2015 Rx Preferred Drug Guide (3-Tier)

Transcription

2015
Rx Preferred
Drug Guide
(3-Tier)
Please bring this guide
with you to your next
doctor visit.
30781(Ed. 10/2014)
Do you have questions?
Call Assurant Health Customer Service at the phone number
printed on the back of your medical identification card.
Dear Member,
To help you know how drugs are covered by your plan, we are
pleased to provide you with a copy of our 2015 Rx Preferred Drug
Guide.
This document provides helpful information on the Assurant Rx
Preferred Drug Guide and your pharmacy benefit plan. You may
want to take this guide with you when you see your doctor to talk
about what is covered under your plan.
Many commonly prescribed drugs are listed in this guide. Please
remember this is not a complete list of drugs covered under
your plan. Because thousands of drugs are included in your
pharmacy benefits plan, we only list the most commonly prescribed
ones.
Most injectable medications are not covered under the prescription
drug benefit but paid subject to the cost-sharing requirements (e.g.
deductible and coinsurance) that apply to other medical services.
Wellness: If required by applicable law, certain medications that are
deemed wellness benefits are provided with no cost-sharing to
members.
Please note that not all drugs listed in this guide are covered by
all pharmacy benefit programs. Check your benefit materials or
contact Assurant Health by calling the number on the back of your
medical identification card to determine if a drug would be covered.
Where required by applicable law, members who have coverage for
medications which have changed status including tier (i.e drug
changed from P (preferred) to NP (non-preferred) on the Rx
Preferred Drug Guide, Prior Authorization List, Step Therapy List, or
Quantity Limit during the plan year, will continue to have those
medications covered at the same benefit level under their plan prior
to the addition, removal or change, until January 1st of the following
calendar year.
2
What is the Assurant Rx Preferred Drug Guide?
Our Rx Preferred Drug Guide is meant to give you a general view of
drugs covered by your plan. Changes to the list are based on the latest
medical findings as well as information from the Food and Drug
Administration (FDA) and drug makers.
This list includes both brand-name and generic drugs and is updated
regularly. Assurant will generally cover the drugs listed on our Rx
Preferred Drug Guide as long as they are medically necessary and plan
rules are followed. Coverage is not limited to drugs on the Rx Preferred
Drug Guide.
Your plan has different copay or coinsurance tiers for generic, brandname, preferred and non-preferred drugs. Usually, preferred drugs are
covered at a lower copay or coinsurance tier, which means you pay less
out of pocket for those drugs.
The Rx Preferred Drug Guide is subject to change without notice. Drugs
on the list are based on reliable medical data, safety and cost. When
you talk to your doctor about what drug may be right for you, it is
important to remember that you and your doctor are responsible for
making the final decision on your drug therapy.
Why is the Rx Preferred Drug Guide subject to
change?
During the year, we may add or remove drugs from the Rx Preferred
Drug Guide. These changes happen for various reasons and may move
a drug from one coverage tier to another.
As brand-name drugs lose their patents, generic versions may
become available. When this happens, the brand-name drug
may move to a higher copayment or coinsurance tier. The
generic drug may be added to the list and available at a lower
copayment or coinsurance tier.
The FDA approves many new drugs throughout the year. Your
plan generally covers new FDA-approved drugs; however, you
may pay a higher copayment or coinsurance tier for these drugs.
The new drug(s) also may be subject to prior authorization or
step-therapy requirements.
Some drugs may also no longer require a prescription. If your
drug becomes available over-the-counter (OTC), the drug will
generally no longer be covered under your prescription plan.
If the FDA removes a drug from the market it will also no longer
be covered under your prescription plan.
3
Why do some drugs have quantity limits?
Your plan may limit the amount of a drug you can receive at one time.
These limits help your doctor and pharmacist check that the drugs are
used appropriately while promoting patient safety. We use medical
guidelines, FDA approval and guidance from drug makers to set these
coverage limits. The quantity limits program includes:
Dose Efficiency Edits – Limits coverage of prescriptions to one
dose per day for drugs that are approved for once-daily dosing.
Maximum Daily Dose – A message is sent to the pharmacy if a
prescription is higher than the maximum allowed dose.
Quantity Limits Over Time – Limits coverage of prescriptions to
a specific number of units in a defined amount of time.
To get coverage for amounts over the allowed quantity, you, your doctor
or the person you appoint to manage your care must request a coverage
override by calling the phone number located on your ID card. The
quantity limit list is subject to change.
What is step-therapy?
With step-therapy you must try one or more alternate drugs before your
plan will cover a step-therapy drug. These drugs are FDA-approved,
treat the same condition(s) and, they may also be available to you at a
lower copay or coinsurance tier.
If it is necessary for you to use a drug on the step therapy list, you, your
doctor, or the person you appoint to manage your care may request a
coverage override by calling the phone number located on your ID card.
What is the Prior Authorization program?
The Prior Authorization program encourages appropriate and cost-effective use of
drugs by allowing coverage only when certain conditions are met.
• A physician, a patient, or a person appointed to manage the patient’s care must
request prior authorization before drugs on the Prior Authorization List may be
covered under a member’s pharmacy benefits plan. If the request is approved, the
drug will then be covered at the applicable costs associated with the member’s plan.
• The Prior Authorization program is based upon current medical findings, FDAapproved manufacturer labeling information, and cost.
• To determine if a drug requires prior authorization, refer to the column titled Prior
Authorization next to the list of drugs in this guide. The list of drugs requiring prior
authorization is subject to change.
4
To initiate a prior authorization request:
• Call the phone number on the back of the member identification card to
obtain more information on the prior authorization review process.
What are generic drugs?
Drug manufacturers develop and release new drugs under a brand
name. When the patent expires, other manufacturers are then able to
make duplicate versions of the same drug. Generic drugs are chemically
the same as their branded counterparts. They are also the same in
dosage, safety, strength, form and intended use. Plus, generics usually
cost less than brand-name drugs.
Generic drugs are only available after the FDA approves them. When
filling your prescription, your pharmacist generally can substitute a
generic drug for a brand-name drug when the generic is rated by the
FDA as equivalent and also where it is permitted by your doctor and
state law.
THERAPEUTIC CLASS LIST KEY (on following pages)
lower case– Generic medication – lowest co-payment
UPPERCASE – Brand-name medication – Higher co-payment
MED – Injectable medication that may be covered under the
medical benefit
Table of Contents – Preferred Drugs by Therapeutic Class
Therapeutic Class
Page(s)
*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*
*AMEBICIDES*
*AMINOGLYCOSIDES
*ANALGESICS - ANTI-INFLAMMATORY*
*ANALGESICS - NONNARCOTIC*
*ANALGESICS - OPIOID*
*ANDROGENS-ANABOLIC*
*ANORECTAL AGENTS*
*ANTHELMINTICS*
*ANTIANGINAL AGENTS*
8
9
9
9
11
12
14
15
15
16
5
*ANTIANXIETY AGENTS*
*ANTIARRHYTHMICS*
*ANTIASTHMATIC AND BRONCHODILATOR AGENTS*
*ANTICOAGULANTS*
*ANTICONVULSANTS*
*ANTIDEPRESSANTS*
*ANTIDIABETICS*
*ANTIDIARRHEALS*
*ANTIDOTES*
*ANTIEMETICS*
*ANTIFUNGALS*
*ANTIHISTAMINES*
*ANTIHYPERLIPIDEMICS*
*ANTIHYPERTENSIVES*
*ANTI-INFECTIVE AGENTS - MISC.*
*ANTIMALARIALS*
*ANTIMYASTHENIC/CHOLINERGIC AGENTS*
*ANTIMYCOBACTERIAL AGENTS*
*ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*
*ANTIPARKINSON AGENTS*
*ANTIPSYCHOTICS/ANTIMANIC AGENTS*
*ANTIVIRALS*
*ASSORTED CLASSES*
*BETA BLOCKERS*
*BIOLOGICALS MISC*
*CALCIUM CHANNEL BLOCKERS*
*CARDIOTONICS*
*CARDIOVASCULAR AGENTS - MISC.*
*CEPHALOSPORINS*
*CONTRACEPTIVES*
*CORTICOSTEROIDS*
*COUGH/COLD/ALLERGY*
*DERMATOLOGICALS*
*DIAGNOSTIC PRODUCTS*
*DIGESTIVE AIDS*
*DIURETICS*
*ENDOCRINE AND METABOLIC AGENTS - MISC.*
*ESTROGENS*
*FLUOROQUINOLONES*
*GASTROINTESTINAL AGENTS - MISC.*
*GENERAL ANESTHETICS*
*GENITOURINARY AGENTS - MISCELLANEOUS*
16
17
17
19
19
22
24
27
27
27
28
28
29
31
34
35
35
35
35
39
40
42
44
46
46
47
48
48
49
49
53
54
56
66
67
67
68
71
72
73
74
74
6
Quantity Limit
3-Tier
G = Generic
P = Preferred Brand
NP = Non Preferred
Brand
MED = Medical
Benefit
Step Therapy
Medication Name
76
76
78
78
79
79
80
80
81
82
83
84
85
85
85
90
91
91
92
93
93
95
95
96
96
98
99
99
100
100
Prior Authorization
*GOUT AGENTS*
*HEMATOLOGICAL AGENTS - MISC.*
*HEMATOPOIETIC AGENTS*
*HEMOSTATICS*
*HYPNOTICS*
*LAXATIVES*
*MACROLIDES*
*MEDICAL DEVICES*
*MIGRAINE PRODUCTS*
*MINERALS & ELECTROLYTES*
*MOUTH/THROAT/DENTAL AGENTS*
*MUSCULOSKELETAL THERAPY AGENTS*
*NASAL AGENTS - SYSTEMIC AND TOPICAL*
*NEUROMUSCULAR AGENTS*
*OPHTHALMIC AGENTS*
*OTIC AGENTS*
*OXYTOCICS*
*PASSIVE IMMUNIZING AGENTS*
*PENICILLINS*
*PROGESTINS*
*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*
*RESPIRATORY AGENTS - MISC.*
*TETRACYCLINES*
*THYROID AGENTS*
*ULCER DRUGS*
*URINARY ANTI-INFECTIVES*
*URINARY ANTISPASMODICS*
*VAGINAL PRODUCTS*
*VASOPRESSORS*
*VITAMINS*
*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*
*Amphetamines** - *Amphetamine Mixtures***
7
ADDERALL
ADDERALL XR CAPSULE
amphetamine-dextroamphet ER
amphetamine-dextroamphetamine
NP
NP
G
G
N
N
N
N
Y
Y
N
N
Y
Y
Y
Y
NP
NP
G
G
G
G
NP
P
G
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
G
N
N
N
N
Y
Y
G
NP
NP
N
N
N
N
Y
Y
Y
Y
Y
P
N
N
Y
NP
NP
G
G
NP
NP
NP
G
G
NP
G
NP
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
Y
Y
Y
N
N
Y
N
Y
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Amphetamines** - *Amphetamines***
DESOXYN
DEXEDRINE
dextroamphetamine
dextroamphetamine ER
dextroamphetamine sulfate solution
methamphetamine
PROCENTRA
VYVANSE
zenzedi
*Analeptics** - *Analeptics***
CAFCIT
caffeine citrate solution
*Attention-Deficit/Hyperactivity Disorder (ADHD) Agents** - *ADHD
Agent - Selective Alpha Adrenergic Agonists***
clonidine ER
INTUNIV
KAPVAY
*Attention-Deficit/Hyperactivity Disorder (ADHD) Agents** - *ADHD
Agent - Selective Norepinephrine Reuptake Inhibitor***
STRATTERA
*Stimulants - Misc.** - *Stimulants - Misc.***
CONCERTA
DAYTRANA
dexmethylphenidate
dexmethylphenidate ER
FOCALIN
FOCALIN XR
METADATE CD
metadate ER
methylin ER
methylin solution
methylin TABLET
METHYLIN TABLET CHEWABLE
methylphenidate solution
methylphenidate ER
methylphenidate ER (CD)
methylphenidate ER (LA)
8
methylphenidate tablet
modafinil
NUVIGIL
PROVIGIL
QUILLIVANT XR
RITALIN LA
RITALIN SR
G
G
NP
NP
NP
NP
NP
N
Y
Y
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
NP
G
G
NP
P
G
Y
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
NP
Y
N
Y
MED
NP
MED
Y
N
Y
N
N
N
Y
Y
Y
MED
Y
N
Y
MED
MED
MED
Y
Y
Y
N
N
N
Y
Y
Y
NP
N
N
Y
MED
Y
N
Y
MED
Y
N
Y
*AMEBICIDES*
*Amebicides** - *Amebicides***
YODOXIN
*AMINOGLYCOSIDES*
*Aminoglycosides** - *Aminoglycosides***
BETHKIS
NEO-FRADIN
neomycin
paromomycin
TOBI
TOBI PODHALER
tobramycin inhalation solution
*ANALGESICS - ANTI-INFLAMMATORY*
*Antirheumatic - Enzyme Inhibitors** - *Antirheumatic - Janus Kinase
(JAK) Inhibitors***
XELJANZ
*Antirheumatic Antimetabolites** - *Antirheumatic
Antimetabolites***
OTREXUP
RHEUMATREX
RASUVO
*Anti-TNF-alpha - Monoclonal Antibodies** - *Anti-TNF-alpha Monoclonal Antibodies***
HUMIRA
*Anti-TNF-alpha - Monoclonoal Antibodies** - *Anti-TNF-alpha Monoclonoal Antibodies***
SIMPONI
SIMPONI ARIA
STELARA
*Gold Compounds** - *Gold Compounds***
RIDAURA
*Interleukin-1 Blockers** - *Interleukin-1 Blockers***
ARCALYST
*Interleukin-1 Receptor Antagonist (IL-1Ra)** - *Interleukin-1 Receptor
Antagonist (IL-1Ra)***
KINERET
9
*Interleukin-1beta Blockers** - *Interleukin-1beta Blockers***
ILARIS
*Interleukin-6 Receptor Inhibitors** - *Interleukin-6 Receptor
Inhibitors***
MED
Y
N
Y
ACTEMRA
*Nonsteroidal Anti-inflammatory Agents (NSAIDs)** - *Cyclooxygenase
2 (COX-2) Inhibitors***
MED
Y
N
Y
NP
N
N
Y
NP
G
NP
P
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
NP
NP
NP
NP
G
G
NP
NP
G
G
NP
G
G
NP
G
G
G
G
G
G
NP
G
NP
NP
NP
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CELEBREX
*Nonsteroidal Anti-inflammatory Agents (NSAIDs)** - *Nonsteroidal
Anti-inflammatory Agent Combinations***
ARTHROTEC
diclofenac-misoprostol
DUEXIS
VIMOVO
*Nonsteroidal Anti-inflammatory Agents (NSAIDs)** - *Nonsteroidal
Anti-inflammatory Agents (NSAIDs)***
ANAPROX
ANAPROX DS
CATAFLAM
DAYPRO
diclofenac potassium
diclofenac sodium
diclofenac sodium ER
EC-NAPROSYN
etodolac
etodolac ER
FELDENE
flurbiprofen
ibuprofen
INDOCIN
indomethacin
indomethacin ER
ketoprofen
ketorolac
mefenamic acid
meloxicam
MOBIC
nabumetone
NALFON
NAPRELAN
NAPROSYN
naproxen
naproxen delayed release
10
naproxen sodium
oxaprozin
piroxicam
PONSTEL
SPRIX
sulindac
tolmetin
VOLTAREN-XR
ZIPSOR
ZORVOLEX
*Phosphodiesterase 4 (PDE4) Inhibitors** - *Phosphodiesterase 4
(PDE4) Inhibitors***
OTEZLA
OTEZLA STARTER PACK
G
G
G
NP
NP
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
Y
Y
N
N
Y
Y
G
N
N
Y
MED
Y
N
Y
MED
Y
N
Y
G
NP
G
NP
G
G
G
G
NP
NP
NP
NP
G
G
NP
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Pyrimidine Synthesis Inhibitors** - *Pyrimidine Synthesis Inhibitors***
leflunomide
*Selective Costimulation Modulators** - *Selective Costimulation
Modulators***
ORENCIA
*Soluble Tumor Necrosis Factor Receptor Agents** - *Soluble Tumor
Necrosis Factor Receptor Agents***
ENBREL
*ANALGESICS - NonNarcotic*
*Analgesic Combinations** - *Analgesics-Sedatives***
alagesic capsule
ALAGESIC LQ SOLUTION
anolor 300 CAPSULE 50-325-40 MG ORAL
BUPAP
butalbital-acetaminophen
butalbital-APAP-caffeine
butalbital-ASA-caffeine
capacet
EQUAGESIC
ESGIC
FIORICET
FIORINAL
margesic
marten-tab
ORBIVAN CF
REPAN
TENCON
