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A list of medications that may lower your patients’ costs

A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

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Page 1: A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

A list of medications that may lower your patients’ costs

Page 2: A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

INTRODUCTION

Catamaran utilizes a Pharmacy and Therapeutics Committee (P & T Committee), made up of

practicing physicians, pharmacists, and nurses to help ensure that our formulary is medically

sound and that it supports patient health. This committee reviews and evaluates medications

on the formulary based on safety and efficacy to help maintain clinical integrity in all

therapeutic categories.

FORMULARY DESIGN

There are numerous formulary designs that can be used by a pharmacy benefits administrator.

Catamaran has chosen a formulary structure which is open and incentive based.

Open Formulary: features uniform co-payments for medications that are preferred

and non-preferred brands, plus lower co-payments for generic drugs.

Incentive Based: features different co-payments for medications that are on or off the

formulary. In this type of formulary, the patient cost structure may be either a two-tier

or three-tier design.

USING THIS FORMULARY REFERENCE GUIDE TO HELP CONTAIN COSTS

Many benefit sponsors use the Catamaran formulary to help manage the overall cost of

providing prescription drug benefits. This formulary offers a wide range of medications from

which to choose. We realize that this formulary reference guide may not include every drug

from every manufacturer. However, choosing a preferred drug when it is appropriate can

provide access to the necessary medications to stay healthy, at a cost that is more affordable.

KNOWING HOW THE FORMULARY INFORMATION IS ORGANIZED

The following formulary reference guide is designed so that generic products are listed first in

each drug category. The preferred brand name products are listed next, and non-preferred

brand products are listed last.

PLEASE NOTE: If a generic product is listed in the “generics” section and its corresponding

brand-name product is not listed in the “preferred brand-name” section, then only the

generic product is on the formulary. If a brand name product is listed in the “preferred brand-

name” section and its corresponding generic product is not listed in the “generics” section,

then a generic version of the medication is not available.

Page 3: A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

CONSIDERING PREFERRED ALTERNATIVES

Catamaran realizes that the medications on the formulary may not always be appropriate for all

patients. However, by referring to this formulary reference guide, one can help ensure the full

advantage of the coverage provided by the prescription drug plan. Possible preferred

alternatives are listed for commonly prescribed non-preferred medications.

Pharmacies cannot substitute a preferred brand-name drug without the prescriber’s approval.

Therefore, a pharmacist may contact the prescriber to obtain authorization to dispense an

alternative preferred product when a non-preferred product is prescribed.

SAVING ON OUT-OF-POCKET COSTS

The prescription drug plan determines the cost for generic, preferred brand-name, and on-

preferred brand-name medications. Benefit providers often design prescription drug plans to

encourage the use of generic and preferred brand-name drugs. Choosing non-preferred drugs

may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments, and

deductible amounts) or not receiving coverage at all. Patients may also pay less for generic

drugs, or they may be asked to pay the cost difference between brand-name drugs and their

generic alternatives, which are preferred by the plan.

CONSULTING THE PRESCRIBER’S OFFICE WHEN APPROPRIATE

When employers and other benefit sponsors design their prescription drug plans, they may

choose to provide coverage only for certain medications or for particular uses, time periods,

doses, or quantities (e.g. they may exclude coverage for medications for unapproved,

unproven, or cosmetic indications, as well as over-the-counter medications). When coverage

for medications is provided based on use or quantity, Catamaran may contact your prescriber’s

office for additional information to determine whether coverage is available under your plan.

Patients who are unsure whether these coverage rules apply for a particular medication can

consult their prescription drug benefit manual or contact a Catamaran Member Services

representative to determine specific coverage requirements.

*Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design

determines what is covered and the applicable co-payment. The medications listed on this formulary are subject to change

pursuant to the formulary management activities of catamaran. The presence of a medication on this formulary list does not

guarantee coverage.

Page 4: A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

Table of Contents

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

AMEBICIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTINEOPLASTICS, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTIBIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTINEOPLASTIC ENZYMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

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ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

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BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

PROGESTERONE ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ANTACIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

HEMATOLOGICAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

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NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

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ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

MISCELLANEOUS AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

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Rocephin

Spectracef

Suprax

FOURTH GENERATION

January 2013

GENERIC

cefepime

ANTI-INFECTIVES

MACROLIDES

PENICILLINS

GENERIC

GENERIC

azithromycin

amoxicillin

clarithromycin

amoxicillin/clavulanate potassium

clarithromycin er

amoxicillin/clavulanate potassium er

e.e.s. 400

amoxicillin/potassium clavulanate

erythrocin stearate

ampicillin

erythromycin

ampicillin sodium

erythromycin base

ampicillin-sulbactam

erythromycin ethylsuccinate

dicloxacillin sodium

PREFERRED BRAND

nafcillin sodium

Dificid

oxacillin sodium

NON PREFERRED

penicillin g potassium

Biaxin

penicillin g procaine

Biaxin Xl

penicillin g sodium

Biaxin Xl Pac

penicillin v potassium

E.e.s. Granules

pfizerpen-g

Ery-tab

PREFERRED BRAND

Eryped 200

Augmentin

Eryped 400

NON PREFERRED

Pce

Augmentin Es-600

Zithromax

Augmentin Xr

Zithromax Tri-pak

Bicillin C-r

Zithromax Z-pak

Bicillin L-a

Zmax

Moxatag

Unasyn

TETRACYCLINES

Unasyn Bulk Pack

GENERIC

avidoxy

CEPHALOSPORIN

demeclocycline hcl

FIRST GENERATION

doxycycline

GENERIC

doxycycline hyclate

cefadroxil

doxycycline monohydrate

cefazolin sodium

minocycline hcl

cephalexin

minocycline hcl er

NON PREFERRED

morgidox 1x100mg

Keflex

morgidox 2x100mg

SECOND GENERATION

tetracycline hcl

GENERIC

NON PREFERRED

cefaclor

Adoxa

cefaclor er

Adoxa Pak 1/100

cefotetan

Adoxa Pak 1/150

cefoxitin sodium

Adoxa Pak 2/100

cefprozil

Alodox Convenience Kit

cefuroxime axetil

Avidoxy Dk

cefuroxime sodium

Doryx

NON PREFERRED

Dynacin

Ceftin

Minocin

Zinacef

Minocin Kit

THIRD GENERATION

Monodox

GENERIC

Nutridox

cefdinir

Ocudox

Cefditoren Pivoxil

Oraxyl

cefotaxime sodium

Solodyn

cefpodoxime proxetil

Vibramycin

ceftazidime

ceftriaxone sodium

QUINOLONES

tazicef

GENERIC

NON PREFERRED

ciprofloxacin er

Cedax

ciprofloxacin hcl

Claforan

levofloxacin

Fortaz

ofloxacin

Effective January 1, 2013

1

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PREFERRED BRAND

Lamisil

Avelox

Onmel

Avelox Abc Pack

Sporanox

NON PREFERRED

Sporanox Pulsepak

Cipro

Terbinex

Cipro Xr

Vfend

Factive

Levaquin

ANTIVIRALS

Noroxin

GENERIC

abacavir

AMINOGLYCOSIDES

acyclovir

GENERIC

didanosine

amikacin sulfate

famciclovir

gentamicin sulfate

lamivudine

kanamycin sulfate

lamivudine/zidovudine

neomycin sulfate

Nevirapine

paromomycin sulfate

ribapak

streptomycin sulfate

ribasphere

tobramycin sulfate

ribatab

PREFERRED BRAND

ribavirin

Tobi

rimantadine hcl

NON PREFERRED

stavudine

Neo-fradin

valacyclovir hcl

zidovudine

SULFONAMIDES

PREFERRED BRAND

Aptivus

GENERIC

Atripla

sulfadiazine

Baraclude

Complera

ANTIMYCOBACTERIAL AGENTS

Crixivan

GENERIC

Edurant

cycloserine

Emtriva

ethambutol hcl

Epivir Hbv

isonarif

Epzicom

isoniazid

Fuzeon

pyrazinamide

Hepsera

rifampin

Incivek

PREFERRED BRAND

Intelence

Mycobutin

Invirase

seromycin

Isentress

NON PREFERRED

Kaletra

Capastat Sulfate

Lexiva

Myambutol

Norvir

Paser

Peg-intron

Priftin

Peg-intron Redipen

Rifadin

Peg-intron Redipen Pak 4

Rifamate

Pegasys

Rifater

Pegasys Proclick

Trecator

Prezista

Relenza Diskhaler

ANTIFUNGALS

Rescriptor

GENERIC

Reyataz

amphotericin b

Selzentry

fluconazole

Stribild

flucytosine

Sustiva

griseofulvin microsize

Tamiflu

griseofulvin ultramicrosize

Trizivir

itraconazole

Truvada

ketoconazole

Valcyte

nystatin

Victrelis

terbinafine hcl

Videx Pediatric

voriconazole

Viracept

PREFERRED BRAND

Viramune Xr

Noxafil

Viread

NON PREFERRED

NON PREFERRED

Ancobon

Combivir

Bio-statin

Copegus

Diflucan

Epivir

Grifulvin V

Famvir

Gris-peg

Effective January 1, 2013

2

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Flumadine

Zyvox

Infergen

NON PREFERRED

Rebetol

Azactam

Retrovir

Bactrim

Rimantalist

Bactrim Ds

Tyzeka

Cleocin

Valtrex

Cleocin Pediatric Granules

Videx Ec

Cleocin Phosphate

Viramune

Coly-mycin M

Virazole

Flagyl

Zerit

Flagyl Er

Ziagen

Invanz

Zovirax

Ketek

Lincocin

ANTIMALARIALS

Pentam 300

Primsol

GENERIC

Septra Ds

Atovaquone/proguanil Hcl

Tindamax

chloroquine phosphate

Vancocin Hcl

hydroxychloroquine sulfate

Xifaxan

mefloquine hcl

Primaquine Phosphate

ANTINEOPLASTICS, ETC.

Qualaquin

quinine sulfate

ALKYLATING AGENTS

PREFERRED BRAND

GENERIC

Coartem

cyclophosphamide

Daraprim

thiotepa

NON PREFERRED

PREFERRED BRAND

Aralen

Alkeran

Malarone

Ceenu

Plaquenil

Hexalen

Leukeran

AMEBICIDES

Myleran

PREFERRED BRAND

Temodar

Yodoxin

NON PREFERRED

Gliadel Wafer

ANTHELMINTICS

Mustargen

GENERIC

mebendazole

ANTIBIOTICS

PREFERRED BRAND

GENERIC

Albenza

bleomycin sulfate

Biltricide

Stromectol

ANTINEOPLASTIC ENZYMES

NON PREFERRED

MISC. ANTI-INFECTIVES

Elspar

GENERIC

Erwinaze

aztreonam

Oncaspar

baciim

bacitracin

ANTIMETABOLITES

clindamycin hcl

GENERIC

clindamycin palmitate hcl

cytarabine

clindamycin phosphate

cytarabine aqueous

clindamycin phosphate pharmacy bulk package

floxuridine

colistimethate sodium

mercaptopurine

dapsone

methotrexate

e.s.p.

methotrexate sodium

erythromycin/sulfisoxazole

PREFERRED BRAND

metronidazole

Oforta

polymyxin b sulfate

Tabloid

sulfamethoxazole/trimethoprim

Trexall

Sulfamethoxazole/trimethoprim Ds

Vidaza

tinidazole

Xeloda

Trimethoprim

NON PREFERRED

vancomycin

Purinethol

vancomycin hcl

PREFERRED BRAND

HORMONAL AGENTS

Alinia

GENERIC

Cayston

anastrozole

Mepron

bicalutamide

Nebupent

exemestane

Effective January 1, 2013

3

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Firmagon

Nexavar

flutamide

Sprycel

letrozole

Sutent

leuprolide acetate

Tarceva

megestrol acetate

Tasigna

tamoxifen citrate

Tykerb

PREFERRED BRAND

Votrient

Depo-provera

Xalkori

Emcyt

Zelboraf

Lupron Depot

NON PREFERRED

Lysodren

Inlyta

Vantas

Iressa

Xtandi

Stivarga

Zoladex

Zolinza

Zytiga

NON PREFERRED

TOPOISOMERASE I INHIBITOR

Arimidex

PREFERRED BRAND

Aromasin

Hycamtin

Casodex

Eligard

ANTINEOPLASTICS MISC.

Fareston

GENERIC

Faslodex

hydroxyurea

Femara

tretinoin

Megace Oral

PREFERRED BRAND

Nilandron

Actimmune

Soltamox

Intron-a

Trelstar Depot

Intron-a W/diluent

Trelstar Depot Mixject

Matulane

Trelstar La

NON PREFERRED

Trelstar La Mixject

Alferon N

Trelstar Mixject

Hydrea

Sylatron

IMMUNOMODULATORS

Synribo

GENERIC

Targretin

azathioprine

Uvadex

azathioprine sodium

cyclosporine

CHEMOTHERAPY RESCUE

cyclosporine modified

GENERIC

gengraf

calcium folinate

hecoria

leucovorin calcium

mycophenolate mofetil

PREFERRED BRAND

tacrolimus

Mesnex

PREFERRED BRAND

Azasan

CARDIOVASCULAR DRUGS

Rapamune

CARDIAC GLYCOSIDES

Revlimid

GENERIC

Sandimmune

Digoxin

Thalomid

NON PREFERRED

NON PREFERRED

Lanoxin

Cellcept

Imuran

ANTIANGINAL AGENTS

Myfortic

GENERIC

Neoral

amyl nitrite

Prograf

isochron

Zortress

isoditrate er

isosorbide dinitrate

MITOTIC INHIBITORS

isosorbide dinitrate er

GENERIC

isosorbide mononitrate

etoposide

isosorbide mononitrate er

minitran

ENZYME INHIBITORS

nitroglycerin

GENERIC

Nitroglycerin Lingual

Vandetanib

nitroglycerin transdermal

PREFERRED BRAND

PREFERRED BRAND

Afinitor

Dilatrate Sr

Bosulif

Nitro-bid

Caprelsa

Nitro-dur

Gleevec

Nitrolingual Pumpspray

Jakafi

Nitrostat

Effective January 1, 2013

4

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Ranexa

taztia xt

NON PREFERRED

verapamil hcl

Imdur

verapamil hcl er

Isordil Titradose

Verapamil Hcl Sr

Monoket

PREFERRED BRAND

Nitromist

Cardizem La

NON PREFERRED

BETA BLOCKERS

Adalat Cc

Calan

GENERIC

Calan Sr

acebutolol hcl

Cardene Sr

atenolol

Cardizem

betaxolol hcl

Cardizem Cd

bisoprolol fumarate

Covera-hs

carvedilol

Dilacor Xr

labetalol hcl

Dynacirc Cr

metoprolol succinate er

Hypertenipine-2.5

metoprolol tartrate

Isoptin Sr

nadolol

Nimotop

pindolol

Norvasc

propranolol hcl

Procardia

propranolol hcl er

Procardia Xl

sorine

Sular

sotalol hcl

Tiazac

sotalol hcl (af)

Verelan

timolol maleate

Verelan Pm

PREFERRED BRAND

Bystolic

ANTIARRHYTHMICS

Coreg Cr

NON PREFERRED

GENERIC

Betapace

amiodarone hcl

Betapace Af

disopyramide phosphate

Coreg

flecainide acetate

Corgard

mexiletine hcl

Hypertenevide-12.5

procainamide hcl

Inderal La

propafenone hcl

Innopran Xl

propafenone hcl er

Kerlone

Quinidine Gluconate

Levatol

quinidine gluconate cr

Lopressor

quinidine gluconate er

Metoprolol

quinidine sulfate

Sectral

quinidine sulfate er

Tenormin

PREFERRED BRAND

Toprol Xl

Pacerone

Trandate

Tikosyn

Zebeta

NON PREFERRED

Cordarone

CALCIUM CHANNEL BLOCKERS

Multaq

Norpace

GENERIC

Norpace Cr

afeditab cr

Rythmol

amlodipine besylate

Rythmol Sr

cartia xt

Tambocor

dilt-cd

dilt-xr

ACE INHIBITORS

diltiazem cd

diltiazem hcl

GENERIC

Diltiazem Hcl Cd

benazepril hcl

diltiazem hcl er

captopril

diltzac

enalapril maleate

felodipine er

fosinopril sodium

isradipine

lisinopril

matzim la

moexipril hcl

nicardipine hcl

perindopril erbumine

nifediac cc

quinapril hcl

nifedical xl

ramipril

nifedipine

trandolapril

nifedipine er

NON PREFERRED

nimodipine

Accupril

nisoldipine

Aceon

nisoldipine er

Altace

Effective January 1, 2013

5

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Lotensin

methyldopa/hydrochlorothiazide

Mavik

metoprolol/hydrochlorothiazide

Prinivil

moexipril/hydrochlorothiazide

Univasc

nadolol/bendroflumethiazide

Vasotec

propranolol/hydrochlorothiazide

Zestril

quinapril/hydrochlorothiazide

valsartan/hydrochlorothiazide

ANGIOTENSIN RCPTR BLOCKER

PREFERRED BRAND

Amturnide

GENERIC

Azor

eprosartan mesylate

Benicar Hct

irbesartan

Exforge

losartan potassium

Exforge Hct

PREFERRED BRAND

Micardis Hct

Atacand

Tarka

Benicar

Tekamlo

Diovan

Tekturna Hct

Micardis

Tribenzor

NON PREFERRED

Twynsta

Avapro

Valturna

Cozaar

NON PREFERRED

Edarbi

Accuretic

Teveten

Atacand Hct

Avalide

DIRECT RENIN INHIBITORS

Clorpres

PREFERRED BRAND

Corzide

Tekturna

Diovan Hct

Dutoprol

ANTIHYPERTENSIVES MISC.

Edarbyclor

GENERIC

Hypertensolol

clonidine hcl

Hyzaar

doxazosin mesylate

Lopressor Hct

eplerenone

Lotensin Hct

guanabenz acetate

Lotrel

guanfacine hcl

Lytensopril

hydralazine hcl

Lytensopril-90

methyldopa

Prinzide

minoxidil

Tenoretic 100

phentolamine mesylate

Tenoretic 50

prazosin hcl

Teveten Hct

Reserpine

Uniretic

terazosin hcl

Vaseretic

PREFERRED BRAND

Zestoretic

Demser

Ziac

Dibenzyline

NON PREFERRED

DIURETICS

Cardura

GENERIC

Catapres

acetazolamide

Catapres-tts-1

Acetazolamide Er

Catapres-tts-2

acetazolamide sodium

Catapres-tts-3

Amiloride Hcl

Inspra

amiloride/hydrochlorothiazide

Minipress

bumetanide

Nexiclon Xr

chlorothiazide

Tenex

chlorthalidone

furosemide

ANTIHYPERTENSIVE COMBO

hydrochlorothiazide

GENERIC

indapamide

amlodipine besylate/benazepril hcl

methazolamide

amlodipine besylate/benazepril hydrochloride

methyclothiazide

atenolol/chlorthalidone

metolazone

benazepril hcl/hydrochlorothiazide

spironolactone

bisoprolol fumarate/hydrochlorothiazide

spironolactone/hydrochlorothiazide

candesartan cilexetil/hydrochlorothiazide

torsemide

captopril/hydrochlorothiazide

Triamterene/hydrochlorothiazide

enalapril maleate/hydrochlorothiazide

NON PREFERRED

fosinopril sodium/hydrochlorothiazide

Aldactazide

irbesartan/hydrochlorothiazide

Aldactone

lisinopril/hydrochlorothiazide

Demadex

losartan potassium/hydrochlorothiazide

Effective January 1, 2013

6

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Diamox

Lescol Xl

Diuril

Lipitor

Dyazide

Livalo

Dyrenium

Lofibra

Edecrin

Lopid

Introl

Mevacor

Lasix

Pravachol

Maxzide

Questran

Maxzide-25

Questran Light

Microzide

Tricor

Midamor

Vascepa

Neptazane

Zocor

Thalitone

Zaroxolyn

CARDIOVASCULAR - MISC.

GENERIC

VASOPRESSORS

Amlodipine Besylate/atorvastatin Calcium

GENERIC

papaverine hcl

ephedrine sulfate

sildenafil citrate

Epinephrine

PREFERRED BRAND

midodrine hcl

Adcirca

norepinephrine bitartrate

Bidil

phenylephrine hcl

Letairis

PREFERRED BRAND

Remodulin

Epipen

Tracleer

Epipen 2-pak

Tyvaso

Epipen-jr

Tyvaso Refill

Epipen-jr 2-pak

Tyvaso Starter

NON PREFERRED

Ventavis

Levophed

NON PREFERRED

Neo-synephrine

Caduet

Twinject

Revatio

ANTIHYPERLIPIDEMICS

DERMATOLOGICALS

GENERIC

ACNE PRODUCTS

atorvastatin calcium

GENERIC

cholestyramine

adapalene

cholestyramine light

amnesteem

colestipol hcl

avar cleanser

colestipol hcl for oral suspension

avar-e emollient

Fenofibrate

avar-e green

fenofibrate micronized

Avita

Fenofibric Acid

benzepro

fluvastatin

benzepro short contact

gemfibrozil

benziq wash

lovastatin

benzoyl peroxide

Micronized Colestipol Hcl

benzoyl peroxide cleanser

pravastatin sodium

benzoyl peroxide cleansing

prevalite

benzoyl peroxide short contact

simvastatin

benzoyl peroxide wash

PREFERRED BRAND

benzoyl peroxide wash acne treatment pack

Altoprev

bp cleanser

Antara

bp cleansing wash

Crestor

bp wash

Fenoglide

bp 10-1

Lipofen

bpo

Lovaza

bpo creamy wash complete pack

Niaspan

bpo 3% foaming cloths

Simcor

bpo 6% foaming cloths

Triglide

bpo 9% foaming cloths

Trilipix

cerisa wash

Vytorin

claravis

Welchol

claris clarifying wash

Zetia

clearplex x

NON PREFERRED

clenia

Advicor

clenia foaming wash

Colestid

clindacin-p

Colestid Flavored

clindamax

Fibricor

clindamycin phosphate

Lescol

clindamycin/benzoyl peroxide

Effective January 1, 2013

7

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clindareach

Duac

ery

Evoclin

erythromycin

Inova

erythromycin/benzoyl peroxide

Inova 4/1 Acne Control Therapy

lavoclen-4 acne wash kit

Inova 8/2 Acne Control Therapy

lavoclen-4 creamy wash

Klaron

lavoclen-8 acne wash kit

Neobenz Micro

lavoclen-8 creamy wash

Neobenz Micro Plus Pack

myorisan

Neobenz Micro Sd

oscion cleanser

Neobenz Micro Wash

pacnex wash

Neobenz Micro Wash Plus Pack

pr benzoyl peroxide wash

Nuox

prascion

Pacnex Hp

prascion fc

Pacnex Lp

prascion ra with sunscreens

Pacnex Mx

ra renewal medicated acne treatment maximum strength

Plexion Cleanser

rosanil cleanser

Plexion Cleansing Cloth

se bpo wash

Plexion Sct

se bpo 3% foaming cloths

Retin-a

se bpo 6% foaming cloths

Retin-a Micro

se bpo 7-5.5 wash kit

Retin-a Micro Pump

se bpo 9% foaming cloths

Rosanil

se 10-5 ss

Sss 10-4

Sodium Sulfacetamide

Sulfoam

sodium sulfacetamide/sulfur

Sumadan Kit

sodium sulfacetamide/sulfur cleanser

Sumadan Wash

sodium sulfacetamide/sulfur cleanser in urea

Sumaxin

sodium sulfacetamide/sulfur cleansing cloths

Sumaxin Cp Kit

sodium sulfacetamide/sulfur green

Sumaxin Ts

sodium sulfacetamide/sulfur in urea

Sumaxin Wash

sodium sulfacetamide/sulfur wash

Tretin-x

sotret

Triaz

sulfacetamide sodium

Triaz Cleanser

sulfacetamide sodium/sulfur cleanser

Triaz Foaming Cloths

sulfacleanse 8/4

Vanoxide Hc

suphera

Vanoxide-hc

tl bpo mx cleanser

Zacare 4% Kit

Tretinoin

Zacare 8% Kit

virti-sulf

Ziana

zaclir cleansing

zencia

ROSACEA AGENTS

PREFERRED BRAND

GENERIC

Acanya

metronidazole

Aczone

rosadan

Atralin

vitazol

Azelex

PREFERRED BRAND

Epiduo

Finacea

Veltin

Metrogel

NON PREFERRED

Oracea

Absorica

NON PREFERRED

Akne-mycin

Finacea Plus

Avar Ls Cleanser

Metrocream

Avar-e Ls

Metrolotion

Benzac Ac Wash

Noritate

Benzac W Wash

Rosadan Kit

Benzaclin

Benzaclin With Pump

ANTIBIOTICS - TOPICAL

Benzamycin

GENERIC

Benzamycinpak

Centany

Benzefoam

gentamicin sulfate

Benzefoamultra

mupirocin

Benziq

NON PREFERRED

Benziq Ls

Altabax

Clarifoam Ef

Bactroban

Cleocin-t

Centany At

Clindacin Pac

Cortisporin

Clindagel

Delos

ANTIFUNGALS - TOPICAL

Desquam-x Wash

Differin

Effective January 1, 2013

8

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GENERIC

NON PREFERRED

ciclodan

Zonalon

ciclopirox

ciclopirox nail lacquer

ANTIPSORIATICS

ciclopirox olamine

GENERIC

ciclopirox topical solution kit

calcipotriene

ciclopirox treatment

Calcitriol

clotrimazole

dritho-creme hp

clotrimazole/betamethasone dipropionate

PREFERRED BRAND

econazole nitrate

Dritho-scalp

exoderm

Oxsoralen Ultra

ketoconazole

Soriatane

ketodan

Tazorac

nuzole

Vectical

nyamyc

NON PREFERRED

nystatin

Amevive

nystatin/triamcinolone

Calcitrene

nystop

Dovonex

pedi-dri

Dovonex Scalp

versiclear

Sorilux

PREFERRED BRAND

Stelara

Exelderm

Zithranol

Mentax

Zithranol-rr

NON PREFERRED

8-mop

Aloquin

Ciclodan Cream Kit

ANTISEBORRHEIC AGENTS

Ciclodan Solution Kit

GENERIC

Cnl8 Nail Kit

glycolic acid

Ertaczo

glycolic acid 70% high purity

Extina

mexar wash

Halotin

seb-prev

Ketocon

seb-prev wash

Ketodan Kit

selenium sulfide

Lamisil

sodium sulfacetamide wash

Loprox

sodium sulfacetamide/urea

Loprox Shampoo

PREFERRED BRAND

Lotrisone

Ovace Plus

Naftin

NON PREFERRED

Nizoral

Ovace Plus Wash

Oxistat

Ovace Wash

Pediaderm Af Complete Kit

Promiseb

Pedipirox-4 Nail

Promiseb Complete

Penlac Nail Lacquer

Selsun Shampoo

Vusion

Tersi Foam

Xolegel

Xolegel Corepak

CORTICOSTEROIDS - TOPICAL

Xolegel Duo/head & Shoulders

GENERIC

Xolegel Duo/xolex

ala cort

alclometasone dipropionate

ANTIVIRALS - TOPICAL

alphatrex

PREFERRED BRAND

amcinonide

Zovirax

apexicon

NON PREFERRED

apexicon e

Denavir

augmented betamethasone dipropionate

Lidovir

betamethasone dipropionate

Xerese

betamethasone valerate

clobetasol propionate

ANTI-INFLAMMATORY AGENTS

clobetasol propionate e

PREFERRED BRAND

clobetasol propionate emollient

Flector

cormax

Voltaren

cormax scalp application

NON PREFERRED

cortalo

Napro 15% Compounding Kit

desonide

Naproderm Compounding Kit

desoximetasone

Pennsaid

diflorasone diacetate

fluocinolone acetonide

ANTIPRURITICS

fluocinolone acetonide body

GENERIC

fluocinolone acetonide scalp

Prudoxin

fluocinonide

Effective January 1, 2013

9

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fluocinonide emollient base

Synalar Cream Kit

fluocinonide-e

Synalar Ointment Kit

fluticasone propionate

Synalar Ts

halac

Temovate

halobetasol propionate

Temovate E

halonate pac

Texacort

hydrocortisone

Topicort

hydrocortisone acetate/aloe

Ultravate

hydrocortisone butyrate

Ultravate Pac

hydrocortisone in absorbase

Ultravate X

hydrocortisone valerate

Vanos

Lokara

Verdeso

mometasone furoate

Westcort

pramcort

prednicarbate

IMMUNOMODULATING AGENTS

scalacort

GENERIC

synalar

imiquimod

triamcinolone acetonide

PREFERRED BRAND

triamcinolone acetonide in absorbase

Elidel

trianex

Protopic

triderm

NON PREFERRED

u-cort

Aldara

PREFERRED BRAND

Zyclara

Capex

Zyclara Pump

Cordran Tape

Halog

DERMATOLOGICALS - MISC.

