2016 Prescription Drug List - Ambetter Texas · PAGE 6 LAST UPDATED 09/2016. PRODUCT DESCRIPTION BRAND/GE TIER LIMITS & RESTRICTIONS EMBEDA CAP ER 50-2 MG morphine-naltrexone BRAND

2016 Prescription Drug ListEffective September 1, 2016

Ambetter.SuperiorHealthPlan.com

Formulary IntroductionFORMULARY

The Ambetter from Superior HealthPlan Formulary, or Preferred Drug List, is a guide to available brand and generic drugs that are approved by the Food and Drug Administration (FDA) and covered through your prescription drug benefit. Generic drugs have the same active ingredients as their brand name counterparts and should be considered the first line of treatment. The FDA requires generics to be safe and work the same as brand name drugs. If there is no generic available, there may be more than one brand name drug to treat a condition. Preferred brand name drugs are listed on Tier 2 to help identify brand drugs that are clinically appropriate, safe, and cost-effective treatment options, if a generic medication on the formulary is not suitable for your condition.

Please note, the Formulary is not meant to be a complete list of the drugs covered under your prescription benefit. Not all dosage forms or strengths of a drug may be covered. This list is periodically reviewed and updated and may be subject to change. Drugs may be added or removed, or additional requirements may be added in order to approve continued usage of a specific drug.

Specific prescription benefit plan designs may not cover certain products or categories, regardless of their appearance in this document. Please check your benefits for coverage limitations and your share of cost for your drugs.

Drug List Key:

Brand name drugs are listed in CAPS and generic drugs are lower case.Drugs are covered under different copay tiers depending on your benefit:

Tier 0 - No copayment for those drugs that are used for prevention and are mandated by Affordable Care Act. Select oral contraceptives, vitamin D, folic acid for women of child bearing age, over-the-counter (OTC) aspirin, and smoking cessation products may be covered under this tier. Certain age or gender limits apply.

Tier 1 - Lowest copayment for those drugs that offer the greatest value compared to other drugs used to treat similarconditions. Select over-the-counter (OTC), generic or brand name drugs may be covered under this tier.

Tier 2 - Medium copayment covers brand name drugs that are generally more affordable, or may be preferred compared to other drugs to treat the same conditions.

Tier 3 - Highest copayment covers higher cost brand name drugs. This tier may also cover non-specialty drugs that are not on the Preferred Drug List but approval has been granted for coverage.

Tier 4 - Coverage for this tier is for “specialty” drugs used to treat complex, chronic conditions that may require specialhandling, storage or clinical management. For members who do not have a four Tier plan, these drugs may be covered under Tier 3.

Prior Authorization for Non-Formulary Drugs

To obtain prior authorization for a non-formulary drug, your provider must fill out the Prior Authorization form. US Script will respond via fax or phone within 48 hours of receipt of all necessary information, except during weekends and holidays. If the request is disapproved, the notice of disapproval will contain a clear explanation of the specific reasons for disapproving the prior authorization request, or if the request was incomplete, the explanation will identify the missing material information that is necessary to complete the request.

TIER DESCRIPTION

0 Preventative

1 Generic

2 Preferred Brand

3 Non-Preferred Brand

4 Specialty

TYPE DESCRIPTION

PA Prior Authorization Prior Authorization required before prescription can be filled.

ST Step TherapyRequires trial and failure of one or more preferred products

prior to coverage.

GL Gender Limit Drug is limited to specific gender.

AL Age Limit Drug is limited to specific age.

MDD Max Daily Dose A limit on the number of times the drug can be taken per day.

MPL Max Package Limit A limit on the amount of drug covered per prescription.

MFL Max Fill LimitThere is a limit on the number of times this drug can be

refilled.

MDS Max Days Supply There is a limit on the amount of this drug that is covered.

S Specialty Drug

Specialty drugs are high-cost drugs used to treat complex or

rare conditions, such as multiple sclerosis, rheumatoid

arthritis, hepatitis C, and hemophilia.

MDS2 Max Days Supply There is a limit on the amount of this drug that is covered.

PAGE 3 LAST UPDATED 09/2016

LIST OF COVERED PRESCRIPTION MEDICATIONSPRODUCT DESCRIPTION BRAND/GE TIER LIMITS & RESTRICTIONS

ANALGESICS

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

celecoxib cap 100 mg generic 1PA

MDD 2 per day


MDD 2 per day


MDD 1 per day


MDD 2 per day

choline & mag trisalicylate tab 1000 mg generic 1

diclofenac potassium tab 50 mg generic 1

diclofenac sodium er tab er 24h 100 mg generic 1

diclofenac sodium tab dr 25 mg generic 1



diclofenac-misoprostol tab dr 50-0.2 mg generic 1

diclofenac-misoprostol tab dr 75-0.2 mg generic 1

diflunisal tab 500 mg generic 1

etodolac cap 200 mg generic 1

etodolac cap 300 mg generic 1

etodolac tab 400 mg generic 1

etodolac tab 500 mg generic 1

fenoprofen calcium tab 600 mg generic 1 MDD 1 per day

FLECTOR PATCH 1.3 %diclofenac epolamine

BRAND 3PA

MDD 2 per day

flurbiprofen tab 100 mg generic 1


PRODUCT DESCRIPTION BRAND/GE TIER LIMITS & RESTRICTIONS

flurbiprofen tab 50 mg generic 1

ibu 800 mg generic 1

ibuprofen suspension 100 mg/5ml generic 1

ibuprofen tab 400 mg generic 1



indomethacin cap 25 mg generic 1

indomethacin cap 50 mg generic 1

indomethacin er cap er 75 mg generic 1

ketoprofen cap 50 mg generic 1

ketoprofen cap 75 mg generic 1

ketorolac tromethamine tab 10 mg generic 1 MDS 20 / 30 days

meclofenamate sodium cap 100 mg generic 1

meclofenamate sodium cap 50 mg generic 1

mefenamic acid cap 250 mg generic 1

meloxicam suspension 7.5 mg/5ml generic 1

meloxicam tab 15 mg generic 1 MDD 1 per day

meloxicam tab 7.5 mg generic 1 MDD 1 per day

MOBIC SUSPENSION 7.5 MG/5MLmeloxicam

BRAND 1

nabumetone tab 500 mg generic 1

nabumetone tab 750 mg generic 1

naproxen dr tab dr 500 mg generic 1

naproxen kit tab 500 mg generic 1

naproxen sodium tab 550 mg generic 1

naproxen suspension 125 mg/5ml generic 1

naproxen tab 250 mg generic 1





oxaprozin tab 600 mg generic 1

piroxicam cap 10 mg generic 1

piroxicam cap 20 mg generic 1

salsalate tab 500 mg generic 1

salsalate tab 750 mg generic 1

sulindac tab 150 mg generic 1

sulindac tab 200 mg generic 1

tolmetin sodium cap 400 mg generic 1

tolmetin sodium tab 200 mg generic 1

tolmetin sodium tab 600 mg generic 1

OPIOID ANALGESICS, LONG-ACTING

BUTRANS PATCH WK 10 MCG/HRbuprenorphine

BRAND 3PA

MDS 4 / 28 Days


BRAND 3PA

MDS 4 / 28 Days


BRAND 3PA

MDS 4 / 28 Days


BRAND 3PA

MDS 4 / 28 Days

BUTRANS PATCH WK 7.5 MCG/HRbuprenorphine

BRAND 3PA

MDS 4 / 28 Days

EMBEDA CAP ER 100-4 MGmorphine-naltrexone

BRAND 3PA

MDD 2 per day

EMBEDA CAP ER 20-0.8 MGmorphine-naltrexone

BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day



EMBEDA CAP ER 50-2 MGmorphine-naltrexone

BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day

EXALGO TB24 DETER 12 MGhydromorphone hcl

BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 1 per day


BRAND 2PA

MDD 2 per day

fentanyl patch 72hr 100 mcg/hr generic 1 MDS 10 / 30 days





hydromorphone hcl er tb24 deter 12 mg generic 1PA

MDD 2 per day


MDD 2 per day


MDD 1 per day


MDD 2 per day

levorphanol tartrate tab 2 mg generic 1



methadone hcl conc 10 mg/ml generic 1 MDS 300 / 30 days

methadone hcl intensol conc 10 mg/ml generic 1 MDS 300 / 30 days

methadone hcl solution 10 mg/5ml generic 1 MDS 1500 / 30 days

METHADONE HCL SOLUTION 10 MG/MLmethadone hcl

BRAND 1

methadone hcl solution 5 mg/5ml generic 1 MDS 3000 / 30 days

methadone hcl tab 10 mg generic 1 MDD 10 per day

methadone hcl tab 5 mg generic 1 MDD 4 per day

methadone hcl tab sol 40 mg generic 1 MDD 2 per day

METHADOSE CONC 10 MG/MLmethadone hcl

BRAND 1 MDS 300 / 30 days

METHADOSE SUGAR-FREE CONC 10MG/MLmethadone hcl


methadose tab 10 mg generic 1 MDD 10 per day

methadose tab sol 40 mg generic 1 MDD 2 per day

morphine sulfate er cap er 24h 100 mg generic 1PA

MDD 2 per day


MDD 2 per day


MDD 2 per day


MDD 2 per day


MDD 2 per day


MDD 2 per day

morphine sulfate er tab er 100 mg generic 1 MDD 2 per day







NUCYNTA ER TAB ER 12H 100 MGtapentadol hcl

BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day

oxycodone hcl er tb12 deter 10 mg generic 1PA

MDD 2 per day


MDD 2 per day


MDD 2 per day


MDD 2 per day

OXYCONTIN TB12 DETER 10 MGoxycodone hcl

BRAND 3PA

MDD 2 per day


BRAND 3 PA


BRAND 3PA

MDD 2 per day


BRAND 3 PA




BRAND 3PA

MDD 2 per day


BRAND 3 PA


BRAND 3PA

MDD 2 per day

oxymorphone hcl er tab er 12h 15 mg generic 3PA

MDD 2 per day


MDD 2 per day


MDD 2 per day

oxymorphone hcl er tab er 12h 7.5 mg generic 3PA

MDD 2 per day

tramadol hcl er (biphasic) tab er 24h 300mg

generic 1 MDD 1 per day

tramadol hcl er tab er 24h 100 mg generic 1 MDD 1 per day



ZOHYDRO ER CAP ER 12H 10 MGhydrocodone bitartrate

BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day




BRAND 3PA

MDD 2 per day

ZOHYDRO ER CP12 DETER 10 MGhydrocodone bitartrate

BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day

OPIOID ANALGESICS, SHORT-ACTING

acetaminophen-codeine #2 tab 300-15 mg generic 1 MDD 13 per day



acetaminophen-codeine solution 120-12mg/5ml

generic 1 MDS 2250 / 30 days

acetaminophen-codeine tab 300-15 mg generic 1 MDD 13 per day



ascomp-codeine cap 50-325-40-30 mg generic 1 MDD 6 per day

astramorph solution 0.5 mg/ml generic 1

astramorph solution 1 mg/ml generic 1

butalbital-apap-caff-cod cap 50-325-40-30mg




butalbital-asa-caff-codeine cap 50-325-40-30 mg


butorphanol tartrate solution 1 mg/ml generic 1

butorphanol tartrate solution 10 mg/ml generic 1PA

MPL 1 / 30 days

butorphanol tartrate solution 2 mg/ml generic 1

co-gesic tab 5-500 mg generic 1 MDD 8 per day

codeine sulfate 15 mg generic 1

codeine sulfate solution 30 mg/5ml generic 1

codeine sulfate tab 15 mg generic 1

duramorph solution 0.5 mg/ml generic 1

duramorph solution 1 mg/ml generic 1

endocet tab 10-325 mg generic 1 MDD 12 per day

endocet tab 5-325 mg generic 1 MDD 12 per day

endocet tab 7.5-325 mg generic 1 MDD 12 per day

endocet tab 7.5-500 mg generic 1 MDD 8 per day

fentanyl citrate loz handle 1200 mcg generic 1PA

MDD 4 per day


MDD 4 per day


MDD 4 per day


MDD 4 per day


MDD 4 per day


MDD 4 per day



hydrocodone-acetaminophen 7.5-500mg/15ml

generic 1

hydrocodone-acetaminophen solution 10-325 mg/15ml

generic 1

hydrocodone-acetaminophen solution 2.5-108 mg/5ml


hydrocodone-acetaminophen solution 5-217 mg/10ml





generic 1

hydrocodone-acetaminophen tab 10-300mg












hydrocodone-acetaminophen tab 2.5-325mg

generic 1



hydrocodone-acetaminophen tab 5-300 mg generic 1 MDD 13 per day















hydrocodone-ibuprofen tab 10-200 mg generic 1

hydrocodone-ibuprofen tab 2.5-200 mg generic 1

hydrocodone-ibuprofen tab 5-200 mg generic 1

hydrocodone-ibuprofen tab 7.5-200 mg generic 1 MDD 5 per day

hydromorphone hcl liquid 1 mg/ml generic 1

hydromorphone hcl pf solution 10 mg/ml generic 1

hydromorphone hcl pf solution 50 mg/5ml generic 1

hydromorphone hcl pf solution 500mg/50ml

generic 1

hydromorphone hcl tab 2 mg generic 1 MDD 8 per day



ibudone tab 5-200 mg generic 1

lorcet hd tab 10-325 mg generic 1 MDD 12 per day

lorcet plus tab 7.5-325 mg generic 1 MDD 12 per day

lorcet tab 5-325 mg generic 1 MDD 12 per day

lortab tab 10-325 mg generic 1 MDD 12 per day

lortab tab 5-325 mg generic 1 MDD 12 per day

lortab tab 7.5-325 mg generic 1 MDD 12 per day

meperidine hcl solution 100 mg/ml generic 1




meperidine hcl solution 50 mg/5ml generic 1 MDS 500 / claim


meperidine hcl tab 100 mg generic 1 MDD 6 per day

meperidine hcl tab 50 mg generic 1 MDD 6 per day

morphine sulfate (pf) solution 0.5 mg/ml generic 1

morphine sulfate (pf) solution 1 mg/ml generic 1

morphine sulfate solution 10 mg/5ml generic 1 MDS 3000 / 30 days

morphine sulfate solution 20 mg/5ml generic 1 MDS 1500 / 30 days

morphine sulfate tab 15 mg generic 1 MDD 6 per day

morphine sulfate tab 30 mg generic 1 MDD 6 per day

nalbuphine hcl solution 10 mg/ml generic 1 MDD 8 per day

nalbuphine hcl solution 20 mg/ml generic 1 MDD 8 per day

NUCYNTA TAB 100 MGtapentadol hcl

BRAND 2PA

MDD 6 per day


BRAND 2PA

MDD 6 per day


BRAND 2PA

MDD 6 per day

oxycodone hcl tab 10 mg generic 1 MDD 12 per day





oxycodone-acetaminophen tab 10-325 mg generic 1 MDD 12 per day

oxycodone-acetaminophen tab 5-325 mg generic 1 MDD 12 per day



oxycodone-acetaminophen tab 7.5-325 mg generic 1 MDD 12 per day

oxycodone-acetaminophen tab 7.5-500 mg generic 1 MDD 8 per day

oxycodone-ibuprofen tab 5-400 mg generic 1 MDD 1 per day

oxymorphone hcl tab 10 mg generic 1 MDD 12 per day

oxymorphone hcl tab 5 mg generic 1 MDD 12 per day

pentazocine-naloxone hcl tab 50-0.5 mg generic 1

reprexain tab 10-200 mg generic 1

roxicet tab 5-325 mg generic 1 MDD 12 per day

TALWIN SOLUTION 30 MG/MLpentazocine lactate

BRAND 3

tramadol hcl 50 mg generic 1 MDD 8 per day

tramadol hcl 50 mg generic 1 MDD 8 per day

tramadol hcl tab 50 mg generic 1 MDD 8 per day

tramadol-acetaminophen tab 37.5-325 mg generic 1 MDD 8 per day

verdrocet tab 2.5-325 mg generic 1

vicodin es tab 7.5-300 mg generic 1 MDD 13 per day

vicodin hp tab 10-300 mg generic 1 MDD 13 per day

vicodin hp tab 10-660 mg generic 1 MDD 6 per day

vicodin tab 5-300 mg generic 1 MDD 13 per day

xylon tab 10-200 mg generic 1

zamicet solution 10-325 mg/15ml generic 1

ZOLVIT SOLUTION 10-300 MG/15MLhydrocodone-acetaminophen

BRAND 2

ANESTHETICS

LOCAL ANESTHETICS

glydo gel 2 % generic 1

lidocaine hcl (pf) solution 0.5 % generic 1



lidocaine hcl (pf) solution 1 % generic 1



lidocaine hcl gel 2 % generic 1

lidocaine hcl solution 0.5 % generic 1

lidocaine hcl solution 1 % generic 1


lidocaine viscous solution 2 % generic 1 MDS 120 / 30 days

lidocaine-prilocaine cream 2.5-2.5 % generic 1

XYLOCAINE SOLUTION 1 %lidocaine hcl (local anesth.)

BRAND 3

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS

ALCOHOL DETERRENTS/ANTI-CRAVING

acamprosate calcium tab dr 333 mg generic 1

CAMPRAL TAB DR 333 MGacamprosate calcium

BRAND 2

depade tab 50 mg generic 1

disulfiram tab 250 mg generic 1

disulfiram tab 500 mg generic 1

naltrexone hcl tab 50 mg generic 1

OPIOID DEPENDENCE TREATMENTS

buprenorphine hcl sl tab 2 mg generic 1PA

MDD 3 per day

buprenorphine hcl sl tab 8 mg generic 1PA

MDD 3 per day

buprenorphine hcl solution 0.3 mg/ml generic 1

buprenorphine hcl-naloxone hcl sl tab 8-2mg

generic 3PA

MDD 3 per day



SUBOXONE FILM 12-3 MGbuprenorphine hcl-naloxone hcl dihydrate

BRAND 3PA

MDD 2 per day

SUBOXONE FILM 2-0.5 MGbuprenorphine hcl-naloxone hcl dihydrate

BRAND 3PA

MDD 3 per day


BRAND 3PA

MDD 3 per day


BRAND 3PA

MDD 2 per day

OPIOID REVERSAL AGENTS

naloxone hcl solution 0.4 mg/ml generic 1

naloxone hcl solution 1 mg/ml generic 1

SMOKING CESSATION AGENTS

buproban tab er 12h 150 mg generic 0 MDD 2 per day

bupropion hcl er (smoking det) tab er 12h150 mg


CHANTIX CONTINUING MONTH PAK TAB 1MGvarenicline tartrate

BRAND 0 MDD 2 per day

CHANTIX STARTING MONTH PAK TAB 0.5MG X 11 & 1 MG X 42varenicline tartrate

BRAND 0

CHANTIX TAB 0.5 MGvarenicline tartrate


CHANTIX TAB 1 MGvarenicline tartrate


NICOTROL INHALER 10 MGnicotine

BRAND 0 MPL 1 / claim

NICOTROL NS SOLUTION 10 MG/MLnicotine


ZYBAN TAB ER 12H 150 MGbupropion hcl (smoking deterrent)




ANTIBACTERIALS

AMINOGLYCOSIDES

amikacin sulfate solution 1 gm/4ml generic 1

amikacin sulfate solution 500 mg/2ml generic 1

garamycin ointment 0.3 % generic 1

gentak ointment 0.3 % generic 1

gentamicin in saline solution 0.8-0.9mg/ml-%

generic 1

GENTAMICIN IN SALINE SOLUTION 0.9-0.9MG/ML-%gentamicin in saline

BRAND 1

gentamicin in saline solution 1-0.9 mg/ml-%

generic 1


generic 1

GENTAMICIN IN SALINE SOLUTION 1.4-0.9MG/ML-%gentamicin in saline

BRAND 1


generic 1

gentamicin sulfate ointment 0.3 % generic 1

gentamicin sulfate solution 0.3 % generic 1

gentamicin sulfate solution 10 mg/ml generic 1

gentamicin sulfate solution 40 mg/ml generic 1

gentasol solution 0.3 % generic 1

kanamycin sulfate solution 333 mg/ml generic 3

neomycin sulfate tab 500 mg generic 1

paromomycin sulfate cap 250 mg generic 1

streptomycin sulfate recon soln 1 gm generic 3

TOBRADEX OINTMENT 0.3-0.1 %tobramycin-dexamethasone

BRAND 3



tobramycin solution 0.3 % generic 1

TOBRAMYCIN SULFATE IN SALINESOLUTION 0.8-0.9 MG/ML-%tobramycin sulfate in saline

BRAND 1

TOBRAMYCIN SULFATE IN SALINESOLUTION 1.2-0.9 MG/ML-%tobramycin sulfate in saline

BRAND 1

tobramycin sulfate solution 10 mg/ml generic 1

tobramycin sulfate solution 80 mg/2ml generic 1

tobrasol solution 0.3 % generic 1

ANTIBACTERIALS, OTHER

acetic acid solution 0.25 % generic 1

ALTABAX 1 %retapamulin

BRAND 2

ALTABAX OINTMENT 1 %retapamulin

BRAND 2

bacitracin ointment 500 unit/gm generic 3

bacitracin recon soln 50000 unit generic 3

chloramphenicol sod succinate recon soln 1gm

generic 4PA

S

clindamax gel 1 % generic 1 AL At least 12 yrs old

clindamycin hcl cap 150 mg generic 1



clindamycin palmitate hcl recon soln 75mg/5ml

generic 1

clindamycin phosphate cream 2 % generic 1

clindamycin phosphate foam 1 % generic 1 AL At least 12 yrs old

clindamycin phosphate gel 1 % generic 1 AL At least 12 yrs old



clindamycin phosphate lotion 1 % generic 1 AL At least 12 yrs old

clindamycin phosphate solution 1 % generic 1 AL At least 12 yrs old

clindamycin phosphate solution 150 mg/ml generic 1

clindamycin phosphate solution 300mg/2ml

generic 1


generic 1


generic 1


generic 1

clindamycin phosphate solution 9 gm/60ml generic 1


generic 1


generic 1


generic 1

CUBICIN RECON SOLN 500 MGdaptomycin

BRAND 3

LINCOCIN SOLUTION 300 MG/MLlincomycin hcl

BRAND 3

LINEZOLID IN SODIUM CHLORIDESOLUTION 600-0.9 MG/300ML-%linezolid in sodium chloride

BRAND 1

linezolid recon susp 100 mg/5ml generic 1

linezolid solution 600 mg/300ml generic 1

linezolid tab 600 mg generic 1PA

MDD 2 per day

mafenide acetate packet 5 % generic 3

methenamine hippurate tab 1 gm generic 1



metronidazole 250 mg generic 1

metronidazole 500 mg generic 1

metronidazole cream 0.75 % generic 1

metronidazole gel 0.75 % generic 1

metronidazole gel 0.75 % generic 1

metronidazole gel 1 % generic 1

metronidazole lotion 0.75 % generic 1

metronidazole tab 250 mg generic 1

metronidazole tab 500 mg generic 1

MONUROL PACKET 3 GMfosfomycin tromethamine

BRAND 3

mupirocin calcium cream 2 % generic 1

mupirocin ointment 2 % generic 1

nitrofurantoin macrocrystal cap 100 mg generic 1

nitrofurantoin macrocrystal cap 50 mg generic 1

nitrofurantoin monohyd macro cap 100 mg generic 1

nitrofurantoin suspension 25 mg/5ml generic 1

polymyxin b sulfate recon soln 500000 unit generic 1

rosadan cream 0.75 % generic 1

rosadan gel 0.75 % generic 1

SULFAMYLON CREAM 85 MG/GMmafenide acetate

BRAND 3

SULFAMYLON PACKET 5 %mafenide acetate

BRAND 3

trimethoprim tab 100 mg generic 1

TYGACIL RECON SOLN 50 MGtigecycline

BRAND 3

vancomycin hcl cap 125 mg generic 1 MDD 4 per day

vancomycin hcl cap 250 mg generic 1MDD 4 per dayMDS 40 / claim(s)



vancomycin hcl recon soln 10 gm generic 1

vancomycin hcl recon soln 1000 mg generic 1

vancomycin hcl recon soln 500 mg generic 1

vandazole gel 0.75 % generic 1

VIBATIV RECON SOLN 750 MGtelavancin hcl

BRAND 3

vitazol cream 0.75 % generic 1

XIFAXAN TAB 200 MGrifaximin

BRAND 3PA

AL At least 12 yrs old

XIFAXAN TAB 550 MGrifaximin

BRAND 3PA


ZYVOX SOLUTION 200 MG/100MLlinezolid

BRAND 2

BETA-LACTAM, CEPHALOSPORINS

CEDAX CAP 400 MGceftibuten

BRAND 3

CEDAX RECON SUSP 180 MG/5MLceftibuten

BRAND 3

CEDAX RECON SUSP 90 MG/5MLceftibuten

BRAND 3

cefaclor cap 250 mg generic 1

cefaclor cap 500 mg generic 1

cefaclor er tab er 12h 500 mg generic 1

cefaclor recon susp 125 mg/5ml generic 1



cefadroxil cap 500 mg generic 1

cefadroxil recon susp 250 mg/5ml generic 1

cefadroxil recon susp 500 mg/5ml generic 1



cefadroxil tab 1 gm generic 1

cefazolin sodium 500 mg generic 1

cefazolin sodium recon soln 1 gm generic 1



cefazolin sodium recon soln 500 mg generic 1

cefdinir cap 300 mg generic 1 AL At least 2 yrs old

cefdinir recon susp 125 mg/5ml generic 1 AL At least 2 yrs old

cefdinir recon susp 250 mg/5ml generic 1 AL At least 2 yrs old

cefditoren pivoxil tab 200 mg generic 3

CEFDITOREN PIVOXIL TAB 200 MGcefditoren pivoxil

BRAND 3

cefditoren pivoxil tab 400 mg generic 3

cefepime hcl recon soln 1 gm generic 1

cefepime hcl recon soln 2 gm generic 1

cefixime recon susp 100 mg/5ml generic 1

cefixime recon susp 200 mg/5ml generic 1

cefotaxime sodium recon soln 1 gm generic 1



cefotetan disodium recon soln 1 gm generic 3



cefoxitin sodium recon soln 1 gm generic 1







cefpodoxime proxetil recon susp 100mg/5ml

generic 1

cefpodoxime proxetil recon susp 50mg/5ml

generic 1

cefpodoxime proxetil tab 100 mg generic 1

cefpodoxime proxetil tab 200 mg generic 1

cefprozil recon susp 125 mg/5ml generic 1

cefprozil recon susp 250 mg/5ml generic 1

cefprozil tab 250 mg generic 1

cefprozil tab 500 mg generic 1

ceftazidime recon soln 1 gm generic 1



CEFTIBUTEN CAP 400 MGceftibuten

BRAND 1

CEFTIBUTEN RECON SUSP 180 MG/5MLceftibuten

BRAND 3

CEFTIN RECON SUSP 125 MG/5MLcefuroxime axetil

BRAND 2

ceftriaxone sodium recon soln 1 gm generic 1

ceftriaxone sodium recon soln 2 gm generic 1

ceftriaxone sodium recon soln 250 mg generic 1

ceftriaxone sodium recon soln 500 mg generic 1

cefuroxime axetil recon susp 125 mg/5ml generic 1

cefuroxime axetil tab 250 mg generic 1

cefuroxime axetil tab 500 mg generic 1

cefuroxime sodium recon soln 1.5 gm generic 1

cefuroxime sodium recon soln 7.5 gm generic 1



cefuroxime sodium recon soln 750 mg generic 1

cephalexin cap 250 mg generic 1



cephalexin recon susp 125 mg/5ml generic 1

cephalexin recon susp 250 mg/5ml generic 1

cephalexin tab 250 mg generic 1

cephalexin tab 500 mg generic 1

SPECTRACEF TAB 200 MGcefditoren pivoxil

BRAND 3

SPECTRACEF TAB 400 MGcefditoren pivoxil

BRAND 3

SUPRAX RECON SUSP 100 MG/5MLcefixime

BRAND 2

SUPRAX RECON SUSP 200 MG/5MLcefixime

BRAND 2

SUPRAX TAB 400 MGcefixime

BRAND 2

tazicef recon soln 1 gm generic 1



TEFLARO RECON SOLN 400 MGceftaroline fosamil

BRAND 3

TEFLARO RECON SOLN 600 MGceftaroline fosamil

BRAND 3

BETA-LACTAM, OTHER

AZACTAM IN DEXTROSE SOLUTION 1 GMaztreonam in dextrose

BRAND 3

AZACTAM IN DEXTROSE SOLUTION 2 GMaztreonam in dextrose

BRAND 3



aztreonam recon soln 1 gm generic 1

aztreonam recon soln 2 gm generic 1

imipenem-cilastatin recon soln 250 mg generic 1

imipenem-cilastatin recon soln 500 mg generic 1

INVANZ RECON SOLN 1 GMertapenem sodium

BRAND 3

meropenem recon soln 1 gm generic 1

meropenem recon soln 500 mg generic 1

BETA-LACTAM, PENICILLINS

amoxicillin cap 250 mg generic 1

amoxicillin cap 500 mg generic 1

amoxicillin chew tab 125 mg generic 1

amoxicillin chew tab 250 mg generic 1

amoxicillin recon susp 125 mg/5ml generic 1




amoxicillin tab 500 mg generic 1

amoxicillin tab 875 mg generic 1

amoxicillin-pot clavulanate chew tab 200-28.5 mg

generic 1

amoxicillin-pot clavulanate chew tab 400-57 mg

generic 1

amoxicillin-pot clavulanate er tab er 12h1000-62.5 mg

generic 1

amoxicillin-pot clavulanate recon susp 200-28.5 mg/5ml

generic 1


generic 1



amoxicillin-pot clavulanate recon susp 400-57 mg/5ml

generic 1


generic 1

amoxicillin-pot clavulanate tab 250-125 mg generic 1



ampicillin cap 250 mg generic 1

ampicillin cap 500 mg generic 1

AMPICILLIN RECON SUSP 125 MG/5MLampicillin

BRAND 1

AMPICILLIN RECON SUSP 250 MG/5MLampicillin

BRAND 1

ampicillin sodium recon soln 1 gm generic 1

ampicillin sodium recon soln 10 gm generic 1

ampicillin-sulbactam sodium recon soln 1.5(1-0.5) gm

generic 1

ampicillin-sulbactam sodium recon soln 15(10-5) gm

generic 1

ampicillin-sulbactam sodium recon soln 3(2-1) gm

generic 1

dicloxacillin sodium cap 250 mg generic 1

dicloxacillin sodium cap 500 mg generic 1

nafcillin sodium recon soln 1 gm generic 1

nafcillin sodium recon soln 10 gm generic 1

oxacillin sodium recon soln 1 gm generic 1

oxacillin sodium recon soln 10 gm generic 1

PENICILLIN G POT IN DEXTROSE SOLUTION40000 UNIT/MLpenicillin g pot in dextrose

BRAND 1



PENICILLIN G POT IN DEXTROSE SOLUTION60000 UNIT/MLpenicillin g pot in dextrose

BRAND 1

penicillin g potassium recon soln 5000000unit

generic 1

PENICILLIN G PROCAINE SUSPENSION600000 UNIT/MLpenicillin g procaine

BRAND 3

penicillin g sodium recon soln 5000000 unit generic 3

penicillin v potassium recon soln 125mg/5ml

generic 1

penicillin v potassium recon soln 250mg/5ml

generic 1

penicillin v potassium tab 250 mg generic 1

penicillin v potassium tab 500 mg generic 1

pfizerpen-g recon soln 5000000 unit generic 1

piperacillin sod-tazobactam so recon soln2-0.25 gm

generic 1

piperacillin sod-tazobactam so recon soln2.25 (2-0.25) gm

generic 1


generic 1


generic 1


generic 1


generic 1


generic 1

TIMENTIN RECON SOLN 3.1 GMticarcillin & pot clavulanate

BRAND 3



MACROLIDES

AZASITE SOLUTION 1 %azithromycin (ophth)

BRAND 3

azithromycin packet 1 gm generic 1

azithromycin recon soln 500 mg generic 1

azithromycin recon susp 100 mg/5ml generic 1

azithromycin recon susp 200 mg/5ml generic 1 MPL 1 / claim

azithromycin tab 250 mg generic 1

azithromycin tab 500 mg generic 1

azithromycin tab 600 mg generic 1 MDS 8 / 28 Days

clarithromycin er tab er 24h 500 mg generic 1

clarithromycin recon susp 125 mg/5ml generic 1

clarithromycin recon susp 250 mg/5ml generic 1

clarithromycin tab 250 mg generic 1

clarithromycin tab 500 mg generic 1

DIFICID TAB 200 MGfidaxomicin

BRAND 2

E.E.S. 400 TAB 400 MGerythromycin ethylsuccinate

BRAND 3

E.E.S. GRANULES RECON SUSP 200MG/5MLerythromycin ethylsuccinate

BRAND 3

ery pad 2 % generic 1 AL At least 12 yrs old

ERY-TAB TAB DR 250 MGerythromycin base

BRAND 3


BRAND 3


BRAND 3

ERYPED 200 RECON SUSP 200 MG/5MLerythromycin ethylsuccinate

BRAND 3



ERYPED 400 RECON SUSP 400 MG/5MLerythromycin ethylsuccinate

BRAND 3

erythromycin base cp dr part 250 mg generic 3

ERYTHROMYCIN BASE TAB 250 MGerythromycin base

BRAND 3

ERYTHROMYCIN BASE TAB 500 MGerythromycin base

BRAND 3

ERYTHROMYCIN ETHYLSUCCINATE TAB 400MGerythromycin ethylsuccinate

BRAND 3

erythromycin ointment 5 mg/gm generic 1

erythromycin pad 2 % generic 1 AL At least 12 yrs old

erythromycin solution 2 % generic 1 AL At least 12 yrs old

ilotycin ointment 5 mg/gm generic 1

KETEK TAB 300 MGtelithromycin


KETEK TAB 400 MGtelithromycin


romycin ointment 5 mg/gm generic 1

ZITHROMAX PACKET 1 GMazithromycin

BRAND 1

QUINOLONES

AVELOX ABC PACK TAB 400 MGmoxifloxacin hcl

BRAND 3

AVELOX SOLUTION 400 MG/250MLmoxifloxacin hcl in sodium chloride

BRAND 3

AVELOX TAB 400 MGmoxifloxacin hcl

BRAND 3

BESIVANCE SUSPENSION 0.6 %besifloxacin hcl

BRAND 3

CETRAXAL SOLUTION 0.2 %ciprofloxacin hcl (otic)

BRAND 1



CIPRO IN D5W SOLUTION 200 MG/100MLciprofloxacin in d5w

BRAND 3

ciprofloxacin hcl solution 0.2 % generic 1

ciprofloxacin hcl solution 0.3 % generic 1

ciprofloxacin hcl tab 100 mg generic 1




ciprofloxacin in d5w solution 200mg/100ml

generic 3

ciprofloxacin recon susp 250 mg/5ml (5%) generic 1

ciprofloxacin recon susp 500 mg/5ml (10%) generic 1

ciprofloxacin solution 400 mg/40ml generic 1

ciprofloxacin-ciproflox hcl er tab er 24h1000 mg

generic 1

ciprofloxacin-ciproflox hcl er tab er 24h 500mg

generic 1

FACTIVE TAB 320 MGgemifloxacin mesylate

BRAND 3

gatifloxacin solution 0.5 % generic 1

levofloxacin in d5w solution 500 mg/100ml generic 1

levofloxacin solution 0.5 % generic 1

levofloxacin solution 25 mg/ml generic 1

levofloxacin solution 25 mg/ml generic 1

levofloxacin tab 250 mg generic 1



moxifloxacin hcl tab 400 mg generic 1

NOROXIN TAB 400 MGnorfloxacin

BRAND 3



ofloxacin solution 0.3 % generic 1

ofloxacin solution 0.3 % generic 1

ofloxacin tab 200 mg generic 1



ZYMAXID SOLUTION 0.5 %gatifloxacin (ophth)

BRAND 3

SULFONAMIDES

silver sulfadiazine cream 1 % generic 1

ssd af cream 1 % generic 1

ssd cream 1 % generic 1

sulfacetamide sodium solution 10 % generic 1 MPL 1 / Claim

sulfadiazine tab 500 mg generic 1

sulfamethoxazole-tmp ds tab 800-160 mg generic 1

sulfamethoxazole-trimethoprim solution400-80 mg/5ml

generic 1

sulfamethoxazole-trimethoprim suspension200-40 mg/5ml

generic 1

sulfamethoxazole-trimethoprim suspension800-160 mg/20ml

generic 1

sulfamethoxazole-trimethoprim tab 400-80mg

generic 1

sulfamethoxazole-trimethoprim tab 800-160 mg

generic 1

sulfatrim pediatric suspension 200-40mg/5ml

generic 1

thermazene cream 1 % generic 1

TETRACYCLINES

avidoxy tab 100 mg generic 1 MDD 2 per day



demeclocycline hcl tab 150 mg generic 1

demeclocycline hcl tab 300 mg generic 1

doxy 100 recon soln 100 mg generic 1

doxycycline hyclate 100 mg generic 1 MDD 2 per day

doxycycline hyclate cap 100 mg generic 1 MDD 2 per day

doxycycline hyclate cap 50 mg generic 1 MDD 2 per day

doxycycline hyclate recon soln 100 mg generic 1

doxycycline hyclate tab 100 mg generic 1 MDD 2 per day

doxycycline hyclate tab 20 mg generic 1 MDD 2 per day

doxycycline monohydrate cap 100 mg generic 1 MDD 2 per day

doxycycline monohydrate cap 50 mg generic 1 MDD 2 per day

doxycycline monohydrate cap 75 mg generic 1

doxycycline monohydrate tab 100 mg generic 1 MDD 2 per day

minocycline hcl cap 100 mg generic 1 MDD 3 per day



minocycline hcl tab 100 mg generic 1 MDD 3 per day



mondoxyne nl cap 100 mg generic 1 MDD 2 per day

mondoxyne nl cap 50 mg generic 1 MDD 2 per day

mondoxyne nl cap 75 mg generic 1

morgidox cap 100 mg generic 1 MDD 2 per day

morgidox cap 50 mg generic 1 MDD 2 per day

tetracycline hcl cap 250 mg generic 1 MDD 8 per day

tetracycline hcl cap 500 mg generic 1 MDD 8 per day



ANTICONVULSANTS

ANTICONVULSANTS, OTHER

levetiracetam er tab er 24h 500 mg generic 1 MDD 4 per day

levetiracetam er tab er 24h 750 mg generic 1 MDD 4 per day

levetiracetam solution 100 mg/ml generic 1 MDS 900 / 30 days

levetiracetam solution 500 mg/5ml generic 1 MDS 900 / 30 days

levetiracetam tab 1000 mg generic 1 MDD 3 per day




POTIGA TAB 200 MGezogabine

BRAND 3PA

MDD 3 per day


BRAND 3PA

MDD 3 per day


BRAND 3PA

MDD 3 per day


BRAND 3PA

MDD 3 per day

roweepra tab 500 mg generic 1 MDD 4 per day

CALCIUM CHANNEL MODIFYING AGENTS

CELONTIN CAP 300 MGmethsuximide


ethosuximide cap 250 mg generic 1 MDD 6 per day

ethosuximide solution 250 mg/5ml generic 1 MDS 900 / 30 days

ZARONTIN CAP 250 MGethosuximide


zonisamide cap 100 mg generic 1 MDD 6 per day





GAMMA-AMINOBUTYRIC ACID (GABA) AUGMENTING AGENTS

DIASTAT ACUDIAL GEL 10 MGdiazepam (anticonvulsant)


DIASTAT ACUDIAL GEL 20 MGdiazepam (anticonvulsant)


DIASTAT PEDIATRIC GEL 2.5 MGdiazepam (anticonvulsant)


diazepam gel 10 mg generic 3 MPL 1 / claim

diazepam gel 2.5 mg generic 3 MPL 1 / claim

diazepam gel 20 mg generic 3 MPL 1 / claim

divalproex sodium er tab er 24h 250 mg generic 1

divalproex sodium er tab er 24h 500 mg generic 1

divalproex sodium tab dr 125 mg generic 1



gabapentin cap 100 mg generic 1



gabapentin solution 250 mg/5ml generic 1 MDS 1800 / 30 days

gabapentin solution 300 mg/6ml generic 1 MDS 1800 / 30 days

gabapentin tab 600 mg generic 1

gabapentin tab 800 mg generic 1

ONFI SUSPENSION 2.5 MG/MLclobazam

BRAND 3PA

MDS 480 / 30 days

ONFI TAB 10 MGclobazam

BRAND 3PA

MDD 2 per day




BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day

phenobarbital elixir 20 mg/5ml generic 1

phenobarbital solution 20 mg/5ml generic 1

phenobarbital tab 100 mg generic 1

phenobarbital tab 16.2 mg generic 1

phenobarbital tab 30 mg generic 1




primidone tab 250 mg generic 1

primidone tab 50 mg generic 1

SABRIL PACKET 500 MGvigabatrin

BRAND 4

PA

MDD 6 per dayS

SABRIL TAB 500 MGvigabatrin

BRAND 4

PA

MDD 6 per dayS

tiagabine hcl tab 2 mg generic 1

tiagabine hcl tab 4 mg generic 1

valproate sodium solution 100 mg/ml generic 1

valproate sodium solution 500 mg/5ml generic 1

valproate sodium syrup 250 mg/5ml generic 1

valproic acid cap 250 mg generic 1

valproic acid solution 250 mg/5ml generic 1

valproic acid syrup 250 mg/5ml generic 1



GLUTAMATE REDUCING AGENTS

felbamate suspension 600 mg/5ml generic 1 MDS 900 / 30 days

felbamate tab 400 mg generic 1 MDD 9 per day

felbamate tab 600 mg generic 1 MDD 6 per day

lamotrigine chew tab 25 mg generic 1

lamotrigine chew tab 5 mg generic 1

lamotrigine tab 100 mg generic 1




topiragen tab 100 mg generic 1 MDD 2 per day




topiramate cap sprink 15 mg generic 1 MDD 6 per day

topiramate cap sprink 25 mg generic 1 MDD 8 per day

topiramate tab 100 mg generic 1 MDD 2 per day




SODIUM CHANNEL AGENTS

BANZEL SUSPENSION 40 MG/MLrufinamide

BRAND 2PA

MDS 2400 / 30 days

BANZEL TAB 200 MGrufinamide

BRAND 2PA

MDD 2 per day

BANZEL TAB 400 MGrufinamide

BRAND 2PA

MDD 8 per day



carbamazepine chew tab 100 mg generic 1

carbamazepine er cap er 12h 100 mg generic 1 ST

carbamazepine er cap er 12h 200 mg generic 1ST

MDD 6 per day

carbamazepine er cap er 12h 300 mg generic 1ST

MDD 4 per day

carbamazepine er tab er 12h 200 mg generic 1ST

MDD 6 per day

carbamazepine er tab er 12h 400 mg generic 1ST

MDD 4 per day

carbamazepine suspension 100 mg/5ml generic 1

carbamazepine tab 200 mg generic 1

DILANTIN CAP 100 MGphenytoin sodium extended

BRAND 2

DILANTIN CAP 30 MGphenytoin sodium extended

BRAND 2

DILANTIN INFATABS CHEW TAB 50 MGphenytoin

BRAND 2

DILANTIN SUSPENSION 125 MG/5MLphenytoin

BRAND 2

epitol tab 200 mg generic 1

fosphenytoin sodium solution 100 mgpe/2ml

generic 1

fosphenytoin sodium solution 500 mgpe/10ml

generic 1

oxcarbazepine suspension 300 mg/5ml generic 1 MDS 1200 / 30 days

oxcarbazepine tab 150 mg generic 1 MDD 3 per day





PEGANONE TAB 250 MGethotoin

BRAND 3

PHENYTEK CAP 200 MGphenytoin sodium extended

BRAND 2

PHENYTEK CAP 300 MGphenytoin sodium extended

BRAND 3

phenytoin chew tab 50 mg generic 1

phenytoin infatabs chew tab 50 mg generic 1

phenytoin sodium extended cap 100 mg generic 1



phenytoin sodium solution 50 mg/ml generic 1

phenytoin suspension 125 mg/5ml generic 1

TEGRETOL CHEW TAB 100 MGcarbamazepine

BRAND 2

TEGRETOL SUSPENSION 100 MG/5MLcarbamazepine

BRAND 2

TEGRETOL TAB 200 MGcarbamazepine

BRAND 2

VIMPAT SOLUTION 10 MG/MLlacosamide

BRAND 3PA

MDS 1200 / 30 days

VIMPAT SOLUTION 200 MG/20MLlacosamide


VIMPAT TAB 100 MGlacosamide

BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 2 per day



ANTIDEMENTIA AGENTS

ANTIDEMENTIA AGENTS, OTHER

ergoloid mesylates 1 mg generic 3

ergoloid mesylates tab 1 mg generic 3

CHOLINESTERASE INHIBITORS

donepezil hcl tab 10 mg generic 1 MDD 2 per day

donepezil hcl tab 5 mg generic 1 MDD 1 per day

donepezil hcl tab disp 10 mg generic 1 MDD 2 per day

donepezil hcl tab disp 5 mg generic 1 MDD 1 per day

galantamine hydrobromide er cap er 24h16 mg


galantamine hydrobromide er cap er 24h24 mg


galantamine hydrobromide er cap er 24h 8mg


galantamine hydrobromide solution 4mg/ml


galantamine hydrobromide tab 12 mg generic 1 MDD 2 per day



rivastigmine tartrate cap 1.5 mg generic 1

rivastigmine tartrate cap 3 mg generic 1

rivastigmine tartrate cap 4.5 mg generic 1

rivastigmine tartrate cap 6 mg generic 1

N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONIST

memantine hcl solution 2 mg/ml generic 1

memantine hcl tab 10 mg generic 1 MDD 2 per day



memantine hcl tab 5 (28)-10 (21) mg generic 1

memantine hcl tab 5 mg generic 1 MDD 1 per day

NAMENDA SOLUTION 10 MG/5MLmemantine hcl

BRAND 2

NAMENDA TITRATION PAK TAB 5 (28)-10(21) MGmemantine hcl

BRAND 2

ANTIDEPRESSANTS

ANTIDEPRESSANTS, OTHER

budeprion sr tab er 12h 100 mg generic 1 MDD 2 per day

budeprion sr tab er 12h 150 mg generic 1 MDD 2 per day

budeprion xl tab er 24h 150 mg generic 1 MDD 1 per day

budeprion xl tab er 24h 300 mg generic 1 MDD 1 per day

bupropion hcl er (sr) tab er 12h 100 mg generic 1 MDD 2 per day



bupropion hcl er (xl) tab er 24h 150 mg generic 1 MDD 1 per day

bupropion hcl er (xl) tab er 24h 300 mg generic 1 MDD 1 per day

bupropion hcl tab 100 mg generic 1 MDD 3 per day

bupropion hcl tab 75 mg generic 1 MDD 3 per day

mirtazapine tab 15 mg generic 1 MDD 1 per day



mirtazapine tab 7.5 mg generic 1 MDD 1 per day

mirtazapine tab disp 15 mg generic 1 MDD 1 per day





perphenazine-amitriptyline tab 2-10 mg generic 1 MDD 4 per day





WELLBUTRIN SR TAB ER 12H 100 MGbupropion hcl


WELLBUTRIN SR TAB ER 12H 150 MGbupropion hcl


WELLBUTRIN TAB 75 MGbupropion hcl


MONOAMINE OXIDASE INHIBITORS

EMSAM 9 MG/24HRselegiline


EMSAM PATCH 24HR 12 MG/24HRselegiline






MARPLAN TAB 10 MGisocarboxazid


phenelzine sulfate tab 15 mg generic 1

tranylcypromine sulfate tab 10 mg generic 1

SSRIS/SNRIS (SELECTIVE SEROTONIN REUPTAKE INHIBITORS/SEROTONIN ANDNOREPINEPHRINE REUPTAKE INHIBITOR

BRINTELLIX TAB 10 MGvortioxetine hbr

BRAND 3PA

MDD 1 per day


BRAND 3PA

MDD 1 per day




BRAND 3PA

MDD 1 per day

citalopram hydrobromide solution 10mg/5ml


citalopram hydrobromide tab 10 mg generic 1 MDD 1.5 per day

citalopram hydrobromide tab 20 mg generic 1 MDD 1.5 per day

citalopram hydrobromide tab 40 mg generic 1 MDD 1 per day

escitalopram oxalate solution 5 mg/5ml generic 1 MDS 600 / 30 days

escitalopram oxalate tab 10 mg generic 1 MDD 1.5 per day

escitalopram oxalate tab 20 mg generic 1 MDD 1 per day

escitalopram oxalate tab 5 mg generic 1 MDD 1.5 per day

fluoxetine hcl (pmdd) cap 10 mg generic 1 MDD 1 per day

fluoxetine hcl (pmdd) cap 20 mg generic 1 MDD 3 per day

fluoxetine hcl cap 10 mg generic 1 MDD 1 per day



fluoxetine hcl solution 20 mg/5ml generic 1 MDS 600 / 30 days

fluoxetine hcl tab 10 mg generic 1 MDD 1 per day



fluvoxamine maleate tab 100 mg generic 1 MDD 3 per day



maprotiline hcl tab 25 mg generic 3





nefazodone hcl tab 100 mg generic 3





OLEPTRO TAB ER 24H 150 MGtrazodone hcl

BRAND 3ST

MDD 1 per day

OLEPTRO TAB ER 24H 300 MGtrazodone hcl

BRAND 3ST

MDD 1 per day

paroxetine hcl er tab er 24h 12.5 mg generic 1PA

MDD 1 per day

paroxetine hcl er tab er 24h 25 mg generic 1PA

MDD 2 per day

paroxetine hcl er tab er 24h 37.5 mg generic 1PA

MDD 2 per day

paroxetine hcl suspension 10 mg/5ml generic 3PA

MDS 900 / 30 days

paroxetine hcl tab 10 mg generic 1 MDD 1 per day




PAXIL SUSPENSION 10 MG/5MLparoxetine hcl

BRAND 3PA

MDS 900 / 30 days

PRISTIQ TAB ER 24H 100 MGdesvenlafaxine succinate

BRAND 2ST

MDD 4 per day


BRAND 2ST

MDD 1 per day


BRAND 2ST

MDD 1 per day



selfemra cap 10 mg generic 1 MDD 1 per day

selfemra cap 20 mg generic 1 MDD 3 per day

sertraline hcl conc 20 mg/ml generic 1 MDS 300 / 30 days

sertraline hcl tab 100 mg generic 1 MDD 2 per day

sertraline hcl tab 25 mg generic 1 MDD 1.5 per day

sertraline hcl tab 50 mg generic 1 MDD 1.5 per day

trazodone hcl tab 100 mg generic 1




venlafaxine hcl er cap er 24h 150 mg generic 1 MDD 2 per day

venlafaxine hcl er cap er 24h 37.5 mg generic 1 MDD 1 per day

venlafaxine hcl er cap er 24h 75 mg generic 1 MDD 1 per day

venlafaxine hcl er tab er 24h 150 mg generic 1 MDD 2 per day

VENLAFAXINE HCL ER TAB ER 24H 150 MGvenlafaxine hcl




venlafaxine hcl er tab er 24h 37.5 mg generic 1 MDD 1 per day

VENLAFAXINE HCL ER TAB ER 24H 37.5 MGvenlafaxine hcl


venlafaxine hcl er tab er 24h 75 mg generic 1 MDD 1 per day



venlafaxine hcl tab 100 mg generic 1 MDD 3 per day


venlafaxine hcl tab 37.5 mg generic 1 MDD 3 per day





VIIBRYD KIT 10 & 20 & 40 MGvilazodone hcl


VIIBRYD TAB 10 MGvilazodone hcl






TRICYCLICS

amitriptyline hcl tab 10 mg generic 1






amoxapine tab 100 mg generic 3




clomipramine hcl cap 25 mg generic 1



desipramine hcl tab 10 mg generic 1








doxepin hcl cap 10 mg generic 1






doxepin hcl conc 10 mg/ml generic 1

imipramine hcl tab 10 mg generic 1



imipramine pamoate cap 100 mg generic 1




nortriptyline hcl cap 10 mg generic 1




protriptyline hcl tab 10 mg generic 1

protriptyline hcl tab 5 mg generic 1

trimipramine maleate cap 100 mg generic 1



ANTIEMETICS

ANTIEMETICS, OTHER

compazine suppos 25 mg generic 1



compro suppos 25 mg generic 1

meclizine hcl tab 12.5 mg generic 1

meclizine hcl tab 25 mg generic 1

metoclopramide hcl solution 10 mg/10ml generic 1 MDD 60 per day

metoclopramide hcl solution 5 mg/5ml generic 1 MDD 60 per day

metoclopramide hcl solution 5 mg/ml generic 1

metoclopramide hcl tab 10 mg generic 1 MDD 6 per day

metoclopramide hcl tab 5 mg generic 1 MDD 6 per day

perphenazine tab 16 mg generic 1




prochlorperazine maleate tab 10 mg generic 1

prochlorperazine maleate tab 5 mg generic 1

prochlorperazine suppos 25 mg generic 1

TRANSDERM-SCOP PATCH 72HR 1MG/3DAYSscopolamine

BRAND 2

trimethobenzamide hcl cap 300 mg generic 1

EMETOGENIC THERAPY ADJUNCTS

ALOXI SOLUTION 0.25 MG/5MLpalonosetron hcl

BRAND 3

ANZEMET SOLUTION 20 MG/MLdolasetron mesylate

BRAND 3

ANZEMET TAB 100 MGdolasetron mesylate

BRAND 3PA

MDS 5 / 30 days

ANZEMET TAB 50 MGdolasetron mesylate

BRAND 3PA

MDS 5 / 30 days



CESAMET CAP 1 MGnabilone

BRAND 3

dronabinol cap 10 mg generic 1

dronabinol cap 2.5 mg generic 1

dronabinol cap 5 mg generic 1

EMEND CAP 125 MGaprepitant

BRAND 2PA

MDS 2 / 30 days


BRAND 2PA

MDS 2 / 30 days


BRAND 2PA

MDS 4 / 30 days

granisetron hcl solution 0.1 mg/ml generic 1

granisetron hcl solution 1 mg/ml generic 1

granisetron hcl tab 1 mg generic 1 MDS 10 / 30 days

ondansetron hcl solution 4 mg/2ml generic 1

ondansetron hcl solution 4 mg/5ml generic 1 MDS 100 / 30 days

ondansetron hcl tab 24 mg generic 1 MDS 4 / 28 days



ondansetron tab disp 4 mg generic 1 MDS 30 / 30 days

ondansetron tab disp 8 mg generic 1 MDS 30 / 30 days

ANTIFUNGALS

ABELCET SUSPENSION 5 MG/MLamphotericin b lipid

BRAND 3

AMBISOME RECON SUSP 50 MGamphotericin b liposome

BRAND 3

AMPHOTEC RECON SUSP 50 MGamphotericin b cholesteryl sulfate complex

BRAND 3



amphotericin b recon soln 50 mg generic 3

CANCIDAS RECON SOLN 50 MGcaspofungin acetate

BRAND 3

CANCIDAS RECON SOLN 70 MGcaspofungin acetate

BRAND 3

ciclodan cream 0.77 % generic 1

ciclodan solution 8 % generic 1

ciclopirox gel 0.77 % generic 1

ciclopirox olamine cream 0.77 % generic 1

ciclopirox olamine suspension 0.77 % generic 1

ciclopirox shampoo 1 % generic 1

ciclopirox solution 8 % generic 1

ciclopirox-vitamin e kit 8 & 5 % generic 1

clotrimazole cream 1 % generic 1

clotrimazole lozenge 10 mg generic 1

clotrimazole solution 1 % generic 1

clotrimazole troche 10 mg generic 1

econazole nitrate cream 1 % generic 1

ERAXIS 100 MGanidulafungin

BRAND 3

ERAXIS 50 MGanidulafungin

BRAND 3

ERAXIS RECON SOLN 100 MGanidulafungin

BRAND 3

ERAXIS RECON SOLN 50 MGanidulafungin

BRAND 3

ERTACZO CREAM 2 %sertaconazole nitrate

BRAND 3 MPL 1 / 30 days

EXELDERM CREAM 1 %sulconazole nitrate




EXELDERM SOLUTION 1 %sulconazole nitrate


fluconazole recon susp 10 mg/ml generic 1

fluconazole recon susp 40 mg/ml generic 1

fluconazole tab 100 mg generic 1




flucytosine cap 250 mg generic 1

flucytosine cap 500 mg generic 1

griseofulvin microsize suspension 125mg/5ml

generic 1ST


griseofulvin microsize tab 500 mg generic 1

griseofulvin ultramicrosize tab 125 mg generic 1

griseofulvin ultramicrosize tab 250 mg generic 1

GYNAZOLE-1 CREAM 2 %butoconazole nitrate (one dose)

