Preferred Drug List

Preferred Drug List
Effective June 1, 2016
Blue Cross Complete participates in the Michigan Common Formulary
PH-06/Rev06/16/2016
Blue Cross Complete of Michigan members,
This Preferred Drug List is a list of medicines that are covered by your pharmacy benefit. The
list includes prescription and non-prescription medicines.
We want to make sure you have the medicine you need. At times, your doctor may feel you
need a medicine that’s not listed as a covered benefit. If this happens, your doctor will work with
us to decide if a different medicine can be covered.
To make sure you have the medicines you need, when you need them, please talk to your
primary care doctor and your pharmacist. They will make sure you have the right information
and medicine to get and stay healthy.
In addition to this list, you can use our online search tool. You’ll also find the Preferred Drug List
Quick Reference on our website at mibluecrosscomplete.com. This is an easy-to-use summary
of the medicines we cover.
If you have questions, please contact Blue Cross Complete of Michigan Pharmacy Services at
1-888-288-3231. You can call this number from 8:30 a.m. until 6 p.m., Monday through Friday.
Sincerely,
Christopher E. Meny, R.Ph.
Market Pharmacy Director
Drug
Alternative Therapy
Alternative Therapy - Antiarthritics
Glucoten
Status
Notes
F
OTC
50+ Adult Eye Health
F
OTC
Antioxidant
F
OTC
Antioxidant A/C/E/Selenium
F
OTC
Antioxidant Formula (selenium)
F
OTC
Antioxidant Vitamins oral tablet 1,000 unit-200
mg-60 unit-2 mg
F
OTC
E-400 C-500 and Beta Carotene
F
OTC
Healthy Eyes
F
OTC
Healthy Eyes SuperVision
F
OTC
ICaps AREDS
F
OTC
I-Vite
F
OTC
I-Vite Protect
F
OTC
Macuvite With Lutein
F
OTC
Multi-Betic
F
OTC
Ocuvite
F
OTC
Ocuvite Lutein and Zeaxanthin
F
OTC
Ocuvite with Lutein
F
OTC
Opti-Vitamins
F
OTC
PreserVision AREDS
F
OTC
PreserVision AREDS 2
F
OTC
Prosight
F
OTC
SAVision
F
OTC
Super Antioxidant
F
OTC
Vision Formula (with lutein)
F
OTC
Vision-Vite + Zinc
F
OTC
Alternative Therapy - Antioxidant
Alternative Therapy - Unclassified
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
2
Drug
Status
Notes
Kelp-Lecithin-B6
F
OTC
Lecithin-Kelp-B6
F
OTC
L-Methyl-MC NAC
F
OTC
Memory Complex
F
OTC
Mens Potent Formula
F
OTC
Metafolbic Plus
F
OTC
Mg-Plus-Protein
F
OTC
codeine sulfate oral tablet
F
QL
fentanyl transdermal patch 72 hour 100 mcg/hr,
12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr
F
PA; QL
hydromorphone oral liquid
F
QL
hydromorphone oral tablet 2 mg, 4 mg
F
QL
hydromorphone rectal
F
QL
meperidine oral solution
F
QL; AL
meperidine oral tablet
F
QL; AL
methadone oral concentrate
F
QL
methadone oral solution 10 mg/5 mL, 5 mg/5 mL
F
QL
methadone oral tablet
F
QL
methadone oral tablet,soluble
F
QL
morphine concentrate oral solution
F
QL
morphine oral solution
F
QL
morphine oral tablet
F
QL
morphine oral tablet extended release
F
QL
oxycodone oral solution
F
oxycodone oral tablet 5 mg
F
QL
tramadol oral tablet
F
QL
Analgesic, Anti-Inflammatory Or
Antipyretic
Analgesic Narcotic Agonists
Analgesic Narcotic Codeine
Combinations
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
3
Drug
Status
acetaminophen-codeine oral solution 120 mg-12
mg /5 mL (5 mL), 300 mg-30 mg /12.5 mL
F
acetaminophen-codeine oral solution 120-12 mg/5
mL
F
acetaminophen-codeine oral tablet
F
Butalbital Compound W/Codeine
F
butalbital-acetaminop-caf-cod oral capsule 50325-40-30 mg
F
codeine-butalbital-ASA-caff
F
Notes
QL
QL
Analgesic Narcotic Hydrocodone
Combinations
hydrocodone-acetaminophen oral solution 2.5167 mg/5 mL
F
hydrocodone-acetaminophen oral solution 7.5325 mg/15 mL
F
QL
hydrocodone-acetaminophen oral tablet 10-325
mg, 5-325 mg, 7.5-325 mg
F
QL
hydrocodone-ibuprofen oral tablet 5-200 mg, 7.5200 mg
F
QL
F
QL
F
QL
8 HOUR PAIN RELIEVER
F
OTC
Acephen
F
OTC
Acetaminophen Extra Strength
F
OTC
acetaminophen oral drops,suspension
F
OTC
acetaminophen oral elixir
F
OTC
acetaminophen oral liquid 160 mg/5 mL
F
OTC
Analgesic Narcotic Oxycodone
Combinations
oxycodone-acetaminophen oral tablet 10-325 mg,
5-325 mg, 7.5-325 mg
Analgesic Narcotic Partial-Mixed
Agonists
pentazocine-naloxone
Analgesic Or Antipyretic Non-Narcotic
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
4
Drug
Status
Notes
acetaminophen oral solution
F
OTC
acetaminophen oral suspension 160 mg/5 mL
F
OTC; QL
acetaminophen oral tablet
F
OTC
acetaminophen oral tablet extended release
F
OTC
acetaminophen rectal
F
OTC
Arthritis Pain Relief (acetam)
F
OTC
Athenol
F
OTC
Child Pain Rel-Fever Reducer
F
OTC
Children's Acetaminophen oral suspension 160
mg/5 mL
F
OTC; QL
Children's Acetaminophen oral suspension 160
mg/5 mL (5 mL)
F
OTC
Children's Acetaminophen oral tablet,chewable
F
OTC
Children's Fever Reducing
F
OTC
Children's Non-Aspirin oral suspension
F
OTC; QL
Children's Non-Aspirin oral tablet,chewable
F
OTC
Children's Non-Aspirin Pain
F
OTC
Children's Pain Relief oral suspension
F
OTC; QL
Children's Pain Reliever oral suspension
F
OTC; QL
Children's Pain-Fever Relief oral suspension
F
OTC; QL
Children's Pain-Fever Relief oral tablet,chewable
F
OTC
Children's Q-PAP
F
OTC; QL
Children's Silapap
F
OTC
Children's Tactinal
F
OTC
Children's Tylenol
F
OTC; QL
Ed-APAP
F
OTC
Fever Reducer
F
OTC
Fever Reducer an Pain Reliever oral suspension
F
OTC; QL
Feverall rectal suppository 120 mg, 325 mg, 650
mg
F
OTC
Infant Fever Reducer-Pain Relf
F
OTC; QL
Infant Pain Reliever
F
OTC; QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
5
Drug
Status
Notes
Infant's Non-Aspirin oral drops
F
OTC
Infants' Pain and Fever
F
OTC; QL
Infants' Pain Relief
F
OTC; QL
Infant's Pain Relief oral drops,suspension 80
mg/0.8 mL
F
OTC
Infant's Pain Relief oral suspension
F
OTC; QL
Little Remedies Fever and Pain
F
OTC; QL
Mapap (acetaminophen) oral capsule
F
OTC
Mapap (acetaminophen) oral suspension
F
OTC; QL
Mapap (acetaminophen) oral tablet
F
OTC
Mapap (acetaminophen) oral tablet,chewable
F
OTC
Mapap Arthritis Pain
F
OTC
Mapap Extra Strength
F
OTC
Non-Aspirin Children's
F
OTC
Non-Aspirin Extra Strength oral tablet
F
OTC
Non-Aspirin oral suspension
F
OTC; QL
Non-Aspirin oral tablet
F
OTC
Non-Aspirin oral tablet,chewable 80 mg
F
OTC
Non-Aspirin Pain Relief oral tablet 500 mg
F
OTC
Nortemp oral suspension
F
OTC; QL
Pain and Fever
F
OTC
Pain Relief Extra Strength
F
OTC
Pain Relief oral liquid
F
OTC
Pain Relief oral tablet
F
OTC
Pain Relief oral tablet extended release
F
OTC
Pain Relief Regular Strength
F
OTC
Pain Reliever
F
OTC
Pain Reliever Extra Strength
F
OTC
PediaCare Fever Reducer
F
OTC; QL
Pharbetol
F
OTC
Q-PAP Extra Strength
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
6
Drug
Status
Notes
Q-PAP oral drops
F
OTC
Q-PAP oral tablet 325 mg
F
OTC
Tactinal
F
OTC
Tactinal Extra Strength
F
OTC
Tylenol
F
OTC
Tylenol Extra Strength oral tablet
F
OTC
butalbital-acetaminophen
F
AL
butalbital-acetaminophen-caff oral capsule 50325-40 mg
F
AL
butalbital-acetaminophen-caff oral tablet 50-32540 mg
F
AL
Capacet
F
AL
Esgic
F
AL
Margesic
F
AL
Marten-Tab
F
AL
Tencon oral tablet 50-325 mg
F
AL
Zebutal oral capsule 50-325-40 mg
F
AL
Enbrel subcutaneous recon soln
F
PA; QL
Enbrel subcutaneous syringe 25 mg/0.5mL (0.51),
50 mg/mL (0.98 mL)
F
PA; QL
Enbrel SureClick
F
PA; QL
Humira
F
PA; QL
Humira Pediatric Crohn's Start
F
PA; QL
Humira Pen
F
PA; QL
Humira Pen Crohn's-UC-HS Start
F
PA; QL
Humira Pen Psoriasis Starter
F
PA; QL
Analgesic Or Antipyretic NonNarcotic/Sedative Combinations
Anti-Inflammatory Tumor Necrosis
Factor Inhibiting Agnts,Non-Seiective
Anti-Inflammatory Tumor Necrosis
Factor Inhibiting Agnts,Tnf-Alpha Sel
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
7
Drug
Dmard - Antimalarials
hydroxychloroquine oral
Status
Notes
F
Dmard - Antimetabolites
methotrexate sodium oral
F
Dmard - Immunosuppressives
azathioprine
F
QL
cyclophosphamide oral capsule
F
PA
cyclosporine modified oral capsule
F
cyclosporine modified oral solution
F
cyclosporine oral capsule
F
mycophenolate mofetil oral capsule
F
QL
mycophenolate mofetil oral suspension for
reconstitution
F
AL
mycophenolate mofetil oral tablet
F
AL
Dmard - Other
minocycline oral capsule
F
sulfasalazine
F
Dmard - Pyrimidine Synthesis
Inhibitors
leflunomide
F
QL
F
PA; QL
ketorolac oral
F
AL
nabumetone
F
QL
sulindac oral
F
Nsaid Analgesic, Cyclooxygenase-2
(Cox-2) Selective Inhibitors
Celecoxib 50mg, 100mg, 200mg, 400mg
Nsaid Analgesics (Cox Non-Specific) Other
Nsaid Analgesics (Cox Non-Specific) Oxicam Derivatives
meloxicam oral tablet
F
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
8
Drug
piroxicam
Status
Notes
F
Nsaid Analgesics (Cox Non-Specific) Phenylacetic Acid Derivatives
diclofenac sodium oral
F
Nsaid Analgesics (Cox Non-Specific) Propionic Acid Derivatives
All Day Pain Relief
F
OTC; QL
Children's Ibuprofen
F
OTC; QL
Children's Profen IB
F
OTC
fenoprofen oral tablet
F
flurbiprofen oral tablet 50 mg
F
Ibu-Drops
F
OTC; QL
Ibuprofen IB
F
OTC
Ibuprofen Jr Strength
F
OTC
ibuprofen oral capsule
F
OTC; QL
ibuprofen oral drops,suspension
F
OTC; QL
ibuprofen oral suspension
F
OTC; QL
ibuprofen oral tablet 100 mg, 200 mg
F
OTC
ibuprofen oral tablet 400 mg, 600 mg, 800 mg
F
Infant's Ibuprofen
F
ketoprofen oral capsule
F
Mediproxen
F
OTC
Motrin IB
F
OTC
naproxen
F
naproxen sodium oral capsule 220mg
F
OTC
naproxen sodium oral tablet 220 mg
F
OTC; QL
naproxen sodium oral tablet, ER multiphase 24 hr
500 mg
F
Wal-Profen oral tablet
F
OTC
Wal-Proxen
F
OTC
OTC; QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
9
Drug
Nsaid Analgesics, (Cox Non-Specific) Indole Acetic Acid Derivatives
indomethacin oral
Status
Notes
F
AL
F
QL; AL
Salicylate Analgesic And Sedative
Combinations
butalbital-aspirin-caffeine oral capsule
Salicylate Analgesic Combinations
choline,magnesium salicylate
F
Salicylate Analgesics
Adult Low Dose Aspirin
F
OTC; AL
Aspir-81
F
OTC; QL; AL
Aspirin Childrens
F
OTC; QL; AL
Aspirin Low Dose
F
OTC; AL
Aspirin Low-Strength
F
OTC; QL; AL
aspirin oral tablet
F
OTC; QL; AL
aspirin oral tablet,chewable
F
OTC; QL; AL
aspirin oral tablet,delayed release (DR/EC) 325
mg
F
OTC; QL; AL
aspirin oral tablet,delayed release (DR/EC) 81 mg
F
OTC; AL
aspirin rectal
F
OTC
Aspir-Low
F
OTC; QL; AL
Bayer Aspirin
F
OTC; QL; AL
Bayer Chewable Aspirin
F
OTC; QL; AL
Child Aspirin
F
OTC; QL; AL
Children's Aspirin
F
OTC; QL; AL
E.C. Prin
F
OTC
Ecotrin Low Strength
F
OTC; QL; AL
Enteric Coated Aspirin
F
OTC; AL
Lite Coat Aspirin
F
OTC; QL; AL
Lo-Dose Aspirin
F
OTC; AL
Salicylate Analgesics, Buffered
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
10
Drug
Status
Notes
aspirin, buffered
F
OTC; AL
Tri-Buffered Aspirin
F
OTC; AL
Anorectal Preparations
Anorectal - Glucocorticoids
hydrocortisone acetate rectal suppository 30 mg
F
Anorectal - Hemorrhoidal Rectal
Glucocorticoid-Local Anesthetic Comb
hydrocortisone-pramoxine rectal cream 1-1 %,
2.5-1 %
F
Antidotes And Other Reversal Agents
Antidote - Acetaminophen Poisoning
acetylcysteine
F
Chelating Agents - Lead Poisoning
Chemet
F
Anti-Infective Agents
Amebicides
paromomycin
F
Aminoglycoside Antibiotic
neomycin
F
Aminopenicillin Antibiotic
amoxicillin oral capsule
F
amoxicillin oral suspension for reconstitution
F
amoxicillin oral tablet
F
amoxicillin oral tablet,chewable 125 mg, 250 mg
F
ampicillin oral capsule
F
ampicillin oral suspension for reconstitution
F
AL
F
AL
AL
AL
Aminopenicillin Antibiotic - BetaLactamase Inhibitor Combinations
amoxicillin-pot clavulanate oral suspension for
reconstitution
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
11
Drug
Status
amoxicillin-pot clavulanate oral tablet
F
amoxicillin-pot clavulanate oral tablet extended
release 12 hr
F
amoxicillin-pot clavulanate oral tablet,chewable
F
Notes
AL
Antibacterial Folate Antagonist - Other
Combinations
sulfamethoxazole-trimethoprim oral tablet
F
Sulfatrim
F
Antibacterial Folate Antagonist Others
trimethoprim
F
Antifungal - Allylamines
terbinafine HCl oral
F
QL
Antifungal - Amphoteric Polyene
Macrolides
nystatin oral tablet
F
Antifungal - Imidazoles
ketoconazole oral
F
QL
fluconazole oral suspension for reconstitution
F
AL
fluconazole oral tablet
F
itraconazole
F
Antifungal - Triazoles
Antifungal Other
griseofulvin microsize
F
griseofulvin ultramicrosize
F
Antileprotic - Sulfone Agents
dapsone
F
Antimalarials
chloroquine phosphate oral
F
QL
Daraprim
F
PA
hydroxychloroquine oral
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
12
Drug
Status
mefloquine
F
primaquine
F
Notes
PA
Antiprotozoal Agents - Other
atovaquone suspension
F
PA
Antiprotozoal-Antibacterial 1St
Generation 2-Methyl-5-Nitroimidazole
metronidazole oral tablet
F
Antiprotozoal-Antibacterial 2Nd
Generation 2-Methyl-5-Nitroimidazole
tinidazole
F
Antitubercular - D-Alanine Analogs
cycloserine
F
Antitubercular - Isonicotinic Acid
Derivatives
isoniazid oral
F
Antitubercular - Niacinamide
Derivatives
pyrazinamide
F
Antitubercular - Rifamycin And
Derivatives
rifabutin
F
rifampin oral
F
Antitubercular Agents Other
ethambutol
F
Trecator
F
Cephalosporin Antibiotics - 1St
Generation
cefadroxil oral capsule
F
cefadroxil oral suspension for reconstitution 250
mg/5 mL, 500 mg/5 mL
F
cefadroxil oral tablet
F
AL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
13
Drug
Status
cephalexin oral capsule 250 mg, 500 mg
F
cephalexin oral suspension for reconstitution
F
Notes
AL
Cephalosporin Antibiotics - 2Nd
Generation
cefaclor oral capsule
F
cefaclor oral suspension for reconstitution 125
mg/5 mL, 250 mg/5 mL, 375 mg/5 mL
F
AL
cefprozil oral suspension for reconstitution
F
AL
cefprozil oral tablet
F
cefuroxime axetil oral tablet
F
Cephalosporin Antibiotics - 3Rd
Generation
cefdinir oral capsule
F
cefdinir oral suspension for reconstitution
F
AL
cefixime
F
AL
cefpodoxime oral suspension for reconstitution
F
AL
cefpodoxime oral tablet
F
Suprax oral capsule
F
Suprax oral suspension for reconstitution 500
mg/5 mL
F
AL
F
PA; QL
ciprofloxacin
F
AL
ciprofloxacin HCl oral
F
levofloxacin oral solution
F
levofloxacin oral tablet
F
moxifloxacin
F
ofloxacin oral tablet 400 mg
F
Cmv Antiviral Agent - Nucleoside
Analogs
valganciclovir
Fluoroquinolone Antibiotics
QL
PA
Glycopeptide Antibiotics
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
14
Drug
vancomycin
Status
Notes
F
Hepatitis B Treatment- Nucleoside
Analogs (Antiviral)
entecavir
F
lamivudine oral tablet 100 mg
F
Hepatitis B Treatment- Nucleotide
Analogs (Antiviral)
adefovir
F
Herpes Antiviral Agent - Purine
Analogs
acyclovir oral capsule
F
QL
acyclovir oral suspension 200 mg/5 mL
F
AL
acyclovir oral tablet 400 mg, 800 mg
F
QL
valacyclovir
F
QL
F
QL
Relenza Diskhaler
F
QL; AL
Tamiflu oral capsule 30 mg, 45 mg, 75 mg
F
QL
Tamiflu oral suspension for reconstitution
F
QL; AL
Herpes Antiviral Agent - Thymidine
Analogs
famciclovir
Influenza Antiviral Agents Neuraminidase Inhibitors
Influenza-A Antiviral Agents
rimantadine
F
Lincosamide Antibiotics
clindamycin HCl
F
clindamycin palmitate HCl
F
AL
azithromycin oral packet
F
QL
azithromycin oral suspension for reconstitution
F
AL
azithromycin oral tablet
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
F
Macrolides
15
Drug
Status
clarithromycin oral suspension for reconstitution
F
clarithromycin oral tablet
F
E.E.S. Granules
F
erythromycin ethylsuccinate oral tablet
F
erythromycin oral capsule,delayed
release(DR/EC)
F
erythromycin oral tablet
F
Notes
AL
QL; AL
Oxazolidinone Antibiotics
linezolid oral
F
PA
penicillin V potassium oral recon soln
F
AL
penicillin V potassium oral tablet
F
Penicillin Antibiotic - Natural
Penicillin Antibiotic - PenicillinaseResistant
dicloxacillin
F
Rifamycins And Related Derivative
Antibiotics
rifabutin
F
rifampin oral
F
Tetracycline Antibiotics
doxycycline hyclate oral capsule
F
doxycycline hyclate oral tablet 100 mg
F
doxycycline monohydrate oral capsule
F
doxycycline monohydrate oral suspension for
reconstitution
F
minocycline oral capsule
F
tetracycline
F
AL
F
PA; Male; QL
AL
Antineoplastics
Antineoplastic - Cyp17 (17 AlphaHydroxylase/C17,20-Lyase) Inhibitor
Zytiga
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
16
Drug
Antineoplastic - Alkylating Agent Alkyl Sulfonates
Myleran
Status
Notes
F
Antineoplastic - Alkylating Agent Ethylenimines And Methylmelamines
Hexalen
F
Antineoplastic - Alkylating Agent Methylhydrazines
Matulane
F
Antineoplastic - Alkylating Agent Nitrogen Mustards
Alkeran oral
F
PA
cyclophosphamide oral capsule
F
PA
Leukeran
F
PA
F
PA
F
PA
bicalutamide
F
PA; Male
flutamide
F
PA; Male
Nilandron
F
PA
Xtandi
F
PA; Male; QL
Zytiga
F
PA; Male; QL
Antineoplastic - Alkylating Agent Triazenes
temozolomide
Antineoplastic - Antiadrenals
Lysodren
Antineoplastic - Antiandrogens
Antineoplastic - Antimetabolite - Folic
Acid Analogs
methotrexate sodium oral
F
Antineoplastic - Antimetabolite - Purine
Analogs
mercaptopurine
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
17
Drug
Status
Notes
Tabloid
F
PA
F
PA
Antineoplastic - Antimetabolite Pyrimidine Analogs
capecitabine
Antineoplastic - Antimetabolite - Urea
Derivatives
hydroxyurea
F
Antineoplastic - Aromatase Inhibitors
anastrozole
F
Female
exemestane
F
letrozole
F
QL; AL
F
PA
F
PA; Male
F
PA; QL
Farydak
F
PA
Zolinza
F
PA
F
PA
F
PA; QL
F
PA
Antineoplastic - Epipodophyllotoxins
etoposide oral
Antineoplastic - Estrogens
Emcyt
Antineoplastic - Hedgehog Pathway
Inhibitor
Erivedge
Antineoplastic - Histone Deacetylase
(Hdac) Inhibitors
Antineoplastic - Interferons
Intron A injection
Antineoplastic - Janus Kinase (Jak)
Inhibitors
Jakafi
Antineoplastic - Lhrh (Gnrh) Agonist
Analog Pituitary Suppressants
leuprolide subcutaneous kit
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
18
Drug
Antineoplastic - Mtor Kinase Inhibitors
Status
Notes
Afinitor Disperz
F
PA; QL
Afinitor oral tablet 10 mg, 2.5 mg, 5 mg
F
PA; QL
Afinitor oral tablet 7.5 mg
F
PA
F
Female
F
PA
Fareston
F
PA
tamoxifen
F
Female; QL
F
PA
Pomalyst
F
PA
Revlimid oral capsule 10 mg, 15 mg, 25 mg, 5 mg
F
PA; QL
Revlimid oral capsule 2.5 mg, 20 mg
F
PA
F
PA
Antineoplastic - Progestins
megestrol oral tablet
Antineoplastic - Retinoids
tretinoin (chemotherapy)
Antineoplastic - Selective Estrogen
Receptor Modulators (Serms)
Antineoplastic - Selective Retinoid X
Receptor Agonists
Targretin oral capsule 75mg
Antineoplastic - Thalidomide Analogs
Antineoplastic - Topoisomerase I
Inhibitors
Hycamtin oral
Methotrexate Rescue Agents
leucovorin calcium oral
F
Methotrexate Rescue Agents - Folic
Acid Antagonist Type
leucovorin calcium oral
F
Urinary Tract Protective Agents Used
In Conjunction With Chemotherapy
Mesnex oral
F
PA
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
19
Drug
Antiseptics And Disinfectants
Antiseptic - Alcohols
Status
Notes
Alcohol Prep Pads
F
OTC
Alcohol Wipes
F
OTC
BD Alcohol Swabs
F
OTC
Curity Alcohol Swabs
F
OTC
F
PA
Biologicals
Antiviral Monoclonal Antibodies
Synagis
Vaccine Viral - Influenza A And B
Flublok 2015-2016 (PF)
F
Flucelvax 2015-2016 (PF)
F
Cardiovascular Therapy Agents
Ace Inhibitor And Calcium Channel
Blocker Combinations
amlodipine-benazepril
F
QL
Ace Inhibitor And Diuretic
Combinations
benazepril-hydrochlorothiazide
F
captopril-hydrochlorothiazide
F
enalapril-hydrochlorothiazide
F
QL
lisinopril-hydrochlorothiazide
F
QL
quinapril-hydrochlorothiazide
F
Ace Inhibitors
benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg
F
QL
captopril oral tablet 12.5mg, 25mg, 50mg, 100mg
F
enalapril maleate oral tablet 10 mg, 2.5 mg, 20
mg, 5 mg
F
QL
Epaned
F
AL
fosinopril oral tablet 10 mg, 20 mg, 40 mg
F
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
20
Drug
Status
Notes
lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30
mg, 40 mg, 5 mg
F
QL
perindopril erbumine oral tablet 2 mg, 4 mg
F
QL
quinapril oral tablet
F
QL
ramipril oral capsule
F
QL
trandolapril oral tablet
F
QL
F
QL
Aldosterone Receptor Antagonists
spironolactone oral tablet
Alpha-Beta Blockers
carvedilol oral tablet
F
labetalol oral tablet
F
Angiotensin Ii Receptor Blocker (Arb)Calcium Channel Blocker Comb.
amlodipine-valsartan
F
Angiotensin Ii Receptor Blocker (Arb)Diuretic Combinations
irbesartan-hydrochlorothiazide
F
QL
losartan-hydrochlorothiazide
F
QL
valsartan-hydrochlorothiazide oral tablet 160-12.5
mg, 160-25 mg, 80-12.5 mg
F
Angiotensin Ii Receptor Blockers (Arbs)
irbesartan oral tablet
F
QL
Losartan oral tablet
F
QL
valsartan oral tablet
F
Antianginal - Coronary Vasodilators
(Nitrates)
isosorbide dinitrate oral
F
isosorbide mononitrate oral tablet
F
isosorbide mononitrate oral tablet extended
release 24 hr
F
Nitro-Bid
F
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
21
Drug
Status
nitroglycerin sublingual tablet 0.4 mg
F
nitroglycerin transdermal patch 24 hour
F
nitroglycerin translingual spray,non-aerosol
F
Nitrolingual
F
Nitrostat
F
Nitro-Time
F
Notes
QL
Antianginal And Anti-Ischemic Agents,
Non-Hemodynamic
Ranexa
F
Antiarrhythmic - Class Ia
disopyramide phosphate oral capsule
F
quinidine sulfate oral tablet
F
AL
Antiarrhythmic - Class Ib
mexiletine
F
Antiarrhythmic - Class Ic
flecainide
F
propafenone oral tablet
F
Antiarrhythmic - Class Ii
Sotalol AF
F
sotalol oral
F
QL
Antiarrhythmic - Class Iii
amiodarone oral
F
Antiarrhythmic - Class Iv
verapamil oral tablet
F
Antihyperlipidemic - Bile Acid
Sequestrants
cholestyramine (with sugar) oral powder
F
cholestyramine (with sugar) oral powder in packet
F
Cholestyramine Light
F
Colestid oral granules
F
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
22
Drug
Status
colestipol oral packet
F
colestipol oral tablet
F
Notes
Antihyperlipidemic - Fibric Acid
Derivatives
fenofibrate micronized oral capsule 130 mg, 43
mg
F
fenofibrate micronized oral capsule 134 mg, 200
mg, 67 mg
F
QL
fenofibrate nanocrystallized
F
QL
fenofibrate oral capsule
F
fenofibrate oral tablet 160 mg, 54 mg
F
fenofibric acid
F
fenofibric acid (choline)
F
QL
gemfibrozil oral
F
QL
atorvastatin
F
QL
fluvastatin oral capsule 20 mg, 40 mg
F
QL
lovastatin
F
QL
pravastatin
F
QL
simvastatin
F
QL
F
QL
F
QL
F
PA
QL
Antihyperlipidemic - HMG CoA
Reductase Inhibitors (Statins)
Antihyperlipidemic - Nicotinic Acid
Derivatives
niacin oral tablet extended release 24 hr 1,000
mg, 500 mg, 750 mg
Antihyperlipidemic - Selective
Cholesterol Absorption Inhibitor
Zetia
Antihyperlipidemic Agents - Dietary
Source
omega-3 acid ethyl esters
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
23
Drug
Antihyperlipidemic Agents - Dietary
Source Combinations
vitamin E oral capsule 100 unit, 400 unit
Status
F
Notes
OTC
Beta Blockers Cardiac Selective
atenolol
F
betaxolol oral
F
bisoprolol fumarate oral tablet 10 mg, 5 mg
F
QL
metoprolol succinate oral tablet extended release
24 hr 100 mg, 200 mg, 25 mg, 50 mg
F
QL
metoprolol tartrate oral tablet 100 mg, 25 mg, 50
mg
F
QL
Beta Blockers Cardiac Selective,
Intrinsic Sympathomimetic Activity
acebutolol
F
Beta Blockers Non-Cardiac Select.,
Intrinsic Sympathomimetic Activity
pindolol
F
Beta Blockers Non-Cardiac Selective
Hemangeol
F
nadolol
F
propranolol oral capsule,extended release 24 hr
120 mg, 160 mg, 60 mg, 80 mg
F
propranolol oral solution
F
propranolol oral tablet
F
Sotalol AF
F
sotalol oral
F
timolol maleate oral
F
AL
QL
QL
Calcium Channel Blockers Benzothiazepines
Cartia XT
F
diltiazem HCl oral capsule, extended release
F
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
24
Drug
Status
Notes
diltiazem HCl oral capsule,ext release degradable
F
QL
diltiazem HCl oral capsule,extended release 24hr
120 mg, 180 mg, 240 mg, 300 mg
F
QL
diltiazem HCl oral tablet 120 mg, 30 mg, 60 mg,
90 mg
F
QL
diltiazem HCl oral tablet extended release 24 hr
180 mg, 300 mg
F
QL
Taztia XT
F
Tiazac oral capsule, extended release 420 mg
F
Calcium Channel Blockers Dihydropyridines
Afeditab CR
F
amlodipine
F
QL
felodipine oral tablet extended release 24 hr 10
mg, 2.5 mg, 5 mg
F
QL
isradipine
F
QL
nicardipine oral
F
QL
Nifedical XL
F
nifedipine oral capsule
F
QL; AL
nifedipine oral tablet extended release
F
QL
nifedipine oral tablet extended release 24hr
F
QL
F
QL
verapamil oral capsule, 24 hr ER pellet CT
F
QL
verapamil oral capsule,ext rel. pellets 24 hr 120
mg, 180 mg, 240 mg
F
QL
verapamil oral tablet
F
verapamil oral tablet extended release
F
Calcium Channel Blockers Dihydropyridines - Cerebrovascular
Specific
nimodipine
Calcium Channel Blockers Phenylakylamines
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
25
Drug
Cardiac Selective Beta Blocker-Thiazide
Diuretic And Related Comb.