ZEBUTAL
11
*Analgesics-Peptide Channel Blockers** - *Selective N-Type Neuronal
Calcium Channel Blockers***
PRIALT
MED
Y
N
Y
G
N
N
Y
G
NP
G
N
N
N
N
N
N
Y
Y
Y
NP
NP
NP
NP
NP
NP
NP
NP
NP
G
G
NP
G
NP
NP
G
G
G
NP
G
NP
P
P
NP
P
NP
G
P
G
G
NP
Y
Y
N
N
N
N
N
N
N
Y
N
Y
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Salicylates** - *Salicylate Combinations***
choline & mag trisalicylate
*Salicylates** - *Salicylates***
diflunisal
MST 600
salsalate
*ANALGESICS - OPIOID*
*Opioid Agonists** - *Opioid Agonists***
ABSTRAL
ACTIQ LOLLIPOP
AVINZA
CONZIP
DEMEROL
DILAUDID
DOLOPHINE
DURAGESIC
EXALGO
fentanyl citrate lollipop
fentanyl patch
FENTORA
hydromorphone
KADIAN
LAZANDA
meperidine
meperitab
methadone
METHADOSE
morphine sulfate ER
MS CONTIN
NUCYNTA
NUCYNTA ER
OPANA
OPANA ER
OXECTA
oxycodone
OXYCONTIN
oxymorphone
oxymorphone ER
ROXICODONE
12
SUBSYS
tramadol
tramadol ER
ULTRAM
ULTRAM ER
ZOHYDRO ER
NP
G
G
NP
NP
NP
Y
N
N
N
N
N
Y
N
N
N
N
N
Y
Y
Y
Y
Y
Y
G
G
G
G
G
P
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
G
G
NP
G
G
NP
NP
G
G
G
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
*Opioid Combinations** - *Codeine Combinations***
acetaminophen-codeine
ascomp-codeine
butalbital compound/codeine
butalbital-APAP-caff-codeine
butalbital-ASA-caff-codeine
CAPITAL/CODEINE
FIORICET/CODEINE
FIORINAL/CODEINE
TYLENOL WITH CODEINE
*Opioid Combinations** - *Dihydrocodeine Combinations***
SYANLGOS-DC
*Opioid Combinations** - *Hydrocodone Combinations***
HYCET
hydrocodone-acetaminophen
hydrocodone-ibuprofen
IBUDONE
LORCET
LORCET HD
LORTAB
NORCO
reprexain
vicodin
vicodin es
vicodin hp
VICOPROFEN
XODOL
ZAMICET
ZOLVIT
*Opioid Combinations** - *Opioid Combinations***
endocet
endodan
oxycodone-acetaminophen
oxycodone-aspirin
oxycodone-ibuprofen
13
PERCOCET
PERCODAN
PRIMLEV
ROXICET SOLUTION
roxicet tablet
XARTEMIS XR
NP
NP
NP
P
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
G
NP
N
N
N
N
Y
Y
NP
G
G
G
P
NP
NP
NP
Y
Y
Y
N
N
Y
Y
Y
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
G
Y
Y
Y
N
N
N
Y
Y
Y
NP
P
P
G
NP
G
NP
NP
NP
P
NP
P
G
NP
MED
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
Y
N
Y
Y
Y
N
Y
N
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Opioid Combinations** - *Tramadol Combinations***
tramadol-acetaminophen
ULTRACET
*Opioid Partial Agonists** - *Opioid Partial Agonists***
BUNAVAIL
buprenorphine sublingual
buprenorphine-naloxone sublingual
butorphanol nasal spray
BUTRANS PATCH
SUBOXONE FILM
SUBOXONE TABLET
ZUBSOLV TABLET
*ANDROGENS-ANABOLIC*
*Anabolic Steroids** - *Anabolic Steroids***
ANADROL-50
OXANDRIN
oxandrolone
*Androgens** - *Androgens***
ANDRODERM
ANDROGEL
ANDROID
androxy
AXIRON
danazol
FIRST TESTOSTERONE CREAM
FIRST TESTOSTERONE OINTMENT
FORTESTA
METHITEST
STRIANT
TESTIM
testosterone gel
VOGELXO
AVEED
*ANORECTAL AGENTS*
*Intrarectal Steroids** - *Intrarectal Steroids***
14
colocort
CORTENEMA
CORTIFOAM
hydrocortisone enema
G
NP
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
G
G
G
G
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
G
G
G
G
G
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
NP
NP
N
N
N
N
N
N
Y
Y
Y
P
N
Y
Y
NP
NP
G
N
N
N
N
N
N
Y
Y
Y
*Rectal Combinations** - *Rectal Anesthetic/Steroids***
ANALPRAM-HC
HC pram
hydrocortisone-pramoxine
lidazone HC
lidocaine-hydrocortisone
lidocort KIT
pramcort
PROCORT
PROCTOFOAM HC
*Rectal Steroids** - *Rectal Steroids***
anucort-HC
ANUSOL-HC 2.5 %
GRx hicort
hemorrhoidal-HC
hemril-30
hydrocortisone acetate suppository
proctocare-HC
proctocream HC
procto-pak
proctosol HC
proctozone-HC
rectacort-HC
*Vasodilating Agents** - *Nitrate Vasodilating Agents***
RECTIV
*ANTHELMINTICS*
*Anthelmintics** - *Anthelmintics***
ALBENZA
BILTRICIDE
STROMECTOL
*ANTIANGINAL AGENTS*
*Antianginals-Other** - *Antianginals-Other***
RANEXA
*Nitrates** - *Nitrates***
DILATRATE-SR
IMDUR
isochron
15
isoditrate ER
ISORDIL
isosorbide dinitrate
isosorbide dinitrate ER
isosorbide mononitrate
isosorbide mononitrate ER
minitran
NITRO-BID
NITRO-DUR
nitroglycerin ER
nitroglycerin patch
nitroglycerin translingual spray
NITROLINGUAL SPRAY
NITROMIST SPRAY
NITROSTAT
nitro-time
G
NP
G
G
G
G
G
NP
NP
G
G
G
NP
NP
P
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
G
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
G
G
G
NP
G
NP
G
G
G
NP
G
NP
G
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*ANTIANXIETY AGENTS*
*Antianxiety Agents - Misc.** - *Antianxiety Agents - Misc.***
buspirone
hydroxyzine HCL syrup
hydroxyzine HCL tablet
hydroxyzine pamoate
meprobamate
VISTRIL
*Benzodiazepines** - *Benzodiazepines***
alprazolam
alprazolam dispersible tablet
alprazolam ER
ALPRAZOLAM INTENSOL CONCENTRATE
alprazolam XR
ATIVAN
chlordiazepoxide
clorazepate
diazepam
DIAZEPAM INTENSOL CONCENTRATE
lorazepam
LORAZEPAM INTENSOL CONCENTRATE
lorazepam TABLET 0.5 MG ORAL
NIRAVAM
oxazepam
TRANXENE-T
16
NP
NP
NP
N
N
N
N
N
N
Y
Y
Y
G
NP
NP
G
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
N
N
Y
G
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
NP
P
G
NP
N
N
N
N
Y
N
N
N
N
N
Y
Y
Y
Y
Y
MED
Y
N
Y
cromolyn sodium concentrate
*Asthma and Bronchodilator Agent Combinations** - *XanthineExpectorants***
G
N
N
Y
difil-G forte
*Bronchodilators - Anticholinergics** - *Bronchodilators Anticholinergics***
G
N
N
Y
NP
G
P
NP
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
NP
N
N
N
N
Y
Y
VALIUM
XANAX
XANAX XR
*ANTIARRHYTHMICS*
*Antiarrhythmics Type I-A** - *Antiarrhythmics Type I-A***
disopyramide
NORPACE
NORPACE CR
quinidine gluconate ER
quinidine sulfate
*Antiarrhythmics Type I-B** - *Antiarrhythmics Type I-B***
mexiletine
*Antiarrhythmics Type I-C** - *Antiarrhythmics Type I-C***
flecainide
propafenone
propafenone ER
RYTHMOL
RYTHMOL SR
*Antiarrhythmics Type III** - *Antiarrhythmics Type III***
amiodarone
CORDARONE
MULTAQ
pacerone
TIKOSYN
*ANTIASTHMATIC AND BRONCHODILATOR AGENTS*
*Antiasthmatic - Monoclonal Antibodies** - *Anti-IgE Monoclonal
Antibodies***
XOLAIR
*Anti-Inflammatory Agents** - *Anti-Inflammatory Agents***
ATROVENT HFA
ipratropium inhalation solution
SPIRIVA HANDIHALER
TUDORZA PRESSAIR
*Leukotriene Modulators** - *5-Lipoxygenase Inhibitors***
ZYFLO CR TABLET EXTENDED RELEASE 12 HR
ZYFLO TABLET
17
*Leukotriene Modulators** - *Leukotriene Receptor Antagonists***
ACCOLATE TABLET
montelukast
SINGULAIR
zafirlukast
*Selective Phosphodiesterase 4 (PDE4) Inhibitors** - *Selective
Phosphodiesterase 4 (PDE4) Inhibitors***
DALIRESP
NP
G
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
N
Y
Y
NP
NP
P
G
P
P
NP
NP
P
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
P
P
NP
NP
P
P
NP
G
P
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
G
G
NP
NP
P
G
NP
P
NP
P
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
Y
N
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Steroid Inhalants** - *Steroid Inhalants***
AEROSPAN
ALVESCO
ASMANEX
budesonide inhalation suspension
FLOVENT DISKUS
FLOVENT HFA
PULMICORT FLEXHALER
PULMICORT INHALATION SUSPENSION
QVAR
*Sympathomimetics** - *Adrenergic Combinations***
ADVAIR DISKUS
ADVAIR HFA
ANORO ELLIPTA
BREO ELLIPTA
COMBIVENT RESPIMAT
DULERA AEROSOL
DUONEB INHALATION SOLUTION
ipratropium-albuterol inhalation solution
SYMBICORT
*Sympathomimetics** - *Beta Adrenergics***
albuterol sulfate ER tablet
albuterol sulfate inhalation solution
albuterol sulfate syrup
albuterol sulfate tablet
ARCAPTA NEOHALER
BROVANA
FORADIL
levalbuterol inhalation solution
PERFOROMIST
PROAIR HFA
PROVENTIL HFA
SEREVENT DISKUS
terbutaline sulfate
18
VENTOLIN HFA
VOSPIRE ER
XOPENEX HFA
XOPENEX INHALATION SOLUTION
P
NP
NP
NP
N
N
N
N
N
N
Y
N
Y
Y
Y
Y
NP
NP
NP
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
NP
G
G
N
N
N
N
N
N
Y
Y
Y
P
P
N
N
N
N
Y
Y
G
NP
NP
N
N
N
N
N
N
Y
Y
Y
NP
G
N
N
N
N
Y
Y
NP
N
N
Y
P
N
N
Y
NP
N
N
Y
G
G
NP
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
*Xanthines** - *Xanthines***
ELIXOPHYLLIN
LUFYLLIN
THEO-24
theochron
theophylline ER
theophylline solution
*ANTICOAGULANTS*
*Coumarin Anticoagulants** - *Coumarin Anticoagulants***
COUMADIN
jantoven
warfarin
*Direct Factor Xa Inhibitors** - *Direct Factor Xa Inhibitors***
ELIQUIS
XARELTO
*Heparins And Heparinoid-Like Agents** - *Low Molecular Weight
Heparins***
enoxaparin
FRAGMIN
LOVENOX
*Heparins And Heparinoid-Like Agents** - *Synthetic Heparinoid-Like
Agents***
ARIXTRA
fondaparinux
*Thrombin Inhibitors** - *Thrombin Inhibitors - Hirudin Type***
IPRIVASK
*Thrombin Inhibitors** - *Thrombin Inhibitors - Selective Direct &
Reversible***
PRADAXA
*ANTICONVULSANTS*
*AMPA Glutamate Receptor Antagonists** - *AMPA Glutamate
Receptor Antagonists***
FYCOMPA
*Anticonvulsants - Benzodiazepines** - *Anticonvulsants Benzodiazepines***
clonazepam
clonazepam dispersible tablet
DIASTAT ACUDIAL
KLONOPIN
19
ONFI
NP
N
N
Y
NP
NP
G
G
G
G
NP
G
G
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
G
G
G
G
G
G
NP
NP
NP
NP
G
G
NP
NP
G
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Anticonvulsants - Misc.** - *Anticonvulsants - Misc.***
APTIOM
BANZEL
carbamazepine chewable tablet
carbamazepine ER
carbamazepine suspension
carbamazepine tablet
CARBATROL
epitol
gabapentin
KEPPRA SOLUTION
KEPPRA TABLET
KEPPRA XR
LAMICTAL
LAMICTAL CHEWABLE TABLET
LAMICTAL ODT
LAMICTAL ODT KIT
LAMICTAL STARTER KIT
LAMICTAL XR
LAMICTAL XR KIT
lamotrigine
lamotrigine chewable tablet
lamotrigine ER
levetiracetam
levetiracetam ER
levetiracetam solution
LYRICA
MYSOLINE
NEURONTIN
NEURONTIN SOLUTION
oxcarbazepine
oxcarbazepine suspension
OXTELLAR XR
POTIGA TABLET
primidone
ropiramate
TEGRETOL
TEGRETOL SUSPENSION
TEGRETOL-XR
TOPAMAX
20
TOPAMAX SPRINKLE
topiragen
topiramate sprinkle
TRILEPTAL SUSPENSION
TRILEPTAL TABLET
TROKENDI XR
VIMPAT
ZONEGRAN
zonisamide
NP
G
G
NP
NP
NP
NP
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
NP
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
NP
NP
G
N
Y
Y
N
N
N
N
N
Y
Y
Y
Y
NP
NP
NP
NP
NP
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
*Carbamates** - *Carbamates***
felbamate
felbamate suspension
FELBATOL SUSPENSION
FELBATOL TABLET
*GABA Modulators** - *GABA Modulators***
GABATRIL
SABRIL PACKET
SABRIL TABLET
tiagabine
*Hydantoins** - *Hydantoins***
DILANTIN
DILANTIN INFATABS
DILANTIN SUSPENSION
PEGANONE
PHENYTEK
phenytoin chewable
phenytoin ER
phenytoin infatabs
phenytoin suspension
*Succinimides** - *Succinimides***
CELONTIN
ethosuximide
ethosuximide solution
ZARONTIN
ZARONTIN SOLUTION
*Valproic Acid** - *Valproic Acid***
DEPAKENE
DEPAKENE SYRUP
DEPAKOTE DR
DEPAKOTE ER
DEPAKOTE SPRINKLES
21
divalproex DR
divalproex ER
divalproex sprinkle
STAVZOR
valproic acid
valproic acid solution
valproic acid syrup
G
G
G
NP
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
G
NP
N
N
N
N
Y
Y
NP
G
G
G
G
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
Y
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
NP
N
N
N
Y
Y
Y
Y
Y
Y
NP
NP
NP
NP
G
G
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
NP
G
G
G
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
*ANTIDEPRESSANTS*
*Alpha-2 Receptor Antagonists (Tetracyclics)** - *Alpha-2 Receptor
Antagonists (Tetracyclics)***
mirtazapine
REMERON
*Antidepressants - Misc.** - *Antidepressants - Misc.***
APLENZIN
budeprion SR
budeprion XL
bupropion HCl
bupropion HCL ER (SR)
bupropion HCl ER (XL)
FORFIVO XL
WELLBUTRIN
WELLBUTRIN SR
WELLBUTRIN XL
*Modified Cyclics** - *Modified Cyclics***
BRINTELLIX
VIIBRYD
VIIBRYD KIT
*Monoamine Oxidase Inhibitors (MAOIs)** - *Monoamine Oxidase
Inhibitors (MAOIs)***
EMSAM
MARPLAN
NARDIL
PARNATE
phenelzine
tranylcypromine
*Selective Serotonin Reuptake Inhibitors (SSRIs)** - *Selective
Serotonin Reuptake Inhibitors (SSRIs)***
CELEXA
citalopram
citalopram solution
escitalopram
fluoxetine
22
fluoxetine solution
fluvoxamine
fluvoxamine ER
LEXAPRO
LUVOX CR
paroxetine
paroxetine ER
PAXIL
PAXIL CR
PEXEVA TABLET
PROZAC
PROZAC WEEKLY CAPSULE DELAYED RELEASE
sertraline
ZOLOFT
fluoxetine delayed release
G
G
G
NP
NP
G
G
NP
NP
NP
NP
NP
G
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
G
N
N
N
N
Y
Y
NP
NP
G
NP
NP
NP
NP
NP
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
G
G
G
G
G
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Serotonin Modulators** - *Serotonin Modulators***
nefazodone
trazodone
*Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)** - *SerotoninNorepinephrine Reuptake Inhibitors (SNRIs)***
CYMBALTA
DESVENLAFAXINE ER TABLET
duloxetine
EFFEXOR XR
FETZIMA
FETZIMA TITRATION PACK
KHEDEZLA
PRISTIQ
venlafaxine
venlafaxine er capsule
VENLAFAXINE HCl ER TABLET
*Tricyclic Agents** - *Tricyclic Agents***
amitriptyline
ANAFRANIL
clomipramine
desipramine
doxepin
imipramine hcl
imipramine pamoate
NORPRAMIN
nortriptyline
PAMELOR
23
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
NP
NP
N
N
N
N
N
N
Y
Y
Y
P
N
N
Y
P
P
P
NP
P
N
N
N
N
N
N
N
N
Y
N
Y
Y
Y
Y
Y
OSENI
*Antidiabetic Combinations** - *Meglitinide-Biguanide
Combinations***
NP
N
Y
Y
PRANDIMET
*Antidiabetic Combinations** - *Sulfonylurea-Biguanide
Combinations***
NP
N
N
Y
G
NP
G
N
N
N
N
N
N
Y
Y
Y
NP
NP
G
N
N
N
N
N
N
Y
Y
Y
NP
NP
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
NP
N
N
N
N
Y
Y
protriptyline
SURMONTIL
TOFRANIL
TOFRANIL-PM
VIVACTIL
*ANTIDIABETICS*
*Alpha-Glucosidase Inhibitors** - *Alpha-Glucosidase Inhibitors***
acarbose
GLYSET
PRECOSE
*Antidiabetic - Amylin Analogs** - *Antidiabetic - Amylin Analogs***
SYMLIN PEN
*Antidiabetic Combinations** - *Dipeptidyl Peptidase-4 InhibitorBiguanide Combinations***
JANUMET
JANUMET XR
JENTADUETO
KAZANO
KOMBIGLYZE XR
*Antidiabetic Combinations** - *DPP-4 Inhibitor-Thiazolidinedione
Combinations***
glipizide-metformin
GLUCOVANCE
glyburide-metformin
*Antidiabetic Combinations** - *Sulfonylurea-Thiazolidinedione
Combinations***
AVANDARYL
DUETACT
pioglitazone-glimepiride
*Antidiabetic Combinations** - *Thiazolidinedione-Biguanide
Combinations***
ACTOPLUS MET
ACTOPLUS MET XR
AVANDAMET
pioglitazone-metformin
*Biguanides** - *Biguanides***
GLUCOPHAGE
GLUCOPHAGE XR
24
GLUMETZA
metformin
metformin ER
RIOMET
NP
G
G
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
NP
P
N
N
N
N
N
N
Y
Y
Y
NP
Y
N
Y
P
NP
P
P
N
N
N
N
N
Y
N
N
Y
Y
Y
Y
P
N
N
Y
P
NP
NP
P
NP
N
N
N
N
N
N
N
Y
N
Y
Y
Y
Y
Y
Y
NP
NP
G
N
N
N
N
N
N
Y
Y
Y
NP
NP
P
P
P
P
P
P
P
P
P
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Diabetic Other** - *Diabetic Other***
GLUCAGEN
GLUCAGON
PROGLYCEM
*Diabetic Other** - *Progesterone Receptor Antagonists***
KORLYM
*Dipeptidyl Peptidase-4 (DPP-4) Inhibitors** - *Dipeptidyl Peptidase-4
(DPP-4) Inhibitors***
JANUVIA
NESINA
ONGLYZA
TRADJENTA
*Dopamine Receptor Agonists - Antidiabetic** - *Dopamine Receptor
Agonists - Ergot Derivatives***
CYCLOSET
