5 Tier Enhanced Drug List - hcsc.bcbsil.com · Example: PROAIR HFA . Drugs used to treat multiple conditions . ... • Is as safe and effective • Meets the same standards set by

4621-D HCSC © Prime Therapeutics LLC 01/18

January 2018

5 Tier Enhanced Drug List

Please consider talking to your doctor about prescribing preferred medications, which

may help reduce your out-of-pocket costs. This list may help guide you and your doctor in

selecting an appropriate medication for you.

The drug list is regularly updated. You can view the most

up-to-date list, or the specialty drug list, at MyPrime.com.

Contents

Introduction ....................................................... I

How drugs are selected .................................... I

How member payment is determined ............... I

How to use this list ............................................ I

Generic drugs ................................................. II Coverage considerations ............................... III Specialty drugs ...............................................IV

Abbreviation/acronym key ............................. V

Therapeutic Class Drug List

Anti-Infective Agents ........................................ 1

Cancer Drugs ................................................... 3Hormones, Diabetes and Related Drugs ......... 4Heart and Circulatory Drugs ............................ 8

Respiratory Agents ........................................ 12Gastrointestinal Drugs ................................... 14Genitourinary Drugs ....................................... 15Central Nervous System Drugs ..................... 15Pain Relief Drugs ........................................... 18Neuromuscular Drugs .................................... 20Supplements .................................................. 21Blood Modifying Drugs ................................... 22Topical Products ............................................ 27Miscellaneous Categories (includes Supplies

and Devices) ................................................ 28Index .............................................................. 30

To search for a drug name within this PDF document, use the Control and F keys on your keyboard, or

go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking

for and click on Search.

For Texas Residents only – Find and estimate prices for medicines on this drug list at: https://www.myprime.com/v/BCBSTX/COMMERCIAL/TX5TIERGEN/en/find-medicine.html

https://www.myprime.com/v/BCBSTX/COMMERCIAL/TX5TIERGEN/en/find-medicine.html

Blue Cross and Blue Shield January 2018 5 Tier Enhanced Drug List I

Introduction

Blue Cross and Blue Shield is pleased to present the 2018 Drug List. This is a list of preferred drugs which

includes brand drugs and a partial listing of generic drugs. Members are encouraged to show this list to their

physicians and pharmacists. Physicians are encouraged to prescribe drugs on this list, when right for the

member. However, decisions regarding therapy and treatment are always between members and their

physician.

Drug List updates – This list is regularly updated as generic drugs become available and changes take place in

the pharmaceuticals market. For the most up-to-date information, visit MyPrime.com and log in or call the

number on the back of your ID card.

How drugs are selected

Drugs on this list are selected based on the recommendations of a committee made up of physicians and

pharmacists from throughout the country. The committee, which includes at least one representative from your

health plan, reviews drugs regulated by the U.S. Food and Drug Administration (FDA).

Both drugs that are newly approved by the FDA as well as those that have been on the market for some time are

considered. Drugs are selected based on safety, efficacy, cost and how they compare to other drugs currently on

the list.

How member payment is determined

This list shows prescription drug products in tiers. Generally, each drug is placed into one of up to six member

payment tiers: Preferred Generic (Tier 1), Non-Preferred Generic (Tier 2), Preferred Brand (Tier 3), Non-Preferred

Brand (Tier 4), Preferred Specialty (Tier 5) and Non-Preferred Specialty (Tier 6). Non-Preferred Brand and Non-

Preferred Specialty drugs are not listed in this document. Based on your benefit design, drugs can either be in

these tiers or you may have fewer tiers, e.g., all generics in one tier. To verify your payment amount for a drug,

visit myprime.com and log in or call the number on the back of your ID card.

Your pharmacy benefit includes coverage for many prescription drugs, although some exclusions may

apply. For example, drugs indicated for cosmetic purposes, e.g., Propecia, for hair growth, may not be covered.

Prescription products that have over-the-counter (OTC) equivalents may not be covered. Drugs that are not FDA-

approved for self-administration may be available through your medical benefit.

How to use this list

Generic drugs are shown in lower-case boldface type. Most generic drugs are followed by a reference brand

drug in (parentheses). The reference brand drug is usually a non-preferred (NP) brand and is only included as

a reference to the brand. Some generic products have no reference brand.

Example: atorvastatin (Lipitor)

Brand drugs are listed in all CAPITAL letters.

Example: PROAIR HFA

Drugs used to treat multiple conditions

Some drugs in the same dosage form may be used to treat more than one medical condition. In these instances,

each medication is classified according to its first FDA-approved use. Please check the index if you do not find

your particular medication in the class/condition section that corresponds to your use.

For Texas Residents only – Find and estimate prices for medicines on this formulary at: https://www.myprime.com/v/BCBSTX/COMMERCIAL/TX5TIERGEN/en/find-medicine.html


Blue Cross and Blue Shield January 2018 5 Tier Enhanced Drug List II

Generic drugs

Using generic drugs, when right for you, can help you save on your out-of-pocket medication costs. Generic drugs

must be approved by the FDA just as brand drugs are, and must meet the same standards.

There are two types of generic drugs:

• A generic equivalent is made with the same active ingredient(s) at the same dosage as the reference drug.

• A generic alternative is a drug typically used to treat the same condition, but the active ingredient(s)

differs from the brand drug.

According to the FDA, compared to its brand counterpart, an FDA-approved generic drug:

• Is chemically the same

• Works just as well in the body

• Is as safe and effective

• Meets the same standards set by the FDA

The main difference between the reference brand drug and the generic equivalent is that the generic often costs

much less.

Preferred brand drugs typically move to a non-preferred brand tier after a generic equivalent becomes available.

You may be responsible for your member share payment amount (copay/coinsurance) plus the difference in cost

between the brand and generic equivalent if you or your doctor requests the reference brand rather than the

generic. Generic drugs generally have the lowest member payment amount.

Consider talking to your doctor about generic drugs

If your doctor writes a prescription for a brand drug that does not have a generic equivalent, consider asking if an

appropriate generic alternative is available.

You can also let your pharmacist know that you would like a generic equivalent for a brand drug, whenever one is

available. Your pharmacist can usually substitute a generic equivalent for its brand counterpart without a new

prescription from your doctor.

Only your doctor can determine whether a generic alternative is right for you and must prescribe the medication.



Blue Cross and Blue Shield January 2018 5 Tier Enhanced Drug List III

Coverage considerations

Most prescription drug benefit plans provide coverage for up to a 30-day supply of medication, with some

exceptions. Your plan may also provide coverage for up to a 90-day supply of maintenance medications.

Maintenance medications are those drugs you may take on an ongoing basis for conditions such as high blood

pressure, diabetes or high cholesterol. Some plans may exclude coverage for certain agents or drug categories,

like those used for erectile dysfunction or weight loss.

Over-the-counter exclusions: Your benefit plan may not provide coverage for prescription medications that

have an over-the-counter version. You should refer to your benefit plan material for details about your particular

benefits.

Compounded medications: Your benefit plan may not provide coverage for compounded medications. Please

see your plan materials or call the number on the back of your ID card to determine whether compounded

medications are covered and/or verify your payment amount.

Repackaged medications: Repackaged versions of medications already available on the market are not

covered.

Prior Authorization (PA): Your benefit plan may require prior authorization for certain drugs. This means that

your doctor will need to submit a prior authorization request for coverage of these medications, and the request

will need to be approved, before the medication will be covered under your plan. For the medications listed in this

document, if a prior authorization is commonly required, it will generally be noted next to the medication with a dot

under the prior authorization column. Some plans may have prior authorization on additional medications beyond

those noted in this document. Refer to your benefit plan materials for details about your particular benefits.

Step Therapy (ST): Your benefit plan may include a step therapy program. This means you may need to try

another proven, cost-effective medication before coverage may be available for the drug included in the program.

Many brand drugs have less-expensive generic or brand alternatives that might be an option for you. For the

medications listed in this document, if a step therapy is commonly required, it will generally be noted next to the

medication with a dot under the step therapy column. Some plans may have step therapy programs on additional

medications beyond those noted in this document. Refer to your benefit plan materials for details about your

particular benefits.

Dispensing Limits (DL): Drug dispensing limits help encourage medication use as intended by the FDA.

Dispensing limits are placed on medications in certain drug categories. For the medications listed in this

document, if a dispensing limit applies, it will generally be noted next to the medication with a dot under the

dispensing limits column. Limits may include: quantity of covered medication per prescription or quantity of

covered medication in a given time period. If your doctor prescribes a greater quantity of medication than what the

dispensing limit allows, you can still get the medication. However, you will be responsible for the full cost of the

prescription beyond what your coverage allows.* For a list of medications and their dispensing limits, visit

myprime.com.

*Please note: For certain controlled substance medications, some state laws may not allow coverage by a health

benefit plan of such medication if dispensed in a quantity beyond what the dispensing limit allows. You will be

responsible for the full cost of the prescription with no benefits applied if the dispensed quantity exceeds the

dispensing limit.

Remember, medication decisions are between you and your doctor. Only you and your doctor can determine which medication is right for you. Discuss any questions or concerns you have about medications you are taking or are prescribed with your doctor. Blue Cross and Blue Shield does not provide health care services and, therefore, cannot guarantee any results or outcomes. For Texas Residents only – Find and estimate prices for medicines on this formulary at: https://www.myprime.com/v/BCBSTX/COMMERCIAL/TX5TIERGEN/en/find-medicine.html


Blue Cross and Blue Shield January 2018 5 Tier Enhanced Drug List IV

Specialty drugs

Specialty drugs are used in the treatment of medical conditions such as hepatitis, hemophilia, multiple sclerosis

and rheumatoid arthritis. Specialty drugs may be oral, topical or injectable medications that can either be

self-administered or administered by a health care professional. For a current list of specialty medications,

visit MyPrime.com.

Note that some drug classes may be excluded by some plans and therefore may not be covered under your

pharmacy benefit. Your plan may have a different coverage level for self-administered specialty drugs. If you

have questions about your coverage for specialty medications or your prescription drug benefit, call the

number on the back of your ID card.

AllianceRx Walgreens Prime

Through AllianceRx Walgreens Prime, members can have covered specialty medications delivered directly

to them or their doctor’s office. When you receive specialty medications through AllianceRx Walgreens

Prime, you also receive at no additional charge the following services:

• Coordination of coverage between you, your doctor and your health plan

• Educational materials about your particular condition and information about managing potential

medication side effects

• Syringes, sharps containers and other supplies with every shipment for self-injectables

• 24/7/365 phone access to a pharmacist for urgent medication issues

To order throughAllianceRx Walgreens Prime:

• Have your doctor call or fax your prescription to AllianceRx Walgreens Prime. Your doctor can call 877-

627-6337 or fax to 877-828-3939.

• If you have an existing prescription for a covered specialty medication, you can call 877-627-6337 to

transfer your prescription.

• A coordinator will contact you to arrange delivery of your medication.

• The prescription can be shipped directly to you or your prescribing doctor’s office. Each package is

individually marked for each member. Refrigerated drugs are shipped in temperature-controlled

packaging.

If you have questions, please contact AllianceRx Walgreens Prime at 877-627-6337, visit www.alliancerxwp.com,

or call the number on the back of your ID card.

* Blue Cross and Blue Shield of Illinois (BCBSIL), Blue Cross and Blue Shield of Montana (BCBSMT), Blue Cross

and Blue Shield of

New Mexico (BCBSNM), Blue Cross and Blue Shield of Oklahoma (BCBSOK), and Blue Cross and Blue Shield

of Texas (BCBSTX)

are Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee

of the Blue Cross and

Blue Shield Association. BCBSIL, BCBSMT, BCBSNM, BCBSOK, and BCBSTX contract with Prime

Therapeutics to provide pharmacy benefit management, home delivery pharmacy and specialty pharmacy

services. BCBSIL, BCBSMT, BCBSNM, BCBSOK, and BCBSTX,

as well as several independent Blue Cross and Blue Shield Plans, have an ownership interest in Prime

Therapeutics LLC.



Blue Cross and Blue Shield January 2018 5 Tier Enhanced Drug List V

Abbreviation/acronym key

caps .................................................... capsules

chew .................................................. chewable

conc ............................................... concentrate

cr .......................................... controlled release

dr ............................................. delayed release

ec ................................................ enteric coated

effe................................................. effervescent

equiv ................................................ equivalent

er ........................................... extended release

inhal................................................... inhalation

inj ......................................................... injection

liq .............................................................. liquid

lotn ........................................................... lotion

nebu ................................................... nebulizer

odt .......................... orally disintegrating tablets

oint ...................................................... ointment

ophth ............................................... ophthalmic

osm .......................................... osmotic release

powd ...................................................... powder

sa ............................................ sustained action

sl ...................................................... sublingual

soln ....................................................... solution

sr .......................................... sustained release

suppos ........................................ suppositories

susp ................................................ suspension

tab ........................................................... tablets

td ....................................................transdermal



2018

for Texas Residents only -- Find and estimate prices for medicines on this formulary at:https://www.myprime.com/v/BCBSTX/COMMERCIAL/TX5TIERGEN/en/find-medicine.html

Blue Cross and Blue Shield January 2018 5 Tier Enhanced Drug List 1

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ANTI-INFECTIVE AGENTSPENICILLINSamoxicillin (trihydrate) cap 250 mgamoxicillin (trihydrate) cap 500 mgamoxicillin (trihydrate) for susp

125 mg/5mlamoxicillin (trihydrate) for susp



400 mg/5mlamoxicillin (trihydrate) tab 500 mgamoxicillin (trihydrate) tab 875 mgpenicillin v potassium tab 250 mgpenicillin v potassium tab 500 mgCEPHALOSPORINScefadroxil cap 500 mgCEFTIN – cefuroxime axetil for susp

125 mg/5mlcephalexin cap 250 mg (Keflex)cephalexin cap 500 mg (Keflex)MACROLIDESazithromycin tab 250 mg (Zithromax) •azithromycin tab 500 mg (Zithromax) •TETRACYCLINESminocycline hcl cap 50 mg (Minocin)minocycline hcl cap 75 mg (Minocin)minocycline hcl cap 100 mg (Minocin)FLUOROQUINOLONESciprofloxacin hcl tab 250 mg (base

equiv) (Cipro)ciprofloxacin hcl tab 500 mg (base

equiv) (Cipro)

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ciprofloxacin hcl tab 750 mg (baseequiv)

levofloxacin tab 250 mg (Levaquin)levofloxacin tab 500 mg (Levaquin)levofloxacin tab 750 mg (Levaquin)AMINOGLYCOSIDESneomycin sulfate tab 500 mgTUBERCULOSISisoniazid tab 100 mgisoniazid tab 300 mgPRIFTIN – rifapentine tab 150 mgFUNGAL INFECTIONSfluconazole for susp 10 mg/ml

(Diflucan)fluconazole tab 50 mg (Diflucan)fluconazole tab 100 mg (Diflucan)fluconazole tab 150 mg (Diflucan)ketoconazole tab 200 mgNOXAFIL – posaconazole tab delayed

release 100 mg•

NOXAFIL – posaconazole susp 40 mg/ml

•

terbinafine hcl tab 250 mg (Lamisil)VIRAL INFECTIONSHepatitisBARACLUDE – entecavir oral soln 0.05

mg/mlEPCLUSA – sofosbuvir-velpatasvir tab

400-100 mg• •

HARVONI – ledipasvir-sofosbuvir tab90-400 mg

• •

MAVYRET – glecaprevir-pibrentasvirtab 100-40 mg

• •

PEGASYS – peginterferon alfa-2a inj180 mcg/ml

• •

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PEGASYS – peginterferon alfa-2a inj180 mcg/0.5ml

• •

PEGASYS PROCLICK – peginterferonalfa-2a inj 135 mcg/0.5ml

• •

PEGASYS PROCLICK – peginterferonalfa-2a inj 180 mcg/0.5ml

• •

SOVALDI – sofosbuvir tab 400 mg • •VOSEVI – sofosbuvir-velpatasvir-

voxilaprevir tab 400-100-100 mg• •

Herpesacyclovir cap 200 mg (Zovirax)acyclovir tab 400 mg (Zovirax)acyclovir tab 800 mg (Zovirax)HIV/AIDSATRIPLA – efavirenz-emtricitabine-

tenofovir df tab 600-200-300 mg•

DESCOVY – emtricitabine-tenofoviralafenamide fumarate tab 200-25 mg

•

GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab150-150-200-10 mg

•

INTELENCE – etravirine tab 25 mg •INTELENCE – etravirine tab 100 mg •INTELENCE – etravirine tab 200 mg •ISENTRESS – raltegravir potassium

packet for susp 100 mg (base equiv)•

ISENTRESS – raltegravir potassiumtab 400 mg (base equiv)

•

ISENTRESS – raltegravir potassiumchew tab 25 mg (base equiv)

•

ISENTRESS – raltegravir potassiumchew tab 100 mg (base equiv)

•

ISENTRESS HD – raltegravirpotassium tab 600 mg (base equiv)

•

KALETRA – lopinavir-ritonavir tab100-25 mg

•

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KALETRA – lopinavir-ritonavir tab200-50 mg

•

nevirapine tab 200 mg (Viramune) •NORVIR – ritonavir tab 100 mg •NORVIR – ritonavir oral soln 80 mg/ml •ODEFSEY – emtricitabine-rilpivirine-

tenofovir af tab 200-25-25 mg•

PREZISTA – darunavir ethanolate susp100 mg/ml (base equiv)

•

PREZISTA – darunavir ethanolate tab75 mg (base equiv)

•


•


•


•

REYATAZ – atazanavir sulfate cap 150mg (base equiv)

•


•


•

STRIBILD – elvitegrav-cobic-emtricitab-tenofovdf tab 150-150-200-300 mg

•

SUSTIVA – efavirenz tab 600 mg •SUSTIVA – efavirenz cap 50 mg •SUSTIVA – efavirenz cap 200 mg •TIVICAY – dolutegravir sodium tab 10

mg (base equiv)•

TIVICAY – dolutegravir sodium tab 25mg (base equiv)

•

TIVICAY – dolutegravir sodium tab 50mg (base equiv)

•

TRUVADA – emtricitabine-tenofovirdisoproxil fumarate tab 100-150 mg

•

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•


•

VIDEX – didanosine for soln 2 gm •VIDEX – didanosine for soln 4 gm •VIRAMUNE – nevirapine susp 50

mg/5ml•

VIREAD – tenofovir disoproxil fumarateoral powder 40 mg/gm

•

VIREAD – tenofovir disoproxil fumaratetab 150 mg

•


•


•


•

ZIAGEN – abacavir sulfate soln 20 mg/ml (base equiv)

•

MALARIAchloroquine phosphate tab 500 mg

(Aralen)DARAPRIM – pyrimethamine tab 25 mg • •hydroxychloroquine sulfate tab

200 mg (Plaquenil)PRIMAQUINE PHOSPHATE –

primaquine phosphate tab 26.3 mg(15 mg base)

WORM INFECTIONSALBENZA – albendazole tab 200 mgBILTRICIDE – praziquantel tab 600 mgOTHER ANTI-INFECTIVESclindamycin hcl cap 75 mg (Cleocin)

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clindamycin hcl cap 150 mg (Cleocin)clindamycin hcl cap 300 mg (Cleocin)IMPAVIDO – miltefosine cap 50 mgmetronidazole tab 250 mg (Flagyl)metronidazole tab 500 mg (Flagyl)SULFADIAZINE – sulfadiazine tab 500

mgsulfamethoxazole-trimethoprim susp

200-40 mg/5mlsulfamethoxazole-trimethoprim tab

400-80 mg (Bactrim)sulfamethoxazole-trimethoprim tab

800-160 mg (Bactrim ds)trimethoprim tab 100 mgXIFAXAN – rifaximin tab 550 mg •CANCER DRUGSACTIMMUNE – interferon gamma-1b

inj 100 mcg/0.5ml (2000000unit/0.5ml)

