
chlorpromaz
chlorpromaz
chlorpromaz
chlorpromaz
tab
tab
tab
tab
tab
10mg
25mg
50mg
100mg
200mg
1
1
1
1
1
ST - Step Therapy
136
Drug Name
COMPAZINE PAK 5MG
COMPAZINE TAB 10MG
compro sup 25mg
fluphenazine con 5mg/ml
fluphenazine elx 2.5/5ml
fluphenazine tab 1mg
fluphenazine tab 2.5mg
perphenazine tab 2mg
prochlorper tab 5mg
prochlorper tab 10mg
thioridazine tab 10mg
trifluoperaz tab 1mg
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
PHENOTHIAZINES TRICYCLIC AGENTS
PHENOTHIAZINES TRICYCLIC AGENTS
perphen/amit
perphen/amit
perphen/amit
perphen/amit
perphen/amit
tab
tab
tab
tab
tab
2-10mg
2-25mg
4-10mg
4-25mg
4-50mg
1
1
1
1
1
PHENYLKETONURIA TREATMENT - AGENTS
PHENYLKETONURIA TREATMENT - AGENTS
KUVAN POW 100MG
KUVAN POW 500MG
KUVAN TAB 100MG
4
4
4
PA
PA
PA
PHOSPHATE
PHOSPHATE
K-PHOS TAB
K-PHOS TAB NEUTRAL
phospha 250 tab neutral
3
3
1
PHOSPHATE BINDER AGENTS
PHOSPHATE BINDER AGENTS
AURYXIA TAB 210MG
calc acetate cap 667mg
3
1
ST - Step Therapy
137
Drug Name
calc acetate tab 667mg
ELIPHOS TAB 667MG
FOSRENOL CHW 500MG
FOSRENOL CHW 750MG
FOSRENOL CHW 1000MG
FOSRENOL POW 750MG
FOSRENOL POW 1000MG
PHOSLO CAP 667MG
PHOSLYRA SOL
RENAGEL TAB 400MG
RENAGEL TAB 800MG
RENVELA PAK 0.8GM
RENVELA PAK 2.4GM
RENVELA TAB 800MG
VELPHORO CHW 500MG
1
3
3
3
3
3
3
3
2
3
3
2
2
2
2
PHOSPHATES
PHOSPHATES
K-PHOS TAB NO 2
3
PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS
PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS
ZYDELIG TAB 100MG
ZYDELIG TAB 150MG
0
0
PA
PA
PHOSPHODIESTERASE 4 (PDE4) INHIBITORS
PHOSPHODIESTERASE 4 (PDE4) INHIBITORS
OTEZLA TAB 10/20/30
OTEZLA TAB 30MG
4
4
PA
PA
PHOSPHODIESTERASE III INHIBITORS
PHOSPHODIESTERASE III INHIBITORS
cilostazol tab 50mg
cilostazol tab 100mg
PLETAL TAB 50MG
PLETAL TAB 100MG
1
1
2
2
PHOTODYNAMIC THERAPY AGENTS - TOPICAL
PHOTODYNAMIC THERAPY AGENTS - TOPICAL
LEVULAN KERA SOL 20%
METVIXIA CRE 16.8%
3
3
PIGMENTING AGENTS
PIGMENTING AGENTS
OXSORALEN LOT 1%
3
PLACEBOS
PLACEBOS
PLACEBO #00 CAP
3
PLASMA KALLIKREIN INHIBITORS
ST - Step Therapy
138
Drug Name
PLASMA KALLIKREIN INHIBITORS
KALBITOR INJ 10MG/ML
4
PA
PLATELET AGGREGATION INHIBITOR COMBINATIONS
PLATELET AGGREGATION INHIBITOR COMBINATIONS
AGGRENOX CAP 25-200MG
asa/dipyrida cap 25-200mg
2
1
PLATELET AGGREGATION INHIBITORS
PLATELET AGGREGATION INHIBITORS
dipyridamole tab 25mg
DURLAZA CAP 162.5MG
PERSANTINE TAB 25MG
PERSANTINE TAB 50MG
PERSANTINE TAB 75MG
1
1
1
3
2
2
2
POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS
POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS
LYNPARZA CAP 50MG
0
PA
POSTHERPETIC NEURALGIA (PHN) AGENTS
POSTHERPETIC NEURALGIA (PHN) AGENTS
GRALISE STAR MIS 300/600
GRALISE TAB 300MG
GRALISE TAB 600MG
2
2
2
POTASSIUM
POTASSIUM
k-effervesce tab 25meq ef
K-TAB TAB 8MEQ CR
K-TAB TAB 10MEQ CR
K-TAB TAB 20MEQ
KLOR-CON M15 TAB 15MEQ ER
klor-con pow 20meq
KLOR-CON/25 POW 25MEQ
MICRO-K CAP 8MEQ CR
MICRO-K CAP 10MEQ CR
POT BICARBON GRA
POT BICARBON POW
pot chloride cap 8meq er
pot chloride cap 10meq er
pot chloride sol 10% sf
pot chloride sol 20% sf
pot chloride tab 8meq er
1
3
2
3
3
1
3
2
2
3
3
1
1
1
1
1
1
1
ST - Step Therapy
139
Drug Name
pot cl micro tab 10meq er
pot cl micro tab 20meq er
1
1
POTASSIUM COMBINATIONS
POTASSIUM COMBINATIONS
pot chloride tab 25meq ef
1
POTASSIUM REMOVING RESINS
POTASSIUM REMOVING RESINS
kionex pow
sod poly sul sus 15gm/60
sod poly sul sus 30/120ml
1
1
1
POTASSIUM SPARING DIURETICS
POTASSIUM SPARING DIURETICS
ALDACTONE TAB 25MG
ALDACTONE TAB 50MG
ALDACTONE TAB 100MG
amiloride tab 5mg
DYRENIUM CAP 50MG
DYRENIUM CAP 100MG
spironolact tab 25mg
2
2
2
1
3
3
1
1
1
PREMENSTRUAL DYSPHORIC DISORDER (PMDD) AGENTS - SSRIS
PREMENSTRUAL DYSPHORIC DISORDER (PMDD) AGENTS - SSRIS
fluoxetine cap 10mg 10mg
SARAFEM TAB 10MG
SARAFEM TAB 20MG
1
1
3
3
PRENATAL MV MIN W/FE-FA
PRENATAL MV MIN W/FE-FA
ATABEX EC TAB
bp multinatl chw plus
bp multinatl tab plus
C-NATE DHA CAP 28-1-200
CITRANATAL MIS B-CALM
CITRANATAL TAB RX
CO-NATAL FA TAB 29-1MG
COMPLETENATE CHW
DUET DHA 400 MIS 25-1-400
DUET DHA MIS BALANCED
elite-ob tab
ENBRACE HR CAP
FOLIVANE-OB CAP
HEMENATAL OB MIS + DHA
3
1
1
3
2
2
3
3
3
3
1
3
3
3
ST - Step Therapy
140
Drug Name
MARNATAL-F CAP
MYNATAL CAP
MYNATE 90 TAB PLUS
NATACHEW CHW
NATALVIT TAB 75-1MG
NATELLE ONE CAP
NEEVO DHA CAP 27-1.13
NEWGEN TAB 32-1MG
O-CAL FA TAB
O-CAL TAB PRENATAL
OB COMPLETE CAP ONE
OB COMPLETE CAP PETITE
OB COMPLETE TAB
OB COMPLETE TAB PREMIER
OB COMPLETE/ CAP DHA
OBSTETRIX EC TAB
OBSTETRIX PAK DHA
ONE A DAY CAP PRENATAL
pnv-select tab
PNV-TOTAL CAP
PREFERA OB TAB
PRENAISSANCE MIS HARMONY
PRENATA CHW 29-1MG
prenatabs fa tab
prenatabs rx tab
prenatal 19 chw tab
prenatal 19 tab
PRENATAL MIS COMPLEAT
PRENATAL-U CAP 106.5-1
PRENATE CAP ESSENTIA
PRENATE STAR TAB 20-1MG
PRENATE TAB ELITE
PROVIDA OB CAP
PUREFE OB CAP PLUS
SE-NATAL 19 TAB
SE-TAN DHA CAP
SELECT-OB CHW
TARON-BC MIS
TARON-C DHA CAP
TL FOLATE TAB
TL-CARE DHA CAP 27-1-500
TRI-TABS DHA MIS
TRINATAL GT TAB
TRINATAL RX TAB 1
trinate tab
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
3
3
3
3
1
1
1
1
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
ST - Step Therapy
141
Drug Name
ULTIMATECARE CAP ONE
ULTIMATECARE CAP ONE NF
ultra tabs tab
VENA-BAL MIS DHA
VINATE C TAB
VINATE CAL TAB
VINATE CARE CHW
VINATE II TAB
VINATE M TAB
VIRT-PN TAB
VITA-PREN TAB
VITAFOL-NANO TAB
VITAFOL-OB TAB 65-1MG
VITAPEARL CAP
VOL-NATE TAB
VOL-TAB RX TAB
VP-PNV-DHA CAP
ZATEAN-PN CAP PLUS
3
3
1
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
PRENATAL MV MIN W/FE-FA-CA-OMEGA 3 FISH OIL
PRENATAL MV MIN W/FE-FA-CA-OMEGA 3 FISH OIL
COMPLETE NAT PAK DHA
NESTABS ABC MIS
PR NATAL 400 PAK EC
PR NATAL 430 PAK
PR NATAL 430 PAK EC
TRIVEEN-DUO PAK DHA
3
3
3
3
3
3
PRENATAL MV MIN W/FE-FA-DHA
PRENATAL MV MIN W/FE-FA-DHA
ACTIVE OB CAP
CITRANATAL CAP HARMONY
CITRANATAL MIS 90 DHA
CITRANATAL PAK ASSURE
CITRANATAL PAK DHA
FOLET DHA PAK
FOLET ONE CAP 38-1-225
INFANATE CAP BALANCE
LEVOMEFOLATE CAP DHA
NEXA PLUS CAP
PAIRE OB MIS
pnv-dha cap
PREFERAOB CAP ONE
PREFERAOB MIS +DHA
PRENAISSANCE CAP BALANCE
PRENAISSANCE CAP PLUS
3
2
2
2
2
3
3
3
3
3
3
1
3
3
3
3
ST - Step Therapy
142
Drug Name
PRENATE CAP ENHANCE
PRENATE CAP PIXIE
PRENATE CAP RESTORE
PRENATE DHA CAP
PRENATE MINI CAP
PREQUE 10 TAB
PROVIDA DHA CAP
SELECT-OB+ PAK DHA
TARON-PREX CAP
THERANATAL CAP ONE
TL-SELECT CAP
TRISTART DHA CAP
TRIVEEN-PRX CAP RNF
VEMAVITE- CAP PRX 2
VITAFOL CAP ULTRA
VITAFOL FE+ CAP
VITAFOL-OB PAK +DHA
VITAFOL-ONE CAP
VITAMEDMD CAP ONE RX
VITAMEDMD MIS PLUS RX
ZATEAN-CH CAP
ZATEAN-PN CAP DHA
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
PRENATAL MV MINERALS W/FA WITHOUT IRON
PRENATAL MV MINERALS W/FA WITHOUT IRON
PRENATE CHW 0.6-0.4
3
PRENATAL VITAMINS
PRENATAL VITAMINS
bp folinatal tab plus b
PRENAISSANCE TAB NEXT
PRENAISSANCE TAB NEXT-B
PRENATE AM TAB 1MG
REDICHEW RX CHW
1
3
3
3
3
PROGESTERONE RECEPTOR ANTAGONISTS
PROGESTERONE RECEPTOR ANTAGONISTS
KORLYM TAB 300MG
3
PA
PROGESTIN CONTRACEPTIVES - IMPLANTS
PROGESTIN CONTRACEPTIVES - IMPLANTS
NEXPLANON IMP 68MG
0
PROGESTIN CONTRACEPTIVES - INJECTABLE
PROGESTIN CONTRACEPTIVES - INJECTABLE
DEPO-PROVERA INJ 150MG/ML
DEPO-SQ PROV INJ 104
medroxypr ac inj 150mg/ml
2
0
0
ST - Step Therapy
143
Drug Name
PROGESTIN CONTRACEPTIVES - ORAL
PROGESTIN CONTRACEPTIVES - ORAL
norethindron tab 0.35mg
ORTHO MICRON TAB 0.35MG
0
2
PROGESTINS
PROGESTINS
AYGESTIN TAB 5MG
medroxypr ac tab 2.5mg
medroxypr ac tab 5mg
medroxypr ac tab 10mg
MEGACE ES SUS 625/5ML
megestrol sus 625mg/5m
norethin ace tab 5mg
progesterone cap 100mg
progesterone cap 200mg
PROGESTERONE CRE 10% KIT
progesterone inj 50mg/ml
PROMETRIUM CAP 100MG
PROMETRIUM CAP 200MG
PROVERA TAB 2.5MG
PROVERA TAB 5MG
PROVERA TAB 10MG
3
1
1
1
0
0
1
1
1
3
1
3
3
3
3
3
PROGESTINS-ANTINEOPLASTIC
PROGESTINS-ANTINEOPLASTIC
MEGACE ORAL SUS 40MG/ML
megestrol ac sus 40mg/ml
megestrol ac tab 20mg
megestrol ac tab 40mg
0
0
0
0
PROSTAGLANDIN - IMPOTENCE AGENTS
PROSTAGLANDIN - IMPOTENCE AGENTS
CAVERJECT INJ 20MCG
CAVERJECT INJ 40MCG
CAVERJECT KIT 10MCG
CAVERJECT KIT 20MCG
EDEX KIT 40MCG
MUSE SUP 125MCG
MUSE SUP 250MCG
MUSE SUP 500MCG
MUSE SUP 1000MCG
3
3
3
3
3
2
2
2
2
QL
QL
QL
QL
QL
QL
QL
QL
QL
4
4
PA
PA
(6ea)
(6ea)
(6ea)
(6ea)
(6ea)
(6ea)
(6ea)
(6ea)
(6ea)
PROSTAGLANDIN VASODILATORS
PROSTAGLANDIN VASODILATORS
ORENITRAM TAB 0.25MG
ORENITRAM TAB 0.125MG
ST - Step Therapy
144
Drug Name
ORENITRAM TAB 1MG
ORENITRAM TAB 2.5MG
TYVASO START SOL 0.6MG/ML
VENTAVIS SOL 10MCG/ML
VENTAVIS SOL 20MCG/ML
4
PA
4
PA
4
PA
4
PA
4
PA
PROSTAGLANDINS - OPHTHALMIC
PROSTAGLANDINS - OPHTHALMIC
bimatoprost sol 0.03%
latanoprost sol 0.005%
LUMIGAN SOL 0.01%
RESCULA SOL 0.15%
TRAVATAN Z DRO 0.004%
travoprost dro 0.004%
XALATAN SOL 0.005%
ZIOPTAN DRO 0.0015%
1
1
3
3
2
1
3
2
PA
PROSTATIC HYPERTROPHY AGENT COMBINATIONS
PROSTATIC HYPERTROPHY AGENT COMBINATIONS
JALYN CAP
3
PA
PROTEASE-ACTIVATED RECEPTOR-1 (PAR-1) ANTAGONISTS
PROTEASE-ACTIVATED RECEPTOR-1 (PAR-1) ANTAGONISTS
ZONTIVITY TAB 2.08MG
3
PROTECTANTS - MOUTH/THROAT
PROTECTANTS - MOUTH/THROAT
EPISIL LIQ
GELCLAIR GEL
MUGARD LIQ
ORAFATE PST 10%
2
3
4
3
PROTON PUMP INHIBITOR-ANTACID COMBINATIONS
PROTON PUMP INHIBITOR-ANTACID COMBINATIONS
omepra/bicar cap 40-1100
ZEGERID CAP 40-1100
ZEGERID POW 20-1680
ZEGERID POW 40-1680
1
3
3
3
PROTON PUMP INHIBITORS
PROTON PUMP INHIBITORS
ACIPHEX SPR CAP 5MG
ACIPHEX SPR CAP 10MG
ACIPHEX TAB 20MG
DEXILANT CAP 30MG DR
DEXILANT CAP 60MG DR
esomepra mag cap 40mg dr
lansoprazole cap 30mg dr
NEXIUM CAP 40MG
3
3
3
2
2
1
1
2
ST - Step Therapy
145
Drug Name
NEXIUM GRA 2.5MG DR
NEXIUM GRA 5MG DR
NEXIUM GRA 10MG DR
NEXIUM GRA 20MG DR
NEXIUM GRA 40MG DR
omeprazole cap 10mg
omeprazole cap 40mg
pantoprazole tab 20mg
pantoprazole tab 40mg
PREVACID CAP 15MG DR
PREVACID CAP 30MG DR
PREVACID TAB 15MG STB
PREVACID TAB 30MG STB
PRILOSEC CAP 10MG
PRILOSEC CAP 40MG
PRILOSEC POW 2.5MG
PRILOSEC POW 10MG
PROTONIX PAK
PROTONIX TAB 20MG
PROTONIX TAB 40MG
rabeprazole tab 20mg
2
2
2
2
2
1
1
1
1
3
PA
3
PA
3
PA
3
PA
3
3
3
3
3
PA
3
PA
3
PA
1
PSEUDOBULBAR AFFECT AGENT COMBINATIONS
PSEUDOBULBAR AFFECT AGENT COMBINATIONS
NUEDEXTA CAP 20-10MG
3
PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.
PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.
ergoloid mes tab 1mg oral
ORAP TAB 1MG
ORAP TAB 2MG
pimozide tab 1mg
pimozide tab 2mg
1
3
3
1
1
PULM HYPERTEN-SOLUBLE GUANYLATE CYCLASE STIMULATOR (SGC)
PULM HYPERTEN-SOLUBLE GUANYLATE CYCLASE STIMULATOR
(SGC)
ADEMPAS
ADEMPAS
ADEMPAS
ADEMPAS
ADEMPAS
TAB
TAB
TAB
TAB
TAB
0.5MG
1.5MG
1MG
2.5MG
2MG
4
4
4
4
4
PA
PA
PA
PA
PA
0
PA
PULMONARY FIBROSIS AGENTS
PULMONARY FIBROSIS AGENTS
ESBRIET CAP 267MG
PULMONARY FIBROSIS AGENTS - KINASE INHIBITORS
ST - Step Therapy
146
Drug Name
PULMONARY FIBROSIS AGENTS - KINASE INHIBITORS
OFEV CAP 100MG
OFEV CAP 150MG
0
0
PA
PA
PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS
PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR
ANTAGONISTS
LETAIRIS TAB 5MG
LETAIRIS TAB 10MG
OPSUMIT TAB 10MG
TRACLEER TAB 62.5MG
TRACLEER TAB 125MG
4
4
4
4
4
PA
PA
PA
PA
PA
PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS
PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS
ADCIRCA TAB 20MG
REVATIO SUS 10MG/ML
REVATIO TAB 20MG
sildenafil tab 20mg
4
4
4
4
PA
PA
PA
PA
PURINE ANALOGS
PURINE ANALOGS
AZASAN TAB 75 MG
AZASAN TAB 100MG
azathioprine tab 50mg
IMURAN TAB 50MG
2
2
1
2
PYRIMIDINE SYNTHESIS INHIBITORS
PYRIMIDINE SYNTHESIS INHIBITORS
ARAVA TAB 10MG
ARAVA TAB 20MG
leflunomide tab 10mg
leflunomide tab 20mg
2
2
1
1
QUATERNARY ANTICHOLINERGICS
QUATERNARY ANTICHOLINERGICS
CANTIL TAB 25MG
CUVPOSA SOL 1MG/5ML
glycopyrrol tab 1mg
glycopyrrol tab 2mg
methscopolam tab 2.5mg
methscopolam tab 5mg
PAMINE FORTE TAB 5MG
PAMINE TAB 2.5MG
propanthelin tab 15mg
ROBINUL FORT TAB 2MG
ROBINUL TAB 1MG
3
3
1
1
1
1
3
3
1
3
3
QUINAZOLINE AGENTS
ST - Step Therapy
147
Drug Name
QUINAZOLINE AGENTS
AGRYLIN CAP 0.5MG
anagrelide cap 0.5mg
anagrelide cap 1mg
2
1
1
QUINOLINONE DERIVATIVES
QUINOLINONE DERIVATIVES
ABILIFY TAB 2MG
ABILIFY TAB 5MG
ABILIFY TAB 10MG
ABILIFY TAB 15MG
ABILIFY TAB 20MG
ABILIFY TAB 30MG
aripiprazole sol 1mg/ml
aripiprazole tab 2mg
aripiprazole tab 10mg TABS
ARIPIPRAZOLE TAB 10MG TBDP
aripiprazole tab 15mg TABS
ARIPIPRAZOLE TAB 15MG TBDP
REXULTI TAB 0.5MG
REXULTI TAB 0.25MG
REXULTI TAB 1MG
REXULTI TAB 2MG
REXULTI TAB 3MG
REXULTI TAB 4MG
3
3
3
3
3
3
1
1
1
1
3
1
3
1
1
3
3
3
3
3
3
RECTAL ANESTHETIC/STEROIDS
RECTAL ANESTHETIC/STEROIDS
ANALPRAM E KIT
ANALPRAM-HC CRE 1-1%
ANALPRAM-HC CRE SINGLES
ANALPRAM-HC LOT 2.5%
hc pramoxine cre 1-1%
hc pramoxine cre 2.5-1%
hydrocort/ kit pramoxin
LIDO-HYDRO GEL 2.8-0.55
lidocaine/hc cre 3%-0.5%
lidocaine/hc kit 2-2%
lidocaine/hc kit 3%-0.5%
lidocaine/hc kit 3%-1%
lidocaine/hc kit 3-2.5%
PROCORT CRE
PROCTOFOAM AER HC 1%
3
3
3
3
1
1
1
3
1
1
1
1
1
3
2
ST - Step Therapy
148
Drug Name
RECTAL STEROIDS
RECTAL STEROIDS
ANUSOL-HC CRE 2.5%
ANUSOL-HC SUP 25MG
hydrocort ac sup 25mg
hydrocort ac sup 30mg
procto-pak cre 1%
PROCTOCORT CRE 1%
PROCTOCORT SUP 30MG
proctosol hc cre 2.5%
2
3
1
1
1
3
3
1
RESERPINE
RESERPINE
reserpine tab 0.1mg
reserpine tab 0.25mg
1
1
RESPIRATORY AGENTS - MISC.
RESPIRATORY AGENTS - MISC.
SURFAXIN SUS 30MG/ML
3
RESTLESS LEG SYNDROME (RLS) AGENTS
RESTLESS LEG SYNDROME (RLS) AGENTS
HORIZANT TAB 300MG
HORIZANT TAB 600MG
3
3
RETINOIDS
RETINOIDS
tretinoin cap 10mg
0
ROSACEA AGENTS
ROSACEA AGENTS
doxycycline cap 40mg
FINACEA AER 15%
FINACEA GEL 15%
METROCREAM CRE 0.75%
METROGEL GEL 1%
METROLOTION LOT 0.75%
metronidazol cre 0.75%
metronidazol gel 0.75%
metronidazol gel 1%
metronidazol lot 0.75%
MIRVASO GEL 0.33%
NORITATE CRE 1%
ORACEA CAP 40MG
ROSADAN KIT 0.75%
SOOLANTRA CRE 1%
1
2
2
3
3
3
1
1
1
1
3
3
2
3
2
RSV AGENTS - NUCLEOSIDE ANALOGUES
RSV AGENTS - NUCLEOSIDE ANALOGUES
ST - Step Therapy
149
Drug Name
VIRAZOLE INH 6GM
3
SALICYLATE COMBINATIONS
SALICYLATE COMBINATIONS
cho mag tris liq 500/5ml
cho mag tris tab 1000mg
1
1
SALICYLATES
SALICYLATES
aspirin low tab 81mg ec
aspirin tab 325mg
aspirin tab 325mg ec
BACKACHE REL TAB EX ST
dewitts tab 325mg
diflunisal tab 500mg
DISALCID TAB 500MG
DISALCID TAB 750MG
DOANS TAB 325MG
salsalate tab 500mg
salsalate tab 750mg
sb backache tab 500mg
st joseph as chw 81mg
467mg
0
0
0
3
1
1
3
3
3
1
1
1
0
SALINE LAXATIVE MIXTURES
SALINE LAXATIVE MIXTURES
OSMOPREP TAB 1.5GM
3
SALIVA STIMULANTS
SALIVA STIMULANTS
cevimeline cap 30mg
EVOXAC CAP 30MG
pilocarpine tab 5mg
pilocarpine tab 7.5mg
SALAGEN TAB 5MG
SALAGEN TAB 7.5MG
1
2
1
1
2
2
SCABICIDES PEDICULICIDES
SCABICIDES PEDICULICIDES
acticin cre 5%
ELIMITE CRE 5%
EURAX CRE 10%
EURAX LOT 10%
lindane lot 1%
lindane sha 1%
malathion lot 0.5%
NATROBA SUS 0.9%
OVIDE LOT 0.5%
SKLICE LOT 0.5%
1
2
3
3
1
1
1
3
2
3
ST - Step Therapy
150
Drug Name
spinosad sus 0.9%
SULF LIME SOL
ULESFIA LOT 5%
1
3
3
SCAR TREATMENT PRODUCTS - COMBINATIONS
SCAR TREATMENT PRODUCTS - COMBINATIONS
RENUU NL PAD 2-30%
3
SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)
SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)
eplerenone tab 25mg
eplerenone tab 50mg
INSPRA TAB 25MG
INSPRA TAB 50MG
1
1
2
2
SELECTIVE CGMP PHOSPHODIESTERASE TYPE 5 INHIBITORS
SELECTIVE CGMP PHOSPHODIESTERASE TYPE 5 INHIBITORS
CIALIS TAB 2.5MG
CIALIS TAB 5MG
CIALIS TAB 10MG
CIALIS TAB 20MG
LEVITRA TAB 2.5MG
LEVITRA TAB 5MG
LEVITRA TAB 10MG
LEVITRA TAB 20MG
STAXYN TAB 10MG
STENDRA TAB 50MG
STENDRA TAB 100MG
STENDRA TAB 200MG
VIAGRA TAB 25MG
VIAGRA TAB 50MG
VIAGRA TAB 100MG
2
2
2
2
3
3
3
3
3
3
3
3
2
2
2
QL
QL
QL
QL
QL
QL
QL
QL
QL
QL
QL
QL
QL
QL
QL
(30ea)
(30ea)
(6ea)
(6ea)
(6ea), PA
(6ea), PA
(6ea), PA
(6ea), PA
(6ea)
(6ea)
(6ea)
(6ea)
(6ea)
(6ea)
(6ea)
SELECTIVE COSTIMULATION MODULATORS
SELECTIVE COSTIMULATION MODULATORS
ORENCIA INJ 125MG/ML
4
PA
SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)
SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)
EVISTA TAB 60MG
OSPHENA TAB 60MG
raloxifene tab 60mg
3
2
0
SELECTIVE MELATONIN RECEPTOR AGONISTS
SELECTIVE MELATONIN RECEPTOR AGONISTS
HETLIOZ CAP 20MG
ROZEREM TAB 8MG
3
3
PA
PA
SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS
SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS
ST - Step Therapy
151
Drug Name
DALIRESP TAB 500MCG
2
SELECTIVE RETINOID X RECEPTOR AGONISTS
SELECTIVE RETINOID X RECEPTOR AGONISTS
bexarotene cap 75mg
TARGRETIN CAP 75MG
0
0
PA
PA
SELECTIVE SEROTONIN AGONIST-NSAID COMBINATIONS
SELECTIVE SEROTONIN AGONIST-NSAID COMBINATIONS
TREXIMET TAB 85-500MG
2
QL (9ea/ 25 Days)
SELECTIVE SEROTONIN AGONISTS 5-HT(1)
SELECTIVE SEROTONIN AGONISTS 5-HT(1)
almotrip mal tab 6.25mg
almotrip mal tab 12.5mg
ALSUMA INJ 6MG/0.5
1
1
3
AMERGE TAB 1MG
AMERGE TAB 2.5MG
AXERT TAB 6.25MG
AXERT TAB 12.5MG
FROVA TAB 2.5MG
IMITREX INJ 4MG/0.5
3
3
3
3
3
3
IMITREX INJ 6MG/0.5
3
IMITREX SPR 5MG/ACT
IMITREX SPR 20MG/ACT
IMITREX TAB 25MG
IMITREX TAB 50MG
IMITREX TAB 100MG
MAXALT TAB 5MG
MAXALT TAB 10MG
MAXALT-MLT TAB 5MG
MAXALT-MLT TAB 10MG
naratriptan tab 1mg
naratriptan tab 2.5mg
RELPAX TAB 20MG
RELPAX TAB 40MG
rizatriptan tab 5mg
rizatriptan tab 5mg odt
rizatriptan tab 10mg
rizatriptan tab 10mg odt
sumatriptan inj 4mg/0.5
3
3
3
3
3
3
3
3
3
1
1
2
2
1
1
1
1
1
sumatriptan inj 6mg/0.5
1
QL (12 ea/ 25 Days)
QL (12 ea/ 25 Days)
QL (6 (12x0.5ml = Total
Qty of 6ml)/25 days)
QL (12 ea/ 25 Days)
QL (12 ea/ 25 Days)
QL (12 ea/ 25 Days)
QL (12 ea/ 25 Days)
QL (18 ea/ 25 Days)
QL (24 ea/25 days)
QL (12ea/ 25 Days)
QL (12ea/ 25 Days)
QL (12ea/ 25 Days)
QL (12ea/ 25 Days)
QL (18 ea/ 25 Days)
QL (18 ea/ 25 Days)
QL (18 ea/ 25 Days)
QL (18 ea/ 25 Days)
QL (12 ea/ 25 Days)
QL (12 ea/ 25 Days)
QL (12ea/ 25 Days)
QL (12ea/ 25 Days)
QL (18 ea/ 25 Days)
QL (18 ea/ 25 Days)
QL (18 ea/ 25 Days)
QL (18 ea/ 25 Days)
ST - Step Therapy
152
Drug Name
sumatriptan spr 5mg/act
sumatriptan spr 20mg/act
sumatriptan tab 25mg
SUMAVEL DOSE INJ 4MG/0.5
SUMAVEL DOSE INJ 6MG/0.5
ZECUITY PAD 6.5MG/4H
zolmitriptan tab 2.5 mg
zolmitriptan tab 2.5mg
zolmitriptan tab 5mg
ZOMIG NASAL SPR 5MG
ZOMIG SPR 2.5MG
ZOMIG TAB 2.5MG
ZOMIG TAB 5MG
ZOMIG ZMT TAB 2.5 MG
ZOMIG ZMT TAB 5MG
1
QL (24 ea/25 days)
1
QL (12ea/ 25 Days)
1
QL (12ea/ 25 Days)
1
QL (12ea/ 25 Days)
1
QL (12ea/ 25 Days)
2
QL (12ea (6ml)/ 25
Days)
2
QL (12ea (6ml)/ 25
Days)
4
PA
1
QL (12ea/ 25 Days)
1
QL (12ea/ 25 Days)
1
QL (12ea/ 25 Days)
2
QL (12ea/ 25 Days)
2
QL (12ea/ 25 Days)
3
QL (12ea/ 25 Days)
3
QL (12ea/ 25 Days)
3
QL (12ea/ 25 Days)
3
QL (12ea/ 25 Days)
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)
CELEXA TAB 10MG
CELEXA TAB 20MG
CELEXA TAB 40MG
citalopram sol 10mg/5ml
citalopram tab 10mg
citalopram tab 20mg
citalopram tab 40mg
escitalopram sol 5mg/5ml
escitalopram tab 5mg
fluoxetine cap 40mg
fluoxetine cap 90mg dr
fluoxetine sol 20mg/5ml
fluoxetine tab 10mg
fluoxetine tab 20mg
FLUOXETINE TAB 60MG
fluvoxamine cap 100mg er
fluvoxamine cap 150mg er
fluvoxamine tab 25mg
3
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
ST - Step Therapy
153
Drug Name
LEXAPRO SOL 5MG/5ML
LEXAPRO TAB 5MG
LEXAPRO TAB 10MG
LEXAPRO TAB 20MG
paroxetin er tab 12.5mg
paroxetin er tab 37.5mg
paroxetine tab 10mg
paroxetine tab 20mg
paroxetine tab 25mg er
paroxetine tab 30mg
paroxetine tab 40mg
PAXIL CR TAB 12.5MG
PAXIL CR TAB 25MG
PAXIL CR TAB 37.5MG
PAXIL SUS 10MG/5ML
PAXIL TAB 10MG
PAXIL TAB 20MG
PAXIL TAB 30MG
PAXIL TAB 40MG
PEXEVA TAB 10MG
PEXEVA TAB 20MG
PEXEVA TAB 30MG
PEXEVA TAB 40MG
PROZAC CAP 10MG
PROZAC CAP 20MG
PROZAC CAP 40MG
PROZAC WEEKL CAP 90MG
sertraline con 20mg/ml
sertraline tab 25mg
sertraline tab 50mg
sertraline tab 100mg
ZOLOFT CON 20MG/ML
ZOLOFT TAB 25MG
ZOLOFT TAB 50MG
ZOLOFT TAB 100MG
1
3
3
3
3
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
1
1
1
3
3
3
3
SELECTIVE VASOPRESSIN V2-RECEPTOR ANTAGONISTS
SELECTIVE VASOPRESSIN V2-RECEPTOR ANTAGONISTS
SAMSCA TAB 15MG
SAMSCA TAB 30MG
4
4
PA
PA
SEMI SOLID VEHICLES
SEMI SOLID VEHICLES
KRISGEL 100 GEL
LANOLIN OIL
3
3
ST - Step Therapy
154
Drug Name
POLYETH GLYC OIN 8000
3
SEROTONIN 1A RECEPT AGONIST/SEROTONIN 2A RECEPT ANTAG
SEROTONIN 1A RECEPT AGONIST/SEROTONIN 2A RECEPT ANTAG
ADDYI TAB 100MG
3
SEROTONIN MODULATORS
SEROTONIN MODULATORS
BRINTELLIX TAB 5MG
BRINTELLIX TAB 10MG
BRINTELLIX TAB 20MG
nefazodone tab 50mg
nefazodone tab 100mg
OLEPTRO TAB 24HR150
OLEPTRO TAB 24HR300
trazodone tab 50mg
trazodone tab 100mg
trazodone tab 150mg
trazodone tab 300mg
VIIBRYD KIT STARTER
VIIBRYD TAB 10MG
VIIBRYD TAB 20MG
VIIBRYD TAB 40MG
2
2
2
1
1
1
1
1
3
3
1
1
1
1
2
2
2
2
PA
PA
SEROTONIN MODULATORS-NUTRITIONAL SUPPLEMENT
COMBINATIONS
SEROTONIN MODULATORS-NUTRITIONAL SUPPLEMENT
COMBINATIONS
TRAZAMINE PAK 50MG
3
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)
CYMBALTA CAP 20MG
CYMBALTA CAP 30MG
CYMBALTA CAP 60MG
desvenlafax tab 50mg er 50mg
DESVENLAFAX TAB 50MG ER 50mg
desvenlafax tab 100mg er 100mg
DESVENLAFAX TAB 100MG ER 100mg
duloxetine cap 20mg
duloxetine cap 30mg
duloxetine cap 60mg
EFFEXOR XR CAP 37.5MG
EFFEXOR XR CAP 75MG
3
3
3
1
3
1
3
1
1
1
3
3
ST - Step Therapy
155
Drug Name
EFFEXOR XR CAP 150MG
FETZIMA CAP 20MG
FETZIMA CAP 40MG
FETZIMA CAP 80MG
FETZIMA CAP 120MG
FETZIMA CAP TITRATIO
IRENKA CAP 40MG
KHEDEZLA TAB 50MG ER
KHEDEZLA TAB 100MG ER
PRISTIQ TAB 25MG
PRISTIQ TAB 50MG
PRISTIQ TAB 100MG
venlafaxine cap 37.5 er
venlafaxine cap 75mg er
venlafaxine cap 150mg er
venlafaxine tab 25mg
venlafaxine tab 37.5 er 37.5mg
VENLAFAXINE TAB 37.5 ER 37.5mg
venlafaxine tab 37.5mg
venlafaxine tab 75mg er 75mg
VENLAFAXINE TAB 75MG ER 75mg
3
3
3
3
3
3
3
2
2
2
2
2
1
1
1
1
1
3
1
1
1
1
3
1
1
3
1
3
SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS
SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS
GLYXAMBI TAB 10-5 MG
GLYXAMBI TAB 25-5 MG
3
3
SINUS NODE INHIBITORS
SINUS NODE INHIBITORS
CORLANOR TAB 5MG
CORLANOR TAB 7.5MG
3
3
SMOKING DETERRENTS
SMOKING DETERRENTS
buproban tab 150mg
CHANTIX PAK 0.5& 1MG
CHANTIX PAK 1MG
CHANTIX TAB 0.5MG
eq nicotine dis 7mg/24hr
nicotine dis 14mg/24h
0
0
0
0
0
0
ST - Step Therapy
156
Drug Name
nicotine dis 21mg/24h
nicotine pol gum 4mg mint
nicotine pol loz 2mg mint
nicotine pol loz 4mg mint
NICOTROL INH
NICOTROL NS SPR 10MG/ML
thrive gum 2mg mint
ZYBAN TAB 150MG SR
0
0
0
0
0
0
0
2
SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS
SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS
FARXIGA TAB 5MG
FARXIGA TAB 10MG
INVOKANA TAB 100MG
INVOKANA TAB 300MG
JARDIANCE TAB 10MG
JARDIANCE TAB 25MG
3
3
2
2
3
3
PA
PA
SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB
SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE
COMB
INVOKAMET TAB 50-500MG
INVOKAMET TAB 50-1000
SYNJARDY TAB
SYNJARDY TAB 5-500MG
SYNJARDY TAB 5-1000MG
SYNJARDY TAB 12.5-500
XIGDUO XR TAB 5-500MG
XIGDUO XR TAB 10-1000
2
2
2
2
3
3
3
3
3
3
3
3
SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS
SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS
ENBREL
ENBREL
ENBREL
ENBREL
INJ 25/0.5ML
INJ 25MG
INJ 50MG/ML
SRCLK INJ 50MG/ML
4
4
4
4
PA
PA
PA
PA
4
4
4
4
PA
PA
PA
PA
SOMATOSTATIC AGENTS
SOMATOSTATIC AGENTS
octreotide
octreotide
octreotide
octreotide
inj
inj
inj
inj
50mcg/ml
100mcg
200mcg
500mcg
ST - Step Therapy
157
Drug Name
octreotide inj 1000mcg
SANDOSTATIN INJ 50MCG/ML
SANDOSTATIN INJ 100MCG
SIGNIFOR INJ 0.3MG/ML
4
PA
4
PA
4
PA
4
PA
4
PA
4
PA
3
PA
3
PA
3
PA
SPACER/AEROSOL-HOLDING CHAMBERS SUPPLIES
SPACER/AEROSOL-HOLDING CHAMBERS SUPPLIES
INSPIREASE MIS DD SYST
INSPIREASE MIS MOUTHPCE
INSPIREASE MIS RES BAG
PANDA MASK MIS PEDIATRI
3
3
3
3
SPERMICIDES
SPERMICIDES
ENCARE SUP 100MG
GYNOL II GEL 3%
SHUR-SEAL GEL 2%
TODAY SPONGE MIS
VCF VAGINAL AER CONTRACP
vcf vaginal gel contrace
VCF VAGINAL MIS CONTRACP
0
0
0
0
0
0
0
SPHINGOSINE 1-PHOSPHATE (S1P) RECEPTOR MODULATORS
SPHINGOSINE 1-PHOSPHATE (S1P) RECEPTOR MODULATORS
GILENYA CAP 0.5MG
4
PA
SSRIS-NUTRITIONAL SUPPLEMENT COMBINATIONS
SSRIS-NUTRITIONAL SUPPLEMENT COMBINATIONS
GABOXETINE PAK
SENTRALOPRAM PAK AM-10
3
3
STEROID COMBINATIONS
STEROID COMBINATIONS
BETA 1 KIT KIT 30MG/5ML
JNT/TUNNEL/ KIT TRIGGER
K10-LIDO KIT
3
3
3
STEROID INHALANTS
STEROID INHALANTS
AEROSPAN AER 80MCG
ALVESCO AER 80MCG
ALVESCO AER 160MCG
ARNUITY ELPT INH 100MCG
ARNUITY ELPT INH 200MCG
3
3
3
3
3
PA
PA
ST - Step Therapy
158
Drug Name
ASMANEX 30 AER 110MCG
ASMANEX 120 AER 220MCG
ASMANEX HFA AER 100 MCG
ASMANEX HFA AER 200 MCG
budesonide sus 0.5mg/2
budesonide sus 0.25mg/2
budesonide sus 1mg/2ml
FLOVENT DISK AER 50MCG
FLOVENT HFA AER 44MCG
PULMICORT INH 90MCG
PULMICORT INH 180MCG
PULMICORT SUS 0.5MG/2
PULMICORT SUS 0.25MG/2
PULMICORT SUS 1MG/2ML
QVAR AER 40MCG
QVAR AER 80MCG
2
2
2
2
1
1
1
2
2
2
2
2
2
2
2
3
3
3
2
2
STEROID-LOCAL ANESTHETIC COMBINATIONS
STEROID-LOCAL ANESTHETIC COMBINATIONS
CORTANE-B LOT
EPIFOAM AER 1%
hc pramoxine cre 2.5-1%
NOVACORT GEL
PRAMOSONE CRE 1%
PRAMOSONE CRE 1-2.5%
PRAMOSONE E CRE 1-2.5%
PRAMOSONE LOT 1%
PRAMOSONE LOT 2.5%
PRAMOSONE OIN 1%
PRAMOSONE OIN 2.5%
3
3
1
3
3
3
3
3
3
3
3
STEROIDS - MOUTH/THROAT
STEROIDS - MOUTH/THROAT
triamcinolon pst 0.1%
1
STIMULANT LAXATIVES
STIMULANT LAXATIVES
CASCARA EXT SAGRADA
3
STIMULANTS - MISC NUTRITIONAL SUPPLEMENT COMBINATIONS
STIMULANTS - MISC NUTRITIONAL SUPPLEMENT COMBINATIONS
SENTRAMODAFI PAK AM-100
3
STIMULANTS - MISC.
ST - Step Therapy
159
Drug Name
STIMULANTS - MISC.
