drug formulary - Health Alliance

Transcription

DRUG FORMULARY
QUALIFIED HEALTH PLANS
EFFECTIVE JANUARY 13, 2015
LAST UPDATED AUGUST 205
INTRODUCTION
This is the Health Alliance Drug Formulary for
Qualified Health Plans (also known as the health
insurance “exchange” plans). In order to assist
members and providers in choosing prescription
drugs for treatment, we encourage members to show
this list to their physicians and pharmacists. In
addition, we encourage prescribers to use this list
when considering treatment options. Final decisions
regarding treatment options are made between the
physician and patient.
The formulary is subject to change at any time.
Members can access the most up-to-date version of
this list by visiting HealthAlliance.org. In addition,
members can login to CatamaranRx.com to access
specific drug coverage and pricing information.
The formulary does not provide information
about an individual’s specific coverage. Please refer
to your plan documents for complete coverage
details.
HOW TO USE THIS LIST
As a general rule, generic drugs have the lowest
member copayment. Typically, when a generic
enters the market the brand drug moves to Tier 3.
Members who choose the brand name after the
release of a generic version may pay the copayment
plus the difference in cost between the brand and
generic drug. Generic drugs can help members save
on out-of-pocket medication costs.
Generic Equivalent vs. Generic Alternative
Generic equivalents are medications that contain
the same active ingredient, with the same strength
and dosage form as the brand medication. Generic
equivalents are as safe and effective and produce
the same results as the brand counterpart.
Generic alternatives can produce the same
intended effect on the body as the comparable
brand. Generic alternatives are medications that
work like a particular brand drug and are used to
treat the same condition. However, the active
ingredient in a generic alternative is different from
the brand medication.
Generics
Talk to Your Doctor
If your doctor writes a prescription for a brand
drug that does not have a generic equivalent,
consider asking if an appropriate generic alternative
is available.
As a patient, you can tell your pharmacist you
are interested in generics. In most situations, your
pharmacist can substitute a generic equivalent for
its brand counterpart without a new prescription
from your doctor.
For more information on generics, visit
AskForGenerics.org.
Like brand drugs, generic drugs go through an
approval process by the Food and Drug
Administration (FDA) and must meet similar
standards of effectiveness and chemical make-up as
branded drugs.
The main difference between the reference brand
drug and its generic equivalent is that the generic
often costs much less.
Drugs to Treat Multiple Conditions
Doctors use some drugs to treat more than one
medical condition. Within this document, each drug
is listed according to its first FDA-approved use.
Please check the index if you do not find your
medication in the therapeutic class that corresponds
to your condition.
This drug list is organized in sections by drug
class or medical condition. Within each section are
subsections to help locate medications. Most drugs
listed, whether generic or brand, are formulary
drugs.
To search within the PDF, choose the search
function, enter a drug name and click “search” or
“find.” You can also search using the index, which
lists drugs alphabetically.
COVERAGE AND LIMITATIONS
Tier Information
A drug’s copayment tier indicates what you will
pay for the medication with each fill.
The majority of generics are Tier 1. These
are your least expensive prescription drugs.
Preferred brand-name drugs are Tier 2, the
lowest brand tier.
Non-preferred brand-name drugs are Tier 3.
Specialty drugs are in Tiers 4, 5, and 6.
o Preferred Specialty drugs are Tier 4
o Non-preferred Specialty drugs are
Tier 5
o Non-Formulary Specialty drugs are
Tier 6
Your pharmacy benefit includes coverage for
the majority of prescription drugs, though some
exclusions may apply.
Utilization Management
Some drugs on this list require utilization
management (UM), i.e. preauthorization, managed
dose limitations and step-therapy. If UM applies to
a drug, it is indicated with one of the following
symbols in the column next to the drug name.
MDL- Managed Dose Limitations
PA- Preauthorization
ST- Step-Therapy
Medical Exception
Medical exception is a process for reviewing
coverage for drugs not on our formulary. Members
may qualify for a medical exception if they meet
one of these:
A. Documented failure of all formulary drugs
within the same therapeutic class
B. Documented allergy to a formulary drug,
with no other formulary choices
C. Successfully maintained condition on a
specific drug where switching to an
alternative drug may cause a health risk:
o Antiarrhythmics
o
o
o
o
Theophylline products
Seizure medications
Antipsychotics
Antidepressants
Physicians—Requesting a Medical
Exception
To request a Medical Exception for a
medication on behalf of a member, or to request
further information, please call the Health Alliance
Pharmacy department at 1-800-851-3379, option 4,
or fax the Preauthorization/Medical Exception form
to 217-255-4598. Forms are available at
HealthAlliance.org. Please provide the following
information when requesting a Medical Exception:
Patient name and Health Alliance
identification number
Physician name, address and phone number
Drug name and strength
Patient diagnosis
Chart documentation/documentation of
previous medical history pertaining to the
requested drug
Contraceptive Coverage Under
Preventive Health Wellness Benefit
A female member age 10–50 years old has
coverage of some FDA-approved contraceptives for
no out-of-pocket cost.
Free contraceptives are listed below:
Tier 1 oral contraceptives
Limit of three units on condoms (male or
female)
Limit of 2.7 units of spermicidal product
Only one Tier 1 prescription drug (like a generic
oral contraceptive) or one over-the-counter (OTC)
product (like male and female condoms or
spermicides) is covered per 30-day period for no
cost to the member.
Brand-name contraceptives that are Tier 2 or
higher are covered with the appropriate member
cost share/quantity restrictions according to the
member’s plan.
Emergency contraception is covered at Tier 1
using generic levonorgestrel/ethinyl estradiolcontaining products. Brand-name emergency
contraception is covered according to the member’s
plan.
Quantities above a 30-day supply, including
vacation overrides and commercially available
extended-cycle contraceptives (like Seasonale), are
subject to appropriate member cost-sharing
according to the member’s plan.
Preferred—At Preferred pharmacies,
members can get hundreds of common
prescriptions FREE.
Preferred Plus—At Preferred Plus
pharmacies, members have the same
benefits as the Preferred pharmacies
mentioned above. In addition, simvastatin,
pravastatin and Ventolin HFA are FREE.
For a list of participating pharmacies and
available drugs in the Rxtra program, visit the
pharmacy section of HealthAlliance.org.
General Exclusions
A. Over-the-counter (OTC) medications and
their equivalents are not covered, unless
otherwise specified within the Formulary.
Nicotine smoking-cessation products (e.g.,
transdermal nicotine, nicotine gum, nicotine
inhaler) coverage is based on specific
member benefits.
B. Any drugs used for cosmetic purposes are
not covered.
C. Experimental drugs, or any drug product
used in an experimental manner, are not
covered.
D. Replacement of lost or stolen medication is
not covered.
E. Non-self-administered injectable drugs,
unless otherwise noted, are not covered
through the pharmacy benefit. Refer to your
description of coverage materials for details.
F. Foreign drugs and drugs not approved by the
FDA are not covered.
G. Drugs used to treat erectile dysfunction.
PHARMACY SAVINGS PROGRAMS
Health Alliance offers members several
programs to lower the drug costs and to help
members take their medications safely and
correctly.
Rxtra
Health Alliance members with prescription
coverage can save money based on where they have
their 30-day-supply of prescriptions filled.
The Rxtra program is simple.
Retail 90
The Retail 90 program allows members to
purchase a 90-day supply of maintenance
medication at a discounted copayment from
participating retail pharmacies. Because this is a
voluntary program designed to increase flexibility,
members who prefer may continue purchasing the
traditional 30-day supply from their pharmacy with
their regular copayment.
Value-Based Benefit
The value-based benefit is designed so that
member copayments are aligned with the value the
drug has for keeping members healthy.
Medications listed below are used to treat
common conditions like asthma, high cholesterol,
high blood pressure and diabetes and are available
to members at a lower cost than other similar
medications.
Vl
Blood Glucose Monitors FREE By Mail
Members with diabetes are eligible to receive a
FREE blood glucose meter if they choose one of the
preferred meters listed below and obtain the meter
by mail. If a member picks up a blood glucose
meter at their local pharmacy, the member’s Tier 2
copayment will apply when obtained with a
prescription. Free meters are limited to one meter
per member per year. The FreeStyle InsuLinx
System is limited to one meter every three years.
Freestyle Lite
and Freestyle InsuLinx
x
FreeStyle Lite System
FreeStyle Freedom Lite System
FreeStyle InsuLinx System
To get an Abbott product, call
1-866-224-8892 and mention Health Alliance
Or visit www.myfreestyle.com/meterprogram
InsuLinx systems are limited to one free product per
member every three years.
Not all benefit plans include each of the programs
listed above. Please refer to your description of
coverage documents for more detail or contact the
Pharmacy department at 1-800-851-3379, option 4.
CONTACT US
Health Alliance Pharmacy Department
301 S. Vine St.
Urbana, IL 61801-3347
1-800-851-3379, option 4
Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
AMEBICIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
CHEMOTHERAPY ADJUNCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
GNRH/LHRH ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
PROGESTERONE ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
ANTACIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
Biaxin XL PAC
DificidST
E.e.s. 400
Ery-TAB
Erythrocin Stearate
Erythromycin Base
Erythromycin Ethylsuccinate
PCE
Zithromax
Zithromax Tri-PAK
Zithromax Z-PAK
Zmax
August 2015
ANTI-INFECTIVES
PENICILLINS
TIER 01
TIER 03
GENERIC
amoxicillin
amoxicillin/clavulanate potassium
amoxicillin/clavulanate potassium ER
ampicillin
dicloxacillin sodium
penicillin v potassium
NON PREFERRED
Amoxicillin
Amoxicillin ER
Ampicillin
Augmentin
Augmentin ES-600
Augmentin XR
Moxatag
TETRACYCLINES
TIER 01
TIER 03
CEPHALOSPORIN
FIRST GENERATION
GENERIC
TIER 01
TIER 03
cefadroxil
cephalexin
NON PREFERRED
Cephalexin
Keflex
SECOND GENERATION
GENERIC
TIER 01
TIER 03
cefaclor
cefprozil
cefuroxime axetil
NON PREFERRED
Cefaclor
Cefaclor ER
Ceftin
QUINOLONES
TIER 01
THIRD GENERATION
GENERIC
TIER 01
TIER 03
cefdinir
cefixime
cefpodoxime proxetil
NON PREFERRED
Cedax
Cefditoren Pivoxil
Ceftibuten
Spectracef
Suprax
TIER 03
MACROLIDES
TIER 01
TIER 02
TIER 03
GENERIC
azithromycin
clarithromycin
clarithromycin ER
erythromycin
PREFERRED BRAND
E.e.s. Granules
Eryped 200
Eryped 400
NON PREFERRED
Azithromycin
Biaxin
Biaxin XL
GENERIC
demeclocycline HCL
doxycycline
doxycycline hyclate
doxycycline hyclate DR
doxycycline monohydrate
minocycline HCL
minocycline HCL ER
NON PREFERRED
Adoxa
Adoxa PAK 1/100
Adoxa PAK 1/150
Adoxa PAK 2/100
Doryx
Minocin
Monodox
Nicazeldoxy 30 Kit
Nicazeldoxy 60 Kit
Nutridox
Solodyn
Targadox
Tetracycline HCL
Vibramycin
GENERIC
ciprofloxacin
ciprofloxacin ER
ciprofloxacin HCL
levofloxacin
moxifloxacin HCL
ofloxacin
NON PREFERRED
Avelox
Avelox Abc Pack
Cipro
Cipro XR
Ciprofloxacin HCL
Factive
Levaquin
Noroxin
Ofloxacin
AMINOGLYCOSIDES
TIER 01
TIER 05
TIER 06
GENERIC
neomycin sulfate
paromomycin sulfate
NON PREFERRED SPECIALTY
BethkisPA
Tobi PodhalerPA
NON FORMULARY SPECIALTY
tobramycinPA
Kitabis PAKPA
TobiPA
Effective August 20, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
1
SULFONAMIDES
TIER 03
TIER 02
NON PREFERRED
Sulfadiazine
ANTIMYCOBACTERIAL AGENTS
TIER 01
TIER 02
TIER 03
TIER 05
GENERIC
ethambutol HCL
isoniazid
pyrazinamide
rifabutin
rifampin
PREFERRED BRAND
Mycobutin
NON PREFERRED
Cycloserine
Isoniazid
Myambutol
Paser
Priftin
Rifadin
Rifamate
Rifater
Trecator
SirturoPA
TIER 03
ANTIFUNGALS
TIER 01
TIER 02
TIER 03
TIER 05
GENERIC
fluconazole
flucytosine
griseofulvin microsize
griseofulvin ultramicrosize
itraconazole
ketoconazole
nystatin
terbinafine HCL
PREFERRED BRAND
Grifulvin V
Gris-peg
NON PREFERRED
Ancobon
Diflucan
Lamisil
NoxafilPA
OnmelPA
Sporanox
Sporanox Pulsepak
voriconazolePA
CresembaPA
VfendPA
TIER 04
ANTIVIRALS
TIER 01
GENERIC
abacavir
acyclovir
adefovir dipivoxilPA
didanosine
entecavirPA
famciclovir
lamivudine
lamivudine/zidovudine
nevirapine
nevirapine ER
rimantadine HCL
stavudine
valacyclovir HCL
valganciclovir
zidovudine
TIER 05
PREFERRED BRAND
Aptivus
Crixivan
Emtriva
Epzicom
Invirase
Isentress
Kaletra
Nevirapine
Norvir
Rescriptor
Reyataz
Sustiva
Videx EC
Videx Pediatric
Viramune
Viramune XR
Viread
Ziagen
NON PREFERRED
BaracludePA
Combivir
Edurant
Epivir
Epivir HBV
Famvir
Flumadine
HepseraPA
Intelence
Lexiva
Prezista
Relenza DiskhalerQL
Retrovir
Rimantalist
Sitavig
TamifluQL
TybostST
TyzekaPA
Valcyte
Valtrex
Viracept
Zerit
Zovirax
PREFERRED SPECIALTY
ribavirin
Copegus
Harvoni
Peg-intronPA
Peg-intron RedipenPA
Peg-intron Redipen PAK 4PA
PegasysPA
Pegasys ProclickPA
PegintronPA
Rebetol
SovaldiPA
Viekira PAKPA
abacavir sulfate/lamivudine/zidovudine
Atripla
Complera
DaklinzaPA
EvotazPA
Fuzeon
InfergenPA
Moderiba
Moderiba 1200 Dose Pack
Moderiba 800 Dose Pack
PrezcobixPA
Ribasphere
Ribasphere Ribapak
2
TIER 06
Ribatab
SelzentryPA
Stribild
TechniviePA
Tivicay
Triumeq
Trizivir
Truvada
Vitekta
OlysioPA
VictrelisPA,QL
ANTIMALARIALS
TIER 01
TIER 02
TIER 03
GENERIC
atovaquone/proguanil HCL
chloroquine phosphate
hydroxychloroquine sulfate
mefloquine HCL
quinine sulfate
PREFERRED BRAND
Coartem
Primaquine Phosphate
NON PREFERRED
Aralen
Daraprim
Malarone
Plaquenil
Qualaquin
TIER 05
ANTINEOPLASTICS, ETC
ALKYLATING AGENTS
TIER 02
TIER 03
TIER 04
TIER 06
NON PREFERRED
Yodoxin
TIER 02
ANTHELMINTICS
TIER 01
TIER 03
GENERIC
ivermectin
NON PREFERRED
Albenza
Biltricide
Stromectol
MISC. ANTI-INFECTIVES
TIER 01
TIER 02
TIER 03
GENERIC
atovaquone
clindamycin palmitate HCL
clindamycin HCL
metronidazole
sulfamethoxazole/trimethoprim
sulfamethoxazole/trimethoprim DS
tinidazole
trimethoprim
vancomycin HCL
PREFERRED BRAND
Mepron
Tindamax
NON PREFERRED
Alinia
Bactrim
Bactrim DS
Cleocin
Cleocin Pediatric Granules
Dapsone
First-vancomycin 25
First-vancomycin 50
Flagyl
Flagyl ER
Ketek
Nebupent
PREFERRED BRAND
Alkeran
Gleostine
Hexalen
Leukeran
Lomustine
Myleran
NON PREFERRED
Cyclophosphamide
PREFERRED SPECIALTY
temozolomidePA
TemodarPA
ValchlorPA
ANTIMETABOLITES
TIER 01
AMEBICIDES
TIER 03
TIER 04
Primsol
Vancocin HCL
XifaxanPA
PREFERRED SPECIALTY
linezolidQL
ZyvoxQL
CaystonPA
Dalvance
SivextroQL
TIER 03
TIER 06
GENERIC
mercaptopurine
methotrexate
PREFERRED BRAND
Tabloid
Trexall
NON PREFERRED
Purinethol
Purixan
capecitabinePA
XelodaPA
HORMONAL AGENTS
TIER 01
TIER 02
TIER 03
TIER 05
GENERIC
anastrozole
bicalutamide
exemestane
flutamide
letrozole
megestrol acetate
tamoxifen citrate
PREFERRED BRAND
Emcyt
Fareston
Lysodren
Nilandron
NON PREFERRED
Arimidex
Aromasin
Casodex
Femara
Megace Oral
Soltamox
leuprolide acetatePA
VantasPA
XtandiPA
ZytigaPA
3
IMMUNOMODULATORS
TIER 01
TIER 02
TIER 03
TIER 05
GENERIC
azathioprine
cyclosporine
cyclosporine modified
mycophenolate mofetil
mycophenolic acid DR
sirolimus
tacrolimus
PREFERRED BRAND
Cyclosporine Modified
Neoral
Prograf
Rapamune
Sandimmune
NON PREFERRED
Astagraf XL
Azasan
Cellcept
Imuran
Myfortic
Zortress
PomalystPA
RevlimidPA
ThalomidPA
TOPOISOMERASE I INHIBITOR
TIER 05
HycamtinPA
ANTINEOPLASTICS MISC.
TIER 01
TIER 03
TIER 05
GENERIC
hydroxyurea
tretinoin
NON PREFERRED
Hydrea
bexarotenePA
ActimmunePA
Alferon NPA
Intron APA
Intron A W/DiluentPA
MatulanePA
ProleukinPA
TargretinPA
CHEMOTHERAPY RESCUE
TIER 01
TIER 02
TIER 03
GENERIC
leucovorin calcium
PREFERRED BRAND
Mesnex
NON PREFERRED
Leucovorin Calcium
MITOTIC INHIBITORS
TIER 03
NON PREFERRED
Etoposide
CHEMOTHERAPY ADJUNCTS
TIER 05
KepivancePA
ENZYME INHIBITORS
TIER 04
TIER 05
TIER 06
PREFERRED SPECIALTY
GleevecPA,QL
TasignaPA
AfinitorPA
Afinitor DisperzPA
BosulifPA,QL
CometriqPA
GilotrifPA
IbrancePA
IclusigPA,QL
ImbruvicaPA
InlytaPA
IressaPA
JakafiPA
Lenvima 10MG Daily DosePA
LynparzaPA
MekinistPA
NexavarPA
SprycelPA
StivargaPA
SutentPA
TafinlarPA
TarcevaPA
TykerbPA
VotrientPA
XalkoriPA
ZelborafPA
ZolinzaPA
ZykadiaPA
FarydakPA
ZydeligPA
CARDIOVASCULAR DRUGS
CARDIAC GLYCOSIDES
TIER 01
TIER 02
TIER 03
GENERIC
digoxin
PREFERRED BRAND
Digoxin
NON PREFERRED
Lanoxin
ANTIANGINAL AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
isosorbide dinitrate
isosorbide dinitrate ER
isosorbide mononitrate
isosorbide mononitrate ER
nitroglycerin
nitroglycerin lingual
nitroglycerin transdermal
nitroglycerin ER
PREFERRED BRAND
Dilatrate SR
Nitro-bid
Nitro-dur
Nitroglycerin Lingual
Nitromist
Nitrostat
NON PREFERRED
Imdur
Isordil Titradose
Isosorbide Dinitrate
Nitrolingual Pumpspray
Ranexa
BETA BLOCKERS
TIER 01
GENERIC
acebutolol HCL
4
TIER 02
TIER 03
atenolol
betaxolol HCL
bisoprolol fumarate
carvedilol
labetalol HCL
metoprolol succinate ER
metoprolol tartrate
nadolol
pindolol
propranolol HCL
propranolol HCL ER
sotalol HCL
sotalol HCL (AF)
PREFERRED BRAND
Bystolic
NON PREFERRED
Betapace
Betapace AF
Coreg
Coreg CR
Corgard
Hypertenevide-12.5
Inderal LA
Inderal XL
Innopran XL
Kerlone
Levatol
Lopressor
Propranolol HCL
Sectral
Sotylize
Tenormin
Timolol Maleate
Toprol XL
Trandate
Zebeta
Sular
Tiazac
Verapamil HCL
Verelan
Verelan PM
ANTIARRHYTHMICS
TIER 01
TIER 02
TIER 03
ACE INHIBITORS
TIER 01
CALCIUM CHANNEL BLOCKERS
TIER 01
TIER 03
GENERIC
amlodipine besylate
diltiazem CD
diltiazem HCL
diltiazem HCL ER
felodipine ER
isradipine
nicardipine HCL
nifedipine
nifedipine ER
nimodipine
nisoldipine
verapamil HCL
verapamil HCL ER
verapamil HCL SR
NON PREFERRED
Adalat CC
Calan
Calan SR
Cardene SR
Cardizem
Cardizem CD
Cardizem LA
Dilacor XR
Hypertenipine-2.5
Nisoldipine
Nisoldipine ER
Norvasc
Nymalize
Procardia
Procardia XL
GENERIC
amiodarone HCL
disopyramide phosphate
flecainide acetate
mexiletine HCL
propafenone HCL
propafenone HCL ER
quinidine gluconate CR
quinidine gluconate ER
quinidine sulfate
PREFERRED BRAND
Multaq
Norpace CR
NON PREFERRED
Cordarone
Norpace
Quinidine Sulfate
Quinidine Sulfate ER
Rythmol
Rythmol SR
Tikosyn
TIER 03
GENERIC
benazepril HCL
captopril
enalapril maleate
fosinopril sodium
lisinopril
moexipril HCL
perindopril erbumine
quinapril HCL
ramipril
trandolapril
NON PREFERRED
Accupril
Aceon
Altace
Epaned
Lotensin
Mavik
Prinivil
Univasc
Vasotec
Zestril
ANGIOTENSIN RCPTR BLOCKER
TIER 01
TIER 02
TIER 03
GENERIC
candesartan cilexetil
irbesartan
losartan potassium
telmisartan
valsartan
PREFERRED BRAND
Benicar
NON PREFERRED
Atacand
Avapro
Cozaar
Diovan
Edarbi
Eprosartan Mesylate
5
Micardis
Teveten
Atacand HCT
Avalide
Captopril/Hydrochlorothiazide
Clorpres
Corzide
Diovan HCT
Dutoprol
Edarbyclor
Exforge
Hypertensolol
Hyzaar
Lopressor HCT
Lotensin HCT
Lotrel
Lytensopril Kit
Lytensopril-90
Lytensopril-90 Kit
Methyldopa/Hydrochlorothiazide
Micardis HCT
Propranolol/Hydrochlorothiazide
Tarka
Tenoretic 100
Tenoretic 50
Teveten HCT
Twynsta
Uniretic
Vaseretic
Zestoretic
Ziac
DIRECT RENIN INHIBITORS
TIER 02
PREFERRED BRAND
Tekturna
ANTIHYPERTENSIVES MISC.
