IA Hawk-i Eff_02-01-16 v1.indd

Transcription

Preferred
Drug List (PDL)
Iowa
Effective Date: 1/1/16
© 2016 United Healthcare Services, Inc. All rights reserved.
Preferred Drug List
INTRODUCTION
UnitedHealthcare assumes no responsibility for the actions
or omissions of any medical provider based upon reliance,
in whole or in part, on the information contained herein.
The medical provider should consult the drug
manufacturer’s product literature or standard references for
more detailed information.
UnitedHealthcare is pleased to provide this Preferred Drug
List (PDL) to be used when prescribing for patients
covered by the pharmacy benefit plan offered by
UnitedHealthcare. The drugs listed in this PDL are
intended to provide sufficient options to treat patients who
require treatment with a drug from that pharmacologic or
therapeutic class. The drugs listed in the UnitedHealthcare
PDL have been reviewed and approved by the Pharmacy
and Therapeutics Committee. The drugs have been selected
to provide the most clinically appropriate and cost-effective
medications for patients who have their drug benefit
administered through UnitedHealthcare. It is also
recognized there may be occasions where an unlisted drug
is desired for proper medical management of a specific
patient. In those infrequent instances, the unlisted
medication may be requested through the prior
authorization process.
National guidelines can be found on the Web sites listed in
the Web site section or go to the National Guideline
Clearinghouse site at http://www.guideline.gov.
PREFACE
The UnitedHealthcare PDL is organized by sections. Each
section includes therapeutic groups identified by either a
drug class or disease state.
Products are listed by generic name. Brand names are
included as a reference to assist in product recognition.
Unless exceptions are noted, generally all applicable
dosage forms and strengths of the drug cited are included in
the PDL. Generics should be considered the first line of
prescribing.
The drugs represented have been reviewed by the
Pharmacy and Therapeutics (P&T) Committee and are
approved for inclusion. The PDL is reflective of current
medical practice as of the date of review.
The UnitedHealthcare PDL covers selected over-thecounter (OTC) products. You are encouraged to prescribe
OTC medications when clinically appropriate.
This edition incorporates drugs added to the PDL since the
last edition as well as numerous revisions to the prescribing
information based on changes in pharmacotherapy.
Comments and suggestions from practicing physicians have
also been incorporated to ensure that the UnitedHealthcare
PDL is reflective of current medical practice.
PHARMACY AND THERAPEUTICS (P&T)
COMMITTEE
The P&T Committee includes physicians and pharmacists
who are not employees or agents of UnitedHealthcare or its
affiliates. They must adhere to the Ethics Policy standards
of the P&T Committee. UnitedHealthcare medical directors
and pharmacists also participate in the P&T Committee.
The P&T Committee meets quarterly to discuss a variety of
issues. Those issues pertaining to pharmaceutical selection
and pharmacy program management are communicated
quarterly. This newsletter is distributed to all participating
physicians who have received the PDL. PDL decisions are
also communicated quarterly on the UnitedHealthcare
internet site.
NOTICE
The information contained in this PDL and its appendices is
provided by UnitedHealthcare, solely for the convenience
of medical providers. UnitedHealthcare does not warrant or
assure accuracy of such information nor is it intended to be
comprehensive in nature.
This PDL is not intended to be a substitute for the
knowledge, expertise, skill and judgment of the medical
provider in their choice of prescription drugs.
UHC1004a {Released 2/25/11}
i
OUTPATIENT PRESCRIPTION DRUG
BENEFIT-COVERED MEDICATIONS
Extended-release and delayed-release products
require their own entry.
diltiazem sustained release CARDIZEM SR
Medically necessary outpatient prescription drugs are
covered when prescribed by a provider licensed to prescribe
federal legend drugs or medicines. Some items
are covered only with prior authorization. Eligibility for
Outpatient Prescription Drug Benefits and copays are based
on the individual member’s benefit plan.
Dosage forms covered will be consistent with the
category and use where listed.
Neomycin/polymixin B/ Cortisporin
Hydrocortisone
PRODUCT SELECTION CRITERIA
The P&T Committee considers clinical information on
new-to-market drugs that are typically included in an
outpatient pharmacy benefit. The evaluation includes all or
part of the following:
• Safety
• Efficacy
• Comparison studies
• Approved indications
• Adverse effects
• Contraindications/Warnings/Precautions
• Pharmacokinetics
• Patient administration/compliance considerations
• Medical outcome and pharmacoeconomic
studies
As listed in the OTIC section, this is limited to the otic
solution and suspension. From this entry the ophthalmic
solution and ointment, and the topical cream cannot be
assumed to be on the list unless there are entries for these
products in the OPHTHALMIC and DERMATOLOGY
sections of the PDL.
When a strength or dosage form is specified, only the
specified strength and dosage form is on the PDL.
Other strengths/dosage forms of the reference product
are not
citalopram 40 mg tabs
Celexa tabs
GENERIC SUBSTITUTION
When a new drug is considered for PDL inclusion, it will
be reviewed relative to similar drugs currently included in
the UnitedHealthcare PDL. This review process may result
in deletion of drug(s) in a particular therapeutic class in an
effort to continually promote the most clinically useful and
cost-effective agents.
The UnitedHealthcare PDL requires generic substitution
on the majority of products when a generic equivalent is
available.
Generic substitution is a pharmacy action whereby a
generic equivalent is dispensed rather than the brand name
product. The PDL indicates generic availability in the
“Covered Drug” column.
All the information in the PDL is provided as a reference
for drug therapy selection. Specific drug selection for an
individual patient rests solely with the prescriber.
If a brand name drug is medically necessary, please submit
a prior authorization request.
PDL PRODUCT DESCRIPTIONS
The UnitedHealthcare MAC list sets a ceiling price for the
reimbursement of certain multisource prescription drugs.
This price will typically cover the acquisition of most
generics but not branded versions of the same drug. The
products selected for inclusion on the MAC list are
commonly prescribed and dispensed and have usually gone
through the FDA’s review and approval process. An
important consideration for generic substitution is the
knowledge that all approvals of generic drugs by the FDA
since 1984, and many generic approvals prior to 1984, have
a showing of bioequivalence between the generic versions
and the reference brand product. To gain FDA approval:
To assist in understanding which specific strengths and
dosage forms are covered on the
PDL, examples are noted below. The general principles
shown in the examples can then usually be extended to
other entries in the book. Any exceptions are noted in the
drug list. There may also be a statement associated with a
drug list that gives additional information about which
specific products or dosage forms are covered.
Products covered include all strengths associated
with the dosage form of the cited brand name
product.
carvedilol
Coreg
1. The generic drug must contain the same active
ingredient(s), be the same strength and the same dosage
form as the brand name product.
All strengths of Coreg would be covered by this listing.
2. The FDA has given the generic an “A” rating compared
to the branded product indicating bioequivalence, and
has determined the generic is therapeutically equivalent
UHC1004a
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• Drugs from manufacturers that do not participate
in the FFS Medicaid Drug Rebate Program
• Diagnostic products
• Medical supplies and DME except as listed:
syringes, needles, lancets, alcohol swabs, spacers,
preferred diabetes test strips, peak flow meters
(Astech, Assess, Peak Air brands, max two per
year), vaporizer (limit of 1 per 3 years), humidifier
(limit of 1 per 3 years)
• Mirena
to the reference brand. The ratings of generic drugs are
available by referring to the FDA reference, Approved
Drug Products with Therapeutic Equivalence
Evaluations (Orange Book).
When the above two criteria are met, a generic can be
substituted with the full expectation that the substituted
product will produce the same clinical effect and safety
profile as the prescribed product. Drug products that have a
narrow therapeutic index (NTI) can also be guided by these
principles. It is not necessary for the health care provider to
approach any one therapeutic class of drug products (e.g.,
NTI drugs) differently from any other class, when there has
been a determination of therapeutic equivalence by the
FDA for the drug products under consideration. Also,
additional clinical tests or examinations by the physician
are not needed when a therapeutically equivalent generic
drug product is substituted for the brand name product.
DAYS SUPPLY DISPENSING LIMITATIONS
UnitedHealthcare members may receive up to a one month
supply of a specific medication per prescription order or
prescription refill. A medication may be reordered or
refilled when eighty-five percent (85%) of the medication
has been utilized. If a claim is submitted before 85% of the
medication has been used, based on the original day supply
submitted on the claim, the claim will reject with a "refill
too soon" message.
There are now many brand name products that are
repackaged or distributed under a generic label. The generic
label version should always be considered therapeutically
equivalent and substitutable for the source branded product.
MANDATORY GENERIC SUBSTITUTION
The UnitedHealthcare PDL requires mandatory generic
substitution on the vast majority of products when a generic
equivalent is available; however, brand name drugs may be
covered in certain situations by requesting a prior
authorization. The UnitedHealthcare PDL prior
authorization (PA) list does not include branded items
where a generic equivalent is covered.
DRUG EFFICACY STUDY IMPLEMENTATION
(DESI) DRUGS
Drugs first marketed between 1938 and 1962 were
approved as safe but required no showing of effectiveness
for FDA approval. Beginning in 1962, all new drugs were
required to be both safe and effective before they could be
marketed. This legislation also applied retroactively to all
drugs approved as safe from 1938-1962. The DESI
program was established by the FDA to review the
effectiveness of these pre-1962 drugs for their labeled
indications, and a determination of “fully effective” was
made for most of these products and they remain in the
marketplace. A few DESI products remain classified as
“less than fully effective” while awaiting final
administrative disposition. Also, classified as DESI are
many products listed as identical, similar, or related to
actual DESI products. UnitedHealthcare’s PDL does not
cover DESI “less than fully effective” drug products.
PRIOR AUTHORIZATION OF NON-PDL
MEDICATIONS
The drugs in the UnitedHealthcare PDL have been selected
to provide the most clinically appropriate and cost-effective
medications for patients who have their drug benefit
administered through UnitedHealthcare. It is also
recognized that there may be occasions where an unlisted
drug is desired for the proper medical management of a
specific patient. In those infrequent instances, the prior
authorization process reviews requests for unlisted
medications the physician may consider medically
necessary for patient management.
Requests for these exceptions should be either made in
writing by the physician and faxed or called into:
PLAN EXCLUSIONS
The following drug categories are excluded from coverage
under the outpatient pharmacy benefit and are not part of
the UnitedHealthcare PDL.
UnitedHealthcare
Pharmacy Services Department
Fax 866-940-7328
Phone 800-310-6826
• DESI drugs
• Antiobesity agents
• Experimental / research drugs
• Cosmetic drugs
• Immunization agents
• Nutritional / diet supplements
• Blood and blood plasma products
• Agents used to promote fertility
• Agents used for erectile dysfunction
• Agents used for cosmetic hair growth
UHC1004a
A prior authorization request form is available in the
UnitedHealthcare provider manual and should be used for
all prior authorization requests if possible. Appropriate
documentation must be provided to support the medical
necessity of the non-PDL request. The UnitedHealthcare
Pharmacy Department will respond to all requests in
accordance with state requirements.
iii
• select muscle relaxants
Additional fills will require prior authorization.
Medications in these classes may also be subject to
individual quantity limits.
Physicians are requested to adhere to this PDL when
prescribing for patients covered by their pharmacy benefit
plan offered by UnitedHealthcare. If a pharmacist receives
a prescription for a non-PDL drug, the pharmacist should
contact the prescribing physician and request that the
prescription be changed to a medication included in this
PDL. If a PDL alternative is not appropriate the physician
should then be instructed to contact the Plan for a prior
authorization.
Additions to the QL program drug list will be made from
time to time and providers notified accordingly. As always,
we recognize that a number of patient-specific variables
must be taken into consideration when drug therapy is
prescribed and therefore overrides will be available through
the medical exception (prior authorization) process. Please
contact the UnitedHealthcare Pharmacy Prior Notification
Service at 800-310-6826 with questions.
Please contact the UnitedHealthcare Pharmacy Prior
Notification Service at 800-310-6826 with questions
concerning the prior authorization process.
Specialty Pharmaceutical Management Program
UnitedHealthcare is continuously looking for ways to
provide high quality cost effective care for Plan members.
The Specialty Pharmaceutical Management Program helps
UnitedHealthcare to achieve these goals. Injectable
medications that are part of this program require plan
authorization and are not available through the retail
pharmacy network.
To obtain authorization, the provider must submit the
appropriate Prior Authorization form to the
UnitedHealthcare Pharmacy Department via fax at 866940-7328.
The UnitedHealthcare Pharmacy Department will review
and respond to all requests in accordance with state
requirements, and if authorized for payment,
UnitedHealthcare will coordinate the delivery of the
product to the member or provider.
Drugs that are part of this program and are on the PDL are
identified in this booklet by the designation "SP".
Prior Authorization request forms can be requested by
calling the UnitedHealthcare Pharmacy Department at 800310-6826.
NON-PDL DRUGS 5-DAY TEMPORARY SUPPLY
OVERRIDES
To ensure the use of PDL drugs, all non- PDL drugs should
be discussed with the prescribing physician. If you cannot
speak to the physician immediately, and there is an
immediate need for the medication, the claim processing
system will accept an override to permit a one-time
dispensing of a 5-day supply of the newly prescribed
non-PDL drug. The pharmacy should submit a claim for a
5 day supply, with a PA Type of 8 and Prior Authorization
number of “00000000120”. Please note that non-preferred
drugs are available for a 5-day supply, however availability
is subject to the benefit design. For assistance, pharmacies
may call 800-310-6826.
The pharmacy should contact the physician to discuss a
PDL drug or if a prior authorization request is warranted.
If the prescribing physician feels a drug is medically
necessary, the physician may fax a request for prior
authorization to UnitedHealthcare at 800-310-6826.
QUANTITY LIMITATIONS (QL)
Prescriptions for monthly quantities greater than the
indicated limit require a prior authorization request.
Quantity limits based on Efficient Medication Dosing
The Efficient Medication Dosing Program is designed to
consolidate medication dosage to the most efficient daily
quantity to increase adherence to therapy and also promote
the efficient use of health care dollars.
The limits for the program are established based on FDA
approval for dosing and the availability of the total daily
dose in the least amount of tablets or capsules daily.
Quantity Limits in the prescription claims processing
system will limit the dispensing to consolidate dosing. The
pharmacy claims processing system will prompt the
pharmacist to request a new prescription order from the
physician.
Controlled Substances
You may fill any FOUR medications from the following
classes in a 30-day period:
• opiate analgesics
• benzodiazepines
• sedative hypnotic agents
• barbiturates
UHC1004a
STEP THERAPY (ST)
The following PDL drugs are routinely covered only after a
sufficient trial of an indicated first-line agent has been
adequately tried and failed. These medications may also be
requested through the Prior authorization process.
While lower cost PDL alternatives may be appropriate in
many instances, other non- PDL alternatives are available
with prior authorization (PA).
STEP Drug
4
First-Line Agent(s)
Amerge
Trial at a minimum dose of 50mg of
sumatriptan tablets.
Aricept 23mg
90 day trial of Aricept 10mg daily
Banzel
30 day trial of two of the following:
lamotrigine, divalproex, or
topiramate.
Breo Ellipta
Ditropan XL
Optivar
1) 30 day trial of one inhaled
corticosteroid (e.g. Arnuity Ellipta,
Asmanex) OR 2) 60 day trial of a longacting beta2- agonist (e.g. Arcapta,
Striverdi) OR 60 day trial of an orally
inhaled anticholinergic agent (e.g. Incruse
Ellipta, Atrovent, Combivent, Anoro
Ellipta).
oxymorphone ER 30-day trial of both Fentanyl patch
and morphine sulfate ER at least
200mg per day
30 day trial of oxybutynin immediate
release.
lansoprazole/
Prevacid OTC
30 day trial of omeprazole 40mg and
pantoprazole 40mg within
previous 180 days is required first
Potiga
30-day trial of two of the following:
lamotrigine, topiramate, carbamazepine,
divalproex, or phenytoin. Step therapy
only applies to members 18 years of age
and older. Members less than 18 require
prior authorization.
DPP4 Inhibitors At least a 90 day trial of 1500mg/day of
(Tradjenta,
metformin.
Jentadueto,
Onglyza, Kombiglyze)
Dulera
Elidel
fenofibrate
1) 30 day trial of one inhaled
corticosteroid (e.g. Arnuity Ellipta,
Asmanex) OR 2) 60 day trial of a longacting beta2- agonist (e.g. Arcapta,
Striverdi) OR 60 day trial of an orally
inhaled anticholinergic agent (e.g. Incruse
Ellipta, Atrovent, Combivent, Anoro
Ellipta).
Protopic 0.03% Trial of two different topical
corticosteroids. Step therapy only applies
to members 12 years of age and older.
Trial of two different topical
corticosteroids. Step therapy only applies
to members 12 years of age and older.
Fill of a statin or 90 days of gemfibrozil
within the previous 180 days.
fentanyl patches 30 day trial of at least 200mg per day of
morphine sulfate ER.
Gabitril
GLP-1 Agonists At least a 90 day trial of 1500mg/day of
(Tanzeum,
metformin
Victoza)
Lantus vials
Protopic 0.1%
Minimum age of 16. Trial of two
different topical corticosteroids.
Ranexa
Trial of one drug from the following
classes: beta blockers, calcium channel
blockers, long acting nitrates
Renvela
8 week trial of calcium acetate
SGLT-2
Inhibitors
(Jardiance,
Invokana,
Invokamet,
Synjardy)
At least a 90 day trial of 1500mg/day of
metformin
tolterodine
release. Step Therapy only applies to
members less than 65 years of age.
trospium
release. Step Therapy only applies to
members less than 65 years of age.
TZD’s
At least a 90 day trial of 1500mg/day of
(ActosPlusMet, metformin
ActoPlusMet XR Duetact)
trial of Toujeo Solostar
levocetirizine
30 day trial of loratadine and cetirizine.
midodrine
Trial of fludrocortisone
Onfi
30 day trial of two of the
following: lamotrigine,
divalproex, or topiramate.
UHC1004a
14 day trial of ketotifen within previous
90 days required first.
5
Uloric
8 week trial of up to 600mg of
allopurinol required first.
Vancocin
One fill of metronidazole tabs or caps
Vimpat
LEGEND
#
Only the dosage forms/strengths of the brand
name products noted are on the PDL
OTC
over-the-counter
delayed-rel delayed-release (also known as enteric coated)
EC
enteric-coated
ext-rel
extended-release (also known as sustainedrelease)
PA
Prior Authorization required
QL
Quantity Limits apply
ST
Step Therapy, see pages V-VI for details
SP
Specialty Pharmaceuticals, see pages IV-V for
details
Xopenex Respules 30 day trial of Albuterol .083% or .5%
respules.
Zohydro ER
30-day trial of both Fentanyl patch and
morphine sulfate ER at least 200mg per
day
PDL SUGGESTIONS
Providers who wish to propose PDL suggestions should
forward the information to the UnitedHealthcare Director
of Pharmacy Services by either mail or fax.
NOTICE
The information contained in this document is proprietary
information. The information may not be copied in whole
or in part without the written permission of
UnitedHealthcare. All rights reserved.
Attn: Director of Pharmacy Services
UnitedHealthcare
Unison Plaza
1001 Brinton Road
Pittsburgh, PA 15221
Phone: 800-310-6826
The drug names listed here are the registered and/or
unregistered trademarks of third-party pharmaceutical
companies unrelated to and unaffiliated with
UnitedHealthcare. These trademarked brand names are
included here for informational purposes only and are not
intended to imply or suggest any affiliation between
UnitedHealthcare and such third-party pharmaceutical
companies.
Providers should furnish adequate documentation, such as
clinical studies from the medical literature, in order for the
request to be considered for PDL addition. This literature
should include information documenting clinical necessity
as well as therapeutic advantages over current PDL
products. Suggestions received by UnitedHealthcare will be
reviewed by the Pharmacy and Therapeutics Committee at
the subsequent P&T Committee meeting.
If viewing this PDL via the Internet, please be advised that
the PDL is updated periodically and changes may appear
prior to their effective date to allow for notification.
EDITOR
Your comments and suggestions regarding the
UnitedHealthcare PDL are encouraged. Your input is
vital to this PDL’s continued success. All responses will
be reviewed and considered. Please send your comments
to:
UnitedHealthcare by UnitedHealthcare
Director of Pharmacy Services
Unison Plaza
1001 Brinton
Road
Pittsburgh, PA 15221
Phone: 800-310-6826
UHC1004a
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Table of Contents
Antineoplastics & Immunosuppressants 4
Antineoplastic Agents . . . . . . . . . . . . . . . . . . . . 4
Hormonal Antineoplastic Agents . . . . . . . . . . . 5
Immunomodulators . . . . . . . . . . . . . . . . . . . . . . 5
Immunosuppressants . . . . . . . . . . . . . . . . . . . . 6
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Dermatology . . . . . . . . . . . . . . . . . . . . . . . 16
Acne Vulgaris . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Bacterial Infections . . . . . . . . . . . . . . . . . . . . . 17
Corticosteroids . . . . . . . . . . . . . . . . . . . . . . . . 17
Fungal Infections . . . . . . . . . . . . . . . . . . . . . . . 18
Psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Rosacea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Scabies and Pediculosis . . . . . . . . . . . . . . . . . 19
Viral Infections . . . . . . . . . . . . . . . . . . . . . . . . . 19
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 19
Blood Modifiers - Anticoagulants . . . . . . 7
Anticoagulants . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Blood Cell Formation . . . . . . . . . . . . . . . . . . . . . 7
Platelet Inhibitors . . . . . . . . . . . . . . . . . . . . . . . . 7
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Ear, Nose & Throat . . . . . . . . . . . . . . . . . . 20
Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Throat and Mouth . . . . . . . . . . . . . . . . . . . . . . .21
Cardiovascular Agents . . . . . . . . . . . . . . . . 8
Ace Inhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Ace Inhibitor/Diuretic Combinations . . . . . . . . 8
Adrenolytics, Central . . . . . . . . . . . . . . . . . . . . . 8
Alpha Blockers . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Angiotensin II Receptor Blockers
(Antagonists) . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Angiotensin II Receptor Blocker
Combinations . . . . . . . . . . . . . . . . . . . . . . . . . 8
Antiarrhythmics and Cardiac Glycosides . . . . 9
Beta Blockers and Beta Blocker/
Diuretic Combinations . . . . . . . . . . . . . . . . . 9
Calcium Channel Blockers . . . . . . . . . . . . . . . . 9
Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Lipid Lowering Agents . . . . . . . . . . . . . . . . . . 11
Nitrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Potassium-Removing Agents . . . . . . . . . . . . . 11
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 12
Endocrinology . . . . . . . . . . . . . . . . . . . . . . 21
Adrenal Corticosteroids . . . . . . . . . . . . . . . . . 21
Androgens . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . 22
Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Thyroid Disease . . . . . . . . . . . . . . . . . . . . . . . . 24
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 24
Gastrointestinal . . . . . . . . . . . . . . . . . . . . 24
Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Emesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Gastroesophageal Reflux Disease (Gerd)/
Peptic Ulcers . . . . . . . . . . . . . . . . . . . . . . . . 25
Gastrointestinal Spasm . . . . . . . . . . . . . . . . . . 25
Inflammatory Bowel Disease . . . . . . . . . . . . . 26
Laxatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Pancreatic Enzymes . . . . . . . . . . . . . . . . . . . . 26
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 26
Central Nervous System . . . . . . . . . . . . . 12
Alzheimer’s Disease . . . . . . . . . . . . . . . . . . . . . 12
Analgesics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Migraine Acute Therapy . . . . . . . . . . . . . . . . . 14
Migraine Prophylactic Therapy . . . . . . . . . . . . 14
Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . 14
Myasthenia Gravis . . . . . . . . . . . . . . . . . . . . . . 15
Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . .15
Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 16
Infectious Diseases . . . . . . . . . . . . . . . . . 27
Anthelmintics . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Antibacterials . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Antifungals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Antivirals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 30
2
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . 52
Anaphylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Cystic Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . 52
Hereditary Angioedema . . . . . . . . . . . . . . . . . 52
Hyperphosphatemia . . . . . . . . . . . . . . . . . . . . 52
Idiopathic Pulmonary Fibrosis (IPF) . . . . . . . . 52
Immune Thrombocytopenic Purpura . . . . . . . 53
Medical Devices . . . . . . . . . . . . . . . . . . . . . . . . 53
Metabolic Modifiers . . . . . . . . . . . . . . . . . . . . . 53
Vaccine (oral) . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Musculoskeletal . . . . . . . . . . . . . . . . . . . . 32
Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Skeletal Muscle Relaxants . . . . . . . . . . . . . . . 33
OB-GYN . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . 33
Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . 34
Hormone Therapy/Menopause . . . . . . . . . . . . 34
Vaginal Infections . . . . . . . . . . . . . . . . . . . . . . . 34
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 36
OTC MEDICATIONS . . . . . . . . . . . . . . . . . 54
Cough/Cold Allergy . . . . . . . . . . . . . . . . . . . . . 54
Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Family Planning . . . . . . . . . . . . . . . . . . . . . . . . 54
First Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Lice Products . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Ophthalmics . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Vitamins/Minerals . . . . . . . . . . . . . . . . . . . . . . . 54
Ophthalmic . . . . . . . . . . . . . . . . . . . . . . . . 36
Allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Anti-Inflammatories . . . . . . . . . . . . . . . . . . . . . 36
Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 38
Psychiatric . . . . . . . . . . . . . . . . . . . . . . . . . 38
Alcohol Deterrents . . . . . . . . . . . . . . . . . . . . . . 38
Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Attention Deficit Hyperactivity
Disorder (ADHD) . . . . . . . . . . . . . . . . . . . . 39
Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . . . . 39
Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Narcotic Antagonists . . . . . . . . . . . . . . . . . . . . 41
Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 42
Index of Covered Drugs . . . . . . . . . . . . . . 55
Respiratory Drugs . . . . . . . . . . . . . . . . . . . 42
Antitussives, Decongestants, Expectorants
and Combinations . . . . . . . . . . . . . . . . . . . . 42
Asthma/COPD . . . . . . . . . . . . . . . . . . . . . . . . 47
Urological . . . . . . . . . . . . . . . . . . . . . . . . . 48
Symptomatic Benign Prostatic Hypertrophy . 48
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 48
Vitamins and Minerals . . . . . . . . . . . . . . . 49
Potassium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
3
Generic Drug Name
Covered
Drug
Brand Drug Name
Requirements & Limits
Antineoplastics & Immunosuppressants
Antineoplastic Agents
Alkylating Agents
altretamine
HEXALEN
busulfan
MYLERAN
chlorambucil
LEUKERAN
cyclophosphamide
CYTOXAN
estramustine
EMCYT
phosphate sodium
lomustine
CEENU
melphalan
ALKERAN
temozolomide
TEMODAR
Antimetabolites
capecitabine
XELODA
fludarabine
OFORTA
mercaptopurine
PURINETHOL
thioguanine
TABLOID
Histone Deacetylase Inhibitors
panobinostat
FARYDAK
vorinostat
ZOLINZA
Kinase Inhibitor
afatinib
GILOTRIF
axitinib
INLYTA
bosutinib
BOSULIF
cabozantinib
COMETRIQ
ceritinib
ZYKADIA
crizotinib
XALKORI
dabrafenib
TAFINLAR
dasatinib
SPRYCEL
erlotinib
TARCEVA
AFINITOR
everolimus
AFINITOR DISPERZ
ibrutinib
IMBRUVICA
idelalisib
ZYDELIG
imatinib mesylate
GLEEVEC
lapatinib ditosylate
TYKERB
levatinib
LENVIMA
brand
brand
brand
generic
brand
generic
brand
generic
OTC = Over the Counter
PA = Prior Authorization required
QL = Quantity Limit
generic
brand
generic
brand
PA, SP
PA, SP
brand
brand
PA, SP
PA, SP
brand
brand
brand
brand
brand
brand
brand
brand
brand
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
brand
PA, SP
brand
brand
brand
brand
brand
PA, SP
PA, SP
PA, QL, SP
PA, SP
PA, SP
ST = Step Therapy
SP = Specialty Pharmacy
4
PA, SP
Generic Drug Name
Covered
Drug
brand
brand
brand
brand
brand
brand
brand
brand
brand
brand
brand
Brand Drug Name
nilotinib
TASIGNA
palbociclib
IBRANCE
pazopanib
VOTRIENT
ponatinib
ICLUSIG
regorafenib
STIVARGA
ruxolitinib
JAKAFI
sorafenib
NEXAVAR
sunitinib
SUTENT
trametinib
MEKINIST
vandetanib
CAPRELSA
vemurafenib
ZELBORAF
Hormonal Antineoplastic Agents
Androgen Biosynthesis Inhibitors
abiraterone
ZYTIGA
Antiandrogens
bicalutamide
CASODEX
flutamide
EULEXIN
Antiestrogens
tamoxifen
NOLVADEX
toremifene
FARESTON
Aromatase Inhibitors
anastrozole
ARIMIDEX
exemestane
AROMASIN
letrozole
FEMARA
Gonadotropin Releasing Hormone Analog
leuprolide
LUPRON
LUPRON DEPOT
leuprolide
Progestin
megestrol acetate
Immunomodulators
Interferons
interferon alfa-2a
interferon alfa-2b
peginterferon alfa-2b
brand
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
generic
generic
generic
brand
generic
generic
generic
LUPRON DEPOT
6-MONTH
generic
PA, SP
brand
PA, SP
LUPRON DEPOT-PED
generic
MEGACE
brand
brand
brand
INTRON A
SYLATRON
QL = Quantity Limit
ST = Step Therapy
5
PA, SP
PA, SP
PA, SP
Generic Drug Name
Miscellaneous
lenalidomide
pomalidomide
Immunosuppressants
Antimetabolites
azathioprine
mycophenolate mofetil
mycophenolate sodium
Calcineurin Inhibitors
cyclosporine
cyclosporine, modified
tacrolimus
Rapamycin Derivative
sirolimus
Other
everolimus
Miscellaneous
alitretinoin 1% gel
bexarotene caps and
topical gel
cysteamine bitartrate
etoposide
hydroxyurea
mitotane
octreotide
olaparib
pasireotide
procarbazine
topotecan
tretinoin
vismodegib
Covered
Drug
REVLIMID
POMALYST
brand
brand
PA, SP
PA, SP
IMURAN
CELLCEPT
MYFORTIC
generic
generic
generic
SANDIMMUNE
GENGRAF
generic
Brand Drug Name
generic
NEORAL
HECORIA
generic
PROGRAF
RAPAMUNE
generic
ZORTRESS
brand
PANRETIN
brand
PA
TARGRETIN
brand
PA
CYSTAGON
VEPESID
DROXIA
brand
generic
generic
HYDREA
LYSODREN
SANDOSTATIN
LYNPARZA
SIGNIFOR
MATULANE
HYCAMTIN
VESANOID
ERIVEDGE
brand
generic
brand
brand
brand
brand
generic
brand
QL = Quantity Limit
ST = Step Therapy
6
PA, SP
PA, SP
PA, SP
caps
PA, SP
Generic Drug Name
Covered
Drug
Brand Drug Name
Blood Modifiers - Anticoagulants
Anticoagulants
apixaban
edoxaban
ELIQUIS
SAVAYSA
brand
brand
enoxaparin
LOVENOX
generic
heparin
rivaroxaban
warfarin
Blood Cell Formation
darbepoetin alfa
HEPARIN
XARELTO
COUMADIN
generic
brand
generic
PA
brand
PA, SP
brand
PA, SP
brand
brand
brand
brand
brand
brand
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
epoetin alfa
filgrastim
oprelvekin
pegfilgrastim
plerixafor
sargramostim
TBO-filgrastim
Platelet Inhibitors
anagrelide
cilostazol
clopidogrel
dipyridamole
Miscellaneous
aminocaproic acid
deferasirox
pentoxifylline
extended-release
ARANESP
EPOGEN
PROCRIT
ZARXIO
NEUMEGA
NEULASTA
MOZOBIL
LEUKINE
GRANIX
PA
PA
PA, QL, SP,
SP and PA only applies for
quantities greater than
14 days
generic
generic
generic
generic
AGRYLIN
PLETAL
PLAVIX
PERSANTINE
QL
brand
AMICAR
EXJADE
brand
JADENU
generic
TRENTAL
QL = Quantity Limit
ST = Step Therapy
7
PA, SP
Generic Drug Name
Brand Drug Name
Covered
Drug
LOTENSIN
CAPOTEN
VASOTEC
generic
generic
generic
Cardiovascular Agents
Ace Inhibitors
benazepril
captopril
enalapril
enalapril oral soln
brand
EPANED
fosinopril
MONOPRIL
lisinopril
ZESTRIL
quinapril
ACCUPRIL
Ace Inhibitor/Diuretic Combinations
benazepril/
LOTENSIN HCT
hydrochlorothiazide
captopril/
CAPOZIDE
hydrochlorothiazide
enalapril/
VASERETIC
hydrochlorothiazide
fosinopril/
MONOPRIL-HCT
hydrochlorothiazide
lisinopril/
ZESTORETIC
hydrochlorothiazide
quinapril/
ACCURETIC
hydrochlorothiazide
Adrenolytics, Central
clonidine
CATAPRES
guanfacine
TENEX
Alpha Blockers
doxazosin
CARDURA
prazosin
MINIPRESS
terazosin
HYTRIN
Angiotensin II Receptor Blockers (Antagonists)
losartan
COZAAR
Angiotensin II Receptor Blocker Combinations
losartan/HCTZ
HYZAAR
QL = Quantity Limit
generic
generic
generic
Members ≥ 8 years of
age will require prior
authorization.
