LIST OF COVERED OVER-THE-COUNTER MEDICATIONS

LIST OF COVERED OVER-THE-COUNTER MEDICATIONS DRUG DESCRIPTION (OTC) BRAND/GEN TIER LIMITS & RESTRICTIONS

ANALGESICS

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

ADULT ASPIRIN REGIMENaspirin

BRAND 1

ASPIR 81aspirin

BRAND 1

ASPIR-LOWaspirin

BRAND 1

ASPIRIN (600 MG SUPPOSITORY, GS 81 MGCHEWABLE TAB, 325 MG TABLET, SM 81MG CHEWABLE TAB, QC 81 MG CHEWABLETAB, HM 325 MG TABLET, HM 81 MGCHEWABLE TAB, 300 MG SUPPOSITORY,SM 325 MG TABLET, GS 325 MG TABLET, 81MG CHEWABLE TABLET, QC 325 MGTABLET)

generic 1

ASPIRIN EC (SM 81 MG, 500 MG, SM 325MG, 81 MG, HM 81 MG, HM 325 MG, QC 81MG, QC 325 MG, 325 MG)

generic 1

CHILDREN'S ASPIRIN (SM 81 MG CHW, 81MG CHEW)

generic 1

ECPIRINaspirin

BRAND 1

ANESTHETICS

LOCAL ANESTHETICS

lidocaine 3% cream generic 1

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS

SMOKING CESSATION AGENTS

NICORETTE (2 MG, 4 MG)nicotine polacrilex

BRAND 1 AL At least 18 yrs old

NICOTINE GUM (HM 4 MG, 2 MG, 4 MG, SM2 MG, SM 4 MG, HM 2 MG)

generic 1 AL At least 18 yrs old

NICOTINE LOZENGE (2 MG MINI, 4 MG MINI,SM 2 MG, HM 2 MG MINI, GS 2 MG MINI, GS4 MG MINI, 4 MG, GS 4 MG, 2 MG, HM 2 MG,SM 4 MG, HM 4 MG)


NICOTINE PATCH (HM 7 MG/24HR PATCH, 7 generic 1 AL At least 18 yrs old

PAGE 1 LAST UPDATED 04/2020

DRUG DESCRIPTION (OTC) BRAND/GEN TIER LIMITS & RESTRICTIONS

MG/24HR PATCH, TRANSDERMAL SYSTEM,SM 7 MG/24HR PATCH, HM 14 MG/24HRPATCH, SM 14 MG/24HR PATCH, SM 21MG/24HR PATCH, HM 21 MG/24HR PATCH,14 MG/24HR PATCH, 21 MG/24HR PATCH)

ANTIFUNGALS

3 DAY VAGINALmiconazole nitrate

BRAND 1

3-DAY VAGINAL CREAM (SM, )clotrimazole

BRAND 1

CLOTRIMAZOLE (SM VAG, VAGINAL) generic 1

clotrimazole-3 2% cream generic 1

miconazole 1 combination pack generic 1

MICONAZOLE 3 4% CREAMmiconazole nitrate

BRAND 1

MICONAZOLE 7 (SM 7 100 MG VAG SUP, SM7 CREAM, 7 100 MG VAG SUPP, 7 CREAM)

generic 1

MICONAZOLE NITRATE (VAGINAL, SMVAGINAL, TOPICAL)

generic 1

qc miconazole-7 cream generic 1

BLOOD GLUCOSE REGULATORS

INSULINS

HUMULIN 70-30insulin nph human isophane/insulin regular,human

BRAND 1

HUMULIN 70/30 KWIKPENinsulin nph human isophane/insulin regular,human

BRAND 1

HUMULIN Ninsulin nph human isophane

BRAND 1

HUMULIN N KWIKPENinsulin nph human isophane

BRAND 1

HUMULIN Rinsulin regular, human

BRAND 1

NOVOLIN Ninsulin nph human isophane

BRAND 1

NOVOLIN Rinsulin regular, human

BRAND 1



CENTRAL NERVOUS SYSTEM AGENTS

CENTRAL NERVOUS SYSTEM, OTHER

8 HOUR ACETAMINOPHEN ER 650 MGacetaminophen

BRAND 1

SM 8 HOUR PAIN RELIEF 650 MGacetaminophen

BRAND 1

8HR ARTHRITIS PAINacetaminophen

BRAND 1

8HR MUSCLE ACHE-PAIN ER 650 MGacetaminophen

BRAND 1

acetaminophen 160 mg/5 ml liq generic 1 AL Up to 6 yrs old

acetaminophen er 650 mg caplet generic 1

acetaminophen er 650 mg tablet generic 1

GS ARTHRITIS PAIN ER 650 MGacetaminophen

BRAND 1

ARTHRITIS PAIN RELIEF (RELF ER 650 MG,SM ER 650 MG, QC ER 650 MG)acetaminophen

BRAND 1

ARTHRITIS PAIN RELIEF (SM ARTHRIT RLFER 650 MG, ARTHRITIS ER 650 MG CAPLT,HM ARTHRITIS ER 650 MG, HM ARTHRITRLF ER 650 MG)acetaminophen

BRAND 1

CHILDREN'S ACETAMINOPHEN (HM CHILD160 MG, CHLD 160 MG/5 ML, CHILD 160 MG)

generic 1 AL Up to 6 yrs old

CHILD'S MAPAP 160 MG TAB CHEWacetaminophen

BRAND 1 AL Up to 6 yrs old

CHILDREN'S PAIN RELIEF (160 ML SUS, QC160 ML)acetaminophen


CHILD'S PAIN RELIEVER SUSPacetaminophen


CHILDREN'S PAIN-FEVER (GS CHLD 160ML, SM CHLD 160 ML, HM CHLD 160 ML,CHILD 160 ML)acetaminophen


CHILDREN'S SILAPAPacetaminophen


ED-APAPacetaminophen


1



INFANT PAIN-FEVER 160 MG/5 MLacetaminophen

BRAND AL Up to 6 yrs old

inf acetaminophen 160 mg/5 ml generic 1 AL Up to 6 yrs old

INFANT PAIN RELIEF 160 MG/5 MLacetaminophen


QC INFANT PAIN RLF 160 MG/5 MLacetaminophen


INFANTS' PAIN-FEVER (INFANTS 160 ML,GS INFANT 160, SM INFANT 160, HMINFANT 160)acetaminophen


JR. STR NON-ASPIRIN PAINacetaminophen


M-PAPacetaminophen


MAPAP ARTHRITIS PAINacetaminophen

BRAND 1

PAIN RELIEF ER 650 MG CAPLETacetaminophen

BRAND 1

PAIN RELIEVER JUNIOR STRENGTHacetaminophen


DERMATOLOGICAL AGENTS

VANALICEpiperonyl butoxide/pyrethrins

BRAND 1

ELECTROLYTES/MINERALS/METALS/VITAMINS

ELECTROLYTE/MINERAL REPLACEMENT

CALCITRATEcalcium citrate

BRAND 1

calcium 600 mg tablet generic 1

calcium carb 1,250 mg/5 ml sus generic 1

children's ferrous sulfate generic 1

FEOSOL (65 MG TABLET, 45 MG CAPLET)ferrous sulfate

BRAND 1

FER-IN-SOLferrous sulfate

BRAND 1

FERATEferrous gluconate

BRAND 1

FEROSUL 325 MG TABLET BRAND 1



ferrous sulfate

FERRIMIN 150ferrous fumarate

BRAND 1

FERRO-TIMEferrous sulfate

BRAND 1

ferrous fumarate 324 mg tab generic 1

ferrous gluconate 324 mg tab generic 1

FERROUS SULFATE (SULF 300 MG/5 MLLIQ, SULFATE 325 MG TABLET, SULF EC325 MG TABLET, SULF 220 MG/5 ML ELIX,SULF 44 MG IRON/5ML LQ, SULF EC 324 MGTABLET, SULF 15 MG IRON/ML DRP)

generic 1

FERROUSULferrous sulfate

BRAND 1

HEMOCYTEferrous fumarate

BRAND 1

IRON (45 MG, 65 MG) generic 1

OYSCO-500calcium carbonate

BRAND 1

oyster shell calcium generic 1

hm slow release iron tablet generic 1

PHOSPHATE BINDERS

calcium acetate 668 mg tablet generic 1

VITAMINS

AQUADEKS PEDIATRIC LIQUIDpediatric multivitamin no.40/phytonadione (vitk1)

BRAND 1QL

AL Up to 3 yrs old

AQUADEKS CHEWABLE TABLETmultivitamin, minerals no.51/folic acid/vitk1/ubidecarenone


CORVITAfolic acid/multivitamin,ther andminerals/lycopene/lutein

BRAND 1

POLY-VI-FLOR (0.25 MG DROPS, 0.5 MGTAB CHEW, 0.25 MG TAB CHEW, 1 MG TABCHEW)pediatric multivitamin no.33 with sodiumfluoride


POLY-VI-FLOR WITH IRON (0.25 MG, 0.5MG)pediatric multivitamin no.33/sodium fluoride/iron




carbonyl

TRI-VI-FLORpediatric multivitamin a,c,and d3 no.38 withsodium fluoride


GASTROINTESTINAL AGENTS

GASTROINTESTINAL AGENTS, OTHER

ANTACID (500 MG CHEW TABLET, GS 500MG CHEWABLE TAB, HM 500 MG CHEWTABLET)calcium carbonate

BRAND 1

ANTACID CALCIUMcalcium carbonate

BRAND 1

ANTACID EXTRA STRENGTH (HM EX-STR750 MG CHWTB, XTRA STRENGTH CHEWTAB, EX-STR 750 MG TAB CHEW)calcium carbonate

BRAND 1

ANTACID ULTRA STR 1,000 MG CHWcalcium carbonate

BRAND 1

CAL-GESTcalcium carbonate

BRAND 1

CALCIUM ANTACID (CALCIUM 750 MG TBCHEW, EX-STR TABLET CHEW, HM CAL1000 MG CHEW TB, SM CAL 500 MG CHEWTAB, CALCIUM EX-STR TABLET, CALCIUM500 MG CHW TAB, CALCIUM 1,000 MG TAB,GS CAL 500 MG CHEW TAB, HM CAL 750MG CHEW TAB)calcium carbonate

BRAND 1

calcium carbonate 648 mg tab generic 1

TUMS (TABLET CHEWABLE, E-X TABLETCHEWABLE, KIDS 300 MG (750) CHEWTAB)calcium carbonate

BRAND 1

TUMS FRESHERScalcium carbonate

BRAND 1

TUMS SMOOTHIEScalcium carbonate

BRAND 1

TUMS ULTRAcalcium carbonate

BRAND 1

TUMS ULTRA STRENGTHcalcium carbonate

BRAND 1

TUMS X-STRcalcium carbonate

BRAND 1



SM CALCIUM ANTACID TAB CHEWcalcium carbonate

BRAND 1

LAXATIVES

CLEARLAX POWDERpolyethylene glycol 3350

BRAND 1

ENEMEEZ (, PLUS)docusate sodium


polyethylene glycol 3350 generic 1

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEX HORMONES/MODIFIERS)

PROGESTINS

AFTERAlevonorgestrel


ECONTRA EZlevonorgestrel


ECONTRA ONE-STEPlevonorgestrel


levonorgestrel generic 1 AL At least 12 yrs old

MY CHOICElevonorgestrel


MY WAYlevonorgestrel


NEW DAYlevonorgestrel


OPCICON ONE-STEPlevonorgestrel


PLAN B ONE-STEPlevonorgestrel


TAKE ACTIONlevonorgestrel


MISCELLANEOUS THERAPEUTIC AGENTS

ANTACID 750 MG CHEWABLE TABLETcalcium carbonate

BRAND 1

RESPIRATORY TRACT/PULMONARY AGENTS

ANTIHISTAMINES

ALL DAY ALLERGY (10 MG TABLET, QC 10MG TAB, SM 10 MG TAB, HM 10 MG TAB)cetirizine hcl

BRAND 1



ALLERGY (LORATADINE) 10 MG TABloratadine

BRAND 1 QL

ALLERGY RELIEF 5 MG/5 ML SOLNloratadine


ALLERGY RELIEF (10 MG, GS 10 MG)loratadine

BRAND 1 QL

ALLERGY RELIEF (SM RELIEF 10 MG ODT,RELIEF 10 MG ODT, RLF (CETRZN) 10 MGTAB)loratadine

BRAND 1

cetirizine hcl 1 mg/ml soln generic 1 AL Up to 11 yrs old

CETIRIZINE HCL (5 MG, 10 MG) generic 1

CHILDREN'S ALL DAY ALLERGY (SM ER 1MG/ML, GS ER 1 MG/ML, ERGY 1 MG/ML)cetirizine hcl


HM CHILD ALL DAY ALLER 1 MG/MLcetirizine hcl


CHILDREN'S ALLERGY (CHILD 5 MG/5 MLSOLN, QC CHILDREN'S 1 MG/ML)loratadine


SM CHILD ALLERGY 5 MG/5 ML SOLloratadine


CHILD ALLERGY RELIEF 1 MG/MLcetirizine hcl


CHILDREN'S CETIRIZINE HCL (HCL 1MG/ML, HM 1 MG/ML)


CHILDREN'S LORATADINE (HM 5 ML, 5 MLSYR, SM 5 ML, 5 ML SOL)