Kenalog

GENERIC

Locoid Lipocream

acticin

Taclonex

aliclen

NON PREFERRED

aluminum acetate

Aclovate

ammonium lactate

Ala Scalp

arnica flower

Aqua Glycolic Hc Scalp & Body

benzoin compound tincture

Carmol-hc

benzoin tincture

Clobeta Cream

boric acid

Clobeta Ointment

capsaicin

Clobex

cem-urea

Cloderm

cerovel

Cloderm Pump

coal tar

Cordran

coal tar base

Cordran Sp

cocaine hcl

Cutivate

durasal

Derma-smoothe/fs Body Oil

ethyl chloride

Derma-smoothe/fs Scalp Oil

ethyl chloride/fine pinpoint

Dermatop

ethyl chloride/fine stream

Desonate

ethyl chloride/medium jet stream

Desonil

ethyl chloride/medium stream

Desowen

ethyl chloride/mist

Desowen Cream/cetaphil Lotion

green soap

Desowen Lotion/cetaphil Cream

hygel

Desowen Ointment/cetaphil Lotion

hypercare

Diprolene

laclotion

Diprolene Af

lactic acid

Elocon

lactic acid e

Epifoam

lactic acid w/vitamin e

First-hydrocortisone

latrix

Halonate

latrix xm

Lidamantle Hc

lidocaine

Locoid

lidocaine hcl

Luxiq

lidocaine hcl jelly

Momexin

lidocaine/prilocaine

Nucort

lindane

Nuzon

malathion

Olux

permethrin

Olux-e

podocon 25 in benzoin tincture

Pandel

podofilox

Pediaderm Hc

pramox gel

Pediaderm Ta

pyrogallic acid

Pramosone

remeven

Scalacort Dk

Effective January 1, 2013

10

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salacyn

Ovide

salicylic acid

Pliaglis

salicylic acid cream

Pontocaine

salicylic acid in ammonium lactate vehicle

Pr Cream

salicylic acid lotion

Pruclair

salicylic acid wart remover

Prumyx

sodium hyaluronate

Qutenza

Spinosad

Radigel

sulfurated lime

Rinnovi Nail System

tl urea

Salex

u-kera e

Salex Cream

umecta mousse

Salex Lotion

urea

salkera

urea hydrating

Salvax

urea in zinc undecylenate/lactic acid vehicle

Salvax Duo Plus

urea nail

Sklice

urea nail kit

Synera

urea topical

Tetrix

urea 40% nail film

Tl-cermide

urea-c40

Tropazone

witch hazel

Umecta

x-viate

Umecta Nail Film

xclair

Umecta Pd

PREFERRED BRAND

Uramaxin

Condylox

Uramaxin Gt

Eurax

Uramaxin Gt Kit

Lidoderm

Veregen

Ulesfia

Virasal

NON PREFERRED

Xerac Ac

Xylocaine

Aluvea

Xylocaine Jelly

Anacaine

Zenieva

Atopiclair

Aurstat

ENDOCRINE AND METABOLIC

Bensal Hp

CORTICOSTEROIDS

Drysol

GENERIC

Eletone

a-hydrocort

Elimite

a-methapred

Emla

asmalpred

Emulsion Sb

asmalpred plus

Epiceram

baycadron

Gebauers Pain Ease

betamethasone sodium phosphate/betamethasone acetate

Gebauers Spray And Stretch

Genadur

budesonide

Gordofilm

cortisone acetate

Gordons Urea

dexamethasone

Hpr

dexamethasone sodium phosphate

Hpr Plus

fludrocortisone acetate

Hpr Plus/mb Hydrogel

hydrocortisone

Hydro 35

methylprednisolone

Hydro 40 Foam

methylprednisolone acetate

Hylatopic

methylprednisolone dose pack

Hylatopic Plus

methylprednisolone sodiumsuccinate

Hylatopic Plus/aurstat

prednisolone

Hylira

prednisolone sodium phosphate

Kerafoam

prednisone

Kerafoam 42

zema-pak 10 day

Keralyt

zema-pak 13 day

Keralyt Scalp

zema-pak 6 day

Kerol

NON PREFERRED

Kerol Ad

Aristospan Intra-articular

Lac-hydrin

Aristospan Intralesional

Lamb Gel

Celestone

Lycelle

Celestone-soluspan

Mb Hydrogel

Cortef

Mimyx

Depo-medrol

Natroba

Dexamethasone Intensol

Neosalus

Dexpak 10 Day

Neosalus 180 Pack

Dexpak 13 Day

Nuvail

Effective January 1, 2013

11

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Dexpak 6 Day

Climara Pro

Entocort Ec

Delestrogen

Flo-pred

Depo-estradiol

Kenalog-10

Divigel

Kenalog-40

Elestrin

Medrol

Estrace

Medrol Dosepak

Estraderm

Millipred

Estrasorb

Millipred Dp

Estrogel

Orapred

Femhrt Low Dose

Orapred Odt

Femhrt 1/5

Pediapred

Femtrace

Prednisone Intensol

Menest

Prelone

Menostar

Rayos

Minivelle

Solu-cortef

Prefest

Solu-medrol

Premarin

Veripred 20

PROGESTINS

ANDROGENS-ANABOLIC

GENERIC

GENERIC

medroxyprogesterone acetate

danazol

norethindrone acetate

oxandrolone

progesterone

testosterone cypionate

PREFERRED BRAND

testosterone enanthate

Makena

PREFERRED BRAND

NON PREFERRED

Androderm

Aygestin

Androgel

Megace Es

Androgel Pump

Prometrium

Androxy

Provera

Axiron

Fortesta

ANTIDIABETIC AGENTS

Methitest

INSULIN

NON PREFERRED

PREFERRED BRAND

Anadrol-50

Apidra

android

Apidra Solostar

Delatestryl

Humalog

Depo-testosterone

Humalog Kwikpen

First-testosterone

Humalog Mix 50/50

First-testosterone Mc Compounding Kit

Humalog Mix 50/50 Kwikpen

Oxandrin

Humalog Mix 75/25

Striant

Humalog Mix 75/25 Kwikpen

Testim

Humulin R U-500 (concentrated)

Testopel

Lantus

testred

Lantus Solostar

Levemir

ESTROGENS

Levemir Flexpen

GENERIC

Novolog

estradiol

Novolog Flexpen

estradiol valerate

Novolog Mix 70/30

estradiol/norethindrone acetate

Novolog Mix 70/30 Prefilled Flexpen

estropipate

Novolog Penfill

Jevantique

AMYLIN ANALOGS

jinteli

PREFERRED BRAND

mimvey

Symlin

ortho-est

Symlinpen 120

PREFERRED BRAND

Symlinpen 60

Cenestin

INCRETIN MIMETIC AGENTS

Combipatch

PREFERRED BRAND

Enjuvia

Bydureon

Evamist

Byetta

Premphase

Victoza

Prempro

SULFONYLUREAS

Vivelle-dot

GENERIC

NON PREFERRED

chlorpropamide

Activella

glimepiride

Alora

glipizide

Angeliq

glipizide er

Climara

Glipizide Xl

glyburide

Effective January 1, 2013

12

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glyburide micronized

Avandamet

tolazamide

Avandaryl

tolbutamide

Glucovance

NON PREFERRED

Metaglip

Amaryl

Diabeta

BISPHOSPHONATES

Glucotrol

GENERIC

Glucotrol Xl

alendronate sodium

Glynase

etidronate disodium

BIGUANIDES

ibandronate sodium

GENERIC

PREFERRED BRAND

metformin hcl

Actonel

metformin hcl er

Atelvia

PREFERRED BRAND

NON PREFERRED

Riomet

Binosto

NON PREFERRED

Boniva

Fortamet

Didronel

Glucophage

Fosamax

Glucophage Xr

Fosamax Plus D

Glumetza

Skelid

MEGLITINIDE ANALOGUES

GENERIC

CALCITONINS

nateglinide

GENERIC

PREFERRED BRAND

Calcitonin-salmon

Prandin

Fortical

NON PREFERRED

NON PREFERRED

Starlix

Miacalcin

DIABETIC OTHER

PREFERRED BRAND

PARATHYROID HORMONE

Glucagon Emergency Kit

PREFERRED BRAND

NON PREFERRED

Forteo

Glucagen

Glucagen Hypokit

RANK LIGAND INHIBITORS

Korlym

PREFERRED BRAND

Proglycem

Xgeva

ALPHA-GLUCOSIDASE INHIBIT

NON PREFERRED

GENERIC

Prolia

acarbose

NON PREFERRED

HORMONE RECEPTOR MDLTR

Glyset

PREFERRED BRAND

Precose

Evista

DPP-4 INHIBITORS

PREFERRED BRAND

FERTILITY REGULATORS

Januvia

GENERIC

Onglyza

Chorionic Gonadotropin

Tradjenta

Novarel

INSULIN SENSITIZING AGENT

Pregnyl W/diluent Benzyl Alcohol/nacl

GENERIC

Pioglitazone Hcl

LHRH/GNRH AGONIST

NON PREFERRED

PREFERRED BRAND

Actos

Lupron Depot-ped

Avandia

Supprelin La

ANTIDIABETIC COMBINATIONS

Synarel

GENERIC

glipizide/metformin hcl

GROWTH HORMONES

glyburide/metformin hcl

PREFERRED BRAND

Pioglitazone Hcl/metformin Hcl

Norditropin Cartridge

PREFERRED BRAND

Norditropin Flexpro

Actoplus Met Xr

Norditropin Nordiflex Pen

Duetact

Nutropin

Janumet

Nutropin Aq

Janumet Xr

Nutropin Aq Nuspin 10

Jentadueto

Nutropin Aq Nuspin 20

Juvisync

Nutropin Aq Nuspin 5

Kombiglyze Xr

Nutropin Aq Pen

Prandimet

NON PREFERRED

NON PREFERRED

Genotropin

Actoplus Met

Genotropin Miniquick

Appformin

Humatrope

Appformin-d

Effective January 1, 2013

13

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Humatrope Combo Pack

Zemplar

Omnitrope

NON PREFERRED

Saizen

Carnitor

Saizen Click.easy

Carnitor Sf

Serostim

Rocaltrol

Tev-tropin

Zorbtive

THYROID AGENTS

GENERIC

GHRH

Levothroid

NON PREFERRED

levothyroxine sodium

Egrifta

levothyroxine sodium tab 0.075mg

Levoxyl

SOMATOMEDINS

liothyronine sodium

methimazole

NON PREFERRED

nature-throid

Increlex

np thyroid 30

np thyroid 60

SOMATOSTATIC AGENTS

np thyroid 90

GENERIC

propylthiouracil

octreotide acetate

Unithroid

PREFERRED BRAND

unithroid direct

Sandostatin Lar Depot

NON PREFERRED

Somatuline Depot

Armour Thyroid

NON PREFERRED

Cytomel

Sandostatin

Nature-throid Nt-2.5

Synthroid

GH RECEPTOR ANTAGONISTS

Tapazole

PREFERRED BRAND

Thyrolar-1

Somavert

Thyrolar-1/2

Thyrolar-1/4

POSTERIOR PITUITARY

Thyrolar-2

GENERIC

Thyrolar-3

desmopressin acetate

Tirosint

minirin

Westhroid

vasopressin

PREFERRED BRAND

GASTROINTESTINAL

Stimate

LAXATIVES

NON PREFERRED

GENERIC

Ddavp

cascara sagrada

Pitressin Synthetic

cascara sagrada aromatic

constulose

CORTICOTROPIN

gavilyte-c

PREFERRED BRAND

gavilyte-g

Acthar Hp

gavilyte-n/flavor pack

lactulose

PROLACTIN INHIBITORS

mineral oil heavy

GENERIC

Peg 3350/electrolytes

cabergoline

peg-3350/electrolytes

peg-3350/nacl/na bicarbonate/kcl

VASOPRESSIN ANTAGONISTS

polyethylene glycol 3350

PREFERRED BRAND

senna

Samsca

senna leaves

senna plus

PROGESTERONE ANTAGONISTS

trilyte

NON PREFERRED

PREFERRED BRAND

Mifeprex

Halflytely Bowel Prep/flavor Packs

Kristalose

METABOLIC MODIFIERS

Suprep Bowel Prep

GENERIC

NON PREFERRED

calcitriol

Colyte-flavor Packs

levocarnitine

Golytely

PREFERRED BRAND

Moviprep

Buphenyl

Nulytely/flavor Packs

Carbaglu

Osmoprep

Cystadane

Prepopik

Hectorol

Visicol

Kuvan

Orfadin

ANTIDIARRHEALS

Sensipar

Effective January 1, 2013

14

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GENERIC

Bentyl

diphenoxylate/atropine

Cantil

lofene

Cuvposa

lonox

Cytotec

loperamide hcl

Dexilant

opium

Digex Nf

opium tincture

First-lansoprazole

paregoric

First-omeprazole

PREFERRED BRAND

Gabitidine

Motofen

Glycopyrroate

NON PREFERRED

Helidac

Lomotil

Levbid

Rezyst Im

Levsin

Rezyst Sb

Levsin/sl

Vsl#3 Ds

Omeclamox-pak

Pamine

ANTACIDS

Pamine Forte

Pamine Fq

GENERIC

Pepcid

sodium bicarbonate

Prevacid

Prevacid Solutab

ULCER DRUGS

Prevpac

GENERIC

Prilosec

Atropine Sulfate

Protonix

belladonna & opium

Robinul

belladonna alkaloids

Robinul Forte

belladonna alkaloids & opium

Sentradine

cimetidine

Symax Duotab

cimetidine hcl

Zantac

colidrops pediatric

Zegerid

dicyclomine hcl

ed-spaz

ANTIEMETICS

famotidine

GENERIC

gastrinex nf

dimenhydrinate

glycopyrrolate

dronabinol

hyomax -dt

granisetron hcl

hyomax-sl

meclizine hcl

hyomax-sr

ondansetron hcl

hyoscyamine sulfate

ondansetron odt

hyoscyamine sulfate er

trimethobenzamide hcl

hyoscyamine sulfate odt

univert

hyoscyamine sulfate sr

PREFERRED BRAND

hyosyne

Anzemet

lansoprazole

Emend

Lansoprazole Odt

Sancuso

Methscopolamine Bromide

Transderm-scop

misoprostol

NON PREFERRED

nizatidine

Antivert

nulev

Cesamet

omeprazole

Coca Cola Syurp

omeprazole/sodium bicarbonate

Granisol

oscimin

Marinol

oscimin sr

Tigan

Pantoprazole Sodium

Zofran

propantheline bromide

Zofran Odt

ranitidine hcl

Zuplenz

scopolamine hydrobromide

sucralfate

DIGESTIVE AIDS

symax fastabs

symax-sl

GENERIC

symax-sr

Pancrelipase

PREFERRED BRAND

PREFERRED BRAND

Carafate

Creon

Nexium

Zenpep

Pylera

NON PREFERRED

NON PREFERRED

Pancreaze

Aciphex

Pertzye

Anaspaz

Sucraid

Atropen

Ultresa

Axid

Viokace

Effective January 1, 2013

15

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GASTROINTESTINAL - MISC.

Sfrowasa

Urso Forte

GENERIC

Urso 250

balsalazide disodium

Zypram

calcium acetate

colocort

GENITOURINARY

cromolyn sodium

dexpanthenol

URINARY ANTI-INFECTIVES

enulose

GENERIC

generlac

hyophen

Hydrocortisone

Methenamine Hippurate

hydrocortisone acetate/pramoxine

methenamine mandelate

lactulose

nitrofurantoin

lidazone hc

Nitrofurantoin Macrocrystal

lidocaine hcl-hydrocortisone acetate with aloe

nitrofurantoin macrocrystalline

lidocaine hcl/hydrocortisone acetate

nitrofurantoin monohydrate

mesalamine

Nitrofurantoin Monohydrate/macrocrystals

metoclopramide hcl

phosphasal

pram-hca

ur n-c

procto-pak

urin d/s

proctocream hc

uryl

proctosol hc

ustell

proctozone-hc

uta

sulfasalazine

uticap

sulfazine

utira-c

sulfazine ec

utrona-c

ursodiol

NON PREFERRED

z-pram

Furadantin

PREFERRED BRAND

Hiprex

Amitiza

Macrobid

Analpram Advanced

Macrodantin

Apriso

Monurol

Asacol

Prosed/ds

Asacol Hd

Urelle

Canasa

Uretron D/s

Cortifoam

Urex

Fosrenol

Uribel

Lotronex

Urogesic-blue

Pentasa

Uroqid #2

Proctofoam Hc

Relistor

URINARY ANTISPASMODICS

Renvela

GENERIC

NON PREFERRED

bethanechol chloride

Actigall

flavoxate hcl

Analpram-hc

oxybutynin chloride

Analpram-hc Singles

oxybutynin chloride er

Anamantle Hc

Tolterodine Tartrate

Anusol-hc

trospium chloride

Azulfidine

trospium chloride er

Azulfidine En-tabs

PREFERRED BRAND

Chenodal

Detrol La

Cimzia

Enablex

Cimzia Starter Kit

Gelnique

Colazal

Oxytrol

Cortenema

Toviaz

Dipentum

Vesicare

Eliphos

NON PREFERRED

Entereg

Detrol

Gastrocrom

Ditropan Xl

Lialda

Myrbetriq

Linzess

Sanctura

Metozolv Odt

Sanctura Xr

Phoslo

Urecholine

Phoslyra

Procort

VAGINAL PRODUCTS

Proctocort

GENERIC

Rectiv

acid jelly

Reglan

clindamycin phosphate

Renagel

metronidazole vaginal

Rowasa

miconazole 3

Effective January 1, 2013

16

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miconazole 3 combo pack

HEMATOPOIETIC AGENTS

nystatin vaginal

GENERIC

terconazole

airavite

Vandazole

b-6 folic acid

zazole

bp vit 3

PREFERRED BRAND

corvita 150

Avc

cyanocobalamin

Crinone

Dexferrum

Estrace

ed cyte f

Estring

fabb

Gynazole-1

fe c plus

Vagifem

ferocon

NON PREFERRED

ferotrin

Cleocin

ferotrinsic

fem ph

ferraplus 90

Femring

ferrex 150 forte

First-progesterone Vgs 100 Compounding Kit

ferrex 150 forte plus

First-progesterone Vgs 200 Compounding Kit

ferrex 28

First-progesterone Vgs 25 Compounding Kit

ferrogels forte

First-progesterone Vgs 400 Compounding Kit

folbee

First-progesterone Vgs 50 Compounding Kit

folcaps

Metrogel-vaginal

folic acid

Premarin

folic acid/vitamin b-6/vitamin b-12

relagard

folitab

Terazol 3

folplex 2.2

Terazol 7

foltrin

hematinic/folic acid

GENITOURINARY - MISC.

hematogen

GENERIC

hematogen fa

alfuzosin hcl er

hematogen forte

citric acid/sodium citrate

hemocyte-f

cytra k crystals

hydroxocobalamin

cytra-k

iferex 150 forte

cytra-2

Infed

cytra-3

martinic

finasteride

mi-omega nf

phenazo

multigen

phenazopyridine hcl

multigen folic

Potassium Citrate

multigen plus

potassium citrate/citric acid

myferon 150 forte

sodium citrate

nufol

tamsulosin hcl

poly-iron 150 forte

taron-crystals

polysaccharide iron forte

tricitrates

purevit dualfe plus

PREFERRED BRAND

se-tan plus

Cystagon

senilezol

Elmiron

tandem f

Rapaflo

tl gard rx

Urocit-k 15

tl icon

NON PREFERRED

tl-fol 500

Avodart

tl-hem 150

Cardura Xl

tricon

Citrolith

trigels-f forte

Flomax

PREFERRED BRAND

Jalyn

Aranesp Albumin Free

K-phos Mf

Droxia

K-phos No 2

Foltrate

Lithostat

Leukine

Oracit

Mozobil

Polycitra-k Crystals

Neulasta

Proscar

Neumega

Pyridium

Neupogen

Shohls Solution Modified

Nplate

Thiola

procrit

Urocit-k 10

Promacta

Urocit-k 5

NON PREFERRED

Uroxatral

Albafort

Animi-3

HEMATOLOGICAL AGENTS

Animi-3/vitamin D

Effective January 1, 2013

17

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Biferarx

Astringyn

Cardiotek-rx

Evicel

Cenfol

Evithrom

Centratex

Recothrom

Corvite Fe

Recothrom Spray Kit

Corvite 150

Thrombin-jmi Diluent

Divista

Thrombin-jmi Epistaxis

epogen

Thrombin-jmi Syringe Spray Kit

Feriva

Thrombin-jmi W/dil Spray Pump Actuator

Ferralet 90

Thrombogen

Ferro-plex Hematinic

Tisseel

Ferrotrin

Fetrin

HEMATOLOGICAL - MISC.

Folbee Ar

GENERIC

Folgard Rx

anagrelide hydrochloride

Folivane-f

cilostazol

Folivane-plus

clopidogrel

Folpace Rx

dextran hm

Fumatinic

dextran 70

Hematron-af

Dipyridamole

Hemetab

pentoxifylline er

Icar-c Plus

ticlopidine hcl

Integra F

PREFERRED BRAND

Integra Plus

Aggrenox

Irospan 24/6

Brilinta

Maxaron Forte

Effient

Nascobal

NON PREFERRED

Nephron Fa

Agrylin

Neurin-sl

Cathflo Activase

Niron Komplete

Firazyr

Novaferrum

Kalbitor

Omontys

Kinlytic

Pre-folic

Persantine

Proferrin-forte

Plavix

Purefe Plus

Pletal

Tandem Plus

Trental

Taron Forte

Zavesca

MOUTH/THROAT/DENTAL AGENT

ANTICOAGULANTS

GENERIC

GENERIC

aquoral

enoxaparin sodium

cavirinse

fondaparinux sodium

cevimeline hcl

Heparin Sodium

chlorhexadine gluconate oral rinse

Heparin Sodium Dcu

chlorhexidine gluconate

Heparin Sodium/nacl 0.45%

chlorhexidine gluconate oral rinse

Heparin Sodium/nacl 0.9%

clotrimazole

Heparin Sodium/sodium Chloride 0.9%

dobells solution

Heparin Sodium/sodium Chloride 0.9% Premix

easygel

jantoven

lidocaine hcl

warfarin sodium

lidocaine viscous

PREFERRED BRAND

neutral sodium fluoride

Pradaxa

numoisyn

Xarelto

nystatin

NON PREFERRED

oralone

Arixtra

perio med

Coumadin

periogard

Fragmin

pilocarpine hcl

Iprivask

pilocarpine hydrochloride

Lovenox

stannous fluoride oral rinse

topex topical anesthetic

HEMOSTATICS

triamcinolone acetonide

GENERIC

triamcinolone in orabase

aminocaproic acid

NON PREFERRED

PREFERRED BRAND

Aphthasol

Lysteda

Caphosol

NON PREFERRED

Debacterol

Amicar

Evoxac

Artiss

First-bxn Mouthwash

Effective January 1, 2013

18

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First-dukes Mouthwash

fluvoxamine maleate

First-marys Mouthwash

imipramine hcl

First-mouthwash Blm

imipramine pamoate

Gel-kam Oral Care Rinse

maprotiline hcl

Gelclair

mirtazapine

Lta 360 Kit

mirtazapine odt

Miracle Mouthwash

nefazodone hcl

Mucotrol

nortriptyline hcl

Nafrinse Daily/acidulated

paroxetine hcl

Nafrinse Daily/neutral

paroxetine hcl er

Nafrinse Weekly

phenelzine sulfate

Neutrasal

protriptyline hcl

Oramagicrx

sertraline hcl

Oravig

tranylcypromine sulfate

Peridex

trazodone hcl

Prevident

trimipramine maleate

Salagen

venlafaxine hcl

Salicept

venlafaxine hcl er

PREFERRED BRAND

NEUROLOGY, CNS, PSYCH

Cymbalta

Paxil

ANTIANXIETY AGENTS

Pristiq

GENERIC

Viibryd

alprazolam

NON PREFERRED

alprazolam er

Amitriptyline

alprazolam odt

Anafranil

Alprazolam Xr

Aplenzin

buspirone hcl

Appbutamone

chlordiazepoxide hcl

Appbutamone-d

clorazepate dipotassium

Celexa

diazepam

Effexor Xr

droperidol

Emsam

hydroxyzine hcl

Forfivo Xl

hydroxyzine pamoate

Gaboxetine

lorazepam

Lexapro

meprobamate

Luvox Cr

oxazepam

Marplan

NON PREFERRED

Nardil

Alprazolam Intensol

Norpramin

Ativan

Oleptro

Diazepam Intensol

Pamelor

Gabavale-5

Parnate

Gabazolamine

Paxil Cr

Gabazolamine-0.5

Pexeva

Lorazepam Intensol

Prozac

Niravam

Prozac Weekly

Sentrazolam Am 0.25

Remeron

Tranxene T

Remeron Soltab

Valium

Sentraflox Am-10

Vistaril

Sentralopram Am-10

Xanax

Sentravil Pm-25

Xanax Xr

Sentroxatine

Surmontil

ANTIDEPRESSANTS

Tofranil

GENERIC

Tofranil-pm

amitriptyline hcl

Trazamine

amoxapine

Trazodone

budeprion sr

Vivactil

budeprion xl

Wellbutrin

bupropion hcl

Wellbutrin Sr

bupropion hcl er

Wellbutrin Xl

bupropion hcl sr

Zoloft

bupropion hcl xl

citalopram hydrobromide

ANTIPSYCHOTICS

clomipramine hcl

GENERIC

desipramine hcl

chlorpromazine hcl

doxepin hcl

clozapine

escitalopram oxalate

Clozapine Odt

fluoxetine dr

compro

fluoxetine hcl

Effective January 1, 2013

19

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fluphenazine decanoate

NON PREFERRED

fluphenazine hcl

Ambien

haloperidol

Ambien Cr

haloperidol decanoate

Amytal Sodium

haloperidol lactate

Butisol Sodium

Lithium Carbonate

Doral

lithium carbonate er

Edluar

Lithium Citrate

Gabazolpidem-5

loxapine

Halcion

loxapine succinate

Intermezzo

olanzapine

Luminal

olanzapine odt

Nembutal

perphenazine

Nembutal Sodium

prochlorperazine

Restoril

prochlorperazine edisylate

Rozerem

prochlorperazine maleate

Seconal

quetiapine fumarate

Sentrazolpidem Pm-5

risperidone

Somnote

Risperidone M-tab

Sonata

risperidone odt

Strazepam

thioridazine hcl

Zolpimist

thiothixene

trifluoperazine hcl

ADHD, NARCOLEPSY, ETC.

ziprasidone hcl

GENERIC

PREFERRED BRAND

Amphetamine/dextroamphetamine

Abilify

caffeine citrate

Abilify Discmelt

caffeine/sodium benzoate

Latuda

dexmethylphenidate hcl

Seroquel Xr

dextroamphetamine sulfate

NON PREFERRED

dextroamphetamine sulfate er

Clozaril

metadate er

Equetro

methamphetamine hcl

Fanapt

methylin

Fanapt Titration Pack

methylin er

Fazaclo

methylphenidate hcl

Geodon

methylphenidate hcl cd

Haldol

methylphenidate hcl er

Haldol Decanoate 100

Methylphenidate Hcl Sr

Haldol Decanoate 50

methylphenidate hydrochloride

Invega

modafinil

Invega Sustenna

PREFERRED BRAND

Lithobid

Daytrana

Loxitane

Intuniv

Navane

Strattera

Risperdal

Vyvanse

Risperdal Consta

NON PREFERRED

Risperdal M-tab

Adderall

Saphris

Adderall Xr

Seroquel

Cafcit

Zyprexa

Concerta

Zyprexa Relprevv

Desoxyn

Zyprexa Zydis

Dexedrine

Focalin

HYPNOTICS

Focalin Xr

GENERIC

Kapvay

chloral hydrate

Kapvay Dose Pack

estazolam

Metadate Cd

flurazepam hcl

Nuvigil

phenobarbital

Procentra

phenobarbital sodium

Provigil

temazepam

Quillivant Xr

triazolam

Ritalin

zaleplon

Ritalin La

zolpidem tartrate

Ritalin Sr

zolpidem tartrate er

Sentramodafin Am-100

PREFERRED BRAND

Lunesta

ANTICONVULSANTS

Silenor

GENERIC

carbamazepine

Effective January 1, 2013

20

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Carbamazepine Er

ANTIPARKINSON AGENTS

clonazepam

GENERIC

clonazepam odt

amantadine hcl

Diazepam

benztropine mesylate

divalproex sodium

bromocriptine mesylate

divalproex sodium dr

carbidopa/levodopa

divalproex sodium er

carbidopa/levodopa cr

epitol

carbidopa/levodopa er

ethosuximide

carbidopa/levodopa odt

Felbamate

carbidopa/levodopa sr

fosphenytoin sodium

Carbidopa/levodopa/entacapone

gabapentin

Entacapone

lamotrigine

pramipexole dihydrochloride

levetiracetam

ropinirole er

levetiracetam er

ropinirole hcl

oxcarbazepine

selegiline hcl

phenytoin

trihexyphenidyl hcl

phenytoin sodium

PREFERRED BRAND

phenytoin sodium extended

Apokyn

primidone

Azilect

tiagabine hydrochloride

Lodosyn

topiragen

Mirapex Er

topiramate

NON PREFERRED

valproic acid

Cogentin

zonisamide

Comtan

PREFERRED BRAND

Eldepryl

Banzel

Mirapex

Celontin

Neupro

diastat pediatric

Parcopa

Dilantin Infatabs

Parlodel

Lamictal Odt

Requip

Lamictal Xr

Requip Xl

Lyrica

Sinemet

Peganone

Sinemet Cr

Potiga

Stalevo 100

Tegretol-xr

Stalevo 125

Vimpat

Stalevo 150

NON PREFERRED

Stalevo 200

Carbatrol

Stalevo 50

Depakene

Stalevo 75

Depakote

Tasmar

Depakote Er

Zelapar

Depakote Sprinkles

diastat acudial

NEUROLOGY, PSYCH - MISC.

