Medicaid Drug Formulary

Transcription

MEDICAID FORMULARY
Effective October 2016
Provided by EnvisionRx
Introduction
The Total Health Care (THC) Medicaid Formulary was developed to serve as a guide for physicians,
pharmacists, health care professionals and members in the selection of cost-effective drug therapy. Total
Health Care recognizes that drug therapy is an integral part of effective health management.
In order to streamline drug coverage policies for Medicaid members and providers, the Michigan
Department of Health and Human Services (MDHHS) has worked with Medicaid health plan providers,
including Total Health Care, to create a formulary that is common across all contracted Medicaid Health.
This is known as the Michigan Medicaid Managed Care Common Formulary.
Total Health Care continually reviews new and existing medications to ensure the Formulary remains
responsive to the needs of our members and health professionals. Criteria used to evaluate drug selection
for the formulary includes, but is not limited to: safety, efficacy and cost-effectiveness data, as well as
comparison of relevant benefits of similar prescription or over-the counter (OTC) agents while minimizing
potential duplications.
Notice
The information contained in this formulary is provided by THC, solely for the convenience of medical
providers and members. THC does not warrant or assure accuracy of this information, nor is it intended to
be comprehensive in nature.
This formulary is not intended to be a substitute for the knowledge, expertise, skill or judgment of the
medical provider in their choice of prescription drugs. Total Health Care assumes no responsibility for the
actions or omissions of any medical provider based upon reliance, in whole or in part, on the information
contained herein. The medical provider should consult the drug manufacturer’s product literature or
standard references for more detailed information.
How to Read the Formulary
Drug Name
All formulary drugs are listed either by their generic names (in lowercase) or by their brand names (in
uppercase). Drugs are grouped together by their therapeutic drug category. Specific drug listings may be
accessed by using the index, using the covered generic name or the covered brand name of the drug. The
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brand names listed are for reference use only, and do not denote coverage, unless specifically noted. Any
drug not found in this Formulary listing shall be considered a non-formulary drug.
Requirements/Limits
This field includes potential limitations to the formulary drug. It also may contain additional information
about the coverage of the drug such as applicable quantity limits (QL). For certain agents within the
Medicaid Formulary, a recommended prescribing guideline may apply.
Prescribing Guidelines
Prescribing guidelines may apply to select drugs on the THC formulary. Prescribing guidelines may vary
by benefit design but may include:
Prior Authorization
Required (PA)
Drug requires prior authorization through a specific physician request
process.
Over the Counter Drugs
(OTC)
Drug coverage is available for drugs that are available OTC with an
authorized prescription from your provider.
Specialty Drugs (SP)
Drug requires processing through THC’s contracted specialty
pharmacy, Diplomat Specialty Pharmacy.
Quantity Limit (QL)
Drug coverage may be limited to specific quantities per prescription
and/or time period.
Age Limit (AL)
Drug coverage may depend on patient age.
Gender Restriction (GR) Drug coverage may depend on patient gender.
Step Therapy Required
(ST)
Drug coverage requires that an alternative or trial of another drug be
used before the medication is covered.
Custom (C)
Drug coverage has unique restrictions.
Benefit Coverage and Limitations
This formulary does not define benefit coverage and limitations. Members should contact Total Health
Care at 1-800-826-2862 if they have questions regarding their coverage. Please note that the formulary
process is evolutionary and changes can occur throughout the year.
Prior Authorization (PA)
Drugs indicated with a “PA” require Prior Authorization for coverage. A prescriber may complete a Prior
Authorization form that can be found on the Total Health Care website at www.THCmi.com. You may also
request a form by calling Total Health Care at 1-844-222-5584. Completed prior authorization forms should
be faxed to 1-866-414-3453. Prior Authorization review of prescribing guidelines will be evaluated utilizing
the established drug review criteria approved by Total Health Care. If the request does not meet the approved
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criteria, the request will not be approved and alternative therapy may be recommended along with the proper
course of alternative action. The requesting provider will be provided written notification of Total Health
Care review decisions. THC’s website has a contact link where members can contact THC’s Pharmacy
Department to ask for an exception request.
Non-Formulary Agents
Drugs not found on the Total Health Care Medicaid Formulary, or any updates published by Total Health
Care, shall be considered a non-formulary drug. Requests for coverage of non-formulary agents may be
requested by the health professional depending on specific coverage parameters. Review for non-formulary
drug requests will require a Prior Authorization request with documentation of medical necessity. Generally,
the following basic medical necessity guidelines are used in conducting a review:



The patient has failed an appropriate trial of formulary or preferred agents.
The use of preferred or formulary agent is contraindicated in the patient.
The formulary drug or preferred agents are not suited for the present patient care need, and the drug
selected is required for patient safety.
If the request does not meet the established guidelines request, it will not be approved and alternative therapy
may be recommended along with the proper course of alternative action.
Common Drug Exclusions
The member’s plan design may exclude certain drug classes. Prior authorization is generally not available for
drugs that are specifically excluded by benefit design. Common excluded coverage may include, but are not
limited to:






Drug products used for cosmetic purposes.
Drug products for erectile dysfunction.
Drug products for infertility treatment.
Experimental drug products or any drug product used in an experimental manner.
Drug products identified by the Drug Efficacy Study Implementation (DESI) as being category 5
(less-than-effective for all indications) or category 6 (removed from the market).
Foreign drugs or drugs not approved by the United States Food & Drug Administration (FDA).
Medicaid Fee-For-Service Carve Out List
The State of Michigan has a carve-out list for the Medicaid formulary. The carve-out drugs include mental
health, HIV/AIDS, Oncology, Hemophilia and other miscellaneous drugs that have been added to the State's
100% carve-out list. These drugs must be billed directly by the pharmacies at point-of-sale to the Michigan
Department of Community Health's contracted Pharmacy Benefits Manager (PBM). A list of the carve-out
drugs can be found at https://michigan.fhsc.com/Providers/DrugInfo.asp.
Mandated Generic Substitution
Total Health Care advocates the use of cost-effective generic drugs where FDA- approved generic equivalent
drugs are available. Generic products are listed in the Formulary and noted as “generic” wherever an FDAapproved generic drug product is available. The brand names listed in the formulary are for reference only.
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Total Health Care Pharmacy and Therapeutics (P&T) Committee
Total Health Care’s Pharmacy & Therapeutics Committee meets quarterly to review and recommend
medications for formulary consideration. The Committee considers clinical information on drugs that are new
to the market and drugs that are typically included in an outpatient pharmacy benefit. This assures that the
formulary remains responsive to patient and physician needs. The Committee is composed of physicians,
pharmacists, and health care professionals. The Committee also uses reference materials from our Pharmacy
Benefits Manager's Pharmacy and Therapeutics Advisory Panel.
Product Selection Criteria
The primary goal of the THC Pharmacy & Therapeutics Committee is to maintain and update the formulary
based upon an objective analysis of the safety, efficacy, approved indications, adverse effects,
contraindications, patient administration/compliance considerations and cost effectiveness of available drugs.
When a drug is considered for formulary inclusion, it will be reviewed relative to similar drugs including
those currently in the THC Formulary. Physicians may request a copy of THC’s drug criteria by calling the
Pharmacy Department at 1-800-826-2862.
Diabetic Testing Supplies
Total Health Care works with J&B Medical Supply to provide diabetic testing supplies to our members.
Covered diabetic testing supplies include Glucocard Vital glucometer, Glucocard Expression glucometer, and
SD Biosensor GlucoNavii glucometer, Glucocard Vital test strips, Glucocard Expression test strips, SD
Biosensor GlucoNavii test strips, lancets, insulin syringes, alcohol swabs and ketone strips. These supplies are
to be filled through J&B Medical Supply. If you have any questions about our diabetic supply program,
please contact J&B Medical Supply at 1-844-236-7933.
Specialty Bio-Pharmaceutical Pharmacy Program
Total Health Care works with Diplomat Specialty Pharmacy to provide Specialty Bio-Pharmaceutical
Pharmacy products to our members. These medications are to be filled exclusively through Diplomat
Specialty Pharmacy.
A Specialty Drug Prior Authorization Request form must be completed and faxed to EnvisionRx at 1-866414-3453 with supporting documentation and the prescription. A prescriber may obtain a Specialty Drug
Prior Authorization Request form found on the Total Health Care website at www.THCmi.com.
Once the order is received, EnvisionRx obtains authorization from Total Health Care. If the specialty prior
authorization is approved, Total Health Care notifies Diplomat Specialty Pharmacy. Then, the Diplomat
Specialty Pharmacy staff ships the medication directly to the physician's office or the patient’s home. All
packages are individually marked for each patient and refrigerated items are shipped in insulated containers.
Where appropriate, each shipment includes needles, syringes and alcohol swabs. If you have any questions
about our Specialty Bio-Pharmaceutical Pharmacy program, please contact EnvisionRx at 1-844-222-5584 or
Diplomat Specialty Pharmacy at 1-877-977-9118.
Contact Information
The Total Health Care Medicaid formulary is designed to assist physicians, members and other health care
professionals in the selection of cost-effective agents. Total Health Care encourages your input and feedback
on how we can assist in improving this document and the formulary management process.
You may contact THC at 1-800-826-2862.
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Medication Limitations
Quantity Limitations
Quantity Limitations are on medications throughout the formulary and are indicated with a "QL" notation.
These are medications that have a daily dose restriction, quantity/days’ supply limitation, and/or a
limitation on the duration of therapy.
Age Limitations
Age Limitations are on medications throughout the formulary and are indicated with an "AL" notation.
Coverage for a medication is indicated by the age limitation. This could be a minimum age, maximum age,
and/or the combination of a minimum and maximum age edit.
Gender Restrictions
Gender restrictions are indicated with a “GR” on the formulary and require the member to be a specific gender
for coverage.
Step Therapy Criteria
Step Therapy medications are indicated with a “ST” on the formulary and require that an alternative, first
line medication be tried and failed before the requested medication can be covered. The online claims
adjudication system will automatically allow for the requested medication to be filled based on electronic
claims history indicating that the first line medication was filled.
Step-Therapy Criteria
Therapy Class
First Line
Second Line
Third Line
Step Therapy Criteria
5-Aminosalicylic
Acid Derivative
Agents
balsalazide
sulfasalazine
sulfasalazine dr
APRISO,
DELZICOL
ASACOL
HD,
PENTASA
Second Line: Prior use of
balsalazide or
sulfasalazine/dr within the
last 180 days.
Acne Agents
benzoyl peroxide,
2.5% gel,
benzoyl peroxide 5%
gel,
benzoyl peroxide 5%
wash,
benzoyl peroxide
10% gel,
benzoyl peroxide
10% wash,
clindamycin 1%
solution,
clindamycin 1%
adapalene
0.1% gel,
adapalene
0.1% cream
v
Third Line: Prior use of
APRISO or DELZICOL
within the last 180 days.
Prior use of TWO first line
agents within the last 180
days.
swab,
erythromycin 2%
solution,
erythromycin-benzoyl
peroxide gel,
tretinoin 0.01% gel,
tretinoin 0.025% gel,
tretinoin 0.025%
cream,
tretinoin 0.05%
cream,
tretinoin 0.1% cream
Antiemetics
Antimigraine Agents
Immunosuppressant
Agents
Pediculicides
Urinary
Antispasmodics
ondansetron tablet,
ondansetron odt,
ondansetron solution
naratriptan,
rizatriptan,
rizatriptan odt,
sumatriptan tablet,
sumatriptan injection
(PA required)
mycophenolate
tablet, capsule,
suspension
granisetron
tablet
Prior use of ondansetron
within the last 180 days.
zolmitriptan,
zolmitriptan
odt
Prior use of TWO first line
agents within the last 180
days.
mycophenolic
acid dr tablet
permethrin 1%
lotion,
pyrethrins-piperonyl
butoxide
oxybutynin tablet,
oxybutynin er tablet,
oxybutynin syrup
malathion
0.5% lotion
Prior use of mycophenolate
tablet, capsule, or
suspension within the last
180 days.
Prior use of permethrin 1%
lotion or pyrethrinspiperonyl butoxide in the
last 180 days.
Prior use of oxybutynin
tablet/syrup in the last 180
days.
tolterodine ir
tablet,
tolterodine er
capsule,
trospium ir
tablet
*Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or
strengths. The benefit design determines what is covered. The medications listed on this formulary are
subject to change pursuant to the formulary management activities of EnvisionRx. The presence of a
medication on this formulary list does not guarantee coverage.
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lowercase italics = Generic drugs
UPPERCASE BOLD = Brand name drugs
Drug
*Adhd/Anti-Narcolepsy/Anti-Obesity/A
norexiants*
caffeine citrate oral solution 20 mg/ml
Status
T1 = Covered
Status
T1
Notes
AL = Age Limit
GR-F = Female Only
GR-M = Male Only
PA = Prior Authorization
QL = Quantity Limit
ST = Step Therapy
Notes
AL (Max 1 Years)
*Aminoglycosides*
neomycin sulfate oral tablet 500 mg
T1
paromomycin sulfate oral capsule 250 mg
T1
TOBI PODHALER INHALATION CAPSULE
28 MG
T1
PA
tobramycin inhalation nebulization solution 300
mg/5ml
T1
PA
celecoxib oral capsule 100 mg, 200 mg, 400 mg,
50 mg
T1
PA; QL (30 EA per 30 days)
diclofenac sodium er oral tablet extended release
24 hr* 100 mg
T1
diclofenac sodium oral tablet delayed release 25
mg, 50 mg, 75 mg
T1
ENBREL SUBCUTANEOUS* 25 MG/0.5ML
T1
PA; QL (2.04 ML per 28 days)
ENBREL SUBCUTANEOUS* 50 MG/ML
T1
ENBREL SUBCUTANEOUS* SOLUTION
RECONSTITUTED 25 MG
T1
ENBREL SURECLICK SUBCUTANEOUS*
50 MG/ML
T1
fenoprofen calcium oral tablet 600 mg
T1
flurbiprofen oral tablet 50 mg
T1
*Analgesics - Anti-Inflammatory*
1
Drug
Status
Notes
HUMIRA PEN SUBCUTANEOUS* 40
MG/0.8ML
T1
HUMIRA SUBCUTANEOUS* 10 MG/0.2ML,
20 MG/0.4ML
T1
HUMIRA SUBCUTANEOUS* 40 MG/0.8ML
T1
ibuprofen junior strength oral tablet chewable
100 mg
T1
ibuprofen oral capsule 200 mg
T1
QL (60 EA per 30 days)
ibuprofen oral suspension 100 mg/5ml
T1
QL (480 ML per 30 days)
ibuprofen oral tablet 200 mg, 400 mg, 600 mg,
800 mg
T1
INDOCIN ORAL SUSPENSION 25 MG/5ML
T1
AL (Max 12 Years)
indomethacin er oral capsule extended release*
75 mg
T1
AL (Max 64 Years)
indomethacin oral capsule 25 mg, 50 mg
T1
AL (Max 64 Years)
infants ibuprofen oral suspension 50 mg/1.25ml
T1
ketoprofen oral capsule 50 mg, 75 mg
T1
ketorolac tromethamine oral tablet 10 mg
T1
AL (Max 64 Years)
leflunomide oral tablet 10 mg, 20 mg
T1
meloxicam oral tablet 15 mg, 7.5 mg
T1
nabumetone oral tablet 500 mg, 750 mg
T1
naproxen dr oral tablet delayed release 375 mg,
500 mg
T1
naproxen oral suspension 125 mg/5ml
T1
naproxen oral tablet 250 mg, 375 mg, 500 mg
T1
naproxen sodium oral capsule 220 mg
T1
naproxen sodium oral tablet 220 mg
T1
sm ibuprofen jr oral tablet 100 mg
T1
sulindac oral tablet 150 mg, 200 mg
T1
*Analgesics - Nonnarcotic*
ACEPHEN SUPPOSITORY 325 MG
T1
acetaminophen er oral tablet extendedrelease*
650 mg
T1
acetaminophen extra strength oral tablet 500 mg
T1
acetaminophen oral liquid† 160 mg/5ml
T1
acetaminophen oral solution 160 mg/5ml
T1
acetaminophen oral suspension 160 mg/5ml
T1
acetaminophen oral tablet 325 mg
T1
acetaminophen oral tablet chewable 80 mg
T1
acetaminophen suppository 120 mg, 650 mg
T1
2
Drug
Status
Notes
aspirin ec low dose oral tablet delayed release 81
mg
T1
QL (30 EA per 30 days); AL (Min
40 Years and Max 79 Years)
aspirin ec oral tablet delayed release 325 mg
T1
aspirin oral tablet 325 mg
T1
aspirin oral tablet chewable 81 mg
T1
aspirin suppository 300 mg, 600 mg
T1
buffered aspirin oral tablet 325 mg
T1
AL (Min 40 Years and Max 79
Years)
butalbital-acetaminophen oral tablet 50-325 mg
T1
QL (120 EA per 30 days); AL
(Min 10 Years and Max 64 Years)
butalbital-apap-caffeine oral capsule 50-325-40
mg
T1
butalbital-apap-caffeine oral tablet 50-325-40 mg
T1
butalbital-aspirin-caffeine oral capsule
50-325-40 mg
T1
(Max 64 Years)
choline-mag trisalicylate oral liquid† 500 mg/5ml
T1
extra strength acetaminophen oral capsule 500
mg
T1
infants pain relief oral suspension 80 mg/0.8ml
T1
pain relief childrens oral suspension 160 mg/5ml
T1
q-pap infants oral solution 80 mg/0.8ml
T1
*Analgesics - Opioid*
acetaminophen-codeine #2 oral tablet 300-15 mg
T1
T1
T1
acetaminophen-codeine oral solution 120-12
mg/5ml
T1
butalbital-apap-caff-cod oral capsule
50-325-40-30 mg
T1
butalbital-asa-caff-codeine oral capsule
50-325-40-30 mg
T1
codeine sulfate oral tablet 15 mg, 30 mg, 60 mg
T1
fentanyl transdermal patch 72 hr 100 mcg/hr, 12
mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr
T1
hydrocodone-acetaminophen oral solution
7.5-325 mg/15ml
T1
hydrocodone-acetaminophen oral tablet 10-325
mg, 7.5-325 mg
T1
3
Drug
Status
Notes
hydrocodone-acetaminophen oral tablet 5-325 mg
T1
hydromorphone hcl oral liquid† 1 mg/ml
T1
hydromorphone hcl oral tablet 2 mg, 4 mg, 8 mg
T1
hydromorphone hcl suppository 3 mg
T1
meperidine hcl oral solution 50 mg/5ml
T1
QL (300 ML per 30 days); AL
(Max 64 Years)
meperidine hcl oral tablet 100 mg, 50 mg
T1
(Max 64 Years)
METHADONE HCL INTENSOL ORAL
CONCENTRATE 10 MG/ML
T1
methadone hcl oral solution 10 mg/5ml
T1
methadone hcl oral solution 5 mg/5ml
T1
methadone hcl oral tablet 10 mg, 5 mg
T1
methadone hcl oral tablet soluble 40 mg
T1
morphine sulfate (concentrate) oral solution 100
mg/5ml
T1
morphine sulfate er oral tablet extendedrelease*
100 mg, 15 mg, 200 mg, 30 mg, 60 mg
T1
morphine sulfate oral solution 10 mg/5ml, 20
mg/5ml
T1
morphine sulfate oral tablet 15 mg, 30 mg
T1
oxycodone hcl oral solution 5 mg/5ml
T1
oxycodone hcl oral tablet 15 mg, 30 mg, 5 mg
T1
oxycodone-acetaminophen oral tablet 10-325 mg,
7.5-325 mg
T1
oxycodone-acetaminophen oral tablet 5-325 mg
T1
pentazocine-naloxone hcl oral tablet 50-0.5 mg
T1
tramadol hcl oral tablet 50 mg
T1
*Androgens-Anabolic*
danazol oral capsule 100 mg, 200 mg, 50 mg
T1
testosterone cypionate intramuscular* solution
100 mg/ml, 200 mg/ml
T1
*Anorectal Agents*
hydrocortisone enema 100 mg/60ml
T1
PROCTOCORT CREAM 1 %
T1
PROCTOZONE-HC CREAM 2.5 %
T1
*Antacids*
ACID GONE ORAL SUSPENSION 95-358
MG/15ML
4
T1
GR-M
Drug
Status
aluminum hydroxide gel oral suspension 320
mg/5ml
T1
antacid calcium extra strength oral tablet
chewable 750 mg
T1
antacid plus anti-gas fast act oral suspension
200-200-20 mg/5ml
T1
antacid/simethicone ds oral suspension
400-400-40 mg/5ml
T1
calcium antacid ultra oral tablet chewable 1000
mg
T1
calcium carbonate antacid oral tablet chewable
500 mg
T1
magnesium oxide oral capsule 400 mg
T1
magnesium oxide oral tablet 250 mg, 400 mg
T1
MAOX ORAL TABLET 420 MG
T1
ri-mox oral suspension 225-200 mg/5ml
T1
sodium bicarbonate oral tablet 325 mg, 650 mg
T1
URO-MAG ORAL CAPSULE 140 MG
T1
Notes
*Anthelmintics*
PIN-X ORAL SUSPENSION 50 MG/ML
T1
*Antianginal Agents*
isosorbide dinitrate er oral tablet
extendedrelease* 40 mg
T1
isosorbide dinitrate oral tablet 10 mg, 20 mg, 30
mg, 5 mg
T1
isosorbide mononitrate er oral tablet extended
release 24 hr* 120 mg, 30 mg, 60 mg
T1
isosorbide mononitrate oral tablet 10 mg, 20 mg
T1
NITRO-BID TRANSDERMAL OINTMENT 2
%
T1
nitroglycerin er oral capsule extended release*
2.5 mg, 6.5 mg, 9 mg
T1
nitroglycerin transdermal patch 24 hr 0.1 mg/hr,
0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr
T1
nitroglycerin translingual solution 0.4 mg/spray