QL
QL
QL
generic
generic
generic
generic
QL
generic
QL
generic
QL
generic
generic
generic
generic
generic
generic
QL
generic
QL
ST = Step Therapy
8
Generic Drug Name
Covered
Drug
Brand Drug Name
Antiarrhythmics and Cardiac Glycosides
amiodarone tabs
CORDARONE
generic
digoxin
LANOXIN
generic
disopyramide
NORPACE
generic
disopyramide
NORPACE CR
generic
extended-release
dofetilide
TIKOSYN
brand
flecainide
TAMBOCOR
generic
mexiletine
MEXITIL
generic
propafenone
RYTHMOL
generic
quinidine gluconate
QUINIDINE GLUCONATE
generic
extended-release
EXT-REL
quinidine sulfate
QUINIDINE SULFATE
generic
quinidine sulfate
QUINIDINE SULFATE
generic
extended-release
EXT-REL
Beta Blockers and Beta Blocker/Diuretic Combinations
acebutalol
SECTRAL
generic
atenolol
TENORMIN
generic
atenolol/chlorthalidone
TENORETIC
generic
bisoprolol
ZEBETA
generic
bisoprolol/
ZIAC
generic
hydrochlorothiazide
carvedilol
COREG
generic
labetalol
TRANDATE
generic
metoprolol
LOPRESSOR
generic
metoprolol succinate
TOPROL XL
generic
pindolol
PINDOLOL
generic
propranolol
INDERAL
generic
propranolol/HCTZ
INDERIDE
generic
sotalol
BETAPACE
generic
timolol maleate
generic
Calcium Channel Blockers
Dihydropyridines
amlodipine
NORVASC
generic
felodipine
PLENDIL
generic
extended-release
nicardipine
CARDENE
generic
nifedipine
PROCARDIA
generic
QL = Quantity Limit
200 mg and 400 mg
ST = Step Therapy
9
IR only
QL
IR only
tablets
QL
QL
Generic Drug Name
Brand Drug Name
nifedipine
extended-release
nimodipine
nimodipine oral soln
Nondihydropyridines
diltiazem
diltiazem
extended-release
diltiazem
extended-release
diltiazem
sustained-release
verapamil
verapamil
extended-release
Diuretics
amiloride
amiloride/
hydrochlorothiazide
bumetanide
chlorothiazide
ADALAT CC
chlorothiazide
chlorthalidone
furosemide
hydrochlorothiazide
hydrochlorothiazide
indapamide
metolazone
spironolactone
spironolactone/
hydrochlorothiazide
torsemide
triamterene/
hydrochlorothiazide
PROCARDIA XL
NIMOTOP
NYMALIZE
Covered
Drug
generic
QL
generic
brand
QL
CARDIZEM
generic
CARDIZEM CD
generic
QL
generic
QL
CARDIZEM SR
generic
QL
CALAN
generic
CALAN SR
generic
MIDAMOR
generic
MODURETIC
generic
BUMEX
DIURIL
DIURIL ORAL
SUSPENSION
CHLORTHALIDONE
LASIX
HYDROCHLOROTHIAZIDE
MICROZIDE
LOZOL
ZAROXOLYN
ALDACTONE
generic
generic
generic
generic
generic
generic
generic
generic
generic
ALDACTAZIDE
generic
DEMADEX
DYAZIDE
generic
DILACOR XR
TIAZAC
generic
MAXZIDE
QL = Quantity Limit
brand
ST = Step Therapy
10
QL
QL
soln, tabs
12.5 mg caps
Generic Drug Name
Brand Drug Name
Covered
Drug
generic
Only the bulk products are
covered (cans). Individual
packets are not covered.
Lipid Lowering Agents
Bile Acid Resin
cholestyramine
QUESTRAN
QUESTRAN-LIGHT
Fibrates
fenofibrate
LOFIBRA
gemfibrozil
LOPID
HMG-CoA Reductase Inhibitors and Combinations
atorvastatin
LIPITOR
lovastatin
MEVACOR
simvastatin
ZOCOR
Niacins
niacin
NIACOR
niacin extended-release NIASPAN
Miscellaneous
alirocumab
PRALUENT
ezetimibe
ZETIA
Nitrates
Oral
isosorbide dinitrate
ISORDIL
ISOSORBIDE
extended-release
DINITRATE ER
isosorbide mononitrate
ISMO
isosorbide
mononitrate
IMDUR
extended-release
Sublingual
ISORDIL S.L.
nitroglycerin
NITROLINGUAL
nitroglycerin
NITROSTAT
Transdermal
NITREK
nitroglycerin
NITRO-DUR
nitroglycerin
NITRO-BID
Potassium-Removing Agents
sodium polysterene
KAYEXALATE
sulfonate
QL = Quantity Limit
generic
generic
ST
generic
generic
generic
QL
QL
generic
generic
brand
brand
PA, QL, SP
PA
generic
generic
generic
generic
generic
generic
generic
generic
transdermal, QL
generic
oint
generic
susp (susp only)
ST = Step Therapy
11
Generic Drug Name
Brand Drug Name
Covered
Drug
Miscellaneous
ambrisentan
bosentan
guanabenz
hydralazine
lomitapide
methyldopa
methyldopa/HCTZ
midodrine
minoxidil
ranolazine
sildenafil
LETAIRIS
TRACLEER
WYTENSIN
APRESOLINE
JUXTAPID
ALDOMET
ALDORIL
PROAMATINE
LONITEN
RANEXA
REVATIO
brand
brand
generic
generic
brand
generic
generic
generic
generic
brand
brand
PA, SP
PA, SP
PA, SP
ST
ST
PA
Central Nervous System
Alzheimer’s Disease
donepezil
ARICEPT
generic
donepezil
ARICEPT
generic
galantamine
RAZADYNE
generic
memantine
NAMENDA
generic
rivastigmine
EXELON
generic
Analgesics
Barbiturate Non-Narcotic Analgesics
butalbital/acetaminophen PHRENILIN
butalbital/acetaminophen SEDAPAP
butalbital/acetaminophen/
FIORICET
caffeine
butalbital/aspirin/caffeine FIORINAL
Non-Narcotic Analgesics
tramadol
ULTRAM
QL = Quantity Limit
5 mg and 10 mg, QL,
Members <18 years
of age will require prior
authorization.
23 mg, ST, Members <18
years of age will require prior
authorization.
QL, Members <18 years
authorization.
authorization.
authorization.
generic
generic
QL
QL
generic
QL
generic
QL
generic
QL
ST = Step Therapy
12
Generic Drug Name
NSAIDS
choline magnesium
trisalicylate
diclofenac sodium
delayed release
etodolac
fenoprofen
ibuprofen
Brand Drug Name
Covered
Drug
TRILISATE
generic
VOLTAREN
generic
LODINE
NALFON
generic
generic
MOTRIN
generic
indomethacin
INDOCIN
ketoprofen
ORUDIS
ketorolac tromethamine
TORADOL
meloxicam
MOBIC
nabumetone
RELAFEN
naproxen
NAPROSYN
naproxen sodium
ANAPROX
oxaprozin
DAYPRO
piroxicam
FELDENE
sulindac
CLINORIL
Opioids — Narcotic Analgesics
butalbital/apap/caff/cod FIORICET W/CODEINE
butalbital/asa/caff/cod
FIORINAL W/CODEINE
butorphanol
STADOL
codeine sulfate
codeine/acetaminophen TYLENOL W/CODEINE
fentanyl transdermal
DURAGESIC
LORCET
IR Only
600 mg
tabs, chew tabs
and susp
generic
generic
generic
generic
generic
generic
generic
generic
generic
generic
IR only
QL
QL
Not EC
generic
generic
generic
generic
generic
generic
QL, 50-325-40-30 mg
QL
nasal spray, QL
QL
QL
QL, ST
generic
QL
brand
generic
generic
generic
ST
QL
QL
QL
LORTAB
hydrocodone/
acetaminophen
LORTAB ELIXIR
NORCO
VICODIN
hydrocodone ER
hydromorphone
meperidine
methadone
VICODIN ES
ZOHYDRO ER
DILAUDID
DEMEROL
DOLOPHINE
QL = Quantity Limit
ST = Step Therapy
13
Generic Drug Name
Brand Drug Name
morphine
MSIR
morphine
RMS
morphine
MS CONTIN
extended-release
oxycodone
OXYFAST
oxycodone
ROXICODONE
oxycodone/
PERCOCET
acetaminophen
oxycodone/aspirin
PERCODAN
oxymorphone ER
OXYMORPHONE ER
pentazocine/naloxone
TALWIN NX
Migraine Acute Therapy
Ergotamine Derivatives
dihydroergotamine
D.H.E. 45
dihydroergotamine
MIGRANAL
ergotamine/caffeine
CAFERGOT
Selective Serotonin Agonists
naratriptan
AMERGE
rizatriptan
MAXALT/MAXALT MLT
sumatriptan
IMITREX
IMITREX
sumatriptan
4 MG AND 6 MG INJ
Migraine Prophylactic Therapy
amitriptyline
ELAVIL
divalproex sodium
cap sprinkle
divalproex sodium
delayed-release
propranolol
verapamil
Multiple Sclerosis
dimethyl fumarate
fingolimod
glatiramer acetate
interferon beta-1a
interferon beta-1a
teriflunomide
Covered
Drug
generic
generic
QL
QL
generic
QL
generic
generic
soln, QL
QL
generic
5/325, QL
generic
generic
generic
QL
QL, ST
QL
generic
generic
generic
inj, QL
generic
generic
generic
ST
QL
QL
generic
4 mg and 6 mg inj
generic
DEPAKOTE SPRINKLE
generic
authorization.
DEPAKOTE
generic
Minimum age 2
INDERAL
CALAN
generic
generic
IR only
brand
brand
brand
brand
brand
brand
PA, SP
PA, SP
PA ,QL, SP
PA ,QL, SP
PA ,QL, SP
PA, SP
TECFIDERA
GILENYA
COPAXONE
AVONEX/AVONEX PEN
REBIF
AUBAGIO
QL = Quantity Limit
ST = Step Therapy
14
Generic Drug Name
Myasthenia Gravis
pyridostigmine
pyridostigmine
extended-release
Parkinson’s Disease
amantadine
benztropine
biperiden
carbidopa/levodopa
carbidopa/levodopa
extended-release
entacapone
pramipexole
ropinirole
selegiline
tolcapone
trihexyphenidyl
Seizures
carbamazepine
carbamazepine
extended-release
clobazam
clonazepam
diazepam
divalproex sodium
cap sprinkle
divalproex sodium
delayed-release
ethosuximide
exogabine
felbamate
Brand Drug Name
Covered
Drug
MESTINON
generic
MESTINON TIMESPAN
brand
SYMMETREL
COGENTIN
AKINETON
SINEMET
generic
generic
generic
generic
SINEMET CR
generic
COMTAN
MIRAPEX
REQUIP
ELDEPRYL
TASMAR
ARTANE
generic
generic
generic
generic
brand
generic
TEGRETOL
CARBATROL
generic
except tabs
tabs
generic
TEGRETOL-XR
ONFI
KLONOPIN
DIASTAT ACUDIAL
brand
generic
generic
ST
tabs
rectal gel, QL
authorization.
DEPAKOTE SPRINKLE
generic
DEPAKOTE
generic
Minimum age 2
ZARONTIN
POTIGA
FELBATOL
generic
brand
generic
Age Limits Apply, ST
felbamate oral susp
FELBATOL ORAL SUSP
generic
gabapentin
lacosamide
NEURONTIN
VIMPAT
generic
brand
QL = Quantity Limit
authorization.
caps and tabs only
ST = Step Therapy
15
Generic Drug Name
Brand Drug Name
lamotrigine
LAMICTAL
Covered
Drug
generic
lamotrigine chew
dispersable tab
LAMICTAL CD CHEW TAB
generic
levetiracetam
KEPPRA
generic
methsuximide
CELONTIN
brand
oxcarbazepine
TRILEPTAL
generic
phenobarbital
phenytoin
phenytoin sodium
extended
pregabalin
pregabalin
primidone
rufinamide
tiagabine
topiramate
PHENOBARBITAL
DILANTIN INFATABS
DILANTIN
generic
generic
topiramate sprinkle caps
TOPAMAX SPRINKLE
generic
valproic acid
vigabatrin oral solution
zonisamide
Miscellaneous
tetrabenazine
DEPAKENE
SABRIL SOLUTION
ZONEGRAN
generic
brand
generic
PA, SP
QL
XENAZINE
brand
PA, SP
ACCUTANE
generic
PA
FINACEA
BENZAC AC
CLEOCIN T
CLEOCIN T
brand
generic
generic
generic
gel
QL
authorization.
QL, Maximum age of 9
for solution
QL, Maximum age of 9
for suspension
generic
PHENYTEK
LYRICA
LYRICA SOLUTION
MYSOLINE
BANZEL
GABITRIL
TOPAMAX
brand
brand
generic
brand
generic
generic
PA
oral solution, PA
tablets only, QL, ST
QL
QL, Members ≥ 8 years
authorization.
Dermatology
Acne Vulgaris
Oral
isotretinoin
Topical
azelaic acid
benzoyl peroxide
clindamycin
clindamycin
QL = Quantity Limit
ST = Step Therapy
16
gel
lotion
Generic Drug Name
Brand Drug Name
clindamycin
erythromycin
erythromycin
erythromycin/benzoyl
peroxide
sulfacetamide
sulfacetamide/sulfur
CLEOCIN T
ERYGEL
T-STAT
Covered
Drug
generic
generic
generic
BENZAMYCIN
generic
SULFACET-R
PLEXION
AVITA
generic
generic
tretinoin
Bacterial Infections
gentamicin
mupirocin
silver sulfadiazine
Corticosteroids
Low Potency
alclometasone
fluocinolone acetonide
hydrocortisone
hydrocortisone
hydrocortisone
Medium Potency
betamethasone val
flurandrenolide
fluticasone propionate
hydrocortisone butyrate
mometasone furoate
mometasone furoate
prednicarbate
triamcinolone acetonide
High Potency
betamethasone
augmented dip
betamethasone
augmented dip
soln
gel 2%
soln
generic
RETIN-A
GENTAK
BACTROBAN
SILVADENE
generic
generic
generic
ointment, 22 gram tube only
ACLOVATE
DERMA-SMOOTHE
OIL/FS
SYNALAR
CORTIZONE
HYTONE
HYTONE
generic
0.05% crm/oint
generic
oil 0.01%
generic
generic
generic
generic
soln/crm 0.01%
crm, oint, lot OTC
crm 2.5%
1% lotion
BETA-VAL
SYNALAR
CORDRAN
CUTIVATE
LOCOID
ELOCON
ELOCON
DERMATOP
KENALOG
KENALOG
generic
generic
brand
generic
generic
generic
generic
generic
generic
generic
crm/oint/lotion 0.1%
crm, oint 0.025%
tape
crm 0.05%, oint 0.005%
crm/oint/soln 0.1%
crm 0.1%
oint 0.1%
crm/oint 0.1%
crm/lot/oint 0.025%
crm/oint/lotion 0.1%
DIPROLENE
generic
lotion 0.05%
DIPROLENE AF
generic
crm 0.05%
QL = Quantity Limit
ST = Step Therapy
17
Generic Drug Name
betamethasone
dipropionate
fluocinonide
fluocinonide emulsified
base
Very High Potency
betamethasone dip
augmented
betamethasone dip
augmented
clobetasol propionate
Fungal Infections
ciclopirox
clotrimazole
clotrimazole
clotrimazole with
betamethasone
ketoconazole
miconazole
miconazole
miconazole
nystatin
terbinafine
tolnaftate
Psoriasis
acitretin
calcipotriene
calcitriol
methoxsalen
Rosacea
brimonidine
metronidazole
Covered
Drug
generic
crm/lotion/oint 0.05%
LIDEX
generic
crm/oint/gel 0.05%
LIDEX E
generic
crm 0.05%
KENALOG
generic
crm 0.5%
DIPROLENE
generic
gel 0.05%
DIPROLENE
generic
oint 0.05%
TEMOVATE
generic
crm/gel/oint/soln 0.05%
PENLAC SOLUTION 8%
LOTRIMIN AF
MYCELEX
generic
generic
generic
OTC
LOTRISONE
generic
NIZORAL
DESENEX POWDER 2%
MICATIN
MONISTAT-DERM
MYCOSTATIN
LAMISIL AT
TINACTIN
generic
generic
generic
generic
generic
generic
generic
SORIATANE
DOVONEX
VECTICAL
OXSORALEN-ULTRA
generic
generic
generic
generic
oral caps, PA
brand
PA
Brand Drug Name
MIRVASO
METROCREAM
generic
METROGEL
METROLOTION
QL = Quantity Limit
ST = Step Therapy
18
powder
OTC
OTC
OTC
Generic Drug Name
Covered
Drug
Brand Drug Name
Scabies and Pediculosis
crotamiton
EURAX
malathion
OVIDE
permethrin
ELIMITE
permethrin
NIX CREME RINSE
RID SHAMPOO/
pyrethrins/piperonyl but
BUTOXIDE SHAMPOO
Viral Infections
podofilox
CONDYLOX SOL
Miscellaneous
aluminum acetate
aluminum chloride
HYPERCARE 20%
hexahydrate
ammonium lactate
LAC-HYDRIN
chloroxine
CAPITROL
fluorouracil
CARAC
fluorouracil
EFUDEX
fluorouracil
FLUOROPLEX
hexachlorophene
PHISOHEX
PROCTOSOL HC
CREAM 2.5%
PROCTOZONE
hydrocortisone
CREAM-HC 2.5%
ANUSOL HC 2.5%
imiquimod 5% cream
ALDARA
ketoconazole
NIZORAL SHAMPOO
lidocaine
LIDAMANTEL
lidocaine
LMX-4
lidocaine
XYLOCAINE
lidocaine/prilocaine
EMLA
nitroglycerin
RECTIV
brand
generic
generic
generic
5%, QL
1%, OTC
generic
4% OTC
generic
sol
brand
soln/cream, OTC
generic
generic
generic
generic
generic
brand
brand
12%
0.5% cream
1% cream
generic
generic
generic
generic
generic
generic
generic
brand
pimecrolimus
ELIDEL
brand
selenium sulfide
SELSUN
generic
QL = Quantity Limit
PA
shampoo 2%
3% cream
4% cream (15 gm tubes), QL
jelly 2%
2.5% cream
0.4% rectal ointment, PA
cream QL, ST, Step therapy
is not required for members
ages 2-11; not covered for
members less than 2 years
of age
shampoo 2.5%
ST = Step Therapy
19
Generic Drug Name
Covered
Drug
Brand Drug Name
ointment 0.03% ST, Step
therapy is not required for
members ages 2-11; not
covered for members less
than 2 years
of age
ointment 0.1%, ST
(minimum age 16)
tacrolimus
PROTOPIC 0.03%
generic
tacrolimus
PROTOPIC 0.1%
generic
urea 40%
UREA 40% CREAM
AND LOTION
generic
cream and lotion
generic
otic
Ear, Nose & Throat
Ear
acetic acid
VOSOL OTIC
acetic acid/
DOMEBORO OTIC
aluminum acetate
acetic acid/
VOSOL HC OTIC
hydrocortisone
benzocaine/antipyrine
BENZOTIC
ciprofloxacin/
CIPRODEX
dexamethasone
neomycin/polymyxin B/
CORTISPORIN OTIC
hydrocortisone
ofloxacin
FLOXIN OTIC
Nose
Antihistamines - First Generation, Sedating
clemastine
CLEMASTINE
cyproheptadine
CYPROHEPTADINE
diphenhydramine
diphenhydramine
BENADRYL
hydroxyzine HCL
ATARAX
hydroxyzine pamoate
VISTARIL
Antihistamines - Second Generation, Nonsedating
cetirizine
ZYRTEC
generic
generic
generic
brand
PA
generic
otic
generic
generic
generic
generic
generic
generic
generic
generic
cetirizine chew tab
ZYRTEC CHEWABLE
TABLET
generic
levocetirizine
XYZAL
generic
QL = Quantity Limit
OTC
OTC
OTC, Members ≥ 8 years
authorization.
tabs, ST
ST = Step Therapy
20
Generic Drug Name
loratadine
Covered
Drug
Brand Drug Name
ALAVERT
generic
OTC
CLARITIN
Antihistamines - Others Antihistamine/Decongestant Combinations
azelastine
ASTELIN
generic
spray
Antihistamine/Decongestant Combinations - First Generation
chlorpheniramine/
phenylephrine/
TRIOTANN
generic
pyrilamine
chlorpheniramine/
pseudoephedrine
DECONAMINE SR
generic
extended-release
Antihistamine/Decongestant Combinations - Second Generation
cetirizine hydrochloride/
pseudoephedrine
hydrochloride
ZYRTEC-D
generic
5 mg-120 mg tablet
12 hours
extended-release
ALAVERT-D
loratadine/
ALAVERT ALRG
generic
OTC
pseudoephedrine
TAB/SINUS
edtended-release
ALLERY/CONG
Nasal Steroids
fluticasone
FLONASE
generic
Throat and Mouth
chlorhexidine gluconate
PERIDEX
generic
lidocaine viscous
XYLOCAINE
generic
pilocarpine
SALAGEN
generic
triamcinolone
KENALOG IN ORABASE
generic
paste
Endocrinology
Adrenal Corticosteroids
cortisone acetate
dexamethasone
DECADRON
fludrocortisone
FLORINEF
hydrocortisone
CORTEF
methylprednisolone
MEDROL
prednisolone
prednisolone
PRELONE
QL = Quantity Limit
generic
generic
generic
generic
generic
generic
ST = Step Therapy
21
syrup
Covered
Drug
Generic Drug Name
Brand Drug Name
prednisolone sodium
phosphate
prednisone
Androgens
testosterone cypionate
ORAPRED
DEPO-TESTOSTERONE
generic
testosterone enanthate
DELATESTRYL
generic
Vials only. Disposable
syringes not covered.
generic
PA
brand
QL
brand
QL
brand
QL
brand
QL, ST
generic
PEDIAPRED
DELTASONE
generic
testosterone gel
TESTOSTERONE 1%
topical tube, packet,
TOPICAL GEL
and pump bottle
Diabetes Mellitus
Glucose Elevating Agents
glucagon, human
GLUCAGON
recombinant
Insulins
insulin aspart
NOVOLOG
insulin aspart
protamine 70%/
NOVOLOG MIX 70/30
insulin aspart 30%
insulin glargine
LANTUS
insulin glargine
TOUJEO SOLOSTAR
300 unit/ml
insulin human
NOVOLIN R
insulin human
RELION R
insulin isophane
HUMULIN N
insulin isophane human
NOVOLIN N
RELION N
NOVOLIN 70/30
70%/regular 30%
RELION 70/30
70%/regular 30%
insulin isophane/regular HUMULIN 70/30
insulin lisopro pro/lispro HUMALOG MIX 50/50
insulin lisopro prot/lispro HUMALOG MIX 75/25
insulin lispro
HUMALOG
insulin regular
HUMULIN R
QL = Quantity Limit
brand
brand
brand
brand
brand
brand
OTC, QL
OTC, QL
OTC, QL
OTC, QL
OTC, QL
brand
OTC, QL
brand
OTC, QL
brand
brand
brand
brand
brand
OTC, QL
QL
QL
QL
OTC, QL
ST = Step Therapy
22
Generic Drug Name
Covered
Drug
Brand Drug Name
Monitoring - Strips and Kits/Diabetic Supplies
ONE TOUCH SYSTEMS (ULTRA 2, ULTRAMINI,
VERIO, VERIO FLEX, VERIO IQ, VERIO SYNC)
brand
ONE TOUCH TEST STRIPS (ULTRA, VERIO)
brand
Oral Agents
acarbose
PRECOSE
canagliflozin
INVOKANA
canagliflozin/metformin
INVOKAMET
chlorpropamide
DIABINESE
empagliflozin
JARDIANCE
empagliflozin/metformin
SYNJARDY
glimepiride
AMARYL
glipizide
GLUCOTROL
glipizide extended-release GLUCOTROL XL
glyburide
MICRONASE
glyburide, micronized
GLYNASE
linagliptin
TRADJENTA
linagliptin/metformin
JENTADUETO
metformin
GLUCOPHAGE
metformin ER
GLUCOPHAGE ER
metformin/glyburide
GLUCOVANCE
nateglinide
STARLIX
pioglitazone
ACTOS
pioglitazone/glimepiride DUETACT
pioglitazone/metformin
ACTOPLUSMET
pioglitazone/metformin ER ACTOPLUS MET XR
repaglinide
PRANDIN
saxagliptin
ONGLYZA
saxagliptin/metformin
KOMBIGLYZE
tolazamide
TOLINASE
tolbutamide
TOLBUTAMIDE
Miscellaneous Antidiabetic Agents
albiglutide
TANZEUM
liraglutide
VICTOZA
pramlintide
SYMLIN
QL = Quantity Limit
QL for insulin dependent or
pregnant members: allow
testing up to 6 times per day
QL for non-insulin
dependent members: allow
once daily testing
generic
brand
brand
generic
brand
brand
generic
generic
generic
generic
generic
brand
brand
generic
generic
generic
brand
generic
generic
generic
brand
generic
brand
brand
generic
generic
brand
brand
brand
ST = Step Therapy
23
ST
ST
ST
ST
ST
ST
QL
ST
QL, ST
ST
ST
ST
ST
ST
PA
Covered
Drug
FOSAMAX
MIACALCIN
MIACALCIN
FORTICAL
DIDRONEL
EVISTA
FORTEO
generic
brand
QL
inj
brand
nasal spray, QL
generic
brand
brand
PA, SP
LEVOXYL
SYNTHROID
CYTOMEL
THYROLAR
TAPAZOLE
PROPYLTHIOURACIL
generic
generic
generic
brand
generic
generic
DOSTINEX
CHOLBAM
DDAVP
INCRELEX
METHERGINE
KORLYM
SOMAVERT
KUVAN
KUVAN POWDER FOR
SOLUTION
generic
brand
generic
brand
generic
brand
brand
brand
Diarrhea
diphenoxylate/atropine
loperamide
Emesis
LOMOTIL
LOPERAMIDE
generic
generic
aprepitant
EMEND
dronabinol
meclizine
metoclopramide
MARINOL
ANTIVERT
REGLAN
ZOFRAN
Generic Drug Name
Osteoporosis
alendronate
calcitonin-salmon
calcitonin-salmon
etidronate
raloxifene
teriparatide inj
Thyroid Disease
levothyroxine
levothyroxine
liothyronine
liotrix
methimazole
propylthiouracil
Miscellaneous
cabergoline
cholic acid
desmopressin
mecasermin
methylergonovine
mifeprstone
pegvisomant
sapropterin
sapropterin powder
Brand Drug Name
PA, SP
QL
PA, SP
PA, SP
PA, SP
PA, SP
brand
PA, SP
Gastrointestinal
ondansetron
brand
generic
generic
generic
generic
ZOFRAN ODT
QL = Quantity Limit
QL applies to 40 mg, 80 mg
and 80-125 mg
PA
ST = Step Therapy
24
QL
Covered
Drug
prochlorperazine
COMPAZINE
generic
promethazine
PHENERGAN
generic
thiethylperazine
TORECAN
brand
trimethobenzamide
TIGAN
generic
Gastroesophageal Reflux Disease (Gerd)/Peptic Ulcers
cimetidine
TAGAMET
generic
esomeprazole
NEXIUM 24HR OTC
brand
Generic Drug Name
esomeprazole granules
famotidine
Brand Drug Name
NEXIUM DELAYED
RELEASE PACKET
PEPCID
brand
generic
PEPCID AC
lansoprazole
PREVACID
generic
lansoprazole
delayed-release
PREVACID SOLUTAB
generic
PRILOSEC
generic
PROTONIX
ZANTAC
ZANTAC
CARAFATE
generic
generic
generic
generic
omeprazole
delayed-release
pantoprazole
ranitidine
ranitidine syrup
sucralfate
sulcralfate
CARAFATE SUSPENSION
Gastrointestinal Spasm
dicyclomine
BENTYL
glycopyrrolate
ROBINUL
hyoscyamine sulfate
LEVSIN
hyoscyamine sulfate
LEVSINEX
extended-release
QL = Quantity Limit
generic
300 mg caps
PA
Members ≥ 2 years
authorization.
