Kaiser Permanente of Georgia Multi-Choice Formularytestinfo.kaiserpermanente.org/info_assets/cpp_ga/pdfs/ga_formulary... · Kaiser Permanente of Georgia Multi Choice Formulary 3

This document includes Kaiser Permanente Georgia’s Multi-Choice formulary as of January 1, 2013. For an updated for-mulary, please visit our website at members.kp.org or call 1-888-865-5813, Monday through Friday 7:00 a.m. to 7:00

p.m. TTY/TDD users should call 1-800-255-0056.

KAISER PERMANENTE OF GEORGIA

MULTI-CHOICEFORMULARY

*Multi-Choice Formulary is for medications covered at Network Pharmacies. Please see HMO Formulary for medications covered at KP Pharmacies* **All drug product strengths and package sizes of a medication may not be included on the same tier on the formulary, check with your Kaiser Permanente

pharmacist for clarification, if needed.**

Kaiser Permanente of Georgia Multi Choice Formulary1

What is the Kaiser Permanente MultiChoice Formulary? A formulary is a list of drugs determined to be safe and effective for our members by our Pharmacy and Therapeutics committee. Use of the formulary enables Kaiser Permanente to provide optimal care to you and your family at reasonable costs. Kaiser Permanente continually updates the formulary throughout the year based on new medical evidence, considering the recommendations of appropriate physician experts. Our physicians and pharmacists work closely together to ensure that our formulary meets your needs.

This formulary is only for use at PPO Provider (Tier 2) and Non-Participating Provider (Tier 3) pharmacies. To see which medications are covered at a Select Provider (Tier 1) pharmacy, please reference the Kaiser Permanente HMO Formulary.

Does the formulary ever change? Yes, Kaiser Permanente periodically updates the formulary based on new medical evidence, considering the recommendations of appropriate physician experts and notifies our doctors, pharmacists, and other clinicians about any changes. If a change in the formulary affects any of your prescriptions, your doctor or pharmacist will let you know.

The enclosed formulary is current as of January 1, 2013 and represents the most commonly prescribed medications. To get updated information about the drugs covered by Kaiser Permanente, please visit our website at members.kp.orgor call

Member Services at 1-888-865-5813, Monday through Friday 7:00 a.m. to 7:00 p.m. TTY/TDD users should call 1-800-255-0056.

How do I use the Formulary? There are two easy ways to find your drug within the formulary:

Medical Condition The drug list begins on page 4. The drugs on this formulary are grouped into categories depending on the type of medical condition that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, “Cardiovascular Agents.” If you know what your drug is used for, simply look for the category name in the list that begins on page 4. Then look under the category name for your drug.

Alphabetical Listing If you are not sure what category to look under, you can look for the drug in the Index that begins on page 48. The Index provides an alphabetical list of all of the drugs included in this document. Both brand-name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to the drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug on the list. You may also use the search function on your computer to search this document for the medication by name.

What are generic drugs? Kaiser Permanente covers both brand-name drugs and generic drugs.




Brand name drugs are drugs that are produced and sold under the original manufacturer’s name.

Generic drugs are produced and sold under their chemical names after the patent of the brand name drug expires. Although the price is lower, the quality and effectiveness of generic drugs is the same as brand name drugs. The Federal Food and Drug Administration (FDA) requires that generic drugs contain the same active ingredients in the same amount as the brand name drug. Generic drugs are listed in lower-case italics (e.g., amoxicillin) within the formulary on page 4. If a drug is available as a generic, it is only listed with the generic name. Brand-name drugs are capitalized in the formulary (e.g., FLOVENT).

Generally, if a drug is available generically, the generic is on Tier 1 and the brand Tier 3. Because all drug product strengths and package sizes of a formulary drug may not be included on the formulary, check with your Kaiser Permanente pharmacist for clarification, if needed.

How much will I pay for Covered Drugs? What you pay for covered drugs is determined by the outpatient prescription drug benefit outlined in your Evidence of Coverage. Multichoice plans have a three tier open formulary benefit.

Open formulary benefits have a generic cost sharing requirement. This means that if you fill a brand name drug when a generic is available, that in addition to your

standard copayment or coinsurance, you will also pay the difference in cost between the brand name and generic drug.

Generics are those covered at the lowest co-payment amount defined as Tier 1. Preferred brands are those brands which will be covered at your preferred brand co-payment amount defined as Tier 2. Non-preferred brands are covered at the non-preferred co-payment defined as Tier 3 coverage amount.

Coverage for prescription drugs is limited to drugs for which a prescription is required by law and those that are listed on the Kaiser Permanente MultiChoice drug formulary. Certain diabetic supplies do not require a prescription, but must still be listed in our formulary in order to be covered under the benefit.

Each prescription refill is provided on the same basis as the original prescription. Copayments are applied on a per prescription basis, for up to the lesser of the dispensing amount listed in the “Schedule of Benefits” or the standard prescription amount.

The standard prescription amount for the following items is: • Migraine medications ― the smallest

package size commercially available • Ophthalmic and otic medications ― the

smallest package size commercially available

• Oral and nasal inhalers ― the smallest standard package unit




Are there any other restrictions on coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

• Quantity Limits (QL): For certain drugs, Kaiser Permanente limits the amount of the drug that will be covered.

• Age Restriction (Age):For certain drugs, Kaiser Permanente limits coverage based on a designated age.

• Criteria Restricted Medication (QRM): For certain drugs, Kaiser Permanente requires review and authorization prior to dispensing. Your Provider must obtain this review and authorization. The list of prescription drugs requiring review and authorization is subject to periodic review and modification by our Pharmacy and Therapeutics Committee.

You can find out if the drug has any additional requirements or limits by looking in the formulary that begins on page 4.

What if my drug is not on the Formulary? You can contact Member Services at 1-888-865-5813, Monday through Friday 7:00 a.m. to 7:00 p.m. TTY/TDD users should call 1-800-255-0056 and ask Member Services for a list of similar drugs that are covered or MedImpact at 1-800-MedImpact.

For more information For more detailed information about your Kaiser Permanente prescription drug coverage, please review your Evidence of Coverage and other plan materials.

If you have questions about Kaiser Permanente, please call Member Services at 1-888-865-5813, Monday through Friday 7:00 a.m. to 7 p.m. TTY/TDD users should call 1-800-255-0056.

Or visit members.kp.org.

ST = Step Therapy, QRM = Physician Review, QL = Quantity Limit, Age = Age Restriction

*Multi-Choice Formulary is for medications covered at Network Pharmacies. Please see HMO Formulary for medications covered at KP Pharmacies* **All drug product strengths and package sizes of a medication may not be included on the same tier on the formulary, check with your Kaiser Permanente pharmacist for

clarification, if needed.**

Kaiser Permanente Georgia Multi Choice Formulary4

Restrictions Tier Generic Name Brand Name Coverage

Status Analgesics

Miscellaneous Analgesics 1 butalb/acetaminophen/caffeine ESGIC PLUS Generic 1 butalb/acetaminophen/caffeine FIORICET Generic 1 butalbital/acetaminophen PHRENILIN Generic 3 butalbital/acetaminophen PHRENILIN FORTE Non-Preferred 1 butalbital/aspirin/caffeine FIORINAL Generic Non-Opioid Analgesics 3 celecoxib CELEBREX Non-Preferred 1 diclofenac potassium CATAFLAM Generic 1 diclofenac sodium VOLTAREN Generic 1 diclofenac sodium extended release VOLTAREN-XR Generic 3 diclofenac sodium/misoprostol ARTHROTEC Non-Preferred 1 diflunisal DIFLUNISAL Generic 1 etodolac LODINE Generic 3 fenoprofen calcium NALFON Non-Preferred 1 flurbiprofen ANSAID Generic 1 ibuprofen MOTRIN Generic 1 indomethacin INDOCIN SR Generic 1 ketoprofen KETOPROFEN Generic

QL 1 ketorolac tromethamine TORADOL Generic 1 meclofenamate sodium MECLOMEN Generic 3 mefenamic acid PONSTEL Non-Preferred 1 meloxicam MOBIC Generic 1 nabumetone RELAFEN Generic 1 naproxen NAPROSYN Generic 1 naproxen sodium ANAPROX Generic 1 naproxen sodium ANAPROX DS Generic 3 naproxen sodium NAPRELAN Non-Preferred 1 oxaprozin DAYPRO Generic 1 piroxicam FELDENE Generic 1 sal-amide/acetamin/p-tlox/caff DURABAC Generic 1 salsalate DISALCID Generic 1 sulindac CLINORIL Generic 1 tolmetin sodium TOLECTIN 600 Generic Opioid Analgesics 1 acetaminophen/codeine TYLENOL/CODEINE Generic 1 buprenorphine hcl SUBUTEX Generic 2 buprenorphine hcl/naloxone hcl SUBOXONE Preferred Brand 3 buprenorphine transdermal BUTRANS Non-Preferred 1 butorphanol tartrate STADOL Generic






Status 1 codeine phos/aspirin EMPIRIN W/CODEINE Generic

1 codeine phos/carisoprodol/asa SOMA COMPOUND W/CODEINE Generic

1 codeine sulf CODEINE SULF Generic

1 codeine/butalbit/acetamin/caff FIORICET W/CODEINE Generic

1 codeine/butalbital/asa/caffein FIORINAL W/CODEINE #3 Generic

1 dhcodeine bt/acetaminophn/caff PANLOR SS Generic 1 fentanyl DURAGESIC Generic 1 fentanyl citrate ACTIQ Generic 3 fentanyl citrate FENTORA Non-Preferred 3 fentanyl sublingual ABSTRAL Non-Preferred 1 hydrocodone bit/acetaminophen LORCET 10/650 Generic 1 hydrocodone bit/acetaminophen LORCET PLUS Generic 1 hydrocodone bit/acetaminophen LORTAB Generic 1 hydrocodone bit/acetaminophen MAXIDONE Generic 1 hydrocodone bit/acetaminophen NORCO Generic 1 hydrocodone bit/acetaminophen VICODIN Generic 3 hydrocodone bit/acetaminophen HYCET Non-Preferred 1 hydrocodone bit/acetaminophen POLYGESIC Generic 1 hydrocodone bit/acetaminophen VICODIN HP Generic 1 hydrocodone bit/acetaminophen XODOL 10/300 Generic 3 hydrocodone bit/acetaminophen ZYDONE Non-Preferred 1 hydrocodone/ibuprofen VICOPROFEN Generic 1 hydromorphone hcl DILAUDID Generic 3 hydromorphone hcl oral suspension DILAUDID Non-Preferred 3 ibuprofen/oxycodone hcl COMBUNOX Non-Preferred 1 levorphanol tartrate LEVO-DROMORAN Generic 1 meperidine hcl DEMEROL Generic 1 methadone hcl METHADONE Generic 1 morphine sulfate MORPHINE SULFATE Generic 1 morphine sulfate MS CONTIN Generic 1 morphine sulfate MSIR Generic 1 morphine sulfate ORAMORPH SR Generic 1 morphine sulfate ROXANOL Generic 3 morphine sulfate AVINZA Non-Preferred 3 morphine sulfate KADIAN Non-Preferred 1 nalbuphine hcl NUBAIN Generic 3 opium OPIUM Non-Preferred 1 opium/belladonna alkaloids B & O SUPPRETTES Generic






Status NO.15-A

1 opium/belladonna alkaloids B & O SUPPRETTES NO.16-A Generic

1 oxycodone hcl ROXICODONE Generic 1 oxycodone hcl OXYIR Generic

QL 3 oxycodone hcl controlled-release OXYCONTIN Non-Preferred 1 oxycodone hcl/acetaminophen PERCOCET Generic 1 oxycodone hcl/acetaminophen TYLOX Generic 2 oxycodone hcl/acetaminophen ROXICET Preferred Brand 1 oxycodone hcl/aspirin PERCODAN Generic 3 oxymorphone hcl OPANA Non-Preferred 3 oxymorphone hcl extended-release OPANA ER Non-Preferred 1 pentazocine hcl/naloxone hcl TALWIN NX Generic 3 tapentadol NUCYNTA Non-Preferred 1 tramadol hcl ULTRAM Generic 1 tramadol hcl extended-release ULTRAM ER Generic 1 tramadol hcl/acetaminophen ULTRACET Generic

Anesthetics Anesthetics, miscellaneous 3 lidocaine LIDODERM Non-Preferred 1 lidocaine hcl XYLOCAINE Generic 1 lidocaine hcl LIDOCAINE HCL Generic 1 lidocaine viscous XYLOCAINE VISCOUS Generic

Antibacterials Aminoglycosides 1 gentamicin sulfate GARAMYCIN Generic 1 neomycin sulfate MYCIFRADIN Generic 3 tobramycin/0.25 normal saline TOBI Non-Preferred Antibacterials, other 1 clindamycin hcl CLEOCIN HCL Generic 1 clindamycin palmitate CLEOCIN PALMITATE Generic 1 clindamycin phosphate CLEOCIN Generic 1 clindamycin phosphate CLEOCIN T Generic 3 meth/meth blue/ba/salicy/hyos PROSED/DS Non-Preferred 1 methenamine hippurate HIPREX Generic 1 methenamine mandelate MANDELAMINE Generic 1 metronidazole METROGEL-VAGINAL Generic 3 mth/me blue/salicy/na phos/hyo URELLE Non-Preferred 2 mupirocin calcium BACTROBAN NASAL Preferred Brand 3 rifaximin XIFAXAN Non-Preferred 1 trimethoprim PROLOPRIM Generic






Status 1 vancomycin hcl VANCOCIN HCL Generic Cephalosporins 1 cefaclor CECLOR Generic 1 cefadroxil hydrate DURICEF Generic 1 cefdinir OMNICEF Generic 3 cefditoren pivoxil SPECTRACEF Non-Preferred 3 cefixime SUPRAX Non-Preferred 1 cefpodoxime proxetil VANTIN Generic 1 cefprozil CEFZIL Generic 3 ceftibuten dihydrate CEDAX Non-Preferred 1 cefuroxime axetil CEFTIN Generic 1 cefuroxime sodium ZINACEF Generic 1 cephalexin monohydrate KEFLEX Generic Ketolides 3 telithromycin KETEK Non-Preferred Macrolides 1 azithromycin ZITHROMAX Generic 1 clarithromycin BIAXIN Generic 1 clarithromycin extended release BIAXIN XL Generic 1 ery e-succ/sulfisoxazole PEDIAZOLE Generic 1 erythromycin base ERYC Generic 1 erythromycin base ERY-TAB Generic 1 erythromycin base ERYTHROMYCIN Generic 1 erythromycin ethylsuccinate E.E.S. Generic 1 erythromycin ethylsuccinate ERYPED Generic

1 erythromycin stearate ERYTHROCIN STEARATE Generic

Penicillins

3 amox tr/potassium clavulanate extended-release AUGMENTIN XR Non-Preferred

1 amoxicillin trihydrate AMOXIL Generic 1 amoxicllin/clavulanate potassium AUGMENTIN Generic 1 amoxicllin/clavulanate potassium AUGMENTIN ES-600 Generic 1 ampicillin sodium AMPICILLIN SODIUM Generic

1 ampicillin trihydrate AMPICILLIN TRIHYDRATE

Generic

1 dicloxacillin sodium DYNAPEN Generic 1 penicillin v potassium PEN-VEE K Generic Nitrofurantoin Derivatives 2 nitrofurantoin FURADANTIN Preferred-Brand 1 nitrofurantoin macrocrystal MACRODANTIN Generic






Status 1 nitrofurantoin monohydrate MACROBID Generic Oxazolidiones 2 linezolid ZYVOX Preferred Brand Quinolones 1 ciprofloxacin CIPRO Generic 3 ciprofloxacin hcl PROQUIN XR Non-Preferred 3 ciprofloxacin hcl-betaine comb CIPRO XR Non-Preferred 3 gemifloxacin mesylate FACTIVE Non-Preferred 1 levofloxacin LEVAQUIN Generic 3 moxifloxacin hcl AVELOX Non-Preferred 3 norfloxacin NOROXIN Non-Preferred 1 ofloxacin FLOXIN Generic Sulfonamides 1 sulfadiazine SULFADIAZINE Generic 1 sulfamethoxazole/trimethoprim BACTRIM DS Generic 1 sulfamethoxazole/trimethoprim SEPTRA Generic 1 sulfamethoxazole/trimethoprim SEPTRA DS Generic 3 sulfanilamide AVC Non-Preferred 3 sulfisoxazole acetyl GANTRISIN Non-Preferred Tetracycline 1 demeclocycline hcl DECLOMYCIN Generic 1 demeclocycline hcl VIBRAMYCIN Generic 1 demeclocycline hcl VIBRA-TABS Generic 3 doxycycline hyclate DORYX Non-Preferred 1 doxycycline monohydrate ADOXA Generic 1 doxycycline monohydrate MONODOX Generic 3 doxycycline monohydrate ORACEA Non-Preferred 1 minocycline hcl DYNACIN Generic 1 minocycline hcl MINOCIN Generic 1 minocycline hcl SOLODYN Generic 1 tetracycline hcl ACHROMYCIN V Generic 1 tetracycline hcl SUMYCIN Generic 3 tetracycline hcl ALA-TET Non-Preferred

Anticonvulsants 1 carbamazepine TEGRETOL Generic 3 carbamazepine CARBATROL Non-Preferred 3 carbamazepine EQUETRO Non-Preferred 3 carbamazepine extended-release TEGRETOL XR Non-Preferred 1 clonazepam KLONOPIN Generic 1 diazepam DIASTAT Generic 2 diazepam DIASTAT ACUDIAL Preferred Brand






Status 1 divalproex sodium DEPAKOTE Generic 1 divalproex sodium DEPAKOTE SPRINKLE Generic 1 divalproex sodium extended release DEPAKOTE ER Generic 1 ethosuximide ZARONTINF Generic 3 felbamate FELBATOL Non-Preferred 1 gabapentin NEURONTIN Generic 1 lamotrigine LAMICTAL Generic 1 levetiracetam KEPPRA Generic 1 levetiracetam extended-release KEPPRA XR Generic 3 mephobarbital MEBARAL Non-Preferred 1 oxcarbazepine TRILEPTAL Generic 1 phenobarbital PHENOBARBITAL Generic 1 phenytoin DILANTIN Generic 2 phenytoin (suspension) DILANTIN-125 Generic 1 phenytoin sodium extended-release DILANTIN Generic 1 phenytoin sodium extended-release PHENYTEK Generic 3 pregabalin LYRICA Non-Preferred 1 primidone MYSOLINE Generic 3 rufinamide BANZEL Non-Preferred 3 tiagabine hcl GABITRIL Non-Preferred 1 topiramate capsule TOPAMAX SPRINKLE Generic 1 topiramate tablet TOPAMAX Generic 1 valproate sodium DEPAKENE Generic 1 valproic acid DEPAKENE Generic

QRM 3 vigabatrin SABRIL Non-Preferred 1 zonisamide ZONEGRAN Generic

Antidementia Agents Cholinesterase Inhibitors 1 donepezil hcl ARICEPT Generic 3 donepezil hcl ARICEPT ODT Non-Preferred 1 galantamine hydrobromide RAZADYNE Generic 1 galantamine hydrobromide RAZADYNE ER Generic 2 mestinon sustained-release MESTION TIMESPAN Preferred Brand 1 pyridostigmine bromide MESTINON Generic 1 rivastigmine tartrate EXELON Generic 2 rivastigmine tartrate (solution) EXELON Preferred brand 2 tacrine COGNEX Preferred Brand Cholinesterase Inhibitors, Misc 1 neostigmine bromide PROSTIGMIN Generic Glutamate Pathway Modifiers 2 memantine hcl NAMENDA Preferred Brand






Status Antidepressants

Antidepressants, Other 1 bupropion extended-release WELLBUTRIN XL Generic 1 bupropion hcl WELLBUTRIN Generic 1 bupropion sustained-release WELLBUTRIN SR Generic 1 mirtazapine REMERON Generic 3 vilazodone VIIBRYD Non-Preferred MAOI 1 phenelzine sulfate NARDIL Generic 3 selegiline EMSAM Non-Preferred 1 tranylcypromine sulfate PARNATE Generic Reuptake Inhibitors 1 citalopram hydrobromide CELEXA Generic 3 duloxetine hcl CYMBALTA Non-Preferred 1 escitalopram oxalate LEXAPRO Generic 1 fluoxetine hcl PROZAC Generic 3 fluoxetine hcl PROZAC WEEKLY Non-Preferred 3 fluoxetine hcl SARAFEM Non-Preferred 1 fluvoxamine maleate LUVOX Generic 1 nefazodone hcl SERZONE Generic 3 paroxetine extended-release PAXIL CR Non-Preferred 1 paroxetine hcl PAXIL Generic 3 paroxetine mesylate PEXEVA Non-Preferred 1 sertraline hcl ZOLOFT Generic 1 trazodone hcl DESYREL Generic 1 venlafaxine extended-release EFFEXOR ER Generic 1 venlafaxine hcl EFFEXOR Generic Tricyclic 1 amitrip hcl/chlordiazepoxide LIMBITROL DS Generic 1 amitriptyline hcl ELAVIL Generic 1 amitriptyline hcl/perphenazine TRIAVIL 10-2 Generic 1 amoxapine ASENDIN Generic 1 clomipramine hcl ANAFRANIL Generic 1 desipramine hcl NORPRAMIN Generic 1 doxepin hcl SINEQUAN Generic 1 imipramine hcl TOFRANIL Generic 1 imipramine pamoate TOFRANIL-PM Generic 1 maprotiline hcl LUDIOMIL Generic 1 nortriptyline hcl PAMELOR Generic 3 nortriptyline hcl AVENTYL SOL Non-Preferred 3 protriptyline hcl VIVACTIL Non-Preferred






Status 3 trimipramine maleate SURMONTIL Non-Preferred

Antidotes, Deterrents, Toxicolgic Agents Toxicologic Agents 1 naloxone hcl NARCAN Generic 1 naltrexone hcl REVIA Generic Antiemetics 2 aprepitant EMEND Preferred Brand 3 dolasetron mesylate ANZEMET Non-Preferred 1 dronabinol MARINOL Generic 3 granisetron hcl KYTRIL Non-Preferred 1 metoclopramide hcl REGLAN Generic 1 ondansetron ZOFRAN Generic 1 ondansetron (orally disentigrating) ZOFRAN ODT Generic 1 prochlorperazine maleate COMPAZINE Generic 1 promethazine hcl PHENERGAN Generic 3 scopolamine hydrobromide SCOPACE Non-Preferred 3 scopolamine hydrobromide TRANSDERM-SCOP Non-Preferred 1 trimethobenzamide hcl TIGAN Generic 1 trimethobenzamide hcl/b-caine TEBAMIDE Generic

Antifungals Antifungals 1 clotrimazole MYCELEX Generic

QL 1 fluconazole DIFLUCAN Generic 2 flucytosine ANCOBON Preferred Brand 1 itraconazole SPORANOX Generic 2 itraconazole (solution) SPORANOX Preferred Brand 1 ketoconazole NIZORAL Generic 1 terbinafine hcl LAMISIL Generic 1 voriconazole VFEND Generic Antifungals, Antibiotics 1 griseofulvin ultramicrosize FULVICIN P/G Generic 1 griseofulvin ultramicrosize GRIS-PEG Generic 1 griseofulvin,microsize GRIFULVIN V Generic 1 nystatin MYCOSTATIN Generic Antifungals, Vaginal 3 butoconazole nitrate GYNAZOLE-1 Non-Preferred 3 nystatin NYSTATIN Non-Preferred 1 terconazole TERAZOL 3 Generic 1 terconazole TERAZOL 7 Generic

Antigout






Status 1 allopurinol ZYLOPRIM Generic 3 colchicine COLCRYS Non-Preferred 1 colchicine/probenecid COL-BENEMID Generic 1 probenecid BENEMID Generic

Antimigraine QL 3 almotriptan malate AXERT Non-Preferred

1 dihydroergotamine mesylate D.H.E.45 Generic 2 dihydroergotamine mesylate MIGRANAL Preferred Brand

QL 3 eletriptan hydrobromide RELPAX Non-Preferred 1 ergot tt/caff/bell alk/p-barb CAFERGOT P-B Generic 2 ergotamine tartrate/caffeine CAFERGOT Preferred Brand

QL 3 frovatriptan succinate FROVA Non-Preferred 1 isometheptene/acetaminoph/caff MIGRALAM Generic

QL 1 naratriptan hcl AMERGE Generic QL 3 rizatriptan benzoate MAXALT Non-Preferred QL 3 rizatriptan orally disentigrating MAXALT MLT Non-Preferred QL 1 sumatriptan IMITREX Generic QL 3 zolmitriptan ZOMIG Non-Preferred QL 3 zolmitriptan orally disentigrating ZOMIG ZMT Non-Preferred

Antimycobacterials Antimycobacterials, other 1 dapsone AVLOSULFON Generic 1 ethambutol hcl MYAMBUTOL Generic 1 isoniazid NYDRAZID Generic 1 pyrazinamide PYRAZINAMIDE Generic 2 rifabutin MYCOBUTIN Preferred Brand Antituberculars 1 rifampin RIFADIN Generic 1 rifampin/isoniazid RIFAMATE Generic

Antineoplastic Agents Antineoplastic Agents 2 abiraterone ZYTIGA Preferred Brand 1 anastrozole ARIMIDEX Generic 2 bexarotene TARGRETIN Preferred Brand 1 bicalutamide CASODEX Generic 2 busulfan MYLERAN Preferred Brand 2 capecitabine XELODA Preferred Brand 2 chlorambucil LEUKERAN Preferred Brand 2 crizotinib XALKORI Preferred Brand 1 cyclophosphamide CYTOXAN Generic






Status 2 dasatinib SPRYCEL Preferred Brand 2 erlotinib hcl TARCEVA Preferred Brand 2 estramustine phos sodium EMCYT Preferred Brand 2 everolimus AFINITOR Preferred Brand 1 exemestane AROMASIN Generic 1 flutamide EULEXIN Generic 2 hydroxyurea DROXIA Preferred Brand 1 hydroxyurea HYDREA Generic 2 imatinib mesylate GLEEVEC Preferred Brand 2 lapatinib TYKERB Preferred Brand 2 lenalidomide REVLIMID Preferred Brand 2 letrozole FEMARA Preferred Brand 1 leucovorin LEUCOVORIN Generic 2 melphalan ALKERAN Preferred Brand 1 mercaptopurine PURINETHOL Generic 2 mesna MESNEX Preferred Brand 1 methotrexate sodium TREXALL Generic 2 nilotinib TASIGNA Preferred Brand 2 pazopanib VOTRIENT Preferred Brand 2 procarbazine MATULANE Preferred Brand 2 sorafenib tosylate NEXAVAR Preferred Brand 2 sunitinib malate SUTENT Preferred Brand 1 tamoxifen citrate NOLVADEX Generic 2 temozolomide TEMODAR Preferred Brand 3 testolactone TESLAC Non-Preferred 2 thioguanine TABLOID Preferred Brand 2 topotecan HYCAMTIN Preferred Brand 2 tretinoin VESANOID Generic 2 vandetanib CAPRELSA Preferred Brand 2 vemurafenib ZELBORAF Preferred Brand 2 vorinostat ZOLINZA Preferred Brand