APTENSIO XR CAP 10MG
CONCERTA TAB 18MG
CONCERTA TAB 27MG
CONCERTA TAB 36MG
CONCERTA TAB 54MG
DAYTRANA DIS 10MG/9HR
dexmethylph cap 15mg er
dexmethylph tab 2.5mg
dexmethylph tab 5mg
dexmethylph tab 10mg
dexmethylphe cap 5mg er
FOCALIN TAB 2.5MG
FOCALIN TAB 5MG
FOCALIN TAB 10MG
FOCALIN XR CAP 5MG
FOCALIN XR CAP 10MG
FOCALIN XR CAP 15MG
FOCALIN XR CAP 20MG
FOCALIN XR CAP 25MG
FOCALIN XR CAP 30MG
FOCALIN XR CAP 35MG
FOCALIN XR CAP 40MG
METADATE CD CAP 10MG
methlphenida chw 2.5mg
METHYLIN CHW 2.5MG
3
3
3
3
3
3
3
3
3
3
3
2
2
2
2
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
2
ST - Step Therapy
160
Drug Name
METHYLIN CHW 5MG
METHYLIN CHW 10MG
METHYLIN SOL 5MG/5ML
METHYLIN SOL 10MG/5ML
methylphenid cap 10mg
methylphenid cap 20mg er
methylphenid chw 5mg
methylphenid chw 10mg
methylphenid sol 5mg/5ml
methylphenid sol 10mg/5ml
methylphenid tab 5mg
methylphenid tab 10mg er
modafinil tab 100mg
modafinil tab 200mg
NUVIGIL TAB 50MG
NUVIGIL TAB 150MG
NUVIGIL TAB 200MG
NUVIGIL TAB 250MG
PROVIGIL TAB 100MG
PROVIGIL TAB 200MG
QUILLIVANT SUS 25MG/5ML
RITALIN LA CAP 10MG
RITALIN LA CAP 20MG
RITALIN LA CAP 30MG
RITALIN LA CAP 40MG
RITALIN LA CAP 60MG
RITALIN TAB 5MG
RITALIN TAB 10MG
RITALIN TAB 20MG
2
2
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
3
3
2
3
3
3
3
3
3
3
3
SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS
ST - Step Therapy
161
Drug Name
SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS
EMEND CAP 40MG
EMEND CAP 80MG
EMEND CAP 125MG
EMEND PAK 80 & 125
VARUBI TAB 90MG
3
3
3
3
3
SUCCINIMIDES
SUCCINIMIDES
CELONTIN CAP 300MG
ethosuximide cap 250mg
ethosuximide sol 250/5ml
ZARONTIN CAP 250MG
ZARONTIN SOL 250/5ML
3
1
1
3
3
SULFONAMIDES
SULFONAMIDES
SULFADIAZINE TAB 500MG
SULFISOXIZOL CRY
3
3
SULFONYLUREA-BIGUANIDE COMBINATIONS
SULFONYLUREA-BIGUANIDE COMBINATIONS
glip/metform tab 2.5-250m
glip/metform tab 2.5-500m
glip/metform tab 5-500mg
GLUCOVANCE TAB 1.25-250
GLUCOVANCE TAB 2.5-500
GLUCOVANCE TAB 5-500MG
glyb/metform tab 1.25-250
glyb/metform tab 2.5-500
glyb/metform tab 5-500mg
1
1
1
3
3
3
1
1
1
SULFONYLUREA-THIAZOLIDINEDIONE COMBINATIONS
SULFONYLUREA-THIAZOLIDINEDIONE COMBINATIONS
DUETACT TAB 30-2MG
DUETACT TAB 30-4MG
pioglit/glim tab 30-2mg
pioglit/glim tab 30-4mg
3
3
1
1
SULFONYLUREAS
SULFONYLUREAS
AMARYL TAB 1MG
AMARYL TAB 2MG
AMARYL TAB 4MG
chlorpropam tab 100mg
chlorpropam tab 250mg
DIABETA TAB 1.25MG
DIABETA TAB 2.5MG
3
3
3
1
1
3
3
ST - Step Therapy
162
Drug Name
DIABETA TAB 5MG
glimepiride tab 1mg
glimepiride tab 2mg
glimepiride tab 4mg
glipizide er tab 2.5mg
glipizide er tab 5mg
glipizide er tab 10mg
glipizide tab 5mg
glipizide tab 10mg
GLUCOTROL TAB 5MG
GLUCOTROL TAB 10MG
GLUCOTROL XL TAB 2.5MG
GLUCOTROL XL TAB 5MG
GLUCOTROL XL TAB 10MG
glyburid mcr tab 1.5mg
glyburid mcr tab 3mg
glyburid mcr tab 6mg
glyburide tab 1.25mg
glyburide tab 2.5mg
glyburide tab 5mg
GLYNASE TAB 1.5MG
GLYNASE TAB 3MG
GLYNASE TAB 6MG
tolazamide tab 250mg
tolazamide tab 500mg
tolbutamide tab 500mg
3
1
1
1
1
1
1
1
1
3
3
3
3
3
1
1
1
1
1
1
3
3
3
1
1
1
SYNTHETIC HEPARINOID-LIKE AGENTS
SYNTHETIC HEPARINOID-LIKE AGENTS
ARIXTRA INJ 2.5/0.5
ARIXTRA INJ 5/0.4ML
ARIXTRA INJ 7.5/0.6
ARIXTRA INJ 10/0.8ML
fondaparinux inj 2.5/0.5
fondaparinux inj 5/0.4ml
fondaparinux inj 7.5/0.6
fondaparinux inj 10/0.8ml
2
2
2
2
1
1
1
1
TAR PRODUCTS
TAR PRODUCTS
coal tar sol 20%
1
TETRACYCLINES
TETRACYCLINES
ACTICLATE TAB 75MG
ACTICLATE TAB 150MG
ADOXA CAP 150MG
3
3
3
ST - Step Therapy
163
Drug Name
ADOXA PAK 1/ TAB 100MG
ADOXA PAK 1/ TAB 150MG
ADOXA TAB 50MG
ADOXA TAB 75MG
demeclocycl tab 150mg
demeclocycl tab 300mg
DORYX TAB 50MG
DORYX TAB 200MG
doxycyc mono cap 50mg
doxycyc mono cap 100mg
doxycyc mono tab 50mg
doxycycl hyc cap 50mg
doxycycl hyc cap 100mg
doxycycl hyc tab 75mg dr
doxycycl hyc tab 100mg
doxycycline sus 25mg/5ml
doxycycline tab 20mg
MINOCIN CAP 50MG
MINOCIN CAP 75MG
MINOCIN CAP 100MG
minocycline cap 50mg
minocycline tab 45mg er
minocycline tab 50mg
MONODOX CAP 75MG
MONODOX CAP 100MG
NUTRIDOX KIT
SOLODYN TAB 55MG
SOLODYN TAB 65MG
SOLODYN TAB 80MG
SOLODYN TAB 105MG
SOLODYN TAB 115MG
TARGADOX TAB 50MG
3
3
3
3
1
1
3
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
3
3
1
1
1
1
1
1
1
1
1
3
3
3
3
ST
3
ST
3
ST
3
ST
3
ST
3
ST - Step Therapy
164
Drug Name
tetracycline cap 250mg
tetracycline cap 500mg
VIBRAMYCIN CAP 100MG
VIBRAMYCIN SUS 25MG/5ML
VIBRAMYCIN SYP 50MG/5ML
1
1
3
2
2
THIAZIDES AND THIAZIDE-LIKE DIURETICS
THIAZIDES AND THIAZIDE-LIKE DIURETICS
chlorothiaz tab 250mg
chlorothiaz tab 500mg
chlorthalid tab 25mg
DIURIL SUS 250/5ML
hydrochlorot cap 12.5mg
hydrochlorot tab 12.5mg
hydrochlorot tab 25mg
hydrochlorot tab 50mg
indapamide tab 1.25mg
indapamide tab 2.5mg
methyclothia tab 5mg
metolazone tab 2.5mg
metolazone tab 5mg
metolazone tab 10mg
MICROZIDE CAP 12.5MG
1
1
1
1
1
3
1
1
1
1
1
1
1
1
1
1
3
THIAZOLIDINEDIONE-BIGUANIDE COMBINATIONS
THIAZOLIDINEDIONE-BIGUANIDE COMBINATIONS
ACTOPLUS MET TAB 15-500MG
ACTOPLUS MET TAB 15-850MG
ACTOPLUS MET TAB XR
AVANDAMET TAB 2-1000MG
pioglita/met tab 15-500mg
pioglita/met tab 15-850mg
3
3
3
3
1
1
THIAZOLIDINEDIONES
THIAZOLIDINEDIONES
ACTOS TAB 15MG
ACTOS TAB 30MG
ACTOS TAB 45MG
AVANDIA TAB 2MG
AVANDIA TAB 4MG
AVANDIA TAB 8MG
pioglitazone tab 15mg
3
3
3
3
3
3
1
1
1
PA
PA
PA
THIENBENZODIAZEPINES
ST - Step Therapy
165
Drug Name
THIENBENZODIAZEPINES
olanzapine tab 2.5mg
olanzapine tab 5mg
olanzapine tab 5mg odt
olanzapine tab 7.5mg
olanzapine tab 10mg
olanzapine tab 15mg
olanzapine tab 20mg
ZYPREXA TAB 2.5MG
ZYPREXA TAB 5MG
ZYPREXA TAB 7.5MG
ZYPREXA TAB 10MG
ZYPREXA TAB 15MG
ZYPREXA TAB 20MG
ZYPREXA ZYDI TAB 5MG
1
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
3
THIENBENZODIAZEPINES SSRIS
THIENBENZODIAZEPINES SSRIS
olanza/fluox cap 3-25mg
SYMBYAX CAP 3-25MG
SYMBYAX CAP 6-25MG
SYMBYAX CAP 6-50MG
SYMBYAX CAP 12-25MG
SYMBYAX CAP 12-50MG
1
1
1
1
1
3
3
3
3
3
THIENOPYRIDINE DERIVATIVES
THIENOPYRIDINE DERIVATIVES
clopidogrel tab 75mg
clopidogrel tab 300mg
EFFIENT TAB 5MG
EFFIENT TAB 10MG
PLAVIX TAB 75MG
PLAVIX TAB 300MG
1
1
2
2
3
3
PA
PA
THIOXANTHENES
THIOXANTHENES
thiothixene cap 1mg
1
ST - Step Therapy
166
Drug Name
thiothixene cap 2mg
thiothixene cap 5mg
thiothixene cap 10mg
1
1
1
THROMBIN INHIBITORS - SELECTIVE DIRECT REVERSIBLE
THROMBIN INHIBITORS - SELECTIVE DIRECT REVERSIBLE
PRADAXA CAP 75MG
PRADAXA CAP 150MG
2
2
THROMBOPOIETIN (TPO) RECEPTOR AGONISTS
THROMBOPOIETIN (TPO) RECEPTOR AGONISTS
PROMACTA
PROMACTA
PROMACTA
PROMACTA
TAB
TAB
TAB
TAB
12.5MG
25MG
50MG
75MG
4
4
4
4
PA
PA
PA
PA
THYROID HORMONES
THYROID HORMONES
ARMOUR THYRO TAB 15MG
CYTOMEL TAB 5MCG
CYTOMEL TAB 25MCG
CYTOMEL TAB 50MCG
levothyroxin tab 25mcg
liothyronine tab 5mcg
NATURE THROI TAB 162.5MG
NATURE-THROI TAB 16.25MG
3
3
3
3
3
3
3
3
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
3
3
ST - Step Therapy
167
Drug Name
NATURE-THROI TAB 65MG
np thyroid tab 30mg
np thyroid tab 60mg
np thyroid tab 90mg
SYNTHROID TAB 25MCG
SYNTHROID TAB 50MCG
SYNTHROID TAB 75MCG
SYNTHROID TAB 88MCG
SYNTHROID TAB 100MCG
THYROLAR-1 TAB 60MG
THYROLAR-1/2 TAB 30MG
THYROLAR-1/4 TAB 15MG
THYROLAR-2 TAB 120MG
THYROLAR-3 TAB 180MG
TIROSINT CAP 13MCG
TIROSINT CAP 25MCG
TIROSINT CAP 50MCG
TIROSINT CAP 75MCG
TIROSINT CAP 88MCG
TIROSINT CAP 100MCG
TIROSINT CAP 112MCG
TIROSINT CAP 125MCG
TIROSINT CAP 137MCG
TIROSINT CAP 150MCG
3
3
3
3
3
3
3
3
3
3
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
TOPICAL ANESTHETIC COMBINATIONS
TOPICAL ANESTHETIC COMBINATIONS
ADAZIN CRE
ANODYNERX PAD
3
3
ST - Step Therapy
168
Drug Name
ANODYNZ MIS 0.0375-5
ATENDIA PAD 4-3%
CETACAINE AER
COMFORT EZ PAD 20-4-1%
DERMACINRX PAK
DERMACINRX PAK DUOPATCH
EMLA CRE 2.5-2.5%
FLEXIN PAD .0375-5%
LEVATIO PAD 0.3-5%
lido/prilocn cre 2.5-2.5%
lido/prilocn kit 2.5-2.5%
lidocaine cre tetracai
LIDOTHOL PAD 4.5-5%
PAIN RELIEF PAD PATCH
PHARM CH TSX PAD 2-4-1%
PLIAGLIS CRE 7-7%
RENOVO LIDO5 CRE 5-0.05%
RENUU PAD 2-5-30%
SCAR PATCH PAD
SOOTHEE PAD
SYNERA DIS 70-70MG
TETRAMEX SPR 2-1-3%
3
3
3
3
3
3
3
3
3
1
1
1
3
3
3
3
3
3
3
3
3
3
TOPICAL ANESTHETIC GASSES
TOPICAL ANESTHETIC GASSES
ETHYL CHLOR AER MED STRM
ethyl chlor aer mist
3
1
TOPICAL DECONGESTANTS
TOPICAL DECONGESTANTS
ADRENALIN SOL 1:1000
TYZINE PED DRO 0.05%
TYZINE SOL 0.1%
3
3
3
TOPICAL SELECTIVE RETINOID X RECEPTOR AGONISTS
TOPICAL SELECTIVE RETINOID X RECEPTOR AGONISTS
TARGRETIN GEL 1%
4
PA
TOPICAL STEROID COMBINATIONS
TOPICAL STEROID COMBINATIONS
calcipotrien oin betameth
CLODAN KIT 0.05%
cortalo gel 2%
DERMACINRX KIT SILAPAK
HALAC KIT
SCALACORT DK KIT
SILAZONE PAK PHARMAPA
SYNALAR KIT 0.025%
1
3
1
3
3
3
3
3
ST - Step Therapy
169
Drug Name
SYNALAR TS KIT 0.01%
TACLONEX OIN
TACLONEX SUS
TRIAMSIL PAK COMBIPAK
TRIAMSIL PAK MULTIPAK
TRIDERMA CRE FORTE
ULTRAVATE X KIT 0.05-10%
WHYTEDERM TD KIT PAK
3
3
3
3
3
3
3
3
TOPOISOMERASE I INHIBITORS
TOPOISOMERASE I INHIBITORS
HYCAMTIN CAP 0.25MG
HYCAMTIN CAP 1MG
0
0
PA
PA
TRAMADOL COMBINATIONS
TRAMADOL COMBINATIONS
tramadl/apap tab 37.5-325
ULTRACET TAB 37.5-325
1
3
TRAMADOL-NUTRITIONAL SUPPLEMENT COMBINATIONS
TRAMADOL-NUTRITIONAL SUPPLEMENT COMBINATIONS
THERATRAMADO PAK -90
3
TRANSDERMAL PATCHES
TRANSDERMAL PATCHES
EXYDERM PAD
3
TRIAZOLES
TRIAZOLES
CRESEMBA CAP 186 MG
DIFLUCAN SUS 10MG/ML
DIFLUCAN SUS 40MG/ML
DIFLUCAN TAB 50MG
DIFLUCAN TAB 100MG
DIFLUCAN TAB 150MG
DIFLUCAN TAB 200MG
fluconazole sus 10mg/ml
fluconazole sus 40mg/ml
fluconazole tab 50mg
itraconazole cap 100mg
NOXAFIL SUS 40MG/ML
NOXAFIL TAB 100MG
ONMEL TAB 200MG
SPORANOX CAP 100MG
SPORANOX SOL 10MG/ML
3
3
3
3
3
3
3
1
1
1
1
1
1
1
3
3
3
3
3
ST - Step Therapy
170
Drug Name
VFEND SUS 40MG/ML
VFEND TAB 50MG
VFEND TAB 200MG
voriconazole sus 40mg/ml
voriconazole tab 50mg
voriconazole tab 200mg
2
2
2
1
1
1
TRICYCLIC AGENTS
TRICYCLIC AGENTS
amitriptylin tab 10mg
amoxapine tab 25mg
amoxapine tab 50mg
amoxapine tab 100mg
amoxapine tab 150mg
ANAFRANIL CAP 25MG
ANAFRANIL CAP 50MG
ANAFRANIL CAP 75MG
clomipramine cap 25mg
desipramine tab 10mg
doxepin hcl cap 10mg
doxepin hcl con 10mg/ml
imipram hcl tab 10mg
imipram pam cap 75mg
1
1
1
1
1
1
1
1
1
1
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
ST - Step Therapy
171
Drug Name
NORPRAMIN TAB 10MG
NORPRAMIN TAB 25MG
NORPRAMIN TAB 50MG
NORPRAMIN TAB 75MG
NORPRAMIN TAB 100MG
NORPRAMIN TAB 150MG
nortriptylin cap 10mg
nortriptylin sol 10mg/5ml
PAMELOR CAP 10MG
PAMELOR CAP 25MG
PAMELOR CAP 50MG
PAMELOR CAP 75MG
protriptylin tab 5mg
protriptylin tab 10mg
SURMONTIL CAP 25MG
SURMONTIL CAP 50MG
SURMONTIL CAP 100MG
TOFRANIL TAB 10MG
TOFRANIL TAB 25MG
TOFRANIL TAB 50MG
TOFRANIL-PM CAP 75MG
trimipramine cap 25mg
2
2
2
2
2
2
1
1
1
1
1
2
2
2
2
1
1
3
3
3
2
2
2
3
3
3
3
1
1
1
TRICYCLIC AGENTS-NUTRITIONAL SUPPLEMENT COMBINATIONS
TRICYCLIC AGENTS-NUTRITIONAL SUPPLEMENT COMBINATIONS
SENTRAVIL PM PAK -25
3
TRIPHASIC CONTRACEPTIVES - ORAL
TRIPHASIC CONTRACEPTIVES - ORAL
aranelle tab
CYCLESSA PAK
enpresse-28 tab
ESTROSTEP FE TAB
nortrel tab 7/7/7
ORTHO TRI- TAB CYCLEN
ORTHO TRI- TAB CYCLN LO
ORTHO-NOVUM TAB 7/7/7
tri-legest tab fe
0
3
0
3
0
3
0
3
0
ST - Step Therapy
172
Drug Name
TRI-NORINYL TAB 28
tri-sprintec tab
velivet pak
3
0
0
TUMOR NECROSIS FACTOR ALPHA BLOCKERS
TUMOR NECROSIS FACTOR ALPHA BLOCKERS
CIMZIA KIT
CIMZIA KIT STARTER
CIMZIA PREFL KIT 200MG/ML
4
4
4
PA
PA
PA
ULCER ANTI-INFECTIVE W/ BISMUTH COMBINATIONS
ULCER ANTI-INFECTIVE W/ BISMUTH COMBINATIONS
PYLERA CAP
2
ULCER ANTI-INFECTIVE W/ PROTON PUMP INHIBITORS
ULCER ANTI-INFECTIVE W/ PROTON PUMP INHIBITORS
lansopr/amox mis /clarith
OMECLAMOX- MIS PAK
PREVPAC MIS
1
3
3
ULCER DRUGS - PROSTAGLANDINS
ULCER DRUGS - PROSTAGLANDINS
CYTOTEC TAB 100MCG
CYTOTEC TAB 200MCG
misoprostol tab 100mcg
misoprostol tab 200mcg
2
2
1
1
UREA CYCLE DISORDER - AGENTS
UREA CYCLE DISORDER - AGENTS
BUPHENYL POW
BUPHENYL TAB 500MG
phenylbutyra pow sodium
RAVICTI LIQ 1.1GM/ML
4
4
4
4
PA
PA
PA
PA
URICOSURICS
URICOSURICS
probenecid tab 500mg
1
URINARY ANALGESICS
URINARY ANALGESICS
phenazo tab 200mg
phenazopyrid tab 100mg
PYRIDIUM TAB 100MG
PYRIDIUM TAB 200MG
1
1
2
2
URINARY ANTI-INFECTIVES
URINARY ANTI-INFECTIVES
FURADANTIN SUS 25MG/5ML
HIPREX TAB 1GM
MACROBID CAP 100MG
MACRODANTIN CAP 25MG
2
3
2
2
ST - Step Therapy
173
Drug Name
methenam hip tab 1gm
methenam man tab 1gm
methenam man tab 500mg
MONUROL PAK GRANULES
NALIDIXIC POW ACID
nitrofur mac cap 25mg
NITROFURAN POW ANHYDROU
nitrofurantn cap 100mg
nitrofurantn sus 25mg/5ml
2
2
1
1
1
3
3
1
1
1
3
1
1
URINARY ANTISEPTIC-ANTISPASMODIC /OR ANALGESICS
URINARY ANTISEPTIC-ANTISPASMODIC /OR ANALGESICS
hyophen tab
phosphasal tab
PROSED/DS TAB
urelle tab
uribel cap 118mg
urimar-t tab
UROGESIC- TAB BLUE
urolet mb tab
ustell cap
UTA CAP 120MG
1
1
3
1
1
1
3
1
1
1
URINARY ANTISPASMODIC - ANTIMUSCARINIC (ANTICHOLINERGIC)
URINARY ANTISPASMODIC - ANTIMUSCARINIC
(ANTICHOLINERGIC)
DETROL LA CAP 2MG
DETROL LA CAP 4MG
DETROL TAB 1MG
DETROL TAB 2MG
DITROPAN XL TAB 5MG
DITROPAN XL TAB 10MG
DITROPAN XL TAB 15MG
ENABLEX TAB 7.5MG
ENABLEX TAB 15MG
GELNIQUE GEL 3%
GELNIQUE GEL 10%
oxybutynin syp 5mg/5ml
oxybutynin tab 5mg
oxybutynin tab 5mg er
3
3
3
3
3
3
3
3
3
2
2
1
1
1
1
1
PA
PA
ST - Step Therapy
174
Drug Name
OXYTROL DIS 3.9MG/24
tolterodine cap 2mg er
tolterodine cap 4mg er
tolterodine tab 1mg
tolterodine tab 2mg
TOVIAZ TAB 4MG
TOVIAZ TAB 8MG
trospium chl cap 60mg er
trospium cl tab 20mg
VESICARE TAB 5MG
VESICARE TAB 10MG
3
PA
1
1
1
1
3
PA
3
PA
1
1
2
2
URINARY ANTISPASMODICS - BETA-3 ADRENERGIC AGONISTS
URINARY ANTISPASMODICS - BETA-3 ADRENERGIC AGONISTS
MYRBETRIQ TAB 25MG
MYRBETRIQ TAB 50MG
2
2
URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS
URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS
bethanechol tab 5mg
bethanechol tab 10mg
URECHOLINE TAB 5MG
URECHOLINE TAB 10MG
URECHOLINE TAB 25MG
URECHOLINE TAB 50MG
1
1
1
1
2
2
2
2
URINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS
URINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS
flavoxate tab 100mg
1
URINARY STONE AGENTS
URINARY STONE AGENTS
LITHOSTAT TAB 250MG
THIOLA TAB 100MG
3
3
URINARY TRACT PROTECTIVE AGENTS
URINARY TRACT PROTECTIVE AGENTS
MESNEX TAB 400MG
0
VAGINAL ANTI-INFECTIVES
VAGINAL ANTI-INFECTIVES
AVC CRE 15%
CLEOCIN CRE 2% VAG
CLEOCIN SUP 100MG
clindamycin cre 2% vag
CLINDESSE CRE 2%
METROGEL-VAG GEL 0.75%
3
2
3
1
3
2
ST - Step Therapy
175
Drug Name
NUVESSA GEL 1.3%
vandazole gel 0.75%
3
1
VAGINAL ESTROGENS
VAGINAL ESTROGENS
ESTRACE VAG CRE 0.1MG/GM
ESTRING MIS 2MG
FEMRING MIS 0.1MG/24
FEMRING MIS 0.05/24H
PREMARIN VAG CRE 0.625MG
VAGIFEM TAB 10MCG
2
3
3
3
2
2
VAGINAL PROGESTINS
VAGINAL PROGESTINS
CRINONE GEL 4% VAG
CRINONE GEL 8% VAG
ENDOMETRIN SUP 100MG
2
2
2
VALPROIC ACID
VALPROIC ACID
DEPAKENE CAP 250MG
DEPAKENE SYP 250/5ML
DEPAKOTE ER TAB 250MG
DEPAKOTE ER TAB 500MG
DEPAKOTE SPR CAP 125MG
DEPAKOTE TAB 125MG DR
divalproex cap 125mg
divalproex tab 125mg dr
divalproex tab 250mg er
divalproex tab 500mg er
STAVZOR CAP 125MG
STAVZOR CAP 250MG
STAVZOR CAP 500MG
valproic acd cap 250mg
valproic acd syp 250/5ml
3
3
3
3
3
3
3
3
1
1
1
1
1
1
3
3
3
1
1
VASODILATORS
VASODILATORS
hydralazine tab 10mg
minoxidil tab 2.5mg
minoxidil tab 10mg
1
1
1
1
1
1
ST - Step Therapy
176
Drug Name
VASOMOTOR SYMPTOM AGENTS - SSRIS
VASOMOTOR SYMPTOM AGENTS - SSRIS
BRISDELLE CAP 7.5MG
2
VASOPRESSIN
VASOPRESSIN
DDAVP SOL 0.01%
DDAVP SPR 0.01%
DDAVP TAB 0.1MG
DDAVP TAB 0.2MG
desmopressin sol 0.01%
desmopressin spr 0.01%
desmopressin tab 0.1mg
desmopressin tab 0.2mg
STIMATE SOL 1.5MG/ML
2
2
2
2
1
1
1
1
3
VASOPRESSORS
VASOPRESSORS
midodrine tab 2.5mg
midodrine tab 5mg
midodrine tab 10mg
1
1
1
VITAMIN D
VITAMIN D
BABY DDROPS LIQ 400UNIT
bio-d-mulsio liq 400unit
D-VI-SOL LIQ 400UNIT
DRISDOL CAP 50000UNT
ergocalcifer cap 50000unt
VITAMIN D2 TAB 400UNIT
vitamin d3 cap 400unit
vitamin d3 dro 400unit
VITAMIN D3 LIQ 1000UNIT
VITAMIN D3 LIQ 1200UNIT
vitamin d3 tab 400unit
vitamin d chw 400unit
0
0
0
2
1
0
0
0
0
0
0
0
VITAMIN E
VITAMIN E
WHEAT GERM OIL
3
VITAMIN K
VITAMIN K
MEPHYTON TAB 5MG
3
WOUND CARE COMBINATIONS
WOUND CARE COMBINATIONS
COLLIGINIX MIS
3
XANTHINE-EXPECTORANTS
ST - Step Therapy
177
Drug Name
XANTHINE-EXPECTORANTS
difil-g fort liq 100-100
1
XANTHINE-NUTRITIONAL SUPPLEMENT COMBINATIONS
XANTHINE-NUTRITIONAL SUPPLEMENT COMBINATIONS
PULMOPHYLLIN PAK
3
XANTHINES
XANTHINES
ELIXOPHYLLIN ELX 80/15ML
LUFYLLIN TAB 400MG
THEO-24 CAP 100MG CR
THEO-24 CAP 400MG ER
theochron tab 100mg cr
theophylline sol 80/15ml
theophylline tab 400mg er
3
3
3
3
3
3
1
1
1
1
1
1
1
ST - Step Therapy
178
Index
1
1 ML SYRIMGE MIS 18GX1" .............. 117
1 ML SYRINGE MIS 22X1-1/2 ........... 118
1.5 ML SYRNG MIS 22X1-1/2 ........... 118
10ML LL SYRN MIS 20GX1.5" ........... 116
10ML LL SYRN MIS 21GX1" .............. 116
10ML LL SYRN MIS 21GX1.5" ........... 116
10ML LL SYRN MIS 23GX1.25 ........... 116
10ML SYRINGE MIS 25GX1.5" .......... 118
10ML SYRINGE MIS LUER-LOK.......... 118
12ML LL SYRN MIS 20GX1" .............. 116
12ML LL SYRN MIS 22GX1" .............. 116
12ML SYRINGE MIS 22GX1.5" .......... 118
12ML SYRINGE MIS REG LUER .......... 118
140ML SYRING MIS LUER-LOC.......... 117
18G SHIELDED MIS NEEDLE ............. 115
1ML SYR/NEED MIS 26GX5/8" .......... 117
1ML SYRINGE MIS 25GX5/8" ............ 118
1ML SYRINGE MIS 26GX3/8" ............ 118
1ML SYRINGE MIS 27GX3/8" ............ 118
1ML TB SYRNG MIS 21GX1" ............. 118
1ML TB SYRNG MIS 22GX1" ............. 118
1ML TB SYRNG MIS 25GX1" ............. 118
1ML TB SYRNG MIS 25GX5/8" .......... 118
1ML TB SYRNG MIS 26GX3/8" .......... 118
1ML TB SYRNG MIS 26GX5/8" .......... 118
1ML TB SYRNG MIS 27GX1/2" .......... 118
1ML TB SYRNG MIS 28GX1/2" .......... 118
1ML TB SYRNG MIS REG LUER .......... 118
2
2.5ML SYRING MIS TRAY PAK ........... 117
20-25ML SYRN MIS LUER LCK .......... 118
20ml syringe mis luer slp ................. 118
3
3ML CARTRIDG MIS PLASTIC ........... 102
3ML LL SYRNG MIS 18GX1.5" ........... 116
3ML LL SYRNG MIS 20GX3/4" ........... 117
3ML LL SYRNG MIS 21GX1.25 .......... 117
3ML LL SYRNG MIS 22GX1.25 .......... 117
3ML LL SYRNG MIS 22GX3/4" ........... 117
3ML LL SYRNG MIS 23GX1.5" ........... 117
3ML LL SYRNG MIS 23GX3/4" ........... 117
3ML LL SYRNG MIS 24GX1" .............. 117
3ML LL SYRNG MIS 25GX1.5" ........... 117
3ML LL SYRNG MIS 26GX3/8" .......... 117
3ML LL SYRNG MIS 26GX5/8" .......... 117
3ML SYRINGE MIS 20GX1" .............. 118
3ML SYRINGE MIS 20GX1.5" ........... 118
3ML SYRINGE MIS 21GX1.5" ........... 118
3ML SYRINGE MIS 22GX1" .............. 118
3ML SYRINGE MIS 23GX1" .............. 118
3ML SYRINGE MIS 25GX1" .............. 118
3ML SYRINGE MIS 25GX1.25 ........... 118
3ML SYRINGE MIS 27GX1.25 ........... 118
3ML SYRINGE MIS REG TIP ............. 118
5
5ML LL SYRNG MIS 20GX1" ............. 116
5ML LL SYRNG MIS 20GX1.5" .......... 117
5ML LL SYRNG MIS 21GX1" ............. 117
5ML LL SYRNG MIS 21GX1.5" .......... 117
5ML LL SYRNG MIS 22GX1" ............. 117
5ML LL SYRNG MIS 23GX1" ............. 117
5ML LL SYRNG MIS 23GX1.25 .......... 117
5ML SYRINGE MIS 27GX1.5" ........... 118
6
6ML LUER LOK MIS 20GX1" ............. 117
6ML LUER LOK MIS 21GX1.25 .......... 117
6ML LUER LOK MIS 22GX1" ............. 117
6ML LUER LOK MIS 22GX1.25 .......... 117
6ML LUER LOK MIS 23GX1" ............. 117
6ML SYRINGE MIS 18GX1" .............. 117
6ML SYRINGE MIS 21GX1" .............. 118
6ML SYRINGE MIS CANNULA ........... 118
8
8-MOP CAP 10MG ............................. 38
A
abacav/lamiv tab /zidovud ................ 39
abacavir tab 300mg.......................... 40
ABILIFY TAB 10MG ......................... 150
ABILIFY TAB 15MG ......................... 150
ABILIFY TAB 20MG ......................... 150
ABILIFY TAB 2MG ........................... 150
ABILIFY TAB 30MG ......................... 150
ABILIFY TAB 5MG ........................... 150
ABSORICA CAP 10MG ......................... 6
ABSORICA CAP 20MG ......................... 6
ABSORICA CAP 25MG ......................... 6
ABSORICA CAP 30MG ......................... 6
179
ABSORICA CAP 35MG ......................... 6
ABSORICA CAP 40MG ......................... 6
ABSTRAL SUB 100MCG .................... 129
ABSTRAL SUB 200MCG .................... 129
ABSTRAL SUB 300MCG .................... 129
ABSTRAL SUB 400MCG .................... 129
ABSTRAL SUB 600MCG .................... 129
ABSTRAL SUB 800MCG .................... 129
acampro cal tab 333mg ...................... 9
ACANYA GEL 1.2-2.5% ....................... 5
acarbose tab 100mg..........................11
acarbose tab 25mg ...........................10
acarbose tab 50mg ...........................10
ACCOLATE TAB 10MG ...................... 105
ACCOLATE TAB 20MG ...................... 105
ACCU-CHEK KIT SPIRIT ................... 102
ACCU-CHEK MIS BATTERY ............... 102
ACCU-CHEK TES ACTIVE ....................72
ACCU-CHEK TES AVIVA .....................72
ACCU-CHEK TES AVIVA PL .................72
ACCU-CHEK TES COMFORT ................72
ACCU-CHEK TES COMPACT ................72
ACCU-CHEK TES DRUM ......................72
ACCU-CHEK TES SMART ....................72
ACCUPRIL TAB 10MG.......................... 2
ACCUPRIL TAB 20MG.......................... 2
ACCUPRIL TAB 40MG.......................... 2
ACCUPRIL TAB 5MG ........................... 2
ACCURETIC TAB 10-12.5 .................... 4
ACCURETIC TAB 20-12.5 .................... 4
ACCURETIC TAB 20-25MG................... 4
ACCUTREND MIS PLUS ......................91
ACCUTREND TES GLUCOSE ................72
ACD FORMULA SOL A ...................... 101
ACD FORMULA SOL B ...................... 101
ace acd/alum sol 2% otic ................. 136
acebutolol cap 200mg .......................50
acebutolol cap 400mg .......................50
ACEON TAB 4MG................................ 2
ACEON TAB 8MG................................ 2
acetasol hc sol otic .......................... 136
acetazolamid cap 500mg er................59
acetazolamid tab 125mg ....................59
acetazolamid tab 250mg ....................59
ACETEST TAB TABLETS ......................72
acetic acid sol 2% otic ..................... 136
acetylcyst sol 10% ......................... 112
acetylcyst sol 20% ......................... 112
ACIPHEX SPR CAP 10MG ................. 148
ACIPHEX SPR CAP 5MG ................... 148
ACIPHEX TAB 20MG ........................ 148
acitretin cap 10mg ........................... 38
acitretin cap 17.5mg......................... 38
acitretin cap 25mg ........................... 38
ACLOVATE CRE 0.05% ...................... 66
ACTEMRA INJ 162/0.9 .................... 103
acticin cre 5%................................ 153
ACTICLATE TAB 150MG ................... 166
ACTICLATE TAB 75MG .................... 166
ACTIGALL CAP 300MG ...................... 89
ACTIMMUNE INJ 2MU/0.5 .................. 36
ACTIQ LOZ 1200MCG...................... 129
ACTIQ LOZ 1600MCG...................... 129
ACTIQ LOZ 200MCG ....................... 129
ACTIQ LOZ 400MCG ....................... 129
ACTIQ LOZ 600MCG ....................... 129
ACTIQ LOZ 800MCG ....................... 129
ACTIVE OB CAP.............................. 144
ACTIVELLA TAB 0.5-0.1 .................... 83
ACTIVELLA TAB 1-0.5MG ................... 83
ACTONEL TAB 150MG ....................... 54
ACTONEL TAB 30MG ......................... 54
ACTONEL TAB 35MG ......................... 54
ACTONEL TAB 5MG ........................... 54
ACTOPLUS MET TAB 15-500MG ........ 168
ACTOPLUS MET TAB 15-850MG ........ 168
ACTOPLUS MET TAB XR................... 168
ACTOS TAB 15MG .......................... 168
ACTOS TAB 30MG .......................... 168
ACTOS TAB 45MG .......................... 168
ACUICYN LIQ ................................... 85
ACULAR LS SOL 0.4% ..................... 127
ACULAR SOL 0.5% OP .................... 127
ACURA TES BLD GLUC ...................... 72
ACUVAIL SOL 0.45% ...................... 127
acyclovir cap 200mg ......................... 95
acyclovir oin 5% .............................. 44
acyclovir sus 200/5ml ....................... 95
acyclovir tab 400mg ......................... 95
acyclovir tab 800mg ......................... 95
ACZONE GEL 5%................................ 4
ADALAT CC TAB 30MG ER ................. 56
180
ADALAT CC TAB 60MG ER ..................56
ADALAT CC TAB 90MG ER ..................56
adapalene cre 0.1% ........................... 6
adapalene gel 0.1% ........................... 6
adapalene gel 0.3% ........................... 6
adapalene lot 0.1% ............................ 6
ADASUVE INH 10MG .........................78
ADAZIN CRE .................................. 171
ADCIRCA TAB 20MG ........................ 149
ADDERALL TAB 10MG ........................12
ADDERALL TAB 12.5MG .....................12
ADDERALL TAB 15MG ........................12
ADDERALL TAB 20MG ........................12
ADDERALL TAB 30MG ........................12
ADDERALL TAB 5MG ..........................12
ADDERALL TAB 7.5MG .......................12
ADDERALL XR CAP 10MG ...................12
ADDERALL XR CAP 5MG .....................12
ADDYI TAB 100MG .......................... 157
adefov dipiv tab 10mg .......................94
ADEMPAS TAB 0.5MG ...................... 149
ADEMPAS TAB 1.5MG ...................... 149
ADEMPAS TAB 1MG ......................... 149
ADEMPAS TAB 2.5MG ...................... 149
ADEMPAS TAB 2MG ......................... 149
ADOXA CAP 150MG ......................... 166
ADOXA PAK 1/ TAB 100MG .............. 166
ADOXA PAK 1/ TAB 150MG .............. 166
ADOXA TAB 50MG ........................... 166
ADOXA TAB 75MG ........................... 166
ADRENACLICK INJ 0.15MG .................14
ADRENACLICK INJ 0.3MG ..................14
ADRENALIN INJ 1MG/ML ....................14
ADRENALIN INJ 30/30ML ...................14
ADRENALIN SOL 1:1000 .................. 172
ADV ALLERGY KIT COLLECTI ..............66
ADVAIR DISKU AER 100/50 ................ 8
ADVAIR DISKU AER 250/50 ................ 8
ADVAIR DISKU AER 500/50 ................ 8
ADVAIR HFA AER 115/21 .................... 8
ADVAIR HFA AER 230/21 .................... 8
ADVAIR HFA AER 45/21 ...................... 8
ADVANCE TES INTUITIO ................... 72
ADVANCE TES MICRO-DW ................. 72
ADVICOR TAB 1000-20 ..................... 96
ADVICOR TAB 1000-40 ..................... 96
ADVICOR TAB 500-20MG .................. 96
ADVICOR TAB 750-20MG .................. 96
advil jr st tab 100mg ...................... 123
ADVIL MIGRAI CAP 200MG .............. 123
ADVIL TAB 200MG.......................... 123
ADVOCATE TES ................................ 72
ADVOCATE TES REDI-COD ................ 72
ADVOCATE TES REDICODE ................ 72
AEROSPAN AER 80MCG ................... 161
AFINITOR DIS TAB 2MG .................... 34
AFINITOR TAB 10MG ........................ 34
AFINITOR TAB 2.5MG ....................... 34
AFINITOR TAB 5MG .......................... 34
AFINITOR TAB 7.5MG ....................... 34
AFREZZA POW 4& 8UNIT................... 97
AFREZZA POW 4UNIT ....................... 97
AFREZZA POW 8&12UNIT .................. 97
AGAMATRIX TES AMP ....................... 72
AGAMATRIX TES JAZZ ...................... 72
AGAMATRIX TES KEYNOTE ................ 72
AGAMATRIX TES PRESTO .................. 72
AGGRENOX CAP 25-200MG ............. 141
AGRYLIN CAP 0.5MG....................... 150
AKTEN GEL 3.5% ........................... 127
AKYNZEO CAP.................................. 28
ALA SCALP LOT 2% .......................... 66
ALA-QUIN CRE 3-0.5% ..................... 30
ALBENZA TAB 200MG ....................... 17
ALBUSTIX TES ................................. 72
albuterol neb 0.083% ....................... 49
albuterol neb 0.5% ........................... 48
albuterol neb 0.63mg/3 .................... 49
albuterol neb 1.25mg/3 .................... 49
albuterol syp 2mg/5ml ...................... 49
albuterol tab 2mg ............................. 49
albuterol tab 4mg ............................. 49
albuterol tab 4mg er ......................... 49
albuterol tab 8mg er ......................... 49
ALCAINE SOL 0.5% OP ................... 127
alclometason cre 0.05% .................... 66
181
alclometason oin 0.05% ....................66
ALCOHOL SWAB PAD .........................44
ALCORTIN A GEL ..............................30
ALDACTAZIDE TAB 25/25 ..................80
ALDACTAZIDE TAB 50/50 ..................80
ALDACTONE TAB 100MG .................. 142
ALDACTONE TAB 25MG.................... 142
ALDACTONE TAB 50MG.................... 142
ALDARA CRE 5%............................. 101
alendronate sol 70/75ml ....................54
alendronate tab 10mg .......................54
alendronate tab 5mg .........................54
ALEVE CAP 220MG .......................... 123
ALEVE TAB 220MG .......................... 123
alfuzosin tab 10mg ............................ 9
ALINIA SUS 100/5ML ........................37
ALINIA TAB 500MG ...........................37
ALKERAN TAB 2MG ......................... 120
all day allg cap 10mg ........................30
all day allg sol 5mg/5ml.....................30
all day pain tab 220mg .................... 123
ALLEGRA ALRG TAB 60MG .................30
aller-ease tab 60mg ..........................30
allergy relf syp 5mg/5ml ....................31
aller-tec tab 10mg ............................30
ALLO-PAX CRE 5-5% .........................30
allopurinol tab 100mg .......................92
allopurinol tab 300mg .......................92
almotrip mal tab 12.5mg ................. 154
almotrip mal tab 6.25mg ................. 154
ALOCRIL SOL 2% ............................ 126
ALOMIDE SOL 0.1% OP ................... 126
ALOQUIN GEL 1.25-1% .....................30
ALORA DIS 0.025MG .........................84
ALORA DIS 0.05MG ...........................84
ALORA DIS 0.075MG .........................84
ALORA DIS 0.1MG.............................84
alosetron tab 0.5mg ........................ 100
alosetron tab 1mg ........................... 100
ALPHAGAN P SOL 0.1% ................... 128
ALPHAGAN P SOL 0.15% ................. 128
alphatrex gel 0.05% ..........................66
ALPRAZOLAM CON 1 MG/ML ...............47
alprazolam tab 0.25 odt .................... 47
alprazolam tab 0.25mg ..................... 47
alprazolam tab 0.5mg ....................... 47
alprazolam tab 0.5mg er ................... 47
alprazolam tab 0.5mg od .................. 47
alprazolam tab 1mg .......................... 47
alprazolam tab 1mg er ...................... 47
alprazolam tab 1mg odt .................... 47
alprazolam tab 2mg .......................... 47
alprazolam tab 2mg odt .................... 47
ALREX SUS 0.2% ........................... 128
ALSUMA INJ 6MG/0.5 ..................... 154
ALTABAX OIN 1%............................. 22
ALTACE CAP 1.25MG .......................... 2
ALTACE CAP 10MG ............................. 2
ALTACE CAP 2.5MG ............................ 2
ALTACE CAP 5MG ............................... 2
ALTOPREV TAB 20MG ER ................... 96
ALUVEA CRE 39% ............................ 81
ALVESCO AER 160MCG ................... 161
ALVESCO AER 80MCG ..................... 161
amantadine cap 100mg..................... 37
amantadine syp 50mg/5ml ................ 37
amantadine tab 100mg ..................... 37
AMARYL TAB 1MG .......................... 165
AMARYL TAB 2MG .......................... 165
AMARYL TAB 4MG .......................... 165
AMBIEN CR TAB 12.5MG ................. 121
AMBIEN CR TAB 6.25MG ................. 120
AMBIEN TAB 10MG ......................... 121
AMBIEN TAB 5MG ........................... 121
amcinonide cre 0.1% ........................ 66
amcinonide lot 0.1%......................... 66
AMCINONIDE OIN 0.1% .................... 66
AMERGE TAB 1MG .......................... 154
AMERGE TAB 2.5MG ....................... 154
amethyst tab 90-20mcg .................... 66
AMICAR TAB 1000MG ....................... 94
AMICAR TAB 500MG ......................... 94
amilor/hctz tab 5-50 ......................... 80
amiloride tab 5mg .......................... 142
aminobez pot pow .......................... 137
182
amiodarone tab 200mg......................22
AMITIZA CAP 24MCG .........................89
AMITIZA CAP 8MCG ..........................89
amitriptylin tab 100mg .................... 173
amitriptylin tab 10mg ...................... 173
amitriptylin tab 150mg .................... 173
amlod/atorva tab 10-10mg ................56
amlod/atorva tab 2.5-10mg ...............55
amlod/atorva tab 5-10mg ..................56
amlod/benazp cap 10-20mg ................ 2
amlod/benazp cap 10-40mg ................ 2
amlod/benazp cap 2.5-10mg ............... 1
amlod/benazp cap 5-10mg.................. 1
amlod/valsar tab /hctz.......................15
amlod/valsar tab 10-160mg ...............15
amlod/valsar tab 10-320mg ...............15
amlod/valsar tab 5-160mg .................15
amlod/valsar tab 5-320mg .................15
amlodipine tab 10mg.........................56
amlodipine tab 2.5mg........................56
amlodipine tab 5mg ..........................56
amnesteem cap 10mg ........................ 6
amnesteem cap 20mg ........................ 7
amnesteem cap 40mg ........................ 7
amox/k clav chw 200mg .................. 138
amox/k clav chw 400mg .................. 138
amox/k clav sus 200/5ml ................. 138
amox/k clav sus 250/5ml ................. 138
amox/k clav sus 400/5ml ................. 138
amox/k clav sus 600/5ml ................. 138
amox/k clav tab 250mg ................... 138
amox/k clav tab 500mg ................... 138
amox/k clav tab 875mg ................... 138
amoxapine tab 100mg .................... 173
amoxapine tab 150mg .................... 173
amoxapine tab 25mg ...................... 173
amoxapine tab 50mg ...................... 173
amoxicillin cap 250mg ...................... 11
amoxicillin cap 500mg ...................... 11
amoxicillin chw 125mg ...................... 11
amoxicillin chw 250mg ...................... 11
AMOXICILLIN POW TRIHYDRA ........... 11
amoxicillin sus 125/5ml .................... 11
amoxicillin tab 500mg ....................... 11
amox-pot cla tab er ........................ 138
amphetamine cap 10mg er ................ 12
amphetamine cap 5mg er.................. 12
amphetamine tab 10mg .................... 12
amphetamine tab 12.5mg ................. 12
amphetamine tab 5mg ...................... 12
amphetamine tab 7.5mg ................... 12
ampicillin cap 250mg ........................ 12
ampicillin cap 500mg ........................ 12
ampicillin sus 125/5ml ...................... 12
ampicillin sus 250/5ml ...................... 12
AMPYRA TAB 10MG......................... 113
AMRIX CAP 15MG ............................. 60
AMRIX CAP 30MG ............................. 60
ANACAINE OIN .............................. 107
ANADROL-50 TAB 50MG.................... 13
ANAFRANIL CAP 25MG .................... 173
ANAFRANIL CAP 50MG .................... 174
ANAFRANIL CAP 75MG .................... 174
anagrelide cap 0.5mg ..................... 150
anagrelide cap 1mg ........................ 150
ANALPRAM E KIT ............................ 151
ANALPRAM-HC CRE 1-1%................ 151
183
ANALPRAM-HC CRE SINGLES............ 151
ANALPRAM-HC LOT 2.5% ................. 151
ANAPROX DS TAB 550MG ................ 123
ANAPROX TAB 275MG ..................... 123
ANASEPT SPR ...................................62
ANASPAZ TAB 0.125MG .....................45
anastrozole tab 1mg .........................44
ANCOBON CAP 250MG .......................29
ANCOBON CAP 500MG .......................29
ANDRODERM DIS 2MG/24HR..............14
ANDRODERM DIS 4MG/24HR..............14
ANDROGEL GEL 1%(25MG) ................14
ANDROGEL GEL 1%(50MG) ................14
ANDROGEL GEL 1.62% ......................14
ANDROGEL GEL PUMP 1% ..................14
ANDROXY TAB 10MG .........................14
ANESTH NEEDL MIS 20GX4" ............ 114
ANGELIQ TAB 0.25-0.5 ......................83
ANGELIQ TAB 0.5-1MG ......................83
ANODYNERX PAD ............................ 171
ANODYNZ MIS 0.0375-5 .................. 171
ANORO ELLIPT AER 62.5-25 ................ 8
ANTABUSE TAB 250MG ....................... 9
ANTABUSE TAB 500MG ....................... 9
ANTARA CAP 30MG ...........................85
ANTARA CAP 90MG ...........................85
ANTICOAG CPD SOL ........................ 101
ANTICOAGULNT SOL SOD CITR ........ 101
ANUSOL-HC CRE 2.5% .................... 151
ANUSOL-HC SUP 25MG .................... 151
ANZEMET TAB 100MG ........................ 1
ANZEMET TAB 50MG .......................... 1
apap/codeine sol 120-12/5 ................64
apap/codeine tab 300-15mg ..............64
apap-caffein cap dihydroc ..................78
APEXICON E CRE 0.05% ....................66
APIDRA INJ SOLOSTAR ......................97
APIDRA INJ U-100 ............................97
APLENZIN TAB 174MG .......................27
APLENZIN TAB 348MG .......................27
APLENZIN TAB 522MG .......................27
APOKYN INJ 10MG/ML .................... 121
APPBUTAMONE PAK .......................... 27
APPFORMIN PAK .............................. 53
apraclonidin sol 0.5% op ................. 128
apri tab ........................................... 65
APRISO CAP 0.375GM ..................... 101
APTENSIO XR CAP 10MG ................. 162
APTIOM TAB 200MG ......................... 23
APTIOM TAB 400MG ......................... 23
APTIOM TAB 600MG ......................... 23
APTIOM TAB 800MG ......................... 23
APTIVUS CAP 250MG ........................ 39
APTIVUS SOL ................................... 39
AQUORAL AER ................................. 81
ARALEN TAB 500MG ......................... 32
aranelle tab ................................... 175
ARANESP INJ 100MCG ...................... 83
ARANESP INJ 10MCG ........................ 82
ARANESP INJ 150MCG ...................... 83
ARANESP INJ 200MCG ...................... 83
ARANESP INJ 25MCG ........................ 82
ARANESP INJ 300MCG ...................... 83
ARANESP INJ 40MCG ........................ 82
ARANESP INJ 500MCG ...................... 83
ARANESP INJ 60MCG ........................ 82
ARAVA TAB 10MG .......................... 149
ARAVA TAB 20MG .......................... 149
ARCALYST INJ 220MG ..................... 103
ARCAPTA CAP 75MCG ....................... 49
ARICEPT TAB 10MG .......................... 63
ARICEPT TAB 23MG .......................... 63
ARICEPT TAB 5MG ............................ 63
ARIMIDEX TAB 1MG ......................... 44
aripiprazole sol 1mg/ml .................. 150
aripiprazole tab 10mg ..................... 150
ARIPIPRAZOLE TAB 10MG ............... 150
ARIPIPRAZOLE TAB 15MG ............... 150
aripiprazole tab 2mg ....................... 150
184
aripiprazole tab 30mg...................... 150
aripiprazole tab 5mg ....................... 150
ARIXTRA INJ 10/0.8ML .................... 166
ARIXTRA INJ 2.5/0.5 ....................... 166
ARIXTRA INJ 5/0.4ML ...................... 166
ARIXTRA INJ 7.5/0.6 ....................... 166
ARMOUR THYRO TAB 120MG ............ 169
ARMOUR THYRO TAB 15MG .............. 169
ARNICA TIN FLOWER....................... 111
ARNUITY ELPT INH 100MCG ............. 161
ARNUITY ELPT INH 200MCG ............. 161
AROMASIN TAB 25MG .......................44
ARTHROTEC 50 TAB ........................ 123
ARTHROTEC 75 TAB ........................ 123
ARZOL SILVER MIS NITR APP .............59
asa/dipyrida cap 25-200mg .............. 141
ASACOL HD TAB 800MG .................. 101
ASMANEX 120 AER 220MCG ............. 161
ASMANEX 30 AER 110MCG ............... 161
ASMANEX HFA AER 100 MCG............ 161
ASMANEX HFA AER 200 MCG............ 161
aspirin low tab 81mg ec ................... 152
aspirin tab 325mg ........................... 152
aspirin tab 325mg ec ....................... 152
ASSURE 3 TES ..................................72
ASSURE 4 TES ..................................72
ASSURE II TES .................................72
ASSURE II TES CHECK ......................72
ASSURE PRISM TES MULTI .................72
ASSURE PRO TES ..............................72
ASSURE TES PLATINUM .....................72
ASTAGRAF XL CAP 0.5MG ................ 108
ASTAGRAF XL CAP 1MG ................... 108
ASTAGRAF XL CAP 5MG ................... 108
ASTEPRO SPR 0.15% ...................... 114
AT LAST KIT GLUCOSE ......................91
AT LAST TES ....................................73
ATABEX EC TAB .............................. 142
ATACAND HCT TAB 16-12.5 ...............16
ATACAND HCT TAB 32-12.5 ...............16
ATACAND HCT TAB 32-25MG ............. 16
ATACAND TAB 16MG ........................ 17
ATACAND TAB 32MG ........................ 17
ATACAND TAB 4MG .......................... 17
ATACAND TAB 8MG .......................... 17
ATELVIA TAB ................................... 54
ATENDIA PAD 4-3% ....................... 171
atenol/chlor tab 100-25mg ................ 49
atenol/chlor tab 50-25mg.................. 49
atenolol tab 100mg .......................... 50
atenolol tab 25mg ............................ 50
atenolol tab 50mg ............................ 50
ATIVAN TAB 0.5MG .......................... 48
ATIVAN TAB 1MG ............................. 48
ATIVAN TAB 2MG ............................. 48
ATORVA/COQ10 PAK 20-100MG ......... 96
