PDL—Medication Categories Guide

Transcription

Whirlpool Corporation
PDL—Medication Categories Guide
Effective August 2014
You can make the most of your pharmacy benefit plan and control your prescription medication costs by using this
Preferred Drug List. Be sure to share this list with your doctor to select cost-effective medications that are
clinically appropriate to treat your condition or maintain your health.
This Preferred Drug List (PDL) was developed by
Whirlpool’s Formulary Review Committee, under the
direction of a committee of doctors and pharmacists.
Understanding Your Tiered Copays
Your pharmacy benefit plan offers five categories—
or tiers—of medications that determine your costs (copays):
Tier 0: Value-Based Medications. Select value-based
medications for controlling cholesterol, blood pressure,
diabetes, asthma, chronic obstructive pulmonary disease
and coronary artery disease are included in Tier 0.
The co-insurance is 0%, which means they are available at
no cost to you.
Tier 1: Generics. Most generic medications are included
in Tier 1. Generics contain the same active ingredient as
their brand-name equivalents and offer the same
effectiveness and safety. These drugs are clinically proven
and typically available at a lower cost. The co-insurance is
10%.
Tier 2: Preferred. Clinically proven and cost-effective
preferred-brand medications and some generic medications
are included in Tier 2. They have higher copays than
generics but are less costly than nonpreferred medications
on the third tier. The co-insurance is 20%.
Tier 3: Nonpreferred. Mostly non-preferred-brand
medications are included in Tier 3. These drugs are not as
clinically or cost-effective compared to other drugs available.
Because a generic version or a second-tier alternative is
available, the co-insurance is 50%.
Tier 4: Brand and generic drugs considered to have
minimal or no clinical and cost-effective value are in Tier 4.
The co-insurance is 100%.
Drug names are the property of their respective o wners.
©2014 Catamaran Inc. All rights reserved. Catamaran is a registered trademark of C atamaran Inc.
How to Use This Guide
Whenever possible, you and your doctor should consult
this guide for the lowest cost brand name and generic
medications available for your therapy. Some tips to
keep in mind when using this guide:
Therapeutic categories are listed alphabetically in all
UPPERCASE letters in black boxes. Therapeutic
classes in each category are printed in all
UPPERCASE letters in bold.
Generic medications are listed in lowercase letters
below the word GENERIC. Brand-name generic
medications have the first letter in Uppercase.
Some medications treat more than one condition.
Check different categories for your medication.
All medications on the PDL have been approved
by the FDA.
Additional Information
Not all medications are listed in this PDL. Medication
coverage and copays may vary from plan to plan. For
more information specific to your plan, log on to
healthscopebenefits.com and click on the Walgreens tab.
For additional assistance, please call 877-WHIRL50
(877-944-7550).
Please note: The PDL is subject to change without notice.
Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
AMEBICIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTIBIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTINEOPLASTIC ENZYMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANGIOGENESIS INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
RADIOPHARMACEUTICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
CELLULAR IMMUNOTHERAPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
CHEMOTHERAPY ADJUNCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
PHOSPHODIESTERASE INHBTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
CALCIUM REGULATORS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
GNRH/LHRH ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
PROGESTERONE ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
ANTACIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30
RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30
TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30
VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33
DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33
MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33
August 2014
TIER 03
ANTI-INFECTIVES
PENICILLINS
TIER 01
TIER 03
GENERIC
amoxicillin
amoxicillin/clavulanate potassium
amoxicillin/clavulanate potassium ER
ampicillin
ampicillin sodium
ampicillin-sulbactam
dicloxacillin sodium
nafcillin sodium
oxacillin sodium
penicillin v potassium
penicillin G potassium
piperacillin sodium/ tazobactam sodium
piperacillin sodium/tazobactam sodium
piperacillin/tazobactam
Amoxicillin
Ampicillin
Ampicillin Sodium
Penicillin G Potassium IN Iso-osmotic Dextrose
Penicillin G Sodium
Pfizerpen-G
NON PREFERRED
Amoxicillin ER
Ampicillin-sulbactam
Augmentin
Augmentin ES-600
Augmentin XR
Bactocill IN Dextrose
Bicillin C-R
Bicillin L-a
Moxatag
Nafcillin Sodium
Nallpen Iso-osmotic IN Dextrose
Nallpen/Dextrose
Penicillin G Procaine
Timentin
Unasyn
Unasyn Bulk Pack
Zosyn
THIRD GENERATION
GENERIC
TIER 01
TIER 03
TIER 03
SECOND GENERATION
GENERIC
TIER 01
cefaclor
cefoxitin sodium
cefprozil
cefuroxime axetil
cefuroxime sodium
Cefaclor
cefepime
NON PREFERRED
Cefepime
Maxipime
MACROLIDES
TIER 01
FIRST GENERATION
GENERIC
TIER 01
TIER 03
cefdinir
cefotaxime sodium
cefpodoxime proxetil
ceftazidime
ceftriaxone sodium
Cefditoren Pivoxil
Ceftazidime/Dextrose
Ceftriaxone IN Iso-osmotic Dextrose
Ceftriaxone/Dextrose
NON PREFERRED
Cedax
Ceftazidime
Ceftibuten
Claforan
Claforan/D5W
Fortaz
Rocephin
Spectracef
Suprax
Tazicef
FOURTH GENERATION
GENERIC
TIER 01
CEPHALOSPORIN
cefadroxil
cefazolin sodium
cephalexin
Cefazolin Sodium
Cephalexin
NON PREFERRED
Ancef
Cefazolin Sodium/Dextrose
Keflex
Cefaclor ER
Cefotetan
Cefotetan/Dextrose
Cefuroxime/Dextrose
NON PREFERRED
Cefoxitin Sodium
Ceftin
Cefuroxime Sodium
Mefoxin
Zinacef
Zinacef IN Iso-osmotic Dextrose
Zinacef IN Iso-osmotic Diluent
TIER 03
GENERIC
azithromycin
clarithromycin
clarithromycin ER
erythromycin
Azithromycin
E.e.s. 400
Erythrocin Stearate
Erythromycin Base
Erythromycin Ethylsuccinate
NON PREFERRED
Biaxin
Biaxin XL
Biaxin XL PAC
Dificid
E.e.s. Granules
Ery-TAB
Eryped 200
Eryped 400
Erythrocin Lactobionate
PCE
Zithromax
Zithromax Tri-PAK
Zithromax Z-PAK
Zmax
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA)
1
TETRACYCLINES
TIER 01
TIER 03
TIER 04
GENERIC
demeclocycline HCL
doxycycline
doxycycline hyclate
doxycycline monohydrate
minocycline HCL
Morgidox 1X100MG
Morgidox 2X100MG
Tetracycline HCL
NON PREFERRED
Acticlate
Adoxa
Adoxa PAK 1/100
Adoxa PAK 1/150
Adoxa PAK 2/100
Alodox Convenience Kit
Avidoxy DK
Dynacin
Minocin
Minocin Kit
Monodox
Nutridox
Ocudox
Oraxyl
Vibramycin
100% COPAY
doxycycline hyclate DR
minocycline HCL ER
Doryx
Nicazeldoxy 30 Kit
Nicazeldoxy 60 Kit
Solodyn
TIER 03
SULFONAMIDES
TIER 01
TIER 02
TIER 03
GENERIC
ciprofloxacin
ciprofloxacin ER
ciprofloxacin HCL
ciprofloxacin I.V.-IN D5W
levofloxacin
levofloxacin IN D5W
moxifloxacin HCL
ofloxacin
PREFERRED
Noroxin
NON PREFERRED
Avelox
Avelox Abc Pack
Cipro
Cipro I.V.-IN D5W
Cipro XR
Factive
Levaquin
Ofloxacin
AMINOGLYCOSIDES
TIER 01
GENERIC
amikacin sulfate
gentamicin sulfate
gentamicin sulfate pediatric
gentamicin sulfate/sodium chloride
gentamicin sulfate/0.9% sodium chloride
isotonic gentamicin
neomycin sulfate
paromomycin sulfate
tobramycin sulfate
Isotonic Gentamicin
TIER 02
GENERIC
Sulfadiazine
ANTIMYCOBACTERIAL AGENTS
TIER 01
TIER 02
TIER 03
QUINOLONES
TIER 01
PREFERRED
tobramycinPA
Tobi Podhaler
NON PREFERRED
BethkisPA
Gentamicin Sulfate/0.9% Sodium Chloride
Streptomycin Sulfate
TobiPA
Tobramycin Sulfate/Sodium Chloride
GENERIC
ethambutol HCL
isoniazid
pyrazinamide
rifampin
Cycloserine
Isoniazid
PREFERRED
rifabutin
NON PREFERRED
Capastat Sulfate
Myambutol
Mycobutin
Paser
Priftin
Rifadin
Rifamate
Rifater
Seromycin
Sirturo
Trecator
ANTIFUNGALS
TIER 01
TIER 02
TIER 03
GENERIC
fluconazole
fluconazole IN dextrose
fluconazole IN NACL
griseofulvin microsize
griseofulvin ultramicrosize
itraconazole
ketoconazole
nystatin
terbinafine HCL
voriconazole
Amphotericin B
Fluconazole IN NACL
PREFERRED
flucytosine
Noxafil
NON PREFERRED
Abelcet
Ambisome
Amphotec
Ancobon
Cancidas
Diflucan
Eraxis
Grifulvin V
Gris-peg
Lamisil
Mycamine
Onmel
Sporanox
Sporanox Pulsepak
2
Terbinex
Vfend
Vfend IV
Famvir
Flumadine
Foscavir
HepseraPA
IncivekPA
InfergenPA
Moderiba
Moderiba 1200 Dose Pack
Moderiba 800 Dose Pack
OlysioPA
Rebetol
Retrovir
Retrovir IV Infusion
Ribatab
Rimantalist
Sitavig
SovaldiPA
Stribild
Trizivir
TyzekaPA
Valtrex
VictrelisPA
Videx EC
Viramune
Viramune XR
Virazole
Vistide
Zerit
Ziagen
Zovirax
ANTIVIRALS
TIER 01
TIER 02
TIER 03
GENERIC
abacavir
abacavir sulfate/lamivudine/zidovudine
acyclovir
acyclovir sodium
cidofovir
didanosine
famciclovir
ganciclovir
lamivudine/zidovudine
nevirapine
nevirapine ER
ribavirin
rimantadine HCL
stavudine
valacyclovir HCL
zidovudine
Acyclovir Sodium
Foscarnet Sodium
Nevirapine
Ribasphere
Ribasphere Ribapak
PREFERRED
adefovir dipivoxilPA
lamivudine
Aptivus
Atripla
BaracludePA
Complera
Crixivan
Emtriva
Epzicom
FuzeonPA
Intelence
Invirase
Isentress
Kaletra
Lexiva
Norvir
Peg-intronPA
Peg-intron RedipenPA
Peg-intron Redipen PAK 4PA
PegasysPA
Pegasys ProclickPA
Prezista
Relenza Diskhaler
Rescriptor
Reyataz
SelzentryPA
Sustiva
Tamiflu
Tivicay
TruvadaPA
Valcyte
Videx Pediatric
Viracept
Viread
NON PREFERRED
Combivir
Copegus
Cytovene
Edurant
Epivir
Epivir HBV
ANTIMALARIALS
TIER 01
TIER 02
TIER 03
GENERIC
atovaquone/proguanil HCL
chloroquine phosphate
hydroxychloroquine sulfate
mefloquine HCL
quinine sulfate
PREFERRED
Daraprim
Primaquine Phosphate
NON PREFERRED
Aralen
Coartem
Malarone
Plaquenil
Qualaquin
AMEBICIDES
TIER 02
PREFERRED
Yodoxin
ANTHELMINTICS
TIER 02
PREFERRED
Albenza
Biltricide
Stromectol
MISC. ANTI-INFECTIVES
TIER 01
GENERIC
aztreonam
bacitracin
clindamycin palmitate HCL
clindamycin phosphate
clindamycin phosphate add-vantage
clindamycin phosphate pharmacy bulk package
clindamycin phosphate IN D5W
clindamycin HCL
colistimethate sodium
3
TIER 02
TIER 03
imipenem/cilastatin
meropenem
metronidazole
metronidazole IN NACL 0.79%
polymyxin b sulfate
sulfamethoxazole/trimethoprim
sulfamethoxazole/trimethoprim DS
tinidazole
trimethoprim
vancomycin HCL
Chloramphenicol Sodium Succinate
Dapsone
Metro IV
Sulfamethoxazole/Trimethoprim
Vancomycin HCL
PREFERRED
atovaquone
Alinia
Nebupent
Zyvox
NON PREFERRED
Azactam
Azactam IN Iso-osmotic Dextrose
Bacitracin
Bactrim
Bactrim DS
CaystonPA
Cleocin
Cleocin IN D5W
Cleocin Pediatric Granules
Cleocin Phosphate
Clindamycin Phosphate
Coly-mycin M
Cubicin
Dalvance
Doribax
First-vancomycin 25
First-vancomycin 50
Flagyl
Flagyl ER
Invanz
Ketek
Lincocin
Mepron
Merrem
Neutrexin
Pentam 300
Primaxin IV
Primaxin IV Add-vantage
Primsol
Sivextro
Synercid
Tindamax
Tygacil
Vancocin HCL
Vancomycin HCL IN Dextrose
Vibativ
Xifaxan
TIER 02
TIER 03
ANTIBIOTICS
TIER 01
TIER 03
TIER 03
NON PREFERRED
Elspar
ErwinazePA
Oncaspar
ANTIMETABOLITES
TIER 01
ANTINEOPLASTICS, ETC
GENERIC
carboplatin
cisplatin
ifosfamide
melphalan hydrochloride
oxaliplatin
temozolomidePA
Carboplatin
GENERIC
bleomycin sulfate
daunorubicin HCL
doxorubicin HCL
doxorubicin HCL liposome
epirubicin HCL
idarubicin HCL
mitomycin
mitoxantrone HCLPA
Adriamycin
Epirubicin HCL
NON PREFERRED
Cosmegen
Daunoxome
Doxil
Ellence
Idamycin PFS
ANTINEOPLASTIC ENZYMES
ALKYLATING AGENTS
TIER 01
Cisplatin
Cyclophosphamide
Ifosfamide
PREFERRED
Alkeran
Hexalen
Leukeran
Lomustine
MyleranPA
Treanda
ValchlorPA
NON PREFERRED
Bicnu
Busulfex
Ceenu
Eloxatin
Gliadel Wafer
Ifex
Mustargen
TemodarPA
Zanosar
TIER 02
GENERIC
azacitidinePA
cladribine
cytarabine
cytarabine aqueous
decitabinePA
floxuridine
fludarabine phosphate
fluorouracil
gemcitabine HCL
mercaptopurine
methotrexate
methotrexate sodium
Cytarabine
Fludarabine Phosphate
Gemcitabine
PREFERRED
capecitabinePA
Folotyn
Trexall
TIER 03
4
NON PREFERRED
Alimta
Arranon
Clolar
DacogenPA
Fludara
Gemzar
Purinethol
Purixan
Tabloid
VidazaPA
XelodaPA
ANGIOGENESIS INHIBITORS
TIER 02
Trelstar MixjectPA
ZytigaPA
IMMUNOMODULATORS
TIER 01
TIER 02
PREFERRED
Avastin
CyramzaPA
ZaltrapPA
ANTIBODIES
TIER 02
TIER 03
PREFERRED
Erbitux
GazyvaPA
HerceptinPA
KadcylaPA
RituxanPA
NON PREFERRED
AdcetrisPA
ArzerraPA
Bexxar
PerjetaPA
Vectibix
YervoyPA
Zevalin Y-90
TIER 03
GENERIC
azathioprine
cyclosporine
cyclosporine modified
mycophenolate mofetil
mycophenolic acid DR
sirolimus
tacrolimus
Cyclosporine Modified
PREFERRED
Atgam
Azasan
Neoral
PomalystPA
Rapamune
RevlimidPA
Sandimmune
ThalomidPA
Thymoglobulin
NON PREFERRED
Astagraf XL
Cellcept
Cellcept Intravenous
Imuran
Myfortic
NulojixPA
Prograf
Simulect
ZortressPA
MITOTIC INHIBITORS
HORMONAL AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
anastrozole
bicalutamide
exemestane
flutamide
letrozole
leuprolide acetatePA
megestrol acetate
tamoxifen citrate
PREFERRED
Depo-provera
Emcyt
FirmagonPA
Lupron DepotPA
Lysodren
VantasPA
XtandiPA
ZoladexPA
NON PREFERRED
Arimidex
Aromasin
Casodex
EligardPA
Fareston
Faslodex
Femara
Megace Oral
Nilandron
Soltamox
Trelstar DepotPA
Trelstar Depot MixjectPA
Trelstar LAPA
Trelstar LA MixjectPA
TIER 01
TIER 02
TIER 03
GENERIC
etoposide
paclitaxel
vincristine sulfate
vinorelbine tartrate
Etoposide
Paclitaxel
Vinblastine Sulfate
PREFERRED
Ixempra Kit
JevtanaPA
NON PREFERRED
Abraxane
Docefrez
Docetaxel
Etopophos
HalavenPA
Marqibo
Navelbine
Taxotere
Teniposide
Vumon
ENZYME INHIBITORS
TIER 02
PREFERRED
AfinitorPA
Afinitor DisperzPA
BosulifPA
GleevecPA
JakafiPA
MekinistPA
NexavarPA
SprycelPA
SutentPA
5
TIER 03
TafinlarPA
TarcevaPA
TasignaPA
Torisel
TykerbPA
VelcadePA
VotrientPA
XalkoriPA
ZelborafPA
NON PREFERRED
Beleodaq
CaprelsaPA
CometriqPA
GilotrifPA
IclusigPA
IstodaxPA
KyprolisPA
StivargaPA
ZolinzaPA
Zydelig
ZykadiaPA
TOPOISOMERASE I INHIBITOR
TIER 01
TIER 03
GENERIC
irinotecan
topotecan HCL
Topotecan HCL
NON PREFERRED
Camptosar
Hycamtin
Irinotecan
RADIOPHARMACEUTICALS
TIER 03
TIER 04
NON PREFERRED
Bexxar 131 Iodine
Metastron
Quadramet
100% COPAY
Xofigo
CELLULAR IMMUNOTHERAPY
TIER 03
NON PREFERRED
Provenge
ANTINEOPLASTICS MISC.
TIER 01
TIER 02
TIER 03
GENERIC
dacarbazine
hydroxyurea
tretinoin
Dacarbazine
PREFERRED
Actimmune
Intron-aPA
Intron-a W/DiluentPA
Matulane
Proleukin
SynriboPA
NON PREFERRED
Alferon N
Hydrea
Nipent
Photofrin
SylatronPA
TargretinPA
Trisenox
Uvadex
CHEMOTHERAPY RESCUE
TIER 03
TIER 04
GENERIC
amifostine
dexrazoxane
leucovorin calcium
mesna
Calcium Folinate
Leucovorin Calcium
NON PREFERRED
Ethyol
Fusilev
Mesnex
Totect
Zinecard
100% COPAY
Voraxaze
CHEMOTHERAPY ADJUNCTS
TIER 02
TIER 03
PREFERRED
Kepivance
NON PREFERRED
Elitek
ANTINEOPLASTIC COMBO
TIER 01
GENERIC
Ifosfamide/Mesna
CARDIOVASCULAR DRUGS
PHOSPHODIESTERASE INHBTR
TIER 01
GENERIC
milrinone lactate
milrinone IN dextrose
CARDIAC GLYCOSIDES
TIER 01
TIER 03
GENERIC
digoxin
Digoxin
NON PREFERRED
Lanoxin
Lanoxin Pediatric
ANTIANGINAL AGENTS
TIER 00
TIER 01
TIER 02
TIER 03
VALUE BASED BENEFIT
Nitrostat
GENERIC
isosorbide dinitrate
isosorbide dinitrate ER
isosorbide mononitrate
isosorbide mononitrate ER
nitroglycerin
nitroglycerin lingual
nitroglycerin transdermal
nitroglycerin IN dextrose 5%
nitroglycerin IN 5% dextrose
Isosorbide Dinitrate
Nitroglycerin
Nitroglycerin IN Dextrose 5%
Nitroglycerin Lingual
PREFERRED
Dilatrate SR
RanexaPA
NON PREFERRED
Imdur
Isordil Titradose
Nitro-bid
Nitro-dur
Nitrolingual Pumpspray
Nitromist
Nitronal
TIER 01
6
Calan
Calan SR
Cardene I.v.
Cardene IV
Cardene SR
Cardizem
Cardizem CD
Cleviprex
Dilacor XR
Hypertenipine-2.5
Isoptin SR
Norvasc
Nymalize
Procardia
Procardia XL
Sular
Tiazac
Verelan
Verelan PM
BETA BLOCKERS
TIER 00
TIER 01
TIER 02
TIER 03
VALUE BASED BENEFIT
carvedilol
GENERIC
acebutolol HCL
atenolol
betaxolol HCL
bisoprolol fumarate
esmolol HCL
labetalol HCL
metoprolol succinate ER
metoprolol tartrate
nadolol
pindolol
propranolol HCL
propranolol HCL ER
sotalol HCL
sotalol HCL (AF)
Propranolol HCL
Timolol Maleate
PREFERRED
Coreg CR
NON PREFERRED
Betapace
Betapace AF
Brevibloc
Bystolic
Coreg
Corgard
Hemangeol
Hypertenevide-12.5
Inderal LA
Inderal XL
Innopran XL
Kerlone
Levatol
Lopressor
Sectral
Sotalol Hydrochloride
Tenormin
Toprol XL
Trandate
Zebeta
ANTIARRHYTHMICS
TIER 01
TIER 02
TIER 03
CALCIUM CHANNEL BLOCKERS
TIER 00
TIER 01
TIER 02
TIER 03
VALUE BASED BENEFIT
amlodipine besylate
diltiazem HCL
verapamil HCL
GENERIC
diltiazem CD
diltiazem HCL ER
felodipine ER
nicardipine HCL
nifedipine
nifedipine ER
nimodipine
nisoldipine
verapamil HCL ER
verapamil HCL SR
Diltiazem HCL
Isradipine
Nisoldipine
Nisoldipine ER
Verapamil HCL
PREFERRED
Cardizem LA
NON PREFERRED
Adalat CC
GENERIC
adenosine
amiodarone HCL
disopyramide phosphate
flecainide acetate
ibutilide fumarate
lidocaine HCL
lidocaine HCL IN D5W
lidocaine HCL/dextrose
mexiletine HCL
propafenone HCL
propafenone HCL ER
quinidine gluconate CR
quinidine gluconate ER
quinidine sulfate
Amiodarone HCL
Lidocaine HCL
Procainamide HCL
Quinidine Sulfate ER
PREFERRED
Tikosyn
NON PREFERRED
Adenocard
Cordarone
Corvert
Multaq
Nexterone
Norpace
Norpace CR
Quinidine Gluconate
Quinidine Sulfate
Rythmol
Rythmol SR
Tambocor
Xylocaine
ACE INHIBITORS
TIER 00
VALUE BASED BENEFIT
benazepril HCL
captopril
enalapril maleate
fosinopril sodium
lisinopril
moexipril HCL
perindopril erbumine
quinapril HCL
ramipril
trandolapril
7
TIER 01
TIER 03
GENERIC
enalaprilat
NON PREFERRED
Accupril
Aceon
Altace
Epaned
Lotensin
Mavik
Prinivil
Univasc
Vasotec
Zestril
ANTIHYPERTENSIVE COMBO
TIER 00
TIER 01
ANGIOTENSIN RCPTR BLOCKER
TIER 00
TIER 01
TIER 03
VALUE BASED BENEFIT
losartan potassium
GENERIC
candesartan cilexetil
eprosartan mesylate
irbesartan
telmisartan
valsartan
NON PREFERRED
AtacandST
AvaproST
BenicarST
CozaarST
DiovanST
Edarbi
MicardisST
TevetenST
TIER 03
DIRECT RENIN INHIBITORS
TIER 03
NON PREFERRED
TekturnaST
ANTIHYPERTENSIVES MISC.