TIER 01
TIER 03
GENERIC
clonidine HCL
doxazosin
doxazosin mesylate
eplerenone
guanfacine HCL
hydralazine HCL
methyldopa
minoxidil
phenoxybenzamine hydrochloride
prazosin HCL
terazosin HCL
NON PREFERRED
Cardura
Catapres
Catapres-tts-1
Catapres-tts-2
Catapres-tts-3
Demser
Dibenzyline
Inspra
Minipress
Reserpine
Tenex
Vecamyl
DIURETICS
TIER 01
ANTIHYPERTENSIVE COMBO
TIER 01
TIER 02
TIER 03
GENERIC
amlodipine besylate/benazepril hydrochloride
amlodipine besylate/benazepril HCL
amlodipine besylate/valsartan
amlodipine/valsartan/hctz
atenolol/chlorthalidone
benazepril HCL/hydrochlorothiazide
bisoprolol fumarate/hydrochlorothiazide
candesartan cilexetil/hydrochlorothiazide
enalapril maleate/hydrochlorothiazide
fosinopril sodium/hydrochlorothiazide
irbesartan/hydrochlorothiazide
lisinopril/hydrochlorothiazide
losartan potassium/hydrochlorothiazide
metoprolol/hydrochlorothiazide
moexipril/hydrochlorothiazide
nadolol/bendroflumethiazide
quinapril/hydrochlorothiazide
telmisartan/amlodipine
telmisartan/hydrochloroth
telmisartan/hydrochlorothiazide
trandolapril/verapamil HCL
trandolapril/verapamil HCL ER
valsartan/hydrochlorothiazide
PREFERRED BRAND
Amturnide
Azor
Benicar HCT
Exforge HCT
Tekamlo
Tekturna HCT
Tribenzor
NON PREFERRED
Accuretic
TIER 03
GENERIC
acetazolamide
acetazolamide ER
amiloride HCL
amiloride/hydrochlorothiazide
bumetanide
chlorothiazide
furosemide
hydrochlorothiazide
indapamide
methazolamide
metolazone
spironolactone
spironolactone/hydrochlorothiazide
torsemide
triamterene/hydrochlorothiazide
NON PREFERRED
Acetazolamide
Aldactazide
Aldactone
Chlorothiazide
Chlorthalidone
Demadex
Diamox
Diuril
Dyazide
Dyrenium
Edecrin
Furosemide
Introl
Lasix
Maxzide
Maxzide-25
Methyclothiazide
Microzide
Neptazane
Triamterene/Hydrochlorothiazide
Zaroxolyn
6
VASOPRESSORS
TIER 01
TIER 02
TIER 05
GENERIC
midodrine HCL
PREFERRED BRAND
Adrenaclick
Auvi-q
Epinephrine
Epipen 2-PAK
Epipen-JR 2-PAK
NortheraPA
CARDIOVASCULAR - MISC.
TIER 01
TIER 03
TIER 04
ANTIHYPERLIPIDEMICS
TIER 01
TIER 02
TIER 03
TIER 06
GENERIC
atorvastatin calcium
cholestyramine
cholestyramine light
colestipol HCL
colestipol HCL for oral suspension
fenofibrate
fenofibrate micronized
fenofibric acid DR
fluvastatin
gemfibrozil
lovastatin
niacin ER
omega-3-acid ethyl estersPA
pravastatin sodium
simvastatin
PREFERRED BRAND
CrestorST
Welchol
NON PREFERRED
Advicor
AltoprevST
Antara
Colestid
Colestid Flavored
Fenofibrate
Fenofibric Acid
Fenoglide
Fibricor
LescolST
Lescol XLST
Lipitor
Lipofen
LiptruzetPA
LivaloST
Lofibra
Lopid
LovazaPA
MevacorST
Niacor
Niaspan
PravacholST
Questran
Questran Light
Simcor
Tricor
Triglide
Trilipix
VascepaPA
VytorinPA
ZetiaST
ZocorST
JuxtapidPA
KynamroPA
PraluentPA
TIER 05
TIER 06
GENERIC
amlodipine besylate/atorvastatin calcium
NON PREFERRED
Bidil
CaduetST
CialisQL,ST
CorlanorST
Tyvaso
Tyvaso Refill
Tyvaso Starter
PREFERRED SPECIALTY
sildenafil citratePA
AdcircaPA
AdempasPA
LetairisPA
OpsumitPA
RevatioPA
TracleerPA
VentavisPA
sildenafilPA
OrenitramPA
DERMATOLOGICALS
ACNE PRODUCTS
TIER 01
TIER 03
GENERIC
adapalene
benzoyl peroxide
benzoyl peroxide SHORT contact
clindamycin phosphate
clindamycin/benzoyl peroxide
erythromycin
erythromycin/benzoyl peroxide
sodium sulfacetamide
sodium sulfacetamide/sulfur
sodium sulfacetamide/sulfur cleanser
sodium sulfacetamide/sulfur cleansing cloths
sodium sulfacetamide/sulfur green
sodium sulfacetamide/sulfur wash
sulfacetamide sodium
sulfacetamide sodium/sulfur cleanser
tretinoin microsphere
tretinoin microsphere P.M.
NON PREFERRED
AbsoricaQL
Acanya
AczonePA
Azelex
Benzac Ac Wash
Benzac W Wash
Benzaclin
Benzaclin With P.M.
Benzamycin
Benzamycinpak
Benzefoam
Benzefoamultra
Benziq
Benziq LS
ClaravisQL
Clindacin Etz
Clindacin PAC
Clinoin
Duac
Fabior
Inova
Inova 4/1 Acne Control Therapy
Inova 8/2 Acne Control Therapy
7
Nuox
Retin-a Micro
Retin-a Micro P.M.
Riax
Rosanil
Sodium Sulfacetamide/Sulfur Cleanser IN Urea
Sodium Sulfacetamide/Sulfur IN Urea
Sulfoam
Sumadan Kit
Sumaxin CP Kit
Vanoxide-HC
Veltin
Zacare 4% Kit
Zacare 8% Kit
ZenataneQL
Ziana
Lotrisone
LuzuST
MentaxST
NaftinST
Nizoral
OxistatST
Pediaderm AF Complete Kit
Pedipirox-4 Nail
Penlac Nail LacquerQL
Vusion
Xolegel
Xolegel Corepak
Xolegel Duo/Head & Shoulders
Xolegel Duo/Xolex
ANTIVIRALS - TOPICAL
TIER 01
ROSACEA AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
metronidazole
PREFERRED BRAND
Doxycycline
Oracea
NON PREFERRED
FinaceaPA
MirvasoST
Rosadan Kit
TIER 02
TIER 03
ANTI-INFLAMMATORY AGENTS
TIER 01
TIER 03
ANTIBIOTICS - TOPICAL
TIER 01
TIER 02
TIER 03
GENERIC
mupirocin
mupirocin calcium
PREFERRED BRAND
Altabax
Bactroban
Centany AT
NON PREFERRED
Cortisporin
Gentamicin Sulfate
Neo-synalar
ANTIFUNGALS - TOPICAL
TIER 01
TIER 03
GENERIC
ciclopirox
ciclopirox nail lacquerQL
ciclopirox olamine
clotrimazole
clotrimazole/betamethasone dipropionate
econazole nitrate
ketoconazole
naftifine HCLST
nystatin
nystatin/triamcinolone
NON PREFERRED
Ciclodan Cream KitPA
Ciclodan Solution Kit
Ciclopirox Topical Solution Kit
Cnl8 Nail KitPA
ErtaczoST
Exelderm
Exoderm
Extina
Halotin
JubliaPA
KerydinPA
Ketodan KitPA
Lamisil Spray
Loprox
Loprox Shampoo
GENERIC
acyclovir
PREFERRED BRAND
Zovirax
NON PREFERRED
DenavirST
Lidovir
GENERIC
diclofenac sodiumST
NON PREFERRED
FlectorST
Lidoprofen
PennsaidST
Voltaren
Vopac Kt
ANTIPRURITICS
TIER 03
NON PREFERRED
Prudoxin
Zonalon
ANTIPSORIATICS
TIER 01
TIER 02
TIER 03
TIER 05
GENERIC
acitretin
calcipotriene
methoxsalen
PREFERRED BRAND
Dritho-creme HP
Oxsoralen Ultra
Soriatane
8-mop
NON PREFERRED
CalcitriolST
TazoracPA
VecticalST
Zithranol
Zithranol-rr
CosentyxPA
Cosentyx Sensoready PenPA
ANTISEBORRHEIC AGENTS
TIER 01
TIER 03
GENERIC
selenium sulfide
sodium sulfacetamide wash
NON PREFERRED
Glycolic Acid
Glycolic Acid 70% High Purity
Ovace Plus
Ovace Plus Wash
8
Ovace Wash
Promiseb CompletePA
Seb-prev
Selrx
Tersi Foam
CORTICOSTEROIDS - TOPICAL
TIER 01
TIER 03
GENERIC
alclometasone dipropionate
augmented betamethasone dipropionate
betamethasone dipropionate
betamethasone valerate
calcipotriene/betamethasone dipropionateQL,ST
clobetasol propionate
clobetasol propionate emollient
desonide
desoximetasone
fluocinolone acetonide
fluocinonide
fluocinonide-e
fluticasone propionate
halobetasol propionate
hydrocortisone
hydrocortisone acetate/aloe
hydrocortisone butyrate
hydrocortisone butyrate (lipid)
hydrocortisone butyrate (lipophilic)
hydrocortisone valerate
hydrocortisone IN absorbase
mometasone furoate
prednicarbate
triamcinolone acetonide
NON PREFERRED
Carmol-HC
Cordran
Cordran Tape
Cortalo
Epifoam
Nuzon
Pramosone
Scalacort DK
Synalar Cream Kit
Synalar Ointment Kit
TaclonexQL,ST
Triamcinolone Acetonide
Ultravate XPA
IMMUNOMODULATING AGENTS
TIER 01
TIER 03
GENERIC
imiquimod
tacrolimus
NON PREFERRED
Elidel
Protopic
Zyclara
Zyclara P.M.
DERMATOLOGICALS - MISC.
TIER 01
GENERIC
ammonium lactate
lactic acid
lactic acid e
lactic acid w/vitamin e
lidocaine
lidocaine HCL
lidocaine HCL jelly
lidocaine/prilocaine
lindane
malathion
TIER 02
TIER 03
permethrin
podofilox
salicylic acid
salicylic acid cream
salicylic acid lotion
urea
urea topical
urea IN zinc undecylenate/lactic acid vehicle
urea 40% nail film
PREFERRED BRAND
Condylox
Eurax
NON PREFERRED
Acuicyn Daily Eyelid & Eyelash Cleanser
Anacaine
Arnica Flower
Aurstat Anti-itch Hydrogel
Benzoin Compound Tincture
Benzoin Tincture
Boric Acid
Capsiderm
Coal TAR
Cocaine HCL
Copasil
Drysol
Elenzapatch
Elimite
Emla
Ethyl Chloride
Ethyl Chloride/Fine Pinpoint
Ethyl Chloride/Fine Stream
Ethyl Chloride/Medium Jet Stream
Ethyl Chloride/Medium Stream
Ethyl Chloride/Mist
Gordofilm
Hydro 35
Hylira
Keralyt
Keralyt Scalp
K2k Pain Relieving Patch
Lac-hydrin
Latrix XM
Lidocaine And Tetracaine Cream
Lidocaine HCL
LidodermPA
Lycelle
Medi-derm/L-RX
Megrix
Neuvaxin
Nuvail
Ovide
Oxsoralen
Pliaglis
Prolida
Pyrogallic Acid
Relyyt
Salex
Salex Cream
Salex Lotion
Salicylic Acid
Salicylic Acid IN Ammonium Lactate Vehicle
Salkera
Salvax
Salvax Duo Plus
Sinelee
SklicePA
Sulfurated Lime
Synera
Ulesfia
Umecta PD
9
StriantPA
TestimPA
Testone CikPA
TestosteronePA
Testosterone P.M.PA
TestredPA
VogelxoPA
Vogelxo P.M.PA
Uramaxin
Veregen
Virasal
Xerac Ac
Xylocaine
Xyphex
ENDOCRINE AND METABOLIC
CORTICOSTEROIDS
TIER 01
TIER 02
TIER 03
TIER 05
TIER 06
GENERIC
dexamethasone
fludrocortisone acetate
hydrocortisone
methylprednisolone
methylprednisolone dose pack
prednisolone
prednisolone sodium phosphate
prednisolone sodium phosphate odt
prednisone
PREFERRED BRAND
Dexamethasone Intensol
Medrol
Millipred
Prednisone Intensol
NON PREFERRED
Celestone
Cortef
Cortisone Acetate
Dexamethasone
Dexpak 10 Day
Dexpak 13 Day
Dexpak 6 Day
FLO-pred
Medrol Dosepak
Millipred DP
Orapred
Orapred Odt
Pediapred
Prednisolone Sodium Phosphate
Prednisone
Rayos
Veripred 20
UcerisPA
budesonidePA
Entocort ECPA
ESTROGENS
TIER 01
TIER 02
TIER 03
CONTRACEPTIVES
TIER 01
ANDROGENS-ANABOLIC
TIER 01
TIER 02
TIER 03
GENERIC
danazol
oxandrolone
testosterone cypionate
testosterone enanthate
PREFERRED BRAND
AndrogelPA
Androgel P.M.PA
NON PREFERRED
Anadrol-50
AndrodermPA
AndroidPA
AndroxyPA
AveedPA
AxironPA
Depo-testosterone
First-testosteronePA
First-testosterone Mc Compounding KitPA
FortestaPA
Oxandrin
GENERIC
estradiol
estradiol valeratePA
estradiol/norethindrone acetate
estropipate
norethindrone acetate/ethinyl estradiol
PREFERRED BRAND
Alora
Femhrt Low Dose
Menest
Menostar
Minivelle
NON PREFERRED
Activella
Angeliq
Cenestin
Climara
Climara Pro
Combipatch
DelestrogenPA
Divigel
Duavee
Elestrin
Enjuvia
Estrace
Estrasorb
Estrogel
Estropipate
Evamist
Prefest
Premarin
Premphase
Prempro
Vivelle-dot
TIER 03
GENERIC
desogestrel/ethinyl estradiol
drospirenone/ethinyl estradiol
levonorgestrel
levonorgestrel and ethinyl estradiol
levonorgestrel/ethinyl estradiol
norethindrone
norethindrone & ethinyl estradiol ferrous fumarate
norethindrone acetate/ethinyl estradiol
norethindrone acetate/ethinyl estradiol/ferrous fumarate
norgestimate/ethinyl estradiol
NON PREFERRED
Beyaz
Brevicon-28
Cyclessa
Desogen
Ella
Estrostep FE
Falessa
Femcon FE
Generess FE
Levonorgestrel
Loestrin FE 1.5/30
10
Loestrin FE 1/20
Loestrin 1.5/30-21
Loestrin 1/20-21
Loseasonique
LO Loestrin FE
LO Minastrin FE
Minastrin 24 FE
Mircette
Modicon
Natazia
Necon 1/50-28
Necon 10/11-28
Nor-QD
Norinyl 1+35
Norinyl 1+50
Nuvaring
Ogestrel
Ortho Evra
Ortho Micronor
Ortho Tri-cyclen
Ortho Tri-cyclen LO
Ortho-cept
Ortho-cyclen
Ortho-novum 1/35
Ortho-novum 7/7/7
Ovcon-35
Plan B
Plan B One-step
Quartette
Safyral
Seasonique
Tri-norinyl 28
Yasmin 28
Yaz
Zovia 1/50e
TIER 03
AMYLIN ANALOGS
NON PREFERRED
TIER 03
Symlinpen 120ST
Symlinpen 60ST
INCRETIN MIMETIC AGENTS
NON PREFERRED
TIER 03
BydureonST
ByettaST
TanzeumQL,ST
TrulicityQL,ST
VictozaST
SULFONYLUREAS
GENERIC
TIER 01
PROGESTINS
TIER 01
TIER 03
GENERIC
medroxyprogesterone acetate
megestrol acetate
norethindrone acetate
progesterone
NON PREFERRED
Aygestin
Megace ES
Progesterone 10% Kit
Prometrium
Provera
ANTIDIABETIC AGENTS
INSULIN
TIER 02
PREFERRED BRAND
HumalogQL
Humalog KwikpenQL
Humalog Mix 50/50QL
Humalog Mix 50/50 KwikpenQL
Humalog Mix 75/25QL
Humalog Mix 75/25 KwikpenQL
Humulin NQL
Humulin N KwikpenQL
Humulin N U-100 PenQL
Humulin RQL
Humulin R U-500 (concentrated)QL
Humulin 70/30QL
Humulin 70/30 KwikpenQL
Humulin 70/30 PenQL
LantusQL
Lantus SolostarQL
LevemirQL
Levemir FlexpenQL
Levemir FlextouchQL
Toujeo SolostarQL
NON PREFERRED
AfrezzaQL
ApidraQL
Apidra SolostarQL
Novolin NQL
Novolin N RelionQL
Novolin RQL
Novolin R RelionQL
Novolin 70/30QL
Novolin 70/30 RelionQL
NovologQL
Novolog FlexpenQL
Novolog Mix 70/30QL
Novolog Mix 70/30 Prefilled FlexpenQL
Novolog PenfillQL
Relion RQL
TIER 02
TIER 03
BIGUANIDES
TIER 01
TIER 03
glimepiride
glipizide
glipizide ER
glyburide
glyburide micronized
tolazamide
PREFERRED BRAND
Diabeta
Glyburide
NON PREFERRED
Amaryl
Chlorpropamide
Glucotrol
Glucotrol XL
Glynase
Tolazamide
Tolbutamide
GENERIC
metformin HCL
metformin HCL ER
NON PREFERRED
FortametST
Glucophage
Glucophage XR
Glumetza
Riomet
MEGLITINIDE ANALOGUES
GENERIC
TIER 01
TIER 03
nateglinide
repaglinide
NON PREFERRED
Prandin
Starlix
DIABETIC OTHER
PREFERRED BRAND
TIER 02
Glucagen Hypokit
Glucagon Emergency Kit
TIER 03
11
TIER 05
NON PREFERRED
FarxigaQL,ST
InvokanaQL,ST
JardianceST
Proglycem
KorlymPA
CALCITONINS
TIER 01
TIER 02
TIER 03
ALPHA-GLUCOSIDASE INHIBIT
GENERIC
TIER 01
TIER 03
acarbose
NON PREFERRED
Glyset
Precose
DPP-4 INHIBITORS
PREFERRED BRAND
TIER 02
TIER 03
TradjentaQL,ST
NON PREFERRED
JanuviaQL,ST
NesinaST
OnglyzaQL,ST
PARATHYROID HORMONE
TIER 05
TIER 06
TIER 03
ANTIDIABETIC COMBINATIONS
GENERIC
TIER 01
TIER 02
TIER 03
glipizide/metformin HCL
glyburide/metformin HCL
pioglitazone HCL-glimepirideST
pioglitazone HCL/metformin HCLST
PREFERRED BRAND
AvandametST
AvandarylST
DuetactST
JentaduetoQL,ST
NON PREFERRED
Actoplus MetST
Actoplus Met XRST
Appformin
Appformin-d
Glucovance
GlyxambiST
InvokametST
JanumetQL,ST
Janumet XRQL,ST
KazanoST
Kombiglyze XRQL,ST
OseniQL,ST
Prandimet
Xigduo XRPA,QL
TIER 01
TIER 03
TIER 03
GENERIC
alendronate sodium
ibandronate sodium
risedronate sodiumST
risedronate sodium DRST
NON PREFERRED
ActonelST
Alendronate Sodium
AtelviaST
BinostoST
BonivaST
Etidronate Disodium
Fosamax
Fosamax Plus D
GENERIC
raloxifene hydrochloride
NON PREFERRED
Evista
Osphena
FERTILITY REGULATORS
TIER 01
TIER 04
TIER 05
GENERIC
clomiphene citratePA
PREFERRED SPECIALTY
chorionic gonadotropinPA
Follistim AQPA
BravellePA
Gonal-fPA
Gonal-f RFFPA
Gonal-f RFF PenPA
Gonal-f RFF RedijectPA
MenopurPA
OvidrelPA
RepronexPA
LHRH/GNRH AGONIST
TIER 02
PREFERRED BRAND
Synarel
GNRH/LHRH ANTAGONISTS
TIER 05
CetrotidePA
Ganirelix AcetatePA
GROWTH HORMONES
TIER 04
TIER 05
BISPHOSPHONATES
TIER 01
ForteoPA
NatparaPA
HORMONE RECEPTOR MDLTR
INSULIN SENSITIZING AGENT
GENERIC
TIER 01
pioglitazone HCLST
NON PREFERRED
ActosST
AvandiaST
GENERIC
calcitonin salmon
calcitonin-salmon
PREFERRED BRAND
Miacalcin
NON PREFERRED
Fortical
PREFERRED SPECIALTY
OmnitropePA
GenotropinPA
Genotropin MiniquickPA
HumatropePA
Humatrope Combo PackPA
Norditropin CartridgePA
Norditropin FlexproPA
Norditropin Nordiflex PenPA
Nutropin AQ Nuspin 10PA
Nutropin AQ PenPA
Tev-tropinPA
GHRH
TIER 06
EgriftaPA
12
SOMATOMEDINS
TIER 05
IncrelexPA
TIER 02
SOMATOSTATIC AGENTS
TIER 04
TIER 05
TIER 06
PREFERRED SPECIALTY
octreotide acetatePA
SandostatinPA
SigniforPA
TIER 03
GH RECEPTOR ANTAGONISTS
TIER 06
SomavertPA
POSTERIOR PITUITARY
TIER 01
TIER 02
TIER 03
GENERIC
desmopressin acetate
PREFERRED BRAND
Stimate
NON PREFERRED
Ddavp
GASTROINTESTINAL
LAXATIVES
TIER 01
CORTICOTROPIN
TIER 06
H.p. ActharPA
PROLACTIN INHIBITORS
TIER 01
TIER 03
GENERIC
cabergoline
VASOPRESSIN ANTAGONISTS
TIER 05
SamscaPA
PROGESTERONE ANTAGONISTS
TIER 03
NON PREFERRED
Mifeprex
METABOLIC MODIFIERS
TIER 01
TIER 03
TIER 05
TIER 06
GENERIC
calcitriol
doxercalciferol
levocarnitine
paricalcitol
sodium phenylbutyrate
NON PREFERRED
Buphenyl
Carnitor
Carnitor SF
Cystadane
Hectorol
Rocaltrol
Zemplar
SensiparPA
CarbagluPA
KuvanPA
MyaleptPA
OrfadinPA
RavictiPA
VimizimPA
THYROID AGENTS
TIER 01
GENERIC
levothyroxine sodium
liothyronine sodium
methimazole
propylthiouracil
PREFERRED BRAND
Armour Thyroid
Synthroid
Thyrolar-1
Thyrolar-1/2
Thyrolar-1/4
Thyrolar-2
Thyrolar-3
NON PREFERRED
Cytomel
Nature-throid
Nature-throid Nt-2.5
Tapazole
Tirosint
Westhroid
Wp Thyroid
GENERIC
lactulose
peg 3350/electrolytes
peg-3350/electrolytes
peg-3350/NACL/NA bicarbonate/KCL
polyethylene glycol 3350
NON PREFERRED
Colyte-flavor Packs
Golytely
Kristalose
Mineral Oil Heavy
Moviprep
Nulytely/Flavor Packs
Osmoprep
Prepopik
Suclear
Suprep Bowel Prep
ANTIDIARRHEALS
TIER 01
TIER 03
GENERIC
diphenoxylate/atropine
loperamide HCL
opium
opium tincture
NON PREFERRED
Diphenoxylate/Atropine
FulyzaqPA
Lomotil
Motofen
Opium Tincture (paregoric)
Rezyst SB
ANTACIDS
TIER 03
NON PREFERRED
Sodium Bicarbonate
ULCER DRUGS
TIER 01
GENERIC
cimetidine
cimetidine HCL
dicyclomine HCL
esomeprazole magnesiumPA,QL
famotidine
glycopyrrolate
hyoscyamine sulfate
hyoscyamine sulfate odt
hyoscyamine sulfate ER
13
TIER 02
TIER 03
hyoscyamine sulfate SR
lansoprazole
lansoprazole/amoxicillin/clarithromycin
methscopolamine bromide
misoprostol
nizatidine
omeprazole
omeprazole/sodium bicarbonate
pantoprazole sodium
rabeprazole sodiumPA
ranitidine HCL
sucralfate
PREFERRED BRAND
Carafate
NON PREFERRED
AciphexPA
Aciphex SprinklePA
Anaspaz
Axid
Belladonna & Opium
Belladonna Alkaloids & Opium
Bentyl
Cantil
Cuvposa
Cytotec
DexilantPA
Esomeprazole StrontiumPA
First-lansoprazolePA
First-omeprazole
Gabitidine
Gastrinex NF
Helidac
Levbid
Levsin
Levsin/SL
NexiumPA,QL
Omeclamox-PAK
Omeprazole + Syrspend SF Alka
Pamine
Pamine Forte
Pamine FQ
Pepcid
Prevacid
Prevacid Solutab
Prevpac
Prilosec
Propantheline Bromide
Protonix
Pylera
Robinul
Robinul Forte
Sentradine
Symax Duotab
Zantac
ZegeridPA
ANTIEMETICS
TIER 01
TIER 02
GENERIC
dronabinol
granisetron HCL
meclizine HCL
ondansetron odt
ondansetron HCL
trimethobenzamide HCL
PREFERRED BRAND
Anzemet
EmendQL
SancusoQL
TIER 03
NON PREFERRED
AkynzeoQL
Cesamet
Diclegis
Granisol
Marinol
Tigan
Transderm-scop
Zofran
Zofran Odt
Zuplenz
DIGESTIVE AIDS
TIER 02
TIER 03
TIER 05
PREFERRED BRAND
Creon
Zenpep
NON PREFERRED
Pancreaze
Pancrelipase
Pertzye
Ultresa
Viokace
SucraidPA
GASTROINTESTINAL - MISC.