T1
NITROSTAT SUBLINGUAL TABLET
SUBLINGUAL 0.3 MG, 0.4 MG, 0.6 MG
T1
RANEXA ORAL TABLET EXTENDED
RELEASE 12 HR* 1000 MG, 500 MG
T1
*Antianxiety Agents*
hydroxyzine hcl oral syrup 10 mg/5ml
T1
AL (Max 12 Years)
5
Drug
Status
Notes
hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg
T1
AL (Max 64 Years)
hydroxyzine pamoate oral capsule 100 mg, 25
mg, 50 mg
T1
AL (Max 64 Years)
*Antiarrhythmics*
amiodarone hcl oral tablet 100 mg, 200 mg, 400
mg
T1
disopyramide phosphate oral capsule 100 mg,
150 mg
T1
flecainide acetate oral tablet 100 mg, 150 mg, 50
mg
T1
mexiletine hcl oral capsule 150 mg, 200 mg, 250
mg
T1
propafenone hcl oral tablet 150 mg, 225 mg, 300
mg
T1
quinidine sulfate er oral tablet extendedrelease*
300 mg
T1
quinidine sulfate oral tablet 200 mg, 300 mg
T1
AL (Max 64 Years)
*Antiasthmatic And Bronchodilator
Agents*
AEROSPAN INHALATION AEROSOL,
SOLUTION 80 MCG/ACT
T1
albuterol sulfate inhalation nebulization solution
(2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%
T1
albuterol sulfate inhalation nebulization solution
0.63 mg/3ml, 1.25 mg/3ml
T1
albuterol sulfate oral syrup 2 mg/5ml
T1
albuterol sulfate oral tablet 2 mg, 4 mg
T1
ATROVENT HFA INHALATION
AEROSOL, SOLUTION 17 MCG/ACT
T1
QL (12.9 GM per 30 days)
budesonide inhalation suspension 0.25 mg/2ml,
0.5 mg/2ml, 1 mg/2ml
T1
(Max 6 Years)
COMBIVENT RESPIMAT INHALATION
AEROSOL, SOLUTION 20-100 MCG/ACT
T1
QL (4 GM per 30 days)
cromolyn sodium inhalation nebulization solution
20 mg/2ml
T1
DULERA INHALATION AEROSOL† 100-5
MCG/ACT, 200-5 MCG/ACT
T1
FORADIL AEROLIZER INHALATION
CAPSULE 12 MCG
T1
INCRUSE ELLIPTA INHALATION
AEROSOL POWDER, BREATH
ACTIVATED 62.5 MCG/INH
T1
6
Drug
Status
Notes
ipratropium bromide inhalation solution 0.02 %
T1
ipratropium-albuterol inhalation solution 0.5-2.5
(3) mg/3ml
T1
metaproterenol sulfate oral tablet 10 mg, 20 mg
T1
montelukast sodium oral packet 4 mg
T1
QL (30 EA per 30 days); AL (Max
5 Years)
montelukast sodium oral tablet 10 mg
T1
15 Years)
montelukast sodium oral tablet chewable 4 mg
T1
5 Years)
montelukast sodium oral tablet chewable 5 mg
T1
PULMICORT FLEXHALER INHALATION
ACTIVATED 180 MCG/ACT, 90 MCG/ACT
T1
QVAR INHALATION AEROSOL,
SOLUTION 40 MCG/ACT, 80 MCG/ACT
T1
SEREVENT DISKUS INHALATION
ACTIVATED 50 MCG/DOSE
T1
SPIRIVA HANDIHALER INHALATION
CAPSULE 18 MCG
T1
SPIRIVA RESPIMAT INHALATION
AEROSOL, SOLUTION 1.25 MCG/ACT, 2.5
MCG/ACT
T1
STRIVERDI RESPIMAT INHALATION
AEROSOL, SOLUTION 2.5 MCG/ACT
T1
SYMBICORT INHALATION AEROSOL†
160-4.5 MCG/ACT, 80-4.5 MCG/ACT
T1
terbutaline sulfate oral tablet 2.5 mg, 5 mg
T1
theophylline er oral tablet extended release 12
hr* 100 mg, 200 mg, 300 mg, 450 mg
T1
theophylline er oral tablet extended release 24
hr* 600 mg
T1
theophylline oral elixir 80 mg/15ml
T1
theophylline oral solution 80 mg/15ml
T1
TUDORZA PRESSAIR INHALATION
ACTIVATED 400 MCG/ACT
T1
VENTOLIN HFA INHALATION AEROSOL,
SOLUTION 108 (90 BASE) MCG/ACT
T1
7
Drug
*Anticoagulants*
Status
Notes
enoxaparin sodium subcutaneous* solution 100
mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml,
40 mg/0.4ml, 60 mg/0.6ml, 80 mg/0.8ml
T1
PA
fondaparinux sodium subcutaneous* solution 10
mg/0.8ml, 2.5 mg/0.5ml, 5 mg/0.4ml, 7.5
mg/0.6ml
T1
PA
heparin sodium (porcine) injection solution
10000 unit/ml, 20000 unit/ml, 5000 unit/ml
T1
heparin sodium (porcine) pf injection solution
5000 unit/0.5ml
T1
warfarin sodium oral tablet 1 mg, 10 mg, 2 mg,
2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg
T1
XARELTO ORAL TABLET 10 MG, 15 MG,
20 MG
T1
acarbose oral tablet 100 mg
T1
acarbose oral tablet 25 mg, 50 mg
T1
APIDRA INJECTION SOLUTION 100
UNIT/ML
T1
APIDRA SOLOSTAR SUBCUTANEOUS*
100 UNIT/ML
T1
QL (60 ML per 30 days); AL (Max
21 Years)
chlorpropamide oral tablet 100 mg
T1
(Max 64 Years)
chlorpropamide oral tablet 250 mg
T1
64 Years)
FARXIGA ORAL TABLET 10 MG, 5 MG
T1
glimepiride oral tablet 1 mg, 2 mg, 4 mg
T1
glipizide er oral tablet extended release 24 hr* 10
mg, 2.5 mg, 5 mg
T1
glipizide oral tablet 10 mg
T1
glipizide oral tablet 5 mg
T1
glipizide-metformin hcl oral tablet 2.5-250 mg,
2.5-500 mg, 5-500 mg
T1
GLUCAGEN HYPOKIT INJECTION
SOLUTION RECONSTITUTED 1 MG
T1
GLUCAGON EMERGENCY INJECTION
KIT 1 MG
T1
glyburide micronized oral tablet 1.5 mg, 3 mg, 6
mg
T1
glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg
T1
glyburide-metformin oral tablet 1.25-250 mg
T1
*Antidiabetics*
8
Drug
Status
Notes
glyburide-metformin oral tablet 2.5-500 mg,
5-500 mg
T1
HUMALOG KWIKPEN SUBCUTANEOUS*
100 UNIT/ML
T1
21 Years)
HUMALOG MIX 50/50 KWIKPEN
SUBCUTANEOUS* (50-50) 100 UNIT/ML
T1
AL (Max 21 Years)
HUMALOG MIX 50/50 SUBCUTANEOUS*
SUSPENSION (50-50) 100 UNIT/ML
T1
HUMALOG MIX 75/25 KWIKPEN
T1
HUMALOG MIX 75/25 SUBCUTANEOUS*
T1
HUMALOG SUBCUTANEOUS* 100
UNIT/ML
T1
HUMALOG SUBCUTANEOUS* SOLUTION
100 UNIT/ML
T1
HUMULIN 70/30 KWIKPEN
T1
21 Years)
HUMULIN 70/30 SUBCUTANEOUS*
T1
HUMULIN N KWIKPEN SUBCUTANEOUS*
100 UNIT/ML
T1
21 Years)
HUMULIN N SUBCUTANEOUS*
SUSPENSION 100 UNIT/ML
T1
HUMULIN R INJECTION SOLUTION 100
UNIT/ML
T1
HUMULIN R U-500 (CONCENTRATED)
SUBCUTANEOUS* SOLUTION 500
UNIT/ML
T1
PA
INVOKANA ORAL TABLET 100 MG, 300
MG
T1
JANUMET ORAL TABLET 50-1000 MG,
50-500 MG
T1
JANUMET XR ORAL TABLET EXTENDED
RELEASE 24 HR* 100-1000 MG, 50-1000
MG, 50-500 MG
T1
JANUVIA ORAL TABLET 100 MG, 25 MG,
50 MG
T1
JENTADUETO ORAL TABLET 2.5-1000
MG, 2.5-500 MG, 2.5-850 MG
T1
PA
LANTUS SOLOSTAR SUBCUTANEOUS*
100 UNIT/ML
T1
21 Years)
LANTUS SUBCUTANEOUS* SOLUTION
100 UNIT/ML
T1
21 Years)
9
Drug
Status
Notes
metformin hcl er oral tablet extended release 24
hr* 500 mg, 750 mg
T1
metformin hcl oral tablet 1000 mg, 500 mg, 850
mg
T1
nateglinide oral tablet 120 mg, 60 mg
T1
NOVOLIN 70/30 SUBCUTANEOUS*
T1
NOVOLIN N SUBCUTANEOUS*
SUSPENSION 100 UNIT/ML
T1
NOVOLIN R INJECTION SOLUTION 100
UNIT/ML
T1
NOVOLOG FLEXPEN SUBCUTANEOUS*
100 UNIT/ML
T1
21 Years)
NOVOLOG MIX 70/30 FLEXPEN
T1
21 Years)
NOVOLOG MIX 70/30 SUBCUTANEOUS*
T1
NOVOLOG PENFILL SUBCUTANEOUS*
100 UNIT/ML
T1
NOVOLOG SUBCUTANEOUS* SOLUTION
100 UNIT/ML
T1
pioglitazone hcl oral tablet 15 mg, 30 mg, 45 mg
T1
repaglinide oral tablet 0.5 mg, 1 mg, 2 mg
T1
TANZEUM SUBCUTANEOUS* 30 MG, 50
MG
T1
tolazamide oral tablet 250 mg, 500 mg
T1
tolbutamide oral tablet 500 mg
T1
TRADJENTA ORAL TABLET 5 MG
T1
PA
VICTOZA SUBCUTANEOUS* 18 MG/3ML
T1
PA; QL (6 ML per 30 days)
*Antidiarrheals*
diphenoxylate-atropine oral liquid† 2.5-0.025
mg/5ml
T1
diphenoxylate-atropine oral tablet 2.5-0.025 mg
T1
loperamide hcl oral capsule 2 mg
T1
loperamide hcl oral suspension 1 mg/7.5ml
T1
paregoric oral tincture 2 mg/5ml
T1
pink bismuth maximum strength oral suspension
525 mg/15ml
T1
pink bismuth oral suspension 262 mg/15ml
T1
pink bismuth oral tablet chewable 262 mg
T1
SOOTHE ORAL TABLET 262 MG
T1
10
Drug
*Antidotes*
Status
Notes
CHEMET ORAL CAPSULE 100 MG
T1
EVZIO INJECTION 0.4 MG/0.4ML
T1
naloxone hcl injection solution 0.4 mg/ml, 1
mg/ml
T1
NARCAN NASAL LIQUID† 4 MG/0.1ML
T1
*Antiemetics*
dimenhydrinate oral tablet 50 mg
T1
dronabinol oral capsule 10 mg, 2.5 mg, 5 mg
T1
PA
granisetron hcl oral tablet 1 mg
T1
ST; QL (4 EA per 30 days)
meclizine hcl oral tablet 12.5 mg, 25 mg
T1
meclizine hcl oral tablet chewable 25 mg
T1
ondansetron hcl oral solution 4 mg/5ml
T1
(Max 12 Years)
ondansetron hcl oral tablet 24 mg
T1
ondansetron hcl oral tablet 4 mg, 8 mg
T1
ondansetron oral tablet dispersible 4 mg, 8 mg
T1
fluconazole oral suspension reconstituted 10
mg/ml, 40 mg/ml
T1
AL (Max 12 Years)
fluconazole oral tablet 100 mg, 150 mg, 200 mg,
50 mg
T1
griseofulvin microsize oral suspension 125
mg/5ml
T1
griseofulvin microsize oral tablet 500 mg
T1
griseofulvin ultramicrosize oral tablet 125 mg,
250 mg
T1
itraconazole oral capsule 100 mg
T1
ketoconazole oral tablet 200 mg
T1
nystatin oral tablet 500000 unit
T1
terbinafine hcl oral tablet 250 mg
T1
*Antifungals*
*Antihistamines*
carbinoxamine maleate oral solution 4 mg/5ml
T1
carbinoxamine maleate oral tablet 4 mg
T1
cetirizine hcl allergy child oral solution 5 mg/5ml
T1
(Max 12 Years)
cetirizine hcl oral tablet 10 mg, 5 mg
T1
cetirizine hcl oral tablet chewable 10 mg, 5 mg
T1
12 Years)
11
Drug
Status
Notes
(Max 12 Years)
childrens loratadine oral syrup 5 mg/5ml
T1
chlorpheniramine maleate er oral tablet
T1
chlorpheniramine maleate oral tablet 4 mg
T1
clemastine fumarate oral syrup 0.67 mg/5ml
T1
clemastine fumarate oral tablet 1.34 mg
T1
clemastine fumarate oral tablet 2.68 mg
T1
cyproheptadine hcl oral syrup 2 mg/5ml
T1
AL (Max 64 Years)
cyproheptadine hcl oral tablet 4 mg
T1
AL (Max 64 Years)
diphenhydramine hcl injection solution 50 mg/ml
T1
AL (Max 64 Years)
diphenhydramine hcl oral capsule 25 mg, 50 mg
T1
AL (Max 64 Years)
diphenhydramine hcl oral elixir 12.5 mg/5ml
T1
diphenhydramine hcl oral liquid† 12.5 mg/5ml
T1
diphenhydramine hcl oral tablet 25 mg
T1
AL (Max 64 Years)
loratadine oral tablet 10 mg
T1
promethazine hcl oral syrup 6.25 mg/5ml
T1
Years)
promethazine hcl oral tablet 12.5 mg, 25 mg, 50
mg
T1
Years)
promethazine hcl suppository 12.5 mg, 25 mg, 50
mg
T1
Years)
atorvastatin calcium oral tablet 10 mg, 20 mg, 40
mg, 80 mg
T1
cholestyramine oral packet 4 gm
T1
cholestyramine oral powder 4 gm/dose
T1
colestipol hcl oral granules 5 gm
T1
colestipol hcl oral packet 5 gm
T1
colestipol hcl oral tablet 1 gm
T1
fenofibrate micronized oral capsule 130 mg, 43
mg
T1
fenofibrate micronized oral capsule 134 mg, 200
mg, 67 mg
T1
fenofibrate oral capsule 150 mg, 50 mg
T1
fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54
mg
T1
fenofibric acid oral capsule delayed release 135
mg, 45 mg
T1
fenofibric acid oral tablet 105 mg, 35 mg
T1
*Antihyperlipidemics*
12
Drug
Status
Notes
fluvastatin sodium oral capsule 20 mg
T1
fluvastatin sodium oral capsule 40 mg
T1
gemfibrozil oral tablet 600 mg
T1
lovastatin oral tablet 10 mg, 20 mg
T1
lovastatin oral tablet 40 mg
T1
niacin er (antihyperlipidemic) oral tablet
T1
T1
T1
omega-3-acid ethyl esters oral capsule 1 gm
T1
PA
pravastatin sodium oral tablet 10 mg, 20 mg, 40
mg, 80 mg
T1
PREVALITE ORAL PACKET 4 GM
T1
PREVALITE ORAL POWDER 4 GM/DOSE
T1
simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5
mg, 80 mg
T1
ZETIA ORAL TABLET 10 MG
T1
amlodipine besy-benazepril hcl oral capsule
10-20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20
mg, 5-40 mg
T1
atenolol-chlorthalidone oral tablet 100-25 mg,
50-25 mg
T1
benazepril hcl oral tablet 10 mg, 20 mg, 5 mg
T1
benazepril hcl oral tablet 40 mg
T1
benazepril-hydrochlorothiazide oral tablet
10-12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg
T1
bisoprolol-hydrochlorothiazide oral tablet
10-6.25 mg
T1
bisoprolol-hydrochlorothiazide oral tablet
2.5-6.25 mg, 5-6.25 mg
T1
captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50
mg
T1
captopril-hydrochlorothiazide oral tablet 25-15
mg, 25-25 mg, 50-15 mg, 50-25 mg
T1
clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg
T1
doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg
T1
doxazosin mesylate oral tablet 8 mg
T1
enalapril maleate oral tablet 10 mg, 2.5 mg, 5 mg
T1
*Antihypertensives*
13
Drug
Status
Notes
enalapril maleate oral tablet 20 mg
T1
enalapril-hydrochlorothiazide oral tablet 10-25
mg, 5-12.5 mg
T1
EPANED ORAL SOLUTION
RECONSTITUTED 1 MG/ML
T1
AL (Max 12 Years)
fosinopril sodium oral tablet 10 mg, 20 mg
T1
fosinopril sodium oral tablet 40 mg
T1
guanfacine hcl oral tablet 1 mg, 2 mg
T1
hydralazine hcl injection solution 20 mg/ml
T1
hydralazine hcl oral tablet 10 mg, 25 mg, 50 mg
T1
hydralazine hcl oral tablet 100 mg
T1
irbesartan oral tablet 150 mg, 300 mg, 75 mg
T1
irbesartan-hydrochlorothiazide oral tablet
150-12.5 mg, 300-12.5 mg
T1
lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30
mg, 40 mg, 5 mg
T1
lisinopril-hydrochlorothiazide oral tablet 10-12.5
mg, 20-12.5 mg, 20-25 mg
T1
losartan potassium oral tablet 100 mg, 25 mg, 50
mg
T1
losartan potassium-hctz oral tablet 100-12.5 mg,
100-25 mg, 50-12.5 mg
T1
methyldopa oral tablet 250 mg, 500 mg
T1
AL (Max 64 Years)
methyldopa-hydrochlorothiazide oral tablet
250-15 mg, 250-25 mg
T1
metoprolol-hydrochlorothiazide oral tablet
100-25 mg, 100-50 mg, 50-25 mg
T1
minoxidil oral tablet 10 mg, 2.5 mg
T1
perindopril erbumine oral tablet 2 mg, 4 mg
T1
prazosin hcl oral capsule 1 mg, 2 mg, 5 mg
T1
quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5
mg
T1
quinapril-hydrochlorothiazide oral tablet 10-12.5
mg, 20-12.5 mg, 20-25 mg
T1
ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5
mg
T1
TEKTURNA HCT ORAL TABLET 150-12.5
MG, 150-25 MG, 300-12.5 MG, 300-25 MG
T1
TEKTURNA ORAL TABLET 150 MG, 300
MG
T1
terazosin hcl oral capsule 1 mg, 5 mg
T1
terazosin hcl oral capsule 10 mg, 2 mg
T1
14
Drug
Status
trandolapril oral tablet 1 mg, 2 mg, 4 mg
T1
valsartan oral tablet 160 mg, 320 mg, 40 mg, 80
mg
T1
valsartan-hydrochlorothiazide oral tablet
160-12.5 mg, 160-25 mg, 80-12.5 mg
T1
Notes
*Anti-Infective Agents - Misc.*
atovaquone oral suspension 750 mg/5ml
T1
PA
CAYSTON INHALATION SOLUTION
RECONSTITUTED 75 MG
T1
PA
clindamycin hcl oral capsule 150 mg, 300 mg, 75
mg
T1
clindamycin palmitate hcl oral solution
reconstituted 75 mg/5ml
T1
dapsone oral tablet 100 mg, 25 mg
T1
FIRST-VANCOMYCIN 25 ORAL
SOLUTION 25 MG/ML
T1
FIRST-VANCOMYCIN 50 ORAL
SOLUTION 50 MG/ML
T1
linezolid oral suspension reconstituted 100
mg/5ml
T1
PA
linezolid oral tablet 600 mg
T1
PA
metronidazole oral tablet 250 mg, 500 mg
T1
sulfamethoxazole-trimethoprim oral suspension
200-40 mg/5ml
T1
sulfamethoxazole-trimethoprim oral tablet 400-80
mg, 800-160 mg
T1
tinidazole oral tablet 250 mg, 500 mg
T1
trimethoprim oral tablet 100 mg
T1
vancomycin hcl intravenous* solution
reconstituted 10 gm, 1000 mg, 500 mg, 5000 mg,
750 mg
T1
AL (Max 12 Years)
*Antimalarials*
chloroquine phosphate oral tablet 250 mg, 500
mg
T1
DARAPRIM ORAL TABLET 25 MG
T1
PA
hydroxychloroquine sulfate oral tablet 200 mg
T1
mefloquine hcl oral tablet 250 mg
T1
primaquine phosphate oral tablet 26.3 mg
T1
PA
*Antimyasthenic Agents*
MESTINON ORAL SYRUP 60 MG/5ML
T1
pyridostigmine bromide oral tablet 60 mg
T1
AL (Max 12 Years)
15
Drug
*Antimyasthenic/Cholinergic Agents*
Status
MESTINON ORAL SYRUP 60 MG/5ML
T1
pyridostigmine bromide oral tablet 60 mg
T1
Notes
AL (Max 12 Years)
*Antimycobacterial Agents*
cycloserine oral capsule 250 mg
T1
ethambutol hcl oral tablet 100 mg, 400 mg
T1
isoniazid oral syrup 50 mg/5ml
T1
isoniazid oral tablet 100 mg, 300 mg
T1
pyrazinamide oral tablet 500 mg
T1
rifabutin oral capsule 150 mg
T1
rifampin oral capsule 150 mg, 300 mg
T1
TRECATOR ORAL TABLET 250 MG
T1
*Antineoplastics And Adjunctive
Therapies*
AFINITOR DISPERZ ORAL TABLET
SOLUBLE 2 MG, 3 MG, 5 MG
T1
AFINITOR ORAL TABLET 10 MG
T1
AFINITOR ORAL TABLET 2.5 MG, 5 MG
T1
AFINITOR ORAL TABLET 7.5 MG
T1
PA
ALKERAN ORAL TABLET 2 MG
T1
PA
anastrozole oral tablet 1 mg
T1
GR-F
bexarotene oral capsule 75 mg
T1
PA
bicalutamide oral tablet 50 mg
T1
PA; GR-M
capecitabine oral tablet 150 mg, 500 mg
T1
PA
cyclophosphamide oral capsule 25 mg, 50 mg
T1
PA
EMCYT ORAL CAPSULE 140 MG
T1
PA; GR-M
ERIVEDGE ORAL CAPSULE 150 MG
T1
etoposide oral capsule 50 mg
T1
PA
exemestane oral tablet 25 mg
T1
FARESTON ORAL TABLET 60 MG
T1
PA
FARYDAK ORAL CAPSULE 10 MG, 15 MG,
20 MG
T1
PA
flutamide oral capsule 125 mg
T1
PA; GR-M
GLEOSTINE ORAL CAPSULE 10 MG, 100
MG, 40 MG
T1
PA
HEXALEN ORAL CAPSULE 50 MG
T1
PA
HYCAMTIN ORAL CAPSULE 0.25 MG, 1
MG
T1
PA
hydroxyurea oral capsule 500 mg
T1
16
Drug
Status
Notes
INTRON A INJECTION SOLUTION
10000000 UNIT/ML, 6000000 UNIT/ML
T1
PA
INTRON A INJECTION SOLUTION
RECONSTITUTED 10000000 UNIT,
18000000 UNIT, 50000000 UNIT
T1
PA
JAKAFI ORAL TABLET 10 MG, 15 MG, 20
MG, 25 MG, 5 MG
T1
letrozole oral tablet 2.5 mg
T1
18 Years)
leucovorin calcium oral tablet 10 mg, 15 mg, 25
mg, 5 mg
T1
LEUKERAN ORAL TABLET 2 MG
T1
PA
leuprolide acetate injection kit 1 mg/0.2ml
T1
PA
LYSODREN ORAL TABLET 500 MG
T1
PA
MATULANE ORAL CAPSULE 50 MG
T1
PA
megestrol acetate oral suspension 400 mg/10ml
T1
megestrol acetate oral tablet 20 mg, 40 mg
T1
mercaptopurine oral tablet 50 mg
T1
MESNEX ORAL TABLET 400 MG
T1
methotrexate oral tablet 2.5 mg
T1
MYLERAN ORAL TABLET 2 MG
T1
PA
NILANDRON ORAL TABLET 150 MG
T1
PA
POMALYST ORAL CAPSULE 1 MG, 2 MG,
3 MG, 4 MG
T1
PA
TABLOID ORAL TABLET 40 MG
T1
PA
tamoxifen citrate oral tablet 10 mg, 20 mg
T1
GR-F; QL (60 EA per 30 days)
temozolomide oral capsule 100 mg, 140 mg, 180
mg, 20 mg, 250 mg, 5 mg
T1
PA
tretinoin oral capsule 10 mg
T1
PA
XTANDI ORAL CAPSULE 40 MG
T1
PA; GR-M; QL (120 EA per 30
days)
ZOLINZA ORAL CAPSULE 100 MG
T1
PA
ZYTIGA ORAL TABLET 250 MG
T1
PA; GR-M; QL (120 EA per 30
days)
amantadine hcl oral capsule 100 mg
T1
amantadine hcl oral syrup 50 mg/5ml
T1
amantadine hcl oral tablet 100 mg
T1
bromocriptine mesylate oral capsule 5 mg
T1
bromocriptine mesylate oral tablet 2.5 mg
T1
GR-F
PA
*Antiparkinson Agents*
17
Drug
Status
Notes
carbidopa-levodopa er oral tablet
extendedrelease* 25-100 mg, 50-200 mg
T1
carbidopa-levodopa oral tablet 10-100 mg,
25-100 mg, 25-250 mg
T1
carbidopa-levodopa oral tablet dispersible
10-100 mg, 25-250 mg
T1
carbidopa-levodopa oral tablet dispersible
25-100 mg
T1
pramipexole dihydrochloride oral tablet 0.125
mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg
T1
ropinirole hcl oral tablet 0.25 mg, 0.5 mg, 1 mg, 2
mg, 3 mg, 4 mg, 5 mg
T1
selegiline hcl oral capsule 5 mg
T1
prochlorperazine maleate oral tablet 10 mg, 5 mg
T1
prochlorperazine suppository 25 mg
T1
*Antipsychotics/Antimanic Agents*
*Antiseptics & Disinfectants*
povidone-iodine external solution 10 %
T1
*Antivirals*
acyclovir oral capsule 200 mg
T1
acyclovir oral suspension 200 mg/5ml
T1
acyclovir oral tablet 400 mg, 800 mg
T1
adefovir dipivoxil oral tablet 10 mg
T1
entecavir oral tablet 0.5 mg, 1 mg
T1
famciclovir oral tablet 125 mg, 250 mg, 500 mg
T1
lamivudine oral tablet 100 mg
T1
RELENZA DISKHALER INHALATION
ACTIVATED 5 MG/BLISTER
T1
rimantadine hcl oral tablet 100 mg
T1
TAMIFLU ORAL CAPSULE 30 MG, 45 MG,
75 MG
T1
TAMIFLU ORAL SUSPENSION
RECONSTITUTED 6 MG/ML
T1
(Max 12 Years)
valacyclovir hcl oral tablet 1 gm
T1
valacyclovir hcl oral tablet 500 mg
T1
valganciclovir hcl oral tablet 450 mg
T1
T1
AL (Max 12 Years)
(Min 5 Years)
*Assorted Classes*
azathioprine oral tablet 50 mg
18
Drug
Status
Notes
cyclosporine modified oral capsule 100 mg, 25
mg, 50 mg
T1
cyclosporine modified oral solution 100 mg/ml
T1
cyclosporine oral capsule 100 mg, 25 mg
T1
mycophenolate mofetil oral capsule 250 mg
T1
mycophenolate mofetil oral suspension
reconstituted 200 mg/ml
T1
mycophenolate mofetil oral tablet 500 mg
T1
mycophenolic acid oral tablet delayed release
180 mg, 360 mg
T1
ST
REVLIMID ORAL CAPSULE 10 MG, 15
MG, 25 MG, 5 MG
T1
REVLIMID ORAL CAPSULE 2.5 MG, 20
MG
T1
PA
sirolimus oral tablet 0.5 mg, 1 mg, 2 mg
T1
sodium polystyrene sulfonate oral powder
T1
sodium polystyrene sulfonate suspension 30
gm/120ml
T1
SPS ORAL SUSPENSION 15 GM/60ML
T1
sterile water for irrigation irrigation solution
T1
tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg
T1
AL (Max 12 Years)
AL (Max 12 Years)
*Beta Blockers*
acebutolol hcl oral capsule 200 mg, 400 mg
T1
atenolol oral tablet 100 mg, 25 mg, 50 mg
T1
betaxolol hcl oral tablet 10 mg, 20 mg
T1
bisoprolol fumarate oral tablet 10 mg
T1
bisoprolol fumarate oral tablet 5 mg
T1
carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg,
6.25 mg
T1
HEMANGEOL ORAL SOLUTION 4.28
MG/ML
T1
labetalol hcl oral tablet 100 mg, 200 mg, 300 mg
T1
metoprolol succinate er oral tablet extended
release 24 hr* 100 mg, 25 mg, 50 mg
T1
metoprolol succinate er oral tablet extended
release 24 hr* 200 mg
T1
metoprolol tartrate oral tablet 100 mg, 25 mg, 50
mg
T1
nadolol oral tablet 20 mg, 40 mg, 80 mg
T1
pindolol oral tablet 10 mg, 5 mg
T1
AL (Max 4 Years)
19
Drug
Status
Notes
propranolol hcl er oral capsule extended release
24 hour 120 mg, 160 mg
T1
24 hour 60 mg
T1
24 hour 80 mg
T1
propranolol hcl oral solution 20 mg/5ml, 40
mg/5ml
T1
propranolol hcl oral tablet 10 mg, 20 mg, 40 mg,
60 mg, 80 mg
T1
sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg
T1
sotalol hcl oral tablet 120 mg, 160 mg, 240 mg,
80 mg
T1
timolol maleate oral tablet 10 mg, 20 mg, 5 mg
T1
*Calcium Channel Blockers*
amlodipine besylate oral tablet 10 mg, 2.5 mg, 5
mg
T1
CARTIA XT ORAL CAPSULE EXTENDED
RELEASE 24 HOUR 120 MG, 180 MG, 240
MG, 300 MG
T1
diltiazem hcl er beads oral capsule extended
release 24 hour 420 mg
T1
diltiazem hcl er oral capsule extended release 24
hour 120 mg, 180 mg
T1
diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg,
90 mg
T1
dilt-xr oral capsule extended release 24 hour 240
mg
T1
felodipine er oral tablet extended release 24 hr*
10 mg
T1
felodipine er oral tablet extended release 24 hr*
2.5 mg, 5 mg
T1
isradipine oral capsule 2.5 mg, 5 mg
T1
MATZIM LA ORAL TABLET EXTENDED
RELEASE 24 HR* 180 MG, 300 MG
T1
nicardipine hcl oral capsule 20 mg, 30 mg
T1
NIFEDICAL XL ORAL TABLET
EXTENDED RELEASE 24 HR* 30 MG, 60
MG
T1
nifedipine er oral tablet extended release 24 hr*
30 mg, 60 mg, 90 mg
T1
nifedipine er osmotic release oral tablet extended
T1
20
Drug
Status
Notes
(Max 64 Years)
nifedipine oral capsule 10 mg, 20 mg
T1
nimodipine oral capsule 30 mg
T1
TAZTIA XT ORAL CAPSULE EXTENDED