BRAND 3

itraconazole cap 100 mg generic 1PA

MDD 4 per day

ketoconazole cream 2 % generic 1

ketoconazole shampoo 2 % generic 1

ketoconazole tab 200 mg generic 1

MENTAX CREAM 1 %butenafine hcl


MICONAZOLE 3 SUPPOS 200 MGmiconazole nitrate vaginal

BRAND 3

MYCAMINE RECON SOLN 100 MGmicafungin sodium

BRAND 3

MYCAMINE RECON SOLN 50 MGmicafungin sodium

BRAND 3



NAFTIFINE HCL CREAM 1 %naftifine hcl


NAFTIN CREAM 1 %naftifine hcl


NAFTIN CREAM 2 %naftifine hcl


NAFTIN GEL 1 %naftifine hcl


NATACYN SUSPENSION 5 %natamycin


NOXAFIL SUSPENSION 40 MG/MLposaconazole

BRAND 3 MDS 600 / 30 Days

nyamyc powder 100000 unit/gm generic 1

nystatin cream 100000 unit/gm generic 1

nystatin ointment 100000 unit/gm generic 1

nystatin powder generic 1

nystatin powder 100000 unit/gm generic 1

nystatin suspension 100000 unit/ml generic 1

nystatin tab 500000 unit generic 1

nystatin-triamcinolone cream 100000-0.1unit/gm-%

generic 1

nystatin-triamcinolone ointment 100000-0.1 unit/gm-%

generic 1

nystop powder 100000 unit/gm generic 1

OXISTAT CREAM 1 %oxiconazole nitrate


OXISTAT LOTION 1 %oxiconazole nitrate


pedi-dri powder 100000 unit/gm generic 1

SPORANOX SOLUTION 10 MG/MLitraconazole

BRAND 3PA

MDS 600 / 30 days



terbinafine hcl 250 mg generic 1 MDD 1 per day

terbinafine hcl tab 250 mg generic 1 MDD 1 per day

terconazole cream 0.4 % generic 1 MPL 1 / Claim

terconazole cream 0.8 % generic 1 MPL 1 / Claim

terconazole suppos 80 mg generic 1 MPL 1 / Claim

voriconazole tab 200 mg generic 1 MDD 4 per day

voriconazole tab 50 mg generic 1 MDD 4 per day

zazole cream 0.4 % generic 1 MPL 1 / Claim

zazole cream 0.8 % generic 1 MPL 1 / Claim

zazole suppos 80 mg generic 1 MPL 1 / Claim

ANTIGOUT AGENTS

allopurinol tab 100 mg generic 1

allopurinol tab 300 mg generic 1

colchicine tab 0.6 mg generic 2 MDS 6 / claim(s)

COLCHICINE TAB 0.6 MGcolchicine

BRAND 2 MDS 6 / claim(s)

colchicine-probenecid tab 0.5-500 mg generic 1

COLCRYS TAB 0.6 MGcolchicine

BRAND 2 MDS 6 / claim(s)

probenecid tab 500 mg generic 1

ULORIC TAB 40 MGfebuxostat

BRAND 3PA

MDD 1 per day

ULORIC TAB 80 MGfebuxostat

BRAND 3PA

MDD 1 per day

ANTIMIGRAINE AGENTS

ERGOT ALKALOIDS

CAFERGOT TAB 1-100 MGergotamine w/ caffeine

BRAND 2



D.H.E. 45 SOLUTION 1 MG/MLdihydroergotamine mesylate

BRAND 2

dihydroergotamine mesylate solution 1mg/ml

generic 1

dihydroergotamine mesylate solution 4mg/ml

generic 1ST

MDS 8 / 30 days

ERGOMAR SL TAB 2 MGergotamine tartrate


MIGRANAL SOLUTION 4 MG/MLdihydroergotamine mesylate

BRAND 2ST

MDS 8 / 30 days

SEROTONIN (5-HT) 1B/1D RECEPTOR AGONISTS

almotriptan malate tab 12.5 mg generic 3

ST

AL At least 12 yrs oldMDS 12 / 30 days

almotriptan malate tab 6.25 mg generic 3

ST


AXERT TAB 12.5 MGalmotriptan malate

BRAND 3

ST


AXERT TAB 6.25 MGalmotriptan malate

BRAND 3

ST


FROVA TAB 2.5 MGfrovatriptan succinate

BRAND 3

ST


IMITREX SOLUTION 20 MG/ACTsumatriptan

BRAND 1 AL At least 18 yrs old

IMITREX SOLUTION 5 MG/ACTsumatriptan


naratriptan hcl tab 1 mg generic 1AL At least 18 yrs old

MDS 9 / 30 days



naratriptan hcl tab 2.5 mg generic 1AL At least 18 yrs old

MDS 9 / 30 days

RELPAX TAB 20 MGeletriptan hydrobromide

BRAND 3

ST


RELPAX TAB 40 MGeletriptan hydrobromide

BRAND 3

ST


rizatriptan benzoate tab 10 mg generic 1AL At least 6 yrs old

MDS 18 / 30 days


MDS 18 / 30 days


MDS 12 / 30 days


MDS 12 / 30 days

rizatriptan benzoate tab disp 10 mg generic 1AL At least 6 yrs old

MDS 18 / 30 days

rizatriptan benzoate tab disp 10 mg generic 1AL At least 6 yrs old

MDS 18 / 30 days

rizatriptan benzoate tab disp 5 mg generic 1

AL At least 6 yrs oldMDS 12 / 30 Days

MDS2 36 / 90 Days

rizatriptan benzoate tab disp 5 mg generic 1

AL At least 6 yrs oldMDS 12 / 30 Days

MDS2 36 / 90 Days

sumatriptan solution 20 mg/act generic 1AL At least 18 yrs old

MDS 6 / 30 days

sumatriptan solution 5 mg/act generic 1AL At least 18 yrs old

MDS 6 / 30 days



sumatriptan succinate refill soln cart 4mg/0.5ml

generic 1AL At least 18 yrs old

MDS 4 / 30 days

sumatriptan succinate refill soln cart 6mg/0.5ml


MDS 4 / 30 days

sumatriptan succinate soln a-inj 4mg/0.5ml


MDS 4 / 30 days

sumatriptan succinate soln a-inj 6mg/0.5ml


MDS 4 / 30 days

sumatriptan succinate soln prsyr 4mg/0.5ml


MDS 4 / 30 days

sumatriptan succinate soln prsyr 6mg/0.5ml


MDS 4 / 30 days

sumatriptan succinate solution 4 mg/0.5ml generic 1AL At least 18 yrs old

MPL 2 / 30 days

sumatriptan succinate solution 6 mg/0.5ml generic 1AL At least 18 yrs old

MDS 4 / 30 days

sumatriptan succinate tab 100 mg generic 1AL At least 18 yrs old

MDS 9 / 30 days


MDS 9 / 30 days


MDS 9 / 30 days

zolmitriptan tab 2.5 mg generic 1

ST


zolmitriptan tab 5 mg generic 1

ST




zolmitriptan tab disp 5 mg generic 1

ST


ZOMIG SOLUTION 2.5 MGzolmitriptan

BRAND 2

ST


ZOMIG SOLUTION 5 MGzolmitriptan

BRAND 2

ST


ZOMIG TAB 2.5 MGzolmitriptan

BRAND 2

ST


ZOMIG TAB 5 MGzolmitriptan

BRAND 2

ST


ZOMIG ZMT TAB DISP 2.5 MGzolmitriptan

BRAND 2

ST


ZOMIG ZMT TAB DISP 5 MGzolmitriptan

BRAND 2

ST


ANTIMYASTHENIC AGENTS

PARASYMPATHOMIMETICS

guanidine hcl tab 125 mg generic 2

MESTINON SYRUP 60 MG/5MLpyridostigmine bromide

BRAND 2

MESTINON TAB ER 180 MGpyridostigmine bromide

BRAND 2

MYTELASE TAB 10 MGambenonium chloride

BRAND 3



pyridostigmine bromide er tab er 180 mg generic 1

pyridostigmine bromide tab 60 mg generic 1

ANTIMYCOBACTERIALS

ANTIMYCOBACTERIALS, OTHER

dapsone tab 100 mg generic 3

dapsone tab 25 mg generic 3

MYCOBUTIN CAP 150 MGrifabutin

BRAND 3 PA

rifabutin cap 150 mg generic 1

ANTITUBERCULARS

CAPASTAT SULFATE RECON SOLN 1 GMcapreomycin sulfate

BRAND 3

CYCLOSERINE CAP 250 MGcycloserine


ethambutol hcl tab 100 mg generic 1

ethambutol hcl tab 400 mg generic 1

isoniazid solution 100 mg/ml generic 1

ISONIAZID SYRUP 50 MG/5MLisoniazid

BRAND 1

isoniazid tab 100 mg generic 1

isoniazid tab 300 mg generic 1

PASER PACKET 4 GMaminosalicylic acid


PRIFTIN TAB 150 MGrifapentine

BRAND 3

pyrazinamide tab 500 mg generic 1

RIFAMATE CAP 150-300 MGisoniazid & rifampin

BRAND 3

rifampin cap 150 mg generic 1



rifampin cap 300 mg generic 1

rifampin recon soln 600 mg generic 1

RIFATER TAB 50-120-300 MGisoniazid-rifampin w/ pyrazinamide


SEROMYCIN CAP 250 MGcycloserine


TRECATOR TAB 250 MGethionamide


ANTINEOPLASTICS

ALKYLATING AGENTS

ALKERAN TAB 2 MGmelphalan

BRAND 2

BICNU RECON SOLN 100 MGcarmustine

BRAND 4PA

S

BUSULFEX SOLUTION 6 MG/MLbusulfan

BRAND 4PA

S

CEENU CAP 10 MGlomustine

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

cyclophosphamide cap 25 mg generic 4PA

S

cyclophosphamide cap 50 mg generic 4PA

S

cyclophosphamide recon soln 1 gm generic 4PA

S

cyclophosphamide recon soln 2 gm generic 4PA

S



cyclophosphamide recon soln 500 mg generic 4PA

S

cyclophosphamide tab 25 mg generic 4PA

S

cyclophosphamide tab 50 mg generic 4PA

S

dacarbazine recon soln 200 mg generic 4PA

S

DAUNOXOME INJECTABLE 2 MG/MLdaunorubicin citrate liposome

BRAND 4PA

S

HEXALEN CAP 50 MGaltretamine

BRAND 4PA

S

IFEX RECON SOLN 1 GMifosfamide

BRAND 4PA

S

ifosfamide recon soln 1 gm generic 4PA

S

ifosfamide solution 1 gm/20ml generic 4PA

S

ifosfamide-mesna kit 1-1 gm generic 4PA

S

LEUKERAN TAB 2 MGchlorambucil

BRAND 4PA

S

lomustine cap 10 mg generic 4PA

S


S


S

MATULANE CAP 50 MGprocarbazine hcl

BRAND 4PA

S



melphalan hcl recon soln 50 mg generic 1

MUSTARGEN RECON SOLN 10 MGmechlorethamine hcl

BRAND 4PA

S

MYLERAN TAB 2 MGbusulfan

BRAND 4PA

S

TEMODAR CAP 100 MGtemozolomide

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

TEMODAR RECON SOLN 100 MGtemozolomide

BRAND 4PA

S

temozolomide cap 100 mg generic 4PA

S


S


S


S


S




S

TREANDA RECON SOLN 100 MGbendamustine hcl

BRAND 4PA

S

TREANDA RECON SOLN 25 MGbendamustine hcl

BRAND 4PA

S

ZANOSAR RECON SOLN 1 GMstreptozocin

BRAND 4PA

S

ANTIANDROGENS

bicalutamide tab 50 mg generic 4PA

S

CASODEX TAB 50 MGbicalutamide

BRAND 4PA

S

flutamide cap 125 mg generic 4PA

S

NILANDRON TAB 150 MGnilutamide


XTANDI CAP 40 MGenzalutamide

BRAND 4PA

S

ZYTIGA TAB 250 MGabiraterone acetate

BRAND 4PA

S

ANTIANGIOGENIC AGENTS

REVLIMID CAP 10 MGlenalidomide

BRAND 4PA

S


BRAND 4PA

S

REVLIMID CAP 2.5 MGlenalidomide

BRAND 4PA

S


BRAND 4PA

S




BRAND 4PA

S

THALOMID CAP 100 MGthalidomide

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

ANTIESTROGENS/MODIFIERS

EMCYT CAP 140 MGestramustine phosphate sodium

BRAND 4 S

FARESTON TAB 60 MGtoremifene citrate

BRAND 2

FASLODEX 125 MG/2.5MLfulvestrant

BRAND 4PA

S

FASLODEX SOLUTION 250 MG/5MLfulvestrant

BRAND 4PA

S

SOLTAMOX SOLUTION 10 MG/5MLtamoxifen citrate

BRAND 3 PA

tamoxifen citrate tab 10 mg generic 0

tamoxifen citrate tab 20 mg generic 0

ANTIMETABOLITES

adrucil solution 500 mg/10ml generic 4PA

S

ALIMTA RECON SOLN 500 MGpemetrexed disodium

BRAND 4PA

S

capecitabine tab 150 mg generic 4PA

S



capecitabine tab 500 mg generic 4PA

S

cladribine solution 10 mg/10ml generic 4

CLOLAR SOLUTION 1 MG/MLclofarabine

BRAND 4PA

S

cytarabine (pf) solution 100 mg/ml generic 4PA

S

cytarabine (pf) solution 20 mg/ml generic 4PA

S

cytarabine recon soln 100 mg generic 4PA

S

cytarabine recon soln 500 mg generic 4PA

S

DEPOCYT SUSPENSION 50 MG/5MLcytarabine liposome

BRAND 4PA

S

DROXIA CAP 200 MGhydroxyurea (sickle cell anemia)

BRAND 3


BRAND 3


BRAND 3

floxuridine recon soln 0.5 gm generic 4PA

S

fluorouracil solution 500 mg/10ml generic 4PA

S

FOLOTYN SOLUTION 20 MG/MLpralatrexate

BRAND 4PA

S

gemcitabine hcl recon soln 2 gm generic 4PA

S

gemcitabine hcl recon soln 200 mg generic 4PA

S



GEMZAR RECON SOLN 200 MGgemcitabine hcl

BRAND 4PA

S

HYDREA CAP 500 MGhydroxyurea

BRAND 3

hydroxyurea cap 500 mg generic 1

mercaptopurine tab 50 mg generic 1

NIPENT RECON SOLN 10 MGpentostatin

BRAND 4PA

S

pentostatin recon soln 10 mg generic 4PA

S

PURINETHOL TAB 50 MGmercaptopurine

BRAND 3

TABLOID TAB 40 MGthioguanine

BRAND 4PA

S

XELODA TAB 150 MGcapecitabine

BRAND 4PA

S

XELODA TAB 500 MGcapecitabine

BRAND 4PA

S

ANTINEOPLASTICS, OTHER

ABRAXANE RECON SUSP 100 MGpaclitaxel protein-bound particles

BRAND 4PA

S

adriamycin recon soln 10 mg generic 4PA

S

ARRANON SOLUTION 5 MG/MLnelarabine

BRAND 4PA

S

azacitidine recon susp 100 mg generic 4PA

S

bleomycin sulfate recon soln 15 unit generic 4PA

S



CAMPATH SOLUTION 30 MG/MLalemtuzumab

BRAND 4PA

S

CAMPTOSAR SOLUTION 100 MG/5MLirinotecan hcl

BRAND 4PA

S

CAMPTOSAR SOLUTION 40 MG/2MLirinotecan hcl

BRAND 4PA

S

carboplatin solution 50 mg/5ml generic 4PA

S

CERUBIDINE RECON SOLN 20 MGdaunorubicin hcl

BRAND 4PA

S

cisplatin solution 100 mg/100ml generic 4PA

S

COSMEGEN RECON SOLN 0.5 MGdactinomycin

BRAND 4PA

S

DACOGEN RECON SOLN 50 MGdecitabine

BRAND 4PA

S

dactinomycin recon soln 0.5 mg generic 4PA

S

daunorubicin hcl injectable 5 mg/ml generic 4PA

S

daunorubicin hcl recon soln 20 mg generic 4PA

S

decitabine recon soln 50 mg generic 4PA

S

DOCEFREZ RECON SOLN 20 MGdocetaxel

BRAND 4PA

S

DOCEFREZ RECON SOLN 80 MGdocetaxel

BRAND 4PA

S

docetaxel conc 20 mg/0.5ml generic 4PA

S



DOCETAXEL CONC 20 MG/0.5MLdocetaxel

BRAND 4PA

S

docetaxel conc 20 mg/ml generic 4PA

S

DOCETAXEL CONC 20 MG/MLdocetaxel

BRAND 4PA

S

docetaxel solution 20 mg/2ml generic 4PA

S

DOCETAXEL SOLUTION 20 MG/2MLdocetaxel

BRAND 4PA

S

DOXIL INJECTABLE 2 MG/MLdoxorubicin hcl liposomal

BRAND 4PA

S

doxorubicin hcl liposomal injectable 2mg/ml

generic 4PA

S

doxorubicin hcl recon soln 10 mg generic 4PA

S

DOXORUBICIN HCL RECON SOLN 10 MGdoxorubicin hcl

BRAND 4PA

S

doxorubicin hcl recon soln 50 mg generic 4PA

S

DOXORUBICIN HCL RECON SOLN 50 MGdoxorubicin hcl

BRAND 4PA

S

doxorubicin hcl solution 2 mg/ml generic 4PA

S

ELOXATIN SOLUTION 100 MG/20MLoxaliplatin

BRAND 4PA

S

ELOXATIN SOLUTION 50 MG/10MLoxaliplatin

BRAND 4PA

S

ELSPAR RECON SOLN 10000 UNITasparaginase

BRAND 4PA

S



epirubicin hcl solution 50 mg/25ml generic 4PA

S

epirubicin hcl solution 50 mg/25ml generic 4PA

S

ERWINAZE RECON SOLN 10000 UNITasparaginase erwinia chrysanthemi

BRAND 4PA

S

FLUDARA RECON SOLN 50 MGfludarabine phosphate

BRAND 4PA

S

fludarabine phosphate recon soln 50 mg generic 4PA

S

fludarabine phosphate solution 50 mg/2ml generic 4PA

S

HALAVEN SOLUTION 1 MG/2MLeribulin mesylate

BRAND 4PA

S

IDAMYCIN PFS SOLUTION 10 MG/10MLidarubicin hcl

BRAND 4PA

S

IDAMYCIN PFS SOLUTION 5 MG/5MLidarubicin hcl

BRAND 4PA

S

idarubicin hcl solution 10 mg/10ml generic 4PA

S

idarubicin hcl solution 5 mg/5ml generic 4PA

S

irinotecan hcl solution 100 mg/5ml generic 4PA

S

irinotecan hcl solution 40 mg/2ml generic 4PA

S

ISTODAX RECON SOLN 10 MGromidepsin

BRAND 4PA

S

IXEMPRA KIT RECON SOLN 15 MGixabepilone

BRAND 4PA

S



JEVTANA SOLUTION 60 MG/1.5MLcabazitaxel

BRAND 4PA

S

leucovorin calcium recon soln 100 mg generic 1




LEUCOVORIN CALCIUM RECON SOLN 50MGleucovorin calcium

BRAND 1


leucovorin calcium solution 10 mg/ml generic 1

leucovorin calcium tab 10 mg generic 1




lipodox 50 injectable 2 mg/ml generic 4PA

S

lipodox injectable 2 mg/ml generic 4PA

S

LYSODREN TAB 500 MGmitotane

BRAND 4PA

S

mitomycin recon soln 20 mg generic 4PA

S

mitoxantrone hcl conc 25 mg/12.5ml generic 4PA

S

NAVELBINE SOLUTION 10 MG/MLvinorelbine tartrate

BRAND 4PA

S

OFORTA TAB 10 MGfludarabine phosphate

BRAND 4PA

S



ONCASPAR SOLUTION 750 UNIT/MLpegaspargase

BRAND 4PA

S

ONTAK SOLUTION 150 MCG/MLdenileukin diftitox

BRAND 4PA

S

oxaliplatin solution 100 mg/20ml generic 4PA

S


S


S


S

paclitaxel conc 100 mg/16.7ml generic 4PA

S

paclitaxel conc 150 mg/25ml generic 4PA

S

PHOTOFRIN RECON SOLN 75 MGporfimer sodium

BRAND 4PA

S

PROLEUKIN RECON SOLN 22000000 UNITaldesleukin

BRAND 4PA

S

SYLATRON KIT 200 MCGpeginterferon alfa-2b (antineoplastic)

BRAND 4PA

S


BRAND 4PA

S

SYLATRON KIT 4 X 200 MCGpeginterferon alfa-2b (antineoplastic)

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S




BRAND 4PA

S

SYNRIBO RECON SOLN 3.5 MGomacetaxine mepesuccinate

BRAND 4PA

S

TAXOTERE CONC 20 MG/0.5MLdocetaxel

BRAND 4PA

S

TAXOTERE CONC 20 MG/MLdocetaxel

BRAND 4PA

S

TENIPOSIDE SOLUTION 10 MG/MLteniposide

BRAND 4PA

S

thiotepa recon soln 15 mg generic 4PA

S

TRISENOX SOLUTION 10 MG/10MLarsenic trioxide

BRAND 4PA

S

UVADEX SOLUTION 20 MCG/MLmethoxsalen (photopheresis)

BRAND 4PA

S

VALSTAR SOLUTION 40 MG/MLvalrubicin

BRAND 4PA

S

VELCADE RECON SOLN 3.5 MGbortezomib

BRAND 4PA

S

VIDAZA RECON SUSP 100 MGazacitidine

BRAND 4PA

S

vinblastine sulfate recon soln 10 mg generic 4PA

S

vincasar pfs solution 1 mg/ml generic 4PA

S

vincristine sulfate solution 1 mg/ml generic 4PA

S

vinorelbine tartrate solution 10 mg/ml generic 4PA

S



vinorelbine tartrate solution 10 mg/ml generic 4PA

S

VORAXAZE RECON SOLN 1000 UNITglucarpidase

BRAND 4PA

S

VUMON SOLUTION 10 MG/MLteniposide

BRAND 4PA

S

ZALTRAP SOLUTION 100 MG/4MLziv-aflibercept

BRAND 4PA

S

ZOLINZA CAP 100 MGvorinostat

BRAND 4PA

S

AROMATASE INHIBITORS, 3RD GENERATION

anastrozole tab 1 mg generic 1

ARIMIDEX TAB 1 MGanastrozole

BRAND 4

AROMASIN TAB 25 MGexemestane

BRAND 4PA

S

exemestane tab 25 mg generic 4 S

FEMARA TAB 2.5 MGletrozole

BRAND 4 PA

letrozole tab 2.5 mg generic 1

ENZYME INHIBITORS

ETOPOPHOS RECON SOLN 100 MGetoposide phosphate

BRAND 4PA

S

etoposide cap 50 mg generic 4PA

S

etoposide solution 1 gm/50ml generic 4PA

S

etoposide solution 100 mg/5ml generic 4PA

S



etoposide solution 500 mg/25ml generic 4PA

S

HYCAMTIN CAP 0.25 MGtopotecan hcl

BRAND 4PA

S

HYCAMTIN CAP 1 MGtopotecan hcl

BRAND 4PA

S

HYCAMTIN RECON SOLN 4 MGtopotecan hcl

BRAND 4PA

S

toposar solution 1 gm/50ml generic 4PA

S

toposar solution 100 mg/5ml generic 4PA

S

toposar solution 500 mg/25ml generic 4PA

S

topotecan hcl recon soln 4 mg generic 4PA

S

MOLECULAR TARGET INHIBITORS

AFINITOR TAB 10 MGeverolimus

BRAND 4PA

S

AFINITOR TAB 2.5 MGeverolimus

BRAND 4PA

S

AFINITOR TAB 5 MGeverolimus

BRAND 4PA

S

AFINITOR TAB 7.5 MGeverolimus

BRAND 4PA

S

BOSULIF TAB 100 MGbosutinib

BRAND 4PA

S

BOSULIF TAB 500 MGbosutinib

BRAND 4PA

S



CAPRELSA TAB 100 MGvandetanib

BRAND 4PA

S

CAPRELSA TAB 300 MGvandetanib

BRAND 4PA

S

COMETRIQ (100 MG DAILY DOSE) KIT 1 X80 & 1 X 20 MGcabozantinib s-malate

BRAND 4PA

S

COMETRIQ (140 MG DAILY DOSE) KIT 1 X80 & 3 X 20 MGcabozantinib s-malate

BRAND 4PA

S

COMETRIQ (60 MG DAILY DOSE) KIT 20 MGcabozantinib s-malate

BRAND 4PA

S

ERIVEDGE CAP 150 MGvismodegib

BRAND 4PA

S

GLEEVEC TAB 100 MGimatinib mesylate

BRAND 4PA

S

GLEEVEC TAB 400 MGimatinib mesylate

BRAND 4PA

S

imatinib mesylate tab 100 mg generic 4PA

S

imatinib mesylate tab 400 mg generic 4PA

S

INLYTA TAB 1 MGaxitinib

BRAND 4PA

S

INLYTA TAB 5 MGaxitinib

BRAND 4PA

S

JAKAFI TAB 10 MGruxolitinib phosphate

BRAND 4PA

S


BRAND 4PA

S




BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

KYPROLIS RECON SOLN 60 MGcarfilzomib

BRAND 4PA

S

NEXAVAR TAB 200 MGsorafenib tosylate

BRAND 4PA

S

NINLARO CAP 2.3 MGixazomib citrate

BRAND 4PA

MDS 4 / 28 Days

NINLARO CAP 3 MGixazomib citrate

BRAND 4PA

MDS 4 / 28 Days

NINLARO CAP 4 MGixazomib citrate

BRAND 4PA

MDS 4 / 28 Days

SPRYCEL TAB 100 MGdasatinib

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

STIVARGA TAB 40 MGregorafenib

BRAND 4PA

S



SUTENT CAP 12.5 MGsunitinib malate

BRAND 4PA

S

SUTENT CAP 25 MGsunitinib malate

BRAND 4PA

S

SUTENT CAP 50 MGsunitinib malate

BRAND 4PA

S

TARCEVA TAB 100 MGerlotinib hcl

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

TASIGNA CAP 150 MGnilotinib hcl

BRAND 4PA

S

TASIGNA CAP 200 MGnilotinib hcl

BRAND 4PA

S

TORISEL SOLUTION 25 MG/MLtemsirolimus

BRAND 4PA

S

TYKERB TAB 250 MGlapatinib ditosylate

BRAND 4PA

S

VANDETANIB TAB 100 MGvandetanib

BRAND 4PA

S

VANDETANIB TAB 300 MGvandetanib

BRAND 4PA

S

VOTRIENT TAB 200 MGpazopanib hcl

BRAND 4PA

S

XALKORI CAP 200 MGcrizotinib

BRAND 4PA

S

XALKORI CAP 250 MGcrizotinib

BRAND 4PA

S



ZELBORAF TAB 240 MGvemurafenib

BRAND 4PA

S

MONOCLONAL ANTIBODIES

ADCETRIS RECON SOLN 50 MGbrentuximab vedotin

BRAND 4PA

S

ARZERRA CONC 100 MG/5MLofatumumab

BRAND 4PA

S

ARZERRA CONC 1000 MG/50MLofatumumab

BRAND 4PA

S

AVASTIN SOLUTION 100 MG/4MLbevacizumab

BRAND 4PA

S

BEXXAR CONC 14 MG/MLtositumomab

BRAND 4PA

S

ERBITUX SOLUTION 100 MG/50MLcetuximab

BRAND 4PA

S

ERBITUX SOLUTION 200 MG/100MLcetuximab

BRAND 4PA

S

HERCEPTIN RECON SOLN 440 MGtrastuzumab

BRAND 4PA

S

PERJETA SOLUTION 420 MG/14MLpertuzumab

BRAND 4PA

S

RITUXAN SOLUTION 100 MG/10MLrituximab

BRAND 4PA

S

RITUXAN SOLUTION 500 MG/50MLrituximab

BRAND 4PA

S

VECTIBIX SOLUTION 100 MG/5MLpanitumumab

BRAND 4PA

S

YERVOY SOLUTION 200 MG/40MLipilimumab

BRAND 4PA

S



YERVOY SOLUTION 50 MG/10MLipilimumab

BRAND 4PA

S

RETINOIDS

bexarotene cap 75 mg generic 4

PA

MPL 1 / 30 daysS

PANRETIN GEL 0.1 %alitretinoin

BRAND 3

TARGRETIN CAP 75 MGbexarotene

BRAND 4

PA

MPL 1 / 30 daysS

TARGRETIN GEL 1 %bexarotene (topical)

BRAND 4PA

S

tretinoin cap 10 mg generic 1

ANTIPARASITICS

ANTIHELMINTHICS

ALBENZA TAB 200 MGalbendazole

BRAND 3

BILTRICIDE TAB 600 MGpraziquantel

BRAND 3

ivermectin tab 3 mg generic 1

mebendazole chew tab 100 mg generic 1

SKLICE LOTION 0.5 %ivermectin (pediculicide)

BRAND 3

STROMECTOL TAB 3 MGivermectin

BRAND 3

ANTIPROTOZOALS

ALINIA RECON SUSP 100 MG/5MLnitazoxanide

BRAND 2

ALINIA TAB 500 MGnitazoxanide

BRAND 2



atovaquone suspension 750 mg/5ml generic 1

atovaquone-proguanil hcl tab 250-100 mg generic 1 MDS 12 / 3 days

atovaquone-proguanil hcl tab 62.5-25 mg generic 1 MDS 12 / 3 days

chloroquine phosphate tab 250 mg generic 1

chloroquine phosphate tab 500 mg generic 1

COARTEM TAB 20-120 MGartemether-lumefantrine


DARAPRIM TAB 25 MGpyrimethamine


hydroxychloroquine sulfate tab 200 mg generic 1

MALARONE TAB 250-100 MGatovaquone-proguanil hcl


MALARONE TAB 62.5-25 MGatovaquone-proguanil hcl


mefloquine hcl tab 250 mg generic 1

MEPRON SUSPENSION 750 MG/5MLatovaquone

BRAND 3

NEBUPENT RECON SOLN 300 MGpentamidine isethionate

BRAND 3

PENTAM RECON SOLN 300 MGpentamidine isethionate

BRAND 3

primaquine phosphate tab 26.3 mg generic 3

PRIMAQUINE PHOSPHATE TAB 26.3 MGprimaquine phosphate

BRAND 3

quinine sulfate cap 324 mg generic 1 MDS 84.0 days supplywithin 365 Days

PEDICULICIDES/SCABICIDES

acticin cream 5 % generic 1

EURAX CREAM 10 %crotamiton

BRAND 3

EURAX LOTION 10 %crotamiton

BRAND 3



lindane lotion 1 % generic 3

lindane shampoo 1 % generic 3

malathion lotion 0.5 % generic 1

NATROBA SUSPENSION 0.9 %spinosad

BRAND 1

permethrin cream 5 % generic 1

SPINOSAD SUSPENSION 0.9 %spinosad

BRAND 2

ULESFIA LOTION 5 %benzyl alcohol (pediculicide)

BRAND 3

ANTIPARKINSON AGENTS

ANTICHOLINERGICS

benztropine mesylate solution 1 mg/ml generic 1

benztropine mesylate tab 0.5 mg generic 1

benztropine mesylate tab 1 mg generic 1

benztropine mesylate tab 2 mg generic 1

trihexyphenidyl hcl elixir 0.4 mg/ml generic 1

trihexyphenidyl hcl tab 2 mg generic 1

trihexyphenidyl hcl tab 5 mg generic 1

ANTIPARKINSON AGENTS, OTHER

amantadine hcl cap 100 mg generic 1

amantadine hcl syrup 50 mg/5ml generic 1

amantadine hcl tab 100 mg generic 1

carbidopa-levodopa-entacapone tab 12.5-50-200 mg

generic 1

CARBIDOPA-LEVODOPA-ENTACAPONE TAB12.5-50-200 MGcarbidopa-levodopa-entacapone

BRAND 1


generic 1




BRAND 1

carbidopa-levodopa-entacapone tab 25-100-200 mg

generic 1

CARBIDOPA-LEVODOPA-ENTACAPONE TAB25-100-200 MGcarbidopa-levodopa-entacapone

BRAND 1


generic 1


BRAND 1


generic 1


BRAND 1

carbidopa-levodopa-entacapone tab 50-200-200 mg

generic 1

CARBIDOPA-LEVODOPA-ENTACAPONE TAB50-200-200 MGcarbidopa-levodopa-entacapone

BRAND 1

entacapone tab 200 mg generic 1 MDD 8 per day

STALEVO 100 TAB 25-100-200 MGcarbidopa-levodopa-entacapone

BRAND 1

STALEVO 125 TAB 31.25-125-200 MGcarbidopa-levodopa-entacapone

BRAND 1


BRAND 1

STALEVO 200 TAB 50-200-200 MGcarbidopa-levodopa-entacapone

BRAND 1


BRAND 1




BRAND 1

TASMAR TAB 100 MGtolcapone

BRAND 3

DOPAMINE AGONISTS

APOKYN SOLUTION 10 MG/MLapomorphine hydrochloride

BRAND 4PA

S

bromocriptine mesylate cap 5 mg generic 1

bromocriptine mesylate tab 2.5 mg generic 1

NEUPRO PATCH 24HR 1 MG/24HRrotigotine

BRAND 2


BRAND 2


BRAND 2


BRAND 2


BRAND 2


BRAND 2

pramipexole dihydrochloride tab 0.125 mg generic 1 MDD 4 per day

pramipexole dihydrochloride tab 0.25 mg generic 1



pramipexole dihydrochloride tab 1 mg generic 1


ropinirole hcl er tab er 24h 12 mg generic 1ST

MDD 2 per day


MDD 1 per day




MDD 1 per day


MDD 1 per day


MDD 2 per day

ropinirole hcl tab 0.25 mg generic 1

ropinirole hcl tab 0.5 mg generic 1

ropinirole hcl tab 1 mg generic 1





DOPAMINE PRECURSORS/L-AMINO ACID DECARBOXYLASE INHIBITORS

carbidopa tab 25 mg generic 1

carbidopa-levodopa er tab er 25-100 mg generic 1

carbidopa-levodopa er tab er 50-200 mg generic 1

carbidopa-levodopa tab 10-100 mg generic 1



carbidopa-levodopa tab disp 10-100 mg generic 1



LODOSYN TAB 25 MGcarbidopa

BRAND 1

MONOAMINE OXIDASE B (MAO-B) INHIBITORS

AZILECT TAB 0.5 MGrasagiline mesylate

BRAND 2PA

MDD 1 per day



AZILECT TAB 1 MGrasagiline mesylate

BRAND 2PA

MDD 1 per day

selegiline hcl cap 5 mg generic 1

selegiline hcl tab 5 mg generic 1

ANTIPSYCHOTICS

1ST GENERATION/TYPICAL

chlorpromazine hcl solution 25 mg/ml generic 3

chlorpromazine hcl solution 50 mg/2ml generic 3

chlorpromazine hcl tab 10 mg generic 1





fluphenazine hcl conc 5 mg/ml generic 1

fluphenazine hcl elixir 2.5 mg/5ml generic 1

fluphenazine hcl solution 2.5 mg/ml generic 1

fluphenazine hcl tab 1 mg generic 1


fluphenazine hcl tab 2.5 mg generic 1


haloperidol decanoate solution 100 mg/ml generic 1 MFL 1 / 28 days

haloperidol decanoate solution 50 mg/ml generic 1 MFL 1 / 28 days

haloperidol lactate solution 5 mg/ml generic 1

haloperidol tab 0.5 mg generic 1

haloperidol tab 1 mg generic 1







loxapine succinate cap 10 mg generic 1




ORAP TAB 1 MGpimozide

BRAND 3

ORAP TAB 2 MGpimozide

BRAND 3

pimozide tab 1 mg generic 1

pimozide tab 2 mg generic 1

thioridazine hcl tab 10 mg generic 1




thiothixene cap 1 mg generic 1




trifluoperazine hcl tab 1 mg generic 1




2ND GENERATION/ATYPICAL

aripiprazole solution 1 mg/ml generic 3

PA




aripiprazole tab 10 mg generic 3

PA

AL At least 6 yrs oldMDD 1 per day


PA



PA



PA



PA



PA


FANAPT TAB 1 MGiloperidone

BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day




BRAND 2PA

MDD 2 per day

FANAPT TITRATION PACK TAB 1 & 2 & 4 &6 MGiloperidone

BRAND 2PA

MPL 2 / 365 days

INVEGA TAB ER 24H 1.5 MGpaliperidone

BRAND 2PA

MDD 1 per day

INVEGA TAB ER 24H 3 MGpaliperidone

BRAND 2PA

MDD 1 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 1 per day

LATUDA TAB 120 MGlurasidone hcl

BRAND 3PA

MDD 1 per day


BRAND 3PA

MDD 1 per day


BRAND 3PA

MDD 1 per day


BRAND 3PA

MDD 1 per day


BRAND 3PA

MDD 1 per day

olanzapine recon soln 10 mg generic 1 MDS 6 / 28 days

olanzapine tab 10 mg generic 1 MDD 1 per day


olanzapine tab 2.5 mg generic 1 MDD 1 per day





olanzapine tab 7.5 mg generic 1 MDD 1 per day

quetiapine fumarate tab 100 mg generic 1AL At least 10 yrs old

MDD 2 per day


MDD 2 per day


MDD 2 per day


MDD 2 per day


MDD 2 per day


MDD 2 per day

RISPERDAL CONSTA RECON SUSP 12.5 MGrisperidone microspheres

BRAND 2PA

MFL 2 / 28 days

RISPERDAL CONSTA RECON SUSP 25 MGrisperidone microspheres

BRAND 2PA

MFL 2 / 28 days

RISPERDAL CONSTA RECON SUSP 37.5 MGrisperidone microspheres

BRAND 2PA

MFL 2 / 28 days

RISPERDAL CONSTA RECON SUSP 50 MGrisperidone microspheres

BRAND 2PA

MFL 2 / 28 days

risperidone m-tab tab disp 0.5 mg generic 1PA

MDD 2 per day

risperidone m-tab tab disp 1 mg generic 1PA

MDD 2 per day


MDD 2 per day


MDD 2 per day




MDD 2 per day

risperidone solution 1 mg/ml generic 1PA

MDS 240 / 30 days

risperidone tab 0.25 mg generic 1 MDD 2 per day

risperidone tab 0.5 mg generic 1 MDD 2 per day

risperidone tab 1 mg generic 1 MDD 2 per day




risperidone tab disp 0.25 mg generic 1PA

MDD 2 per day

risperidone tab disp 0.5 mg generic 1PA

MDD 2 per day

risperidone tab disp 1 mg generic 1PA

MDD 2 per day


MDD 2 per day


MDD 2 per day


MDD 2 per day

SAPHRIS SL TAB 10 MGasenapine maleate

BRAND 2PA

MDD 2 per day

SAPHRIS SL TAB 5 MGasenapine maleate

BRAND 2PA

MDD 2 per day

SEROQUEL XR TAB ER 24H 150 MGquetiapine fumarate

BRAND 2

PA





BRAND 2

PA



BRAND 2

PA



BRAND 2

PA



BRAND 2

PA


ziprasidone hcl cap 20 mg generic 1AL At least 18 yrs old

MDD 2 per day


MDD 2 per day


MDD 2 per day


MDD 2 per day

TREATMENT-RESISTANT

clozapine tab 100 mg generic 1




ANTISPASTICITY AGENTS

baclofen tab 10 mg generic 1

baclofen tab 20 mg generic 1

dantrolene sodium cap 100 mg generic 1 MDD 4 per day





ed baclofen tab 10 mg generic 1

tizanidine hcl 2 mg generic 1

tizanidine hcl 4 mg generic 1

tizanidine hcl cap 2 mg generic 1



tizanidine hcl tab 2 mg generic 1




ANTIVIRALS

ANTI-CYTOMEGALOVIRUS (CMV) AGENTS

cidofovir solution 75 mg/ml generic 3

FOSCAVIR SOLUTION 6000 MG/250MLfoscarnet sodium

BRAND 3

ganciclovir sodium recon soln 500 mg generic 1

VALCYTE RECON SOLN 50 MG/MLvalganciclovir hcl

BRAND 2PA

MDS 540 / 30 days

VALCYTE TAB 450 MGvalganciclovir hcl

BRAND 2PA

MDD 4 per day

valganciclovir hcl tab 450 mg generic 1PA

MDD 4 per day

valganciclovir hcl tab 450 mg generic 1PA

MDD 4 per day

VISTIDE SOLUTION 75 MG/MLcidofovir

BRAND 3



ZIRGAN GEL 0.15 %ganciclovir ophthalmic

BRAND 2

ANTI-HEPATITIS B (HBV) AGENTS

adefovir dipivoxil tab 10 mg generic 4

PA

MDD 1 per dayS

BARACLUDE SOLUTION 0.05 MG/MLentecavir

BRAND 4

PA

MDS 600 / 30 daysS

BARACLUDE TAB 0.5 MGentecavir

BRAND 4

PA

MDD 1 per dayS

BARACLUDE TAB 1 MGentecavir

BRAND 4

PA

MDD 1 per dayS

entecavir tab 0.5 mg generic 4

PA

MDD 1 per dayS

entecavir tab 1 mg generic 4

PA

MDD 1 per dayS

EPIVIR HBV SOLUTION 5 MG/MLlamivudine (hbv)

BRAND 4MDS 1800 / 30 days

S

EPIVIR HBV TAB 100 MGlamivudine (hbv)

BRAND 4MDD 3 per day

S

HEPSERA TAB 10 MGadefovir dipivoxil

BRAND 4

PA

MDD 1 per dayS

lamivudine tab 100 mg generic 1MDD 3 per day

S



TYZEKA TAB 600 MGtelbivudine

BRAND 4

PA

MDD 1 per dayS

ANTI-HEPATITIS C (HCV) AGENTS

EPCLUSA TAB 400-100 MGsofosbuvir-velpatasvir

BRAND 4 PA

HARVONI TAB 90-400 MGledipasvir-sofosbuvir

BRAND 4

PA

MDD 1 per dayS

INCIVEK TAB 375 MGtelaprevir

BRAND 4MDD 6 per day

S

INFERGEN INJECTABLE 15 MCG/0.5MLinterferon alfacon-1

BRAND 4PA

S

INFERGEN INJECTABLE 9 MCG/0.3MLinterferon alfacon-1

BRAND 4PA

S

INTRON A RECON SOLN 18000000 UNITinterferon alfa-2b

BRAND 4PA

S

moderiba tab 200 mg generic 1 MDD 7 per day

PEG-INTRON KIT 120 MCG/0.5MLpeginterferon alfa-2b

BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS



PEG-INTRON REDIPEN KIT 120 MCG/0.5MLpeginterferon alfa-2b

BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS

PEG-INTRON REDIPEN PAK 4 KIT 120MCG/0.5MLpeginterferon alfa-2b

BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS

PEGASYS KIT 180 MCG/0.5MLpeginterferon alfa-2a

BRAND 4

PA

MDS 1 / 28 daysS

PEGASYS PROCLICK SOLUTION 135MCG/0.5MLpeginterferon alfa-2a

BRAND 4

PA

MPL 2 / 28 daysS



PEGASYS PROCLICK SOLUTION 180MCG/0.5MLpeginterferon alfa-2a

BRAND 4

PA

MPL 2 / 28 daysS

PEGASYS SOLUTION 180 MCG/0.5MLpeginterferon alfa-2a

BRAND 4

PA

MPL 2 / 28 daysS

PEGASYS SOLUTION 180 MCG/MLpeginterferon alfa-2a

BRAND 4

PA

MPL 4 / 28 daysS

PEGINTRON KIT 120 MCG/0.5MLpeginterferon alfa-2b

BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS


BRAND 4

PA

MDS 4 / 28 daysS

REBETOL SOLUTION 40 MG/MLribavirin (hepatitis c)

BRAND 4

PA

MDS 1050 / 30 daysS

ribasphere cap 200 mg generic 1 MDD 7 per day

ribasphere tab 200 mg generic 1 MDD 7 per day

ribavirin cap 200 mg generic 1 MDD 7 per day

ribavirin tab 200 mg generic 1 MDD 7 per day

SOVALDI TAB 400 MGsofosbuvir

BRAND 4

PA

MDD 1 per dayS



VICTRELIS CAP 200 MGboceprevir

BRAND 4

PA

MDD 12 per dayS

ANTI-HIV AGENTS, INTEGRASE INHIBITORS (INSTI)

GENVOYA TAB 150-150-200-10 MGelvitegravir-cobicistat-emtricitabine-tenofovir alafenamide


ISENTRESS CHEW TAB 100 MGraltegravir potassium

BRAND 2

ISENTRESS CHEW TAB 25 MGraltegravir potassium

BRAND 2

ISENTRESS TAB 400 MGraltegravir potassium


STRIBILD TAB 150-150-200-300 MGelvitegravir-cobicistat-emtricitabine-tenofovir


ANTI-HIV AGENTS, NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTI)

ATRIPLA TAB 600-200-300 MGefavirenz-emtricitabine-tenofovir disoproxilfumarate


COMPLERA TAB 200-25-300 MGemtricitabine-rilpivirine-tenofovir disoproxilfumarate


EDURANT TAB 25 MGrilpivirine hcl


INTELENCE TAB 100 MGetravirine






nevirapine er tab er 24h 400 mg generic 1 MDD 1 per day



nevirapine suspension 50 mg/5ml generic 1 MDS 1200 / 30 days

nevirapine tab 200 mg generic 1 MDD 2 per day

ODEFSEY TAB 200-25-25 MGemtricitabine-rilpivirine-tenofoviralafenamide fumarate


RESCRIPTOR TAB 100 MGdelavirdine mesylate


RESCRIPTOR TAB 200 MGdelavirdine mesylate


SUSTIVA CAP 200 MGefavirenz


SUSTIVA CAP 50 MGefavirenz


SUSTIVA TAB 600 MGefavirenz


VIRAMUNE SUSPENSION 50 MG/5MLnevirapine


VIRAMUNE XR TAB ER 24H 100 MGnevirapine


VIRAMUNE XR TAB ER 24H 400 MGnevirapine


ANTI-HIV AGENTS, NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASEINHIBITORS (NRTI)

abacavir sulfate tab 300 mg generic 1 MDD 2 per day

abacavir-lamivudine-zidovudine tab 300-150-300 mg


DESCOVY TAB 200-25 MGemtricitabine-tenofovir alafenamidefumarate


didanosine cap dr 125 mg generic 1 MDD 2 per day






EMTRIVA CAP 200 MGemtricitabine


EMTRIVA SOLUTION 10 MG/MLemtricitabine

BRAND 2

EPIVIR SOLUTION 10 MG/MLlamivudine


EPIVIR TAB 150 MGlamivudine


EPIVIR TAB 300 MGlamivudine


EPZICOM TAB 600-300 MGabacavir sulfate-lamivudine


lamivudine solution 10 mg/ml generic 1 MDS 900 / 30 days

lamivudine tab 150 mg generic 1 MDD 2 per day

lamivudine tab 300 mg generic 1 MDD 1 per day

lamivudine-zidovudine tab 150-300 mg generic 1 MDD 2 per day

RETROVIR SOLUTION 10 MG/MLzidovudine

BRAND 1

stavudine cap 15 mg generic 1 MDD 2 per day




stavudine recon soln 1 mg/ml generic 1 MDS 2400 / 30 days

TRIZIVIR TAB 300-150-300 MGabacavir sulfate-lamivudine-zidovudine


TRUVADA TAB 200-300 MGemtricitabine-tenofovir disoproxil fumarate

BRAND 2PA

MDD 1 per day

VIDEX RECON SOLN 2 GMdidanosine

BRAND 2



VIDEX RECON SOLN 4 GMdidanosine

BRAND 2

VIREAD POWDER 40 MG/GMtenofovir disoproxil fumarate

BRAND 2

VIREAD TAB 150 MGtenofovir disoproxil fumarate







BRAND 2

ZIAGEN SOLUTION 20 MG/MLabacavir sulfate

BRAND 2

zidovudine cap 100 mg generic 1 MDD 6 per day

zidovudine syrup 50 mg/5ml generic 1 MDS 1800 / 30 days

zidovudine tab 300 mg generic 1 MDD 2 per day

ANTI-HIV AGENTS, OTHER

FUZEON KIT 90 MGenfuvirtide

BRAND 4

PA

MPL 1 / 30 daysS

FUZEON RECON SOLN 90 MGenfuvirtide

BRAND 4

PA

MPL 1 / 30 daysS

SELZENTRY TAB 150 MGmaraviroc


SELZENTRY TAB 300 MGmaraviroc


TRIUMEQ TAB 600-50-300 MGabacavir-dolutegravir-lamivudine


TYBOST TAB 150 MGcobicistat




ANTI-HIV AGENTS, PROTEASE INHIBITORS

APTIVUS CAP 250 MGtipranavir


APTIVUS SOLUTION 100 MG/MLtipranavir


CRIXIVAN CAP 200 MGindinavir sulfate


CRIXIVAN CAP 400 MGindinavir sulfate


INVIRASE CAP 200 MGsaquinavir mesylate


INVIRASE TAB 500 MGsaquinavir mesylate


KALETRA SOLUTION 400-100 MG/5MLlopinavir-ritonavir


KALETRA TAB 100-25 MGlopinavir-ritonavir


KALETRA TAB 200-50 MGlopinavir-ritonavir


LEXIVA SUSPENSION 50 MG/MLfosamprenavir calcium


LEXIVA TAB 700 MGfosamprenavir calcium


NORVIR CAP 100 MGritonavir


NORVIR SOLUTION 80 MG/MLritonavir


NORVIR TAB 100 MGritonavir


PREZISTA SUSPENSION 100 MG/MLdarunavir ethanolate


PREZISTA TAB 150 MGdarunavir ethanolate












REYATAZ CAP 100 MGatazanavir sulfate








VIRACEPT TAB 250 MGnelfinavir mesylate


VIRACEPT TAB 625 MGnelfinavir mesylate


ANTI-INFLUENZA AGENTS

RELENZA DISKHALER AER POW BA 5MG/BLISTERzanamivir


rimantadine hcl tab 100 mg generic 1 MDD 2 per day

TAMIFLU CAP 30 MGoseltamivir phosphate






TAMIFLU RECON SUSP 6 MG/MLoseltamivir phosphate




ANTIHERPETIC AGENTS

acyclovir cap 200 mg generic 1 MDS 50 / 30 days

acyclovir ointment 5 % generic 1

acyclovir suspension 200 mg/5ml generic 1 MDS 400 / 30 days

acyclovir tab 400 mg generic 1 MDD 5 per day

acyclovir tab 800 mg generic 1 MDD 5 per day

DENAVIR CREAM 1 %penciclovir

BRAND 3

famciclovir tab 125 mg generic 1PA

MDD 3 per day


MDD 3 per day


MDD 4 per day

trifluridine solution 1 % generic 1

valacyclovir hcl tab 1 gm generic 1 MDD 4 per day

valacyclovir hcl tab 500 mg generic 1 MDD 2 per day

ZOVIRAX CREAM 5 %acyclovir topical

BRAND 3

ANXIOLYTICS

ANXIOLYTICS, OTHER

buspirone hcl tab 10 mg generic 1



buspirone hcl tab 5 mg generic 1 MDD 1 per day

buspirone hcl tab 7.5 mg generic 1

meprobamate tab 200 mg generic 1



meprobamate tab 400 mg generic 1

BENZODIAZEPINES

alprazolam tab 0.25 mg generic 1 MDD 4 per day

alprazolam tab 0.5 mg generic 1 MDD 4 per day

alprazolam tab 1 mg generic 1 MDD 4 per day

alprazolam tab 2 mg generic 1 MDD 4 per day

clonazepam tab 0.5 mg generic 1

clonazepam tab 1 mg generic 1

clonazepam tab 2 mg generic 1

diazepam tab 10 mg generic 1 MDD 4 per day



lorazepam tab 0.5 mg generic 1 MDD 3 per day

lorazepam tab 1 mg generic 1 MDD 4 per day

lorazepam tab 2 mg generic 1 MDD 3 per day

BIPOLAR AGENTS

MOOD STABILIZERS

EQUETRO CAP ER 12H 100 MGcarbamazepine (antipsychotic)