TIER 01
TIER 02
TIER 03
GENERIC
alosetron hydrochloridePA
balsalazide disodium
calcium acetate
cromolyn sodium
hydrocort ene 100MG
hydrocortisone
hydrocortisone acetate/lidocaine HCL
hydrocortisone acetate/pramoxine
lactulose
lidocaine HCL/hydrocortisone acetate
mesalamine
metoclopramide odt
metoclopramide HCL
sulfasalazine
ursodiol
PREFERRED BRAND
AmitizaQL
Analpram-HC
Analpram-HC Singles
Apriso
Asacol HD
Canasa
Cortifoam
Delzicol
Dipentum
LinzessQL
RelistorPA
NON PREFERRED
Actigall
Anusol-HC
Auryxia
Azulfidine
Azulfidine EN-TABS
Chenodal
Colazal
Cortenema
Eliphos
Entereg
Fosrenol
Gastrocrom
GiazoPA
Lialda
14
TIER 04
TIER 05
TIER 06
Lidocaine HCL-hydrocortisone Acetate With Aloe
LotronexPA
Metozolv Odt
Pentasa
Phoslo
Phoslyra
Procort
Proctocort
Proctofoam HC
Rectiv
Reglan
Renagel
Renvela
Rowasa
Sevelamer Carbonate
Sfrowasa
Urso Forte
Urso 250
PREFERRED SPECIALTY
CimziaPA
Cimzia Starter KitPA
Velphoro
CholbamPA
GattexPA
Gelnique
Sanctura
Sanctura XR
Toviaz
Urecholine
VAGINAL PRODUCTS
TIER 01
TIER 02
TIER 03
GENITOURINARY
URINARY ANTI-INFECTIVES
TIER 01
TIER 02
TIER 03
GENERIC
methenamine hippurate
methenamine mandelate
nitrofurantoin
nitrofurantoin macrocrystals
nitrofurantoin monohydrate
nitrofurantoin monohydrate/macrocrystals
PREFERRED BRAND
Macrodantin
NON PREFERRED
Furadantin
Hiprex
Macrobid
Methenamine Mandelate
Monurol
Prosed/DS
Uretron D/S
Urimar-t
Urogesic-blue
Uroqid #2
Uta
GENITOURINARY - MISC.
TIER 01
TIER 02
URINARY ANTISPASMODICS
TIER 01
TIER 02
TIER 03
GENERIC
bethanechol chloride
flavoxate HCL
oxybutynin chloride
oxybutynin chloride ER
tolterodine tartrate
tolterodine tartrate ER
trospium chloride
trospium chloride ER
PREFERRED BRAND
Myrbetriq
Vesicare
NON PREFERRED
Detrol
Detrol LA
Ditropan XL
Enablex
GENERIC
clindamycin phosphate
metronidazole vaginal
terconazole
PREFERRED BRAND
Endometrin
Estrace
Estring
NON PREFERRED
Avc
Cleocin
Clindesse
Crinone
Fem PH
Femring
First-progesterone VGS 100 Compounding Kit
Gynazole-1
Metrogel-vaginal
Premarin
Relagard
Terazol 3
Terazol 7
Vagifem
TIER 03
GENERIC
alfuzosin HCL ER
citric acid/sodium citrate
finasteride
phenazopyridine HCL
potassium citrate ER
potassium citrate-citric acid crystals
potassium citrate/citric acid
potassium citrate/sodium citrate/citric acid
sodium citrate/citric acid
tamsulosin HCL
tricitrates
PREFERRED BRAND
Avodart
Cardura XL
Jalyn
Oracit
Shohls Solution Modified
Urocit-k 10
Urocit-k 15
Urocit-k 5
Uroxatral
NON PREFERRED
Citrolith
Cystagon
Cytra-3
Elmiron
Flomax
K-phos NO 2
Lithostat
Proscar
Pyridium
Rapaflo
15
TIER 06
ThiolaPA
ProcysbiPA
HEMATOLOGICAL
HEMATOPOIETIC AGENTS
TIER 01
TIER 02
TIER 03
TIER 04
TIER 05
GENERIC
folic acid
folic acid/vitamin b-6/vitamin b-12
PREFERRED BRAND
Droxia
Nascobal
NON PREFERRED
Abaneu-SL
Animi-3
Animi-3/Vitamin D
B-6 Folic Acid
Biferarx
Cenfol
Centratex
Ciferex
Corvite 150
Divista
Ed Cyte F
Feriva
Ferivafa
Ferralet 90
Ferrex 150 Forte Plus
Ferrex 28
Ferro-plex Hematinic
Ferrotrin
Focalgin Dss
Folgard RX
Folivane-f
Folivane-plus
Foltrate
Fusion Plus
Hematogen Fa
Hematron-AF
Hemocyte Plus
Hemocyte-f
Icar-c Plus
Integra F
Integra Plus
Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C
Threon/Suc
Irospan 24/6
Is 24/6
Maxaron Forte
Maxfe
Mircera
Multigen
Multigen Folic
Multigen Plus
MV FE Asparto Gly/FE Fum/Succ Acid/Vit C/Threonic
Acd/B12/Fa
MV FE Asparto Gly/Vit C/Vit B12/CA Threonate/Succ
Acd/Stomac
Natalvirt Flt
Nephron Fa
Novaferrum
Pre-folic
Proferrin-forte
Protectiron
Tandem F
Tandem Plus
PREFERRED SPECIALTY
Granix
Aranesp Albumin Free
TIER 06
Epogen
Leukine
Neulasta
Neulasta Delivery Kit
NeumegaPA
Neupogen
OmontysPA
Procrit
PromactaPA
VprivPA
CerdelgaPA
ZavescaPA
ANTICOAGULANTS
TIER 01
TIER 02
TIER 03
GENERIC
enoxaparin sodium
fondaparinux sodium
warfarin sodium
PREFERRED BRAND
Arixtra
Coumadin
Fragmin
Xarelto
Xarelto Starter Pack
NON PREFERRED
EliquisST
Lovenox
PradaxaST
SavaysaST
HEMOSTATICS
TIER 01
TIER 02
TIER 03
GENERIC
aminocaproic acid
tranexamic acid
PREFERRED BRAND
Lysteda
NON PREFERRED
Amicar
Aminocaproic Acid
Artiss
Astringyn
Evicel
Evithrom
Recothrom
Recothrom Spray Kit
Thrombin-jmi Diluent
Thrombin-jmi Epistaxis
Thrombin-jmi Syringe Spray Kit
Thrombin-jmi W/Dil Spray P.M. Actuator
Thrombogen
Tisseel
Tisseel VH
HEMATOLOGICAL - MISC.
TIER 01
TIER 02
TIER 03
GENERIC
anagrelide hydrochloride
cilostazol
clopidogrel
dipyridamole
pentoxifylline ER
ticlopidine HCL
PREFERRED BRAND
Brilinta
NON PREFERRED
Aggrenox
Agrylin
Aspirin/Dipyridamole
EffientPA
16
TIER 05
TIER 06
Persantine
Plavix
Pletal
ZontivityST
RuconestPA
FirazyrPA,QL
Ativan
Diazepam
Gabavale-5
Gabazolamine
Gabazolamine-0.5
Hydroxyzine Pamoate
Lorazepam Intensol
NiravamST
Sentrazolam AM 0.25
Tranxene T
Valium
Vistaril
Xanax
Xanax XR
MOUTH/THROAT/DENTAL AGENT
TIER 01
TIER 03
GENERIC
cevimeline HCL
chlorhexidine gluconate
chlorhexidine gluconate oral rinse
clotrimazole
lidocaine viscous
lidocaine HCL
lidocaine HCL viscous
nystatin
pilocarpine hydrochloride
pilocarpine HCL
stannous fluoride oral rinse
triamcinolone IN orabase
NON PREFERRED
Aquoral
Caphosol
Debacterol
Evoxac
First-bxn Mouthwash
First-dukes Mouthwash
First-marys Mouthwash
First-mouthwash Blm
Gel-kam Oral Care Rinse
Gelclair
Lta 360 Kit
Nafrinse Daily/Acidulated
Nafrinse Daily/Neutral
Nafrinse Weekly
Neutrasal
Numoisyn
Orafate
Oravig
Peridex
Prevident
Prothelial
Salagen
NEUROLOGY, CNS, PSYCH
ANTIANXIETY AGENTS
TIER 01
TIER 03
GENERIC
alprazolam
alprazolam odtST
alprazolam ER
buspirone HCL
chlordiazepoxide HCL
clorazepate dipotassium
diazepam
gene-xene TAB 15MG
gene-xene TAB 3.75MG
gene-xene TAB 7.5MG
hydroxyzine pamoate
hydroxyzine HCL
lorazepam
meprobamate
oxazepam
NON PREFERRED
Alprazolam Intensol
ANTIDEPRESSANTS
TIER 01
TIER 02
TIER 03
GENERIC
amitriptyline HCL
bupropion HCL
bupropion HCL ER
bupropion HCL SR
bupropion HCL XL
citalopram hydrobromide
clomipramine HCL
desipramine HCL
doxepin HCL
duloxetine HCLQL
escitalopram oxalate
fluoxetine DR
fluoxetine HCL
fluvoxamine maleate
fluvoxamine maleate ER
imipramine pamoate
imipramine HCL
mirtazapine
mirtazapine odt
nefazodone HCL
nortriptyline HCL
paroxetine HCL
paroxetine HCL ER
phenelzine sulfate
protriptyline HCL
sertraline HCL
tranylcypromine sulfate
trazodone HCL
venlafaxine HCL
venlafaxine HCL ER
PREFERRED BRAND
Emsam
Paxil
NON PREFERRED
Amoxapine
Anafranil
AplenzinPA,QL
Appbutamone
Appbutamone-d
BrintellixPA
Celexa
CymbaltaQL
Desvenlafaxine ER
Doxepin HCL
Effexor XR
FetzimaPA
Fetzima Titration Pack
Fluoxetine HCL
Forfivo XL
Gaboxetine
Khedezla
Lexapro
17
Luvox CR
Maprotiline HCL
Marplan
Nardil
Nefazodone HCL
Norpramin
Nortriptyline HCL
OleptroST
Pamelor
Parnate
Paxil CR
PexevaST
PristiqPA
Prozac
Prozac Weekly
Remeron
Remeron Soltab
Sentraflox AM-10
Sentralopram AM-10
Sentravil PM-25
Sentroxatine
Surmontil
Tofranil
Tofranil-PM
Trazamine
ViibrydPA
Vivactil
Wellbutrin
Wellbutrin SR
Wellbutrin XL
ZoloftQL
LatudaST
Lithium
Lithium Carbonate
Lithobid
Loxitane
RexultiST
RisperdalST
Risperdal M-TAB
SaphrisST
Seroquel
Seroquel XRST
Versacloz
ZyprexaST
Zyprexa Zydis
HYPNOTICS
TIER 01
TIER 03
ANTIPSYCHOTICS
TIER 01
TIER 02
TIER 03
GENERIC
aripiprazoleST
chlorpromazine HCL
clozapine
fluphenazine HCL
haloperidol
lithium carbonate
lithium carbonate ER
loxapine
loxapine succinate
olanzapine
olanzapine odt
perphenazine
prochlorperazine
prochlorperazine maleate
quetiapine fumarate
risperidone
risperidone odt
thioridazine HCL
thiothixene
trifluoperazine HCL
ziprasidone HCL
PREFERRED BRAND
Clozapine Odt
Equetro
Fazaclo
Geodon
NON PREFERRED
AbilifyST
Abilify Discmelt
Clozaril
Compazine
FanaptST
Fanapt Titration PackST
Fluphenazine HCL
InvegaST
TIER 06
GENERIC
estazolam
eszopiclone
flurazepam HCL
phenobarbital
temazepam
triazolam
zaleplon
zolpidem tartrate
zolpidem tartrate ER
NON PREFERRED
Ambien
Ambien CR
BelsomraST
Butisol Sodium
Doral
EdluarPA
Flurazepam HCL
Gabazolpidem-5
Halcion
IntermezzoPA
Lunesta
Phenobarbital
Quazepam
Restoril
Rozerem
Seconal
Sentrazolpidem PM-5
SilenorST
Sonata
Strazepam
ZolpimistST
HetliozPA
ADHD, NARCOLEPSY, ETC.
TIER 01
GENERIC
amphetamine/dextroamphetamine
caffeine citrate
clonidine HCL ER
dexmethylphenidate HCL
dexmethylphenidate HCL ER
dextroamphetamine sulfate
dextroamphetamine sulfate ER
guanfacine ER
methamphetamine HCL
methylphenidate hydrochloride
methylphenidate HCL
methylphenidate HCL CD
methylphenidate HCL ER
methylphenidate HCL SR
modafinilPA
TIER 03
18
NON PREFERRED
Adderall
Adderall XR
Aptensio XR
Cafcit
Concerta
Daytrana
Desoxyn
Dexedrine
Evekeo
Focalin
Focalin XR
Intuniv
Kapvay
Kapvay Dose Pack
Metadate CD
Methylin
Methylphenidate HCL ER
NuvigilPA
Procentra
ProvigilPA
Quillivant XRPA,QL
Ritalin
Ritalin LA
Ritalin SR
Sentramodafin AM-100
Strattera
Vyvanse
Zenzedi
TIER 03
ANTICONVULSANTS
TIER 01
TIER 02
GENERIC
carbamazepine
carbamazepine ER
clonazepam
clonazepam odt
divalproex sodium
divalproex sodium DR
divalproex sodium ER
ethosuximide
felbamate
gabapentin
lamotrigine
lamotrigine odt
lamotrigine ER
levetiracetam
levetiracetam ER
oxcarbazepine
phenytoin
phenytoin sodium extended
primidone
tiagabine hydrochloride
topiramate
valproic acid
zonisamide
PREFERRED BRAND
Banzel
Carbatrol
Depakene
Depakote
Depakote ER
Depakote Sprinkles
Dilantin
Felbatol
Gabitril
Klonopin
Lamictal
Lamictal Chewable Dispersible
Lamictal Odt
TIER 05
Lamictal Starter/Not Taking Carbamazepine
Lamictal Starter/Taking Carbamazepine/Not Taking
Valproate
Lamictal Starter/Taking Valproate
Lamictal XR
Mysoline
Phenytek
Tegretol
Tegretol-XR
Zarontin
Zonegran
NON PREFERRED
AptiomST
Celontin
Diastat Acudial
Diastat Pediatric
Diazepam
Dilantin Infatabs
Dilantin-125
Fycompa
Keppra
Keppra XR
LyricaST
Neurontin
Onfi
Oxtellar XR
Peganone
PotigaPA
Qudexy XRST
Stavzor
Therapentin-60
Therapentin-90
Topamax
Topamax Sprinkle
Topiramate ERST
Trileptal
Trokendi XRPA,ST
Vimpat
SabrilPA
ANTIPARKINSON AGENTS
TIER 01
TIER 03
GENERIC
amantadine HCL
benztropine mesylate
bromocriptine mesylate
carbidopa
carbidopa/levodopa
carbidopa/levodopa odt
carbidopa/levodopa ER
entacapone
pramipexole dihydrochloride
pramipexole dihydrochloride ER
ropinirole ER
ropinirole HCL
selegiline HCL
tolcapone
trihexyphenidyl HCL
NON PREFERRED
Amantadine HCL
Azilect
Carbidopa/Levodopa/Entacapone
Comtan
Duopa
Eldepryl
Lodosyn
Mirapex
Mirapex ER
Neupro
19
TIER 05
Parcopa
Parlodel
Requip
Requip XL
Rytary
Sinemet
Sinemet CR
Stalevo 100
Stalevo 125
Stalevo 150
Stalevo 200
Stalevo 50
Stalevo 75
Tasmar
Zelapar
ApokynPA
NEUROLOGY, PSYCH - MISC.