TIER 01
TIER 02
TIER 03
GENERIC
clonidine HCL
doxazosin mesylate
eplerenone
fenoldopam mesylate
guanfacine HCL
hydralazine HCL
methyldopa
minoxidil
prazosin HCL
terazosin HCL
Methyldopate HCL
Nitropress
Phentolamine Mesylate
Reserpine
PREFERRED
Demser
Dibenzyline
NON PREFERRED
Cardura
Catapres
Catapres-tts-1
Catapres-tts-2
Catapres-tts-3
Corlopam
Inspra
Minipress
Tenex
Vecamyl
TIER 04
VALUE BASED BENEFIT
benazepril HCL/hydrochlorothiazide
enalapril maleate/hydrochlorothiazide
lisinopril/hydrochlorothiazide
losartan potassium/hydrochlorothiazide
Captopril/Hydrochlorothiazide
GENERIC
amlodipine besylate/benazepril hydrochloride
amlodipine besylate/benazepril HCL
atenolol/chlorthalidone
bisoprolol fumarate/hydrochlorothiazide
candesartan cilexetil/hydrochlorothiazide
fosinopril sodium/hydrochlorothiazide
irbesartan/hydrochlorothiazide
metoprolol/hydrochlorothiazide
moexipril/hydrochlorothiazide
nadolol/bendroflumethiazide
quinapril/hydrochlorothiazide
telmisartan/amlodipine
telmisartan/hydrochloroth
telmisartan/hydrochlorothiazide
valsartan/hydrochlorothiazide
Clorpres
Methyldopa/Hydrochlorothiazide
Propranolol/Hydrochlorothiazide
NON PREFERRED
Accuretic
Atacand HCTST
AvalideST
AzorST
Benicar HCTST
Corzide
Diovan HCTST
Dutoprol
ExforgeST
Exforge HCTST
Hypertensolol
HyzaarST
Lopressor HCT
Lotensin HCT
Lotrel
Lytensopril Kit
Lytensopril-90
Lytensopril-90 Kit
Micardis HCTST
Tarka
Tekturna HCTST
Tenoretic 100
Tenoretic 50
Teveten HCTST
Twynsta
Uniretic
Vaseretic
Zestoretic
Ziac
100% COPAY
Amturnide
Edarbyclor
Tekamlo
Tribenzor
DIURETICS
TIER 00
TIER 01
VALUE BASED BENEFIT
hydrochlorothiazide
Chlorthalidone
GENERIC
acetazolamide
acetazolamide sodium
8
TIER 03
acetazolamide ER
amiloride HCL
amiloride/hydrochlorothiazide
bumetanide
chlorothiazide
chlorothiazide sodium
furosemide
indapamide
mannitol
methazolamide
metolazone
spironolactone
spironolactone/hydrochlorothiazide
torsemide
triamterene/hydrochlorothiazide
Acetazolamide
Furosemide
Methyclothiazide
Torsemide
NON PREFERRED
Aldactazide
Aldactone
Chlorothiazide
Demadex
Diamox
Diuril
Dyazide
Dyrenium
Edecrin
Introl
Lasix
Maxzide
Maxzide-25
Microzide
Neptazane
Sodium Diuril
Sodium Edecrin
Triamterene/Hydrochlorothiazide
Zaroxolyn
TIER 01
TIER 02
TIER 03
VASOPRESSORS
TIER 01
TIER 03
GENERIC
dobutamine HCL
dobutamine HCL/D5W
dobutamine/dextrose 5%
dopamine HCL
dopamine HCL-dextrose 5%
dopamine HCL/dextrose 5%
dopamine/D5W
ephedrine sulfate
midodrine HCL
norepinephrine bitartrate
phenylephrine HCL
Adrenaclick
Auvi-q
Dopamine HCL
Epinephrine
Epipen 2-PAK
Epipen-JR 2-PAK
NON PREFERRED
Adrenalin
Dobutamine/Dextrose 5%
Levophed
Neo-synephrine
Northera
Phenylephrine HCL
ANTIHYPERLIPIDEMICS
TIER 00
TIER 04
VALUE BASED BENEFIT
atorvastatin calcium
lovastatin
pravastatin sodium
simvastatin
GENERIC
cholestyramine
cholestyramine light
colestipol HCL
colestipol HCL for oral suspension
fenofibrate
fenofibrate micronized
fluvastatin
gemfibrozil
niacin ER
Fenofibric AcidST
PREFERRED
omega-3-acid ethyl esters
JuxtapidPA
KynamroPA
Welchol
Zetia
NON PREFERRED
Advicor
AltoprevST
Colestid
Colestid Flavored
CrestorST
Fenofibrate
FibricorST
Lescol
Lescol XLST
Lipitor
LivaloST
Lopid
Lovaza
Mevacor
Niacor
Niaspan
Pravachol
Questran
Questran Light
Simcor
Zocor
100% COPAY
fenofibric acid DR
AntaraST
FenoglideST
Lipofen
Lofibra
Tricor
TriglideST
Trilipix
Vytorin
CARDIOVASCULAR - MISC.
TIER 01
TIER 02
GENERIC
amlodipine besylate/atorvastatin calcium
epoprostenol sodium
papaverine HCL
VeletriPA
PREFERRED
sildenafilPA
sildenafil citratePA
AdempasPA
Bidil
Cialis
FlolanPA
LetairisPA
9
TIER 03
TIER 04
Muse
RemodulinPA
RevatioPA
TracleerPA
VentavisPA
Viagra
NON PREFERRED
AdcircaPA
Caduet
Levitra
Natrecor
OrenitramPA
Staxyn
Stendra
TyvasoPA
Tyvaso RefillPA
Tyvaso StarterPA
100% COPAY
OpsumitPA
TIER 04
DERMATOLOGICALS
ACNE PRODUCTS
TIER 01
TIER 03
GENERIC
adapalenePA
clindamycin/benzoyl peroxide
erythromycin
erythromycin/benzoyl peroxide
sodium sulfacetamide
sodium sulfacetamide/sulfur
sodium sulfacetamide/sulfur cleanser
sodium sulfacetamide/sulfur cleansing cloths
sodium sulfacetamide/sulfur green
sodium sulfacetamide/sulfur wash
sulfacetamide sodium
sulfacetamide sodium/sulfur cleanser
tretinoinPA
tretinoin microspherePA
tretinoin microsphere P.M.PA
Claravis
Clindacin PAC
Sodium Sulfacetamide/Sulfur
Sodium Sulfacetamide/Sulfur Cleanser IN Urea
Sodium Sulfacetamide/Sulfur IN Urea
NON PREFERRED
Absorica
Acanya
Aczone
Akne-mycin
AtralinPA
Avar
Avar LS
Avar LS Cleanser
Avar-e LS
Azelex
Benzaclin
Benzamycin
Benzamycinpak
Clarifoam EF
Cleocin-t
Clindacin Etz
Clindagel
DifferinPA
Duac
Erygel
Evoclin
Fabior
Klaron
Neuac Kit
Nuox
Plexion
Plexion Cleanser
Plexion Cleansing Cloths
Retin-aPA
Retin-a MicroPA
Retin-a Micro P.M.PA
Rosanil
Sulfoam
Sumadan Wash
Sumadan XLT
Sumaxin
Sumaxin CP Kit
Sumaxin Ts
Sumaxin Wash
Tretin-xPA
VeltinPA
ZianaPA
100% COPAY
Benzaclin With P.M.
EpiduoPA
Sumadan Kit
ROSACEA AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
metronidazole
PREFERRED
Finacea
Oracea
NON PREFERRED
Metrocream
Metrogel
Metrolotion
Noritate
Rosadan Kit
ANTIBIOTICS - TOPICAL
TIER 01
TIER 03
GENERIC
mupirocin
mupirocin calcium
Gentamicin Sulfate
NON PREFERRED
Altabax
Bactroban
Centany
Centany AT
Cortisporin
Neo-synalar
Neo-synalar Kit
ANTIFUNGALS - TOPICAL
TIER 01
TIER 02
TIER 03
GENERIC
ciclopirox
ciclopirox nail lacquer
ciclopirox olamine
clotrimazole
clotrimazole/betamethasone dipropionate
econazole nitrate
ketoconazole
nystatin
nystatin/triamcinolone
Ciclodan Solution Kit
Ciclopirox Topical Solution Kit
PREFERRED
Ertaczo
Mentax
NON PREFERRED
Cnl8 Nail Kit
Exelderm
10
TIER 04
Extina
Halotin
Jublia
Lamisil Spray
Loprox
Loprox Shampoo
Lotrisone
Luzu
Naftin
Nizoral
Oxistat
Pediaderm AF Complete Kit
Pedipirox-4 Nail
Penlac Nail Lacquer
Vusion
Xolegel
Xolegel Corepak
Xolegel Duo/Head & Shoulders
Xolegel Duo/Xolex
100% COPAY
Ciclodan Cream Kit
Ecoza
Ketodan Kit
TIER 04
ANTISEBORRHEIC AGENTS
TIER 01
TIER 03
TIER 04
ANTIVIRALS - TOPICAL
TIER 02
TIER 03
TIER 04
PREFERRED
acyclovir
NON PREFERRED
Denavir
Xerese
Zovirax
100% COPAY
Lidovir
TIER 03
TIER 01
GENERIC
diclofenac sodium
NON PREFERRED
Flector
Lidoprofen
Pennsaid
Voltaren
Vopac
Vopac GB
Vopac Kt
ANTIPRURITICS
TIER 01
TIER 03
GENERIC
Prudoxin
NON PREFERRED
Zonalon
ANTIPSORIATICS
TIER 01
TIER 02
TIER 03
GENERIC
calcipotriene
Calcitriol
PREFERRED
acitretin
methoxsalen
StelaraPA
NON PREFERRED
Dovonex
Dritho-creme HP
Oxsoralen Ultra
Soriatane
Tazorac
Vectical
Zithranol
Zithranol-rr
GENERIC
selenium sulfide
sodium sulfacetamide wash
Seb-prev
Selenium Sulfide
Sodium Sulfacetamide/Urea
NON PREFERRED
Glycolic Acid
Glycolic Acid 70% High Purity
Ovace Plus
Ovace Plus Wash
Ovace Wash
Promiseb
Selrx
Selsun Shampoo
Tersi Foam
TL Triseb
100% COPAY
Promiseb Complete
CORTICOSTEROIDS - TOPICAL
ANTI-INFLAMMATORY AGENTS
TIER 01
8-mop
100% COPAY
Sorilux
TIER 02
TIER 03
GENERIC
alclometasone dipropionate
amcinonide
augmented betamethasone dipropionate
betamethasone dipropionate
betamethasone valerate
clobetasol propionate
clobetasol propionate emollient
desonide
desoximetasone
diflorasone diacetate
fluocinolone acetonide
fluocinonide
fluocinonide emollient base
fluocinonide-e
fluticasone propionate
halobetasol propionate
hydrocortisone
hydrocortisone acetate/aloe
hydrocortisone butyrate
hydrocortisone valerate
hydrocortisone IN absorbase
mometasone furoate
prednicarbate
triamcinolone acetonide
Amcinonide
Apexicon E
Desoximetasone
Diflorasone Diacetate
Triamcinolone Acetonide
Trianex
U-cort
PREFERRED
hydrocortisone butyrate (lipid)
hydrocortisone butyrate (lipophilic)
Capex
Cordran Tape
NON PREFERRED
Aclovate
Ala Scalp
Carmol-HC
Clobex
11
TIER 04
Clodan Kit
Cordran
Cutivate
Derma-smoothe/FS Body
Derma-smoothe/FS Body Oil
Derma-smoothe/FS Scalp
Derma-smoothe/FS Scalp Oil
Dermasorb HC
Dermasorb Ta
Dermatop
Desonate
Desowen
Desowen Cream/Cetaphil Lotion
Desowen Lotion/Cetaphil Cream
Desowen Ointment/Cetaphil Lotion
Diprolene
Diprolene AF
Elocon
Epifoam
First-hydrocortisone
Halog
Halonate
Kenalog
Locoid
Locoid Lipocream
Luxiq
Nucort
Nuzon
Olux
Olux-e
Pandel
Pediaderm HC
Pediaderm Ta
Pramosone
Scalacort DK
Synalar
Temovate
Temovate E
Texacort
Topicort
Ultravate
Ultravate PAC
Vanos
Verdeso
Westcort
100% COPAY
calcipotriene/betamethasone dipropionate
Synalar Cream Kit
Synalar Ointment Kit
Synalar Ts
Taclonex
Ultravate X
IMMUNOMODULATING AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
imiquimod
PREFERRED
ElidelPA
ProtopicPA
NON PREFERRED
Aldara
Zyclara
Zyclara P.M.
DERMATOLOGICALS - MISC.
TIER 01
GENERIC
ammonium lactate
episone CRE
lactic acid
TIER 02
TIER 03
lactic acid e
lactic acid w/vitamin e
lidocaine
lidocaine HCL
lidocaine HCL jelly
lidocaine/prilocaine
lindane
malathion
permethrin
podofilox
salicylic acid
sodium hyaluronate
urea
urea topical
urea IN zinc undecylenate/lactic acid vehicle
urea 40% nail film
Aluminum Acetate
Benzoin Compound Tincture
Cocaine HCL
Ethyl Chloride/Fine Pinpoint
Ethyl Chloride/Fine Stream
Ethyl Chloride/Medium Jet Stream
Ethyl Chloride/Medium Stream
Ethyl Chloride/Mist
Hylira
Latrix XM
Lidocaine HCL
Lidocaine/Prilocaine
Mb Hydrogel
Pr Cream
Pruclair
Prumyx
Salicylic Acid
Salicylic Acid IN Ammonium Lactate Vehicle
TL-cermide
PREFERRED
Condylox
Eurax
Oxsoralen
NON PREFERRED
Aluvea
Anacaine
Arnica Flower
Atopiclair
Aurstat
Aurstat Anti-itch Hydrogel
Aurstat Anti-itch Hydrogel Kit
Benzoin Tincture
Boric Acid
Cem-urea
Coal TAR
Dermasorb XM
Drysol
Elenzapatch
Eletone
Eletone Twinpack
Elimite
Emla
Emulsion SB
Epiceram
Ethyl Chloride
Gebauers Pain Ease
Gebauers Spray And Stretch
Genadur
Gordofilm
Gordons Urea
Hydro 35
Hydro 40 Foam
Kerafoam
Kerafoam 42
12
TIER 04
Keralac
Lac-hydrin
Lidoderm
Lycelle
Natroba
Neosalus
Neosalus CP
Nivatopic Plus
Ovide
Pliaglis
Presera
Pyrogallic Acid
Qutenza
Radigel
Salkera
Salvax Duo Plus
Sklice
Spinosad
Sulfurated Lime
Synera
Tetrix
Tropazone
Ulesfia
Umecta
Umecta Nail Film
Umecta PD
Uramaxin
Uramaxin GT
Uramaxin GT Kit
Utopic
Veregen
Vexa
Witch Hazel
Xclair
Xerac Ac
Xylocaine
100% COPAY
Hylatopic
Hylatopic Plus
HPR
HPR Plus
HPR Plus/Mb Hydrogel
Nuvail
Ultrasal-ER
Virasal
TIER 03
ANDROGENS-ANABOLIC
TIER 01
TIER 02
TIER 03
ENDOCRINE AND METABOLIC
CORTICOSTEROIDS
TIER 01
GENERIC
betamethasone sodium phosphate/betamethasone
acetate
budesonide
dexamethasone
dexamethasone sodium phosphate
fludrocortisone acetate
hydrocortisone
methylprednisolone
methylprednisolone acetate
methylprednisolone dose pack
methylprednisolone sodiumsuccinate
prednisolone
prednisolone sodium phosphate
prednisone
Cortisone Acetate
Dexamethasone
Dexamethasone Intensol
Prednisolone Sodium Phosphate
Prednisone
Prednisone Intensol
NON PREFERRED
A-hydrocort
Aristospan Intra-articular
Aristospan Intralesional
Celestone
Celestone-soluspan
Cortef
Depo-medrol
Dexamethasone Sodium Phosphate
Dexpak 10 Day
Dexpak 13 Day
Dexpak 6 Day
Entocort EC
FLO-pred
Interarticular Joint Kit
Kenalog-10
Kenalog-40
Medrol
Medrol Dosepak
Millipred
Millipred DP
Orapred
Orapred Odt
Pediapred
Prelone
Rayos
Solu-cortef
Solu-medrol
Uceris
Veripred 20
GENERIC
danazol
oxandrolonePA
testosterone cypionatePA
testosterone enanthatePA
AndroxyPA
PREFERRED
AndrodermPA
AndrogelPA
Androgel P.M.PA
NON PREFERRED
Anadrol-50PA
AndroidPA
Aveed
AxironPA
Depo-testosteronePA
First-testosterone
First-testosterone Mc Compounding KitPA
FortestaPA
OxandrinPA
StriantPA
TestimPA
Testopel
TestosteronePA
Testosterone P.M.PA
TestredPA
VogelxoPA
Vogelxo P.M.PA
ESTROGENS
TIER 01
GENERIC
estradiol
estradiol valerate
estradiol/norethindrone acetate
estropipate
Estropipate
Jinteli
13
TIER 02
TIER 03
PREFERRED
Cenestin
Climara
Combipatch
Divigel
Enjuvia
Evamist
Premphase
Prempro
Vivelle-dot
NON PREFERRED
Activella
Alora
Angeliq
Climara Pro
Delestrogen
Depo-estradiol
Duavee
Elestrin
Estrace
Estrasorb
Estrogel
Femhrt Low Dose
Menest
Menostar
Minivelle
Prefest
Premarin
CONTRACEPTIVES
TIER 00
TIER 01
TIER 02
TIER 03
GENERIC
drospirenone/ethinyl estradiol
levonorgestrel and ethinyl estradiol
levonorgestrel/ethinyl estradiol
norethindrone
norgestimate/ethinyl estradiol
Amethyst
Beyaz
Generess FE
Loseasonique
Natazia
Necon 1/50-28
Necon 10/11-28
Norinyl 1+35
Ogestrel
Ortho Tri-cyclen LO
Ortho-novum 7/7/7
Safyral
Zovia 1/50e
GENERIC
desogestrel/ethinyl estradiol
levonorgestrel
norethindrone acetate/ethinyl estradiol
norethindrone acetate/ethinyl estradiol/ferrous fumarate
Brevicon-28
PREFERRED
Desogen
NON PREFERRED
Ella
Estrostep FE
Falessa
Loestrin 1.5/30-21
Loestrin 1/20-21
Lomedia 24 FE
LO Loestrin FE
LO Minastrin FE
Mircette
Modicon
Nor-QD
TIER 04
Nordette-28
Norinyl 1+50
Ortho Micronor
Ortho Tri-cyclen
Ortho-cept
Ortho-cyclen
Ortho-novum 1/35
Ovcon-35
Plan B
Plan B One-step
Quartette
Tri-norinyl 28
Yasmin 28
Yaz
100% COPAY
Cyclessa
Femcon FE
Loestrin FE 1.5/30
Loestrin FE 1/20
Loestrin 24 FE
Minastrin 24 FE
Seasonique
PROGESTINS
TIER 00
TIER 01
TIER 03
GENERIC
medroxyprogesterone acetate
GENERIC
norethindrone acetate
progesterone
NON PREFERRED
Aygestin
MakenaPA
Megace ES
Prometrium
Provera
ANTIDIABETIC AGENTS
INSULIN
TIER 00
TIER 02
TIER 03
VALUE BASED BENEFIT
Humalog
Humalog Mix 50/50
Humalog Mix 75/25
Humulin R U-500 (concentrated)
Lantus
Levemir
Novolog
Novolog Mix 70/30
PREFERRED
Apidra
Apidra Solostar
Humalog Kwikpen
Humalog Mix 50/50 Kwikpen
Humalog Mix 75/25 Kwikpen
Lantus Solostar
Levemir Flexpen
Novolog Flexpen
Novolog Mix 70/30 Prefilled Flexpen
Novolog Penfill
NON PREFERRED
Levemir Flextouch
AMYLIN ANALOGS
PREFERRED
TIER 02
Symlinpen 120PA
Symlinpen 60PA
INCRETIN MIMETIC AGENTS
PREFERRED
TIER 02
TIER 03
ByettaPA
NON PREFERRED
Bydureon
Tanzeum
14
VictozaPA
TIER 01
SULFONYLUREAS
VALUE BASED BENEFIT
TIER 00
TIER 01
TIER 03
BIGUANIDES
TIER 00
TIER 03
glimepiride
glipizide
glipizide ER
glyburide
glyburide micronized
Glyburide
GENERIC
tolazamide
Chlorpropamide
Tolazamide
Tolbutamide
NON PREFERRED
Amaryl
Diabeta
Glucotrol
Glucotrol XL
Glynase
VALUE BASED BENEFIT
metformin HCL
metformin HCL ER
NON PREFERRED
Fortamet
Glucophage
Glucophage XR
Glumetza
Riomet
MEGLITINIDE ANALOGUES
GENERIC
TIER 01
TIER 02
TIER 03
nateglinide
PREFERRED
repaglinide
NON PREFERRED
Prandin
Starlix
TIER 02
TIER 03
TIER 04
BISPHOSPHONATES
TIER 01
TIER 02
TIER 03
DIABETIC OTHER
PREFERRED
TIER 02
TIER 03
Glucagon Emergency Kit
Korlym
NON PREFERRED
Farxiga
Glucagen
Glucagen Hypokit
InvokanaPA
Jardiance
Proglycem
ALPHA-GLUCOSIDASE INHIBIT
GENERIC
TIER 01
TIER 03
acarbose
NON PREFERRED
Glyset
Precose
DPP-4 INHIBITORS
NON PREFERRED
TIER 03
Januvia
Nesina
Onglyza
Tradjenta
TIER 04
pioglitazone HCL
NON PREFERRED
Actos
Avandia
ANTIDIABETIC COMBINATIONS
VALUE BASED BENEFIT
TIER 00
glyburide/metformin HCL
GENERIC
alendronate sodiumQL
pamidronate disodium
risedronate sodiumQL
Alendronate SodiumQL
Etidronate Disodium
PREFERRED
ActonelQL,ST
Zoledronic AcidPA
NON PREFERRED
ibandronate sodiumQL
zoledronic acidPA
Didronel
FosamaxQL
Pamidronate Disodium
ReclastPA
ZometaPA
100% COPAY
BinostoQL
BonivaQL
CALCITONINS
TIER 01
TIER 03
GENERIC
calcitonin salmon
calcitonin-salmon
NON PREFERRED
Fortical
Miacalcin
PARATHYROID HORMONE
TIER 02
PREFERRED
Forteo
RANK LIGAND INHIBITORS
TIER 03
INSULIN SENSITIZING AGENT
GENERIC
TIER 01
TIER 03
GENERIC
glipizide/metformin HCL
pioglitazone HCL/metformin HCL
PREFERRED
pioglitazone HCL-glimepiride
NON PREFERRED
Actoplus Met
Actoplus Met XR
Appformin
Appformin-d
Duetact
Glucovance
Invokamet
Janumet
Janumet XR
Juvisync
Kombiglyze XR
Prandimet
100% COPAY
Avandamet
Avandaryl
Kazano
Oseni
NON PREFERRED
ProliaPA
XgevaPA
CALCIUM REGULATORS - MISC
TIER 03
NON PREFERRED
Ganite
HORMONE RECEPTOR MDLTR
TIER 02
15
TIER 03
PREFERRED
raloxifene hydrochloride
NON PREFERRED
Evista
Osphena
TIER 02
TIER 03
PREFERRED
Sandostatin Lar DepotPA
Somatuline DepotPA
NON PREFERRED
SandostatinPA
SigniforPA
FERTILITY REGULATORS
TIER 01
TIER 02
TIER 03
GENERIC
chorionic gonadotropin
clomiphene citrate
PREFERRED
Bravelle
Gonal-f
Gonal-f RFF
Gonal-f RFF Pen
Ovidrel
Repronex
NON PREFERRED
Follistim AQ
Gonal-f RFF Rediject
Menopur
LHRH/GNRH AGONIST
TIER 02
TIER 03
PREFERRED
Lupron Depot-PEDPA
Supprelin LAPA
Synarel
NON PREFERRED
Lupaneta PackPA
GNRH/LHRH ANTAGONISTS
TIER 02
TIER 03
PREFERRED
Cetrotide
NON PREFERRED
Ganirelix Acetate
GROWTH HORMONES
TIER 02
TIER 03
PREFERRED
GenotropinPA
Genotropin MiniquickPA
HumatropePA
Humatrope Combo PackPA
NON PREFERRED
Norditropin CartridgePA
Norditropin FlexproPA
Norditropin Nordiflex PenPA
NutropinPA
Nutropin AQ Nuspin 10PA
Nutropin AQ PenPA
OmnitropePA
SaizenPA
Saizen Click.easyPA
SerostimPA
Tev-tropinPA
ZorbtivePA
GHRH
TIER 03
NON PREFERRED
EgriftaPA
SOMATOMEDINS
TIER 03
NON PREFERRED
IncrelexPA
SOMATOSTATIC AGENTS
TIER 01
GENERIC
octreotide acetatePA
GH RECEPTOR ANTAGONISTS
TIER 02
PREFERRED
SomavertPA
POSTERIOR PITUITARY
TIER 01
TIER 02
TIER 03
GENERIC
desmopressin acetate
vasopressin
PREFERRED
Stimate
NON PREFERRED
Ddavp
Pitressin Synthetic
CORTICOTROPIN
TIER 03
NON PREFERRED
Acthar HPPA
PROLACTIN INHIBITORS
TIER 01
GENERIC
cabergoline
VASOPRESSIN ANTAGONISTS
TIER 03
NON PREFERRED
Samsca
Vaprisol
PROGESTERONE ANTAGONISTS
TIER 03
NON PREFERRED
Mifeprex
METABOLIC MODIFIERS
TIER 01
TIER 02
TIER 03
GENERIC
calcitriol
levocarnitine
PREFERRED
doxercalciferol
paricalcitol
sodium phenylbutyrate
AldurazymePA
Cystadane
ElaprasePA
FabrazymePA
KuvanPA
MyaleptPA
NaglazymePA
Orfadin
RavictiPA
Sensipar
NON PREFERRED
Ammonul
Buphenyl
CarbagluPA
Carnitor
Carnitor SF
Hectorol
LumizymePA
MyozymePA
Rocaltrol
VimizimPA
Zemplar
16
THYROID AGENTS
TIER 01
TIER 03
GENERIC
levothyroxine sodium
liothyronine sodium
methimazole
propylthiouracil
Levothyroxine Sodium
NON PREFERRED
Armour Thyroid
Cytomel
Nature-throid
Nature-throid Nt-2.5
Synthroid
Tapazole
Thyrolar-1
Thyrolar-1/2
Thyrolar-1/4
Thyrolar-2
Thyrolar-3
Tirosint
Triostat
Westhroid
Westhroid-p
Wp Thyroid
ULCER DRUGS
TIER 01
TIER 02
GASTROINTESTINAL
LAXATIVES
TIER 01
TIER 03
TIER 03
GENERIC
lactulose
peg 3350/electrolytes
peg-3350/electrolytes
peg-3350/NACL/NA bicarbonate/KCL
polyethylene glycol 3350
NON PREFERRED
Cascara Sagrada
Colyte-flavor Packs
Golytely
Halflytely Bowel Prep/Flavor Packs
Kristalose
Mineral Oil Heavy
Moviprep
Nulytely/Flavor Packs
Osmoprep
Prepopik
Senna Leaves
Suclear
Suprep Bowel Prep
ANTIDIARRHEALS
TIER 01
TIER 02
TIER 03
GENERIC
diphenoxylate/atropine
loperamide HCL
opium
opium tincture
Diphenoxylate/Atropine
Opium Tincture (paregoric)
PREFERRED
Motofen
NON PREFERRED
FulyzaqPA
Lomotil
Restora RX
Rezyst IM
Rezyst SB
Vsl#3 DS
ANTACIDS
TIER 03
NON PREFERRED
Sodium Bicarbonate
GENERIC
atropine sulfate
cimetidine
cimetidine HCL
dicyclomine HCL
famotidine
glycopyrrolate
hyoscyamine sulfate
hyoscyamine sulfate odt
hyoscyamine sulfate ER
hyoscyamine sulfate SR
methscopolamine bromide
misoprostol
nizatidine
ranitidine HCL
sucralfate
Anaspaz
Belladonna & Opium
Belladonna Alkaloids & Opium
Dicyclomine HCL
Famotidine Premixed
Propantheline Bromide
Scopolamine Hydrobromide
PREFERRED
Pylera
NON PREFERRED
Atropen
Atropine Sulfate
Axid
Bentyl
Cantil
Carafate
Cuvposa
Cytotec
Digex NF
Famotidine
Gabitidine
Gastrinex NF
Glycate
Helidac
Levbid
Levsin
Levsin/SL
Pamine
Pamine Forte
Pamine FQ
Pepcid
Robinul
Robinul Forte
Sentradine
Symax Duotab
Zantac
ANTIEMETICS
TIER 01
TIER 02
GENERIC
dronabinol
granisetron HCLQL
meclizine HCL
ondansetron odtQL
ondansetron HCLQL
trimethobenzamide HCL
Dimenhydrinate
GranisolQL
PREFERRED
AnzemetQL
DiclegisPA
EmendQL
Transderm-scop
17
TIER 03
TIER 04
NON PREFERRED
Aloxi
Cesamet
Marinol
SancusoQL
Tigan
ZofranQL
Zofran OdtQL
100% COPAY
ZuplenzQL
Dipentum
Entereg
Gastrocrom
GattexPA
Giazo
Lialda
Lidocaine HCL-hydrocortisone Acetate With Aloe
Linzess
Metozolv Odt
Phoslo
Phoslyra
Procort
Proctocort
Reglan
Renvela
Rowasa
Sevelamer Carbonate
Sfrowasa
Urso Forte
Urso 250
Velphoro
DIGESTIVE AIDS
TIER 02
TIER 03
PREFERRED
Creon
Pancreaze
Pancrelipase
Zenpep
NON PREFERRED
Pertzye
Sucraid
Ultresa
Viokace
GENITOURINARY
GASTROINTESTINAL - MISC.
