List of Covered Drugs - Inland Empire Health Plan

Transcription

Formulary
IEHP DualChoice Cal MediConnect Plan
(Medicare-Medicaid Plan)
IEHP DualChoice
P.O. Box 1800, Rancho Cucamonga, CA 91729-1800
©2016 Inland Empire Health Plan. All Rights Reserved. Updated: August 19, 2015
H5355_CMC_16_03445_Final_1 Approved
1-877-273-IEHP (4347)
1-800-718-4347 TTY
January
2016
IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) |
2016 List of Covered Drugs (Formulary)
HPMS Approved Formulary File Submission ID 00016450, Version 7
This is a list of drugs that members can get in IEHP DualChoice.

IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts
with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.
 The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year.
We will send you a notice before we make a change that affects you.
 Benefits and/or co-payments may change on January 1 of each year.
 You can always check IEHP DualChoice’s up-to-date List of Covered Drugs online at www.iehp.org
or by calling 1-877-273-IEHP (4347), 8am-8pm (PST), 7 days week, including holidays. TTY/TDD
users should call 1-800-718-4347. The call is free.
 You can get this information for free in other formats, such as large print, braille, or audio. Call
1-877-273-IEHP (4347). The call is free.
 Limitations, copays, and restrictions may apply. For more information, call IEHP DualChoice
Member Services or read the IEHP DualChoice Member Handbook.
 Co-pays for prescription drugs may vary based on the level of Extra Help you receive. Please
contact the plan for more details.
 You can get this information for free in other languages. Call 1-877-273-IEHP (4347), 8am-8pm
(PST), 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347. The call is
free.
 Usted puede obtener esta información gratis en otros idiomas. Llame al 1-877-273-IEHP (4347),
8am-8pm (Hora del Pacifico), los 7 días de la semana, incluidos días festivos. Los usuarios de
TTY/TDD deben llamar al 1-800-718-4347. La llamada es gratuita.
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If you have questions, please call IEHP DualChoice at 1-877-273-IEHP (4347), 8am-8pm (PST),
7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347. The call is free.
For more information, visit www.iehp.org.
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Frequently Asked Questions (FAQ)
Find answers here to questions you have about this List of Covered Drugs. You can read all of the FAQ
to learn more, or look for a question and answer.
1.
What prescription drugs are on the List of Covered Drugs?
(We call the List of Covered Drugs the “Drug List” for short.)
The drugs on the Drug List are the drugs covered by IEHP DualChoice. The drugs are available at
pharmacies within our network. A pharmacy is in our network if we have an agreement with them to
work with us and provide you services. We refer to these pharmacies as “network pharmacies.”
IEHP DualChoice will cover all medically necessary drugs on the Drug List if:
 your doctor or other prescriber says you need them to get better or stay healthy, and
 you fill the prescription at an IEHP DualChoice network pharmacy.
In some cases, you have to do something before you can get a drug (see question #5 below).
You can also see an up-to-date list of drugs that we cover on our website at www.iehp.org or call
Member Services at 1-877-273-IEHP (4347).
2.
Does the Drug List ever change?
Yes. IEHP DualChoice may add or remove drugs on the Drug List during the year. Generally, the Drug
List will only change if:
 a cheaper drug comes along that works as well as a drug on the Drug List now, or
 we learn that a drug is not safe.
We may also change our rules about drugs. For example, we could:
 Decide to require or not require prior approval for a drug. (Prior approval is permission from IEHP
DualChoice before you can get a drug.)
 Add or change the amount of a drug you can get (called “quantity limits”).
(For more information on these drug rules, see page 4.)
We will tell you when a drug you are taking is removed from the Drug List. We will also tell you when we
change our rules for covering a drug. Questions 3, 4, and 7 below have more information on what
happens when the Drug List changes.
→ You can always check IEHP DualChoice’s up to date Drug List online at www.iehp.org. You can also
call Member Services to check the current Drug List at 1-877-273-IEHP (4347).
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What happens when a cheaper drug comes along that works as well as
a drug on the Drug List now?
3.
If you are taking a drug that is removed because a cheaper drug that works just as well comes along, we
will tell you. We will tell you at least 60 days before we remove it from the Drug List or when you ask for
a refill. Then you can get a 60-day supply of the drug before the drug is removed from the drug list. You
will receive a letter at least 60-days before the change is effective. This information is also available on
our website at www.iehp.org.
What happens when we find out a drug is not safe?
4.
If the Food and Drug Administration (FDA) says a drug you are taking is not safe, we will take it off the
Drug List right away. We will also send you a letter telling you that. Please contact the prescribing doctor
after you receive your letter.
Are there any restrictions or limits on drug coverage? Or are there any
required actions to take in order to get certain drugs?
5.
Yes, some drugs have coverage rules or have limits on the amount you can get. In some cases you or
your doctor or other prescriber must do something before you can get the drug. For example:
 Prior approval (or prior authorization): For some drugs, you or your doctor or other prescriber
must get approval from IEHP DualChoice before you fill your prescription. If you don’t get
approval, IEHP DualChoice may not cover the drug.
 Quantity limits: Sometimes IEHP DualChoice limits the amount of a drug you can get.
You can find out if your drug has any additional requirements or limits by looking in the tables on pages
11-84. You can also get more information by visiting our web site at www.iehp.org. We have posted
online documents that explain our prior authorization restrictions. You may also ask us to send you a
copy.
You can ask for an “exception” from these limits. Please see Question 11 for more information on
exceptions.
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If you are in a nursing home or other long-term care facility and need a drug that is not on the Drug
List, or if you cannot easily get the drug you need, we can help. We will cover a 31-day emergency
supply of the drug you need (unless you have a prescription for fewer days), whether or not you are
a new IEHP DualChoice member. This will give you time to talk to your doctor or other prescriber.
He or she can help you decide if there is a similar drug on the Drug List you can take instead or
whether to request an exception. Please see Question 11 for more information about exceptions.
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6.
How will you know if the drug you want has limitations or if there are
required actions to take to get the drug?
The List of Covered Drugs that begins on page 11 has a column labeled “Necessary actions,
restrictions, or limits on use.”
7.
What happens if we change our rules on how we cover some of the
drugs? For example, if we add prior authorization (approval) and/or
quantity limits restrictions on a drug.
We will tell you if we add prior approval and/or quantity limits restrictions on a drug. We will tell you at
least 60 days before the restriction is added or when you next ask your pharmacy for a refill. Then, you
can get a 60-day supply of the drug before the change to the coverage rules is made. This gives you
time to talk to your doctor or other prescriber about what to do next.
8.
How can you find a drug on the Drug List?
There are two ways to find a drug:
 You can search alphabetically (if you know how to spell the drug), or
 You can search by medical condition.
To search alphabetically, go to the Alphabetical Listing section. You can find it in the index that begins
on page 85. Look in the index and find your drug. Next to your drug, you will see the page number
where you can find the coverage information. Turn to the page listed in the index and find the name of
your drug in the first column of the list.
To search by medical condition, find the section labeled “List of drugs by medical condition” on page
11. The drugs in this section are grouped into categories depending on the type of medical conditions
they are used to treat. For example, if you have a heart condition, you should look in the category,
Cardiovascular Agents. That is where you will find drugs that treat heart conditions.
9.
What if the drug you want to take is not on the Drug List?
If you don’t see your drug on the Drug List, call Member Services at 1-877-273-IEHP (4347), 8am-8pm
(PST), 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347 and ask about it.
If you learn that IEHP DualChoice will not cover the drug, you can do one of these things:
 Ask Member Services for a list of drugs like the one you want to take. Then show the list to your
doctor or other prescriber. He or she can prescribe a drug on the Drug List that is like the one you
want to take. Or
 You can ask the health plan to make an exception to cover your drug. Please see question 11 for
more information about exceptions.
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10. What if you are a new IEHP DualChoice member and can’t find your
drug on the Drug List or have a problem getting your drug?
We can help. We may cover a temporary 31-day supply of your drug during the first 90 days you are a
member of IEHP DualChoice. This will give you time to talk to your doctor or other prescriber. He or she
can help you decide if there is a similar drug on the Drug List you can take instead or whether to request
an exception.
We will cover a 31-day supply of your drug if:
 you are taking a drug that is not on our Drug List, or
 health plan rules do not let you get the amount ordered by your prescriber, or
 the drug requires prior approval by IEHP DualChoice.
If you live in a nursing home or other long-term care facility, you may refill your prescription for as long
as 98 days. You may refill the drug multiple times during your first 90 days in the plan. This gives your
prescriber time to change your drugs to those on the Drug List or ask for an exception.
As a new member in our plan or continuing member who was affected by a formulary change from one
year the next, you may be taking drugs that are not on our formulary. Or, you may be taking drugs that
are on our formulary that are hard for you to get. For example, you may need our approval before you
can get your drug. Either way, talk to your doctor. He or she can help you choose the right course of
action. This could be changing to a drug we do cover or seeking a formulary exception so that we will
cover the drug. While you talk to your doctor to determine the right course of action for you, we may
cover your drug in certain cases during the first 90 days you are a member of our plan.
For each of your drugs that is not on our formulary or is hard for you to get, we will cover a temporary
31-day supply (unless you have a prescription written for fewer days) when you go to a network
pharmacy. After your first 31-day supply, we will not pay for these drugs, even if you have been a
member of the plan less than 90 days.
If you are a resident of a long-term care facility, we will cover your prescription refill until we have
provided you with a 98-day transition supply, consistent with dispensing increment, (unless you have a
prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days
of your membership. If you need a drug that is not on our formulary or it is hard for you to get, but you
are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that
drug (unless you have a prescription for fewer days) while you ask for a formulary exception.
11. Can you ask for an exception to cover your drug?
Yes. You can ask IEHP DualChoice to make an exception to cover a drug that is not on the Drug List.
You can also ask us to change the rules on your drug.
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 For example, IEHP DualChoice may limit the amount of a drug we will cover. If your drug has
a limit, you can ask us to change the limit and cover more.
 Other examples: You can ask us to drop prior approval requirements.
12. How long does it take to get an exception?
First, we must receive a statement from your prescriber supporting your request for an exception. After
we receive the statement, we will give you a decision on your exception request within 72 hours.
If you or your prescriber think your health may be harmed if you have to wait 72 hours for a decision,
you can ask for an expedited exception. This is a faster decision. If your prescriber supports your
request, we will give you a decision within 24 hours of receiving your prescriber’s supporting statement.
13. How can you ask for an exception?
To ask for an exception, call IEHP DualChoice Member Services. IEHP DualChoice Member Services
will work with you and your provider to help you ask for an exception.
14. What are generic drugs?
Generic drugs are made up of the same ingredients as brand name drugs. They usually cost less than
the brand name drug and their names are less commonly known. Generic drugs are approved by the
Food and Drug Administration (FDA).
IEHP DualChoice covers both brand name drugs and generic drugs.
15. What are OTC drugs?
OTC stands for “over-the-counter”. IEHP DualChoice covers some OTC drugs when they are written as
prescriptions by your provider.
You can read the IEHP DualChoice Drug List to see what OTC drugs are covered.
16. Does IEHP DualChoice cover OTC non-drug products?
IEHP DualChoice covers some OTC non-drug products when they are written as prescriptions by your
provider.
You can read the IEHP DualChoice Drug List to see what OTC non-drug products are covered.
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17. What is your co-pay?
You can read the IEHP DualChoice Drug List to learn about the co-pay for each drug.
IEHP DualChoice members living in nursing homes or other long-term care facilities will have no copays. Some members getting long-term care in the community will also have no co-pays.
Co-pays are listed by tiers. Tiers are groups of drugs with the same co-pay.
 Tier 1 are generic drugs. The co-pay will be from $0 to $2.95, depending on your level of Medi-Cal
eligibility.
 Tier 2 are brand name drugs. The co-pay will be from $0 to $7.40, depending on your level of
Medi-Cal eligibility.
 Tier 3 drugs have a co-pay of $0.
List of Covered Drugs
The list of covered drugs that begins on the page 11 gives you information about the drugs covered by
IEHP DualChoice. If you have trouble finding your drug in the list, turn to the Index that begins on page
85.
The first column of the chart lists the name of the drug. Brand name drugs are capitalized (e.g.,
NEXIUM) and generic drugs are listed in lower-case italics (e.g., omeprazole).
The information in the “Necessary actions, restrictions, or limits on use” column tells you if IEHP
DualChoice has any rules for covering your drug.
Below are the meanings of the codes used in the “Necessary actions, restrictions, or limits on use”
column:
UPPERCASE BOLD=
Brand name drugs
lowercase italics=
Generic drugs
Drug Tier
1= Tier 1; 2= Tier 2;
3= Tier 3
NC= Not Covered
NF= Non-Formulary
Requirements / Limits
PA= Prior Authorization
B vs D= Part B vs D Prior Authorization
QL= Quantity Limit
Tier 1: Drugs in this tier are generic drugs (including brand drugs treated as generic). The copay is a set
payment you make for these generic drugs. For example, the copay is from $0 to $2.95. This amount
depends on your income.
Tier 2: Drugs in this tier are brand name drugs. The copay is from $0 to $7.40. This amount depends on
your income.
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Tier 3: Drugs in this tier are drugs that are non-Medicare drugs/Over-the-Counter (OTC) drugs. These
drugs are covered by Medi-Cal. They have a $0 co-pay.
NC: Not covered. These are drugs not covered by IEHP DualChoice.
NF: Non-Formulary. Drugs that are not on our prescribed drugs list (known as a Formulary).
PA: Prior Authorization. IEHP DualChoice requires you or your physician to get approval from us first
before filling a certain drug. This extra step is called “prior authorization.” If you don't get approval, IEHP
DualChoice may not cover the drug.
B vs D: Part B vs D Prior Authorization. This is a drug that has a special “PA” requirement. It may be
covered under one or two benefit programs: 1) Medicare Part B, and/or 2) Medicare Part D. This
depends on many factors. Your physician may need to give us more details about the use and setting of
the drug.
QL: Quantity Limit. For certain drugs, IEHP DualChoice limits the amount of the drug that it will cover.
This may be in addition to a standard one month or three month supply.
Note: A drug in Tier 3 means the drug is not a “Part D drug.” You will not be required to pay a copay for
these drugs. These drugs also have different rules for appeals. An appeal is a formal way of asking us to
review a decision we made about your coverage and to change it if you think we made a mistake. For
example, we might decide that a drug that you want is not covered or is no longer covered by Medicare
or Medi-Cal. If you or your doctor disagrees with our decision, you can appeal. If you ever have a
question, call Member Services at 1-877-273-IEHP (4347). You can also read the Member Handbook to
learn how to appeal a decision.
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IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan)
2016 Formulary
Table of Contents
Additional Demonstration Drugs ....................................................................................................................... 11 Analgesics .......................................................................................................................................................... 20 Anesthetics ......................................................................................................................................................... 21 Anti-Addiction/ Substance Abuse Treatment Agents ........................................................................................ 21 Antibacterials ..................................................................................................................................................... 22 Anticonvulsants .................................................................................................................................................. 27 Antidementia Agents .......................................................................................................................................... 30 Antidepressants .................................................................................................................................................. 30 Antiemetics......................................................................................................................................................... 33 Antifungals ......................................................................................................................................................... 34 Antigout Agents ................................................................................................................................................. 35 Anti-Inflammatory Agents ................................................................................................................................. 35 Antimigraine Agents .......................................................................................................................................... 36 Antimyasthenic Agents ...................................................................................................................................... 36 Antimycobacterials............................................................................................................................................. 36 Antineoplastics ................................................................................................................................................... 37 Antiparasitics...................................................................................................................................................... 41 Antiparkinson Agents......................................................................................................................................... 42 Antipsychotics .................................................................................................................................................... 43 Antispasticity Agents ......................................................................................................................................... 45 Antivirals ............................................................................................................................................................ 45 Anxiolytics ......................................................................................................................................................... 49 Bipolar Agents.................................................................................................................................................... 50 Blood Glucose Regulators.................................................................................................................................. 50 Blood Products/ Modifiers/ Volume Expanders ................................................................................................ 52 Cardiovascular Agents ....................................................................................................................................... 54 Central Nervous System Agents ........................................................................................................................ 59 Dental And Oral Agents ..................................................................................................................................... 60 Dermatological Agents....................................................................................................................................... 61 Enzyme Replacement/ Modifiers ....................................................................................................................... 62 Gastrointestinal Agents ...................................................................................................................................... 62 Genitourinary Agents ......................................................................................................................................... 64 Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal) ................................................................... 65 Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary) .................................................................. 67 Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers) ...................................... 68 Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid) ................................................................... 70 Hormonal Agents, Suppressant (Adrenal) ......................................................................................................... 71 Hormonal Agents, Suppressant (Parathyroid) .................................................................................................... 71 Hormonal Agents, Suppressant (Pituitary)......................................................................................................... 71 Hormonal Agents, Suppressant (Thyroid) ......................................................................................................... 72 Immunological Agents ....................................................................................................................................... 72 Inflammatory Bowel Disease Agents................................................................................................................. 75 Metabolic Bone Disease Agents ........................................................................................................................ 76 Ophthalmic Agents............................................................................................................................................. 77 9
Otic Agents......................................................................................................................................................... 78 Respiratory Tract/ Pulmonary Agents ................................................................................................................ 79 Skeletal Muscle Relaxants ................................................................................................................................. 82 Sleep Disorder Agents........................................................................................................................................ 82 Therapeutic Nutrients/ Minerals/ Electrolytes ................................................................................................... 82 Index ................................................................................................................................................................... 85 10
List of Drugs by Medical Condition
The drugs in this section are grouped into categories depending on the type of medical conditions they are
used to treat. For example, if you have a heart condition, you should look in the category, Cardiovascular
Agents. That is where you will find drugs that treat heart conditions.
Drug Name
Tier Requirements / Limits
Additional Demonstration Drugs
Additional Demonstration Drugs
12 HOUR DECONGESTANT ORAL TABLET EXTENDED
RELEASE 120 MG
3
QL (60 EA per 30 days)
3 DAY VAGINAL VAGINAL CREAM 200 MG/5 GRAM (4 %)
3
QL (25 GM per 30 days)
ABREVA TOPICAL CREAM 10 %
3
ACEPHEN RECTAL SUPPOSITORY 120 MG, 325 MG
3
acetaminophen oral solution 160 mg/5 ml (5 ml)
3
ACNE FOAMING FACE WASH TOPICAL CLEANSER 10 %
3
ACNE MEDICATION TOPICAL GEL 10 %, 5 %
3
ACNE MEDICATION TOPICAL LOTION 10 %
3
ACNE TREATMENT (BENZOYL PEROX) TOPICAL CREAM 10 %
3
ADULT COUGH FORMULA DM MAX ORAL LIQUID 10-200 MG/5
ML
3
QL (240 ML per 30 days)
ADULT ROBITUSSIN PEAK COLD DM ORAL LIQUID 10-100
MG/5 ML
3
ALAVERT D-12 ALLERGY-SINUS ORAL TABLET EXTENDED
RELEASE 12 HR 5-120 MG
3
ALLER-CHLOR ORAL SYRUP 2 MG/5 ML
3
ALLER-CHLOR ORAL TABLET 4 MG
3
ALLERCLEAR ORAL TABLET 10 MG
3
ALLERGY (DIPHENHYDRAMINE) ORAL TABLET 25 MG
3
ALLERGY MULTI-SYMPTOM ORAL TABLET 2-5-325 MG
3
ALLERGY RELIEF (LORATADINE) ORAL SOLUTION 5 MG/5 ML
3
ALLERGY RELIEF (LORATADINE) ORAL
TABLET,DISINTEGRATING 10 MG
3
ALLERGY RELIEF(DIPHENHYDRAMIN) ORAL CAPSULE 25 MG
3
AMLACTIN TOPICAL CREAM
3
ANTACID ANTI-GAS ORAL SUSPENSION 200-200-20 MG/5 ML,
400-400-40 MG/5 ML
3
You can find information on what the symbols and abbreviations in this table mean by going to page 7.