LORATADINE (5 ML, SM 5 ML) generic 1 AL Up to 11 yrs old

LORATADINE (HM 10 MG, SM 10 MG) generic 1

LORATADINE (QC 10 MG, 10 MG) generic 1 QL

loratadine allergy generic 1 AL Up to 11 yrs old

RESPIRATORY TRACT AGENTS, OTHER

ADULT TUSSIN CHEST CONGESTIONguaifenesin

BRAND 1

ADULT TUSSIN COUGH CONGEST DMguaifenesin/dextromethorphan hbr


ALL DAY ALLERGY-D (, GNP, SM)cetirizine hcl/pseudoephedrine hcl

BRAND 1



ALLERGY COMPLETE-Dcetirizine hcl/pseudoephedrine hcl

BRAND 1

ALLERGY RELIEF D-24HR TABLETloratadine/pseudoephedrine sulfate

BRAND 1

ALLERGY RELIEF-NASAL DECONGESTloratadine/pseudoephedrine sulfate

BRAND 1

ALLERGY-CONGESTION 12HRloratadine/pseudoephedrine sulfate

BRAND 1

ALLERGY-CONGES RELF ER TABLETloratadine/pseudoephedrine sulfate

BRAND 1

cetirizine-pseudoephedrine er generic 1

CHEST CONGESTION RELIEF (HMCONGEST RLF 400 MG TB, CONGEST RLF400 MG TAB, SM CONGESTION RELIEFCAP)guaifenesin

BRAND 1

CHILD MUCINEX CHEST MINI-MELTSguaifenesin

BRAND 1

CHILD MUCINEX COUGH MINI-MELTSguaifenesin/dextromethorphan hbr


CHILD MUCUS-COUGH RELIEFguaifenesin/dextromethorphan hbr


CHILDREN'S MUCUS RELIEFguaifenesin

BRAND 1

COUGH DMguaifenesin/dextromethorphan hbr


GUAIFENESIN (200 MG/10 ML, 300 MG/15ML, 100 MG/5 ML)

generic 1

GUAIFENESIN-DEXTROMETHORPHAN(GUAIFENESIN-DM 200-20 MG/10 ML,GUAIFENESIN-DM 100-10 MG/5 ML,GUAIFENESIN DM SYRUP)


guaifenesin-dm er generic 1 AL Up to 20 yrs old

LIQUITUSS GGguaifenesin

BRAND 1

LORATA-DINE Dloratadine/pseudoephedrine sulfate

BRAND 1

LORATADINE-D (24HR, SM 12 HOUR, QC24HR, 12 HOUR)loratadine/pseudoephedrine sulfate

BRAND 1

MUCINEX BRAND 1



guaifenesin

MUCINEX DM ER 600-30 MG TABLETguaifenesin/dextromethorphan hbr


MUCOSAguaifenesin

BRAND 1

MUCUS DM MAX ER 1,200-60 MG TBguaifenesin/dextromethorphan hbr


MUCUS ER 600 MG TABLETguaifenesin

BRAND 1

MUCUS RELIEF (QC 400 MG CAPLET, 400MG TABLET)guaifenesin

BRAND 1

MUCUS RELIEF CHEST CONGESTIONguaifenesin

BRAND 1

MUCUS RELIEF DM COUGHguaifenesin/dextromethorphan hbr


MUCUS RLF DM ER 600-30 MG TABguaifenesin/dextromethorphan hbr


MUCUS RELIEF DM MAX LIQUIDguaifenesin/dextromethorphan hbr


MUCUS RELIEF DM MAX ERguaifenesin/dextromethorphan hbr


MUCUS RELIEF ER (ER 600 MG TABLET, ER1,200 MG TAB, QC ER 600 MG TAB, SM ER600 MG TAB, QC ER 1,200 MG TB)guaifenesin

BRAND 1

MUCUS-CHEST CONGESTIONguaifenesin

BRAND 1

MUCUS-ER MAX (MG TABLET, SM MG TAB)guaifenesin

BRAND 1

ROBAFEN 200 MG/10 ML SYRUPguaifenesin

BRAND 1

ROBAFEN DM COUGHguaifenesin/dextromethorphan hbr


ROBAFEN DM PEAK COLDguaifenesin/dextromethorphan hbr


SILTUSSIN SAguaifenesin

BRAND 1

TUSSIN (100 MG/5 ML SYRUP, 400 MGTABLET)guaifenesin

BRAND 1



TUSSIN CHEST CONGESTION LIQUIDguaifenesin

BRAND 1

TUSSIN DM (400-20 MG/20 ML LIQ, SM 400-20 MG/20 ML, LIQUID)guaifenesin/dextromethorphan hbr


HM TUSSIN DM MAX LIQUIDguaifenesin/dextromethorphan hbr


TUSSIN HONEYguaifenesin

BRAND 1

TUSSIN MUCUS-CHEST CONGESTION (GS200 MG/10, GS 100 MG/5, 200 MG/10, SM 200MG/10, QC 200 MG/10)guaifenesin

BRAND 1


LIST OF COVERED PRESCRIPTION MEDICATIONS DRUG DESCRIPTION (RX) BRAND/GEN TIER LIMITS & RESTRICTIONS

ANALGESICS

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

butalb-aspirin-caffe 50-325-40 generic 1

celecoxib generic 1

DICLOFENAC SODIUM (DR 50 MG, DR 25MG, DR 75 MG, EC 50 MG, EC 25 MG, EC 75MG)

generic 1

ec-naproxen generic 1

IBUibuprofen

BRAND 1

IBUPROFEN (400 MG TABLET, 600 MGTABLET, 800 MG TABLET, 100 MG/5 MLSUSP)

generic 1

INDOMETHACIN (25 MG, 50 MG) generic 1

KETOROLAC TROMETHAMINE (30 MG/MLVIAL, 10 MG TABLET, 60 MG/2 ML SYRINGE,15 MG/ML SYRINGE, 60 MG/2 MLCARPUJECT, 60 MG/2 ML VIAL, 30 MG/MLSYRINGE, 15 MG/ML VIAL, 30 MG/MLCARPUJECT)


meloxicam generic 1

nabumetone generic 1

NAPROXEN (250 MG, DR 375 MG, 375 MG,500 MG, DR 500 MG)

generic 1

salsalate generic 1

OPIOID ANALGESICS, LONG-ACTING

ARYMO ERmorphine sulfate

BRAND 1PA

AL At least 18 yrs old

FENTANYL (12, 25, 75, 50, 100) generic 1 AL At least 18 yrs old

HYSINGLA ERhydrocodone bitartrate

BRAND 1PA


MORPHABOND ERmorphine sulfate

BRAND 1PA


morphine sulf er 30 mg tablet generic 1 AL At least 18 yrs old


DRUG DESCRIPTION (RX) BRAND/GEN TIER LIMITS & RESTRICTIONS

MORPHINE SULFATE ER (ER 200 MG, ER 60MG, ER 100 MG, ER 15 MG)


SUBLOCADEbuprenorphine

BRAND 1PA


XTAMPZA ERoxycodone myristate

BRAND 1PA


OPIOID ANALGESICS, SHORT-ACTING

ACETAMINOPHEN-CODEINE(ACETAMINOPHEN-COD #4 TABLET,ACETAMINOPHEN-COD #3 TABLET,ACETAMINOPHEN-COD #2 TABLET,ACETAMIN-CODEIN 300-30 MG/12.5,ACETAMINOP-CODEINE 120-12 MG/5)


belladonna-opium generic 1

butalb-caff-acetaminoph-codein generic 1 AL At least 12 yrs old

butalbital-asa-caffeine cap generic 1

codeine sulfate generic 1 AL At least 12 yrs old

HYDROCODONE-ACETAMINOPHEN(HYDROCODONE-ACETAMIN 5-217/10,HYDROCODONE-ACETAMIN 7.5-325,HYDROCODONE-ACETAMIN 10-325 MG,HYDROCODONE-ACETAMIN 2.5-108/5,HYDROCODONE-ACETAMIN 5-300 MG,HYDROCODONE-ACETAMIN 5-325 MG,HYDROCODONE-ACETAMN 7.5-325/15,HYDROCODONE-ACETAMIN 7.5-300,HYDROCODONE-ACETAMIN 10-300 MG)

generic 1

hydrocodone-ibuprofen generic 1

HYDROMORPHONE HCL (2 MG TABLET, 8MG TABLET, 4 MG TABLET, 0.5 MG/0.5 ML)

generic 1

MORPHINE SULFATE (SULFATE IR 30 MGTAB, SULF 100 MG/5 ML CONC, SULF 10MG/5 ML SOLN, SULFATE IR 15 MG TAB,SULF 20 MG/5 ML SOLN)

generic 1

OXYCODONE HCL (5 MG/5 ML SOLN, 10 MGTABLET, 20 MG TABLET, 5 MG TABLET, 30MG TABLET, 15 MG TABLET)

generic 1

OXYCODONE-ACETAMINOPHEN(OXYCODON-ACETAMINOPHEN 2.5-325,OXYCODONE-ACETAMINOPHEN 10-325,OXYCODONE-ACETAMINOPHEN 5-325,OXYCODON-ACETAMINOPHEN 7.5-325)

generic 1



tramadol hcl 50 mg tablet generic 1 AL At least 12 yrs old

VICODIN HPhydrocodone bitartrate/acetaminophen

BRAND 1

ANESTHETICS

LOCAL ANESTHETICS

BUPIVACAINE HCL (0.25% VIAL, 0.5% (5MG/ML) AMP, 0.75% VIAL, 0.25% (2.5MG/ML), 0.5% VIAL, 0.75% AMPUL)

generic 1

bupivacaine hcl-epinephrine generic 1

lidocaine 5% patch generic 1 PA

lidocaine 5% ointment generic 1

LIDOCAINE HCL (HCL 4% SOLUTION, HCL2% JEL UROJET AC, HCL 2% JELLY URO-JET, HCL 1% 20 MG/2 ML VL, HCL 1.5%AMPUL, 3% CREAM, HCL 2% AMPUL, HCL2% 40 MG/2 ML, HCL 1% VIAL, HCL 0.5%VIAL, HCL 1% 50 MG/5 ML, HCL 2% 100MG/5 ML, HCL 2% 40 MG/2 ML VL, HCL 1%20 MG/2 ML, HCL 1% 50 MG/5 ML VL, HCL1% AMPUL, HCL 1% 300 MG/30 ML, HCL 4%AMPUL, HCL 2% VIAL, HCL 2% JELLY)

generic 1

lidocaine hcl in 7.5% dextrose generic 1

lidocaine hcl viscous generic 1

lidocaine hcl-epinephrine generic 1

lidocaine-epinephrine generic 1

lidocaine-prilocaine generic 1 QL

ZTLIDOlidocaine

BRAND 1 PA

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS

ALCOHOL DETERRENTS/ANTI-CRAVING

acamprosate calcium generic 1

disulfiram generic 1

naltrexone hcl generic 1

VIVITROLnaltrexone microspheres

BRAND 1PA


OPIOID DEPENDENCE TREATMENTS



BUPRENORPHINE HCL (2 MG, 8 MG) generic 1PA


BUPRENORPHINE-NALOXONE(BUPRENORPHIN-NALOXON 8-2 MG,BUPRENORPHN-NALOXN 2-0.5 MG)

generic 1PA


SUBOXONEbuprenorphine hcl/naloxone hcl

BRAND 1PA


ZUBSOLVbuprenorphine hcl/naloxone hcl

BRAND 1PA


OPIOID REVERSAL AGENTS

NALOXONE HCL (2 MG/2 ML SYRINGE, 0.4MG/ML CARPUJECT, 0.4 MG/ML VIAL, 4MG/10 ML VIAL)

generic 1

NARCANnaloxone hcl

BRAND 1

SMOKING CESSATION AGENTS

bupropion hcl sr 150 mg tablet generic 1 AL At least 6 yrs old

CHANTIX (1 MG CONT MONTH BOX, 0.5 MGTABLET, 1 MG TABLET, STARTING MONTHBOX)varenicline tartrate


ANTIBACTERIALS

AMINOGLYCOSIDES

GENTAMICIN SULFATE (20 MG/2 ML VIAL,80 MG/2 ML VIAL, 800 MG/20 ML VIAL, 3MG/ML EYE DROP, 0.1% CREAM, 40 MG/MLVIAL, 0.3% EYE DROP)

generic 1

GENTAMICIN SULFATE IN NS (ISOTON 80MG/100 ML, 70 MG/NS 50 ML PB, ISO 120MG/100 ML, ISOTON 60 MG/50 ML, ISOTON80 MG/50 ML, ISOTON 100 MG/50 ML, ISO100 MG/100 ML)

generic 1

neomycin sulfate generic 1

tobramycin 0.3% eye drop generic 1

TOBRAMYCIN SULFATE (10 MG/ML, 80 MG/2ML, 40 MG/ML)

generic 1

ANTIBACTERIALS, OTHER



acetic acid 0.25% irrig soln generic 1

CLEOCIN 100 MG VAGINAL OVULEclindamycin phosphate

BRAND 1

CLEOCIN PHOSPHATE (300 MG/2 ML, 900MG/6 ML, 600 MG/4 ML)clindamycin phosphate

BRAND 1

clindamycin hcl generic 1

clindamycin palmitate hcl generic 1 AL Up to 11 yrs old

clindamycin pediatric generic 1 AL Up to 11 yrs old

CLINDAMYCIN PHOSPHATE (PHOSPLEDGET, PH SOLUTION)


CLINDAMYCIN PHOSPHATE (9 G/60 MLVIAL, 600 MG/4 ML VL, 300 MG/2 ML VL, 900MG/6 ML VL)

generic 1

CLINDESSEclindamycin phosphate

BRAND 1

colistimethate generic 1

FIRVANQvancomycin hcl

BRAND 1

lincomycin hcl generic 1

linezolid 600 mg tablet generic 1

methenamine hippurate generic 1

methenamine mandelate generic 1

METRONIDAZOLE (250 MG TABLET, 500MG/100 ML, VAGINAL 0.75% GL, 500 MGTABLET)

generic 1

mupirocin 2% ointment generic 1

NEOMYCIN-POLYMYXIN B (40 MG/ML AMP,40 MG/ML VL)

generic 1

NITROFURANTOIN (25 MG/5 ML SUSP, MCR25 MG CAP, MCR 50 MG CAP, MCR 100 MGCAP)

generic 1

nitrofurantoin mono-macro generic 1

polymyxin b sulfate generic 1

tinidazole generic 1

trimethoprim generic 1

VANCOMYCIN HCL (1 GM VIAL, 500 MG A-VVIAL, HCL 250 MG CAPSULE, 1 GM ADD- generic 1



VAN VIAL, HCL 1.5 GRAM VIAL, 500 MGVIAL, HCL 125 MG CAPSULE, HCL 250 MGVIAL, HCL 5 GM VIAL, HCL 10 GM VIAL, HCL750 MG VIAL, HCL 1.25 GRAM VIAL)