atorvastatin tab 10mg ...................... 96
atovaq/progu tab 250-100 ................ 32
atovaq/progu tab 62.5-25 ................. 32
atovaquone sus 750/5ml ................... 37
ATRALIN GEL 0.05% ........................... 7
ATRIPLA TAB ................................... 39
ATROPINE SUL OIN 1% OP ................ 70
atropine sul sol 1% op ...................... 70
ATROVENT HFA AER 17MCG .............. 55
ATROVENT NAS SOL 0.03% ............. 114
ATROVENT NAS SOL 0.06% ............. 114
AUBAGIO TAB 14MG ....................... 112
AUBAGIO TAB 7MG......................... 112
aug betamet cre 0.05% .................... 66
aug betamet lot 0.05% ..................... 66
aug betamet oin 0.05% .................... 66
AUGMENTIN SUS 125/5ML .............. 138
AUGMENTIN SUS 250/5ML .............. 138
AUGMENTIN SUS ES-600 ................ 138
AUGMENTIN TAB 500MG ................. 138
AUGMENTIN TAB 875MG ................. 138
AUGMENTIN XR TAB 12HR .............. 138
AURYXIA TAB 210MG ...................... 140
AUTOCODE TES BLD GLUC ................ 73
AUTODISC LIQ LOW/HIGH ................ 91
AUTOLET LITE KIT STARTER .............. 91
AUTOSHIELD MIS 29X3/16" ............ 114
185
AUTOSHIELD MIS 29X5/16" ............. 114
AUTOSHIELD MIS 30GX3/16 ............ 114
AVALIDE TAB 150-12.5......................16
AVALIDE TAB 300-12.5......................16
AVANDAMET TAB 2-1000MG............. 168
AVANDIA TAB 2MG ......................... 168
AVANDIA TAB 4MG ......................... 168
AVANDIA TAB 8MG ......................... 168
AVAPRO TAB 150MG .........................17
AVAPRO TAB 300MG .........................17
AVAPRO TAB 75MG ...........................17
AVAR AER 9.5-5% ............................. 5
avar cleanse emu 10-5% .................... 5
AVAR LS AER 10-2% .......................... 5
AVAR LS LIQ 10-2% ........................... 5
AVAR LS PAD 10-2% .......................... 5
AVAR PAD 9.5-5% ............................. 5
avar-e green cre 10-5% ..................... 5
AVAR-E LS CRE 10-2% ....................... 5
AVC CRE 15% ................................ 178
AVELOX TAB 400MG ..........................87
avita cre 0.025% ............................... 7
avita gel 0.025% ............................... 7
AVODART CAP 0.5MG ......................... 1
AVONEX KIT 30MCG ........................ 112
AVONEX PEN KIT 30MCG ................. 112
AVONEX PREFL KIT 30MCG .............. 112
AXERT TAB 12.5MG ......................... 154
AXERT TAB 6.25MG ......................... 154
AXID CAP 300MG ..............................93
AXIRON SOL 30MG/ACT .....................14
AYGESTIN TAB 5MG ........................ 146
azacitidine inj 100mg ........................32
AZASAN TAB 100MG ....................... 149
AZASAN TAB 75 MG ........................ 149
AZASITE SOL 1% ............................ 126
azathioprine tab 50mg ..................... 149
azelastine dro 0.05% ...................... 126
azelastine spr 0.1% ........................ 114
azelastine spr 0.15% ....................... 114
AZELEX CRE 20% .............................. 7
AZILECT TAB 0.5MG ..........................37
AZILECT TAB 1MG.............................37
azithromycin pow 1gm pak ................44
azithromycin sus 100/5ml ..................44
azithromycin sus 200/5ml ..................44
azithromycin tab 250mg ................... 45
AZOPT SUS 1% OP ......................... 127
AZOR TAB 10-20MG ......................... 15
AZOR TAB 10-40MG ......................... 15
AZOR TAB 5-20MG ........................... 15
AZOR TAB 5-40MG ........................... 15
AZULFIDINE TAB 500MG ................. 102
AZULFIDINE TAB 500MG EN ............ 102
B
BABY DDROPS LIQ 400UNIT ............ 180
bacitracin oin op ............................ 126
BACITRACIN POW ZINC USP .............. 22
BACKACHE REL TAB EX ST .............. 152
baclofen tab 10mg ........................... 60
baclofen tab 20mg ........................... 60
BACTRIM DS TAB 800-160 ................ 18
BACTRIM TAB 400-80MG................... 18
BACTROBAN CRE 2% ........................ 22
BACTROBAN OIN 2% ........................ 22
BACTROBAN OIN NASAL 2% ............ 113
balsalazide cap 750mg .................... 102
balziva tab ...................................... 65
BANZEL SUS 40MG/ML ..................... 23
BANZEL TAB 200MG ......................... 23
BANZEL TAB 400MG ......................... 23
BARACLUDE SOL .05MG/ML ............... 94
BARACLUDE TAB 0.5MG .................... 94
BARACLUDE TAB 1MG ....................... 94
BAYER BREEZE KIT 2 SYSTEM............ 91
BAYER BREEZE LIQ HIGH CNT ........... 91
BAYER BREEZE LIQ LOW CNTL ........... 91
BAYER BREEZE LIQ NORM CNT .......... 91
BAYER BREEZE MIS 2 TEST ............... 73
BAYER CONTOR TES BLD GLUC .......... 73
BAYER CONTOR TES NEXT................. 73
BD ECLIPSE MIS 1ML/27G ............... 114
BD ECLIPSE MIS 1ML/30G ............... 114
BD MAGNIGUID MIS MAGNIFIR .......... 91
BD NEEDLE MIS 23GX1.25 .............. 114
BD NEEDLE MIS 30G X 1"................ 114
BD NEEDLES MIS 25GX7/8"............. 115
BD SAFE CLIP MIS NDL CLPR ........... 111
BECONASE AQ SUS 0.042% ............ 114
BELLA/OPIUM SUP 16.2-30................ 22
186
BELLA/OPIUM SUP 16.2-60 ................22
BELSOMRA TAB 10MG ..................... 135
BELSOMRA TAB 15MG ..................... 135
BELSOMRA TAB 20MG ..................... 135
BELSOMRA TAB 5MG ....................... 135
benazep/hctz tab 10-12.5 ................... 4
benazep/hctz tab 20-12.5 ................... 4
benazep/hctz tab 20-25mg ................. 4
benazep/hctz tab 5-6.25 ..................... 4
benazepril tab 10mg .......................... 2
benazepril tab 5mg ............................ 2
BENICAR HCT TAB 20-12.5 ................16
BENICAR HCT TAB 40-12.5 ................16
BENICAR HCT TAB 40-25MG ..............16
BENICAR TAB 20MG ..........................17
BENICAR TAB 40MG ..........................17
BENICAR TAB 5MG ............................17
BENSAL HP OIN .............................. 104
BENTYL CAP 10MG ............................43
BENTYL TAB 20MG ............................43
BENZACLIN GEL 1-5% ........................ 5
BENZALKONIUM SOL 50% .................62
BENZAMYCIN GEL 5-3% ..................... 5
BENZAMYCIN GEL PAK ....................... 5
BENZEFOAM AER 9.8% ....................... 7
BENZIQ GEL 5.25% ........................... 7
BENZIQ LS GEL 2.75% ....................... 7
benzonatate cap 100mg ....................43
benztropine tab 0.5mg ......................37
benztropine tab 1mg .........................37
benztropine tab 2mg .........................37
BEPREVE DRO 1.5% ........................ 126
BERINERT INJ 500UNIT .....................55
BESIVANCE SUS 0.6%..................... 126
BETA 1 KIT KIT 30MG/5ML ............... 161
BETADINE SOL 5% OP ..................... 127
BETAGAN SOL 0.5% OP .....................52
betameth dip cre 0.05% ....................66
betameth dip lot 0.05% .....................66
betameth dip oin 0.05% ....................66
betameth val aer 0.12% ....................66
betameth val cre 0.1% ......................66
betameth val lot 0.1% ...................... 66
betameth val oin 0.1% ..................... 66
BETAPACE AF TAB 120MG ................. 51
BETAPACE AF TAB 160MG ................. 51
BETAPACE AF TAB 80MG ................... 51
BETAPACE TAB 120MG ...................... 51
BETAPACE TAB 160MG ...................... 51
BETAPACE TAB 80MG ....................... 51
betaxolol sol 0.5% op ....................... 52
betaxolol tab 10mg .......................... 50
betaxolol tab 20mg .......................... 50
bethanechol tab 10mg .................... 178
bethanechol tab 5mg ...................... 178
BETHKIS NEB 300/4ML ..................... 11
BETIMOL SOL 0.25% ........................ 52
BETIMOL SOL 0.5% .......................... 52
BETOPTIC-S SUS 0.25% OP .............. 52
bexarotene cap 75mg ..................... 154
BEYAZ TAB ...................................... 65
BG STAR TES BLD GLUC ................... 73
BIAXIN SUS 250/5ML ....................... 64
BIAXIN TAB 250MG .......................... 64
BIAXIN TAB 500MG .......................... 64
bicalutamide tab 50mg ..................... 20
BIDIL TAB ..................................... 119
BIEST/PROGES CRE .......................... 83
BILTRICIDE TAB 600MG .................... 17
bimatoprost sol 0.03%.................... 147
BINOSTO TAB 70MG ......................... 54
bio-d-mulsio liq 400unit .................. 180
BIOSCANNER TES GLUCOSE .............. 73
BIO-STATIN CAP 1000000 ................. 29
BIO-STATIN CAP 500000 .................. 29
bisoprl/hctz tab 10/6.25 .................... 49
bisoprl/hctz tab 2.5/6.25 ................... 49
bisoprl/hctz tab 5-6.25mg ................. 49
bisoprol fum tab 10mg ...................... 50
bisoprol fum tab 5mg ....................... 50
BLEPH-10 SOL 10% OP ................... 129
BLEPHAMIDE OIN S.O.P. ................. 128
BLEPHAMIDE SUS OP ...................... 128
BLOOD GLUCOS TES ........................ 73
BLOOD GLUCOS TES PREMIUM .......... 73
BLOOD GLUCOS TES STRIPS ............. 73
187
BLUESTAR MIS .................................91
BLUNT CANNUL MIS 17GX1.5".......... 115
BONIVA TAB 150MG ..........................54
BOSULIF TAB 100MG .........................35
BOSULIF TAB 500MG .........................35
bp 10-1 emu ..................................... 5
bp cleansing emu 10-4% .................... 5
bp foam aer 9.8% .............................. 7
bp folinatal tab plus b ...................... 145
bp multinatl chw plus ...................... 142
bp multinatl tab plus ....................... 142
bp wash liq 7% .................................. 7
bpo cloths mis 6% ............................. 7
BPO GEL 4% ..................................... 7
BPO GEL 8% ..................................... 7
BRAVELLE INJ 75UNIT ..................... 136
BREEZE 2 MIS SYSTEM ......................91
BREO ELLIPTA INH 100-25 .................. 8
BREO ELLIPTA INH 200-25 .................. 8
BRILINTA TAB 60MG .........................80
BRILINTA TAB 90MG .........................80
brimonidine sol 0.15%..................... 128
brimonidine sol 0.2% op .................. 128
BRINTELLIX TAB 10MG .................... 157
BRINTELLIX TAB 20MG .................... 157
BRINTELLIX TAB 5MG ...................... 157
BRISDELLE CAP 7.5MG .................... 179
bromfenac sol 0.09% op .................. 127
bromocriptin cap 5mg .......................37
bromocriptin tab 2.5mg .....................37
brompheniram chw 12mg ..................30
BROVANA NEB 15MCG .......................49
budesonide cap 3mg/24hr..................89
budesonide sus 0.25mg/2 ................ 161
budesonide sus 0.5mg/2 .................. 161
budesonide sus 1mg/2ml ................. 161
budesonide sus 32mcg .................... 114
BULB IRR SYR MIS 60ML ................. 115
bumetanide tab 0.5mg .................... 107
bumetanide tab 1mg ....................... 107
bumetanide tab 2mg ....................... 107
BUNAVAIL MIS 2.1-0.3 .................... 135
BUNAVAIL MIS 4.2-0.7 .................... 135
BUNAVAIL MIS 6.3-1MG .................. 135
BUPAP TAB 50-300MG .......................14
BUPHENYL POW .............................. 176
BUPHENYL TAB 500MG ................... 176
bupren/nalox sub 2-0.5mg .............. 135
bupren/nalox sub 8-2mg ................. 135
buprenorphin sub 2mg .................... 135
buprenorphin sub 8mg .................... 135
buproban tab 150mg ...................... 159
bupropion tab 100mg ....................... 27
bupropion tab 100mg sr .................... 27
bupropion tab 75mg ......................... 27
bupropn hcl tab 150mg xl ................. 27
bupropn hcl tab 300mg xl ................. 27
buspirone tab 10mg ......................... 21
buspirone tab 15mg ......................... 21
buspirone tab 30mg ......................... 21
buspirone tab 5mg ........................... 20
buspirone tab 7.5mg ........................ 21
but/apap/caf cap .............................. 14
but/apap/caf cap codeine .................. 64
but/apap/caf tab .............................. 14
but/asa/caf/ cap cod 30mg ................ 64
but/asa/caff cap ............................... 14
butal/apap tab 50-325mg ................. 14
BUTISOL SOD TAB 30MG .................. 45
BUTISOL SOD TAB 50MG .................. 45
butorphanol sol 10mg/ml ................ 135
BUTRANS DIS 10MCG/HR ................ 135
BUTRANS DIS 5MCG/HR ................. 135
BUTRANS DIS 7.5/HR ..................... 135
BYDUREON INJ .............................. 101
BYETTA INJ 10MCG ........................ 101
BYETTA INJ 5MCG .......................... 101
BYSTOLIC TAB 10MG ........................ 50
BYSTOLIC TAB 2.5MG ....................... 50
BYSTOLIC TAB 20MG ........................ 50
BYSTOLIC TAB 5MG .......................... 50
C
cabergoline tab 0.5mg ...................... 80
CA-DTPA SOL 1000MG ...................... 28
CADUET TAB 10-10MG ...................... 56
CADUET TAB 10-20MG ...................... 56
CADUET TAB 10-40MG ...................... 56
CADUET TAB 10-80MG ...................... 56
188
CADUET TAB 2.5-10MG .....................56
CADUET TAB 2.5-20MG .....................56
CADUET TAB 2.5-40MG .....................56
CADUET TAB 5-10MG ........................56
CADUET TAB 5-20MG ........................56
CADUET TAB 5-40MG ........................56
CADUET TAB 5-80MG ........................56
CAFERGOT TAB 1-100MG ...................82
caffeine cit sol 60mg/3ml ...................13
CALAN SR TAB 120MG .......................56
CALAN SR TAB 180MG .......................56
CALAN SR TAB 240MG .......................56
CALAN TAB 120MG............................56
CALAN TAB 80MG .............................56
calc acetate cap 667mg ................... 140
calc acetate tab 667mg ................... 140
calcipotrien cre 0.005% .....................38
calcipotrien oin 0.005% .....................38
calcipotrien oin betameth ................. 172
calcipotrien sol 0.005% .....................38
calcitonin spr 200/act ........................55
calcitriol cap 0.25mcg ........................99
calcitriol cap 0.5mcg .........................99
calcitriol oin 3mcg/gm .......................38
calcitriol sol 1mcg/ml ........................99
CAMPHOMEX SPR............................ 107
camrese lo tab..................................85
camrese tab .....................................85
CANASA SUP 1000MG ..................... 102
candesa/hctz tab 16-12.5 ..................16
candesa/hctz tab 32-12.5 ..................16
candesa/hctz tab 32-25mg.................16
candesartan tab 16mg .......................17
candesartan tab 32mg .......................17
candesartan tab 4mg ........................17
candesartan tab 8mg ........................17
CANTIL TAB 25MG .......................... 150
capecitabine tab 150mg .....................32
capecitabine tab 500mg .....................33
CAPEX SHA 0.01% ............................66
CAPITAL/COD SUS 120-12/5 ..............64
CAPRELSA TAB 100MG ......................35
CAPRELSA TAB 300MG ......................35
captopr/hctz tab 25-15mg .................. 4
captopr/hctz tab 50-25mg ................... 4
captopril tab 100mg ........................... 2
captopril tab 12.5mg .......................... 2
captopril tab 25mg ............................. 2
captopril tab 50mg ............................. 2
CARAC CRE 0.5% ............................. 36
CARAFATE SUS 1GM/10ML .............. 110
CARAFATE TAB 1GM ....................... 110
carb/levo 50 tab /entacap ............... 106
carb/levo 75 tab /entacap ............... 106
carb/levo er tab 25-100mg .............. 106
carb/levo er tab 50-200mg .............. 106
carb/levo tab 10-100mg.................. 106
carb/levo tab 25-100mg.................. 106
carb/levo tab 25-250mg.................. 106
carb/levo100 tab /entacap .............. 106
CARBAGLU TAB 200MG ..................... 99
carbamazepin cap 100mg er .............. 23
carbamazepin chw 100mg ................. 23
carbamazepin sus 100/5ml ................ 23
carbamazepin tab 200mg er .............. 23
carbamazepin tab 400mg er .............. 23
CARBAPHEN 12 LIQ ........................ 121
CARBAPHEN 12 SUS PED ................ 121
CARBATROL CAP 100MG ................... 23
CARBATROL CAP 200MG ................... 24
CARBATROL CAP 300MG ................... 24
carbidopa tab 25mg ......................... 71
carbinoxamin sol 4mg/5ml ................ 30
carbinoxamin tab 4mg ...................... 30
CARDIO CHEK MIS KIT ..................... 91
CARDIZEM CD CAP 120MG/24 ........... 56
CARDIZEM LA TAB 120MG ................. 56
CARDIZEM LA TAB 300MG/24 ............ 57
189
CARDIZEM LA TAB 420MG/24 .............57
CARDIZEM TAB 120MG ......................57
CARDIZEM TAB 30MG ........................57
CARDIZEM TAB 60MG ........................57
CARDURA TAB 1MG ...........................20
CARDURA TAB 2MG ...........................20
CARDURA TAB 4MG ...........................20
CARDURA TAB 8MG ...........................20
CARDURA XL TAB 4MG ....................... 9
CARDURA XL TAB 8MG ....................... 9
CARESENS N TES ..............................73
carisopr/asa tab 200-325 ................. 113
carisoprodol tab 250mg .....................60
carisoprodol tab 350mg .....................60
carisoprodol tab asa/cod .................. 113
CARNITOR SOL 1GM/10ML .................59
CARNITOR TAB 330MG ......................59
carteolol sol 1% op ...........................52
carvedilol tab 12.5mg ........................10
carvedilol tab 25mg ..........................10
carvedilol tab 3.125mg ......................10
carvedilol tab 6.25mg ........................10
CASCARA EXT SAGRADA .................. 162
CASODEX TAB 50MG .........................20
CATAPRES TAB 0.1MG .......................19
CATAPRES TAB 0.2MG .......................19
CATAPRES TAB 0.3MG .......................19
CATAPRES-TTS DIS 0.1/24HR ............19
CAVERJECT INJ 20MCG .................... 146
CAVERJECT INJ 40MCG .................... 146
CAVERJECT KIT 10MCG ................... 147
CAVERJECT KIT 20MCG ................... 147
CAYA DPR ........................................76
CAYSTON INH 75MG .........................18
cdp/amitrip tab 10-25mg ...................48
cdp/amitrip tab 5-12.5mg ..................48
CEDAX CAP 400MG ...........................61
CEDAX SUS 180/5ML.........................61
CEDAX SUS 90MG/5ML ......................61
cefaclor cap 250mg ...........................61
cefaclor cap 500mg ...........................61
CEFACLOR ER TAB 500MG .................61
cefaclor sus 125/5ml .........................61
cefaclor sus 250/5ml .........................61
cefaclor sus 375/5ml ........................ 61
cefadroxil cap 500mg ....................... 61
cefadroxil sus 250/5ml ...................... 61
cefadroxil sus 500/5ml ...................... 61
cefadroxil tab 1gm ........................... 61
cefdinir cap 300mg ........................... 61
cefdinir sus 125/5ml ......................... 61
cefdinir sus 250/5ml ......................... 62
cefditoren tab 200mg ....................... 62
cefditoren tab 400mg ....................... 62
cefixime sus 100/5ml........................ 62
cefixime sus 200/5ml........................ 62
cefpodo prox sus 100/5ml ................. 62
cefpodo prox sus 50mg/5ml .............. 62
cefpodoxime tab 100mg .................... 62
cefpodoxime tab 200mg .................... 62
cefprozil sus 125/5ml ....................... 61
cefprozil sus 250/5ml ....................... 61
cefprozil tab 250mg .......................... 61
cefprozil tab 500mg .......................... 61
ceftibuten cap 400mg ....................... 62
ceftibuten sus 180/5ml ..................... 62
CEFTIN SUS 125/5ML ....................... 61
CEFTIN SUS 250/5ML ....................... 61
CEFTIN TAB 250MG .......................... 61
CEFTIN TAB 500MG .......................... 61
cefuroxime tab 250mg ...................... 61
cefuroxime tab 500mg ...................... 61
CELEBREX CAP 100MG ...................... 70
CELEBREX CAP 200MG ...................... 70
CELEBREX CAP 400MG ...................... 70
CELEBREX CAP 50MG........................ 70
celecoxib cap 100mg ........................ 70
celecoxib cap 200mg ........................ 70
celecoxib cap 400mg ........................ 70
celecoxib cap 50mg .......................... 70
CELEXA TAB 10MG ......................... 155
CELEXA TAB 20MG ......................... 155
CELEXA TAB 40MG ......................... 155
CELLCEPT CAP 250MG .................... 102
CELLCEPT SUS 200MG/ML ............... 102
CELLCEPT TAB 500MG .................... 102
CELONTIN CAP 300MG .................... 164
CEM-UREA SOL 45% ........................ 81
CENTANY AT KIT 2% ........................ 22
CENTANY OIN 2% ............................ 22
190
cephalexin cap 250mg .......................61
cephalexin sus 125/5ml .....................61
cephalexin sus 250/5ml .....................61
cephalexin tab 250mg .......................61
cephalexin tab 500mg .......................61
CERDELGA CAP 84MG......................... 9
CERVIDIL VAG MIS 10MG INS ............. 1
CESAMET CAP 1MG ...........................28
CETACAINE AER ............................. 171
cetirizine tab 5mg .............................31
CETRAXAL SOL 0.2% ...................... 136
CETROTIDE KIT 0.25MG ....................91
cevimeline cap 30mg ....................... 152
CHANTIX PAK 0.5& 1MG .................. 159
CHANTIX PAK 1MG .......................... 159
CHANTIX TAB 0.5MG ....................... 159
CHEMET CAP 100MG .........................28
CHENODAL TAB 250MG .....................89
CHILD MOTRIN CHW 50MG .............. 123
chlord/clidi cap 5-2.5mg ....................22
chlordiazep cap 10mg ........................48
chlordiazep cap 25mg........................48
chlordiazep cap 5mg .........................48
chlorhex glu sol 0.12% ......................43
CHLORHEX GLU SOL 20% ..................62
chloroquine tab 250mg ......................32
chloroquine tab 500mg ......................32
chlorothiaz tab 250mg ..................... 167
chlorothiaz tab 500mg ..................... 167
chlorpromaz tab 100mg ................... 139
chlorpromaz tab 10mg..................... 139
chlorpromaz tab 200mg ................... 139
chlorpropam tab 100mg .................. 165
chlorpropam tab 250mg .................. 165
chlorthalid tab 100mg ..................... 167
chlorthalid tab 25mg ....................... 167
chlorthalid tab 50mg ....................... 167
chlorzoxazon tab 500mg ....................60
cho mag tris liq 500/5ml .................. 152
cho mag tris tab 1000mg ................. 152
CHOLBAM CAP 250MG .......................53
CHOLBAM CAP 50MG .........................53
cholestyram pow 4gm ....................... 53
cholestyram pow 4gm lite ................. 53
CIALIS TAB 10MG .......................... 153
CIALIS TAB 2.5MG ......................... 153
CIALIS TAB 20MG .......................... 153
CIALIS TAB 5MG ............................ 153
CICLODAN CRE KIT 0.77% ................ 29
CICLODAN SOL KIT 8% .................... 29
ciclopirox cre 0.77% ......................... 29
ciclopirox gel 0.77% ......................... 29
ciclopirox kit 8% .............................. 29
ciclopirox sha 1% ............................. 29
ciclopirox sol 8% .............................. 29
ciclopirox sus 0.77% ........................ 29
cilostazol tab 100mg....................... 140
cilostazol tab 50mg ........................ 140
CILOXAN OIN 0.3% OP ................... 126
CILOXAN SOL 0.3% OP ................... 126
cimetidine sol 300/5ml...................... 93
cimetidine tab 300mg ....................... 93
CIMZIA KIT ................................... 175
CIMZIA KIT STARTER ..................... 175
CIMZIA PREFL KIT 200MG/ML .......... 175
CINRYZE SOL 500 UNIT .................... 55
CIPRO (10%) SUS 500MG/5 .............. 87
CIPRO (5%) SUS 250MG/5 ................ 87
CIPRO HC SUS OTIC ....................... 136
CIPRO TAB 250MG ........................... 87
CIPRO TAB 500MG ........................... 87
CIPRO XR TAB 1000MG ..................... 87
CIPRO XR TAB 500MG....................... 87
CIPRODEX SUS 0.3-0.1% ................ 136
ciprofloxacn sol 0.2% ..................... 136
ciprofloxacn sol 0.3% op ................. 126
ciprofloxacn sus 250mg/5 ................. 87
ciprofloxacn sus 500mg/5 ................. 87
ciprofloxacn tab 1000mg ................... 87
ciprofloxacn tab 100mg ..................... 87
ciprofloxacn tab 250mg..................... 87
ciprofloxacn tab 500mg er ................. 87
citalopram sol 10mg/5ml ................ 155
citalopram tab 10mg ...................... 155
191
citalopram tab 20mg ....................... 155
citalopram tab 40mg ....................... 156
CITRANATAL CAP HARMONY ............. 144
CITRANATAL MIS 90 DHA ................ 144
CITRANATAL MIS B-CALM ................ 142
CITRANATAL PAK ASSURE................ 144
CITRANATAL PAK DHA ..................... 144
CITRANATAL TAB RX ....................... 142
citric acid/ sol sod citr .......................63
CITRUS POW BERGAMOT ...................11
claravis cap 30mg .............................. 7
CLARIFOAM EF AER 10-5% ................. 5
CLARINEX RDT TAB 2.5MG .................31
CLARINEX RDT TAB 5MG ...................31
CLARINEX SYP 0.5MG/ML...................31
CLARINEX TAB 5MG ..........................31
CLARINEX-D TAB 2.5-120 ..................71
clarithromyc sus 125/5ml ..................64
clarithromyc sus 250/5ml ..................64
clarithromyc tab 250mg .....................64
clarithromyc tab 500mg .....................64
clarithromyc tab 500mg er .................64
CLARYS CRE .....................................72
clemastine tab 2.68mg ......................30
CLEOCIN CAP 150MG ...................... 106
CLEOCIN CAP 300MG ...................... 106
CLEOCIN CAP 75MG ........................ 106
CLEOCIN CRE 2% VAG .................... 178
CLEOCIN PED SOL 75MG/5ML .......... 106
CLEOCIN SUP 100MG ...................... 178
CLEOCIN-T GEL 1% ........................... 4
CLEOCIN-T LOT 1% ........................... 4
CLEOCIN-T PAD 1% ........................... 4
CLEOCIN-T SOL 1% ........................... 4
CLEVER CHEK TES ............................73
CLEVER CHEK TES AUTO CD ..............73
CLEVER CHEK TES VOICE ..................73
CLEVER CHOIC TES MICRO ................73
CLEVR CHOICE TES AUTO-CD.............73
CLIMARA DIS 0.025MG ......................84
CLIMARA DIS 0.0375MG ....................84
CLIMARA DIS 0.05MG .......................84
CLIMARA DIS 0.06MG .......................84
CLIMARA DIS 0.075MG ......................84
CLIMARA DIS 0.1MG .........................84
CLIMARA PRO DIS WEEKLY ................83
CLIN SINGLE KIT USE ..................... 106
CLINDACIN KIT PAC 1%...................... 5
clindacin-p pad 1% ............................. 4
CLINDAGEL GEL 1% ........................... 4
clindamy/ben gel 1-5% ....................... 5
clindamycin aer 1% ............................ 4
clindamycin cap 150mg................... 106
clindamycin cap 300mg................... 107
clindamycin cap 75mg .................... 106
clindamycin cre 2% vag .................. 178
clindamycin gel 1% ............................ 4
clindamycin lot 1% ............................. 5
clindamycin sol 1% ............................ 5
clindamycin sol 75mg/5ml ............... 107
CLINDESSE CRE 2% ....................... 178
CLINITEST TAB CHLD RES ................. 73
CLIN-LIDO KIT ............................... 106
clinpro 5000 pst 1.1% ...................... 87
clobetasol aer 0.05% ........................ 66
clobetasol cre 0.05% ........................ 66
clobetasol e cre 0.05% ..................... 66
clobetasol gel 0.05% ........................ 66
clobetasol lot 0.05% ......................... 66
clobetasol oin 0.05% ........................ 66
clobetasol sha 0.05% ....................... 66
clobetasol spr 0.05% ........................ 66
CLOBEX LOT 0.05%.......................... 66
CLOBEX SHA 0.05% ......................... 67
CLOBEX SPR 0.05%.......................... 67
clocortolone cre piv 0.1% .................. 67
CLODAN KIT 0.05% ........................ 172
CLODERM CRE 0.1% PMP .................. 67
clomiphene tab 50mg ..................... 137
clomipramine cap 25mg .................. 174
clonazep odt tab 0.125mg ................. 23
clonazep odt tab 0.25mg ................... 23
clonazep odt tab 0.5mg .................... 23
clonazep odt tab 1mg ....................... 23
clonazep odt tab 2mg ....................... 23
clonazepam tab 0.5mg...................... 23
clonazepam tab 1mg ........................ 23
clonazepam tab 2mg ........................ 23
clonidine dis 0.1/24hr ....................... 19
clonidine dis 0.2/24hr ....................... 19
192
clonidine dis 0.3/24hr ........................19
clonidine tab 0.1mg ..........................20
clonidine tab 0.1mg er ........................ 8
clonidine tab 0.2mg ..........................20
clonidine tab 0.3mg ..........................20
clopidogrel tab 300mg ..................... 169
clopidogrel tab 75mg ....................... 169
cloraz dipot tab 15mg ........................48
cloraz dipot tab 3.75mg .....................48
cloraz dipot tab 7.5mg .......................48
clorpres tab 0.1-15mg ........................ 8
clorpres tab 0.2-15mg ........................ 8
clorpres tab 0.3-15mg ........................ 9
clotrim/beta cre diprop ......................30
clotrim/beta lot diprop .......................30
CLOTRIMAZOLE CRY ....................... 100
clotrimazole tro 10mg .......................19
clozapine tab 100/odt ........................77
clozapine tab 100mg .........................77
clozapine tab 12.5/odt .......................77
clozapine tab 200mg .........................77
clozapine tab 25mg ...........................77
clozapine tab 25mg odt .....................77
clozapine tab 50mg ...........................77
CLOZARIL TAB 100MG .......................77
CLOZARIL TAB 25MG.........................77
C-NATE DHA CAP 28-1-200 .............. 142
CNL8 NAIL KIT .................................29
coal tar sol 20% ............................. 166
COARTEM TAB 20-120MG ..................32
cocaine hcl sol 10% ........................ 107
cocaine hcl sol 4% .......................... 107
CODAR AR LIQ 2-8/5ML ................... 134
codeine sulf tab 15mg ..................... 129
COLAZAL CAP 750MG ...................... 102
colchicine cap 0.6mg .........................92
colchicine tab 0.6mg .........................92
COLCRYS TAB 0.6MG.........................92
COLESTID GRA 5GM ..........................53
COLESTID POW 5GM .........................53
COLESTID TAB 1GM ..........................53
colestipol gra 5gm ............................53
colestipol tab 1gm ............................ 53
COLLIGINIX MIS ............................ 180
colocort ene 100mg ........................ 103
COLY-MYCIN S SUS OTIC ................ 136
COLYTE/FLAVR SOL PACKS ................ 54
COMBIGAN SOL 0.2/0.5% ................. 52
COMBIPATCH DIS .05/.14 ................. 83
COMBIPATCH DIS .05/.25 ................. 83
COMBIVENT AER RESPIMAT ................. 8
COMBIVIR TAB 150-300 .................... 39
COMETRIQ KIT 100MG ...................... 35
COMETRIQ KIT 140MG ...................... 35
COMETRIQ KIT 60MG ....................... 35
COMFORT EZ MIS 33GX5MM............ 115
COMFORT EZ PAD 20-4-1% ............. 171
COMPAZINE PAK 5MG ..................... 139
COMPAZINE TAB 10MG ................... 139
COMPLERA TAB ................................ 39
COMPLETE NAT PAK DHA ................ 144
COMPLETENATE CHW ..................... 143
compro sup 25mg .......................... 139
COMTAN TAB 200MG ...................... 138
CO-NATAL FA TAB 29-1MG .............. 143
CONCERTA TAB 18MG ..................... 162
CONCERTA TAB 27MG ..................... 162
CONCERTA TAB 36MG ..................... 162
CONCERTA TAB 54MG ..................... 162
CONDYLOX GEL 0.5% ..................... 104
CONDYLOX SOL 0.5% ..................... 104
CONFIRM/MICR TES GLUCOSE ........... 73
CONTROL AST TES ........................... 73
CONTROL TES.................................. 73
controlrx cre 1.1% ........................... 87
CONZIP CAP 100MG ....................... 129
CONZIP CAP 200MG ....................... 129
CONZIP CAP 300MG ....................... 129
COPAXONE INJ 20MG/ML ................ 112
COPAXONE INJ 40MG/ML ................ 112
COPEGUS TAB 200MG ....................... 94
CORDARONE TAB 200MG .................. 22
CORDRAN 24X3 TAP 4MCG/CM .......... 67
CORDRAN CRE 0.05%....................... 67
CORDRAN LOT 0.05% ....................... 67
CORDRAN OIN 0.05% ....................... 67
193
COREG CR CAP 10MG ........................10
COREG CR CAP 20MG ........................10
COREG CR CAP 40MG ........................10
COREG CR CAP 80MG ........................10
COREG TAB 12.5MG ..........................10
COREG TAB 25MG .............................10
COREG TAB 3.125MG ........................10
COREG TAB 6.25MG ..........................10
CORGARD TAB 20MG ........................51
CORGARD TAB 40MG ........................51
CORGARD TAB 80MG ........................51
CORLANOR TAB 5MG ....................... 159
CORLANOR TAB 7.5MG .................... 159
cormax scalp sol 0.05% .....................67
cortalo gel 2% ................................ 172
CORTANE-B LOT ............................. 161
CORTEF TAB 10MG............................89
CORTEF TAB 20MG............................89
CORTEF TAB 5MG .............................89
CORTENEMA ENE 100MG ................. 103
CORTIFOAM AER 90MG .................... 103
cortisone ac tab 25mg .......................89
CORTISPORIN CRE 0.5% ...................22
CORTISPORIN OIN 1% ......................22
CORTISPORIN SOL 1% OTIC ............ 136
CORZIDE TAB 40-5MG .......................49
CORZIDE TAB 80-5MG .......................49
COSENTYX INJ 150MG/ML ..................38
COSENTYX PEN INJ 150MG/ML ...........38
COSOPT PF SOL ................................52
COSOPT SOL 22.3-6.8 .......................52
COUMADIN TAB 10MG .......................69
COUMADIN TAB 1MG .........................69
COUMADIN TAB 2.5MG ......................69
COUMADIN TAB 2MG .........................69
COUMADIN TAB 3MG .........................69
COUMADIN TAB 4MG .........................69
COUMADIN TAB 5MG .........................69
COUMADIN TAB 6MG .........................69
COUMADIN TAB 7.5MG ......................69
covaryx hs tab ..................................83
covaryx tab 1.25-2.5 .........................83
CO-VERATROL CAP ...........................11
COZAAR TAB 100MG .........................17
COZAAR TAB 25MG ...........................17
COZAAR TAB 50MG ...........................17
CREON CAP 12000UNT...................... 78
CREON CAP 24000UNT...................... 78
CREON CAP 3000UNIT ...................... 78
CREON CAP 36000UNT...................... 78
CREON CAP 6000UNIT ...................... 78
CRESEMBA CAP 186 MG .................. 173
CRESTOR TAB 10MG ......................... 96
CRESTOR TAB 20MG ......................... 96
CRESTOR TAB 40MG ......................... 96
CRESTOR TAB 5MG .......................... 96
CRINONE GEL 4% VAG ................... 178
CRINONE GEL 8% VAG ................... 178
CRIXIVAN CAP 200MG ...................... 39
CRIXIVAN CAP 400MG ...................... 40
cromolyn sod con 100/5ml ................ 89
cromolyn sod neb 20mg/2ml ............. 19
cromolyn sod sol 4% op .................. 126
CRONO SYR MIS 10ML .................... 115
CRONO SYR MIS 20ML .................... 115
cryselle-28 tab 28 tabs ..................... 65
CUPRIMINE CAP 250MG .................... 62
CUTIVATE CRE 0.05%....................... 67
CUTIVATE LOT 0.05% ....................... 67
CUVPOSA SOL 1MG/5ML ................. 150
CVS ADVANCED TES GLUCOSE .......... 73
CYCLESSA PAK .............................. 175
cyclobenzapr tab 10mg ..................... 60
cyclobenzapr tab 5mg ....................... 60
cyclobenzapr tab 7.5mg .................... 60
CYCLOGYL SOL 0.5% OP ................... 70
CYCLOGYL SOL 1% OP ...................... 70
CYCLOGYL SOL 2% OP ...................... 70
CYCLOMYDRIL SOL OP ...................... 70
cyclopentol sol 1% op ....................... 70
cyclopentol sol 2% op ....................... 70
CYCLOPHOSPH CAP 25MG ............... 120
CYCLOPHOSPH CAP 50MG ............... 120
cycloserine cap 250mg...................... 33
CYCLOSET TAB 0.8MG ...................... 80
cyclosporine cap 100mg .................... 71
cyclosporine cap 25mg...................... 70
cyclosporine cap 50mg mod .............. 70
CYMBALTA CAP 20MG ..................... 158
CYMBALTA CAP 30MG ..................... 158
CYMBALTA CAP 60MG ..................... 158
cyproheptad syp 2mg/5ml ................. 31
194
cyproheptad tab 4mg ........................31
CYSTADANE POW..............................97
CYSTAGON CAP 150MG .....................71
CYSTAGON CAP 50MG .......................71
CYSTARAN SOL 0.44% .................... 129
CYTOMEL TAB 25MCG...................... 170
CYTOMEL TAB 50MCG...................... 170
CYTOMEL TAB 5MCG ....................... 170
CYTOTEC TAB 100MCG .................... 176
CYTOTEC TAB 200MCG .................... 176
cytra-3 syp ......................................63
D
D.H.E. 45 INJ 1MG/ML ..................... 110
DAKLINZA TAB 30MG ........................94
DAKLINZA TAB 60MG ........................94
DALIRESP TAB 500MCG ................... 154
danazol cap 100mg ...........................14
danazol cap 200mg ...........................14
danazol cap 50mg .............................14
DANTRIUM CAP 25MG .......................79
DANTRIUM CAP 50MG .......................79
dantrolene cap 100mg .......................79
dantrolene cap 25mg ........................79
dantrolene cap 50mg ........................79
dapsone tab 100mg ........................ 105
dapsone tab 25mg .......................... 105
DARAPRIM TAB 25MG ........................32
DAYPRO TAB 600MG ....................... 123
DAYTRANA DIS 10MG/9HR ............... 162
DDAVP SOL 0.01%.......................... 179
DDAVP SPR 0.01% .......................... 179
DDAVP TAB 0.1MG .......................... 179
DDAVP TAB 0.2MG .......................... 179
DEBACTEROL SOL 30-50%.................43
DECON-A ELX 2-5MG/5M ...................71
DECON-G DRO 2-1-40MG ..................71
DELZICOL CAP 400MG ..................... 102
DEMADEX TAB 10MG ....................... 107
DEMADEX TAB 20MG ....................... 107
DEMADEX TAB 5MG......................... 107
demeclocycl tab 150mg ................... 166
demeclocycl tab 300mg ................... 166
DEMEROL TAB 100MG ..................... 130
DEMEROL TAB 50MG ...................... 129
DEMSER CAP 250MG .......................... 9
DENAVIR CRE 1% ............................ 44
DEPAKENE CAP 250MG ................... 179
DEPAKENE SYP 250/5ML ................. 179
DEPAKOTE ER TAB 250MG............... 179
DEPAKOTE ER TAB 500MG............... 179
DEPAKOTE SPR CAP 125MG ............. 179
DEPAKOTE TAB 125MG DR .............. 179
DEPEN TITRA TAB 250MG ................. 62
DEPO-PROVERA INJ 150MG/ML ........ 146
DEPO-SQ PROV INJ 104 .................. 146
DERMA SILKRX PAK DICLOPAK ........ 123
DERMACINRX KIT ANALGESI ........... 123
DERMACINRX KIT COMBOPAK .......... 111
DERMACINRX KIT PHARMAPA .......... 111
DERMACINRX KIT SILAPAK .............. 172
DERMACINRX PAK .......................... 171
DERMACINRX PAK DUOPATCH ......... 171
DERMACINRX PAK INFLAMMA .......... 123
DERMACINRX PAK LEXITRAL.............. 19
DERMAPAK PAK PLUS ......................... 5
DERMA-SMOOTH OIL /FS BODY ......... 67
DERMA-SMOOTH OIL /FS SCLP .......... 67
DERMASORB AF KIT 3-0.5% .............. 30
DERMASORB HC KIT 2% ................... 67
DERMASORB TA KIT 0.1% ................. 67
DERMASORB XM KIT 39% ................. 81
DERMATOP CRE 0.1% ....................... 67
DERMATOP OIN 0.1% ....................... 67
DERMOTIC OIL 0.01% .................... 136
desipramine tab 100mg .................. 174
desipramine tab 10mg .................... 174
desipramine tab 150mg .................. 174
desloratadin tab 2.5 odt .................... 31
desloratadin tab 5mg ........................ 31
desloratadin tab 5mg odt .................. 31
desmopressin sol 0.01% ................. 179
desmopressin spr 0.01% ................. 179
desmopressin tab 0.1mg ................. 179
desmopressin tab 0.2mg ................. 179
195
deso/ethinyl tab estradio ...................53
DESOGEN-28 TAB .............................65
DESONATE GEL 0.05% ......................67