BRAND 3ST

MDD 2 per day


BRAND 3ST

MDD 8 per day


BRAND 3ST

MDD 4 per day

lithium carbonate cap 150 mg generic 1





lithium carbonate er tab er 300 mg generic 1

lithium carbonate er tab er 450 mg generic 1

lithium carbonate tab 300 mg generic 1

lithium solution 8 meq/5ml generic 1

BLOOD GLUCOSE REGULATORS

ANTIDIABETIC AGENTS

acarbose tab 100 mg generic 1 MDD 3 per day



ACTOPLUS MET TAB 15-500 MGpioglitazone hcl-metformin hcl


ACTOPLUS MET TAB 15-850 MGpioglitazone hcl-metformin hcl


AVANDIA TAB 2 MGrosiglitazone maleate






BYETTA 10 MCG PEN SOLN PEN 10MCG/0.04MLexenatide

BRAND 2PA

MDS 1.2 / 30 days

BYETTA 5 MCG PEN SOLN PEN 5MCG/0.02MLexenatide

BRAND 2PA

MDS 2.4 / 30 days

chlorpropamide tab 100 mg generic 1 MDD 3 per day

CYCLOSET TAB 0.8 MGbromocriptine mesylate (diabetes)


glimepiride tab 1 mg generic 1 MDD 1 per day





glipizide er tab er 24h 10 mg generic 1 MDD 2 per day

glipizide er tab er 24h 2.5 mg generic 1 MDD 2 per day

glipizide er tab er 24h 5 mg generic 1 MDD 2 per day

glipizide tab 10 mg generic 1 MDD 4 per day

glipizide tab 5 mg generic 1 MDD 4 per day

glipizide xl tab er 24h 10 mg generic 1 MDD 2 per day

glipizide xl tab er 24h 2.5 mg generic 1 MDD 2 per day

glipizide xl tab er 24h 5 mg generic 1 MDD 2 per day

glipizide-metformin hcl tab 2.5-250 mg generic 1 MDD 2 per day

glipizide-metformin hcl tab 2.5-500 mg generic 1 MDD 2 per day

glipizide-metformin hcl tab 5-500 mg generic 1 MDD 4 per day

glyburide micronized tab 1.5 mg generic 1 MDD 4 per day

glyburide micronized tab 3 mg generic 1 MDD 4 per day

glyburide micronized tab 6 mg generic 1 MDD 4 per day

glyburide tab 1.25 mg generic 1 MDD 4 per day

glyburide tab 2.5 mg generic 1 MDD 4 per day

glyburide tab 5 mg generic 1 MDD 4 per day

GLYBURIDE TAB 5 MGglyburide


glyburide-metformin tab 1.25-250 mg generic 1 MDD 2 per day

glyburide-metformin tab 2.5-500 mg generic 1 MDD 2 per day

glyburide-metformin tab 5-500 mg generic 1 MDD 4 per day

GLYSET TAB 100 MGmiglitol

BRAND 3


BRAND 3




BRAND 3

INVOKANA TAB 100 MGcanagliflozin

BRAND 3PA

MDD 1 per day

INVOKANA TAB 300 MGcanagliflozin

BRAND 3PA

MDD 1 per day

JANUVIA TAB 100 MGsitagliptin phosphate

BRAND 2PA

MDD 1 per day


BRAND 2PA

MDD 1 per day


BRAND 2PA

MDD 1 per day

lidocaine ointment 5 % generic 1

metformin hcl er (osm) tab er 24h 1000 mg generic 1 MDD 2 per day

metformin hcl er tab er 24h 500 mg generic 1 MDD 4 per day

metformin hcl er tab er 24h 750 mg generic 1 MDD 2 per day

metformin hcl tab 1000 mg generic 1 MDD 2.5 per day

metformin hcl tab 500 mg generic 1 MDD 5 per day

metformin hcl tab 850 mg generic 1 MDD 3 per day

nateglinide tab 120 mg generic 1 MDD 3 per day

nateglinide tab 60 mg generic 1 MDD 3 per day

ONGLYZA TAB 2.5 MGsaxagliptin hcl


ONGLYZA TAB 5 MGsaxagliptin hcl


pioglitazone hcl tab 15 mg generic 1 MDD 1 per day





pioglitazone hcl-metformin hcl tab 15-500mg


pioglitazone hcl-metformin hcl tab 15-850mg


PRANDIMET TAB 1-500 MGrepaglinide-metformin hcl


PRANDIMET TAB 2-500 MGrepaglinide-metformin hcl


PRANDIN TAB 0.5 MGrepaglinide


PRANDIN TAB 1 MGrepaglinide


PRANDIN TAB 2 MGrepaglinide


repaglinide tab 0.5 mg generic 1 MDD 4 per day

repaglinide tab 1 mg generic 1 MDD 4 per day

repaglinide tab 2 mg generic 1 MDD 4 per day

SYMLINPEN 120 SOLN PEN 2700MCG/2.7MLpramlintide acetate

BRAND 2PA

MDS 10.8 / 30 days

SYMLINPEN 60 SOLN PEN 1500MCG/1.5MLpramlintide acetate

BRAND 2PA

MDS 6 / 30 days

tolazamide tab 250 mg generic 1 MDD 4 per day

tolazamide tab 500 mg generic 1 MDD 4 per day

tolbutamide tab 500 mg generic 1 MDD 6 per day

TRADJENTA TAB 5 MGlinagliptin


VICTOZA SOLN PEN 18 MG/3MLliraglutide

BRAND 2PA

MDS 9 / 30 days



GLYCEMIC AGENTS

GLUCAGEN DIAGNOSTIC RECON SOLN 1MGglucagon hcl rdna (diagnostic)


GLUCAGEN HYPOKIT RECON SOLN 1 MGglucagon hcl (rdna)


GLUCAGON EMERGENCY KIT 1 MGglucagon (rdna)


PROGLYCEM SUSPENSION 50 MG/MLdiazoxide

BRAND 3

INSULINS

APIDRA SOLOSTAR SOLN PEN 100 UNIT/MLinsulin glulisine

BRAND 3

APIDRA SOLUTION 100 UNIT/MLinsulin glulisine

BRAND 2

HUMALOG KWIKPEN SOLN PEN 100UNIT/MLinsulin lispro (human)

BRAND 2

HUMALOG MIX 50/50 KWIKPEN SUSP PEN(50-50) 100 UNIT/MLinsulin lispro protamine & lispro (human)

BRAND 2

HUMALOG MIX 50/50 PEN SUSP PEN (50-50) 100 UNIT/MLinsulin lispro protamine & lispro (human)

BRAND 2

HUMALOG MIX 50/50 SUSPENSION (50-50)100 UNIT/MLinsulin lispro protamine & lispro (human)

BRAND 2

HUMALOG MIX 75/25 KWIKPEN SUSP PEN(75-25) 100 UNIT/MLinsulin lispro protamine & lispro (human)

BRAND 2

HUMALOG MIX 75/25 PEN SUSP PEN (75-25) 100 UNIT/MLinsulin lispro protamine & lispro (human)

BRAND 2



HUMALOG PEN SOLN PEN 100 UNIT/MLinsulin lispro (human)

BRAND 2

HUMALOG SOLN CART 100 UNIT/MLinsulin lispro (human)

BRAND 2

HUMALOG SOLUTION 100 UNIT/MLinsulin lispro (human)

BRAND 2

HUMULIN 70/30 KWIKPEN SUSP PEN (70-30) 100 UNIT/MLinsulin nph isophane & reg (human)

BRAND 2

HUMULIN 70/30 PEN SUSP PEN (70-30)100 UNIT/MLinsulin isophane & reg (human)

BRAND 2

HUMULIN 70/30 SUSPENSION (70-30) 100UNIT/MLinsulin isophane & reg (human)

BRAND 2

HUMULIN N KWIKPEN SUSP PEN 100UNIT/MLinsulin isophane (human)

BRAND 2

HUMULIN N PEN SUSP PEN 100 UNIT/MLinsulin isophane (human)

BRAND 2

HUMULIN N SUSPENSION 100 UNIT/MLinsulin isophane (human)

BRAND 2

HUMULIN R SOLUTION 100 UNIT/MLinsulin regular (human)

BRAND 2

HUMULIN R U-500 (CONCENTRATED)SOLUTION 500 UNIT/MLinsulin regular (human)

BRAND 2

LANTUS SOLOSTAR SOLN PEN 100UNIT/MLinsulin glargine

BRAND 2

LANTUS SOLUTION 100 UNIT/MLinsulin glargine

BRAND 2

LEVEMIR FLEXPEN SOLN PEN 100 UNIT/MLinsulin detemir

BRAND 2



LEVEMIR FLEXTOUCH SOLN PEN 100UNIT/MLinsulin detemir

BRAND 2

LEVEMIR SOLUTION 100 UNIT/MLinsulin detemir

BRAND 2

NOVOLIN 70/30 RELION SUSPENSION (70-30) 100 UNIT/MLinsulin isophane & reg (human)

BRAND 2

NOVOLIN 70/30 SUSPENSION (70-30) 100UNIT/MLinsulin isophane & reg (human)

BRAND 2

NOVOLIN N RELION SUSPENSION 100UNIT/MLinsulin isophane (human)

BRAND 2

NOVOLIN N SUSPENSION 100 UNIT/MLinsulin nph (human) (isophane)

BRAND 2

NOVOLIN R RELION SOLUTION 100UNIT/MLinsulin regular (human)

BRAND 2

NOVOLIN R SOLUTION 100 UNIT/MLinsulin regular (human)

BRAND 2

NOVOLOG FLEXPEN SOLN PEN 100UNIT/MLinsulin aspart

BRAND 2

NOVOLOG MIX 70/30 FLEXPEN SUSP PEN(70-30) 100 UNIT/MLinsulin aspart protamine & aspart (human)

BRAND 2

NOVOLOG MIX 70/30 SUSPENSION (70-30)100 UNIT/MLinsulin aspart protamine & aspart (human)

BRAND 2

NOVOLOG PENFILL SOLN CART 100UNIT/MLinsulin aspart

BRAND 2

NOVOLOG SOLUTION 100 UNIT/MLinsulin aspart

BRAND 2



RELION 70/30 SUSPENSION (70-30) 100UNIT/MLinsulin isophane & reg (human)

BRAND 2

RELION N SUSPENSION 100 UNIT/MLinsulin isophane (human)

BRAND 2

RELION R SOLUTION 100 UNIT/MLinsulin regular (human)

BRAND 2

BLOOD PRODUCTS/MODIFIERS/VOLUME EXPANDERS

ANTICOAGULANTS

COUMADIN RECON SOLN 5 MGwarfarin sodium

BRAND 2

COUMADIN TAB 1 MGwarfarin sodium

BRAND 2


BRAND 2


BRAND 2

COUMADIN TAB 2.5 MGwarfarin sodium

BRAND 2


BRAND 2


BRAND 2


BRAND 2


BRAND 2

COUMADIN TAB 7.5 MGwarfarin sodium

BRAND 2

ELIQUIS TAB 2.5 MGapixaban


ELIQUIS TAB 5 MGapixaban




enoxaparin sodium solution 100 mg/ml generic 4MDS 60 / 30 Days

S

enoxaparin sodium solution 120 mg/0.8ml generic 4MDS 48 / 30 Days

S

enoxaparin sodium solution 150 mg/ml generic 4MDS 60 / 30 Days

S


S

enoxaparin sodium solution 300 mg/3ml generic 4MDS 180 / 30 days

S


S


S


S

fondaparinux sodium solution 10 mg/0.8ml generic 4PA

S

fondaparinux sodium solution 2.5mg/0.5ml

generic 4PA

S


generic 4PA

S

fondaparinux sodium solution 5 mg/0.4ml generic 4PA

S


generic 4

PA

MDS 5.4 / 9 DaysS

MDS2 5.4 / 180 Days

FRAGMIN SOLUTION 10000 UNIT/MLdalteparin sodium

BRAND 4PA

S



FRAGMIN SOLUTION 12500 UNIT/0.5MLdalteparin sodium

BRAND 4PA

S


BRAND 4PA

S

FRAGMIN SOLUTION 18000 UNT/0.72MLdalteparin sodium

BRAND 4PA

S


BRAND 4PA

S

FRAGMIN SOLUTION 25000 UNIT/MLdalteparin sodium

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

heparin (porcine) in d5w solution 40-5unit/ml-%

generic 1

HEPARIN (PORCINE) IN NACL SOLUTION100-0.45 UNIT/ML-%heparin (porcine) in sodium chloride

BRAND 1

HEPARIN (PORCINE) IN NACL SOLUTION50-0.45 UNIT/ML-%heparin (porcine) in sodium chloride

BRAND 1

heparin sodium (porcine) solution 10000unit/ml

generic 1


generic 1


generic 1

jantoven tab 1 mg generic 1





jantoven tab 2.5 mg generic 1





jantoven tab 7.5 mg generic 1

PRADAXA CAP 150 MGdabigatran etexilate mesylate


PRADAXA CAP 75 MGdabigatran etexilate mesylate


warfarin sodium tab 1 mg generic 1



warfarin sodium tab 2.5 mg generic 1





warfarin sodium tab 7.5 mg generic 1

XARELTO TAB 10 MGrivaroxaban






BLOOD FORMATION MODIFIERS

anagrelide hcl cap 0.5 mg generic 1

anagrelide hcl cap 1 mg generic 1



ARANESP (ALBUMIN FREE) SOLN PRSYR200 MCG/0.4MLdarbepoetin alfa

BRAND 4PA

S

ARANESP (ALBUMIN FREE) SOLN PRSYR300 MCG/0.6MLdarbepoetin alfa

BRAND 4PA

S

ARANESP (ALBUMIN FREE) SOLN PRSYR500 MCG/MLdarbepoetin alfa

BRAND 4PA

S

ARANESP (ALBUMIN FREE) SOLUTION 100MCG/MLdarbepoetin alfa

BRAND 4PA

S


BRAND 4 S


BRAND 4PA

S


BRAND 4PA

S

EPOGEN SOLUTION 10000 UNIT/MLepoetin alfa

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

LEUKINE RECON SOLN 250 MCGsargramostim

BRAND 4PA

S



LEUKINE SOLUTION 500 MCG/MLsargramostim

BRAND 4PA

S

MOZOBIL SOLUTION 24 MG/1.2MLplerixafor

BRAND 4PA

S

NEULASTA ONPRO PREF SY KT 6 MG/0.6MLpegfilgrastim

BRAND 4PA

S

NEULASTA SOLN PRSYR 6 MG/0.6MLpegfilgrastim

BRAND 4PA

S

NEUPOGEN SOLN PRSYR 300 MCG/0.5MLfilgrastim

BRAND 4PA

S

NEUPOGEN SOLN PRSYR 480 MCG/0.8MLfilgrastim

BRAND 4PA

S

NEUPOGEN SOLUTION 300 MCG/MLfilgrastim

BRAND 4PA

S

NEUPOGEN SOLUTION 480 MCG/1.6MLfilgrastim

BRAND 4PA

S

NPLATE RECON SOLN 250 MCGromiplostim

BRAND 4PA

S

NPLATE RECON SOLN 500 MCGromiplostim

BRAND 4PA

S

OMONTYS SOLUTION 10 MG/MLpeginesatide acetate

BRAND 3

PROCRIT SOLUTION 10000 UNIT/MLepoetin alfa

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S




BRAND 4PA

S


BRAND 4PA

S

PROMACTA TAB 12.5 MGeltrombopag olamine

BRAND 4PA

S

PROMACTA TAB 25 MGeltrombopag olamine

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

COAGULANTS

tranexamic acid solution 1000 mg/10ml generic 1

tranexamic acid tab 650 mg generic 1

PLATELET MODIFYING AGENTS

AGGRENOX CAP ER 12H 25-200 MGaspirin-dipyridamole

BRAND 2PA

MDD 2 per day

aspirin-dipyridamole er cap er 12h 25-200mg

generic 1PA

MDD 2 per day

BRILINTA TAB 90 MGticagrelor

BRAND 2

cilostazol tab 100 mg generic 1

cilostazol tab 50 mg generic 1

clopidogrel bisulfate tab 300 mg generic 1

clopidogrel bisulfate tab 75 mg generic 1 MDD 1 per day

dipyridamole tab 25 mg generic 1





EFFIENT TAB 10 MGprasugrel hcl


EFFIENT TAB 5 MGprasugrel hcl


REOPRO SOLUTION 2 MG/MLabciximab

BRAND 3

ticlopidine hcl tab 250 mg generic 1

CARDIOVASCULAR AGENTS

ALPHA-ADRENERGIC AGONISTS

clonidine hcl tab 0.1 mg generic 1 MDD 8 per day



guanabenz acetate tab 4 mg generic 1

guanabenz acetate tab 8 mg generic 1

guanfacine hcl tab 1 mg generic 1

guanfacine hcl tab 2 mg generic 1

methyldopa tab 250 mg generic 1 MDD 6 per day

methyldopa tab 500 mg generic 1 MDD 6 per day

methyldopate hcl solution 250 mg/5ml generic 3

midodrine hcl tab 10 mg generic 1

midodrine hcl tab 2.5 mg generic 1

midodrine hcl tab 5 mg generic 1

ALPHA-ADRENERGIC BLOCKING AGENTS

DIBENZYLINE CAP 10 MGphenoxybenzamine hcl

BRAND 3

doxazosin mesylate tab 1 mg generic 1






phenoxybenzamine hcl cap 10 mg generic 3

prazosin hcl cap 1 mg generic 1 MDD 4 per day



ANGIOTENSIN II RECEPTOR ANTAGONISTS

BENICAR TAB 20 MGolmesartan medoxomil






candesartan cilexetil tab 16 mg generic 1 MDD 1 per day




EDARBI TAB 40 MGazilsartan medoxomil

BRAND 3ST

MDD 1 per day

EDARBI TAB 80 MGazilsartan medoxomil

BRAND 3ST

MDD 1 per day

eprosartan mesylate tab 600 mg generic 1 MDD 1 per day

irbesartan tab 150 mg generic 1 MDD 1 per day



losartan potassium tab 100 mg generic 1 MDD 1 per day





MICARDIS TAB 20 MGtelmisartan






telmisartan tab 20 mg generic 1 MDD 1 per day



TEVETEN TAB 400 MGeprosartan mesylate

BRAND 3ST

MDD 2 per day

TEVETEN TAB 600 MGeprosartan mesylate

BRAND 3ST

MDD 1 per day

valsartan tab 160 mg generic 1 MDD 1 per day




ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS

benazepril hcl tab 10 mg generic 1




captopril tab 100 mg generic 1

captopril tab 12.5 mg generic 1



enalapril maleate 10 mg generic 1



enalapril maleate 5 mg generic 1

enalapril maleate tab 10 mg generic 1

enalapril maleate tab 2.5 mg generic 1



fosinopril sodium 10 mg generic 1



fosinopril sodium tab 10 mg generic 1



lisinopril 2.5 mg generic 1

lisinopril 20 mg generic 1



lisinopril tab 10 mg generic 1

lisinopril tab 2.5 mg generic 1





moexipril hcl tab 15 mg generic 1

moexipril hcl tab 7.5 mg generic 1

perindopril erbumine tab 2 mg generic 1



quinapril hcl tab 10 mg generic 1






ramipril cap 1.25 mg generic 1

ramipril cap 10 mg generic 1

ramipril cap 2.5 mg generic 1

ramipril cap 5 mg generic 1

trandolapril tab 1 mg generic 1



ANTIARRHYTHMICS

amiodarone hcl 150 mg/3ml generic 1

amiodarone hcl solution 150 mg/3ml generic 1

AMIODARONE HCL SOLUTION 900MG/18MLamiodarone hcl

BRAND 1

amiodarone hcl tab 100 mg generic 1



disopyramide phosphate cap 100 mg generic 1

disopyramide phosphate cap 150 mg generic 1

flecainide acetate tab 100 mg generic 1



mexiletine hcl cap 150 mg generic 1



MULTAQ TAB 400 MGdronedarone hcl

BRAND 3



pacerone tab 100 mg generic 1



PROCAINAMIDE HCL SOLUTION 500MG/MLprocainamide hcl

BRAND 1

propafenone hcl er cap er 12h 225 mg generic 1



propafenone hcl tab 150 mg generic 1



quinidine sulfate er tab er 300 mg generic 1

quinidine sulfate tab 200 mg generic 1

quinidine sulfate tab 300 mg generic 1

sorine tab 120 mg generic 1 MDD 2 per day


sorine tab 240 mg generic 1


sotalol hcl tab 120 mg generic 1 MDD 2 per day


sotalol hcl tab 240 mg generic 1


TIKOSYN CAP 125 MCGdofetilide

BRAND 2


BRAND 2


BRAND 2



BETA-ADRENERGIC BLOCKING AGENTS

acebutolol hcl cap 200 mg generic 1

acebutolol hcl cap 400 mg generic 1

atenolol tab 100 mg generic 1



betaxolol hcl tab 10 mg generic 1

betaxolol hcl tab 20 mg generic 1

bisoprolol fumarate tab 10 mg generic 1

bisoprolol fumarate tab 5 mg generic 1

BYSTOLIC TAB 10 MGnebivolol hcl


BYSTOLIC TAB 2.5 MGnebivolol hcl






carvedilol tab 12.5 mg generic 1

carvedilol tab 25 mg generic 1



labetalol hcl solution 5 mg/ml generic 1

labetalol hcl tab 100 mg generic 1



LEVATOL TAB 20 MGpenbutolol sulfate

BRAND 3

metoprolol succinate er tab er 24h 100 mg generic 1






metoprolol tartrate solution 1 mg/ml generic 1

metoprolol tartrate solution 5 mg/5ml generic 1

metoprolol tartrate tab 100 mg generic 1



nadolol tab 20 mg generic 1



pindolol tab 10 mg generic 1

pindolol tab 5 mg generic 1

propranolol hcl er cap er 24h 120 mg generic 1




propranolol hcl solution 1 mg/ml generic 1

propranolol hcl solution 20 mg/5ml generic 1

propranolol hcl solution 40 mg/5ml generic 1

propranolol hcl tab 10 mg generic 1





timolol maleate tab 10 mg generic 1





CALCIUM CHANNEL BLOCKING AGENTS

afeditab cr tab er 24h 30 mg generic 1

afeditab cr tab er 24h 60 mg generic 1

amlodipine besylate tab 10 mg generic 1

amlodipine besylate tab 2.5 mg generic 1

amlodipine besylate tab 5 mg generic 1

cartia xt cap er 24h 120 mg generic 1




dilt-cd cap er 24h 120 mg generic 1




dilt-xr cap er 24h 120 mg generic 1



diltiazem cd cap er 24h 120 mg generic 1



diltiazem hcl er beads cap er 24h 120 mg generic 1





diltiazem hcl er cap er 12h 120 mg generic 1








diltiazem hcl er coated beads cap er 24h120 mg

generic 1


generic 1


generic 1


generic 1


generic 1

diltiazem hcl er coated beads tab er 24h180 mg

generic 1


generic 1


generic 1


generic 1


generic 1

DILTIAZEM HCL RECON SOLN 100 MGdiltiazem hcl

BRAND 1

diltiazem hcl solution 50 mg/10ml generic 1

diltiazem hcl tab 120 mg generic 1






diltzac cap er 24h 120 mg generic 1





felodipine er tab er 24h 10 mg generic 1

felodipine er tab er 24h 2.5 mg generic 1

felodipine er tab er 24h 5 mg generic 1

isradipine cap 2.5 mg generic 1

isradipine cap 5 mg generic 1

matzim la tab er 24h 180 mg generic 1





nicardipine hcl cap 20 mg generic 1

nicardipine hcl cap 30 mg generic 1

nicardipine hcl solution 2.5 mg/ml generic 1

nifediac cc tab er 24h 30 mg generic 1



nifedical xl tab er 24h 30 mg generic 1

nifedical xl tab er 24h 60 mg generic 1

nifedipine cap 10 mg generic 1

nifedipine cap 20 mg generic 1

nifedipine er osmotic release tab er 24h 30mg

generic 1



nifedipine er osmotic release tab er 24h 60mg

generic 1

nifedipine er osmotic tab er 24h 30 mg generic 1



nifedipine er tab er 24h 30 mg generic 1



nimodipine cap 30 mg generic 1

nisoldipine er tab er 24h 17 mg generic 1





nisoldipine er tab er 24h 8.5 mg generic 1

taztia xt cap er 24h 120 mg generic 1





verapamil hcl er 120 mg generic 1

verapamil hcl er cap er 24h 100 mg generic 1









verapamil hcl er tab er 120 mg generic 1



verapamil hcl solution 2.5 mg/ml generic 1

verapamil hcl tab 120 mg generic 1



CARDIOVASCULAR AGENTS, OTHER

amiloride-hydrochlorothiazide tab 5-50 mg generic 1

amlodipine besy-benazepril hcl cap 10-20mg

generic 1


generic 1

amlodipine besy-benazepril hcl cap 2.5-10mg

generic 1


generic 1


generic 1


generic 1

atenolol-chlorthalidone tab 100-25 mg generic 1

atenolol-chlorthalidone tab 50-25 mg generic 1

benazepril-hydrochlorothiazide 20-12.5 mg generic 1

benazepril-hydrochlorothiazide 20-25 mg generic 1

benazepril-hydrochlorothiazide tab 10-12.5mg

generic 1


generic 1

benazepril-hydrochlorothiazide tab 20-25mg

generic 1




generic 1

BIDIL TAB 20-37.5 MGisosorbide dinitrate-hydralazine hcl

BRAND 2

digitek tab 125 mcg generic 1

digitek tab 250 mcg generic 1

digox tab 125 mcg generic 1

digox tab 250 mcg generic 1

digoxin solution 0.05 mg/ml generic 1

digoxin solution 0.25 mg/ml generic 1

digoxin tab 125 mcg generic 1

digoxin tab 250 mcg generic 1

enalapril-hydrochlorothiazide tab 10-25 mg generic 1

enalapril-hydrochlorothiazide tab 5-12.5mg

generic 1

fosinopril sodium-hctz tab 10-12.5 mg generic 1

fosinopril sodium-hctz tab 20-12.5 mg generic 1

LANOXIN SOLUTION 0.25 MG/MLdigoxin

BRAND 2

LANOXIN TAB 125 MCGdigoxin

BRAND 2

LANOXIN TAB 187.5 MCGdigoxin

BRAND 2

LANOXIN TAB 250 MCGdigoxin

BRAND 2

LANOXIN TAB 62.5 MCGdigoxin

BRAND 2

lisinopril-hydrochlorothiazide 10-12.5 mg generic 1

lisinopril-hydrochlorothiazide 20-12.5 mg generic 1

lisinopril-hydrochlorothiazide 20-25 mg generic 1



lisinopril-hydrochlorothiazide tab 10-12.5mg

generic 1

lisinopril-hydrochlorothiazide tab 20-12.5mg

generic 1

lisinopril-hydrochlorothiazide tab 20-25 mg generic 1

losartan potassium-hctz tab 100-12.5 mg generic 1 MDD 1 per day

losartan potassium-hctz tab 100-25 mg generic 1 MDD 1 per day

losartan potassium-hctz tab 50-12.5 mg generic 1 MDD 1 per day

pentoxifylline er tab er 400 mg generic 1 MDD 3 per day

RANEXA TAB ER 12H 500 MGranolazine


spironolactone-hctz tab 25-25 mg generic 1

TEKTURNA TAB 150 MGaliskiren fumarate


TEKTURNA TAB 300 MGaliskiren fumarate


triamterene-hctz cap 37.5-25 mg generic 1

triamterene-hctz tab 37.5-25 mg generic 1

triamterene-hctz tab 75-50 mg generic 1

valsartan-hydrochlorothiazide tab 160-12.5mg

generic 1

valsartan-hydrochlorothiazide tab 160-25mg

generic 1


generic 1

valsartan-hydrochlorothiazide tab 320-25mg

generic 1


generic 1



DIURETICS, CARBONIC ANHYDRASE INHIBITORS

acetazolamide er cap er 12h 500 mg generic 1 MDD 2 per day

acetazolamide sodium recon soln 500 mg generic 1

acetazolamide tab 125 mg generic 1 MDD 8 per day

acetazolamide tab 250 mg generic 1 MDD 4 per day

DIURETICS, LOOP

bumetanide solution 0.25 mg/ml generic 1

bumetanide tab 0.5 mg generic 1 MDD 5 per day

bumetanide tab 1 mg generic 1 MDD 5 per day

bumetanide tab 2 mg generic 1 MDD 5 per day

EDECRIN TAB 25 MGethacrynic acid


furosemide solution 10 mg/ml generic 1



furosemide tab 20 mg generic 1



torsemide solution 20 mg/2ml generic 1

torsemide tab 10 mg generic 1




DIURETICS, POTASSIUM-SPARING

amiloride hcl tab 5 mg generic 1

DYRENIUM CAP 100 MGtriamterene




DYRENIUM CAP 50 MGtriamterene


eplerenone tab 25 mg generic 1

eplerenone tab 50 mg generic 1

spironolactone tab 100 mg generic 1



DIURETICS, THIAZIDE

chlorothiazide tab 250 mg generic 1

chlorothiazide tab 500 mg generic 1

chlorthalidone tab 25 mg generic 1

chlorthalidone tab 50 mg generic 1

hydrochlorothiazide cap 12.5 mg generic 1 MDD 2 per day

hydrochlorothiazide tab 12.5 mg generic 1 MDD 2 per day

hydrochlorothiazide tab 25 mg generic 1 MDD 2 per day

hydrochlorothiazide tab 50 mg generic 1 MDD 2 per day

indapamide tab 1.25 mg generic 1 MDD 1 per day

indapamide tab 2.5 mg generic 1 MDD 2 per day

methyclothiazide tab 5 mg generic 1

metolazone tab 10 mg generic 1 MDD 2 per day

metolazone tab 2.5 mg generic 1 MDD 2 per day

metolazone tab 5 mg generic 1 MDD 2 per day

DYSLIPIDEMICS, FIBRIC ACID DERIVATIVES

fenofibrate micronized cap 134 mg generic 1 MDD 1 per day





fenofibrate tab 145 mg generic 1 MDD 1 per day




gemfibrozil tab 600 mg generic 1 MDD 2 per day

DYSLIPIDEMICS, HMG COA REDUCTASE INHIBITORS

ALTOPREV TAB ER 24H 20 MGlovastatin






atorvastatin calcium tab 10 mg generic 1 MDD 1 per day




CRESTOR TAB 10 MGrosuvastatin calcium

BRAND 2 ST


BRAND 2 ST


BRAND 2 ST


BRAND 2 ST

fluvastatin sodium cap 20 mg generic 3 MDD 1 per day

fluvastatin sodium cap 40 mg generic 3 MDD 2 per day

LIVALO TAB 1 MGpitavastatin calcium

BRAND 3ST

MDD 1 per day


BRAND 3ST

MDD 1 per day




BRAND 3ST

MDD 1 per day

lovastatin tab 10 mg generic 1 MDD 1 per day



pravastatin sodium 40 mg generic 1 MDD 1 per day

pravastatin sodium tab 10 mg generic 1 MDD 1 per day




simvastatin tab 10 mg generic 1 MDD 1 per day





DYSLIPIDEMICS, OTHER

ADVICOR TAB ER 24H 1000-20 MGniacin-lovastatin

BRAND 3PA

MDD 2 per day


BRAND 3PA

MDD 1 per day


BRAND 3PA

MDD 1 per day


BRAND 3PA

MDD 1 per day

cholestyramine light packet 4 gm generic 1 MDD 6 per day

cholestyramine light powder 4 gm/dose generic 1 MDS 720 / 30 days

cholestyramine packet 4 gm generic 1 MDD 6 per day



cholestyramine powder 4 gm/dose generic 1 MDS 756 / 30 days

colestipol hcl granules 5 gm generic 1 MDD 6 per day

colestipol hcl packet 5 gm generic 1 MDD 6 per day

colestipol hcl tab 1 gm generic 1 MDD 16 per day

niacin er (antihyperlipidemic) tab er 1000mg






NIASPAN TAB ER 1000 MGniacin (antihyperlipidemic)

BRAND 2ST

MDD 2 per day





omega-3-acid ethyl esters cap 1 gm generic 1ST

MDD 4 per day

prevalite packet 4 gm generic 1 MDD 6 per day

prevalite powder 4 gm/dose generic 1 MDS 720 / 30 days

SIMCOR TAB ER 24H 1000-20 MGniacin-simvastatin

BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 1 per day


BRAND 2PA

MDD 1 per day


BRAND 2PA

MDD 1 per day


BRAND 2PA

MDD 1 per day



VYTORIN TAB 10-10 MGezetimibe-simvastatin

BRAND 2ST

MDD 1 per day


BRAND 2ST

MDD 1 per day


BRAND 2ST

MDD 1 per day


BRAND 2ST

MDD 1 per day

WELCHOL PACKET 3.75 GMcolesevelam hcl


WELCHOL TAB 625 MGcolesevelam hcl


ZETIA TAB 10 MGezetimibe

BRAND 2ST

MDD 1 per day

VASODILATORS, DIRECT-ACTING ARTERIAL

hydralazine hcl solution 20 mg/ml generic 1

hydralazine hcl tab 10 mg generic 1




minoxidil tab 10 mg generic 1

minoxidil tab 2.5 mg generic 1

VASODILATORS, DIRECT-ACTING ARTERIAL/VENOUS

isochron tab er 40 mg generic 1

isoditrate er tab er 40 mg generic 1

isosorbide dinitrate er tab er 40 mg generic 1

isosorbide dinitrate tab 10 mg generic 1






isosorbide mononitrate er tab er 24h 120mg

generic 1

isosorbide mononitrate er tab er 24h 30 mg generic 1

isosorbide mononitrate er tab er 24h 60 mg generic 1

isosorbide mononitrate tab 20 mg generic 1

minitran patch 24hr 0.1 mg/hr generic 1




MONOKET TAB 20 MGisosorbide mononitrate

BRAND 3

NITRO-BID OINTMENT 2 %nitroglycerin

BRAND 3

nitroglycerin patch 24hr 0.1 mg/hr generic 1




nitroglycerin solution 5 mg/ml generic 1

NITROSTAT SL TAB 0.3 MGnitroglycerin

BRAND 2


BRAND 2


BRAND 2

CENTRAL NERVOUS SYSTEM AGENTS

ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, AMPHETAMINES

amphetamine-dextroamphet er cap er 24h10 mg

generic 1AL 6 to 18 yrs old

MDD 1 per day




generic 1 AL 6 to 18 yrs old



MDD 2 per day



MDD 2 per day



MDD 2 per day



MDD 1 per day

amphetamine-dextroamphetamine tab 10mg


MDD 3 per day

amphetamine-dextroamphetamine tab12.5 mg


MDD 3 per day



MDD 3 per day



MDD 3 per day


generic 1 AL At least 6 yrs old



MDD 3 per day

amphetamine-dextroamphetamine tab 7.5mg


MDD 3 per day

DESOXYN TAB 5 MGmethamphetamine hcl

BRAND 3AL At least 6 yrs old

MDD 5 per day

dexedrine tab 10 mg generic 1AL At least 6 yrs old

MDD 4 per day

dexedrine tab 5 mg generic 1AL At least 6 yrs old

MDD 4 per day



dextroamphetamine sulfate er cap er 24h10 mg


MDD 4 per day

dextroamphetamine sulfate er cap er 24h15 mg


MDD 4 per day

dextroamphetamine sulfate er cap er 24h 5mg


dextroamphetamine sulfate tab 10 mg generic 1AL At least 6 yrs old

MDD 4 per day

dextroamphetamine sulfate tab 5 mg generic 1AL At least 6 yrs old

MDD 4 per day

methamphetamine hcl tab 5 mg generic 3AL At least 6 yrs old

MDD 5 per day

VYVANSE CAP 10 MGlisdexamfetamine dimesylate

BRAND 2AL 6 to 17 yrs old

MDD 1 per day



MDD 1 per day



MDD 1 per day



MDD 1 per day



MDD 1 per day



MDD 1 per day



MDD 1 per day

zenzedi tab 10 mg generic 1AL At least 6 yrs old

MDD 4 per day

zenzedi tab 5 mg generic 1AL At least 6 yrs old

MDD 4 per day



ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, NON-AMPHETAMINES

dexmethylphenidate hcl tab 10 mg generic 1AL At least 6 yrs old

MDD 2 per day

dexmethylphenidate hcl tab 2.5 mg generic 1AL At least 6 yrs old

MDD 2 per day

dexmethylphenidate hcl tab 5 mg generic 1AL At least 6 yrs old

MDD 2 per day

guanfacine hcl er tab er 24h 1 mg generic 1

PA



PA



PA



PA


INTUNIV TAB ER 24H 1 MGguanfacine hcl (adhd)

BRAND 2

PA



BRAND 2

PA



BRAND 2

PA



BRAND 2

PA




metadate er tab er 20 mg generic 1AL 6 to 18 yrs old

MDD 3 per day

methylin er tab er 10 mg generic 1AL 6 to 18 yrs old

MDD 3 per day

methylin er tab er 20 mg generic 1AL 6 to 18 yrs old

MDD 3 per day

methylin tab 10 mg generic 1AL At least 6 yrs old

MDD 5 per day


MDD 5 per day


MDD 5 per day

methylphenidate hcl er (cd) cap er 10 mg generic 1AL 6 to 18 yrs old

MDD 1 per day


MDD 1 per day


MDD 1 per day


MDD 1 per day


MDD 1 per day


MDD 1 per day

methylphenidate hcl er (la) cap er 24h 20mg






MDD 3 per day





MDD 3 per day





methylphenidate hcl er tab er 10 mg generic 1AL 6 to 18 yrs old

MDD 3 per day


MDD 1 per day


MDD 3 per day

methylphenidate hcl er tab er 24h 18 mg generic 1AL 6 to 18 yrs old

MDD 1 per day


MDD 1 per day

METHYLPHENIDATE HCL ER TAB ER 24H 27MGmethylphenidate hcl


MDD 1 per day


MDD 2 per day



MDD 2 per day


MDD 2 per day



MDD 2 per day


MDD 1 per day




MDD 2 per day


MDD 2 per day

methylphenidate hcl solution 10 mg/5ml generic 1AL At least 6 yrs old

MDS 900 / 30 Days

methylphenidate hcl solution 5 mg/5ml generic 1AL At least 6 yrs old

MDS 900 / 30 Days

methylphenidate hcl tab 10 mg generic 1AL At least 6 yrs old

MDD 5 per day


MDD 5 per day


MDD 5 per day

STRATTERA CAP 10 MGatomoxetine hcl

BRAND 2

PA



BRAND 2

PA



BRAND 2

PA



BRAND 2

PA



BRAND 2

PA





BRAND 2

PA


CENTRAL NERVOUS SYSTEM, OTHER

butalbital-apap-caffeine cap 50-300-40 mg generic 1

butalbital-apap-caffeine cap 50-325-40 mg generic 1

butalbital-apap-caffeine tab 50-325-40 mg generic 1

butalbital-apap-caffeine tab 50-500-40 mg generic 1

butalbital-asa-caffeine cap 50-325-40 mg generic 1

butalbital-aspirin-caffeine cap 50-325-40mg

generic 1

capacet cap 50-325-40 mg generic 1

esgic cap 50-325-40 mg generic 1

HORIZANT TAB ER 600 MGgabapentin enacarbil

BRAND 3

margesic cap 50-325-40 mg generic 1

NUEDEXTA CAP 20-10 MGdextromethorphan hbr-quinidine sulfate

BRAND 3

ORBIVAN CAP 50-300-40 MGbutalbital-acetaminophen-caffeine

BRAND 2

repan tab 50-325-40 mg generic 1

RILUTEK TAB 50 MGriluzole

BRAND 3

riluzole tab 50 mg generic 3

tetrabenazine tab 12.5 mg generic 4PA

S

tetrabenazine tab 25 mg generic 4PA

S

XENAZINE TAB 12.5 MGtetrabenazine

BRAND 4PA

S



XENAZINE TAB 25 MGtetrabenazine

BRAND 4PA

S

zebutal cap 50-325-40 mg generic 1

zebutal cap 50-500-40 mg generic 1

FIBROMYALGIA AGENTS

duloxetine hcl cp dr part 20 mg generic 1 MDD 2 per day



LYRICA CAP 100 MGpregabalin

BRAND 2PA

MDD 3 per day


BRAND 2PA

MDD 3 per day


BRAND 2PA

MDD 3 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 3 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 3 per day


BRAND 2PA

MDD 3 per day

LYRICA SOLUTION 20 MG/MLpregabalin


SAVELLA TAB 100 MGmilnacipran hcl

BRAND 2PA

MDD 2 per day



SAVELLA TAB 12.5 MGmilnacipran hcl

BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day


BRAND 2PA

MDD 2 per day

SAVELLA TITRATION PACK MISC 12.5 & 25& 50 MGmilnacipran hcl

BRAND 2 PA

MULTIPLE SCLEROSIS AGENTS

AMPYRA TAB ER 12H 10 MGdalfampridine

BRAND 4PA

S

AVONEX KIT 30 MCGinterferon beta-1a

BRAND 4PA

S

AVONEX PEN AUT-IJ KIT 30 MCG/0.5MLinterferon beta-1a

BRAND 4PA

S

AVONEX PREFILLED PREF SY KT 30MCG/0.5MLinterferon beta-1a

BRAND 4PA

S

AVONEX PREFILLED PREF SY KT 30MCG/0.5MLinterferon beta-1a

BRAND 4PA

S

BETASERON KIT 0.3 MGinterferon beta-1b

BRAND 4PA

S

COPAXONE SOLN PRSYR 20 MG/MLglatiramer acetate

BRAND 4PA

S

COPAXONE SOLN PRSYR 40 MG/MLglatiramer acetate

BRAND 4PA

S

EXTAVIA KIT 0.3 MGinterferon beta-1b

BRAND 4PA

S



GILENYA CAP 0.5 MGfingolimod hcl

BRAND 4PA

S

glatopa soln prsyr 20 mg/ml generic 4PA

S

REBIF REBIDOSE SOLN A-INJ 22MCG/0.5MLinterferon beta-1a

BRAND 4PA

S

REBIF REBIDOSE SOLN A-INJ 44MCG/0.5MLinterferon beta-1a

BRAND 4PA

S

REBIF REBIDOSE TITRATION PACK SOLN A-INJ 6X8.8 & 6X22 MCGinterferon beta-1a

BRAND 4PA

S

REBIF SOLN PRSYR 22 MCG/0.5MLinterferon beta-1a

BRAND 4PA

S

REBIF SOLN PRSYR 44 MCG/0.5MLinterferon beta-1a

BRAND 4PA

S

REBIF TITRATION PACK SOLN PRSYR 6X8.8& 6X22 MCGinterferon beta-1a

BRAND 4PA

S

TYSABRI CONC 300 MG/15MLnatalizumab

BRAND 4PA

S

ZINBRYTA SOLN PRSYR 150 MG/MLdaclizumab (multiple sclerosis)

BRAND 4 PA

DENTAL AND ORAL AGENTS

ARESTIN MISC 1 MGminocycline hcl (subgingival)

BRAND 3 PA

cevimeline hcl cap 30 mg generic 1

chlorhexidine gluconate solution 0.12 % generic 1

GEL-KAM ORAL CARE RINSE CONC 0.63 %stannous fluoride

BRAND 0

KEPIVANCE RECON SOLN 6.25 MGpalifermin

BRAND 4PA

S



paroex solution 0.12 % generic 1

periogard solution 0.12 % generic 1

pilocarpine hcl tab 5 mg generic 1

pilocarpine hcl tab 7.5 mg generic 1

stannous fluoride conc 0.63 % generic 0

DERMATOLOGICAL AGENTS

acitretin cap 10 mg generic 1 MDD 1 per day

acitretin cap 17.5 mg generic 1 MDD 1 per day

acitretin cap 25 mg generic 1 MDD 2 per day

adapalene cream 0.1 % generic 1PA


adapalene gel 0.1 % generic 1PA


adapalene gel 0.3 % generic 1ST


ADAPALENE LOTION 0.1 %adapalene

BRAND 1ST


ala cort cream 1 % generic 1

ammonium lactate cream 12 % generic 1

ammonium lactate lotion 12 % generic 1

amnesteem cap 10 mg generic 3PA






avar cleanser emulsion 10-5 % generic 1 AL At least 12 yrs old

avar-e emollient cream 10-5 % generic 1ST




avar-e green cream 10-5 % generic 1ST


avita cream 0.025 % generic 1 AL At least 12 yrs old

avita gel 0.025 % generic 1 AL At least 12 yrs old

AZELEX CREAM 20 %azelaic acid (acne)

BRAND 3ST


benzepro creamy wash liquid 7 % generic 1 AL At least 12 yrs old

benzepro foam 5.3 % generic 1 AL At least 12 yrs old

benzepro short contact foam 9.8 % generic 1 AL At least 12 yrs old

benzoyl peroxide cleanser lotion 6 % generic 1 AL At least 12 yrs old

benzoyl peroxide creamy wash liquid 4 % generic 1 AL At least 12 yrs old

benzoyl peroxide foam 5.3 % generic 1 AL At least 12 yrs old

benzoyl peroxide foam 9.8 % generic 1 AL At least 12 yrs old

benzoyl peroxide gel 10 % generic 1 AL At least 12 yrs old

benzoyl peroxide gel 5 % generic 1 AL At least 12 yrs old

benzoyl peroxide short contact foam 9.8 % generic 1 AL At least 12 yrs old

benzoyl peroxide wash liquid 10 % generic 1 AL At least 12 yrs old

benzoyl peroxide wash liquid 7 % generic 1 AL At least 12 yrs old

benzoyl peroxide-erythromycin gel 5-3 % generic 1

PA

AL At least 12 yrs oldMPL 1 / Claim

bp foam foam 5.3 % generic 1 AL At least 12 yrs old

bp foam foam 9.8 % generic 1 AL At least 12 yrs old

bp foaming wash liquid 10 % generic 1 AL At least 12 yrs old

bp wash liquid 7 % generic 1 AL At least 12 yrs old

bp wash liquid 7 % generic 1 AL At least 12 yrs old



calcipotriene cream 0.005 % generic 1 MPL 1 / claim

calcipotriene ointment 0.005 % generic 1 MPL 1 / claim

calcipotriene solution 0.005 % generic 1 MPL 1 / claim

calcipotriene-betameth diprop ointment0.005-0.064 %

generic 1 ST

calcitrene ointment 0.005 % generic 1 MPL 1 / claim

calcitriol ointment 3 mcg/gm generic 1 MPL 1 / Claim

claravis cap 10 mg generic 3PA








clenia cream 10-5 % generic 1ST


clenia foaming wash emulsion 10-5 % generic 1 AL At least 12 yrs old

clindacin etz swab 1 % generic 1 AL At least 12 yrs old

clindacin-p swab 1 % generic 1 AL At least 12 yrs old

clindamycin phos-benzoyl perox gel 1-5 % generic 1PA


clindamycin phos-benzoyl perox gel 1.2-5 % generic 1PA


clindamycin phosphate swab 1 % generic 1 AL At least 12 yrs old

clotrimazole-betamethasone cream 1-0.05%

generic 1

clotrimazole-betamethasone lotion 1-0.05%

generic 1



CORTISPORIN CREAM 3.5-10000-0.5neomycin-polymyxin-hc

BRAND 2

CORTISPORIN OINTMENT 1 %bacitracin-polymyxin-neomycin hc

BRAND 2

diclofenac sodium gel 1 % generic 1

diclofenac sodium gel 3 % generic 1 MPL 1 / claim

DIFFERIN LOTION 0.1 %adapalene

BRAND 2ST


ELIDEL CREAM 1 %pimecrolimus

BRAND 2

PA

AL At least 2 yrs oldMPL 1 / 30 days

EPIDUO GEL 0.1-2.5 %adapalene-benzoyl peroxide

BRAND 3ST


FINACEA GEL 15 %azelaic acid

BRAND 2

finasteride tab 1 mg generic 1

fluorouracil cream 5 % generic 1 MPL 1 / Claim

fluorouracil solution 2 % generic 1 MPL 1 / claim

fluorouracil solution 5 % generic 1 MPL 1 / claim

hydrocortisone cream 1 % generic 1

hydrocortisone cream 2.5 % generic 1

hydrocortisone lotion 2.5 % generic 1

hydrocortisone ointment 1 % generic 1

hydrocortisone ointment 2.5 % generic 1

imiquimod cream 5 % generic 1 MDS 12 / claim

laclotion lotion 12 % generic 1

lavoclen-4 creamy wash liquid 4 % generic 1 AL At least 12 yrs old




lidocaine ointment 5 % generic 1

lidocaine pak ointment 5 % generic 1

lidocaine patch 5 % generic 1

LIDODERM PATCH 5 %lidocaine

BRAND 2

methoxsalen rapid cap 10 mg generic 1 MDD 4 per day

myorisan cap 10 mg generic 3PA








neuac gel 1.2-5 % generic 1PA


oscion cleanser lotion 6 % generic 1 AL At least 12 yrs old

OXSORALEN LOTION 1 %methoxsalen (topical)

BRAND 2

OXSORALEN ULTRA CAP 10 MGmethoxsalen rapid


pacnex wash liquid 7 % generic 1 AL At least 12 yrs old

PICATO GEL 0.015 %ingenol mebutate

BRAND 2

PICATO GEL 0.05 %ingenol mebutate

BRAND 2

podofilox solution 0.5 % generic 1

pr benzoyl peroxide wash liquid 7 % generic 1 AL At least 12 yrs old

pr benzoyl peroxide wash liquid 7 % generic 1 AL At least 12 yrs old



prascion emulsion 10-5 % generic 1 AL At least 12 yrs old

premium lidocaine ointment 5 % generic 1

PRUDOXIN CREAM 5 %doxepin hcl (antipruritic)

BRAND 3

RECTIV OINTMENT 0.4 %nitroglycerin (intra-anal)

BRAND 3

REGRANEX GEL 0.01 %becaplermin

BRAND 3

rosaderm emulsion 10-5 % generic 1 AL At least 12 yrs old

rosanil cleanser emulsion 10-5 % generic 1 AL At least 12 yrs old

SANTYL OINTMENT 250 UNIT/GMcollagenase

BRAND 3

se 10-5 ss cream 10-5 % generic 1ST


se bpo wash liquid 7 % generic 1 AL At least 12 yrs old

selenium sulfide lotion 2.5 % generic 1 MPL 1 / Claim

SOLARAZE GEL 3 %diclofenac sodium (actinic keratoses)


SORIATANE CAP 10 MGacitretin


SORIATANE CAP 17.5 MGacitretin


SORIATANE CAP 25 MGacitretin


sotret cap 20 mg generic 3PA


sss 10-5 cream 10-5 % generic 1ST


STELARA SOLN PRSYR 45 MG/0.5MLustekinumab

BRAND 4PA

S



STELARA SOLN PRSYR 90 MG/MLustekinumab

BRAND 4PA

S

sulfacetamide sod-sulfur wash emulsion10-5 %


sulfacetamide sodium (acne) lotion 10 % generic 1AL At least 12 yrs old

MPL 1 / Claim

sulfacetamide sodium suspension 10 % generic 1AL At least 12 yrs old

MPL 1 / Claim

sulfacetamide sodium-sulfur cream 10-5 % generic 1ST


sulfacetamide sodium-sulfur emulsion 10-5%


sulfacetamide sodium-sulfur liquid 9-4.5 % generic 1ST


suphera cream 10-5 % generic 1ST


SYNERA PATCH 70-70 MGlidocaine-tetracaine

BRAND 3

TACLONEX OINTMENT 0.005-0.064 %calcipotriene-betamethasone dipropionate

BRAND 3 ST

TACLONEX SUSPENSION 0.005-0.064 %calcipotriene-betamethasone dipropionate

BRAND 3 ST

tacrolimus ointment 0.03 % generic 1AL At least 2 yrs old

MPL 1 / 30 days

tacrolimus ointment 0.1 % generic 1AL At least 2 yrs old

MPL 1 / 30 days

TAZORAC CREAM 0.05 %tazarotene

BRAND 2

TAZORAC CREAM 0.1 %tazarotene

BRAND 2

TAZORAC GEL 0.05 %tazarotene

BRAND 2



TAZORAC GEL 0.1 %tazarotene

BRAND 2

topisulf cream 10-5 % generic 1ST


tretinoin cream 0.025 % generic 1 AL At least 12 yrs old



tretinoin gel 0.01 % generic 1 AL At least 12 yrs old

tretinoin gel 0.025 % generic 1 AL At least 12 yrs old

tretinoin microsphere gel 0.1 % generic 1PA


tretinoin microsphere pump gel 0.1 % generic 1PA


VECTICAL OINTMENT 3 MCG/GMcalcitriol (topical)