VANCOMYCIN HCL-0.9% NACL (VANCO 500MG/100 ML-0.9%, VANCO 750 MG/150 ML-0.9%, VANCOMYCIN 1 G/200ML-0.9%)

generic 1

vancomycin-d5w 500 mg/100 ml generic 1

BETA-LACTAM, CEPHALOSPORINS

CEFACLOR (500 MG, 250 MG) generic 1

cefadroxil 500 mg capsule generic 1

CEFAZOLIN SODIUM (1 GM ADD-VAN, 20GM BULK, 1 GM, 500 MG, 10 GM)

generic 1

CEFDINIR (250 MG/5 ML SUSP, 300 MGCAPSULE, 125 MG/5 ML SUSP)

generic 1

CEFEPIME HCL (2 GRAM, 1 GM) generic 1

cefixime 400 mg capsule generic 1

cefotaxime sodium 1 gm vial generic 1

cefotetan generic 1

cefotetan & dextrose generic 1

cefoxitin generic 1

cefoxitin sodium generic 1

CEFPROZIL (250 MG/5 ML SUSP, 125 MG/5ML SUSP, 250 MG TABLET, 500 MG TABLET)

generic 1

CEFTRIAXONE (1 GM-D5W BAG, 1 GM ADD-VANT VIAL, 1 GM PIGGYBACK, 250 MG VIAL,2 GM PIGGYBACK, 2 GM-D5W BAG, 2 GMADD VIAL)

generic 1

CEFTRIAXONE (500 MG, 10 GM, 1 GM, 2GM)

generic 1

cefuroxime generic 1

cefuroxime sodium generic 1

CEPHALEXIN (125 MG/5 ML SUSP, 250 MGCAPSULE, 750 MG CAPSULE, 250 MG/5 MLSUSP, 500 MG CAPSULE)

generic 1

BETA-LACTAM, OTHER

AZACTAMaztreonam

BRAND 1



imipenem-cilastatin sodium generic 1

meropenem generic 1

meropenem-0.9% nacl generic 1

BETA-LACTAM, PENICILLINS

AMOXICILLIN (250 MG CAPSULE, 500 MGTABLET, 500 MG CAPSULE, 125 MG/5 MLSUSP, 200 MG/5 ML SUSP, 875 MG TABLET,250 MG/5 ML SUSP, 400 MG/5 ML SUSP)

generic 1

AMOXICILLIN (125 MG, 250 MG) generic 1

AMOXICILLIN-CLAVULANATE POTASS (600-42.9 MG/5 ML SUS, 875-125 MG TABLET,400-57 MG/5 ML SUSP, 500-125 MG TABLET,250-62.5 MG/5 ML SUS, 250-125 MG TABLET,200-28.5 MG/5 ML SUS)

generic 1

AMPICILLIN SODIUM (10 GM VIAL, 2 GMADD-VANTAGE VL, 500 MG VIAL, 250 MGVIAL, 1 GM ADD-VANTAGE VL, 10 GMBOTTLE, 125 MG VIAL, 2 GM VIAL, 1 GMVIAL)

generic 1

ampicillin 500 mg capsule generic 1

AMPICILLIN-SULBACTAM (AMPICILLIN-SULB3 GM ADD VIAL, AMPICILLIN-SULB 1.5 GADD VIAL, AMPICILLIN-SULBACTAM 15 GMVL, AMPICILLIN-SULBACTAM 3 GM VIAL,AMPICILLIN-SULBACTAM 1.5 GM VL)

generic 1

BICILLIN C-R 1.2 MILLION UNITpenicillin g benzathine/penicillin g procaine

BRAND 1

BICILLIN C-R 900-300 SYRINGEpenicillin g benzathine/penicillin g procaine

BRAND 1

BICILLIN L-A (600,000 UNIT/ML, 1,200,000UNITS)penicillin g benzathine

BRAND 1

BICILLIN L-A 2,400,000 UNITSpenicillin g benzathine

BRAND 1

dicloxacillin sodium generic 1

pen g 1.2 million unit/2 ml generic 1

penicillin g 600,000 unit/1 ml generic 1

penicillin g sodium generic 1

PENICILLIN V POTASSIUM (250 MG TABLET,250 MG/5 ML SOLN, 125 MG/5 ML SOLN, 500MG TABLET)

generic 1



PIPERACILLIN-TAZOBACTAM (PIPERACIL-TAZOBACT 2.25 GM VL, PIPERACIL-TAZO3.375 GM ADD VL, PIPERACIL-TAZOBACT4.5 GM VIAL, PIPERACIL-TAZO 4.5 GM ADDVIAL, PIPERACIL-TAZOBACT 3.375 GM VL,PIPERACIL-TAZOBACT 13.5 GM VL,PIPERACIL-TAZOBACT 40.5 GRAM,PIPERACIL-TAZO 2.25 GM ADD VL)

generic 1

MACROLIDES

AZITHROMYCIN (200 MG/5 ML SUSP, I.V.500 MG VIAL, 100 MG/5 ML SUSP)

generic 1

AZITHROMYCIN (500 MG ADD-VAN VL, 500MG TABLET, 600 MG TABLET, 1 GM PWDPACKET, 250 MG TABLET)

generic 1

CLARITHROMYCIN (125 ML, 250 ML) generic 1 AL Up to 11 yrs old

CLARITHROMYCIN (500 MG, 250 MG) generic 1

clarithromycin er generic 1

E.E.S. 200erythromycin ethylsuccinate

BRAND 1

erythromycin 0.5% eye ointment generic 1

QUINOLONES

CIPRO (5%, 10%)ciprofloxacin


ciprofloxacin 0.3% eye drop generic 1

CIPROFLOXACIN HCL (500 MG, 100 MG, 750MG, 250 MG)


ciprofloxacin-d5w generic 1

LEVOFLOXACIN (500 MG, 750 MG, 250 MG) generic 1 AL At least 12 yrs old

levofloxacin-d5w generic 1

moxifloxacin 0.5% eye drops generic 1

OFLOXACIN (EYE, EAR) generic 1

SULFONAMIDES

silver sulfadiazine generic 1

SULFAMETHOXAZOLE-TRIMETHOPRIM (SSTABLET, SUSP, DS TABLET)

generic 1

TETRACYCLINES



DOXYCYCLINE HYCLATE (75 MG TAB, 50MG CAP, 100 MG TAB, 150 MG TAB, 100 MGCAP)

generic 1

doxycycline hyclate 20 mg tab generic 1

MINOCYCLINE HCL (100 MG, 50 MG, 75 MG) generic 1

ANTICONVULSANTS

ANTICONVULSANTS, OTHER

BRIVIACT (50 MG TABLET, 10 MG/ML ORALSOLN, 100 MG TABLET, 25 MG TABLET, 10MG TABLET, 75 MG TABLET)brivaracetam

BRAND 1PA


BRIVIACT 50 MG/5 ML VIALbrivaracetam

BRAND 1PA


KEPPRA (750 MG TABLET, 250 MG TABLET,100 MG/ML ORAL SOLN, 1,000 MG TABLET,500 MG TABLET)levetiracetam

BRAND 1 PA

KEPPRA XRlevetiracetam

BRAND 1 PA

LEVETIRACETAM (100 MG/ML SOLN, 500MG/5 ML VIAL, 500 MG TABLET, 750 MGTABLET, 250 MG TABLET, 1,000 MGTABLET, 500 MG/5 ML SOLN)

generic 1

levetiracetam er generic 1

ROWEEPRAlevetiracetam

BRAND 1 PA

CALCIUM CHANNEL MODIFYING AGENTS

ETHOSUXIMIDE (250 MG/5 ML SOLN, 250MG CAPSULE)

generic 1

ZARONTIN 250 MG CAPSULEethosuximide

BRAND 1 PA

zonisamide generic 1

GAMMA-AMINOBUTYRIC ACID (GABA) AUGMENTING AGENTS

CLOBAZAM (10 MG TABLET, 2.5 MG/MLSUSPENSION, 20 MG TABLET)


DEPAKOTEdivalproex sodium

BRAND 1 PA

DEPAKOTE ERdivalproex sodium

BRAND 1 PA



DEPAKOTE SPRINKLEdivalproex sodium

BRAND 1 PA

DIASTATdiazepam

BRAND 1PA

AL Up to 18 yrs old

DIASTAT ACUDIALdiazepam

BRAND 1PA

AL Up to 18 yrs old

DIAZEPAM (2.5 MG SYS, 20 MG SYST, 10MG SYST)


DIVALPROEX SODIUM (SOD 250 MG TAB,SOD 500 MG TAB, 125 MG CAP SPRNK, SOD125 MG TAB)

generic 1

divalproex sodium er generic 1

GABAPENTIN (300 MG/6 ML SOLN, 250 MG/5ML SOLN, 800 MG TABLET, 100 MGCAPSULE, 300 MG CAPSULE, 600 MGTABLET, 400 MG CAPSULE)

generic 1

GABITRILtiagabine hcl

BRAND 1 PA

MYSOLINEprimidone

BRAND 1 PA

NEURONTIN (800 MG TABLET, 100 MGCAPSULE, 300 MG CAPSULE, 400 MGCAPSULE, 600 MG TABLET, 250 MG/5 MLSOLUTION)gabapentin

BRAND 1 PA

ONFI (2.5 MG/ML SUSPENSION, 20 MGTABLET, 10 MG TABLET)clobazam

BRAND 1PA


PHENOBARBITAL (60 MG TABLET, 97.2 MGTABLET, 100 MG TABLET, 15 MG TABLET,64.8 MG TABLET, 20 MG/5 ML SOLN, 30 MGTABLET, 16.2 MG TABLET, 20 MG/5 ML ELIX,32.4 MG TABLET)

generic 1

primidone generic 1

SABRIL (500 MG TABLET, 500 MG POWDERPACKET)vigabatrin

BRAND 1 PA

SYMPAZANclobazam

BRAND 1PA


tiagabine hcl generic 1

1



VALPROIC ACID (500 MG/10 ML SOL, 250MG CAPSULE, 250 MG/5 ML SOLN)

generic

VIGABATRIN (500 MG POWDER PACKT, 500MG TABLET)

generic 1

VIGADRONEvigabatrin

BRAND 1 PA

GLUTAMATE REDUCING AGENTS

FELBAMATE (400 MG TABLET, 600 MGTABLET, 600 MG/5 ML SUSP)

generic 1

FELBATOL (400 MG TABLET, 600 MGTABLET, 600 MG/5 ML SUSP)felbamate

BRAND 1 PA

FYCOMPA (10 MG TABLET, 6 MG TABLET,12 MG TABLET, 2 MG TABLET, 8 MGTABLET, 0.5 MG/ML ORAL SUSP, 4 MGTABLET)perampanel

BRAND 1PA


LAMICTAL (200 MG, 25 MG DISPER, 5 MGDISPER, 150 MG, 100 MG, 25 MG)lamotrigine

BRAND 1 PA

LAMICTAL (BLUE)lamotrigine

BRAND 1

LAMICTAL (GREEN)lamotrigine

BRAND 1

LAMICTAL (ORANGE)lamotrigine

BRAND 1

LAMICTAL ODTlamotrigine

BRAND 1

LAMICTAL ODT (BLUE)lamotrigine

BRAND 1 PA

LAMICTAL ODT (GREEN)lamotrigine

BRAND 1 PA

LAMICTAL ODT (ORANGE)lamotrigine

BRAND 1 PA

LAMICTAL XRlamotrigine

BRAND 1PA


LAMICTAL XR (BLUE)lamotrigine

BRAND 1PA


LAMICTAL XR (GREEN)lamotrigine

BRAND 1PA




LAMICTAL XR (ORANGE)lamotrigine

BRAND 1PA


LAMOTRIGINE (5 MG DISPER TABLET, 200MG TABLET, 150 MG TABLET, 25 MGDISPER TAB, 100 MG TABLET, 25 MGTABLET)

generic 1

lamotrigine (blue) generic 1 PA

lamotrigine (green) generic 1 PA

lamotrigine (orange) generic 1 PA

lamotrigine er generic 1 AL At least 13 yrs old

lamotrigine odt generic 1 PA

lamotrigine odt (blue) generic 1

lamotrigine odt (green) generic 1

lamotrigine odt (orange) generic 1

QUDEXY XRtopiramate

BRAND 1 PA

SUBVENITElamotrigine

BRAND 1 PA

SUBVENITE (BLUE)lamotrigine

BRAND 1 PA

SUBVENITE (GREEN)lamotrigine

BRAND 1 PA

SUBVENITE (ORANGE)lamotrigine

BRAND 1 PA

TOPAMAX (100 MG TABLET, 50 MG TABLET,25 MG SPRINKLE CAP, 25 MG TABLET, 200MG TABLET, 15 MG SPRINKLE CAP)topiramate

BRAND 1 PA

TOPIRAMATE (25 MG SPRINKLE CAP, 15MG SPRINKLE CAP, 200 MG TABLET, 50 MGTABLET, 25 MG TABLET, 100 MG TABLET)

generic 1

topiramate er generic 1

TROKENDI XRtopiramate

BRAND 1PA


SODIUM CHANNEL AGENTS



APTIOMeslicarbazepine acetate

BRAND 1PA


BANZEL (400 MG TABLET, 40 MG/MLSUSPENSION, 200 MG TABLET)rufinamide

BRAND 1PA


CARBAMAZEPINE (200 MG TABLET, 100 MGTAB CHEW, 100 MG/5 ML SUSP)

generic 1

CARBAMAZEPINE ER (ER 100 MG CAP, ER400 MG TABLET, ER 300 MG CAP, ER 200MG TABLET, ER 200 MG CAP, ER 100 MGTABLET)

generic 1

CARBATROLcarbamazepine

BRAND 1 PA

DILANTIN (30 MG, 100 MG)phenytoin sodium extended

BRAND 1 PA

DILANTIN-125phenytoin

BRAND 1 PA

EPITOLcarbamazepine

BRAND 1 PA

OXCARBAZEPINE (150 MG TABLET, 300MG/5 ML SUSP, 300 MG TABLET, 600 MGTABLET)

generic 1

OXTELLAR XRoxcarbazepine

BRAND 1PA


PHENYTOIN (125 MG/5 ML SUSP, 50 MGINFATAB, 50 MG TABLET CHEW, 100 MG/4ML SUSP)

generic 1

phenytoin sodium extended generic 1

TEGRETOL (200 MG TABLET, 100 MG/5 MLSUSP)carbamazepine

BRAND 1 PA

TEGRETOL XRcarbamazepine

BRAND 1 PA

TRILEPTAL (600 MG TABLET, 300 MG/5 MLSUSP, 300 MG TABLET, 150 MG TABLET)oxcarbazepine