OTC Pepcid AC 10 mg
and 20 mg also covered/
encouraged with written
prescription.
PA
orally disintegrating tabs,
Members ≥ 2 years
authorization. QL
Capsules only, QL
150 mg tabs
suspension, Members 10
years of age up to 65 years
authorization.
generic
generic
generic
generic
ST = Step Therapy
25
Generic Drug Name
Covered
Drug
Brand Drug Name
Inflammatory Bowel Disease
balsalazide
COLAZAL
budesonide
ENTOCORT EC
hydrocortisone
COLOCORT
APRISO
mesalamine
LIALDA
mesalamine
ROWASA
mesalamine
PENTASA
extended-release
mesalamine supp
CANASA
olsalazine sodium
DIPENTUM
sulfasalazine
AZULFIDINE
sulfasalazine
AZULFIDINE EN-TABS
delayed-release
Laxatives
lactulose
ENULOSE
peg 3350/electrolytes
COLYTE
peg 3350/sodium
bicarbonate/sodium
TRILYTE
chloride
peg 3350/sodium
bicarbonate/sodium
NULYTELY
chloride/potassium
chloride
polyethylene glycol 3350 MIRALAX
Pancreatic Enzymes
CREON
pancrelipase
generic
generic
generic
PA
enema
brand
generic
enema only
brand
brand
brand
generic
generic
generic
generic
generic
generic
generic
brand
CREON 3000 UNIT
ZENPEP
Miscellaneous
atropine sulfate
bismuth subsalicylate +
metronidazole +
tetracycline
misoprostol
naloxegol
teduglutide
SAL-TROPINE
brand
HELIDAC
brand
generic
brand
brand
CYTOTEC
MOVANTIK
GATTEX
QL = Quantity Limit
ST = Step Therapy
26
PA
PA, SP
Generic Drug Name
Covered
Drug
Brand Drug Name
ACTIGALL
ursodiol
generic
URSO
URSO FORTE
Infectious Diseases
Anthelmintics
albendazole
ALBENZA
ivermectin
STROMECTOL
praziquantel
BILTRICIDE
Antibacterials
Cephalosporins - First Generation
cefadroxil
DURICEF
cephalexin
KEFLEX
Cephalosporins - Second Generation
cefaclor
CECLOR
cefprozil
CEFZIL
cefuroxime axetil
CEFTIN
Cephalosporins - Third Generation
cefdinir
OMNICEF
cefixime
SUPRAX
Fluoroquinolones
ciprofloxacin
CIPRO
levofloxacin
LEVAQUIN
ofloxacin
FLOXIN
Macrolides
azithromycin
ZITHROMAX
clarithromycin
BIAXIN
clarithromycin ER
BIAXIN XL
erythromycin
ERYC
delayed-release
erythromycin
ERY-TAB
delayed-release
erythromycin
E.E.S.
ethylsuccinate
erythromycin stearate
ERYTHROCIN
erythromycin/sulfisoxazole PEDIAZOLE
QL = Quantity Limit
brand
brand
brand
PA
generic
generic
tabs are not covered
generic
generic
generic
generic
brand
400 mg caps only, QL
generic
generic
generic
tablets only
tabs
generic
generic
generic
generic
brand
generic
generic
generic
ST = Step Therapy
27
QL
Generic Drug Name
Covered
Drug
Brand Drug Name
Penicillins
amoxicillin
amoxicillin
amoxicillin/clavulanate
ampicillin
dicloxacillin
penicillin VK
Sulfonamides
sulfamethoxazole/
trimethoprim, DS
sulfisoxazole
Tetracyclines
doxycycline monohydrate
AMOXICILLIN CAPSULES
AND CHEWABLES
AMOXIL SUSP
AUGMENTIN
PRINCIPEN
DICLOXACILLIN
VEETIDS
BACTRIM
generic
generic
generic
generic
generic
generic
Except 500 mg and 875 mg
film-coated tabs.
suspension
generic
BACTRIM DS
generic
DOXYCYCLINE
MONOHYDRATE
MINOCIN
SUMYCIN
generic
minocycline
tetracycline
Miscellaneous
vancomycin HCl
VANCOCIN HCL
Antifungals
clotrimazole
MYCELEX
fluconazole
DIFLUCAN
griseofulvin microsize
GRIFULVIN V
griseofulvin ultramicrosize GRIS-PEG
itraconazole
SPORANOX
ketoconazole
NIZORAL
nystatin
MYCOSTATIN
terbinafine
LAMISIL
voriconazole
VFEND
Antivirals
Cytomegalovirus Treatment
ganciclovir
CYTOVENE
valganciclovir
VALCYTE
Entry/Fusion Inhibitors
enfuvirtide
FUZEON KIT
QL = Quantity Limit
generic
generic
capsules, except 75 mg
generic
cap, ST
generic
generic
brand
brand
generic
generic
generic
generic
generic
troches
QL
QL
PA
generic
generic
tabs only
brand
SP
ST = Step Therapy
28
PA, QL
Covered
Drug
Generic Drug Name
Brand Drug Name
Hepatitis Treatment
adefovir
daclatasvir
entecavir
interferon alfa-2b
interferon alfacon-1
lamivudine
ledipasvir/sofosbuvir
peginterferon alfa-2a
peginterferon alfa-2a
HEPSERA
DAKLINZA
BARACLUDE
INTRON A
INFERGEN
EPIVIR HBV
HARVONI
PEGASYS
PEGASYS PROCLICK
brand
brand
brand
brand
brand
brand
brand
brand
brand
ribavirin
REBETOL/COPEGUS
generic
sofosbuvir
SOVALDI
PA
PA, SP
PA, SP
PA
PA, SP
PA, SP
200 mg caps and tabs only,
PA, SP
brand
PA, SP
Herpes Treatment
acyclovir
ZOVIRAX
generic
valacyclovir
VALTREX
generic
Influenza Treatment
amantadine
SYMMETREL
generic
except tabs
oseltamivir
TAMIFLU
brand
QL
rimantadine
FLUMADINE
generic
zanamivir
RELENZA
brand
QL
Non-Nucleoside Reverse Transcriptase Inhibitors
delavirdine
RESCRIPTOR
brand
efavirenz
SUSTIVA
brand
nevirapine
VIRAMUNE
generic
nevirapine ER
VIRAMUNE XR
brand
rilpivirine
EDURANT
brand
Nucleoside Analogues Nucleoside Reverse - Transcriptase Inhibitors/and Combinations
abacavir
ZIAGEN
generic
abacavir/lamivudine
EPZICOM
brand
abacavir/lamivudine/
TRIZIVIR
generic
zidovudine
didanosine
VIDEX
brand
didanosine
VIDEX EC
generic
delayed-release
emtricitabine
EMTRIVA
brand
QL = Quantity Limit
ST = Step Therapy
29
Generic Drug Name
Covered
Drug
Brand Drug Name
emtricitabine/rilpivirine/
COMPLERA
brand
tenofovir
lamivudine
EPIVIR
generic
lamivudine/zidovudine
COMBIVIR
generic
stavudine
ZERIT
generic
zalcitabine
HIVID
brand
zidovudine
RETROVIR
generic
Nucleoside/Nucleotide Reverse - Transcriptase Inhibitor Combination
cobicistat/elvitegravir/
STRIBILD
brand
PA
emtricitabine/tenofovir
efavirenz/emtricitabine/
ATRIPLA
brand
tenofovir
emtricitabine/tenofovir
TRUVADA
brand
PA
Nucleotide Analogues Nucleotide Reverse-Transcriptase Inhibitor
tenofovir
VIREAD
brand
Protease Inhibitors
amprenavir
AGENERASE
brand
atazanavir
REYATAZ
brand
REYATAZ POWDER
Members ≥ 8 years of age
atazanavir
brand
will require prior authorization
PACKET
darunavir
PREZISTA
brand
fosamprenavir
LEXIVA
brand
indinavir
CRIXIVAN
brand
lopinavir/ritonavir
KALETRA
brand
nelfinavir
VIRACEPT
brand
ritonavir
NORVIR
brand
saquinavir
FORTOVASE
brand
saquinavir mesylate
INVIRASE
brand
tipranavir
APTIVUS
brand
Miscellaneous
abacavir/dolutegravir/
TRIUMEQ
brand
lamivudine
atovaquone
MEPRON
generic
PA
bedaquiline
SIRTURO
brand
PA
chloroquine phosphate
ARALEN
generic
clindamycin
CLEOCIN
generic
150 mg and 300 mg only
cobicistat
TYBOST
brand
dapsone
DAPSONE
brand
QL = Quantity Limit
ST = Step Therapy
30
Generic Drug Name
Brand Drug Name
darunavir/cobicistat
dolutegravir
ethambutol
etravirine
hydroxychloroquine
isoniazid
linezolid
maraviroc
mefloquine
metronidazole
neomycin sulfate
PREZCOBIX
TIVICAY
MYAMBUTOL
INTELENCE
PLAQUENIL
ISONIAZID
ZYVOX
SELZENTRY
LARIAM
FLAGYL
Covered
Drug
brand
brand
generic
brand
generic
generic
generic
brand
generic
generic
brand
nitazoxanide suspension
ALINIA SUSPENSION
brand
nitazoxanide tablet
nitrofurantoin
extended-release
nitrofurantoin
macrocrystals
nitrofurantoin
macrocrystals
ALINIA
brand
nitrofurantoin susp
MACROBID
generic
MACRODANTIN
generic
MACRODANTIN 25 MG
FURADANTIN SUSP
25 MG/5 ML
palivizumab
paromomycin
povidone-iodine
primaquine
pyrazinamide
pyrimethamine
raltegravir
raltegravir
SYNAGIS
HUMATIN
raltegravir susp
ISENTRESS SUSP
rifabutin
rifampin
trimethoprim
MYCOBUTIN
RIFADIN
TRIMETHOPRIM
QL = Quantity Limit
PA
tabs only
authorization.
PA
brand
generic
PYRAZINAMIDE
DARAPRIM
ISENTRESS
ISENTRESS CHEWABLE
brand
generic
brand
generic
generic
brand
brand
brand
brand
authorization.
PA
OTC
PA
chewable tablet
authorization.
brand
generic
generic
ST = Step Therapy
31
tabs only
Generic Drug Name
Covered
Drug
Brand Drug Name
Musculoskeletal
Arthritis
Disease Modifying Anti-Rheumatic Drugs
adalimumab
HUMIRA
anakinra
KINERET
auranofin
RIDAURA
azathioprine
IMURAN
certolizumab pegol
CIMZIA
hydroxychloroquine
PLAQUENIL
leflunomide
ARAVA
methotrexate
penicillamine
CUPRIMINE
sulfasalazine
AZULFIDINE
sulfasalazine
AZULFIDINE EN-TABS
delayed-release
NSAIDs and Other Analgesics
celecoxib
CELEBREX
choline magnesium
TRILISATE
trisalicylate
VOLTAREN 1% TOPICAL
diclofenac 1% gel
GEL
diclofenac potassium
CATAFLAM
diclofenac sodium
VOLTAREN
delayed-release
diclofenac sodium
VOLTAREN XR
extended-release
etodolac
LODINE
fenoprofen
NALFON
ibuprofen
MOTRIN
indomethacin
INDOCIN
ketoprofen
ORUDIS
meloxicam
MOBIC
naproxen
NAPROSYN
naproxen sodium
ANAPROX
oxaprozin
DAYPRO
piroxicam
FELDENE
QL = Quantity Limit
brand
brand
brand
generic
brand
generic
generic
generic
brand
generic
PA, SP
PA, SP
PA, SP
generic
generic
PA, QL
generic
brand
PA
generic
generic
generic
generic
generic
generic
generic
generic
generic
generic
generic
generic
generic
IR only
600 mg
tabs, chew tabs and susp
ST = Step Therapy
32
IR only
QL
not EC
Generic Drug Name
Brand Drug Name
sulindac
CLINORIL
Gout
allopurinol
ZYLOPRIM
colchicine
MITIGARE
febuxostat
ULORIC
probenecid
PROBENECID
Skeletal Muscle Relaxants
Muscle Spasm
chlorzoxazone
PARAFON FORTE DSC
cyclobenzaprine
FLEXERIL
methocarbamol
ROBAXIN
orphenadrine
NORFLEX
extended-release
Spasticity
baclofen
BACLOFEN
dantrolene
DANTRIUM
diazepam
VALIUM
tizanidine
ZANAFLEX
Covered
Drug
generic
generic
brand
brand
generic
ST
generic
generic
generic
generic
generic
generic
generic
generic
QL
tabs only, QL
generic
generic
QL
QL
generic
generic
QL
1.5 mg tab
generic
QL
generic
QL
brand
ring, QL
brand
QL
OB-GYN
Contraceptives
Biphasic
desogestrel/EE
MIRCETTE
norethindrone/EE
ORTHO-NOVUM 10/11
Emergency Contraception
levonorgestrel
PLAN B
levonorgestrel
PLAN B ONE STEP
Extended Cycle
levonorgestrel/EE
SEASONALE
Injectable
medroxyprogesterone
DEPO-PROVERA
acetate
Intravaginal
etonogestrel/EE
NUVARING
ORTHO COIL
ortho diaphragm
ORTHO FLAT
ORTHO FLEX
QL = Quantity Limit
ST = Step Therapy
33
Generic Drug Name
Brand Drug Name
Monophasic - 20 mcg Estrogen
levonorgestrel/EE
ALESSE
norethindrone acetate/EE LOESTRIN 1/20
norethindrone acetate/
LOESTRIN FE 1/20
EE/iron
desogestrel/EE
ORTHO-CEPT
levonorgestrel/EE
NORDETTE
norethindrone acetate/EE LOESTRIN 1.5/30
LOESTRIN FE 1.5/30
EE/iron
norgestrel/EE
LO/OVRAL
ethynodiol diacetate/EE ZOVIA 1/35
norethindrone/EE
BALZIVA
norethindrone/EE
MODICON
norethindrone/EE
ORTHO-NOVUM 1/35
norgestimate/EE
ORTHO-CYCLEN
ethynodiol diacetate/EE ZOVIA 1/50
norethindrone/EE
OVCON 50
norethindrone/ME
ORTHO-NOVUM 1/50
norgestrel/EE
OVRAL
Progestin
norethindrone
ORTHO MICRONOR
norgestrel
OVRETTE
Transdermal
norelgestromin/EE
ORTHO EVRA
Triphasic
desogestrel/EE
CYCLESSA
levonorgestrel/EE
TRIVORA
norethindrone
ESTROSTEP FE
acetate/EE/iron
norethindrone/EE
ORTHO-NOVUM 7/7/7
norethindrone/EE
TRI-NORINYL
norgestimate/EE
ORTHO TRI-CYCLEN
QL = Quantity Limit
Covered
Drug
generic
generic
0.1/20, QL
1/20, QL
generic
1/20, QL
generic
generic
generic
0.15/30, QL
0.15/30, QL
1.5/30, QL
generic
1.5/30, QL
generic
0.3/30, QL
generic
generic
generic
generic
generic
1/35, QL
0.4/35, QL
0.5/35, QL
1/35, QL
0.25/35, QL
generic
generic
generic
generic
1/50, QL
1/50, QL
1/50, QL
0.5/50, QL
generic
generic
generic
generic
generic
QL
QL
generic
QL
generic
generic
generic
QL
QL
QL
ST = Step Therapy
34
Generic Drug Name
Brand Drug Name
Covered
Drug
DANOCRINE
generic
Gender edits apply: for
female patients only.
Endometriosis
danazol
Hormone Therapy/Menopause
Estrogens - Intravaginal
estradiol
ESTRACE CRM
estrogens, conjugated
PREMARIN
Estrogens - Oral
estradiol
ESTRACE
estrogens, conjugated
PREMARIN
estrogens, conjugated,
CENESTIN
synthetic A
ENJUVIA
synthetic B
estropipate
OGEN
Estrogens - Transdermal
estradiol
CLIMARA
Estrogen/Progestin
PREMPHASE
estrogens, conjugated/
medroxyprogesterone PREMPRO
Progestins
medroxyprogesterone
PROVERA
acetate
norethindrone acetate
AYGESTIN
Vaginal Infections
Oral
fluconazole
DIFLUCAN
metronidazole
FLAGYL
Vaginal
clindamycin
CLEOCIN
METROGEL-VAGINAL
metronidazole
METROGEL 1%
miconazole
MONISTAT
miconazole
MONISTAT 3
terconazole
TERAZOL 3/7
QL = Quantity Limit
brand
brand
generic
brand
brand
brand
generic
generic
QL
brand
generic
generic
generic
generic
QL
tabs
generic
crm
generic
generic
generic
generic
ST = Step Therapy
35
crm
OTC
crm
Generic Drug Name
Miscellaneous
conjugated estrogen/
bazedoxifene
methylergonovine
tranexamic acid
Covered
Drug
Brand Drug Name
brand
DUAVEE
METHERGINE
LYSTEDA
generic
generic
OPTIVAR
CROLOM
ALAWAY OTC
generic
generic
brand
VOLTAREN
OCUFEN
ACULAR/ACULAR LS
generic
generic
generic
DEXASOL
generic
PA
Ophthalmic
Allergy
azelastine
cromolyn sodium
ketotifen
Anti-Inflammatories
Nonsteroidal
diclofenac sodium
flurbiprofen
ketorolac
Steroidal
dexamethasone sodium
phosphate
fluorometholone
FML
FML SOP
fluorometholone
FML FORTE
fluorometholone acetate FLAREX
prednisolone acetate
PRED FORTE
prednisolone acetate
PRED MILD
prednisolone phosphate INFLAMASE FORTE
rimexolone
VEXOL
Anti-Infective/Anti-Inflammatory Combinations
gentamicin/prednisolone
PRED-G
acetate
MAXITROL
dexamethasone
CORTISPORIN
hydrocortisone
sulfacetamide/pred phos VASOCIDIN
tobramycin/
TOBRADEX
dexamethasone
QL = Quantity Limit
ST
QL
generic
0.1%
generic
generic
generic
brand
generic
brand
susp 0.25%
1%
0.12%
1%
brand
generic
generic
generic
generic
ST = Step Therapy
36
10%/0.25%
Generic Drug Name
Covered
Drug
Brand Drug Name
Glaucoma
Beta-Blockers
carteolol
generic
levobunolol
BETAGAN
generic
metipranolol
OPTIPRANOLOL
generic
timolol
TIMOPTIC XE
generic
timolol hemihydrate
BETIMOL
brand
timolol maleate
TIMOPTIC
generic
Carbonic Anhydrase Inhibitors
dorzolamide
TRUSOPT
generic
Carbonic Anhydrase Inhibitor/Beta-Blocker Combination
dorzolamide/
COSOPT
generic
timolol maleate
Cholinesterase Inhibitor
ecothiophate
PHOSPHOLINE IODINE
brand
Mydriatics
atropine
ISOPTO ATROPINE
generic
cyclopentolate
CYCLOGYL
generic
homatropine
ISOPTO HOMATROPINE
generic
scopolamine
ISOPTO HYOSCINE
brand
Oral
acetazolamide
ACETAZOLAMIDE
generic
acetazolamide
DIAMOX SEQUELS
generic
extended-release
methazolamide
NEPTAZANE
generic
Prostaglandins
latanoprost
XALATAN
generic
Topical - Parasympathomimetics
pilocarpine
ISOPTO CARPINE
generic
pilocarpine
PILOPINE HS GEL
brand
Topical - Sympathomimetics
brimonidine
ALPHAGAN P
brand
brimonidine
BRIMONIDINE
generic
Infections
Bacterial
bacitracin
generic
ciprofloxacin
CILOXAN
generic
erythromycin
ERYTHROMYCIN
generic
gatifloxin
ZYMAR
brand
QL = Quantity Limit
ophthalmic solution
0.3% ophthalmic solution
gel forming solution
ST = Step Therapy
37
QL
0.2%
PA
Generic Drug Name
Brand Drug Name
gentamicin
gramicidin
ofloxacin
polymyxin B/bacitracin
polymyxin B/trimethoprim
sulfacetamide
sulfacetamide/
phenylephrine
tobramycin
Viral
trifluridine
Miscellaneous
cysteamine 0.44%
ophthalmic solution
sodium chloride
hypertonic
GENTAK
Covered
Drug
generic
NEOSPORIN
generic
OCUFLOX
POLYSPORIN
POLYTRIM
BLEPH-10
generic
generic
generic
generic
oint/soln
brand
VASOSULF
TOBREX
generic
VIROPTIC
generic
CYSTARAN
brand
PA, SP
MURO 128
generic
soln 5%
CAMPRAL
ANTABUSE
REVIA
brand
generic
generic
XANAX
LIBRIUM
KLONOPIN
TRANXENE
VALIUM
ATIVAN
SERAX
generic
generic
generic
generic
generic
generic
generic
BUSPAR
LUVOX
generic
generic
Psychiatric
Alcohol Deterrents
acamprosate
disulfiram
naltrexone
Anxiety
Benzodiazepines
alprazolam
chlordiazepoxide
clonazepam
clorazepate
diazepam
lorazepam
oxazepam
Miscellaneous
buspirone
fluvoxamine
QL = Quantity Limit
ST = Step Therapy
38
QL, IR only
not wafers
QL
QL
QL
Generic Drug Name
Brand Drug Name
Attention Deficit Hyperactivity Disorder (ADHD)
amphetamine/
dextroamphetamine
ADDERALL
mixed salts
amphetamine/
ADDERALL XR
dextroamphetamine
(BRAND ADDERALL
mixed salts
XR IS PREFERRED)
extended-release
dextroamphetamine
DEXEDRINE
dextroamphetamine
DEXTROSTAT
dextroamphetamine
DEXEDRINE SPANSULE
extended-release
guanfacine ER
INTUNIV
lisdexamfetamine
VYVANSE
Covered
Drug
generic
Age Limits Apply, QL
brand
generic
brand
generic
generic
brand
Age Limits Apply
Age Limits Apply,
tabs only, QL
methylphenidate
RITALIN
generic
methylphenidate
extended-release
CONCERTA
generic
generic
generic
authorization.
generic
Minimum age 2
methylphenidate
extended-release
METADATE ER
RITALIN-SR
RITALIN LA
Bipolar Disorder
divalproex sodium
cap sprinkle
DEPAKOTE SPRINKLE
divalproex sodium
DEPAKOTE
delayed-release
lithium carbonate
LITHIUM CARBONATE
ESKALITH CR
lithium carbonate
extended-release
LITHOBID
Depression
Monoamine Oxidase Inhibitor (MAOI)
tranylcypromine
PARNATE
QL = Quantity Limit
generic
generic
generic
ST = Step Therapy
39
Generic Drug Name
Covered
Drug
Brand Drug Name
Selective Serotonin Reuptake Inhibitor (SSRIs)
citalopram
CELEXA
escitalopram
LEXAPRO
generic
generic
fluoxetine
generic
PROZAC
paroxetine
PAXIL
generic
sertraline
ZOLOFT
generic
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
duloxetine
CYMBALTA
generic
venlafaxine
EFFEXOR
generic
venlafaxine XR
EFFEXOR XR
generic
Tricyclic Antidepressants (TCAs)
amitriptyline
ELAVIL
generic
amoxapine
generic
desipramine
NORPRAMIN
generic
doxepin
SINEQUAN
generic
imipramine HCL
TOFRANIL
generic
nortriptyline
PAMELOR
generic
Tricyclic Antidepressant/Phenothiazine combination
amitriptyline/perphenazine TRIAVIL
generic
Miscellaneous Agents
bupropion
WELLBUTRIN
generic
bupropion
WELLBUTRIN SR
generic
extended-release
bupropion
WELLBUTRIN XL
generic
extended-release
maprotiline
LUDIOMIL
generic
mirtazapine
REMERON
generic
trazodone
DESYREL
generic
Insomnia
Benzodiazepines
flurazepam
DALMANE
generic
temazepam
RESTORIL
generic
triazolam
HALCION
generic
Non-Benzodiazepines
chloral hydrate
CHLORAL HYDRATE
generic
diphenhydramine
NYTOL QUICK CAPS
generic
zaleplon
SONATA
generic
zolpidem
AMBIEN
generic
QL = Quantity Limit
QL
10 mg and 20 mg caps and
20 mg soln only
tablets
tablets, QL
QL
QL
QL
tablets
tablets
QL
150 mg and 300 mg
tabs (not soltabs)
150 mg only
QL
15 mg and 30 mg only, QL
QL
ST = Step Therapy
40
OTC
QL
QL
Generic Drug Name
Brand Drug Name
Covered
Drug
Narcotic Antagonists
buprenorphine
SUBUTEX
generic
buprenorphine/naloxone
SUBOXONE
naloxone
naltrexone
Psychoses
Atypicals
NALOXONE INJ
REVIA
brand
PA, QL
2 mg and 8 mg film only,
PA, QL
generic
generic
aripiprazole
ABILIFY TABLETS
aripiprazole ER injection
ABILIFY MAINTENA
clozapine
CLOZARIL
generic
olanzapine
ZYPREXA
generic
paliperidone
paliperidone
quetiapine
INVEGA SUSTENNA
INVEGA TRINZA
SEROQUEL
brand
brand
generic
risperidone
RISPERDAL
generic
risperidone
RISPERDAL CONSTA
risperidone oral soln
RISPERDAL SOLUTION
generic
ziprasidone
GEODON
generic
QL = Quantity Limit
generic
brand
brand
Age Limit Applies,
tablets, PA, QL,
Certain daily doses require
half tablet dosing:
5 mg once daily – must be
dosed as 10 mg tablet,
½ tab once daily
½ tab once daily
½ tab once daily
Age Limit Applies, PA, QL
100 mg only, Age Limit
Applies
Age Limit Applies,
tablets, QL
Age Limit Applies, PA
Age Limit Applies, QL
Age Limit Applies, QL,
(Not M-Tabs)
QL, Members ≥ 8 years
authorization.