RELEASE 24 HOUR 120 MG, 180 MG, 240
MG, 300 MG, 360 MG
T1
verapamil hcl er oral capsule extended release 24
hour 100 mg, 120 mg, 180 mg, 200 mg, 240 mg,
300 mg
T1
verapamil hcl er oral tablet extendedrelease* 120
mg, 180 mg, 240 mg
T1
verapamil hcl oral tablet 120 mg, 40 mg, 80 mg
T1
*Cardiotonics*
digoxin oral tablet 125 mcg, 250 mcg
T1
*Cardiovascular Agents - Misc.*
ADCIRCA ORAL TABLET 20 MG
T1
ADEMPAS ORAL TABLET 0.5 MG, 1 MG,
1.5 MG, 2 MG, 2.5 MG
T1
LETAIRIS ORAL TABLET 10 MG, 5 MG
T1
sildenafil citrate oral tablet 20 mg
T1
PA
TRACLEER ORAL TABLET 125 MG, 62.5
MG
T1
*Cephalosporins*
cefaclor oral capsule 250 mg, 500 mg
T1
cefaclor oral suspension reconstituted 125
mg/5ml, 250 mg/5ml, 375 mg/5ml
T1
cefadroxil oral capsule 500 mg
T1
cefadroxil oral suspension reconstituted 250
mg/5ml, 500 mg/5ml
T1
cefadroxil oral tablet 1 gm
T1
cefdinir oral capsule 300 mg
T1
cefdinir oral suspension reconstituted 125
mg/5ml, 250 mg/5ml
T1
cefixime oral suspension reconstituted 100
mg/5ml, 200 mg/5ml
T1
AL (Max 12 Years)
cefpodoxime proxetil oral suspension
reconstituted 100 mg/5ml, 50 mg/5ml
T1
AL (Max 12 Years)
cefpodoxime proxetil oral tablet 100 mg, 200 mg
T1
cefprozil oral suspension reconstituted 125
mg/5ml, 250 mg/5ml
T1
cefprozil oral tablet 250 mg, 500 mg
T1
AL (Max 12 Years)
AL (Max 12 Years)
AL (Max 12 Years)
21
Drug
Status
Notes
ceftriaxone sodium injection solution
reconstituted 250 mg
T1
cefuroxime axetil oral tablet 250 mg, 500 mg
T1
cephalexin oral capsule 250 mg, 500 mg
T1
cephalexin oral suspension reconstituted 125
mg/5ml, 250 mg/5ml
T1
SUPRAX ORAL CAPSULE 400 MG
T1
SUPRAX ORAL SUSPENSION
RECONSTITUTED 500 MG/5ML
T1
AL (Max 12 Years)
AMETHYST ORAL TABLET 90-20 MCG
T1
GR-F
ARANELLE ORAL TABLET 0.5/1/0.5-35
MG-MCG
T1
GR-F
AVIANE ORAL TABLET 0.1-20 MG-MCG
T1
GR-F
BALZIVA ORAL TABLET 0.4-35 MG-MCG
T1
GR-F
drospirenone-ethinyl estradiol oral tablet 3-0.03
mg
T1
GR-F
ELLA ORAL TABLET 30 MG
T1
GR-F
GIANVI ORAL TABLET 3-0.02 MG
T1
GR-F
JUNEL 1/20 ORAL TABLET 1-20 MG-MCG
T1
GR-F
KAITLIB FE ORAL TABLET CHEWABLE
0.8-25 MG-MCG
T1
GR-F
KARIVA ORAL TABLET 0.15-0.02/0.01 MG
(21/5)
T1
GR-F
levonorgestrel oral tablet 0.75 mg, 1.5 mg
T1
GR-F
LEVORA 0.15/30 (28) ORAL TABLET
0.15-30 MG-MCG
T1
GR-F
LO LOESTRIN FE ORAL TABLET 1 MG-10
MCG / 10 MCG
T1
GR-F
LOMEDIA 24 FE ORAL TABLET 1-20
MG-MCG(24)
T1
GR-F
LOW-OGESTREL ORAL TABLET 0.3-30
MG-MCG
T1
GR-F
medroxyprogesterone acetate intramuscular*
suspension 150 mg/ml
T1
GR-F; QL (1 ML per 90 days)
MICROGESTIN 1.5/30 ORAL TABLET
1.5-30 MG-MCG
T1
GR-F
MICROGESTIN FE 1.5/30 ORAL TABLET
1.5-30 MG-MCG
T1
GR-F
MICROGESTIN FE 1/20 ORAL TABLET
1-20 MG-MCG
T1
GR-F
*Contraceptives*
22
Drug
Status
Notes
MINASTRIN 24 FE ORAL TABLET
CHEWABLE 1-20 MG-MCG(24)
T1
PA; GR-F
NECON 0.5/35 (28) ORAL TABLET 0.5-35
MG-MCG
T1
GR-F
NECON 1/35 (28) ORAL TABLET 1-35
MG-MCG
T1
GR-F
NECON 1/50 (28) ORAL TABLET 1-50
MG-MCG
T1
GR-F
NECON 10/11 (28) ORAL TABLET 35 MCG
T1
GR-F
NORA-BE ORAL TABLET 0.35 MG
T1
GR-F
NORTREL 7/7/7 ORAL TABLET
0.5/0.75/1-35 MG-MCG
T1
GR-F
NUVARING VAGINAL RING 0.12-0.015
MG/24HR
T1
OGESTREL ORAL TABLET 0.5-50
MG-MCG
T1
GR-F
QUASENSE ORAL TABLET 0.15-0.03 MG
T1
GR-F
RECLIPSEN ORAL TABLET 0.15-30
MG-MCG
T1
GR-F
SAFYRAL ORAL TABLET 3-0.03-0.451 MG
T1
GR-F
SPRINTEC 28 ORAL TABLET 0.25-35
MG-MCG
T1
GR-F
TRI-LEGEST FE ORAL TABLET
1-20/1-30/1-35 MG-MCG
T1
GR-F
TRINESSA LO ORAL TABLET
0.18/0.215/0.25 MG-25 MCG
T1
GR-F
TRI-SPRINTEC ORAL TABLET
0.18/0.215/0.25 MG-35 MCG
T1
GR-F
TRIVORA (28) ORAL TABLET
T1
GR-F
VELIVET ORAL TABLET 0.1/0.125/0.15
-0.025 MG
T1
GR-F
WYMZYA FE ORAL TABLET CHEWABLE
0.4-35 MG-MCG
T1
PA; GR-F
XULANE TRANSDERMAL PATCH
WEEKLY 150-35 MCG/24HR
T1
ZOVIA 1/35E (28) ORAL TABLET 1-35
MG-MCG
T1
GR-F
ZOVIA 1/50E (28) ORAL TABLET 1-50
MG-MCG
T1
GR-F
*Corticosteroids*
dexamethasone oral elixir 0.5 mg/5ml
T1
dexamethasone oral solution 0.5 mg/5ml
T1
23
Drug
Status
dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg,
1.5 mg, 2 mg, 4 mg, 6 mg
T1
fludrocortisone acetate oral tablet 0.1 mg
T1
hydrocortisone oral tablet 10 mg, 20 mg, 5 mg
T1
methylprednisolone oral 4 mg
T1
methylprednisolone oral tablet 16 mg, 32 mg, 4
mg, 8 mg
T1
prednisolone oral solution 15 mg/5ml
T1
prednisolone sodium phosphate oral solution 15
mg/5ml, 6.7 (5 base) mg/5ml
T1
prednisone (pak) oral tablet 5 mg
T1
prednisone oral 10 mg (21), 5 mg (21)
T1
prednisone oral solution 5 mg/5ml
T1
prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20
mg, 5 mg, 50 mg
T1
Notes
*Cough/Cold/Allergy*
acetylcysteine inhalation solution 10 %, 20 %
T1
cheratussin ac oral solution 100-10 mg/5ml
T1
cheratussin dac oral solution 30-10-100 mg/5ml
T1
dextromethorphan-guaifenesin oral solution
10-100 mg/5ml
T1
guaifenesin oral solution 100 mg/5ml
T1
guaifenesin oral syrup 100 mg/5ml
T1
guaifenesin oral tablet 200 mg, 400 mg
T1
guaifenesin-dm oral syrup 100-10 mg/5ml
T1
loratadine-d 12hr oral tablet extended release 12
hr* 5-120 mg
T1
loratadine-d 24hr oral tablet extended release 24
hr* 10-240 mg
T1
promethazine-dm oral syrup 6.25-15 mg/5ml
T1
pseudoeph-bromphen-dm oral syrup 30-2-10
mg/5ml
T1
sodium chloride inhalation nebulization solution
0.9 %, 7 %
T1
tussin dm max adult oral liquid† 10-200 mg/5ml
T1
*Dermatologicals*
ABREVA EXTERNAL CREAM 10 %
T1
acitretin oral capsule 10 mg, 17.5 mg, 25 mg
T1
PA
adapalene external cream 0.1 %
T1
ST; QL (45 GM per 30 days)
adapalene external gel 0.1 %
T1
ST; QL (45 GM per 30 days)
24
Drug
Status
Notes
alclometasone dipropionate external cream 0.05
%
T1
alclometasone dipropionate external ointment
0.05 %
T1
ammonium lactate external cream 12 %
T1
ammonium lactate external lotion 12 %
T1
bacitracin external ointment 500 unit/gm
T1
bacitracin zinc external ointment 500 unit/gm
T1
benzoyl peroxide external gel 10 %
T1
benzoyl peroxide external gel 2.5 %, 5 %
T1
benzoyl peroxide wash external liquid† 10 %, 5 %
T1
benzoyl peroxide-erythromycin external gel 5-3 %
T1
betamethasone dipropionate aug external cream
0.05 %
T1
betamethasone dipropionate aug external gel 0.05
%
T1
betamethasone dipropionate aug external lotion
0.05 %
T1
betamethasone dipropionate aug external
ointment 0.05 %
T1
betamethasone dipropionate external cream 0.05
%
T1
betamethasone dipropionate external lotion 0.05
%
T1
betamethasone dipropionate external ointment
0.05 %
T1
betamethasone valerate external cream 0.1 %
T1
betamethasone valerate external lotion 0.1 %
T1
betamethasone valerate external ointment 0.1 %
T1
calcipotriene external cream 0.005 %
T1
PA
calcipotriene external solution 0.005 %
T1
CALCITRENE EXTERNAL OINTMENT
0.005 %
T1
PA; QL (60 GM per 30 days)
capsaicin external cream 0.025 %, 0.075 %, 0.1
%
T1
ciclopirox external solution 8 %
T1
QL (6.6 ML per 28 days)
CLARAVIS ORAL CAPSULE 10 MG, 20
MG, 30 MG, 40 MG
T1
clindamycin phosphate external solution 1 %
T1
clindamycin phosphate external swab 1 %
T1
clobetasol propionate external cream 0.05 %
T1
25
Drug
Status
Notes
clobetasol propionate external ointment 0.05 %
T1
clobetasol propionate external solution 0.05 %
T1
clotrimazole external cream 1 %
T1
clotrimazole external solution 1 %
T1
clotrimazole-betamethasone external cream
1-0.05 %
T1
CORTIZONE-10/ALOE EXTERNAL
CREAM 1 %
T1
desonide external ointment 0.05 %
T1
diclofenac sodium transdermal gel 3 %
T1
PA
DRYSOL EXTERNAL SOLUTION 20 %
T1
econazole nitrate external cream 1 %
T1
ELIDEL EXTERNAL CREAM 1 %
T1
erythromycin external solution 2 %
T1
fluocinolone acetonide external cream 0.01 %
T1
fluocinolone acetonide external cream 0.025 %
T1
fluocinolone acetonide external ointment 0.025 %
T1
fluocinonide external cream 0.05 %
T1
fluocinonide external ointment 0.05 %
T1
fluocinonide external solution 0.05 %
T1
fluocinonide-e external cream 0.05 %
T1
fluorouracil external cream 0.5 %, 5 %
T1
PA
fluticasone propionate external cream 0.05 %
T1
fluticasone propionate external ointment 0.005 %
T1
gentamicin sulfate external cream 0.1 %
T1
gentamicin sulfate external ointment 0.1 %
T1
halobetasol propionate external cream 0.05 %
T1
halobetasol propionate external ointment 0.05 %
T1
hydrocortisone external cream 0.5 %, 1 %, 2.5 %
T1
hydrocortisone external lotion 1 %, 2.5 %
T1
hydrocortisone external ointment 0.5 %, 1 %, 2.5
%
T1
hydrocortisone valerate external cream 0.2 %
T1
imiquimod external cream 5 %
T1
ketoconazole external cream 2 %
T1
ketoconazole external shampoo 2 %
T1
lice killing maximum strength external shampoo
0.33-4 %
T1
lice treatment external liquid† 0.33-4 %
T1
26
Drug
Status
Notes
lidocaine external cream 4 %
T1
lidocaine external patch 5 %
T1
lidocaine hcl external cream 3 %
T1
lidocaine hcl external gel 2 %
T1
lidocaine hcl external solution 4 %
T1
lidocaine-prilocaine external cream 2.5-2.5 %
T1
lindane external lotion 1 %
T1
lindane external shampoo 1 %
T1
malathion external lotion 0.5 %
T1
ST; QL (59 ML per 30 days)
metronidazole external cream 0.75 %
T1
metronidazole external gel 0.75 %
T1
mometasone furoate external cream 0.1 %
T1
mometasone furoate external ointment 0.1 %
T1
mometasone furoate external solution 0.1 %
T1
mupirocin external ointment 2 %
T1
nystatin external cream 100000 unit/gm
T1
nystatin external ointment 100000 unit/gm
T1
nystatin external powder 100000 unit/gm
T1
permethrin external cream 5 %
T1
permethrin lice treatment external lotion 1 %
T1
podofilox external solution 0.5 %
T1
SANTYL EXTERNAL OINTMENT 250
UNIT/GM
T1
sb lice treatment external liquid† 1 %
T1
selenium sulfide external lotion 2.5 %
T1
selenium sulf-pyrithione-urea external shampoo
2.25 %
T1
silver sulfadiazine external cream 1 %
T1
sulfacetamide sodium (acne) external lotion 10 %
T1
sulfacetamide sodium-sulfur external emulsion
10-5 %
T1
sure comfort alcohol prep external pad 70 %
T1
tacrolimus external ointment 0.03 %, 0.1 %
T1
tolnaftate external aerosol, powder 1 %
T1
tretinoin external cream 0.025 %
T1
QL (45 GM per 30 days); AL (Min
tretinoin external cream 0.05 %, 0.1 %
T1
ST; QL (45 GM per 30 days); AL
tretinoin external gel 0.01 %, 0.025 %
T1
ST; QL (45 GM per 30 days); AL
PA
PA
27
Drug
Status
Notes
triamcinolone acetonide external cream 0.025 %,
0.1 %
T1
triamcinolone acetonide external cream 0.5 %
T1
triamcinolone acetonide external lotion 0.025 %
T1
triamcinolone acetonide external lotion 0.1 %
T1
triamcinolone acetonide external ointment 0.025
%, 0.1 %
T1
triamcinolone acetonide external ointment 0.5 %
T1
triple antibiotic external ointment 3.5-400-5000
T1
trixaicin external cream 0.025 %
T1
urea external cream 40 %
T1
vitamin e skin external oil
T1
*Diagnostic Products*
BAYER CONTOUR NEXT TEST IN VITRO
STRIP
T1
FREESTYLE LITE TEST IN VITRO STRIP
T1
FREESTYLE TEST IN VITRO STRIP
T1
GLUCOCARD EXPRESSION TEST IN
VITRO STRIP
T1
GLUCOCARD VITAL TEST IN VITRO
STRIP
T1
GLUCONAVII BLOOD GLUCOSE TEST IN
VITRO STRIP
T1
KETOSTIX IN VITRO STRIP
T1
ONETOUCH ULTRA BLUE IN VITRO
STRIP
T1
PRECISION XTRA KETONE IN VITRO
STRIP
T1
*Dietary Products/Dietary Management
Products*
CARDIOTEK RX ORAL TABLET
T1
CEREFOLIN ORAL TABLET 6-1-50-5 MG
T1
FOLBIC ORAL TABLET 2.5-25-2 MG
T1
l-methylfolate-algae-b12-b6 oral capsule
3-90.314-2-35 mg
T1
l-methylfolate-b6-b12 oral tablet 1.13-25-2 mg,
3-35-2 mg
T1
l-methyl-mc nac oral tablet 6-2-600 mg
T1
methylfol-algae-b12-acetylcyst oral tablet
6-90.314-2-600 mg
T1
PODIAPN ORAL CAPSULE 5-2-35-300 MG
T1
28
Drug
Status
PROSTAMEN ORAL CAPSULE
T1
VITA-RESPA ORAL TABLET 2.2-25-1.3 MG
T1
Notes
*Digestive Aids*
CREON ORAL CAPSULE DELAYED
RELEASE PARTICLES 12000 UNIT, 24000
UNIT, 3000-9500 UNIT, 36000 UNIT, 6000
UNIT
T1
PANCREAZE ORAL CAPSULE DELAYED
UNIT, 21000 UNIT, 4200 UNIT
T1
ZENPEP ORAL CAPSULE DELAYED
UNIT, 20000 UNIT, 25000 UNIT, 3000-10000
UNIT, 5000 UNIT
T1
*Diuretics*
acetazolamide er oral capsule extended release
12 hour 500 mg
T1
acetazolamide oral tablet 125 mg, 250 mg
T1
amiloride hcl oral tablet 5 mg
T1
amiloride-hydrochlorothiazide oral tablet 5-50
mg
T1
bumetanide oral tablet 0.5 mg, 1 mg, 2 mg
T1
chlorothiazide oral tablet 250 mg, 500 mg
T1
chlorthalidone oral tablet 25 mg, 50 mg
T1
DIURIL ORAL SUSPENSION 250 MG/5ML
T1
AL (Max 12 Years)
furosemide oral solution 10 mg/ml, 8 mg/ml
T1
AL (Max 12 Years)
furosemide oral tablet 20 mg, 40 mg, 80 mg
T1
hydrochlorothiazide oral capsule 12.5 mg
T1
hydrochlorothiazide oral tablet 12.5 mg, 25 mg,
50 mg
T1
indapamide oral tablet 1.25 mg, 2.5 mg
T1
methazolamide oral tablet 25 mg, 50 mg
T1
methyclothiazide oral tablet 5 mg
T1
metolazone oral tablet 10 mg, 2.5 mg, 5 mg
T1
spironolactone oral tablet 100 mg, 25 mg, 50 mg
T1
spironolactone-hctz oral tablet 25-25 mg
T1
torsemide oral tablet 10 mg, 20 mg
T1
torsemide oral tablet 100 mg, 5 mg
T1
triamterene-hctz oral capsule 37.5-25 mg, 50-25
mg
T1
triamterene-hctz oral tablet 37.5-25 mg, 75-50 mg
T1
29
Drug
*Endocrine And Metabolic Agents Misc.*
Status
Notes
alendronate sodium oral tablet 10 mg, 40 mg, 5
mg
T1
alendronate sodium oral tablet 35 mg, 70 mg
T1
cabergoline oral tablet 0.5 mg
T1
calcitonin (salmon) nasal solution 200 unit/act
T1
calcitriol oral capsule 0.25 mcg, 0.5 mcg
T1
calcitriol oral solution 1 mcg/ml
T1
AL (Max 12 Years)
desmopressin ace rhinal tube nasal solution 0.01
%
T1
PA
desmopressin ace spray refrig nasal solution 0.01
%
T1
PA
desmopressin acetate oral tablet 0.1 mg, 0.2 mg
T1
desmopressin acetate spray nasal solution 0.01 %
T1
PA
etidronate disodium oral tablet 200 mg, 400 mg
T1
FORTEO SUBCUTANEOUS* SOLUTION
600 MCG/2.4ML
T1
ibandronate sodium oral tablet 150 mg
T1
INCRELEX SUBCUTANEOUS* SOLUTION
40 MG/4ML
T1
PA
NORDITROPIN FLEXPRO
SUBCUTANEOUS* SOLUTION 10
MG/1.5ML, 15 MG/1.5ML, 30 MG/3ML, 5
MG/1.5ML
T1
PA
octreotide acetate injection solution 100 mcg/ml,
1000 mcg/ml, 200 mcg/ml, 50 mcg/ml
T1
PA
raloxifene hcl oral tablet 60 mg
T1
GR-F; QL (30 EA per 30 days);
AL (Min 40 Years)
SENSIPAR ORAL TABLET 30 MG, 60 MG
T1
SENSIPAR ORAL TABLET 90 MG
T1
STIMATE NASAL SOLUTION 1.5 MG/ML
T1
PA
est estrogens-methyltest hs oral tablet 0.625-1.25
mg
T1
GR-F
est estrogens-methyltest oral tablet 1.25-2.5 mg
T1
GR-F
estradiol oral tablet 0.5 mg, 1 mg, 2 mg
T1
GR-F; AL (Max 64 Years)
estradiol transdermal patch biweekly 0.025
mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.075
mg/24hr, 0.1 mg/24hr
T1
*Estrogens*
30
Drug
Status
Notes
estradiol transdermal patch weekly 0.025
mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06
mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr
T1
estradiol-norethindrone acet oral tablet 0.5-0.1
mg, 1-0.5 mg
T1
GR-F
estropipate oral tablet 0.75 mg, 1.5 mg, 3 mg
T1
GR-F; AL (Max 64 Years)
JINTELI ORAL TABLET 1-5 MG-MCG
T1
GR-F
MENEST ORAL TABLET 0.3 MG, 0.625 MG,
1.25 MG, 2.5 MG
T1
GR-F
norethindrone-eth estradiol oral tablet 0.5-2.5
mg-mcg
T1
PREMARIN ORAL TABLET 0.3 MG, 0.45
MG, 0.625 MG, 0.9 MG, 1.25 MG
T1
AL (Max 64 Years)
PREMPHASE ORAL TABLET 0.625-5 MG
T1
PREMPRO ORAL TABLET 0.3-1.5 MG,
0.45-1.5 MG, 0.625-2.5 MG, 0.625-5 MG
T1
*Fluoroquinolones*
ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500
mg, 750 mg
T1
ciprofloxacin oral suspension reconstituted 250
mg/5ml (5%), 500 mg/5ml (10%)
T1
levofloxacin oral tablet 250 mg, 500 mg, 750 mg
T1
ofloxacin oral tablet 400 mg
T1
AL (Max 12 Years)
*Gastrointestinal Agents - Misc.*
APRISO ORAL CAPSULE EXTENDED
RELEASE 24 HOUR 0.375 GM
T1
ST
ASACOL HD ORAL TABLET DELAYED
RELEASE 800 MG
T1
balsalazide disodium oral capsule 750 mg
T1
calcium acetate (phos binder) oral capsule 667
mg
T1
calcium acetate (phos binder) oral tablet 667 mg
T1
DELZICOL ORAL CAPSULE DELAYED
RELEASE 400 MG
T1
ST
FOSRENOL ORAL TABLET CHEWABLE
1000 MG, 500 MG, 750 MG
T1
PA
infants gas relief oral suspension 40 mg/0.6ml
T1
mesalamine enema 4 gm
T1
metoclopramide hcl oral solution 5 mg/5ml
T1
metoclopramide hcl oral tablet 10 mg, 5 mg
T1
PENTASA ORAL CAPSULE EXTENDED
RELEASE* 250 MG, 500 MG
T1
31
Drug
Status
Notes
PHOSLYRA ORAL SOLUTION 667
MG/5ML
T1
RENAGEL ORAL TABLET 400 MG, 800 MG
T1
PA
RENVELA ORAL TABLET 800 MG
T1
PA
simethicone oral tablet chewable 125 mg, 80 mg
T1
sulfasalazine oral tablet 500 mg
T1
sulfasalazine oral tablet delayed release 500 mg
T1
ursodiol oral capsule 300 mg
T1
ursodiol oral tablet 250 mg, 500 mg
T1
*Genitourinary Agents - Miscellaneous*
cytra-2 oral solution 500-334 mg/5ml
T1
cytra-k oral solution 1100-334 mg/5ml
T1
ELMIRON ORAL CAPSULE 100 MG
T1
finasteride oral tablet 5 mg
T1
GR-M; QL (30 EA per 30 days)
K-PHOS NO 2 ORAL TABLET 305-700 MG
T1
PHENAZO ORAL TABLET 200 MG
T1
phenazopyridine hcl oral tablet 100 mg
T1
potassium citrate er oral tablet extendedrelease*
10 meq (1080 mg), 5 meq (540 mg)
T1
sodium chloride irrigation solution 0.9 %
T1
tamsulosin hcl oral capsule 0.4 mg
T1
TARON-CRYSTALS ORAL PACKET
3300-1002 MG
T1
*Gout Agents*
allopurinol oral tablet 100 mg
T1
allopurinol oral tablet 300 mg
T1
colchicine-probenecid oral tablet 0.5-500 mg
T1
COLCRYS ORAL TABLET 0.6 MG
T1
probenecid oral tablet 500 mg
T1
ULORIC ORAL TABLET 40 MG
T1
ULORIC ORAL TABLET 80 MG
T1
PA
*Hematological Agents - Misc.*
anagrelide hcl oral capsule 0.5 mg, 1 mg
T1
cilostazol oral tablet 100 mg, 50 mg
T1
clopidogrel bisulfate oral tablet 300 mg
T1
clopidogrel bisulfate oral tablet 75 mg
T1
dipyridamole oral tablet 25 mg, 75 mg
T1
dipyridamole oral tablet 50 mg
T1
32
Drug
pentoxifylline er oral tablet extendedrelease* 400
mg
Status
Notes
T1
*Hematopoietic Agents*
ARANESP (ALBUMIN FREE) INJECTION
100 MCG/0.5ML, 150 MCG/0.3ML, 200
MCG/0.4ML, 25 MCG/0.42ML, 300
MCG/0.6ML, 40 MCG/0.4ML, 500 MCG/ML,
60 MCG/0.3ML
T1
PA
ARANESP (ALBUMIN FREE) INJECTION
SOLUTION 10 MCG/0.4ML, 100 MCG/ML,
150 MCG/0.75ML, 200 MCG/ML, 25
MCG/ML, 300 MCG/ML, 40 MCG/ML, 60
MCG/ML
T1
PA
b-12 oral tablet 500 mcg
T1
cyanocobalamin injection solution 1000 mcg/ml
T1
D 1000 PLUS ALOE ORAL TABLET
T1
DROXIA ORAL CAPSULE 200 MG, 300 MG,
400 MG
T1
EPOGEN INJECTION SOLUTION 10000
UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML,
3000 UNIT/ML, 4000 UNIT/ML
T1
fabb oral tablet 2.2-25-1 mg
T1
ferrous gluconate oral tablet 225 (27 fe) mg, 240
(27 fe) mg, 324 (37.5 fe) mg, 324 (38 fe) mg, 325
(36 fe) mg
T1
ferrous sulfate oral elixir 220 (44 fe) mg/5ml
T1
AL (Max 12 Years)
ferrous sulfate oral liquid† 220 (44 fe) mg/5ml
T1
AL (Max 12 Years)
ferrous sulfate oral solution 75 (15 fe) mg/ml
T1
AL (Max 12 Years)
ferrous sulfate oral syrup 300 (60 fe) mg/5ml
T1
AL (Max 12 Years)
ferrous sulfate oral tablet delayed release 324 (65
fe) mg, 325 (65 fe) mg
T1
folbee oral tablet 2.5-25-1 mg
T1
FOLGARD ORAL TABLET
T1
folic acid oral tablet 1 mg, 800 mcg
T1
folic acid oral tablet 400 mcg
T1
folinic-plus oral tablet 4-50-2 mg
T1
folplex 2.2 oral tablet 2.2-25-0.5 mg
T1
FOLTABS 800 ORAL TABLET 800-10-115
MCG-MG-MCG
T1
hm iron oral tablet 200 (65 fe) mg
T1
hm slow release iron oral tablet extendedrelease*
45 mg
T1
PA
33
Drug
Status
Notes
iron 100 plus oral tablet 100-250-0.025-1 mg
T1
iron oral tablet 325 (65 fe) mg
T1
NEUPOGEN INJECTION 300 MCG/0.5ML,
480 MCG/0.8ML
T1
PA
NEUPOGEN INJECTION SOLUTION 300
MCG/ML, 480 MCG/1.6ML
T1
PA
PROCRIT INJECTION SOLUTION 10000
UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML,
3000 UNIT/ML, 4000 UNIT/ML, 40000
UNIT/ML
T1
PA
slow iron oral tablet extendedrelease* 160 (50 fe)
mg
T1
slow release iron oral tablet extendedrelease*
47.5 mg
T1
sm slow release iron oral tablet extendedrelease*
142 (45 fe) mg
T1
vitamin b-12 oral tablet 1000 mcg
T1
ZARXIO INJECTION 300 MCG/0.5ML, 480
MCG/0.8ML
T1
PA
bisacodyl ec oral tablet delayed release 5 mg
T1
bisacodyl suppository 10 mg
T1
cvs laxative dietary supplemnt oral tablet 500 mg
T1
cvs senna-extra oral tablet 17.2 mg
T1
cvs stool softener oral capsule 50 mg
T1
docusate calcium oral capsule 240 mg
T1
docusate sodium oral capsule 100 mg, 250 mg
T1
docusate sodium oral liquid† 150 mg/15ml
T1
docusate sodium oral tablet 100 mg
T1
DOCUSOL MINI ENEMA 283 MG
T1
enema enema
T1
ENEMEEZ PLUS ENEMA 20-283 MG
T1
GAVILYTE-G ORAL SOLUTION
RECONSTITUTED 236 GM
T1
GAVILYTE-N WITH FLAVOR PACK
ORAL SOLUTION RECONSTITUTED 420
GM
T1
geri-mucil oral powder 68 %
T1
lactulose oral solution 10 gm/15ml
T1
METAMUCIL MULTIHEALTH FIBER
ORAL POWDER 63 %
T1
*Laxatives*
34
Drug
Status
mineral oil enema
T1
natural fiber laxative oral powder 28.3 %, 58.6 %
T1
natural fiber therapy oral powder 30.9 %, 48.57
%
T1
peg 3350/electrolytes oral solution reconstituted
240 gm
T1
polyethylene glycol 3350 oral packet
T1
polyethylene glycol 3350 oral powder
T1
qc natural vegetable oral powder 95 %
T1
senna laxative oral tablet 25 mg
T1
senna oral capsule 8.6 mg
T1
senna oral syrup 8.8 mg/5ml
T1
senna oral tablet 8.6 mg
T1
SENNA SMOOTH ORAL TABLET 15 MG
T1
senna-docusate sodium oral tablet 8.6-50 mg
T1
Notes
*Macrolides*
azithromycin oral packet 1 gm
T1
azithromycin oral suspension reconstituted 100
mg/5ml, 200 mg/5ml
T1
azithromycin oral tablet 250 mg, 500 mg, 600 mg
T1
clarithromycin oral suspension reconstituted 125
mg/5ml, 250 mg/5ml
T1
clarithromycin oral tablet 250 mg, 500 mg
T1
ERYPED 200 ORAL SUSPENSION
RECONSTITUTED 200 MG/5ML
T1
erythromycin base oral capsule delayed release
particles 250 mg
T1
erythromycin base oral tablet 250 mg, 500 mg
T1
erythromycin ethylsuccinate oral tablet 400 mg
T1
(Max 12 Years)
*Medical Devices*
ACCU-CHEK MULTICLIX LANCETS
T1