BRAND 1 PA

VIMPAT (10 MG/ML SOLUTION, 150 MGTABLET, 100 MG TABLET, 200 MG TABLET,50 MG TABLET, STARTER KIT)lacosamide

BRAND 1 PA

ANTIDEMENTIA AGENTS



CHOLINESTERASE INHIBITORS

DONEPEZIL HCL (10 MG, 5 MG) generic 1 AL At least 18 yrs old

donepezil hcl odt generic 1 AL At least 18 yrs old

EXELONrivastigmine


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

MEMANTINE HCL (10 MG, 5 MG) generic 1 AL At least 18 yrs old

ANTIDEPRESSANTS

ANTIDEPRESSANTS, OTHER

bupropion hcl generic 1 AL At least 6 yrs old

BUPROPION HCL SR (200 MG, 100 MG) generic 1 AL At least 6 yrs old

bupropion hcl xl 450 mg tablet generic 1 AL At least 18 yrs old

BUPROPION XL (300 MG, 150 MG) generic 1 AL At least 6 yrs old

chlordiazepoxide-amitriptyline generic 1 AL At least 18 yrs old

MIRTAZAPINE (15 MG TABLET, 45 MGTABLET, 45 MG ODT, 7.5 MG TABLET, 30MG TABLET, 15 MG ODT, 30 MG ODT)


perphenazine-amitriptyline generic 1 AL At least 18 yrs old

SSRIS/SNRIS (SELECTIVE SEROTONIN REUPTAKE INHIBITOR/SEROTONIN AND NOREPINEPHRINEREUPTAKE INHIBITOR)

CITALOPRAM HBR (10 MG/5 ML SOLN, 20MG/10 ML SOL)

generic 1 AL 6.0 to 11.0 yrs old

CITALOPRAM HBR (20 MG, 10 MG, 40 MG) generic 1 AL At least 6 yrs old

desvenlafaxine succinate er generic 1 AL At least 18 yrs old

ESCITALOPRAM OXALATE (10 MG, 5 MG, 20MG)


FLUOXETINE HCL (40 MG, 10 MG, 20 MG) generic 1 AL At least 6 yrs old

fluoxetine 20 mg/5 ml solution generic 1 AL 6.0 to 11.0 yrs old

fluvoxamine maleate generic 1 AL At least 6 yrs old

paroxetine hcl generic 1 AL At least 6 yrs old

sertraline 20 mg/ml oral conc generic 1 AL 6.0 to 11.0 yrs old



SERTRALINE HCL (50 MG, 25 MG, 100 MG) generic 1 AL At least 6 yrs old

trazodone hcl generic 1 AL At least 6 yrs old

TRINTELLIXvortioxetine hydrobromide

BRAND 1PA


venlafaxine hcl generic 1 AL At least 6 yrs old

VENLAFAXINE HCL ER (ER 37.5 MG, ER 75MG, ER 150 MG)


VIIBRYD (10 MG, 20 MG, 40 MG)vilazodone hcl


TRICYCLICS

amitriptyline hcl generic 1 AL At least 12 yrs old

amoxapine generic 1 AL At least 16 yrs old

clomipramine hcl generic 1PA


desipramine hcl generic 1 AL At least 13 yrs old

DOXEPIN HCL (25 MG CAPSULE, 150 MGCAPSULE, 10 MG/ML ORAL CONC, 100 MGCAPSULE, 50 MG CAPSULE, 10 MGCAPSULE, 75 MG CAPSULE)


imipramine hcl generic 1 AL At least 6 yrs old

NORTRIPTYLINE HCL (HCL 75 MG CAP, HCL10 MG CAP, HCL 25 MG CAP, HCL 50 MGCAP, 10 MG/5 ML SOLN)


ANTIEMETICS

ANTIEMETICS, OTHER

DICLEGISdoxylamine succinate/pyridoxine hcl (b6)


meclizine hcl generic 1

METOCLOPRAMIDE HCL (10 MG TABLET, 5MG TABLET, 10 MG/10 ML SOL, 5 MG/5 MLSOLN)

generic 1

perphenazine generic 1 AL At least 6 yrs old

prochlorperazine maleate generic 1

PROMETHAZINE HCL (25 MG generic 1



SUPPOSITORY, 12.5 MG TABLET, 12.5 MGSUPPOS, 50 MG TABLET, 25 MG TABLET)

PROMETHEGANpromethazine hcl

BRAND 1

TRANSDERM-SCOPscopolamine

BRAND 1PA


EMETOGENIC THERAPY ADJUNCTS

APREPITANT (125 MG, 40 MG, 80 MG) generic 1

GRANISETRON HCL (1 MG TABLET, 0.1MG/ML VIAL, 1 MG/ML VIAL)

generic 1

ONDANSETRON HCL (4 MG/5 MLSOLUTION, HCL 4 MG/2 ML VIAL, HCL 8 MGTABLET, HCL 4 MG TABLET, 40 MG/20 MLVIAL, HCL 4 MG/2 ML SYR)

generic 1

ondansetron odt generic 1

ANTIFUNGALS

amphotericin b generic 1

CICLOPIROX (0.77% CREAM, 0.77%TOPICAL SUSP, 8% SOLUTION)

generic 1

CLOTRIMAZOLE (1% SOLUTION, 10 MGTROCHE, 1% TOPICAL CREAM)

generic 1

econazole nitrate generic 1

ERAXIS (WATER DILUENT)anidulafungin

BRAND 1

FLUCONAZOLE (150 MG TABLET, 40 MG/MLSUSP, 10 MG/ML SUSP)

generic 1

FLUCONAZOLE (50 MG, 200 MG, 100 MG) generic 1

FLUCONAZOLE-NACL (200 MG/100 ML, 400MG/200 ML)

generic 1

GRISEOFULVIN (125 MG/5 ML SUSP, MICRO500 MG TAB)

generic 1

GYNAZOLE 1butoconazole nitrate

BRAND 1

KETOCONAZOLE (SHAMPOO, CREAM) generic 1

miconazole 3 generic 1

NYSTATIN (100,000 UNIT/GM CREAM,500,000 UNIT ORAL TAB, 500,000 UNIT/5 MLSUS, 100,000 UNIT/ML SUSP, 100,000

generic 1



UNIT/GM OINT, 100,000 UNIT/GM POWD)

NYSTATIN-TRIAMCINOLONE (CREAM,OINTM)

generic 1

terbinafine hcl generic 1

terconazole 0.4% cream generic 1 QL

terconazole 0.8% cream generic 1 QL

ANTIGOUT AGENTS

allopurinol generic 1

colchicine 0.6 mg capsule generic 1 AL At least 18 yrs old

colchicine 0.6 mg tablet generic 1 AL At least 4 yrs old

probenecid generic 1

probenecid-colchicine generic 1

ANTIMIGRAINE AGENTS

ANTIMIGRAINE AGENTS, OTHER

EMGALITY PENgalcanezumab-gnlm


EMGALITY SYRINGEgalcanezumab-gnlm


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

RIZATRIPTAN (10 MG ODT, 10 MG TABLET,5 MG TABLET, 5 MG ODT)


sumatriptan generic 1 AL At least 18 yrs old

SUMATRIPTAN SUCCINATE (SUCC 50 MGTABLET, 6 MG/0.5 ML VIAL, SUCC 25 MGTABLET, SUCC 100 MG TABLET)


ANTIMYASTHENIC AGENTS

PARASYMPATHOMIMETICS

guanidine hcl generic 1

MESTINON 60 MG/5 ML SYRUPpyridostigmine bromide

BRAND 1

PYRIDOSTIGMINE BROMIDE (BR 30 MGTABLET, BR 60 MG TABLET, 60 MG/5 MLSOLN)

generic 1

1



pyridostigmine bromide er generic

ANTIMYCOBACTERIALS

ANTIMYCOBACTERIALS, OTHER

DAPSONE (100 MG, 25 MG) generic 1

rifabutin generic 1

ANTITUBERCULARS

ethambutol hcl generic 1

ISONIAZID (50 MG/5 ML SOLUTION, 300 MGTABLET, 100 MG TABLET)

generic 1

pyrazinamide generic 1

RIFAMPIN (150 MG CAPSULE, IV 600 MGVIAL, 300 MG CAPSULE)

generic 1

ANTINEOPLASTICS

ALKYLATING AGENTS

ALKERAN 2 MG TABLETmelphalan


BICNUcarmustine

BRAND 1

cisplatin 50 mg vial generic 1

CYCLOPHOSPHAMIDE (25 MG CAPSULE, 50MG CAPSULE, 1 GM VIAL, 500 MG VIAL, 2GM VIAL)

generic 1

ifosfamide generic 1

LEUKERANchlorambucil

BRAND 1

MATULANEprocarbazine hcl

BRAND 1

melphalan hcl generic 1

MYLERANbusulfan

BRAND 1

TEMODAR 100 MG VIALtemozolomide

BRAND 1

temozolomide generic 1

thiotepa 100 mg vial generic 1

TREANDAbendamustine hcl

BRAND 1



ANTIANDROGENS

bicalutamide generic 1 AL At least 18 yrs old

flutamide generic 1 AL At least 18 yrs old

XTANDIenzalutamide


ZYTIGAabiraterone acetate


ANTIANGIOGENIC AGENTS

POMALYSTpomalidomide


REVLIMIDlenalidomide


ANTIESTROGENS/MODIFIERS

tamoxifen citrate generic 1 AL At least 18 yrs old

ANTIMETABOLITES

ALIMTApemetrexed disodium

BRAND 1

cladribine generic 1

cytarabine generic 1

floxuridine generic 1

FLUOROURACIL (5,000 MG/100 ML, 2.5GM/50 ML BTL, 2.5 GM/50 ML VIAL, 500MG/10 ML VIAL, 2,500 MG/50 ML VL, 2%TOPICAL SOLN, 5% CREAM, 5 GM/100 MLBTL, 5 GM/100 ML VIAL, 1,000 MG/20 ML VL,5% TOPICAL SOLN)

generic 1

gemcitabine hcl generic 1

hydroxyurea generic 1

mercaptopurine generic 1

XELODAcapecitabine


ANTINEOPLASTICS, OTHER

azacitidine generic 1

bleomycin sulfate generic 1

bortezomib generic 1

CARBOPLATIN (150 MG/15 ML, 50 MG/5 ML, generic 1



450 MG/45 ML, 600 MG/60 ML)

CISPLATIN (100 MG/100 ML, 50 MG/50 ML,200 MG/200 ML)

generic 1

dacarbazine generic 1

daunorubicin hcl generic 1

decitabine generic 1

dexrazoxane generic 1 AL At least 18 yrs old

docetaxel generic 1 AL At least 18 yrs old

DOXORUBICIN HCL (50 MG, 150 MG/75 ML,20 MG/10 ML, 10 MG/5 ML, 50 MG/25 ML, 200MG/100 ML)

generic 1

doxorubicin hcl liposome generic 1

EPIRUBICIN HCL (HCL 200 MG, 200 MG/100ML, 50 MG/25 ML)

generic 1

fludarabine phosphate generic 1

idarubicin hcl generic 1

IRINOTECAN HCL (100 MG/5 ML VL, 40 MG/2ML VIAL, 500 MG/25 ML VL)

generic 1

LEUCOVORIN CALCIUM (CALCIUM 100 MGVIAL, CALCIUM 10 MG TAB, CALCIUM 5 MGTAB, CALCIUM 25 MG TAB, CALCIUM 200MG VIAL, CALCIUM 50 MG VIAL, CALCIUM350 MG VIAL, CALCIUM 15 MG TAB,CALCIUM 500 MG VL, CAL 100 MG/10 ML VL,CAL 500 MG/50 ML VL)

generic 1

mitomycin generic 1

mitoxantrone hcl generic 1 AL At least 18 yrs old

MUTAMYCINmitomycin

BRAND 1

ONCASPARpegaspargase

BRAND 1

oxaliplatin generic 1

paclitaxel generic 1

PARAPLATINcarboplatin

BRAND 1

thiotepa 15 mg vial generic 1

VALSTARvalrubicin

BRAND 1



vinblastine sulfate generic 1

vincristine sulfate generic 1

vinorelbine tartrate generic 1

ZOLADEXgoserelin acetate

BRAND 1PA


AROMATASE INHIBITORS, 3RD GENERATION

anastrozole generic 1 AL At least 18 yrs old

exemestane generic 1 AL At least 18 yrs old

letrozole generic 1 AL At least 18 yrs old

ENZYME INHIBITORS

ETOPOSIDE (1,000 MG/50 ML, 500 MG/25ML, 100 MG/5 ML)

generic 1

topotecan hcl 4 mg vial generic 1 AL At least 6 yrs old

topotecan hcl 4 mg/4 ml vial generic 1

MOLECULAR TARGET INHIBITORS

imatinib mesylate generic 1 AL At least 1 yrs old

IRESSAgefitinib


SUTENTsunitinib malate


VOTRIENTpazopanib hcl


MONOCLONAL ANTIBODY/ANTIBODY-DRUG CONJUGATE

ARZERRAofatumumab

BRAND 1

CAMPATHalemtuzumab

BRAND 1

RITUXANrituximab

BRAND 1

RETINOIDS

PANRETINalitretinoin

BRAND 1 PA

tretinoin 10 mg capsule generic 1 AL At least 1 yrs old

TREATMENT ADJUNCTS



mesna generic 1

ANTIPARASITICS

ANTIHELMINTHICS

albendazole generic 1

BILTRICIDEpraziquantel

BRAND 1

ivermectin 3 mg tablet generic 1

ANTIPROTOZOALS

atovaquone generic 1

chloroquine phosphate generic 1

hydroxychloroquine sulfate generic 1

mefloquine hcl generic 1

NEBUPENTpentamidine isethionate

BRAND 1

primaquine generic 1

PEDICULICIDES/SCABICIDES

permethrin generic 1

ANTIPARKINSON AGENTS

ANTICHOLINERGICS

BENZTROPINE MESYLATE (1 MG TABLET, 2MG TABLET, 0.5 MG TAB)


TRIHEXYPHENIDYL HCL (5 MG TABLET, 2MG TABLET, 2 MG/5 ML ELX)


ANTIPARKINSON AGENTS, OTHER

AMANTADINE (50 MG/5 ML SOLUTION, 100MG TABLET, 100 MG/10 ML SOLN, 100 MGCAPSULE)


carbidopa-levodopa-entacapone generic 1 AL At least 18 yrs old

DOPAMINE AGONISTS

pramipexole dihydrochloride generic 1 AL At least 18 yrs old

ropinirole hcl generic 1 AL At least 18 yrs old

DOPAMINE PRECURSORS/L-AMINO ACID DECARBOXYLASE INHIBITORS



CARBIDOPA-LEVODOPA (25-250, 10-100, 25-100)


carbidopa-levodopa er generic 1 AL At least 18 yrs old

MONOAMINE OXIDASE B (MAO-B) INHIBITORS

SELEGILINE HCL (5 MG TABLET, 5 MGCAPSULE)