Age Limit Applies, QL
ST = Step Therapy
41
Generic Drug Name
Miscellaneous
chlorpromazine
dextromethorphan/
quinidine
fluphenazine
fluphenazine decanoate
haloperidol
haloperidol decanoate
loxapine
perphenazine
pimozide
thioridazine
thiothixene
trifluoperazine
Brand Drug Name
Covered
Drug
THORAZINE
generic
NUEDEXTA
brand
PROLIXIN
PROLIXIN DECANOATE
HALDOL
HALDOL DECANOATE
LOXITANE
TRILAFON
ORAP
MELLARIL
NAVANE
STELAZINE
PA
generic
generic
generic
generic
generic
generic
generic
generic
generic
generic
Respiratory Drugs
Antitussives, Decongestants, Expectorants and Combinations
benzonatate
TESSALON
generic
brompheniramine &
DIMETAPP CLD ELX/
generic
phenylephrine
ALLERGY
ACCUHIST DROPS
brompheniramine/
generic
pseudoephedrine
RESPERAL-DM
BROMFENEX PD CAP
brompheniramine/
pseudoephedrine
brompheniramine/
pseudoephedrine
brompheniramine/
pseudoephedrine/
dextromethorphan
brompheniramine/
pseudoephedrine/
dextromethorphan
DIMETAPP ELX
CLD/ALLE
liquid
generic
UNI-HIST DRO
CARDEC SYP
RONDEC SYRUP
generic
syrup
ACCUHIST PDX DROPS
generic
liquid
BROMALINE DM
generic
elixir
QL = Quantity Limit
ST = Step Therapy
42
Generic Drug Name
Covered
Drug
generic
syrup
HISTACOL DM
generic
syrup
RYNATUSS
generic
RONDEC DROPS
generic
liquid
generic
syrup
TUSSI-12 S
generic
susp
TANAFED
generic
susp
TRIOTANN PEDIATRIC
SUSP
generic
susp
Brand Drug Name
BROMFED DM
brompheniramine/
pseudoephedrine/
dextromethorphan
DALLERGY DM
CARBOFED
NEO DM
ANAPLEX DM
brompheniramine/
pseudoephedrine/
dextromethorphan/
guaifenesin
carbetapentane/
chlorpheniramine/
ephedrine/
phenylephrine
carbinoxamine/
pseudoephedrine
chlorphen-PEmethscopolamine
chlorphen tan/
carbetapentane tan
chlorphen tan/
pseudoeph tan
chlorphen tan/pyrilamine
tan/PE tan
DURADRYL
QV-ALLERGY
R-TANNAMINE
chlorpheniramine maleate ED A-HIST TABLETS AND
phenylephrine HCL
LIQUID
HISTEX
chlorpheniramine/
pseudoephedrine
CPM/PSE
RONDEC DROPS
chlorpheniramine/
phenylephrine
CARDEC DRO
RONDEC SYRUP
chlorpheniramine/
phenylephrine
CARDEC SYP
chlorpheniramine tan/
RYNATAN PEDIATRIC
phenylephrine tan
SUSP
QL = Quantity Limit
generic
generic
generic
liquid
generic
syrup
generic
susp
ST = Step Therapy
43
Generic Drug Name
Brand Drug Name
codeine/
chlorpheniramine/
pseudoephedrine
DIHISTINE DH
Covered
Drug
PHENYLHIST LIQ DH
generic
GUIATUSS AC
codeine/guaifenesin
generic
GG/CODEINE
QL
M-CLEAR WC
codeine/guaifenesin/
pseudoephedrine
codeine/promethazine
codeine/promethazine/
phenylephrine
dextromethorphan/
brompheniramine/
pseudoephedrine
dextromethorphan/
carbinoxamine/
pseudoephedrine
dextromethorphanguaifenesin
dextromethorphanguaifenesin
dextromethorphan hbr
dextromethorphan/
promethazine
guaifenesin
guaifenesin
guaifenesin
extended-release
guaifenesin/
pseudoephedrine/
dextromethorphan
generic
GUIATUSS DAC
PROMETHAZINE
W/CODEINE
PROMETHAZINE VC
W/CODEINE
generic
QL
generic
QL
BROMETANE DX
generic
CARDEC-DM
generic
drops
DURATUSS DM ELX
generic
soln 25-225 mg/5 ml
ROBITUSSIN LIQ CGH/
generic
CONG
ROBITUSSIN SYP MAX-ST
generic
ROBITUSSIN PED SYP
PHENERGAN DM
generic
PROMETHAZINE SYP DM
ROBITUSSIN
generic
ROBITUSSIN SYP
generic
CHST CNG
MUCINEX
generic
ROBITUSSIN CF
generic
QL = Quantity Limit
liq 10-200 mg/ 5 ml
syrup
OTC
syrup 100 mg/5 ml
ST = Step Therapy
44
OTC
Generic Drug Name
guaifenesin/
pseudoephedrine
extended-release
hydrocodone/
chlorpheniramine/
phenylephrine
hydrocodone/guaifenesin
hydrocodone/homatropine
loratadine &
pseudoephedrine SR
24hr
phenyleph/bromphen/
dextromethorphan/
guaifenesin
phenylephrine/
chlorpheniramine
phenylephrine/
chlorpheniramine/
dextromethorphan
phenylephrine/
chlorpheniramine/
dextromethorphan
phenylephrine/
chlorpheniramine/
dextromethorphan
phenylephrine/
chlorpheniramine/
dihydrocodeine
Brand Drug Name
Covered
Drug
GUAIFED
generic
HISTUSSIN HC
generic
VITUSSIN
HYDROCODO/GG SYP
HYCODAN
HYDROMET SYP
generic
generic
HYDROCODONE/
TAB HOMATROP
ALLERGY/CONG TAB
RELIEF
generic
ALLANHIST SYP PDX
generic
QUAL-TUSSIN SYP DC
generic
ATUSS DR
DE-CHLOR DM
tab 10-240 mg
generic
syrup
generic
syrup
generic
liquid
RONDEC DM
STATUSS DM SYP
CARDEC DM SYP
MINUTUSS DR SYP
RONDEC DM DROPS
CARDEC DM DRO
ROBITUSSIN LIQ
CGH/ALRG
generic
DIHYDRO-PE SYP
QL = Quantity Limit
ST = Step Therapy
45
Generic Drug Name
Brand Drug Name
Covered
Drug
phenylephrine/
dextromethorphan
phenylephrine/
dextromethorphan/
guaifenesin
phenylephrine/ephed/
CPM w/
carbetapentane
DIMETAPP DRO
DCON/CGH
generic
ROBITUSSIN LIQ
CGH/CLD
generic
RYNATUSS PEDIATRIC
SUSP
generic
ROBITUSSIN LIQ
HD/CHST
generic
QUAL-TUSSIN SYP DC
generic
CODAL-DM
generic
CODIMAL DH
generic
syrup
TUSSI 12D S
generic
susp
PROMETH VC SYP
6.25-5/5
generic
syrup 6.25-5 mg/ 5 mg
MAPAP COLD TAB
generic
phenylephrine/guaifenesin
phenylephrine/
hydrocodone/
guaifenesin
phenylephrine/
pyrilamine/
dextromethorphan
phenylephrine/
pyrilamine
w/hydrocodone
phenylephrine tan/
pyrilamine tan/
carbeta tan
promethazine &
phenylephrine
pseudoephedrine/
acetaminophen/
dextromethorphan
pseudoephedrine/
chlorpheniramine/
dextromethorphan
pseudoephedrine/
dextromethorphan/
guaifenesin
PEDIACARE LIQ
MULTI-SY
ROBITUSSIN LIQ PED
NGHT
MULTI SYMPTOM TAB
COLD RLF
QL = Quantity Limit
susp
generic
generic
ST = Step Therapy
46
Generic Drug Name
pseudoephedrine/
iburprofen
Covered
Drug
Brand Drug Name
CHILD IBUPRO
SUS COLD
generic
IBUOROFEN TAB
COLD/SIN
TANAFED DMX
SUSPENSION
pseudoephedrine tan/
dexchlorphen tan/
DM tan
TRI-FED X
pyrilamine tan/
RYNA-12 S
phenyleph tan
TRIPROL/PSE SYP
tripolidine/
pseudoephedrine
APHEDRID TAB
Asthma/COPD
Inhalers - Beta Agonists
albuterol sulfate
VENTOLIN HFA
indacaterol
ARCAPTA NEOHALER
olodaterol
STRIVERDI RESPIMAT
Inhalers - Corticosteroids
fluticasone furoate
ARNUITY ELLIPTA
mometasone
ASMANEX TWISTHALER
mometasone inhalation
ASMANEX HFA
Inhalers - Corticosteroid/Beta Agonist Combinations
fluticasone/vilanterol
BREO ELLIPTA
mometasone/formoterol DULERA
Inhalers - Others
cromolyn
INTAL
ipratropium/albuterol
COMBIVENT
COMBIVENT RESPIMAT
ipratropium HFA
ATROVENT HFA
nedocromil
TILADE
omalizumab
XOLAIR
umeclidinium inhalation
INCRUSE ELLIPTA
umeclidinium/vilanterol
ANORO ELLIPTA
Inhalers for Nebulization
albuterol
generic
susp
generic
susp
generic
brand
brand
brand
QL
brand
brand
brand
QL
QL
brand
brand
ST
QL, ST
brand
brand
brand
brand
brand
brand
QL
QL
inhaler
PA, SP
brand
generic
ACCUNEB
QL = Quantity Limit
0.63 mg/3 ml and 1.25
mg /3 ml, Covered for
members less than 8 years
of age. Members ≥ 8 years
authorization.
ST = Step Therapy
47
Generic Drug Name
Brand Drug Name
albuterol
PROVENTIL
Covered
Drug
generic
budesonide
PULMICORT RESPULES
generic
cromolyn
INTAL
ipratropium
ATROVENT
DUONEB
levalbuterol HCl
XOPENEX RESPULES
Oral Agents - Beta Agonists
METAPROTERENOL
metaproterenol
SYRUP
terbutaline
BRETHINE
Oral Agents - Leukotriene Modifiers
montelukast
SINGULAIR
Oral Agents - Theophylline
theophylline
THEOPHYLLINE
theophylline ext-rel
THEO-24
THEOCHRON
THEOPHYLLINE EXT-REL
UNIPHYL
generic
generic
generic
generic
soln 0.083%, 0.5%
susp, Members ≥ 5 years
authorization. QL
soln, QL
soln, QL
soln
QL, ST
generic
generic
generic
QL
generic
brand
generic
generic
generic
liquid
caps
tabs
caps (12 hr)
tabs
Urological
Symptomatic Benign Prostatic Hypertrophy
alfuzosin ER
UROXATRAL
doxazosin
CARDURA
finasteride
PROSCAR
tamsulosin
FLOMAX
terazosin
HYTRIN
Miscellaneous
bethanechol
URECHOLINE
hyoscyamine,
methenamine,
phenyl salicylate,
UTIRA C
sodium phosphate
monobasic, methylene
blue
HIPREX
methenamine hippurate
UREX
oxybutynin chloride
DITROPAN XL
QL = Quantity Limit
generic
generic
generic
generic
generic
generic
brand
generic
generic
ST = Step Therapy
48
QL, ST
PYRIDIUM
BICITRA
DETROL
SANCTURA
Covered
Drug
generic
generic
generic
generic
generic
generic
generic
ROCALTROL
generic
Generic Drug Name
Brand Drug Name
oxybutynin IR
potassium citrate
propantheline
phenazopyridine
sodium citrate/citric acid
tolterodine
trospium
DITROPAN
UROCIT-K
ST
ST
Vitamins and Minerals
calcitriol
authorization.
inj, Coverage for these
medications will be
determined by the member’s
individual benefits.
Please refer to individual
plan documents for coverage
information.
Coverage for these
medications will be
information.
calcitriol oral soln
ROCALTROL SOLUTION
generic
cyanocobalamin
VITAMIN B-12
generic
ergocalciferol (D2)
DRISDOL
generic
NIFEREX
generic
caps, OTC
FEOSOL
generic
OTC
Coverage for these
medications will be
information.
ferrous bisglycinate/
polysaccarides iron
ferrous sulfate
GEL-KAM
LURIDE
fluoride
generic
LURIDE LOZI-TABS
PREVIDENT
PHOS-FLUR
folic acid
generic
FOLIC ACID
QL = Quantity Limit
ST = Step Therapy
49
Generic Drug Name
multivitamins/
fluoride/±iron
phytonadione
polysaccharide iron
complex
prenatal-FE Bis-FE
prot succ-FA-CA
& omega 3
prenatal-FE Bis-FE
prot succ-FA-CA
& omega 3
prenat-FE Bis-FE
prot succ-FA-CA
& omega 3
prenat-FE bis-FE
prot succ-FA-CA
& omega DR
prenatal vit w/FE
bisglyc-FE prot
succ-FA
prenatal vit w/FE
bisglycinate
chelate-FA
prenatal vit w/FE
bisglycinate
chelate-FA
prenatal vit w/FE
bisglycinate
chelate-FA
prenatal vit w/FE
polysac cmplx-FA
prenatal vit w/iron
carbonyl-FA
Brand Drug Name
POLY-VI-FLOR
Covered
Drug
generic
Coverage for these
medications will be
information.
brand
MEPHYTON
generic
NIFEREX
COMPLETE NATALCARE
PAK DHA
brand
TRUST NATALCARE
PAK DHA
brand
PRUET DHA PAK
SETONET PAK
brand
PRUET DHAEC PAK
brand
VINATE III
brand
GENTEX ADE 28-1 MG
brand
VINATE AZ EX
brand
VITAPHIL
brand
EDGE OB CHW
brand
ATABEX PRENATAL
brand
QL = Quantity Limit
ST = Step Therapy
50
elixir, OTC
Generic Drug Name
Brand Drug Name
Covered
Drug
generic
QL
PRENATAL VITAMINS W/
FOLIC ACID
prenatal vitamins
w/folic acid
CENOGEN OB/ULTRA
MATERNA
NATALCARE
NESTABSCBF/FA/RX
NIFEREX-PN FORTE
prenatal vit w/o vit a
w/FE bisglycinate-fa
tab 32-1 mg
prenatal w/o A w/FE
FOLTABS PRENATAL
carbonyl-FE
TRI RX
gluc-DSS-FA
prenatal w/o A
FOLTABS PAK PLUS DHA
w/fecbn-fegl-DSS-FA
RE OB + DHA PAK
& DHA
brand
brand
brand
Coverage for these
medications will be
information.
Coverage for these
medications will be
information.
vitamin ADC/
fluoride/±iron drops
TRI-VI-FLOR
generic
vitamin B complex/
vitamin C/folic acid
NEPHROCAPS
generic
K-PHOS NEUTRAL
K-PHOS ORIGINAL
generic
brand
tabs
K-LYTE
generic
tabs
K-LOR
generic
powder
Potassium
phosphorus
potassium acid phosphate
potassium bicarbonate/
potassium citrate
effervescent
potassium chloride
QL = Quantity Limit
ST = Step Therapy
51
Generic Drug Name
Brand Drug Name
potassium chloride
potassium chloride
extended-release
POTASSIUM CHLORIDE
Covered
Drug
generic
MICRO-K 10
generic
caps
generic
tabs
liquid
K-DUR 10
potassium chloride
extended-release
potassium iodide
K-DUR 20
KLOR-CON 8
KLOR-CON 10
PIMA
brand
Miscellaneous
Anaphylaxis
EPIPEN
epinephrine
brand
EPIPEN JR.
TWINJECT
Cryopyrin — Associated Periodic Syndromes (CAPS)
canakinumab
ILARIS
brand
rilonacept
ARCALYST
brand
Cystic Fibrosis
acetylcysteine
MUCOMYST
generic
aztreonam
CAYSTON
brand
dornase alfa
PULMOZYME
brand
KALYDECO
ivacaftor
brand
KALYDECO GRANULES
lumacaftor/ivacaftor
ORKAMBI
brand
tobramycin neb soln
BETHKIS
brand
Hereditary Angioedema
icatibant
FIRAZYR
brand
C1 Inhibitor, Human
BERINERT
brand
Hyperphosphatemia
calcium acetate
generic
cinacalcet
SENSIPAR
brand
sevelamer
RENVELA
generic
Idiopathic Pulmonary Fibrosis (IPF)
nintedanib
OFEV
brand
pirfenidone capsule
ESBRIET
brand
QL = Quantity Limit
QL
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
PA, SP
667 mg tablet only
PA
ST
ST = Step Therapy
52
PA, SP
PA, SP
Generic Drug Name
Brand Drug Name
Immune Thrombocytopenic Purpura
eltromobpag
PROMACTA
Medical Devices
Spacers
Metabolic Modifiers
carglumic acid
CARBAGLU
glycerol phenylbutyrate
RAVICTI
sodium phenylbutyrate
BUPHENYL ORAL
oral powder
POWDER
Vaccine (oral)
typhoid vaccine
VIVOTIF BERNA
QL = Quantity Limit
Covered
Drug
brand
PA, SP
QL
brand
brand
PA, SP
PA, SP
generic
PA
brand
capsules
ST = Step Therapy
53
Generic Drug Name
Brand Drug Name Examples
OTC MEDICATIONS
The following is a list of OTC products on the PDL. Some OTC products are listed on the drug
list. OTC products covered are restricted to generics when available. Brand names are provided
as reference only.
Cough/Cold Allergy
BENADRYL
CLARITIN
antihistamines
ALAVERT
ZYRTEC
ZYRTEC D
ALAVERT ALRG TAB/SINUS
cetirizine/pseudoephedrine OTC
loratadine/pseudoephedrine
ALLERGY/CONG
Diabetes
alcohol swabs
CURITY ALCOHOL PADS
HUMULIN
insulin (vials only)
NOVOLIN
Family Planning
condoms
contraceptive foam
contraceptive gel
First Aid
hydrocortisone crm, oint
Lice Products
permethrin
piperonyl butoxide gel, liquid shampoo
Ophthalmics
allergic conjunctivitis
Vitamins/Minerals
iron
ferrous fumarate, ferrous, gluconate,
errous sulfate, ferrous bis-glycinate
chelate and polysaccharide iron caps
iron polysaccharides
QL = Quantity Limit
TROJAN
DELFEN
GYNOL II
CORTAID
NIX
PIPERONYL BUTOXIDE
ALAWAY
FERGON
FEOSOL
NIFEREX
ST = Step Therapy
54
Index of
Drugs
Index
ofCovered
Covered
Drugs
A
abacavir . . . . . . . . . . . . . . . . . 29, 30
abacavir/dolutegravir/
lamivudine. . . . . . . . . . . . . . . 30
abacavir/lamivudine. . . . . . . . . 29
abacavir/lamivudine/
zidovudine. . . . . . . . . . . . . . . 29
ABILIFY MAINTENA. . . . . . . . . 41
ABILIFY TABLETS. . . . . . . . . . . 41
abiraterone . . . . . . . . . . . . . . . . . . . 5
acamprosate. . . . . . . . . . . . . . . . 38
acarbose . . . . . . . . . . . . . . . . . . . 23
ACCUHIST DROPS. . . . . . . . . 42
ACCUHIST PDX DROPS . . . 42
ACCUNEB. . . . . . . . . . . . . . . . . 47
ACCUPRIL. . . . . . . . . . . . . . . . . . . 8
ACCURETIC. . . . . . . . . . . . . . . . . . 8
ACCUTANE . . . . . . . . . . . . . . . . . 16
acebutalol . . . . . . . . . . . . . . . . . . . . 9
acetazolamide. . . . . . . . . . . . . . . 37
acetazolamide
extended-release. . . . . . . . 37
acetic acid. . . . . . . . . . . . . . . . . . 20
acetic acid/aluminum
acetate. . . . . . . . . . . . . . . . . . 20
acetic acid/hydrocortisone . . 20
acetylcysteine. . . . . . . . . . . . . . . 52
acitretin. . . . . . . . . . . . . . . . . . . . . . 18
ACLOVATE. . . . . . . . . . . . . . . . . . 17
ACTIGALL. . . . . . . . . . . . . . . . . . 27
ACTOPLUS MET XR. . . . . . . . 23
ACTOPLUSMET. . . . . . . . . . . . 23
ACTOS. . . . . . . . . . . . . . . . . . . . . 23
ACULAR/ACULAR LS. . . . . . 36
acyclovir. . . . . . . . . . . . . . . . . . . . 29
ADALAT CC. . . . . . . . . . . . . . . . . 10
adalimumab. . . . . . . . . . . . . . . . . 32
ADDERALL . . . . . . . . . . . . . . . . 39
ADDERALL XR (BRAND
ADDERALL XR IS
PREFERRED). . . . . . . . . . 39
adefovir. . . . . . . . . . . . . . . . . . . . . 29
afatinib. . . . . . . . . . . . . . . . . . . . . . . 4
AFINITOR. . . . . . . . . . . . . . . . . . . . 4
AFINITOR DISPERZ. . . . . . . . . . 4
AGENERASE. . . . . . . . . . . . . . . 30
AGRYLIN. . . . . . . . . . . . . . . . . . . . . 7
AKINETON. . . . . . . . . . . . . . . . . . 15
ALAVERT. . . . . . . . . . . . . . . 21, 54
ALAVERT-D. . . . . . . . . . . . . . . . 21
ALAVERT ALRG TAB/
SINUS. . . . . . . . . . . . . . . 21, 54
ALAWAY. . . . . . . . . . . . . . . . . 36, 54
ALAWAY OTC. . . . . . . . . . . . . . . 36
albendazole. . . . . . . . . . . . . . . . . 27
ALBENZA. . . . . . . . . . . . . . . . . . 27
albiglutide. . . . . . . . . . . . . . . . . . . 23
albuterol. . . . . . . . . . . . . . . . . 47, 48
albuterol sulfate. . . . . . . . . . . . . 47
alclometasone. . . . . . . . . . . . . . . 17
alcohol swabs. . . . . . . . . . . . . . . 54
ALDACTAZIDE . . . . . . . . . . . . . . 10
ALDACTONE. . . . . . . . . . . . . . . . 10
ALDARA. . . . . . . . . . . . . . . . . . . . . 19
ALDOMET. . . . . . . . . . . . . . . . . . . 12
ALDORIL. . . . . . . . . . . . . . . . . . . . 12
alendronate. . . . . . . . . . . . . . . . . 24
ALESSE. . . . . . . . . . . . . . . . . . . . 34
alfuzosin ER. . . . . . . . . . . . . . . . 48
ALINIA. . . . . . . . . . . . . . . . . . . . . 31
ALINIA SUSPENSION. . . . . . 31
alirocumab . . . . . . . . . . . . . . . . . . 11
alitretinoin 1% gel. . . . . . . . . . . . . 6
ALKERAN. . . . . . . . . . . . . . . . . . . . 4
ALLANHIST SYP PDX. . . . . . 45
allergic conjunctivitis. . . . . . . . 54
ALL CAPS = Brand-name drug
lower case = Generic drug
55
ALLERGY/CONG . . . . . . . 45, 54
ALLERGY/CONG TAB
RELIEF. . . . . . . . . . . . . . . . . 45
ALLERY/CONG. . . . . . . . . . . . 21
allopurinol. . . . . . . . . . . . . . . . . . . 33
ALPHAGAN P. . . . . . . . . . . . . . 37
alprazolam. . . . . . . . . . . . . . . . . . 38
altretamine. . . . . . . . . . . . . . . . . . . . 4
aluminum acetate. . . . . . . . 19, 20
aluminum chloride
hexahydrate. . . . . . . . . . . . . . 19
amantadine. . . . . . . . . . . . . . 15, 29
AMARYL. . . . . . . . . . . . . . . . . . . 23
AMBIEN. . . . . . . . . . . . . . . . . . . . 40
ambrisentan . . . . . . . . . . . . . . . . . 12
AMERGE. . . . . . . . . . . . . . . . . . . . 14
AMICAR. . . . . . . . . . . . . . . . . . . . . . 7
amiloride. . . . . . . . . . . . . . . . . . . . . 10
amiloride/
hydrochlorothiazide. . . . . . . 10
aminocaproic acid. . . . . . . . . . . . . 7
amiodarone tabs. . . . . . . . . . . . . . 9
amitriptyline. . . . . . . . . . . . . . 14, 40
amitriptyline/perphenazine . . 40
amlodipine. . . . . . . . . . . . . . . . . . . . 9
ammonium lactate. . . . . . . . . . . . 19
amoxapine. . . . . . . . . . . . . . . . . . 40
amoxicillin . . . . . . . . . . . . . . . . . . 28
amoxicillin/clavulanate . . . . . . 28
AMOXICILLIN CAPSULES
AND CHEWABLES. . . . . 28
AMOXIL SUSP. . . . . . . . . . . . . 28
amphetamine/
dextroamphetamine mixed
salts . . . . . . . . . . . . . . . . . . . . 39
amphetamine/
dextroamphetamine mixed
salts extended-release. . . 39
ampicillin. . . . . . . . . . . . . . . . . . . . 28
Index of Covered Drugs
amprenavir. . . . . . . . . . . . . . . . . . 30
anagrelide. . . . . . . . . . . . . . . . . . . . 7
anakinra. . . . . . . . . . . . . . . . . . . . 32
ANAPLEX DM. . . . . . . . . . . . . . 43
ANAPROX. . . . . . . . . . . . . . . 13, 32
anastrozole. . . . . . . . . . . . . . . . . . . 5
ANORO ELLIPTA. . . . . . . . . . . 47
ANTABUSE. . . . . . . . . . . . . . . . . 38
antihistamines . . . . . . . 20, 21, 54
ANTIVERT. . . . . . . . . . . . . . . . . . 24
ANUSOL HC 2.5% . . . . . . . . . . 19
APHEDRID TAB. . . . . . . . . . . . 47
apixaban. . . . . . . . . . . . . . . . . . . . . . 7
aprepitant. . . . . . . . . . . . . . . . . . . 24
APRESOLINE. . . . . . . . . . . . . . . 12
APRISO. . . . . . . . . . . . . . . . . . . . 26
APTIVUS. . . . . . . . . . . . . . . . . . . 30
ARALEN . . . . . . . . . . . . . . . . . . . 30
ARANESP. . . . . . . . . . . . . . . . . . . . 7
ARAVA. . . . . . . . . . . . . . . . . . . . . 32
ARCALYST. . . . . . . . . . . . . . . . . . 52
ARCAPTA NEOHALER. . . . . 47
ARICEPT. . . . . . . . . . . . . . . . . . . . 12
ARIMIDEX . . . . . . . . . . . . . . . . . . . 5
aripiprazole . . . . . . . . . . . . . . . . . . 41
aripiprazole ER injection. . . . . . 41
ARNUITY ELLIPTA. . . . . . . . . 47
AROMASIN. . . . . . . . . . . . . . . . . . . 5
ARTANE. . . . . . . . . . . . . . . . . . . . . 15
ASMANEX HFA. . . . . . . . . . . . 47
ASMANEX TWISTHALER. . . 47
ASTELIN. . . . . . . . . . . . . . . . . . . 21
ATABEX PRENATAL. . . . . . . . 50
ATARAX. . . . . . . . . . . . . . . . . . . . 20
atazanavir. . . . . . . . . . . . . . . . . . . 30
atenolol. . . . . . . . . . . . . . . . . . . . . . . 9
atenolol/chlorthalidone. . . . . . . . 9
ATIVAN. . . . . . . . . . . . . . . . . . . . . 38
atorvastatin. . . . . . . . . . . . . . . . . . 11
atovaquone. . . . . . . . . . . . . . . . . 30
ATRIPLA. . . . . . . . . . . . . . . . . . . 30
atropine. . . . . . . . . . . . . . 24, 26, 37
atropine sulfate. . . . . . . . . . . . . 26
ATROVENT. . . . . . . . . . . . . . 47, 48
ATROVENT HFA. . . . . . . . . . . . 47
ATUSS DR. . . . . . . . . . . . . . . . . . 45
AUBAGIO. . . . . . . . . . . . . . . . . . . 14
AUGMENTIN. . . . . . . . . . . . . . . 28
auranofin. . . . . . . . . . . . . . . . . . . 32
AVITA. . . . . . . . . . . . . . . . . . . . . . . . 17
AVONEX/AVONEX PEN . . . . 14
axitinib. . . . . . . . . . . . . . . . . . . . . . . . 4
AYGESTIN. . . . . . . . . . . . . . . . . . 35
azathioprine. . . . . . . . . . . . . . . 6, 32
azelaic acid. . . . . . . . . . . . . . . . . . 16
azelastine. . . . . . . . . . . . . . . . 21, 36
azithromycin. . . . . . . . . . . . . . . . 27
aztreonam. . . . . . . . . . . . . . . . . . 52
AZULFIDINE. . . . . . . . . . . . 26, 32
AZULFIDINE
EN-TABS. . . . . . . . . . . . . 26, 32
B
bacitracin. . . . . . . . . . . . . . . . 37, 38
baclofen. . . . . . . . . . . . . . . . . . . . 33
BACTRIM. . . . . . . . . . . . . . . . . . . 28
BACTRIM DS. . . . . . . . . . . . . . . 28
BACTROBAN. . . . . . . . . . . . . . . . 17
balsalazide. . . . . . . . . . . . . . . . . . 26
BALZIVA. . . . . . . . . . . . . . . . . . . 34
BANZEL. . . . . . . . . . . . . . . . . . . . 16
BARACLUDE. . . . . . . . . . . . . . . 29
bedaquiline. . . . . . . . . . . . . . . . . 30
BENADRYL. . . . . . . . . . . . . 20, 54
benazepril. . . . . . . . . . . . . . . . . . . . . 8
benazepril/
hydrochlorothiazide. . . . . . . . 8
56
BENTYL. . . . . . . . . . . . . . . . . . . . 25
BENZAC AC. . . . . . . . . . . . . . . . 16
BENZAMYCIN. . . . . . . . . . . . . . 17
benzocaine/antipyrine. . . . . . . 20
benzonatate. . . . . . . . . . . . . . . . . 42
BENZOTIC. . . . . . . . . . . . . . . . . 20
benzoyl peroxide. . . . . . . . . 16, 17
benztropine. . . . . . . . . . . . . . . . . . 15
BERINERT. . . . . . . . . . . . . . . . . 52