TIER 01
TIER 02
TIER 03
GENERIC
balsalazide disodium
calcium acetate
cromolyn sodium
hydrocort ene 100MG
hydrocortisone
hydrocortisone acetate/lidocaine HCL
hydrocortisone acetate/pramoxine
lactulose
lidocaine HCL/hydrocortisone acetate
mesalamine
metoclopramide HCL
sulfasalazine
ursodiol
Dexpanthenol
Eliphos
PREFERRED
Amitiza
Anusol-HC
Apriso
Asacol
Asacol HD
Canasa
CimziaPA
Cimzia Starter KitPA
Cortifoam
Delzicol
EntyvioPA
Fosrenol
Lotronex
Pentasa
Proctofoam HC
RelistorPA
RemicadePA
Renagel
NON PREFERRED
Actigall
Analpram Advanced
Analpram-HC
Analpram-HC Singles
Azulfidine
Azulfidine EN-TABS
Chenodal
Colazal
Cortenema
URINARY ANTI-INFECTIVES
TIER 01
TIER 03
GENERIC
methenamine hippurate
methenamine mandelate
nitrofurantoin
nitrofurantoin macrocrystals
nitrofurantoin monohydrate
nitrofurantoin monohydrate/macrocrystals
Methenamine Mandelate
Uretron D/S
Urex
Urogesic-blue
NON PREFERRED
Furadantin
Hiprex
Macrobid
Macrodantin
Monurol
Prosed/DS
Urelle
Uribel
Urimar-t
Uroqid #2
URINARY ANTISPASMODICS
TIER 01
TIER 03
GENERIC
bethanechol chloride
flavoxate HCL
oxybutynin chloride
oxybutynin chloride ER
tolterodine tartrate
tolterodine tartrate ER
trospium chloride
trospium chloride ER
NON PREFERRED
Detrol
Detrol LA
Ditropan XL
Enablex
Gelnique
Myrbetriq
Oxytrol
Sanctura
Sanctura XR
Toviaz
Urecholine
18
Vesicare
HEMATOPOIETIC AGENTS
TIER 01
VAGINAL PRODUCTS
TIER 01
TIER 02
TIER 03
GENERIC
metronidazole vaginal
terconazole
Relagard
PREFERRED
Avc
Estring
Premarin
Vagifem
NON PREFERRED
Cleocin
Clindesse
CrinonePA
Endometrin
Estrace
Fem PH
Femring
First-progesterone VGS 100 Compounding Kit
Gynazole-1
Metrogel-vaginal
Terazol 3
Terazol 7
TIER 02
GENITOURINARY - MISC.
TIER 01
TIER 02
TIER 03
TIER 04
GENERIC
alfuzosin HCL ER
citric acid/sodium citrate
finasteride
hydrochloric acid
phenazopyridine HCL
potassium citrate-citric acid crystals
tamsulosin HCL
Cytra-3
Potassium Citrate
Tricitrates
PREFERRED
Cystagon
Elmiron
NON PREFERRED
Avodart
Cardura XL
Citrolith
Flomax
K-phos NO 2
Lithostat
Oracit
Potassium Citrate ER
ProcysbiPA
Proscar
Pyridium
Shohls Solution Modified
Thiola
Urocit-k 10
Urocit-k 15
Urocit-k 5
Uroxatral
100% COPAY
Jalyn
Rapaflo
HEMATOLOGICAL
TIER 03
GENERIC
cyanocobalamin
folic acid
folic acid/vitamin b-6/vitamin b-12
sodium ferric gluconate complex/sucrose
Animi-3
Centratex
Ferrex 150 Forte Plus
Ferrex 28
Folic Acid
Folivane-f
Folivane-plus
Hematogen Fa
Hydroxocobalamin
Icar-c Plus
Multigen
Multigen Folic
Multigen Plus
PREFERRED
Aranesp Albumin FreePA
Droxia
ElelysoPA
Foltrate
LeukinePA
MozobilPA
NeulastaPA
NeumegaPA
NeupogenPA
NplatePA
ProcritPA
PromactaPA
NON PREFERRED
Albafort
Animi-3/Vitamin D
B-6 Folic Acid
Biferarx
Cenfol
CerezymePA
Corvite 150
Divista
Ed Cyte F
EpogenPA
Feraheme
Feriva
Ferivafa
Ferralet 90
Ferrlecit
Ferro-plex Hematinic
Ferrotrin
Folgard RX
Fusion Plus
GranixPA
Hematron-AF
Hemocyte Plus
Hemocyte-f
Injectafer
Integra F
Integra Plus
Iron
Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C
Threon/Suc
Irospan 24/6
Is 24/6
Maxaron Forte
Maxfe
MV FE Asparto Gly/FE Fum/Succ Acid/Vit C/Threonic
Acd/B12/Fa
MV FE Asparto Gly/Vit C/Vit B12/CA Threonate/Succ
Acd/Stomac
19
Nascobal
Natalvirt Flt
Nephron Fa
Novaferrum
OmontysPA
Pre-folic
Proferrin-forte
Protectiron
Tandem F
Tandem Plus
Venofer
VprivPA
ZavescaPA
Recothrom Spray Kit
Thrombogen
Tisseel
Trasylol
HEMATOLOGICAL - MISC.
TIER 00
TIER 01
ANTICOAGULANTS
TIER 00
TIER 01
TIER 02
TIER 03
VALUE BASED BENEFIT
warfarin sodium
GENERIC
enoxaparin sodium
fondaparinux sodium
heparin lock
heparin lock flush
heparin lock flush for flushing vascular access devices
heparin lock flush/NACL for flushing vascular access
devices
heparin sodium
heparin sodium dcu
heparin sodium lock flush
heparin sodium/sodium chloride 0.9% premix
heparin sodium/D5W
heparin sodium/NACL 0.9%
Heparin Sodium/D5W
Heparin Sodium/NACL 0.45%
Heparin Sodium/Sodium Chloride 0.9%
PREFERRED
Fragmin
NON PREFERRED
argatroban
Angiomax
Argatroban
Arixtra
Coumadin
Eliquis
Heparin Lock Flush
Heparin Sodium
Iprivask
Lovenox
Pradaxa
Xarelto
TIER 02
TIER 03
MOUTH/THROAT/DENTAL AGENT
TIER 01
HEMOSTATICS
TIER 01
TIER 02
TIER 03
GENERIC
aminocaproic acid
Thrombin-jmi Diluent
Thrombin-jmi Epistaxis
Thrombin-jmi Syringe Spray Kit
Thrombin-jmi W/Dil Spray P.M. Actuator
PREFERRED
tranexamic acid
Aminocaproic Acid
NON PREFERRED
Amicar
Artiss
Astringyn
Cyklokapron
Evicel
Evithrom
Lysteda
Recothrom
VALUE BASED BENEFIT
clopidogrel
GENERIC
anagrelide hydrochloride
cilostazol
dipyridamole
hetastarch 6%/NACL
pentoxifylline ER
ticlopidine HCL
LMD 10% Dextrose 5%
LMD 10% Sodium Chloride 0.9%
Protamine Sulfate
Voluven
PREFERRED
Aggrenox
Effient
SolirisPA
NON PREFERRED
Activase
Aggrastat
Agrylin
Brilinta
Cathflo Activase
Firazyr
Hespan
Hextend
Integrilin
Kalbitor
Kinlytic
Persantine
Plavix
Pletal
Reopro
Retavase
Retavase Half-kit
Tnkase
Trental
Zontivity
TIER 02
TIER 03
GENERIC
chlorhexidine gluconate
chlorhexidine gluconate oral rinse
clotrimazole
lidocaine viscous
lidocaine HCL
nystatin
pilocarpine hydrochloride
pilocarpine HCL
stannous fluoride oral rinse
triamcinolone IN orabase
Nafrinse Daily/Acidulated
Nafrinse Daily/Neutral
Nafrinse Weekly
PREFERRED
cevimeline HCL
NON PREFERRED
Aquoral
Caphosol
Debacterol
Evoxac
20
TIER 04
First-bxn Mouthwash
First-dukes Mouthwash
First-marys Mouthwash
First-mouthwash Blm
Gel-kam Oral Care Rinse
Gelclair
Lta 360 Kit
Neutrasal
Numoisyn
Peridex
Prevident
Salagen
100% COPAY
Oravig
NEUROLOGY, CNS, PSYCH
ANTIANXIETY AGENTS
TIER 01
TIER 03
GENERIC
alprazolam
alprazolam odt
alprazolam ER
buspirone HCL
chlordiazepoxide HCL
clorazepate dipotassium
diazepam
droperidol
gene-xene TAB 15MG
gene-xene TAB 3.75MG
gene-xene TAB 7.5MG
hydroxyzine pamoate
hydroxyzine HCL
lorazepam
meprobamate
oxazepam
Diazepam
Diazepam Intensol
Hydroxyzine HCL
Hydroxyzine Pamoate
Lorazepam Intensol
NON PREFERRED
Alprazolam Intensol
Ativan
Gabavale-5
Gabazolamine
Gabazolamine-0.5
Niravam
Sentrazolam AM 0.25
Tranxene T
Valium
Vistaril
Xanax
Xanax XR
TIER 02
TIER 03
ANTIDEPRESSANTS
TIER 01
GENERIC
amitriptyline HCL
bupropion HCL
bupropion HCL ERQL
bupropion HCL SRQL
bupropion HCL XLQL
citalopram hydrobromideQL
clomipramine HCL
desipramine HCL
doxepin HCL
escitalopram oxalateQL
fluoxetine DRQL
fluoxetine HCLQL
fluvoxamine maleateQL
fluvoxamine maleate ERQL
TIER 04
imipramine pamoate
imipramine HCL
mirtazapine
mirtazapine odt
nefazodone HCL
nortriptyline HCL
paroxetine HCLQL
paroxetine HCL ERQL
phenelzine sulfate
protriptyline HCL
sertraline HCLQL
tranylcypromine sulfate
trazodone HCL
trimipramine maleate
venlafaxine HCLQL
venlafaxine HCL ERQL
Amoxapine
Doxepin HCL
Maprotiline HCL
Nefazodone HCL
Nortriptyline HCL
Venlafaxine HCL ERQL
PREFERRED
duloxetine HCLQL
PristiqQL
NON PREFERRED
Anafranil
AplenzinQL
Appbutamone
Appbutamone-d
CelexaQL
CymbaltaQL
Desvenlafaxine ERST
Effexor XRQL
Emsam
Fluoxetine HCL
Gaboxetine
KhedezlaST
LexaproQL
Luvox CRQL,ST
Marplan
Nardil
Norpramin
Oleptro
Pamelor
Parnate
PaxilQL
Paxil CRQL
PexevaQL,ST
ProzacQL
Prozac WeeklyQL
Remeron
Remeron Soltab
Sentraflox AM-10
Sentralopram AM-10
Sentravil PM-25
Sentroxatine
Surmontil
Tofranil
Tofranil-PM
Trazamine
ViibrydQL,ST
Vivactil
Wellbutrin
Wellbutrin SRQL
Wellbutrin XLQL
ZoloftQL
100% COPAY
BrintellixST
FetzimaST
21
Fetzima Titration PackST
Forfivo XLQL
ANTIPSYCHOTICS
TIER 01
TIER 02
TIER 03
GENERIC
chlorpromazine HCL
clozapine
fluphenazine decanoate
fluphenazine HCL
haloperidol
haloperidol decanoate
haloperidol lactate
lithium carbonate
lithium carbonate ER
loxapine
loxapine succinate
olanzapine
olanzapine odt
perphenazine
prochlorperazine
prochlorperazine edisylate
prochlorperazine maleate
quetiapine fumarate
risperidone
risperidone odt
thioridazine HCL
thiothixene
trifluoperazine HCL
ziprasidone HCL
Chlorpromazine HCL
Clozapine Odt
Fluphenazine HCL
Lithium Carbonate
Lithium Citrate
PREFERRED
Seroquel XR
NON PREFERRED
Abilify
Abilify Discmelt
Abilify Maintena
Adasuve
Clozaril
Compazine
Equetro
Fanapt
Fanapt Titration Pack
Fazaclo
Geodon
Haldol
Haldol Decanoate 100
Haldol Decanoate 50
Invega
Invega Sustenna
Latuda
Lithobid
Loxitane
Risperdal
Risperdal Consta
Risperdal M-TAB
Saphris
Seroquel
Versacloz
Zyprexa
Zyprexa Relprevv
Zyprexa Zydis
HYPNOTICS
TIER 01
GENERIC
dexmedetomidine HCL
TIER 03
TIER 04
estazolam
eszopiclone
flurazepam HCL
phenobarbital
temazepam
triazolam
zaleplon
zolpidem tartrate
zolpidem tartrate ER
Phenobarbital Sodium
NON PREFERRED
Ambien
Ambien CR
Amytal Sodium
Butisol Sodium
Doral
Gabazolpidem-5
Halcion
HetliozPA
Lunesta
Nembutal Sodium
Phenobarbital
Precedex
Quazepam
Restoril
RozeremST
Seconal
Sentrazolpidem PM-5
Sonata
Strazepam
100% COPAY
EdluarST
IntermezzoST
Silenor
ZolpimistST
ADHD, NARCOLEPSY, ETC.
TIER 01
TIER 02
TIER 03
GENERIC
amphetamine/dextroamphetamineQL
caffeine citrate
clonidine HCL ER
dexmethylphenidate HCLQL
dexmethylphenidate HCL ERQL
dextroamphetamine sulfateQL
dextroamphetamine sulfate ERQL
doxapram HCL
methamphetamine HCLQL
methylphenidate hydrochloride
methylphenidate HCLQL
methylphenidate HCL CDQL
methylphenidate HCL ERQL
methylphenidate HCL SRQL
modafinilPA
Caffeine/Sodium Benzoate
Methylphenidate HCL ERQL
PREFERRED
DaytranaQL
StratteraQL,ST
VyvanseQL
NON PREFERRED
AdderallQL
Adderall XRQL
Cafcit
ConcertaQL
DesoxynQL
DexedrineQL
Dopram
FocalinQL
Focalin XRQL
22
Intuniv
Kapvay
Kapvay Dose Pack
Metadate CDQL
Methylin
NuvigilPA,QL
ProcentraQL
ProvigilPA
Quillivant XRQL
RitalinQL
Ritalin LAQL
Ritalin SRQL
Sentramodafin AM-100
Felbatol
Keppra
Keppra XR
Klonopin
Lamictal
Lamictal Chewable Dispersible
Lamictal Odt
Lamictal Starter/Taking Valproate
Lamictal XR
Mysoline
Neurontin
Oxtellar XR
Phenytek
Qudexy XR
SabrilPA
Stavzor
Tegretol
Therapentin-60
Therapentin-90
Topamax
Topamax Sprinkle
Topiramate ER
Trileptal
Trokendi XR
Vimpat
Zarontin
Zonegran
ANTICONVULSANTS
TIER 01
TIER 02
TIER 03
GENERIC
carbamazepine
carbamazepine ER
clonazepam
clonazepam odt
divalproex sodium
divalproex sodium DR
divalproex sodium ER
ethosuximide
felbamate
fosphenytoin sodium
gabapentin
lamotrigine
lamotrigine ER
levetiracetam
levetiracetam ER
oxcarbazepine
phenytoin sodium
phenytoin sodium extended
primidone
topiramate
valproate sodium
valproic acid
zonisamide
Diazepam
Levetiracetam
PREFERRED
phenytoin
tiagabine hydrochloride
Banzel
Celontin
Dilantin Infatabs
Fycompa
Gabitril
Lamictal Starter/Not Taking Carbamazepine
Lamictal Starter/Taking Carbamazepine/Not Taking
Valproate
Lyrica
Onfi
Peganone
Potiga
Tegretol-XR
NON PREFERRED
Aptiom
Carbatrol
Cerebyx
Depacon
Depakene
Depakote
Depakote ER
Depakote Sprinkles
Diastat Acudial
Diastat Pediatric
Dilantin
ANTIPARKINSON AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
amantadine HCL
benztropine mesylate
bromocriptine mesylate
carbidopa/levodopa
carbidopa/levodopa odt
carbidopa/levodopa ER
entacapone
pramipexole dihydrochloride
ropinirole HCL
selegiline HCL
trihexyphenidyl HCL
Amantadine HCL
PREFERRED
carbidopa
ropinirole ER
ApokynPA
Azilect
Carbidopa/Levodopa/Entacapone
NON PREFERRED
Cogentin
Comtan
Eldepryl
Lodosyn
Mirapex
Mirapex ER
Neupro
Parcopa
Parlodel
Requip
Requip XL
Sinemet
Sinemet CR
Stalevo 100
Stalevo 125
Stalevo 150
Stalevo 200
Stalevo 50
Stalevo 75
Tasmar
23
Zelapar
TIER 03
NEUROLOGY, PSYCH - MISC.
TIER 01
TIER 02
TIER 03
TIER 04
GENERIC
acamprosate calcium DR
disulfiram
donepezil HCL
fluoxetineQL
galantamine
galantamine hydrobromide
olanzapine/fluoxetine
rivastigmine tartrate
Chlordiazepoxide/Amitriptyline
Ergoloid Mesylates
Perphenazine/Amitriptyline
PREFERRED
AvonexPA
Avonex PenPA
BetaseronPA
CopaxonePA
Orap
RebifPA
Rebif Titration PackPA
XenazinePA
XyremPA
NON PREFERRED
AmpyraPA
Antabuse
Aricept
Aricept Odt
AubagioPA
Brisdelle
Campral
Exelon
ExtaviaPA
GilenyaPA
Gralise Starter
Namenda
Namenda Titration PAK
Nuedexta
Razadyne
Razadyne ER
Rebif RebidosePA
Rebif Rebidose Titration PackPA
SarafemQL
Savella
Savella Titration Pack
Symbyax
TecfideraPA
Tecfidera Starter PackPA
TysabriPA
100% COPAY
Gralise
Horizant
Namenda XR
Namenda XR Titration Pack
NEUROMUSCULAR AGENTS
TIER 01
TIER 02
GENERIC
atracurium besylate
pancuronium bromide
riluzole
rocuronium bromide
vecuronium bromide
Anectine
Quelicin
Quelicin 1000
PREFERRED
MyoblocPA
NON PREFERRED
cisatracurium besylate
BotoxPA
DysportPA
Nimbex
Rilutek
XeominPA
Zemuron
MUSCULOSKELETAL AGENTS
TIER 01
TIER 03
GENERIC
baclofen
carisoprodol
carisoprodol/aspirin
carisoprodol/aspirin/codeine
chlorzoxazone
cyclobenzaprine HCL
dantrolene sodium
metaxalone
methocarbamol
orphenadrine citrate
orphenadrine citrate ER
orphenadrine/asa/caffeine
tizanidine HCL
Carisoprodol
NON PREFERRED
Amrix
Cyclobenzaprine Comfort PAC
Dantrium
Dantrium IV
Dantrolene Sodium
Fexmid
Flexeril
Lorzone
Norflex
Parafon Forte DSC
Prazolamine
Robaxin
Robaxin-750
Ryanodex
Skelaxin
Soma
Therabenzaprine-60
Therabenzaprine-90
Therabenzaprine-90-5
Tizanidine Comfort PAC
Zanaflex
ANTIMYASTHENIC AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
neostigmine methylsulfate
pyridostigmine bromide
Enlon
Guanidine HCL
PREFERRED
Mestinon Timespan
Prostigmin
NON PREFERRED
Bloxiverz
Enlon-plus
Mestinon
Regonol
OPHTHALMOLOGY AND OTIC
ANTI-INFECTIVES
TIER 01
GENERIC
bacitracin/polymyxin b
ciprofloxacin HCL
erythromycin
24
TIER 02
TIER 03
gatifloxacin
gentamicin sulfate
levofloxacin
neomycin/bacitracin/polymyxin
neomycin/polymyxin/bacitracin zinc
neomycin/polymyxin/gramicidin
ofloxacin
polymyxin b sulfate/trimethoprim sulfate
sulfacetamide sodium
tobramycin sulfate
trifluridine
trimethoprim sulfate/polymyxin b sulfate
PREFERRED
Ciloxan
Natacyn
Vigamox
NON PREFERRED
Azasite
Bacitracin
Besivance
Betadine Ophthalmic Prep
Bleph-10
Garamycin
Mitosol
Moxeza
Neosporin
Ocuflox
Polytrim
Sulfacetamide Sodium
Tobrex
Viroptic
Zirgan
Zymaxid
TIER 02
TIER 03
PROSTAGLANDINS
TIER 01
TIER 02
TIER 03
ARTIFICIAL TEAR/LUBRICANT
TIER 02
PREFERRED
Lacrisert
BETA-BLOCKERS
TIER 01
TIER 02
TIER 03
GENERIC
betaxolol HCL
carteolol HCL
dorzolamide HCL/timolol maleate
levobunolol HCL
timolol maleate
timolol maleate ophthalmic gel forming
Levobunolol HCL
PREFERRED
Betimol
Betoptic-s
NON PREFERRED
Betagan
Combigan
Cosopt
Cosopt PF
Istalol
Metipranolol
Timoptic
Timoptic Ocudose
Timoptic-xe
OPHTHALMIC STEROIDS
TIER 01
GENERIC
dexamethasone sodium phosphate
fluorometholone
neomycin/polymyxin/bacitracin/hydrocortisone
neomycin/polymyxin/dexamethasone
prednisolone acetate
sulfacetamide sodium/prednisolone sodium phosphate
tobramycin/dexamethasone
Neomycin/Polymyxin/Hydrocortisone
Prednisolone Sodium Phosphate
PREFERRED
Alrex
Blephamide S.o.p.