desonide cre 0.05% ..........................67
desonide lot 0.05% ...........................67
desonide oin 0.05% ..........................67
DESOWEN CRE 0.05% .......................67
DESOWEN LOT 0.05% .......................67
DESOWEN OIN 0.05% .......................67
desoximetas cre 0.05% .....................67
desoximetas cre 0.25% .....................67
desoximetas gel 0.05% .....................67
desoximetas oin 0.05% .....................67
desoximetas oin 0.25% .....................67
DESOXYN TAB 5MG ...........................13
desvenlafax tab 100mg er ................ 158
DESVENLAFAX TAB 100MG ER .......... 158
desvenlafax tab 50mg er ................. 158
DESVENLAFAX TAB 50MG ER ............ 158
DETROL LA CAP 2MG ....................... 177
DETROL LA CAP 4MG ....................... 177
DETROL TAB 1MG ........................... 177
DETROL TAB 2MG ........................... 177
dewitts tab 325mg .......................... 152
dexameth pho sol 0.1% op .............. 128
DEXAMETHASON CON 1MG/ML ...........89
dexamethason elx 0.5/5ml .................89
dexamethason sol 0.5/5ml .................89
dexamethason tab 0.5mg ..................89
dexamethason tab 0.75mg.................89
dexamethason tab 1.5mg ..................89
dexamethason tab 1mg .....................89
DEXEDRINE CAP 10MG CR .................13
DEXEDRINE CAP 15MG CR .................13
DEXEDRINE CAP 5MG CR ...................13
DEXILANT CAP 30MG DR ................. 148
DEXILANT CAP 60MG DR ................. 148
dexmethylph cap 15mg er ............... 162
dexmethylph tab 10mg .................... 162
dexmethylph tab 2.5mg ................... 162
dexmethylph tab 5mg ..................... 162
dexmethylphe cap 10mg er ............. 162
dexmethylphe cap 20mg er ............. 162
dexmethylphe cap 5mg er ............... 162
DEXPAK PAK 10 DAY ........................ 90
dextroamphet cap 10mg er ............... 13
dextroamphet cap 15mg er ............... 13
dextroamphet cap 5mg er ................. 13
dextroamphet sol 5mg/5ml ............... 13
dextroamphet tab 10mg.................... 13
dextroamphet tab 5mg ..................... 13
DIABETA TAB 1.25MG ..................... 165
DIABETA TAB 2.5MG....................... 165
DIABETA TAB 5MG ......................... 165
DIAMOX SEQUE CAP 500MG CR ......... 59
DIASCREEN 10 MIS .......................... 91
DIASTAT ACDL GEL 12.5-20 .............. 23
DIASTAT ACDL GEL 5-10MG .............. 23
DIASTAT PED GEL 2.5M GEL .............. 23
DIASTIX TES STRIPS ........................ 73
DIATRUE PLUS TES STRIPS ............... 73
diazepam con 5mg/ml ...................... 48
diazepam gel 10mg .......................... 23
diazepam gel 2.5mg ......................... 23
diazepam gel 20mg .......................... 23
diazepam sol 1mg/ml ....................... 48
diazepam tab 10mg .......................... 48
diazepam tab 2mg ........................... 48
diazepam tab 5mg ........................... 48
DIBENZYLINE CAP 10MG ..................... 9
DICLEGIS TAB 10-10MG ................... 28
diclo/misopr tab 50-0.2mg .............. 123
diclo/misopr tab 75-0.2mg .............. 123
diclofen pot tab 50mg ..................... 123
diclofenac gel 3% ............................. 36
diclofenac sol 0.1% op .................... 128
diclofenac sol 1.5% .......................... 19
diclofenac tab 100mg er .................. 123
diclofenac tab 25mg dr ................... 123
dicloxacill cap 250mg...................... 138
dicloxacill cap 500mg...................... 138
dicyclomine cap 10mg ...................... 43
dicyclomine sol 10mg/5ml ................. 43
dicyclomine tab 20mg ....................... 43
didanosine cap 125mg ...................... 40
196
didanosine cap 200mg .......................40
DIFFERIN CRE 0.1% ........................... 7
DIFFERIN GEL 0.1% ........................... 7
DIFFERIN GEL 0.3% ........................... 7
DIFFERIN LOT 0.1% ........................... 7
DIFICID TAB 200MG ..........................86
difil-g fort liq 100-100 ..................... 180
diflorasone cre 0.05% .......................67
diflorasone oin 0.05% .......................67
DIFLUCAN SUS 10MG/ML ................. 173
DIFLUCAN SUS 40MG/ML ................. 173
DIFLUCAN TAB 100MG..................... 173
DIFLUCAN TAB 150MG..................... 173
DIFLUCAN TAB 200MG..................... 173
DIFLUCAN TAB 50MG ...................... 173
diflunisal tab 500mg ........................ 152
digoxin sol 50mcg/ml ........................59
digoxin tab 0.125mg .........................59
digoxin tab 0.25mg ...........................59
dihydrocod/ cap asa/caff ....................78
dihydroergot inj 1mg/ml .................. 110
dihydroergot spr 4mg/ml ................. 110
DILANTIN CAP 100MG .......................98
DILANTIN CAP 30MG .........................98
DILANTIN CHW 50MG ........................98
DILANTIN-125 SUS 125/5ML ..............98
DILATRATE SR CAP 40MG ................ 119
DILAUDID LIQ 1MG/ML .................... 130
DILAUDID TAB 2MG ........................ 130
DILAUDID TAB 4MG ........................ 130
DILAUDID TAB 8MG ........................ 130
diltiazem cap 120mg er .....................57
diltiazem cap 120mg/24 ....................57
diltiazem cap 180mg/24 ....................57
diltiazem cap 240mg/24 ....................57
diltiazem cap 300mg/24 ....................57
diltiazem cap 360mg/24 ....................57
diltiazem cap 420mg/24 ....................57
diltiazem cap 60mg er .......................57
diltiazem cap 90mg er .......................57
diltiazem tab 120mg ......................... 57
diltiazem tab 30mg........................... 57
diltiazem tab 60mg........................... 57
diltiazem tab 90mg........................... 57
DIOVAN HCT TAB 160-12.5 ............... 16
DIOVAN HCT TAB 160-25MG ............. 16
DIOVAN HCT TAB 320-12.5 ............... 16
DIOVAN HCT TAB 320-25MG ............. 16
DIOVAN HCT TAB 80/12.5 ................. 16
DIOVAN TAB 160MG ......................... 17
DIOVAN TAB 320MG ......................... 17
DIOVAN TAB 40MG ........................... 17
DIOVAN TAB 80MG ........................... 17
DIPENTOCAINE CRE 5-5-2%.............. 19
DIPENTUM CAP 250MG ................... 102
diphen/atrop liq 2.5/5 ....................... 37
diphen/atrop tab 2.5mg .................... 37
DIPROLENE AF CRE 0.05% ................ 67
DIPROLENE LOT 0.05%..................... 67
DIPROLENE OIN 0.05% ..................... 67
dipyridamole tab 25mg ................... 141
DISALCID TAB 500MG .................... 152
DISALCID TAB 750MG .................... 152
disopyramide cap 100mg .................. 21
disopyramide cap 150mg .................. 21
disulfiram tab 250mg.......................... 9
disulfiram tab 500mg .......................... 9
DITROPAN XL TAB 10MG ................. 177
DITROPAN XL TAB 15MG ................. 177
DITROPAN XL TAB 5MG................... 177
DIURIL SUS 250/5ML...................... 167
divalproex cap 125mg..................... 179
divalproex tab 125mg dr ................. 179
divalproex tab 250mg er ................. 179
divalproex tab 500mg er ................. 179
DIVIGEL GEL 0.25MG ....................... 84
DIVIGEL GEL 0.5MG ......................... 84
DIVIGEL GEL 1MG/GM ...................... 84
DOANS TAB 325MG ........................ 152
DOLOPHINE TAB 10MG ................... 130
DOLOPHINE TAB 5MG ..................... 130
donepezil tab 10mg .......................... 63
197
donepezil tab 10mg odt .....................63
donepezil tab 5mg ............................63
donepezil tab 5mg odt .......................63
donepezil tab hcl 23mg ......................63
DONNATAL ELX ................................22
DONNATAL TAB 16.2MG ....................22
DONNATAL TAB EXTENTAB ................22
DORAL TAB 15MG .............................47
DORYX TAB 200MG ......................... 166
DORYX TAB 50MG ........................... 166
dorzol/timol sol 22.3-6.8 ...................52
dorzolamide sol 2% op .................... 127
DOVONEX CRE 0.005% .....................38
doxazosin tab 1mg ............................20
doxazosin tab 2mg ............................20
doxazosin tab 4mg ............................20
doxazosin tab 8mg ............................20
doxepin hcl cap 100mg .................... 174
doxepin hcl cap 10mg...................... 174
doxepin hcl cap 150mg .................... 174
doxepin hcl con 10mg/ml ................. 174
doxercalcif cap 0.5mcg ......................99
doxercalcif cap 1mcg .........................99
doxercalcif cap 2.5mcg ......................99
doxycyc mono cap 100mg................ 166
doxycyc mono cap 50mg ................. 166
doxycyc mono tab 100mg ................ 166
doxycyc mono tab 150mg ................ 166
doxycyc mono tab 50mg .................. 166
doxycyc mono tab 75mg .................. 166
doxycycl hyc cap 100mg .................. 166
doxycycl hyc cap 50mg.................... 166
doxycycl hyc tab 100mg .................. 166
doxycycl hyc tab 100mg dr .............. 166
doxycycl hyc tab 150mg dr .............. 166
doxycycl hyc tab 75mg dr ................ 166
doxycycline cap 150mg ................... 166
doxycycline cap 40mg ..................... 151
doxycycline cap 75mg ..................... 166
doxycycline sus 25mg/5ml ............... 166
doxycycline tab 20mg ...................... 166
DRISDOL CAP 50000UNT ................. 180
DRITHO-CREME CRE HP 1% ...............38
dronabinol cap 10mg ........................ 28
dronabinol cap 2.5mg ....................... 28
dronabinol cap 5mg .......................... 28
drospir/ethi tab 3-0.03mg ................. 65
DROXIA CAP 200MG ......................... 71
DROXIA CAP 300MG ......................... 71
DROXIA CAP 400MG ......................... 71
DRYSOL SOL 20% .......................... 111
DSG PAK PAK .................................. 19
DUAC GEL 1.2-5%.............................. 5
DUAVEE TAB 0.45-20 ....................... 83
DUET DHA 400 MIS 25-1-400 .......... 143
DUET DHA MIS BALANCED .............. 143
DUETACT TAB 30-2MG .................... 165
DUETACT TAB 30-4MG .................... 165
DUEXIS TAB 800-26.6 .................... 123
DULERA AER 100-5MCG ...................... 8
DULERA AER 200-5MCG ...................... 8
duloxetine cap 20mg ...................... 158
DUO-CARE MIS ................................ 91
DUO-CARE TES ................................ 73
DUOPA SUS 4.63-20 ....................... 106
DURAGESIC DIS 100MCG/H ............ 130
DURAGESIC DIS 12MCG/HR ............ 130
DUREZOL EMU 0.05% ..................... 128
DURLAZA CAP 162.5MG .................. 141
dutasteride cap 0.5mg ........................ 1
DUTOPROL TAB 100-12.5 .................. 49
DUTOPROL TAB 25-12.5.................... 49
DUTOPROL TAB 50-12.5.................... 49
D-VI-SOL LIQ 400UNIT ................... 180
DYAZIDE CAP 37.5-25 ...................... 80
DYMISTA SPR 137-50 ....................... 30
DYRENIUM CAP 100MG ................... 142
DYRENIUM CAP 50MG ..................... 142
E
e.e.s. 400 tab 400mg ....................... 82
EASY PLUS II TES BLD GLUC ............. 73
EASY PLUS TES BLD GLUC................. 73
EASY STEP TES ................................ 73
EASY TALK TES BLD GLUC ................. 73
198
EASY TOUCH TES STRIPS ..................73
EASY TRAK TES BLD GLUC .................73
EASYGLUCO TES ...............................73
EASYGLUCO TES PLUS .......................73
EASYMAX 15 TES ..............................73
EASYMAX TES ..................................73
EASYPLUS TES BLD GLUC ..................73
EASYPRO PLUS TES ...........................73
EASYPRO TES BLD GLUC....................73
EC-NAPROSYN TAB 375MG .............. 123
EC-NAPROSYN TAB 500MG .............. 123
econazole cre 1% ........................... 100
ECOZA AER 1% .............................. 100
EDARBI TAB 40MG ............................17
EDARBI TAB 80MG ............................17
EDARBYCLOR TAB 40-12.5 .................16
EDARBYCLOR TAB 40-25MG ...............16
EDECRIN TAB 25MG ........................ 107
EDEX KIT 40MCG ............................ 147
ed-flex cap .......................................13
EDLUAR SUB 10MG ......................... 121
EDLUAR SUB 5MG ........................... 121
ed-spaz tab 0.125mg ........................45
EDURANT TAB 25MG .........................40
EFFEXOR XR CAP 150MG ................. 158
EFFEXOR XR CAP 37.5MG ................ 158
EFFEXOR XR CAP 75MG ................... 158
EFFIENT TAB 10MG ......................... 169
EFFIENT TAB 5MG ........................... 169
EFUDEX CRE 5% ...............................36
EGRIFTA SOL 1MG ............................92
EGRIFTA SOL 2MG ............................93
ELDEPRYL CAP 5MG ..........................37
ELEMENT TES ...................................73
ELEMNT COMPA TES STRIPS ..............73
ELESTAT DRO 0.05% ...................... 126
ELESTRIN GEL 0.06% ........................84
ELIDEL CRE 1% .............................. 109
ELIMITE CRE 5% ............................ 153
ELIPHOS TAB 667MG ....................... 140
ELIQUIS TAB 2.5MG ..........................79
ELIQUIS TAB 5MG .............................79
elite-ob tab .................................... 143
ELIXOPHYLLIN ELX 80/15ML ............ 180
ELLA TAB 30MG ................................81
ELMIRON CAP 100MG ...................... 103
ELOCON CRE 0.1% ........................... 67
ELOCON LOT 0.1% ........................... 67
ELOCON OIN 0.1% ........................... 67
EMADINE SOL 0.05% OP ................. 126
EMBEDA CAP 100-4MG ................... 130
EMBEDA CAP 20-0.8MG .................. 130
EMBEDA CAP 30-1.2MG .................. 130
EMBEDA CAP 50-2MG ..................... 130
EMBEDA CAP 60-2.4MG .................. 130
EMBEDA CAP 80-3.2MG .................. 130
EMBRACE EVO TES ........................... 73
EMBRACE PRO TES ........................... 73
EMBRACE TES BLD GLUC .................. 73
EMCYT CAP 140MG ........................... 85
EMEND CAP 125MG ........................ 164
EMEND CAP 40MG .......................... 164
EMEND CAP 80MG .......................... 164
EMEND PAK 80 & 125 ..................... 164
EMLA CRE 2.5-2.5% ....................... 171
EMSAM DIS 12MG/24H ................... 111
EMSAM DIS 6MG/24HR ................... 111
EMSAM DIS 9MG/24HR ................... 111
EMTRIVA CAP 200MG........................ 41
EMTRIVA SOL 10MG/ML .................... 41
EMULSION SB EMU ......................... 110
EMVOREN CRE ................................. 19
ENABLEX TAB 15MG ....................... 177
ENABLEX TAB 7.5MG ...................... 177
enalapr/hctz tab 10-25mg ................... 4
enalapr/hctz tab 5-12.5mg .................. 4
enalapril tab 10mg ............................. 3
enalapril tab 2.5mg ............................ 2
enalapril tab 20mg ............................. 3
enalapril tab 5mg ............................... 2
ENBRACE HR CAP ........................... 143
ENBREL INJ 25/0.5ML ..................... 160
ENBREL INJ 25MG .......................... 160
ENBREL INJ 50MG/ML ..................... 160
ENBREL SRCLK INJ 50MG/ML ........... 160
ENCARE SUP 100MG ....................... 160
ENDOMETRIN SUP 100MG ............... 178
ENJUVIA TAB 0.3MG ......................... 84
ENJUVIA TAB 0.45MG ....................... 84
ENJUVIA TAB 0.625MG ..................... 84
ENJUVIA TAB 0.9MG ......................... 84
ENJUVIA TAB 1.25MG ....................... 84
199
enoxaparin inj 100mg/ml ................. 108
enoxaparin inj 120/0.8 .................... 108
enoxaparin inj 150mg/ml ................. 108
enoxaparin inj 30/0.3ml .................. 108
enoxaparin inj 300/3ml ................... 108
enpresse-28 tab ............................. 175
entacapone tab 200mg .................... 138
entecavir tab 0.5mg ..........................94
entecavir tab 1mg .............................94
ENTEREG CAP 12MG........................ 138
ENTOCORT EC CAP 3MG/24HR ...........90
ENTRESTO TAB 24-26MG ................. 118
ENTRESTO TAB 49-51MG ................. 118
ENTRESTO TAB 97-103MG ............... 118
enulose sol 10gm/15 ....................... 103
ENVARSUS XR TAB 0.75MG .............. 108
ENVARSUS XR TAB 1MG .................. 108
ENVARSUS XR TAB 4MG .................. 108
EPANED SOL 1MG/ML ......................... 3
EPIDUO FORTE GEL 0.3-2.5% ............. 5
EPIDUO GEL 0.1-2.5% ....................... 5
EPIFOAM AER 1% ........................... 161
epinastine dro 0.05% ...................... 126
epinephrine inj 0.15mg ......................14
epinephrine inj 0.1mg/ml ................. 111
epinephrine inj 0.3mg .......................14
epinephrine inj 1mg/ml ................... 111
EPIPEN-JR INJ 2-PAK .........................14
EPISIL LIQ ..................................... 147
EPISNAP KIT ....................................14
epitol tab 200mg ..............................24
EPIVIR HBV SOL 5MG/ML ...................94
EPIVIR HBV TAB 100MG ....................94
EPIVIR SOL 10MG/ML ........................41
EPIVIR TAB 150MG ...........................41
EPIVIR TAB 300MG ...........................41
eplerenone tab 25mg ...................... 153
eplerenone tab 50mg ...................... 153
EPOGEN INJ 10000/ML ......................83
EPOGEN INJ 2000/ML ........................83
EPOGEN INJ 20000/ML ......................83
EPOGEN INJ 3000/ML ........................83
EPOGEN INJ 4000/ML ........................83
eprosart mes tab 600mg ................... 17
EPZICOM TAB 600-300 ..................... 39
eq nicotine dis 7mg/24hr ................ 159
EQL TRUETEST TES BLD GLUC ........... 73
EQUAGESIC TAB 200-325 ................. 14
EQUETRO CAP 100MG ....................... 38
EQUETRO CAP 200MG ....................... 38
EQUETRO CAP 300MG ....................... 38
ergocalcifer cap 50000unt ............... 180
ergoloid mes tab 1mg oral ............... 148
ERGOMAR SUB 2MG ....................... 110
ERIVEDGE CAP 150MG ...................... 34
ERTACZO CRE 2% .......................... 100
ery pad 2% ....................................... 5
ERYGEL GEL 2% ................................ 5
ERYPED SUS 200/5ML....................... 82
ERYPED SUS 400/5ML....................... 82
ERY-TAB TAB 250MG EC ................... 82
ERY-TAB TAB 333MG EC ................... 82
ERY-TAB TAB 500MG EC ................... 82
erythrocin tab 250mg ....................... 82
erythromycin cap 250mg ec .............. 82
erythromycin gel /benzoyl ................... 5
erythromycin gel 2% .......................... 5
erythromycin sol 2% .......................... 5
erythromycin tab 250mg bs ............... 82
erythromycin tab 500mg bs ............... 82
ESBRIET CAP 267MG ...................... 149
escitalopram sol 5mg/5ml ............... 156
escitalopram tab 10mg ................... 156
escitalopram tab 20mg ................... 156
escitalopram tab 5mg ..................... 156
ESGIC TAB ...................................... 14
esomepra mag cap 40mg dr ............ 148
estazolam tab 1mg ........................... 47
estazolam tab 2mg ........................... 47
ESTRACE TAB 0.5MG ........................ 84
ESTRACE TAB 1MG ........................... 84
ESTRACE TAB 2MG ........................... 84
ESTRACE VAG CRE 0.1MG/GM ......... 178
estradiol dis 0.025mg ....................... 84
estradiol dis 0.0375mg ..................... 84
estradiol dis 0.05mg ......................... 84
estradiol dis 0.06mg ......................... 84
estradiol dis 0.075mg ....................... 84
estradiol dis 0.1mg ........................... 84
200
ESTRADIOL MIS 10MG.......................84
ESTRADIOL MIS 12.5MG ....................84
ESTRADIOL MIS 25MG.......................84
ESTRADIOL MIS 6MG ........................84
estradiol tab 0.5mg ...........................84
estradiol tab 1mg..............................84
estradiol tab 2mg..............................84
ESTRING MIS 2MG .......................... 178
ESTROGEL GEL .................................84
estropipate tab 0.75mg .....................84
estropipate tab 1.5mg .......................84
estropipate tab 3mg ..........................84
ESTROSTEP FE TAB ......................... 175
eszopiclone tab 1mg ....................... 121
ethambutol tab 100mg ......................33
ethambutol tab 400mg ......................33
ethosuximide cap 250mg ................. 164
ethosuximide sol 250/5ml ................ 164
ETHYL CHLOR AER MED STRM .......... 172
ethyl chlor aer mist ......................... 172
etidron disd tab 200mg .....................54
etidron disd tab 400mg .....................54
etodolac cap 200mg ........................ 123
etodolac cap 300mg ........................ 123
etodolac er tab 400mg .................... 123
etodolac tab 400mg ........................ 124
etodolac tab 500mg ........................ 124
etoposide cap 50mg ........................ 111
EURAX CRE 10%............................. 153
EURAX LOT 10% ............................. 153
EVAMIST SPR 1.53MG .......................84
EVEKEO TAB 10MG ...........................13
EVEKEO TAB 5MG .............................13
EVENCARE + TES BLD GLUC ..............73
EVENCARE G2 TES ............................74
EVENCARE G3 TES ............................74
EVENCARE TES BLD GLUC ..................74
EVENCARE TES MINI .........................74
EVISTA TAB 60MG .......................... 154
EVOCLIN AER 1% .............................. 5
EVOLUTION TES AUTOCODE ..............74
EVOTAZ TAB 300-150........................39
EVOXAC CAP 30MG ........................ 152
EXACTECH TES ................................ 74
EXACTECH TES R-S-G ....................... 74
EXALGO TAB 12MG......................... 130
EXALGO TAB 16MG......................... 130
EXALGO TAB 32MG......................... 130
EXALGO TAB 8MG .......................... 130
EXELDERM CRE 1% ........................ 100
EXELDERM SOL 1% ........................ 100
EXELON CAP 1.5MG .......................... 63
EXELON CAP 3MG............................. 63
EXELON CAP 4.5MG .......................... 63
EXELON CAP 6MG............................. 63
EXELON DIS 13.3/24 ........................ 63
EXELON DIS 4.6MG/24 ..................... 63
EXELON DIS 9.5MG/24 ..................... 63
exemestane tab 25mg ...................... 44
EXFORGE TAB 10-160MG .................. 15
EXFORGE TAB 10-320MG .................. 15
EXFORGE TAB 5-160MG .................... 15
EXFORGE TAB 5-320MG .................... 15
EXFORGEH/10- TAB 160-12.5 ............ 15
EXFORGEH/10- TAB 160-25............... 15
EXFORGEH/10- TAB 320-25............... 15
EXFORGEH/5- TAB 160-12.5.............. 15
EXFORGEH/5- TAB 160-25 ................ 15
EXJADE TAB 125MG.......................... 28
EXJADE TAB 250MG.......................... 28
EXJADE TAB 500MG.......................... 28
exoderm lot 25-1% .......................... 30
EXTAVIA INJ 0.3MG ........................ 112
EXTINA AER 2% ............................. 100
EXYDERM PAD ............................... 173
EZ SMART PLS TES BLD GLUC ........... 74
EZ SMART TES BLD GLUC.................. 74
F
FABIOR AER 0.1% .............................. 7
FACTIVE TAB 320MG ........................ 87
FALESSA KIT ................................... 65
famciclovir tab 125mg ...................... 95
famotidine sus 40mg/5ml .................. 94
famotidine tab 40mg ........................ 94
FAMVIR TAB 125MG ......................... 96
FAMVIR TAB 250MG ......................... 96
201
FAMVIR TAB 500MG ..........................96
FANAPT PAK .....................................46
FANAPT TAB 10MG ............................46
FANAPT TAB 12MG ............................46
FANAPT TAB 1MG ..............................46
FANAPT TAB 2MG ..............................46
FANAPT TAB 4MG ..............................46
FANAPT TAB 6MG ..............................46
FANAPT TAB 8MG ..............................46
FANATREX SUS 25MG/ML ..................24
FARESTON TAB 60MG ........................28
FARXIGA TAB 10MG ........................ 159
FARXIGA TAB 5MG .......................... 159
FARYDAK CAP 10MG ..........................34
FARYDAK CAP 15MG ..........................34
FARYDAK CAP 20MG ..........................34
FAZACLO TAB 100/ODT .....................77
FAZACLO TAB 12.5/ODT ....................77
FAZACLO TAB 150MG ........................77
FAZACLO TAB 200MG ........................77
FAZACLO TAB 25MG ODT ...................77
FC FEMALE MIS CONDOM...................66
felbamate sus 600/5ml ......................59
felbamate tab 400mg ........................59
felbamate tab 600mg ........................59
FELBATOL SUS 600/5ML ....................59
FELBATOL TAB 400MG .......................59
FELBATOL TAB 600MG .......................59
FELDENE CAP 10MG ........................ 124
FELDENE CAP 20MG ........................ 124
felodipine tab 10mg er ......................57
felodipine tab 2.5mg er .....................57
felodipine tab 5mg er ........................57
FEM PH GEL ................................... 111
FEMARA TAB 2.5MG ..........................44
FEMCAP MIS 26MM ...........................62
FEMCAP MIS 30MM ...........................62
FEMCON FE CHW ..............................65
FEMHRT TAB 0.5-2.5 .........................83
FEMRING MIS 0.05/24H................... 178
FEMRING MIS 0.1MG/24 .................. 178
fenofibrate cap 130mg.......................85
fenofibrate cap 43mg ........................85
fenofibrate cap 50mg ........................ 85
fenofibrate cap 67mg ........................ 85
fenofibrate tab 120mg ...................... 85
fenofibrate tab 40mg ........................ 85
fenofibric cap 135mg dr .................... 86
fenofibric cap 45mg dr ...................... 86
fenofibric tab 105mg ........................ 86
fenofibric tab 35mg .......................... 86
FENOGLIDE TAB 120MG .................... 86
FENOGLIDE TAB 40MG ...................... 86
fenoprofen cap 400mg .................... 124
fenoprofen tab 600mg .................... 124
fentanyl dis 100mcg/h .................... 130
fentanyl dis 12mcg/hr ..................... 130
FENTANYL DIS 37.5MCG ................. 130
FENTANYL DIS 62.5MCG ................. 130
FENTANYL DIS 87.5MCG ................. 130
fentanyl ot loz 1200mcg .................. 130
fentanyl ot loz 1600mcg .................. 130
fentanyl ot loz 200mcg ................... 130
FENTORA TAB 100MCG ................... 130
FENTORA TAB 200MCG ................... 130
FENTORA TAB 400MCG ................... 130
FENTORA TAB 600MCG ................... 130
FENTORA TAB 800MCG ................... 130
fer-iron dro 15mg/ml ...................... 104
FERRIPROX TAB 500MG .................... 28
FERRLECIT INJ 12.5MG/M ............... 104
FERROUS SUL LIQ 220/5ML ............. 104
ferrous sulf elx 220/5ml .................. 104
FERROUS SULF SYP 300/5ML ........... 104
FETZIMA CAP 120MG ...................... 158
FETZIMA CAP 20MG ........................ 158
FETZIMA CAP 40MG ........................ 158
FETZIMA CAP 80MG ........................ 158
FETZIMA CAP TITRATIO .................. 158
202
FEXMID TAB 7.5MG ...........................60
FIBRICOR TAB 105MG .......................86
FIBRICOR TAB 35MG .........................86
FIFTY50 GLUC TES 2.0 ......................74
FINACEA AER 15% .......................... 152
FINACEA GEL 15% .......................... 152
finasteride tab 5mg ............................ 1
FINGERSTIX MIS LANCETS .................91
FIORICET CAP ..................................14
FIORICET CAP CODEINE ....................64
FIORINAL CAP ..................................14
FIORINAL/COD CAP 30MG ..................64
FIRAZYR INJ 30MG/3ML .....................54
FLAGYL CAP 375MG ..........................18
FLAGYL ER TAB 750MG ......................18
FLAGYL TAB 250MG ..........................18
FLAGYL TAB 500MG ..........................18
FLAREX SUS 0.1% OP ..................... 128
flavoxate tab 100mg ....................... 178
flecainide tab 100mg .........................21
flecainide tab 150mg .........................21
flecainide tab 50mg ...........................21
FLECTOR DIS 1.3% ...........................19
FLEXEPAX MIS ................................ 113
FLEXIN PAD .0375-5% .................... 171
FLEXIZOL PAK COMBIPAK ................ 123
FLOMAX CAP 0.4MG ........................... 9
FLO-PRED SUS .................................90
FLORIVA DRO 0.25MG .......................87
FLOVENT DISK AER 100MCG ............ 161
FLOVENT DISK AER 250MCG ............ 161
FLOVENT DISK AER 50MCG .............. 161
FLOVENT HFA AER 110MCG.............. 161
FLOVENT HFA AER 220MCG.............. 161
FLOVENT HFA AER 44MCG ............... 161
FLOWTUSS SOL 2.5-200 ....................43
fluconazole sus 10mg/ml ................. 173
fluconazole sus 40mg/ml ................. 173
fluconazole tab 100mg .................... 173
fluconazole tab 50mg ...................... 173
flucytosine cap 250mg .......................29
flucytosine cap 500mg .......................29
fludrocort tab 0.1mg ....................... 110
FLUMADINE TAB 100MG .................. 102
flunisolide spr 0.025% .................... 114
fluocin acet cre 0.01% ...................... 67
fluocin acet cre 0.025% .................... 67
fluocin acet oil 0.01% sc ................... 67
fluocin acet oil body .......................... 67
fluocin acet oil ear0.01%................. 136
fluocin acet oin 0.025% .................... 67
fluocin acet sol 0.01% ...................... 67
fluocinonide cre 0.05% ..................... 68
fluocinonide cre 0.1% ....................... 67
fluocinonide cre -e 0.05% ................. 68
fluocinonide gel 0.05% ..................... 68
fluocinonide oin 0.05% ..................... 68
fluocinonide sol 0.05% ...................... 68
FLUORABON DRO ............................. 86
FLUOR-A-DAY CHW 0.25MG F ............ 87
FLUOR-A-DAY CHW 0.5MG F .............. 87
FLUOR-A-DAY CHW 1MG F ................ 87
fluoridex dd pst sensitiv .................... 72
FLUORIDEX GEL SENSITIV ................ 72
fluoritab chw 0.25mg f ...................... 86
fluoritab chw 0.5mg f........................ 86
fluoritab chw 1mg f .......................... 86
fluoromethol sus 0.1% op ............... 128
FLUOROPLEX CRE 1% ....................... 36
fluorouracil cre 0.5% ........................ 36
fluorouracil cre 5% ........................... 36
fluorouracil dro 2% ........................... 36
fluorouracil dro 5% ........................... 36
fluoxetine cap 10mg ................ 142, 156
fluoxetine cap 20mg ................ 142, 156
fluoxetine cap 40mg ....................... 156
fluoxetine cap 90mg dr ................... 156
fluoxetine sol 20mg/5ml ................. 156
fluoxetine tab 10mg ....................... 156
fluoxetine tab 20mg ....................... 156
FLUOXETINE TAB 60MG .................. 156
fluphenazine con 5mg/ml ................ 139
fluphenazine elx 2.5/5ml ................. 139
fluphenazine tab 10mg ................... 139
fluphenazine tab 1mg ..................... 139
fluphenazine tab 2.5mg .................. 139
fluphenazine tab 5mg ..................... 139
flura-drops dro 0.25mg f ................... 86
flurazepam cap 15mg ....................... 47
flurazepam cap 30mg ....................... 47
203
flurbiprofen sol 0.03% op ................ 128
flurbiprofen tab 100mg .................... 124
flurbiprofen tab 50mg ...................... 124
flutamide cap 125mg.........................20
fluticasone cre 0.05% ........................68
fluticasone lot 0.05% ........................68
fluticasone oin 0.005% ......................68
fluvastatin cap 20mg .........................96
fluvastatin cap 40mg .........................96
fluvastatin tab 80mg er .....................96
fluvoxamine cap 100mg er ............... 156
fluvoxamine cap 150mg er ............... 156
fluvoxamine tab 100mg ................... 156
fluvoxamine tab 25mg ..................... 156
fluvoxamine tab 50mg ..................... 156
FML FORTE SUS 0.25% OP ............... 128
FML LIQUIFLM SUS 0.1% OP ............ 129
FML OIN 0.1% OP ........................... 129
FOCALIN TAB 10MG ........................ 163
FOCALIN TAB 2.5MG ....................... 162
FOCALIN TAB 5MG .......................... 163
FOCALIN XR CAP 10MG ................... 163
FOCALIN XR CAP 15MG ................... 163
FOCALIN XR CAP 20MG ................... 163
FOCALIN XR CAP 25MG ................... 163
FOCALIN XR CAP 30MG ................... 163
FOCALIN XR CAP 35MG ................... 163
FOCALIN XR CAP 40MG ................... 163
FOCALIN XR CAP 5MG ..................... 163
FOLET DHA PAK .............................. 144
FOLET ONE CAP 38-1-225 ................ 145
folic acid tab 1mg .............................88
folic acid tab 400mcg ........................88
folic acid tab 800mcg ........................88
FOLIVANE-OB CAP .......................... 143
FOLLISTIM AQ INJ 300UNIT ............. 136
FOLLISTIM AQ INJ 75UNIT ............... 136
fondaparinux inj 10/0.8ml ................ 166
fondaparinux inj 2.5/0.5 .................. 166
fondaparinux inj 5/0.4ml ................. 166
fondaparinux inj 7.5/0.6 .................. 166
FOOD COLOR LIQ BLUE .....................65
FORA D10 TES BLD GLUC ..................74
FORA D15G TES BLD GLUC ................74
FORA D20 TES BLD GLUC .................. 74
FORA G20 TES BLD GLUC .................. 74
FORA G30A TES BLD GLUC ................ 74
FORA GD20 TES BLD GLUC................ 74
FORA GD50 TES ............................... 74
FORA V10 TES BLD GLUC .................. 74
FORA V30A TES BLD GLUC ................ 74
FORACARE TES GD40 ....................... 74
FORACARE TES PREM V10 ................. 74
FORACARE TES TST N GO ................. 74
FORADIL CAP AEROLIZE ................... 49
FORFIVO XL TAB 450MG ................... 27
formadon sol ................................... 43
forma-ray sol 20% ........................... 43
FORTAMET TAB 1000MG ................... 53
FORTAMET TAB 500MG ..................... 53
FORTEO SOL 600/2.4 ..................... 137
FORTESTA GEL 10MG/ACT ................. 14
FORTICAL SPR 200/ACT .................... 55
FOSAMAX + D TAB 70-2800 .............. 54
FOSAMAX + D TAB 70-5600 .............. 54
FOSAMAX TAB 70MG ........................ 54
fosinop/hctz tab 10/12.5 ..................... 4
fosinop/hctz tab 20/12.5 ..................... 4
fosinopril tab 10mg ............................ 3
FOSRENOL CHW 1000MG ................ 140
FOSRENOL CHW 500MG .................. 140
FOSRENOL CHW 750MG .................. 140
FOSRENOL POW 1000MG ................ 140
FOSRENOL POW 750MG .................. 140
FRAGMIN INJ 10000/ML .................. 108
FRAGMIN INJ 12500UNT ................. 108
FRAGMIN INJ 15000UNT ................. 108
FRAGMIN INJ 18000UNT ................. 108
FRAGMIN INJ 2500/0.2 ................... 108
FRAGMIN INJ 5000/0.2 ................... 108
FRAGMIN INJ 7500/0.3 ................... 108
FRAGMIN INJ 95000UNT ................. 108
FREESTYLE TES................................ 74
FREESTYLE TES INSULINX ................. 74
FREESTYLE TES LITE ........................ 74
FROVA TAB 2.5MG ......................... 154
204
FULYZAQ TAB 125MG ........................27
FURADANTIN SUS 25MG/5ML ........... 176
furosemide sol 10mg/ml .................. 107
FUROSEMIDE SOL 8MG/ML .............. 107
furosemide tab 20mg ...................... 107
FUSION PAK SPRINKLE .................... 104
FUZEON INJ 90MG ............................39
FYCOMPA TAB 10MG .........................12
FYCOMPA TAB 12MG .........................12
FYCOMPA TAB 2MG ...........................12
FYCOMPA TAB 4MG ...........................12
FYCOMPA TAB 6MG ...........................12
FYCOMPA TAB 8MG ...........................12
G
G4 SENSOR KIT ................................91
gabapentin cap 100mg ......................24
gabapentin sol 250/5ml .....................24
gabapentin tab 600mg ......................24
gabapentin tab 800mg ......................24
GABAVALE-5 PAK ..............................47
GABAZOLAMINE PAK .........................47
GABAZOLAMINE PAK 0.5MG ...............47
GABITRIL TAB 12MG .........................88
GABITRIL TAB 16MG .........................88
GABITRIL TAB 2MG ...........................88
GABITRIL TAB 4MG ...........................88
GABOXETINE PAK ........................... 161
galantamine cap 16mg er ..................63
galantamine cap 24mg er ..................63
galantamine cap 8mg er ....................63
galantamine sol 4mg/ml ....................63
galantamine tab 12mg.......................63
galantamine tab 4mg ........................63
galantamine tab 8mg ........................63
GANIRELIX AC INJ ............................91
GARAMYCIN SOL 0.3% OP ............... 126
GASTRINEX NF CAP...........................22
GASTROCROM CON 100/5ML ..............89
gatifloxacin sol 0.5% ....................... 126
GATTEX KIT 5MG ..............................89
gavilyte-c sol ....................................54
gavilyte-h kit ....................................54
GE100 BLOOD TES GLUCOSE............. 74
GELCLAIR GEL ............................... 147
GELFILM MIS OP ............................ 129
GELNIQUE GEL 10% ....................... 177
GELNIQUE GEL 3% ......................... 177
gemfibrozil tab 600mg ...................... 86
GENERESS FE CHW .......................... 65
gengraf cap 100mg .......................... 71
gengraf cap 25mg ............................ 71
gengraf sol 100mg/ml....................... 71
GENOTROPIN INJ 0.2MG ................... 93
GENOTROPIN INJ 12MG .................... 93
GENOTROPIN INJ 1MG ...................... 93
gentamicin cre 0.1% ........................ 22
gentamicin oin 0.1% ........................ 22
gentamicin oin 0.3% op .................. 126
gentamicin sol 0.3% op .................. 126
GEODON CAP 20MG.......................... 38
GEODON CAP 40MG.......................... 38
GEODON CAP 60MG.......................... 38
GEODON CAP 80MG.......................... 38
gg/codeine sol 100-10/5 ................... 44
GHT TEST TES STRIPS ...................... 74
gianvi tab 3-0.02mg ......................... 65
GIAZO TAB 1.1GM .......................... 102
GILENYA CAP 0.5MG ....................... 161
GILOTRIF TAB 20MG......................... 35
GILOTRIF TAB 30MG......................... 35
GILOTRIF TAB 40MG......................... 35
GILTUSS LIQ PED-C ......................... 44
glatopa inj 20mg/ml ....................... 112
GLEEVEC TAB 100MG ....................... 35
GLEEVEC TAB 400MG ....................... 35
GLEOSTINE CAP 100MG .................. 120
GLEOSTINE CAP 10MG .................... 120
GLEOSTINE CAP 40MG .................... 120
glimepiride tab 1mg ....................... 165
205
glimepiride tab 2mg ........................ 165
glimepiride tab 4mg ........................ 165
glip/metform tab 2.5-250m .............. 164
glip/metform tab 2.5-500m .............. 164
glip/metform tab 5-500mg ............... 164
glipizide er tab 10mg ....................... 165
glipizide er tab 2.5mg ...................... 165
glipizide er tab 5mg ........................ 165
glipizide tab 10mg .......................... 165
glipizide tab 5mg ............................ 165
GLUCAGEN INJ HYPOKIT ....................72
GLUCAGON KIT 1MG .........................72
GLUCO PERFEC TES 3 ........................74
GLUCOCARD 01 TES PLUS .................74
GLUCOCARD 01 TES SENSOR .............74
GLUCOCARD TES EXPRESSI ...............74
GLUCOCARD TES SHINE ....................74
GLUCOCARD TES VITAL .....................74
GLUCOCARD TES X-SENSOR ..............74
GLUCOCOM TES................................74
GLUCOLET 2 MIS LANCING ................91
GLUCONAVII TES STRIPS ..................74
GLUCOPHAGE TAB 1000MG ................53
GLUCOPHAGE TAB 500MG .................53
GLUCOPHAGE TAB 500MG XR .............53
GLUCOPHAGE TAB 750MG XR .............53
GLUCOPHAGE TAB 850MG .................53
GLUCOTROL TAB 10MG ................... 165
GLUCOTROL TAB 5MG ..................... 165
GLUCOTROL XL TAB 10MG ............... 165
GLUCOTROL XL TAB 2.5MG .............. 165
GLUCOTROL XL TAB 5MG ................. 165
GLUCOVANCE TAB 1.25-250 ............ 164
GLUCOVANCE TAB 2.5-500 .............. 164
GLUCOVANCE TAB 5-500MG ............ 164
GLUMETZA TAB 1000MG ....................53
GLUMETZA TAB 500MG ......................53
GLUTARALDEHY SOL 25% ..................43
glyb/metform tab 1.25-250 .............. 165
glyb/metform tab 2.5-500 ............... 165
glyb/metform tab 5-500mg .............. 165
glyburid mcr tab 1.5mg ................... 165
glyburid mcr tab 3mg ...................... 165
glyburid mcr tab 6mg ...................... 165
glyburide tab 1.25mg ...................... 165
glyburide tab 2.5mg ........................ 165