Antiparasitics Amebacides 1 iodoquinol ALDARA Generic 1 paromomycin sulfate HUMATIN Generic Anaerobic Antiprotozoal – Antibacterial Agents 1 metronidazole FLAGYL Generic 3 metronidazole extended release FLAGYL ER Non-Preferred Anthelmintics 2 albendazole ALBENZA Preferred Brand 3 ivermectin STROMECTOL Non-Preferred






Status Antimalarial 1 atovaquone/proguanil hcl MALARONE Generic 1 chloroquine phosphate ARALEN PHOSPHATE Generic 1 hydroxychloroquine sulfate PLAQUENIL Generic 1 mefloquine hcl LARIAM Generic 2 primaquine phosphate PRIMAQUINE Preferred Brand 2 pyrimethamine DARAPRIM Preferred Brand 1 quinine sulfate QUININE SULFATE Generic 3 quinine sulfate QUALAQUIN Non-Preferred

Antiprotozoal, Miscellaneous 2 atovaquone MEPRON Preferred Brand

3 tinidazole TINDAMAX Non-Preferred Antiparkinson Agents

Antiparkinson Agents, other 1 amantadine hcl SYMMETREL Generic

1 benztropine mesylate COGENTIN Generic 1 benztropine mesylate PARLODEL Generic

3 carbidopa LODOSYN Non-Preferred 1 carbidopa/levodopa SINEMET Generic 1 carbidopa/levodopa SINEMET CR Generic 3 carbidopa/levodopa PARCOPA Non-Preferred 2 carbidopa/levodopa/entacapone STALEVO Preferred Brand 2 entacapone COMTAN Preferred Brand 1 pramipexole di-hcl MIRAPEX Generic 3 rasagiline mesylate AZILECT Non-Preferred

1 ropinirole hcl REQUIP Generic 1 selegiline hcl ELDEPRYL Generic 3 selegiline hcl ZELAPAR Non-Preferred

1 trihexyphenidyl hcl ARTANE Generic Antipsychotics

Conventional Antispychotics 1 chlorpromazine hcl THORAZINE Generic

1 fluphenazine decanoate PROLIXIN DECANOATE Generic

1 fluphenazine hcl PROLIXIN Generic 1 haloperidol HALDOL Generic

1 haloperidol decanoate HALDOL DECANOATE 50 Generic

1 loxapine succinate LOXITANE Generic 3 molindone hcl MOBAN Non-Preferred






Status 1 perphenazine TRILAFON Generic 3 pimozide ORAP Non-Preferred 1 thioridazine hcl MELLARIL Generic 1 thiothixene NAVANE Generic 1 trifluoperazine hcl STELAZINE Generic Atypical Antispychotics 2 aripiprazole ABILIFY Preferred Brand 1 clozapine CLOZARIL Generic 3 lurasidone LATUDA Non-Preferred 3 clozapine FAZACLO Non-Preferred 1 olanzapine ZYPREXA Generic 1 olanzapine ZYPREXA ZYDIS Generic 3 olanzapine/fluoxetine hcl SYMBYAX Non-Preferred 3 paliperidone INVEGA Non-Preferred 1 quetiapine fumarate SEROQUEL Generic 1 risperidone RISPERDAL Generic 3 risperidone RISPERDAL M-TAB Non-Preferred 3 risperidone microspheres RISPERDAL CONSTA Non-Preferred 1 ziprasidone hcl GEODON Generic

Antivirals Anti-CMV Agents 1 ganciclovir CYTOVENE Generic 3 valganciclovir hydrochloride VALCYTE Non-Preferred Anti-Hepatitis C, Protease Inhibitors 3 boceprevir VICTRELIS Non-Preferred 3 telaprevir INCIVEK Non-Preferred Antiherpetic Agents 1 acyclovir ZOVIRAX Generic 1 famciclovir FAMVIR Generic 1 valacyclovir hcl VALTREX Generic Anti-HIV, CCR5 Antagonist 2 maraviroc SELZENTRY Preferred Brand Anti-HIV, Fusion Inhibitors 2 enfuvirtide FUZEON Preferred Brand Anti-HIV, Integrase Inhibitors 2 raltegravir ISENTRESS Preferred Brand Anti-HIV, Misc 2 efavirenz/emtricitab/tenofovir ATRIPLA Preferred Brand Anti-HIV, NRTI 1 abacavir sulfate ZIAGEN Generic 2 abacavir sulfate/lamivudine EPZICOM Preferred Brand






Status 2 abacavir/lamivudine/zidovudine TRIZIVIR Preferred Brand 2 delavirdine mesylate RESCRIPTOR Preferred Brand 1 didanosine VIDEX EC Generic 2 didanosine solution VIDEX Preferred Brand 2 efavirenz SUSTIVA Preferred Brand 2 emtricitabine EMTRIVA Preferred Brand 2 emtricitabine/tenofovir TRUVADA Preferred Brand 2 etravirine INTELENCE Preferred Brand 1 lamivudine EPIVIR Generic 1 lamivudine/zidovudine COMBIVIR Generic 1 nevirapine VIRAMUNE Generic 3 rilpivirine EDURANT Non-Preferred 1 stavudine ZERIT Generic 3 tenofovir disoproxil fumarate VIREAD Non-Preferred 1 zidovudine RETROVIR Generic Anti-HIV, Protease Inhibitors 2 atazanavir sulfate REYATAZ Preferred Brand

2 darunavir ethanolate PREZISTA Preferred Brand 2 fosamprenavir calcium LEXIVA Preferred Brand 2 indinavir sulfate CRIXIVAN Preferred Brand 2 nelfinavir mesylate VIRACEPT Preferred Brand 2 ritonavir NORVIR Preferred Brand

2 ritonavir/lopinavir KALETRA Preferred Brand 2 saquinavir mesylate INVIRASE Preferred Brand

2 tipranavir APTIVUS Preferred Brand Antiinfluenza 2 oseltamivir phosphate TAMIFLU Preferred Brand 1 rimantadine hcl FLUMADINE Generic 2 zanamivir RELENZA Preferred Brand Antivirals, other 2 adefovir dipivoxil HEPSERA Preferred Brand 3 entecavir BARACLUDE Non-Preferred

3 interferon alfacon-1 INFERGEN Non-Preferred 3 lamivudine EPIVIR HBV Non-Preferred 3 palivizumab SYNAGIS Non-Preferred

2 peginterferon alfa-2a PEGASYS Preferred Brand 2 peginterferon alfa-2a PEG-INTRON Preferred Brand

3 peginterferon-alfa 2b PEG-INTRON REDIPEN Non-Preferred

1 ribavirin COPEGUS Generic 1 ribavirin REBETOL Generic






Status 3 ribavirin RIBATAB Non-Preferred

Anxiolytics 1 alprazolam XANAX Generic 3 alprazolam NIRAVAM Non-Preferred 1 alprazolam extended-release XANAX XR Generic 1 buspirone hcl BUSPAR Generic 1 buspirone hcl VANSPAR Generic 1 chlordiazepoxide hcl LIBRIUM Generic 1 clorazepate dipotassium TRANXENE SD Generic 1 clorazepate dipotassium TRANXENE T-TAB Generic 1 diazepam VALIUM Generic 1 lorazepam ATIVAN Generic 1 lorazepam LORAZEPAM INTENSO Generic 1 meprobamate MILTOWN Generic 1 oxazepam SERAX Generic

Autonomic Drugs, Miscellaneous 3 varenicline CHANTIX Non-Preferred Bipolar Agents

1 lithium carbonate capsule LITHIUM CARBONATE Generic 1 lithium carbonate extended release LITHOBID ER Generic 2 lithium carbonate tablet LITHOBID Preferred-Brand 1 lithium citrate CIBALITH-S Generic

Blood Glucose Regulators Antidiabetic Agents, Alphaglucosidase Inhibitors

1 acarbose PRECOSE Generic 3 miglitol GLYSET Non-Preferred

Antidiabetic Agents, Amylinomimetics QRM 3 pramlintide acetate SYMLIN Non-Preferred

Antidiabetic Agents, Antihypoglycemics 2 diazoxide PROGLYCEM Preferred-Brand 2 glucagon GLUCAGON Preferred-Brand 2 glucagons,human recombinant GLUCAGEN Preferred-Brand Antidiabetic Agents, Biguanides

1 metformin extended-release GLUCOPHAGE XR Generic 1 metformin hcl GLUCOPHAGE Generic 3 metformin hcl FORTAMET Non-Preferred 3 metformin hcl GLUMETZA Non-Preferred 3 metformin hcl RIOMET Non-Preferred

Antidiabetic Agents, DPP-4 Inhibitors QRM 3 saxagliptin ONGLYZA Non-Preferred






Status

QRM 3 saxagliptin/metformin extended-release KOMBIGLYZE XR Non-Preferred

QRM 3 sitagliptin phosphate JANUVIA Non-Preferred QRM 3 sitagliptin/metformin JANUMET Non-Preferred QRM 3 sitagliptin/simvastatin JUVISYNC Non-Preferred

Antidibetic Agents, Incretin Mimetics QRM 3 exenatide extended-release BYDUREON Non-Preferred QRM 3 exenatide BYETTA Non-Preferred QRM 3 linagliptin TRADJENTA Non-Preferred QRM 3 liraglutide VICTOZA Non-Preferred

Antidiabetic Agents, Meglitinides 1 nateglinide STARLIX Generic 3 repaglinide PRANDIN Non-Preferred

Antidiabetic Agents, Miscellaneous 1 glyburide/metformin hcl GLUCOVANCE Generic Antidiabetic Agents, Sulfonylureas

1 glimepiride AMARYL Generic 1 glipizide GLUCOTROL Generic

1 glipizide extended-release GLUCOTROL XL Generic 1 glipizide/metformin hcl METAGLIP Generic 1 glyburide MICRONASE Generic 1 glyburide DIABETA Generic 1 glyburide,micronized GLYNASE Generic 1 glyburide/metformin hcl GLUCOVANCE Generic 1 tolazamide TOLINASE Generic 1 tolbutamide ORINASE Generic

Antidiabetic Agents, Thiazolidinediones 2 pioglitazone hcl ACTOS Preferred Brand 3 pioglitazone hcl/metformin hcl ACTOPLUS MET Non-Preferred 3 pioglitazone/glimepiride DUETACT Non-Preferred

Blood Sugar Diagnostics

QL 1 blood sugar diagnostic ONE TOUCH ULTRA TEST STRIPS Generic

QL 3 blood sugar diagnostic ACCU-CHEK TEST STRIPS Non-Preferred

QL 3 blood sugar diagnostic ASCENSIA TEST STRIPS Non-Preferred QL 3 blood sugar diagnostic FREESTYLE TEST STRIPS Non-Preferred QL 3 blood sugar diagnostic PRODIGY TEST STRIPS Non-Preferred

Diabetic Supplies QL 1 blood-glucose meter ONE TOUCH ULTRA 2 Generic QL 3 blood-glucose meter ACCU-CHEK Non-Preferred






Status QL 3 blood-glucose meter ASCENSIA BREEZE Non-Preferred QL 3 blood-glucose meter FREESTYLE SYSTEM Non-Preferred

QL 3 blood-glucose meter ONE TOUCH ULTRA SMART Non-Preferred

QL 3 blood-glucose meter ONE TOUCH ULTRAMINI Non-Preferred

QL 3 blood-glucose meter PRODIGY Non-Preferred Insulins 3 hum insulin nph/reg insulin hm NOVOLIN 70/30 Non-Preferred 3 hum insulin nph/reg insulin hm HUMULIN 50/50 Non-Preferred 2 hum insulin nph/reg insulin hm HUMULIN 70/30 Preferred Brand 3 insulin aspart NOVOLOG INJ VIAL Non-Preferred 3 insulin detemir LEVEMIR Non-Preferred 3 insulin glargine,hum.rec.anlog LANTUS Non-Preferred 3 insulin glulisine APIDRA Non-Preferred 3 insulin lispro,human rec.anlog HUMALOG Non-Preferred 3 insulin nph human recom NOVOLIN N Non-Preferred 2 insulin nph human recom HUMULIN N Preferred Brand 3 insulin npl/insulin lispro HUMALOG MIX 50/50 Non-Preferred 3 insulin npl/insulin lispro HUMALOG MIX 75/25 Non-Preferred 3 insulin regular human rec NOVOLIN R Non-Preferred 2 insulin regular human rec HUMULIN R Preferred Brand 3 insuln asp prt/insulin aspart NOVOLOG MIX 70/30 Non-Preferred Syringes & Accessories

QL 1 syringe with needle,disposable BD INSULIN SYRINGE Generic Blood Products/ Modifiers/Volume Expanders

Anticoagulants, Factor Xa Inhibitors, Indirect 1 fondaparinux sodium ARIXTRA Generic

Anticoagulants, Low Molecular Weight Heparins 3 dalteparin sodium,porcine FRAGMIN Non-Preferred 1 enoxaparin sodium LOVENOX Generic

Anticoagulants, Oral 3 dabigatran PRADAXA Non-Preferred

QRM, QL 3 rivaroxaban XARELTO Non-Preferred 1 warfarin sodium COUMADIN Generic

Blood Formation Products, Colony Stimulating Factors 2 filgrastim NEUPOGEN Preferred Brand 2 oprelvekin NEUMEGA Preferred Brand 3 pegfilgrastim NEULASTA Non-Preferred 2 sargramostim LEUKINE Preferred Brand

Blood Formation Products, Erythropoietins






Status 2 darbepoetin alfa ARANESP Preferred Brand 2 epoetin alfa PROCRIT Preferred Brand 3 epoetin alfa EPOGEN Non-Preferred

Coagulants, Protease Inhibitors 1 aminocaproic acid AMICAR Generic

Hematological Products, Other 1 anagrelide hcl AGRYLIN Generic 3 gelatin sponge,absorbable GELFOAM Non-Preferred 1 heparin sodium,porcine HEPARIN SODIUM Generic 1 pentoxifylline TRENTAL Generic 2 phytonadione MEPHYTON Preferred Brand

Ion Removing Agents 2 sodium polystyrene sulfonate KAYEXALATE Non-Preferred

Iron Overload Agents 2 deferasirox EXJADE Preferred Brand

1 deferoxamine mesylate DESFERAL MESYLATE Generic

Platelet Aggregation Inhibitors 2 aspirin/dipyridamole AGGRENOX Preferred Brand 1 cilostazol PLETAL Generic 2 clopidogrel bisulfate PLAVIX Generic 1 dipyridamole PERSANTINE Generic 3 ticagrelor BRILINTA Non-Preferred 1 ticlopidine hcl TICLID Generic

Cardiovascular Agents Alpha Adrenergic Agonists

1 clonidine hcl CATAPRES Generic 3 clonidine hcl suspension NEXICLON XR Non-Preferred 1 clonidine hcl transdermal CATAPRES-TTS Generic 1 guanabenz acetate WYTENSIN Generic 1 guanfacine hcl TENEX Generic 1 methyldopa ALDOMET Generic 1 methyldopa/hydrochlorothiazide ALDORIL-25 Generic 1 midodrine hcl PROAMATINE Generic

Alpha-Adrenergic Blocking Agents 1 doxazosin mesylate CARDURA Generic 3 phenoxybenzamine hcl DIBENZYLINE Non-Preferred 1 phentolamine mesylate REGITINE Generic 1 prazosin hcl MINIPRESS Generic 3 reserpine SERPASIL Non-Preferred 1 terazosin hcl HYTRIN Generic






Status Alpha-Beta Adrenergic Blocking Agents

1 carvedilol COREG Generic 3 carvedilol controlled-release COREG CR Non-Preferred 1 labetalol hcl TRANDATE Generic

Antiarrthymics 1 amiodarone hcl CORDARONE Generic 1 amiodarone hcl PACERONE Generic 1 disopyramide phosphate NORPACE Generic

1 disopyramide phosphate sustained-release NORPACE CR Preferred Brand

2 dofetilide TIKOSYN Preferred Brand 1 flecainide acetate TAMBOCOR Generic 1 lidocaine hcl/pf LIDOCAINE HCL Generic 1 mexiletine hcl MEXITIL Generic 1 procainamide hcl PRONESTYL Generic 1 propafenone hcl RYTHMOL Generic 3 propafenone hcl RYTHMOL SR Non-Preferred 1 quinidine gluconate QUINAGLUTE Generic 1 quinidine sulfate QUINIDINE SULFATE Generic

Beta-Adrenergic Blocking Agents 1 acebutolol hcl SECTRAL Generic 1 atenolol TENORMIN Generic

1 atenolol/chlorthalidone TENORETIC Generic 1 betaxolol hcl KERLONE Generic

1 bisoprol/hydrochlorothiazide ZIAC Generic 1 bisoprolol fumarate ZEBETA Generic

1 metoprol/hydrochlorothiazide LOPRESSOR HCT Generic 1 metoprolol succinate extended-release TOPROL XL Generic 1 metoprolol tartrate LOPRESSOR Generic 1 nadolol CORGARD Generic

3 nadolol/bendroflumethiazide CORZIDE Non-Preferred 3 penbutolol sulfate LEVATOL Non-Preferred

1 pindolol VISKEN Generic 3 propranolol extended-release INNOPRAN XL Non-Preferred 1 propranolol hcl INDERAL Generic 1 propranolol sustained-release INDERAL LA Generic

1 propranolol/hydrochlorothiazide INDERIDE-40/25 Generic 1 sotalol hcl BETAPACE Generic 1 sotalol hcl BETAPACE AF Generic 1 timolol maleate BLOCADREN Generic Calcium Channel Blocking Agents






Status 1 amlodipine besylate NORVASC Generic 1 diltiazem hcl extended-release cap CARDIZEM CD Generic 1 diltiazem hcl extended-release cap TIAZAC Generic

1 diltiazem hcl extended-release tab CARDIZEM LA Generic 1 felodipine PLENDIL Generic 1 isradipine DYNACIRC Generic

3 isradipine DYNACIRC CR Non-Preferred 1 nicardipine hcl CARDENE Generic

3 nicardipine hcl sustained-release CARDENE SR Non-Preferred 1 nifedipine PROCARDIA Generic 1 nifedipine extended-release ADALAT CC Generic 1 nifedipine extended-release PROCARDIA XL Generic

1 nimodipine NIMOTOP Generic 3 nisoldipine SULAR Non-Preferred

1 verapamil hc sustained-release cap VERELAN Generic 3 verapamil hcl COVERA-HS Non-Preferred

1 verapamil hcl extended-release cap VERELAN PM Generic 1 verapamil hcl sustained-release cap CALAN SR Generic 1 verapamil hcl sustained-release tab ISOPTIN SR Generic

Calcium Channel Blocking/ ACEI Combination 1 amlodipine besylate/benazepril LOTREL Generic 1 trandolapril/verapamil hcl TARKA Generic

Calcium Channel Blocking/ HMG CoA Reductase Inhibitor 3 amlodipine/atorvast cal CADUET Non-Preferred

Direct Cardiac Inotropes 1 digoxin LANOXIN Generic 3 digoxin LANOXICAPS Non-Preferred 2 digoxin solution DIGOXIN ELIXIR Preferred Brand

Diuretics 1 amiloride hcl MIDAMOR Generic 1 amiloride/hydrochlorothiazide MODURETIC Generic 1 bumetanide BUMEX Generic 1 chlorothiazide DIURIL Generic 1 chlorthalidone HYGROTON Generic 1 eplerenone INSPRA Generic 3 ethacrynic acid EDECRIN Non-Preferred 1 furosemide LASIX Generic 1 hydrochlorothiazide MICROZIDE Generic 1 indapamide LOZOL Generic 1 metolazone ZAROXOLYN Generic 1 spironolact/hydrochlorothiazide ALDACTAZIDE Generic






Status 1 spironolactone ALDACTONE Generic 1 torsemide DEMADEX Generic 3 triamterene DYRENIUM Non-Preferred 1 triamterene/hydrochlorothiazide DYAZIDE Generic 1 triamterene/hydrochlorothiazide MAXZIDE Generic

Dyslipidemics, Bile Acid Sequestrants 3 cholestyramine/aspartame QUESTRAN LIGHT Non-Preferred 1 cholestyramine/sucrose QUESTRAN Generic 3 colesevelam hcl WELCHOL Non-Preferred 1 colestipol hcl COLESTID Generic

Dyslipidemics, Cholesterol Absorption Inhibitors 3 ezetimibe ZETIA Non-Preferred 3 ezetimibe/simvastatin VYTORIN Non-Preferred

Dyslipidemics, Fibrates 1 fenofibrate TRIGLIDE Generic 1 fenofibrate nanocrystallized TRICOR Generic 1 fenofibrate,micronized LOFIBRA Generic 3 fenofibric acid TRILIPIX Non-Preferred 1 gemfibrozil LOPID Generic

Dyslipidemics, HMG CoA Reductase Inhibitors 1 atorvastatin calcium LIPITOR Generic 3 fluvastatin extended-release LESCOL XL Non-Preferred 3 fluvastatin sodium LESCOL Non-Preferred 1 lovastatin MEVACOR Generic 3 lovastatin ALTOPREV Non-Preferred 3 pitavastatin LIVALO Non-Preferred 1 pravastatin sodium PRAVACHOL Generic 3 rosuvastatin calcium CRESTOR Non-Preferred 1 simvastatin ZOCOR Generic

Dyslipidemics, Niacin 3 niacin NIASPAN Non-Preferred 3 niacin/lovastatin ADVICOR Non-Preferred

Dyslipidemics, Omega 3 Fatty Acids 3 omega-3 acid ethyl esters OMACOR Non-Preferred

Partial Fatty Oxidase Inhibitors 3 ranolazine RANEXA Non-Preferred

Renin Angiotensin Aldosterone System Inhibitors, Angiotensin Converting Enzyme 1 benazepril hcl LOTENSIN Generic 1 benazepril/hydrochlorothiazide LOTENSIN HCT Generic 1 captopril CAPOTEN Generic 1 captopril/hydrochlorothiazide CAPOZIDE Generic






Status 1 enalapril maleate VASOTEC Generic 1 enalapril/hydrochlorothiazide VASERETIC Generic 1 fosinopril sodium MONOPRIL Generic 1 fosinopril/hydrochlorothiazide MONOPRIL HCT Generic 1 lisinopril PRINIVIL Generic 1 lisinopril ZESTRIL Generic 1 lisinopril/hydrochlorothiazide PRINZIDE Generic 1 lisinopril/hydrochlorothiazide ZESTORETIC Generic 1 moexipril hcl UNIVASC Generic 1 moexipril/hydrochlorothiazide UNIRETIC Generic 1 perindopril erbumine ACEON Generic 1 quinapril hcl ACCUPRIL Generic 1 quinapril/hydrochlorothiazide ACCURETIC Generic 1 ramipril ALTACE Generic 1 trandolapril MAVIK Generic

Angiotensin Aldosterone System Inhibitors, Angiotensin II Receptor Antagonists 3 azilsartan medoxomil EDARBI Non-Preferred 3 candesartan cilexetil ATACAND Non-Preferred 3 candesartan/hydrochlorothiazide ATACAND HCT Non-Preferred 3 eprosartan mesylate TEVETEN Non-Preferred 3 eprosartan/hydrochlorothiazide TEVETEN HCT Non-Preferred 3 irbesartan AVAPRO Non-Preferred 3 irbesartan/hydrochlorothiazide AVALIDE Non-Preferred 1 losartan potassium COZAAR Generic 1 losartan/hctz HYZAAR Generic 3 olmesartan medoxomil BENICAR Non-Preferred 3 olmesartn/hydrochlorothiazide BENICAR HCT Non-Preferred 3 telmisartan MICARDIS Non-Preferred 3 telmisartan/hydrochlorothiazide MICARDIS HCT Non-Preferred 3 valsartan DIOVAN Non-Preferred 1 valsartan/hydrochlorothiazide DIOVAN HCT Generic Renin Inhibitor, Direct 3 aliskiren TEKTURNA Non-Preferred 3 aliskiren/hydrochlorothiazide TEKTURNA HCT Non-Preferred Renin Inhibitor, Direct/Angiotensin II Receptor Antagonists 3 aliskiren/valsartan VALTURNA Non-Preferred Renin Inhibitor, Direct/Calcium Channel Blocker 3 aliskiren/amlodipine TEKAMLO Non-Preferred Renin Inhibitor, Direct/Calcium Channel Blocker/ Thiazide Combo 3

aliskiren, amlodipine and hydrochloro-thiazide AMTURNIDE Non-Preferred






Status Vasodilating Agents

1 amyl nitrite AMYL NITRITE Generic 2 bosentan TRACLEER Preferred Brand 1 epoprostenol sodium FLOLAN Generic 1 ergoloid mesylates HYDERGINE Generic 1 hydralazine hcl APRESOLINE Generic 1 hydralazine/hydrochlorothiazide APRESAZIDE Generic 3 isosorb dinit/hydralazine hcl BIDIL Non-Preferred 1 isosorbide dinitrate ISORDIL Generic 1 isosorbide mononitrate IMDUR Generic 1 isoxsuprine hcl VASODILAN Generic 1 minoxidil LONITEN Generic 3 nitroglycerin aerosol NITROMIST Non-Preferred 3 nitroglycerin solution NITROLINGUAL Non-Preferred 1 nitroglycerin subligual NITROSTAT Generic 1 nitroglycerin topical ointment NITRO-BID Generic

Excludes 0.8mg

strength 1 nitroglycerin transdermal patch NITRO-DUR Generic

Only 0.8mg strength

2 nitroglycerin transdermal patch NITRO-DUR Preferred Brand

1 papaverine hcl PAVABID Generic 3 sildenafil REVATIO Non-Preferred 3 tadalafil ADCIRCA Non-Preferred 2 treprostinil REMODULIN Preferred Brand

Central Nervous System Agents Amphetamines 1 amphet asp/amphet/d-amphet ADDERALL Generic 1 amphet asp/amphet/d-amphet ADDERALL XR Generic 1 d-amphetamine sulfate DEXEDRINE Generic 1 d-amphetamine sulfate DEXTROSTAT Generic 3 methamphetamine hcl DESOXYN Non-Preferred Central Nervous System Agents, Miscellaneous 3 dextromethorphan/quinidine NUEDEXTA Non-Preferred Non-amphetamines

3 armodafinil NUVIGIL Non-Preferred 3 atomoxetine hcl STRATTERA Non-Preferred

3 clonidine extended-release KAPVAY Non-Preferred 1 dexmethylphenidate FOCALIN Generic 3 dexmethylphenidate extended-release FOCALIN XR Non-Preferred 3 guanfacine extended-release INTUNIV Non-Preferred