BRAND 1 MPL 1 / Claim

VELTIN GEL 1.2-0.025 %clindamycin phosphate-tretinoin

BRAND 3ST


VEREGEN OINTMENT 15 %sinecatechins

BRAND 3

virti-sulf cream 10-5 % generic 1ST


VOLTAREN GEL 1 %diclofenac sodium (topical)

BRAND 2

zenatane cap 10 mg generic 3PA










ZIANA GEL 1.2-0.025 %clindamycin phosphate-tretinoin

BRAND 3ST


ZONALON CREAM 5 %doxepin hcl (antipruritic)

BRAND 3

ENZYME REPLACEMENT/MODIFIERS

ADAGEN SOLUTION 250 UNIT/MLpegademase bovine

BRAND 4PA

S

ALDURAZYME SOLUTION 2.9 MG/5MLlaronidase

BRAND 4PA

S

BUPHENYL POWDER 3 GM/TSPsodium phenylbutyrate

BRAND 3

BUPHENYL TAB 500 MGsodium phenylbutyrate

BRAND 3

CARBAGLU TAB 200 MGcarglumic acid

BRAND 4PA

S

CEREZYME RECON SOLN 200 UNITimiglucerase

BRAND 4PA

S

CEREZYME RECON SOLN 400 UNITimiglucerase

BRAND 4PA

S

CREON CP DR PART 12000 UNITpancrelipase (lipase-protease-amylase)

BRAND 2


BRAND 2

CREON CP DR PART 3000-9500 UNITpancrelipase (lipase-protease-amylase)

BRAND 2


BRAND 2


BRAND 2



CYSTADANE POWDERbetaine

BRAND 4PA

S

ELAPRASE SOLUTION 6 MG/3MLidursulfase

BRAND 4PA

S

ELELYSO RECON SOLN 200 UNITtaliglucerase alfa

BRAND 4PA

S

FABRAZYME RECON SOLN 35 MGagalsidase beta

BRAND 4PA

S

KUVAN TAB SOL 100 MGsapropterin dihydrochloride

BRAND 4PA

S

LUMIZYME RECON SOLN 50 MGalglucosidase alfa

BRAND 4PA

S

MYOZYME RECON SOLN 50 MGalglucosidase alfa

BRAND 4PA

S

NAGLAZYME SOLUTION 1 MG/MLgalsulfase

BRAND 4PA

S

ORFADIN CAP 10 MGnitisinone

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

PANCREAZE CP DR PART 10500 UNITpancrelipase (lipase-protease-amylase)

BRAND 2


BRAND 2


BRAND 2


BRAND 2



pancrelipase (lip-prot-amyl) cp dr part5000 unit

generic 1

sodium phenylbutyrate powder 3 gm/tsp generic 3

SUCRAID SOLUTION 8500 UNIT/MLsacrosidase

BRAND 3

VPRIV RECON SOLN 400 UNITvelaglucerase alfa

BRAND 4PA

S

ZAVESCA CAP 100 MGmiglustat

BRAND 4PA

S

ZENPEP CP DR PART 10000 UNITpancrelipase (lipase-protease-amylase)

BRAND 2


BRAND 2


BRAND 2


BRAND 2

ZENPEP CP DR PART 3000-10000 UNITpancrelipase (lipase-protease-amylase)

BRAND 2


BRAND 2

GASTROINTESTINAL AGENTS

ANTISPASMODICS, GASTROINTESTINAL

ATROPINE SULFATE SOLUTION 0.05MG/MLatropine sulfate

BRAND 1

atropine sulfate solution 0.1 mg/ml generic 1

atropine sulfate solution 0.4 mg/ml generic 1

atropine sulfate solution 1 mg/ml generic 1

CANTIL TAB 25 MGmepenzolate bromide

BRAND 3



chlordiazepoxide-clidinium cap 5-2.5 mg generic 1

dicyclomine hcl cap 10 mg generic 1

dicyclomine hcl solution 10 mg/5ml generic 1

dicyclomine hcl tab 20 mg generic 1

glycopyrrolate solution 4 mg/20ml generic 1

glycopyrrolate tab 1 mg generic 1

glycopyrrolate tab 2 mg generic 1

methscopolamine bromide tab 2.5 mg generic 1

methscopolamine bromide tab 5 mg generic 1

GASTROINTESTINAL AGENTS, OTHER

CHOLBAM CAP 250 MGcholic acid

BRAND 4PA

S

CHOLBAM CAP 50 MGcholic acid

BRAND 4PA

S

diphenoxylate-atropine liquid 2.5-0.025mg/5ml

generic 1

diphenoxylate-atropine tab 2.5-0.025 mg generic 1

ENTEREG CAP 12 MGalvimopan

BRAND 3

lofene tab 2.5-0.025 mg generic 1

lonox tab 2.5-0.025 mg generic 1

loperamide hcl cap 2 mg generic 1

MOTOFEN TAB 1-0.025 MGdifenoxin w/ atropine

BRAND 3

RELISTOR KIT 12 MG/0.6MLmethylnaltrexone bromide

BRAND 2

RELISTOR SOLUTION 12 MG/0.6MLmethylnaltrexone bromide

BRAND 2

RELISTOR SOLUTION 8 MG/0.4MLmethylnaltrexone bromide

BRAND 2



ursodiol cap 300 mg generic 1

ursodiol tab 250 mg generic 1

ursodiol tab 500 mg generic 1

HISTAMINE2 (H2) RECEPTOR ANTAGONISTS

cimetidine hcl solution 300 mg/5ml generic 1 MDS 600 / 30 days

cimetidine tab 200 mg generic 1




FAMOTIDINE PREMIXED SOLUTION 20-0.9MG/50ML-%famotidine in nacl

BRAND 1

famotidine recon susp 40 mg/5ml generic 1 MDS 300 / 30 days

famotidine solution 20 mg/2ml generic 1




famotidine tab 20 mg generic 1

famotidine tab 40 mg generic 1

nizatidine cap 150 mg generic 1

nizatidine cap 300 mg generic 1

nizatidine solution 15 mg/ml generic 1 MDS 600 / 30 days

ranitidine hcl 150 mg generic 1

ranitidine hcl cap 150 mg generic 1

ranitidine hcl cap 300 mg generic 1

ranitidine hcl solution 150 mg/6ml generic 1

ranitidine hcl solution 50 mg/2ml generic 1

ranitidine hcl syrup 15 mg/ml generic 1 MDS 600 / 30 days



ranitidine hcl syrup 150 mg/10ml generic 1 MDS 600 / 30 days

ranitidine hcl syrup 75 mg/5ml generic 1 MDS 600 / 30 days

ranitidine hcl tab 150 mg generic 1

ranitidine hcl tab 300 mg generic 1

IRRITABLE BOWEL SYNDROME AGENTS

alosetron hcl tab 0.5 mg generic 1

alosetron hcl tab 1 mg generic 1

AMITIZA CAP 24 MCGlubiprostone

BRAND 2PA

MDD 2 per day

AMITIZA CAP 8 MCGlubiprostone

BRAND 2PA

MDD 2 per day

LOTRONEX TAB 0.5 MGalosetron hcl

BRAND 2

LOTRONEX TAB 1 MGalosetron hcl

BRAND 2

LAXATIVES

constulose solution 10 gm/15ml generic 1

enulose solution 10 gm/15ml generic 1

gavilyte-g recon soln 236 gm generic 0

generlac solution 10 gm/15ml generic 1

GOLYTELY RECON SOLN 236 GMpeg 3350-kcl-sod bicarb-sod chloride-sodsulfate

BRAND 0

lactulose 10 gm/15ml generic 1

lactulose encephalopathy solution 10gm/15ml

generic 1

lactulose solution 10 gm/15ml generic 1

lactulose solution 20 gm/30ml generic 1



OSMOPREP TAB 1.102-0.398 GMsodium phosphate monobasic-sodiumphosphate dibasic

BRAND 3

peg-3350/electrolytes recon soln 236 gm generic 0

peg-3350/electrolytes recon soln 236 gm generic 0

PREPOPIK PACKET 10-3.5-12 MG-GM-GMsodium picosulfate-magnesium oxide-anhydrous citric acid

BRAND 3

SUPREP BOWEL PREP SOLUTIONsodium sulfate-potassium sulfate-magnesium sulfate

BRAND 0

VISICOL TAB 1.102-0.398 GMsodium phosphate monobasic-sodiumphosphate dibasic-mcc


PROTECTANTS

CARAFATE SUSPENSION 1 GM/10MLsucralfate


CARAFATE TAB 1 GMsucralfate


misoprostol tab 100 mcg generic 1 MDD 4 per day

misoprostol tab 200 mcg generic 1 MDD 4 per day

sucralfate tab 1 gm generic 1 MDD 4 per day

PROTON PUMP INHIBITORS

DEXILANT CAP DR 30 MGdexlansoprazole

BRAND 3ST

MDD 1 per day

DEXILANT CAP DR 60 MGdexlansoprazole

BRAND 3ST

MDD 1 per day

esomeprazole magnesium cap dr 20 mg generic 1 MDD 2 per day

esomeprazole magnesium cap dr 40 mg generic 3ST

MDD 1 per day

lansoprazole cap dr 15 mg generic 1 MDD 1 per day



lansoprazole cap dr 30 mg generic 1

NEXIUM CAP DR 20 MGesomeprazole magnesium


omeprazole 20 mg generic 1 MDD 2 per day

omeprazole cap dr 10 mg generic 1 MDD 2 per day



omeprazole-sodium bicarbonate cap 20-1100 mg


pantoprazole sodium tab dr 20 mg generic 1 MDD 1 per day

pantoprazole sodium tab dr 40 mg generic 1

rabeprazole sodium tab dr 20 mg generic 1 MDD 1 per day

GENITOURINARY AGENTS

ANTISPASMODICS, URINARY

DETROL LA CAP ER 24H 2 MGtolterodine tartrate

BRAND 3PA

MDD 1 per day

DETROL LA CAP ER 24H 4 MGtolterodine tartrate

BRAND 3PA

MDD 1 per day

ENABLEX TAB ER 24H 15 MGdarifenacin hydrobromide

BRAND 3PA

MDD 1 per day

ENABLEX TAB ER 24H 7.5 MGdarifenacin hydrobromide

BRAND 3PA

MDD 1 per day

flavoxate hcl tab 100 mg generic 1

MYRBETRIQ TAB ER 24H 25 MGmirabegron

BRAND 3 PA

MYRBETRIQ TAB ER 24H 50 MGmirabegron

BRAND 3 PA

oxybutynin chloride er tab er 24h 10 mg generic 1





oxybutynin chloride syrup 5 mg/5ml generic 1

oxybutynin chloride tab 5 mg generic 1

tolterodine tartrate er cap er 24h 2 mg generic 1 MDD 1 per day

tolterodine tartrate er cap er 24h 4 mg generic 1 MDD 1 per day

tolterodine tartrate tab 1 mg generic 1

tolterodine tartrate tab 2 mg generic 1

TOVIAZ TAB ER 24H 4 MGfesoterodine fumarate

BRAND 3PA

MDD 1 per day

TOVIAZ TAB ER 24H 8 MGfesoterodine fumarate

BRAND 3PA

MDD 1 per day

trospium chloride er cap er 24h 60 mg generic 1 MDD 1 per day

trospium chloride tab 20 mg generic 1

VESICARE TAB 10 MGsolifenacin succinate

BRAND 2PA

MDD 1 per day

VESICARE TAB 5 MGsolifenacin succinate

BRAND 2PA

MDD 1 per day

BENIGN PROSTATIC HYPERTROPHY AGENTS

alfuzosin hcl er tab er 24h 10 mg generic 1 MDD 1 per day

AVODART CAP 0.5 MGdutasteride

BRAND 2PA

MDD 1 per day

CIALIS TAB 5 MGtadalafil

BRAND 3PA

MDD 1 per day

dutasteride cap 0.5 mg generic 1PA

MDD 1 per day

finasteride tab 5 mg generic 1

RAPAFLO CAP 4 MGsilodosin

BRAND 2



RAPAFLO CAP 8 MGsilodosin

BRAND 2

tamsulosin hcl cap 0.4 mg generic 1

terazosin hcl cap 1 mg generic 1




GENITOURINARY AGENTS, OTHER

aminoacetic acid solution 1.5 % generic 1

argyle sterile saline solution 0.9 % generic 1

bethanechol chloride tab 10 mg generic 1 MDD 4 per day




citric acid-sodium citrate solution 334-500mg/5ml

generic 1

CUPRIMINE CAP 250 MGpenicillamine

BRAND 3

curity sterile saline solution 0.9 % generic 1

CYSTAGON CAP 150 MGcysteamine bitartrate

BRAND 3 PA

CYSTAGON CAP 50 MGcysteamine bitartrate

BRAND 3 PA

cytra-2 solution 500-334 mg/5ml generic 1

ELMIRON CAP 100 MGpentosan polysulfate sodium

BRAND 2

glycine solution 1.5 % generic 1

glycine urologic solution 1.5 % generic 1

liqui-dualcitra 500-334 mg/5ml generic 1



phenazo tab 200 mg generic 1

phenazopyridine hcl tab 100 mg generic 1

phenazopyridine hcl tab 200 mg generic 1

potassium citrate er tab er 10 meq (1080mg)

generic 1

RESECTISOL SOLUTION 5 %mannitol (gu irrigant)

BRAND 1

sod citrate-citric acid solution 500-334mg/5ml

generic 1

sodium chloride solution 0.9 % generic 1

SORBITOL SOLUTION 3 %sorbitol irrigation

BRAND 1

SORBITOL SOLUTION 3.3 %sorbitol irrigation

BRAND 1

SORBITOL-MANNITOL SOLUTION 2.7-0.54GM/100MLsorbitol-mannitol

BRAND 1

STENDRA TAB 100 MGavanafil






virtrate-2 solution 500-334 mg/5ml generic 1

PHOSPHATE BINDERS

calcium acetate (phos binder) cap 667 mg generic 1

calcium acetate (phos binder) tab 667 mg generic 1

calcium acetate cap 667 mg generic 1

FOSRENOL CHEW TAB 1000 MGlanthanum carbonate

BRAND 2


BRAND 2




BRAND 2

PHOSLYRA SOLUTION 667 MG/5MLcalcium acetate (phosphate binder)

BRAND 2

RENAGEL TAB 400 MGsevelamer hcl

BRAND 3

RENAGEL TAB 800 MGsevelamer hcl

BRAND 3

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (ADRENAL)

A-HYDROCORT RECON SOLN 100 MGhydrocortisone sod succinate

BRAND 1

a-methapred 125 mg generic 1

a-methapred recon soln 125 mg generic 1

a-methapred recon soln 40 mg generic 1

alclometasone dipropionate cream 0.05 % generic 1

alclometasone dipropionate ointment 0.05%

generic 1

amcinonide cream 0.1 % generic 1

amcinonide lotion 0.1 % generic 3

amcinonide ointment 0.1 % generic 3

anucort-hc suppos 25 mg generic 1

anusol-hc suppos 25 mg generic 1

apexicon ointment 0.05 % generic 1

asmalpred plus solution 15 mg/5ml generic 1

asmalpred solution 15 mg/5ml generic 1

baycadron elixir 0.5 mg/5ml generic 1

beta-val cream 0.1 % generic 1

beta-val lotion 0.1 % generic 1

betamethasone dipropionate aug cream0.05 %

generic 1



betamethasone dipropionate aug lotion0.05 %

generic 1

betamethasone dipropionate aug ointment0.05 %

generic 1

betamethasone dipropionate cream 0.05 % generic 1

betamethasone dipropionate lotion 0.05 % generic 1

betamethasone dipropionate ointment0.05 %

generic 1

betamethasone valerate cream 0.1 % generic 1

betamethasone valerate foam 0.12 % generic 1

betamethasone valerate lotion 0.1 % generic 1

betamethasone valerate ointment 0.1 % generic 1

clobetasol propionate cream 0.05 % generic 1

clobetasol propionate e cream 0.05 % generic 1

clobetasol propionate foam 0.05 % generic 1

clobetasol propionate gel 0.05 % generic 1

clobetasol propionate ointment 0.05 % generic 1

clobetasol propionate solution 0.05 % generic 1

CLODERM CREAM 0.1 %clocortolone pivalate

BRAND 3

CLODERM PUMP CREAM 0.1 %clocortolone pivalate

BRAND 3

CORDRAN CREAM 0.05 %flurandrenolide

BRAND 3

CORDRAN LOTION 0.05 %flurandrenolide

BRAND 3

CORDRAN TAPE 4 MCG/SQCMflurandrenolide

BRAND 3

cormax ointment 0.05 % generic 1

cormax scalp application solution 0.05 % generic 1



cormax solution 0.05 % generic 1

cortisone acetate tab 25 mg generic 1

deltasone tab 20 mg generic 1

DEPO-MEDROL SUSPENSION 20 MG/MLmethylprednisolone acetate

BRAND 3

desonide cream 0.05 % generic 1

desonide lotion 0.05 % generic 1

desonide ointment 0.05 % generic 1

desoximetasone cream 0.25 % generic 1

desoximetasone gel 0.05 % generic 1

desoximetasone ointment 0.25 % generic 1

dexamethasone elixir 0.5 mg/5ml generic 1

DEXAMETHASONE INTENSOL CONC 1MG/MLdexamethasone

BRAND 1

dexamethasone sodium phosphate solution120 mg/30ml

generic 1

dexamethasone sodium phosphate solution20 mg/5ml

generic 1

dexamethasone sodium phosphate solution4 mg/ml

generic 1

dexamethasone solution 0.5 mg/5ml generic 1

dexamethasone tab 0.5 mg generic 1


dexamethasone tab 1 mg generic 1







diflorasone diacetate cream 0.05 % generic 2

diflorasone diacetate ointment 0.05 % generic 1

fludrocortisone acetate tab 0.1 mg generic 1

fluocinolone acetonide cream 0.01 % generic 1

fluocinolone acetonide cream 0.025 % generic 1

fluocinolone acetonide ointment 0.025 % generic 1

fluocinolone acetonide scalp oil 0.01 % generic 1

fluocinolone acetonide solution 0.01 % generic 1

fluocinonide cream 0.05 % generic 1

fluocinonide gel 0.05 % generic 1

fluocinonide ointment 0.05 % generic 1

fluocinonide solution 0.05 % generic 1

fluocinonide-e cream 0.05 % generic 1

fluticasone propionate cream 0.05 % generic 1

fluticasone propionate lotion 0.05 % generic 1

fluticasone propionate ointment 0.005 % generic 1

grx hicort 25 suppos 25 mg generic 1

halobetasol propionate cream 0.05 % generic 1

halobetasol propionate ointment 0.05 % generic 1

HALOG CREAM 0.1 %halcinonide

BRAND 3

HALOG OINTMENT 0.1 %halcinonide

BRAND 3

hemmorex-hc suppos 25 mg generic 1

hemmorex-hc suppos 30 mg generic 1

hemorrhoidal-hc suppos 25 mg generic 1

hemril-30 suppos 30 mg generic 1

hydrocortisone acetate suppos 25 mg generic 1



hydrocortisone acetate suppos 30 mg generic 1

hydrocortisone butyrate cream 0.1 % generic 1

hydrocortisone butyrate ointment 0.1 % generic 1

hydrocortisone butyrate solution 0.1 % generic 1

hydrocortisone tab 10 mg generic 1



hydrocortisone valerate cream 0.2 % generic 1

hydrocortisone valerate ointment 0.2 % generic 1

KENALOG SUSPENSION 40 MG/MLtriamcinolone acetonide

BRAND 3

lokara lotion 0.05 % generic 1

MEDROL TAB 2 MGmethylprednisolone

BRAND 3

methylprednisolone (pak) 4 mg generic 1

methylprednisolone (pak) tab 4 mg generic 1

methylprednisolone acetate suspension 40mg/ml

generic 1

methylprednisolone acetate suspension 80mg/ml

generic 1

methylprednisolone sodium succ recon soln1000 mg

generic 1


generic 1


generic 1


generic 1

methylprednisolone tab 16 mg generic 1






methylprednisolone tab thpk 4 mg generic 1

MILLIPRED DP 12-DAY TAB THPK 5 MG (48)prednisolone

BRAND 3

MILLIPRED DP TAB THPK 5 MG (21)prednisolone

BRAND 3

MILLIPRED DP TAB THPK 5 MG (48)prednisolone

BRAND 3

MILLIPRED SOLUTION 10 MG/5MLprednisolone sodium phosphate

BRAND 3

MILLIPRED TAB 5 MGprednisolone

BRAND 3

mometasone furoate cream 0.1 % generic 1

mometasone furoate ointment 0.1 % generic 1

mometasone furoate solution 0.1 % generic 1

oralone paste 0.1 % generic 1

ORAPRED ODT TAB DISP 10 MGprednisolone sodium phosphate

BRAND 3


BRAND 3


BRAND 3

prednicarbate cream 0.1 % generic 1

prednicarbate ointment 0.1 % generic 1

prednisolone sodium phosphate solution 15mg/5ml

generic 1

PREDNISOLONE SODIUM PHOSPHATESOLUTION 25 MG/5MLprednisolone sodium phosphate

BRAND 1

prednisolone sodium phosphate solution6.7 (5 base) mg/5ml

generic 1



prednisolone solution 15 mg/5ml generic 1

prednisolone syrup 15 mg/5ml generic 1

prednisone solution 5 mg/5ml generic 1

prednisone tab 1 mg generic 1


prednisone tab 2.5 mg generic 1




rectacort-hc suppos 25 mg generic 1

SOLU-CORTEF RECON SOLN 250 MGhydrocortisone sod succinate

BRAND 3

SOLU-MEDROL RECON SOLN 2 GMmethylprednisolone sod succ

BRAND 3

triamcinolone acetonide cream 0.025 % generic 1



triamcinolone acetonide lotion 0.025 % generic 1

triamcinolone acetonide lotion 0.1 % generic 1

triamcinolone acetonide ointment 0.025 % generic 1



triamcinolone acetonide paste 0.1 % generic 1

triderm cream 0.1 % generic 1

VERIPRED 20 SOLUTION 20 MG/5MLprednisolone sodium phosphate

BRAND 3

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PITUITARY)

chorionic gonadotropin recon soln 10000unit

generic 4PA

S



desmopressin ace spray refrig solution 0.01%

generic 1

desmopressin acetate solution 4 mcg/ml generic 1 PA

desmopressin acetate spray solution 0.01%

generic 1

desmopressin acetate tab 0.1 mg generic 1PA

MDD 6 per day

desmopressin acetate tab 0.2 mg generic 1PA

MDD 8 per day

GENOTROPIN MINIQUICK RECON SOLN 0.2MGsomatropin

BRAND 4PA

S

GENOTROPIN RECON SOLN 5 MGsomatropin

BRAND 4PA

S

HUMATROPE RECON SOLN 12 MGsomatropin

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

INCRELEX SOLUTION 40 MG/4MLmecasermin

BRAND 4PA

S

NORDITROPIN FLEXPRO SOLUTION 10MG/1.5MLsomatropin

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S



NORDITROPIN NORDIFLEX PEN SOLUTION10 MG/1.5MLsomatropin

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

NORDITROPIN SOLUTION 15 MG/1.5MLsomatropin

BRAND 4PA

S

NORDITROPIN SOLUTION 5 MG/1.5MLsomatropin

BRAND 4PA

S

novarel recon soln 10000 unit generic 4PA

S

NUTROPIN AQ NUSPIN 10 SOLUTION 10MG/2MLsomatropin

BRAND 4PA

S

NUTROPIN AQ PEN SOLUTION 10 MG/2MLsomatropin

BRAND 4PA

S

NUTROPIN AQ SOLUTION 10 MG/2MLsomatropin

BRAND 4PA

S

NUTROPIN RECON SOLN 10 MGsomatropin

BRAND 4PA

S

OMNITROPE SOLUTION 10 MG/1.5MLsomatropin

BRAND 4PA

S

OMNITROPE SOLUTION 5 MG/1.5MLsomatropin

BRAND 4PA

S

pregnyl recon soln 10000 unit generic 4PA

S

SAIZEN CLICK.EASY RECON SOLN 8.8 MGsomatropin (non-refrigerated)

BRAND 4PA

S



SAIZEN RECON SOLN 5 MGsomatropin (non-refrigerated)

BRAND 4PA

S

SAIZEN RECON SOLN 8.8 MGsomatropin (non-refrigerated)

BRAND 4PA

S

SEROSTIM RECON SOLN 4 MGsomatropin (non-refrigerated)

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

STIMATE SOLUTION 1.5 MG/MLdesmopressin acetate

BRAND 4PA

S

TEV-TROPIN RECON SOLN 5 MGsomatropin

BRAND 4PA

S

ZOMACTON RECON SOLN 10 MGsomatropin

BRAND 4PA

S

ZOMACTON RECON SOLN 5 MGsomatropin

BRAND 4PA

S

ZORBTIVE RECON SOLN 8.8 MGsomatropin (non-refrigerated)

BRAND 4PA

S

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEXHORMONES/MODIFIERS)

ANABOLIC STEROIDS

ANADROL-50 TAB 50 MGoxymetholone

BRAND 3

oxandrolone tab 10 mg generic 1

oxandrolone tab 2.5 mg generic 1

ANDROGENS

ANDRODERM PATCH 24HR 2 MG/24HRtestosterone

BRAND 2PA

MDD 1 per day



ANDRODERM PATCH 24HR 4 MG/24HRtestosterone

BRAND 2PA

MDD 1 per day

ANDROXY TAB 10 MGfluoxymesterone

BRAND 3

danazol cap 100 mg generic 1



METHITEST TAB 10 MGmethyltestosterone

BRAND 3

testosterone cypionate solution 100 mg/ml generic 1

testosterone cypionate solution 200 mg/ml generic 1

testosterone enanthate solution 200mg/ml

generic 1

ESTROGENS

ALORA PATCH TW 0.025 MG/24HRestradiol

BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female

altavera tab 0.15-30 mg-mcg generic 0 GL Female

alyacen 1/35 tab 1-35 mg-mcg generic 0 GL Female

alyacen 7/7/7 tab 0.5/0.75/1-35 mg-mcg generic 0 GL Female

amethia lo tab 0.1-0.02 & 0.01 mg generic 0 GL Female

amethia tab 0.15-0.03 &0.01 mg generic 0 GL Female

amethyst tab 90-20 mcg generic 0 GL Female

apri tab 0.15-30 mg-mcg generic 0 GL Female



aranelle tab 0.5/1/0.5-35 mg-mcg generic 0 GL Female

ashlyna tab 0.15-0.03 &0.01 mg generic 0 GL Female

aubra tab 0.1-20 mg-mcg generic 0 GL Female

aviane tab 0.1-20 mg-mcg generic 0 GL Female

azurette tab 0.15-0.02/0.01 mg (21/5) generic 0 GL Female

balziva tab 0.4-35 mg-mcg generic 0 GL Female

bekyree tab 0.15-0.02/0.01 mg (21/5) generic 0 GL Female

BEYAZ TAB 3-0.02-0.451 MGdrospirenone-ethinyl estradiol-levomefolate calcium

BRAND 0 GL Female

blisovi 24 fe tab 1-20 mg-mcg(24) generic 0 GL Female

blisovi fe 1.5/30 tab 1.5-30 mg-mcg generic 0 GL Female

blisovi fe 1/20 tab 1-20 mg-mcg generic 0 GL Female

BREVICON (28) TAB 0.5-35 MG-MCGnorethindrone & eth estradiol

BRAND 0 GL Female

briellyn tab 0.4-35 mg-mcg generic 0 GL Female

camrese lo tab 0.1-0.02 & 0.01 mg generic 0 GL Female

camrese tab 0.15-0.03 &0.01 mg generic 0 GL Female

caziant tab 0.1/0.125/0.15 -0.025 mg generic 0 GL Female

CENESTIN TAB 0.3 MGestrogens, conjugated synthetic a

BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female



cesia tab 0.1/0.125/0.15 -0.025 mg generic 0 GL Female

chateal tab 0.15-30 mg-mcg generic 0 GL Female

CLIMARA PRO PATCH WK 0.045-0.015MG/DAYestradiol-levonorgestrel

BRAND 3 GL Female

cryselle-28 tab 0.3-30 mg-mcg generic 0 GL Female

cyclafem 1/35 tab 1-35 mg-mcg generic 0 GL Female

cyclafem 7/7/7 tab 0.5/0.75/1-35 mg-mcg generic 0 GL Female

CYCLESSA TAB 0.1/0.125/0.15 -0.025 MGdesogestrel-ethinyl estradiol (triphasic)

BRAND 0 GL Female

cyred tab 0.15-30 mg-mcg generic 0 GL Female

dasetta 1/35 tab 1-35 mg-mcg generic 0 GL Female

dasetta 7/7/7 tab 0.5/0.75/1-35 mg-mcg generic 0 GL Female

daysee tab 0.15-0.03 &0.01 mg generic 0 GL Female

delyla tab 0.1-20 mg-mcg generic 0 GL Female

DEPO-ESTRADIOL OIL 5 MG/MLestradiol cypionate

BRAND 3 GL Female

DESOGEN TAB 0.15-30 MG-MCGdesogestrel & ethinyl estradiol

BRAND 0 GL Female

desogestrel-ethinyl estradiol tab 0.15-0.02/0.01 mg (21/5)

generic 0 GL Female

desogestrel-ethinyl estradiol tab 0.15-30mg-mcg

generic 0 GL Female

DIVIGEL GEL 0.25 MG/0.25GMestradiol

BRAND 3 GL Female

DIVIGEL GEL 0.5 MG/0.5GMestradiol

BRAND 3 GL Female

DIVIGEL GEL 1 MG/GMestradiol

BRAND 3 GL Female

drospirenone-ethinyl estradiol tab 3-0.02mg

generic 0 GL Female



drospirenone-ethinyl estradiol tab 3-0.03mg

generic 0 GL Female

ELESTRIN GEL 0.52 MG/0.87 GM (0.06%)estradiol

BRAND 3 GL Female

elinest tab 0.3-30 mg-mcg generic 0 GL Female

emoquette tab 0.15-30 mg-mcg generic 0 GL Female

ENJUVIA TAB 0.3 MGestrogens, conjugated synthetic b

BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female

enpresse-28 tab generic 0 GL Female

enskyce tab 0.15-30 mg-mcg generic 0 GL Female

estarylla tab 0.25-35 mg-mcg generic 0 GL Female

ESTRACE CREAM 0.1 MG/GMestradiol vaginal

BRAND 3 GL Female

ESTRADERM PATCH TW 0.05 MG/24HRestradiol

BRAND 3 GL Female

ESTRADERM PATCH TW 0.1 MG/24HRestradiol

BRAND 3 GL Female

estradiol patch tw 0.025 mg/24hr generic 1 GL Female







estradiol patch wk 0.025 mg/24hr generic 1 GL Female






estradiol tab 0.5 mg generic 1 GL Female

estradiol tab 1 mg generic 1 GL Female

estradiol tab 2 mg generic 1 GL Female

estradiol valerate oil 10 mg/ml generic 1 GL Female



ESTRASORB EMULSION 4.35 MG/1.74GMestradiol

BRAND 3 GL Female

ESTROGEL GEL 0.75 MG/1.25 GM (0.06%)estradiol

BRAND 3 GL Female

estropipate tab 0.75 mg generic 1 GL Female

estropipate tab 1.5 mg generic 1 GL Female

estropipate tab 3 mg generic 1 GL Female

ESTROSTEP FE TAB 1-20/1-30/1-35 MG-MCGnorethindrone acetate-ethinyl estradiol-fe

BRAND 0 GL Female

EVAMIST SOLUTION 1.53 MG/SPRAYestradiol

BRAND 3 GL Female

falmina tab 0.1-20 mg-mcg generic 0 GL Female

FEMCON FE CHEW TAB 0.4-35 MG-MCGnorethindrone & ethinyl estradiol-fe

BRAND 0 GL Female

FEMRING RING 0.05 MG/24HRestradiol acetate vaginal

BRAND 3 GL Female



FEMRING RING 0.1 MG/24HRestradiol acetate vaginal

BRAND 3 GL Female

GENERESS FE CHEW TAB 0.8-25 MG-MCGnorethindrone & ethinyl estradiol-fe

BRAND 0 GL Female

gianvi tab 3-0.02 mg generic 0 GL Female

gildagia tab 0.4-35 mg-mcg generic 0 GL Female

gildess 1.5/30 tab 1.5-30 mg-mcg generic 0 GL Female

gildess 1/20 tab 1-20 mg-mcg generic 0 GL Female

gildess 24 fe tab 1-20 mg-mcg(24) generic 0 GL Female

gildess fe 1.5/30 tab 1.5-30 mg-mcg generic 0 GL Female

gildess fe 1/20 tab 1-20 mg-mcg generic 0 GL Female

introvale tab 0.15-0.03 mg generic 0 GL Female

jolessa tab 0.15-0.03 mg generic 0 GL Female

juleber tab 0.15-30 mg-mcg generic 0 GL Female

junel 1.5/30 tab 1.5-30 mg-mcg generic 0 GL Female

junel 1/20 tab 1-20 mg-mcg generic 0 GL Female

junel fe 1.5/30 tab 1.5-30 mg-mcg generic 0 GL Female

junel fe 1/20 tab 1-20 mg-mcg generic 0 GL Female

junel fe 24 tab 1-20 mg-mcg(24) generic 0 GL Female

kariva tab 0.15-0.02/0.01 mg (21/5) generic 0 GL Female

kelnor 1/35 tab 1-35 mg-mcg generic 0 GL Female

kimidess tab 0.15-0.02/0.01 mg (21/5) generic 0 GL Female

kurvelo tab 0.15-30 mg-mcg generic 0 GL Female

larin 1.5/30 tab 1.5-30 mg-mcg generic 0 GL Female

larin 1/20 tab 1-20 mg-mcg generic 0 GL Female

larin 24 fe tab 1-20 mg-mcg(24) generic 0 GL Female



larin fe 1.5/30 tab 1.5-30 mg-mcg generic 0 GL Female

larin fe 1/20 tab 1-20 mg-mcg generic 0 GL Female

layolis fe chew tab 0.8-25 mg-mcg generic 0 GL Female

leena tab 0.5/1/0.5-35 mg-mcg generic 0 GL Female

lessina tab 0.1-20 mg-mcg generic 0 GL Female

levonest tab generic 0 GL Female

levonorgest-eth estrad 91-day tab 0.1-0.02& 0.01 mg

generic 0 GL Female

levonorgest-eth estrad 91-day tab 0.15-0.03 &0.01 mg

generic 0 GL Female

levonorgest-eth estrad 91-day tab 0.15-0.03 mg

generic 0 GL Female

levonorgestrel-ethinyl estrad tab 0.1-20mg-mcg

generic 0 GL Female

levonorgestrel-ethinyl estrad tab 0.15-30mg-mcg

generic 0 GL Female

levonorgestrel-ethinyl estrad tab 90-20mcg

generic 0 GL Female

levora 0.15/30 (28) tab 0.15-30 mg-mcg generic 0 GL Female

LO LOESTRIN FE TAB 1 MG-10 MCG / 10MCGnorethindrone acetate-ethinyl estradiol-fefum (biphasic)

BRAND 0 GL Female

LO/OVRAL (28) TAB 0.3-30 MG-MCGnorgestrel & ethinyl estradiol

BRAND 0 GL Female

LOESTRIN 1.5/30 (21) TAB 1.5-30 MG-MCGnorethindrone acet & eth estra

BRAND 0 GL Female

LOESTRIN 1/20 (21) TAB 1-20 MG-MCGnorethindrone acet & eth estra

BRAND 0 GL Female

LOESTRIN 24 FE TAB 1-20 MG-MCGnorethin acet & estrad-fe

BRAND 0 GL Female



LOESTRIN FE 1.5/30 TAB 1.5-30 MG-MCGnorethin acet & estrad-fe

BRAND 0 GL Female

LOESTRIN FE 1/20 TAB 1-20 MG-MCGnorethin acet & estrad-fe

BRAND 0 GL Female

lomedia 24 fe tab 1-20 mg-mcg(24) generic 0 GL Female

loryna tab 3-0.02 mg generic 0 GL Female

LOSEASONIQUE TAB 0.1-0.02 & 0.01 MGlevonorgestrel-ethinyl estradiol (91-day)

BRAND 0 GL Female

low-ogestrel tab 0.3-30 mg-mcg generic 0 GL Female

lutera tab 0.1-20 mg-mcg generic 0 GL Female

marlissa tab 0.15-30 mg-mcg generic 0 GL Female

MENEST TAB 0.3 MGesterified estrogens

BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female

MENOSTAR PATCH WK 14 MCG/24HRestradiol

BRAND 3 GL Female

microgestin 1.5/30 tab 1.5-30 mg-mcg generic 0 GL Female

microgestin 1/20 tab 1-20 mg-mcg generic 0 GL Female

microgestin 24 fe tab 1-20 mg-mcg generic 0 GL Female

microgestin fe 1.5/30 tab 1.5-30 mg-mcg generic 0 GL Female

microgestin fe 1/20 tab 1-20 mg-mcg generic 0 GL Female

MINASTRIN 24 FE CHEW TAB 1-20 MG-MCG(24)norethin acet & estrad-fe

BRAND 0 GL Female

MINIVELLE PATCH TW 0.0375 MG/24HRestradiol

BRAND 3 GL Female




BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female

MIRCETTE TAB 0.15-0.02/0.01 MG (21/5)desogestrel-ethinyl estradiol (biphasic)

BRAND 0 GL Female

MODICON (28) TAB 0.5-35 MG-MCGnorethindrone & eth estradiol

BRAND 0 GL Female

mono-linyah tab 0.25-35 mg-mcg generic 0 GL Female

mononessa tab 0.25-35 mg-mcg generic 0 GL Female

myzilra tab generic 0 GL Female

NATAZIA TAB 3/2-2/2-3/1 MGestradiol valerate-dienogest

BRAND 0 GL Female

necon 0.5/35 (28) tab 0.5-35 mg-mcg generic 0 GL Female

necon 1/35 (28) tab 1-35 mg-mcg generic 0 GL Female

NECON 1/50 (28) TAB 1-50 MG-MCGnorethindrone & mestranol

BRAND 0 GL Female

NECON 10/11 (28) TAB 35 MCGnorethindrone-eth estradiol (biphasic)

BRAND 0 GL Female

necon 7/7/7 tab 0.5/0.75/1-35 mg-mcg generic 0 GL Female

nikki tab 3-0.02 mg generic 0 GL Female

NORDETTE (28) TAB 0.15-30 MG-MCGlevonorgestrel & eth estradiol

BRAND 0 GL Female

norethin ace-eth estrad-fe tab 1-20 mg-mcg

generic 0 GL Female

norethin ace-eth estrad-fe tab 1-20 mg-mcg(24)

generic 0 GL Female

norethin-eth estradiol-fe chew tab 0.8-25mg-mcg

generic 0 GL Female



norethindrone acet-ethinyl est tab 1-20mg-mcg

generic 0 GL Female

norgestim-eth estrad triphasic tab0.18/0.215/0.25 mg-25 mcg

generic 0 GL Female

norgestim-eth estrad triphasic tab0.18/0.215/0.25 mg-35 mcg

generic 0 GL Female

norgestimate-eth estradiol tab 0.25-35 mg-mcg

generic 0 GL Female

norgestrel-ethinyl estradiol tab 0.3-30 mg-mcg

generic 0 GL Female

NORINYL 1+35 (28) TAB 1-35 MG-MCGnorethindrone & eth estradiol

BRAND 0 GL Female

NORINYL 1+50 (28) TAB 1-50 MG-MCGnorethindrone & mestranol

BRAND 0 GL Female

nortrel 0.5/35 (28) tab 0.5-35 mg-mcg generic 0 GL Female

nortrel 1/35 (21) tab 1-35 mg-mcg generic 0 GL Female

nortrel 1/35 (28) tab 1-35 mg-mcg generic 0 GL Female

nortrel 7/7/7 tab 0.5/0.75/1-35 mg-mcg generic 0 GL Female

NUVARING RING 0.12-0.015 MG/24HRetonogestrel-ethinyl estradiol

BRAND 0 GL Female

ocella tab 3-0.03 mg generic 0 GL Female

OGESTREL TAB 0.5-50 MG-MCGnorgestrel & ethinyl estradiol

BRAND 0 GL Female

orsythia tab 0.1-20 mg-mcg generic 0 GL Female

ORTHO EVRA PATCH WK 150-35MCG/24HRnorelgestromin-ethinyl estradiol

BRAND 0 GL Female

ORTHO TRI-CYCLEN (28) TAB0.18/0.215/0.25 MG-35 MCGnorgestimate-ethinyl estradiol (triphasic)

BRAND 0 GL Female

ORTHO TRI-CYCLEN LO TAB0.18/0.215/0.25 MG-25 MCGnorgestimate-ethinyl estradiol (triphasic)

BRAND 0 GL Female



ORTHO-CEPT (28) TAB 0.15-30 MG-MCGdesogestrel & ethinyl estradiol

BRAND 0 GL Female

ORTHO-CYCLEN (28) TAB 0.25-35 MG-MCGnorgestimate-ethinyl estradiol

BRAND 0 GL Female

ORTHO-NOVUM 1/35 (28) TAB 1-35 MG-MCGnorethindrone & eth estradiol

BRAND 0 GL Female

ORTHO-NOVUM 7/7/7 (28) TAB0.5/0.75/1-35 MG-MCGnorethindrone-eth estradiol (triphasic)

BRAND 0 GL Female

OVCON-35 (28) TAB 0.4-35 MG-MCGnorethindrone & eth estradiol

BRAND 0 GL Female

philith tab 0.4-35 mg-mcg generic 0 GL Female

pimtrea tab 0.15-0.02/0.01 mg (21/5) generic 0 GL Female

pirmella 1/35 tab 1-35 mg-mcg generic 0 GL Female

pirmella 7/7/7 tab 0.5/0.75/1-35 mg-mcg generic 0 GL Female

portia-28 tab 0.15-30 mg-mcg generic 0 GL Female

PREMARIN CREAM 0.625 MG/GMestrogens, conjugated vaginal

BRAND 2 GL Female

PREMARIN RECON SOLN 25 MGestrogens, conjugated

BRAND 2 GL Female

PREMARIN TAB 0.3 MGestrogens, conjugated

BRAND 2 GL Female


BRAND 2 GL Female


BRAND 2 GL Female


BRAND 2 GL Female


BRAND 2 GL Female



PREMPRO TAB 0.3-1.5 MGconjugated estrogens-medroxyprogesterone acetate

BRAND 2 GL Female


BRAND 2 GL Female


BRAND 2 GL Female

PREMPRO TAB 0.625-5 MGconjugated estrogens-medroxyprogesterone acetate

BRAND 2 GL Female

previfem tab 0.25-35 mg-mcg generic 0 GL Female

quasense tab 0.15-0.03 mg generic 0 GL Female

reclipsen tab 0.15-30 mg-mcg generic 0 GL Female

SAFYRAL TAB 3-0.03-0.451 MGdrospirenone-ethinyl estradiol-levomefolate calcium

BRAND 0 GL Female

SEASONALE TAB 0.15-0.03 MGlevonorgestrel-ethinyl estradiol (91-day)

BRAND 0 GL Female

SEASONIQUE TAB 0.15-0.03 &0.01 MGlevonorgestrel-ethinyl estradiol (91-day)

BRAND 0 GL Female

setlakin tab 0.15-0.03 mg generic 0 GL Female

solia tab 0.15-30 mg-mcg generic 0 GL Female

sprintec 28 tab 0.25-35 mg-mcg generic 0 GL Female

sronyx tab 0.1-20 mg-mcg generic 0 GL Female

syeda tab 3-0.03 mg generic 0 GL Female

tarina fe 1/20 tab 1-20 mg-mcg generic 0 GL Female

tilia fe tab 1-20/1-30/1-35 mg-mcg generic 0 GL Female

tri-estarylla tab 0.18/0.215/0.25 mg-35mcg

generic 0 GL Female



tri-legest fe tab 1-20/1-30/1-35 mg-mcg generic 0 GL Female

tri-linyah tab 0.18/0.215/0.25 mg-35 mcg generic 0 GL Female

tri-lo-estarylla tab 0.18/0.215/0.25 mg-25mcg

generic 0 GL Female

tri-lo-marzia tab 0.18/0.215/0.25 mg-25mcg

generic 0 GL Female

tri-lo-sprintec tab 0.18/0.215/0.25 mg-25mcg

generic 0 GL Female

TRI-NORINYL (28) TAB 0.5/1/0.5-35 MG-MCGnorethindrone-eth estradiol (triphasic)

BRAND 0 GL Female

tri-previfem tab 0.18/0.215/0.25 mg-35mcg

generic 0 GL Female

tri-sprintec tab 0.18/0.215/0.25 mg-35 mcg generic 0 GL Female

trinessa (28) tab 0.18/0.215/0.25 mg-35mcg

generic 0 GL Female

trinessa lo tab 0.18/0.215/0.25 mg-25 mcg generic 0 GL Female

trivora (28) tab generic 0 GL Female

velivet tab 0.1/0.125/0.15 -0.025 mg generic 0 GL Female

vestura tab 3-0.02 mg generic 0 GL Female

viorele tab 0.15-0.02/0.01 mg (21/5) generic 0 GL Female

VIVELLE-DOT PATCH TW 0.025 MG/24HRestradiol

BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female


BRAND 3 GL Female



vyfemla tab 0.4-35 mg-mcg generic 0 GL Female

wera tab 0.5-35 mg-mcg generic 0 GL Female

wymzya fe chew tab 0.4-35 mg-mcg generic 0 GL Female

XULANE PATCH WK 150-35 MCG/24HRnorelgestromin-ethinyl estradiol

BRAND 0 GL Female

YASMIN 28 TAB 3-0.03 MGdrospirenone-ethinyl estradiol

BRAND 0 GL Female

YAZ TAB 3-0.02 MGdrospirenone-ethinyl estradiol

BRAND 0 GL Female

zarah tab 3-0.03 mg generic 0 GL Female

zenchent fe chew tab 0.4-35 mg-mcg generic 0 GL Female

zenchent tab 0.4-35 mg-mcg generic 0 GL Female

zeosa chew tab 0.4-35 mg-mcg generic 0 GL Female

zovia 1/35e (28) tab 1-35 mg-mcg generic 0 GL Female

ZOVIA 1/50E (28) TAB 1-50 MG-MCGethynodiol diacet & eth estrad

BRAND 0 GL Female

PROGESTERONE AGONISTS/ANTAGONISTS

ELLA TAB 30 MGulipristal acetate

BRAND 0 GL Female

PROGESTINS

AYGESTIN TAB 5 MGnorethindrone acetate

BRAND 0

camila tab 0.35 mg generic 0 GL Female

deblitane tab 0.35 mg generic 0 GL Female

DEPO-PROVERA SUSPENSION 150 MG/MLmedroxyprogesterone acetate(contraceptive)

BRAND 0 GL Female

DEPO-SUBQ PROVERA 104 SUSPENSION104 MG/0.65MLmedroxyprogesterone acetate(contraceptive)

BRAND 0 GL Female



errin tab 0.35 mg generic 0 GL Female

heather tab 0.35 mg generic 0 GL Female

IMPLANON IMPLANT 68 MGetonogestrel

BRAND 0 GL Female

jencycla tab 0.35 mg generic 0 GL Female

jolivette tab 0.35 mg generic 0 GL Female

levonorgestrel tab 0.75 mg generic 0 GL Female

levonorgestrel tab 1.5 mg generic 0 GL Female

LILETTA (52 MG) IUD 18.6 MCG/DAYlevonorgestrel (iud)

BRAND 0 GL Female

lyza tab 0.35 mg generic 0 GL Female

medroxyprogesterone acetate suspension150 mg/ml

generic 0 GL Female

medroxyprogesterone acetate tab 10 mg generic 1

medroxyprogesterone acetate tab 2.5 mg generic 1

medroxyprogesterone acetate tab 5 mg generic 1

MEGACE ES SUSPENSION 625 MG/5MLmegestrol acetate (appetite)

BRAND 3

MEGACE ORAL SUSPENSION 40 MG/MLmegestrol acetate

BRAND 3

megestrol acetate suspension 40 mg/ml generic 1

megestrol acetate suspension 400mg/10ml

generic 1

megestrol acetate suspension 625 mg/5ml generic 3

megestrol acetate tab 20 mg generic 1

megestrol acetate tab 40 mg generic 1

MIRENA IUD 20 MCG/24HRlevonorgestrel (iud)

BRAND 0 GL Female

my way tab 1.5 mg generic 0 GL Female



NEXPLANON IMPLANT 68 MGetonogestrel

BRAND 0 GL Female

next choice one dose tab 1.5 mg generic 0 GL Female

next choice tab 0.75 mg generic 0 GL Female

NOR-QD TAB 0.35 MGnorethindrone (contraceptive)

BRAND 0 GL Female

nora-be tab 0.35 mg generic 0 GL Female

norethindrone acetate tab 5 mg generic 0

norethindrone tab 0.35 mg generic 0 GL Female

norlyroc tab 0.35 mg generic 0 GL Female

ORTHO MICRONOR TAB 0.35 MGnorethindrone (contraceptive)

BRAND 0 GL Female

PLAN B ONE-STEP TAB 1.5 MGlevonorgestrel (emergency oc)

BRAND 0 GL Female

PLAN B TAB 0.75 MGlevonorgestrel (emergency oc)

BRAND 0 GL Female

progesterone micronized cap 100 mg generic 1

progesterone micronized cap 200 mg generic 1

sharobel tab 0.35 mg generic 0 GL Female

SKYLA IUD 13.5 MGlevonorgestrel (iud)

BRAND 0 GL Female

SELECTIVE ESTROGEN RECEPTOR MODIFYING AGENTS

EVISTA 60 MGraloxifene hcl

BRAND 2GL Female

MDD 1 per day

EVISTA TAB 60 MGraloxifene hcl

BRAND 2GL Female

MDD 1 per day

raloxifene hcl tab 60 mg generic 0GL Female

MDD 1 per day



HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (THYROID)

levo-t tab 100 mcg generic 1












levothroid tab 100 mcg generic 1












levothyroxine sodium 100 mcg generic 1








levothyroxine sodium recon soln 100 mcg generic 1

levothyroxine sodium recon soln 500 mcg generic 1

levothyroxine sodium tab 100 mcg generic 1












levoxyl tab 100 mcg generic 1













liothyronine sodium solution 10 mcg/ml generic 1

liothyronine sodium tab 25 mcg generic 1



THYROLAR-1 TAB 60 (12.5-50) MG (MCG)liotrix (t3-t4)

BRAND 3

THYROLAR-1/2 TAB 30 (6.25-25) MG (MCG)liotrix (t3-t4)

BRAND 3

THYROLAR-1/4 TAB 15 (3.1-12.5) MG(MCG)liotrix (t3-t4)

BRAND 3

THYROLAR-2 TAB 120 (25-100) MG (MCG)liotrix (t3-t4)

BRAND 3

THYROLAR-3 TAB 180 (37.5-150) MG(MCG)liotrix (t3-t4)

BRAND 3

unithroid direct tab 100 mcg generic 1











unithroid tab 100 mcg generic 1














HORMONAL AGENTS, SUPPRESSANT (PARATHYROID)

SENSIPAR TAB 30 MGcinacalcet hcl

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

HORMONAL AGENTS, SUPPRESSANT (PITUITARY)

cabergoline tab 0.5 mg generic 1

ELIGARD KIT 22.5 MGleuprolide acetate (3 month)

BRAND 4PA

S

ELIGARD KIT 30 MGleuprolide acetate (4 month)

BRAND 4PA

S

ELIGARD KIT 45 MGleuprolide acetate (6 month)

BRAND 4PA

S

ELIGARD KIT 7.5 MGleuprolide acetate

BRAND 4PA

S



FIRMAGON RECON SOLN 120 MGdegarelix acetate

BRAND 4PA

S

FIRMAGON RECON SOLN 80 MGdegarelix acetate

BRAND 4PA

S

leuprolide acetate kit 1 mg/0.2ml generic 4PA

S

LUPRON DEPOT KIT 11.25 MGleuprolide acetate (3 month)

BRAND 4PA

S

LUPRON DEPOT KIT 22.5 MGleuprolide acetate (3 month)

BRAND 4PA

S

LUPRON DEPOT KIT 3.75 MGleuprolide acetate

BRAND 4PA

S

LUPRON DEPOT KIT 30 MGleuprolide acetate (4 month)

BRAND 4PA

S

LUPRON DEPOT KIT 45 MGleuprolide acetate (6 month)

BRAND 4PA

S

LUPRON DEPOT KIT 7.5 MGleuprolide acetate

BRAND 4PA

S

LUPRON DEPOT-PED KIT 11.25 MGleuprolide acetate (cpp)

BRAND 4PA

S

LUPRON DEPOT-PED KIT 15 MGleuprolide acetate (cpp)

BRAND 4PA

S

LUPRON DEPOT-PED KIT 30 MG (PED)leuprolide acetate (cpp) (3 month)

BRAND 4PA

S

LUPRON DEPOT-PED KIT 7.5 MGleuprolide acetate (cpp)