Lotemax
Pred Mild
Zylet
NON PREFERRED
Blephamide
Durezol
Flarex
FML
FML Forte
FML Liquifilm
Maxidex
Maxitrol
Omnipred
Pred Forte
Pred-G
Pred-G S.o.p.
Tobradex
Tobradex ST
Vexol
GENERIC
latanoprost
PREFERRED
Travatan Z
Travoprost
NON PREFERRED
Lumigan
Rescula
Xalatan
Zioptan
CYCLOPLEGIC MYDRIATICS
TIER 01
TIER 02
TIER 03
GENERIC
atropine sulfate
homatropine HBR
Atropine Sulfate
PREFERRED
cyclopentolate HCL
NON PREFERRED
Cyclogyl
Cyclomydril
Isopto Atropine
Isopto Homatropine
Isopto Hyoscine
DECONGESTANTS
TIER 01
GENERIC
phenylephrine HCL
Mydfrin
Naphazoline HCL
MIOTICS
TIER 01
TIER 02
TIER 03
GENERIC
pilocarpine HCL
PREFERRED
Isopto Carbachol
Phospholine Iodide
Pilopine HS
NON PREFERRED
Isopto Carpine
25
ADRENERGIC AGENTS
TIER 01
TIER 03
GENERIC
apraclonidine
brimonidine tartrate
NON PREFERRED
Alphagan P
Iopidine
Simbrinza
TIER 02
TIER 03
IMMUNOMODULATORS
TIER 02
PREFERRED
RestasisPA
LOCAL ANESTHETICS
TIER 01
TIER 03
GENERIC
proparacaine HCL
tetracaine HCL
NON PREFERRED
Akten
Alcaine
OPHTHALMICS - MISC.
TIER 01
TIER 02
TIER 03
GENERIC
azelastine HCL
bromfenac
cromolyn sodium
diclofenac sodium
dorzolamide HCL
epinastine HCL
flurbiprofen sodium
ketorolac tromethamine
Bromfenac
PREFERRED
Azopt
CystaranPA
Pataday
Patanol
NON PREFERRED
Acular
Acular LS
Acuvail
Alocril
Alomide
Bepreve
Bromday
Elestat
Emadine
Ilevro
Lastacaft
Nevanac
Ocufen
Optivar
Prolensa
Trusopt
TIER 04
OXYTOCICS
TIER 01
TIER 03
GENERIC
acetic acid
antipyrine/benzocaine
fluocinolone acetonide
fluocinolone acetonide ear drops
hydrocortisone/acetic acid
neomycin/polymyxin/hydrocortisone
neomycin/polymyxin/HC
ofloxacin
Acetic Acid/Aluminum Acetate
Antipyrine/Benzocaine
Ciprofloxacin
Myoxin
GENERIC
methylergonovine maleate
oxytocin
NON PREFERRED
Cervidil
Hemabate
Pitocin
Prepidil
Prostin E2
PAIN MANAGEMENT
ANALGESICS - NONNARCOTIC
TIER 01
TIER 02
TIER 03
OTIC AGENTS
TIER 01
Otozin
PREFERRED
Cipro HC
Ciprodex
NON PREFERRED
Cetraxal
Coly-mycin S
Cortisporin
Cortisporin-tc
Cresylate
Dermotic
Pramotic
Vosol HC
100% COPAY
Auralgan
TIER 04
GENERIC
butal/asa/caff
butalbital/acetaminophen
butalbital/acetaminophen/caffeine
butalbital/apap/caffeine
butalbital/asa/caffeine
choline magnesium trisalicylate
diflunisal
salsalate
Alagesic LQ
Butalbital/Aspirin/Caffeine
Mst 600
Rhinoflex-650
Tencon
PREFERRED
Ofirmev
Phrenilin Forte
NON PREFERRED
Bupap
Dolgic Plus
Dologesic
Equagesic
Esgic
Esgic-plus
Fioricet
Fiorinal
Levacet
Orbivan
Staflex
100% COPAY
Orbivan CF
ANALGESICS - OPIOID
TIER 01
GENERIC
acetaminophen/codeine
acetaminophen/codeine #2
acetaminophen/codeine phosphate
26
TIER 02
TIER 03
alfentanil
buprenorphine HCL
butalbital/acetaminophen/caffeine/codeine
butalbital/aspirin/caffeine/codeine
butorphanol tartrateQL
fentanylQL
fentanyl citrate oral transmucosalQL
hydrocodone bitartrate/acetaminophen
hydrocodone/acetaminophen
hydrocodone/ibuprofen
hydromorphone HCL
hydromorphone HCL ER
meperidine HCL
methadone HCL
morphine sulfate
nalbuphine HCL
oxycodone HCL
oxycodone/acetaminophen
oxycodone/aspirin
oxycodone/ibuprofen
oxymorphone hydrochloride
oxymorphone hydrochloride ER
pentazocine/acetaminophen
pentazocine/naloxone HCL
tramadol hydrochloride/acetaminophen
tramadol HCL
tramadol HCL ER
Acetaminophen/Caffeine/Dihydrocodeine Bitartrate
Codeine Sulfate
Hydrocodone Bitartrate/Acetaminophen
Hydrocodone/Acetaminophen
Hydromorphone HCL
Hydromorphone HCL Dosette
Levorphanol Tartrate
Maxidone
Meperidine HCL
Methadone HCL
Methadose
Methadose Sugar-free
Morphine Sulfate
Oxycodone HCL
Tramadol HCL ER
Trezix
Xolox
PREFERRED
buprenorphine HCL/naloxone HCL
morphine sulfate ER
OxycontinQL
NON PREFERRED
AbstralQL
ActiqQL
Alfenta
Aspirin-caffeine-dihydrocodeine
Avinza
Buprenex
Capital/Codeine
Demerol
Dilaudid
Dilaudid-HP
Dolophine
Dolophine HCL
DuragesicQL
Exalgo
FentoraQL
Fioricet/Codeine
Fiorinal/Codeine #3
Hycet
Hydromorphone HCL ER
Ibudone
Infumorph 200
TIER 04
Infumorph 500
Kadian
Liquicet
Lorcet Plus
Lorcet 10/650
Lortab
Magnacet
Morphine Sulfate Add-vantage
MS Contin
Norco
Nucynta
Nucynta ER
Opana
Opana ER (crush Resistant)
Percocet
Percodan
Primlev
Reprexain
Roxicet
Roxicodone
Rybix Odt
Suboxone
Subsys
Synalgos-dc
Talwin
Theracodeine-300
Theracodophen-low-90
Theracodophen-325
Theracodophen-650
Theracodophen-750
Theratramadol-60
Theratramadol-90
Tylenol/Codeine #3
Tylenol/Codeine #4
Ultiva
Ultracet
Ultram
Ultram ER
Vicoprofen
Xartemis XR
Xodol
Zohydro ER
Zolvit
Zydone
100% COPAY
Butrans
Conzip
Lazanda
ANTI-INFLAMMATORY
TIER 01
GENERIC
diclofenac potassium
diclofenac sodium DR
diclofenac sodium ER
diclofenac sodium/misoprostol
etodolac
etodolac ER
flurbiprofen
ibuprofen
indomethacin
indomethacin sodium
indomethacin ER
ketoprofen
ketorolac tromethamine
leflunomide
mefenamic acid
meloxicam
nabumetone
naproxen
27
TIER 02
TIER 03
naproxen sodium
oxaprozin
piroxicam
sulindac
tolmetin sodium
Fenoprofen Calcium
Indomethacin
Ketoprofen ER
Meclofenamate Sodium
Meloxicam
Tolmetin Sodium
PREFERRED
ArcalystPA
CelebrexST
EnbrelPA
Enbrel SureclickPA
HumiraPA
Humira PenPA
Humira Pen-crohns DiseasestarterPA
Humira Pen-psoriasis StarterPA
OrenciaPA
Ridaura
NON PREFERRED
ActemraPA
Anaprox
Anaprox DS
Arava
Arthrotec 50
Arthrotec 75
Caldolor
Cataflam
Daypro
Duexis
EC-naprosyn
Feldene
Ibuprofen Comfort PAC
IlarisPA
Indocin
Indocin IV
IC 400
IC 800
KineretPA
Meloxicam Comfort PAC
Mobic
Nalfon
Naprelan
Naprosyn
Naproxen Comfort PAC
Neoprofen
OtezlaPA
Ponstel
Rasuvo
Rheumatrex
SimponiPA
Simponi AriaPA
Therafeldamine
Theraprofen-60
Theraprofen-800
Theraprofen-90
Theraproxen-500
Theraproxen-60
Theraproxen-90
Trepadiclofen-25
Trepoxen-250
Trepoxicam-7.5
Vimovo
Voltaren-XR
XeljanzPA
Zipsor
TIER 04
100% COPAY
Ketorolac Tromethamine
Sprix
MIGRAINE PRODUCTS
TIER 01
TIER 02
TIER 03
TIER 04
GENERIC
dihydroergotamine mesylatePA
naratriptan HCLQL
rizatriptan benzoatePA
rizatriptan benzoate odtPA
sumatriptan succinateQL
sumatriptan succinate refill
zolmitriptanPA
zolmitriptan odtPA
Migergot
SumatriptanPA
PREFERRED
Ergomar
RelpaxQL
NON PREFERRED
Alsuma
AmergePA
AxertPA
Cafergot
D.h.e. 45PA
Dihydroergotamine MesylatePA
FrovaPA
ImitrexPA
Imitrex Statdose Refill
Imitrex Statdose System
MaxaltPA
Maxalt-MLTPA
Migral
MigranalPA
Sumatriptan SuccinatePA
Sumavel Dosepro
TreximetPA
ZomigPA
Zomig Nasal SprayPA
Zomig ZMTPA
100% COPAY
Cambia
GOUT AGENTS
TIER 01
TIER 03
GENERIC
allopurinol
probenecid
probenecid/colchicine
NON PREFERRED
Aloprim
Colcrys
KrystexxaPA
Uloric
Zyloprim
LOCAL ANESTHETICS-INJ
TIER 01
TIER 03
GENERIC
bupivacaine HCL
chloroprocaine HCL
lidocaine HCL
lidocaine/epinephrine
ropivacaine HCL
Carbocaine
Marcaine
Marcaine W/O Epi
Marcaine/Epinephrine
Mepivacaine HCL
NON PREFERRED
bupivacaine/epinephrine
28
BD Pudendal/Local Block Tray 1% Lidocaine
Duocaine
Durasafe Spinal/Epidural Tray/1% Xylocaine/19GX36"close
CATH
Durasafe Spinal/Epidural Tray/1% Xylocaine/19GX36"open
CATH
Durasafe Spinal/Epidural Tray/1% Xylocaine/20GX36"close
CATH
Durasafe Spinal/Epidural Tray/1% Xylocaine/20GX36"open
CATH
Exparel
Lidocaine HCL/Dextrose
Monoject Bone Marrow Biopsy Prepping Tray
Monoject Bone Marrow Biopsy Tray/Biop Aspir Needle
11GX4"
Monoject Bone Marrow Biopsy Tray/Biop Aspir Needle
8GX4"
Monoject Bone Marrow Biopsy Tray/Sternal-iliac Needle
16G
Naropin
Nesacaine
Nesacaine-mpf
Sensorcaine-mpf/Epinephrine
Tetracaine HCL
Turkel Paracentesis Procedure Tray/8french
Xylocaine
Xylocaine-mpf
Xylocaine-mpf/Epinephrine
Xylocaine/Epinephrine
TIER 04
COUGH/COLD/ALLERGY
TIER 01
RESPIRATORY, ALLERGY, ETC
ANTIHISTAMINES
TIER 01
TIER 03
TIER 04
GENERIC
carbinoxamine maleate
clemastine fumarate
cyproheptadine HCL
desloratadine odt
diphenhydramine HCL
promethazine HCL
promethazine HCL plain
Brompheniramine Tannate
Clemastine Fumarate
Dexchlorpheniramine Maleate
Doxytex
Ed-chlor-tan
NON PREFERRED
Karbinal ER
Palgic
Phenergan
Respa-BR
100% COPAY
cetirizine HCL
desloratadine
levocetirizine dihydrochloride
Clarinex
Clarinex Reditabs
Xyzal
NASAL AGENTS
TIER 01
TIER 02
TIER 03
GENERIC
budesonide
flunisolide
fluticasone propionate
ipratropium bromide
Flunisolide
PREFERRED
azelastine HCL
NON PREFERRED
Adrenalin
Astelin
Astepro
Atrovent
Bactroban Nasal
Patanase
Qnasl
Tyzine
Tyzine Pediatric Nasal Drops
100% COPAY
Beconase AQ
Dymista
Flonase
Nasacort AQ
Nasonex
Omnaris
Rhinocort Aqua
Veramyst
Zetonna
TIER 02
TIER 03
GENERIC
acetylcysteine
benzonatate
bromphen/pseudoephedrine HCL/dextromethorphan HBR
hydrocodone bitartrate/chlorpheniramine maleate/PSE
hydrocodone bitartrate/homatropine methylbromide
hydrocodone/homatropine
phenylephrine/guaifenesin
promethazine-DM
promethazine/codeine
promethazine/dextromethorphan
sodium chloride
Dextromethorphan HBR/Chlorpheniramine/Phenylephrine
HCL
Pediatex TD
Relhist
Suttar-SF
Suttar-2
PREFERRED
hydrocodone polistirex/chlorpheniramine polistirex
Tussicaps
NON PREFERRED
Alahist Ac
Alahist DHC
Allfen CD
Allfen CDX
Ambifed CD
Ambifed CDX
Ambifed-G CD
Ambifed-G CDX
Carbaphen 12
Carbaphen 12 PED
Cotab A
Cotab AX
Cotabflu
Cpb Wc
Decon-a
Donatuss Dc
Exactuss
Gilphex TR
Giltuss
Giltuss PED-c
Giltuss TR
Hyper-sal
Hypersal
J-cof DHC
J-max DHC
Maxifed CD
Maxifed CDX
29
TIER 04
Maxifed-G CD
Maxifed-G CDX
Maxiflu CD
Maxiflu CDX
Maxiphen CD
Maxiphen CDX
Nebusal
Neotuss Plus
Panatuss Dxp
Pediatex TDM
Phenflu CD
Phenflu CDX
Poly-tussin DHC
Rescon-JR
Rescon-MX
Rezira
Tessalon Perles
Tussionex Pennkinetic Extended Release
Vituz
Zonatuss
Zutripro
100% COPAY
Clarinex-d 12 HOUR
Clarinex-d 24 HOUR
Semprex-d
TIER 03
ANTIASTHMATIC/COPD AGENTS
TIER 00
TIER 01
TIER 02
VALUE BASED BENEFIT
budesonide
Advair Diskus
Advair HFA
Asmanex 120 Metered Doses
Dulera
Flovent Diskus
Flovent HFA
Proair HFA
Pulmicort Flexhaler
Qvar
Symbicort
GENERIC
albuterol sulfate
albuterol sulfate ER
albuterol TAB 4MG
aminophylline
cromolyn sodium
epinephrine HCL
ipratropium bromide
ipratropium bromide/albuterol sulfate
montelukast sodium
terbutaline sulfate
theophylline
theophylline CR
theophylline ER
theophylline/D5W
zafirlukast
Metaproterenol Sulfate
Theophylline/D5W
PREFERRED
levalbuterol
levalbuterol HCL
Atrovent HFA
Combivent
Elixophyllin
Foradil Aerolizer
Maxair Autohaler
TIER 04
Perforomist
Serevent Diskus
Spiriva Handihaler
Xopenex HFA
NON PREFERRED
Accolate
Accuneb
Adrenalin
Aerospan
Alvesco
Anoro Ellipta
Arcapta Neohaler
Breo Ellipta
Brondil
Brovana
Daliresp
Duoneb
Isuprel
Lufyllin
Proventil HFA
Pulmicort
Pulmophylline
Senophylline
Singulair
Striverdi Respimat
Theo-24
Tudorza Pressair
Ventolin HFA
Vospire ER
XolairPA
Xopenex
Xopenex Concentrate
Zyflo
Zyflo CR
100% COPAY
Combivent Respimat
RESPIRATORY AGENTS - MISC
TIER 02
TIER 03
PREFERRED
PulmozymePA
NON PREFERRED
Aralast NPPA
Curosurf
GlassiaPA
Infasurf
KalydecoPA
Prolastin-cPA
Surfaxin
Survanta Intratracheal
ZemairaPA
TOXOIDS
TIER 01
TIER 02
TIER 03
GENERIC
Adacel
PREFERRED
Boostrix
Daptacel
Infanrix
Tenivac
Tetanus/Diphtheria Toxoids-adsorbed Adult
NON PREFERRED
Diphtheria/Tetanus Toxoids Adsorbed Pediatric
Kinrix
Pediarix
Pentacel
Tetanus Toxoid Adsorbed
VACCINES
30
TIER 02
TIER 03
PREFERRED
Acthib
Comvax
Hiberix
Imovax Rabies (h.d.c.v.)
Ipol Inactivated IPV
M-m-r II W/Diluent 10 Dose
Menomune-a/C/Y/W-135
Pedvax HIB
Pneumovax 23
Pneumovax 23/1 Dose
Pneumovax 23/5 Dose
Typhim VI
Varivax
Yf-vax
NON PREFERRED
Afluria PF 2012-2013
Afluria 2012-2013
Afluria 2013-2014
Afluria 2014-2015
Bcg Vaccine
Biothrax
Cervarix
Engerix-b
Fluarix Quadrivalent 2013-2014
Fluarix Quadrivalent 2014-2015
Fluarix 2012-2013
Fluarix 2013-2014
Flublok 2013-2014
Flucelvax 2012-2013
Flucelvax 2013-2014
Flucelvax 2014-2015
Flulaval Quadrivalent 2013-2014
Flulaval Quadrivalent 2014-2015
Flulaval 2012-2013
Flulaval 2013-2014
Flulaval 2014-2015
Flumist Nasal Vaccine 2012-2013
Flumist Quadrivalent
Fluvirin PF 2012-2013
Fluvirin 2012-2013
Fluvirin 2013-2014
Fluvirin 2014-2015
Fluzone High-dose PF 2012-2013
Fluzone Pediatric PF 2012-2013
Fluzone PF 2012-2013
Fluzone PF 2013-2014
Fluzone Quadrivalent 2013-2014
Fluzone Quadrivalent 2014-2015
Fluzone Split 2012-2013
Gardasil
Havrix
Influenza A (h1n1) Monovalent 2009
Ixiaro
Medical Provider EZ Flu Shot 2014-2015
Menactra
Menhibrix
Menveo
Prevnar 13
Proquad
Rabavert
Recombivax HB
Rotarix
Rotateq
Twinrix
Vaqta
Vivotif Berna
Zostavax
VITAMINS
VITAMINS
TIER 01
TIER 02
TIER 03
GENERIC
ascorbic acid
ergocalciferol
phytonadione
thiamine HCL
vitamin c 222MG
vitamin d
vitamin k1
Pyridoxine HCL
Vitamin K1
Wheat Germ
PREFERRED
Mephyton
NON PREFERRED
Aquasol A Parenteral
Decara
Drisdol
MULTIVITAMINS
TIER 01
GENERIC
b-complex
b-complex 100
niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper
Albafort
Cavan-alpha Kit
Cod Liver Oil
Crnatal
CO-natal Fa
Elite-OB
Folbecal
Folcaps Omega 3
Folivane-prx DHA NF
Folivane-OB
Inatal Advance
Inatal GT
Inatal Ultra
M.v.i. Adult
Macnatal CN DHA
Mynatal
Mynatal Advance
Mynatal Ultracaplet
Natalvit
OB-natal One
Pr Natal 400
Pr Natal 400 EC
Pr Natal 430
Pr Natal 430 EC
Prenatabs RX
Prenatal Ad
Strovite
Taron-bc
Taron-c DHA
Taron-duo EC
Taron-prex
Tricare
Trinate
31
TIER 02
TIER 03
Triveen-duo DHA
Triveen-prx RNF
Triveen-ten
Triveen-u
TL G-FOL OS
Vemavite-prx 2
Vinacal
Vinate AZ Extra
Vinate C
Vinate Calcium
Vinate Care
Vinate GT
Vinate IC
Vinate II
Vinate M
Vinate One
Vinate Pn Care
Vitaroca Plus
Zatean-pn
Zatean-pn DHA
Zatean-pn Plus
Zatean-CH
PREFERRED
Bal-care DHA
NON PREFERRED
Adrenal C Formula
Atabex EC
Atabex Prenatal
B-nexa
Bacmin
Bal-care DHA Essential
Citranatal Assure
Citranatal B-calm
Citranatal DHA
Citranatal Harmony
Citranatal RX
Citranatal 90 DHA
Concept DHA
Concept OB
Corvite
Dialyvite Supreme D
Dialyvite 3000
Dialyvite 5000
Dialyvite/Zinc
Diatx ZN
Duet DHA
Duet DHA Balanced
Duet DHA EC
Duet DHA 400
Duet DHA 400EC
Duet DHA 430
Duet DHA 430EC
Escavite
Escavite D
Folet DHA
Folet One
Folgard OS
Fortavit
Gesticare DHA
M.v.i. Pediatric
M.v.i.-12 Without Vitamin K
M-vit
Marnatal-f
Maxinate
Moms Choice RX
Mykidz Iron Fl
Natachew
Natafort
Natalvirt CA
Natalvirt 90 DHA
Natelle One
Neevo DHA
Nephplex RX
Nephro-vite RX
Nephrocaps
Nephrocaps QT
Nestabs
Nestabs Abc
Nestabs DHA
Newgen
Nexa Plus
Nexa Select
Nicadan
Nicazel
Nicazel Forte
Nicomide
Nutricap
Nutrivit
O-CAL Fa
O-CAL Prenatal
Obstetrix DHA
Obstetrix EC
OB Complete
OB Complete One
OB Complete Petite
OB Complete Premier
OB Complete 400
OB Complete/DHA
Paire OB
Poly-VI-flor
Poly-VI-flor/Iron
Prefera OB
Prefera OB + DHA
Preferaob One
Prefol-DHA
Prenata
Prenatal-u
Prenate
Prenate AM
Prenate DHA
Prenate Elite
Prenate Enhance
Prenate Essential
Prenate Mini
Prenate Pixie
Prenate Restore
Prenate Star
Prenexa
Preque 10
Protect Plus
Protectbone
Protectnatal
Provida OB
Quflora Pediatric
R-natal OB
Renatabs
Renatabs With Iron
Renax
Req 49+
Select-ob+dha
Select-OB
Siderol
Strovite Forte
Strovite One
Supervite
Supervite EC
Support-500
Synagex
Synatek
Tri-VI-flor
32
Tricare Prenatal Compleat
Tricare Prenatal DHA One
Udamin
Udamin SP
Vinacal B
Vinate DHA
Vinate DHA RF
Vita-pren
Vitafol
Vitafol Ultra
Vitafol-nano
Vitafol-ob+dha
Vitafol-one
Vitafol-plus
Vitafol-pn
Vitafol-OB
Vital-d RX
Vitamedmd One RX/Quatrefolic
Vitamedmd Plus RX/Quatre Folic
Vitamedmd Redichew RX
Vitamedmd Redichew RX/Quatrefolic
Vitapearl
Viva CT Prenatal
Viva DHA
MEDICAL DEVICES
DIABETIC SUPPLIES
TIER 00
VALUE BASED BENEFIT
Insulin Syringe/0.5ML/30G X 5/16"
Relion Insulin Syringe/U-100/0.5ML/29G X 1/2"
MISCELLANEOUS
TIER 02
TIER 03
PREFERRED
Chemet
ExjadePA
NON PREFERRED
FerriproxPA
Pentetate Calcium Trisodium
Pentetate Zinc Trisodium
33
Index
A
A-hydrocort, 13
abacavir, 3
abacavir sulfate/lamivudine/zidovudine, 3
Abelcet, 2
Abilify, 22
Abilify Discmelt, 22
Abilify Maintena, 22
Abraxane, 5
Absorica, 10
Abstral, 27
acamprosate calcium DR, 24
Acanya, 10
acarbose, 15
Accolate, 30
Accuneb, 30
Accupril, 8
Accuretic, 8
acebutolol HCL, 7
Aceon, 8
Acetaminophen/Caffeine/Dihydrocodeine
Bitartrate, 27
acetaminophen/codeine, 26
acetaminophen/codeine #2, 26
acetaminophen/codeine phosphate, 26
acetazolamide, 8
Acetazolamide, 9
acetazolamide ER, 9
acetazolamide sodium, 8
acetic acid, 26
Acetic Acid/Aluminum Acetate, 26
acetylcysteine, 29