*Incretin Mimetic Agents (GLP-1 Receptor Agonists)** - *Incretin
Mimetic Agents (GLP-1 Receptor Agonists)***
BYDUREON
BYETTA
TANZEUM
VICTOZA
TRULICITY
*Insulin Sensitizing Agents** - *Thiazolidinediones***
ACTOS
AVANDIA
pioglitazone
*Insulin** - *Human Insulin***
APIDRA
APIDRA SOLOSTAR
HUMALOG KWIKPEN
HUMALOG MIX 50/50
HUMALOG MIX 50/50 KWIKPEN
HUMALOG MIX 50/50 PEN
HUMALOG MIX 75/25
HUMALOG Mix 75/25 KWIKPEN
HUMALOG MIX 75/25 PEN
HUMALOG PEN
HUMULIN 70/30 KWIKPEN
25
HUMULIN 70/30 PEN
HUMULIN N KWIKPEN
HUMULIN N Pen
HUMULIN R U-500
LANTUS
LANTUS SOLOSTAR
LEVEMIR
LEVEMIR FLEXPEN
NOVOLOG
NOVOLOG FLEXPEN
NOVOLOG MIX 70/30 *
NOVOLOG MIX 70/30 FLEXPEN
P
P
P
P
P
P
P
P
P
P
P
P
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
G
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
P
N
N
Y
Y
Y
Y
NP
G
NP
G
G
G
G
NP
NP
G
G
G
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
G
N
N
Y
*Meglitinide Analogues** - *Meglitinide Analogues***
nateglinide
PRANDIN
repaglinide
STARLIX
*Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors** - *SodiumGlucose Co-Transporter 2 (SGLT2) Inhibitors***
FARXIGA
INVOKANA
*Sulfonylureas** - *Sulfonylureas***
AMARYL
chlorpropamide
DIABETA
glimepiride
glipizide
glipizide ER
glipizide XL
GLUCOTROL
GLUCOTROL XL
glyburide
glyburide micronized
glycron
GLYNASE
tolazamide
*ANTIDIARRHEALS*
*Antidiarrheal - Chloride Channel Antagonists** - *Antidiarrheal Chloride Channel Antagonists***
FULYZAQ
*Antiperistaltic Agents** - *Antiperistaltic Agents***
diphenatol
26
diphenoxylate-atropine
lofene
LOMOTIL
lonox
MOTOFEN
opium tincture 10 MG/ML
G
G
NP
G
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
P
NP
NP
N
Y
Y
N
N
N
Y
Y
Y
MED
MED
P
Y
Y
N
N
N
N
Y
Y
Y
G
NP
G
NP
MED
N
N
N
N
Y
N
N
N
N
N
Y
Y
Y
Y
Y
NP
G
NP
G
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
G
N
N
N
N
N
N
Y
Y
Y
NP
NP
N
N
N
Y
Y
Y
NP
N
N
Y
*ANTIDOTES*
*Antidotes - Chelating Agents** - *Antidotes - Chelating Agents***
CHEMET
EXJADE
FERRIPROX
*Antidotes** - *Antidotes***
deferoxamine mesylate
DESFERAL
RADIOGARDASE
*Opioid Antagonists** - *Opioid Antagonists***
depade
EVZIO
naltrexone tablet
REVIA
VIVITROL
*ANTIEMETICS*
*5-HT3 Receptor Antagonists** - *5-HT3 Receptor Antagonists***
ANZEMET
granisetron
GRANISOL SOLUTION
ondansetron
ondansetron odt
SANCUSO
ZOFRAN
ZOFRAN ODT
ZUPLENZ
*Antiemetics - Anticholinergic** - *Antiemetics - Anticholinergic***
TIGAN
TRANSDERM-SCOP
trimethobenzamide
*Antiemetics - Miscellaneous** - *Antiemetic Combinations***
DICLEGIS
AKYNZEO
*Antiemetics - Miscellaneous** - *Antiemetics - Miscellaneous***
CESAMET
27
dronabinol
MARINOL
*Substance P/Neurokinin 1 (NK1) Receptor Antagonists** - *Substance
P/Neurokinin 1 (NK1) Receptor Antagonists***
EMEND
G
NP
N
N
N
N
Y
Y
P
N
N
Y
NP
G
G
NP
G
G
G
NP
NP
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
N
N
Y
NP
NP
NP
G
G
G
G
NP
NP
NP
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
N
N
N
N
Y
Y
G
G
N
N
N
N
Y
Y
*ANTIFUNGALS*
*Antifungals** - *Antifungals***
BIO-STATIN CAPSULE
bio-statin oral powder
flucytosine
GRIFULVIN V
griseofulvin microsize suspension
griseofulvin microsize tablet
griseofulvin ultramicrosize tablet
GRIS-PEG
LAMISIL
NYSTATIN ORAL POWDER
NYSTATIN TABLET
terbinafine
*Imidazole-Related Antifungals** - *Imidazoles***
ketoconazole
*Imidazole-Related Antifungals** - *Triazoles***
DIFLUCAN 150 MG
DIFLUCAN SUSPENSION
Diflucan TABLET (all other strengths)
fluconazole 150 mg
fluconazole suspension
fluconazole tablet (all other strengths)
itraconazole
NOXAFIL
ONMEL
SPORANOX
VFEND
voriconazole
*ANTIHISTAMINES*
*Antihistamines - Alkylamines** - *Antihistamines - Alkylamines***
ED-CHLOR-TAN
RESPA-BR
*Antihistamines - Ethanolamines** - *Antihistamines Ethanolamines***
arbinoxa
carbinoxamine Maleate
28
clemastine fumarate
DOXYTEK
KARBINAL ER
PALGIC
G
NP
NP
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
NP
G
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
G
G
G
G
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
N
N
Y
P
NP
N
N
N
N
Y
Y
MED
NP
G
P
Y
N
N
N
Y
Y
N
N
Y
Y
Y
Y
G
NP
G
G
G
NP
NP
P
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
G
N
N
Y
N
Y
Y
*Antihistamines - Non-Sedating** - *Antihistamines - Non-Sedating***
CLARINEX
CLARINEX REDITABS
desloratadine
desloratadine odt
levocetirizine
XYZAL
*Antihistamines - Phenothiazines** - *Antihistamines Phenothiazines***
phenadoz suppository
promethazine hcl
promethazine hcl suppository
promethegan suppository 12.5 mg, 25 mg
PROMETHEGAN SUPPOSITORY 50 MG
*Antihistamines - Piperidines** - *Antihistamines - Piperidines***
cyproheptadine
*ANTIHYPERLIPIDEMICS*
*Antihyperlipidemics - Combinations** - *Intest Cholest Absorp InhibHMG CoA Reductase Inhib Comb***
LIPTRUZET
VYTORIN
*Antihyperlipidemics - Misc.** - *Antihyperlipidemics - Misc.***
KYNAMRO
LOVAZA
omega-3-acid Ethyl Esters
Vascepa
*Bile Acid Sequestrants** - *Bile Acid Sequestrants***
cholestyramine light
COLESTID
colestipol
micronized colestipol
prevalite
QUESTRAN
QUESTRAN LIGHT
WELCHOL
*Fibric Acid Derivatives** - *Fibric Acid Derivatives***
ANTARA
fenofibrate
29
fenofibrate micronized
fenofibric acid
FENOGLIDE
FIBRICOR
gemfibrozil
LIPOFEN
LOFIBRA
LOPID
TRICOR
TRIGLIDE
TRILIPIX
*HMG CoA Reductase Inhibitors** - *HMG CoA Reductase Inhibitor
Combinations***
ADVICOR
SIMCOR
G
G
NP
NP
G
NP
NP
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
N
N
N
N
Y
Y
NP
G
P
G
NP
NP
NP
NP
G
NP
NP
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
Y
Y
Y
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
P
N
N
Y
NP
Y
Y
Y
G
P
N
N
N
N
Y
Y
NP
N
N
Y
*HMG CoA Reductase Inhibitors** - *HMG CoA Reductase Inhibitors***
ALTOPREV
atorvastatin
CRESTOR
fluvastatin
LESCOL
LESCOL XL
LIPITOR
LIVALO
lovastatin
MEVACOR
PRAVACHOL
pravastatin
simvastatin
ZOCOR
*Intestinal Cholesterol Absorption Inhibitors** - *Intestinal Cholesterol
Absorption Inhibitors***
ZETIA
*Microsomal Triglyceride Transfer Protein (MTP) Inhibitors** *Microsomal Triglyceride Transfer Protein Inhibitors***
JUXTAPID
*Nicotinic Acid Derivatives** - *Nicotinic Acid Derivatives***
niacin ER
NIASPAN
*ANTIHYPERTENSIVES*
*ACE Inhibitors** - *ACE Inhibitors***
ACCUPRIL
30
ACEON
ALTACE
benazepril
captopril
enalapril
EPANED
fosinopril
lisinopril
LOTENSIN
MAVIK
moexipril
perindopril
PRINIVIL
quinapril
ramipril
trandolapril
UNIVASC
VASOTEC
ZESTRIL
*Agents for Pheochromocytoma** - *Agents for
Pheochromocytoma***
DEMSER
DIBENZYLINE
*Angiotensin II Receptor Antagonists** - *Angiotensin II Receptor
Antagonists***
ATACAND
AVAPRO
BENICAR
candesartan
COZAAR
DIOVAN
EDARBI
eprosartan
irbesartan
losartan
TEVETEN
*Antiadrenergic Antihypertensives** - *Antiadrenergics - Centrally
Acting***
CATAPRES
CATAPRES-TTS
clonidine
clonidine patch
NP
NP
G
G
G
NP
G
G
NP
NP
G
G
NP
G
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
P
N
N
N
N
Y
Y
NP
NP
NP
G
NP
NP
NP
G
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
Y
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
G
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
31
guanfacine
methyldopa
TENEX
*Antiadrenergic Antihypertensives** - *Antiadrenergics - Peripherally
Acting***
CARDURA
doxazosin
MINIPRESS
prazosin
terazosin
*Antihypertensive Combinations** - *ACE Inhibitor & Calcium Channel
Blocker Combinations***
amlodipine-benazepril
LOTREL
TARKA
*Antihypertensive Combinations** - *ACE Inhibitors &
Thiazide/Thiazide-Like***
ACCURETIC
benazepril-hydrochlorothiazide
enalapril-hydrochlorothiazide
fosinopril-HCTZ
lisinopril-hydrochlorothiazide
LOTENSIN HCT
moexipril-hydrochlorothiazide
PRINZIDE
quinapril-hydrochlorothiazide
UNIRETIC
VASERETIC
ZESTORETIC
*Antihypertensive Combinations** - *Adrenolytics-Central &
Thiazide/Thiazide-Like Comb***
CLORPRES
*Antihypertensive Combinations** - *Angiotensin II Receptor Antag &
Ca Channel Blocker Comb***
AZOR
EXFORGE
amlodipine-valsartan
*Antihypertensive Combinations** - *Angiotensin II Receptor Antag &
Thiazide/Thiazide-Like***
ATACAND HCT
AVALIDE
BENICAR HCT
candesartan-HCTZ
DIOVAN HCT
G
G
NP
N
N
N
N
N
N
Y
Y
Y
NP
G
NP
G
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
NP
NP
N
N
N
N
Y
N
Y
Y
Y
NP
G
G
G
G
NP
G
NP
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
P
P
N
N
N
Y
N
N
Y
Y
Y
NP
NP
NP
G
NP
N
N
N
N
N
N
N
Y
N
Y
Y
Y
Y
Y
Y
32
NP
NP
G
G
NP
G
N
N
N
N
N
N
Y
N
N
N
N
N
Y
Y
Y
Y
Y
Y
P
NP
N
N
N
Y
Y
Y
G
G
NP
P
NP
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
TEKAMLO
*Antihypertensive Combinations** - *Direct Renin Inhibitors &
Thiazide/Thiazide-Like Comb***
NP
N
N
Y
TEKTURNA HCT
*Antihypertensive Combinations** - *Direct Renin Inhibitors-Ca
Channel Blocker-Thiazide Comb***
NP
N
N
Y
NP
N
N
Y
NP
N
Y
Y
NP
N
N
Y
G
NP
N
N
N
N
Y
Y
G
G
N
N
N
N
Y
Y
NP
Y
N
Y
EDARBYCLOR
HYZAAR
irbesartan-HCTZ
losartan-HCTZ
TEVETEN HCT
valsartan-HCTZ
*Antihypertensive Combinations** - *Angiotensin II Receptor Ant-Ca
Channel Blocker-Thiazides***
EXFORGE HCT
TRIBENZOR
*Antihypertensive Combinations** - *Beta Blocker & Diuretic
Combinations***
atenolol-chlorthalidone
bisoprolol-hydrochlorothiazide
CORZIDE
DUTOPROL
LOPRESSOR HCT
metoprolol-hydrochlorothiazide
nadolol-bendroflumethiazide
TENORETIC
ZIAC
*Antihypertensive Combinations** - *Direct Renin Inhibitors & Calcium
Channel Blocker Comb***
AMTURNIDE
*Antihypertensives - Misc.** - *Antihypertensives - Misc.***
VECAMYL
*Direct Renin Inhibitors** - *Direct Renin Inhibitors***
TEKTURNA
*Selective Aldosterone Receptor Antagonists (SARAs)** - *Selective
Aldosterone Receptor Antagonists (SARAs)***
eplerenone
INSPRA
*Vasodilators** - *Vasodilators***
hydralazine
minoxidil
*ANTI-INFECTIVE AGENTS - MISC.*
*Anti-infective Agents - Misc.** - *Anti-infective Agents - Misc.***
CAYSTON
33
colistimethate sodium
COLY-MYCIN M
FIRST-VANCOMYCIN
FLAGYL
FLAGYL ER
metronidazole
NEBUPENT
PRIMSOL
TINDAMAX
tinidazole
trimethoprim
VANCOCIN
vancomycin
XIFAXAN
*Anti-infective Misc. - Combinations** - *Anti-infective Misc. Combinations***
BACTRIM
BACTRIM DS
E.S.P. suspension
erythromycin-sulfisoxazole suspension
SEPTRA
SEPTRA DS
SMZ-TMP DS
sulfamethoxazole-TMP DS
sulfamethoxazole-trimethoprim suspension
sulfamethoxazole-trimethoprim tablet
sulfatrim pediatric suspension
G
NP
NP
NP
NP
G
P
NP
NP
G
G
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
G
G
NP
NP
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
N
N
Y
NP
G
N
N
N
N
Y
Y
NP
P
N
N
N
N
Y
Y
G
NP
NP
N
N
N
N
N
N
Y
Y
Y
*Antiprotozoal Agents** - *Antiprotozoal Agents***
ALINIA
*Ketolides** - *Ketolides***
KETEK
*Lincosamides** - *Lincosamides***
CLEOCIN
clindamycin
*Oxazolidinones** - *Oxazolidinones***
SIVEXTRO
ZYVOX
*ANTIMALARIALS*
*Antimalarial Combinations** - *Antimalarial Combinations***
atovaquone-proguanil
COARTEM
MALARONE
34
*Antimalarials** - *Antimalarials***
ARALEN
chloroquine
DARAPRIM
hydroxychloroquine
mefloquine
PLAQUENIL
QUALAQUIN
quinine sulfate
NP
G
NP
G
G
NP
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
P
N
N
Y
G
N
N
Y
NP
NP
N
N
N
N
Y
Y
G
G
P
NP
NP
G
NP
G
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
P
P
MED
N
N
Y
N
N
N
Y
Y
Y
NP
G
Y
Y
N
N
Y
Y
P
P
N
N
N
N
Y
Y
*ANTIMYASTHENIC AGENTS*
*Antimyasthenic Agents** - *Antimyasthenic Agents***
MESTINON
*ANTIMYASTHENIC/CHOLINERGIC AGENTS*
*Antimyasthenic/Cholinergic Agents** - *Antimyasthenic/Cholinergic
Agents***
pyridostigmine bromide
*ANTIMYCOBACTERIAL AGENTS*
*Anti TB Combinations** - *Anti TB Combinations***
RIFAMATE
RIFATER
*Antimycobacterial Agents** - *Antimycobacterial Agents***
ethambutol
isoniazid
MYAMBUTOL
PASER PACKET
PRIFTIN
pyrazinamide
RIFADIN
rifampin
SIRTURO
TRECATOR
*ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*
*Alkylating Agents** - *Alkylating Agents***
HEXALEN
MYLERAN
TREANDA
*Alkylating Agents** - *Imidazotetrazines***
TEMODAR
temozolomide
*Alkylating Agents** - *Nitrogen Mustards***
ALKERAN
LEUKERAN
35
*Antimetabolites** - *Antimetabolites***
capecitabine
mercaptopurine
methotrexate
PURINETHOL
TABLOID
TREXALL
XELODA
azacitidine
DACOGEN
decitabine
FOLOTYN
PURIXAN
VIDAZA
*Antineoplastic - Hedgehog Pathway Inhibitors** - *Antineoplastic Hedgehog Pathway Inhibitors***
ERIVEDGE
*Antineoplastic - Hormonal and Related Agents** - *Androgen
Biosynthesis Inhibitors***
ZYTIGA
G
G
G
NP
P
NP
NP
G
MED
MED
MED
NP
MED
Y
N
N
N
N
N
Y
Y
Y
Y
Y
N
Y
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
Y
N
Y
P
Y
N
Y
NP
N
N
Y
G
NP
G
P
NP
N
N
N
N
Y
N
N
N
N
N
Y
Y
Y
Y
Y
NP
NP
G
N
N
N
N
N
N
Y
Y
Y
G
NP
NP
G
NP
G
N
N
N
N
N
N
N
Y
N
N
Y
N
Y
Y
Y
Y
Y
Y
MED
N
N
Y
*Antineoplastic - Hormonal and Related Agents** - *Antiadrenals***
LYSODREN
*Antineoplastic - Hormonal and Related Agents** - *Antiandrogens***
bicalutamide
CASODEX
flutamide
NILANDRON
XTANDI
*Antineoplastic - Hormonal and Related Agents** - *Antiestrogens***
FARESTON
SOLTAMOX
tamoxifen
*Antineoplastic - Hormonal and Related Agents** - *Aromatase
Inhibitors***
anastrozole
ARIMIDEX
AROMASIN
exemestane
FEMARA
letrozole
*Antineoplastic - Hormonal and Related Agents** - *Estrogen Receptor
Antagonist***
FASLODEX
36
*Antineoplastic - Hormonal and Related Agents** - *EstrogensAntineoplastic***
EMCYT
*Antineoplastic - Hormonal and Related Agents** - *Gonadotropin
Releasing Hormone (GnRH) Antagonists***
FIRMAGON
P
N
N
Y
MED
Y
N
Y
MED
MED
MED
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
G
N
N
N
N
Y
Y
NP
Y
N
Y
NP
NP
Y
Y
N
N
Y
Y
NP
MED
Y
Y
N
N
Y
Y
NP
Y
N
Y
NP
NP
NP
Y
Y
Y
N
N
N
Y
Y
Y
NP
NP
P
Y
Y
Y
N
N
N
Y
Y
Y
*Antineoplastic - Hormonal and Related Agents** - *LHRH Analogs***
ELIGARD KIT
leuprolide acetate kit
LUPRON DEPOT KIT
TRELSTAR DEPOT
TRELSTAR LA
TRELSTAR LA MIXJECT
VANTAS KIT
ZOLADEX IMPLANT
*Antineoplastic - Hormonal and Related Agents** - *ProgestinsAntineoplastic***
MEGACE
megestrol acetate
*Antineoplastic - Immunomodulators** - *Antineoplastic Immunomodulators***
POMALYST
*Antineoplastic Enzyme Inhibitors** - *Antineoplastic - BRAF Kinase
Inhibitors***
TAFINLAR
ZELBORAF
*Antineoplastic Enzyme Inhibitors** - *Antineoplastic - Histone
Deacetylase Inhibitors***
ZOLINZA
BELEODAQ
*Antineoplastic Enzyme Inhibitors** - *Antineoplastic - MEK
Inhibitors***
MEKINIST
*Antineoplastic Enzyme Inhibitors** - *Antineoplastic - mTOR Kinase
Inhibitors***
AFINITOR
AFINITOR DISPERZ
TORISEL
*Antineoplastic Enzyme Inhibitors** - *Antineoplastic - Multikinase
Inhibitors***
NEXAVAR
STIVARGA
SUTENT
*Antineoplastic Enzyme Inhibitors** - *Antineoplastic - Tyrosine Kinase
Inhibitors***
37
BOSULIF
CAPRELSA
COMETRIQ KIT
GILOTRIF
GLEEVEC
ICLUSIG
IMBRUVICA
INLYTA
SPRYCEL
TARCEVA
TASIGNA
TYKERB
VOTRIENT
XALKORI
ZYKADIA
*Antineoplastic Enzyme Inhibitors** - *Janus Associated Kinase (JAK)
Inhibitors***
JAKAFI
NP
NP
NP
NP
P
NP
NP
NP
NP
P
NP
NP
NP
NP
NP