glyburide tab 5mg .......................... 165
glycopyrrol tab 1mg ....................... 150
glycopyrrol tab 2mg ....................... 150
GLYNASE TAB 1.5MG ...................... 165
GLYNASE TAB 3MG ......................... 165
GLYNASE TAB 6MG ......................... 165
GLYSET TAB 100MG ......................... 11
GLYSET TAB 25MG ........................... 11
GLYSET TAB 50MG ........................... 11
GLYXAMBI TAB 10-5 MG ................. 159
GLYXAMBI TAB 25-5 MG ................. 159
GMATE BLOOD TES GLUCOSE ............ 74
GOLYTELY SOL................................. 54
GONAL-F INJ 1050UNIT .................. 136
GONAL-F INJ 450UNIT .................... 136
GONAL-F RFF INJ 300 ..................... 136
GONAL-F RFF INJ 450 ..................... 136
GONAL-F RFF INJ 75UNIT ................ 136
GONAL-F RFF INJ 900 ..................... 136
GORDOFILM SOL ............................ 104
GORDONS UREA OIN 40% ................ 81
grafco silvr mis nit appl ..................... 59
GRALISE STAR MIS 300/600............ 141
GRALISE TAB 300MG ...................... 141
GRALISE TAB 600MG ...................... 141
granisetron tab 1mg ........................... 1
GRANIX INJ 300/0.5 ......................... 92
GRANIX INJ 480/0.8 ......................... 92
GRANULEX AER ................................ 82
GRASTEK SUB 2800BAU...................... 9
GRIFULVIN V TAB 500MG .................. 29
griseofulvin sus 125/5ml ................... 29
griseofulvin tab micr 500................... 29
griseofulvin tab ultr 125 .................... 29
griseofulvin tab ultr 250 .................... 29
GRIS-PEG TAB 125MG ...................... 29
GRIS-PEG TAB 250MG ...................... 29
guanfacine tab 1mg .......................... 20
guanfacine tab 1mg er ........................ 8
guanfacine tab 2mg .......................... 20
GUANIDINE TAB 125MG .................... 33
GUARDIAN RT MIS REPLACE .............. 91
GYNAZOLE-1 CRE 2% ..................... 100
206
GYNOL II GEL 3% ........................... 160
H
H.P. ACTHAR INJ 80UNIT ...................69
HALAC KIT ..................................... 172
HALCION TAB 0.25MG .......................47
halobetasol cre 0.05% .......................68
halobetasol oin 0.05% .......................68
HALOG CRE 0.1% .............................68
HALOG OIN 0.1% .............................68
haloperidol con 2mg/ml .....................55
haloperidol tab 0.5mg .......................55
haloperidol tab 10mg ........................55
haloperidol tab 1mg ..........................55
haloperidol tab 20mg ........................55
HALOTIN CRE 1% .............................29
HARVONI TAB 90-400MG ...................94
hc butyrate cre 0.1% ........................68
hc butyrate oin 0.1% ........................68
hc butyrate sol 0.1% .........................68
hc pramoxine cre 1-1% ................... 151
hc pramoxine cre 2.5-1% ........ 151, 161
hc valerate cre 0.2% .........................68
hc valerate oin 0.2% .........................68
HEALTHPRO TES STRIPS ....................74
HECTOROL CAP 0.5MCG ....................99
HECTOROL CAP 1MCG .......................99
HECTOROL CAP 2.5MCG ....................99
HEMANGEOL SOL 4.28/ML .................51
HEMENATAL OB MIS + DHA ............. 143
HEPSERA TAB 10MG ..........................94
HETLIOZ CAP 20MG ........................ 154
HEXALEN CAP 50MG ........................... 9
HIPREX TAB 1GM ............................ 176
homatropine sol 5% op .....................70
HORIZANT TAB 300MG .................... 151
HORIZANT TAB 600MG .................... 151
HPR PLUS MB KIT HYDROGEL .............82
HSA DILUENT SOL STERILE.............. 137
H-TRON PLUS MIS INS PUMP ............ 102
HUBER NEEDLE MIS 19GX1.25 ......... 115
HUBER NEEDLE MIS 19GX3/4" ......... 115
HUBER NEEDLE MIS 20GX1.25 ......... 115
HUMALOG INJ 100/ML .......................97
HUMALOG KWIK INJ 100/ML ..............97
HUMALOG KWIK INJ 200/ML .............. 97
HUMALOG MIX INJ 50/50 .................. 97
HUMALOG MIX INJ 50/50KWP ............ 97
HUMALOG MIX INJ 75/25KWP ............ 97
HUMALOG MIX SUS 75/25 ................. 97
HUMAPEN MIS LUXURA ................... 115
HUMATROPE INJ 12MG ..................... 93
HUMATROPE INJ 24MG ..................... 93
HUMATROPE INJ 5MG ....................... 93
HUMATROPE INJ 6MG ....................... 93
HUMATROPEN MIS FOR 6MG............ 115
HUMIRA INJ 10MG/0.2 ...................... 19
HUMIRA KIT 20MG/0.4 ..................... 19
HUMIRA KIT 40MG/0.8 ..................... 19
HUMIRA PEN INJ 40MG/0.8 ............... 19
HUMULIN INJ 70/30KWP ................... 97
HUMULIN N INJ U-100KWP ................ 97
HUMULIN R INJ U-500 ...................... 97
HURRISEAL SOL ............................... 71
HYALUCIL-0.5 CRE ........................... 36
HYALUCIL-4 CRE .............................. 36
HYCAMTIN CAP 0.25MG .................. 172
HYCAMTIN CAP 1MG ....................... 172
HYCET SOL 7.5-325 .......................... 98
HYCOFENIX SOL .............................. 44
hyd pol/cpm liq 10-8/5ml ................ 134
hydralazine tab 100mg ................... 179
hydralazine tab 10mg ..................... 179
HYDREA CAP 500MG ......................... 36
HYDRO 35 AER ................................ 81
HYDRO 40 AER FOAM ....................... 81
hydro/chlor/ liq 5-4-60mg ............... 134
hydroc/homat tab 5-1.5mg ............... 43
hydrochlorot cap 12.5mg ................ 167
hydrochlorot tab 12.5mg ................. 167
hydrochlorot tab 25mg ................... 167
hydrochlorot tab 50mg ................... 167
hydroco/apap sol 10-325mg .............. 98
hydroco/apap sol 7.5-325 ................. 98
hydroco/apap tab 10-325mg ............. 98
hydroco/apap tab 2.5-325 ................. 98
hydroco/apap tab 5-325mg ............... 98
hydroco/apap tab 7.5-325 ................. 98
hydrocod/hom syp 5-1.5/5 ................ 43
207
hydrocod/ibu tab 2.5-200 ..................98
hydrocod/ibu tab 7.5-200 ..................98
hydrocort ac sup 25mg .................... 151
hydrocort ac sup 30mg .................... 151
hydrocort cre 2.5% ...........................68
hydrocort cre iodoquin .......................30
hydrocort lot 2.5% ............................68
hydrocort oin 2.5% ...........................68
hydrocort tab 10mg ..........................90
hydrocort tab 20mg ..........................90
hydrocort tab 5mg ............................90
hydrocort/ cre iodoquin .....................30
hydrocort/ kit pramoxin ................... 151
hydrogen per sol 30% .......................43
hydromorphon liq 1mg/ml................ 130
HYDROMORPHON SUP 3MG .............. 130
hydromorphon tab 12mg er ............. 131
hydromorphon tab 2mg ................... 130
hydromorphon tab 8mg er ............... 131
hydroxychlor tab 200mg ....................32
hydroxyurea cap 500mg ....................36
hydroxyz hcl syp 10mg/5ml ...............21
hydroxyz hcl tab 10mg ......................21
hydroxyz pam cap 100mg ..................21
hydroxyz pam cap 25mg ....................21
hydroxyz pam cap 50mg ....................21
hygel gel 0.2% .................................82
HYLATOPIC AER .............................. 111
HYLIRA GEL 0.2% .............................82
HYLIRA LOT 0.1% .............................82
hyophen tab ................................... 176
hyoscyamine dro 0.125/ml .................45
hyoscyamine elx 0.125/5 ...................45
hyoscyamine sub 0.125mg .................45
hyoscyamine tab 0.125mg .................45
hyoscyamine tab 0.375 er ..................45
HYPERSAL NEB 3.5% ...................... 111
HYPER-SAL NEB 7% ........................ 111
HYPERTENEVID PAK 12.5MG ..............10
HYPERTENIPIN PAK 2.5MG .................56
HYPERTENSOLO PAK......................... 50
HYPO NEEDLE MIS 14GX1" .............. 115
HYPO NEEDLE MIS 14GX1.5" ........... 115
HYPO NEEDLE MIS 16GX3/4" ........... 115
HYPO NEEDLE MIS 21GX1.25 ........... 115
HYSINGLA ER TAB 100 MG .............. 131
HYSINGLA ER TAB 120 MG .............. 131
HYSINGLA ER TAB 20 MG ................ 131
208
HYSINGLA ER TAB 30 MG................. 131
HYZAAR TAB 100-12.5 ......................16
HYZAAR TAB 100-25 .........................16
HYZAAR TAB 50-12.5 ........................16
I
ibandronate tab 150mg .....................54
IBRANCE CAP 100MG ........................70
IBRANCE CAP 125MG ........................70
IBRANCE CAP 75MG ..........................70
IBU/MINREX PAK ............................ 126
ibudone tab 10-200mg ......................98
ibudone tab 5-200mg ........................98
ibuprofen dro 50/1.25 ..................... 124
ibuprofen jr chw 100mg ................... 124
ibuprofen sus 100/5ml..................... 124
ibuprofen tab 400mg ....................... 124
ibuprofen tab 600mg ....................... 124
ibuprofen tab 800mg ....................... 124
IC 400 KIT 400MG .......................... 123
IC 800 KIT 800MG .......................... 123
ICLUSIG TAB 15MG ...........................35
ICLUSIG TAB 45MG ...........................35
ILEVRO DRO 0.3% OP ..................... 128
ilotycin oin op ................................. 126
IMBRUVICA CAP 140MG .....................35
imipram hcl tab 10mg ..................... 174
imipram pam cap 100mg ................. 174
imipram pam cap 75mg ................... 174
imiquimod cre 5% ........................... 101
IMITREX INJ 4MG/0.5 ...................... 154
IMITREX INJ 6MG/0.5 ...................... 154
IMITREX SPR 20MG/ACT .................. 154
IMITREX SPR 5MG/ACT .................... 154
IMITREX TAB 100MG ....................... 155
IMITREX TAB 25MG ......................... 154
IMITREX TAB 50MG ......................... 154
IMURAN TAB 50MG ......................... 149
IN TOUCH TES BLOOD .......................74
INCRELEX INJ 40MG/4ML ................. 103
INCRUSE ELPT INH 62.5MCG ............. 55
indapamide tab 1.25mg .................. 167
indapamide tab 2.5mg .................... 167
INDERAL LA CAP 120MG ................... 51
INDERAL LA CAP 160MG ................... 51
INDERAL LA CAP 60MG ..................... 51
INDERAL LA CAP 80MG ..................... 51
INDOCIN SUP 50MG ....................... 124
INDOCIN SUS 25MG/5ML ................ 124
indomethacin cap 25mg .................. 124
indomethacin cap 50mg .................. 124
indomethacin cap 75mg er .............. 124
INFANATE CAP BALANCE ................. 145
INFINITY TES BLD GLUC ................... 74
INLYTA TAB 1MG .............................. 35
INLYTA TAB 5MG .............................. 35
INNOPRAN XL CAP 120MG ................. 51
INNOPRAN XL CAP 80MG .................. 51
INOVA 4/1 KIT ACNE CON ................... 5
INOVA 8/2 KIT ACNE CON ................... 5
INOVA KIT 4% ................................... 5
INOVA KIT 8% ................................... 5
INSPIREASE MIS DD SYST .............. 160
INSPIREASE MIS MOUTHPCE ........... 160
INSPIREASE MIS RES BAG .............. 160
INSPRA TAB 25MG ......................... 153
INSPRA TAB 50MG ......................... 153
INSULIN PEN MIS 31GX4MM ............ 116
INSULIN SYRG MIS 0.3/28G ............ 116
INSULIN SYRG MIS 1ML .................. 116
INSULIN SYRG MIS 1ML/25G ........... 116
INSULIN SYRG MIS 2/27.5G ............ 116
209
INSULIN SYRG MIS 2ML/29G............ 116
INSUPEN MIS 33GX4MM .................. 116
INSUPEN SENS MIS 32GX8MM ......... 116
INTELENCE TAB 100MG .....................40
INTELENCE TAB 200MG .....................40
INTELENCE TAB 25MG .......................40
INTERMEZZO SUB 1.75MG ............... 121
INTERMEZZO SUB 3.5MG ................. 121
INTRON A INJ 10MU ..........................36
INTRON A INJ 18MU ..........................36
INTRON A INJ 25MU ..........................36
INTRON A INJ 50MU ..........................36
INTUNIV TAB 1MG ............................. 8
INTUNIV TAB 2MG ............................. 8
INTUNIV TAB 3MG ............................. 8
INTUNIV TAB 4MG ............................. 8
INVEGA TAB 1.5MG ...........................46
INVEGA TAB 3MG .............................46
INVEGA TAB 6MG .............................46
INVEGA TAB 9MG .............................46
INVIRASE CAP 200MG .......................40
INVIRASE TAB 500MG .......................40
INVOKAMET TAB 150-1000 .............. 159
INVOKAMET TAB 150-500 ................ 159
INVOKAMET TAB 50-1000 ................ 159
INVOKAMET TAB 50-500MG ............. 159
INVOKANA TAB 100MG .................... 159
INVOKANA TAB 300MG .................... 159
IONSYS PAD 40MCG/AC................... 131
IOPIDINE SOL 0.5% OP ................... 128
IOPIDINE SOL 1% OP ...................... 128
ipratropium sol 0.02%inh ..................55
ipratropium spr 0.03% .................... 114
ipratropium spr 0.06% .................... 114
ipratropium/ sol albuter ...................... 8
irbesar/hctz tab 150-12.5 ..................16
irbesar/hctz tab 300-12.5 ..................16
irbesartan tab 150mg ........................17
irbesartan tab 300mg ........................17
irbesartan tab 75mg ..........................17
IRENKA CAP 40MG .......................... 158
IRESSA TAB 250MG ..........................35
ISENTRESS CHW 100MG....................39
ISENTRESS CHW 25MG .....................39
ISENTRESS POW 100MG ....................39
ISENTRESS TAB 400MG .....................39
ISO CARBACHO SOL 1.5% OP.......... 110
ISO CARBACHO SOL 3% OP ............ 110
ISO HOMATROP SOL 2% OP .............. 70
ISO HOMATROP SOL 5% OP .............. 70
ISO HYOSCINE SOL 0.25% OP ........... 70
isometh/caff tab /apap .................... 110
isoniazid syp 50mg/5ml .................... 33
isoniazid tab 100mg ......................... 33
isoniazid tab 300mg ......................... 33
ISOPTO CARP SOL 1% OP ............... 110
ISORDIL TAB 40MG ........................ 119
ISORDIL TAB 5MG .......................... 119
isosorb din tab 10mg ...................... 119
isosorb din tab 40mg er .................. 119
isosorb din tab 5mg ........................ 119
isosorb mono tab 10mg .................. 119
isosorb mono tab 120mg er ............. 120
isosorb mono tab 20mg .................. 120
isosorb mono tab 30mg er............... 120
isosorb mono tab 60mg er............... 120
isoxsuprine tab 10mg ..................... 138
isoxsuprine tab hcl 20mg ................ 138
isradipine cap 2.5mg ........................ 57
isradipine cap 5mg ........................... 57
ISTALOL SOL 0.5% OP ...................... 52
itraconazole cap 100mg .................. 173
ivermectin tab 3mg .......................... 18
J
JADENU TAB 180MG ......................... 28
JADENU TAB 360MG ......................... 28
JADENU TAB 90MG ........................... 28
JAKAFI TAB 10MG .......................... 104
JAKAFI TAB 15MG .......................... 104
JAKAFI TAB 20MG .......................... 104
JAKAFI TAB 25MG .......................... 104
JAKAFI TAB 5MG ............................ 104
JALYN CAP..................................... 147
JANUMET TAB 50-1000 ..................... 79
JANUMET TAB 50-500MG .................. 79
JANUMET XR TAB 100-1000............... 79
JANUMET XR TAB 50-1000 ................ 79
JANUMET XR TAB 50-500MG.............. 79
210
JANUVIA TAB 100MG .........................79
JANUVIA TAB 25MG ..........................79
JANUVIA TAB 50MG ..........................79
JARDIANCE TAB 10MG ..................... 159
JARDIANCE TAB 25MG ..................... 159
JENTADUETO TAB 2.5-1000 ...............79
JENTADUETO TAB 2.5-500 .................79
JENTADUETO TAB 2.5-850 .................79
jinteli tab 1mg-5mcg .........................83
JNT/TUNNEL/ KIT TRIGGER .............. 161
J-TIP KIT KIT ADAPTERS .................. 116
JUBLIA SOL 10% ............................ 100
junel 1.5/30 tab................................65
junel fe 24 tab 1/20 ..........................65
junel fe tab 1.5/30 ............................65
JUXTAPID CAP 10MG ....................... 110
JUXTAPID CAP 20MG ....................... 110
JUXTAPID CAP 30MG ....................... 110
JUXTAPID CAP 40MG ....................... 110
JUXTAPID CAP 5MG ......................... 110
JUXTAPID CAP 60MG ....................... 110
K
k citrate sol citr acd...........................63
K10-LIDO KIT ................................. 161
KADIAN CAP 100MG ER ................... 131
KADIAN CAP 10MG ER ..................... 131
KADIAN CAP 200MG ER ................... 131
KADIAN CAP 20MG ER ..................... 131
KADIAN CAP 30MG ER ..................... 131
KADIAN CAP 40MG ER ..................... 131
KADIAN CAP 50MG ER ..................... 131
KADIAN CAP 60MG ER ..................... 131
KADIAN CAP 80MG ER ..................... 131
KALBITOR INJ 10MG/ML .................. 141
KALETRA SOL ...................................39
KALETRA TAB 100-25MG ...................39
KALETRA TAB 200-50MG ...................39
KALYDECO PAK 50MG ........................62
KALYDECO PAK 75MG ........................62
KALYDECO TAB 150MG ......................62
KAPVAY TAB 0.1 MG ........................... 8
KARBINAL ER SUS 4MG/5ML ..............30
karidium dro 0.125mg .......................87
KAZANO 12.5- TAB 1000MG ...............79
KAZANO 12.5- TAB 500MG ................79
k-effervesce tab 25meq ef ............... 141
KEFLEX CAP 250MG .......................... 61
KEFLEX CAP 500MG .......................... 61
KEFLEX CAP 750MG .......................... 61
kelnor tab 1/35 ................................ 65
KENALOG AER SPRAY ....................... 68
KENGREAL SOL 50MG ....................... 80
KEPPRA SOL 100MG/ML .................... 24
KEPPRA TAB 1000MG ........................ 24
KEPPRA TAB 250MG ......................... 24
KEPPRA TAB 500MG ......................... 24
KEPPRA TAB 750MG ......................... 24
KEPPRA XR TAB 500MG ..................... 24
KEPPRA XR TAB 750MG ..................... 24
KERAFOAM 42 AER 42% ................... 81
KERAFOAM AER 30% ........................ 81
KERALAC CRE 47%........................... 81
KERALYT GEL 6% ........................... 104
KERALYT KIT SCALP 6% .................. 104
KERLONE TAB 10MG ......................... 50
KERLONE TAB 20MG ......................... 50
KERR TRIPLE MIS DYE SWAB ............. 43
KERYDIN SOL 5% .......................... 137
KETEK TAB 300MG ......................... 105
KETEK TAB 400MG ......................... 105
ketoconazole cre 2% ...................... 100
ketoconazole sha 2% ...................... 100
ketoconazole tab 200mg ................. 100
ketodan aer 2% ............................. 100
KETODAN KIT 2% .......................... 100
KETO-DIASTIX TES ........................ 113
ketoprofen cap 200mg er ................ 124
ketoprofen cap 50mg ...................... 124
ketoprofen cap 75mg ...................... 124
ketorolac sol 0.4% ......................... 128
ketorolac sol 0.5% ......................... 128
ketorolac tab 10mg ........................ 124
KEVEYIS TAB 50MG .......................... 59
KHEDEZLA TAB 100MG ER ............... 158
KHEDEZLA TAB 50MG ER ................ 158
KINERET INJ .................................. 103
kionex pow .................................... 142
KITABIS PAK NEB 300/5ML ............... 11
KLARON LOT 10% .............................. 5
KLATSKIN BIO MIS 16X4" ............... 116
KLONOPIN TAB 0.5MG ...................... 23
KLONOPIN TAB 1MG ......................... 23
211
KLONOPIN TAB 2MG ..........................23
KLOR-CON M15 TAB 15MEQ ER ........ 141
klor-con pow 20meq........................ 141
KLOR-CON/25 POW 25MEQ .............. 141
KOMBIGLYZE TAB 2.5-1000 ...............79
KOMBIGLYZE TAB 5-1000MG..............79
KOMBIGLYZE TAB 5-500MG ...............79
KORLYM TAB 300MG ....................... 146
K-PHOS TAB ................................... 139
K-PHOS TAB NEUTRAL ..................... 140
K-PHOS TAB NO 2 ........................... 140
KRISGEL 100 GEL ........................... 157
KRISTALOSE PAK 10GM ................... 105
KRISTALOSE PAK 20GM ................... 105
KROGER BLOOD TES GLUCOSE...........74
KROGER TES ....................................74
K-TAB TAB 10MEQ CR ..................... 141
K-TAB TAB 20MEQ .......................... 141
K-TAB TAB 8MEQ CR ....................... 141
KUVAN POW 100MG ........................ 139
KUVAN POW 500MG ........................ 139
KUVAN TAB 100MG ......................... 139
KYNAMRO INJ 200MG/ML ...................31
L
labetalol tab 100mg ..........................10
labetalol tab 200mg ..........................10
labetalol tab 300mg ..........................10
LACRISERT MIS 5MG OP ....................44
lactic acid lot 10% ............................82
lactulose sol 10gm/15 ..................... 105
LAMICTAL CHW 25MG .......................24
LAMICTAL CHW 2MG .........................24
LAMICTAL CHW 5MG .........................24
LAMICTAL KIT START 35 ....................24
LAMICTAL ODT KIT ...........................24
LAMICTAL ODT TAB 100MG ................24
LAMICTAL ODT TAB 200MG ................24
LAMICTAL ODT TAB 25MG ..................24
LAMICTAL ODT TAB 50MG ..................24
LAMICTAL TAB 100MG .......................24
LAMICTAL TAB 150MG .......................24
LAMICTAL TAB 200MG .......................24
LAMICTAL TAB 25MG .........................24
LAMICTAL XR KIT..............................24
LAMICTAL XR TAB 100MG ................. 24
LAMICTAL XR TAB 25MG ................... 24
LAMICTAL XR TAB 50MG ................... 24
LAMISIL GRA 125MG ........................ 29
LAMISIL GRA 187.5MG ..................... 29
LAMISIL TAB 250MG ......................... 29
lamivud/zido tab 150-300 ................. 39
lamivudine sol 10mg/ml .................... 41
lamivudine tab 100mg ...................... 94
lamotrigine chw 25mg ...................... 24
lamotrigine chw 5mg ........................ 24
lamotrigine tab 100mg ...................... 25
lamotrigine tab 100mg er .................. 25
lamotrigine tab 25mg ....................... 24
lamotrigine tab 25mg er.................... 24
lamotrigine tab 25mg odt .................. 24
lamotrigine tab 50mg er.................... 25
lamotrigine tab 50mg odt .................. 25
LANOLIN OIL ................................. 157
LANOXIN TAB 0.0625MG ................... 59
LANOXIN TAB 0.125MG ..................... 59
LANOXIN TAB 0.1875MG ................... 59
LANOXIN TAB 0.25MG ...................... 59
lansopr/amox mis /clarith................ 175
lansoprazole cap 30mg dr ............... 148
LANTUS INJ 100/ML ......................... 97
LANTUS INJ SOLOSTAR ..................... 97
LASIX TAB 20MG............................ 107
LASIX TAB 40MG............................ 107
LASIX TAB 80MG............................ 107
LASTACAFT SOL 0.25%................... 126
latanoprost sol 0.005% ................... 147
LATRIX XM EMU 45%........................ 81
LATUDA TAB 120MG ......................... 39
LATUDA TAB 20MG ........................... 38
LATUDA TAB 40MG ........................... 38
212
LATUDA TAB 60MG ...........................38
LATUDA TAB 80MG ...........................38
LAZANDA SPR 100MCG .................... 131
LAZANDA SPR 400MCG .................... 131
LDO PLUS GEL 4% .......................... 107
leflunomide tab 10mg...................... 149
leflunomide tab 20mg...................... 149
LENVIMA CAP 10MG ..........................35
LENVIMA CAP 14MG ..........................35
LENVIMA CAP 20MG ..........................35
LENVIMA CAP 24MG ..........................35
LESCOL XL TAB 80MG .......................96
LETAIRIS TAB 10MG ........................ 149
LETAIRIS TAB 5MG ......................... 149
letrozole tab 2.5mg ...........................44
leucovor ca tab 10mg ........................88
leucovor ca tab 5mg ..........................88
LEUKERAN TAB 2MG........................ 120
LEUKINE INJ 250MCG ........................92
leuprolide inj 1mg/0.2 ..................... 106
LEVACET TAB ...................................13
levalbuterol neb 0.31mg ....................49
levalbuterol neb 1.25/0.5 ...................49
LEVAQUIN TAB 250MG ......................88
LEVAQUIN TAB 500MG ......................88
LEVAQUIN TAB 750MG ......................88
LEVATIO PAD 0.3-5% ...................... 171
LEVATOL TAB 20MG ..........................51
LEVBID TAB 0.375 ER........................45
LEVEMIR INJ ....................................97
LEVEMIR INJ FLEXTOUC .....................97
levetiraceta sol 100mg/ml ..................25
levetiraceta tab 1000mg ....................25
levetiraceta tab 250mg ......................25
levetiraceta tab 500mg er ..................25
levetiraceta tab 750mg er ..................25
LEVITRA TAB 10MG ......................... 153
LEVITRA TAB 2.5MG ........................ 153
LEVITRA TAB 20MG ......................... 153
LEVITRA TAB 5MG........................... 153
levobunolol sol 0.25% op .................. 52
levobunolol sol 0.5% op .................... 52
levocarnitin sol 1gm/10ml ................. 59
levocarnitin tab 330mg ..................... 59
levocetirizi sol 2.5/5ml ...................... 31
levocetirizi tab 5mg .......................... 31
levofloxacin sol 0.5% ...................... 126
levofloxacin sol 25mg/ml................... 88
levofloxacin tab 250mg ..................... 88
LEVOLEUCOVOR SOL 250MG/25 ........ 88
LEVOMEFOLATE CAP DHA ................ 145
levonor/ethi tab 0.1-0.02 .................. 65
levonor/ethi tab estradio .............. 65, 85
levonorgestr tab 1.5mg ..................... 81
levorphanol tab 2mg....................... 131
levothyroxin tab 100mcg ................. 170
levothyroxin tab 25mcg .................. 170
LEVSIN TAB 0.125MG ....................... 45
LEVSIN/SL SUB 0.125MG .................. 45
LEVULAN KERA SOL 20% ................ 140
LEXAPRO SOL 5MG/5ML .................. 156
LEXAPRO TAB 10MG ....................... 156
LEXAPRO TAB 20MG ....................... 156
LEXAPRO TAB 5MG ......................... 156
LEXIVA SUS 50MG/ML ...................... 40
LEXIVA TAB 700MG .......................... 40
LIALDA TAB 1.2GM ......................... 102
LIBERTY NEXT TES GEN .................... 75
LIBERTY TES ................................... 75
LIBRAX CAP 5-2.5MG ........................ 22
lido/prilocn cre 2.5-2.5% ................ 171
lido/prilocn kit 2.5-2.5% ................. 171
lidocaine cre tetracai ...................... 171
lidocaine oin 5% ............................ 107
213
lidocaine pad 5% ............................ 107
lidocaine sol 2% visc .........................15
lidocaine sol 4% ....................... 15, 107
lidocaine/hc cre 3%-0.5% ................ 151
lidocaine/hc kit 2-2% ...................... 151
lidocaine/hc kit 3%-0.5% ................ 151
lidocaine/hc kit 3%-1% ................... 151
lidocaine/hc kit 3-2.5% ................... 151
LIDODERM DIS 5% ......................... 107
LIDO-HYDRO GEL 2.8-0.55 .............. 151
LIDOTHOL PAD 4.5-5% ................... 171
LIDOVEX CRE 3.75% ....................... 107
LIDOVIN CRE 3.95% ....................... 107
LIDOZOL CRE 3.75% ....................... 107
lindane lot 1% ................................ 153
lindane sha 1%............................... 153
linezolid tab 600mg ......................... 137
LINSEED OIL RAW ............................86
LINZESS CAP 145MCG .......................99
LINZESS CAP 290MCG .......................99
liothyronine tab 25mcg .................... 170
liothyronine tab 50mcg .................... 170
liothyronine tab 5mcg ...................... 170
LIPITOR TAB 10MG ...........................96
LIPITOR TAB 20MG ...........................96
LIPITOR TAB 40MG ...........................96
LIPITOR TAB 80MG ...........................96
LIPOFEN CAP 150MG .........................86
LIPOFEN CAP 50MG ...........................86
lisinop/hctz tab 10-12.5 ...................... 4
lisinop/hctz tab 20-12.5 ...................... 4
lisinop/hctz tab 20-25mg .................... 4
lisinopril tab 10mg ............................. 3
lisinopril tab 2.5mg ............................ 3
lisinopril tab 5mg ............................... 3
lithium carb cap 150mg .....................32
lithium carb tab 300mg .....................32
lithium carb tab 300mg er ..................32
lithium carb tab 450mg er ..................32
LITHIUM SOL 8MEQ/5ML....................32
LITHOBID TAB 300MG CR ..................32
LITHOSTAT TAB 250MG .................. 178
LIVALO TAB 1MG.............................. 96
LIVALO TAB 2MG.............................. 96
LIVALO TAB 4MG.............................. 96
LO LOESTRIN TAB ............................ 53
LOCOID CRE 0.1% ........................... 68
LOCOID LIPO CRE 0.1% .................... 68
LOCOID LOT 0.1% ........................... 68
LOCOID OIN 0.1% ........................... 68
LOCOID SOL 0.1% ........................... 68
LODOSYN TAB 25MG ........................ 71
LOESTRIN 21 TAB 1.5/30 .................. 65
LOESTRIN FE TAB 1.5/30 .................. 65
LOESTRIN FE TAB 1/20 ..................... 65
LOESTRIN TAB 1/20-21 .................... 65
LOFIBRA CAP 134MG ........................ 86
LOFIBRA CAP 200MG ........................ 86
LOFIBRA CAP 67MG .......................... 86
LOFIBRA TAB 160MG ........................ 86
LOFIBRA TAB 54MG .......................... 86
LOMOTIL TAB 2.5MG ........................ 37
lomustine cap 100mg ..................... 120
lomustine cap 10mg ....................... 120
lomustine cap 40mg ....................... 120
LONSURF TAB 15-6.14 ...................... 36
LONSURF TAB 20-8.19 ...................... 36
LOPID TAB 600MG............................ 86
LOPRESS HCT TAB 100-25MG ............ 50
LOPRESS HCT TAB 50-25MG.............. 50
LOPRESSOR TAB 100MG ................... 50
LOPRESSOR TAB 50MG ..................... 50
LOPROX SHA 1% ............................. 29
lorazepam con 2mg/ml ..................... 48
lorazepam tab 0.5mg........................ 48
lorazepam tab 1mg .......................... 48
lorazepam tab 2mg .......................... 48
LORTAB ELX 10-300MG..................... 98
LORZONE TAB 375MG ....................... 60
LORZONE TAB 750MG ....................... 60
losartan pot tab 100mg..................... 17
losartan pot tab 25mg ...................... 17
losartan pot tab 50mg ...................... 17
losartan/hct tab 100-12.5 ................. 16
losartan/hct tab 100-25 .................... 16
losartan/hct tab 50-12.5 ................... 16
LOTEMAX GEL 0.5% ....................... 129
214
LOTEMAX OIN 0.5% ........................ 129
LOTEMAX SUS 0.5%........................ 129
LOTENSIN HCT TAB 10-12.5 ............... 4
LOTENSIN HCT TAB 20-12.5 ............... 4
LOTENSIN HCT TAB 20-25MG .............. 4
LOTENSIN TAB 10MG ......................... 3
LOTENSIN TAB 20MG ......................... 3
LOTENSIN TAB 40MG ......................... 3
LOTREL CAP 10-20MG ........................ 2
LOTREL CAP 10-40MG ........................ 2
LOTREL CAP 2.5-10MG ....................... 2
LOTREL CAP 5-10MG .......................... 2
LOTREL CAP 5-20MG .......................... 2
LOTRISONE CRE ...............................30
LOTRONEX TAB 0.5MG .................... 100
LOTRONEX TAB 1MG ....................... 100
lovastatin tab 10mg ..........................96
LOVAZA CAP 1GM .............................31
LOVENOX INJ 100MG/ML ................. 108
LOVENOX INJ 120/0.8 ..................... 108
LOVENOX INJ 150MG/ML ................. 108
LOVENOX INJ 30/0.3ML ................... 108
LOVENOX INJ 300/3ML .................... 108
LOVENOX INJ 40/0.4ML ................... 108
LOVENOX INJ 60/0.6ML ................... 108
LOVENOX INJ 80/0.8ML ................... 108
loxapine cap 10mg ............................78
loxapine cap 25mg ............................78
loxapine cap 50mg ............................78
loxapine cap 5mg..............................78
LOZI-FLUR LOZ 1MG F.......................87
LTA 360 KIT SOL 4% .........................15
LUER-LOK SYR MIS 1ML/20G............ 117
LUFYLLIN TAB 400MG ...................... 180
LUGOLS SOL STRONG ..................... 103
LUMIGAN SOL 0.01% ...................... 147
LUNESTA TAB 1MG.......................... 121
LUNESTA TAB 2MG.......................... 121
LUNESTA TAB 3MG.......................... 121
LURIDE CHW 0.25MG F......................87
LURIDE CHW 0.5MG F .......................87
LURIDE CHW 1MG F ..........................87
LURIDE DRO 0.5MG/ML .....................87
LUXIQ AER 0.12%.............................68
LUZU CRE 1% ................................ 100
LYNPARZA CAP 50MG ..................... 141
LYRICA CAP 100MG .......................... 25
LYRICA CAP 150MG .......................... 25
LYRICA CAP 200MG .......................... 25
LYRICA CAP 225MG .......................... 25
LYRICA CAP 25MG ............................ 25
LYRICA CAP 300MG .......................... 25
LYRICA CAP 50MG ............................ 25
LYRICA CAP 75MG ............................ 25
LYRICA SOL 20MG/ML ....................... 25
LYSODREN TAB 500MG ..................... 19
LYSTEDA TAB 650MG ........................ 94
LYTENSOPRIL PAK KIT ........................ 2
M
MACADAMIA OIL NUT OIL ................. 86
MACROBID CAP 100MG ................... 176
MACRODANTIN CAP 100MG ............. 176
MACRODANTIN CAP 25MG ............... 176
MACRODANTIN CAP 50MG ............... 176
MALARONE TAB 250-100................... 32
MALARONE TAB 62.5-25 ................... 32
malathion lot 0.5% ......................... 153
maprotiline tab 25mg ....................... 27
margesic cap ................................... 14
MARINOL CAP 10MG ......................... 28
MARINOL CAP 2.5MG ........................ 28
MARINOL CAP 5MG ........................... 28
MARNATAL-F CAP ........................... 143
MARPLAN TAB 10MG ....................... 111
MATULANE CAP 50MG ....................... 36
matzim la tab 180mg/24 ................... 57
matzim la tab 240mg/24 ................... 57
matzim la tab 300mg/24 ................... 57
matzim la tab 360mg/24 ................... 57
matzim la tab 420mg/24 ................... 57
MAVIK TAB 1MG................................. 3
MAVIK TAB 2MG................................. 3
MAVIK TAB 4MG................................. 3
MAXALT TAB 10MG ......................... 155
MAXALT TAB 5MG .......................... 155
MAXALT-MLT TAB 10MG .................. 155
MAXALT-MLT TAB 5MG .................... 155
MAXIDEX SUS 0.1% OP .................. 129
215
MAXIMA BLOOD TES GLUCOSE ...........75
MAXITROL OIN 0.1% OP .................. 128
MAXITROL SUS 0.1% OP ................. 128
MAXZIDE TAB 75-50 .........................80
MAXZIDE-25 TAB ..............................80
meclofen sod cap 100mg ................. 124
meclofen sod cap 50mg ................... 124
MEDROL PAK 4MG.............................90
MEDROL TAB 16MG ...........................90
MEDROL TAB 2MG.............................90
MEDROL TAB 32MG ...........................90
MEDROL TAB 4MG.............................90
MEDROL TAB 8MG.............................90
medroxypr ac inj 150mg/ml ............. 146
medroxypr ac tab 10mg................... 146
medroxypr ac tab 2.5mg.................. 146
medroxypr ac tab 5mg .................... 146
mefenam acid cap 250mg ................ 124
mefloquine tab 250mg.......................32
MEGACE ES SUS 625/5ML ................ 146
MEGACE ORAL SUS 40MG/ML ........... 146
megestrol ac sus 40mg/ml ............... 146
megestrol ac tab 20mg .................... 146
megestrol ac tab 40mg .................... 146
megestrol sus 625mg/5m ................ 146
MEIJER BLOOD TES GLUCOSE ............75
MEIJER TES TRUETEST ......................75
MEIJER TES TRUETRAC ......................75
MEKINIST TAB 0.5MG ........................34
MEKINIST TAB 2MG ..........................34
meloxicam sus 7.5/5ml.................... 124
meloxicam tab 15mg ....................... 124
meloxicam tab 7.5mg ...................... 124
memant titra pak 5-10mg ................ 113
memantine hc sol 2mg/ml ............... 113
memantine tab hcl 10mg ................. 113
memantine tab hcl 5mg ................... 113
MENEST TAB 0.3MG ..........................84
MENEST TAB 0.625MG .......................84
MENEST TAB 1.25MG ........................85
MENEST TAB 2.5MG ..........................85
MENOPUR INJ 75UNIT ..................... 136
MENOSTAR DIS 14MCG .....................85
MEPER/PROMET CAP 50-25MG.......... 109
meperidine sol 50mg/5ml ................ 131
meperidine tab 100mg .................... 131
meperidine tab 50mg...................... 131
MEPHYTON TAB 5MG ...................... 180
meprobamate tab 200mg .................. 21
meprobamate tab 400mg .................. 21
MEPRON SUS ................................... 37
mercaptopur tab 50mg ..................... 33
mesalamine ene 4gm...................... 102
mesalamine kit 4gm ....................... 102
MESNEX TAB 400MG....................... 178
MESTINON SYP 60MG/5ML ................ 33
MESTINON TAB 60MG ....................... 33
MESTINON TAB TIMESPAN ................ 33
METADATE CD CAP 10MG ................ 163
metaproteren syp 10mg/5ml ............. 49
metaproteren tab 10mg .................... 49
metaproteren tab 20mg .................... 49
metaxalone tab 400mg ..................... 60
metaxalone tab 800mg ..................... 60
metformin er tab 1000mg ................. 53
metformin tab 1000mg ..................... 53
metformin tab 500mg ....................... 53
metformin tab 500mg er ................... 53
metformin tab 750mg er ................... 53
metformin tab 850mg ....................... 53
methadone con 10mg/ml ................ 131
methadone sol 10mg/5ml ............... 131
methadone sol 5mg/5ml ................. 131
methadone tab 10mg ..................... 131
methadone tab 40mg ..................... 131
methadone tab 5mg ....................... 131
METHADOSE CON 10MG/ML ............ 131
methamphetam tab 5mg ................... 13
methazolamid tab 25mg ................... 59
methazolamid tab 50mg ................... 59
methenam hip tab 1gm ................... 176
methenam man tab 1gm ................. 176
methenam man tab 500mg ............. 176
methimazole tab 10mg ..................... 43
methimazole tab 5mg ....................... 43
METHITEST TAB 10MG ...................... 14
methlphenida chw 2.5mg ................ 163
216
methocarbam tab 500mg ...................60
methocarbam tab 750mg ...................60
methotrexate inj 25mg/ml .................33
methotrexate tab 2.5mg ....................33
methoxsalen cap 10mg ......................38
methscopolam tab 2.5mg ................ 150
methscopolam tab 5mg ................... 150
methyclothia tab 5mg...................... 167
methyld/hctz tab 250/15 .................... 9
methyld/hctz tab 250/25 .................... 9
methyldopa tab 250mg ......................20
methyldopa tab 500mg ......................20
methylergon tab 0.2mg ................... 137
METHYLIN CHW 10MG ..................... 163
METHYLIN CHW 2.5MG .................... 163
METHYLIN CHW 5MG ....................... 163
METHYLIN SOL 10MG/5ML ............... 163
METHYLIN SOL 5MG/5ML ................. 163
methylphenid cap 10mg .................. 163
methylphenid cap 20mg er ............... 163
methylphenid chw 10mg .................. 163
methylphenid chw 5mg.................... 163
methylphenid sol 10mg/5ml ............. 163
methylphenid sol 5mg/5ml ............... 163
methylphenid tab 10mg ................... 163
methylphenid tab 10mg er ............... 163
methylphenid tab 20mg ................... 163
methylphenid tab 5mg..................... 163
methylpred pak 4mg .........................90
methylpred tab 16mg ........................90
methylpred tab 32mg ........................90
methylpred tab 4mg ..........................90
methylpred tab 8mg ..........................90
methyltestos cap 10mg .....................14
metipranolol sol 0.3% oph................. 52
metoclopram sol 5mg/5ml ................. 89
metoclopram tab 10mg ..................... 89
metoclopram tab 5mg....................... 89
metoclopram tab 5mg odt ................. 89
metolazone tab 10mg ..................... 167
metolazone tab 2.5mg .................... 167
metolazone tab 5mg ....................... 167
metoprl/hctz tab 100-25mg ............... 50
metoprl/hctz tab 100-50mg ............... 50
metoprl/hctz tab 50-25mg ................ 50
metoprol tar tab 100mg .................... 50
metoprol tar tab 25mg ...................... 50
metoprol tar tab 50mg ...................... 50
metoprolol tab 100mg er ................... 50
metoprolol tab 200mg er ................... 50
metoprolol tab 25mg er .................... 50
metoprolol tab 50mg er .................... 50
METOZOLV ODT TAB 5MG ................. 89
METROCREAM CRE 0.75% ............... 152