Status
atenolol-chlorthalidone
F
bisoprolol-hydrochlorothiazide oral tablet 10-6.25
mg, 2.5-6.25 mg, 5-6.25 mg
F
metoprolol ta-hydrochlorothiaz
F
Notes
QL
Cardiovascular Sympathomimetic Anaphylaxis Therapy Single Agents
epinephrine injection auto-injector
F
QL
EpiPen 2-Pak
F
QL
EpiPen Jr 2-Pak
F
QL
F
QL
Cardiovascular Sympathomimetics
midodrine
Central Alpha-2 Agonists-Thiazide
Diuretic And Related Comb.
methyldopa-hydrochlorothiazide
F
Central Alpha-2 Receptor Agonists
clonidine
F
QL
clonidine HCl oral tablet
F
guanfacine oral tablet
F
QL
methyldopa
F
AL
Digitalis Glycosides
digoxin oral tablet
F
Direct Acting Vasodilators
hydralazine injection
F
hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50
mg
F
minoxidil oral
F
QL
Diuretic - Aldosterone Receptor
Antagonist, Non-Selective
spironolactone
F
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
26
Drug
Diuretic - Carbonic Anhydrase
Inhibitors
Status
acetazolamide
F
methazolamide oral
F
Notes
Diuretic - Loop
bumetanide oral
F
furosemide oral solution 10 mg/mL, 40 mg/5 mL
(8 mg/mL)
F
AL
furosemide oral tablet
F
QL
torsemide oral tablet 5mg, 10 mg, 100 mg, 20 mg
F
QL
F
QL
amiloride-hydrochlorothiazide
F
QL
spironolacton-hydrochlorothiazide
F
QL
triamterene-hydrochlorothiazide
F
Diuretic - Potassium Sparing
amiloride
Diuretic - Potassium Sparing-Thiazide
And Related Combinations
Diuretic - Thiazides And Related
chlorothiazide
F
chlorthalidone oral tablet 25 mg, 50 mg
F
QL
hydrochlorothiazide oral capsule
F
QL
hydrochlorothiazide oral tablet 12.5 mg
F
hydrochlorothiazide oral tablet 25 mg, 50 mg
F
QL
indapamide oral tablet 1.25 mg, 2.5 mg
F
QL
methyclothiazide
F
metolazone
F
QL
Dopamine D1 Receptor Agonists,
Antihypertensive
Corlopam
F
Non-Cardiac Selective Beta BlockerThiazide Diuretic And Related Comb.
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
27
Drug
propranolol-hydrochlorothiazid
Status
Notes
F
Peripheral Alpha-1 Receptor Blockers
doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg
F
QL
prazosin oral
F
QL
terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg
F
QL
F
PA; QL
Letairis
F
PA; QL
Tracleer
F
PA; QL
Adcirca
F
PA; QL
sildenafil oral
F
PA
F
PA; QL
F
PA; QL
hydroxyzine HCl oral solution 10 mg/5 mL
F
AL
hydroxyzine HCl oral tablet
F
AL
hydroxyzine pamoate
F
AL
F
QL
Pulmonary Antihypertensive AgentsSoluble Guanylate Cyclase Stimulator
Adempas
Pulmonary Arterial Hypertension Endothelin Receptor Antagonists
Pulmonary Arterial Hypertension
Agents-Selective Cgmp-Pde5 Inhibitors
Renin Inhibitor, Direct
Tekturna
Renin Inhibitor, Direct And Diuretic
Combinations
Tekturna HCT
Central Nervous System Agents
Antianxiety Agent - Antihistamine Type
Antidepressant-Norepinephrine And
Dopamine Reuptake Inhibitors (Ndris)
bupropion HCl oral tablet extended release 150
mg
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
28
Drug
Antiparkinson - Dopaminerg-Peripheral
Dopa-Decarboxylase Inhibit Comb
Status
carbidopa-levodopa oral tablet
F
carbidopa-levodopa oral tablet extended release
F
carbidopa-levodopa oral tablet,disintegrating 10100 mg, 25-250 mg
F
carbidopa-levodopa oral tablet,disintegrating 25100 mg
F
Notes
QL
Antiparkinson Therapy - Ergot
Alkaloids And Derivatives
bromocriptine oral capsule
F
bromocriptine oral tablet
F
QL
F
QL
amantadine HCl oral capsule
F
QL
amantadine HCl oral solution
F
QL
amantadine HCl oral tablet
F
pramipexole oral tablet
F
QL
ropinirole oral tablet
F
QL
F
AL
F
QL
naratriptan
F
QL
rizatriptan
F
QL
Antiparkinson Therapy - Monoamine
Oxidase Inhibitor(Mao-B)
selegiline HCl oral capsule
Antiparkinson Therapy - Non-Ergot
Dopamine Agonist Agents
Cns Stimulant - Analeptics
caffeine citrated oral
Migraine Therapy - AnalgesicVasoconstrictor-Sedative Combinations
isometh-dichloral-acetaminophn
Migraine Therapy - Selective Serotonin
Agonists 5-Ht(1)
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
29
Drug
Status
Notes
sumatriptan succinate oral
F
QL
sumatriptan succinate subcutaneous cartridge 4
mg/0.5 mL, 6 mg/0.5 mL
F
PA; QL
sumatriptan succinate subcutaneous pen injector
F
PA; QL
sumatriptan succinate subcutaneous solution
F
PA; QL
zolmitriptan
F
ST; QL
diphenhydramine HCl oral capsule
F
OTC; AL
diphenhydramine HCl oral tablet 25 mg
F
OTC; AL
F
QL
Nicorelief
F
OTC
nicotine (polacrilex)
F
OTC
nicotine transdermal patch 24 hour 14 mg/24 hr, 7
mg/24 hr
F
OTC
nicotine transdermal patch, TD daily, sequential
F
OTC; QL
Nicotrol
F
Nicotrol NS
F
NTS Step 1
F
OTC
Stop Smoking Aid
F
OTC
Chantix
F
QL
Chantix Continuing Month Box
F
QL
Chantix Starting Month Box
F
QL
Sedative-Hypnotic - Antihistamines
Chemical Dependency, Agents To Treat
Smoking Deterrents - Ne And
Dopamine Reuptake Inhibitor (Ndri)Type
bupropion HCl oral tablet extended release 150
mg
Smoking Deterrents - Nicotine-Type
Smoking Deterrents - Nicotinic
Receptor Partial Agonist, Alpha4beta2
Chemicals-Pharmaceutical Adjuvants
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
30
Drug
Pharmaceutical Adjuvant - Inhalation
Vehicles
sodium chloride inhalation solution for
nebulization 0.9 %, 7 %
Status
Notes
F
Cognitive Disorder Therapy
Alzheimer's Disease Therapy Cholinesterase Inhibitors
donepezil oral tablet 10 mg, 5 mg
F
QL; AL
donepezil oral tablet 23 mg
F
QL
galantamine oral capsule,ext rel. pellets 24 hr
F
QL
galantamine oral solution
F
galantamine oral tablet
F
QL
rivastigmine tartrate
F
AL
memantine oral tablet
F
PA; QL; AL
memantine oral tablets,dose pack
F
PA; QL; AL
F
QL
Azurette (28)
F
Female
desog-e.estradiol/e.estradiol
F
Female
Kariva (28)
F
Female
Lo Loestrin Fe
F
Female
Necon 10/11 (28)
F
Female
Viorele (28)
F
Female
Altavera (28)
F
Female
Alyacen 1/35 (28)
F
Female
Apri
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
F
Female
Alzheimer's Disease Therapy - Nmda
Receptor Antagonists
Contraceptives
Contraceptive Injectable - Progestin
medroxyprogesterone intramuscular
Contraceptive Oral - Biphasic
Contraceptive Oral - Monophasic
31
Drug
Status
Notes
Aviane
F
Female
Balziva (28)
F
Female
Brevicon (28)
F
Female
Briellyn
F
Female
Cryselle (28)
F
Female
Cyclafem 1/35 (28)
F
Female
Dasetta 1/35 (28)
F
Female
desogestrel-ethinyl estradiol
F
Female
drospirenone-ethinyl estradiol oral tablet 3-0.03
mg
F
Female
Elinest
F
Enskyce
F
Female
Estarylla
F
Female
Falmina (28)
F
Female
Femcon Fe
F
PA; Female
Generess Fe
F
PA; Female
Gianvi (28)
F
Female
Gildagia
F
Female
Gildess 1.5/30 (21)
F
Female
Gildess 1/20 (21)
F
Female
Gildess 24 Fe
F
Female
Gildess FE 1.5/30 (28)
F
Gildess FE 1/20 (28)
F
Introvale
F
Female
Jolessa
F
Female
Junel 1.5/30 (21)
F
Female
Junel 1/20 (21)
F
Female
Junel FE 1.5/30 (28)
F
Female
Junel FE 1/20 (28)
F
Female
Kelnor 1/35 (28)
F
Female
Kurvelo
F
Female
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
32
Drug
Status
Notes
Larin 1.5/30 (21)
F
Female
Larin 1/20 (21)
F
Female
Larin Fe 1.5/30 (28)
F
Female
Larin Fe 1/20 (28)
F
Female
Layolis Fe
F
PA; Female
Lessina
F
Female
levonorgestrel-ethinyl estrad
F
Female
Levora-28
F
Female
Loestrin 1/20 (21)
F
Female
Lomedia 24 Fe
F
Female
Loryna (28)
F
Female
Low-Ogestrel (28)
F
Female
Lutera (28)
F
Female
Marlissa
F
Female
Microgestin 1.5/30 (21)
F
Female
Microgestin 1/20 (21)
F
Female
Microgestin Fe 1.5/30 (28)
F
Female
Microgestin FE 1/20 (28)
F
Female
Minastrin 24 Fe
F
PA; Female
Modicon (28)
F
Female
Mono-Linyah
F
Female
Mononessa (28)
F
Female
Necon 0.5/35 (28)
F
Female
Necon 1/35 (28)
F
Female
Necon 1/50 (28)
F
Female
Nikki (28)
F
Female
noreth-ethinyl estradiol-iron
F
Female
norethindrone ac-eth estradiol oral tablet 1-20
mg-mcg
F
Female
norethindrone-e.estradiol-iron
F
Female
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
33
Drug
Status
Notes
norgestimate-ethinyl estradiol oral tablet 0.25-35
mg-mcg
F
Female
norgestrel-ethinyl estradiol
F
Norinyl 1+50 (28)
F
Nortrel 0.5/35 (28)
F
Female
Nortrel 1/35 (21)
F
Female
Ocella
F
Female
Ogestrel (28)
F
Female
Orsythia
F
Ovcon-35 (28)
F
Philith
F
Portia
F
Previfem
F
Quasense
F
Female
Reclipsen (28)
F
Female
Safyral
F
Female
Sprintec (28)
F
Female
Sronyx
F
Female
Syeda
F
Female
Vestura (28)
F
Female
Wera (28)
F
Wymzya Fe
F
PA
Yasmin (28)
F
Female
Zarah
F
ZenChent (28)
F
Female
Zenchent Fe
F
PA; Female
Zovia 1/35E (28)
F
Female
Zovia 1/50E (28)
F
Female
Camila
F
Female
Deblitane
F
Female
Female
Female
Contraceptive Oral - Progestin
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
34
Drug
Status
Notes
Errin
F
Female
Heather
F
Female
Jencycla
F
Female
Jolivette
F
Female
Nora-BE
F
Female
norethindrone (contraceptive)
F
Female
Norlyroc
F
Female
Ortho Micronor
F
Female
Sharobel
F
Female
Alyacen 7/7/7 (28)
F
Female
Aranelle (28)
F
Female
Caziant (28)
F
Female
Cyclafem 7/7/7 (28)
F
Female
Dasetta 7/7/7 (28)
F
Female
Enpresse
F
Female
Leena 28
F
Female
Levonest (28)
F
Female
Myzilra
F
Necon 7/7/7 (28)
F
Female
norgestimate-ethinyl estradiol oral tablet
0.18/0.215/0.25 mg-25 mcg, 0.18/0.215/0.25 mg35 mcg (28)
F
Female
Nortrel 7/7/7 (28)
F
Female
Ortho Tri-Cyclen (28)
F
Female
Ortho Tri-Cyclen Lo (28)
F
Female
Ortho-Novum 7/7/7 (28)
F
Female
Tilia Fe
F
Female
Tri-Estarylla
F
Female
Tri-Legest Fe
F
Female
Tri-Linyah
F
Female
Contraceptive Oral - Triphasic
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
35
Drug
Status
Notes
TriNessa (28)
F
Female
Tri-Previfem (28)
F
Tri-Sprintec (28)
F
Female
Trivora (28)
F
Female
Velivet Triphasic Regimen (28)
F
Female
F
Female; QL
F
Female; QL
Fallback Solo
F
Female; OTC
My Way
F
Female; OTC
Next Choice One Dose
F
Female; OTC
Take Action
F
Female; OTC
Fallback Solo
F
Female; OTC
My Way
F
Female; OTC
Next Choice One Dose
F
Female; OTC
Take Action
F
Female; OTC
Gynol II
F
Female; OTC
Today Contraceptive Sponge
F
Female; OTC
Vaginal Contraceptive Foam
F
Female; OTC
Claravis
F
PA; QL
Myorisan oral capsule 10 mg, 20 mg, 40 mg
F
Contraceptive Transdermal
Combinations
Xulane
Contraceptives - Intravaginal, Systemic
NuvaRing
Emergency Contraceptives
Emergency Contraceptives - Progestin
Type
Spermicides
Dermatological
Acne Therapy Systemic - Retinoids And
Derivatives
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
36
Drug
Acne Therapy Topical - Anti-Infective
Status
clindamycin phosphate topical gel
F
clindamycin phosphate topical lotion
F
clindamycin phosphate topical solution
F
clindamycin phosphate topical swab
F
erythromycin with ethanol topical solution
F
metronidazole topical cream
F
Notes
Acne Therapy Topical - Anti-InfectiveKeratolytic Combinations
clindamycin-benzoyl peroxide topical gel 1-5 %
F
erythromycin-benzoyl peroxide gel
F
QL
benzoyl peroxide topical cleanser 5 %
F
OTC
benzoyl peroxide topical gel 10 %
F
OTC; QL
benzoyl peroxide topical gel 5 %
F
OTC
adapalene topical cream
F
ST; QL
adapalene topical gel 0.1 %
F
ST; QL
tretinoin topical cream
F
QL; AL
tretinoin topical gel 0.01 %, 0.025 %
F
QL; AL
Acne Therapy Topical - Keratolytic
Acne Therapy Topical - Retinoids And
Derivatives
Dermatological - Antibacterial
Aminoglycosides
gentamicin topical cream or ointment
F
Dermatological - Antibacterial Mixtures
bacitracin-polymyxin B topical ointment
F
OTC
Triple Antibiotic topical ointment
F
OTC
F
QL
Dermatological - Antibacterial Other
Mupirocin ointment
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
37
Drug
Dermatological - Antibacterial
Polymyxins And Derivatives
bacitracin topical ointment
Status
Notes
F
OTC
Antibiotic-Pain Relief (bacit)
F
OTC
Neosporin Plus PainRelief(bac)
F
OTC
Tri-Biozene
F
OTC
Triple Antibiotic Plus
F
OTC
F
OTC
Dermatological - Antibacterial-Local
Anesthetic Combinations
Dermatological - Antifungal
Allylamines
Terbinafine 1% cream
Dermatological - Antifungal
Amphoteric Polyene Macrolides
nystatin topical cream
F
nystatin topical ointment
F
nystatin topical powder
F
QL
Dermatological - Antifungal
Hydroxypyridinone
ciclopirox topical solution
F
Dermatological - Antifungal Imidazole
And Related Agents
clotrimazole topical cream
F
OTC
econazole topical cream
F
QL
ketoconazole topical cream
F
QL
ketoconazole topical shampoo
F
QL
miconazole nitrate topical cream
F
OTC
F
OTC
Dermatological - Antifungal
Thiocarbamate
tolnaftate topical aerosol powder
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
38
Drug
Dermatological - AntifungalGlucocorticoid Combinations
Status
clotrimazole-betamethasone cream and lotion
F
nystatin-triamcinolone cream and ointment
F
Notes
Dermatological - Antineoplastic
Antimetabolites
fluorouracil topical cream
F
Dermatological - Antineoplastic Or
Premalignant Lesions - Nsaid's
diclofenac sodium topical gel 3 %
F
PA
Dermatological - Antiperspirants
aluminum chloride solution
F
Dermatological - Antipsoriatic Agents
Systemic, Vitamin A Derivatives
Acitretin oral capsule
F
PA
calcipotriene scalp
F
PA; QL
calcipotriene topical cream
F
PA
calcipotriene topical ointment
F
PA; QL
Dermatological - Antipsoriatic Agents
Topical
Dermatological - Antiseborrheic
selenium sulfide topical lotion
F
selenium sulfide topical shampoo 2.25 %
F
Dermatological - Antiviral, Herpes
Abreva 10% cream
F
OTC
Dermatological - Burn Products AntiInfective
silver sulfadiazine 1% cream
F
Dermatological - Calcineurin Inhibitors
Elidel cream
F
PA; QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
39
Drug
tacrolimus topical ointment
Status
Notes
F
PA
ammonium lactate topical cream
F
OTC; QL
ammonium lactate topical lotion
F
OTC; QL
Dermatological - Emollients
Dermatological - Enzymes
Santyl
F
Dermatological - Glucocorticoid
betamethasone dipropionate topical cream
F
QL
betamethasone valerate topical cream
F
QL
betamethasone valerate topical lotion
F
QL
betamethasone valerate topical ointment
F
QL
betamethasone, augmented cream
F
betamethasone, augmented gel
F
clobetasol scalp solution
F
PA; QL
clobetasol topical cream
F
PA; QL
clobetasol topical ointment
F
PA; QL
Cortizone-10 topical ointment
F
OTC
fluocinonide topical cream 0.05 %
F
QL
fluocinonide topical ointment
F
QL
fluocinonide topical solution
F
QL
Fluocinonide-E cream
F
QL
halobetasol propionate cream
F
halobetasol propionate ointment
F
hydrocortisone acetate topical cream
F
OTC
hydrocortisone topical cream 0.5 %, 1 %
F
OTC
hydrocortisone topical cream 2.5 %
F
hydrocortisone topical lotion 2.5 %
F
hydrocortisone topical ointment 0.5 %, 1 %
F
hydrocortisone topical ointment 2.5 %
F
hydrocortisone valerate topical cream
F
QL
mometasone topical cream
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
F
QL
OTC
40
Drug
Status
Notes
mometasone topical solution
F
QL
triamcinolone acetonide topical cream 0.025 %,
0.1 %, 0.5 %
F
QL
triamcinolone acetonide topical lotion 0.025 %
F
triamcinolone acetonide topical lotion 0.1 %
F
QL
triamcinolone acetonide topical ointment 0.025
%, 0.1 %
F
QL
triamcinolone acetonide topical ointment 0.5 %
F
Dermatological - Immunomodulator Imidazoquinolinamines
Imiquimod cream packet
F
PA; QL
Dermatological - KeratolyticAntimitotic Single Agents
Podofilox topical solution
F
Dermatological - Local Anesthetic
Combinations
lidocaine-prilocaine topical cream
F
QL
Dermatological - Topical Local
Anesthetic Amides
lidocaine HCl 2% jelly
F
lidocaine HCl topical cream 3 %
F
lidocaine topical adhesive patch,medicated
F
PA
Lidocream 4% topical cream
F
OTC
F
OTC
F
OTC; QL
Dermatological Irritants-CounterIrritant Single Agents
capsaicin topical cream 0.025 %
Scabicide And Pediculicide
Combinations
Lice Killing Shampoo
Scabicide And Pediculicide Single
Agents
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
41
Drug
Status
Notes
lindane topical shampoo
F
QL
malathion lotion
F
ST; QL
permethrin topical cream
F
QL
permethrin topical liquid
F
OTC; QL
Eating Disorder Therapy
Appetite Stimulants - Progestin
Hormone Type
megestrol oral suspension 400 mg/10 mL (10
mL), 400 mg/10 mL (40 mg/mL)
F
Electrolyte Balance-Nutritional
Products
B-Complex Vitamin Combinations
Alba-Lybe
F
OTC
Apetex
F
OTC
Apetigen
F
OTC
B Complex Plus Vitamin C
F
OTC
B complex-vitamin C-folic acid
F
OTC
B-100 Complex oral tablet extended release
F
OTC
Balanced B Complex-Vit C
F
OTC
Balanced B-100 Complex oral tablet extended
release 100 mg
F
OTC
Balanced B-100 oral tablet 100 mg
F
OTC
B-Complex oral tablet 300 mg-150 mg calcium
F
OTC
B-complex with vitamin C oral tablet
F
OTC
B-complex with vitamin C oral tablet
F
OTC
B-complex with vitamin C oral tablet extended
release
F
OTC
B-complex with vitamin C oral tablet extended
release
F
OTC
Biopetit
F
OTC
Cardiotek-RX (bioperine)
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
42
Drug
Status
Notes
Complex B-100 oral tablet extended release 400
mcg
F
OTC
Complex B-50
F
OTC
DIALYVITE 3000
F
DIALYVITE 800
F
OTC
Dialyvite 800 Plus D
F
OTC
Dialyvite 800 with Zinc 15
F
OTC
Dialyvite 800 with Zinc 50
F
OTC
Dialyvite 800-Ultra D
F
OTC
Dialyvite oral tablet 100-1 mg
F
Dialyvite Supreme D
F
Fatigue Relief Complex
F
OTC
Folbee AR
F
OTC
Folbee Plus oral tablet 5 mg
F
Folbee Plus oral tablet 5-1.5-25 mg
F
Lysiplex Plus oral tablet
F
Medtycholl-B Complex-Liver
F
OTC
Natural B-100 Complex
F
OTC
Nephrocaps Qt
F
Nephronex
F
OTC
Nephronex-SL
F
OTC
Nutrivit
F
OTC
ProRenal
F
OTC
Quin B Strong
F
OTC
Renal Caps
F
Reno Caps
F
Stress B Plus Zinc
F
OTC
Stress B With Zinc
F
OTC
Stress Formula
F
OTC
Stress Formula 600 C
F
OTC
Stress Formula Energy
F
OTC
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
43
Drug
Status
Notes
Stress Formula plus Iron
F
OTC
Stress Formula with Iron
F
OTC
Stress Formula With Iron(sulf)
F
OTC
Stress Formula with Zinc
F
OTC
Super B Complex + C
F
OTC
Super B Complex-Vitamin C
F
OTC
Super B/C
F
OTC
Superplex-T
F
OTC
Supervite
F
Support-500
F
OTC
Total B/C
F
OTC
Triphrocaps
F
Virt-Vite Plus
F
vit B complex-folic acid
F
OTC
Vita-Bee with C
F
OTC
Vitamin B Complex With C
F
OTC
Vitamins B Complex oral tablet 500 mg-400
mcg- 18 mg iron
F
OTC
Vitamins for Hair oral tablet
F
OTC
B Complete
F
OTC
B Complex 1
F
OTC
B Complex 100 injection
F
B Complex sublingual
F
OTC
B Complex-Vitamin B12
F
OTC
B-50 Complex oral tablet extended release
F
OTC
Bal B-100
F
OTC
Bal B-50
F
OTC
Balance B-100
F
OTC
Balance B-50
F
OTC
B-Complex Vitamins
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
44
Drug
Status
Notes
Balanced B-100 Complex oral tablet extended
release
F
OTC
Balanced B-100 oral tablet
F
OTC
Balanced B-50
F
OTC
Complex B-100 oral tablet extended release
F
OTC
Folgard
F
OTC
Hi-B Complex
F
OTC
Natural B-100
F
OTC
PoDiaPN
F
OTC
Stress B-Biotin
F
OTC
Stress Formula
F
OTC
Super B-50 Complex
F
OTC
Super B-50 Complex Plus
F
OTC
Super Quints B-50
F
OTC
Ultra B-100 Complex
F
OTC
vitamin B complex
F
OTC
Vitamins B Complex oral capsule
F
OTC
Vitamins B Complex oral tablet
F
OTC
Apetigen Plus oral liquid
F
OTC
Dialyvite oral tablet 1-100-300-50 mg-mg-mcgmg
F
Nephplex Rx
F
Rabano Yodado
F
Rena-Vite Rx
F
B-Complex Vitamins And
Combinations
OTC
Brewers Yeast
Brewer's Yeast
F
OTC
Yeast tablet
F
OTC
F
OTC
Dietary Product - Dietary Supplements
Diabetic Support Formula
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
45
Drug
Status
Notes
Hair,Skin and Nails oral tablet 3.3 mg iron-25
mcg
F
OTC
Megavite
F
OTC
Megavite Golden Years 55+
F
OTC
Niacin-Aze AC-Turmer-FA-B6-ZN
F
Nicadan
F
Nicazel
F
NicAzel Forte
F
One Daily oral tablet 300-18-400-50 mg-mgmcg-mg
F
OTC
One Daily Women's Metabolism
F
OTC
Prostamen
F
OTC
Vitamin D3 Complete
F
OTC
VP-Zel
F
Electrolyte Depleters - Ion Exchange
Resin
Kionex
F
sodium polystyrene (sorb free)
F
sodium polystyrene sulfonate oral powder
F
sodium polystyrene sulfonate rectal
F
Geriatric Vitamins
A Thru Z Select oral tablet
F
OTC
Central Vite
F
OTC
Central-Vite oral tablet
F
OTC
Central-Vite Select
F
OTC
Centravites 50 Plus
F
OTC
Cerovite Senior
F
OTC
Complete Senior oral tablet
F
OTC
Daily Multivitamin-Minerals
F
OTC
Milltrium Senior
F
OTC
Multivitamin 50 Plus
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
46
Drug
Status
Notes
multivitamin with minerals oral tablet
F
OTC
Multi-Vite 50 and Over
F
OTC
REQ49+
F
Spectravite Senior oral tablet
F
OTC
Theratrum Complete 50 Plus
F
OTC
Theratrum Complete 50 Plus/Lut
F
OTC
Vision Plus Lutein
F
OTC
Vitrum Senior oral tablet
F
OTC
Calci-Chew
F
OTC
Calci-Mix
F
OTC
Calcionate
F
OTC
Calcitrate
F
OTC
Calcium 500 oral tablet,chewable
F
OTC
calcium acetate oral tablet 667 mg
F
calcium amino acid chelate
F
OTC
calcium carbonate oral powder
F
OTC
calcium carbonate oral suspension
F
OTC
calcium carbonate oral tablet 500 mg calcium
(1,250 mg), 600 mg (1,500 mg)
F
OTC
calcium carbonate oral tablet,chewable 260 mg
(650 mg), 500 mg calcium (1,250 mg)
F
OTC
calcium chloride intravenous
F
calcium citrate
F
calcium gluconate intravenous
F
calcium gluconate oral tablet 45 mg (500 mg), 50
mg calcium, 60 mg (650 mg), 61 mg (648 mg)
F
OTC
calcium lactate
F
OTC
calcium phosphate
F
OTC
Cal-Mint
F
OTC
Coral Calcium oral tablet
F
OTC
Minerals And Electrolytes - Calcium
Replacement
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
47
Drug
Status
Notes
Oysco-500
F
OTC
Oyster Shell Calcium
F
OTC
Oyster Shell Calcium 500
F
OTC
ADVANCED Calcium
F
OTC
Biocal
F
OTC
Bone Density Calcium + D
F
OTC
Bone Essentials
F
OTC
Ca-D3-mag ox-zinc-cop-mang-bor
F
OTC
Ca-D3-mag-zinc-cop-mang-bor
F
OTC
Cal Mag Zinc + D3
F
OTC
Calci-Max
F
OTC
Calcium 600 + Minerals
F
OTC
Calcium 600 Plus Soy
F
OTC
Calcium 600+D3 Plus
F
OTC
calcium carb-D3-mag cmb11-zinc
F
OTC
calcium carbonate-vit D3-min
F
OTC
Calcium Citrate Plus
F
OTC
Calcium for Women
F
OTC
Calcium Magnesium
F
OTC
Calcium Magnesium + D
F
OTC
Calcium Soft Chew
F
OTC
Calcium with Boron
F
OTC
calcium-magnesium
F
OTC
calcium-magnesium-zinc
F
OTC
calcium-vitamin D3-vitamin K oral
tablet,chewable 500 mg-1,000 unit-40 mcg, 500200-40 mg-unit-mcg, 500-500-40 mg-unit-mcg
F
OTC
Cal-Mag
F
OTC
CalMag Thins
F
OTC
Minerals And Electrolytes - Calcium
Replacement Combinations
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
48
Drug
Status
Notes
Caltrate 600+D Plus Minerals
F
OTC
Citracal + Bone Density
F
OTC
Citracal Chew
F
OTC
Citracal D + Heart Health
F
OTC
Citracal Plus Magnesium
F
OTC
Coral Calcium oral capsule
F
OTC
Fem-Cal Citrate
F
OTC
Folgard OS
F
LoCalnesium
F
OTC
LoCalnesium-C
F
OTC
Oyster Shell Calcium and Mag