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
Y
N
N
Y
N
Y
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
Y
N
Y
MED
MED
G
MED
P
MED
MED
MED
MED
Y
Y
N
Y
N
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
N
N
Y
P
Y
N
Y
MED
MED
N
Y
N
N
Y
Y
MED
N
N
Y
NP
Y
N
Y
*Antineoplastics Misc.** - *Antineoplastics Misc.***
ACTIMMUNE
ALFERON N
hydroxyurea
INTRON-A
MATULANE
SYLATRON KIT
KEYTRUDA
PROLEUKIN
SYNRIBO
*Antineoplastics Misc.** - *Retinoids***
tretinoin capsule
*Antineoplastics Misc.** - *Selective Retinoid X Receptor Agonists***
TARGRETIN
*Chemotherapy Rescue/Antidote Agents** - *Folic Acid Antagonists
Rescue Agents***
leucovorin calcium
FUSILEV
*Chemotherapy Rescue/Antidote Agents** - *Urinary Tract Protective
Agents***
MESNEX
*Topoisomerase I Inhibitors** - *Topoisomerase I Inhibitors***
HYCAMTIN CAPSULE
*Antineoplastic- Angiogenesis Inhibitors**
38
AVASTIN
MED
Y
N
Y
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
MED
MED
Y
Y
N
N
Y
Y
MED
MED
NP
Y
Y
Y
N
N
N
Y
Y
Y
MED
MED
Y
Y
N
N
Y
Y
MED
MED
Y
Y
N
N
Y
Y
NP
Y
N
Y
G
G
N
N
N
N
Y
Y
NP
N
N
Y
NP
G
N
N
N
N
Y
Y
*Antineoplastic- Antibodies***
CYRAMZA
ZALTRAP
RITUXAN
ADCETRIS
ARZERRA
ERBITUX
GAZYVA
HERCEPTIN
PERJETA
VECTIBIX
YERVOY
KADCYLA
*Antineoplastic- Enzymes***
ERWINAZE
ONCASPAR
*Antineoplastic Mitotic Inhibitor***
HALAVEN
IXEMPRA
JEVTANA
*Antineoplastic-Antibiotics***
mitoxantrone
VALSTAR
*Antineoplastic Enzyme Inhibitors** - *Antineoplastic - Proteasome
Inhibitors***
KYPROLIS
VELCADE
*Antineoplastic Enzyme Inhibitors** - *Antineoplastic Phosphatidylinositol 3-Kinase Inhibitor***
ZYDELIG
*ANTIPARKINSON AGENTS*
*Antiparkinson Anticholinergics** - *Antiparkinson Anticholinergics***
benztropine mesylate
trihexyphenidyl
*Antiparkinson COMT Inhibitors** - *Central/Peripheral COMT
Inhibitors***
TASMAR
*Antiparkinson COMT Inhibitors** - *Peripheral COMT Inhibitors***
COMTAN
entacapone
*Antiparkinson Dopaminergics** - *Antiparkinson Dopaminergics***
39
amantadine
bromocriptine mesylate
PARLODEL
APOKYN
G
G
NP
MED
N
N
N
Y
N
N
N
N
Y
Y
Y
Y
G
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
P
NP
NP
G
NP
NP
G
G
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
P
NP
G
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
G
G
NP
N
N
N
N
N
N
Y
Y
Y
NP
NP
P
G
N
N
N
N
N
Y
N
N
Y
Y
Y
Y
NP
NP
NP
NP
NP
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Antiparkinson Dopaminergics** - *Levodopa Combinations***
carbidopa-levodopa
carbidopa-levodopa dispersible
carbidopa-levodopa ER
SINEMET CR
STALEVO
*Antiparkinson Dopaminergics** - *Nonergoline Dopamine Receptor
Agonists***
MIRAPEX
MIRAPEX ER
NEUPRO PATCH
pramipexole
REQUIP
REQUIP XL
ropinirole
ropinirole ER
*Antiparkinson Monoamine Oxidase Inhibitors** - *Antiparkinson
Monoamine Oxidase Inhibitors***
AZILECT
ELDEPRYL
selegiline
ZELAPAR
*ANTIPSYCHOTICS/ANTIMANIC AGENTS*
*Antimanic Agents** - *Antimanic Agents***
lithium carbonate
lithium carbonate ER
LITHOBID
*Antipsychotics - Misc.** - *Antipsychotics - Misc.***
EQUETRO
GEODON
LATUDA
ziprasidone
*Benzisoxazoles** - *Benzisoxazoles***
FANAPT
FANAPT TITRATION PACK
INVEGA
RISPERDAL
RISPERDAL M
40
RISPERDAL SOLUTION
risperidone
risperidone ODT
risperidone solution
NP
G
G
G
N
N
N
N
Y
N
N
N
Y
Y
Y
Y
G
G
N
N
N
N
Y
Y
G
NP
NP
NP
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
N
Y
Y
G
NP
P
N
N
N
N
Y
N
Y
Y
Y
G
N
N
Y
G
G
NP
NP
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
G
G
G
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
MED
NP
N
N
N
Y
N
Y
Y
Y
Y
G
N
N
Y
*Butyrophenones** - *Butyrophenones***
haloperidol
haloperidol concentrate
*Dibenzapines** - *Dibenzodiazepines***
clozapine
CLOZARIL
FAZACLO
VERSACLOZ
*Dibenzapines** - *Dibenzo-oxepino Pyrroles***
SAPHRIS
*Dibenzapines** - *Dibenzothiazepines***
quetiapine
SEROQUEL
SEROQUEL XR
*Dibenzapines** - *Dibenzoxazepines***
loxapine
*Dibenzapines** - *Thienbenzodiazepines***
olanzapine
olanzapine ODT
ZYPREXA
ZYPREXA ZYDIS
*Phenothiazines** - *Phenothiazines***
chlorpromazine
compazine suppository
compro suppository
fluphenazine
perphenazine
prochlorperazine
thioridazine
trifluoperazine
*Quinolinone Derivatives** - *Quinolinone Derivatives***
ABILIFY
ABILIFY MAINTENA INJ
ABILIFY SOLUTION
*Thioxanthenes** - *Thioxanthenes***
thiothixene
*ANTIVIRALS*
41
*Antiretrovirals** - *Antiretroviral Combinations***
ATRIPLA
COMBIVIR
COMPLERA
EPZICOM
KALETRA
lamivudine-zidovudine
STRIBILD
TRUVADA
TRIUMEQ
*Antiretrovirals** - *Antiretrovirals - CCR5 Antagonists (Entry
Inhibitor)***
SELZENTRY
NP
NP
NP
NP
P
G
NP
P
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
MED
Y
N
Y
NP
NP
N
N
N
N
Y
Y
P
NP
NP
P
P
P
P
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
G
NP
P
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
G
G
NP
P
N
N
N
N
N
N
N
N
Y
Y
Y
Y
*Antiretrovirals** - *Antiretrovirals - Fusion Inhibitors***
FUZEON
*Antiretrovirals** - *Antiretrovirals - Integrase Inhibitors***
ISENTRESS
TIVICAY
*Antiretrovirals** - *Antiretrovirals - Protease Inhibitors***
APTIVUS
CRIXIVAN
INVIRASE
LEXIVA
NORVIR
PREZISTA
REYATAZ
VIRACEPT
*Antiretrovirals** - *Antiretrovirals - RTI-Non-Nucleoside Analogues***
EDURANT
INTELENCE
nevirapine
RESCRIPTOR
SUSTIVA
VIRAMUNE SUSPENSION
VIRAMUNE TABLET
VIRAMUNE XR TABLET
*Antiretrovirals** - *Antiretrovirals - RTI-Nucleoside AnaloguesPurines***
abacavir
didanosine
VIDEX EC
VIDEX SOLUTION
42
ZIAGEN SOLUTION
ZIAGEN TABLET
*Antiretrovirals** - *Antiretrovirals - RTI-Nucleoside AnaloguesPyrimidines***
EMTRIVA
EMTRIVA SOLUTION
EPIVIR HBV SOLUTION
EPIVIR TABLET
lamivudine
*Antiretrovirals** - *Antiretrovirals - RTI-Nucleoside AnaloguesThymidines***
RETROVIR
RETROVIR SYRUP
stavudine capsule
stavudine solution
ZERIT
zidovudine
zidovudine syrup
NP
NP
N
N
N
N
Y
Y
P
P
NP
NP
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
NP
G
G
NP
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
P
N
N
Y
MED
MED
MED
MED
P
P
MED
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
G
NP
NP
NP
NP
P
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
NP
NP
P
NP
NP
MED
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
*Antiretrovirals** - *Antiretrovirals - RTI-Nucleotide Analogues***
VIREAD
*CMV Agents** - *CMV Agents***
cidofovir
CYTOVENE
FOSCAVIR
ganciclovir
VALCYTE SOLUTION
VALCYTE TABLET
VISTIDE
*Hepatitis Agents** - *Hepatitis B Agents***
adefovir
BARACLUDE
BARACLUDE SOLUTION
HEPSERA
TYZEKA
entecavir
*Hepatitis Agents** - *Hepatitis C Agents***
COPEGUS
HARVONI
INCIVEK
MODERIBA
OLYSIO
PEGASYS
43
PEG-INTRON
REBETOL
RIBASPHERE CAPSULE
RIBASPHERE TABLET 200 MG ORAL
RIBASPHERE TABLET 400 MG, 600 MG
RIBATAB
ribavirin
SOVALDI
VICTRELIS
RIBAPAK
MED
NP
P
P
NP
NP
G
NP
NP
NP
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
NP
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
G
NP
N
N
N
N
Y
Y
NP
G
N
N
N
N
Y
Y
NP
NP
N
N
N
N
Y
Y
NP
N
N
Y
NP
N
N
Y
NP
P
NP
N
N
N
N
N
N
Y
Y
Y
MED
N
N
Y
NP
Y
N
Y
NP
Y
N
Y
*Herpes Agents** - *Herpes Agents - Purine Analogues***
acyclovir
valacyclovir
VALTREX
ZOVIRAX
*Herpes Agents** - *Herpes Agents - Thymidine Analogues***
famciclovir
FAMVIR
*Influenza Agents** - *Influenza Agents***
FLUMADINE
rimantadine
*Influenza Agents** - *Neuraminidase Inhibitors***
RELENZA
TAMIFLU
*Respiratory Syncytial Virus (RSV) Agents** - *RSV Agents - Nucleoside
Analogues***
VIRAZOLE
*Antiretrovirals** TYBOST
*ASSORTED CLASSES*
*Chelating Agents** - *Chelating Agents***
CUPRIMINE
DEPEN TITRATABS
SYPRINE
*Enzymes** - *Enzymes***
XIAFLEX
*Immunomodulators** - *Antileprotics***
THALOMID
*Immunomodulators** - *Immunomodulators for Myelodysplastic
Syndromes***
REVLIMID
*Immunosuppressive Agents** - *Cyclosporine Analogs***
44
cyclosporine
cyclosporine modified
gengraf
NEORAL
SANDIMMUNE
*Immunosuppressive Agents** - *Immune Globulin
Immunosuppressants***
ATGAM
THYMOGLOBULIN
*Immunosuppressive Agents** - *Inosine Monophosphate
Dehydrogenase Inhibitors***
CELLCEPT
mycophenolate mofetil
mycophenolic acid
G
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
MED
MED
N
N
N
N
Y
Y
NP
G
G
N
N
N
N
N
N
Y
Y
Y
NP
P
NP
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
MED
N
N
Y
NP
G
NP
N
N
N
N
N
N
Y
Y
Y
MED
N
N
Y
G
NP
G
G
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
MED
Y
N
Y
MED
Y
N
Y
*Immunosuppressive Agents** - *Macrolide Immunosuppressants***
ASTAGRAF XL
HECORIA
PROGRAF
RAPAMUNE
tacrolimus
ZORTRESS
*Immunosuppressive Agents** - *Monoclonal Antibodies***
SIMULECT
*Immunosuppressive Agents** - *Purine Analogs***
AZASAN
azathioprine
IMURAN
*Immunosuppressive Agents** - *Selective T-Cell Costimulation
Blockers***
NULOJIX
*Potassium Removing Resins** - *Potassium Removing Resins***
kalexate
KAYEXALATE
kionex
sodium polystyrene sulfonate
SPS SUSPENSION
*Systemic Lupus Erythematosus Agents** - *B-Lymphocyte Stimulator
(BLyS)-Specific Inhibitors***
BENLYSTA
*Lymphatic Agents***
SYLVANT
*BETA BLOCKERS*
*Alpha-Beta Blockers** - *Alpha-Beta Blockers***
45
carvedilol
COREG
COREG CR
labetalol
TRANDATE
G
NP
P
G
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
G
G
G
P
NP
NP
NP
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
NP
NP
NP
NP
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
Y
N
Y
NP
NP
NP
Y
Y
Y
N
N
N
Y
Y
Y
NP
N
N
Y
*Beta Blockers Cardio-Selective** - *Beta Blockers Cardio-Selective***
acebutolol
atenolol
betaxolol
bisoprolol
BYSTOLIC
KERLONE
LOPRESSOR
metoprolol Succinate ER
metoprolol tartrate
SECTRAL
TENORMIN
TOPROL XL
ZEBETA
*Beta Blockers Non-Selective** - *Beta Blockers Non-Selective***
BETAPACE
BETAPACE AF
CORGARD
INDERAL LA
INDERAL XL
LEVATOL
nadolol
propranolol
propranolol ER
sorine
sotalol
*BIOLOGICALS MISC*
*Biologicals Misc** - *Biologicals Misc***
ADAGEN
*Allergenic Extracts***
GRASTEK
ORALAIR
RAGWITEK
*CALCIUM CHANNEL BLOCKERS*
*Calcium Channel Blockers** - *Calcium Channel Blockers***
ADALAT CC
46
afeditab
amlodipine
CALAN
CALAN SR
CARDENE SR
CARDIZEM
CARDIZEM CD
CARDIZEM LA
cartia XT
DILACOR XT
dilt-CD
diltiazem
diltiazem CD
diltiazem ER
dilt-XR
diltzac
felodipine
ISOPTIN SR
matzim LA
nicardipine
nifediac CC
nifedical XL
nifedipine
nifedipine ER
nimodipine
nisoldipine
nisoldipine ER
NORVASC
NYMALYZE
PROCARDIA
PROCARDIA XL
SULAR
taztia XT
TIAZAC
verapamil
verapamil ER
VERELAN
VERELAN PM
G
G
NP
NP
NP
NP
NP
NP
G
NP
G
G
G
G
G
G
G
NP
G
G
G
G
G
G
G
G
G
NP
NP
NP
NP
NP
G
NP
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
N
N
Y
*CARDIOTONICS*
*Cardiac Glycosides** - *Cardiac Glycosides***
digox
47
digoxin
LANOXIN
G
NP
N
N
N
N
Y
Y
NP
N
N
Y
NP
NP
NP
N
N
N
N
N
N
Y
Y
Y
MED
MED
NP
MED
NP
MED
NP
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
P
NP
P
Y
Y
Y
N
N
N
Y
Y
Y
NP
NP
G
Y
Y
Y
N
N
N
Y
Y
Y
NP
Y
N
Y
P
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
G
NP
N
N
N
N
N
N
Y
Y
Y
*CARDIOVASCULAR AGENTS – MISC.*
*Cardiovascular Agents Misc. – Combinations** - *Nitrate & Vasodilator
Combinations***
BIDIL
*Impotence Agents** - *Prostaglandin – Impotence Agents***
CAVERJECT (applies only to plans with ED coverage)
EDEX (applies only to plans with ED coverage)
MUSE (applies only to plans with ED coverage)
*Prostaglandin Vasodilators** - *Prostaglandin Vasodilators***
epoprostenol
REMODULIN
TYVASO
VELETRI
VENTAVIS
FLOLAN
ORENITRAM
*Pulmonary Hypertension – Endothelin Receptor Antagonists** *Pulmonary Hypertension – Endothelin Receptor Antagonists***
LETAIRIS
OPSUMIT
TRACLEER
*Pulmonary Hypertension – Phosphodiesterase Inhibitors** *Pulmonary Hypertension – Phosphodiesterase Inhibitors***
ADCIRCA
REVATIO
sildenafil citrate
*Pulmonary Hypertension – Sol Guanylate Cyclase Stimulator** - *Pulm
Hyperten-Soluble Guanylate Cyclase Stimulator (sGC)***
ADEMPAS
*Impotence Agents** - *Selective cGMP Phosphodiesterase Type 5
Inhibitor Agents***
CIALIS (applies only to plans with ED coverage)
LEVITRA (applies only to plans with ED coverage)
STAXYN (applies only to plans with ED coverage)
STENDRA (applies only to plans with ED coverage)
VIAGRA (applies only to plans with ED coverage)
*CEPHALOSPORINS*
st
st
*Cephalosporins – 1 Generation** - *Cephalosporins – 1
Generation***
cefadroxil
cephalexin
KEFLEX
48
nd
Generation***
nd
cefaclor
cefprozil
CEFTIN
cefuroxime
rd
rd
Generation***
CEDAX
cefdinir
cefpodoxime
SPECTRACEF
SUPRAX
G
G
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
G
G
NP
NP
G
G
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
G
G
G
G
G
G
NP
NP
G
G
G
G
G
NP
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
Y
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*CONTRACEPTIVES*
*Combination Contraceptives – Oral** - *Biphasic Contraceptives –
Oral***
azurette
desogestrel-ethinyl estradiol
kariva
LO LOESTRIN FE
MIRCETTE
pimtrea
viorele
*Combination Contraceptives – Oral** - *Combination Contraceptives –
Oral***
altavera
alyacen
apri
aubra
aviane
balziva
BEYAZ
BREVICON
briellyn
chateal
cryselle
cyclafem
dasetta
DESOGEN
drospirenone-ethinyl estradiol
elinest
emoquette
enskyce
49
estarylla
FALESSA
falmina
FEMCON FE
GENERESS FE
gianvi
gildagia
gildess
gildess FE
junel
junel FE
kelnor
kurvelo
larin
larin Fe
lessina
levonorgestrel-ethinyl estradiol
levora
LOESTRIN
LOESTRIN FE
loryna
low-ogestrel
lutera
marlissa
microgestin
microgestin FE
MINASTRIN 24 FE
MODICON
mono-linyah
mononessa
necon
NECON 1/50
NECON 10/11
norgestimate-eth estradiol
NORINYL
nortrel
ocella
orsythia
ORTHO-CEPT
ORTHO-CYCLEN
ORTHO-NOVUM
G
NP
G
NP
NP
G
G
G
G
G
G
G
G
G
G
G
G
G
NP
NP
G
G
G
G
G
G
NP
NP
G
G
G
NP
NP
G
NP
G
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
Y
Y
N
N
N
Y
Y
N
Y
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
50
OVCON
philith
pirmella
portia
previfem
reclipsen
SAFYRAL
solia
sprintec
sronyx
syeda
vestura
vyfemla
wera
wymzya Fe
YASMIN
YAZ
zarah
zenchent
zenchent FE
zeosa
zovia
*Combination Contraceptives – Oral** - *Extended-Cycle
Contraceptives – Oral***
amethia
amethia Lo
camrese
camrese Lo
daysee
introvale
jolessa
levonorgest-Eth Estrad 91-Day
LOSEASONIQUE
Quartette
quasense
SEASONIQUE
*Combination Contraceptives – Oral** - *Four Phase Contraceptives –
Oral***
NATAZIA
*Combination Contraceptives – Oral** - *Triphasic Contraceptives –
Oral***
alyacen
NP
G
G
G
G
G
NP
G
G
G
G
G
G
G
G
NP
NP
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
G
G
G
G
G
G
NP
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
Y
Y
G
N
N
Y
51
aranelle
caziant
cesia
cyclafem
CYCLESSA
dasetta
enpresse
ESTROSTEP FE
leena
levonest
myzilra
necon
norgestim-eth estrad
nortrel
ORTHO- NOVUM
ORTHO TRI-CYCLEN
ORTHO TRI-CYCLEN LO
pirmella
tilia Fe
tri-estarylla
tri-legest Fe
tri-linyah
trinessa
TRI-NORINYL
tri-previfem
tri-sprintec
trivora
velivet
*Combination Contraceptives – Transdermal** - *Combination
Contraceptives – Transdermal***