ANTIPSYCHOTICS

1ST GENERATION/TYPICAL

chlorpromazine 25 mg/ml amp generic 1 AL At least 18 yrs old

CHLORPROMAZINE HCL (50 MG, 200 MG,100 MG, 10 MG, 25 MG)


DROPERIDOL (2.5 MG/ML AMPUL, 5 MG/2ML VIAL)


fluphenazine decanoate generic 1 AL At least 18 yrs old

FLUPHENAZINE HCL (10 MG TABLET, 5MG/ML CONC, 5 MG TABLET, 2.5 MG/5 MLELIX, 2.5 MG TABLET, 1 MG TABLET)


fluphenazine 2.5 mg/ml vial generic 1 AL At least 18 yrs old

haloperidol generic 1 AL At least 6 yrs old

HALOPERIDOL DECANOATE (DECAN 50MG/ML AMP, DEC 50 MG/ML VIAL, DEC 500MG/5 ML VL, DEC 100 MG/ML VIAL, DEC 250MG/5 ML VL, DEC 100 MG/ML AMP)


haloperidol decanoate 100 generic 1 AL At least 18 yrs old

HALOPERIDOL LACTATE (50 MG/10 ML VL,5 MG/ML AMPUL, 5 MG/ML VIAL)


haloperidol lac 2 mg/ml conc generic 1 AL At least 6 yrs old

loxapine generic 1 AL At least 18 yrs old

pimozide generic 1 AL At least 18 yrs old

thioridazine hcl generic 1 AL At least 18 yrs old

thiothixene generic 1 AL At least 18 yrs old

trifluoperazine hcl generic 1 AL At least 18 yrs old

2ND GENERATION/ATYPICAL



ABILIFY MAINTENA (ER 300 MG SYR, ER300 MG VL, ER 400 MG VL, ER 400 MG SYR)aripiprazole

BRAND 1PA


ARIPIPRAZOLE (15 MG TABLET, 1 MG/MLSOLUTION, 10 MG TABLET, 30 MG TABLET,5 MG TABLET, 20 MG TABLET, 2 MGTABLET)


ARISTADAaripiprazole lauroxil

BRAND 1PA


ARISTADA INITIOaripiprazole lauroxil, submicronized

BRAND 1PA


FANAPT (10 MG, 1 MG, 2 MG, 6 MG, 8 MG, 4MG, 12 MG)iloperidone


INVEGA SUSTENNApaliperidone palmitate

BRAND 1PA


INVEGA TRINZApaliperidone palmitate

BRAND 1PA


LATUDAlurasidone hcl


OLANZAPINE (20 MG, 10 MG, 5 MG, 2.5 MG,7.5 MG, 15 MG)


olanzapine odt generic 1 AL At least 6 yrs old

PERSERISrisperidone

BRAND 1PA


quetiapine fumarate generic 1 AL At least 6 yrs old

quetiapine fumarate er generic 1 AL At least 6 yrs old

RISPERDAL CONSTArisperidone microspheres

BRAND 1PA


RISPERIDONE (2 MG TABLET, 4 MGTABLET, 0.25 MG TABLET, 1 MG/MLSOLUTION, 1 MG TABLET, 3 MG TABLET,0.5 MG TABLET)


risperidone odt generic 1 AL At least 6 yrs old

ziprasidone hcl generic 1 AL At least 6 yrs old



TREATMENT-RESISTANT

clozapine generic 1 AL At least 6 yrs old

CLOZARILclozapine


ANTISPASTICITY AGENTS

BACLOFEN (10 MG, 20 MG, 5 MG) generic 1

TIZANIDINE HCL (4 MG, 2 MG) generic 1

ANTIVIRALS

ANTI-CYTOMEGALOVIRUS (CMV) AGENTS

ganciclovir sodium generic 1

VALGANCICLOVIR HCL (450 MG TABLET,HCL 50 MG/ML)

generic 1

ANTI-HEPATITIS B (HBV) AGENTS

entecavir generic 1

EPIVIR HBV 25 MG/5 ML SOLNlamivudine


lamivudine hbv generic 1

ANTI-HEPATITIS C (HCV) AGENTS, DIRECT ACTING AGENTS

MAVYRETglecaprevir/pibrentasvir

BRAND 1PA


sofosbuvir-velpatasvir generic 1PA


VOSEVIsofosbuvir/velpatasvir/voxilaprevir

BRAND 1PA


ANTI-HEPATITIS C (HCV) AGENTS, OTHER

INTRON Ainterferon alfa-2b,recomb.

BRAND 1

PEGASYS (180 MCG/ML VIAL, 180 MCG/0.5ML SYRINGE)peginterferon alfa-2a

BRAND 1PA


PEGINTRONpeginterferon alfa-2b

BRAND 1PA


RIBAVIRIN (200 MG CAPSULE, 200 MG generic 1 PA



TABLET) AL At least 5 yrs old

ANTI-HIV AGENTS, INTEGRASE INHIBITORS (INSTI)

BIKTARVYbictegravir sodium/emtricitabine/tenofoviralafenamide fumar

BRAND 1PA


GENVOYAelvitegravir/cobicistat/emtricitabine/tenofoviralafenamide

BRAND 1PA


ISENTRESS (100 MG POWDER PACKET, 25MG TABLET CHEW, 400 MG TABLET, 100MG TABLET CHEW)raltegravir potassium

BRAND 1 PA

ISENTRESS HDraltegravir potassium

BRAND 1 PA

STRIBILDelvitegravir/cobicistat/emtricitabine/tenofovirdisoproxil

BRAND 1PA


TIVICAYdolutegravir sodium

BRAND 1 PA

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

ATRIPLAefavirenz/emtricitabine/tenofovir disoproxilfumarate

BRAND 1PA


COMPLERAemtricitabine/rilpivirine hcl/tenofovir disoproxilfumarate

BRAND 1PA


DELSTRIGOdoravirine/lamivudine/tenofovir disoproxilfumarate

BRAND 1PA


EDURANTrilpivirine hcl

BRAND 1PA


INTELENCEetravirine

BRAND 1 PA

NEVIRAPINE (50 MG/5 ML SUSP, 200 MGTABLET)

generic 1 PA

nevirapine er generic 1 PA

ODEFSEYemtricitabine/rilpivirine hcl/tenofoviralafenamide fumarate

BRAND 1PA


PIFELTRO BRAND 1 PA



doravirine AL At least 18 yrs old

SUSTIVA (200 MG CAPSULE, 600 MGTABLET, 50 MG CAPSULE)efavirenz

BRAND 1 PA

SYMFIefavirenz/lamivudine/tenofovir disoproxilfumarate

BRAND 1 PA

SYMFI LOefavirenz/lamivudine/tenofovir disoproxilfumarate

BRAND 1 PA

VIRAMUNE 50 MG/5 ML SUSPnevirapine

BRAND 1 PA

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

abacavir 300 mg tablet generic 1 PA

abacavir-lamivudine generic 1 PA

CIMDUOlamivudine/tenofovir disoproxil fumarate

BRAND 1 PA

DIDANOSINE (400 MG, 250 MG) generic 1 PA

EMTRIVA (10 MG/ML SOLUTION, 200 MGCAPSULE)emtricitabine

BRAND 1 PA

EPIVIR 10 MG/ML ORAL SOLNlamivudine

BRAND 1 PA

LAMIVUDINE (300 MG TABLET, 150 MGTABLET, 10 MG/ML ORAL SOLN)

generic 1 PA

lamivudine-zidovudine generic 1 PA

RETROVIR 200 MG/20 ML VIALzidovudine

BRAND 1 PA

stavudine generic 1 PA

TEMIXYSlamivudine/tenofovir disoproxil fumarate

BRAND 1 PA

tenofovir disoproxil fumarate generic 1

TRIZIVIRabacavir sulfate/lamivudine/zidovudine

BRAND 1 PA

TRUVADAemtricitabine/tenofovir disoproxil fumarate

BRAND 1 PA

VIDEX 2 GM PEDIATRIC SOLNdidanosine

BRAND 1 PA



VIREAD (POWDER, 200 MG TABLET, 150 MGTABLET, 250 MG TABLET)tenofovir disoproxil fumarate

BRAND 1

ZIAGEN 20 MG/ML SOLUTIONabacavir sulfate

BRAND 1 PA

ZIDOVUDINE (50 MG/5 ML SYRUP, 300 MGTABLET, 100 MG CAPSULE)

generic 1 PA

ANTI-HIV AGENTS, OTHER

DESCOVYemtricitabine/tenofovir alafenamide fumarate

BRAND 1 PA

DOVATOdolutegravir sodium/lamivudine

BRAND 1PA


FUZEONenfuvirtide

BRAND 1PA


JULUCAdolutegravir sodium/rilpivirine hcl

BRAND 1PA


SELZENTRY (20 MG/ML ORAL SOLN, 300MG TABLET, 25 MG TABLET, 150 MGTABLET, 75 MG TABLET)maraviroc

BRAND 1PA


TRIUMEQabacavir sulfate/dolutegravir sodium/lamivudine

BRAND 1PA


TROGARZOibalizumab-uiyk

BRAND 1PA


TYBOSTcobicistat

BRAND 1PA


ANTI-HIV AGENTS, PROTEASE INHIBITORS

APTIVUS (100 MG/ML SOLUTION, 250 MGCAPSULE)tipranavir/vitamin e tpgs

BRAND 1 PA

CRIXIVANindinavir sulfate

BRAND 1 PA

EVOTAZatazanavir sulfate/cobicistat

BRAND 1PA


INVIRASE 500 MG TABLETsaquinavir mesylate

BRAND 1 PA

1



KALETRA (100-25 MG TABLET, 80 MG-20MG/ML SOLN, 200-50 MG TABLET)lopinavir/ritonavir

BRAND PA

LEXIVA (50 MG/ML SUSPENSION, 700 MGTABLET)fosamprenavir calcium

BRAND 1 PA

NORVIR (80 MG/ML SOLUTION, 100 MGTABLET, 100 MG POWDER PACKET)ritonavir

BRAND 1 PA

PREZCOBIXdarunavir ethanolate/cobicistat

BRAND 1PA


PREZISTA (600 MG TABLET, 100 MG/MLSUSPENSION, 150 MG TABLET, 75 MGTABLET, 800 MG TABLET)darunavir ethanolate

BRAND 1 PA

REYATAZ (200 MG CAPSULE, 50 MGPOWDER PACKET, 300 MG CAPSULE, 150MG CAPSULE)atazanavir sulfate

BRAND 1 PA

SYMTUZAdarunavir eth/cobicistat/emtricitabine/tenofoviralafenamide

BRAND 1 PA

VIRACEPTnelfinavir mesylate

BRAND 1 PA

ANTI-INFLUENZA AGENTS

OSELTAMIVIR PHOSPHATE (30 MG, 75 MG,45 MG)

generic 1

oseltamivir 6 mg/ml suspension generic 1 AL Up to 12 yrs old

ANTIHERPETIC AGENTS

acyclovir 200 mg/5 ml susp generic 1 AL Up to 17 yrs old

ACYCLOVIR (200 MG CAPSULE, 400 MGTABLET, 800 MG TABLET)

generic 1

DENAVIRpenciclovir

BRAND 1

trifluridine generic 1

valacyclovir generic 1

ZOVIRAX (OINTMENT, CREAM)acyclovir


ANXIOLYTICS



ANXIOLYTICS, OTHER

buspirone hcl generic 1

BENZODIAZEPINES

alprazolam generic 1 AL At least 7 yrs old

chlordiazepoxide hcl generic 1 AL At least 6 yrs old

CLONAZEPAM (0.5 MG DIS TABLET, 0.25MG ODT, 0.5 MG TABLET, 0.5 MG ODT, 2 MGODT, 0.125 MG ODT, 1 MG ODT, 1 MGTABLET, 1 MG DIS TABLET, 2 MG TABLET,0.125 MG DIS TAB)

generic 1

clorazepate dipotassium generic 1 AL At least 9 yrs old

DIAZEPAM (2 MG TABLET, 10 MG TABLET, 5MG/5 ML SOLUTION, 5 MG TABLET)

generic 1

KLONOPINclonazepam

BRAND 1 PA

lisinopril 5 mg tablet generic 1

LORAZEPAM (4 MG/ML CARPUJECT, 2MG/ML ORAL CONCENT, 0.5 MG TABLET, 4MG/ML VIAL, 2 MG/ML VIAL, 1 MG TABLET, 2MG/ML CARPUJECT, 20 MG/10 ML VIAL, 2MG TABLET)

generic 1

LORAZEPAM INTENSOLlorazepam

BRAND 1

oxazepam generic 1 AL At least 6 yrs old

BIPOLAR AGENTS

MOOD STABILIZERS

EQUETROcarbamazepine

BRAND 1PA


LITHIUM CARBONATE (300 MG TAB, 600 MGCAP, 150 MG CAP, 300 MG CAP)


lithium carbonate er generic 1 AL At least 6 yrs old

BLOOD GLUCOSE REGULATORS

ANTIDIABETIC AGENTS

acarbose generic 1

BYDUREON PEN BRAND 1



exenatide microspheres

BYETTAexenatide

BRAND 1

FARXIGAdapagliflozin propanediol

BRAND 1

FORTAMETmetformin hcl

BRAND 1

glimepiride generic 1

glipizide generic 1

glipizide er generic 1

glipizide xl generic 1

glipizide-metformin generic 1

GLUMETZAmetformin hcl

BRAND 1

glyburide generic 1

glyburide micronized generic 1

glyburide-metformin hcl generic 1

GLYSETmiglitol

BRAND 1

GLYXAMBIempagliflozin/linagliptin


INVOKAMETcanagliflozin/metformin hcl

BRAND 1

INVOKANAcanagliflozin

BRAND 1

JANUMETsitagliptin phosphate/metformin hcl


JANUMET XRsitagliptin phosphate/metformin hcl


JANUVIAsitagliptin phosphate


JARDIANCEempagliflozin

BRAND 1

JENTADUETOlinagliptin/metformin hcl


KOMBIGLYZE XRsaxagliptin hcl/metformin hcl


metformin er gastric generic 1



metformin er osmotic generic 1

METFORMIN HCL (1,000 MG, 850 MG, 500MG)