ADVOCATE INSULIN PEN NEEDLES 29G
X 12.7MM
T1
ASSURE DOSE CONTROL IN VITRO
SOLUTION NORMAL
T1
BAYER CONTOUR NEXT CONTROL IN
VITRO SOLUTION NORMAL
T1
BD AUTOSHIELD 29G X 5MM , 29G X 8MM
T1
BD AUTOSHIELD DUO 30G X 5 MM
T1
35
Drug
Status
Notes
BD INSULIN SYR ULTRAFINE II 31G X
5/16" 0.5 ML
T1
BD INSULIN SYRINGE 26G X 1/2" 1 ML,
27.5G X 5/8" 2 ML, 29G X 1/2" 2 ML, U-100 1
ML
T1
BD INSULIN SYRINGE MICROFINE 27G X
5/8" 1 ML, 28G X 1/2" 0.3 ML, 28G X 1/2" 0.5
ML
T1
BD INSULIN SYRINGE U-40 25G X 5/8" 1
ML
T1
BD INSULIN SYRINGE ULTRAFINE 30G X
1/2" 1 ML, 31G X 15/64" 0.3 ML, 31G X
15/64" 0.5 ML, 31G X 15/64" 1 ML
T1
BD INTEGRA SYRINGE 25G X 1" 1 ML
T1
BD LANCET DEVICE
T1
BD PEN
T1
CAREFINE PEN NEEDLES 30G X 8 MM ,
32G X 5 MM
T1
careone insulin syringe 30g x 1/2" 0.3 ml, 30g x
1/2" 0.5 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 1 ml
T1
COMFORT ASSIST INSULIN SYRINGE
29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 30G X
5/16" 0.3 ML, 30G X 5/16" 0.5 ML
T1
condoms
T1
CURITY ALCOHOL PREPS PAD 70 %
T1
EASIVENT
T1
EASIVENT MASK LARGE
T1
EASIVENT MASK MEDIUM
T1
EASIVENT MASK SMALL
T1
easy comfort insulin syringe 30g x 5/16" 1 ml
T1
EASY TOUCH INSULIN SYRINGE 27G X
1/2" 0.5 ML, 27G X 1/2" 1 ML
T1
elite-thin insulin syringe 28g x 5/16" 1 ml, 29g x
5/16" 0.5 ml, 29g x 5/16" 1 ml
T1
EXEL COMFORT POINT INSULIN SYR
29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X
5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X
5/16" 1 ML
T1
FC2 FEMALE CONDOM
T1
FIFTY50 PEN NEEDLES 32G X 6 MM
T1
FREESTYLE CONTROL SOLUTION IN
VITRO LIQUID†
T1
36
Drug
Status
Notes
GLUCOCARD EXPRESSION CONTROL IN
VITRO SOLUTION
T1
GLUCOCARD EXPRESSION MONITOR
KIT W/DEVICE
T1
GLUCOCARD VITAL MONITOR KIT
W/DEVICE
T1
h-e-b incontrol pen needles 31g x 5 mm
T1
insulin syringe 29g x 1" 0.3 ml, 29g x 1/2" 1 ml
T1
kmart valu insulin syringe 30g u-100 0.3 ml,
u-100 0.5 ml
T1
LITE TOUCH PEN NEEDLES 31G X 5 MM
T1
LITETOUCH PEN NEEDLES 31G X 8 MM
T1
MONOJECT INSULIN SYRINGE 25G X 5/8"
1 ML
T1
ONETOUCH ULTRA CONTROL IN VITRO
SOLUTION
T1
pen needles 29g x 12mm , 32g x 4 mm
T1
premium condoms lubricated
T1
qc insulin syringe 29g 0.3 ml, 29g 0.5 ml, 29g 1
ml, 30g 0.5 ml
T1
RELI-ON INSULIN SYRINGE 30G 0.3 ML
T1
SURE-LANCE THIN LANCETS 28G
T1
TECHLITE PEN NEEDLES 31G X 6 MM ,
32G X 8 MM
T1
TERUMO INSULIN SYRINGE 30G X 3/8"
0.5 ML, 30G X 3/8" 1 ML
T1
TERUMO SURGUARD INSULIN SYR 28G X
1/2" 1 ML
T1
THINPRO INSULIN SYRINGE 31G X 3/8"
0.3 ML, 31G X 3/8" 0.5 ML, 31G X 3/8" 1 ML
T1
TRUSTEX NON-LUBRICATED
T1
ULTICARE INSULIN SYRINGE 31G X 5/16"
0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1
ML
T1
ULTICARE MICRO PEN NEEDLES 31G X 8
MM
T1
ULTILET INSULIN SYRINGE 29G X 7/16"
0.3 ML, 29G X 7/16" 0.5 ML
T1
naratriptan hcl oral tablet 1 mg, 2.5 mg
T1
rizatriptan benzoate oral tablet 10 mg, 5 mg
T1
*Migraine Products*
37
Drug
Status
Notes
rizatriptan benzoate oral tablet dispersible 10 mg,
5 mg
T1
sumatriptan succinate oral tablet 100 mg, 25 mg,
50 mg
T1
sumatriptan succinate refill subcutaneous* 4
mg/0.5ml, 6 mg/0.5ml
T1
sumatriptan succinate subcutaneous* 4 mg/0.5ml,
6 mg/0.5ml
T1
sumatriptan succinate subcutaneous* solution 6
mg/0.5ml
T1
zolmitriptan oral tablet 2.5 mg, 5 mg
T1
zolmitriptan oral tablet dispersible 2.5 mg, 5 mg
T1
*Minerals & Electrolytes*
BEELITH ORAL TABLET 362-20 MG
T1
cal-citrate plus vitamin d oral tablet 250-100
mg-unit
T1
calcium + d3 oral tablet 600-200 mg-unit
T1
calcium 500 + d oral tablet 500-125 mg-unit
T1
calcium 500 + d3 oral tablet 500-600 mg-unit
T1
calcium 500+d oral tablet 500-200 mg-unit
T1
calcium 500+d3 oral tablet 500-400 mg-unit
T1
calcium 600 + d oral tablet 600-200 mg-unit
T1
calcium 600 oral tablet 1500 (600 ca) mg
T1
calcium 600+d oral tablet 600-800 mg-unit
T1
calcium 600+d3 oral tablet 600-400 mg-unit
T1
calcium carbonate oral suspension 1250 (500 ca)
mg/5ml
T1
calcium carbonate oral tablet 1250 (500 ca) mg,
600 mg
T1
calcium carbonate oral tablet chewable 260 mg
T1
calcium carbonate-vitamin d oral tablet 600-400
mg-unit
T1
calcium citrate + d3 maximum oral tablet
315-250 mg-unit
T1
calcium citrate oral granules 760 mg/3.5gm
T1
calcium citrate oral tablet 200 mg
T1
calcium citrate-vitamin d oral tablet 315-200
mg-unit
T1
calcium oral tablet 600-200 mg-unit
T1
calcium oral tablet chewable 500 mg
T1
38
Drug
Status
calcium/vitamin d3 gummies oral tablet chewable
200-200 mg-unit
T1
chelated magnesium oral tablet 100 mg
T1
DISNEY CALCIUM + VITAMIN D3 ORAL
TABLET CHEWABLE 250-135-200
MG-MG-UNIT
T1
GLYCOPHOS INTRAVENOUS* SOLUTION
1 MMOLE/ML
T1
K-PHOS ORAL TABLET 500 MG
T1
MAG64 ORAL TABLET
EXTENDEDRELEASE* 535 (64 MG) MG
T1
MAGINEX ORAL TABLET DELAYED
RELEASE 615 MG
T1
magnesium chloride injection solution 200 mg/ml
T1
magnesium citrate oral tablet 100 mg
T1
magnesium gluconate oral tablet 27.5 mg, 500 mg
T1
magnesium oral capsule 300 mg, 400 mg
T1
magnesium oral tablet 200 mg, 250 mg, 30 mg
T1
magnesium oxide -mg supplement oral tablet 250
mg
T1
magnesium oxide oral tablet 400 (240 mg) mg,
400 (241.3 mg) mg, 500 mg
T1
magnesium sulfate in d5w intravenous* solution
10-5 mg/ml-%
T1
magnesium sulfate injection solution 50 %
T1
magnesium sulfate intravenous* solution 2
gm/50ml, 4 gm/50ml
T1
MAGONATE ORAL LIQUID† 1000 (54 MG)
MG/5ML
T1
MAGONATE ORAL TABLET 500 (27 MG)
MG
T1
MAG-TAB SR ORAL TABLET
EXTENDEDRELEASE* 84 MG (7MEQ)
T1
ORALYTE ORAL SOLUTION
T1
oyster shell calcium 250+d oral tablet 250-125
mg-unit
T1
oyster shell calcium oral tablet 500 mg
T1
oyster shell calcium plus d oral tablet 500-125
mg-unit
T1
oyster shell calcium/d oral tablet 250-125 mg-unit
T1
oyster shell calcium/d3 oral tablet 500-400
mg-unit
T1
Notes
39
Drug
Status
Notes
oyster shell/d oral tablet 500-200 mg-unit
T1
phos-nak oral packet 280-160-250 mg
T1
PHOSPHA 250 NEUTRAL ORAL TABLET
155-852-130 MG
T1
pot bicarb-pot chloride oral tablet effervescent 25
meq
T1
potassium bicarbonate oral tablet effervescent 25
meq
T1
potassium chloride crys er oral tablet
extendedrelease* 10 meq, 20 meq
T1
potassium chloride er oral capsule extended
release* 10 meq, 8 meq
T1
potassium chloride er oral tablet
extendedrelease* 10 meq, 8 meq
T1
potassium chloride oral packet 20 meq
T1
potassium chloride oral solution 20 meq/15ml
(10%), 40 meq/15ml (20%)
T1
potassium phosphates intravenous* solution 15
mmole/5ml, 150 mmole/50ml, 45 mmole/15ml
T1
ra magnesium oral capsule 500 mg
T1
ra oyster shell calcium/d oral tablet 500-200
mg-unit
T1
slow magnesium/calcium oral tablet delayed
release 64-106 mg
T1
SLOW-MAG ORAL TABLET DELAYED
RELEASE 71.5-119 MG
T1
sodium fluoride oral solution 1.1 (0.5 f) mg/ml
T1
16 Years)
sodium fluoride oral tablet chewable 0.55 (0.25 f)
mg
T1
AL (Max 16 Years)
sodium fluoride oral tablet chewable 1.1 (0.5 f)
mg, 2.2 (1 f) mg
T1
16 Years)
sodium phosphate intravenous* solution 3
mmole/ml
T1
*Mouth/Throat/Dental Agents*
chlorhexidine gluconate mouth/throat solution
0.12 %
T1
clotrimazole mouth/throat lozenge 10 mg
T1
DENTAGEL DENTAL GEL 1.1 %
T1
AL (Max 16 Years)
lidocaine viscous mouth/throat solution 2 %
T1
nystatin mouth/throat suspension 100000 unit/ml
T1
pilocarpine hcl oral tablet 5 mg
T1
40
Drug
Status
sf 5000 plus dental cream 1.1 %
T1
triamcinolone acetonide mouth/throat paste 0.1 %
T1
Notes
*Multivitamins*
APETIGEN ORAL ELIXIR
T1
APETIGEN-PLUS ORAL SOLUTION
T1
b complex formula 1 oral tablet
T1
b complex oral capsule
T1
b complex-c oral tablet
T1
b complex-c-biotin-e-fa oral tablet 0.4 mg
T1
b-100 complex oral tablet
T1
b-100 complex oral tablet extendedrelease*
T1
b-100 cr oral tablet extendedrelease*
T1
b-complex/b-12 sublingual liquid†
T1
benfotiamine multi-b oral capsule
T1
bp folinatal plus b oral tablet 1 mg
T1
brewers yeast oral tablet
T1
childrens chewable vitamins oral tablet chewable
T1
childrens multivitamin oral tablet chewable 60
mg
T1
childrens vitamins/iron oral tablet chewable 15
mg
T1
COMPLETE FORMULATION PEDIATRIC
ORAL SOLUTION 45 MG/0.5ML
T1
daily multiple vitamins/min oral tablet
T1
daily vitamin formula+iron oral tablet
T1
daily vite oral tablet
T1
DIALYVITE 3000 ORAL TABLET 3 MG
T1
DIALYVITE 5000 ORAL TABLET 5 MG
T1
DIALYVITE 800/ZINC ORAL TABLET 0.8
MG
T1
DIALYVITE ORAL TABLET
T1
DIALYVITE SUPREME D ORAL TABLET 3
MG
T1
DIALYVITE/ZINC ORAL TABLET
T1
DINO-LIFE W/IRON-ZINC ORAL TABLET
CHEWABLE 30-200-3
T1
e-400/selenium oral capsule 400-50 unit-mcg
T1
ecee plus oral tablet
T1
Years)
41
Drug
Status
Notes
ELITE-OB ORAL TABLET 50-1.25 MG
T1
eql one daily womens oral tablet
T1
FOLBEE PLUS CZ ORAL TABLET 5 MG
T1
gnp b-complex plus vitamin c oral tablet
T1
hm vitamin b100 complex oral tablet
T1
multi adult gummies oral tablet chewable
T1
multi-delyn/iron oral liquid†
T1
multi-vit/fluoride oral solution 0.25 mg/ml
T1
multi-vitamin/fluoride/iron oral solution 0.25-10
mg/ml
T1
multivitamins pediatric oral solution
T1
multi-vitamins/fluoride oral solution 0.5 mg/ml
T1
multivitamins/fluoride oral tablet chewable 0.25
mg, 0.5 mg, 1 mg
T1
MYKIDZ IRON ORAL SUSPENSION 10
MG/2ML
T1
mynatal plus oral tablet
T1
Years)
mynate 90 plus oral tablet extendedrelease*
T1
Years)
NEPHROCAPS QT ORAL TABLET
DISPERSIBLE 1 MG
T1
NEPHRONEX ORAL LIQUID†
T1
NEWGEN ORAL TABLET 32-1 MG
T1
Years)
OBSTETRIX DHA ORAL 29-1 & 387 MG
T1
Years)
OBSTETRIX EC ORAL TABLET 29-1 MG
T1
Years)
polyvitamin oral solution 35 mg/ml
T1
poly-vitamin/iron oral solution 10 mg/ml
T1
prenatal 19 oral tablet chewable 29-1 mg
T1
Years)
T1
Years)
prenatal low iron oral tablet 27-1 mg
42
Drug
Status
Notes
T1
Years)
prenatal oral tablet 28-0.8 mg
T1
Years)
prenatal plus iron oral tablet 29-1 mg
T1
Years)
PRENATAL-U ORAL CAPSULE 106.5-1 MG
T1
Years)
PRENATE AM ORAL TABLET 1 MG
T1
Years)
T1
Years)
prenatal multi +dha oral capsule 27-0.8-228 mg
pretab oral tablet 29-1 mg
qc childrens vitamins/extra c oral tablet chewable
T1
ra b-complex/vitamin c cr oral tablet
extendedrelease*
T1
rabano yodado oral liquid†
T1
RENAL ORAL CAPSULE 1 MG
T1
renal vitamin oral tablet 0.8 mg
T1
SCOOBY-DOO ONE A DAY ORAL TABLET
CHEWABLE
T1
SUPERVITE ORAL LIQUID†
T1
TARON-BC ORAL 20-1 & 25 (2) MG
T1
Years)
trinatal rx 1 oral tablet 60-1 mg
T1
Years)
TRINATE ORAL TABLET
T1
Years)
tri-tabs dha oral 32-1 mg
T1
Years)
TRI-VI-FLOR ORAL SUSPENSION 0.25
MG/ML
T1
tri-vi-floro oral suspension 0.5 mg/ml
T1
43
Drug
Status
Notes
tri-vit/fluoride oral solution 0.25 mg/ml, 0.5
mg/ml
T1
tri-vit/fluoride/iron oral solution 0.25-10 mg/ml
T1
tri-vitamin oral solution 1500-400-35
T1
ultra multi formula/iron oral capsule
T1
VINATE II ORAL TABLET 29-1 MG
T1
Years)
VINATE M ORAL TABLET 27-1 MG
T1
Years)
virt-vite gt oral tablet 90-1 mg
T1
Years)
virt-vite plus oral tablet 5 mg
T1
vita-bee/c oral tablet
T1
VITAL-D RX ORAL TABLET 1 MG
T1
vitamin b complex-c oral capsule
T1
vitamin b-complex 100 injection injectable
T1
vitamin b-complex oral tablet
T1
vp-heme ob oral tablet 28-6-1 mg
T1
Years)
*Musculoskeletal Therapy Agents*
baclofen oral tablet 10 mg, 20 mg
T1
chlorzoxazone oral tablet 500 mg
T1
AL (Max 64 Years)
cyclobenzaprine hcl oral tablet 10 mg, 5 mg
T1
AL (Max 64 Years)
methocarbamol oral tablet 500 mg, 750 mg
T1
AL (Max 64 Years)
orphenadrine citrate er oral tablet extended
T1
64 Years)
tizanidine hcl oral tablet 2 mg, 4 mg
T1
*Nasal Agents - Systemic And Topical*
azelastine hcl nasal solution 0.1 %
T1
childrens silfedrine oral liquid† 15 mg/5ml
T1
cromolyn sodium nasal aerosol, solution 5.2
mg/act
T1
flunisolide nasal solution 25 mcg/act (0.025%)
T1
fluticasone propionate nasal suspension 50
mcg/act
T1
ipratropium bromide nasal solution 0.03 %, 0.06
%
T1
44
Drug
Status
Notes
long acting nasal spray nasal solution 0.05 %
T1
NASACORT ALLERGY 24HR CHILDREN
NASAL AEROSOL† 55 MCG/ACT
T1
NASACORT ALLERGY 24HR NASAL
AEROSOL† 55 MCG/ACT
T1
nasal decongestant oral liquid† 30 mg/5ml
T1
pseudoephedrine hcl er oral tablet extended
T1
pseudoephedrine hcl oral syrup 30 mg/5ml
T1
pseudoephedrine hcl oral tablet 30 mg, 60 mg
T1
saline mist spray nasal solution 0.65 %
T1
triamcinolone acetonide nasal aerosol† 55
mcg/act
T1
*Nutrients*
alba-lybe nr oral liquid† 325-10-50 mg/5ml
T1
*Ophthalmic Agents*
allergy eye ophthalmic solution 0.025-0.3 %
T1
apraclonidine hcl ophthalmic solution 0.5 %
T1
artificial tears ophthalmic ointment 83-15 %
T1
artificial tears ophthalmic solution 0.1-0.3 %, 0.4
%
T1
atropine sulfate ophthalmic ointment 1 %
T1
atropine sulfate ophthalmic solution 1 %
T1
azelastine hcl ophthalmic solution 0.05 %
T1
bacitracin ophthalmic ointment 500 unit/gm
T1
bacitracin-polymyxin b ophthalmic ointment
500-10000 unit/gm
T1
bacitra-neomycin-polymyxin-hc ophthalmic
ointment 1 %
T1
betaxolol hcl ophthalmic solution 0.5 %
T1
BIOLLE GEL TEARS OPHTHALMIC GEL
1%
T1
BLEPHAMIDE OPHTHALMIC
SUSPENSION 10-0.2 %
T1
BLEPHAMIDE S.O.P. OPHTHALMIC
OINTMENT 10-0.2 %
T1
brimonidine tartrate ophthalmic solution 0.15 %,
0.2 %
T1
carteolol hcl ophthalmic solution 1 %
T1
ciprofloxacin hcl ophthalmic solution 0.3 %
T1
cromolyn sodium ophthalmic solution 4 %
T1
45
Drug
Status
Notes
cyclopentolate hcl ophthalmic solution 1 %, 2 %
T1
dexamethasone sodium phosphate ophthalmic
solution 0.1 %
T1
diclofenac sodium ophthalmic solution 0.1 %
T1
dorzolamide hcl ophthalmic solution 2 %
T1
dorzolamide hcl-timolol mal ophthalmic solution
22.3-6.8 mg/ml
T1
erythromycin ophthalmic ointment 5 mg/gm
T1
eye allergy relief ophthalmic solution 0.027-0.315
%
T1
FLAREX OPHTHALMIC SUSPENSION 0.1
%
T1
fluorometholone ophthalmic suspension 0.1 %
T1
flurbiprofen sodium ophthalmic solution 0.03 %
T1
FML FORTE OPHTHALMIC SUSPENSION
0.25 %
T1
FML OPHTHALMIC OINTMENT 0.1 %
T1
gentamicin sulfate ophthalmic ointment 0.3 %
T1
gentamicin sulfate ophthalmic solution 0.3 %
T1
homatropine hbr ophthalmic solution 5 %
T1
ketorolac tromethamine ophthalmic solution 0.5
%
T1
ketotifen fumarate ophthalmic solution 0.025 %
T1
latanoprost ophthalmic solution 0.005 %
T1
levobunolol hcl ophthalmic solution 0.5 %
T1
levofloxacin ophthalmic solution 0.5 %
T1
lubricant drops ophthalmic solution 1.4 %
T1
lubricant drops/dual-action ophthalmic solution
0.5-0.9 %
T1
lubricant eye drops ophthalmic solution 0.4-0.3
%, 0.5 %, 0.6 %
T1
lubricant eye ophthalmic ointment
T1
metipranolol ophthalmic solution 0.3 %
T1
naphazoline hcl ophthalmic solution 0.1 %
T1
neomycin-bacitracin zn-polymyx ophthalmic
ointment 5-400-10000
T1
neomycin-polymyxin-dexameth ophthalmic
ointment 3.5-10000-0.1
T1
neomycin-polymyxin-dexameth ophthalmic
suspension 3.5-10000-0.1
T1
46
Drug
Status
neomycin-polymyxin-gramicidin ophthalmic
solution 1.75-10000-.025
T1
neomycin-polymyxin-hc ophthalmic suspension
3.5-10000-1
T1
ofloxacin ophthalmic solution 0.3 %
T1
phenylephrine hcl ophthalmic solution 2.5 %
T1
PHOSPHOLINE IODIDE OPHTHALMIC
SOLUTION RECONSTITUTED 0.125 %
T1
pilocarpine hcl ophthalmic solution 1 %, 2 %, 4
%
T1
polymyxin b-trimethoprim ophthalmic solution
10000-0.1 unit/ml-%
T1
PRED MILD OPHTHALMIC SUSPENSION
0.12 %
T1
prednisolone acetate ophthalmic suspension 1 %
T1
prednisolone sodium phosphate ophthalmic
solution 1 %
T1
proparacaine hcl ophthalmic solution 0.5 %
T1
px artificial tears ophthalmic solution 5-6 mg/ml
T1
ra artificial tears ophthalmic solution 1-0.3 %
T1
sm dry eye relief ophthalmic solution 0.2-0.2-1 %
T1
sodium chloride (hypertonic) ophthalmic ointment
5%
T1
sodium chloride (hypertonic) ophthalmic solution
5%
T1
sulfacetamide sodium ophthalmic ointment 10 %
T1
sulfacetamide sodium ophthalmic solution 10 %
T1
sulfacetamide-prednisolone ophthalmic solution
10-0.23 %
T1
timolol maleate ophthalmic gel forming solution
0.25 %, 0.5 %
T1
timolol maleate ophthalmic solution 0.25 %, 0.5
%
T1
TOBRADEX OPHTHALMIC OINTMENT
0.3-0.1 %
T1
tobramycin ophthalmic solution 0.3 %
T1
tobramycin-dexamethasone ophthalmic
suspension 0.3-0.1 %
T1
travoprost ophthalmic solution 0.004 %
T1
trifluridine ophthalmic solution 1 %
T1
tropicamide ophthalmic solution 0.5 %, 1 %
T1
Notes
47
Drug
VIGAMOX OPHTHALMIC SOLUTION 0.5
%
Status
T1
Notes
*Otic Agents*
acetic acid otic solution 2 %
T1
acetic acid-aluminum acetate otic solution 2 %
T1
antipyrine-benzocaine otic solution 5.4-1.4 %
T1
CIPRODEX OTIC SUSPENSION 0.3-0.1 %
T1
hydrocortisone-acetic acid otic solution 1-2 %
T1
neomycin-polymyxin-hc otic solution 3.5-10000-1
T1
neomycin-polymyxin-hc otic suspension
3.5-10000-1
T1
ofloxacin otic solution 0.3 %
T1
T1
AL (Min 12 Years)
RHOGAM ULTRA-FILTERED PLUS
INTRAMUSCULAR* 1500 UNIT
T1
GR-F
SYNAGIS INTRAMUSCULAR* SOLUTION
100 MG/ML, 50 MG/0.5ML
T1
PA
AL (Max 12 Years)
*Oxytocics*
methylergonovine maleate oral tablet 0.2 mg
*Passive Immunizing Agents*
*Penicillins*
amoxicillin oral capsule 250 mg, 500 mg
T1
amoxicillin oral suspension reconstituted 125
mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml
T1
amoxicillin oral tablet 500 mg, 875 mg
T1
amoxicillin oral tablet chewable 125 mg, 250 mg
T1
amoxicillin-pot clavulanate er oral tablet
extended release 12 hr* 1000-62.5 mg
T1
amoxicillin-pot clavulanate oral suspension
reconstituted 200-28.5 mg/5ml, 250-62.5 mg/5ml,
400-57 mg/5ml, 600-42.9 mg/5ml
T1
amoxicillin-pot clavulanate oral tablet 250-125
mg, 500-125 mg, 875-125 mg
T1
amoxicillin-pot clavulanate oral tablet chewable
200-28.5 mg, 400-57 mg
T1
ampicillin oral capsule 250 mg, 500 mg
T1
ampicillin oral suspension reconstituted 125
mg/5ml, 250 mg/5ml
T1
dicloxacillin sodium oral capsule 250 mg, 500 mg
T1
penicillin v potassium oral solution reconstituted
125 mg/5ml, 250 mg/5ml
T1
penicillin v potassium oral tablet 250 mg, 500 mg
T1
48
AL (Max 12 Years)
AL (Max 12 Years)
Drug
*Potassium Removing Agents***
Status
sodium polystyrene sulfonate oral powder
T1
sodium polystyrene sulfonate suspension 30
gm/120ml
T1
SPS ORAL SUSPENSION 15 GM/60ML
T1
Notes
*Prenatal Mv & Minerals W/
Fa-Omega Fatty Acids W/O Iron***
cvs prenatal gummy oral tablet chewable
0.4-113.5 mg
T1
medroxyprogesterone acetate oral tablet 10 mg,
2.5 mg, 5 mg
T1
GR-F
norethindrone acetate oral tablet 5 mg
T1
progesterone micronized oral capsule 100 mg
T1
progesterone micronized oral capsule 200 mg
T1
AMPYRA ORAL TABLET EXTENDED
RELEASE 12 HR* 10 MG
T1
PA
AVONEX INTRAMUSCULAR* KIT 30 MCG
T1
AVONEX PREFILLED INTRAMUSCULAR*
30 MCG/0.5ML
T1
bupropion hcl er (smoking det) oral tablet
extended release 12 hr* 150 mg
T1
CHANTIX ORAL TABLET 0.5 MG, 1 MG
T1
CHANTIX STARTING MONTH PAK ORAL
TABLET 0.5 MG X 11 & 1 MG X 42
T1
donepezil hcl oral tablet 10 mg
T1
40 Years)
donepezil hcl oral tablet 5 mg
T1
40 Years)
GILENYA ORAL CAPSULE 0.5 MG
T1
PA
GLATOPA SUBCUTANEOUS* 20 MG/ML
T1
memantine hcl oral tablet 10 mg, 5 mg
T1
PA; QL (60 EA per 30 days); AL
(Min 40 Years)
memantine hcl oral tablet 5 (28)-10 (21) mg
T1
PA; QL (49 EA per 365 days); AL
(Min 40 Years)
nicotine polacrilex mouth/throat gum 2 mg
T1
nicotine polacrilex mouth/throat gum 4 mg
T1
nicotine polacrilex mouth/throat lozenge 2 mg, 4
mg
T1
*Progestins*
*Psychotherapeutic And Neurological
Agents - Misc.*
49
Drug
Status
Notes
nicotine step 1 transdermal patch 24 hr 21
mg/24hr
T1
nicotine transdermal kit 21-14-7 mg/24hr
T1
nicotine transdermal patch 24 hr 14 mg/24hr, 7
mg/24hr
T1
NICOTROL INHALATION INHALER 10
MG
T1
NICOTROL NS NASAL SOLUTION 10
MG/ML
T1
rivastigmine tartrate oral capsule 1.5 mg, 3 mg,
4.5 mg, 6 mg
T1
AL (Min 40 Years)
TECFIDERA ORAL 120 & 240 MG
T1
TECFIDERA ORAL CAPSULE DELAYED
RELEASE 120 MG, 240 MG
T1
T1
PA
T1
*Respiratory Agents - Misc.*
PULMOZYME INHALATION SOLUTION 1
MG/ML
*Sodium-Glucose Co-Transporter 2
Inhibitor-Biguanide Comb***
INVOKAMET ORAL TABLET 150-1000 MG,
150-500 MG, 50-1000 MG, 50-500 MG
*Tetracyclines*
doxycycline monohydrate oral capsule 100 mg,
150 mg, 50 mg, 75 mg
T1
doxycycline monohydrate oral suspension
reconstituted 25 mg/5ml
T1
minocycline hcl oral capsule 100 mg, 50 mg, 75
mg
T1
tetracycline hcl oral capsule 250 mg, 500 mg
T1
AL (Min 8 Years)
ARMOUR THYROID ORAL TABLET 120
MG, 15 MG, 180 MG, 240 MG, 30 MG, 300
MG, 60 MG, 90 MG
T1
AL (Max 64 Years)
levothyroxine sodium oral tablet 100 mcg, 112
mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200
mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg
T1
LEVOXYL ORAL TABLET 100 MCG, 112
MCG, 125 MCG, 137 MCG, 150 MCG, 175
MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG,
88 MCG
T1
methimazole oral tablet 10 mg, 5 mg
T1
AL (Max 12 Years)
*Thyroid Agents*
50
Drug
Status
Notes
NATURE-THROID ORAL TABLET 113.75
MG, 130 MG, 146.25 MG, 16.25 MG, 162.5
MG, 195 MG, 260 MG, 32.5 MG, 325 MG,
48.75 MG, 65 MG, 81.25 MG, 97.5 MG
T1
AL (Max 64 Years)
np thyroid oral tablet 30 mg, 60 mg, 90 mg
T1
AL (Max 64 Years)
propylthiouracil oral tablet 50 mg
T1
SYNTHROID ORAL TABLET 100 MCG, 112
MCG, 125 MCG, 137 MCG, 150 MCG, 175
MCG, 200 MCG, 25 MCG, 300 MCG, 50
MCG, 75 MCG, 88 MCG
T1
UNITHROID DIRECT ORAL TABLET 100
MCG, 112 MCG, 125 MCG, 150 MCG, 175
MCG, 200 MCG, 25 MCG, 300 MCG, 50
MCG, 75 MCG, 88 MCG
T1
UNITHROID ORAL TABLET 137 MCG
T1
WESTHROID ORAL TABLET 195 MG, 32.5
MG, 65 MG, 97.5 MG
T1
AL (Max 64 Years)
WP THYROID ORAL TABLET 113.75 MG,
130 MG, 16.25 MG, 32.5 MG, 48.75 MG, 65
MG, 81.25 MG, 97.5 MG
T1
AL (Max 64 Years)
*Ulcer Drugs*
cimetidine 200 oral tablet 200 mg
T1
cimetidine hcl oral solution 300 mg/5ml
T1
cimetidine oral tablet 300 mg, 400 mg, 800 mg
T1
dicyclomine hcl oral capsule 10 mg