BRAND 4PA

S

octreotide acetate solution 100 mcg/ml generic 4PA

S

octreotide acetate solution 1000 mcg/5ml generic 4PA

S




S


S


S


S

SANDOSTATIN SOLUTION 100 MCG/MLoctreotide acetate

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

SOMATULINE DEPOT SOLUTION 120MG/0.5MLlanreotide acetate

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

SOMAVERT RECON SOLN 10 MGpegvisomant

BRAND 4PA

S


BRAND 4PA

S




BRAND 4PA

S

SYNAREL SOLUTION 2 MG/MLnafarelin acetate

BRAND 4PA

S

TRELSTAR DEPOT MIXJECT RECON SUSP3.75 MGtriptorelin pamoate

BRAND 4PA

S

TRELSTAR LA MIXJECT RECON SUSP 11.25MGtriptorelin pamoate

BRAND 4PA

S

TRELSTAR MIXJECT RECON SUSP 22.5 MGtriptorelin pamoate

BRAND 4PA

S

TRELSTAR RECON SUSP 11.25 MGtriptorelin pamoate

BRAND 4PA

S

TRELSTAR RECON SUSP 3.75 MGtriptorelin pamoate

BRAND 4PA

S

ZOLADEX IMPLANT 10.8 MGgoserelin acetate

BRAND 4PA

S

ZOLADEX IMPLANT 3.6 MGgoserelin acetate

BRAND 4PA

S

HORMONAL AGENTS, SUPPRESSANT (THYROID)

ANTITHYROID AGENTS

methimazole tab 10 mg generic 1

methimazole tab 5 mg generic 1

propylthiouracil tab 50 mg generic 1

IMMUNOLOGICAL AGENTS

IMMUNE SUPPRESSANTS

AZASAN TAB 100 MGazathioprine

BRAND 3



AZASAN TAB 75 MGazathioprine

BRAND 3

azathioprine sodium recon soln 100 mg generic 1

azathioprine tab 50 mg generic 1

CELLCEPT INTRAVENOUS RECON SOLN 500MGmycophenolate mofetil hcl

BRAND 3

CIMZIA KIT 2 X 200 MGcertolizumab pegol

BRAND 4PA

S

CIMZIA PREFILLED KIT 2 X 200 MG/MLcertolizumab pegol

BRAND 4PA

S

CIMZIA STARTER KIT KIT 6 X 200 MG/MLcertolizumab pegol

BRAND 4PA

S

cyclosporine cap 100 mg generic 1

cyclosporine cap 25 mg generic 1

cyclosporine modified cap 100 mg generic 1



cyclosporine modified solution 100 mg/ml generic 1

cyclosporine solution 50 mg/ml generic 1

ENBREL RECON SOLN 25 MGetanercept

BRAND 4 S

ENBREL SOLN PRSYR 25 MG/0.5MLetanercept

BRAND 4PA

S

ENBREL SOLN PRSYR 50 MG/MLetanercept

BRAND 4PA

S

ENBREL SURECLICK SOLN A-INJ 50 MG/MLetanercept

BRAND 4PA

S

gengraf cap 100 mg generic 1





gengraf solution 100 mg/ml generic 1

hecoria cap 0.5 mg generic 1

hecoria cap 1 mg generic 1

hecoria cap 5 mg generic 1

HUMIRA PEDIATRIC CROHNS START PREFSY KT 40 MG/0.8MLadalimumab

BRAND 4PA

S

HUMIRA PEN PEN KIT 40 MG/0.8MLadalimumab

BRAND 4PA

S

HUMIRA PEN-CROHNS STARTER PEN KIT 40MG/0.8MLadalimumab

BRAND 4PA

S

HUMIRA PEN-PSORIASIS STARTER PEN KIT40 MG/0.8MLadalimumab

BRAND 4PA

S

HUMIRA PREF SY KT 20 MG/0.4MLadalimumab

BRAND 4PA

S

HUMIRA PREF SY KT 40 MG/0.8MLadalimumab

BRAND 4PA

S

KINERET SOLN PRSYR 100 MG/0.67MLanakinra

BRAND 4PA

S

methotrexate sodium (pf) solution 250mg/10ml

generic 1 S

methotrexate sodium (pf) solution 50mg/2ml

generic 1 S

methotrexate sodium recon soln 1 gm generic 1 S

methotrexate sodium solution 25 mg/ml generic 1 S

methotrexate sodium solution 250mg/10ml

generic 1 S



methotrexate sodium solution 50 mg/2ml generic 1 S

methotrexate tab 2.5 mg generic 1 S

mycophenolate mofetil cap 250 mg generic 1

mycophenolate mofetil tab 500 mg generic 1

mycophenolic acid tab dr 180 mg generic 1

mycophenolic acid tab dr 360 mg generic 1

MYFORTIC TAB DR 180 MGmycophenolate sodium

BRAND 2

MYFORTIC TAB DR 360 MGmycophenolate sodium

BRAND 2

NULOJIX RECON SOLN 250 MGbelatacept

BRAND 4PA

S

ORENCIA RECON SOLN 250 MGabatacept

BRAND 4PA

S

ORENCIA SOLN PRSYR 125 MG/MLabatacept

BRAND 4PA

S

PROGRAF CAP 1 MGtacrolimus

BRAND 2

PROGRAF SOLUTION 5 MG/MLtacrolimus

BRAND 2

RAPAMUNE SOLUTION 1 MG/MLsirolimus

BRAND 2

REMICADE RECON SOLN 100 MGinfliximab

BRAND 4PA

S

RHEUMATREX TAB 2.5 MGmethotrexate sodium (antirheumatic)

BRAND 4PA

S

SIMPONI SOLN A-INJ 50 MG/0.5MLgolimumab

BRAND 4PA

S

SIMPONI SOLN PRSYR 50 MG/0.5MLgolimumab

BRAND 4PA

S



sirolimus tab 0.5 mg generic 1

sirolimus tab 1 mg generic 1

sirolimus tab 2 mg generic 1

tacrolimus cap 0.5 mg generic 1

tacrolimus cap 1 mg generic 1

tacrolimus cap 5 mg generic 1

TREXALL TAB 10 MGmethotrexate sodium

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

TREXALL TAB 7.5 MGmethotrexate sodium

BRAND 4PA

S

XELJANZ TAB 5 MGtofacitinib citrate

BRAND 4PA

S

ZORTRESS TAB 0.25 MGeverolimus (immunosuppressant)

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

IMMUNIZING AGENTS, PASSIVE

ATGAM INJECTABLE 50 MG/MLlymphocyte immune globulin,anti-thymocyte globulin (equine)

BRAND 4PA

S

CARIMUNE NF RECON SOLN 3 GMimmune globulin (human) iv

BRAND 4PA

S



GAMMAGARD S/D LESS IGA RECON SOLN 5GMimmune globulin (human) iv

BRAND 4PA

S

GAMMAGARD S/D RECON SOLN 10 GMimmune globulin (human) iv

BRAND 4PA

S

GAMMAGARD S/D RECON SOLN 2.5 GMimmune globulin (human) iv

BRAND 4PA

S

GAMMAGARD S/D RECON SOLN 5 GMimmune globulin (human) iv

BRAND 4PA

S

GAMMAGARD SOLUTION 1 GM/10MLimmune globulin (human) iv orsubcutaneous

BRAND 4PA

S

GAMMAKED SOLUTION 1 GM/10MLimmune globulin (human) iv orsubcutaneous

BRAND 4PA

S

GAMUNEX-C SOLUTION 1 GM/10MLimmune globulin (human) iv orsubcutaneous

BRAND 4PA

S

HIZENTRA 20% SOLUTION 1 GM/5MLimmune globulin (human) subcutaneous

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

HIZENTRA SOLUTION 10 GM/50MLimmune globulin (human) subcutaneous

BRAND 4PA

S

THYMOGLOBULIN RECON SOLN 25 MGanti-thymocyte globulin (rabbit),lymphocyte immune globulin

BRAND 4PA

S

IMMUNOMODULATORS

ACTEMRA SOLUTION 200 MG/10MLtocilizumab

BRAND 4PA

S




BRAND 4PA

S


BRAND 4PA

S

ACTIMMUNE SOLUTION 2000000UNIT/0.5MLinterferon gamma-1b

BRAND 4PA

S

ARCALYST RECON SOLN 220 MGrilonacept

BRAND 4PA

S

leflunomide tab 10 mg generic 1 MDD 1 per day

leflunomide tab 20 mg generic 1 MDD 1 per day

RIDAURA CAP 3 MGauranofin

BRAND 3

SIMULECT RECON SOLN 10 MGbasiliximab

BRAND 3

SIMULECT RECON SOLN 20 MGbasiliximab

BRAND 3

VACCINES

ADACEL SUSPENSION 5-2-15.5 LF-MCG/0.5tetanus toxoid-diphtheria-acellularpertussis adsorb (tdap)

BRAND 0

AFLURIA PRESERVATIVE FREE SUSP PRSYR0.5 MLinfluenza virus vaccine split preservativefree

BRAND 0

AFLURIA SUSPENSIONinfluenza virus vaccine split

BRAND 0

AGRIFLU SUSP PRSYR 0.5 MLinfluenza virus vaccine types a & bpreservative free

BRAND 0

BOOSTRIX SUSPENSION 5-2.5-18.5tetanus toxoid-diphtheria-acellularpertussis adsorb (tdap)

BRAND 0



FLUARIX QUADRIVALENT SUSP PRSYR 0.5MLinfluenza virus vaccine split quadrivalent

BRAND 0

FLUARIX SUSP PRSYR 0.5 MLinfluenza virus vaccine split preservativefree

BRAND 0

FLUCELVAX SUSP PRSYR 0.5 MLinfluenza virus vaccine tissue-culturedsubunit

BRAND 0

FLULAVAL QUADRIVALENT SUSP PRSYR 0.5MLinfluenza virus vaccine split quadrivalent

BRAND 0

FLULAVAL QUADRIVALENT SUSPENSIONinfluenza virus vaccine split quadrivalent

BRAND 0

FLULAVAL SUSPENSIONinfluenza virus vaccine split

BRAND 0

FLUVIRIN PRESERVATIVE FREE SUSP PRSYR0.5 MLinfluenza virus vaccine types a & bpreservative free

BRAND 0

FLUVIRIN SUSP PRSYR 0.5 MLinfluenza virus vaccine types a & b surfaceantigen

BRAND 0

FLUVIRIN SUSPENSIONinfluenza virus vaccine types a & b surfaceantigen

BRAND 0

FLUZONE HIGH-DOSE SUSP PRSYR 0.5 MLinfluenza virus vaccine split high-dosepreservative free

BRAND 0

FLUZONE PEDIATRIC PF SUSP PRSYR 0.25MLinfluenza virus vaccine split preservativefree

BRAND 0

FLUZONE PRESERVATIVE FREE SUSP PRSYR0.5 MLinfluenza virus vaccine split preservativefree

BRAND 0



FLUZONE PRESERVATIVE FREESUSPENSIONinfluenza virus vaccine split preservativefree

BRAND 0

FLUZONE QUADRIVALENT SUSP PRSYR 0.5MLinfluenza virus vaccine split quadrivalent

BRAND 0

FLUZONE QUADRIVALENT SUSPENSIONinfluenza virus vaccine split quadrivalent

BRAND 0

FLUZONE QUADRIVALENT SUSPENSION 0.5MLinfluenza virus vaccine split quadrivalent

BRAND 0

FLUZONE SUSP PEN 9 MCG/STRAINinfluenza virus vaccine split

BRAND 0

FLUZONE SUSPENSIONinfluenza virus vaccine split

BRAND 0

MENACTRA INJECTABLEmeningococcal (a,c,y&w-135)polysaccharide conjugate vaccine

BRAND 0

MENOMUNE INJECTABLEmeningococcal vac a,c,y&w-135

BRAND 0

MENVEO RECON SOLNmeningococcal (a,c,y&w-135)oligosaccharide conjugate vac

BRAND 0

PNEUMOVAX 23 INJECTABLE 25MCG/0.5MLpneumococcal vac polyvalent

BRAND 0

PREVNAR 13 SUSPENSIONpneumococcal 13-valent conjugate vaccine

BRAND 0

ZOSTAVAX RECON SOLN 19400UNT/0.65MLzoster vaccine live




INFLAMMATORY BOWEL DISEASE AGENTS

AMINOSALICYLATES

APRISO CAP ER 24H 0.375 GMmesalamine

BRAND 2

ASACOL HD TAB DR 800 MGmesalamine


ASACOL TAB DR 400 MGmesalamine


balsalazide disodium cap 750 mg generic 1

CANASA SUPPOS 1000 MGmesalamine

BRAND 2

DIPENTUM CAP 250 MGolsalazine sodium

BRAND 2

LIALDA TAB DR 1.2 GMmesalamine

BRAND 2

mesalamine enema 4 gm generic 1

PENTASA CAP ER 250 MGmesalamine

BRAND 2

PENTASA CAP ER 500 MGmesalamine

BRAND 2

GLUCOCORTICOIDS

budesonide cp dr part 3 mg generic 1

colocort enema 100 mg/60ml generic 1

hydrocortisone cream 1 % generic 1

hydrocortisone cream 2.5 % generic 1

hydrocortisone enema 100 mg/60ml generic 1

procto-med hc cream 2.5 % generic 1

proctocream hc cream 2.5 % generic 1

proctosol hc cream 2.5 % generic 1

proctozone-hc cream 2.5 % generic 1



SULFONAMIDES

sulfasalazine tab 500 mg generic 1

sulfasalazine tab dr 500 mg generic 1

METABOLIC BONE DISEASE AGENTS

ACTONEL TAB 150 MGrisedronate sodium

BRAND 2PA

MDS 1 / 28 days

ACTONEL TAB 30 MGrisedronate sodium

BRAND 2PA

MDD 1 per day

alendronate sodium tab 10 mg generic 1 MDD 1 per day

alendronate sodium tab 35 mg generic 1 MDS 4 / 28 days



alendronate sodium tab 70 mg generic 1 MDS 4 / 28 days

AREDIA RECON SOLN 30 MGpamidronate disodium

BRAND 4PA

S

ATELVIA TAB DR 35 MGrisedronate sodium

BRAND 2 PA

BONIVA SOLUTION 3 MG/3MLibandronate sodium

BRAND 4PA

S

calcitonin (salmon) solution 200 unit/act generic 1 MPL 1 / 30 days

calcitriol cap 0.25 mcg generic 1

calcitriol cap 0.5 mcg generic 1

calcitriol solution 1 mcg/ml generic 1

calcitriol solution 1 mcg/ml generic 1

doxercalciferol cap 0.5 mcg generic 1

doxercalciferol cap 1 mcg generic 1

doxercalciferol cap 2.5 mcg generic 1



doxercalciferol solution 4 mcg/2ml generic 1

etidronate disodium tab 200 mg generic 1

etidronate disodium tab 400 mg generic 1

FORTEO SOLUTION 600 MCG/2.4MLteriparatide (recombinant)

BRAND 4

PA

MPL 1 / 28 daysS

FOSAMAX PLUS D TAB 70-2800 MG-UNITalendronate sodium-cholecalciferol

BRAND 3PA

MDS 4 / 28 days

FOSAMAX PLUS D TAB 70-5600 MG-UNITalendronate sodium-cholecalciferol

BRAND 3PA

MDS 4 / 28 days

ibandronate sodium solution 3 mg/3ml generic 4PA

S

ibandronate sodium tab 150 mg generic 1 MDS 1 / 28 days

pamidronate disodium recon soln 30 mg generic 4PA

S

pamidronate disodium recon soln 90 mg generic 4PA

S

pamidronate disodium solution 30mg/10ml

generic 4PA

S

PAMIDRONATE DISODIUM SOLUTION 6MG/MLpamidronate disodium

BRAND 4PA

S

pamidronate disodium solution 90mg/10ml

generic 4PA

S

paricalcitol cap 1 mcg generic 1



paricalcitol solution 2 mcg/ml generic 1

paricalcitol solution 5 mcg/ml generic 1



PROLIA SOLUTION 60 MG/MLdenosumab

BRAND 4PA

S

RECLAST SOLUTION 5 MG/100MLzoledronic acid

BRAND 4PA

S

risedronate sodium tab 150 mg generic 1PA

MDS 1 / 28 days


MDD 1 per day


MDS 4 / 28 days


MDD 1 per day

risedronate sodium tab dr 35 mg generic 1 PA

SKELID TAB 200 MGtiludronate disodium

BRAND 3

XGEVA SOLUTION 120 MG/1.7MLdenosumab

BRAND 4PA

S

ZEMPLAR CAP 1 MCGparicalcitol

BRAND 3


BRAND 3


BRAND 3

ZEMPLAR SOLUTION 2 MCG/MLparicalcitol

BRAND 3

ZEMPLAR SOLUTION 5 MCG/MLparicalcitol

BRAND 3

zoledronic acid conc 4 mg/5ml generic 4PA

S

ZOLEDRONIC ACID RECON SOLN 4 MGzoledronic acid

BRAND 4PA

S



ZOLEDRONIC ACID SOLUTION 4 MG/100MLzoledronic acid

BRAND 4PA

S

zoledronic acid solution 5 mg/100ml generic 4PA

S

ZOMETA CONC 4 MG/5MLzoledronic acid

BRAND 4PA

S

ZOMETA SOLUTION 4 MG/100MLzoledronic acid

BRAND 4PA

S

MISCELLANEOUS THERAPEUTIC AGENTS

1ST CHOICE LANCETS SUPER THIN MISClancets


1ST CHOICE LANCETS THIN MISClancets


1ST CHOICE LANCETS ULTRA THIN MISClancets


1ST CHOICE PEN NEEDLES MISC 31G X 6MMinsulin pen needle


1ST CHOICE PEN NEEDLES MISC 31G X 8MMinsulin pen needle


1ST TIER UNIFINE PENTIPS MISC 29G X12MMinsulin pen needle


1ST TIER UNIFINE PENTIPS MISC 31G X 5MMinsulin pen needle










1ST TIER UNIFINE PENTIPS PLUS MISC 29GX 12MMinsulin pen needle


1ST TIER UNIFINE PENTIPS PLUS MISC 31GX 5 MMinsulin pen needle








1ST TIER UNILET COMFORTOUCH MISClancets


ACCU-CHEK ACTIVE GLUCOSE CONT LIQUIDblood glucose calibration

BRAND 1

ACCU-CHEK AVIVA SOLUTIONblood glucose calibration

BRAND 1

ACCU-CHEK COMFORT CURVE LINEARSOLUTIONblood glucose calibration

BRAND 1

ACCU-CHEK COMFORT CURVE SOLUTIONblood glucose calibration

BRAND 1

ACCU-CHEK COMPACT BLUE CONTROLLIQUIDblood glucose calibration

BRAND 1

ACCU-CHEK COMPACT PLUS CONTROLSOLUTIONblood glucose calibration

BRAND 1



ACCU-CHEK FASTCLIX LANCETS MISClancets


ACCU-CHEK INSTANT CONTROL LIQUIDblood glucose calibration

BRAND 1

ACCU-CHEK MULTICLIX LANCETS MISClancets


ACCU-CHEK SAFE-T PRO LANCETS MISClancets


ACCU-CHEK SMARTVIEW CONTROL LIQUIDblood glucose calibration

BRAND 1

ACCU-CHEK SOFT TOUCH LANCETS MISClancets


ACCU-CHEK SOFTCLIX LANCET DEV MISClancet devices

BRAND 1

ACCU-CHEK SOFTCLIX LANCETS MISClancets


ACCUSURE INSULIN SYRINGE 29G X 1/2"0.5 MLinsulin syringe/needle u-100


ACCUSURE INSULIN SYRINGE 29G X 1/2" 1MLinsulin syringe/needle u-100


ACCUSURE INSULIN SYRINGE 30G X 5/16"0.5 MLinsulin syringe/needle u-100


ACCUSURE INSULIN SYRINGE 30G X 5/16" 1MLinsulin syringe/needle u-100


accusure insulin syringe 31g x 5/16" 0.5 ml generic 1 MDS 450 / 90 days

accusure insulin syringe 31g x 5/16" 1 ml generic 1 MDS 450 / 90 days

ACCUTREND GLUCOSE CONTROLSOLUTIONblood glucose calibration

BRAND 1



ACTI-LANCE 28G MISClancets


ACTI-LANCE LITE LANCETS 28G MISClancets


ACTI-LANCE SPECIAL LANCETS 17G MISClancets


ACTI-LANCE UNIVERSAL 23G MISClancets


ACURA CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

ACURA CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

ADJUSTABLE LANCING DEVICE MISClancet devices

BRAND 1

ADVANCE INTUITION CONTROL LIQUIDNORMALblood glucose calibration

BRAND 1

ADVOCATE CONTROL SOLUTION LIQUIDLOWblood glucose calibration

BRAND 1

ADVOCATE INSULIN PEN NEEDLES MISC29G X 12.7MMinsulin pen needle


ADVOCATE INSULIN PEN NEEDLES MISC31G X 5 MMinsulin pen needle


ADVOCATE INSULIN PEN NEEDLES MISC31G X 8 MMinsulin pen needle


ADVOCATE INSULIN SYRINGE MISC 29G X1/2" 0.3 MLinsulin syringe/needle u-100






ADVOCATE INSULIN SYRINGE MISC 29G X1/2" 1 MLinsulin syringe/needle u-100














ADVOCATE LANCETS 30G MISClancets


ADVOCATE LANCETS MISClancets


ADVOCATE LANCING DEVICE MISClancet devices

BRAND 1

ADVOCATE RAPID-SAFE LANCING MISClancet devices

BRAND 1

ADVOCATE REDI-CODE+ CONTROLSOLUTION LOWblood glucose calibration

BRAND 1

ADVOCATE SAFETY LANCETS 26G MISClancets


ADVOCATE SAFETY LANCETS MISClancets




AF LANCETS SUPER THIN MISClancets


AGAMATRIX CONTROL SOLUTIONblood glucose calibration

BRAND 1

AGAMATRIX CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

AGAMATRIX ULTRA-THIN LANCETS MISClancets


ALTERNATE SITE LANCING DEVICE MISClancet devices

BRAND 1

amiodarone hcl powder generic 1

ANTI-STICK INSULIN SYRINGE MISC 29G X1/2" 1 MLinsulin syringe/needle u-100


AQUA LANCE ADJUSTABLE LANCINGDEVICElancet devices

BRAND 1

argyle sterile water solution generic 1

ASCENSIA AUTODISC CONTROL LIQUIDNORMALblood glucose calibration

BRAND 1

ASCENSIA AUTODISC CONTROLS LIQUIDblood glucose calibration

BRAND 1

ASSURE 3 CONTROL LIQUIDblood glucose calibration

BRAND 1

ASSURE 4 CONTROL LEVEL 1 & 2 LIQUIDblood glucose calibration

BRAND 1

ASSURE COMFORT LANCETS 28G MISClancets


ASSURE COMFORT LANCETS 30G MISClancets


ASSURE DOSE CONTROL SOLUTIONNORMALblood glucose calibration

BRAND 1



ASSURE DOSE NORM/HIGH CONTROLSOLUTIONblood glucose calibration

BRAND 1

ASSURE HAEMOLANCE PLUS HIGH MISClancets


ASSURE HAEMOLANCE PLUS LOW MISClancets


ASSURE HAEMOLANCE PLUS MICRO MISClancets


ASSURE HAEMOLANCE PLUS NORMALMISClancets


ASSURE HAEMOLANCE PLUS PED MISClancets


ASSURE ID INSULIN SAFETY SYR MISC 29GX 1/2" 0.5 MLinsulin syringe/needle u-100


ASSURE ID INSULIN SAFETY SYR MISC 29GX 1/2" 1 MLinsulin syringe/needle u-100


ASSURE LANCE LANCETS 21G MISClancets


ASSURE LANCE LANCETS MISClancets


ASSURE LANCE PLUS SAFETY 25G MISClancets


ASSURE LANCE PLUS SAFETY 30G MISClancets


ASSURE LANCETS MISClancets


ASSURE PRISM CONTROL LEVEL 1&2SOLUTIONblood glucose calibration

BRAND 1

ASSURE PRO CONTROL LEVEL 1 & 2 LIQUIDblood glucose calibration

BRAND 1



ATOVAQUONE POWDERatovaquone (bulk)

BRAND 1

AURORA HEALTHCARE LANCETS MISClancets


AURORA LANCET SUPER THIN 30G MISClancets


AURORA LANCET THIN 23G MISClancets


AURORA PEN NEEDLES MISC 29G X 12MMinsulin pen needle


AURORA PEN NEEDLES MISC 31G X 6 MMinsulin pen needle


AURORA PEN NEEDLES MISC 31G X 8 MMinsulin pen needle


AURORA UNIFINE PENTIPS MISC 31G X 5MMinsulin pen needle


AURORA UNIFINE PENTIPS MISC 32G X 4MMinsulin pen needle


AUTO-LANCET MINI MISClancet devices

BRAND 1

AUTO-LANCET MISClancet devices

BRAND 1

AUTOLET IMPRESSION MISClancet devices

BRAND 1

AUTOLET LANCING DEVICE MISClancet devices

BRAND 1

AUTOLET MINI MISClancet devices

BRAND 1

BAYER BREEZE 2 CONTROL LIQUID LOWblood glucose calibration

BRAND 1

BAYER BREEZE 2 CONTROL LIQUIDNORMALblood glucose calibration

BRAND 1



BAYER CONTOUR LIQUID LOWblood glucose calibration

BRAND 1

BAYER CONTOUR LIQUID NORMALblood glucose calibration

BRAND 1

BAYER CONTOUR NEXT CONTROLSOLUTION LOWblood glucose calibration

BRAND 1

BAYER CONTOUR NEXT CONTROLSOLUTION NORMALblood glucose calibration

BRAND 1

BAYER MICROLET 2 LANCING DEVIC MISClancet devices

BRAND 1

BAYER MICROLET LANCETS MISClancets


BD AUTOSHIELD MISC 29G X 12MMinsulin pen needle


BD AUTOSHIELD MISC 29G X 8MMinsulin pen needle


BD INSULIN SYR ULTRAFINE II MISC 31G X5/16" 0.5 MLinsulin syringe/needle u-100


BD INSULIN SYR ULTRAFINE II MISC 31G X5/16" 1 MLinsulin syringe/needle u-100


BD INSULIN SYRINGE HALF-UNIT MISC 31GX 5/16" 0.3 MLinsulin syringe/needle u-100


BD INSULIN SYRINGE MICROFINE MISC 27GX 5/8" 1 MLinsulin syringe/needle u-100


BD INSULIN SYRINGE MICROFINE MISC 28GX 1/2" 0.3 MLinsulin syringe/needle u-100


BD INSULIN SYRINGE MICROFINE MISC 28GX 1/2" 0.5 MLinsulin syringe/needle u-100




BD INSULIN SYRINGE MICROFINE MISC 28GX 1/2" 1 MLinsulin syringe/needle u-100


BD INSULIN SYRINGE MISC 25G X 1" 1 MLinsulin syringe/needle u-100


BD INSULIN SYRINGE MISC 25G X 5/8" 1 MLinsulin syringe/needle u-100








BD INSULIN SYRINGE MISC 29G X 1/2" 0.5MLinsulin syringe/needle u-100








BD INSULIN SYRINGE MISC U-100 1 MLinsulin syringes (disposable)


BD INSULIN SYRINGE ULTRAFINE MISC 29GX 1/2" 0.3 MLinsulin syringe/needle u-100




BD INSULIN SYRINGE ULTRAFINE MISC 29GX 1/2" 1 MLinsulin syringe/needle u-100


















BD INTEGRA INSULIN SYRINGE MISC 29G X1/2" 1 MLinsulin syringe/needle u-100


BD INTEGRA SYRINGE MISC 25G X 1" 1 MLinsulin syringe/needle u-100


BD LANCET DEVICE MISClancet devices

BRAND 1

BD LANCET ULTRAFINE 30G MISClancets


BD LANCET ULTRAFINE 33G MISClancets


BD MICROTAINER LANCETS MISClancets




BD PEN NEEDLE NANO U/F MISC 32G X 4MMinsulin pen needle


BD PEN NEEDLE SHORT U/F MISC 31G X 8MMinsulin pen needle


BD PEN NEEDLE ULTRAFINE MISC 29G X12.7MMinsulin pen needle


BD SAFETY-LOK INSULIN SYRINGE MISC29G X 1/2" 1 MLinsulin syringe/needle u-100


BD SAFETYGLIDE INSULIN SYRINGE MISC29G X 1/2" 0.5 MLinsulin syringe/needle u-100


BD SAFETYGLIDE INSULIN SYRINGE MISC30G X 5/16" 0.5 MLinsulin syringe/needle u-100


blood glucose system pak kit generic 1 MDS 1 / 730 days

blood glucose test strip generic 1 MDS 100 / 30 days

BULLSEYE MINI SAFETY LANCETS MISClancets


BULLSEYE SAFETY LANCETS MISClancets


CARDIOCOM LANCING DEVICE MISClancet devices

BRAND 1

CAREFINE PEN NEEDLES MISC 29G X 12MMinsulin pen needle


CAREFINE PEN NEEDLES MISC 30G X 8 MMinsulin pen needle














CAREONE ADVANCED LANCING DEV MISClancet devices

BRAND 1

CAREONE INSULIN SYRINGE MISC 30G X1/2" 0.3 MLinsulin syringe/needle u-100




CAREONE INSULIN SYRINGE MISC 30G X1/2" 1 MLinsulin syringe/needle u-100






CAREONE INSULIN SYRINGE MISC 31G X5/16" 1 MLinsulin syringe/needle u-100


CAREONE LANCET THIN 23G MISClancets


CAREONE LANCET ULTRA THIN 28G MISClancets


CAREONE ULTIGUARD INSULIN SYR MISC29G X 1/2" 0.3 MLinsulin syringe/needle u-100






CAREONE ULTIGUARD INSULIN SYR MISC29G X 1/2" 1 MLinsulin syringe/needle u-100






CAREONE ULTIGUARD INSULIN SYR MISC30G X 5/16" 1 MLinsulin syringe/needle u-100


CAREONE UNIFINE PENTIPS MISC 29G X12MMinsulin pen needle


CAREONE UNIFINE PENTIPS MISC 31G X 5MMinsulin pen needle








CAREONE UNIFINE PENTIPS PLUS MISC 29GX 12MMinsulin pen needle


CAREONE UNIFINE PENTIPS PLUS MISC 31GX 5 MMinsulin pen needle










CARESENS CONTROL A SOLUTIONblood glucose calibration

BRAND 1

CAYA DIAPHRAGMdiaphragm arc-spring

BRAND 0

CHEK-STIX CONTROL STRIPacetone (urine) test

BRAND 1 MPL 1 / 30 Days

CHEMSTRIP K STRIPacetone (urine) test


CLEANLET LANCETS 28G MISClancets


CLEVER CHEK LANCETS MISClancets


CLEVER CHOICE GLUCOSE CONTROLLIQUID LOWblood glucose calibration

BRAND 1

CLICKFINE PEN NEEDLES MISC 31G X 6 MMinsulin pen needle






clindamycin phosphate powder generic 1

CLINDAMYCIN PHOSPHATE POWDERclindamycin phosphate (bulk)

BRAND 1

CLOSERCARE MISClancet devices

BRAND 1

COAGUCHEK LANCETS MISClancets




COMFORT ASSIST INSULIN SYRINGE MISC29G X 1/2" 0.3 MLinsulin syringe/needle u-100




COMFORT ASSIST INSULIN SYRINGE MISC29G X 1/2" 1 MLinsulin syringe/needle u-100














COMFORT ASSURED LANCETS 28G MISClancets


COMFORT ASSURED LANCETS 33G MISClancets


COMFORT EZ INSULIN SYRINGE MISC 28G X1/2" 0.5 MLinsulin syringe/needle u-100


COMFORT EZ INSULIN SYRINGE MISC 28G X1/2" 1 MLinsulin syringe/needle u-100






























COMFORT EZ PEN NEEDLES MISC 31G X 5MMinsulin pen needle












COMFORT LANCETS MISClancets


CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

CVS INSULIN SYRINGE MISC 29G X 1/2" 0.3MLinsulin syringe/needle u-100




CVS INSULIN SYRINGE MISC 29G X 1/2" 1MLinsulin syringe/needle u-100








CVS LANCETS 21G MISClancets


CVS LANCETS MICRO THIN 33G MISClancets


CVS LANCETS ORIGINAL MISClancets


CVS LANCETS THIN 26G MISClancets


CVS LANCETS THIN MISClancets


CVS LANCETS ULTRA THIN 30G MISClancets


CVS LANCING DEVICE MISClancet devices

BRAND 1

CVS ULTRA THIN LANCETS MISClancets


DIASTAR EASY TEST II LANCETS MISClancets


DIASTAR EASY TEST LANCETS MISClancets


DIATRUE CONTROL LEVEL 1 SOLUTIONLOWblood glucose calibration

BRAND 1

DIATRUE CONTROL LEVEL 2 SOLUTIONNORMALblood glucose calibration

BRAND 1

DROPLET LANCETS ULTRA THIN 30G MISClancets


DROPLET LANCING DEVICE MISClancet devices

BRAND 1

DRUG MART LANCETS THIN 26G MISClancets


DRUG MART LANCETS ULTRA THIN MISClancets




DRUG MART LANCING DEVICE MISClancet devices

BRAND 1

DRUG MART ON-THE-GO LANCET 30GMISClancets


DRUG MART ULTRA COMFORT SYR MISC29G X 1/2" 0.3 MLinsulin syringe/needle u-100


DRUG MART ULTRA COMFORT SYR MISC29G X 1/2" 1 MLinsulin syringe/needle u-100






DRUG MART ULTRA COMFORT SYR MISC30G X 5/16" 1 MLinsulin syringe/needle u-100






DRUG MART UNIFINE PENTIPS MISC 29G X12MMinsulin pen needle


DRUG MART UNIFINE PENTIPS MISC 31G X5 MMinsulin pen needle










DRUG MART UNIFINE PENTIPS PLUS MISC32G X 4 MMinsulin pen needle


DRUG MART UNILET LANCETS 28G MISClancets


DRUG MART UNILET LANCETS 30G MISClancets


DUANE READE LANCET ALTERN SITE MISClancets


DUANE READE LANCET SUPER THIN MISClancets


DUANE READE LANCET ULTRA THIN MISClancets


DUANE READE UNIFINE PENTIPS MISC 29GX 12MMinsulin pen needle


DUANE READE UNIFINE PENTIPS MISC 31GX 6 MMinsulin pen needle


DUANE READE UNIFINE PENTIPS MISC 31GX 8 MMinsulin pen needle


E-Z JECT LANCET MICRO-THIN 33G MISClancets


E-Z JECT LANCET SUPER THIN 30G MISClancets


E-Z JECT LANCETS 21G MISClancets




E-Z JECT LANCETS MISClancets


E-Z JECT LANCETS THIN 26G MISClancets


EASY COMFORT INSULIN SYRINGE MISC30G X 1/2" 0.5 MLinsulin syringe/needle u-100


EASY COMFORT INSULIN SYRINGE MISC30G X 1/2" 1 MLinsulin syringe/needle u-100












EASY COMFORT LANCETS MISClancets


EASY COMFORT PEN NEEDLES MISC 31G X5 MMinsulin pen needle










EASY MINI LANCING DEVICE MISClancet devices

BRAND 1

EASY PLUS CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

EASY PLUS CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

EASY PLUS II CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

EASY STEP CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

EASY STEP CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

EASY TALK CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

EASY TALK CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

EASY TOUCH CONTROL HIGH & LOWSOLUTIONblood glucose calibration

BRAND 1

EASY TOUCH HEALTHPRO CONTROLSOLUTIONblood glucose calibration

BRAND 1

EASY TOUCH INSULIN SAFETY SYR MISC29G X 1/2" 0.5 MLinsulin syringe/needle u-100


EASY TOUCH INSULIN SAFETY SYR MISC29G X 1/2" 1 MLinsulin syringe/needle u-100


EASY TOUCH INSULIN SAFETY SYR MISC30G X 1/2" 1 MLinsulin syringe/needle u-100




EASY TOUCH INSULIN SAFETY SYR MISC30G X 5/16" 0.5 MLinsulin syringe/needle u-100


EASY TOUCH INSULIN SYRINGE MISC 27G X1/2" 0.5 MLinsulin syringe/needle u-100


EASY TOUCH INSULIN SYRINGE MISC 27G X1/2" 1 MLinsulin syringe/needle u-100






























EASY TOUCH LANCETS 21G MISClancets






EASY TOUCH LANCETS 26G/TWIST MISClancets


















EASY TOUCH LANCING DEVICE MISClancet devices

BRAND 1

EASY TOUCH PEN NEEDLES MISC 29G X12MMinsulin pen needle


EASY TOUCH PEN NEEDLES MISC 31G X 5MMinsulin pen needle












EASY TOUCH SAFETY LANCETS 21G MISClancets








EASY TRAK CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

EASY TRAK CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1



EASY TWIST & CAP LANCETS MISClancets


EASYGLUCO CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

EASYGLUCO CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

EASYMAX 15 LEVEL 1 CONTROL SOLUTIONblood glucose calibration

BRAND 1

EASYMAX 15 LEVEL 2 CONTROL SOLUTIONblood glucose calibration

BRAND 1

EASYMAX CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

EASYMAX CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

ECLIPSE CONTROL LIQUID LOWblood glucose calibration

BRAND 1

ECLIPSE CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

ELEMENT COMPACT CONTROL 2 SOLUTIONblood glucose calibration

BRAND 1

ELEMENT COMPACT CONTROL 3 SOLUTIONblood glucose calibration

BRAND 1

ELEMENT CONTROL LIQUID LOWblood glucose calibration

BRAND 1

ELEMENT CONTROL LIQUID NORMALblood glucose calibration

BRAND 1

ELEMENT PLUS CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

ELEMENT PLUS CONTROL SOLUTIONNORMALblood glucose calibration

BRAND 1

EMBRACE CONTROL SOLUTION LOWblood glucose calibration

BRAND 1



EMBRACE EVO CONTROL LEVEL 1 LIQUIDLOWblood glucose calibration

BRAND 1

EMBRACE EVO CONTROL LEVEL 2 LIQUIDNORMALblood glucose calibration

BRAND 1

EMBRACE LANCETS ULTRA THIN 30G MISClancets


EMBRACE PRO GLUCOSE CONTROL LIQUIDblood glucose calibration

BRAND 1

ENVISION CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

ENVISION CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

EQL COLOR LANCETS 21G MISClancets


EQL COLOR LANCETS MICRO 33G MISClancets


EQL INSULIN SYRINGE MISC 29G X 1/2" 0.3MLinsulin syringe/needle u-100


EQL INSULIN SYRINGE MISC 29G X 1/2" 0.5MLinsulin syringe/needle u-100


EQL INSULIN SYRINGE MISC 29G X 1/2" 1MLinsulin syringe/needle u-100


EQL INSULIN SYRINGE MISC 30G X 5/16"0.3 MLinsulin syringe/needle u-100














EQL SHORT PEN NEEDLE MISC 31G X 8 MMinsulin pen needle


EQL SUPER THIN LANCETS 30G MISClancets


EQL THIN LANCETS 26G MISClancets


EQL ULTRA COMFORT INSULIN SYR MISC30G X 5/16" 1 MLinsulin syringe/needle u-100


EQL ULTRA COMFORT INSULIN SYR MISC31G X 5/16" 0.3 MLinsulin syringe/needle u-100


EQL ULTRA SHORT PEN NEEDLE MISC 31GX 6 MMinsulin pen needle


EVENCARE CONTROL LOW/HIGH LIQUIDblood glucose calibration

BRAND 1

EVENCARE G2 LOW/HIGH CONTROLSOLUTIONblood glucose calibration

BRAND 1

EVENCARE G3 LOW/HIGH CONTROLSOLUTIONblood glucose calibration

BRAND 1

EVOLUTION CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1



EXEL COMFORT POINT INSULIN SYR MISC28G X 1/2" 1 MLinsulin syringe/needle u-100


EXEL COMFORT POINT INSULIN SYR MISC29G X 1/2" 0.3 MLinsulin syringe/needle u-100












EXEL COMFORT POINT PEN NEEDLE MISC29G X 12MMinsulin pen needle


EXEL COMFORT POINT PEN NEEDLE MISC31G X 6 MMinsulin pen needle


EXEL COMFORT POINT PEN NEEDLE MISC31G X 8 MMinsulin pen needle


EZ SMART BLOOD GLUCOSE LANCETS MISClancets


EZ-LETS LANCETS 21G MISClancets


ez-lets lancets 23g misc generic 1 MDS 200 / 30 days









FEMCAP DEVICE 22 MMcervical caps

BRAND 0


BRAND 0


BRAND 0

FIFTY50 CONTROL 2.0 SOLUTIONblood glucose calibration

BRAND 1

FIFTY50 LANCING DEVICE MISClancet devices

BRAND 1

FIFTY50 PEN NEEDLES MISC 31G X 5 MMinsulin pen needle


FIFTY50 PEN NEEDLES MISC 31G X 8 MMinsulin pen needle


FIFTY50 SAFETY SEAL LANCETS MISClancets


FIFTY50 SUPERIOR COMFORT SYR MISC31G X 5/16" 0.3 MLinsulin syringe/needle u-100


FIFTY50 SUPERIOR COMFORT SYR MISC31G X 5/16" 0.5 MLinsulin syringe/needle u-100


FIFTY50 SUPERIOR COMFORT SYR MISC31G X 5/16" 1 MLinsulin syringe/needle u-100


FINE 30 MISClancets


FINGERSTIX LANCETS MISClancets




fluticasone propionate powder generic 1

FLUTICASONE PROPIONATE POWDERfluticasone propionate (bulk)

BRAND 1

FORA CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

FORA CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

FORA LANCETS MISClancets


FORA LANCING DEVICE MISClancet devices

BRAND 1

FORACARE GDH CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

FORACARE GDH CONTROL SOLUTIONNORMALblood glucose calibration

BRAND 1

FORTISCARE CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

FORTISCARE CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

FREDS PHARMACY AUTOLET LANCINGMISClancet devices

BRAND 1

FREDS PHARMACY UNIFINE PENTIP+ MISC31G X 5 MMinsulin pen needle


FREDS PHARMACY UNIFINE PENTIP+ MISC31G X 8 MMinsulin pen needle


FREDS PHARMACY UNIFINE PENTIPS MISC32G X 4 MMinsulin pen needle


FREDS PHARMACY UNILET LANC 28G MISClancets




FREDS PHARMACY UNILET LANC 30G MISClancets


FREESTYLE CONTROL SOLUTION LIQUIDblood glucose calibration

BRAND 1

FREESTYLE LANCETS MISClancets


FREESTYLE PRECISION INS SYR MISC 30G X5/16" 0.5 MLinsulin syringe/needle u-100


FREESTYLE PRECISION INS SYR MISC 30G X5/16" 1 MLinsulin syringe/needle u-100


FREESTYLE PRECISION INS SYR MISC 31G X5/16" 0.5 MLinsulin syringe/needle u-100


FREESTYLE PRECISION INS SYR MISC 31G X5/16" 1 MLinsulin syringe/needle u-100


freestyle test generic 1 MDS 100 / 30 days

FREESTYLE UNISTICK II LANCETS MISClancets


GE100 CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

GLOBAL EASE INJECT PEN NEEDLES MISC29G X 12MMinsulin pen needle


GLOBAL EASE INJECT PEN NEEDLES MISC31G X 5 MMinsulin pen needle








GLOBAL INJECT EASE INSULIN SYR MISC28G X 1/2" 0.5 MLinsulin syringe/needle u-100


GLOBAL INJECT EASE INSULIN SYR MISC28G X 1/2" 1 MLinsulin syringe/needle u-100




























GLOBAL INJECT EASE LANCETS 28G MISClancets


GLOBAL INJECT EASE LANCETS 30G MISClancets


GLOBAL LANCING DEVICE MISClancet devices

BRAND 1

GLUCOCARD 01 CONTROL LIQUIDblood glucose calibration

BRAND 1

GLUCOCARD 01 CONTROL SOLUTIONNORMALblood glucose calibration

BRAND 1

GLUCOCARD EXPRESSION CONTROLSOLUTIONblood glucose calibration

BRAND 1

GLUCOCARD SHINE CONTROL SOLUTIONblood glucose calibration

BRAND 1

GLUCOCARD X-SENSOR CONTROLSOLUTION NORMALblood glucose calibration

BRAND 1

GLUCOCOM CONTROL LIQUID NORMALblood glucose calibration

BRAND 1

GLUCOCOM LANCETS 28G MISClancets






GLUCOLAB CONTROL LIQUID LOWblood glucose calibration

BRAND 1



GLUCOLAB CONTROL LIQUID NORMALblood glucose calibration

BRAND 1

GLUCOLET 2 AUTOMATIC LANCING MISClancet devices

BRAND 1

GLUCOPRO INSULIN SYRINGE MISC 30G X1/2" 0.3 MLinsulin syringe/needle u-100




GLUCOPRO INSULIN SYRINGE MISC 30G X1/2" 1 MLinsulin syringe/needle u-100














glucose control solution generic 1

GLUCOSE CONTROL SOLUTIONblood glucose calibration

BRAND 1

glucose control solution normal generic 1



GLUCOSOURCE LANCET DEVICE MISClancet devices

BRAND 1

GLUCOSOURCE LANCETS MISClancets


GMATE CONTROL LEVEL 2 SOLUTIONblood glucose calibration

BRAND 1

GNP CLICKFINE PEN NEEDLES MISC 31G X 6MMinsulin pen needle


GNP CLICKFINE PEN NEEDLES MISC 31G X 8MMinsulin pen needle


GNP INSULIN SYRINGE MISC 28G X 1/2" 0.5MLinsulin syringe/needle u-100


GNP INSULIN SYRINGE MISC 28G X 1/2" 1MLinsulin syringe/needle u-100








GNP INSULIN SYRINGE MISC 30G X 5/16"0.3 MLinsulin syringe/needle u-100














GNP LANCETS 21G MISClancets


GNP LANCETS MICRO THIN 33G MISClancets


GNP LANCETS MISClancets


GNP LANCETS SUPER THIN 30G MISClancets


GNP LANCETS THIN 26G MISClancets


GNP LANCETS THIN MISClancets


GNP MICRO THIN LANCETS 33G MISClancets


GNP SUPER THIN LANCETS 30G MISClancets


GNP ULTRA COM INSULIN SYRINGE MISC28G X 1/2" 0.5 MLinsulin syringe/needle u-100


GNP ULTRA COM INSULIN SYRINGE MISC28G X 1/2" 1 MLinsulin syringe/needle u-100






















H&H THINLET LANCETS 26G MISClancets


H&H THINLET LANCETS 30G MISClancets


H-E-B INCONTROL ADV LANCING MISClancet devices

BRAND 1

H-E-B INCONTROL LANCETS 28G MISClancets


H-E-B INCONTROL LANCETS 30G MISClancets




H-E-B INCONTROL PEN NEEDLES MISC 31GX 5 MMinsulin pen needle








HAEMOLANCE LOW FLOW LANCETS MISClancets


HAEMOLANCE MISClancets


HAEMOLANCE PLUS HIGH FLOW MISClancets


HAEMOLANCE PLUS LOW FLOW MISClancets


HAEMOLANCE PLUS MAX FLOW MISClancets


HAEMOLANCE PLUS MISClancets


HAEMOLANCE PLUS PEDIATRIC FLOW MISClancets


HEALTH CARE LANCING DEVICE MISClancet devices

BRAND 1

HEALTHWISE LANCETS 30G MISClancets


HEALTHWISE LANCING PEN MISClancet devices

BRAND 1

HEALTHWISE MINI PEN NEEDLES MISC 31GX 6 MMinsulin pen needle




HEALTHWISE PEN NEEDLES MISC 29G X12MMinsulin pen needle


HEALTHWISE SHORT PEN NEEDLES MISC31G X 8 MMinsulin pen needle


HEALTHWISE UNIFINE PENTIPS MISC 32G X4 MMinsulin pen needle


HEALTHY ACCENTS LANCING DEVICE MISClancet devices

BRAND 1

HEALTHY ACCENTS UNIFINE PENTIP MISC29G X 12MMinsulin pen needle


HEALTHY ACCENTS UNIFINE PENTIP MISC31G X 5 MMinsulin pen needle








HEALTHY ACCENTS UNILET LANCETS MISClancets


HM LANCETS MICRO THIN 33G MISClancets


HM LANCETS ULTRA THIN 30G MISClancets


HY-VEE INSULIN SYRINGE 29G X 1/2" 0.3MLinsulin syringe/needle u-100






HY-VEE INSULIN SYRINGE 29G X 1/2" 1 MLinsulin syringe/needle u-100






HY-VEE INSULIN SYRINGE 30G X 1/2" 1 MLinsulin syringe/needle u-100


hy-vee lancets generic 1 MDS 200 / 30 days

hy-vee thin lancets generic 1 MDS 200 / 30 days

IN TOUCH GLUCOSE CONTROL SOLUTIONblood glucose calibration

BRAND 1

IN TOUCH LANCING DEVICE MISClancet devices

BRAND 1

IN TOUCH STERILE LANCETS 30G MISClancets


INFINITY CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

INFINITY CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

insulin syringe misc 28g x 1/2" 0.5 ml generic 1 MDS 450 / 90 days

INSULIN SYRINGE MISC 28G X 1/2" 0.5 MLinsulin syringe/needle u-100


INSULIN SYRINGE MISC 28G X 1/2" 1 MLinsulin syringe/needle u-100


INSULIN SYRINGE MISC 29G X 1" 0.3 MLinsulin syringe/needle u-100










insulin syringe misc 29g x 1/2" 1 ml generic 1 MDS 450 / 90 days





















INSULIN SYRINGE/NEEDLE 28G X 1/2" 0.5MLinsulin syringe/needle u-100


INSULIN SYRINGE/NEEDLE 28G X 1/2" 1 MLinsulin syringe/needle u-100




INSULIN SYRINGE/NEEDLE MISC 27G X 1/2"0.5 MLinsulin syringe/needle u-100


INSULIN SYRINGE/NEEDLE MISC 28G X 1/2"0.5 MLinsulin syringe/needle u-100


insulin syringe/needle misc 28g x 1/2" 1 ml generic 1 MDS 450 / 90 days

INSULIN SYRINGE/NEEDLE MISC 28G X 1/2"1 MLinsulin syringe/needle u-100


INSUPEN PEN NEEDLES MISC 32G X 4 MMinsulin pen needle


INSUPEN SENSITIVE MISC 32G X 6 MMinsulin pen needle


INSUPEN ULTRAFIN MISC 29G X 12MMinsulin pen needle


INSUPEN ULTRAFIN MISC 30G X 8 MMinsulin pen needle






KETOCAREacetone (urine) test


KETOCARE STRIPacetone (urine) test


ketone test strip generic 1 MPL 1 / 30 Days

KETOSTIX STRIPacetone (urine) test


KINNEY LANCETS MISClancets


KINNEY THIN LANCETS MISClancets




KINRAY INSULIN SYRINGE MISC 29G X 1/2"0.5 MLinsulin syringe/needle u-100


KINRAY INSULIN SYRINGE MISC 31G X5/16" 0.3 MLinsulin syringe/needle u-100


KINRAY INSULIN SYRINGE MISC 31G X5/16" 0.5 MLinsulin syringe/needle u-100


KINRAY INSULIN SYRINGE MISC 31G X5/16" 1 MLinsulin syringe/needle u-100


KMART VALU INSULIN SYRINGE 29G MISCU-100 1 MLinsulin syringes (disposable)


KMART VALU INSULIN SYRINGE 30G MISCU-100 1 MLinsulin syringes (disposable)