Status 1 methylphenidate METHYLIN Generic 1 methylphenidate extended-release METADATE ER Generic 1 methylphenidate extended-release CONCERTA Generic 3 methylphenidate extended-release METADATE CD Non-Preferred 3 methylphenidate extended-release RITALIN LA Non-Preferred 1 methylphenidate hcl RITALIN Generic 1 methylphenidate sustained release RITALIN-SR Generic 3 methylphenidate transdermal patch DAYTRANA Non-Preferred 1 modafinil PROVIGIL Generic 2 riluzole RILUTEK Preferred Brand 3 sodium oxybate XYREM Non-Preferred

Contraceptives/ Oxytocics Contraceptives, Devices

2 copper intrauterine PARAGARD Preferred Brand 2 diaphragm ALL FLEX Preferred Brand

Contraceptives, Intravaginal 3 etonogestrel/ethinyl estradiol NUVARING Non-Preferred

Contraceptives, Injectable 1 medroxyprogesterone acet DEPO-PROVERA Generic

3 medroxyprogesterone acet DEPO-SUBQ PROVERA 104 Non-Preferred

Contraceptives, Oral 3 desogestrel-ethinyl estradiol APRI Non-Preferred 1 desogestrel-ethinyl estradiol CYCLESSA Generic 3 desogestrel-ethinyl estradiol DESOGEN Non-Preferred 1 desogestrel-ethinyl estradiol KARIVA Generic 3 desogestrel-ethinyl estradiol MIRCETTE Non-Preferred 3 desogestrel-ethinyl estradiol ORTHO-CEPT Non-Preferred 1 desogestrel-ethinyl estradiol RECLIPSEN Generic 3 estradiol valerate/dienogest NATAZIA Non-Preferred 1 ethinyl estradiol/drospirenone OCELLA Generic 1 ethinyl estradiol/drospirenone YASMIN Generic 3 ethinyl estradiol/drospirenone YAZ Non-Preferred 3 ethinyl estradiol/drospirenone/folate BEYAZ Non-Preferred 3 ethinyl estradiol/drospirenone/folate SAFYRAL Non-Preferred 3 ethinyl estradiol/levonorgestrel TRIPHASIL Non-Preferred 1 ethinyl estradiol/levonorgestrel TRIVORA Generic 1 ethynodiol d-ethinyl estradiol ZOVIA Generic 2 levonorgestrel PLAN B Preferred Brand 3 levonorgestrel-eth estra ALESSE-28 Non-Preferred 1 levonorgestrel-eth estra AVIANE Generic






Status 1 levonorgestrel-eth estra LEVORA Generic 3 levonorgestrel-eth estra NORDETTE-28 Non-Preferred 3 levonorgestrel-eth estra SEASONALE Non-Preferred 3 l-norgest-eth estr/ethin estra SEASONIQUE Non-Preferred 3 noreth a-et estra/fe fumarate ESTROSTEP FE Non-Preferred 3 noreth a-et estra/fe fumarate LO LOESTRIN FE Non-Preferred 3 noreth a-et estra/fe fumarate LOESTRIN 24 FE Non-Preferred 3 noreth a-et estra/fe fumarate LOESTRIN FE Non-Preferred 1 noreth a-et estra/fe fumarate TILIA Generic 3 noreth-ethinyl estradiol/iron FEMCON FE Non-Preferred 3 noreth-ethinyl estradiol/iron OVCON FE Non-Preferred 3 norethindrone MICRONOR Non-Preferred 1 norethindrone NORA-BE Generic 1 norethindrone NOR-Q-D Generic 3 norethindrone a-e estradiol JUNEL 1/20 Non-Preferred 3 norethindrone a-e estradiol LOESTRIN Generic 1 norethindrone a-e estradiol MICROGESTIN FE 1/20, Generic 1 norethindrone-ethinyl estrad BREVICON Generic 3 norethindrone-ethinyl estrad MODICON Non-Preferred 1 norethindrone-ethinyl estrad NECON Generic 3 norethindrone-ethinyl estrad ORTHO-NOVUM Non-Preferred 3 norethindrone-ethinyl estrad OVCON-35 Non-Preferred 3 norethindrone-ethinyl estrad OVCON-50 Non-Preferred 1 norethindrone-ethinyl estrad TRI-NORINYL Generic 1 norethindrone-ethinyl estradiol NORTREL Generic 3 norethindrone-mestranol NORINYL 1+35 Non-Preferred 3 norethindrone-mestranol NORINYL 1+50 Non-Preferred 3 norethindrone-mestranol ORTHO-NOVUM Non-Preferred 1 norgestimate-ethinyl estradiol CRYSELLE Generic 3 norgestimate-ethinyl estradiol LO/OVRAL-28 Non-Preferred 3 norgestimate-ethinyl estradiol ORTHO TRI-CYCLEN Non-Preferred

3 norgestimate-ethinyl estradiol ORTHO TRI-CYCLEN LO Non-Preferred

3 norgestimate-ethinyl estradiol ORTHO-CYCLEN Non-Preferred 1 norgestimate-ethinyl estradiol SPRINTEC Generic 1 norgestimate-ethinyl estradiol TRI-SPRINTEC Generic 3 norgestryl-ethiny estradiol OGESTREL Non-Preferred

QL 2 ulipristal ELLA Preferred Brand Contraceptives, Transdermal 3 ethinyl estradiol/norelgest ORTHO EVRA Non-Preferred Oxytocics






Status 2 methylergonovine maleate METHERGINE Preferred Brand

Dental and Oral Agents 1 chlorhexidine gluconate PERIDEX Generic 1 doxycycline hyclate PERIOSTAT Generic

3 mag hydrox/alh/smc/dpha/lido FIRST-MOUTHWASH BLM Non-Preferred

1 triamcinolone acetonide KENALOG IN ORABASE Generic

Dermatologic Agents Acne Agents – Topical

3 azelaic acid AZELEX Non-Preferred 1 clindamycin phos/benzoyl perox BENZACLIN Generic

3 clindamycin phos/benzoyl perox DUAC Non-Preferred 3 clindamycin/tretinoin ZIANA Non-Preferred 1 sulfacetamide sodium KLARON Generic 3 sulfacetamide sodium SEB-PREV Non-Preferred

Anesthetics– Topical 1 benzocaine FOILLE PLUS Generic 1 ethyl chloride ETHYL CHLORIDE Generic 3 hc acetate/lidocaine hcl LIDAMANTLE HC Non-Preferred 1 hc acetate/pramoxine hcl PRAMOSONE Generic 3 hc acetate/pramoxine hcl PRAMOSONE-E Non-Preferred 3 lidocaine LIDODERM Non-Preferred 3 lidocaine hcl LIDAMANTLE Non-Preferred 1 lidocaine/prilocaine EMLA Generic 3 tetracaine/benzocaine/butam. CETACAINE Non-Preferred Antibacterials–Topical 3 cadexomer iodine IODOSORB Non-Preferred 3 clioquinol/hydrocortisone VIOFORM-HC Non-Preferred 3 hc/aloe polysacch/iodoquinol ALCORTIN Non-Preferred 3 hexachlorophene PHISOHEX Non-Preferred 1 hydrocortisone/iodoquinol VYTONE Generic 1 silver nitrate applicator SILVER NITRATE Generic Antibiotics– Topical

1 clindamycin phosphate CLEOCIN T Generic 1 clindamycin phosphate CLINDAGEL Generic 3 clindamycin phosphate EVOCLIN Non-Preferred 3 dapsone ACZONE Non-Preferred 3 erythromycin base AKNE-MYCIN Non-Preferred 1 erythromycin base ERYGEL Generic






Status 1 erythromycin base/benz per BENZAMYCIN Generic 3 erythromycin base/benz per BENZAMYCINPAK Non-Preferred 1 erythromycin base/ethanol EMGEL Generic 1 gentamicin sulfate GARAMYCIN Generic 1 mupirocin BACTROBAN Generic 1 mupirocin CENTANY Generic 3 mupirocin calcium BACTROBAN Non-Preferred

Antibiotics/Anti-inflammatory 1 neomy sulf/polymyx b sulf/hc CORTISPORIN Generic 1 neomycin/bacitra/polymyxin/hc CORTISPORIN Generic

Antifungals–Topical 3 butenafine hcl MENTAX Non-Preferred 3 ciclopirox PENLAC Non-Preferred 1 ciclopirox olamine LOPROX Generic 1 clotrimazole/betamet diprop LOTRISONE Generic 1 econazole nitrate SPECTAZOLE Generic 3 ketoconazole KURIC Non-Preferred 1 ketoconazole NIZORAL Generic 3 miconazole nitrate/zinc oxide VUSION Non-Preferred 3 naftifine hcl NAFTIN Non-Preferred 1 nystatin MYCOSTATIN Generic 1 nystatin/triamcin MYCOLOG II Generic 3 oxiconazole nitrate OXISTAT Non-Preferred 3 sertaconazole nitrate ERTACZO Non-Preferred 3 sulconazole nitrate EXELDERM Non-Preferred

Anti-inflammatory 1 alclometasone dipropionate ACLOVATE Generic 1 amcinonide CYCLOCORT Generic 1 betamet diprop/prop gly DIPROLENE Generic

1 betamet diprop/prop gly DIPROLENE AF Generic 1 betamethasone dipropionate DEL-BETA Generic 1 betamethasone dipropionate DIPROSONE Generic 1 betamethasone valerate LUXIQ Generic 1 betamethasone valerate VALISONE Generic 1 clobetasol propionate CLOBEX Generic 1 clobetasol propionate OLUX Generic 1 clobetasol propionate TEMOVATE Generic 3 clobetasol propionate/emoll OLUX-E Non-Preferred 1 clobetasol propionate/emoll TEMOVATE E Generic 3 clocortolone pivalate CLODERM Non-Preferred 1 desonide DESOWEN Generic






Status 1 desoximetasone TOPICORT Generic 1 diflorasone diacetate APEXICON Generic 1 diflorasone diacetate MAXIFLOR Generic 1 diflorasone diacetate PSORCON Generic 1 diflorasone diacetate/emollient APEXICON E Generic 1 diflorasone diacetate/emollient PSORCON E Generic 3 fluocinolone acetonide CAPEX SHAMPOO Non-Preferred

1 fluocinolone acetonide DERMA-SMOOTHE/FS OIL Generic

1 fluocinolone acetonide SYNALAR Generic 1 fluocinonide LIDEX Generic 3 fluocinonide VANOS Non-Preferred 1 fluocinonide/emollient LIDEX-E Generic 3 flurandrenolide CORDRAN Non-Preferred 1 fluticasone propionate CUTIVATE Generic 3 halcinonide HALOG Non-Preferred 1 halobetasol propionate ULTRAVATE Generic 1 hydrocortisone HYTONE Generic 3 hydrocortisone LACTICARE-HC Non-Preferred 3 hydrocortisone REDERM Non-Preferred 3 hydrocortisone SCALACORT Non-Preferred 1 hydrocortisone acetate/urea CARMOL HC Generic 1 hydrocortisone butyrate LOCOID Generic 3 hydrocortisone butyrate/emoll LOCOID LIPOCREAM Non-Preferred 3 hydrocortisone probutate PANDEL Non-Preferred 1 hydrocortisone valerate WESTCORT Generic 3 hydrocortisone/benz per VANOXIDE-HC Non-Preferred 1 mometasone furoate ELOCON Generic 1 prednicarbate DERMATOP Generic 1 triamcinolone acetonide KENALOG Generic 3 triamcinolone acetonide TRIDERM Non-Preferred

Antineoplastics – Topical 3 diclofenac sodium SOLARAZE Non-Preferred 3 fluorouracil CARAC Non-Preferred 1 fluorouracil EFUDEX Generic 2 fluorouracil FLUOROPLEX Preferred Brand

Antiparasitics 3 crotamiton EURAX Non-Preferred

1 lindane KWELL Generic 1 malathion OVIDE Generic 3 nitazoxanide ALINIA Non-Preferred






Status 1 permethrin ELIMITE Generic 3 spinosad NATROBA Non-Preferred Anti-pruitic

3 doxepin hcl ZONALON Non-Preferred 3 hc acetate/pramoxine hcl ANALPRAM HC Non-Preferred 1 pramoxine hcl PROCTOFOAM Generic Antipsoriatic Agents

3 acitretin SORIATANE Non-Preferred 3 anthralin DRITHOCREME HP Non-Preferred 3 anthralin DRITHO-SCALP Non-Preferred 3 anthralin PSORIATEC Non-Preferred 3 efalizumab RAPTIVA Non-Preferred 3 golimumab SIMPONI Non-Preferred 3 ustekinumab STELARA Non-Preferred

Antivirals– Topical 3 acyclovir ZOVIRAX Non-Preferred 3 penciclovir DENAVIR Non-Preferred

Caustic Agents 1 podofilox CONDYLOX Generic 3 podophyllum resin PODODERM Non-Preferred Dermatology, Misc. 1 acetic acid ACETIC ACID Generic 1 aluminum chloride DRYSOL Generic 2 monobenzone BENOQUIN Preferred Brand Emollients 1 ammonium lactate LAC-HYDRIN Generic 3 dl-e ac/grape/hyaluronic acid ATOPICLAIR Non-Preferred 3 emollient combination no. 3 MIMYX Non-Preferred 3 emollient combination no.10 BIAFINE Non-Preferred 3 lactic acid LACTINOL Non-Preferred 3 lactic acid LACTINOL-E Non-Preferred Hypopigmentation Agents 3 dioxybenzone/pdo/hydroquinone SOLAQUIN FORTE Non-Preferred 1 hydroquinone LUSTRA Generic 1 hydroquinone LUSTRA-ULTRA Generic 3 hydroquinone/avobenz/octinox ACLARO Non-Preferred 3 kera1/oxbn/avobnz/o-crl/h-quin GLYQUIN XM Non-Preferred 3 oxyben/pdo/octinox/h-quinone GLYQUIN Non-Preferred

1 oxybenzone/octinox/h-quinone OXYBENZONE/ OCTINOX/H-QUINONE

Generic






Status 3 vit e ac/avobnz/octinox/h-quin LUSTRA-AF Non-Preferred Immunodulators 1 imiquimod ALDARA Generic 2 interferon alfa-2b,recomb. INTRON A Preferred Brand Immunosuppressive Agents – Topical 2 pimecrolimus ELIDEL Preferred Brand 3 tacrolimus PROTOPIC Non-Preferred Keratolytics 3 benzoyl peroxide microspheres NEOBENZ MICRO Non-Preferred 3 benzoyl peroxide/urea ZODERM Non-Preferred 1 podofilox CONDYLOX Generic 3 salicylic acid SALEX Non-Preferred 1 urea CARMOL Generic Mitotic Inhibitors 2 calcipotriene DOVONEX Preferred Brand 2 calcitriol VECTICAL Preferred Brand 3 selenium sulfide SELSEB Non-Preferred 3 selenium sulfide SELSUN RX Non-Preferred 1 sulfacetamide sodium OVACE Generic 1 sulfacetamide sodium/urea CARMOL Generic 1 sulfacetamide sodium/urea ROSULA NS Generic Non-Steroidal Anti-Inflammatory Agents – Topical 3 diclofenac FLECTOR Non-Preferred 3 diclofenac VOLTAREN GEL Non-Preferred Photochemotherapy Agents 3 methoxsalen 8-MOP Non-Preferred

2 methoxsalen, rapid OXSORALEN-ULTRA

Preferred Brand

Rectal Agents 3 hc acetate/lidocain hcl/alo v ANAMANTLE HC Non-Preferred 1 hc acetate/lidocaine hcl ANAMANTLE HC Generic 3 hc acetate/pramoxine hcl PROCTOFOAM-HC Non-Preferred 1 hydrocortisone CORTENEMA Generic 1 hydrocortisone PROCTOCORT Generic 1 hydrocortisone acetate ANUSOL-HC Generic 3 hydrocortisone acetate CORTIFOAM Non-Preferred 1 hydrocortisone acetate PROCTOCORT Generic Retinoids

QL, AGE 1 adapalene DIFFERIN Generic 1 isotretinoin ACCUTANE Generic QL, AGE 3 tazarotene TAZORAC Non-Preferred






Status QL, AGE 1 tretinoin RETIN-A Generic

QL, AGE 3 tretinoin microspheres RETIN-A MICRO Non-Preferred

QL, AGE 3 tretinoin microspheres RETIN-A MICRO PUMP Non-Preferred

Rosacea Agents – Topical 3 azelaic acid FINACEA Non-Preferred 1 metronidazole cream METROCREAM Generic 1 metronidazole gel METROGEL Generic 1 metronidazole lotion METROLOTION Generic 3 metronidazole/skin cleanser METROGEL Non-Preferred

Subcutaneous Enzymes/ Mucous Membranes – Topical 2 collagenase SANTYL Preferred 3 papain/urea/chlorophyllin PANAFIL Non-Preferred 3 trypsin/balsam peru/castor oil GRANULEX Non-Preferred 3 trypsin/balsam peru/castor oil TBC Non-Preferred 3 trypsin/balsam peru/castor oil XENADERM Non-Preferred Sulfonamides– Topical 3 na sulfacetm/avobenzone/sulfur ROSAC Non-Preferred 1 silver sulfadiazine SILVADENE Generic 3 sulfacetamide sodium/sulfur AVAR Non-Preferred 1 sulfacetamide sodium/sulfur PLEXION Generic 3 sulfacetamide sodium/sulfur PLEXION SCT Non-Preferred 1 sulfacetamide sodium/sulfur ROSULA Generic Wound Care Agents 2 becaplermin REGRANEX Preferred Brand 3 collagenase SANTYL Non-Preferred 3 papain/urea/chlorophyllin PANAFIL Non-Preferred 3 trypsin/balsam peru/castor oil GRANULEX Non-Preferred 3 trypsin/balsam peru/castor oil XENADERM Non-Preferred

Deterrants/ Replacements Alcohol Deterrants 3 acamprosate calcium CAMPRAL Non-Preferred 1 disulfiram ANTABUSE 250 MG Generic

Enzyme Replacements/ Modifiers 3 amylase/lipase/protease CREON Non-Preferred 2 amylase/lipase/protease ZENPEP Preferred Brand 2 pancrelipase PANCREAZE Preferred Brand

Gastrointestinal Agents Antispasmodics, Gastrointestinal

1 atropine sulfate ATROPINE SULFATE Generic






Status 1 clidinium br/chlordiazepoxide LIBRAX Generic 1 dicyclomine hcl BENTYL Generic 1 ergotamine tart/bellad alk/pb BELLERGAL-S Generic 1 glycopyrrolate ROBINUL Generic 1 glycopyrrolate ROBINUL FORTE Generic 3 hyoscyamine CYSTOSPAZ Non-Preferred 3 hyoscyamine sulfate ANASPAZ Non-Preferred 1 hyoscyamine sulfate LEVBID Generic 1 hyoscyamine sulfate LEVSIN Generic 3 hyoscyamine sulfate LEVSIN-SL Non-Preferred 1 hyoscyamine sulfate NULEV Generic 1 hyoscyamine sulfate SYMAX Generic 3 hyoscyamine sulfate SYMAX DUOTAB Non-Preferred 1 phenobarb/hyoscy/atropine/scop DONNATAL Generic 1 propantheline bromide PRO-BANTHINE Generic 1 scopolamine methylbromide PAMINE Generic 1 scopolamine methylbromide PAMINE FORTE Generic

H. Pylori Agents 3 bismuth sal/metronid/tetracyc HELIDAC Non-Preferred 3 lansoprazole/amox tr/clarith PREVPAC Non-Preferred

H2 Blocking Agents 1 cimetidine TAGAMET Generic

1 nizatidine AXID Generic Only 75 mg/5 ml syrup

1 ranitidine hcl ZANTAC Generic

Irritable Bowel Syndrome 3 alosetron hcl LOTRONEX Non-Preferred Protectants 1 misoprostol CYTOTEC Generic 1 sucralfate CARAFATE Generic Gastrointestinal Agents, Other

3 bisac/nacl/nahco3/kcl/peg 3350 HALFLYTELY Non-Preferred 3 difenoxin hcl/atropine sulfate MOTOFEN Non-Preferred 1 diphenoxylate hcl/atrop sulf LOMOTIL Generic 3 lactulose CHRONULAC Non-Preferred 1 lactulose ENULOSE Generic 3 lactulose KRISTALOSE Non-Preferred 3 lubiprostone AMITIZA Non-Preferred 3 na phos mono&dibasic/cellulose OSMOPREP Non-Preferred 3 na phos mono&dibasic/cellulose VISICOL Non-Preferred






Status 1 paregoric PAREGORIC Generic 1 peg 3350/na sulf,bicarb,cl/kcl COLYTE Generic 1 peg 3350/na sulf,bicarb,cl/kcl GOLYTELY Generic 3 peg3350/sod sul/nacl/asb/c/kcl MOVIPREP Non-Preferred 1 sod chloride/nahco3/kcl/peg’s NULYTELY Generic 1 ursodiol ACTIGALL Generic 1 ursodiol URSO Generic 1 ursodiol URSO FORTE Generic

Genitourinary Agents Antispasmodic, Urinary

3 darifenacin hydrobromide ENABLEX Non-Preferred 1 flavoxate hcl URISPAS Generic 1 oxybutynin chloride DITROPAN Generic 1 oxybutynin chloride extended-release DITROPAN XL Generic 2 oxybutynin chloride transdermal OXYTROL Preferred Brand 3 solifenacin succinate VESICARE Non-Preferred 3 tolterodine tartrate DETROL Non-Preferred 3 tolterodine tartrate extended-release DETROL LA Non-Preferred 1 trospium chloride SANCTURA Generic 3 trospium chloride extended-release SANCTURA XR Non-Preferred

Benign Prostatic Hypertrophy 1 alfuzosin hcl UROXATRAL Generic

3 dutasteride AVODART Non-Preferred 1 finasteride PROSCAR Generic 1 tamsulosin hcl FLOMAX Generic

Parasympathomimetics 1 bethanechol chloride URECHOLINE Generic 3 cevimeline hcl EVOXAC Non-Preferred 1 pilocarpine hcl SALAGEN Generic Phosphate Binders 2 calcium acetate ELIPHOS Preferred Brand 2 calcium acetate PHOSLO Preferred Brand 2 calcium acetate PHOSLYRA Preferred Brand 3 lanthanum carbonate FOSRENOL Non-Preferred 2 sevelamer carbonate RENVELA Preferred Brand 3 sevelamer hcl RENAGEL Non-Preferred Urinary Ph Modifiers 3 citric acid/g-lactone/mag carb RENACIDIN Non-Preferred 1 citric acid/potassium citrate POLYCITRA-K Generic 3 citric acid/sodium citrate BICITRA Non-Preferred 3 phosphorus #1 URO-KP-NEUTRAL Non-Preferred






Status 1 potassium citrate UROCIT-K Generic 2 potassium phosphate PHOSPHA Preferred Brand 3 potassium phosphate,monobasic K-PHOS NEUTRAL Non-Preferred 2 potassium phosphate,monobasic K-PHOS ORIGINAL Preferred Brand 1 sod/potass/k cit/sodium cit/ca POLYCITRA Generic Urinary Tract Analgesic 2 pentosan polysulfate sodium ELMIRON Preferred Brand

Hormonal Agents, Stimulant/ Replacement/ Modifying – Adrenal Glucocorticoids 1 budesonide ENTOCORT EC Generic 1 cortisone acetate CORTONE ACETATE Generic 1 dexamethasone DECADRON Generic 1 hydrocortisone CORTEF Generic 3 hydrocortisone sod succinate SOLU-CORTEF Non-Preferred 1 methylprednisolone MEDROL Generic 1 methylprednisolone sod succ SOLU-MEDROL Generic 2 mitotane LYSODREN Preferred Brand 1 prednisolone PRELONE Generic 1 prednisolone acetate PREDNISOLONE Generic 1 prednisolone sod phosphate ORAPRED Generic 3 prednisolone sod phosphate ORAPRED ODT Non-Preferred 1 prednisolone sod phosphate PEDIAPRED Generic 1 prednisone PREDNISONE Generic 1 triamcinolone acetonide KENALOG-40 Generic Mineralocorticoids 1 fludrocortisone acetate FLORINEF ACETATE Generic

Hormonal Agents, Stimulant/ Replacement/ Modifying – Parathyroid Metabolic Bone Disease

Bisphosphonates 1 alendronate sodium FOSAMAX Generic 3 alendronate sodium/vitamin d3 FOSAMAX PLUS D Non-Preferred 1 etidronate disodium DIDRONEL Generic 1 ibandronate sodium BONIVA Generic 1 pamidronate AREDIA Generic

3 risedronate sod/calcium carbonate ACTONEL WITH CALCIUM Non-Preferred

3 risedronate sodium ACTONEL Non-Preferred Calcium Regulating Hormones 1 calcitonin,salmon,synthetic FORTICAL Generic 1 calcitonin,salmon,synthetic MIACALCIN Generic Parathyroid Hormone Analogs






Status 3 teriparatide FORTEO Non-Preferred Vitamin D Related/ Metabolic Bone Disease Agents 3 doxercalciferol HECTOROL Non-Preferred 3 paricalcitol ZEMPLAR Non-Preferred

Hormonal Agents, Stimulant/ Replacement/ Modifying – Pituitary QRM 3 corticotropin ACTHAR Non-Preferred

1 desmopressin (nonrefrigerated) DDAVP Generic 3 desmopressin acetate STIMATE Non-Preferred

Hormonal Agents, Stimulant/ Replacement/ Modifying – Prostaglandins

1 alprostadil PROSTIN VR PEDIATRIC Generic

Hormonal Agents, Stimulant/ Replacement/ Modifying – Sex Hormone Modifiers Androgens/ Anabolic Steroids 1 danazol DANOCRINE Generic 1 fluoxymesterone HALOTESTIN Generic 2 methyltestosterone ANDROID 10 Preferred Brand 3 methyltestosterone METHITEST Non-Preferred 2 methyltestosterone TESTRED Preferred Brand 1 oxandrolone OXANDRIN Generic 2 testosterone ANDRODERM Preferred Brand 3 testosterone ANDROGEL Non-Preferred 3 testosterone TESTIM Non-Preferred

1 testosterone cypionate DEPO-TESTOSTERONE Generic

1 testosterone enanthate DELATESTRYL Generic 3 testosterone gel FORTESTA Non-Preferred Estrogens 1 estradiol ESTRACE TAB Generic 1 estradiol GYNODIOL Generic 3 estradiol acetate FEMTRACE Non-Preferred 3 estradiol acetate vaginal tablets FEMRING Non-Preferred 3 estradiol emulsion ESTRASORB Non-Preferred 3 estradiol gel ESTROGEL Non-Preferred 1 estradiol transdemal CLIMARA DIS Generic 3 estradiol transdermal ALORA Non-Preferred 3 estradiol transdermal ESTRADERM Non-Preferred 3 estradiol transdermal MENOSTAR Non-Preferred 3 estradiol transdermal VIVELLE-DOT Non-Preferred 1 estradiol vaginal ESTRACE CREAM Generic 2 estradiol vaginal ring ESTRING Preferred Brand