BETA-VAL. . . . . . . . . . . . . . . . . . . 17
BETAGAN. . . . . . . . . . . . . . . . . . 37
betamethasone
augmented dip. . . . . . . . . . . 17
betamethasone
dip augmented. . . . . . . . . . . 18
betamethasone
dipropionate. . . . . . . . . . . . . . 18
betamethasone val. . . . . . . . . . . 17
BETAPACE. . . . . . . . . . . . . . . . . . . 9
bethanechol. . . . . . . . . . . . . . . . . 48
BETHKIS. . . . . . . . . . . . . . . . . . . 52
BETIMOL. . . . . . . . . . . . . . . . . . . 37
bexarotene caps and
topical gel. . . . . . . . . . . . . . . . . 6
BIAXIN. . . . . . . . . . . . . . . . . . . . . 27
BIAXIN XL. . . . . . . . . . . . . . . . . 27
bicalutamide. . . . . . . . . . . . . . . . . . 5
BICITRA. . . . . . . . . . . . . . . . . . . . 49
BILTRICIDE . . . . . . . . . . . . . . . . 27
biperiden . . . . . . . . . . . . . . . . . . . . 15
bismuth subsalicylate +
metronidazole
+ tetracycline . . . . . . . . . . . 26
bisoprolol. . . . . . . . . . . . . . . . . . . . . 9
bisoprolol/
BLEPH-10 . . . . . . . . . . . . . . . . . 38
bosentan . . . . . . . . . . . . . . . . . . . . 12
BOSULIF. . . . . . . . . . . . . . . . . . . . . 4
bosutinib. . . . . . . . . . . . . . . . . . . . . . 4
BREO ELLIPTA. . . . . . . . . . . . . 47
BRETHINE. . . . . . . . . . . . . . . . . 48
brimonidine. . . . . . . . . . . . . . 18, 37
BROMALINE DM. . . . . . . . . . . 42
BROMETANE DX. . . . . . . . . . . 44
BROMFED DM. . . . . . . . . . . . . 43
BROMFENEX PD CAP. . . . . 42
brompheniramine/
pseudoephedrine. . . . . 42-44
brompheniramine/
pseudoephedrine/
dextromethorphan. . . . 42, 43
brompheniramine/
pseudoephedrine/
dextromethorphan/
guaifenesin. . . . . . . . . . . . . . 43
brompheniramine &
phenylephrine. . . . . . . . . . . 42
budesonide. . . . . . . . . . . . . . 26, 48
bumetanide. . . . . . . . . . . . . . . . . . 10
BUMEX. . . . . . . . . . . . . . . . . . . . . 10
BUPHENYL ORAL
POWDER. . . . . . . . . . . . . . . 53
buprenorphine. . . . . . . . . . . . . . . 41
buprenorphine/naloxone. . . . . 41
bupropion. . . . . . . . . . . . . . . . . . . 40
bupropion
BUSPAR . . . . . . . . . . . . . . . . . . . 38
buspirone. . . . . . . . . . . . . . . . . . . 38
busulfan. . . . . . . . . . . . . . . . . . . . . . 4
butalbital/acetaminophen . . . . 12
butalbital/acetaminophen/
caffeine. . . . . . . . . . . . . . . . . . 12
butalbital/apap/caff/cod. . . . . 13
butalbital/asa/caff/cod . . . . . . 13
butalbital/aspirin/caffeine. . . . 12
butorphanol. . . . . . . . . . . . . . . . . . 13
C
C1 Inhibitor, Human. . . . . . . . . 52
cabergoline. . . . . . . . . . . . . . . . . 24
cabozantinib. . . . . . . . . . . . . . . . . . 4
CAFERGOT . . . . . . . . . . . . . . . . . 14
CALAN. . . . . . . . . . . . . . . . . . 10, 14
CALAN SR . . . . . . . . . . . . . . . . . . 10
calcipotriene. . . . . . . . . . . . . . . . . 18
calcitonin-salmon . . . . . . . . . . . 24
calcitriol . . . . . . . . . . . . . . . . . 18, 49
calcitriol oral soln. . . . . . . . . . . . 49
calcium acetate. . . . . . . . . . . . . 52
CAMPRAL. . . . . . . . . . . . . . . . . . 38
canagliflozin . . . . . . . . . . . . . . . . 23
canagliflozin/metformin . . . . . 23
canakinumab . . . . . . . . . . . . . . . 52
CANASA . . . . . . . . . . . . . . . . . . . 26
capecitabine. . . . . . . . . . . . . . . . . . 4
CAPITROL. . . . . . . . . . . . . . . . . . . 19
CAPOTEN. . . . . . . . . . . . . . . . . . . . 8
CAPOZIDE. . . . . . . . . . . . . . . . . . . 8
CAPRELSA. . . . . . . . . . . . . . . . . . . 5
captopril. . . . . . . . . . . . . . . . . . . . . . 8
captopril/
CARAC. . . . . . . . . . . . . . . . . . . . . . 19
CARAFATE. . . . . . . . . . . . . . . . . 25
CARAFATE SUSPENSION. . 25
CARBAGLU. . . . . . . . . . . . . . . . 53
carbamazepine. . . . . . . . . . . . . . . 15
carbamazepine
extended-release. . . . . . . . . 15
CARBATROL. . . . . . . . . . . . . . . . 15
carbetapentane/
chlorpheniramine/
ephedrine/
phenylephrine. . . . . . . . . . . 43
carbidopa/levodopa. . . . . . . . . . 15
57
carbidopa/levodopa
carbinoxamine/
pseudoephedrine. . . . . 43, 44
CARBOFED. . . . . . . . . . . . . . . . 43
CARDEC-DM. . . . . . . . . . . . . . . 44
CARDEC DM DRO. . . . . . . . . . 45
CARDEC DM SYP. . . . . . . . . . 45
CARDEC DRO. . . . . . . . . . . . . . 43
CARDEC SYP. . . . . . . . . . . 42, 43
CARDENE . . . . . . . . . . . . . . . . . . . 9
CARDIZEM. . . . . . . . . . . . . . . . . . 10
CARDIZEM CD. . . . . . . . . . . . . . 10
CARDIZEM SR. . . . . . . . . . . . . . 10
CARDURA . . . . . . . . . . . . . . . 8, 48
carglumic acid . . . . . . . . . . . . . . 53
carteolol. . . . . . . . . . . . . . . . . . . . 37
carvedilol. . . . . . . . . . . . . . . . . . . . . 9
CASODEX. . . . . . . . . . . . . . . . . . . . 5
CATAFLAM. . . . . . . . . . . . . . . . . 32
CATAPRES. . . . . . . . . . . . . . . . . . . 8
CAYSTON . . . . . . . . . . . . . . . . . . 52
CECLOR . . . . . . . . . . . . . . . . . . . 27
CEENU . . . . . . . . . . . . . . . . . . . . . . 4
cefaclor. . . . . . . . . . . . . . . . . . . . . 27
cefadroxil. . . . . . . . . . . . . . . . . . . 27
cefdinir. . . . . . . . . . . . . . . . . . . . . 27
cefixime. . . . . . . . . . . . . . . . . . . . 27
cefprozil. . . . . . . . . . . . . . . . . . . . 27
CEFTIN . . . . . . . . . . . . . . . . . . . . 27
cefuroxime axetil. . . . . . . . . . . . 27
CEFZIL. . . . . . . . . . . . . . . . . . . . . 27
CELEBREX. . . . . . . . . . . . . . . . 32
celecoxib. . . . . . . . . . . . . . . . . . . 32
CELEXA. . . . . . . . . . . . . . . . . . . . 40
CELLCEPT. . . . . . . . . . . . . . . . . . . 6
CELONTIN. . . . . . . . . . . . . . . . . . 16
CENESTIN. . . . . . . . . . . . . . . . . 35
CENOGEN OB/ULTRA. . . . . . 51
cephalexin. . . . . . . . . . . . . . . . . . 27
ceritinib. . . . . . . . . . . . . . . . . . . . . . . 4
certolizumab pegol. . . . . . . . . . 32
cetirizine. . . . . . . . . . . . . 20, 21, 54
cetirizine/pseudoephedrine
OTC. . . . . . . . . . . . . . . . . . . . . 54
cetirizine chew tab . . . . . . . . . . 20
cetirizine hydrochloride/
pseudoephedrine
hydrochloride 12 hours
CHILD IBUPRO
SUS COLD. . . . . . . . . . . . . . 47
chloral hydrate. . . . . . . . . . . . . . 40
chlorambucil. . . . . . . . . . . . . . . . . . 4
chlordiazepoxide. . . . . . . . . . . . 38
chlorhexidine gluconate. . . . . 21
chloroquine phosphate. . . . . . 30
chlorothiazide. . . . . . . . . . . . . . . . 10
chloroxine. . . . . . . . . . . . . . . . . . . . 19
chlorphen-PEmethscopolamine . . . . . . . 43
chlorphen tan/carbetapentane
tan. . . . . . . . . . . . . . . . . . . . . . 43
chlorphen tan/pseudoeph
tan. . . . . . . . . . . . . . . . . . . . . . 43
chlorphen tan/pyrilamine tan/
PE tan. . . . . . . . . . . . . . . . . . 43
chlorpheniramine/
phenylephrine. . . . 21, 43, 45
chlorpheniramine/
phenylephrine/
pyrilamine. . . . . . . . . . . . . . . 21
chlorpheniramine/
pseudoephedrine. 21, 43, 44
chlorpheniramine/
pseudoephedrine
chlorpheniramine maleate
phenylephrine HCL. . . . . . 43
chlorpheniramine tan/
phenylephrine tan. . . . . . . . 43
chlorpromazine. . . . . . . . . . . . . . 42
chlorpropamide . . . . . . . . . . . . . 23
chlorthalidone. . . . . . . . . . . . . 9, 10
chlorzoxazone. . . . . . . . . . . . . . . 33
CHOLBAM. . . . . . . . . . . . . . . . . 24
cholestyramine. . . . . . . . . . . . . . . 11
cholic acid. . . . . . . . . . . . . . . . . . 24
choline magnesium
trisalicylate. . . . . . . . . . . 13, 32
ciclopirox. . . . . . . . . . . . . . . . . . . . 18
cilostazol. . . . . . . . . . . . . . . . . . . . . . 7
CILOXAN. . . . . . . . . . . . . . . . . . . 37
cimetidine. . . . . . . . . . . . . . . . . . . 25
CIMZIA. . . . . . . . . . . . . . . . . . . . . 32
cinacalcet. . . . . . . . . . . . . . . . . . . 52
CIPRO. . . . . . . . . . . . . . . . . . . . . . 27
CIPRODEX. . . . . . . . . . . . . . . . . 20
ciprofloxacin. . . . . . . . . 20, 27, 37
ciprofloxacin/
dexamethasone . . . . . . . . . 20
citalopram . . . . . . . . . . . . . . . . . . 40
clarithromycin. . . . . . . . . . . . . . . 27
clarithromycin ER. . . . . . . . . . . 27
CLARITIN. . . . . . . . . . . . . . . 21, 54
clemastine. . . . . . . . . . . . . . . . . . 20
CLEOCIN. . . . . . . . . 16, 17, 30, 35
CLEOCIN T. . . . . . . . . . . . . . 16, 17
CLIMARA. . . . . . . . . . . . . . . . . . . 35
clindamycin. . . . . . . 16, 17, 30, 35
CLINORIL. . . . . . . . . . . . . . . 13, 33
clobazam. . . . . . . . . . . . . . . . . . . . 15
clobetasol propionate. . . . . . . . 18
clonazepam. . . . . . . . . . . . . . 15, 38
clonidine. . . . . . . . . . . . . . . . . . . . . . 8
clopidogrel. . . . . . . . . . . . . . . . . . . . 7
clorazepate. . . . . . . . . . . . . . . . . 38
58
clotrimazole. . . . . . . . . . . . . . 18, 28
clotrimazole with
betamethasone. . . . . . . . . . . 18
clozapine . . . . . . . . . . . . . . . . . . . . 41
CLOZARIL. . . . . . . . . . . . . . . . . . . 41
cobicistat. . . . . . . . . . . . . . . . 30, 31
cobicistat/elvitegravir/
emtricitabine/tenofovir. . . 30
CODAL-DM. . . . . . . . . . . . . . . . . 46
codeine/acetaminophen. . . . . . 13
codeine/chlorpheniramine/
pseudoephedrine. . . . . . . . 44
codeine/guaifenesin. . . . . . . . 44
codeine/guaifenesin/
codeine/promethazine . . . . . . 44
codeine/promethazine/
phenylephrine. . . . . . . . . . . 44
codeine sulfate. . . . . . . . . . . . . . . 13
CODIMAL DH. . . . . . . . . . . . . . 46
COGENTIN. . . . . . . . . . . . . . . . . . 15
COLAZAL. . . . . . . . . . . . . . . . . . 26
colchicine. . . . . . . . . . . . . . . . . . . 33
COLOCORT. . . . . . . . . . . . . . . . 26
COLYTE. . . . . . . . . . . . . . . . . . . . 26
COMBIVENT. . . . . . . . . . . . . . . 47
COMBIVENT RESPIMAT . . . 47
COMBIVIR . . . . . . . . . . . . . . . . . 30
COMETRIQ. . . . . . . . . . . . . . . . . . . 4
COMPAZINE. . . . . . . . . . . . . . . 25
COMPLERA. . . . . . . . . . . . . . . . 30
COMPLETE NATALCARE
PAK DHA. . . . . . . . . . . . . . . 50
COMTAN. . . . . . . . . . . . . . . . . . . . 15
CONCERTA. . . . . . . . . . . . . . . . 39
condoms. . . . . . . . . . . . . . . . . . . . 54
CONDYLOX SOL. . . . . . . . . . . . 19
conjugated estrogen/
bazedoxifene. . . . . . . . . . . . 36
contraceptive foam. . . . . . . . . . 54
contraceptive gel. . . . . . . . . . . . 54
COPAXONE. . . . . . . . . . . . . . . . . 14
CORDARONE. . . . . . . . . . . . . . . . 9
CORDRAN. . . . . . . . . . . . . . . . . . 17
COREG . . . . . . . . . . . . . . . . . . . . . . 9
CORTAID. . . . . . . . . . . . . . . . . . . 54
CORTEF. . . . . . . . . . . . . . . . . . . . 21
cortisone acetate. . . . . . . . . . . . 21
CORTISPORIN. . . . . . . . . . 20, 36
CORTISPORIN OTIC. . . . . . . . 20
CORTIZONE . . . . . . . . . . . . . . . . 17
COSOPT. . . . . . . . . . . . . . . . . . . 37
COUMADIN. . . . . . . . . . . . . . . . . . 7
COZAAR. . . . . . . . . . . . . . . . . . . . . 8
CPM/PSE. . . . . . . . . . . . . . . . . . 43
CREON . . . . . . . . . . . . . . . . . . . . 26
CREON 3000 UNIT . . . . . . . . 26
CRIXIVAN. . . . . . . . . . . . . . . . . . 30
crizotinib. . . . . . . . . . . . . . . . . . . . . . 4
CROLOM. . . . . . . . . . . . . . . . . . . 36
cromolyn. . . . . . . . . . . . . 36, 47, 48
cromolyn sodium. . . . . . . . . . . . 36
crotamiton. . . . . . . . . . . . . . . . . . . 19
CUPRIMINE. . . . . . . . . . . . . . . . 32
CURITY ALCOHOL PADS. . 54
CUTIVATE. . . . . . . . . . . . . . . . . . . 17
cyanocobalamin. . . . . . . . . . . . . 49
CYCLESSA. . . . . . . . . . . . . . . . . 34
cyclobenzaprine. . . . . . . . . . . . . 33
CYCLOGYL. . . . . . . . . . . . . . . . . 37
cyclopentolate. . . . . . . . . . . . . . 37
cyclophosphamide . . . . . . . . . . . . 4
cyclosporine. . . . . . . . . . . . . . . . . . 6
cyclosporine, modified. . . . . . . . . 6
CYMBALTA. . . . . . . . . . . . . . . . . 40
cyproheptadine . . . . . . . . . . . . . 20
CYSTAGON. . . . . . . . . . . . . . . . . . . 6
CYSTARAN. . . . . . . . . . . . . . . . . 38
cysteamine 0.44% ophthalmic
solution. . . . . . . . . . . . . . . . . 38
cysteamine bitartrate. . . . . . . . . . 6
CYTOMEL. . . . . . . . . . . . . . . . . . 24
CYTOTEC. . . . . . . . . . . . . . . . . . . 26
CYTOVENE. . . . . . . . . . . . . . . . . 28
CYTOXAN. . . . . . . . . . . . . . . . . . . . 4
D
D.H.E. 45. . . . . . . . . . . . . . . . . . . . 14
dabrafenib. . . . . . . . . . . . . . . . . . . . 4
daclatasvir. . . . . . . . . . . . . . . . . . 29
DAKLINZA. . . . . . . . . . . . . . . . . 29
DALLERGY DM. . . . . . . . . . . . . 43
DALMANE. . . . . . . . . . . . . . . . . . 40
danazol. . . . . . . . . . . . . . . . . . . . . 35
DANOCRINE. . . . . . . . . . . . . . . 35
DANTRIUM. . . . . . . . . . . . . . . . . 33
dantrolene. . . . . . . . . . . . . . . . . . 33
dapsone. . . . . . . . . . . . . . . . . . . . 30
DARAPRIM. . . . . . . . . . . . . . . . . 31
darbepoetin alfa. . . . . . . . . . . . . . . 7
darunavir. . . . . . . . . . . . . . . . . 30, 31
darunavir/cobicistat. . . . . . . . . 31
dasatinib. . . . . . . . . . . . . . . . . . . . . . 4
DAYPRO . . . . . . . . . . . . . . . . 13, 32
DDAVP. . . . . . . . . . . . . . . . . . . . . 24
DE-CHLOR DM. . . . . . . . . . . . . 45
DECADRON. . . . . . . . . . . . . . . . 21
DECONAMINE SR. . . . . . . . . . 21
deferasirox. . . . . . . . . . . . . . . . . . . . 7
DELATESTRYL. . . . . . . . . . . . . 22
delavirdine. . . . . . . . . . . . . . . . . . 29
DELFEN . . . . . . . . . . . . . . . . . . . 54
DELTASONE . . . . . . . . . . . . . . . 22
DEMADEX. . . . . . . . . . . . . . . . . . 10
DEMEROL. . . . . . . . . . . . . . . . . . 13
59
DEPAKENE. . . . . . . . . . . . . . . . . 16
DEPAKOTE. . . . . . . . . . 14, 15, 39
DEPAKOTE
SPRINKLE. . . . . . . 14, 15, 39
DEPO-PROVERA. . . . . . . . . . . 33
DEPO-TESTOSTERONE. . . . 22
DERMA-SMOOTHE
OIL/FS. . . . . . . . . . . . . . . . . . 17
DERMATOP. . . . . . . . . . . . . . . . . 17
DESENEX POWDER 2%. . . . 18
desipramine. . . . . . . . . . . . . . . . . 40
desmopressin. . . . . . . . . . . . . . . 24
desogestrel/EE. . . . . . . . . . 33, 34
DESYREL. . . . . . . . . . . . . . . . . . 40
DETROL. . . . . . . . . . . . . . . . . . . . 49
dexamethasone. . . . . . 20, 21, 36
dexamethasone sodium
phosphate. . . . . . . . . . . . . . . 36
DEXASOL. . . . . . . . . . . . . . . . . . 36
DEXEDRINE. . . . . . . . . . . . . . . 39
DEXEDRINE SPANSULE. . . 39
dextroamphetamine. . . . . . . . . 39
dextroamphetamine
dextromethorphanguaifenesin . . . . . . . . . . . . . 44
dextromethorphan/
brompheniramine/
dextromethorphan/
carbinoxamine/
dextromethorphan/
promethazine. . . . . . . . . . . . 44
dextromethorphan/
quinidine. . . . . . . . . . . . . . . . 42
dextromethorphan hbr. . . . . . . 44
DEXTROSTAT . . . . . . . . . . . . . . 39
DIABINESE . . . . . . . . . . . . . . . . 23
DIAMOX SEQUELS. . . . . . . . . 37
DIASTAT ACUDIAL . . . . . . . . . . 15
diazepam. . . . . . . . . . . . 15, 33, 38
diclofenac 1% gel. . . . . . . . . . . 32
diclofenac potassium. . . . . . . . 32
diclofenac sodium. . . . 13, 32, 36
diclofenac sodium
delayed-release . . . . . . . . . 32
diclofenac sodium
delayed release. . . . . . . . . . . 13
diclofenac sodium
dicloxacillin . . . . . . . . . . . . . . . . . 28
dicyclomine. . . . . . . . . . . . . . . . . 25
didanosine. . . . . . . . . . . . . . . . . . 29
didanosine delayed-release. . 29
DIDRONEL. . . . . . . . . . . . . . . . . 24
DIFLUCAN. . . . . . . . . . . . . . 28, 35
digoxin. . . . . . . . . . . . . . . . . . . . . . . . 9
DIHISTINE DH. . . . . . . . . . . . . 44
DIHYDRO-PE SYP . . . . . . . . . 45
dihydroergotamine. . . . . . . . . . . 14
DILACOR XR. . . . . . . . . . . . . . . . 10
DILANTIN. . . . . . . . . . . . . . . . . . . 16
DILANTIN INFATABS. . . . . . . . 16
DILAUDID. . . . . . . . . . . . . . . . . . . 13
diltiazem. . . . . . . . . . . . . . . . . . . . . 10
diltiazem extended-release. . . 10
diltiazem sustained-release. . . 10
DIMETAPP CLD ELX/
ALLERGY. . . . . . . . . . . . . . . 42
DIMETAPP DRO
DCON/CGH. . . . . . . . . . . . 46
DIMETAPP ELX
CLD/ALLE. . . . . . . . . . . . . . 42
dimethyl fumarate. . . . . . . . . . . . 14
DIPENTUM. . . . . . . . . . . . . . . . . 26
diphenhydramine. . . . . . . . . 20, 40
diphenoxylate/atropine. . . . . . 24
DIPROLENE . . . . . . . . . . . . 17, 18
DIPROLENE AF. . . . . . . . . . . . . 17
dipyridamole. . . . . . . . . . . . . . . . . . 7
disopyramide. . . . . . . . . . . . . . . . . . 9
disopyramide
extended-release. . . . . . . . . . 9
disulfiram. . . . . . . . . . . . . . . . . . . 38
DITROPAN. . . . . . . . . . . . . . 48, 49
DITROPAN XL. . . . . . . . . . . . . . 48
DIURIL. . . . . . . . . . . . . . . . . . . . . . 10
DIURIL ORAL
SUSPENSION. . . . . . . . . . . 10
divalproex sodium cap
sprinkle. . . . . . . . . . 14, 15, 39
divalproex sodium
delayed-release . . 14, 15, 39
dofetilide. . . . . . . . . . . . . . . . . . . . . . 9
DOLOPHINE. . . . . . . . . . . . . . . . 13
dolutegravir. . . . . . . . . . . . . . 30, 31
DOMEBORO OTIC . . . . . . . . . 20
donepezil. . . . . . . . . . . . . . . . . . . . 12
dornase alfa . . . . . . . . . . . . . . . . 52
dorzolamide. . . . . . . . . . . . . . . . . 37
dorzolamide/timolol
maleate. . . . . . . . . . . . . . . . . 37
DOSTINEX. . . . . . . . . . . . . . . . . 24
DOVONEX. . . . . . . . . . . . . . . . . . 18
doxazosin. . . . . . . . . . . . . . . . . 8, 48
doxepin. . . . . . . . . . . . . . . . . . . . . 40
doxycycline monohydrate. . . . 28
DRISDOL . . . . . . . . . . . . . . . . . . 49
dronabinol. . . . . . . . . . . . . . . . . . 24
DROXIA. . . . . . . . . . . . . . . . . . . . . . 6
DUAVEE. . . . . . . . . . . . . . . . . . . . 36
DUETACT . . . . . . . . . . . . . . . . . . 23
DULERA. . . . . . . . . . . . . . . . . . . 47
duloxetine . . . . . . . . . . . . . . . . . . 40
DUONEB. . . . . . . . . . . . . . . . . . . 48
DURADRYL. . . . . . . . . . . . . . . . 43
DURAGESIC. . . . . . . . . . . . . . . . 13
60
DURATUSS DM ELX . . . . . . . 44
DURICEF . . . . . . . . . . . . . . . . . . 27
DYAZIDE. . . . . . . . . . . . . . . . . . . . 10
E
E.E.S.. . . . . . . . . . . . . . . . . . . . . . . 27
ecothiophate. . . . . . . . . . . . . . . . 37
ED A-HIST TABLETS AND
LIQUID . . . . . . . . . . . . . . . . . 43
EDGE OB CHW. . . . . . . . . . . . 50
edoxaban. . . . . . . . . . . . . . . . . . . . . 7
EDURANT. . . . . . . . . . . . . . . . . . 29
efavirenz. . . . . . . . . . . . . . . . . 29, 30
efavirenz/emtricitabine/
tenofovir . . . . . . . . . . . . . . . . 30
EFFEXOR. . . . . . . . . . . . . . . . . . 40
EFFEXOR XR. . . . . . . . . . . . . . 40
EFUDEX. . . . . . . . . . . . . . . . . . . . 19
ELAVIL. . . . . . . . . . . . . . . . . . 14, 40
ELDEPRYL. . . . . . . . . . . . . . . . . . 15
ELIDEL. . . . . . . . . . . . . . . . . . . . . . 19
ELIMITE. . . . . . . . . . . . . . . . . . . . . 19
ELIQUIS. . . . . . . . . . . . . . . . . . . . . . 7
ELOCON. . . . . . . . . . . . . . . . . . . . 17
eltromobpag. . . . . . . . . . . . . . . . 53
EMCYT. . . . . . . . . . . . . . . . . . . . . . . 4
EMEND. . . . . . . . . . . . . . . . . . . . 24
EMLA. . . . . . . . . . . . . . . . . . . . . . . 19
empagliflozin. . . . . . . . . . . . . . . . 23
empagliflozin/metformin. . . . . 23
emtricitabine. . . . . . . . . . . . . 29, 30
emtricitabine/rilpivirine/
tenofovir . . . . . . . . . . . . . . . . 30
emtricitabine/tenofovir. . . . . . 30
EMTRIVA. . . . . . . . . . . . . . . . . . . 29
enalapril. . . . . . . . . . . . . . . . . . . . . . 8
enalapril/
enalapril oral soln . . . . . . . . . . . . . 8
enfuvirtide. . . . . . . . . . . . . . . . . . 28
ENJUVIA. . . . . . . . . . . . . . . . . . . 35
enoxaparin. . . . . . . . . . . . . . . . . . . . 7
entacapone. . . . . . . . . . . . . . . . . . 15
entecavir. . . . . . . . . . . . . . . . . . . . 29
ENTOCORT EC. . . . . . . . . . . . . 26
ENULOSE. . . . . . . . . . . . . . . . . . 26
EPANED. . . . . . . . . . . . . . . . . . . . . 8
epinephrine. . . . . . . . . . . . . . . . . 52
EPIPEN. . . . . . . . . . . . . . . . . . . . 52
EPIPEN JR.. . . . . . . . . . . . . . . . 52
EPIVIR . . . . . . . . . . . . . . . . . . 29, 30
EPIVIR HBV. . . . . . . . . . . . . . . . 29
epoetin alfa. . . . . . . . . . . . . . . . . . . 7
EPOGEN. . . . . . . . . . . . . . . . . . . . . 7
EPZICOM . . . . . . . . . . . . . . . . . . 29
ergocalciferol (D2). . . . . . . . . . 49
ergotamine/caffeine . . . . . . . . . 14
ERIVEDGE. . . . . . . . . . . . . . . . . . . 6
erlotinib. . . . . . . . . . . . . . . . . . . . . . . 4
ERY-TAB . . . . . . . . . . . . . . . . . . . 27
ERYC. . . . . . . . . . . . . . . . . . . . . . . 27
ERYGEL. . . . . . . . . . . . . . . . . . . . . 17
ERYTHROCIN. . . . . . . . . . . . . . 27
erythromycin. . . . . . . . . . 17, 27, 37
erythromycin/benzoyl
peroxide. . . . . . . . . . . . . . . . . . 17
erythromycin/sulfisoxazole . . 27
erythromycin
delayed-release . . . . . . . . . 27
erythromycin
ethylsuccinate. . . . . . . . . . . 27
erythromycin stearate . . . . . . . 27
ESBRIET. . . . . . . . . . . . . . . . . . . 52
escitalopram. . . . . . . . . . . . . . . . 40
ESKALITH CR. . . . . . . . . . . . . . 39
esomeprazole. . . . . . . . . . . . . . . 25
esomeprazole granules. . . . . . 25
ESTRACE . . . . . . . . . . . . . . . . . . 35
ESTRACE CRM. . . . . . . . . . . . . 35
estradiol. . . . . . . . . . . . . . . . . . . . 35
estramustine phosphate
sodium. . . . . . . . . . . . . . . . . . . . 4
estrogens, conjugated. . . . . . . 35
estrogens, conjugated/
medroxyprogesterone. . . . 35
synthetic A. . . . . . . . . . . . . . 35
synthetic B. . . . . . . . . . . . . . 35