F
OTC
Pro-Cal oral tablet
F
OTC
Soy Formula
F
OTC
Super Cal-Mag
F
OTC
TL G-Fol OS
F
Viactiv
F
OTC
Calcet Creamy Bites
F
OTC
Calcet Petites
F
OTC
Cal-Citrate
F
OTC
Calcitrate-Vitamin D
F
OTC
Calcium 500 + D (D3)
F
OTC
Calcium 500 + D oral tablet 500 mg(1,250mg) 200 unit
F
OTC
Calcium 500 + D oral tablet,chewable
F
OTC
Calcium 600 + D(3) oral capsule
F
OTC
Calcium 600 + D(3) oral tablet 600 mg(1,500mg)
-200 unit, 600-125 mg-unit
F
OTC
Calcium 600 with Vitamin D3 oral capsule
F
OTC
Calcium 600 with Vitamin D3 oral
tablet,chewable
F
OTC
Minerals And Electrolytes - Calcium
Replacement/Vitamin D Combinations
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
49
Drug
Status
Notes
Calcium Adult (calcium phos)
F
OTC
calcium carb and citrate-vitD3
F
OTC
calcium carbonate-vitamin D3 oral capsule
F
OTC
calcium carbonate-vitamin D3 oral tablet 1,000
mg(2,500 mg)-800 unit, 500mg (1,250mg) -600
unit, 600 mg(1,500mg) -400 unit, 600
mg(1,500mg) -800 unit
F
OTC
calcium carbonate-vitamin D3 oral
tablet,chewable 500-100 mg-unit
F
OTC
Calcium Citrate + D
F
OTC
calcium citrate malate-vit D3
F
OTC
calcium citrate-vitamin D2
F
OTC
calcium citrate-vitamin D3 oral tablet 200 mg
calcium -250 unit, 200-125 mg-unit, 250 mg
calcium- 200 unit, 315-250 mg-unit
F
OTC
calcium phosphate-vitamin D3
F
OTC
Calcium+D oral tablet 400-133.3 mg-unit
F
OTC
Cal-Quick
F
OTC
Caltrate 600 + D
F
OTC
Caltrate with Vitamin D3
F
OTC
Citracal + D Maximum
F
OTC
Citracal + D Petites
F
OTC
Citracal + D Slow Release
F
OTC
Citracal + D3 (calcium phos) oral tablet,chewable
250 mg calcium- 500 unit
F
OTC
Citracal Regular
F
OTC
Citrus Calcium
F
OTC
Flintstones Bone Support
F
OTC
Hi-Cal Plus Vit D
F
OTC
Liquid Calcium with Vitamin D
F
OTC
Os-Cal 500 + D3
F
OTC
Osteo-Poretical
F
OTC
Oysco 500/D oral tablet
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
50
Drug
Status
Notes
Oyster Shell Calcium With D
F
OTC
Oyster Shell Calcium-Vit D3
F
OTC
Parva-Cal 250
F
OTC
Parva-Cal 500
F
OTC
Prosteon
F
OTC
Risacal-D
F
OTC
TheraCal
F
OTC
TheraCal D2000
F
OTC
TheraCal D4000
F
OTC
Upcal D
F
OTC
EZFE 200
F
OTC
FE C Plus
F
OTC
Feosol
F
OTC
Feraheme
F
Fer-Iron
F
OTC
FeroSul oral solution
F
OTC; AL
FeroSul oral tablet
F
OTC
Ferretts
F
OTC
Ferretts Carbonyl Iron
F
OTC
Ferretts IPS
F
OTC
Ferrex 150
F
OTC
Ferrimin 150
F
OTC
Ferrocite
F
OTC
ferrous fumarate
F
OTC
ferrous gluconate oral tablet 236 mg (27 mg iron),
240 mg (27 mg iron), 256 mg (28 mg iron), 324
mg (36 mg iron), 324 mg (37.5 mg iron), 324 mg
(38 mg iron), 325 mg (36 mg iron)
F
OTC
ferrous sulfate oral drops
F
OTC; AL
ferrous sulfate oral liquid
F
OTC; AL
ferrous sulfate oral solution
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
F
OTC; AL
Minerals And Electrolytes - Iron
51
Drug
Status
Notes
ferrous sulfate oral tablet 325 mg (65 mg iron)
F
OTC
ferrous sulfate oral tablet extended release
F
OTC
ferrous sulfate oral tablet,delayed release
(DR/EC)
F
OTC
FerrouSul
F
OTC
Hemocyte
F
OTC
High Potency Iron
F
OTC
Icar oral suspension
F
OTC
iFerex 150
F
OTC
Infed
F
Injectafer
F
Iron (dried)
F
OTC
Iron 100 Plus
F
OTC; AL
Iron Chews
F
OTC
Iron High Potency
F
OTC
iron oral capsule, extended release
F
OTC
iron oral tablet 18 mg
F
OTC
iron oral tablet extended release 159 mg (45 mg
iron)
F
OTC
IronUp
F
OTC
Myferon 150
F
OTC
MyKidz Iron oral suspension 15 mg iron/1.5 mL
F
OTC
NovaFerrum 125
F
OTC
NovaFerrum 50
F
OTC
NovaFerrum oral drops
F
OTC
Nu-Iron
F
OTC
Perfect Iron
F
OTC
Poly-Iron
F
OTC
Pro Fe
F
OTC
Proferrin ES
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
52
Drug
Status
Notes
Slow Release Iron oral tablet extended release
142 mg (45 mg iron), 143 mg (45 mg iron), 159
mg (45 mg iron), 160 mg (50 mg iron), 168 mg
(50 mg iron), 47.5 mg iron
F
sodium ferric gluconat-sucrose
F
Tandem Dual Action
F
Venofer
F
Wee Care
F
OTC
Abatron
F
OTC
Abatron AF
F
OTC
Active FE
F
Apetigen Plus oral tablet
F
OTC
Central-Vite oral tablet
F
OTC
Centratex
F
Corvita 150
F
Corvite 150 oral tablet 150 mg iron- 1 mg
F
Corvite FE oral tablet 150 mg iron- 1 mg
F
Duofer
F
OTC
FE C
F
OTC
Feosol Bifera
F
OTC
FeRiva
F
Feriva 21-7 Tablet
F
FeRiva FA (Sumalate)
F
Ferocon
F
Ferractiv
F
Ferralet 90 Dual-Iron Delivery
F
FerraPlus 90
F
Ferrex 150 Forte
F
OTC
Ferrex 150 Forte Plus
F
OTC
Ferrex 150 Plus
F
OTC
OTC
OTC
Minerals And Electrolytes - Iron
Combinations
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
53
Drug
Status
Notes
Ferrex 28
F
OTC
Ferrocite Plus
F
Ferrogels Forte
F
Focalgin DSS
F
Folitab
F
Folivane-F
F
Folivane-Plus
F
Fusion
F
Fusion Plus
F
Hematinic Plus Vit/Minerals
F
Hematinic/Folic Acid
F
Hematogen
F
Hematogen FA
F
Hematogen Forte
F
Hematron
F
Hemax
F
HemeTab
F
Hemocyte-Plus
F
I.L.X. B-12
F
OTC
Icar-C
F
OTC
iFerex 150 Forte
F
OTC
Integra
F
OTC
Integra F
F
Integra Plus
F
Iron 21/7
F
OTC
Iron with Stool Softener
F
OTC
iron-vitamin C
F
OTC
Iro-Plex (iron carbonyl)
F
OTC
Iro-Plex (iron polysaccharide)
F
OTC
Irospan 24/6
F
Liver with Iron
F
OTC
OTC
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
54
Drug
Status
Notes
Lydia Pinkham Herbal oral tablet
F
OTC
Maxaron Forte
F
MaxFe (folate-docusate)
F
Multigen
F
Multigen Folic
F
Multigen Plus
F
Nephron FA
F
OB Complete oral tablet
F
Parvlex
F
OTC
Poly-Iron 150 Forte
F
OTC
Proferrin-Forte
F
Siderol oral tablet
F
OTC
Stress Formula
F
OTC
Taron Forte
F
TL Icon
F
Tricon
F
Trigels-F Forte
F
Vitafol
F
Vitron-C
F
OTC
Laxative Dietary Supplement
F
OTC
Mag 64
F
OTC
Mag Glycinate
F
OTC
MagBid ER
F
OTC
Mag-Delay
F
OTC
Mag-G
F
OTC
Maginex
F
OTC
magnesium
F
OTC
Magnesium (oxide/AA chelate)
F
OTC
magnesium amino acid chelate
F
OTC
magnesium chloride injection
F
OTC
Minerals And Electrolytes - Magnesium
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
55
Drug
Status
Notes
magnesium chloride oral
F
OTC
magnesium citrate oral tablet
F
OTC
magnesium gluconate oral
F
OTC
magnesium oxide
F
OTC
magnesium sulfate in D5W intravenous
piggyback 1 gram/100 mL
F
magnesium sulfate in water
F
magnesium sulfate injection
F
Magonate (magnesium carb)
F
OTC
MagOx
F
OTC
Magtab
F
OTC
Phillips
F
OTC
Slow-Mag
F
OTC
Uro-Mag
F
OTC
F
OTC
F
OTC
CeraLyte-70 oral solution
F
OTC
CeraSport oral liquid
F
OTC
Oralyte
F
OTC
Pediatric Electrolyte oral solution
F
OTC
Pediatric Freezer Pops
F
OTC
PediaVance
F
OTC
Minerals And Electrolytes - Magnesium
Combinations
Beelith
Minerals And Electrolytes - Multiple
Minerals
calcium-magnesium-copper-zinc
Minerals And Electrolytes - Oral
Electrolytes
Minerals And Electrolytes - Phosphate
Glycophos
F
Phos-NaK
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
56
Drug
Status
potassium phosphate m-/d-basic
F
sodium phosphate
F
Notes
Minerals And Electrolytes - Potassium
Combinations
potassium bicarb and chloride
F
Minerals And Electrolytes - Potassium,
Oral
potassium bicarb-citric acid
F
potassium chloride oral capsule, ER 10 mEq, 8
mEq
F
potassium chloride oral liquid 20 mEq/15 mL,
40 mEq/15 mL
F
potassium chloride 20mEq oral packet
F
potassium chloride oral tablet extended release 10
mEq, 8 mEq
F
potassium chloride oral tablet, ER
particles/crystals 10 mEq, 20 mEq
F
Potassium 25 mEq tablet, effervescent
F
Multivitamin And Mineral
Combinations
50+ Adult Eye Health
F
OTC
A Thru Z
F
OTC
A Thru Z Men's Ultimate
F
OTC
A Thru Z Select 50+ Formula
F
OTC
A Thru Z Select oral tablet 300-600-300 mcg,
500-300-250 mcg
F
OTC
A Thru Z Select Women's
F
OTC
ABC Plus
F
OTC
Actical
F
OTC
Adult Multivitamin Gummies
F
OTC
Adult One Daily Gummies
F
OTC
Advanced AM-PM
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
57
Drug
Status
Notes
Antioxidant
F
OTC
Antioxidant A/C/E/Selenium
F
OTC
Antioxidant Formula (selenium)
F
OTC
Antioxidant Vitamins oral tablet 1,000 unit-200
mg-60 unit-2 mg
F
OTC
Apatate Forte
F
OTC
AquADEKs
F
OTC
Bacmin
F
Bee-Zee
F
OTC
Berocca (FA-guarana-caff)
F
OTC
Bio-35
F
OTC
Bio-35, Gluten Free
F
OTC
Biocel (with Lutein)
F
OTC
Biosupp
F
OTC
Biotect Plus
F
OTC
Biotin Plus-Calcium and Vit D3
F
OTC
Biovol
F
OTC
Bladder 2.2
F
OTC
Body, Hair, Skin and Nails
F
OTC
Calcium Citrate + D with Mag
F
OTC
Calcium Citrate Plus (Vit B6)
F
OTC
Cardiamin
F
OTC
Centamin
F
OTC
Central Vite
F
OTC
Central Vite with Lutein
F
OTC
Central-Vite Cardio
F
OTC
Central-Vite Energy
F
OTC
Central-Vite Men's Under 50
F
OTC
Central-Vite oral tablet
F
OTC
Central-Vite Performance oral tablet 18 mg iron400 mcg-50 mg
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
58
Drug
Status
Notes
Central-Vite Select
F
OTC
Central-Vite Senior
F
OTC
Central-Vite with Lycopene
F
OTC
Central-Vite Women's Mature
F
OTC
Centram-Care
F
OTC
Centravites
F
OTC
Centrum
F
OTC
Centrum Men
F
OTC
Centrum Silver
F
OTC
Centrum Silver Ultra Men's
F
OTC
Centrum Silver Women
F
OTC
Centrum Specialist Energy
F
OTC
Centrum Specialist Heart
F
OTC
Centrum Ultra Men's
F
OTC
Century Adults 50+
F
OTC
Century Cardio
F
OTC
Century Energy Metabolism
F
OTC
Century Mature oral tablet 0.4-300-250 mg-mcgmcg, 500-300-250 mcg
F
OTC
Century Ultimate Men's
F
OTC
Century Ultimate Women's oral tablet 8 mg iron400 mcg-300 mcg
F
OTC
Cerovite
F
OTC
Certa Plus
F
OTC
CertaVite Senior-Antioxidant
F
OTC
CertaVite-Antioxid (iron gluc) oral liquid 9 mg
iron/15 mL
F
OTC
Compete
F
OTC
Complete 50+
F
OTC
Complete Multi
F
OTC
Complete Multi 50+
F
OTC
Complete Multivitamin oral tablet
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
59
Drug
Status
Notes
Complete Multivitamin-Mineral oral liquid
F
OTC
Complete oral tablet 18-500-300-250 mg-mcgmcg-mcg
F
OTC
Complete Premium Vitamin
F
OTC
Complete Senior oral tablet 0.4-300-250 mg-mcgmcg
F
OTC
Corvita
F
Corvite
F
Corvite Free
F
Daily Gummies
F
OTC
Daily Multiple For Women 50+
F
OTC
Daily Multiple oral tablet , 400-120 mcg-mg
F
OTC
Daily Multivitamin
F
OTC
Daily Multivitamin-Minerals
F
OTC
Daily Multi-Vitamins/Iron
F
OTC
DAILY VITAMIN FORMULA-MINERALS
F
OTC
Daily Vitamin with Iron
F
OTC
Daily Vitamin with Iron and CA
F
OTC
Daily Vites/Iron
F
OTC
Daily-Vite
F
OTC
Diabetes Health
F
OTC
Diabetes Health Formula
F
OTC
Diabetes Health Pack
F
OTC
Dialyvite 5000
F
ECee Plus
F
Eldercaps
F
ESSENTIAL Balance with Lutein
F
OTC
ESSENTIAL Daily
F
OTC
ESSENTIAL Man
F
OTC
ESSENTIAL Man 50+
F
OTC
Essential Woman 50+
F
OTC
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
60
Drug
Status
Notes
Fosfree
F
OTC
Freedavite
F
OTC
Hair Vitamins
F
OTC
Hair, Skin and Nails-Argan Oil
F
OTC
Hair,Skin and Nails oral tablet , 1 mg iron-66.7
mcg-1,000 mcg
F
OTC
Hair,Skin and Nails(FA-biotin)
F
OTC
Healthy Eyes
F
OTC
Healthy Eyes SuperVision
F
OTC
Heartburn and Acid Reflux-Aloe
F
OTC
ICaps
F
OTC
I-Caps
F
OTC
ICaps AREDS
F
OTC
Icaps MV
F
OTC
Icaps Plus
F
OTC
I-Vite
F
OTC
I-Vite Protect
F
OTC
K-Pax Immune Support
F
OTC
K-PAX oral capsule
F
OTC
Life-Pack Men's
F
OTC
Life-Pack Women's
F
OTC
Macular Vitamin oral tablet 500-5-1 mcg-mg-mg
F
OTC
Macuvite Eye Care
F
OTC
Maximin Pack
F
OTC
MAXIMUM DAILY GREEN
F
OTC
Maximum Daily Multivitamin
F
OTC
Mega Multi for Women
F
OTC
Mega Multiple/Chelated Mineral
F
OTC
Mega Multivitamin For Men
F
OTC
Mega Multivitamin with Mineral
F
OTC
Men's Biomultiple
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
61
Drug
Status
Notes
Men's Daily
F
OTC
Men's Daily Multivit-Mineral
F
OTC
Men's Multivitamin Gummies
F
OTC
Men's One Daily
F
OTC
Men's Pack
F
OTC
Monocaps
F
OTC
Multi For Her oral tablet
F
OTC
Multi Vitamin
F
OTC
Multi-Betic
F
OTC
Multi-Delyn with Iron
F
OTC
Multilex
F
OTC
Multilex-T and M
F
OTC
Multiple Vitamin, Womens
F
OTC
Multiple Vitamin-Minerals
F
OTC
Multi-Vitamin HP/Minerals
F
OTC
multivitamin with iron
F
OTC
multivitamin with minerals
F
OTC
mv-min-folic acid-lutein
F
OTC
My-Vitalife
F
OTC
Nicomide
F
Nicomide (selenium-chromium)
F
Nutricap
F
Ocutabs
F
OTC
Ocuvite
F
OTC
Ocuvite with Lutein
F
OTC
Omnicap
F
OTC
One Daily Calcium/Iron
F
OTC
One Daily Complete
F
OTC
One Daily Energy oral tablet
F
OTC
One Daily Essential oral tablet 0.4 mg
F
OTC
One Daily For Men
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
62
Drug
Status
Notes
One Daily For Women
F
OTC
One Daily Gummy Vites
F
OTC
One Daily Healthy Weight
F
OTC
One Daily Maximum
F
OTC
One Daily Men's 50+ oral tablet 400-120 mcg-mg
F
OTC
One Daily Multi-Vit w-Mineral
F
OTC
One Daily oral tablet 0.4-600 mg-mcg
F
OTC
One Daily Plus Iron oral tablet
F
OTC
One Daily Plus Minerals
F
OTC
One Daily With Iron
F
OTC
One Daily Women 50 Plus
F
OTC
One Daily Womens 50 Plus
F
OTC
One Daily Women's oral tablet 27-0.4 mg
F
OTC
One-A-Day Cholesterol Plus
F
OTC
One-A-Day Maximum Formula
F
OTC
One-A-Day Men VitaCraves
F
OTC
One-A-Day Menopause Formula
F
OTC
One-A-Day Men's 50+ Advantage oral tablet 40020-370 mcg
F
OTC
One-A-Day Men's Multivitamin
F
OTC
One-A-Day Teen Advantage oral tablet 9 mg
iron-400 mcg
F
OTC
One-A-Day VitaCraves
F
OTC
One-A-Day VitaCraves Energy
F
OTC
One-A-Day Vitacraves Immunity
F
OTC
One-A-Day Vitacraves Omega-3
F
OTC
One-A-Day WeightSmart
F
OTC
One-A-Day Women VitaCraves
F
OTC
One-A-Day Women's 50+
F
OTC
One-A-Day Women's Active
F
OTC
One-A-Day Womens Formula oral tablet 18 mg
iron-400 mcg-500 mg
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
63
Drug
Status
Notes
One-A-Day Women's Healthy Skin
F
OTC
Optisource
F
OTC
Opti-Vitamins
F
OTC
Opurity Multivitamin
F
OTC
Oxi-Freeda
F
OTC
PreserVision AREDS
F
OTC
PreserVision Lutein
F
OTC
Prevent
F
OTC
ProCerv HP
F
OTC
ProRenal QD
F
OTC
Prosight with Lutein
F
OTC
Protect Cardio AF
F
OTC
Protect Iron
F
Protect Plus SO
F
OTC
Quintabs-M
F
OTC
Quintabs-M Iron Free
F
OTC
REQ49+
F
SAVision
F
OTC
Sentry oral tablet 18-500-300-250 mg-mcg-mcgmcg
F
OTC
Sentry Senior
F
OTC
Softgels Multivit-A,B,D,E,K,Zn
F
Solo
F
OTC
Spectravite Adult
F
OTC
Spectravite Adult 50+
F
OTC
Spectravite Men's
F
OTC
Spectravite Senior oral tablet 500-300-250 mcg
F
OTC
Spectravite Ultra Men 50+
F
OTC
Spectravite Ultra Men's Sr
F
OTC
Spectravite Ultra Women's Sr
F
OTC
Stress B-Complex
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
64
Drug
Status
Notes
Stress Formula Advanced
F
OTC
Strovite Forte
F
Strovite One
F
Sunvite
F
OTC
Super Antioxidant
F
OTC
Super Ginseng Multivitamin
F
OTC
Super Multiple
F
OTC
Super Multiple - Low Iron
F
OTC
Super Thera Vite M
F
OTC
Superior 35
F
OTC
Supervite (EC)
F
Support
F
OTC
Tab-A-Vite/Iron
F
OTC
Tab-A-Vite-Minerals
F
OTC
Thera M Plus (ferrous fumarat)
F
OTC
Theradex M
F
OTC
Theragran-M Premier 50 Plus
F
OTC
Theralogix Companion
F
OTC
Thera-M
F
OTC
Theramill Forte oral capsule 67 mcg-12.5 mg 12.5 mg-17 mg
F
OTC
TheraNatal oral combo pack
F
OTC
Therapeutic M + beta-Carotene
F
OTC
Therapeutic-M oral tablet 9 mg iron-400 mcg
F
OTC
Therapeutic-M Vitamin/Minerals
F
OTC
Thera-Tabs M
F
OTC
Theratrum Complete with Lutein
F
OTC
Therems
F
OTC
Therems-H
F
OTC
Therems-M
F
OTC
Totalday Multiple
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
65
Drug
Status
Notes
TRUEplus Diabetic Multivitamin
F
OTC
TYR Cooler oral liquid
F
OTC
Udamin SP
F
Ultimate Men's Complete 50+
F
OTC
Ultimate Women's Complete 50+
F
OTC
Ultra Freeda
F
OTC
Unicomplex-M
F
OTC
V-C Forte
F
VIC-Forte
F
Vision
F
OTC
Vision Formula
F
OTC
Vision Formula (with lutein)
F
OTC
Vision-Vite + Zinc
F
OTC
Vitacel (with Lutein)
F
OTC
Vital-D Rx
F
Vitalee
F
OTC
Vitamin D-3 with Aloe
F
OTC
Vitamins A-D-E selenium
F
OTC
Vitamins and Minerals
F
OTC
Vitatrum
F
OTC
Vitrum Senior oral tablet 500-300-250 mcg
F
OTC
Whole Source Multi-Vitamins
F
OTC
Women's Active
F
OTC
Women's Biomultiple
F
OTC
Women's Complex
F
OTC
Women's Daily Caplet
F
OTC
Women's Daily Formula oral tablet 27-0.4 mg
F
OTC
Women's Daily Multivitamin
F
OTC
Women's Multivitamin Gummies
F
OTC
F
OTC
Multivitamins
A Thru Z Advanced Formula
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
66
Drug
Status
Notes
Animi-3 With Vitamin D
F
Antioxidant
F
OTC
Central Vite
F
OTC
Central-Vite
F
OTC
Central-Vite Women's Under 50
F
OTC
Centrum Complete
F
OTC
Century oral tablet 18-400 mg-mcg
F
OTC
Century Ultimate Women's oral tablet 18-400
mg-mcg
F
OTC
Cerefolin
F
OTC
Cerovite Advanced Formula
F
OTC
Certavite-Antioxidant
F
OTC
Chewable-Vite
F
OTC
Complete Multivitamin-Mineral oral tablet
F
OTC
Daily Multiple For Men 50+
F
OTC
Daily Multiple For Women
F
OTC
Daily Multiple oral tablet , 18-400 mg-mcg
F
OTC
Daily Multi-Vitamin
F
OTC
Daily Multivitamin with Iron
F
OTC
Daily Value
F
OTC
Daily Vitamin Formula
F
OTC
Daily Vitamin Formula + Iron
F
OTC
Daily-Vite
F
OTC
Decubi Vite
F
OTC
Diabetes Health Support
F
OTC
DIALYVITE 800 with Iron
F
E-400 C-500 and Beta Carotene
F
OTC
Essentia
F
OTC
ESSENTIAL Balance with Lutein
F
OTC
Fortavit
F
Infuvite Adult
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
67
Drug
Status
Notes
L-Methyl-MC
F
OTC
M.V.I. Adult
F
Men's Multi-Vitamin
F
OTC
Metafolbic
F
OTC
Multi Complete with Iron
F
OTC
Multi-Day with Iron
F
OTC
Multi-Delyn
F
OTC
Multiple Vitamins
F
OTC
multivitamin
F
OTC
Multi-Vite
F
OTC
My Favorite Multiple
F
OTC
Once Daily
F
OTC
Oncovite
F
OTC
One Daily Energy oral tablet 9 mg iron-400 mcg200 mg
F
OTC
One Daily Essential oral tablet , 400 mcg
F
OTC
One Daily For Men 50+ Advanced
F
OTC
One Daily Men's 50+ oral tablet 400-600-120
mcg-mcg-mg
F
OTC
One Daily Multivitamin
F
OTC
One Daily Multivit-Iron(folic)
F
OTC
One Daily oral tablet
F
OTC
One Daily Plus Iron oral tablet 18-400 mg-mcg
F
OTC
One Daily Women's Health
F
OTC
One Daily Women's oral tablet 18 mg iron-400
mcg-450 mg Ca
F
OTC
One-A-Day Energy
F
OTC
One-A-Day Essential
F
OTC
One-A-Day Maximum Formula
F
OTC
One-A-Day Men's 50+ Advantage oral tablet 400300-120 mcg-mcg-mg
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
68
Drug
Status
Notes
One-A-Day Teen Advantage oral tablet 18-400
mg-mcg
F
OTC
One-A-Day Womens Formula oral tablet 18 mg
iron-400 mcg-500 mg Ca
F
OTC
One-A-Day Women's Petites
F
OTC
Pharmacist Favorite Multi-Vit
F
OTC
Quintabs
F
OTC
Sentry oral tablet 18-400 mg-mcg
F
OTC
Se-Tan Plus
F
Spectravite Advanced Formula oral tablet 18-400
mg-mcg
F
OTC
Spectravite Ultra Women
F
OTC
Super Multivitamin
F
OTC
Tab-A-Vite
F
OTC
Thera
F
OTC
Thera Vitamin
F
OTC
Therapeutic Liquid
F
OTC
Thera-Tabs
F
OTC
Therems
F
OTC
Vit 3
F
vitamins A and D
F
OTC
Vitamins for Hair oral tablet
F
OTC
Women's One Daily
F
OTC
Yelets
F
OTC
ANIMAL CHEWS
F
OTC
Animal Shape Vitamins
F
OTC
Chewable Multivit-A,B,D,E,K,Zn
F
Chewable-Vite
F
OTC
Child Multivitamins
F
OTC
Children's Chewable
F
OTC
Children's Chewable Multivitmn
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
F
OTC
Pediatric Vitamins
69
Drug
Status
Notes
Children's Chewable Vitamin
F
OTC
Children's Chewables
F
OTC
Children's Chewables Extra C
F
OTC
Children's Chewables with Iron
F
OTC
Childs Chew Vite
F
OTC
Complete Formulation D3000
F
Complete Formulation Multivit oral capsule
F
Complete Formulation Pediatric
F
Dino-Life
F
OTC
Dino-Life with Extra C
F
OTC
Flintstones Gummies
F
OTC
Flintstones Gummies Omega-3
F
OTC
Flintstones Multivitamin
F
OTC
Flintstones/Extra C oral tablet,chewable
F
OTC
One-A-Day Teen Him VitaCraves
F
OTC
Ped Multivitamins-A,B,D,E,K,Zn
F
Poly-Vita
F
OTC
Poly-Vitamin
F
OTC
Poly-Vitamins
F
OTC
Tri-Vitamin
F
OTC; QL
Zoo Friends
F
OTC
Zoo Friends Original
F
OTC
Animal Shapes Complete oral tablet,chewable 18
mg iron
F
OTC
AquADEKs Pediatric
F
OTC
Centrum Kids
F
OTC
Cerovite Jr
F
OTC
Chewable-Vite with Iron
F
OTC
Child Complete Multivitamin
F
OTC
OTC
Pediatric Vitamins And Mineral
Combinations
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
70
Drug
Status
Notes
Child Vitamin with Minerals
F
OTC
Children's Chew Multivit-Iron
F
OTC
Children's Chewable w/Minerals
F
OTC
Children's Complete Vitamin
F
OTC
Child's Chewable Vitamins/Iron oral
tablet,chewable
F
OTC
Child's Vitamin with Iron
F
OTC
Childs/Iron
F
OTC
Dino-Life with Iron-Zinc
F
OTC
Flintstones Complete (iron)
F
OTC
Flintstones Plus Calcium
F
OTC
Flintstones with Iron
F
OTC
Honey Bears with Iron-Zinc
F
OTC
MyKidz Iron oral suspension 10-1,500-400 mg unit-unit/2 mL
F
OTC
NovaFerrum Pediatric
F
OTC
Poly-Vi-Sol
F
OTC
Poly-Vi-Sol with Iron
F
OTC
Poly-Vita (iron)
F
OTC
Poly-Vitamin with Iron
F
OTC
Polyvitamin/Iron
F
OTC
Scooby-Doo One A Day
F
OTC
Pediatric Vitamins With Fluoride
Combinations
Multi-Vitamin With Fluoride oral tablet,chewable
1 mg
F
Multivitamins With Fluoride oral tablet,chewable
1 mg
F
Mvc-Fluoride
F
Quflora Pediatric
F
Tri-Vi-Flor
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
71
Drug
Status
Notes
Tri-Vitamin With Fluoride oral drops 0.25 mg
fluor. (0.55 mg)/mL
F
Vitamins A,C,D and Fluoride
F
QL
CompleteNate
F
Female; QL; AL
Folbecal
F
Female; QL; AL
HemeNatal OB
F
Female; QL; AL
iNatal Advance
F
Female; QL; AL
iNatal Ultra
F
Female; QL; AL
KPN oral tablet
F
OTC
M-Vit
F
Female; QL; AL
Mynatal Advance
F
Female; QL; AL
Mynatal oral tablet
F
Female; QL; AL
Mynatal Plus
F
Female; QL; AL
Mynatal-Z
F
Mynate 90 Plus
F
Female; QL; AL
Nestabs
F
Female; QL; AL
Nestabs DHA
F
Female; AL
NewGen
F
Female; QL; AL
Obstetrix DHA
F
Obstetrix EC
F
Female; QL; AL
Obtrex DHA
F
Female; AL
O-Cal FA
F
Female; AL
P D Natal Vitamins-Folic Acid
F
Female; OTC; QL; AL
PNV 29-1
F
Female; QL; AL
Prefera-OB
F
Female; QL; AL
Prenaissance
F
Prenatabs FA
F
Female; QL; AL
Prenatabs Rx
F
Female; QL; AL
Prenatal 19
F
Female; OTC; QL; AL
Prenatal Formula oral tablet 28 mg iron- 800 mcg
F
Female; OTC; QL; AL
Prenatal Vitamins And Minerals
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
72
Drug
Status
Notes
Prenatal Low Iron
F
Female; QL; AL
Prenatal Multi-DHA oral capsule 27 mg iron-800
mcg-228 mg
F
Female; OTC; QL; AL
Prenatal oral tablet 28 mg iron- 800 mcg
F
Female; OTC; QL; AL
Prenatal Plus
F
Female; QL; AL
Prenatal Plus (calcium carb)
F
Female; QL; AL
Prenatal Tablet
F
Female; OTC; QL; AL
Prenatal Vitamin oral tablet , 27-0.8 mg
F
Female; OTC; QL; AL
Prenatal Vitamin Plus Low Iron
F
Female; QL; AL
Prenatal Vitamin with Minerals
F
Female; OTC; QL; AL
Prenatal-U
F
Female; QL; AL
Prenate AM
F
Female; QL; AL
PreTAB
F
Female; QL; AL
Right Step Prenatal Vitamins
F
OTC
TheraNatal oral tablet
F
Female; OTC; QL; AL
TriAdvance
F
Female; QL; AL
TriCare
F
Female; QL; AL
Trinatal GT
F
Female; QL; AL
Trinatal Rx 1
F
Female; QL; AL
Trinate
F
Female; QL; AL
Tri-Tabs DHA
F
Female; AL
Vinate GT
F
Female; QL; AL