T1
AL (Max 64 Years)
dicyclomine hcl oral solution 10 mg/5ml
T1
AL (Max 64 Years)
dicyclomine hcl oral tablet 20 mg
T1
AL (Max 64 Years)
famotidine oral tablet 10 mg, 20 mg, 40 mg
T1
FIRST-LANSOPRAZOLE ORAL
SUSPENSION 3 MG/ML
T1
AL (Max 12 Years)
FIRST-OMEPRAZOLE ORAL
SUSPENSION 2 MG/ML
T1
AL (Max 12 Years)
glycopyrrolate oral tablet 1 mg, 2 mg
T1
hyoscyamine sulfate er oral tablet extended
release 12 hr* 0.375 mg
T1
AL (Max 64 Years)
hyoscyamine sulfate oral elixir 0.125 mg/5ml
T1
AL (Max 64 Years)
hyoscyamine sulfate oral solution 0.125 mg/ml
T1
AL (Max 64 Years)
hyoscyamine sulfate oral tablet 0.125 mg
T1
AL (Max 64 Years)
hyoscyamine sulfate oral tablet dispersible 0.125
mg
T1
AL (Max 64 Years)
hyoscyamine sulfate sublingual tablet sublingual
0.125 mg
T1
AL (Max 64 Years)
AL (Max 12 Years)
51
Drug
Status
Notes
lansoprazole oral capsule delayed release 15 mg
T1
lansoprazole oral capsule delayed release 30 mg
T1
misoprostol oral tablet 100 mcg, 200 mcg
T1
NEXIUM 24HR ORAL CAPSULE DELAYED
RELEASE 20 MG
T1
omeprazole magnesium oral capsule delayed
release 20.6 (20 base) mg
T1
omeprazole oral capsule delayed release 10 mg,
20 mg
T1
omeprazole oral capsule delayed release 40 mg
T1
omeprazole oral tablet delayed release 20 mg
T1
pantoprazole sodium oral tablet delayed release
20 mg
T1
pantoprazole sodium oral tablet delayed release
40 mg
T1
ranitidine hcl oral capsule 150 mg, 300 mg
T1
ranitidine hcl oral syrup 75 mg/5ml
T1
ranitidine hcl oral tablet 150 mg, 300 mg, 75 mg
T1
sucralfate oral tablet 1 gm
T1
*Urinary Anti-Infectives*
methenamine hippurate oral tablet 1 gm
T1
methenamine mandelate oral tablet 0.5 gm, 1 gm
T1
nitrofurantoin macrocrystal oral capsule 100 mg,
50 mg
T1
64 Years)
nitrofurantoin monohyd macro oral capsule 100
mg
T1
64 Years)
nitrofurantoin oral suspension 25 mg/5ml
T1
AL (Max 12 Years)
bethanechol chloride oral tablet 10 mg, 25 mg, 5
mg, 50 mg
T1
bethanechol chloride oral tablet 10 mg, 25 mg, 5
mg, 50 mg
T1
flavoxate hcl oral tablet 100 mg
T1
oxybutynin chloride er oral tablet extended
release 24 hr* 10 mg, 15 mg
T1
oxybutynin chloride er oral tablet extended
release 24 hr* 5 mg
T1
oxybutynin chloride oral syrup 5 mg/5ml
T1
oxybutynin chloride oral tablet 5 mg
T1
OXYTROL FOR WOMEN TRANSDERMAL
PATCH BIWEEKLY 3.9 MG/24HR
T1
*Urinary Antispasmodics*
52
Drug
Status
Notes
tolterodine tartrate er oral capsule extended
release 24 hour 2 mg, 4 mg
T1
tolterodine tartrate oral tablet 1 mg, 2 mg
T1
trospium chloride oral tablet 20 mg
T1
T1
AL (Min 60 Years)
clindamycin phosphate vaginal cream 2 %
T1
GR-F
clotrimazole 3 vaginal cream 2 %
T1
GR-F
clotrimazole vaginal cream 1 %
T1
GR-F
ESTRACE VAGINAL CREAM 0.1 MG/GM
T1
GR-F; QL (42.5 GM per 30 days)
FIRST-PROGESTERONE VGS 100
VAGINAL SUPPOSITORY 100 MG
T1
GR-F
T1
GR-F
FIRST-PROGESTERONE VGS 25 VAGINAL
SUPPOSITORY 25 MG
T1
GR-F
T1
GR-F
FIRST-PROGESTERONE VGS 50 VAGINAL
SUPPOSITORY 50 MG
T1
GR-F
metronidazole vaginal gel 0.75 %
T1
GR-F
miconazole 3 combo pack vaginal kit 200 & 2
mg-% (9gm)
T1
GR-F
miconazole 3 vaginal kit
T1
GR-F
miconazole 3 vaginal suppository 200 mg
T1
GR-F
miconazole 7 vaginal cream 2 %
T1
GR-F
miconazole 7 vaginal suppository 100 mg
T1
GR-F
OPTIONS GYNOL II CONTRACEPTIVE
VAGINAL GEL 3 %
T1
GR-F
PREMARIN VAGINAL CREAM 0.625
MG/GM
T1
GR-F; QL (30 GM per 20 days)
ra miconazole 3 combo pack app vaginal kit 200
& 2 mg-% (9gm)
T1
GR-F
terconazole vaginal cream 0.4 %, 0.8 %
T1
GR-F
terconazole vaginal suppository 80 mg
T1
GR-F
TODAY SPONGE VAGINAL 1000 MG
T1
GR-F
VCF VAGINAL CONTRACEPTIVE
VAGINAL FOAM 12.5 %
T1
GR-F
*Vaccines*
ZOSTAVAX SUBCUTANEOUS* SOLUTION
RECONSTITUTED 19400 UNT/0.65ML
*Vaginal Products*
53
Drug
*Vasopressors*
Status
Notes
epinephrine injection 0.15 mg/0.15ml, 0.3
mg/0.3ml
T1
EPIPEN 2-PAK INJECTION 0.3 MG/0.3ML
T1
EPIPEN JR 2-PAK INJECTION 0.15
MG/0.3ML
T1
midodrine hcl oral tablet 10 mg, 2.5 mg, 5 mg
T1
*Vitamins*
AQUA-E ORAL LIQUID† 30-2 MG/ML
T1
aqueous vitamin e oral solution 15 unit/0.3ml
T1
arkaliox oral capsule 200 mg
T1
biotin maximum strength oral tablet 10000 mcg
T1
biotin oral capsule 1 mg, 2500 mcg, 5 mg
T1
biotin oral tablet 1000 mcg, 300 mcg, 5000 mcg,
800 mcg
T1
CALCIFEROL ORAL SOLUTION 8000
UNIT/ML
T1
CYTO B7 ORAL LIQUID† 5 MG/ML
T1
d 2000 oral tablet 2000 unit
T1
d 400 oral tablet 400 unit
T1
d3-1000 oral tablet 1000 unit
T1
e-400 oral capsule 400 unit
T1
gnp niacin oral tablet 250 mg
T1
gnp vitamin d oral tablet chewable 400 unit
T1
LIQUI-E ORAL LIQUID† 400 UNIT/15ML
T1
mega biotin oral capsule 10 mg
T1
MEPHYTON ORAL TABLET 5 MG
T1
natural vitamin d-3 oral tablet 5000 unit
T1
niacin er oral capsule extended release* 250 mg,
500 mg
T1
niacin er oral tablet extendedrelease* 750 mg
T1
niacin oral tablet 100 mg, 50 mg
T1
niacinamide oral tablet 100 mg, 500 mg
T1
niacinamide oral tablet extendedrelease* 500 mg
T1
POTABA ORAL CAPSULE 500 MG
T1
pyridoxine hcl oral tablet 100 mg, 25 mg
T1
ra niacin oral tablet 500 mg
T1
sm niacin cr oral tablet extendedrelease* 250 mg
T1
vitamin b1 oral tablet 100 mg
T1
54
Drug
Status
vitamin b-1 oral tablet 100 mg
T1
T1
T1
T1
vitamin d (ergocalciferol) oral capsule 50000 unit
T1
vitamin d oral liquid† 400 unit/ml
T1
vitamin d3 oral capsule 1000 unit, 2000 unit, 400
unit, 5000 unit
T1
vitamin e oral capsule 100 unit, 1000 unit, 200
unit
T1
vitamin e oral oil 100 unt/0.25ml
T1
vitamin e oral tablet 100 unit
T1
wheat germ oil oral oil
T1
Notes
55
56
Index
Index
Index
Index
ABREVA ..................................................................... 24
acarbose ............................................................................. 8
ACCU-CHEK MULTICLIX
LANCETS ................................................................ 35
acebutolol hcl ......................................................... 19
ACEPHEN ................................................................... 2
acetaminophen ......................................................... 2
acetaminophen er ................................................. 2
acetaminophen extra strength ........... 2
acetaminophen-codeine .............................. 3
acetaminophen-codeine #2 .................... 3
acetazolamide ........................................................ 29
acetazolamide er ............................................... 29
acetic acid ................................................................... 48
acetic acid-aluminum acetate ........ 48
acetylcysteine ......................................................... 24
ACID GONE ............................................................ 4
acitretin ........................................................................... 24
acyclovir ......................................................................... 18
adapalene ..................................................................... 24
ADCIRCA ................................................................. 21
adefovir dipivoxil .............................................. 18
ADEMPAS ............................................................... 21
ADVOCATE INSULIN PEN
NEEDLES ................................................................. 35
AEROSPAN .............................................................. 6
AFINITOR .............................................................. 16
AFINITOR DISPERZ .......................... 16
alba-lybe nr ............................................................... 45
albuterol sulfate ...................................................... 6
alclometasone dipropionate ............. 25
alendronate sodium ....................................... 30
ALKERAN .............................................................. 16
allergy eye ................................................................... 45
allopurinol .................................................................. 32
aluminum hydroxide gel ............................. 5
amantadine hcl ..................................................... 17
AMETHYST ........................................................ 22
amiloride hcl ........................................................... 29
amiloride-hydrochlorothiazide .... 29
amiodarone hcl ........................................................ 6
amlodipine besy-benazepril hcl
....................................................................................................... 13
amlodipine besylate ...................................... 20
ammonium lactate ........................................... 25
amoxicillin .................................................................. 48
amoxicillin-pot clavulanate .............. 48
amoxicillin-pot clavulanate er ..... 48
ampicillin ...................................................................... 48
AMPYRA ................................................................... 49
anagrelide hcl ........................................................ 32
anastrozole ................................................................. 16
antacid calcium extra strength ........ 5
antacid plus anti-gas fast act ............. 5
antacid/simethicone ds ................................. 5
antipyrine-benzocaine ............................... 48
APETIGEN ............................................................ 41
APETIGEN-PLUS ..................................... 41
APIDRA ........................................................................... 8
APIDRA SOLOSTAR .............................. 8
apraclonidine hcl .............................................. 45
APRISO ........................................................................ 31
AQUA-E ....................................................................... 54
aqueous vitamin e ............................................ 54
ARANELLE .......................................................... 22
ARANESP (ALBUMIN FREE)
....................................................................................................... 33
arkaliox ............................................................................ 54
ARMOUR THYROID ......................... 50
artificial tears ........................................................ 45
ASACOL HD ....................................................... 31
aspirin .................................................................................... 3
aspirin ec ........................................................................... 3
aspirin ec low dose ............................................ 3
ASSURE DOSE CONTROL .... 35
atenolol ............................................................................ 19
atenolol-chlorthalidone .......................... 13
atorvastatin calcium .................................... 12
atovaquone ................................................................. 15
atropine sulfate .................................................... 45
ATROVENT HFA .......................................... 6
AVIANE ....................................................................... 22
AVONEX .................................................................... 49
AVONEX PREFILLED .................... 49
azathioprine .............................................................. 18
azelastine hcl ............................................... 44, 45
azithromycin ............................................................. 35
b complex ...................................................................... 41
b complex formula 1 .................................... 41
b complex-c ............................................................... 41
b complex-c-biotin-e-fa ........................... 41
b-100 complex ....................................................... 41
b-100 cr ........................................................................... 41
b-12 ........................................................................................ 33
bacitracin ......................................................... 25, 45
bacitracin zinc ....................................................... 25
bacitracin-polymyxin b ............................ 45
bacitra-neomycin-polymyxin-hc
....................................................................................................... 45
baclofen ........................................................................... 44
balsalazide disodium .................................. 31
BALZIVA .................................................................. 22
BAYER CONTOUR NEXT
CONTROL .............................................................. 35
BAYER CONTOUR NEXT
TEST .................................................................................. 28
b-complex/b-12 .................................................... 41
BD AUTOSHIELD .................................... 35
BD AUTOSHIELD DUO ................ 35
BD INSULIN SYR ULTRAFINE
II ................................................................................................ 36
BD INSULIN SYRINGE ................. 36
BD INSULIN SYRINGE
MICROFINE ....................................................... 36
BD INSULIN SYRINGE U-40
....................................................................................................... 36
BD INSULIN SYRINGE
ULTRAFINE ....................................................... 36
BD INTEGRA SYRINGE ............. 36
BD LANCET DEVICE ....................... 36
BD PEN ......................................................................... 36
BEELITH .................................................................. 38
benazepril hcl ......................................................... 13
benazepril-hydrochlorothiazide
....................................................................................................... 13
benfotiamine multi-b ................................... 41
benzoyl peroxide ................................................ 25
benzoyl peroxide wash ............................. 25
benzoyl peroxide-erythromycin ... 25
betamethasone dipropionate ........... 25
betamethasone dipropionate aug
....................................................................................................... 25
betamethasone valerate .......................... 25
betaxolol hcl ................................................. 19, 45
bethanechol chloride ................................... 52
bexarotene ................................................................... 16
bicalutamide ............................................................. 16
BIOLLE GEL TEARS ........................ 45
biotin .................................................................................... 54
biotin maximum strength ...................... 54
bisacodyl ........................................................................ 34
bisacodyl ec ............................................................... 34
bisoprolol fumarate ...................................... 19
bisoprolol-hydrochlorothiazide
....................................................................................................... 13
BLEPHAMIDE ................................................ 45
BLEPHAMIDE S.O.P. ........................ 45
bp folinatal plus b ............................................ 41
brewers yeast .......................................................... 41
brimonidine tartrate ..................................... 45
bromocriptine mesylate ........................... 17
budesonide ...................................................................... 6
buffered aspirin ....................................................... 3
bumetanide ................................................................. 29
bupropion hcl er (smoking det) ... 49
butalbital-acetaminophen ........................ 3
butalbital-apap-caff-cod ............................ 3
butalbital-apap-caffeine ............................. 3
butalbital-asa-caff-codeine ................... 3
butalbital-aspirin-caffeine ...................... 3
57
Index
Index
Index
cabergoline ................................................................ 30
caffeine citrate .......................................................... 1
CALCIFEROL ................................................. 54
calcipotriene ............................................................ 25
calcitonin (salmon) ........................................ 30
cal-citrate plus vitamin d ...................... 38
CALCITRENE ................................................. 25
calcitriol ......................................................................... 30
calcium ............................................................................. 38
calcium + d3 ............................................................ 38
calcium 500 + d .................................................. 38
calcium 500 + d3 .............................................. 38
calcium 500+d ...................................................... 38
calcium 500+d3 .................................................. 38
calcium 600 ............................................................... 38
calcium 600 + d .................................................. 38
calcium 600+d ...................................................... 38
calcium 600+d3 .................................................. 38
calcium acetate (phos binder) ....... 31
calcium antacid ultra ..................................... 5
calcium carbonate ........................................... 38
calcium carbonate antacid ..................... 5
calcium carbonate-vitamin d .......... 38
calcium citrate ...................................................... 38
calcium citrate + d3 maximum .... 38
calcium citrate-vitamin d ..................... 38
calcium/vitamin d3 gummies .......... 39
capecitabine ............................................................. 16
capsaicin ........................................................................ 25
captopril ......................................................................... 13
captopril-hydrochlorothiazide ..... 13
carbidopa-levodopa ..................................... 18
carbidopa-levodopa er ............................. 18
carbinoxamine maleate ........................... 11
CARDIOTEK RX ....................................... 28
CAREFINE PEN NEEDLES ... 36
careone insulin syringe ........................... 36
carteolol hcl .............................................................. 45
CARTIA XT .......................................................... 20
carvedilol ...................................................................... 19
CAYSTON ............................................................... 15
cefaclor ............................................................................ 21
cefadroxil ...................................................................... 21
cefdinir ............................................................................. 21
cefixime ............................................................................ 21
cefpodoxime proxetil ................................... 21
cefprozil .......................................................................... 21
ceftriaxone sodium ......................................... 22
cefuroxime axetil ............................................... 22
celecoxib ............................................................................ 1
cephalexin .................................................................... 22
CEREFOLIN ....................................................... 28
cetirizine hcl ............................................................. 11
cetirizine hcl allergy child .................. 11
CHANTIX ................................................................. 49
CHANTIX STARTING
MONTH PAK .................................................... 49
chelated magnesium ..................................... 39
CHEMET ................................................................... 11
cheratussin ac ........................................................ 24
cheratussin dac .................................................... 24
childrens chewable vitamins ........... 41
childrens loratadine ..................................... 12
childrens multivitamin .............................. 41
childrens silfedrine ........................................ 44
childrens vitamins/iron ............................ 41
chlorhexidine gluconate ......................... 40
chloroquine phosphate ............................. 15
chlorothiazide ........................................................ 29
chlorpheniramine maleate .................. 12
chlorpheniramine maleate er ......... 12
chlorpropamide ....................................................... 8
chlorthalidone ....................................................... 29
chlorzoxazone ........................................................ 44
cholestyramine ..................................................... 12
choline-mag trisalicylate .......................... 3
ciclopirox ...................................................................... 25