Only 10mg 2 estradiol vaginal tablets VAGIFEM Preferred Brand






Status strength All other strengths

3 estradiol vaginal tablets VAGIFEM Non-Preferred

3 estradiol/levonorgestrel CLIMARA PRO Non-Preferred 1 estradiol/noreth ac ACTIVELLA Generic 3 estradiol/noreth ac transdermal COMBIPATCH Non-Preferred 3 estradiol/norgestimate PREFEST Non-Preferred 3 estrogen,con/m-progest acet PREMPHASE Non-Preferred 3 estrogen,con/m-progest acet PREMPRO Non-Preferred 3 estrogens,conj.,synthetic a CENESTIN Non-Preferred 3 estrogens,conj.,synthetic b ENJUVIA Non-Preferred 3 estrogens,conjugated PREMARIN TAB Non-Preferred

2 estrogens,conjugated vaginal PREMARIN VAGINAL CREAM Preferred Brand

3 estrogens,esterified MENEST Non-Preferred 1 estropipate OGEN Generic 3 ethinyl estradiol/noreth ac FEMHRT Non-Preferred Estrogens/Androgen Combinations 1 estrogen,ester/me-testosterone ESTRATEST Generic Progestins 2 etonogestrel NEXPLANON Preferred Brand 2 levonorgestrel MIRENA Preferred Brand 1 medroxyprogesterone acet PROVERA Generic 1 megestrol acetate MEGACE Generic 1 norethindrone acetate AYGESTIN Generic

3 progesterone PROGESTERONE IN OIL

Non-Preferred

3 progesterone,micronized PROCHIEVE Non-Preferred 3 progesterone,micronized PROMETRIUM Non-Preferred Selective Estrogen Receptor Modifying Agents 2 raloxifene hcl EVISTA Preferred Brand

Hormonal Agents, Stimulant/ Replacement/ Modifying – Thyroid 1 levothyroxine sodium LEVOTHROID Generic 1 levothyroxine sodium LEVOXYL Generic 1 levothyroxine sodium SYNTHROID Generic 1 levothyroxine sodium UNITHROID Generic 1 liothyronine sodium CYTOMEL Generic 3 liotrix THYROLAR Non-Preferred 3 thyroid ARMOUR THYROID Non-Preferred 3 thyroid,pork THYROID,PORK Non-Preferred

Hormonal Agents Suppressants – Parathyroid






Status 2 cinacalcet hcl SENSIPAR Preferred Brand

Hormonal Agents Suppressants – Pituitary Dopamine Agonists 1 bromocriptine mesylate CYCLOSET Generic 1 cabergoline DOSTINEX Generic Gonadotropin Releasing Hormone Analogs 3 goserelin acetate ZOLADEX Non-Preferred 1 leuprolide acetate LUPRON Generic 3 leuprolide acetate LUPRON DEPOT Non-Preferred 3 leuprolide acetate LUPRON DEPOT-PED Non-Preferred 2 nafarelin SYNAREL Preferred Brand Somatostatin Analogs 1 octreotide acetate SANDOSTATIN Generic 3 octreotide acetate SANDOSTATIN LAR Non-Preferred

Hormonal Agents Suppressants – Thyroid 1 methimazole TAPAZOLE Generic 1 propylthiouracil PROPYLTHIOURACIL Generic

Endocrine-Metabolic Agents QRM 3 somatropin GENTROPIN Non-Preferred QRM 3 somatropin HUMATROPE Non-Preferred QRM 3 somatropin NORDITROPIN Non-Preferred QRM 3 somatropin NUTROPIN AQ Non-Preferred QRM 3 somatropin OMNITROPE Non-Preferred QRM 3 somatropin SAIZEN Non-Preferred QRM 3 somatropin SEROSTIM Non-Preferred QRM 3 somatropin ZORBTIVE Non-Preferred

Immunological Agents Immune Suppressants – Non-TNF Inhibitors 3 azathioprine AZASAN Non-Preferred 1 azathioprine IMURAN Generic 1 cyclosporine SANDIMMUNE Generic 1 cyclosporine, modified NEORAL Generic

QRM 3 fingolimod GILENYA Non-Preferred 1 mycophenolate mofetil CELLCEPT Generic 2 mycophenolate sodium MYFORTIC Preferred Brand 2 penicillamine CUPRIMINE Preferred Brand 2 penicillamine DEPEN Preferred Brand 2 sirolimus RAPAMUNE Preferred Brand 1 tacrolimus anhydrous PROGRAF Generic Immune Suppressants – TNF Inhibitors 2 adalimumab HUMIRA Preferred Brand






Status 2 etanercept ENBREL Preferred Brand Immunomodulators – Interferons, Beta 2 interferon beta-1a AVONEX Preferred Brand 2 interferon beta-1a REBIF Preferred Brand

3 interferon beta-1a/albumin AVONEX ADMINISTRATION PACK

Non-Preferred

3 interferon beta-1b BETASERON Non-Preferred 2 Interferon beta-1b EXTAVIA Preferred Brand 2 interferon gamma-1b ACTIMMUNE Preferred Brand Immunomodulators – Other 2 auranofin RIDAURA Preferred Brand 2 glatiramer acetate COPAXONE Preferred Brand 1 leflunomide ARAVA Generic

QRM 3 omalizumab XOLAIR Non-Preferred 2 thalidomide THALOMID Preferred Brand

Inflammatory Bowel Disease Agents Salicylates 1 balsalazide disodium COLAZAL Generic 2 mesalamine controlled-release PENTASA Preferred Brand 2 mesalamine delayed-release ASACOL Preferred Brand 2 mesalamine suppository CANASA Preferred Brand 1 mesalamine suspension ROWASA Generic 3 mesalamine tablet LIALDA Non-Preferred 3 olsalazine sodium DIPENTUM Non-Preferred Sulfonamides 1 sulfasalazine AZULFIDINE Generic

Miscellaneous Agents QRM 3 dalfampridine AMPYRA Non-Preferred QL 1 epinephrine ADRENACLICK Generic QL 3 epinephrine EPIPEN Non-Preferred QL 3 epinephrine EPIPEN JR Non-Preferred QL 3 epinephrine TWINJECT Non-Preferred

QRM 3 icatibant FIRAZYR Non-Preferred QRM 3 ivacaftor KALYDECO Non-Preferred

3 urine acetone test, strips KETOCARE Non-Preferred 3 urine acetone test, strips KETOSTIX Non-Preferred 3 urine acetone test, strips KETOSTIX REAGENT Non-Preferred

3 urine gluc-acet comb. test, strip KETO-DIASTIX REAGENT

Non-Preferred

Ophthalmic Agents






Status Anesthetics 1 proparacaine hcl OPTHETIC Generic 3 tetracaine hcl PONTOCAINE Non-Preferred Anti-allergy Agents 3 aflcaftadine LASTACAFT Non-Preferred 1 azelastine hcl OPTIVAR Generic 1 cromolyn sodium OPTICROM Generic 3 epinastine hcl ELESTAT Non-Preferred 3 lodoxamide tromethamine ALOMIDE Non-Preferred 3 nedocromil sodium ALOCRIL Non-Preferred 3 olopatadine hcl PATADAY Non-Preferred 3 olopatadine hcl PATANOL Non-Preferred 3 pemirolast potassium ALAMAST Non-Preferred Antibiotics 1 bacitracin AK-TRACIN Generic 1 bacitracin/polymyxin b sulfate POLYSPORIN Generic 3 ciprofloxacin (ophthalmic ointment) CILOXAN Non-Preferred 1 ciprofloxacin (ophthalmic solution) CILOXAN Generic 1 erythromycin base ROMYCIN Generic 2 gatifloxacin ZYMAR Preferred Brand 2 gatifloxacin ZYMAXID Preferred Brand 1 gentamicin sulfate GARAMYCIN Generic 1 levofloxacin QUIXIN Generic 3 moxifloxacin hcl VIGAMOX Non-Preferred 1 neomycin/bacitracin/polymyxin NEOSPORIN Generic 1 neomycin/polymyxn b/gramicidin NEOSPORIN Generic 1 ofloxacin OCUFLOX Generic 1 polymyxin b sulfate/tmp POLYTRIM Generic 2 tobramycin sulfate ointment TOBREX Preferred Brand 1 tobramycin sulfate solution TOBREX Generic Antibiotics/Corticosteroids 2 gentamicin/prednisol ac PRED-G Preferred Brand 1 neo/polymyx b sulf/dexameth MAXITROL Generic 1 neomy sulf/bacitrac zn/poly/hc CORTISPORIN Generic 1 neomy sulf/polymyx b sulf/hc CORTISPORIN Generic 2 tobramycin sulfate/dexameth oint TOBRADEX Preferred Brand 1 tobramycin sulfate/dexameth susp TOBRADEX Generic 3 tobramycin/lotepred etab ZYLET Non-Preferred Ophthalmic, Anti-Fungals 2 natamycin NATACYN Preferred Brand Anti-glaucoma Agents






Status 1 acetazolamide DIAMOX Generic 1 acetazolamide DIAMOX SEQUELS Generic 2 apraclonidine hcl IOPIDINE Preferred Brand 1 betaxolol hcl BETOPTIC Generic 2 betaxolol hcl BETOPTIC S Preferred Brand 1 brimonidine tartrate ALPHAGAN Generic 1 brimonidine tartrate ALPHAGAN P Generic 3 brinzolamide AZOPT Non-Preferred 2 carbachol ISOPTO CARBACHOL Preferred Brand 1 carteolol hcl OCUPRESS Generic 1 dorzolamide hcl TRUSOPT Generic

2 ecothiophate iodide PHOSPHOLINE IODIDE

Preferred Brand

1 levobunolol hcl BETAGAN Generic 1 methazolamide NEPTAZANE Generic 1 metipranolol OPTIPRANOLOL Generic 1 pilocarpine hcl ISOPTO CARPINE Generic 3 pilocarpine hcl PILOPINE HS Non-Preferred 3 timolol BETIMOL Non-Preferred 3 timolol maleate ISTALOL Non-Preferred 1 timolol maleate TIMOPTIC Generic 3 timolol maleate TIMOPTIC-XE Non-Preferred 1 timolol maleate/dorzolam hcl COSOPT Generic Anti-inflammatories 3 bromfenac sodium XIBROM Non-Preferred 1 dexamethasone ophthalmic solution DECADRON Generic 2 dexamethasone ophthalmic suspension MAXIDEX Preferred Brand 1 dexamethasone sod phosphate tab DECADRON Generic 1 diclofenac sodium VOLTAREN Generic 1 fluorometholone FML Generic 3 fluorometholone FML FORTE Non-Preferred 3 fluorometholone FML S.O.P. Non-Preferred 2 fluorometholone acetate FLAREX Preferred Brand 1 flurbiprofen sodium OCUFEN Generic 1 ketorolac tromethamine ACULAR Generic 1 ketorolac tromethamine ACULAR LS Generic 1 ketorolac tromethamine ACULAR PF Generic 3 loteprednol etabonate ALREX Non-Preferred 3 loteprednol etabonate LOTEMAX Non-Preferred 3 nepafenac NEVANAC Non-Preferred 1 prednisolone acetate OMNIPRED Generic






Status 1 prednisolone acetate PRED FORTE Generic 2 prednisolone acetate PRED MILD Preferred Brand 3 prednisolone sod phosphate INFLAMASE FORTE Non-Preferred 1 prednisolone sod phosphate PREDNISOL Generic 3 rimexolone VEXOL Non-Preferred Antivirals 1 trifluridine VIROPTIC Generic Mydriatics 1 atropine sulfate ISOPTO ATROPINE Generic 1 cyclopentolate hcl CYCLOGYL Generic

2 homatropine hbr ISOPTO HOMATROPINE Preferred Brand

2 scopolamine hydrobromide ISOPTO HYOSCINE Preferred Brand 1 tropicamide MYDRIACYL Generic Ophthalmic, Other 2 cyclosporine RESTASIS Preferred Brand 3 hydroxypropyl cellulose LACRISERT Non-Preferred Prostaglandins 3 bimatoprost LUMIGAN Non-Preferred 1 latanoprost XALATAN Generic 3 travoprost TRAVATAN Z Non-Preferred Sulfonamides 1 na sulfacetm/prednis sp VASOCIDIN Generic 2 na sulfacetm/prednisol ac BLEPHAMIDE Preferred Brand 1 sulfacetamide sodium BLEPH-10 Generic 1 sulfacetamide sodium SULFAC Generic Vasoconstrictors 1 naphazoline hcl ALBALON Generic 3 naphazoline hcl/phenir mal NAPHCON-A Non-Preferred 1 phenylephrine hcl MYDFRIN Generic

Otic (Ear) Agents Anti-inflammatories 1 acetic acid VOSOL Generic 1 acetic acid/aluminum acetate DOMEBORO Generic 1 acetic acid/hydrocortisone ACETASOL-HC Generic 1 acetic acid/hydrocortisone VOSOL HC Generic 2 ciprofloxacin hcl/dexamethasone CIPRODEX Preferred Brand 3 ciprofloxacin hcl/hydrocortisone CIPRO HC Non-Preferred 3 fluocinolone acetonide oil DERMOTIC Non-Preferred 1 hc/pramoxine/chloroxylenol ZOTO-HC Generic 2 neomy sulf/colist sul/hc/thonz CORTISPORIN-TC Preferred Brand






Status 1 neomy sulf/polymyx b sulf/hc CORTISPORIN Generic 3 neomy sulf/polymyx b sulf/hc OTICIN Non-Preferred 1 ofloxacin FLOXIN Generic Local Anesthetics 1 antipyrine/benzocaine/glycerin AURALGAN Generic 3 benzocaine AMERICAINE Non-Preferred 3 phenylephrine/antipyrine/benzocaine OTOGESIC Non-Preferred 3 pramoxine hcl/chloroxylenol PRAMOTIC Non-Preferred

Respiratory Tract Agents Antihistamines 1 azelastine hcl ASTELIN Generic 3 carbinoxamine maleate PALGIC Non-Preferred 1 hydroxyzine hcl ATARAX Generic 1 hydroxyzine pamoate VISTARIL Generic 1 promethazine hcl PHENERGAN Generic Antihistamines/Decongestants 3 pseudoephedrine hcl/acrivas SEMPREX-D Non-Preferred Antihistamine/Decongestants/Anticholinergic Combinations 3 p-ephed hcl/chlor-mal/bell alk RESPA A.R. Non-Preferred Antihistamine/Decongestant Combinations 1 phenylephrine hcl/prometh hcl PHENERGAN VC Generic 3 phenylephrine/chlor-tan RYNATAN Non-Preferred 3 phenylephrine/chlor-tan RYNATAN PEDIATRIC Non-Preferred 3 phenylephrine/pyril mal/cp POLY HIST FORTE Non-Preferred 3 phenylephrine/pyril mal/cp POLY HIST PD Non-Preferred Bronchodilators/Anticholinergic 1 ipratropium bromide ATROVENT Generic Antitussives/Antihistamines/Decongestants 3 p-ephed hcl/hydrocodone/bpm M-END Non-Preferred

1 phenylephrine hcl/cod/prometh PHENERGAN VC W/CODEINE Generic

Antitussive/Antihistamine 1 codeine/promethazine hcl PHENERGAN W/ CODE Generic 3 hydrocodone/chlorphen polis TUSSIONEX Non-Preferred Antitussive/Anticholinergic 1 hydrocodone bit/homatropine HYCODAN Generic Antitussive/Antihistamine/Decongestant 3 car-b-pen ta/ephed tan/pe/cp RYNATUSS Non-Preferred 3 dextromethorphan/pe/bromphenir LORTUSS DM Non-Preferred 3 d-methorp tan/p-epd tan/cp DICEL DM Non-Preferred 3 d-methorphan hb/pe/d-bp TUSSALL-ER Non-Preferred






Status 3 d-methorphan hb/p-ephed hcl/cp M-END DM Non-Preferred Antitussive/Antihistamine 3 d-methorphan hb/prometh hcl PROMETHAZINE-DM Non-Preferred Anti-leukotrienes 1 montelukast sodium SINGULAIR Generic 3 zafirlukast ACCOLATE Non-Preferred 3 zileuton ZYFLO Non-Preferred Bronchodilators/Anticholinergic 1 ipratropium bromide ATROVENT Generic 2 ipratropium bromide ATROVENT HFA Preferred Brand 2 tiotropium SPIRIVA Preferred Brand Bronchodilators/Anti-inflammatory 2 beclomethasone dipropionate QVAR Preferred Brand 3 budesonide PULMICORT

FLEXHALER Non-Preferred

1 budesonide PULMICORT RESPULES 0.25 MG & 0.5 MG

Generic

2 budesonide PULMICORT RESPULES 1 MG Preferred Brand

3 flunisolide AEROBID Non-Preferred 3 flunisolide/menthol AEROBID-M Non-Preferred 3 fluticasone propionate FLOVENT DISKUS

AER Non-Preferred

2 fluticasone propionate FLOVENT HFA 44 MCG

Preferred Brand

3 fluticasone propionate FLOVENT HFA 110 MCG & 220 MCG Non-Preferred

2 mometasone furoate ASMANEX Preferred Brand 3 triamcinolone acetonide AZMACORT Non-Preferred Bronchodilators/Phosphodiesterase 2 inhibitors 1 aminophylline AMINOPHYLLINE Generic 1 theophylline anhydrous UNIPHYL Generic Bronchodilators/Phosphodiesterase 2 inhibitors/Expectorant 1 guaifenesin/dyphylline DYFLEX-G Generic Bronchodilators/Sympathomimetic 1 albuterol sulfate ACCUNEB Generic 2 albuterol sulfate PROAIR HFA Preferred Brand 3 albuterol sulfate PROVENTIL HFA Non-Preferred 3 albuterol sulfate VENTOLIN HFA Non- Preferred 1 albuterol sulfate VOSPIRE ER Generic






Status 2 albuterol sulfate/ipratropium COMBIVENT Preferred Brand

2 albuterol sulfate/ipratropium COMBIVENT RESPIMAT Preferred Brand

1 albuterol sulfate/ipratropium DUONEB Generic 1 epinephrine EPINEPHRINE Generic 3 formoterol fumarate FORADIL Non-Preferred

1 levalbuterol hcl XOPENEX NEBULIZER Generic

3 levalbuterol tartrate XOPENEX HFA Non-Preferred 3 pirbuterol acetate MAXAIR AUTOHALER Non-Preferred 2 salmeterol xinafoate SEREVENT DISKUS Preferred Brand 1 terbutaline sulfate BRETHINE Generic Beta-Adrenergic/Glucocorticoid Combination 3 fluticasone/salmeterol ADVAIR DISKUS Non-Preferred 3 mometasone/formoterol DULERA Non-Preferred Mast Cell Stabilizers 3 cromolyn sodium GASTROCROM Non-Preferred 1 cromolyn sodium INTAL Generic Nasal Anti-inflammatorySteroids 3 beclomethasone dipropionate BECONASE AQ Non-Preferred 3 budesonide RHINOCORT AQUA Non-Preferred 1 flunisolide NASAREL Generic 1 fluticasone propionate FLONASE Generic 3 mometasone furoate NASONEX Non-Preferred 3 triamcinolone acetonide NASACORT AQ Non-Preferred Respiratory Aids/Devices 2 inhaler, assist devices AEROCHAMBER Preferred Brand 3 inhaler, assist devices EASIVENT Non-Preferred 3 inhaler, assist devices MICROCHAMBER Non-Preferred 3 inhaler, assist devices OPTICHAMBER Non-Preferred 3 inhaler, assist devices VORTEX Non-Preferred Respiratory Tract Agents, Other 1 acetylcysteine MUCOMYST-10 Generic 1 benzonatate TESSALON PERLE Generic 2 dornase alfa PULMOZYME Preferred Brand 3 roflumilast DALIRESP Non-Preferred 3 sildenafil citrate REVATIO Non-Preferred 3 tetrahydrozoline hcl TYZINE Non-Preferred

Sedatives/Hypnotics 1 estazolam PROSOM Generic 3 eszopiclone LUNESTA Non-Preferred






Status 1 flurazepam hcl DALMANE Generic 1 lorazepam ATIVAN Generic 1 midazolam hcl VERSED Generic 3 ramelteon ROZEREM Non-Preferred 1 temazepam RESTORIL Generic 1 triazolam HALCION Generic 1 zaleplon SONATA Generic 3 zolipdem sublingual EDLUAR Non-Preferred 3 zolpidem oral spray ZOLPIMIST Non-Preferred 1 zolpidem tartrate AMBIEN Generic 1 zolpidem tartrate AMBIEN CR Generic

Skeletal Muscle Relaxants 1 baclofen LIORESAL Generic 1 carisoprodol SOMA Generic 1 carisoprodol/aspirin SOMA COMPOUND Generic

1 chlorzoxazone PARAFON FORTE DSC Generic

3 cyclobenzaprine extended-release AMRIX Non-Preferred 1 cyclobenzaprine hcl FLEXERIL Generic 1 dantrolene sodium DANTRIUM Generic 1 metaxalone SKELAXIN Generic 1 methocarbamol ROBAXIN Generic 1 orphenadrine citrate NORFLEX Generic 1 orphenadrine/aspirin/caffeine NORGESIC FORTE Generic 1 tizanidine hcl ZANAFLEX Generic Fluoride Preparations 3 sodium fluoride FLUORITAB Non-Preferred 3 sodium fluoride FLURA-TAB Non-Preferred 3 sodium fluoride LUDENT FLUORIDE Non-Preferred 1 sodium fluoride LURIDE Generic 1 sodium fluoride PREVIDENT Generic

1 sodium fluoride PREVIDENT 5000 PLUS

Generic

3 sodium fluoride/pot nitrate PREVIDENT 5000 SENSITIVE Non-Preferred

1 stannous fluoride GEL-KAM Generic Pediatric Vitamins 1 fluoride ion/iron/vit a,c&d TRI-VI-FLOR W/IRON Generic 1 fluoride ion/multivitamins POLY-VI-FLOR Generic

1 fluoride ion/multivits w-fe POLY-VI-FLOR W/IRON

Generic






Status 3 fluoride ion/vit a,c&d FLUORABON BASIC Non-Preferred 1 fluoride ion/vit a,c&d TRI-VI-FLOR Generic Potassium Replacement 1 pot chloride/pot bicarb/cit ac K-LYTE/CL Generic 1 potassium bicarbonate/cit ac K-LYTE Generic 1 potassium chloride K-DUR Generic 1 potassium chloride K-TAB Generic 3 potassium chloride MICRO-K Non-Preferred 2 potassium chrloide powder KLOR-CON 20 MEQ Preferred Brand 1 potassium gluconate KAON Generic Vitamin D Preparations 1 calcitriol ROCALTROL Generic 1 ergocalciferol DRISDOL Generic

Kaiser Permanente of Georgia Multi Choice Formulary




Index of Drugs

8

8-MOP ..................................................................................... 32

A

abacavir sulfate ....................................................................... 15 abacavir sulfate/lamivudine .................................................. 15 abacavir/lamivudine/zidovudine .......................................... 16 ABILIFY .................................................................................... 15 abiraterone.............................................................................. 12 ABSTRAL ................................................................................... 5 acamprosate calcium ............................................................. 33 acarbose .................................................................................. 17 ACCOLATE ............................................................................. 45 ACCU-CHEK ........................................................................... 18 ACCU-CHEK TEST STRIPS .................................................... 18 ACCUNEB ............................................................................... 45 ACCUPRIL ............................................................................... 24 ACCURETIC ............................................................................ 24 ACCUTANE ............................................................................ 32 acebutolol hcl ......................................................................... 21 ACEON .................................................................................... 24 acetaminophen/codeine ......................................................... 4 ACETASOL-HC ....................................................................... 43 acetazolamide ........................................................................ 42 acetic acid ......................................................................... 31, 43 ACETIC ACID ......................................................................... 31 acetic acid/aluminum acetate .............................................. 43 acetic acid/hydrocortisone ................................................... 43 acetylcysteine ......................................................................... 46 ACHROMYCIN V ...................................................................... 8 acitretin .................................................................................... 31 ACLARO .................................................................................. 31 ACLOVATE ............................................................................. 29 ACTIGALL ............................................................................... 35 ACTIMMUNE .......................................................................... 40 ACTIQ ........................................................................................ 5 ACTIVELLA .............................................................................. 38 ACTONEL ............................................................................... 36 ACTONEL WITH CALCIUM .................................................. 36 ACTOPLUS MET..................................................................... 18 ACTOS ..................................................................................... 18 ACULAR ................................................................................... 42 ACULAR LS ............................................................................. 42 ACULAR PF ............................................................................. 42 acyclovir ............................................................................. 15, 31 ACZONE ................................................................................. 28 ADALAT CC ............................................................................ 22

adalimumab ............................................................................ 39 adapalene ............................................................................... 32 ADCIRCA ................................................................................ 25 ADDERALL.............................................................................. 25 ADDERALL XR ........................................................................ 25 adefovir dipivoxil ................................................................... 16 ADOXA ..................................................................................... 8 ADRENACLICK ...................................................................... 40 ADVAIR DISKUS ..................................................................... 46 ADVICOR ................................................................................ 23 AEROBID ................................................................................ 45 AEROBID-M ........................................................................... 45 AEROCHAMBER .................................................................... 46 AFINITOR ............................................................................... 13 aflcaftadine ............................................................................. 41 AGGRENOX ........................................................................... 20 AGRYLIN ................................................................................. 20 AKNE-MYCIN ......................................................................... 28 AK-TRACIN ............................................................................. 41 ALAMAST ............................................................................... 41 ALA-TET .................................................................................... 8 ALBALON ............................................................................... 43 albendazole ............................................................................ 13 ALBENZA ................................................................................ 13 albuterol sulfate ............................................................... 45, 46 albuterol sulfate/ipratropium ............................................... 46 alclometasone dipropionate ................................................ 29 ALCORTIN .............................................................................. 28 ALDACTAZIDE ....................................................................... 22 ALDACTONE ......................................................................... 23 ALDARA ............................................................................ 13, 32 ALDOMET .............................................................................. 20 ALDORIL-25 ............................................................................ 20 alendronate sodium .............................................................. 36 alendronate sodium/vitamin d3 ........................................... 36 ALESSE-28 .............................................................................. 26 alfuzosin hcl ............................................................................ 35 ALINIA ..................................................................................... 30 aliskiren ................................................................................... 24 aliskiren, amlodipine and hydrochloro-thiazide................. 24 aliskiren/amlodipine .............................................................. 24 aliskiren/hydrochlorothiazide ............................................... 24 aliskiren/valsartan .................................................................. 24 ALKERAN ................................................................................ 13 ALL FLEX ................................................................................. 26 allopurinol ............................................................................... 12 almotriptan malate ................................................................ 12 ALOCRIL ................................................................................. 41 ALOMIDE ................................................................................ 41 ALORA .................................................................................... 37





alosetron hcl ........................................................................... 34 ALPHAGAN ............................................................................ 42 ALPHAGAN P ......................................................................... 42 alprazolam ............................................................................... 17 alprazolam extended-release ............................................... 17 alprostadil ............................................................................... 37 ALREX ...................................................................................... 42 ALTACE ................................................................................... 24 ALTOPREV .............................................................................. 23 aluminum chloride ................................................................. 31 amantadine hcl ....................................................................... 14 AMARYL .................................................................................. 18 AMBIEN ................................................................................... 47 AMBIEN CR ............................................................................. 47 amcinonide ............................................................................. 29 AMERGE.................................................................................. 12 AMERICAINE .......................................................................... 44 AMICAR ................................................................................... 20 amiloride hcl ........................................................................... 22 amiloride/hydrochlorothiazide ............................................. 22 aminocaproic acid .................................................................. 20 aminophylline ......................................................................... 45 AMINOPHYLLINE .................................................................. 45 amiodarone hcl ....................................................................... 21 AMITIZA .................................................................................. 34 amitrip hcl/chlordiazepoxide ................................................ 10 amitriptyline hcl ...................................................................... 10 amitriptyline hcl/perphenazine ............................................. 10 amlodipine besylate .............................................................. 22 amlodipine besylate/benazepril ........................................... 22 amlodipine/atorvast cal ......................................................... 22 ammonium lactate ................................................................. 31 amox tr/potassium clavulanate extended-release ............... 7 amoxapine .............................................................................. 10 amoxicillin ................................................................................. 2 amoxicillin trihydrate ............................................................... 7 amoxicllin/clavulanate potassium .......................................... 7 AMOXIL ..................................................................................... 7 amphet asp/amphet/d-amphet ........................................... 25 ampicillin sodium ..................................................................... 7 AMPICILLIN SODIUM .............................................................. 7 ampicillin trihydrate ................................................................. 7 AMPICILLIN TRIHYDRATE ...................................................... 7 AMPYRA .................................................................................. 40 AMRIX ...................................................................................... 47 AMTURNIDE ........................................................................... 24 amyl nitrite .............................................................................. 25 AMYL NITRITE ........................................................................ 25 amylase/lipase/protease ....................................................... 33 ANAFRANIL ............................................................................ 10 anagrelide hcl ......................................................................... 20