Vinate II
F
Female; QL; AL
Vinate M
F
Female; QL; AL
Vinate One
F
Female; QL; AL
Vinate Ultra
F
Female; QL; AL
Virt Nate
F
Female; QL; AL
Virt-Advance
F
Female; QL; AL
Virt-Select
F
Virt-Vite GT
F
Female; QL; AL
Vol-Nate
F
Female; QL; AL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
73
Drug
Vol-Tab Rx
Status
Notes
F
Female; QL; AL
B Complex w-Vit C
F
OTC
B-Complex With B-12
F
OTC
Cerefolin NAC (algal oil)
F
OTC
FaBB
F
Folbee
F
Folbic
F
OTC
Folbic RF
F
OTC
Folgard RX
F
Folinic-Plus
F
Folplex 2.2
F
Foltabs 800
F
OTC
Foltanx
F
OTC
Foltanx RF
F
OTC
Foltx
F
OTC
Homocysteine Formula
F
OTC
levomefol-B6-meB12-algal oil
F
OTC
Lmefol Ca-acetyl-meB12-algal
F
OTC
L-Methyl-B6-B12
F
OTC
L-Methylfolate Ca P-5-P Me-Cbl
F
OTC
LMTHF-Pyridoxine-Cyanocobalamn
F
OTC
Metafolbic Plus RF
F
OTC
Metanx (algal oil)
F
OTC
Niva-Fol
F
OTC
TL Gard Rx
F
Virt-Vite
F
Virt-Vite Forte
F
Vita-Respa
F
Vitamins - B Preparation Combinations
OTC
OTC
Vitamins - B-1, Thiamine And
Derivatives
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
74
Drug
Status
Notes
Arkaliox
F
OTC
thiamine HCl (vitamin B1) oral tablet 100 mg
F
OTC
Vitamin B-1 (mononitrate)
F
OTC
Vitamin B-1 oral tablet 100 mg, 50 mg
F
OTC
F
OTC
niacin (inositol niacinate) oral tablet
F
OTC
niacin oral capsule, extended release 250 mg
F
OTC
niacin oral tablet 100 mg, 250 mg, 50 mg
F
OTC
niacin oral tablet extended release 250 mg
F
OTC
niacinamide
F
OTC
Slo-Niacin oral tablet extended release 750 mg
F
OTC
F
OTC
biotin oral capsule 1 mg, 2,500 mcg, 5 mg
F
OTC
biotin oral tablet
F
OTC
Cyto B7
F
OTC
Hard Nail
F
OTC
Mega Biotin
F
OTC
Meribin
F
OTC
Calcidol
F
OTC
Calciferol
F
OTC
calcitriol oral capsule
F
QL
calcitriol oral solution
F
AL
cholecalciferol (vitamin D3) oral capsule 1,000
unit, 5,000 unit, 50,000 unit
F
OTC
Vitamins - B-2, Riboflavin And
Derivatives
Vitamin B-2 oral tablet 25 mg
Vitamins - B-3, Niacin And Derivatives
Vitamins - B-6, Pyridoxine And
Derivatives
Vitamin B-6 oral tablet 100 mg, 25 mg, 50 mg
Vitamins - Biotin
Vitamins - D Derivatives
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
75
Drug
Status
Notes
cholecalciferol (vitamin D3) oral drops 400
unit/mL
F
OTC
cholecalciferol (vitamin D3) oral tablet 1,000
unit, 2,000 unit, 5,000 unit
F
OTC
cholecalciferol (vitamin D3) oral tablet,chewable
400 unit
F
OTC
D3-2000
F
OTC
Delta D3
F
OTC
Dialyvite Vitamin D
F
OTC
Dialyvite Vitamin D3 Max
F
OTC
D-Vita
F
OTC
ergocalciferol (vitamin D2) oral capsule
F
ergocalciferol (vitamin D2) oral drops
F
OTC
Replesta
F
OTC
Thera-D
F
OTC
Vital-D Rx
F
Vitamin D3 oral capsule 1,000 unit, 2,000 unit,
400 unit
F
OTC
Vitamin D3 oral tablet 2,000 unit, 400 unit, 5,000
unit
F
OTC
Aqua-E
F
OTC
Aquasol E
F
OTC
Liqui-E
F
OTC
vitamin E (dl, acetate) oral capsule 1,000 unit,
200 unit, 400 unit
F
OTC
vitamin E (dl, acetate) oral drops
F
OTC
vitamin E acetate
F
OTC
vitamin E mixed
F
OTC
vitamin E oral
F
OTC
vitamin E oral
F
OTC
vitamin E succinate
F
OTC
Vitamins - E
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
76
Drug
wheat germ oil
Status
F
Notes
OTC
Vitamins - Folic Acid And Derivatives
folic acid oral tablet 1 mg
F
folic acid oral tablet 400mcg, 800 mcg
F
OTC
Vitamins - Folic Acid Combinations
FaBB
F
Folbee
F
Folbic
F
Folgard RX
F
Folplex 2.2
F
Niva-Fol
F
TL Gard Rx
F
Virt-Vite
F
Virt-Vite Forte
F
Vita-Respa
F
OTC
OTC
OTC
Vitamins - Paba
Potaba oral capsule
F
Endocrine
Agents To Treat Hypoglycemia
(Hyperglycemics)
Dex4 Glucose oral tablet,chewable
F
OTC
dextrose oral liquid
F
OTC
GlucaGen HypoKit
F
Glucagon Emergency Kit (human)
F
QL
glucose
F
OTC
Glucose Gel
F
OTC
Proglycem
F
Androgen - Single Agents
Testosterone transdermal gel in metered-dose
pump 12.5 mg/1.25 gm (1 %)
testosterone cypionate
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
F
F
Male
77
Drug
Status
testosterone enanthate
F
testosterone transdermal gel in packet,
25 mg/2.5 gm, 50 mg/5 gm
F
Notes
Antidiuretic And Vasopressor
Hormones
desmopressin nasal
F
PA
desmopressin oral
F
QL
Stimate
F
PA
F
QL
Januvia
F
PA; QL
Tradjenta
F
PA
nateglinide
F
QL
repaglinide
F
QL
F
PA; QL
Farxiga
F
PA; QL
Invokana
F
PA; QL
Antihyperglycemic - Alpha-Glucosidase
Inhibitors
acarbose oral tablet 100 mg, 25 mg, 50 mg
Antihyperglycemic - Dipeptidyl
Peptidase-4 (Dpp-4) Inhibitors
Antihyperglycemic - Meglitinide
Analogs
Antihyperglycemic - Sglt-2 Inhibitor
And Biguanide Combinations
Invokamet
Antihyperglycemic - Sodium Glucose
Cotransporter-2 (Sglt2) Inhibitors
Antihyperglycemic - Sulfonylurea And
Biguanide Combinations
glipizide-metformin
F
glyburide-metformin oral tablet 1.25-250 mg
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
78
Drug
glyburide-metformin oral tablet 2.5-500 mg, 5500 mg
Status
Notes
F
QL
chlorpropamide oral tablet 100 mg, 250 mg
F
QL; AL
glimepiride
F
QL
glipizide oral tablet 10 mg, 5 mg
F
QL
glipizide oral tablet extended release 24hr
F
QL
glyburide micronized
F
QL
glyburide oral
F
QL
tolazamide
F
tolbutamide
F
Antihyperglycemic - Sulfonylurea
Derivatives
Antihyperglycemic, Incretin
Mimetic,Glp-1 Receptor Agonist
Analog-Type
Tanzeum
F
PA; QL
Victoza 2-Pak
F
PA; QL
Victoza 3-Pak
F
PA; QL
Janumet
F
PA; QL
Janumet XR
F
PA; QL
Jentadueto
F
PA
Antihyperglycemic-Dipeptidyl
Peptidase-4(Dpp-4)Inhibitor And
Biguanide
Antithyroid Agents, Thionamides Imidazole Derivatives
methimazole oral tablet 10 mg, 5 mg
F
Antithyroid Agents, Thionamides Thiouracil Derivatives
propylthiouracil
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
79
Drug
Bone Formation Stimulating Agents Parathyroid Hormone-Type
Status
Notes
F
PA; QL
alendronate oral tablet 10 mg, 35 mg, 40 mg, 5
mg, 70 mg
F
QL
etidronate disodium
F
ibandronate oral
F
QL
F
PA; QL
F
QL
F
Female
estradiol-norethindrone acet
F
Female
Norethindrone-eth estradiol oral tablet
1-5 mg-mcg
F
Female
norethindrone ac-eth estradiol oral tablet
0.5-2.5 mg-mcg
F
Female; QL
Premphase
F
Female; QL
Prempro
F
Female; QL
estradiol oral
F
Female; AL
estradiol transdermal patch semiweekly 0.025
mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1
mg/24 hr
F
Female; QL
estradiol transdermal patch weekly
F
Female; QL
estropipate
F
Female; AL
Menest
F
Female
Forteo
Bone Resorption Inhibitors Bisphosphonates
Calcimimetic, Parathyroid Calcium
Receptor Sensitivity Enhancer
Sensipar oral tablet 30 mg, 60 mg, 90 mg
Calcitonins
calcitonin (salmon)
Estrogen-Androgen
estrogens-methyltestosterone
Estrogen-Progestin
Estrogens
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
80
Drug
Premarin oral
Status
F
Notes
Female; QL; AL
Glucocorticoids
Dexamethasone oral solution
F
Dexamethasone oral tablet
F
hydrocortisone oral tablet
F
Methylprednisolone oral tablet
F
Methylprednisolone dosepack
F
prednisolone oral solution 15 mg/5 mL
F
prednisolone sodium phosphate oral solution 15
mg/5 mL (3 mg/mL), 5 mg base/5 mL (6.7 mg/5
mL)
F
prednisone oral tablet
F
prednisone oral solution
F
Gonadotropin Inhibitor Pituitary
Suppressants
danazol oral
F
Growth Hormones
Norditropin FlexPro
F
PA
Humulin 70/30
F
OTC; QL
Humulin 70/30 KwikPen
F
OTC; QL; AL
Novolin 70/30
F
OTC; QL
Humulin N
F
OTC; QL
Humulin N KwikPen
F
OTC; QL; AL
Novolin N
F
OTC; QL
Humulin R
F
OTC; QL
Humulin R U-500 (Concentrated)
F
PA
Novolin R
F
OTC; QL
Human Insulins - Fixed Combinations
Human Insulins - Intermediate Acting
Human Insulins - Short Acting
Insulin Analogs - Fixed Combinations
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
81
Drug
Status
Notes
Humalog Mix 50-50
F
Humalog Mix 50-50 KwikPen
F
Humalog Mix 75-25
F
Humalog Mix 75-25 KwikPen
F
Novolog Mix 70-30
F
Novolog Mix 70-30 FlexPen
F
QL; AL
Lantus
F
QL
Lantus Solostar
F
QL; AL
Apidra
F
QL
Apidra SoloStar
F
QL; AL
Humalog KwikPen subcutaneous insulin pen 100
unit/mL
F
QL; AL
Humalog subcutaneous cartridge
F
QL
Humalog
F
Novolog
F
Novolog Flexpen
F
QL; AL
Novolog PenFill
F
QL
metformin oral tablet 1,000 mg, 500 mg, 850 mg
F
QL
metformin oral tablet extended release 24 hr
500mg, 750mg
F
AL
QL; AL
Insulin Analogs - Long Acting
Insulin Analogs - Rapid Acting
Insulin Response Enhancers Biguanides
Insulin Response Enhancers Thiazolidinediones (Ppar-Gamma
Agonists)
pioglitazone
F
QL
F
PA
Insulin-Like Growth Factor-1 (Igf-1)
Increlex
Mineralocorticoids
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
82
Drug
fludrocortisone
Status
Notes
F
Oxytocic - Ergot Alkaloids
methylergonovine oral
F
AL
medroxyprogesterone oral
F
Female
norethindrone acetate
F
Female; QL
progesterone micronized oral capsule 100 mg,
200 mg
F
Female; QL
Progestins
Prolactin Inhibitor - Ergot Derivative
Dopamine Receptor Agonists
cabergoline
F
Selective Estrogen Receptor Modulators
(Serms)
raloxifene
F
Female; QL; AL
F
PA
Armour Thyroid
F
AL
Nature-Throid
F
AL
NP Thyroid
F
AL
Somatostatic Agents
octreotide acetate injection solution 1,000
mcg/mL, 100 mcg/mL, 200 mcg/mL, 50 mcg/mL
Thyroid Hormones - Animal Source
(Porcine)
Thyroid Hormones - Synthetic T3
(Triiodothyronine)
liothyronine oral
F
Thyroid Hormones - Synthetic T4
(Thyroxine)
levothyroxine oral tablet, 25 mcg, 50 mcg, 75
mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 150
mcg, 175 mcg, 200 mcg, 300 mcg,
F
Gastrointestinal Therapy Agents
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
83
Drug
Antacid - Alginate Combinations
Status
Notes
Foaming Antacid oral tablet,chewable
F
OTC
Gaviscon oral tablet,chewable
F
OTC
F
OTC
Acid Gone Antacid
F
OTC
Acid Gone Antacid E.Strength
F
OTC
Alka-Seltzer Gold
F
OTC
Alka-Seltzer Heartburn
F
OTC
Antacid (calcium carb-mag hyd)
F
OTC
Antacid ExSt (ca carb-mag hyd)
F
OTC
Antacid ExSt (mag carb-Al hyd)
F
OTC
Antacid Supreme
F
OTC
Foaming Antacid oral suspension
F
OTC
Gaviscon Extra Strength
F
OTC
Heartburn Antacid
F
OTC
Heartburn Relief
F
OTC
MAG-AL
F
OTC
Mi-Acid oral tablet,chewable
F
OTC
Riginic
F
OTC
Rolaids
F
OTC
F
OTC
Alcalak
F
OTC
Antacid (calcium carbonate) oral tablet,chewable
200 mg calcium (500 mg)
F
OTC
Antacid Calcium oral tablet,chewable 215 mg
calcium (500 mg)
F
OTC
Antacid Ext Str (calcium carb)
F
OTC
Antacid - Aluminum
aluminum hydroxide gel
Antacid - Antacid Combinations
Antacid - Bicarbonate
sodium bicarbonate oral
Antacid - Calcium
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
84
Drug
Status
Notes
Antacid Extra-Strength oral tablet,chewable 168
mg (420 mg), 300 mg (750 mg)
F
OTC
Antacid Ultra Strength
F
OTC
Calcium Antacid
F
OTC
Calcium Antacid Ultra Max St
F
OTC
calcium carbonate oral suspension
F
OTC
calcium carbonate oral tablet 260 mg calcium
(648 mg)
F
OTC
calcium carbonate oral tablet,chewable 200 mg
calcium (500 mg), 400 mg (1,000 mg)
F
OTC
Cal-Gest Antacid
F
OTC
Children's Pepto
F
OTC
Children's Soothe
F
OTC
Smooth Antacid
F
OTC
Tums Freshers
F
OTC
Tums oral tablet,chewable 200 mg calcium (500
mg)
F
OTC
Tums Ultra
F
OTC
Ultra Strength Antacid
F
OTC
Ultra Strength Calcium Antacid
F
OTC
Phillips' (magnesium hydroxide
F
OTC
Phillips Milk of Magnesia oral tablet,chewable
F
OTC
Ri-Mag
F
OTC
Advanced Antacid-Antigas oral suspension 200200-20 mg/5 mL
F
OTC
Alka-Seltzer Heartburn+Gas
F
OTC
Almacone
F
OTC
Almacone-2
F
OTC
Antacid
F
OTC
Antacid Anti-Gas
F
OTC
Antacid - Magnesium
Antacid - Simethicone Combinations
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
85
Drug
Status
Notes
Antacid Anti-Gas (ca carb-sim)
F
OTC
Antacid Anti-Gas Double Str
F
OTC
Antacid Extra-Strength oral suspension 200-20020 mg/5 mL
F
OTC
Antacid Liquid
F
OTC
Antacid M
F
OTC
Antacid Maximum Strength
F
OTC
Antacid Multi-Symptom
F
OTC
Antacid Plus Anti-Gas
F
OTC
Antacid Regular Strength
F
OTC
Antacid with Simethicone
F
OTC
Antacid-Antigas II
F
OTC
Antacid-Antigas oral suspension 200-200-20
mg/5 mL
F
OTC
Antacid-Simethicone
F
OTC
Comfort Gel
F
OTC
Comfort Gel Extra Strength
F
OTC
E-Z-Gas II
F
OTC
Flanax Antacid
F
OTC
Gelusil Antacid and Anti-Gas oral
tablet,chewable
F
OTC
Geri-Lanta
F
OTC
Geri-Mox Antacid-Antigas
F
OTC
Liquid Antacid
F
OTC
Maalox Advanced
F
OTC
Maalox Maximum Strength
F
OTC
Mag-Al Plus
F
OTC
Mag-Al Plus Extra Strength
F
OTC
Maglox
F
OTC
Masanti Double Strength
F
OTC
Mi-Acid oral suspension
F
OTC
Mintox
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
86
Drug
Status
Notes
Mintox Maximum Strength
F
OTC
Mintox Plus
F
OTC
Ri-Gel
F
OTC
Ri-Gel II
F
OTC
Ri-Mag Plus
F
OTC
Ri-Mox
F
OTC
Ri-Mox Plus
F
OTC
Rulox
F
OTC
F
OTC
Anti-Diarrhea
F
OTC
Anti-Diarrheal (loperamide) oral capsule
F
OTC
Diamode
F
OTC
loperamide oral capsule
F
OTC
loperamide oral liquid 1 mg/7.5 mL
F
OTC
loperamide oral tablet
F
OTC
paregoric
F
Antacid Combinations Other
Dewee's Carminative
Antidiarrheal - Antiperistaltic Agents
Antidiarrheal - Bismuth Agents
Bismatrol
F
OTC
Bismuth Maximum Strength
F
OTC
Bismuth oral suspension
F
OTC
Bismuth oral tablet
F
OTC
bismuth subsalicylate oral suspension
F
OTC
Diarrhea Relief (bismuth subs)
F
OTC
Diotame 262 mg chewable tablet
F
OTC
Kaopectate (bismuth subsalicy)
F
OTC
Kaopectate Ex Str (bismuth ss)
F
OTC
Kao-Tin (bismuth subsalicylat)
F
OTC
K-Pec Antidiarrheal (bism sub)
F
OTC
Peptic Relief
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
F
OTC
87
Drug
Status
Notes
Pepto-Bismol Max St
F
OTC
Pink Bismuth
F
OTC
Pink Bismuth Maximum Strength
F
OTC
Soothe (bismuth subsalicylate) oral tablet
F
OTC
Soothe Regular Strength
F
OTC
Stomach Relief Max Strength
F
OTC
Stomach Relief oral suspension 525 mg/15 mL
F
OTC
Stomach Relief oral tablet
F
OTC
Stomach Relief oral tablet,chewable
F
OTC
Stomach Relief Original
F
OTC
Antidiarrheal AntiperistalticAnticholinergic Combinations
diphenoxylate-atropine
F
Antiemetic - Anticholinergics
Transderm-Scop
F
QL
dimenhydrinate oral
F
OTC
meclizine oral tablet 12.5 mg, 25 mg
F
OTC
meclizine oral tablet,chewable
F
OTC
F
PA
Antiemetic - Antihistamines
Antiemetic - Cannabinoids
dronabinol
Antiemetic - Dopamine (D2)/5-Ht3
Antagonists
trimethobenzamide oral
F
Antiemetic - Phenothiazines
prochlorperazine
F
QL
prochlorperazine maleate oral
F
QL
promethazine oral
F
AL
promethazine rectal suppository 12.5 mg, 25 mg
F
AL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
88
Drug
Antiemetic - Selective Serotonin 5-Ht3
Antagonists
Status
Notes
granisetron HCl oral
F
ST; QL
ondansetron HCl oral solution
F
QL; AL
ondansetron HCl oral tablet 24 mg, 4 mg, 8 mg
F
QL
ondansetron oral tablet,disintegrating 4 mg, 8 mg
F
QL
Colonic Acidifier (Ammonia Inhibitor)
lactulose oral solution 10 gram/15 mL, 10
gram/15 mL (15 mL)
F
Digestive Enzyme Mixtures
Creon oral capsule,delayed release(DR/EC)
F
Pancreaze DR capsules
F
Zenpep oral capsule,delayed release(DR/EC)
F
QL
Gallstone Solubilizing (Litholysis)
Agents
ursodiol oral capsule
F
ursodiol oral tablet
F
QL
Gastric Acid Secretion Reducers Histamine H2-Receptor Antagonists
Acid Control (ranitidine) oral tablet 150 mg
F
OTC
Acid Controller
F
OTC
Acid Reducer (famotidine)
F
OTC
Acid Reducer (ranitidine)
F
OTC
cimetidine oral tablet 200 mg
F
OTC
cimetidine oral tablet 300 mg, 400 mg, 800 mg
F
famotidine oral tablet 10 mg, 20 mg
F
famotidine oral tablet 40 mg
F
Heartburn Prevention
F
OTC
Heartburn Relief (cimetidine)
F
OTC
Heartburn Relief (famotidine)
F
OTC
Heartburn Relief (ranitidine) oral tablet 75 mg
F
OTC
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
89
Drug
Status
Notes
ranitidine HCl oral capsule
F
ranitidine HCl oral syrup
F
QL
ranitidine HCl oral tablet 150 mg, 75 mg
F
OTC
ranitidine HCl oral tablet 300 mg
F
Wal-Zan 150
F
OTC
Wal-Zan 75
F
OTC
lansoprazole oral capsule,delayed release(DR/EC)
15 mg
F
ST; OTC; QL
lansoprazole oral capsule,delayed release(DR/EC)
30 mg
F
ST; QL
Nexium 24HR oral capsule,delayed
release(DR/EC)
F
ST; OTC
omeprazole magnesium
F
OTC; QL
omeprazole oral capsule,delayed release(DR/EC)
10 mg, 20 mg, 40 mg
F
QL
omeprazole oral tablet,delayed release (DR/EC)
F
OTC; QL
pantoprazole oral
F
QL
Prevacid SoluTab
F
AL
F
QL
Gas Relief 80
F
OTC
Gas Relief Extra Strength oral tablet,chewable
F
OTC
Gas Relief oral drops,suspension
F
OTC
Gas Relief oral tablet,chewable
F
OTC
Gas-X Extra Strength oral tablet,chewable
F
OTC
Gas-X oral tablet,chewable
F
OTC
Infants Gas Relief
F
OTC
Mi-Acid Gas Relief
F
OTC
Gastric Acid Secretion Reducing Agents
- Proton Pump Inhibitors (Ppis)
Gastric Mucosa - Cytoprotective
Prostaglandin Analogs
misoprostol
Gastrointestinal Antiflatulents
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
90
Drug
Status
Notes
Mytab Gas
F
OTC
Mytab Gas Maximum Strength
F
OTC
simethicone oral drops,suspension
F
OTC
simethicone oral tablet,chewable
F
OTC
Gastrointestinal Prokinetic Agents - D2
Antagonist/5-Ht4 Agonists
metoclopramide HCl oral solution
F
metoclopramide HCl oral tablet
F
Gi Antispasmodic - Belladonna
Alkaloids
hyoscyamine sulfate oral
F
hyoscyamine sulfate sublingual
F
AL
Gi Antispasmodic - Quaternary
Ammonium Compounds
glycopyrrolate oral
F
propantheline
F
Gi Antispasmodic - Synthetic Tertiary
Amines
dicyclomine oral capsule
F
AL
dicyclomine oral solution
F
AL
dicyclomine oral tablet
F
AL
Ibs Agent - Gastrointestinal Chloride
Channel Activator Agents
Amitiza
F
Inflammatory Bowel Agent Aminosalicylates And Related Agents
Apriso
F
ST
Asacol HD
F
ST; QL
balsalazide
F
Canasa
F
Delzicol oral capsule,delayed release(DR/EC)
F
ST
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
91
Drug
Status
Dipentum
F
mesalamine rectal
F
Pentasa
F
Sulfasalazine tablet, DR tablet
F
Notes
QL
ST; QL
Inflammatory Bowel Agent Glucocorticoids
hydrocortisone rectal enema
F
Inflammatory Bowel Agent - Tumor
Necrosis Factor Alpha Blockers
Humira
F
PA; QL
Humira Pediatric Crohn's Start
F
PA; QL
Benefiber Clear SF (dextrin)
F
OTC
Benefiber Sugar Free (dextrin) oral powder 3
gram/3.8 gram
F
OTC
Best Fiber
F
OTC
Child's Fiber Select Gummies
F
OTC
Citrucel
F
OTC
Citrucel (sucrose)
F
OTC
Citrucel Sugar Free
F
OTC
Colox
F
OTC
Daily Fiber
F
OTC
Easy Fiber (wheat dextrin)
F
OTC
Easy Fiber oral powder
F
OTC
Equalactin
F
OTC
fiber
F
OTC
Fiber (calcium polycarbophil)
F
OTC
Fiber (dextrin)
F
OTC
Fiber (psyllium husk)
F
OTC
Fiber (psyllium husk/sugar) oral powder 3.4
gram/11 gram, 3.4 gram/12 gram
F
OTC
Laxative - Bulk Forming
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
92
Drug
Status
Notes
Fiber (with aspartame)
F
OTC
Fiber Choice (inulin)
F
OTC
Fiber Gummies (with chromium)
F
OTC
Fiber Laxative (ca polycarbo)
F
OTC
Fiber Laxative (methylcellulo)
F
OTC
Fiber Laxative (psyllium husk)
F
OTC
Fiber Select Gummies
F
OTC
Fiber Smooth (sucrose)
F
OTC
Fiber Supplement (inulin)
F
OTC
Fiber Therapy (ca polycarboph)
F
OTC
Fiber Therapy (m-cell/sugar) oral powder 2
gram/19 gram
F
OTC
Fiber Therapy (m-cellulose)
F
OTC
Fiber Therapy (psyllium seed)
F
OTC
Fiber Therapy (psyllium)
F
OTC
Fiber Therapy Laxative (husk)
F
OTC
Fiber With Probiotic
F
OTC
Fiber-Caps (psyllium husk)
F
OTC
FiberCon
F
OTC
Fiber-Lax
F
OTC
Fiber-Stat
F
OTC
Fiber-Tabs
F
OTC
Geri-Mucil
F
OTC
Hydrocil Instant
F
OTC
HyFiber with FOS
F
OTC
Konsyl (sugar)
F
OTC
Konsyl Balance
F
OTC
Konsyl Easy Mix
F
OTC
Konsyl Fiber
F
OTC
Konsyl Formula-D
F
OTC
Konsyl Sugar-Free (aspartame)
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
93
Drug
Status
Notes
Konsyl Sugar-Free oral powder
F
OTC
Konsyl Sugar-Free oral powder in packet
F
OTC
LiquaFiber
F
OTC
Metamucil (with sugar) oral powder 3.4 gram/12
gram
F
OTC
Metamucil (with sugar) oral powder in packet
F
OTC
Metamucil Fiber Singles
F
OTC
Metamucil MultiHealth Fiber
F
OTC
Metamucil oral capsule
F
OTC
Metamucil oral powder
F
OTC
Metamucil oral wafer
F
OTC
Metamucil Plus Calcium
F
OTC
Metamucil Sugar-Free (aspart)
F
OTC
Natural Daily Fiber
F
OTC
Natural Fiber Laxative
F
OTC
Natural Fiber Laxative (sugar) oral powder 3.4
gram/12 gram, 3.4 gram/7 gram
F
OTC
Natural Fiber Laxative Smooth
F
OTC
Natural Fiber Laxative Therapy
F
OTC
Natural Fiber Laxative(aspart) oral powder
F
OTC
Natural Fiber Supplement oral powder in packet
F
OTC
Natural Psyllium Fiber
F
OTC
Natural Vegetable
F
OTC
Natural Vegetable (psyllium)
F
OTC
Natural Vegetable Powder
F
OTC
Nutrisource Fiber
F
OTC
psyllium husk oral capsule 0.52 gram
F
OTC
psyllium husk oral powder
F
OTC
Reguloid
F
OTC
Reguloid (dextrose)
F
OTC
Reguloid, Sugar Free
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
94
Drug
Status
Notes
Soluble Fiber
F
OTC
Unifiber
F
OTC
Wal-Mucil Fiber
F
OTC
Wal-Mucil Fiber (aspartame)
F
OTC
Wal-Mucil Natural Fiber Lax
F
OTC
Wal-Mucil with Calcium
F
OTC
Kondremul
F
OTC
Mineral Oil Extra Heavy
F
OTC
Mineral Oil Heavy oral
F
OTC
Mineral Oil Laxative
F
OTC
mineral oil oral
F
OTC
mineral oil rectal
F
OTC
Ready-To-Use Enema (min oil)
F
OTC
Citrate of Magnesia
F
OTC
Citroma
F
OTC
Epsom Salt oral
F
OTC
Fleet Glycerin (Adult)
F
OTC
Fleet Glycerin (Child)
F
OTC
Fleet Glycerin Laxative
F
OTC
glycerin (adult)
F
OTC
glycerin (child)
F
OTC
Kristalose
F
lactulose oral solution 10 gram/15 mL, 20
gram/30 mL
F
Laxative (glycerin-pediatric)
F
OTC
magnesium citrate oral solution
F
OTC
Milk of Magnesia
F
OTC
Milk Of Magnesia Concentrated
F
OTC
Pedia-Lax
F
OTC
Laxative - Lubricant
Laxative - Saline And Osmotic
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
95
Drug
Status
Notes
Phillips Milk of Magnesia oral suspension 400
mg/5 mL
F
OTC
polyethylene glycol 3350 oral powder
F
OTC
polyethylene glycol 3350 oral powder in packet
F
OTC; QL
Sani-Supp (Adult)
F
OTC
Sani-Supp (Infant)
F
OTC
Suppository Adult
F
OTC
Enema Disposable
F
OTC
Enema rectal enema 19-7 gram/118 mL
F
OTC
Fleet Enema
F
OTC
Fleet Enema Extra
F
OTC
Fleet Pediatric
F
OTC
Gavilyte-C
F
GaviLyte-G
F
GaviLyte-N
F
Golytely
F
MoviPrep
F
Oral Saline Laxative
F
OsmoPrep
F
peg 3350-electrolytes
F
QL
PEG-3350 with flavor packs
F
QL
peg-electrolyte soln
F
QL
Phosphate Laxative oral liquid
F
OTC
Preparation Cleansing
F
OTC
Ready-To-Use Enema
F
OTC
Suprep Bowel Prep Kit
F
TriLyte With Flavor Packets
F
Laxative - Saline/Osmotic Mixtures
OTC
Laxative - Stimulant
Alophen
F
OTC
Bisac-Evac
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
96
Drug
Status
Notes
bisacodyl oral
F
OTC; QL
bisacodyl rectal
F
OTC; QL
Bisa-Lax
F
OTC
Biscolax
F
OTC; QL
castor oil oral
F
OTC
Chocolate Laxative
F
OTC
Correctol
F
OTC
Ducodyl
F
OTC
Ex-Lax (sennosides)
F
OTC
Ex-Lax Maximum Strength
F
OTC
Fleet Bisacodyl