Dilantin

GENERIC

Felbatol

chlordiazepoxide/amitriptyline

Gabitril

disulfiram

Keppra

donepezil hcl

Keppra Xr

ergoloid mesylates

Klonopin

fluoxetine

Lamictal

galantamine

Lamictal Chewable Dispersible

galantamine hydrobromide

Lamictal Starter/not Taking Carbamazepine

olanzapine/fluoxetine

Lamictal Starter/taking Carbamazepine/not Taking Valproate

perphenazine/amitriptyline

rivastigmine tartrate

Lamictal Starter/taking Valproate

PREFERRED BRAND

Mysoline

Ampyra

Neurontin

Avonex

Onfi

Avonex Pen

Phenytek

Copaxone

Sabril

Namenda

Stavzor

Namenda Titration Pak

Tegretol

Nuedexta

Therapentin-60

Orap

Therapentin-90

Rebif

Topamax

Rebif Titration Pack

Topamax Sprinkle

Savella

Trileptal

Xenazine

Zarontin

Xyrem

Zonegran

Effective January 1, 2013

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NON PREFERRED

ANTIMYASTHENIC AGENTS

Antabuse

GENERIC

Aricept

Guanidine Hcl

Aricept Odt

neostigmine methylsulfate

Aubagio

pyridostigmine bromide

Betaseron

PREFERRED BRAND

Campral

Mestinon Timespan

Exelon

Prostigmin

Extavia

NON PREFERRED

Gilenya

Enlon

Gralise

Mestinon

Gralise Starter

Mytelase

Horizant

Regonol

Razadyne

Razadyne Er

OPHTHALMOLOGY AND OTIC

Sarafem

ANTI-INFECTIVES

Savella Titration Pack

GENERIC

Symbyax

ak-poly-bac

bacitracin

NEUROMUSCULAR AGENTS

bacitracin/polymyxin b

PREFERRED BRAND

ciprofloxacin hcl

Rilutek

erythromycin

NON PREFERRED

garamycin

Anectine

gentak

Botox

gentamicin sulfate

Dysport

ilotycin

Myobloc

levofloxacin

Quelicin

neo-polycin

Quelicin 1000

neomycin/bacitracin/polymyxin

Xeomin

neomycin/polymyxin/bacitracin zinc

neomycin/polymyxin/gramicidin

MUSCULOSKELETAL AGENTS

ofloxacin

GENERIC

polycin b

baclofen

Polymyxin B Sulfate/trimethoprim Sulfate

carisoprodol

romycin

carisoprodol/aspirin

sodium sulfacetamide

carisoprodol/aspirin/codeine

sulfacetamide sodium

chlorzoxazone

tobramycin sulfate

cyclobenzaprine hcl

tobrasol

cyclobenzaprine hcl er

Trifluridine

dantrolene sodium

trimethoprim sulfate/polymyxin b sulfate

ed baclofen

PREFERRED BRAND

Metaxalone

Besivance

methocarbamol

Ciloxan

orphenadrine citrate

Moxeza

orphenadrine citrate er

Natacyn

orphenadrine compound ds

Vigamox

orphenadrine/asa/caffeine

Zymaxid

tizanidine hcl

NON PREFERRED

NON PREFERRED

Azasite

Amrix

Betadine Ophthalmic Prep

Cyclobenzaprine Comfort Pac

Bleph-10

Dantrium

Iquix

Fexmid

Mitosol

Flexeril

Neosporin

Lorzone

Ocuflox

Norflex

Polytrim

Parafon Forte Dsc

Quixin

Prazolamine

Tobrex

Robaxin

Viroptic

Robaxin-750

Zirgan

Skelaxin

Soma

ARTIFICIAL TEAR/LUBRICANT

Therabenzaprine-60

PREFERRED BRAND

Therabenzaprine-90

Lacrisert

Therabenzaprine-90-5

Tizanidine Comfort Pac

BETA-BLOCKERS

Zanaflex

GENERIC

betaxolol hcl

Effective January 1, 2013

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carteolol hcl

GENERIC

dorzolamide hcl/timolol maleate

ak-pentolate

levobunolol hcl

atropine sulfate

Metipranolol

atropine-care

timolol maleate

cyclopentolate hcl

Timolol Maleate Ophthalmic Gel Forming

cylate

PREFERRED BRAND

homatropaire

Betoptic-s

homatropine hbr

Combigan

mydral

NON PREFERRED

tropicamide

Betagan

NON PREFERRED

Betimol

Cyclogyl

Cosopt

Cyclomydril

Cosopt Pf

Isopto Atropine

Istalol

Isopto Homatropine

Optipranolol

Isopto Hyoscine

Timoptic

Mydriacyl

Timoptic Ocudose

Timoptic-xe

DECONGESTANTS

GENERIC

OPHTHALMIC STEROIDS

ak-con

GENERIC

altafrin

dexamethasone sodium phosphate

neofrin

fluor-op

phenylephrine hcl

Fluorometholone

NON PREFERRED

neomycin/polymyxin/bacitracin/hydrocortisone

Mydfrin

neomycin/polymyxin/dexamethasone

neomycin/polymyxin/hydrocortisone

MIOTICS

poly-dex

GENERIC

Prednisolone Acetate

pilocarpine hcl

prednisolone sodium phosphate

PREFERRED BRAND

sulfacetamide sodium/prednisolone sodium phosphate

Isopto Carbachol

tobramycin/dexamethasone

Phospholine Iodide

PREFERRED BRAND

Pilopine Hs

Alrex

NON PREFERRED

Blephamide S.o.p.

Isopto Carpine

Durezol

Fml

ADRENERGIC AGENTS

Lotemax

GENERIC

Pred Mild

apraclonidine

Tobradex St

brimonidine tartrate

Zylet

NON PREFERRED

NON PREFERRED

Alphagan P

Blephamide

Iopidine

Flarex

Fml Forte

IMMUNOMODULATORS

Fml Liquifilm

PREFERRED BRAND

Maxidex

Restasis

Maxitrol

Omnipred

LOCAL ANESTHETICS

Poly-pred

GENERIC

Pred Forte

altacaine

Pred-g

parcaine

Pred-g S.o.p.

proparacaine hcl

Tobradex

tetcaine

Vexol

tetracaine hcl

tetravisc

PROSTAGLANDINS

tetravisc forte

GENERIC

NON PREFERRED

latanoprost

Akten

PREFERRED BRAND

Alcaine

Lumigan

Travatan Z

OPHTHALMICS - MISC.

NON PREFERRED

GENERIC

Xalatan

akorn balanced salt solution

Zioptan

azelastine hcl

balanced salt solution

CYCLOPLEGIC MYDRIATICS

bromfenac

cromolyn sodium

Effective January 1, 2013

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diclofenac sodium

dorzolamide hcl

GENERIC

epinastine hcl

methylergonovine maleate

flurbiprofen sodium

Oxytocin

ketorolac tromethamine

NON PREFERRED

PREFERRED BRAND

Cervidil

Acuvail

Hemabate

Azopt

Methergine

Bromday

Pitocin

Nevanac

Prepidil

Pataday

Prostin E2

Patanol

NON PREFERRED

PAIN MANAGEMENT

Acular

ANALGESICS - NONNARCOTIC

Acular Ls

GENERIC

Alamast

ali-flex

Alocril

alpain

Alomide

anabar

Bepreve

anolor 300

Elestat

biogesic

Emadine

bp poly-650

Ilevro

bupap

Lastacaft

butal/asa/caff

Ocufen

butalbital compound

Optivar

butalbital/acetaminophen

Trusopt

butalbital/acetaminophen/caffeine

Voltaren

Butalbital/asa/caffeine

butalbital/aspirin/caffeine

OTIC AGENTS

cafgesic forte

GENERIC

capacet

acetasol hc

cephadyn

acetic acid

choline magnesium trisalicylate

acetic acid/aluminum acetate

diflunisal

antipyrine/benzocaine

dologesic

aurax

dolorex

aurodex

duraxin

Ciprofloxacin

ed-flex

fluocinolone acetonide

frenadol

hydrocortisone/acetic acid

margesic

myoxin

marten-tab

neomycin/polymyxin/hc

mst 600

neomycin/polymyxin/hydrocortisone

novagesic

ofloxacin

promacet

otic care

repan

oticin

rhinoflex

otozin

rhinoflex-650

PREFERRED BRAND

salsalate

Ciprodex

tencon

NON PREFERRED

zebutal

Auralgan

zflex

cetraxal

zgesic

Cipro Hc

NON PREFERRED

Coly-mycin S

Acuflex

Cortisporin

Alagesic Lq

Cortisporin-tc

Bioregesic

Cresylate

Dolgic Plus

Dermotic

Durabac

Neotic

Durabac Forte

Pinnacaine Otic

Equagesic

Pramotic

Esgic

Treagan Otic

Esgic-plus

Trioxin

Fioricet

Vosol

Fiorinal

Vosol Hc

Flextra

Zinotic

Flextra Ds

Zinotic Es

Flextra-650

Lagesic

OXYTOCICS

Levacet

Orbivan

Effective January 1, 2013

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Orbivan Cf

Suboxone

Phrenilin Forte

NON PREFERRED

Relagesic

Actiq

Sedapap

Alfenta

Staflex

Buprenex

Capital/codeine

ANALGESICS - OPIOID

Cocet

Cocet Plus

GENERIC

Conzip

acetaminophen/caffeine/dihydrocodeine bitartrate

Demerol

acetaminophen/codeine

Dilaudid

acetaminophen/codeine #2

Dilaudid-hp

acetaminophen/codeine #3

Dilaudid-5

acetaminophen/codeine #4

Dolophine

acetaminophen/codeine phosphate

Dolophine Hcl

alfentanil

Duragesic

ascomp/codeine

Exalgo

astramorph

Fioricet/codeine

buprenorphine hcl

Fiorinal/codeine #3

butalbital/acetaminophen/caffeine/codeine

Hycet

butalbital/aspirn/caffeine/codeine

hydrocodone-acetaminophen tab 7.5-750 mg

butorphanol tartrate

Hydromorphone

co-gesic

Infumorph 200

codeine phosphate

Infumorph 500

Codeine Sulfate

Kadian

Duramorph

Lazanda

endocet

Liquicet

Endodan

Lorcet Plus

fentanyl

Lorcet 10/650

fentanyl citrate oral transmucosal

Lortab

hydrocodone bitartrate/acetaminophen

Magnacet

hydrocodone/acetaminophen

Maxidone

hydrocodone/ibuprofen

Methadone Hcl Intensol

hydrogesic

Morphine

hydromorphone hcl

morphine sulfate powder

hydromorphone hcl dosette

Morphine/saline

ibudone

Ms Contin

levorphanol tartrate

Ms/hydrogel

meperidine hcl

Norco

meperitab

Onsolis

methadone hcl

Opana

Methadose

Oramorph Sr

Methadose Sugar-free

Oxecta

Morphine Sulfate

oxycodone

Morphine Sulfate Er

Percocet

nalbuphine hcl

Percodan

oxycodone hcl

Primlev

oxycodone/acetaminophen

Reprexain

oxycodone/aspirin

Roxicet

oxycodone/ibuprofen

Roxicodone

oxymorphone hydrochloride

Rybix Odt

oxymorphone hydrochloride er

Ryzolt

pentazocine/acetaminophen

Subsys

pentazocine/naloxone hcl

Subutex

stagesic

Synalgos-dc

tramadol hcl

Talwin

Tramadol Hcl Er

Theracodeine-300

Tramadol Hydrochloride/acetaminophen

Theracodophen-low-90

trezix

Theracodophen-325

vicodin hp

Theracodophen-650

PREFERRED BRAND

Theracodophen-750

Abstral

Theratramadol-60

Avinza

Theratramadol-90

Butrans

Tylenol/codeine #3

Fentora

Tylenol/codeine #4

Nucynta

Tylox

Nucynta Er

Ultracet

Opana Er

Ultram

Opana Er (crush Resistant)

Ultram Er

Oxycontin

Vicodin

Effective January 1, 2013

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Vicodin Es

Nalfon

Vicoprofen

Naprelan

Xodol

Naprosyn

Xolox

Naproxen Comfort Pac

Zamicet

Orencia

Zolvit

Ponstel

Zydone

Rheumatrex

Simponi

ANTI-INFLAMMATORY

Sprix

Therafeldamine

GENERIC

Theraprofen-60

diclofenac potassium

Theraprofen-800

diclofenac sodium dr

Theraprofen-90

diclofenac sodium er

Theraproxen

Diclofenac Sodium Xr

Theraproxen-500

diclofenac sodium/misoprostol

Theraproxen-60

etodolac

Theraproxen-90

etodolac er

Trepadiclofen-25

fenoprofen calcium

Trepoxen-250

flurbiprofen

Trepoxicam-7.5

ibuprofen

Voltaren-xr

indomethacin

Wound Gel

indomethacin er

Xeljanz

ketoprofen

Zipsor

ketoprofen er

ketorolac tromethamine

MIGRAINE PRODUCTS

leflunomide

meclofenamate sodium

GENERIC

mefenamic acid

dihydroergotamine mesylate

Meloxicam

naratriptan hcl

nabumetone

Sumatriptan

naproxen

sumatriptan succinate

naproxen dr

Sumatriptan Succinate Refill

naproxen sodium

PREFERRED BRAND

oxaprozin

Cafergot

piroxicam

Ergomar

sulindac

Maxalt

tolmetin sodium

Maxalt-mlt

PREFERRED BRAND

Relpax

Arcalyst

Treximet

Celebrex

Zomig

Enbrel

Zomig Zmt

Enbrel Sureclick

NON PREFERRED

Humira

Alsuma

Humira Pen

Amerge

Humira Pen-crohns Diseasestarter

Axert

Humira Pen-psoriasis Starter

Cambia

Ridaura

D.h.e. 45

Vimovo

Frova

NON PREFERRED

Imitrex

Anaprox

Imitrex Statdose Refill

Anaprox Ds

Imitrex Statdose System

Arava

Migergot

Arthrotec 50

Migral

Arthrotec 75

Migranal

Cataflam

Sumavel Dosepro

Clinoril

Daypro

GOUT AGENTS

Duexis

GENERIC

Ec-naprosyn

Allopurinol

Feldene

probenecid

Ibuprofen Comfort Pac

probenecid/colchicine

Ic 400

PREFERRED BRAND

Ic 800

Colcrys

Ilaris

Uloric

Indocin

NON PREFERRED

Kineret

Zyloprim

Meloxicam Comfort Pac

Mobic

LOCAL ANESTHETICS-INJ

Myochrysine

Effective January 1, 2013

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GENERIC

levocetirizine dihydrochloride

bd pudendal/local block tray 1% lidocaine

lohist-12

bupivacaine hcl

phenadoz

Bupivacaine/epinephrine

promethazine hcl

chloroprocaine hcl

promethazine hcl plain

lidocaine hcl

promethegan

lidocaine/epinephrine

respa-br

mepivacaine hcl

respivent df

polocaine

respivent df 30

polocaine-mpf

PREFERRED BRAND

sensorcaine

Clarinex Reditabs

sensorcaine-mpf

NON PREFERRED

sensorcaine/epinephrine

Aerohist

tetracaine hcl

Ahist

NON PREFERRED

Ala-hist

Argyle Pneumothorax Procedure Tray/8fr

Allerx Df

Carbocaine

Allerx Df 30

Duocaine

Clarinex

Durasafe Spinal/epidural Tray/1% Xylocaine/19gx36"close Cath

Doxytex

Ed Chlorped

Durasafe Spinal/epidural Tray/1% Xylocaine/19gx36"open Cath

Ed-chlor-tan

Lodrane 24

Durasafe Spinal/epidural Tray/1% Xylocaine/20gx36"close Cath

Palgic

Phenergan

Durasafe Spinal/epidural Tray/1% Xylocaine/20gx36"open Cath

Phenergan Fortis

Ryneze

Exparel

Vazol

Lets Kit

Xyzal

Marcaine

Marcaine W/o Epi

NASAL AGENTS

Marcaine/epinephrine

GENERIC

Monoject Basic Biopsy Tray Without Biopsy Needle 20gx 1-1/2"

azelastine hcl

Monoject Bone Marrow Aspiration Tray/iliac Needle 16g

flunisolide

Monoject Bone Marrow Aspiration Tray/rosenthal Needle 16gx2"

fluticasone propionate

ipratropium bromide

Monoject Bone Marrow Biopsy Tray/biop Aspir Needle 11gx4"

triamcinolone acetonide

PREFERRED BRAND

Monoject Bone Marrow Biopsy Tray/biop Aspir Needle 8gx4"

Astepro

Nasonex

Monoject Bone Marrow Biopsy Tray/biop Aspir/iliac Aspir Ndle

Qnasl

Rhinocort Aqua

Naropin

Veramyst

Nesacaine

NON PREFERRED

Nesacaine-mpf

Adrenalin

Pontocaine

Astelin

Pontocaine Niphanoid

Atrovent

Sensorcaine-mpf/epinephrine

Bactroban Nasal

Xylocaine

Beconase Aq

Xylocaine-mpf

Dymista

Xylocaine-mpf/epinephrine

Flonase

Xylocaine/epinephrine

Lusonal

Nasacort Aq

RESPIRATORY, ALLERGY, ETC

Omnaris

ANTIHISTAMINES

Patanase

GENERIC

Tyzine

arbinoxa

Tyzine Pediatric Nasal Drops

bpm

Zetonna

bromax

brompheniramine tannate

COUGH/COLD/ALLERGY

bromspiro

GENERIC

carbinoxamine maleate

acetylcysteine

cetirizine hcl

airacof

clemastine fumarate

albatussin nn

cyproheptadine hcl

alenaze-d

desloratadine

alenaze-d nr

dexchlorpheniramine maleate

balacall dm

dexchlorpheniramine maleate cr

benzonatate

diphenhydramine hcl

bidhist-d

dytuss

biotuss

fexofenadine hcl

Effective January 1, 2013

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biotuss pediatric

rinate pediatric

bpm pseudo

robafen ac

bromatan plus

romilar ac

bromfed dm

ru-hist forte

centergy

ru-tuss

centergy dm

simuc-gp

ceron-dm

sodium chloride

chlor-mes d

sudahist

chlor-mes jr

sudatex-dm

coldec dm

sutan-dm

dacex-dm

tannihist-12 rf

de-chlor dm

tgq 15dm/5peh/2cpm

de-chlor dr

tgq 30pse/150gfn/15dm

dehistine

tgq 30pse/3brm/15dm

despec-exp

tgq 50pse/3brm/30dm

dex-tuss

tgq 7.5peh/4brm/15dm

dextromethorphan hbr/chlorpheniramine/phenylephrine hcl

tl-dex dm

dextromethorphan hbr/phenylephrine hcl/chlorpheniramine

tl-hist cd

dihydro-cp

tl-hist cm

dihydro-pe

trexbrom

dm-pe-chlor

tussafed ex

ed-a-hist dm

tussigon

entre-b

v-cof

exefen-ir

v-hist

expectuss

vazotab

g/p

z-dex

gani-tuss dm nr

z-dex 12d

gani-tuss nr

z-tuss dm

ganidin-nr

zotex-pe

genexa la

zotex-12d

gentex lq

PREFERRED BRAND

gfn 1200/dm 60

Clarinex-d 12 Hour

gfn 550/pse 60

Clarinex-d 24 Hour

guaifenesin/phenylephrinehcl

Rezira

hdc dm

Tussicaps

hydrocodone bitartrate/homatropine methylbromide

Zutripro

hydrocodone polistirex and chlorpheniramine polistirex

NON PREFERRED

hydrocodone/homatropine

Aerokid

hydromet

Ala-hist D

indamix dm

Alahist Ac

kgs-pe

Alahist Dhc

lohist-12d

Allerscript

myci-gc

Allerx Dose Pack

myhist-pd

Allerx Pe

mytussin ac

Allerx-d

nasohist

Allfen Cd

neutrahist

Allfen Cdx

nohist

Ambifed Cd

nohist dmx

Ambifed Cdx

nortuss-de

Ambifed-g Cd

nortuss-ex

Ambifed-g Cdx

p chlor dm

Atuss Ds

pe-guai

C-tan D Plus

phenylephrine/guaifenesin

Carba-xp

promethazine vc

Carbaphen 12

promethazine vc plain

Carbaphen 12 Ped

promethazine vc/codeine

Carbatuss

promethazine-dm

Carbatuss-cl

promethazine/codeine

Carbatuss-12

promethazine/dextromethorphan

Cenhist

protid

Cgu Wc

pulmari-gp

Corzall

r-tanna

Corzall Plus

r-tanna pediatric

Corzall-pe

relacon-dm nr

Cotab A

relasin dm

Cotab Ax

relcof pse

Cotabflu

relera

Cpb Wc

resperal-dm

Dallergy

respivent-d

Dallergy Dm

Effective January 1, 2013

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Dallergy Jr

Ru-tuss Dm

Dallergy Pe

Semprex-d

Dallergy Pse

Seradex

Dallergy-jr

Stahist

Decon-a

Suttar-sf

Deltuss Dmx

Suttar-2

Despec-pdc

Tekral

Donatuss Dc

Tessalon

Donatuss Xp

Tessalon Perles

Donatussin Dm

Trispec Dmx

Drymax

Trispec Dmx Pediatric

Duraflu

Trispec Pse

Ed Chlorped D

Trispec Pse Pediatric

Ed Dm

Trituss

Exactuss

Tusnel Ped-c

Exall

Tussionex Pennkinetic Extended Release

Exall-d

Tusso-c

Gentex 30

Tusso-dmr

Gilphex Tr

Tusso-zmr

Giltuss

Vazobid

Giltuss Ped-c

Vazotan

Giltuss Pediatric

Z-cof I

Giltuss Tr

Zonatuss

Hydroc/apap

Zotex

hydrocodone 10mg

Zotex -gp

Hyper-sal

Zotex Pe

Hypersal

Zotex Pediatric

J-cof Dhc

Zotex-c

J-max Dhc

Zotex-d

J-tan D

Zotex-dm

J-tan D Sr

Zotex-ex

Lodrane 12d

Zotex-g

Lodrane 24d

Maxifed Cd

ANTIASTHMATIC/COPD AGENTS

Maxifed Cdx

GENERIC

Maxifed-g Cd

albuterol sulfate

Maxifed-g Cdx

albuterol sulfate er

Maxiflu Cd

aminophylline

Maxiflu Cdx

budesonide

Maxiphen Cd

copd

Maxiphen Cdx

cromolyn sodium

Nariz

dg 200

Nasohist Dm

difil-g forte

Nasotuss

difil-g 400

Nebusal

dy-g

Neo Dm

dyflex-g

Neotuss Plus

dylix

Norel Sr

dyphylline gg

Notuss-ac

dyphylline-gg

Panatuss Dxp

epinephrine hcl

Pediatex Td

ipratropium bromide

Pediatex Tdm

ipratropium bromide/albuterol sulfate

Phena-plus

jay-phyl

Phena-s

levalbuterol

Phenflu Cd

Levalbuterol Hcl

Phenflu Cdx

metaproterenol sulfate

Poly Hist Dhc

montelukast sodium

Poly Hist Nc

terbutaline sulfate

Poly Hist Pd

theochron

Poly-tussin Dhc

theophylline

Poly-tussin Ex

theophylline cr

Pro-clear

theophylline er

Prohist Cd

Zafirlukast

Prohist Cf

PREFERRED BRAND

Prohist Lq

Advair Diskus

Relhist

Advair Hfa

Rescon

Alvesco

Rescon-jr

Asmanex 120 Metered Doses

Rescon-mx

Asmanex 14 Metered Doses

Respa-a.r.

Effective January 1, 2013

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Asmanex 30 Metered Doses

Boostrix

Asmanex 60 Metered Doses

Daptacel

Asmanex 7 Metered Doses

Infanrix

Atrovent Hfa

Kinrix

Combivent

Pediarix

Combivent Respimat

Pentacel

Daliresp

Tenivac

Dulera

Trihibit

Elixophyllin

Tripedia

Foradil Aerolizer

Perforomist

VACCINES

Proair Hfa

Pulmicort Flexhaler

GENERIC

Qvar

influenza a (h1n1) monovalent 2009

Serevent Diskus

influenza a (h1n1) monovalent 2009 pf

Spiriva Handihaler

pneumovax 23/1 dose

Symbicort

pneumovax 23/5 dose

Tudorza Pressair

yf-vax

Ventolin Hfa

PREFERRED BRAND

NON PREFERRED

Acthib

Accolate

Afluria Pf 2010-2011

Accuneb

Afluria Pf 2011-2012

Adrenalin

Afluria Pf 2012-2013

Arcapta Neohaler

Afluria 2009-2010

Broncomar-1

Afluria 2011-2012

Brondil

Afluria 2012-2013

Brovana

Agriflu 2010-2011

Dilex-g 200

Biothrax

Dilex-g 400

Cervarix

Duoneb

Comvax

Ed-bron G

Engerix-b

Flovent Diskus

Fluarix 2010-2011

Flovent Hfa

Fluarix 2011-2012

Isuprel

Fluarix 2012-2013

Lufyllin

Flucelvax 2012-2013

Maxair Autohaler

Flulaval 2010-2011

Proventil Hfa

Flulaval 2011-2012

Pulmicort

Flulaval 2012-2013

Pulmophylline

Flumist Nasal Vaccine 2010-2011

Senophylline

Flumist Nasal Vaccine 2011-2012

Singulair

Flumist Nasal Vaccine 2012-2013

Theo-24

Fluvirin Pf 2011-2012

Vospire Er

Fluvirin Pf 2012-2013

Xolair

Fluvirin 2010-2011

Xopenex

Fluvirin 2011-2012

Xopenex Concentrate

Fluvirin 2012-2013

Xopenex Hfa

Fluzone High-dose Pf 2010-2011

Zyflo

Fluzone High-dose Pf 2011-2012

Zyflo Cr

Fluzone High-dose Pf 2012-2013

Fluzone Pediatric Pf 2010-2011

RESPIRATORY AGENTS - MISC

Fluzone Pediatric Pf 2011-2012

PREFERRED BRAND

Fluzone Pediatric Pf 2012-2013

Kalydeco

Fluzone Pf 2010-2011

Pulmozyme

Fluzone Pf 2011-2012

NON PREFERRED

Fluzone Pf 2012-2013

Curosurf

Fluzone Split 2010-2011

Infasurf

Fluzone Split 2011-2012

Survanta Intratracheal

Fluzone Split 2012-2013

Gardasil

TOXOIDS

Havrix

Hiberix

Imovax Rabies (h.d.c.v.)