•

anastrozole tab 1 mg (Arimidex)bicalutamide tab 50 mg (Casodex) •KISQALI – ribociclib succinate tab 200

mg (base equiv)• • •

KISQALI FEMARA 200 DOSE –ribociclib tab 200 mg & letrozole tab2.5 mg therapy pack

• • •


• • •


• • •

letrozole tab 2.5 mg (Femara)LEUCOVORIN CALCIUM – leucovorin

calcium tab 10 mg

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LEUCOVORIN CALCIUM – leucovorincalcium tab 15 mg

LEUKERAN – chlorambucil tab 2 mg •megestrol acetate tab 20 mgmegestrol acetate tab 40 mgMEKINIST – trametinib dimethyl

sulfoxide tab 0.5 mg (baseequivalent)

• • •

MEKINIST – trametinib dimethylsulfoxide tab 2 mg (base equivalent)

• • •

MYLERAN – busulfan tab 2 mg •NEXAVAR – sorafenib tosylate tab 200

mg (base equivalent)• • •

RYDAPT – midostaurin cap 25 mg • • •SUTENT – sunitinib malate cap 12.5

mg (base equivalent)• • •

SUTENT – sunitinib malate cap 25 mg(base equivalent)

• • •

SUTENT – sunitinib malate cap 37.5mg (base equivalent)

• • •

SUTENT – sunitinib malate cap 50 mg(base equivalent)

• • •

SYLATRON – peginterferon alfa-2b forinj kit 200 mcg

• •


• •


• •

TAFINLAR – dabrafenib mesylate cap50 mg (base equivalent)

• • •

TAFINLAR – dabrafenib mesylate cap75 mg (base equivalent)

• • •

tamoxifen citrate tab 10 mg (baseequivalent)

tamoxifen citrate tab 20 mg (baseequivalent)

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TARCEVA – erlotinib hcl tab 25 mg(base equivalent)

• • •


• • •


• • •

TASIGNA – nilotinib hcl cap 150 mg(base equivalent)

• • •

TASIGNA – nilotinib hcl cap 200 mg(base equivalent)

• • •

VOTRIENT – pazopanib hcl tab 200 mg(base equiv)

• • •

XALKORI – crizotinib cap 200 mg • • •XALKORI – crizotinib cap 250 mg • • •XTANDI – enzalutamide cap 40 mg • • •ZELBORAF – vemurafenib tab 240 mg • • •ZYTIGA – abiraterone acetate tab 250

mg• • •

ZYTIGA – abiraterone acetate tab 500mg

• • •

HORMONES, DIABETES AND RELATED DRUGSCORTICOSTEROIDSCORTISONE ACETATE – cortisone

acetate tab 25 mgdexamethasone tab 0.5 mgdexamethasone tab 0.75 mgdexamethasone tab 1.5 mgdexamethasone tab 4 mgdexamethasone tab 6 mgprednisolone sod phosphate oral

soln 15 mg/5ml (base equiv)prednisolone syrup 15 mg/5ml (usp

solution equivalent) (Prelone)prednisone tab 1 mgprednisone tab 2.5 mg

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prednisone tab 5 mgprednisone tab 10 mgprednisone tab 20 mgMALE HORMONESANDROGEL – testosterone td gel

20.25 mg/1.25gm (1.62%)• •

ANDROGEL – testosterone td gel 40.5mg/2.5gm (1.62%)

• •

ANDROGEL PUMP – testosterone tdgel 20.25 mg/act (1.62%)

• •

ESTROGENSCOMBIPATCH – estradiol-

norethindrone ace td pttw 0.05-0.14mg/day

COMBIPATCH – estradiol-norethindrone ace td pttw 0.05-0.25mg/day

DIVIGEL – estradiol td gel 0.25mg/0.25gm (0.1%)

DIVIGEL – estradiol td gel 0.5mg/0.5gm (0.1%)

DIVIGEL – estradiol td gel 1 mg/gm(0.1%)

estradiol tab 0.5 mg (Estrace)estradiol tab 1 mg (Estrace)estradiol tab 2 mg (Estrace)PROGESTINSmedroxyprogesterone acetate tab

2.5 mg (Provera)medroxyprogesterone acetate tab

5 mg (Provera)medroxyprogesterone acetate tab

10 mg (Provera)BIRTH CONTROLdesogestrel & ethinyl estradiol tab

0.15 mg-30 mcg (Desogen)•

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ELLA – ulipristal acetate tab 30 mg •levonorgestrel & ethinyl estradiol tab

0.1 mg-20 mcg•

MIRENA – levonorgestrel releasing iud20 mcg/day (52 mg total)

norethindrone & ethinyl estradiol tab1 mg-35 mcg (Norinyl 1+35)

•

norgestimate & ethinyl estradiol tab0.25 mg-35 mcg (Ortho-cyclen)

•

norgestimate-eth estrad tab0.18-35/0.215-35/0.25-35 mg-mcg(Ortho tri-cyclen)

•

NUVARING – etonogestrel-ethinylestradiol va ring 0.120-0.015 mg/24hr

•

SKYLA – levonorgestrel releasing iud14 mcg/day (13.5 mg total)

INFERTILITYFOLLISTIM AQ – follitropin beta inj 75

unit/0.5ml• •

FOLLISTIM AQ – follitropin beta inj 300unit/0.36ml

• •


• •


• •

DIABETESglimepiride tab 1 mg (Amaryl)glimepiride tab 2 mg (Amaryl)glimepiride tab 4 mg (Amaryl)glipizide tab er 24hr 2.5 mg (Glucotrol

xl)glipizide tab er 24hr 5 mg (Glucotrol

xl)glipizide tab 5 mg (Glucotrol)glipizide tab 10 mg (Glucotrol)

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GLUCAGON EMERGENCY KIT –glucagon (rdna) for inj kit 1 mg

glyburide micronized tab 1.5 mg(Glynase)

glyburide micronized tab 3 mg(Glynase)

glyburide micronized tab 6 mg(Glynase)

glyburide tab 1.25 mgglyburide tab 2.5 mgglyburide tab 5 mgglyburide-metformin tab 1.25-250 mg

(Glucovance)glyburide-metformin tab 2.5-500 mg

(Glucovance)glyburide-metformin tab 5-500 mg

(Glucovance)INVOKAMET – canagliflozin-metformin

hcl tab 50-500 mg•

INVOKAMET – canagliflozin-metforminhcl tab 50-1000 mg

•


•


•

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr 50-500 mg

•


•


•

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr 150-1000mg

•

INVOKANA – canagliflozin tab 100 mg •INVOKANA – canagliflozin tab 300 mg •JARDIANCE – empagliflozin tab 10 mg •

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JARDIANCE – empagliflozin tab 25 mg •metformin hcl tab er 24hr 500 mg

(Glucophage xr)metformin hcl tab er 24hr 750 mg

(Glucophage xr)metformin hcl tab 500 mg

(Glucophage)metformin hcl tab 850 mg

(Glucophage)metformin hcl tab 1000 mg

(Glucophage)pioglitazone hcl tab 15 mg (base

equiv) (Actos)pioglitazone hcl tab 30 mg (base

equiv) (Actos)pioglitazone hcl tab 45 mg (base

equiv) (Actos)VICTOZA – liraglutide soln pen-injector

18 mg/3ml (6 mg/ml)• •

DIABETES - INSULINSRapid-Acting InsulinsNOVOLOG – insulin aspart inj 100 unit/

ml•

NOVOLOG FLEXPEN – insulin aspartsoln pen-injector 100 unit/ml

•

NOVOLOG PENFILL – insulin aspartsoln cartridge 100 unit/ml

•

Short-Acting InsulinsHUMULIN R U-500 (CONCENTR –

insulin regular (human) inj 500 unit/ml•

HUMULIN R U-500 KWIKPEN – insulinregular (human) soln pen-injector 500unit/ml

•

NOVOLIN R – insulin regular (human)inj 100 unit/ml

•

Intermediate-Acting Insulins

2018



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NOVOLIN N – insulin nph (human)(isophane) inj 100 unit/ml

•

NOVOLIN 70/30 – insulin nph isophane& regular human inj 100 unit/ml(70-30)

•

NOVOLOG MIX 70/30 – insulin aspartprot & aspart (human) inj 100 unit/ml(70-30)

•

NOVOLOG MIX 70/30 PREFILL –insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30)

•

Basal InsulinsLANTUS – insulin glargine inj 100 unit/

ml•

LANTUS SOLOSTAR – insulin glarginesoln pen-injector 100 unit/ml

•

LEVEMIR – insulin detemir inj 100 unit/ml

•

LEVEMIR FLEXTOUCH – insulindetemir soln pen-injector 100 unit/ml

•

TOUJEO SOLOSTAR – insulin glarginesoln pen-injector 300 unit/ml

•

TRESIBA FLEXTOUCH – insulindegludec soln pen-injector 100 unit/ml

•

TRESIBA FLEXTOUCH – insulindegludec soln pen-injector 200 unit/ml

•

THYROID REGULATIONlevothyroxine sodium tab 25 mcg

(Synthroid)levothyroxine sodium tab 50 mcg



(Synthroid)

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levothyroxine sodium tab 100 mcg(Synthroid)








methimazole tab 5 mg (Tapazole)methimazole tab 10 mg (Tapazole)thyroid tab 30 mg (1/2 grain) (Armour

thyroid)thyroid tab 60 mg (1 grain) (Armour

thyroid)thyroid tab 90 mg (1 1/2 grain)

(Armour thyroid)GROWTH HORMONEINCRELEX – mecasermin inj 40

mg/4ml (10 mg/ml)•

OMNITROPE – somatropin for inj 5.8mg

• •

OMNITROPE – somatropin inj 5mg/1.5ml

• •

OMNITROPE – somatropin inj 10mg/1.5ml

• •

OTHER HORMONES AND RELATED DRUGSalendronate sodium tab 5 mg •alendronate sodium tab 10 mg •

2018



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alendronate sodium tab 35 mg •alendronate sodium tab 70 mg

(Fosamax)•

NITYR – nitisinone tab 2 mg •NITYR – nitisinone tab 5 mg •NITYR – nitisinone tab 10 mg •ORFADIN – nitisinone susp 4 mg/ml •ORFADIN – nitisinone cap 2 mg •ORFADIN – nitisinone cap 5 mg •ORFADIN – nitisinone cap 10 mg •ORFADIN – nitisinone cap 20 mg •SENSIPAR – cinacalcet hcl tab 30 mg

(base equiv)SENSIPAR – cinacalcet hcl tab 60 mg

(base equiv)SENSIPAR – cinacalcet hcl tab 90 mg

(base equiv)STIMATE – desmopressin acetate

nasal soln 1.5 mg/mlSTRENSIQ – asfotase alfa

subcutaneous inj 18 mg/0.45ml• •

STRENSIQ – asfotase alfasubcutaneous inj 28 mg/0.7ml

• •

STRENSIQ – asfotase alfasubcutaneous inj 40 mg/ml

• •

STRENSIQ – asfotase alfasubcutaneous inj 80 mg/0.8ml

• •

TYMLOS – abaloparatidesubcutaneous soln pen-injector 3120mcg/1.56ml

• • •

HEART AND CIRCULATORY DRUGSANGIOTENSIN CONVERTING ENZYME (ACE)INHIBITORS AND COMBINATIbenazepril hcl tab 5 mgbenazepril hcl tab 10 mg (Lotensin)benazepril hcl tab 20 mg (Lotensin)

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benazepril hcl tab 40 mg (Lotensin)enalapril maleate &

hydrochlorothiazide tab 5-12.5 mgenalapril maleate &

hydrochlorothiazide tab 10-25 mg(Vaseretic)

enalapril maleate tab 2.5 mg(Vasotec)

enalapril maleate tab 5 mg (Vasotec)enalapril maleate tab 10 mg (Vasotec)enalapril maleate tab 20 mg (Vasotec)fosinopril sodium tab 10 mgfosinopril sodium tab 20 mgfosinopril sodium tab 40 mglisinopril & hydrochlorothiazide tab

10-12.5 mg (Zestoretic)lisinopril & hydrochlorothiazide tab

20-12.5 mg (Zestoretic)lisinopril & hydrochlorothiazide tab

20-25 mg (Zestoretic)lisinopril tab 2.5 mg (Zestril)lisinopril tab 5 mg (Prinivil)lisinopril tab 10 mg (Prinivil)lisinopril tab 20 mg (Prinivil)lisinopril tab 30 mg (Zestril)lisinopril tab 40 mg (Zestril)perindopril erbumine tab 2 mgquinapril hcl tab 5 mg (Accupril)quinapril hcl tab 10 mg (Accupril)quinapril hcl tab 20 mg (Accupril)quinapril hcl tab 40 mg (Accupril)ramipril cap 1.25 mg (Altace)ramipril cap 2.5 mg (Altace)ramipril cap 5 mg (Altace)

2018



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ramipril cap 10 mg (Altace)trandolapril tab 1 mg (Mavik)trandolapril tab 2 mg (Mavik)trandolapril tab 4 mg (Mavik)ANGIOTENSIN II RECEPTOR ANTAGONISTS (ARBS)AND COMBINATIONSirbesartan tab 75 mg (Avapro)irbesartan tab 150 mg (Avapro)irbesartan tab 300 mg (Avapro)irbesartan-hydrochlorothiazide tab

150-12.5 mg (Avalide)irbesartan-hydrochlorothiazide tab

300-12.5 mg (Avalide)losartan potassium &

hydrochlorothiazide tab 50-12.5 mg(Hyzaar)

losartan potassium &hydrochlorothiazide tab100-12.5 mg (Hyzaar)

losartan potassium &hydrochlorothiazide tab 100-25 mg(Hyzaar)

losartan potassium tab 25 mg(Cozaar)



valsartan-hydrochlorothiazide tab80-12.5 mg (Diovan hct)

valsartan-hydrochlorothiazide tab320-12.5 mg (Diovan hct)

valsartan-hydrochlorothiazide tab320-25 mg (Diovan hct)

BETA BLOCKERS AND COMBINATIONSacebutolol hcl cap 200 mg (Sectral)

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acebutolol hcl cap 400 mg (Sectral)atenolol & chlorthalidone tab

50-25 mg (Tenoretic 50)atenolol & chlorthalidone tab

100-25 mg (Tenoretic 100)atenolol tab 25 mg (Tenormin)atenolol tab 50 mg (Tenormin)atenolol tab 100 mg (Tenormin)bisoprolol & hydrochlorothiazide tab

2.5-6.25 mg (Ziac)bisoprolol & hydrochlorothiazide tab

5-6.25 mg (Ziac)bisoprolol & hydrochlorothiazide tab

10-6.25 mg (Ziac)bisoprolol fumarate tab 5 mg

(Zebeta)carvedilol tab 3.125 mg (Coreg)carvedilol tab 6.25 mg (Coreg)carvedilol tab 12.5 mg (Coreg)carvedilol tab 25 mg (Coreg)metoprolol succinate tab er 24hr

25 mg (tartrate equiv) (Toprol xl)metoprolol succinate tab er 24hr

50 mg (tartrate equiv) (Toprol xl)metoprolol tartrate tab 25 mgmetoprolol tartrate tab 50 mg

(Lopressor)metoprolol tartrate tab 100 mg

(Lopressor)propranolol hcl tab 10 mgpropranolol hcl tab 20 mgpropranolol hcl tab 40 mgpropranolol hcl tab 80 mgCALCIUM CHANNEL BLOCKERS ANDCOMBINATIONS

2018



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amlodipine besylate tab 2.5 mg(Norvasc)

amlodipine besylate tab 5 mg(Norvasc)

amlodipine besylate tab 10 mg(Norvasc)

diltiazem hcl cap er 24hr 120 mgdiltiazem hcl coated beads cap er

24hr 120 mg (Cardizem cd)diltiazem hcl coated beads cap er

24hr 180 mg (Cardizem cd)diltiazem hcl tab 30 mg (Cardizem)diltiazem hcl tab 60 mg (Cardizem)diltiazem hcl tab 90 mgdiltiazem hcl tab 120 mg (Cardizem)ENTRESTO – sacubitril-valsartan tab

24-26 mg• •

ENTRESTO – sacubitril-valsartan tab49-51 mg

• •

ENTRESTO – sacubitril-valsartan tab97-103 mg

• •

nifedipine tab er 24hr 30 mg (Adalatcc)

nifedipine tab er 24hr osmoticrelease 30 mg (Procardia xl)

verapamil hcl tab er 120 mg (Calansr)



verapamil hcl tab 80 mg (Calan)verapamil hcl tab 120 mg (Calan)CHEST PAINisosorbide mononitrate tab er 24hr

30 mg

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isosorbide mononitrate tab er 24hr60 mg

isosorbide mononitrate tab 10 mgisosorbide mononitrate tab 20 mgnitroglycerin cap er 2.5 mgCHOLESTEROL LOWERINGatorvastatin calcium tab 10 mg (base

equivalent) (Lipitor)atorvastatin calcium tab 20 mg (base



equivalent) (Lipitor)fenofibrate tab 54 mg (Lofibra) •gemfibrozil tab 600 mg (Lopid) •lovastatin tab 10 mglovastatin tab 20 mg (Mevacor)lovastatin tab 40 mg (Mevacor)PRALUENT – alirocumab

subcutaneous soln pen-injector 75mg/ml

• • •

PRALUENT – alirocumabsubcutaneous soln pen-injector 150mg/ml

• • •

pravastatin sodium tab 10 mgpravastatin sodium tab 20 mg

(Pravachol)pravastatin sodium tab 40 mg

(Pravachol)REPATHA – evolocumab subcutaneous

soln prefilled syringe 140 mg/ml• • •

REPATHA PUSHTRONEX SYSTEM– evolocumab subcutaneous solncartridge/infusor 420 mg/3.5ml

• • •

2018



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REPATHA SURECLICK – evolocumabsubcutaneous soln auto-injector 140mg/ml

• • •

simvastatin tab 5 mg (Zocor)simvastatin tab 10 mg (Zocor)simvastatin tab 20 mg (Zocor)simvastatin tab 40 mg (Zocor)simvastatin tab 80 mg (Zocor)WELCHOL – colesevelam hcl tab 625

mgWELCHOL – colesevelam hcl packet

for susp 3.75 gmFLUID RETENTIONamiloride & hydrochlorothiazide tab

5-50 mgbumetanide tab 0.5 mgbumetanide tab 1 mgchlorothiazide tab 500 mgfurosemide oral soln 10 mg/mlfurosemide tab 20 mg (Lasix)furosemide tab 40 mg (Lasix)furosemide tab 80 mg (Lasix)hydrochlorothiazide cap 12.5 mg

(Microzide)hydrochlorothiazide tab 12.5 mghydrochlorothiazide tab 25 mghydrochlorothiazide tab 50 mgindapamide tab 1.25 mgindapamide tab 2.5 mgspironolactone tab 25 mg (Aldactone)spironolactone tab 50 mg (Aldactone)torsemide tab 5 mg (Demadex)torsemide tab 10 mg (Demadex)torsemide tab 20 mg (Demadex)

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triamterene & hydrochlorothiazidecap 37.5-25 mg (Dyazide)

triamterene & hydrochlorothiazidetab 37.5-25 mg (Maxzide-25)

triamterene & hydrochlorothiazidetab 75-50 mg (Maxzide)