TIER 01
TIER 02
TIER 03
TIER 04
GENERIC
acamprosate calcium DR
bupropion HCL SR
disulfiram
donepezil HCL
ergoloid mesylates
fluoxetine
galantamine
galantamine hydrobromide
memantine HCL
memantine HCL titration PAK
olanzapine/fluoxetinePA
rivastigmine tartrate
PREFERRED BRAND
Antabuse
Campral
Chantix
Chantix Continuing Month PAK
Chantix Starting Month PAK
Namenda
Namenda Titration PAK
Namenda XR
Namenda XR Titration Pack
Nicotrol Inhaler
Nicotrol Ns
Sarafem
NON PREFERRED
Aricept
Aricept Odt
BrisdelleST
Chlordiazepoxide/Amitriptyline
Exelon
Galantamine Hydrobromide
GraliseST
Gralise StarterST
HorizantST
Nuedexta
Orap
Perphenazine/Amitriptyline
Razadyne
Razadyne ER
SavellaPA
Savella Titration PackPA
SymbyaxPA
Zyban
PREFERRED SPECIALTY
BetaseronPA
CopaxonePA
RebifPA
Rebif RebidosePA
TIER 05
TIER 06
Rebif Rebidose Titration PackPA
Rebif Titration PackPA
AubagioPA
AvonexPA
Avonex PenPA
ExtaviaPA
GilenyaPA
PlegridyPA
Plegridy Starter PackPA
TecfideraPA
Tecfidera Starter PackPA
tetrabenazinePA
AmpyraPA
XenazinePA
XyremST
NEUROMUSCULAR AGENTS
TIER 05
riluzole
Rilutek
MUSCULOSKELETAL AGENTS
TIER 01
TIER 03
GENERIC
baclofen
carisoprodol
carisoprodol/aspirin
carisoprodol/aspirin/codeine
chlorzoxazone
cyclobenzaprine HCL
dantrolene sodium
metaxalone
methocarbamol
orphenadrine citrate ER
orphenadrine/asa/caffeine
tizanidine HCL
NON PREFERRED
Amrix
Carisoprodol
Dantrium
Dantrolene Sodium
FexmidST
Lorzone
Metaxalone
Parafon Forte DSC
Prazolamine
Robaxin
Robaxin-750
Skelaxin
Soma
Therabenzaprine-60
Therabenzaprine-90
Therabenzaprine-90-5
Zanaflex
ANTIMYASTHENIC AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
pyridostigmine bromide
PREFERRED BRAND
Mestinon Timespan
NON PREFERRED
Guanidine HCL
Mestinon
Prostigmin
OPHTHALMOLOGY AND OTIC
ANTI-INFECTIVES
TIER 01
20
TIER 03
GENERIC
bacitracin/polymyxin b
ciprofloxacin HCL
erythromycin
gatifloxacin
gentamicin sulfate
levofloxacin
neomycin/bacitracin/polymyxin
neomycin/polymyxin/bacitracin zinc
neomycin/polymyxin/gramicidin
ofloxacin
polymyxin b sulfate/trimethoprim sulfate
sulfacetamide sodium
tobramycin sulfate
trifluridine
trimethoprim sulfate/polymyxin b sulfate
NON PREFERRED
Azasite
Bacitracin
Besivance
Betadine Ophthalmic Prep
Bleph-10
Ciloxan
Garamycin
MitosolPA
Moxeza
Natacyn
Neosporin
Ocuflox
Polytrim
Sulfacetamide Sodium
Tobrex
Vigamox
Viroptic
Zirgan
Zymaxid
TIER 02
TIER 03
PROSTAGLANDINS
TIER 01
TIER 02
TIER 03
ARTIFICIAL TEAR/LUBRICANT
TIER 03
neomycin/polymyxin/bacitracin/hydrocortisone
neomycin/polymyxin/dexamethasone
prednisolone acetate
sulfacetamide sodium/prednisolone sodium phosphate
tobramycin/dexamethasone
PREFERRED BRAND
Blephamide
Blephamide S.o.p.
Flarex
FML
FML Forte
Pred Mild
Pred-G
Pred-G S.o.p.
Tobradex
Tobradex ST
Vexol
NON PREFERRED
Alrex
Durezol
FML Liquifilm
Lotemax
Maxidex
Maxitrol
Neomycin/Polymyxin/Hydrocortisone
Omnipred
Pred Forte
Prednisolone Sodium Phosphate
Zylet
NON PREFERRED
Lacrisert
GENERIC
latanoprost
PREFERRED BRAND
Lumigan
Travatan Z
Travoprost
NON PREFERRED
Bimatoprost
Rescula
Xalatan
Zioptan
BETA-BLOCKERS
TIER 01
TIER 02
TIER 03
GENERIC
betaxolol HCL
carteolol HCL
dorzolamide HCL/timolol maleate
levobunolol HCL
timolol maleate
timolol maleate ophthalmic gel forming
PREFERRED BRAND
Betoptic-s
Timoptic
NON PREFERRED
Betagan
Betimol
Combigan
Cosopt
Cosopt PF
Istalol
Levobunolol HCL
Metipranolol
Timoptic Ocudose
Timoptic-xe
OPHTHALMIC STEROIDS
TIER 01
GENERIC
dexamethasone sodium phosphate
fluorometholone
CYCLOPLEGIC MYDRIATICS
TIER 01
TIER 02
TIER 03
GENERIC
atropine sulfate
cyclopentolate HCL
homatropine HBR
PREFERRED BRAND
Cyclogyl
Cyclomydril
Isopto Homatropine
NON PREFERRED
Atropine Sulfate
Isopto Atropine
Isopto Hyoscine
DECONGESTANTS
TIER 01
TIER 03
GENERIC
phenylephrine HCL
NON PREFERRED
Mydfrin
Naphazoline HCL
MIOTICS
TIER 01
TIER 02
GENERIC
pilocarpine HCL
PREFERRED BRAND
Isopto Carbachol
21
TIER 03
Phospholine Iodide
NON PREFERRED
Isopto Carpine
TIER 03
ADRENERGIC AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
apraclonidine
brimonidine tartrate
PREFERRED BRAND
Alphagan P
NON PREFERRED
Iopidine
Simbrinza
IMMUNOMODULATORS
TIER 02
PREFERRED BRAND
Restasis
OXYTOCICS
LOCAL ANESTHETICS
TIER 01
TIER 03
GENERIC
proparacaine HCL
tetracaine HCL
NON PREFERRED
Akten
Alcaine
TIER 01
TIER 03
OPHTHALMICS - MISC.
TIER 01
TIER 02
TIER 03
GENERIC
azelastine HCL
bromfenac
cromolyn sodium
diclofenac sodium
dorzolamide HCL
epinastine HCL
flurbiprofen sodium
ketorolac tromethamine
PREFERRED BRAND
Alomide
NON PREFERRED
Acular
Acular LS
Acuvail
Alocril
Azopt
Bepreve
Cystaran
Elestat
Emadine
Ilevro
Lastacaft
Nevanac
Ocufen
Optivar
Pataday
Patanol
Pazeo
Prolensa
Trusopt
OTIC AGENTS
TIER 01
GENERIC
acetic acid
antipyrine/benzocaine
fluocinolone acetonide
fluocinolone acetonide ear drops
hydrocortisone/acetic acid
neomycin/polymyxin/hydrocortisone
neomycin/polymyxin/HC
ofloxacin
NON PREFERRED
Acetic Acid/Aluminum Acetate
Antipyrine/Benzocaine
Auralgan
Cetraxal
Cipro HC
Ciprodex
Ciprofloxacin
Coly-mycin S
Cortisporin
Cortisporin-tc
Cresylate
Dermotic
Myoxin
Otozin
Pramotic
Vosol HC
GENERIC
methylergonovine maleate
NON PREFERRED
CervidilPA
PrepidilPA
Prostin E2PA
PAIN MANAGEMENT
ANALGESICS - NONNARCOTIC
TIER 01
TIER 02
TIER 03
GENERIC
butalbital/acetaminophen
butalbital/acetaminophen/caffeine
butalbital/apap/caffeine
butalbital/aspirin/caffeine
choline magnesium trisalicylate
diflunisal
salsalate
PREFERRED BRAND
Phrenilin Forte
NON PREFERRED
Bupap
Choline Magnesium Trisalicylate
Disalcid
Dolgic Plus
Dologesic
Equagesic
Esgic
Fioricet
Fiorinal
Levacet
Rhinoflex-650
Staflex
Tencon
Vanatol LQ
ANALGESICS - OPIOID
TIER 01
GENERIC
acetaminophen/caffeine/dihydrocodeine
acetaminophen/codeine
acetaminophen/codeine #2
acetaminophen/codeine phosphate
buprenorphine HCL
buprenorphine HCL/naloxone HCL
butalbital/acetaminophen/caffeine/codeine
butalbital/aspirin/caffeine/codeine
butorphanol tartrate
codeine sulfate
22
TIER 02
TIER 03
fentanylQL
fentanyl citrate oral transmucosalPA
hydrocodone bitartrate/acetaminophen
hydrocodone/acetaminophen
hydrocodone/ibuprofen
hydromorphone HCL
hydromorphone HCL ERQL
meperidine HCL
methadone HCL
morphine sulfate
morphine sulfate ERQL,ST
oxycodone HCL
oxycodone/acetaminophen
oxycodone/aspirin
oxycodone/ibuprofen
oxymorphone hydrochloride
oxymorphone hydrochloride ER
pentazocine/acetaminophen
pentazocine/naloxone HCL
tramadol hydrochloride/acetaminophen
tramadol HCL
tramadol HCL ER
PREFERRED BRAND
Capital/Codeine
Dilaudid
NON PREFERRED
AbstralPA
Acetaminophen/Caffeine/Dihydrocodeine Bitartrate
ActiqPA
Aspirin-caffeine-dihydrocodeine
AvinzaQL,ST
ButransST
Codeine Sulfate
ConzipQL,ST
Demerol
Dolophine
Dolophine HCL
DuragesicQL
EmbedaQL,ST
ExalgoQL,ST
FentanylQL
FentoraPA
Fioricet/Codeine
Fiorinal/Codeine #3
Hycet
Hydrocodone Bitartrate/Acetaminophen
Hydrocodone/Acetaminophen
Hydromorphone HCL
Hydromorphone HCL ERQL
Ibudone
KadianQL,ST
LazandaPA
Levorphanol Tartrate
Liquicet
Lorcet Plus
Lorcet 10/650
Lortab
Magnacet
Maxidone
Meperidine HCL
Methadone HCL
Methadose
Methadose Sugar-free
Morphine Sulfate
Morphine Sulfate ERQL,ST
MS ContinQL
Norco
NucyntaQL,ST
Nucynta ERQL,ST
Opana
Opana ER (crush Resistant)QL,ST
OxectaPA
Oxycodone HCL
Oxycodone HCL ERQL
OxycontinQL,ST
Percocet
Percodan
Primlev
Reprexain
Roxicet
Roxicodone
SuboxoneST
SubsysPA
Synalgos-dc
Theracodeine-300
Theracodophen-low-90
Theracodophen-325
Theracodophen-650
Theracodophen-750
Theratramadol-60
Theratramadol-90
Tramadol HCL ERQL,ST
Trezix
Tylenol/Codeine #3
Tylenol/Codeine #4
Ultracet
Ultram
Ultram ER
Vicoprofen
Xartemis XRST
Xodol
Xolox
Zamicet
Zohydro ERQL,ST
Zubsolv
Zydone
ANTI-INFLAMMATORY
TIER 01
TIER 02
TIER 03
GENERIC
celecoxibST
diclofenac potassium
diclofenac sodium DR
diclofenac sodium ER
diclofenac sodium/misoprostol
etodolac
etodolac ER
flurbiprofen
ibuprofen
indomethacin
indomethacin ER
ketoprofen
ketorolac tromethamineQL
leflunomide
mefenamic acid
meloxicam
nabumetone
naproxen
naproxen sodium
naproxen sodium ER
oxaprozin
piroxicam
sulindac
tolmetin sodium
PREFERRED BRAND
Nalfon
Ridaura
NON PREFERRED
Anaprox
Anaprox DS
23
TIER 04
TIER 05
Arava
Arthrotec 50
Arthrotec 75
Cataflam
CelebrexST
Daypro
Duexis
EC-naprosyn
Feldene
Fenoprofen Calcium
Indocin
IC 400
IC 800
Ketoprofen ER
Meclofenamate Sodium
Meloxicam
Mobic
Naprelan
Naprosyn
Naproxen
Ponstel
Rheumatrex
SprixQL
Therafeldamine
Theraprofen-60
Theraprofen-800
Theraprofen-90
Theraproxen-500
Theraproxen-60
Theraproxen-90
Tolmetin Sodium
Trepadiclofen-25
Trepoxen-250
Trepoxicam-7.5
VimovoQL,ST
Voltaren-XR
Zipsor
PREFERRED SPECIALTY
EnbrelPA
Enbrel SureclickPA
HumiraPA
Humira Pediatric Crohns Disease Starter PackPA
Humira PenPA
Humira Pen-crohns DiseasestarterPA
Humira Pen-psoriasis StarterPA
KineretPA
OrenciaPA
OtezlaPA
SimponiPA
XeljanzPA
AmergeQL
AxertQL
Cambia
Ergomar
FrovaQL
ImitrexQL
Imitrex Statdose RefillQL
Imitrex Statdose SystemQL
MaxaltQL
Maxalt-MLTQL
Migergot
Migral
RelpaxQL
Sumatriptan SuccinateQL
ZomigQL
Zomig Nasal SprayQL
Zomig ZMTQL
GOUT AGENTS
TIER 01
TIER 02
TIER 03
RESPIRATORY, ALLERGY, ETC
ANTIHISTAMINES
TIER 01
TIER 03
MIGRAINE PRODUCTS
TIER 01
TIER 02
TIER 03
GENERIC
almotriptan malateQL
naratriptan HCLQL
rizatriptan benzoateQL
rizatriptan benzoate odtQL
sumatriptan succinateQL
sumatriptan succinate refillQL
zolmitriptanQL
zolmitriptan odtQL
PREFERRED BRAND
Cafergot
Dihydroergotamine MesylateQL
MigranalQL
SumatriptanQL
NON PREFERRED
AlsumaQL
GENERIC
allopurinol
probenecid
probenecid/colchicine
PREFERRED BRAND
Colcrys
NON PREFERRED
Colchicine
Mitigare
Uloric
Zyloprim
GENERIC
carbinoxamine maleate
clemastine fumarate
cyproheptadine HCL
desloratadine
desloratadine odt
diphenhydramine HCL
levocetirizine dihydrochloride
promethazine HCL
promethazine HCL plain
NON PREFERRED
Brompheniramine Tannate
Clarinex
Clarinex Reditabs
Clemastine Fumarate
Dexchlorpheniramine Maleate
Doxytex
Karbinal ER
Palgic
Respa-BR
Xyzal
NASAL AGENTS
TIER 01
TIER 03
GENERIC
azelastine HCL
budesonide
flunisolide
fluticasone propionate
ipratropium bromide
olopatadine HCL
NON PREFERRED
Adrenalin
Astelin
Astepro
Atrovent
24
Bactroban Nasal
Beconase AQ
DymistaPA
Flonase
Flunisolide
Nasacort AQ
Nasonex
Omnaris
Patanase
Qnasl
Qnasl Childrens
Rhinocort Aqua
Tyzine
Tyzine Pediatric Nasal Drops
Veramyst
Zetonna
Zonatuss
Zutripro
ANTIASTHMATIC/COPD AGENTS
TIER 01
COUGH/COLD/ALLERGY
TIER 01
TIER 03
GENERIC
acetylcysteine
benzonatate
bromphen/pseudoephedrine HCL/dextromethorphan HBR
hydrocodone bitartrate/chlorpheniramine maleate/PSE
hydrocodone bitartrate/homatropine methylbromide
hydrocodone polistirex/chlorpheniramine polistirex
hydrocodone/homatropine
phenylephrine/guaifenesin
promethazine-DM
promethazine/codeine
promethazine/dextromethorphan
promethazine/phenylephrine/codeine
sodium chloride
NON PREFERRED
Carbaphen 12
Carbaphen 12 PED
Clarinex-d 12 HOUR
Clarinex-d 24 HOUR
Codar AR
Cpb Wc
Decon-a
Dextromethorphan HBR/Chlorpheniramine/Phenylephrine
HCL
Exactuss
Gilphex TR
Giltuss
Giltuss PED-c
Giltuss TR
Histex-ac
Hycofenix
Hyper-sal
Hypersal
Nebusal
Neotuss Plus
Panatuss Dxp
Pediatex TD
Pediatex TDM
Promethazine/Phenylephrine
Relhist
Rescon-JR
Rescon-MX
Rezira
Semprex-d
Suttar-SF
Suttar-2
Tessalon Perles
Tussicaps
Tussionex Pennkinetic Extended Release
Tuzistra XR
Vituz
TIER 02
TIER 03
GENERIC
albuterol sulfate
albuterol sulfate ER
albuterol TAB 4MG
aminophylline
budesonide
ipratropium bromide
ipratropium bromide/albuterol sulfate
levalbuterol
levalbuterol HCL
montelukast sodium
terbutaline sulfate
theophylline
theophylline CR
theophylline ER
zafirlukast
Ventolin HFAQL
PREFERRED BRAND
Aerospan
Asmanex HFA
Asmanex Twisthaler 120 Metered DosesQL
Atrovent HFA
Combivent Respimat
Dulera
Foradil Aerolizer
Maxair Autohaler
Pulmicort Flexhaler
QvarQL
Serevent Diskus
Spiriva Handihaler
Spiriva Respimat
Striverdi Respimat
Symbicort
Tudorza Pressair
NON PREFERRED
Accolate
Accuneb
Advair DiskusST
Advair HFAST
Alvesco
Anoro ElliptaST
Arcapta NeohalerQL
Breo ElliptaST
Brovana
Cromolyn Sodium
DalirespST
Duoneb
Elixophyllin
Flovent DiskusPA
Flovent HFAPA,QL
Lufyllin
Metaproterenol Sulfate
Perforomist
Pulmicort
Pulmophylline
Senophylline
Singulair
Theo-24
Vospire ER
Xopenex
Xopenex Concentrate
25
Xopenex HFA
Zyflo
Zyflo CR
RESPIRATORY AGENTS - MISC
TIER 02
TIER 03
TIER 05
TIER 06
PREFERRED BRAND
OrkambiPA
NON PREFERRED
Curosurf
Infasurf
Surfaxin
Survanta Intratracheal
Aralast NPPA
KalydecoPA
Prolastin-cPA
PulmozymePA
ZemairaPA
Esbriet
Ofev
TOXOIDS
TIER 02
PREFERRED BRAND
Adacel
Boostrix
Tetanus/Diphtheria Toxoids-adsorbed
Tetanus/Diphtheria Toxoids-adsorbed Adult
TIER 03
VACCINES
TIER 02
PREFERRED BRAND
Afluria PF 2012-2013
Afluria 2012-2013
Afluria 2013-2014
Afluria 2014-2015
Afluria 2015-2016
Bexsero
Cervarix
Engerix-b
Fluarix 2013-2014
Fluarix 2014-2015
Flublok 2013-2014
Flublok 2014-2015
Flublok 2015-2016
Flucelvax 2013-2014
Flucelvax 2014-2015
Flucelvax 2015-2016
Flulaval Quadrivalent 2013-2014
Flulaval 2013-2014
Flulaval 2014-2015
Flumist Quadrivalent
Fluvirin PF 2013-2014
Fluvirin PF 2014-2015
Fluvirin 2013-2014
Fluvirin 2014-2015
Fluvirin 2015-2016
Fluzone High-dose PF 2013-2014
Fluzone Intradermal
Fluzone Intradermal Quadrivalent
Fluzone Intradermal Quadrivalent 2015-2016
Fluzone Pediatric PF 2013-2014
Fluzone PF 2013-2014
Fluzone PF 2014-2015
Fluzone Quadrivalent 2013-2014
Fluzone Split 2013-2014
Gardasil
Gardasil 9PA
Havrix
M-m-r II
Medical Provider EZ Flu Shot 2014-2015
Menactra
Menomune-a/C/Y/W-135
Menveo
Pneumovax 23
Pneumovax 23/1 Dose
Pneumovax 23/5 Dose
Prevnar 13
Proquad
Recombivax HB
Trumenba
Twinrix
Vaqta
Varivax
Zostavax
NON PREFERRED
Influenza A (h1n1) Monovalent 2009
Rotarix
Rotateq
Vivotif BernaQL
VITAMINS
VITAMINS
TIER 01
TIER 02
TIER 03
GENERIC
ergocalciferol
vitamin d
PREFERRED BRAND
Mephyton
NON PREFERRED
Drisdol
Wheat Germ
MULTIVITAMINS
TIER 01
TIER 03
GENERIC
niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper
NON PREFERRED
Adrenal C Formula
Atabex EC
Bacmin
Bal-care DHA
Bal-care DHA Essential
Citranatal Assure