GENERIC

Influenza Vaccine For Safeway Dependants

decavac

Ipol Inactivated Ipv

diphtheria/tetanus toxoid pediatric

Ixiaro

diphtheria/tetanus toxoids adsorbed pediatric

Je-vax

tetanus toxoid adsorbed

M-m-r Ii W/diluent 10 Dose

tetanus/diphtheria toxoids-adsorbed adult

Menactra

PREFERRED BRAND

Menhibrix

Adacel

Effective January 1, 2013

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Menomune-a/c/y/w-135

hemocyte-plus

Menveo

inatal advance

Pedvax Hib

inatal gt

Prevnar 13

inatal ultra

Proquad

lysiplex plus

Rabavert

m-vit

Recombivax Hb

macnatal cn dha

Rotarix

mult-vitamin/fluoride

Rotateq

multi vitamin/fluoride

Twinrix

multi-vit/fluoride

Typhim Vi

multi-vit/iron/fluoride

Vaqta

multi-vitamin/fluoride

Varivax

multi-vitamin/fluoride/iron

Vivotif Berna

multivitamin with fluoride

Zostavax

multivitamin/fluoride

multivitamins/fluoride

VITAMINS

mvc-fluoride

mynatal advance

VITAMINS

mynatal plus

GENERIC

mynatal ultracaplet

ascor l nc

mynatal-z

ascor l 500

mynate 90 plus

ascorbic acid

mynephrocaps

cenolate

nephronex

Ergocalciferol

neurodep

mega-c/a plus

nicotinamide w/zinc oxide/cupric oxide/folic acid

niacin

nicotinamide/zinc oxide/cupric oxide/folic acid

niacor

nicotinamide/zinc/copper/fa

ortho-cs 250

nutricap

phytonadione

nutrifac zx

pyridoxine hcl

ob-natal one

thiamine hcl

obstetrix ec

vitamin c 222mg

pnv-dha

vitamin d

pnv-select

vitamin k1

poly-vitamin/fluoride

wheat germ

poly-vitamin/iron/fluoride

PREFERRED BRAND

polyvitamin/fluoride

Mephyton

pr natal 400

NON PREFERRED

pr natal 400 ec

Aquasol A Parenteral

pr natal 430

Decara

pr natal 430 ec

Drisdol

prenafirst

prenaissance plus

MULTIVITAMINS

prenaplus

GENERIC

prenatabs fa

b-complex

prenatabs obn

b-complex 100

prenatabs rx

b-plex

prenatal ad

b-plex plus

prenatal low iron

biocel

prenatal plus/iron

bp folinatal plus b

prenatal 19

bp multinatal plus

prenatal-u

cavan one omega

rena-vite rx

cavan prenatal/ec calcium

renal

cavan-ec sod dha

renalpren

co-natal fa

reno caps

cod liver oil

se-care

complete natal dha

se-care conceive

completenate

se-natal one

corvita

se-natal 19

corvite free

se-natal 90

dialyvite

se-plete dha

elite ob with dha

se-tan dha

elite-ob

seton et-ec

ferrocite plus

setonet

folbecal

siderol

folbee plus

strovite plus

folbee plus cz

taron ec calcium

gentex ade

taron-ec cal

hematinic plus vitamins/minerals

taron-prex

Effective January 1, 2013

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therobec

Concept Ob

tl nicotinamide

Corenate-dha

tri rx

Corvite

tri-vit/fluoride

Crnatal

tri-vit/fluoride/iron

Dialyvite Supreme D

tri-vitamin/fluoride

Dialyvite 3000

tri-vitamin/iron/fluoride

Dialyvite 5000

triadvance

Dialyvite/zinc

tricare

Diatx Zn

trimesis rx

Duet Dha

trinatal rx 1

Duet Dha Balanced

trinate

Duet Dha Ec

triphrocaps

Elite-ob 400

triple-vitamin/fluoride

Escavite

trust natal dha

Folcal Dha

ultimatecare one

Folcaps Omega 3

ultimatecare one nf

Folgard Os

ultra tabs

Folivane-ec Calcium Dha Nf

urosex

Folivane-ob

v-c forte

Folivane-prx Dha Nf

vic-forte

Fortavit

vinate az

Gesticare Dha

vinate c

Hemenatal Ob

vinate care

Hemenatal Ob + Dha

vinate gt

Hemocyte Plus

vinate ic

L-methylfolate Pnv Dha

vinate ii

Lactocal-f

vinate m

Levomefolate Dha

vinate one

Levomefolate Pnv

vinate pn care

Marnatal-f

vinate ultra

Marnatal-f Plus Duo Pack

vita s forte

Maxinate

vita-min

Multichew

vitacel

Mykidz Iron Fl

vitafol-ob

Mynatal

vitamin b-complex 100

Nata Komplete

vitamin forte

Natachew

vitamins a/c/d/fluoride

Natafort

vitaspire

Natalvit

vol-care rx

Natelle One

vp-zel

Natelle-ez

PREFERRED BRAND

Nephplex Rx

Neevo

Nephro-vite Rx

Neevo Dha

Nephrocaps

Prefera Ob

Nephrocaps Qt

Prefera Ob + Dha

Nestabs

Preferaob One

Nestabs Dha

NON PREFERRED

Nexa Plus

Adrenal C Formula

Nexa Select

Advanced Am/pm

Nicazel

Albafort

Nicomide

Ap-zel

Nutri-tab Ob

Atabex Ec

Nutri-tab Ob + Dha

Atabex Prenatal

Nutrivit

B-nexa

O-cal Fa

Bacmin

O-cal Prenatal

Bal-care Dha

Ob Complete

Bal-care Dha Essential

Ob Complete One

Caromega

Ob Complete Petite

Cavan-alpha Kit

Ob Complete Premier

Cavan-folate Dha

Ob Complete With Dha

Cavan-folate Ob

Ob Complete 400

Citranatal Assure

Ob Complete/dha

Citranatal B-calm

Obstetrix Dha

Citranatal Dha

Paire Ob

Citranatal Harmony

Pnv Ob+dha

Citranatal Rx

Pnv-dha+docusate

Citranatal 90 Dha

Pnv-omega

Complete-rf Prenatal

Pnv-total

Concept Dha

Poly-vi-flor

Effective January 1, 2013

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Poly-vi-flor/iron

Udamin

Prenaissance

Udamin Sp

Prenaissance Balance

Ultimate Ob Dha

Prenaissance Harmony Dha

Ultimatecare Advantage

Prenaissance Next

Ultimatecare Combo

Prenata

V-natal

Prenatal Mv & Min/fe-fa-dha

V-natal Dha

Prenatal Plus

Vemavite-prx 2

Prenatal Plus Iron

Vena-bal Dha

Prenatal Vitamins Plus

Venatal Complete Dha

Prenate Dha

Venatal-fa

Prenate Elite

Vinacal

Prenate Essential

Vinate Az Extra

Prenate Mini

Vinate Calcium

Prena1 Chew/quatrefolic

Vinate Dha

Prena1 Plus/quatrefolic

Virt-bal Dha

Prena1/quatrefolic

Virt-bal Dha Plus

Prenexa

Virt-pn

Preque 10

Virt-pn Dha

Promar

Virt-select

Protect Cardio

Vita-pren

Protect Plus

Vitafol

Protect Plus Nr

Vitafol-ob+dha

Protectbone

Vitafol-one

Protectiron

Vitafol-plus

Protectnatal

Vitafol-pn

Purefe Ob Plus

Vitaject

Reaphirm

Vital-d Rx

Relnate Dha

Vitamax Pediatric

Renatabs

Vitamedmd One Rx/quatrefolic

Renatabs With Iron

Vitamedmd Plus Rx/quatre Folic

Renax

Vitamedmd Redichew Rx/quatrefolic

Renax 5.5

Vitaroca Plus

Req 49+

Viva Ct Prenatal

Select-ob

Viva Dha

Select-ob+dha

Vol-nate

Senetonic

Vol-plus

Strovite

Vol-tab Rx

Strovite Advance

Vp-ch-pnv

Strovite Forte

Vp-era Ob Plus

Strovite One

Vp-ggr-b6 Prenatal

Supervite

Vp-pnv-dha

Supervite Ec

Zatean-ch

Support

Zatean-pn

Support-500

Zatean-pn Dha

Synagex

Zatean-pn Plus

Synatek

Zingiber

Tandem Dha

Tandem Ob

MEDICAL DEVICES

Taron-bc

DIABETIC SUPPLIES

Taron-c Dha

PREFERRED BRAND

Taron-duo Ec

Accu-chek Active Strips

Tl G-fol Os

Accu-chek Advantage Diabetes Care Kit

Tl-assure One

Accu-chek Aviva

Tl-assure+dha

Accu-chek Aviva Plus

Tl-fluorivite

Accu-chek Comfort Curve Test Strips

Tl-select

Accu-chek Compact Plus Care Kit

Tl-select Dha

Accu-chek Compact Strips

Tri-vi-flor

Accu-chek Compact Test Drum

Tri-vi-floro

Accu-chek Fastclix Lancets

Tri-zel

Accu-chek Multiclix Lancets

Tricare Dha 301

Accu-chek Nano Smartview

Tricare Prenatal Dha One

Accu-chek Safe-t-pro Lancets

Trinatal Gt

Accu-chek Safe-t-pro Pluslancets

Trinatal Ultra

Accu-chek Smartview Strips

Triveen-duo Dha

Accu-chek Soft Touch Lancets

Triveen-one

Accu-chek Softclix Lancets

Triveen-prx Rnf

Acti-lance Lancets 28g

Triveen-ten

Acti-lance Lite Safety Lancets 28g

Triveen-u

Effective January 1, 2013

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Acti-lance Special Safety Lancets 17g

Cvs Lancets Original

Acti-lance Special Safetylancets 17g

Cvs Lancets Thin

Acti-lance Universal Safety Lancets 23g

Cvs Lancets Thin 26g

Advocate Lancets

Cvs Lancets Ultra Thin 30g

Advocate Safety Lancets

Cvs Lancets 21g

Af Lancets Super Thin

Cvs Ultra Thin Lancets

Agamatrix Ultra-thin Lancets 33g

Diastar Easy Test Ii Lancets 30g

Assure Haemolance Plus High Flow 18g

Diastar Easy Test Lancets30g

Assure Haemolance Plus Low Flow 25g

Droplet Lancets Ultra Thin 30g

Assure Haemolance Plus Micro Flow 28g

Drug Mart Lancets Thin

Assure Haemolance Plus Normal Flow 21g

Drug Mart Lancets Ultra Thin

Assure Haemolance Plus Pediatric Blade

Drug Mart Unilet Lancets Super Thin 30g

Assure Lance Lancets

Drug Mart Unilet Lancets Ultra Thin 28g

Assure Lancets

Duane Reade Lancet Alternate Site 26g

At Last Lancets

Duane Reade Lancet Super Thin 30g

Aurora Healthcare Lancets

Duane Reade Lancet Ultra Thin 28g

Aurora Lancet Super Thin 30g

E-z Ject Lancets

Aurora Lancet Thin 23g

E-z Ject Lancets Color

Bayer Microlet Lancets

E-z Ject Lancets Super Thin

Bd Insulin Syringe Luer-lok/u-100/1ml

E-z Ject Lancets Super Thin 30g

Bd Insulin Syringe Microfine Iv/u-100/0.3ml/28g X 1/2"

E-z Ject Lancets Thin 26g

Bd Insulin Syringe Microfine Iv/u-100/0.5ml/28g X 1/2"

E-z Ject Lancets 21g

Bd Insulin Syringe Microfine Iv/u-100/1ml/27g X 5/8"

E-zject Lancets Micro-thin 33g

Bd Insulin Syringe Microfine Iv/u-100/1ml/28g X 1/2"

Easy Comfort Lancets

Bd Insulin Syringe Microfine/u-100/0.3ml/28g X 1/2"

Easy Touch Lancets

Bd Insulin Syringe Microfine/u-100/0.5ml/28g X 1/2"

Easytest Ii Lancets

Bd Insulin Syringe Microfine/u-100/1ml/27g X 5/8"

Easytest Lancets

Bd Insulin Syringe Microfine/u-100/1ml/28g X 1/2"

Eql Color Lancets 21g

Bd Insulin Syringe Safetyglide/u-100/0.3ml/31g X 5/16"

Eql Super Thin Lancets 30g

Bd Insulin Syringe Safetyglide/0.5ml/29g X 1/2"

Eql Thin Lancets 26g

Bd Insulin Syringe Safetyglide/1ml/29g X 1/2"

Ez Smart Blood Glucose Lancets

Bd Insulin Syringe Slip Tip/u-100/1ml

Ez-lets Lancets 21g

Bd Insulin Syringe U-40/1ml/25g X 5/8"

Ez-lets Lancets 23g

Bd Insulin Syringe Ultrafine Half-unit/0.3ml/31g X 5/16"

Ez-lets Lancets 26g Super-soft

Bd Insulin Syringe Ultrafine Ii/short/0.5ml/31g X 5/16"

Ez-lets Lancets 28g Ultra-soft

Bd Insulin Syringe Ultrafine Ii/short/1ml/31g X 5/16"

Ez-lets Lancets 30g

Bd Insulin Syringe Ultrafine/u-100/0.3ml/29g X 1/2"

Fasttake Test Strips

Bd Insulin Syringe Ultrafine/u-100/0.5ml/29g X 1/2"

Fifty50 Safety Seal Lancets 30g

Bd Insulin Syringe Ultrafine/u-100/1ml/29g X 1/2"

Fifty50 Safety Seal Lancets 32g

Bd Insulin Syringe Ultrafine/u-100/1ml/30g X 1/2"

Fine 30

Bd Insulin Syringe Ultrafine/0.3ml/30g X 1/2"

Fingerstix Lancets

Bd Insulin Syringe Ultrafine/0.3ml/31g X 5/16"

Fora Lancets

Bd Insulin Syringe Ultrafine/0.5ml/30g X 1/2"

Freestyle Lancets

Bd Insulin Syringe Ultrafine/0.5ml/31g X 5/16"

Freestyle Unistick Ii Lancets

Bd Insulin Syringe Ultrafine/1ml/30g X 1/2"

Gentle-let Gp Lancets

Bd Insulin Syringe Ultrafine/1ml/31g X 5/16"

Gentle-let Lancets General Purpose Style/fine Point

Bd Insulin Syringe/detachable Needle/u-100/1ml/25g X 1"

Gentle-let Lancets General Purpose Style/medium Point

Bd Insulin Syringe/detachable Needle/u-100/1ml/25g X 5/8"

Gentle-let Lancets Safety Style/fine Point

Gentle-let Lancets Safety Style/medium Point

Bd Insulin Syringe/detachable Needle/u-100/1ml/26g X 1/2"

Global Inject Ease Lancets 28g

Global Inject Ease Lancets 30g

Bd Insulin Syringe/u-100/0.5ml/30g X 1/2"

Glucocom Lancets 28g

Bd Insulin Syringe/u-100/1ml/27g X 1/2"

Glucocom Lancets 30g

Bd Insulin Syringe/u-100/1ml/28g X 1/2"

Glucocom Lancets 33g

Bd Insulin Syringe/u-100/2ml/27.5g X 5/8"

Glucosource Lancets

Bd Insulin Syringe/u-100/2ml/29g X 1/2"

Gnp Lancets

Bd Lancet Ultrafine 30g

Gnp Lancets Micro Thin 33g

Bd Lancet Ultrafine 33g

Gnp Lancets Super Thin 30g

Bd Microtainer Lancets

Gnp Lancets Thin

Bullseye Mini Safety Lancets

Gnp Lancets Thin 26g

Bullseye Safety Lancets

Gnp Lancets 21g

Careone Lancet Thin

Gnp Micro Thin Lancets 33g

Careone Lancet Ultra Thin

Gnp Super Thin Lancets/30g

Cleanlet Lancets 28g

H&h Thinlet Lancets 26g

Clever Chek Lancets Ultrathin

H&h Thinlet Super Thin Lancets 30g

Clever Chek Lancets Ultrathin 30g

H-e-b Incontrol Lancets Super Thin 30g

Coaguchek Lancets

H-e-b Incontrol Lancets Ultra Thin 28g

Comfort Assured Lancets Micro Thin 33g

Haemolance

Comfort Assured Lancets Super Thin 28g

Haemolance Low Flow Lancets

Comfort Lancets

Haemolance Plus

Cvs Lancets Micro Thin 33g

Effective January 1, 2013

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Haemolance Plus High Flow

Monolet Lancets

Haemolance Plus Low Flow

Monolet Opd Lancets

Haemolance Plus Max Flow

Monolettor Safety Lancets

Haemolance Plus Pediatric Flow

Myglucohealth Mgh Softlance Lancets 30g

Healthwise Lancets 30g

Netgroup Lancets

Healthy Accents Unilet Lancets Super Thin 30g

Nova Safety Lancets 23g

Hm Lancets Micro Thin 33g

Nova Safety Lancets 28g

Hm Lancets Ultra Thin 30g

Nova Sureflex Lancets

Hy-vee Lancets

Novofine Autocover 30gx8mm

Hy-vee Thin Lancets

Novofine 30gx8mm

Keep Fit Lancets 28g/twist

Novofine 32gx6mm

Keep Fit Lancets 30g/twist

Novotwist 30gx8mm

Keep Fit Lancets 32g/twist

Novotwist 32gx5mm

Keep Fit Lancets 33g/twist

On Call Lancets

Keep Fit Safety Lancets 21g/pressure Activated

On Call Plus Lancets

Keep Fit Safety Lancets 23g/pressure Activated

Onetouch Basic System

Keep Fit Safety Lancets 26g/button Activated

Onetouch Basic/profile Test Strips

Keep Fit Safety Lancets 26g/pressure Activated

Onetouch Basic/profile/one Touch Ii Test Strips

Keep Fit Safety Lancets 28g/button Activated

Onetouch Club Lancets Fine Point

Keep Fit Safety Lancets 28g/pressure Activated

Onetouch Combo Pack

Kinney Lancets

Onetouch Delica Lancets

Kinney Thin Lancets

Onetouch Delica Lancets Fine 30g

Kroger Lancets

Onetouch Finepoint Lancets

Kroger Lancets Micro Thin33g

Onetouch Lancets

Kroger Lancets Super Thin

Onetouch Profile System

Kroger Lancets Thin

Onetouch Ultra Blue

Kroger Lancets Thin 26g

Onetouch Ultra Mini

Kroger Lancets Ultrathin 30g

Onetouch Ultra System Kit

Kroger Lancets 21g

Onetouch Ultra Test Strips

Lady Lite Lancets

Onetouch Ultra 2

Lancets Thin

Onetouch Ultrasoft Lancets

Lancets Ultra Thin

Onetouch Verio Control Solution High

Lancets Ultra Thin 30g

Onetouch Verio Iq Blood Glucose Monitoring System

Leader Lancets Colored

Onetouch Verio Iq Test Strips

Leader Super Thin Lancet

Onetouch Verio Mid Control Solution

Leader Thin Lancets

Onetouch Verio Test Strips

Lifescan Unistik Ii Lancets

Perfect Lancets 30g

Lifescan Unistik 2 Deep Penetration

Perfect Pressure Activated Safety Lancets 28g

Lite Touch Lancets

Pharmacist Choice Ultra Thin Lancets

Live Better Lancet Super Thin 30g

Pharmacist Choice Ultra Thin Lancets 28g

Live Better Lancet Ultra Thin 28g

Pharmacist Choice Ultra Thin Lancets 30g

Longs Lancets Standard

Pharmacist Choice Ultra Thin Lancets 31g

Longs Lancets Thin

Pharmacy Counter Lancets

Longs Lancets Ultra Thin

Precision Thin Lancets

Major Comfort Lancets

Precision Thins Gp Lancet

Medi-lance Lancets

Precision Ultra Lancet

Medichoice Pre-set Safety Lancet Dual Use

Preferred Plus Lancets Colored 21g

Medichoice Pre-set Safety Lancet Low Flow

Preferred Plus Lancets Super Thin 30g

Medichoice Pre-set Safety Lancet Medium Flow

Preferred Plus Lancets Thin 26g

Medichoice Pre-set Safety Lancet Moderate Flow

Prodigy Pressure Activated Safety Lancets

Medichoice Safety Lancet Extra

Prodigy Safety Lancets

Medichoice Safety Lancet Normal

Prodigy Twist Top Lancets

Medicine Shoppe Lancets

Pss Select Gp Lancets

Medicine Shoppe Lancets Thin

Pss Select Safety Lancets

Medisense Thin Lancets

Px Lancets

Medlance Plus Lancets

Px Lancets Ultra Thin

Medlance Plus Lancets Lite 25g

Qc Lancets Super Thin

Medlance Plus Superlite 30g

Qc Lancets Ultra Thin

Medlance Plus Universal Lancets 21g

Ra E-zject Color Lancets Micro-thin 33g

Medlance Plus/lite 25g

Ra E-zject Lancets Thin 26g

Medlance/extra

Ra E-zject Lancets Thin 28g

Medlance/lite

Ra E-zject Lancets Ultra Thin 30g

Medlance/universal

Ra E-zject Lancets 28g

Meijer Color Lancets Universal 33g

Reality Lancets

Meijer Lancets

Reality Trigger Lancets

Meijer Lancets Thin

Relion Lancets

Meijer Lancets Universal 33g

Relion Lancets Standard 21g

Meijer Super Thin Lancets

Relion Lancets Thin 26g

Microlet Lancets

Relion Lancets Ultra-thin30g

Microtainer Safety Flow Lancet/sterile/single-use

Relion Thin Lancets

Effective January 1, 2013

35

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Relion Ultra Thin Lancets

Ultra-thin Ii Lancets/30g X 1/8"

Relion Ultra Thin Lancets30g

Ultra-thin Ii Safety Autolancets 26g

Relion Ultra Thin Plus Lancets 32g

Unilet Comfortouch Lancet

Relion Ultra Thin Plus Lancets 33g

Unilet Excelite

Renew Advanced Lancing Cartridge Refills

Unilet Excelite Ii

Rightest Gl300 Lancets

Unilet G.p. Lancet

Safe-t-lance Low Flow 25g

Unilet G.p. Superlite Lancet

Safe-t-lance Normal Flow 21g

Unilet Gp 28 Ultra Thin

Safe-t-lance Plus Safety Lancet High Flow

Unilet Lancet

Safe-t-lance Plus Safety Lancet Low Flow

Unilet Superlite Lancet

Safe-t-lance Plus Safety Lancet Normal Flow

Universal 1 Lancets Thin 26g

Safety Lancet 2mm

Universal 1 Lancets Ultra Thin 30g

Safety Lancets

Value Plus Lancets Standard 21g

Safety Lancets 21g

Value Plus Lancets Super Thin 30g

Safety Let Lancets

Value Plus Lancets Thin 26g

Safety Seal Lancets 28g

Valumark Lancet Super Thin 30g

Safety Seal Lancets 30g

Valumark Lancet Ultra Thin 28g

Sb Lancets Thin

Vida Mia Unilet Lancets Super Thin 30g

Sb Lancets Ultra Thin

Vida Mia Unilet Lancets Ultra Thin 28g

Single-let

Vitalet Pro Lancets

Sm Lancets 21g

Vitalet Pro Plus Lancets

Sm Micro Thin Lancets 33g

W&f Lancets Colored 21g

Sm Super Thin Lancets 30g

W&f Lancets 26g

Sm Thin Lancets 26g

Walgreens Advanced Travellancets 28g

Smart Diabetes Vantage Universal Lancets 30g

Walgreens Comfort Assuredlancets Micro Thin/33g

Smart Sense Color Lancets Universal 33g

Walgreens Comfort Assuredlancets Super Thin/28g

Smart Sense Standard Lancets Universal 21g

Walgreens Lancets

Smart Sense Super Thin Lancets Universal 30g

Walgreens Thin Lancets

Smart Sense Thin Lancets Universal 26g

Walgreens Ultra Thin Lancets

Smartest Lancets 28g

1st Choice Lancets Super Thin

Solo V2 Twist Lancets

1st Choice Lancets Thin

Sterilance Tl

1st Choice Lancets Ultra Thin

Sure Comfort Lancets 28g

1st Tier Unilet Comfortouch Lancets 28g

Sure Comfort Lancets 30g

1st Tier Unilet Comfortouch Lancets 30g

Sure-lance Flat Lancets

Sure-lance Lancets 26g

MISCELLANEOUS AGENTS

Sure-lance Thin Lancets 28g

Sure-lance Ultra Thin Lancets

GENERIC

Sure-touch Lancets Universal

pentetate calcium trisodium

Surelite Lancets

pentetate zinc trisodium

Surestep Pro Test Strips

PREFERRED BRAND

Surestep Test Strips

Chemet

Techlite Ast Lancets

Exjade

Techlite Lancets

NON PREFERRED

Tgt Lancet Alternate Site

Ferriprox

Tgt Lancet Super Thin 30g

Tgt Lancet Thin 23g

Tgt Lancet Ultra Thin 28g

Thinlets Gp Lancets

Thinlets Lancet

Todays Health Super Thin Lancets 30g

Todays Health Ultra Thin Lancets 28g

Trueplus Lancets 28g

Trueplus Lancets 28g Super Thin

Trueplus Lancets 30g

Trueplus Lancets 30g Ultra Thin

Trueplus Lancets 33g

Trueplus Lancets 33g Micro Thin

Trueplus Safety Lancets 28g

Ulticare Thin Lancets 30g

Ultilet Basic Lancets 30g

Ultilet Classic Lancets

Ultilet Lancets

Ultilet Safety Lancets 23g

Ultra Thin Lancets 28g

Ultra Thin Lancets 30g

Ultra-thin Ii Auto Lancet

Ultra-thin Ii Lancets 28g

Ultra-thin Ii Lancets 30g

Ultra-thin Ii Lancets/28g X 1/8"