HEART RHYTHMamiodarone hcl tab 200 mg

(Cordarone)sotalol hcl tab 80 mg (Betapace)sotalol hcl tab 120 mg (Betapace)sotalol hcl tab 160 mg (Betapace)OTHER HEART RELATED DRUGSADCIRCA – tadalafil tab 20 mg (pah) • • •clonidine hcl tab 0.1 mg (Catapres)clonidine hcl tab 0.2 mg (Catapres)clonidine hcl tab 0.3 mg (Catapres)doxazosin mesylate tab 1 mg

(Cardura)doxazosin mesylate tab 2 mg



(Cardura)guanfacine hcl tab 1 mg (Tenex)guanfacine hcl tab 2 mg (Tenex)hydralazine hcl tab 10 mghydralazine hcl tab 25 mghydralazine hcl tab 50 mgmethyldopa tab 250 mgmethyldopa tab 500 mgminoxidil tab 2.5 mgminoxidil tab 10 mgOPSUMIT – macitentan tab 10 mg • • •

2018



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prazosin hcl cap 1 mg (Minipress)prazosin hcl cap 2 mg (Minipress)terazosin hcl cap 1 mgterazosin hcl cap 2 mgterazosin hcl cap 5 mgterazosin hcl cap 10 mgTRACLEER – bosentan tab 62.5 mg • • •TRACLEER – bosentan tab 125 mg • • •UPTRAVI – selexipag tab therapy pack

200 mcg (140) & 800 mcg (60)• • •

UPTRAVI – selexipag tab 200 mcg • • •UPTRAVI – selexipag tab 400 mcg • • •UPTRAVI – selexipag tab 600 mcg • • •UPTRAVI – selexipag tab 800 mcg • • •UPTRAVI – selexipag tab 1000 mcg • • •UPTRAVI – selexipag tab 1200 mcg • • •UPTRAVI – selexipag tab 1400 mcg • • •UPTRAVI – selexipag tab 1600 mcg • • •ERECTILE DYSFUNCTIONCIALIS – tadalafil tab 2.5 mg • •CIALIS – tadalafil tab 5 mg • •CIALIS – tadalafil tab 10 mg • •CIALIS – tadalafil tab 20 mg • •BEE STING KITSEPINEPHRINE (Mylan Products) –

epinephrine solution auto-injector0.15 mg/0.3ml (1:2000)

EPINEPHRINE (Mylan Products) –epinephrine solution auto-injector 0.3mg/0.3ml (1:1000)

EPIPEN 2-PAK – epinephrine solutionauto-injector 0.3 mg/0.3ml (1:1000)

EPIPEN-JR 2-PAK – epinephrinesolution auto-injector 0.15 mg/0.3ml(1:2000)

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RESPIRATORY AGENTSANTIHISTAMINESpromethazine hcl syrup 6.25 mg/5mlpromethazine hcl tab 12.5 mgpromethazine hcl tab 25 mgpromethazine hcl tab 50 mgNASAL PRODUCTSfluticasone propionate nasal susp

50 mcg/act (Flonase)•

COUGH/COLD/ALLERGYbenzonatate cap 100 mg (Tessalon

perles)benzonatate cap 200 mgpromethazine & phenylephrine syrup

6.25-5 mg/5mlpromethazine w/ codeine syrup

6.25-10 mg/5mlpromethazine-dm syrup

6.25-15 mg/5mlpromethazine-phenylephrine-

codeine syrup 6.25-5-10 mg/5mlASTHMA/COPDADVAIR DISKUS – fluticasone-

salmeterol aer powder ba 100-50mcg/dose

•

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba 250-50mcg/dose

•

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba 500-50mcg/dose

•

ADVAIR HFA – fluticasone-salmeterolinhal aerosol 45-21 mcg/act

•


•

2018



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•

albuterol sulfate syrup 2 mg/5mlANORO ELLIPTA – umeclidinium-

vilanterol aero powd ba 62.5-25 mcg/inh

•

ARNUITY ELLIPTA – fluticasonefuroate aerosol powder breath activ100 mcg/act

•

ARNUITY ELLIPTA – fluticasonefuroate aerosol powder breath activ200 mcg/act

•

ASMANEX HFA – mometasone furoateinhal aerosol suspension 100 mcg/act

•

ASMANEX HFA – mometasone furoateinhal aerosol suspension 200 mcg/act

•

ASMANEX TWISTHALER 120 ME –mometasone furoate inhal powd 220mcg/inh (breath activated)

•

ASMANEX TWISTHALER 30 MET –mometasone furoate inhal powd 110mcg/inh (breath activated)

•


•


•

BREO ELLIPTA – fluticasone furoate-vilanterol aero powd ba 100-25 mcg/inh

•

BREO ELLIPTA – fluticasone furoate-vilanterol aero powd ba 200-25 mcg/inh

•

DULERA – mometasone furoate-formoterol fumarate aerosol 100-5mcg/act

•

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DULERA – mometasone furoate-formoterol fumarate aerosol 200-5mcg/act

•

FLOVENT DISKUS – fluticasonepropionate aer pow ba 50 mcg/blister

•


•


•

FLOVENT HFA – fluticasonepropionate hfa inhal aero 44 mcg/act(50/valve)

•

FLOVENT HFA – fluticasonepropionate hfa inhal aer 110 mcg/act(125/valve)

•

FLOVENT HFA – fluticasonepropionate hfa inhal aer 220 mcg/act(250/valve)

•

FLUTICASONE PROPIONATE/SA –fluticasone-salmeterol aer powder ba55-14 mcg/act

•


•


•

INCRUSE ELLIPTA – umeclidinium braero powd breath act 62.5 mcg/inh(base eq)

•

ipratropium bromide inhal soln0.02%

•

montelukast sodium chew tab 4 mg(base equiv) (Singulair)

montelukast sodium chew tab 5 mg(base equiv) (Singulair)

2018



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montelukast sodium tab 10 mg (baseequiv) (Singulair)

PROAIR HFA – albuterol sulfate inhalaero 108 mcg/act (90mcg base equiv)

•

PROAIR RESPICLICK – albuterolsulfate aer pow ba 108 mcg/act (90mcg base equiv)

•

QVAR – beclomethasone diprop inhalaero soln 40 mcg/act (50/valve)

•

QVAR – beclomethasone diprop inhalaero soln 80 mcg/act (100/valve)

•

SEREVENT DISKUS – salmeterolxinafoate aer pow ba 50 mcg/dose(base equiv)

•

SPIRIVA HANDIHALER – tiotropiumbromide monohydrate inhal cap 18mcg (base equiv)

•

SPIRIVA RESPIMAT – tiotropiumbromide monohydrate inhal aerosol1.25 mcg/act

•

SPIRIVA RESPIMAT – tiotropiumbromide monohydrate inhal aerosol2.5 mcg/act

•

STIOLTO RESPIMAT – tiotropium br-olodaterol inhal aero soln 2.5-2.5mcg/act

•

STRIVERDI RESPIMAT – olodaterolhcl inhal aerosol soln 2.5 mcg/act(base equiv)

•

SYMBICORT – budesonide-formoterolfumarate dihyd aerosol 80-4.5 mcg/act

•

SYMBICORT – budesonide-formoterolfumarate dihyd aerosol 160-4.5 mcg/act

•

theophylline tab er 12hr 100 mgVENTOLIN HFA – albuterol sulfate

inhal aero 108 mcg/act (90mcg baseequiv)

•

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OTHER RESPIRATORY DRUGSKALYDECO – ivacaftor tab 150 mg • • •KALYDECO – ivacaftor packet 50 mg • • •KALYDECO – ivacaftor packet 75 mg • • •PULMOZYME – dornase alfa inhal soln

1 mg/ml•

GASTROINTESTINAL DRUGSLAXATIVESlactulose solution 10 gm/15mlpeg 3350-kcl-sod bicarb-nacl for soln

420 gm (Nulytely/flavor pack)peg 3350-kcl-na bicarb-nacl-na

sulfate for soln 236 gm (Golytely)peg 3350-kcl-na bicarb-nacl-na

sulfate for soln 240 gm (Colyte-flavor packs)

polyethylene glycol 3350 oralpowder

ULCER/GERDcimetidine tab 300 mgcimetidine tab 400 mgdicyclomine hcl cap 10 mg (Bentyl)dicyclomine hcl tab 20 mg (Bentyl)famotidine tab 40 mg (Pepcid)misoprostol tab 100 mcg (Cytotec)misoprostol tab 200 mcg (Cytotec)nizatidine cap 150 mgomeprazole cap delayed release

10 mg (Prilosec)•

omeprazole cap delayed release20 mg (Prilosec)

•

omeprazole cap delayed release40 mg (Prilosec)

•

pantoprazole sodium ec tab 20 mg(base equiv) (Protonix)

•

2018



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pantoprazole sodium ec tab 40 mg(base equiv) (Protonix)

•

ranitidine hcl syrup 15 mg/ml(75 mg/5ml)

ranitidine hcl tab 300 mg (Zantac)NAUSEA AND VOMITINGEMEND – aprepitant for oral susp 125

mg (125 mg/5ml)•

EMEND – aprepitant capsule 40 mg •EMEND – aprepitant capsule 125 mg •ondansetron hcl tab 4 mg (Zofran) •ondansetron orally disintegrating tab

4 mg (Zofran odt)•

DIGESTIVE ENZYMESZENPEP – pancrelipase (lip-prot-amyl)

dr cap 3000-10000-16000 unitZENPEP – pancrelipase (lip-prot-amyl)







dr cap 40000-136000-218000 unitOTHER GASTROINTESTINAL DRUGSAPRISO – mesalamine cap er 24hr

0.375 gmCANASA – mesalamine suppos 1000

mgCHENODAL – chenodiol tab 250 mg •

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lactulose (encephalopathy) solution10 gm/15ml

metoclopramide hcl soln 5 mg/5ml(10 mg/10ml)

metoclopramide hcl tab 5 mg(Reglan)

metoclopramide hcl tab 10 mg(Reglan)

VIBERZI – eluxadoline tab 75 mg •VIBERZI – eluxadoline tab 100 mg •GENITOURINARY DRUGSURINARY TRACT SPASMSbethanechol chloride tab 5 mg

(Urecholine)oxybutynin chloride syrup 5 mg/5mlVAGINAL PRODUCTSESTRACE – estradiol vaginal cream

0.1 mg/gmOTHER GENITOURINARY DRUGSalfuzosin hcl tab er 24hr 10 mg

(Uroxatral)CYSTAGON – cysteamine bitartrate

cap 50 mg•

CYSTAGON – cysteamine bitartratecap 150 mg

•

finasteride tab 5 mg (Proscar)tamsulosin hcl cap 0.4 mg (Flomax)CENTRAL NERVOUS SYSTEM DRUGSANXIETYalprazolam tab 0.25 mg (Xanax)alprazolam tab 0.5 mg (Xanax)alprazolam tab 1 mg (Xanax)alprazolam tab 2 mg (Xanax)buspirone hcl tab 5 mgbuspirone hcl tab 10 mg

2018



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buspirone hcl tab 15 mgchlordiazepoxide hcl cap 5 mgchlordiazepoxide hcl cap 10 mgchlordiazepoxide hcl cap 25 mgclorazepate dipotassium tab 3.75 mg

(Tranxene t)clorazepate dipotassium tab 7.5 mg

(Tranxene t)diazepam tab 2 mg (Valium)diazepam tab 5 mg (Valium)diazepam tab 10 mg (Valium)hydroxyzine hcl syrup 10 mg/5mlhydroxyzine hcl tab 10 mghydroxyzine hcl tab 25 mghydroxyzine hcl tab 50 mghydroxyzine pamoate cap 25 mg

(Vistaril)hydroxyzine pamoate cap 50 mg

(Vistaril)lorazepam tab 0.5 mg (Ativan) •lorazepam tab 1 mg (Ativan) •lorazepam tab 2 mg (Ativan) •DEPRESSIONamitriptyline hcl tab 10 mgamitriptyline hcl tab 25 mgamitriptyline hcl tab 50 mgamitriptyline hcl tab 75 mgamitriptyline hcl tab 100 mgbupropion hcl tab er 12hr 100 mg

(Wellbutrin sr)bupropion hcl tab er 12hr 150 mg

(Wellbutrin sr)citalopram hydrobromide tab 10 mg

(base equiv) (Celexa)

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citalopram hydrobromide tab 20 mg(base equiv) (Celexa)

citalopram hydrobromide tab 40 mg(base equiv) (Celexa)

doxepin hcl cap 10 mgdoxepin hcl cap 25 mgdoxepin hcl conc 10 mg/mlescitalopram oxalate tab 5 mg (base

equiv) (Lexapro)escitalopram oxalate tab 10 mg

(base equiv) (Lexapro)escitalopram oxalate tab 20 mg

(base equiv) (Lexapro)fluoxetine hcl cap 10 mg (Prozac)fluoxetine hcl cap 20 mg (Prozac)fluoxetine hcl cap 40 mg (Prozac)fluoxetine hcl solution 20 mg/5mlfluoxetine hcl tab 10 mgimipramine hcl tab 10 mg (Tofranil)imipramine hcl tab 25 mg (Tofranil)imipramine hcl tab 50 mg (Tofranil)mirtazapine tab 15 mg (Remeron)mirtazapine tab 30 mg (Remeron)mirtazapine tab 45 mg (Remeron)nortriptyline hcl cap 10 mg (Pamelor)nortriptyline hcl cap 25 mg (Pamelor)nortriptyline hcl cap 50 mg (Pamelor)nortriptyline hcl cap 75 mg (Pamelor)paroxetine hcl tab 10 mg (Paxil)paroxetine hcl tab 20 mg (Paxil)paroxetine hcl tab 30 mg (Paxil)paroxetine hcl tab 40 mg (Paxil)sertraline hcl tab 25 mg (Zoloft)sertraline hcl tab 50 mg (Zoloft)

2018



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sertraline hcl tab 100 mg (Zoloft)trazodone hcl tab 50 mgtrazodone hcl tab 100 mgtrazodone hcl tab 150 mgvenlafaxine hcl cap er 24hr 37.5 mg

(base equivalent) (Effexor xr)venlafaxine hcl cap er 24hr 75 mg

(base equivalent) (Effexor xr)venlafaxine hcl cap er 24hr 150 mg

(base equivalent) (Effexor xr)PSYCHOTIC AND BIPOLAR DISORDERSFLUPHENAZINE HCL – fluphenazine

hcl elixir 2.5 mg/5mlFLUPHENAZINE HCL – fluphenazine

hcl oral conc 5 mg/mlfluphenazine hcl tab 1 mgfluphenazine hcl tab 2.5 mgfluphenazine hcl tab 5 mgfluphenazine hcl tab 10 mghaloperidol lactate oral conc 2 mg/mlhaloperidol tab 0.5 mghaloperidol tab 1 mghaloperidol tab 2 mglithium carbonate cap 150 mg

(Lithium carbonate)lithium carbonate cap 300 mglithium carbonate cap 600 mg

(Lithium carbonate)lithium carbonate tab 300 mgolanzapine tab 2.5 mg (Zyprexa) •olanzapine tab 5 mg (Zyprexa) •olanzapine tab 7.5 mg (Zyprexa) •olanzapine tab 10 mg (Zyprexa) •prochlorperazine maleate tab 5 mg

(base equivalent) (Compazine)

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prochlorperazine maleate tab 10 mg(base equivalent) (Compazine)

quetiapine fumarate tab 25 mg(Seroquel)

•


•


•

risperidone tab 0.25 mg (Risperdal) •risperidone tab 0.5 mg (Risperdal) •risperidone tab 1 mg (Risperdal) •risperidone tab 2 mg (Risperdal) •risperidone tab 3 mg (Risperdal) •risperidone tab 4 mg (Risperdal) •SLEEP AIDSestazolam tab 1 mgestazolam tab 2 mgphenobarbital tab 16.2 mgphenobarbital tab 32.4 mgtemazepam cap 15 mg (Restoril)temazepam cap 30 mg (Restoril)zaleplon cap 5 mg (Sonata) •zaleplon cap 10 mg (Sonata) •zolpidem tartrate tab 5 mg (Ambien) •zolpidem tartrate tab 10 mg (Ambien) •MULTIPLE SCLEROSISAUBAGIO – teriflunomide tab 7 mg • •AUBAGIO – teriflunomide tab 14 mg • •AVONEX – interferon beta-1a im

prefilled syringe kit 30 mcg/0.5ml• •

AVONEX – interferon beta-1a for im injkit 30mcg (33mcg(6.6 mu)/vial)

• •

AVONEX PEN – interferon beta-1a imauto-injector kit 30 mcg/0.5ml

• •

2018



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BETASERON – interferon beta-1b forinj kit 0.3 mg

• •

COPAXONE – glatiramer acetate solnprefilled syringe 20 mg/ml

• •

COPAXONE – glatiramer acetate solnprefilled syringe 40 mg/ml

• •

GILENYA – fingolimod hcl cap 0.5 mg(base equiv)

• •

PLEGRIDY – peginterferon beta-1asoln pen-injector 125 mcg/0.5ml

• •

PLEGRIDY – peginterferon beta-1asoln prefilled syringe 125 mcg/0.5ml

• •

PLEGRIDY STARTER PACK –peginterferon beta-1a soln pen-inj 63& 94 mcg/0.5ml pack

• •

PLEGRIDY STARTER PACK –peginterferon beta-1a soln pref syr 63& 94 mcg/0.5ml pack

• •

REBIF – interferon beta-1a soln pref syr22 mcg/0.5ml (12mu/ml)

• •

REBIF – interferon beta-1a soln pref syr44 mcg/0.5ml (24mu/ml)

• •

REBIF REBIDOSE – interferon beta-1asoln auto-inj 22 mcg/0.5ml (12mu/ml)

• •

REBIF REBIDOSE – interferon beta-1asoln auto-inj 44 mcg/0.5ml (24mu/ml)

• •

REBIF REBIDOSE TITRATION –interferon beta-1a auto-inj 6x8.8mcg/0.2ml & 6x22 mcg/0.5ml

• •

REBIF TITRATION PACK – interferonbeta-1a pref syr 6x8.8 mcg/0.2ml &6x22 mcg/0.5ml

• •

TECFIDERA – dimethyl fumaratecapsule delayed release 120 mg

• •

TECFIDERA – dimethyl fumaratecapsule delayed release 240 mg

• •

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TECFIDERA STARTER PACK –dimethyl fumarate capsule dr starterpack 120 mg & 240 mg

• •

OTHER CENTRAL NERVOUS SYSTEM DRUGSCHANTIX – varenicline tartrate tab 0.5

mg (base equiv)CHANTIX – varenicline tartrate tab 1

mg (base equiv)CHANTIX CONTINUING MONTH –

varenicline tartrate tab 1 mg (baseequiv)

CHANTIX STARTING MONTH PA –varenicline tartrate tab 0.5 mg x 11 &tab 1 mg x 42 pack

donepezil hydrochloride tab 5 mg(Aricept)

donepezil hydrochloride tab 10 mg(Aricept)

NICOTROL INHALER – nicotine inhalersystem 10 mg (4 mg delivered)

NICOTROL NS – nicotine nasal spray10 mg/ml (0.5 mg/spray)