estropipate. . . . . . . . . . . . . . . . . . 35
ESTROSTEP FE. . . . . . . . . . . . 34
ethambutol. . . . . . . . . . . . . . . . . . 31
ethosuximide. . . . . . . . . . . . . . . . . 15
ethynodiol diacetate/EE. . . . . 34
etidronate. . . . . . . . . . . . . . . . . . . 24
etodolac. . . . . . . . . . . . . . . . . 13, 32
etonogestrel/EE. . . . . . . . . . . . 33
etoposide. . . . . . . . . . . . . . . . . . . . . 6
etravirine. . . . . . . . . . . . . . . . . . . . 31
EULEXIN. . . . . . . . . . . . . . . . . . . . . 5
EURAX. . . . . . . . . . . . . . . . . . . . . . 19
everolimus. . . . . . . . . . . . . . . . . 4, 6
EVISTA. . . . . . . . . . . . . . . . . . . . . 24
EXELON. . . . . . . . . . . . . . . . . . . . 12
exemestane. . . . . . . . . . . . . . . . . . . 5
EXJADE. . . . . . . . . . . . . . . . . . . . . . 7
exogabine . . . . . . . . . . . . . . . . . . . 15
ezetimibe. . . . . . . . . . . . . . . . . . . . 11
F
famotidine. . . . . . . . . . . . . . . . . . 25
FARESTON. . . . . . . . . . . . . . . . . . . 5
FARYDAK. . . . . . . . . . . . . . . . . . . . 4
febuxostat. . . . . . . . . . . . . . . . . . 33
felbamate. . . . . . . . . . . . . . . . . . . . 15
felbamate oral susp. . . . . . . . . . 15
FELBATOL. . . . . . . . . . . . . . . . . . 15
61
FELBATOL ORAL SUSP. . . . . 15
FELDENE. . . . . . . . . . . . . . . 13, 32
felodipine extended-release . . . 9
FEMARA. . . . . . . . . . . . . . . . . . . . . 5
fenofibrate. . . . . . . . . . . . . . . . . . . 11
fenoprofen. . . . . . . . . . . . . . . 13, 32
fentanyl transdermal. . . . . . . . . . 13
FEOSOL. . . . . . . . . . . . . . . . . 49, 54
FERGON. . . . . . . . . . . . . . . . . . . 54
ferrous bisglycinate/
polysaccarides iron. . . . . . 49
ferrous sulfate . . . . . . . . . . . . . . 49
filgrastim. . . . . . . . . . . . . . . . . . . . . . 7
FINACEA. . . . . . . . . . . . . . . . . . . . 16
finasteride. . . . . . . . . . . . . . . . . . 48
fingolimod. . . . . . . . . . . . . . . . . . . 14
FIORICET. . . . . . . . . . . . . . . 12, 13
FIORICET W/CODEINE. . . . . 13
FIORINAL. . . . . . . . . . . . . . . 12, 13
FIORINAL W/CODEINE. . . . . 13
FIRAZYR. . . . . . . . . . . . . . . . . . . 52
FLAGYL. . . . . . . . . . . . . . . . . 31, 35
FLAREX. . . . . . . . . . . . . . . . . . . . 36
flecainide. . . . . . . . . . . . . . . . . . . . . 9
FLEXERIL. . . . . . . . . . . . . . . . . . 33
FLOMAX. . . . . . . . . . . . . . . . . . . 48
FLONASE. . . . . . . . . . . . . . . . . . 21
FLORINEF . . . . . . . . . . . . . . . . . 21
FLOXIN . . . . . . . . . . . . . . . . . 20, 27
FLOXIN OTIC. . . . . . . . . . . . . . . 20
fluconazole . . . . . . . . . . . . . . 28, 35
fludarabine. . . . . . . . . . . . . . . . . . . . 4
fludrocortisone. . . . . . . . . . . . . . 21
FLUMADINE. . . . . . . . . . . . . . . 29
fluocinolone acetonide . . . . . . . 17
fluocinonide. . . . . . . . . . . . . . . . . . 18
fluocinonide emulsified
base. . . . . . . . . . . . . . . . . . . . . 18
fluoride. . . . . . . . . . . . . . . . . . 49-51
fluorometholone. . . . . . . . . . . . . 36
fluorometholone acetate. . . . . 36
FLUOROPLEX . . . . . . . . . . . . . . 19
fluorouracil. . . . . . . . . . . . . . . . . . . 19
fluoxetine. . . . . . . . . . . . . . . . . . . 40
fluphenazine. . . . . . . . . . . . . . . . 42
fluphenazine decanoate. . . . . 42
flurandrenolide. . . . . . . . . . . . . . . 17
flurazepam. . . . . . . . . . . . . . . . . . 40
flurbiprofen. . . . . . . . . . . . . . . . . 36
flutamide . . . . . . . . . . . . . . . . . . . . . 5
fluticasone. . . . . . . . . . . . 17, 21, 47
fluticasone/vilanterol. . . . . . . . 47
fluticasone furoate. . . . . . . . . . 47
fluticasone propionate. . . . . . . . 17
fluvoxamine. . . . . . . . . . . . . . . . . 38
FML. . . . . . . . . . . . . . . . . . . . . . . . 36
FML FORTE. . . . . . . . . . . . . . . . 36
FML SOP. . . . . . . . . . . . . . . . . . . 36
folic acid. . . . . . . . . . . . . . . . . 49, 51
FOLTABS PAK PLUS DHA
RE OB + DHA PAK. . . . . . 51
FOLTABS PRENATAL. . . . . . . . 51
FORTEO. . . . . . . . . . . . . . . . . . . . 24
FORTICAL. . . . . . . . . . . . . . . . . . 24
FORTOVASE . . . . . . . . . . . . . . . 30
FOSAMAX. . . . . . . . . . . . . . . . . . 24
fosamprenavir. . . . . . . . . . . . . . . 30
fosinopril. . . . . . . . . . . . . . . . . . . . . . 8
fosinopril/
FURADANTIN SUSP
25 MG/5 ML. . . . . . . . . . . . 31
furosemide. . . . . . . . . . . . . . . . . . . 10
FUZEON KIT. . . . . . . . . . . . . . . 28
G
gabapentin. . . . . . . . . . . . . . . . . . . 15
GABITRIL. . . . . . . . . . . . . . . . . . . 16
galantamine. . . . . . . . . . . . . . . . . . 12
ganciclovir. . . . . . . . . . . . . . . . . . 28
gatifloxin. . . . . . . . . . . . . . . . . . . . 37
GATTEX. . . . . . . . . . . . . . . . . . . . 26
GEL-KAM. . . . . . . . . . . . . . . . . . 49
gemfibrozil. . . . . . . . . . . . . . . . . . . 11
GENGRAF. . . . . . . . . . . . . . . . . . . 6
GENTAK . . . . . . . . . . . . . . . . 17, 38
gentamicin. . . . . . . . . . . 17, 36, 38
gentamicin/prednisolone
acetate. . . . . . . . . . . . . . . . . . 36
GENTEX ADE 28-1 MG. . . . 50
GEODON. . . . . . . . . . . . . . . . . . . . 41
GG/CODEINE. . . . . . . . . . . . . . 44
GILENYA. . . . . . . . . . . . . . . . . . . . 14
GILOTRIF. . . . . . . . . . . . . . . . . . . . 4
glatiramer acetate. . . . . . . . . . . . 14
GLEEVEC. . . . . . . . . . . . . . . . . . . . 4
glimepiride. . . . . . . . . . . . . . . . . . 23
glipizide. . . . . . . . . . . . . . . . . . . . . 23
glipizide extended-release. . . 23
GLUCAGON. . . . . . . . . . . . . . . . 22
glucagon, human
recombinant. . . . . . . . . . . . . 22
GLUCOPHAGE. . . . . . . . . . . . . 23
GLUCOPHAGE ER. . . . . . . . . 23
GLUCOTROL. . . . . . . . . . . . . . . 23
GLUCOTROL XL. . . . . . . . . . . 23
GLUCOVANCE. . . . . . . . . . . . . 23
glyburide. . . . . . . . . . . . . . . . . . . . 23
glyburide, micronized. . . . . . . . 23
glycerol phenylbutyrate. . . . . . 53
glycopyrrolate. . . . . . . . . . . . . . . 25
GLYNASE. . . . . . . . . . . . . . . . . . 23
GRANIX. . . . . . . . . . . . . . . . . . . . . . 7
GRIFULVIN V. . . . . . . . . . . . . . . 28
GRIS-PEG. . . . . . . . . . . . . . . . . . 28
griseofulvin microsize. . . . . . . . 28
62
griseofulvin ultramicrosize. . . 28
GUAIFED. . . . . . . . . . . . . . . . . . . 45
guaifenesin. . . . . . . . . . . . . . 43-46
guaifenesin/pseudoephedrine/
dextromethorphan. . . . . . . 44
guaifenesin/pseudoephedrine
guaifenesin
guanabenz. . . . . . . . . . . . . . . . . . . 12
guanfacine. . . . . . . . . . . . . . . . 8, 39
guanfacine ER. . . . . . . . . . . . . . 39
GUIATUSS AC. . . . . . . . . . . . . . 44
GUIATUSS DAC. . . . . . . . . . . . 44
GYNOL II. . . . . . . . . . . . . . . . . . . 54
H
HALCION. . . . . . . . . . . . . . . . . . . 40
HALDOL. . . . . . . . . . . . . . . . . . . 42
HALDOL DECANOATE. . . . . 42
haloperidol. . . . . . . . . . . . . . . . . . 42
haloperidol decanoate. . . . . . . 42
HARVONI . . . . . . . . . . . . . . . . . . 29
HECORIA. . . . . . . . . . . . . . . . . . . . 6
HELIDAC. . . . . . . . . . . . . . . . . . . 26
heparin. . . . . . . . . . . . . . . . . . . . . . . 7
HEPSERA. . . . . . . . . . . . . . . . . . 29
hexachlorophene. . . . . . . . . . . . . 19
HEXALEN. . . . . . . . . . . . . . . . . . . . 4
HIPREX. . . . . . . . . . . . . . . . . . . . 48
HISTACOL DM . . . . . . . . . . . . . 43
HISTEX . . . . . . . . . . . . . . . . . . . . 43
HISTUSSIN HC. . . . . . . . . . . . . 45
HIVID . . . . . . . . . . . . . . . . . . . . . . 30
homatropine. . . . . . . . . . . . . 37, 45
HUMALOG. . . . . . . . . . . . . . . . . 22
HUMALOG MIX 50/50. . . . . 22
HUMALOG MIX 75/25. . . . . 22
HUMATIN. . . . . . . . . . . . . . . . . . 31
HUMIRA. . . . . . . . . . . . . . . . . . . 32
HUMULIN. . . . . . . . . . . . . . . 22, 54
HUMULIN 70/30. . . . . . . . . . . 22
HUMULIN N . . . . . . . . . . . . . . . 22
HUMULIN R. . . . . . . . . . . . . . . . 22
HYCAMTIN. . . . . . . . . . . . . . . . . . . 6
HYCODAN. . . . . . . . . . . . . . . . . 45
hydralazine. . . . . . . . . . . . . . . . . . . 12
HYDREA. . . . . . . . . . . . . . . . . . . . . 6
hydrochlorothiazide. . . . . . . . 8-10
HYDROCODO/GG SYP. . . . 45
hydrocodone/
acetaminophen. . . . . . . . . . . 13
hydrocodone/chlorpheniramine/
phenylephrine. . . . . . . . . . . 45
hydrocodone/guaifenesin.45, 46
hydrocodone/homatropine . . 45
HYDROCODONE/TAB
HOMATROP. . . . . . . . . . . . 45
hydrocodone ER. . . . . . . . . . . . . 13
hydrocortisone
. . . . . . . . 17, 19-21, 26, 36, 54
hydrocortisone butyrate . . . . . . 17
hydrocortisone crm, oint. . . . . 54
HYDROMET SYP. . . . . . . . . . . 45
hydromorphone. . . . . . . . . . . . . . 13
hydroxychloroquine. . . . . . . 31, 32
hydroxyurea. . . . . . . . . . . . . . . . . . . 6
hydroxyzine HCL. . . . . . . . . . . . 20
hydroxyzine pamoate. . . . . . . . 20
hyoscyamine, methenamine,
phenyl salicylate, sodium
phosphate monobasic,
methylene blue. . . . . . . . . . 48
hyoscyamine sulfate. . . . . . . . . 25
hyoscyamine sulfate
HYPERCARE 20%. . . . . . . . . . 19
HYTONE. . . . . . . . . . . . . . . . . . . . 17
HYTRIN. . . . . . . . . . . . . . . . . . 8, 48
HYZAAR . . . . . . . . . . . . . . . . . . . . . 8
I
IBRANCE . . . . . . . . . . . . . . . . . . . . 5
ibrutinib. . . . . . . . . . . . . . . . . . . . . . . 4
IBUOROFEN TAB
COLD/SIN. . . . . . . . . . . . . . 47
ibuprofen. . . . . . . . . . . . . . . . 13, 32
icatibant. . . . . . . . . . . . . . . . . . . . 52
ICLUSIG. . . . . . . . . . . . . . . . . . . . . . 5
idelalisib. . . . . . . . . . . . . . . . . . . . . . 4
ILARIS . . . . . . . . . . . . . . . . . . . . . 52
imatinib mesylate. . . . . . . . . . . . . . 4
IMBRUVICA. . . . . . . . . . . . . . . . . . 4
IMDUR. . . . . . . . . . . . . . . . . . . . . . 11
imipramine HCL. . . . . . . . . . . . . 40
imiquimod 5% cream. . . . . . . . . 19
IMITREX . . . . . . . . . . . . . . . . . . . . 14
IMITREX 4 MG AND
6 MG INJ. . . . . . . . . . . . . . . . 14
IMURAN . . . . . . . . . . . . . . . . . 6, 32
INCRELEX . . . . . . . . . . . . . . . . 24
INCRUSE ELLIPTA. . . . . . . . . 47
indacaterol. . . . . . . . . . . . . . . . . . 47
indapamide. . . . . . . . . . . . . . . . . . 10
INDERAL. . . . . . . . . . . . . . . . . 9, 14
INDERIDE. . . . . . . . . . . . . . . . . . . . 9
indinavir . . . . . . . . . . . . . . . . . . . . 30
INDOCIN. . . . . . . . . . . . . . . . 13, 32
indomethacin . . . . . . . . . . . . 13, 32
INFERGEN. . . . . . . . . . . . . . . . . 29
INFLAMASE FORTE. . . . . . . . 36
INLYTA. . . . . . . . . . . . . . . . . . . . . . . 4
insulin (vials only) . . . . . . . . . . . 54
insulin aspart. . . . . . . . . . . . . . . . 22
insulin aspart protamine 70%/
insulin aspart 30%. . . . . . . 22
insulin glargine. . . . . . . . . . . . . . 22
63
insulin glargine 300 unit/ml. 22
insulin human. . . . . . . . . . . . . . . 22
insulin isophane. . . . . . . . . . . . . 22
insulin isophane/regular. . . . . 22
insulin isophane human. . . . . . 22
insulin isophane human 70%/
regular 30%. . . . . . . . . . . . . 22
insulin lisopro pro/lispro. . . . . 22
insulin lisopro prot/lispro . . . . 22
insulin lispro . . . . . . . . . . . . . . . . 22
insulin regular. . . . . . . . . . . . . . . 22
INTAL. . . . . . . . . . . . . . . . . . . 47, 48
INTELENCE. . . . . . . . . . . . . . . . 31
interferon alfa-2a. . . . . . . . . . . . . 5
interferon alfa-2b . . . . . . . . . 5, 29
interferon alfacon-1. . . . . . . . . 29
interferon beta-1a. . . . . . . . . . . . 14
INTRON A. . . . . . . . . . . . . . . . 5, 29
INTUNIV . . . . . . . . . . . . . . . . . . . 39
INVEGA SUSTENNA . . . . . . . . 41
INVEGA TRINZA . . . . . . . . . . . . 41
INVIRASE. . . . . . . . . . . . . . . . . . 30
INVOKAMET . . . . . . . . . . . . . . . 23
INVOKANA. . . . . . . . . . . . . . . . . 23
ipratropium . . . . . . . . . . . . . . 47, 48
ipratropium/albuterol. . . . . 47, 48
ipratropium HFA . . . . . . . . . . . . 47
iron polysaccharides. . . . . . . . . 54
iron - ferrous fumarate, ferrous,
gluconate, errous sulfate,
ferrous bis-glycinate chelate
and polysaccharide
iron caps . . . . . . . . . . . . . . . 54
ISENTRESS. . . . . . . . . . . . . . . . 31
ISENTRESS CHEWABLE. . . 31
ISENTRESS SUSP . . . . . . . . . 31
ISMO. . . . . . . . . . . . . . . . . . . . . . . . 11
isoniazid. . . . . . . . . . . . . . . . . . . . 31
ISOPTO ATROPINE. . . . . . . . . 37
ISOPTO CARPINE. . . . . . . . . . 37
ISOPTO HOMATROPINE. . . 37
ISOPTO HYOSCINE. . . . . . . . 37
ISORDIL . . . . . . . . . . . . . . . . . . . . 11
ISORDIL S.L. . . . . . . . . . . . . . . . . 11
isosorbide dinitrate. . . . . . . . . . . 11
ISOSORBIDE
DINITRATE ER. . . . . . . . . . . 11
isosorbide mononitrate. . . . . . . 11
isosorbide mononitrate
isotretinoin. . . . . . . . . . . . . . . . . . . 16
itraconazole. . . . . . . . . . . . . . . . . 28
ivacaftor. . . . . . . . . . . . . . . . . . . . 52
ivermectin. . . . . . . . . . . . . . . . . . . 27
J
JADENU. . . . . . . . . . . . . . . . . . . . . 7
JAKAFI. . . . . . . . . . . . . . . . . . . . . . . 5
JARDIANCE. . . . . . . . . . . . . . . . 23
JENTADUETO. . . . . . . . . . . . . . 23
JUXTAPID. . . . . . . . . . . . . . . . . . . 12
K
K-DUR 10. . . . . . . . . . . . . . . . . . 52
K-DUR 20. . . . . . . . . . . . . . . . . . 52
K-LOR. . . . . . . . . . . . . . . . . . . . . . . 51
K-LYTE. . . . . . . . . . . . . . . . . . . . . . 51
K-PHOS NEUTRAL. . . . . . . . . . 51
K-PHOS ORIGINAL . . . . . . . . . 51
KALETRA . . . . . . . . . . . . . . . . . . 30
KALYDECO. . . . . . . . . . . . . . . . . 52
KALYDECO GRANULES. . . . 52
KAYEXALATE. . . . . . . . . . . . . . . 11
KEFLEX. . . . . . . . . . . . . . . . . . . . 27
KENALOG. . . . . . . . . . . . 17, 18, 21
KENALOG IN ORABASE . . . 21
KEPPRA. . . . . . . . . . . . . . . . . . . . 16
ketoconazole. . . . . . . . . 18, 19, 28
ketoprofen. . . . . . . . . . . . . . . 13, 32
ketorolac . . . . . . . . . . . . . . . . 13, 36
ketorolac tromethamine. . . . . . 13
ketotifen. . . . . . . . . . . . . . . . . . . . 36
KINERET. . . . . . . . . . . . . . . . . . . 32
KLONOPIN. . . . . . . . . . . . . . 15, 38
KLOR-CON 10 . . . . . . . . . . . . . 52
KLOR-CON 8. . . . . . . . . . . . . . . 52
KOMBIGLYZE. . . . . . . . . . . . . . 23
KORLYM . . . . . . . . . . . . . . . . . . . 24
KUVAN. . . . . . . . . . . . . . . . . . . . . 24
KUVAN POWDER FOR
SOLUTION. . . . . . . . . . . . . . 24
L
labetalol. . . . . . . . . . . . . . . . . . . . . . 9
LAC-HYDRIN . . . . . . . . . . . . . . . 19
lacosamide . . . . . . . . . . . . . . . . . . 15
lactulose. . . . . . . . . . . . . . . . . . . . 26
LAMICTAL. . . . . . . . . . . . . . . . . . . 16
LAMICTAL CD CHEW TAB. . . 16
LAMISIL. . . . . . . . . . . . . . . . . 18, 28
LAMISIL AT. . . . . . . . . . . . . . . . . . 18
lamivudine. . . . . . . . . . . . . . . 29, 30
lamivudine/zidovudine. . . . 29, 30
lamotrigine. . . . . . . . . . . . . . . . . . . 16
lamotrigine chew dispersable
tab. . . . . . . . . . . . . . . . . . . . . . . 16
LANOXIN . . . . . . . . . . . . . . . . . . . . 9
lansoprazole. . . . . . . . . . . . . . . . 25
lansoprazole
delayed-release . . . . . . . . . 25
LANTUS. . . . . . . . . . . . . . . . . . . . 22
lapatinib ditosylate . . . . . . . . . . . . 4
LARIAM. . . . . . . . . . . . . . . . . . . . 31
LASIX. . . . . . . . . . . . . . . . . . . . . . . 10
latanoprost. . . . . . . . . . . . . . . . . . 37
64
ledipasvir/sofosbuvir. . . . . . . . 29
leflunomide. . . . . . . . . . . . . . . . . 32
lenalidomide. . . . . . . . . . . . . . . . . . 6
LENVIMA. . . . . . . . . . . . . . . . . . . . . 4
LETAIRIS. . . . . . . . . . . . . . . . . . . . 12
letrozole. . . . . . . . . . . . . . . . . . . . . . 5
LEUKERAN. . . . . . . . . . . . . . . . . . 4
LEUKINE. . . . . . . . . . . . . . . . . . . . . 7
leuprolide. . . . . . . . . . . . . . . . . . . . . 5
levalbuterol HCl. . . . . . . . . . . . . 48
LEVAQUIN. . . . . . . . . . . . . . . . . 27
levatinib. . . . . . . . . . . . . . . . . . . . . . . 4
levetiracetam . . . . . . . . . . . . . . . . 16
levobunolol . . . . . . . . . . . . . . . . . 37
levocetirizine. . . . . . . . . . . . . . . . 20
levofloxacin. . . . . . . . . . . . . . . . . 27
levonorgestrel. . . . . . . . . . . . 33, 34
levonorgestrel/EE. . . . . . . . 33, 34
levothyroxine. . . . . . . . . . . . . . . . 24
LEVOXYL. . . . . . . . . . . . . . . . . . . 24
LEVSIN. . . . . . . . . . . . . . . . . . . . . 25
LEVSINEX. . . . . . . . . . . . . . . . . . 25
LEXAPRO. . . . . . . . . . . . . . . . . . 40
LEXIVA. . . . . . . . . . . . . . . . . . . . . 30
LIALDA. . . . . . . . . . . . . . . . . . . . . 26
LIBRIUM. . . . . . . . . . . . . . . . . . . 38
LIDAMANTEL. . . . . . . . . . . . . . . 19
LIDEX. . . . . . . . . . . . . . . . . . . . . . . 18
LIDEX E. . . . . . . . . . . . . . . . . . . . . 18
lidocaine. . . . . . . . . . . . . . . . . 19, 21
lidocaine/prilocaine. . . . . . . . . . 19
lidocaine viscous. . . . . . . . . . . . 21
linagliptin. . . . . . . . . . . . . . . . . . . 23
linagliptin/metformin. . . . . . . . 23
linezolid. . . . . . . . . . . . . . . . . . . . . 31
liothyronine. . . . . . . . . . . . . . . . . 24
liotrix. . . . . . . . . . . . . . . . . . . . . . . 24
LIPITOR. . . . . . . . . . . . . . . . . . . . . 11
liraglutide. . . . . . . . . . . . . . . . . . . 23
lisdexamfetamine . . . . . . . . . . . 39
lisinopril. . . . . . . . . . . . . . . . . . . 8, 77
lisinopril/hydrochlorothiazide. . . 8
lithium carbonate. . . . . . . . . . . . 39
lithium carbonate
LITHOBID. . . . . . . . . . . . . . . . . . 39
LMX-4. . . . . . . . . . . . . . . . . . . . . . . 19
LO/OVRAL. . . . . . . . . . . . . . . . . 34
LOCOID. . . . . . . . . . . . . . . . . . . . . 17
LODINE. . . . . . . . . . . . . . . . . 13, 32
LOESTRIN 1/20. . . . . . . . . . . . 34
LOESTRIN 1.5/30. . . . . . . . . . 34
LOESTRIN FE 1/20 . . . . . . . . 34
LOESTRIN FE 1.5/30. . . . . . . 34
LOFIBRA. . . . . . . . . . . . . . . . . . . . 11
lomitapide . . . . . . . . . . . . . . . . . . . 12
LOMOTIL. . . . . . . . . . . . . . . . . . . 24
lomustine. . . . . . . . . . . . . . . . . . . . . 4
LONITEN. . . . . . . . . . . . . . . . . . . . 12
loperamide. . . . . . . . . . . . . . . . . . 24
LOPID. . . . . . . . . . . . . . . . . . . . . . . 11
lopinavir/ritonavir. . . . . . . . . . . . 30
LOPRESSOR. . . . . . . . . . . . . . . . . 9
loratadine. . . . . . . . . . . . 21, 45, 54
loratadine/
pseudoephedrine
. . . . . . . . . . . . . . . . . . 21, 45, 54
loratadine/pseudoephedrine
edtended-release. . . . . . . . 21
loratadine & pseudoephedrine
SR 24hr. . . . . . . . . . . . . . . . . 45
lorazepam. . . . . . . . . . . . . . . . . . . 38
LORCET. . . . . . . . . . . . . . . . . . . . . 13
LORTAB. . . . . . . . . . . . . . . . . . . . . 13
LORTAB ELIXIR. . . . . . . . . . . . . 13
losartan. . . . . . . . . . . . . . . . . . . . . . . 8
losartan/HCTZ. . . . . . . . . . . . . . . . 8
LOTENSIN . . . . . . . . . . . . . . . . . . . 8
LOTENSIN HCT. . . . . . . . . . . . . . 8
LOTRIMIN AF. . . . . . . . . . . . . . . . 18
LOTRISONE. . . . . . . . . . . . . . . . . 18
lovastatin. . . . . . . . . . . . . . . . . . . . 11
LOVENOX. . . . . . . . . . . . . . . . . . . . 7
loxapine . . . . . . . . . . . . . . . . . . . . 42
LOXITANE. . . . . . . . . . . . . . . . . . 42
LOZOL. . . . . . . . . . . . . . . . . . . . . . 10
LUDIOMIL. . . . . . . . . . . . . . . . . . 40
lumacaftor/ivacaftor. . . . . . . . . 52
LUPRON. . . . . . . . . . . . . . . . . . . . . 5
LUPRON DEPOT. . . . . . . . . . . . . 5
LUPRON DEPOT-PED. . . . . . . . 5
LUPRON DEPOT
6-MONTH. . . . . . . . . . . . . . . . . 5
LURIDE. . . . . . . . . . . . . . . . . . . . 49
LURIDE LOZI-TABS. . . . . . . . . 49
LUVOX. . . . . . . . . . . . . . . . . . . . . 38
LYNPARZA. . . . . . . . . . . . . . . . . . . 6
LYRICA. . . . . . . . . . . . . . . . . . . . . . 16
LYRICA SOLUTION. . . . . . . . . . 16
LYSODREN. . . . . . . . . . . . . . . . . . . 6
LYSTEDA. . . . . . . . . . . . . . . . . . . 36
M
M-CLEAR WC. . . . . . . . . . . . . . 44
MACROBID. . . . . . . . . . . . . . . . 31
MACRODANTIN. . . . . . . . . . . . 31
MACRODANTIN 25 MG . . . . 31
malathion. . . . . . . . . . . . . . . . . . . . 19
MAPAP COLD TAB. . . . . . . . . 46
maprotiline. . . . . . . . . . . . . . . . . . 40
maraviroc. . . . . . . . . . . . . . . . . . . 31
MARINOL. . . . . . . . . . . . . . . . . . 24
MATERNA. . . . . . . . . . . . . . . . . . . 51
65
MATULANE. . . . . . . . . . . . . . . . . . 6
MAXALT/MAXALT MLT. . . . . . 14
MAXITROL. . . . . . . . . . . . . . . . . 36
MAXZIDE. . . . . . . . . . . . . . . . . . . 10
mecasermin . . . . . . . . . . . . . . . . 24
meclizine. . . . . . . . . . . . . . . . . . . . 24
MEDROL. . . . . . . . . . . . . . . . . . . 21
medroxyprogesterone
acetate. . . . . . . . . . . . . . . 33, 35
mefloquine. . . . . . . . . . . . . . . . . . 31
MEGACE. . . . . . . . . . . . . . . . . . . . . 5
megestrol acetate. . . . . . . . . . . . . 5
MEKINIST. . . . . . . . . . . . . . . . . . . . 5
MELLARIL. . . . . . . . . . . . . . . . . 42
meloxicam. . . . . . . . . . . . . . . 13, 32
melphalan . . . . . . . . . . . . . . . . . . . . 4
memantine. . . . . . . . . . . . . . . . . . . 12
meperidine. . . . . . . . . . . . . . . . . . . 13
MEPHYTON. . . . . . . . . . . . . . . . 50
MEPRON. . . . . . . . . . . . . . . . . . . 30
mercaptopurine. . . . . . . . . . . . . . . 4
mesalamine. . . . . . . . . . . . . . . . . 26
mesalamine
mesalamine supp . . . . . . . . . . . 26