Effective January 1, 2013

36

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Index

A

Actoplus Met, 13

alclometasone dipropionate, 9

Actoplus Met Xr, 13

Aldactazide, 6

a-hydrocort, 11

Actos, 13

Aldactone, 6

a-methapred, 11

Acuflex, 24

Aldara, 10

abacavir, 2

Acular, 24

alenaze-d, 27

Abilify, 20

Acular Ls, 24

alenaze-d nr, 27

Abilify Discmelt, 20

Acuvail, 24

alendronate sodium, 13

Absorica, 8

acyclovir, 2

Alfenta, 25

Abstral, 25

Aczone, 8

alfentanil, 25

Acanya, 8

Adacel, 30

Alferon N, 4

acarbose, 13

Adalat Cc, 5

alfuzosin hcl er, 17

Accolate, 30

adapalene, 7

ali-flex, 24

Accu-chek Active Strips, 33

Adcirca, 7

aliclen, 10

Accu-chek Advantage Diabetes Care Kit, 33

Adderall, 20

Alinia, 3

Adderall Xr, 20

Alkeran, 3

Accu-chek Aviva, 33

Adoxa, 1

Allerscript, 28

Accu-chek Aviva Plus, 33

Adoxa Pak 1/100, 1

Allerx Df, 27

Accu-chek Comfort Curve Test Strips, 33

Adoxa Pak 1/150, 1

Allerx Df 30, 27

Accu-chek Compact Plus Care Kit, 33

Adoxa Pak 2/100, 1

Allerx Dose Pack, 28

Accu-chek Compact Strips, 33

Adrenal C Formula, 32

Allerx Pe, 28

Accu-chek Compact Test Drum, 33

Adrenalin, 27, 30

Allerx-d, 28

Accu-chek Fastclix Lancets, 33

Advair Diskus, 29

Allfen Cd, 28

Accu-chek Multiclix Lancets, 33

Advair Hfa, 29

Allfen Cdx, 28

Accu-chek Nano Smartview, 33

Advanced Am/pm, 32

Allopurinol, 26

Accu-chek Safe-t-pro Lancets, 33

Advicor, 7

Alocril, 24

Accu-chek Safe-t-pro Pluslancets, 33

Advocate Lancets, 34

Alodox Convenience Kit, 1

Accu-chek Smartview Strips, 33

Advocate Safety Lancets, 34

Alomide, 24

Accu-chek Soft Touch Lancets, 33

Aerohist, 27

Aloquin, 9

Accu-chek Softclix Lancets, 33

Aerokid, 28

Alora, 12

Accuneb, 30

Af Lancets Super Thin, 34

alpain, 24

Accupril, 5

afeditab cr, 5

Alphagan P, 23

Accuretic, 6

Afinitor, 4

alphatrex, 9

acebutolol hcl, 5

Afluria 2009-2010, 30

alprazolam, 19

Aceon, 5

Afluria 2011-2012, 30

alprazolam er, 19

acetaminophen/caffeine/dihydrocodeine bitartrate, 25

Afluria 2012-2013, 30

Alprazolam Intensol, 19

Afluria Pf 2010-2011, 30

alprazolam odt, 19

acetaminophen/codeine, 25

Afluria Pf 2011-2012, 30

Alprazolam Xr, 19

acetaminophen/codeine #2, 25

Afluria Pf 2012-2013, 30

Alrex, 23

acetaminophen/codeine #3, 25

Agamatrix Ultra-thin Lancets 33g, 34

Alsuma, 26

acetaminophen/codeine #4, 25

Aggrenox, 18

Altabax, 8

acetaminophen/codeine phosphate, 25

Agriflu 2010-2011, 30

altacaine, 23

acetasol hc, 24

Agrylin, 18

Altace, 5

acetazolamide, 6

Ahist, 27

altafrin, 23

Acetazolamide Er, 6

airacof, 27

Altoprev, 7

acetazolamide sodium, 6

airavite, 17

aluminum acetate, 10

acetic acid, 24

ak-con, 23

Aluvea, 11

acetic acid/aluminum acetate, 24

ak-pentolate, 23

Alvesco, 29

acetylcysteine, 27

ak-poly-bac, 22

amantadine hcl, 21

acid jelly, 16

Akne-mycin, 8

Amaryl, 13

Aciphex, 15

akorn balanced salt solution, 23

Ambien, 20

Aclovate, 10

Akten, 23

Ambien Cr, 20

Acthar Hp, 14

ala cort, 9

Ambifed Cd, 28

Acthib, 30

Ala Scalp, 10

Ambifed Cdx, 28

Acti-lance Lancets 28g, 33

Ala-hist, 27

Ambifed-g Cd, 28

Acti-lance Lite Safety Lancets 28g, 33

Ala-hist D, 28

Ambifed-g Cdx, 28

Acti-lance Special Safety Lancets 17g, 34

Alagesic Lq, 24

amcinonide, 9

Alahist Ac, 28

Amerge, 26

Acti-lance Special Safetylancets 17g, 34

Alahist Dhc, 28

Amevive, 9

Acti-lance Universal Safety Lancets 23g, 34

Alamast, 24

Amicar, 18

Albafort, 17, 32

amikacin sulfate, 2

acticin, 10

albatussin nn, 27

Amiloride Hcl, 6

Actigall, 16

Albenza, 3

amiloride/hydrochlorothiazide, 6

Actimmune, 4

albuterol sulfate, 29

aminocaproic acid, 18

Actiq, 25

albuterol sulfate er, 29

aminophylline, 29

Activella, 12

Alcaine, 23

amiodarone hcl, 5

Actonel, 13

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Amitiza, 16

apraclonidine, 23

Atripla, 2

Amitriptyline, 19

Apriso, 16

Atropen, 15

amitriptyline hcl, 19

Aptivus, 2

Atropine Sulfate, 15

amlodipine besylate, 5

Aqua Glycolic Hc Scalp & Body, 10

atropine sulfate, 23

Amlodipine Besylate/atorvastatin Calcium, 7

Aquasol A Parenteral, 31

atropine-care, 23

aquoral, 18

Atrovent, 27

amlodipine besylate/benazepril hcl, 6

Aralen, 3

Atrovent Hfa, 30

amlodipine besylate/benazepril hydrochloride, 6

Aranesp Albumin Free, 17

Atuss Ds, 28

Arava, 26

Aubagio, 22

ammonium lactate, 10

arbinoxa, 27

augmented betamethasone dipropionate, 9

amnesteem, 7

Arcalyst, 26

amoxapine, 19

Arcapta Neohaler, 30

Augmentin, 1

amoxicillin, 1

Argyle Pneumothorax Procedure Tray/8fr, 27

Augmentin Es-600, 1

amoxicillin/clavulanate potassium, 1

Augmentin Xr, 1

amoxicillin/clavulanate potassium er, 1

Aricept, 22

Auralgan, 24

amoxicillin/potassium clavulanate, 1

Aricept Odt, 22

aurax, 24

Amphetamine/dextroamphetamine, 20

Arimidex, 4

aurodex, 24

amphotericin b, 2

Aristospan Intra-articular, 11

Aurora Healthcare Lancets, 34

ampicillin, 1

Aristospan Intralesional, 11

Aurora Lancet Super Thin 30g, 34

ampicillin sodium, 1

Arixtra, 18

Aurora Lancet Thin 23g, 34

ampicillin-sulbactam, 1

Armour Thyroid, 14

Aurstat, 11

Ampyra, 21

arnica flower, 10

Avalide, 6

Amrix, 22

Aromasin, 4

Avandamet, 13

Amturnide, 6

Arthrotec 50, 26

Avandaryl, 13

amyl nitrite, 4

Arthrotec 75, 26

Avandia, 13

Amytal Sodium, 20

Artiss, 18

Avapro, 6

anabar, 24

Asacol, 16

avar cleanser, 7

Anacaine, 11

Asacol Hd, 16

Avar Ls Cleanser, 8

Anadrol-50, 12

ascomp/codeine, 25

avar-e emollient, 7

Anafranil, 19

ascor l 500, 31

avar-e green, 7

anagrelide hydrochloride, 18

ascor l nc, 31

Avar-e Ls, 8

Analpram Advanced, 16

ascorbic acid, 31

Avc, 17

Analpram-hc, 16

asmalpred, 11

Avelox, 2

Analpram-hc Singles, 16

asmalpred plus, 11

Avelox Abc Pack, 2

Anamantle Hc, 16

Asmanex 120 Metered Doses, 29

avidoxy, 1

Anaprox, 26

Asmanex 14 Metered Doses, 29

Avidoxy Dk, 1

Anaprox Ds, 26

Asmanex 30 Metered Doses, 30

Avinza, 25

Anaspaz, 15

Asmanex 60 Metered Doses, 30

Avita, 7

anastrozole, 3

Asmanex 7 Metered Doses, 30

Avodart, 17

Ancobon, 2

Assure Haemolance Plus High Flow 18g, 34

Avonex, 21

Androderm, 12

Avonex Pen, 21

Androgel, 12

Assure Haemolance Plus Low Flow 25g, 34

Axert, 26

Androgel Pump, 12

Axid, 15

android, 12

Assure Haemolance Plus Micro Flow 28g, 34

Axiron, 12

Androxy, 12

Aygestin, 12

Anectine, 22

Assure Haemolance Plus Normal Flow 21g, 34

Azactam, 3

Angeliq, 12

Azasan, 4

Animi-3, 17

Assure Haemolance Plus Pediatric Blade, 34

Azasite, 22

Animi-3/vitamin D, 17

azathioprine, 4

anolor 300, 24

Assure Lance Lancets, 34

azathioprine sodium, 4

Antabuse, 22

Assure Lancets, 34

azelastine hcl, 23, 27

Antara, 7

Astelin, 27

Azelex, 8

antipyrine/benzocaine, 24

Astepro, 27

Azilect, 21

Antivert, 15

astramorph, 25

azithromycin, 1

Anusol-hc, 16

Astringyn, 18

Azopt, 24

Anzemet, 15

At Last Lancets, 34

Azor, 6

Ap-zel, 32

Atabex Ec, 32

aztreonam, 3

apexicon, 9

Atabex Prenatal, 32

Azulfidine, 16

apexicon e, 9

Atacand, 6

Azulfidine En-tabs, 16

Aphthasol, 18

Atacand Hct, 6

B

Apidra, 12

Atelvia, 13

b-6 folic acid, 17

Apidra Solostar, 12

atenolol, 5

b-complex, 31

Aplenzin, 19

atenolol/chlorthalidone, 6

b-complex 100, 31

Apokyn, 21

Ativan, 19

B-nexa, 32

Appbutamone, 19

Atopiclair, 11

b-plex, 31

Appbutamone-d, 19

atorvastatin calcium, 7

b-plex plus, 31

Appformin, 13

Atovaquone/proguanil Hcl, 3

baciim, 3

Appformin-d, 13

Atralin, 8

bacitracin, 3, 22

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bacitracin/polymyxin b, 22

100/1ml/30g X 1/2", 34

bethanechol chloride, 16

baclofen, 22

Bd Insulin Syringe/detachable Needle/u-100/1ml/25g X 1", 34

Betimol, 23

Bacmin, 32

Betoptic-s, 23

Bactrim, 3

Bd Insulin Syringe/detachable Needle/u-100/1ml/25g X 5/8", 34

Biaxin, 1

Bactrim Ds, 3

Biaxin Xl, 1

Bactroban, 8

Bd Insulin Syringe/detachable Needle/u-100/1ml/26g X 1/2", 34

Biaxin Xl Pac, 1

Bactroban Nasal, 27

bicalutamide, 3

Bal-care Dha, 32

Bd Insulin Syringe/u-100/0.5ml/30g X 1/2", 34

Bicillin C-r, 1

Bal-care Dha Essential, 32

Bicillin L-a, 1

balacall dm, 27

Bd Insulin Syringe/u-100/1ml/27g X 1/2", 34

bidhist-d, 27

balanced salt solution, 23

Bidil, 7

balsalazide disodium, 16

Bd Insulin Syringe/u-100/1ml/28g X 1/2", 34

Biferarx, 18

Banzel, 21

Biltricide, 3

Baraclude, 2

Bd Insulin Syringe/u-100/2ml/27.5g X 5/8", 34

Binosto, 13

baycadron, 11

Bio-statin, 2

Bayer Microlet Lancets, 34

Bd Insulin Syringe/u-100/2ml/29g X 1/2", 34

biocel, 31

Bd Insulin Syringe Luer-lok/u-100/1ml, 34

biogesic, 24

Bd Lancet Ultrafine 30g, 34

Bioregesic, 24

Bd Insulin Syringe Microfine Iv/u-100/0.3ml/28g X 1/2", 34

Bd Lancet Ultrafine 33g, 34

Biothrax, 30

Bd Microtainer Lancets, 34

biotuss, 27

Bd Insulin Syringe Microfine Iv/u-100/0.5ml/28g X 1/2", 34

bd pudendal/local block tray 1% lidocaine, 27

biotuss pediatric, 28

bisoprolol fumarate, 5

Bd Insulin Syringe Microfine Iv/u-100/1ml/27g X 5/8", 34

Beconase Aq, 27

bisoprolol fumarate/hydrochlorothiazide, 6

belladonna & opium, 15

Bd Insulin Syringe Microfine Iv/u-100/1ml/28g X 1/2", 34

belladonna alkaloids, 15

bleomycin sulfate, 3

belladonna alkaloids & opium, 15

Bleph-10, 22

Bd Insulin Syringe Microfine/u-100/0.3ml/28g X 1/2", 34

benazepril hcl, 5

Blephamide, 23

benazepril hcl/hydrochlorothiazide, 6

Blephamide S.o.p., 23

Bd Insulin Syringe Microfine/u-100/0.5ml/28g X 1/2", 34

Benicar, 6

Boniva, 13

Benicar Hct, 6

Boostrix, 30

Bd Insulin Syringe Microfine/u-100/1ml/27g X 5/8", 34

Bensal Hp, 11

boric acid, 10

Bentyl, 15

Bosulif, 4

Bd Insulin Syringe Microfine/u-100/1ml/28g X 1/2", 34

Benzac Ac Wash, 8

Botox, 22

Benzac W Wash, 8

bp 10-1, 7

Bd Insulin Syringe Safetyglide/0.5ml/29g X 1/2", 34

Benzaclin, 8

bp cleanser, 7

Benzaclin With Pump, 8

bp cleansing wash, 7

Bd Insulin Syringe Safetyglide/1ml/29g X 1/2", 34

Benzamycin, 8

bp folinatal plus b, 31

Benzamycinpak, 8

bp multinatal plus, 31

Bd Insulin Syringe Safetyglide/u-100/0.3ml/31g X 5/16", 34

Benzefoam, 8

bp poly-650, 24

Benzefoamultra, 8

bp vit 3, 17

Bd Insulin Syringe Slip Tip/u-100/1ml, 34

benzepro, 7

bp wash, 7

Bd Insulin Syringe U-40/1ml/25g X 5/8", 34

benzepro short contact, 7

bpm, 27

Benziq, 8

bpm pseudo, 28

Bd Insulin Syringe Ultrafine Half-unit/0.3ml/31g X 5/16", 34

Benziq Ls, 8

bpo, 7

benziq wash, 7

bpo 3% foaming cloths, 7

Bd Insulin Syringe Ultrafine Ii/short/0.5ml/31g X 5/16", 34

benzoin compound tincture, 10

bpo 6% foaming cloths, 7

benzoin tincture, 10

bpo 9% foaming cloths, 7

Bd Insulin Syringe Ultrafine Ii/short/1ml/31g X 5/16", 34

benzonatate, 27

bpo creamy wash complete pack, 7

benzoyl peroxide, 7

Brilinta, 18

Bd Insulin Syringe Ultrafine/0.3ml/30g X 1/2", 34

benzoyl peroxide cleanser, 7

brimonidine tartrate, 23

benzoyl peroxide cleansing, 7

bromatan plus, 28

Bd Insulin Syringe Ultrafine/0.3ml/31g X 5/16", 34

benzoyl peroxide short contact, 7

bromax, 27

benzoyl peroxide wash, 7

Bromday, 24

Bd Insulin Syringe Ultrafine/0.5ml/30g X 1/2", 34

benzoyl peroxide wash acne treatment pack, 7

bromfed dm, 28

bromfenac, 23

Bd Insulin Syringe Ultrafine/0.5ml/31g X 5/16", 34

benztropine mesylate, 21

bromocriptine mesylate, 21

Bepreve, 24

brompheniramine tannate, 27

Bd Insulin Syringe Ultrafine/1ml/30g X 1/2", 34

Besivance, 22

bromspiro, 27

Betadine Ophthalmic Prep, 22

Broncomar-1, 30

Bd Insulin Syringe Ultrafine/1ml/31g X 5/16", 34

Betagan, 23

Brondil, 30

betamethasone dipropionate, 9

Brovana, 30

Bd Insulin Syringe Ultrafine/u-100/0.3ml/29g X 1/2", 34

betamethasone sodium phosphate/betamethasone acetate, 11

budeprion sr, 19

budeprion xl, 19

Bd Insulin Syringe Ultrafine/u-100/0.5ml/29g X 1/2", 34

betamethasone valerate, 9

budesonide, 11, 29

Betapace, 5

Bullseye Mini Safety Lancets, 34

Bd Insulin Syringe Ultrafine/u-100/1ml/29g X 1/2", 34

Betapace Af, 5

Bullseye Safety Lancets, 34

Betaseron, 22

bumetanide, 6

Bd Insulin Syringe Ultrafine/u-

betaxolol hcl, 5, 22

bupap, 24

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Buphenyl, 14

Carbatuss-cl, 28

Cellcept, 4

bupivacaine hcl, 27

carbidopa/levodopa, 21

Celontin, 21

Bupivacaine/epinephrine, 27

carbidopa/levodopa cr, 21

cem-urea, 10

Buprenex, 25

carbidopa/levodopa er, 21

Cenestin, 12

buprenorphine hcl, 25

carbidopa/levodopa odt, 21

Cenfol, 18

bupropion hcl, 19

carbidopa/levodopa sr, 21

Cenhist, 28

bupropion hcl er, 19

Carbidopa/levodopa/entacapone, 21

cenolate, 31

bupropion hcl sr, 19

carbinoxamine maleate, 27

Centany, 8

bupropion hcl xl, 19

Carbocaine, 27

Centany At, 8

buspirone hcl, 19

Cardene Sr, 5

centergy, 28

butal/asa/caff, 24

Cardiotek-rx, 18

centergy dm, 28

butalbital compound, 24

Cardizem, 5

Centratex, 18

butalbital/acetaminophen, 24

Cardizem Cd, 5

cephadyn, 24

butalbital/acetaminophen/caffeine, 24

Cardizem La, 5

cephalexin, 1

butalbital/acetaminophen/caffeine/codeine, 25

Cardura, 6

cerisa wash, 7

Cardura Xl, 17

ceron-dm, 28

Butalbital/asa/caffeine, 24

Careone Lancet Thin, 34

cerovel, 10

butalbital/aspirin/caffeine, 24

Careone Lancet Ultra Thin, 34

Cervarix, 30

butalbital/aspirn/caffeine/codeine, 25

carisoprodol, 22

Cervidil, 24

Butisol Sodium, 20

carisoprodol/aspirin, 22

Cesamet, 15

butorphanol tartrate, 25

carisoprodol/aspirin/codeine, 22

cetirizine hcl, 27

Butrans, 25

Carmol-hc, 10

cetraxal, 24

Bydureon, 12

Carnitor, 14

cevimeline hcl, 18

Byetta, 12

Carnitor Sf, 14

Cgu Wc, 28

Bystolic, 5

Caromega, 32

Chemet, 36

C

carteolol hcl, 23

Chenodal, 16

cartia xt, 5

chlor-mes d, 28

C-tan D Plus, 28

carvedilol, 5

chlor-mes jr, 28

cabergoline, 14

cascara sagrada, 14

chloral hydrate, 20

Caduet, 7

cascara sagrada aromatic, 14

chlordiazepoxide hcl, 19

Cafcit, 20

Casodex, 4

chlordiazepoxide/amitriptyline, 21

Cafergot, 26

Cataflam, 26

chlorhexadine gluconate oral rinse, 18

caffeine citrate, 20

Catapres, 6

chlorhexidine gluconate, 18

caffeine/sodium benzoate, 20

Catapres-tts-1, 6

chlorhexidine gluconate oral rinse, 18

cafgesic forte, 24

Catapres-tts-2, 6

chloroprocaine hcl, 27

Calan, 5

Catapres-tts-3, 6

chloroquine phosphate, 3

Calan Sr, 5

Cathflo Activase, 18

chlorothiazide, 6

calcipotriene, 9

cavan one omega, 31

chlorpromazine hcl, 19

Calcitonin-salmon, 13

cavan prenatal/ec calcium, 31

chlorpropamide, 12

Calcitrene, 9

Cavan-alpha Kit, 32

chlorthalidone, 6

Calcitriol, 9

cavan-ec sod dha, 31

chlorzoxazone, 22

calcitriol, 14

Cavan-folate Dha, 32

cholestyramine, 7

calcium acetate, 16

Cavan-folate Ob, 32

cholestyramine light, 7

calcium folinate, 4

cavirinse, 18

choline magnesium trisalicylate, 24

Cambia, 26

Cayston, 3

Chorionic Gonadotropin, 13

Campral, 22

Cedax, 1

ciclodan, 9

Canasa, 16

Ceenu, 3

Ciclodan Cream Kit, 9

candesartan cilexetil/hydrochlorothiazide, 6

cefaclor, 1

Ciclodan Solution Kit, 9

cefaclor er, 1

ciclopirox, 9

Cantil, 15

cefadroxil, 1

ciclopirox nail lacquer, 9

capacet, 24

cefazolin sodium, 1

ciclopirox olamine, 9

Capastat Sulfate, 2

cefdinir, 1

ciclopirox topical solution kit, 9

Capex, 10

Cefditoren Pivoxil, 1

ciclopirox treatment, 9

Caphosol, 18

cefepime, 1

cilostazol, 18

Capital/codeine, 25

cefotaxime sodium, 1

Ciloxan, 22

Caprelsa, 4

cefotetan, 1

cimetidine, 15

capsaicin, 10

cefoxitin sodium, 1

cimetidine hcl, 15

captopril, 5

cefpodoxime proxetil, 1

Cimzia, 16

captopril/hydrochlorothiazide, 6

cefprozil, 1

Cimzia Starter Kit, 16

Carafate, 15

ceftazidime, 1

Cipro, 2

Carba-xp, 28

Ceftin, 1

Cipro Hc, 24

Carbaglu, 14

ceftriaxone sodium, 1

Cipro Xr, 2

carbamazepine, 20

cefuroxime axetil, 1

Ciprodex, 24

Carbamazepine Er, 21

cefuroxime sodium, 1

Ciprofloxacin, 24

Carbaphen 12, 28

Celebrex, 26

ciprofloxacin er, 1

Carbaphen 12 Ped, 28

Celestone, 11

ciprofloxacin hcl, 1, 22

Carbatrol, 21

Celestone-soluspan, 11

citalopram hydrobromide, 19

Carbatuss, 28

Celexa, 19

Citranatal 90 Dha, 32

Carbatuss-12, 28

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Citranatal Assure, 32

coal tar base, 10

Corvite, 32

Citranatal B-calm, 32

Coartem, 3

Corvite 150, 18

Citranatal Dha, 32

Coca Cola Syurp, 15

Corvite Fe, 18

Citranatal Harmony, 32

cocaine hcl, 10

corvite free, 31

Citranatal Rx, 32

Cocet, 25

Corzall, 28

citric acid/sodium citrate, 17

Cocet Plus, 25

Corzall Plus, 28

Citrolith, 17

cod liver oil, 31

Corzall-pe, 28

Claforan, 1

codeine phosphate, 25

Corzide, 6

claravis, 7

Codeine Sulfate, 25

Cosopt, 23

Clarifoam Ef, 8

Cogentin, 21

Cosopt Pf, 23

Clarinex, 27

Colazal, 16

Cotab A, 28

Clarinex Reditabs, 27

Colcrys, 26

Cotab Ax, 28

Clarinex-d 12 Hour, 28

coldec dm, 28

Cotabflu, 28

Clarinex-d 24 Hour, 28

Colestid, 7

Coumadin, 18

claris clarifying wash, 7

Colestid Flavored, 7

Covera-hs, 5

clarithromycin, 1

colestipol hcl, 7

Cozaar, 6

clarithromycin er, 1

colestipol hcl for oral suspension, 7

Cpb Wc, 28

Cleanlet Lancets 28g, 34

colidrops pediatric, 15

Creon, 15

clearplex x, 7

colistimethate sodium, 3

Crestor, 7

clemastine fumarate, 27

colocort, 16

Cresylate, 24

clenia, 7

Coly-mycin M, 3

Crinone, 17

clenia foaming wash, 7

Coly-mycin S, 24

Crixivan, 2

Cleocin, 3, 17

Colyte-flavor Packs, 14

Crnatal, 32

Cleocin Pediatric Granules, 3

Combigan, 23

cromolyn sodium, 16, 23, 29

Cleocin Phosphate, 3

Combipatch, 12

Curosurf, 30

Cleocin-t, 8

Combivent, 30

Cutivate, 10

Clever Chek Lancets Ultrathin, 34

Combivent Respimat, 30

Cuvposa, 15

Clever Chek Lancets Ultrathin 30g, 34

Combivir, 2

Cvs Lancets 21g, 34

Climara, 12

Comfort Assured Lancets Micro Thin 33g, 34

Cvs Lancets Micro Thin 33g, 34

Climara Pro, 12

Cvs Lancets Original, 34

Clindacin Pac, 8

Comfort Assured Lancets Super Thin 28g, 34

Cvs Lancets Thin, 34

clindacin-p, 7

Cvs Lancets Thin 26g, 34

Clindagel, 8

Comfort Lancets, 34

Cvs Lancets Ultra Thin 30g, 34

clindamax, 7

Complera, 2

Cvs Ultra Thin Lancets, 34

clindamycin hcl, 3

complete natal dha, 31

cyanocobalamin, 17