METROGEL GEL 1% ........................ 152
METROGEL-VAG GEL 0.75% ............ 178
METROLOTION LOT 0.75% .............. 152
metronidazol cap 375mg ................... 18
metronidazol cre 0.75% .................. 152
metronidazol gel 0.75% .................. 152
metronidazol gel 1% ...................... 152
metronidazol lot 0.75%................... 152
metronidazol tab 250mg ................... 18
metronidazol tab 500mg ................... 18
METVIXIA CRE 16.8% ..................... 140
MEVACOR TAB 40MG ........................ 97
mexiletine cap 150mg....................... 21
MIACALCIN INJ 200/ML ..................... 55
MIACALCIN SPR 200/ACT .................. 55
MICARDIS HCT TAB 40/12.5 .............. 16
MICARDIS HCT TAB 80/12.5 .............. 16
MICARDIS HCT TAB 80-25MG ............ 16
MICARDIS TAB 20MG........................ 17
MICARDIS TAB 40MG........................ 17
MICARDIS TAB 80MG........................ 17
miconazole 3 sup 200mg................. 100
MICONAZOLE POW ......................... 100
MICRO-BUMIN KIT ........................... 75
217
MICRODOT TES ................................75
MICRO-K CAP 10MEQ CR ................. 141
MICRO-K CAP 8MEQ CR ................... 141
MICROZIDE CAP 12.5MG ................. 168
midodrine tab 10mg ........................ 180
midodrine tab 2.5mg ....................... 180
midodrine tab 5mg .......................... 180
MIFEPREX TAB 200MG ........................ 1
migergot sup 2/100 ..........................82
migragesic cap ida .......................... 110
MIGRANAL SPR 4MG/ML .................. 110
MILLIPRED DP PAK 5MG ....................90
MILLIPRED SOL 10MG/5ML ................90
MILLIPRED TAB 5MG .........................90
mimvey lo tab 0.5-0.1 .......................83
mimvey tab 1-0.5mg .........................83
MINASTRIN 24 CHW FE .....................65
MINIPRESS CAP 1MG.........................20
MINIPRESS CAP 2MG.........................20
MINIPRESS CAP 5MG.........................20
MINIVELLE DIS 0.0375MG .................85
MINOCIN CAP 100MG ...................... 167
MINOCIN CAP 50MG ........................ 167
MINOCIN CAP 75MG ........................ 167
minocycline cap 100mg ................... 167
minocycline cap 50mg ..................... 167
minocycline cap 75mg ..................... 167
minocycline tab 100mg .................... 167
minocycline tab 135mg er ................ 167
minocycline tab 45mg er .................. 167
minocycline tab 50mg ..................... 167
minocycline tab 75mg ..................... 167
minocycline tab 90mg er .................. 167
minoxidil tab 10mg ......................... 179
minoxidil tab 2.5mg ........................ 179
MIRAPEX ER TAB 0.375MG ............... 121
MIRAPEX ER TAB 0.75MG................. 121
MIRAPEX ER TAB 1.5MG .................. 121
MIRAPEX ER TAB 2.25MG................. 121
MIRAPEX ER TAB 3.75MG................. 121
MIRAPEX ER TAB 3MG ..................... 121
MIRAPEX ER TAB 4.5MG .................. 121
MIRAPEX TAB 0.125MG ................... 122
MIRAPEX TAB 0.25MG ..................... 122
MIRAPEX TAB 0.5MG ....................... 122
MIRAPEX TAB 0.75MG ..................... 122
MIRAPEX TAB 1.5MG ...................... 122
MIRAPEX TAB 1MG ......................... 122
MIRCERA INJ 100MCG ...................... 83
MIRCERA INJ 200MCG ...................... 83
MIRCERA INJ 50MCG ........................ 83
MIRCERA INJ 75MCG ........................ 83
MIRCETTE TAB 28 DAY ..................... 53
mirtazapine tab 15mg ....................... 10
mirtazapine tab 15mg odt ................. 10
mirtazapine tab 7.5mg ...................... 10
MIRVASO GEL 0.33% ..................... 152
misoprostol tab 100mcg .................. 176
misoprostol tab 200mcg .................. 176
MITIGARE CAP 0.6MG ....................... 92
MITOSOL KIT 0.2MG ....................... 126
MOBIC SUS 7.5/5ML ....................... 124
MOBIC TAB 15MG .......................... 124
MOBIC TAB 7.5MG ......................... 124
modafinil tab 100mg....................... 164
modafinil tab 200mg....................... 164
MODERIBA PAK 1000/DAY ................. 95
MODERIBA PAK 1200/DAY ................. 95
MODERIBA PAK 600/DAY .................. 95
MODERIBA PAK 800/DAY .................. 95
moderiba tab 200mg ........................ 95
MODICON TAB 0.5/35 ....................... 65
moexipr/hctz tab 15-12.5.................... 4
moexipr/hctz tab 15-25mg .................. 4
moexipr/hctz tab 7.5-12.5................... 4
moexipril tab 15mg ............................ 3
moexipril tab 7.5mg ........................... 3
mometasone cre 0.1% ...................... 68
mometasone oin 0.1% ...................... 68
mometasone sol 0.1% ...................... 68
MONODOX CAP 100MG ................... 167
MONODOX CAP 75MG ..................... 167
MONOJECT S/P MIS 20ML/LT ........... 117
MONOJECT S/P MIS 35ML/REG ........ 117
MONOJECTOR MIS END CAPS ............ 91
montelukast chw 4mg ..................... 105
montelukast chw 5mg ..................... 105
montelukast gra 4mg...................... 105
218
montelukast tab 10mg..................... 105
MONUROL PAK GRANULES ............... 176
morphine sul cap 100mg er .............. 132
morphine sul cap 10mg er ............... 131
morphine sul cap 120mg er .............. 132
morphine sul sol 100/5ml ................ 132
morphine sul sol 10mg/5ml .............. 132
morphine sul sol 20mg/5ml .............. 132
morphine sul sup 10mg ................... 132
morphine sul sup 20mg ................... 132
MORPHINE SUL SUP 30MG ............... 132
morphine sul sup 5mg ..................... 132
morphine sul tab 100mg er .............. 132
morphine sul tab 15mg .................... 132
morphine sul tab 15mg er ................ 132
morphine sul tab 200mg er .............. 132
morphine sul tab 30mg .................... 132
MOTOFEN TAB ..................................37
MOTRIN CHILD SUS 100/5ML ........... 124
motrin ib tab 200mg ....................... 124
MOTRIN INFAN DRO 50/1.25 ............ 124
MOTRIN JR ST CHW 100MG ............. 124
MOTRIN JR ST TAB 100MG ............... 124
MOVANTIK TAB 12.5MG ................... 138
MOVANTIK TAB 25MG ..................... 138
MOVIPREP SOL .................................54
MOXATAG TAB 775MG .......................12
MOXEZA SOL 0.5% ......................... 126
moxifloxacin tab 400mg.....................88
MS CONTIN TAB 100MG CR .............. 132
MS CONTIN TAB 15MG CR ............... 132
MS CONTIN TAB 200MG CR .............. 132
MUGARD LIQ .................................. 147
MULTAQ TAB 400MG .........................22
MULTISTIX 10 TES SG .................... 113
mupirocin ca cre 2% ......................... 22
mupirocin oin 2% ............................. 22
MUSE SUP 1000MCG ...................... 147
MUSE SUP 125MCG ........................ 147
MUSE SUP 250MCG ........................ 147
MUSE SUP 500MCG ........................ 147
MYALEPT INJ 11.3MG ...................... 105
MYAMBUTOL TAB 100MG................... 33
MYAMBUTOL TAB 400MG................... 33
MYCOBUTIN CAP 150MG ................... 33
mycophenolat cap 250mg ............... 102
mycophenolat sus 200mg/ml ........... 102
mycophenolat tab 500mg ................ 102
mycophenolic tab 180mg dr ............ 102
mycophenolic tab 360mg dr ............ 102
MYDRIACYL SOL 1% OP .................... 70
MYFORTIC TAB 180MG .................... 102
MYFORTIC TAB 360MG .................... 102
MYGLUCOHEALT TES BLD GLUC ......... 75
MYKIDZ IRON SUS 15/1.5ML ........... 104
MYLERAN TAB 2MG............................. 9
MYNATAL CAP ................................ 143
MYNATE 90 TAB PLUS ..................... 143
MYRBETRIQ TAB 25MG ................... 177
MYRBETRIQ TAB 50MG ................... 177
MYSOLINE TAB 250MG ...................... 25
MYSOLINE TAB 50MG ....................... 25
N
NA HYDROXIDE SOL 10% ................. 45
nabumetone tab 500mg .................. 124
nabumetone tab 750mg .................. 124
nadolol tab 20mg ............................. 51
nadolol tab 40mg ............................. 51
nadolol tab 80mg ............................. 51
nadolol/bend tab 40-5mg .................. 50
nadolol/bend tab 80-5mg .................. 50
NAFRINSE DLY SOL /NEUTRAL ........... 87
NAFRINSE SOL DAILY ....................... 72
NAFRINSE WK SOL 0.2% .................. 87
naftifine cre hcl 1% .......................... 29
NAFTIN CRE 1% ............................... 29
NAFTIN CRE 2% ............................... 29
NAFTIN GEL 1% ............................... 29
NAFTIN GEL 2% ............................... 29
NALFON CAP 400MG ....................... 124
219
NALIDIXIC POW ACID ..................... 176
naltrexone tab 50mg ....................... 134
NAMENDA SOL 10MG/5ML ............... 113
NAMENDA TAB 10MG ...................... 113
NAMENDA TAB 5-10MG ................... 113
NAMENDA TAB 5MG ........................ 113
NAMENDA XR CAP 14MG .................. 113
NAMENDA XR CAP 21MG .................. 113
NAMENDA XR CAP 28MG .................. 113
NAMENDA XR CAP 7MG ................... 113
NAMENDA XR CAP TITRATIO ............ 113
NAMZARIC CAP 14-10MG ...................27
NAMZARIC CAP 28-10MG ...................27
naphazoline sol 0.1% op .................. 127
NAPRELAN TAB 375MG CR ............... 124
NAPROPAK PAK .............................. 123
NAPROPAK PAK COOL ...................... 123
NAPROPAX MIS.................................19
NAPROSYN TAB 250MG ................... 125
NAPROSYN TAB 375MG ................... 125
NAPROSYN TAB 500MG ................... 125
naproxen dr tab 375mg ................... 125
naproxen dr tab 500mg ................... 125
NAPROXEN POW SODIUM ................ 125
naproxen sod cap 220mg ................. 125
naproxen sod tab 275mg ................. 125
naproxen sod tab 375mg cr ............. 125
naproxen sod tab 500mg cr ............. 125
naproxen sod tab 550mg ................. 125
naproxen sus 125/5ml ..................... 125
naproxen tab 250mg ....................... 125
naproxen tab 375mg ....................... 125
naproxen tab 500mg ....................... 125
naratriptan tab 1mg ........................ 155
naratriptan tab 2.5mg ..................... 155
NARDIL TAB 15MG .......................... 112
NASCOBAL SPR 500MCG ....................64
NASONEX SPR 50MCG/AC ................ 114
NATACHEW CHW ............................ 143
NATACYN SUS 5% OP ..................... 127
NATALVIT TAB 75-1MG .................... 143
NATAZIA TAB ...................................88
nateglinide tab 120mg ..................... 109
nateglinide tab 60mg ...................... 109
NATELLE ONE CAP .......................... 143
NATESTO GEL 5.5MG ........................ 14
NATPARA INJ 100MCG .................... 137
NATPARA INJ 25MCG ...................... 137
NATPARA INJ 50MCG ...................... 137
NATPARA INJ 75MCG ...................... 137
NATROBA SUS 0.9% ....................... 153
NATURE THROI TAB 162.5MG .......... 170
NATURE-THROI TAB 113.75MG ........ 170
NATURE-THROI TAB 130MG ............ 170
NATURE-THROI TAB 146.25MG ........ 170
NATURE-THROI TAB 16.25MG .......... 170
NATURE-THROI TAB 32.5MG ........... 170
NATURE-THROI TAB 65MG .............. 170
NATURE-THROI TAB 97.5MG ........... 170
NAZIREX CRE .................................. 30
NEBUSAL NEB 6% .......................... 111
necon tab 1/50-28 ........................... 65
NECON TAB 10/11-28 ....................... 53
NEEVO DHA CAP 27-1.13 ................ 143
nefazodone tab 100mg ................... 157
nefazodone tab 50mg ..................... 157
neo/poly/dex oin 0.1% op ............... 128
neo/poly/dex sus 0.1% op............... 128
neo/poly/gra sol op ........................ 126
neo/poly/hc sol 1% otic .................. 136
neo/poly/hc sus 1% otic.................. 136
neo/poly/hc sus op ......................... 128
neomycin tab 500mg ........................ 11
neo-polycin oin hc 1%op ................. 128
neo-polycin oin op .......................... 126
NEOPROFEN SOL 10MG/ML.............. 125
NEORAL CAP 100MG ......................... 71
NEORAL CAP 25MG ........................... 71
NEORAL SOL 100MG/ML .................... 71
NEOSPORIN SOL OP ....................... 126
NEO-SYNALAR CRE ........................... 22
NEO-SYNALAR KIT ........................... 22
220
NEOTUSS PLUS LIQ ......................... 121
NEPTAZANE TAB 25MG ......................59
NEPTAZANE TAB 50MG ......................59
NESINA TAB 12.5MG .........................79
NESINA TAB 25MG ............................79
NESINA TAB 6.25MG .........................79
NESTABS ABC MIS .......................... 144
neuac gel 1.2-5% .............................. 5
NEUAC KIT 1.2-5% ............................ 5
NEULASTA INJ 6MG/0.6M ..................92
NEULASTA KIT 6MG/0.6M ..................92
NEUPOGEN INJ 300/0.5 .....................92
NEUPOGEN INJ 300MCG ....................92
NEUPOGEN INJ 480/0.8 .....................92
NEUPOGEN INJ 480MCG ....................92
NEUPRO DIS 1MG/24HR .................. 122
NEUPRO DIS 2MG/24HR .................. 122
NEUPRO DIS 3MG/24HR .................. 122
NEUPRO DIS 4MG/24HR .................. 122
NEUPRO DIS 6MG/24HR .................. 122
NEUPRO DIS 8MG/24HR .................. 122
NEURONTIN CAP 100MG ....................25
NEURONTIN CAP 300MG ....................25
NEURONTIN CAP 400MG ....................25
NEURONTIN SOL 250/5ML .................25
NEURONTIN TAB 600MG ....................25
NEURONTIN TAB 800MG ....................25
NEUTEK 2TEK TES STRIPS .................75
NEUTRASAL POW ..............................81
NEVANAC SUS 0.1% ....................... 128
nevirapine sus 50mg/5ml...................40
nevirapine tab 200mg .......................40
nevirapine tab 400mg er ....................40
NEWGEN TAB 32-1MG ..................... 143
NEXA PLUS CAP .............................. 145
NEXAVAR TAB 200MG........................34
NEXGEN TES ....................................75
NEXIUM CAP 40MG ......................... 148
NEXIUM GRA 10MG DR .................... 148
NEXIUM GRA 2.5MG DR ................... 148
NEXIUM GRA 20MG DR .................... 148
NEXIUM GRA 40MG DR .................... 148
NEXIUM GRA 5MG DR ...................... 148
NEXPLANON IMP 68MG .................... 146
niacin er tab 1000mg ...................... 119
niacin er tab 500mg ........................ 119
niacin er tab 750mg ....................... 119
niacor tab 500mg ........................... 119
NIASPAN TAB 1000 ER .................... 119
NIASPAN TAB 500MG ER ................. 119
NIASPAN TAB 750MG ER ................. 119
nicardipine cap 20mg........................ 57
nicardipine cap 30mg........................ 57
nicotine dis 14mg/24h .................... 159
nicotine dis 21mg/24h .................... 159
nicotine pol gum 4mg mint .............. 159
nicotine pol loz 2mg mint ................ 159
nicotine pol loz 4mg mint ................ 159
NICOTROL INH .............................. 159
NICOTROL NS SPR 10MG/ML ........... 159
nifediac cc tab 60mg er ..................... 57
nifedical xl tab 30mg ........................ 57
nifedical xl tab 60mg ........................ 57
nifedipine cap 10mg ......................... 57
nifedipine cap 20mg ......................... 57
nifedipine tab 30mg er ...................... 57
nifedipine tab 90mg er ...................... 57
NILANDRON TAB 150MG ................... 20
nimodipine cap 30mg ....................... 58
NIRAVAM TAB 0.25MG ...................... 48
nisoldipine tab 17mg er .................... 58
nisoldipine tab 20mg ........................ 58
nisoldipine tab 25.5mg...................... 58
nisoldipine tab 34mg er .................... 58
nisoldipine tab 8.5mg er ................... 58
NITRATEST TES PAPER ..................... 75
NITRO-BID OIN 2% ........................ 120
NITRO-DUR DIS 0.1MG/HR .............. 120
nitrofur mac cap 100mg .................. 176
nitrofur mac cap 25mg.................... 176
nitrofur mac cap 50mg.................... 176
NITROFURAN POW ANHYDROU ........ 176
nitrofurantn cap 100mg .................. 176
nitrofurantn sus 25mg/5ml .............. 176
nitroglycer aer 400mcg ................... 120
221
nitroglycer cap 2.5mg er .................. 120
nitroglycer cap 6.5mg er .................. 120
nitroglycer cap 9mg er .................... 120
nitroglycer dis 0.1mg/hr .................. 120
nitroglycrn spr 0.4mg ...................... 120
NITROLINGUAL SPR PUMPSPRA ........ 120
NITROMIST AER 400MCG ................. 120
NITRONAL SOL 1MG/ML ................... 120
NITROSTAT SUB 0.3MG ................... 120
NITROSTAT SUB 0.4MG ................... 120
NITROSTAT SUB 0.6MG ................... 120
nizatidine cap 150mg ........................94
nizatidine cap 300mg ........................94
nizatidine sol 15mg/ml ......................94
NIZORAL SHA 2% ........................... 100
NORCO TAB 10-325MG ......................98
NORCO TAB 5-325MG........................98
NORCO TAB 7.5-325 .........................98
NORDITROPIN INJ 10/1.5ML ..............93
NORDITROPIN INJ 15/1.5ML ..............93
NORDITROPIN INJ 30/3ML .................93
NORDITROPIN INJ 5/1.5ML ................93
noreth/ethin chw fe ...........................65
noreth/ethin tab 0.5-2.5 ....................83
noreth/ethin tab 1/20 ........................65
noreth/ethin tab fe 1/20 ....................65
norethin ace tab 5mg ...................... 146
norethindron tab 0.35mg ................. 146
NORINYL TAB 1+50-28 ......................65
NORITATE CRE 1% ......................... 152
NORPACE CAP 100MG .......................21
NORPACE CAP 100MG CR ...................21
NORPACE CAP 150MG .......................21
NORPACE CAP 150MG CR ...................21
NORPRAMIN TAB 100MG .................. 174
NORPRAMIN TAB 10MG ................... 174
NORPRAMIN TAB 150MG .................. 174
NORPRAMIN TAB 25MG ................... 174
NORPRAMIN TAB 50MG ................... 174
NORPRAMIN TAB 75MG ................... 174
NORTHERA CAP 100MG ................... 119
NORTHERA CAP 200MG ................... 119
NORTHERA CAP 300MG ................... 119
nortrel tab 0.5/35 ............................ 65
nortrel tab 1/35 ............................... 65
nortrel tab 7/7/7 ............................ 175
nortriptylin cap 10mg ..................... 174
nortriptylin sol 10mg/5ml ................ 174
NORTUSS-EX LIQ 200-20/5 ............... 44
NORVASC TAB 10MG ........................ 58
NORVASC TAB 2.5MG ....................... 58
NORVASC TAB 5MG .......................... 58
NORVIR CAP 100MG ......................... 40
NORVIR SOL 80MG/ML...................... 40
NORVIR TAB 100MG ......................... 40
NOVA MAX TES GLUCOSE ................. 75
NOVACORT GEL ............................. 161
NOVOCLAIR CRE .............................. 19
NOVOFINE MIS 30GX8MM ............... 117
NOVOFINE MIS 32GX6MM ............... 117
NOVOFINE PLS MIS 32GX4MM ......... 117
NOVOLIN INJ 70/30.......................... 98
NOVOLIN N INJ U-100 ...................... 98
NOVOLIN R INJ U-100 ...................... 98
NOVOLOG INJ 100/ML ...................... 98
NOVOLOG INJ FLEXPEN..................... 98
NOVOLOG INJ PENFILL ..................... 98
NOVOLOG MIX INJ 70/30 .................. 98
NOVOLOG MIX INJ FLEXPEN .............. 98
NOVOTWIST MIS 32GX5MM............. 117
NOXAFIL SUS 40MG/ML .................. 173
NOXAFIL TAB 100MG ...................... 173
np thyroid tab 30mg ....................... 170
np thyroid tab 60mg ....................... 170
np thyroid tab 90mg ....................... 170
NUCORT LOT 2% ............................. 68
NUCYNTA ER TAB 100MG ................ 132
NUCYNTA ER TAB 150MG ................ 132
NUCYNTA ER TAB 200MG ................ 132
NUCYNTA ER TAB 250MG ................ 132
NUCYNTA ER TAB 50MG .................. 132
NUCYNTA TAB 100MG ..................... 132
NUCYNTA TAB 50MG ....................... 132
NUCYNTA TAB 75MG ....................... 132
NUEDEXTA CAP 20-10MG ................ 148
NULYTELY SOL FLAV PKS .................. 54
222
NUOX GEL 6-3% ................................ 7
NUTRIDOX KIT ............................... 167
NUTROPIN AQ INJ 10MG/2ML .............93
NUTROPIN AQ INJ 20MG/2ML .............93
NUTROPIN AQ INJ NUSPIN 5 ..............93
NUVAIL SOL 16% ........................... 111
NUVARING MIS.................................66
NUVESSA GEL 1.3% ........................ 178
NUVIGIL TAB 150MG ....................... 164
NUVIGIL TAB 200MG ....................... 164
NUVIGIL TAB 250MG ....................... 164
NUVIGIL TAB 50MG ......................... 164
NYMALIZE SOL 60/20ML ....................58
nystat/triam cre................................30
nystat/triam oin ................................30
nystatin cre 100000 ..........................29
nystatin oin 100000 ..........................29
nystatin pow ....................................29
nystatin sus 100000 ..........................19
nystatin tab 500000 ..........................29
nystop pow 100000...........................29
O
OB COMPLETE CAP ONE ................... 143
OB COMPLETE CAP PETITE ............... 143
OB COMPLETE TAB .......................... 143
OB COMPLETE TAB PREMIER ............ 143
OB COMPLETE/ CAP DHA ................. 143
OBSTETRIX EC TAB ......................... 143
OBSTETRIX PAK DHA ...................... 143
O-CAL FA TAB ................................ 143
O-CAL TAB PRENATAL ..................... 143
octreotide inj 1000mcg .................... 160
octreotide inj 100mcg ...................... 160
octreotide inj 50mcg/ml ................... 160
OCUFEN SOL 0.03% OP ................... 128
OCUFLOX DRO 0.3% OP .................. 126
ODOMZO CAP 200MG ........................34
OFEV CAP 100MG ........................... 149
OFEV CAP 150MG ........................... 149
ofloxacin dro 0.3% op ..................... 127
ofloxacin dro 0.3%otic ..................... 136
ofloxacin tab 400mg ..........................88
ogestrel tab .....................................65
olanza/fluox cap 12-25mg................ 169
olanza/fluox cap 12-50mg ............... 169
olanza/fluox cap 3-25mg ................. 169
olanzapine tab 10mg ...................... 168
olanzapine tab 10mg odt ................. 168
olanzapine tab 2.5mg ..................... 168
olanzapine tab 5mg ........................ 168
olanzapine tab 5mg odt .................. 168
olanzapine tab 7.5mg ..................... 168
OLEPTRO TAB 24HR150 .................. 157
OLEPTRO TAB 24HR300 .................. 157
olopatadine spr 0.6% ..................... 114
OLUX AER 0.05% ............................. 68
OLUX-E AER 0.05% .......................... 68
OLYSIO CAP 150MG.......................... 95
OMECLAMOX- MIS PAK ................... 175
OMEGA-3/D-3 KIT WELLNESS ............ 31
omega-3-acid cap 1gm ..................... 31
omepra/bicar cap 40-1100 .............. 147
omeprazole cap 10mg..................... 148
omeprazole cap 40mg..................... 148
OMNARIS SPR................................ 114
OMNIFLEX DPR ................................ 76
OMNIPOD KIT STARTER .................. 102
OMNIPOD MIS ............................... 103
OMNIPRED SUS 1% OP ................... 129
OMNITROPE INJ 5.8MG ..................... 93
ON CALL PLUS TES BLD GLUC ............ 75
ON CALL TES EXPRESS ..................... 75
ON CALL VIVD TES BLD GLUC ............ 75
ondansetron sol 4mg/5ml.................... 1
ondansetron tab 24mg ........................ 1
ondansetron tab 4mg ......................... 1
ondansetron tab 4mg odt .................... 1
ondansetron tab 8mg ......................... 1
ondansetron tab 8mg odt .................... 1
ONE A DAY CAP PRENATAL .............. 143
ONETOUCH TES ULTRA BL ................. 75
ONETOUCH TES VERIO ..................... 75
ONEXTON GEL 1.2-3.75 ...................... 5
ONFI SUS 2.5MG/ML......................... 23
223
ONFI TAB 10MG ................................23
ONFI TAB 20MG ................................23
ONGLYZA TAB 2.5MG ........................79
ONGLYZA TAB 5MG ...........................79
ONMEL TAB 200MG ......................... 173
OPANA ER TAB 10MG ...................... 132
OPANA ER TAB 15MG ...................... 132
OPANA ER TAB 20MG ...................... 132
OPANA ER TAB 30MG ...................... 132
OPANA ER TAB 40MG ...................... 132
OPANA ER TAB 5MG ........................ 132
OPANA ER TAB 7.5MG ..................... 132
OPANA TAB 10MG ........................... 132
OPANA TAB 5MG ............................. 132
opium tin 1% ...................................37
opium tinct tin 2mg/5ml ....................37
OPSUMIT TAB 10MG ........................ 149
OPTASE GEL .....................................82
OPTIUM TES .....................................75
OPTIUMEZ TES .................................75
OPTUMRX TES BLD GLUC ...................75
ORACEA CAP 40MG ......................... 152
ORACIT SOL .....................................63
ORAFATE PST 10% ......................... 147
ORALAIR SUB 300 IR ...................... 111
ORAP TAB 1MG ............................... 148
ORAP TAB 2MG ............................... 148
ORAPRED ODT TAB 10MG ..................90
ORAVIG TAB 50MG ...........................19
ORENCIA INJ 125MG/ML .................. 154
ORENITRAM TAB 0.125MG ............... 147
ORENITRAM TAB 0.25MG ................. 147
ORENITRAM TAB 1MG ..................... 147
ORENITRAM TAB 2.5MG ................... 147
ORFADIN CAP 10MG ..........................95
ORFADIN CAP 2MG ...........................95
ORFADIN CAP 5MG ...........................95
ORKAMBI TAB 200-125 .....................71
orph/asa/caf tab ............................. 113
orphenadrine tab 100mg er ................60
ORTHO COIL DPR KIT 100 .................76
ORTHO COIL DPR KIT 105 .................76
ORTHO COIL DPR KIT 50 ...................76
ORTHO FLAT DPR KIT 55 ...................76
ORTHO FLAT DPR KIT 60 ................... 76
ORTHO MICRON TAB 0.35MG........... 146
ORTHO TRI- TAB CYCLEN ................ 175
ORTHO TRI- TAB CYCLN LO ............. 175
ORTHO-CYCLEN TAB 0.25/35 ............. 65
ORTHO-NOVUM TAB 1/35.................. 65
ORTHO-NOVUM TAB 7/7/7 .............. 175
OSENI TAB 12.5-15 .......................... 80
OSENI TAB 12.5-30 .......................... 80
OSENI TAB 12.5-45 .......................... 80
OSENI TAB 25-15MG ........................ 80
OSENI TAB 25-30MG ........................ 80
OSENI TAB 25-45MG ........................ 80
OSMOPREP TAB 1.5GM ................... 152
OSPHENA TAB 60MG ...................... 154
OTEZLA TAB 10/20/30 .................... 140
OTEZLA TAB 30MG ......................... 140
OTREXUP INJ 10MG .......................... 42
OTREXUP INJ 15MG .......................... 42
OTREXUP INJ 20MG .......................... 42
OTREXUP INJ 25MG .......................... 42
OTREXUP INJ 7.5/0.4 ....................... 42
OVACE PLUS AER 9.8% ..................... 42
OVACE PLUS CRE 10% ...................... 42
OVACE PLUS GEL 10% WASH ............ 42
OVACE PLUS LOT 9.8% ..................... 42
OVACE PLUS SHA 10% ..................... 42
OVACE WASH LIQ 10% ..................... 42
OVCON-35 TAB ................................ 65
OVIDE LOT 0.5% ........................... 153
OVIDREL INJ ................................. 136
OXANDRIN TAB 10MG ....................... 13
OXANDRIN TAB 2.5MG ...................... 13
oxandrolone tab 10mg ...................... 13
oxandrolone tab 2.5mg ..................... 13
oxaprozin tab 600mg ...................... 125
OXAYDO TAB 5MG .......................... 132
OXAYDO TAB 7.5MG ....................... 132
oxazepam cap 10mg......................... 48
224
oxazepam cap 15mg .........................48
oxazepam cap 30mg .........................48
oxcarbazepin sus 300mg/5m ..............25
oxcarbazepin tab 150mg ....................25
OXISTAT CRE 1% ........................... 100
OXISTAT LOT 1%............................ 100
OXSORALEN LOT 1% ....................... 141
OXSORALEN-UL CAP 10MG ................38
OXTELLAR XR TAB 150MG ..................25
oxybutynin syp 5mg/5ml ................. 177
oxybutynin tab 10mg er .................. 177
oxybutynin tab 15mg er .................. 177
oxybutynin tab 5mg ........................ 177
oxybutynin tab 5mg er .................... 177
oxycod/apap tab 10-325mg ............. 134
oxycod/apap tab 2.5-325 ................. 134
oxycod/apap tab 5-325mg ............... 134
oxycod/apap tab 7.5-325 ................. 134
oxycod/asa tab ............................... 134
oxycod/ibu tab 5-400mg .................. 134
oxycodone cap 5mg ........................ 132
oxycodone con 100/5ml ................... 132
oxycodone sol 5mg/5ml ................... 132
oxycodone tab 10mg ....................... 133
oxycodone tab 10mg er ................... 133
oxycodone tab 15mg ....................... 133
oxycodone tab 20mg ....................... 133
oxycodone tab 30mg ....................... 133
oxycodone tab 5mg ......................... 133
OXYCONTIN TAB 10MG CR ............... 133
oxymorphone tab 10mg er ............... 133
oxymorphone tab 30mg er .............. 133
oxymorphone tab 40mg er .............. 133
oxymorphone tab 5mg er ................ 133
oxymorphone tab 7.5mg er ............. 133
oxymorphone tab hcl 10mg ............. 133
oxymorphone tab hcl 5mg ............... 133
OXYTROL DIS 3.9MG/24 ................. 177
P
pacerone tab 100mg......................... 22
pacerone tab 400mg......................... 22
PAIN RELIEF PAD PATCH ................. 171
PAIRE OB MIS ................................ 145
paliperidone tab er 1.5mg ................. 46
paliperidone tab er 3mg .................... 46
PAMELOR CAP 10MG ....................... 174
PAMELOR CAP 25MG ....................... 174
PAMELOR CAP 50MG ....................... 174
PAMELOR CAP 75MG ....................... 174
PAMINE FORTE TAB 5MG ................. 150
PAMINE FQ KIT ................................ 23
PAMINE TAB 2.5MG ........................ 150
PANCREAZE CAP 10500UNT............... 78
PANCREAZE CAP 4200UNIT ............... 78
pancrelipase cap 5000unit ................. 78
PANDA MASK MIS PEDIATRI ............ 160
PANDEL CRE 0.1% ........................... 68
PANRETIN GEL 0.1% ........................ 36
pantoprazole tab 20mg ................... 148
pantoprazole tab 40mg ................... 148
PARAFON FORT TAB 500MG............... 60
paricalcitol cap 1 mcg ....................... 99
PARLODEL CAP 5MG ......................... 37
PARNATE TAB 10MG ....................... 112
paromomycin cap 250mg .................. 11
paroxetin er tab 12.5mg ................. 156
paroxetin er tab 37.5mg ................. 156
paroxetine tab 10mg ...................... 156
paroxetine tab 25mg er .................. 156
225
paroxetine tab 40mg ....................... 156
PASER GRA 4GM ...............................33
PATADAY SOL 0.2% ........................ 126
PATANASE SPR 0.6% ...................... 114
PATANOL SOL 0.1% OP ................... 126
PAXIL CR TAB 12.5MG ..................... 156
PAXIL CR TAB 25MG ........................ 156
PAXIL CR TAB 37.5MG ..................... 156
PAXIL SUS 10MG/5ML ..................... 156
PAXIL TAB 10MG ............................ 156
PAXIL TAB 20MG ............................ 156
PAXIL TAB 30MG ............................ 156
PAXIL TAB 40MG ............................ 156
PAZEO DRO 0.7% ........................... 126
PCCA ACACIA SYP BASE .................. 135
PCE TAB 333MG EC ...........................82
PCE TAB 500MG EC ...........................82
PCP 100 KIT .....................................54
PEDIADERM AF KIT COMPLETE ...........29
PEDIADERM HC KIT ...........................68
PEDIAPRED SOL 6.7/5ML ...................90
PEDIATEX TDM SUS ........................ 121
PEDIPAK PAK ...................................30
peg-3350 sol electrol .........................54
peg-3350/kcl sol /sodium ..................54
PEGANONE TAB 250MG .....................98
PEGASYS INJ ....................................95
PEGASYS INJ 180MCG/M ...................95
PEGASYS INJ PROCLICK ....................95
PEG-INTRON KIT 120 RP....................95
PEG-INTRON KIT 150MCG ..................95
PEG-INTRON KIT 50MCG RP ...............95
PEG-INTRON KIT 80MCG ...................95
PEN NEEDLES MIS 29GX12.7............ 117
penicilln vk sol 125/5ml ................... 114
penicilln vk sol 250/5ml ................... 114
penicilln vk tab 250mg .................... 114
penicilln vk tab 500mg .................... 114
PENLAC SOL 8% ...............................29
PENNSAID SOL 2% ...........................19
PENTASA CAP 250MG CR ................. 102
PENTASA CAP 500MG CR ................. 102
pentaz/nalox tab 50-0.5mg .............. 135
pentoxifylli tab 400mg er ...................94
PEPCID SUS 40MG/5ML .....................94
PEPCID TAB 40MG ............................94
PERCOCET TAB 10-325MG............... 134
PERCOCET TAB 2.5-325 .................. 134
PERCOCET TAB 5-325MG ................ 134
PERCOCET TAB 7.5-325 .................. 134
PERCODAN TAB ............................. 135
PERFOROMIST NEB 20MCG ............... 49
PERIDEX SOL 0.12% ........................ 43
perindopril tab 2mg ............................ 3
perphen/amit tab 2-10mg ............... 139
perphenazine tab 16mg .................. 139
perphenazine tab 2mg .................... 139
PERSANTINE TAB 25MG .................. 141
PERTZYE CAP................................... 78
PEXEVA TAB 10MG ......................... 156
PEXEVA TAB 20MG ......................... 156
PEXEVA TAB 30MG ......................... 156
PEXEVA TAB 40MG ......................... 156
PHARM CH TSX PAD 2-4-1% ............ 171
phenadoz sup 12.5mg ...................... 31
phenadoz sup 25mg ......................... 31
phenazo tab 200mg ........................ 176
phenazopyrid tab 100mg................. 176
phenelzine tab 15mg ...................... 112
phenobarb elx 20mg/5ml .................. 45
phenobarb tab 100mg ...................... 45
phenobarb tab 15mg ........................ 45
phenobarb tab 16.2mg ..................... 45
phenobarb tab 30mg ........................ 45
phenobarb tab 32.4mg ..................... 45
phenobarb tab 60mg ........................ 45
phenobarb tab 64.8mg ..................... 45
phenobarb tab 97.2mg ..................... 45
phenoxybenza cap 10mg ..................... 9
phenylbutyra pow sodium ............... 176
phenylephrin sol 10% op ................. 127
phenylephrin sol 2.5% op................ 127
226
PHENYTEK CAP 200MG ......................98
PHENYTEK CAP 300MG ......................98
phenytoin chw 50mg .........................98
phenytoin ex cap 100mg....................98
phenytoin sus 125/5ml ......................98
phos-flur gel 1.1% ............................87
PHOSLO CAP 667MG ....................... 140
PHOSLYRA SOL ............................... 140
phospha 250 tab neutral .................. 140
phosphasal tab ............................... 176
PHOSPHOLINE SOL 0.125%OP ......... 110
PICATO GEL 0.015% .........................36
PICATO GEL 0.05% ...........................36
pilocarpine sol 1% op ...................... 110
pilocarpine tab 5mg ........................ 153
pilocarpine tab 7.5mg ...................... 153
pimozide tab 1mg ........................... 148
pimozide tab 2mg ........................... 148
pindolol tab 10mg .............................51
pindolol tab 5mg ...............................51
pioglit/glim tab 30-2mg ................... 165
pioglit/glim tab 30-4mg ................... 165
pioglita/met tab 15-500mg .............. 168
pioglita/met tab 15-850mg .............. 168
pioglitazone tab 15mg ..................... 168
piroxicam cap 10mg ........................ 125
piroxicam cap 20mg ........................ 125
PLACEBO #00 CAP .......................... 141
PLAQUENIL TAB 200MG .....................32
PLAS ADAPT MIS 1ML ...................... 117
PLAVIX TAB 300MG ......................... 169
PLAVIX TAB 75MG........................... 169
PLEGRIDY INJ ................................. 112
PLEGRIDY INJ PEN .......................... 112
PLEGRIDY INJ STARTER ................... 112
PLEGRIDY PEN INJ STARTER ............ 112
PLETAL TAB 100MG ......................... 140
PLETAL TAB 50MG........................... 140
PLEXION CLTH PAD 9.8-4.8%.............. 5
PLEXION CRE 9.8-4.8% ...................... 5
PLEXION LIQ 9.8-4.8% ....................... 5
PLEXION LOT 9.8-4.8% ...................... 5
PLIAGLIS CRE 7-7% ....................... 171
pnv-dha cap .................................. 145
pnv-select tab ................................ 143
PNV-TOTAL CAP ............................. 143
POCKETCHEM TES EZ ....................... 75
PODOCON SOL 25% ....................... 104
podofilox sol 0.5% ......................... 104
polycin oin op ................................ 126
POLYETH GLYC OIN 8000 ................ 157
POLYTRIM SOL OP .......................... 126
POLY-VI-FLOR MIS FS 0.25 ............. 137
POLY-VI-FLOR MIS FS 0.5MG ........... 137
POMALYST CAP 1MG ......................... 34
POMALYST CAP 2MG ......................... 34
POMALYST CAP 3MG ......................... 34
POMALYST CAP 4MG ......................... 34
PONSTEL CAP 250MG ..................... 125
POT BICARBON GRA ....................... 141
POT BICARBON POW ...................... 142
pot chloride cap 10meq er ............... 142
pot chloride cap 8meq er................. 142
pot chloride sol 10% sf ................... 142
pot chloride sol 20% sf ................... 142
pot chloride tab 10meq er ............... 142
pot chloride tab 20meq er ............... 142
pot chloride tab 25meq ef ............... 142
pot chloride tab 8meq er ................. 142
pot citrate tab 1080mg ..................... 64
pot citrate tab 1620mg ..................... 64
pot citrate tab 540mg er ................... 63
pot cl micro tab 10meq er ............... 142
pot cl micro tab 20meq er ............... 142
POT HYDROXID SOL 5% ................... 45
POTABA CAP 500MG ....................... 137
POTABA TAB 500MG ....................... 137
POTASSIUM P- POW AMINOBEN ....... 137
POTIGA TAB 200MG ......................... 25
POTIGA TAB 300MG ......................... 25
POTIGA TAB 400MG ......................... 25
POTIGA TAB 50MG ........................... 25
PR NATAL 400 PAK EC .................... 144
PR NATAL 430 PAK ......................... 144
PR NATAL 430 PAK EC .................... 144
PRADAXA CAP 150MG ..................... 169
PRADAXA CAP 75MG ....................... 169
PRALUENT INJ 150MG/ML ............... 137
227
PRALUENT INJ 75MG/ML .................. 137
pramipexole tab 0.125mg ................ 122
pramipexole tab 0.25mg .................. 122
pramipexole tab 0.375mg ................ 122
pramipexole tab 0.5mg .................... 122
pramipexole tab 0.75 er .................. 122
pramipexole tab 0.75mg .................. 122
pramipexole tab 1.5mg.................... 122
pramipexole tab 1.5mg er ................ 122
pramipexole tab 1mg ...................... 122
pramipexole tab 3mg ...................... 122
pramipexole tab 4.5mg .................... 122
PRAMOSONE CRE 1% ...................... 162
PRAMOSONE CRE 1-2.5% ................ 162
PRAMOSONE E CRE 1-2.5% ............. 162
PRAMOSONE LOT 1% ...................... 162
PRAMOSONE LOT 2.5% ................... 162
PRAMOSONE OIN 1% ...................... 162
PRAMOSONE OIN 2.5% ................... 162
PRANDIMET TAB 1-500MG ............... 109
PRANDIMET TAB 2-500MG ............... 109
PRANDIN TAB 0.5MG ....................... 109
PRANDIN TAB 1MG ......................... 109
PRANDIN TAB 2MG ......................... 109
prascion fc pad 10-5% ....................... 6
PRASCION RA CRE 10-5% .................. 6
PRASTERA KIT ................................ 125
PRAVACHOL TAB 20MG ......................97
PRAVACHOL TAB 40MG ......................97
PRAVACHOL TAB 80MG ......................97
pravastatin tab 10mg ........................97
PRAZOLAMINE PAK ......................... 113
prazosin hcl cap 1mg.........................20
PRECISION PT TES OF CARE ..............75
PRECISION TES PCX..........................75
PRECISION TES PCX PLUS .................75
PRECISION TES QID..........................75
PRECISION TES SOF-TACT .................75
PRECISION TES XTRA ........................75
PRECOSE TAB 100MG ........................11
PRECOSE TAB 25MG..........................11
PRECOSE TAB 50MG ......................... 11
PRED MILD SUS 0.12% OP .............. 129
PRED SOD PHO SOL 1% OP ............. 129
pred sod pho sol 5mg/5ml ................. 90
PRED-G S.O.P OIN OP..................... 128
PRED-G SUS OP ............................. 128
prednicarbat cre 0.1% ...................... 68
prednicarbat oin 0.1% ...................... 68
prednisolone sol 15mg/5ml ............... 90
prednisolone sol 25mg/5ml ............... 90
prednisolone sus 1% op .................. 129