MESTINON. . . . . . . . . . . . . . . . . . 15
MESTINON TIMESPAN. . . . . . 15
METADATE ER . . . . . . . . . . . . . 39
metaproterenol. . . . . . . . . . . . . . 48
METAPROTERENOL
SYRUP . . . . . . . . . . . . . . . . . 48
metformin. . . . . . . . . . . . . . . . . . . 23
metformin/glyburide. . . . . . . . . 23
metformin ER. . . . . . . . . . . . . . . 23
methadone . . . . . . . . . . . . . . . . . . 13
methazolamide. . . . . . . . . . . . . . 37
methenamine hippurate. . . . . 48
METHERGINE . . . . . . . . . . 24, 36
methimazole. . . . . . . . . . . . . . . . 24
methocarbamol . . . . . . . . . . . . . 33
methotrexate. . . . . . . . . . . . . . . . 32
methoxsalen. . . . . . . . . . . . . . . . . 18
methsuximide. . . . . . . . . . . . . . . . 16
methyldopa. . . . . . . . . . . . . . . . . . 12
methyldopa/HCTZ. . . . . . . . . . . 12
methylergonovine. . . . . . . . 24, 36
methylphenidate. . . . . . . . . . . . 39
methylphenidate
methylprednisolone . . . . . . . . . 21
metipranolol. . . . . . . . . . . . . . . . . 37
metoclopramide. . . . . . . . . . . . . 24
metolazone. . . . . . . . . . . . . . . . . . 10
metoprolol. . . . . . . . . . . . . . . . . . . . 9
metoprolol succinate. . . . . . . . . . 9
METROCREAM. . . . . . . . . . . . . . 18
METROGEL. . . . . . . . . . . . . 18, 35
METROGEL-VAGINAL. . . . . . 35
METROGEL 1%. . . . . . . . . . . . 35
METROLOTION. . . . . . . . . . . . . . 18
metronidazole. . . . 18, 26, 31, 35
MEVACOR . . . . . . . . . . . . . . . . . . 11
mexiletine. . . . . . . . . . . . . . . . . . . . . 9
MEXITIL. . . . . . . . . . . . . . . . . . . . . . 9
MIACALCIN . . . . . . . . . . . . . . . . 24
MICATIN. . . . . . . . . . . . . . . . . . . . . 18
miconazole. . . . . . . . . . . . . . . 18, 35
MICRO-K 10 . . . . . . . . . . . . . . . 52
MICRONASE. . . . . . . . . . . . . . . 23
MICROZIDE. . . . . . . . . . . . . . . . . 10
MIDAMOR. . . . . . . . . . . . . . . . . . . 10
midodrine. . . . . . . . . . . . . . . . . . . . 12
mifeprstone. . . . . . . . . . . . . . . . . 24
MIGRANAL. . . . . . . . . . . . . . . . . . 14
MINIPRESS. . . . . . . . . . . . . . . . . . 8
MINOCIN. . . . . . . . . . . . . . . . . . . 28
minocycline. . . . . . . . . . . . . . . . . 28
minoxidil. . . . . . . . . . . . . . . . . . . . . 12
MINUTUSS DR SYP. . . . . . . . 45
MIRALAX . . . . . . . . . . . . . . . . . . 26
MIRAPEX. . . . . . . . . . . . . . . . . . . 15
MIRCETTE. . . . . . . . . . . . . . . . . 33
mirtazapine. . . . . . . . . . . . . . . . . 40
MIRVASO . . . . . . . . . . . . . . . . . . . 18
misoprostol. . . . . . . . . . . . . . . . . 26
MITIGARE. . . . . . . . . . . . . . . . . . 33
mitotane. . . . . . . . . . . . . . . . . . . . . . 6
MOBIC. . . . . . . . . . . . . . . . . . 13, 32
MODICON. . . . . . . . . . . . . . . . . . 34
MODURETIC. . . . . . . . . . . . . . . . 10
mometasone. . . . . . . . . . . . . 17, 47
mometasone/formoterol. . . . . 47
mometasone furoate. . . . . . . . . 17
mometasone inhalation. . . . . . 47
MONISTAT. . . . . . . . . . . . . . . . . . 35
MONISTAT-DERM. . . . . . . . . . . 18
MONISTAT 3. . . . . . . . . . . . . . . . 35
MONOPRIL. . . . . . . . . . . . . . . . . . 8
MONOPRIL-HCT. . . . . . . . . . . . . 8
montelukast. . . . . . . . . . . . . . . . . 48
morphine. . . . . . . . . . . . . . . . . . . . 14
morphine extended-release. . . 14
MOTRIN. . . . . . . . . . . . . . . . . 13, 32
MOVANTIK. . . . . . . . . . . . . . . . . 26
MOZOBIL. . . . . . . . . . . . . . . . . . . . 7
MS CONTIN. . . . . . . . . . . . . . . . . 14
MSIR. . . . . . . . . . . . . . . . . . . . . . . . 14
MUCINEX. . . . . . . . . . . . . . . . . . 44
MUCOMYST. . . . . . . . . . . . . . . . 52
MULTI SYMPTOM TAB
COLD RLF. . . . . . . . . . . . . . 46
multivitamins/fluoride/
±iron. . . . . . . . . . . . . . . . . . . . 50
mupirocin. . . . . . . . . . . . . . . . . . . . 17
MURO 128. . . . . . . . . . . . . . . . . 38
MYAMBUTOL . . . . . . . . . . . . . . 31
66
MYCELEX. . . . . . . . . . . . . . . 18, 28
MYCOBUTIN. . . . . . . . . . . . . . . 31
mycophenolate mofetil . . . . . . . . 6
mycophenolate sodium. . . . . . . . 6
MYCOSTATIN. . . . . . . . . . . . 18, 28
MYFORTIC. . . . . . . . . . . . . . . . . . . 6
MYLERAN. . . . . . . . . . . . . . . . . . . . 4
MYSOLINE. . . . . . . . . . . . . . . . . . 16
N
nabumetone. . . . . . . . . . . . . . . . . 13
NALFON. . . . . . . . . . . . . . . . 13, 32
naloxegol. . . . . . . . . . . . . . . . . . . 26
naloxone. . . . . . . . . . . . . . . . . 14, 41
NALOXONE INJ. . . . . . . . . . . . . 41
naltrexone. . . . . . . . . . . . . . . 38, 41
NAMENDA. . . . . . . . . . . . . . . . . . 12
NAPROSYN. . . . . . . . . . . . . 13, 32
naproxen . . . . . . . . . . . . . . . . 13, 32
naproxen sodium. . . . . . . . . 13, 32
naratriptan. . . . . . . . . . . . . . . . . . . 14
NATALCARE. . . . . . . . . . . . . 50, 51
nateglinide. . . . . . . . . . . . . . . . . . 23
NAVANE . . . . . . . . . . . . . . . . . . . 42
nedocromil. . . . . . . . . . . . . . . . . . 47
nelfinavir. . . . . . . . . . . . . . . . . . . . 30
NEO DM. . . . . . . . . . . . . . . . . . . . 43
dexamethasone . . . . . . . . . 36
gramicidin. . . . . . . . . . . . . . . 38
hydrocortisone. . . . . . . . 20, 36
neomycin sulfate. . . . . . . . . . . . 31
NEORAL. . . . . . . . . . . . . . . . . . . . . 6
NEOSPORIN. . . . . . . . . . . . . . . 38
NEPHROCAPS. . . . . . . . . . . . . . 51
NEPTAZANE. . . . . . . . . . . . . . . 37
NESTABSCBF/FA/RX . . . . . . 51
NEULASTA. . . . . . . . . . . . . . . . . . . 7
NEUMEGA. . . . . . . . . . . . . . . . . . . 7
NEURONTIN. . . . . . . . . . . . . . . . 15
nevirapine. . . . . . . . . . . . . . . . . . . 29
nevirapine ER. . . . . . . . . . . . . . . 29
NEXAVAR. . . . . . . . . . . . . . . . . . . . 5
NEXIUM 24HR OTC. . . . . . . . 25
NEXIUM DELAYED
RELEASE PACKET . . . . . 25
niacin. . . . . . . . . . . . . . . . . . . . . . . . 11
niacin extended-release. . . . . . 11
NIACOR. . . . . . . . . . . . . . . . . . . . . 11
NIASPAN. . . . . . . . . . . . . . . . . . . . 11
nicardipine. . . . . . . . . . . . . . . . . . . . 9
nifedipine. . . . . . . . . . . . . . . . . 9, 10
nifedipine
NIFEREX. . . . . . . . . . . . 49, 50, 54
NIFEREX-PN FORTE. . . . . . . . 51
nilotinib. . . . . . . . . . . . . . . . . . . . . . . 5
nimodipine. . . . . . . . . . . . . . . . . . . 10
nimodipine oral soln. . . . . . . . . . 10
NIMOTOP. . . . . . . . . . . . . . . . . . . 10
nintedanib. . . . . . . . . . . . . . . . . . 52
nitazoxanide suspension. . . . . 31
nitazoxanide tablet. . . . . . . . . . 31
NITREK. . . . . . . . . . . . . . . . . . . . . 11
NITRO-BID. . . . . . . . . . . . . . . . . . 11
NITRO-DUR. . . . . . . . . . . . . . . . . 11
nitrofurantoin
nitrofurantoin
macrocrystals. . . . . . . . . . . . 31
nitrofurantoin susp. . . . . . . . . . 31
nitroglycerin. . . . . . . . . . . . . . 11, 19
NITROLINGUAL. . . . . . . . . . . . . 11
NITROSTAT. . . . . . . . . . . . . . . . . . 11
NIX. . . . . . . . . . . . . . . . . . . . . . 19, 54
NIX CREME RINSE . . . . . . . . . 19
NIZORAL. . . . . . . . . . . . 18, 19, 28
NIZORAL SHAMPOO . . . . . . . 19
NOLVADEX. . . . . . . . . . . . . . . . . . . 5
NORCO. . . . . . . . . . . . . . . . . . . . . 13
NORDETTE . . . . . . . . . . . . . . . . 34
norelgestromin/EE. . . . . . . . . . 34
norethindrone. . . . . . . . . . . . 33-35
norethindrone/EE. . . . . . . . 33, 34
norethindrone/ME. . . . . . . . . . 34
norethindrone acetate. . . . 34, 35
norethindrone acetate/EE. . . 34
EE/iron. . . . . . . . . . . . . . . . . 34
NORFLEX. . . . . . . . . . . . . . . . . . 33
norgestimate/EE. . . . . . . . . . . . 34
norgestrel. . . . . . . . . . . . . . . . . . . 34
norgestrel/EE . . . . . . . . . . . . . . 34
NORPACE. . . . . . . . . . . . . . . . . . . . 9
NORPACE CR. . . . . . . . . . . . . . . . 9
NORPRAMIN. . . . . . . . . . . . . . . 40
nortriptyline. . . . . . . . . . . . . . . . . 40
NORVASC. . . . . . . . . . . . . . . . . . . . 9
NORVIR. . . . . . . . . . . . . . . . . . . . 30
NOVOLIN. . . . . . . . . . . . . . . 22, 54
NOVOLIN 70/30 . . . . . . . . . . . 22
NOVOLIN N. . . . . . . . . . . . . . . . 22
NOVOLIN R . . . . . . . . . . . . . . . . 22
NOVOLOG. . . . . . . . . . . . . . . . . . 22
NOVOLOG MIX 70/30. . . . . . 22
NUEDEXTA. . . . . . . . . . . . . . . . 42
NULYTELY . . . . . . . . . . . . . . . . . 26
NUVARING. . . . . . . . . . . . . . . . . 33
NYMALIZE. . . . . . . . . . . . . . . . . . 10
nystatin. . . . . . . . . . . . . . . . . . 18, 28
NYTOL QUICK CAPS. . . . . . . 40
O
octreotide. . . . . . . . . . . . . . . . . . . . . 6
67
OCUFEN. . . . . . . . . . . . . . . . . . . 36
OCUFLOX. . . . . . . . . . . . . . . . . . 38
OFEV. . . . . . . . . . . . . . . . . . . . . . . 52
ofloxacin. . . . . . . . . . . . . 20, 27, 38
OFORTA. . . . . . . . . . . . . . . . . . . . . . 4
OGEN. . . . . . . . . . . . . . . . . . . . . . 35
olanzapine. . . . . . . . . . . . . . . . . . . 41
olaparib. . . . . . . . . . . . . . . . . . . . . . . 6
olodaterol. . . . . . . . . . . . . . . . . . . 47
olsalazine sodium. . . . . . . . . . . 26
omalizumab. . . . . . . . . . . . . . . . . 47
omeprazole
delayed-release . . . . . . . . . 25
OMNICEF. . . . . . . . . . . . . . . . . . 27
ondansetron. . . . . . . . . . . . . . . . 24
One Touch Systems (ULTRA 2,
ULTRAMINI, VERIO, VERIO
FLEX, VERIO IQ, VERIO
SYNC). . . . . . . . . . . . . . . . . . 23
One Touch Test Strips (ULTRA,
VERIO) . . . . . . . . . . . . . . . . . 23
ONFI. . . . . . . . . . . . . . . . . . . . . . . . 15
ONGLYZA. . . . . . . . . . . . . . . . . . 23
oprelvekin. . . . . . . . . . . . . . . . . . . . 7
OPTIPRANOLOL. . . . . . . . . . . 37
OPTIVAR. . . . . . . . . . . . . . . . . . . 36
ORAP. . . . . . . . . . . . . . . . . . . . . . 42
ORAPRED . . . . . . . . . . . . . . . . . 22
ORKAMBI. . . . . . . . . . . . . . . . . . 52
orphenadrine
ORTHO-CEPT. . . . . . . . . . . . . . 34
ORTHO-CYCLEN. . . . . . . . . . . 34
ORTHO-NOVUM 1/35 . . . . . 34
ORTHO-NOVUM 1/50 . . . . . 34
ORTHO-NOVUM 10/11. . . . . 33
ORTHO-NOVUM 7/7/7. . . . . 34
ORTHO COIL. . . . . . . . . . . . . . . 33
ortho diaphragm . . . . . . . . . . . . 33
ORTHO EVRA. . . . . . . . . . . . . . 34
ORTHO FLAT. . . . . . . . . . . . . . . 33
ORTHO FLEX. . . . . . . . . . . . . . 33
ORTHO MICRONOR. . . . . . . . 34
ORTHO TRI-CYCLEN. . . . . . . 34
ORUDIS. . . . . . . . . . . . . . . . . 13, 32
oseltamivir. . . . . . . . . . . . . . . . . . 29
OVCON 50. . . . . . . . . . . . . . . . . 34
OVIDE. . . . . . . . . . . . . . . . . . . . . . . 19
OVRAL. . . . . . . . . . . . . . . . . . . . . 34
OVRETTE . . . . . . . . . . . . . . . . . . 34
oxaprozin. . . . . . . . . . . . . . . . 13, 32
oxazepam. . . . . . . . . . . . . . . . . . . 38
oxcarbazepine . . . . . . . . . . . . . . . 16
OXSORALEN-ULTRA. . . . . . . . 18
oxybutynin chloride. . . . . . . . . . 48
oxybutynin IR . . . . . . . . . . . . . . . 49
oxycodone. . . . . . . . . . . . . . . . . . . 14
oxycodone/acetaminophen. . . 14
oxycodone/aspirin . . . . . . . . . . . 14
OXYFAST. . . . . . . . . . . . . . . . . . . . 14
oxymorphone ER. . . . . . . . . . . . . 14
P
palbociclib. . . . . . . . . . . . . . . . . . . . 5
paliperidone. . . . . . . . . . . . . . . . . . 41
palivizumab. . . . . . . . . . . . . . . . . 31
PAMELOR. . . . . . . . . . . . . . . . . . 40
pancrelipase. . . . . . . . . . . . . . . . 26
panobinostat. . . . . . . . . . . . . . . . . . 4
PANRETIN. . . . . . . . . . . . . . . . . . . 6
pantoprazole. . . . . . . . . . . . . . . . 25
PARAFON FORTE DSC. . . . . 33
PARNATE . . . . . . . . . . . . . . . . . . 39
paromomycin . . . . . . . . . . . . . . . 31
paroxetine. . . . . . . . . . . . . . . . . . 40
pasireotide. . . . . . . . . . . . . . . . . . . . 6
PAXIL. . . . . . . . . . . . . . . . . . . . . . 40
pazopanib. . . . . . . . . . . . . . . . . . . . . 5
PEDIACARE LIQ
MULTI-SY. . . . . . . . . . . . . . . 46
PEDIAPRED . . . . . . . . . . . . . . . 22
PEDIAZOLE. . . . . . . . . . . . . . . . 27
peg 3350/electrolytes. . . . . . 26
peg 3350/sodium bicarbonate/
sodium chloride. . . . . . . . . . 26
peg 3350/sodium bicarbonate/
sodium chloride/potassium
chloride. . . . . . . . . . . . . . . . . 26
PEGASYS . . . . . . . . . . . . . . . . . . 29
PEGASYS PROCLICK. . . . . . 29
pegfilgrastim. . . . . . . . . . . . . . . . . . 7
peginterferon alfa-2a. . . . . . . . 29
peginterferon alfa-2b. . . . . . . . . . 5
pegvisomant. . . . . . . . . . . . . . . . 24
penicillamine. . . . . . . . . . . . . . . . 32
penicillin VK . . . . . . . . . . . . . . . . 28
PENLAC SOLUTION 8% . . . . 18
PENTASA . . . . . . . . . . . . . . . . . . 26
pentazocine/naloxone. . . . . . . . 14
pentoxifylline
PEPCID. . . . . . . . . . . . . . . . . . . . 25
PEPCID AC . . . . . . . . . . . . . . . . 25
PERCOCET. . . . . . . . . . . . . . . . . 14
PERCODAN. . . . . . . . . . . . . . . . . 14
PERIDEX. . . . . . . . . . . . . . . . . . . 21
permethrin. . . . . . . . . . . . . . . 19, 54
perphenazine . . . . . . . . . . . . 40, 42
PERSANTINE. . . . . . . . . . . . . . . . 7
phenazopyridine. . . . . . . . . . . . . 49
PHENERGAN. . . . . . . . . . . 25, 44
PHENERGAN DM. . . . . . . . . . 44
phenobarbital. . . . . . . . . . . . . . . . 16
phenyleph/bromphen/
dextromethorphan/
guaifenesin. . . . . . . . . . . . . . 45
68
phenylephrine/
chlorpheniramine. . . . . . . . 45
phenylephrine/
chlorpheniramine/
phenylephrine/
chlorpheniramine/
dihydrocodeine. . . . . . . . . . 45
phenylephrine/
phenylephrine/
dextromethorphan/
guaifenesin. . . . . . . . . . . . . . 46
phenylephrine/ephed/CPM
w/carbetapentane. . . . . . . 46
phenylephrine/guaifenesin. . 46
phenylephrine/hydrocodone/
guaifenesin. . . . . . . . . . . . . . 46
phenylephrine/pyrilamine/
phenylephrine/pyrilamine
w/hydrocodone. . . . . . . . . . 46
phenylephrine tan/pyrilamine
tan/carbeta tan. . . . . . . . . . 46
PHENYLHIST LIQ DH. . . . . . 44
PHENYTEK. . . . . . . . . . . . . . . . . 16
phenytoin. . . . . . . . . . . . . . . . . . . . 16
phenytoin sodium extended. . . 16
PHISOHEX. . . . . . . . . . . . . . . . . . 19
PHOS-FLUR . . . . . . . . . . . . . . . 49
PHOSPHOLINE IODINE. . . . 37
phosphorus. . . . . . . . . . . . . . . . . . 51
PHRENILIN. . . . . . . . . . . . . . . . . 12
phytonadione. . . . . . . . . . . . . . . 50
pilocarpine. . . . . . . . . . . . . . . 21, 37
PILOPINE HS GEL. . . . . . . . . 37
PIMA. . . . . . . . . . . . . . . . . . . . . . . 52
pimecrolimus. . . . . . . . . . . . . . . . . 19
pimozide. . . . . . . . . . . . . . . . . . . . 42
pindolol. . . . . . . . . . . . . . . . . . . . . . . 9
pioglitazone. . . . . . . . . . . . . . . . . 23
pioglitazone/glimepiride. . . . . 23
pioglitazone/metformin. . . . . . 23
pioglitazone/metformin ER. . 23
PIPERONYL BUTOXIDE. . . . 54
piperonyl butoxide gel, liquid
shampoo. . . . . . . . . . . . . . . . 54
pirfenidone capsule . . . . . . . . . 52
piroxicam. . . . . . . . . . . . . . . . 13, 32
PLAN B. . . . . . . . . . . . . . . . . . . . 33
PLAN B ONE STEP. . . . . . . . . 33
PLAQUENIL. . . . . . . . . . . . . 31, 32
PLAVIX. . . . . . . . . . . . . . . . . . . . . . . 7
PLENDIL. . . . . . . . . . . . . . . . . . . . . 9
plerixafor . . . . . . . . . . . . . . . . . . . . . 7
PLETAL . . . . . . . . . . . . . . . . . . . . . . 7
PLEXION. . . . . . . . . . . . . . . . . . . . 17
podofilox. . . . . . . . . . . . . . . . . . . . . 19
POLY-VI-FLOR. . . . . . . . . . . . . . 50
polyethylene glycol 3350. . . . 26
polymyxin B/bacitracin. . . . . . 38
polymyxin B/trimethoprim. . . 38
polysaccharide iron complex. 50
POLYSPORIN. . . . . . . . . . . . . . . 38
POLYTRIM. . . . . . . . . . . . . . . . . . 38
pomalidomide. . . . . . . . . . . . . . . . . 6
POMALYST. . . . . . . . . . . . . . . . . . . 6
ponatinib. . . . . . . . . . . . . . . . . . . . . . 5
potassium acid phosphate. . . . 51
potassium bicarbonate/
potassium citrate
effervescent. . . . . . . . . . . . . . 51
potassium chloride. . . 26, 51, 52
potassium chloride
potassium citrate. . . . . . . . . 49, 51
potassium iodide. . . . . . . . . . . . 52
POTIGA . . . . . . . . . . . . . . . . . . . . . 15
povidone-iodine. . . . . . . . . . . . . 31
PRALUENT . . . . . . . . . . . . . . . . . 11
pramipexole. . . . . . . . . . . . . . . . . . 15
pramlintide. . . . . . . . . . . . . . . . . . 23
PRANDIN. . . . . . . . . . . . . . . . . . 23
praziquantel. . . . . . . . . . . . . . . . . 27
prazosin . . . . . . . . . . . . . . . . . . . . . . 8
PRECOSE. . . . . . . . . . . . . . . . . . 23
PRED-G. . . . . . . . . . . . . . . . . . . . 36
PRED FORTE . . . . . . . . . . . . . . 36
PRED MILD. . . . . . . . . . . . . . . . 36
prednicarbate. . . . . . . . . . . . . . . . 17
prednisolone. . . . . . . . . 21, 22, 36
prednisolone acetate. . . . . . . . 36
prednisolone phosphate. . . . . 36
prednisolone sodium
phosphate. . . . . . . . . . . . . . . 22
prednisone. . . . . . . . . . . . . . . . . . 22
pregabalin. . . . . . . . . . . . . . . . . . . 16
PRELONE. . . . . . . . . . . . . . . . . . 21
PREMARIN. . . . . . . . . . . . . . . . . 35
PREMPHASE. . . . . . . . . . . . . . 35
PREMPRO. . . . . . . . . . . . . . . . . 35
prenat-FE Bis-FE prot succ-FACA & omega 3. . . . . . . . . . . 50
prenat-FE bis-FE prot succ-FACA & omega DR. . . . . . . . . 50
prenatal-FE Bis-FE prot succFA-CA & omega 3. . . . . . . 50
prenatal vit w/FE bisglyc-FE
prot succ-FA . . . . . . . . . . . . 50
prenatal vit w/FE bisglycinate
chelate-FA . . . . . . . . . . . . . . 50
prenatal vit w/FE polysac
cmplx-FA. . . . . . . . . . . . . . . . 50
prenatal vit w/iron
carbonyl-FA. . . . . . . . . . . . . 50
prenatal vit w/o vit a w/FE
bisglycinate-fa tab
32-1 mg . . . . . . . . . . . . . . . . . 51
69
PRENATAL VITAMINS
W/ FOLIC ACID. . . . . . . . . . 51
prenatal vitamins
w/folic acid. . . . . . . . . . . . . . . 51
prenatal w/o A w/FE carbonylFE gluc-DSS-FA. . . . . . . . . . 51
prenatal w/o A w/fecbn-feglDSS-FA & DHA. . . . . . . . . . 51
PREVACID. . . . . . . . . . . . . . . . . 25
PREVACID SOLUTAB. . . . . . . 25
PREVIDENT. . . . . . . . . . . . . . . . 49
PREZCOBIX. . . . . . . . . . . . . . . 31
PREZISTA. . . . . . . . . . . . . . . . . . 30
PRILOSEC . . . . . . . . . . . . . . . . . 25
primaquine. . . . . . . . . . . . . . . . . . 31
primidone. . . . . . . . . . . . . . . . . . . . 16
PRINCIPEN. . . . . . . . . . . . . . . . 28
PROAMATINE. . . . . . . . . . . . . . . 12
probenecid. . . . . . . . . . . . . . . . . . 33
procarbazine. . . . . . . . . . . . . . . . . . 6
PROCARDIA. . . . . . . . . . . . . 9, 10
PROCARDIA XL. . . . . . . . . . . . . 10
prochlorperazine. . . . . . . . . . . . 25
PROCRIT. . . . . . . . . . . . . . . . . . . . . 7
PROCTOSOL HC CREAM
2.5%. . . . . . . . . . . . . . . . . . . . . 19
PROCTOZONE CREAM-HC
2.5%. . . . . . . . . . . . . . . . . . . . . 19
PROGRAF. . . . . . . . . . . . . . . . . . . . 6
PROLIXIN. . . . . . . . . . . . . . . . . . 42
PROLIXIN DECANOATE. . . . 42
PROMACTA. . . . . . . . . . . . . . . . 53
PROMETH VC SYP
6.25-5/5. . . . . . . . . . . . . . . . 46
promethazine. . . . . . . . 25, 44, 46
promethazine & phenylephrine. . 44, 46
PROMETHAZINE SYP DM. . 44
PROMETHAZINE VC
W/CODEINE . . . . . . . . . . . 44
PROMETHAZINE
W/CODEINE . . . . . . . . . . . 44
propafenone. . . . . . . . . . . . . . . . . . 9
propantheline. . . . . . . . . . . . . . . 49
propranolol. . . . . . . . . . . . . . . . 9, 14
propranolol/HCTZ . . . . . . . . . . . . 9
propylthiouracil. . . . . . . . . . . . . . 24
PROSCAR. . . . . . . . . . . . . . . . . . 48
PROTONIX. . . . . . . . . . . . . . . . . 25
PROTOPIC 0.03%. . . . . . . . . . 20
PROTOPIC 0.1% . . . . . . . . . . . 20
PROVENTIL. . . . . . . . . . . . . . . . 48
PROVERA. . . . . . . . . . . . . . . . . . 35
PROZAC. . . . . . . . . . . . . . . . . . . 40
PRUET DHA PAK SETONET
PAK. . . . . . . . . . . . . . . . . . . . . 50
PRUET DHAEC PAK . . . . . . . 50
pseudoephedrine/
acetaminophen/
pseudoephedrine/
chlorpheniramine/
pseudoephedrine/
dextromethorphan/
guaifenesin. . . . . . . . . . . 43, 46
pseudoephedrine/
iburprofen. . . . . . . . . . . . . . . 47
pseudoephedrine tan/
dexchlorphen tan/
DM tan. . . . . . . . . . . . . . . . . . 47
PULMICORT RESPULES. . . 48
PULMOZYME. . . . . . . . . . . . . . 52
PURINETHOL. . . . . . . . . . . . . . . . 4
pyrazinamide. . . . . . . . . . . . . . . . 31
pyrethrins/piperonyl but. . . . . . 19
PYRIDIUM . . . . . . . . . . . . . . . . . 49
pyridostigmine. . . . . . . . . . . . . . . 15
pyridostigmine
pyrilamine tan/
phenyleph tan. . . . . . . . . . . 47
pyrimethamine. . . . . . . . . . . . . . 31
Q
QUAL-TUSSIN
SYP DC. . . . . . . . . . . . . . 45, 46
QUESTRAN. . . . . . . . . . . . . . . . . 11
QUESTRAN-LIGHT. . . . . . . . . . 11
quetiapine . . . . . . . . . . . . . . . . . . . 41
quinapril. . . . . . . . . . . . . . . . . . . . . . 8
quinapril/
QUINIDINE GLUCONATE
EXT-REL. . . . . . . . . . . . . . . . . . 9
quinidine gluconate
quinidine sulfate. . . . . . . . . . . . . . 9
QUINIDINE SULFATE
EXT-REL. . . . . . . . . . . . . . . . . . 9
quinidine sulfate
QV-ALLERGY . . . . . . . . . . . . . . 43
R
R-TANNAMINE. . . . . . . . . . . . . 43
raloxifene. . . . . . . . . . . . . . . . . . . 24
raltegravir. . . . . . . . . . . . . . . . . . . 31
raltegravir susp. . . . . . . . . . . . . . 31
RANEXA. . . . . . . . . . . . . . . . . . . . 12
ranitidine. . . . . . . . . . . . . . . . . . . . 25
ranitidine syrup. . . . . . . . . . . . . . 25
ranolazine. . . . . . . . . . . . . . . . . . . . 12
RAPAMUNE. . . . . . . . . . . . . . . . . . 6