F
OTC
Fleet Laxative
F
OTC; QL
Gentle Laxative
F
OTC
Geri-kot
F
OTC
Laxative (bisacodyl)
F
OTC
Laxative (sennosides) oral tablet 17.2 mg, 25 mg
F
OTC
Laxative (sennosides) oral tablet,chewable
F
OTC
Laxative Feminine
F
OTC
Laxative Maximum Strength
F
OTC
Laxative Pills
F
OTC
Laxative Pills Regular
F
OTC
Natural Laxative
F
OTC
Natural Senna Laxative
F
OTC
Natural Veg Laxative(sennosid)
F
OTC
Natural Vegetable Laxative
F
OTC
Perdiem Overnight Relief
F
OTC
Senexon
F
OTC
Senna Lax
F
OTC
Senna Laxative
F
OTC
senna leaf
F
OTC
senna oral syrup
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
97
Drug
Status
Notes
senna oral tablet
F
OTC
Senna-Extra
F
OTC
Senno
F
OTC
Senokot
F
OTC
SenokotXTRA
F
OTC
Sen-O-Tab
F
OTC
The Magic Bullet
F
OTC
Vegetable Laxative
F
OTC
Woman's Laxative
F
OTC
Women's Laxative (bisacodyl)
F
OTC
F
OTC
Laxative - Stimulant And Bulk Forming
Combinations
Senna Prompt
Laxative - Stimulant And
Saline/Osmotic Combinations
GaviLyte-H and Bisacodyl
F
PEG-Prep
F
Prepopik
F
Laxative - Stimulant And Surfactant
Combinations
Doc-Q-Lax
F
OTC
DOK Plus
F
OTC
Lax Stool Softener With Senna
F
OTC
Laxacin
F
OTC
Laxative Plus Stool Softener
F
OTC
Medi-Laxx
F
OTC
P-COL RITE
F
OTC
PERI-COLACE
F
OTC
Senexon-S
F
OTC
Senna Laxative-Stool Softener
F
OTC
Senna Plus
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
98
Drug
Status
Notes
Senna with Docusate Sodium
F
OTC
Sennalax-S
F
OTC
Senna-S
F
OTC
Senna-Time S
F
OTC
sennosides-docusate sodium
F
OTC
Senokot-S
F
OTC
Stimulant Laxative Plus
F
OTC
Stool Softener-Laxative
F
OTC
Stool Softener-Stimulant Laxat
F
OTC
COLACE Clear
F
OTC
Col-Rite oral capsule 100 mg, 50 mg
F
OTC
Diocto
F
OTC
Dioctyl
F
OTC
Docu
F
OTC
Docuprene
F
OTC
docusate calcium
F
OTC
docusate sodium oral capsule 100 mg
F
OTC; QL
docusate sodium oral capsule 250 mg
F
OTC
docusate sodium oral liquid
F
OTC
docusate sodium oral syrup
F
OTC
docusate sodium oral tablet
F
OTC
Docusil
F
OTC; QL
Docusol
F
OTC
DocuSol Kids
F
OTC
DocuSol Plus
F
OTC
DOK
F
OTC
Dulcolax Stool Softener (DSS)
F
OTC
Enemeez
F
OTC
Enemeez Plus
F
OTC
Kao-Tin (docusate calcium)
F
OTC
Laxative - Surfactant
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
99
Drug
Status
Notes
Pedia-Lax Stool Softener
F
OTC
Phillips Liqui-Gels
F
OTC
Promolaxin
F
OTC
Silace
F
OTC
Stool Softener
F
OTC
Surfak
F
OTC
F
OTC
F
QL
F
PA
F
PA; QL
Laxative Combinations - Other
Ceo-Two
Peptic Ulcer - Gastric Lumen Adherent
Cytoprotectives
sucralfate oral tablet
Short Bowel Syndrome (Sbs) Agents
octreotide acetate injection solution 1,000
mcg/mL, 100 mcg/mL, 200 mcg/mL, 50 mcg/mL
Genitourinary Therapy
Interstitial Cystitis Agents
Elmiron
Phosphate Binders
Auryxia
F
calcium acetate oral capsule
F
calcium acetate oral tablet 667 mg
F
Calphron
F
Fosrenol
F
MagneBind 300
F
MagneBind 400
F
Phoslyra
F
Renagel
F
Renvela
F
Velphoro
F
OTC
OTC
PA
Phosphate Binders - Calcium-Based
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
100
Drug
Status
calcium acetate oral capsule
F
calcium acetate oral tablet 667 mg
F
Calphron
F
Phoslyra
F
Notes
OTC
Phosphate Binders - Iron-Based
Auryxia
F
Velphoro
F
Prostatic Hypertrophy Agent - Alpha-1Adrenoceptor Antagonists
tamsulosin
F
QL
F
Male; QL
Prostatic Hypertrophy Agent - Type Ii
5-Alpha Reductase Inhibitors
finasteride oral tablet 5 mg
Urinary Acidifier - Phosphates
K-Phos No 2
F
K-Phos Original
F
Urinary Alkalinizer - Citrates
Cytra K Crystals
F
Cytra-2
F
potassium citrate oral tablet extended release 10
mEq (1,080 mg), 5 mEq (540 mg)
F
potassium citrate-citric acid
F
sodium citrate-citric acid
F
Tricitrates
F
Urocit-K 10
F
Urocit-K 5
F
Virtrate-3
F
Urinary Analgesics
phenazopyridine oral tablet 100 mg, 200 mg
F
Urinary Antibacterial - Methenamine
And Salts
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
101
Drug
Status
methenamine hippurate
F
methenamine mandelate
F
Notes
Urinary Antibacterial - Nitrofuran
Derivatives
nitrofurantoin macrocrystal oral capsule 100 mg,
50 mg
F
QL; AL
nitrofurantoin monohyd/m-cryst
F
QL
nitrofurantoin oral
F
AL
Urinary Anti-Infective MethenamineAntispas-Analg Combinations
Uretron D-S oral tablet 81.6-10.8-40.8 mg
F
Utira-C
F
Urinary Antispasmodic - Smooth
Muscle Relaxants
flavoxate
F
oxybutynin chloride oral syrup
F
QL
oxybutynin chloride oral tablet
F
QL
oxybutynin chloride oral tablet extended release
24hr 10 mg, 15 mg, 5 mg
F
QL
tolterodine oral capsule,extended release 24hr
F
ST; QL
tolterodine oral tablet
F
ST; QL
trospium oral tablet
F
ST; QL
F
QL
F
QL
Urinary Retention Therapy Parasympathomimetic Agents
bethanechol chloride
Gout And Hyperuricemia Therapy
Gout Acute Therapy - Antimitotics
colchicine oral tablet
Gout And Hyperuricemia - AntimitoticUricosuric Combinations
colchicine-probenecid
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
102
Drug
Hyperuricemia Therapy - Uricosurics
probenecid
Status
Notes
F
Hyperuricemia Therapy - Xanthine
Oxidase Inhibitors
allopurinol
F
QL
Uloric oral tablet 40 mg
F
PA; QL
Uloric oral tablet 80 mg
F
PA
Hematological Agents
Anticoagulants - Coumarin
warfarin
F
Direct Factor Xa Inhibitors
Eliquis
F
QL
Xarelto oral tablet
F
QL
Xarelto oral tablets,dose pack
F
QL
Aranesp (in polysorbate)
F
PA
Epogen injection solution 10,000 unit/mL, 2,000
unit/mL, 20,000 unit/2 mL, 20,000 unit/mL, 3,000
unit/mL, 4,000 unit/mL
F
PA
Procrit
F
PA
F
PA
Erythropoietins
Granulocyte Colony-Stimulating Factor
(G-Csf)
Neupogen
Hematorheologic Agents
pentoxifylline
F
Heparins
heparin (porcine) injection solution 10,000
unit/mL, 5,000 unit/mL
F
Indirect Factor Xa Inhibitors
fondaparinux
F
PA
Low Molecular Weight Heparins
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
103
Drug
enoxaparin subcutaneous syringe
Status
Notes
F
PA
F
QL
Platelet Aggregation Inhibitors Phosphodiesterase Iii Inhibitors
cilostazol
Platelet Aggregation Inhibitors Quinazoline Agents
anagrelide
F
Platelet Aggregation Inhibitors Salicylates
Adult Low Dose Aspirin
F
OTC; AL
Aspir-81
F
OTC; QL; AL
Aspirin Childrens
F
OTC; QL; AL
Aspirin Low Dose
F
OTC; AL
Aspirin Low-Strength
F
OTC; QL; AL
aspirin oral tablet
F
OTC; QL; AL
aspirin oral tablet,chewable
F
OTC; QL; AL
aspirin oral tablet,delayed release (DR/EC) 325
mg
F
OTC; QL; AL
aspirin oral tablet,delayed release (DR/EC) 81 mg
F
OTC; AL
Aspir-Low
F
OTC; QL; AL
Bayer Aspirin
F
OTC; QL; AL
Bayer Chewable Aspirin
F
OTC; QL; AL
Child Aspirin
F
OTC; QL; AL
Children's Aspirin
F
OTC; QL; AL
E.C. Prin
F
OTC
Ecotrin Low Strength
F
OTC; QL; AL
Enteric Coated Aspirin
F
OTC; AL
Lite Coat Aspirin
F
OTC; QL; AL
Lo-Dose Aspirin
F
OTC; AL
Platelet Aggregation Inhibitors Thienopyridine Agents
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
104
Drug
clopidogrel oral tablet 300 mg, 75 mg
Status
Notes
F
QL
dipyridamole oral tablet 25 mg, 75 mg
F
QL
dipyridamole oral tablet 50 mg
F
Platelet Aggregation Inhib-Pdesterase
And Adenosine Deaminase Inhibitr
Sickle Cell Anemia Agents
Droxia
F
Thrombin Inhibitor - Selective Direct
And Reversible
Pradaxa oral capsule 150 mg, 75 mg
F
Immunosuppressive Agents
Immunosuppressive - Calcineurin
Inhibitors
cyclosporine modified oral capsule
F
cyclosporine modified oral solution
F
cyclosporine oral capsule
F
tacrolimus oral
F
AL
Immunosuppressive - Inosine
Monophosphate Dehydrogenase
Inhibitors
mycophenolate mofetil oral capsule
F
QL
mycophenolate mofetil oral suspension for
reconstitution
F
AL
mycophenolate mofetil oral tablet
F
mycophenolate sodium
F
ST
Immunosuppressive - Mammalian
Target Of Rapamycin (Mtor) Inhibitors
sirolimus
F
Immunosuppressive - Purine Analogs
azathioprine
F
QL
Locomotor System
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
105
Drug
Als Agent - Benzathiazoles
riluzole
Status
Notes
F
Antimyasthenic Agent - Reversible
Cholinesterase Inhibitors
pyridostigmine bromide
F
Skeletal Muscle Relaxant - Central
Muscle Relaxants
baclofen
F
AL
chlorzoxazone
F
AL
cyclobenzaprine oral tablet 10 mg, 5 mg
F
AL
methocarbamol oral
F
AL
orphenadrine citrate oral
F
QL; AL
tizanidine oral tablet
F
AL
Accu-Chek Aviva Plus test strp
F
OTC; QL
Accu-Chek SmartView Test Strip
F
OTC; QL
F
OTC; QL
Accu-Chek Aviva Control Soln
F
OTC
Accu-Chek Aviva Plus Meter
F
OTC; QL
Accu-Chek FastClix
F
OTC; QL
Accu-Chek FastClix kit
F
OTC
Accu-Chek Multiclix Lancet
F
OTC; QL
Accu-Chek Multiclix Lancet kit
F
OTC
Accu-Chek Nano
F
OTC; QL
Medical Supplies And Durable Medical
Equipment (Dme)
Medical Supplies And Dme - Blood
Glucose Tests
Medical Supplies And Dme - Female
Condoms
FC2 Female Condom
Medical Supplies And Dme - Glucose
Monitoring Test Supplies
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
106
Drug
Status
Notes
Accu-Chek SmartView Contrl Sol
F
OTC
Accu-Chek Soft Dev Lancets
F
OTC
Accu-Chek Softclix Lancet Dev
F
OTC
Accu-Chek Softclix Lancets
F
OTC; QL
Alternate Site Lancet
F
OTC
Fine 30 Universal Lancets
F
OTC
First Choice Lancets Thin
F
OTC
inControl Super Thin Lancets
F
OTC
inControl Ultra Thin Lancets
F
OTC
Micro Thin Lancets
F
OTC
Nova Safety Lancets 28 gauge
F
OTC
Nova Sureflex Lancets
F
OTC
ReliOn Ultra Thin Plus Lancets
F
OTC
Smart Sense Lancets 26 gauge, 33 gauge
F
OTC
Soft Touch Lancets
F
OTC; QL
Ultra Thin Lancets 28 gauge
F
OTC
Ultra Thin Plus Lancets
F
OTC
UltraLANCE Lancets 26 gauge
F
OTC
Universal 1 Lancets 33 gauge
F
OTC
F
OTC; QL
1st Tier Unifine Pentips needle 29 gauge x 1/2"
F
OTC
Advocate Pen Needles needle 31 gauge x 5/16"
F
OTC
Advocate Syringes syringe 1 mL 30 gauge x 5/16
F
OTC
BD Insulin Pen Needle UF Mini
F
OTC
BD Insulin Pen Needle UF Orig
F
OTC; QL
BD Insulin Pen Needle UF Short
F
OTC
BD Insulin Syringe Half Unit
F
OTC; QL
Medical Supplies And Dme - Hearing
Aid Supplies And Batteries
Hearing Aid Batteries
Medical Supplies And Dme - Insulin
Needles-Syringes And Admin Supplies
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
107
Drug
Status
Notes
BD Insulin Syringe Micro-Fine syringe 1 mL 28
gauge x 1/2"
F
OTC; QL
BD Insulin Syringe syringe 1 mL 28 gauge x 1/2"
F
OTC; QL
BD Insulin Syringe Ultra-Fine
F
OTC; QL
BD Integra Insulin Syringe
F
OTC; QL
BD Lo-Dose Micro-Fine IV syringe 1/2 mL 28
gauge x 1/2"
F
OTC
BD Lo-Dose Ultra-Fine syringe 0.3 mL 29 gauge
x 1/2"
F
OTC
BD Ultra-Fine Nano Pen Needles
F
OTC
Easy Comfort Insulin Syringe syringe 1 mL 30
gauge x 5/16
F
OTC
Easy Touch Insulin Syringe syringe 0.5 mL 31
gauge x 5/16, 1 mL 28 gauge x 1/2", 1 mL 31
gauge x 5/16
F
OTC; QL
Easy Touch needle 31 gauge x 3/16"
F
OTC; QL
inControl Pen Needle needle 29 gauge x 1/2", 32
gauge x 5/32"
F
OTC
insulin syringe-needle U-100 syringe 0.3 mL 30
gauge x 5/16, 0.3 mL 31 gauge x 5/16, 0.5 mL 29
gauge x 1/2", 1 mL 29 gauge x 1/2", 1 mL 30
gauge x 3/8", 1 mL 31 gauge x 5/16, 1/2 mL 28
gauge x 1/2", 1/2 mL 30 gauge x 5/16
F
OTC; QL
insulin syringes (disposable)
F
OTC
NovoFine 30
F
OTC; QL
Novofine 32
F
OTC; QL
Novofine Autocover
F
OTC; QL
Pen Needle needle 29 gauge x 1/2", 31 gauge x
5/16"
F
OTC
SafeSnap Insulin Syringe syringe 0.3 mL 30
gauge x 5/16"
F
OTC
Sure Comfort Pen Needle needle 29 gauge x 1/2"
F
OTC; QL
Sure-Fine Pen Needles needle 29 gauge x 1/2"
F
OTC; QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
108
Drug
Status
Notes
Sure-Ject Insulin Syringe syringe 1 mL 28 gauge
x 1/2"
F
OTC; QL
Ulticare Pen Needle needle 31 gauge x 5/16"
F
OTC; QL
Ulticare syringe 1 mL 29 x 1/2", 1 mL 30 gauge x
1/2"
F
OTC; QL
Ultilet Pen Needle needle 29 gauge
F
OTC
Ultra Comfort Insulin Syringe syringe 1 mL 28,
1/2 mL 28 gauge x 1/2"
F
OTC
Unifine Pentips needle 29 gauge x 1/2"
F
OTC
Unifine Pentips Plus needle 31 gauge x 5/16"
F
OTC
Aimsco
F
OTC; QL
Condoms-Prem Lubricated
F
OTC; QL
Kimono Condoms(Non-lubricated)
F
OTC; QL
Kimono Maxx Condoms
F
OTC; QL
Kimono MicroThin Aqua Lube Con
F
OTC; QL
Kimono MicroThin Condoms
F
OTC
Kimono MicroThin Large Condoms
F
OTC; QL
Kimono Textured Condoms
F
OTC; QL
Trustex Latex Condom
F
OTC; QL
Trustex Lubricated Condoms
F
OTC; QL
Trustex Non-Lub Condoms
F
OTC; QL
Trustex-RIA Lub/Spermicide
F
OTC; QL
Trustex-RIA Non-Lub Condoms
F
OTC; QL
BD Sharps Collector
F
OTC
Sharps Container
F
OTC
Medical Supplies And Dme - Male
Condoms
Medical Supplies And Dme Miscellaneous Other
Medical Supplies And Dme - Needles
And Syringes
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
109
Drug
SafeSnap Syringe syringe 1 mL 25 gauge x 5/8",
1 mL 27 gauge x 1/2", 3 mL
Status
Notes
F
OTC
Peak Air Peak Flow Meter
F
OTC; QL
Personal Best Full Range
F
OTC
Aerochamber MV
F
QL
OptiChamber Diamond Lg Mask
F
QL
OptiChamber Diamond VHC
F
QL
OptiChamber Diamond-Med Msk
F
QL
OptiChamber Diamond-Sml Mask
F
QL
PrimeAire
F
QL
ProChamber
F
QL
Vortex Holding Chamber
F
QL
1st Tier Unifine Pentips needle 29 gauge x 1/2"
F
OTC
Accu-Chek Aviva Control Soln
F
OTC
Accu-Chek Aviva Plus Meter
F
OTC; QL
Accu-Chek Aviva Plus test strp
F
OTC; QL
Accu-Chek FastClix
F
OTC; QL
Accu-Chek FastClix kit
F
OTC
Accu-Chek Multiclix Lancet
F
OTC; QL
Accu-Chek Multiclix Lancet kit
F
OTC
Accu-Chek Nano
F
OTC; QL
Accu-Chek SmartView Contrl Sol
F
OTC
Accu-Chek SmartView Test Strip
F
OTC; QL
Accu-Chek Soft Dev Lancets
F
OTC
Accu-Chek Softclix Lancet Dev
F
OTC
Medical Supplies And Dme - Peak Flow
Meters
Medical Supplies And Dme Respiratory Therapy Supplies
Medical Supply, Fdb Superset
Medical Supply, Fdb Superset
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
110
Drug
Status
Notes
Accu-Chek Softclix Lancets
F
OTC; QL
Advocate Pen Needles needle 31 gauge x 5/16"
F
OTC
Advocate Syringes syringe 1 mL 30 gauge x 5/16
F
OTC
Aerochamber MV
F
QL
Aimsco
F
OTC; QL
Alternate Site Lancet
F
OTC
BD Insulin Pen Needle UF Mini
F
OTC
BD Insulin Pen Needle UF Orig
F
OTC; QL
BD Insulin Pen Needle UF Short
F
OTC
BD Insulin Syringe Half Unit
F
OTC; QL
BD Insulin Syringe Micro-Fine syringe 1 mL 28
gauge x 1/2"
F
OTC; QL
BD Insulin Syringe syringe 1 mL 28 gauge x 1/2"
F
OTC; QL
BD Insulin Syringe Ultra-Fine
F
OTC; QL
BD Integra Insulin Syringe
F
OTC; QL
BD Lo-Dose Micro-Fine IV syringe 1/2 mL 28
gauge x 1/2"
F
OTC
BD Lo-Dose Ultra-Fine syringe 0.3 mL 29 gauge
x 1/2"
F
OTC
BD Sharps Collector
F
OTC
BD Ultra-Fine Nano Pen Needles
F
OTC
Condoms-Prem Lubricated
F
OTC; QL
Easy Comfort Insulin Syringe syringe 1 mL 30
gauge x 5/16
F
OTC
Easy Touch Insulin Syringe syringe 0.5 mL 31
gauge x 5/16, 1 mL 28 gauge x 1/2", 1 mL 31
gauge x 5/16
F
OTC; QL
Easy Touch needle 31 gauge x 3/16"
F
OTC; QL
FC2 Female Condom
F
OTC; QL
Fine 30 Universal Lancets
F
OTC
First Choice Lancets Thin
F
OTC
Hearing Aid Batteries
F
OTC; QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
111
Drug
Status
Notes
inControl Pen Needle needle 29 gauge x 1/2", 32
gauge x 5/32"
F
OTC
inControl Super Thin Lancets
F
OTC
inControl Ultra Thin Lancets
F
OTC
insulin syringe-needle U-100 syringe 0.3 mL 30
gauge x 5/16, 0.3 mL 31 gauge x 5/16, 0.5 mL 29
gauge x 1/2", 1 mL 29 gauge x 1/2", 1 mL 30
gauge x 3/8", 1 mL 31 gauge x 5/16, 1/2 mL 28
gauge x 1/2", 1/2 mL 30 gauge x 5/16
F
OTC; QL
insulin syringes (disposable)
F
OTC
Ketone Care
F
OTC
Ketone Urine Test
F
OTC
Ketostix
F
OTC
Kimono Condoms(Non-lubricated)
F
OTC; QL
Kimono Maxx Condoms
F
OTC; QL
Kimono MicroThin Aqua Lube Con
F
OTC; QL
Kimono MicroThin Condoms
F
OTC
Kimono MicroThin Large Condoms
F
OTC; QL
Kimono Textured Condoms
F
OTC; QL
Micro Thin Lancets
F
OTC
Nova Safety Lancets 28 gauge
F
OTC
Nova Sureflex Lancets
F
OTC
NovoFine 30
F
OTC; QL
Novofine 32
F
OTC; QL
Novofine Autocover
F
OTC; QL
OptiChamber Diamond Lg Mask
F
QL
OptiChamber Diamond VHC
F
QL
OptiChamber Diamond-Med Msk
F
QL
OptiChamber Diamond-Sml Mask
F
QL
Peak Air Peak Flow Meter
F
OTC; QL
Pen Needle needle 29 gauge x 1/2", 31 gauge x
5/16"
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
112
Drug
Status
Notes
Personal Best Full Range
F
OTC
PrimeAire
F
QL
ProChamber
F
QL
ReliOn Ultra Thin Plus Lancets
F
OTC
SafeSnap Insulin Syringe syringe 0.3 mL 30
gauge x 5/16"
F
OTC
SafeSnap Syringe syringe 1 mL 25 gauge x 5/8",
1 mL 27 gauge x 1/2", 3 mL
F
OTC
Sharps Container
F
OTC
Smart Sense Lancets 26 gauge, 33 gauge
F
OTC
Soft Touch Lancets
F
OTC; QL
Sure Comfort Pen Needle needle 29 gauge x 1/2"
F
OTC; QL
Sure-Fine Pen Needles needle 29 gauge x 1/2"
F
OTC; QL
Sure-Ject Insulin Syringe syringe 1 mL 28 gauge
x 1/2"
F
OTC; QL
Trustex Latex Condom
F
OTC; QL
Trustex Lubricated Condoms
F
OTC; QL
Trustex Non-Lub Condoms
F
OTC; QL
Trustex-RIA Lub/Spermicide
F
OTC; QL
Trustex-RIA Non-Lub Condoms
F
OTC; QL
Ulticare Pen Needle needle 31 gauge x 5/16"
F
OTC; QL
Ulticare syringe 1 mL 29 x 1/2", 1 mL 30 gauge x
1/2"
F
OTC; QL
Ultilet Pen Needle needle 29 gauge
F
OTC
Ultra Comfort Insulin Syringe syringe 1 mL 28,
1/2 mL 28 gauge x 1/2"
F
OTC
Ultra Thin Lancets 28 gauge
F
OTC
Ultra Thin Plus Lancets
F
OTC
UltraLANCE Lancets 26 gauge
F
OTC
Unifine Pentips needle 29 gauge x 1/2"
F
OTC
Unifine Pentips Plus needle 31 gauge x 5/16"
F
OTC
Universal 1 Lancets 33 gauge
F
OTC
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
113
Drug
Vortex Holding Chamber
Status
Notes
F
QL
calcitriol oral capsule
F
QL
calcitriol oral solution
F
AL
doxercalciferol
F
paricalcitol
F
Zemplar 2mcg/mL, 5mcg/mL, 10mcg/mL IV soln
F
Metabolic Modifiers
Hyperparathyroid Treatment Agents Vitamin D Analog-Type
Mouth-Throat-Dental - Preparations
Dental Product - Fluoride Preparations
Denta 5000 Plus cream
F
DentaGel 1.1% gel
F
AL
Fluoridex Daily Defense
F
AL
Fluoritab oral tablet,chewable 0.5 mg fluoride
(1.1 mg)
F
QL; AL
Fluoritab oral tablet,chewable 1 mg fluoride (2.2
mg)
F
AL
Perio Med
F
OTC; QL
PreviDent 5000 Plus cream
F
PreviDent dental gel
F
AL
SF 1.1% gel
F
AL
SF 5000 Plus cream
F
sodium fluoride oral drops
F
QL; AL
sodium fluoride oral tablet,chewable 0.25 mg
fluorid (0.55 mg)
F
AL
sodium fluoride oral tablet,chewable 0.5 mg
fluoride (1.1 mg), 1 mg fluoride (2.2 mg)
F
QL; AL
Stannous Fluoride 0.63% rinse
F
Mouth And Throat - Antifungals
clotrimazole 10mg troche
F
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
114
Drug
nystatin oral suspension
Status
F
Notes
QL
Mouth And Throat - Antiseptics
chlorhexidine gluconate rinse
F
Mouth And Throat - Glucocorticoids
triamcinolone acetonide dental
F
QL
Mouth And Throat - Local Anesthetic
Amides
Lidocaine Viscous
F
Mouth And Throat - Saliva Stimulants
pilocarpine HCl oral tablet 5 mg
F
Periodontal Product - TetracyclineType, Collagenase Inhibitors
doxycycline hyclate oral tablet 20 mg
F
QL
Avonex (with albumin)
F
PA; QL
Avonex intramuscular pen injector kit
F
PA; QL
Avonex intramuscular syringe
F
PA; QL
Avonex intramuscular syringe kit
F
PA; QL
Glatopa
F
PA; QL
Tecfidera oral capsule,delayed release(DR/EC)
120 mg, 120 mg (14)- 240 mg (46), 240 mg
F
PA; QL
F
PA
F
PA
Multiple Sclerosis Agents
Multiple Sclerosis Agent - Interferons
Multiple Sclerosis Agent - Others
Multiple Sclerosis Agent - Potassium
Channel Blocker
Ampyra
Multiple Sclerosis Agent - Sphingosine
1-Phosphate Receptor Modulator
Gilenya
Ophthalmic Agents
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
115
Drug
Artificial Tears And Lubricant
Combinations
Status
Notes
Artificial Tears (PF)
F
OTC
Artificial Tears ophthalmic drops , 0.1-0.3 %,
0.5-0.6 %
F
OTC
Artificial Tears(glycerin-peg)
F
OTC
Bion Tears (PF)
F
OTC
Lubricant Eye Drops (glyc-pg)
F
OTC
Lubricant Eye(dextran70-hypml)
F
OTC
Natural Tears (PF)
F
OTC
Tears Naturale Free (PF)
F
OTC
Tears Naturale II
F
OTC
Tears Pure
F
OTC
Artificial Tears (polyvin alc)
F
OTC
Lubricant Eye Drops ophthalmic dropperette
F
OTC
polyvinyl alcohol
F
OTC
Artificial Tears And Lubricant Single
Agents
Miotics - Cholinesterase Inhibitors
Phospholine Iodide
F
Miotics - Direct Acting
pilocarpine HCl ophthalmic drops 1 %, 2 %, 4 %
F
Ophthalmic - AntibacterialGlucocorticoid Combinations
Blephamide
F
Blephamide S.O.P.
F
neomycin-bacitracin-poly-HC
F
neomycin-polymyxin B-dexameth
F
neomycin-polymyxin-HC ophthalmic
F
Neo-Polycin HC
F
sulfacetamide-prednisolone
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
116
Drug
Status
TobraDex ophthalmic ointment
F
tobramycin-dexamethasone
F
Notes
Ophthalmic - Anticholinergics
atropine ophthalmic
F
cyclopentolate ophthalmic drops 1 %, 2 %
F
homatropine HBr
F
tropicamide ophthalmic
F
Ophthalmic - AntihistamineDecongestant Combinations
Eye Allergy Relief
F
OTC
Visine-A
F
OTC
Ophthalmic - Antihistamines
azelastine ophthalmic
F
ketotifen fumarate
F
OTC; QL
Ophthalmic - Anti-Inflammatory,
Glucocorticoids
dexamethasone sodium phosphate ophthalmic
F
Flarex
F
fluorometholone
F
QL
FML Forte
F
QL
FML S.O.P.
F
Pred Mild
F
prednisolone acetate
F
prednisolone sodium phosphate ophthalmic
F
Ophthalmic - Anti-Inflammatory,
Nsaids
diclofenac sodium ophthalmic
F
flurbiprofen sodium
F
ketorolac ophthalmic drops 0.5 %
F
QL
Ophthalmic - Beta Blockers-Carbonic
Anhydrase Inhibitor Combinations
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
117
Drug
dorzolamide-timolol
Status
Notes
F
QL
F
QL
Ophthalmic - Carbonic Anhydrase
Inhibitors
dorzolamide
Ophthalmic - Decongestants
naphazoline
F
phenylephrine HCl ophthalmic drops 2.5 %
F
Ophthalmic - Hyperosmolar Agents
Artificial Tears ophthalmic drops
F
OTC
Ophthalmic - Intraocular Pressure
Reducing Agents, Beta-Blockers
betaxolol ophthalmic
F
carteolol
F
levobunolol ophthalmic drops 0.5 %
F
metipranolol
F
timolol maleate ophthalmic
F
Ophthalmic - Local Anesthetic Esters
proparacaine
F
Ophthalmic - Mast Cell Stabilizers
cromolyn ophthalmic
F
Ophthalmic Antibacterial Mixtures
bacitracin-polymyxin B ophthalmic
F
neomycin-bacitracin-polymyxin
F
neomycin-polymyxin-gramicidin
F
polymyxin B sulf-trimethoprim
F
Ophthalmic Antibiotic Aminoglycosides
gentamicin ophthalmic drops, ointment
F
tobramycin ophthalmic drops, ointment
F
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
118
Drug
Ophthalmic Antibiotic Dehydropeptidase Inhibitors
bacitracin ophthalmic
Status
Notes
F
Ophthalmic Antibiotic Fluoroquinolones
ciprofloxacin HCl ophthalmic
F
levofloxacin ophthalmic
F
ofloxacin ophthalmic
F
Vigamox
F
QL
QL
Ophthalmic Antibiotic - Macrolides
erythromycin ophthalmic ointment
F
Ophthalmic Antibiotic - Sulfonamides
sulfacetamide 10% solution, ointment
F
Ophthalmic Antivirals
trifluridine
F
Ophthalmic-Intraocular Press.