acitretin, 11
Aclovate, 11
Actemra, 28
Acthar HP, 16
Acthib, 31
Acticlate, 2
Actigall, 18
Actimmune, 6
Actiq, 27
Activase, 20
Activella, 14
Actonel, 15
Actoplus Met, 15
Actoplus Met XR, 15
Actos, 15
Acular, 26
Acular LS, 26
Acuvail, 26
acyclovir, 3, 11
acyclovir sodium, 3
Acyclovir Sodium, 3
Aczone, 10
Adacel, 30
Adalat CC, 7
adapalene, 10
Adasuve, 22
Adcetris, 5
Adcirca, 10
Adderall, 22
Adderall XR, 22
adefovir dipivoxil, 3
Adempas, 9
Adenocard, 7
adenosine, 7
Adoxa, 2
Adoxa PAK 1/100, 2
Adoxa PAK 1/150, 2
Adoxa PAK 2/100, 2
Adrenaclick, 9
Adrenal C Formula, 32
Adrenalin, 9, 29, 30
Adriamycin, 4
Advair Diskus, 30
Advair HFA, 30
Advicor, 9
Aerospan, 30
Afinitor, 5
Afinitor Disperz, 5
Afluria 2012-2013, 31
Afluria 2013-2014, 31
Afluria 2014-2015, 31
Afluria PF 2012-2013, 31
Afluria PF 2013-2014, 31
Afluria PF 2014-2015, 31
Aggrastat, 20
Aggrenox, 20
Agrylin, 20
Akne-mycin, 10
Akten, 26
Ala Scalp, 11
Alagesic LQ, 26
Alahist Ac, 29
Alahist DHC, 29
Albafort, 19, 31
Albenza, 3
albuterol sulfate, 30
albuterol sulfate ER, 30
albuterol TAB 4MG, 30
Alcaine, 26
alclometasone dipropionate, 11
Aldactazide, 9
Aldactone, 9
Aldara, 12
Aldurazyme, 16
alendronate sodium, 15
Alendronate Sodium, 15
Alfenta, 27
alfentanil, 27
Alferon N, 6
alfuzosin HCL ER, 19
Alimta, 5
Alinia, 4
Alkeran, 4
Allfen CD, 29
Allfen CDX, 29
allopurinol, 28
Alocril, 26
Alodox Convenience Kit, 2
Alomide, 26
Aloprim, 28
Alora, 14
Aloxi, 18
Alphagan P, 26
alprazolam, 21
alprazolam ER, 21
Alprazolam Intensol, 21
alprazolam odt, 21
Alrex, 25
Alsuma, 28
Altabax, 10
Altace, 8
Altoprev, 9
Aluminum Acetate, 12
Aluvea, 12
Alvesco, 30
amantadine HCL, 23
Amantadine HCL, 23
Amaryl, 15
Ambien, 22
Ambien CR, 22
Ambifed CD, 29
Ambifed CDX, 29
Ambifed-G CD, 29
Ambifed-G CDX, 29
Ambisome, 2
amcinonide, 11
Amcinonide, 11
Amerge, 28
Amethyst, 14
Amicar, 20
amifostine, 6
amikacin sulfate, 2
amiloride HCL, 9
amiloride/hydrochlorothiazide, 9
aminocaproic acid, 20
Aminocaproic Acid, 20
aminophylline, 30
amiodarone HCL, 7
Amiodarone HCL, 7
Amitiza, 18
amitriptyline HCL, 21
amlodipine besylate, 7
amlodipine besylate/atorvastatin calcium,
9
amlodipine besylate/benazepril HCL, 8
amlodipine besylate/benazepril
hydrochloride, 8
ammonium lactate, 12
Ammonul, 16
Amoxapine, 21
amoxicillin, 1
Amoxicillin, 1
Amoxicillin ER, 1
amoxicillin/clavulanate potassium, 1
amoxicillin/clavulanate potassium ER, 1
amphetamine/dextroamphetamine, 22
Amphotec, 2
Amphotericin B, 2
ampicillin, 1
Ampicillin, 1
ampicillin sodium, 1
Ampicillin Sodium, 1
ampicillin-sulbactam, 1
Ampicillin-sulbactam, 1
Ampyra, 24
Amrix, 24
Amturnide, 8
Amytal Sodium, 22
Anacaine, 12
Anadrol-50, 13
Anafranil, 21
anagrelide hydrochloride, 20
Analpram Advanced, 18
Analpram-HC, 18
Analpram-HC Singles, 18
Anaprox, 28
Anaprox DS, 28
Anaspaz, 17
anastrozole, 5
Ancef, 1
Ancobon, 2
Androderm, 13
Androgel, 13
Androgel P.M., 13
Android, 13
Androxy, 13
Anectine, 24
Angeliq, 14
Angiomax, 20
Animi-3, 19
Animi-3/Vitamin D, 19
Anoro Ellipta, 30
Antabuse, 24
Antara, 9
antipyrine/benzocaine, 26
Antipyrine/Benzocaine, 26
Anusol-HC, 18
Anzemet, 17
Apexicon E, 11
Apidra, 14
Apidra Solostar, 14
Aplenzin, 21
Apokyn, 23
Appbutamone, 21
Appbutamone-d, 21
Appformin, 15
Appformin-d, 15
apraclonidine, 26
Apriso, 18
Aptiom, 23
Aptivus, 3
Aquasol A Parenteral, 31
Aquoral, 20
Aralast NP, 30
Aralen, 3
Aranesp Albumin Free, 19
Arava, 28
Arcalyst, 28
Arcapta Neohaler, 30
argatroban, 20
Argatroban, 20
Aricept, 24
Aricept Odt, 24
Arimidex, 5
Aristospan Intra-articular, 13
Aristospan Intralesional, 13
Arixtra, 20
Armour Thyroid, 17
Arnica Flower, 12
Aromasin, 5
Arranon, 5
Arthrotec 50, 28
Arthrotec 75, 28
Artiss, 20
Arzerra, 5
Asacol, 18
Asacol HD, 18
ascorbic acid, 31
Asmanex 120 Metered Doses, 30
Aspirin-caffeine-dihydrocodeine, 27
Astagraf XL, 5
Astelin, 29
Astepro, 29
Astringyn, 20
Atabex EC, 32
Atabex Prenatal, 32
Atacand, 8
Atacand HCT, 8
atenolol, 7
atenolol/chlorthalidone, 8
Atgam, 5
Ativan, 21
Atopiclair, 12
atorvastatin calcium, 9
atovaquone, 4
atovaquone/proguanil HCL, 3
atracurium besylate, 24
Atralin, 10
Atripla, 3
Atropen, 17
atropine sulfate, 17, 25
Atropine Sulfate, 17, 25
Atrovent, 29
Atrovent HFA, 30
Aubagio, 24
augmented betamethasone dipropionate,
11
Augmentin, 1
Augmentin ES-600, 1
Augmentin XR, 1
Auralgan, 26
Aurstat, 12
Aurstat Anti-itch Hydrogel, 12
Aurstat Anti-itch Hydrogel Kit, 12
Auvi-q, 9
Avalide, 8
Avandamet, 15
Avandaryl, 15
Avandia, 15
Avapro, 8
Avar, 10
Avar LS, 10
Avar LS Cleanser, 10
Avar-e LS, 10
Avastin, 5
Avc, 19
Aveed, 13
Avelox, 2
Avelox Abc Pack, 2
Avidoxy DK, 2
Avinza, 27
Avodart, 19
Avonex, 24
Avonex Pen, 24
Axert, 28
Axid, 17
Axiron, 13
Aygestin, 14
azacitidine, 4
Azactam, 4
Azactam IN Iso-osmotic Dextrose, 4
Azasan, 5
Azasite, 25
azathioprine, 5
azelastine HCL, 26, 29
Azelex, 10
Azilect, 23
azithromycin, 1
Azithromycin, 1
Azopt, 26
Azor, 8
aztreonam, 3
Azulfidine, 18
Azulfidine EN-TABS, 18
B
B-6 Folic Acid, 19
b-complex, 31
b-complex 100, 31
B-nexa, 32
bacitracin, 3
Bacitracin, 4, 25
bacitracin/polymyxin b, 24
baclofen, 24
Bacmin, 32
Bactocill IN Dextrose, 1
Bactrim, 4
Bactrim DS, 4
Bactroban, 10
Bactroban Nasal, 29
Bal-care DHA, 32
Bal-care DHA Essential, 32
balsalazide disodium, 18
Banzel, 23
Baraclude, 3
Bcg Vaccine, 31
BD Pudendal/Local Block Tray 1%
Lidocaine, 29
Beconase AQ, 29
Beleodaq, 6
Belladonna & Opium, 17
Belladonna Alkaloids & Opium, 17
benazepril HCL, 7
benazepril HCL/hydrochlorothiazide, 8
Benicar, 8
Benicar HCT, 8
Bentyl, 17
Benzaclin, 10
Benzaclin With P.M., 10
Benzamycin, 10
Benzamycinpak, 10
Benzoin Compound Tincture, 12
Benzoin Tincture, 12
benzonatate, 29
benztropine mesylate, 23
Bepreve, 26
Besivance, 25
Betadine Ophthalmic Prep, 25
Betagan, 25
betamethasone dipropionate, 11
betamethasone sodium
phosphate/betamethasone acetate, 13
betamethasone valerate, 11
Betapace, 7
Betapace AF, 7
Betaseron, 24
betaxolol HCL, 7, 25
bethanechol chloride, 18
Bethkis, 2
Betimol, 25
Betoptic-s, 25
Bexxar, 5
Bexxar 131 Iodine, 6
Beyaz, 14
Biaxin, 1
Biaxin XL, 1
Biaxin XL PAC, 1
bicalutamide, 5
Bicillin C-R, 1
Bicillin L-a, 1
Bicnu, 4
Bidil, 9
Biferarx, 19
Biltricide, 3
Binosto, 15
Biothrax, 31
bisoprolol fumarate, 7
bisoprolol fumarate/hydrochlorothiazide,
8
bleomycin sulfate, 4
Bleph-10, 25
Blephamide, 25
Blephamide S.o.p., 25
Bloxiverz, 24
Boniva, 15
Boostrix, 30
Boric Acid, 12
Bosulif, 5
Botox, 24
Bravelle, 16
Breo Ellipta, 30
Brevibloc, 7
Brevicon-28, 14
Brilinta, 20
brimonidine tartrate, 26
Brintellix, 21
Brisdelle, 24
Bromday, 26
bromfenac, 26
Bromfenac, 26
bromocriptine mesylate, 23
bromphen/pseudoephedrine
HCL/dextromethorphan HBR, 29
Brompheniramine Tannate, 29
Brondil, 30
Brovana, 30
budesonide, 13, 29, 30
bumetanide, 9
Bupap, 26
Buphenyl, 16
bupivacaine HCL, 28
bupivacaine/epinephrine, 28
Buprenex, 27
buprenorphine HCL, 27
buprenorphine HCL/naloxone HCL, 27
bupropion HCL, 21
bupropion HCL ER, 21
bupropion HCL SR, 21
bupropion HCL XL, 21
buspirone HCL, 21
Busulfex, 4
butal/asa/caff, 26
butalbital/acetaminophen, 26
butalbital/acetaminophen/caffeine, 26
butalbital/acetaminophen/caffeine/codein
e, 27
butalbital/apap/caffeine, 26
butalbital/asa/caffeine, 26
Butalbital/Aspirin/Caffeine, 26
butalbital/aspirin/caffeine/codeine, 27
Butisol Sodium, 22
butorphanol tartrate, 27
Butrans, 27
Bydureon, 14
Byetta, 14
Bystolic, 7
C
cabergoline, 16
Caduet, 10
Cafcit, 22
Cafergot, 28
caffeine citrate, 22
Caffeine/Sodium Benzoate, 22
Calan, 7
Calan SR, 7
calcipotriene, 11
calcipotriene/betamethasone
dipropionate, 12
calcitonin salmon, 15
calcitonin-salmon, 15
Calcitriol, 11
calcitriol, 16
calcium acetate, 18
Calcium Folinate, 6
Caldolor, 28
Cambia, 28
Campral, 24
Camptosar, 6
Canasa, 18
Cancidas, 2
candesartan cilexetil, 8
candesartan cilexetil/hydrochlorothiazide,
8
Cantil, 17
Capastat Sulfate, 2
capecitabine, 4
Capex, 11
Caphosol, 20
Capital/Codeine, 27
Caprelsa, 6
captopril, 7
Captopril/Hydrochlorothiazide, 8
Carafate, 17
Carbaglu, 16
carbamazepine, 23
carbamazepine ER, 23
Carbaphen 12, 29
Carbaphen 12 PED, 29
Carbatrol, 23
carbidopa, 23
carbidopa/levodopa, 23
carbidopa/levodopa ER, 23
carbidopa/levodopa odt, 23
Carbidopa/Levodopa/Entacapone, 23
carbinoxamine maleate, 29
Carbocaine, 28
carboplatin, 4
Carboplatin, 4
Cardene I.v., 7
Cardene IV, 7
Cardene SR, 7
Cardizem, 7
Cardizem CD, 7
Cardizem LA, 7
Cardura, 8
Cardura XL, 19
carisoprodol, 24
Carisoprodol, 24
carisoprodol/aspirin, 24
carisoprodol/aspirin/codeine, 24
Carmol-HC, 11
Carnitor, 16
Carnitor SF, 16
carteolol HCL, 25
carvedilol, 7
Cascara Sagrada, 17
Casodex, 5
Cataflam, 28
Catapres, 8
Catapres-tts-1, 8
Catapres-tts-2, 8
Catapres-tts-3, 8
Cathflo Activase, 20
Cavan-alpha Kit, 31
Cayston, 4
Cedax, 1
Ceenu, 4
cefaclor, 1
Cefaclor, 1
Cefaclor ER, 1
cefadroxil, 1
cefazolin sodium, 1
Cefazolin Sodium, 1
Cefazolin Sodium/Dextrose, 1
cefdinir, 1
Cefditoren Pivoxil, 1
cefepime, 1
Cefepime, 1
cefotaxime sodium, 1
Cefotetan, 1
Cefotetan/Dextrose, 1
cefoxitin sodium, 1
Cefoxitin Sodium, 1
cefpodoxime proxetil, 1
cefprozil, 1
ceftazidime, 1
Ceftazidime, 1
Ceftazidime/Dextrose, 1
Ceftibuten, 1
Ceftin, 1
Ceftriaxone IN Iso-osmotic Dextrose, 1
ceftriaxone sodium, 1
Ceftriaxone/Dextrose, 1
cefuroxime axetil, 1
cefuroxime sodium, 1
Cefuroxime Sodium, 1
Cefuroxime/Dextrose, 1
Celebrex, 28
Celestone, 13
Celestone-soluspan, 13
Celexa, 21
Cellcept, 5
Cellcept Intravenous, 5
Celontin, 23
Cem-urea, 12
Cenestin, 14
Cenfol, 19
Centany, 10
Centany AT, 10
Centratex, 19
cephalexin, 1
Cephalexin, 1
Cerebyx, 23
Cerezyme, 19
Cervarix, 31
Cervidil, 26
Cesamet, 18
cetirizine HCL, 29
Cetraxal, 26
Cetrotide, 16
cevimeline HCL, 20
Chemet, 33
Chenodal, 18
Chloramphenicol Sodium Succinate, 4
chlordiazepoxide HCL, 21
Chlordiazepoxide/Amitriptyline, 24
chlorhexidine gluconate, 20
chlorhexidine gluconate oral rinse, 20
chloroprocaine HCL, 28
chloroquine phosphate, 3
chlorothiazide, 9
Chlorothiazide, 9
chlorothiazide sodium, 9
chlorpromazine HCL, 22
Chlorpromazine HCL, 22
Chlorpropamide, 15
Chlorthalidone, 8
chlorzoxazone, 24
cholestyramine, 9
cholestyramine light, 9
choline magnesium trisalicylate, 26
chorionic gonadotropin, 16
Cialis, 9
Ciclodan Cream Kit, 11
Ciclodan Solution Kit, 10
ciclopirox, 10
ciclopirox nail lacquer, 10
ciclopirox olamine, 10
Ciclopirox Topical Solution Kit, 10
cidofovir, 3
cilostazol, 20
Ciloxan, 25
cimetidine, 17
cimetidine HCL, 17
Cimzia, 18
Cimzia Starter Kit, 18
Cipro, 2
Cipro HC, 26
Cipro I.V.-IN D5W, 2
Cipro XR, 2
Ciprodex, 26
ciprofloxacin, 2
Ciprofloxacin, 26
ciprofloxacin ER, 2
ciprofloxacin HCL, 2, 24
ciprofloxacin I.V.-IN D5W, 2
cisatracurium besylate, 24
cisplatin, 4
Cisplatin, 4
citalopram hydrobromide, 21
Citranatal 90 DHA, 32
Citranatal Assure, 32
Citranatal B-calm, 32
Citranatal DHA, 32
Citranatal Harmony, 32
Citranatal RX, 32
citric acid/sodium citrate, 19
Citrolith, 19
cladribine, 4
Claforan, 1
Claforan/D5W, 1
Claravis, 10
Clarifoam EF, 10
Clarinex, 29
Clarinex Reditabs, 29
Clarinex-d 12 HOUR, 30
Clarinex-d 24 HOUR, 30
clarithromycin, 1
clarithromycin ER, 1
clemastine fumarate, 29
Clemastine Fumarate, 29
Cleocin, 4, 19
Cleocin IN D5W, 4
Cleocin Pediatric Granules, 4
Cleocin Phosphate, 4
Cleocin-t, 10
Cleviprex, 7
Climara, 14
Climara Pro, 14
Clindacin Etz, 10
Clindacin PAC, 10
Clindagel, 10
clindamycin HCL, 3
clindamycin palmitate HCL, 3
clindamycin phosphate, 3, 10, 19
Clindamycin Phosphate, 4
clindamycin phosphate add-vantage, 3
clindamycin phosphate IN D5W, 3
clindamycin phosphate pharmacy bulk
package, 3
clindamycin/benzoyl peroxide, 10
Clindesse, 19
clobetasol propionate, 11
clobetasol propionate emollient, 11
Clobex, 11
Clodan Kit, 12
Clolar, 5
clomiphene citrate, 16
clomipramine HCL, 21
clonazepam, 23
clonazepam odt, 23
clonidine HCL, 8
clonidine HCL ER, 22
clopidogrel, 20
clorazepate dipotassium, 21
Clorpres, 8
clotrimazole, 10, 20
clotrimazole/betamethasone dipropionate,
10
clozapine, 22
Clozapine Odt, 22
Clozaril, 22
Cnl8 Nail Kit, 10
CO-natal Fa, 31
Coal TAR, 12
Coartem, 3
Cocaine HCL, 12
Cod Liver Oil, 31
Codeine Sulfate, 27
Cogentin, 23
Colazal, 18
Colcrys, 28
Colestid, 9
Colestid Flavored, 9
colestipol HCL, 9
colestipol HCL for oral suspension, 9
colistimethate sodium, 3
Coly-mycin M, 4
Coly-mycin S, 26
Colyte-flavor Packs, 17
Combigan, 25
Combipatch, 14
Combivent, 30
Combivent Respimat, 30
Combivir, 3
Cometriq, 6
Compazine, 22
Complera, 3
Comtan, 23
Comvax, 31
Concept DHA, 32
Concept OB, 32
Concerta, 22
Condylox, 12
Conzip, 27
Copaxone, 24
Copegus, 3
Cordarone, 7
Cordran, 12
Cordran Tape, 11
Coreg, 7
Coreg CR, 7
Corgard, 7
Corlopam, 8
Cortef, 13
Cortenema, 18
Cortifoam, 18
Cortisone Acetate, 13
Cortisporin, 10, 26
Cortisporin-tc, 26
Corvert, 7
Corvite, 32
Corvite 150, 19
Corzide, 8
Cosmegen, 4
Cosopt, 25
Cosopt PF, 25
Cotab A, 29
Cotab AX, 29
Cotabflu, 29
Coumadin, 20
Cozaar, 8
Cpb Wc, 29
Creon, 18
Crestor, 9
Cresylate, 26
Crinone, 19
Crixivan, 3
Crnatal, 31
cromolyn sodium, 18, 26, 30
Cubicin, 4
Curosurf, 30
Cutivate, 12
Cuvposa, 17
cyanocobalamin, 19
Cyclessa, 14
Cyclobenzaprine Comfort PAC, 24
cyclobenzaprine HCL, 24
Cyclogyl, 25
Cyclomydril, 25
cyclopentolate HCL, 25
Cyclophosphamide, 4
Cycloserine, 2
cyclosporine, 5
cyclosporine modified, 5
Cyclosporine Modified, 5
Cyklokapron, 20
Cymbalta, 21
cyproheptadine HCL, 29
Cyramza, 5
Cystadane, 16
Cystagon, 19
Cystaran, 26
cytarabine, 4
Cytarabine, 4
cytarabine aqueous, 4
Cytomel, 17
Cytotec, 17
Cytovene, 3
Cytra-3, 19
D
D.h.e. 45, 28
dacarbazine, 6
Dacarbazine, 6
Dacogen, 5
Daliresp, 30
Dalvance, 4
danazol, 13
Dantrium, 24
Dantrium IV, 24
dantrolene sodium, 24
Dantrolene Sodium, 24
Dapsone, 4
Daptacel, 30
Daraprim, 3
daunorubicin HCL, 4
Daunoxome, 4
Daypro, 28
Daytrana, 22
Ddavp, 16
Debacterol, 20
Decara, 31
decitabine, 4
Decon-a, 29
Delestrogen, 14
Delzicol, 18
Demadex, 9
demeclocycline HCL, 2
Demerol, 27
Demser, 8
Denavir, 11
Depacon, 23
Depakene, 23
Depakote, 23
Depakote ER, 23
Depakote Sprinkles, 23
Depo-estradiol, 14
Depo-medrol, 13
Depo-provera, 5
Depo-testosterone, 13
Derma-smoothe/FS Body, 12
Derma-smoothe/FS Body Oil, 12
Derma-smoothe/FS Scalp, 12
Derma-smoothe/FS Scalp Oil, 12
Dermasorb HC, 12
Dermasorb Ta, 12
Dermasorb XM, 12
Dermatop, 12
Dermotic, 26
desipramine HCL, 21
desloratadine, 29
desloratadine odt, 29
desmopressin acetate, 16
Desogen, 14
desogestrel/ethinyl estradiol, 14
Desonate, 12
desonide, 11
Desowen, 12
Desowen Cream/Cetaphil Lotion, 12
Desowen Lotion/Cetaphil Cream, 12
Desowen Ointment/Cetaphil Lotion, 12
desoximetasone, 11
Desoximetasone, 11
Desoxyn, 22
Desvenlafaxine ER, 21
Detrol, 18
Detrol LA, 18
dexamethasone, 13
Dexamethasone, 13
Dexamethasone Intensol, 13
dexamethasone sodium phosphate, 13,
25
Dexamethasone Sodium Phosphate, 13
Dexchlorpheniramine Maleate, 29
Dexedrine, 22
dexmedetomidine HCL, 22
dexmethylphenidate HCL, 22
dexmethylphenidate HCL ER, 22
Dexpak 10 Day, 13
Dexpak 13 Day, 13
Dexpak 6 Day, 13
Dexpanthenol, 18
dexrazoxane, 6
dextroamphetamine sulfate, 22
dextroamphetamine sulfate ER, 22
Dextromethorphan
HBR/Chlorpheniramine/Phenylephrine
HCL, 29
Diabeta, 15
Dialyvite 3000, 32
Dialyvite 5000, 32
Dialyvite Supreme D, 32
Dialyvite/Zinc, 32
Diamox, 9
Diastat Acudial, 23
Diastat Pediatric, 23
Diatx ZN, 32
diazepam, 21
Diazepam, 21, 23
Diazepam Intensol, 21
Dibenzyline, 8
Diclegis, 17
diclofenac potassium, 27
diclofenac sodium, 11, 26
diclofenac sodium DR, 27
diclofenac sodium ER, 27
diclofenac sodium/misoprostol, 27
dicloxacillin sodium, 1
dicyclomine HCL, 17
Dicyclomine HCL, 17
didanosine, 3
Didronel, 15
Differin, 10
Dificid, 1
diflorasone diacetate, 11
Diflorasone Diacetate, 11
Diflucan, 2
diflunisal, 26
Digex NF, 17
digoxin, 6
Digoxin, 6
dihydroergotamine mesylate, 28
Dihydroergotamine Mesylate, 28
Dilacor XR, 7
Dilantin, 23
Dilantin Infatabs, 23
Dilatrate SR, 6
Dilaudid, 27
Dilaudid-HP, 27
diltiazem CD, 7
diltiazem HCL, 7
Diltiazem HCL, 7
diltiazem HCL ER, 7
Dimenhydrinate, 17
Diovan, 8
Diovan HCT, 8
Dipentum, 18
diphenhydramine HCL, 29
diphenoxylate/atropine, 17
Diphenoxylate/Atropine, 17
Diphtheria/Tetanus Toxoids Adsorbed
Pediatric, 30