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Drug Name
ANTIBIOTIC + PAIN RELIEF TOPICAL OINTMENT 3.5-500-10,000
MG-UNIT-UNIT/G
3
ANTI-DANDRUFF WITH MENTHOL TOPICAL SUSPENSION 1 %
3
ANTI-DIARRHEAL (LOPERAMIDE) ORAL LIQUID 1 MG/5 ML
3
AQUANIL HC TOPICAL LOTION 1 %
3
ARTIFICIAL TEARS (POLYVIN ALC) OPHTHALMIC DROPS 1.4
%
3
ARTIFICIAL TEARS OPHTHALMIC DROPS 0.5-0.6 %
3
ARTIFICIAL TEARS(GLYCERIN-PEG) OPHTHALMIC DROPS 10.3 %
3
aspirin oral tablet 325 mg
3
aspirin oral tablet,chewable 81 mg
3
aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg
3
AYR SALINE NASAL DROPS 0.65 %
3
bacitracin topical ointment 500 unit/gram
3
bacitracin zinc topical ointment 500 unit/gram
3
bacitracin-polymyxin b topical packet 500-10,000 unit/gram
3
benzonatate oral capsule 100 mg
3
benzonatate oral capsule 200 mg
3
benzoyl peroxide topical cleanser 5 %
3
benzoyl peroxide topical gel 2.5 %
3
benzoyl peroxide topical lotion 5 %
3
BIO-B KIDS ORAL LIQUID 4-10-15 MG/5 ML
3
BIO-S-PRES DX ORAL DROPS 2.5-5-50 MG/ML
3
bisacodyl oral tablet,delayed release (dr/ec) 5 mg
3
brompheniramine-pseudoeph-dm oral syrup 2-30-10 mg/5 ml
3
BROTAPP DM ORAL ELIXIR 1-15-5 MG/5 ML
3
BROTAPP ORAL LIQUID 1-15 MG/5 ML
3
calamine topical lotion
3
calamine-zinc oxide topical lotion 8-8 %
3
CALCIUM 600 ORAL TABLET 600 MG (1,500 MG)
3
calcium carbonate oral tablet 500 mg calcium (1,250 mg)
3
calcium gluconate oral tablet 45 mg (500 mg)
3
calcium lactate oral tablet 84 mg (648 mg)
3
12
Drug Name
CETIRI-D ORAL TABLET EXTENDED RELEASE 12 HR 5-120 MG
3
cetirizine oral tablet 10 mg, 5 mg
3
cetirizine oral tablet,chewable 5 mg
3
CHEMSTRIP 10/SG STRIP
3
CHILD ALLERGY RELF(CETIRIZINE) ORAL
TABLET,CHEWABLE 10 MG
3
CHILD MUCINEX STUFFY NOSE-COLD ORAL LIQUID 2.5-100
MG/5 ML
3
CHILD MUCUS RELIEF COUGH ORAL LIQUID 5-100 MG/5 ML
3
CHILD SUPPOSITORY RECTAL SUPPOSITORY
3
CHILDREN'S BENEFIBER ORAL POWDER 3 GRAM/3.5 GRAM
3
CHILDREN'S CLARITIN ORAL TABLET,CHEWABLE 5 MG
3
CHILDREN'S COLD & COUGH ORAL SOLUTION 1-2.5-5 MG/5
ML
3
CHILDREN'S IRON ORAL DROPS 15 MG IRON (75 MG)/ML
3
CHILDREN'S NON-ASPIRIN PAIN ORAL TABLET,CHEWABLE 80
MG
3
CHILDREN'S PAIN & FEVER RELIEF ORAL ELIXIR 160 MG/5
ML
3
CHILDREN'S PAIN RELIEVER ORAL SUSPENSION 160 MG/5 ML
3
CHILDREN'S SILAPAP ORAL LIQUID 160 MG/5 ML
3
CHILDREN'S SILFEDRINE ORAL LIQUID 15 MG/5 ML
3
chlorpheniramine maleate oral tablet extended release 12 mg
3
cholecalciferol (vitamin d3) oral capsule 1,000 unit, 10,000 unit, 400 unit,
5,000 unit, 50,000 unit
3
cholecalciferol (vitamin d3) oral drops 400 unit/ml
3
cholecalciferol (vitamin d3) oral tablet 5,000 unit
3
cholecalciferol (vitamin d3) oral tablet,chewable 400 unit
3
clotrimazole vaginal cream 1 %
3
COMPLETE LICE TREATMENT TOPICAL KIT 4-0.33-0.5 %
3
CONCEPTROL VAGINAL GEL 4 %
3
CONDOMS-PREM LUBRICATED DEVICE
3
CORN-CALLUS REMOVER TOPICAL LIQUID
3
cromolyn nasal spray,non-aerosol 5.2 mg/spray (4 %)
3
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Drug Name
cyanocobalamin (vitamin b-12) injection solution 1,000 mcg/ml
3
DESITIN TOPICAL CREAM 13 %
3
dextromethorphan-guaifenesin oral syrup 10-100 mg/5 ml
3
DIABETIC TUSSIN EX ORAL LIQUID 100 MG/5 ML
3
DIAPER RASH TOPICAL OINTMENT 40 %
3
DIMAPHEN (PE) ORAL SOLUTION 1-2.5 MG/5 ML
3
DIOCTO ORAL SYRUP 60 MG/15 ML
3
diphenhydramine hcl oral tablet 50 mg
3
DOCU ORAL LIQUID 50 MG/5 ML
3
DOK ORAL TABLET 100 MG
3
EAR DROPS (CARBAMIDE PEROXIDE) OTIC DROPS 6.5 %
3
ELLA ORAL TABLET 30 MG
3
ENEMA RECTAL ENEMA 19-7 GRAM/118 ML
3
ergocalciferol (vitamin d2) oral capsule 50,000 unit
3
ergocalciferol (vitamin d2) oral tablet 400 unit
3
EYE ALLERGY RELIEF OPHTHALMIC DROPS 0.02675-0.315 %
3
EYE ITCH RELIEF OPHTHALMIC DROPS 0.025 %
3
EYE WASH OPHTHALMIC DROPS
3
famotidine oral tablet 10 mg
3
ferrous sulfate oral liquid 300 mg (60 mg iron)/5 ml
3
ferrous sulfate oral solution 220 mg (44 mg iron)/5 ml
3
ferrous sulfate oral tablet 325 mg (65 mg iron)
3
ferrous sulfate oral tablet,delayed release (dr/ec) 324 mg (65 mg iron), 325
mg (65 mg iron)
3
FEVERALL RECTAL SUPPOSITORY 80 MG
3
FIBER LAXATIVE ORAL TABLET 625 MG
3
FLANDERS BUTTOCKS TOPICAL OINTMENT
3
FLEET GLYCERIN (ADULT) RECTAL SUPPOSITORY
3
FLEET PEDIATRIC RECTAL ENEMA 9.5-3.5 GRAM/59 ML
3
folic acid oral tablet 1 mg, 400 mcg
3
FOR STY RELIEF OPHTHALMIC OINTMENT
3
FORA TEST STRIP STRIP
3
FORACARE LANCETS 30 GAUGE
3
14
Drug Name
FULL SPECTRUM B-VITAMIN C ORAL TABLET 0.8 MG
3
GAS RELIEF ORAL DROPS,SUSPENSION 40 MG/0.6 ML
3
GENTEAL MILD TO MODERATE OPHTHALMIC DROPS 0.3 %
3
GENTEAL MILD OPHTHALMIC DROPS 0.2 %
3
glucose oral tablet,chewable 4 gram
3
GRX DYNE TOPICAL SWAB 10 %
3
GYNOL II VAGINAL GEL 3 %
3
HIBICLENS TOPICAL LIQUID 4 %
3
hydrocortisone acetate topical cream 0.5 %
3
hydrocortisone topical ointment 0.5 %
3
HYDROMET ORAL SYRUP 5-1.5 MG/5 ML
3
ibuprofen oral capsule 200 mg
3
ibuprofen oral tablet 200 mg
3
INFANT'S NON-ASPIRIN ORAL DROPS 100 MG/ML
3
INFANT'S PAIN RELIEVER ORAL DROPS,SUSPENSION 80
MG/0.8 ML
3
INTENSE COUGH RELIEVER ORAL LIQUID 30-200 MG/5 ML
3
IOPHEN C-NR ORAL LIQUID 10-100 MG/5 ML
3
ISOPTO TEARS OPHTHALMIC DROPS 0.5 %
3
KETO-DIASTIX STRIP
3
KETONE CARE STRIP
3
KONSYL (SUGAR) ORAL POWDER IN PACKET 3.4 GRAM
3
LAXATIVE ORAL TABLET 5 MG
3
levonorgestrel oral tablet 0.75 mg
3
LICE KILLING TOPICAL SHAMPOO 0.33-4 %
3
LICE TREATMENT (RESMETHRIN) TOPICAL KIT 4-0.33-0.5 %
3
LOHIST - D ORAL LIQUID 2-30 MG/5 ML
3
loperamide oral tablet 2 mg
3
LORATADINE-D ORAL TABLET EXTENDED RELEASE 24 HR 10240 MG
3
LUBRICANT EYE DROPS OPHTHALMIC DROPS 0.5 %
3
LUBRICANT EYE OPHTHALMIC OINTMENT 56.8-41.5 %, 57.342.5 %
3
15
Drug Name
magnesium citrate oral solution
3
magnesium oxide oral tablet 250 mg, 400 mg, 420 mg, 500 mg
3
MEDI-CORTISONE TOPICAL CREAM 1 %
3
MEDI-FIRST ANTI-FUNGAL TOPICAL PACKET 1 %
3
MEPHYTON ORAL TABLET 5 MG
3
METAMUCIL SUNRISE ORAL POWDER
3
MICONAZOLE 7 VAGINAL CREAM 2 %
3
miconazole nitrate topical cream 2 %
3
miconazole nitrate vaginal comb pack,prefill appl & cream 4 % (200 mg)2% (9 gram)
3
miconazole nitrate vaginal suppository 100 mg
3
MICONAZOLE-3 VAGINAL KIT 200 MG- 2 % (9 GRAM)
3
MILK OF MAGNESIA CONCENTRATED ORAL SUSPENSION
2,400 MG/10 ML
3
MILK OF MAGNESIA ORAL SUSPENSION 400 MG/5 ML
3
MINTOX PLUS ORAL TABLET,CHEWABLE 200-200-25 MG
3
MOTION SICKNESS RELIEF(MECLIZ) ORAL
3
MUCINEX COUGH MINI-MELTS ORAL GRANULES IN PACKET
5-100 MG
3
MUCINEX D MAXIMUM STRENGTH ORAL TABLET EXTENDED
RELEASE 12 HR 120-1,200 MG
3
MUCINEX D ORAL TABLET EXTENDED RELEASE 12 HR 60-600
MG
3
MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HR 30600 MG
3
MUCINEX DM ORAL TABLET, ER MULTIPHASE 12 HR 60-1,200
MG
3
MUCINEX ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG
3
MUCUS RELIEF ER ORAL TABLET EXTENDED RELEASE 12HR
600 MG
3
MURO 128 OPHTHALMIC DROPS 2 %
3
naproxen sodium oral tablet 220 mg
3
NASAL DECONGESTANT (OXYMETAZL) NASAL SPRAY,NONAEROSOL 0.05 %
3
NASAL DECONGESTANT (PSEUDOEPH) ORAL TABLET 30 MG
3
16
Drug Name
NATURAL BALANCE OPHTHALMIC DROPS 0.4 %
3
NATURAL VEGETABLE POWDER ORAL POWDER 3.4 GRAM/12
GRAM
3
NEXT CHOICE ONE DOSE ORAL TABLET 1.5 MG
3
NIACIN FLUSH FREE ORAL CAPSULE 400 MG NIACIN (500 MG)
3
niacin oral capsule, extended release 250 mg, 500 mg
3
niacin oral tablet 100 mg, 250 mg, 50 mg, 500 mg
3
niacin oral tablet extended release 500 mg
3
NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 MG/24 HR
3
nicotine (polacrilex) buccal gum 2 mg, 4 mg
3
nicotine (polacrilex) buccal lozenge 2 mg, 4 mg
3
nicotine transdermal patch 24 hour 21 mg/24 hr, 7 mg/24 hr
3
nicotine transdermal patch, td daily, sequential 21-14-7 mg/24 hr
3
NON-ASPIRIN JR STRENGTH ORAL TABLET,CHEWABLE 160
MG
3
NUTRISOURCE FIBER ORAL POWDER
3
OCEAN NASAL NASAL AEROSOL,SPRAY 0.65 %
3
omeprazole oral tablet,delayed release (dr/ec) 20 mg
3
PAIN RELIEVER EXTRA STRENGTH ORAL TABLET 500 MG
3
PANDA MASK DEVICE
3
PEAK AIR PEAK FLOW METER DEVICE
3
PEDIA-LAX STOOL SOFTENER ORAL SYRUP 50 MG/15 ML
3
PEDIATRIC COUGH & COLD ORAL LIQUID 1-15-5 MG/5 ML
3
PEDIATRIC ELECTROLYTE ORAL SOLUTION
3
PEDIATRIC MEDIUM MASK DEVICE
3
permethrin topical liquid 1 %
3
PHARBEDRYL ORAL CAPSULE 50 MG
3
phentermine oral tablet 37.5 mg
3
PA; QL (31 EA per 31 days)
PINK BISMUTH ORAL SUSPENSION 525 MG/15 ML
3
PINK BISMUTH ORAL TABLET 262 MG
3
POLYSPORIN TOPICAL OINTMENT 500-10,000 UNIT/GRAM
3
POLY-VI-SOL ORAL DROPS 750-35-400 UNIT-MG-UNIT/ML
3
17
Drug Name
POLY-VITAMIN WITH IRON ORAL DROPS 1,500 UNIT-400 UNIT10 MG/ML
3
povidone-iodine topical solution 10 %
3
PRENATAL VITAMIN ORAL TABLET , 27-0.8 MG
3
PRENATAL VITAMIN WITH MINERALS ORAL TABLET 28-0.8
MG
3
PRILOSEC OTC ORAL TABLET,DELAYED RELEASE (DR/EC) 20
MG
3
PROMETHAZINE VC-CODEINE ORAL SYRUP 6.25-5-10 MG/5 ML
3
promethazine-codeine oral syrup 6.25-10 mg/5 ml
3
promethazine-dm oral syrup 6.25-15 mg/5 ml
3
psyllium husk oral capsule 0.52 gram
3
PYRETHRIN LICE TREATMENT M TOPICAL LIQUID 0.33-4 %
3
pyridoxine oral tablet 25 mg
3
Q-PAP ORAL TABLET 325 MG
3
ranitidine hcl oral tablet 75 mg
3
REESE'S PINWORM MEDICINE ORAL SUSPENSION 50 MG/ML
3
REFRESH LACRI-LUBE OPHTHALMIC OINTMENT 56.8-42.5 %
3
ROBITUSSIN PEDIATRIC ORAL SYRUP 7.5 MG/5 ML
3
SCALPICIN TOPICAL SOLUTION 1 %
3
SCOT-TUSSIN DM ORAL LIQUID 2-15 MG/5 ML
3
SCOT-TUSSIN SENIOR ORAL LIQUID 15-200 MG/5 ML
3
SENNA ORAL SYRUP 8.8 MG/5 ML
3
SENNA ORAL TABLET 8.6 MG
3
SENNA PLUS ORAL TABLET 8.6-50 MG
3
SILAPAP ORAL DROPS 80 MG/0.8 ML
3
simethicone oral tablet,chewable 80 mg
3
SLEEP TABLET (DIPHENHYDRAMINE) ORAL TABLET 25 MG
3
sodium bicarbonate oral tablet 325 mg, 650 mg
3
sodium chloride inhalation solution for nebulization 0.9 %
3
sodium chloride ophthalmic drops 5 %
3
sodium chloride ophthalmic ointment 5 %
3
SOLUBLE FIBER ORAL TABLET 500 MG
3
18
Drug Name
SOOTHE (BISMUTH SUBSALICYLATE) ORAL
3
STOMACH RELIEF ORAL SUSPENSION 262 MG/15 ML
3
STOOL SOFTENER ORAL CAPSULE 100 MG, 250 MG, 50 MG
3
SUDOGEST ORAL TABLET 60 MG
3
SUPER PAIN RELIEF ORAL TABLET 250-250-65 MG
3
SYSTANE NIGHTTIME OPHTHALMIC OINTMENT 94-3 %
3
TEARS NATURALE FORTE OPHTHALMIC DROPS 0.1-0.3-0.2 %
3
TEARS NATURALE II OPHTHALMIC DROPS
3
terbinafine hcl topical cream 1 %
3
thiamine hcl oral tablet 250 mg
3
tolnaftate topical solution 1 %
3
TRIPLE ANTIBIOTIC TOPICAL OINTMENT 3.5MG-400 UNIT5,000 UNIT/GRAM
3
TRI-VITA ORAL DROPS 1,500-35-400 UNIT-MG-UNIT/ML
3
TRYMINE D ORAL SYRUP 1.25-30 MG/5 ML
3
TUSSIN CF ORAL LIQUID 5-10-100 MG/5 ML
3
urea topical lotion 10 %
3
VAGINAL CONTRACEPTIVE FILM VAGINAL FILM 28 %
3
VAGINAL CONTRACEPTIVE FOAM VAGINAL FOAM 12.5 %
3
VISINE-A OPHTHALMIC DROPS 0.025-0.3 %
3
vitamin a palmitate oral capsule 10,000 unit
3
VITAMIN B-1 (MONONITRATE) ORAL TABLET 100 MG
3
VITAMIN B-1 ORAL TABLET 100 MG, 50 MG
3
VITAMIN B-2 ORAL TABLET 100 MG
3
VITAMIN B-6 ORAL TABLET 100 MG, 50 MG
3
VITAMIN C ORAL TABLET 500 MG
3
VITAMIN D3 ORAL CAPSULE 2,000 UNIT, 4,000 UNIT
3
VITAMIN D3 ORAL TABLET 1,000 UNIT, 2,000 UNIT, 400 UNIT
3
vitamin e oral capsule 400 unit
3
WAL-ACT D COLD & ALLERGY ORAL TABLET 2.5-60 MG
3
WAL-FINATE-D ORAL TABLET 4-60 MG
3
19
Drug Name
WAL-MUCIL FIBER (ASPARTAME) ORAL POWDER 3.4
GRAM/5.8 GRAM
3
WART REMOVER TOPICAL GEL 17 %
3
WART REMOVER TOPICAL LIQUID , 17 %
3
zinc gluconate oral tablet 50 mg
3
zinc oral tablet 50 mg
3
zinc oxide topical ointment
3
zinc oxide topical paste 25 %
3
Analgesics
Analgesics
acetaminophen-codeine oral solution 300 mg-30 mg /12.5 ml
1
acetaminophen-codeine oral tablet 300-15 mg
1
1
1
hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg
1
hydrocodone-ibuprofen oral tablet 7.5-200 mg
1
oxycodone-acetaminophen oral tablet 5-325 mg
1
tramadol-acetaminophen oral tablet 37.5-325 mg
1
celecoxib oral capsule 100 mg, 200 mg, 400 mg
1
diclofenac sodium oral tablet,delayed release (dr/ec) 25 mg, 75 mg
1
diclofenac sodium topical drops 1.5 %
1
ibuprofen oral tablet 800 mg
1
indomethacin oral capsule 25 mg
1
PA; QL (124 EA per 31
days)
meloxicam oral tablet 15 mg, 7.5 mg
1
nabumetone oral tablet 500 mg, 750 mg
1
naproxen oral tablet 375 mg, 500 mg
1
Nonsteroidal Anti-Inflammatory Drugs
Opioid Analgesics, Long-Acting
DURAMORPH (PF) INJECTION SOLUTION 0.5 MG/ML, 1 MG/ML
2
fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50
mcg/hr, 75 mcg/hr
1
morphine oral capsule,extend.release pellets 10 mg, 100 mg, 20 mg, 30 mg,
50 mg, 60 mg, 80 mg
1
20
Drug Name
morphine oral solution 10 mg/5 ml
1
morphine oral tablet 15 mg, 30 mg
1
morphine oral tablet extended release 100 mg, 15 mg, 30 mg, 60 mg
1
morphine oral tablet extended release 200 mg
1
tramadol oral tablet extended release 24 hr 100 mg
1
tramadol oral tablet extended release 24 hr 200 mg
1
butorphanol tartrate nasal spray,non-aerosol 10 mg/ml
1
QL (22.5 ML per 31 days)
fentanyl citrate buccal lozenge on a handle 1,200 mcg, 1,600 mcg, 200 mcg,
400 mcg, 600 mcg, 800 mcg
1
days)
hydromorphone (pf) injection solution 10 mg/ml
1
hydromorphone oral tablet 2 mg, 4 mg, 8 mg
1
LAZANDA NASAL SPRAY,NON-AEROSOL 100 MCG/SPRAY, 400
MCG/SPRAY
2
oxycodone oral tablet 10 mg, 15 mg, 20 mg, 30 mg, 5 mg
1
tramadol oral tablet 50 mg
1
Opioid Analgesics, Short-Acting
Anesthetics
Local Anesthetics
lidocaine (pf) injection solution 5 mg/ml (0.5 %)
1
lidocaine hcl injection solution 20 mg/ml (2 %)
1
lidocaine hcl mucous membrane gel 2 %
1
lidocaine hcl mucous membrane solution 2 %, 4 % (40 mg/ml)
1
lidocaine topical adhesive patch,medicated 5 %(700 mg/patch)
1
lidocaine topical ointment 5 %
1
lidocaine-prilocaine topical cream 2.5-2.5 %
1
Anti-Addiction/ Substance Abuse Treatment Agents
Alcohol Deterrents/ Anti-Craving
acamprosate oral tablet,delayed release (dr/ec) 333 mg
1
disulfiram oral tablet 250 mg, 500 mg
1
Opioid Dependence Treatments
buprenorphine hcl injection syringe 0.3 mg/ml
1
buprenorphine hcl sublingual tablet 2 mg, 8 mg
1
buprenorphine-naloxone sublingual tablet 2-0.5 mg
1
21
Drug Name
buprenorphine-naloxone sublingual tablet 8-2 mg
1
naltrexone oral tablet 50 mg
1
Opioid Reversal Agents
naloxone injection syringe 1 mg/ml
1
Smoking Cessation Agents
CHANTIX ORAL TABLET 0.5 MG, 1 MG
2
NICOTROL INHALATION CARTRIDGE 10 MG
2
NICOTROL NS NASAL SPRAY,NON-AEROSOL 10 MG/ML
2
days)
Antibacterials
Aminoglycosides
amikacin injection solution 500 mg/2 ml
1
gentak ophthalmic ointment 0.3 % (3 mg/gram)
1
gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 60
mg/50 ml, 70 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml, 90 mg/100 ml
1
gentamicin injection solution 40 mg/ml
1
gentamicin ophthalmic drops 0.3 %
1
gentamicin topical cream 0.1 %
1
gentamicin topical ointment 0.1 %
1
neomycin oral tablet 500 mg
1
neomycin-polymyxin b gu irrigation solution 40 mg-200,000 unit/ml
1
paromomycin oral capsule 250 mg
1
streptomycin intramuscular recon soln 1 gram
1
TOBI PODHALER INHALATION CAPSULE, W/INHALATION
DEVICE 28 MG
2
TOBRADEX OPHTHALMIC OINTMENT 0.3-0.1 %
2
tobramycin in 0.225 % nacl inhalation solution for nebulization 300 mg/5
ml
1
tobramycin in 0.9 % nacl intravenous piggyback 80 mg/100 ml
1
tobramycin ophthalmic drops 0.3 %
1
tobramycin sulfate injection solution 10 mg/ml, 40 mg/ml
1
TOBREX OPHTHALMIC OINTMENT 0.3 %
2
ZANOSAR INTRAVENOUS RECON SOLN 1 GRAM
2
Antibacterials
22
days)
PA; QL (10 ML per 1 day)
PA
Drug Name
colistin (colistimethate na) injection recon soln 150 mg
1
B vs D
SYNERCID INTRAVENOUS RECON SOLN 500 MG
2
PA
Antibacterials, Other
acetic acid otic solution 2 %
1
bacitracin ophthalmic ointment 500 unit/gram
1
chloramphenicol sod succinate intravenous recon soln 1 gram
1
clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg
1
clindamycin in 5 % dextrose intravenous piggyback 300 mg/50 ml, 600
mg/50 ml, 900 mg/50 ml
1
clindamycin phosphate intravenous solution 600 mg/4 ml
1
clindamycin phosphate topical foam 1 %
1
clindamycin phosphate topical gel 1 %
1
clindamycin phosphate topical lotion 1 %
1
clindamycin phosphate topical solution 1 %
1
clindamycin phosphate topical swab 1 %
1
clindamycin phosphate vaginal cream 2 %
1
CUBICIN INTRAVENOUS RECON SOLN 500 MG
2
isopropyl alcohol-benzocaine topical pads, medicated 70-6 %
1
LINCOCIN INJECTION SOLUTION 300 MG/ML
2
linezolid intravenous parenteral solution 600 mg/300 ml
1
PA
linezolid oral tablet 600 mg
1
metronidazole in nacl (iso-os) intravenous piggyback 500 mg/100 ml
1
metronidazole oral tablet 250 mg, 500 mg
1
metronidazole topical cream 0.75 %
1
metronidazole topical gel 0.75 %, 1 %
1
metronidazole topical lotion 0.75 %
1
metronidazole vaginal gel 0.75 %
1
mupirocin calcium topical cream 2 %
1
mupirocin topical ointment 2 %
1
nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg
1
PA
nitrofurantoin monohyd/m-cryst oral capsule 100 mg
1
PA
nitrofurantoin oral suspension 25 mg/5 ml
1
PA
PRIMSOL ORAL SOLUTION 50 MG/5 ML
2
PA
23
Drug Name
trimethoprim oral tablet 100 mg
1
TYGACIL INTRAVENOUS RECON SOLN 50 MG
2
PA
vancomycin intravenous recon soln 1,000 mg, 10 gram, 500 mg
1
B vs D
vancomycin oral capsule 125 mg
1
vancomycin oral capsule 250 mg
1
ZYVOX ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5
ML
2
PA; QL (1680 ML per 28
days)
Beta-Lactam, Cephalosporins
cefaclor oral capsule 250 mg, 500 mg
1
cefaclor oral tablet extended release 12 hr 500 mg
1
cefadroxil oral capsule 500 mg
1
cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml
1
cefadroxil oral tablet 1 gram
1
cefazolin in dextrose (iso-os) intravenous piggyback 1 gram/50 ml
1
cefazolin injection recon soln 1 gram, 10 gram, 500 mg
1
cefdinir oral capsule 300 mg
1
cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml
1
cefepime injection recon soln 1 gram, 2 gram
1
cefotaxime injection recon soln 1 gram, 2 gram, 500 mg
1
cefoxitin in dextrose, iso-osm intravenous piggyback 1 gram/50 ml, 2
gram/50 ml
1
cefoxitin intravenous recon soln 1 gram, 10 gram, 2 gram
1
cefpodoxime oral suspension for reconstitution 100 mg/5 ml, 50 mg/5 ml
1
cefpodoxime oral tablet 100 mg, 200 mg
1
cefprozil oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml
1
cefprozil oral tablet 250 mg, 500 mg
1
ceftazidime in d5w intravenous piggyback 1 gram/50 ml, 2 gram/50 ml
1
ceftazidime injection recon soln 1 gram, 2 gram, 6 gram
1
ceftriaxone injection recon soln 10 gram, 250 mg, 500 mg
1
ceftriaxone intravenous recon soln 1 gram, 2 gram
1
cefuroxime axetil oral tablet 250 mg, 500 mg
1
cefuroxime sodium injection recon soln 1.5 gram, 750 mg
1
cefuroxime sodium intravenous recon soln 7.5 gram
1
cephalexin oral capsule 250 mg, 500 mg
1
24
Drug Name
cephalexin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml
1
cephalexin oral tablet 250 mg, 500 mg
1
SUPRAX ORAL CAPSULE 400 MG
2
SUPRAX ORAL TABLET,CHEWABLE 100 MG, 200 MG
2
TEFLARO INTRAVENOUS RECON SOLN 400 MG, 600 MG
2
Beta-Lactam, Other
aztreonam injection recon soln 1 gram
1
CAYSTON INHALATION SOLUTION FOR NEBULIZATION 75
MG/ML
2
imipenem-cilastatin intravenous recon soln 250 mg, 500 mg
1
INVANZ INJECTION RECON SOLN 1 GRAM
2
meropenem intravenous recon soln 500 mg
1
days)
PA
Beta-Lactam, Penicillins
amoxicillin oral capsule 250 mg, 500 mg
1
amoxicillin oral suspension for reconstitution 125 mg/5 ml, 200 mg/5 ml,
250 mg/5 ml, 400 mg/5 ml
1
amoxicillin oral tablet 500 mg, 875 mg
1
amoxicillin oral tablet,chewable 125 mg, 250 mg
1
amoxicillin-pot clavulanate oral suspension for reconstitution 200-28.5
mg/5 ml, 250-62.5 mg/5 ml, 400-57 mg/5 ml, 600-42.9 mg/5 ml
1
amoxicillin-pot clavulanate oral tablet 250-125 mg, 500-125 mg, 875-125
mg
1
amoxicillin-pot clavulanate oral tablet extended release 12 hr 1,000-62.5
mg
1
amoxicillin-pot clavulanate oral tablet,chewable 200-28.5 mg, 400-57 mg
1
ampicillin oral capsule 250 mg, 500 mg
1
ampicillin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml
1
ampicillin sodium injection recon soln 1 gram, 10 gram, 125 mg
1
ampicillin-sulbactam injection recon soln 15 gram, 3 gram
1
BICILLIN C-R INTRAMUSCULAR SYRINGE 1,200,000 UNIT/ 2
ML(600K/600K), 1,200,000 UNIT/ 2 ML(900K/300K)
2
BICILLIN L-A INTRAMUSCULAR SYRINGE 1,200,000 UNIT/2 ML,
2,400,000 UNIT/4 ML, 600,000 UNIT/ML
2
dicloxacillin oral capsule 250 mg, 500 mg
1
nafcillin injection recon soln 1 gram, 10 gram
1
25
Drug Name
oxacillin in dextrose(iso-osm) intravenous piggyback 1 gram/50 ml, 2
gram/50 ml
1
oxacillin injection recon soln 10 gram
1
oxacillin intravenous recon soln 2 gram
1
penicillin g pot in dextrose intravenous piggyback 2 million unit/50 ml, 3
million unit/50 ml
1
penicillin g potassium injection recon soln 5 million unit
1
penicillin g procaine intramuscular syringe 1.2 million unit/2 ml
1
penicillin g sodium injection recon soln 5 million unit
1
penicillin v potassium oral recon soln 125 mg/5 ml, 250 mg/5 ml
1
penicillin v potassium oral tablet 250 mg, 500 mg
1
piperacillin-tazobactam intravenous recon soln 3.375 gram, 4.5 gram
1
Macrolides
azithromycin intravenous recon soln 500 mg, 500 mg (2 mg/ml)
1
azithromycin oral suspension for reconstitution 100 mg/5 ml, 200 mg/5 ml
1
azithromycin oral tablet 250 mg, 500 mg, 600 mg
1
clarithromycin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml
1
clarithromycin oral tablet 250 mg, 500 mg
1
clarithromycin oral tablet extended release 24 hr 500 mg
1
ery pads topical swab 2 %
1
ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 250 MG,
333 MG, 500 MG
2
erythrocin (as stearate) oral tablet 250 mg
1
erythrocin intravenous recon soln 500 mg
1
erythromycin ophthalmic ointment 5 mg/gram (0.5 %)
1
erythromycin oral tablet 250 mg, 500 mg
1
erythromycin with ethanol topical gel 2 %
1
erythromycin with ethanol topical solution 2 %
1
Quinolones
ciprofloxacin (mixture) oral tablet, er multiphase 24 hr 1,000 mg, 500 mg
1
ciprofloxacin hcl ophthalmic drops 0.3 %
1
ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg
1
ciprofloxacin in 5 % dextrose intravenous piggyback 200 mg/100 ml
1
ciprofloxacin lactate intravenous solution 400 mg/40 ml
1
26
Drug Name
levofloxacin in d5w intravenous piggyback 500 mg/100 ml
1
levofloxacin intravenous solution 25 mg/ml
1
levofloxacin ophthalmic drops 0.5 %
1
levofloxacin oral solution 250 mg/10 ml
1
levofloxacin oral tablet 250 mg, 500 mg, 750 mg
1
ofloxacin ophthalmic drops 0.3 %
1
ofloxacin oral tablet 400 mg
1
ofloxacin otic drops 0.3 %
1
VIGAMOX OPHTHALMIC DROPS 0.5 %
2
Sulfonamides
silver sulfadiazine topical cream 1 %
1
SSD TOPICAL CREAM 1 %
2
sulfacetamide sodium (acne) topical suspension 10 %
1
sulfacetamide sodium ophthalmic drops 10 %
1
sulfadiazine oral tablet 500 mg
1
sulfamethoxazole-trimethoprim intravenous solution 400-80 mg/5 ml
1
sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5 ml
1
sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800-160 mg
1
Tetracyclines
doxycycline hyclate intravenous recon soln 100 mg
1
doxycycline hyclate oral capsule 100 mg, 50 mg
1