ANALPRAM HC ..................................................................... 31 ANAMANTLE HC .................................................................. 32 ANAPROX ................................................................................. 4 ANAPROX DS .......................................................................... 4 ANASPAZ ................................................................................ 34 anastrozole ............................................................................. 12 ANCOBON ............................................................................. 11 ANDRODERM ........................................................................ 37 ANDROGEL ............................................................................ 37 ANDROID 10 .......................................................................... 37 ANSAID ..................................................................................... 4 ANTABUSE 250 MG .............................................................. 33 anthralin .................................................................................. 31 Antibacterials ..................................................................... 6, 28 Anticonvulsants ........................................................................ 8 Antifungals ........................................................................ 11, 29 Antigout .................................................................................. 11 Antineoplastic Agents ........................................................... 12 Antiparasitics .................................................................... 13, 30 antipyrine/benzocaine/glycerin ........................................... 44 ANUSOL-HC........................................................................... 32 Anxiolytics ............................................................................... 17 ANZEMET ............................................................................... 11 APEXICON.............................................................................. 30 APEXICON E .......................................................................... 30 APIDRA ................................................................................... 19 apraclonidine hcl ................................................................... 42 aprepitant ............................................................................... 11 APRESAZIDE .......................................................................... 25 APRESOLINE .......................................................................... 25 APRI ......................................................................................... 26 APTIVUS .................................................................................. 16 ARALEN PHOSPHATE .......................................................... 14 ARANESP ................................................................................ 20 ARAVA ..................................................................................... 40 AREDIA ................................................................................... 36 ARICEPT .................................................................................... 9 ARICEPT ODT .......................................................................... 9 ARIMIDEX ............................................................................... 12 aripiprazole ............................................................................. 15 ARIXTRA .................................................................................. 19 armodafinil .............................................................................. 25 ARMOUR THYROID............................................................... 38 AROMASIN ............................................................................. 13 ARTANE .................................................................................. 14 ARTHROTEC ............................................................................ 4 ASACOL .................................................................................. 40 ASCENSIA BREEZE ............................................................... 19 ASCENSIA TEST STRIPS ....................................................... 18 ASENDIN ................................................................................ 10 ASMANEX .............................................................................. 45





aspirin/dipyridamole .............................................................. 20 ASTELIN .................................................................................. 44 ATACAND ............................................................................... 24 ATACAND HCT ...................................................................... 24 ATARAX ................................................................................... 44 atazanavir sulfate .................................................................... 16 atenolol.................................................................................... 21 atenolol/chlorthalidone ......................................................... 21 ATIVAN .............................................................................. 17, 47 atomoxetine hcl ...................................................................... 25 ATOPICLAIR ........................................................................... 31 atorvastatin calcium ............................................................... 23 atovaquone ............................................................................. 14 atovaquone/proguanil hcl ..................................................... 14 ATRIPLA ................................................................................... 15 atropine sulfate .......................................................... 33, 34, 43 ATROPINE SULFATE ............................................................. 33 ATROVENT ....................................................................... 44, 45 ATROVENT HFA .................................................................... 45 AUGMENTIN ............................................................................ 7 AUGMENTIN ES-600 ............................................................... 7 AUGMENTIN XR ...................................................................... 7 AURALGAN ............................................................................. 44 auranofin ................................................................................. 40 AVALIDE .................................................................................. 24 AVAPRO .................................................................................. 24 AVAR ........................................................................................ 33 AVC ............................................................................................ 8 AVELOX ..................................................................................... 8 AVENTYL SOL ........................................................................ 10 AVIANE .................................................................................... 26 AVINZA ...................................................................................... 5 AVLOSULFON ........................................................................ 12 AVODART ............................................................................... 35 AVONEX .................................................................................. 40 AVONEX ADMINISTRATION PACK .................................... 40 AXERT ...................................................................................... 12 AXID ......................................................................................... 34 AYGESTIN ............................................................................... 38 AZASAN .................................................................................. 39 azathioprine ............................................................................ 39 azelaic acid ........................................................................ 28, 33 azelastine hcl..................................................................... 41, 44 AZELEX .................................................................................... 28 AZILECT ................................................................................... 14 azilsartan medoxomil ............................................................. 24 azithromycin .............................................................................. 7 AZMACORT ............................................................................ 45 AZOPT ..................................................................................... 42 AZULFIDINE ............................................................................ 40

B

B & O SUPPRETTES NO.15-A ................................................ 5 B & O SUPPRETTES NO.16-A ................................................ 6 bacitracin ................................................................................ 41 bacitracin/polymyxin b sulfate ............................................. 41 baclofen .................................................................................. 47 BACTRIM DS ............................................................................ 8 BACTROBAN ..................................................................... 6, 29 BACTROBAN NASAL .............................................................. 6 balsalazide disodium ............................................................. 40 BANZEL ..................................................................................... 9 BARACLUDE .......................................................................... 16 BD INSULIN SYRINGE ........................................................... 19 becaplermin ........................................................................... 33 beclomethasone dipropionate ...................................... 45, 46 BECONASE AQ ..................................................................... 46 BELLERGAL-S ......................................................................... 34 benazepril hcl ......................................................................... 23 benazepril/hydrochlorothiazide ........................................... 23 BENEMID ................................................................................ 12 BENICAR ................................................................................. 24 BENICAR HCT ........................................................................ 24 BENOQUIN ............................................................................ 31 BENTYL ................................................................................... 34 BENZACLIN ............................................................................ 28 BENZAMYCIN ........................................................................ 29 BENZAMYCINPAK ................................................................. 29 benzocaine ....................................................................... 28, 44 benzonatate ........................................................................... 46 benzoyl peroxide microspheres .......................................... 32 benzoyl peroxide/urea .......................................................... 32 benztropine mesylate ............................................................ 14 BETAGAN ............................................................................... 42 betamet diprop/prop gly...................................................... 29 betamethasone dipropionate .............................................. 29 betamethasone valerate ....................................................... 29 BETAPACE.............................................................................. 21 BETAPACE AF ........................................................................ 21 BETASERON .......................................................................... 40 betaxolol hcl ..................................................................... 21, 42 bethanechol chloride ............................................................ 35 BETIMOL................................................................................. 42 BETOPTIC ............................................................................... 42 BETOPTIC S ........................................................................... 42 bexarotene ............................................................................. 12 BEYAZ ..................................................................................... 26 BIAFINE ................................................................................... 31 BIAXIN ....................................................................................... 7 BIAXIN XL ................................................................................. 7 bicalutamide ........................................................................... 12





BICITRA ................................................................................... 35 BIDIL ........................................................................................ 25 bimatoprost ............................................................................ 43 bisac/nacl/nahco3/kcl/peg 3350 .......................................... 34 bismuth sal/metronid/tetracyc ............................................. 34 bisoprol/hydrochlorothiazide ............................................... 21 bisoprolol fumarate ............................................................... 21 BLEPH-10................................................................................. 43 BLEPHAMIDE ......................................................................... 43 BLOCADREN .......................................................................... 21 blood sugar diagnostic ......................................................... 18 blood-glucose meter ....................................................... 18, 19 boceprevir ............................................................................... 15 BONIVA ................................................................................... 36 bosentan ................................................................................. 25 BRETHINE ............................................................................... 46 BREVICON .............................................................................. 27 BRILINTA ................................................................................. 20 brimonidine tartrate ............................................................... 42 brinzolamide ........................................................................... 42 bromfenac sodium ................................................................. 42 bromocriptine mesylate ........................................................ 39 budesonide ................................................................. 36, 45, 46 bumetanide ............................................................................. 22 BUMEX .................................................................................... 22 buprenorphine hcl ................................................................... 4 buprenorphine hcl/naloxone hcl ............................................ 4 buprenorphine transdermal .................................................... 4 bupropion extended-release................................................ 10 bupropion hcl ......................................................................... 10 bupropion sustained-release ................................................ 10 BUSPAR ................................................................................... 17 buspirone hcl .......................................................................... 17 busulfan ................................................................................... 12 butalb/acetaminophen/caffeine ............................................ 4 butalbital/acetaminophen ...................................................... 4 butalbital/aspirin/caffeine ....................................................... 4 butenafine hcl ......................................................................... 29 butoconazole nitrate .............................................................. 11 butorphanol tartrate ................................................................ 4 BUTRANS .................................................................................. 4 BYDUREON ............................................................................ 18 BYETTA.................................................................................... 18

C

cabergoline ............................................................................. 39 cadexomer iodine .................................................................. 28 CADUET .................................................................................. 22 CAFERGOT ............................................................................. 12 CAFERGOT P-B ...................................................................... 12

CALAN SR ............................................................................... 22 calcipotriene ........................................................................... 32 calcitonin,salmon,synthetic .................................................. 36 calcitriol ............................................................................. 32, 48 calcium acetate ...................................................................... 35 CAMPRAL ............................................................................... 33 CANASA ................................................................................. 40 candesartan cilexetil .............................................................. 24 candesartan/hydrochlorothiazide ........................................ 24 capecitabine ........................................................................... 12 CAPEX SHAMPOO ................................................................ 30 CAPOTEN ............................................................................... 23 CAPOZIDE .............................................................................. 23 CAPRELSA .............................................................................. 13 captopril .................................................................................. 23 captopril/hydrochlorothiazide ............................................. 23 CARAC .................................................................................... 30 CARAFATE ............................................................................. 34 carbachol ................................................................................ 42 carbamazepine ......................................................................... 8 carbamazepine extended-release ......................................... 8 CARBATROL............................................................................. 8 carbidopa ................................................................................ 14 carbidopa/levodopa .............................................................. 14 carbidopa/levodopa/entacapone ....................................... 14 carbinoxamine maleate ........................................................ 44 car-b-pen ta/ephed tan/pe/cp ............................................. 44 CARDENE ............................................................................... 22 CARDENE SR ......................................................................... 22 Cardiovascular Agents ............................................................ 1 CARDIZEM CD ....................................................................... 22 CARDIZEM LA ........................................................................ 22 CARDURA ............................................................................... 20 carisoprodol ....................................................................... 5, 47 carisoprodol/aspirin .............................................................. 47 CARMOL ........................................................................... 30, 32 CARMOL HC .......................................................................... 30 carteolol hcl ............................................................................ 42 carvedilol................................................................................. 21 carvedilol controlled-release ................................................ 21 CASODEX ............................................................................... 12 CATAFLAM ............................................................................... 4 CATAPRES .............................................................................. 20 CATAPRES-TTS ...................................................................... 20 CECLOR .................................................................................... 7 CEDAX ...................................................................................... 7 cefaclor ...................................................................................... 7 cefadroxil hydrate .................................................................... 7 cefdinir ...................................................................................... 7 cefditoren pivoxil ..................................................................... 7 cefixime ..................................................................................... 7





cefpodoxime proxetil .............................................................. 7 cefprozil ..................................................................................... 7 ceftibuten dihydrate ................................................................ 7 CEFTIN ...................................................................................... 7 cefuroxime axetil ...................................................................... 7 cefuroxime sodium .................................................................. 7 CEFZIL ....................................................................................... 7 CELEBREX ................................................................................. 4 celecoxib ................................................................................... 4 CELEXA ................................................................................... 10 CELLCEPT ............................................................................... 39 CENESTIN ............................................................................... 38 CENTANY ............................................................................... 29 cephalexin monohydrate ........................................................ 7 CETACAINE ............................................................................ 28 cevimeline hcl ......................................................................... 35 CHANTIX ................................................................................. 17 chlorambucil ........................................................................... 12 chlordiazepoxide hcl .............................................................. 17 chlorhexidine gluconate ........................................................ 28 chloroquine phosphate ......................................................... 14 chlorothiazide ......................................................................... 22 chlorpromazine hcl ................................................................. 14 chlorthalidone................................................................... 21, 22 chlorzoxazone ......................................................................... 47 cholestyramine/aspartame ................................................... 23 cholestyramine/sucrose ......................................................... 23 CHRONULAC ......................................................................... 34 CIBALITH-S ............................................................................. 17 ciclopirox ................................................................................. 29 ciclopirox olamine .................................................................. 29 cilostazol .................................................................................. 20 CILOXAN ................................................................................. 41 cimetidine ............................................................................... 34 cinacalcet hcl .......................................................................... 39 CIPRO .................................................................................. 8, 43 CIPRO HC ............................................................................... 43 CIPRO XR .................................................................................. 8 CIPRODEX .............................................................................. 43 ciprofloxacin ................................................................. 8, 41, 43 ciprofloxacin (ophthalmic ointment)l ................................... 41 ciprofloxacin (ophthalmic solution) ...................................... 41 ciprofloxacin hcl ................................................................. 8, 43 ciprofloxacin hcl/dexamethasone ........................................ 43 ciprofloxacin hcl/hydrocortisone .......................................... 43 ciprofloxacin hcl-betaine comb .............................................. 8 citalopram hydrobromide ..................................................... 10 citric acid/g-lactone/mag carb ............................................. 35 citric acid/potassium citrate .................................................. 35 citric acid/sodium citrate ....................................................... 35 clarithromycin ........................................................................... 7

clarithromycin extended release ........................................... 7 CLEOCIN ............................................................................ 6, 28 CLEOCIN HCL.......................................................................... 6 CLEOCIN PALMITATE ............................................................ 6 CLEOCIN T ......................................................................... 6, 28 clidinium br/chlordiazepoxide ............................................. 34 CLIMARA DIS ......................................................................... 37 CLIMARA PRO ....................................................................... 38 CLINDAGEL ............................................................................ 28 clindamycin hcl ......................................................................... 6 clindamycin palmitate ............................................................. 6 clindamycin phos/benzoyl perox ......................................... 28 clindamycin phosphate ..................................................... 6, 28 clindamycin/tretinoin............................................................. 28 CLINORIL .................................................................................. 4 clioquinol/hydrocortisone .................................................... 28 clobetasol propionate ........................................................... 29 clobetasol propionate/emoll ............................................... 29 CLOBEX .................................................................................. 29 clocortolone pivalate ............................................................. 29 CLODERM .............................................................................. 29 clomipramine hcl ................................................................... 10 clonazepam .............................................................................. 8 clonidine extended-release .................................................. 25 clonidine hcl ........................................................................... 20 clonidine hcl suspension ....................................................... 20 clonidine hcl transdermal ..................................................... 20 clopidogrel bisulfate ............................................................. 20 clorazepate dipotassium ....................................................... 17 clotrimazole ...................................................................... 11, 29 clotrimazole/betamet diprop ............................................... 29 clozapine ................................................................................. 15 CLOZARIL ............................................................................... 15 codeine phos/aspirin ............................................................... 5 codeine phos/carisoprodol/asa ............................................. 5 codeine sulf .............................................................................. 5 CODEINE SULF ........................................................................ 5 codeine/butalbit/acetamin/caff ............................................. 5 codeine/butalbital/asa/caffein ............................................... 5 codeine/promethazine hcl ................................................... 44 COGENTIN............................................................................. 14 COGNEX .................................................................................. 9 COLAZAL ................................................................................ 40 COL-BENEMID ...................................................................... 12 colchicine ................................................................................ 12 colchicine/probenecid .......................................................... 12 COLCRYS ................................................................................ 12 colesevelam hcl ...................................................................... 23 COLESTID ............................................................................... 23 colestipol hcl .......................................................................... 23 collagenase............................................................................. 33





COLYTE ................................................................................... 35 COMBIPATCH ........................................................................ 38 COMBIVENT ........................................................................... 46 COMBIVENT RESPIMAT ....................................................... 46 COMBIVIR ............................................................................... 16 COMBUNOX ............................................................................ 5 COMPAZINE ........................................................................... 11 COMTAN ................................................................................ 14 CONCERTA ............................................................................ 26 CONDYLOX ...................................................................... 31, 32 COPAXONE ............................................................................ 40 COPEGUS ............................................................................... 16 copper intrauterine ................................................................ 26 CORDARONE ......................................................................... 21 CORDRAN .............................................................................. 30 COREG .................................................................................... 21 COREG CR .............................................................................. 21 CORGARD .............................................................................. 21 CORTEF ................................................................................... 36 CORTENEMA ......................................................................... 32 CORTIFOAM .......................................................................... 32 cortisone acetate .................................................................... 36 CORTISPORIN ...................................................... 29, 41, 43, 44 CORTISPORIN-TC .................................................................. 43 CORTONE ACETATE ............................................................ 36 CORZIDE ................................................................................. 21 COSOPT .................................................................................. 42 COUMADIN ............................................................................ 19 COVERA-HS ............................................................................ 22 COZAAR .................................................................................. 24 CREON .................................................................................... 33 CRESTOR ................................................................................ 23 CRIXIVAN ................................................................................ 16 crizotinib .................................................................................. 12 cromolyn sodium .............................................................. 41, 46 crotamiton ............................................................................... 30 CRYSELLE ................................................................................ 27 CUPRIMINE ............................................................................. 39 CUTIVATE ............................................................................... 30 CYCLESSA ............................................................................... 26 cyclobenzaprine extended-release ...................................... 47 cyclobenzaprine hcl ............................................................... 47 CYCLOCORT .......................................................................... 29 CYCLOGYL ............................................................................. 43 cyclopentolate hcl .................................................................. 43 cyclophosphamide ................................................................. 12 CYCLOSET .............................................................................. 39 cyclosporine ...................................................................... 39, 43 cyclosporine, modified .......................................................... 39 CYMBALTA ............................................................................. 10 CYSTOSPAZ ............................................................................ 34

CYTOMEL ............................................................................... 38 CYTOTEC ............................................................................... 34 CYTOVENE ............................................................................. 15 CYTOXAN ............................................................................... 12

D

D.H.E.45 .................................................................................. 12 dabigatran .............................................................................. 19 dalfampridine ......................................................................... 40 DALIRESP ................................................................................ 46 DALMANE .............................................................................. 47 dalteparin sodium,porcine ................................................... 19 d-amphetamine sulfate ......................................................... 25 danazol .................................................................................... 37 DANOCRINE .......................................................................... 37 DANTRIUM ............................................................................. 47 dantrolene sodium ................................................................ 47 dapsone ............................................................................ 12, 28 DARAPRIM .............................................................................. 14 darbepoetin alfa .................................................................... 20 darifenacin hydrobromide .................................................... 35 darunavir ethanolate ............................................................. 16 dasatinib ................................................................................. 13 DAYPRO .................................................................................... 4 DAYTRANA ............................................................................ 26 DDAVP .................................................................................... 37 DECADRON ..................................................................... 36, 42 DECLOMYCIN ......................................................................... 8 deferasirox .............................................................................. 20 deferoxamine mesylate......................................................... 20 DELATESTRYL ........................................................................ 37 delavirdine mesylate ............................................................. 16 DEL-BETA ............................................................................... 29 DEMADEX .............................................................................. 23 demeclocycline hcl .................................................................. 8 DEMEROL ................................................................................. 5 DENAVIR ................................................................................. 31 DEPAKENE ............................................................................... 9 DEPAKOTE ............................................................................... 9 DEPAKOTE ER ......................................................................... 9 DEPAKOTE SPRINKLE ............................................................ 9 DEPEN .................................................................................... 39 DEPO-PROVERA .................................................................... 26 DEPO-SUBQ PROVERA 104 ................................................. 26 DEPO-TESTOSTERONE ....................................................... 37 DERMA-SMOOTHE/FS OIL ................................................. 30 DERMATOP ............................................................................ 30 DERMOTIC ............................................................................. 43 DESFERAL MESYLATE .......................................................... 20 desipramine hcl ...................................................................... 10





desmopressin (nonrefrigerated) ........................................... 37 desmopressin acetate ........................................................... 37 DESOGEN ............................................................................... 26 desogestrel-ethinyl estradiol ................................................ 26 desonide ................................................................................. 29 DESOWEN .............................................................................. 29 desoximetasone ..................................................................... 30 DESOXYN ............................................................................... 25 DESYREL ................................................................................. 10 DETROL ................................................................................... 35 DETROL LA ............................................................................. 35 dexamethasone .......................................................... 36, 42, 43 dexamethasone ophthalmic solution .................................. 42 dexamethasone ophthalmic suspension............................. 42 dexamethasone sod phosphate tab .................................... 42 DEXEDRINE ............................................................................ 25 dexmethylphenidate .............................................................. 25 dexmethylphenidate extended-release .............................. 25 dextromethorphan/pe/bromphenir ..................................... 44 dextromethorphan/quinidine ............................................... 25 DEXTROSTAT ......................................................................... 25 dhcodeine bt/acetaminophn/caff .......................................... 5 DIABETA ................................................................................. 18 DIAMOX .................................................................................. 42 DIAMOX SEQUELS ................................................................ 42 diaphragm ............................................................................... 26 DIASTAT .................................................................................... 8 DIASTAT ACUDIAL .................................................................. 8 diazepam ............................................................................. 8, 17 diazoxide ................................................................................. 17 DIBENZYLINE ......................................................................... 20 DICEL DM ............................................................................... 44 diclofenac ................................................................ 4, 30, 32, 42 diclofenac potassium ............................................................... 4 diclofenac sodium ........................................................ 4, 30, 42 diclofenac sodium extended release .................................... 4 diclofenac sodium/misoprostol .............................................. 4 dicloxacillin sodium ................................................................. 7 dicyclomine hcl ....................................................................... 34 didanosine .............................................................................. 16 didanosine solution ............................................................... 16 DIDRONEL .............................................................................. 36 difenoxin hcl/atropine sulfate ............................................... 34 DIFFERIN ................................................................................. 32 diflorasone diacetate ............................................................. 30 diflorasone diacetate/emollient ........................................... 30 DIFLUCAN .............................................................................. 11 diflunisal .................................................................................... 4 DIFLUNISAL .............................................................................. 4 digoxin ..................................................................................... 22 DIGOXIN ELIXIR ..................................................................... 22

digoxin solution ..................................................................... 22 dihydroergotamine mesylate ............................................... 12 DILANTIN ................................................................................. 9 DILANTIN-125 .......................................................................... 9 DILAUDID ................................................................................. 5 diltiazem hcl extended-release cap .................................... 22 diltiazem hcl extended-release tab ..................................... 22 DIOVAN .................................................................................. 24 DIOVAN HCT ......................................................................... 24 dioxybenzone/pdo/hydroquinone ...................................... 31 DIPENTUM ............................................................................. 40 diphenoxylate hcl/atrop sulf................................................. 34 DIPROLENE ............................................................................ 29 DIPROLENE AF ...................................................................... 29 DIPROSONE ........................................................................... 29 dipyridamole .......................................................................... 20 DISALCID .................................................................................. 4 disopyramide phosphate ...................................................... 21 disopyramide phosphate sustained-release ...................... 21 disulfiram ................................................................................ 33 DITROPAN.............................................................................. 35 DITROPAN XL ........................................................................ 35 DIURIL ..................................................................................... 22 divalproex sodium ................................................................... 9 divalproex sodium extended release .................................... 9 dl-e ac/grape/hyaluronic acid .............................................. 31 d-methorp tan/p-epd tan/cp ............................................... 44 d-methorphan hb/pe/d-bp .................................................. 44 d-methorphan hb/p-ephed hcl/cp ...................................... 45 d-methorphan hb/prometh hcl ............................................ 45 dofetilide................................................................................. 21 dolasetron mesylate .............................................................. 11 DOLOBID ................................................................................. 4 DOMEBORO .......................................................................... 43 donepezil hcl ............................................................................ 9 DONNATAL ........................................................................... 34 dornase alfa ............................................................................ 46 DORYX ...................................................................................... 8 dorzolamide hcl ..................................................................... 42 DOSTINEX .............................................................................. 39 DOVONEX .............................................................................. 32 doxazosin mesylate ............................................................... 20 doxepin hcl ....................................................................... 10, 31 doxercalciferol........................................................................ 37 doxycycline hyclate ............................................................ 8, 28 doxycycline monohydrate ...................................................... 8 DRISDOL ................................................................................. 48 DRITHOCREME HP ............................................................... 31 DRITHO-SCALP ..................................................................... 31 dronabinol .............................................................................. 11 DROXIA ................................................................................... 13





DRYSOL ................................................................................... 31 DUAC ....................................................................................... 28 DUETACT ................................................................................ 18 DULERA ................................................................................... 46 duloxetine hcl ......................................................................... 10 DUONEB ................................................................................. 46 DURABAC ................................................................................. 4 DURAGESIC .............................................................................. 5 DURICEF.................................................................................... 7 dutasteride .............................................................................. 35 DYAZIDE ................................................................................. 23 DYFLEX-G ............................................................................... 45 DYNACIN .................................................................................. 8 DYNACIRC .............................................................................. 22 DYNACIRC CR ........................................................................ 22 DYNAPEN ................................................................................. 7 DYRENIUM .............................................................................. 23