Diprolene, 12
Diprolene AF, 12
dipyridamole, 20
disopyramide phosphate, 7
disulfiram, 24
Ditropan XL, 18
Diuril, 9
divalproex sodium, 23
divalproex sodium DR, 23
divalproex sodium ER, 23
Divigel, 14
Divista, 19
dobutamine HCL, 9
dobutamine HCL/D5W, 9
dobutamine/dextrose 5%, 9
Dobutamine/Dextrose 5%, 9
Docefrez, 5
Docetaxel, 5
Dolgic Plus, 26
Dologesic, 26
Dolophine, 27
Dolophine HCL, 27
Donatuss Dc, 29
donepezil HCL, 24
dopamine HCL, 9
Dopamine HCL, 9
dopamine HCL-dextrose 5%, 9
dopamine HCL/dextrose 5%, 9
dopamine/D5W, 9
Dopram, 22
Doral, 22
Doribax, 4
Doryx, 2
dorzolamide HCL, 26
dorzolamide HCL/timolol maleate, 25
Dovonex, 11
doxapram HCL, 22
doxazosin mesylate, 8
doxepin HCL, 21
Doxepin HCL, 21
doxercalciferol, 16
Doxil, 4
doxorubicin HCL, 4
doxorubicin HCL liposome, 4
doxycycline, 2
doxycycline hyclate, 2
doxycycline hyclate DR, 2
doxycycline monohydrate, 2
Doxytex, 29
Drisdol, 31
Dritho-creme HP, 11
dronabinol, 17
droperidol, 21
drospirenone/ethinyl estradiol, 14
Droxia, 19
Drysol, 12
Duac, 10
Duavee, 14
Duet DHA, 32
Duet DHA 400, 32
Duet DHA 400EC, 32
Duet DHA 430, 32
Duet DHA 430EC, 32
Duet DHA Balanced, 32
Duet DHA EC, 32
Duetact, 15
Duexis, 28
Dulera, 30
duloxetine HCL, 21
Duocaine, 29
Duoneb, 30
Duragesic, 27
Durasafe Spinal/Epidural Tray/1%
Xylocaine/19GX36"close CATH, 29
Xylocaine/19GX36"open CATH, 29
Xylocaine/20GX36"close CATH, 29
Xylocaine/20GX36"open CATH, 29
Durezol, 25
Dutoprol, 8
Dyazide, 9
Dymista, 29
Dynacin, 2
Dyrenium, 9
Dysport, 24
E
E.e.s. 400, 1
E.e.s. Granules, 1
EC-naprosyn, 28
econazole nitrate, 10
Ecoza, 11
Ed Cyte F, 19
Ed-chlor-tan, 29
Edarbi, 8
Edarbyclor, 8
Edecrin, 9
Edluar, 22
Edurant, 3
Effexor XR, 21
Effient, 20
Egrifta, 16
Elaprase, 16
Eldepryl, 23
Elelyso, 19
Elenzapatch, 12
Elestat, 26
Elestrin, 14
Eletone, 12
Eletone Twinpack, 12
Elidel, 12
Eligard, 5
Elimite, 12
Eliphos, 18
Eliquis, 20
Elite-OB, 31
Elitek, 6
Elixophyllin, 30
Ella, 14
Ellence, 4
Elmiron, 19
Elocon, 12
Eloxatin, 4
Elspar, 4
Emadine, 26
Emcyt, 5
Emend, 17
Emla, 12
Emsam, 21
Emtriva, 3
Emulsion SB, 12
Enablex, 18
enalapril maleate, 7
enalapril maleate/hydrochlorothiazide, 8
enalaprilat, 8
Enbrel, 28
Enbrel Sureclick, 28
Endometrin, 19
Engerix-b, 31
Enjuvia, 14
Enlon, 24
Enlon-plus, 24
enoxaparin sodium, 20
entacapone, 23
Entereg, 18
Entocort EC, 13
Entyvio, 18
Epaned, 8
ephedrine sulfate, 9
Epiceram, 12
Epiduo, 10
Epifoam, 12
epinastine HCL, 26
Epinephrine, 9
epinephrine HCL, 30
Epipen 2-PAK, 9
Epipen-JR 2-PAK, 9
epirubicin HCL, 4
Epirubicin HCL, 4
episone CRE, 12
Epivir, 3
Epivir HBV, 3
eplerenone, 8
Epogen, 19
epoprostenol sodium, 9
eprosartan mesylate, 8
Epzicom, 3
Equagesic, 26
Equetro, 22
Eraxis, 2
Erbitux, 5
ergocalciferol, 31
Ergoloid Mesylates, 24
Ergomar, 28
Ertaczo, 10
Erwinaze, 4
Ery-TAB, 1
Erygel, 10
Eryped 200, 1
Eryped 400, 1
Erythrocin Lactobionate, 1
Erythrocin Stearate, 1
erythromycin, 1, 10, 24
Erythromycin Base, 1
Erythromycin Ethylsuccinate, 1
erythromycin/benzoyl peroxide, 10
Escavite, 32
Escavite D, 32
escitalopram oxalate, 21
Esgic, 26
Esgic-plus, 26
esmolol HCL, 7
estazolam, 22
Estrace, 14, 19
estradiol, 13
estradiol valerate, 13
estradiol/norethindrone acetate, 13
Estrasorb, 14
Estring, 19
Estrogel, 14
estropipate, 13
Estropipate, 13
Estrostep FE, 14
eszopiclone, 22
ethambutol HCL, 2
ethosuximide, 23
Ethyl Chloride, 12
Ethyl Chloride/Fine Pinpoint, 12
Ethyl Chloride/Fine Stream, 12
Ethyl Chloride/Medium Jet Stream, 12
Ethyl Chloride/Medium Stream, 12
Ethyl Chloride/Mist, 12
Ethyol, 6
Etidronate Disodium, 15
etodolac, 27
etodolac ER, 27
Etopophos, 5
etoposide, 5
Etoposide, 5
Eurax, 12
Evamist, 14
Evicel, 20
Evista, 16
Evithrom, 20
Evoclin, 10
Evoxac, 20
Exactuss, 29
Exalgo, 27
Exelderm, 10
Exelon, 24
exemestane, 5
Exforge, 8
Exforge HCT, 8
Exjade, 33
Exparel, 29
Extavia, 24
Extina, 11
F
Fabior, 10
Fabrazyme, 16
Factive, 2
Falessa, 14
famciclovir, 3
famotidine, 17
Famotidine, 17
Famotidine Premixed, 17
Famvir, 3
Fanapt, 22
Fanapt Titration Pack, 22
Fareston, 5
Farxiga, 15
Faslodex, 5
Fazaclo, 22
felbamate, 23
Felbatol, 23
Feldene, 28
felodipine ER, 7
Fem PH, 19
Femara, 5
Femcon FE, 14
Femhrt Low Dose, 14
Femring, 19
fenofibrate, 9
Fenofibrate, 9
fenofibrate micronized, 9
Fenofibric Acid, 9
fenofibric acid DR, 9
Fenoglide, 9
fenoldopam mesylate, 8
Fenoprofen Calcium, 28
fentanyl, 27
fentanyl citrate oral transmucosal, 27
Fentora, 27
Feraheme, 19
Feriva, 19
Ferivafa, 19
Ferralet 90, 19
Ferrex 150 Forte Plus, 19
Ferrex 28, 19
Ferriprox, 33
Ferrlecit, 19
Ferro-plex Hematinic, 19
Ferrotrin, 19
Fetzima, 21
Fetzima Titration Pack, 22
Fexmid, 24
Fibricor, 9
Finacea, 10
finasteride, 19
Fioricet, 26
Fioricet/Codeine, 27
Fiorinal, 26
Fiorinal/Codeine #3, 27
Firazyr, 20
Firmagon, 5
First-bxn Mouthwash, 21
First-dukes Mouthwash, 21
First-hydrocortisone, 12
First-marys Mouthwash, 21
First-mouthwash Blm, 21
First-progesterone VGS 100
Compounding Kit, 19
Compounding Kit, 19
First-progesterone VGS 25 Compounding
Kit, 19
Compounding Kit, 19
First-progesterone VGS 50 Compounding
Kit, 19
First-testosterone, 13
First-testosterone Mc Compounding Kit,
13
First-vancomycin 25, 4
First-vancomycin 50, 4
Flagyl, 4
Flagyl ER, 4
Flarex, 25
flavoxate HCL, 18
flecainide acetate, 7
Flector, 11
Flexeril, 24
FLO-pred, 13
Flolan, 9
Flomax, 19
Flonase, 29
Flovent Diskus, 30
Flovent HFA, 30
floxuridine, 4
Fluarix 2012-2013, 31
Fluarix 2013-2014, 31
Fluarix Quadrivalent 2013-2014, 31
Fluarix Quadrivalent 2014-2015, 31
Flublok 2013-2014, 31
Flucelvax 2012-2013, 31
Flucelvax 2013-2014, 31
Flucelvax 2014-2015, 31
fluconazole, 2
fluconazole IN dextrose, 2
fluconazole IN NACL, 2
Fluconazole IN NACL, 2
flucytosine, 2
Fludara, 5
fludarabine phosphate, 4
Fludarabine Phosphate, 4
fludrocortisone acetate, 13
Flulaval 2012-2013, 31
Flulaval 2013-2014, 31
Flulaval 2014-2015, 31
Flulaval Quadrivalent 2013-2014, 31
Flulaval Quadrivalent 2014-2015, 31
Flumadine, 3
Flumist Nasal Vaccine 2012-2013, 31
Flumist Quadrivalent, 31
flunisolide, 29
Flunisolide, 29
fluocinolone acetonide, 11, 26
fluocinolone acetonide ear drops, 26
fluocinonide, 11
fluocinonide emollient base, 11
fluocinonide-e, 11
fluorometholone, 25
fluorouracil, 4
fluoxetine, 24
fluoxetine DR, 21
fluoxetine HCL, 21
Fluoxetine HCL, 21
fluphenazine decanoate, 22
fluphenazine HCL, 22
Fluphenazine HCL, 22
flurazepam HCL, 22
flurbiprofen, 27
flurbiprofen sodium, 26
flutamide, 5
fluticasone propionate, 11, 29
fluvastatin, 9
Fluvirin 2012-2013, 31
Fluvirin 2013-2014, 31
Fluvirin 2014-2015, 31
Fluvirin PF 2012-2013, 31
fluvoxamine maleate, 21
fluvoxamine maleate ER, 21
Fluzone High-dose PF 2012-2013, 31
Fluzone Pediatric PF 2012-2013, 31
Fluzone PF 2012-2013, 31
Fluzone PF 2013-2014, 31
Fluzone Quadrivalent 2013-2014, 31
Fluzone Quadrivalent 2014-2015, 31
Fluzone Split 2012-2013, 31
FML, 25
FML Forte, 25
FML Liquifilm, 25
Focalin, 22
Focalin XR, 22
Folbecal, 31
Folcaps Omega 3, 31
Folet DHA, 32
Folet One, 32
Folgard OS, 32
Folgard RX, 19
folic acid, 19
Folic Acid, 19
folic acid/vitamin b-6/vitamin b-12, 19
Folivane-f, 19
Folivane-OB, 31
Folivane-plus, 19
Folivane-prx DHA NF, 31
Follistim AQ, 16
Folotyn, 4
Foltrate, 19
fondaparinux sodium, 20
Foradil Aerolizer, 30
Forfivo XL, 22
Fortamet, 15
Fortavit, 32
Fortaz, 1
Forteo, 15
Fortesta, 13
Fortical, 15
Fosamax, 15
Foscarnet Sodium, 3
Foscavir, 3
fosinopril sodium, 7
fosinopril sodium/hydrochlorothiazide, 8
fosphenytoin sodium, 23
Fosrenol, 18
Fragmin, 20
Frova, 28
Fulyzaq, 17
Furadantin, 18
furosemide, 9
Furosemide, 9
Fusilev, 6
Fusion Plus, 19
Fuzeon, 3
Fycompa, 23
G
gabapentin, 23
Gabavale-5, 21
Gabazolamine, 21
Gabazolamine-0.5, 21
Gabazolpidem-5, 22
Gabitidine, 17
Gabitril, 23
Gaboxetine, 21
galantamine, 24
galantamine hydrobromide, 24
ganciclovir, 3
Ganirelix Acetate, 16
Ganite, 15
Garamycin, 25
Gardasil, 31
Gastrinex NF, 17
Gastrocrom, 18
gatifloxacin, 25
Gattex, 18
Gazyva, 5
Gebauers Pain Ease, 12
Gebauers Spray And Stretch, 12
Gel-kam Oral Care Rinse, 21
Gelclair, 21
Gelnique, 18
Gemcitabine, 4
gemcitabine HCL, 4
gemfibrozil, 9
Gemzar, 5
Genadur, 12
gene-xene TAB 15MG, 21
gene-xene TAB 3.75MG, 21
gene-xene TAB 7.5MG, 21
Generess FE, 14
Genotropin, 16
Genotropin Miniquick, 16
gentamicin sulfate, 2, 25
Gentamicin Sulfate, 10
gentamicin sulfate pediatric, 2
gentamicin sulfate/0.9% sodium chloride,
2
Gentamicin Sulfate/0.9% Sodium
Chloride, 2
gentamicin sulfate/sodium chloride, 2
Geodon, 22
Gesticare DHA, 32
Giazo, 18
Gilenya, 24
Gilotrif, 6
Gilphex TR, 29
Giltuss, 29
Giltuss PED-c, 29
Giltuss TR, 29
Glassia, 30
Gleevec, 5
Gliadel Wafer, 4
glimepiride, 15
glipizide, 15
glipizide ER, 15
glipizide/metformin HCL, 15
Glucagen, 15
Glucagen Hypokit, 15
Glucagon Emergency Kit, 15
Glucophage, 15
Glucophage XR, 15
Glucotrol, 15
Glucotrol XL, 15
Glucovance, 15
Glumetza, 15
glyburide, 15
Glyburide, 15
glyburide micronized, 15
glyburide/metformin HCL, 15
Glycate, 17
Glycolic Acid, 11
Glycolic Acid 70% High Purity, 11
glycopyrrolate, 17
Glynase, 15
Glyset, 15
Golytely, 17
Gonal-f, 16
Gonal-f RFF, 16
Gonal-f RFF Pen, 16
Gonal-f RFF Rediject, 16
Gordofilm, 12
Gordons Urea, 12
Gralise, 24
Gralise Starter, 24
granisetron HCL, 17
Granisol, 17
Granix, 19
Grifulvin V, 2
Gris-peg, 2
griseofulvin microsize, 2
griseofulvin ultramicrosize, 2
guanfacine HCL, 8
Guanidine HCL, 24
Gynazole-1, 19
H
Halaven, 5
Halcion, 22
Haldol, 22
Haldol Decanoate 100, 22
Haldol Decanoate 50, 22
Halflytely Bowel Prep/Flavor Packs, 17
halobetasol propionate, 11
Halog, 12
Halonate, 12
haloperidol, 22
haloperidol decanoate, 22
haloperidol lactate, 22
Halotin, 11
Havrix, 31
Hectorol, 16
Helidac, 17
Hemabate, 26
Hemangeol, 7
Hematogen Fa, 19
Hematron-AF, 19
Hemocyte Plus, 19
Hemocyte-f, 19
heparin lock, 20
heparin lock flush, 20
Heparin Lock Flush, 20
heparin lock flush for flushing vascular
access devices, 20
heparin lock flush/NACL for flushing
vascular access devices, 20
heparin sodium, 20
Heparin Sodium, 20
heparin sodium dcu, 20
heparin sodium lock flush, 20
heparin sodium/D5W, 20
Heparin Sodium/D5W, 20
Heparin Sodium/NACL 0.45%, 20
heparin sodium/NACL 0.9%, 20
Heparin Sodium/Sodium Chloride 0.9%,
20
heparin sodium/sodium chloride 0.9%
premix, 20
Hepsera, 3
Herceptin, 5
Hespan, 20
hetastarch 6%/NACL, 20
Hetlioz, 22
Hexalen, 4
Hextend, 20
Hiberix, 31
Hiprex, 18
homatropine HBR, 25
Horizant, 24
HPR, 13
HPR Plus, 13
HPR Plus/Mb Hydrogel, 13
Humalog, 14
Humalog Kwikpen, 14
Humalog Mix 50/50, 14
Humalog Mix 50/50 Kwikpen, 14
Humalog Mix 75/25, 14
Humalog Mix 75/25 Kwikpen, 14
Humatrope, 16
Humatrope Combo Pack, 16
Humira, 28
Humira Pen, 28
Humira Pen-crohns Diseasestarter, 28
Humira Pen-psoriasis Starter, 28
Humulin R U-500 (concentrated), 14
Hycamtin, 6
Hycet, 27
hydralazine HCL, 8
Hydrea, 6
Hydro 35, 12
Hydro 40 Foam, 12
hydrochloric acid, 19
hydrochlorothiazide, 8
hydrocodone bitartrate/acetaminophen,
27
Hydrocodone Bitartrate/Acetaminophen,
27
hydrocodone bitartrate/chlorpheniramine
maleate/PSE, 29
hydrocodone bitartrate/homatropine
methylbromide, 29
hydrocodone polistirex/chlorpheniramine
polistirex, 29
hydrocodone/acetaminophen, 27
Hydrocodone/Acetaminophen, 27
hydrocodone/homatropine, 29
hydrocodone/ibuprofen, 27
hydrocort ene 100MG, 18
hydrocortisone, 11, 13, 18
hydrocortisone acetate/aloe, 11
hydrocortisone acetate/lidocaine HCL, 18
hydrocortisone acetate/pramoxine, 18
hydrocortisone butyrate, 11
hydrocortisone butyrate (lipid), 11
hydrocortisone butyrate (lipophilic), 11
hydrocortisone IN absorbase, 11
hydrocortisone valerate, 11
hydrocortisone/acetic acid, 26
hydromorphone HCL, 27
Hydromorphone HCL, 27
Hydromorphone HCL Dosette, 27
hydromorphone HCL ER, 27
Hydromorphone HCL ER, 27
Hydroxocobalamin, 19
hydroxychloroquine sulfate, 3
hydroxyurea, 6
hydroxyzine HCL, 21
Hydroxyzine HCL, 21
hydroxyzine pamoate, 21
Hydroxyzine Pamoate, 21
Hylatopic, 13
Hylatopic Plus, 13
Hylira, 12
hyoscyamine sulfate, 17
hyoscyamine sulfate ER, 17
hyoscyamine sulfate odt, 17
hyoscyamine sulfate SR, 17
Hyper-sal, 29
Hypersal, 29
Hypertenevide-12.5, 7
Hypertenipine-2.5, 7
Hypertensolol, 8
Hyzaar, 8
I
ibandronate sodium, 15
Ibudone, 27
ibuprofen, 27
Ibuprofen Comfort PAC, 28
ibutilide fumarate, 7
IC 400, 28
IC 800, 28
Icar-c Plus, 19
Iclusig, 6
Idamycin PFS, 4
idarubicin HCL, 4
Ifex, 4
ifosfamide, 4
Ifosfamide, 4
Ifosfamide/Mesna, 6
Ilaris, 28
Ilevro, 26
Imdur, 6
imipenem/cilastatin, 4
imipramine HCL, 21
imipramine pamoate, 21
imiquimod, 12
Imitrex, 28
Imitrex Statdose Refill, 28
Imitrex Statdose System, 28
Imovax Rabies (h.d.c.v.), 31
Imuran, 5
Inatal Advance, 31
Inatal GT, 31
Inatal Ultra, 31
Incivek, 3
Increlex, 16
indapamide, 9
Inderal LA, 7
Inderal XL, 7
Indocin, 28
Indocin IV, 28
indomethacin, 27
Indomethacin, 28
indomethacin ER, 27
indomethacin sodium, 27
Infanrix, 30
Infasurf, 30
Infergen, 3
Influenza A (h1n1) Monovalent 2009, 31
Infumorph 200, 27
Infumorph 500, 27
Injectafer, 19
Innopran XL, 7
Inspra, 8
Insulin Syringe/0.5ML/30G X 5/16", 33
Integra F, 19
Integra Plus, 19
Integrilin, 20
Intelence, 3
Interarticular Joint Kit, 13
Intermezzo, 22
Introl, 9
Intron-a, 6
Intron-a W/Diluent, 6
Intuniv, 23
Invanz, 4
Invega, 22
Invega Sustenna, 22
Invirase, 3
Invokamet, 15
Invokana, 15
Iopidine, 26
Ipol Inactivated IPV, 31
ipratropium bromide, 29, 30
ipratropium bromide/albuterol sulfate, 30
Iprivask, 20
irbesartan, 8
irbesartan/hydrochlorothiazide, 8
irinotecan, 6
Irinotecan, 6
Iron, 19
Iron Asp Gly/ Polysacch Compl/Ascorb
CAL/B12/Fa/C Threon/Suc, 19
Irospan 24/6, 19
Is 24/6, 19
Isentress, 3
isoniazid, 2
Isoniazid, 2
Isoptin SR, 7
Isopto Atropine, 25
Isopto Carbachol, 25
Isopto Carpine, 25
Isopto Homatropine, 25
Isopto Hyoscine, 25
Isordil Titradose, 6
isosorbide dinitrate, 6
Isosorbide Dinitrate, 6
isosorbide dinitrate ER, 6
isosorbide mononitrate, 6
isosorbide mononitrate ER, 6
isotonic gentamicin, 2
Isotonic Gentamicin, 2
Isradipine, 7
Istalol, 25
Istodax, 6
Isuprel, 30
itraconazole, 2
Ixempra Kit, 5
Ixiaro, 31
J
J-cof DHC, 29
J-max DHC, 29
Jakafi, 5
Jalyn, 19
Janumet, 15
Janumet XR, 15
Januvia, 15
Jardiance, 15
Jevtana, 5
Jinteli, 13
Jublia, 11
Juvisync, 15
Juxtapid, 9
K
K-phos NO 2, 19
Kadcyla, 5
Kadian, 27
Kalbitor, 20
Kaletra, 3
Kalydeco, 30
Kapvay, 23
Kapvay Dose Pack, 23
Karbinal ER, 29
Kazano, 15
Keflex, 1
Kenalog, 12
Kenalog-10, 13
Kenalog-40, 13
Kepivance, 6
Keppra, 23
Keppra XR, 23
Kerafoam, 12
Kerafoam 42, 12
Keralac, 13
Kerlone, 7
Ketek, 4
ketoconazole, 2, 10
Ketodan Kit, 11
ketoprofen, 27
Ketoprofen ER, 28
ketorolac tromethamine, 26, 27
Ketorolac Tromethamine, 28
Khedezla, 21
Kineret, 28
Kinlytic, 20
Kinrix, 30
Klaron, 10
Klonopin, 23
Kombiglyze XR, 15
Korlym, 15
Kristalose, 17
Krystexxa, 28
Kuvan, 16
Kynamro, 9
Kyprolis, 6
L
labetalol HCL, 7
Lac-hydrin, 13
Lacrisert, 25
lactic acid, 12
lactic acid e, 12
lactic acid w/vitamin e, 12
lactulose, 17, 18
Lamictal, 23
Lamictal Chewable Dispersible, 23
Lamictal Odt, 23
Lamictal Starter/Not Taking
Carbamazepine, 23
Lamictal Starter/Taking
Carbamazepine/Not Taking Valproate,
23
Lamictal Starter/Taking Valproate, 23
Lamictal XR, 23
Lamisil, 2
Lamisil Spray, 11
lamivudine, 3
lamivudine/zidovudine, 3
lamotrigine, 23
lamotrigine ER, 23
Lanoxin, 6
Lanoxin Pediatric, 6
Lantus, 14
Lantus Solostar, 14
Lasix, 9
Lastacaft, 26
latanoprost, 25
Latrix XM, 12
Latuda, 22
Lazanda, 27
leflunomide, 27
Lescol, 9
Lescol XL, 9
Letairis, 9
letrozole, 5
leucovorin calcium, 6
Leucovorin Calcium, 6
Leukeran, 4
Leukine, 19
leuprolide acetate, 5
Levacet, 26
levalbuterol, 30
levalbuterol HCL, 30
Levaquin, 2
Levatol, 7
Levbid, 17
Levemir, 14
Levemir Flexpen, 14
Levemir Flextouch, 14
levetiracetam, 23
Levetiracetam, 23
levetiracetam ER, 23
Levitra, 10
levobunolol HCL, 25
Levobunolol HCL, 25
levocarnitine, 16
levocetirizine dihydrochloride, 29
levofloxacin, 2, 25
levofloxacin IN D5W, 2
levonorgestrel, 14
levonorgestrel and ethinyl estradiol, 14
levonorgestrel/ethinyl estradiol, 14
Levophed, 9
Levorphanol Tartrate, 27
levothyroxine sodium, 17
Levothyroxine Sodium, 17
Levsin, 17
Levsin/SL, 17
Lexapro, 21
Lexiva, 3
Lialda, 18
lidocaine, 12