Reducing, Sel. Alpha Adrenergic
Agonists
apraclonidine
F
brimonidine
F
Ophthalmic-Intraocular Pressure
Reducing Agents, Prostaglandin
Analogs
latanoprost
F
travoprost (benzalkonium)
F
QL
Otic
Otic - Anti-Infective Mixtures
acetic acid-aluminum acetate
F
Otic - Anti-Infective-Glucocorticoid
Combinations
Ciprodex
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
F
AL
119
Drug
neomycin-polymyxin-HC otic
Status
Notes
F
Otic - Anti-Infectives Other
acetic acid otic
F
Otic - Fluoroquinolones
ofloxacin otic
F
QL
Otic - Glucocorticoids
hydrocortisone-acetic acid
F
Respiratory Therapy Agents
2Nd Generation AntihistamineDecongestant Combinations
cetirizine-pseudoephedrine ER 5-120mg tablet
F
OTC; QL
Loratadine-D oral tablet extended release 24 hr
F
OTC; QL
chlorpheniramine maleate oral tablet 4mg
F
OTC
chlorpheniramine maleate oral tablet extended
release 12mg
F
OTC
Antihistamine - 1St Generation Alkylamines
Antihistamine - 1St Generation Ethanolamines
carbinoxamine maleate tablet 4mg
F
carbinoxamine maleate liquid 4 mg/5 mL
F
clemastine oral tablet 1.34 mg
F
clemastine oral tablet 2.68 mg
F
diphenhydramine HCl injection solution 50
mg/mL
F
AL
diphenhydramine HCl injection syringe
F
AL
diphenhydramine HCl oral capsule
F
OTC; AL
diphenhydramine HCl oral elixir
F
OTC; AL
diphenhydramine HCl oral liquid
F
OTC
diphenhydramine HCl oral syrup
F
OTC
diphenhydramine HCl oral tablet 25 mg
F
OTC; AL
OTC; QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
120
Drug
Antihistamine - 1St Generation Phenothiazines
Status
Notes
promethazine oral
F
AL
promethazine rectal suppository 12.5 mg, 25 mg
F
AL
Promethegan rectal suppository 12.5 mg, 25 mg
F
Promethegan rectal suppository 50 mg
F
AL
Cyproheptadine tablet 4mg
F
AL
Cyproheptadine syrup 2 mg/5 mL, 4 mg/10 mL
F
AL
Antihistamine - 1St Generation Piperidines
Antihistamines - 1St Generation
carbinoxamine maleate
F
chlorpheniramine maleate oral tablet
F
OTC
chlorpheniramine maleate oral tablet extended
release
F
OTC
clemastine oral tablet 1.34 mg
F
OTC; QL
clemastine oral tablet 2.68 mg
F
cyproheptadine
F
AL
diphenhydramine HCl injection solution 50
mg/mL
F
AL
diphenhydramine HCl injection syringe
F
AL
diphenhydramine HCl oral capsule
F
OTC; AL
diphenhydramine HCl oral elixir
F
OTC; AL
diphenhydramine HCl oral liquid
F
OTC
diphenhydramine HCl oral syrup
F
OTC
diphenhydramine HCl oral tablet 25 mg
F
OTC; AL
promethazine oral
F
AL
promethazine rectal suppository 12.5 mg, 25 mg
F
AL
Promethegan rectal suppository 12.5 mg, 25 mg
F
Promethegan rectal suppository 50 mg
F
AL
Antihistamines - 2Nd Generation
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
121
Drug
Status
Notes
cetirizine oral solution 1 mg/mL, 5 mg/5 mL
F
OTC; QL; AL
cetirizine oral tablet
F
OTC; QL
cetirizine oral tablet,chewable
F
OTC; QL; AL
fexofenadine oral suspension
F
OTC
fexofenadine oral tablet
F
OTC
loratadine oral solution
F
OTC; QL; AL
loratadine oral tablet
F
OTC; QL
cetirizine oral solution 1 mg/mL, 5 mg/5 mL
F
OTC; QL; AL
cetirizine oral tablet
F
OTC; QL
cetirizine oral tablet,chewable
F
OTC; QL; AL
fexofenadine oral suspension
F
OTC
fexofenadine oral tablet
F
OTC
loratadine oral solution
F
OTC; QL; AL
loratadine oral tablet
F
OTC; QL
Antihistamines - 2Nd Generation Piperazines
Antihistamines - 2Nd Generation Piperidines
Antitussives - Nonnarcotic
benzonatate oral capsule 100 mg, 200 mg
F
Asthma Therapy - Glucocorticoids
Aerospan
F
QL
Arnuity Ellipta
F
QL
Asmanex HFA
F
Asmanex Twisthaler
F
QL
budesonide inhalation
F
QL; AL
Flovent Diskus inhalation blister with device 100
mcg/actuation, 250 mcg/actuation, 50
mcg/actuation
F
QL
Flovent HFA inhalation HFA aerosol inhaler 110
mcg/actuation, 220 mcg/actuation, 44
mcg/actuation
F
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
122
Drug
Status
Notes
Pulmicort Flexhaler
F
QL
Qvar
F
QL
montelukast oral granules in packet
F
QL; AL
montelukast oral tablet
F
QL; AL
montelukast oral tablet,chewable 4 mg, 5 mg
F
QL; AL
zafirlukast
F
Asthma Therapy - Leukotriene
Receptor Antagonists
Asthma Therapy - Mast Cell Stabilizers
cromolyn inhalation
F
Asthma Therapy - Xanthines
theophylline oral elixir
F
theophylline oral solution
F
theophylline oral tablet extended release
F
theophylline oral tablet extended release 12 hr
F
Asthma/Copd - Anticholinergic Agents,
Inhaled Long Acting
Incruse Ellipta
F
Spiriva Respimat inhalation mist 2.5
mcg/actuation
F
QL
Spiriva with HandiHaler
F
QL
Tudorza Pressair
F
QL
Atrovent HFA
F
QL
ipratropium bromide inhalation
F
Asthma/Copd - Anticholinergic Agents,
Inhaled Short Acting
Asthma/Copd Therapy - Beta 2Adrenergic Agents, Inhaled, Long
Acting
Foradil Aerolizer
F
QL
Serevent Diskus
F
QL
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
123
Drug
Asthma/Copd Therapy - Beta 2Adrenergic Agents, Inhaled, Short
Acting
Status
Notes
albuterol sulfate inhalation solution for
nebulization 0.63 mg/3 mL, 1.25 mg/3 mL
F
albuterol sulfate inhalation solution for
nebulization 2.5 mg /3 mL (0.083 %), 2.5 mg/0.5
mL, 5 mg/mL
F
Ventolin HFA
F
QL
Xopenex HFA
F
PA; QL
QL
Asthma/Copd Therapy - Beta
Adrenergic Agents
albuterol sulfate oral syrup
F
albuterol sulfate oral tablet
F
metaproterenol oral tablet
F
terbutaline oral
F
Asthma/Copd Therapy - Beta
Adrenergic-Anticholinergic
Combinations
Anoro Ellipta
F
QL
Combivent Respimat
F
QL
ipratropium-albuterol
F
QL
Breo Ellipta
F
QL
Dulera
F
QL
Symbicort
F
QL
F
PA
Asthma/Copd Therapy - Beta
Adrenergic-Glucocorticoid
Combinations
Cystic Fibrosis - Inhaled
Aminoglycosides
Tobi Podhaler
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
124
Drug
tobramycin in 0.225 % NaCl (300 mg/ 5 mL
ampule)
Status
Notes
F
PA
F
PA
Cystic Fibrosis - Inhaled Monobactams
Cayston
Mucolytics
acetylcysteine
F
Pulmozyme
F
PA
Narcotic Antitussive-Anticholinergic
Combinations
Hydrocodone Compound
F
hydrocodone-homatropine oral syrup 5-1.5 mg/5
mL
F
Narcotic Antitussive-Expectorant
Combinations
Cheratussin AC
F
OTC; QL
codeine-guaifenesin 10-100 mg/5 mL
F
OTC; QL
Virtussin AC
F
OTC; QL
F
QL
F
QL
Flonase Allergy Relief
F
OTC
flunisolide nasal spray,non-aerosol 25 mcg (0.025
%)
F
QL
fluticasone nasal
F
OTC; QL
Nasacort
F
OTC; QL
triamcinolone acetonide nasal
F
QL
cromolyn nasal
F
OTC
Nasalcrom
F
OTC
Nasal Anticholinergics
ipratropium bromide nasal
Nasal Antihistamines
azelastine nasal aerosol,spray
Nasal Corticosteroids
Nasal Mast Cell Stabilizers
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
125
Drug
Nasal Moisturizers
Status
Notes
Altamist
F
OTC
Ayr Saline nasal aerosol,spray
F
OTC
Baby Ayr Saline
F
OTC
Deep Sea Nasal
F
OTC
Little Remedies
F
OTC
Nasal Moisturizing
F
OTC
Nasal Spray (sodium chloride)
F
OTC
Ocean for Kids
F
OTC
Ocean Nasal
F
OTC
Saline Mist
F
OTC
Saline Nasal
F
OTC
Saline Nasal Mist nasal aerosol,spray
F
OTC
Saline Nose
F
OTC
Sea Soft Nasal Mist
F
OTC
Q-Tussin DM
F
OTC
Robafen DM
F
OTC
Nasal Decongestant (pseudoeph) oral tablet
F
OTC
pseudoephedrine HCl oral liquid
F
OTC; QL
pseudoephedrine HCl oral tablet
F
OTC; QL
Sudogest
F
OTC
Suphedrin oral tablet
F
OTC
Suphedrine
F
OTC
Wal-phed oral tablet 30 mg
F
OTC
F
Female
Non-Narcotic Antitussive-Expectorant
Combinations
Systemic Sympathomimetic
Decongestants
Vaginal Products
Vaginal Antibacterial - Lincosamides
clindamycin phosphate vaginal
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
126
Drug
Vaginal Antifungal - Imidazoles
Status
Notes
3-Day Vaginal
F
Female; OTC
Clotrimazole 3 Day
F
Female; OTC
clotrimazole vaginal cream
F
Female; OTC
Clotrimazole-3
F
Female; OTC
Clotrimazole-7
F
Female; OTC
Gyne-Lotrimin
F
Female; OTC
Miconazole 7
F
Female; OTC
miconazole nitrate vaginal comb pack,prefill appl,
cream
F
Female; OTC
miconazole nitrate vaginal cream
F
Female; OTC
miconazole nitrate vaginal suppository
F
Female; OTC
Miconazole-3 prefil,cream,wipe
F
Female; OTC
Miconazole-3 vaginal kit
F
Female; OTC
Miconazole-3 vaginal suppository
F
Female
Monistat 3 vaginal comb pack,prefill appl, cream
F
Female; OTC
Monistat 3 vaginal kit
F
Female; OTC
Monistat 7
F
Female; OTC
Vagistat-3
F
Female; OTC
Terazol 3 vaginal cream
F
Female
Terazol 7
F
Female
terconazole
F
Female
F
Female
Estrace vaginal
F
Female; QL
Premarin vaginal
F
Female; QL
Vaginal Antifungal - Triazoles
Vaginal Antiprotozoal-Antibacterial Nitroimidazole Derivatives
metronidazole vaginal
Vaginal Estrogens
AL = Age Limit
F = Formulary
GL = Gender Limit
OTC = Over The Counter
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
127
Index
1
1st Tier Unifine Pentips .... 107, 110
3
3-Day Vaginal .......................... 127
5
50+ Adult Eye Health ............. 2, 57
8
8 HOUR PAIN RELIEVER ......... 4
A
A Thru Z ..................................... 57
A Thru Z Advanced Formula ..... 66
A Thru Z Men's Ultimate ........... 57
A Thru Z Select .................... 46, 57
A Thru Z Select 50+ Formula .... 57
A Thru Z Select Women's .......... 57
Abatron ....................................... 53
Abatron AF ................................. 53
ABC Plus .................................... 57
Abreva ........................................ 39
acarbose ...................................... 78
Accu-Chek Aviva Control Soln106,
110
Accu-Chek Aviva Plus Meter .. 106,
110
Accu-Chek Aviva Plus test strp106,
110
Accu-Chek FastClix ......... 106, 110
Accu-Chek Multiclix Lancet ... 106,
110
Accu-Chek Nano .............. 106, 110
Accu-Chek SmartView Contrl Sol
...................................... 107, 110
Accu-Chek SmartView Test Strip
...................................... 106, 110
Accu-Chek Soft Dev Lancets .. 107,
110
Accu-Chek Softclix Lancet Dev
...................................... 107, 110
Accu-Chek Softclix Lancets .... 107,
111
acebutolol ................................... 24
Acephen ........................................ 4
acetaminophen .......................... 4, 5
Acetaminophen Extra Strength..... 4
acetaminophen-codeine ............ 3, 4
acetazolamide ............................. 27
acetic acid ................................. 120
acetic acid-aluminum acetate .... 119
acetylcysteine ...................... 11, 125
Acid Control (ranitidine)............. 89
Acid Controller ........................... 89
Acid Gone Antacid ..................... 84
Acid Gone Antacid E.Strength ... 84
Acid Reducer (famotidine) ......... 89
Acid Reducer (ranitidine) ........... 89
acitretin ....................................... 39
Actical ......................................... 57
Active FE .................................... 53
acyclovir...................................... 15
adapalene .................................... 37
Adcirca ........................................ 28
adefovir ....................................... 15
Adempas ..................................... 28
Adult Low Dose Aspirin ..... 10, 104
Adult Multivitamin Gummies ..... 57
Adult One Daily Gummies ......... 57
Advanced AM-PM ...................... 57
Advanced Antacid-Antigas ......... 85
ADVANCED Calcium................ 48
Advil ............................................. 9
Advocate Pen Needles ...... 107, 111
Advocate Syringes ............ 107, 111
Aerochamber MV ............. 110, 111
Aerospan ................................... 122
Afeditab CR ................................ 25
Afinitor........................................ 19
Afinitor Disperz .......................... 19
Aimsco .............................. 109, 111
Akwa Tears (polyvinyl alcohol) 116
Alavert .............................. 121, 122
Alaway ...................................... 117
Alba-Lybe ................................... 42
albuterol sulfate......................... 124
Alcalak ........................................ 84
Alcohol Prep Pads ....................... 20
Alcohol Wipes ............................ 20
alendronate .................................. 80
Alka-Seltzer Gold ....................... 84
Alka-Seltzer Heartburn ............... 84
Alka-Seltzer Heartburn+Gas ....... 85
Alkeran........................................ 17
All Day Allergy (cetirizine) ...... 122
All Day Allergy-D .................... 120
All Day Pain Relief ....................... 9
Aller-Chlor ....................... 120, 121
Allergy Medication................... 120
allopurinol ................................ 103
Almacone ................................... 85
Almacone-2 ................................ 85
Alophen ...................................... 96
Altamist .................................... 126
Altavera (28)............................... 31
Alternate Site Lancet ........ 107, 111
aluminum chloride...................... 39
aluminum hydroxide gel ............. 84
Alyacen 1/35 (28) ....................... 31
Alyacen 7/7/7 (28) ...................... 35
amantadine HCl .......................... 29
amiloride..................................... 27
amiloride-hydrochlorothiazide ... 27
amiodarone ................................. 22
Amitiza ....................................... 91
amlodipine .................................. 25
amlodipine-benazepril ................ 20
amlodipine-valsartan .................. 21
ammonium lactate ...................... 40
amoxicillin .................................. 11
amoxicillin-pot clavulanate ...11, 12
ampicillin .................................... 11
Ampyra ..................................... 115
anagrelide ................................. 104
anastrozole .................................. 18
AndroGel .................................... 77
ANIMAL CHEWS ..................... 69
Animal Shape Vitamins.............. 69
Animal Shapes Complete ........... 70
Animi-3 With Vitamin D ........... 67
Anoro Ellipta ............................ 124
Antacid ....................................... 85
Antacid (calcium carb-mag hyd) 84
Antacid (calcium carbonate) ...... 84
Antacid Anti-Gas ........................ 85
Antacid Anti-Gas (ca carb-sim).. 86
Antacid Anti-Gas Double Str ..... 86
Antacid Calcium ......................... 84
Antacid ExSt (ca carb-mag hyd) 84
Antacid ExSt (mag carb-Al hyd) 84
Antacid Ext Str (calcium carb) ... 84
Antacid Extra-Strength ..........85, 86
Antacid Liquid............................ 86
Antacid M ................................... 86
128
Antacid Maximum Strength ....... 86
Antacid Multi-Symptom............. 86
Antacid Plus Anti-Gas ................ 86
Antacid Regular Strength ........... 86
Antacid Supreme ........................ 84
Antacid Ultra Strength................ 85
Antacid with Simethicone .......... 86
Antacid-Antigas.......................... 86
Antacid-Antigas II ...................... 86
Antacid-Simethicone .................. 86
Antibiotic-Pain Relief (bacit) ..... 38
Anti-Diarrhea.............................. 87
Anti-Diarrheal (loperamide) ....... 87
Antifungal (clotrimazole) ........... 38
Anti-Itch (HC) ............................ 40
Antioxidant ........................2, 58, 67
Antioxidant A/C/E/Selenium.. 2, 58
Antioxidant Formula (selenium) . 2,
58
Antioxidant Vitamins ............. 2, 58
Apatate Forte .............................. 58
Apetex ........................................ 42
Apetigen ..................................... 42
Apetigen Plus ....................... 45, 53
Apidra ......................................... 82
Apidra SoloStar .......................... 82
apraclonidine ............................ 119
Apri............................................. 31
Apriso ......................................... 91
AquADEKs ................................ 58
AquADEKs Pediatric ................. 70
Aqua-E........................................ 76
Aquasol E ................................... 76
Aranelle (28)............................... 35
Aranesp (in polysorbate) .......... 103
Arkaliox ................................ 74, 75
Armour Thyroid ......................... 83
Arnuity Ellipta .......................... 122
Arthritis Pain Relief (acetam) ....... 5
Artificial Tears ................. 116, 118
Artificial Tears (PF) ......... 115, 116
Artificial Tears (polyvin alc) .... 116
Artificial Tears(glycerin-peg) ... 116
Asacol HD .................................. 91
Asmanex HFA .......................... 122
Asmanex Twisthaler ................. 122
Aspir-81 .............................. 10, 104
aspirin ................................. 10, 104
Aspirin Childrens ............... 10, 104
Aspirin Low Dose .............. 10, 104
Aspirin Low-Strength ......... 10, 104
aspirin, buffered .................... 10, 11
Aspir-Low ........................... 10, 104
atenolol........................................ 24
atenolol-chlorthalidone ............... 26
Athenol.......................................... 5
atorvastatin .................................. 23
atovaquone .................................. 13
atropine ..................................... 117
Atrovent HFA ........................... 123
Auryxia ............................. 100, 101
Avar ............................................ 37
Aviane ......................................... 32
Avonex ...................................... 115
Avonex (with albumin) ............. 115
Ayr Saline ................................. 126
azathioprine ........................... 8, 105
azelastine ........................... 117, 125
azithromycin ............................... 15
Azurette (28) ............................... 31
B
B Complete ................................. 44
B Complex .................................. 44
B Complex 1 ............................... 44
B Complex 100 ........................... 44
B Complex Plus Vitamin C......... 42
B Complex w-Vit C .................... 74
B Complex-Vitamin B12 ............ 44
B complex-vitamin C-folic acid.. 42
B-100 Complex ........................... 42
B-50 Complex ............................. 44
Baby Ayr Saline ........................ 126
bacitracin ............................. 38, 119
bacitracin-polymyxin B ...... 37, 118
baclofen..................................... 106
Bacmin ........................................ 58
Bal B-100 .................................... 44
Bal B-50 ...................................... 44
Balance B-100............................. 44
Balance B-50............................... 44
Balanced B Complex-Vit C ........ 42
Balanced B-100..................... 42, 45
Balanced B-100 Complex ..... 42, 45
Balanced B-50............................. 45
balsalazide ................................... 91
Balziva (28)................................. 32
Bayer Aspirin ...................... 10, 104
Bayer Chewable Aspirin ..... 10, 104
B-Complex .................................. 42
B-Complex With B-12 ................ 74
B-complex with vitamin C .......... 42
BD Alcohol Swabs...................... 20
BD Insulin Pen Needle UF Mini
...................................... 107, 111
BD Insulin Pen Needle UF Orig
...................................... 107, 111
BD Insulin Pen Needle UF Short
...................................... 107, 111
BD Insulin Syringe ........... 108, 111
BD Insulin Syringe Half Unit .. 107,
111
BD Insulin Syringe Micro-Fine108,
111
BD Insulin Syringe Ultra-Fine 108,
111
BD Integra Insulin Syringe108, 111
BD Lo-Dose Micro-Fine IV .... 108,
111
BD Lo-Dose Ultra-Fine .... 108, 111
BD Sharps Collector......... 109, 111
BD Ultra-Fine Nano Pen Needles
...................................... 108, 111
Beelith ........................................ 56
Bee-Zee ...................................... 58
benazepril ................................... 20
benazepril-hydrochlorothiazide .. 20
Benefiber Clear SF (dextrin) ...... 92
Benefiber Sugar Free (dextrin) ... 92
benzonatate ............................... 122
benzoyl peroxide ........................ 37
Berocca (FA-guarana-caff)......... 58
Best Fiber ................................... 92
betamethasone dipropionate ....... 40
betamethasone valerate............... 40
betamethasone, augmented ......... 40
betaxolol ............................. 24, 118
bethanechol chloride................. 102
bexarotene .................................. 19
bicalutamide ............................... 17
Bio-35 ......................................... 58
Bio-35, Gluten Free .................... 58
Biocal ......................................... 48
Biocel (with Lutein) ................... 58
Bion Tears (PF) ........................ 116
Biopetit ....................................... 42
Biosupp....................................... 58
Biotect Plus ................................ 58
biotin........................................... 75
Biotin Plus-Calcium and Vit D3. 58
Biovol ......................................... 58
Bisac-Evac .................................. 96
bisacodyl..................................... 97
Bisa-Lax ..................................... 97
129
Biscolax ...................................... 97
Bismatrol .................................... 87
Bismuth ...................................... 87
Bismuth Maximum Strength ...... 87
bismuth subsalicylate ................. 87
bisoprolol fumarate..................... 24
bisoprolol-hydrochlorothiazide .. 26
Bladder 2.2 ................................. 58
Blephamide............................... 116
Blephamide S.O.P. ................... 116
Body, Hair, Skin and Nails ......... 58
Bone Density Calcium + D ........ 48
Bone Essentials........................... 48
Breo Ellipta............................... 124
Brevicon (28) .............................. 32
Brewer's Yeast ............................ 45
Briellyn ....................................... 32
brimonidine .............................. 119
bromocriptine ............................. 29
budesonide ................................ 122
bumetanide ................................. 27
bupropion HCl ...................... 28, 30
Butalbital Compound W/Codeine 4
butalbital-acetaminop-caf-cod ...... 4
butalbital-acetaminophen ............. 7
butalbital-acetaminophen-caff ...... 7
butalbital-aspirin-caffeine........... 10
C
cabergoline ................................. 83
Ca-D3-mag ox-zinc-cop-mang-bor
................................................ 48
Ca-D3-mag-zinc-cop-mang-bor . 48
caffeine citrated .......................... 29
Cal Mag Zinc + D3 ..................... 48
Calcet Creamy Bites ................... 49
Calcet Petites .............................. 49
Calci-Chew ................................. 47
Calcidol ...................................... 75
Calciferol .................................... 75
Calci-Max ................................... 48
Calci-Mix.................................... 47
Calcionate ................................... 47
calcipotriene ............................... 39
calcitonin (salmon) ..................... 80
Calcitrate .................................... 47
Cal-Citrate .................................. 49
Calcitrate-Vitamin D .................. 49
calcitriol .............................. 75, 114
Calcium 500 ............................... 47
Calcium 500 + D ........................ 49
Calcium 500 + D (D3) ................ 49
Calcium 600 + D(3) .................... 49
Calcium 600 + Minerals.............. 48
Calcium 600 Plus Soy ................. 48
Calcium 600 with Vitamin D3 .... 49
Calcium 600+D3 Plus ................. 48
calcium acetate ............ 47, 100, 101
Calcium Adult (calcium phos) .... 50
calcium amino acid chelate ......... 47
Calcium Antacid ......................... 85
Calcium Antacid Ultra Max St ... 85
calcium carb and citrate-vitD3 .... 50
calcium carb-D3-mag cmb11-zinc
................................................ 48
calcium carbonate ................. 47, 85
calcium carbonate-vit D3-min .... 48
calcium carbonate-vitamin D3 .... 50
calcium chloride .......................... 47
calcium citrate ............................. 47
Calcium Citrate + D .................... 50
Calcium Citrate + D with Mag.... 58
calcium citrate malate-vit D3 ...... 50
Calcium Citrate Plus ................... 48
Calcium Citrate Plus (Vit B6) ..... 58
calcium citrate-vitamin D2 ......... 50
calcium citrate-vitamin D3 ......... 50
Calcium for Women.................... 48
calcium gluconate ....................... 47
calcium lactate ............................ 47
Calcium Magnesium ................... 48
Calcium Magnesium + D ............ 48
calcium phosphate....................... 47
calcium phosphate-vitamin D3 ... 50
Calcium Soft Chew ..................... 48
Calcium with Boron .................... 48
Calcium+D .................................. 50
calcium-magnesium .................... 48
calcium-magnesium-copper-zinc 56
calcium-magnesium-zinc ............ 48
calcium-vitamin D3-vitamin K ... 48
Cal-Gest Antacid......................... 85
Cal-Mag ...................................... 48
CalMag Thins ............................. 48
Cal-Mint ...................................... 47
Calphron............................ 100, 101
Cal-Quick .................................... 50
Caltrate 600 + D .......................... 50
Caltrate 600+D Plus Minerals..... 49
Caltrate with Vitamin D3 ............ 50
Camila ......................................... 34
Canasa ......................................... 91
Capacet.......................................... 7
capecitabine ................................ 18
capsaicin ..................................... 41
captopril ...................................... 20
captopril-hydrochlorothiazide .... 20
carbidopa-levodopa .................... 29
carbinoxamine maleate ..... 120, 121
Cardiamin ................................... 58
Cardiotek-RX (bioperine)........... 42
carteolol .................................... 118
Cartia XT .................................... 24
carvedilol .................................... 21
castor oil ..................................... 97
Cayston ..................................... 125
Caziant (28) ................................ 35
cefaclor ....................................... 14
cefadroxil .................................... 13
cefdinir ....................................... 14
cefixime ...................................... 14
cefpodoxime ............................... 14
cefprozil ...................................... 14
cefuroxime axetil ........................ 14
Celebrex ....................................... 8
celecoxib....................................... 8
Centamin .................................... 58
Central Vite .....................46, 58, 67
Central Vite with Lutein ............. 58
Central-Vite ...............46, 53, 58, 67
Central-Vite Cardio .................... 58
Central-Vite Energy ................... 58
Central-Vite Men's Under 50 ..... 58
Central-Vite Performance........... 58
Central-Vite Select ................46, 59
Central-Vite Senior..................... 59
Central-Vite with Lycopene ....... 59
Central-Vite Women's Mature.... 59
Central-Vite Women's Under 50 67
Centram-Care ............................. 59
Centratex .................................... 53
Centravites .................................. 59
Centravites 50 Plus ..................... 46
Centrum ...................................... 59
Centrum Complete ..................... 67
Centrum Kids ............................. 70
Centrum Men.............................. 59
Centrum Silver ........................... 59
Centrum Silver Ultra Men's ........ 59
Centrum Silver Women .............. 59
Centrum Specialist Energy ......... 59
Centrum Specialist Heart............ 59
Centrum Ultra Men's .................. 59
Century ....................................... 67
130
Century Adults 50+ .................... 59
Century Cardio ........................... 59
Century Energy Metabolism....... 59
Century Mature........................... 59
Century Ultimate Men's.............. 59
Century Ultimate Women's .. 59, 67
Ceo-Two ................................... 100
cephalexin................................... 14
CeraLyte-70 ................................ 56
CeraSport .................................... 56
Cerefolin ..................................... 67
Cerefolin NAC (algal oil) ........... 74
Cerovite ...................................... 59
Cerovite Advanced Formula....... 67
Cerovite Jr .................................. 70
Cerovite Senior ........................... 46
Certa Plus ................................... 59
CertaVite Senior-Antioxidant..... 59
CertaVite-Antioxid (iron gluc) ... 59
Certavite-Antioxidant ................. 67
cetirizine ................................... 122
cetirizine-pseudoephedrine ....... 120
Chantix ....................................... 30
Chantix Continuing Month Box . 30
Chantix Starting Month Box ...... 30
Chemet........................................ 11
Cheratussin AC......................... 125
Chewable Multivit-A,B,D,E,K,Zn
................................................ 69
Chewable-Vite ...................... 67, 69
Chewable-Vite with Iron ............ 70
Child Aspirin ...................... 10, 104
Child Complete Multivitamin..... 70
Child Multivitamins ................... 69
Child Pain Rel-Fever Reducer ...... 5
Child Vitamin with Minerals ...... 71
Children's Acetaminophen ........... 5
Children's Aspirin ............... 10, 104
Children's Chew Multivit-Iron ... 71
Children's Chewable ................... 69
Children's Chewable Multivitmn 69
Children's Chewable Vitamin ..... 70
Children's Chewable w/Minerals 71
Children's Chewables ................. 70
Children's Chewables Extra C .... 70
Children's Chewables with Iron . 70
Children's Complete Vitamin ..... 71
Children's Fever Reducing ........... 5
Children's Ibuprofen ..................... 9
Children's Non-Aspirin................. 5
Children's Non-Aspirin Pain ........ 5
Children's Pain Relief ................... 5
Children's Pain Reliever................ 5
Children's Pain-Fever Relief ......... 5
Children's Pepto .......................... 85
Children's Profen IB...................... 9
Children's Q-PAP .......................... 5
Children's Silapap ......................... 5
Children's Soothe ........................ 85
Children's Tactinal ........................ 5
Children's Tylenol ......................... 5
Childs Chew Vite ........................ 70
Child's Chewable Vitamins/Iron . 71
Child's Fiber Select Gummies..... 92
Child's Vitamin with Iron ........... 71
Childs/Iron .................................. 71
chlorhexidine gluconate ............ 115
chloroquine phosphate ................ 12
chlorothiazide.............................. 27
chlorpheniramine maleate . 120, 121
chlorpropamide ........................... 79
chlorthalidone ............................. 27
chlorzoxazone ........................... 106
Chocolate Laxative ..................... 97
cholecalciferol (vitamin D3) . 75, 76
cholestyramine (with sugar) ........ 22
Cholestyramine Light.................. 22
choline,magnesium salicylate ..... 10
ciclopirox .................................... 38
cilostazol ................................... 104
cimetidine.................................... 89
Ciprodex.................................... 119
ciprofloxacin ............................... 14
ciprofloxacin HCl................ 14, 119
Citracal + Bone Density .............. 49
Citracal + D Maximum ............... 50
Citracal + D Petites ..................... 50
Citracal + D Slow Release .......... 50
Citracal + D3 (calcium phos) ...... 50
Citracal Chew ............................. 49
Citracal D + Heart Health ........... 49
Citracal Plus Magnesium ............ 49
Citracal Regular .......................... 50
Citrate of Magnesia ..................... 95
Citroma ....................................... 95
Citrucel........................................ 92
Citrucel (sucrose) ........................ 92
Citrucel Sugar Free ..................... 92
Citrus Calcium ............................ 50
Claravis ....................................... 36
clarithromycin ............................. 16
clemastine ......................... 120, 121
clindamycin HCl......................... 15
clindamycin palmitate HCl ......... 15
clindamycin phosphate ....... 37, 126
clindamycin-benzoyl peroxide ... 37
clobetasol .................................... 40
clonidine ..................................... 26
clonidine HCl ............................. 26
clopidogrel ........................ 104, 105
clotrimazole .................38, 114, 127
Clotrimazole 3 Day .................. 127
Clotrimazole-3 .......................... 127
Clotrimazole-7 .......................... 127
clotrimazole-betamethasone ....... 39
codeine sulfate .............................. 3
codeine-butalbital-ASA-caff ........ 4
codeine-guaifenesin .................. 125
COLACE Clear .......................... 99
colchicine ................................. 102
colchicine-probenecid .............. 102
Colestid....................................... 22
colestipol .................................... 23
Colox .......................................... 92
Col-Rite ...................................... 99
Combivent Respimat ................ 124
Comfort Gel................................ 86
Comfort Gel Extra Strength ....... 86
Compete ..................................... 59
Complete .................................... 60
Complete 50+ ............................. 59
Complete Formulation D3000 .... 70
Complete Formulation Multivit.. 70
Complete Formulation Pediatric 70
Complete Multi........................... 59
Complete Multi 50+ ................... 59
Complete Multivitamin .............. 59
Complete Multivitamin-Mineral 60,
67
Complete Premium Vitamin ....... 60
Complete Senior ....................46, 60
CompleteNate ............................. 72
Complex B-100 .....................43, 45
Complex B-50 ............................ 43
Compro ....................................... 88
Condoms-Prem Lubricated109, 111
Coral Calcium........................47, 49
Corlopam .................................... 27
Correctol ..................................... 97
Cortizone-10 ............................... 40
Corvita ........................................ 60
Corvita 150 ................................. 53
Corvite ........................................ 60
131
Corvite 150 ................................. 53
Corvite FE .................................. 53
Corvite Free ................................ 60
Covaryx H.S. .............................. 80
Creon .......................................... 89
cromolyn ................... 118, 123, 125
Cryselle (28) ............................... 32
Curity Alcohol Swabs ................ 20
Cyclafem 1/35 (28) ..................... 32
Cyclafem 7/7/7 (28).................... 35
cyclobenzaprine ........................ 106
cyclopentolate........................... 117
cyclophosphamide .................. 8, 17
cycloserine .................................. 13
cyclosporine.......................... 8, 105
cyclosporine modified .......... 8, 105
cyproheptadine ......................... 121
Cyto B7....................................... 75
Cytra K Crystals ....................... 101
Cytra-2 ...................................... 101
D
D3-2000 ...................................... 76
Daily Fiber .................................. 92
Daily Gummies........................... 60
Daily Multiple ...................... 60, 67
Daily Multiple For Men 50+ ...... 67
Daily Multiple For Women ........ 67
Daily Multiple For Women 50+ . 60
Daily Multivitamin ..................... 60
Daily Multi-Vitamin ................... 67
Daily Multivitamin with Iron ..... 67
Daily Multivitamin-Minerals 46, 60
Daily Multi-Vitamins/Iron.......... 60
Daily Value................................. 67
Daily Vitamin Formula .............. 67
Daily Vitamin Formula + Iron.... 67
DAILY VITAMIN FORMULAMINERALS............................ 60
Daily Vitamin with Iron ............. 60
Daily Vitamin with Iron and CA 60
Daily Vites/Iron .......................... 60
Daily-Vite ............................. 60, 67
danazol........................................ 81
dapsone ....................................... 12
Daraprim..................................... 12
Dasetta 1/35 (28) ........................ 32
Dasetta 7/7/7 (28) ....................... 35
Deblitane .................................... 34
Decubi Vite................................. 67
Deep Sea Nasal ......................... 126
Delta D3 ..................................... 76
Delzicol ....................................... 91
Denta 5000 Plus ........................ 114
DentaGel ................................... 114
desmopressin ............................... 78
desog-e.estradiol/e.estradiol ........ 31
desogestrel-ethinyl estradiol ....... 32
Dewee's Carminative .................. 87
Dex4 Glucose .............................. 77
dexamethasone ............................ 81
dexamethasone sodium phosphate
.............................................. 117
dextrose ....................................... 77
Diabetes Health ........................... 60
Diabetes Health Formula ............ 60
Diabetes Health Pack .................. 60
Diabetes Health Support ............. 67
Diabetic Support Formula ........... 45
Dialyvite................................ 43, 45
DIALYVITE 3000 ...................... 43
Dialyvite 5000............................. 60
DIALYVITE 800 ........................ 43
Dialyvite 800 Plus D ................... 43
DIALYVITE 800 with Iron ........ 67
Dialyvite 800 with Zinc 15 ......... 43
Dialyvite 800 with Zinc 50 ......... 43
Dialyvite 800-Ultra D ................. 43
Dialyvite Supreme D................... 43
Dialyvite Vitamin D.................... 76
Dialyvite Vitamin D3 Max ......... 76
Diamode ...................................... 87
Diarrhea Relief (bismuth subs) ... 87
diclofenac sodium ........... 9, 39, 117
dicloxacillin ................................ 16
dicyclomine ................................. 91
digoxin ........................................ 26
diltiazem HCl ........................ 24, 25
dimenhydrinate ........................... 88
Dino-Life .................................... 70
Dino-Life with Extra C ............... 70
Dino-Life with Iron-Zinc ............ 71
Diocto.......................................... 99
Dioctyl ........................................ 99
Diotame ....................................... 87
Dipentum .................................... 92
diphenhydramine HCl . 30, 120, 121
diphenoxylate-atropine ............... 88
dipyridamole ............................. 105