doxycycline hyclate oral tablet 100 mg, 20 mg, 50 mg
1
doxycycline monohydrate oral suspension for reconstitution 25 mg/5 ml
1
doxycycline monohydrate oral tablet 150 mg, 75 mg
1
minocycline oral capsule 100 mg, 50 mg, 75 mg
1
minocycline oral tablet 100 mg, 50 mg, 75 mg
1
tetracycline oral capsule 250 mg, 500 mg
1
Anticonvulsants
Anticonvulsants, Other
DIAZEPAM RECTAL KIT 12.5-15-17.5-20 MG, 2.5 MG, 5-7.5-10 MG
2
levetiracetam intravenous solution 500 mg/5 ml
1
levetiracetam oral solution 100 mg/ml
1
27
Drug Name
levetiracetam oral tablet 1,000 mg, 250 mg, 500 mg, 750 mg
1
levetiracetam oral tablet extended release 24 hr 500 mg
1
levetiracetam oral tablet extended release 24 hr 750 mg
1
POTIGA ORAL TABLET 200 MG, 300 MG, 400 MG, 50 MG
2
Calcium Channel Modifying Agents
CELONTIN ORAL CAPSULE 300 MG
2
ethosuximide oral capsule 250 mg
1
ethosuximide oral solution 250 mg/5 ml
1
LYRICA ORAL CAPSULE 100 MG
2
LYRICA ORAL CAPSULE 150 MG, 200 MG, 25 MG, 50 MG, 75 MG
2
LYRICA ORAL CAPSULE 225 MG, 300 MG
2
LYRICA ORAL SOLUTION 20 MG/ML
2
zonisamide oral capsule 100 mg, 25 mg, 50 mg
1
Gamma-Aminobutyric Acid (GABA) Augmenting Agents
clonazepam oral tablet 0.5 mg, 1 mg, 2 mg
1
clonazepam oral tablet,disintegrating 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2
mg
1
clorazepate dipotassium oral tablet 15 mg, 3.75 mg, 7.5 mg
1
diazepam intensol oral concentrate 5 mg/ml
1
diazepam oral solution 5 mg/5 ml
1
diazepam oral tablet 10 mg, 2 mg, 5 mg
1
divalproex oral capsule, sprinkle 125 mg
1
divalproex oral tablet extended release 24 hr 250 mg, 500 mg
1
divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg, 500 mg
1
gabapentin oral capsule 100 mg, 300 mg, 400 mg
1
gabapentin oral solution 250 mg/5 ml
1
gabapentin oral tablet 600 mg
1
gabapentin oral tablet 800 mg
1
GABITRIL ORAL TABLET 12 MG, 16 MG
2
lorazepam oral tablet 0.5 mg, 1 mg, 2 mg
1
ONFI ORAL SUSPENSION 2.5 MG/ML
2
days)
ONFI ORAL TABLET 10 MG, 20 MG
2
phenobarbital oral elixir 20 mg/5 ml
1
PA
28
Drug Name
phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg,
64.8 mg, 97.2 mg
1
PA
primidone oral tablet 250 mg, 50 mg
1
SABRIL ORAL POWDER IN PACKET 500 MG
2
days)
SABRIL ORAL TABLET 500 MG
2
days)
tiagabine oral tablet 2 mg, 4 mg
1
valproate sodium intravenous solution 500 mg/5 ml (100 mg/ml)
1
valproic acid (as sodium salt) oral solution 250 mg/5 ml
1
valproic acid oral capsule 250 mg
1
Glutamate Reducing Agents
felbamate oral suspension 600 mg/5 ml
1
felbamate oral tablet 400 mg, 600 mg
1
FYCOMPA ORAL TABLET 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8
MG
2
lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg
1
lamotrigine oral tablet extended release 24hr 100 mg, 200 mg, 25 mg, 250
mg, 300 mg, 50 mg
1
lamotrigine oral tablet, chewable dispersible 25 mg, 5 mg
1
topiramate oral capsule, sprinkle 15 mg, 25 mg
1
topiramate oral tablet 100 mg, 200 mg, 50 mg
1
topiramate oral tablet 25 mg
1
Sodium Channel Agents
APTIOM ORAL TABLET 200 MG, 400 MG, 800 MG
2
APTIOM ORAL TABLET 600 MG
2
BANZEL ORAL SUSPENSION 40 MG/ML
2
BANZEL ORAL TABLET 200 MG, 400 MG
2
carbamazepine oral suspension 100 mg/5 ml
1
carbamazepine oral tablet 200 mg
1
carbamazepine oral tablet extended release 12 hr 200 mg, 400 mg
1
carbamazepine oral tablet,chewable 100 mg
1
DILANTIN ORAL CAPSULE 30 MG
2
fosphenytoin injection solution 100 mg pe/2 ml
1
29
Drug Name
oxcarbazepine oral suspension 300 mg/5 ml
1
oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg
1
PEGANONE ORAL TABLET 250 MG
2
phenytoin oral suspension 125 mg/5 ml
1
phenytoin oral tablet,chewable 50 mg
1
phenytoin sodium extended oral capsule 100 mg, 200 mg, 300 mg
1
phenytoin sodium intravenous solution 50 mg/ml
1
VIMPAT INTRAVENOUS SOLUTION 200 MG/20 ML
2
VIMPAT ORAL SOLUTION 10 MG/ML
2
VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG
2
1
PA
donepezil oral tablet 10 mg, 5 mg
1
donepezil oral tablet,disintegrating 10 mg, 5 mg
1
galantamine oral capsule,ext rel. pellets 24 hr 16 mg, 24 mg, 8 mg
1
galantamine oral solution 4 mg/ml
1
galantamine oral tablet 12 mg, 4 mg, 8 mg
1
rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 mg
1
NAMENDA ORAL SOLUTION 10 MG/5 ML
2
NAMENDA XR ORAL CAP,SPRINKLE,ER 24HR DOSE PACK 7-1421-28 MG
2
NAMENDA XR ORAL CAPSULE,SPRINKLE,ER 24HR 14 MG, 21
MG, 28 MG, 7 MG
2
fluoxetine oral tablet 60 mg
1
olanzapine-fluoxetine oral capsule 12-25 mg, 12-50 mg, 3-25 mg, 6-25 mg,
6-50 mg
1
2
Antidementia Agents
Antidementia Agents, Other
ergoloid oral tablet 1 mg
Cholinesterase Inhibitors
N-Methyl-D-Aspartate (NMDA) Receptor Antagonist
Antidepressants
Antidepressants
Antidepressants, Other
ABILIFY MAINTENA INTRAMUSCULAR
SUSPENSION,EXTENDED REL SYRING 300 MG, 400 MG
30
Drug Name
buproban oral tablet extended release 150 mg
1
bupropion hcl oral tablet 100 mg
1
bupropion hcl oral tablet 75 mg
1
bupropion hcl oral tablet extended release 100 mg, 150 mg, 200 mg
1
bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg
1
maprotiline oral tablet 25 mg
1
1
1
mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg
1
mirtazapine oral tablet,disintegrating 15 mg, 30 mg, 45 mg
1
nefazodone oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg
1
trazodone oral tablet 100 mg, 150 mg, 300 mg, 50 mg
1
Monoamine Oxidase Inhibitors
EMSAM TRANSDERMAL PATCH 24 HOUR 12 MG/24 HR, 6 MG/24
HR, 9 MG/24 HR
2
MARPLAN ORAL TABLET 10 MG
2
phenelzine oral tablet 15 mg
1
tranylcypromine oral tablet 10 mg
1
SSRIs/ SNRIs
BRINTELLIX ORAL TABLET 10 MG
2
2
2
days)
citalopram oral solution 10 mg/5 ml
1
citalopram oral tablet 10 mg, 20 mg, 40 mg
1
desvenlafaxine oral tablet extended release 24 hr 100 mg, 50 mg
1
duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg
1
escitalopram oxalate oral solution 5 mg/5 ml
1
escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg
1
FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK 20 MG
(2)- 40 MG (26)
2
FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR 120 MG,
20 MG, 40 MG, 80 MG
2
fluoxetine oral capsule 10 mg, 40 mg
1
31
Drug Name
fluoxetine oral capsule 20 mg
1
fluoxetine oral capsule,delayed release(dr/ec) 90 mg
1
fluoxetine oral solution 20 mg/5 ml
1
1
1
fluvoxamine oral tablet 100 mg
1
1
1
paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg
1
paroxetine hcl oral tablet extended release 24 hr 12.5 mg, 37.5 mg
1
paroxetine hcl oral tablet extended release 24 hr 25 mg
1
PAXIL ORAL SUSPENSION 10 MG/5 ML
2
sertraline oral concentrate 20 mg/ml
1
sertraline oral tablet 100 mg
1
sertraline oral tablet 25 mg, 50 mg
1
venlafaxine oral capsule,extended release 24hr 150 mg, 37.5 mg, 75 mg
1
venlafaxine oral tablet 100 mg
1
venlafaxine oral tablet 25 mg, 37.5 mg, 50 mg
1
venlafaxine oral tablet 75 mg
1
venlafaxine oral tablet extended release 24hr 150 mg, 225 mg, 37.5 mg, 75
mg
1
VIIBRYD ORAL TABLET 10 MG, 20 MG, 40 MG
2
amitriptyline oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg
1
PA
amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg
1
clomipramine oral capsule 25 mg, 50 mg, 75 mg
1
desipramine oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg
1
doxepin oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg
1
PA
doxepin oral concentrate 10 mg/ml
1
PA
imipramine hcl oral tablet 10 mg, 25 mg, 50 mg
1
PA
imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, 75 mg
1
PA
nortriptyline oral capsule 10 mg, 25 mg, 50 mg, 75 mg
1
nortriptyline oral solution 10 mg/5 ml
1
Tricyclics
32
PA
Drug Name
protriptyline oral tablet 10 mg, 5 mg
1
SURMONTIL ORAL CAPSULE 100 MG
2
2
days)
2
days)
Antiemetics
Antiemetics, Other
chlorpromazine injection solution 25 mg/ml
1
chlorpromazine oral tablet 10 mg, 100 mg, 200 mg, 50 mg
1
chlorpromazine oral tablet 25 mg
1
compro rectal suppository 25 mg
1
diphenhydramine hcl injection solution 50 mg/ml
1
hydroxyzine hcl intramuscular solution 25 mg/ml, 50 mg/ml
1
PA
hydroxyzine hcl oral solution 10 mg/5 ml
1
PA
hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg
1
PA
hydroxyzine pamoate oral capsule 100 mg, 25 mg, 50 mg
1
PA
meclizine oral tablet 12.5 mg, 25 mg
1
perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg
1
prochlorperazine edisylate injection solution 10 mg/2 ml (5 mg/ml)
1
prochlorperazine maleate oral tablet 10 mg, 5 mg
1
prochlorperazine rectal suppository 25 mg
1
promethazine injection solution 25 mg/ml, 50 mg/ml
1
PA
promethazine oral syrup 6.25 mg/5 ml
1
PA
promethazine oral tablet 12.5 mg, 25 mg, 50 mg
1
PA
promethazine rectal suppository 12.5 mg, 25 mg
1
PA
promethegan rectal suppository 25 mg, 50 mg
1
PA
dronabinol oral capsule 10 mg, 2.5 mg, 5 mg
1
PA
EMEND ORAL CAPSULE 125 MG, 40 MG, 80 MG
2
PA
EMEND ORAL CAPSULE,DOSE PACK 125 MG (1)- 80 MG (2)
2
PA
granisetron (pf) intravenous solution 100 mcg/ml
1
B vs D
granisetron hcl intravenous solution 1 mg/ml (1 ml)
1
B vs D
B vs D
Emetogenic Therapy Adjuncts
33
Drug Name
granisetron hcl oral tablet 1 mg
1
B vs D
ondansetron hcl (pf) injection solution 4 mg/2 ml
1
ondansetron hcl oral solution 4 mg/5 ml
1
B vs D
ondansetron hcl oral tablet 24 mg, 4 mg, 8 mg
1
B vs D
ondansetron oral tablet,disintegrating 4 mg, 8 mg
1
B vs D
ABELCET INTRAVENOUS SUSPENSION 5 MG/ML
2
PA
AMBISOME INTRAVENOUS SUSPENSION FOR
RECONSTITUTION 50 MG
2
PA
amphotericin b injection recon soln 50 mg
1
PA
CANCIDAS INTRAVENOUS RECON SOLN 50 MG, 70 MG
2
PA
ciclopirox topical cream 0.77 %
1
ciclopirox topical gel 0.77 %
1
ciclopirox topical shampoo 1 %
1
ciclopirox topical suspension 0.77 %
1
clotrimazole mucous membrane troche 10 mg
1
clotrimazole topical cream 1 %
1
clotrimazole topical solution 1 %
1
econazole topical cream 1 %
1
fluconazole in dextrose(iso-o) intravenous piggyback 400 mg/200 ml
1
fluconazole oral suspension for reconstitution 10 mg/ml, 40 mg/ml
1
fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg
1
flucytosine oral capsule 250 mg, 500 mg
1
griseofulvin microsize oral suspension 125 mg/5 ml
1
itraconazole oral capsule 100 mg
1
ketoconazole oral tablet 200 mg
1
ketoconazole topical cream 2 %
1
ketoconazole topical shampoo 2 %
1
miconazole-3 vaginal suppository 200 mg
1
MYCAMINE INTRAVENOUS RECON SOLN 100 MG, 50 MG
2
NATACYN OPHTHALMIC DROPS,SUSPENSION 5 %
2
NOXAFIL ORAL SUSPENSION 200 MG/5 ML (40 MG/ML)
2
Antifungals
Antifungals
34
PA
PA
Drug Name
nystatin oral suspension 100,000 unit/ml
1
nystatin oral tablet 500,000 unit
1
nystatin topical cream 100,000 unit/gram
1
nystatin topical ointment 100,000 unit/gram
1
nystatin topical powder 100,000 unit/gram
1
SPORANOX ORAL SOLUTION 10 MG/ML
2
terbinafine hcl oral tablet 250 mg
1
terconazole vaginal cream 0.4 %, 0.8 %
1
terconazole vaginal suppository 80 mg
1
voriconazole intravenous solution 200 mg
1
PA
voriconazole oral suspension for reconstitution 200 mg/5 ml (40 mg/ml)
1
voriconazole oral tablet 200 mg, 50 mg
1
ZOLINZA ORAL CAPSULE 100 MG
2
days)
PA
Antigout Agents
Antigout Agents
allopurinol oral tablet 100 mg, 300 mg
1
colchicine oral capsule 0.6 mg
1
colchicine oral tablet 0.6 mg
1
colchicine-probenecid oral tablet 0.5-500 mg
1
COLCRYS ORAL TABLET 0.6 MG
2
probenecid oral tablet 500 mg
1
Anti-Inflammatory Agents
Nonsteroidal Anti-Inflammatory Drugs
diclofenac potassium oral tablet 50 mg
1
diclofenac sodium oral tablet extended release 24 hr 100 mg
1
diclofenac sodium oral tablet,delayed release (dr/ec) 50 mg
1
flurbiprofen oral tablet 100 mg, 50 mg
1
ibuprofen oral suspension 100 mg/5 ml
1
ibuprofen oral tablet 400 mg, 600 mg
1
indomethacin oral capsule 50 mg
1
days)
indomethacin oral capsule, extended release 75 mg
1
35
Drug Name
naproxen oral suspension 125 mg/5 ml
1
naproxen oral tablet 250 mg
1
sulindac oral tablet 150 mg, 200 mg
1
Antimigraine Agents
Ergot Alkaloids
dihydroergotamine injection solution 1 mg/ml
1
ERGOMAR SUBLINGUAL TABLET 2 MG
2
rizatriptan oral tablet 10 mg, 5 mg
1
rizatriptan oral tablet,disintegrating 10 mg, 5 mg
1
sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg
1
sumatriptan succinate subcutaneous pen injector 6 mg/0.5 ml
1
sumatriptan succinate subcutaneous solution 6 mg/0.5 ml
1
Serotonin (5-HT) 1B/1D Receptor Agonists
Antimyasthenic Agents
Parasympathomimetics
guanidine oral tablet 125 mg
1
pyridostigmine bromide oral tablet 60 mg
1
Antimycobacterials
Antimycobacterials, Other
dapsone oral tablet 100 mg, 25 mg
1
rifabutin oral capsule 150 mg
1
Antituberculars
CAPASTAT INJECTION RECON SOLN 1 GRAM
2
ethambutol oral tablet 100 mg, 400 mg
1
isoniazid injection solution 100 mg/ml
1
isoniazid oral solution 50 mg/5 ml
1
isoniazid oral tablet 100 mg, 300 mg
1
PASER ORAL GRANULES DR FOR SUSP IN PACKET 4 GRAM
2
pyrazinamide oral tablet 500 mg
1
RIFAMATE ORAL CAPSULE 300-150 MG
2
rifampin intravenous recon soln 600 mg
1
rifampin oral capsule 150 mg, 300 mg
1
RIFATER ORAL TABLET 50-120-300 MG
2
36
PA
Drug Name
SIRTURO ORAL TABLET 100 MG
2
TRECATOR ORAL TABLET 250 MG
2
days)
Antineoplastics
Alkylating Agents
BUSULFEX INTRAVENOUS SOLUTION 60 MG/10 ML
2
cyclophosphamide oral capsule 25 mg, 50 mg
1
B vs D
HEXALEN ORAL CAPSULE 50 MG
2
PA
LEUKERAN ORAL TABLET 2 MG
2
LOMUSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG
2
MATULANE ORAL CAPSULE 50 MG
2
melphalan hcl intravenous recon soln 50 mg
1
PA
Antiandrogens
bicalutamide oral tablet 50 mg
1
flutamide oral capsule 125 mg
1
NILANDRON ORAL TABLET 150 MG
2
PA
XTANDI ORAL CAPSULE 40 MG
2
PA
ZYTIGA ORAL TABLET 250 MG
2
days)
POMALYST ORAL CAPSULE 1 MG, 2 MG, 3 MG, 4 MG
2
REVLIMID ORAL CAPSULE 10 MG, 15 MG, 25 MG, 5 MG
2
PA
THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 MG, 50 MG
2
PA
EMCYT ORAL CAPSULE 140 MG
2
PA
FARESTON ORAL TABLET 60 MG
2
SOLTAMOX ORAL SOLUTION 10 MG/5 ML
2
tamoxifen oral tablet 10 mg, 20 mg
1
Antiangiogenic Agents
Antiestrogens/Modifiers
Antimetabolites
gemcitabine intravenous recon soln 1 gram
1
B vs D
hydroxyurea oral capsule 500 mg
1
PURIXAN ORAL SUSPENSION 20 MG/ML
2
PA
TABLOID ORAL TABLET 40 MG
2
PA
37
Drug Name
Antineoplastics
ALIMTA INTRAVENOUS RECON SOLN 500 MG
2
B vs D
ARRANON INTRAVENOUS SOLUTION 250 MG/50 ML
2
PA
AVASTIN INTRAVENOUS SOLUTION 25 MG/ML
2
PA
azacitidine injection recon soln 100 mg
1
B vs D
BELEODAQ INTRAVENOUS RECON SOLN 500 MG
2
PA
BICNU INTRAVENOUS RECON SOLN 100 MG
2
B vs D
bleomycin injection recon soln 30 unit
1
PA
carboplatin intravenous solution 10 mg/ml
1
B vs D
cisplatin intravenous solution 1 mg/ml
1
B vs D
cladribine intravenous solution 10 mg/10 ml
1
B vs D
COSMEGEN INTRAVENOUS RECON SOLN 0.5 MG
2
PA
cytarabine (pf) injection solution 2 gram/20 ml (100 mg/ml)
1
B vs D
cytarabine injection solution 20 mg/ml
1
B vs D
dacarbazine intravenous recon soln 200 mg
1
B vs D
daunorubicin intravenous solution 5 mg/ml
1
B vs D
decitabine intravenous recon soln 50 mg
1
B vs D
dexrazoxane hcl intravenous recon soln 250 mg
1
DOCEFREZ INTRAVENOUS RECON SOLN 20 MG
2
PA
DOCETAXEL INTRAVENOUS SOLUTION 80 MG/4 ML (20
MG/ML)
2
PA
docetaxel intravenous solution 80 mg/8 ml (10 mg/ml)
1
PA
DOXIL INTRAVENOUS SUSPENSION 2 MG/ML
2
doxorubicin intravenous solution 50 mg/25 ml
1
B vs D
ELITEK INTRAVENOUS RECON SOLN 1.5 MG
2
B vs D
epirubicin intravenous solution 50 mg/25 ml
1
PA
ERBITUX INTRAVENOUS SOLUTION 100 MG/50 ML
2
PA
ERWINAZE INTRAMUSCULAR RECON SOLN 10,000 UNIT
2
PA
FASLODEX INTRAMUSCULAR SYRINGE 250 MG/5 ML
2
PA
HALAVEN INTRAVENOUS SOLUTION 1 MG/2 ML (0.5 MG/ML)
2
B vs D
HERCEPTIN INTRAVENOUS RECON SOLN 440 MG
2
B vs D
idarubicin intravenous solution 1 mg/ml
1
B vs D
ifosfamide intravenous recon soln 1 gram
1
38
Drug Name
irinotecan intravenous solution 100 mg/5 ml
1
ISTODAX INTRAVENOUS RECON SOLN 10 MG/2 ML
2
PA
IXEMPRA INTRAVENOUS RECON SOLN 45 MG
2
PA
JEVTANA INTRAVENOUS SOLUTION 10 MG/ML (FIRST
DILUTION)
2
B vs D
KADCYLA INTRAVENOUS RECON SOLN 100 MG
2
PA
levoleucovorin calcium intravenous solution 10 mg/ml
1
PA
LYNPARZA ORAL CAPSULE 50 MG
2
PA
mesna intravenous solution 100 mg/ml
1
B vs D
MESNEX ORAL TABLET 400 MG
2
mitomycin intravenous recon soln 20 mg
1
B vs D
MUSTARGEN INJECTION RECON SOLN 10 MG
2
PA
oxaliplatin intravenous solution 100 mg/20 ml
1
PA
paclitaxel intravenous concentrate 6 mg/ml
1
B vs D
PERJETA INTRAVENOUS SOLUTION 420 MG/14 ML (30 MG/ML)
2
PA
PROLEUKIN INTRAVENOUS RECON SOLN 22 MILLION UNIT
2
PA
TREANDA INTRAVENOUS RECON SOLN 100 MG
2
PA
TREANDA INTRAVENOUS SOLUTION 45 MG/0.5 ML
2
PA
TRISENOX INTRAVENOUS SOLUTION 10 MG/10 ML
2
B vs D
VECTIBIX INTRAVENOUS SOLUTION 100 MG/5 ML (20 MG/ML)
2
B vs D
VELCADE INJECTION RECON SOLN 3.5 MG
2
PA
vinblastine intravenous solution 1 mg/ml
1
B vs D
vincristine intravenous solution 1 mg/ml
1
B vs D
vinorelbine intravenous solution 50 mg/5 ml
1
B vs D
ABRAXANE INTRAVENOUS SUSPENSION FOR
2
PA
amifostine crystalline intravenous recon soln 500 mg
1
fludarabine intravenous recon soln 50 mg
1
leucovorin calcium injection recon soln 100 mg, 350 mg
1
leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg
1
mitoxantrone intravenous concentrate 2 mg/ml
1
B vs D
ONCASPAR INJECTION SOLUTION 750 UNIT/ML
2
PA
Antineoplastics, Other
B vs D
39
Drug Name
REVLIMID ORAL CAPSULE 2.5 MG, 20 MG
2
PA
SYNRIBO SUBCUTANEOUS RECON SOLN 3.5 MG
2
PA
YERVOY INTRAVENOUS SOLUTION 50 MG/10 ML (5 MG/ML)
2
PA
ZALTRAP INTRAVENOUS SOLUTION 100 MG/4 ML (25 MG/ML)
2
PA
anastrozole oral tablet 1 mg
1
exemestane oral tablet 25 mg
1
letrozole oral tablet 2.5 mg
1
etoposide intravenous solution 20 mg/ml
1
B vs D
FARYDAK ORAL CAPSULE 10 MG, 15 MG, 20 MG
2
PA
IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG
2
PA
toposar intravenous solution 20 mg/ml
1
B vs D
topotecan intravenous recon soln 4 mg
1
ZYDELIG ORAL TABLET 100 MG, 150 MG
2
PA
AFINITOR ORAL TABLET 10 MG, 2.5 MG, 5 MG, 7.5 MG
2
BOSULIF ORAL TABLET 100 MG, 500 MG
2
PA
CAPRELSA ORAL TABLET 100 MG, 300 MG
2
PA
COMETRIQ ORAL CAPSULE 100 MG/DAY(80 MG[1]-20 MG[1]),
140 MG/DAY(80 MG[1]-20 MG[3]), 60 MG/DAY (20 MG [3]/DAY)
2
PA
ERIVEDGE ORAL CAPSULE 150 MG
2
GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG
2
GLEEVEC ORAL TABLET 100 MG
2
GLEEVEC ORAL TABLET 400 MG
2
ICLUSIG ORAL TABLET 15 MG
2
ICLUSIG ORAL TABLET 45 MG
2
IMBRUVICA ORAL CAPSULE 140 MG
2
days)
INLYTA ORAL TABLET 1 MG, 5 MG
2
JAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MG
2
LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG [1]/DAY), 14 MG
(10 MG[1] -4 MG[1])/DAY, 20 MG/DAY (10 MG [2]/DAY)
2
LENVIMA ORAL CAPSULE 24 MG (10 MG[2] -4 MG[1])/DAY
2
rd
Aromatase Inhibitors, 3 Generation
Enzyme Inhibitors
Molecular Target Inhibitors
40
Drug Name
MEKINIST ORAL TABLET 0.5 MG
2
MEKINIST ORAL TABLET 2 MG
2
NEXAVAR ORAL TABLET 200 MG
2
days)
SPRYCEL ORAL TABLET 100 MG, 140 MG
2
SPRYCEL ORAL TABLET 20 MG, 50 MG, 70 MG, 80 MG
2
STIVARGA ORAL TABLET 40 MG
2
PA
SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 37.5 MG, 50 MG
2
TAFINLAR ORAL CAPSULE 50 MG, 75 MG
2
PA
TARCEVA ORAL TABLET 100 MG, 150 MG, 25 MG
2
TASIGNA ORAL CAPSULE 150 MG, 200 MG
2
days)
TYKERB ORAL TABLET 250 MG
2
days)
VOTRIENT ORAL TABLET 200 MG
2
PA
XALKORI ORAL CAPSULE 200 MG, 250 MG
2
ZELBORAF ORAL TABLET 240 MG
2
days)
ZYKADIA ORAL CAPSULE 150 MG
2
days)
ARZERRA INTRAVENOUS SOLUTION 100 MG/5 ML
2
PA
KEYTRUDA INTRAVENOUS RECON SOLN 50 MG
2
PA
OPDIVO INTRAVENOUS SOLUTION 40 MG/4 ML
2
PA
RITUXAN INTRAVENOUS CONCENTRATE 10 MG/ML
2
B vs D
SYLVANT INTRAVENOUS RECON SOLN 100 MG
2
PA
PANRETIN TOPICAL GEL 0.1 %
2
PA
TARGRETIN ORAL CAPSULE 75 MG
2
PA
TARGRETIN TOPICAL GEL 1 %
2
tretinoin (chemotherapy) oral capsule 10 mg
1
tretinoin topical cream 0.025 %, 0.05 %, 0.1 %
1
tretinoin topical gel 0.01 %, 0.025 %
1
Monoclonal Antibodies
Retinoids
Antiparasitics
41
Drug Name
Anthelmintics
ALBENZA ORAL TABLET 200 MG
2
BILTRICIDE ORAL TABLET 600 MG
2
ivermectin oral tablet 3 mg
1
Antiprotozoals
ALINIA ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5
ML
2
ALINIA ORAL TABLET 500 MG
2
atovaquone oral suspension 750 mg/5 ml
1
atovaquone-proguanil oral tablet 250-100 mg, 62.5-25 mg
1
chloroquine phosphate oral tablet 250 mg, 500 mg
1
COARTEM ORAL TABLET 20-120 MG
2
DARAPRIM ORAL TABLET 25 MG
2
hydroxychloroquine oral tablet 200 mg
1
mefloquine oral tablet 250 mg
1
NEBUPENT INHALATION RECON SOLN 300 MG
2
PENTAM INJECTION RECON SOLN 300 MG
2
primaquine oral tablet 26.3 mg
1
quinine sulfate oral capsule 324 mg
1
PA
B vs D
PA
Pediculicides/ Scabicides
malathion topical lotion 0.5 %
1
permethrin topical cream 5 %
1
Antiparkinson Agents
Anticholinergics
benztropine injection solution 2 mg/2 ml
1
benztropine oral tablet 0.5 mg, 1 mg, 2 mg
1
PA
trihexyphenidyl oral elixir 0.4 mg/ml
1
PA
trihexyphenidyl oral tablet 2 mg, 5 mg
1
PA
Antiparkinson Agents, Other
entacapone oral tablet 200 mg
1
tolcapone oral tablet 100 mg
1
PA
2
days)
Dopamine Agonists
APOKYN SUBCUTANEOUS CARTRIDGE 10 MG/ML
42
Drug Name
bromocriptine oral capsule 5 mg
1
bromocriptine oral tablet 2.5 mg
1
NEUPRO TRANSDERMAL PATCH 24 HOUR 1 MG/24 HOUR, 2
MG/24 HOUR, 3 MG/24 HOUR, 4 MG/24 HOUR, 6 MG/24 HOUR, 8
MG/24 HOUR
2
pramipexole oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg
1
ropinirole oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg
1
Dopamine Precursors/ L-Amino Acid Decarboxylase Inhibitors
carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25-250 mg
1
carbidopa-levodopa oral tablet extended release 25-100 mg, 50-200 mg
1
carbidopa-levodopa oral tablet,disintegrating 10-100 mg, 25-100 mg, 25250 mg
1
Monoamine Oxidase B (MAO-B) Inhibitors
AZILECT ORAL TABLET 0.5 MG, 1 MG
2
selegiline hcl oral capsule 5 mg
1
selegiline hcl oral tablet 5 mg
1
ZELAPAR ORAL TABLET,DISINTEGRATING 1.25 MG
2
Antipsychotics
1st Generation/ Typical
fluphenazine decanoate injection solution 25 mg/ml
1
fluphenazine hcl injection solution 2.5 mg/ml
1
fluphenazine hcl oral concentrate 5 mg/ml
1
fluphenazine hcl oral elixir 2.5 mg/5 ml
1
fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg
1
haloperidol decanoate intramuscular solution 100 mg/ml, 50 mg/ml
1
haloperidol lactate injection solution 5 mg/ml
1
haloperidol lactate oral concentrate 2 mg/ml
1
haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg
1
loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg
1
ORAP ORAL TABLET 1 MG, 2 MG
2
thioridazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg
1
thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg
1
trifluoperazine oral tablet 1 mg, 10 mg, 2 mg, 5 mg
1
PA
43
Drug Name
2nd Generation/ Atypical
ABILIFY DISCMELT ORAL TABLET,DISINTEGRATING 10 MG
2
ABILIFY MAINTENA INTRAMUSCULAR
SUSPENSION,EXTENDED REL RECON 300 MG
2
aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg
1
FANAPT ORAL TABLET 1 MG, 10 MG, 12 MG, 2 MG, 4 MG, 6 MG,
8 MG
2
FANAPT ORAL TABLETS,DOSE PACK 1MG(2)-2MG(2)- 4MG(2)6MG(2)
2
GEODON INTRAMUSCULAR RECON SOLN 20 MG/ML (FINAL
CONC.)