E

E.E.S. .......................................................................................... 7 EASIVENT ................................................................................ 46 econazole nitrate .................................................................... 29 ecothiophate iodide .............................................................. 42 EDARBI .................................................................................... 24 EDECRIN ................................................................................. 22 EDLUAR ................................................................................... 47 EDURANT ............................................................................... 16 efalizumab ............................................................................... 31 efavirenz ............................................................................ 15, 16 efavirenz/emtricitab/tenofovir .............................................. 15 EFFEXOR ................................................................................. 10 EFFEXOR ER ........................................................................... 10 EFUDEX ................................................................................... 30 ELAVIL ..................................................................................... 10 ELDEPRYL ............................................................................... 14 ELESTAT .................................................................................. 41 eletriptan hydrobromide ....................................................... 12 ELIDEL ..................................................................................... 32 ELIMITE ................................................................................... 31 ELIPHOS .................................................................................. 35 ELLA ......................................................................................... 27 ELMIRON ................................................................................ 36 ELOCON ................................................................................. 30 EMCYT ..................................................................................... 13 EMEND .................................................................................... 11 EMGEL ..................................................................................... 29 EMLA ....................................................................................... 28 emollient combination no. 3 ................................................. 31 emollient combination no.10 ................................................ 31 EMPIRIN W/CODEINE ............................................................ 5

EMSAM ................................................................................... 10 emtricitabine .......................................................................... 16 emtricitabine/tenofovir ......................................................... 16 EMTRIVA ................................................................................. 16 ENABLEX ................................................................................ 35 enalapril maleate ................................................................... 24 enalapril/hydrochlorothiazide .............................................. 24 ENBREL ................................................................................... 40 enfuvirtide ............................................................................... 15 ENJUVIA ................................................................................. 38 enoxaparin sodium ................................................................ 19 entacapone ............................................................................. 14 entecavir ................................................................................. 16 ENTOCORT EC ...................................................................... 36 ENULOSE................................................................................ 34 epinastine hcl ......................................................................... 41 epinephrine ...................................................................... 40, 46 EPINEPHRINE ........................................................................ 46 EPIPEN .................................................................................... 40 EPIPEN JR ............................................................................... 40 EPIVIR ...................................................................................... 16 EPIVIR HBV ............................................................................. 16 eplerenone ............................................................................. 22 epoetin alfa ............................................................................. 20 EPOGEN ................................................................................. 20 epoprostenol sodium ............................................................ 25 eprosartan mesylate .............................................................. 24 eprosartan/hydrochlorothiazide .......................................... 24 EPZICOM ................................................................................ 15 EQUETRO ................................................................................. 8 ergocalciferol ......................................................................... 48 ergoloid mesylates ................................................................ 25 ergot tt/caff/bell alk/p-barb ................................................. 12 ergotamine tart/bellad alk/pb ............................................. 34 ergotamine tartrate/caffeine ................................................ 12 erlotinib hcl ............................................................................. 13 ERTACZO................................................................................ 29 ery e-succ/sulfisoxazole .......................................................... 7 ERYC .......................................................................................... 7 ERYGEL ................................................................................... 28 ERYPED ..................................................................................... 7 ERY-TAB .................................................................................... 7 ERYTHROCIN STEARATE ....................................................... 7 ERYTHROMYCIN ..................................................................... 7 erythromycin base ................................................. 7, 28, 29, 41 erythromycin base/benz per ................................................ 29 erythromycin base/ethanol ................................................... 29 erythromycin ethylsuccinate ................................................... 7 erythromycin stearate.............................................................. 7 escitalopram oxalate ............................................................. 10 ESGIC PLUS .............................................................................. 4





estazolam ................................................................................ 46 ESTRACE CREAM .................................................................. 37 ESTRACE TAB ........................................................................ 37 ESTRADERM ........................................................................... 37 estradiol ................................................................. 26, 27, 37, 38 estradiol acetate ..................................................................... 37 estradiol acetate vaginal tablets .......................................... 37 estradiol emulsion .................................................................. 37 estradiol gel ............................................................................ 37 estradiol transdemal .............................................................. 37 estradiol transdermal ............................................................. 37 estradiol vaginal ............................................................... 37, 38 estradiol vaginal ring ............................................................. 37 estradiol vaginal tablets .................................................. 37, 38 estradiol valerate/dienogest ................................................. 26 estradiol/levonorgestrel .................................................. 26, 38 estradiol/noreth ac ................................................................. 38 estradiol/noreth ac transdermal ........................................... 38 estradiol/norgestimate .......................................................... 38 estramustine phos sodium .................................................... 13 ESTRASORB ............................................................................ 37 ESTRATEST ............................................................................. 38 ESTRING.................................................................................. 37 ESTROGEL .............................................................................. 37 estrogen,con/m-progest acet .............................................. 38 estrogen,ester/me-testosterone .......................................... 38 estrogens,conj.,synthetic a ................................................... 38 estrogens,conj.,synthetic b ................................................... 38 estrogens,conjugated............................................................ 38 estrogens,conjugated vaginal .............................................. 38 estrogens,esterified ............................................................... 38 estropipate .............................................................................. 38 ESTROSTEP FE ....................................................................... 27 eszopiclone ............................................................................. 46 etanercept ............................................................................... 40 ethacrynic acid ........................................................................ 22 ethambutol hcl ....................................................................... 12 ethinyl estradiol/drospirenone ............................................. 26 ethinyl estradiol/drospirenone/folate.................................. 26 ethinyl estradiol/levonorgestrel ........................................... 26 ethinyl estradiol/norelgest .................................................... 27 ethinyl estradiol/noreth ac .................................................... 38 ethosuximide ............................................................................ 9 ethyl chloride .......................................................................... 28 ETHYL CHLORIDE .................................................................. 28 ethynodiol d-ethinyl estradiol............................................... 26 etidronate disodium .............................................................. 36 etodolac .................................................................................... 4 etonogestrel ..................................................................... 26, 38 etonogestrel/ethinyl estradiol .............................................. 26 etravirine.................................................................................. 16

EULEXIN .................................................................................. 13 EURAX ..................................................................................... 30 everolimus .............................................................................. 13 EVISTA..................................................................................... 38 EVOCLIN ................................................................................. 28 EVOXAC.................................................................................. 35 EXELDERM ............................................................................. 29 EXELON .................................................................................... 9 exemestane ............................................................................ 13 exenatide ................................................................................ 18 exenatide extended-release ................................................ 18 EXJADE ................................................................................... 20 EXTAVIA .................................................................................. 40 ezetimibe ................................................................................ 23 ezetimibe/simvastatin ........................................................... 23

F

FACTIVE .................................................................................... 8 famciclovir ............................................................................... 15 FAMVIR ................................................................................... 15 FAZACLO ................................................................................ 15 felbamate .................................................................................. 9 FELBATOL ................................................................................ 9 FELDENE .................................................................................. 4 felodipine ................................................................................ 22 FEMARA .................................................................................. 13 FEMCON FE ........................................................................... 27 FEMHRT .................................................................................. 38 FEMRING ................................................................................ 37 FEMTRACE ............................................................................. 37 fenofibrate .............................................................................. 23 fenofibrate nanocrystallized ................................................. 23 fenofibrate,micronized .......................................................... 23 fenofibric acid ........................................................................ 23 fenoprofen calcium .................................................................. 4 fentanyl...................................................................................... 5 fentanyl citrate ......................................................................... 5 fentanyl sublingual................................................................... 5 FENTORA ................................................................................. 5 filgrastim ................................................................................. 19 FINACEA ................................................................................. 33 finasteride ............................................................................... 35 fingolimod .............................................................................. 39 FIORICET .............................................................................. 4, 5 FIORICET W/CODEINE .......................................................... 5 FIORINAL .............................................................................. 4, 5 FIORINAL W/CODEINE #3 ..................................................... 5 FIRAZYR .................................................................................. 40 FIRST-MOUTHWASH BLM ................................................... 28 FLAGYL ................................................................................... 13





FLAGYL ER .............................................................................. 13 FLAREX .................................................................................... 42 flavoxate hcl ............................................................................ 35 flecainide acetate ................................................................... 21 FLECTOR ................................................................................. 32 FLEXERIL ................................................................................. 47 FLOLAN ................................................................................... 25 FLOMAX .................................................................................. 35 FLONASE ................................................................................ 46 FLORINEF ACETATE ............................................................. 36 FLOVENT DISKUS AER ......................................................... 45 FLOVENT HFA ........................................................................ 45 FLOXIN ................................................................................ 8, 44 fluconazole .............................................................................. 11 flucytosine ............................................................................... 11 fludrocortisone acetate ......................................................... 36 FLUMADINE ........................................................................... 16 flunisolide .......................................................................... 45, 46 flunisolide/menthol ................................................................ 45 fluocinolone acetonide.................................................... 30, 43 fluocinolone acetonide oil .................................................... 43 fluocinonide ............................................................................ 30 fluocinonide/emollient .......................................................... 30 FLUORABON BASIC .............................................................. 48 fluoride ion/iron/vit a,c&d ..................................................... 47 fluoride ion/multivitamins ..................................................... 47 fluoride ion/multivits w-fe ..................................................... 47 fluoride ion/vit a,c&d ............................................................. 48 FLUORITAB ............................................................................. 47 fluorometholone .................................................................... 42 fluorometholone acetate ...................................................... 42 FLUOROPLEX ......................................................................... 30 fluorouracil .............................................................................. 30 fluoxetine hcl .................................................................... 10, 15 fluoxymesterone ..................................................................... 37 fluphenazine decanoate ........................................................ 14 fluphenazine hcl ..................................................................... 14 flurandrenolide ....................................................................... 30 FLURA-TAB ............................................................................. 47 flurazepam hcl ........................................................................ 47 flurbiprofen ......................................................................... 4, 42 flurbiprofen sodium ............................................................... 42 flutamide ................................................................................. 13 fluticasone propionate .............................................. 30, 45, 46 fluticasone/salmeterol ........................................................... 46 fluvastatin extended-release ................................................ 23 fluvastatin sodium .................................................................. 23 fluvoxamine maleate .............................................................. 10 FML .......................................................................................... 42 FML FORTE ............................................................................. 42 FML S.O.P. .............................................................................. 42

FOCALIN ................................................................................ 25 FOCALIN XR ........................................................................... 25 FOILLE PLUS .......................................................................... 28 fondaparinux sodium ............................................................ 19 FORADIL ................................................................................. 46 formoterol fumarate .............................................................. 46 FORTAMET............................................................................. 17 FORTEO .................................................................................. 37 FORTESTA .............................................................................. 37 FORTICAL ............................................................................... 36 FOSAMAX .............................................................................. 36 FOSAMAX PLUS D ................................................................ 36 fosamprenavir calcium .......................................................... 16 fosinopril sodium ................................................................... 24 fosinopril/hydrochlorothiazide ............................................. 24 FOSRENOL ............................................................................. 35 FRAGMIN................................................................................ 19 FREESTYLE SYSTEM ............................................................. 19 FREESTYLE TEST STRIPS ...................................................... 18 FROVA..................................................................................... 12 frovatriptan succinate ............................................................ 12 FULVICIN P/G ........................................................................ 11 FURADANTIN .......................................................................... 7 furosemide .............................................................................. 22 FUZEON .................................................................................. 15

G

gabapentin ............................................................................... 9 GABITRIL................................................................................... 9 galantamine hydrobromide .................................................... 9 ganciclovir ............................................................................... 15 GANTRISIN ............................................................................... 8 GARAMYCIN ................................................................ 6, 29, 41 GASTROCROM ...................................................................... 46 gatifloxacin ............................................................................. 41 gelatin sponge,absorbable .................................................. 20 GELFOAM .............................................................................. 20 GEL-KAM ................................................................................ 47 gemfibrozil .............................................................................. 23 gemifloxacin mesylate ............................................................ 8 gentamicin sulfate ....................................................... 6, 29, 41 gentamicin/prednisol ac ....................................................... 41 GENTROPIN ........................................................................... 39 GEODON ............................................................................... 15 GILENYA ................................................................................. 39 glatiramer acetate ................................................................. 40 GLEEVEC ................................................................................ 13 glimepiride ............................................................................. 18 glipizide................................................................................... 18 glipizide extended-release ................................................... 18





glipizide/metformin hcl ......................................................... 18 GLUCAGEN ............................................................................ 17 glucagon ................................................................................. 17 GLUCAGON ........................................................................... 17 glucagons,human recombinant ........................................... 17 GLUCOPHAGE ....................................................................... 17 GLUCOPHAGE XR ................................................................. 17 GLUCOTROL .......................................................................... 18 GLUCOTROL XL ..................................................................... 18 GLUCOVANCE ....................................................................... 18 GLUMETZA ............................................................................. 17 glyburide ................................................................................. 18 glyburide,micronized ............................................................. 18 glyburide/metformin hcl ....................................................... 18 glycopyrrolate ......................................................................... 34 GLYNASE ................................................................................ 18 GLYQUIN ................................................................................ 31 GLYQUIN XM ......................................................................... 31 GLYSET .................................................................................... 17 golimumab .............................................................................. 31 GOLYTELY .............................................................................. 35 goserelin acetate .................................................................... 39 granisetron hcl ........................................................................ 11 GRANULEX ............................................................................. 33 GRIFULVIN V ........................................................................... 11 griseofulvin ultramicrosize .................................................... 11 griseofulvin,microsize ............................................................ 11 GRIS-PEG ................................................................................ 11 guaifenesin/dyphylline .......................................................... 45 guanabenz acetate ................................................................ 20 guanfacine extended-release ............................................... 25 guanfacine hcl ........................................................................ 20 GYNAZOLE-1 .......................................................................... 11 GYNODIOL ............................................................................. 37

H

halcinonide.............................................................................. 30 HALCION ................................................................................ 47 HALDOL .................................................................................. 14 HALDOL DECANOATE 50.................................................... 14 HALFLYTELY ........................................................................... 34 halobetasol propionate ......................................................... 30 HALOG .................................................................................... 30 haloperidol .............................................................................. 14 haloperidol decanoate .......................................................... 14 HALOTESTIN .......................................................................... 37 hc acetate/lidocain hcl/alo v ................................................. 32 hc acetate/lidocaine hcl .................................................. 28, 32 hc acetate/pramoxine hcl ......................................... 28, 31, 32 hc/aloe polysacch/iodoquinol .............................................. 28

hc/pramoxine hcl/chloroxylenol .......................................... 43 HECTOROL ............................................................................ 37 HELIDAC ................................................................................. 34 HEPARIN SODIUM ................................................................ 20 heparin sodium,porcine ........................................................ 20 HEPSERA ................................................................................ 16 hexachlorophene ................................................................... 28 HIPREX ...................................................................................... 6 homatropine hbr .................................................................... 43 hum insulin nph/reg insulin hm ............................................ 19 HUMALOG ............................................................................. 19 HUMALOG MIX 50/50 ........................................................... 19 HUMALOG MIX 75/25 ........................................................... 19 HUMATIN ............................................................................... 13 HUMATROPE ......................................................................... 39 HUMIRA .................................................................................. 39 HUMULIN 50/50 ..................................................................... 19 HUMULIN 70/30 ..................................................................... 19 HUMULIN N ........................................................................... 19 HUMULIN R ............................................................................ 19 HYCAMTIN ............................................................................. 13 HYCET ....................................................................................... 5 HYCODAN.............................................................................. 44 HYDERGINE ........................................................................... 25 hydralazine hcl........................................................................ 25 hydralazine/hydrochlorothiazide ......................................... 25 HYDREA .................................................................................. 13 hydrochlorothiazide.................................. 20, 21, 22, 23, 24, 25 hydrocodone bit/acetaminophen ......................................... 5 hydrocodone bit/homatropine ............................................ 44 hydrocodone/chlorphen polis ............................................. 44 hydrocodone/ibuprofen ......................................................... 5 hydrocortisone ................................................28, 30, 32, 36, 43 hydrocortisone acetate ................................................... 30, 32 hydrocortisone acetate/urea ................................................ 30 hydrocortisone butyrate ....................................................... 30 hydrocortisone butyrate/emoll ............................................ 30 hydrocortisone probutate..................................................... 30 hydrocortisone sod succinate .............................................. 36 hydrocortisone valerate ........................................................ 30 hydrocortisone/benz per ...................................................... 30 hydrocortisone/iodoquinol................................................... 28 hydromorphone hcl ................................................................. 5 hydromorphone hcl oral suspension ..................................... 5 hydroquinone ......................................................................... 31 hydroquinone/avobenz/octinox .......................................... 31 hydroxychloroquine sulfate .................................................. 14 hydroxypropyl cellulose ........................................................ 43 hydroxyurea ............................................................................ 13 hydroxyzine hcl....................................................................... 44 hydroxyzine pamoate ............................................................ 44





HYGROTON ........................................................................... 22 hyoscyamine ........................................................................... 34 hyoscyamine sulfate ............................................................... 34 HYTONE .................................................................................. 30 HYTRIN .................................................................................... 20 HYZAAR ................................................................................... 24

I

ibandronate sodium .............................................................. 36 ibuprofen ............................................................................... 4, 5 ibuprofen/oxycodone hcl ........................................................ 5 icatibant ................................................................................... 40 imatinib mesylate ................................................................... 13 IMDUR ..................................................................................... 25 imipramine hcl ........................................................................ 10 imipramine pamoate ............................................................. 10 imiquimod ............................................................................... 32 IMITREX ................................................................................... 12 IMURAN .................................................................................. 39 INCIVEK ................................................................................... 15 indapamide ............................................................................. 22 INDERAL ................................................................................. 21 INDERAL LA ............................................................................ 21 INDERIDE-40/25 ..................................................................... 21 indinavir sulfate ...................................................................... 16 INDOCIN ................................................................................... 4 INDOCIN SR ............................................................................. 4 indomethacin ............................................................................ 4 INFERGEN .............................................................................. 16 INFLAMASE FORTE ............................................................... 43 inhaler, assist devices ............................................................ 46 INNOPRAN XL ........................................................................ 21 INSPRA .................................................................................... 22 insulin aspart ........................................................................... 19 insulin detemir ........................................................................ 19 insulin glargine,hum.rec.anlog ............................................. 19 insulin glulisine ....................................................................... 19 insulin lispro,human rec.anlog .............................................. 19 insulin nph human recom ...................................................... 19 insulin npl/insulin lispro ......................................................... 19 insulin regular human rec ...................................................... 19 insuln asp prt/insulin aspart .................................................. 19 INTAL ....................................................................................... 46 INTELENCE ............................................................................. 16 interferon alfa-2b,recomb. .................................................... 32 interferon alfacon-1 ................................................................ 16 interferon beta-1a .................................................................. 40 interferon beta-1a/albumin ................................................... 40 interferon beta-1b .................................................................. 40 Interferon beta-1b .................................................................. 40

interferon gamma-1b ............................................................ 40 INTRON A ............................................................................... 32 INTUNIV .................................................................................. 25 INVEGA ................................................................................... 15 INVIRASE ................................................................................ 16 iodoquinol ........................................................................ 13, 28 IODOSORB ............................................................................. 28 IOPIDINE ................................................................................ 42 ipratropium bromide ....................................................... 44, 45 irbesartan ................................................................................ 24 irbesartan/hydrochlorothiazide ............................................ 24 ISENTRESS ............................................................................. 15 isometheptene/acetaminoph/caff ....................................... 12 isoniazid .................................................................................. 12 ISOPTIN SR ............................................................................. 22 ISOPTO ATROPINE ............................................................... 43 ISOPTO CARBACHOL .......................................................... 42 ISOPTO CARPINE.................................................................. 42 ISOPTO HOMATROPINE ..................................................... 43 ISOPTO HYOSCINE .............................................................. 43 ISORDIL ................................................................................... 25 isosorb dinit/hydralazine hcl................................................. 25 isosorbide dinitrate ............................................................... 25 isosorbide mononitrate......................................................... 25 isotretinoin .............................................................................. 32 isoxsuprine hcl........................................................................ 25 isradipine ................................................................................ 22 ISTALOL .................................................................................. 42 itraconazole ............................................................................ 11 itraconazole (solution) ........................................................... 11 ivacaftor................................................................................... 40 ivermectin ............................................................................... 13

J

JANUMET ............................................................................... 18 JANUVIA ................................................................................. 18 JUNEL 1/20 ............................................................................. 27 JUVISYNC ............................................................................... 18

K

KADIAN ..................................................................................... 5 KALETRA ................................................................................. 16 KALYDECO ............................................................................. 40 KAON ...................................................................................... 48 KAPVAY ................................................................................... 25 KARIVA .................................................................................... 26 KAYEXALATE ......................................................................... 20 K-DUR ...................................................................................... 48





KEFLEX ...................................................................................... 7 KENALOG ................................................................... 28, 30, 36 KENALOG IN ORABASE ....................................................... 28 KENALOG-40 .......................................................................... 36 KEPPRA...................................................................................... 9 KEPPRA XR ................................................................................ 9 kera1/oxbn/avobnz/o-crl/h-quin .......................................... 31 KERLONE ................................................................................ 21 KETEK ........................................................................................ 7 KETOCARE ............................................................................. 40 ketoconazole .................................................................... 11, 29 KETO-DIASTIX REAGENT..................................................... 40 ketoprofen ................................................................................ 4 KETOPROFEN .......................................................................... 4 ketorolac tromethamine .................................................... 4, 42 KETOSTIX ................................................................................ 40 KETOSTIX REAGENT ............................................................ 40 KLARON .................................................................................. 28 KLONOPIN ............................................................................... 8 KLOR-CON ............................................................................. 48 K-LYTE ..................................................................................... 48 K-LYTE/CL ............................................................................... 48 KOMBIGLYZE XR ................................................................... 18 K-PHOS NEUTRAL ................................................................. 36 K-PHOS ORIGINAL ................................................................ 36 KRISTALOSE ........................................................................... 34 K-TAB ....................................................................................... 48 KURIC ....................................................................................... 29 KWELL ..................................................................................... 30 KYTRIL ...................................................................................... 11

L

labetalol hcl ............................................................................. 21 LAC-HYDRIN ........................................................................... 31 LACRISERT .............................................................................. 43 lactic acid ................................................................................ 31 LACTICARE-HC ...................................................................... 30 LACTINOL ............................................................................... 31 LACTINOL-E ........................................................................... 31 lactulose .................................................................................. 34 LAMICTAL ................................................................................. 9 LAMISIL ................................................................................... 11 lamivudine ......................................................................... 15, 16 lamivudine/zidovudine .......................................................... 16 lamotrigine ................................................................................ 9 LANOXICAPS ......................................................................... 22 LANOXIN ................................................................................ 22 lansoprazole/amox tr/clarith ................................................. 34 lanthanum carbonate............................................................. 35 LANTUS ................................................................................... 19

lapatinib .................................................................................. 13 LARIAM ................................................................................... 14 LASIX ....................................................................................... 22 LASTACAFT ............................................................................ 41 latanoprost ............................................................................. 43 LATUDA .................................................................................. 15 leflunomide............................................................................. 40 lenalidomide .......................................................................... 13 LESCOL ................................................................................... 23 LESCOL XL ............................................................................. 23 letrozole .................................................................................. 13 leucovorin ............................................................................... 13 LEUCOVORIN ........................................................................ 13 LEUKERAN.............................................................................. 12 LEUKINE .................................................................................. 19 leuprolide acetate ................................................................. 39 levalbuterol hcl ....................................................................... 46 levalbuterol tartrate ............................................................... 46 LEVAQUIN ................................................................................ 8 LEVATOL................................................................................. 21 LEVBID .................................................................................... 34 LEVEMIR.................................................................................. 19 levetiracetam ............................................................................ 9 levetiracetam extended-release ............................................ 9 levobunolol hcl ....................................................................... 42 LEVO-DROMORAN ................................................................. 5 levofloxacin ......................................................................... 8, 41 levonorgestrel ............................................................ 26, 27, 38 levonorgestrel-eth estra .................................................. 26, 27 LEVORA .................................................................................. 27 levorphanol tartrate ................................................................. 5 LEVOTHROID ......................................................................... 38 levothyroxine sodium ............................................................ 38 LEVOXYL ................................................................................. 38 LEVSIN .................................................................................... 34 LEVSIN-SL ............................................................................... 34 LEXAPRO ................................................................................ 10 LEXIVA ..................................................................................... 16 LIALDA .................................................................................... 40 LIBRAX .................................................................................... 34 LIBRIUM .................................................................................. 17 LIDAMANTLE ......................................................................... 28 LIDAMANTLE HC .................................................................. 28 LIDEX ....................................................................................... 30 LIDEX-E ................................................................................... 30 lidocaine ................................................................. 6, 21, 28, 32 lidocaine hcl ........................................................... 6, 21, 28, 32 LIDOCAINE HCL ................................................................ 6, 21 lidocaine hcl/pf ...................................................................... 21 lidocaine viscous ...................................................................... 6 lidocaine/prilocaine ............................................................... 28





LIDODERM.......................................................................... 6, 28 LIMBITROL DS ........................................................................ 10 linagliptin................................................................................. 18 lindane ..................................................................................... 30 linezolid ..................................................................................... 8 LIORESAL ................................................................................ 47 liothyronine sodium ............................................................... 38 liotrix ........................................................................................ 38 LIPITOR .................................................................................... 23 liraglutide ................................................................................ 18 lisinopril ................................................................................... 24 lisinopril/hydrochlorothiazide ............................................... 24 LITHIUM CARBONATE ......................................................... 17 lithium carbonate capsule ..................................................... 17 lithium carbonate extended release .................................... 17 lithium carbonate tablet ........................................................ 17 lithium citrate .......................................................................... 17 LITHOBID ................................................................................ 17 LITHOBID ER .......................................................................... 17 LIVALO..................................................................................... 23 l-norgest-eth estr/ethin estra ................................................ 27 LO LOESTRIN FE ................................................................... 27 LO/OVRAL-28 ......................................................................... 27 LOCOID ................................................................................... 30 LOCOID LIPOCREAM ........................................................... 30 LODINE ..................................................................................... 4 LODOSYN ............................................................................... 14 lodoxamide tromethamine ................................................... 41 LOESTRIN ............................................................................... 27 LOESTRIN 24 FE ..................................................................... 27 LOESTRIN FE .......................................................................... 27 LOFIBRA .................................................................................. 23 LOMOTIL................................................................................. 34 LONITEN ................................................................................. 25 LOPID ...................................................................................... 23 LOPRESSOR ............................................................................ 21 LOPRESSOR HCT ................................................................... 21 LOPROX .................................................................................. 29 lorazepam ......................................................................... 17, 47 LORAZEPAM INTENSOL ...................................................... 17 LORCET 10/650 ........................................................................ 5 LORCET PLUS ........................................................................... 5 LORTAB ..................................................................................... 5 LORTUSS DM ......................................................................... 44 losartan potassium ................................................................. 24 losartan/hctz ........................................................................... 24 LOTEMAX ............................................................................... 42 LOTENSIN ............................................................................... 23 LOTENSIN HCT ...................................................................... 23 loteprednol etabonate .......................................................... 42 LOTREL .................................................................................... 22