NUEDEXTA – dextromethorphan hbr-quinidine sulfate cap 20-10 mg

PAIN RELIEF DRUGSNARCOTIC DRUGSacetaminophen w/ codeine soln

120-12 mg/5mlacetaminophen w/ codeine tab

300-15 mg (Tylenol/codeine)acetaminophen w/ codeine tab

300-30 mg (Tylenol/codeine #3)acetaminophen w/ codeine tab

300-60 mg (Tylenol/codeine #4)hydrocodone-acetaminophen tab

10-325 mg (Norco)

2018



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hydrocodone-acetaminophen tab5-325 mg (Norco)

hydrocodone-acetaminophen tab7.5-325 mg (Norco)

hydrocodone-ibuprofen tab7.5-200 mg (Vicoprofen)

hydromorphone hcl tab 2 mg(Dilaudid)

hydromorphone hcl tab 4 mg(Dilaudid)

methadone hcl tab for oral susp40 mg

methadone hcl tab 5 mg (Dolophinehcl)

methadone hcl tab 10 mg (Dolophine)MORPHINE SULFATE – morphine

sulfate tab 15 mgMORPHINE SULFATE – morphine

sulfate tab 30 mgoxycodone hcl tab 5 mg (Roxicodone)oxycodone w/ acetaminophen tab

5-325 mg (Percocet)OXYCONTIN – oxycodone hcl tab er

12hr deter 10 mg•

OXYCONTIN – oxycodone hcl tab er12hr deter 15 mg

•


•


•


•


•


•

tramadol hcl tab 50 mg (Ultram) •

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tramadol-acetaminophen tab37.5-325 mg (Ultracet)

RHEUMATOID AND OSTEOARTHRITISdiclofenac sodium tab delayed

release 50 mgdiclofenac sodium tab delayed

release 75 mgENBREL – etanercept for

subcutaneous inj 25 mg• • •

ENBREL – etanercept subcutaneoussoln prefilled syringe 25 mg/0.5ml

• • •

ENBREL – etanercept subcutaneoussoln prefilled syringe 50 mg/ml

• • •

ENBREL MINI – etanerceptsubcutaneous solution cartridge 50mg/ml

• • •

ENBREL SURECLICK – etanerceptsubcutaneous solution auto-injector50 mg/ml

• • •

flurbiprofen tab 50 mgflurbiprofen tab 100 mgHUMIRA – adalimumab prefilled

syringe kit 10 mg/0.2ml• • •

HUMIRA – adalimumab prefilledsyringe kit 20 mg/0.4ml

• • •

HUMIRA – adalimumab prefilledsyringe kit 40 mg/0.8ml

• • •

HUMIRA PEDIATRIC CROHNS D –adalimumab prefilled syringe kit 40mg/0.8ml

• • •

HUMIRA PEN – adalimumab pen-injector kit 40 mg/0.8ml

• • •

HUMIRA PEN-CROHNS DISEASE– adalimumab pen-injector kit 40mg/0.8ml

• • •

HUMIRA PEN-PSORIASIS STAR– adalimumab pen-injector kit 40mg/0.8ml

• • •

2018



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ibuprofen tab 400 mgibuprofen tab 600 mgibuprofen tab 800 mgindomethacin cap 25 mgindomethacin cap 50 mgketoprofen cap 50 mgketoprofen cap 75 mgketorolac tromethamine tab 10 mg •meloxicam tab 7.5 mg (Mobic)meloxicam tab 15 mg (Mobic)nabumetone tab 500 mgnabumetone tab 750 mgnaproxen sodium tab 275 mg

(Anaprox)naproxen sodium tab 550 mg

(Anaprox ds)naproxen tab ec 375 mg (Ec-

naprosyn)naproxen tab ec 500 mg (Ec-

naprosyn)naproxen tab 250 mg (Naprosyn)naproxen tab 375 mg (Naprosyn)naproxen tab 500 mg (Naprosyn)OTEZLA – apremilast tab starter

therapy pack 10 mg & 20 mg & 30 mg• • •

OTEZLA – apremilast tab 30 mg • • •SIMPONI – golimumab subcutaneous

soln auto-injector 50 mg/0.5ml• • •

SIMPONI – golimumab subcutaneoussoln auto-injector 100 mg/ml

• • •

SIMPONI – golimumab subcutaneoussoln prefilled syringe 50 mg/0.5ml

• • •

SIMPONI – golimumab subcutaneoussoln prefilled syringe 100 mg/ml

• • •

sulindac tab 150 mg

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sulindac tab 200 mgMIGRAINE HEADACHESsumatriptan succinate tab 25 mg

(Imitrex)•

sumatriptan succinate tab 50 mg(Imitrex)

•

sumatriptan succinate tab 100 mg(Imitrex)

•

GOUTallopurinol tab 100 mg (Zyloprim)allopurinol tab 300 mg (Zyloprim)NEUROMUSCULAR DRUGSSEIZURESclonazepam tab 0.5 mg (Klonopin)clonazepam tab 1 mg (Klonopin)clonazepam tab 2 mg (Klonopin)DIASTAT ACUDIAL – diazepam rectal

gel delivery system 10 mgDIASTAT ACUDIAL – diazepam rectal

gel delivery system 20 mgDIASTAT PEDIATRIC – diazepam

rectal gel delivery system 2.5 mgdivalproex sodium tab delayed

release 125 mg (Depakote)divalproex sodium tab delayed

release 250 mg (Depakote)gabapentin cap 100 mg (Neurontin)gabapentin cap 300 mg (Neurontin)gabapentin cap 400 mg (Neurontin)lamotrigine tab 25 mg (Lamictal)lamotrigine tab 100 mg (Lamictal)lamotrigine tab 150 mg (Lamictal)lamotrigine tab 200 mg (Lamictal)levetiracetam tab 250 mg (Keppra)oxcarbazepine tab 150 mg (Trileptal)

2018



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primidone tab 50 mg (Mysoline)SABRIL – vigabatrin tab 500 mg •SABRIL – vigabatrin powd pack 500 mg •topiramate tab 25 mg (Topamax)topiramate tab 50 mg (Topamax)topiramate tab 100 mg (Topamax)topiramate tab 200 mg (Topamax)zonisamide cap 25 mg (Zonegran)PARKINSON'S DISEASEamantadine hcl syrup 50 mg/5mlbenztropine mesylate tab 0.5 mgbenztropine mesylate tab 1 mgbenztropine mesylate tab 2 mgcarbidopa & levodopa tab 10-100 mg

(Sinemet)pramipexole dihydrochloride tab

0.125 mg (Mirapex)pramipexole dihydrochloride tab




1 mg (Mirapex)pramipexole dihydrochloride tab

1.5 mg (Mirapex)ropinirole hydrochloride tab 0.25 mg

(Requip)ropinirole hydrochloride tab 0.5 mg

(Requip)ropinirole hydrochloride tab 1 mg

(Requip)ropinirole hydrochloride tab 2 mg

(Requip)

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ropinirole hydrochloride tab 3 mg(Requip)



trihexyphenidyl hcl tab 2 mgtrihexyphenidyl hcl tab 5 mgMUSCLE RELAXANTSbaclofen tab 10 mgcarisoprodol tab 350 mg (Soma)chlorzoxazone tab 500 mg (Parafon

forte dsc)cyclobenzaprine hcl tab 5 mgcyclobenzaprine hcl tab 10 mgmethocarbamol tab 500 mg (Robaxin)methocarbamol tab 750 mg

(Robaxin-750)tizanidine hcl tab 2 mg (base

equivalent)•

tizanidine hcl tab 4 mg (baseequivalent) (Zanaflex)

•

SUPPLEMENTSVITAMINSergocalciferol cap 50000 unit

(Drisdol)MEPHYTON – phytonadione tab 5 mgMULTIVITAMINSKOSHER PRENATAL PLUS IRON –

prenatal vit w/ iron carbonyl-fa tab30-1 mg

PRENATAL PLUS – prenatal vit w/ fefumarate-fa tab 27-1 mg

PRENATAL VITAMINS PLUS LO –prenatal vit w/ fe fumarate-fa tab 27-1mg

2018



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MINERALS AND ELECTROLYTESpotassium chloride

microencapsulated crys er tab 10meq

potassium chloridemicroencapsulated crys er tab 20meq

potassium chloride tab er 8 meq(600 mg)

potassium chloride tab er 10 meq (K-tab)

BLOOD MODIFYING DRUGSADVATE – antihemophilic factor rahf-

pfm for inj 250 unit•

ADVATE – antihemophilic factor rahf-pfm for inj 500 unit

•


•


•


•


•


•

ADYNOVATE – antihemophilic factorrecomb pegylated for inj 250 unit

•


•


•


•


•

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•


•

AFSTYLA – antihemophilic fact rcmbsingle chain for inj kit 250 unit

•


•


•


•


•


•


•

ALPHANATE/VON WILLEBRAND –antihemophilic factor/vwf (human) forinj 250 unit

•


•


•


•


•

ALPHANINE SD – coagulation factor ixfor inj 500 unit

•


•

2018



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•

ALPROLIX – coagulation factor ix(recomb) (rfixfc) for inj 250 unit

•


•


•


•


•


•

BEBULIN – factor ix complex for inj200-1200 unit

•

BENEFIX – coagulation factor ix(recombinant) for inj kit 250 unit

•


•


•


•


•

BRILINTA – ticagrelor tab 60 mgBRILINTA – ticagrelor tab 90 mgCEREZYME – imiglucerase for inj 400

unit•

cilostazol tab 50 mg (Pletal)cilostazol tab 100 mg (Pletal)clopidogrel bisulfate tab 75 mg (base

equiv) (Plavix)COAGADEX – coagulation factor x

(human) for inj 250 unit•

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COAGADEX – coagulation factor x(human) for inj 500 unit

•

CORIFACT – factor xiii concentrate(human) for inj kit 1000-1600 unit

•

cyanocobalamin inj 1000 mcg/mldipyridamole tab 25 mg (Persantine)ELIQUIS – apixaban tab 2.5 mg •ELIQUIS – apixaban tab 5 mg •ELOCTATE – antihemophilic factor

(recomb) rfviiifc for inj 250 unit•

ELOCTATE – antihemophilic factor(recomb) rfviiifc for inj 500 unit

•


•


•


•


•


•


•


•


•

FEIBA – antiinhibitor coagulantcomplex for inj

•

FIRAZYR – icatibant acetate inj 30mg/3ml (base equivalent)

• •

folic acid tab 1 mgGRANIX – tbo-filgrastim soln prefilled

syringe 300 mcg/0.5ml•

GRANIX – tbo-filgrastim soln prefilledsyringe 480 mcg/0.8ml

•

2018



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HELIXATE FS – antihemophilic factor(recombinant) for inj kit 250 unit

•


•


•


•


•

HEMOFIL M – antihemophilic factor(human) for inj 250 unit

•


•


•


•

HUMATE-P – antihemophilic factor/vwf(human) for inj 250-600 unit

•


•


•

IDELVION – coagulation factor ix(recomb) (rix-fp) for inj 250 unit

•


•


•


•

IXINITY – coagulation factor ix(recombinant) for inj 250 unit

•


•

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•


•


•


•

KOATE – antihemophilic factor (human)for inj 250 unit

•


•


•

KOATE-DVI – antihemophilic factor(human) for inj 250 unit

•


•


•

KOGENATE FS – antihemophilic factor(recombinant) for inj kit 250 unit

•


•


•


•


•

KOGENATE FS BIO-SET –antihemophilic factor (recombinant)for inj kit 250 unit

•


•

2018



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•


•


•

KOVALTRY – antihemophilic factor(recombinant) for inj 250 unit

•


•


•


•


•

MONOCLATE-P – antihemophilic factor(human) for inj kit 1000 unit

•

MONOCLATE-P – antihemophilic factor(human) for inj kit 1500 unit

•

MONONINE – coagulation factor ix forinj 1000 unit

•

NEUPOGEN – filgrastim soln prefilledsyringe 300 mcg/0.5ml

•

NEUPOGEN – filgrastim soln prefilledsyringe 480 mcg/0.8ml (600 mcg/ml)

•

NEUPOGEN – filgrastim inj 300 mcg/ml •NEUPOGEN – filgrastim inj 480

mcg/1.6ml (300 mcg/ml)•

NOVOEIGHT – antihemophilic factor(recombinant) for inj 250 unit

•


•


•

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•


•


•

NOVOSEVEN RT – coagulation factorviia (recomb) for inj 1 mg (1000 mcg)

•


•


•


•

NUWIQ – antihemophilic factor (bdd-rfviii) for inj 250 unit

•


•


•


•


•


•


•

NUWIQ – antihemophilic factor (bdd-rfviii) for inj kit 250 unit

•


•


•


•

2018



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•


•


•

OBIZUR – antihemophilic factor(recomb porc) rpfviii for inj 500 unit

•

pentoxifylline tab er 400 mgPROCRIT – epoetin alfa inj 2000 unit/

ml• •

PROCRIT – epoetin alfa inj 3000 unit/ml

• •


• •


• •


• •


• •

PROFILNINE – factor ix complex for inj500 unit

•


•


•

PROFILNINE SD – factor ix complexfor inj 500 unit

•


•


•

RECOMBINATE – antihemophilic factor(recombinant) for inj 220-400 unit

•


•

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•


•


•

RIXUBIS – coagulation factor ix(recombinant) for inj 250 unit

•


•


•


•


•

TRETTEN – coagulation factor xiii a-subunit for inj 2000-3125 unit

•

VONVENDI – von willebrand factor(recombinant) for inj 650 unit

•

VONVENDI – von willebrand factor(recombinant) for inj 1300 unit

•

warfarin sodium tab 1 mg (Coumadin)warfarin sodium tab 2 mg (Coumadin)warfarin sodium tab 2.5 mg

(Coumadin)warfarin sodium tab 3 mg (Coumadin)warfarin sodium tab 4 mg (Coumadin)warfarin sodium tab 5 mg (Coumadin)warfarin sodium tab 6 mg (Coumadin)warfarin sodium tab 7.5 mg

(Coumadin)warfarin sodium tab 10 mg

(Coumadin)WILATE – antihemophilic factor/vwf

(human) for inj 500-500 unit kit•

2018



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WILATE – antihemophilic factor/vwf(human) for inj 1000-1000 unit kit

•

XARELTO – rivaroxaban tab 10 mg •XARELTO – rivaroxaban tab 15 mg •XARELTO – rivaroxaban tab 20 mg •XARELTO STARTER PACK –

rivaroxaban tab starter therapy pack15 mg & 20 mg

•

XYNTHA – antihemophilic factorrecombinant paf for inj kit 250 unit

•


•


•


•

XYNTHA SOLOFUSE – antihemophilicfactor recombinant paf for inj kit 250unit

•


•


•


•


•

ZARXIO – filgrastim-sndz soln prefilledsyringe 300 mcg/0.5ml

•

ZARXIO – filgrastim-sndz soln prefilledsyringe 480 mcg/0.8ml

•

TOPICAL PRODUCTSEYE

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Anti-infectivesBACITRACIN – bacitracin ophth oint

500 unit/gmbacitracin-polymyxin b ophth ointciprofloxacin hcl ophth soln 0.3%

(Ciloxan)erythromycin ophth oint 5 mg/gmgentamicin sulfate ophth soln 0.3%

(Garamycin)NATACYN – natamycin ophth susp 5%ofloxacin ophth soln 0.3% (Ocuflox)polymyxin b-trimethoprim ophth

soln 10000 unit/ml-0.1% (Polytrim)tobramycin ophth soln 0.3% (Tobrex)Steroids and Combination ProductsDEXAMETHASONE SODIUM PHOS –

dexamethasone sodium phosphateophth soln 0.1%

neomycin-polymyxin-dexamethasone ophth oint 0.1%(Maxitrol)

neomycin-polymyxin-dexamethasone ophth susp 0.1%(Maxitrol)

sulfacetamide sodium-prednisoloneophth soln 10-0.23(0.25)%

Glaucomabrimonidine tartrate ophth soln 0.2%carteolol hcl ophth soln 1%dorzolamide hcl-timolol maleate

ophth soln 22.3-6.8 mg/ml (Cosopt)latanoprost ophth soln 0.005%

(Xalatan)•

levobunolol hcl ophth soln 0.5%(Betagan)

2018



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timolol maleate ophth soln 0.25%(Timoptic)

timolol maleate ophth soln 0.5%(Timoptic)

Other Eye Productscromolyn sodium ophth soln 4%cyclopentolate hcl ophth soln 1%

(Cyclogyl)diclofenac sodium ophth soln 0.1%ketorolac tromethamine ophth soln

0.5% (Acular)proparacaine hcl ophth soln 0.5%

(Alcaine)tetracaine hcl ophth soln 0.5%tropicamide ophth soln 0.5%tropicamide ophth soln 1%

(Mydriacyl)MOUTH AND THROAT (LOCAL)chlorhexidine gluconate soln 0.12%

(Peridex)lidocaine hcl viscous soln 2%ANORECTAL AGENTSCORTIFOAM – hydrocortisone acetate

rectal foam 10% (90 mg/dose)hydrocortisone rectal cream 2.5%

(Anusol-hc)SKIN CONDITIONS/PRODUCTSAcneFINACEA – azelaic acid foam 15%FINACEA – azelaic acid gel 15%SOOLANTRA – ivermectin cream 1%TAZORAC – tazarotene cream 0.05%TAZORAC – tazarotene gel 0.05%TAZORAC – tazarotene gel 0.1%Anti-infectives

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mupirocin oint 2% (Bactroban)silver sulfadiazine cream 1%

(Silvadene)Corticosteroidshydrocortisone cream 2.5%hydrocortisone oint 2.5%triamcinolone acetonide cream

0.025%triamcinolone acetonide cream 0.1%triamcinolone acetonide cream 0.5%triamcinolone acetonide oint 0.025%triamcinolone acetonide oint 0.1%Other Skin ProductsCOSENTYX – secukinumab

subcutaneous soln prefilled syringe150 mg/ml

• • •

COSENTYX SENSOREADY PEN –secukinumab subcutaneous solnauto-injector 150 mg/ml

• • •

lidocaine hcl gel 2% •lidocaine hcl soln 4% (Xylocaine) •selenium sulfide lotion 2.5%STELARA – ustekinumab inj 45

mg/0.5ml• • •

STELARA – ustekinumab soln prefilledsyringe 45 mg/0.5ml

• • •

STELARA – ustekinumab soln prefilledsyringe 90 mg/ml

• • •

VALCHLOR – mechlorethamine hcl gel0.016% (base equivalent)

•

MISCELLANEOUS CATEGORIESDIABETIC SUPPLIESTEST STRIPS – ASCENSIA BREEZE

2, CONTOUR, CONTOUR NEXT•

INSULIN PEN NEEDLES – VARIOUS •

2018



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INSULIN SYRINGES – VARIOUS •LANCETS – VARIOUSRESPIRATORY INHALER-ASSIST DEVICESBREATHERITE – spacer/aerosol-

holding chambers - deviceMISCELLANEOUS DRUGSCHEMET – succimer cap 100 mgDEPEN TITRATABS – penicillamine tab

250 mg•

NARCAN – naloxone hcl nasal spray 4mg/0.1ml

RAPAMUNE – sirolimus oral soln 1 mg/ml

REVLIMID – lenalidomide caps 2.5 mg • • •REVLIMID – lenalidomide cap 5 mg • • •REVLIMID – lenalidomide cap 10 mg • • •REVLIMID – lenalidomide cap 15 mg • • •REVLIMID – lenalidomide cap 20 mg • • •REVLIMID – lenalidomide cap 25 mg • • •THALOMID – thalidomide cap 50 mg • • •THALOMID – thalidomide cap 100 mg • • •THALOMID – thalidomide cap 150 mg • • •THALOMID – thalidomide cap 200 mg • • •