disopyramide phosphate.............. 22
Doc-Q-Lax .................................. 98
Docu ............................................ 99
Docuprene ................................... 99
docusate calcium ........................ 99
docusate sodium ......................... 99
Docusil ....................................... 99
Docusol....................................... 99
DocuSol Kids ............................. 99
DocuSol Plus .............................. 99
DOK ........................................... 99
DOK Plus ................................... 98
donepezil .................................... 31
dorzolamide .............................. 118
dorzolamide-timolol ......... 117, 118
doxazosin .................................... 28
doxercalciferol .......................... 114
doxycycline hyclate ............ 16, 115
doxycycline monohydrate .......... 16
dronabinol................................... 88
drospirenone-ethinyl estradiol .... 32
Droxia ....................................... 105
Ducodyl ...................................... 97
Dulcolax Stool Softener (DSS) .. 99
Dulera ....................................... 124
Duofer......................................... 53
D-Vita ......................................... 76
E
E.C. Prin ............................. 10, 104
E.E.S. Granules .......................... 16
E-400 C-500 and Beta Carotene .. 2,
67
Easy Comfort Insulin Syringe . 108,
111
Easy Fiber ................................... 92
Easy Fiber (wheat dextrin) ......... 92
Easy Touch ....................... 108, 111
Easy Touch Insulin Syringe .... 108,
111
ECee Plus ................................... 60
econazole .................................... 38
Ecotrin Low Strength ......... 10, 104
Ed-APAP ...................................... 5
Eldercaps .................................... 60
Elidel .......................................... 39
Elinest ......................................... 32
Eliquis....................................... 103
Elmiron ..................................... 100
Emcyt ......................................... 18
enalapril maleate......................... 20
enalapril-hydrochlorothiazide .... 20
Enbrel ........................................... 7
Enbrel SureClick .......................... 7
Endocet ......................................... 4
Enema ......................................... 96
132
Enema Disposable ...................... 96
Enemeez ..................................... 99
Enemeez Plus ............................. 99
enoxaparin ........................ 103, 104
Enpresse...................................... 35
Enskyce ...................................... 32
entecavir ..................................... 15
Enteric Coated Aspirin ....... 10, 104
Epaned ........................................ 20
epinephrine ................................. 26
EpiPen 2-Pak .............................. 26
EpiPen Jr 2-Pak .......................... 26
Epogen ...................................... 103
Epsom Salt.................................. 95
Equalactin ................................... 92
ergocalciferol (vitamin D2) ........ 76
Erivedge...................................... 18
Errin ............................................ 35
erythromycin ...................... 16, 119
erythromycin ethylsuccinate ....... 16
erythromycin with ethanol.......... 37
erythromycin-benzoyl peroxide.. 37
Esgic ............................................. 7
Essentia....................................... 67
ESSENTIAL Balance with Lutein
.......................................... 60, 67
ESSENTIAL Daily ..................... 60
ESSENTIAL Man ...................... 60
ESSENTIAL Man 50+ ............... 60
Essential Woman 50+ ................. 60
Estarylla ...................................... 32
Estrace ...................................... 127
estradiol ...................................... 80
estradiol-norethindrone acet ....... 80
estrogens-methyltestosterone ..... 80
estropipate .................................. 80
ethambutol .................................. 13
etidronate disodium .................... 80
etoposide..................................... 18
exemestane ................................. 18
Ex-Lax (sennosides) ................... 97
Ex-Lax Maximum Strength ........ 97
Eye Allergy Relief .................... 117
EZFE 200 ................................... 51
E-Z-Gas II................................... 86
F
FaBB..................................... 74, 77
Fallback Solo .............................. 36
Falmina (28) ............................... 32
famciclovir.................................. 15
famotidine................................... 89
Fareston....................................... 19
Farxiga ........................................ 78
Farydak ....................................... 18
Fatigue Relief Complex .............. 43
FC2 Female Condom ........ 106, 111
FE C ............................................ 53
FE C Plus .................................... 51
felodipine .................................... 25
Fem-Cal Citrate........................... 49
Femcon Fe................................... 32
fenofibrate ................................... 23
fenofibrate micronized ................ 23
fenofibrate nanocrystallized ........ 23
fenofibric acid ............................. 23
fenofibric acid (choline) .............. 23
fenoprofen ..................................... 9
fentanyl ......................................... 3
Feosol .......................................... 51
Feosol Bifera ............................... 53
Feraheme ..................................... 51
Fer-Iron ....................................... 51
FeRiva ......................................... 53
Feriva 21-7 Tablet ....................... 53
FeRiva FA (Sumalate) ................ 53
Ferocon ....................................... 53
FeroSul ........................................ 51
Ferractiv ...................................... 53
Ferralet 90 Dual-Iron Delivery ... 53
FerraPlus 90 ................................ 53
Ferretts ........................................ 51
Ferretts Carbonyl Iron ................. 51
Ferretts IPS ................................. 51
Ferrex 150 ................................... 51
Ferrex 150 Forte.......................... 53
Ferrex 150 Forte Plus .................. 53
Ferrex 150 Plus ........................... 53
Ferrex 28 ..................................... 54
Ferrimin 150 ............................... 51
Ferrocite ...................................... 51
Ferrocite Plus .............................. 54
Ferrogels Forte ............................ 54
ferrous fumarate .......................... 51
ferrous gluconate......................... 51
ferrous sulfate ....................... 51, 52
FerrouSul .................................... 52
Fever Reducer ............................... 5
Fever Reducer an Pain Reliever .... 5
Feverall ......................................... 5
fexofenadine.............................. 122
fiber ............................................. 92
Fiber (calcium polycarbophil)..... 92
Fiber (dextrin)............................. 92
Fiber (psyllium husk) ................. 92
Fiber (psyllium husk/sugar)........ 92
Fiber (with aspartame)................ 93
Fiber Choice (inulin) .................. 93
Fiber Gummies (with chromium) 93
Fiber Laxative (ca polycarbo) .... 93
Fiber Laxative (methylcellulo) ... 93
Fiber Laxative (psyllium husk) .. 93
Fiber Select Gummies ................ 93
Fiber Smooth (sucrose) .............. 93
Fiber Supplement (inulin) .......... 93
Fiber Therapy (ca polycarboph) . 93
Fiber Therapy (m-cell/sugar)...... 93
Fiber Therapy (m-cellulose) ....... 93
Fiber Therapy (psyllium seed).... 93
Fiber Therapy (psyllium)............ 93
Fiber Therapy Laxative (husk) ... 93
Fiber With Probiotic ................... 93
Fiber-Caps (psyllium husk) ........ 93
FiberCon ..................................... 93
Fiber-Lax .................................... 93
Fiber-Stat .................................... 93
Fiber-Tabs .................................. 93
finasteride ................................. 101
Fine 30 Universal Lancets 107, 111
First Choice Lancets Thin 107, 111
Flanax Antacid ........................... 86
Flarex ........................................ 117
flavoxate ................................... 102
flecainide .................................... 22
Fleet Bisacodyl ........................... 97
Fleet Enema ................................ 96
Fleet Enema Extra ...................... 96
Fleet Glycerin (Adult) ................ 95
Fleet Glycerin (Child) ................ 95
Fleet Glycerin Laxative .............. 95
Fleet Laxative ............................. 97
Fleet Pediatric ............................. 96
Flintstones Bone Support ........... 50
Flintstones Complete (iron) ........ 71
Flintstones Gummies .................. 70
Flintstones Gummies Omega-3 .. 70
Flintstones Multivitamin ............ 70
Flintstones Plus Calcium ............ 71
Flintstones with Iron ................... 71
Flintstones/Extra C ..................... 70
Flonase Allergy Relief.............. 125
Flovent Diskus.......................... 122
Flovent HFA ............................. 122
Flublok 2015-2016 (PF) ............. 20
133
Flucelvax 2015-2016 (PF) .......... 20
fluconazole ................................. 12
fludrocortisone...................... 82, 83
flunisolide ................................. 125
fluocinonide ................................ 40
Fluocinonide-E ........................... 40
Fluoridex Daily Defense........... 114
Fluoritab ................................... 114
fluorometholone ....................... 117
fluorouracil ................................. 39
flurbiprofen ................................... 9
flurbiprofen sodium .................. 117
flutamide..................................... 17
fluticasone ................................ 125
fluvastatin ................................... 23
FML Forte ................................ 117
FML S.O.P. .............................. 117
Foaming Antacid .................. 83, 84
Focalgin DSS.............................. 54
Folbecal ...................................... 72
Folbee ................................... 74, 77
Folbee AR................................... 43
Folbee Plus ................................. 43
Folbic .................................... 74, 77
Folbic RF .................................... 74
Folgard........................................ 45
Folgard OS ................................. 49
Folgard RX ........................... 74, 77
folic acid ..................................... 77
Folinic-Plus ................................ 74
Folitab......................................... 54
Folivane-F .................................. 54
Folivane-Plus .............................. 54
Folplex 2.2 ............................ 74, 77
Foltabs 800 ................................. 74
Foltanx ........................................ 74
Foltanx RF .................................. 74
Foltx ........................................... 74
fondaparinux............................. 103
Foradil Aerolizer ...................... 123
Fortavit ....................................... 67
Forteo.......................................... 80
Fosfree ........................................ 61
fosinopril .................................... 20
Fosrenol .................................... 100
Freedavite ................................... 61
furosemide .................................. 27
Fusion ......................................... 54
Fusion Plus ................................. 54
G
galantamine ................................ 31
Gas Relief ................................... 90
Gas Relief 80 .............................. 90
Gas Relief Extra Strength ........... 90
Gas-X .......................................... 90
Gas-X Extra Strength .................. 90
Gavilyte-C ................................... 96
GaviLyte-G ................................. 96
GaviLyte-H and Bisacodyl ......... 98
GaviLyte-N ................................. 96
Gaviscon ..................................... 84
Gaviscon Extra Strength ............. 84
Gelusil Antacid and Anti-Gas ..... 86
gemfibrozil .................................. 23
Generess Fe ................................. 32
gentamicin ........................... 37, 118
Gentle Laxative ........................... 97
Geri-kot ....................................... 97
Geri-Lanta ................................... 86
Geri-Mox Antacid-Antigas ......... 86
Geri-Mucil .................................. 93
Gianvi (28) .................................. 32
Gildagia....................................... 32
Gildess 1.5/30 (21) ...................... 32
Gildess 1/20 (21) ......................... 32
Gildess 24 Fe .............................. 32
Gildess FE 1.5/30 (28) ................ 32
Gildess FE 1/20 (28) ................... 32
Gilenya ...................................... 115
Glatopa ...................................... 115
glimepiride .................................. 79
glipizide ...................................... 79
glipizide-metformin .................... 78
GlucaGen HypoKit ..................... 77
Glucagon Emergency Kit (human)
................................................ 77
glucose ........................................ 77
Glucose Gel................................. 77
Glucoten ........................................ 2
glyburide ..................................... 79
glyburide micronized .................. 79
glyburide-metformin ............. 78, 79
glycerin (adult) ............................ 95
glycerin (child) ............................ 95
Glycophos ................................... 56
glycopyrrolate ............................. 91
Golytely ...................................... 96
granisetron HCl ........................... 89
griseofulvin microsize ................. 12
griseofulvin ultramicrosize ......... 12
guanfacine ................................... 26
Gyne-Lotrimin .......................... 127
Gynol II ...................................... 36
H
Hair Vitamins ............................. 61
Hair, Skin and Nails-Argan Oil .. 61
Hair,Skin and Nails ...............46, 61
Hair,Skin and Nails(FA-biotin) .. 61
halobetasol propionate ................ 40
Hard Nail .................................... 75
Healthy Eyes............................2, 61
Healthy Eyes SuperVision.......2, 61
Hearing Aid Batteries ....... 107, 111
Heartburn and Acid Reflux-Aloe 61
Heartburn Antacid ...................... 84
Heartburn Prevention ................. 89
Heartburn Relief ......................... 84
Heartburn Relief (cimetidine)..... 89
Heartburn Relief (famotidine) .... 89
Heartburn Relief (ranitidine) ...... 89
Heather ....................................... 35
Hemangeol ................................. 24
Hematinic Plus Vit/Minerals ...... 54
Hematinic/Folic Acid ................. 54
Hematogen ................................. 54
Hematogen FA ........................... 54
Hematogen Forte ........................ 54
Hematron .................................... 54
Hemax ........................................ 54
HemeNatal OB ........................... 72
HemeTab .................................... 54
Hemmorex-HC ........................... 11
Hemocyte ................................... 52
Hemocyte-Plus ........................... 54
heparin (porcine) ...................... 103
Hexalen....................................... 17
Hi-B Complex ............................ 45
Hi-Cal Plus Vit D ....................... 50
High Potency Iron ...................... 52
homatropine HBr ...................... 117
Homocysteine Formula .............. 74
Honey Bears with Iron-Zinc ....... 71
Humalog ..................................... 82
Humalog KwikPen ..................... 82
Humalog Mix 50-50 ..............81, 82
Humalog Mix 50-50 KwikPen ... 82
Humalog Mix 75-25 ................... 82
Humalog Mix 75-25 KwikPen ... 82
Humira .....................................7, 92
Humira Pediatric Crohn's Start 7, 92
Humira Pen ................................... 7
Humira Pen Crohn's-UC-HS Start 7
Humira Pen Psoriasis Starter ........ 7
134
Humulin 70/30............................ 81
Humulin 70/30 KwikPen ............ 81
Humulin N .................................. 81
Humulin N KwikPen .................. 81
Humulin R .................................. 81
Humulin R U-500 (Concentrated)
................................................ 81
Hycamtin .................................... 19
hydralazine ................................. 26
hydrochlorothiazide .................... 27
Hydrocil Instant .......................... 93
Hydrocodone Compound.......... 125
hydrocodone-acetaminophen ........ 4
hydrocodone-homatropine........ 125
hydrocodone-ibuprofen ................ 4
hydrocortisone .................40, 81, 92
hydrocortisone acetate .......... 11, 40
hydrocortisone valerate .............. 40
hydrocortisone-acetic acid ........ 120
hydrocortisone-pramoxine.......... 11
hydromorphone ............................ 3
hydroxychloroquine................ 8, 12
hydroxyurea ................................ 18
hydroxyzine HCl ........................ 28
hydroxyzine pamoate ................. 28
HyFiber with FOS ...................... 93
hyoscyamine sulfate ................... 91
I
I.L.X. B-12 ................................. 54
ibandronate ................................. 80
Ibu-Drops...................................... 9
ibuprofen ...................................... 9
Ibuprofen IB ................................. 9
Ibuprofen Jr Strength .................... 9
ICaps........................................... 61
I-Caps ......................................... 61
I-Caps ......................................... 61
I-Caps ......................................... 61
ICaps AREDS......................... 2, 61
Icaps MV .................................... 61
Icaps Plus.................................... 61
Icar .............................................. 52
Icar-C .......................................... 54
iFerex 150 ................................... 52
iFerex 150 Forte ......................... 54
imiquimod .................................. 41
iNatal Advance ........................... 72
iNatal Ultra ................................. 72
inControl Pen Needle ....... 108, 112
inControl Super Thin Lancets . 107,
112
inControl Ultra Thin Lancets ... 107,
112
Increlex ....................................... 82
Incruse Ellipta ........................... 123
indapamide .................................. 27
indomethacin ............................... 10
Infant Fever Reducer-Pain Relf .... 5
Infant Pain Reliever ...................... 5
Infants Gas Relief ....................... 90
Infant's Ibuprofen .......................... 9
Infant's Non-Aspirin ..................... 6
Infants' Pain and Fever .................. 6
Infants' Pain Relief ........................ 6
Infant's Pain Relief ........................ 6
Infed ............................................ 52
Infuvite Adult .............................. 67
Injectafer ..................................... 52
insulin syringe-needle U-100 ... 108,
112
insulin syringes (disposable) .... 108,
112
Integra ......................................... 54
Integra F ...................................... 54
Integra Plus ................................. 54
Intron A ....................................... 18
Introvale ...................................... 32
Invokamet ................................... 78
Invokana...................................... 78
ipratropium bromide ......... 123, 125
ipratropium-albuterol ................ 124
irbesartan ..................................... 21
irbesartan-hydrochlorothiazide ... 21
iron .............................................. 52
Iron (dried) .................................. 52
Iron 100 Plus ............................... 52
Iron 21/7 ...................................... 54
Iron Chews .................................. 52
Iron High Potency ....................... 52
Iron with Stool Softener .............. 54
IronUp ......................................... 52
iron-vitamin C ............................. 54
Iro-Plex (iron carbonyl) .............. 54
Iro-Plex (iron polysaccharide) .... 54
Irospan 24/6 ................................ 54
isometh-dichloral-acetaminophn. 29
isoniazid ...................................... 13
isosorbide dinitrate ...................... 21
isosorbide mononitrate ................ 21
isradipine..................................... 25
itraconazole ................................. 12
I-Vite ....................................... 2, 61
I-Vite Protect ...........................2, 61
J
Jakafi .......................................... 18
Janumet....................................... 79
Janumet XR ................................ 79
Januvia ........................................ 78
Jencycla ...................................... 35
Jentadueto ................................... 79
Jinteli .......................................... 80
Jock Itch (terbinafine) ................ 38
Jolessa......................................... 32
Jolivette ...................................... 35
Junel 1.5/30 (21) ......................... 32
Junel 1/20 (21) ............................ 32
Junel FE 1.5/30 (28) ................... 32
Junel FE 1/20 (28) ...................... 32
K
Kaopectate (bismuth subsalicy) .. 87
Kaopectate Ex Str (bismuth ss) .. 87
Kao-Tin (bismuth subsalicylat) .. 87
Kao-Tin (docusate calcium) ....... 99
Kariva (28) ................................. 31
Kelnor 1/35 (28) ......................... 32
Kelp-Lecithin-B6.......................2, 3
ketoconazole ..........................12, 38
Ketone Care .............................. 112
Ketone Urine Test .................... 112
ketoprofen..................................... 9
ketorolac ................................8, 117
Ketostix .................................... 112
ketotifen fumarate..................... 117
Kimono Condoms(Non-lubricated)
...................................... 109, 112
Kimono Maxx Condoms .. 109, 112
Kimono MicroThin Aqua Lube
Con ............................... 109, 112
Kimono MicroThin Condoms . 109,
112
Kimono MicroThin Large
Condoms....................... 109, 112
Kimono Textured Condoms .... 109,
112
Kionex ........................................ 46
Kondremul .................................. 95
Konsyl (sugar) ............................ 93
Konsyl Balance........................... 93
Konsyl Easy Mix ........................ 93
Konsyl Fiber ............................... 93
Konsyl Formula-D ...................... 93
Konsyl Sugar-Free...................... 94
Konsyl Sugar-Free (aspartame) .. 93
135
K-PAX ........................................ 61
K-Pax Immune Support .............. 61
K-Pec Antidiarrheal (bism sub) .. 87
K-Phos No 2 ............................. 101
K-Phos Original ........................ 101
KPN ............................................ 72
Kristalose .................................... 95
Kurvelo ....................................... 32
L
labetalol ...................................... 21
lactulose ................................ 89, 95
lamivudine .................................. 15
lansoprazole ................................ 90
Lantus ......................................... 82
Lantus Solostar ........................... 82
Larin 1.5/30 (21)......................... 33
Larin 1/20 (21)............................ 33
Larin Fe 1.5/30 (28).................... 33
Larin Fe 1/20 (28)....................... 33
latanoprost ................................ 119
Lax Stool Softener With Senna .. 98
Laxacin ....................................... 98
Laxative (bisacodyl) ................... 97
Laxative (glycerin-pediatric) ...... 95
Laxative (sennosides) ................. 97
Laxative Dietary Supplement ..... 55
Laxative Feminine ...................... 97
Laxative Maximum Strength ...... 97
Laxative Pills .............................. 97
Laxative Pills Regular ................ 97
Laxative Plus Stool Softener ...... 98
Layolis Fe ................................... 33
Lecithin-Kelp-B6.......................... 3
Leena 28 ..................................... 35
leflunomide................................... 8
Lessina ........................................ 33
Letairis ........................................ 28
letrozole ...................................... 18
leucovorin calcium ..................... 19
Leukeran ..................................... 17
leuprolide .................................... 18
levobunolol ............................... 118
levofloxacin ........................ 14, 119
levomefol-B6-meB12-algal oil... 74
Levonest (28) .............................. 35
levonorgestrel-ethinyl estrad ...... 33
Levora-28 ................................... 33
levothyroxine .............................. 83
Lice Killing................................. 41
lidocaine ..................................... 41
lidocaine HCl .............................. 41
Lidocaine Viscous..................... 115
lidocaine-prilocaine..................... 41
Lidocream ................................... 41
Life-Pack Men's .......................... 61
Life-Pack Women's ..................... 61
lindane................................... 41, 42
linezolid ...................................... 16
liothyronine ................................. 83
LiquaFiber ................................... 94
Liquid Antacid ............................ 86
Liquid Calcium with Vitamin D . 50
Liqui-E ........................................ 76
lisinopril ...................................... 21
lisinopril-hydrochlorothiazide..... 20
Lite Coat Aspirin ................ 10, 104
Little Remedies ......................... 126
Little Remedies Fever and Pain .... 6
Liver with Iron ............................ 54
Lmefol Ca-acetyl-meB12-algal .. 74
L-Methyl-B6-B12 ....................... 74
L-Methylfolate Ca P-5-P Me-Cbl74
L-Methyl-MC.............................. 68
L-Methyl-MC NAC ...................... 3
LMTHF-PyridoxineCyanocobalamn ...................... 74
Lo Loestrin Fe ............................. 31
LoCalnesium ............................... 49
LoCalnesium-C ........................... 49
Lo-Dose Aspirin ................. 10, 104
Loestrin 1/20 (21) ....................... 33
Lomedia 24 Fe ............................ 33
loperamide .................................. 87
loratadine .................................. 122
Loratadine-D ............................. 120
Loryna (28) ................................. 33
losartan ........................................ 21
losartan-hydrochlorothiazide ...... 21
lovastatin ..................................... 23
Low-Ogestrel (28)....................... 33
Lubricant Eye Drops ................. 116
Lubricant Eye Drops (glyc-pg) . 116
Lubricant Eye(dextran70-hypml)
.............................................. 116
Lutera (28) .................................. 33
Lydia Pinkham Herbal ................ 55
Lysiplex Plus............................... 43
Lysodren ..................................... 17
M
M.V.I. Adult................................ 68
Maalox Advanced ....................... 86
Maalox Maximum Strength ........ 86
Macular Vitamin......................... 61
Macuvite Eye Care ..................... 61
Macuvite With Lutein .................. 2
Mag 64........................................ 55
Mag Glycinate ............................ 55
MAG-AL .................................... 84
Mag-Al Plus ............................... 86
Mag-Al Plus Extra Strength ....... 86
MagBid ER ................................. 55
Mag-Delay .................................. 55
Mag-G ........................................ 55
Maginex ...................................... 55
Maglox ....................................... 86
MagneBind 300 ........................ 100
MagneBind 400 ........................ 100
magnesium ................................. 55
Magnesium (oxide/AA chelate) . 55
magnesium amino acid chelate... 55
magnesium chloride ..............55, 56
magnesium citrate..................56, 95
magnesium gluconate ................. 56
magnesium oxide........................ 56
magnesium sulfate ...................... 56
magnesium sulfate in D5W ........ 56
magnesium sulfate in water ........ 56
Magonate (magnesium carb) ...... 56
MagOx ........................................ 56
Magtab ........................................ 56
malathion .................................... 42
Mapap (acetaminophen) ............... 6
Mapap Arthritis Pain .................... 6
Mapap Extra Strength ................... 6
Margesic ....................................... 7
Marlissa ...................................... 33
Marten-Tab ................................... 7
Masanti Double Strength ............ 86
Matulane ..................................... 17
Maxaron Forte ............................ 55
MaxFe (folate-docusate)............. 55
Maximin Pack............................. 61
MAXIMUM DAILY GREEN.... 61
Maximum Daily Multivitamin ... 61
meclizine .................................... 88
Medi-Laxx .................................. 98
Mediproxen .................................. 9
medroxyprogesterone ............31, 83
Medtycholl-B Complex-Liver .... 43
mefloquine .................................. 13
Mega Biotin ................................ 75
Mega Multi for Women .............. 61
Mega Multiple/Chelated Mineral 61
136
Mega Multivitamin For Men ...... 61
Mega Multivitamin with Mineral 61
Megavite ..................................... 46
Megavite Golden Years 55+....... 46
megestrol .............................. 19, 42
meloxicam .................................... 8
memantine .................................. 31
Memory Complex......................... 3
Menest ........................................ 80
Men's Biomultiple ...................... 61
Men's Daily ................................ 62
Men's Daily Multivit-Mineral .... 62
Men's Multi-Vitamin .................. 68
Men's Multivitamin Gummies .... 62
Men's One Daily ......................... 62
Men's Pack.................................. 62
Mens Potent Formula ................... 3
meperidine .................................... 3
mercaptopurine ........................... 17
Meribin ....................................... 75
mesalamine ................................. 92
Mesnex ....................................... 19
Metafolbic .................................. 68
Metafolbic Plus............................. 3
Metafolbic Plus RF ..................... 74
Metamucil ................................... 94
Metamucil (with sugar) .............. 94
Metamucil Fiber Singles............. 94
Metamucil MultiHealth Fiber ..... 94
Metamucil Plus Calcium ............ 94
Metamucil Sugar-Free (aspart) ... 94
Metanx (algal oil) ....................... 74
metaproterenol .......................... 124
metformin ................................... 82
methadone .................................... 3
methazolamide............................ 27
methenamine hippurate .... 101, 102
methenamine mandelate ........... 102
methimazole ............................... 79
methocarbamol ......................... 106
methotrexate sodium .............. 8, 17
methyclothiazide ........................ 27
methyldopa ................................. 26
methyldopa-hydrochlorothiazide 26
methylergonovine ....................... 83
methylprednisolone .................... 81
metipranolol.............................. 118
metoclopramide HCl .................. 91
metolazone.................................. 27
metoprolol succinate................... 24
metoprolol ta-hydrochlorothiaz .. 26
metoprolol tartrate....................... 24
metronidazole................ 13, 37, 127
mexiletine.................................... 22
Mg-Plus-Protein ............................ 3
Mi-Acid ................................. 84, 86
Mi-Acid Gas Relief ..................... 90
Miconazole 7............................. 127
miconazole nitrate ............... 38, 127
Miconazole-3 ............................ 127
Miconazole-3 prefil,cream,wipe127
Micro Thin Lancets ........... 107, 112
Microgestin 1.5/30 (21) .............. 33
Microgestin 1/20 (21) ................. 33
Microgestin Fe 1.5/30 (28) ......... 33
Microgestin FE 1/20 (28) ............ 33
midodrine .................................... 26
Milk of Magnesia ........................ 95
Milk Of Magnesia Concentrated . 95
Milltrium Senior ......................... 46
Minastrin 24 Fe ........................... 33
mineral oil ................................... 95
Mineral Oil Extra Heavy ............. 95
Mineral Oil Heavy ...................... 95
Mineral Oil Laxative ................... 95
minocycline ............................. 8, 16
minoxidil ..................................... 26
Mintox......................................... 86
Mintox Maximum Strength......... 87
Mintox Plus ................................. 87
misoprostol.................................. 90
Modicon (28) .............................. 33
mometasone .......................... 40, 41
Monistat 3 ................................. 127
Monistat 7 ................................. 127
Monocaps .................................... 62
Mono-Linyah .............................. 33
Mononessa (28)........................... 33
montelukast ............................... 123
morphine ....................................... 3
morphine concentrate .................... 3
Motrin IB ...................................... 9
MoviPrep .................................... 96
moxifloxacin ............................... 14
Multi Complete with Iron ........... 68
Multi For Her .............................. 62
Multi Vitamin ............................. 62
Multi-Betic .............................. 2, 62
Multi-Day with Iron .................... 68
Multi-Delyn ................................ 68
Multi-Delyn with Iron ................. 62
Multigen ...................................... 55
Multigen Folic ............................ 55
Multigen Plus ............................. 55
Multilex ...................................... 62
Multilex-T and M ....................... 62
Multiple Vitamin, Womens ........ 62
Multiple Vitamin-Minerals......... 62
Multiple Vitamins....................... 68
multivitamin ............................... 68
Multivitamin 50 Plus .................. 46
Multi-Vitamin HP/Minerals ....... 62
Multi-Vitamin With Fluoride ..... 71
multivitamin with iron ................ 62
multivitamin with minerals ...47, 62
Multivitamins With Fluoride ...... 71
Multi-Vite ................................... 68
Multi-Vite 50 and Over .............. 47
mupirocin ................................... 37
Mvc-Fluoride .............................. 71
M-Vit .......................................... 72
mv-min-folic acid-lutein............. 62
My Favorite Multiple ................. 68
My Way ...................................... 36
mycophenolate mofetil ..........8, 105
mycophenolate sodium ............. 105
Myferon 150 ............................... 52
MyKidz Iron ..........................52, 71
Myleran ...................................... 17
Mynatal....................................... 72
Mynatal Advance ....................... 72
Mynatal Plus ............................... 72
Mynatal-Z ................................... 72
Mynate 90 Plus ........................... 72
Myorisan..................................... 36
Mytab Gas .................................. 91
Mytab Gas Maximum Strength .. 91
My-Vitalife ................................. 62
Myzilra ....................................... 35
N
nabumetone .................................. 8
nadolol ........................................ 24
naphazoline............................... 118
naproxen ....................................... 9
naproxen sodium .......................... 9
naratriptan................................... 29
Nasacort .................................... 125
Nasal Decongestant (pseudoeph)
.............................................. 126
Nasal Moisturizing ................... 126
Nasal Spray (sodium chloride) . 126
Nasalcrom................................. 125
nateglinide .................................. 78
137
Natural B-100 ............................. 45
Natural B-100 Complex ............. 43
Natural Daily Fiber ..................... 94
Natural Fiber Laxative ................ 94
Natural Fiber Laxative (sugar) ... 94
Natural Fiber Laxative Smooth .. 94
Natural Fiber Laxative Therapy . 94
Natural Fiber Laxative(aspart) ... 94
Natural Fiber Supplement........... 94
Natural Laxative ......................... 97
Natural Psyllium Fiber ............... 94
Natural Senna Laxative .............. 97
Natural Tears (PF) .................... 116
Natural Veg Laxative(sennosid) . 97
Natural Vegetable ....................... 94
Natural Vegetable (psyllium) ..... 94
Natural Vegetable Laxative ........ 97
Natural Vegetable Powder .......... 94
Nature-Throid ............................. 83
Necon 0.5/35 (28) ....................... 33
Necon 1/35 (28) .......................... 33
Necon 1/50 (28) .......................... 33
Necon 10/11 (28) ........................ 31
Necon 7/7/7 (28) ......................... 35
neomycin .................................... 11
neomycin-bacitracin-poly-HC .. 116
neomycin-bacitracin-polymyxin118
neomycin-polymyxin B-dexameth
.............................................. 116
neomycin-polymyxin-gramicidin
.............................................. 118
neomycin-polymyxin-HC . 116, 120
Neo-Polycin HC ....................... 116
Neosporin Plus PainRelief(bac) . 38
Nephplex Rx ............................... 45
Nephrocaps Qt ............................ 43
Nephron FA ................................ 55
Nephronex .................................. 43
Nephronex-SL ............................ 43
Nestabs ....................................... 72
Nestabs DHA .............................. 72
Neupogen.................................. 103
NewGen ...................................... 72
Nexium 24HR............................. 90
Next Choice One Dose ............... 36