clindamycin palmitate hcl, 3

Complete-rf Prenatal, 32

Cyclobenzaprine Comfort Pac, 22

clindamycin phosphate, 3, 7, 16

completenate, 31

cyclobenzaprine hcl, 22

clindamycin phosphate pharmacy bulk package, 3

compro, 19

cyclobenzaprine hcl er, 22

Comtan, 21

Cyclogyl, 23

clindamycin/benzoyl peroxide, 7

Comvax, 30

Cyclomydril, 23

clindareach, 8

Concept Dha, 32

cyclopentolate hcl, 23

Clinoril, 26

Concept Ob, 32

cyclophosphamide, 3

Clobeta Cream, 10

Concerta, 20

cycloserine, 2

Clobeta Ointment, 10

Condylox, 11

cyclosporine, 4

clobetasol propionate, 9

constulose, 14

cyclosporine modified, 4

clobetasol propionate e, 9

Conzip, 25

cylate, 23

clobetasol propionate emollient, 9

Copaxone, 21

Cymbalta, 19

Clobex, 10

copd, 29

cyproheptadine hcl, 27

Cloderm, 10

Copegus, 2

Cystadane, 14

Cloderm Pump, 10

Cordarone, 5

Cystagon, 17

clomipramine hcl, 19

Cordran, 10

cytarabine, 3

clonazepam, 21

Cordran Sp, 10

cytarabine aqueous, 3

clonazepam odt, 21

Cordran Tape, 10

Cytomel, 14

clonidine hcl, 6

Coreg, 5

Cytotec, 15

clopidogrel, 18

Coreg Cr, 5

cytra k crystals, 17

clorazepate dipotassium, 19

Corenate-dha, 32

cytra-2, 17

Clorpres, 6

Corgard, 5

cytra-3, 17

clotrimazole, 9, 18

cormax, 9

cytra-k, 17

clotrimazole/betamethasone dipropionate, 9

cormax scalp application, 9

D

cortalo, 9

D.h.e. 45, 26

clozapine, 19

Cortef, 11

dacex-dm, 28

Clozapine Odt, 19

Cortenema, 16

Daliresp, 30

Clozaril, 20

Cortifoam, 16

Dallergy, 28

Cnl8 Nail Kit, 9

cortisone acetate, 11

Dallergy Dm, 28

co-gesic, 25

Cortisporin, 8, 24

Dallergy Jr, 29

co-natal fa, 31

Cortisporin-tc, 24

Dallergy Pe, 29

Coaguchek Lancets, 34

corvita, 31

Dallergy Pse, 29

coal tar, 10

corvita 150, 17

Dallergy-jr, 29

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danazol, 12

dexpanthenol, 16

Dipentum, 16

Dantrium, 22

dextran 70, 18

diphenhydramine hcl, 27

dantrolene sodium, 22

dextran hm, 18

diphenoxylate/atropine, 15

dapsone, 3

dextroamphetamine sulfate, 20

diphtheria/tetanus toxoid pediatric, 30

Daptacel, 30

dextroamphetamine sulfate er, 20

diphtheria/tetanus toxoids adsorbed pediatric, 30

Daraprim, 3

dextromethorphan hbr/chlorpheniramine/phenylephrine hcl, 28

Daypro, 26

Diprolene, 10

Daytrana, 20

Diprolene Af, 10

Ddavp, 14

Dipyridamole, 18

dextromethorphan hbr/phenylephrine hcl/chlorpheniramine, 28

de-chlor dm, 28

disopyramide phosphate, 5

de-chlor dr, 28

disulfiram, 21

dg 200, 29

Debacterol, 18

Ditropan Xl, 16

Diabeta, 13

Decara, 31

Diuril, 7

dialyvite, 31

decavac, 30

divalproex sodium, 21

Dialyvite 3000, 32

Decon-a, 29

divalproex sodium dr, 21

Dialyvite 5000, 32

dehistine, 28

divalproex sodium er, 21

Dialyvite Supreme D, 32

Delatestryl, 12

Divigel, 12

Dialyvite/zinc, 32

Delestrogen, 12

Divista, 18

Diamox, 7

Delos, 8

dm-pe-chlor, 28

Diastar Easy Test Ii Lancets 30g, 34

Deltuss Dmx, 29

dobells solution, 18

Diastar Easy Test Lancets30g, 34

Demadex, 6

Dolgic Plus, 24

diastat acudial, 21

demeclocycline hcl, 1

dologesic, 24

diastat pediatric, 21

Demerol, 25

Dolophine, 25

Diatx Zn, 32

Demser, 6

Dolophine Hcl, 25

diazepam, 19

Denavir, 9

dolorex, 24

Diazepam, 21

Depakene, 21

Donatuss Dc, 29

Diazepam Intensol, 19

Depakote, 21

Donatuss Xp, 29

Dibenzyline, 6

Depakote Er, 21

Donatussin Dm, 29

diclofenac potassium, 26

Depakote Sprinkles, 21

donepezil hcl, 21

diclofenac sodium, 24

Depo-estradiol, 12

Doral, 20

diclofenac sodium dr, 26

Depo-medrol, 11

Doryx, 1

diclofenac sodium er, 26

Depo-provera, 4

dorzolamide hcl, 24

Diclofenac Sodium Xr, 26

Depo-testosterone, 12

dorzolamide hcl/timolol maleate, 23

diclofenac sodium/misoprostol, 26

Derma-smoothe/fs Body Oil, 10

Dovonex, 9

dicloxacillin sodium, 1

Derma-smoothe/fs Scalp Oil, 10

Dovonex Scalp, 9

dicyclomine hcl, 15

Dermatop, 10

doxazosin mesylate, 6

didanosine, 2

Dermotic, 24

doxepin hcl, 19

Didronel, 13

desipramine hcl, 19

doxycycline, 1

Differin, 8

desloratadine, 27

doxycycline hyclate, 1

Dificid, 1

desmopressin acetate, 14

doxycycline monohydrate, 1

difil-g 400, 29

Desonate, 10

Doxytex, 27

difil-g forte, 29

desonide, 9

Drisdol, 31

diflorasone diacetate, 9

Desonil, 10

dritho-creme hp, 9

Diflucan, 2

Desowen, 10

Dritho-scalp, 9

diflunisal, 24

Desowen Cream/cetaphil Lotion, 10

dronabinol, 15

Digex Nf, 15

Desowen Lotion/cetaphil Cream, 10

droperidol, 19

Digoxin, 4

Desowen Ointment/cetaphil Lotion, 10

Droplet Lancets Ultra Thin 30g, 34

dihydro-cp, 28

desoximetasone, 9

Droxia, 17

dihydro-pe, 28

Desoxyn, 20

Drug Mart Lancets Thin, 34

dihydroergotamine mesylate, 26

despec-exp, 28

Drug Mart Lancets Ultra Thin, 34

Dilacor Xr, 5

Despec-pdc, 29

Drug Mart Unilet Lancets Super Thin 30g, 34

Dilantin, 21

Desquam-x Wash, 8

Dilantin Infatabs, 21

Detrol, 16

Drug Mart Unilet Lancets Ultra Thin 28g, 34

Dilatrate Sr, 4

Detrol La, 16

Dilaudid, 25

dex-tuss, 28

Drymax, 29

Dilaudid-5, 25

dexamethasone, 11

Drysol, 11

Dilaudid-hp, 25

Dexamethasone Intensol, 11

Duac, 8

Dilex-g 200, 30

dexamethasone sodium phosphate, 11, 23

Duane Reade Lancet Alternate Site 26g, 34

Dilex-g 400, 30

dilt-cd, 5

dexchlorpheniramine maleate, 27

Duane Reade Lancet Super Thin 30g, 34

dilt-xr, 5

dexchlorpheniramine maleate cr, 27

Duane Reade Lancet Ultra Thin 28g, 34

diltiazem cd, 5

Dexedrine, 20

Duet Dha, 32

diltiazem hcl, 5

Dexferrum, 17

Duet Dha Balanced, 32

Diltiazem Hcl Cd, 5

Dexilant, 15

Duet Dha Ec, 32

diltiazem hcl er, 5

dexmethylphenidate hcl, 20

Duetact, 13

diltzac, 5

Dexpak 10 Day, 11

Duexis, 26

dimenhydrinate, 15

Dexpak 13 Day, 11

Dulera, 30

Diovan, 6

Dexpak 6 Day, 12

Duocaine, 27

Diovan Hct, 6

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Duoneb, 30

Elestrin, 12

erythrocin stearate, 1

Durabac, 24

Eletone, 11

erythromycin, 1, 8, 22

Durabac Forte, 24

Elidel, 10

erythromycin base, 1

Duraflu, 29

Eligard, 4

erythromycin ethylsuccinate, 1

Duragesic, 25

Elimite, 11

erythromycin/benzoyl peroxide, 8

Duramorph, 25

Eliphos, 16

erythromycin/sulfisoxazole, 3

Durasafe Spinal/epidural Tray/1% Xylocaine/19gx36"close Cath, 27

elite ob with dha, 31

Escavite, 32

elite-ob, 31

escitalopram oxalate, 19

Durasafe Spinal/epidural Tray/1% Xylocaine/19gx36"open Cath, 27

Elite-ob 400, 32

Esgic, 24

Elixophyllin, 30

Esgic-plus, 24

Durasafe Spinal/epidural Tray/1% Xylocaine/20gx36"close Cath, 27

Elmiron, 17

estazolam, 20

Elocon, 10

Estrace, 12, 17

Durasafe Spinal/epidural Tray/1% Xylocaine/20gx36"open Cath, 27

Elspar, 3

Estraderm, 12

Emadine, 24

estradiol, 12

durasal, 10

Emcyt, 4

estradiol valerate, 12

duraxin, 24

Emend, 15

estradiol/norethindrone acetate, 12

Durezol, 23

Emla, 11

Estrasorb, 12

Dutoprol, 6

Emsam, 19

Estring, 17

dy-g, 29

Emtriva, 2

Estrogel, 12

Dyazide, 7

Emulsion Sb, 11

estropipate, 12

dyflex-g, 29

Enablex, 16

ethambutol hcl, 2

dylix, 29

enalapril maleate, 5

ethosuximide, 21

Dymista, 27

enalapril maleate/hydrochlorothiazide, 6

ethyl chloride, 10

Dynacin, 1

Enbrel, 26

ethyl chloride/fine pinpoint, 10

Dynacirc Cr, 5

Enbrel Sureclick, 26

ethyl chloride/fine stream, 10

dyphylline gg, 29

endocet, 25

ethyl chloride/medium jet stream, 10

dyphylline-gg, 29

Endodan, 25

ethyl chloride/medium stream, 10

Dyrenium, 7

Engerix-b, 30

ethyl chloride/mist, 10

Dysport, 22

Enjuvia, 12

etidronate disodium, 13

dytuss, 27

Enlon, 22

etodolac, 26

E

enoxaparin sodium, 18

etodolac er, 26

Entacapone, 21

etoposide, 4

E-z Ject Lancets, 34

Entereg, 16

Eurax, 11

E-z Ject Lancets 21g, 34

Entocort Ec, 12

Evamist, 12

E-z Ject Lancets Color, 34

entre-b, 28

Evicel, 18

E-z Ject Lancets Super Thin, 34

enulose, 16

Evista, 13

E-z Ject Lancets Super Thin 30g, 34

ephedrine sulfate, 7

Evithrom, 18

E-z Ject Lancets Thin 26g, 34

Epiceram, 11

Evoclin, 8

E-zject Lancets Micro-thin 33g, 34

Epiduo, 8

Evoxac, 18

e.e.s. 400, 1

Epifoam, 10

Exactuss, 29

E.e.s. Granules, 1

epinastine hcl, 24

Exalgo, 25

e.s.p., 3

Epinephrine, 7

Exall, 29

Easy Comfort Lancets, 34

epinephrine hcl, 29

Exall-d, 29

Easy Touch Lancets, 34

Epipen, 7

exefen-ir, 28

easygel, 18

Epipen 2-pak, 7

Exelderm, 9

Easytest Ii Lancets, 34

Epipen-jr, 7

Exelon, 22

Easytest Lancets, 34

Epipen-jr 2-pak, 7

exemestane, 3

Ec-naprosyn, 26

epitol, 21

Exforge, 6

econazole nitrate, 9

Epivir, 2

Exforge Hct, 6

ed baclofen, 22

Epivir Hbv, 2

Exjade, 36

Ed Chlorped, 27

eplerenone, 6

exoderm, 9

Ed Chlorped D, 29

epogen, 18

Exparel, 27

ed cyte f, 17

eprosartan mesylate, 6

expectuss, 28

Ed Dm, 29

Epzicom, 2

Extavia, 22

ed-a-hist dm, 28

Eql Color Lancets 21g, 34

Extina, 9

Ed-bron G, 30

Eql Super Thin Lancets 30g, 34

Ez Smart Blood Glucose Lancets, 34

Ed-chlor-tan, 27

Eql Thin Lancets 26g, 34

Ez-lets Lancets 21g, 34

ed-flex, 24

Equagesic, 24

Ez-lets Lancets 23g, 34

ed-spaz, 15

Equetro, 20

Ez-lets Lancets 26g Super-soft, 34

Edarbi, 6

Ergocalciferol, 31

Ez-lets Lancets 28g Ultra-soft, 34

Edarbyclor, 6

ergoloid mesylates, 21

Ez-lets Lancets 30g, 34

Edecrin, 7

Ergomar, 26

F

Edluar, 20

Ertaczo, 9

Edurant, 2

fabb, 17

Erwinaze, 3

Effexor Xr, 19

Factive, 2

ery, 8

Effient, 18

famciclovir, 2

Ery-tab, 1

Egrifta, 14

famotidine, 15

Eryped 200, 1

Eldepryl, 21

Famvir, 2

Eryped 400, 1

Elestat, 24

Fanapt, 20

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Fanapt Titration Pack, 20

First-progesterone Vgs 400 Compounding Kit, 17

Fluzone Pediatric Pf 2012-2013, 30

Fareston, 4

Fluzone Pf 2010-2011, 30

Faslodex, 4

First-progesterone Vgs 50 Compounding Kit, 17

Fluzone Pf 2011-2012, 30

Fasttake Test Strips, 34

Fluzone Pf 2012-2013, 30

Fazaclo, 20

First-testosterone, 12

Fluzone Split 2010-2011, 30

fe c plus, 17

First-testosterone Mc Compounding Kit, 12

Fluzone Split 2011-2012, 30

Felbamate, 21

Fluzone Split 2012-2013, 30

Felbatol, 21

Flagyl, 3

Fml, 23

Feldene, 26

Flagyl Er, 3

Fml Forte, 23

felodipine er, 5

Flarex, 23

Fml Liquifilm, 23

fem ph, 17

flavoxate hcl, 16

Focalin, 20

Femara, 4

flecainide acetate, 5

Focalin Xr, 20

Femhrt 1/5, 12

Flector, 9

folbecal, 31

Femhrt Low Dose, 12

Flexeril, 22

folbee, 17

Femring, 17

Flextra, 24

Folbee Ar, 18

Femtrace, 12

Flextra Ds, 24

folbee plus, 31

Fenofibrate, 7

Flextra-650, 24

folbee plus cz, 31

fenofibrate micronized, 7

Flo-pred, 12

Folcal Dha, 32

Fenofibric Acid, 7

Flomax, 17

folcaps, 17

Fenoglide, 7

Flonase, 27

Folcaps Omega 3, 32

fenoprofen calcium, 26

Flovent Diskus, 30

Folgard Os, 32

fentanyl, 25

Flovent Hfa, 30

Folgard Rx, 18

fentanyl citrate oral transmucosal, 25

floxuridine, 3

folic acid, 17

Fentora, 25

Fluarix 2010-2011, 30

folic acid/vitamin b-6/vitamin b-12, 17

Feriva, 18

Fluarix 2011-2012, 30

folitab, 17

ferocon, 17

Fluarix 2012-2013, 30

Folivane-ec Calcium Dha Nf, 32

ferotrin, 17

Flucelvax 2012-2013, 30

Folivane-f, 18

ferotrinsic, 17

fluconazole, 2

Folivane-ob, 32

Ferralet 90, 18

flucytosine, 2

Folivane-plus, 18

ferraplus 90, 17

fludrocortisone acetate, 11

Folivane-prx Dha Nf, 32

ferrex 150 forte, 17

Flulaval 2010-2011, 30

Folpace Rx, 18

ferrex 150 forte plus, 17

Flulaval 2011-2012, 30

folplex 2.2, 17

ferrex 28, 17

Flulaval 2012-2013, 30

Foltrate, 17

Ferriprox, 36

Flumadine, 3

foltrin, 17

Ferro-plex Hematinic, 18

Flumist Nasal Vaccine 2010-2011, 30

fondaparinux sodium, 18

ferrocite plus, 31

Flumist Nasal Vaccine 2011-2012, 30

Fora Lancets, 34

ferrogels forte, 17

Flumist Nasal Vaccine 2012-2013, 30

Foradil Aerolizer, 30

Ferrotrin, 18

flunisolide, 27

Forfivo Xl, 19

Fetrin, 18

fluocinolone acetonide, 9, 24

Fortamet, 13

Fexmid, 22

fluocinolone acetonide body, 9

Fortavit, 32

fexofenadine hcl, 27

fluocinolone acetonide scalp, 9

Fortaz, 1

Fibricor, 7

fluocinonide, 9

Forteo, 13

Fifty50 Safety Seal Lancets 30g, 34

fluocinonide emollient base, 10

Fortesta, 12

Fifty50 Safety Seal Lancets 32g, 34

fluocinonide-e, 10

Fortical, 13

Finacea, 8

fluor-op, 23

Fosamax, 13

Finacea Plus, 8

Fluorometholone, 23

Fosamax Plus D, 13

finasteride, 17

fluoxetine, 21

fosinopril sodium, 5

Fine 30, 34

fluoxetine dr, 19

fosinopril sodium/hydrochlorothiazide, 6

Fingerstix Lancets, 34

fluoxetine hcl, 19

fosphenytoin sodium, 21

Fioricet, 24

fluphenazine decanoate, 20

Fosrenol, 16

Fioricet/codeine, 25

fluphenazine hcl, 20

Fragmin, 18

Fiorinal, 24

flurazepam hcl, 20

Freestyle Lancets, 34

Fiorinal/codeine #3, 25

flurbiprofen, 26

Freestyle Unistick Ii Lancets, 34

Firazyr, 18

flurbiprofen sodium, 24

frenadol, 24

Firmagon, 4

flutamide, 4

Frova, 26

First-bxn Mouthwash, 18

fluticasone propionate, 10, 27

Fumatinic, 18

First-dukes Mouthwash, 19

fluvastatin, 7

Furadantin, 16

First-hydrocortisone, 10

Fluvirin 2010-2011, 30

furosemide, 6

First-lansoprazole, 15

Fluvirin 2011-2012, 30

Fuzeon, 2

First-marys Mouthwash, 19

Fluvirin 2012-2013, 30

G

First-mouthwash Blm, 19

Fluvirin Pf 2011-2012, 30

g/p, 28

First-omeprazole, 15

Fluvirin Pf 2012-2013, 30

gabapentin, 21

First-progesterone Vgs 100 Compounding Kit, 17

fluvoxamine maleate, 19

Gabavale-5, 19

Fluzone High-dose Pf 2010-2011, 30

Gabazolamine, 19

First-progesterone Vgs 200 Compounding Kit, 17

Fluzone High-dose Pf 2011-2012, 30

Gabazolamine-0.5, 19

Fluzone High-dose Pf 2012-2013, 30

Gabazolpidem-5, 20

First-progesterone Vgs 25 Compounding Kit, 17

Fluzone Pediatric Pf 2010-2011, 30

Gabitidine, 15

Fluzone Pediatric Pf 2011-2012, 30

Gabitril, 21

Page 53: A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

Gaboxetine, 19

Glucotrol Xl, 13

Healthy Accents Unilet Lancets Super Thin 30g, 35

galantamine, 21

Glucovance, 13

galantamine hydrobromide, 21

Glumetza, 13

hecoria, 4

gani-tuss dm nr, 28

glyburide, 12

Hectorol, 14

gani-tuss nr, 28

glyburide micronized, 13

Helidac, 15

ganidin-nr, 28

glyburide/metformin hcl, 13

Hemabate, 24

garamycin, 22

glycolic acid, 9

hematinic plus vitamins/minerals, 31

Gardasil, 30

glycolic acid 70% high purity, 9

hematinic/folic acid, 17

gastrinex nf, 15

Glycopyrroate, 15

hematogen, 17

Gastrocrom, 16

glycopyrrolate, 15

hematogen fa, 17

gavilyte-c, 14

Glynase, 13

hematogen forte, 17

gavilyte-g, 14

Glyset, 13

Hematron-af, 18

gavilyte-n/flavor pack, 14

Gnp Lancets, 34

Hemenatal Ob, 32

Gebauers Pain Ease, 11

Gnp Lancets 21g, 34

Hemenatal Ob + Dha, 32

Gebauers Spray And Stretch, 11

Gnp Lancets Micro Thin 33g, 34

Hemetab, 18

Gel-kam Oral Care Rinse, 19

Gnp Lancets Super Thin 30g, 34

Hemocyte Plus, 32

Gelclair, 19

Gnp Lancets Thin, 34

hemocyte-f, 17

Gelnique, 16

Gnp Lancets Thin 26g, 34

hemocyte-plus, 31

gemfibrozil, 7

Gnp Micro Thin Lancets 33g, 34

Heparin Sodium, 18

Genadur, 11

Gnp Super Thin Lancets/30g, 34

Heparin Sodium Dcu, 18

generlac, 16

Golytely, 14

Heparin Sodium/nacl 0.45%, 18

genexa la, 28

Gordofilm, 11

Heparin Sodium/nacl 0.9%, 18

gengraf, 4

Gordons Urea, 11

Heparin Sodium/sodium Chloride 0.9%, 18

Genotropin, 13

Gralise, 22

Genotropin Miniquick, 13

Gralise Starter, 22

Heparin Sodium/sodium Chloride 0.9% Premix, 18

gentak, 22

granisetron hcl, 15

gentamicin sulfate, 2, 8, 22

Granisol, 15

Hepsera, 2

Gentex 30, 29

green soap, 10

Hexalen, 3

gentex ade, 31

Grifulvin V, 2

Hiberix, 30

gentex lq, 28

Gris-peg, 2

Hiprex, 16

Gentle-let Gp Lancets, 34

griseofulvin microsize, 2

Hm Lancets Micro Thin 33g, 35

Gentle-let Lancets General Purpose Style/fine Point, 34

griseofulvin ultramicrosize, 2

Hm Lancets Ultra Thin 30g, 35

guaifenesin/phenylephrinehcl, 28

homatropaire, 23

Gentle-let Lancets General Purpose Style/medium Point, 34

guanabenz acetate, 6

homatropine hbr, 23

guanfacine hcl, 6

Horizant, 22

Gentle-let Lancets Safety Style/fine Point, 34

Guanidine Hcl, 22

Hpr, 11

Gynazole-1, 17

Hpr Plus, 11

Gentle-let Lancets Safety Style/medium Point, 34

H

Hpr Plus/mb Hydrogel, 11

Humalog, 12

H&h Thinlet Lancets 26g, 34

Geodon, 20

Humalog Kwikpen, 12

H&h Thinlet Super Thin Lancets 30g, 34

Gesticare Dha, 32

Humalog Mix 50/50, 12

H-e-b Incontrol Lancets Super Thin 30g, 34

gfn 1200/dm 60, 28

Humalog Mix 50/50 Kwikpen, 12

gfn 550/pse 60, 28

Humalog Mix 75/25, 12

H-e-b Incontrol Lancets Ultra Thin 28g, 34

Gilenya, 22

Humalog Mix 75/25 Kwikpen, 12

Gilphex Tr, 29

Humatrope, 13

Haemolance, 34

Giltuss, 29

Humatrope Combo Pack, 14

Haemolance Low Flow Lancets, 34

Giltuss Ped-c, 29

Humira, 26

Haemolance Plus, 34

Giltuss Pediatric, 29

Humira Pen, 26

Haemolance Plus High Flow, 35

Giltuss Tr, 29

Humira Pen-crohns Diseasestarter, 26

Haemolance Plus Low Flow, 35

Gleevec, 4

Humira Pen-psoriasis Starter, 26

Haemolance Plus Max Flow, 35

Gliadel Wafer, 3

Humulin R U-500 (concentrated), 12

Haemolance Plus Pediatric Flow, 35

glimepiride, 12

Hy-vee Lancets, 35

halac, 10

glipizide, 12

Hy-vee Thin Lancets, 35

Halcion, 20

glipizide er, 12

Hycamtin, 4

Haldol, 20

Glipizide Xl, 12

Hycet, 25

Haldol Decanoate 100, 20

glipizide/metformin hcl, 13

hydralazine hcl, 6

Haldol Decanoate 50, 20

Global Inject Ease Lancets 28g, 34

Hydrea, 4

Halflytely Bowel Prep/flavor Packs, 14

Global Inject Ease Lancets 30g, 34

Hydro 35, 11

halobetasol propionate, 10

Glucagen, 13

Hydro 40 Foam, 11

Halog, 10

Glucagen Hypokit, 13

Hydroc/apap, 29

Halonate, 10

Glucagon Emergency Kit, 13

hydrochlorothiazide, 6

halonate pac, 10

Glucocom Lancets 28g, 34

hydrocodone 10mg, 29

haloperidol, 20

Glucocom Lancets 30g, 34

hydrocodone bitartrate/acetaminophen, 25

haloperidol decanoate, 20

Glucocom Lancets 33g, 34

haloperidol lactate, 20

Glucophage, 13

hydrocodone bitartrate/homatropine methylbromide, 28

Halotin, 9

Glucophage Xr, 13

Havrix, 30

Glucosource Lancets, 34

hydrocodone polistirex and chlorpheniramine polistirex, 28

hdc dm, 28

Glucotrol, 13

Healthwise Lancets 30g, 35

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hydrocodone-acetaminophen tab 7.5-750 mg, 25