2018



INDEX

Aacebutolol hcl cap 200 mg (Sectral).................................9acebutolol hcl cap 400 mg (Sectral).................................9acetaminophen w/ codeine soln 120-12 mg/5ml........... 18acetaminophen w/ codeine tab 300-15 mg (Tylenol/codeine)............................................................................ 18

acetaminophen w/ codeine tab 300-30 mg (Tylenol/codeine #3).......................................................................18

acetaminophen w/ codeine tab 300-60 mg (Tylenol/codeine #4).......................................................................18

ACTIMMUNE – interferon gamma-1b inj 100 mcg/0.5ml(2000000 unit/0.5ml)........................................................... 3

acyclovir cap 200 mg (Zovirax).........................................2acyclovir tab 400 mg (Zovirax)..........................................2acyclovir tab 800 mg (Zovirax)..........................................2ADCIRCA – tadalafil tab 20 mg (pah)................................11ADVAIR DISKUS – fluticasone-salmeterol aer powder ba100-50 mcg/dose...............................................................12

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba250-50 mcg/dose...............................................................12

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba500-50 mcg/dose...............................................................12

ADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21mcg/act...............................................................................12

ADVAIR HFA – fluticasone-salmeterol inhal aerosol 115-21mcg/act...............................................................................12

ADVAIR HFA – fluticasone-salmeterol inhal aerosol230-21 mcg/act..................................................................13

ADVATE – antihemophilic factor rahf-pfm for inj 250unit......................................................................................22







ADYNOVATE – antihemophilic factor recomb pegylated forinj 250 unit.........................................................................22



ADYNOVATE – antihemophilic factor recomb pegylated forinj 1000 unit.......................................................................22




AFSTYLA – antihemophilic fact rcmb single chain for inj kit250 unit..............................................................................22

AFSTYLA – antihemophilic fact rcmb single chain for inj kit500 unit..............................................................................22

AFSTYLA – antihemophilic fact rcmb single chain for inj kit1000 unit............................................................................22





ALBENZA – albendazole tab 200 mg.................................. 3albuterol sulfate syrup 2 mg/5ml....................................13alendronate sodium tab 5 mg........................................... 7alendronate sodium tab 10 mg......................................... 7alendronate sodium tab 35 mg......................................... 8alendronate sodium tab 70 mg (Fosamax)...................... 8alfuzosin hcl tab er 24hr 10 mg (Uroxatral)................... 15allopurinol tab 100 mg (Zyloprim).................................. 20allopurinol tab 300 mg (Zyloprim).................................. 20ALPHANATE/VON WILLEBRAND – antihemophilic factor/vwf (human) for inj 250 unit..............................................22

ALPHANATE/VON WILLEBRAND – antihemophilic factor/vwf (human) for inj 500 unit..............................................22

ALPHANATE/VON WILLEBRAND – antihemophilic factor/vwf (human) for inj 1000 unit............................................22



ALPHANINE SD – coagulation factor ix for inj 500 unit.....22ALPHANINE SD – coagulation factor ix for inj 1000unit......................................................................................22

ALPHANINE SD – coagulation factor ix for inj 1500unit......................................................................................23

alprazolam tab 0.25 mg (Xanax)......................................15alprazolam tab 0.5 mg (Xanax)........................................15alprazolam tab 1 mg (Xanax)...........................................15alprazolam tab 2 mg (Xanax)...........................................15ALPROLIX – coagulation factor ix (recomb) (rfixfc) for inj250 unit..............................................................................23

2018



ALPROLIX – coagulation factor ix (recomb) (rfixfc) for inj500 unit..............................................................................23

ALPROLIX – coagulation factor ix (recomb) (rfixfc) for inj1000 unit............................................................................23




amantadine hcl syrup 50 mg/5ml....................................21amiloride & hydrochlorothiazide tab 5-50 mg............... 11amiodarone hcl tab 200 mg (Cordarone)....................... 11amitriptyline hcl tab 10 mg..............................................16amitriptyline hcl tab 25 mg..............................................16amitriptyline hcl tab 50 mg..............................................16amitriptyline hcl tab 75 mg..............................................16amitriptyline hcl tab 100 mg............................................16amlodipine besylate tab 2.5 mg (Norvasc).................... 10amlodipine besylate tab 5 mg (Norvasc)....................... 10amlodipine besylate tab 10 mg (Norvasc)..................... 10amoxicillin (trihydrate) cap 250 mg..................................1amoxicillin (trihydrate) cap 500 mg..................................1amoxicillin (trihydrate) for susp 125 mg/5ml...................1amoxicillin (trihydrate) for susp 200 mg/5ml...................1amoxicillin (trihydrate) for susp 250 mg/5ml...................1amoxicillin (trihydrate) for susp 400 mg/5ml...................1amoxicillin (trihydrate) tab 500 mg...................................1amoxicillin (trihydrate) tab 875 mg...................................1anastrozole tab 1 mg (Arimidex).......................................3ANDROGEL PUMP – testosterone td gel 20.25 mg/act(1.62%).................................................................................5

ANDROGEL – testosterone td gel 20.25 mg/1.25gm(1.62%).................................................................................5

ANDROGEL – testosterone td gel 40.5 mg/2.5gm(1.62%).................................................................................5

ANORO ELLIPTA – umeclidinium-vilanterol aero powd ba62.5-25 mcg/inh.................................................................13

APRISO – mesalamine cap er 24hr 0.375 gm...................15ARNUITY ELLIPTA – fluticasone furoate aerosol powderbreath activ 100 mcg/act.................................................. 13

ARNUITY ELLIPTA – fluticasone furoate aerosol powderbreath activ 200 mcg/act.................................................. 13

ASMANEX HFA – mometasone furoate inhal aerosolsuspension 100 mcg/act................................................... 13

ASMANEX HFA – mometasone furoate inhal aerosolsuspension 200 mcg/act................................................... 13

ASMANEX TWISTHALER 120 ME – mometasone furoateinhal powd 220 mcg/inh (breath activated)...................... 13

ASMANEX TWISTHALER 30 MET – mometasone furoateinhal powd 110 mcg/inh (breath activated).......................13

ASMANEX TWISTHALER 30 MET – mometasone furoateinhal powd 220 mcg/inh (breath activated)...................... 13

ASMANEX TWISTHALER 60 MET – mometasone furoateinhal powd 220 mcg/inh (breath activated)...................... 13

atenolol & chlorthalidone tab 50-25 mg (Tenoretic50)........................................................................................ 9

atenolol & chlorthalidone tab 100-25 mg (Tenoretic100)...................................................................................... 9

atenolol tab 25 mg (Tenormin).......................................... 9atenolol tab 50 mg (Tenormin).......................................... 9atenolol tab 100 mg (Tenormin)........................................ 9atorvastatin calcium tab 10 mg (base equivalent)(Lipitor)..............................................................................10

atorvastatin calcium tab 20 mg (base equivalent)(Lipitor)..............................................................................10



ATRIPLA – efavirenz-emtricitabine-tenofovir df tab600-200-300 mg.................................................................. 2

AUBAGIO – teriflunomide tab 7 mg...................................17AUBAGIO – teriflunomide tab 14 mg.................................17AVONEX – interferon beta-1a for im inj kit 30mcg(33mcg(6.6 mu)/vial)......................................................... 17

AVONEX – interferon beta-1a im prefilled syringe kit 30mcg/0.5ml...........................................................................17

AVONEX PEN – interferon beta-1a im auto-injector kit 30mcg/0.5ml...........................................................................17

azithromycin tab 250 mg (Zithromax).............................. 1azithromycin tab 500 mg (Zithromax).............................. 1B

BACITRACIN – bacitracin ophth oint 500 unit/gm............. 27bacitracin-polymyxin b ophth oint..................................27baclofen tab 10 mg...........................................................21BARACLUDE – entecavir oral soln 0.05 mg/ml...................1BEBULIN – factor ix complex for inj 200-1200 unit............23benazepril hcl tab 5 mg..................................................... 8benazepril hcl tab 10 mg (Lotensin).................................8benazepril hcl tab 20 mg (Lotensin).................................8benazepril hcl tab 40 mg (Lotensin).................................8BENEFIX – coagulation factor ix (recombinant) for inj kit250 unit..............................................................................23

BENEFIX – coagulation factor ix (recombinant) for inj kit500 unit..............................................................................23

BENEFIX – coagulation factor ix (recombinant) for inj kit1000 unit............................................................................23



benzonatate cap 200 mg..................................................12benzonatate cap 100 mg (Tessalon perles)................... 12benztropine mesylate tab 0.5 mg....................................21

2018



benztropine mesylate tab 1 mg.......................................21benztropine mesylate tab 2 mg.......................................21BETASERON – interferon beta-1b for inj kit 0.3 mg.......... 18bethanechol chloride tab 5 mg (Urecholine)................. 15bicalutamide tab 50 mg (Casodex)...................................3BILTRICIDE – praziquantel tab 600 mg...............................3bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg(Ziac)....................................................................................9

bisoprolol & hydrochlorothiazide tab 5-6.25 mg(Ziac)....................................................................................9

bisoprolol & hydrochlorothiazide tab 10-6.25 mg(Ziac)....................................................................................9

bisoprolol fumarate tab 5 mg (Zebeta).............................9BREATHERITE – spacer/aerosol-holding chambers -device.................................................................................29

BREO ELLIPTA – fluticasone furoate-vilanterol aero powdba 100-25 mcg/inh............................................................ 13

BREO ELLIPTA – fluticasone furoate-vilanterol aero powdba 200-25 mcg/inh............................................................ 13

BRILINTA – ticagrelor tab 60 mg....................................... 23BRILINTA – ticagrelor tab 90 mg....................................... 23brimonidine tartrate ophth soln 0.2%.............................27bumetanide tab 0.5 mg.................................................... 11bumetanide tab 1 mg........................................................11bupropion hcl tab er 12hr 100 mg (Wellbutrin sr).........16bupropion hcl tab er 12hr 150 mg (Wellbutrin sr).........16buspirone hcl tab 5 mg....................................................15buspirone hcl tab 10 mg..................................................15buspirone hcl tab 15 mg..................................................16C

CANASA – mesalamine suppos 1000 mg......................... 15carbidopa & levodopa tab 10-100 mg (Sinemet)...........21carisoprodol tab 350 mg (Soma).................................... 21carteolol hcl ophth soln 1%............................................ 27carvedilol tab 3.125 mg (Coreg)........................................9carvedilol tab 6.25 mg (Coreg)..........................................9carvedilol tab 12.5 mg (Coreg)..........................................9carvedilol tab 25 mg (Coreg).............................................9cefadroxil cap 500 mg........................................................1CEFTIN – cefuroxime axetil for susp 125 mg/5ml............... 1cephalexin cap 250 mg (Keflex)........................................1cephalexin cap 500 mg (Keflex)........................................1CEREZYME – imiglucerase for inj 400 unit....................... 23CHANTIX CONTINUING MONTH – varenicline tartrate tab1 mg (base equiv).............................................................18

CHANTIX STARTING MONTH PA – varenicline tartratetab 0.5 mg x 11 & tab 1 mg x 42 pack............................. 18

CHANTIX – varenicline tartrate tab 0.5 mg (baseequiv)................................................................................. 18

CHANTIX – varenicline tartrate tab 1 mg (base equiv)......18CHEMET – succimer cap 100 mg......................................29CHENODAL – chenodiol tab 250 mg.................................15

chlordiazepoxide hcl cap 5 mg.......................................16chlordiazepoxide hcl cap 10 mg.....................................16chlordiazepoxide hcl cap 25 mg.....................................16chlorhexidine gluconate soln 0.12% (Peridex)..............28chloroquine phosphate tab 500 mg (Aralen)...................3chlorothiazide tab 500 mg............................................... 11chlorzoxazone tab 500 mg (Parafon forte dsc)............. 21CIALIS – tadalafil tab 2.5 mg............................................. 12CIALIS – tadalafil tab 5 mg................................................ 12CIALIS – tadalafil tab 10 mg.............................................. 12CIALIS – tadalafil tab 20 mg.............................................. 12cilostazol tab 50 mg (Pletal)............................................23cilostazol tab 100 mg (Pletal)..........................................23cimetidine tab 300 mg......................................................14cimetidine tab 400 mg......................................................14ciprofloxacin hcl ophth soln 0.3% (Ciloxan)................. 27ciprofloxacin hcl tab 750 mg (base equiv).......................1ciprofloxacin hcl tab 250 mg (base equiv) (Cipro)..........1ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)..........1citalopram hydrobromide tab 10 mg (base equiv)(Celexa)............................................................................. 16

citalopram hydrobromide tab 20 mg (base equiv)(Celexa)............................................................................. 16

citalopram hydrobromide tab 40 mg (base equiv)(Celexa)............................................................................. 16

clindamycin hcl cap 75 mg (Cleocin)...............................3clindamycin hcl cap 150 mg (Cleocin).............................3clindamycin hcl cap 300 mg (Cleocin).............................3clonazepam tab 0.5 mg (Klonopin).................................20clonazepam tab 1 mg (Klonopin)....................................20clonazepam tab 2 mg (Klonopin)....................................20clonidine hcl tab 0.1 mg (Catapres)............................... 11clonidine hcl tab 0.2 mg (Catapres)............................... 11clonidine hcl tab 0.3 mg (Catapres)............................... 11clopidogrel bisulfate tab 75 mg (base equiv)(Plavix).............................................................................. 23

clorazepate dipotassium tab 3.75 mg (Tranxene t).......16clorazepate dipotassium tab 7.5 mg (Tranxene t).........16COAGADEX – coagulation factor x (human) for inj 250unit......................................................................................23

COAGADEX – coagulation factor x (human) for inj 500unit......................................................................................23

COMBIPATCH – estradiol-norethindrone ace td pttw0.05-0.14 mg/day.................................................................5

COMBIPATCH – estradiol-norethindrone ace td pttw0.05-0.25 mg/day.................................................................5

COPAXONE – glatiramer acetate soln prefilled syringe 20mg/ml..................................................................................18

COPAXONE – glatiramer acetate soln prefilled syringe 40mg/ml..................................................................................18

CORIFACT – factor xiii concentrate (human) for inj kit1000-1600 unit...................................................................23

2018



CORTIFOAM – hydrocortisone acetate rectal foam 10%(90 mg/dose)..................................................................... 28

CORTISONE ACETATE – cortisone acetate tab 25 mg...... 4COSENTYX – secukinumab subcutaneous soln prefilledsyringe 150 mg/ml.............................................................28

COSENTYX SENSOREADY PEN – secukinumabsubcutaneous soln auto-injector 150 mg/ml.....................28

cromolyn sodium ophth soln 4%....................................28cyanocobalamin inj 1000 mcg/ml................................... 23cyclobenzaprine hcl tab 5 mg.........................................21cyclobenzaprine hcl tab 10 mg.......................................21cyclopentolate hcl ophth soln 1% (Cyclogyl)................28CYSTAGON – cysteamine bitartrate cap 50 mg................15CYSTAGON – cysteamine bitartrate cap 150 mg..............15

DDARAPRIM – pyrimethamine tab 25 mg............................. 3DEPEN TITRATABS – penicillamine tab 250 mg.............. 29DESCOVY – emtricitabine-tenofovir alafenamide fumaratetab 200-25 mg..................................................................... 2

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg(Desogen)............................................................................5

DEXAMETHASONE SODIUM PHOS – dexamethasonesodium phosphate ophth soln 0.1%................................. 27

dexamethasone tab 0.5 mg............................................... 4dexamethasone tab 0.75 mg............................................. 4dexamethasone tab 1.5 mg............................................... 4dexamethasone tab 4 mg.................................................. 4dexamethasone tab 6 mg.................................................. 4DIASTAT ACUDIAL – diazepam rectal gel delivery system10 mg.................................................................................20

DIASTAT ACUDIAL – diazepam rectal gel delivery system20 mg.................................................................................20

DIASTAT PEDIATRIC – diazepam rectal gel deliverysystem 2.5 mg...................................................................20

diazepam tab 2 mg (Valium)............................................16diazepam tab 5 mg (Valium)............................................16diazepam tab 10 mg (Valium)..........................................16diclofenac sodium ophth soln 0.1%...............................28diclofenac sodium tab delayed release 50 mg..............19diclofenac sodium tab delayed release 75 mg..............19dicyclomine hcl cap 10 mg (Bentyl)...............................14dicyclomine hcl tab 20 mg (Bentyl)................................14diltiazem hcl cap er 24hr 120 mg....................................10diltiazem hcl coated beads cap er 24hr 120 mg(Cardizem cd)...................................................................10

diltiazem hcl coated beads cap er 24hr 180 mg(Cardizem cd)...................................................................10

diltiazem hcl tab 90 mg....................................................10diltiazem hcl tab 30 mg (Cardizem)................................10diltiazem hcl tab 60 mg (Cardizem)................................10diltiazem hcl tab 120 mg (Cardizem)..............................10dipyridamole tab 25 mg (Persantine)............................. 23

divalproex sodium tab delayed release 125 mg(Depakote)........................................................................ 20

divalproex sodium tab delayed release 250 mg(Depakote)........................................................................ 20

DIVIGEL – estradiol td gel 0.25 mg/0.25gm (0.1%).............5DIVIGEL – estradiol td gel 0.5 mg/0.5gm (0.1%).................5DIVIGEL – estradiol td gel 1 mg/gm (0.1%).........................5donepezil hydrochloride tab 5 mg (Aricept)..................18donepezil hydrochloride tab 10 mg (Aricept)................18dorzolamide hcl-timolol maleate ophth soln 22.3-6.8mg/ml (Cosopt)................................................................ 27

doxazosin mesylate tab 1 mg (Cardura)........................11doxazosin mesylate tab 2 mg (Cardura)........................11doxazosin mesylate tab 4 mg (Cardura)........................11doxazosin mesylate tab 8 mg (Cardura)........................11doxepin hcl cap 10 mg.....................................................16doxepin hcl cap 25 mg.....................................................16doxepin hcl conc 10 mg/ml............................................. 16DULERA – mometasone furoate-formoterol fumarateaerosol 100-5 mcg/act...................................................... 13

DULERA – mometasone furoate-formoterol fumarateaerosol 200-5 mcg/act...................................................... 13

EELIQUIS – apixaban tab 2.5 mg........................................ 23ELIQUIS – apixaban tab 5 mg........................................... 23ELLA – ulipristal acetate tab 30 mg.....................................5ELOCTATE – antihemophilic factor (recomb) rfviiifc for inj250 unit..............................................................................23

ELOCTATE – antihemophilic factor (recomb) rfviiifc for inj500 unit..............................................................................23

ELOCTATE – antihemophilic factor (recomb) rfviiifc for inj750 unit..............................................................................23

ELOCTATE – antihemophilic factor (recomb) rfviiifc for inj1000 unit............................................................................23







EMEND – aprepitant capsule 40 mg..................................15EMEND – aprepitant capsule 125 mg................................15EMEND – aprepitant for oral susp 125 mg (125mg/5ml).............................................................................. 15

enalapril maleate & hydrochlorothiazide tab 5-12.5mg........................................................................................ 8

2018



enalapril maleate & hydrochlorothiazide tab 10-25 mg(Vaseretic)...........................................................................8

enalapril maleate tab 2.5 mg (Vasotec)............................8enalapril maleate tab 5 mg (Vasotec)...............................8enalapril maleate tab 10 mg (Vasotec).............................8enalapril maleate tab 20 mg (Vasotec).............................8ENBREL – etanercept for subcutaneous inj 25 mg........... 19ENBREL – etanercept subcutaneous soln prefilled syringe25 mg/0.5ml.......................................................................19