LOTRISONE ............................................................................ 29 LOTRONEX ............................................................................ 34 lovastatin ................................................................................. 23 LOVENOX ............................................................................... 19 loxapine succinate ................................................................. 14 LOXITANE .............................................................................. 14 LOZOL ..................................................................................... 22 lubiprostone ........................................................................... 34 LUDENT FLUORIDE .............................................................. 47 LUDIOMIL ............................................................................... 10 LUMIGAN ............................................................................... 43 LUNESTA ................................................................................ 46 LUPRON .................................................................................. 39 LUPRON DEPOT .................................................................... 39 LUPRON DEPOT-PED ........................................................... 39 lurasidone ............................................................................... 15 LURIDE .................................................................................... 47 LUSTRA ............................................................................. 31, 32 LUSTRA-AF ............................................................................. 32 LUSTRA-ULTRA ...................................................................... 31 LUVOX ..................................................................................... 10 LUXIQ ...................................................................................... 29 LYRICA ...................................................................................... 9 LYSODREN ............................................................................. 36

M

MACROBID .............................................................................. 8 MACRODANTIN ...................................................................... 7 mag hydrox/alh/smc/dpha/lido ........................................... 28 MALARONE ........................................................................... 14 malathion ................................................................................ 30 MANDELAMINE ...................................................................... 6 MAOI ....................................................................................... 10 maprotiline hcl ....................................................................... 10 maraviroc ................................................................................ 15 MARINOL................................................................................ 11 MATULANE ............................................................................ 13 MAVIK ..................................................................................... 24 MAXAIR AUTOHALER........................................................... 46 MAXALT .................................................................................. 12 MAXALT MLT ......................................................................... 12 MAXIDEX ................................................................................ 42 MAXIDONE .............................................................................. 5 MAXIFLOR .............................................................................. 30 MAXITROL .............................................................................. 41 MAXZIDE ................................................................................ 23 MEBARAL ................................................................................. 9 meclofenamate sodium .......................................................... 4 MECLOMEN ............................................................................. 4 MEDROL ................................................................................. 36





medroxyprogesterone acet ............................................ 26, 38 mefenamic acid ........................................................................ 4 mefloquine hcl ........................................................................ 14 MEGACE ................................................................................. 38 megestrol acetate .................................................................. 38 MELLARIL ................................................................................ 15 meloxicam ................................................................................. 4 melphalan ............................................................................... 13 memantine hcl .......................................................................... 9 M-END ............................................................................... 44, 45 M-END DM ............................................................................. 45 MENEST .................................................................................. 38 MENOSTAR ............................................................................ 37 MENTAX.................................................................................. 29 meperidine hcl .......................................................................... 5 mephobarbital .......................................................................... 9 MEPHYTON ............................................................................ 20 meprobamate ......................................................................... 17 MEPRON ................................................................................. 14 mercaptopurine ...................................................................... 13 mesalamine controlled-release ............................................ 40 mesalamine delayed-release ................................................ 40 mesalamine suppository ....................................................... 40 mesalamine suspension ........................................................ 40 mesalamine tablet .................................................................. 40 mesna ...................................................................................... 13 MESNEX .................................................................................. 13 MESTINON ............................................................................... 9 mestinon sustained-release .................................................... 9 MESTION TIMESPAN .............................................................. 9 METADATE CD ...................................................................... 26 METADATE ER ....................................................................... 26 METAGLIP ............................................................................... 18 metaxalone ............................................................................. 47 metformin extended-release .......................................... 17, 18 metformin hcl .................................................................... 17, 18 meth/meth blue/ba/salicy/hyos ............................................. 6 METHADONE........................................................................... 5 methadone hcl.......................................................................... 5 methamphetamine hcl .......................................................... 25 methazolamide ....................................................................... 42 methenamine hippurate .......................................................... 6 methenamine mandelate ........................................................ 6 METHERGINE ......................................................................... 28 methimazole ........................................................................... 39 METHITEST ............................................................................. 37 methocarbamol ...................................................................... 47 methotrexate sodium ............................................................ 13 methoxsalen ........................................................................... 32 methoxsalen, rapid ................................................................ 32 methyldopa ............................................................................. 20

methyldopa/hydrochlorothiazide ........................................ 20 methylergonovine maleate .................................................. 28 METHYLIN .............................................................................. 26 methylphenidate .................................................................... 26 methylphenidate extended-release .................................... 26 methylphenidate hcl .............................................................. 26 methylphenidate sustained release .................................... 26 methylphenidate transdermal patch ................................... 26 methylprednisolone .............................................................. 36 methylprednisolone sod succ .............................................. 36 methyltestosterone ............................................................... 37 metipranolol ........................................................................... 42 metoclopramide hcl .............................................................. 11 metolazone ............................................................................. 22 metoprol/hydrochlorothiazide ............................................. 21 metoprolol succinate extended-release ............................. 21 metoprolol tartrate ................................................................ 21 METROCREAM ...................................................................... 33 METROGEL ........................................................................ 6, 33 METROGEL-VAGINAL ............................................................ 6 METROLOTION ..................................................................... 33 metronidazole .............................................................. 6, 13, 33 metronidazole cream ............................................................ 33 metronidazole extended release ......................................... 13 metronidazole gel.................................................................. 33 metronidazole lotion ............................................................. 33 metronidazole/skin cleanser ................................................ 33 MEVACOR .............................................................................. 23 mexiletine hcl ......................................................................... 21 MEXITIL ................................................................................... 21 MIACALCIN ............................................................................ 36 MICARDIS ............................................................................... 24 MICARDIS HCT ...................................................................... 24 miconazole nitrate/zinc oxide .............................................. 29 MICROCHAMBER ................................................................. 46 MICROGESTIN FE 1/20, 1.5/30............................................ 27 MICRO-K ................................................................................. 48 MICRONASE .......................................................................... 18 MICRONOR ............................................................................ 27 MICROZIDE ............................................................................ 22 MIDAMOR .............................................................................. 22 midazolam hcl ........................................................................ 47 midodrine hcl ......................................................................... 20 miglitol .................................................................................... 17 MIGRALAM ............................................................................. 12 MIGRANAL ............................................................................. 12 MILTOWN ............................................................................... 17 MIMYX ..................................................................................... 31 MINIPRESS ............................................................................. 20 MINOCIN .................................................................................. 8 minocycline hcl ......................................................................... 8





minoxidil .................................................................................. 25 MIRAPEX ................................................................................. 14 MIRCETTE ............................................................................... 26 MIRENA ................................................................................... 38 mirtazapine ............................................................................. 10 misoprostol ......................................................................... 4, 34 mitotane .................................................................................. 36 MOBAN ................................................................................... 14 MOBIC ....................................................................................... 4 modafinil ................................................................................. 26 MODICON .............................................................................. 27 MODURETIC ........................................................................... 22 moexipril hcl ........................................................................... 24 moexipril/hydrochlorothiazide ............................................. 24 molindone hcl ......................................................................... 14 mometasone furoate ................................................. 30, 45, 46 mometasone/formoterol ....................................................... 46 monobenzone ........................................................................ 31 MONODOX .............................................................................. 8 MONOPRIL ............................................................................. 24 MONOPRIL HCT .................................................................... 24 montelukast sodium .............................................................. 45 morphine sulfate ...................................................................... 5 MORPHINE SULFATE .............................................................. 5 MOTOFEN .............................................................................. 34 MOTRIN .................................................................................... 4 MOVIPREP .............................................................................. 35 moxifloxacin hcl .................................................................. 8, 41 MS CONTIN .............................................................................. 5 MSIR ........................................................................................... 5 mth/me blue/salicy/na phos/hyo ........................................... 6 MUCOMYST-10 ...................................................................... 46 mupirocin ............................................................................ 6, 29 mupirocin calcium .............................................................. 6, 29 MYAMBUTOL ......................................................................... 12 MYCELEX ................................................................................ 11 MYCIFRADIN ............................................................................ 6 MYCOBUTIN .......................................................................... 12 MYCOLOG II ........................................................................... 29 mycophenolate mofetil ......................................................... 39 mycophenolate sodium ......................................................... 39 MYCOSTATIN .................................................................. 11, 29 MYDFRIN................................................................................. 43 MYDRIACYL ............................................................................ 43 MYFORTIC .............................................................................. 39 MYLERAN ................................................................................ 12 MYSOLINE ................................................................................ 9

N

na phos mono&dibasic/cellulose ......................................... 34

na sulfacetm/avobenzone/sulfur ......................................... 33 na sulfacetm/prednis sp ........................................................ 43 na sulfacetm/prednisol ac .................................................... 43 nabumetone ............................................................................. 4 nadolol .................................................................................... 21 nadolol/bendroflumethiazide .............................................. 21 nafarelin .................................................................................. 39 naftifine hcl ............................................................................. 29 NAFTIN ................................................................................... 29 nalbuphine hcl .......................................................................... 5 NALFON ................................................................................... 4 naloxone hcl ................................................................... 4, 6, 11 naltrexone hcl ......................................................................... 11 NAMENDA ............................................................................... 9 naphazoline hcl ...................................................................... 43 naphazoline hcl/phenir mal .................................................. 43 NAPHCON-A ......................................................................... 43 NAPRELAN ............................................................................... 4 NAPROSYN .............................................................................. 4 naproxen ................................................................................... 4 naproxen sodium ..................................................................... 4 naratriptan hcl ........................................................................ 12 NARCAN ................................................................................. 11 NARDIL ................................................................................... 10 NASACORT AQ ..................................................................... 46 NASAREL ................................................................................ 46 NASONEX .............................................................................. 46 NATACYN ............................................................................... 41 natamycin ................................................................................ 41 NATAZIA ................................................................................. 26 nateglinide .............................................................................. 18 NATROBA ............................................................................... 31 NAVANE ................................................................................. 15 NECON ................................................................................... 27 nedocromil sodium ............................................................... 41 nefazodone hcl ....................................................................... 10 nelfinavir mesylate ................................................................. 16 neo/polymyx b sulf/dexameth ............................................. 41 NEOBENZ MICRO ................................................................. 32 neomy sulf/bacitrac zn/poly/hc ............................................ 41 neomy sulf/colist sul/hc/thonz ............................................. 43 neomy sulf/polymyx b sulf/hc .................................. 29, 41, 44 neomycin sulfate ...................................................................... 6 neomycin/bacitra/polymyxin/hc .......................................... 29 neomycin/bacitracin/polymyxin ........................................... 41 neomycin/polymyxn b/gramicidin ....................................... 41 NEORAL .................................................................................. 39 NEOSPORIN........................................................................... 41 neostigmine bromide .............................................................. 9 nepafenac ............................................................................... 42 NEPTAZANE .......................................................................... 42





NEULASTA .............................................................................. 19 NEUMEGA .............................................................................. 19 NEUPOGEN ............................................................................ 19 NEURONTIN ............................................................................. 9 NEVANAC ............................................................................... 42 nevirapine ................................................................................ 16 NEXAVAR ................................................................................ 13 NEXICLON XR ........................................................................ 20 NEXPLANON .......................................................................... 38 niacin ........................................................................................ 23 niacin/lovastatin ..................................................................... 23 NIASPAN ................................................................................. 23 nicardipine hcl ........................................................................ 22 nicardipine hcl sustained-release ......................................... 22 nifedipine ................................................................................ 22 nifedipine extended-release ................................................ 22 nilotinib .................................................................................... 13 nimodipine .............................................................................. 22 NIMOTOP ............................................................................... 22 NIRAVAM ................................................................................ 17 nisoldipine ............................................................................... 22 nitazoxanide ............................................................................ 30 NITRO-BID .............................................................................. 25 NITRO-DUR ............................................................................. 25 nitrofurantoin ........................................................................ 7, 8 nitrofurantoin macrocrystal ..................................................... 7 nitrofurantoin monohydrate ................................................... 8 nitroglycerin aerosol .............................................................. 25 nitroglycerin solution ............................................................. 25 nitroglycerin subligual ........................................................... 25 nitroglycerin topical ointment .............................................. 25 nitroglycerin transdermal patch ........................................... 25 NITROLINGUAL ..................................................................... 25 NITROMIST ............................................................................. 25 NITROSTAT ............................................................................ 25 nizatidine ................................................................................. 34 NIZORAL ........................................................................... 11, 29 NOLVADEX ............................................................................. 13 NORA-BE ................................................................................ 27 NORCO ..................................................................................... 5 NORDETTE-28 ........................................................................ 27 NORDITROPIN ....................................................................... 39 noreth a-et estra/fe fumarate ............................................... 27 noreth-ethinyl estradiol/iron ................................................. 27 norethindrone ................................................................... 27, 38 norethindrone acetate ........................................................... 38 norethindrone a-e estradiol .................................................. 27 norethindrone-ethinyl estrad ................................................ 27 norethindrone-ethinyl estradiol............................................ 27 norethindrone-mestranol ...................................................... 27 NORFLEX ................................................................................ 47

norfloxacin ................................................................................ 8 NORGESIC FORTE ................................................................ 47 norgestimate-ethinyl estradiol ............................................. 27 norgestryl-ethiny estradiol .................................................... 27 NORINYL 1+35 ....................................................................... 27 NORINYL 1+50 ....................................................................... 27 NOROXIN ................................................................................. 8 NORPACE ............................................................................... 21 NORPACE CR ........................................................................ 21 NORPRAMIN .......................................................................... 10 NOR-Q-D ................................................................................ 27 NORTREL ................................................................................ 27 nortriptyline hcl ...................................................................... 10 NORVASC ............................................................................... 22 NORVIR ................................................................................... 16 NOVOLIN 70/30 ..................................................................... 19 NOVOLIN N ........................................................................... 19 NOVOLIN R ............................................................................ 19 NOVOLOG INJ VIAL ............................................................. 19 NOVOLOG MIX 70/30 .......................................................... 19 NUBAIN .................................................................................... 5 NUCYNTA ................................................................................. 6 NUEDEXTA ............................................................................. 25 NULEV ..................................................................................... 34 NULYTELY ............................................................................... 35 NUTROPIN AQ ...................................................................... 39 NUVARING ............................................................................. 26 NUVIGIL .................................................................................. 25 NYDRAZID .............................................................................. 12 nystatin .............................................................................. 11, 29 NYSTATIN ............................................................................... 11 nystatin/triamcin .................................................................... 29

O

OCELLA .................................................................................. 26 octreotide acetate ................................................................. 39 OCUFEN ................................................................................. 42 OCUFLOX ............................................................................... 41 OCUPRESS ............................................................................. 42 ofloxacin ........................................................................ 8, 41, 44 OGEN ...................................................................................... 38 OGESTREL .............................................................................. 27 olanzapine .............................................................................. 15 olanzapine/fluoxetine hcl ..................................................... 15 olmesartan medoxomil ......................................................... 24 olmesartn/hydrochlorothiazide ............................................ 24 olopatadine hcl ...................................................................... 41 olsalazine sodium .................................................................. 40 OLUX ....................................................................................... 29 OLUX-E ................................................................................... 29





OMACOR ................................................................................ 23 omalizumab ............................................................................ 40 omega-3 acid ethyl esters ..................................................... 23 OMNICEF .................................................................................. 7 OMNIPRED ............................................................................. 42 OMNITROPE .......................................................................... 39 ondansetron ............................................................................ 11 ondansetron (orally disentigrating) ...................................... 11 ONE TOUCH ULTRA 2 .......................................................... 18 ONE TOUCH ULTRA SMART ............................................... 19 ONE TOUCH ULTRA TEST STRIPS ...................................... 18 ONE TOUCH ULTRAMINI ..................................................... 19 ONGLYZA ............................................................................... 17 OPANA ...................................................................................... 6 OPANA ER ................................................................................ 6 opium ..................................................................................... 5, 6 OPIUM ....................................................................................... 5 opium/belladonna alkaloids ............................................... 5, 6 oprelvekin ................................................................................ 19 OPTHETIC ............................................................................... 41 OPTICHAMBER ...................................................................... 46 OPTICROM ............................................................................. 41 OPTIPRANOLOL .................................................................... 42 OPTIVAR .................................................................................. 41 ORACEA .................................................................................... 8 ORAMORPH SR ........................................................................ 5 ORAP ....................................................................................... 15 ORAPRED ................................................................................ 36 ORAPRED ODT ...................................................................... 36 ORINASE ................................................................................. 18 orphenadrine citrate .............................................................. 47 orphenadrine/aspirin/caffeine .............................................. 47 ORTHO EVRA ......................................................................... 27 ORTHO TRI-CYCLEN ............................................................. 27 ORTHO TRI-CYCLEN LO ...................................................... 27 ORTHO-CEPT ......................................................................... 26 ORTHO-CYCLEN ................................................................... 27 ORTHO-NOVUM .................................................................... 27 oseltamivir phosphate ........................................................... 16 OSMOPREP ............................................................................ 34 OTICIN .................................................................................... 44 OTOGESIC .............................................................................. 44 OVACE .................................................................................... 32 OVCON FE.............................................................................. 27 OVCON-35 .............................................................................. 27 OVCON-50 .............................................................................. 27 OVIDE ...................................................................................... 30 OXANDRIN ............................................................................. 37 oxandrolone ............................................................................ 37 oxaprozin ................................................................................... 4 oxazepam ................................................................................ 17

oxcarbazepine .......................................................................... 9 oxiconazole nitrate ................................................................ 29 OXISTAT ................................................................................. 29 OXSORALEN-ULTRA ............................................................ 32 oxyben/pdo/octinox/h-quinone .......................................... 31 OXYBENZONE/ OCTINOX/H-QUINONE .......................... 31 oxybenzone/octinox/h-quinone .......................................... 31 oxybutynin chloride ............................................................... 35 oxybutynin chloride extended-release ............................... 35 oxybutynin chloride transdermal ......................................... 35 oxycodone hcl ...................................................................... 5, 6 oxycodone hcl controlled-release ......................................... 6 oxycodone hcl/acetaminophen ............................................. 6 oxycodone hcl/aspirin ............................................................. 6 OXYCONTIN ............................................................................ 6 OXYIR ........................................................................................ 6 oxymorphone hcl ..................................................................... 6 oxymorphone hcl extended-release ..................................... 6 OXYTROL ................................................................................ 35

P

PACERONE ............................................................................ 21 PALGIC .................................................................................... 44 paliperidone ........................................................................... 15 palivizumab ............................................................................. 16 PAMELOR ............................................................................... 10 pamidronate ........................................................................... 36 PAMINE................................................................................... 34 PAMINE FORTE ..................................................................... 34 PANAFIL ................................................................................. 33 PANCREAZE ........................................................................... 33 pancrelipase ........................................................................... 33 PANDEL .................................................................................. 30 PANLOR SS .............................................................................. 5 papain/urea/chlorophyllin .................................................... 33 papaverine hcl ........................................................................ 25 PARAFON FORTE DSC ........................................................ 47 PARAGARD ............................................................................ 26 PARCOPA ............................................................................... 14 paregoric................................................................................. 35 PAREGORIC ........................................................................... 35 paricalcitol .............................................................................. 37 PARLODEL .............................................................................. 14 PARNATE ................................................................................ 10 paromomycin sulfate ............................................................. 13 paroxetine extended-release ............................................... 10 paroxetine hcl ........................................................................ 10 paroxetine mesylate .............................................................. 10 PATADAY ................................................................................ 41 PATANOL ............................................................................... 41





PAVABID ................................................................................. 25 PAXIL ....................................................................................... 10 PAXIL CR ................................................................................. 10 pazopanib ............................................................................... 13 PEDIAPRED ............................................................................. 36 PEDIAZOLE ............................................................................... 7 peg 3350/na sulf,bicarb,cl/kcl ............................................... 35 peg3350/sod sul/nacl/asb/c/kcl ........................................... 35 PEGASYS ................................................................................. 16 pegfilgrastim ........................................................................... 19 peginterferon alfa-2a ............................................................. 16 peginterferon-alfa 2b ............................................................. 16 PEG-INTRON .......................................................................... 16 PEG-INTRON REDIPEN ........................................................ 16 pemirolast potassium ............................................................ 41 penbutolol sulfate .................................................................. 21 penciclovir ............................................................................... 31 penicillamine ........................................................................... 39 penicillin v potassium .............................................................. 7 PENLAC ................................................................................... 29 PENTASA ................................................................................ 40 pentazocine hcl/naloxone hcl ................................................. 6 pentosan polysulfate sodium ............................................... 36 pentoxifylline .......................................................................... 20 PEN-VEE K ................................................................................ 7 p-ephed hcl/chlor-mal/bell alk ............................................. 44 p-ephed hcl/hydrocodone/bpm .......................................... 44 PERCOCET ............................................................................... 6 PERCODAN .............................................................................. 6 PERIDEX .................................................................................. 28 perindopril erbumine ............................................................. 24 PERIOSTAT ............................................................................. 28 permethrin .............................................................................. 31 perphenazine .................................................................... 10, 15 PERSANTINE .......................................................................... 20 PEXEVA ................................................................................... 10 phenelzine sulfate .................................................................. 10 PHENERGAN .................................................................... 11, 44 PHENERGAN VC .................................................................... 44 PHENERGAN VC W/CODEINE ............................................ 44 PHENERGAN W/ CODEINE ................................................. 44 phenobarb/hyoscy/atropine/scop ....................................... 34 phenobarbital ........................................................................... 9 PHENOBARBITAL .................................................................... 9 phenoxybenzamine hcl ......................................................... 20 phentolamine mesylate ......................................................... 20 phenylephrine hcl............................................................. 43, 44 phenylephrine hcl/cod/prometh .......................................... 44 phenylephrine hcl/prometh hcl ............................................ 44 phenylephrine/antipy/b-caine .............................................. 44 phenylephrine/chlor-tan ........................................................ 44

phenylephrine/pyril mal/cp .................................................. 44 PHENYTEK ................................................................................ 9 phenytoin .................................................................................. 9 phenytoin (suspension) ........................................................... 9 phenytoin sodium extended-release .................................... 9 PHISOHEX .............................................................................. 28 PHOSLO.................................................................................. 35 PHOSLYRA.............................................................................. 35 PHOSPHA ............................................................................... 36 PHOSPHOLINE IODIDE ....................................................... 42 phosphorus #1........................................................................ 35 PHRENILIN ............................................................................... 4 PHRENILIN FORTE .................................................................. 4 phytonadione ......................................................................... 20 pilocarpine hcl .................................................................. 35, 42 PILOPINE HS .......................................................................... 42 pimecrolimus .......................................................................... 32 pimozide ................................................................................. 15 pindolol ................................................................................... 21 pioglitazone hcl ...................................................................... 18 pioglitazone hcl/metformin hcl ............................................ 18 pioglitazone/glimepiride ...................................................... 18 pirbuterol acetate .................................................................. 46 piroxicam .................................................................................. 4 pitavastatin ............................................................................. 23 PLAN B .................................................................................... 26 PLAQUENIL ............................................................................ 14 PLAVIX ..................................................................................... 20 PLENDIL .................................................................................. 22 PLETAL .................................................................................... 20 PLEXION ................................................................................. 33 PLEXION SCT ......................................................................... 33 PODODERM........................................................................... 31 podofilox ........................................................................... 31, 32 podophyllum resin ................................................................. 31 POLY HIST FORTE ................................................................. 44 POLY HIST PD ........................................................................ 44 POLYCITRA....................................................................... 35, 36 POLYCITRA-K ......................................................................... 35 POLYGESIC .............................................................................. 5 polymyxin b sulfate/tmp ....................................................... 41 POLYSPORIN ......................................................................... 41 POLYTRIM .............................................................................. 41 POLY-VI-FLOR ........................................................................ 47 POLY-VI-FLOR W/IRON ........................................................ 47 PONSTEL .................................................................................. 4 PONTOCAINE ....................................................................... 41 pot chloride/pot bicarb/cit ac .............................................. 48 potassium bicarbonate/cit ac ............................................... 48 potassium chloride ................................................................ 48 potassium chrloide powder .................................................. 48





potassium citrate .............................................................. 35, 36 potassium gluconate ............................................................. 48 potassium phosphate ............................................................ 36 potassium phosphate,monobasic ........................................ 36 PRADAXA ................................................................................ 19 pramipexole di-hcl ................................................................. 14 pramlintide acetate ................................................................ 17 PRAMOSONE ......................................................................... 28 PRAMOSONE-E ..................................................................... 28 PRAMOTIC .............................................................................. 44 pramoxine hcl ....................................................... 28, 31, 32, 44 pramoxine hcl/chloroxylenol ................................................ 44 PRANDIN ................................................................................ 18 PRAVACHOL ........................................................................... 23 pravastatin sodium ................................................................. 23 prazosin hcl ............................................................................. 20 PRECOSE ................................................................................ 17 PRED FORTE........................................................................... 43 PRED MILD.............................................................................. 43 PRED-G .................................................................................... 41 prednicarbate ......................................................................... 30 PREDNISOL ............................................................................ 43 prednisolone ............................................................... 36, 42, 43 PREDNISOLONE .................................................................... 36 prednisolone acetate ................................................. 36, 42, 43 prednisolone sod phosphate ......................................... 36, 43 prednisone .............................................................................. 36 PREDNISONE ......................................................................... 36 PREFEST .................................................................................. 38 pregabalin ................................................................................. 9 PRELONE ................................................................................ 36 PREMARIN TAB ...................................................................... 38 PREMARIN VAGINAL CREAM .............................................. 38 PREMPHASE ........................................................................... 38 PREMPRO ............................................................................... 38 PREVIDENT ............................................................................. 47 PREVIDENT 5000 PLUS.......................................................... 47 PREVIDENT 5000 SENSITIVE ................................................ 47 PREVPAC ................................................................................. 34 PREZISTA................................................................................. 16 PRIMAQUINE .......................................................................... 14 primaquine phosphate .......................................................... 14 primidone .................................................................................. 9 PRINIVIL ................................................................................... 24 PRINZIDE ................................................................................. 24 PROAIR HFA ........................................................................... 45 PROAMATINE ........................................................................ 20 PRO-BANTHINE ..................................................................... 34 probenecid.............................................................................. 12 procainamide hcl .................................................................... 21 procarbazine ........................................................................... 13