2
PA
INVEGA ORAL TABLET EXTENDED RELEASE 24HR 1.5 MG, 3
MG, 9 MG
2
INVEGA ORAL TABLET EXTENDED RELEASE 24HR 6 MG
2
INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75
ML
2
PA; QL (0.75 ML per 28
days)
INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 156 MG/ML
2
PA; QL (1 ML per 28 days)
INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 234 MG/1.5 ML
2
days)
2
days)
2
days)
LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG, 80 MG
2
olanzapine intramuscular recon soln 10 mg
1
PA
olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg
1
olanzapine oral tablet,disintegrating 10 mg, 15 mg, 20 mg, 5 mg
1
quetiapine oral tablet 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg
1
RISPERDAL CONSTA INTRAMUSCULAR SYRINGE 12.5 MG/2
ML, 25 MG/2 ML, 37.5 MG/2 ML, 50 MG/2 ML
2
PA
risperidone oral solution 1 mg/ml
1
risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg
1
risperidone oral tablet 4 mg
1
risperidone oral tablet,disintegrating 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg
1
risperidone oral tablet,disintegrating 4 mg
1
SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET 10 MG, 2.5
MG, 5 MG
2
44
Drug Name
ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg
1
ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR
2
PA
Treatment-Resistant
clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg
1
clozapine oral tablet,disintegrating 100 mg
1
clozapine oral tablet,disintegrating 12.5 mg
1
1
1
1
FAZACLO ORAL TABLET,DISINTEGRATING 100 MG
2
days)
FAZACLO ORAL TABLET,DISINTEGRATING 12.5 MG
2
2
days)
2
days)
2
VERSACLOZ ORAL SUSPENSION 50 MG/ML
2
days)
Antispasticity Agents
Antispasticity Agents
baclofen oral tablet 10 mg, 20 mg
1
dantrolene oral capsule 100 mg, 25 mg, 50 mg
1
tizanidine oral tablet 2 mg, 4 mg
1
Antivirals
Anti-Cytomegalovirus (CMV) Agents
cidofovir intravenous solution 75 mg/ml
1
foscarnet intravenous solution 24 mg/ml
1
ganciclovir sodium intravenous recon soln 500 mg
1
VALCYTE ORAL RECON SOLN 50 MG/ML
2
valganciclovir oral tablet 450 mg
1
ZIRGAN OPHTHALMIC GEL 0.15 %
2
PA
Anti-Hepatitis B (HBV) Agents
45
Drug Name
adefovir oral tablet 10 mg
1
PA
BARACLUDE ORAL SOLUTION 0.05 MG/ML
2
days)
entecavir oral tablet 0.5 mg, 1 mg
1
EPIVIR HBV ORAL SOLUTION 25 MG/5 ML (5 MG/ML)
2
INTRON A INJECTION RECON SOLN 10 MILLION UNIT (1 ML)
2
PA
INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML
2
PA
lamivudine oral tablet 100 mg, 150 mg, 300 mg
1
ribavirin oral capsule 200 mg
1
PA
ribavirin oral tablet 200 mg
1
PA
TYZEKA ORAL TABLET 600 MG
2
VIRAZOLE INHALATION RECON SOLN 6 GRAM
2
PA
VIREAD ORAL POWDER 40 MG/SCOOP (40 MG/GRAM)
2
VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG, 300 MG
2
HARVONI ORAL TABLET 90-400 MG
2
INTRON A INJECTION RECON SOLN 18 MILLION UNIT (1 ML),
50 MILLION UNIT (1 ML)
2
PA
OLYSIO ORAL CAPSULE 150 MG
2
PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 135
MCG/0.5 ML, 180 MCG/0.5 ML
2
PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML
2
PEGASYS SUBCUTANEOUS SYRINGE 180 MCG/0.5 ML
2
PEGINTRON REDIPEN SUBCUTANEOUS PEN INJECTOR KIT
120 MCG/0.5 ML, 150 MCG/0.5 ML, 50 MCG/0.5 ML, 80 MCG/0.5
ML
2
PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5 ML
2
SOVALDI ORAL TABLET 400 MG
2
SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG
2
Anti-Hepatitis C (HCV) Agents
Antiherpetic Agents
acyclovir oral capsule 200 mg
1
acyclovir oral suspension 200 mg/5 ml
1
acyclovir oral tablet 400 mg, 800 mg
1
acyclovir sodium intravenous solution 50 mg/ml
1
acyclovir topical ointment 5 %
1
46
Drug Name
famciclovir oral tablet 125 mg, 250 mg
1
famciclovir oral tablet 500 mg
1
trifluridine ophthalmic drops 1 %
1
valacyclovir oral tablet 1 gram
1
valacyclovir oral tablet 500 mg
1
Anti-HIV Agents, Integrase Inhibitors (INSTI)
ISENTRESS ORAL POWDER IN PACKET 100 MG
2
ISENTRESS ORAL TABLET 400 MG
2
ISENTRESS ORAL TABLET,CHEWABLE 100 MG, 25 MG
2
STRIBILD ORAL TABLET 150-150-200-300 MG
2
TIVICAY ORAL TABLET 50 MG
2
VITEKTA ORAL TABLET 150 MG, 85 MG
2
COMPLERA ORAL TABLET 200-25-300 MG
2
EDURANT ORAL TABLET 25 MG
2
INTELENCE ORAL TABLET 100 MG, 200 MG
2
INTELENCE ORAL TABLET 25 MG
2
nevirapine oral suspension 50 mg/5 ml
1
nevirapine oral tablet 200 mg
1
nevirapine oral tablet extended release 24 hr 400 mg
1
RESCRIPTOR ORAL TABLET 200 MG
2
RESCRIPTOR ORAL TABLET, DISPERSIBLE 100 MG
2
SUSTIVA ORAL CAPSULE 200 MG
2
SUSTIVA ORAL CAPSULE 50 MG
2
SUSTIVA ORAL TABLET 600 MG
2
VIRAMUNE XR ORAL TABLET EXTENDED RELEASE 24 HR 100
MG
2
Anti-HIV Agents, Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)
Anti-HIV Agents, Nucleoside And Nucleotide Reverse Transcriptase Inhibitors (NRTI)
abacavir oral tablet 300 mg
1
abacavir-lamivudine-zidovudine oral tablet 300-150-300 mg
1
ATRIPLA ORAL TABLET 600-200-300 MG
2
didanosine oral capsule,delayed release(dr/ec) 125 mg, 200 mg, 250 mg,
400 mg
1
47
Drug Name
EMTRIVA ORAL CAPSULE 200 MG
2
EMTRIVA ORAL SOLUTION 10 MG/ML
2
EPZICOM ORAL TABLET 600-300 MG
2
lamivudine oral solution 10 mg/ml
1
lamivudine-zidovudine oral tablet 150-300 mg
1
RETROVIR INTRAVENOUS SOLUTION 10 MG/ML
2
stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg
1
stavudine oral recon soln 1 mg/ml
1
TRUVADA ORAL TABLET 200-300 MG
2
VIDEX 2 GRAM PEDIATRIC ORAL RECON SOLN 10 MG/ML
(FINAL)
2
ZIAGEN ORAL SOLUTION 20 MG/ML
2
zidovudine oral capsule 100 mg
1
zidovudine oral syrup 10 mg/ml
1
zidovudine oral tablet 300 mg
1
Anti-HIV Agents, Other
FUZEON SUBCUTANEOUS RECON SOLN 90 MG
2
SELZENTRY ORAL TABLET 150 MG
2
SELZENTRY ORAL TABLET 300 MG
2
TRIUMEQ ORAL TABLET 600-50-300 MG
2
TYBOST ORAL TABLET 150 MG
2
APTIVUS ORAL CAPSULE 250 MG
2
APTIVUS ORAL SOLUTION 100 MG/ML
2
CRIXIVAN ORAL CAPSULE 200 MG
2
CRIXIVAN ORAL CAPSULE 400 MG
2
EVOTAZ ORAL TABLET 300-150 MG
2
INVIRASE ORAL CAPSULE 200 MG
2
INVIRASE ORAL TABLET 500 MG
2
KALETRA ORAL SOLUTION 400-100 MG/5 ML
2
QL (387.5 ML per 31 days)
KALETRA ORAL TABLET 100-25 MG
2
KALETRA ORAL TABLET 200-50 MG
2
LEXIVA ORAL SUSPENSION 50 MG/ML
2
Anti-HIV Agents, Protease Inhibitors
48
Drug Name
LEXIVA ORAL TABLET 700 MG
2
NORVIR ORAL CAPSULE 100 MG
2
NORVIR ORAL SOLUTION 80 MG/ML
2
NORVIR ORAL TABLET 100 MG
2
PREZCOBIX ORAL TABLET 800-150 MG-MG
2
PREZISTA ORAL SUSPENSION 100 MG/ML
2
PREZISTA ORAL TABLET 150 MG
2
PREZISTA ORAL TABLET 600 MG, 800 MG
2
PREZISTA ORAL TABLET 75 MG
2
REYATAZ ORAL CAPSULE 150 MG, 300 MG
2
REYATAZ ORAL CAPSULE 200 MG
2
REYATAZ ORAL POWDER IN PACKET 50 MG
2
VIRACEPT ORAL TABLET 250 MG
2
VIRACEPT ORAL TABLET 625 MG
2
Anti-Influenza Agents
amantadine hcl oral capsule 100 mg
1
amantadine hcl oral solution 50 mg/5 ml
1
amantadine hcl oral tablet 100 mg
1
RELENZA DISKHALER INHALATION BLISTER WITH DEVICE 5
MG/ACTUATION
2
rimantadine oral tablet 100 mg
1
TAMIFLU ORAL CAPSULE 30 MG
2
TAMIFLU ORAL CAPSULE 45 MG, 75 MG
2
Anxiolytics
Anxiolytics, Other
buspirone oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg
1
meprobamate oral tablet 200 mg, 400 mg
1
PA
triazolam oral tablet 0.125 mg, 0.25 mg
1
alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg
1
alprazolam oral tablet extended release 24 hr 0.5 mg, 1 mg
1
alprazolam oral tablet extended release 24 hr 2 mg
1
alprazolam oral tablet extended release 24 hr 3 mg
1
Benzodiazepines
49
Drug Name
Bipolar Agents
Mood Stabilizers
carbamazepine oral capsule, er multiphase 12 hr 100 mg, 200 mg, 300 mg
1
lithium carbonate oral capsule 150 mg, 300 mg, 600 mg
1
lithium carbonate oral tablet 300 mg
1
lithium carbonate oral tablet extended release 300 mg, 450 mg
1
lithium citrate oral solution 8 meq/5 ml
1
Blood Glucose Regulators
Antidiabetic Agents
BYETTA SUBCUTANEOUS PEN INJECTOR 10 MCG/DOSE(250
MCG/ML) 2.4 ML, 5 MCG/DOSE (250 MCG/ML) 1.2 ML
2
CYCLOSET ORAL TABLET 0.8 MG
2
PA
glimepiride oral tablet 1 mg, 2 mg, 4 mg
1
glipizide oral tablet 10 mg
1
glipizide oral tablet 5 mg
1
glipizide oral tablet extended release 24hr 10 mg
1
glipizide oral tablet extended release 24hr 2.5 mg, 5 mg
1
glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg
1
PA
glyburide oral tablet 1.25 mg, 2.5 mg
1
days)
glyburide oral tablet 5 mg
1
days)
INVOKAMET ORAL TABLET 150-1,000 MG, 150-500 MG, 50-1,000
MG
2
INVOKAMET ORAL TABLET 50-500 MG
2
days)
INVOKANA ORAL TABLET 100 MG, 300 MG
2
JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG
2
metformin oral tablet 1,000 mg, 500 mg, 850 mg
1
metformin oral tablet extended release 24 hr 500 mg, 750 mg
1
nateglinide oral tablet 120 mg, 60 mg
1
pioglitazone oral tablet 15 mg, 30 mg, 45 mg
1
repaglinide oral tablet 0.5 mg, 1 mg, 2 mg
1
SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR 2,700 MCG/2.7
ML
2
PA
50
Drug Name
2
PA
glipizide-metformin oral tablet 2.5-250 mg
1
glipizide-metformin oral tablet 2.5-500 mg, 5-500 mg
1
glyburide-metformin oral tablet 1.25-250 mg
1
glyburide-metformin oral tablet 2.5-500 mg, 5-500 mg
1
days)
JANUMET ORAL TABLET 50-1,000 MG, 50-500 MG
2
pioglitazone-glimepiride oral tablet 30-2 mg, 30-4 mg
1
pioglitazone-metformin oral tablet 15-500 mg, 15-850 mg
1
SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR 1,500 MCG/1.5
ML
Blood Glucose Regulators
Glycemic Agents
GLUCAGEN HYPOKIT INJECTION RECON SOLN 1 MG
2
GLUCAGON EMERGENCY KIT (HUMAN) INJECTION KIT 1 MG
2
KORLYM ORAL TABLET 300 MG
2
days)
PROGLYCEM ORAL SUSPENSION 50 MG/ML
2
Insulins
APIDRA SOLOSTAR SUBCUTANEOUS INSULIN PEN 100
UNIT/ML
2
APIDRA SUBCUTANEOUS SOLUTION 100 UNIT/ML
2
gauze pad topical bandage 2 x 2 "
1
HUMALOG MIX 50-50 SUBCUTANEOUS SUSPENSION 100
UNIT/ML (50-50)
2
HUMALOG MIX 75-25 SUBCUTANEOUS SUSPENSION 100
UNIT/ML (75-25)
2
HUMALOG SUBCUTANEOUS SOLUTION 100 UNIT/ML
2
HUMULIN 70/30 SUBCUTANEOUS SUSPENSION 100 UNIT/ML
(70-30)
2
HUMULIN N SUBCUTANEOUS SUSPENSION 100 UNIT/ML
2
HUMULIN R INJECTION SOLUTION 100 UNIT/ML
2
HUMULIN R U-500 "CONCENTRATED" SUBCUTANEOUS
SOLUTION 500 UNIT/ML
2
INSULIN PEN NEEDLE NEEDLE 29 GAUGE X 1/2 "
2
51
Drug Name
INSULIN SYRINGE-NEEDLE U-100 SYRINGE 0.3 ML 29, 1 ML 29 X
1/2", 1/2 ML 28
2
LANTUS SOLOSTAR SUBCUTANEOUS INSULIN PEN 100
UNIT/ML (3 ML)
2
LANTUS SUBCUTANEOUS SOLUTION 100 UNIT/ML
2
LEVEMIR SUBCUTANEOUS SOLUTION 100 UNIT/ML
2
NOVOLIN 70/30 SUBCUTANEOUS SUSPENSION 100 UNIT/ML (7030)
2
NOVOLIN N SUBCUTANEOUS SUSPENSION 100 UNIT/ML
2
NOVOLIN R INJECTION SOLUTION 100 UNIT/ML
2
NOVOLOG MIX 70-30 SUBCUTANEOUS SOLUTION 100 UNIT/ML
(70-30)
2
NOVOLOG SUBCUTANEOUS SOLUTION 100 UNIT/ML
2
SAFETY NEEDLES NEEDLE 18 X 1 1/2 "
2
Blood Products/ Modifiers/ Volume Expanders
Anticoagulants
ARGATROBAN IN 0.9 % SOD CHLOR INTRAVENOUS SOLUTION
125 MG/125 ML (1 MG/ML)
2
ARGATROBAN INTRAVENOUS SOLUTION 100 MG/ML
2
COUMADIN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 MG, 3 MG, 4
MG, 5 MG, 6 MG, 7.5 MG
2
ELIQUIS ORAL TABLET 2.5 MG
2
ELIQUIS ORAL TABLET 5 MG
2
enoxaparin subcutaneous solution 300 mg/3 ml
1
enoxaparin subcutaneous syringe 100 mg/ml, 150 mg/ml
1
enoxaparin subcutaneous syringe 120 mg/0.8 ml, 80 mg/0.8 ml
1
enoxaparin subcutaneous syringe 30 mg/0.3 ml
1
1
1
fondaparinux subcutaneous syringe 10 mg/0.8 ml, 2.5 mg/0.5 ml, 5 mg/0.4
ml, 7.5 mg/0.6 ml
1
FRAGMIN SUBCUTANEOUS SOLUTION 25,000 ANTI-XA
UNIT/ML
2
PA
FRAGMIN SUBCUTANEOUS SYRINGE 10,000 ANTI-XA UNIT/ML,
12,500 ANTI-XA UNIT/0.5 ML, 15,000 ANTI-XA UNIT/0.6 ML, 18,000
ANTI-XA UNIT/0.72 ML, 2,500 ANTI-XA UNIT/0.2 ML, 5,000 ANTIXA UNIT/0.2 ML, 7,500 ANTI-XA UNIT/0.3 ML
52
2
PA
Drug Name
heparin (porcine) in 5 % dex intravenous parenteral solution 20,000
unit/500 ml (40 unit/ml), 25,000 unit/250 ml(100 unit/ml), 25,000 unit/500
ml (50 unit/ml)
1
B vs D
heparin (porcine) injection solution 1,000 unit/ml, 10,000 unit/ml, 20,000
unit/ml, 5,000 unit/ml
1
B vs D
jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5
mg
1
PRADAXA ORAL CAPSULE 150 MG, 75 MG
2
warfarin oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5
mg
1
XARELTO ORAL TABLET 10 MG, 20 MG
2
XARELTO ORAL TABLET 15 MG
2
XARELTO ORAL TABLETS,DOSE PACK 15 MG (42)- 20 MG (9)
2
Blood Formation Modifiers
anagrelide oral capsule 0.5 mg, 1 mg
1
EPOGEN INJECTION SOLUTION 2,000 UNIT/ML, 20,000 UNIT/2
ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML
2
PA
LEUKINE INJECTION RECON SOLN 250 MCG
2
PA
MOZOBIL SUBCUTANEOUS SOLUTION 24 MG/1.2 ML (20
MG/ML)
2
PA
NEULASTA SUBCUTANEOUS SYRINGE 6 MG/0.6ML
2
PA
NEUMEGA SUBCUTANEOUS RECON SOLN 5 MG
2
PA
NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6
ML
2
PA
NEUPOGEN INJECTION SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8
ML
2
PA
PROCRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000
UNIT/ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML, 40,000
UNIT/ML
2
PA
PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MG
2
PA
Coagulants
tranexamic acid intravenous solution 1,000 mg/10 ml (100 mg/ml)
1
tranexamic acid oral tablet 650 mg
1
Platelet Modifying Agents
AGGRENOX ORAL CAPSULE, ER MULTIPHASE 12 HR 25-200
MG
2
53
Drug Name
BRILINTA ORAL TABLET 90 MG
2
cilostazol oral tablet 100 mg, 50 mg
1
clopidogrel oral tablet 300 mg, 75 mg
1
dipyridamole oral tablet 25 mg, 50 mg, 75 mg
1
PA
Cardiovascular Agents
Alpha-Adrenergic Agonists
clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg
1
clonidine transdermal patch weekly 0.1 mg/24 hr, 0.2 mg/24 hr, 0.3 mg/24
hr
1
guanfacine oral tablet 1 mg, 2 mg
1
PA
methyldopa oral tablet 250 mg, 500 mg
1
PA
midodrine oral tablet 10 mg, 2.5 mg, 5 mg
1
NORTHERA ORAL CAPSULE 100 MG, 200 MG, 300 MG
2
PA
Alpha-Adrenergic Blocking Agents
prazosin oral capsule 1 mg, 2 mg, 5 mg
1
Angiotensin II Receptor Antagonists
eprosartan oral tablet 600 mg
1
irbesartan oral tablet 150 mg, 300 mg, 75 mg
1
losartan oral tablet 100 mg, 25 mg, 50 mg
1
benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg
1
captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg
1
enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg
1
fosinopril oral tablet 10 mg, 20 mg, 40 mg
1
lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg
1
moexipril oral tablet 15 mg, 7.5 mg
1
quinapril oral tablet 10 mg, 20 mg, 40 mg, 5 mg
1
ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg
1
trandolapril oral tablet 1 mg, 2 mg, 4 mg
1
Angiotensin-Converting Enzyme (ACE) Inhibitors
Antiarrhythmics
amiodarone intravenous solution 50 mg/ml
1
amiodarone oral tablet 200 mg, 400 mg
1
disopyramide phosphate oral capsule 100 mg, 150 mg
1
54
PA
Drug Name
flecainide oral tablet 100 mg, 150 mg, 50 mg
1
mexiletine oral capsule 150 mg, 200 mg, 250 mg
1
MULTAQ ORAL TABLET 400 MG
2
procainamide injection solution 100 mg/ml, 500 mg/ml
1
propafenone oral capsule,extended release 12 hr 225 mg, 325 mg, 425 mg
1
propafenone oral tablet 150 mg, 225 mg, 300 mg
1
quinidine gluconate oral tablet extended release 324 mg
1
quinidine sulfate oral tablet 200 mg, 300 mg
1
sotalol af oral tablet 120 mg
1
sotalol oral tablet 160 mg, 240 mg, 80 mg
1
TIKOSYN ORAL CAPSULE 125 MCG, 250 MCG, 500 MCG
2
PA
Beta-Adrenergic Blocking Agents
acebutolol oral capsule 200 mg, 400 mg
1
atenolol oral tablet 100 mg, 25 mg, 50 mg
1
betaxolol oral tablet 10 mg, 20 mg
1
bisoprolol fumarate oral tablet 10 mg, 5 mg
1
carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg
1
labetalol intravenous solution 5 mg/ml
1
labetalol oral tablet 100 mg, 200 mg, 300 mg
1
metoprolol succinate oral tablet extended release 24 hr 100 mg, 25 mg, 50
mg
1
metoprolol succinate oral tablet extended release 24 hr 200 mg
1
metoprolol tartrate intravenous solution 5 mg/5 ml
1
metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg
1
nadolol oral tablet 20 mg, 40 mg, 80 mg
1
pindolol oral tablet 10 mg, 5 mg
1
propranolol intravenous solution 1 mg/ml
1
propranolol oral capsule,extended release 24 hr 120 mg, 160 mg, 60 mg, 80
mg
1
propranolol oral solution 20 mg/5 ml, 40 mg/5 ml
1
propranolol oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg
1
timolol maleate oral tablet 10 mg, 20 mg, 5 mg
1
Calcium Channel Blocking Agents
55
Drug Name
afeditab cr oral tablet extended release 30 mg, 60 mg
1
amlodipine oral tablet 10 mg, 2.5 mg, 5 mg
1
cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300
mg
1
diltiazem hcl intravenous solution 5 mg/ml
1
diltiazem hcl oral capsule, extended release 180 mg, 360 mg, 420 mg
1
diltiazem hcl oral capsule,extended release 12 hr 120 mg, 60 mg, 90 mg
1
diltiazem hcl oral capsule,extended release 24hr 120 mg, 240 mg, 300 mg
1
diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg
1
dilt-xr oral capsule,ext release degradable 120 mg, 180 mg, 240 mg
1
felodipine oral tablet extended release 24 hr 10 mg, 2.5 mg, 5 mg
1
nicardipine oral capsule 20 mg, 30 mg
1
nifedical xl oral tablet extended release 24hr 30 mg, 60 mg
1
nifedipine oral tablet extended release 24hr 30 mg, 60 mg, 90 mg
1
taztia xt oral capsule, extended release 120 mg, 180 mg, 240 mg, 300 mg,
360 mg
1
verapamil intravenous solution 2.5 mg/ml
1
verapamil oral capsule, 24 hr er pellet ct 100 mg, 200 mg, 300 mg
1
verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg, 360
mg
1
verapamil oral tablet 120 mg, 80 mg
1
verapamil oral tablet extended release 180 mg, 240 mg
1
Cardiovascular Agents
amlodipine-benazepril oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5-10
mg, 5-20 mg, 5-40 mg
1
atenolol-chlorthalidone oral tablet 100-25 mg, 50-25 mg
1
benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25
mg, 5-6.25 mg
1
bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25
mg
1
captopril-hydrochlorothiazide oral tablet 25-15 mg, 25-25 mg, 50-15 mg,
50-25 mg
1
DEMSER ORAL CAPSULE 250 MG
2
enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg
1
fosinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg
1
56
PA
Drug Name
lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg
1
losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg, 50-12.5
mg
1
methyldopa-hydrochlorothiazide oral tablet 250-15 mg, 250-25 mg
1
PA
metoprolol ta-hydrochlorothiaz oral tablet 100-25 mg, 100-50 mg, 50-25 mg
1
moexipril-hydrochlorothiazide oral tablet 15-12.5 mg, 15-25 mg, 7.5-12.5
mg
1
nadolol-bendroflumethiazide oral tablet 40-5 mg, 80-5 mg
1
propranolol-hydrochlorothiazid oral tablet 40-25 mg, 80-25 mg
1
quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25
mg
1
spironolacton-hydrochlorothiaz oral tablet 25-25 mg
1
triamterene-hydrochlorothiazid oral capsule 37.5-25 mg, 50-25 mg
1
triamterene-hydrochlorothiazid oral tablet 37.5-25 mg, 75-50 mg
1
valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 32012.5 mg, 320-25 mg, 80-12.5 mg
1
VYTORIN 10-10 ORAL TABLET 10-10 MG
2
2
2
digitek oral tablet 125 mcg, 250 mcg
1
PA
digoxin injection solution 250 mcg/ml
1
PA
digoxin oral solution 50 mcg/ml
1
PA
digoxin oral tablet 125 mcg, 250 mcg
1
PA
LANOXIN ORAL TABLET 125 MCG, 250 MCG
2
PA
LANOXIN ORAL TABLET 187.5 MCG, 62.5 MCG
2
pentoxifylline oral tablet extended release 400 mg
1
RANEXA ORAL TABLET EXTENDED RELEASE 12 HR 1,000 MG,
500 MG
2
Cardiovascular Agents, Other
PA
Diuretics, Carbonic Anhydrase Inhibitors
acetazolamide oral capsule, extended release 500 mg
1
acetazolamide oral tablet 125 mg, 250 mg
1
acetazolamide sodium injection recon soln 500 mg
1
methazolamide oral tablet 25 mg, 50 mg
1
57
Drug Name
Diuretics, Loop
bumetanide injection solution 0.25 mg/ml
1
bumetanide oral tablet 0.5 mg, 1 mg, 2 mg
1
EDECRIN ORAL TABLET 25 MG
2
furosemide injection solution 10 mg/ml
1
furosemide oral solution 10 mg/ml, 40 mg/5 ml
1
furosemide oral tablet 20 mg, 40 mg, 80 mg
1
torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg
1
Diuretics, Potassium-Sparing
amiloride oral tablet 5 mg
1
spironolactone oral tablet 100 mg, 25 mg, 50 mg
1
Diuretics, Thiazide
chlorothiazide oral tablet 250 mg, 500 mg
1
chlorthalidone oral tablet 25 mg, 50 mg
1
hydrochlorothiazide oral capsule 12.5 mg
1
hydrochlorothiazide oral tablet 25 mg, 50 mg
1
indapamide oral tablet 1.25 mg, 2.5 mg
1
metolazone oral tablet 10 mg, 2.5 mg, 5 mg
1
Dyslipidemics, Fibric Acid Derivatives
fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg
1
fenofibrate micronized oral capsule 43 mg
1
fenofibrate nanocrystallized oral tablet 145 mg, 48 mg
1
fenofibrate oral tablet 160 mg, 54 mg
1
gemfibrozil oral tablet 600 mg
1
Dyslipidemics, HMG CoA Reductase Inhibitors
atorvastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg
1
lovastatin oral tablet 10 mg, 20 mg, 40 mg
1
pravastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg
1
simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg
1
Dyslipidemics, Other
cholestyramine light oral powder in packet 4 gram
1
colestipol oral granules 5 gram
1
colestipol oral tablet 1 gram
1
58
Drug Name
JUXTAPID ORAL CAPSULE 10 MG, 30 MG, 40 MG, 5 MG, 60 MG
2
JUXTAPID ORAL CAPSULE 20 MG
2
KYNAMRO SUBCUTANEOUS SYRINGE 200 MG/ML
2
niacin oral tablet extended release 24 hr 1,000 mg, 500 mg, 750 mg
1
niacor oral tablet 500 mg
1
omega-3 acid ethyl esters oral capsule 1 gram
1
WELCHOL ORAL POWDER IN PACKET 3.75 GRAM
2
WELCHOL ORAL TABLET 625 MG
2
ZETIA ORAL TABLET 10 MG
2
Vasodilators, Direct-Acting Arterial
hydralazine injection solution 20 mg/ml
1
hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg
1
minoxidil oral tablet 10 mg, 2.5 mg
1
Vasodilators, Direct-Acting Arterial/ Venous
isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg
1
isosorbide dinitrate oral tablet extended release 40 mg
1
isosorbide mononitrate oral tablet 10 mg, 20 mg
1
isosorbide mononitrate oral tablet extended release 24 hr 120 mg, 30 mg, 60
mg
1
nitroglycerin intravenous solution 50 mg/10 ml (5 mg/ml)
1
nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr,
0.6 mg/hr
1
nitroglycerin translingual spray,non-aerosol 400 mcg/spray
1
NITROSTAT SUBLINGUAL TABLET 0.3 MG, 0.4 MG, 0.6 MG
2
Central Nervous System Agents
Attention Deficit Hyperactivity Disorder Agents, Amphetamines
amphetamine salt combo oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg,
5 mg, 7.5 mg
1
dextroamphetamine oral capsule, extended release 10 mg, 15 mg, 5 mg
1
dextroamphetamine oral tablet 10 mg, 5 mg
1
Attention Deficit Hyperactivity Disorder Agents, Non-Amphetamines
clonidine hcl oral tablet extended release 12 hr 0.1 mg
1
dexmethylphenidate oral capsule,er biphasic 50-50 10 mg, 15 mg, 20 mg, 30
mg, 40 mg, 5 mg
1
59
Drug Name
FOCALIN XR ORAL CAPSULE,ER BIPHASIC 50-50 25 MG, 35 MG
2
guanfacine oral tablet extended release 24 hr 1 mg, 2 mg, 3 mg, 4 mg
1
methylphenidate oral capsule, er biphasic 30-70 10 mg, 50 mg, 60 mg
1
methylphenidate oral capsule,er biphasic 50-50 20 mg, 30 mg, 40 mg
1
methylphenidate oral solution 10 mg/5 ml, 5 mg/5 ml
1
methylphenidate oral tablet 10 mg, 20 mg, 5 mg
1
methylphenidate oral tablet extended release 10 mg, 20 mg
1
STRATTERA ORAL CAPSULE 10 MG, 18 MG, 25 MG
2
STRATTERA ORAL CAPSULE 100 MG, 60 MG, 80 MG
2
STRATTERA ORAL CAPSULE 40 MG
2
NUEDEXTA ORAL CAPSULE 20-10 MG
2
PA
riluzole oral tablet 50 mg
1
XENAZINE ORAL TABLET 12.5 MG, 25 MG
2
PA
1
AMPYRA ORAL TABLET EXTENDED RELEASE 12 HR 10 MG
2
PA
AUBAGIO ORAL TABLET 14 MG, 7 MG
2
PA
AVONEX (WITH ALBUMIN) INTRAMUSCULAR KIT 30 MCG
2
PA
AVONEX INTRAMUSCULAR SYRINGE KIT 30 MCG/0.5 ML
2
PA
BETASERON SUBCUTANEOUS KIT 0.3 MG
2
PA
GILENYA ORAL CAPSULE 0.5 MG
2
PA
glatopa subcutaneous syringe 20 mg/ml
1
REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE 22 MCG/0.5
ML, 44 MCG/0.5 ML
2
PA
REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 22 MCG/0.5
ML, 44 MCG/0.5 ML, 8.8MCG/0.2ML-22 MCG/0.5ML (6)
2
PA
REBIF TITRATION PACK SUBCUTANEOUS SYRINGE
8.8MCG/0.2ML-22 MCG/0.5ML (6)
2
PA
Central Nervous System, Other
Fibromyalgia Agents
duloxetine oral capsule,delayed release(dr/ec) 40 mg
Multiple Sclerosis Agents
Dental And Oral Agents
Dental And Oral Agents
chlorhexidine gluconate mucous membrane mouthwash 0.12 %
1
pilocarpine hcl oral tablet 5 mg, 7.5 mg
1
60
Drug Name
triamcinolone acetonide dental paste 0.1 %
1
Dermatological Agents
Dermatological Agents
acitretin oral capsule 10 mg, 17.5 mg, 25 mg
1
PA
amnesteem oral capsule 10 mg, 20 mg, 40 mg
1
betamethasone dipropionate topical lotion 0.05 %
1
calcipotriene topical cream 0.005 %
1