ENBREL – etanercept subcutaneous soln prefilled syringe50 mg/ml............................................................................19

ENBREL MINI – etanercept subcutaneous solutioncartridge 50 mg/ml............................................................ 19

ENBREL SURECLICK – etanercept subcutaneoussolution auto-injector 50 mg/ml.........................................19

ENTRESTO – sacubitril-valsartan tab 24-26 mg............... 10ENTRESTO – sacubitril-valsartan tab 49-51 mg............... 10ENTRESTO – sacubitril-valsartan tab 97-103 mg............. 10EPCLUSA – sofosbuvir-velpatasvir tab 400-100 mg........... 1EPINEPHRINE (Mylan Products) – epinephrine solutionauto-injector 0.15 mg/0.3ml (1:2000)................................12

EPINEPHRINE (Mylan Products) – epinephrine solutionauto-injector 0.3 mg/0.3ml (1:1000)..................................12

EPIPEN-JR 2-PAK – epinephrine solution auto-injector0.15 mg/0.3ml (1:2000).....................................................12

EPIPEN 2-PAK – epinephrine solution auto-injector 0.3mg/0.3ml (1:1000)............................................................. 12

ergocalciferol cap 50000 unit (Drisdol)..........................21erythromycin ophth oint 5 mg/gm..................................27escitalopram oxalate tab 5 mg (base equiv)(Lexapro)...........................................................................16

escitalopram oxalate tab 10 mg (base equiv)(Lexapro)...........................................................................16

escitalopram oxalate tab 20 mg (base equiv)(Lexapro)...........................................................................16

estazolam tab 1 mg.......................................................... 17estazolam tab 2 mg.......................................................... 17ESTRACE – estradiol vaginal cream 0.1 mg/gm...............15estradiol tab 0.5 mg (Estrace)...........................................5estradiol tab 1 mg (Estrace)..............................................5estradiol tab 2 mg (Estrace)..............................................5F

famotidine tab 40 mg (Pepcid)........................................14FEIBA – antiinhibitor coagulant complex for inj................. 23fenofibrate tab 54 mg (Lofibra)....................................... 10FINACEA – azelaic acid foam 15%................................... 28FINACEA – azelaic acid gel 15%.......................................28finasteride tab 5 mg (Proscar)........................................ 15FIRAZYR – icatibant acetate inj 30 mg/3ml (baseequivalent)......................................................................... 23

FLOVENT DISKUS – fluticasone propionate aer pow ba50 mcg/blister.................................................................... 13

FLOVENT DISKUS – fluticasone propionate aer pow ba100 mcg/blister.................................................................. 13

FLOVENT DISKUS – fluticasone propionate aer pow ba250 mcg/blister.................................................................. 13

FLOVENT HFA – fluticasone propionate hfa inhal aer 110mcg/act (125/valve)...........................................................13

FLOVENT HFA – fluticasone propionate hfa inhal aer 220mcg/act (250/valve)...........................................................13

FLOVENT HFA – fluticasone propionate hfa inhal aero 44mcg/act (50/valve)............................................................. 13

fluconazole for susp 10 mg/ml (Diflucan)........................1fluconazole tab 50 mg (Diflucan)......................................1fluconazole tab 100 mg (Diflucan)....................................1fluconazole tab 150 mg (Diflucan)....................................1fluoxetine hcl cap 10 mg (Prozac)..................................16fluoxetine hcl cap 20 mg (Prozac)..................................16fluoxetine hcl cap 40 mg (Prozac)..................................16fluoxetine hcl solution 20 mg/5ml.................................. 16fluoxetine hcl tab 10 mg.................................................. 16FLUPHENAZINE HCL – fluphenazine hcl elixir 2.5mg/5ml............................................................................... 17

FLUPHENAZINE HCL – fluphenazine hcl oral conc 5 mg/ml........................................................................................17

fluphenazine hcl tab 1 mg............................................... 17fluphenazine hcl tab 2.5 mg............................................ 17fluphenazine hcl tab 5 mg............................................... 17fluphenazine hcl tab 10 mg............................................. 17flurbiprofen tab 50 mg......................................................19flurbiprofen tab 100 mg................................................... 19FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aer powder ba 55-14 mcg/act.........................13

FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aer powder ba 113-14 mcg/act....................... 13

FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aer powder ba 232-14 mcg/act.......................13

fluticasone propionate nasal susp 50 mcg/act(Flonase)........................................................................... 12

folic acid tab 1 mg............................................................23FOLLISTIM AQ – follitropin beta inj 75 unit/0.5ml............... 5FOLLISTIM AQ – follitropin beta inj 300 unit/0.36ml............5FOLLISTIM AQ – follitropin beta inj 600 unit/0.72ml............5FOLLISTIM AQ – follitropin beta inj 900 unit/1.08ml............5fosinopril sodium tab 10 mg............................................. 8fosinopril sodium tab 20 mg............................................. 8fosinopril sodium tab 40 mg............................................. 8furosemide oral soln 10 mg/ml....................................... 11furosemide tab 20 mg (Lasix)......................................... 11furosemide tab 40 mg (Lasix)......................................... 11furosemide tab 80 mg (Lasix)......................................... 11G

gabapentin cap 100 mg (Neurontin)...............................20gabapentin cap 300 mg (Neurontin)...............................20

2018



gabapentin cap 400 mg (Neurontin)...............................20gemfibrozil tab 600 mg (Lopid).......................................10gentamicin sulfate ophth soln 0.3% (Garamycin).........27GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab150-150-200-10 mg.............................................................2

GILENYA – fingolimod hcl cap 0.5 mg (base equiv)..........18glimepiride tab 1 mg (Amaryl)...........................................5glimepiride tab 2 mg (Amaryl)...........................................5glimepiride tab 4 mg (Amaryl)...........................................5glipizide tab er 24hr 2.5 mg (Glucotrol xl)....................... 5glipizide tab er 24hr 5 mg (Glucotrol xl).......................... 5glipizide tab 5 mg (Glucotrol)............................................5glipizide tab 10 mg (Glucotrol)..........................................5GLUCAGON EMERGENCY KIT – glucagon (rdna) for injkit 1 mg................................................................................6

glyburide-metformin tab 1.25-250 mg (Glucovance)...... 6glyburide-metformin tab 2.5-500 mg (Glucovance)........ 6glyburide-metformin tab 5-500 mg (Glucovance)........... 6glyburide micronized tab 1.5 mg (Glynase).....................6glyburide micronized tab 3 mg (Glynase)........................6glyburide micronized tab 6 mg (Glynase)........................6glyburide tab 1.25 mg.........................................................6glyburide tab 2.5 mg...........................................................6glyburide tab 5 mg..............................................................6GRANIX – tbo-filgrastim soln prefilled syringe 300mcg/0.5ml...........................................................................23

GRANIX – tbo-filgrastim soln prefilled syringe 480mcg/0.8ml...........................................................................23

guanfacine hcl tab 1 mg (Tenex).................................... 11guanfacine hcl tab 2 mg (Tenex).................................... 11H

haloperidol lactate oral conc 2 mg/ml............................17haloperidol tab 0.5 mg..................................................... 17haloperidol tab 1 mg........................................................ 17haloperidol tab 2 mg........................................................ 17HARVONI – ledipasvir-sofosbuvir tab 90-400 mg................1HELIXATE FS – antihemophilic factor (recombinant) for injkit 250 unit.........................................................................24

HELIXATE FS – antihemophilic factor (recombinant) for injkit 500 unit.........................................................................24

HELIXATE FS – antihemophilic factor (recombinant) for injkit 1000 unit.......................................................................24



HEMOFIL M – antihemophilic factor (human) for inj 250unit......................................................................................24




HUMATE-P – antihemophilic factor/vwf (human) for inj250-600 unit.......................................................................24

HUMATE-P – antihemophilic factor/vwf (human) for inj500-1200 unit.....................................................................24

HUMATE-P – antihemophilic factor/vwf (human) for inj1000-2400 unit...................................................................24

HUMIRA – adalimumab prefilled syringe kit 10mg/0.2ml............................................................................ 19



HUMIRA PEDIATRIC CROHNS D – adalimumab prefilledsyringe kit 40 mg/0.8ml.....................................................19

HUMIRA PEN – adalimumab pen-injector kit 40mg/0.8ml............................................................................ 19

HUMIRA PEN-CROHNS DISEASE – adalimumab pen-injector kit 40 mg/0.8ml.....................................................19

HUMIRA PEN-PSORIASIS STAR – adalimumab pen-injector kit 40 mg/0.8ml.....................................................19

HUMULIN R U-500 (CONCENTR – insulin regular(human) inj 500 unit/ml....................................................... 6

HUMULIN R U-500 KWIKPEN – insulin regular (human)soln pen-injector 500 unit/ml...............................................6

hydralazine hcl tab 10 mg............................................... 11hydralazine hcl tab 25 mg............................................... 11hydralazine hcl tab 50 mg............................................... 11hydrochlorothiazide cap 12.5 mg (Microzide)............... 11hydrochlorothiazide tab 12.5 mg.................................... 11hydrochlorothiazide tab 25 mg....................................... 11hydrochlorothiazide tab 50 mg....................................... 11hydrocodone-acetaminophen tab 7.5-325 mg(Norco).............................................................................. 19

hydrocodone-acetaminophen tab 5-325 mg(Norco).............................................................................. 19

hydrocodone-acetaminophen tab 10-325 mg(Norco).............................................................................. 18

hydrocodone-ibuprofen tab 7.5-200 mg(Vicoprofen)......................................................................19

hydrocortisone cream 2.5%.............................................28hydrocortisone oint 2.5%.................................................28hydrocortisone rectal cream 2.5% (Anusol-hc)............ 28hydromorphone hcl tab 2 mg (Dilaudid)........................19hydromorphone hcl tab 4 mg (Dilaudid)........................19hydroxychloroquine sulfate tab 200 mg (Plaquenil).......3hydroxyzine hcl syrup 10 mg/5ml...................................16hydroxyzine hcl tab 10 mg.............................................. 16hydroxyzine hcl tab 25 mg.............................................. 16hydroxyzine hcl tab 50 mg.............................................. 16hydroxyzine pamoate cap 25 mg (Vistaril).................... 16hydroxyzine pamoate cap 50 mg (Vistaril).................... 16

2018



Iibuprofen tab 400 mg....................................................... 20ibuprofen tab 600 mg....................................................... 20ibuprofen tab 800 mg....................................................... 20IDELVION – coagulation factor ix (recomb) (rix-fp) for inj250 unit..............................................................................24

IDELVION – coagulation factor ix (recomb) (rix-fp) for inj500 unit..............................................................................24

IDELVION – coagulation factor ix (recomb) (rix-fp) for inj1000 unit............................................................................24

IDELVION – coagulation factor ix (recomb) (rix-fp) for inj2000 unit............................................................................24

imipramine hcl tab 10 mg (Tofranil)............................... 16imipramine hcl tab 25 mg (Tofranil)............................... 16imipramine hcl tab 50 mg (Tofranil)............................... 16IMPAVIDO – miltefosine cap 50 mg.....................................3INCRELEX – mecasermin inj 40 mg/4ml (10 mg/ml)...........7INCRUSE ELLIPTA – umeclidinium br aero powd breathact 62.5 mcg/inh (base eq)...............................................13

indapamide tab 1.25 mg...................................................11indapamide tab 2.5 mg.....................................................11indomethacin cap 25 mg................................................. 20indomethacin cap 50 mg................................................. 20INSULIN PEN NEEDLES – VARIOUS...............................28INSULIN SYRINGES – VARIOUS......................................29INTELENCE – etravirine tab 25 mg.....................................2INTELENCE – etravirine tab 100 mg...................................2INTELENCE – etravirine tab 200 mg...................................2INVOKAMET – canagliflozin-metformin hcl tab 50-500mg........................................................................................ 6

INVOKAMET – canagliflozin-metformin hcl tab 50-1000mg........................................................................................ 6



INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr50-500 mg............................................................................6

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr50-1000 mg......................................................................... 6

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr150-500 mg......................................................................... 6

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr150-1000 mg....................................................................... 6

INVOKANA – canagliflozin tab 100 mg................................6INVOKANA – canagliflozin tab 300 mg................................6ipratropium bromide inhal soln 0.02%...........................13irbesartan-hydrochlorothiazide tab 150-12.5 mg(Avalide).............................................................................. 9

irbesartan-hydrochlorothiazide tab 300-12.5 mg(Avalide).............................................................................. 9

irbesartan tab 75 mg (Avapro).......................................... 9

irbesartan tab 150 mg (Avapro)........................................ 9irbesartan tab 300 mg (Avapro)........................................ 9ISENTRESS HD – raltegravir potassium tab 600 mg (baseequiv)....................................................................................2

ISENTRESS – raltegravir potassium chew tab 25 mg(base equiv).........................................................................2

ISENTRESS – raltegravir potassium chew tab 100 mg(base equiv).........................................................................2

ISENTRESS – raltegravir potassium packet for susp 100mg (base equiv).................................................................. 2

ISENTRESS – raltegravir potassium tab 400 mg (baseequiv)....................................................................................2

isoniazid tab 100 mg.......................................................... 1isoniazid tab 300 mg.......................................................... 1isosorbide mononitrate tab er 24hr 30 mg.................... 10isosorbide mononitrate tab er 24hr 60 mg.................... 10isosorbide mononitrate tab 10 mg................................. 10isosorbide mononitrate tab 20 mg................................. 10IXINITY – coagulation factor ix (recombinant) for inj 250unit......................................................................................24

IXINITY – coagulation factor ix (recombinant) for inj 500unit......................................................................................24





JJARDIANCE – empagliflozin tab 10 mg...............................6JARDIANCE – empagliflozin tab 25 mg...............................6

KKALETRA – lopinavir-ritonavir tab 100-25 mg.....................2KALETRA – lopinavir-ritonavir tab 200-50 mg.....................2KALYDECO – ivacaftor packet 50 mg............................... 14KALYDECO – ivacaftor packet 75 mg............................... 14KALYDECO – ivacaftor tab 150 mg................................... 14ketoconazole tab 200 mg...................................................1ketoprofen cap 50 mg...................................................... 20ketoprofen cap 75 mg...................................................... 20ketorolac tromethamine ophth soln 0.5% (Acular)....... 28ketorolac tromethamine tab 10 mg.................................20KISQALI FEMARA 200 DOSE – ribociclib tab 200 mg &letrozole tab 2.5 mg therapy pack......................................3

KISQALI FEMARA 400 DOSE – ribociclib tab 200 mg &letrozole tab 2.5 mg therapy pack......................................3

KISQALI FEMARA 600 DOSE – ribociclib tab 200 mg &letrozole tab 2.5 mg therapy pack......................................3

KISQALI – ribociclib succinate tab 200 mg (base equiv).....3

2018



KOATE – antihemophilic factor (human) for inj 250unit......................................................................................24



KOATE-DVI – antihemophilic factor (human) for inj 250unit......................................................................................24



KOGENATE FS – antihemophilic factor (recombinant) forinj kit 250 unit....................................................................24

KOGENATE FS – antihemophilic factor (recombinant) forinj kit 500 unit....................................................................24

KOGENATE FS – antihemophilic factor (recombinant) forinj kit 1000 unit..................................................................24



KOGENATE FS BIO-SET – antihemophilic factor(recombinant) for inj kit 250 unit.......................................24

KOGENATE FS BIO-SET – antihemophilic factor(recombinant) for inj kit 500 unit.......................................24

KOGENATE FS BIO-SET – antihemophilic factor(recombinant) for inj kit 1000 unit.....................................25



KOSHER PRENATAL PLUS IRON – prenatal vit w/ ironcarbonyl-fa tab 30-1 mg....................................................21

KOVALTRY – antihemophilic factor (recombinant) for inj250 unit..............................................................................25

KOVALTRY – antihemophilic factor (recombinant) for inj500 unit..............................................................................25

KOVALTRY – antihemophilic factor (recombinant) for inj1000 unit............................................................................25



Llactulose (encephalopathy) solution 10 gm/15ml......... 15lactulose solution 10 gm/15ml........................................ 14lamotrigine tab 25 mg (Lamictal)....................................20lamotrigine tab 100 mg (Lamictal)..................................20lamotrigine tab 150 mg (Lamictal)..................................20lamotrigine tab 200 mg (Lamictal)..................................20LANCETS – VARIOUS....................................................... 29

LANTUS – insulin glargine inj 100 unit/ml........................... 7LANTUS SOLOSTAR – insulin glargine soln pen-injector100 unit/ml........................................................................... 7

latanoprost ophth soln 0.005% (Xalatan).......................27letrozole tab 2.5 mg (Femara)........................................... 3LEUCOVORIN CALCIUM – leucovorin calcium tab 10mg........................................................................................ 3

LEUCOVORIN CALCIUM – leucovorin calcium tab 15mg........................................................................................ 4

LEUKERAN – chlorambucil tab 2 mg.................................. 4LEVEMIR FLEXTOUCH – insulin detemir soln pen-injector100 unit/ml........................................................................... 7

LEVEMIR – insulin detemir inj 100 unit/ml...........................7levetiracetam tab 250 mg (Keppra).................................20levobunolol hcl ophth soln 0.5% (Betagan).................. 27levofloxacin tab 250 mg (Levaquin)................................. 1levofloxacin tab 500 mg (Levaquin)................................. 1levofloxacin tab 750 mg (Levaquin)................................. 1levonorgestrel & ethinyl estradiol tab 0.1 mg-20mcg...................................................................................... 5

levothyroxine sodium tab 25 mcg (Synthroid)................7levothyroxine sodium tab 50 mcg (Synthroid)................7levothyroxine sodium tab 75 mcg (Synthroid)................7levothyroxine sodium tab 88 mcg (Synthroid)................7levothyroxine sodium tab 100 mcg (Synthroid)..............7levothyroxine sodium tab 112 mcg (Synthroid).............. 7levothyroxine sodium tab 125 mcg (Synthroid)..............7levothyroxine sodium tab 137 mcg (Synthroid)..............7levothyroxine sodium tab 150 mcg (Synthroid)..............7levothyroxine sodium tab 175 mcg (Synthroid)..............7levothyroxine sodium tab 200 mcg (Synthroid)..............7levothyroxine sodium tab 300 mcg (Synthroid)..............7lidocaine hcl gel 2%......................................................... 28lidocaine hcl soln 4% (Xylocaine)...................................28lidocaine hcl viscous soln 2%........................................ 28lisinopril & hydrochlorothiazide tab 10-12.5 mg(Zestoretic)......................................................................... 8

lisinopril & hydrochlorothiazide tab 20-12.5 mg(Zestoretic)......................................................................... 8

lisinopril & hydrochlorothiazide tab 20-25 mg(Zestoretic)......................................................................... 8

lisinopril tab 5 mg (Prinivil)............................................... 8lisinopril tab 10 mg (Prinivil)............................................. 8lisinopril tab 20 mg (Prinivil)............................................. 8lisinopril tab 2.5 mg (Zestril)............................................. 8lisinopril tab 30 mg (Zestril).............................................. 8lisinopril tab 40 mg (Zestril).............................................. 8lithium carbonate cap 300 mg.........................................17lithium carbonate cap 150 mg (Lithium carbonate)......17lithium carbonate cap 600 mg (Lithium carbonate)......17lithium carbonate tab 300 mg......................................... 17lorazepam tab 0.5 mg (Ativan)........................................ 16lorazepam tab 1 mg (Ativan)........................................... 16