lidocaine HCL, 7, 12, 20, 28
Lidocaine HCL, 7, 12
lidocaine HCL IN D5W, 7
lidocaine HCL jelly, 12
Lidocaine HCL-hydrocortisone Acetate
With Aloe, 18
lidocaine HCL/dextrose, 7
Lidocaine HCL/Dextrose, 29
lidocaine HCL/hydrocortisone acetate, 18
lidocaine viscous, 20
lidocaine/epinephrine, 28
lidocaine/prilocaine, 12
Lidocaine/Prilocaine, 12
Lidoderm, 13
Lidoprofen, 11
Lidovir, 11
Lincocin, 4
lindane, 12
Linzess, 18
liothyronine sodium, 17
Lipitor, 9
Lipofen, 9
Liquicet, 27
lisinopril, 7
lisinopril/hydrochlorothiazide, 8
lithium carbonate, 22
Lithium Carbonate, 22
lithium carbonate ER, 22
Lithium Citrate, 22
Lithobid, 22
Lithostat, 19
Livalo, 9
LMD 10% Dextrose 5%, 20
LMD 10% Sodium Chloride 0.9%, 20
LO Loestrin FE, 14
LO Minastrin FE, 14
Locoid, 12
Locoid Lipocream, 12
Lodosyn, 23
Loestrin 1.5/30-21, 14
Loestrin 1/20-21, 14
Loestrin 24 FE, 14
Loestrin FE 1.5/30, 14
Loestrin FE 1/20, 14
Lofibra, 9
Lomedia 24 FE, 14
Lomotil, 17
Lomustine, 4
loperamide HCL, 17
Lopid, 9
Lopressor, 7
Lopressor HCT, 8
Loprox, 11
Loprox Shampoo, 11
lorazepam, 21
Lorazepam Intensol, 21
Lorcet 10/650, 27
Lorcet Plus, 27
Lortab, 27
Lorzone, 24
losartan potassium, 8
losartan potassium/hydrochlorothiazide,
8
Loseasonique, 14
Lotemax, 25
Lotensin, 8
Lotensin HCT, 8
Lotrel, 8
Lotrisone, 11
Lotronex, 18
lovastatin, 9
Lovaza, 9
Lovenox, 20
loxapine, 22
loxapine succinate, 22
Loxitane, 22
Lta 360 Kit, 21
Lufyllin, 30
Lumigan, 25
Lumizyme, 16
Lunesta, 22
Lupaneta Pack, 16
Lupron Depot, 5
Lupron Depot-PED, 16
Luvox CR, 21
Luxiq, 12
Luzu, 11
Lycelle, 13
Lyrica, 23
Lysodren, 5
Lysteda, 20
Lytensopril Kit, 8
Lytensopril-90, 8
Lytensopril-90 Kit, 8
M
M-m-r II W/Diluent 10 Dose, 31
M-vit, 32
M.v.i. Adult, 31
M.v.i. Pediatric, 32
M.v.i.-12 Without Vitamin K, 32
Macnatal CN DHA, 31
Macrobid, 18
Macrodantin, 18
Magnacet, 27
Makena, 14
Malarone, 3
malathion, 12
mannitol, 9
Maprotiline HCL, 21
Marcaine, 28
Marcaine W/O Epi, 28
Marcaine/Epinephrine, 28
Marinol, 18
Marnatal-f, 32
Marplan, 21
Marqibo, 5
Matulane, 6
Mavik, 8
Maxair Autohaler, 30
Maxalt, 28
Maxalt-MLT, 28
Maxaron Forte, 19
Maxfe, 19
Maxidex, 25
Maxidone, 27
Maxifed CD, 29
Maxifed CDX, 29
Maxifed-G CD, 30
Maxifed-G CDX, 30
Maxiflu CD, 30
Maxiflu CDX, 30
Maxinate, 32
Maxiphen CD, 30
Maxiphen CDX, 30
Maxipime, 1
Maxitrol, 25
Maxzide, 9
Maxzide-25, 9
Mb Hydrogel, 12
meclizine HCL, 17
Meclofenamate Sodium, 28
Medical Provider EZ Flu Shot 2014-2015,
31
Medrol, 13
Medrol Dosepak, 13
medroxyprogesterone acetate, 14
mefenamic acid, 27
mefloquine HCL, 3
Mefoxin, 1
Megace ES, 14
Megace Oral, 5
megestrol acetate, 5
Mekinist, 5
meloxicam, 27
Meloxicam, 28
Meloxicam Comfort PAC, 28
melphalan hydrochloride, 4
Menactra, 31
Menest, 14
Menhibrix, 31
Menomune-a/C/Y/W-135, 31
Menopur, 16
Menostar, 14
Mentax, 10
Menveo, 31
meperidine HCL, 27
Meperidine HCL, 27
Mephyton, 31
Mepivacaine HCL, 28
meprobamate, 21
Mepron, 4
mercaptopurine, 4
meropenem, 4
Merrem, 4
mesalamine, 18
mesna, 6
Mesnex, 6
Mestinon, 24
Mestinon Timespan, 24
Metadate CD, 23
Metaproterenol Sulfate, 30
Metastron, 6
metaxalone, 24
metformin HCL, 15
metformin HCL ER, 15
methadone HCL, 27
Methadone HCL, 27
Methadose, 27
Methadose Sugar-free, 27
methamphetamine HCL, 22
methazolamide, 9
methenamine hippurate, 18
methenamine mandelate, 18
Methenamine Mandelate, 18
methimazole, 17
methocarbamol, 24
methotrexate, 4
methotrexate sodium, 4
methoxsalen, 11
methscopolamine bromide, 17
Methyclothiazide, 9
methyldopa, 8
Methyldopa/Hydrochlorothiazide, 8
Methyldopate HCL, 8
methylergonovine maleate, 26
Methylin, 23
methylphenidate HCL, 22
methylphenidate HCL CD, 22
methylphenidate HCL ER, 22
Methylphenidate HCL ER, 22
methylphenidate HCL SR, 22
methylphenidate hydrochloride, 22
methylprednisolone, 13
methylprednisolone acetate, 13
methylprednisolone dose pack, 13
methylprednisolone sodiumsuccinate, 13
Metipranolol, 25
metoclopramide HCL, 18
metolazone, 9
metoprolol succinate ER, 7
metoprolol tartrate, 7
metoprolol/hydrochlorothiazide, 8
Metozolv Odt, 18
Metro IV, 4
Metrocream, 10
Metrogel, 10
Metrogel-vaginal, 19
Metrolotion, 10
metronidazole, 4, 10
metronidazole IN NACL 0.79%, 4
metronidazole vaginal, 19
Mevacor, 9
mexiletine HCL, 7
Miacalcin, 15
Micardis, 8
Micardis HCT, 8
Microzide, 9
midodrine HCL, 9
Mifeprex, 16
Migergot, 28
Migral, 28
Migranal, 28
Millipred, 13
Millipred DP, 13
milrinone IN dextrose, 6
milrinone lactate, 6
Minastrin 24 FE, 14
Mineral Oil Heavy, 17
Minipress, 8
Minivelle, 14
Minocin, 2
Minocin Kit, 2
minocycline HCL, 2
minocycline HCL ER, 2
minoxidil, 8
Mirapex, 23
Mirapex ER, 23
Mircette, 14
mirtazapine, 21
mirtazapine odt, 21
misoprostol, 17
mitomycin, 4
Mitosol, 25
mitoxantrone HCL, 4
Mobic, 28
modafinil, 22
Moderiba, 3
Moderiba 1200 Dose Pack, 3
Moderiba 800 Dose Pack, 3
Modicon, 14
moexipril HCL, 7
moexipril/hydrochlorothiazide, 8
mometasone furoate, 11
Moms Choice RX, 32
Monodox, 2
Monoject Bone Marrow Biopsy Prepping
Tray, 29
Monoject Bone Marrow Biopsy Tray/Biop
Aspir Needle 11GX4", 29
Monoject Bone Marrow Biopsy Tray/Biop
Aspir Needle 8GX4", 29
Monoject Bone Marrow Biopsy
Tray/Sternal-iliac Needle 16G, 29
montelukast sodium, 30
Monurol, 18
Morgidox 1X100MG, 2
Morgidox 2X100MG, 2
morphine sulfate, 27
Morphine Sulfate, 27
Morphine Sulfate Add-vantage, 27
morphine sulfate ER, 27
Motofen, 17
Moviprep, 17
Moxatag, 1
Moxeza, 25
moxifloxacin HCL, 2
Mozobil, 19
MS Contin, 27
Mst 600, 26
Multaq, 7
Multigen, 19
Multigen Folic, 19
Multigen Plus, 19
mupirocin, 10
mupirocin calcium, 10
Muse, 10
Mustargen, 4
MV FE Asparto Gly/FE Fum/Succ Acid/Vit
C/Threonic Acd/B12/Fa, 19
MV FE Asparto Gly/Vit C/Vit B12/CA
Threonate/Succ Acd/Stomac, 19
Myalept, 16
Myambutol, 2
Mycamine, 2
Mycobutin, 2
mycophenolate mofetil, 5
mycophenolic acid DR, 5
Mydfrin, 25
Myfortic, 5
Mykidz Iron Fl, 32
Myleran, 4
Mynatal, 31
Mynatal Advance, 31
Mynatal Ultracaplet, 31
Myobloc, 24
Myoxin, 26
Myozyme, 16
Myrbetriq, 18
Mysoline, 23
N
nabumetone, 27
nadolol, 7
nadolol/bendroflumethiazide, 8
nafcillin sodium, 1
Nafcillin Sodium, 1
Nafrinse Daily/Acidulated, 20
Nafrinse Daily/Neutral, 20
Nafrinse Weekly, 20
Naftin, 11
Naglazyme, 16
nalbuphine HCL, 27
Nalfon, 28
Nallpen Iso-osmotic IN Dextrose, 1
Nallpen/Dextrose, 1
Namenda, 24
Namenda Titration PAK, 24
Namenda XR, 24
Namenda XR Titration Pack, 24
Naphazoline HCL, 25
Naprelan, 28
Naprosyn, 28
naproxen, 27
Naproxen Comfort PAC, 28
naproxen sodium, 28
naratriptan HCL, 28
Nardil, 21
Naropin, 29
Nasacort AQ, 29
Nascobal, 20
Nasonex, 29
Natachew, 32
Natacyn, 25
Natafort, 32
Natalvirt 90 DHA, 32
Natalvirt CA, 32
Natalvirt Flt, 20
Natalvit, 31
Natazia, 14
nateglinide, 15
Natelle One, 32
Natrecor, 10
Natroba, 13
Nature-throid, 17
Nature-throid Nt-2.5, 17
Navelbine, 5
Nebupent, 4
Nebusal, 30
Necon 1/50-28, 14
Necon 10/11-28, 14
Neevo DHA, 32
nefazodone HCL, 21
Nefazodone HCL, 21
Nembutal Sodium, 22
Neo-synalar, 10
Neo-synalar Kit, 10
Neo-synephrine, 9
neomycin sulfate, 2
neomycin/bacitracin/polymyxin, 25
neomycin/polymyxin/bacitracin zinc, 25
neomycin/polymyxin/bacitracin/hydrocorti
sone, 25
neomycin/polymyxin/dexamethasone, 25
neomycin/polymyxin/gramicidin, 25
neomycin/polymyxin/HC, 26
Neomycin/Polymyxin/Hydrocortisone, 25
neomycin/polymyxin/hydrocortisone, 26
Neoprofen, 28
Neoral, 5
Neosalus, 13
Neosalus CP, 13
Neosporin, 25
neostigmine methylsulfate, 24
Neotuss Plus, 30
Nephplex RX, 32
Nephro-vite RX, 32
Nephrocaps, 32
Nephrocaps QT, 32
Nephron Fa, 20
Neptazane, 9
Nesacaine, 29
Nesacaine-mpf, 29
Nesina, 15
Nestabs, 32
Nestabs Abc, 32
Nestabs DHA, 32
Neuac Kit, 10
Neulasta, 19
Neumega, 19
Neupogen, 19
Neupro, 23
Neurontin, 23
Neutrasal, 21
Neutrexin, 4
Nevanac, 26
nevirapine, 3
Nevirapine, 3
nevirapine ER, 3
Newgen, 32
Nexa Plus, 32
Nexa Select, 32
Nexavar, 5
Nexterone, 7
niacin ER, 9
niacinamide/azelaic ac/ turmer/fa/b6/zinc
ox/copper, 31
Niacor, 9
Niaspan, 9
Nicadan, 32
nicardipine HCL, 7
Nicazel, 32
Nicazel Forte, 32
Nicazeldoxy 30 Kit, 2
Nicazeldoxy 60 Kit, 2
Nicomide, 32
nifedipine, 7
nifedipine ER, 7
Nilandron, 5
Nimbex, 24
nimodipine, 7
Nipent, 6
Niravam, 21
nisoldipine, 7
Nisoldipine, 7
Nisoldipine ER, 7
Nitro-bid, 6
Nitro-dur, 6
nitrofurantoin, 18
nitrofurantoin macrocrystals, 18
nitrofurantoin monohydrate, 18
nitrofurantoin
monohydrate/macrocrystals, 18
nitroglycerin, 6
Nitroglycerin, 6
nitroglycerin IN 5% dextrose, 6
nitroglycerin IN dextrose 5%, 6
Nitroglycerin IN Dextrose 5%, 6
nitroglycerin lingual, 6
Nitroglycerin Lingual, 6
nitroglycerin transdermal, 6
Nitrolingual Pumpspray, 6
Nitromist, 6
Nitronal, 6
Nitropress, 8
Nitrostat, 6
Nivatopic Plus, 13
nizatidine, 17
Nizoral, 11
Nor-QD, 14
Norco, 27
Nordette-28, 14
Norditropin Cartridge, 16
Norditropin Flexpro, 16
Norditropin Nordiflex Pen, 16
norepinephrine bitartrate, 9
norethindrone, 14
norethindrone acetate, 14
norethindrone acetate/ethinyl estradiol,
14
norethindrone acetate/ethinyl
estradiol/ferrous fumarate, 14
Norflex, 24
norgestimate/ethinyl estradiol, 14
Norinyl 1+35, 14
Norinyl 1+50, 14
Noritate, 10
Noroxin, 2
Norpace, 7
Norpace CR, 7
Norpramin, 21
Northera, 9
nortriptyline HCL, 21
Nortriptyline HCL, 21
Norvasc, 7
Norvir, 3
Novaferrum, 20
Novolog, 14
Novolog Flexpen, 14
Novolog Mix 70/30, 14
Novolog Mix 70/30 Prefilled Flexpen, 14
Novolog Penfill, 14
Noxafil, 2
Nplate, 19
Nucort, 12
Nucynta, 27
Nucynta ER, 27
Nuedexta, 24
Nulojix, 5
Nulytely/Flavor Packs, 17
Numoisyn, 21
Nuox, 10
Nutricap, 32
Nutridox, 2
Nutrivit, 32
Nutropin, 16
Nutropin AQ Nuspin 10, 16
Nutropin AQ Pen, 16
Nuvail, 13
Nuvigil, 23
Nuzon, 12
Nymalize, 7
nystatin, 2, 10, 20
nystatin/triamcinolone, 10
O
O-CAL Fa, 32
O-CAL Prenatal, 32
OB Complete, 32
OB Complete 400, 32
OB Complete One, 32
OB Complete Petite, 32
OB Complete Premier, 32
OB Complete/DHA, 32
OB-natal One, 31
Obstetrix DHA, 32
Obstetrix EC, 32
octreotide acetate, 16
Ocudox, 2
Ocufen, 26
Ocuflox, 25
Ofirmev, 26
ofloxacin, 2, 25, 26
Ofloxacin, 2
Ogestrel, 14
olanzapine, 22
olanzapine odt, 22
olanzapine/fluoxetine, 24
Oleptro, 21
Olux, 12
Olux-e, 12
Olysio, 3
omega-3-acid ethyl esters, 9
Omnaris, 29
Omnipred, 25
Omnitrope, 16
Omontys, 20
Oncaspar, 4
ondansetron HCL, 17
ondansetron odt, 17
Onfi, 23
Onglyza, 15
Onmel, 2
Opana, 27
Opana ER (crush Resistant), 27
opium, 17
opium tincture, 17
Opium Tincture (paregoric), 17
Opsumit, 10
Optivar, 26
Oracea, 10
Oracit, 19
Orap, 24
Orapred, 13
Orapred Odt, 13
Oravig, 21
Oraxyl, 2
Orbivan, 26
Orbivan CF, 26
Orencia, 28
Orenitram, 10
Orfadin, 16
orphenadrine citrate, 24
orphenadrine citrate ER, 24
orphenadrine/asa/caffeine, 24
Ortho Micronor, 14
Ortho Tri-cyclen, 14
Ortho Tri-cyclen LO, 14
Ortho-cept, 14
Ortho-cyclen, 14
Ortho-novum 1/35, 14
Ortho-novum 7/7/7, 14
Oseni, 15
Osmoprep, 17
Osphena, 16
Otezla, 28
Otozin, 26
Ovace Plus, 11
Ovace Plus Wash, 11
Ovace Wash, 11
Ovcon-35, 14
Ovide, 13
Ovidrel, 16
oxacillin sodium, 1
oxaliplatin, 4
Oxandrin, 13
oxandrolone, 13
oxaprozin, 28
oxazepam, 21
oxcarbazepine, 23
Oxistat, 11
Oxsoralen, 12
Oxsoralen Ultra, 11
Oxtellar XR, 23
oxybutynin chloride, 18
oxybutynin chloride ER, 18
oxycodone HCL, 27
Oxycodone HCL, 27
oxycodone/acetaminophen, 27
oxycodone/aspirin, 27
oxycodone/ibuprofen, 27
Oxycontin, 27
oxymorphone hydrochloride, 27
oxymorphone hydrochloride ER, 27
oxytocin, 26
Oxytrol, 18
P
paclitaxel, 5
Paclitaxel, 5
Paire OB, 32
Palgic, 29
Pamelor, 21
pamidronate disodium, 15
Pamidronate Disodium, 15
Pamine, 17
Pamine Forte, 17
Pamine FQ, 17
Panatuss Dxp, 30
Pancreaze, 18
Pancrelipase, 18
pancuronium bromide, 24
Pandel, 12
papaverine HCL, 9
Parafon Forte DSC, 24
Parcopa, 23
paricalcitol, 16
Parlodel, 23
Parnate, 21
paromomycin sulfate, 2
paroxetine HCL, 21
paroxetine HCL ER, 21
Paser, 2
Pataday, 26
Patanase, 29
Patanol, 26
Paxil, 21
Paxil CR, 21
PCE, 1
Pediaderm AF Complete Kit, 11
Pediaderm HC, 12
Pediaderm Ta, 12
Pediapred, 13
Pediarix, 30
Pediatex TD, 29
Pediatex TDM, 30
Pedipirox-4 Nail, 11
Pedvax HIB, 31
peg 3350/electrolytes, 17
peg-3350/electrolytes, 17
peg-3350/NACL/NA bicarbonate/KCL, 17
Peg-intron, 3
Peg-intron Redipen, 3
Peg-intron Redipen PAK 4, 3
Peganone, 23
Pegasys, 3
Pegasys Proclick, 3
penicillin G potassium, 1
Penicillin G Potassium IN Iso-osmotic
Dextrose, 1
Penicillin G Procaine, 1
Penicillin G Sodium, 1
penicillin v potassium, 1
Penlac Nail Lacquer, 11
Pennsaid, 11
Pentacel, 30
Pentam 300, 4
Pentasa, 18
pentazocine/acetaminophen, 27
pentazocine/naloxone HCL, 27
Pentetate Calcium Trisodium, 33
Pentetate Zinc Trisodium, 33
pentoxifylline ER, 20
Pepcid, 17
Percocet, 27
Percodan, 27
Perforomist, 30
Peridex, 21
perindopril erbumine, 7
Perjeta, 5
permethrin, 12
perphenazine, 22
Perphenazine/Amitriptyline, 24
Persantine, 20
Pertzye, 18
Pexeva, 21
Pfizerpen-G, 1
phenazopyridine HCL, 19
phenelzine sulfate, 21
Phenergan, 29
Phenflu CD, 30
Phenflu CDX, 30
phenobarbital, 22
Phenobarbital, 22
Phenobarbital Sodium, 22
Phentolamine Mesylate, 8
phenylephrine HCL, 9, 25
Phenylephrine HCL, 9
phenylephrine/guaifenesin, 29
Phenytek, 23
phenytoin, 23
phenytoin sodium, 23
phenytoin sodium extended, 23
Phoslo, 18
Phoslyra, 18
Phospholine Iodide, 25
Photofrin, 6
Phrenilin Forte, 26
phytonadione, 31
pilocarpine HCL, 20, 25
pilocarpine hydrochloride, 20
Pilopine HS, 25
pindolol, 7
pioglitazone HCL, 15
pioglitazone HCL-glimepiride, 15
pioglitazone HCL/metformin HCL, 15
piperacillin sodium/ tazobactam sodium,
1
piperacillin sodium/tazobactam sodium, 1
piperacillin/tazobactam, 1
piroxicam, 28
Pitocin, 26
Pitressin Synthetic, 16
Plan B, 14
Plan B One-step, 14
Plaquenil, 3
Plavix, 20
Pletal, 20
Plexion, 10
Plexion Cleanser, 10
Plexion Cleansing Cloths, 10
Pliaglis, 13
Pneumovax 23, 31
Pneumovax 23/1 Dose, 31
Pneumovax 23/5 Dose, 31
podofilox, 12
Poly-tussin DHC, 30
Poly-VI-flor, 32
Poly-VI-flor/Iron, 32
polyethylene glycol 3350, 17
polymyxin b sulfate, 4
polymyxin b sulfate/trimethoprim sulfate,
25
Polytrim, 25
Pomalyst, 5
Ponstel, 28
Potassium Citrate, 19
Potassium Citrate ER, 19
potassium citrate-citric acid crystals, 19
Potiga, 23
Pr Cream, 12
Pr Natal 400, 31
Pr Natal 400 EC, 31
Pr Natal 430, 31
Pr Natal 430 EC, 31
Pradaxa, 20
pramipexole dihydrochloride, 23
Pramosone, 12
Pramotic, 26
Prandimet, 15
Prandin, 15
Pravachol, 9
pravastatin sodium, 9
Prazolamine, 24
prazosin HCL, 8
Pre-folic, 20
Precedex, 22
Precose, 15
Pred Forte, 25
Pred Mild, 25
Pred-G, 25
Pred-G S.o.p., 25
prednicarbate, 11
prednisolone, 13
prednisolone acetate, 25
prednisolone sodium phosphate, 13
Prednisolone Sodium Phosphate, 13, 25
prednisone, 13
Prednisone, 13
Prednisone Intensol, 13
Prefera OB, 32
Prefera OB + DHA, 32
Preferaob One, 32
Prefest, 14
Prefol-DHA, 32
Prelone, 13
Premarin, 14, 19
Premphase, 14
Prempro, 14
Prenata, 32
Prenatabs RX, 31
Prenatal Ad, 31
Prenatal-u, 32
Prenate, 32
Prenate AM, 32
Prenate DHA, 32
Prenate Elite, 32
Prenate Enhance, 32
Prenate Essential, 32
Prenate Mini, 32
Prenate Pixie, 32
Prenate Restore, 32
Prenate Star, 32
Prenexa, 32
Prepidil, 26
Prepopik, 17
Preque 10, 32
Presera, 13
Prevident, 21
Prevnar 13, 31
Prezista, 3
Priftin, 2
Primaquine Phosphate, 3
Primaxin IV, 4
Primaxin IV Add-vantage, 4
primidone, 23
Primlev, 27
Primsol, 4
Prinivil, 8
Pristiq, 21
Proair HFA, 30
probenecid, 28
probenecid/colchicine, 28
Procainamide HCL, 7
Procardia, 7
Procardia XL, 7
Procentra, 23
prochlorperazine, 22
prochlorperazine edisylate, 22
prochlorperazine maleate, 22
Procort, 18
Procrit, 19
Proctocort, 18
Proctofoam HC, 18
Procysbi, 19
Proferrin-forte, 20
progesterone, 14
Proglycem, 15
Prograf, 5
Prolastin-c, 30
Prolensa, 26
Proleukin, 6
Prolia, 15
Promacta, 19
promethazine HCL, 29
promethazine HCL plain, 29
promethazine-DM, 29
promethazine/codeine, 29
promethazine/dextromethorphan, 29
Prometrium, 14
Promiseb, 11
Promiseb Complete, 11
propafenone HCL, 7
propafenone HCL ER, 7
Propantheline Bromide, 17
proparacaine HCL, 26
propranolol HCL, 7
Propranolol HCL, 7
propranolol HCL ER, 7
Propranolol/Hydrochlorothiazide, 8
propylthiouracil, 17
Proquad, 31
Proscar, 19
Prosed/DS, 18
Prostigmin, 24
Prostin E2, 26
Protamine Sulfate, 20
Protect Plus, 32
Protectbone, 32
Protectiron, 20