calcipotriene topical ointment 0.005 %
1
calcipotriene topical solution 0.005 %
1
clindamycin-benzoyl peroxide topical gel 1-5 %
1
clotrimazole-betamethasone topical cream 1-0.05 %
1
clotrimazole-betamethasone topical lotion 1-0.05 %
1
diclofenac sodium topical gel 3 %
1
doxycycline monohydrate oral capsule 100 mg, 50 mg
1
doxycycline monohydrate oral tablet 100 mg, 50 mg
1
ELIDEL TOPICAL CREAM 1 %
2
erythromycin-benzoyl peroxide topical gel 3-5 %
1
fluorouracil intravenous solution 2.5 gram/50 ml
1
fluorouracil topical cream 5 %
1
fluorouracil topical solution 2 %, 5 %
1
fluticasone topical cream 0.05 %
1
fluticasone topical ointment 0.005 %
1
imiquimod topical cream in packet 5 %
1
methoxsalen rapid oral capsule 10 mg
1
nystatin-triamcinolone topical cream 100,000-0.1 unit/g-%
1
nystatin-triamcinolone topical ointment 100,000-0.1 unit/gram-%
1
podofilox topical solution 0.5 %
1
prednicarbate topical cream 0.1 %
1
SANTYL TOPICAL OINTMENT 250 UNIT/GRAM
2
selenium sulfide topical suspension 2.5 %
1
tacrolimus topical ointment 0.03 %, 0.1 %
1
PA
TAZORAC TOPICAL CREAM 0.05 %, 0.1 %
2
PA
PA
PA
61
Drug Name
TAZORAC TOPICAL GEL 0.05 %, 0.1 %
2
PA
UVADEX INJECTION SOLUTION 20 MCG/ML
2
B vs D
VALCHLOR TOPICAL GEL 0.016 %
2
PA
ADAGEN INTRAMUSCULAR SOLUTION 250 UNIT/ML
2
PA
ALDURAZYME INTRAVENOUS SOLUTION 2.9 MG/5 ML
2
PA
CERDELGA ORAL CAPSULE 84 MG
2
PA
CEREZYME INTRAVENOUS RECON SOLN 400 UNIT
2
PA
CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,00038,000 -60,000 UNIT, 24,000-76,000 -120,000 UNIT, 3,000-9,500- 15,000
UNIT, 36,000-114,000- 180,000 UNIT, 6,000-19,000 -30,000 UNIT
2
CYSTADANE ORAL POWDER 1 GRAM/1.7 ML
2
CYSTAGON ORAL CAPSULE 150 MG, 50 MG
2
PA
ELAPRASE INTRAVENOUS SOLUTION 6 MG/3 ML
2
PA
FABRAZYME INTRAVENOUS RECON SOLN 35 MG
2
PA
KUVAN ORAL POWDER IN PACKET 500 MG
2
PA
KUVAN ORAL TABLET,SOLUBLE 100 MG
2
PA
MYOZYME INTRAVENOUS RECON SOLN 50 MG
2
PA
NAGLAZYME INTRAVENOUS SOLUTION 5 MG/5 ML
2
PA
ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG
2
PA
PROCYSBI ORAL CAPSULE, DELAYED REL SPRINKLE 25 MG,
75 MG
2
PA
RAVICTI ORAL LIQUID 1.1 GRAM/ML
2
days)
VPRIV INTRAVENOUS RECON SOLN 400 UNIT
2
PA
ZAVESCA ORAL CAPSULE 100 MG
2
PA
ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,00034,000 -55,000 UNIT, 15,000-51,000 -82,000 UNIT, 20,000-68,000 109,000 UNIT, 25,000-85,000- 136,000 UNIT, 3,000-10,000- 16,000
UNIT, 40,000-136,000- 218,000 UNIT, 5,000-17,000 -27,000 UNIT
2
Enzyme Replacement/ Modifiers
Enzyme Replacement/ Modifiers
Gastrointestinal Agents
Antispasmodics, Gastrointestinal
atropine injection syringe 0.05 mg/ml, 0.1 mg/ml
1
dicyclomine oral capsule 10 mg
1
62
Drug Name
dicyclomine oral solution 10 mg/5 ml
1
dicyclomine oral tablet 20 mg
1
glycopyrrolate injection solution 0.2 mg/ml
1
glycopyrrolate oral tablet 1 mg, 2 mg
1
TRANSDERM-SCOP TRANSDERMAL PATCH 72 HOUR 1.5 MG (1
MG OVER 3 DAYS)
2
Gastrointestinal Agents, Other
diphenoxylate-atropine oral liquid 2.5-0.025 mg/5 ml
1
diphenoxylate-atropine oral tablet 2.5-0.025 mg
1
GATTEX ONE-VIAL SUBCUTANEOUS KIT 5 MG
2
loperamide oral capsule 2 mg
1
metoclopramide hcl injection solution 5 mg/ml
1
metoclopramide hcl oral solution 5 mg/5 ml
1
metoclopramide hcl oral tablet 10 mg, 5 mg
1
proctozone-hc rectal cream 2.5 %
1
RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6 ML
2
ursodiol oral capsule 300 mg
1
ursodiol oral tablet 250 mg, 500 mg
1
days)
Histamine2 (H2) Receptor Antagonists
cimetidine hcl oral solution 300 mg/5 ml
1
cimetidine oral tablet 200 mg, 300 mg, 400 mg, 800 mg
1
famotidine (pf) intravenous solution 20 mg/2 ml
1
famotidine (pf)-nacl (iso-os) intravenous piggyback 20 mg/50 ml
1
famotidine oral suspension 40 mg/5 ml
1
famotidine oral tablet 20 mg, 40 mg
1
ranitidine hcl oral syrup 15 mg/ml
1
ranitidine hcl oral tablet 150 mg, 300 mg
1
Irritable Bowel Syndrome Agents
alosetron oral tablet 0.5 mg, 1 mg
1
AMITIZA ORAL CAPSULE 24 MCG, 8 MCG
2
budesonide oral capsule,delayed,extend.release 3 mg
1
63
Drug Name
DELZICOL ORAL CAPSULE,DELAYED RELEASE(DR/EC) 400
MG
2
LINZESS ORAL CAPSULE 145 MCG, 290 MCG
2
Laxatives
gavilyte-c oral recon soln 240-22.72-6.72 -5.84 gram
1
gavilyte-g oral recon soln 236-22.74-6.74 -5.86 gram
1
gavilyte-n oral recon soln 420 gram
1
lactulose oral solution 10 gram/15 ml
1
polyethylene glycol 3350 oral powder 17 gram/dose
1
trilyte with flavor packets oral recon soln 420 gram
1
Protectants
misoprostol oral tablet 100 mcg, 200 mcg
1
sucralfate oral tablet 1 gram
1
Proton Pump Inhibitors
esomeprazole sodium intravenous recon soln 20 mg, 40 mg
1
lansoprazole oral capsule,delayed release(dr/ec) 15 mg, 30 mg
1
omeprazole oral capsule,delayed release(dr/ec) 10 mg
1
omeprazole oral capsule,delayed release(dr/ec) 20 mg, 40 mg
1
pantoprazole oral tablet,delayed release (dr/ec) 20 mg, 40 mg
1
Genitourinary Agents
Antispasmodics, Urinary
flavoxate oral tablet 100 mg
1
MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 25
MG, 50 MG
2
oxybutynin chloride oral syrup 5 mg/5 ml
1
oxybutynin chloride oral tablet 5 mg
1
oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg, 5 mg
1
tolterodine oral capsule,extended release 24hr 2 mg, 4 mg
1
tolterodine oral tablet 1 mg, 2 mg
1
trospium oral capsule,extended release 24hr 60 mg
1
trospium oral tablet 20 mg
1
AVODART ORAL CAPSULE 0.5 MG
2
doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg
1
Benign Prostatic Hypertrophy Agents
64
Drug Name
finasteride oral tablet 5 mg
1
tamsulosin oral capsule,extended release 24hr 0.4 mg
1
terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg
1
Genitourinary Agents, Other
bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg
1
DEPEN TITRATABS ORAL TABLET 250 MG
2
ELMIRON ORAL CAPSULE 100 MG
2
potassium citrate oral tablet extended release 10 meq (1,080 mg), 15 meq, 5
meq (540 mg)
1
sodium phenylbutyrate oral powder 0.94 gram/gram
1
Phosphate Binders
calcium acetate oral capsule 667 mg
1
FOSRENOL ORAL POWDER IN PACKET 1,000 MG, 750 MG
2
FOSRENOL ORAL TABLET,CHEWABLE 1,000 MG, 500 MG, 750
MG
2
RENAGEL ORAL TABLET 400 MG
2
Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal)
Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal)
a-hydrocort injection recon soln 100 mg
1
betamethasone dipropionate topical cream 0.05 %
1
betamethasone dipropionate topical ointment 0.05 %
1
betamethasone valerate topical cream 0.1 %
1
betamethasone valerate topical lotion 0.1 %
1
betamethasone valerate topical ointment 0.1 %
1
betamethasone, augmented topical cream 0.05 %
1
betamethasone, augmented topical gel 0.05 %
1
betamethasone, augmented topical lotion 0.05 %
1
betamethasone, augmented topical ointment 0.05 %
1
clobetasol topical foam 0.05 %
1
clobetasol topical gel 0.05 %
1
clobetasol topical lotion 0.05 %
1
clobetasol topical ointment 0.05 %
1
clobetasol topical shampoo 0.05 %
1
B vs D
65
Drug Name
clobetasol topical solution 0.05 %
1
clobetasol-emollient topical cream 0.05 %
1
DEPO-MEDROL INJECTION SUSPENSION 20 MG/ML
2
desonide topical cream 0.05 %
1
desonide topical lotion 0.05 %
1
desonide topical ointment 0.05 %
1
desoximetasone topical cream 0.05 %, 0.25 %
1
desoximetasone topical gel 0.05 %
1
desoximetasone topical ointment 0.05 %, 0.25 %
1
dexamethasone intensol oral drops 1 mg/ml
1
dexamethasone oral elixir 0.5 mg/5 ml
1
dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg
1
dexamethasone sodium phosphate injection solution 10 mg/ml
1
dexamethasone sodium phosphate injection solution 4 mg/ml
1
fludrocortisone oral tablet 0.1 mg
1
fluocinolone topical cream 0.01 %, 0.025 %
1
fluocinolone topical oil 0.01 %
1
fluocinolone topical ointment 0.025 %
1
fluocinolone topical solution 0.01 %
1
fluocinonide topical gel 0.05 %
1
fluocinonide topical ointment 0.05 %
1
fluocinonide topical solution 0.05 %
1
fluocinonide-e topical cream 0.05 %
1
halobetasol propionate topical cream 0.05 %
1
halobetasol propionate topical ointment 0.05 %
1
hydrocortisone butyrate topical ointment 0.1 %
1
hydrocortisone butyrate topical solution 0.1 %
1
hydrocortisone oral tablet 10 mg, 20 mg, 5 mg
1
hydrocortisone topical cream 1 %, 2.5 %
1
hydrocortisone topical lotion 2.5 %
1
hydrocortisone topical ointment 1 %, 2.5 %
1
hydrocortisone valerate topical cream 0.2 %
1
hydrocortisone valerate topical ointment 0.2 %
1
66
B vs D
B vs D
Drug Name
methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml
1
B vs D
methylprednisolone oral tablet 16 mg, 32 mg, 8 mg
1
methylprednisolone oral tablets,dose pack 4 mg
1
mometasone topical cream 0.1 %
1
mometasone topical ointment 0.1 %
1
mometasone topical solution 0.1 %
1
prednicarbate topical ointment 0.1 %
1
prednisolone sodium phosphate oral solution 15 mg/5 ml, 25 mg/5 ml (5
mg/ml), 5 mg base/5 ml (6.7 mg/5 ml)
1
prednisone intensol oral concentrate 5 mg/ml
1
prednisone oral solution 5 mg/5 ml
1
prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg
1
prednisone oral tablet 50 mg
1
B vs D
SOLU-CORTEF (PF) INJECTION RECON SOLN 100 MG/2 ML, 250
MG/2 ML
2
B vs D
SOLU-MEDROL (PF) INJECTION RECON SOLN 125 MG/2 ML, 40
MG/ML
2
B vs D
SOLU-MEDROL (PF) INTRAVENOUS RECON SOLN 500 MG/4 ML
2
B vs D
SOLU-MEDROL INTRAVENOUS RECON SOLN 2 GRAM
2
B vs D
triamcinolone acetonide topical cream 0.025 %, 0.1 %, 0.5 %
1
triamcinolone acetonide topical lotion 0.025 %, 0.1 %
1
triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 %
1
Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary)
Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary)
desmopressin injection solution 4 mcg/ml
1
desmopressin nasal spray,non-aerosol 10 mcg/spray (0.1 ml)
1
desmopressin oral tablet 0.1 mg, 0.2 mg
1
GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0.2
MG/0.25 ML, 0.4 MG/0.25 ML, 0.6 MG/0.25 ML, 0.8 MG/0.25 ML, 1
MG/0.25 ML, 1.2 MG/0.25 ML, 1.4 MG/0.25 ML, 1.6 MG/0.25 ML, 1.8
MG/0.25 ML, 2 MG/0.25 ML
2
PA
GENOTROPIN SUBCUTANEOUS CARTRIDGE 12 MG/ML (36
UNIT/ML), 5 MG/ML (15 UNIT/ML)
2
PA
INCRELEX SUBCUTANEOUS SOLUTION 10 MG/ML
2
PA
67
Drug Name
OMNITROPE SUBCUTANEOUS CARTRIDGE 10 MG/1.5 ML (6.7
MG/ML), 5 MG/1.5 ML (3.3 MG/ML)
2
PA
OMNITROPE SUBCUTANEOUS RECON SOLN 5.8 MG
2
PA
STIMATE NASAL SPRAY,NON-AEROSOL 150 MCG/SPRAY (0.1
ML)
2
Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers)
Anabolic Steroids
ANADROL-50 ORAL TABLET 50 MG
2
oxandrolone oral tablet 10 mg, 2.5 mg
1
PA
Androgens
ANDRODERM TRANSDERMAL PATCH 24 HOUR 2 MG/24 HOUR,
4 MG/24 HR
2
danazol oral capsule 100 mg, 200 mg, 50 mg
1
DEPO-TESTOSTERONE INTRAMUSCULAR OIL 100 MG/ML
2
METHITEST ORAL TABLET 10 MG
2
testosterone cypionate intramuscular oil 200 mg/ml
1
PA
testosterone enanthate intramuscular oil 200 mg/ml
1
PA
ENJUVIA ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG, 1.25
MG
2
PA
estradiol oral tablet 0.5 mg, 1 mg, 2 mg
1
PA
estradiol transdermal patch weekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05
mg/24 hr, 0.06 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr
1
PA
estropipate oral tablet 0.75 mg, 1.5 mg, 3 mg
1
PA
MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG, 2.5 MG
2
PA
PREMARIN ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG,
1.25 MG
2
PA
PREMARIN VAGINAL CREAM 0.625 MG/GRAM
2
PA
Estrogens
Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers)
apri oral tablet 0.15-0.03 mg
1
aubra oral tablet 0.1-20 mg-mcg
1
aviane oral tablet 0.1-20 mg-mcg
1
balziva (28) oral tablet 0.4-35 mg-mcg
1
cryselle (28) oral tablet 0.3-30 mg-mcg
1
delyla (28) oral tablet 0.1-20 mg-mcg
1
68
Drug Name
enpresse oral tablet 50-30 (6)/75-40 (5)/125-30(10)
1
falmina (28) oral tablet 0.1-20 mg-mcg
1
gildess oral tablet 1.5-30 mg-mcg
1
jinteli oral tablet 1-5 mg-mcg
1
junel 1.5/30 (21) oral tablet 1.5-30 mg-mcg
1
junel 1/20 (21) oral tablet 1-20 mg-mcg
1
junel fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7)
1
junel fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7)
1
larin 1.5/30 (21) oral tablet 1.5-30 mg-mcg
1
larin 1/20 (21) oral tablet 1-20 mg-mcg
1
leena 28 oral tablet 0.5/1/0.5-35 mg-mcg
1
lessina oral tablet 0.1-20 mg-mcg
1
levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg
1
levora-28 oral tablet 0.15-0.03 mg
1
microgestin 1.5/30 (21) oral tablet 1.5-30 mg-mcg
1
microgestin 1/20 (21) oral tablet 1-20 mg-mcg
1
microgestin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7)
1
microgestin fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7)
1
necon 0.5/35 (28) oral tablet 0.5-35 mg-mcg
1
necon 1/35 (28) oral tablet 1-35 mg-mcg
1
necon 10/11 (28) oral tablet 0.5-35/1-35 mg-mcg/mg-mcg
1
necon 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg
1
norlyroc oral tablet 0.35 mg
1
nortrel 0.5/35 (28) oral tablet 0.5-35 mg-mcg
1
nortrel 1/35 (21) oral tablet 1-35 mg-mcg
1
nortrel 1/35 (28) oral tablet 1-35 mg-mcg
1
nortrel 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg
1
portia oral tablet 0.15-0.03 mg
1
PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45-1.5 MG, 0.625-2.5 MG,
0.625-5 MG
2
previfem oral tablet 0.25-35 mg-mcg
1
quasense oral tablets,dose pack,3 month 0.15-30 mg-mcg
1
reclipsen (28) oral tablet 0.15-0.03 mg
1
PA
PA
69
Drug Name
sprintec (28) oral tablet 0.25-35 mg-mcg
1
sronyx oral tablet 0.1-20 mg-mcg
1
tri-legest fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9)
1
trinessa (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28)
1
tri-previfem (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28)
1
tri-sprintec (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28)
1
trivora (28) oral tablet 50-30 (6)/75-40 (5)/125-30(10)
1
zovia 1/35e (28) oral tablet 1-35 mg-mcg
1
zovia 1/50e (28) oral tablet 1-50 mg-mcg
1
Progestins
camila oral tablet 0.35 mg
1
DEPO-PROVERA INTRAMUSCULAR SOLUTION 400 MG/ML
2
errin oral tablet 0.35 mg
1
medroxyprogesterone intramuscular suspension 150 mg/ml
1
medroxyprogesterone oral tablet 10 mg, 2.5 mg, 5 mg
1
megestrol oral suspension 400 mg/10 ml (40 mg/ml)
1
PA
megestrol oral tablet 20 mg, 40 mg
1
PA
norethindrone acetate oral tablet 5 mg
1
Selective Estrogen Receptor Modifying Agents
raloxifene oral tablet 60 mg
1
Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid)
Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid)
levothyroxine 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
1
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
2
liothyronine intravenous solution 10 mcg/ml
1
liothyronine oral tablet 25 mcg, 5 mcg, 50 mcg
1
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
2
UNITHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 150
MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88
MCG
2
70
B vs D
Drug Name
Hormonal Agents, Suppressant (Adrenal)
Hormonal Agents, Suppressant (Adrenal)
LYSODREN ORAL TABLET 500 MG
2
Hormonal Agents, Suppressant (Parathyroid)
Hormonal Agents, Suppressant (Parathyroid)
SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG
2
Hormonal Agents, Suppressant (Pituitary)
Hormonal Agents, Suppressant (Pituitary)
cabergoline oral tablet 0.5 mg
1
ELIGARD SUBCUTANEOUS SYRINGE 22.5 MG, 30 MG, 45 MG, 7.5
MG
2
PA
FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS
RECON SOLN 120 MG, 80 MG
2
B vs D
leuprolide subcutaneous kit 1 mg/0.2 ml
1
PA
LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT
11.25 MG, 22.5 MG
2
PA
30 MG
2
PA
45 MG
2
PA
LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 3.75 MG, 7.5
MG
2
PA
LUPRON DEPOT-PED INTRAMUSCULAR KIT 11.25 MG, 15 MG
2
PA
octreotide acetate injection solution 1,000 mcg/ml, 100 mcg/ml, 200 mcg/ml,
50 mcg/ml, 500 mcg/ml
1
B vs D
SANDOSTATIN LAR DEPOT INTRAMUSCULAR KIT 10 MG, 20
MG, 30 MG
2
B vs D
SIGNIFOR LAR INTRAMUSCULAR SUSPENSION FOR
RECONSTITUTION 20 MG, 40 MG, 60 MG
2
PA
SIGNIFOR SUBCUTANEOUS SOLUTION 0.3 MG/ML (1 ML), 0.6
MG/ML (1 ML), 0.9 MG/ML (1 ML)
2
days)
SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 120 MG/0.5
ML, 60 MG/0.2 ML, 90 MG/0.3 ML
2
PA
SOMAVERT SUBCUTANEOUS RECON SOLN 10 MG, 15 MG, 20
MG, 25 MG, 30 MG
2
PA
SYNAREL NASAL SPRAY,NON-AEROSOL 2 MG/ML
2
PA
71
Drug Name
Hormonal Agents, Suppressant (Thyroid)
Antithyroid Agents
methimazole oral tablet 10 mg, 5 mg
1
propylthiouracil oral tablet 50 mg
1
Immunological Agents
Angioedema (HAE) Agents
CINRYZE INTRAVENOUS RECON SOLN 500 UNIT (5 ML)
2
PA
FIRAZYR SUBCUTANEOUS SYRINGE 30 MG/3 ML
2
PA
AFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 2 MG, 3
MG, 5 MG
2
PA
ATGAM INTRAVENOUS INJECTABLE 50 MG/ML
2
PA
azathioprine oral tablet 50 mg
1
B vs D
BENLYSTA INTRAVENOUS RECON SOLN 120 MG
2
PA
CELLCEPT INTRAVENOUS INTRAVENOUS RECON SOLN 500
MG
2
B vs D
cyclosporine intravenous solution 250 mg/5 ml
1
B vs D
cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg
1
B vs D
cyclosporine modified oral solution 100 mg/ml
1
B vs D
cyclosporine oral capsule 100 mg, 25 mg
1
B vs D
ENBREL SUBCUTANEOUS RECON SOLN 25 MG (1 ML)
2
PA
ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51), 50
MG/ML (0.98 ML)
2
PA
HUMIRA CROHN'S DIS START PCK SUBCUTANEOUS PEN
INJECTOR KIT 40 MG/0.8 ML
2
PA
HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20
MG/0.4 ML, 40 MG/0.8 ML
2
PA
KINERET SUBCUTANEOUS SYRINGE 100 MG/0.67 ML
2
PA
mercaptopurine oral tablet 50 mg
1
methotrexate sodium (pf) injection recon soln 1 gram
1
B vs D
methotrexate sodium (pf) injection solution 25 mg/ml
1
B vs D
methotrexate sodium oral tablet 2.5 mg
1
B vs D
mycophenolate mofetil oral capsule 250 mg
1
B vs D
mycophenolate mofetil oral suspension for reconstitution 200 mg/ml
1
B vs D
mycophenolate mofetil oral tablet 500 mg
1
B vs D
Immune Suppressants
72
Drug Name
mycophenolate sodium oral tablet,delayed release (dr/ec) 180 mg, 360 mg
1
B vs D
NULOJIX INTRAVENOUS RECON SOLN 250 MG
2
PA
ORENCIA (WITH MALTOSE) INTRAVENOUS RECON SOLN 250
MG
2
B vs D
ORENCIA SUBCUTANEOUS SYRINGE 125 MG/ML
2
PROGRAF INTRAVENOUS SOLUTION 5 MG/ML
2
B vs D
RAPAMUNE ORAL SOLUTION 1 MG/ML
2
B vs D
REMICADE INTRAVENOUS RECON SOLN 100 MG
2
PA
SIMULECT INTRAVENOUS RECON SOLN 20 MG
2
PA
sirolimus oral tablet 0.5 mg, 1 mg, 2 mg
1
B vs D
tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg
1
B vs D
TORISEL INTRAVENOUS RECON SOLN 30 MG/3 ML (10 MG/ML)
(FIRST)
2
PA
ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG
2
B vs D; QL (62 EA per 31
days)
CARIMUNE NF NANOFILTERED INTRAVENOUS RECON SOLN 6
GRAM
2
PA
GAMMAGARD LIQUID INJECTION SOLUTION 10 %
2
PA
THYMOGLOBULIN INTRAVENOUS RECON SOLN 25 MG
2
B vs D
Immunizing Agents, Passive
Immunological Agents
leflunomide oral tablet 10 mg, 20 mg
1
SYNAGIS INTRAMUSCULAR SOLUTION 50 MG/0.5 ML
2
PA
ACTEMRA INTRAVENOUS SOLUTION 200 MG/10 ML (20
MG/ML)
2
PA
ACTIMMUNE SUBCUTANEOUS SOLUTION 100 MCG/0.5 ML
2
PA
ARCALYST SUBCUTANEOUS RECON SOLN 220 MG
2
PA
ILARIS (PF) SUBCUTANEOUS RECON SOLN 180 MG/1.2 ML (150
MG/ML)
2
PA
RIDAURA ORAL CAPSULE 3 MG
2
TYSABRI INTRAVENOUS SOLUTION 300 MG/15 ML
2
Immunomodulators
PA
Vaccines
ACTHIB (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML
2
73
Drug Name
ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR
SUSPENSION 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML
2
BOOSTRIX TDAP INTRAMUSCULAR SUSPENSION 2.5-8-5 LFMCG-LF/0.5ML
2
BOOSTRIX TDAP INTRAMUSCULAR SYRINGE 2.5-8-5 LF-MCGLF/0.5ML
2
CERVARIX VACCINE (PF) INTRAMUSCULAR SYRINGE 20-20
MCG/0.5 ML
2
COMVAX (PF) INTRAMUSCULAR SUSPENSION 5-7.5-125
MCG/0.5 ML
2
DAPTACEL (DTAP PEDIATRIC) (PF) INTRAMUSCULAR
SUSPENSION 15-10-5 LF-MCG-LF/0.5ML
2
ENGERIX-B (PF) INTRAMUSCULAR SYRINGE 20 MCG/ML
2
PA
ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SUSPENSION 10
MCG/0.5 ML
2
PA
ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 10
MCG/0.5 ML
2
PA
GARDASIL (PF) INTRAMUSCULAR SUSPENSION 20-40-40-20
MCG/0.5 ML
2
PA
GARDASIL 9 (PF) INTRAMUSCULAR SUSPENSION 0.5 ML
2
PA
GARDASIL 9 (PF) INTRAMUSCULAR SYRINGE 0.5 ML
2
PA
HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA
UNIT/ML
2
HAVRIX (PF) INTRAMUSCULAR SYRINGE 720 ELISA UNIT/0.5
ML
2
IMOVAX RABIES VACCINE (PF) INTRAMUSCULAR RECON
SOLN 2.5 UNIT
2
INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION 25-58-10
LF-MCG-LF/0.5ML
2
IPOL INJECTION SUSPENSION 40-8-32 UNIT/0.5 ML
2
IXIARO (PF) INTRAMUSCULAR SYRINGE 6 MCG/0.5 ML
2
MENACTRA (PF) INTRAMUSCULAR SOLUTION 4 MCG/0.5 ML
2
MENOMUNE - A/C/Y/W-135 (PF) SUBCUTANEOUS RECON SOLN
50 MCG
2
MENVEO A-C-Y-W-135-DIP (PF) INTRAMUSCULAR KIT 10-5
MCG/0.5 ML
2
M-M-R II (PF) SUBCUTANEOUS RECON SOLN 1,000-12,500
TCID50/0.5 ML
2
74
PA
Drug Name
PEDVAX HIB (PF) INTRAMUSCULAR SOLUTION 7.5 MCG/0.5 ML
2
PROQUAD (PF) SUBCUTANEOUS SUSPENSION FOR
RECONSTITUTION 10EXP3-4.3-3- 3.99 TCID50/0.5
2
QUADRACEL (PF) INTRAMUSCULAR SUSPENSION 15 LF-48
MCG- 5 LF UNIT/0.5ML
2
RABAVERT (PF) INTRAMUSCULAR SUSPENSION FOR
RECONSTITUTION 2.5 UNIT
2
RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 10
MCG/ML, 40 MCG/ML
2
B vs D
RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10
MCG/ML, 5 MCG/0.5 ML
2
B vs D
ROTARIX ORAL SUSPENSION FOR RECONSTITUTION 10EXP6
CCID50/ML
2
ROTATEQ VACCINE ORAL SUSPENSION 2 ML
2
TETANUS,DIPHTHERIA TOX PED(PF) INTRAMUSCULAR
SUSPENSION 5-25 LF UNIT/0.5 ML
2
TETANUS-DIPHTHERIA TOXOIDS-TD INTRAMUSCULAR
SUSPENSION 2-2 LF UNIT/0.5 ML
2
TRUMENBA INTRAMUSCULAR SYRINGE 120 MCG/0.5 ML
2
TWINRIX (PF) INTRAMUSCULAR SUSPENSION 720 ELISA UNIT
-20 MCG/ML
2
TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG/0.5 ML
2
VAQTA (PF) INTRAMUSCULAR SYRINGE 25 UNIT/0.5 ML, 50
UNIT/ML
2
VARIVAX (PF) SUBCUTANEOUS SUSPENSION FOR
RECONSTITUTION 1,350 UNIT/0.5 ML
2
VARIZIG INTRAMUSCULAR SOLUTION 125 UNIT/1.2 ML
2
YF-VAX (PF) SUBCUTANEOUS SUSPENSION FOR
RECONSTITUTION 10 EXP4.74 UNIT/0.5 ML
2
ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR
RECONSTITUTION 19,400 UNIT/0.65 ML
2
Inflammatory Bowel Disease Agents
Aminosalicylates
balsalazide oral capsule 750 mg
1
CANASA RECTAL SUPPOSITORY 1,000 MG
2
DIPENTUM ORAL CAPSULE 250 MG
2
PA
75
Drug Name
mesalamine with cleansing wipe rectal enema kit 4 gram/60 ml
1
Glucocorticoids
hydrocortisone rectal enema 100 mg/60 ml
1
methylprednisolone oral tablet 4 mg
1
prednisolone acetate ophthalmic drops,suspension 1 %
1
proctosol hc rectal cream 2.5 %
1
Sulfonamides
sulfasalazine oral tablet 500 mg
1
sulfazine ec oral tablet,delayed release (dr/ec) 500 mg
1
Metabolic Bone Disease Agents
Metabolic Bone Disease Agents
alendronate oral tablet 10 mg, 40 mg, 5 mg
1
alendronate oral tablet 35 mg, 70 mg
1
calcitonin (salmon) nasal spray,non-aerosol 200 unit/actuation
1
calcitriol intravenous solution 1 mcg/ml
1
B vs D
calcitriol oral capsule 0.25 mcg, 0.5 mcg
1
B vs D
calcitriol oral solution 1 mcg/ml
1
B vs D
etidronate disodium oral tablet 200 mg, 400 mg
1
FORTEO SUBCUTANEOUS PEN INJECTOR 20 MCG/DOSE - 600
MCG/2.4 ML
2
PA
ibandronate intravenous solution 3 mg/3 ml
1
PA
ibandronate oral tablet 150 mg
1
MIACALCIN INJECTION SOLUTION 200 UNIT/ML
2
NATPARA SUBCUTANEOUS CARTRIDGE 100 MCG/DOSE, 25
MCG/DOSE, 50 MCG/DOSE, 75 MCG/DOSE
2
pamidronate intravenous solution 30 mg/10 ml (3 mg/ml), 60 mg/10 ml (6
mg/ml), 90 mg/10 ml (9 mg/ml)
1
PA
paricalcitol hemodialysis port injection solution 2 mcg/ml, 5 mcg/ml
1
paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg
1
PROLIA SUBCUTANEOUS SYRINGE 60 MG/ML
2
days)
risedronate oral tablet 150 mg
1
risedronate oral tablet 30 mg, 5 mg
1
risedronate oral tablet 35 mg, 35 mg (12 pack)
1
76
Drug Name
risedronate oral tablet,delayed release (dr/ec) 35 mg
1
XGEVA SUBCUTANEOUS SOLUTION 120 MG/1.7 ML (70 MG/ML)
2
days)
zoledronic acid intravenous solution 4 mg/5 ml
1
B vs D
zoledronic acid-mannitol-water intravenous solution 5 mg/100 ml
1
B vs D; QL (200 ML per
365 days)
ZOMETA INTRAVENOUS SOLUTION 4 MG/100 ML
2
B vs D
Ophthalmic Agents
Ophthalmic Agents
bacitracin-polymyxin b ophthalmic ointment 500-10,000 unit/gram
1
BLEPHAMIDE OPHTHALMIC DROPS,SUSPENSION 10-0.2 %
2
BLEPHAMIDE S.O.P. OPHTHALMIC OINTMENT 10-0.2 %
2
neomycin-bacitracin-poly-hc ophthalmic ointment 3.5-400-10,000 mgunit/g-1%
1
neomycin-polymyxin b-dexameth ophthalmic drops,suspension 3.5mg/ml10,000 unit/ml-0.1 %
1
neomycin-polymyxin b-dexameth ophthalmic ointment 3.5 mg/g-10,000