generic 1

metformin hcl er generic 1

ONGLYZAsaxagliptin hcl


pioglitazone hcl generic 1

repaglinide generic 1

TRADJENTAlinagliptin


GLYCEMIC AGENTS

GLUCAGEN 1 MG HYPOKITglucagon,human recombinant

BRAND 1 QL

GLUCAGEN DIAGNOSTIC 1 MG VIALglucagon,human recombinant

BRAND 1

GLUCAGON EMERGENCY KITglucagon hcl

BRAND 1

glucagon hcl generic 1

PROGLYCEMdiazoxide

BRAND 1

INSULINS

BASAGLAR KWIKPEN U-100insulin glargine,human recombinant analog

BRAND 1

HUMALOG (100 UNITS/ML CARTRIDGE, 100UNIT/ML VIAL)insulin lispro

BRAND 1

HUMALOG KWIKPEN U-100insulin lispro

BRAND 1

HUMALOG MIX 50-50insulin lispro protamine and insulin lispro

BRAND 1

HUMALOG MIX 50-50 KWIKPENinsulin lispro protamine and insulin lispro

BRAND 1

HUMALOG MIX 75-25insulin lispro protamine and insulin lispro

BRAND 1

HUMALOG MIX 75-25 KWIKPENinsulin lispro protamine and insulin lispro

BRAND 1

LANTUSinsulin glargine,human recombinant analog

BRAND 1

LANTUS SOLOSTAR BRAND 1



insulin glargine,human recombinant analog

LEVEMIRinsulin detemir

BRAND 1

LEVEMIR FLEXTOUCHinsulin detemir

BRAND 1

NOVOLOG (100 CARTRIDGE, 100 VIAL)insulin aspart

BRAND 1

NOVOLOG FLEXPENinsulin aspart

BRAND 1

NOVOLOG MIX 70-30insulin aspart protamine human/insulin aspart

BRAND 1

NOVOLOG MIX 70-30 FLEXPENinsulin aspart protamine human/insulin aspart

BRAND 1

BLOOD PRODUCTS/MODIFIERS/VOLUME EXPANDERS

ANTICOAGULANTS

CATHFLO ACTIVASEalteplase

BRAND 1

COUMADINwarfarin sodium

BRAND 1

ELIQUIS (5 MG TABLET, 2.5 MG TABLET,DVT-PE TREAT START 5MG)apixaban


ENOXAPARIN SODIUM (150 MG/MLSYRINGE, 80 MG/0.8 ML SYR, 300 MG/3 MLVIAL, 120 MG/0.8 ML SYR, 30 MG/0.3 MLSYR, 60 MG/0.6 ML SYR, 100 MG/MLSYRINGE, 40 MG/0.4 ML SYR)

generic 1

heparin 500 unit/5 ml (100/ml) generic 1

HEPARIN SODIUM (SOD 5,000 UNIT/0.5 ML,2,000 UNIT/2 ML VIAL, 5,000 UNIT/MLCARPUJCT, SOD 1,000 UNIT/ML VIAL, SOD10,000 UNIT/ML VL, SOD 5,000 UNIT/MLVIAL, SOD 5,000 UNIT/ML SYRG, SOD 20,000UNIT/ML VL, SOD 5,000 UNIT/ 0.5 ML)

generic 1

heparin 1,000 unit/500 ml-ns generic 1

JANTOVENwarfarin sodium

BRAND 1

PRADAXAdabigatran etexilate mesylate


warfarin sodium generic 1

1



XARELTO (2.5 MG TABLET, 15 MG TABLET,20 MG TABLET, STARTER PACK, 10 MGTABLET)rivaroxaban

BRAND AL At least 18 yrs old

BLOOD FORMATION MODIFIERS

anagrelide hcl generic 1

ARANESP (500 MCG/1 ML SYRINGE, 150MCG/0.3 ML SYRINGE, 100 MCG/ML VIAL, 60MCG/0.3 ML SYRINGE, 25 MCG/ML VIAL, 40MCG/ML VIAL, 40 MCG/0.4 ML SYRINGE, 300MCG/0.6 ML SYRINGE, 10 MCG/0.4 MLSYRINGE, 300 MCG/ML VIAL, 200 MCG/0.4ML SYRINGE, 100 MCG/0.5 ML SYRINGE, 25MCG/0.42 ML SYRING, 200 MCG/ML VIAL, 60MCG/ML VIAL)darbepoetin alfa in polysorbate 80

BRAND 1 PA

GRANIX (300 MCG/ML VIAL, 300 MCG/0.5 MLSYRINGE, 300 MCG/0.5 ML SAFE SYR, 480MCG/0.8 ML SYRINGE, 480 MCG/0.8 MLSAFE SYR, 480 MCG/1.6 ML VIAL)tbo-filgrastim

BRAND 1 PA

LEUKINEsargramostim

BRAND 1 PA

NEULASTA (6 ML SYRINGE, ONPRO 6 MLKIT)pegfilgrastim

BRAND 1 PA

NEUPOGEN (300 MCG/ML VIAL, 300MCG/0.5 ML SYR, 480 MCG/1.6 ML VIAL, 480MCG/0.8 ML SYR)filgrastim

BRAND 1 PA

PROCRITepoetin alfa

BRAND 1 PA

HEMOSTASIS AGENTS

ADVATEantihemophilic factor (fviii) recombinant,fulllength

BRAND 1

ADYNOVATEantihemophilic factor (fviii) recombinant, fulllength, peg

BRAND 1

AFSTYLAantihemophilic factor viii recomb,single-chn,b-dom truncated

BRAND 1

ALPHANATEantihemophilic factor, human/von willebrandfactor,human

BRAND 1



ALPHANINE SDfactor ix

BRAND 1

ALPROLIXfactor ix recombinant, fc fusion protein

BRAND 1

AMICAR (500 MG TABLET, 1,000 MGTABLET, 0.25 GRAM/ML ORAL SOLN)aminocaproic acid

BRAND 1

aminocaproic acid 5 g/20 ml vl generic 1

BENEFIXfactor ix human recombinant

BRAND 1

COAGADEXcoagulation factor x

BRAND 1

CORIFACTfactor xiii

BRAND 1

ELOCTATEantihemophilic factor (fviii) recombinant, fcfusion protein

BRAND 1

ESPEROCTantihemophilic factor (fviii) rec, b-dom truncatedpeg-exei

BRAND 1

FEIBA NFanti-inhibitor coagulant complex

BRAND 1

HEMLIBRAemicizumab-kxwh

BRAND 1

HEMOFIL Mantihemophilic factor, human

BRAND 1

HUMATE-Pantihemophilic factor, human/von willebrandfactor,human

BRAND 1

IDELVIONfactor ix recombinant,albumin fusion protein

BRAND 1

IXINITY (3,000, 2,000, 250)factor ix human recombinant, threonine 148

BRAND 1

JIVIantihemophilic factor (fviii) rec, b-domaindeleted peg-aucl


KOATEantihemophilic factor, human

BRAND 1

KOGENATE FSantihemophilic factor (fviii) recombinant,fulllength

BRAND 1

KOVALTRY BRAND 1



antihemophilic factor (fviii) recombinant,fulllength

MEPHYTONphytonadione (vit k1)

BRAND 1

MONONINEfactor ix

BRAND 1

NOVOEIGHTantihemophilic factor viii recombinant, b-domaintruncated

BRAND 1

NOVOSEVEN RTcoagulation factor viia (recombinant)

BRAND 1

NUWIQantihemophilic factor viii rec hek cell, b-domaindeleted

BRAND 1

OBIZURantihemophilic factor viii, recombinant porcinesequence

BRAND 1

PHYTONADIONE (1 MG/0.5 ML SYR, 10MG/ML AMPUL)

generic 1

PROFILNINEfactor ix complex, prothrombin cplx conc(pcc)no.4, 3-factor

BRAND 1

REBINYNfactor ix (human) recombinant, pegylated

BRAND 1

RECOMBINATEantihemophilic factor viii, human recombinant

BRAND 1

RIXUBISfactor ix human recombinant

BRAND 1

TRANEXAMIC ACID (650 MG TABLET, 1,000MG/10 ML)

generic 1

tranexamic acid-nacl generic 1

TRETTENfactor xiii a-subunit, recombinant

BRAND 1

vitamin k1 generic 1

VONVENDIvon willebrand factor (recombinant)

BRAND 1

WILATE (500-500, 1,000-1,000)antihemophilic factor, human/von willebrandfactor,human

BRAND 1

XYNTHAantihemophilic factor (factor viii) recomb,b-domain deleted

BRAND 1



XYNTHA SOLOFUSEantihemophilic factor (factor viii) recomb,b-domain deleted

BRAND 1

PLATELET MODIFYING AGENTS

AGGRENOXaspirin/dipyridamole

BRAND 1

BRILINTAticagrelor

BRAND 1

cilostazol generic 1

clopidogrel 75 mg tablet generic 1

DIPYRIDAMOLE (75 MG, 25 MG, 50 MG) generic 1

prasugrel hcl generic 1

CARDIOVASCULAR AGENTS

ALPHA-ADRENERGIC AGONISTS

CATAPRES-TTS 1clonidine

BRAND 1


BRAND 1


BRAND 1

CLONIDINE HCL (0.3 MG, 0.2 MG, 0.1 MG) generic 1

guanfacine hcl generic 1

methyldopa generic 1

midodrine hcl generic 1

ALPHA-ADRENERGIC BLOCKING AGENTS

doxazosin mesylate generic 1

prazosin hcl generic 1

terazosin hcl generic 1

ANGIOTENSIN II RECEPTOR ANTAGONISTS

irbesartan generic 1

losartan potassium generic 1

olmesartan medoxomil generic 1

ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS

benazepril hcl generic 1

1



enalapril maleate generic

fosinopril sodium generic 1

LISINOPRIL (10 MG, 30 MG, 40 MG, 2.5 MG,20 MG)

generic 1

quinapril hcl generic 1

ramipril generic 1

ANTIARRHYTHMICS

AMIODARONE HCL (200 MG, 100 MG) generic 1

flecainide acetate generic 1

mexiletine hcl generic 1

propafenone hcl generic 1

quinidine sulfate generic 1

sotalol generic 1

sotalol af generic 1

TIKOSYNdofetilide

BRAND 1

BETA-ADRENERGIC BLOCKING AGENTS

acebutolol hcl generic 1

atenolol generic 1

bisoprolol fumarate generic 1

carvedilol generic 1

LABETALOL HCL (100 MG, 200 MG, 300 MG) generic 1

metoprolol succinate generic 1

METOPROLOL TARTRATE (50 MG, 100 MG,25 MG)

generic 1

PROPRANOLOL HCL (20 MG/5 ML SOLN, 40MG TABLET, 10 MG TABLET, 20 MGTABLET, 40 MG/5 ML SOLN, 60 MG TABLET,80 MG TABLET)

generic 1

propranolol hcl er generic 1

CALCIUM CHANNEL BLOCKING AGENTS

amlodipine besylate generic 1

diltiazem 12hr er generic 1

diltiazem 24hr er generic 1

1



diltiazem 24hr er (cd) generic

DILTIAZEM HCL (90 MG, 30 MG, 60 MG, 120MG)

generic 1

felodipine er generic 1

nifedipine generic 1

nifedipine er generic 1

nimodipine generic 1 AL At least 18 yrs old

VERAPAMIL ER (ER 240 MG CAPSULE, ER240 MG TABLET, ER 120 MG CAPSULE, ER120 MG TABLET, ER 180 MG TABLET, ER180 MG CAPSULE)

generic 1

VERAPAMIL HCL (80 MG TABLET, 40 MGTABLET, 360 MG CAP PELLET, 120 MGTABLET)

generic 1

verapamil sr generic 1

CARDIOVASCULAR AGENTS, OTHER

amiloride-hydrochlorothiazide generic 1

amlodipine besylate-benazepril generic 1

amlodipine-olmesartan generic 1

amlodipine-valsartan generic 1

atenolol-chlorthalidone generic 1

bisoprolol-hydrochlorothiazide generic 1

DIGOXIN (0.05 MG/ML SOLUTION, 125 MCGTABLET, 0.125 MG TABLET, 250 MCGTABLET, 0.25 MG TABLET)

generic 1

dobutamine 250 mg/20 ml vial generic 1

dobutamine hcl in dextrose generic 1

enalapril-hydrochlorothiazide generic 1

ENTRESTOsacubitril/valsartan

BRAND 1

fosinopril-hydrochlorothiazide generic 1

lisinopril-hydrochlorothiazide generic 1

losartan-hydrochlorothiazide generic 1

milrinone in 5% dextrose generic 1

milrinone lactate generic 1

pentoxifylline generic 1



quinapril-hydrochlorothiazide generic 1

RANEXAranolazine

BRAND 1

spironolactone-hctz generic 1

TRIAMTERENE-HYDROCHLOROTHIAZID(75-50 MG TAB, 37.5-25 MG CP, 37.5-25 MGTB)

generic 1

DIURETICS, CARBONIC ANHYDRASE INHIBITORS

acetazolamide generic 1

acetazolamide er generic 1

DIURETICS, LOOP

BUMETANIDE (1 MG/4 ML VIAL, 1 MGTABLET, 0.5 MG TABLET, 2.5 MG/10 MLVIAL, 2 MG TABLET)

generic 1

FUROSEMIDE (100 MG/10 ML SYRING, 80MG TABLET, 20 MG TABLET, 40 MG/4 MLVIAL, 40 MG/4 ML SYRINGE, 40 MG/5 MLSOLN, 10 MG/ML SOLUTION, 40 MGTABLET, 100 MG/10 ML VIAL, 20 MG/2 MLVIAL)

generic 1

torsemide generic 1

DIURETICS, POTASSIUM-SPARING

amiloride hcl generic 1

eplerenone generic 1

spironolactone generic 1

DIURETICS, THIAZIDE

chlorthalidone generic 1

DIURILchlorothiazide


HYDROCHLOROTHIAZIDE (12.5 MG TB, 50MG TAB, 12.5 MG CP, 25 MG TAB)

generic 1

indapamide generic 1

metolazone generic 1

DYSLIPIDEMICS, FIBRIC ACID DERIVATIVES

FENOFIBRATE (145 MG, 48 MG) generic 1

gemfibrozil generic 1

DYSLIPIDEMICS, HMG COA REDUCTASE INHIBITORS



atorvastatin calcium generic 1

lovastatin generic 1

pravastatin sodium generic 1

rosuvastatin calcium generic 1

SIMVASTATIN (20 MG, 40 MG, 5 MG, 80 MG,10 MG)

generic 1

DYSLIPIDEMICS, OTHER

CHOLESTYRAMINE (POWDER, PACKET) generic 1

CHOLESTYRAMINE LIGHT (POWDER,PACKET)

generic 1

COLESTID (PACKET, FLAVORED, )colestipol hcl

BRAND 1

COLESTIPOL HCL (HCL GRANULES,MICRONIZED 1 GM TAB, HCL GRANULESPACKET, HCL 1 GM TABLET)

generic 1

ezetimibe generic 1 AL At least 10 yrs old

niacin er generic 1

VASODILATORS, DIRECT-ACTING ARTERIAL

HYDRALAZINE HCL (25 MG, 10 MG, 100 MG,50 MG)

generic 1

minoxidil generic 1

VASODILATORS, DIRECT-ACTING ARTERIAL/VENOUS

isosorbide dinitrate generic 1

isosorbide mononitrate generic 1

isosorbide mononitrate er generic 1

NITROGLYCERIN (0.6 MG, 0.3 MG, 0.4 MG) generic 1

nitroglycerin patch generic 1

CENTRAL NERVOUS SYSTEM AGENTS

ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, AMPHETAMINES

DEXTROAMPHETAMINE SULFATE (10 MG, 5MG)

generic 1

dextroamphetamine-amphet er generic 1 AL At least 6 yrs old

dextroamphetamine-amphetamine generic 1 AL At least 3 yrs old

DYANAVEL XR BRAND 1 AL At least 6 yrs old



amphetamine

VYVANSE (10 MG CHEWABLE TABLET, 60MG CAPSULE, 60 MG CHEWABLE TABLET,20 MG CAPSULE, 50 MG CAPSULE, 30 MGCAPSULE, 20 MG CHEWABLE TABLET, 10MG CAPSULE, 30 MG CHEWABLE TABLET,40 MG CHEWABLE TABLET, 70 MGCAPSULE, 40 MG CAPSULE, 50 MGCHEWABLE TABLET)lisdexamfetamine dimesylate


ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, NON-AMPHETAMINES

APTENSIO XRmethylphenidate hcl


atomoxetine hcl generic 1 AL At least 6 yrs old

DAYTRANAmethylphenidate


dexmethylphenidate hcl generic 1

FOCALIN XRdexmethylphenidate hcl


guanfacine hcl er generic 1

METHYLPHENIDATE ER (ER 20 MG, ER 10MG)


METHYLPHENIDATE HCL (5 MG, 20 MG, 10MG)

generic 1

methylphenidate hcl cd generic 1 AL At least 6 yrs old

methylphenidate hcl er (cd) generic 1 AL At least 6 yrs old

QUILLICHEW ERmethylphenidate hcl


QUILLIVANT XRmethylphenidate hcl


CENTRAL NERVOUS SYSTEM, OTHER

AUSTEDOdeutetrabenazine

BRAND 1PA


BUTALBITAL-ACETAMINOPHEN (50-325, 50-300)

generic 1

butalbital-acetaminophen-caffe generic 1

INGREZZAvalbenazine tosylate

BRAND 1PA




NUEDEXTAdextromethorphan hbr/quinidine sulfate


riluzole generic 1

tetrabenazine generic 1PA


FIBROMYALGIA AGENTS

duloxetine hcl generic 1 AL At least 6 yrs old

PREGABALIN (200 MG, 100 MG, 225 MG, 75MG, 25 MG, 150 MG, 50 MG, 300 MG)

generic 1

MULTIPLE SCLEROSIS AGENTS

AUBAGIOteriflunomide


AVONEX PREFILLED SYR 30 MCG KTinterferon beta-1a


AVONEX PENinterferon beta-1a


BETASERON (0.3 MG VIAL, 0.3 MG KIT)interferon beta-1b


COPAXONE 20 MG/ML SYRINGEglatiramer acetate


dalfampridine er generic 1 AL At least 18 yrs old

GILENYAfingolimod hcl


REBIFinterferon beta-1a/albumin human

BRAND 1

REBIF REBIDOSEinterferon beta-1a/albumin human

BRAND 1

TECFIDERAdimethyl fumarate


DENTAL AND ORAL AGENTS

chlorhexidine gluconate generic 1

PILOCARPINE HCL (7.5 MG, 5 MG) generic 1

sodium fluoride 1.1% gel generic 1

triamcinolone 0.1% paste generic 1

DERMATOLOGICAL AGENTS



acitretin generic 1

ALA-QUINclioquinol/hydrocortisone

BRAND 1

AMMONIUM LACTATE (CREAM, LOTION) generic 1

AMNESTEEMisotretinoin


AVITA 0.025% CREAMtretinoin


CALCIPOTRIENE (CREAM, OINTMENT) generic 1PA


calcitriol 3 mcg/g ointment generic 1

CLARAVISisotretinoin


clinda-benzoyl perox 1-5% pump generic 1 AL At least 12 yrs old

clotrimazole-betamethasone crm generic 1

CORTISPORIN (CREAM, OINTMENT)neomycin/bacitracin/polymyxinb/hydrocortisone

BRAND 1

COSENTYX (2 SYRINGES)secukinumab

BRAND 1PA


COSENTYX PENsecukinumab

BRAND 1PA


COSENTYX PEN (2 PENS)secukinumab

BRAND 1PA


COSENTYX SYRINGEsecukinumab

BRAND 1PA


diclofenac sodium 1% gel generic 1

diclofenac sodium 3% gel generic 1PA


DIFFERIN (LOTION, CREAM)adapalene


doxepin 5% cream generic 1PA


ELIDELpimecrolimus

BRAND 1



EUCRISAcrisaborole


FINACEA 15% GELazelaic acid

BRAND 1

imiquimod 5% cream packet generic 1 AL At least 12 yrs old

isotretinoin generic 1 AL At least 12 yrs old

LIDOCAINE-HYDROCORTISONE (2.8-0.55%GEL, 3-0.5% CREAM)

generic 1

lidocaine-hc 3-2.5% gel kit generic 1 QL

METRONIDAZOLE (0.75% CREAM, TOPICAL0.75% GL, TOPICAL 1% GEL, TOP 1% GELPUMP)

generic 1

MYORISANisotretinoin


NATROBAspinosad

BRAND 1

podofilox generic 1

PROCTOFOAM-HChydrocortisone acetate/pramoxine hcl

BRAND 1

PROTOPIC 0.03% OINTMENTtacrolimus

BRAND 1

PROTOPIC 0.1% OINTMENTtacrolimus


RETIN-A (0.025%, 0.05%, 0.1%)tretinoin


salicylic acid 6% cream generic 1

SANTYLcollagenase clostridium histolyticum

BRAND 1

SELENIUM SULFIDE (2.25% SHAMPOO,2.5% LOTION)

generic 1

silver nitrate 0.5% soln generic 1

UREA (CREAM, LOTION) generic 1

ZENATANEisotretinoin


ELECTROLYTES/MINERALS/METALS/VITAMINS

ELECTROLYTE/MINERAL REPLACEMENT



AMINOSYN (8.5%, 10%)parenteral amino acid 10 % combination no.2

BRAND 1

AMINOSYN II (15%, 7%, 8.5%, 10%)parenteral amino acid 7 % combination no.2

BRAND 1

AMINOSYN II WITH ELECTROLYTESamino acids 8.5 %/electrolyte-tpn soln

BRAND 1

AMINOSYN Mamino acids 3.5 %/electrolyte-m solution

BRAND 1

AMINOSYN WITH ELECTROLYTES (8.5%-ELECTROLYTES, 7%-ELECTROLYTE)amino acids 8.5 %/electrolyte-tpn soln

BRAND 1

AMINOSYN-HBCamino acids 7 %

BRAND 1

AMINOSYN-PF (10%, 7%)parenteral amino acid 7 % combination no.1(pediatric)

BRAND 1

AMINOSYN-RFparenteral amino acid 5.2 % combination no.1(renal)

BRAND 1

calcium chloride 10% vial generic 1

CALCIUM GLUCONATE (10,000 MG/100 ML,5,000 MG/50 ML VL, 1,000 MG/10 ML VL)

generic 1

CENTRATEXferrous fumarate/folic acid/multivitamin-minerals no.15

BRAND 1

chromium generic 1

CLINIMIX (5%-20%, 4.25%-5%, 4.25%-10%,5%-15%)amino acids 4.25 %/dextrose 10 % in water

BRAND 1

CLINIMIX E (5%-15%, 4.25%-10%, 2.75%-5%,4.25%-5%, 5%-20%)amino acids 5 %/calcium/electrolyte-tpnsoln/dextrose 20 %

BRAND 1

CLINISOLparenteral amino acid 15% combination no.5

BRAND 1

copper chloride generic 1

DELFLEX WITH 1.5% DEXTROSEperitoneal dialysis solution no.19 and dextrose1.5 %

BRAND 1

dextrose 10%-0.2% nacl generic 1




dextrose 2.5%-0.45% nacl generic 1


dextrose 5%-0.2% nacl-kcl generic 1









dextrose 5%-1/2ns-kcl generic 1

dextrose 5%-1/4ns-kcl generic 1

dextrose 5%-electrolyte #48 generic 1

dextrose 5%-ns-kcl generic 1

dextrose 5%-potassium chloride generic 1

dextrose in lactated ringers generic 1

DEXTROSE IN WATER (10%-WATER IVSOLUTION, 20%-WATER IV SOLN, 70%-WATER IV SOLN, 5%-WATER VIAL, 50%-WATER IV SOLN, 50%-WATER ABBOJECT,50%-WATER VIAL, 50%-WATER SYRINGE,40%-WATER IV SOLN, 5%-WATER 50 ML,25%-WATER SYRINGE, 5%-WATER 100 ML,30%-WATER IV SOLN, 5%-WATER IV SOLN)

generic 1

EFFER-Kpotassium bicarbonate/citric acid

BRAND 1

fluoride generic 1

FREAMINE IIIparenteral amino acid 10 % combination no.4

BRAND 1

FUSION PLUSiron fum,polysac comp/folic acid/vit b compcno.18/l. casei

BRAND 1

glucose in water generic 1

HEMATOGEN FAferrous fumarate/ascorbicacid/cyanocobalamin/folic acid

BRAND 1

HEMOCYTE PLUS BRAND 1



ferrous fumarate/folic acid/multivitamin-minerals no.15

HEMOCYTE-Fferrous fumarate/folic acid

BRAND 1

HEPATAMINEamino acids 8 %

BRAND 1

HYPERLYTE CRsodium/potassium/magnesium/calcium/chloride/acetate

BRAND 1

IFEREX 150 FORTEiron polysaccharidecomplex/cyanocobalamin/folic acid

BRAND 1

INTEGRA Firon fumarate,polysac comp/folic acid/vitaminc/niacinamide

BRAND 1

INTEGRA PLUSiron fumarate,polysac cplex/folic acid/vitb compwith c no.9

BRAND 1

INTRALIPIDfat emulsions

BRAND 1

IODOPENsodium iodide

BRAND 1

IONOSOL B WITH DEXTROSE 5%electrolyte-b solution/dextrose 5 % in water

BRAND 1

IONOSOL MB-DEXTROSE 5%electrolyte-mb solution/dextrose 5 % in water

BRAND 1

ISOLYTE P WITH DEXTROSEelectrolyte-p solution/dextrose 5 % in water

BRAND 1

ISOLYTE S (OLUTION-EXCEL, OLN PH7.4)electrolyte-s solution

BRAND 1

KLOR-CONpotassium chloride

BRAND 1

KLOR-CON 10potassium chloride

BRAND 1

KLOR-CON 8potassium chloride

BRAND 1

KLOR-CON M10potassium chloride

BRAND 1


BRAND 1


BRAND 1



KLOR-CON-EFpotassium bicarbonate/citric acid

BRAND 1

LACTATED RINGERS (IRRIGATION,INJECTION)

generic 1

LEVOCARNITINE (1 G/10 ML SOLN, 330 MGTABLET)

generic 1

magnesium chloride generic 1

MAGNESIUM SULFATE (SULF 2 G/50 MLBAG, SULF 40 G/1,000 ML, SULF 4 G/100 MLBAG, SULFATE 50% VIAL, SULF 4 G/50 MLBAG, SULF 20 G/500 ML BAG)

generic 1

manganese chloride generic 1

manganese sulfate generic 1

MULTITRACE-4zinc sulfate/cupric sulfate/manganesesulf/chromic chloride

BRAND 1

MULTITRACE-5zinc sulfate/coppersulfate/manganese/chromium/selenium

BRAND 1

NEPHRAMINEamino acids 5.4 %

BRAND 1

NORMOSOL-M AND DEXTROSEelectrolyte-m solution/dextrose 5 % in water

BRAND 1

NORMOSOL-Relectrolyte-r solution

BRAND 1

NORMOSOL-R AND DEXTROSEelectrolyte-r solution/dextrose 5 % in water

BRAND 1

NORMOSOL-R PH 7.4electrolyte-r (ph 7.4)