Incivek, 2

J

Increlex, 14

J-cof Dhc, 29

hydrocodone/acetaminophen, 25

indamix dm, 28

J-max Dhc, 29

hydrocodone/homatropine, 28

indapamide, 6

J-tan D, 29

hydrocodone/ibuprofen, 25

Inderal La, 5

J-tan D Sr, 29

hydrocortisone, 10, 11

Indocin, 26

Jakafi, 4

Hydrocortisone, 16

indomethacin, 26

Jalyn, 17

hydrocortisone acetate/aloe, 10

indomethacin er, 26

jantoven, 18

hydrocortisone acetate/pramoxine, 16

Infanrix, 30

Janumet, 13

hydrocortisone butyrate, 10

Infasurf, 30

Janumet Xr, 13

hydrocortisone in absorbase, 10

Infed, 17

Januvia, 13

hydrocortisone valerate, 10

Infergen, 3

jay-phyl, 29

hydrocortisone/acetic acid, 24

influenza a (h1n1) monovalent 2009, 30

Je-vax, 30

hydrogesic, 25

influenza a (h1n1) monovalent 2009 pf, 30

Jentadueto, 13

hydromet, 28

Jevantique, 12

Hydromorphone, 25

Influenza Vaccine For Safeway Dependants, 30

jinteli, 12

hydromorphone hcl, 25

Juvisync, 13

hydromorphone hcl dosette, 25

Infumorph 200, 25

K

hydroxocobalamin, 17

Infumorph 500, 25

hydroxychloroquine sulfate, 3

Inlyta, 4

K-phos Mf, 17

hydroxyurea, 4

Innopran Xl, 5

K-phos No 2, 17

hydroxyzine hcl, 19

Inova, 8

Kadian, 25

hydroxyzine pamoate, 19

Inova 4/1 Acne Control Therapy, 8

Kalbitor, 18

hygel, 10

Inova 8/2 Acne Control Therapy, 8

Kaletra, 2

Hylatopic, 11

Inspra, 6

Kalydeco, 30

Hylatopic Plus, 11

Integra F, 18

kanamycin sulfate, 2

Hylatopic Plus/aurstat, 11

Integra Plus, 18

Kapvay, 20

Hylira, 11

Intelence, 2

Kapvay Dose Pack, 20

hyomax -dt, 15

Intermezzo, 20

Keep Fit Lancets 28g/twist, 35

hyomax-sl, 15

Introl, 7

Keep Fit Lancets 30g/twist, 35

hyomax-sr, 15

Intron-a, 4

Keep Fit Lancets 32g/twist, 35

hyophen, 16

Intron-a W/diluent, 4

Keep Fit Lancets 33g/twist, 35

hyoscyamine sulfate, 15

Intuniv, 20

Keep Fit Safety Lancets 21g/pressure Activated, 35

hyoscyamine sulfate er, 15

Invanz, 3

hyoscyamine sulfate odt, 15

Invega, 20

Keep Fit Safety Lancets 23g/pressure Activated, 35

hyoscyamine sulfate sr, 15

Invega Sustenna, 20

hyosyne, 15

Invirase, 2

Keep Fit Safety Lancets 26g/button Activated, 35

Hyper-sal, 29

Iopidine, 23

hypercare, 10

Ipol Inactivated Ipv, 30

Keep Fit Safety Lancets 26g/pressure Activated, 35

Hypersal, 29

ipratropium bromide, 27, 29

Hypertenevide-12.5, 5

ipratropium bromide/albuterol sulfate, 29

Keep Fit Safety Lancets 28g/button Activated, 35

Hypertenipine-2.5, 5

Iprivask, 18

Hypertensolol, 6

Iquix, 22

Keep Fit Safety Lancets 28g/pressure Activated, 35

Hyzaar, 6

irbesartan, 6

I

irbesartan/hydrochlorothiazide, 6

Keflex, 1

Iressa, 4

Kenalog, 10

ibandronate sodium, 13

Irospan 24/6, 18

Kenalog-10, 12

ibudone, 25

Isentress, 2

Kenalog-40, 12

ibuprofen, 26

isochron, 4

Keppra, 21

Ibuprofen Comfort Pac, 26

isoditrate er, 4

Keppra Xr, 21

Ic 400, 26

isonarif, 2

Kerafoam, 11

Ic 800, 26

isoniazid, 2

Kerafoam 42, 11

Icar-c Plus, 18

Isoptin Sr, 5

Keralyt, 11

iferex 150 forte, 17

Isopto Atropine, 23

Keralyt Scalp, 11

Ilaris, 26

Isopto Carbachol, 23

Kerlone, 5

Ilevro, 24

Isopto Carpine, 23

Kerol, 11

ilotycin, 22

Isopto Homatropine, 23

Kerol Ad, 11

Imdur, 5

Isopto Hyoscine, 23

Ketek, 3

imipramine hcl, 19

Isordil Titradose, 5

Ketocon, 9

imipramine pamoate, 19

isosorbide dinitrate, 4

ketoconazole, 2, 9

imiquimod, 10

isosorbide dinitrate er, 4

ketodan, 9

Imitrex, 26

isosorbide mononitrate, 4

Ketodan Kit, 9

Imitrex Statdose Refill, 26

isosorbide mononitrate er, 4

ketoprofen, 26

Imitrex Statdose System, 26

isradipine, 5

ketoprofen er, 26

Imovax Rabies (h.d.c.v.), 30

Istalol, 23

ketorolac tromethamine, 24, 26

Imuran, 4

Isuprel, 30

kgs-pe, 28

inatal advance, 31

itraconazole, 2

Kineret, 26

inatal gt, 31

Ixiaro, 30

Kinlytic, 18

inatal ultra, 31

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Kinney Lancets, 35

Letairis, 7

Locoid Lipocream, 10

Kinney Thin Lancets, 35

letrozole, 4

Lodosyn, 21

Kinrix, 30

Lets Kit, 27

Lodrane 12d, 29

Klaron, 8

leucovorin calcium, 4

Lodrane 24, 27

Klonopin, 21

Leukeran, 3

Lodrane 24d, 29

Kombiglyze Xr, 13

Leukine, 17

lofene, 15

Korlym, 13

leuprolide acetate, 4

Lofibra, 7

Kristalose, 14

Levacet, 24

lohist-12, 27

Kroger Lancets, 35

levalbuterol, 29

lohist-12d, 28

Kroger Lancets 21g, 35

Levalbuterol Hcl, 29

Lokara, 10

Kroger Lancets Micro Thin33g, 35

Levaquin, 2

Lomotil, 15

Kroger Lancets Super Thin, 35

Levatol, 5

Longs Lancets Standard, 35

Kroger Lancets Thin, 35

Levbid, 15

Longs Lancets Thin, 35

Kroger Lancets Thin 26g, 35

Levemir, 12

Longs Lancets Ultra Thin, 35

Kroger Lancets Ultrathin 30g, 35

Levemir Flexpen, 12

lonox, 15

Kuvan, 14

levetiracetam, 21

loperamide hcl, 15

L

levetiracetam er, 21

Lopid, 7

levobunolol hcl, 23

Lopressor, 5

L-methylfolate Pnv Dha, 32

levocarnitine, 14

Lopressor Hct, 6

labetalol hcl, 5

levocetirizine dihydrochloride, 27

Loprox, 9

Lac-hydrin, 11

levofloxacin, 1, 22

Loprox Shampoo, 9

laclotion, 10

Levomefolate Dha, 32

lorazepam, 19

Lacrisert, 22

Levomefolate Pnv, 32

Lorazepam Intensol, 19

lactic acid, 10

Levophed, 7

Lorcet 10/650, 25

lactic acid e, 10

levorphanol tartrate, 25

Lorcet Plus, 25

lactic acid w/vitamin e, 10

Levothroid, 14

Lortab, 25

Lactocal-f, 32

levothyroxine sodium, 14

Lorzone, 22

lactulose, 14, 16

levothyroxine sodium tab 0.075mg, 14

losartan potassium, 6

Lady Lite Lancets, 35

Levoxyl, 14

losartan potassium/hydrochlorothiazide, 6

Lagesic, 24

Levsin, 15

Lamb Gel, 11

Levsin/sl, 15

Lotemax, 23

Lamictal, 21

Lexapro, 19

Lotensin, 6

Lamictal Chewable Dispersible, 21

Lexiva, 2

Lotensin Hct, 6

Lamictal Odt, 21

Lialda, 16

Lotrel, 6

Lamictal Starter/not Taking Carbamazepine, 21

Lidamantle Hc, 10

Lotrisone, 9

lidazone hc, 16

Lotronex, 16

Lamictal Starter/taking Carbamazepine/not Taking Valproate, 21

lidocaine, 10

lovastatin, 7

lidocaine hcl, 10, 18, 27

Lovaza, 7

Lamictal Starter/taking Valproate, 21

lidocaine hcl jelly, 10

Lovenox, 18

Lamictal Xr, 21

lidocaine hcl-hydrocortisone acetate with aloe, 16

loxapine, 20

Lamisil, 2, 9

loxapine succinate, 20

lamivudine, 2

lidocaine hcl/hydrocortisone acetate, 16

Loxitane, 20

lamivudine/zidovudine, 2

lidocaine viscous, 18

Lta 360 Kit, 19

lamotrigine, 21

lidocaine/epinephrine, 27

Lufyllin, 30

Lancets Thin, 35

lidocaine/prilocaine, 10

Lumigan, 23

Lancets Ultra Thin, 35

Lidoderm, 11

Luminal, 20

Lancets Ultra Thin 30g, 35

Lidovir, 9

Lunesta, 20

Lanoxin, 4

Lifescan Unistik 2 Deep Penetration, 35

Lupron Depot, 4

lansoprazole, 15

Lifescan Unistik Ii Lancets, 35

Lupron Depot-ped, 13

Lansoprazole Odt, 15

Lincocin, 3

Lusonal, 27

Lantus, 12

lindane, 10

Luvox Cr, 19

Lantus Solostar, 12

Linzess, 16

Luxiq, 10

Lasix, 7

liothyronine sodium, 14

Lycelle, 11

Lastacaft, 24

Lipitor, 7

Lyrica, 21

latanoprost, 23

Lipofen, 7

lysiplex plus, 31

latrix, 10

Liquicet, 25

Lysodren, 4

latrix xm, 10

lisinopril, 5

Lysteda, 18

Latuda, 20

lisinopril/hydrochlorothiazide, 6

Lytensopril, 6

lavoclen-4 acne wash kit, 8

Lite Touch Lancets, 35

Lytensopril-90, 6

lavoclen-4 creamy wash, 8

Lithium Carbonate, 20

M

lavoclen-8 acne wash kit, 8

lithium carbonate er, 20

lavoclen-8 creamy wash, 8

M-m-r Ii W/diluent 10 Dose, 30

Lithium Citrate, 20

Lazanda, 25

m-vit, 31

Lithobid, 20

Leader Lancets Colored, 35

macnatal cn dha, 31

Lithostat, 17

Leader Super Thin Lancet, 35

Macrobid, 16

Livalo, 7

Leader Thin Lancets, 35

Macrodantin, 16

Live Better Lancet Super Thin 30g, 35

leflunomide, 26

Magnacet, 25

Live Better Lancet Ultra Thin 28g, 35

Lescol, 7

Major Comfort Lancets, 35

Locoid, 10

Lescol Xl, 7

Makena, 12

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Malarone, 3

Megace Oral, 4

metoprolol succinate er, 5

malathion, 10

megestrol acetate, 4

metoprolol tartrate, 5

maprotiline hcl, 19

Meijer Color Lancets Universal 33g, 35

metoprolol/hydrochlorothiazide, 6

Marcaine, 27

Meijer Lancets, 35

Metozolv Odt, 16

Marcaine W/o Epi, 27

Meijer Lancets Thin, 35

Metrocream, 8

Marcaine/epinephrine, 27

Meijer Lancets Universal 33g, 35

Metrogel, 8

margesic, 24

Meijer Super Thin Lancets, 35

Metrogel-vaginal, 17

Marinol, 15

Meloxicam, 26

Metrolotion, 8

Marnatal-f, 32

Meloxicam Comfort Pac, 26

metronidazole, 3, 8

Marnatal-f Plus Duo Pack, 32

Menactra, 30

metronidazole vaginal, 16

Marplan, 19

Menest, 12

Mevacor, 7

marten-tab, 24

Menhibrix, 30

mexar wash, 9

martinic, 17

Menomune-a/c/y/w-135, 31

mexiletine hcl, 5

Matulane, 4

Menostar, 12

mi-omega nf, 17

matzim la, 5

Mentax, 9

Miacalcin, 13

Mavik, 6

Menveo, 31

Micardis, 6

Maxair Autohaler, 30

meperidine hcl, 25

Micardis Hct, 6

Maxalt, 26

meperitab, 25

miconazole 3, 16

Maxalt-mlt, 26

Mephyton, 31

miconazole 3 combo pack, 17

Maxaron Forte, 18

mepivacaine hcl, 27

Microlet Lancets, 35

Maxidex, 23

meprobamate, 19

Micronized Colestipol Hcl, 7

Maxidone, 25

Mepron, 3

Microtainer Safety Flow Lancet/sterile/single-use, 35

Maxifed Cd, 29

mercaptopurine, 3

Maxifed Cdx, 29

mesalamine, 16

Microzide, 7

Maxifed-g Cd, 29

Mesnex, 4

Midamor, 7

Maxifed-g Cdx, 29

Mestinon, 22

midodrine hcl, 7

Maxiflu Cd, 29

Mestinon Timespan, 22

Mifeprex, 14

Maxiflu Cdx, 29

Metadate Cd, 20

Migergot, 26

Maxinate, 32

metadate er, 20

Migral, 26

Maxiphen Cd, 29

Metaglip, 13

Migranal, 26

Maxiphen Cdx, 29

metaproterenol sulfate, 29

Millipred, 12

Maxitrol, 23

Metaxalone, 22

Millipred Dp, 12

Maxzide, 7

metformin hcl, 13

mimvey, 12

Maxzide-25, 7

metformin hcl er, 13

Mimyx, 11

Mb Hydrogel, 11

methadone hcl, 25

mineral oil heavy, 14

mebendazole, 3

Methadone Hcl Intensol, 25

Minipress, 6

meclizine hcl, 15

Methadose, 25

minirin, 14

meclofenamate sodium, 26

Methadose Sugar-free, 25

minitran, 4

Medi-lance Lancets, 35

methamphetamine hcl, 20

Minivelle, 12

Medichoice Pre-set Safety Lancet Dual Use, 35

methazolamide, 6

Minocin, 1

Methenamine Hippurate, 16

Minocin Kit, 1

Medichoice Pre-set Safety Lancet Low Flow, 35

methenamine mandelate, 16

minocycline hcl, 1

Methergine, 24

minocycline hcl er, 1

Medichoice Pre-set Safety Lancet Medium Flow, 35

methimazole, 14

minoxidil, 6

Methitest, 12

Miracle Mouthwash, 19

Medichoice Pre-set Safety Lancet Moderate Flow, 35

methocarbamol, 22

Mirapex, 21

methotrexate, 3

Mirapex Er, 21

Medichoice Safety Lancet Extra, 35

methotrexate sodium, 3

mirtazapine, 19

Medichoice Safety Lancet Normal, 35

Methscopolamine Bromide, 15

mirtazapine odt, 19

Medicine Shoppe Lancets, 35

methyclothiazide, 6

misoprostol, 15

Medicine Shoppe Lancets Thin, 35

methyldopa, 6

Mitosol, 22

Medisense Thin Lancets, 35

methyldopa/hydrochlorothiazide, 6

Mobic, 26

Medlance Plus Lancets, 35

methylergonovine maleate, 24

modafinil, 20

Medlance Plus Lancets Lite 25g, 35

methylin, 20

moexipril hcl, 5

Medlance Plus Superlite 30g, 35

methylin er, 20

moexipril/hydrochlorothiazide, 6

Medlance Plus Universal Lancets 21g, 35

methylphenidate hcl, 20

mometasone furoate, 10

methylphenidate hcl cd, 20

Momexin, 10

Medlance Plus/lite 25g, 35

methylphenidate hcl er, 20

Monodox, 1

Medlance/extra, 35

Methylphenidate Hcl Sr, 20

Monoject Basic Biopsy Tray Without Biopsy Needle 20gx 1-1/2", 27

Medlance/lite, 35

methylphenidate hydrochloride, 20

Medlance/universal, 35

methylprednisolone, 11

Monoject Bone Marrow Aspiration Tray/iliac Needle 16g, 27

Medrol, 12

methylprednisolone acetate, 11

Medrol Dosepak, 12

methylprednisolone dose pack, 11

Monoject Bone Marrow Aspiration Tray/rosenthal Needle 16gx2", 27

medroxyprogesterone acetate, 12

methylprednisolone sodiumsuccinate, 11

mefenamic acid, 26

Metipranolol, 23

Monoject Bone Marrow Biopsy Tray/biop Aspir Needle 11gx4", 27

mefloquine hcl, 3

metoclopramide hcl, 16

mega-c/a plus, 31

metolazone, 6

Monoject Bone Marrow Biopsy Tray/biop Aspir Needle 8gx4", 27

Megace Es, 12

Metoprolol, 5

Page 57: A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

Monoject Bone Marrow Biopsy Tray/biop Aspir/iliac Aspir Ndle, 27

Mytelase, 22

neomycin/polymyxin/gramicidin, 22

mytussin ac, 28

neomycin/polymyxin/hc, 24

Monoket, 5

N

neomycin/polymyxin/hydrocortisone, 23, 24

Monolet Lancets, 35

nabumetone, 26

Monolet Opd Lancets, 35

Neoral, 4

nadolol, 5

Monolettor Safety Lancets, 35

Neosalus, 11

nadolol/bendroflumethiazide, 6

montelukast sodium, 29

Neosalus 180 Pack, 11

nafcillin sodium, 1

Monurol, 16

Neosporin, 22

Nafrinse Daily/acidulated, 19

morgidox 1x100mg, 1

neostigmine methylsulfate, 22

Nafrinse Daily/neutral, 19

morgidox 2x100mg, 1

Neotic, 24

Nafrinse Weekly, 19

Morphine, 25

Neotuss Plus, 29

Naftin, 9

Morphine Sulfate, 25

Nephplex Rx, 32

nalbuphine hcl, 25

Morphine Sulfate Er, 25

Nephro-vite Rx, 32

Nalfon, 26

morphine sulfate powder, 25

Nephrocaps, 32

Namenda, 21

Morphine/saline, 25

Nephrocaps Qt, 32

Namenda Titration Pak, 21

Motofen, 15

Nephron Fa, 18

Naprelan, 26

Moviprep, 14

nephronex, 31

Napro 15% Compounding Kit, 9

Moxatag, 1

Neptazane, 7

Naproderm Compounding Kit, 9

Moxeza, 22

Nesacaine, 27

Naprosyn, 26

Mozobil, 17

Nesacaine-mpf, 27

naproxen, 26

Ms Contin, 25

Nestabs, 32

Naproxen Comfort Pac, 26

Ms/hydrogel, 25

Nestabs Dha, 32

naproxen dr, 26

mst 600, 24

Netgroup Lancets, 35

naproxen sodium, 26

Mucotrol, 19

Neulasta, 17

naratriptan hcl, 26

mult-vitamin/fluoride, 31

Neumega, 17

Nardil, 19

Multaq, 5

Neupogen, 17

Nariz, 29

multi vitamin/fluoride, 31

Neupro, 21

Naropin, 27

multi-vit/fluoride, 31

Neurin-sl, 18

Nasacort Aq, 27

multi-vit/iron/fluoride, 31

neurodep, 31

Nascobal, 18

multi-vitamin/fluoride, 31

Neurontin, 21

nasohist, 28

multi-vitamin/fluoride/iron, 31

neutrahist, 28

Nasohist Dm, 29

Multichew, 32

neutral sodium fluoride, 18

Nasonex, 27

multigen, 17

Neutrasal, 19

Nasotuss, 29

multigen folic, 17

Nevanac, 24

Nata Komplete, 32

multigen plus, 17

Nevirapine, 2

Natachew, 32

multivitamin with fluoride, 31

Nexa Plus, 32

Natacyn, 22

multivitamin/fluoride, 31

Nexa Select, 32

Natafort, 32

multivitamins/fluoride, 31

Nexavar, 4

Natalvit, 32

mupirocin, 8

Nexiclon Xr, 6

nateglinide, 13

Mustargen, 3

Nexium, 15

Natelle One, 32

mvc-fluoride, 31

niacin, 31

Natelle-ez, 32

Myambutol, 2

niacor, 31

Natroba, 11

myci-gc, 28

Niaspan, 7

nature-throid, 14

Mycobutin, 2

nicardipine hcl, 5

Nature-throid Nt-2.5, 14

mycophenolate mofetil, 4

Nicazel, 32

Navane, 20

Mydfrin, 23

Nicomide, 32

Nebupent, 3

mydral, 23

nicotinamide w/zinc oxide/cupric oxide/folic acid, 31

Nebusal, 29

Mydriacyl, 23

Neevo, 32

myferon 150 forte, 17

nicotinamide/zinc oxide/cupric oxide/folic acid, 31

Neevo Dha, 32

Myfortic, 4

nefazodone hcl, 19

Myglucohealth Mgh Softlance Lancets 30g, 35

nicotinamide/zinc/copper/fa, 31

Nembutal, 20

nifediac cc, 5

Nembutal Sodium, 20

myhist-pd, 28

nifedical xl, 5

Neo Dm, 29

Mykidz Iron Fl, 32

nifedipine, 5

Neo-fradin, 2

Myleran, 3

nifedipine er, 5

neo-polycin, 22

Mynatal, 32

Nilandron, 4

Neo-synephrine, 7

mynatal advance, 31

nimodipine, 5

Neobenz Micro, 8

mynatal plus, 31

Nimotop, 5

Neobenz Micro Plus Pack, 8

mynatal ultracaplet, 31

Niravam, 19

Neobenz Micro Sd, 8

mynatal-z, 31

Niron Komplete, 18

Neobenz Micro Wash, 8

mynate 90 plus, 31

nisoldipine, 5

Neobenz Micro Wash Plus Pack, 8

mynephrocaps, 31

nisoldipine er, 5

neofrin, 23

Myobloc, 22

Nitro-bid, 4

neomycin sulfate, 2

Myochrysine, 26

Nitro-dur, 4

neomycin/bacitracin/polymyxin, 22

myorisan, 8

nitrofurantoin, 16

neomycin/polymyxin/bacitracin zinc, 22

myoxin, 24

Nitrofurantoin Macrocrystal, 16

neomycin/polymyxin/bacitracin/hydrocortisone, 23

Myrbetriq, 16

nitrofurantoin macrocrystalline, 16

Mysoline, 21

nitrofurantoin monohydrate, 16

neomycin/polymyxin/dexamethasone, 23

Page 58: A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

Nitrofurantoin Monohydrate/macrocrystals, 16

Nutropin Aq, 13

Onetouch Verio Control Solution High, 35

Nutropin Aq Nuspin 10, 13

nitroglycerin, 4

Nutropin Aq Nuspin 20, 13

Onetouch Verio Iq Blood Glucose Monitoring System, 35

Nitroglycerin Lingual, 4

Nutropin Aq Nuspin 5, 13

nitroglycerin transdermal, 4

Nutropin Aq Pen, 13

Onetouch Verio Iq Test Strips, 35

Nitrolingual Pumpspray, 4

Nuvail, 11

Onetouch Verio Mid Control Solution, 35

Nitromist, 5

Nuvigil, 20

Onetouch Verio Test Strips, 35

Nitrostat, 4

nuzole, 9

Onfi, 21

nizatidine, 15

Nuzon, 10

Onglyza, 13

Nizoral, 9

nyamyc, 9

Onmel, 2

nohist, 28

nystatin, 2, 9, 18

Onsolis, 25

nohist dmx, 28

nystatin vaginal, 17

Opana, 25

Norco, 25

nystatin/triamcinolone, 9

Opana Er, 25

Norditropin Cartridge, 13

nystop, 9

Opana Er (crush Resistant), 25

Norditropin Flexpro, 13

O

opium, 15

Norditropin Nordiflex Pen, 13

opium tincture, 15

O-cal Fa, 32

Norel Sr, 29

Optipranolol, 23

O-cal Prenatal, 32

norepinephrine bitartrate, 7

Optivar, 24

Ob Complete, 32

norethindrone acetate, 12

Oracea, 8

Ob Complete 400, 32

Norflex, 22

Oracit, 17

Ob Complete One, 32

Noritate, 8

oralone, 18

Ob Complete Petite, 32

Noroxin, 2

Oramagicrx, 19

Ob Complete Premier, 32

Norpace, 5

Oramorph Sr, 25

Ob Complete With Dha, 32

Norpace Cr, 5

Orap, 21

Ob Complete/dha, 32

Norpramin, 19

Orapred, 12

ob-natal one, 31

nortriptyline hcl, 19

Orapred Odt, 12

Obstetrix Dha, 32

nortuss-de, 28

Oravig, 19

obstetrix ec, 31

nortuss-ex, 28

Oraxyl, 1

octreotide acetate, 14

Norvasc, 5

Orbivan, 24

Ocudox, 1

Norvir, 2

Orbivan Cf, 25

Ocufen, 24

Notuss-ac, 29

Orencia, 26

Ocuflox, 22

Nova Safety Lancets 23g, 35

Orfadin, 14

ofloxacin, 1, 22, 24

Nova Safety Lancets 28g, 35

orphenadrine citrate, 22

Oforta, 3

Nova Sureflex Lancets, 35

orphenadrine citrate er, 22

olanzapine, 20

Novaferrum, 18

orphenadrine compound ds, 22

olanzapine odt, 20

novagesic, 24

orphenadrine/asa/caffeine, 22

olanzapine/fluoxetine, 21

Novarel, 13

ortho-cs 250, 31

Oleptro, 19

Novofine 30gx8mm, 35

ortho-est, 12

Olux, 10

Novofine 32gx6mm, 35

oscimin, 15

Olux-e, 10

Novofine Autocover 30gx8mm, 35

oscimin sr, 15

Omeclamox-pak, 15

Novolog, 12

oscion cleanser, 8

omeprazole, 15

Novolog Flexpen, 12

Osmoprep, 14

omeprazole/sodium bicarbonate, 15

Novolog Mix 70/30, 12

otic care, 24

Omnaris, 27

Novolog Mix 70/30 Prefilled Flexpen, 12

oticin, 24

Omnipred, 23

Novolog Penfill, 12

otozin, 24

Omnitrope, 14

Novotwist 30gx8mm, 35

Ovace Plus, 9

Omontys, 18

Novotwist 32gx5mm, 35

Ovace Plus Wash, 9

On Call Lancets, 35

Noxafil, 2

Ovace Wash, 9

On Call Plus Lancets, 35

np thyroid 30, 14

Ovide, 11

Oncaspar, 3

np thyroid 60, 14

oxacillin sodium, 1

ondansetron hcl, 15

np thyroid 90, 14

Oxandrin, 12

ondansetron odt, 15

Nplate, 17

oxandrolone, 12

Onetouch Basic System, 35

Nucort, 10

oxaprozin, 26

Onetouch Basic/profile Test Strips, 35

Nucynta, 25

oxazepam, 19

Onetouch Basic/profile/one Touch Ii Test Strips, 35

Nucynta Er, 25

oxcarbazepine, 21

Nuedexta, 21

Oxecta, 25

Onetouch Club Lancets Fine Point, 35

nufol, 17

Oxistat, 9

Onetouch Combo Pack, 35

nulev, 15

Oxsoralen Ultra, 9

Onetouch Delica Lancets, 35

Nulytely/flavor Packs, 14

oxybutynin chloride, 16

Onetouch Delica Lancets Fine 30g, 35

numoisyn, 18

oxybutynin chloride er, 16

Onetouch Finepoint Lancets, 35

Nuox, 8

oxycodone, 25

Onetouch Lancets, 35

Nutri-tab Ob, 32

oxycodone hcl, 25

Onetouch Profile System, 35

Nutri-tab Ob + Dha, 32

oxycodone/acetaminophen, 25

Onetouch Ultra 2, 35

nutricap, 31

oxycodone/aspirin, 25

Onetouch Ultra Blue, 35

Nutridox, 1

oxycodone/ibuprofen, 25

Onetouch Ultra Mini, 35

nutrifac zx, 31

Oxycontin, 25

Onetouch Ultra System Kit, 35

Nutrivit, 32

oxymorphone hydrochloride, 25

Onetouch Ultra Test Strips, 35

Nutropin, 13

oxymorphone hydrochloride er, 25

Onetouch Ultrasoft Lancets, 35

Page 59: A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

Oxytocin, 24

pentetate calcium trisodium, 36

Plexion Cleanser, 8

Oxytrol, 16

pentetate zinc trisodium, 36

Plexion Cleansing Cloth, 8

P

pentoxifylline er, 18

Plexion Sct, 8

Pepcid, 15

Pliaglis, 11

p chlor dm, 28

Percocet, 25

pneumovax 23/1 dose, 30

Pacerone, 5

Percodan, 25

pneumovax 23/5 dose, 30

Pacnex Hp, 8

Perfect Lancets 30g, 35

Pnv Ob+dha, 32

Pacnex Lp, 8

Perfect Pressure Activated Safety Lancets 28g, 35

pnv-dha, 31

Pacnex Mx, 8

Pnv-dha+docusate, 32

pacnex wash, 8

Perforomist, 30

Pnv-omega, 32

Paire Ob, 32

Peridex, 19

pnv-select, 31

Palgic, 27

perindopril erbumine, 5

Pnv-total, 32

Pamelor, 19

perio med, 18

podocon 25 in benzoin tincture, 10

Pamine, 15

periogard, 18

podofilox, 10

Pamine Forte, 15

permethrin, 10

polocaine, 27

Pamine Fq, 15

perphenazine, 20

polocaine-mpf, 27

Panatuss Dxp, 29

perphenazine/amitriptyline, 21

Poly Hist Dhc, 29

Pancreaze, 15

Persantine, 18

Poly Hist Nc, 29

Pancrelipase, 15

Pertzye, 15

Poly Hist Pd, 29

Pandel, 10

Pexeva, 19

poly-dex, 23

Pantoprazole Sodium, 15

pfizerpen-g, 1

poly-iron 150 forte, 17

papaverine hcl, 7

Pharmacist Choice Ultra Thin Lancets, 35

Poly-pred, 23

Parafon Forte Dsc, 22

Poly-tussin Dhc, 29

parcaine, 23

Pharmacist Choice Ultra Thin Lancets 28g, 35

Poly-tussin Ex, 29

Parcopa, 21

Poly-vi-flor, 32

paregoric, 15

Pharmacist Choice Ultra Thin Lancets 30g, 35

Poly-vi-flor/iron, 33

Parlodel, 21

poly-vitamin/fluoride, 31

Parnate, 19

Pharmacist Choice Ultra Thin Lancets 31g, 35

poly-vitamin/iron/fluoride, 31

paromomycin sulfate, 2

polycin b, 22

paroxetine hcl, 19

Pharmacy Counter Lancets, 35

Polycitra-k Crystals, 17

paroxetine hcl er, 19

Phena-plus, 29

polyethylene glycol 3350, 14

Paser, 2

Phena-s, 29

polymyxin b sulfate, 3

Pataday, 24

phenadoz, 27

Polymyxin B Sulfate/trimethoprim Sulfate, 22

Patanase, 27

phenazo, 17

Patanol, 24

phenazopyridine hcl, 17

polysaccharide iron forte, 17

Paxil, 19

phenelzine sulfate, 19

Polytrim, 22

Paxil Cr, 19

Phenergan, 27

polyvitamin/fluoride, 31

Pce, 1

Phenergan Fortis, 27

Ponstel, 26

pe-guai, 28

Phenflu Cd, 29

Pontocaine, 11, 27

pedi-dri, 9

Phenflu Cdx, 29

Pontocaine Niphanoid, 27

Pediaderm Af Complete Kit, 9

phenobarbital, 20

Potassium Citrate, 17

Pediaderm Hc, 10

phenobarbital sodium, 20

potassium citrate/citric acid, 17

Pediaderm Ta, 10

phentolamine mesylate, 6

Potiga, 21

Pediapred, 12

phenylephrine hcl, 7, 23

pr benzoyl peroxide wash, 8

Pediarix, 30

phenylephrine/guaifenesin, 28

Pr Cream, 11

Pediatex Td, 29

Phenytek, 21

pr natal 400, 31

Pediatex Tdm, 29

phenytoin, 21

pr natal 400 ec, 31

Pedipirox-4 Nail, 9

phenytoin sodium, 21

pr natal 430, 31

Pedvax Hib, 31

phenytoin sodium extended, 21

pr natal 430 ec, 31

Peg 3350/electrolytes, 14

Phoslo, 16

Pradaxa, 18

peg-3350/electrolytes, 14

Phoslyra, 16

pram-hca, 16

peg-3350/nacl/na bicarbonate/kcl, 14

phosphasal, 16

pramcort, 10

Peg-intron, 2

Phospholine Iodide, 23

pramipexole dihydrochloride, 21

Peg-intron Redipen, 2

Phrenilin Forte, 25

Pramosone, 10

Peg-intron Redipen Pak 4, 2

phytonadione, 31

Pramotic, 24

Peganone, 21

pilocarpine hcl, 18, 23

pramox gel, 10

Pegasys, 2

pilocarpine hydrochloride, 18

Prandimet, 13

Pegasys Proclick, 2

Pilopine Hs, 23

Prandin, 13

penicillin g potassium, 1

pindolol, 5

prascion, 8

penicillin g procaine, 1

Pinnacaine Otic, 24

prascion fc, 8

penicillin g sodium, 1

Pioglitazone Hcl, 13

prascion ra with sunscreens, 8

penicillin v potassium, 1

Pioglitazone Hcl/metformin Hcl, 13

Pravachol, 7

Penlac Nail Lacquer, 9

piroxicam, 26

pravastatin sodium, 7

Pennsaid, 9

Pitocin, 24

Prazolamine, 22

Pentacel, 30

Pitressin Synthetic, 14

prazosin hcl, 6

Pentam 300, 3

Plaquenil, 3

Pre-folic, 18

Pentasa, 16

Plavix, 18

Precision Thin Lancets, 35

pentazocine/acetaminophen, 25

Pletal, 18

Precision Thins Gp Lancet, 35

pentazocine/naloxone hcl, 25

Page 60: A list of medications that may lower your patients’ costs · 2017-03-27 · Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments,