niacin .................................... 23, 75
niacin (inositol niacinate) ........... 75
niacinamide ................................ 75
Niacin-Aze AC-Turmer-FA-B6-ZN
................................................ 46
Nicadan....................................... 46
nicardipine .................................. 25
Nicazel ........................................ 46
NicAzel Forte .............................. 46
Nicomide ..................................... 62
Nicomide (selenium-chromium) . 62
Nicorelief .................................... 30
nicotine........................................ 30
nicotine (polacrilex) .................... 30
Nicotrol ....................................... 30
Nicotrol NS ................................. 30
Nifedical XL ............................... 25
nifedipine .................................... 25
Nikki (28) .................................... 33
Nilandron .................................... 17
nimodipine .................................. 25
Nitro-Bid ..................................... 21
nitrofurantoin ............................ 102
nitrofurantoin macrocrystal ....... 102
nitrofurantoin monohyd/m-cryst
.............................................. 102
nitroglycerin ................................ 22
Nitrolingual ................................. 22
Nitrostat ...................................... 22
Nitro-Time .................................. 22
Niva-Fol ................................ 74, 77
Non-Aspirin .................................. 6
Non-Aspirin Children's ................. 6
Non-Aspirin Extra Strength .......... 6
Non-Aspirin Pain Relief ............... 6
Nora-BE ...................................... 35
Norditropin FlexPro .................... 81
noreth-ethinyl estradiol-iron ....... 33
norethindrone (contraceptive) ..... 35
norethindrone acetate .................. 83
norethindrone ac-eth estradiol.... 33,
80
norethindrone-e.estradiol-iron .... 33
norgestimate-ethinyl estradiol .... 34,
35
norgestrel-ethinyl estradiol ......... 34
Norinyl 1+50 (28) ....................... 34
Norlyroc ...................................... 35
Nortemp ........................................ 6
Nortrel 0.5/35 (28) ...................... 34
Nortrel 1/35 (21) ......................... 34
Nortrel 7/7/7 (28) ........................ 35
Nova Safety Lancets ......... 107, 112
Nova Sureflex Lancets ...... 107, 112
NovaFerrum ................................ 52
NovaFerrum 125 ......................... 52
NovaFerrum 50 ........................... 52
NovaFerrum Pediatric ................ 71
NovoFine 30 ..................... 108, 112
Novofine 32 ...................... 108, 112
Novofine Autocover ......... 108, 112
Novolin 70/30 ............................. 81
Novolin N ................................... 81
Novolin R ................................... 81
Novolog ...................................... 82
Novolog Flexpen ........................ 82
Novolog Mix 70-30 .................... 82
Novolog Mix 70-30 FlexPen ...... 82
Novolog PenFill ......................... 82
NP Thyroid ................................. 83
NTS Step 1 ................................. 30
Nu-Iron ....................................... 52
Nutricap ...................................... 62
Nutrisource Fiber ........................ 94
Nutrivit ....................................... 43
NuvaRing ................................... 36
nystatin ..........................12, 38, 115
nystatin-triamcinolone ................ 39
O
OB Complete .............................. 55
Obstetrix DHA ........................... 72
Obstetrix EC ............................... 72
Obtrex DHA ............................... 72
O-Cal FA .................................... 72
Ocean for Kids.......................... 126
Ocean Nasal.............................. 126
Ocella ......................................... 34
octreotide acetate ................ 83, 100
Ocutabs ....................................... 62
Ocuvite ....................................2, 62
Ocuvite Lutein and Zeaxanthin .... 2
Ocuvite with Lutein .................2, 62
ofloxacin ......................14, 119, 120
Ogestrel (28) ............................... 34
omega-3 acid ethyl esters ........... 23
omeprazole ................................. 90
omeprazole magnesium .............. 90
Omnicap ..................................... 62
Once Daily.................................. 68
Oncovite ..................................... 68
ondansetron ................................ 89
ondansetron HCl ......................... 89
One Daily ........................46, 63, 68
One Daily Calcium/Iron ............. 62
One Daily Complete ................... 62
One Daily Energy ..................62, 68
One Daily Essential ...............62, 68
One Daily For Men..................... 62
138
One Daily For Men 50+ Advanced
................................................ 68
One Daily For Women ............... 63
One Daily Gummy Vites ............ 63
One Daily Healthy Weight ......... 63
One Daily Maximum .................. 63
One Daily Men's 50+............ 63, 68
One Daily Multi-Vit w-Mineral . 63
One Daily Multivitamin ............. 68
One Daily Multivit-Iron(folic) ... 68
One Daily Plus Iron .............. 63, 68
One Daily Plus Minerals ............ 63
One Daily With Iron ................... 63
One Daily Women 50 Plus ......... 63
One Daily Women's.............. 63, 68
One Daily Womens 50 Plus ....... 63
One Daily Women's Health ........ 68
One Daily Women's Metabolism 46
One-A-Day Cholesterol Plus ...... 63
One-A-Day Energy..................... 68
One-A-Day Essential .................. 68
One-A-Day Maximum Formula 63,
68
One-A-Day Men VitaCraves ...... 63
One-A-Day Menopause Formula 63
One-A-Day Men's 50+ Advantage
.......................................... 63, 68
One-A-Day Men's Multivitamin. 63
One-A-Day Teen Advantage 63, 69
One-A-Day Teen Him VitaCraves
................................................ 70
One-A-Day VitaCraves .............. 63
One-A-Day VitaCraves Energy .. 63
One-A-Day Vitacraves Immunity
................................................ 63
One-A-Day Vitacraves Omega-3 63
One-A-Day WeightSmart ........... 63
One-A-Day Women VitaCraves. 63
One-A-Day Women's 50+ .......... 63
One-A-Day Women's Active...... 63
One-A-Day Womens Formula .. 63,
69
One-A-Day Women's Healthy Skin
................................................ 64
One-A-Day Women's Petites...... 69
OptiChamber Diamond Lg Mask
...................................... 110, 112
OptiChamber Diamond VHC .. 110,
112
OptiChamber Diamond-Med Msk
...................................... 110, 112
OptiChamber Diamond-Sml Mask
...................................... 110, 112
Optisource ................................... 64
Opti-Vitamins ......................... 2, 64
Opurity Multivitamin .................. 64
Oral Saline Laxative ................... 96
Oralyte ........................................ 56
orphenadrine citrate .................. 106
Orsythia....................................... 34
Ortho Micronor ........................... 35
Ortho Tri-Cyclen (28) ................. 35
Ortho Tri-Cyclen Lo (28)............ 35
Ortho-Novum 7/7/7 (28) ............. 35
Os-Cal 500 + D3 ......................... 50
OsmoPrep.................................... 96
Osteo-Poretical............................ 50
Ovcon-35 (28) ............................. 34
Oxi-Freeda .................................. 64
oxybutynin chloride .................. 102
oxycodone ..................................... 3
oxycodone-acetaminophen ........... 4
Oysco 500/D ............................... 50
Oysco-500 ................................... 48
Oyster Shell Calcium .................. 48
Oyster Shell Calcium 500 ........... 48
Oyster Shell Calcium and Mag ... 49
Oyster Shell Calcium With D ..... 51
Oyster Shell Calcium-Vit D3 ...... 51
P
P D Natal Vitamins-Folic Acid ... 72
Pain and Fever .............................. 6
Pain Relief..................................... 6
Pain Relief Extra Strength ............ 6
Pain Relief Regular Strength ........ 6
Pain Reliever ................................. 6
Pain Reliever Extra Strength ......... 6
Pancreaze .................................... 89
pantoprazole ................................ 90
paregoric ..................................... 87
paricalcitol ................................ 114
paromomycin .............................. 11
Parva-Cal 250 ............................. 51
Parva-Cal 500 ............................. 51
Parvlex ........................................ 55
P-COL RITE ............................... 98
Peak Air Peak Flow Meter 110, 112
Ped Multivitamins-A,B,D,E,K,Zn
................................................ 70
PediaCare Fever Reducer .............. 6
Pedia-Lax .................................... 95
Pedia-Lax Stool Softener .......... 100
Pediatric Electrolyte ................... 56
Pediatric Freezer Pops ................ 56
PediaVance ................................. 56
peg 3350-electrolytes ................. 96
PEG-3350 with flavor packs ...... 96
peg-electrolyte soln .................... 96
PEG-Prep .................................... 98
Pen Needle........................ 108, 112
penicillin V potassium ................ 16
Pentasa ........................................ 92
pentazocine-naloxone ................... 4
pentoxifylline............................ 103
Peptic Relief ............................... 87
Pepto-Bismol Max St ................. 88
Perdiem Overnight Relief ........... 97
Perfect Iron ................................. 52
PERI-COLACE .......................... 98
perindopril erbumine .................. 21
Perio Med ................................. 114
permethrin .................................. 42
Personal Best Full Range . 110, 113
Pharbetol....................................... 6
Pharmacist Favorite Multi-Vit.... 69
Phenadoz .................................. 121
phenazopyridine ....................... 101
phenylephrine HCl ................... 118
Philith ......................................... 34
Phillips ........................................ 56
Phillips' (magnesium hydroxide . 85
Phillips Liqui-Gels ................... 100
Phillips Milk of Magnesia .....85, 96
Phoslyra ............................ 100, 101
Phos-NaK ................................... 56
Phosphate Laxative..................... 96
Phospholine Iodide ................... 116
pilocarpine HCl ................ 115, 116
pindolol....................................... 24
Pink Bismuth .............................. 88
Pink Bismuth Maximum Strength
................................................ 88
pioglitazone ................................ 82
piroxicam ...................................... 9
PNV 29-1.................................... 72
PoDiaPN ..................................... 45
podofilox .................................... 41
polyethylene glycol 3350 ........... 96
Poly-Iron..................................... 52
Poly-Iron 150 Forte .................... 55
polymyxin B sulf-trimethoprim 118
polyvinyl alcohol ...................... 116
Poly-Vi-Sol................................. 71
139
Poly-Vi-Sol with Iron ................. 71
Poly-Vita .................................... 70
Poly-Vita (iron) .......................... 71
Poly-Vitamin .............................. 70
Poly-Vitamin with Iron .............. 71
Polyvitamin/Iron ......................... 71
Poly-Vitamins ............................. 70
Pomalyst ..................................... 19
Portia .......................................... 34
Potaba ......................................... 77
potassium bicarb and chloride .... 57
potassium bicarb-citric acid........ 57
potassium chloride ...................... 57
potassium citrate ....................... 101
potassium citrate-citric acid...... 101
potassium phosphate m-/d-basic. 57
Pradaxa ..................................... 105
pramipexole ................................ 29
pravastatin .................................. 23
prazosin ...................................... 28
Pred Mild .................................. 117
prednisolone ............................... 81
prednisolone acetate ................. 117
prednisolone sodium phosphate 81,
117
prednisone .................................. 81
Prefera-OB.................................. 72
Premarin ............................. 81, 127
Premphase .................................. 80
Prempro ...................................... 80
Prenaissance ............................... 72
Prenatabs FA .............................. 72
Prenatabs Rx ............................... 72
Prenatal ....................................... 73
Prenatal 19 .................................. 72
Prenatal Formula ........................ 72
Prenatal Low Iron ....................... 73
Prenatal Multi-DHA ................... 73
Prenatal Plus ............................... 73
Prenatal Plus (calcium carb) ....... 73
Prenatal Tablet ............................ 73
Prenatal Vitamin ......................... 73
Prenatal Vitamin Plus Low Iron . 73
Prenatal Vitamin with Minerals.. 73
Prenatal-U ................................... 73
Prenate AM................................. 73
Preparation Cleansing................. 96
Prepopik...................................... 98
PreserVision AREDS ............. 2, 64
PreserVision AREDS 2 ................ 2
PreserVision Lutein .................... 64
PreTAB ....................................... 73
Prevacid SoluTab ........................ 90
Prevent ........................................ 64
PreviDent .................................. 114
PreviDent 5000 Plus ................. 114
Previfem ...................................... 34
primaquine .................................. 13
PrimeAire .......................... 110, 113
Pro Fe .......................................... 52
probenecid ................................. 103
Pro-Cal ........................................ 49
ProCerv HP ................................. 64
ProChamber ...................... 110, 113
prochlorperazine ......................... 88
prochlorperazine maleate ............ 88
Procrit........................................ 103
Proferrin ES ................................ 52
Proferrin-Forte ............................ 55
progesterone micronized ............. 83
Proglycem ................................... 77
promethazine ....................... 88, 121
Promethegan ............................. 121
Promolaxin ................................ 100
propafenone ................................ 22
propantheline .............................. 91
proparacaine .............................. 118
propranolol .................................. 24
propranolol-hydrochlorothiazid . 27,
28
propylthiouracil ........................... 79
ProRenal...................................... 43
ProRenal QD ............................... 64
Prosight ......................................... 2
Prosight with Lutein.................... 64
Prostamen.................................... 46
Prosteon ...................................... 51
Protect Cardio AF ....................... 64
Protect Iron ................................. 64
Protect Plus SO ........................... 64
pseudoephedrine HCl ................ 126
psyllium husk .............................. 94
Pulmicort Flexhaler................... 123
Pulmozyme ............................... 125
pyrazinamide ............................... 13
pyridostigmine bromide ............ 106
Q
Q-PAP ........................................... 7
Q-PAP Extra Strength ................... 6
Q-Tussin DM ............................ 126
Quasense ..................................... 34
Quflora Pediatric ......................... 71
Quin B Strong............................. 43
quinapril ..................................... 21
quinapril-hydrochlorothiazide .... 20
quinidine sulfate ......................... 22
Quintabs ..................................... 69
Quintabs-M................................. 64
Quintabs-M Iron Free ................. 64
Qvar .......................................... 123
R
Rabano Yodado .......................... 45
raloxifene .................................... 83
ramipril ....................................... 21
Ranexa ........................................ 22
ranitidine HCl ............................. 90
Ready-To-Use Enema ................ 96
Ready-To-Use Enema (min oil) . 95
Reclipsen (28)............................. 34
Reguloid ..................................... 94
Reguloid (dextrose) .................... 94
Reguloid, Sugar Free .................. 94
Relenza Diskhaler....................... 15
ReliOn Ultra Thin Plus Lancets
...................................... 107, 113
Renagel ..................................... 100
Renal Caps.................................. 43
Rena-Vite Rx .............................. 45
Reno Caps .................................. 43
Renvela ..................................... 100
repaglinide .................................. 78
Replesta ...................................... 76
REQ49+ .................................47, 64
Revlimid ..................................... 19
rifabutin .................................13, 16
rifampin .................................13, 16
Ri-Gel ......................................... 87
Ri-Gel II ..................................... 87
Right Step Prenatal Vitamins ..... 73
Riginic ........................................ 84
riluzole .............................. 105, 106
Ri-Mag ....................................... 85
Ri-Mag Plus................................ 87
rimantadine ................................. 15
Ri-Mox ....................................... 87
Ri-Mox Plus ............................... 87
Risacal-D .................................... 51
rivastigmine tartrate.................... 31
rizatriptan ................................... 29
Robafen DM ............................. 126
Rolaids ........................................ 84
ropinirole .................................... 29
Rulox .......................................... 87
140
S
SafeSnap Insulin Syringe . 108, 113
SafeSnap Syringe ..... 109, 110, 113
Safyral ........................................ 34
Saline Mist ................................ 126
Saline Nasal .............................. 126
Saline Nasal Mist...................... 126
Saline Nose ............................... 126
Sani-Supp (Adult)....................... 96
Sani-Supp (Infant) ...................... 96
Santyl .......................................... 40
SAVision ................................ 2, 64
Scooby-Doo One A Day............. 71
Sea Soft Nasal Mist .................. 126
selegiline HCl ............................. 29
selenium sulfide .......................... 39
Senexon ...................................... 97
Senexon-S ................................... 98
senna ..................................... 97, 98
Senna Lax ................................... 97
Senna Laxative ........................... 97
Senna Laxative-Stool Softener ... 98
senna leaf .................................... 97
Senna Plus .................................. 98
Senna Prompt ............................. 98
Senna with Docusate Sodium ..... 99
Senna-Extra ................................ 98
Sennalax-S .................................. 99
Senna-S ....................................... 99
Senna-Time S ............................. 99
Senno .......................................... 98
sennosides-docusate sodium....... 99
Senokot ....................................... 98
Senokot-S ................................... 99
SenokotXTRA ............................ 98
Sen-O-Tab .................................. 98
Sensipar ...................................... 80
Sentry.................................... 64, 69
Sentry Senior .............................. 64
Serevent Diskus ........................ 123
Se-Tan Plus................................. 69
SF ............................................. 114
SF 5000 Plus............................. 114
Sharobel ...................................... 35
Sharps Container .............. 109, 113
Siderol ........................................ 55
Silace ........................................ 100
sildenafil ..................................... 28
silver sulfadiazine ....................... 39
simethicone................................. 91
simvastatin .................................. 23
sirolimus.................................... 105
Slo-Niacin ................................... 75
Slow Release Iron ....................... 53
Slow-Mag.................................... 56
Smart Sense Lancets ......... 107, 113
Smooth Antacid .......................... 85
sodium bicarbonate ..................... 84
sodium chloride..................... 30, 31
sodium citrate-citric acid........... 101
sodium ferric gluconat-sucrose ... 53
sodium fluoride ......................... 114
sodium phosphate ....................... 57
sodium polystyrene (sorb free) ... 46
sodium polystyrene sulfonate ..... 46
Soft Touch Lancets ........... 107, 113
Softgels Multivit-A,B,D,E,K,Zn . 64
Solo ............................................. 64
Soluble Fiber ............................... 95
Soothe (bismuth subsalicylate) ... 88
Soothe Regular Strength ............. 88
sotalol .................................... 22, 24
Sotalol AF ............................. 22, 24
Soy Formula ................................ 49
Spectravite Adult ........................ 64
Spectravite Adult 50+ ................. 64
Spectravite Advanced Formula ... 69
Spectravite Men's ........................ 64
Spectravite Senior ................. 47, 64
Spectravite Ultra Men 50+ .......... 64
Spectravite Ultra Men's Sr .......... 64
Spectravite Ultra Women ............ 69
Spectravite Ultra Women's Sr ..... 64
Spiriva Respimat ....................... 123
Spiriva with HandiHaler ........... 123
spironolactone ....................... 21, 26
spironolacton-hydrochlorothiaz .. 27
Sprintec (28) ............................... 34
Sronyx ......................................... 34
Stimate ........................................ 78
Stimulant Laxative Plus .............. 99
Stomach Relief ............................ 88
Stomach Relief Max Strength ..... 88
Stomach Relief Original ............. 88
Stool Softener ........................... 100
Stool Softener-Laxative .............. 99
Stool Softener-Stimulant Laxat... 99
Stop Smoking Aid ....................... 30
Stress B Plus Zinc ....................... 43
Stress B With Zinc ...................... 43
Stress B-Biotin ............................ 45
Stress B-Complex ....................... 64
Stress Formula .................43, 45, 55
Stress Formula 600 C ................. 43
Stress Formula Advanced ........... 65
Stress Formula Energy ............... 43
Stress Formula plus Iron............. 44
Stress Formula with Iron ............ 44
Stress Formula With Iron(sulf)... 44
Stress Formula with Zinc ........... 44
Strovite Forte .............................. 65
Strovite One................................ 65
sucralfate .................................. 100
Sudogest ................................... 126
sulfacetamide sodium ............... 119
sulfacetamide-prednisolone ...... 116
sulfamethoxazole-trimethoprim . 12
sulfasalazine ............................8, 92
Sulfatrim ..................................... 12
sulindac......................................... 8
sumatriptan succinate ................. 30
Sunvite ........................................ 65
Super Antioxidant....................2, 65
Super B Complex + C ................ 44
Super B Complex-Vitamin C ..... 44
Super B/C ................................... 44
Super B-50 Complex .................. 45
Super B-50 Complex Plus .......... 45
Super Cal-Mag ........................... 49
Super Ginseng Multivitamin ...... 65
Super Multiple ............................ 65
Super Multiple - Low Iron.......... 65
Super Multivitamin..................... 69
Super Quints B-50 ...................... 45
Super Thera Vite M .................... 65
Superior 35 ................................. 65
Superplex-T ................................ 44
Supervite..................................... 44
Supervite (EC) ............................ 65
Suphedrin ................................. 126
Suphedrine ................................ 126
Support ....................................... 65
Support-500 ................................ 44
Suppository Adult....................... 96
Suprax......................................... 14
Suprep Bowel Prep Kit ............... 96
Sure Comfort Pen Needle . 108, 113
Sure-Fine Pen Needles ..... 108, 113
Sure-Ject Insulin Syringe.. 109, 113
Surfak ....................................... 100
Syeda .......................................... 34
Symbicort ................................. 124
Synagis ....................................... 20
141
T
Tab-A-Vite ................................. 69
Tab-A-Vite/Iron.......................... 65
Tab-A-Vite-Minerals .................. 65
Tabloid........................................ 18
tacrolimus ........................... 40, 105
Tactinal ......................................... 7
Tactinal Extra Strength ................. 7
Take Action ................................ 36
Tamiflu ....................................... 15
tamoxifen .................................... 19
tamsulosin................................. 101
Tandem Dual Action .................. 53
Tanzeum ..................................... 79
Targretin ..................................... 19
Taron Forte ................................. 55
Taztia XT .................................... 25
Tears Naturale Free (PF) .......... 116
Tears Naturale II ....................... 116
Tears Pure ................................. 116
Tecfidera................................... 115
Tekturna...................................... 28
Tekturna HCT............................. 28
temozolomide ............................. 17
Tencon .......................................... 7
Terazol 3 ................................... 127
Terazol 7 ................................... 127
terazosin...................................... 28
terbinafine HCl ........................... 12
terbutaline ................................. 124
terconazole................................ 127
testosterone ................................. 78
testosterone cypionate ................ 77
testosterone enanthate................. 78
tetracycline ................................. 16
The Magic Bullet ........................ 98
theophylline .............................. 123
Thera........................................... 69
Thera M Plus (ferrous fumarat) .. 65
Thera Vitamin............................. 69
TheraCal ..................................... 51
TheraCal D2000 ......................... 51
TheraCal D4000 ......................... 51
Thera-D ...................................... 76
Theradex M ................................ 65
Theragran-M Premier 50 Plus .... 65
Theralogix Companion ............... 65
Thera-M ...................................... 65
Theramill Forte ........................... 65
TheraNatal ............................ 65, 73
Therapeutic Liquid ..................... 69
Therapeutic M + beta-Carotene .. 65
Therapeutic-M ............................ 65
Therapeutic-M Vitamin/Minerals65
Thera-Tabs .................................. 69
Thera-Tabs M ............................. 65
Theratrum Complete 50 Plus ...... 47
Theratrum Complete 50 Plus/Lut 47
Theratrum Complete with Lutein 65
Therems ................................ 65, 69
Therems-H .................................. 65
Therems-M.................................. 65
thiamine HCl (vitamin B1) ......... 75
Tiazac .......................................... 25
Tilia Fe ........................................ 35
timolol maleate ................... 24, 118
tinidazole ..................................... 13
tizanidine ................................... 106
TL Gard Rx ........................... 74, 77
TL G-Fol OS ............................... 49
TL Icon ....................................... 55
Tobi Podhaler ............................ 124
TobraDex .................................. 117
tobramycin ................................ 118
tobramycin in 0.225 % NaCl .... 125
tobramycin-dexamethasone ...... 117
Today Contraceptive Sponge ...... 36
tolazamide ................................... 79
tolbutamide ................................. 79
tolnaftate ..................................... 38
tolterodine ................................. 102
torsemide ..................................... 27
Total B/C..................................... 44
Totalday Multiple ....................... 65
Tracleer ....................................... 28
Tradjenta ..................................... 78
tramadol ........................................ 3
trandolapril .................................. 21
Transderm-Scop .......................... 88
travoprost (benzalkonium) ........ 119
Trecator ....................................... 13
tretinoin ....................................... 37
tretinoin (chemotherapy) ............. 19
TriAdvance ................................. 73
triamcinolone acetonide ..... 41, 115,
125
triamterene-hydrochlorothiazid... 27
Tri-Biozene ................................. 38
Tri-Buffered Aspirin ................... 11
TriCare ........................................ 73
Tricitrates .................................. 101
Tricon .......................................... 55
Tri-Estarylla................................ 35
trifluridine................................. 119
Trigels-F Forte............................ 55
Tri-Legest Fe .............................. 35
Tri-Linyah .................................. 35
TriLyte With Flavor Packets ...... 96
trimethobenzamide ..................... 88
trimethoprim ............................... 12
Trinatal GT ................................. 73
Trinatal Rx 1............................... 73
Trinate ........................................ 73
TriNessa (28) .............................. 36
Triphrocaps................................. 44
Triple Antibiotic ......................... 37
Triple Antibiotic Plus ................. 38
Tri-Previfem (28) ....................... 36
Tri-Sprintec (28) ......................... 36
Tri-Tabs DHA ............................ 73
Tri-Vi-Flor .................................. 71
Tri-Vitamin................................. 70
Tri-Vitamin With Fluoride ......... 72
Trivora (28) ................................ 36
tropicamide ............................... 117
trospium.................................... 102
TRUEplus Diabetic Multivitamin
................................................ 66
Trustex Latex Condom ..... 109, 113
Trustex Lubricated Condoms .. 109,
113
Trustex Non-Lub Condoms ..... 109,
113
Trustex-RIA Lub/Spermicide .. 109,
113
Trustex-RIA Non-Lub Condoms
...................................... 109, 113
Tudorza Pressair ....................... 123
Tums ........................................... 85
Tums Freshers ............................ 85
Tums Ultra.................................. 85
Tylenol ......................................... 7
Tylenol Extra Strength ................. 7
TYR Cooler ................................ 66
U
Udamin SP.................................. 66
Uloric ........................................ 103
Ulticare ............................. 109, 113
Ulticare Pen Needle .......... 109, 113
Ultilet Pen Needle ............ 109, 113
Ultimate Men's Complete 50+ .... 66
Ultimate Women's Complete 50+
................................................ 66
142
Ultra B-100 Complex ................. 45
Ultra Comfort Insulin Syringe . 109,
113
Ultra Freeda ................................ 66
Ultra Strength Antacid................ 85
Ultra Strength Calcium Antacid . 85
Ultra Thin Lancets ............ 107, 113
Ultra Thin Plus Lancets .... 107, 113
UltraLANCE Lancets ....... 107, 113
Unicomplex-M ........................... 66
Unifiber ...................................... 95
Unifine Pentips ................. 109, 113
Unifine Pentips Plus ......... 109, 113
Universal 1 Lancets .......... 107, 113
Upcal D....................................... 51
Uretron D-S .............................. 102
Urocit-K 10............................... 101
Urocit-K 5................................. 101
Uro-Mag ..................................... 56
ursodiol ....................................... 89
Utira-C ...................................... 102
V
Vaginal Contraceptive Foam ...... 36
Vagistat-3 ................................. 127
valacyclovir ................................ 15
valganciclovir ............................. 14
valsartan...................................... 21
valsartan-hydrochlorothiazide .... 21
vancomycin .......................... 14, 15
V-C Forte.................................... 66
Vegetable Laxative ..................... 98
Velivet Triphasic Regimen (28) . 36
Velphoro ........................... 100, 101
Venofer ....................................... 53
Ventolin HFA ........................... 124
verapamil .............................. 22, 25
Vestura (28) ................................ 34
Viactiv ........................................ 49
VIC-Forte ................................... 66
Victoza 2-Pak ............................. 79
Victoza 3-Pak ............................. 79
Vigamox ................................... 119
Vinate GT ................................... 73
Vinate II...................................... 73
Vinate M ..................................... 73
Vinate One.................................. 73
Vinate Ultra ................................ 73
Viorele (28) ................................ 31
Virt Nate ..................................... 73
Virt-Advance .............................. 73
Virtrate-3 ................................... 101
Virt-Select ................................... 73
Virtussin AC ............................. 125
Virt-Vite ................................ 74, 77
Virt-Vite Forte ...................... 74, 77
Virt-Vite GT ............................... 73
Virt-Vite Plus .............................. 44
Visine-A .................................... 117
Vision .......................................... 66
Vision Formula ........................... 66
Vision Formula (with lutein) .. 2, 66
Vision Plus Lutein ...................... 47
Vision-Vite + Zinc .................. 2, 66
Vit 3 ............................................ 69
vit B complex-folic acid.............. 44
Vita-Bee with C .......................... 44
Vitacel (with Lutein) ................... 66
Vitafol ......................................... 55
Vital-D Rx............................. 66, 76
Vitalee ......................................... 66
vitamin B complex ...................... 45
Vitamin B Complex With C ....... 44
Vitamin B-1 ................................ 75
Vitamin B-1 (mononitrate) ......... 75
Vitamin B-2 ................................ 75
Vitamin B-6 ................................ 75
Vitamin D3 ................................. 76
Vitamin D3 Complete ................. 46
Vitamin D-3 with Aloe ............... 66
vitamin E ............................... 24, 76
vitamin E (dl, acetate) ................. 76
vitamin E acetate ......................... 76
vitamin E mixed .......................... 76
vitamin E succinate ..................... 76
vitamins A and D ........................ 69
Vitamins A,C,D and Fluoride ..... 72
Vitamins A-D-E selenium........... 66
Vitamins and Minerals ................ 66
Vitamins B Complex............. 44, 45
Vitamins for Hair .................. 44, 69
Vita-Respa ............................ 74, 77
Vitatrum ...................................... 66
Vitron-C ...................................... 55
Vitrum Senior ....................... 47, 66
Vol-Nate...................................... 73
Vol-Tab Rx ................................. 74
Vortex Holding Chamber .. 110, 114
VP-Zel ......................................... 46
W
Wal-Mucil Fiber (aspartame) ..... 95
Wal-Mucil Natural Fiber Lax ..... 95
Wal-Mucil with Calcium ............ 95
Wal-phed .................................. 126
Wal-Profen ................................... 9
Wal-Proxen................................... 9
Wal-Zan 150 ............................... 90
Wal-Zan 75 ................................. 90
warfarin .................................... 103
Wee Care .................................... 53
Wera (28).................................... 34
wheat germ oil ............................ 77
Whole Source Multi-Vitamins ... 66
Woman's Laxative ...................... 98
Women's Active ......................... 66
Women's Biomultiple ................. 66
Women's Complex ..................... 66
Women's Daily Caplet ................ 66
Women's Daily Formula............. 66
Women's Daily Multivitamin ..... 66
Women's Laxative (bisacodyl) ... 98
Women's Multivitamin Gummies66
Women's One Daily ................... 69
Wymzya Fe................................. 34
X
Xarelto ...................................... 103
Xopenex HFA........................... 124
Xtandi ......................................... 17
Xulane ........................................ 36
Y
Yasmin (28) ................................ 34
yeast ............................................ 45
Yelets .......................................... 69
Z
zafirlukast ................................. 123
Zarah........................................... 34
Zebutal .......................................... 7
Zemplar .................................... 114
ZenChent (28)............................. 34
Zenchent Fe ................................ 34
Zenpep ........................................ 89
Zetia ............................................ 23
Zolinza ........................................ 18
zolmitriptan ................................ 30
Zoo Friends ................................ 70
Zoo Friends Original .................. 70
Zovia 1/35E (28) ........................ 34
Zovia 1/50E (28) ........................ 34
Zytiga ....................................16, 17
Wal-Mucil Fiber ......................... 95
143
144