KROGER INSULIN SYRINGE MISC 29G X 1/2"0.3 MLinsulin syringe/needle u-100


KROGER INSULIN SYRINGE MISC 29G X 1/2"0.5 MLinsulin syringe/needle u-100


KROGER INSULIN SYRINGE MISC 29G X 1/2"1 MLinsulin syringe/needle u-100


KROGER INSULIN SYRINGE MISC 30G X5/16" 0.3 MLinsulin syringe/needle u-100




KROGER INSULIN SYRINGE MISC 30G X5/16" 1 MLinsulin syringe/needle u-100








KROGER INSULIN SYRINGE MISC 31G X5/16" 1 MLinsulin syringe/needle u-100


KROGER LANCETS 21G MISClancets


KROGER LANCETS MICRO THIN 33G MISClancets


kroger lancets misc generic 1 MDS 200 / 30 days

KROGER LANCETS SUPER THIN MISClancets


KROGER LANCETS THIN 26G MISClancets


kroger lancets thin misc generic 1 MDS 200 / 30 days

KROGER LANCETS ULTRATHIN 30G MISClancets


KROGER LANCING DEVICE MISClancet devices

BRAND 1

KROGER PEN NEEDLES MISC 29G X 12MMinsulin pen needle


KROGER PEN NEEDLES MISC 31G X 6 MMinsulin pen needle


KROGER PEN NEEDLES MISC 31G X 8 MMinsulin pen needle


LADY LITE LANCETS MISClancets


LANCET DEVICE MISClancet devices

BRAND 1



LANCET DEVICE WITH EJECTOR MISClancet devices

BRAND 1

LANCETS 28G MISClancets


LANCETS 30G MISClancets


LANCETS MICRO THIN 33G MISClancets


lancets misc generic 1 MDS 200 / 30 days

LANCETS MISClancets


LANCETS SUPER THIN 28G MISClancets


lancets thin misc generic 1 MDS 200 / 30 days

LANCETS THIN MISClancets


LANCETS ULTRA FINE MISClancets


LANCETS ULTRA THIN 30G MISClancets


LANCETS ULTRA THIN MISClancets


lancing device misc generic 1

LANCING DEVICE MISClancet devices

BRAND 1

LANZO MISClancet devices

BRAND 1

LEADER ADVANCED LANCING DEVICE MISClancet devices

BRAND 1

LEADER INSULIN SYRINGE MISC 28G X 1/2"0.5 MLinsulin syringe/needle u-100




LEADER INSULIN SYRINGE MISC 28G X 1/2"1 MLinsulin syringe/needle u-100






LEADER INSULIN SYRINGE MISC 29G X 1/2"1 MLinsulin syringe/needle u-100


LEADER INSULIN SYRINGE MISC 30G X5/16" 0.3 MLinsulin syringe/needle u-100




LEADER INSULIN SYRINGE MISC 30G X5/16" 1 MLinsulin syringe/needle u-100






LEADER INSULIN SYRINGE MISC 31G X5/16" 1 MLinsulin syringe/needle u-100


LEADER UNIFINE PENTIPS MISC 31G X 5MMinsulin pen needle


LEADER UNIFINE PENTIPS MISC 32G X 4MMinsulin pen needle




LEADER UNIFINE PENTIPS PLUS MISC 31G X5 MMinsulin pen needle






LIBERTY GLUCOSE CONTROL LIQUIDNORMALblood glucose calibration

BRAND 1

LIBERTY GLUCOSE CONTROL MIDSOLUTIONblood glucose calibration

BRAND 1

LIBERTY GLUCOSE CONTROL SOLUTIONblood glucose calibration

BRAND 1

LIBERTY GLUCOSE CONTROL SOLUTIONNORMALblood glucose calibration

BRAND 1

LIBERTY MEDICAL LANCETS MISClancets


LIBERTY MINI LANCING DEVICE MISClancet devices

BRAND 1

LITE TOUCH LANCETS MISClancets


LITE TOUCH LANCING DEVICE MISClancet devices

BRAND 1

LITE TOUCH LANCING PEN MISClancet devices

BRAND 1

LITE TOUCH PEN NEEDLES MISC 31G X 5MMinsulin pen needle


LITETOUCH INSULIN SYRINGE MISC 28G X1/2" 0.5 MLinsulin syringe/needle u-100




LITETOUCH INSULIN SYRINGE MISC 28G X1/2" 1 MLinsulin syringe/needle u-100




















LITETOUCH LANCETS MISClancets


LITETOUCH PEN NEEDLES MISC 29G X12.7MMinsulin pen needle




LITETOUCH PEN NEEDLES MISC 31G X 6MMinsulin pen needle


LITETOUCH PEN NEEDLES MISC 31G X 8MMinsulin pen needle


LIVE BETTER ADV LANCING DEVICE MISClancet devices

BRAND 1

LIVE BETTER LANCET SUPER THIN MISClancets


LIVE BETTER LANCET ULTRA THIN MISClancets


LIVE BETTER PEN NEEDLES MISC 29G X12MMinsulin pen needle


LIVE BETTER PEN NEEDLES MISC 31G X 6MMinsulin pen needle


LIVE BETTER PEN NEEDLES MISC 31G X 8MMinsulin pen needle


LONGS INSULIN SYRINGE MISC 31G X 5/16"0.5 MLinsulin syringe/needle u-100


LONGS LANCETS STANDARD MISClancets


LONGS LANCETS THIN MISClancets


LONGS LANCETS ULTRA THIN MISClancets


MAGELLAN INSULIN SAFETY SYR MISC 29GX 1/2" 0.3 MLinsulin syringe/needle u-100






MAGELLAN INSULIN SAFETY SYR MISC 29GX 1/2" 1 MLinsulin syringe/needle u-100






MAGELLAN INSULIN SAFETY SYR MISC 30GX 5/16" 1 MLinsulin syringe/needle u-100


MAJOR COMFORT LANCETS MISClancets


MAXI-COMFORT INSULIN SYRINGE MISC28G X 1/2" 0.5 MLinsulin syringe/needle u-100


MAXI-COMFORT INSULIN SYRINGE MISC28G X 1/2" 1 MLinsulin syringe/needle u-100


MAXIMA CONTROL SOLUTIONblood glucose calibration

BRAND 1

MAXIMA CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

MEDI-LANCE LANCETS MISClancets


MEDIC INSULIN SYRINGE MISC 30G X 5/16"0.3 MLinsulin syringe/needle u-100


MEDIC INSULIN SYRINGE MISC 30G X 5/16"0.5 MLinsulin syringe/needle u-100


MEDICHOICE SAFETY LANCET EXTRA MISClancets


MEDICHOICE SAFETY LANCET MISClancets




MEDICHOICE SAFETY LANCET NORM MISClancets


MEDICINE SHOPPE LANCETS MISClancets


MEDICINE SHOPPE LANCETS THIN MISClancets


MEDICINE SHOPPE PEN NEEDLES MISC 29GX 12MMinsulin pen needle


MEDICINE SHOPPE PEN NEEDLES MISC 31GX 6 MMinsulin pen needle


MEDICINE SHOPPE PEN NEEDLES MISC 31GX 8 MMinsulin pen needle


MEDISENSE GLUCOSE KETONE CONTRLIQUIDblood glucose calibration

BRAND 1

MEDISENSE HI/MID/LOW CONTROL LIQUIDblood glucose calibration

BRAND 1

MEDISENSE HIGH/LOW CONTROL LIQUIDblood glucose calibration

BRAND 1

MEDISENSE MID CONTROL LIQUIDblood glucose calibration

BRAND 1

MEDISENSE THIN LANCETS MISClancets


MEDLANCE EXTRA 21G MISClancets


MEDLANCE LITE 25G MISClancets


MEDLANCE PLUS EXTRA 21G MISClancets


MEDLANCE PLUS LANCETS MISClancets




MEDLANCE PLUS LITE 25G MISClancets


MEDLANCE PLUS SPECIAL 0.8MM MISClancets


MEDLANCE PLUS SUPERLITE 30G MISClancets


MEDLANCE PLUS UNIVERSAL 21G MISClancets


MEDLANCE UNIVERSAL 21G MISClancets


MEIJER LANCETS MISClancets


MEIJER LANCETS THIN MISClancets


MEIJER LANCETS UNIVERSAL 30G MISClancets


MEIJER LANCETS UNIVERSAL 33G MISClancets


MEIJER PEN NEEDLES MISC 29G X 12MMinsulin pen needle


MEIJER PEN NEEDLES MISC 31G X 6 MMinsulin pen needle


MEIJER PEN NEEDLES MISC 31G X 8 MMinsulin pen needle


MEIJER SUPER THIN LANCETS MISClancets


metaproterenol sulfate powder generic 1

MICRODOT CONTROL HIGH/LOWSOLUTIONblood glucose calibration

BRAND 1

MICRODOT CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

MICROLET LANCETS MISClancets




MICROTAINER SAFETY FLOW LANCET MISClancets


MINI LANCING DEVICE MISClancet devices

BRAND 1

MONOJECT INSULIN SYRINGE MISC 25G X5/8" 1 MLinsulin syringe/needle u-100




MONOJECT INSULIN SYRINGE MISC 28G X1/2" 0.5 MLinsulin syringe/needle u-100




















MONOJECT INSULIN SYRINGE MISC U-1001 MLinsulin syringes (disposable)


MONOJECT ULTRA COMFORT SYRINGEMISC 28G X 1/2" 0.5 MLinsulin syringe/needle u-100


MONOJECT ULTRA COMFORT SYRINGEMISC 28G X 1/2" 1 MLinsulin syringe/needle u-100






MONOJECT ULTRA COMFORT SYRINGEMISC 29G X 1/2" 1 MLinsulin syringe/needle u-100










MONOLET LANCETS MISClancets


MONOLET OPD LANCETS MISClancets


MONOLETTOR SAFETY LANCETS MISClancets




MOORE MONO INSULIN SYRINGE MISC28G X 1/2" 0.5 MLinsulin syringe/needle u-100


MOORE MONO INSULIN SYRINGE MISC28G X 1/2" 1 MLinsulin syringe/needle u-100


MOORE MONO INSULIN SYRINGE MISC29G X 1/2" 0.5 MLinsulin syringe/needle u-100


MOORE MONO INSULIN SYRINGE MISC29G X 1/2" 1 MLinsulin syringe/needle u-100


MS INSULIN SYRINGE MISC 29G X 1/2" 0.3MLinsulin syringe/needle u-100




MS INSULIN SYRINGE MISC 29G X 1/2" 1MLinsulin syringe/needle u-100
















multi-lancet device misc generic 1

MYGLUCOHEALTH CONTROL SOLUTIONblood glucose calibration

BRAND 1

MYGLUCOHEALTH LANCETS 30G MISClancets


NETGROUP LANCETS MISClancets


NEUTEK 2TEK CONTROL SOLUTIONblood glucose calibration

BRAND 1

NOVA MAX PLUS GLU/KET CONTROLLIQUIDblood glucose calibration

BRAND 1

NOVA SAFETY LANCETS 23G MISClancets


NOVA SAFETY LANCETS 28G MISClancets


NOVA SUREFLEX LANCETS MISClancets


NOVA SUREFLEX LANCING DEVICE MISClancet devices

BRAND 1

NOVOFINE AUTOCOVER MISC 30G X 8 MMinsulin pen needle


NOVOFINE MISC 30G X 8 MMinsulin pen needle


NOVOFINE MISC 32G X 6 MMinsulin pen needle


NOVOFINE PLUS MISC 32G X 4 MMinsulin pen needle


NOVOTWIST MISC 30G X 8 MMinsulin pen needle




NOVOTWIST MISC 32G X 5 MMinsulin pen needle


nystatin domestic powder generic 1

nystatin powder generic 1

OMNIFLEX DIAPHRAGM DIAPHRAGMdiaphragms

BRAND 0

ON CALL EXPRESS GLUCOSE CONTRSOLUTIONblood glucose calibration

BRAND 1

ON CALL LANCETS MISClancets


ON CALL LANCING DEVICE MISClancet devices

BRAND 1

ON CALL PLUS GLUCOSE CONTROLSOLUTIONblood glucose calibration

BRAND 1

ON CALL PLUS LANCETS MISClancets


ON CALL PLUS LANCING DEVICE MISClancet devices

BRAND 1

ON CALL VIVID GLUCOSE CONTROLSOLUTIONblood glucose calibration

BRAND 1

ONETOUCH DELICA LANCETS 33G MISClancets


ONETOUCH DELICA LANCETS FINE MISClancets


ONETOUCH DELICA LANCING DEV MISClancet devices

BRAND 1

ONETOUCH FINEPOINT LANCETS MISClancets


ONETOUCH LANCETS MISClancets




ONETOUCH ULTRA CONTROL SOLUTIONblood glucose calibration

BRAND 1

ONETOUCH ULTRASOFT LANCETS MISClancets


ONETOUCH VERIO SOLUTIONblood glucose calibration

BRAND 1

OPTUMRX GLUCOSE CONTROL SOLUTIONblood glucose calibration

BRAND 1

ORSINI INSULIN SYRINGE MISC 29G X 1/2"0.5 MLinsulin syringe/needle u-100


ORSINI INSULIN SYRINGE MISC 30G X 5/16"0.5 MLinsulin syringe/needle u-100


ORSINI INSULIN SYRINGE MISC 30G X 5/16"1 MLinsulin syringe/needle u-100


ORTHO DIAPHRAGM ALL-FLEXDIAPHRAGM 65 MMdiaphragm arc-spring

BRAND 0


BRAND 0


BRAND 0


BRAND 0

ORTHO DIAPHRAGM COIL KIT 100 MMdiaphragm coil spring

BRAND 0


BRAND 0


BRAND 0



ORTHO DIAPHRAGM FLAT KIT 55 MMdiaphragm flat spring

BRAND 0


BRAND 0


BRAND 0


BRAND 0


BRAND 0


BRAND 0


BRAND 0


BRAND 0


BRAND 0

PARAGARD INTRAUTERINE COPPER IUDcopper (iud)

BRAND 0 GL Female

PC LANCETS SUPER THIN 30G MISClancets


PC UNIFINE PENTIPS MISC 29G X 12MMinsulin pen needle


PC UNIFINE PENTIPS MISC 31G X 5 MMinsulin pen needle






pen needles 1/2" misc 29g x 12mm generic 1 MDS 150 / 30 days

PEN NEEDLES 3/16" MISC 31G X 5 MMinsulin pen needle






pen needles 5/16" misc 31g x 8 mm generic 1 MDS 150 / 30 days



PEN NEEDLES MISC 29G X 12MMinsulin pen needle


pen needles misc 31g x 6 mm generic 1 MDS 150 / 30 days

PEN NEEDLES MISC 31G X 6 MMinsulin pen needle


PENTIPS MISC 31G X 5 MMinsulin pen needle






PERFECT LANCETS 28G MISClancets


PERFECT LANCETS 30G MISClancets


PHARMACIST CHOICE LANCETS MISClancets


PHARMACY COUNTER LANCETS MISClancets


PHISOHEX LIQUID 3 %hexachlorophene

BRAND 1

POCKETCHEM EZ CONTROL SOLUTIONblood glucose calibration

BRAND 1

PRECISION GLUCOSE KETONE CONTRLIQUIDblood glucose calibration

BRAND 1

PRECISION SURE-DOSE SYRINGE MISC 28GX 1/2" 0.5 MLinsulin syringe/needle u-100




PRECISION SURE-DOSE SYRINGE MISC 28GX 1/2" 1 MLinsulin syringe/needle u-100








PRECISION SUREDOSE PLUS SYR MISC 29GX 1/2" 0.3 MLinsulin syringe/needle u-100


PRECISION SUREDOSE PLUS SYR MISC 29GX 1/2" 1 MLinsulin syringe/needle u-100


PREFERRED PLUS INSULIN SYRINGE MISC28G X 1/2" 0.5 MLinsulin syringe/needle u-100


PREFERRED PLUS INSULIN SYRINGE MISC28G X 1/2" 1 MLinsulin syringe/needle u-100
















PREFERRED PLUS LANCETS COLORED MISClancets


PREFERRED PLUS LANCETS THIN MISClancets


PREFERRED PLUS UNIFINE PENTIPS MISC29G X 12MMinsulin pen needle


PREFERRED PLUS UNIFINE PENTIPS MISC31G X 5 MMinsulin pen needle








PRENTIF FITTING SET MISCcervical caps

BRAND 0

PRESTIGE GLUCOSE CONTROL LIQUID LOWblood glucose calibration

BRAND 1

PRODIGY CONTROL SOLUTION SOLUTIONLOWblood glucose calibration

BRAND 1

PRODIGY INSULIN SYRINGE MISC 28G X1/2" 1 MLinsulin syringe/needle u-100




PRODIGY INSULIN SYRINGE MISC 31G X5/16" 0.3 MLinsulin syringe/needle u-100


PRODIGY INSULIN SYRINGE MISC 31G X5/16" 0.5 MLinsulin syringe/needle u-100


PRODIGY LANCETS 21G MISClancets






PRODIGY LANCING DEVICE MISClancet devices

BRAND 1

PRODIGY MINI PEN NEEDLES MISC 31G X 5MMinsulin pen needle


PRODIGY SAFETY LANCETS 26G MISClancets


PRODIGY SHORT PEN NEEDLES MISC 31G X8 MMinsulin pen needle


PRODIGY TWIST TOP LANCETS 28G MISClancets


PX ADVANCED LANCING DEVICE MISClancet devices

BRAND 1

PX EXTRA SHORT PEN NEEDLES MISC 31G X6 MMinsulin pen needle


PX INSULIN SYRINGE MISC 30G X 1/2" 0.3MLinsulin syringe/needle u-100






PX INSULIN SYRINGE MISC 30G X 1/2" 1 MLinsulin syringe/needle u-100






PX INSULIN SYRINGE MISC 31G X 5/16" 1MLinsulin syringe/needle u-100


PX LANCET AUTO INJECTOR MISClancet devices

BRAND 1

PX LANCETS MISClancets


PX LANCETS ULTRA THIN MISClancets


PX MINI PEN NEEDLES MISC 31G X 5 MMinsulin pen needle


PX PEN NEEDLE MISC 29G X 12MMinsulin pen needle


PX PEN NEEDLE MISC 31G X 8 MMinsulin pen needle


QC ADVANCED LANCING DEVICE MISClancet devices

BRAND 1

QC INSULIN SYRINGE MISC 29G X 1/2" 0.3MLinsulin syringe/needle u-100




QC INSULIN SYRINGE MISC 29G X 1/2" 1MLinsulin syringe/needle u-100






QC INSULIN SYRINGE MISC 31G X 5/16" 1MLinsulin syringe/needle u-100


QC LANCETS SUPER THIN 30G MISClancets


QC LANCETS ULTRA THIN MISClancets


QC PEN NEEDLES MISC 29G X 12MMinsulin pen needle


QC PEN NEEDLES MISC 31G X 6 MMinsulin pen needle


QC PEN NEEDLES MISC 31G X 8 MMinsulin pen needle


QC UNIFINE PENTIPS MISC 32G X 4 MMinsulin pen needle


QUICKTEK CONTROL SOLUTION LIQUIDblood glucose calibration

BRAND 1

QUINTET CONTROL HIGH/NORMALSOLUTIONblood glucose calibration

BRAND 1

RA E-ZJECT COLOR LANCETS 33G MISClancets


RA E-ZJECT LANCETS 28G MISClancets


RA E-ZJECT LANCETS THIN 26G MISClancets


RA E-ZJECT LANCETS THIN 28G MISClancets


RA E-ZJECT LANCETS ULTRA THIN MISClancets




RA INSULIN SYRINGE MISC 29G X 1/2" 1 MLinsulin syringe/needle u-100


RA INSULIN SYRINGE MISC 30G X 5/16" 0.5MLinsulin syringe/needle u-100


RA INSULIN SYRINGE MISC 30G X 5/16" 1MLinsulin syringe/needle u-100


RA LANCING DEVICE MISClancet devices

BRAND 1

RA PEN NEEDLES MISC 31G X 5 MMinsulin pen needle


RA PEN NEEDLES MISC 31G X 8 MMinsulin pen needle


REFUAH PLUS GLUCOSE CONTROLSOLUTIONblood glucose calibration

BRAND 1

RELI-ON INSULIN SYRINGE MISC 29G X 1/2"1 MLinsulin syringe/needle u-100


RELION INSULIN SYRINGE MISC 29G X 1/2"0.3 MLinsulin syringe/needle u-100


RELION INSULIN SYRINGE MISC 29G X 1/2"0.5 MLinsulin syringe/needle u-100


RELION INSULIN SYRINGE MISC 29G X 1/2"1 MLinsulin syringe/needle u-100


RELION INSULIN SYRINGE MISC 30G X5/16" 0.3 MLinsulin syringe/needle u-100






RELION INSULIN SYRINGE MISC 30G X5/16" 1 MLinsulin syringe/needle u-100






RELION INSULIN SYRINGE MISC 31G X5/16" 1 MLinsulin syringe/needle u-100


RELION LANCETS MICRO-THIN 33G MISClancets


RELION LANCETS STANDARD 21G MISClancets


RELION LANCETS THIN 26G MISClancets


RELION LANCETS ULTRA-THIN 30G MISClancets


RELION LANCING DEVICE MISClancet devices

BRAND 1

RELION MINI PEN NEEDLES MISC 31G X 6MMinsulin pen needle


RELION PEN NEEDLES MISC 29G X 12MMinsulin pen needle


RELION PEN NEEDLES MISC 31G X 8 MMinsulin pen needle


RELION PEN NEEDLES MISC 32G X 4 MMinsulin pen needle


RELION SHORT PEN NEEDLES MISC 31G X 8MMinsulin pen needle




RELION ULTRA THIN LANCETS 30G MISClancets


RELION ULTRA THIN PLUS LANCETS MISClancets


RENEW ADV CARTRIDGE REFILLS MISClancets


RENEW ADVANCED LANCING DEVICE MISClancet devices

BRAND 1

REXALL LANCETS ULTRA THIN 30G MISClancets


RIGHTEST GC300 CONTROL LIQUIDNORMALblood glucose calibration

BRAND 1

RIGHTEST GD500 LANCING DEVICE MISClancet devices

BRAND 1

RIGHTEST GL300 LANCETS MISClancets


SAFESNAP INSULIN SYRINGE MISC 28G X1/2" 1 MLinsulin syringe/needle u-100


SAFESNAP INSULIN SYRINGE MISC 29G X1/2" 0.5 MLinsulin syringe/needle u-100


SAFESNAP INSULIN SYRINGE MISC 29G X1/2" 1 MLinsulin syringe/needle u-100






SAFETY LANCET 21G/PRESSURE ACT MISClancets




SAFETY LANCET 28G/PRESSURE ACT MISClancets


SAFETY LANCET 2MM MISClancets


SAFETY LANCETS 21G MISClancets


SAFETY LANCETS 28G MISClancets


SAFETY LANCETS MISClancets


SAFETY LET LANCETS MISClancets


SAFETY SEAL LANCETS MISClancets


SAFETY-GLIDE SYRINGE MISC 29G X 1/2"0.3 MLinsulin syringe/needle u-100


SAPSCARE TWIST TOP LANCETS MISClancets


SB INSULIN SYRINGE MISC 29G X 1/2" 0.5MLinsulin syringe/needle u-100


SB INSULIN SYRINGE MISC 29G X 1/2" 1 MLinsulin syringe/needle u-100


SB INSULIN SYRINGE MISC 30G X 5/16" 0.5MLinsulin syringe/needle u-100


SB INSULIN SYRINGE MISC 30G X 5/16" 1MLinsulin syringe/needle u-100


SB INSULIN SYRINGE MISC 31G X 5/16" 1MLinsulin syringe/needle u-100


SB LANCETS THIN MISClancets




SB LANCETS ULTRA THIN MISClancets


SCHNUCKS INSULIN SYRINGE MISC 29G X1/2" 0.5 MLinsulin syringe/needle u-100


SCHNUCKS INSULIN SYRINGE MISC 30G X5/16" 0.5 MLinsulin syringe/needle u-100


select-lite lancing device misc generic 1

SHOPKO AUTOLET LANCING DEVICE MISClancet devices

BRAND 1

SHOPKO ON-THE-GO LANCETS 30G MISClancets


SHOPKO UNIFINE PENTIPS MISC 29G X12MMinsulin pen needle


SHOPKO UNIFINE PENTIPS MISC 31G X 5MMinsulin pen needle






SHOPKO UNILET LANCETS 28G MISClancets


SHOPKO UNILET LANCETS 30G MISClancets


SIMPLE DIAGNOSTICS LANCING DEV MISClancet devices

BRAND 1

SM INSULIN SYRINGE MISC 28G X 1/2" 0.5MLinsulin syringe/needle u-100




SM INSULIN SYRINGE MISC 28G X 1/2" 1MLinsulin syringe/needle u-100




















SM LANCETS 21G MISClancets


SM LANCETS 33G MISClancets


SM SUPER THIN LANCETS 30G MISClancets




SM THIN LANCETS 26G MISClancets


SMART DIABETES VANTAGE LANCETS MISClancets


SMART DIABETES VANTAGE LANCING MISClancet devices

BRAND 1

SMART SENSE COLOR LANCETS 33G MISClancets


SMART SENSE STANDARD LANCETS MISClancets


SMART SENSE SUPER THIN LANCETS MISClancets


SMART SENSE THIN LANCETS 26G MISClancets


SMARTEST CONTROL MEDIUM SOLUTIONblood glucose calibration

BRAND 1

SMARTEST LANCETS 28G MISClancets


sodium polystyrene sulfonate powder generic 1

SOLARTEK GLUCOSE CONTROL LIQUIDblood glucose calibration

BRAND 1

SOLUS V2 CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

SOLUS V2 LANCETS 28G MISClancets


SOLUS V2 LANCING DEVICE MISClancet devices

BRAND 1

SOLUS V2 TWIST LANCETS 30G MISClancets


stannous fluoride powder generic 0

STERILANCE TL MISClancets


sterile water for irrigation solution generic 1



SUPER THIN LANCETS MISClancets


SURE COMFORT INSULIN SYRINGE MISC28G X 1/2" 0.5 MLinsulin syringe/needle u-100


SURE COMFORT INSULIN SYRINGE MISC28G X 1/2" 1 MLinsulin syringe/needle u-100




























SURE COMFORT LANCETS 28G MISClancets


SURE COMFORT LANCETS 30G MISClancets


SURE COMFORT LANCING PEN MISClancet devices

BRAND 1

SURE COMFORT PEN NEEDLES MISC 29G X12.7MMinsulin pen needle


SURE COMFORT PEN NEEDLES MISC 30G X8 MMinsulin pen needle










SURE EDGE GLUCOSE CONTROL SOLUTIONLOWblood glucose calibration

BRAND 1



SURE EDGE GLUCOSE CONTROL SOLUTIONNORMALblood glucose calibration

BRAND 1

SURE-FINE PEN NEEDLES MISC 29G X12.7MMinsulin pen needle


SURE-FINE PEN NEEDLES MISC 31G X 5 MMinsulin pen needle


SURE-FINE PEN NEEDLES MISC 31G X 8 MMinsulin pen needle


SURE-JECT INSULIN SYRINGE MISC 28G X1/2" 0.5 MLinsulin syringe/needle u-100


SURE-JECT INSULIN SYRINGE MISC 28G X1/2" 1 MLinsulin syringe/needle u-100






















SURE-LANCE FLAT LANCETS MISClancets


SURE-LANCE LANCETS 26G MISClancets


SURE-LANCE THIN LANCETS 28G MISClancets


SURE-LANCE ULTRA THIN LANCETS MISClancets


SURE-PEN MISClancet devices

BRAND 1

SURE-TEST EASYPLUS CONTROL SOLUTIONNORMALblood glucose calibration

BRAND 1

SURE-TOUCH LANCETS UNIVERSAL MISClancets


SURECHEK CONTROL SOLUTION LIQUIDLOWblood glucose calibration

BRAND 1

SURECHEK CONTROL SOLUTION LIQUIDNORMALblood glucose calibration

BRAND 1

surelite lancets generic 1 MDS 200 / 30 days

SURELITE LANCETS MISClancets


SURESTEP GLUCOSE CONTROL SOLUTIONblood glucose calibration

BRAND 1

SURESTEP PRO LOW GLUCOSE LIQUIDblood glucose calibration

BRAND 1



SURESTEP PRO NORMAL GLUCOSE LIQUIDblood glucose calibration

BRAND 1

TAI DOC CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

TECHLITE AST LANCETS MISClancets


TECHLITE LANCETS 30G MISClancets


TECHLITE LANCETS MISClancets


TELCARE GLUCOSE CONTROL SOLUTIONblood glucose calibration

BRAND 1

TERUMO INSULIN SYRINGE MISC 27G X1/2" 0.5 MLinsulin syringe/needle u-100


TERUMO INSULIN SYRINGE MISC 27G X1/2" 1 MLinsulin syringe/needle u-100


















TERUMO SURGUARD INSULIN SYR MISC28G X 1/2" 0.5 MLinsulin syringe/needle u-100


TERUMO SURGUARD INSULIN SYR MISC28G X 1/2" 1 MLinsulin syringe/needle u-100






TERUMO SURGUARD INSULIN SYR MISC29G X 1/2" 1 MLinsulin syringe/needle u-100


TGT ADVANCED LANCING DEVICE MISClancet devices

BRAND 1

TGT LANCET ALTERNATE SITE MISClancets


TGT LANCET MICRO THIN 33G MISClancets


TGT LANCET SUPER THIN 30G MISClancets


TGT LANCET THIN 23G MISClancets


TGT LANCET THIN 26G MISClancets


TGT LANCET ULTRA THIN 28G MISClancets


TGT LANCET ULTRA THIN 30G MISClancets




TGT LANCING DEVICE MISClancet devices

BRAND 1

THINPRO INSULIN SYRINGE MISC 28G X1/2" 0.5 MLinsulin syringe/needle u-100


THINPRO INSULIN SYRINGE MISC 28G X1/2" 1 MLinsulin syringe/needle u-100






THINPRO INSULIN SYRINGE MISC 29G X1/2" 1 MLinsulin syringe/needle u-100






TODAYS HEALTH LANCING DEVICE MISClancet devices

BRAND 1

TODAYS HEALTH MINI PEN NEEDLES MISC31G X 6 MMinsulin pen needle


TODAYS HEALTH PEN NEEDLES MISC 29G X12MMinsulin pen needle


TODAYS HEALTH SHORT PEN NEEDLE MISC31G X 8 MMinsulin pen needle


TODAYS HEALTH THIN LANCETS 28G MISClancets




TODAYS HEALTH THIN LANCETS 30G MISClancets


TOPCARE CLICKFINE PEN NEEDLES MISC31G X 6 MMinsulin pen needle


TOPCARE CLICKFINE PEN NEEDLES MISC31G X 8 MMinsulin pen needle


TOPCARE ULTRA COMFORT INS SYR MISC29G X 1/2" 0.3 MLinsulin syringe/needle u-100




TOPCARE ULTRA COMFORT INS SYR MISC29G X 1/2" 1 MLinsulin syringe/needle u-100
















TRAVEL LANCETS MISClancets


TRUE METRIX AIR GLUCOSE METER KITW/DEVICEblood glucose monitoring supplies


TRUE METRIX AIR KIT W/DEVICEblood glucose monitoring supplies


TRUE METRIX BLOOD GLUCOSE TEST STRIPglucose blood


TRUE METRIX LEVEL 1 SOLUTION LOWblood glucose calibration

BRAND 1

TRUE METRIX LEVEL 2 SOLUTION NORMALblood glucose calibration

BRAND 1

TRUE METRIX METER KIT W/DEVICEblood glucose monitoring supplies


TRUECONTROL GLUCOSE CONT LEV 0LIQUIDblood glucose calibration

BRAND 1

TRUECONTROL GLUCOSE CONT LEV 1LIQUIDblood glucose calibration

BRAND 1

TRUEDRAW LANCING DEVICE MISClancet devices

BRAND 1

TRUEPLUS INSULIN SYRINGE MISC 28G X1/2" 0.5 MLinsulin syringe/needle u-100


TRUEPLUS INSULIN SYRINGE MISC 28G X1/2" 1 MLinsulin syringe/needle u-100






















TRUEPLUS LANCETS 26G MISClancets








TRUEPLUS SAFETY LANCETS 28G MISClancets


TRUERESULT BLOOD GLUCOSE KITW/DEVICEblood glucose monitoring supplies


TRUETEST CONTROL LEVEL 1 LIQUIDblood glucose calibration

BRAND 1




BRAND 1


BRAND 1

TRUETEST TEST STRIPglucose blood


TRUETRACK GLUCOSE CONTROL LIQUIDblood glucose calibration

BRAND 1

TRUETRACK GLUCOSE CONTROL LIQUIDLOWblood glucose calibration

BRAND 1

TRUETRACK TEST STRIPglucose blood


ULTI-LANCE AUTO-ADJUST DEVICE MISClancet devices

BRAND 1

ULTI-LANCE AUTOMATIC MISClancet devices

BRAND 1

ULTI-LANCE MINI ADJUSTABLE MISClancet devices

BRAND 1

ULTICARE INSULIN SAFETY SYR MISC 29G X1/2" 0.5 MLinsulin syringe/needle u-100


ULTICARE INSULIN SAFETY SYR MISC 29G X1/2" 1 MLinsulin syringe/needle u-100


ULTICARE INSULIN SYRINGE MISC 28G X1/2" 0.5 MLinsulin syringe/needle u-100


ULTICARE INSULIN SYRINGE MISC 28G X1/2" 1 MLinsulin syringe/needle u-100




























ULTICARE MICRO PEN NEEDLES MISC 32GX 4 MMinsulin pen needle




ULTICARE MINI PEN NEEDLES MISC 31G X 6MMinsulin pen needle


ULTICARE PEN NEEDLES MISC 29G X12.7MMinsulin pen needle


ULTICARE PEN NEEDLES MISC 29G X 12MMinsulin pen needle


ULTICARE SHORT PEN NEEDLES MISC 31G X8 MMinsulin pen needle


ULTICARE THIN LANCETS 30G MISClancets


ULTILET BASIC LANCETS 30G MISClancets


ULTILET CLASSIC LANCETS MISClancets


ULTILET INSULIN SYRINGE MISC 29G X7/16" 0.3 MLinsulin syringe/needle u-100


ULTILET INSULIN SYRINGE MISC 29G X7/16" 0.5 MLinsulin syringe/needle u-100


ULTILET INSULIN SYRINGE MISC 29G X7/16" 1 MLinsulin syringe/needle u-100


ULTILET INSULIN SYRINGE SHORT MISC30G X 5/16" 0.3 MLinsulin syringe/needle u-100




ULTILET INSULIN SYRINGE SHORT MISC30G X 5/16" 1 MLinsulin syringe/needle u-100








ULTILET INSULIN SYRINGE SHORT MISC31G X 5/16" 1 MLinsulin syringe/needle u-100


ULTILET LANCETS MISClancets


ULTILET PEN NEEDLE MISC 31G X 8 MMinsulin pen needle


ULTILET SAFETY LANCETS 23G MISClancets


ULTRA COMFORT INSULIN SYRINGE MISC29G X 1/2" 0.5 MLinsulin syringe/needle u-100


ULTRA COMFORT INSULIN SYRINGE MISC29G X 1/2" 1 MLinsulin syringe/needle u-100














ULTRA THIN LANCETS 28G MISClancets


ULTRA THIN LANCETS 30G MISClancets


ULTRA-COMFORT INSULIN SYRINGE MISC28G X 1/2" 0.5 MLinsulin syringe/needle u-100


ULTRA-COMFORT INSULIN SYRINGE MISC28G X 1/2" 1 MLinsulin syringe/needle u-100






















ULTRA-THIN II AUTO LANCET MISClancets


ULTRA-THIN II INS SYR SHORT MISC 30G X5/16" 0.3 MLinsulin syringe/needle u-100




ULTRA-THIN II INS SYR SHORT MISC 30G X5/16" 1 MLinsulin syringe/needle u-100






ULTRA-THIN II INS SYR SHORT MISC 31G X5/16" 1 MLinsulin syringe/needle u-100


ULTRA-THIN II INSULIN SYRINGE MISC 29GX 1/2" 0.3 MLinsulin syringe/needle u-100


ULTRA-THIN II INSULIN SYRINGE MISC 29GX 1/2" 0.5 MLinsulin syringe/needle u-100


ULTRA-THIN II INSULIN SYRINGE MISC 29GX 1/2" 1 MLinsulin syringe/needle u-100


ULTRA-THIN II LANCETS MISClancets


ULTRA-THIN II MINI PEN NEEDLE MISC 31GX 5 MMinsulin pen needle


ULTRA-THIN II PEN NEEDLE SHORT MISC31G X 8 MMinsulin pen needle




ULTRA-THIN II PEN NEEDLES MISC 29G X12.7MMinsulin pen needle


ULTRATRAK PRO CONTROL SOLUTIONblood glucose calibration

BRAND 1

ULTRATRAK PRO CONTROL SOLUTIONNORMALblood glucose calibration

BRAND 1

ULTRATRAK ULTIMATE CONTROLSOLUTIONblood glucose calibration

BRAND 1

UNIFINE PENTIPS MISC 29G X 12MMinsulin pen needle


UNIFINE PENTIPS MISC 31G X 5 MMinsulin pen needle








UNIFINE PENTIPS PLUS MISC 29G X 12MMinsulin pen needle


UNIFINE PENTIPS PLUS MISC 31G X 5 MMinsulin pen needle








UNILET COMFORTOUCH LANCET MISClancets


UNILET EXCELITE II MISClancets




UNILET EXCELITE MISClancets


UNILET G.P. LANCET MISClancets


UNILET G.P. SUPERLITE LANCET MISClancets


UNILET GP 28 ULTRA THIN MISClancets


UNILET LANCET MISClancets


UNILET MICRO-THIN 33G MISClancets


UNILET SUPER-THIN 30G MISClancets


UNILET SUPERLITE LANCET MISClancets


UNILET ULTRA-THIN 28G MISClancets


UNISTIK 3 GENTLE MISClancets


UNISTIK SAFETY LANCETS 28G MISClancets


UNISTIK SAFETY LANCETS 30G MISClancets


UNISTRIP CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

UNIVERSAL 1 LANCETS THIN 26G MISClancets


UNIVERSAL 1 LANCETS ULTRA THIN MISClancets


V-R MONO INSULIN SYRINGE MISC 28G X1/2" 0.5 MLinsulin syringe/needle u-100




V-R MONO INSULIN SYRINGE MISC 28G X1/2" 1 MLinsulin syringe/needle u-100






V-R MONO INSULIN SYRINGE MISC 29G X1/2" 1 MLinsulin syringe/needle u-100


VALUE HEALTH INSULIN SYRINGE MISC 29GX 1/2" 0.5 MLinsulin syringe/needle u-100


VALUE HEALTH INSULIN SYRINGE MISC 29GX 1/2" 1 MLinsulin syringe/needle u-100


VALUE PLUS LANCET STANDARD 21G MISClancets


VALUE PLUS LANCETS SUPER THIN MISClancets


VALUE PLUS LANCETS THIN 26G MISClancets


VALUE PLUS LANCING DEVICE MISClancet devices

BRAND 1

VALUMARK LANCET SUPER THIN 30G MISClancets


VALUMARK LANCET ULTRA THIN 28G MISClancets


VALUMARK PEN NEEDLES MISC 29G X12MMinsulin pen needle


VALUMARK PEN NEEDLES MISC 31G X 6MMinsulin pen needle




VALUMARK PEN NEEDLES MISC 31G X 8MMinsulin pen needle


VANISHPOINT INSULIN SYRINGE MISC 29GX 1/2" 1 MLinsulin syringe/needle u-100


VANISHPOINT INSULIN SYRINGE MISC 30GX 1/2" 0.5 MLinsulin syringe/needle u-100


VICTORY CONTROL LEVEL 1/2 SOLUTIONblood glucose calibration

BRAND 1

VIDA MIA AUTOLET LANCING DEV MISClancet devices

BRAND 1

VIDA MIA UNIFINE PENTIPS MISC 29G X12MMinsulin pen needle


VIDA MIA UNIFINE PENTIPS MISC 31G X 6MMinsulin pen needle






VIDA MIA UNILET LANCETS 28G MISClancets


VIDA MIA UNILET LANCETS 30G MISClancets


VISTOGARD PACKET 10 GMuridine triacetate (emergency treatment)

BRAND 4

VOCAL POINT CONTROL SOLUTION LOWblood glucose calibration

BRAND 1

VP INSULIN SYRINGE MISC 29G X 1/2" 0.3MLinsulin syringe/needle u-100




W&F LANCETS 26G MISClancets


W&F LANCETS COLORED 21G MISClancets


WALGREENS ADV TRAVEL LANCETS MISClancets


WALGREENS LANCETS MICRO THIN MISClancets


WALGREENS LANCETS MISClancets


WALGREENS LANCETS SUPER THIN MISClancets


WALGREENS LANCING DEVICE MISClancet devices

BRAND 1

WALGREENS THIN LANCETS MISClancets


WALGREENS ULTRA THIN LANCETS MISClancets


WD MEDIC INSULIN SYRINGE MISC 29G X1/2" 0.3 MLinsulin syringe/needle u-100




WD MEDIC INSULIN SYRINGE MISC 29G X1/2" 1 MLinsulin syringe/needle u-100






WD MEDIC INSULIN SYRINGE MISC 30G X5/16" 1 MLinsulin syringe/needle u-100




WEGMANS UNIFINE PENTIPS PLUS MISC31G X 5 MMinsulin pen needle








WIDE-SEAL DIAPHRAGM 60 DIAPHRAGM 2%diaphragm wide seal

BRAND 0


BRAND 0


BRAND 0


BRAND 0


BRAND 0


BRAND 0


BRAND 0


BRAND 0



XPRES CONTROL SOLUTION NORMALblood glucose calibration

BRAND 1

OPHTHALMIC AGENTS

OPHTHALMIC AGENTS, OTHER

LACRISERT INSERT 5 MGartificial tear insert

BRAND 3

LASTACAFT SOLUTION 0.25 %alcaftadine

BRAND 2

mydral solution 0.5 % generic 1

mydral solution 1 % generic 1

neo-polycin ointment 3.5-400-10000 generic 1

neomycin-bacitracin zn-polymyx ointment5-400-10000

generic 1

neomycin-polymyxin-dexameth ointment3.5-10000-0.1

generic 1

neomycin-polymyxin-dexameth suspension3.5-10000-0.1

generic 1

neomycin-polymyxin-hc suspension 3.5-10000-1

generic 1

parcaine solution 0.5 % generic 1

poly-dex ointment 3.5-10000-0.1 generic 1

polymyxin b-trimethoprim solution 10000-0.1 unit/ml-%

generic 1

proparacaine hcl solution 0.5 % generic 1

RESTASIS EMULSION 0.05 %cyclosporine (ophth)

BRAND 2

tobramycin-dexamethasone suspension0.3-0.1 %

generic 1

tropicamide solution 0.5 % generic 1

tropicamide solution 1 % generic 1



OPHTHALMIC ANTI-ALLERGY AGENTS

ALOCRIL SOLUTION 2 %nedocromil sodium (ophth)

BRAND 3

ALOMIDE SOLUTION 0.1 %lodoxamide tromethamine

BRAND 3

azelastine hcl solution 0.05 % generic 1 MPL 1 / claim

BEPREVE SOLUTION 1.5 %bepotastine besilate

BRAND 3

cromolyn sodium solution 4 % generic 1

EMADINE SOLUTION 0.05 %emedastine difumarate

BRAND 3

epinastine hcl solution 0.05 % generic 1

PATADAY SOLUTION 0.2 %olopatadine hcl

BRAND 2

PATANOL SOLUTION 0.1 %olopatadine hcl

BRAND 3

OPHTHALMIC ANTI-INFLAMMATORIES

ALREX SUSPENSION 0.2 %loteprednol etabonate

BRAND 2

bromfenac sodium (once-daily) solution0.09 %

generic 1

bromfenac sodium solution 0.09 % generic 1

dexamethasone sodium phosphate solution0.1 %

generic 1

diclofenac sodium solution 0.1 % generic 1

DUREZOL EMULSION 0.05 %difluprednate

BRAND 2

fluorometholone suspension 0.1 % generic 1

flurbiprofen sodium solution 0.03 % generic 1

FML FORTE SUSPENSION 0.25 %fluorometholone (ophth)

BRAND 3



FML OINTMENT 0.1 %fluorometholone (ophth)

BRAND 3

ILEVRO SUSPENSION 0.3 %nepafenac

BRAND 3

ketorolac tromethamine solution 0.4 % generic 1 MPL 1 / claim

ketorolac tromethamine solution 0.5 % generic 1 MPL 1 / Claim

LOTEMAX GEL 0.5 %loteprednol etabonate

BRAND 2

LOTEMAX OINTMENT 0.5 %loteprednol etabonate

BRAND 2

LOTEMAX SUSPENSION 0.5 %loteprednol etabonate

BRAND 2

MAXIDEX SUSPENSION 0.1 %dexamethasone (ophth)

BRAND 3

NEVANAC SUSPENSION 0.1 %nepafenac

BRAND 3

PRED MILD SUSPENSION 0.12 %prednisolone acetate (ophth)

BRAND 3

prednisolone acetate suspension 1 % generic 1

PREDNISOLONE SODIUM PHOSPHATESOLUTION 1 %prednisolone sodium phosphate (ophth)

BRAND 3

VEXOL SUSPENSION 1 %rimexolone

BRAND 3

OPHTHALMIC ANTIGLAUCOMA AGENTS

apraclonidine hcl solution 0.5 % generic 1

AZOPT SUSPENSION 1 %brinzolamide

BRAND 2 MPL 1 / Claim

betaxolol hcl solution 0.5 % generic 1 MPL 1 / Claim

brimonidine tartrate solution 0.15 % generic 1 MPL 1 / Claim

brimonidine tartrate solution 0.2 % generic 1 MPL 1 / Claim



carteolol hcl solution 1 % generic 1

COMBIGAN SOLUTION 0.2-0.5 %brimonidine tartrate-timolol maleate

BRAND 2

dorzolamide hcl solution 2 % generic 1 MPL 1 / Claim

dorzolamide hcl-timolol mal solution 22.3-6.8 mg/ml

generic 1 MPL 1 / Claim

IOPIDINE SOLUTION 1 %apraclonidine hcl

BRAND 3

levobunolol hcl solution 0.25 % generic 1 MPL 1 / Claim

levobunolol hcl solution 0.5 % generic 1 MPL 1 / Claim

methazolamide tab 25 mg generic 1 MDD 6 per day

methazolamide tab 50 mg generic 1 MDD 6 per day

metipranolol solution 0.3 % generic 1

PHOSPHOLINE IODIDE RECON SOLN 0.125%echothiophate iodide

BRAND 3

pilocarpine hcl solution 1 % generic 1



timolol maleate gel f soln 0.25 % generic 1

timolol maleate gel f soln 0.5 % generic 1

timolol maleate solution 0.25 % generic 1

timolol maleate solution 0.5 % generic 1

OPHTHALMIC PROSTAGLANDIN AND PROSTAMIDE ANALOGS

bimatoprost solution 0.03 % generic 3 ST

latanoprost solution 0.005 % generic 1

LUMIGAN SOLUTION 0.01 %bimatoprost

BRAND 3 ST

TRAVATAN Z SOLUTION 0.004 %travoprost

BRAND 2



ZIOPTAN SOLUTION 0.0015 %tafluprost

BRAND 2

OTIC AGENTS

acetasol hc solution 2-1 % generic 1

acetic acid solution 2 % generic 1

antipyrine-benzocaine solution 5.4-1.4 % generic 1

antipyrine-benzocaine solution 54-14mg/ml

generic 1

aurodex solution 5.4-1.4 % generic 1

CIPRO HC SUSPENSION 0.2-1 %ciprofloxacin-hydrocortisone

BRAND 3

CIPRODEX SUSPENSION 0.3-0.1 %ciprofloxacin-dexamethasone

BRAND 2

COLY-MYCIN S SUSPENSION 3.3-3-10-0.5MG/MLneomycin-colistin-hc-thonzonium

BRAND 3

CORTISPORIN SOLUTION 3.5-10000-1neomycin-polymyxin-hc (otic)

BRAND 2

CORTISPORIN-TC SUSPENSION 3.3-3-10-0.5MG/MLneomycin-colistin-hc-thonzonium

BRAND 3

cortomycin solution 3.5-10000-1 generic 1

cortomycin suspension 3.5-10000-1 generic 1

fluocinolone acetonide oil 0.01 % generic 1

hydrocortisone-acetic acid solution 1-2 % generic 1

neomycin-polymyxin-hc solution 1 % generic 1

neomycin-polymyxin-hc solution 3.5-10000-1

generic 1

neomycin-polymyxin-hc suspension 3.5-10000-1

generic 1



RESPIRATORY TRACT/PULMONARY AGENTS

ANTI-INFLAMMATORIES, INHALED CORTICOSTEROIDS

ALVESCO AERO SOLN 160 MCG/ACTciclesonide

BRAND 3PA

MPL 1 / 30 days

ALVESCO AERO SOLN 80 MCG/ACTciclesonide

BRAND 3PA

MPL 1 / 30 days

ASMANEX 120 METERED DOSES AER POWBA 220 MCG/INHmometasone furoate (inhalation)










ASMANEX 7 METERED DOSES AER POW BA110 MCG/INHmometasone furoate (inhalation)


budesonide suspension 0.25 mg/2ml generic 3PA

MDS 120 / 30 days

budesonide suspension 0.5 mg/2ml generic 3PA

MDS 120 / 30 days

budesonide suspension 1 mg/2ml generic 1PA

MDS 120 / 30 days

budesonide suspension 32 mcg/act generic 1PA

MPL 1 / 30 days



FLOVENT DISKUS AER POW BA 100MCG/BLISTfluticasone propionate (inhalation)






FLOVENT HFA AEROSOL 110 MCG/ACTfluticasone propionate hfa






flunisolide solution 25 mcg/act (0.025%) generic 1 MPL 1 / 30 days

flunisolide solution 29 mcg/act (0.025%) generic 1 MPL 1 / 30 days

fluticasone propionate suspension 50mcg/act

generic 1 MPL 1 / 30 days

mometasone furoate suspension 50mcg/act

generic 1PA

MPL 2 / 30 days

NASONEX SUSPENSION 50 MCG/ACTmometasone furoate (nasal)

BRAND 2PA

MPL 2 / 30 days

PULMICORT FLEXHALER AER POW BA 180MCG/ACTbudesonide (inhalation)

BRAND 2PA

MPL 1 / 30 days

PULMICORT FLEXHALER AER POW BA 90MCG/ACTbudesonide (inhalation)

BRAND 2PA

MPL 1 / 30 Days

PULMICORT SUSPENSION 0.5 MG/2MLbudesonide (inhalation)

BRAND 3PA

MDS 120 / 30 days

PULMICORT SUSPENSION 1 MG/2MLbudesonide (inhalation)

BRAND 2PA

MDS 120 / 30 days



QVAR AERO SOLN 40 MCG/ACTbeclomethasone dipropionate


QVAR AERO SOLN 80 MCG/ACTbeclomethasone dipropionate


RHINOCORT AQUA SUSPENSION 32MCG/ACTbudesonide (nasal)

BRAND 3PA

MPL 1 / 30 days

ANTIHISTAMINES

ALLEGRA TAB 60 MGfexofenadine hcl


arbinoxa solution 4 mg/5ml generic 1

arbinoxa tab 4 mg generic 1

ASTELIN SOLUTION 137 MCG/SPRAYazelastine hcl


ASTEPRO SOLUTION 0.15 %azelastine hcl


azelastine hcl solution 0.1 % generic 1 MPL 1 / 30 days

azelastine hcl solution 0.15 % generic 1 MPL 1 / 30 days

azelastine hcl solution 137 mcg/spray generic 1 MPL 1 / 30 days

carbinoxamine maleate solution 4 mg/5ml generic 1

carbinoxamine maleate tab 4 mg generic 1

cetirizine hcl solution 1 mg/ml generic 1 MDS 300 / 30 days

cetirizine hcl syrup 1 mg/ml generic 1 MDS 300 / 30 days

cetirizine hcl syrup 5 mg/5ml generic 1 MDS 300 / 30 days

clemastine fumarate syrup 0.67 mg/5ml generic 1

clemastine fumarate tab 2.68 mg generic 1

cyproheptadine hcl 4 mg generic 1

cyproheptadine hcl syrup 2 mg/5ml generic 1

cyproheptadine hcl tab 4 mg generic 1



desloratadine tab 5 mg generic 1 MDD 1 per day

desloratadine tab disp 2.5 mg generic 1 MDD 1 per day

desloratadine tab disp 5 mg generic 1 MDD 1 per day

DEXCHLORPHENIRAMINE MALEATE SYRUP2 MG/5MLdexchlorpheniramine maleate

BRAND 3

diphenhydramine hcl cap 50 mg generic 1

diphenhydramine hcl elixir 12.5 mg/5ml generic 1

diphenhydramine hcl solution 50 mg/ml generic 1

hydroxyzine hcl solution 10 mg/5ml generic 1

hydroxyzine hcl solution 50 mg/ml generic 1

hydroxyzine hcl syrup 10 mg/5ml generic 1

hydroxyzine hcl tab 10 mg generic 1



hydroxyzine pamoate cap 100 mg generic 1



levocetirizine dihydrochloride solution 2.5mg/5ml


levocetirizine dihydrochloride tab 5 mg generic 1 MDD 1 per day

olopatadine hcl solution 0.6 % generic 1

pharbedryl cap 50 mg generic 1

phenadoz suppos 12.5 mg generic 1

phenadoz suppos 25 mg generic 1

phenergan suppos 12.5 mg generic 1

phenergan suppos 25 mg generic 1

promethazine hcl solution 25 mg/ml generic 1



promethazine hcl solution 50 mg/ml generic 1

promethazine hcl solution 6.25 mg/5ml generic 1

promethazine hcl suppos 12.5 mg generic 1

promethazine hcl suppos 25 mg generic 1

promethazine hcl syrup 6.25 mg/5ml generic 1

promethazine hcl tab 12.5 mg generic 1

promethazine hcl tab 25 mg generic 1

promethazine hcl tab 50 mg generic 1

promethegan suppos 12.5 mg generic 1

promethegan suppos 25 mg generic 1

ANTILEUKOTRIENES

montelukast sodium chew tab 4 mg generic 1 MDD 1 per day

montelukast sodium chew tab 5 mg generic 1 MDD 1 per day

montelukast sodium packet 4 mg generic 1 MDD 1 per day

montelukast sodium tab 10 mg generic 1 MDD 1 per day

zafirlukast tab 10 mg generic 1 MDD 2 per day

zafirlukast tab 20 mg generic 1 MDD 2 per day

ZYFLO CR TAB ER 12H 600 MGzileuton


BRONCHODILATORS, ANTICHOLINERGIC

ATROVENT HFA AERO SOLN 17 MCG/ACTipratropium bromide hfa


INCRUSE ELLIPTA AER POW BA 62.5MCG/INHumeclidinium bromide


ipratropium bromide solution 0.02 % generic 1 MDS 450 / 30 days

ipratropium bromide solution 0.03 % generic 1 MDS 30 / 30 days

ipratropium bromide solution 0.06 % generic 1



SPIRIVA HANDIHALER CAP 18 MCGtiotropium bromide monohydrate


SPIRIVA RESPIMAT AERO SOLN 1.25MCG/ACTtiotropium bromide monohydrate


SPIRIVA RESPIMAT AERO SOLN 2.5MCG/ACTtiotropium bromide monohydrate


BRONCHODILATORS, SYMPATHOMIMETIC

ADRENACLICK SOLN A-INJ 0.3 MG/0.3MLepinephrine

BRAND 2 MPL 1 / claim(s)

albuterol sulfate er tab er 12h 4 mg generic 1

albuterol sulfate er tab er 12h 8 mg generic 1

albuterol sulfate nebu soln (2.5 mg/3ml)0.083%


albuterol sulfate nebu soln (5 mg/ml) 0.5% generic 1 MPL 3 / 30 days

albuterol sulfate nebu soln (5 mg/ml) 0.5% generic 1 MPL 3 / 30 days

albuterol sulfate nebu soln 0.63 mg/3ml generic 1 MDS 450 / 30 days

albuterol sulfate nebu soln 1.25 mg/3ml generic 1 MDS 450 / 30 days

albuterol sulfate syrup 2 mg/5ml generic 1

albuterol sulfate tab 2 mg generic 1

albuterol sulfate tab 4 mg generic 1

ARCAPTA NEOHALER CAP 75 MCGindacaterol maleate

BRAND 2PA

MPL 1 / 30 days

AUVI-Q SOLN A-INJ 0.3 MG/0.3MLepinephrine


BROVANA NEBU SOLN 15 MCG/2MLarformoterol tartrate

BRAND 3PA

MDS 120 / 30 days

epinephrine hcl soln prsyr 0.1 mg/ml generic 1

epinephrine hcl solution 1 mg/ml generic 1



EPINEPHRINE SOLN A-INJ 0.3 MG/0.3MLepinephrine


EPIPEN 2-PAK SOLN A-INJ 0.3 MG/0.3MLepinephrine


EPIPEN JR 2-PAK SOLN A-INJ 0.15MG/0.3MLepinephrine


EPIPEN JR SOLN A-INJ 0.15 MG/0.3MLepinephrine


EPIPEN SOLN A-INJ 0.3 MG/0.3MLepinephrine


FORADIL AEROLIZER CAP 12 MCGformoterol fumarate

BRAND 2PA

MDD 2 per day

levalbuterol hcl nebu soln 0.31 mg/3ml generic 1 MDS 360 / 30 days


levalbuterol hcl nebu soln 1.25 mg/0.5ml generic 1


MAXAIR AUTOHALER AERO BA 200MCG/INHpirbuterol acetate


metaproterenol sulfate syrup 10 mg/5ml generic 1

metaproterenol sulfate tab 10 mg generic 1

metaproterenol sulfate tab 20 mg generic 1

PROAIR HFA AERO SOLN 108 (90 BASE)MCG/ACTalbuterol sulfate


PROVENTIL HFA AERO SOLN 108 (90 BASE)MCG/ACTalbuterol sulfate


SEREVENT DISKUS AER POW BA 50MCG/DOSEsalmeterol xinafoate




terbutaline sulfate solution 1 mg/ml generic 1

terbutaline sulfate tab 2.5 mg generic 1

terbutaline sulfate tab 5 mg generic 1

TWINJECT SOLN A-INJ 0.3 MG/0.3MLepinephrine


VENTOLIN HFA AERO SOLN 108 (90 BASE)MCG/ACTalbuterol sulfate


XOPENEX HFA AEROSOL 45 MCG/ACTlevalbuterol tartrate

BRAND 3PA

MPL 2 / 30 days

CYSTIC FIBROSIS AGENTS

CAYSTON RECON SOLN 75 MGaztreonam lysine

BRAND 4PA

S

KALYDECO TAB 150 MGivacaftor

BRAND 4PA

S

TOBI NEBU SOLN 300 MG/5MLtobramycin

BRAND 4PA

S

tobramycin nebu soln 300 mg/5ml generic 4PA

S

PHOSPHODIESTERASE INHIBITORS, AIRWAYS DISEASE

aminophylline solution 25 mg/ml generic 1

ELIXOPHYLLIN ELIXIR 80 MG/15MLtheophylline

BRAND 1

LUFYLLIN TAB 200 MGdyphylline

BRAND 3

LUFYLLIN TAB 400 MGdyphylline

BRAND 3

theochron tab er 12h 100 mg generic 1





theophylline er tab er 12h 100 mg generic 1






PULMONARY ANTIHYPERTENSIVES

ADCIRCA TAB 20 MGtadalafil (pulmonary hypertension)