Citranatal B-calm
Citranatal DHA
Citranatal Harmony
Citranatal RX
Citranatal 90 DHA
Cod Liver Oil
Concept DHA
Concept OB
Corvite
Crnatal
CO-natal Fa
Dialyvite Supreme D
Dialyvite 3000
Dialyvite 5000
26
Dialyvite/Zinc
Diatx ZN
Duet DHA Balanced
Duet DHA 400
Duet DHA 400EC
Duet DHA 430
Duet DHA 430EC
Elite-OB
Enbrace HR
Escavite
Escavite D
Focalgin CA
Focalgin 90 DHA
Folbecal
Folcaps Omega 3
Folet One
Folgard OS
Folivane-prx DHA NF
Folivane-OB
Fortavit
Gesticare DHA
Inatal Advance
Inatal GT
Inatal Ultra
M-vitQL
Macnatal CN DHA
Marnatal-f
Moms Choice RX
Mykidz Iron Fl
Mynatal
Mynatal Advance
Mynatal Ultracaplet
Natachew
Natafort
Natalvirt CA
Natalvirt 90 DHA
Natalvit
Natelle One
Neevo DHA
Nephplex RX
Nephro-vite RX
Nephrocaps
Nephrocaps QT
Nestabs
Nestabs Abc
Nestabs DHA
Newgen
Nexa Plus
Nicadan
Nicazel
Nicazel Forte
Nicomide
Niva-plusQL
Nutricap
Nutrivit
O-CAL FaQL
O-CAL Prenatal
Obstetrix DHA
Obstetrix EC
OB Complete
OB Complete One
OB Complete Petite
OB Complete Premier
OB Complete 400
OB Complete/DHA
OB-natal One
Paire OB
Poly-VI-flor
Poly-VI-flor FS
Poly-VI-flor/Iron
Pr Natal 400
Pr Natal 400 EC
Pr Natal 430
Pr Natal 430 EC
Prefera OB
Prefera OB + DHA
Preferaob +dha
Preferaob One
Prefol-DHA
Prenata
Prenatabs RX
Prenatal Ad
Prenatal-u
Prenate
Prenate AM
Prenate DHA
Prenate Elite
Prenate Enhance
Prenate Essential
Prenate Mini
Prenate Pixie
Prenate Restore
Prenate Star
Preque 10
Protect Plus
Protectbone
Protectnatal
Provida DHA
Provida OB
Quflora Pediatric
R-natal OB
Renatabs
Renatabs With Iron
Req 49+
Select-ob+dha
Select-OB
Siderol
Strovite
Strovite Forte
Strovite One
Supervite
Supervite EC
Support-500
Synagex
Synatek
Taron-bc
Taron-c DHA
Taron-prex
Tri-VI-flor
TricareQL
Tricare Prenatal Compleat
Tricare Prenatal DHA One
Trinate
Triveen-duo DHA
Triveen-prx RNF
TL G-FOL OS
Udamin
Udamin SP
Vemavite-prx 2
Vinacal B
Vinate AZ Extra
Vinate C
Vinate Calcium
Vinate Care
Vinate DHA
Vinate DHA RF
Vinate GT
Vinate IC
Vinate II
Vinate M
27
Vinate One
Vita-pren
Vitafol
Vitafol Ultra
Vitafol-nano
Vitafol-ob+dha
Vitafol-one
Vitafol-pn
Vitafol-OB
Vital-d RX
Vitamedmd One RX/Quatrefolic
Vitamedmd Plus RX/Quatre Folic
Vitamedmd Redichew RX
Vitamedmd Redichew RX/Quatrefolic
Vitapearl
Vitaroca Plus
Viva DHA
Zatean-pn
Zatean-pn DHA
Zatean-pn Plus
Zatean-CH
MEDICAL DEVICES
DIABETIC SUPPLIES
TIER 02
PREFERRED BRAND
Insulin Syringe/0.5ML/30G X 5/16"
Relion Insulin Syringe/U-100/0.5ML/29G X 1/2"
MISCELLANEOUS
TIER 03
TIER 05
NON PREFERRED
Chemet
ExjadePA
FerriproxPA
JadenuPA
28
Index
A
abacavir, 2
abacavir sulfate/lamivudine/zidovudine, 2
Abaneu-SL, 16
Abilify, 18
Abilify Discmelt, 18
Absorica, 7
Abstral, 23
acamprosate calcium DR, 20
Acanya, 7
acarbose, 12
Accolate, 25
Accuneb, 25
Accupril, 5
Accuretic, 6
acebutolol HCL, 4
Aceon, 5
acetaminophen/caffeine/dihydrocodeine,
22
Acetaminophen/Caffeine/Dihydrocodeine
Bitartrate, 23
acetaminophen/codeine, 22
acetaminophen/codeine #2, 22
acetaminophen/codeine phosphate, 22
acetazolamide, 6
Acetazolamide, 6
acetazolamide ER, 6
acetic acid, 22
Acetic Acid/Aluminum Acetate, 22
acetylcysteine, 25
Aciphex, 14
Aciphex Sprinkle, 14
acitretin, 8
Actigall, 14
Actimmune, 4
Actiq, 23
Activella, 10
Actonel, 12
Actoplus Met, 12
Actoplus Met XR, 12
Actos, 12
Acuicyn Daily Eyelid & Eyelash Cleanser,
9
Acular, 22
Acular LS, 22
Acuvail, 22
acyclovir, 2, 8
Aczone, 7
Adacel, 26
Adalat CC, 5
adapalene, 7
Adcirca, 7
Adderall, 19
Adderall XR, 19
adefovir dipivoxil, 2
Adempas, 7
Adoxa, 1
Adoxa PAK 1/100, 1
Adoxa PAK 1/150, 1
Adoxa PAK 2/100, 1
Adrenaclick, 7
Adrenal C Formula, 26
Adrenalin, 24
Advair Diskus, 25
Advair HFA, 25
Advicor, 7
Aerospan, 25
Afinitor, 4
Afinitor Disperz, 4
Afluria 2012-2013, 26
Afluria 2013-2014, 26
Afluria 2014-2015, 26
Afluria 2015-2016, 26
Afluria PF 2012-2013, 26
Afluria PF 2013-2014, 26
Afluria PF 2014-2015, 26
Afluria PF 2015-2016, 26
Afrezza, 11
Aggrenox, 16
Agrylin, 16
Akten, 22
Akynzeo, 14
Albenza, 3
albuterol sulfate, 25
albuterol sulfate ER, 25
albuterol TAB 4MG, 25
Alcaine, 22
alclometasone dipropionate, 9
Aldactazide, 6
Aldactone, 6
alendronate sodium, 12
Alendronate Sodium, 12
Alferon N, 4
alfuzosin HCL ER, 15
Alinia, 3
Alkeran, 3
allopurinol, 24
almotriptan malate, 24
Alocril, 22
Alomide, 22
Alora, 10
alosetron hydrochloride, 14
Alphagan P, 22
alprazolam, 17
alprazolam ER, 17
Alprazolam Intensol, 17
alprazolam odt, 17
Alrex, 21
Alsuma, 24
Altabax, 8
Altace, 5
Altoprev, 7
Alvesco, 25
amantadine HCL, 19
Amantadine HCL, 19
Amaryl, 11
Ambien, 18
Ambien CR, 18
Amerge, 24
Amicar, 16
amiloride HCL, 6
amiloride/hydrochlorothiazide, 6
aminocaproic acid, 16
Aminocaproic Acid, 16
aminophylline, 25
amiodarone HCL, 5
Amitiza, 14
amitriptyline HCL, 17
amlodipine besylate, 5
amlodipine besylate/atorvastatin calcium,
7
amlodipine besylate/benazepril HCL, 6
amlodipine besylate/benazepril
hydrochloride, 6
amlodipine besylate/valsartan, 6
amlodipine/valsartan/hctz, 6
ammonium lactate, 9
Amoxapine, 17
amoxicillin, 1
Amoxicillin, 1
Amoxicillin ER, 1
amoxicillin/clavulanate potassium, 1
amoxicillin/clavulanate potassium ER, 1
amphetamine/dextroamphetamine, 18
ampicillin, 1
Ampicillin, 1
Ampyra, 20
Amrix, 20
Amturnide, 6
Anacaine, 9
Anadrol-50, 10
Anafranil, 17
anagrelide hydrochloride, 16
Analpram-HC, 14
Analpram-HC Singles, 14
Anaprox, 23
Anaprox DS, 23
Anaspaz, 14
anastrozole, 3
Ancobon, 2
Androderm, 10
Androgel, 10
Androgel P.M., 10
Android, 10
Androxy, 10
Angeliq, 10
Animi-3, 16
Animi-3/Vitamin D, 16
Anoro Ellipta, 25
Antabuse, 20
Antara, 7
antipyrine/benzocaine, 22
Antipyrine/Benzocaine, 22
Anusol-HC, 14
Anzemet, 14
Apidra, 11
Apidra Solostar, 11
Aplenzin, 17
Apokyn, 20
Appbutamone, 17
Appbutamone-d, 17
Appformin, 12
Appformin-d, 12
apraclonidine, 22
Apriso, 14
Aptensio XR, 19
Aptiom, 19
Aptivus, 2
Aquoral, 17
Aralast NP, 26
Aralen, 3
Aranesp Albumin Free, 16
Arava, 24
Arcapta Neohaler, 25
Aricept, 20
Aricept Odt, 20
Arimidex, 3
aripiprazole, 18
Arixtra, 16
Armour Thyroid, 13
Arnica Flower, 9
Aromasin, 3
Arthrotec 50, 24
Arthrotec 75, 24
Artiss, 16
Asacol HD, 14
Asmanex HFA, 25
Asmanex Twisthaler 120 Metered Doses,
25
25
25
25
25
Aspirin-caffeine-dihydrocodeine, 23
Aspirin/Dipyridamole, 16
Astagraf XL, 4
Astelin, 24
Astepro, 24
Astringyn, 16
Atabex EC, 26
Atacand, 5
Atacand HCT, 6
Atelvia, 12
atenolol, 5
atenolol/chlorthalidone, 6
Ativan, 17
atorvastatin calcium, 7
atovaquone, 3
atovaquone/proguanil HCL, 3
Atripla, 2
atropine sulfate, 21
Atropine Sulfate, 21
Atrovent, 24
Atrovent HFA, 25
Aubagio, 20
augmented betamethasone dipropionate,
9
Augmentin, 1
Augmentin ES-600, 1
Augmentin XR, 1
Auralgan, 22
Aurstat Anti-itch Hydrogel, 9
Auryxia, 14
Auvi-q, 7
Avalide, 6
Avandamet, 12
Avandaryl, 12
Avandia, 12
Avapro, 5
Avc, 15
Aveed, 10
Avelox, 1
Avelox Abc Pack, 1
Avinza, 23
Avodart, 15
Avonex, 20
Avonex Pen, 20
Axert, 24
Axid, 14
Axiron, 10
Aygestin, 11
Azasan, 4
Azasite, 21
azathioprine, 4
azelastine HCL, 22, 24
Azelex, 7
Azilect, 19
azithromycin, 1
Azithromycin, 1
Azopt, 22
Azor, 6
Azulfidine, 14
Azulfidine EN-TABS, 14
B
B-6 Folic Acid, 16
Bacitracin, 21
bacitracin/polymyxin b, 21
baclofen, 20
Bacmin, 26
Bactrim, 3
Bactrim DS, 3
Bactroban, 8
Bactroban Nasal, 25
Bal-care DHA, 26
Bal-care DHA Essential, 26
balsalazide disodium, 14
Banzel, 19
Baraclude, 2
Beconase AQ, 25
Belladonna & Opium, 14
Belladonna Alkaloids & Opium, 14
Belsomra, 18
benazepril HCL, 5
benazepril HCL/hydrochlorothiazide, 6
Benicar, 5
Benicar HCT, 6
Bentyl, 14
Benzac Ac Wash, 7
Benzac W Wash, 7
Benzaclin, 7
Benzaclin With P.M., 7
Benzamycin, 7
Benzamycinpak, 7
Benzefoam, 7
Benzefoamultra, 7
Benziq, 7
Benziq LS, 7
Benzoin Compound Tincture, 9
Benzoin Tincture, 9
benzonatate, 25
benzoyl peroxide, 7
benzoyl peroxide SHORT contact, 7
benztropine mesylate, 19
Bepreve, 22
Besivance, 21
Betadine Ophthalmic Prep, 21
Betagan, 21
betamethasone dipropionate, 9
betamethasone valerate, 9
Betapace, 5
Betapace AF, 5
Betaseron, 20
betaxolol HCL, 5, 21
bethanechol chloride, 15
Bethkis, 1
Betimol, 21
Betoptic-s, 21
bexarotene, 4
Bexsero, 26
Beyaz, 10
Biaxin, 1
Biaxin XL, 1
Biaxin XL PAC, 1
bicalutamide, 3
Bidil, 7
Biferarx, 16
Biltricide, 3
Bimatoprost, 21
Binosto, 12
bisoprolol fumarate, 5
bisoprolol fumarate/hydrochlorothiazide,
6
Bleph-10, 21
Blephamide, 21
Blephamide S.o.p., 21
Boniva, 12
Boostrix, 26
Boric Acid, 9
Bosulif, 4
Bravelle, 12
Breo Ellipta, 25
Brevicon-28, 10
Brilinta, 16
brimonidine tartrate, 22
Brintellix, 17
Brisdelle, 20
bromfenac, 22
bromocriptine mesylate, 19
bromphen/pseudoephedrine
HCL/dextromethorphan HBR, 25
Brompheniramine Tannate, 24
Brovana, 25
budesonide, 10, 24, 25
bumetanide, 6
Bupap, 22
Buphenyl, 13
buprenorphine HCL, 22
buprenorphine HCL/naloxone HCL, 22
bupropion HCL, 17
bupropion HCL ER, 17
bupropion HCL SR, 17, 20
bupropion HCL XL, 17
buspirone HCL, 17
butalbital/acetaminophen, 22
butalbital/acetaminophen/caffeine, 22
butalbital/acetaminophen/caffeine/codein
e, 22
butalbital/apap/caffeine, 22
butalbital/aspirin/caffeine, 22
butalbital/aspirin/caffeine/codeine, 22
Butisol Sodium, 18
butorphanol tartrate, 22
Butrans, 23
Bydureon, 11
Byetta, 11
Bystolic, 5
C
cabergoline, 13
Caduet, 7
Cafcit, 19
Cafergot, 24
caffeine citrate, 18
Calan, 5
Calan SR, 5
calcipotriene, 8
calcipotriene/betamethasone
dipropionate, 9
calcitonin salmon, 12
calcitonin-salmon, 12
Calcitriol, 8
calcitriol, 13
calcium acetate, 14
Cambia, 24
Campral, 20
Canasa, 14
candesartan cilexetil, 5
candesartan cilexetil/hydrochlorothiazide,
6
Cantil, 14
capecitabine, 3
Caphosol, 17
Capital/Codeine, 23
Capsiderm, 9
captopril, 5
Captopril/Hydrochlorothiazide, 6
Carafate, 14
Carbaglu, 13
carbamazepine, 19
carbamazepine ER, 19
Carbaphen 12, 25
Carbaphen 12 PED, 25
Carbatrol, 19
carbidopa, 19
carbidopa/levodopa, 19
carbidopa/levodopa ER, 19
carbidopa/levodopa odt, 19
Carbidopa/Levodopa/Entacapone, 19
carbinoxamine maleate, 24
Cardene SR, 5
Cardizem, 5
Cardizem CD, 5
Cardizem LA, 5
Cardura, 6
Cardura XL, 15
carisoprodol, 20
Carisoprodol, 20
carisoprodol/aspirin, 20
carisoprodol/aspirin/codeine, 20
Carmol-HC, 9
Carnitor, 13
Carnitor SF, 13
carteolol HCL, 21
carvedilol, 5
Casodex, 3
Cataflam, 24
Catapres, 6
Catapres-tts-1, 6
Catapres-tts-2, 6
Catapres-tts-3, 6
Cayston, 3
Cedax, 1
cefaclor, 1
Cefaclor, 1
Cefaclor ER, 1
cefadroxil, 1
cefdinir, 1
Cefditoren Pivoxil, 1
cefixime, 1
cefpodoxime proxetil, 1
cefprozil, 1
Ceftibuten, 1
Ceftin, 1
cefuroxime axetil, 1
Celebrex, 24
celecoxib, 23
Celestone, 10
Celexa, 17
Cellcept, 4
Celontin, 19
Cenestin, 10
Cenfol, 16
Centany AT, 8
Centratex, 16
cephalexin, 1
Cephalexin, 1
Cerdelga, 16
Cervarix, 26
Cervidil, 22
Cesamet, 14
Cetraxal, 22
Cetrotide, 12
cevimeline HCL, 17
Chantix, 20
Chantix Continuing Month PAK, 20
Chantix Starting Month PAK, 20
Chemet, 28
Chenodal, 14
chlordiazepoxide HCL, 17
Chlordiazepoxide/Amitriptyline, 20
chlorhexidine gluconate, 17
chlorhexidine gluconate oral rinse, 17
chloroquine phosphate, 3
chlorothiazide, 6
Chlorothiazide, 6
chlorpromazine HCL, 18
Chlorpropamide, 11
Chlorthalidone, 6
chlorzoxazone, 20
Cholbam, 15
cholestyramine, 7
cholestyramine light, 7
choline magnesium trisalicylate, 22
Choline Magnesium Trisalicylate, 22
chorionic gonadotropin, 12
Cialis, 7
Ciclodan Cream Kit, 8
Ciclodan Solution Kit, 8
ciclopirox, 8
ciclopirox nail lacquer, 8
ciclopirox olamine, 8
Ciclopirox Topical Solution Kit, 8
Ciferex, 16
cilostazol, 16
Ciloxan, 21
cimetidine, 13
cimetidine HCL, 13
Cimzia, 15
Cimzia Starter Kit, 15
Cipro, 1
Cipro HC, 22
Cipro XR, 1
Ciprodex, 22
ciprofloxacin, 1
Ciprofloxacin, 22
ciprofloxacin ER, 1
ciprofloxacin HCL, 1, 21
Ciprofloxacin HCL, 1
citalopram hydrobromide, 17
Citranatal 90 DHA, 26
Citranatal Assure, 26
Citranatal B-calm, 26
Citranatal DHA, 26
Citranatal Harmony, 26
Citranatal RX, 26
citric acid/sodium citrate, 15
Citrolith, 15
Claravis, 7
Clarinex, 24
Clarinex Reditabs, 24
Clarinex-d 12 HOUR, 25
Clarinex-d 24 HOUR, 25
clarithromycin, 1
clarithromycin ER, 1
clemastine fumarate, 24
Clemastine Fumarate, 24
Cleocin, 3, 15
Cleocin Pediatric Granules, 3
Climara, 10
Climara Pro, 10
Clindacin Etz, 7
Clindacin PAC, 7
clindamycin HCL, 3
clindamycin palmitate HCL, 3
clindamycin phosphate, 7, 15
clindamycin/benzoyl peroxide, 7
Clindesse, 15
Clinoin, 7
clobetasol propionate, 9
clobetasol propionate emollient, 9
clomiphene citrate, 12
clomipramine HCL, 17
clonazepam, 19
clonazepam odt, 19
clonidine HCL, 6
clonidine HCL ER, 18
clopidogrel, 16
clorazepate dipotassium, 17
Clorpres, 6
clotrimazole, 8, 17
clotrimazole/betamethasone dipropionate,
8
clozapine, 18
Clozapine Odt, 18
Clozaril, 18
Cnl8 Nail Kit, 8
CO-natal Fa, 26
Coal TAR, 9
Coartem, 3
Cocaine HCL, 9
Cod Liver Oil, 26
Codar AR, 25
codeine sulfate, 22
Codeine Sulfate, 23
Colazal, 14
Colchicine, 24
Colcrys, 24
Colestid, 7
Colestid Flavored, 7
colestipol HCL, 7
colestipol HCL for oral suspension, 7
Coly-mycin S, 22
Colyte-flavor Packs, 13
Combigan, 21
Combipatch, 10
Combivent Respimat, 25
Combivir, 2
Cometriq, 4
Compazine, 18
Complera, 2
Comtan, 19
Concept DHA, 26
Concept OB, 26
Concerta, 19
Condylox, 9
Conzip, 23
Copasil, 9
Copaxone, 20
Copegus, 2
Cordarone, 5
Cordran, 9
Cordran Tape, 9
Coreg, 5
Coreg CR, 5
Corgard, 5
Corlanor, 7
Cortalo, 9
Cortef, 10
Cortenema, 14
Cortifoam, 14
Cortisone Acetate, 10
Cortisporin, 8, 22
Cortisporin-tc, 22
Corvite, 26
Corvite 150, 16
Corzide, 6
Cosentyx, 8
Cosentyx Sensoready Pen, 8
Cosopt, 21
Cosopt PF, 21
Coumadin, 16
Cozaar, 5
Cpb Wc, 25
Creon, 14
Cresemba, 2
Crestor, 7
Cresylate, 22
Crinone, 15
Crixivan, 2
Crnatal, 26
cromolyn sodium, 14, 22
Cromolyn Sodium, 25
Curosurf, 26
Cuvposa, 14
Cyclessa, 10
cyclobenzaprine HCL, 20
Cyclogyl, 21
Cyclomydril, 21
cyclopentolate HCL, 21
Cyclophosphamide, 3
Cycloserine, 2
cyclosporine, 4
cyclosporine modified, 4
Cyclosporine Modified, 4
Cymbalta, 17
cyproheptadine HCL, 24
Cystadane, 13
Cystagon, 15
Cystaran, 22
Cytomel, 13
Cytotec, 14
Cytra-3, 15
D
Daklinza, 2
Daliresp, 25
Dalvance, 3
danazol, 10
Dantrium, 20
dantrolene sodium, 20
Dantrolene Sodium, 20
Dapsone, 3