2018



lorazepam tab 2 mg (Ativan)........................................... 16losartan potassium & hydrochlorothiazide tab 50-12.5mg (Hyzaar)........................................................................ 9

losartan potassium & hydrochlorothiazide tab 100-12.5mg (Hyzaar)........................................................................ 9

losartan potassium & hydrochlorothiazide tab 100-25mg (Hyzaar)........................................................................ 9

losartan potassium tab 25 mg (Cozaar)...........................9losartan potassium tab 50 mg (Cozaar)...........................9losartan potassium tab 100 mg (Cozaar).........................9lovastatin tab 10 mg.........................................................10lovastatin tab 20 mg (Mevacor).......................................10lovastatin tab 40 mg (Mevacor).......................................10M

MAVYRET – glecaprevir-pibrentasvir tab 100-40 mg.......... 1medroxyprogesterone acetate tab 2.5 mg (Provera)...... 5medroxyprogesterone acetate tab 5 mg (Provera).........5medroxyprogesterone acetate tab 10 mg (Provera).......5megestrol acetate tab 20 mg.............................................4megestrol acetate tab 40 mg.............................................4MEKINIST – trametinib dimethyl sulfoxide tab 0.5 mg(base equivalent).................................................................4

MEKINIST – trametinib dimethyl sulfoxide tab 2 mg (baseequivalent)............................................................................4

meloxicam tab 7.5 mg (Mobic)........................................20meloxicam tab 15 mg (Mobic).........................................20MEPHYTON – phytonadione tab 5 mg.............................. 21metformin hcl tab er 24hr 500 mg (Glucophage xr)........6metformin hcl tab er 24hr 750 mg (Glucophage xr)........6metformin hcl tab 500 mg (Glucophage)......................... 6metformin hcl tab 850 mg (Glucophage)......................... 6metformin hcl tab 1000 mg (Glucophage)....................... 6methadone hcl tab for oral susp 40 mg.........................19methadone hcl tab 10 mg (Dolophine)...........................19methadone hcl tab 5 mg (Dolophine hcl).......................19methimazole tab 5 mg (Tapazole)..................................... 7methimazole tab 10 mg (Tapazole)................................... 7methocarbamol tab 750 mg (Robaxin-750)....................21methocarbamol tab 500 mg (Robaxin)...........................21methyldopa tab 250 mg................................................... 11methyldopa tab 500 mg................................................... 11metoclopramide hcl soln 5 mg/5ml (10 mg/10ml).........15metoclopramide hcl tab 5 mg (Reglan)..........................15metoclopramide hcl tab 10 mg (Reglan)........................15metoprolol succinate tab er 24hr 25 mg (tartrate equiv)(Toprol xl)........................................................................... 9

metoprolol succinate tab er 24hr 50 mg (tartrate equiv)(Toprol xl)........................................................................... 9

metoprolol tartrate tab 25 mg........................................... 9metoprolol tartrate tab 50 mg (Lopressor)...................... 9metoprolol tartrate tab 100 mg (Lopressor).................... 9metronidazole tab 250 mg (Flagyl)................................... 3

metronidazole tab 500 mg (Flagyl)................................... 3minocycline hcl cap 50 mg (Minocin).............................. 1minocycline hcl cap 75 mg (Minocin).............................. 1minocycline hcl cap 100 mg (Minocin)............................ 1minoxidil tab 2.5 mg.........................................................11minoxidil tab 10 mg..........................................................11MIRENA – levonorgestrel releasing iud 20 mcg/day (52mg total)...............................................................................5

mirtazapine tab 15 mg (Remeron).................................. 16mirtazapine tab 30 mg (Remeron).................................. 16mirtazapine tab 45 mg (Remeron).................................. 16misoprostol tab 100 mcg (Cytotec)................................ 14misoprostol tab 200 mcg (Cytotec)................................ 14MONOCLATE-P – antihemophilic factor (human) for inj kit1000 unit............................................................................25

MONOCLATE-P – antihemophilic factor (human) for inj kit1500 unit............................................................................25

MONONINE – coagulation factor ix for inj 1000 unit..........25montelukast sodium chew tab 4 mg (base equiv)(Singulair)......................................................................... 13

montelukast sodium chew tab 5 mg (base equiv)(Singulair)......................................................................... 13

montelukast sodium tab 10 mg (base equiv)(Singulair)......................................................................... 14

MORPHINE SULFATE – morphine sulfate tab 15 mg....... 19MORPHINE SULFATE – morphine sulfate tab 30 mg....... 19mupirocin oint 2% (Bactroban).......................................28MYLERAN – busulfan tab 2 mg...........................................4

Nnabumetone tab 500 mg.................................................. 20nabumetone tab 750 mg.................................................. 20naproxen sodium tab 275 mg (Anaprox)....................... 20naproxen sodium tab 550 mg (Anaprox ds)..................20naproxen tab ec 375 mg (Ec-naprosyn).........................20naproxen tab ec 500 mg (Ec-naprosyn).........................20naproxen tab 250 mg (Naprosyn)................................... 20naproxen tab 375 mg (Naprosyn)................................... 20naproxen tab 500 mg (Naprosyn)................................... 20NARCAN – naloxone hcl nasal spray 4 mg/0.1ml............. 29NATACYN – natamycin ophth susp 5%............................. 27neomycin-polymyxin-dexamethasone ophth oint 0.1%(Maxitrol)...........................................................................27

neomycin-polymyxin-dexamethasone ophth susp0.1% (Maxitrol)................................................................. 27

neomycin sulfate tab 500 mg............................................1NEUPOGEN – filgrastim inj 300 mcg/ml............................25NEUPOGEN – filgrastim inj 480 mcg/1.6ml (300 mcg/ml)...................................................................................... 25

NEUPOGEN – filgrastim soln prefilled syringe 300mcg/0.5ml...........................................................................25

NEUPOGEN – filgrastim soln prefilled syringe 480mcg/0.8ml (600 mcg/ml)................................................... 25

2018



nevirapine tab 200 mg (Viramune)....................................2NEXAVAR – sorafenib tosylate tab 200 mg (baseequivalent)............................................................................4

NICOTROL INHALER – nicotine inhaler system 10 mg (4mg delivered).....................................................................18

NICOTROL NS – nicotine nasal spray 10 mg/ml (0.5 mg/spray)................................................................................. 18

nifedipine tab er 24hr 30 mg (Adalat cc)........................10nifedipine tab er 24hr osmotic release 30 mg(Procardia xl)....................................................................10

nitroglycerin cap er 2.5 mg............................................. 10NITYR – nitisinone tab 2 mg................................................8NITYR – nitisinone tab 5 mg................................................8NITYR – nitisinone tab 10 mg..............................................8nizatidine cap 150 mg...................................................... 14norethindrone & ethinyl estradiol tab 1 mg-35 mcg(Norinyl 1+35).....................................................................5

norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg(Ortho-cyclen).................................................................... 5

norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35mg-mcg (Ortho tri-cyclen)................................................5

nortriptyline hcl cap 10 mg (Pamelor)............................16nortriptyline hcl cap 25 mg (Pamelor)............................16nortriptyline hcl cap 50 mg (Pamelor)............................16nortriptyline hcl cap 75 mg (Pamelor)............................16NORVIR – ritonavir oral soln 80 mg/ml................................2NORVIR – ritonavir tab 100 mg........................................... 2NOVOEIGHT – antihemophilic factor (recombinant) for inj250 unit..............................................................................25

NOVOEIGHT – antihemophilic factor (recombinant) for inj500 unit..............................................................................25

NOVOEIGHT – antihemophilic factor (recombinant) for inj1000 unit............................................................................25




NOVOLIN 70/30 – insulin nph isophane & regular humaninj 100 unit/ml (70-30).........................................................7

NOVOLIN N – insulin nph (human) (isophane) inj 100 unit/ml..........................................................................................7

NOVOLIN R – insulin regular (human) inj 100 unit/ml......... 6NOVOLOG FLEXPEN – insulin aspart soln pen-injector100 unit/ml........................................................................... 6

NOVOLOG – insulin aspart inj 100 unit/ml.......................... 6NOVOLOG MIX 70/30 – insulin aspart prot & aspart(human) inj 100 unit/ml (70-30).......................................... 7

NOVOLOG MIX 70/30 PREFILL – insulin aspart prot &aspart sus pen-inj 100 unit/ml (70-30)................................7

NOVOLOG PENFILL – insulin aspart soln cartridge 100unit/ml...................................................................................6

NOVOSEVEN RT – coagulation factor viia (recomb) for inj1 mg (1000 mcg)...............................................................25




NOXAFIL – posaconazole susp 40 mg/ml...........................1NOXAFIL – posaconazole tab delayed release 100 mg......1NUEDEXTA – dextromethorphan hbr-quinidine sulfate cap20-10 mg............................................................................18

NUVARING – etonogestrel-ethinyl estradiol va ring0.120-0.015 mg/24hr...........................................................5

NUWIQ – antihemophilic factor (bdd-rfviii) for inj kit 250unit......................................................................................25







NUWIQ – antihemophilic factor (bdd-rfviii) for inj 250unit......................................................................................25







OOBIZUR – antihemophilic factor (recomb porc) rpfviii for inj500 unit..............................................................................26

ODEFSEY – emtricitabine-rilpivirine-tenofovir af tab200-25-25 mg...................................................................... 2

ofloxacin ophth soln 0.3% (Ocuflox)..............................27olanzapine tab 2.5 mg (Zyprexa).....................................17olanzapine tab 5 mg (Zyprexa)........................................17olanzapine tab 7.5 mg (Zyprexa).....................................17olanzapine tab 10 mg (Zyprexa)......................................17

2018



omeprazole cap delayed release 10 mg (Prilosec)....... 14omeprazole cap delayed release 20 mg (Prilosec)....... 14omeprazole cap delayed release 40 mg (Prilosec)....... 14OMNITROPE – somatropin for inj 5.8 mg........................... 7OMNITROPE – somatropin inj 5 mg/1.5ml..........................7OMNITROPE – somatropin inj 10 mg/1.5ml........................7ondansetron hcl tab 4 mg (Zofran).................................15ondansetron orally disintegrating tab 4 mg (Zofranodt).....................................................................................15

OPSUMIT – macitentan tab 10 mg....................................11ORFADIN – nitisinone cap 2 mg..........................................8ORFADIN – nitisinone cap 5 mg..........................................8ORFADIN – nitisinone cap 10 mg........................................8ORFADIN – nitisinone cap 20 mg........................................8ORFADIN – nitisinone susp 4 mg/ml................................... 8OTEZLA – apremilast tab 30 mg....................................... 20OTEZLA – apremilast tab starter therapy pack 10 mg & 20mg & 30 mg.......................................................................20

oxcarbazepine tab 150 mg (Trileptal)............................. 20oxybutynin chloride syrup 5 mg/5ml..............................15oxycodone hcl tab 5 mg (Roxicodone).......................... 19oxycodone w/ acetaminophen tab 5-325 mg(Percocet)......................................................................... 19

OXYCONTIN – oxycodone hcl tab er 12hr deter 10mg...................................................................................... 19







Ppantoprazole sodium ec tab 20 mg (base equiv)(Protonix).......................................................................... 14

pantoprazole sodium ec tab 40 mg (base equiv)(Protonix).......................................................................... 15

paroxetine hcl tab 10 mg (Paxil).....................................16paroxetine hcl tab 20 mg (Paxil).....................................16paroxetine hcl tab 30 mg (Paxil).....................................16paroxetine hcl tab 40 mg (Paxil).....................................16PEGASYS – peginterferon alfa-2a inj 180 mcg/ml.............. 1PEGASYS – peginterferon alfa-2a inj 180 mcg/0.5ml......... 2PEGASYS PROCLICK – peginterferon alfa-2a inj 135mcg/0.5ml.............................................................................2

PEGASYS PROCLICK – peginterferon alfa-2a inj 180mcg/0.5ml.............................................................................2

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm(Colyte-flavor packs).......................................................14

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm(Golytely)...........................................................................14

peg 3350-kcl-sod bicarb-nacl for soln 420 gm(Nulytely/flavor pack)......................................................14

penicillin v potassium tab 250 mg....................................1penicillin v potassium tab 500 mg....................................1pentoxifylline tab er 400 mg............................................26perindopril erbumine tab 2 mg......................................... 8phenobarbital tab 16.2 mg...............................................17phenobarbital tab 32.4 mg...............................................17pioglitazone hcl tab 15 mg (base equiv) (Actos).............6pioglitazone hcl tab 30 mg (base equiv) (Actos).............6pioglitazone hcl tab 45 mg (base equiv) (Actos).............6PLEGRIDY – peginterferon beta-1a soln pen-injector 125mcg/0.5ml...........................................................................18

PLEGRIDY – peginterferon beta-1a soln prefilled syringe125 mcg/0.5ml...................................................................18

PLEGRIDY STARTER PACK – peginterferon beta-1a solnpen-inj 63 & 94 mcg/0.5ml pack.......................................18

PLEGRIDY STARTER PACK – peginterferon beta-1a solnpref syr 63 & 94 mcg/0.5ml pack..................................... 18

polyethylene glycol 3350 oral powder........................... 14polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% (Polytrim)...........................................................27

potassium chloride microencapsulated crys er tab 10meq....................................................................................22

potassium chloride microencapsulated crys er tab 20meq....................................................................................22

potassium chloride tab er 10 meq (K-tab)..................... 22potassium chloride tab er 8 meq (600 mg)....................22PRALUENT – alirocumab subcutaneous soln pen-injector75 mg/ml............................................................................10

PRALUENT – alirocumab subcutaneous soln pen-injector150 mg/ml..........................................................................10

pramipexole dihydrochloride tab 0.125 mg(Mirapex)........................................................................... 21

pramipexole dihydrochloride tab 0.25 mg(Mirapex)........................................................................... 21

pramipexole dihydrochloride tab 0.5 mg (Mirapex)......21pramipexole dihydrochloride tab 0.75 mg(Mirapex)........................................................................... 21

pramipexole dihydrochloride tab 1 mg (Mirapex).........21pramipexole dihydrochloride tab 1.5 mg (Mirapex)......21pravastatin sodium tab 10 mg........................................ 10pravastatin sodium tab 20 mg (Pravachol)....................10pravastatin sodium tab 40 mg (Pravachol)....................10prazosin hcl cap 1 mg (Minipress)................................. 12prazosin hcl cap 2 mg (Minipress)................................. 12prednisolone sod phosphate oral soln 15 mg/5ml(base equiv)........................................................................4

2018



prednisolone syrup 15 mg/5ml (usp solutionequivalent) (Prelone).........................................................4

prednisone tab 1 mg.......................................................... 4prednisone tab 2.5 mg....................................................... 4prednisone tab 5 mg.......................................................... 5prednisone tab 10 mg........................................................ 5prednisone tab 20 mg........................................................ 5PRENATAL PLUS – prenatal vit w/ fe fumarate-fa tab 27-1mg...................................................................................... 21

PRENATAL VITAMINS PLUS LO – prenatal vit w/ fefumarate-fa tab 27-1 mg................................................... 21

PREZISTA – darunavir ethanolate susp 100 mg/ml (baseequiv)....................................................................................2

PREZISTA – darunavir ethanolate tab 75 mg (baseequiv)....................................................................................2




PRIFTIN – rifapentine tab 150 mg....................................... 1PRIMAQUINE PHOSPHATE – primaquine phosphate tab26.3 mg (15 mg base)........................................................ 3

primidone tab 50 mg (Mysoline)..................................... 21PROAIR HFA – albuterol sulfate inhal aero 108 mcg/act(90mcg base equiv).......................................................... 14

PROAIR RESPICLICK – albuterol sulfate aer pow ba 108mcg/act (90 mcg base equiv)........................................... 14

prochlorperazine maleate tab 5 mg (base equivalent)(Compazine)..................................................................... 17

prochlorperazine maleate tab 10 mg (base equivalent)(Compazine)..................................................................... 17

PROCRIT – epoetin alfa inj 2000 unit/ml...........................26PROCRIT – epoetin alfa inj 3000 unit/ml...........................26PROCRIT – epoetin alfa inj 4000 unit/ml...........................26PROCRIT – epoetin alfa inj 10000 unit/ml.........................26PROCRIT – epoetin alfa inj 20000 unit/ml.........................26PROCRIT – epoetin alfa inj 40000 unit/ml.........................26PROFILNINE – factor ix complex for inj 500 unit...............26PROFILNINE – factor ix complex for inj 1000 unit.............26PROFILNINE – factor ix complex for inj 1500 unit.............26PROFILNINE SD – factor ix complex for inj 500 unit.........26PROFILNINE SD – factor ix complex for inj 1000 unit.......26PROFILNINE SD – factor ix complex for inj 1500 unit.......26promethazine & phenylephrine syrup 6.25-5mg/5ml...............................................................................12

promethazine-dm syrup 6.25-15 mg/5ml........................12promethazine hcl syrup 6.25 mg/5ml............................. 12promethazine hcl tab 12.5 mg.........................................12promethazine hcl tab 25 mg............................................12promethazine hcl tab 50 mg............................................12

promethazine-phenylephrine-codeine syrup 6.25-5-10mg/5ml...............................................................................12

promethazine w/ codeine syrup 6.25-10 mg/5ml...........12proparacaine hcl ophth soln 0.5% (Alcaine)................. 28propranolol hcl tab 10 mg................................................. 9propranolol hcl tab 20 mg................................................. 9propranolol hcl tab 40 mg................................................. 9propranolol hcl tab 80 mg................................................. 9PULMOZYME – dornase alfa inhal soln 1 mg/ml.............. 14

Qquetiapine fumarate tab 25 mg (Seroquel).................... 17quetiapine fumarate tab 50 mg (Seroquel).................... 17quetiapine fumarate tab 100 mg (Seroquel).................. 17quinapril hcl tab 5 mg (Accupril)...................................... 8quinapril hcl tab 10 mg (Accupril).................................... 8quinapril hcl tab 20 mg (Accupril).................................... 8quinapril hcl tab 40 mg (Accupril).................................... 8QVAR – beclomethasone diprop inhal aero soln 40 mcg/act (50/valve).....................................................................14

QVAR – beclomethasone diprop inhal aero soln 80 mcg/act (100/valve)...................................................................14

Rramipril cap 1.25 mg (Altace)............................................ 8ramipril cap 2.5 mg (Altace).............................................. 8ramipril cap 5 mg (Altace)................................................. 8ramipril cap 10 mg (Altace)............................................... 9ranitidine hcl syrup 15 mg/ml (75 mg/5ml).................... 15ranitidine hcl tab 300 mg (Zantac)..................................15RAPAMUNE – sirolimus oral soln 1 mg/ml........................ 29REBIF – interferon beta-1a soln pref syr 22 mcg/0.5ml(12mu/ml)...........................................................................18

REBIF – interferon beta-1a soln pref syr 44 mcg/0.5ml(24mu/ml)...........................................................................18

REBIF REBIDOSE – interferon beta-1a soln auto-inj 22mcg/0.5ml (12mu/ml).........................................................18

REBIF REBIDOSE – interferon beta-1a soln auto-inj 44mcg/0.5ml (24mu/ml).........................................................18

REBIF REBIDOSE TITRATION – interferon beta-1a auto-inj 6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml............................ 18

REBIF TITRATION PACK – interferon beta-1a pref syr6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml................................. 18

RECOMBINATE – antihemophilic factor (recombinant) forinj 220-400 unit..................................................................26

RECOMBINATE – antihemophilic factor (recombinant) forinj 401-800 unit..................................................................26