cilostazol ........................................................................ 32
cimetidine ..................................................................... 51
cimetidine 200 ....................................................... 51
cimetidine hcl ......................................................... 51
CIPRODEX ............................................................ 48
ciprofloxacin ............................................................ 31
ciprofloxacin hcl .................................... 31, 45
CLARAVIS ............................................................. 25
clarithromycin ....................................................... 35
clemastine fumarate ..................................... 12
clindamycin hcl ................................................... 15
clindamycin palmitate hcl ................... 15
clindamycin phosphate ................ 25, 53
clobetasol propionate .................... 25, 26
clonidine hcl ............................................................. 13
clopidogrel bisulfate .................................... 32
clotrimazole ...................................... 26, 40, 53
clotrimazole 3 ........................................................ 53
clotrimazole-betamethasone ............ 26
codeine sulfate .......................................................... 3
colchicine-probenecid ............................... 32
COLCRYS ............................................................... 32
colestipol hcl ........................................................... 12
COMBIVENT RESPIMAT ............ 6
COMFORT ASSIST INSULIN
SYRINGE .................................................................. 36
COMPLETE FORMULATION
PEDIATRIC ......................................................... 41
condoms .......................................................................... 36
CORTIZONE-10/ALOE .................. 26
CREON ......................................................................... 29
cromolyn sodium ........................... 6, 44, 45
CURITY ALCOHOL PREPS
58
36
cvs laxative dietary supplemnt ..... 34
cvs prenatal gummy ...................................... 49
cvs senna-extra .................................................... 34
cvs stool softener ............................................... 34
cyanocobalamin ................................................. 33
cyclobenzaprine hcl ...................................... 44
cyclopentolate hcl ............................................ 46
cyclophosphamide ........................................... 16
cycloserine .................................................................. 16
cyclosporine ............................................................. 19
cyclosporine modified ............................... 19
cyproheptadine hcl ......................................... 12
CYTO B7 .................................................................... 54
cytra-2 ............................................................................... 32
cytra-k ................................................................................ 32
D 1000 PLUS ALOE ............................... 33
d 2000 ................................................................................ 54
d 400 .................................................................................... 54
d3-1000 ............................................................................ 54
daily multiple vitamins/min ............... 41
daily vitamin formula+iron .............. 41
daily vite ......................................................................... 41
danazol ................................................................................. 4
dapsone ............................................................................ 15
DARAPRIM .......................................................... 15
DELZICOL ............................................................ 31
DENTAGEL ......................................................... 40
desmopressin ace rhinal tube ........ 30
desmopressin ace spray refrig ...... 30
desmopressin acetate .................................. 30
desmopressin acetate spray .............. 30
desonide .......................................................................... 26
dexamethasone ......................................... 23, 24
dexamethasone sodium phosphate
....................................................................................................... 46
dextromethorphan-guaifenesin .... 24
DIALYVITE ......................................................... 41
DIALYVITE 3000 ....................................... 41
DIALYVITE 5000 ....................................... 41
DIALYVITE 800/ZINC ..................... 41
DIALYVITE SUPREME D ........ 41
DIALYVITE/ZINC ................................... 41
diclofenac sodium ........................ 1, 26, 46
diclofenac sodium er ....................................... 1
dicloxacillin sodium ..................................... 48
dicyclomine hcl .................................................... 51
digoxin .............................................................................. 21
diltiazem hcl ............................................................. 20
diltiazem hcl er ..................................................... 20
diltiazem hcl er beads ................................ 20
dilt-xr .................................................................................. 20
dimenhydrinate .................................................... 11
DINO-LIFE W/IRON-ZINC .... 41
.......................................................................................................
Index
Index
Index
diphenhydramine hcl ................................... 12
diphenoxylate-atropine ............................ 10
dipyridamole ............................................................ 32
DISNEY CALCIUM +
VITAMIN D3 ...................................................... 39
disopyramide phosphate ............................ 6
DIURIL ......................................................................... 29
docusate calcium ............................................... 34
docusate sodium ................................................. 34
DOCUSOL MINI ......................................... 34
donepezil hcl ............................................................ 49
dorzolamide hcl ................................................... 46
dorzolamide hcl-timolol mal ........... 46
doxazosin mesylate ........................................ 13
doxycycline monohydrate .................... 50
dronabinol ................................................................... 11
drospirenone-ethinyl estradiol ..... 22
DROXIA ...................................................................... 33
DRYSOL ..................................................................... 26
DULERA ......................................................................... 6
e-400 .................................................................................... 54
e-400/selenium ..................................................... 41
EASIVENT ............................................................. 36
EASIVENT MASK LARGE ..... 36
EASIVENT MASK MEDIUM
....................................................................................................... 36
EASIVENT MASK SMALL ..... 36
easy comfort insulin syringe ............ 36
EASY TOUCH INSULIN
SYRINGE .................................................................. 36
ecee plus ......................................................................... 41
econazole nitrate ............................................... 26
ELIDEL ........................................................................ 26
ELITE-OB ................................................................ 42
elite-thin insulin syringe ........................ 36
ELLA ................................................................................ 22
ELMIRON ............................................................... 32
EMCYT ......................................................................... 16
enalapril maleate .................................. 13, 14
enalapril-hydrochlorothiazide ..... 14
ENBREL ......................................................................... 1
ENBREL SURECLICK ........................ 1
enema ................................................................................. 34
ENEMEEZ PLUS ........................................ 34
enoxaparin sodium ............................................. 8
entecavir ......................................................................... 18
EPANED ..................................................................... 14
epinephrine ................................................................ 54
EPIPEN 2-PAK ............................................... 54
EPIPEN JR 2-PAK .................................... 54
EPOGEN .................................................................... 33
eql one daily womens ................................. 42
ERIVEDGE ............................................................ 16
ERYPED 200 ....................................................... 35
erythromycin ................................................ 26, 46
erythromycin base ........................................... 35
erythromycin ethylsuccinate ............ 35
est estrogens-methyltest .......................... 30
est estrogens-methyltest hs ................. 30
ESTRACE ................................................................ 53
estradiol .............................................................. 30, 31
estradiol-norethindrone acet .......... 31
estropipate .................................................................. 31
ethambutol hcl ....................................................... 16
etidronate disodium ...................................... 30
etoposide ........................................................................ 16
EVZIO ............................................................................ 11
EXEL COMFORT POINT
INSULIN SYR ................................................... 36
exemestane ................................................................. 16
extra strength acetaminophen ........... 3
eye allergy relief ................................................ 46
fabb ........................................................................................ 33
famciclovir .................................................................. 18
famotidine .................................................................... 51
FARESTON ........................................................... 16
FARXIGA ..................................................................... 8
FARYDAK .............................................................. 16
FC2 FEMALE CONDOM ............ 36
felodipine er .............................................................. 20
fenofibrate ................................................................... 12
fenofibrate micronized .............................. 12
fenofibric acid ....................................................... 12
fenoprofen calcium ............................................ 1
fentanyl ................................................................................. 3
ferrous gluconate .............................................. 33
ferrous sulfate ........................................................ 33
FIFTY50 PEN NEEDLES ............. 36
finasteride .................................................................... 32
FIRST-LANSOPRAZOLE .......... 51
FIRST-OMEPRAZOLE .................. 51
FIRST-PROGESTERONE VGS
100 .......................................................................................... 53
200 .......................................................................................... 53
25 .............................................................................................. 53
400 .......................................................................................... 53
50 .............................................................................................. 53
FIRST-VANCOMYCIN 25 ......... 15
FIRST-VANCOMYCIN 50 ......... 15
FLAREX ..................................................................... 46
flavoxate hcl ............................................................. 52
flecainide acetate .................................................. 6
fluconazole ................................................................. 11
fludrocortisone acetate ............................ 24
flunisolide .................................................................... 44
fluocinolone acetonide ............................. 26
fluocinonide .............................................................. 26
fluocinonide-e ........................................................ 26
fluorometholone ................................................. 46
fluorouracil ................................................................ 26
flurbiprofen .................................................................... 1
flurbiprofen sodium ...................................... 46
flutamide ........................................................................ 16
fluticasone propionate .................. 26, 44
fluvastatin sodium ........................................... 13
FML ..................................................................................... 46
FML FORTE ....................................................... 46
folbee ................................................................................... 33
FOLBEE PLUS CZ .................................. 42
FOLBIC ........................................................................ 28
FOLGARD .............................................................. 33
folic acid ........................................................................ 33
folinic-plus .................................................................. 33
folplex 2.2 ..................................................................... 33
FOLTABS 800 ................................................... 33
fondaparinux sodium ...................................... 8
FORADIL AEROLIZER ................... 6
FORTEO .................................................................... 30
fosinopril sodium .............................................. 14
FOSRENOL .......................................................... 31
FREESTYLE CONTROL
SOLUTION ............................................................ 36
FREESTYLE LITE TEST ........... 28
FREESTYLE TEST ................................ 28
furosemide ................................................................... 29
GAVILYTE-G ................................................... 34
GAVILYTE-N WITH FLAVOR
PACK ................................................................................ 34
gemfibrozil .................................................................. 13
gentamicin sulfate ............................... 26, 46
geri-mucil ..................................................................... 34
GIANVI ......................................................................... 22
GILENYA ................................................................. 49
GLATOPA ............................................................... 49
GLEOSTINE ....................................................... 16
glimepiride ..................................................................... 8
glipizide ............................................................................... 8
glipizide er ...................................................................... 8
glipizide-metformin hcl ............................... 8
GLUCAGEN HYPOKIT .................... 8
GLUCAGON EMERGENCY .... 8
GLUCOCARD EXPRESSION
CONTROL .............................................................. 37
MONITOR .............................................................. 37
TEST .................................................................................. 28
GLUCOCARD VITAL
MONITOR .............................................................. 37
GLUCOCARD VITAL TEST
....................................................................................................... 28
59
Index
Index
Index
GLUCONAVII BLOOD
GLUCOSE TEST ......................................... 28
glyburide ............................................................................ 8
glyburide micronized ...................................... 8
glyburide-metformin ................................ 8, 9
GLYCOPHOS ................................................... 39
glycopyrrolate ....................................................... 51
gnp b-complex plus vitamin c ........ 42
gnp niacin .................................................................... 54
gnp vitamin d .......................................................... 54
granisetron hcl ..................................................... 11
griseofulvin microsize ............................... 11
griseofulvin ultramicrosize ................ 11
guaifenesin ................................................................. 24
guaifenesin-dm ..................................................... 24
guanfacine hcl ....................................................... 14
halobetasol propionate ............................ 26
h-e-b incontrol pen needles ............... 37
HEMANGEOL ................................................ 19
heparin sodium (porcine) ......................... 8
heparin sodium (porcine) pf ................ 8
HEXALEN ............................................................... 16
hm iron ............................................................................. 33
hm slow release iron ................................... 33
hm vitamin b100 complex .................... 42
homatropine hbr ................................................ 46
HUMALOG ............................................................... 9
HUMALOG KWIKPEN ...................... 9
HUMALOG MIX 50/50 ......................... 9
HUMALOG MIX 50/50
KWIKPEN ................................................................... 9
HUMALOG MIX 75/25 ......................... 9
HUMALOG MIX 75/25
KWIKPEN ................................................................... 9
HUMIRA ........................................................................ 2
HUMIRA PEN ...................................................... 2
HUMULIN 70/30 ............................................... 9
HUMULIN 70/30 KWIKPEN ..... 9
HUMULIN N ........................................................... 9
HUMULIN N KWIKPEN ................. 9
HUMULIN R ........................................................... 9
HUMULIN R U-500
(CONCENTRATED) ................................. 9
HYCAMTIN ......................................................... 16
hydralazine hcl ..................................................... 14
hydrochlorothiazide ..................................... 29
hydrocodone-acetaminophen ..... 3, 4
hydrocortisone .................................. 4, 24, 26
hydrocortisone valerate .......................... 26
hydrocortisone-acetic acid ................ 48
hydromorphone hcl ........................................... 4
hydroxychloroquine sulfate ............... 15
hydroxyurea .............................................................. 16
hydroxyzine hcl ................................................ 5, 6
hydroxyzine pamoate ...................................... 6
hyoscyamine sulfate ...................................... 51
hyoscyamine sulfate er ............................. 51
ibandronate sodium ...................................... 30
ibuprofen ........................................................................... 2
ibuprofen junior strength ......................... 2
imiquimod .................................................................... 26
INCRELEX ............................................................ 30
INCRUSE ELLIPTA ................................. 6
indapamide ................................................................. 29
INDOCIN ....................................................................... 2
indomethacin ............................................................... 2
indomethacin er ...................................................... 2
infants gas relief ................................................ 31
infants ibuprofen ................................................... 2
infants pain relief ................................................. 3
insulin syringe ....................................................... 37
INTRON A ............................................................... 17
INVOKAMET ................................................... 50
INVOKANA .............................................................. 9