Daraprim, 3
Daypro, 24
Daytrana, 19
Ddavp, 13
Debacterol, 17
Decon-a, 25
Delestrogen, 10
Delzicol, 14
Demadex, 6
demeclocycline HCL, 1
Demerol, 23
Demser, 6
Denavir, 8
Depakene, 19
Depakote, 19
Depakote ER, 19
Depakote Sprinkles, 19
Depo-testosterone, 10
Dermotic, 22
desipramine HCL, 17
desloratadine, 24
desloratadine odt, 24
desmopressin acetate, 13
Desogen, 10
desogestrel/ethinyl estradiol, 10
desonide, 9
desoximetasone, 9
Desoxyn, 19
Desvenlafaxine ER, 17
Detrol, 15
Detrol LA, 15
dexamethasone, 10
Dexamethasone, 10
Dexamethasone Intensol, 10
dexamethasone sodium phosphate, 21
Dexchlorpheniramine Maleate, 24
Dexedrine, 19
Dexilant, 14
dexmethylphenidate HCL, 18
dexmethylphenidate HCL ER, 18
Dexpak 10 Day, 10
Dexpak 13 Day, 10
Dexpak 6 Day, 10
dextroamphetamine sulfate, 18
dextroamphetamine sulfate ER, 18
Dextromethorphan
HBR/Chlorpheniramine/Phenylephrine
HCL, 25
Diabeta, 11
Dialyvite 3000, 26
Dialyvite 5000, 26
Dialyvite Supreme D, 26
Dialyvite/Zinc, 27
Diamox, 6
Diastat Acudial, 19
Diastat Pediatric, 19
Diatx ZN, 27
diazepam, 17
Diazepam, 17, 19
Dibenzyline, 6
Diclegis, 14
diclofenac potassium, 23
diclofenac sodium, 8, 22
diclofenac sodium DR, 23
diclofenac sodium ER, 23
diclofenac sodium/misoprostol, 23
dicloxacillin sodium, 1
dicyclomine HCL, 13
didanosine, 2
Dificid, 1
Diflucan, 2
diflunisal, 22
digoxin, 4
Digoxin, 4
Dihydroergotamine Mesylate, 24
Dilacor XR, 5
Dilantin, 19
Dilantin Infatabs, 19
Dilantin-125, 19
Dilatrate SR, 4
Dilaudid, 23
diltiazem CD, 5
diltiazem HCL, 5
diltiazem HCL ER, 5
Diovan, 5
Diovan HCT, 6
Dipentum, 14
diphenhydramine HCL, 24
diphenoxylate/atropine, 13
Diphenoxylate/Atropine, 13
dipyridamole, 16
Disalcid, 22
disopyramide phosphate, 5
disulfiram, 20
Ditropan XL, 15
Diuril, 6
divalproex sodium, 19
divalproex sodium DR, 19
divalproex sodium ER, 19
Divigel, 10
Divista, 16
Dolgic Plus, 22
Dologesic, 22
Dolophine, 23
Dolophine HCL, 23
donepezil HCL, 20
Doral, 18
Doryx, 1
dorzolamide HCL, 22
dorzolamide HCL/timolol maleate, 21
doxazosin, 6
doxazosin mesylate, 6
doxepin HCL, 17
Doxepin HCL, 17
doxercalciferol, 13
doxycycline, 1
Doxycycline, 8
doxycycline hyclate, 1
doxycycline hyclate DR, 1
doxycycline monohydrate, 1
Doxytex, 24
Drisdol, 26
Dritho-creme HP, 8
dronabinol, 14
drospirenone/ethinyl estradiol, 10
Droxia, 16
Drysol, 9
Duac, 7
Duavee, 10
Duet DHA 400, 27
Duet DHA 400EC, 27
Duet DHA 430, 27
Duet DHA 430EC, 27
Duet DHA Balanced, 27
Duetact, 12
Duexis, 24
Dulera, 25
duloxetine HCL, 17
Duoneb, 25
Duopa, 19
Duragesic, 23
Durezol, 21
Dutoprol, 6
Dyazide, 6
Dymista, 25
Dyrenium, 6
E
E.e.s. 400, 1
E.e.s. Granules, 1
EC-naprosyn, 24
econazole nitrate, 8
Ed Cyte F, 16
Edarbi, 5
Edarbyclor, 6
Edecrin, 6
Edluar, 18
Edurant, 2
Effexor XR, 17
Effient, 16
Egrifta, 12
Eldepryl, 19
Elenzapatch, 9
Elestat, 22
Elestrin, 10
Elidel, 9
Elimite, 9
Eliphos, 14
Eliquis, 16
Elite-OB, 27
Elixophyllin, 25
Ella, 10
Elmiron, 15
Emadine, 22
Embeda, 23
Emcyt, 3
Emend, 14
Emla, 9
Emsam, 17
Emtriva, 2
Enablex, 15
enalapril maleate, 5
enalapril maleate/hydrochlorothiazide, 6
Enbrace HR, 27
Enbrel, 24
Enbrel Sureclick, 24
Endometrin, 15
Engerix-b, 26
Enjuvia, 10
enoxaparin sodium, 16
entacapone, 19
entecavir, 2
Entereg, 14
Entocort EC, 10
Epaned, 5
Epifoam, 9
epinastine HCL, 22
Epinephrine, 7
Epipen 2-PAK, 7
Epipen-JR 2-PAK, 7
Epivir, 2
Epivir HBV, 2
eplerenone, 6
Epogen, 16
Eprosartan Mesylate, 5
Epzicom, 2
Equagesic, 22
Equetro, 18
ergocalciferol, 26
ergoloid mesylates, 20
Ergomar, 24
Ertaczo, 8
Ery-TAB, 1
Eryped 200, 1
Eryped 400, 1
Erythrocin Stearate, 1
erythromycin, 1, 7, 21
Erythromycin Base, 1
Erythromycin Ethylsuccinate, 1
erythromycin/benzoyl peroxide, 7
Esbriet, 26
Escavite, 27
Escavite D, 27
escitalopram oxalate, 17
Esgic, 22
esomeprazole magnesium, 13
Esomeprazole Strontium, 14
estazolam, 18
Estrace, 10, 15
estradiol, 10
estradiol valerate, 10
estradiol/norethindrone acetate, 10
Estrasorb, 10
Estring, 15
Estrogel, 10
estropipate, 10
Estropipate, 10
Estrostep FE, 10
eszopiclone, 18
ethambutol HCL, 2
ethosuximide, 19
Ethyl Chloride, 9
Ethyl Chloride/Fine Pinpoint, 9
Ethyl Chloride/Fine Stream, 9
Ethyl Chloride/Medium Jet Stream, 9
Ethyl Chloride/Medium Stream, 9
Ethyl Chloride/Mist, 9
Etidronate Disodium, 12
etodolac, 23
etodolac ER, 23
Etoposide, 4
Eurax, 9
Evamist, 10
Evekeo, 19
Evicel, 16
Evista, 12
Evithrom, 16
Evotaz, 2
Evoxac, 17
Exactuss, 25
Exalgo, 23
Exelderm, 8
Exelon, 20
exemestane, 3
Exforge, 6
Exforge HCT, 6
Exjade, 28
Exoderm, 8
Extavia, 20
Extina, 8
F
Fabior, 7
Factive, 1
Falessa, 10
famciclovir, 2
famotidine, 13
Famvir, 2
Fanapt, 18
Fanapt Titration Pack, 18
Fareston, 3
Farxiga, 12
Farydak, 4
Fazaclo, 18
felbamate, 19
Felbatol, 19
Feldene, 24
felodipine ER, 5
Fem PH, 15
Femara, 3
Femcon FE, 10
Femhrt Low Dose, 10
Femring, 15
fenofibrate, 7
Fenofibrate, 7
fenofibrate micronized, 7
Fenofibric Acid, 7
fenofibric acid DR, 7
Fenoglide, 7
Fenoprofen Calcium, 24
fentanyl, 23
Fentanyl, 23
fentanyl citrate oral transmucosal, 23
Fentora, 23
Feriva, 16
Ferivafa, 16
Ferralet 90, 16
Ferrex 150 Forte Plus, 16
Ferrex 28, 16
Ferriprox, 28
Ferro-plex Hematinic, 16
Ferrotrin, 16
Fetzima, 17
Fetzima Titration Pack, 17
Fexmid, 20
Fibricor, 7
Finacea, 8
finasteride, 15
Fioricet, 22
Fioricet/Codeine, 23
Fiorinal, 22
Fiorinal/Codeine #3, 23
Firazyr, 17
First-bxn Mouthwash, 17
First-dukes Mouthwash, 17
First-lansoprazole, 14
First-marys Mouthwash, 17
First-mouthwash Blm, 17
First-omeprazole, 14
First-progesterone VGS 100
Compounding Kit, 15
Compounding Kit, 15
First-progesterone VGS 25 Compounding
Kit, 15
Compounding Kit, 15
First-progesterone VGS 50 Compounding
Kit, 15
First-testosterone, 10
First-testosterone Mc Compounding Kit,
10
First-vancomycin 25, 3
First-vancomycin 50, 3
Flagyl, 3
Flagyl ER, 3
Flarex, 21
flavoxate HCL, 15
flecainide acetate, 5
Flector, 8
FLO-pred, 10
Flomax, 15
Flonase, 25
Flovent Diskus, 25
Flovent HFA, 25
Fluarix 2013-2014, 26
Fluarix 2014-2015, 26
Flublok 2013-2014, 26
Flublok 2014-2015, 26
Flublok 2015-2016, 26
Flucelvax 2013-2014, 26
Flucelvax 2014-2015, 26
Flucelvax 2015-2016, 26
fluconazole, 2
flucytosine, 2
fludrocortisone acetate, 10
Flulaval 2013-2014, 26
Flulaval 2014-2015, 26
Flulaval Quadrivalent 2013-2014, 26
Flumadine, 2
Flumist Quadrivalent, 26
flunisolide, 24
Flunisolide, 25
fluocinolone acetonide, 9, 22
fluocinolone acetonide ear drops, 22
fluocinonide, 9
fluocinonide-e, 9
fluorometholone, 21
fluoxetine, 20
fluoxetine DR, 17
fluoxetine HCL, 17
Fluoxetine HCL, 17
fluphenazine HCL, 18
Fluphenazine HCL, 18
flurazepam HCL, 18
Flurazepam HCL, 18
flurbiprofen, 23
flurbiprofen sodium, 22
flutamide, 3
fluticasone propionate, 9, 24
fluvastatin, 7
Fluvirin 2013-2014, 26
Fluvirin 2014-2015, 26
Fluvirin 2015-2016, 26
Fluvirin PF 2013-2014, 26
Fluvirin PF 2014-2015, 26
fluvoxamine maleate, 17
fluvoxamine maleate ER, 17
Fluzone High-dose PF 2013-2014, 26
Fluzone Intradermal, 26
Fluzone Intradermal Quadrivalent, 26
Fluzone Intradermal Quadrivalent 20152016, 26
Fluzone Pediatric PF 2013-2014, 26
Fluzone PF 2013-2014, 26
Fluzone PF 2014-2015, 26
Fluzone Quadrivalent 2013-2014, 26
Fluzone Split 2013-2014, 26
FML, 21
FML Forte, 21
FML Liquifilm, 21
Focalgin 90 DHA, 27
Focalgin CA, 27
Focalgin Dss, 16
Focalin, 19
Focalin XR, 19
Folbecal, 27
Folcaps Omega 3, 27
Folet One, 27
Folgard OS, 27
Folgard RX, 16
folic acid, 16
folic acid/vitamin b-6/vitamin b-12, 16
Folivane-f, 16
Folivane-OB, 27
Folivane-plus, 16
Folivane-prx DHA NF, 27
Follistim AQ, 12
Foltrate, 16
fondaparinux sodium, 16
Foradil Aerolizer, 25
Forfivo XL, 17
Fortamet, 11
Fortavit, 27
Forteo, 12
Fortesta, 10
Fortical, 12
Fosamax, 12
Fosamax Plus D, 12
fosinopril sodium, 5
fosinopril sodium/hydrochlorothiazide, 6
Fosrenol, 14
Fragmin, 16
Frova, 24
Fulyzaq, 13
Furadantin, 15
furosemide, 6
Furosemide, 6
Fusion Plus, 16
Fuzeon, 2
Fycompa, 19
G
gabapentin, 19
Gabavale-5, 17
Gabazolamine, 17
Gabazolamine-0.5, 17
Gabazolpidem-5, 18
Gabitidine, 14
Gabitril, 19
Gaboxetine, 17
galantamine, 20
galantamine hydrobromide, 20
Galantamine Hydrobromide, 20
Ganirelix Acetate, 12
Garamycin, 21
Gardasil, 26
Gardasil 9, 26
Gastrinex NF, 14
Gastrocrom, 14
gatifloxacin, 21
Gattex, 15
Gel-kam Oral Care Rinse, 17
Gelclair, 17
Gelnique, 15
gemfibrozil, 7
gene-xene TAB 15MG, 17
gene-xene TAB 3.75MG, 17
gene-xene TAB 7.5MG, 17
Generess FE, 10
Genotropin, 12
Genotropin Miniquick, 12
Gentamicin Sulfate, 8
gentamicin sulfate, 21
Geodon, 18
Gesticare DHA, 27
Giazo, 14
Gilenya, 20
Gilotrif, 4
Gilphex TR, 25
Giltuss, 25
Giltuss PED-c, 25
Giltuss TR, 25
Gleevec, 4
Gleostine, 3
glimepiride, 11
glipizide, 11
glipizide ER, 11
glipizide/metformin HCL, 12
Glucagen Hypokit, 11
Glucagon Emergency Kit, 11
Glucophage, 11
Glucophage XR, 11
Glucotrol, 11
Glucotrol XL, 11
Glucovance, 12
Glumetza, 11
glyburide, 11
Glyburide, 11
glyburide micronized, 11
glyburide/metformin HCL, 12
Glycolic Acid, 8
Glycolic Acid 70% High Purity, 8
glycopyrrolate, 13
Glynase, 11
Glyset, 12
Glyxambi, 12
Golytely, 13
Gonal-f, 12
Gonal-f RFF, 12
Gonal-f RFF Pen, 12
Gonal-f RFF Rediject, 12
Gordofilm, 9
Gralise, 20
Gralise Starter, 20
granisetron HCL, 14
Granisol, 14
Granix, 16
Grifulvin V, 2
Gris-peg, 2
griseofulvin microsize, 2
griseofulvin ultramicrosize, 2
guanfacine ER, 18
guanfacine HCL, 6
Guanidine HCL, 20
Gynazole-1, 15
H
H.p. Acthar, 13
Halcion, 18
halobetasol propionate, 9
haloperidol, 18
Halotin, 8
Harvoni, 2
Havrix, 26
Hectorol, 13
Helidac, 14
Hematogen Fa, 16
Hematron-AF, 16
Hemocyte Plus, 16
Hemocyte-f, 16
Hepsera, 2
Hetlioz, 18
Hexalen, 3
Hiprex, 15
Histex-ac, 25
homatropine HBR, 21
Horizant, 20
Humalog, 11
Humalog Kwikpen, 11
Humalog Mix 50/50, 11
Humalog Mix 50/50 Kwikpen, 11
Humalog Mix 75/25, 11
Humalog Mix 75/25 Kwikpen, 11
Humatrope, 12
Humatrope Combo Pack, 12
Humira, 24
Humira Pediatric Crohns Disease Starter
Pack, 24
Humira Pen, 24
Humira Pen-crohns Diseasestarter, 24
Humira Pen-psoriasis Starter, 24
Humulin 70/30, 11
Humulin 70/30 Kwikpen, 11
Humulin 70/30 Pen, 11
Humulin N, 11
Humulin N Kwikpen, 11
Humulin N U-100 Pen, 11
Humulin R, 11
Humulin R U-500 (concentrated), 11
Hycamtin, 4
Hycet, 23
Hycofenix, 25
hydralazine HCL, 6
Hydrea, 4
Hydro 35, 9
hydrochlorothiazide, 6
hydrocodone bitartrate/acetaminophen,
23
Hydrocodone Bitartrate/Acetaminophen,
23
hydrocodone bitartrate/chlorpheniramine
maleate/PSE, 25
hydrocodone bitartrate/homatropine
methylbromide, 25
hydrocodone polistirex/chlorpheniramine
polistirex, 25
hydrocodone/acetaminophen, 23
Hydrocodone/Acetaminophen, 23
hydrocodone/homatropine, 25
hydrocodone/ibuprofen, 23
hydrocort ene 100MG, 14
hydrocortisone, 9, 10, 14
hydrocortisone acetate/aloe, 9
Integra F, 16
hydrocortisone acetate/lidocaine HCL, 14 Integra Plus, 16
hydrocortisone acetate/pramoxine, 14
Intelence, 2
hydrocortisone butyrate, 9
Intermezzo, 18
hydrocortisone butyrate (lipid), 9
Introl, 6
hydrocortisone butyrate (lipophilic), 9
Intron A, 4
hydrocortisone IN absorbase, 9
Intron A W/Diluent, 4
hydrocortisone valerate, 9
Intuniv, 19
hydrocortisone/acetic acid, 22
Invega, 18
hydromorphone HCL, 23
Invirase, 2
Hydromorphone HCL, 23
Invokamet, 12
hydromorphone HCL ER, 23
Invokana, 12
Hydromorphone HCL ER, 23
Iopidine, 22
hydroxychloroquine sulfate, 3
ipratropium bromide, 24, 25
hydroxyurea, 4
ipratropium bromide/albuterol sulfate, 25
hydroxyzine HCL, 17
irbesartan, 5
hydroxyzine pamoate, 17
irbesartan/hydrochlorothiazide, 6
Hydroxyzine Pamoate, 17
Iressa, 4
Hylira, 9
Iron Asp Gly/ Polysacch Compl/Ascorb
hyoscyamine sulfate, 13
CAL/B12/Fa/C Threon/Suc, 16
hyoscyamine sulfate ER, 13
Irospan 24/6, 16
hyoscyamine sulfate odt, 13
Is 24/6, 16
hyoscyamine sulfate SR, 14
Isentress, 2
Hyper-sal, 25
isoniazid, 2
Hypersal, 25
Isoniazid, 2
Hypertenevide-12.5, 5
Isopto Atropine, 21
Hypertenipine-2.5, 5
Isopto Carbachol, 21
Hypertensolol, 6
Isopto Carpine, 22
Hyzaar, 6
Isopto Homatropine, 21
Isopto Hyoscine, 21
I
Isordil Titradose, 4
ibandronate sodium, 12
isosorbide dinitrate, 4
Ibrance, 4
Isosorbide Dinitrate, 4
Ibudone, 23
isosorbide dinitrate ER, 4
ibuprofen, 23
isosorbide mononitrate, 4
IC 400, 24
isosorbide mononitrate ER, 4
IC 800, 24
isradipine, 5
Icar-c Plus, 16
Istalol, 21
Iclusig, 4
itraconazole, 2
Ilevro, 22
ivermectin, 3
Imbruvica, 4
J
Imdur, 4
imipramine HCL, 17
Jadenu, 28
imipramine pamoate, 17
Jakafi, 4
imiquimod, 9
Jalyn, 15
Imitrex, 24
Janumet, 12
Imitrex Statdose Refill, 24
Janumet XR, 12
Imitrex Statdose System, 24
Januvia, 12
Imuran, 4
Jardiance, 12
Inatal Advance, 27
Jentadueto, 12
Inatal GT, 27
Jublia, 8
Inatal Ultra, 27
Juxtapid, 7
Increlex, 13
K
indapamide, 6
K-phos NO 2, 15
Inderal LA, 5
K2k Pain Relieving Patch, 9
Inderal XL, 5
Kadian, 23
Indocin, 24
Kaletra, 2
indomethacin, 23
Kalydeco, 26
indomethacin ER, 23
Kapvay, 19
Infasurf, 26
Kapvay Dose Pack, 19
Infergen, 2
Karbinal ER, 24
Influenza A (h1n1) Monovalent 2009, 26
Kazano, 12
Inlyta, 4
Keflex, 1
Innopran XL, 5
Kepivance, 4
Inova, 7
Keppra, 19
Inova 4/1 Acne Control Therapy, 7
Keppra XR, 19
Inova 8/2 Acne Control Therapy, 7
Keralyt, 9
Inspra, 6
Keralyt Scalp, 9
Insulin Syringe/0.5ML/30G X 5/16", 28
Kerlone, 5
Kerydin, 8
Ketek, 3
ketoconazole, 2, 8
Ketodan Kit, 8
ketoprofen, 23
Ketoprofen ER, 24
ketorolac tromethamine, 22, 23
Khedezla, 17
Kineret, 24
Kitabis PAK, 1
Klonopin, 19
Kombiglyze XR, 12
Korlym, 12
Kristalose, 13
Kuvan, 13
Kynamro, 7
L
labetalol HCL, 5
Lac-hydrin, 9
Lacrisert, 21
lactic acid, 9
lactic acid e, 9
lactic acid w/vitamin e, 9
lactulose, 13, 14
Lamictal, 19
Lamictal Chewable Dispersible, 19
Lamictal Odt, 19
Lamictal Starter/Not Taking
Carbamazepine, 19
Lamictal Starter/Taking
Carbamazepine/Not Taking Valproate,
19
Lamictal Starter/Taking Valproate, 19
Lamictal XR, 19
Lamisil, 2
Lamisil Spray, 8
lamivudine, 2
lamivudine/zidovudine, 2
lamotrigine, 19
lamotrigine ER, 19
lamotrigine odt, 19
Lanoxin, 4
lansoprazole, 14
lansoprazole/amoxicillin/clarithromycin,
14
Lantus, 11
Lantus Solostar, 11
Lasix, 6
Lastacaft, 22
latanoprost, 21
Latrix XM, 9
Latuda, 18
Lazanda, 23
leflunomide, 23