BRAND 4PA

S

LETAIRIS TAB 10 MGambrisentan

BRAND 4PA

S

LETAIRIS TAB 5 MGambrisentan

BRAND 4PA

S

REMODULIN SOLUTION 1 MG/MLtreprostinil sodium

BRAND 4PA

S


BRAND 4PA

S

REMODULIN SOLUTION 2.5 MG/MLtreprostinil sodium

BRAND 4PA

S


BRAND 4PA

S

REVATIO SOLUTION 10 MG/12.5MLsildenafil citrate (pulmonary hypertension)

BRAND 4PA

S

REVATIO TAB 20 MGsildenafil citrate (pulmonary hypertension)

BRAND 4PA

S

sildenafil citrate solution 10 mg/12.5ml generic 4PA

S

sildenafil citrate tab 20 mg generic 4PA

S



TRACLEER TAB 125 MGbosentan

BRAND 4

PA

MDD 2 per dayS

TRACLEER TAB 62.5 MGbosentan

BRAND 4

PA

MDD 1 per dayS

VENTAVIS SOLUTION 10 MCG/MLiloprost

BRAND 4PA

S

VENTAVIS SOLUTION 20 MCG/MLiloprost

BRAND 4PA

S

RESPIRATORY TRACT AGENTS, OTHER

acetylcysteine solution 10 % generic 1

acetylcysteine solution 20 % generic 1

ADVAIR DISKUS AER POW BA 100-50MCG/DOSEfluticasone-salmeterol

BRAND 2PA

MPL 1 / 30 days


BRAND 2PA

MPL 1 / 30 days


BRAND 2PA

MPL 1 / 30 days

ADVAIR HFA AEROSOL 115-21 MCG/ACTfluticasone-salmeterol

BRAND 2PA

MPL 1 / 30 days


BRAND 2PA

MPL 1 / 30 days


BRAND 2PA

MPL 1 / 30 days

ARALAST NP RECON SOLN 1000 MGalpha1-proteinase inhibitor (human)

BRAND 4PA

S


BRAND 4PA

S




BRAND 4PA

S

ARALAST RECON SOLN 800 MGalpha1-proteinase inhibitor (human)

BRAND 4PA

S

benzonatate cap 100 mg generic 1 MDD 6 per day

benzonatate cap 200 mg generic 1 MDD 3 per day

BREO ELLIPTA AER POW BA 100-25MCG/INHfluticasone furoate-vilanterol


BREO ELLIPTA AER POW BA 200-25MCG/INHfluticasone furoate-vilanterol


cromolyn sodium nebu soln 20 mg/2ml generic 1 MDS 240 / 30 days

HYPERSAL NEBU SOLN 3.5 %sodium chloride (inhalant)

BRAND 1

ipratropium-albuterol solution 0.5-2.5 (3)mg/3ml


NEBUSAL NEBU SOLN 6 %sodium chloride (inhalant)

BRAND 1

PROLASTIN RECON SUSP 1000 MGalpha1-proteinase inhibitor (human)

BRAND 4PA

S

PROLASTIN-C RECON SOLN 1000 MGalpha1-proteinase inhibitor (human)

BRAND 4PA

S

pulmosal nebu soln 7 % generic 1

PULMOZYME SOLUTION 1 MG/MLdornase alfa

BRAND 4PA

S

sodium chloride nebu soln 7 % generic 1

SYMBICORT AEROSOL 160-4.5 MCG/ACTbudesonide-formoterol fumarate dihydrate

BRAND 2PA

MPL 1 / 30 days

SYMBICORT AEROSOL 80-4.5 MCG/ACTbudesonide-formoterol fumarate dihydrate

BRAND 2PA

MPL 1 / 30 days



TYZINE SOLUTION 0.05 %tetrahydrozoline hcl

BRAND 3

TYZINE SOLUTION 0.1 %tetrahydrozoline hcl

BRAND 3

XOLAIR RECON SOLN 150 MGomalizumab

BRAND 4PA

S

ZEMAIRA RECON SOLN 1000 MGalpha1-proteinase inhibitor (human)

BRAND 4PA

S

SKELETAL MUSCLE RELAXANTS

BOTOX RECON SOLN 100 UNITonabotulinumtoxina

BRAND 3 PA

BOTOX RECON SOLN 200 UNITonabotulinumtoxina

BRAND 3 PA

carisoprodol tab 250 mg generic 1

carisoprodol tab 350 mg generic 1

chlorzoxazone tab 500 mg generic 1

cyclobenzaprine hcl tab 10 mg generic 1 MDD 3 per day

cyclobenzaprine hcl tab 5 mg generic 1 MDD 3 per day

cyclobenzaprine hcl tab 7.5 mg generic 1 MDD 3 per day

DYSPORT (GLABELLAR LINES) RECON SOLN300 UNITabobotulinumtoxina (glabellar lines)

BRAND 3 PA

DYSPORT RECON SOLN 300 UNITabobotulinumtoxina

BRAND 3 PA

DYSPORT RECON SOLN 500 UNITabobotulinumtoxina

BRAND 3 PA

metaxall tab 800 mg generic 1 MDD 4 per day

metaxalone tab 800 mg generic 1 MDD 4 per day

methocarbamol tab 500 mg generic 1

methocarbamol tab 750 mg generic 1



orphenadrine citrate er tab er 12h 100 mg generic 1 MDD 2 per day

XEOMIN RECON SOLN 50 UNITincobotulinumtoxina

BRAND 3 PA

SLEEP DISORDER AGENTS

GABA RECEPTOR MODULATORS

estazolam tab 1 mg generic 1

estazolam tab 2 mg generic 1

eszopiclone tab 1 mg generic 1

ST



ST



ST


LUNESTA TAB 1 MGeszopiclone

BRAND 3

ST



BRAND 3

ST



BRAND 3

ST


triazolam tab 0.125 mg generic 1

triazolam tab 0.25 mg generic 1

zaleplon cap 10 mg generic 1AL At least 18 yrs old

MDD 2 per day



zaleplon cap 5 mg generic 1AL At least 18 yrs old

MDD 1 per day

zolpidem tartrate tab 10 mg generic 1AL At least 18 yrs old

MDD 1 per day

zolpidem tartrate tab 5 mg generic 1AL At least 18 yrs old

MDD 1 per day

SLEEP DISORDERS, OTHER

modafinil tab 100 mg generic 1

PA


modafinil tab 200 mg generic 1

PA


NUVIGIL TAB 150 MGarmodafinil

BRAND 2

PA



BRAND 2

PA



BRAND 2

PA



BRAND 2

PA


ROZEREM TAB 8 MGramelteon

BRAND 3

ST


XYREM SOLUTION 500 MG/MLsodium oxybate

BRAND 4

PA

MDS 540 / 30 daysS



THERAPEUTIC NUTRIENTS/MINERALS/ELECTROLYTES

ELECTROLYTE/MINERAL MODIFIERS

CHEMET CAP 100 MGsuccimer

BRAND 3

EXJADE TAB SOL 125 MGdeferasirox

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

FERRIPROX TAB 500 MGdeferiprone

BRAND 3

JADENU TAB 180 MGdeferasirox

BRAND 4PA

S


BRAND 4PA

S


BRAND 4PA

S

kionex powder generic 1

kionex suspension 15 gm/60ml generic 1

SAMSCA TAB 15 MGtolvaptan

BRAND 4PA

S

SAMSCA TAB 30 MGtolvaptan

BRAND 4PA

S

sodium polystyrene sulfonate powder generic 1

sodium polystyrene sulfonate suspension15 gm/60ml

generic 1

sps suspension 15 gm/60ml generic 1

SYPRINE CAP 250 MGtrientine hcl

BRAND 4PA

S



ELECTROLYTE/MINERAL REPLACEMENT

AMMONIUM CHLORIDE SOLUTION 5MEQ/MLammonium chloride

BRAND 3

calcium chloride solution 10 % generic 1

calcium gluconate solution 10 % generic 1

delflex-lm/1.5% dextrose solution 346mosm/l

generic 1

DEXTROSE 5%/ELECTROLYTE #48SOLUTIONelectrolyte-48 in dextrose

BRAND 1

dextrose in lactated ringers solution 5 % generic 1

dextrose in ringers solution 5 % generic 1

DIANEAL LOW CALCIUM/1.5% DEXSOLUTION 344 MOSM/Lperitoneal dialysis solutions

BRAND 1

DIANEAL PD-2/1.5% DEXTROSE SOLUTION346 MOSM/Lperitoneal dialysis solutions

BRAND 1

effer-k effer tab 25 meq generic 1

effervescent pot chloride effer tab 25 meq generic 1

epiklor packet 20 meq generic 1

hematinic/folic acid tab 324-1 mg generic 1 MDD 1 per day

hemocyte-f tab 324-1 mg generic 1 MDD 1 per day

inpersol-lm/1.5% dextrose solution 346mosm/l

generic 1

IONOSOL-B IN D5W SOLUTIONelectrolyte-b in dextrose

BRAND 1

IONOSOL-MB IN D5W SOLUTIONelectrolyte-mb in dextrose

BRAND 1

isolyte-m in d5w solution generic 1



ISOLYTE-P IN D5W SOLUTIONelectrolyte-p in dextrose

BRAND 1

ISOLYTE-S SOLUTIONelectrolyte-s

BRAND 1

k-effervescent effer tab 25 meq generic 1

k-prime effer tab 25 meq generic 1

k-sol solution 20 meq/15ml (10%) generic 1

k-vescent effer tab 25 meq generic 1

k-vescent packet 20 meq generic 1

kcl in dextrose-nacl solution 10-5-0.45meq/l-%-%

generic 1


generic 1


generic 1


generic 1


generic 1


generic 1


generic 1

KCL IN DEXTROSE-NACL SOLUTION 40-5-0.9 MEQ/L-%-%potassium chloride in dextrose & sodiumchloride

BRAND 1

KCL-LACTATED RINGERS-D5W SOLUTION20 MEQ/Lpotassium chloride in d5w lactated ringers

BRAND 1

klor-con 10 tab er 10 meq generic 1

klor-con m10 tab er 10 meq generic 1



KLOR-CON M15 TAB ER 15 MEQpotassium chloride microencapsulatedcrystals cr

BRAND 1

klor-con m20 tab er 20 meq generic 1

klor-con packet 20 meq generic 1

klor-con sprinkle cap er 10 meq generic 1

klor-con sprinkle cap er 8 meq generic 1

klor-con tab er 8 meq generic 1

klor-con/ef effer tab 25 meq generic 1

lactated ringers solution generic 1

MAGNESIUM SULFATE SOLUTION 2GM/50MLmagnesium sulfate

BRAND 1


BRAND 1


BRAND 1


BRAND 1


BRAND 1

magnesium sulfate solution 50 % generic 1

NORMOSOL-M IN D5W SOLUTIONelectrolyte-m in dextrose

BRAND 1

NORMOSOL-R PH 7.4 SOLUTIONelectrolyte-r (ph 7.4)

BRAND 1

nutrilyte conc generic 1

nutrilyte ii conc generic 1



physiolyte solution generic 1

physiosol irrigation solution generic 1

PLASMA-LYTE 148 SOLUTIONelectrolyte-148

BRAND 1

PLASMA-LYTE A SOLUTIONelectrolyte-a

BRAND 1

PLASMA-LYTE-56 IN D5W SOLUTIONelectrolyte-56 in dextrose

BRAND 1

pot bicarb-pot chloride effer tab 25 meq generic 1

potassium acetate solution 2 meq/ml generic 1

potassium acetate solution 4 meq/ml generic 1

potassium bicarbonate effer tab 25 meq generic 1

potassium chloride crys er tab er 10 meq generic 1

potassium chloride crys er tab er 20 meq generic 1

potassium chloride er cap er 10 meq generic 1

potassium chloride er cap er 8 meq generic 1

potassium chloride er tab er 10 meq generic 1

potassium chloride er tab er 8 meq generic 1

POTASSIUM CHLORIDE ER TAB ER 8 MEQpotassium chloride

BRAND 1

potassium chloride in dextrose solution 20-5 meq/l-%

generic 1

potassium chloride in dextrose solution 40-5 meq/l-%

generic 1

potassium chloride in nacl solution 20-0.45meq/l-%

generic 1


generic 1


generic 1



potassium chloride packet 20 meq generic 1

potassium chloride solution 0.4 meq/ml generic 1

potassium chloride solution 10 meq/100ml generic 1


POTASSIUM CHLORIDE SOLUTION 10MEQ/50MLpotassium chloride

BRAND 1

potassium chloride solution 2 meq/ml generic 1

potassium chloride solution 20 meq/15ml(10%)

generic 1

potassium chloride solution 20 meq/15ml(10%)

generic 1



POTASSIUM CHLORIDE SOLUTION 30MEQ/100MLpotassium chloride

BRAND 1

potassium phosphates solution 15mmole/5ml

generic 1


generic 1


generic 1


generic 1

ringers irrigation solution generic 1

ringers solution generic 1

sodium acetate solution 2 meq/ml generic 1

sodium acetate solution 4 meq/ml generic 1

sodium chloride 0.9 % generic 1





sodium chloride solution 2.5 meq/ml generic 1

sodium chloride solution 3 % generic 1

sodium chloride solution 4 meq/ml generic 1

sodium chloride solution 5 % generic 1

sodium phosphate solution 3 mmole/ml generic 1

tis-u-sol solution generic 1

tpn electrolytes conc generic 1

tpn electrolytes solution generic 1

ULTRABAG/DIANEAL PD-2/1.5% DEXSOLUTION 346 MOSM/Lperitoneal dialysis solutions

BRAND 1

ULTRABAG/DIANEAL/1.5% DEXTROSESOLUTION 344 MOSM/Lperitoneal dialysis solutions

BRAND 1

AMINOSYN II IN DEXTROSE 25% SOLUTION4.25 %amino acid infusion in d25w

BRAND 3

CLINIMIX E/DEXTROSE (5/20) SOLUTION 5%amino acid electrolyte w/ calcium infusionin d20w

BRAND 3

CLINIMIX/DEXTROSE (2.75/5) SOLUTION2.75 %amino acid infusion in d5w

BRAND 3


BRAND 3


BRAND 3


BRAND 3



CLINIMIX/DEXTROSE (5/25) SOLUTION 5 %amino acid infusion in d25w

BRAND 3

DRISDOL CAP 50000 UNITergocalciferol

BRAND 0

ergocalciferol cap 50000 unit generic 0

folic acid 1 mg generic 0GL FemaleAL 12 to 55 yrs old

folic acid tab 1 mg generic 0GL FemaleAL 12 to 55 yrs old

lactated ringers solution generic 1

vitamin d (ergocalciferol) cap 50000 unit generic 0


Index of Covered Drugs

11st Choice Lancets Super Thin 2151st Choice Lancets Thin 2151st Choice Lancets Ultra Thin 2151st Choice Pen Needles 2151st Tier Unifine Pentips 215,2161st Tier Unifine Pentips Plus 2161st Tier Unilet ComforTouch 216

AA-Hydrocort 170Abacavir Sulfate 98,100Abacavir Sulfate-Lamivudine 99Abacavir Sulfate-Lamivudine-Zidovudine 98,99Abacavir-Dolutegravir-Lamivudine 100Abatacept 205Abciximab 119Abelcet 50Abiraterone Acetate 63AbobotulinumtoxinA 327AbobotulinumtoxinA (Glabellar Lines) 327Abraxane 66Acamprosate Calcium 17Acarbose 105Accu-Chek Active Glucose Cont 216Accu-Chek Aviva 216Accu-Chek Comfort Curve 216Accu-Chek Comfort Curve Linear 216Accu-Chek Compact Blue Control 216Accu-Chek Compact Plus Control 216Accu-Chek FastClix Lancets 217Accu-Chek Instant Control 217Accu-Chek Multiclix Lancets 217Accu-Chek Safe-T Pro Lancets 217Accu-Chek SmartView Control 217Accu-Chek Soft Touch Lancets 217Accu-Chek Softclix Lancet Dev 217Accu-Chek Softclix Lancets 217Accusure Insulin Syringe 217Accutrend Glucose Control 217

Acebutolol HCl 125Acetaminophen w/ Codeine 11Acetazolamide 134Acetazolamide Sodium 134Acetic Acid 20Acetic Acid (Otic) 315Acetone (Urine) Test 229,258Acetylcysteine 325Acitretin 151,156Actemra 207,208Acti-Lance 28G 218Acti-Lance Lite Lancets 28G 218Acti-Lance Special Lancets 17G 218Acti-Lance Universal 23G 218Actimmune 208Actonel 212Actoplus Met 105Acura Control 218Acyclovir 103Acyclovir Topical 103Adacel 208Adagen 159Adalimumab 204Adapalene 151,154Adapalene-Benzoyl Peroxide 154Adcetris 78Adcirca 324Adefovir Dipivoxil 93Adjustable Lancing Device 218Adrenaclick 321Advair Diskus 325Advair HFA 325Advance Intuition Control 218Advicor 137Advocate Control Solution 218Advocate Insulin Pen Needles 218Advocate Insulin Syringe 218,219Advocate Lancets 219Advocate Lancets 30G 219Advocate Lancing Device 219Advocate Rapid-Safe Lancing 219

Advocate Redi-Code+ Control 219Advocate Safety Lancets 219Advocate Safety Lancets 26G 219AF Lancets Super Thin 220Afinitor 74Afluria 208Afluria Preservative Free 208Agalsidase beta 160AgaMatrix Control 220AgaMatrix Ultra-Thin Lancets 220Aggrenox 118Agriflu 208Albendazole 79Albenza 79Albuterol Sulfate 321,322,323Alcaftadine 311Alclometasone Dipropionate 170Aldesleukin 71Aldurazyme 159Alemtuzumab 67Alendronate Sodium 212Alendronate Sodium-Cholecalciferol 213Alfuzosin HCl 167Alglucosidase Alfa 160Alimta 64Alinia 79Aliskiren Fumarate 133Alitretinoin 79Alkeran 60Allegra 318Allopurinol 54Almotriptan Malate 55Alocril 312Alomide 312Alora 180Alosetron HCl 164Aloxi 49Alpha1-Proteinase Inhibitor (Human) 325,326,327Alprazolam 104Alrex 312Altabax 20

Alternate Site Lancing Device 220Altoprev 136Altretamine 61Alvesco 316Alvimopan 162Amantadine HCl 81Ambenonium Chloride 58AmBisome 50Ambrisentan 324Amcinonide 170Amikacin Sulfate 19Amiloride & Hydrochlorothiazide 131Amiloride HCl 134Amino Acid Electrolyte w/ Calcium Infusion inD20W 336Amino Acid Infusion in D10W 336Amino Acid Infusion in D25W 336,337Amino Acid Infusion in D5W 336Aminophylline 323Aminosalicylic Acid 59Aminosyn II in Dextrose 25% 336Amiodarone HCl 123,124Amiodarone HCl (Bulk) 220Amitiza 164Amitriptyline HCl 47Amlodipine Besylate 127Amlodipine Besylate-Benazepril HCl 131Ammonium Chloride 331Amoxapine 47Amoxicillin 27Amoxicillin & Pot Clavulanate 27,28Amphetamine-Dextroamphetamine 140,141Amphotec 50Amphotericin B 51Amphotericin B Cholesteryl Sulfate Complex 50Amphotericin B Lipid 50Amphotericin B Liposome 50Ampicillin 28Ampicillin & Sulbactam Sodium 28Ampicillin Sodium 28Ampyra 149

Anadrol-50 179Anagrelide HCl 115Anakinra 204Anastrozole 73Androderm 179,180Androxy 180Anidulafungin 51Anti-Stick Insulin Syringe 220Anti-Thymocyte Globulin (Rabbit), LymphocyteImmune Globulin 207Antipyrine-Benzocaine 315Anzemet 49Apidra 109Apidra SoloStar 109Apixaban 112Apokyn 83Apomorphine Hydrochloride 83Apraclonidine HCl 313,314Aprepitant 50Apriso 211Aptivus 101Aqua Lance Adjustable Lancing 220Aralast 326Aralast NP 325,326Aranesp (Albumin Free) 115,116Arcalyst 208Arcapta Neohaler 321Aredia 212Arestin 150Arformoterol Tartrate 321Arimidex 73Aripiprazole 86,87Armodafinil 329Aromasin 73Arranon 66Arsenic Trioxide 72Artemether-Lumefantrine 80Artificial Tear Insert 311Arzerra 78Asacol 211Asacol HD 211

Ascensia Autodisc Control 220Ascensia Autodisc Controls 220Asenapine Maleate 90Asmanex 120 Metered Doses 316Asmanex 14 Metered Doses 316Asmanex 30 Metered Doses 316Asmanex 60 Metered Doses 316Asmanex 7 Metered Doses 316Asparaginase 68Asparaginase Erwinia Chrysanthemi 69Aspirin-Dipyridamole 118Assure 3 Control 220Assure 4 Control Level 1 & 2 220Assure Comfort Lancets 28G 220Assure Comfort Lancets 30G 220Assure Dose Control 220Assure Dose Norm/High Control 221Assure Haemolance Plus High 221Assure Haemolance Plus Low 221Assure Haemolance Plus Micro 221Assure Haemolance Plus Normal 221Assure Haemolance Plus Ped 221Assure ID Insulin Safety Syr 221Assure Lance Lancets 221Assure Lance Lancets 21G 221Assure Lance Plus Safety 25G 221Assure Lance Plus Safety 30G 221Assure Lancets 221Assure Prism Control Level 1&2 221Assure Pro Control Level 1 & 2 221Astelin 318Astepro 318Atazanavir Sulfate 102Atelvia 212Atenolol 125Atenolol & Chlorthalidone 131Atgam 206Atomoxetine HCl 146,147Atorvastatin Calcium 136Atovaquone 80,222Atovaquone (Bulk) 222

Atovaquone-Proguanil HCl 80Atripla 97Atropine Sulfate 161Atrovent HFA 320Auranofin 208Aurora Healthcare Lancets 222Aurora Lancet Super Thin 30G 222Aurora Lancet Thin 23G 222Aurora Pen Needles 222Aurora Unifine Pentips 222Auto-Lancet 222Auto-Lancet Mini 222Autolet Impression 222Autolet Lancing Device 222Autolet Mini 222Auvi-Q 321Avanafil 169Avandia 105Avastin 78Avelox 31Avelox ABC Pack 31Avodart 167Avonex 149Avonex Pen 149Avonex Prefilled 149Axert 55Axitinib 75Aygestin 193Azacitidine 66,72Azactam in Dextrose 26Azasan 202,203AzaSite 30Azathioprine 202,203Azathioprine Sodium 203Azelaic Acid 154Azelaic Acid (Acne) 152Azelastine HCl 318Azelastine HCl (Ophth) 312Azelex 152Azilect 84,85Azilsartan Medoxomil 120

Azithromycin 30,31Azithromycin (Ophth) 30Azopt 313Aztreonam 27Aztreonam in Dextrose 26Aztreonam Lysine 323

BBacitracin 20Bacitracin (Ophthalmic) 20Bacitracin-Polymyxin-Neomycin HC 154Baclofen 91,92Balsalazide Disodium 211Banzel 38Baraclude 93Basiliximab 208Bayer Breeze 2 Control 222Bayer Contour 223Bayer Contour Next Control 223Bayer Microlet 2 Lancing Devic 223Bayer Microlet Lancets 223BD AutoShield 223BD Insulin Syr Ultrafine II 223BD Insulin Syringe 224BD Insulin Syringe Half-Unit 223BD Insulin Syringe MicroFine 223,224BD Insulin Syringe Ultrafine 224,225BD Integra Insulin Syringe 225BD Integra Syringe 225BD Lancet Device 225BD Lancet Ultrafine 30G 225BD Lancet Ultrafine 33G 225BD Microtainer Lancets 225BD Pen Needle Mini U/F 225BD Pen Needle Nano U/F 226BD Pen Needle Short U/F 226BD Pen Needle Ultrafine 226BD Safety-Lok Insulin Syringe 226BD SafetyGlide Insulin Syringe 226Becaplermin 156Beclomethasone Dipropionate 318

Belatacept 205Benazepril & Hydrochlorothiazide 131,132Benazepril HCl 121Bendamustine HCl 63Benicar 120Benzonatate 326Benzoyl Peroxide 152,154,155,156Benzoyl Peroxide-Erythromycin 152Benztropine Mesylate 81Benzyl Alcohol (Pediculicide) 81Bepotastine Besilate 312Bepreve 312Besifloxacin HCl 31Besivance 31Betaine 160Betamethasone Dipropionate (Topical) 171Betamethasone Dipropionate Augmented 170,171Betamethasone Valerate 170,171Betaseron 149Betaxolol HCl 125Betaxolol HCl (Ophth) 313Bethanechol Chloride 168Bevacizumab 78Bexarotene 79Bexarotene (Topical) 79Bexxar 78Beyaz 181Bicalutamide 63BiCNU 60BiDil 132Biltricide 79Bimatoprost 314Bisoprolol Fumarate 125Bleomycin Sulfate 66Blood GlucoseCalibration216,217,218,219,220,221,222,223,229,232,233,237,240,241,242,243,245,246,247,249,250,251,256,263,266,267,268,272,273,274,276,278,281,282,284,288,290,291,292,293,297,298,299,305,306,308,311Blood Glucose Monitoring Supplies 226,297,298

Boceprevir 97Boniva 212Boostrix 208Bortezomib 72Bosentan 325Bosulif 74Bosutinib 74Botox 327Brentuximab Vedotin 78Breo Ellipta 326Brevicon (28) 181Brilinta 118Brimonidine Tartrate 313Brimonidine Tartrate-Timolol Maleate 314Brintellix 43,44Brinzolamide 313Bromfenac Sodium (Ophth) 312Bromocriptine Mesylate 83Bromocriptine Mesylate (Diabetes) 105Brovana 321Budesonide 211Budesonide (Inhalation) 316,317Budesonide (Nasal) 316,318Budesonide-Formoterol Fumarate Dihydrate 326Bullseye Mini Safety Lancets 226Bullseye Safety Lancets 226Bumetanide 134Buphenyl 159Buprenorphine 6Buprenorphine HCl 17Buprenorphine HCl-Naloxone HCl Dihydrate 17,18Bupropion HCl 42,43Bupropion HCl (Smoking Deterrent) 18Buspirone HCl 103Busulfan 60,62Busulfex 60Butalbital-Acetaminophen-Caffeine 147,148Butalbital-Acetaminophen-Caffeine w/ Codeine 11Butalbital-Aspirin-Caffeine 147Butalbital-Aspirin-Caffeine w/Cod 11,12Butenafine HCl 52

Butoconazole Nitrate (One Dose) 52Butorphanol Tartrate 12Butrans 6Byetta 10 MCG Pen 105Byetta 5 MCG Pen 105Bystolic 125

CCabazitaxel 70Cabergoline 199Cabozantinib S-Malate 75Cafergot 54Calcipotriene 153Calcipotriene-BetamethasoneDipropionate 153,157Calcitonin (Salmon) 212Calcitriol 212Calcitriol (Topical) 153,158Calcium Acetate (Phosphate Binder) 169,170Calcium Chloride (Dihydrate) 331Calcium Gluconate 331Campath 67Campral 17Camptosar 67Canagliflozin 107Canasa 211Cancidas 51Candesartan Cilexetil 120Cantil 161Capastat Sulfate 59Capecitabine 64,65,66Caprelsa 75Capreomycin Sulfate 59Captopril 121Carafate 165Carbaglu 159Carbamazepine 39,40Carbamazepine (Antipsychotic) 104Carbidopa 84Carbidopa-Levodopa 84Carbidopa-Levodopa-Entacapone 81,82,83

Carbinoxamine Maleate 318Carboplatin 67CardioCom Lancing Device 226CareFine Pen Needles 226,227CareOne Advanced Lancing Dev 227CareOne Insulin Syringe 227CareOne Lancet Thin 23G 227CareOne Lancet Ultra Thin 28G 227CareOne UltiGuard Insulin Syr 227,228CareOne Unifine Pentips 228CareOne Unifine Pentips Plus 228,229CareSens Control A 229Carfilzomib 76Carglumic Acid 159Carimune NF 206Carisoprodol 327Carmustine 60Carteolol HCl (Ophth) 314Carvedilol 125Casodex 63Caspofungin Acetate 51Caya 229Cayston 323Cedax 23CeeNU 60Cefaclor 23Cefaclor Monohydrate 23Cefadroxil 23,24Cefazolin Sodium 24Cefdinir 24Cefditoren Pivoxil 24,26Cefepime HCl 24Cefixime 24,26Cefotaxime Sodium 24Cefotetan Disodium 24Cefoxitin Sodium 24,25Cefpodoxime Proxetil 25Cefprozil 25Ceftaroline Fosamil 26Ceftazidime 25,26Ceftibuten 23,25

Ceftin 25Ceftriaxone Sodium 25Cefuroxime Axetil 25Cefuroxime Sodium 25,26Celecoxib 4CellCept Intravenous 203Celontin 35Cenestin 181Cephalexin 26Cerezyme 159Certolizumab Pegol 203Cerubidine 67Cervical Caps 245,278Cesamet 50Cetirizine HCl 318Cetraxal 31Cetuximab 78Cevimeline HCl 150Chantix 18Chantix Continuing Month Pak 18Chantix Starting Month Pak 18Chek-Stix Control 229Chemet 330Chemstrip K 229Chlorambucil 61Chloramphenicol Sodium Succinate 20Chlordiazepoxide HCl-Clidinium Bromide 162Chlorhexidine Gluconate (Mouth-Throat) 150,151Chloroquine Phosphate 80Chlorothiazide 135Chlorpromazine HCl 85Chlorpropamide 105Chlorthalidone 135Chlorzoxazone 327Cholbam 162Cholestyramine 137,138Cholestyramine Light 137,138Cholic Acid 162Choline & Mag Salicylate 4Chorionic Gonadotropin 176,178Cialis 167

Ciclesonide 316Ciclopirox 51Ciclopirox & Vitamin E 51Ciclopirox Olamine 51Cidofovir 92Cilostazol 118Cimetidine 163Cimetidine HCl 163Cimzia 203Cimzia Prefilled 203Cimzia Starter Kit 203Cinacalcet HCl 199Cipro HC 315Cipro in D5W 32Ciprodex 315Ciprofloxacin 32Ciprofloxacin HCl 32Ciprofloxacin HCl (Ophth) 32Ciprofloxacin HCl (Otic) 31,32Ciprofloxacin in D5W 32Ciprofloxacin-Ciprofloxacin HCl 32Ciprofloxacin-Dexamethasone 315Ciprofloxacin-Hydrocortisone 315Cisplatin 67Citalopram Hydrobromide 44Cladribine 65Clarithromycin 30Cleanlet Lancets 28G 229Clemastine Fumarate 318Clever Chek Lancets 229Clever Choice Glucose Control 229Clickfine Pen Needles 229Climara Pro 182Clindamycin HCl 20Clindamycin Palmitate Hydrochloride 20Clindamycin Phosphate 21,229Clindamycin Phosphate (Bulk) 229Clindamycin Phosphate (Topical) 20,21,153Clindamycin Phosphate Vaginal 20Clindamycin Phosphate-Benzoyl Peroxide 153

Clindamycin Phosphate-Benzoyl Peroxide(Refrigerate) 153,155Clindamycin Phosphate-Tretinoin 158,159Clinimix E/Dextrose (5/20) 336Clinimix/Dextrose (2.75/5) 336Clinimix/Dextrose (4.25/10) 336Clinimix/Dextrose (4.25/25) 336Clinimix/Dextrose (4.25/5) 336Clinimix/Dextrose (5/25) 337Clobazam 36,37Clobetasol Propionate 171,172Clobetasol Propionate Emollient Base 171Clocortolone Pivalate 171Cloderm 171Cloderm Pump 171Clofarabine 65Clolar 65Clomipramine HCl 47Clonazepam 104Clonidine HCl 119Clopidogrel Bisulfate 118Closercare 229Clotrimazole 51Clotrimazole (Topical) 51Clotrimazole w/ Betamethasone 153Clozapine 91CoaguChek Lancets 229Coartem 80Cobicistat 100Codeine Sulfate 12Colchicine 54Colchicine w/ Probenecid 54Colcrys 54Colesevelam HCl 139Colestipol HCl 138Collagenase 156Coly-Mycin S 315Combigan 314Cometriq (100 mg Daily Dose) 75Cometriq (140 mg Daily Dose) 75Cometriq (60 mg Daily Dose) 75

Comfort Assist Insulin Syringe 230Comfort Assured Lancets 28G 230Comfort Assured Lancets 33G 230Comfort EZ Insulin Syringe 230,231Comfort EZ Pen Needles 232Comfort Lancets 232Complera 97Conjugated Estrogens-MedroxyprogesteroneAcetate 190,191Control 232Copaxone 149Copper (IUD) 275Cordran 171Cortisone Acetate 172Cortisporin 154,315Cortisporin-TC 315Cosmegen 67Coumadin 112Creon 159Crestor 136Crixivan 101Crizotinib 77Cromolyn Sodium 326Cromolyn Sodium (Ophth) 312Crotamiton 80Cubicin 21Cuprimine 168CVS Insulin Syringe 232CVS Lancets 21G 233CVS Lancets Micro Thin 33G 233CVS Lancets Original 233CVS Lancets Thin 233CVS Lancets Thin 26G 233CVS Lancets Ultra Thin 30G 233CVS Lancing Device 233CVS Ultra Thin Lancets 233Cyclessa 182Cyclobenzaprine HCl 327Cyclophosphamide 60,61Cycloserine 59,60CycloSERINE 59

Cycloset 105Cyclosporine 203Cyclosporine (Ophth) 311Cyclosporine Modified (ForMicroemulsion) 203,204Cyproheptadine HCl 318Cystadane 160Cystagon 168Cysteamine Bitartrate 168Cytarabine 65Cytarabine Liposome 65

DD.H.E. 45 55Dabigatran Etexilate Mesylate 115Dacarbazine 61Daclizumab (Multiple Sclerosis) 150Dacogen 67Dactinomycin 67Dalfampridine 149Dalteparin Sodium 113,114Danazol 180Dantrolene Sodium 91,92Dapsone 59Daptomycin 21Daraprim 80Darbepoetin Alfa 115,116Darifenacin Hydrobromide 166Darunavir Ethanolate 101,102Dasatinib 76Daunorubicin Citrate Liposome 61Daunorubicin HCl 67DaunoXome 61Decitabine 67Deferasirox 330Deferiprone 330Degarelix Acetate 200Delavirdine Mesylate 98Demeclocycline HCl 34Denavir 103Denileukin Diftitox 71

Denosumab 214Depo-Estradiol 182Depo-Medrol 172Depo-Provera 193Depo-SubQ Provera 104 193DepoCyt 65Descovy 98Desipramine HCl 47,48Desloratadine 319Desmopressin Acetate 177,179Desmopressin Acetate Spray 177Desmopressin Acetate Spray Refrigerated 177Desogen 182Desogestrel & EthinylEstradiol 180,182,183,185,190,191Desogestrel-Ethinyl Estradiol(Biphasic) 181,182,185,188,190,192Desogestrel-Ethinyl Estradiol(Triphasic) 181,182,192Desonide 172,174Desoximetasone 172Desoxyn 141Desvenlafaxine Succinate 45Detrol LA 166Dexamethasone 170,172Dexamethasone (Ophth) 313Dexamethasone Intensol 172Dexamethasone Sodium Phosphate 172Dexamethasone Sodium Phosphate (Ophth) 312Dexchlorpheniramine Maleate 319Dexilant 165Dexlansoprazole 165Dexmethylphenidate HCl 143Dextroamphetamine Sulfate 141,142Dextromethorphan HBr-Quinidine Sulfate 147Dextrose 5%/Electrolyte #48 331Dextrose in Lactated Ringers 331Dextrose in Ringers 331Dianeal Low Calcium/1.5% Dex 331Dianeal PD-2/1.5% Dextrose 331Diaphragm Arc-Spring 229,274

Diaphragm Coil Spring 274Diaphragm Flat Spring 275Diaphragm Wide Seal 310Diaphragms 273Diastar Easy Test II Lancets 233Diastar Easy Test Lancets 233Diastat AcuDial 36Diastat Pediatric 36DiaTrue Control Level 1 233DiaTrue Control Level 2 233Diazepam 104Diazepam (Anticonvulsant) 36Diazoxide 109Dibenzyline 119Diclofenac Epolamine 4Diclofenac Potassium 4Diclofenac Sodium 4Diclofenac Sodium (Actinic Keratoses) 154,156Diclofenac Sodium (Ophth) 312Diclofenac Sodium (Topical) 154,158Diclofenac w/ Misoprostol 4Dicloxacillin Sodium 28Dicyclomine HCl 162Didanosine 98,99,100Difenoxin w/ Atropine 162Differin 154Dificid 30Diflorasone Diacetate 170,173Diflunisal 4Difluprednate 312Digoxin 132Dihydroergotamine Mesylate 55Dilantin 39Dilantin Infatabs 39Diltiazem HCl 127,128,129Diltiazem HCl Coated Beads 127,128,129Diltiazem HCl Extended ReleaseBeads 127,129,130Dipentum 211Diphenhydramine HCl 319Diphenoxylate w/ Atropine 162

Dipyridamole 118,119Disopyramide Phosphate 123Disulfiram 17Divalproex Sodium 36Divigel 182Docefrez 67Docetaxel 67,68,72DOCEtaxel 68Dofetilide 124Dolasetron Mesylate 49Donepezil Hydrochloride 41Dornase Alfa 326Dorzolamide HCl 314Dorzolamide HCl-Timolol Maleate 314Doxazosin Mesylate 119,120Doxepin HCl 48Doxepin HCl (Antipruritic) 156,159Doxercalciferol 212,213Doxil 68Doxorubicin HCl 66,68DOXOrubicin HCl 68Doxorubicin HCl Liposomal 68,70Doxycycline (Monohydrate) 33,34Doxycycline Hyclate 34Drisdol 337Dronabinol 50Dronedarone HCl 123Droplet Lancets Ultra Thin 30G 233Droplet Lancing Device 233Drospirenone-EthinylEstradiol 182,183,185,187,188,189,191,192,193Drospirenone-Ethinyl Estradiol-LevomefolateCalcium 181,191Droxia 65Drug Mart Lancets Thin 26G 233Drug Mart Lancets Ultra Thin 233Drug Mart Lancing Device 234Drug Mart On-The-Go Lancet 30G 234Drug Mart Ultra Comfort Syr 234Drug Mart Unifine Pentips 234,235Drug Mart Unifine Pentips Plus 235

Drug Mart Unilet Lancets 28G 235Drug Mart Unilet Lancets 30G 235Duane Reade Lancet Altern Site 235Duane Reade Lancet Super Thin 235Duane Reade Lancet Ultra Thin 235Duane Reade Unifine Pentips 235Duloxetine HCl 148Durezol 312Dutasteride 167Dyphylline 323Dyrenium 134,135Dysport 327Dysport (Glabellar Lines) 327

EE-Z Ject Lancet Micro-Thin 33G 235E-Z Ject Lancet Super Thin 30G 235E-Z Ject Lancets 236E-Z Ject Lancets 21G 235E-Z Ject Lancets Thin 26G 236E.E.S. 400 30E.E.S. Granules 30Easy Comfort Insulin Syringe 236Easy Comfort Lancets 236Easy Comfort Pen Needles 236,237Easy Mini Lancing Device 237Easy Plus Control 237Easy Plus II Control 237Easy Step Control 237Easy Talk Control 237Easy Touch Control High & Low 237Easy Touch HealthPro Control 237Easy Touch Insulin Safety Syr 237,238Easy Touch Insulin Syringe 238,239Easy Touch Lancets 21G 239Easy Touch Lancets 23G 239Easy Touch Lancets 26G 239Easy Touch Lancets 26G/Twist 239Easy Touch Lancets 28G 239Easy Touch Lancets 28G/Twist 239Easy Touch Lancets 30G 239

Easy Touch Lancets 30G/Twist 239Easy Touch Lancets 32G 239Easy Touch Lancets 32G/Twist 239Easy Touch Lancets 33G/Twist 239Easy Touch Lancing Device 240Easy Touch Pen Needles 240Easy Touch Safety Lancets 21G 240Easy Touch Safety Lancets 23G 240Easy Touch Safety Lancets 26G 240Easy Touch Safety Lancets 28G 240Easy Trak Control 240Easy Twist & Cap Lancets 241EasyGluco Control 241EasyMax 15 Level 1 Control 241EasyMax 15 Level 2 Control 241EasyMax Control 241Echothiophate Iodide 314Eclipse Control 241Econazole Nitrate 51Edarbi 120Edecrin 134Edurant 97Efavirenz 98Efavirenz-Emtricitabine-Tenofovir DisoproxilFumarate 97Effient 119Elaprase 160Electrolyte-148 334Electrolyte-48 in Dextrose 331Electrolyte-56 in Dextrose 334Electrolyte-A 334Electrolyte-B in Dextrose 331Electrolyte-M in Dextrose 331,333Electrolyte-MB in Dextrose 331Electrolyte-P in Dextrose 332Electrolyte-R (PH 7.4) 333Electrolyte-S 332Elelyso 160Element Compact Control 2 241Element Compact Control 3 241Element Control 241

Element Plus Control 241Elestrin 183Eletriptan Hydrobromide 56Elidel 154Eligard 199Eliquis 112Elixophyllin 323Ella 193Elmiron 168Eloxatin 68Elspar 68Eltrombopag Olamine 118Elvitegravir-Cobicistat-Emtricitabine-Tenofovir 97Elvitegravir-Cobicistat-Emtricitabine-TenofovirAlafenamide 97Emadine 312Embeda 6,7Embrace Control 241Embrace Evo Control Level 1 242Embrace Evo Control Level 2 242Embrace Lancets Ultra Thin 30G 242Embrace Pro Glucose Control 242Emcyt 64Emedastine Difumarate 312Emend 50Emsam 43Emtricitabine 99Emtricitabine-Rilpivirine-Tenofovir AlafenamideFumarate 98Emtricitabine-Rilpivirine-Tenofovir DisoproxilFumarate 97Emtricitabine-Tenofovir Alafenamide Fumarate 98Emtricitabine-Tenofovir Disoproxil Fumarate 99Emtriva 99Enablex 166Enalapril Maleate 121,122Enalapril Maleate & Hydrochlorothiazide 132Enbrel 203Enbrel SureClick 203Enfuvirtide 100Enjuvia 183

Enoxaparin Sodium 113Entacapone 82Entecavir 93Entereg 162Envision Control 242Enzalutamide 63Epclusa 94Epiduo 154Epinastine HCl (Ophth) 312Epinephrine 321,322,323EPINEPHrine 322Epinephrine HCl 321EpiPen 322EpiPen 2-Pak 322EpiPen Jr 322EpiPen Jr 2-Pak 322Epirubicin HCl 69Epivir 99Epivir HBV 93Eplerenone 135Epoetin Alfa 116,117,118Epogen 116Eprosartan Mesylate 120,121Epzicom 99EQL Color Lancets 21G 242EQL Color Lancets Micro 33G 242EQL Insulin Syringe 242,243EQL Short Pen Needle 243EQL Super Thin Lancets 30G 243EQL Thin Lancets 26G 243EQL Ultra Comfort Insulin Syr 243EQL Ultra Short Pen Needle 243Equetro 104Eraxis 51Erbitux 78Ergocalciferol 337Ergoloid Mesylates 41Ergomar 55Ergotamine Tartrate 55Ergotamine w/ Caffeine 54Eribulin Mesylate 69

Erivedge 75Erlotinib HCl 77Ertaczo 51Ertapenem Sodium 27Erwinaze 69Ery-Tab 30EryPed 200 30EryPed 400 31Erythromycin (Acne Aid) 30,31Erythromycin (Ophth) 31Erythromycin Base 30,31Erythromycin Ethylsuccinate 30,31Escitalopram Oxalate 44Esomeprazole Magnesium 165,166Estazolam 328Esterified Estrogens 187Estrace 183Estraderm 183Estradiol 180,182,183,184,187,188,192Estradiol Acetate Vaginal 184,185Estradiol Cypionate 182Estradiol Vaginal 183Estradiol Valerate 184Estradiol Valerate-Dienogest 188Estradiol-Levonorgestrel 182Estramustine Phosphate Sodium 64Estrasorb 184Estrogel 184Estrogens, Conjugated 190Estrogens, Conjugated Synthetic A 181Estrogens, Conjugated Synthetic B 183Estrogens, Conjugated Vaginal 190Estropipate 184Estrostep Fe 184Eszopiclone 328Etanercept 203Ethacrynic Acid 134Ethambutol HCl 59Ethionamide 60Ethosuximide 35Ethotoin 40

Ethynodiol Diacet & Eth Estrad 185,193Etidronate Disodium 213Etodolac 4Etonogestrel 194,195Etonogestrel-Ethinyl Estradiol 189Etopophos 73Etoposide 73,74Etoposide Phosphate 73Etravirine 97Eurax 80Evamist 184EvenCare Control Low/High 243EvenCare G2 Low/High Control 243EvenCare G3 Low/High Control 243Everolimus 74Everolimus (Immunosuppressant) 206Evista 195Evolution Control 243Exalgo 7Exel Comfort Point Insulin Syr 243,244Exel Comfort Point Pen Needle 244Exelderm 51,52Exemestane 73Exenatide 105Exjade 330Extavia 149Ez Smart Blood Glucose Lancets 244EZ-Lets Lancets 21G 244EZ-Lets Lancets 26G 245EZ-Lets Lancets 28G 245EZ-Lets Lancets 30G 245Ezetimibe 139Ezetimibe-Simvastatin 139Ezogabine 35

FFabrazyme 160Factive 32Famciclovir 103Famotidine 163Famotidine in NaCl 163

Famotidine Premixed 163Fanapt 87,88Fanapt Titration Pack 88Fareston 64Faslodex 64Febuxostat 54Felbamate 38Felodipine 129Femara 73FemCap 245Femcon Fe 184Femring 184,185Fenofibrate 136Fenofibrate Micronized 135Fenoprofen Calcium 4Fentanyl 7Fentanyl Citrate 12Ferriprox 330Ferrous Fumarate-Folic Acid 331Fesoterodine Fumarate 167Fexofenadine HCl 318Fidaxomicin 30Fifty50 Control 2.0 245Fifty50 Lancing Device 245Fifty50 Pen Needles 245Fifty50 Safety Seal Lancets 245Fifty50 Superior Comfort Syr 245Filgrastim 117Finacea 154Finasteride 167Finasteride (Alopecia) 154Fine 30 245Fingerstix Lancets 245Fingolimod HCl 150Firmagon 200Flavoxate HCl 166Flecainide Acetate 123Flector 4Flovent Diskus 317Flovent HFA 317Floxuridine 65

Fluarix 209Fluarix Quadrivalent 209Flucelvax 209Fluconazole 52Flucytosine 52Fludara 69Fludarabine Phosphate 69,70Fludrocortisone Acetate 173Flulaval 209Flulaval Quadrivalent 209Flunisolide (Nasal) 317Fluocinolone Acetonide 173Fluocinolone Acetonide (Otic) 315Fluocinonide 173Fluocinonide Emulsified Base 173Fluorometholone (Ophth) 312,313Fluorouracil 64,65Fluorouracil (Topical) 154Fluoxetine HCl 44Fluoxetine HCl (PMDD) 44,46Fluoxymesterone 180Fluphenazine HCl 85Flurandrenolide 171Flurbiprofen 4,5Flurbiprofen Sodium 312Flutamide 63Fluticasone Furoate-Vilanterol 326Fluticasone Propionate 173,246Fluticasone Propionate HFA 317Fluticasone Propionate (Bulk) 246Fluticasone Propionate (Inhalation) 317Fluticasone Propionate (Nasal) 317Fluticasone Propionate HFA 317Fluticasone-Salmeterol 325Fluvastatin Sodium 136Fluvirin 209Fluvirin Preservative Free 209Fluvoxamine Maleate 44Fluzone 210Fluzone High-Dose 209Fluzone Pediatric PF 209

Fluzone Preservative Free 209,210Fluzone Quadrivalent 210FML 313FML Forte 312Folic Acid 337Folotyn 65Fondaparinux Sodium 113FORA Control 246FORA Lancets 246FORA Lancing Device 246ForaCare GDH Control 246Foradil Aerolizer 322Formoterol Fumarate 322Forteo 213FortisCare Control 246Fosamax Plus D 213Fosamprenavir Calcium 101Foscarnet Sodium 92Foscavir 92Fosfomycin Tromethamine 22Fosinopril Sodium 122Fosinopril Sodium & Hydrochlorothiazide 132Fosphenytoin Sodium 39Fosrenol 169,170Fragmin 113,114Freds Pharmacy Autolet Lancing 246Freds Pharmacy Unifine Pentip+ 246Freds Pharmacy Unifine Pentips 246Freds Pharmacy Unilet Lanc 28G 246Freds Pharmacy Unilet Lanc 30G 247FreeStyle Control Solution 247FreeStyle Lancets 247FreeStyle Precision Ins Syr 247FreeStyle Unistick II Lancets 247Frova 55Frovatriptan Succinate 55Fulvestrant 64Furosemide 134Fuzeon 100

GGabapentin 36Gabapentin Enacarbil 147Galantamine Hydrobromide 41Galsulfase 160Gammagard 207Gammagard S/D 207Gammagard S/D Less IgA 206,207Gammaked 207Gamunex-C 207Ganciclovir Ophthalmic 93Ganciclovir Sodium 92Gatifloxacin (Ophth) 32,33GE100 Control 247Gel-Kam Oral Care Rinse 150Gemcitabine HCl 65,66Gemfibrozil 136Gemifloxacin Mesylate 32Gemzar 66Generess FE 185Genotropin 177Genotropin MiniQuick 177Gentamicin in Saline 19Gentamicin Sulfate 19Gentamicin Sulfate (Ophth) 19Genvoya 97Gilenya 150Glatiramer Acetate 149,150Gleevec 75Glimepiride 105,106Glipizide 106Glipizide-Metformin HCl 106Global Ease Inject Pen Needles 247Global Inject Ease Insulin Syr 248,249Global Inject Ease Lancets 28G 249Global Inject Ease Lancets 30G 249Global Lancing Device 249GlucaGen Diagnostic 109GlucaGen HypoKit 109Glucagon (rDNA) 109