RECOMBINATE – antihemophilic factor (recombinant) forinj 801-1240 unit................................................................26

RECOMBINATE – antihemophilic factor (recombinant) forinj 1241-1800 unit..............................................................26

RECOMBINATE – antihemophilic factor (recombinant) forinj 1801-2400 unit..............................................................26

2018



REPATHA – evolocumab subcutaneous soln prefilledsyringe 140 mg/ml.............................................................10

REPATHA PUSHTRONEX SYSTEM – evolocumabsubcutaneous soln cartridge/infusor 420 mg/3.5ml..........10

REPATHA SURECLICK – evolocumab subcutaneous solnauto-injector 140 mg/ml.................................................... 11

REVLIMID – lenalidomide cap 5 mg..................................29REVLIMID – lenalidomide cap 10 mg................................29REVLIMID – lenalidomide cap 15 mg................................29REVLIMID – lenalidomide cap 20 mg................................29REVLIMID – lenalidomide cap 25 mg................................29REVLIMID – lenalidomide caps 2.5 mg............................. 29REYATAZ – atazanavir sulfate cap 150 mg (baseequiv)....................................................................................2

REYATAZ – atazanavir sulfate cap 200 mg (baseequiv)....................................................................................2

REYATAZ – atazanavir sulfate cap 300 mg (baseequiv)....................................................................................2

risperidone tab 0.25 mg (Risperdal)...............................17risperidone tab 0.5 mg (Risperdal).................................17risperidone tab 1 mg (Risperdal)....................................17risperidone tab 2 mg (Risperdal)....................................17risperidone tab 3 mg (Risperdal)....................................17risperidone tab 4 mg (Risperdal)....................................17RIXUBIS – coagulation factor ix (recombinant) for inj 250unit......................................................................................26

RIXUBIS – coagulation factor ix (recombinant) for inj 500unit......................................................................................26




ropinirole hydrochloride tab 0.25 mg (Requip)............. 21ropinirole hydrochloride tab 0.5 mg (Requip)............... 21ropinirole hydrochloride tab 1 mg (Requip).................. 21ropinirole hydrochloride tab 2 mg (Requip).................. 21ropinirole hydrochloride tab 3 mg (Requip).................. 21ropinirole hydrochloride tab 4 mg (Requip).................. 21ropinirole hydrochloride tab 5 mg (Requip).................. 21RYDAPT – midostaurin cap 25 mg...................................... 4

SSABRIL – vigabatrin powd pack 500 mg........................... 21SABRIL – vigabatrin tab 500 mg........................................21selenium sulfide lotion 2.5%........................................... 28SENSIPAR – cinacalcet hcl tab 30 mg (base equiv)............8SENSIPAR – cinacalcet hcl tab 60 mg (base equiv)............8SENSIPAR – cinacalcet hcl tab 90 mg (base equiv)............8SEREVENT DISKUS – salmeterol xinafoate aer pow ba50 mcg/dose (base equiv)................................................ 14

sertraline hcl tab 25 mg (Zoloft)..................................... 16

sertraline hcl tab 50 mg (Zoloft)..................................... 16sertraline hcl tab 100 mg (Zoloft)................................... 17silver sulfadiazine cream 1% (Silvadene)...................... 28SIMPONI – golimumab subcutaneous soln auto-injector50 mg/0.5ml.......................................................................20

SIMPONI – golimumab subcutaneous soln auto-injector100 mg/ml..........................................................................20

SIMPONI – golimumab subcutaneous soln prefilledsyringe 50 mg/0.5ml..........................................................20

SIMPONI – golimumab subcutaneous soln prefilledsyringe 100 mg/ml.............................................................20

simvastatin tab 5 mg (Zocor).......................................... 11simvastatin tab 10 mg (Zocor)........................................ 11simvastatin tab 20 mg (Zocor)........................................ 11simvastatin tab 40 mg (Zocor)........................................ 11simvastatin tab 80 mg (Zocor)........................................ 11SKYLA – levonorgestrel releasing iud 14 mcg/day (13.5mg total)...............................................................................5

SOOLANTRA – ivermectin cream 1%............................... 28sotalol hcl tab 80 mg (Betapace)....................................11sotalol hcl tab 120 mg (Betapace)..................................11sotalol hcl tab 160 mg (Betapace)..................................11SOVALDI – sofosbuvir tab 400 mg...................................... 2SPIRIVA HANDIHALER – tiotropium bromidemonohydrate inhal cap 18 mcg (base equiv)................... 14

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 1.25 mcg/act................................................14

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 2.5 mcg/act..................................................14

spironolactone tab 25 mg (Aldactone)...........................11spironolactone tab 50 mg (Aldactone)...........................11STELARA – ustekinumab inj 45 mg/0.5ml.........................28STELARA – ustekinumab soln prefilled syringe 45mg/0.5ml............................................................................ 28

STELARA – ustekinumab soln prefilled syringe 90 mg/ml........................................................................................28

STIMATE – desmopressin acetate nasal soln 1.5 mg/ml..........................................................................................8

STIOLTO RESPIMAT – tiotropium br-olodaterol inhal aerosoln 2.5-2.5 mcg/act..........................................................14

STRENSIQ – asfotase alfa subcutaneous inj 18mg/0.45ml............................................................................ 8

STRENSIQ – asfotase alfa subcutaneous inj 28mg/0.7ml.............................................................................. 8

STRENSIQ – asfotase alfa subcutaneous inj 40 mg/ml...... 8STRENSIQ – asfotase alfa subcutaneous inj 80mg/0.8ml.............................................................................. 8

STRIBILD – elvitegrav-cobic-emtricitab-tenofovdf tab150-150-200-300 mg...........................................................2

STRIVERDI RESPIMAT – olodaterol hcl inhal aerosol soln2.5 mcg/act (base equiv).................................................. 14

sulfacetamide sodium-prednisolone ophth soln10-0.23(0.25)%.................................................................. 27

2018



SULFADIAZINE – sulfadiazine tab 500 mg......................... 3sulfamethoxazole-trimethoprim susp 200-40mg/5ml.................................................................................3

sulfamethoxazole-trimethoprim tab 400-80 mg(Bactrim)............................................................................. 3

sulfamethoxazole-trimethoprim tab 800-160 mg(Bactrim ds)........................................................................3

sulindac tab 150 mg......................................................... 20sulindac tab 200 mg......................................................... 20sumatriptan succinate tab 25 mg (Imitrex)....................20sumatriptan succinate tab 50 mg (Imitrex)....................20sumatriptan succinate tab 100 mg (Imitrex)..................20SUSTIVA – efavirenz cap 50 mg......................................... 2SUSTIVA – efavirenz cap 200 mg....................................... 2SUSTIVA – efavirenz tab 600 mg........................................ 2SUTENT – sunitinib malate cap 12.5 mg (baseequivalent)............................................................................4

SUTENT – sunitinib malate cap 25 mg (baseequivalent)............................................................................4

SUTENT – sunitinib malate cap 37.5 mg (baseequivalent)............................................................................4

SUTENT – sunitinib malate cap 50 mg (baseequivalent)............................................................................4

SYLATRON – peginterferon alfa-2b for inj kit 200 mcg....... 4SYLATRON – peginterferon alfa-2b for inj kit 300 mcg....... 4SYLATRON – peginterferon alfa-2b for inj kit 600 mcg....... 4SYMBICORT – budesonide-formoterol fumarate dihydaerosol 80-4.5 mcg/act..................................................... 14

SYMBICORT – budesonide-formoterol fumarate dihydaerosol 160-4.5 mcg/act................................................... 14

TTAFINLAR – dabrafenib mesylate cap 50 mg (baseequivalent)............................................................................4

TAFINLAR – dabrafenib mesylate cap 75 mg (baseequivalent)............................................................................4

tamoxifen citrate tab 10 mg (base equivalent)................4tamoxifen citrate tab 20 mg (base equivalent)................4tamsulosin hcl cap 0.4 mg (Flomax).............................. 15TARCEVA – erlotinib hcl tab 25 mg (base equivalent).........4TARCEVA – erlotinib hcl tab 100 mg (base equivalent).......4TARCEVA – erlotinib hcl tab 150 mg (base equivalent).......4TASIGNA – nilotinib hcl cap 150 mg (base equivalent)....... 4TASIGNA – nilotinib hcl cap 200 mg (base equivalent)....... 4TAZORAC – tazarotene cream 0.05%...............................28TAZORAC – tazarotene gel 0.05%.................................... 28TAZORAC – tazarotene gel 0.1%...................................... 28TECFIDERA – dimethyl fumarate capsule delayed release120 mg...............................................................................18

TECFIDERA – dimethyl fumarate capsule delayed release240 mg...............................................................................18

TECFIDERA STARTER PACK – dimethyl fumaratecapsule dr starter pack 120 mg & 240 mg....................... 18

temazepam cap 15 mg (Restoril).................................... 17temazepam cap 30 mg (Restoril).................................... 17terazosin hcl cap 1 mg.....................................................12terazosin hcl cap 2 mg.....................................................12terazosin hcl cap 5 mg.....................................................12terazosin hcl cap 10 mg...................................................12terbinafine hcl tab 250 mg (Lamisil).................................1TEST STRIPS – ASCENSIA BREEZE 2, CONTOUR,CONTOUR NEXT..............................................................28

tetracaine hcl ophth soln 0.5%....................................... 28THALOMID – thalidomide cap 50 mg................................ 29THALOMID – thalidomide cap 100 mg.............................. 29THALOMID – thalidomide cap 150 mg.............................. 29THALOMID – thalidomide cap 200 mg.............................. 29theophylline tab er 12hr 100 mg.....................................14thyroid tab 30 mg (1/2 grain) (Armour thyroid)............... 7thyroid tab 90 mg (1 1/2 grain) (Armour thyroid)............ 7thyroid tab 60 mg (1 grain) (Armour thyroid).................. 7timolol maleate ophth soln 0.25% (Timoptic)................28timolol maleate ophth soln 0.5% (Timoptic)..................28TIVICAY – dolutegravir sodium tab 10 mg (base equiv)...... 2TIVICAY – dolutegravir sodium tab 25 mg (base equiv)...... 2TIVICAY – dolutegravir sodium tab 50 mg (base equiv)...... 2tizanidine hcl tab 2 mg (base equivalent)......................21tizanidine hcl tab 4 mg (base equivalent)(Zanaflex).......................................................................... 21

tobramycin ophth soln 0.3% (Tobrex)............................ 27topiramate tab 25 mg (Topamax).................................... 21topiramate tab 50 mg (Topamax).................................... 21topiramate tab 100 mg (Topamax).................................. 21topiramate tab 200 mg (Topamax).................................. 21torsemide tab 5 mg (Demadex).......................................11torsemide tab 10 mg (Demadex).....................................11torsemide tab 20 mg (Demadex).....................................11TOUJEO SOLOSTAR – insulin glargine soln pen-injector300 unit/ml........................................................................... 7

TRACLEER – bosentan tab 62.5 mg.................................12TRACLEER – bosentan tab 125 mg..................................12tramadol-acetaminophen tab 37.5-325 mg(Ultracet)........................................................................... 19

tramadol hcl tab 50 mg (Ultram).....................................19trandolapril tab 1 mg (Mavik)............................................ 9trandolapril tab 2 mg (Mavik)............................................ 9trandolapril tab 4 mg (Mavik)............................................ 9trazodone hcl tab 50 mg.................................................. 17trazodone hcl tab 100 mg................................................ 17trazodone hcl tab 150 mg................................................ 17TRESIBA FLEXTOUCH – insulin degludec soln pen-injector 100 unit/ml..............................................................7

TRESIBA FLEXTOUCH – insulin degludec soln pen-injector 200 unit/ml..............................................................7

TRETTEN – coagulation factor xiii a-subunit for inj2000-3125 unit...................................................................26

2018



triamcinolone acetonide cream 0.025%......................... 28triamcinolone acetonide cream 0.1%............................. 28triamcinolone acetonide cream 0.5%............................. 28triamcinolone acetonide oint 0.025%............................. 28triamcinolone acetonide oint 0.1%................................. 28triamterene & hydrochlorothiazide cap 37.5-25 mg(Dyazide)........................................................................... 11

triamterene & hydrochlorothiazide tab 37.5-25 mg(Maxzide-25)..................................................................... 11

triamterene & hydrochlorothiazide tab 75-50 mg(Maxzide)...........................................................................11

trihexyphenidyl hcl tab 2 mg...........................................21trihexyphenidyl hcl tab 5 mg...........................................21trimethoprim tab 100 mg................................................... 3tropicamide ophth soln 0.5%.......................................... 28tropicamide ophth soln 1% (Mydriacyl)......................... 28TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 100-150 mg...................................................................2

TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 133-200 mg...................................................................3

TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 167-250 mg................................................................... 3

TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 200-300 mg...................................................................3

TYMLOS – abaloparatide subcutaneous soln pen-injector3120 mcg/1.56ml.................................................................8

UUPTRAVI – selexipag tab 200 mcg....................................12UPTRAVI – selexipag tab 400 mcg....................................12UPTRAVI – selexipag tab 600 mcg....................................12UPTRAVI – selexipag tab 800 mcg....................................12UPTRAVI – selexipag tab 1000 mcg..................................12UPTRAVI – selexipag tab 1200 mcg..................................12UPTRAVI – selexipag tab 1400 mcg..................................12UPTRAVI – selexipag tab 1600 mcg..................................12UPTRAVI – selexipag tab therapy pack 200 mcg (140) &800 mcg (60)..................................................................... 12

VVALCHLOR – mechlorethamine hcl gel 0.016% (baseequivalent)......................................................................... 28

valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovanhct).......................................................................................9

valsartan-hydrochlorothiazide tab 320-12.5 mg (Diovanhct).......................................................................................9

valsartan-hydrochlorothiazide tab 320-25 mg (Diovanhct).......................................................................................9

venlafaxine hcl cap er 24hr 37.5 mg (base equivalent)(Effexor xr)....................................................................... 17

venlafaxine hcl cap er 24hr 75 mg (base equivalent)(Effexor xr)....................................................................... 17

venlafaxine hcl cap er 24hr 150 mg (base equivalent)(Effexor xr)....................................................................... 17

VENTOLIN HFA – albuterol sulfate inhal aero 108 mcg/act(90mcg base equiv).......................................................... 14

verapamil hcl tab er 120 mg (Calan sr)..........................10verapamil hcl tab er 180 mg (Calan sr)..........................10verapamil hcl tab er 240 mg (Calan sr)..........................10verapamil hcl tab 80 mg (Calan).....................................10verapamil hcl tab 120 mg (Calan)...................................10VIBERZI – eluxadoline tab 75 mg......................................15VIBERZI – eluxadoline tab 100 mg....................................15VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)........................................................................................ 6

VIDEX – didanosine for soln 2 gm.......................................3VIDEX – didanosine for soln 4 gm.......................................3VIRAMUNE – nevirapine susp 50 mg/5ml...........................3VIREAD – tenofovir disoproxil fumarate oral powder 40mg/gm.................................................................................. 3

VIREAD – tenofovir disoproxil fumarate tab 150 mg........... 3VIREAD – tenofovir disoproxil fumarate tab 200 mg........... 3VIREAD – tenofovir disoproxil fumarate tab 250 mg........... 3VIREAD – tenofovir disoproxil fumarate tab 300 mg........... 3VONVENDI – von willebrand factor (recombinant) for inj650 unit..............................................................................26

VONVENDI – von willebrand factor (recombinant) for inj1300 unit............................................................................26

VOSEVI – sofosbuvir-velpatasvir-voxilaprevir tab400-100-100 mg.................................................................. 2

VOTRIENT – pazopanib hcl tab 200 mg (base equiv).........4

Wwarfarin sodium tab 1 mg (Coumadin).......................... 26warfarin sodium tab 2 mg (Coumadin).......................... 26warfarin sodium tab 2.5 mg (Coumadin)....................... 26warfarin sodium tab 3 mg (Coumadin).......................... 26warfarin sodium tab 4 mg (Coumadin).......................... 26warfarin sodium tab 5 mg (Coumadin).......................... 26warfarin sodium tab 6 mg (Coumadin).......................... 26warfarin sodium tab 7.5 mg (Coumadin)....................... 26warfarin sodium tab 10 mg (Coumadin)........................ 26WELCHOL – colesevelam hcl packet for susp 3.75gm...................................................................................... 11

WELCHOL – colesevelam hcl tab 625 mg........................ 11WILATE – antihemophilic factor/vwf (human) for inj500-500 unit kit..................................................................26

WILATE – antihemophilic factor/vwf (human) for inj1000-1000 unit kit..............................................................27

XXALKORI – crizotinib cap 200 mg....................................... 4XALKORI – crizotinib cap 250 mg....................................... 4XARELTO – rivaroxaban tab 10 mg...................................27XARELTO – rivaroxaban tab 15 mg...................................27

2018



XARELTO – rivaroxaban tab 20 mg...................................27XARELTO STARTER PACK – rivaroxaban tab startertherapy pack 15 mg & 20 mg...........................................27

XIFAXAN – rifaximin tab 550 mg......................................... 3XTANDI – enzalutamide cap 40 mg.....................................4XYNTHA – antihemophilic factor recombinant paf for inj kit250 unit..............................................................................27

XYNTHA – antihemophilic factor recombinant paf for inj kit500 unit..............................................................................27

XYNTHA – antihemophilic factor recombinant paf for inj kit1000 unit............................................................................27

XYNTHA – antihemophilic factor recombinant paf for inj kit2000 unit............................................................................27

XYNTHA SOLOFUSE – antihemophilic factor recombinantpaf for inj kit 250 unit........................................................27

XYNTHA SOLOFUSE – antihemophilic factor recombinantpaf for inj kit 500 unit........................................................27

XYNTHA SOLOFUSE – antihemophilic factor recombinantpaf for inj kit 1000 unit......................................................27



Y

Zzaleplon cap 5 mg (Sonata).............................................17zaleplon cap 10 mg (Sonata)...........................................17ZARXIO – filgrastim-sndz soln prefilled syringe 300mcg/0.5ml...........................................................................27

ZARXIO – filgrastim-sndz soln prefilled syringe 480mcg/0.8ml...........................................................................27

ZELBORAF – vemurafenib tab 240 mg............................... 4ZENPEP – pancrelipase (lip-prot-amyl) dr cap3000-10000-16000 unit..................................................... 15

ZENPEP – pancrelipase (lip-prot-amyl) dr cap5000-17000-27000 unit..................................................... 15

ZENPEP – pancrelipase (lip-prot-amyl) dr cap10000-34000-55000 unit...................................................15



ZENPEP – pancrelipase (lip-prot-amyl) dr cap20000-68000-109000 unit.................................................15

ZENPEP – pancrelipase (lip-prot-amyl) dr cap25000-85000-136000 unit.................................................15

ZENPEP – pancrelipase (lip-prot-amyl) dr cap40000-136000-218000 unit...............................................15

ZIAGEN – abacavir sulfate soln 20 mg/ml (base equiv)...... 3zolpidem tartrate tab 5 mg (Ambien)..............................17zolpidem tartrate tab 10 mg (Ambien)............................17

zonisamide cap 25 mg (Zonegran)................................. 21ZYTIGA – abiraterone acetate tab 250 mg..........................4ZYTIGA – abiraterone acetate tab 500 mg..........................4

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5 Tier Enhanced Drug List - hcsc.bcbsil.com · Example: PROAIR HFA . Drugs used to treat multiple conditions . ... • Is as safe and effective • Meets the same standards set by