Lenvima 10MG Daily Dose, 4
Lescol, 7
Lescol XL, 7
Letairis, 7
letrozole, 3
leucovorin calcium, 4
Leucovorin Calcium, 4
Leukeran, 3
Leukine, 16
leuprolide acetate, 3
Levacet, 22
levalbuterol, 25
levalbuterol HCL, 25
Levaquin, 1
Levatol, 5
Levbid, 14
Levemir, 11
Levemir Flexpen, 11
Levemir Flextouch, 11
levetiracetam, 19
levetiracetam ER, 19
levobunolol HCL, 21
Levobunolol HCL, 21
levocarnitine, 13
levocetirizine dihydrochloride, 24
levofloxacin, 1, 21
levonorgestrel, 10
Levonorgestrel, 10
levonorgestrel and ethinyl estradiol, 10
levonorgestrel/ethinyl estradiol, 10
Levorphanol Tartrate, 23
levothyroxine sodium, 13
Levsin, 14
Levsin/SL, 14
Lexapro, 17
Lexiva, 2
Lialda, 14
lidocaine, 9
Lidocaine And Tetracaine Cream, 9
lidocaine HCL, 9, 17
Lidocaine HCL, 9
lidocaine HCL jelly, 9
lidocaine HCL viscous, 17
Lidocaine HCL-hydrocortisone Acetate
With Aloe, 15
lidocaine HCL/hydrocortisone acetate, 14
lidocaine viscous, 17
lidocaine/prilocaine, 9
Lidoderm, 9
Lidoprofen, 8
Lidovir, 8
lindane, 9
linezolid, 3
Linzess, 14
liothyronine sodium, 13
Lipitor, 7
Lipofen, 7
Liptruzet, 7
Liquicet, 23
lisinopril, 5
lisinopril/hydrochlorothiazide, 6
Lithium, 18
lithium carbonate, 18
Lithium Carbonate, 18
lithium carbonate ER, 18
Lithobid, 18
Lithostat, 15
Livalo, 7
LO Loestrin FE, 11
LO Minastrin FE, 11
Lodosyn, 19
Loestrin 1.5/30-21, 11
Loestrin 1/20-21, 11
Loestrin FE 1.5/30, 10
Loestrin FE 1/20, 11
Lofibra, 7
Lomotil, 13
Lomustine, 3
loperamide HCL, 13
Lopid, 7
Lopressor, 5
Lopressor HCT, 6
Loprox, 8
Loprox Shampoo, 8
lorazepam, 17
Lorazepam Intensol, 17
Lorcet 10/650, 23
Lorcet Plus, 23
Lortab, 23
Lorzone, 20
losartan potassium, 5
losartan potassium/hydrochlorothiazide,
6
Loseasonique, 11
Lotemax, 21
Lotensin, 5
Lotensin HCT, 6
Lotrel, 6
Lotrisone, 8
Lotronex, 15
lovastatin, 7
Lovaza, 7
Lovenox, 16
loxapine, 18
loxapine succinate, 18
Loxitane, 18
Lta 360 Kit, 17
Lufyllin, 25
Lumigan, 21
Lunesta, 18
Luvox CR, 18
Luzu, 8
Lycelle, 9
Lynparza, 4
Lyrica, 19
Lysodren, 3
Lysteda, 16
Lytensopril Kit, 6
Lytensopril-90, 6
Lytensopril-90 Kit, 6
M
M-m-r II, 26
M-vit, 27
Macnatal CN DHA, 27
Macrobid, 15
Macrodantin, 15
Magnacet, 23
Malarone, 3
malathion, 9
Maprotiline HCL, 18
Marinol, 14
Marnatal-f, 27
Marplan, 18
Matulane, 4
Mavik, 5
Maxair Autohaler, 25
Maxalt, 24
Maxalt-MLT, 24
Maxaron Forte, 16
Maxfe, 16
Maxidex, 21
Maxidone, 23
Maxitrol, 21
Maxzide, 6
Maxzide-25, 6
meclizine HCL, 14
Meclofenamate Sodium, 24
Medi-derm/L-RX, 9
Medical Provider EZ Flu Shot 2014-2015,
26
Medrol, 10
Medrol Dosepak, 10
medroxyprogesterone acetate, 11
mefenamic acid, 23
mefloquine HCL, 3
Megace ES, 11
Megace Oral, 3
megestrol acetate, 3, 11
Megrix, 9
Mekinist, 4
meloxicam, 23
Meloxicam, 24
memantine HCL, 20
memantine HCL titration PAK, 20
Menactra, 26
Menest, 10
Menomune-a/C/Y/W-135, 26
Menopur, 12
Menostar, 10
Mentax, 8
Menveo, 26
meperidine HCL, 23
Meperidine HCL, 23
Mephyton, 26
meprobamate, 17
Mepron, 3
mercaptopurine, 3
mesalamine, 14
Mesnex, 4
Mestinon, 20
Mestinon Timespan, 20
Metadate CD, 19
Metaproterenol Sulfate, 25
metaxalone, 20
Metaxalone, 20
metformin HCL, 11
metformin HCL ER, 11
methadone HCL, 23
Methadone HCL, 23
Methadose, 23
Methadose Sugar-free, 23
methamphetamine HCL, 18
methazolamide, 6
methenamine hippurate, 15
methenamine mandelate, 15
Methenamine Mandelate, 15
methimazole, 13
methocarbamol, 20
methotrexate, 3
methoxsalen, 8
methscopolamine bromide, 14
Methyclothiazide, 6
methyldopa, 6
Methyldopa/Hydrochlorothiazide, 6
methylergonovine maleate, 22
Methylin, 19
methylphenidate HCL, 18
methylphenidate HCL CD, 18
methylphenidate HCL ER, 18
Methylphenidate HCL ER, 19
methylphenidate HCL SR, 18
methylphenidate hydrochloride, 18
methylprednisolone, 10
methylprednisolone dose pack, 10
Metipranolol, 21
metoclopramide HCL, 14
metoclopramide odt, 14
metolazone, 6
metoprolol succinate ER, 5
metoprolol tartrate, 5
metoprolol/hydrochlorothiazide, 6
Metozolv Odt, 15
Metrogel-vaginal, 15
metronidazole, 3, 8
metronidazole vaginal, 15
Mevacor, 7
mexiletine HCL, 5
Miacalcin, 12
Micardis, 6
Micardis HCT, 6
Microzide, 6
midodrine HCL, 7
Mifeprex, 13
Migergot, 24
Migral, 24
Migranal, 24
Millipred, 10
Millipred DP, 10
Minastrin 24 FE, 11
Mineral Oil Heavy, 13
Minipress, 6
Minivelle, 10
Minocin, 1
minocycline HCL, 1
minocycline HCL ER, 1
minoxidil, 6
Mirapex, 19
Mirapex ER, 19
Mircera, 16
Mircette, 11
mirtazapine, 17
mirtazapine odt, 17
Mirvaso, 8
misoprostol, 14
Mitigare, 24
Mitosol, 21
Mobic, 24
modafinil, 18
Moderiba, 2
Moderiba 1200 Dose Pack, 2
Moderiba 800 Dose Pack, 2
Modicon, 11
moexipril HCL, 5
moexipril/hydrochlorothiazide, 6
mometasone furoate, 9
Moms Choice RX, 27
Monodox, 1
montelukast sodium, 25
Monurol, 15
morphine sulfate, 23
Morphine Sulfate, 23
morphine sulfate ER, 23
Morphine Sulfate ER, 23
Motofen, 13
Moviprep, 13
Moxatag, 1
Moxeza, 21
moxifloxacin HCL, 1
MS Contin, 23
Multaq, 5
Multigen, 16
Multigen Folic, 16
Multigen Plus, 16
mupirocin, 8
mupirocin calcium, 8
MV FE Asparto Gly/FE Fum/Succ Acid/Vit
C/Threonic Acd/B12/Fa, 16
MV FE Asparto Gly/Vit C/Vit B12/CA
Threonate/Succ Acd/Stomac, 16
Myalept, 13
Myambutol, 2
Mycobutin, 2
mycophenolate mofetil, 4
mycophenolic acid DR, 4
Mydfrin, 21
Myfortic, 4
Mykidz Iron Fl, 27
Myleran, 3
Mynatal, 27
Mynatal Advance, 27
Mynatal Ultracaplet, 27
Myoxin, 22
Myrbetriq, 15
Mysoline, 19
N
nabumetone, 23
nadolol, 5
nadolol/bendroflumethiazide, 6
Nafrinse Daily/Acidulated, 17
Nafrinse Daily/Neutral, 17
Nafrinse Weekly, 17
naftifine HCL, 8
Naftin, 8
Nalfon, 23
Namenda, 20
Namenda Titration PAK, 20
Namenda XR, 20
Namenda XR Titration Pack, 20
Naphazoline HCL, 21
Naprelan, 24
Naprosyn, 24
naproxen, 23
Naproxen, 24
naproxen sodium, 23
naproxen sodium ER, 23
naratriptan HCL, 24
Nardil, 18
Nasacort AQ, 25
Nascobal, 16
Nasonex, 25
Natachew, 27
Natacyn, 21
Natafort, 27
Natalvirt 90 DHA, 27
Natalvirt CA, 27
Natalvirt Flt, 16
Natalvit, 27
Natazia, 11
nateglinide, 11
Natelle One, 27
Natpara, 12
Nature-throid, 13
Nature-throid Nt-2.5, 13
Nebupent, 3
Nebusal, 25
Necon 1/50-28, 11
Necon 10/11-28, 11
Neevo DHA, 27
nefazodone HCL, 17
Nefazodone HCL, 18
Neo-synalar, 8
neomycin sulfate, 1
neomycin/bacitracin/polymyxin, 21
neomycin/polymyxin/bacitracin zinc, 21
neomycin/polymyxin/bacitracin/hydrocorti
sone, 21
neomycin/polymyxin/dexamethasone, 21
neomycin/polymyxin/gramicidin, 21
neomycin/polymyxin/HC, 22
Neomycin/Polymyxin/Hydrocortisone, 21
neomycin/polymyxin/hydrocortisone, 22
Neoral, 4
Neosporin, 21
Neotuss Plus, 25
Nephplex RX, 27
Nephro-vite RX, 27
Nephrocaps, 27
Nephrocaps QT, 27
Nephron Fa, 16
Neptazane, 6
Nesina, 12
Nestabs, 27
Nestabs Abc, 27
Nestabs DHA, 27
Neulasta, 16
Neulasta Delivery Kit, 16
Neumega, 16
Neupogen, 16
Neupro, 19
Neurontin, 19
Neutrasal, 17
Neuvaxin, 9
Nevanac, 22
nevirapine, 2
Nevirapine, 2
nevirapine ER, 2
Newgen, 27
Nexa Plus, 27
Nexavar, 4
Nexium, 14
niacin ER, 7
niacinamide/azelaic ac/ turmer/fa/b6/zinc
ox/copper, 26
Niacor, 7
Niaspan, 7
Nicadan, 27
nicardipine HCL, 5
Nicazel, 27
Nicazel Forte, 27
Nicazeldoxy 30 Kit, 1
Nicazeldoxy 60 Kit, 1
Nicomide, 27
Nicotrol Inhaler, 20
Nicotrol Ns, 20
nifedipine, 5
nifedipine ER, 5
Nilandron, 3
nimodipine, 5
Niravam, 17
nisoldipine, 5
Nisoldipine, 5
Nisoldipine ER, 5
Nitro-bid, 4
Nitro-dur, 4
nitrofurantoin, 15
nitrofurantoin macrocrystals, 15
nitrofurantoin monohydrate, 15
nitrofurantoin
monohydrate/macrocrystals, 15
nitroglycerin, 4
nitroglycerin ER, 4
nitroglycerin lingual, 4
Nitroglycerin Lingual, 4
nitroglycerin transdermal, 4
Nitrolingual Pumpspray, 4
Nitromist, 4
Nitrostat, 4
Niva-plus, 27
nizatidine, 14
Nizoral, 8
Nor-QD, 11
Norco, 23
Norditropin Cartridge, 12
Norditropin Flexpro, 12
Norditropin Nordiflex Pen, 12
norethindrone, 10
norethindrone & ethinyl estradiol ferrous
fumarate, 10
norethindrone acetate, 11
norethindrone acetate/ethinyl estradiol,
10(2)
norethindrone acetate/ethinyl
estradiol/ferrous fumarate, 10
norgestimate/ethinyl estradiol, 10
Norinyl 1+35, 11
Norinyl 1+50, 11
Noroxin, 1
Norpace, 5
Norpace CR, 5
Norpramin, 18
Northera, 7
nortriptyline HCL, 17
Nortriptyline HCL, 18
Norvasc, 5
Norvir, 2
Novaferrum, 16
Novolin 70/30, 11
Novolin 70/30 Relion, 11
Novolin N, 11
Novolin N Relion, 11
Novolin R, 11
Novolin R Relion, 11
Novolog, 11
Novolog Flexpen, 11
Novolog Mix 70/30, 11
Novolog Mix 70/30 Prefilled Flexpen, 11
Novolog Penfill, 11
Noxafil, 2
Nucynta, 23
Nucynta ER, 23
Nuedexta, 20
Nulytely/Flavor Packs, 13
Numoisyn, 17
Nuox, 8
Nutricap, 27
Nutridox, 1
Nutrivit, 27
Nutropin AQ Nuspin 10, 12
Nutropin AQ Pen, 12
Nuvail, 9
Nuvaring, 11
Nuvigil, 19
Nuzon, 9
Nymalize, 5
nystatin, 2, 8, 17
nystatin/triamcinolone, 8
O
O-CAL Fa, 27
O-CAL Prenatal, 27
OB Complete, 27
OB Complete 400, 27
OB Complete One, 27
OB Complete Petite, 27
OB Complete Premier, 27
OB Complete/DHA, 27
OB-natal One, 27
Obstetrix DHA, 27
Obstetrix EC, 27
octreotide acetate, 13
Ocufen, 22
Ocuflox, 21
Ofev, 26
ofloxacin, 1, 21, 22
Ofloxacin, 1
Ogestrel, 11
olanzapine, 18
olanzapine odt, 18
olanzapine/fluoxetine, 20
Oleptro, 18
olopatadine HCL, 24
Olysio, 3
Omeclamox-PAK, 14
omega-3-acid ethyl esters, 7
omeprazole, 14
Omeprazole + Syrspend SF Alka, 14
omeprazole/sodium bicarbonate, 14
Omnaris, 25
Omnipred, 21
Omnitrope, 12
Omontys, 16
ondansetron HCL, 14
ondansetron odt, 14
Onfi, 19
Onglyza, 12
Onmel, 2
Opana, 23
Opana ER (crush Resistant), 23
opium, 13
opium tincture, 13
Opium Tincture (paregoric), 13
Opsumit, 7
Optivar, 22
Oracea, 8
Oracit, 15
Orafate, 17
Orap, 20
Orapred, 10
Orapred Odt, 10
Oravig, 17
Orencia, 24
Orenitram, 7
Orfadin, 13
Orkambi, 26
orphenadrine citrate ER, 20
orphenadrine/asa/caffeine, 20
Ortho Evra, 11
Ortho Micronor, 11
Ortho Tri-cyclen, 11
Ortho Tri-cyclen LO, 11
Ortho-cept, 11
Ortho-cyclen, 11
Ortho-novum 1/35, 11
Ortho-novum 7/7/7, 11
Oseni, 12
Osmoprep, 13
Osphena, 12
Otezla, 24
Otozin, 22
Ovace Plus, 8
Ovace Plus Wash, 8
Ovace Wash, 9
Ovcon-35, 11
Ovide, 9
Ovidrel, 12
Oxandrin, 10
oxandrolone, 10
oxaprozin, 23
oxazepam, 17
oxcarbazepine, 19
Oxecta, 23
Oxistat, 8
Oxsoralen, 9
Oxsoralen Ultra, 8
Oxtellar XR, 19
oxybutynin chloride, 15
oxybutynin chloride ER, 15
oxycodone HCL, 23
Oxycodone HCL, 23
Oxycodone HCL ER, 23
oxycodone/acetaminophen, 23
oxycodone/aspirin, 23
oxycodone/ibuprofen, 23
Oxycontin, 23
oxymorphone hydrochloride, 23
oxymorphone hydrochloride ER, 23
P
Paire OB, 27
Palgic, 24
Pamelor, 18
Pamine, 14
Pamine Forte, 14
Pamine FQ, 14
Panatuss Dxp, 25
Pancreaze, 14
Pancrelipase, 14
pantoprazole sodium, 14
Parafon Forte DSC, 20
Parcopa, 20
paricalcitol, 13
Parlodel, 20
Parnate, 18
paromomycin sulfate, 1
paroxetine HCL, 17
paroxetine HCL ER, 17
Paser, 2
Pataday, 22
Patanase, 25
Patanol, 22
Paxil, 17
Paxil CR, 18
Pazeo, 22
PCE, 1
Pediaderm AF Complete Kit, 8
Pediapred, 10
Pediatex TD, 25
Pediatex TDM, 25
Pedipirox-4 Nail, 8
peg 3350/electrolytes, 13
peg-3350/electrolytes, 13
peg-3350/NACL/NA bicarbonate/KCL, 13
Peg-intron, 2
Peg-intron Redipen, 2
Peg-intron Redipen PAK 4, 2
Peganone, 19
Pegasys, 2
Pegasys Proclick, 2
Pegintron, 2
penicillin v potassium, 1
Penlac Nail Lacquer, 8
Pennsaid, 8
Pentasa, 15
pentazocine/acetaminophen, 23
pentazocine/naloxone HCL, 23
pentoxifylline ER, 16
Pepcid, 14
Percocet, 23
Percodan, 23
Perforomist, 25
Peridex, 17
perindopril erbumine, 5
permethrin, 9
perphenazine, 18
Perphenazine/Amitriptyline, 20
Persantine, 17
Pertzye, 14
Pexeva, 18
phenazopyridine HCL, 15
phenelzine sulfate, 17
phenobarbital, 18
Phenobarbital, 18
phenoxybenzamine hydrochloride, 6
phenylephrine HCL, 21
phenylephrine/guaifenesin, 25
Phenytek, 19
phenytoin, 19
phenytoin sodium extended, 19
Phoslo, 15
Phoslyra, 15
Phospholine Iodide, 22
Phrenilin Forte, 22
pilocarpine HCL, 17, 21
pilocarpine hydrochloride, 17
pindolol, 5
pioglitazone HCL, 12
pioglitazone HCL-glimepiride, 12
pioglitazone HCL/metformin HCL, 12
piroxicam, 23
Plan B, 11
Plan B One-step, 11
Plaquenil, 3
Plavix, 17
Plegridy, 20
Plegridy Starter Pack, 20
Pletal, 17
Pliaglis, 9
Pneumovax 23, 26
Pneumovax 23/1 Dose, 26
Pneumovax 23/5 Dose, 26
podofilox, 9
Poly-VI-flor, 27
Poly-VI-flor FS, 27
Poly-VI-flor/Iron, 27
polyethylene glycol 3350, 13
polymyxin b sulfate/trimethoprim sulfate,
21
Polytrim, 21
Pomalyst, 4
Ponstel, 24
potassium citrate ER, 15
potassium citrate-citric acid crystals, 15
potassium citrate/citric acid, 15
potassium citrate/sodium citrate/citric
acid, 15
Potiga, 19
Pr Natal 400, 27
Pr Natal 400 EC, 27
Pr Natal 430, 27
Pr Natal 430 EC, 27
Pradaxa, 16
Praluent, 7
pramipexole dihydrochloride, 19
pramipexole dihydrochloride ER, 19
Pramosone, 9
Pramotic, 22
Prandimet, 12
Prandin, 11
Pravachol, 7
pravastatin sodium, 7
Prazolamine, 20
prazosin HCL, 6
Pre-folic, 16
Precose, 12
Pred Forte, 21
Pred Mild, 21
Pred-G, 21
Pred-G S.o.p., 21
prednicarbate, 9
prednisolone, 10
prednisolone acetate, 21
prednisolone sodium phosphate, 10
Prednisolone Sodium Phosphate, 10, 21
prednisolone sodium phosphate odt, 10
prednisone, 10
Prednisone, 10
Prednisone Intensol, 10
Prefera OB, 27
Prefera OB + DHA, 27
Preferaob +dha, 27
Preferaob One, 27
Prefest, 10
Prefol-DHA, 27
Premarin, 10, 15
Premphase, 10
Prempro, 10
Prenata, 27
Prenatabs RX, 27
Prenatal Ad, 27
Prenatal-u, 27
Prenate, 27
Prenate AM, 27
Prenate DHA, 27
Prenate Elite, 27
Prenate Enhance, 27
Prenate Essential, 27
Prenate Mini, 27
Prenate Pixie, 27
Prenate Restore, 27
Prenate Star, 27
Prepidil, 22
Prepopik, 13
Preque 10, 27
Prevacid, 14
Prevacid Solutab, 14
Prevident, 17
Prevnar 13, 26
Prevpac, 14
Prezcobix, 2
Prezista, 2
Priftin, 2
Prilosec, 14
Primaquine Phosphate, 3
primidone, 19
Primlev, 23
Primsol, 3
Prinivil, 5
Pristiq, 18
probenecid, 24
probenecid/colchicine, 24
Procardia, 5
Procardia XL, 5
Procentra, 19
prochlorperazine, 18
prochlorperazine maleate, 18
Procort, 15
Procrit, 16
Proctocort, 15
Proctofoam HC, 15
Procysbi, 16
Proferrin-forte, 16
progesterone, 11
Progesterone 10% Kit, 11
Proglycem, 12
Prograf, 4
Prolastin-c, 26
Prolensa, 22
Proleukin, 4
Prolida, 9
Promacta, 16
promethazine HCL, 24
promethazine HCL plain, 24
promethazine-DM, 25