PROCARDIA ........................................................................... 22 PROCARDIA XL ...................................................................... 22 PROCHIEVE ............................................................................ 38 prochlorperazine maleate..................................................... 11 PROCRIT ................................................................................. 20 PROCTOCORT....................................................................... 32 PROCTOFOAM ............................................................... 31, 32 PROCTOFOAM-HC............................................................... 32 PRODIGY .......................................................................... 18, 19 PRODIGY TEST STRIPS ......................................................... 18 progesterone.......................................................................... 38 PROGESTERONE IN OIL ...................................................... 38 progesterone,micronized ..................................................... 38 PROGLYCEM .......................................................................... 17 PROGRAF ............................................................................... 39 PROLIXIN ................................................................................ 14 PROLIXIN DECANOATE ....................................................... 14 PROLOPRIM ............................................................................. 6 promethazine hcl ............................................................. 11, 44 PROMETHAZINE-DM ........................................................... 45 PROMETRIUM ........................................................................ 38 PRONESTYL ........................................................................... 21 propafenone hcl..................................................................... 21 propantheline bromide ......................................................... 34 proparacaine hcl .................................................................... 41 propranolol extended-release ............................................. 21 propranolol hcl ....................................................................... 21 propranolol sustained-release ............................................. 21 propranolol/hydrochlorothiazide ........................................ 21 propylthiouracil ...................................................................... 39 PROPYLTHIOURACIL ............................................................ 39 PROQUIN XR ............................................................................ 8 PROSCAR................................................................................ 35 PROSED/DS ............................................................................. 6 PROSOM................................................................................. 46 PROSTIGMIN ........................................................................... 9 PROSTIN VR PEDIATRIC ....................................................... 37 PROTOPIC .............................................................................. 32 protriptyline hcl ...................................................................... 10 PROVENTIL HFA .................................................................... 45 PROVERA .......................................................................... 26, 38 PROVIGIL ................................................................................ 26 PROZAC .................................................................................. 10 PROZAC WEEKLY .................................................................. 10 pseudoephedrine hcl/acrivas ............................................... 44 PSORCON .............................................................................. 30 PSORCON E ........................................................................... 30 PSORIATEC ............................................................................ 31 PULMICORT FLEXHALER ..................................................... 45 PULMICORT RESPULES ........................................................ 45 PULMOZYME ......................................................................... 46





PURINETHOL .......................................................................... 13 pyrazinamide .......................................................................... 12 PYRAZINAMIDE ..................................................................... 12 pyridostigmine bromide.......................................................... 9 pyrimethamine........................................................................ 14

Q

QUALAQUIN .......................................................................... 14 QUESTRAN ............................................................................. 23 QUESTRAN LIGHT ................................................................. 23 quetiapine fumarate .............................................................. 15 QUINAGLUTE ......................................................................... 21 quinapril hcl ............................................................................ 24 quinapril/hydrochlorothiazide .............................................. 24 quinidine gluconate ............................................................... 21 quinidine sulfate ..................................................................... 21 QUINIDINE SULFATE ............................................................ 21 quinine sulfate ........................................................................ 14 QUININE SULFATE ................................................................ 14 QUIXIN .................................................................................... 41 QVAR ....................................................................................... 45

R

raloxifene hcl........................................................................... 38 raltegravir ................................................................................ 15 ramelteon ................................................................................ 47 ramipril..................................................................................... 24 RANEXA .................................................................................. 23 ranitidine hcl ........................................................................... 34 ranolazine ................................................................................ 23 RAPAMUNE ............................................................................ 39 RAPTIVA .................................................................................. 31 rasagiline mesylate................................................................. 14 RAZADYNE ............................................................................... 9 RAZADYNE ER .......................................................................... 9 REBETOL ................................................................................. 16 REBIF ....................................................................................... 40 RECLIPSEN.............................................................................. 26 REDERM .................................................................................. 30 REGITINE ................................................................................ 20 REGLAN .................................................................................. 11 REGRANEX ............................................................................. 33 RELAFEN ................................................................................... 4 RELENZA ................................................................................. 16 RELPAX .................................................................................... 12 REMERON ............................................................................... 10 REMODULIN ........................................................................... 25 RENACIDIN ............................................................................. 35

RENAGEL ................................................................................ 35 RENVELA ................................................................................ 35 repaglinide ............................................................................. 18 REQUIP ................................................................................... 14 RESCRIPTOR .......................................................................... 16 reserpine ................................................................................. 20 RESPA A.R. ............................................................................. 44 Respiratory Tract Agents ................................................ 44, 46 RESTASIS ................................................................................ 43 RESTORIL ................................................................................ 47 RETIN-A .................................................................................. 33 RETIN-A MICRO .................................................................... 33 RETIN-A MICRO PUMP ......................................................... 33 RETROVIR ............................................................................... 16 REVATIO ........................................................................... 25, 46 REVIA ....................................................................................... 11 REVLIMID ................................................................................ 13 REYATAZ ................................................................................. 16 RHINOCORT AQUA .............................................................. 46 RIBATAB ................................................................................. 17 ribavirin ............................................................................. 16, 17 RIDAURA ................................................................................. 40 rifabutin ................................................................................... 12 RIFADIN .................................................................................. 12 RIFAMATE .............................................................................. 12 rifampin ................................................................................... 12 rifampin/isoniazid .................................................................. 12 rifaximin ..................................................................................... 6 rilpivirine ................................................................................. 16 RILUTEK .................................................................................. 26 riluzole ..................................................................................... 26 rimantadine hcl ...................................................................... 16 rimexolone .............................................................................. 43 RIOMET ................................................................................... 17 risedronate sod/calcium carbonate .................................... 36 risedronate sodium ............................................................... 36 RISPERDAL ............................................................................. 15 RISPERDAL CONSTA ............................................................ 15 RISPERDAL M-TAB ................................................................ 15 risperidone ............................................................................. 15 risperidone microspheres ..................................................... 15 RITALIN ................................................................................... 26 RITALIN LA ............................................................................. 26 RITALIN-SR ............................................................................. 26 ritonavir ................................................................................... 16 ritonavir/lopinavir ................................................................... 16 rivastigmine tartrate ................................................................ 9 rivastigmine tartrate (solution) ............................................... 9 rizatriptan benzoate .............................................................. 12 rizatriptan orally disentigrating ............................................ 12 ROBAXIN ................................................................................ 47





ROBINUL ................................................................................. 34 ROBINUL FORTE ................................................................... 34 ROCALTROL ........................................................................... 48 roflumilast ................................................................................ 46 ROMYCIN ................................................................................ 41 ropinirole hcl ........................................................................... 14 ROSAC..................................................................................... 33 ROSULA ............................................................................. 32, 33 ROSULA NS ............................................................................ 32 rosuvastatin calcium ............................................................... 23 ROWASA ................................................................................. 40 ROXANOL ................................................................................. 5 ROXICET ................................................................................... 6 ROXICODONE ......................................................................... 6 ROZEREM ............................................................................... 47 rufinamide ................................................................................. 9 RYNATAN ............................................................................... 44 RYNATAN PEDIATRIC ........................................................... 44 RYNATUSS .............................................................................. 44 RYTHMOL ............................................................................... 21 RYTHMOL SR .......................................................................... 21

S

SABRIL ....................................................................................... 9 SAFYRAL ................................................................................. 26 SAIZEN .................................................................................... 39 SALAGEN ................................................................................ 35 sal-amide/acetamin/p-tlox/caff .............................................. 4 SALEX ...................................................................................... 32 salicylic acid ............................................................................ 32 salmeterol xinafoate .............................................................. 46 salsalate ..................................................................................... 4 SANCTURA ............................................................................. 35 SANCTURA XR ....................................................................... 35 SANDIMMUNE ....................................................................... 39 SANDOSTATIN ...................................................................... 39 SANDOSTATIN LAR .............................................................. 39 SANTYL ................................................................................... 33 saquinavir mesylate ................................................................ 16 SARAFEM ................................................................................ 10 sargramostim .......................................................................... 19 saxagliptin ......................................................................... 17, 18 saxagliptin/metformin extended-release ............................ 18 SCALACORT ........................................................................... 30 SCOPACE ............................................................................... 11 scopolamine hydrobromide ........................................... 11, 43 scopolamine methylbromide ................................................ 34 SEASONALE ........................................................................... 27 SEASONIQUE ......................................................................... 27 SEB-PREV ................................................................................ 28

SECTRAL ................................................................................. 21 selegiline ........................................................................... 10, 14 selegiline hcl ........................................................................... 14 selenium sulfide ..................................................................... 32 SELSEB .................................................................................... 32 SELSUN RX ............................................................................. 32 SELZENTRY ............................................................................ 15 SEMPREX-D ............................................................................ 44 SENSIPAR ............................................................................... 39 SEPTRA ..................................................................................... 8 SEPTRA DS ............................................................................... 8 SERAX ..................................................................................... 17 SEREVENT DISKUS ................................................................ 46 SEROQUEL ............................................................................. 15 SEROSTIM .............................................................................. 39 SERPASIL ................................................................................ 20 sertaconazole nitrate ............................................................. 29 sertraline hcl ........................................................................... 10 SERZONE ................................................................................ 10 sevelamer carbonate ............................................................. 35 sevlamer hcl ............................................................................ 35 sildenafil ............................................................................ 25, 46 sildenafil citrate ...................................................................... 46 SILVADENE............................................................................. 33 SILVER NITRATE .................................................................... 28 silver nitrate applicator ......................................................... 28 silver sulfadiazine ................................................................... 33 SIMPONI ................................................................................. 31 simvastatin ........................................................................ 18, 23 SINEMET ................................................................................. 14 SINEMET CR........................................................................... 14 SINEQUAN ............................................................................. 10 SINGULAIR ............................................................................. 45 sirolimus .................................................................................. 39 sitagliptin phosphate ............................................................ 18 sitagliptin/metformin ............................................................. 18 sitagliptin/simvastatin ........................................................... 18 SKELAXIN ............................................................................... 47 sod chloride/nahco3/kcl/peg’s ............................................ 35 sod/potass/k cit/sodium cit/ca ............................................ 36 sodium fluoride ...................................................................... 47 sodium fluoride/pot nitrate .................................................. 47 sodium oxybate ..................................................................... 26 sodium polystyrene sulfonate .............................................. 20 SOLAQUIN FORTE ................................................................ 31 SOLARAZE .............................................................................. 30 solifenacin succinate ............................................................. 35 SOLODYN ................................................................................ 8 SOLU-CORTEF ....................................................................... 36 SOLU-MEDROL ...................................................................... 36 SOMA .................................................................................. 5, 47





SOMA COMPOUND ......................................................... 5, 47 SOMA COMPOUND W/CODEINE ....................................... 5 somatropin .............................................................................. 39 SONATA .................................................................................. 47 sorafenib tosylate ................................................................... 13 SORIATANE ............................................................................ 31 sotalol hcl ................................................................................ 21 SPECTAZOLE ......................................................................... 29 SPECTRACEF ............................................................................ 7 spinosad .................................................................................. 31 SPIRIVA .................................................................................... 45 spironolact/hydrochlorothiazide .......................................... 22 spironolactone ........................................................................ 23 SPORANOX ............................................................................ 11 SPRINTEC ................................................................................ 27 SPRYCEL .................................................................................. 13 STADOL .................................................................................... 4 STALEVO ................................................................................. 14 stannous fluoride .................................................................... 47 STARLIX ................................................................................... 18 stavudine ................................................................................. 16 STELARA ................................................................................. 31 STELAZINE .............................................................................. 15 STIMATE.................................................................................. 37 STRATTERA ............................................................................ 25 STROMECTOL ........................................................................ 13 SUBOXONE .............................................................................. 4 SUBUTEX ................................................................................... 4 sucralfate ................................................................................. 34 SULAR ...................................................................................... 22 sulconazole nitrate ................................................................. 29 SULFAC ................................................................................... 43 sulfacetamide sodium ......................................... 28, 32, 33, 43 sulfacetamide sodium/sulfur ................................................ 33 sulfacetamide sodium/urea .................................................. 32 sulfadiazine ......................................................................... 8, 33 SULFADIAZINE ......................................................................... 8 sulfamethoxazole/trimethoprim ............................................. 8 sulfanilamide ............................................................................. 8 sulfasalazine ............................................................................ 40 sulfisoxazole acetyl................................................................... 8 sulindac...................................................................................... 4 sumatriptan ............................................................................. 12 SUMYCIN .................................................................................. 8 sunitinib malate ...................................................................... 13 SUPRAX ..................................................................................... 7 SURMONTIL ........................................................................... 11 SUSTIVA .................................................................................. 16 SUTENT ................................................................................... 13 SYMAX ..................................................................................... 34 SYMAX DUOTAB ................................................................... 34

SYMBYAX ................................................................................ 15 SYMLIN ................................................................................... 17 SYMMETREL ........................................................................... 14 SYNAGIS ................................................................................. 16 SYNALAR ................................................................................ 30 SYNAREL................................................................................. 39 SYNTHROID ........................................................................... 38 syringe with needle,disposable, .......................................... 19

T

TABLOID ................................................................................. 13 tacrine........................................................................................ 9 tacrolimus ......................................................................... 32, 39 tacrolimus anhydrous ............................................................ 39 tadalafil.................................................................................... 25 TAGAMET ............................................................................... 34 TALWIN NX .............................................................................. 6 TAMBOCOR ........................................................................... 21 TAMIFLU ................................................................................. 16 tamoxifen citrate .................................................................... 13 tamsulosin hcl ......................................................................... 35 TAPAZOLE .............................................................................. 39 tapentadol ................................................................................ 6 TARCEVA ................................................................................ 13 TARGRETIN ............................................................................ 12 TARKA ..................................................................................... 22 TASIGNA ................................................................................ 13 tazarotene ............................................................................... 32 TAZORAC ............................................................................... 32 TBC .......................................................................................... 33 TEBAMIDE .............................................................................. 11 TEGRETOL................................................................................ 8 TEGRETOL XR .......................................................................... 8 TEKAMLO ............................................................................... 24 TEKTURNA ............................................................................. 24 TEKTURNA HCT .................................................................... 24 telaprevir ................................................................................. 15 telithromycin ............................................................................. 7 telmisartan .............................................................................. 24 telmisartan/hydrochlorothiazide .......................................... 24 temazepam ............................................................................. 47 TEMODAR .............................................................................. 13 TEMOVATE ............................................................................ 29 TEMOVATE E ......................................................................... 29 temozolomide ........................................................................ 13 TENEX ..................................................................................... 20 tenofovir disoproxil fumarate ............................................... 16 TENORETIC ............................................................................ 21 TENORMIN............................................................................. 21 TERAZOL 3 ............................................................................. 11





TERAZOL 7 .............................................................................. 11 terazosin hcl ............................................................................ 20 terbinafine hcl ......................................................................... 11 terbutaline sulfate .................................................................. 46 terconazole ............................................................................. 11 teriparatide ............................................................................. 37 TESLAC .................................................................................... 13 TESSALON PERLE.................................................................. 46 TESTIM .................................................................................... 37 testolactone ............................................................................ 13 testosterone ...................................................................... 37, 38 testosterone cypionate.......................................................... 37 testosterone enanthate ......................................................... 37 testosterone gel ..................................................................... 37 TESTRED ................................................................................. 37 tetracaine hcl .......................................................................... 41 tetracaine/benzocaine/butam. ............................................. 28 tetracycline hcl .......................................................................... 8 tetrahydrozoline hcl ............................................................... 46 TEVETEN ................................................................................. 24 TEVETEN HCT ........................................................................ 24 thalidomide ............................................................................. 40 THALOMID ............................................................................. 40 theophylline anhydrous ......................................................... 45 thioguanine ............................................................................. 13 thioridazine hcl ....................................................................... 15 thiothixene .............................................................................. 15 THORAZINE ............................................................................ 14 thyroid ..................................................................................... 38 thyroid,pork ............................................................................ 38 THYROID,PORK...................................................................... 38 THYROLAR .............................................................................. 38 tiagabine hcl ............................................................................. 9 TIAZAC .................................................................................... 22 ticagrelor ................................................................................. 20 TICLID ...................................................................................... 20 ticlopidine hcl ......................................................................... 20 TIGAN ...................................................................................... 11 TIKOSYN ................................................................................. 21 TILIA ......................................................................................... 27 timolol ................................................................................ 21, 42 timolol maleate ................................................................ 21, 42 timolol maleate/dorzolam hcl............................................... 42 TIMOPTIC ............................................................................... 42 TIMOPTIC-XE ......................................................................... 42 TINDAMAX ............................................................................. 14 tinidazole ................................................................................. 14 tiotropium ............................................................................... 45 tipranavir ................................................................................. 16 tizanidine hcl ........................................................................... 47 TOBI ........................................................................................... 6

TOBRADEX ............................................................................. 41 tobramycin sulfate ointment ................................................ 41 tobramycin sulfate solution .................................................. 41 tobramycin sulfate/dexameth oint ...................................... 41 tobramycin sulfate/dexameth susp ..................................... 41 tobramycin/0.25 normal saline ............................................... 6 tobramycin/lotepred etab .................................................... 41 TOBREX .................................................................................. 41 TOFRANIL............................................................................... 10 TOFRANIL-PM ....................................................................... 10 tolazamide .............................................................................. 18 tolbutamide ............................................................................ 18 TOLECTIN 600 ......................................................................... 4 TOLINASE............................................................................... 18 tolmetin sodium ....................................................................... 4 tolterodine tartrate ................................................................ 35 tolterodine tartrate extended-release ................................ 35 TOPAMAX ................................................................................ 9 TOPAMAX SPRINKLE .............................................................. 9 TOPICORT .............................................................................. 30 topiramate capsule .................................................................. 9 topiramate tablet ..................................................................... 9 topotecan ............................................................................... 13 TOPROL XL ............................................................................. 21 TORADOL ................................................................................. 4 torsemide ................................................................................ 23 TRACLEER .............................................................................. 25 TRADJENTA ........................................................................... 18 tramadol hcl .............................................................................. 6 tramadol hcl extended-release .............................................. 6 tramadol hcl/acetaminophen ................................................. 6 TRANDATE ............................................................................. 21 trandolapril ....................................................................... 22, 24 trandolapril/verapamil hcl..................................................... 22 TRANSDERM-SCOP .............................................................. 11 TRANXENE SD ....................................................................... 17 TRANXENE T-TAB ................................................................. 17 tranylcypromine sulfate ......................................................... 10 TRAVATAN Z .......................................................................... 43 travoprost................................................................................ 43 trazodone hcl.......................................................................... 10 TRENTAL ................................................................................ 20 treprostinil .............................................................................. 25 tretinoin ....................................................................... 13, 28, 33 tretinoin microspheres .......................................................... 33 TREXALL ................................................................................. 13 triamcinolone acetonide ................................28, 30, 36, 45, 46 triamterene ............................................................................. 23 triamterene/hydrochlorothiazide ......................................... 23 TRIAVIL 10-2 ........................................................................... 10 triazolam ................................................................................. 47





TRICOR .................................................................................... 23 TRIDERM ................................................................................. 30 trifluoperazine hcl ................................................................... 15 trifluridine ................................................................................ 43 TRIGLIDE ................................................................................. 23 trihexyphenidyl hcl ................................................................. 14 TRILAFON ............................................................................... 15 TRILEPTAL ................................................................................. 9 TRILIPIX.................................................................................... 23 trimethobenzamide hcl ......................................................... 11 trimethobenzamide hcl/b-caine ........................................... 11 trimethoprim ......................................................................... 6, 8 trimipramine maleate ............................................................ 11 TRI-NORINYL .......................................................................... 27 TRIPHASIL ............................................................................... 26 TRI-SPRINTEC ......................................................................... 27 TRI-VI-FLOR ...................................................................... 47, 48 TRI-VI-FLOR W/IRON ............................................................ 47 TRIVORA.................................................................................. 26 TRIZIVIR ................................................................................... 16 tropicamide ............................................................................. 43 trospium chloride ................................................................... 35 trospium chloride extended-release ................................... 35 TRUSOPT................................................................................. 42 TRUVADA ................................................................................ 16 trypsin/balsam peru/castor oil .............................................. 33 TUSSALL-ER ............................................................................ 44 TUSSIONEX ............................................................................ 44 TWINJECT .............................................................................. 40 TYKERB .................................................................................... 13 TYLENOL/CODEINE ............................................................... 4 TYLOX ........................................................................................ 6 TYZINE ..................................................................................... 46

U

ulipristal ................................................................................... 27 ULTRACET ................................................................................ 6 ULTRAM .................................................................................... 6 ULTRAM ER ............................................................................... 6 ULTRAVATE ............................................................................ 30 UNIPHYL .................................................................................. 45 UNIRETIC ................................................................................ 24 UNITHROID ............................................................................ 38 UNIVASC ................................................................................. 24 urea .............................................................................. 30, 32, 33 URECHOLINE ......................................................................... 35 URELLE ...................................................................................... 6 urine acetone test,strips ........................................................ 40 urine gluc-acet comb.tst,strip ............................................... 40 URISPAS .................................................................................. 35

UROCIT-K ............................................................................... 36 URO-KP-NEUTRAL ................................................................ 35 UROXATRAL ........................................................................... 35 URSO ....................................................................................... 35 URSO FORTE ......................................................................... 35 ursodiol ................................................................................... 35 ustekinumab ........................................................................... 31

V

VAGIFEM .......................................................................... 37, 38 valacyclovir hcl ....................................................................... 15 VALCYTE ................................................................................. 15 valganciclovir hydrochloride ................................................ 15 VALISONE .............................................................................. 29 VALIUM ................................................................................... 17 valproate sodium ..................................................................... 9 valproic acid ............................................................................. 9 valsartan .................................................................................. 24 valsartan/hydrochlorothiazide .............................................. 24 VALTREX ................................................................................. 15 VALTURNA ............................................................................. 24 VANCOCIN HCL ...................................................................... 7 vancomycin hcl ......................................................................... 7 vandetanib .............................................................................. 13 VANOS .................................................................................... 30 VANOXIDE-HC ...................................................................... 30 VANSPAR ................................................................................ 17 VANTIN ..................................................................................... 7 varenicline ............................................................................... 17 VASERETIC ............................................................................. 24 VASOCIDIN ............................................................................ 43 VASODILAN ........................................................................... 25 VASOTEC................................................................................ 24 VECTICAL ............................................................................... 32 vemurafenib ............................................................................ 13 venlafaxine extended-release .............................................. 10 venlafaxine hcl ........................................................................ 10 VENTOLIN HFA ..................................................................... 45 verapamil hc sustained-release cap .................................... 22 verapamil hcl .......................................................................... 22 verapamil hcl extended-release cap ................................... 22 verapamil hcl sustained-release cap ................................... 22 verapamil hcl sustained-release tab .................................... 22 VERELAN ................................................................................ 22 VERELAN PM.......................................................................... 22 VERSED ................................................................................... 47 VESANOID.............................................................................. 13 VESICARE ............................................................................... 35 VEXOL ..................................................................................... 43 VFEND..................................................................................... 11





VIBRAMYCIN ............................................................................ 8 VIBRA-TABS .............................................................................. 8 VICODIN ................................................................................... 5 VICODIN HP ............................................................................. 5 VICOPROFEN ........................................................................... 5 VICTOZA ................................................................................. 18 VICTRELIS ................................................................................ 15 VIDEX ....................................................................................... 16 VIDEX EC ................................................................................. 16 vigabatrin .................................................................................. 9 VIGAMOX ............................................................................... 41 VIIBRYD ................................................................................... 10 vilazodone ............................................................................... 10 VIOFORM-HC ......................................................................... 28 VIRACEPT ................................................................................ 16 VIRAMUNE .............................................................................. 16 VIREAD .................................................................................... 16 VIROPTIC................................................................................. 43 VISICOL ................................................................................... 34 VISKEN .................................................................................... 21 VISTARIL .................................................................................. 44 vit e ac/avobnz/octinox/h-quin ............................................ 32 VIVACTIL ................................................................................. 10 VIVELLE-DOT .......................................................................... 37 VOLTAREN.................................................................... 4, 32, 42 VOLTAREN GEL ..................................................................... 32 VOLTAREN-XR ......................................................................... 4 voriconazole ............................................................................ 11 vorinostat................................................................................. 13 VORTEX ................................................................................... 46 VOSOL ..................................................................................... 43 VOSOL HC .............................................................................. 43 VOSPIRE ER ............................................................................ 45 VOTRIENT ............................................................................... 13 VUSION ................................................................................... 29 VYTONE .................................................................................. 28 VYTORIN ................................................................................. 23

W

warfarin sodium ...................................................................... 19 WELCHOL ............................................................................... 23 WELLBUTRIN .......................................................................... 10 WELLBUTRIN SR .................................................................... 10 WELLBUTRIN XL..................................................................... 10 WESTCORT ............................................................................. 30 WYTENSIN .............................................................................. 20

X

XALATAN ................................................................................ 43 XALKORI ................................................................................. 12 XANAX .................................................................................... 17 XANAX XR .............................................................................. 17 XARELTO ................................................................................ 19 XELODA .................................................................................. 12 XENADERM ............................................................................ 33 XIBROM .................................................................................. 42 XIFAXAN ................................................................................... 6 XODOL 10/300 ......................................................................... 5 XOLAIR .................................................................................... 40 XOPENEX ............................................................................... 46 XOPENEX HFA....................................................................... 46 XYLOCAINE .............................................................................. 6 XYLOCAINE VISCOUS ............................................................ 6 XYREM..................................................................................... 26

Y

YASMIN ................................................................................... 26 YAZ .......................................................................................... 26

Z

zafirlukast ................................................................................ 45 zaleplon ................................................................................... 47 ZANAFLEX .............................................................................. 47 zanamivir ................................................................................. 16 ZANTAC .................................................................................. 34 ZARONTINF ............................................................................. 9 ZAROXOLYN .......................................................................... 22 ZEBETA ................................................................................... 21 ZELAPAR ................................................................................. 14 ZELBORAF .............................................................................. 13 ZEMPLAR ................................................................................ 37 ZENPEP ................................................................................... 33 ZERIT ....................................................................................... 16 ZESTORETIC .......................................................................... 24 ZESTRIL ................................................................................... 24 ZETIA ....................................................................................... 23 ZIAC ......................................................................................... 21 ZIAGEN ................................................................................... 15 ZIANA ...................................................................................... 28 zidovudine .............................................................................. 16 zileuton .................................................................................... 45 ZINACEF ................................................................................... 7 ziprasidone hcl ....................................................................... 15 ZITHROMAX ............................................................................. 7





ZOCOR .................................................................................... 23 ZODERM ................................................................................. 32 ZOFRAN .................................................................................. 11 ZOFRAN ODT......................................................................... 11 ZOLADEX ................................................................................ 39 ZOLINZA ................................................................................. 13 zolipdem sublingual............................................................... 47 zolmitriptan ............................................................................. 12 zolmitriptan orally disentigrating ......................................... 12 ZOLOFT ................................................................................... 10 zolpidem oral spray................................................................ 47 zolpidem tartrate .................................................................... 47 ZOLPIMIST .............................................................................. 47 ZOMIG ..................................................................................... 12 ZOMIG ZMT ............................................................................ 12 ZONALON .............................................................................. 31

ZONEGRAN ............................................................................. 9 zonisamide ................................................................................ 9 ZORBTIVE ............................................................................... 39 ZOTO-HC ............................................................................... 43 ZOVIA ...................................................................................... 26 ZOVIRAX ........................................................................... 15, 31 ZYDONE ................................................................................... 5 ZYFLO ..................................................................................... 45 ZYLET ...................................................................................... 41 ZYLOPRIM............................................................................... 12 ZYMAR .................................................................................... 41 ZYMAXID ................................................................................ 41 ZYPREXA ................................................................................. 15 ZYPREXA ZYDIS ..................................................................... 15 ZYTIGA .................................................................................... 12 ZYVOX ....................................................................................... 8

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Kaiser Permanente of Georgia Multi-Choice Formularytestinfo.kaiserpermanente.org/info_assets/cpp_ga/pdfs/ga_formulary... · Kaiser Permanente of Georgia Multi Choice Formulary 3