prednisolone tab 10mg odt ................ 90
PREDNISONE CON 5MG/ML ............... 90
prednisone pak 10mg ....................... 90
prednisone pak 5mg ......................... 90
prednisone sol 5mg/5ml .................... 90
prednisone tab 10mg ........................ 90
prednisone tab 1mg.......................... 90
prednisone tab 2.5mg ....................... 90
prednisone tab 5mg.......................... 90
PREFERA OB TAB ........................... 143
PREFERAOB CAP ONE ..................... 145
PREFERAOB MIS +DHA ................... 145
PREFEST TAB ................................... 83
pregnyl inj 10000unt ...................... 136
PREMARIN TAB 0.3MG ...................... 85
PREMARIN TAB 0.45MG .................... 85
PREMARIN TAB 0.625MG ................... 85
PREMARIN TAB 0.9MG ...................... 85
PREMARIN TAB 1.25MG .................... 85
PREMARIN VAG CRE 0.625MG .......... 178
PREMPHASE TAB .............................. 83
PREMPRO TAB .625-2.5 .................... 83
PREMPRO TAB 0.3-1.5 ...................... 83
PREMPRO TAB 0.45-1.5 .................... 83
PREMPRO TAB 0.625-5 ..................... 83
PRENAISSANCE CAP BALANCE ......... 145
PRENAISSANCE CAP PLUS ............... 145
PRENAISSANCE MIS HARMONY ........ 143
PRENAISSANCE TAB NEXT ............... 145
PRENAISSANCE TAB NEXT-B ........... 145
PRENATA CHW 29-1MG ................... 143
228
prenatabs fa tab ............................. 143
prenatabs rx tab ............................. 143
prenatal 19 chw tab ........................ 143
prenatal 19 tab ............................... 143
PRENATAL MIS COMPLEAT ............... 143
PRENATAL-U CAP 106.5-1 ................ 143
PRENATE AM TAB 1MG .................... 145
PRENATE CAP ENHANCE .................. 145
PRENATE CAP ESSENTIA .................. 143
PRENATE CAP PIXIE ........................ 145
PRENATE CAP RESTORE ................... 145
PRENATE CHW 0.6-0.4 .................... 145
PRENATE DHA CAP .......................... 145
PRENATE MINI CAP ......................... 145
PRENATE STAR TAB 20-1MG ............ 143
PRENATE TAB ELITE ........................ 143
PRENTIF MIS 22MM ...........................62
PRENTIF MIS 25MM ...........................62
PRENTIF MIS 28MM ...........................62
PRENTIF MIS 31MM ...........................62
PRENTIF MIS FITTING .......................62
PREPIDIL GEL 0.5MG/3G .................... 1
PREPOPIK PAK ..................................54
PREQUE 10 TAB .............................. 145
PRESTALIA TAB 14-10MG ................... 2
PRESTALIA TAB 3.5-2.5 ...................... 2
PRESTALIA TAB 7-5MG ....................... 2
PREVACID CAP 15MG DR ................. 148
PREVACID CAP 30MG DR ................. 148
PREVACID TAB 15MG STB ................ 148
PREVACID TAB 30MG STB ................ 148
PREVDNT 5000 PST 1.1% ..................87
PREVIDENT CRE 5000 PLS .................87
PREVIDENT GEL 1.1% .......................87
PREVPAC MIS ................................. 175
PREZCOBIX TAB 800-150 ..................39
PREZISTA SUS 100MG/ML..................40
PREZISTA TAB 150MG .......................40
PREZISTA TAB 600MG .......................40
PREZISTA TAB 75MG .........................40
PREZISTA TAB 800MG .......................40
PRIFTIN TAB 150MG ..........................33
PRILOSEC CAP 10MG....................... 148
PRILOSEC CAP 40MG....................... 148
PRILOSEC POW 10MG ..................... 148
PRILOSEC POW 2.5MG .................... 148
PRIMAQUINE TAB 26.3MG ................. 32
primidone tab 250mg ....................... 26
primidone tab 50mg ......................... 26
PRIMLEV TAB 10-300MG ................. 135
PRIMLEV TAB 5-300MG ................... 135
PRIMLEV TAB 7.5-300 ..................... 135
PRIMSOL SOL 50MG/5ML .................. 18
PRINIVIL TAB 10MG ........................... 3
PRINIVIL TAB 20MG ........................... 3
PRINIVIL TAB 5MG ............................. 3
PRISTIQ TAB 100MG ...................... 158
PRISTIQ TAB 25MG ........................ 158
PRISTIQ TAB 50MG ........................ 158
PROAIR RESPI AER ........................... 49
proben/colch tab 500-0.5 .................. 92
probenecid tab 500mg .................... 176
PROCARDIA CAP 10MG ..................... 58
PROCARDIA XL TAB 30MG CR ............ 58
PRO-C-DURE 5 KIT 40MG/ML ............. 90
PRO-C-DURE 6 KIT 40MG/ML ............. 90
PROCENTRA SOL 5MG/5ML ................ 13
prochlorper tab 10mg ..................... 139
prochlorper tab 5mg ....................... 139
PROCORT CRE ............................... 151
PROCRIT INJ 40000/ML..................... 83
PROCTOCORT CRE 1% .................... 151
PROCTOCORT SUP 30MG................. 151
PROCTOFOAM AER HC 1%............... 151
procto-pak cre 1% ......................... 151
proctosol hc cre 2.5% ..................... 151
PROCYSBI CAP 25MG ........................ 71
PROCYSBI CAP 75MG ........................ 71
PRODIGY NO TES CODING ................ 75
PRODRIN TAB ................................ 110
progesterone cap 100mg................. 146
progesterone cap 200mg................. 146
PROGESTERONE CRE 10% KIT ......... 146
progesterone inj 50mg/ml ............... 146
PROGLYCEM SUS 50MG/ML ............... 72
PROGRAF CAP 0.5MG ...................... 108
PROGRAF CAP 1MG ........................ 108
PROGRAF CAP 5MG ........................ 108
PROLENSA SOL 0.07% .................... 128
PROMACTA TAB 12.5MG .................. 169
229
PROMACTA TAB 25MG ..................... 169
PROMACTA TAB 50MG ..................... 169
PROMACTA TAB 75MG ..................... 169
PROMACTIN AA SUS PLUS................ 126
prometh vc syp plain .........................71
prometh vc/ syp codeine.................. 134
prometh/cod syp 6.25-10 ................ 134
promethazine syp 6.25/5ml ...............31
promethazine syp dm ...................... 121
promethazine tab 12.5mg ..................31
promethazine tab 25mg .....................31
promethazine tab 50mg .....................31
promethegan sup 50mg .....................31
PROMETRIUM CAP 100MG ................ 146
PROMETRIUM CAP 200MG ................ 146
PROMISEB KIT COMPLETE ..................42
propafenone cap 225mg er ................21
propafenone cap 325mg er ................21
propafenone cap 425mg sr.................21
propafenone tab 150mg.....................21
propanthelin tab 15mg .................... 150
proparacaine sol 0.5% op ................ 127
propran/hctz tab 40/25 .....................50
propran/hctz tab 80/25 .....................50
propranolol cap 120mg er ..................51
propranolol cap 160mg er ..................51
propranolol cap 60mg er ....................51
propranolol cap 80mg er ....................51
propranolol sol 20mg/5ml ..................51
propranolol sol 40mg/5ml ..................51
propranolol tab 10mg ........................51
propylthiour tab 50mg .......................43
PROSCAR TAB 5MG ............................ 1
PROSED/DS TAB ............................. 176
PROSTIN E2 SUP 20MG ...................... 1
PROTONIX PAK ............................... 148
PROTONIX TAB 20MG ...................... 148
PROTONIX TAB 40MG ...................... 148
PROTOPIC OIN 0.03% ..................... 109
PROTOPIC OIN 0.1% ....................... 109
protriptylin tab 10mg ...................... 174
protriptylin tab 5mg ....................... 174
PROVENTIL AER HFA ........................ 49
PROVERA TAB 10MG ....................... 146
PROVERA TAB 2.5MG ...................... 146
PROVERA TAB 5MG......................... 146
PROVIDA DHA CAP ......................... 145
PROVIDA OB CAP ........................... 143
PROVIGIL TAB 100MG..................... 164
PROVIGIL TAB 200MG..................... 164
PROZAC CAP 10MG ........................ 156
PROZAC CAP 20MG ........................ 156
PROZAC CAP 40MG ........................ 156
PROZAC WEEKL CAP 90MG .............. 157
PROZENA PAD 4% .......................... 107
prudoxin cre 5% .............................. 37
PRVDNT 5000 PST ENAML PR ............. 72
PSORCON CRE 0.05% ....................... 68
PTS PANELS TES GLUCOSE................ 75
PTS PANELS TES KETONE .................. 75
PULMICORT INH 180MCG ................ 161
PULMICORT INH 90MCG .................. 161
PULMICORT SUS 0.25MG/2 ............. 161
PULMICORT SUS 0.5MG/2 ............... 161
PULMICORT SUS 1MG/2ML .............. 161
PULMOPHYLLIN PAK ....................... 180
PULMOZYME SOL 1MG/ML ................. 99
PUMP INSULIN MIS BOOK #2 .......... 103
PUREFE OB CAP PLUS ..................... 143
PURIXAN SUS 20MG/ML .................... 33
PYLERA CAP................................... 175
pyrazinamide tab 500mg ................... 33
PYRIDIUM TAB 100MG .................... 176
PYRIDIUM TAB 200MG .................... 176
pyridostigm tab 60mg ....................... 33
pyridostigmi tab 180mg .................... 33
PYROGALL ACD OIN ....................... 104
Q
qnapril/hctz tab 10-12.5 ..................... 4
qnapril/hctz tab 20-12.5 ..................... 4
qnapril/hctz tab 20-25mg .................... 4
QNASL AER 80MCG ........................ 114
QNASL CHILD SPR 40MCG ............... 114
QUALAQUIN CAP 324MG ................... 32
QUARTETTE TAB .............................. 85
quazepam tab 15mg ......................... 47
230
QUDEXY XR CAP 100/24HR ................26
QUDEXY XR CAP 150/24HR ................26
QUDEXY XR CAP 200/24HR ................26
QUDEXY XR CAP 25/24HR ..................26
QUDEXY XR CAP 50/24HR ..................26
QUESTRAN POW 4GM ........................53
QUESTRAN POW 4GM LITE .................53
quetiapine tab 100mg .......................77
quetiapine tab 25mg .........................77
quetiapine tab 50mg .........................77
QUICKTEK TES .................................75
QUILLIVANT SUS 25MG/5ML ............ 164
quinapril tab 10mg ............................. 3
quinapril tab 20mg ............................. 3
quinapril tab 40mg ............................. 3
quinapril tab 5mg .............................. 3
quinidine gl tab 324mg cr ..................21
quinidine su tab 200mg .....................21
quinidine su tab 300mg .....................21
quinidine su tab 300mg er .................21
quinine sulf cap 324mg......................32
quinine sulf tab 260mg ......................32
QUINTET AC TES BLD GLUC ...............75
QUINTET TES BLD GLUC ....................75
QUINZYME TAB 90MG........................11
QUTENZA KIT 8% 1-PCH ................. 107
QVAR AER 40MCG ........................... 161
QVAR AER 80MCG ........................... 161
R
RA TRUETEST TES.............................75
rabeprazole tab 20mg ..................... 148
RADIOGARDASE CAP 0.5GM ...............28
raloxifene tab 60mg ........................ 154
ramipril cap 1.25mg ........................... 3
ramipril cap 10mg .............................. 3
ramipril cap 2.5mg ............................. 3
ramipril cap 5mg ............................... 3
RANEXA TAB 1000MG ........................20
RANEXA TAB 500MG .........................20
ranitidine cap 300mg.........................94
ranitidine syp 75mg/5ml ....................94
ranitidine tab 300mg .........................94
RAPAFLO CAP 4MG ............................. 9
RAPAFLO CAP 8MG ............................. 9
RAPAMUNE SOL 1MG/ML ................. 108
RAPAMUNE TAB 0.5MG ................... 108
RAPAMUNE TAB 1MG ...................... 109
RAPAMUNE TAB 2MG ...................... 109
RASUVO INJ 10MG ........................... 42
RASUVO INJ 12.5MG ........................ 42
RASUVO INJ 15MG ........................... 42
RASUVO INJ 17.5MG ........................ 42
RASUVO INJ 22.5MG ........................ 42
RASUVO INJ 25MG ........................... 42
RASUVO INJ 27.5MG ........................ 42
RASUVO INJ 30MG ........................... 42
RASUVO INJ 7.5MG .......................... 42
RAVICTI LIQ 1.1GM/ML ................... 176
RAYOS TAB 1MG .............................. 90
RAYOS TAB 2MG .............................. 91
RAYOS TAB 5MG .............................. 91
RAZADYNE ER CAP 16MG .................. 63
RAZADYNE ER CAP 24MG .................. 63
RAZADYNE ER CAP 8MG .................... 63
RAZADYNE TAB 12MG ....................... 63
RAZADYNE TAB 4MG ........................ 63
RAZADYNE TAB 8MG ........................ 63
rea lo 39 cre 39% ............................ 81
rea lo 40 cre 40% ............................ 81
rea lo 40 lot 40% ............................. 81
REBETOL CAP 200MG ....................... 95
REBETOL SOL 40MG/ML .................... 95
REBIF INJ 22/0.5 ........................... 112
REBIF INJ 44/0.5 ........................... 112
REBIF REBIDO INJ 22/0.5 ............... 112
REBIF REBIDO INJ 44/0.5 ............... 112
REBIF REBIDO INJ TITRATN ............ 112
REBIF TITRTN INJ PACK .................. 112
RECTIV OIN 0.4% .......................... 119
REDICHEW RX CHW ....................... 145
REFUAH PLUS TES BLD GLUC............. 75
REGLAN TAB 10MG ........................... 89
REGLAN TAB 5MG ............................ 89
relagard gel ................................... 111
RELENZA MIS DISKHALE ................. 119
RELHIST CHW .................................. 71
RELION BLOOD TES GLUCOSE ........... 75
RELION KETON TES .......................... 75
RELION PRIME TES ........................... 75
231
RELION PRIME TES GLUCOSE .............75
RELION TES ULTIMA..........................75
RELISTOR INJ 12/0.6ML .................. 138
RELISTOR INJ 8/0.4ML .................... 138
RELPAX TAB 20MG .......................... 155
RELPAX TAB 40MG .......................... 155
REMATEX CRE ................................ 107
REMERON SLTB TAB 15MG .................10
REMERON TAB 15MG .........................10
REMERON TAB 30MG .........................10
REMERON TAB 45MG .........................10
RENAGEL TAB 400MG ...................... 140
RENAGEL TAB 800MG ...................... 140
RENOVO LIDO5 CRE 5-0.05% .......... 171
RENUU NL PAD 2-30%..................... 153
RENUU PAD 2-5-30% ...................... 171
RENVELA PAK 0.8GM ....................... 140
RENVELA PAK 2.4GM ....................... 140
RENVELA TAB 800MG ...................... 140
repaglinide tab 0.5mg ..................... 109
repaglinide tab 1mg ........................ 109
repaglinide tab 2mg ........................ 109
REPATHA INJ 140MG/ML .................. 137
REPATHA SURE INJ 140MG/ML ......... 137
REPREXAIN TAB 2.5-200....................98
REPREXAIN TAB 5-200MG ..................98
REPRONEX INJ 75UNIT .................... 136
REQUIP TAB 0.25MG ....................... 122
REQUIP TAB 0.5MG ......................... 122
REQUIP TAB 1MG ............................ 122
REQUIP TAB 2MG ............................ 122
REQUIP TAB 3MG ............................ 122
REQUIP TAB 4MG ............................ 122
REQUIP TAB 5MG ............................ 122
REQUIP XL TAB 12MG...................... 122
REQUIP XL TAB 2MG ....................... 122
REQUIP XL TAB 4MG ....................... 122
REQUIP XL TAB 6MG ....................... 122
REQUIP XL TAB 8MG ....................... 122
RESCON-MX TAB ..............................71
RESCRIPTOR TAB 100 MG ..................40
RESCRIPTOR TAB 200MG ...................40
RESCULA SOL 0.15% ...................... 147
reserpine tab 0.1mg ........................ 151
reserpine tab 0.25mg ..................... 151
RESPA-BR TAB 11MG ........................ 30
RESTASIS EMU 0.05% .................... 127
RESTORA RX CAP 60-1.25 ................. 28
RESTORA SPRI PAK 15-0.25 .............. 28
RESTORIL CAP 15MG ........................ 47
RESTORIL CAP 22.5MG ..................... 47
RESTORIL CAP 30MG ........................ 47
RESTORIL CAP 7.5MG ....................... 47
RETIN-A CRE 0.025% ......................... 7
RETIN-A CRE 0.05% ........................... 7
RETIN-A CRE 0.1%............................. 7
RETIN-A GEL 0.01% ........................... 7
RETIN-A GEL 0.025% ......................... 7
RETIN-A MICR GEL 0.04% ................... 7
RETIN-A MICR GEL 0.08% ................... 7
RETIN-A MICR GEL 0.1% .................... 7
RETROVIR CAP 100MG ...................... 41
RETROVIR SYP 50MG/5ML ................. 41
REVATIO SUS 10MG/ML .................. 149
REVATIO TAB 20MG ....................... 149
REVEAL TES BLD GLUC ..................... 75
REVIA TAB 50MG ........................... 134
REVLIMID CAP 10MG ...................... 101
REVLIMID CAP 15MG ...................... 101
REVLIMID CAP 2.5MG ..................... 101
REVLIMID CAP 20MG ...................... 101
REVLIMID CAP 25MG ...................... 101
REVLIMID CAP 5MG ........................ 101
REXULTI TAB 0.25MG ..................... 150
REXULTI TAB 0.5MG ....................... 150
REXULTI TAB 1MG .......................... 150
REXULTI TAB 2MG .......................... 150
REXULTI TAB 3MG .......................... 150
REXULTI TAB 4MG .......................... 150
REYATAZ CAP 150MG ....................... 40
REYATAZ CAP 200MG ....................... 40
REYATAZ CAP 300MG ....................... 40
REYATAZ POW 50MG ........................ 40
REZIRA SOL 60-5/5ML .................... 134
RHEUMATREX TAB 2.5MG .................. 42
RHINOCORT SUS AQUA .................. 114
RIAX AER 5.5%.................................. 7
RIAX AER 9.5%.................................. 7
ribasphere tab 400mg....................... 95
ribasphere tab 600mg....................... 95
232
ribavirin cap 200mg ..........................95
RIDAURA CAP 3MG ...........................91
rifabutin cap 150mg ..........................33
RIFADIN CAP 150MG .........................33
RIFADIN CAP 300MG .........................33
RIFAMATE CAP .................................18
rifampin cap 150mg ..........................33
rifampin cap 300mg ..........................33
RIFATER TAB ....................................18
RIGHTEST TES GS100 .......................75
RIGHTEST TES GS300 .......................75
RIGHTEST TES GS550 .......................76
RILUTEK TAB 50MG ...........................46
riluzole tab 50mg ..............................46
rimantadine tab 100mg ................... 102
RIMANTALIST PAK .......................... 102
RIOMET SOL ....................................53
risedron sod tab 35mg dr ...................54
risedronate tab 150mg ......................54
risedronate tab 30mg ........................54
risedronate tab 35mg ........................54
risedronate tab 5mg ..........................54
RISPERDAL M TAB 0.5MG ..................46
RISPERDAL M TAB 1MG .....................46
RISPERDAL SOL 1MG/ML ...................46
RISPERDAL TAB 0.25MG ....................46
RISPERDAL TAB 0.5MG ......................46
RISPERDAL TAB 1MG ........................46
RISPERDAL TAB 2MG ........................46
RISPERDAL TAB 3MG ........................46
RISPERDAL TAB 4MG ........................46
risperidone sol 1mg/ml ......................46
risperidone tab 0.25 odt ....................46
risperidone tab 0.25mg .....................46
risperidone tab 0.5mg .......................46
risperidone tab 0.5mg od ...................46
risperidone tab 1mg ..........................46
risperidone tab 1mg odt ....................46
risperidone tab 4mg odt .................... 47
RITALIN LA CAP 10MG .................... 164
RITALIN LA CAP 20MG .................... 164
RITALIN LA CAP 30MG .................... 164
RITALIN LA CAP 40MG .................... 164
RITALIN LA CAP 60MG .................... 164
RITALIN TAB 10MG......................... 164
RITALIN TAB 20MG......................... 164
RITALIN TAB 5MG .......................... 164
rivastigmine cap 1.5mg..................... 63
rivastigmine cap 3mg ....................... 63
rivastigmine cap 4.5mg..................... 63
rivastigmine cap 6mg ....................... 63
rivastigmine dis 13.3/24 ................... 63
rivastigmine dis 4.6mg/24 ................. 63
rivastigmine dis 9.5mg/24 ................. 63
rizatriptan tab 10mg ....................... 155
rizatriptan tab 10mg odt ................. 155
rizatriptan tab 5mg......................... 155
rizatriptan tab 5mg odt ................... 155
ROBAXIN TAB 500MG ....................... 60
ROBAXIN-750 TAB 750MG ................. 60
ROBINUL FORT TAB 2MG................. 150
ROBINUL TAB 1MG ......................... 150
ROCALTROL CAP 0.25MCG ................ 99
ROCALTROL CAP 0.5MCG .................. 99
ROCALTROL SOL 1MCG/ML ................ 99
ropinirole tab 0.25mg ..................... 122
ropinirole tab 0.5mg ....................... 122
ropinirole tab 12mg er .................... 123
ropinirole tab 1mg .......................... 122
ropinirole tab 2mg er ...................... 122
ROSADAN KIT 0.75% ..................... 152
ROSANIL KIT ..................................... 6
ROSENTHAL MIS ............................ 117
ROSULA LIQ 10-4.5% ......................... 6
ROWASA KIT 4GM .......................... 102
ROXICET SOL 5-325/5 .................... 135
ROXICODONE TAB 15MG................. 133
233
ROXICODONE TAB 30MG ................. 133
ROXICODONE TAB 5MG ................... 133
ROZEREM TAB 8MG ......................... 154
RUCONEST INJ 2100UNIT ..................55
RYTARY CAP ................................... 106
RYTARY CAP 23.75-95 ..................... 106
RYTHMOL SR CAP 225MG ...................22
RYTHMOL SR CAP 325MG...................22
RYTHMOL SR CAP 425MG ...................22
RYTHMOL TAB 150MG .......................22
RYTHMOL TAB 225MG .......................22
S
SABRIL POW 500MG .........................88
SABRIL TAB 500MG...........................88
SAFETYGLIDE MIS 27GX5/8" ............ 117
SAFTY NEEDLE MIS 21GX5/8" .......... 117
SAFTY NEEDLE MIS 23GX5/8" .......... 117
SAFYRAL TAB ...................................65
SAIZEN INJ 5MG ...............................93
SAIZEN INJ 8.8MG ............................93
SALAGEN TAB 5MG ......................... 153
SALAGEN TAB 7.5MG ...................... 153
SALEX CREAM KIT 6% ..................... 104
SALEX LOTION KIT 6% .................... 104
SALEX SHA 6% ............................... 104
salicylic ac aer 6% .......................... 104
salicylic ac cre 6% .......................... 104
salicylic ac gel 6%........................... 104
salicylic ac kit 6% cream.................. 105
salicylic ac kit 6% lotn ..................... 105
SALICYLIC AC LIQ 26% ................... 105
salicylic ac liq 27.5% ....................... 105
salicylic ac lot 6% ........................... 105
salicylic ac sha 6% .......................... 105
salicylic ac sol 28.5% ...................... 105
salicylic aer 6% .............................. 105
SALINE/PHENO SOL ........................ 137
SALKERA AER 6% ........................... 104
salsalate tab 500mg ........................ 152
salsalate tab 750mg ........................ 152
SALVAX AER 6% ............................. 105
SALVAX DUO KIT PLUS .................... 104
SAMSCA TAB 15MG ......................... 157
SAMSCA TAB 30MG ......................... 157
SANCUSO DIS 3.1MG ......................... 1
SANDIMMUNE CAP 100MG .................71
SANDIMMUNE CAP 25MG .................. 71
SANDIMMUNE SOL 100MG/ML ........... 71
SANDOSTATIN INJ 1000MCG ........... 160
SANDOSTATIN INJ 100MCG ............. 160
SANDOSTATIN INJ 50MCG/ML ......... 160
SANTYL OIN 250/GM ........................ 82
SAPHRIS SUB 10MG ......................... 77
SAPHRIS SUB 2.5MG ........................ 77
SAPHRIS SUB 5MG ........................... 77
SARAFEM TAB 10MG ....................... 142
SARAFEM TAB 20MG ....................... 142
SAVAYSA TAB 15MG ......................... 79
SAVAYSA TAB 30MG ......................... 79
SAVAYSA TAB 60MG ......................... 79
SAVELLA MIS TITR PAK ..................... 86
SAVELLA TAB 100MG ........................ 86
SAVELLA TAB 12.5MG ....................... 86
SAVELLA TAB 25MG .......................... 86
SAVELLA TAB 50MG .......................... 86
sb backache tab 500mg .................. 152
SCALACORT DK KIT ........................ 172
scalacort lot 2% ............................... 68
SCAR PATCH PAD ........................... 171
SECONAL CAP 100MG ....................... 45
SECTRAL CAP 200MG ........................ 51
SECTRAL CAP 400MG ........................ 51
SELECT-OB CHW ............................ 144
SELECT-OB+ PAK DHA .................... 145
selegiline cap 5mg............................ 37
selegiline tab 5mg ............................ 37
selenium sul lot 2.5% ....................... 42
SELENIUM SUL SHA 2.25% ............... 42
SELRX SHA 2.3% ............................. 42
SELZENTRY TAB 150MG .................... 39
SELZENTRY TAB 300MG .................... 39
SEMPREX-D CAP 8-60MG .................. 71
SE-NATAL 19 TAB .......................... 143
SENSIPAR TAB 30MG ........................ 55
SENSIPAR TAB 60MG ........................ 55
SENSIPAR TAB 90MG ........................ 55
SENTRADINE PAK ............................. 93
SENTRALOPRAM PAK AM-10 ............ 161
SENTRAMODAFI PAK AM-100 ........... 162
SENTRAVIL PM PAK -25 .................. 175
234
SENTRAZOLPID PAK PM-5 ..................88
SEREVENT DIS AER 50MCG ................49
SEROQUEL TAB 100MG ......................77
SEROQUEL TAB 200MG ......................77
SEROQUEL TAB 25MG .......................77
SEROQUEL TAB 300MG ......................77
SEROQUEL TAB 400MG ......................77
SEROQUEL TAB 50MG .......................77
SEROQUEL XR TAB 150MG .................77
SEROQUEL XR TAB 50MG...................77
SEROSTIM INJ 4MG...........................93
SEROSTIM INJ 5MG...........................93
SEROSTIM INJ 6MG...........................93
sertraline con 20mg/ml ................... 157
sertraline tab 100mg ....................... 157
sertraline tab 25mg ......................... 157
sertraline tab 50mg ......................... 157
SE-TAN DHA CAP ............................ 143
SFROWASA ENE 4GM ...................... 102
SHOHLS SOL MODIFIED ....................64
SHUR-SEAL GEL 2% ........................ 160
SIDEKICK KIT SYSTEM ......................91
SIGNIFOR INJ 0.3MG/ML ................. 160
SILAZONE PAK PHARMAPA ............... 172
sildenafil tab 20mg ......................... 149
SILENOR TAB 3MG ............................99
SILENOR TAB 6MG ............................99
SILMANIX CRE................................ 107
SILVADENE CRE 1% ..........................55
SILVER NITRA OIN 10% ....................59
SILVER NITRA SOL 0.5% ...................60
SILVER NITRA SOL 10% ....................60
SILVER NITRA SOL 25% ....................60
SILVER NITRA SOL 50% ....................60
silver sulfa cre 1% ............................55
SIMBRINZA SUS 1-0.2%....................10
SIMCOR TAB 1000-20 .......................96
SIMCOR TAB 1000-40 .......................96
SIMCOR TAB 500-20MG .....................96
SIMCOR TAB 500-40MG .....................96
SIMCOR TAB 750-20MG .....................96
SIMPONI INJ 100MG/ML .................... 19
SIMPONI INJ 50/0.5ML ..................... 19
simvastatin tab 10mg ....................... 97
simvastatin tab 5mg ......................... 97
SINEMET CR TAB 25-100MG ............ 106
SINEMET CR TAB 50-200MG ............ 106
SINEMET TAB 10-100MG ................. 106
SINEMET TAB 25-100MG ................. 106
SINEMET TAB 25-250MG ................. 106
SINGULAIR CHW 4MG ..................... 105
SINGULAIR CHW 5MG ..................... 105
SINGULAIR GRA 4MG ..................... 105
SINGULAIR TAB 10MG .................... 105
sirolimus tab 0.5mg ........................ 109
sirolimus tab 1mg .......................... 109
sirolimus tab 2mg .......................... 109
SIRTURO TAB 100MG ....................... 33
SITAVIG TAB 50MG .......................... 95
SIVEXTRO TAB 200MG .................... 137
SKELAXIN TAB 800MG ...................... 60
SKLICE LOT 0.5% .......................... 153
SMART SENSE TES TEST ................... 76
SMARTEST TES BLD GLUC ................. 76
smz/tmp ds tab 800-160 ................... 18
smz-tmp sus 200-40/5 ..................... 18
smz-tmp tab 400-80mg .................... 18
sod chloride neb 0.9% .................... 111
sod fluoride dro 0.5mg/ml ................. 87
sod fluoride tab 0.5mg f .................... 87
sod fluoride tab 1mg f....................... 87
sod poly sul sus 15gm/60................ 142
sod poly sul sus 30/120ml ............... 142
sod sul/sulf cre 10-2% ........................ 6
sod sul/sulf cre 9.8-4.8% .................... 6
SOD SUL/SULF EMU 10-5% ................. 6
sod sul/sulf gel 10-5% ........................ 6
sod sul/sulf kit ................................... 6
sod sul/sulf liq 10-2% ......................... 6
sod sul/sulf liq 9.8-4.8% ..................... 6
sod sul/sulf liq 9-4.5% ........................ 6
sod sul/sulf liq wash ........................... 6
sod sul/sulf lot 10-5% ........................ 6
sod sul/sulf lot 9.8-4.8% ..................... 6
235
sod sul/sulf pad 10-4%....................... 6
SOD SUL/SULF SUS 10-5% ................. 6
sod sul/sulf sus 8-4% ......................... 6
sod sulfacet gel 10% .........................42
sod sulfacet sha 10% ........................42
sodium chlor neb 10% ..................... 111
sodium chlor neb 3% ...................... 111
sodium chlor neb 7% ...................... 111
sodium sulfa liq 10% wash .................42
SODIUM SULFA LIQ 10% WASH .........42
SOF-SENSOR MIS .............................91
SOLARAZE GEL 3% W/W ...................36
SOLODYN TAB 105MG ..................... 167
SOLODYN TAB 115MG ..................... 167
SOLODYN TAB 55MG ....................... 167
SOLODYN TAB 65MG ....................... 167
SOLODYN TAB 80MG ....................... 167
SOLTAMOX SOL 10MG/5ML ................28
SOLUS V2 TES AUDIBLE ....................76
SOMA TAB 250MG.............................60
SOMA TAB 350MG.............................60
SOMAVERT INJ 10MG ........................92
SOMAVERT INJ 15MG ........................92
SOMAVERT INJ 20MG ........................92
SOMAVERT INJ 25MG ........................92
SOMAVERT INJ 30MG ........................92
SONATA CAP 10MG ......................... 121
SONATA CAP 5MG ........................... 121
SOOLANTRA CRE 1% ...................... 152
SOOTHEE PAD ................................ 171
SORIATANE CAP 10MG ......................38
SORIATANE CAP 17.5MG ...................38
SORIATANE CAP 25MG ......................38
SORILUX AER 0.005% .......................38
sotalol af tab 120mg .........................52
sotalol af tab 160mg .........................52
sotalol af tab 80mg ...........................52
sotalol hcl tab 120mg ........................52
sotalol hcl tab 80mg ..........................52
SOTYLIZE SOL 5MG/ML .....................52
SOVALDI TAB 400MG ........................95
SPECTRACEF TAB 200MG ...................62
SPECTRACEF TAB 400MG ...................62
spinosad sus 0.9% .......................... 153
SPIRIVA AER RESPIMAT .................... 55
SPIRIVA CAP HANDIHLR ................... 55
SPIRIVA SPR RESPIMAT .................... 55
spirono/hctz tab 25/25 ..................... 80
spironolact tab 100mg .................... 142
spironolact tab 25mg ...................... 142
spironolact tab 50mg ...................... 142
SPORANOX CAP 100MG................... 173
SPORANOX SOL 10MG/ML ............... 173
sprintec 28 tab 28 day ...................... 65
SPRIX SPR 15.75MG ....................... 125
SPRYCEL TAB 100MG ........................ 35
SPRYCEL TAB 140MG ........................ 35
SPRYCEL TAB 20MG.......................... 35
SPRYCEL TAB 50MG.......................... 35
SPRYCEL TAB 70MG.......................... 35
SPRYCEL TAB 80MG.......................... 35
SSKI SOL 1GM/ML .......................... 104
sss 10-5 aer 10-5% ............................ 6
st joseph as chw 81mg ................... 152
STALEVO 100 TAB .......................... 106
STALEVO 125 TAB .......................... 106
STALEVO 150 TAB .......................... 106
STALEVO 200 TAB .......................... 106
STALEVO 50 TAB ............................ 106
STALEVO 75 TAB ............................ 106
STARLIX TAB 120MG ...................... 109
STARLIX TAB 60MG ........................ 109
stavudine cap 15mg ......................... 41
stavudine cap 20mg ......................... 41
stavudine cap 30mg ......................... 41
stavudine cap 40mg ......................... 41
stavudine sol 1mg/ml ....................... 41
STAVZOR CAP 125MG ..................... 179
STAVZOR CAP 250MG ..................... 179
STAVZOR CAP 500MG ..................... 179
STAXYN TAB 10MG ......................... 153
STELARA INJ 45MG/0.5 ..................... 38
STELARA INJ 90MG/ML ..................... 38
STENDRA TAB 100MG ..................... 153
STENDRA TAB 200MG ..................... 153
STENDRA TAB 50MG ....................... 153
sterile dilu sol epopros .................... 137
STERILE DILU SOL FLOLAN ............. 137
STIMATE SOL 1.5MG/ML ................. 179
STIMEX NEEDL MIS 22GX4.25 ......... 117
236
STIMEX NEEDL MIS 22X2-1/8........... 117
STIOLTO AER RESPIMAT ..................... 8
STIVARGA TAB 40MG ........................34
STRATTERA CAP 100MG ..................... 8
STRATTERA CAP 10MG ....................... 8
STRATTERA CAP 18MG ....................... 8
STRATTERA CAP 25MG ....................... 8
STRATTERA CAP 40MG ....................... 8
STRATTERA CAP 60MG ....................... 8
STRATTERA CAP 80MG ....................... 8
STRAZEPAM PAK ...............................47
STRIANT MIS 30MG ..........................14
STRIBILD TAB ..................................39
STRIVERDI AER RESPIMAT .................49
STROMECTOL TAB 3MG .....................18
SUBOXONE MIS 12-3MG .................. 135
SUBOXONE MIS 2-0.5MG ................. 135
SUBOXONE MIS 4-1MG.................... 135
SUBOXONE MIS 8-2MG.................... 135
SUBSYS SPR 100MCG ...................... 133
SUBSYS SPR 1200MCG .................... 133
SUBSYS SPR 1600MCG .................... 133
SUBSYS SPR 200MCG ...................... 133
SUBSYS SPR 400MCG ...................... 133
SUBSYS SPR 600MCG ...................... 133
SUBSYS SPR 800MCG ...................... 133
SUCRAID SOL 8500/ML .....................78
sucralfate tab 1gm .......................... 110
SULAR TAB 17MG .............................58
SULAR TAB 34MG .............................58
SULAR TAB 8.5MG ............................58
SULF LIME SOL ............................... 153
sulf/pred na sol op .......................... 128
sulf/sunscrn kit 9-4.5% ...................... 6
sulfacet sod oin 10% op .................. 129
sulfacet sod sol 10% op ................... 129
sulfacetamid sus 10% ........................ 5
SULFADIAZINE TAB 500MG .............. 164
SULFAMYLON CRE 85MG/GM ..............55
SULFAMYLON PAK 5% .......................55
sulfasalazin tab 500mg .................... 102
sulfazine ec tab 500mg .................... 102
SULFISOXIZOL CRY......................... 164
SULFOAM SHA 2% ............................. 7
sulindac tab 150mg ......................... 125
sulindac tab 200mg ......................... 125
SUMADAN KIT ................................... 6
SUMADAN WASH LIQ 9-4.5% .............. 6
SUMADAN XLT KIT 9-4.5% .................. 6
sumatriptan inj 4mg/0.5 ................. 155
sumatriptan inj 6mg/0.5 ................. 155
sumatriptan spr 20mg/act ............... 155
sumatriptan spr 5mg/act ................. 155
sumatriptan tab 100mg .................. 155
sumatriptan tab 25mg .................... 155
sumatriptan tab 50mg .................... 155
SUMAVEL DOSE INJ 4MG/0.5 ........... 155
SUMAVEL DOSE INJ 6MG/0.5 ........... 155
SUMAXIN CP KIT ................................ 6
SUMAXIN PAD 10-4% ......................... 6
SUMAXIN TS SUS 8-4% ...................... 6
SUMAXIN WASH LIQ 9-4% .................. 6
SUPRACIL CRE ............................... 104
SUPRAX CAP 400MG ......................... 62
SUPRAX CHW 100MG ........................ 62
SUPRAX CHW 200MG ........................ 62
SUPRAX SUS 100/5ML ...................... 62
SUPRAX SUS 200/5ML ...................... 62
SUPRAX SUS 500/5ML ...................... 62
SUPREME II MIS PADDLES ................ 91
SUPREME TES .................................. 76
SUPREP BOWEL SOL PREP ................. 54
SURE EDGE TES ............................... 76
SURECHEK TES BLD GLUC ................. 76
SURE-TEST TES EASYPLUS ................ 76
SURFAXIN SUS 30MG/ML ................ 151
SURMONTIL CAP 100MG ................. 175
SURMONTIL CAP 25MG ................... 174
SURMONTIL CAP 50MG ................... 174
SUSTIVA CAP 200MG ........................ 40
SUSTIVA CAP 50MG.......................... 40
SUSTIVA TAB 600MG ........................ 40
SUTENT CAP 12.5MG ........................ 34
SUTENT CAP 25MG ........................... 34
SUTENT CAP 37.5MG ........................ 34
SUTENT CAP 50MG ........................... 34
SUTTAR-SF SYP ............................... 44
SYLATRON KIT 200MCG .................... 36
SYLATRON KIT 300MCG .................... 36
SYLATRON KIT 600MCG .................... 36
SYMAX DUOTAB TAB ........................ 45
SYMBICORT AER 160-4.5 .................... 8
237
SYMBICORT AER 80-4.5...................... 8
SYMBYAX CAP 12-25MG................... 169
SYMBYAX CAP 12-50MG................... 169
SYMBYAX CAP 3-25MG .................... 169
SYMBYAX CAP 6-25MG .................... 169
SYMBYAX CAP 6-50MG .................... 169
SYMLINPEN 60 INJ 1000MCG .............27
SYMLNPEN 120 INJ 1000MCG .............27
SYMPATH NDL MIS 18GX6" .............. 117
SYNALAR CRE 0.025%.......................68
SYNALAR KIT 0.025% ..................... 172
SYNALAR OIN 0.025% .......................68
SYNALAR SOL 0.01% ........................68
SYNALAR TS KIT 0.01%................... 172
SYNALGOS-DC CAP ...........................78
SYNAREL SOL 2MG/ML .................... 106
SYNERA DIS 70-70MG ..................... 171
SYNJARDY TAB ............................... 159
SYNJARDY TAB 12.5-500 ................. 160
SYNJARDY TAB 5-1000MG ............... 159
SYNJARDY TAB 5-500MG ................. 159
SYNTHROID TAB 100MCG ................ 170
SYNTHROID TAB 25MCG .................. 170
SYPRINE CAP 250MG .........................62
T
TABLOID TAB 40MG ..........................33
TABRADOL SUS 1MG/ML ....................60
TACLONEX OIN ............................... 172
TACLONEX SUS .............................. 172
tacrolimus cap 0.5mg ...................... 109
tacrolimus cap 1mg ......................... 109
tacrolimus cap 5mg ......................... 109
tacrolimus oin 0.03% ...................... 109
tacrolimus oin 0.1% ........................ 109
TAFINLAR CAP 50MG ........................ 34
TAFINLAR CAP 75MG ........................ 34
TAMIFLU CAP 30MG ........................ 119
TAMIFLU CAP 45MG ........................ 119
TAMIFLU CAP 75MG ........................ 119
TAMIFLU SUS 6MG/ML .................... 119
tamoxifen tab 10mg ......................... 28
tamoxifen tab 20mg ......................... 28
tamsulosin cap 0.4mg ......................... 9
TANZEUM INJ 30MG ....................... 101
TANZEUM INJ 50MG ....................... 101
TAPAZOLE TAB 10MG ....................... 43
TAPAZOLE TAB 5MG ......................... 43
TARCEVA TAB 100MG ....................... 35
TARCEVA TAB 150MG ....................... 35
TARCEVA TAB 25MG ......................... 35
TARGADOX TAB 50MG .................... 167
TARGRETIN CAP 75MG .................... 154
TARGRETIN GEL 1% ....................... 172
TARKA TAB 1-240 CR ......................... 2
TARKA TAB 2-180 CR ......................... 2
TARKA TAB 2-240 CR ......................... 2
TARKA TAB 4-240 CR ......................... 2
taron gra crystals ............................. 64
TARON-BC MIS .............................. 144
TARON-C DHA CAP ......................... 144
TARON-PREX CAP ........................... 145
TASIGNA CAP 150MG ....................... 35
TASIGNA CAP 200MG ....................... 35
TASMAR TAB 100MG ......................... 61
TAZORAC CRE 0.05% ....................... 38
TAZORAC CRE 0.1% ......................... 38
TAZORAC GEL 0.05% ....................... 38
TAZORAC GEL 0.1% ......................... 38
TB SYRINGE MIS 0.5/28G ............... 118
tbc aer ............................................ 82
TECFIDERA CAP 120MG .................. 112
TECFIDERA CAP 240MG .................. 113
TECFIDERA MIS STARTER ............... 113
TECHNIVIE TAB ............................... 94
TEGRETOL SUS 100/5ML ................... 26
TEGRETOL TAB 200MG ..................... 26
TEGRETOL-XR TAB 100MG ................ 26
TEKTURNA HCT TAB 150-12.5 ........... 80
238
TEKTURNA HCT TAB 150-25MG ..........80
TEKTURNA HCT TAB 300-12.5 ............80