unit/g-0.1 %
1
neomycin-polymyxin-gramicidin ophthalmic drops 1.75 mg-10,000 unit0.025mg/ml
1
neomycin-polymyxin-hc ophthalmic drops,suspension 3.5-10,000-10 mgunit-mg/ml
1
polymyxin b sulf-trimethoprim ophthalmic drops 10,000 unit- 1 mg/ml
1
sulfacetamide-prednisolone ophthalmic drops 10 %-0.23 % (0.25 %)
1
tobramycin-dexamethasone ophthalmic drops,suspension 0.3-0.1 %
1
Ophthalmic Agents, Other
LACRISERT OPHTHALMIC INSERT 5 MG
2
naphazoline ophthalmic drops 0.1 %
1
proparacaine ophthalmic drops 0.5 %
1
RESTASIS OPHTHALMIC DROPPERETTE 0.05 %
2
Ophthalmic Anti-Allergy Agents
ALOMIDE OPHTHALMIC DROPS 0.1 %
2
azelastine ophthalmic drops 0.05 %
1
cromolyn ophthalmic drops 4 %
1
PATADAY OPHTHALMIC DROPS 0.2 %
2
77
Drug Name
PATANOL OPHTHALMIC DROPS 0.1 %
2
PAZEO OPHTHALMIC DROPS 0.7 %
2
Ophthalmic Antiglaucoma Agents
apraclonidine ophthalmic drops 0.5 %
1
betaxolol ophthalmic drops 0.5 %
1
BETOPTIC S OPHTHALMIC DROPS,SUSPENSION 0.25 %
2
brimonidine ophthalmic drops 0.15 %, 0.2 %
1
carteolol ophthalmic drops 1 %
1
dorzolamide ophthalmic drops 2 %
1
dorzolamide-timolol ophthalmic drops 22.3-6.8 mg/ml
1
levobunolol ophthalmic drops 0.5 %
1
metipranolol ophthalmic drops 0.3 %
1
PHOSPHOLINE IODIDE OPHTHALMIC DROPS 0.125 %
2
timolol maleate ophthalmic drops 0.25 %, 0.5 %
1
timolol maleate ophthalmic gel forming solution 0.25 %, 0.5 %
1
Ophthalmic Anti-Inflammatories
bromfenac ophthalmic drops 0.09 %
1
dexamethasone sodium phosphate ophthalmic drops 0.1 %
1
diclofenac sodium ophthalmic drops 0.1 %
1
DUREZOL OPHTHALMIC DROPS 0.05 %
2
flurbiprofen sodium ophthalmic drops 0.03 %
1
FML FORTE OPHTHALMIC DROPS,SUSPENSION 0.25 %
2
ketorolac ophthalmic drops 0.4 %, 0.5 %
1
prednisolone sodium phosphate ophthalmic drops 1 %
1
Ophthalmic Prostaglandin and Prostamide Analogs
latanoprost ophthalmic drops 0.005 %
1
TRAVATAN Z OPHTHALMIC DROPS 0.004 %
2
travoprost (benzalkonium) ophthalmic drops 0.004 %
1
Otic Agents
Otic Agents
CIPRODEX OTIC DROPS,SUSPENSION 0.3-0.1 %
2
hydrocortisone-acetic acid otic drops 1-2 %
1
78
PA
Drug Name
neomycin-polymyxin-hc otic drops,suspension 3.5-10,000-1 mg/ml-unit/ml%
1
neomycin-polymyxin-hc otic solution 3.5-10,000-1 mg/ml-unit/ml-%
1
Respiratory Tract/ Pulmonary Agents
Antihistamines
azelastine nasal aerosol,spray 137 mcg (0.1 %)
1
carbinoxamine maleate oral liquid 4 mg/5 ml
1
PA
carbinoxamine maleate oral tablet 4 mg
1
PA
cetirizine oral solution 1 mg/ml
1
clemastine oral tablet 2.68 mg
1
PA
cyproheptadine oral syrup 2 mg/5 ml
1
PA
cyproheptadine oral tablet 4 mg
1
PA
levocetirizine oral solution 2.5 mg/5 ml
1
levocetirizine oral tablet 5 mg
1
Anti-Inflammatories, Inhaled Corticosteroids
ADVAIR DISKUS INHALATION BLISTER WITH DEVICE 100-50
MCG/DOSE, 250-50 MCG/DOSE, 500-50 MCG/DOSE
2
ADVAIR HFA INHALATION HFA AEROSOL INHALER 115-21
MCG/ACTUATION, 230-21 MCG/ACTUATION, 45-21
MCG/ACTUATION
2
PA; QL (12 GM per 30
days)
ASMANEX TWISTHALER INHALATION AEROSOL POWDR
BREATH ACTIVATED 220 MCG (120 DOSES), 220 MCG (60
DOSES)
2
budesonide inhalation suspension for nebulization 0.25 mg/2 ml
1
B vs D; QL (248 ML per 31
days)
budesonide inhalation suspension for nebulization 0.5 mg/2 ml
1
days)
FLOVENT HFA INHALATION HFA AEROSOL INHALER 110
MCG/ACTUATION
2
MCG/ACTUATION
2
MCG/ACTUATION
2
QL (10.6 GM per 30 days)
flunisolide nasal spray,non-aerosol 25 mcg (0.025 %)
1
fluticasone nasal spray,suspension 50 mcg/actuation
1
79
Drug Name
2
QL (17.4 GM per 30 days)
montelukast oral tablet 10 mg
1
montelukast oral tablet,chewable 4 mg, 5 mg
1
zafirlukast oral tablet 10 mg, 20 mg
1
QVAR INHALATION AEROSOL 40 MCG/ACTUATION, 80
MCG/ACTUATION
Antileukotrienes
Bronchodilators, Anticholinergic
ATROVENT HFA INHALATION HFA AEROSOL INHALER 17
MCG/ACTUATION
2
ipratropium bromide inhalation solution 0.02 %
1
days)
ipratropium bromide nasal spray,non-aerosol 0.03 %, 0.06 %
1
SPIRIVA RESPIMAT INHALATION MIST 2.5 MCG/ACTUATION
2
SPIRIVA WITH HANDIHALER INHALATION CAPSULE,
W/INHALATION DEVICE 18 MCG
2
TUDORZA PRESSAIR INHALATION AEROSOL POWDR BREATH
ACTIVATED 400 MCG/ACTUATION
2
TUDORZA PRESSAIR INHALATION AEROSOL POWDR BREATH
ACTIVATED 400 MCG/ACTUATION (30 ACTUAT)
2
albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25
mg/3 ml, 2.5 mg /3 ml (0.083 %)
1
days)
albuterol sulfate inhalation solution for nebulization 5 mg/ml
1
days)
albuterol sulfate oral syrup 2 mg/5 ml
1
albuterol sulfate oral tablet 2 mg, 4 mg
1
albuterol sulfate oral tablet extended release 12 hr 4 mg, 8 mg
1
AUVI-Q INJECTION AUTO-INJECTOR 0.15 MG/0.15 ML (1:1,000),
0.3 MG/0.3 ML (1:1,000)
2
epinephrine injection auto-injector 0.15 mg/0.15 ml (1:1,000), 0.3 mg/0.3 ml
(1:1,000)
1
EPIPEN 2-PAK INJECTION AUTO-INJECTOR 0.3 MG/0.3 ML
(1:1,000)
2
EPIPEN JR 2-PAK INJECTION AUTO-INJECTOR 0.15 MG/0.3 ML
(1:2,000)
2
levalbuterol hcl inhalation solution for nebulization 0.31 mg/3 ml, 0.63 mg/3
ml
1
days)
Bronchodilators, Sympathomimetic
80
Drug Name
levalbuterol hcl inhalation solution for nebulization 1.25 mg/0.5 ml
1
B vs D; QL (90 EA per 30
days)
metaproterenol oral syrup 10 mg/5 ml
1
metaproterenol oral tablet 10 mg, 20 mg
1
SEREVENT DISKUS INHALATION BLISTER WITH DEVICE 50
MCG/DOSE
2
terbutaline oral tablet 2.5 mg, 5 mg
1
terbutaline subcutaneous solution 1 mg/ml
1
VENTOLIN HFA INHALATION HFA AEROSOL INHALER 90
MCG/ACTUATION
2
KALYDECO ORAL GRANULES IN PACKET 50 MG, 75 MG
2
KALYDECO ORAL TABLET 150 MG
2
cromolyn inhalation solution for nebulization 20 mg/2 ml
1
B vs D
cromolyn oral solution 100 mg/5 ml
1
Cystic Fibrosis Agents
Mast Cell Stabilizers
Phosphodiesterase Inhibitors, Airways Disease
aminophylline intravenous solution 250 mg/10 ml
1
DALIRESP ORAL TABLET 500 MCG
2
theophylline oral tablet extended release 12 hr 100 mg, 200 mg, 300 mg,
450 mg
1
theophylline oral tablet extended release 400 mg, 600 mg
1
PA
Pulmonary Antihypertensives
ADCIRCA ORAL TABLET 20 MG
2
ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG
2
LETAIRIS ORAL TABLET 10 MG, 5 MG
2
PA
OPSUMIT ORAL TABLET 10 MG
2
REMODULIN INJECTION SOLUTION 1 MG/ML, 10 MG/ML, 2.5
MG/ML, 5 MG/ML
2
PA
sildenafil oral tablet 20 mg
1
PA
TRACLEER ORAL TABLET 125 MG, 62.5 MG
2
1
B vs D
Respiratory Tract Agents, Other
acetylcysteine solution 100 mg/ml (10 %), 200 mg/ml (20 %)
81
Drug Name
ANORO ELLIPTA INHALATION BLISTER WITH DEVICE 62.5-25
MCG/ACTUATION
2
ZEMAIRA INTRAVENOUS RECON SOLN 1,000 MG
2
B vs D
COMBIVENT RESPIMAT INHALATION MIST 20-100
MCG/ACTUATION
2
ESBRIET ORAL CAPSULE 267 MG
2
PA
ipratropium-albuterol inhalation solution for nebulization 0.5 mg-3 mg(2.5
mg base)/3 ml
1
days)
OFEV ORAL CAPSULE 100 MG, 150 MG
2
promethazine vc oral syrup 6.25-5 mg/5 ml
1
PA
PULMOZYME INHALATION SOLUTION 1 MG/ML
2
B vs D
XOLAIR SUBCUTANEOUS RECON SOLN 150 MG
2
PA
carisoprodol oral tablet 350 mg
1
cyclobenzaprine oral tablet 10 mg, 5 mg
1
methocarbamol oral tablet 500 mg, 750 mg
1
PA
temazepam oral capsule 15 mg, 22.5 mg, 30 mg, 7.5 mg
1
zaleplon oral capsule 10 mg, 5 mg
1
zolpidem oral tablet 10 mg, 5 mg
1
zolpidem oral tablet,ext release multiphase 12.5 mg, 6.25 mg
1
HETLIOZ ORAL CAPSULE 20 MG
2
modafinil oral tablet 100 mg, 200 mg
1
ROZEREM ORAL TABLET 8 MG
2
XYREM ORAL SOLUTION 500 MG/ML
2
PA
EXJADE ORAL TABLET, DISPERSIBLE 125 MG, 250 MG, 500 MG
2
PA
FERRIPROX ORAL TABLET 500 MG
2
PA
sodium polystyrene (sorb free) oral suspension 15 gram/60 ml
1
Respiratory Tract/ Pulmonary Agents
Skeletal Muscle Relaxants
Skeletal Muscle Relaxants
Sleep Disorder Agents
GABA Receptor Modulators
Sleep Disorders, Other
Therapeutic Nutrients/ Minerals/ Electrolytes
Electrolyte/ Mineral Modifiers
82
Drug Name
2
PA
CARBAGLU ORAL TABLET, DISPERSIBLE 200 MG
2
PA
ISOLYTE-S INTRAVENOUS PARENTERAL SOLUTION
2
B vs D
KLOR-CON 10 ORAL TABLET EXTENDED RELEASE 10 MEQ
2
KLOR-CON 8 ORAL TABLET EXTENDED RELEASE 8 MEQ
2
klor-con m15 oral tablet,er particles/crystals 15 meq
1
klor-con m20 oral tablet,er particles/crystals 20 meq
1
K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ
2
magnesium sulfate injection solution 4 meq/ml (50 %)
1
magnesium sulfate injection syringe 4 meq/ml
1
PHYSIOLYTE IRRIGATION SOLUTION 140-5-3-98 MEQ/L
2
B vs D
PLASMA-LYTE 148 INTRAVENOUS PARENTERAL SOLUTION
2
B vs D
PLASMA-LYTE A INTRAVENOUS PARENTERAL SOLUTION
2
B vs D
potassium chloride intravenous piggyback 10 meq/100 ml, 20 meq/100 ml,
40 meq/100 ml
1
potassium chloride intravenous solution 2 meq/ml
1
potassium chloride oral capsule, extended release 10 meq, 8 meq
1
potassium chloride oral tablet extended release 8 meq
1
potassium chloride oral tablet,er particles/crystals 10 meq, 20 meq
1
sodium chloride 0.45 % intravenous parenteral solution 0.45 %
1
sodium chloride 0.9 % intravenous parenteral solution 0.9 %
1
sodium chloride 3 % intravenous parenteral solution 3 %
1
sodium chloride 5 % intravenous parenteral solution 5 %
1
sodium chloride intravenous parenteral solution 2.5 meq/ml
1
sodium chloride irrigation solution 0.9 %
1
sodium fluoride oral tablet,chewable 0.5 mg fluoride (1.1 mg)
1
SYPRINE ORAL CAPSULE 250 MG
Electrolyte/ Mineral Replacement
Therapeutic Nutrients/ Minerals/ Electrolytes
AMINOSYN II 8.5 %-ELECTROLYTES INTRAVENOUS
PARENTERAL SOLUTION 8.5 %
2
B vs D
AMINOSYN-HBC 7% INTRAVENOUS PARENTERAL SOLUTION
7%
2
B vs D
CLINIMIX 4.25%-D25W SULF-FREE INTRAVENOUS
PARENTERAL SOLUTION 4.25 %
2
B vs D
83
Drug Name
d10 % & 0.45 % sodium chloride intravenous parenteral solution
1
d2.5 %-0.45 % sodium chloride intravenous parenteral solution
1
d5 % and 0.9 % sodium chloride intravenous parenteral solution
1
d5 %-0.45 % sodium chloride intravenous parenteral solution
1
dextrose 10 % and 0.2 % nacl intravenous parenteral solution
1
dextrose 10 % in water (d10w) intravenous parenteral solution 10 %
1
dextrose 5 % in water (d5w) intravenous parenteral solution
1
dextrose 5 %-lactated ringers intravenous parenteral solution
1
dextrose 5%-0.2 % sod chloride intravenous parenteral solution
1
dextrose 5%-0.3 % sod.chloride intravenous parenteral solution
1
dextrose with sodium chloride intravenous parenteral solution 5-0.2 %
1
dextrose-kcl-nacl intravenous solution 5-0.224-0.225 %
1
INTRALIPID INTRAVENOUS EMULSION 30 %
2
lactated ringers irrigation solution
1
levocarnitine oral tablet 330 mg
1
B vs D
NUTRILIPID INTRAVENOUS EMULSION 20 %
2
PA
potassium chlorid-d5-0.45%nacl intravenous parenteral solution 10 meq/l,
20 meq/l, 30 meq/l, 40 meq/l
1
potassium chloride in 5 % dex intravenous parenteral solution 20 meq/l, 40
meq/l
1
potassium chloride-d5-0.2%nacl intravenous parenteral solution 20 meq/l
1
potassium chloride-d5-0.3%nacl intravenous parenteral solution 20 meq/l
1
potassium chloride-d5-0.9%nacl intravenous parenteral solution 20 meq/l,
40 meq/l
1
prenatal vitamins low iron oral tablet 27 mg iron- 1 mg
1
ringers intravenous parenteral solution
1
ringers irrigation solution
1
84
B vs D
PA
Index
1 12 HOUR DECONGESTANT
.......................................... 11
3 3 DAY VAGINAL ............... 11
A abacavir ................................ 47
abacavir-lamivudinezidovudine ........................ 47
ABELCET ............................ 34
ABILIFY DISCMELT ......... 44
ABILIFY MAINTENA .. 30, 44
ABRAXANE........................ 39
ABREVA ............................. 11
acamprosate .......................... 21
acebutolol ............................. 55
ACEPHEN ........................... 11
acetaminophen...................... 11
acetaminophen-codeine ........ 20
acetazolamide ....................... 57
acetazolamide sodium .......... 57
acetic acid ............................. 23
acetylcysteine ....................... 81
acitretin ................................. 61
ACNE FOAMING FACE
WASH .............................. 11
ACNE MEDICATION......... 11
ACNE TREATMENT
(BENZOYL PEROX) ...... 11
ACTEMRA .......................... 73
ACTHIB (PF) ....................... 73
ACTIMMUNE ..................... 73
acyclovir ............................... 46
acyclovir sodium .................. 46
ADACEL(TDAP
ADOLESN/ADULT)(PF) 74
ADAGEN ............................. 62
ADCIRCA ............................ 81
adefovir................................. 46
ADEMPAS ........................... 81
ADULT COUGH FORMULA
DM MAX ......................... 11
ADULT ROBITUSSIN PEAK
COLD DM ....................... 11
ADVAIR DISKUS ............... 79
ADVAIR HFA ..................... 79
afeditab cr ............................. 56
AFINITOR ........................... 40
AFINITOR DISPERZ .......... 72
AGGRENOX........................ 53
a-hydrocort ........................... 65
ALAVERT D-12 ALLERGYSINUS .............................. 11
ALBENZA ........................... 42
albuterol sulfate .................... 80
ALDURAZYME .................. 62
alendronate ........................... 76
ALIMTA .............................. 38
ALINIA ................................ 42
ALLER-CHLOR .................. 11
ALLERCLEAR .................... 11
ALLERGY
(DIPHENHYDRAMINE) 11
ALLERGY MULTISYMPTOM ...................... 11
ALLERGY RELIEF
(LORATADINE).............. 11
ALLERGY
RELIEF(DIPHENHYDRA
MIN) ................................. 11
allopurinol ............................ 35
ALOMIDE............................ 77
alosetron ............................... 63
alprazolam ............................ 49
amantadine hcl ...................... 49
AMBISOME ........................ 34
amifostine crystalline ........... 39
amikacin ............................... 22
amiloride ............................... 58
aminophylline ....................... 81
AMINOSYN II 8.5 %ELECTROLYTES............ 83
AMINOSYN-HBC 7%......... 83
amiodarone ........................... 54
AMITIZA ............................. 63
amitriptyline ......................... 32
AMLACTIN ......................... 11
amlodipine ............................ 56
amlodipine-benazepril .......... 56
amnesteem ............................ 61
amoxapine ............................ 32
amoxicillin ............................ 25
amoxicillin-pot clavulanate .. 25
amphetamine salt combo ...... 59
amphotericin b ...................... 34
ampicillin .............................. 25
ampicillin sodium ................. 25
ampicillin-sulbactam ............ 25
AMPYRA ............................. 60
ANADROL-50 ..................... 68
anagrelide .............................53
anastrozole ............................ 40
ANDRODERM .................... 68
ANORO ELLIPTA ............... 82
ANTACID ANTI-GAS ........11
ANTIBIOTIC + PAIN
RELIEF.............................12
ANTI-DANDRUFF WITH
MENTHOL....................... 12
ANTI-DIARRHEAL
(LOPERAMIDE) .............. 12
APIDRA ............................... 51
APIDRA SOLOSTAR.......... 51
APOKYN .............................42
apraclonidine ........................ 78
apri ........................................ 68
APTIOM ...............................29
APTIVUS .............................48
AQUANIL HC .....................12
ARCALYST .........................73
ARGATROBAN .................. 52
ARGATROBAN IN 0.9 %
SOD CHLOR....................52
aripiprazole ........................... 44
ARRANON .......................... 38
ARTIFICIAL TEARS .......... 12
ARTIFICIAL TEARS
(POLYVIN ALC) .............12
ARTIFICIAL
TEARS(GLYCERIN-PEG)
.......................................... 12
ARZERRA ...........................41
ASMANEX TWISTHALER 79
aspirin ...................................12
atenolol ................................. 55
atenolol-chlorthalidone ......... 56
ATGAM ...............................72
atorvastatin ........................... 58
atovaquone ............................ 42
atovaquone-proguanil ...........42
ATRIPLA ............................. 47
atropine ................................. 62
ATROVENT HFA................ 80
AUBAGIO ............................ 60
85
aubra ..................................... 68
AUVI-Q................................ 80
AVASTIN ............................ 38
aviane ................................... 68
AVODART .......................... 64
AVONEX ............................. 60
AVONEX (WITH ALBUMIN)
.......................................... 60
AYR SALINE ...................... 12
azacitidine............................. 38
azathioprine .......................... 72
azelastine ........................ 77, 79
AZILECT ............................. 43
azithromycin ......................... 26
aztreonam ............................. 25
B bacitracin ........................ 12, 23
bacitracin zinc ...................... 12
bacitracin-polymyxin b .. 12, 77
baclofen ................................ 45
balsalazide ............................ 75
balziva (28)........................... 68
BANZEL .............................. 29
BARACLUDE ..................... 46
BELEODAQ ........................ 38
benazepril ............................. 54
benazepril-hydrochlorothiazide
.......................................... 56
BENLYSTA ......................... 72
benzonatate ........................... 12
benzoyl peroxide .................. 12
benztropine ........................... 42
betamethasone dipropionate 61,
65
betamethasone valerate ........ 65
betamethasone, augmented... 65
BETASERON ...................... 60
betaxolol ......................... 55, 78
bethanechol chloride ............ 65
BETOPTIC S ....................... 78
bicalutamide ......................... 37
BICILLIN C-R ..................... 25
BICILLIN L-A ..................... 25
BICNU ................................. 38
BILTRICIDE........................ 42
BIO-B KIDS......................... 12
BIO-S-PRES DX .................. 12
bisacodyl............................... 12
bisoprolol fumarate .............. 55
86
bisoprolol-hydrochlorothiazide
.......................................... 56
bleomycin ............................. 38
BLEPHAMIDE .................... 77
BLEPHAMIDE S.O.P. ......... 77
BOOSTRIX TDAP............... 74
BOSULIF ............................. 40
BRILINTA ........................... 54
brimonidine .......................... 78
BRINTELLIX ...................... 31
bromfenac ............................. 78
bromocriptine ....................... 43
brompheniramine-pseudoephdm ..................................... 12
BROTAPP ............................ 12
BROTAPP DM..................... 12
budesonide ...................... 63, 79
bumetanide ........................... 58
buprenorphine hcl ................. 21
buprenorphine-naloxone. 21, 22
buproban ............................... 31
bupropion hcl........................ 31
buspirone .............................. 49
BUSULFEX ......................... 37
butorphanol tartrate .............. 21
BYETTA .............................. 50
C cabergoline ........................... 71
calamine................................ 12
calamine-zinc oxide .............. 12
calcipotriene ......................... 61
calcitonin (salmon) ............... 76
calcitriol ................................ 76
CALCIUM 600..................... 12
calcium acetate ..................... 65
calcium carbonate ................. 12
calcium gluconate ................. 12
calcium lactate ...................... 12
camila ................................... 70
CANASA.............................. 75
CANCIDAS.......................... 34
CAPASTAT ......................... 36
CAPRELSA.......................... 40
captopril ................................ 54
captopril-hydrochlorothiazide
.......................................... 56
CARBAGLU ........................ 83
carbamazepine ................ 29, 50
carbidopa-levodopa .............. 43
carbinoxamine maleate ......... 79
carboplatin ............................ 38
CARIMUNE NF
NANOFILTERED ............ 73
carisoprodol .......................... 82
carteolol ................................ 78
cartia xt ................................. 56
carvedilol .............................. 55
CAYSTON ........................... 25
cefaclor ................................. 24
cefadroxil .............................. 24
cefazolin ............................... 24
cefazolin in dextrose (iso-os) 24
cefdinir .................................. 24
cefepime ............................... 24
cefotaxime ............................ 24
cefoxitin ................................ 24
cefoxitin in dextrose, iso-osm
.......................................... 24
cefpodoxime ......................... 24
cefprozil ................................ 24
ceftazidime ........................... 24
ceftazidime in d5w ...............24
ceftriaxone ............................24
cefuroxime axetil .................. 24
cefuroxime sodium ............... 24
celecoxib ............................... 20
CELLCEPT INTRAVENOUS
.......................................... 72
CELONTIN .......................... 28
cephalexin .......................24, 25
CERDELGA .........................62
CEREZYME.........................62
CERVARIX VACCINE (PF)
.......................................... 74
CETIRI-D ............................. 13
cetirizine .........................13, 79
CHANTIX ............................ 22
CHEMSTRIP 10/SG ............13
CHILD ALLERGY
RELF(CETIRIZINE) ........ 13
CHILD MUCINEX STUFFY
NOSE-COLD ...................13
CHILD MUCUS RELIEF
COUGH ............................ 13
CHILD SUPPOSITORY ......13
CHILDREN'S BENEFIBER 13
CHILDREN'S CLARITIN ... 13
CHILDREN'S COLD &
COUGH ............................ 13
CHILDREN'S IRON ............ 13
CHILDREN'S NON-ASPIRIN
PAIN ................................ 13
CHILDREN'S PAIN &
FEVER RELIEF............... 13
CHILDREN'S PAIN
RELIEVER....................... 13
CHILDREN'S SILAPAP ..... 13
CHILDREN'S SILFEDRINE
.......................................... 13
chloramphenicol sod succinate
.......................................... 23
chlorhexidine gluconate ....... 60
chloroquine phosphate.......... 42
chlorothiazide ....................... 58
chlorpheniramine maleate .... 13
chlorpromazine ..................... 33
chlorthalidone ....................... 58
cholecalciferol (vitamin d3) . 13
cholestyramine light ............. 58
ciclopirox.............................. 34
cidofovir ............................... 45
cilostazol............................... 54
cimetidine ............................. 63
cimetidine hcl ....................... 63
CINRYZE ............................ 72
CIPRODEX .......................... 78
ciprofloxacin (mixture) ........ 26
ciprofloxacin hcl................... 26
ciprofloxacin in 5 % dextrose
.......................................... 26
ciprofloxacin lactate ............. 26
cisplatin ................................ 38
citalopram ............................. 31
cladribine .............................. 38
clarithromycin ...................... 26
clemastine ............................. 79
clindamycin hcl .................... 23
clindamycin in 5 % dextrose 23
clindamycin phosphate ......... 23
clindamycin-benzoyl peroxide
.......................................... 61
CLINIMIX 4.25%-D25W
SULF-FREE ..................... 83
clobetasol........................ 65, 66
clobetasol-emollient ............. 66
clomipramine........................ 32
clonazepam ........................... 28
clonidine ............................... 54
clonidine hcl ................... 54, 59
clopidogrel............................ 54
clorazepate dipotassium ....... 28
clotrimazole .................... 13, 34
clotrimazole-betamethasone . 61
clozapine............................... 45
COARTEM .......................... 42
colchicine.............................. 35
colchicine-probenecid .......... 35
COLCRYS............................ 35
colestipol .............................. 58
colistin (colistimethate na) ... 23
COMBIVENT RESPIMAT . 82
COMETRIQ ......................... 40
COMPLERA ........................ 47
COMPLETE LICE
TREATMENT .................. 13
compro .................................. 33
COMVAX (PF) .................... 74
CONCEPTROL .................... 13