ORTHO EVRA PATCH
xulane patch
*Combination Contraceptives - Vaginal** - *Combination
Contraceptives - Vaginal***
NUVARING
G
G
G
G
NP
G
G
NP
G
G
G
G
G
G
NP
NP
NP
G
G
G
G
G
G
NP
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
Y
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
Y
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
G
N
N
Y
N
Y
Y
NP
N
Y
Y
MED
N
N
Y
MED
MED
N
N
N
N
Y
Y
*Copper Contraceptives - IUD** - *Copper Contraceptives - IUD***
Paragard Intrauterine Copper INTRAUTERINE DEVICE INTRAUTERINE
*Progestin Contraceptives - Implants** - *Progestin Contraceptives Implants***
Implanon IMPLANT 68 MG SUBCUTANEOUS*
Nexplanon IMPLANT 68 MG SUBCUTANEOUS*
*Progestin Contraceptives - Injectable** - *Progestin Contraceptives Injectable***
52
DEPO PROVERA INJ
DEPO-SUBQ PROVERA INJ
medroxyprogesterone acetate inj
MED
MED
MED
N
N
N
N
N
N
Y
Y
Y
MED
MED
N
N
N
N
Y
Y
G
G
G
G
G
G
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
G
G
NP
G
NP
G
NP
NP
NP
G
NP
NP
G
G
NP
NP
NP
NP
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Progestin Contraceptives - IUD** - *Progestin Contraceptives - IUD***
Mirena INTRAUTERINE DEVICE 20 MCG/24HR INTRAUTERINE
Skyla INTRAUTERINE DEVICE 13.5 MG INTRAUTERINE
*Progestin Contraceptives - Oral** - *Progestin Contraceptives Oral***
camila
errin
heather
jencycla
jolivette
lyza
nora-be
norethindrone
NOR-QD
ORTHO MICRONOR
*CORTICOSTEROIDS*
*Glucocorticosteroids** - *Glucocorticosteroids***
asmalpred
asmalpred plus
baycadron
budesonide ER
CORTEF
dexamethasone elixir
dexamethasone intensol concentrate
dexamethasone tablet
DEXPAK
ENTOCORT EC
FLO-PRED
hydrocortisone tablet
MEDROL PAK
MEDROLTABLET
methylprednisolone pak
methylprednisolone tablet
MILLIPRED
MILLIPRED DP
ORAPRED ODT
ORAPRED SOLUTION
PEDIAPRED SOLUTION
prednisolone sodium phosphate solution
53
prednisolone solution
prednisolone syrup
prednisone
PREDNISONE INTENSOL CONCENTRATE
prednisone pak
PRELONE SYRUP
RAYOS
UCERIS
VERIPRED
G
G
G
NP
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
N
N
Y
G
NP
NP
N
N
N
N
N
N
Y
Y
Y
G
G
G
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
NP
N
N
N
N
Y
Y
G
G
G
G
G
G
G
G
G
G
G
NP
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Mineralocorticoids** - *Mineralocorticoids***
fludrocortisone
*COUGH/COLD/ALLERGY*
*Antitussives** - *Antitussive - Nonnarcotic***
benzonatate
TESSALON PERLES
ZONATUSS
*Antitussives** - *Antitussive - Opioid***
hydrocodone-homatropine syrup
hydrocodone-homatropine tablet
hydromet syrup
tussigon
*Cough/Cold/Allergy Combinations** - *Antitussive-Expectorant Decongest-Antihist***
ALBATUSSIN NN LIQUID
NEOTUSS-D LIQUID
*Cough/Cold/Allergy Combinations** - *Antitussive-Expectorant***
cheratussin AC
gani-tuss NR liquid
guaiatussin ac syrup
guaifenesin AC syrup
guaifenesin-codeine solution
guaifenesin-codeine syrup
guiatuss AC syrup
iophen C-NR liquid
m-clear WC solution
myci-GC solution
mytussin AC syrup
NORTUSS-EX LIQUID
relcof C solution
robafen AC syrup
romilar AC solution
virtussin A/C solution
54
*Cough/Cold/Allergy Combinations** - *Antitussive-ExpectorantsAntihistamine***
NP
N
N
Y
NP
G
NP
NP
NP
NP
G
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
NP
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
GILPHEX TR
*Cough/Cold/Allergy Combinations** - *Decongestant-Antihistamine
w/ Expectorant***
NP
N
N
Y
DECON-G LIQUID
*Cough/Cold/Allergy Combinations** - *Non-Narc AntitussiveAntihistamine***
NP
N
N
Y
promethazine-DM SYRUP
*Cough/Cold/Allergy Combinations** - *Non-Narc AntitussiveDecongestant-Antihistamine***
G
N
N
Y
G
NP
NP
G
NP
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
TUSNEL
*Cough/Cold/Allergy Combinations** - *Antitussive-ExpectorantsDecongestant***
ALBATUSSIN
cheratussin DAC solution
EXACTUSS LIQUID
GILTUSS LIQUID
GILTUSS PED-C LIQUID
GILTUSS TR
guaifenesin DAC syrup
mytussin DAC solution
TGQ 30PSE/150GFN/15DM SYRUP
TUSNEL Ped-C SYRUP
TUSSO-DMR
Z-COF I SUSPENSION
*Cough/Cold/Allergy Combinations** - *Decongestant &
Antihistamine***
CLARINEX-D 12 Hour
CLARINEX-D 24 Hour
DECON-A ELIXIR
RELHIST
RESCON-JR
RESCON-MX
SEMPREX-D
*Cough/Cold/Allergy Combinations** - *Decongestant w/
Expectorant***
bromfed DM syrup
CARBAPEH 12 Ped SUSPENSION
CARBAPHEN PED SUSPENSION
dimetane DX syrup
NEOTUSS PLUS LIQUID
PEDIATEX TDM SUSPENSION
pseudoeph-bromphen-DM syrup
55
TGQ 30PSE/3BRM/15DM SYRUP
*Cough/Cold/Allergy Combinations** - *Opioid AntitussiveAntihistamine***
hydrocod Polst-CPM polst ER LIQUID
promethazine-codeine syrup
TUSSICAPS
TUSSIONEX
VITUZ SOLUTION
*Cough/Cold/Allergy Combinations** - *Opioid AntitussiveDecongestant***
REZIRA SOLUTION
*Cough/Cold/Allergy Combinations** - *Opioid AntitussiveDecongestant-Antihistamine***
CPB WC LIQUID
PHENYLHISTINE DH LIQUID
TRICODE AR LIQUID
NP
N
N
Y
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
N
N
Y
NP
NP
NP
N
N
N
N
N
N
Y
Y
Y
NP
G
G
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
G
N
N
Y
NP
NP
NP
G
G
NP
G
G
G
NP
G
G
NP
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
Y
Y
*Misc. Respiratory Inhalants** - *Misc. Respiratory Inhalants***
HYPERSAL NEBULIZATION SOLUTION
nebusal nebulization solution
pulmosal nebulization solution
sodium chloride nebulization solution
*Mucolytics** - *Mucolytics***
acetylcysteine solution
*DERMATOLOGICALS*
*Acne Products** - *Acne Antibiotics***
ACZONE
AKNE-MYCIN
CLEOCIN-T
clindacin ETZ
clindacin-P
CLINDAGEL
clindamax
clindamycin external
ery pad
ERYGEL
erythromycin external
erythromycin pad
EVOCLIN
KLARON
sulfacetamide sodium external
*Acne Products** - *Acne Combinations***
ACANYA
56
avar cleanser
AVAR LS CLEANSER LIQUID
AVAR LS PAD
AVAR PAD
avar-e emollient cream
avar-e green
AVAR-E LS CREAM
BENZAMYCIN
benzoyl peroxide-erythromycin
bp 10-1
bp cleansing wash emulsion
cerisa wash emulsion
claris clarifying wash emulsion
clenia
clindamycin phos-benzoyl perox external
DUAC
EPIDUO
PLEXION
prascion emulsion
prascion fc pad
prascion ra cream
rosaderm emulsion
rosanil cleanser emulsion
SE 10-5 SS
sulfacetamide sodium-sulfur external
sulfacleanse 8/4 suspension
suphera cream
topisulf cream
VANOXIDE-HC LOTION
virti-sulf cream
zencia liquid
G
NP
NP
NP
G
G
NP
NP
G
G
G
G
G
G
G
NP
P
NP
G
G
G
G
G
G
G
G
G
G
NP
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
Y
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
G
G
NP
G
NP
G
G
NP
N
N
N
N
N
N
N
N
N
Y
N
Y
Y
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Acne Products** - *Acne Products***
ABSORICA
adapalene
amnesteem
ATRALIN
avita
AZELEX
benzepro foam
benzepro short contact foam
BENZIQ
57
BENZIQ LS
benzoyl peroxide external
BP foam external
BPO EXTERNAL
claravis
DIFFERIN
FABIOR
myorisan
NUOX EXTERNAL
RETIN-A
RETIN-A MICRO
RIAX FOAM
sotret
SULFOAM SHAMPOO
tretinoin external
tretinoin microsphere external
TRETIN-X
ZACLIR CLEANSING LOTION
zenatane
*Agents for External Genital and Perianal Warts** - *Agents for External
Genital and Perianal Warts***
VEREGEN OINTMENT
NP
G
G
NP
G
NP
NP
G
NP
NP
P
NP
G
NP
G
G
NP
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
N
Y
N
Y
Y
N
N
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
N
N
Y
NP
NP
NP
G
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
NP
NP
G
NP
G
G
G
NP
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Antibiotics - Topical** - *Antibiotic Steroid Combinations - Topical***
CORTISPORIN
*Antibiotics - Topical** - *Antibiotics - Topical***
ALTABAX OINTMENT
BACTROBAN
CENTANY
gentamicin sulfate
mupirocin external
*Antifungals - Topical** - *Antifungals - Topical Combinations***
ALA QUIN CREAM
ALCORTIN A
ALOQUIN
clotrimazole-betamethasone
DERMASORB AF KIT
dermazene
exoderm
hydrocortisone-iodoquinol
LOTROSONE
nystatin-triamcinolone
versiclear LOTION 25-1 % EXTERNAL
58
VUSION
VYTONE
NP
NP
N
N
N
N
Y
Y
G
G
NP
NP
NP
NP
G
G
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
G
G
NP
NP
NP
NP
NP
G
G
G
G
NP
G
NP
G
G
G
NP
G
NP
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Antifungals - Topical** - *Antifungals - Topical***
ciclodan
ciclopirox
CNL8 NAIL KIT
HALOTIN
LOPROX
NAFTIN
nyamyc powder
nystatin
nystop powder
pedi-dri powder
PENLAC
*Antifungals - Topical** - *Imidazole-Related Antifungals - Topical***
antifungal cream
baza antifungal cream
carrington antifungal cream
econazole
ECOZA FOAM
ERTACZA
EXELDERM
EXTINA FOAM
JUBLIA
ketoconazole
ketodan foam
KP miconazole nitrate
kuric
LUZU
micaderm
MICATIN
miconazole nitrate
micro guard
neosporin AF cream
NIZORAL SHAMPOO
nuzole
OXISTAT
podactin
RA antifungal cream
remedy antifungal cream
secura antifungal cream
59
secura antifungal extra thick cream
SM antifungal miconazole cream
soothe & cool INZO antifungal cream
XOLEGEL
*Anti-inflammatory Agents - Topical** - *Anti-inflammatory Agents Topical***
FLECTOR PATCH
PENNSAID SOLUTION
VOLTAREN GEL
*Antineoplastic or Premalignant Lesion Agents - Topical** *Antineoplastic Alkylating Agents - Topical***
VALCHLOR
*Antineoplastic or Premalignant Lesion Agents - Topical** *Antineoplastic Antimetabolites - Topical***
CARAC
EFUDEX
FLUOROPLEX
fluorouracil
*Antineoplastic or Premalignant Lesion Agents - Topical** *Antineoplastic or Premalignant Lesions - Topical Misc.***
PICATO
*Antineoplastic or Premalignant Lesion Agents - Topical** *Antineoplastic or Premalignant Lesions - Topical NSAID's***
diclofenac Sodium 3 % transdermal
SOLARAZE 3 % TRANSDERMAL
*Antineoplastic or Premalignant Lesion Agents - Topical** *Antineoplastic Retinoids - Topical***
PANRETIN
*Antineoplastic or Premalignant Lesion Agents - Topical** *Photodynamic Therapy Agents - Topical***
LEVULAN KERASTICK
METVIXIA
*Antineoplastic or Premalignant Lesion Agents - Topical** - *Topical
Selective Retinoid X Receptor Agonists***
TARGRETIN
G
G
G
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
P
NP
P
N
N
N
N
Y
Y
Y
Y
Y
NP
Y
N
Y
NP
NP
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
P
N
N
Y
G
NP
N
N
N
N
Y
Y
P
N
N
Y
NP
NP
N
N
N
N
Y
Y
P
Y
N
Y
NP
NP
N
N
N
N
Y
Y
NP
G
NP
P
N
N
N
N
N
N
N
N
Y
Y
Y
Y
*Antipruritics - Topical** - *Antipruritics - Topical***
PRUDOXIN
ZONALON
*Antipsoriatics** - *Antipsoriatics - Systemic***
8-MOP
acitretin
OXSORALEN ULTRA
SORIATANE
*Antipsoriatics** - *Antipsoriatics***
60
calcipotriene
DOVONEX
DRITHO-CRÈME HP
SORILUX FOAM
TAZORAC
VECTICAL
ZITHRANOL SHAMPOO
ZITHRANOL-RR CREAM
G
NP
NP
NP
P
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
N
N
N
N
Y
Y
G
NP
NP
G
NP
G
G
G
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
G
NP
NP
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
G
NP
G
G
G
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
G
N
N
Y
*Antiseborrheic Products** - *Antiseborrheic Combinations***
SELRX SHAMPOO
SODIUM SULFACETAMIDE WASH
*Antiseborrheic Products** - *Antiseborrheic Products***
mexar wash
OVACE
OVACE PLUS
RE 10 wash
SEB-PREV
SEB-PREV WASH
selenium sulfide lotion
sodium sulfacetamide shampoo
sulfacetamide sodium 10 % (cleans)
sulfacetamide sodium liquide 10 % external
TERSI FOAM
*Antivirals - Topical** - *Antiviral Topical Combinations***
XERESE
*Antivirals - Topical** - *Antivirals - Topical***
acyclovir ointment
DENAVIR
ZOVIRAX CREAM
ZOVIRAX OINTMENT
*Burn Products** - *Burn Products***
mafenide acetate packet
SILVADENE CREAM
silver sulfadiazine cream
SSD AF cream
SSD cream
SULFAMYLON
thermazene
*Cauterizing Agents** - *Cauterizing Agent Combinations***
grafco silver nit applicator
*Cauterizing Agents** - *Cauterizing Agents***
61
TRI-CHLOR LIQUID
NP
N
N
Y
NP
G
G
G
G
NP
G
G
G
G
NP
G
G
G
G
NP
NP
NP
G
NP
NP
NP
NP
NP
G
NP
G
G
NP
NP
NP
G
G
G
G
G
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Corticosteroids - Topical** - *Corticosteroids - Topical***
ACLOVATE
alclometasone
alphatrex
amcinonide
apexicon
APEXICON E
betamethasone dipropionate
betamethasone dipropionate aug
betamethasone valerate
beta-val
CAPEX SHAMPOO
clobetasol propionate
clobetasol propionate E
clobetasol propionate emulsion foam
clobetasol propionate foam
CLOBEX
CORDRAN LOTION
CORDRAN TAPE
cormax
CUTIVATE
DERMA-SMOOTHE/FS BODY OIL
DERMA-SMOOTHE/FS SCALP OIL
DERMATOPP
DESONATE
desonide
DESOWEN
desoximetasone
diflorasone
DIPROLENE
DIPROLENE AF
ELOCON
fluocinolone acetonide
fluocinolone acetonide body oil
fluocinolone acetonide scalp oil
fluocinonide
fluocinonide-E
fluticasone propionate external
halobetasol propionate
HALOG
62
hydrocortisone
hydrocortisone butyr lipo base
hydrocortisone butyrate
hydrocortisone valerate
isovate
KENALOG
LOCOID
LOCOID LIPOCREAM
lokara
LUXIQ
mometasone furoate
NUCORT
OLUX
OLUX-E
PANDEL
prednicarbate
scalacort
SYNALAR
TEMOVATE
TEMOVATE E
TEXACORT
TOPICORT
triamcinolone acetonide
TRIANEX
triderm
ULTRAVATE
VERDESO
WESTCORT
*Corticosteroids - Topical** - *Steroid-Local Anesthetic
Combinations***
CORTANE-B
EPIFOAM
hydrocortisone ace-pramoxine cream
NOVACORT
PRAMOSONE
PRAMOSONE E
G
G
G
G
G
NP
NP
NP
G
NP
G
NP
NP
NP
NP
G
G
NP
NP
NP
NP
NP
G
NP
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
G
G
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
*Corticosteroids - Topical** - *Topical Steroid Combinations***
cortalo
hydrocortisone acetate-aloe
TACLONEX
u-Cort
*Emollient/Keratolytic Agents** - *Emollient/Keratolytic Agents***
63
ALUVEA
carmol 40
CEM-UREA
cerovel
cerovel
DERMASORB XM KIT
GORDONS UREA
KERALAC
KERFOAM 42
RE 40
RE urea 40
remeven
TL urea
U-kera E
UMECTA
urea external
urea nail
urea-C40
UTOPIC
X-viate
*Emollient/Keratolytic Agents** - *Emollient/Keratolytic
Combinations***
latrix
RE urea 50
UMECTA PD
URAMAXIN FOAM
urea hydrating foam
urea in zn undecyl-lactic acid
UREA Nail KIT 40 & 0.2 %
UREA Nail STICK 50 %
NP
G
NP
G
G
NP
NP
NP
NP
G
G
G
G
G
NP
G
G
G
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
NP
NP
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
G
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
G
NP
G
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
*Emollients** - *Emollients***
hygel
HYLIRA
lactic acid external
sodium hyaluronate external
*Enzymes - Topical** - *Enzymes - Topical***
OPTASE
revina
SANTYL
TBC aerosol
vasolex
*Immunomodulating Agents - Topical** - *Immunomodulators
64
Imidazoquinolinamines - Topical***
ALDARA
imiquimod
ZYCLARA
*Immunosuppressive Agents - Topical** - *Macrolide
Immunosuppressants - Topical***
ELIDEL
PROTOPIC
*Keratolytic/Antimitotic Agents** - *Keratolytic and/or Antimitotic
Combinations***
BENSAL HP
GORDOFILM SOLUTION
SALKERA FOAM
SALVAX DUO PLUS KIT
NP
G
NP
N
N
N
N
N
N
Y
Y
Y
P
P
Y
Y
N
N
Y
Y
NP
NP
NP
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
G
NP
NP
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
NP
G
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