Protectnatal, 32
Protopic, 12
protriptyline HCL, 21
Provenge, 6
Proventil HFA, 30
Provera, 14
Provida OB, 32
Provigil, 23
Prozac, 21
Prozac Weekly, 21
Pruclair, 12
Prudoxin, 11
Prumyx, 12
Pulmicort, 30
Pulmicort Flexhaler, 30
Pulmophylline, 30
Pulmozyme, 30
Purinethol, 5
Purixan, 5
Pylera, 17
pyrazinamide, 2
Pyridium, 19
pyridostigmine bromide, 24
Pyridoxine HCL, 31
Pyrogallic Acid, 13
Q
Qnasl, 29
Quadramet, 6
Qualaquin, 3
Quartette, 14
Quazepam, 22
Qudexy XR, 23
Quelicin, 24
Quelicin 1000, 24
Questran, 9
Questran Light, 9
quetiapine fumarate, 22
Quflora Pediatric, 32
Quillivant XR, 23
quinapril HCL, 7
quinapril/hydrochlorothiazide, 8
Quinidine Gluconate, 7
quinidine gluconate CR, 7
quinidine gluconate ER, 7
quinidine sulfate, 7
Quinidine Sulfate, 7
Quinidine Sulfate ER, 7
quinine sulfate, 3
Qutenza, 13
Qvar, 30
R
R-natal OB, 32
Rabavert, 31
Radigel, 13
raloxifene hydrochloride, 16
ramipril, 7
Ranexa, 6
ranitidine HCL, 17
Rapaflo, 19
Rapamune, 5
Rasuvo, 28
Ravicti, 16
Rayos, 13
Razadyne, 24
Razadyne ER, 24
Rebetol, 3
Rebif, 24
Rebif Rebidose, 24
Rebif Rebidose Titration Pack, 24
Rebif Titration Pack, 24
Reclast, 15
Recombivax HB, 31
Recothrom, 20
Recothrom Spray Kit, 20
Reglan, 18
Regonol, 24
Relagard, 19
Relenza Diskhaler, 3
Relhist, 29
Relion Insulin Syringe/U-100/0.5ML/29G
X 1/2", 33
Relistor, 18
Relpax, 28
Remeron, 21
Remeron Soltab, 21
Remicade, 18
Remodulin, 10
Renagel, 18
Renatabs, 32
Renatabs With Iron, 32
Renax, 32
Renvela, 18
Reopro, 20
repaglinide, 15
Reprexain, 27
Repronex, 16
Req 49+, 32
Requip, 23
Requip XL, 23
Rescon-JR, 30
Rescon-MX, 30
Rescriptor, 3
Rescula, 25
Reserpine, 8
Respa-BR, 29
Restasis, 26
Restora RX, 17
Restoril, 22
Retavase, 20
Retavase Half-kit, 20
Retin-a, 10
Retin-a Micro, 10
Retin-a Micro P.M., 10
Retrovir, 3
Retrovir IV Infusion, 3
Revatio, 10
Revlimid, 5
Reyataz, 3
Rezira, 30
Rezyst IM, 17
Rezyst SB, 17
Rheumatrex, 28
Rhinocort Aqua, 29
Rhinoflex-650, 26
Ribasphere, 3
Ribasphere Ribapak, 3
Ribatab, 3
ribavirin, 3
Ridaura, 28
rifabutin, 2
Rifadin, 2
Rifamate, 2
rifampin, 2
Rifater, 2
Rilutek, 24
riluzole, 24
rimantadine HCL, 3
Rimantalist, 3
Riomet, 15
risedronate sodium, 15
Risperdal, 22
Risperdal Consta, 22
Risperdal M-TAB, 22
risperidone, 22
risperidone odt, 22
Ritalin, 23
Ritalin LA, 23
Ritalin SR, 23
Rituxan, 5
rivastigmine tartrate, 24
rizatriptan benzoate, 28
rizatriptan benzoate odt, 28
Robaxin, 24
Robaxin-750, 24
Robinul, 17
Robinul Forte, 17
Rocaltrol, 16
Rocephin, 1
rocuronium bromide, 24
ropinirole ER, 23
ropinirole HCL, 23
ropivacaine HCL, 28
Rosadan Kit, 10
Rosanil, 10
Rotarix, 31
Rotateq, 31
Rowasa, 18
Roxicet, 27
Roxicodone, 27
Rozerem, 22
Ryanodex, 24
Rybix Odt, 27
Rythmol, 7
Rythmol SR, 7
S
Sabril, 23
Safyral, 14
Saizen, 16
Saizen Click.easy, 16
Salagen, 21
salicylic acid, 12
Salicylic Acid, 12
Salicylic Acid IN Ammonium Lactate
Vehicle, 12
Salkera, 13
salsalate, 26
Salvax Duo Plus, 13
Samsca, 16
Sanctura, 18
Sanctura XR, 18
Sancuso, 18
Sandimmune, 5
Sandostatin, 16
Sandostatin Lar Depot, 16
Saphris, 22
Sarafem, 24
Savella, 24
Savella Titration Pack, 24
Scalacort DK, 12
Scopolamine Hydrobromide, 17
Seasonique, 14
Seb-prev, 11
Seconal, 22
Sectral, 7
Select-OB, 32
Select-ob+dha, 32
selegiline HCL, 23
selenium sulfide, 11
Selenium Sulfide, 11
Selrx, 11
Selsun Shampoo, 11
Selzentry, 3
Semprex-d, 30
Senna Leaves, 17
Senophylline, 30
Sensipar, 16
Sensorcaine-mpf/Epinephrine, 29
Sentradine, 17
Sentraflox AM-10, 21
Sentralopram AM-10, 21
Sentramodafin AM-100, 23
Sentravil PM-25, 21
Sentrazolam AM 0.25, 21
Sentrazolpidem PM-5, 22
Sentroxatine, 21
Serevent Diskus, 30
Seromycin, 2
Seroquel, 22
Seroquel XR, 22
Serostim, 16
sertraline HCL, 21
Sevelamer Carbonate, 18
Sfrowasa, 18
Shohls Solution Modified, 19
Siderol, 32
Signifor, 16
sildenafil, 9
sildenafil citrate, 9
Silenor, 22
Simbrinza, 26
Simcor, 9
Simponi, 28
Simponi Aria, 28
Simulect, 5
simvastatin, 9
Sinemet, 23
Sinemet CR, 23
Singulair, 30
sirolimus, 5
Sirturo, 2
Sitavig, 3
Sivextro, 4
Skelaxin, 24
Sklice, 13
Sodium Bicarbonate, 17
sodium chloride, 29
Sodium Diuril, 9
Sodium Edecrin, 9
sodium ferric gluconate complex/sucrose,
19
sodium hyaluronate, 12
sodium phenylbutyrate, 16
sodium sulfacetamide, 10, 11, 25
sodium sulfacetamide wash, 11
sodium sulfacetamide/sulfur, 10
Sodium Sulfacetamide/Sulfur, 10
sodium sulfacetamide/sulfur cleanser, 10
Sodium Sulfacetamide/Sulfur Cleanser IN
Urea, 10
sodium sulfacetamide/sulfur cleansing
cloths, 10
sodium sulfacetamide/sulfur green, 10
Sodium Sulfacetamide/Sulfur IN Urea, 10
sodium sulfacetamide/sulfur wash, 10
Sodium Sulfacetamide/Urea, 11
Soliris, 20
Solodyn, 2
Soltamox, 5
Solu-cortef, 13
Solu-medrol, 13
Soma, 24
Somatuline Depot, 16
Somavert, 16
Sonata, 22
Soriatane, 11
Sorilux, 11
sotalol HCL, 7
sotalol HCL (AF), 7
Sotalol Hydrochloride, 7
Sovaldi, 3
Spectracef, 1
Spinosad, 13
Spiriva Handihaler, 30
spironolactone, 9
spironolactone/hydrochlorothiazide, 9
Sporanox, 2
Sporanox Pulsepak, 2
Sprix, 28
Sprycel, 5
Staflex, 26
Stalevo 100, 23
Stalevo 125, 23
Stalevo 150, 23
Stalevo 200, 23
Stalevo 50, 23
Stalevo 75, 23
stannous fluoride oral rinse, 20
Starlix, 15
stavudine, 3
Stavzor, 23
Staxyn, 10
Stelara, 11
Stendra, 10
Stimate, 16
Stivarga, 6
Strattera, 22
Strazepam, 22
Streptomycin Sulfate, 2
Striant, 13
Stribild, 3
Striverdi Respimat, 30
Stromectol, 3
Strovite, 31
Strovite Forte, 32
Strovite One, 32
Suboxone, 27
Subsys, 27
Suclear, 17
Sucraid, 18
sucralfate, 17
Sular, 7
sulfacetamide sodium, 10, 25
Sulfacetamide Sodium, 25
sulfacetamide sodium/prednisolone
sodium phosphate, 25
sulfacetamide sodium/sulfur cleanser, 10
Sulfadiazine, 2
sulfamethoxazole/trimethoprim, 4
Sulfamethoxazole/Trimethoprim, 4
sulfamethoxazole/trimethoprim DS, 4
sulfasalazine, 18
Sulfoam, 10
Sulfurated Lime, 13
sulindac, 28
Sumadan Kit, 10
Sumadan Wash, 10
Sumadan XLT, 10
Sumatriptan, 28
sumatriptan succinate, 28
Sumatriptan Succinate, 28
sumatriptan succinate refill, 28
Sumavel Dosepro, 28
Sumaxin, 10
Sumaxin CP Kit, 10
Sumaxin Ts, 10
Sumaxin Wash, 10
Supervite, 32
Supervite EC, 32
Support-500, 32
Supprelin LA, 16
Suprax, 1
Suprep Bowel Prep, 17
Surfaxin, 30
Surmontil, 21
Survanta Intratracheal, 30
Sustiva, 3
Sutent, 5
Suttar-2, 29
Suttar-SF, 29
Sylatron, 6
Symax Duotab, 17
Symbicort, 30
Symbyax, 24
Symlinpen 120, 14
Symlinpen 60, 14
Synagex, 32
Synalar, 12
Synalar Cream Kit, 12
Synalar Ointment Kit, 12
Synalar Ts, 12
Synalgos-dc, 27
Synarel, 16
Synatek, 32
Synera, 13
Synercid, 4
Synribo, 6
Synthroid, 17
T
Tabloid, 5
Taclonex, 12
tacrolimus, 5
Tafinlar, 6
Talwin, 27
Tambocor, 7
Tamiflu, 3
tamoxifen citrate, 5
tamsulosin HCL, 19
Tandem F, 20
Tandem Plus, 20
Tanzeum, 14
Tapazole, 17
Tarceva, 6
Targretin, 6
Tarka, 8
Taron-bc, 31
Taron-c DHA, 31
Taron-duo EC, 31
Taron-prex, 31
Tasigna, 6
Tasmar, 23
Taxotere, 5
Tazicef, 1
Tazorac, 11
Tecfidera, 24
Tecfidera Starter Pack, 24
Tegretol, 23
Tegretol-XR, 23
Tekamlo, 8
Tekturna, 8
Tekturna HCT, 8
telmisartan, 8
telmisartan/amlodipine, 8
telmisartan/hydrochloroth, 8
telmisartan/hydrochlorothiazide, 8
temazepam, 22
Temodar, 4
Temovate, 12
Temovate E, 12
temozolomide, 4
Tencon, 26
Tenex, 8
Teniposide, 5
Tenivac, 30
Tenoretic 100, 8
Tenoretic 50, 8
Tenormin, 7
Terazol 3, 19
Terazol 7, 19
terazosin HCL, 8
terbinafine HCL, 2
Terbinex, 3
terbutaline sulfate, 30
terconazole, 19
Tersi Foam, 11
Tessalon Perles, 30
Testim, 13
Testopel, 13
Testosterone, 13
testosterone cypionate, 13
testosterone enanthate, 13
Testosterone P.M., 13
Testred, 13
Tetanus Toxoid Adsorbed, 30
Tetanus/Diphtheria Toxoids-adsorbed
Adult, 30
tetracaine HCL, 26
Tetracaine HCL, 29
Tetracycline HCL, 2
Tetrix, 13
Tev-tropin, 16
Teveten, 8
Teveten HCT, 8
Texacort, 12
Thalomid, 5
Theo-24, 30
theophylline, 30
theophylline CR, 30
theophylline ER, 30
theophylline/D5W, 30
Theophylline/D5W, 30
Therabenzaprine-60, 24
Therabenzaprine-90, 24
Therabenzaprine-90-5, 24
Theracodeine-300, 27
Theracodophen-325, 27
Theracodophen-low-90, 27
Therafeldamine, 28
Therapentin-60, 23
Therapentin-90, 23
Theraprofen-60, 28
Theraprofen-800, 28
Theraprofen-90, 28
Theraproxen-500, 28
Theraproxen-60, 28
Theraproxen-90, 28
Theratramadol-60, 27
Theratramadol-90, 27
thiamine HCL, 31
Thiola, 19
thioridazine HCL, 22
thiothixene, 22
Thrombin-jmi Diluent, 20
Thrombin-jmi Epistaxis, 20
Thrombin-jmi Syringe Spray Kit, 20
Thrombin-jmi W/Dil Spray P.M. Actuator,
20
Thrombogen, 20
Thymoglobulin, 5
Thyrolar-1, 17
Thyrolar-1/2, 17
Thyrolar-1/4, 17
Thyrolar-2, 17
Thyrolar-3, 17
tiagabine hydrochloride, 23
Tiazac, 7
ticlopidine HCL, 20
Tigan, 18
Tikosyn, 7
Timentin, 1
Timolol Maleate, 7
timolol maleate, 25
timolol maleate ophthalmic gel forming,
25
Timoptic, 25
Timoptic Ocudose, 25
Timoptic-xe, 25
Tindamax, 4
tinidazole, 4
Tirosint, 17
Tisseel, 20
Tivicay, 3
Tizanidine Comfort PAC, 24
tizanidine HCL, 24
TL G-FOL OS, 32
TL Triseb, 11
TL-cermide, 12
Tnkase, 20
Tobi, 2
Tobi Podhaler, 2
Tobradex, 25
Tobradex ST, 25
tobramycin, 2
tobramycin sulfate, 2, 25
Tobramycin Sulfate/Sodium Chloride, 2
tobramycin/dexamethasone, 25
Tobrex, 25
Tofranil, 21
Tofranil-PM, 21
tolazamide, 15
Tolazamide, 15
Tolbutamide, 15
tolmetin sodium, 28
Tolmetin Sodium, 28
tolterodine tartrate, 18
tolterodine tartrate ER, 18
Topamax, 23
Topamax Sprinkle, 23
Topicort, 12
topiramate, 23
Topiramate ER, 23
topotecan HCL, 6
Topotecan HCL, 6
Toprol XL, 7
Torisel, 6
torsemide, 9
Torsemide, 9
Totect, 6
Toviaz, 18
Tracleer, 10
Tradjenta, 15
tramadol HCL, 27
tramadol HCL ER, 27
Tramadol HCL ER, 27
tramadol hydrochloride/acetaminophen,
27
Trandate, 7
trandolapril, 7
tranexamic acid, 20
Transderm-scop, 17
Tranxene T, 21
tranylcypromine sulfate, 21
Trasylol, 20
Travatan Z, 25
Travoprost, 25
Trazamine, 21
trazodone HCL, 21
Treanda, 4
Trecator, 2
Trelstar Depot, 5
Trelstar Depot Mixject, 5
Trelstar LA, 5
Trelstar LA Mixject, 5
Trelstar Mixject, 5
Trental, 20
Trepadiclofen-25, 28
Trepoxen-250, 28
Trepoxicam-7.5, 28
Tretin-x, 10
tretinoin, 6, 10
tretinoin microsphere, 10
tretinoin microsphere P.M., 10
Trexall, 4
Treximet, 28
Trezix, 27
Tri-norinyl 28, 14
Tri-VI-flor, 32
triamcinolone acetonide, 11, 20, 29
Triamcinolone Acetonide, 11
triamcinolone IN orabase, 20
triamterene/hydrochlorothiazide, 9
Triamterene/Hydrochlorothiazide, 9
Trianex, 11
triazolam, 22
Tribenzor, 8
Tricare, 31
Tricare Prenatal Compleat, 33
Tricare Prenatal DHA One, 33
Tricitrates, 19
Tricor, 9
trifluoperazine HCL, 22
trifluridine, 25
Triglide, 9
trihexyphenidyl HCL, 23
Trileptal, 23
Trilipix, 9
trimethobenzamide HCL, 17
trimethoprim, 4
trimethoprim sulfate/polymyxin b sulfate,
25
trimipramine maleate, 21
Trinate, 31
Triostat, 17
Trisenox, 6
Triveen-duo DHA, 32
Triveen-prx RNF, 32
Triveen-ten, 32
Triveen-u, 32
Trizivir, 3
Trokendi XR, 23
Tropazone, 13
trospium chloride, 18
trospium chloride ER, 18
Trusopt, 26
Truvada, 3
Tudorza Pressair, 30
Turkel Paracentesis Procedure
Tray/8french, 29
Tussicaps, 29
Tussionex Pennkinetic Extended
Release, 30
Twinrix, 31
Twynsta, 8
Tygacil, 4
Tykerb, 6
Tylenol/Codeine #3, 27
Tylenol/Codeine #4, 27
Typhim VI, 31
Tysabri, 24
Tyvaso, 10
Tyvaso Refill, 10
Tyvaso Starter, 10
Tyzeka, 3
Tyzine, 29
Tyzine Pediatric Nasal Drops, 29
U
U-cort, 11
Uceris, 13
Udamin, 33
Udamin SP, 33
Ulesfia, 13
Uloric, 28
Ultiva, 27
Ultracet, 27
Ultram, 27
Ultram ER, 27
Ultrasal-ER, 13
Ultravate, 12
Ultravate PAC, 12
Ultravate X, 12
Ultresa, 18
Umecta, 13
Umecta Nail Film, 13
Umecta PD, 13
Unasyn, 1
Unasyn Bulk Pack, 1
Uniretic, 8
Univasc, 8
Uramaxin, 13
Uramaxin GT, 13
Uramaxin GT Kit, 13
urea, 12
urea 40% nail film, 12
urea IN zinc undecylenate/lactic acid
vehicle, 12
urea topical, 12
Urecholine, 18
Urelle, 18
Uretron D/S, 18
Urex, 18
Uribel, 18
Urimar-t, 18
Urocit-k 10, 19
Urocit-k 15, 19
Urocit-k 5, 19
Urogesic-blue, 18
Uroqid #2, 18
Uroxatral, 19
Urso 250, 18
Urso Forte, 18
ursodiol, 18
Utopic, 13
Uvadex, 6
V
Vagifem, 19
valacyclovir HCL, 3
Valchlor, 4
Valcyte, 3
Valium, 21
valproate sodium, 23
valproic acid, 23
valsartan, 8
valsartan/hydrochlorothiazide, 8
Valtrex, 3
Vancocin HCL, 4
vancomycin HCL, 4
Vancomycin HCL, 4
Vancomycin HCL IN Dextrose, 4
Vanos, 12
Vantas, 5
Vaprisol, 16
Vaqta, 31
Varivax, 31
Vaseretic, 8
vasopressin, 16
Vasotec, 8
Vecamyl, 8
Vectibix, 5
Vectical, 11
vecuronium bromide, 24
Velcade, 6
Veletri, 9
Velphoro, 18
Veltin, 10
Vemavite-prx 2, 32
venlafaxine HCL, 21
venlafaxine HCL ER, 21
Venlafaxine HCL ER, 21
Venofer, 20
Ventavis, 10
Ventolin HFA, 30
Veramyst, 29
verapamil HCL, 7
Verapamil HCL, 7
verapamil HCL ER, 7
verapamil HCL SR, 7
Verdeso, 12
Veregen, 13
Verelan, 7
Verelan PM, 7
Veripred 20, 13
Versacloz, 22
Vesicare, 19
Vexa, 13
Vexol, 25
Vfend, 3
Vfend IV, 3
Viagra, 10
Vibativ, 4
Vibramycin, 2
Vicoprofen, 27
Victoza, 15
Victrelis, 3
Vidaza, 5
Videx EC, 3
Videx Pediatric, 3
Vigamox, 25
Viibryd, 21
Vimizim, 16
Vimovo, 28
Vimpat, 23
Vinacal, 32
Vinacal B, 33
Vinate AZ Extra, 32
Vinate C, 32
Vinate Calcium, 32
Vinate Care, 32
Vinate DHA, 33
Vinate DHA RF, 33
Vinate GT, 32
Vinate IC, 32
Vinate II, 32
Vinate M, 32
Vinate One, 32
Vinate Pn Care, 32
Vinblastine Sulfate, 5
vincristine sulfate, 5
vinorelbine tartrate, 5
Viokace, 18
Viracept, 3
Viramune, 3
Viramune XR, 3
Virasal, 13
Virazole, 3
Viread, 3
Viroptic, 25
Vistaril, 21
Vistide, 3
Vita-pren, 33
Vitafol, 33
Vitafol Ultra, 33
Vitafol-nano, 33
Vitafol-OB, 33
Vitafol-ob+dha, 33
Vitafol-one, 33
Vitafol-plus, 33
Vitafol-pn, 33
Vital-d RX, 33
Vitamedmd One RX/Quatrefolic, 33
Vitamedmd Plus RX/Quatre Folic, 33
Vitamedmd Redichew RX, 33
Vitamedmd Redichew RX/Quatrefolic, 33
vitamin c 222MG, 31
vitamin d, 31
vitamin k1, 31
Vitamin K1, 31
Vitapearl, 33
Vitaroca Plus, 32
Vituz, 30
Viva CT Prenatal, 33
Viva DHA, 33
Vivactil, 21
Vivelle-dot, 14
Vivotif Berna, 31
Vogelxo, 13
Vogelxo P.M., 13
Voltaren, 11
Voltaren-XR, 28
Voluven, 20
Vopac, 11
Vopac GB, 11
Vopac Kt, 11
Voraxaze, 6
voriconazole, 2
Vosol HC, 26
Vospire ER, 30
Votrient, 6
Vpriv, 20
Vsl#3 DS, 17
Vumon, 5
Vusion, 11
Vytorin, 9
Vyvanse, 22
W
warfarin sodium, 20
Welchol, 9
Wellbutrin, 21
Wellbutrin SR, 21
Wellbutrin XL, 21
Westcort, 12
Westhroid, 17
Westhroid-p, 17
Wheat Germ, 31
Witch Hazel, 13
Wp Thyroid, 17
X
Xalatan, 25
Xalkori, 6
Xanax, 21
Xanax XR, 21
Xarelto, 20
Xartemis XR, 27
Xclair, 13
Xeljanz, 28
Xeloda, 5
Xenazine, 24
Xeomin, 24
Xerac Ac, 13
Xerese, 11
Xgeva, 15
Xifaxan, 4
Xodol, 27
Xofigo, 6
Xolair, 30
Xolegel, 11
Xolegel Corepak, 11
Xolegel Duo/Head & Shoulders, 11
Xolegel Duo/Xolex, 11
Xolox, 27
Xopenex, 30
Xopenex Concentrate, 30
Xopenex HFA, 30
Xtandi, 5
Xylocaine, 7, 13, 29
Xylocaine-mpf, 29
Xylocaine-mpf/Epinephrine, 29
Xylocaine/Epinephrine, 29
Xyrem, 24
Xyzal, 29
Y
Yasmin 28, 14
Yaz, 14
Yervoy, 5
Yf-vax, 31
Yodoxin, 3
Z
zafirlukast, 30
zaleplon, 22
Zaltrap, 5
Zanaflex, 24
Zanosar, 4
Zantac, 17
Zarontin, 23
Zaroxolyn, 9
Zatean-CH, 32
Zatean-pn, 32
Zatean-pn DHA, 32
Zatean-pn Plus, 32
Zavesca, 20
Zebeta, 7
Zelapar, 24
Zelboraf, 6
Zemaira, 30
Zemplar, 16
Zemuron, 24
Zenpep, 18
Zerit, 3
Zestoretic, 8
Zestril, 8
Zetia, 9
Zetonna, 29
Zevalin Y-90, 5
Ziac, 8
Ziagen, 3
Ziana, 10
zidovudine, 3
Zinacef, 1
Zinacef IN Iso-osmotic Dextrose, 1
Zinacef IN Iso-osmotic Diluent, 1
Zinecard, 6
Zioptan, 25
ziprasidone HCL, 22
Zipsor, 28
Zirgan, 25
Zithranol, 11
Zithranol-rr, 11
Zithromax, 1
Zithromax Tri-PAK, 1
Zithromax Z-PAK, 1
Zmax, 1
Zocor, 9
Zofran, 18
Zofran Odt, 18
Zohydro ER, 27
Zoladex, 5
Zoledronic Acid, 15
zoledronic acid, 15
Zolinza, 6
zolmitriptan, 28
zolmitriptan odt, 28
Zoloft, 21
zolpidem tartrate, 22
zolpidem tartrate ER, 22
Zolpimist, 22
Zolvit, 27
Zometa, 15
Zomig, 28
Zomig Nasal Spray, 28
Zomig ZMT, 28
Zonalon, 11
Zonatuss, 30
Zonegran, 23
zonisamide, 23
Zontivity, 20
Zorbtive, 16
Zortress, 5
Zostavax, 31
Zosyn, 1
Zovia 1/50e, 14
Zovirax, 3, 11
Zuplenz, 18
Zutripro, 30
Zyclara, 12
Zyclara P.M., 12
Zydelig, 6
Zydone, 27
Zyflo, 30
Zyflo CR, 30
Zykadia, 6
Zylet, 25
Zyloprim, 28
Zymaxid, 25
Zyprexa, 22
Zyprexa Relprevv, 22
Zyprexa Zydis, 22
Zytiga, 5
Zyvox, 4
8
8-mop, 11

PDL—Medication Categories Guide

Transcription

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