ipratropium bromide ........................... 7, 44
ipratropium-albuterol .................................... 7
irbesartan ..................................................................... 14
irbesartan-hydrochlorothiazide
....................................................................................................... 14
iron ......................................................................................... 34
iron 100 plus ............................................................ 34
isoniazid ......................................................................... 16
isosorbide dinitrate ........................................... 5
isosorbide dinitrate er ................................... 5
isosorbide mononitrate ................................ 5
isosorbide mononitrate er ....................... 5
isradipine ...................................................................... 20
itraconazole .............................................................. 11
JAKAFI ......................................................................... 17
JANUMET ................................................................... 9
JANUMET XR ..................................................... 9
JANUVIA ...................................................................... 9
JENTADUETO .................................................... 9
JINTELI ...................................................................... 31
JUNEL 1/20 ............................................................ 22
KAITLIB FE ........................................................ 22
KARIVA ...................................................................... 22
ketoconazole ................................................. 11, 26
ketoprofen ........................................................................ 2
ketorolac tromethamine .................. 2, 46
KETOSTIX ............................................................ 28
ketotifen fumarate ............................................ 46
kmart valu insulin syringe 30g ..... 37
K-PHOS ........................................................................ 39
K-PHOS NO 2 .................................................... 32
labetalol hcl .............................................................. 19
lactulose ......................................................................... 34
lamivudine ................................................................... 18
lansoprazole ............................................................. 52
LANTUS .......................................................................... 9
LANTUS SOLOSTAR ............................ 9
latanoprost ................................................................. 46
leflunomide ..................................................................... 2
LETAIRIS ................................................................ 21
letrozole .......................................................................... 17
leucovorin calcium ......................................... 17
LEUKERAN ......................................................... 17
leuprolide acetate ............................................ 17
levobunolol hcl ..................................................... 46
levofloxacin ................................................... 31, 46
levonorgestrel ........................................................ 22
LEVORA 0.15/30 (28) ........................... 22
levothyroxine sodium .................................. 50
LEVOXYL ............................................................... 50
lice killing maximum strength ....... 26
lice treatment .......................................................... 26
lidocaine ......................................................................... 27
lidocaine hcl ............................................................. 27
lidocaine viscous ............................................... 40
lidocaine-prilocaine ..................................... 27
lindane .............................................................................. 27
linezolid ........................................................................... 15
LIQUI-E ....................................................................... 54
lisinopril ......................................................................... 14
lisinopril-hydrochlorothiazide ..... 14
LITE TOUCH PEN NEEDLES
....................................................................................................... 37
LITETOUCH PEN NEEDLES
....................................................................................................... 37
l-methylfolate-algae-b12-b6 ............ 28
l-methylfolate-b6-b12 ................................. 28
l-methyl-mc nac ................................................... 28
LO LOESTRIN FE ................................... 22
LOMEDIA 24 FE ......................................... 22
long acting nasal spray ........................... 45
loperamide hcl ...................................................... 10
loratadine ..................................................................... 12
loratadine-d 12hr ............................................. 24
loratadine-d 24hr ............................................. 24
losartan potassium ......................................... 14
losartan potassium-hctz .......................... 14
lovastatin ....................................................................... 13
LOW-OGESTREL .................................... 22
lubricant drops ..................................................... 46
lubricant drops/dual-action .............. 46
lubricant eye ............................................................ 46
lubricant eye drops ........................................ 46
LYSODREN .......................................................... 17
MAG64 ........................................................................... 39
MAGINEX ............................................................... 39
magnesium .................................................................. 39
magnesium chloride ..................................... 39
magnesium citrate ........................................... 39
magnesium gluconate ................................ 39
magnesium oxide ....................................... 5, 39
60
Index
Index
Index
magnesium oxide -mg supplement
....................................................................................................... 39
magnesium sulfate ........................................... 39
magnesium sulfate in d5w ................... 39
MAGONATE ...................................................... 39
MAG-TAB SR ................................................... 39
malathion ...................................................................... 27
MAOX ................................................................................. 5
MATULANE ........................................................ 17
MATZIM LA ....................................................... 20
meclizine hcl ............................................................ 11
medroxyprogesterone acetate
........................................................................................... 22, 49
mefloquine hcl ....................................................... 15
mega biotin ................................................................ 54
megestrol acetate .............................................. 17
meloxicam ........................................................................ 2
memantine hcl ....................................................... 49
MENEST .................................................................... 31
meperidine hcl ........................................................... 4
MEPHYTON ....................................................... 54
mercaptopurine ................................................... 17
mesalamine ................................................................ 31
MESNEX .................................................................... 17
MESTINON ............................................... 15, 16
METAMUCIL
MULTIHEALTH FIBER .............. 34
metaproterenol sulfate .................................. 7
metformin hcl .......................................................... 10
metformin hcl er ................................................. 10
methadone hcl ........................................................... 4
METHADONE HCL
INTENSOL ................................................................. 4
methazolamide ...................................................... 29
methenamine hippurate ........................... 52
methenamine mandelate ........................ 52
methimazole .............................................................. 50
methocarbamol .................................................... 44
methotrexate ............................................................. 17
methyclothiazide ................................................ 29
methyldopa ................................................................. 14
methyldopa-hydrochlorothiazide
....................................................................................................... 14
methylergonovine maleate .................. 48
methylfol-algae-b12-acetylcyst ... 28
methylprednisolone ....................................... 24
metipranolol ............................................................. 46
metoclopramide hcl ....................................... 31
metolazone .................................................................. 29
metoprolol succinate er .......................... 19
metoprolol tartrate ......................................... 19
metoprolol-hydrochlorothiazide
....................................................................................................... 14
metronidazole ................................. 15, 27, 53
mexiletine hcl .............................................................. 6
miconazole 3 ............................................................ 53
miconazole 3 combo pack ................... 53
miconazole 7 ............................................................ 53
MICROGESTIN 1.5/30 ..................... 22
MICROGESTIN FE 1.5/30 ......... 22
MICROGESTIN FE 1/20 ............... 22
midodrine hcl .......................................................... 54
MINASTRIN 24 FE ................................. 23
mineral oil ................................................................... 35
minocycline hcl .................................................... 50
minoxidil ........................................................................ 14
misoprostol ................................................................ 52
mometasone furoate ..................................... 27
MONOJECT INSULIN
SYRINGE .................................................................. 37
montelukast sodium ........................................... 7
morphine sulfate .................................................... 4
morphine sulfate (concentrate) ....... 4
morphine sulfate er ............................................ 4
multi adult gummies ..................................... 42
multi-delyn/iron .................................................. 42
multi-vit/fluoride ................................................ 42
multi-vitamin/fluoride/iron ................ 42
multivitamins pediatric ............................ 42
multivitamins/fluoride ............................... 42
multi-vitamins/fluoride ............................ 42
mupirocin ..................................................................... 27
mycophenolate mofetil .............................. 19
mycophenolic acid .......................................... 19
MYKIDZ IRON .............................................. 42
MYLERAN ............................................................. 17
mynatal plus ............................................................. 42
mynate 90 plus ...................................................... 42
nabumetone ................................................................... 2
nadolol .............................................................................. 19
naloxone hcl ............................................................. 11
naphazoline hcl ................................................... 46
naproxen ............................................................................ 2
naproxen dr ................................................................... 2
naproxen sodium ................................................... 2
naratriptan hcl ...................................................... 37
NARCAN .................................................................... 11
NASACORT ALLERGY 24HR
....................................................................................................... 45
NASACORT ALLERGY 24HR
CHILDREN ........................................................... 45
nasal decongestant ......................................... 45
nateglinide .................................................................. 10
natural fiber laxative .................................. 35
natural fiber therapy ................................... 35
natural vitamin d-3 ........................................ 54
NATURE-THROID ................................. 51
NECON 0.5/35 (28) .................................... 23
NECON 1/35 (28) .......................................... 23
NECON 1/50 (28) .......................................... 23
NECON 10/11 (28) ...................................... 23
neomycin sulfate .................................................... 1
neomycin-bacitracin zn-polymyx
....................................................................................................... 46
neomycin-polymyxin-dexameth ... 46
neomycin-polymyxin-gramicidin
....................................................................................................... 47
neomycin-polymyxin-hc .............. 47, 48
NEPHROCAPS QT .................................. 42
NEPHRONEX ................................................... 42
NEUPOGEN ......................................................... 34
NEWGEN .................................................................. 42
NEXIUM 24HR ............................................... 52
niacin .................................................................................. 54
niacin er .......................................................................... 54
niacin er (antihyperlipidemic) ...... 13
niacinamide ............................................................... 54
nicardipine hcl ...................................................... 20
nicotine ............................................................................. 50
nicotine polacrilex .......................................... 49
nicotine step 1 ........................................................ 50
NICOTROL ........................................................... 50
NICOTROL NS .............................................. 50
NIFEDICAL XL ............................................ 20
nifedipine ...................................................................... 21
nifedipine er .............................................................. 20
nifedipine er osmotic release .......... 20
NILANDRON ..................................................... 17
nimodipine .................................................................. 21
NITRO-BID ............................................................... 5
nitrofurantoin ......................................................... 52
nitrofurantoin macrocrystal ............. 52
nitrofurantoin monohyd macro ... 52
nitroglycerin ................................................................. 5
nitroglycerin er ........................................................ 5
NITROSTAT ........................................................... 5
NORA-BE ................................................................. 23
NORDITROPIN FLEXPRO .... 30
norethindrone acetate ............................... 49
norethindrone-eth estradiol .............. 31
NORTREL 7/7/7 ............................................ 23
NOVOLIN 70/30 ............................................ 10
NOVOLIN N ........................................................ 10
NOVOLIN R ........................................................ 10
NOVOLOG ............................................................ 10
NOVOLOG FLEXPEN ..................... 10
NOVOLOG MIX 70/30 ...................... 10
NOVOLOG MIX 70/30
FLEXPEN ................................................................. 10
NOVOLOG PENFILL ........................ 10
np thyroid ..................................................................... 51
NUVARING .......................................................... 23
nystatin ..................................................... 11, 27, 40
OBSTETRIX DHA .................................... 42
OBSTETRIX EC .......................................... 42
61
Index
Index
Index
octreotide acetate ............................................. 30
ofloxacin ................................................. 31, 47, 48
OGESTREL .......................................................... 23
omega-3-acid ethyl esters .................... 13
omeprazole ................................................................. 52
omeprazole magnesium ........................... 52
ondansetron .............................................................. 11
ondansetron hcl ................................................... 11
ONETOUCH ULTRA BLUE
....................................................................................................... 28
ONETOUCH ULTRA
CONTROL .............................................................. 37
OPTIONS GYNOL II
CONTRACEPTIVE ................................ 53
ORALYTE ............................................................... 39
orphenadrine citrate er ........................... 44
oxybutynin chloride ....................................... 52
oxybutynin chloride er .............................. 52
oxycodone hcl ............................................................ 4
oxycodone-acetaminophen ..................... 4
OXYTROL FOR WOMEN ........ 52
oyster shell calcium ...................................... 39
oyster shell calcium 250+d ............... 39
oyster shell calcium plus d ................. 39
oyster shell calcium/d ................................ 39
oyster shell calcium/d3 ............................ 39
oyster shell/d ........................................................... 40
pain relief childrens ......................................... 3
PANCREAZE ..................................................... 29
pantoprazole sodium ................................... 52
paregoric ....................................................................... 10
paromomycin sulfate ....................................... 1
peg 3350/electrolytes .................................. 35
pen needles ................................................................. 37
penicillin v potassium ................................ 48
PENTASA ................................................................. 31
pentazocine-naloxone hcl ........................ 4
pentoxifylline er .................................................. 33
perindopril erbumine .................................. 14
permethrin ................................................................... 27
permethrin lice treatment ..................... 27
PHENAZO ............................................................... 32
phenazopyridine hcl ..................................... 32
phenylephrine hcl ............................................. 47
PHOSLYRA .......................................................... 32
phos-nak ......................................................................... 40
PHOSPHA 250 NEUTRAL ........ 40
PHOSPHOLINE IODIDE ............ 47
pilocarpine hcl .......................................... 40, 47
pindolol ............................................................................ 19
pink bismuth ............................................................. 10
pink bismuth maximum strength
....................................................................................................... 10
PIN-X .................................................................................... 5
pioglitazone hcl ................................................... 10
PODIAPN .................................................................. 28
podofilox ........................................................................ 27
polyethylene glycol 3350 ...................... 35
polymyxin b-trimethoprim ................... 47
polyvitamin ................................................................. 42
poly-vitamin/iron .............................................. 42