CONDOMS-PREM
LUBRICATED................. 13
CORN-CALLUS REMOVER
.......................................... 13
COSMEGEN ........................ 38
COUMADIN ........................ 52
CREON ................................ 62
CRIXIVAN .......................... 48
cromolyn ................... 13, 77, 81
cryselle (28) .......................... 68
CUBICIN.............................. 23
cyanocobalamin (vitamin b-12)
.......................................... 14
cyclobenzaprine .................... 82
cyclophosphamide ................ 37
CYCLOSET ......................... 50
cyclosporine.......................... 72
cyclosporine modified .......... 72
cyproheptadine ..................... 79
CYSTADANE ...................... 62
CYSTAGON ........................ 62
cytarabine ............................. 38
cytarabine (pf) ...................... 38
D d10 % & 0.45 % sodium
chloride ............................. 84
d2.5 %-0.45 % sodium
chloride ............................. 84
d5 % and 0.9 % sodium
chloride ............................. 84
d5 %-0.45 % sodium chloride
.......................................... 84
dacarbazine ........................... 38
DALIRESP ........................... 81
danazol .................................. 68
dantrolene ............................. 45
dapsone ................................. 36
DAPTACEL (DTAP
PEDIATRIC) (PF) ............74
DARAPRIM .........................42
daunorubicin ......................... 38
decitabine .............................. 38
delyla (28) ............................. 68
DELZICOL........................... 64
DEMSER .............................. 56
DEPEN TITRATABS ..........65
DEPO-MEDROL ................. 66
DEPO-PROVERA ................ 70
DEPO-TESTOSTERONE .... 68
desipramine........................... 32
DESITIN............................... 14
desmopressin ........................ 67
desonide ................................ 66
desoximetasone..................... 66
desvenlafaxine ...................... 31
dexamethasone ..................... 66
dexamethasone intensol ........ 66
dexamethasone sodium
phosphate .................... 66, 78
dexmethylphenidate .............. 59
dexrazoxane hcl ....................38
dextroamphetamine .............. 59
dextromethorphan-guaifenesin
.......................................... 14
dextrose 10 % and 0.2 % nacl
.......................................... 84
dextrose 10 % in water (d10w)
.......................................... 84
dextrose 5 % in water (d5w) . 84
dextrose 5 %-lactated ringers84
dextrose 5%-0.2 % sod
chloride ............................. 84
dextrose 5%-0.3 %
sod.chloride ......................84
dextrose with sodium chloride
.......................................... 84
dextrose-kcl-nacl ..................84
DIABETIC TUSSIN EX ......14
DIAPER RASH ....................14
diazepam ............................... 28
DIAZEPAM ......................... 27
diazepam intensol ................. 28
87
diclofenac potassium ............ 35
diclofenac sodium ... 20, 35, 61,
78
dicloxacillin .......................... 25
dicyclomine .................... 62, 63
didanosine............................. 47
digitek ................................... 57
digoxin.................................. 57
dihydroergotamine ............... 36
DILANTIN ........................... 29
diltiazem hcl ......................... 56
dilt-xr .................................... 56
DIMAPHEN (PE) ................ 14
DIOCTO ............................... 14
DIPENTUM ......................... 75
diphenhydramine hcl ...... 14, 33
diphenoxylate-atropine ......... 63
dipyridamole ........................ 54
disopyramide phosphate ....... 54
disulfiram ............................. 21
divalproex ............................. 28
DOCEFREZ ......................... 38
docetaxel............................... 38
DOCETAXEL ...................... 38
DOCU .................................. 14
DOK ..................................... 14
donepezil .............................. 30
dorzolamide .......................... 78
dorzolamide-timolol ............. 78
doxazosin.............................. 64
doxepin ................................. 32
DOXIL ................................. 38
doxorubicin........................... 38
doxycycline hyclate .............. 27
doxycycline monohydrate ... 27,
61
dronabinol............................. 33
duloxetine ....................... 31, 60
DURAMORPH (PF) ............ 20
DUREZOL ........................... 78
E EAR DROPS (CARBAMIDE
PEROXIDE) ..................... 14
econazole .............................. 34
EDECRIN ............................ 58
EDURANT ........................... 47
ELAPRASE.......................... 62
ELIDEL ................................ 61
ELIGARD ............................ 71
ELIQUIS .............................. 52
88
ELITEK ................................ 38
ELLA .................................... 14
ELMIRON ............................ 65
EMCYT ................................ 37
EMEND ................................ 33
EMSAM ............................... 31
EMTRIVA ............................ 48
enalapril maleate................... 54
enalapril-hydrochlorothiazide
.......................................... 56
ENBREL .............................. 72
ENEMA ................................ 14
ENGERIX-B (PF) ................ 74
ENGERIX-B PEDIATRIC
(PF) ................................... 74
ENJUVIA ............................. 68
enoxaparin ............................ 52
enpresse ................................ 69
entacapone ............................ 42
entecavir ............................... 46
epinephrine ........................... 80
EPIPEN 2-PAK .................... 80
EPIPEN JR 2-PAK ............... 80
epirubicin .............................. 38
EPIVIR HBV........................ 46
EPOGEN .............................. 53
eprosartan ............................. 54
EPZICOM ............................ 48
ERBITUX............................. 38
ergocalciferol (vitamin d2) ... 14
ergoloid................................. 30
ERGOMAR .......................... 36
ERIVEDGE .......................... 40
errin ...................................... 70
ERWINAZE ......................... 38
ery pads................................. 26
ERY-TAB............................. 26
erythrocin.............................. 26
erythrocin (as stearate) ......... 26
erythromycin ........................ 26
erythromycin with ethanol.... 26
erythromycin-benzoyl peroxide
.......................................... 61
ESBRIET .............................. 82
escitalopram oxalate ............. 31
esomeprazole sodium ........... 64
estradiol ................................ 68
estropipate ............................ 68
ethambutol ............................ 36
ethosuximide ........................ 28
etidronate disodium .............. 76
etoposide ...............................40
EVOTAZ .............................. 48
exemestane ........................... 40
EXJADE ...............................82
EYE ALLERGY RELIEF ....14
EYE ITCH RELIEF .............14
EYE WASH..........................14
F FABRAZYME .....................62
falmina (28) .......................... 69
famciclovir ............................ 47
famotidine .......................14, 63
famotidine (pf) ...................... 63
famotidine (pf)-nacl (iso-os) 63
FANAPT...............................44
FARESTON .........................37
FARYDAK ........................... 40
FASLODEX .........................38
FAZACLO ............................ 45
felbamate .............................. 29
felodipine .............................. 56
fenofibrate............................. 58
fenofibrate micronized.......... 58
fenofibrate nanocrystallized .58
fentanyl ................................. 20
fentanyl citrate ......................21
FERRIPROX ........................ 82
ferrous sulfate .......................14
FETZIMA ............................. 31
FEVERALL .......................... 14
FIBER LAXATIVE.............. 14
finasteride .............................65
FIRAZYR ............................. 72
FIRMAGON KIT W
DILUENT SYRINGE ......71
FLANDERS BUTTOCKS ... 14
flavoxate ............................... 64
flecainide .............................. 55
FLEET GLYCERIN (ADULT)
.......................................... 14
FLEET PEDIATRIC ............ 14
FLOVENT HFA ................... 79
fluconazole ........................... 34
fluconazole in dextrose(iso-o)
.......................................... 34
flucytosine ............................ 34
fludarabine ............................ 39
fludrocortisone ...................... 66
flunisolide .............................79
fluocinolone.......................... 66
fluocinonide.......................... 66
fluocinonide-e....................... 66
fluorouracil ........................... 61
fluoxetine.................. 30, 31, 32
fluphenazine decanoate ........ 43
fluphenazine hcl ................... 43
flurbiprofen........................... 35
flurbiprofen sodium .............. 78
flutamide............................... 37
fluticasone ...................... 61, 79
fluvoxamine .......................... 32
FML FORTE ........................ 78
FOCALIN XR ...................... 60
folic acid ............................... 14
fondaparinux......................... 52
FOR STY RELIEF ............... 14
FORA TEST STRIP ............. 14
FORACARE LANCETS ..... 14
FORTEO .............................. 76
foscarnet ............................... 45
fosinopril .............................. 54
fosinopril-hydrochlorothiazide
.......................................... 56
fosphenytoin ......................... 29
FOSRENOL ......................... 65
FRAGMIN ........................... 52
FULL SPECTRUM BVITAMIN C ..................... 15
furosemide ............................ 58
FUZEON .............................. 48
FYCOMPA .......................... 29
G gabapentin ............................ 28
GABITRIL ........................... 28
galantamine .......................... 30
GAMMAGARD LIQUID .... 73
ganciclovir sodium ............... 45
GARDASIL (PF) ................. 74
GARDASIL 9 (PF) .............. 74
GAS RELIEF ....................... 15
GATTEX ONE-VIAL .......... 63
gauze pad .............................. 51
gavilyte-c .............................. 64
gavilyte-g.............................. 64
gavilyte-n.............................. 64
gemcitabine .......................... 37
gemfibrozil ........................... 58
GENOTROPIN .................... 67
GENOTROPIN MINIQUICK
.......................................... 67
gentak ................................... 22
gentamicin ............................ 22
gentamicin in nacl (iso-osm) 22
GENTEAL MILD TO
MODERATE .................... 15
GENTEAL MILD ................ 15
GEODON ............................. 44
gildess ................................... 69
GILENYA ............................ 60
GILOTRIF ............................ 40
glatopa .................................. 60
GLEEVEC ............................ 40
glimepiride............................ 50
glipizide ................................ 50
glipizide-metformin .............. 51
GLUCAGEN HYPOKIT ..... 51
GLUCAGON EMERGENCY
KIT (HUMAN)................. 51
glucose .................................. 15
glyburide............................... 50
glyburide micronized ............ 50
glyburide-metformin ............ 51
glycopyrrolate ....................... 63
granisetron (pf) ..................... 33
granisetron hcl ................ 33, 34
griseofulvin microsize .......... 34
GRX DYNE ......................... 15
guanfacine ...................... 54, 60
guanidine .............................. 36
GYNOL II ............................ 15
H HALAVEN........................... 38
halobetasol propionate .......... 66
haloperidol ............................ 43
haloperidol decanoate ........... 43
haloperidol lactate ................ 43
HARVONI............................ 46
HAVRIX (PF) ...................... 74
heparin (porcine) .................. 53
heparin (porcine) in 5 % dex 53
HERCEPTIN ........................ 38
HETLIOZ ............................. 82
HEXALEN ........................... 37
HIBICLENS ......................... 15
HUMALOG.......................... 51
HUMALOG MIX 50-50 ...... 51
HUMALOG MIX 75-25 ...... 51
HUMIRA .............................. 72
HUMIRA CROHN'S DIS
START PCK .....................72
HUMULIN 70/30 .................51
HUMULIN N .......................51
HUMULIN R........................51
HUMULIN R U-500 ............51
hydralazine ...........................59
hydrochlorothiazide .............. 58
hydrocodone-acetaminophen 20
hydrocodone-ibuprofen ........ 20
hydrocortisone .......... 15, 66, 76
hydrocortisone acetate .......... 15
hydrocortisone butyrate ........66
hydrocortisone valerate ........ 66
hydrocortisone-acetic acid .... 78
HYDROMET .......................15
hydromorphone..................... 21
hydromorphone (pf).............. 21
hydroxychloroquine .............. 42
hydroxyurea .......................... 37
hydroxyzine hcl ....................33
hydroxyzine pamoate............ 33
I ibandronate ........................... 76
IBRANCE............................. 40
ibuprofen................... 15, 20, 35
ICLUSIG .............................. 40
idarubicin .............................. 38
ifosfamide .............................38
ILARIS (PF) ......................... 73
IMBRUVICA .......................40
imipenem-cilastatin .............. 25
imipramine hcl ...................... 32
imipramine pamoate ............. 32
imiquimod............................. 61
IMOVAX RABIES VACCINE
(PF) ................................... 74
INCRELEX .......................... 67
indapamide ........................... 58
indomethacin .................. 20, 35
INFANRIX (DTAP) (PF) .....74
INFANT'S NON-ASPIRIN ..15
INFANT'S PAIN RELIEVER
.......................................... 15
INLYTA ............................... 40
INSULIN PEN NEEDLE .....51
INSULIN SYRINGENEEDLE U-100 ............... 52
INTELENCE ........................ 47
89
INTENSE COUGH
RELIEVER....................... 15
INTRALIPID ....................... 84
INTRON A ........................... 46
INVANZ............................... 25
INVEGA............................... 44
INVEGA SUSTENNA......... 44
INVIRASE ........................... 48
INVOKAMET...................... 50
INVOKANA ........................ 50
IOPHEN C-NR..................... 15
IPOL ..................................... 74
ipratropium bromide ............. 80
ipratropium-albuterol ........... 82
irbesartan .............................. 54
irinotecan .............................. 39
ISENTRESS ......................... 47
ISOLYTE-S.......................... 83
isoniazid ............................... 36
isopropyl alcohol-benzocaine
.......................................... 23
ISOPTO TEARS .................. 15
isosorbide dinitrate ............... 59
isosorbide mononitrate ......... 59
ISTODAX ............................ 39
itraconazole .......................... 34
ivermectin ............................. 42
IXEMPRA ............................ 39
IXIARO (PF) ........................ 74
J JAKAFI ................................ 40
jantoven ................................ 53
JANUMET ........................... 51
JANUVIA ............................ 50
JEVTANA ............................ 39
jinteli .................................... 69
junel 1.5/30 (21) ................... 69
junel 1/20 (21) ...................... 69
junel fe 1.5/30 (28) ............... 69
junel fe 1/20 (28) .................. 69
JUXTAPID ........................... 59
K KADCYLA .......................... 39
KALETRA ........................... 48
KALYDECO ........................ 81
ketoconazole ......................... 34
KETO-DIASTIX .................. 15
KETONE CARE .................. 15
ketorolac ............................... 78
KEYTRUDA ........................ 41
90
KINERET ............................. 72
KLOR-CON 10 .................... 83
KLOR-CON 8 ...................... 83
klor-con m15 ........................ 83
klor-con m20 ........................ 83
KONSYL (SUGAR) ............ 15
KORLYM ............................. 51
K-TAB .................................. 83
KUVAN................................ 62
KYNAMRO ......................... 59
L labetalol ................................ 55
LACRISERT ........................ 77
lactated ringers ..................... 84
lactulose ................................ 64
lamivudine ...................... 46, 48
lamivudine-zidovudine ......... 48
lamotrigine............................ 29
LANOXIN ............................ 57
lansoprazole .......................... 64
LANTUS .............................. 52
LANTUS SOLOSTAR......... 52
larin 1.5/30 (21) .................... 69
larin 1/20 (21) ....................... 69
latanoprost ............................ 78
LATUDA.............................. 44
LAXATIVE .......................... 15
LAZANDA........................... 21
leena 28................................. 69
leflunomide ........................... 73
LENVIMA............................ 40
lessina ................................... 69
LETAIRIS ............................ 81
letrozole ................................ 40
leucovorin calcium ............... 39
LEUKERAN ........................ 37
LEUKINE............................. 53
leuprolide .............................. 71
levalbuterol hcl ............... 80, 81
LEVEMIR ............................ 52
levetiracetam .................. 27, 28
levobunolol ........................... 78
levocarnitine ......................... 84
levocetirizine ........................ 79
levofloxacin .......................... 27
levofloxacin in d5w .............. 27
levoleucovorin calcium ........ 39
levonorgestrel ....................... 15
levonorgestrel-ethinyl estrad 69
levora-28 ............................... 69
levothyroxine ........................ 70
LEVOXYL ........................... 70
LEXIVA ......................... 48, 49
LICE KILLING .................... 15
LICE TREATMENT
(RESMETHRIN) .............. 15
lidocaine ............................... 21
lidocaine (pf) ........................ 21
lidocaine hcl.......................... 21
lidocaine-prilocaine ..............21
LINCOCIN ...........................23
linezolid ................................ 23
LINZESS .............................. 64
liothyronine...........................70
lisinopril ................................ 54
lisinopril-hydrochlorothiazide
.......................................... 57
lithium carbonate .................. 50
lithium citrate........................ 50
LOHIST - D .......................... 15
LOMUSTINE ....................... 37
loperamide ...................... 15, 63
LORATADINE-D ................15
lorazepam ............................. 28
losartan ................................. 54
losartan-hydrochlorothiazide 57
lovastatin...............................58
loxapine succinate ................43
LUBRICANT EYE .............. 15
LUBRICANT EYE DROPS. 15
LUPRON DEPOT ................ 71
LUPRON DEPOT (3
MONTH) ..........................71
LUPRON DEPOT (4
MONTH) ..........................71
LUPRON DEPOT (6
MONTH) ..........................71
LUPRON DEPOT-PED .......71
LYNPARZA .........................39
LYRICA ...............................28
LYSODREN .........................71
M magnesium citrate ................. 16
magnesium oxide .................. 16
magnesium sulfate ................ 83
malathion .............................. 42
maprotiline ............................ 31
MARPLAN........................... 31
MATULANE ........................ 37
meclizine............................... 33
MEDI-CORTISONE ............ 16
MEDI-FIRST ANTI-FUNGAL
.......................................... 16
medroxyprogesterone ........... 70
mefloquine............................ 42
megestrol .............................. 70
MEKINIST ........................... 41
meloxicam ............................ 20
melphalan hcl ....................... 37
MENACTRA (PF) ............... 74
MENEST .............................. 68
MENOMUNE - A/C/Y/W-135
(PF) ................................... 74
MENVEO A-C-Y-W-135-DIP
(PF) ................................... 74
MEPHYTON........................ 16
meprobamate ........................ 49
mercaptopurine ..................... 72
meropenem ........................... 25
mesalamine with cleansing
wipe .................................. 76
mesna .................................... 39
MESNEX ............................. 39
METAMUCIL SUNRISE .... 16
metaproterenol...................... 81
metformin ............................. 50
methazolamide ..................... 57
methimazole ......................... 72
METHITEST........................ 68
methocarbamol ..................... 82
methotrexate sodium ............ 72
methotrexate sodium (pf) ..... 72
methoxsalen rapid ................ 61
methyldopa ........................... 54
methyldopahydrochlorothiazide.......... 57
methylphenidate ................... 60
methylprednisolone ........ 67, 76
methylprednisolone acetate .. 67
metipranolol ......................... 78
metoclopramide hcl .............. 63
metolazone ........................... 58
metoprolol succinate ............ 55
metoprolol ta-hydrochlorothiaz
.......................................... 57
metoprolol tartrate ................ 55
metronidazole ....................... 23
metronidazole in nacl (iso-os)
.......................................... 23
mexiletine ............................. 55
MIACALCIN ....................... 76
MICONAZOLE 7................. 16
miconazole nitrate ................ 16
miconazole-3 ........................ 34
MICONAZOLE-3 ................ 16
microgestin 1.5/30 (21) ........ 69
microgestin 1/20 (21) ........... 69
microgestin fe 1.5/30 (28) .... 69
microgestin fe 1/20 (28) ....... 69
midodrine.............................. 54
MILK OF MAGNESIA........ 16
MILK OF MAGNESIA
CONCENTRATED .......... 16
minocycline .......................... 27
minoxidil .............................. 59
MINTOX PLUS ................... 16
mirtazapine ........................... 31
misoprostol ........................... 64
mitomycin............................. 39
mitoxantrone......................... 39
M-M-R II (PF) ...................... 74
modafinil .............................. 82
moexipril .............................. 54
moexipril-hydrochlorothiazide
.......................................... 57
mometasone .......................... 67
montelukast .......................... 80
morphine......................... 20, 21
MOTION SICKNESS
RELIEF(MECLIZ) ........... 16
MOZOBIL ............................ 53
MUCINEX ........................... 16
MUCINEX COUGH MINIMELTS ............................. 16
MUCINEX D ....................... 16
MUCINEX D MAXIMUM
STRENGTH ..................... 16
MUCINEX DM .................... 16
MUCUS RELIEF ER ........... 16
MULTAQ ............................. 55
mupirocin.............................. 23
mupirocin calcium ................ 23
MURO 128 ........................... 16
MUSTARGEN ..................... 39
MYCAMINE ........................ 34
mycophenolate mofetil ......... 72
mycophenolate sodium ......... 73
MYOZYME ......................... 62
MYRBETRIQ ...................... 64
N nabumetone........................... 20
nadolol .................................. 55
nadolol-bendroflumethiazide 57
nafcillin ................................. 25
NAGLAZYME .....................62
naloxone ............................... 22
naltrexone ............................. 22