NP
G
NP
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
N
N
Y
G
N
N
Y
NP
NP
N
N
N
N
Y
Y
*Keratolytic/Antimitotic Agents** - *Keratolytic/Antimitotic Agents***
aliclen
CONDYLOX EXTERNAL
PODOCON EXTERNAL
podofilox external
RE SA
salacyn
Salicylic acid external
*Local Anesthetics - Topical** - *Local Anesthetics - Topical***
ANACAINE
lidocaine HCl external
lidocaine patch
LIDODERM PATCH
LIDORX
QUTENZA PATCH KIT
XYLOCAINE SOLUTION
*Local Anesthetics - Topical** - *Topical Anesthetic Combinations***
EMLA
lidocaine-prilocaine
PLIAGLIS
SYNERA PATCH
*Misc. Topical** - *Astringents***
XERAC AC
*Misc. Topical** - *Misc. Topical***
hypercare
*Rosacea Agents** - *Rosacea Agents***
FINACEA
METROCREAM
65
METROGEL
METROLOTION
metronidazole external cream, lotion
MIRVASO
NORITATE
ORACEA ORAL
rosadan external
vitazol
NP
NP
G
NP
NP
P
G
G
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
NP
G
G
NP
NP
G
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
N
N
Y
NP
N
N
Y
NP
N
Y
Y
MED
N
N
Y
MED
N
N
Y
P
P
P
P
P
P
P
P
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
*Scabicides & Pediculicides** - *Scabicides & Pediculicides***
acticin
ELIMITE
EURAX
lindane external
malathion external
NATROBA EXTERNAL
OVIDE EXTERNAL
permethrin external
SKLICE EXTERNAL
ULESFIA EXTERNAL
*Wound Care Products** - *Wound Care - Growth Factor Agents***
REGRANEX EXTERNAL
*Wound Care Products** - *Wound Care Combinations***
REGENECARE EXTERNAL
*Wound Care Products** - *Wound Cleansers/Decubitus Ulcer
Therapy***
LAVARE WOULD WASH EXTERNAL
*DIAGNOSTIC PRODUCTS*
*Diagnostic Biologicals** - *Multiple Skin Tests***
GLUCOSE TEST STRIP (ANY OTHER BRAND NAME)
*Diagnostic Drugs** - *Diagnostic Drugs***
Thyrogen SOLUTION RECONSTITUTED 1.1 MG INTRAMUSCULAR*
*Diagnostic Products, Misc.** - *Diagnostic Products, Misc.***
Hyskon SOLUTION 32-10 %
*Diagnostic Tests** - *Diagnostic Tests***
EXACTECH
EXACTECH R-S-G
FreeStyle InsuLinx Test STRIP IN VITRO
FreeStyle Lite Test STRIP IN VITRO
FreeStyle Test STRIP IN VITRO
OneTouch Test STRIP IN VITRO
OneTouch Ultra Blue STRIP IN VITRO
OneTouch Verio STRIP IN VITRO
66
Precision PCX Plus Test STRIP IN VITRO
Precision PCx STRIP IN VITRO
Precision Point of Care Test STRIP IN VITRO
Precision QID Test STRIP IN VITRO
Precision Sof-Tact Test STRIP IN VITRO
Precision Xtra Blood Glucose STRIP IN VITRO
P
P
P
P
P
P
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
P
NP
NP
NP
NP
NP
P
N
N
N
N
N
N
N
N
N
Y
N
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
G
G
NP
G
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
G
NP
NP
NP
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
G
NP
NP
G
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
N
N
Y
*DIGESTIVE AIDS*
*Digestive Enzymes** - *Digestive Enzymes***
CREON
PANCREAZE
PERTZYE
SUCRAID
ULTRESA
VIOKASE
ZENPEP
*DIURETICS*
*Carbonic Anhydrase Inhibitors** - *Carbonic Anhydrase Inhibitors***
acetazolamide
acetazolamide ER
DIAMOX
methazolamide
NEPTAZANE
*Diuretic Combinations** - *Diuretic Combinations***
ALDACTAZIDE
amiloride-hydrochlorothiazide
DYAZIDE
MAXZIDE
MAXZIDE-25
spironolactone-HCTZ
triamterene-HCTZ
*Loop Diuretics** - *Loop Diuretics***
bumetanide
DEMADEX
EDECRIN
furosemide
LASIX
torsemide
*Osmotic Diuretics** - *Osmotic Diuretics***
INTROL
*Potassium Sparing Diuretics** - *Potassium Sparing Diuretics***
ALDACTONE
67
amiloride
DYRENIUM
spironolactone
*Thiazides and Thiazide-Like Diuretics** - *Thiazides and Thiazide-Like
Diuretics***
chlorothiazide
DIURIL
hydrochlorothiazide
indapamide
metolazone
MICROZIDE
ZAROXOLYN
G
NP
G
N
N
N
N
N
N
Y
Y
Y
G
NP
G
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
NP
G
P
NP
NP
NP
NP
G
G
NP
G
NP
G
NP
N
N
N
N
N
N
N
N
N
Y
N
N
Y
Y
N
N
N
Y
Y
N
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
MED
N
N
N
N
N
N
Y
Y
Y
MED
N
N
Y
MED
Y
N
Y
MED
MED
Y
Y
N
N
Y
Y
MED
Y
N
Y
*ENDOCRINE AND METABOLIC AGENTS - MISC.*
*Bone Density Regulators** - *Bisphosphonates***
ACTONEL
alendronate
ATELVIA
BINOSTRO
BONIVA
FOSAMAX
FOSAMAX PLUS D
ibandronate
pamidronate
RECLAST
risedronate
SKELID
zoledronic acid
ZOMETA
*Bone Density Regulators** - *Calcitonins***
calcitonin (salmon) nasal solution
MIACALCIN NASAL SOLUTION
MIACALCIN SOLUTUION INJECTABLE
*Bone Density Regulators** - *Calcium Regulators - Misc.***
GANITE
*Bone Density Regulators** - *Parathyroid Hormone And
Derivatives***
FORTEO
*Bone Density Regulators** - *RANK Ligand (RANKL) Inhibitors***
PROLIA
XGEVA
*Corticotropin** - *Corticotropin***
ACTHAR HP
68
*Fertility Regulators** - *Ovulation Stimulants-Synthetic***
NP
G
G
N
N
N
N
N
N
Y
Y
Y
MED
Y
N
Y
MED
MED
MED
MED
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
EVISTA
*Insulin-Like Growth Factors (Somatomedins)** - *Insulin-Like Growth
Factors (Somatomedins)***
P
N
N
Y
INCRELEX
*LHRH/GnRH Agonist Analog Pituitary Suppressants** - *LHRH/GnRH
Agonist Analog Combinations***
MED
Y
N
Y
LUPANETA PACK
*LHRH/GnRH Agonist Analog Pituitary Suppressants** - *LHRH/GnRH
Agonist Analog Pituitary Suppressants***
MED
Y
N
Y
MED
MED
NP
Y
Y
N
N
N
N
Y
Y
Y
NP
Y
N
Y
NP
NP
G
N
N
N
N
N
N
Y
Y
Y
MED
Y
N
Y
P
Y
N
Y
P
N
N
Y
CLOMID
serophene
clomiphene citrate
*Growth Hormone Receptor Antagonists** - *Growth Hormone
SOMAVERT
*Growth Hormones** - *Growth Hormones***
GENOTROPIN
HUMATROPE
NORDITROPIN
NUTROPIN AQ, NUTROPIN
OMNITROPE
SAIZEN
SEROSTIM
TEV-TROPIN
ZORBTIVE
*Hormone Receptor Modulators** - *Selective Estrogen Receptor
Modulators (SERMs)***
LUPRON DEPOT-PED KIT
SUPPRELIN LA KIT
SYNAREL
*Metabolic Modifiers** - *Calcimimetic Agents***
SENSIPAR
*Metabolic Modifiers** - *Carnitine Replenisher - Agents***
CARNITOR
CARNITOR SF
levocarnitine
*Metabolic Modifiers** - *Fabry Disease - Agents***
FABRAZYME
*Metabolic Modifiers** - *Hereditary Tyrosinemia Type 1 (HT-1)
Treatment - Agents***
ORFADIN
*Metabolic Modifiers** - *Homocystinuria Treatment - Agents***
CYSTADANE
69
*Metabolic Modifiers** - *Hyperammonemia Treatment - Agents***
NP
Y
N
Y
G
G
NP
MED
P
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
ALDURAZYME
*Metabolic Modifiers** - *Mucopolysaccharidosis II (MPS II) Agents***
MED
Y
N
Y
ELAPRASE
*Metabolic Modifiers** - *Mucopolysaccharidosis IV (MPS IV) Agents***
MED
Y
N
Y
VIMIZIM
*Metabolic Modifiers** - *Mucopolysaccharidosis VI (MPS VI) Agents***
MED
Y
N
Y
MED
Y
N
Y
P
Y
N
Y
MED
P
NP
G
N
Y
Y
N
N
N
N
N
Y
Y
Y
Y
NP
NP
G
G
G
G
G
NP
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
G
N
N
Y
MED
MED
MED
MED
Y
Y
Y
Y
N
N
N
N
Y
Y
Y
Y
CARBAGLU
*Metabolic Modifiers** - *Hyperparathyroid Treatment - Vitamin D
Analogs***
calcitriol oral
paricalcitol oral
ROCALTROL ORAL
ZEMPLAR INTRAVENOUS
ZEMPLAR ORAL
*Metabolic Modifiers** - *Mucopolysaccharidosis I (MPS I) - Agents***
NAGLAZYME
*Metabolic Modifiers** - *Phenylketonuria Treatment - Agents***
KUVAN
*Metabolic Modifiers** - *Urea Cycle Disorder - Agents***
AMMONUL SOLUTION INTRAVENOUS
BUPHENYL
RAVICTI
sodium phenylbutyrate
*Posterior Pituitary Hormones** - *Vasopressin***
DDAVP SOLUTION
DDAVP TABLET
desmopressin ace rhinal tube nasal
desmopressin ace spray refrig solution nasal
desmopressin acetate spray solution nasal
desmopressin acetate tablet
minirin solution nasal
STIMATE SOLUTION NASAL
*Prolactin Inhibitors** - *Dopamine Receptor Agonists***
cabergoline
*Somatostatic Agents** - *Somatostatic Agents***
octreotide acetate injection
SANDOSTATIN
SANDOSTATIN LAR DEPOT
SIGNIFOR
70
SOMATULINE DEPOT
*Vasopressin Receptor Antagonists** - *Selective Vasopressin V2Receptor Antagonists***
SAMSCA
MED
Y
N
Y
P
Y
N
Y
MED
MED
MED
MED
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
MED
Y
N
Y
MED
MED
Y
Y
N
N
Y
Y
MED
MED
Y
Y
N
N
Y
Y
NP
Y
N
Y
G
G
G
G
G
G
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
NP
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
*Fertility Regulators** BRAVELLE
GONAL-F
FOLLISTIM AQ
chorionic gonadotropin
NOVAREL
OVIDREL
PREGNYL
MENOPUR
REPRONEX
*Growth Hormones Releasing Hormones (GHRH)***
EGRIFTA
*GnRH/LHRH Antagonists**
CETROTIDE
GANIRELIX ACETATE
*Metabolic Modifiers** - *GAA Deficiency Treatment- Agents***
LUMIZYME
MYOZYME
*Metabolic Modifiers** - *Leptin Analogues***
MYALEPT
*ESTROGENS*
*Estrogen Combinations** - *Estrogen & Androgen***
covaryx
covaryx HS
EEMT
EEMT HS
essian H.S. TABLET 0.625-1.25 MG ORAL
essian TABLET 1.25-2.5 MG ORAL
est estrogens-methyltest
est estrogens-methyltest DS
est estrogens-methyltest HS
methyltest-est estrogens
methyltest-est estrogens HS
*Estrogen Combinations** - *Estrogen & Progestin***
ACTIVELLA
ANGELIQ
CLIMARA PRO
COMBIPATCH
71
estradiol-norethindrone acet
FEMHRT LOW DOSE
mimvey
PREFEST
PREMPHASE
PREMPRO
*Estrogen Combinations** - *Estrogen-Selective Estrogen Receptor
Modulator Comb***
DUAVEE
G
NP
G
NP
P
P
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
P
N
N
Y
NP
NP
NP
NP
NP
NP
NP
NP
G
G
NP
NP
G
NP
NP
NP
NP
G
P
P
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
G
G
NP
NP
G
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Estrogens** - *Estrogens***
ALORA
CENESTIN
CLIMARA
DIVIGEL
ELESTRIN
ENJUVIA
ESTRACE TABLET
ESTRADERM
estradiol patch
estradiol tablet
ESTRAGEL
ESTRASORB
estropipate
EVAMIST
MENEST
MENOSTAR
MINIVELLE
ortho-est
PREMARIN TABLET
VIVELLE-DOT
*FLUOROQUINOLONES*
*Fluoroquinolones** - *Fluoroquinolones***
CIPRO ORAL
CIPRO XR
ciprofloxacin oral
ciprofloxacin-ciproflox HCl ER
FACTIVE
LEVAQUIN ORAL
levofloxacin oral
NOROXIN
ofloxacin
*GASTROINTESTINAL AGENTS - MISC.*
72
*Gallstone Solubilizing Agents** - *Gallstone Solubilizing Agents***
ACTIGALL
CHENODAL
URSO
URSO FORTE
ursodiol
*Gastrointestinal Antiallergy Agents** - *Gastrointestinal Antiallergy
Agents***
cromolyn sodium concentrate oral
GASTROCROM CONCENTRATE ORAL
*Gastrointestinal Chloride Channel Activators** - *Gastrointestinal
Chloride Channel Activators***
AMITIZA
NP
NP
NP
NP
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
NP
N
N
N
N
Y
Y
P
N
Y
Y
G
NP
NP
N
N
N
N
N
N
Y
Y
Y
P
P
NP
NP
G
P
NP
P
NP
NP
P
G
P
NP
G
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
Y
Y
N
N
Y
N
Y
Y
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
G
N
N
N
N
N
N
Y
Y
Y
*Gastrointestinal Stimulants** - *Gastrointestinal Stimulants***
metoclopramide
METOZOLV ODT
REGLAN
*Inflammatory Bowel Agents** - *Inflammatory Bowel Agents***
APRISO
ASACOL HD
AZULFIDINE
AZULFIDINE ENTAB
balsalazide disodium CAPSULE
CANASA
COLAZAL
DELZICOL
DIPENTUM
GIAZO
LIALDA
mesalamine enema
PENTASA
SF ROWASA ENEMA
sulfasalazine
sulfasalazine delayed release
sulfazine EC
CIMZIA
REMICADE
ENTYVIO
*Intestinal Acidifiers** - *Intestinal Acidifiers***
enulose
generlac
lactulose encephalopathy
73
*Irritable Bowel Syndrome (IBS) Agents** - *IBS Agent - Guanylate
Cyclase-C (GC-C) Agonists***
LINZESS
*Irritable Bowel Syndrome (IBS) Agents** - *IBS Agent - Selective 5-HT3
LOTRONEX
*Peripheral Opioid Receptor Antagonists** - *Peripheral Opioid
RELISTOR
RELISTOR KIT
P
N
Y
Y
NP
Y
N
Y
P
P
Y
Y
N
N
Y
Y
G
G
NP
P
NP
P
NP
P
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
MED
Y
N
Y
MED
MED
MED
MED
MED
MED
MED
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
G
NP
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
*Phosphate Binder Agents** - *Phosphate Binder Agents***
calcium acetate (phos binder)
calcium acetate oral capsule
ELIPHOS
FORSRENOL
PHOSLO
PHOSLYRA
RENAGEL
RENVELA
VELPHORO
*Short Bowel Syndrome (SBS) Agents** - *Glucagon-Like Peptide-2
(GLP-2) Analogs***
GATTEX KIT
*GENERAL ANESTHETICS*
*Volatile Anesthetics** - *Volatile Anesthetics***
FORANE
isoflurane
sevoflurane
sojourn
SUPRANE
terrell
ULTANE
*GENITOURINARY AGENTS - MISCELLANEOUS*
*Acidifiers** - *Phosphates***
K-PHOS No 2
*Alkalinizers** - *Citrates***
citric acid-sodium citrate solution oral
CITROLITH
cytra K crystals
cytra-2 solution
CYTRA-3 SYRUP
CYTRA-K SOLUTION
ORACIT
74
potassium citrate-citric acid packet
POTASSIUM CITRATE-CITRIC ACID SOLUTION
taron-crystals packet
UROCIT-K 10
UROCIT-K 5
G
NP
G
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
NP
Y
Y
N
Y
Y
Y
G
MED
N
N
N
N
Y
Y
MED
MED
MED
MED
MED
MED
MED
MED
MED
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
P
N
N
Y
P
G
NP
N
N
N
N
N
N
Y
Y
Y
G
NP
NP
P
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
P
N
N
Y
G
G
N
N
N
N
Y
Y
*Cystinosis Agents** - *Cystinosis Agents***
CYSTAGON
PROCYSBI
*Genitourinary Irrigants** - *Anti-infective Genitourinary Irrigants***
neomycin-polymyxin b gu irrigation
NEOPORIN GU IRRIGATION
*Genitourinary Irrigants** - *Genitourinary Irrigants***
acetic acid irrigation
aminoacetic acid irrigation
argyle sterile saline irrigation
curity sterile saline irrigation
glycine irrigation
glycine urologic irrigation
RENACIDIN SOLUTION IRRIGATION
RESECTISOL SOLUTION IRRIGATION
sodium chloride solution irrigation
*Interstitial Cystitis Agents** - *Interstitial Cystitis Agents***
ELMIRON
*Prostatic Hypertrophy Agents** - *5-Alpha Reductase Inhibitors***
AVODART
finasteride
PROSCAR
*Prostatic Hypertrophy Agents** - *Alpha 1-Adrenoceptor
Antagonists***
alfuzosin
CARDURA XL
FLOMAX
RAPAFLO
tamsulosin
UROXATRAL
*Prostatic Hypertrophy Agents** - *Prostatic Hypertrophy Agent
Combinations***
JALYN
*Urinary Analgesics** - *Urinary Analgesics***
phenazo
phenazopyridine
*Urinary Stone Agents** - *Urinary Stone Agents***
75
LITOSTAT
THIOLA
*Prostatic Hypertrophy Agents** - *Selective cGMP Phosphodiesterase
Type 5 Inhibitor***
CIALIS 2.5MG, CIALIS 5MG (for BPH use)
NP
NP
N
N
N
N
Y
Y
P
Y
N
Y
G
N
N
Y
G
P
NP
NP
NP
NP
N
N
Y
N
N
N
N
N
N
Y
N
Y
Y
Y
Y
Y
Y
Y
G
N
N
Y
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*GOUT AGENTS*
*Gout Agent Combinations** - *Gout Agent Combinations***
colchicine-probenecid
*Gout Agents** - *Gout Agents***
allopurinol
COLCRYS
KRYSTEXXA
ULORIC
ZYLOPRIM
MITIGARE
*Uricosurics** - *Uricosurics***
probenecid
*HEMATOLOGICAL AGENTS - MISC.*
*Antihemophilic Products** - *Antihemophilic Products***
ADVATE
ALPHANATE/VWF
ALPHANINE SD
BEBULIN
BEBULIN VH
BENEFIX
CORIFACT
FEIBA NF
FEIBA VH
HELIXATE FS
HEMOFIL M
HUMATE-P
KCENTRA
KOATE-DVI
KOGENATE FS
KOGENATE FS BIO-SET
MONOCLATE-P
MONONINE
NOVOSEVEN RT
PROFILNINE SD
RECOMBINATE
RIASTAP
RIXUBIS
76
TRETTEN
WILATE
XYNTHA
XYNTHA SOLOFUSE KIT
ALPROLIX
ELOCTATE
*Bradykinin B2 Receptor Antagonists** - *Bradykinin B2 Receptor
Antagonists***
FIRAZYR
MED
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
MED
Y
N
Y
MED
MED
MED
Y
Y
Y
N
N
N
Y
Y
Y
MED
Y
N
Y
G
G
N
N
N
N
Y
Y
MED
Y
N
Y
NP
N
N
Y
G
NP
N
N
N
N
Y
Y
P
N
N
Y
G
NP
N
N
N
N
Y
Y
NP
G
N
N
N
N
Y
Y
G
P
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
MED
Y
N
Y
*Complement Inhibitors** - *C1 Inhibitors***
BERINERT
CINRYZE
RUCONEST
*Complement Inhibitors** - *Complement Inhibitors***