POMALYST ......................................................... 17
pot bicarb-pot chloride ............................ 40
POTABA ..................................................................... 54
potassium bicarbonate ............................. 40
potassium chloride ......................................... 40
potassium chloride crys er ................. 40
potassium chloride er ................................. 40
potassium citrate er ...................................... 32
potassium phosphates ................................ 40
povidone-iodine .................................................. 18
pramipexole dihydrochloride ......... 18
pravastatin sodium ......................................... 13
prazosin hcl ............................................................... 14
PRECISION XTRA KETONE
....................................................................................................... 28
PRED MILD ......................................................... 47
prednisolone ............................................................. 24
prednisolone acetate ................................... 47
prednisolone sodium phosphate
........................................................................................... 24, 47
prednisone ................................................................... 24
prednisone (pak) ................................................ 24
PREMARIN .............................................. 31, 53
premium condoms lubricated ......... 37
PREMPHASE .................................................... 31
PREMPRO .............................................................. 31
prenatal ........................................................................... 43
prenatal 19 ................................................................. 42
prenatal low iron .............................................. 42
prenatal multi +dha ..................................... 43
prenatal plus iron ............................................ 43
PRENATAL-U .................................................. 43
PRENATE AM ................................................. 43
pretab ................................................................................. 43
PREVALITE ........................................................ 13
primaquine phosphate ............................... 15
probenecid .................................................................. 32
prochlorperazine ............................................... 18
prochlorperazine maleate ................... 18
PROCRIT ................................................................. 34
PROCTOCORT ................................................. 4
PROCTOZONE-HC ................................... 4
progesterone micronized ....................... 49
promethazine hcl ............................................... 12
promethazine-dm .............................................. 24
propafenone hcl ...................................................... 6
proparacaine hcl ............................................... 47
propranolol hcl .................................................... 20
propranolol hcl er ........................................... 20
propylthiouracil .................................................. 51
PROSTAMEN ................................................... 29
pseudoeph-bromphen-dm ..................... 24
pseudoephedrine hcl .................................... 45
pseudoephedrine hcl er ........................... 45
PULMICORT FLEXHALER ..... 7
PULMOZYME ................................................. 50
px artificial tears ............................................... 47
pyrazinamide ........................................................... 16
pyridostigmine bromide .............. 15, 16
pyridoxine hcl ........................................................ 54
qc childrens vitamins/extra c .......... 43
qc insulin syringe ............................................. 37
qc natural vegetable ..................................... 35
q-pap infants ................................................................ 3
QUASENSE ........................................................... 23
quinapril hcl ............................................................. 14
quinapril-hydrochlorothiazide ..... 14
quinidine sulfate ..................................................... 6
quinidine sulfate er ............................................ 6
QVAR ................................................................................... 7
ra artificial tears ............................................... 47
ra b-complex/vitamin c cr ................... 43
ra magnesium ......................................................... 40
ra miconazole 3 combo pack app
....................................................................................................... 53
ra niacin ......................................................................... 54
ra oyster shell calcium/d ....................... 40
rabano yodado ...................................................... 43
raloxifene hcl .......................................................... 30
ramipril ............................................................................ 14
RANEXA ........................................................................ 5
ranitidine hcl ........................................................... 52
RECLIPSEN ........................................................ 23
RELENZA DISKHALER .............. 18
RELI-ON INSULIN SYRINGE
....................................................................................................... 37
RENAGEL ............................................................... 32
RENAL .......................................................................... 43
renal vitamin ........................................................... 43
RENVELA ............................................................... 32
repaglinide ................................................................. 10
REVLIMID ............................................................. 19
RHOGAM ULTRA-FILTERED
PLUS .................................................................................. 48
rifabutin .......................................................................... 16
rifampin ........................................................................... 16
rimantadine hcl ................................................... 18
ri-mox ..................................................................................... 5
rivastigmine tartrate .................................... 50
rizatriptan benzoate .......................... 37, 38
ropinirole hcl .......................................................... 18
SAFYRAL ................................................................. 23
saline mist spray ................................................ 45
SANTYL ...................................................................... 27
62
Index
Index
Index
sb lice treatment ................................................. 27
SCOOBY-DOO ONE A DAY
....................................................................................................... 43
selegiline hcl ............................................................ 18
selenium sulfide ................................................... 27
selenium sulf-pyrithione-urea ....... 27
senna .................................................................................... 35
senna laxative ........................................................ 35
SENNA SMOOTH ..................................... 35
senna-docusate sodium ........................... 35
SENSIPAR ............................................................... 30
SEREVENT DISKUS ............................... 7
sf 5000 plus ................................................................ 41
sildenafil citrate .................................................. 21
silver sulfadiazine ............................................ 27
simethicone ................................................................ 32
simvastatin .................................................................. 13
sirolimus ........................................................................ 19
slow iron ........................................................................ 34
slow magnesium/calcium ...................... 40
slow release iron ............................................... 34
SLOW-MAG ........................................................ 40
sm dry eye relief ................................................. 47
sm ibuprofen jr ......................................................... 2
sm niacin cr ............................................................... 54
sm slow release iron .................................... 34
sodium bicarbonate ........................................... 5
sodium chloride ....................................... 24, 32
sodium chloride (hypertonic) ......... 47
sodium fluoride .................................................... 40
sodium phosphate ............................................ 40
sodium polystyrene sulfonate
........................................................................................... 19, 49
SOOTHE .................................................................... 10
sotalol hcl ..................................................................... 20
sotalol hcl (af) ....................................................... 20
SPIRIVA HANDIHALER ................ 7
SPIRIVA RESPIMAT ............................. 7
spironolactone ...................................................... 29
spironolactone-hctz ....................................... 29
SPRINTEC 28 .................................................... 23
SPS ............................................................................ 19, 49
sterile water for irrigation .................. 19
STIMATE ................................................................. 30
STRIVERDI RESPIMAT .................. 7
sucralfate ...................................................................... 52
sulfacetamide sodium ................................. 47
sulfacetamide sodium (acne) .......... 27
sulfacetamide sodium-sulfur ........... 27
sulfacetamide-prednisolone ............. 47
sulfamethoxazole-trimethoprim
....................................................................................................... 15
sulfasalazine ............................................................ 32
sulindac ............................................................................... 2
sumatriptan succinate ............................... 38
sumatriptan succinate refill .............. 38
SUPERVITE ........................................................ 43
SUPRAX ...................................................................... 22
sure comfort alcohol prep ................... 27
SURE-LANCE THIN
LANCETS 28G ................................................ 37
SYMBICORT ......................................................... 7
SYNAGIS ................................................................... 48
SYNTHROID ...................................................... 51
TABLOID ................................................................. 17
tacrolimus ........................................................ 19, 27
TAMIFLU ................................................................. 18
tamoxifen citrate ................................................ 17
tamsulosin hcl ........................................................ 32
TANZEUM ............................................................. 10
TARON-BC ............................................................ 43
TARON-CRYSTALS ............................ 32
TAZTIA XT .......................................................... 21
TECFIDERA ....................................................... 50
TECHLITE PEN NEEDLES ... 37
TEKTURNA ......................................................... 14
TEKTURNA HCT ...................................... 14
temozolomide .......................................................... 17
terazosin hcl ............................................................. 14
terbinafine hcl ....................................................... 11
terbutaline sulfate ................................................ 7
terconazole ................................................................. 53
TERUMO INSULIN SYRINGE
....................................................................................................... 37
TERUMO SURGUARD
INSULIN SYR ................................................... 37
testosterone cypionate ................................... 4
tetracycline hcl ..................................................... 50
theophylline ................................................................... 7
theophylline er .......................................................... 7
THINPRO INSULIN SYRINGE
....................................................................................................... 37
timolol maleate ........................................ 20, 47
tinidazole ....................................................................... 15
tizanidine hcl ........................................................... 44
TOBI PODHALER ....................................... 1
TOBRADEX ......................................................... 47
tobramycin .......................................................... 1, 47
tobramycin-dexamethasone .............. 47
TODAY SPONGE ...................................... 53
tolazamide ................................................................... 10
tolbutamide ................................................................ 10
tolnaftate ........................................................................ 27
tolterodine tartrate ......................................... 53
tolterodine tartrate er ................................ 53
torsemide ....................................................................... 29
TRACLEER .......................................................... 21
TRADJENTA ..................................................... 10
tramadol hcl ................................................................. 4
trandolapril ............................................................... 15
travoprost ..................................................................... 47
TRECATOR ......................................................... 16
tretinoin ............................................................... 17, 27
triamcinolone acetonide
............................................................................... 28, 41, 45
triamterene-hctz ................................................. 29
trifluridine ................................................................... 47
TRI-LEGEST FE ......................................... 23
trimethoprim ............................................................ 15
trinatal rx 1 ................................................................ 43
TRINATE .................................................................. 43
TRINESSA LO ................................................. 23
triple antibiotic .................................................... 28
TRI-SPRINTEC ............................................. 23
tri-tabs dha ................................................................. 43
TRI-VI-FLOR .................................................... 43
tri-vi-floro .................................................................... 43
tri-vit/fluoride ........................................................ 44
tri-vit/fluoride/iron ......................................... 44
tri-vitamin .................................................................... 44
TRIVORA (28) ................................................. 23
trixaicin ........................................................................... 28
tropicamide ................................................................ 47
trospium chloride ............................................. 53
TRUSTEX NON-LUBRICATED
....................................................................................................... 37
TUDORZA PRESSAIR ......................... 7
tussin dm max adult ...................................... 24
ULORIC ...................................................................... 32
ULTICARE INSULIN
SYRINGE .................................................................. 37
ULTICARE MICRO PEN
NEEDLES ................................................................. 37
ULTILET INSULIN SYRINGE
....................................................................................................... 37
ultra multi formula/iron ......................... 44
UNITHROID ....................................................... 51
UNITHROID DIRECT ...................... 51
urea ........................................................................................ 28
URO-MAG .................................................................. 5
ursodiol ............................................................................ 32
valacyclovir hcl ................................................... 18
valganciclovir hcl ............................................ 18
valsartan ........................................................................ 15
valsartan-hydrochlorothiazide ..... 15
vancomycin hcl .................................................... 15
VCF VAGINAL
CONTRACEPTIVE ................................ 53
VELIVET .................................................................. 23
VENTOLIN HFA ............................................. 7
verapamil hcl .......................................................... 21
verapamil hcl er ................................................. 21
VICTOZA ................................................................. 10
VIGAMOX .............................................................. 48
VINATE II ............................................................... 44
63
Index
VINATE M .............................................................. 44
virt-vite gt ..................................................................... 44
virt-vite plus .............................................................. 44
vita-bee/c ....................................................................... 44
VITAL-D RX ....................................................... 44
vitamin b complex-c ..................................... 44
vitamin b1 .................................................................... 54
vitamin b-1 .................................................................. 55
vitamin b-12 .............................................................. 34
vitamin b-2 .................................................................. 55
vitamin b-6 .................................................................. 55
vitamin b-complex ........................................... 44
vitamin b-complex 100 ............................. 44
vitamin d ........................................................................ 55
vitamin d (ergocalciferol) .................... 55
vitamin d3 .................................................................... 55
vitamin e ......................................................................... 55
vitamin e skin .......................................................... 28
VITA-RESPA ..................................................... 29
vp-heme ob ................................................................. 44
warfarin sodium ..................................................... 8
WESTHROID .................................................... 51
wheat germ oil ...................................................... 55
WP THYROID ................................................. 51
WYMZYA FE .................................................... 23
XARELTO ................................................................... 8
XTANDI ....................................................................... 17
XULANE ..................................................................... 23
ZARXIO ...................................................................... 34
ZENPEP ....................................................................... 29
ZETIA ............................................................................. 13
ZOLINZA ................................................................. 17
zolmitriptan ............................................................... 38
ZOSTAVAX .......................................................... 53
ZOVIA 1/35E (28) ....................................... 23
ZOVIA 1/50E (28) ....................................... 23
ZYTIGA ....................................................................... 17
64

Medicaid Drug Formulary

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