Glucagon Emergency 109Glucagon HCl (rDNA) 109Glucagon HCl rDNA (Diagnostic) 109Glucarpidase 73Glucocard 01 Control 249Glucocard Expression Control 249Glucocard Shine Control 249Glucocard X-Sensor Control 249GlucoCom Control 249GlucoCom Lancets 28G 249GlucoCom Lancets 30G 249GlucoCom Lancets 33G 249GlucoLab Control 249,250Glucolet 2 Automatic Lancing 250GlucoPro Insulin Syringe 250Glucose Blood 226,247,297,299Glucose Control 250Glucosource Lancet Device 251Glucosource Lancets 251Glyburide 106GlyBURIDE 106Glyburide Micronized 106Glyburide-Metformin 106Glycine (GU Irrigant) 168Glycopyrrolate 162Glyset 106,107Gmate Control Level 2 251GNP Clickfine Pen Needles 251GNP Insulin Syringe 251,252GNP Lancets 252GNP Lancets 21G 252GNP Lancets Micro Thin 33G 252GNP Lancets Super Thin 30G 252GNP Lancets Thin 252GNP Lancets Thin 26G 252GNP Micro Thin Lancets 33G 252GNP Super Thin Lancets 30G 252GNP Ultra Com Insulin Syringe 252,253Golimumab 205Golytely 164Goserelin Acetate 202

Granisetron HCl 50Griseofulvin Microsize 52Griseofulvin Ultramicrosize 52Guanabenz Acetate 119Guanfacine HCl 119Guanfacine HCl (ADHD) 143Guanidine HCl 58Gynazole-1 52

HH&H Thinlet Lancets 26G 253H&H Thinlet Lancets 30G 253H-E-B inControl Adv Lancing 253H-E-B inControl Lancets 28G 253H-E-B inControl Lancets 30G 253H-E-B inControl Pen Needles 253,254Haemolance 254Haemolance Low Flow Lancets 254Haemolance Plus 254Haemolance Plus High Flow 254Haemolance Plus Low Flow 254Haemolance Plus Max Flow 254Haemolance Plus Pediatric Flow 254Halaven 69Halcinonide 173Halobetasol Propionate 173Halog 173Haloperidol 85,86Haloperidol Decanoate 85Haloperidol Lactate 85Harvoni 94Health Care Lancing Device 254HealthWise Lancets 30G 254HealthWise Lancing Pen 254HealthWise Mini Pen Needles 254HealthWise Pen Needles 255HealthWise Short Pen Needles 255HealthWise Unifine Pentips 255Healthy Accents Lancing Device 255Healthy Accents Unifine Pentip 255Healthy Accents Unilet Lancets 255

Heparin (Porcine) in NaCl 114Heparin (Porcine) in Sodium Chloride 114Heparin Sod (Porcine) in D5W 114Heparin Sodium (Porcine) 114Hepsera 93Herceptin 78Hexachlorophene 276Hexalen 61Hizentra 207Hizentra 20% 207HM Lancets Micro Thin 33G 255HM Lancets Ultra Thin 30G 255Horizant 147HumaLOG 110HumaLOG KwikPen 109HumaLOG Mix 50/50 109HumaLOG Mix 50/50 KwikPen 109HumaLOG Mix 50/50 Pen 109HumaLOG Mix 75/25 109HumaLOG Mix 75/25 KwikPen 109HumaLOG Mix 75/25 Pen 109HumaLOG Pen 110Humatrope 177Humira 204Humira Pediatric Crohns Start 204Humira Pen 204Humira Pen-Crohns Starter 204Humira Pen-Psoriasis Starter 204HumuLIN 70/30 110HumuLIN 70/30 KwikPen 110HumuLIN 70/30 Pen 110HumuLIN N 110HumuLIN N KwikPen 110HumuLIN N Pen 110HumuLIN R 110HumuLIN R U-500 (CONCENTRATED) 110Hy-Vee Insulin Syringe 255,256Hycamtin 74Hydralazine HCl 139Hydrea 66Hydrochlorothiazide 135

Hydrocodone Bitartrate 10,11Hydrocodone-Acetaminophen 12,13,14,16Hydrocodone-Ibuprofen 14,16Hydrocortisone 174Hydrocortisone (Intrarectal) 211Hydrocortisone (Rectal) 211Hydrocortisone (Topical) 151,154,211Hydrocortisone Acetate (Rectal) 170,173,174,176Hydrocortisone Butyrate 174Hydrocortisone Sod Succinate 170,176Hydrocortisone Valerate 174Hydrocortisone w/Acetic Acid 315Hydromorphone HCl 7,14Hydroxychloroquine Sulfate 80Hydroxyurea 66Hydroxyurea (Sickle Cell Anemia) 65Hydroxyzine HCl 319Hydroxyzine Pamoate 319HyperSal 326

IIbandronate Sodium 212,213Ibuprofen 5Idamycin PFS 69Idarubicin HCl 69Idursulfase 160Ifex 61Ifosfamide 61Ifosfamide & Mesna 61Ilevro 313Iloperidone 87,88Iloprost 325Imatinib Mesylate 75Imiglucerase 159Imipenem-Cilastatin 27Imipramine HCl 48Imipramine Pamoate 48Imiquimod 154Imitrex 55Immune Globulin (Human) IV 206,207

Immune Globulin (Human) IV orSubcutaneous 207Immune Globulin (Human) Subcutaneous 207Implanon 194In Touch Glucose Control 256In Touch Lancing Device 256In Touch Sterile Lancets 30G 256Incivek 94IncobotulinumtoxinA 328Increlex 177Incruse Ellipta 320Indacaterol Maleate 321Indapamide 135Indinavir Sulfate 101Indomethacin 5Infergen 94Infinity Control 256Infliximab 205Influenza Virus Vaccine Split 208,209,210Influenza Virus Vaccine Split High-DosePreservative Free 209Influenza Virus Vaccine Split PreservativeFree 208,209,210Influenza Virus Vaccine Split Quadrivalent 209,210Influenza Virus Vaccine Tissue-CulturedSubunit 209Influenza Virus Vaccine Types A & B PreservativeFree 208,209Influenza Virus Vaccine Types A & B SurfaceAntigen 209Ingenol Mebutate 155Inlyta 75Insulin Aspart 111Insulin Aspart Protamine & Aspart (Human) 111Insulin Detemir 110,111Insulin Glargine 110Insulin Glulisine 109Insulin Isophane & Reg (Human) 110,111,112Insulin Isophane (Human) 110,111,112Insulin Lispro (Human) 109,110Insulin Lispro Protamine & Lispro (Human) 109

Insulin NPH (Human) (Isophane) 111Insulin NPH Isophane & Reg (Human) 110Insulin PenNeedle215,216,218,222,223,225,226,227,228,229,232,234,235,236,237,240,243,244,245,246,247,251,253,254,255,258,260,262,263,264,265,267,268,272,273,275,276,278,279,280,281,282,283,286,290,291,295,296,300,301,302,304,305,307,308,310Insulin Regular (Human) 110,111,112Insulin Syringe 256,257Insulin Syringe/Needle 257,258Insulin Syringe/Needle U-100 217,218,219,220,221,223,224,225,226,227,228,230,231,232,234,236,237,238,239,242,243,244,245,247,248,249,250,251,252,253,255,256,257,258,259,260,261,262,263,264,265,266,269,270,271,272,274,276,277,278,279,280,281,282,283,284,285,286,287,289,290,291,292,293,294,295,296,297,298,299,300,301,302,303,304,306,307,308,309Insulin Syringes (Disposable) 224,259,270Insupen Pen Needles 258Insupen Sensitive 258Insupen Ultrafin 258Intelence 97Interferon Alfa-2B 94Interferon alfacon-1 94Interferon Beta-1a 149,150Interferon Beta-1b 149Interferon Gamma-1B 208Intron A 94Intuniv 143INVanz 27Invega 88Invirase 101Invokana 107Ionosol-B in D5W 331Ionosol-MB in D5W 331Iopidine 314Ipilimumab 78,79

Ipratropium Bromide 320Ipratropium Bromide (Nasal) 320Ipratropium Bromide HFA 320Ipratropium-Albuterol 326Irbesartan 120Irinotecan HCl 67,69Irrigation Solutions, Physiological 334Isentress 97Isocarboxazid 43Isolyte-P in D5W 332Isolyte-S 332Isoniazid 59Isoniazid & Rifampin 59Isoniazid-Rifampin w/ Pyrazinamide 60Isosorbide Dinitrate 139,140Isosorbide Dinitrate-Hydralazine HCl 132Isosorbide Mononitrate 140Isotretinoin 151,153,155,156,158,159Isradipine 129Istodax 69Itraconazole 52,53Ivacaftor 323Ivermectin 79Ivermectin (Pediculicide) 79Ixabepilone 69Ixazomib Citrate 76Ixempra Kit 69

JJadenu 330Jakafi 75,76Januvia 107Jevtana 70

KKaletra 101Kalydeco 323Kanamycin Sulfate 19KCl in Dextrose-NaCl 332KCl-Lactated Ringers-D5W 332Kenalog 174

Kepivance 150Ketek 31KetoCare 258Ketoconazole 52Ketoconazole (Topical) 52Ketoprofen 5Ketorolac Tromethamine 5Ketorolac Tromethamine (Ophth) 313Ketostix 258Kineret 204Kinney Lancets 258Kinney Thin Lancets 258Kinray Insulin Syringe 259Klor-Con M15 333Kmart Valu Insulin Syringe 29G 259Kmart Valu Insulin Syringe 30G 259Kroger Insulin Syringe 259,260Kroger Lancets 21G 260Kroger Lancets Micro Thin 33G 260Kroger Lancets Super Thin 260Kroger Lancets Thin 26G 260Kroger Lancets UltraThin 30G 260Kroger Lancing Device 260Kroger Pen Needles 260Kuvan 160Kyprolis 76

LLabetalol HCl 125Lacosamide 40Lacrisert 311Lactated Ringer's 333Lactated Ringer's (Irrigation) 337Lactic Acid (Ammonium Lactate) 151,154Lactulose 164Lactulose (Encephalopathy) 164Lady Lite Lancets 260Lamivudine 99Lamivudine (HBV) 93Lamivudine-Zidovudine 99Lamotrigine 38

Lancet Device 260Lancet Device with Ejector 261LancetDevices 217,218,219,220,222,223,225,226,227,229,233,234,237,240,245,246,249,250,251,253,254,255,256,260,261,263,265,269,272,273,279,280,282,283,284,286,288,290,292,294,295,297,299,307,308,309Lancets 215,216,217,218,219,220,221,222,223,225,226,227,229,230,232,233,234,235,236,239,240,241,242,243,244,245,246,247,249,251,252,253,254,255,256,258,260,261,263,264,265,266,267,268,269,270,272,273,274,275,276,278,279,280,281,283,284,285,286,287,288,289,290,292,293,294,295,296,297,298,301,302,303,304,305,306,307,308,309Lancets 28G 261Lancets 30G 261Lancets Micro Thin 33G 261Lancets Super Thin 28G 261Lancets Thin 261Lancets Ultra Fine 261Lancets Ultra Thin 261Lancets Ultra Thin 30G 261Lancing Device 261Lanoxin 132Lanreotide Acetate 201Lansoprazole 165,166Lanthanum Carbonate 169,170Lantus 110Lantus SoloStar 110LANZO 261Lapatinib Ditosylate 77Laronidase 159Lastacaft 311Latanoprost 314Latuda 88Leader Advanced Lancing Device 261Leader Insulin Syringe 261,262Leader Unifine Pentips 262Leader Unifine Pentips Plus 263

Ledipasvir-Sofosbuvir 94Leflunomide 208Lenalidomide 63,64Letairis 324Letrozole 73Leucovorin Calcium 70Leukeran 61Leukine 116,117Leuprolide Acetate 199,200Leuprolide Acetate (3 Month) 199,200Leuprolide Acetate (4 Month) 199,200Leuprolide Acetate (6 Month) 199,200Leuprolide Acetate (CPP) 200Leuprolide Acetate (CPP) (3 Month) 200Levalbuterol HCl 322Levalbuterol Tartrate 323Levatol 125Levemir 111Levemir FlexPen 110Levemir FlexTouch 111Levetiracetam 35Levobunolol HCl 314Levocetirizine Dihydrochloride 319Levofloxacin 32Levofloxacin (Ophth) 32Levofloxacin in D5W 32Levonorgestrel & EthEstradiol 180,181,182,184,185,186,187,188,189,190,191Levonorgestrel (Emergency OC) 194,195Levonorgestrel (IUD) 194,195Levonorgestrel-Eth Estradiol(Triphasic) 183,186,188,192Levonorgestrel-Ethinyl Estradiol (91-Day) 180,181,182,185,186,187,191Levonorgestrel-Ethinyl Estradiol(Continuous) 180,186Levorphanol Tartrate 7Levothyroxine Sodium 196,197,198,199Lexiva 101Lialda 211

Liberty Glucose Control 263Liberty Glucose Control Mid 263Liberty Medical Lancets 263Liberty Mini Lancing Device 263Lidocaine 107,155,156Lidocaine HCl 16,17,154Lidocaine HCl (Local Anesth.) 16,17Lidocaine HCl (Mouth-Throat) 17Lidocaine-Prilocaine 17Lidocaine-Tetracaine 157Lidoderm 155Liletta (52 MG) 194Linagliptin 108Lincocin 21Lincomycin HCl 21Lindane 81Linezolid 21,23Linezolid in Sodium Chloride 21Liothyronine Sodium 198Liotrix (T3-T4) 198Liraglutide 108Lisdexamfetamine Dimesylate 142Lisinopril 122Lisinopril & Hydrochlorothiazide 132,133Lite Touch Lancets 263Lite Touch Lancing Device 263Lite Touch Lancing Pen 263Lite Touch Pen Needles 263Litetouch Insulin Syringe 263,264Litetouch Lancets 264Litetouch Pen Needles 264,265Lithium 105Lithium Carbonate 104,105Livalo 136,137Live Better Adv Lancing Device 265Live Better Lancet Super Thin 265Live Better Lancet Ultra Thin 265Live Better Pen Needles 265Lo Loestrin Fe 186Lo/Ovral (28) 186Lodosyn 84

Lodoxamide Tromethamine 312Loestrin 1.5/30 (21) 186Loestrin 1/20 (21) 186Loestrin 24 Fe 186Loestrin Fe 1.5/30 187Loestrin Fe 1/20 187Lomustine 60,61Longs Insulin Syringe 265Longs Lancets Standard 265Longs Lancets Thin 265Longs Lancets Ultra Thin 265Loperamide HCl 162Lopinavir-Ritonavir 101Lorazepam 104Losartan Potassium 120,121Losartan Potassium & Hydrochlorothiazide 133LoSeasonique 187Lotemax 313Loteprednol Etabonate 312,313Lotronex 164Lovastatin 136,137Loxapine Succinate 86Lubiprostone 164Lufyllin 323Lumigan 314Lumizyme 160Lunesta 328Lupron Depot 200Lupron Depot-Ped 200Lurasidone HCl 88Lymphocyte Immune Globulin,Anti-ThymocyteGlobulin (Equine) 206Lyrica 148Lysodren 70

MMafenide Acetate 21,22Magellan Insulin Safety Syr 265,266Magnesium Sulfate 333Major Comfort Lancets 266Malarone 80

Malathion 81Mannitol (GU Irrigant) 169Maprotiline HCl 44Maraviroc 100Marplan 43Matulane 61Maxair Autohaler 322Maxi-Comfort Insulin Syringe 266Maxidex 313Maxima Control 266Mebendazole 79Mecasermin 177Mechlorethamine HCl 62Meclizine HCl 49Meclofenamate Sodium 5Medi-Lance Lancets 266Medic Insulin Syringe 266MediChoice Safety Lancet 266MediChoice Safety Lancet Extra 266MediChoice Safety Lancet Norm 267Medicine Shoppe Lancets 267Medicine Shoppe Lancets Thin 267Medicine Shoppe Pen Needles 267MediSense Glucose Ketone Contr 267Medisense Hi/Mid/Low Control 267Medisense High/Low Control 267Medisense Mid Control 267MediSense Thin Lancets 267Medlance Extra 21G 267Medlance Lite 25G 267Medlance Plus Extra 21G 267Medlance Plus Lancets 267Medlance Plus Lite 25G 268Medlance Plus Special 0.8mm 268Medlance Plus SuperLite 30G 268Medlance Plus Universal 21G 268Medlance Universal 21G 268Medrol 174Medroxyprogesterone Acetate 194Medroxyprogesterone Acetate(Contraceptive) 193,194

Mefenamic Acid 5Mefloquine HCl 80Megace ES 194Megace Oral 194Megestrol Acetate 194Megestrol Acetate (Appetite) 194Meijer Lancets 268Meijer Lancets Thin 268Meijer Lancets Universal 30G 268Meijer Lancets Universal 33G 268Meijer Pen Needles 268Meijer Super Thin Lancets 268Meloxicam 5Melphalan 60Melphalan HCl 62Memantine HCl 41,42Menactra 210Menest 187Meningococcal (A,C,Y&W-135) OligosaccharideConjugate Vac 210Meningococcal (A,C,Y&W-135) PolysaccharideConjugate Vaccine 210Meningococcal Vac A,C,Y&W-135 210Menomune 210Menostar 187Mentax 52Menveo 210Mepenzolate Bromide 161Meperidine HCl 14,15Meprobamate 103,104Mepron 80Mercaptopurine 66Meropenem 27Mesalamine 211Mestinon 58Metaproterenol Sulfate 268,322Metaxalone 327Metformin HCl 107Methadone HCl 8Methadose 8Methadose Sugar-Free 8

Methamphetamine HCl 141,142Methazolamide 314Methenamine Hippurate 21Methimazole 202Methitest 180Methocarbamol 327Methotrexate Sodium 204,205,206Methotrexate Sodium (Antirheumatic) 205Methoxsalen (Photopheresis) 72Methoxsalen (Topical) 155Methoxsalen Rapid 155Methscopolamine Bromide 162Methsuximide 35Methyclothiazide 135Methyldopa 119Methyldopate HCl 119Methylnaltrexone Bromide 162Methylphenidate HCl 144,145,146Methylphenidate HCl ER 145Methylprednisolone 174,175Methylprednisolone Acetate 172,174Methylprednisolone Sod Succ 170,174,176Methyltestosterone 180Metipranolol 314Metoclopramide HCl 49Metolazone 135Metoprolol Succinate 125,126Metoprolol Tartrate 126Metronidazole 22Metronidazole (Topical) 22,23Metronidazole Vaginal 22,23Mexiletine HCl 123Micafungin Sodium 52Micardis 121Miconazole 3 52Miconazole Nitrate Vaginal 52Microdot Control 268Microdot Control High/Low 268Microlet Lancets 268Microtainer Safety Flow Lancet 269Midodrine HCl 119

Miglitol 106,107Miglustat 161Migranal 55Millipred 175Millipred DP 175Millipred DP 12-Day 175Milnacipran HCl 148,149Minastrin 24 Fe 187Mini Lancing Device 269Minivelle 187,188Minocycline HCl 34Minocycline HCl (Subgingival) 150Minoxidil 139Mirabegron 166Mircette 188Mirena 194Mirtazapine 42Misoprostol 165Mitomycin 70Mitotane 70Mitoxantrone HCl 70Mobic 5Modafinil 329Modicon (28) 188Moexipril HCl 122Mometasone Furoate 175Mometasone Furoate (Inhalation) 316Mometasone Furoate (Nasal) 317Monoject Insulin Syringe 269,270Monoject Ultra Comfort Syringe 270Monoket 140Monolet Lancets 270Monolet OPD Lancets 270Monolettor Safety Lancets 270Montelukast Sodium 320Monurol 22Moore Mono Insulin Syringe 271Morphine Sulfate 8,9,11,12,15Morphine-Naltrexone 6,7Motofen 162MoviPrep 164

Moxifloxacin HCl 31,32Moxifloxacin HCl in Sodium Chloride 31Mozobil 117MS Insulin Syringe 271,272Multaq 123Mupirocin 22Mupirocin Calcium (Topical) 22Mustargen 62Mycamine 52Mycobutin 59Mycophenolate Mofetil 205Mycophenolate Mofetil HCl 203Mycophenolate Sodium 205Myfortic 205MyGlucoHealth Control 272MyGlucoHealth Lancets 30G 272Myleran 62Myozyme 160Myrbetriq 166Mytelase 58

NNabilone 50Nabumetone 5Nadolol 126Nafarelin Acetate 202Nafcillin Sodium 28Naftifine HCl 53Naftin 53Naglazyme 160Nalbuphine HCl 15Naloxone HCl 18Naltrexone HCl 17Namenda 42Namenda Titration Pak 42Naproxen 5,6Naproxen Sodium 5Naratriptan HCl 55,56Nasonex 317Natacyn 53Natalizumab 150

Natamycin 53Natazia 188Nateglinide 107Natroba 81Navelbine 70Nebivolol HCl 125Nebupent 80Nebusal 326Necon 1/50 (28) 188Necon 10/11 (28) 188Nedocromil Sodium (Ophth) 312Nefazodone HCl 45Nelarabine 66Nelfinavir Mesylate 102Neomycin Sulfate 19Neomycin-Bacitracin Zn-Polymyxin 311Neomycin-Colistin-HC-Thonzonium 315Neomycin-Polymy-Dexameth 311Neomycin-Polymyxin-HC 154Neomycin-Polymyxin-HC (Ophth) 311Neomycin-Polymyxin-HC (Otic) 315Nepafenac 313NetGroup Lancets 272Neulasta 117Neulasta Onpro 117Neupogen 117Neupro 83Neutek 2Tek Control 272Nevanac 313Nevirapine 97,98NexAVAR 76NexIUM 166Nexplanon 195Niacin (Antihyperlipidemic) 138Niacin-Lovastatin 137Niacin-Simvastatin 138Niaspan 138Nicardipine HCl 129Nicotine 18Nicotrol 18Nicotrol NS 18

Nifedipine 127,129,130Nilandron 63Nilotinib HCl 77Nilutamide 63Nimodipine 130Ninlaro 76Nipent 66Nisoldipine 130Nitazoxanide 79Nitisinone 160Nitro-Bid 140Nitrofurantoin 22Nitrofurantoin Macrocrystal 22Nitrofurantoin Monohyd Macro 22Nitroglycerin 140Nitroglycerin (Intra-Anal) 156Nitrostat 140Nizatidine 163Nor-QD 195Nordette (28) 188Norditropin 178Norditropin FlexPro 177Norditropin NordiFlex Pen 178Norelgestromin-Ethinyl Estradiol 189,193Norethin Acet & Estrad-Fe 181,185,186,187,188,191Norethindrone & EthEstradiol 180,181,182,185,188,189,190,193Norethindrone & Ethinyl Estradiol-Fe 184,185,186,188,193Norethindrone & Mestranol 188,189Norethindrone (Contraceptive) 193,194,195Norethindrone Acet & Eth Estra 185,186,187,189Norethindrone Acetate 193,195Norethindrone Acetate-Ethinyl Estradiol-Fe 184,191,192Norethindrone Acetate-Ethinyl Estradiol-Fe Fum(Biphasic) 186Norethindrone-Eth Estradiol (Biphasic) 188Norethindrone-Eth Estradiol(Triphasic) 180,181,182,186,188,189,190,192

Norfloxacin 32Norgestimate-EthinylEstradiol 183,188,189,190,191Norgestimate-Ethinyl Estradiol(Triphasic) 189,191,192Norgestrel & EthinylEstradiol 182,183,186,187,189Norinyl 1+35 (28) 189Norinyl 1+50 (28) 189Normosol-M in D5W 333Normosol-R pH 7.4 333Noroxin 32Nortriptyline HCl 48Norvir 101Nova Max Plus Glu/Ket Control 272Nova Safety Lancets 23G 272Nova Safety Lancets 28G 272Nova Sureflex Lancets 272Nova Sureflex Lancing Device 272NovoFine 272NovoFine Autocover 272NovoFine Plus 272NovoLIN 70/30 111NovoLIN 70/30 ReliOn 111NovoLIN N 111NovoLIN N ReliOn 111NovoLIN R 111NovoLIN R ReliOn 111NovoLOG 111NovoLOG FlexPen 111NovoLOG Mix 70/30 111NovoLOG Mix 70/30 FlexPen 111NovoLOG PenFill 111NovoTwist 272,273Noxafil 53Nplate 117Nucynta 15Nucynta ER 9Nuedexta 147Nulojix 205Nutropin 178

Nutropin AQ 178Nutropin AQ NuSpin 10 178Nutropin AQ Pen 178NuvaRing 189Nuvigil 329Nystatin 53Nystatin (Mouth-Throat) 53Nystatin (Topical) 53,273Nystatin-Triamcinolone 53

OOctreotide Acetate 200,201Odefsey 98Ofatumumab 78Ofloxacin 33Ofloxacin (Ophth) 33Ofloxacin (Otic) 33Oforta 70Ogestrel 189Olanzapine 88,89Oleptro 45Olmesartan Medoxomil 120Olopatadine HCl 312Olopatadine HCl (Nasal) 319Olsalazine Sodium 211Omacetaxine Mepesuccinate 72Omalizumab 327Omega-3-acid Ethyl Esters 138Omeprazole 166Omeprazole-Sodium Bicarbonate 166Omniflex Diaphragm 273Omnitrope 178Omontys 117On Call Express Glucose Contr 273On Call Lancets 273On Call Lancing Device 273On Call Plus Glucose Control 273On Call Plus Lancets 273On Call Plus Lancing Device 273On Call Vivid Glucose Control 273OnabotulinumtoxinA 327

Oncaspar 71Ondansetron 50Ondansetron HCl 50OneTouch Delica Lancets 33G 273OneTouch Delica Lancets Fine 273OneTouch Delica Lancing Dev 273OneTouch FinePoint Lancets 273OneTouch Lancets 273OneTouch Ultra Control 274OneTouch UltraSoft Lancets 274OneTouch Verio 274Onfi 36,37Onglyza 107Ontak 71OptumRx Glucose Control 274Orap 86Orapred ODT 175Orbivan 147Orencia 205Orfadin 160Orphenadrine Citrate 328Orsini Insulin Syringe 274Ortho Diaphragm All-Flex 274Ortho Diaphragm Coil 274Ortho Diaphragm Flat 275Ortho Evra 189Ortho Micronor 195Ortho Tri-Cyclen (28) 189Ortho Tri-Cyclen Lo 189Ortho-Cept (28) 190Ortho-Cyclen (28) 190Ortho-Novum 1/35 (28) 190Ortho-Novum 7/7/7 (28) 190Oseltamivir Phosphate 102OsmoPrep 165Ovcon-35 (28) 190Oxacillin Sodium 28Oxaliplatin 68,71Oxandrolone 179Oxaprozin 6Oxcarbazepine 39

Oxiconazole Nitrate 53Oxistat 53Oxsoralen 155Oxsoralen Ultra 155Oxybutynin Chloride 166,167Oxycodone HCl 9,10,15Oxycodone w/ Acetaminophen 12,15,16Oxycodone-Ibuprofen 16OxyCONTIN 9,10Oxymetholone 179Oxymorphone HCl 10,16

PPaclitaxel 71Paclitaxel Protein-Bound Particles 66Palifermin 150Paliperidone 88Palonosetron HCl 49Pamidronate Disodium 212,213Pancreaze 160Pancrelipase (Lipase-Protease-Amylase) 159,160,161Panitumumab 78Panretin 79Pantoprazole Sodium 166Paragard Intrauterine Copper 275Parenteral Electrolytes 333,336Paricalcitol 213,214Paromomycin Sulfate 19Paroxetine HCl 45Paser 59Pataday 312Patanol 312Paxil 45Pazopanib HCl 77PC Lancets Super Thin 30G 275PC Unifine Pentips 275PEG 3350-KCl-NaCl-Na Sulfate-Na Ascorbate-Ascorbic Acid 164PEG 3350-KCl-Sod Bicarb-Sod Chloride-SodSulfate 164,165

Peg-Intron 94Peg-Intron Redipen 95Peg-Intron Redipen Pak 4 95Pegademase Bovine 159Peganone 40Pegaspargase 71Pegasys 95,96Pegasys ProClick 95,96Pegfilgrastim 117Peginesatide Acetate 117Peginterferon alfa-2a 95,96Peginterferon alfa-2b 94,95,96Peginterferon alfa-2b (Antineoplastic) 71,72PegIntron 96Pegvisomant 201,202Pemetrexed Disodium 64Pen Needles 276Pen Needles 3/16" 275Pen Needles 5/16" 276Penbutolol Sulfate 125Penciclovir 103Penicillamine 168Penicillin G Pot in Dextrose 28,29Penicillin G Potassium 29Penicillin G Procaine 29Penicillin G Sodium 29Penicillin V Potassium 29Pentam 80Pentamidine Isethionate 80Pentasa 211Pentazocine Lactate 16Pentazocine w/ Naloxone 16PenTips 276Pentosan Polysulfate Sodium 168Pentostatin 66Pentoxifylline 133Perfect Lancets 28G 276Perfect Lancets 30G 276Perindopril Erbumine 122Peritoneal Dialysis Solutions 331,336Perjeta 78

Permethrin 80,81Perphenazine 49Perphenazine-Amitriptyline 43Pertuzumab 78Pharmacist Choice Lancets 276Pharmacy Counter Lancets 276Phenazopyridine HCl 169Phenelzine Sulfate 43Phenobarbital 37Phenoxybenzamine HCl 119,120Phenytek 40Phenytoin 39,40Phenytoin Sodium 40Phenytoin Sodium Extended 39,40Phisohex 276Phoslyra 170Phospholine Iodide 314Photofrin 71Picato 155Pilocarpine HCl 314Pilocarpine HCl (Oral) 151Pimecrolimus 154Pimozide 86Pindolol 126Pioglitazone HCl 107Pioglitazone HCl-Metformin HCl 105,108Piperacillin Sodium-Tazobactam Sodium 29Pirbuterol Acetate 322Piroxicam 6Pitavastatin Calcium 136,137Plan B 195Plan B One-Step 195Plasma-Lyte 148 334Plasma-Lyte A 334Plasma-Lyte-56 in D5W 334Plerixafor 117Pneumococcal 13-Valent Conjugate Vaccine 210Pneumococcal Vac Polyvalent 210Pneumovax 23 210PocketChem EZ Control 276Podofilox 155

Polymyxin B Sulfate 22Polymyxin B-Trimethoprim 311Porfimer Sodium 71Posaconazole 53Potassium Acetate 334Potassium Bicarb & Chloride 331,334Potassium Bicarbonate 331,332,333,334Potassium Chloride 331,332,333,334,335Potassium Chloride ER 334Potassium Chloride in D5W Lactated Ringers 332Potassium Chloride in Dextrose 334Potassium Chloride in Dextrose & SodiumChloride 332Potassium Chloride in NaCl 334Potassium Chloride Microencapsulated CrystalsCR 332,333,334Potassium Citrate (Alkalinizer) 169Potassium Phosphates 335Potiga 35Pradaxa 115Pralatrexate 65Pramipexole Dihydrochloride 83Pramlintide Acetate 108PrandiMet 108Prandin 108Prasugrel HCl 119Pravastatin Sodium 137Praziquantel 79Prazosin HCl 120Precision Glucose Ketone Contr 276Precision Sure-Dose Syringe 276,277Precision SureDose Plus Syr 277Pred Mild 313Prednicarbate 175Prednisolone 175,176Prednisolone Acetate (Ophth) 313Prednisolone Sodium Phosphate 170,175,176PrednisoLONE Sodium Phosphate 175,313Prednisolone Sodium Phosphate (Ophth) 313Prednisone 172,176Preferred Plus Insulin Syringe 277,278

Preferred Plus Lancets Colored 278Preferred Plus Lancets Thin 278Preferred Plus Unifine Pentips 278Pregabalin 148Premarin 190Premphase 190Prempro 191Prentif Fitting Set 278Prepopik 165Prestige Glucose Control 278Prevnar 13 210Prezista 101,102Priftin 59Primaquine Phosphate 80Primidone 37Pristiq 45ProAir HFA 322Probenecid 54Procainamide HCl 124Procarbazine HCl 61Prochlorperazine 48,49Prochlorperazine Maleate 49Procrit 117,118Prodigy Control Solution 278Prodigy Insulin Syringe 278,279Prodigy Lancets 21G 279Prodigy Lancets 26G 279Prodigy Lancets 28G 279Prodigy Lancing Device 279Prodigy Mini Pen Needles 279Prodigy Safety Lancets 26G 279Prodigy Short Pen Needles 279Prodigy Twist Top Lancets 28G 279Progesterone Micronized 195Proglycem 109Prograf 205Prolastin 326Prolastin-C 326Proleukin 71Prolia 214Promacta 118

Promethazine HCl 319,320Propafenone HCl 124Proparacaine HCl 311Propranolol HCl 126Propylthiouracil 202Protriptyline HCl 48Proventil HFA 322Prudoxin 156Pulmicort 317Pulmicort Flexhaler 317Pulmozyme 326Purinethol 66PX Advanced Lancing Device 279PX Extra Short Pen Needles 279PX Insulin Syringe 279,280PX Lancet Auto Injector 280PX Lancets 280PX Lancets Ultra Thin 280PX Mini Pen Needles 280PX Pen Needle 280Pyrazinamide 59Pyridostigmine Bromide 58,59Pyrimethamine 80

QQC Advanced Lancing Device 280QC Insulin Syringe 280,281QC Lancets Super Thin 30G 281QC Lancets Ultra Thin 281QC Pen Needles 281QC Unifine Pentips 281Quetiapine Fumarate 89,90,91QuickTek Control Solution 281Quinapril HCl 122,123Quinidine Sulfate 124Quinine Sulfate 80Quintet Control High/Normal 281Qvar 318

RRA E-Zject Color Lancets 33G 281

RA E-Zject Lancets 28G 281RA E-Zject Lancets Thin 26G 281RA E-Zject Lancets Thin 28G 281RA E-Zject Lancets Ultra Thin 281RA Insulin Syringe 281,282RA Lancing Device 282RA Pen Needles 282Rabeprazole Sodium 166Raloxifene HCl 195Raltegravir Potassium 97Ramelteon 329Ramipril 123Ranexa 133Ranitidine HCl 163,164Ranolazine 133Rapaflo 167,168Rapamune 205Rasagiline Mesylate 84,85Rebetol 96Rebif 150Rebif Rebidose 150Rebif Rebidose Titration Pack 150Rebif Titration Pack 150Reclast 214Rectiv 156RefuAH Plus Glucose Control 282Regorafenib 76Regranex 156Relenza Diskhaler 102Reli-On Insulin Syringe 282ReliOn 70/30 112ReliOn Insulin Syringe 282,283ReliOn Lancets Micro-Thin 33G 283ReliOn Lancets Standard 21G 283ReliOn Lancets Thin 26G 283ReliOn Lancets Ultra-Thin 30G 283ReliOn Lancing Device 283ReliOn Mini Pen Needles 283ReliOn N 112ReliOn Pen Needles 283ReliOn R 112

ReliOn Short Pen Needles 283ReliOn Ultra Thin Lancets 30G 284ReliOn Ultra Thin Plus Lancets 284Relistor 162Relpax 56Remicade 205Remodulin 324Renagel 170Renew Adv Cartridge Refills 284Renew Advanced Lancing Device 284ReoPro 119Repaglinide 108Repaglinide-Metformin HCl 108Rescriptor 98Resectisol 169Restasis 311Retapamulin 20Retrovir 99Revatio 324Revlimid 63,64Rexall Lancets Ultra Thin 30G 284Reyataz 102Rheumatrex 205Rhinocort Aqua 318Ribavirin (Hepatitis C) 94,96Ridaura 208Rifabutin 59Rifamate 59Rifampin 59,60Rifapentine 59Rifater 60Rifaximin 23Rightest GC300 Control 284Rightest GD500 Lancing Device 284Rightest GL300 Lancets 284Rilonacept 208Rilpivirine HCl 97Rilutek 147Riluzole 147Rimantadine Hydrochloride 102Rimexolone 313

Ringer's 335Ringer's Irrigation 335,336Risedronate Sodium 212,214RisperDAL Consta 89Risperidone 89,90Risperidone Microspheres 89Ritonavir 101Rituxan 78Rituximab 78Rivaroxaban 115Rivastigmine Tartrate 41Rizatriptan Benzoate 56Romidepsin 69Romiplostim 117Ropinirole Hydrochloride 83,84Rosiglitazone Maleate 105Rosuvastatin Calcium 136Rotigotine 83Rozerem 329Rufinamide 38Ruxolitinib Phosphate 75,76

SSabril 37Sacrosidase 161SafeSnap Insulin Syringe 284Safety Lancet 21G/Pressure Act 284Safety Lancet 28G/Pressure Act 285Safety Lancet 2MM 285Safety Lancets 285Safety Lancets 21G 285Safety Lancets 28G 285Safety Let Lancets 285Safety Seal Lancets 285Safety-Glide Syringe 285Safyral 191Saizen 179Saizen Click.Easy 178Salmeterol Xinafoate 322Salsalate 6Samsca 330

SandoSTATIN 201Santyl 156Saphris 90Sapropterin Dihydrochloride 160SAPScare Twist Top Lancets 285Saquinavir Mesylate 101Sargramostim 116,117Savella 148,149Savella Titration Pack 149Saxagliptin HCl 107SB Insulin Syringe 285SB Lancets Thin 285SB Lancets Ultra Thin 286Schnucks Insulin Syringe 286Scopolamine 49Seasonale 191Seasonique 191Selegiline 43Selegiline HCl 85Selenium Sulfide 156Selzentry 100Sensipar 199Serevent Diskus 322Seromycin 60SEROquel XR 90,91Serostim 179Sertaconazole Nitrate 51Sertraline HCl 46Sevelamer HCl 170Shopko Autolet Lancing Device 286Shopko On-the-Go Lancets 30G 286Shopko Unifine Pentips 286Shopko Unilet Lancets 28G 286Shopko Unilet Lancets 30G 286Sildenafil Citrate (Pulmonary Hypertension) 324Silodosin 167,168Silver Sulfadiazine 33Simcor 138Simple Diagnostics Lancing Dev 286Simponi 205Simulect 208

Simvastatin 137Sinecatechins 158Sirolimus 205,206Sitagliptin Phosphate 107Skelid 214Sklice 79Skyla 195SM Insulin Syringe 286,287SM Lancets 21G 287SM Lancets 33G 287SM Super Thin Lancets 30G 287SM Thin Lancets 26G 288Smart Diabetes Vantage Lancets 288Smart Diabetes Vantage Lancing 288Smart Sense Color Lancets 33G 288Smart Sense Standard Lancets 288Smart Sense Super Thin Lancets 288Smart Sense Thin Lancets 26G 288Smartest Control Medium 288Smartest Lancets 28G 288Sodium Acetate 335Sodium Chloride 335,336Sodium Chloride (GU Irrigant) 168,169Sodium Chloride (Inhalant) 326Sodium Citrate & Citric Acid 168,169Sodium Oxybate 329Sodium Phenylbutyrate 159,161Sodium Phosphate 336Sodium Phosphate Monobasic-Sodium PhosphateDibasic 165Sodium Phosphate Monobasic-Sodium PhosphateDibasic-MCC 165Sodium Picosulfate-Magnesium Oxide-AnhydrousCitric Acid 165Sodium Polystyrene Sulfonate 330Sodium Polystyrene Sulfonate (Bulk) 288Sodium Sulfate-Potassium Sulfate-MagnesiumSulfate 165Sofosbuvir 96Sofosbuvir-Velpatasvir 94Solaraze 156

Solartek Glucose Control 288Solifenacin Succinate 167Soltamox 64Solu-CORTEF 176Solu-MEDROL 176Solus V2 Control 288Solus V2 Lancets 28G 288Solus V2 Lancing Device 288Solus V2 Twist Lancets 30G 288Somatropin 177,178,179Somatropin (Non-Refrigerated) 178,179Somatuline Depot 201Somavert 201,202Sorafenib Tosylate 76Sorbitol 169Sorbitol Irrigation 169Sorbitol-Mannitol 169Soriatane 156Sotalol HCl 124Sovaldi 96Spectracef 26Spinosad 81Spiriva HandiHaler 321Spiriva Respimat 321Spironolactone 135Spironolactone & Hydrochlorothiazide 133Sporanox 53Sprycel 76Stalevo 100 82Stalevo 125 82Stalevo 150 82Stalevo 200 82Stalevo 50 82Stalevo 75 83Stannous Fluoride 150,151Stannous Fluoride (Bulk) 288Stavudine 99Stelara 156,157Stendra 169SteriLance TL 288Stimate 179

Stivarga 76Strattera 146,147Streptomycin Sulfate 19Streptozocin 63Stribild 97Stromectol 79Suboxone 18Succimer 330Sucraid 161Sucralfate 165Sulconazole Nitrate 51,52Sulfacetamide Sodium (Acne) 157Sulfacetamide Sodium (Ophth) 33Sulfacetamide Sodium w/Sulfur 151,152,153,156,157,158Sulfadiazine 33Sulfamethoxazole-Trimethoprim 33Sulfamylon 22Sulfasalazine 212Sulindac 6Sumatriptan 55,56Sumatriptan Succinate 57Sunitinib Malate 77Super Thin Lancets 289Suprax 26Suprep Bowel Prep 165Sure Comfort Insulin Syringe 289,290Sure Comfort Lancets 28G 290Sure Comfort Lancets 30G 290Sure Comfort Lancing Pen 290Sure Comfort Pen Needles 290Sure Edge Glucose Control 290,291Sure-Fine Pen Needles 291Sure-Ject Insulin Syringe 291,292Sure-Lance Flat Lancets 292Sure-Lance Lancets 26G 292Sure-Lance Thin Lancets 28G 292Sure-Lance Ultra Thin Lancets 292Sure-Pen 292Sure-Test EasyPlus Control 292Sure-Touch Lancets Universal 292

SureChek Control Solution 292Surelite Lancets 292SureStep Glucose Control 292SureStep Pro Low Glucose 292SureStep Pro Normal Glucose 293Sustiva 98Sutent 77Sylatron 71,72Symbicort 326SymlinPen 120 108SymlinPen 60 108Synarel 202Synera 157Synribo 72Syprine 330

TTabloid 66Taclonex 157Tacrolimus 204,205,206Tacrolimus (Topical) 157Tadalafil 167Tadalafil (Pulmonary Hypertension) 324Tafluprost 315Tai Doc Control 293Taliglucerase Alfa 160Talwin 16Tamiflu 102Tamoxifen Citrate 64Tamsulosin HCl 168Tapentadol HCl 9,15Tarceva 77Targretin 79Tasigna 77Tasmar 83Taxotere 72Tazarotene 157,158Tazorac 157,158TechLite AST Lancets 293TechLite Lancets 293TechLite Lancets 30G 293

Teflaro 26TEGretol 40Tekturna 133Telaprevir 94Telavancin HCl 23Telbivudine 94Telcare Glucose Control 293Telithromycin 31Telmisartan 121Temodar 62Temozolomide 62,63Temsirolimus 77Teniposide 72,73Tenofovir Disoproxil Fumarate 100Terazosin HCl 168Terbinafine HCl 54Terbutaline Sulfate 323Terconazole Vaginal 54Teriparatide (Recombinant) 213Terumo Insulin Syringe 293,294Terumo SurGuard Insulin Syr 294Testosterone 179,180Testosterone Cypionate 180Testosterone Enanthate 180Tetanus Toxoid-Diphtheria-Acellular PertussisAdsorb (Tdap) 208Tetrabenazine 147,148Tetracycline HCl 34Tetrahydrozoline HCl 327Tev-Tropin 179Teveten 121TGT Advanced Lancing Device 294TGT Lancet Alternate Site 294TGT Lancet Micro Thin 33G 294TGT Lancet Super Thin 30G 294TGT Lancet Thin 23G 294TGT Lancet Thin 26G 294TGT Lancet Ultra Thin 28G 294TGT Lancet Ultra Thin 30G 294TGT Lancing Device 295Thalidomide 64

Thalomid 64Theophylline 323,324Thinpro Insulin Syringe 295Thioguanine 66Thioridazine HCl 86Thiotepa 72Thiothixene 86Thymoglobulin 207Thyrolar-1 198Thyrolar-1/2 198Thyrolar-1/4 198Thyrolar-2 198Thyrolar-3 198Tiagabine HCl 37Ticagrelor 118Ticarcillin & Pot Clavulanate 29Ticlopidine HCl 119Tigecycline 22Tikosyn 124Tiludronate Disodium 214Timentin 29Timolol Maleate 126,127Timolol Maleate (Ophth) 314Tiotropium Bromide Monohydrate 321Tipranavir 101Tizanidine HCl 92Tobi 323TobraDex 19Tobramycin 323Tobramycin (Ophth) 20Tobramycin Sulfate 20Tobramycin Sulfate in Saline 20Tobramycin-Dexamethasone 19,311Tocilizumab 207,208Todays Health Lancing Device 295Todays Health Mini Pen Needles 295Todays Health Pen Needles 295Todays Health Short Pen Needle 295Todays Health Thin Lancets 28G 295Todays Health Thin Lancets 30G 296Tofacitinib Citrate 206

Tolazamide 108Tolbutamide 108Tolcapone 83Tolmetin Sodium 6Tolterodine Tartrate 166,167Tolvaptan 330TopCare Clickfine Pen Needles 296TopCare Ultra Comfort Ins Syr 296Topiramate 38Topotecan HCl 74Toremifene Citrate 64Torisel 77Torsemide 134Tositumomab 78Toviaz 167Tracleer 325Tradjenta 108Tramadol HCl 10,16Tramadol-Acetaminophen 16Trandolapril 123Tranexamic Acid 118Transderm-Scop 49Tranylcypromine Sulfate 43Trastuzumab 78Travatan Z 314Travel Lancets 297Travoprost 314Trazodone HCl 45,46Treanda 63Trecator 60Trelstar 202Trelstar Depot Mixject 202Trelstar LA Mixject 202Trelstar Mixject 202Treprostinil Sodium 324Tretinoin 152,158Tretinoin (Chemotherapy) 79Tretinoin Microsphere 158Trexall 206Tri-Norinyl (28) 192Triamcinolone Acetonide 174

Triamcinolone Acetonide (Mouth) 175,176Triamcinolone Acetonide (Topical) 176Triamterene 134,135Triamterene & Hydrochlorothiazide 133Triazolam 328Trientine HCl 330Trifluoperazine HCl 86Trifluridine 103Trihexyphenidyl HCl 81Trimethobenzamide HCl 49Trimethoprim 22Trimipramine Maleate 48Triptorelin Pamoate 202Trisenox 72Triumeq 100Trizivir 99Tropicamide 311Trospium Chloride 167True Metrix Air 297True Metrix Air Glucose Meter 297True Metrix Blood Glucose Test 297True Metrix Level 1 297True Metrix Level 2 297True Metrix Meter 297TrueControl Glucose Cont Lev 0 297TrueControl Glucose Cont Lev 1 297TRUEdraw Lancing Device 297TRUEplus Insulin Syringe 297,298TRUEplus Lancets 26G 298TRUEplus Lancets 28G 298TRUEplus Lancets 30G 298TRUEplus Lancets 33G 298TRUEplus Safety Lancets 28G 298TRUEresult Blood Glucose 298TRUEtest Control Level 1 298TRUEtest Control Level 2 299TRUEtest Control Level 3 299TRUEtest Test 299TrueTrack Glucose Control 299TrueTrack Test 299Truvada 99

Twinject 323Tybost 100Tygacil 22Tykerb 77Tysabri 150Tyzeka 94Tyzine 327

UUlesfia 81Ulipristal Acetate 193Uloric 54Ulti-Lance Auto-Adjust Device 299Ulti-Lance Automatic 299Ulti-Lance Mini Adjustable 299UltiCare Insulin Safety Syr 299UltiCare Insulin Syringe 299,300UltiCare Micro Pen Needles 300UltiCare Mini Pen Needles 301UltiCare Pen Needles 301UltiCare Short Pen Needles 301UltiCare Thin Lancets 30G 301Ultilet Basic Lancets 30G 301Ultilet Classic Lancets 301Ultilet Insulin Syringe 301Ultilet Insulin Syringe Short 301,302Ultilet Lancets 302Ultilet Pen Needle 302Ultilet Safety Lancets 23G 302Ultra Comfort Insulin Syringe 302Ultra Thin Lancets 28G 303Ultra Thin Lancets 30G 303Ultra-Comfort Insulin Syringe 303Ultra-Thin II Auto Lancet 304Ultra-Thin II Ins Syr Short 304Ultra-Thin II Insulin Syringe 304Ultra-Thin II Lancets 304Ultra-Thin II Mini Pen Needle 304Ultra-Thin II Pen Needle Short 304Ultra-Thin II Pen Needles 305UltraBag/Dianeal PD-2/1.5% Dex 336

UltraBag/Dianeal/1.5% Dextrose 336UltraTRAK PRO Control 305UltraTRAK Ultimate Control 305Umeclidinium Bromide 320Unifine Pentips 305Unifine Pentips Plus 305Unilet ComforTouch Lancet 305Unilet ExceLite 306Unilet ExceLite II 305Unilet G.P. Lancet 306Unilet G.P. Superlite Lancet 306Unilet GP 28 Ultra Thin 306Unilet Lancet 306Unilet Micro-Thin 33G 306Unilet Super-Thin 30G 306Unilet Superlite Lancet 306Unilet Ultra-Thin 28G 306Unistik 3 Gentle 306Unistik Safety Lancets 28G 306Unistik Safety Lancets 30G 306Unistrip Control 306Universal 1 Lancets Thin 26G 306Universal 1 Lancets Ultra Thin 306Uridine Triacetate (Emergency Treatment) 308Ursodiol 163Ustekinumab 156,157Uvadex 72

VV-R Mono Insulin Syringe 306,307Valacyclovir HCl 103Valcyte 92Valganciclovir HCl 92Valproate Sodium 37Valproic Acid 37Valrubicin 72Valsartan 121Valsartan-Hydrochlorothiazide 133Valstar 72Value Health Insulin Syringe 307Value Plus Lancet Standard 21G 307

Value Plus Lancets Super Thin 307Value Plus Lancets Thin 26G 307Value Plus Lancing Device 307ValuMark Lancet Super Thin 30G 307ValuMark Lancet Ultra Thin 28G 307ValuMark Pen Needles 307,308Vancomycin HCl 22,23Vandetanib 75,77VanishPoint Insulin Syringe 308Varenicline Tartrate 18Vectibix 78Vectical 158Velaglucerase Alfa 161Velcade 72Veltin 158Vemurafenib 78Venlafaxine HCl 46,47Venlafaxine HCl ER 46Ventavis 325Ventolin HFA 323Verapamil HCl 130,131Veregen 158Veripred 20 176VESIcare 167Vexol 313Vibativ 23Victory Control Level 1/2 308Victoza 108Victrelis 97Vida Mia Autolet Lancing Dev 308Vida Mia Unifine Pentips 308Vida Mia Unilet Lancets 28G 308Vida Mia Unilet Lancets 30G 308Vidaza 72Videx 99,100Vigabatrin 37Viibryd 47Vilazodone HCl 47Vimpat 40Vinblastine Sulfate 72Vincristine Sulfate 72

Vinorelbine Tartrate 70,72,73Viracept 102Viramune 98Viramune XR 98Viread 100Visicol 165Vismodegib 75Vistide 92Vistogard 308Vivelle-Dot 192Vocal Point Control 308Voltaren 158Voraxaze 73Voriconazole 54Vorinostat 73Vortioxetine HBr 43,44Votrient 77VP Insulin Syringe 308Vpriv 161Vumon 73Vytorin 139Vyvanse 142

WW&F Lancets 26G 309W&F Lancets Colored 21G 309Walgreens Adv Travel Lancets 309Walgreens Lancets 309Walgreens Lancets Micro Thin 309Walgreens Lancets Super Thin 309Walgreens Lancing Device 309Walgreens Thin Lancets 309Walgreens Ultra Thin Lancets 309Warfarin Sodium 112,114,115Water For Irrigation, Sterile 220,288WD Medic Insulin Syringe 309Wegmans Unifine Pentips Plus 310Welchol 139Wellbutrin 43Wellbutrin SR 43Wide-Seal Diaphragm 60 310

Wide-Seal Diaphragm 65 310Wide-Seal Diaphragm 70 310Wide-Seal Diaphragm 75 310Wide-Seal Diaphragm 80 310Wide-Seal Diaphragm 85 310Wide-Seal Diaphragm 90 310Wide-Seal Diaphragm 95 310

XXalkori 77Xarelto 115Xeljanz 206Xeloda 66Xenazine 147,148Xeomin 328Xgeva 214Xifaxan 23Xolair 327Xopenex HFA 323Xpres Control 311Xtandi 63Xulane 193Xylocaine 17Xyrem 329

YYasmin 28 193YAZ 193Yervoy 78,79

ZZafirlukast 320Zaleplon 328,329Zaltrap 73Zanamivir 102Zanosar 63Zarontin 35Zavesca 161Zelboraf 78Zemaira 327Zemplar 214

Zenpep 161Zetia 139Ziagen 100Ziana 159Zidovudine 99,100Zileuton 320Zinbryta 150Zioptan 315Ziprasidone HCl 91Zirgan 93Zithromax 31Ziv-Aflibercept 73Zohydro ER 10,11Zoladex 202Zoledronic Acid 214,215Zolinza 73Zolmitriptan 57,58Zolpidem Tartrate 329Zolvit 16Zomacton 179Zometa 215Zomig 58Zomig ZMT 58Zonalon 159Zonisamide 35,36Zorbtive 179Zortress 206Zostavax 210Zoster Vaccine Live 210Zovia 1/50E (28) 193Zovirax 103Zyban 18Zyflo CR 320Zymaxid 33Zytiga 63Zyvox 23

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2016 Prescription Drug List - Ambetter Texas · PAGE 6 LAST UPDATED 09/2016. PRODUCT DESCRIPTION BRAND/GE TIER LIMITS & RESTRICTIONS EMBEDA CAP ER 50-2 MG morphine-naltrexone BRAND