promethazine/codeine, 25
promethazine/dextromethorphan, 25
Promethazine/Phenylephrine, 25
promethazine/phenylephrine/codeine, 25
Prometrium, 11
Promiseb Complete, 9
propafenone HCL, 5
propafenone HCL ER, 5
Propantheline Bromide, 14
proparacaine HCL, 22
propranolol HCL, 5
Propranolol HCL, 5
propranolol HCL ER, 5
Propranolol/Hydrochlorothiazide, 6
propylthiouracil, 13
Proquad, 26
Proscar, 15
Prosed/DS, 15
Prostigmin, 20
Prostin E2, 22
Protect Plus, 27
Protectbone, 27
Protectiron, 16
Protectnatal, 27
Prothelial, 17
Protonix, 14
Protopic, 9
protriptyline HCL, 17
Provera, 11
Provida DHA, 27
Provida OB, 27
Provigil, 19
Prozac, 18
Prozac Weekly, 18
Prudoxin, 8
Pulmicort, 25
Pulmicort Flexhaler, 25
Pulmophylline, 25
Pulmozyme, 26
Purinethol, 3
Purixan, 3
Pylera, 14
pyrazinamide, 2
Pyridium, 15
pyridostigmine bromide, 20
Pyrogallic Acid, 9
Q
Qnasl, 25
Qnasl Childrens, 25
Qualaquin, 3
Quartette, 11
Quazepam, 18
Qudexy XR, 19
Questran, 7
Questran Light, 7
quetiapine fumarate, 18
Quflora Pediatric, 27
Quillivant XR, 19
quinapril HCL, 5
quinapril/hydrochlorothiazide, 6
quinidine gluconate CR, 5
quinidine gluconate ER, 5
quinidine sulfate, 5
Quinidine Sulfate, 5
Quinidine Sulfate ER, 5
quinine sulfate, 3
Qvar, 25
R
R-natal OB, 27
rabeprazole sodium, 14
raloxifene hydrochloride, 12
ramipril, 5
Ranexa, 4
ranitidine HCL, 14
Rapaflo, 15
Rapamune, 4
Ravicti, 13
Rayos, 10
Razadyne, 20
Razadyne ER, 20
Rebetol, 2
Rebif, 20
Rebif Rebidose, 20
Rebif Rebidose Titration Pack, 20
Rebif Titration Pack, 20
Recombivax HB, 26
Recothrom, 16
Recothrom Spray Kit, 16
Rectiv, 15
Reglan, 15
Relagard, 15
Relenza Diskhaler, 2
Relhist, 25
Relion Insulin Syringe/U-100/0.5ML/29G
X 1/2", 28
Relion R, 11
Relistor, 14
Relpax, 24
Relyyt, 9
Remeron, 18
Remeron Soltab, 18
Renagel, 15
Renatabs, 27
Renatabs With Iron, 27
Renvela, 15
repaglinide, 11
Reprexain, 23
Repronex, 12
Req 49+, 27
Requip, 20
Requip XL, 20
Rescon-JR, 25
Rescon-MX, 25
Rescriptor, 2
Rescula, 21
Reserpine, 6
Respa-BR, 24
Restasis, 22
Restoril, 18
Retin-a Micro, 8
Retin-a Micro P.M., 8
Retrovir, 2
Revatio, 7
Revlimid, 4
Rexulti, 18
Reyataz, 2
Rezira, 25
Rezyst SB, 13
Rheumatrex, 24
Rhinocort Aqua, 25
Rhinoflex-650, 22
Riax, 8
Ribasphere, 2
Ribasphere Ribapak, 2
Ribatab, 3
ribavirin, 2
Ridaura, 23
rifabutin, 2
Rifadin, 2
Rifamate, 2
rifampin, 2
Rifater, 2
Rilutek, 20
riluzole, 20
rimantadine HCL, 2
Rimantalist, 2
Riomet, 11
risedronate sodium, 12
risedronate sodium DR, 12
Risperdal, 18
Risperdal M-TAB, 18
risperidone, 18
risperidone odt, 18
Ritalin, 19
Ritalin LA, 19
Ritalin SR, 19
rivastigmine tartrate, 20
rizatriptan benzoate, 24
rizatriptan benzoate odt, 24
Robaxin, 20
Robaxin-750, 20
Robinul, 14
Robinul Forte, 14
Rocaltrol, 13
ropinirole ER, 19
ropinirole HCL, 19
Rosadan Kit, 8
Rosanil, 8
Rotarix, 26
Rotateq, 26
Rowasa, 15
Roxicet, 23
Roxicodone, 23
Rozerem, 18
Ruconest, 17
Rytary, 20
Rythmol, 5
Rythmol SR, 5
S
Sabril, 19
Safyral, 11
Salagen, 17
Salex, 9
Salex Cream, 9
Salex Lotion, 9
salicylic acid, 9
Salicylic Acid, 9
salicylic acid cream, 9
Salicylic Acid IN Ammonium Lactate
Vehicle, 9
salicylic acid lotion, 9
Salkera, 9
salsalate, 22
Salvax, 9
Salvax Duo Plus, 9
Samsca, 13
Sanctura, 15
Sanctura XR, 15
Sancuso, 14
Sandimmune, 4
Sandostatin, 13
Saphris, 18
Sarafem, 20
Savaysa, 16
Savella, 20
Savella Titration Pack, 20
Scalacort DK, 9
Seasonique, 11
Seb-prev, 9
Seconal, 18
Sectral, 5
Select-OB, 27
Select-ob+dha, 27
selegiline HCL, 19
selenium sulfide, 8
Selrx, 9
Selzentry, 3
Semprex-d, 25
Senophylline, 25
Sensipar, 13
Sentradine, 14
Sentraflox AM-10, 18
Sentralopram AM-10, 18
Sentramodafin AM-100, 19
Sentravil PM-25, 18
Sentrazolam AM 0.25, 17
Sentrazolpidem PM-5, 18
Sentroxatine, 18
Serevent Diskus, 25
Seroquel, 18
Seroquel XR, 18
sertraline HCL, 17
Sevelamer Carbonate, 15
Sfrowasa, 15
Shohls Solution Modified, 15
Siderol, 27
Signifor, 13
sildenafil, 7
sildenafil citrate, 7
Silenor, 18
Simbrinza, 22
Simcor, 7
Simponi, 24
simvastatin, 7
Sinelee, 9
Sinemet, 20
Sinemet CR, 20
Singulair, 25
sirolimus, 4
Sirturo, 2
Sitavig, 2
Sivextro, 3
Skelaxin, 20
Sklice, 9
Sodium Bicarbonate, 13
sodium chloride, 25
sodium citrate/citric acid, 15
sodium phenylbutyrate, 13
sodium sulfacetamide, 7, 8, 21
sodium sulfacetamide wash, 8
sodium sulfacetamide/sulfur, 7
sodium sulfacetamide/sulfur cleanser, 7
Sodium Sulfacetamide/Sulfur Cleanser IN
Urea, 8
sodium sulfacetamide/sulfur cleansing
cloths, 7
sodium sulfacetamide/sulfur green, 7
Sodium Sulfacetamide/Sulfur IN Urea, 8
sodium sulfacetamide/sulfur wash, 7
Solodyn, 1
Soltamox, 3
Soma, 20
Somavert, 13
Sonata, 18
Soriatane, 8
sotalol HCL, 5
sotalol HCL (AF), 5
Sotylize, 5
Sovaldi, 2
Spectracef, 1
Spiriva Handihaler, 25
Spiriva Respimat, 25
spironolactone, 6
spironolactone/hydrochlorothiazide, 6
Sporanox, 2
Sporanox Pulsepak, 2
Sprix, 24
Sprycel, 4
Staflex, 22
Stalevo 100, 20
Stalevo 125, 20
Stalevo 150, 20
Stalevo 200, 20
Stalevo 50, 20
Stalevo 75, 20
stannous fluoride oral rinse, 17
Starlix, 11
stavudine, 2
Stavzor, 19
Stimate, 13
Stivarga, 4
Strattera, 19
Strazepam, 18
Striant, 10
Stribild, 3
Striverdi Respimat, 25
Stromectol, 3
Strovite, 27
Strovite Forte, 27
Strovite One, 27
Suboxone, 23
Subsys, 23
Suclear, 13
Sucraid, 14
sucralfate, 14
Sular, 5
sulfacetamide sodium, 7, 21
Sulfacetamide Sodium, 21
sulfacetamide sodium/prednisolone
sodium phosphate, 21
sulfacetamide sodium/sulfur cleanser, 7
Sulfadiazine, 2
sulfamethoxazole/trimethoprim, 3
sulfamethoxazole/trimethoprim DS, 3
sulfasalazine, 14
Sulfoam, 8
Sulfurated Lime, 9
sulindac, 23
Sumadan Kit, 8
Sumatriptan, 24
sumatriptan succinate, 24
Sumatriptan Succinate, 24
sumatriptan succinate refill, 24
Sumaxin CP Kit, 8
Supervite, 27
Supervite EC, 27
Support-500, 27
Suprax, 1
Suprep Bowel Prep, 13
Surfaxin, 26
Surmontil, 18
Survanta Intratracheal, 26
Sustiva, 2
Sutent, 4
Suttar-2, 25
Suttar-SF, 25
Symax Duotab, 14
Symbicort, 25
Symbyax, 20
Symlinpen 120, 11
Symlinpen 60, 11
Synagex, 27
Synalar Cream Kit, 9
Synalar Ointment Kit, 9
Synalgos-dc, 23
Synarel, 12
Synatek, 27
Synera, 9
Synthroid, 13
T
Tabloid, 3
Taclonex, 9
tacrolimus, 4, 9
Tafinlar, 4
Tamiflu, 2
tamoxifen citrate, 3
tamsulosin HCL, 15
Tandem F, 16
Tandem Plus, 16
Tanzeum, 11
Tapazole, 13
Tarceva, 4
Targadox, 1
Targretin, 4
Tarka, 6
Taron-bc, 27
Taron-c DHA, 27
Taron-prex, 27
Tasigna, 4
Tasmar, 20
Tazorac, 8
Tecfidera, 20
Tecfidera Starter Pack, 20
Technivie, 3
Tegretol, 19
Tegretol-XR, 19
Tekamlo, 6
Tekturna, 6
Tekturna HCT, 6
telmisartan, 5
telmisartan/amlodipine, 6
telmisartan/hydrochloroth, 6
telmisartan/hydrochlorothiazide, 6
temazepam, 18
Temodar, 3
temozolomide, 3
Tencon, 22
Tenex, 6
Tenoretic 100, 6
Tenoretic 50, 6
Tenormin, 5
Terazol 3, 15
Terazol 7, 15
terazosin HCL, 6
terbinafine HCL, 2
terbutaline sulfate, 25
terconazole, 15
Tersi Foam, 9
Tessalon Perles, 25
Testim, 10
Testone Cik, 10
Testosterone, 10
testosterone cypionate, 10
testosterone enanthate, 10
Testosterone P.M., 10
Testred, 10
Tetanus/Diphtheria Toxoids-adsorbed,
26
Tetanus/Diphtheria Toxoids-adsorbed
Adult, 26
tetrabenazine, 20
tetracaine HCL, 22
Tetracycline HCL, 1
Tev-tropin, 12
Teveten, 6
Teveten HCT, 6
Thalomid, 4
Theo-24, 25
theophylline, 25
theophylline CR, 25
theophylline ER, 25
Therabenzaprine-60, 20
Therabenzaprine-90, 20
Therabenzaprine-90-5, 20
Theracodeine-300, 23
Theracodophen-325, 23
Theracodophen-low-90, 23
Therafeldamine, 24
Therapentin-60, 19
Therapentin-90, 19
Theraprofen-60, 24
Theraprofen-800, 24
Theraprofen-90, 24
Theraproxen-500, 24
Theraproxen-60, 24
Theraproxen-90, 24
Theratramadol-60, 23
Theratramadol-90, 23
Thiola, 16
thioridazine HCL, 18
thiothixene, 18
Thrombin-jmi Diluent, 16
Thrombin-jmi Epistaxis, 16
Thrombin-jmi Syringe Spray Kit, 16
Thrombin-jmi W/Dil Spray P.M. Actuator,
16
Thrombogen, 16
Thyrolar-1, 13
Thyrolar-1/2, 13
Thyrolar-1/4, 13
Thyrolar-2, 13
Thyrolar-3, 13
tiagabine hydrochloride, 19
Tiazac, 5
ticlopidine HCL, 16
Tigan, 14
Tikosyn, 5
Timolol Maleate, 5
timolol maleate, 21
timolol maleate ophthalmic gel forming,
21
Timoptic, 21
Timoptic Ocudose, 21
Timoptic-xe, 21
Tindamax, 3
tinidazole, 3
Tirosint, 13
Tisseel, 16
Tisseel VH, 16
Tivicay, 3
tizanidine HCL, 20
TL G-FOL OS, 27
Tobi, 1
Tobi Podhaler, 1
Tobradex, 21
Tobradex ST, 21
tobramycin, 1
tobramycin sulfate, 21
tobramycin/dexamethasone, 21
Tobrex, 21
Tofranil, 18
Tofranil-PM, 18
tolazamide, 11
Tolazamide, 11
Tolbutamide, 11
tolcapone, 19
tolmetin sodium, 23
Tolmetin Sodium, 24
tolterodine tartrate, 15
tolterodine tartrate ER, 15
Topamax, 19
Topamax Sprinkle, 19
topiramate, 19
Topiramate ER, 19
Toprol XL, 5
torsemide, 6
Toujeo Solostar, 11
Toviaz, 15
Tracleer, 7
Tradjenta, 12
tramadol HCL, 23
tramadol HCL ER, 23
Tramadol HCL ER, 23
tramadol hydrochloride/acetaminophen,
23
Trandate, 5
trandolapril, 5
trandolapril/verapamil HCL, 6
trandolapril/verapamil HCL ER, 6
tranexamic acid, 16
Transderm-scop, 14
Tranxene T, 17
tranylcypromine sulfate, 17
Travatan Z, 21
Travoprost, 21
Trazamine, 18
trazodone HCL, 17
Trecator, 2
Trepadiclofen-25, 24
Trepoxen-250, 24
Trepoxicam-7.5, 24
tretinoin, 4
tretinoin microsphere, 7
tretinoin microsphere P.M., 7
Trexall, 3
Trezix, 23
Tri-norinyl 28, 11
Tri-VI-flor, 27
triamcinolone acetonide, 9, 17, 24
Triamcinolone Acetonide, 9
triamcinolone IN orabase, 17
triamterene/hydrochlorothiazide, 6
Triamterene/Hydrochlorothiazide, 6
triazolam, 18
Tribenzor, 6
Tricare, 27
Tricare Prenatal Compleat, 27
Tricare Prenatal DHA One, 27
tricitrates, 15
Tricor, 7
trifluoperazine HCL, 18
trifluridine, 21
Triglide, 7
trihexyphenidyl HCL, 19
Trileptal, 19
Trilipix, 7
trimethobenzamide HCL, 14
trimethoprim, 3
trimethoprim sulfate/polymyxin b sulfate,
21
Trinate, 27
Triumeq, 3
Triveen-duo DHA, 27
Triveen-prx RNF, 27
Trizivir, 3
Trokendi XR, 19
trospium chloride, 15
trospium chloride ER, 15
Trulicity, 11
Trumenba, 26
Trusopt, 22
Truvada, 3
Tudorza Pressair, 25
Tussicaps, 25
Tussionex Pennkinetic Extended
Release, 25
Tuzistra XR, 25
Twinrix, 26
Twynsta, 6
Tybost, 2
Tykerb, 4
Tylenol/Codeine #3, 23
Tylenol/Codeine #4, 23
Tyvaso, 7
Tyvaso Refill, 7
Tyvaso Starter, 7
Tyzeka, 2
Tyzine, 25
Tyzine Pediatric Nasal Drops, 25
U
Uceris, 10
Udamin, 27
Udamin SP, 27
Ulesfia, 9
Uloric, 24
Ultracet, 23
Ultram, 23
Ultram ER, 23
Ultravate X, 9
Ultresa, 14
Umecta PD, 9
Uniretic, 6
Univasc, 5
Uramaxin, 10
urea, 9
urea 40% nail film, 9
urea IN zinc undecylenate/lactic acid
vehicle, 9
urea topical, 9
Urecholine, 15
Uretron D/S, 15
Urimar-t, 15
Urocit-k 10, 15
Urocit-k 15, 15
Urocit-k 5, 15
Urogesic-blue, 15
Uroqid #2, 15
Uroxatral, 15
Urso 250, 15
Urso Forte, 15
ursodiol, 14
Uta, 15
V
Vagifem, 15
valacyclovir HCL, 2
Valchlor, 3
Valcyte, 2
valganciclovir, 2
Valium, 17
valproic acid, 19
valsartan, 5
valsartan/hydrochlorothiazide, 6
Valtrex, 2
Vanatol LQ, 22
Vancocin HCL, 3
vancomycin HCL, 3
Vanoxide-HC, 8
Vantas, 3
Vaqta, 26
Varivax, 26
Vascepa, 7
Vaseretic, 6
Vasotec, 5
Vecamyl, 6
Vectical, 8
Velphoro, 15
Veltin, 8
Vemavite-prx 2, 27
venlafaxine HCL, 17
venlafaxine HCL ER, 17
Ventavis, 7
Ventolin HFA, 25
Veramyst, 25
verapamil HCL, 5
Verapamil HCL, 5
verapamil HCL ER, 5
verapamil HCL SR, 5
Veregen, 10
Verelan, 5
Verelan PM, 5
Veripred 20, 10
Versacloz, 18
Vesicare, 15
Vexol, 21
Vfend, 2
Vibramycin, 1
Vicoprofen, 23
Victoza, 11
Victrelis, 3
Videx EC, 2
Videx Pediatric, 2
Viekira PAK, 2
Vigamox, 21
Viibryd, 18
Vimizim, 13
Vimovo, 24
Vimpat, 19
Vinacal B, 27
Vinate AZ Extra, 27
Vinate C, 27
Vinate Calcium, 27
Vinate Care, 27
Vinate DHA, 27
Vinate DHA RF, 27
Vinate GT, 27
Vinate IC, 27
Vinate II, 27
Vinate M, 27
Vinate One, 28
Viokace, 14
Viracept, 2
Viramune, 2
Viramune XR, 2
Virasal, 10
Viread, 2
Viroptic, 21
Vistaril, 17
Vita-pren, 28
Vitafol, 28
Vitafol Ultra, 28
Vitafol-nano, 28
Vitafol-OB, 28
Vitafol-ob+dha, 28
Vitafol-one, 28
Vitafol-pn, 28
Vital-d RX, 28
Vitamedmd One RX/Quatrefolic, 28
Vitamedmd Plus RX/Quatre Folic, 28
Vitamedmd Redichew RX, 28
Vitamedmd Redichew RX/Quatrefolic, 28
vitamin d, 26
Vitapearl, 28
Vitaroca Plus, 28
Vitekta, 3
Vituz, 25
Viva DHA, 28
Vivactil, 18
Vivelle-dot, 10
Vivotif Berna, 26
Vogelxo, 10
Vogelxo P.M., 10
Voltaren, 8
Voltaren-XR, 24
Vopac Kt, 8
voriconazole, 2
Vosol HC, 22
Vospire ER, 25
Votrient, 4
Vpriv, 16
Vusion, 8
Vytorin, 7
Vyvanse, 19
W
warfarin sodium, 16
Welchol, 7
Wellbutrin, 18
Wellbutrin SR, 18
Wellbutrin XL, 18
Westhroid, 13
Wheat Germ, 26
Wp Thyroid, 13
X
Xalatan, 21
Xalkori, 4
Xanax, 17
Xanax XR, 17
Xarelto, 16
Xarelto Starter Pack, 16
Xartemis XR, 23
Xeljanz, 24
Xeloda, 3
Xenazine, 20
Xerac Ac, 10
Xifaxan, 3
Xigduo XR, 12
Xodol, 23
Xolegel, 8
Xolegel Corepak, 8
Xolegel Duo/Head & Shoulders, 8
Xolegel Duo/Xolex, 8
Xolox, 23
Xopenex, 25
Xopenex Concentrate, 25
Xopenex HFA, 26
Xtandi, 3
Xylocaine, 10
Xyphex, 10
Xyrem, 20
Xyzal, 24
Y
Yasmin 28, 11
Yaz, 11
Yodoxin, 3
Z
Zacare 4% Kit, 8
Zacare 8% Kit, 8
zafirlukast, 25
zaleplon, 18
Zamicet, 23
Zanaflex, 20
Zantac, 14
Zarontin, 19
Zaroxolyn, 6
Zatean-CH, 28
Zatean-pn, 28
Zatean-pn DHA, 28
Zatean-pn Plus, 28
Zavesca, 16
Zebeta, 5
Zegerid, 14
Zelapar, 20
Zelboraf, 4
Zemaira, 26
Zemplar, 13
Zenatane, 8
Zenpep, 14
Zenzedi, 19
Zerit, 2
Zestoretic, 6
Zestril, 5
Zetia, 7
Zetonna, 25
Ziac, 6
Ziagen, 2
Ziana, 8
zidovudine, 2
Zioptan, 21
ziprasidone HCL, 18
Zipsor, 24
Zirgan, 21
Zithranol, 8
Zithranol-rr, 8
Zithromax, 1
Zithromax Tri-PAK, 1
Zithromax Z-PAK, 1
Zmax, 1
Zocor, 7
Zofran, 14
Zofran Odt, 14
Zohydro ER, 23
Zolinza, 4
zolmitriptan, 24
zolmitriptan odt, 24
Zoloft, 18
zolpidem tartrate, 18
zolpidem tartrate ER, 18
Zolpimist, 18
Zomig, 24
Zomig Nasal Spray, 24
Zomig ZMT, 24
Zonalon, 8
Zonatuss, 25
Zonegran, 19
zonisamide, 19
Zontivity, 17
Zortress, 4
Zostavax, 26
Zovia 1/50e, 11
Zovirax, 2, 8
Zubsolv, 23
Zuplenz, 14
Zutripro, 25
Zyban, 20
Zyclara, 9
Zyclara P.M., 9
Zydelig, 4
Zydone, 23
Zyflo, 26
Zyflo CR, 26
Zykadia, 4
Zylet, 21
Zyloprim, 24
Zymaxid, 21
Zyprexa, 18
Zyprexa Zydis, 18
Zytiga, 3
Zyvox, 3
8
8-mop, 8

drug formulary - Health Alliance

Transcription

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