SOLIRIS
*Hematorheologic Agents** - *Hematorheologic Agents***
pentopak
pentoxifylline
*Plasma Kallikrein Inhibitors** - *Plasma Kallikrein Inhibitors***
KALBITOR
*Platelet Aggregation Inhibitors** - *Cyclopentyltriazolopyrimidine
(CPTP) Derivatives***
BRILINTA
*Platelet Aggregation Inhibitors** - *Phosphodiesterase III
Inhibitors***
cilostazol
PLETAL
*Platelet Aggregation Inhibitors** - *Platelet Aggregation Inhibitor
Combinations***
AGGRENOX
*Platelet Aggregation Inhibitors** - *Platelet Aggregation Inhibitors***
dipyridamole
PERSANTIN
*Platelet Aggregation Inhibitors** - *Quinazoline Agents***
AGRYLIN
anagrelide
*Platelet Aggregation Inhibitors** - *Thienopyridine Derivatives***
clopidogrel
EFFIENT
PLAVIX
ticlopidine
*Thrombolytic Enzymes**
ACTIVASE
77
*Human Protein C***
CEPROTIN
MED
Y
N
Y
MED
MED
MED
NP
Y
Y
Y
Y
N
N
N
N
Y
Y
Y
Y
NP
N
N
Y
MED
MED
MED
MED
Y
Y
Y
Y
N
N
N
N
Y
Y
Y
Y
MED
MED
MED
Y
Y
Y
N
N
N
Y
Y
Y
MED
Y
N
Y
MED
Y
N
Y
MED
NP
Y
Y
N
N
Y
Y
MED
Y
N
Y
NP
G
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
G
NP
N
N
N
N
N
N
Y
Y
Y
*HEMATOPOIETIC AGENTS*
*Agents for Gaucher Disease** - *Agents for Gaucher Disease***
CEREZYME
ELELYSO
VPRIV
ZAVESCA
*Agents for Sickle Cell Anemia** - *Cytotoxic Agents***
DROXIA
*Hematopoietic Growth Factors** - *Erythropoietins***
ARANESP (ALBUMIN FREE)
OMONTYS
PROCRIT
EPOGEN
*Hematopoietic Growth Factors** - *Granulocyte Colony-Stimulating
Factors (G-CSF)***
GRANIX
NEULASTA
NEUPOGEN
*Hematopoietic Growth Factors** - *Granulocyte/Macrophage ColonyStimulating Factor(GM-CSF)***
LEUKINE
*Hematopoietic Growth Factors** - *Interleukins***
NEUMEGA
*Hematopoietic Growth Factors** - *Thrombopoietin (TPO) Receptor
Agonists***
NPLATE
PROMACTA
*Stem Cell Mobilizers***
MOZOBIL
*HEMOSTATICS*
*Hemostatics - Systemic** - *Hemostatics - Systemic***
AMICAR
aminocaproic acid
LYSTEDA
tranexamic acid
*HYPNOTICS*
*Barbiturate Hypnotics** - *Barbiturate Hypnotics***
BUTISOL
phenobarbital soution, tablet
SECONAL
78
*Hypnotics - Tricyclic Agents** - *Hypnotics - Tricyclic Agents***
SILENOR
NP
N
Y
Y
NP
G
G
NP
G
NP
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
NP
G
NP
NP
NP
G
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
Y
Y
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
Y
N
N
Y
Y
Y
NP
G
G
G
NP
P
NP
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Non-Barbiturate Hypnotics** - *Benzodiazepine Hypnotics***
DORAL
estazolam
flurazepam
HALCION
midazolam syrup
RESTORIL
temazepam
triazolam
*Non-Barbiturate Hypnotics** - *Non-Benzodiazepine - GABA-Receptor
Modulators***
AMBIEN
AMBIEN CR
EDLUAR
eszopiclone
INTERMEZZO
LUNESTA
SONATA
zaleplon
zolpidem
zolpidem ER
ZOLPIMIST
*Selective Melatonin Receptor Agonists** - *Selective Melatonin
Receptor Agonists***
HETLIOZ
ROZEREM
*LAXATIVES*
*Laxative Combinations** - *Bowel Evacuant Combinations***
COLYTE WITH FLAVOR PACKS
gaviLyte-C
gaviLyte-G
gaviLyte-N with flavor pack
GOLYTELY
MOVIPREP
NULYTELY WITH FLAVOR PACKS
peg 3350/electrolytes
peg3350-kcl-na bicarb-nacl
PREPOPIK PACKET
SUCLEAR KIT
SUPREP BOWEL PREP
79
triLyte
G
N
N
Y
G
NP
G
N
N
N
N
N
N
Y
Y
Y
NP
N
N
Y
G
NP
NP
N
N
N
N
N
N
Y
Y
Y
NP
NP
NP
G
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
NP
NP
NP
NP
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
NP
NP
NP
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
*Laxatives - Miscellaneous** - *Laxatives - Miscellaneous***
constulose
KRISTALOSE
lactulose
*Saline Laxatives** - *Saline Laxative Mixtures***
OSMOPREP
*MACROLIDES*
*Azithromycin** - *Azithromycin***
azithromycin
ZITHROMAX
ZMAX
*Clarithromycin** - *Clarithromycin***
BIAXIN
BIAXIN XL
BIAXIN XL PAC
clarithromycin
clarithromycin ER
*Erythromycins** - *Erythromycins***
E.E.S. 400 TABLET
E.E.S. GRANULES
ERYPED 200
ERYPED 400
ERY-TAB
ERYTHROCIN STEARATE
erythromycin base
PCE
*Fidaxomicin** - *Fidaxomicin***
DIFICID
*MEDICAL DEVICES*
*Contraceptives** - *Cervical Caps***
FemCap DEVICE 22 MM VAGINAL
Prentif Cavity-Rim Cerv Cap DEVICE 22 MM VAGINAL
Prentif Fitting Set VAGINAL
*Contraceptives** - *Diaphragms***
Omniflex Diaphragm DIAPHRAGM VAGINAL
80
Ortho Diaphragm Coil KIT 100 MM VAGINAL
Ortho Diaphragm Flat KIT 55 MM VAGINAL
Wide-Seal Diaphragm 60 DIAPHRAGM 2 % VAGINAL
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
P
NP
G
N
N
N
N
N
N
Y
Y
Y
G
G
P
P
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
NP
NP
N
N
N
N
Y
Y
G
G
G
NP
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
*Diabetic Supplies** - *Glucose Monitoring Test Supplies***
BD LANCETS
BRAND LANCETS (any other brand name)
lancets (any generic)
*Parenteral Therapy Supplies** - *Needles & Syringes***
insulin syringes (any generic)
pen needles (any generic)
BD PEN NEEDLES
BD INSULIN SYRINGES
BRAND PEN NEEDLES (any other brand name)
BRAND INSULIN SYRINGES (any other brand name)
*MIGRAINE PRODUCTS*
*Migraine Combinations** - *Ergot Combinations***
CAFERGOT
MIGERGOT
*Migraine Combinations** - *Migraine Combinations***
epidrin
isometheptene-APAP-dichloral
migragesic IDA
MIGRALAM
nodolor
81
PRODRIN
*Migraine Combinations** - *Selective Serotonin Agonist-NSAID
Combinations***
TREXIMET
NP
N
N
Y
NP
N
Y
Y
NP
N
N
Y
NP
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
NP
NP
NP
NP
NP
NP
G
NP
G
G
G
NP
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
Y
N
N
N
N
Y
N
N
N
Y
N
N
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
G
N
N
N
N
Y
Y
NP
G
G
N
N
N
N
N
N
Y
Y
Y
*Migraine Products - NSAIDs** - *Migraine Products - NSAIDs***
CAMBIA
*Migraine Products** - *Migraine Products***
D.H.E. 45 SOLUTION
dihydroergotamine mesylate solution
ERGOMAR
MIGRAL
MIGRANAL
*Serotonin Agonists** - *Selective Serotonin Agonists 5-HT(1)***
ALSUMA
AMERGE
AXERT
FROVA
IMITREX
MAXALT
MAXALT-MLT
naratriptan
RELPAX
rizatriptan
rizatriptan MLT
sumatriptan
SUMAVEL
zolmitriptan
zolmitriptan ZMT
ZOMIG
ZOMIG NASAL SPRAY
ZOMIG ZMT
*MINERALS & ELECTROLYTES*
*Iodine Products** - *Iodine Products***
SSKI SOLUTION
*Phosphate** - *Phosphate***
K-PHOS
phospha 250 neutral
*Potassium** - *Potassium Combinations***
EFFER-K
effervescent pot chloride
pot bicarb-pot chloride
*Potassium** - *Potassium***
82
EFFER-K
epiklor
kaon-Cl-10
K-effervescent
klor-con M10
KLOR-CON M15
klor-con M20
klor-con packet 20meq
KLOR-CON PACKET 25 MEQ ORAL
klor-con tablet extended release
klor-con/EF
k-prime
k-vescent
MICRO-K
potassium bicarbonate oral
potassium chloride crys ER
potassium chloride liquid 20 MEQ/15ML
potassium chloride packet
potassium chloride solution 20 MEQ/15ML
G
G
G
G
G
NP
G
G
NP
G
G
G
G
NP
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
G
NP
N
N
N
N
N
N
Y
Y
Y
G
G
NP
N
N
N
N
N
N
Y
Y
Y
G
NP
G
N
N
N
N
N
N
Y
Y
Y
G
G
N
N
N
N
Y
Y
G
NP
G
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
*MOUTH/THROAT/DENTAL AGENTS*
*Anesthetics Topical Oral** - *Anesthetics Topical Oral***
lidocaine hcl mouth/throat
lidocaine viscous
LTA 360 kit
*Anti-infectives - Throat** - *Anti-infectives - Throat***
clotrimazole lozenge mouth/throat
nystatin suspension mouth/throat
ORAVIG
*Antiseptics - Mouth/Throat** - *Antiseptics - Mouth/Throat***
chlorhexidine gluconate solution mouth/throat
PERIDEX MOUTH/THROAT
periogard mouth/throat
*Steroids - Mouth/Throat** - *Steroids - Mouth/Throat***
oralone paste dental
triamcinolone acetonide paste dental
*Throat Products - Misc.** - *Saliva Stimulants***
cevimeline
EVOXAC
pilocarpine oral
SALAGEN
*MUSCULOSKELETAL THERAPY AGENTS*
83
*Central Muscle Relaxants** - *Central Muscle Relaxants***
AMRIX
baclofen oral
carisoprodol oral
chlorzoxazone oral
cyclobenzaprine oral
ed baclofen
FEXMID
LORZONE
metaxalone oral
methocarbamol oral
orphenadrine ER oral
PARAFON FORTE DSC
ROBAXIN
SKELAXIN
SOMA
tizanidine oral
ZANAFLEX
NP
G
G
G
G
G
NP
NP
G
G
G
NP
NP
NP
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
G
N
N
N
N
Y
Y
G
G
G
N
N
N
N
N
N
Y
Y
Y
MED
MED
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
G
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
*Direct Muscle Relaxants** - *Direct Muscle Relaxants***
DANTRIUM
dantrolene oral
*Muscle Relaxant Combinations** - *Muscle Relaxant Combinations***
carisoprodol-aspirin oral
carisoprodol-aspirin-codeine oral
orphenadrine-aspirin-caffeine oral
*Viscosupplements** - *Viscosupplements***
GEL-ONE
ORTHOVISC
SUPARTZ
SYNVISC ONE
EUFLEXXA
HYALGAN
MONOVISC
*NASAL AGENTS - SYSTEMIC AND TOPICAL*
*Nasal Agent Combinations** - *Antihistamine-Steroid***
DYMISTA
*Nasal Antiallergy** - *Nasal Antihistamines***
ASTEPRO
azelastine nasal
PATANASE NASAL
olopatadine nasal
84
*Nasal Anticholinergics** - *Nasal Anticholinergics***
ATROVENT NASAL
ipratropium bromide nasal
NP
G
N
N
N
N
Y
Y
NP
N
N
Y
NP
G
NP
G
G
NP
P
NP
NP
NP
G
P
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
N
N
Y
N
N
N
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
N
N
N
N
Y
Y
NP
G
N
N
N
N
Y
Y
MED
MED
MED
MED
Y
Y
Y
Y
N
N
N
N
Y
Y
Y
Y
P
NP
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
G
N
N
N
N
Y
Y
*Nasal Anti-infectives** - *Nasal Antibiotics***
BACTROBAN OINTMENT NASAL
*Nasal Steroids** - *Nasal Steroids***
BECONASE AQ NASAL
budesonide suspension nasal
FLONASE NASAL
flunisolide solution nasal
fluticasone propionate suspension nasal
NASACORT AQ SUSPENSION NASAL
NASONEX SUSPENSION NASAL
OMNARIS SUSPENSION NASAL
QNASL SOLUTION NASAL
RHINOCORT AQUA SUSPENSION NASAL
triamcinolone acetonide nasal
VERAMYST SUSPENSION NASAL
ZETONNA SOLUTION NASAL
*Sympathomimetic Decongestants** - *Topical Decongestants***
ADRENALIN SOLUTION NASAL
TYZINE SOLUTION NASAL
*NEUROMUSCULAR AGENTS*
*ALS Agents** - *Benzathiazoles***
RILUTEK
riluzole
*Neuromuscular Blocking Agent - Neurotoxins** - *Neuromuscular
Blocking Agent - Neurotoxins***
BOTOX SOLUTION INJECTION
DYSPORT SOLUTION INTRAMUSCULAR
XEOMIN SOLUTION INTRAMUSCULAR
MYOBLOC
*OPHTHALMIC AGENTS*
*Beta-blockers - Ophthalmic** - *Beta-blockers - Ophthalmic
Combinations***
COMBIGAN OPHTHALMIC
COSOPT OPHTHALMIC
COSOPT PF OPHTHALMIC
dorzolamide HCl-timolol mal ophthalmic
*Beta-blockers - Ophthalmic** - *Beta-blockers - Ophthalmic***
BETAGAN OPHTHALMIC
betaxolol ophthalmic
85
BETIMOL OPHTHALMIC
BETOPTIC-S OPHTHALMIC
carteolol HCl ophthalmic
ISTALOL OPHTHALMIC
levobunolol HCl ophthalmic
METIPRANOLOL OPHTHALMIC
OPTIPRANOLOL OPHTHALMIC
timolol maleate gel forming solution ophthalmic
timolol maleate ophthalmic
TIMOPTIC OCUDOSE PHTHALMIC
TIMOPTIC OPHTHALMIC
TIMOPTIC-XE GEL FORMING OPHTHALMIC
NP
NP
G
NP
G
NP
NP
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
G
G
G
NP
G
G
G
G
NP
NP
G
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
G
NP
N
N
N
N
N
N
Y
Y
Y
P
P
NP
Y
Y
Y
N
N
N
Y
Y
Y
NP
N
N
Y
*Cycloplegic Mydriatics** - *Cycloplegic Mydriatic Combinations***
CYCLOMYDRIL OPHTHALMIC
*Cycloplegic Mydriatics** - *Cycloplegic Mydriatics***
AK-pentolate ophthalmic
atropine sulfate ophthalmic
atropine-care ophthalmic
CYCLOGYL OPHTHALMIC
cyclopentolate ophthalmic
cylate ophthalmic
homatropaire ophthalmic
homatropine ophthalmic
ISOPTO HOMATROPINE OPHTHALMIC
ISOPTO HYOSINE OPHTHALMIC
mydral ophthalmic
MYDRIACYL OPHTHALMIC
tropicamide ophthalmic
*Miotics** - *Miotics - Cholinesterase Inhibitors***
PHOSPHOLINE IODIDE OPHTHALMIC
*Miotics** - *Miotics - Direct Acting***
ISOPTO CARBACHOL OPHTHALMIC
pilocarpine ophthalmic
PILOPINE OPHTHALMIC
*Ophthalmic - Angiogenesis Inhibitors** - *Vascular Endothelial Growth
Factor (VEGF) Antagonists***
EYLEA INTRAOCULAR
LUCENTIS INTRAOCULAR
MACUGEN INTRAOCULAR
*Ophthalmic Adrenergic Agents** - *Alpha Adrenergic Agonist &
Carbonic Anhydrase Inhib Comb***
SIMBRINZA OPHTHALMIC
86
*Ophthalmic Adrenergic Agents** - *Ophthalmic Selective Alpha
Adrenergic Agonists***
ALPHAGAN P OPHTHALMIC
apraclonidine ophthalmic
brimonidine ophthalmic
IOPIDINE OPHTHALMIC
P
G
G
NP
N
N
N
N
N
N
N
N
Y
Y
Y
Y
P
NP
NP
G
G
G
NP
G
G
G
G
G
G
NP
NP
NP
G
G
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
G
G
G
G
G
NP
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
*Ophthalmic Anti-infectives** - *Ophthalmic Antibiotics***
AZASITE OPHTHALMIC
BESIVANCE OPHTHALMIC
CILOXIN OPHTHALMIC
ciprofloxacin ophthalmic
erythromycin ophthalmic
garamycin ointment ophthalmic
GARAMYCIN SOLUTION OPHTHALMIC
gatifloxacin ophthalmic
gentak ophthalmic
gentamicin ophthalmic
gentasol ophthalmic
ilotycin ophthalmic
levofloxacin ophthalmic
MITOSOL KIT OPHTHALMIC
MOXEZA OPHTHALMIC
OCUFLOX OPHTHALMIC
ofloxacin ophthalmic
romycin ophthalmic
tobramycin ophthalmic
tobrasol ophthalmic
TOBREX OPHTHALMIC
VIGAMOX OPHTHALMIC
ZYMAXID OPHTHALMIC
*Ophthalmic Anti-infectives** - *Ophthalmic Antifungal***
NATACYN OPHTHALMIC
*Ophthalmic Anti-infectives** - *Ophthalmic Anti-infective
Combinations***
ak-poly-bac ophthalmic
bacitracin-polymyxin B ophthalmic
neomycin-bacitracin zn-polymyx ophthalmic
neomycin-polymyxin-gramicidin ophthalmic
neo-polycin ophthalmic
NEOSPORIN
polycin b ophthalmic
polycin ophthalmic
87
polymyxin B-trimethoprim ophthalmic
POLYTRIM
triple antibiotic ophthalmic
G
NP
G
N
N
N
N
N
N
Y
Y
Y
NP
N
N
Y
G
NP
NP
N
N
N
N
N
N
Y
Y
Y
G
N
N
Y
P
N
N
Y
NP
NP
G
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
Y
N
Y
G
NP
NP
NP
G
G
G
NP
NP
G
NP
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Ophthalmic Anti-infectives** - *Ophthalmic Antiseptics***
BETADINE OPHTHALMIC PREP SOLUTION
*Ophthalmic Anti-infectives** - *Ophthalmic Antivirals***
trifluridine ophthalmic
VIROPTIC OPHTHALMIC
ZIRGAN OPHTHALMIC
*Ophthalmic Anti-infectives** - *Ophthalmic Sulfonamides***
sulfacetamide sodium ophthalmic
*Ophthalmic Immunomodulators** - *Ophthalmic
Immunomodulators***
RESTASIS OPHTHALMIC
*Ophthalmic Local Anesthetics** - *Ophthalmic Local Anesthetics***
AKTEN OPHTHALMIC
ALCAINE OPHTHALMIC
altacaine ophthalmic
parcaine ophthalmic
proparacaine ophthalmic
tetcaine ophthalmic
tetravisc forte ophthalmic
tetravisc ophthalmic
*Ophthalmic Photodynamic Therapy Agents** - *Ophthalmic
Photodynamic Therapy Agents***
VISUDYNE
*Ophthalmic Steroids** - *Ophthalmic Steroid Combinations***
bacitra-neomycin-polymyxin-hc ophthalmic
BLEPHAMIDE OPHTHALMIC
BLEPHAMIDE S.O.P. OPHTHALMIC
MAXITROL OPHTHALMIC
neomycin-polymyxin-dexameth ophthalmic
neo-polycin HC ophthalmic
poly-dex ophthalmic
PRED-G OPHTHALMIC
PRED-G S.O.P. OPHTHALMIC
sulfacetamide-prednisolone ophthalmic
TOBRADEX OPHTHALMIC
TOBRADEX ST
tobramycin-dexamethasone ophthalmic
ZYLET OPHTHALMIC
*Ophthalmic Steroids** - *Ophthalmic Steroids***
88
ALREX OPHTHALMIC
dexamethasone ophthalmic
DUREZOL OPHTHALMIC
FLAREX OPHTHALMIC
fluorometholone ophthalmic
fluor-op ophthalmic
FML FORTE OPHTHALMIC
FML LIQUIFILM OPHTHALMIC
FML OINTMENT OPHTHALMIC
LOTEMAX OPHTHALMIC
MAXIDEX OPHTHALMIC
OMNIPRED OPHTHALMIC
OZUDEX IMPLANT INTRAOCULAR