TEKTURNA HCT TAB 300-25MG ..........80
TEKTURNA TAB 150MG ......................80
TEKTURNA TAB 300MG ......................80
TELCARE TES BLD GLUC ....................76
telmis/amlod tab 40-10mg .................15
telmis/amlod tab 40-5mg...................15
telmis/amlod tab 80-10mg .................15
telmis/amlod tab 80-5mg...................15
telmisa/hctz tab 40-12.5....................16
telmisa/hctz tab 80-12.5....................16
telmisa/hctz tab 80-25mg ..................16
telmisartan tab 20mg ........................17
temazepam cap 15mg .......................47
temazepam cap 22.5mg ....................47
temazepam cap 30mg .......................47
temazepam cap 7.5mg ......................47
TEMODAR CAP 100MG ..................... 100
TEMODAR CAP 140MG ..................... 100
TEMODAR CAP 180MG ..................... 100
TEMODAR CAP 20MG ....................... 100
TEMODAR CAP 250MG ..................... 101
TEMODAR CAP 5MG ........................ 100
TEMODAR INJ 100MG ...................... 101
TEMOVATE CRE 0.05% ......................68
TEMOVATE E CRE 0.05%EML ..............68
TEMOVATE GEL 0.05% ......................69
TEMOVATE OIN 0.05% ......................69
TEMOVATE SOL 0.05% ......................69
temozolomide cap 100mg ................ 101
temozolomide cap 20mg .................. 101
temozolomide cap 5mg .................... 101
TENEX TAB 1MG ...............................20
TENEX TAB 2MG ...............................20
TENORETIC TAB 100 .........................50
TENORETIC TAB 50 ...........................50
TENORMIN TAB 100MG ......................51
TENORMIN TAB 25MG .......................51
TENORMIN TAB 50MG .......................51
TERAZOL 3 CRE 0.8% ..................... 100
TERAZOL 7 CRE 0.4% ..................... 100
terazosin cap 10mg .......................... 20
terazosin cap 1mg ............................ 20
terazosin cap 2mg ............................ 20
terazosin cap 5mg ............................ 20
terbinafine tab 250mg ...................... 29
terbutaline tab 2.5mg ....................... 49
terbutaline tab 5mg .......................... 49
terconazole cre 0.4% ...................... 100
TERSI FOAM AER 2.25% ................... 42
TESSALON PER CAP 100MG ............... 43
testosterone gel 1%(25mg) ............... 14
testosterone gel 1%(50mg) ............... 15
testosterone gel 10mg/act................. 15
testosterone gel pump 1% ................ 15
TESTRED CAP 10MG ......................... 15
tetrabenazin tab 12.5mg ................. 112
tetrabenazin tab 25mg .................... 112
tetracaine sol 0.5% op .................... 127
tetracycline cap 250mg ................... 167
tetracycline cap 500mg ................... 167
TETRAMEX SPR 2-1-3% .................. 172
TEXACORT SOL 2.5% ....................... 69
TEXAVITE LQ LIQ ........................... 138
TGQ 15DM/5PE SYP H/2CPM ............ 121
TGQ 30/ SYP 150/15 ........................ 44
TGQ 30/PSE/3 SYP BRM/15DM ......... 121
THALOMID CAP 100MG ..................... 32
THALOMID CAP 150MG ..................... 32
THALOMID CAP 200MG ..................... 32
THALOMID CAP 50MG ....................... 32
THEO-24 CAP 100MG CR ................. 180
THEO-24 CAP 200MG CR ................. 180
THEO-24 CAP 300MG CR ................. 180
THEO-24 CAP 400MG ER ................. 180
theochron tab 100mg cr .................. 180
theophylline sol 80/15ml ................. 181
theophylline tab 400mg er............... 181
THERABENZAPR PAK -90 ................. 113
THERABENZAPR PAK -90-5 .............. 113
THERACODEINE PAK -300 ................. 64
THERACODOPHN PAK -325 ................ 99
239
THERAFELDAMI PAK ........................ 125
THERANATAL CAP ONE .................... 145
THERAPENTIN PAK -90 ......................23
THERAPROFEN PAK 800MG .............. 125
THERAPROFEN PAK -90 ................... 125
THERAPROXEN PAK 500MG .............. 125
THERAPROXEN PAK -90 ................... 125
THERATRAMADO PAK -90 ................ 172
THIABENDAZOL POW ........................18
THIOLA TAB 100MG ........................ 178
thioridazine tab 100mg .................... 139
thioridazine tab 10mg...................... 139
thiothixene cap 10mg ...................... 169
thiothixene cap 1mg........................ 169
thrive gum 2mg mint ...................... 159
THYROLAR-1 TAB 60MG ................... 171
THYROLAR-1/2 TAB 30MG ................ 171
THYROLAR-1/4 TAB 15MG ................ 171
THYROLAR-2 TAB 120MG ................. 171
THYROLAR-3 TAB 180MG ................. 171
tiagabine tab 2mg .............................88
tiagabine tab 4mg .............................88
TIAZAC CAP 120MG/24 ......................58
TIAZAC CAP 180MG/24 ......................58
TIAZAC CAP 240MG/24 ......................58
TIAZAC CAP 300MG/24 ......................58
TIAZAC CAP 360MG/24 ......................58
TIAZAC CAP 420MG/24 ......................58
TIGAN CAP 300MG ............................28
TIKOSYN CAP 125MCG ......................22
TIKOSYN CAP 250MCG ......................22
TIKOSYN CAP 500MCG ......................22
timolol gel sol 0.25% op ....................52
timolol gel sol 0.5% op ......................52
timolol mal sol 0.25% op ...................52
timolol mal sol 0.5% op .....................52
timolol mal tab 10mg ........................52
timolol mal tab 20mg ........................52
timolol mal tab 5mg ..........................52
TIMOPTIC OCU SOL 0.25% OP ...........52
TIMOPTIC OCU SOL 0.5% OP .............52
TIMOPTIC SOL 0.25% OP...................52
TIMOPTIC SOL 0.5% OP .................... 52
TIMOPTIC-XE SOL 0.25% OP ............. 52
TIMOPTIC-XE SOL 0.5% OP ............... 52
TINDAMAX TAB 250MG ..................... 18
TINDAMAX TAB 500MG ..................... 18
tinidazole tab 250mg ........................ 18
tinidazole tab 500mg ........................ 18
TIROSINT CAP 100MCG .................. 171
TIROSINT CAP 112MCG .................. 171
TIROSINT CAP 125MCG .................. 171
TIROSINT CAP 137MCG .................. 171
TIROSINT CAP 13MCG .................... 171
TIROSINT CAP 150MCG .................. 171
TIROSINT CAP 25MCG .................... 171
TIROSINT CAP 50MCG .................... 171
TIROSINT CAP 75MCG .................... 171
TIROSINT CAP 88MCG .................... 171
TIVICAY TAB 50MG........................... 39
TIVORBEX CAP 20MG...................... 125
TIVORBEX CAP 40MG...................... 125
tizanidine cap 2mg ........................... 60
tizanidine tab 2mg ........................... 60
tizanidine tab 4mg ........................... 60
TL FOLATE TAB .............................. 144
TL-CARE DHA CAP 27-1-500 ............ 144
TL-SELECT CAP .............................. 145
TOBI NEB 300/5ML ........................... 11
TOBI PODHALR CAP 28MG ................. 11
tobra/dexame sus 0.3-0.1% ............ 128
TOBRADEX OIN 0.3-0.1% ............... 128
TOBRADEX ST SUS 0.3-0.05............ 128
TOBRADEX SUS 0.3-0.1% ............... 128
tobramycin neb 300/5ml ................... 11
tobramycin sol 0.3% op .................. 127
TOBREX OIN 0.3% OP .................... 127
TOBREX SOL 0.3% OP .................... 127
TODAY SPONGE MIS ....................... 160
TOFRANIL TAB 10MG ...................... 175
TOFRANIL TAB 25MG ...................... 175
TOFRANIL TAB 50MG ...................... 175
TOFRANIL-PM CAP 100MG ............... 175
TOFRANIL-PM CAP 75MG ................. 175
240
TOLAK CRE 4%.................................36
tolazamide tab 250mg ..................... 165
tolazamide tab 500mg ..................... 165
tolbutamide tab 500mg ................... 166
tolcapone tab 100mg.........................61
tolmetin sod cap 400mg .................. 125
tolmetin sod tab 200mg ................... 125
tolmetin sod tab 600mg ................... 125
tolterodine cap 2mg er .................... 177
tolterodine cap 4mg er .................... 177
tolterodine tab 1mg ........................ 177
tolterodine tab 2mg ........................ 177
TOOMEY SYRIN MIS 70ML ................ 118
TOPAMAX SPR CAP 15MG ...................26
TOPAMAX SPR CAP 25MG ...................26
TOPAMAX TAB 100MG .......................26
TOPAMAX TAB 200MG .......................26
TOPAMAX TAB 25MG .........................26
TOPAMAX TAB 50MG .........................26
TOPICORT CRE 0.05% .......................69
TOPICORT CRE 0.25% .......................69
TOPICORT GEL 0.05% .......................69
TOPICORT OIN 0.05% .......................69
TOPICORT OIN 0.25% .......................69
TOPICORT SPR 0.25% .......................69
topiramate cap 15mg ........................26
topiramate cap 25mg ........................26
topiramate cap er 100mg...................26
topiramate cap er 25mg ....................26
topiramate cap er 50mg ....................26
topiramate tab 100mg .......................26
topiramate tab 200mg .......................26
topiramate tab 25mg.........................26
topiramate tab 50mg.........................26
TOPROL XL TAB 100MG .....................51
TOPROL XL TAB 200MG .....................51
TOPROL XL TAB 25MG .......................51
TOPROL XL TAB 50MG .......................51
torsemide tab 100mg ...................... 108
torsemide tab 10mg ........................ 108
torsemide tab 20mg ........................ 108
torsemide tab 5mg .......................... 108
TOUJEO SOLO INJ 300IU/ML ..............98
TOVIAZ TAB 4MG ............................ 177
TOVIAZ TAB 8MG ........................... 177
TRACLEER TAB 125MG .................... 149
TRACLEER TAB 62.5MG ................... 149
TRADJENTA TAB 5MG ....................... 79
tramadl/apap tab 37.5-325 ............. 172
TRAMADOL HCL CAP 150MG ER ....... 133
tramadol hcl cap er 100mg .............. 133
tramadol hcl tab 100mg er .............. 133
tramadol hcl tab 50mg .................... 133
TRANDATE TAB 100MG ..................... 10
TRANDATE TAB 200MG ..................... 10
TRANDATE TAB 300MG ..................... 10
trando/verap tab 1-240 er ................... 2
trandolapril tab 1mg ........................... 3
TRANSDERM-SC DIS 1MG ................. 28
TRANXENE T TAB 15MG .................... 48
TRANXENE T TAB 3.75MG ................. 48
TRANXENE T TAB 7.5MG ................... 48
tranylcyprom tab 10mg ................... 112
TRAVATAN Z DRO 0.004% .............. 147
travoprost dro 0.004% ................... 147
TRAZAMINE PAK 50MG ................... 158
trazodone tab 100mg ..................... 157
trazodone tab 150mg ..................... 157
trazodone tab 300mg ..................... 157
trazodone tab 50mg ....................... 157
TRECATOR TAB 250MG ..................... 33
TREPADICLOFE PAK 25MG ............... 125
TREPOXICAM PAK 7.5MG................. 125
tretinoin cap 10mg ......................... 151
tretinoin cre 0.05% ............................ 7
tretinoin cre 0.1% .............................. 7
tretinoin gel 0.01% ............................ 7
tretinoin gel 0.04% ............................ 7
tretinoin gel 0.05% ............................ 7
tretinoin gel 0.1% .............................. 7
TRETIN-X CRE 0.0375%...................... 7
241
TRETIN-X CRE 0.075% ....................... 7
TRETIN-X CRE KIT 0.025% ................. 7
TRETIN-X CRE KIT 0.05% ................... 7
TRETIN-X CRE KIT 0.1% ..................... 7
TREXALL TAB 10MG ..........................33
TREXALL TAB 15MG ..........................33
TREXALL TAB 5MG ............................33
TREXALL TAB 7.5MG .........................33
TREXIMET TAB 85-500MG ................ 154
TREZIX CAP .....................................78
triamcinolon aer 55mcg/ac ............... 114
triamcinolon aer spray .......................69
triamcinolon cre 0.025% ....................69
triamcinolon cre 0.1% .......................69
triamcinolon cre 0.5% .......................69
triamcinolon lot 0.025% ....................69
triamcinolon lot 0.1% ........................69
triamcinolon oin 0.025% ....................69
triamcinolon oin 0.1% .......................69
triamcinolon oin 0.5% .......................69
triamcinolon pst 0.1% ..................... 162
TRIAMSIL PAK COMBIPAK ................ 172
TRIAMSIL PAK MULTIPAK ................. 172
triamt/hctz cap 37.5-25 .....................80
triamt/hctz cap 50-25mg ...................80
triamt/hctz tab 37.5-25 .....................80
triamt/hctz tab 75-50mg ...................80
TRIANEX OIN 0.05% .........................69
triazolam tab 0.125mg ......................47
triazolam tab 0.25mg ........................47
TRIBENZOR20- TAB 5-12.5MG............15
TRIBENZOR40- TAB 10-12.5 ..............15
TRIBENZOR40- TAB 10-25MG.............15
TRIBENZOR40- TAB 5-12.5MG............15
TRIBENZOR40- TAB 5-25MG ..............15
TRI-CHLOR LIQ 80% .........................60
TRICITRASOL CON .......................... 101
tricitrates sol ....................................64
TRICOR TAB 145MG ..........................86
TRICOR TAB 48MG ............................86
TRIDERMA CRE FORTE..................... 172
TRIFERIC SOL ................................ 104
trifluoperaz tab 10mg ...................... 139
trifluoperaz tab 1mg ........................ 139
trifluridine sol 1% op ...................... 127
TRIGLIDE TAB 160MG ....................... 86
trihexyphen elx 0.4mg/ml ................. 37
trihexyphen tab 2mg ........................ 37
trihexyphen tab 5mg ........................ 37
tri-legest tab fe .............................. 175
TRILEPTAL SUS 300MG/5M ................ 26
TRILEPTAL TAB 150MG ..................... 26
TRILEPTAL TAB 300MG ..................... 26
TRILEPTAL TAB 600MG ..................... 26
TRILIPIX CAP 135MG ........................ 86
TRILIPIX CAP 45MG .......................... 86
trimethobenz cap 300mg .................. 28
trimethoprim sol polymyxn .............. 126
trimethoprim tab 100mg ................... 18
trimipramine cap 100mg ................. 175
trimipramine cap 25mg ................... 175
trimipramine cap 50mg ................... 175
TRINATAL GT TAB .......................... 144
TRINATAL RX TAB 1........................ 144
trinate tab ..................................... 144
TRI-NORINYL TAB 28 ...................... 175
triple dye liq .................................... 43
tri-sprintec tab ............................... 175
TRISTART DHA CAP ........................ 145
TRI-TABS DHA MIS......................... 144
TRIUMEQ TAB .................................. 39
TRIVEEN-DUO PAK DHA .................. 144
TRIVEEN-PRX CAP RNF ................... 145
TRIZIVIR TAB .................................. 39
TROKENDI XR CAP 100MG................. 26
TROKENDI XR CAP 200MG................. 26
TROKENDI XR CAP 25MG .................. 26
TROKENDI XR CAP 50MG .................. 26
tropicamide sol 0.5% op ................... 70
tropicamide sol 1% op ...................... 70
trospium chl cap 60mg er ................ 177
trospium cl tab 20mg...................... 177
TRUE METRIX TES ............................ 76
TRUE METRIX TES GLUCOSE ............. 76
TRUETEST TES ................................. 76
TRUETEST TES BLD GLUC ................. 76
TRUETRACK TES .............................. 76
TRUETRACK TES BLD GLUC ............... 76
TRULICITY INJ 0.75/0.5 .................. 101
TRULICITY INJ 1.5/0.5 .................... 101
242
TRUSOPT SOL 2% OP ...................... 127
TRUVADA TAB 200-300 .....................39
TUDORZA PRES AER 400/ACT ............55
TURPENTINE SOL SPIRITS ............... 107
TUSNEL CAP .....................................44
TUSSICAPS CAP 10-8MG.................. 134
TUSSICAPS CAP 5-4MG ................... 134
TUSSIONEX SUS 10-8/5ML .............. 134
TUZISTRA XR SUS .......................... 134
TWYNSTA TAB 40-10MG ....................16
TWYNSTA TAB 40-5MG ......................15
TWYNSTA TAB 80-10MG ....................16
TWYNSTA TAB 80-5MG ......................16
TYBOST TAB 150MG ..........................42
TYKERB TAB 250MG ..........................35
TYLENOL/COD TAB #3 .......................64
TYLENOL/COD TAB #4 .......................64
TYVASO START SOL 0.6MG/ML ......... 147
TYZEKA TAB 600MG ..........................94
TYZINE PED DRO 0.05% .................. 172
TYZINE SOL 0.1% ........................... 172
U
UCERIS AER 2MG/ACT ..................... 103
UCERIS TAB 9MG ..............................91
ULESFIA LOT 5% ............................ 153
ULORIC TAB 40MG ............................92
ULORIC TAB 80MG ............................92
ULTIMA TES .....................................76
ULTIMATECARE CAP ONE ................. 144
ULTIMATECARE CAP ONE NF ............ 144
ultra tabs tab ................................. 144
ULTRACET TAB 37.5-325 ................. 172
ULTRAM ER TAB 100MG ................... 133
ULTRAM ER TAB 200MG ................... 134
ULTRAM ER TAB 300MG ................... 134
ULTRAM TAB 50MG ......................... 134
ULTRASAL-ER SOL 28.5% ................ 105
ULTRATRAK TES ULTIMATE ................76
ULTRATRK PRO TES ..........................76
ULTRAVATE CRE 0.05% .....................69
ULTRAVATE OIN 0.05% .....................69
ULTRAVATE X KIT 0.05-10% ............ 172
ULTRESA CAP 13800UNT ...................78
ULTRESA CAP 20700UNT ...................78
ULTRESA CAP 23000UNT ...................78
UMECTA EMU ...................................81
umecta mouss aer 40% .................... 81
UMECTA NAIL SUS FILM .................... 81
UMECTA PD EMU 40-0.3% ................. 81
UMECTA PD SUS 40-0.3% ................. 81
UNIFINE PNTP MIS 29GX12MM ........ 118
UNIFINE PNTP MIS 31GX5MM .......... 118
UNISTRIP1 TES GENERIC .................. 76
URAMAXIN AER 20% ........................ 81
URAMAXIN CRE 45% ........................ 81
URAMAXIN GEL 45% ........................ 81
URAMAXIN GT KIT 45% .................... 81
URAMAXIN LOT 45% ........................ 81
urea 40% sus nail ............................ 81
urea cre 45% .................................. 81
urea cre 47% .................................. 81
urea cre 50% .................................. 81
urea emu 50% ................................. 82
urea gel 40% ................................... 81
urea hydrati aer 35% ....................... 82
urea lot 45% ................................... 81
urea nail gel 45% ............................. 81
UREA NAIL KIT ................................ 82
UREA NAIL MIS 50% ........................ 82
urea sus 50% .................................. 82
URECHOLINE TAB 10MG.................. 178
URECHOLINE TAB 5MG ................... 178
urelle tab ...................................... 177
UREVAZ CRE 44% ............................ 81
uribel cap 118mg ........................... 177
urimar-t tab .................................. 177
URIN-TEK KIT .................................. 91
UROCIT-K 10 TAB ............................ 64
UROCIT-K 15 TAB ............................ 64
UROCIT-K 5 TAB .............................. 64
UROGESIC- TAB BLUE .................... 177
urolet mb tab ................................ 177
UROQID #2 TAB ............................ 109
UROXATRAL TAB 10MG ....................... 9
URSO 250 TAB 250MG ...................... 89
URSO FORTE TAB 500MG .................. 89
ursodiol cap 300mg .......................... 89
ursodiol tab 250mg .......................... 89
243
ursodiol tab 500mg ...........................89
ustell cap ....................................... 177
UTA CAP 120MG ............................. 177
UTOPIC CRE 41% .............................81
V
VAGIFEM TAB 10MCG ...................... 178
valacyclovir tab 1gm .........................95
valacyclovir tab 500mg ......................95
VALCHLOR GEL 0.016% .....................35
VALCYTE SOL 50MG/ML .....................64
VALCYTE TAB 450MG ........................64
valganciclov tab 450mg .....................64
VALIUM TAB 10MG ............................48
VALIUM TAB 2MG..............................48
VALIUM TAB 5MG..............................48
valproic acd cap 250mg ................... 179
valproic acd syp 250/5ml ................. 179
valsart/hctz tab 160-12.5 ..................16
valsart/hctz tab 160-25mg .................16
valsart/hctz tab 320-12.5 ..................16
valsart/hctz tab 320-25mg .................16
valsart/hctz tab 80-12.5 ....................16
valsartan tab 160mg .........................17
valsartan tab 320mg .........................17
valsartan tab 40mg ...........................17
valsartan tab 80mg ...........................17
VALTREX TAB 1GM ............................95
VALTREX TAB 500MG ........................95
VANATOL LQ SOL ..............................14
VANCOCIN HCL CAP 125MG ...............18
VANCOCIN HCL CAP 250MG ...............18
vancomycin cap 125mg .....................18
vancomycin cap 250mg .....................18
VANCOMYCN 25 SOL 25MG/ML ...........18
VANCOMYCN 50 SOL 50MG/ML ...........18
vandazole gel 0.75% ....................... 178
VANOS CRE 0.1% .............................69
VANOXIDE-HC LOT 5-0.5% ................. 6
VARUBI TAB 90MG .......................... 164
VASCEPA CAP 1GM ...........................31
VASERETIC TAB 10-25MG ................... 4
VASOTEC TAB 10MG .......................... 3
VASOTEC TAB 2.5MG ......................... 3
VASOTEC TAB 20MG .......................... 3
VASOTEC TAB 5MG ............................ 3
VCF VAGINAL AER CONTRACP .......... 160
vcf vaginal gel contrace .................. 160
VCF VAGINAL MIS CONTRACP .......... 160
VECAMYL TAB 2.5MG ........................ 32
VECTICAL OIN 3MCG/GM .................. 38
velivet pak .................................... 175
VELPHORO CHW 500MG .................. 140
VELTIN GEL ....................................... 6
VEMAVITE- CAP PRX 2 .................... 145
VENA-BAL MIS DHA ........................ 144
venlafaxine cap 150mg er ............... 158
venlafaxine cap 37.5 er ................... 158
venlafaxine cap 75mg er ................. 158
venlafaxine tab 100mg ................... 158
venlafaxine tab 150mg er ................ 158
VENLAFAXINE TAB 150MG ER .......... 158
venlafaxine tab 225mg er ................ 158
VENLAFAXINE TAB 225MG ER .......... 159
venlafaxine tab 25mg ..................... 158
venlafaxine tab 37.5 er ................... 158
VENLAFAXINE TAB 37.5 ER ............. 158
venlafaxine tab 37.5mg .................. 158
venlafaxine tab 75mg er ................. 158
VENLAFAXINE TAB 75MG ER ............ 158
VENTAVIS SOL 10MCG/ML .............. 147
VENTAVIS SOL 20MCG/ML .............. 147
VERAMYST SPR 27.5MCG ................ 114
verapamil cap 100mg er ................... 58
verapamil cap 360mg sr .................... 58
verapamil tab 120mg........................ 58
verapamil tab 120mg er .................... 58
verapamil tab 40mg ......................... 58
verapamil tab 80mg ......................... 58
VERDESO AER 0.05% ....................... 69
VEREGEN OIN 15% ............................ 9
VERELAN CAP 120MG SR ................... 58
VERELAN CAP 180MG SR ................... 58
VERELAN CAP 240MG SR ................... 58
244
VERELAN CAP 360MG SR ...................58
VERELAN PM CAP 100MG ER ..............58
VERIPRED 20 SOL 20MG/5ML .............91
VERSACLOZ SUS 50MG/ML ................77
VESICARE TAB 10MG ...................... 177
VESICARE TAB 5MG ........................ 177
VEXOL SUS 1% OP.......................... 129
VFEND SUS 40MG/ML ...................... 173
VFEND TAB 200MG ......................... 173
VFEND TAB 50MG ........................... 173
VIAGRA TAB 100MG ........................ 154
VIAGRA TAB 25MG .......................... 153
VIAGRA TAB 50MG .......................... 154
VIASPAN SOL ................................. 136
VIBRAMYCIN CAP 100MG ................. 167
VIBRAMYCIN SUS 25MG/5ML ........... 167
VIBRAMYCIN SYP 50MG/5ML ............ 167
vicodin es tab 7.5-300 .......................98
vicodin hp tab 10-300mg ...................98
vicodin tab 5-300mg .........................98
VICOPROFEN TAB 7.5-200 .................99
VICTORY TES AGM-4000....................76
VICTOZA INJ 18MG/3ML .................. 101
VICTRELIS CAP 200MG ......................95
VIDAZA INJ 100MG ...........................33
VIDEX EC CAP 125MG .......................41
VIDEX EC CAP 200MG .......................41
VIDEX EC CAP 250MG .......................41
VIDEX EC CAP 400MG .......................41
VIDEX SOL 2GM ...............................41
VIDEX SOL 4GM ...............................41
VIEKIRA PAK TAB .............................94
VIGAMOX DRO 0.5% ....................... 127
VIIBRYD KIT STARTER ..................... 157
VIIBRYD TAB 10MG ......................... 157
VIIBRYD TAB 20MG ......................... 157
VIIBRYD TAB 40MG ......................... 157
VIMOVO TAB 375-20MG .................. 123
VIMOVO TAB 500-20MG .................. 123
VIMPAT SOL 10MG/ML .......................26
VIMPAT TAB 100MG ..........................26
VIMPAT TAB 150MG ..........................26
VIMPAT TAB 200MG ..........................26
VIMPAT TAB 50MG ............................26
VINATE C TAB ................................ 144
VINATE CAL TAB ............................ 144
VINATE CARE CHW ......................... 144
VINATE II TAB ............................... 144
VINATE M TAB ............................... 144
VIOKACE TAB .................................. 78
VIOKACE TAB 20880 ........................ 78
VIRACEPT TAB 250MG ...................... 40
VIRACEPT TAB 625MG ...................... 40
VIRAMUNE SUS 50MG/5ML ................ 40
VIRAMUNE TAB 200MG ..................... 40
VIRAMUNE XR TAB 100MG ................ 40
VIRAMUNE XR TAB 400MG ................ 40
VIRASAL LIQ 27.5% ....................... 105
VIRAZOLE INH 6GM ........................ 152
VIREAD POW 40MG/GM .................... 41
VIREAD TAB 150MG ......................... 41
VIREAD TAB 200MG ......................... 41
VIREAD TAB 250MG ......................... 41
VIREAD TAB 300MG ......................... 41
VIROPTIC SOL 1% OP ..................... 127
VIRT-PN TAB ................................. 144
VISTARIL CAP 25MG ......................... 21
VISTARIL CAP 50MG ......................... 21
VITAFOL CAP ULTRA ....................... 145
VITAFOL FE+ CAP .......................... 145
VITAFOL-NANO TAB........................ 144
VITAFOL-OB PAK +DHA .................. 145
VITAFOL-OB TAB 65-1MG ................ 144
VITAFOL-ONE CAP .......................... 145
VITAMEDMD CAP ONE RX ................ 145
VITAMEDMD MIS PLUS RX ............... 145
vitamin d chw 400unit .................... 180
VITAMIN D2 TAB 400UNIT ............... 180
vitamin d3 cap 400unit ................... 180
vitamin d3 dro 400unit ................... 180
VITAMIN D3 LIQ 1000UNIT ............. 180
VITAMIN D3 LIQ 1200UNIT ............. 180
vitamin d3 tab 400unit.................... 180
VITAPEARL CAP.............................. 144
VITA-PREN TAB .............................. 144
VITEKTA TAB 150MG ........................ 39
VITEKTA TAB 85MG .......................... 39
VITUZ SOL 5-4MG .......................... 134
VIVELLE-DOT DIS 0.025MG ............... 85
VIVELLE-DOT DIS 0.0375MG ............. 85
245
VIVELLE-DOT DIS 0.05MG .................85
VIVELLE-DOT DIS 0.075MG................85
VIVELLE-DOT DIS 0.1MG ...................85
VOCAL POINT TES BLD GLUC .............76
VOGELXO GEL 1%(50MG) ..................15
VOGELXO GEL PUMP 1% ....................15
VOL-NATE TAB ............................... 144
VOL-TAB RX TAB ............................ 144
VOLTAREN GEL 1% ...........................19
voriconazole sus 40mg/ml ............... 173
voriconazole tab 200mg ................... 173
voriconazole tab 50mg .................... 173
VOSPIRE ER TAB 4MG .......................49
VOSPIRE ER TAB 8MG .......................49
VOTRIENT TAB 200MG ......................35
VP-PNV-DHA CAP ............................ 144
VUSION OIN.....................................30
VYTONE CRE 1-1.9% .........................30
VYTORIN TAB 10-10MG ................... 103
VYTORIN TAB 10-20MG ................... 103
VYTORIN TAB 10-40MG ................... 103
VYTORIN TAB 10-80MG ................... 103
VYVANSE CAP 10MG..........................13
VYVANSE CAP 20MG..........................13
VYVANSE CAP 30MG..........................13
VYVANSE CAP 40MG..........................13
VYVANSE CAP 50MG..........................13
VYVANSE CAP 60MG..........................13
VYVANSE CAP 70MG..........................13
W
wal-profen cap 200mg ..................... 125
wal-zyr chw 10mg.............................31
wal-zyr chw 5mg ..............................31
warfarin sod tab 10mg ......................69
warfarin tab 1mg ..............................69
warfarin tab 2.5mg ...........................69
warfarin tab 2mg ..............................69
warfarin tab 3mg ..............................70
warfarin tab 4mg ..............................70
warfarin tab 5mg ..............................70
warfarin tab 6mg ..............................70
warfarin tab 7.5mg ...........................70
WAVESENSE TES PRESTO ..................76
wee care sus 15/1.25 ...................... 104
WELCHOL PAK 3.75GM ......................53
WELCHOL TAB 625MG .......................53
WELLBUTRIN TAB 100MG .................. 27
WELLBUTRIN TAB 100MG SR ............. 27
WELLBUTRIN TAB 75MG .................... 27
WELLBUTRIN TAB XL 150MG ............. 27
WELLBUTRIN TAB XL 300MG ............. 27
WESTCORT OIN 0.2% ....................... 69
WHEAT GERM OIL .......................... 180
WHYTEDERM TD KIT PAK ................ 172
WIDE-SEAL DPR KIT 60 .................... 76
WIDE-SEAL DPR KIT 65 .................... 76
WIDE-SEAL DPR KIT 70 .................... 76
WIDE-SEAL DPR KIT 75 .................... 76
WIDE-SEAL DPR KIT 80 .................... 76
WIDE-SEAL DPR KIT 85 .................... 76
WIDE-SEAL DPR KIT 90 .................... 77
WIDE-SEAL DPR KIT 95 .................... 77
X
XALATAN SOL 0.005% .................... 147
XALKORI CAP 200MG ........................ 35
XALKORI CAP 250MG ........................ 35
XANAX TAB 0.25MG.......................... 48
XANAX TAB 0.5MG ........................... 48
XANAX TAB 1MG .............................. 48
XANAX TAB 2MG .............................. 48
XANAX XR TAB 0.5MG....................... 48
XANAX XR TAB 1MG ......................... 48
XANAX XR TAB 2MG ......................... 48
XANAX XR TAB 3MG ......................... 48
XARELTO STAR TAB 15/20MG ............ 79
XARELTO TAB 10MG ......................... 79
XARELTO TAB 15MG ......................... 79
XARELTO TAB 20MG ......................... 79
XARTEMIS XR TAB 7.5-325.............. 135
XELJANZ TAB 5MG ........................... 42
XELODA TAB 150MG ......................... 33
XELODA TAB 500MG ......................... 33
XENADERM OIN ............................... 82
XENAZINE TAB 12.5MG ................... 112
XENAZINE TAB 25MG ..................... 112
XERAC-AC SOL 6.25% ...................... 44
XERESE CRE 5-1% ........................... 44
XIFAXAN TAB 200MG ........................ 18
XIFAXAN TAB 550MG ........................ 18
XIGDUO XR TAB 10-1000 ................ 160
246
XIGDUO XR TAB 10-500MG .............. 160
XIGDUO XR TAB 5-1000MG .............. 160
XIGDUO XR TAB 5-500MG ............... 160
XODOL TAB 10-300MG ......................99
XODOL TAB 5-300MG ........................99
XODOL TAB 7.5-300 ..........................99
XOLEGEL DUO/ KIT XOLEX .................30
XOLEGEL GEL 2% ........................... 100
XOLEGEL KIT COREPAK .....................30
XOPENEX CONC NEB 1.25/0.5 ............49
XOPENEX HFA AER ............................49
XOPENEX NEB 0.31MG ......................49
XOPENEX NEB 0.63MG ......................49
XOPENEX NEB 1.25/3ML ....................49
XTANDI CAP 40MG ............................20
xulane dis 150-35 .............................66
XYLOCAINE SOL 4% ........................ 107
XYREM SOL 500MG/ML ......................18
XYZAL SOL .......................................31
XYZAL TAB 5MG ...............................31
Y
YALE NEEDLES MIS 21GX2" ............. 118
YASMIN 28 TAB 3-0.03MG .................65
YAZ TAB 3-0.02MG ...........................65
YODOXIN TAB 210MG........................11
YODOXIN TAB 650MG........................11
Z
ZACARE KIT KIT 4%........................... 6
ZACARE KIT KIT 8%........................... 6
ZACLIR LOT 8% ................................. 7
zafirlukast tab 10mg ....................... 105
zafirlukast tab 20mg ....................... 105
zaleplon cap 10mg .......................... 121
zaleplon cap 5mg ............................ 121
ZANAFLEX CAP 2MG ..........................60
ZANAFLEX CAP 4MG ..........................60
ZANAFLEX CAP 6MG ..........................60
ZANAFLEX TAB 4MG ..........................60
ZANTAC TAB 300MG .........................94
ZARONTIN CAP 250MG .................... 164
ZARONTIN SOL 250/5ML ................. 164
ZARXIO INJ 300/0.5 ..........................92
ZARXIO INJ 480/0.8 ..........................92
ZATEAN-CH CAP ............................. 145
ZATEAN-PN CAP DHA ...................... 145
ZATEAN-PN CAP PLUS ..................... 144
ZAVARA CAP 1MG-5750 .................... 88
ZAVESCA CAP 100MG ......................... 9
zazole cre 0.8% ............................. 100
zazole sup 80mg ............................ 100
ZEBETA TAB 10MG ........................... 51
ZEBETA TAB 5MG ............................. 51
ZECUITY PAD 6.5MG/4H ................. 155
ZEGERID CAP 40-1100 ................... 147
ZEGERID POW 20-1680 .................. 148
ZEGERID POW 40-1680 .................. 148
ZELAPAR TAB 1.25MG ....................... 37
ZELBORAF TAB 240MG...................... 34
ZEMPLAR CAP 1MCG ......................... 99
ZEMPLAR CAP 2MCG ......................... 99
zenchent fe chw 0.4mg-35 ................ 65
ZENPEP CAP 10000UNT..................... 78
ZENPEP CAP 15000UNT..................... 78
ZENPEP CAP 20000UNT..................... 78
ZENPEP CAP 25000UNT..................... 78
ZENPEP CAP 3000UNIT ..................... 78
ZENPEP CAP 40000UNT..................... 78
ZENPEP CAP 5000UNIT ..................... 78
zenzedi tab 15mg ............................. 13
zenzedi tab 2.5mg ............................ 13
zenzedi tab 20mg ............................. 13
zenzedi tab 30mg ............................. 13
zenzedi tab 7.5mg ............................ 13
ZERIT CAP 15MG.............................. 41
ZERIT CAP 20MG.............................. 41
ZERIT CAP 30MG.............................. 41
ZERIT CAP 40MG.............................. 41
ZERIT SOL 1MG/ML .......................... 41
ZESTORETIC TAB 10-12.5 ................... 4
ZESTORETIC TAB 20-12.5 ................... 4
ZESTORETIC TAB 20-25MG ................. 4
ZESTRIL TAB 2.5MG ........................... 3
ZESTRIL TAB 30MG ............................ 3
ZESTRIL TAB 40MG ............................ 3
ZETIA TAB 10MG............................ 103
ZETONNA AER 37MCG .................... 114
ZIAC TAB 10/6.25 ............................ 50
ZIAC TAB 2.5/6.25 ........................... 50
ZIAC TAB 5-6.25MG ......................... 50
ZIAGEN SOL 20MG/ML ...................... 41
ZIAGEN TAB 300MG ......................... 41
zidovudine cap 100mg ...................... 41
247
zidovudine syp 50mg/5ml ..................41
zidovudine tab 300mg .......................41
ZIOPTAN DRO 0.0015%................... 147
ziprasidone cap 20mg ........................39
ZIPSOR CAP 25MG .......................... 125
ZIRGAN GEL 0.15% ........................ 127
ZITHRANOL SHA 1% .........................38
ZITHRANOL-RR CRE 1.2% .................38
ZITHROMAX POW 1GM PAK ................45
ZITHROMAX SUS 100/5ML .................45
ZITHROMAX SUS 200/5ML .................45
ZITHROMAX TAB 250MG ....................45
ZITHROMAX TAB 500MG ....................45
ZITHROMAX TAB 600MG ....................45
ZMAX SUS 2GM ................................45
ZN-DTPA SOL 1000MG ......................28
ZOCOR TAB 10MG.............................97
ZOCOR TAB 20MG.............................97
ZOCOR TAB 40MG.............................97
ZOCOR TAB 5MG ..............................97
ZOCOR TAB 80MG.............................97
ZOFRAN SOL 4MG/5ML ....................... 1
ZOFRAN TAB 4MG .............................. 1
ZOFRAN TAB 4MG ODT ....................... 1
ZOFRAN TAB 8MG .............................. 1
ZOFRAN TAB 8MG ODT ....................... 1
ZOHYDRO ER CAP 10MG .................. 134
ZOHYDRO ER CAP 15MG .................. 134
ZOHYDRO ER CAP 20MG .................. 134
ZOHYDRO ER CAP 30MG .................. 134
ZOHYDRO ER CAP 40MG .................. 134
ZOHYDRO ER CAP 50MG .................. 134
ZOLINZA CAP 100MG ........................34
zolmitriptan tab 2.5 mg ................... 155
zolmitriptan tab 2.5mg .................... 155
zolmitriptan tab 5mg ....................... 155
ZOLOFT CON 20MG/ML .................... 157
ZOLOFT TAB 100MG ........................ 157
ZOLOFT TAB 25MG.......................... 157
ZOLOFT TAB 50MG.......................... 157
zolpidem er tab 12.5mg ................... 121
zolpidem er tab 6.25mg ................... 121
zolpidem tab 10mg ......................... 121
zolpidem tab 5mg .......................... 121
ZOLPIMIST SPR 5MG ...................... 121
ZOMACTON INJ 10MG ....................... 93
ZOMIG NASAL SPR 5MG .................. 155
ZOMIG SPR 2.5MG ......................... 155
ZOMIG TAB 2.5MG ......................... 155
ZOMIG TAB 5MG ............................ 155
ZOMIG ZMT TAB 2.5 MG ................. 155
ZOMIG ZMT TAB 5MG ..................... 155
ZONALON CRE 5% ........................... 37
ZONATUSS CAP 150MG ..................... 43
ZONEGRAN CAP 100MG .................... 26
ZONEGRAN CAP 25MG ...................... 26
zonisamide cap 100mg ..................... 27
zonisamide cap 25mg ....................... 27
zonisamide cap 50mg ....................... 27
ZONTIVITY TAB 2.08MG .................. 147
ZORBTIVE INJ 8.8MG........................ 93
ZORTRESS TAB 0.25MG .................. 109
ZORTRESS TAB 0.5MG .................... 109
ZORTRESS TAB 0.75MG .................. 109
ZORVOLEX CAP 18MG ..................... 125
ZORVOLEX CAP 35MG ..................... 125
zovia 1/50e tab ................................ 65
ZOVIRAX CAP 200MG ....................... 95
ZOVIRAX CRE 5% ............................ 44
ZOVIRAX OIN 5% ............................ 44
ZOVIRAX SUS 200/5ML ..................... 95
ZOVIRAX TAB 400MG ....................... 95
ZOVIRAX TAB 800MG ....................... 95
ZUBSOLV SUB 1.4-0.36 .................. 135
ZUBSOLV SUB 11.4-2.9 .................. 135
ZUBSOLV SUB 2.9-0.71 .................. 135
ZUBSOLV SUB 5.7-1.4 .................... 135
ZUBSOLV SUB 8.6-2.1 .................... 135
ZUPLENZ MIS 4MG ............................. 1
ZUPLENZ MIS 8MG ............................. 1
ZUTRIPRO LIQ 60-4-5MG ................ 134
ZYBAN TAB 150MG SR .................... 159
ZYCLARA CRE 3.75% ...................... 101
ZYCLARA PUMP CRE 2.5% ............... 101
ZYDELIG TAB 100MG ...................... 140
ZYDELIG TAB 150MG ...................... 140
ZYFLO CR TAB 600MG ........................ 1
ZYFLO TAB 600MG ............................. 1
ZYKADIA CAP 150MG ........................ 35
248
ZYLET SUS 0.5-0.3% ...................... 128
ZYLOPRIM TAB 100MG ......................92
ZYLOPRIM TAB 300MG ......................92
ZYMAXID SOL 0.5% ........................ 127
ZYPREXA TAB 10MG ........................ 168
ZYPREXA TAB 15MG ........................ 168
ZYPREXA TAB 2.5MG ....................... 168
ZYPREXA TAB 20MG ........................ 168
ZYPREXA TAB 5MG .......................... 168
ZYPREXA TAB 7.5MG ....................... 168
ZYPREXA ZYDI TAB 10MG ................ 168
ZYPREXA ZYDI TAB 15MG ................ 168
ZYPREXA ZYDI TAB 20MG ............... 168
ZYPREXA ZYDI TAB 5MG ................. 168
ZYRTEC ALLGY CAP 10MG ................. 31
ZYRTEC ALLGY TAB 10MG ................. 31
ZYRTEC CHILD CHW ALG 10MG ......... 31
ZYRTEC CHILD CHW ALG 5MG ........... 31
ZYRTEC CHILD SYP 1MG/ML .............. 31
ZYRTEC CHILD TAB 10MG ................. 31
ZYTIGA TAB 250MG .......................... 14
ZYVOX SUS 100MG/5M ................... 137
ZYVOX TAB 600MG ......................... 137
249
This formulary was updated 11/01/2015. For more recent information or other questions,
please contact CareFirst Pharmacy Services at 800-241-3371 or visit www.carefirst.com/rx.
The CareFirst BlueCross BlueShield
family of health care plans
10455 Mill Run Circle
Owings Mills, MD 21117
www.carefirst.com/rx
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association.
® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.
SUM3083-1S (11/15)

CareFirst Formulary 2 (ACA Plans) 2015

Transcription

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