Precision Ultra Lancet, 35

Primlev, 25

Protectiron, 33

Precose, 13

Primsol, 3

Protectnatal, 33

Pred Forte, 23

Prinivil, 6

protid, 28

Pred Mild, 23

Prinzide, 6

Protonix, 15

Pred-g, 23

Pristiq, 19

Protopic, 10

Pred-g S.o.p., 23

Pro-clear, 29

protriptyline hcl, 19

prednicarbate, 10

Proair Hfa, 30

Proventil Hfa, 30

prednisolone, 11

probenecid, 26

Provera, 12

Prednisolone Acetate, 23

probenecid/colchicine, 26

Provigil, 20

prednisolone sodium phosphate, 11, 23

procainamide hcl, 5

Prozac, 19

prednisone, 11

Procardia, 5

Prozac Weekly, 19

Prednisone Intensol, 12

Procardia Xl, 5

Pruclair, 11

Prefera Ob, 32

Procentra, 20

Prudoxin, 9

Prefera Ob + Dha, 32

prochlorperazine, 20

Prumyx, 11

Preferaob One, 32

prochlorperazine edisylate, 20

Pss Select Gp Lancets, 35

Preferred Plus Lancets Colored 21g, 35

prochlorperazine maleate, 20

Pss Select Safety Lancets, 35

Preferred Plus Lancets Super Thin 30g, 35

Procort, 16

pulmari-gp, 28

procrit, 17

Pulmicort, 30

Preferred Plus Lancets Thin 26g, 35

procto-pak, 16

Pulmicort Flexhaler, 30

Prefest, 12

Proctocort, 16

Pulmophylline, 30

Pregnyl W/diluent Benzyl Alcohol/nacl, 13

proctocream hc, 16

Pulmozyme, 30

Proctofoam Hc, 16

Purefe Ob Plus, 33

Prelone, 12

proctosol hc, 16

Purefe Plus, 18

Premarin, 12, 17

proctozone-hc, 16

purevit dualfe plus, 17

Premphase, 12

Prodigy Pressure Activated Safety Lancets, 35

Purinethol, 3

Prempro, 12

Px Lancets, 35

Prena1 Chew/quatrefolic, 33

Prodigy Safety Lancets, 35

Px Lancets Ultra Thin, 35

Prena1 Plus/quatrefolic, 33

Prodigy Twist Top Lancets, 35

Pylera, 15

Prena1/quatrefolic, 33

Proferrin-forte, 18

pyrazinamide, 2

prenafirst, 31

progesterone, 12

Pyridium, 17

Prenaissance, 33

Proglycem, 13

pyridostigmine bromide, 22

Prenaissance Balance, 33

Prograf, 4

pyridoxine hcl, 31

Prenaissance Harmony Dha, 33

Prohist Cd, 29

pyrogallic acid, 10

Prenaissance Next, 33

Prohist Cf, 29

Q

prenaissance plus, 31

Prohist Lq, 29

Qc Lancets Super Thin, 35

prenaplus, 31

Prolia, 13

Qc Lancets Ultra Thin, 35

Prenata, 33

promacet, 24

Qnasl, 27

prenatabs fa, 31

Promacta, 17

Qualaquin, 3

prenatabs obn, 31

Promar, 33

Quelicin, 22

prenatabs rx, 31

promethazine hcl, 27

Quelicin 1000, 22

prenatal 19, 31

promethazine hcl plain, 27

Questran, 7

prenatal ad, 31

promethazine vc, 28

Questran Light, 7

prenatal low iron, 31

promethazine vc plain, 28

quetiapine fumarate, 20

Prenatal Mv & Min/fe-fa-dha, 33

promethazine vc/codeine, 28

Quillivant Xr, 20

Prenatal Plus, 33

promethazine-dm, 28

quinapril hcl, 5

Prenatal Plus Iron, 33

promethazine/codeine, 28

quinapril/hydrochlorothiazide, 6

prenatal plus/iron, 31

promethazine/dextromethorphan, 28

Quinidine Gluconate, 5

Prenatal Vitamins Plus, 33

promethegan, 27

quinidine gluconate cr, 5

prenatal-u, 31

Prometrium, 12

quinidine gluconate er, 5

Prenate Dha, 33

Promiseb, 9

quinidine sulfate, 5

Prenate Elite, 33

Promiseb Complete, 9

quinidine sulfate er, 5

Prenate Essential, 33

propafenone hcl, 5

quinine sulfate, 3

Prenate Mini, 33

propafenone hcl er, 5

Quixin, 22

Prenexa, 33

propantheline bromide, 15

Qutenza, 11

Prepidil, 24

proparacaine hcl, 23

Qvar, 30

Prepopik, 14

propranolol hcl, 5

R

Preque 10, 33

propranolol hcl er, 5

Prevacid, 15

propranolol/hydrochlorothiazide, 6

r-tanna, 28

Prevacid Solutab, 15

propylthiouracil, 14

r-tanna pediatric, 28

prevalite, 7

Proquad, 31

Ra E-zject Color Lancets Micro-thin 33g, 35

Prevident, 19

Proscar, 17

Prevnar 13, 31

Prosed/ds, 16

Ra E-zject Lancets 28g, 35

Prevpac, 15

Prostigmin, 22

Ra E-zject Lancets Thin 26g, 35

Prezista, 2

Prostin E2, 24

Ra E-zject Lancets Thin 28g, 35

Priftin, 2

Protect Cardio, 33

Ra E-zject Lancets Ultra Thin 30g, 35

Prilosec, 15

Protect Plus, 33

ra renewal medicated acne treatment maximum strength, 8

Primaquine Phosphate, 3

Protect Plus Nr, 33

primidone, 21

Protectbone, 33

Rabavert, 31

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Radigel, 11

respa-br, 27

ru-hist forte, 28

ramipril, 5

resperal-dm, 28

ru-tuss, 28

Ranexa, 5

respivent df, 27

Ru-tuss Dm, 29

ranitidine hcl, 15

respivent df 30, 27

Rybix Odt, 25

Rapaflo, 17

respivent-d, 28

Ryneze, 27

Rapamune, 4

Restasis, 23

Rythmol, 5

Rayos, 12

Restoril, 20

Rythmol Sr, 5

Razadyne, 22

Retin-a, 8

Ryzolt, 25

Razadyne Er, 22

Retin-a Micro, 8

S

Reality Lancets, 35

Retin-a Micro Pump, 8

Sabril, 21

Reality Trigger Lancets, 35

Retrovir, 3

Safe-t-lance Low Flow 25g, 36

Reaphirm, 33

Revatio, 7

Safe-t-lance Normal Flow 21g, 36

Rebetol, 3

Revlimid, 4

Safe-t-lance Plus Safety Lancet High Flow, 36

Rebif, 21

Reyataz, 2

Rebif Titration Pack, 21

Rezira, 28

Safe-t-lance Plus Safety Lancet Low Flow, 36

Recombivax Hb, 31

Rezyst Im, 15

Recothrom, 18

Rezyst Sb, 15

Safe-t-lance Plus Safety Lancet Normal Flow, 36

Recothrom Spray Kit, 18

Rheumatrex, 26

Rectiv, 16

Rhinocort Aqua, 27

Safety Lancet 2mm, 36

Reglan, 16

rhinoflex, 24

Safety Lancets, 36

Regonol, 22

rhinoflex-650, 24

Safety Lancets 21g, 36

relacon-dm nr, 28

ribapak, 2

Safety Let Lancets, 36

relagard, 17

ribasphere, 2

Safety Seal Lancets 28g, 36

Relagesic, 25

ribatab, 2

Safety Seal Lancets 30g, 36

relasin dm, 28

ribavirin, 2

Saizen, 14

relcof pse, 28

Ridaura, 26

Saizen Click.easy, 14

Relenza Diskhaler, 2

Rifadin, 2

salacyn, 11

relera, 28

Rifamate, 2

Salagen, 19

Relhist, 29

rifampin, 2

Salex, 11

Relion Lancets, 35

Rifater, 2

Salex Cream, 11

Relion Lancets Standard 21g, 35

Rightest Gl300 Lancets, 36

Salex Lotion, 11

Relion Lancets Thin 26g, 35

Rilutek, 22

Salicept, 19

Relion Lancets Ultra-thin30g, 35

rimantadine hcl, 2

salicylic acid, 11

Relion Thin Lancets, 35

Rimantalist, 3

salicylic acid cream, 11

Relion Ultra Thin Lancets, 36

rinate pediatric, 28

salicylic acid in ammonium lactate vehicle, 11

Relion Ultra Thin Lancets30g, 36

Rinnovi Nail System, 11

Relion Ultra Thin Plus Lancets 32g, 36

Riomet, 13

salicylic acid lotion, 11

Relion Ultra Thin Plus Lancets 33g, 36

Risperdal, 20

salicylic acid wart remover, 11

Relistor, 16

Risperdal Consta, 20

salkera, 11

Relnate Dha, 33

Risperdal M-tab, 20

salsalate, 24

Relpax, 26

risperidone, 20

Salvax, 11

Remeron, 19

Risperidone M-tab, 20

Salvax Duo Plus, 11

Remeron Soltab, 19

risperidone odt, 20

Samsca, 14

remeven, 10

Ritalin, 20

Sanctura, 16

Remodulin, 7

Ritalin La, 20

Sanctura Xr, 16

rena-vite rx, 31

Ritalin Sr, 20

Sancuso, 15

Renagel, 16

rivastigmine tartrate, 21

Sandimmune, 4

renal, 31

robafen ac, 28

Sandostatin, 14

renalpren, 31

Robaxin, 22

Sandostatin Lar Depot, 14

Renatabs, 33

Robaxin-750, 22

Saphris, 20

Renatabs With Iron, 33

Robinul, 15

Sarafem, 22

Renax, 33

Robinul Forte, 15

Savella, 21

Renax 5.5, 33

Rocaltrol, 14

Savella Titration Pack, 22

Renew Advanced Lancing Cartridge Refills, 36

Rocephin, 1

Sb Lancets Thin, 36

romilar ac, 28

Sb Lancets Ultra Thin, 36

reno caps, 31

romycin, 22

scalacort, 10

Renvela, 16

ropinirole er, 21

Scalacort Dk, 10

repan, 24

ropinirole hcl, 21

scopolamine hydrobromide, 15

Reprexain, 25

rosadan, 8

se 10-5 ss, 8

Req 49+, 33

Rosadan Kit, 8

se bpo 3% foaming cloths, 8

Requip, 21

Rosanil, 8

se bpo 6% foaming cloths, 8

Requip Xl, 21

rosanil cleanser, 8

se bpo 7-5.5 wash kit, 8

Rescon, 29

Rotarix, 31

se bpo 9% foaming cloths, 8

Rescon-jr, 29

Rotateq, 31

se bpo wash, 8

Rescon-mx, 29

Rowasa, 16

se-care, 31

Rescriptor, 2

Roxicet, 25

se-care conceive, 31

Reserpine, 6

Roxicodone, 25

se-natal 19, 31

Respa-a.r., 29

Rozerem, 20

se-natal 90, 31

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se-natal one, 31

33g, 36

Strattera, 20

se-plete dha, 31

Smart Sense Standard Lancets Universal 21g, 36

Strazepam, 20

se-tan dha, 31

streptomycin sulfate, 2

se-tan plus, 17

Smart Sense Super Thin Lancets Universal 30g, 36

Striant, 12

seb-prev, 9

Stribild, 2

seb-prev wash, 9

Smart Sense Thin Lancets Universal 26g, 36

Stromectol, 3

Seconal, 20

Strovite, 33

Sectral, 5

Smartest Lancets 28g, 36

Strovite Advance, 33

Sedapap, 25

sodium bicarbonate, 15

Strovite Forte, 33

Select-ob, 33

sodium chloride, 28

Strovite One, 33

Select-ob+dha, 33

sodium citrate, 17

strovite plus, 31

selegiline hcl, 21

sodium hyaluronate, 11

Suboxone, 25

selenium sulfide, 9

Sodium Sulfacetamide, 8

Subsys, 25

Selsun Shampoo, 9

sodium sulfacetamide, 22

Subutex, 25

Selzentry, 2

sodium sulfacetamide wash, 9

Sucraid, 15

Semprex-d, 29

sodium sulfacetamide/sulfur, 8

sucralfate, 15

Senetonic, 33

sodium sulfacetamide/sulfur cleanser, 8

sudahist, 28

senilezol, 17

sodium sulfacetamide/sulfur cleanser in urea, 8

sudatex-dm, 28

senna, 14

Sular, 5

senna leaves, 14

sodium sulfacetamide/sulfur cleansing cloths, 8

sulfacetamide sodium, 8, 22

senna plus, 14

sulfacetamide sodium/prednisolone sodium phosphate, 23

Senophylline, 30

sodium sulfacetamide/sulfur green, 8

Sensipar, 14

sodium sulfacetamide/sulfur in urea, 8

sulfacetamide sodium/sulfur cleanser, 8

sensorcaine, 27

sodium sulfacetamide/sulfur wash, 8

sulfacleanse 8/4, 8

sensorcaine-mpf, 27

sodium sulfacetamide/urea, 9

sulfadiazine, 2

Sensorcaine-mpf/epinephrine, 27

Solo V2 Twist Lancets, 36

sulfamethoxazole/trimethoprim, 3

sensorcaine/epinephrine, 27

Solodyn, 1

Sulfamethoxazole/trimethoprim Ds, 3

Sentradine, 15

Soltamox, 4

sulfasalazine, 16

Sentraflox Am-10, 19

Solu-cortef, 12

sulfazine, 16

Sentralopram Am-10, 19

Solu-medrol, 12

sulfazine ec, 16

Sentramodafin Am-100, 20

Soma, 22

Sulfoam, 8

Sentravil Pm-25, 19

Somatuline Depot, 14

sulfurated lime, 11

Sentrazolam Am 0.25, 19

Somavert, 14

sulindac, 26

Sentrazolpidem Pm-5, 20

Somnote, 20

Sumadan Kit, 8

Sentroxatine, 19

Sonata, 20

Sumadan Wash, 8

Septra Ds, 3

Soriatane, 9

Sumatriptan, 26

Seradex, 29

Sorilux, 9

sumatriptan succinate, 26

Serevent Diskus, 30

sorine, 5

Sumatriptan Succinate Refill, 26

seromycin, 2

sotalol hcl, 5

Sumavel Dosepro, 26

Seroquel, 20

sotalol hcl (af), 5

Sumaxin, 8

Seroquel Xr, 20

sotret, 8

Sumaxin Cp Kit, 8

Serostim, 14

Spectracef, 1

Sumaxin Ts, 8

sertraline hcl, 19

Spinosad, 11

Sumaxin Wash, 8

seton et-ec, 31

Spiriva Handihaler, 30

Supervite, 33

setonet, 31

spironolactone, 6

Supervite Ec, 33

Sfrowasa, 16

spironolactone/hydrochlorothiazide, 6

suphera, 8

Shohls Solution Modified, 17

Sporanox, 2

Support, 33

siderol, 31

Sporanox Pulsepak, 2

Support-500, 33

sildenafil citrate, 7

Sprix, 26

Supprelin La, 13

Silenor, 20

Sprycel, 4

Suprax, 1

Simcor, 7

Sss 10-4, 8

Suprep Bowel Prep, 14

Simponi, 26

Staflex, 25

Sure Comfort Lancets 28g, 36

simuc-gp, 28

stagesic, 25

Sure Comfort Lancets 30g, 36

simvastatin, 7

Stahist, 29

Sure-lance Flat Lancets, 36

Sinemet, 21

Stalevo 100, 21

Sure-lance Lancets 26g, 36

Sinemet Cr, 21

Stalevo 125, 21

Sure-lance Thin Lancets 28g, 36

Single-let, 36

Stalevo 150, 21

Sure-lance Ultra Thin Lancets, 36

Singulair, 30

Stalevo 200, 21

Sure-touch Lancets Universal, 36

Skelaxin, 22

Stalevo 50, 21

Surelite Lancets, 36

Skelid, 13

Stalevo 75, 21

Surestep Pro Test Strips, 36

Sklice, 11

stannous fluoride oral rinse, 18

Surestep Test Strips, 36

Sm Lancets 21g, 36

Starlix, 13

Surmontil, 19

Sm Micro Thin Lancets 33g, 36

stavudine, 2

Survanta Intratracheal, 30

Sm Super Thin Lancets 30g, 36

Stavzor, 21

Sustiva, 2

Sm Thin Lancets 26g, 36

Stelara, 9

sutan-dm, 28

Smart Diabetes Vantage Universal Lancets 30g, 36

Sterilance Tl, 36

Sutent, 4

Stimate, 14

Suttar-2, 29

Smart Sense Color Lancets Universal

Stivarga, 4

Suttar-sf, 29

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Sylatron, 4

Tenoretic 50, 6

Thinlets Gp Lancets, 36

Symax Duotab, 15

Tenormin, 5

Thinlets Lancet, 36

symax fastabs, 15

Terazol 3, 17

Thiola, 17

symax-sl, 15

Terazol 7, 17

thioridazine hcl, 20

symax-sr, 15

terazosin hcl, 6

thiotepa, 3

Symbicort, 30

terbinafine hcl, 2

thiothixene, 20

Symbyax, 22

Terbinex, 2

Thrombin-jmi Diluent, 18

Symlin, 12

terbutaline sulfate, 29

Thrombin-jmi Epistaxis, 18

Symlinpen 120, 12

terconazole, 17

Thrombin-jmi Syringe Spray Kit, 18

Symlinpen 60, 12

Tersi Foam, 9

Thrombin-jmi W/dil Spray Pump Actuator, 18

Synagex, 33

Tessalon, 29

synalar, 10

Tessalon Perles, 29

Thrombogen, 18

Synalar Cream Kit, 10

Testim, 12

Thyrolar-1, 14

Synalar Ointment Kit, 10

Testopel, 12

Thyrolar-1/2, 14

Synalar Ts, 10

testosterone cypionate, 12

Thyrolar-1/4, 14

Synalgos-dc, 25

testosterone enanthate, 12

Thyrolar-2, 14

Synarel, 13

testred, 12

Thyrolar-3, 14

Synatek, 33

tetanus toxoid adsorbed, 30

tiagabine hydrochloride, 21

Synera, 11

tetanus/diphtheria toxoids-adsorbed adult, 30

Tiazac, 5

Synribo, 4

ticlopidine hcl, 18

Synthroid, 14

tetcaine, 23

Tigan, 15

T

tetracaine hcl, 23, 27

Tikosyn, 5

tetracycline hcl, 1

timolol maleate, 5, 23

Tabloid, 3

tetravisc, 23

Timolol Maleate Ophthalmic Gel Forming, 23

Taclonex, 10

tetravisc forte, 23

tacrolimus, 4

Tetrix, 11

Timoptic, 23

Talwin, 25

Tev-tropin, 14

Timoptic Ocudose, 23

Tambocor, 5

Teveten, 6

Timoptic-xe, 23

Tamiflu, 2

Teveten Hct, 6

Tindamax, 3

tamoxifen citrate, 4

Texacort, 10

tinidazole, 3

tamsulosin hcl, 17

tgq 15dm/5peh/2cpm, 28

Tirosint, 14

Tandem Dha, 33

tgq 30pse/150gfn/15dm, 28

Tisseel, 18

tandem f, 17

tgq 30pse/3brm/15dm, 28

Tizanidine Comfort Pac, 22

Tandem Ob, 33

tgq 50pse/3brm/30dm, 28

tizanidine hcl, 22

Tandem Plus, 18

tgq 7.5peh/4brm/15dm, 28

tl bpo mx cleanser, 8

tannihist-12 rf, 28

Tgt Lancet Alternate Site, 36

Tl G-fol Os, 33

Tapazole, 14

Tgt Lancet Super Thin 30g, 36

tl gard rx, 17

Tarceva, 4

Tgt Lancet Thin 23g, 36

tl icon, 17

Targretin, 4

Tgt Lancet Ultra Thin 28g, 36

tl nicotinamide, 32

Tarka, 6

Thalitone, 7

tl urea, 11

taron ec calcium, 31

Thalomid, 4

Tl-assure One, 33

Taron Forte, 18

Theo-24, 30

Tl-assure+dha, 33

Taron-bc, 33

theochron, 29

Tl-cermide, 11

Taron-c Dha, 33

theophylline, 29

tl-dex dm, 28

taron-crystals, 17

theophylline cr, 29

Tl-fluorivite, 33

Taron-duo Ec, 33

theophylline er, 29

tl-fol 500, 17

taron-ec cal, 31

Therabenzaprine-60, 22

tl-hem 150, 17

taron-prex, 31

Therabenzaprine-90, 22

tl-hist cd, 28

Tasigna, 4

Therabenzaprine-90-5, 22

tl-hist cm, 28

Tasmar, 21

Theracodeine-300, 25

Tl-select, 33

tazicef, 1

Theracodophen-325, 25

Tl-select Dha, 33

Tazorac, 9

Theracodophen-650, 25

Tobi, 2

taztia xt, 5

Theracodophen-750, 25

Tobradex, 23

Techlite Ast Lancets, 36

Theracodophen-low-90, 25

Tobradex St, 23

Techlite Lancets, 36

Therafeldamine, 26

tobramycin sulfate, 2, 22

Tegretol, 21

Therapentin-60, 21

tobramycin/dexamethasone, 23

Tegretol-xr, 21

Therapentin-90, 21

tobrasol, 22

Tekamlo, 6

Theraprofen-60, 26

Tobrex, 22

Tekral, 29

Theraprofen-800, 26

Todays Health Super Thin Lancets 30g, 36

Tekturna, 6

Theraprofen-90, 26

Tekturna Hct, 6

Theraproxen, 26

Todays Health Ultra Thin Lancets 28g, 36

temazepam, 20

Theraproxen-500, 26

Temodar, 3

Theraproxen-60, 26

Tofranil, 19

Temovate, 10

Theraproxen-90, 26

Tofranil-pm, 19

Temovate E, 10

Theratramadol-60, 25

tolazamide, 13

tencon, 24

Theratramadol-90, 25

tolbutamide, 13

Tenex, 6

therobec, 32

tolmetin sodium, 26

Tenivac, 30

thiamine hcl, 31

Tolterodine Tartrate, 16

Tenoretic 100, 6

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Topamax, 21

trifluoperazine hcl, 20

Tyvaso Starter, 7

Topamax Sprinkle, 21

Trifluridine, 22

Tyzeka, 3

topex topical anesthetic, 18

trigels-f forte, 17

Tyzine, 27

Topicort, 10

Triglide, 7

Tyzine Pediatric Nasal Drops, 27

topiragen, 21

trihexyphenidyl hcl, 21

U

topiramate, 21

Trihibit, 30

u-cort, 10

Toprol Xl, 5

Trileptal, 21

u-kera e, 11

torsemide, 6

Trilipix, 7

Udamin, 33

Toviaz, 16

trilyte, 14

Udamin Sp, 33

Tracleer, 7

trimesis rx, 32

Ulesfia, 11

Tradjenta, 13

trimethobenzamide hcl, 15

Uloric, 26

tramadol hcl, 25

Trimethoprim, 3

Ulticare Thin Lancets 30g, 36

Tramadol Hcl Er, 25

trimethoprim sulfate/polymyxin b sulfate, 22

Ultilet Basic Lancets 30g, 36

Tramadol Hydrochloride/acetaminophen, 25

Ultilet Classic Lancets, 36

trimipramine maleate, 19

Ultilet Lancets, 36

Trandate, 5

Trinatal Gt, 33

Ultilet Safety Lancets 23g, 36

trandolapril, 5

trinatal rx 1, 32

Ultimate Ob Dha, 33

Transderm-scop, 15

Trinatal Ultra, 33

Ultimatecare Advantage, 33

Tranxene T, 19

trinate, 32

Ultimatecare Combo, 33

tranylcypromine sulfate, 19

Trioxin, 24

ultimatecare one, 32

Travatan Z, 23

Tripedia, 30

ultimatecare one nf, 32

Trazamine, 19

triphrocaps, 32

ultra tabs, 32

Trazodone, 19

triple-vitamin/fluoride, 32

Ultra Thin Lancets 28g, 36

trazodone hcl, 19

Trispec Dmx, 29

Ultra Thin Lancets 30g, 36

Treagan Otic, 24

Trispec Dmx Pediatric, 29

Ultra-thin Ii Auto Lancet, 36

Trecator, 2

Trispec Pse, 29

Ultra-thin Ii Lancets 28g, 36

Trelstar Depot, 4

Trispec Pse Pediatric, 29

Ultra-thin Ii Lancets 30g, 36

Trelstar Depot Mixject, 4

Trituss, 29

Ultra-thin Ii Lancets/28g X 1/8", 36

Trelstar La, 4

Triveen-duo Dha, 33

Ultra-thin Ii Lancets/30g X 1/8", 36

Trelstar La Mixject, 4

Triveen-one, 33

Ultra-thin Ii Safety Autolancets 26g, 36

Trelstar Mixject, 4

Triveen-prx Rnf, 33

Ultracet, 25

Trental, 18

Triveen-ten, 33

Ultram, 25

Trepadiclofen-25, 26

Triveen-u, 33

Ultram Er, 25

Trepoxen-250, 26

Trizivir, 2

Ultravate, 10

Trepoxicam-7.5, 26

Tropazone, 11

Ultravate Pac, 10

Tretin-x, 8

tropicamide, 23

Ultravate X, 10

tretinoin, 4

trospium chloride, 16

Ultresa, 15

Tretinoin, 8

trospium chloride er, 16

Umecta, 11

Trexall, 3

Trueplus Lancets 28g, 36

umecta mousse, 11

trexbrom, 28

Trueplus Lancets 28g Super Thin, 36

Umecta Nail Film, 11

Treximet, 26

Trueplus Lancets 30g, 36

Umecta Pd, 11

trezix, 25

Trueplus Lancets 30g Ultra Thin, 36

Unasyn, 1

tri rx, 32

Trueplus Lancets 33g, 36

Unasyn Bulk Pack, 1

Tri-vi-flor, 33

Trueplus Lancets 33g Micro Thin, 36

Unilet Comfortouch Lancet, 36

Tri-vi-floro, 33

Trueplus Safety Lancets 28g, 36

Unilet Excelite, 36

tri-vit/fluoride, 32

Trusopt, 24

Unilet Excelite Ii, 36

tri-vit/fluoride/iron, 32

trust natal dha, 32

Unilet G.p. Lancet, 36

tri-vitamin/fluoride, 32

Truvada, 2

Unilet G.p. Superlite Lancet, 36

tri-vitamin/iron/fluoride, 32

Tudorza Pressair, 30

Unilet Gp 28 Ultra Thin, 36

Tri-zel, 33

Tusnel Ped-c, 29

Unilet Lancet, 36

triadvance, 32

tussafed ex, 28

Unilet Superlite Lancet, 36

triamcinolone acetonide, 10, 18, 27

Tussicaps, 28

Uniretic, 6

triamcinolone acetonide in absorbase, 10

tussigon, 28

Unithroid, 14

triamcinolone in orabase, 18

Tussionex Pennkinetic Extended Release, 29

unithroid direct, 14

Triamterene/hydrochlorothiazide, 6

Univasc, 6

trianex, 10

Tusso-c, 29

Universal 1 Lancets Thin 26g, 36

Triaz, 8

Tusso-dmr, 29

Universal 1 Lancets Ultra Thin 30g, 36

Triaz Cleanser, 8

Tusso-zmr, 29

univert, 15

Triaz Foaming Cloths, 8

Twinject, 7

ur n-c, 16

triazolam, 20

Twinrix, 31

Uramaxin, 11

Tribenzor, 6

Twynsta, 6

Uramaxin Gt, 11

tricare, 32

Tykerb, 4

Uramaxin Gt Kit, 11

Tricare Dha 301, 33

Tylenol/codeine #3, 25

urea, 11

Tricare Prenatal Dha One, 33

Tylenol/codeine #4, 25

urea 40% nail film, 11

tricitrates, 17

Tylox, 25

urea hydrating, 11

tricon, 17

Typhim Vi, 31

urea in zinc undecylenate/lactic acid vehicle, 11

Tricor, 7

Tyvaso, 7

triderm, 10

Tyvaso Refill, 7

urea nail, 11

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urea nail kit, 11

Venatal Complete Dha, 33

vita s forte, 32

urea topical, 11

Venatal-fa, 33

vita-min, 32

urea-c40, 11

venlafaxine hcl, 19

Vita-pren, 33

Urecholine, 16

venlafaxine hcl er, 19

vitacel, 32

Urelle, 16

Ventavis, 7

Vitafol, 33

Uretron D/s, 16

Ventolin Hfa, 30

vitafol-ob, 32

Urex, 16

Veramyst, 27

Vitafol-ob+dha, 33

Uribel, 16

verapamil hcl, 5

Vitafol-one, 33

urin d/s, 16

verapamil hcl er, 5

Vitafol-plus, 33

Urocit-k 10, 17

Verapamil Hcl Sr, 5

Vitafol-pn, 33

Urocit-k 15, 17

Verdeso, 10

Vitaject, 33

Urocit-k 5, 17

Veregen, 11

Vital-d Rx, 33

Urogesic-blue, 16

Verelan, 5

Vitalet Pro Lancets, 36

Uroqid #2, 16

Verelan Pm, 5

Vitalet Pro Plus Lancets, 36

urosex, 32

Veripred 20, 12

Vitamax Pediatric, 33

Uroxatral, 17

versiclear, 9

Vitamedmd One Rx/quatrefolic, 33

Urso 250, 16

Vesicare, 16

Vitamedmd Plus Rx/quatre Folic, 33

Urso Forte, 16

Vexol, 23

Vitamedmd Redichew Rx/quatrefolic, 33

ursodiol, 16

Vfend, 2

vitamin b-complex 100, 32

uryl, 16

Vibramycin, 1

vitamin c 222mg, 31

ustell, 16

vic-forte, 32

vitamin d, 31

uta, 16

Vicodin, 25

vitamin forte, 32

uticap, 16

Vicodin Es, 26

vitamin k1, 31

utira-c, 16

vicodin hp, 25

vitamins a/c/d/fluoride, 32

utrona-c, 16

Vicoprofen, 26

Vitaroca Plus, 33

Uvadex, 4

Victoza, 12

vitaspire, 32

V

Victrelis, 2

vitazol, 8

Vida Mia Unilet Lancets Super Thin 30g, 36

Viva Ct Prenatal, 33

v-c forte, 32

Viva Dha, 33

v-cof, 28

Vida Mia Unilet Lancets Ultra Thin 28g, 36

Vivactil, 19

v-hist, 28

Vivelle-dot, 12

V-natal, 33

Vidaza, 3

Vivotif Berna, 31

V-natal Dha, 33

Videx Pediatric, 2

vol-care rx, 32

Vagifem, 17

Videx Ec, 3

Vol-nate, 33

valacyclovir hcl, 2

Vigamox, 22

Vol-plus, 33

Valcyte, 2

Viibryd, 19

Vol-tab Rx, 33

Valium, 19

Vimovo, 26

Voltaren, 9, 24

valproic acid, 21

Vimpat, 21

Voltaren-xr, 26

valsartan/hydrochlorothiazide, 6

Vinacal, 33

voriconazole, 2

Valtrex, 3

vinate az, 32

Vosol, 24

Valturna, 6

Vinate Az Extra, 33

Vosol Hc, 24

Value Plus Lancets Standard 21g, 36

vinate c, 32

Vospire Er, 30

Value Plus Lancets Super Thin 30g, 36

Vinate Calcium, 33

Votrient, 4

Value Plus Lancets Thin 26g, 36

vinate care, 32

Vp-ch-pnv, 33

Valumark Lancet Super Thin 30g, 36

Vinate Dha, 33

Vp-era Ob Plus, 33

Valumark Lancet Ultra Thin 28g, 36

vinate gt, 32

Vp-ggr-b6 Prenatal, 33

Vancocin Hcl, 3

vinate ic, 32

Vp-pnv-dha, 33

vancomycin, 3

vinate ii, 32

vp-zel, 32

vancomycin hcl, 3

vinate m, 32

Vsl#3 Ds, 15

Vandazole, 17

vinate one, 32

Vusion, 9

Vandetanib, 4

vinate pn care, 32

Vytorin, 7

Vanos, 10

vinate ultra, 32

Vyvanse, 20

Vanoxide Hc, 8

Viokace, 15

W

Vanoxide-hc, 8

Viracept, 2

Vantas, 4

W&f Lancets 26g, 36

Viramune, 3

Vaqta, 31

W&f Lancets Colored 21g, 36

Viramune Xr, 2

Varivax, 31

Walgreens Advanced Travellancets 28g, 36

Virasal, 11

Vascepa, 7

Virazole, 3

Vaseretic, 6

Walgreens Comfort Assuredlancets Micro Thin/33g, 36

Viread, 2

vasopressin, 14

Viroptic, 22

Vasotec, 6

Walgreens Comfort Assuredlancets Super Thin/28g, 36

Virt-bal Dha, 33

Vazobid, 29

Virt-bal Dha Plus, 33

Vazol, 27

Walgreens Lancets, 36

Virt-pn, 33

vazotab, 28

Walgreens Thin Lancets, 36

Virt-pn Dha, 33

Vazotan, 29

Walgreens Ultra Thin Lancets, 36

Virt-select, 33

Vectical, 9

warfarin sodium, 18

virti-sulf, 8

Veltin, 8

Welchol, 7

Visicol, 14

Vemavite-prx 2, 33

Wellbutrin, 19

Vistaril, 19

Vena-bal Dha, 33

Wellbutrin Sr, 19

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Wellbutrin Xl, 19

Zegerid, 15

Zyclara, 10

Westcort, 10

Zelapar, 21

Zyclara Pump, 10

Westhroid, 14

Zelboraf, 4

Zydone, 26

wheat germ, 31

zema-pak 10 day, 11

Zyflo, 30

witch hazel, 11

zema-pak 13 day, 11

Zyflo Cr, 30

Wound Gel, 26

zema-pak 6 day, 11

Zylet, 23

X

Zemplar, 14

Zyloprim, 26

zencia, 8

Zymaxid, 22

x-viate, 11

Zenieva, 11

Zypram, 16

Xalatan, 23

Zenpep, 15

Zyprexa, 20

Xalkori, 4

Zerit, 3

Zyprexa Relprevv, 20

Xanax, 19

Zestoretic, 6

Zyprexa Zydis, 20

Xanax Xr, 19

Zestril, 6

Zytiga, 4

Xarelto, 18

Zetia, 7

Zyvox, 3

xclair, 11

Zetonna, 27

1

Xeljanz, 26

zflex, 24

Xeloda, 3

1st Choice Lancets Super Thin, 36

zgesic, 24

Xenazine, 21

1st Choice Lancets Thin, 36

Ziac, 6

Xeomin, 22

1st Choice Lancets Ultra Thin, 36

Ziagen, 3

Xerac Ac, 11

1st Tier Unilet Comfortouch Lancets 28g, 36

Ziana, 8

Xerese, 9

zidovudine, 2

Xgeva, 13

1st Tier Unilet Comfortouch Lancets 30g, 36

Zinacef, 1

Xifaxan, 3

Zingiber, 33

Xodol, 26

8

Zinotic, 24

Xolair, 30

Zinotic Es, 24

8-mop, 9

Xolegel, 9

Zioptan, 23

Xolegel Corepak, 9

ziprasidone hcl, 20

Xolegel Duo/head & Shoulders, 9

Zipsor, 26

Xolegel Duo/xolex, 9

Zirgan, 22

Xolox, 26

Zithranol, 9

Xopenex, 30

Zithranol-rr, 9

Xopenex Concentrate, 30

Zithromax, 1

Xopenex Hfa, 30

Zithromax Tri-pak, 1

Xtandi, 4

Zithromax Z-pak, 1

Xylocaine, 11, 27

Zmax, 1

Xylocaine Jelly, 11

Zocor, 7

Xylocaine-mpf, 27

Zofran, 15

Xylocaine-mpf/epinephrine, 27

Zofran Odt, 15

Xylocaine/epinephrine, 27

Zoladex, 4

Xyrem, 21

Zolinza, 4

Xyzal, 27

Zoloft, 19

Y

zolpidem tartrate, 20

zolpidem tartrate er, 20

yf-vax, 30

Zolpimist, 20

Yodoxin, 3

Zolvit, 26

Z

Zomig, 26

Z-cof I, 29

Zomig Zmt, 26

z-dex, 28

Zonalon, 9

z-dex 12d, 28

Zonatuss, 29

z-pram, 16

Zonegran, 21

z-tuss dm, 28

zonisamide, 21

Zacare 4% Kit, 8

Zorbtive, 14

Zacare 8% Kit, 8

Zortress, 4

zaclir cleansing, 8

Zostavax, 31

Zafirlukast, 29

Zotex, 29

zaleplon, 20

Zotex -gp, 29

Zamicet, 26

Zotex Pe, 29

Zanaflex, 22

Zotex Pediatric, 29

Zantac, 15

zotex-12d, 28

Zarontin, 21

Zotex-c, 29

Zaroxolyn, 7

Zotex-d, 29

Zatean-ch, 33

Zotex-dm, 29

Zatean-pn, 33

Zotex-ex, 29

Zatean-pn Dha, 33

Zotex-g, 29

Zatean-pn Plus, 33

zotex-pe, 28

Zavesca, 18

Zovirax, 3, 9

zazole, 17

Zuplenz, 15

Zebeta, 5

Zutripro, 28

zebutal, 24