RAVICTI. . . . . . . . . . . . . . . . . . . . 53
RAZADYNE. . . . . . . . . . . . . . . . . 12
REBETOL/COPEGUS. . . . . . 29
REBIF. . . . . . . . . . . . . . . . . . . . . . . 14
RECTIV. . . . . . . . . . . . . . . . . . . . . . 19
REGLAN. . . . . . . . . . . . . . . . . . . 24
70
regorafenib. . . . . . . . . . . . . . . . . . . 5
RELAFEN. . . . . . . . . . . . . . . . . . . 13
RELENZA. . . . . . . . . . . . . . . . . . 29
RELION 70/30. . . . . . . . . . . . . 22
RELION N. . . . . . . . . . . . . . . . . . 22
RELION R. . . . . . . . . . . . . . . . . . 22
REMERON. . . . . . . . . . . . . . . . . 40
RENVELA. . . . . . . . . . . . . . . . . . 52
repaglinide. . . . . . . . . . . . . . . . . . 23
REQUIP. . . . . . . . . . . . . . . . . . . . . 15
RESCRIPTOR. . . . . . . . . . . . . . 29
RESPERAL-DM . . . . . . . . . . . . 42
RESTORIL. . . . . . . . . . . . . . . . . . 40
RETIN-A. . . . . . . . . . . . . . . . . . . . . 17
RETROVIR . . . . . . . . . . . . . . . . . 30
REVATIO. . . . . . . . . . . . . . . . . . . . 12
REVIA. . . . . . . . . . . . . . . . . . . 38, 41
REVLIMID. . . . . . . . . . . . . . . . . . . . 6
REYATAZ. . . . . . . . . . . . . . . . . . . 30
REYATAZ POWDER
PACKET. . . . . . . . . . . . . . . . 30
ribavirin. . . . . . . . . . . . . . . . . . . . . 29
RID SHAMPOO/BUTOXIDE
SHAMPOO . . . . . . . . . . . . . . 19
RIDAURA . . . . . . . . . . . . . . . . . . 32
rifabutin. . . . . . . . . . . . . . . . . . . . . 31
RIFADIN. . . . . . . . . . . . . . . . . . . . 31
rifampin. . . . . . . . . . . . . . . . . . . . . 31
rilonacept. . . . . . . . . . . . . . . . . . . 52
rilpivirine. . . . . . . . . . . . . . . . . 29, 30
rimantadine. . . . . . . . . . . . . . . . . 29
rimexolone. . . . . . . . . . . . . . . . . . 36
RISPERDAL. . . . . . . . . . . . . . . . . 41
RISPERDAL CONSTA. . . . . . . 41
RISPERDAL SOLUTION. . . . . 41
risperidone. . . . . . . . . . . . . . . . . . . 41
risperidone oral soln. . . . . . . . . . 41
RITALIN. . . . . . . . . . . . . . . . . . . . 39
RITALIN-SR. . . . . . . . . . . . . . . . 39
RITALIN LA. . . . . . . . . . . . . . . . . 39
ritonavir. . . . . . . . . . . . . . . . . . . . . 30
rivaroxaban. . . . . . . . . . . . . . . . . . . 7
rivastigmine. . . . . . . . . . . . . . . . . . 12
rizatriptan. . . . . . . . . . . . . . . . . . . . 14
RMS. . . . . . . . . . . . . . . . . . . . . . . . . 14
ROBAXIN. . . . . . . . . . . . . . . . . . 33
ROBINUL. . . . . . . . . . . . . . . . . . 25
ROBITUSSIN. . . . . . . . . . . . 44-46
ROBITUSSIN CF. . . . . . . . . . . 44
ROBITUSSIN LIQ
CGH/ALRG. . . . . . . . . . . . . 45
ROBITUSSIN LIQ
CGH/CLD. . . . . . . . . . . . . . 46
ROBITUSSIN LIQ
CGH/CONG. . . . . . . . . . . . 44
ROBITUSSIN LIQ
HD/CHST . . . . . . . . . . . . . . 46
ROBITUSSIN LIQ
PED NGHT. . . . . . . . . . . . . 46
ROBITUSSIN PED SYP. . . . . 44
ROBITUSSIN SYP
CHST CNG. . . . . . . . . . . . . 44
ROBITUSSIN SYP
MAX-ST. . . . . . . . . . . . . . . . . 44
ROCALTROL. . . . . . . . . . . . . . . 49
ROCALTROL SOLUTION . . . 49
RONDEC DM. . . . . . . . . . . . . . . 45
RONDEC DM DROPS. . . . . . 45
RONDEC DROPS. . . . . . . . . . 43
RONDEC SYRUP. . . . . . . . 42, 43
ropinirole . . . . . . . . . . . . . . . . . . . . 15
ROWASA. . . . . . . . . . . . . . . . . . . 26
ROXICODONE. . . . . . . . . . . . . . 14
rufinamide. . . . . . . . . . . . . . . . . . . 16
ruxolitinib. . . . . . . . . . . . . . . . . . . . . 5
RYNA-12 S. . . . . . . . . . . . . . . . . 47
RYNATAN PEDIATRIC
SUSP. . . . . . . . . . . . . . . . . . . 43
RYNATUSS. . . . . . . . . . . . . . 43, 46
RYNATUSS PEDIATRIC
SUSP. . . . . . . . . . . . . . . . . . . 46
RYTHMOL. . . . . . . . . . . . . . . . . . . . 9
S
SABRIL SOLUTION . . . . . . . . . 16
SAL-TROPINE. . . . . . . . . . . . . . 26
SALAGEN. . . . . . . . . . . . . . . . . . 21
SANCTURA. . . . . . . . . . . . . . . . 49
SANDIMMUNE. . . . . . . . . . . . . . . 6
SANDOSTATIN. . . . . . . . . . . . . . . 6
sapropterin . . . . . . . . . . . . . . . . . 24
sapropterin powder. . . . . . . . . . 24
saquinavir. . . . . . . . . . . . . . . . . . . 30
saquinavir mesylate . . . . . . . . . 30
sargramostim. . . . . . . . . . . . . . . . . 7
SAVAYSA. . . . . . . . . . . . . . . . . . . . . 7
saxagliptin. . . . . . . . . . . . . . . . . . 23
saxagliptin/metformin. . . . . . . 23
scopolamine. . . . . . . . . . . . . . . . 37
SEASONALE. . . . . . . . . . . . . . . 33
SECTRAL . . . . . . . . . . . . . . . . . . . . 9
SEDAPAP. . . . . . . . . . . . . . . . . . . 12
selegiline. . . . . . . . . . . . . . . . . . . . 15
selenium sulfide. . . . . . . . . . . . . . 19
SELSUN . . . . . . . . . . . . . . . . . . . . 19
SELZENTRY . . . . . . . . . . . . . . . 31
SENSIPAR . . . . . . . . . . . . . . . . . 52
SERAX. . . . . . . . . . . . . . . . . . . . . 38
SEROQUEL. . . . . . . . . . . . . . . . . 41
sertraline . . . . . . . . . . . . . . . . . . . 40
sevelamer. . . . . . . . . . . . . . . . . . . 52
SIGNIFOR. . . . . . . . . . . . . . . . . . . . 6
sildenafil. . . . . . . . . . . . . . . . . . . . . 12
SILVADENE. . . . . . . . . . . . . . . . . 17
silver sulfadiazine . . . . . . . . . . . . 17
simvastatin. . . . . . . . . . . . . . . . . . . 11
SINEMET . . . . . . . . . . . . . . . . . . . 15
71
SINEMET CR. . . . . . . . . . . . . . . . 15
SINEQUAN. . . . . . . . . . . . . . . . . 40
SINGULAIR. . . . . . . . . . . . . . . . 48
sirolimus. . . . . . . . . . . . . . . . . . . . . . 6
SIRTURO. . . . . . . . . . . . . . . . . . . 30
sodium chloride hypertonic. . 38
sodium citrate/citric acid. . . . 49
sodium phenylbutyrate oral
powder. . . . . . . . . . . . . . . . . . 53
sodium polysterene
sulfonate. . . . . . . . . . . . . . . . . 11
sofosbuvir. . . . . . . . . . . . . . . . . . . 29
somavert. . . . . . . . . . . . . . . . . . . . 24
SONATA. . . . . . . . . . . . . . . . . . . . 40
sorafenib . . . . . . . . . . . . . . . . . . . . . 5
SORIATANE. . . . . . . . . . . . . . . . . 18
sotalol. . . . . . . . . . . . . . . . . . . . . . . . 9
SOVALDI. . . . . . . . . . . . . . . . . . . 29
Spacers. . . . . . . . . . . . . . . . . . . . . 53
spironolactone. . . . . . . . . . . . . . . 10
spironolactone/
SPORANOX. . . . . . . . . . . . . . . . 28
SPRYCEL. . . . . . . . . . . . . . . . . . . . 4
STADOL. . . . . . . . . . . . . . . . . . . . . 13
STARLIX. . . . . . . . . . . . . . . . . . . . 23
STATUSS DM SYP. . . . . . . . . . 45
stavudine. . . . . . . . . . . . . . . . . . . 30
STELAZINE. . . . . . . . . . . . . . . . 42
STIVARGA. . . . . . . . . . . . . . . . . . . . 5
STRIBILD . . . . . . . . . . . . . . . . . . 30
STRIVERDI RESPIMAT. . . . . 47
STROMECTOL . . . . . . . . . . . . . 27
SUBOXONE. . . . . . . . . . . . . . . . . 41
SUBUTEX. . . . . . . . . . . . . . . . . . . 41
sucralfate. . . . . . . . . . . . . . . . . . . 25
sulcralfate . . . . . . . . . . . . . . . . . . 25
SULFACET-R. . . . . . . . . . . . . . . . 17
sulfacetamide. . . . . . . . 17, 36, 38
sulfacetamide/
phenylephrine. . . . . . . . . . . 38
sulfacetamide/pred phos. . . . 36
sulfacetamide/sulfur. . . . . . . . . 17
sulfamethoxazole/
trimethoprim, DS. . . . . . . . . 28
sulfasalazine. . . . . . . . . . . . . 26, 32
sulfasalazine
delayed-release . . . . . . 26, 32
sulfisoxazole. . . . . . . . . . . . . 27, 28
sulindac . . . . . . . . . . . . . . . . . 13, 33
sumatriptan. . . . . . . . . . . . . . . . . . 14
SUMYCIN. . . . . . . . . . . . . . . . . . 28
sunitinib . . . . . . . . . . . . . . . . . . . . . . 5
SUPRAX. . . . . . . . . . . . . . . . . . . 27
SUSTIVA . . . . . . . . . . . . . . . . . . . 29
SUTENT. . . . . . . . . . . . . . . . . . . . . . 5
SYLATRON. . . . . . . . . . . . . . . . . . . 5
SYMLIN. . . . . . . . . . . . . . . . . . . . 23
SYMMETREL. . . . . . . . . . . . 15, 29
SYNAGIS. . . . . . . . . . . . . . . . . . . 31
SYNALAR. . . . . . . . . . . . . . . . . . . 17
SYNJARDY. . . . . . . . . . . . . . . . . 23
SYNTHROID . . . . . . . . . . . . . . . 24
T
T-STAT. . . . . . . . . . . . . . . . . . . . . . . 17
tabloid. . . . . . . . . . . . . . . . . . . . . . . . 4
tacrolimus . . . . . . . . . . . . . . . . 6, 20
TAFINLAR. . . . . . . . . . . . . . . . . . . . 4
TAGAMET. . . . . . . . . . . . . . . . . . 25
TALWIN NX. . . . . . . . . . . . . . . . . . 14
TAMBOCOR. . . . . . . . . . . . . . . . . . 9
TAMIFLU. . . . . . . . . . . . . . . . . . . 29
tamoxifen. . . . . . . . . . . . . . . . . . . . . 5
tamsulosin. . . . . . . . . . . . . . . . . . 48
TANAFED. . . . . . . . . . . . . . . 43, 47
TANAFED DMX
SUSPENSION. . . . . . . . . . 47
TANZEUM. . . . . . . . . . . . . . . . . . 23
TAPAZOLE. . . . . . . . . . . . . . . . . 24
TARCEVA. . . . . . . . . . . . . . . . . . . . 4
TARGRETIN. . . . . . . . . . . . . . . . . . 6
TASIGNA. . . . . . . . . . . . . . . . . . . . . 5
TASMAR. . . . . . . . . . . . . . . . . . . . . 15
TBO-filgrastim. . . . . . . . . . . . . . . . 7
TECFIDERA. . . . . . . . . . . . . . . . . 14
teduglutide. . . . . . . . . . . . . . . . . . 26
TEGRETOL. . . . . . . . . . . . . . . . . . 15
TEGRETOL-XR. . . . . . . . . . . . . . 15
temazepam. . . . . . . . . . . . . . . . . 40
TEMODAR . . . . . . . . . . . . . . . . . . . 4
TEMOVATE. . . . . . . . . . . . . . . . . . 18
temozolomide. . . . . . . . . . . . . . . . . 4
TENEX. . . . . . . . . . . . . . . . . . . . . . . 8
tenofovir. . . . . . . . . . . . . . . . . . . . 30
TENORETIC. . . . . . . . . . . . . . . . . . 9
TENORMIN . . . . . . . . . . . . . . . . . . 9
TERAZOL 3/7. . . . . . . . . . . . . . 35
terazosin. . . . . . . . . . . . . . . . . . 8, 48
terbinafine. . . . . . . . . . . . . . . 18, 28
terbutaline. . . . . . . . . . . . . . . . . . 48
terconazole. . . . . . . . . . . . . . . . . 35
teriflunomide. . . . . . . . . . . . . . . . . 14
teriparatide inj. . . . . . . . . . . . . . . 24
TESSALON. . . . . . . . . . . . . . . . . 42
TESTOSTERONE 1%
TOPICAL GEL . . . . . . . . . . 22
testosterone cypionate. . . . . . 22
testosterone enanthate. . . . . . 22
testosterone gel topical
tube, packet, and pump
bottle . . . . . . . . . . . . . . . . . . . 22
tetrabenazine. . . . . . . . . . . . . . . . 16
tetracycline. . . . . . . . . . . . . . 26, 28
THEO-24. . . . . . . . . . . . . . . . . . . 48
THEOCHRON. . . . . . . . . . . . . . 48
72
theophylline. . . . . . . . . . . . . . . . . 48
theophylline ext-rel. . . . . . . . . . 48
thiethylperazine. . . . . . . . . . . . . 25
thioguanine. . . . . . . . . . . . . . . . . . . 4
thioridazine . . . . . . . . . . . . . . . . . 42
thiothixene. . . . . . . . . . . . . . . . . . 42
THORAZINE . . . . . . . . . . . . . . . 42
THYROLAR . . . . . . . . . . . . . . . . 24
tiagabine. . . . . . . . . . . . . . . . . . . . . 16
TIAZAC. . . . . . . . . . . . . . . . . . . . . . 10
TIGAN. . . . . . . . . . . . . . . . . . . . . . 25
TIKOSYN. . . . . . . . . . . . . . . . . . . . . 9
TILADE. . . . . . . . . . . . . . . . . . . . . 47
timolol. . . . . . . . . . . . . . . . . . . . 9, 37
timolol hemihydrate . . . . . . . . . 37
timolol maleate. . . . . . . . . . . . 9, 37
TIMOPTIC. . . . . . . . . . . . . . . . . . 37
TIMOPTIC XE . . . . . . . . . . . . . . 37
TINACTIN . . . . . . . . . . . . . . . . . . . 18
tipranavir. . . . . . . . . . . . . . . . . . . . 30
TIVICAY . . . . . . . . . . . . . . . . . . . . 31
tizanidine. . . . . . . . . . . . . . . . . . . 33
TOBRADEX. . . . . . . . . . . . . . . . 36
tobramycin. . . . . . . . . . . 36, 38, 52
tobramycin/
dexamethasone . . . . . . . . . 36
tobramycin neb soln. . . . . . . . . 52
TOBREX. . . . . . . . . . . . . . . . . . . 38
TOFRANIL . . . . . . . . . . . . . . . . . 40
tolazamide. . . . . . . . . . . . . . . . . . 23
tolbutamide. . . . . . . . . . . . . . . . . 23
tolcapone. . . . . . . . . . . . . . . . . . . . 15
TOLINASE. . . . . . . . . . . . . . . . . . 23
tolnaftate. . . . . . . . . . . . . . . . . . . . 18
tolterodine. . . . . . . . . . . . . . . . . . 49
TOPAMAX. . . . . . . . . . . . . . . . . . . 16
TOPAMAX SPRINKLE. . . . . . . 16
topiramate. . . . . . . . . . . . . . . . . . . 16
topiramate sprinkle caps. . . . . . 16
topotecan. . . . . . . . . . . . . . . . . . . . . 6
TOPROL XL. . . . . . . . . . . . . . . . . . 9
TORADOL. . . . . . . . . . . . . . . . . . . 13
TORECAN. . . . . . . . . . . . . . . . . . 25
toremifene. . . . . . . . . . . . . . . . . . . . 5
torsemide. . . . . . . . . . . . . . . . . . . . 10
TOUJEO SOLOSTAR. . . . . . . . 22
TRACLEER. . . . . . . . . . . . . . . . . . 12
TRADJENTA. . . . . . . . . . . . . . . . 23
tramadol. . . . . . . . . . . . . . . . . . . . . 12
trametinib. . . . . . . . . . . . . . . . . . . . . 5
TRANDATE. . . . . . . . . . . . . . . . . . . 9
tranexamic acid. . . . . . . . . . . . . 36
TRANXENE. . . . . . . . . . . . . . . . 38
tranylcypromine. . . . . . . . . . . . . 39
trazodone. . . . . . . . . . . . . . . . . . . 40
TRENTAL. . . . . . . . . . . . . . . . . . . . . 7
tretinoin. . . . . . . . . . . . . . . . . . . 6, 17
TRI-FED X. . . . . . . . . . . . . . . . . . 47
TRI-NORINYL. . . . . . . . . . . . . . 34
TRI-VI-FLOR. . . . . . . . . . . . . . . . . 51
TRI RX. . . . . . . . . . . . . . . . . . . . . . 51
triamcinolone . . . . . . . . . 17, 18, 21
triamcinolone acetonide. . 17, 18
triamterene/
TRIAVIL. . . . . . . . . . . . . . . . . . . . 40
triazolam. . . . . . . . . . . . . . . . . . . . 40
trifluoperazine. . . . . . . . . . . . . . . 42
trifluridine. . . . . . . . . . . . . . . . . . . 38
trihexyphenidyl. . . . . . . . . . . . . . . 15
TRILAFON . . . . . . . . . . . . . . . . . 42
TRILEPTAL. . . . . . . . . . . . . . . . . . 16
TRILISATE. . . . . . . . . . . . . . . 13, 32
TRILYTE. . . . . . . . . . . . . . . . . . . . 26
trimethobenzamide. . . . . . . . . . 25
trimethoprim. . . . . . . . . 28, 31, 38
TRIOTANN . . . . . . . . . . . . . . 21, 43
TRIOTANN PEDIATRIC
SUSP. . . . . . . . . . . . . . . . . . . 43
tripolidine/
TRIPROL/PSE SYP . . . . . . . . 47
TRIUMEQ. . . . . . . . . . . . . . . . . . 30
TRIVORA. . . . . . . . . . . . . . . . . . . 34
TRIZIVIR . . . . . . . . . . . . . . . . . . . 29
TROJAN. . . . . . . . . . . . . . . . . . . . 54
trospium. . . . . . . . . . . . . . . . . . . . 49
TRUSOPT. . . . . . . . . . . . . . . . . . 37
TRUST NATALCARE
PAK DHA. . . . . . . . . . . . . . . 50
TRUVADA. . . . . . . . . . . . . . . . . . 30
TUSSI-12 S. . . . . . . . . . . . . . . . . 43
TUSSI 12D S . . . . . . . . . . . . . . . 46
TWINJECT . . . . . . . . . . . . . . . . . 52
TYBOST. . . . . . . . . . . . . . . . . . . . 30
TYKERB . . . . . . . . . . . . . . . . . . . . . 4
TYLENOL W/CODEINE. . . . . 13
typhoid vaccine . . . . . . . . . . . . . 53
U
ULORIC. . . . . . . . . . . . . . . . . . . . 33
ULTRAM. . . . . . . . . . . . . . . . . . . . . 12
umeclidinium/vilanterol. . . . . . 47
umeclidinium inhalation. . . . . . 47
UNI-HIST DRO. . . . . . . . . . . . . 42
UNIPHYL . . . . . . . . . . . . . . . . . . 48
urea 40%. . . . . . . . . . . . . . . . . . . 20
UREA 40% CREAM AND
LOTION. . . . . . . . . . . . . . . . . 20
URECHOLINE. . . . . . . . . . . . . . 48
UREX. . . . . . . . . . . . . . . . . . . . . . 48
UROCIT-K. . . . . . . . . . . . . . . . . . 49
UROXATRAL. . . . . . . . . . . . . . . 48
73
URSO. . . . . . . . . . . . . . . . . . . . . . 27
URSO FORTE. . . . . . . . . . . . . . 27
ursodiol. . . . . . . . . . . . . . . . . . . . . 27
UTIRA C. . . . . . . . . . . . . . . . . . . . 48
V
valacyclovir . . . . . . . . . . . . . . . . . 29
VALCYTE. . . . . . . . . . . . . . . . . . . 28
valganciclovir. . . . . . . . . . . . . . . . 28
VALIUM. . . . . . . . . . . . . . . . . 33, 38
valproic acid . . . . . . . . . . . . . . . . . 16
VALTREX. . . . . . . . . . . . . . . . . . . 29
VANCOCIN HCL . . . . . . . . . . . 28
vancomycin HCl. . . . . . . . . . . . . 28
vandetanib. . . . . . . . . . . . . . . . . . . . 5
VASERETIC. . . . . . . . . . . . . . . . . . 8
VASOCIDIN. . . . . . . . . . . . . . . . 36
VASOSULF. . . . . . . . . . . . . . . . . 38
VASOTEC . . . . . . . . . . . . . . . . . . . . 8
VECTICAL. . . . . . . . . . . . . . . . . . . 18
VEETIDS. . . . . . . . . . . . . . . . . . . 28
vemurafenib. . . . . . . . . . . . . . . . . . 5
venlafaxine . . . . . . . . . . . . . . . . . 40
venlafaxine XR. . . . . . . . . . . . . . 40
VENTOLIN HFA . . . . . . . . . . . . 47
VEPESID. . . . . . . . . . . . . . . . . . . . . 6
verapamil. . . . . . . . . . . . . . . . 10, 14
verapamil extended-release. . . 10
VESANOID. . . . . . . . . . . . . . . . . . . 6
VEXOL. . . . . . . . . . . . . . . . . . . . . 36
VFEND. . . . . . . . . . . . . . . . . . . . . 28
VICODIN. . . . . . . . . . . . . . . . . . . . 13
VICODIN ES. . . . . . . . . . . . . . . . . 13
VICTOZA. . . . . . . . . . . . . . . . . . . 23
VIDEX. . . . . . . . . . . . . . . . . . . . . . 29
VIDEX EC. . . . . . . . . . . . . . . . . . 29
vigabatrin oral solution. . . . . . . . 16
VIMPAT. . . . . . . . . . . . . . . . . . . . . . 15
VINATE AZ EX. . . . . . . . . . . . . . 50
VINATE III . . . . . . . . . . . . . . . . . . 50
VIRACEPT. . . . . . . . . . . . . . . . . . 30
VIRAMUNE. . . . . . . . . . . . . . . . . 29
VIRAMUNE XR. . . . . . . . . . . . . 29
VIREAD. . . . . . . . . . . . . . . . . . . . 30
VIROPTIC. . . . . . . . . . . . . . . . . . 38
vismodegib . . . . . . . . . . . . . . . . . . . 6
VISTARIL. . . . . . . . . . . . . . . . . . . 20
vitamin ADC/fluoride/±iron
drops . . . . . . . . . . . . . . . . . . . . 51
VITAMIN B-12. . . . . . . . . . . . . . 49
vitamin B complex/vitamin C/
folic acid. . . . . . . . . . . . . . . . . 51
VITAPHIL. . . . . . . . . . . . . . . . . . . 50
VITUSSIN . . . . . . . . . . . . . . . . . . 45
VIVOTIF BERNA. . . . . . . . . . . . 53
VOLTAREN. . . . . . . . . . 13, 32, 36
VOLTAREN 1% TOPICAL
GEL . . . . . . . . . . . . . . . . . . . . 32
VOLTAREN XR. . . . . . . . . . . . . 32
voriconazole . . . . . . . . . . . . . . . . 28
vorinostat. . . . . . . . . . . . . . . . . . . . . 4
VOSOL HC OTIC . . . . . . . . . . . 20
VOSOL OTIC . . . . . . . . . . . . . . . 20
VOTRIENT. . . . . . . . . . . . . . . . . . . . 5
VYVANSE. . . . . . . . . . . . . . . . . . 39
W
warfarin. . . . . . . . . . . . . . . . . . . . . . . 7
WELLBUTRIN. . . . . . . . . . . . . . 40
WELLBUTRIN SR. . . . . . . . . . 40
WELLBUTRIN XL. . . . . . . . . . 40
WYTENSIN. . . . . . . . . . . . . . . . . . 12
X
XALATAN. . . . . . . . . . . . . . . . . . . 37
XALKORI. . . . . . . . . . . . . . . . . . . . . 4
XANAX. . . . . . . . . . . . . . . . . . . . . 38
XARELTO . . . . . . . . . . . . . . . . . . . . 7
XELODA . . . . . . . . . . . . . . . . . . . . . 4
XENAZINE. . . . . . . . . . . . . . . . . . 16
XOLAIR. . . . . . . . . . . . . . . . . . . . 47
XOPENEX RESPULES. . . . . 48
XYLOCAINE. . . . . . . . . . . . . 19, 21
XYZAL. . . . . . . . . . . . . . . . . . . . . 20
Z
zalcitabine. . . . . . . . . . . . . . . . . . 30
zaleplon. . . . . . . . . . . . . . . . . . . . . 40
ZANAFLEX. . . . . . . . . . . . . . . . . 33
zanamivir . . . . . . . . . . . . . . . . . . . 29
ZANTAC. . . . . . . . . . . . . . . . . . . . 25
ZARONTIN. . . . . . . . . . . . . . . . . . 15
ZAROXOLYN. . . . . . . . . . . . . . . . 10
zarxio. . . . . . . . . . . . . . . . . . . . . . . . . 7
ZEBETA. . . . . . . . . . . . . . . . . . . . . . 9
ZELBORAF. . . . . . . . . . . . . . . . . . 5
ZENPEP. . . . . . . . . . . . . . . . . . . 26
ZERIT. . . . . . . . . . . . . . . . . . . . . . 30
ZESTORETIC. . . . . . . . . . . . . . . . . 8
ZESTRIL . . . . . . . . . . . . . . . . . . . . . 8
ZETIA. . . . . . . . . . . . . . . . . . . . . . . 11
ZIAC . . . . . . . . . . . . . . . . . . . . . . . . . 9
ZIAGEN. . . . . . . . . . . . . . . . . . . . 29
zidovudine. . . . . . . . . . . . . . . 29, 30
ziprasidone . . . . . . . . . . . . . . . . . . 41
ZITHROMAX. . . . . . . . . . . . . . . 27
ZOCOR. . . . . . . . . . . . . . . . . . . . . . 11
ZOFRAN. . . . . . . . . . . . . . . . . . . 24
ZOFRAN ODT. . . . . . . . . . . . . . 24
ZOHYDRO ER. . . . . . . . . . . . . . . 13
ZOLINZA. . . . . . . . . . . . . . . . . . . . . 4
ZOLOFT. . . . . . . . . . . . . . . . . . . . 40
zolpidem. . . . . . . . . . . . . . . . . . . . 40
ZONEGRAN. . . . . . . . . . . . . . . . . 16
74
zonisamide. . . . . . . . . . . . . . . . . . . 16
ZORTRESS. . . . . . . . . . . . . . . . . . . 6
ZOVIA 1/35. . . . . . . . . . . . . . . . 34
ZOVIA 1/50. . . . . . . . . . . . . . . . 34
ZOVIRAX. . . . . . . . . . . . . . . . . . . 29
ZYDELIG. . . . . . . . . . . . . . . . . . . . . 4
ZYKADIA. . . . . . . . . . . . . . . . . . . . . 4
ZYLOPRIM. . . . . . . . . . . . . . . . . 33
ZYMAR. . . . . . . . . . . . . . . . . . . . . 37
ZYPREXA. . . . . . . . . . . . . . . . . . . 41
ZYRTEC. . . . . . . . . . . . . . . . . 20, 54
ZYRTEC-D . . . . . . . . . . . . . . . . . 21
ZYRTEC CHEWABLE
TABLET. . . . . . . . . . . . . . . . . 20
ZYRTEC D. . . . . . . . . . . . . . . . . . 54
ZYTIGA. . . . . . . . . . . . . . . . . . . . . . . 5
ZYVOX. . . . . . . . . . . . . . . . . . . . . 31
Notes
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75
“My Medications” worksheet
Take this worksheet with you each time you visit a doctor. Each of your doctors should be aware of every
drug you take and you should have a list as well.
Name of Medicine
and Strength
Drug
Tier
I Take This
Medicine For
Directions
Doctor
Example: Lisinopril, 20mg
Tier 1
High blood pressure
One tablet daily
Dr. Johnson
76
© 2016 United HealthCare Services, Inc. All rights reserved.
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IA Hawk-i Eff_02-01-16 v1.indd

Transcription

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