PRED FORTE OPHTHALMIC
PRED MILD OPHTHALMIC
prednisolone ophthalmic
VEXOL OPHTHALMIC
P
G
NP
NP
G
G
NP
NP
NP
P
NP
NP
MED
NP
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
NP
NP
G
NP
G
NP
NP
G
NP
NP
P
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
P
G
NP
N
N
N
N
N
N
Y
Y
Y
MED
N
N
Y
NP
N
N
Y
*Ophthalmic Surgical Aids** - *Ophthalmic Surgical Aids***
GELFILM OPHTHALMIC
*Ophthalmics - Misc.** - *Ophthalmic Antiallergic***
ALOCRIL OPHTHALMIC
ALOMIDE OPHTHALMIC
azelastine ophthalmic
BEPREVE OPHTHALMIC
cromolyn sodium ophthalmic
ELESTAT OPHTHALMIC
EMADINE OPHTHALMIC
epinastine ophthalmic
LASTACAFT OPHTHALMIC
OPTIVAR OPHTHALMIC
PATADAY OPHTHALMIC
PATANOL OPHTHALMIC
*Ophthalmics - Misc.** - *Ophthalmic Carbonic Anhydrase
Inhibitors***
AZOPT OPHTHALMIC
dorzolamide ophthalmic
TRUSOPT OPHTHALMIC
*Ophthalmics - Misc.** - *Ophthalmic Enzymes***
JETREA SOLUTION INTRAOCULAR
*Ophthalmics - Misc.** - *Ophthalmic Nonsteroidal Anti-inflammatory
Agents***
ACULAR LS OPHTHALMIC
89
ACUVAIL OPHTHALMIC
diclofenac ophthalmic
flurbiprofen ophthalmic
ILVERO OPHTHALMIC
ketorolac ophthalmic
NEVANAC OPHTHALMIC
OCUFEN OPHTHALMIC
PROLENSA OPHTHALMIC
NP
G
G
NP
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
NP
Y
N
Y
G
P
NP
P
G
NP
NP
N
N
N
N
N
N
N
N
N
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
N
N
N
N
Y
Y
NP
NP
N
N
N
N
Y
Y
NP
G
N
N
N
N
Y
Y
G
G
G
NP
G
G
G
G
NP
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Ophthalmics - Misc.** - *Ophthalmics - Cystinosis Agents**
CYSTARAN OPHTHALMIC
*Prostaglandins - Ophthalmic** - *Prostaglandins - Ophthalmic***
latanoprost ophthalmic
LUMIGAN OPHTHALMIC
RESCULA OPHTHALMIC
TRAVATAN Z OPHTHALMIC
travoprost ophthalmic
XALATAN OPHTHALMIC
ZIOPTAN OPTHALMIC
*OTIC AGENTS*
*Otic Agents - Miscellaneous** - *Otic Agents - Miscellaneous***
acetic acid otic
CRESYLATE OTIC
*Otic Analgesics** - *Otic Analgesics***
PINNACAINE OTIC
RE BENZOTIC OTIC
*Otic Anti-infectives** - *Otic Anti-infectives***
CETRAXAL OTIC
ofloxacin otic
*Otic Combinations** - *Otic Analgesic Combinations***
a/b otic
aero otic HC
antipyrine-benzocaine otic
AURALGAN OTIC
aurax otic
aurodex otic
auroguard otic
auroto otic
CORTANE-B OTIC
cortic-nd otic
cyotic otic
exotic-hc otic
90
MYOXIN OTIC
otic care otic
OTIC EDGE OTIC
OTICIN HC NR OTIC
oticin OTIC
otirx otic
oto-end 10 otic
otomar otic
otomax-hc solution
OTOZIN OTIC
pramoxine-chloroxylenol otic
pramoxine-hc-chloroxylenol aq otic
RE pramoxine-hc otic
zotane hc otic
NP
G
NP
NP
G
G
G
G
G
NP
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
P
NP
NP
NP
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
G
G
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
N
N
Y
MED
MED
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
*Otic Combinations** - *Otic Steroid-Anti-infective Combinations***
antibiotic ear solution
CIPRO HC OTIC
CIPRODEX OTIC
COLY-MYCIN S OTIC
CORTISPORIN OTIC
CORTISPORIN-TC OTIC
cortomycin otic
neomycin-polymyxin-hc otic
*Otic Steroids** - *Otic Steroids***
acetasol hc otic
DERMOTIC OIL OTIC
fluocinolone acetonide oil otic
hydrocortisone-acetic otic
VOSOL HC OTIC
*OXYTOCICS*
*Oxytocics** - *Oxytocics***
methylergonovine maleate
*PASSIVE IMMUNIZING AGENTS*
*Immune Serums** - *Immune Serums***
CARIMUNE NF SOLUTION RECONSTITUTED INTRAVENOUS
CYTOGAM INJECTABLE INTRAVENOUS
FLEBOGAMMA DIF SOLUTION INTRAVENOUS
FLEBOGAMMA SOLUTION INTRAVENOUS
GAMASTAN S/D INJECTABLE INTRAMUSCULAR
GAMMAGARD INJECTION
GAMMAGARD S/D SOLUTION INTRAVENOUS
91
GAMMAKED SOLUTION
GAMMAPLEX SOLUTION INTRAVENOUS
GAMUNEX SOLUTION INTRAVENOUS
HEPAGAM B SOLUTION INJECTION
HIZENTRA SOLUTION SUBCUTANEOUS
HYPERHEP B S/D SOLUTION INTRAMUSCULAR
HYPERRHO S/D INJECTABLE INTRAMUSCULAR
HYPERTET S/D INJECTABLE INTRAMUSCULAR
MICRHOGAM ULTRA-FILTERED PLUS INJECTABLE INTRAMUSCULAR
NABI-HB SOLUTION INTRAMUSCULAR
OCTAGAM SOLUTION INTRAVENOUS
PRIVIGEN SOLUTION INTRAVENOUS
RHOGAM ULTRA-FILTERED PLUS INJECTABLE INTRAMUSCULAR
RHOPHYLAC SOLUTION INJECTION
VARIZIG SOLUTION RECONSTITUTED INJECTION
WINRHO SDF SOLUTION INJECTION
HYQVIA INJECTABLE
BIVIGAM
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
MED
Y
Y
Y
N
Y
Y
Y
N
N
N
Y
Y
N
N
N
Y
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
MED
Y
N
Y
G
G
NP
N
N
N
N
N
N
Y
Y
Y
G
N
N
Y
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
N
N
Y
NP
MED
G
NP
N
Y
N
N
N
N
N
N
Y
Y
Y
Y
*Monoclonal Antibodies** - *Antiviral Monoclonal Antibodies***
SYNAGIS SOLUTION INTRAMUSCULAR
*PENICILLINS*
*Aminopenicillins** - *Aminopenicillins***
amoxicillin
ampicillin
MOXATAG
*Natural Penicillins** - *Natural Penicillins***
penicillin v potassium
*Penicillin Combinations** - *Penicillin Combinations***
amoxicillin-pot clavulanate
amoxicillin-pot clavulanate ER
AUGMENTIN
AUGMENTIN ES
AUGMENTIN XR
*Penicillinase-Resistant Penicillins** - *Penicillinase-Resistant
Penicillins***
dicloxacillin sodium
*PROGESTINS*
*Progestins** - *Progestins***
AYGESTIN
MAKENA OIL INTRAMUSCULAR
medroxyprogesterone acetate
MEGACE ES
92
norethindrone acetate TABLET 5 MG ORAL
progesterone micronized capsule oral
progesterone oil intramuscular
PROMETRIUM ORAL
PROVERA
G
G
MED
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
G
NP
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
Y
N
Y
NP
NP
G
G
NP
P
G
G
NP
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
P
P
P
P
N
N
N
N
N
N
N
N
Y
Y
Y
Y
G
NP
N
N
N
N
Y
Y
P
P
N
N
N
N
Y
Y
P
Y
N
Y
*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*
*Agents for Chemical Dependency** - *Alcohol Deterrents***
acamprosate calcium
ANTABUSE
CAMPRAL
disulfiram
*Anti-Cataplectic Agents** - *Anti-Cataplectic Agents***
XYREM
*Antidementia Agents** - *Cholinomimetics - ACHE Inhibitors***
ARICEPT
ARICEPT ODT
donepezil
donepezil odt
EXELON ORAL
EXELON PATCH
galantamine
galantamine er
RAZADYNE
RAZADYNE ER
rivastigmine
*Antidementia Agents** - *N-Methyl-D-Aspartate (NMDA) Receptor
Antagonists***
NAMENDA
NAMENDA TITRATION PACK
NAMENDA XR
NAMENDA XR TITRATION PACK
*Combination Psychotherapeutics** - *Thienbenzodiazepines &
SSRIs***
olanzapine-fluoxetine
SYMBAX
*Fibromyalgia Agents** - *Fibromyalgia Agent - SNRIs***
SAVELLA
SAVELLA TITRATION PACK
*Movement Disorder Drug Therapy** - *Movement Disorder Drug
Therapy***
XENAZINE
*Multiple Sclerosis Agents** - *MS Agents - Pyrimidine Synthesis
Inhibitors***
93
NP
Y
N
Y
MED
MED
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
MED
Y
N
Y
MED
MED
Y
Y
Y
Y
Y
Y
NP
Y
N
Y
MED
MED
Y
Y
N
N
Y
Y
NP
Y
N
Y
NP
NP
N
N
Y
Y
Y
Y
G
G
N
N
N
N
Y
Y
NUEDEXTA
*Psychotherapeutic and Neurological Agents - Misc.** *Psychotherapeutic and Neurological Agents - Misc.***
NP
N
N
Y
ORAP
*Restless Leg Syndrome (RLS) Agents** - *Restless Leg Syndrome (RLS)
Agents***
NP
N
N
Y
NP
N
Y
Y
G
N
N
Y
AUBAGIO
*Multiple Sclerosis Agents** - *Multiple Sclerosis Agents Interferons***
AVONEX
BETASERON
EXTAVIA
REBIF
REBIF REBIDOSE
REBIF TITRATION PACK
PLEGRIDY
*Multiple Sclerosis Agents** - *Multiple Sclerosis Agents - Monoclonal
Antibodies***
TYSABRI
*Multiple Sclerosis Agents** - *Multiple Sclerosis Agents - Nrf2 Pathway
Activators***
TECFIDERA
TECFIDERA 120 & 240 MG
*Multiple Sclerosis Agents** - *Multiple Sclerosis Agents - Potassium
Channel Blockers***
AMPYRA
*Multiple Sclerosis Agents** - *Multiple Sclerosis Agents***
COPAXONE
COPAXONE KIT
*Multiple Sclerosis Agents** - *Sphingosine 1-Phosphate (S1P) Receptor
Modulators***
GILENYA
*Postherpetic Neuralgia (PHN) Agents** - *Postherpetic Neuralgia
(PHN) Agents***
GRALISE
GRALISE STARTER PACK
*Premenstrual Dysphoric Disorder (PMDD) Agents** - *Premenstrual
Dysphoric Disorder (PMDD) Agents - SSRIs***
fluoxetine (PMDD)
SARAFEM
*Pseudobulbar Affect (PBA) Agents** - *Pseudobulbar Affect Agent
Combinations***
HORIZANT
*Smoking Deterrents** - *Smoking Deterrents***
bupropion ER (Smoking Det) EXTENDED RELEASE 12 HR
94
CHANTIX
NICORETTE GUM
NICORETTE LOZENGE
NICORETTE STARTER KIT
NICOTROL INHALER
NICOTROL NASAL SPRAY
ZYBAN EXTENDED RELEASE 12 HR
*Vasomotor Symptom Agents** - *Vasomotor Symptom Agents SSRIs***
BRISDELLE
NP
NP
NP
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
NP
N
N
Y
MED
MED
MED
MED
MED
Y
Y
Y
Y
Y
N
N
N
N
N
Y
Y
Y
Y
Y
NP
Y
N
Y
P
Y
N
Y
MED
MED
N
N
N
N
Y
Y
MED
MED
N
N
N
N
Y
Y
NP
NP
Y
Y
N
N
Y
Y
NP
NP
G
G
NP
G
G
NP
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
*RESPIRATORY AGENTS - MISC.*
*Alpha-Proteinase Inhibitor (Human)** - *Alpha-Proteinase Inhibitor
(Human)***
ARALAST NP SOLUTION INTRAVENOUS
GLASSIA SOLUTION INTRAVENOUS
PROLASTIN SOLUTION INTRAVENOUS
PROLASTIN-C SOLUTION INTRAVENOUS
ZEMAIRA SOLUTION INTRAVENOUS
*Cystic Fibrosis Agents** - *CFTR Potentiators***
KALYDECO
*Cystic Fibrosis Agents** - *Hydrolytic Enzymes***
PULMOZYME
*Pleural Sclerosing Agents** - *Pleural Sclerosing Agents***
SCLEROSOL INTRAPLEURAL AEROSOL
STERILE TALC POWDER INTRAPLEURAL
*Respiratory Agents - Misc.** - *Respiratory Agents - Misc.***
CUROSULF SUSPENSION INHALATION
INFASURF SUSPENSION 35-0.9 MG/ML-% INHALATION
*Pulmonary Fibrosis Agents***
ESBRIET
OFEV
*TETRACYCLINES*
*Tetracyclines** - *Tetracyclines***
ADOXA
ADOXA PAK
avidoxy
demeclocycline
DORYX
doxycycline hyclate
doxycycline monohydrate
MINOCIN
minocycline
95
minocycline ER
MONODOX
morgidox
SOLODYN
tetracycline
VIBRAMYCIN
G
NP
G
NP
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
G
G
NP
N
N
N
N
N
N
Y
Y
Y
NP
NP
G
G
G
G
NP
G
NP
NP
NP
G
G
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
G
NP
NP
G
N
N
N
N
N
N
N
N
Y
Y
Y
Y
NP
G
N
N
N
N
Y
Y
G
G
G
N
N
N
N
N
N
Y
Y
Y
*THYROID AGENTS*
*Antithyroid Agents** - *Antithyroid Agents***
methimazole
propylthiouracil
TAPAZOLE
*Thyroid Hormones** - *Thyroid Hormones***
ARMOUR THYROID
CYTOMEL
levothroid
levothyroxine sodium
levoxyl
liothyronine sodium
NATURE-THROID
np thyroid
SYNTHROID
THYROLAR
TIROSINT
unithroid
unithroid direct
WESTHROID
WESTHROID-P
WP THYROID
*ULCER DRUGS*
*Antispasmodics** - *Anticholinergic Combinations***
clidinium-chlordiazepoxide
DONNATAL
GASTRINEX NF CAPSULE
RE chlordiazepoxide/clidinium
*Antispasmodics** - *Antispasmodics***
BENTYL
dicyclomine
*Antispasmodics** - *Belladonna Alkaloids***
colidrops solution oral
ed-spaz
hyomax
96
hyomax-ft
hyomax-sl
hyomax-sr
hyoscyamine sulfate ER
hyoscyamine sulfate oral
hyoscyamine sulfate sublingual
hyosyne
nulev odt
oscimin oral
oscimin SR
oscimin sublingual
SYMAX DUOTAB
symax fastabs
symax-SL
symax-SR
G
G
G
G
G
G
G
G
G
G
G
NP
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
NP
G
G
NP
NP
NP
NP
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
G
N
N
N
N
N
N
Y
Y
Y
NP
NP
P
NP
G
G
P
G
G
NP
NP
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
Y
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
*Antispasmodics** - *Quaternary Anticholinergics***
CANTIL
CUVPOSA
GLYCATE
glycopyrrolate
methscopolamine bromide
PAMINE
PAMINE FORTE
ROBINUL ORAL
RONINUL-FORTE ORAL
*Misc. Anti-Ulcer** - *Misc. Anti-Ulcer***
CARAFATE SUSPENSION
CARAFATE TABLET
sucralfate tablet
*Proton Pump Inhibitors** - *Proton Pump Inhibitors***
ACIPHEX SPRINKLE
ACIPHEX TABLET
DEXILANT
ESOMEPRAZOLE STRONTIUM
KP omeprazole magnesium capsule
lansoprazole
NEXIUM
omeprazole
pantoprazole
PREVACID
PREVACID SOLUTAB
97
PRILOSEC
PROTONIX
rabeprazole
NP
NP
G
N
N
N
Y
Y
N
Y
Y
Y
NP
G
N
N
N
N
Y
Y
G
NP
N
N
N
Y
Y
Y
P
N
N
Y
G
P
NP
N
N
N
N
N
Y
Y
Y
Y
NP
N
N
Y
G
G
G
G
NP
NP
NP
G
G
G
G
G
G
G
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
NP
NP
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
*Ulcer Drugs - Prostaglandins** - *Ulcer Drugs - Prostaglandins***
CYTOTEC
misoprostol tablet
*Ulcer Therapy Combinations** - *Proton Pump Inhibitor-Antacid
Combinations***
omeprazole-sodium bicarbonate
ZEGERID
*Ulcer Therapy Combinations** - *Ulcer Anti-Infective w/ Bismuth
Combinations***
PYLERA
*Ulcer Therapy Combinations** - *Ulcer Anti-Infective w/ Proton Pump
Inhibitors***
amoxicill-clarithro-lansopraz
OMECLAMOX-PAK
PREVPAK
*URINARY ANTI-INFECTIVES*
*Urinary Anti-infective Combinations** - *Methenamine Combos***
UROQID #2
*Urinary Anti-infective Combinations** - *Urinary AntisepticAntispasmodic &/or Analgesics***
hyophen
phosenamine
phosphasal
ur n-c
URELLE
URIBEL
URIMAR-T
urin ds
uryl
ustell
uta
uticap
utira-c
utrona-c
*Urinary Anti-infectives** - *Urinary Anti-infectives***
FURADANTAN SUSPENSION
HIPREX
MACROBID
MACRODANTIN
methenamine hippurate
98
methenamine mandelate TABLET 1 GM ORAL
MONUROL PACKET
nitrofurantoin macrocrystal
nitrofurantoin monohyd macro
nitrofurantoin suspension
UREX
G
NP
G
G
G
NP
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
P
N
Y
Y
NP
G
NP
P
N
N
N
N
Y
N
Y
Y
Y
Y
Y
Y
G
N
N
Y
NP
NP
P
NP
G
G
NP
G
G
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
N
N
Y
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NP
NP
NP
G
G
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
NP
NP
G
NP
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
*URINARY ANTISPASMODICS*
*Beta-3 Adrenergic Agonists** - *Beta-3 Adrenergic Agonists***
MYRBETRIQ
*Urinary Antispasmodic - Antimuscarinics (Anticholinergic)** - *Urinary
Antispasmodic - Antimuscarinic (Anticholinergic)***
DETROL LA
oxybutynin
SANCTURA, SANCTURA XR
VESICARE
*Urinary Antispasmodics - Cholinergic Agonists** - *Urinary
Antispasmodics - Cholinergic Agonists***
bethanechol chloride
*Urinary Antispasmodics** - *Urinary Antispasmodics***
DETROL
DITROPAN XL
GELNIQUE
oxybutynin chloride er
tolterodine
TOVIAZ
trospium
trospium er
URECHOLINE
*VAGINAL PRODUCTS*
*Vaginal Anti-infectives** - *Imidazole-Related Antifungals***
GYNAZOLE-1
TERAZOLE 3
TERAZOLE 7
terconazole
zazole
*Vaginal Anti-infectives** - *Vaginal Anti-infectives***
AVC
CLEOCIN VAGINAL
clindamycin vaginal
CLINDESSE
METRO-GEL VAGINAL
99
metronidazole vaginal
vandazole
G
G
N
N
N
N
Y
Y
NP
NP
NP
P
NP
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
P
P
P
N
N
N
N
N
N
Y
Y
Y
NP
P
P
P
NP
N
N
N
N
N
Y
N
N
N
N
Y
Y
Y
Y
Y
G
N
N
Y
NP
Y
N
Y
NP
G
G
N
N
N
N
N
N
Y
Y
Y
P
N
N
Y
NP
N
N
Y
*Vaginal Estrogens** - *Vaginal Estrogens***
ESTRACE CREAM VAGINAL
ESTRING
FEMRING
PREMARIN CREAM VAGINAL
VAGIFEM
*Vaginal Progestins** - *Vaginal Progestins***
CRINONE
ENDOMETRIN
PROCHIEVE
*VASOPRESSORS*
*Anaphylaxis Therapy Agents** - *Anaphylaxis Therapy Agents***
ADRENACLICK
AUVI-Q
EPIPEN
EPIPEN JR
TWINJECT
*Vasopressors** - *Vasopressors***
midodrine
*Neurogenic Orthostatic Hypotension Agent***
NORTHERA
*VITAMINS*
*Oil Soluble Vitamins** - *Vitamin D***
DRISDOL
ergocalciferol
vitamin D (ergocalciferol)
*Oil Soluble Vitamins** - *Vitamin K***
MEPHYTON
*Water Soluble Vitamins** - *PABA***
POTABA
100

2015 Rx Preferred Drug Guide (3-Tier)

Transcription

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