NAMENDA .......................... 30
NAMENDA XR ................... 30
naphazoline ........................... 77
naproxen .........................20, 36
naproxen sodium .................. 16
NASAL DECONGESTANT
(OXYMETAZL)...............16
NASAL DECONGESTANT
(PSEUDOEPH) ................ 16
NATACYN........................... 34
nateglinide ............................ 50
NATPARA ...........................76
NATURAL BALANCE .......17
NATURAL VEGETABLE
POWDER .........................17
NEBUPENT .........................42
necon 0.5/35 (28) .................. 69
necon 1/35 (28) ..................... 69
necon 10/11 (28) ................... 69
necon 7/7/7 (28) ....................69
nefazodone ............................ 31
neomycin .............................. 22
neomycin-bacitracin-poly-hc 77
neomycin-polymyxin b gu ....22
neomycin-polymyxin bdexameth........................... 77
neomycin-polymyxingramicidin ......................... 77
neomycin-polymyxin-hc. 77, 79
NEULASTA .........................53
NEUMEGA .......................... 53
NEUPOGEN.........................53
NEUPRO .............................. 43
nevirapine ............................. 47
NEXAVAR........................... 41
NEXT CHOICE ONE DOSE
.......................................... 17
niacin ..............................17, 59
NIACIN FLUSH FREE ........17
niacor .................................... 59
nicardipine ............................ 56
NICODERM CQ .................. 17
91
nicotine ................................. 17
nicotine (polacrilex) ............. 17
NICOTROL.......................... 22
NICOTROL NS ................... 22
nifedical xl ............................ 56
nifedipine.............................. 56
NILANDRON ...................... 37
nitrofurantoin........................ 23
nitrofurantoin macrocrystal .. 23
nitrofurantoin monohyd/mcryst .................................. 23
nitroglycerin ......................... 59
NITROSTAT........................ 59
NON-ASPIRIN JR
STRENGTH ..................... 17
norethindrone acetate ........... 70
norlyroc ................................ 69
NORTHERA ........................ 54
nortrel 0.5/35 (28) ................ 69
nortrel 1/35 (21) ................... 69
nortrel 1/35 (28) ................... 69
nortrel 7/7/7 (28) .................. 69
nortriptyline .......................... 32
NORVIR .............................. 49
NOVOLIN 70/30 ................. 52
NOVOLIN N ........................ 52
NOVOLIN R ........................ 52
NOVOLOG .......................... 52
NOVOLOG MIX 70-30 ....... 52
NOXAFIL ............................ 34
NUEDEXTA ........................ 60
NULOJIX ............................. 73
NUTRILIPID…………….. 84
NUTRISOURCE FIBER ..... 17
nystatin ................................. 35
nystatin-triamcinolone .......... 61
O OCEAN NASAL .................. 17
octreotide acetate .................. 71
OFEV ................................... 82
ofloxacin ............................... 27
olanzapine............................. 44
olanzapine-fluoxetine ........... 30
OLYSIO ............................... 46
omega-3 acid ethyl esters ..... 59
omeprazole ..................... 17, 64
OMNITROPE....................... 68
ONCASPAR ........................ 39
ondansetron .......................... 34
ondansetron hcl .................... 34
92
ondansetron hcl (pf).............. 34
ONFI ..................................... 28
OPDIVO ............................... 41
OPSUMIT ............................ 81
ORAP ................................... 43
ORENCIA ............................ 73
ORENCIA (WITH
MALTOSE) ...................... 73
ORFADIN ............................ 62
oxacillin ................................ 26
oxacillin in dextrose(iso-osm)
.......................................... 26
oxaliplatin ............................. 39
oxandrolone .......................... 68
oxcarbazepine ....................... 30
oxybutynin chloride .............. 64
oxycodone ............................ 21
oxycodone-acetaminophen ... 20
P paclitaxel .............................. 39
PAIN RELIEVER EXTRA
STRENGTH ..................... 17
pamidronate .......................... 76
PANDA MASK.................... 17
PANRETIN .......................... 41
pantoprazole ......................... 64
paricalcitol ............................ 76
paromomycin ........................ 22
paroxetine hcl ....................... 32
PASER.................................. 36
PATADAY ........................... 77
PATANOL ........................... 78
PAXIL .................................. 32
PAZEO ................................. 78
PEAK AIR PEAK FLOW
METER ............................ 17
PEDIA-LAX STOOL
SOFTENER ...................... 17
PEDIATRIC COUGH &
COLD ............................... 17
PEDIATRIC ELECTROLYTE
.......................................... 17
PEDIATRIC MEDIUM
MASK .............................. 17
PEDVAX HIB (PF) .............. 75
PEGANONE ........................ 30
PEGASYS ............................ 46
PEGASYS PROCLICK ....... 46
PEGINTRON ....................... 46
PEGINTRON REDIPEN ..... 46
penicillin g pot in dextrose ...26
penicillin g potassium ...........26
penicillin g procaine .............26
penicillin g sodium ...............26
penicillin v potassium ...........26
PENTAM .............................. 42
pentoxifylline ........................ 57
PERJETA .............................39
permethrin....................... 17, 42
perphenazine ......................... 33
PHARBEDRYL ...................17
phenelzine .............................31
phenobarbital ..................28, 29
phentermine .......................... 17
phenytoin ..............................30
phenytoin sodium ................. 30
phenytoin sodium extended .. 30
PHOSPHOLINE IODIDE ....78
PHYSIOLYTE .....................83
pilocarpine hcl ...................... 60
pindolol ................................. 55
PINK BISMUTH ..................17
pioglitazone .......................... 50
pioglitazone-glimepiride....... 51
pioglitazone-metformin ........ 51
piperacillin-tazobactam ........ 26
PLASMA-LYTE 148 ........... 83
PLASMA-LYTE A .............. 83
podofilox...............................61
polyethylene glycol 3350 ..... 64
polymyxin b sulf-trimethoprim
.......................................... 77
POLYSPORIN ..................... 17
POLY-VI-SOL ..................... 17
POLY-VITAMIN WITH
IRON ................................ 18
POMALYST.........................37
portia .....................................69
potassium chlorid-d50.45%nacl ......................... 84
potassium chloride ................ 83
potassium chloride in 5 % dex
.......................................... 84
potassium chloride-d50.2%nacl ........................... 84
potassium citrate ................... 65
POTIGA ............................... 28
povidone-iodine.................... 18
PRADAXA .......................... 53
pramipexole .......................... 43
pravastatin ............................ 58
prazosin ................................ 54
prednicarbate .................. 61, 67
prednisolone acetate ............. 76
prednisolone sodium phosphate
.................................... 67, 78
prednisone ............................ 67
prednisone intensol............... 67
PREMARIN ......................... 68
PREMPRO ........................... 69
PRENATAL VITAMIN....... 18
PRENATAL VITAMIN WITH
MINERALS ..................... 18
prenatal vitamins low iron .... 84
previfem ............................... 69
PREZCOBIX........................ 49
PREZISTA ........................... 49
PRILOSEC OTC .................. 18
primaquine............................ 42
primidone ............................. 29
PRIMSOL ............................ 23
probenecid ............................ 35
procainamide ........................ 55
prochlorperazine ................... 33
prochlorperazine edisylate.... 33
prochlorperazine maleate ..... 33
PROCRIT ............................. 53
proctosol hc .......................... 76
proctozone-hc ....................... 63
PROCYSBI .......................... 62
PROGLYCEM ..................... 51
PROGRAF ........................... 73
PROLEUKIN ....................... 39
PROLIA ............................... 76
PROMACTA........................ 53
promethazine ........................ 33
promethazine vc ................... 82
PROMETHAZINE VCCODEINE ........................ 18
promethazine-codeine .......... 18
promethazine-dm.................. 18
promethegan ......................... 33
propafenone .......................... 55
proparacaine ......................... 77
propranolol ........................... 55
propranolol-hydrochlorothiazid
.......................................... 57
propylthiouracil .................... 72
PROQUAD (PF) .................. 75
protriptyline .......................... 33
psyllium husk ....................... 18
PULMOZYME..................... 82
PURIXAN ............................ 37
pyrazinamide ........................ 36
PYRETHRIN LICE
TREATMENT M ............. 18
pyridostigmine bromide ....... 36
pyridoxine............................. 18
Q Q-PAP .................................. 18
QUADRACEL (PF) ............. 75
quasense................................ 69
quetiapine ............................. 44
quinapril................................ 54
quinapril-hydrochlorothiazide
.......................................... 57
quinidine gluconate .............. 55
quinidine sulfate ................... 55
quinine sulfate ...................... 42
QVAR................................... 80
R RABAVERT (PF) ................ 75
raloxifene .............................. 70
ramipril ................................. 54
RANEXA ............................. 57
ranitidine hcl ................... 18, 63
RAPAMUNE........................ 73
RAVICTI .............................. 62
REBIF (WITH ALBUMIN) . 60
REBIF REBIDOSE .............. 60
REBIF TITRATION PACK. 60
reclipsen (28) ........................ 69
RECOMBIVAX HB (PF) .... 75
REESE'S PINWORM
MEDICINE ...................... 18
REFRESH LACRI-LUBE.... 18
RELENZA DISKHALER .... 49
RELISTOR ........................... 63
REMICADE ......................... 73
REMODULIN ...................... 81
RENAGEL ........................... 65
repaglinide ............................ 50
RESCRIPTOR ...................... 47
RESTASIS............................ 77
RETROVIR .......................... 48
REVLIMID.....................37, 40
REYATAZ ........................... 49
ribavirin ................................46
RIDAURA ............................ 73
rifabutin ................................ 36
RIFAMATE .......................... 36
rifampin ................................ 36
RIFATER .............................36
riluzole .................................. 60
rimantadine ........................... 49
ringers ................................... 84
risedronate ......................76, 77
RISPERDAL CONSTA ....... 44
risperidone ............................ 44
RITUXAN ............................ 41
rivastigmine tartrate .............. 30
rizatriptan .............................. 36
ROBITUSSIN PEDIATRIC .18
ropinirole .............................. 43
ROTARIX ............................ 75
ROTATEQ VACCINE .........75
ROZEREM ...........................82
S SABRIL ................................ 29
SAFETY NEEDLES ............52
SANDOSTATIN LAR
DEPOT ............................. 71
SANTYL .............................. 61
SAPHRIS (BLACK
CHERRY).........................44
SCALPICIN .........................18
SCOT-TUSSIN DM .............18
SCOT-TUSSIN SENIOR .....18
selegiline hcl ......................... 43
selenium sulfide .................... 61
SELZENTRY .......................48
SENNA ................................. 18
SENNA PLUS ...................... 18
SENSIPAR ........................... 71
SEREVENT DISKUS ..........81
sertraline ............................... 32
SIGNIFOR ............................ 71
SIGNIFOR LAR ...................71
SILAPAP .............................. 18
sildenafil ............................... 81
silver sulfadiazine .................27
simethicone ........................... 18
SIMULECT .......................... 73
simvastatin ............................ 58
sirolimus ............................... 73
93
SIRTURO ............................. 37
SLEEP TABLET
(DIPHENHYDRAMINE) 18
sodium bicarbonate .............. 18
sodium chloride .............. 18, 83
sodium chloride 0.45 %........ 83
sodium chloride 0.9 %.......... 83
sodium chloride 3 %............. 83
sodium chloride 5 %............. 83
sodium fluoride .................... 83
sodium phenylbutyrate ......... 65
sodium polystyrene (sorb free)
.......................................... 82
SOLTAMOX........................ 37
SOLUBLE FIBER ............... 18
SOLU-CORTEF (PF)........... 67
SOLU-MEDROL ................. 67
SOLU-MEDROL (PF) ......... 67
SOMATULINE DEPOT ...... 71
SOMAVERT ........................ 71
SOOTHE (BISMUTH
SUBSALICYLATE) ........ 19
sotalol ................................... 55
sotalol af ............................... 55
SOVALDI ............................ 46
SPIRIVA RESPIMAT ......... 80
SPIRIVA WITH
HANDIHALER................ 80
spironolactone ...................... 58
spironolacton-hydrochlorothiaz
.......................................... 57
SPORANOX ........................ 35
sprintec (28).......................... 70
SPRYCEL ............................ 41
sronyx ................................... 70
SSD ...................................... 27
stavudine............................... 48
STIMATE ............................ 68
STIVARGA.......................... 41
STOMACH RELIEF ............ 19
STOOL SOFTENER ............ 19
STRATTERA ....................... 60
streptomycin ......................... 22
STRIBILD ............................ 47
sucralfate .............................. 64
SUDOGEST ......................... 19
sulfacetamide sodium ........... 27
sulfacetamide sodium (acne) 27
sulfacetamide-prednisolone.. 77
sulfadiazine........................... 27
94
sulfamethoxazole-trimethoprim
.......................................... 27
sulfasalazine ......................... 76
sulfazine ec ........................... 76
sulindac................................. 36
sumatriptan succinate ........... 36
SUPER PAIN RELIEF......... 19
SUPRAX .............................. 25
SURMONTIL....................... 33
SUSTIVA ............................. 47
SUTENT............................... 41
SYLATRON......................... 46
SYLVANT ........................... 41
SYMLINPEN 120 ................ 50
SYMLINPEN 60 .................. 51
SYNAGIS............................. 73
SYNAREL............................ 71
SYNERCID .......................... 23
SYNRIBO ............................ 40
SYNTHROID ....................... 70
SYPRINE ............................. 83
SYSTANE NIGHTTIME ..... 19
T TABLOID ............................ 37
tacrolimus ....................... 61, 73
TAFINLAR .......................... 41
TAMIFLU ............................ 49
tamoxifen .............................. 37
tamsulosin............................. 65
TARCEVA ........................... 41
TARGRETIN ....................... 41
TASIGNA ............................ 41
TAZORAC ..................... 61, 62
taztia xt ................................. 56
TEARS NATURALE FORTE
.......................................... 19
TEARS NATURALE II ....... 19
TEFLARO ............................ 25
temazepam ............................ 82
terazosin................................ 65
terbinafine hcl ................. 19, 35
terbutaline ............................. 81
terconazole............................ 35
testosterone cypionate .......... 68
testosterone enanthate........... 68
TETANUS,DIPHTHERIA
TOX PED(PF) .................. 75
TETANUS-DIPHTHERIA
TOXOIDS-TD .................. 75
tetracycline ........................... 27
THALOMID .........................37
theophylline ..........................81
thiamine hcl .......................... 19
thioridazine ........................... 43
thiothixene ............................43
THYMOGLOBULIN ........... 73
tiagabine ............................... 29
TIKOSYN............................. 55
timolol maleate ............... 55, 78
TIVICAY .............................. 47
tizanidine .............................. 45
TOBI PODHALER .............. 22
TOBRADEX ........................22
tobramycin ............................ 22
tobramycin in 0.225 % nacl .. 22
tobramycin in 0.9 % nacl ...... 22
tobramycin sulfate ................ 22
tobramycin-dexamethasone .. 77
TOBREX .............................. 22
tolcapone...............................42
tolnaftate ............................... 19
tolterodine ............................. 64
topiramate ............................. 29
toposar .................................. 40
topotecan............................... 40
TORISEL .............................. 73
torsemide .............................. 58
TRACLEER .........................81
tramadol ................................ 21
tramadol-acetaminophen ...... 20
trandolapril ........................... 54
tranexamic acid ..................... 53
TRANSDERM-SCOP ..........63
tranylcypromine .................... 31
TRAVATAN Z ..................... 78
travoprost (benzalkonium).... 78
trazodone ..............................31
TREANDA ...........................39
TRECATOR .........................37
tretinoin.................................41
tretinoin (chemotherapy) ...... 41
triamcinolone acetonide.. 61, 67
triamterene-hydrochlorothiazid
.......................................... 57
triazolam ............................... 49
trifluoperazine....................... 43
trifluridine ............................. 47
trihexyphenidyl ..................... 42
tri-legest fe ............................ 70
trilyte with flavor packets ..... 64
trimethoprim ......................... 24
trinessa (28) .......................... 70
TRIPLE ANTIBIOTIC ........ 19
tri-previfem (28) ................... 70
TRISENOX .......................... 39
tri-sprintec (28)..................... 70
TRIUMEQ............................ 48
TRI-VITA............................. 19
trivora (28)............................ 70
trospium................................ 64
TRUMENBA ....................... 75
TRUVADA .......................... 48
TRYMINE D ........................ 19
TUDORZA PRESSAIR ....... 80
TUSSIN CF .......................... 19
TWINRIX (PF) .................... 75
TYBOST .............................. 48
TYGACIL ............................ 24
TYKERB .............................. 41
TYPHIM VI ......................... 75
TYSABRI ............................. 73
TYZEKA .............................. 46
U UNITHROID........................ 70
urea ....................................... 19
ursodiol ................................. 63
UVADEX ............................. 62
V VAGINAL
CONTRACEPTIVE FILM
.......................................... 19
VAGINAL
CONTRACEPTIVE FOAM
.......................................... 19
valacyclovir .......................... 47
VALCHLOR ........................ 62
VALCYTE ........................... 45
valganciclovir ....................... 45
valproate sodium .................. 29
valproic acid ......................... 29
valproic acid (as sodium salt)
.......................................... 29
valsartan-hydrochlorothiazide
.......................................... 57
vancomycin .......................... 24
VAQTA (PF) ........................ 75
VARIVAX (PF) ................... 75
VARIZIG.............................. 75
VECTIBIX ........................... 39
VELCADE ........................... 39
venlafaxine ........................... 32
VENTOLIN HFA ................. 81
verapamil .............................. 56
VERSACLOZ ...................... 45
VIDEX 2 GRAM PEDIATRIC
.......................................... 48
VIGAMOX........................... 27
VIIBRYD ............................. 32
VIMPAT............................... 30
vinblastine ............................ 39
vincristine ............................. 39
vinorelbine ............................ 39
VIRACEPT .......................... 49
VIRAMUNE XR .................. 47
VIRAZOLE .......................... 46
VIREAD ............................... 46
VISINE-A............................. 19
vitamin a palmitate ............... 19
VITAMIN B-1...................... 19
VITAMIN B-1
(MONONITRATE) .......... 19
VITAMIN B-2...................... 19
VITAMIN B-6...................... 19
VITAMIN C ......................... 19
VITAMIN D3 ....................... 19
vitamin e ............................... 19
VITEKTA............................. 47
voriconazole ......................... 35
VOTRIENT .......................... 41
VPRIV .................................. 62
VYTORIN 10-10.................. 57
VYTORIN 10-20.................. 57
VYTORIN 10-40.................. 57
W WAL-ACT D COLD &
ALLERGY ....................... 19
WAL-FINATE-D ................. 19
WAL-MUCIL FIBER
(ASPARTAME) ............... 20
warfarin ................................ 53
WART REMOVER .............. 20
WELCHOL .......................... 59
X XALKORI ............................41
XARELTO ........................... 53
XENAZINE .......................... 60
XGEVA ................................ 77
XOLAIR ............................... 82
XTANDI ...............................37
XYREM ................................ 82
Y YERVOY ............................. 40
YF-VAX (PF) ....................... 75
Z zafirlukast ............................. 80
zaleplon.................................82
ZALTRAP ............................ 40
ZANOSAR ........................... 22
ZAVESCA ............................ 62
ZELAPAR ............................ 43
ZELBORAF .........................41
ZEMAIRA ............................ 82
ZENPEP ............................... 62
ZETIA................................... 59
ZIAGEN ............................... 48
zidovudine ............................ 48
zinc ....................................... 20
zinc gluconate .......................20
zinc oxide.............................. 20
ziprasidone hcl ......................45
ZIRGAN ...............................45
zoledronic acid...................... 77
zoledronic acid-mannitol-water
.......................................... 77
ZOLINZA ............................. 35
zolpidem ............................... 82
ZOMETA ............................. 77
zonisamide ............................ 28
ZORTRESS .......................... 73
ZOSTAVAX (PF) ................75
zovia 1/35e (28) ....................70
zovia 1/50e (28) ....................70
ZYDELIG ............................. 40
ZYKADIA ............................ 41
ZYPREXA RELPREVV ......45
ZYTIGA ............................... 37
ZYVOX ................................ 24
95
ZOSTAVAX (PF) ................ 75
zovia 1/35e (28).................... 70
zovia 1/50e (28).................... 70
96
ZYDELIG ............................. 40
ZYKADIA ............................ 41
ZYPREXA RELPREVV ...... 45
ZYTIGA ............................... 37
ZYVOX ................................ 24
Formulary
IEHP DualChoice Cal MediConnect Plan
(Medicare-Medicaid Plan)
IEHP DualChoice
P.O. Box 1800, Rancho Cucamonga, CA 91729-1800
©2016 Inland Empire Health Plan. All Rights Reserved. Updated: August 19, 2015
H5355_CMC_16_03445_Final_1 Approved
1-877-273-IEHP (4347)
1-800-718-4347 TTY
January
2015

List of Covered Drugs - Inland Empire Health Plan

Transcription

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