BRAND 1

NUTRILIPIDfat emulsions

BRAND 1

PLASMA-LYTE 148electrolyte-148 solution

BRAND 1

PLASMA-LYTE A PH 7.4electrolyte-a solution

BRAND 1

PLENAMINEparenteral amino acid 15% combination no.1

BRAND 1

potassium acetate generic 1

potassium chl-normal saline generic 1

POTASSIUM CHLORIDE (ER 10 MEQ generic 1



TABLET, 20 MEQ PACKET, 40 MEQ/20 MLCONC, 60 MEQ/30 ML CONC, 10% (20MEQ/15ML), 20 MEQ/10 ML CONC, 10MEQ/50 ML SOL, ER 8 MEQ CAPSULE, 20MEQ/50 ML SOL, ER 8 MEQ TABLET, 10MEQ/100 ML SOL, ER 10 MEQ CAPSULE, 2MEQ/ML CONC, 20% (40 MEQ/15ML), 30MEQ/100 ML SOL, 10% (40 MEQ/30ML), 40MEQ/100 ML SOL, 10 MEQ/5 ML CONC, ER20 MEQ TABLET, 20 MEQ/100 ML SOL)

potassium chloride in d5lr generic 1

potassium chloride-nacl generic 1

potassium phosp 45 mmol/15 ml generic 1

potassium phosphates generic 1

PREMASOL 10% IV SOLUTIONparenteral amino acid 10% combination no.7

BRAND 1

PROCALAMINEamino acids 3 %/electrolyte-tpn soln/glycerin

BRAND 1

PROSOLparenteral amino acid 20 % combination no.1

BRAND 1

PUREVIT DUALFE PLUSiron fumarate-iron polysacch cplex/folicacid/multivit no.18

BRAND 1

ringers injection generic 1

ringers irrigation generic 1

SE-TAN PLUSiron fumarate-iron polysacch cplex/folicacid/multivit no.18

BRAND 1

SODIUM ACETATE (400 MEQ/100 ML, 200MEQ/100 ML, 100 MEQ/50 ML, 40 MEQ/20 MLVL)

generic 1

sodium bicarbonate 4.2% vial generic 1

SODIUM CHLORIDE (SODIUM CHLORIDE5% IV SOLN, SODIUM CHLORIDE 0.9% 50ML, SODIUM CHLORIDE 0.9% IRRIG.,SODIUM CHLORIDE 4 MEQ/ML VL, SODIUMCHLORIDE 3% IV SOLN, SODIUM CHLORIDE0.9% PRCSS SOL, SODIUM CHLORIDE 50MEQ/20 ML, SALINE 0.45% SOLN-EXCELCON, SODIUM CHLORIDE 0.9% SOLN,SODIUM CHLORIDE 0.9% 500 ML, SODIUMCHLORIDE 0.9% 1,000 ML, SODIUMCHLORIDE 0.9% SOL-EXCEL, SODIUMCHLORIDE 0.9% VIAL, SODIUM CHLORIDE

generic 1



0.9% SOLUTION, SODIUM CHLORIDE 0.45%SOLN, SODIUM CHLORIDE 0.9% IRRIG,SODIUM CHLORIDE 100 MEQ/40 ML,SODIUM CHLORIDE 0.9% 100 ML)

sodium fluoride 0.5 mg/ml drop generic 1

sodium phosphate generic 1

SYNTHAMIN 17 WITHOUT ELTYEparenteral amino acid 10 % combination no.6

BRAND 1

TANDEM PLUSiron fumarate-iron polysacch cplex/folicacid/multivit no.18

BRAND 1

TIS-U-SOL PENTALYTEsodium chloride/pot chloride/mag sul/sodphos,db/pot phos,mb

BRAND 1

TPN ELECTROLYTESsodium/potassium/magnesium/calcium/chloride/acetate

BRAND 1

TPN ELECTROLYTES IIsodium/potassium/magnesium/calcium/chloride/acetate

BRAND 1

TRAVASOLparenteral amino acid 10 % combination no.6

BRAND 1

TRICONferrous fumarate/ascorbic acid/b12-if/folic acid

BRAND 1

TROPHAMINE 10% IV SOLUTIONamino acids 10 %

BRAND 1

zinc chloride generic 1

ZINC SULFATE (30 MG/10 ML, 25 MG/5 ML) generic 1

ELECTROLYTE/MINERAL/METAL MODIFIERS

deferoxamine mesylate generic 1

SODIUM POLYSTYRENE SULFONATE(SODIUM POLYSTYRENE POWDER, SODPOLYSTYREN 15 G/60 ML)

generic 1

SPS (15 GM/60 ML SUSPENSION, 30 GM/120ML ENEMA SUSP)sodium polystyrene sulfonate/sorbitol solution

BRAND 1

PHOSPHATE BINDERS

CALCIUM ACETATE (667 MG CAPSULE, 667MG GELCAP)

generic 1

RENVELA (0.8, 2.4)sevelamer carbonate




sevelamer hcl generic 1

VITAMINS

ascorbic acid generic 1

BACMINmultivitamin with minerals no.20/iron/folic acid

BRAND 1

CITRANATAL B-CALMprenatal vitaminno.48/iron,carbonyl,gluconate/folic acid/b6


COMPLETE NATAL DHAprenatal vit no.2/iron bg chel,succ-prot/folicacid/omega-3


CONCEPT DHAmv-min 75/ferrous fum/iron ps cplx/folicac/omega-3/dha/epa


CONCEPT OBmv-mins no.74/ferrous fumarate/iron pscplx/folic acid


cyanocobalamin injection generic 1

DIALYVITEfolic acid/vitamin b complex and vitamin c

BRAND 1

DIALYVITE 3000folic acid/vitamin b comp andc/selenium/minerals/zinc

BRAND 1

DIALYVITE 5000multivitamins with minerals no.11/folic acid

BRAND 1

DIALYVITE SUPREME Dmultivitamin-minerals no.25/folic acid/vitamind3

BRAND 1

DIALYVITE ZINCvitamin b complex no.11/folic acid/vitc/biotin/zinc oxide

BRAND 1

FOLIC ACID (5 MG/ML VIAL, 1 MG TABLET) generic 1

FOLIVANE-OBmv-mins no.74/ferrous fumarate/iron pscplx/folic acid


FOLTRATEcyanocobalamin/folic acid

BRAND 1

INFUVITE ADULT VIALmultivitamin infusion, adult no.4 with vitamin k

BRAND 1

INFUVITE PEDIATRICmultivitamin infusion, pediatric no.1 with vitamin BRAND 1



k

KABIVENamino acid 3.31 % no.1/d9.8w/fatemulsions/electrolyte no.10

BRAND 1

M-NATAL PLUSprenatal vits with calcium no.72/ferrousfumarate/folic acid


M.V.I. ADULTmultivitamin infusion, adult no.1 with witamin k

BRAND 1

M.V.I. PEDIATRICmultivitamin infusion, pediatric no.2 with vitamink

BRAND 1

MULTIVITAMIN WITH FLUORIDE (MULTIVIT-FLUOR 0.25 MG CHW, MULTIVIT-FLUOR 0.5MG CHEW, MULTIVIT-FLUORIDE 1 MGCHW)


NEPHPLEX RXvit b complex no.3/folic acid/ascorbicacid/biotin/zinc oxid

BRAND 1

NEPHRO-VITE RXvitamin b complex no.3/folic acid/ascorbicacid(vitc)/biotin

BRAND 1

PERIKABIVENamino acid 2.36 % no.1/d6.8w/fatemulsions/electrolytes no.9

BRAND 1

PNV 29-1prenatal vitamin with calciumno.76/iron,carbonyl/folic acid


prenatal vitamin plus low iron generic 1 AL At least 12 yrs old

PREPLUSprenatal vits with calcium no.72/ferrousfumarate/folic acid


pyridoxine hcl generic 1

SE-NATAL 19prenatal vits with calcium 118/ferrousfumarate/folic acid


SELECT-OBprenatal vit no.128/iron polysaccharidecomplex/folic acid


SELECT-OB + DHAprenatal vitamins no.33/iron polysachcomplex/folic acid/dha


STROVITE ONE BRAND 1



multivit with mins10/folic acid/vit d3/a lipoicacid/lutein

TARON-C DHAmv-min 75/ferrous fum/iron ps cplx/folicac/omega-3/dha/epa


thiamine hcl generic 1

THRIVITE RXprenatal vitamin with calciumno.76/iron,carbonyl/folic acid


TRINATAL RX 1prenatal vitamin 27 with calcium/ferrousfumarate/folic acid


TRIVEEN-DUO DHAprenatal vit with calcium 53/iron bis,s-p/folicacid/omega-3


TRUST NATAL DHAprenatal vit no.2/iron bg chel,succ-prot/folicacid/omega-3


VIRT-C DHAmv-min 75/ferrous fum/iron ps cplx/folicac/omega-3/dha/epa


VIRT-FEFA PLUSiron fumarate,polysac cplex/folic acid/vitb compwith c no.9

BRAND 1

VITAFOL GUMMIESprenatal vit no.112/iron phosph/folicacid/omega-3s/dha/epa


VITAFOL ULTRAprenatal vit no.67/iron polysaccharides/folatecomb.no.1/dha


VITAFOL-OBprenatal vits with calcium no.10/ferrousfumarate/folic acid


VITAFOL-OB+DHAprenatal vits with calcium no.10/ferrousfum/folic acid/dha


VITAFOL-ONEprenatal vits no.26/iron polysaccharidecplex/folic acid/dha


VITAL-D RXvit b complex no.4/vit d3/ascorbic acid/folicacid/zinc oxid

BRAND 1

VP-VITE RXvitamin b complex no.3/folic acid/ascorbic BRAND 1



acid(vitc)/biotin

GASTROINTESTINAL AGENTS

ANTISPASMODICS, GASTROINTESTINAL

belladonna-phenobarbital generic 1

DICYCLOMINE HCL (20 MG TABLET, 10 MGCAPSULE, 10 MG/5 ML SOLN)

generic 1

GLYCOPYRROLATE (1 MG, 2 MG) generic 1

GLYRX-PFglycopyrrolate/pf

BRAND 1

HYOSCYAMINE SULFATE (0.125 MG ODT,SULF 0.125 MG TAB, 0.125 MG TAB SL,0.125 MG/5 ML ELIX, 0.125 MG/ML DROP)

generic 1

hyoscyamine sulfate er generic 1

propantheline bromide generic 1

GASTROINTESTINAL AGENTS, OTHER

cromolyn 100 mg/5 ml oral conc generic 1

diphenoxylate-atrop 2.5-0.025 generic 1

loperamide generic 1

MOVANTIKnaloxegol oxalate

BRAND 1 PA

PYLERAcolloidal bismuthsubcitrate/metronidazole/tetracycline hcl

BRAND 1

URSODIOL (250 MG TABLET, 300 MGCAPSULE, 500 MG TABLET)

generic 1

HISTAMINE2 (H2) RECEPTOR ANTAGONISTS

FAMOTIDINE (40 MG/4 ML VIAL, 20 MGTABLET, 20 MG PIGGYBACK, 40 MGTABLET, 20 MG/2 ML VIAL)

generic 1

famotidine 200 mg/20 ml vial generic 1

IRRITABLE BOWEL SYNDROME AGENTS

alosetron hcl generic 1

LINZESSlinaclotide

BRAND 1PA


LOTRONEXalosetron hcl

BRAND 1



LAXATIVES

CLENPIQsodium picosulfate/magnesium oxide/citric acid


GOLYTELY PACKETpeg 3350/sod sulf/sod bicarb/sodchloride/potassium chloride

BRAND 1 QL

GOLYTELY SOLUTIONpeg 3350/sod sulf/sod bicarb/sodchloride/potassium chloride

BRAND 1 QL

LACTULOSE (20 GM/30 ML, 10 GM/15 ML) generic 1

peg 3350-electrolyte solution generic 1

peg-3350 and electrolytes generic 1

TRILYTE WITH FLAVOR PACKETSsodium chloride/sodium bicarbonate/potassiumchloride/peg

BRAND 1

PROTECTANTS

misoprostol generic 1

SUCRALFATE (1 GM TABLET, 1 GM/10 MLSUSP)

generic 1

PROTON PUMP INHIBITORS

NEXIUM (20 MG, 2.5 MG, 10 MG, 40 MG, 5MG)esomeprazole magnesium


omeprazole generic 1 AL At least 1 yrs old

PANTOPRAZOLE SODIUM (40 MG, 20 MG) generic 1 AL At least 5 yrs old

PREVACID (30 MG, 15 MG)lansoprazole

BRAND 1 AL 1.0 to 11.0 yrs old

PROTONIX 40 MG SUSPENSIONpantoprazole sodium

BRAND 1 AL 5.0 to 11.0 yrs old

GENETIC OR ENZYME DISORDER: REPLACEMENT, MODIFIERS, TREATMENT

ARALAST NPalpha-1-proteinase inhibitor

BRAND 1PA


CREONlipase/protease/amylase

BRAND 1 PA

CYSTADANEbetaine

BRAND 1

CYSTAGON BRAND 1



cysteamine bitartrate

ELELYSOtaliglucerase alfa

BRAND 1PA


FABRAZYMEagalsidase beta

BRAND 1PA


GLASSIAalpha-1-proteinase inhibitor

BRAND 1PA


PANCREAZElipase/protease/amylase

BRAND 1 PA

PERTZYE (4,000, 8,000, 16,000)lipase/protease/amylase

BRAND 1 PA

PERTZYE DR 24,000 UNIT CAPSULElipase/protease/amylase

BRAND 1 PA

PROLASTIN Calpha-1-proteinase inhibitor

BRAND 1PA


VIOKACElipase/protease/amylase

BRAND 1PA


ZAVESCAmiglustat

BRAND 1PA


ZEMAIRAalpha-1-proteinase inhibitor

BRAND 1PA


ZENPEP (10,000, 20,000, 25,000, 5,000)lipase/protease/amylase

BRAND 1 PA

ZENPEP (15,000, 3,000, 40,000)lipase/protease/amylase

BRAND 1 PA

GENITOURINARY AGENTS

ANTISPASMODICS, URINARY

OXYBUTYNIN CHLORIDE (5 MG/5 MLSYRUP, 5 MG TABLET)

generic 1

oxybutynin chloride er generic 1

solifenacin succinate generic 1 AL At least 18 yrs old

TOVIAZfesoterodine fumarate


BENIGN PROSTATIC HYPERTROPHY AGENTS



alfuzosin hcl er generic 1

dutasteride generic 1

finasteride 5 mg tablet generic 1

tamsulosin hcl generic 1

GENITOURINARY AGENTS, OTHER

bethanechol chloride generic 1

K-PHOS NEUTRALsodium phosphate,dibasic/pot phos,monob/sodphosphate mono

BRAND 1

K-PHOS NO.2sodium phosphate,monobasic/potassiumphosphate,monobasic

BRAND 1

K-PHOS ORIGINALpotassium phosphate,monobasic

BRAND 1

ORACITcitric acid/sodium citrate

BRAND 1

phenazopyridine hcl generic 1

PHOSPHA 250 NEUTRALsodium phosphate,dibasic/pot phos,monob/sodphosphate mono

BRAND 1

potass cit-sod cit-citric acid generic 1

potassium citrate er generic 1

potassium citrate-citric acid generic 1

RENACIDINcitric acid/gluconolactone/magnesiumcarbonate

BRAND 1

sodium citrate-citric acid generic 1

THIOLAtiopronin

BRAND 1

TRICITRATESsodium/potassium/potassium citrate/sodiumcitrate/cit ac

BRAND 1

VIRT-PHOS 250 NEUTRALsodium phosphate,dibasic/pot phos,monob/sodphosphate mono

BRAND 1

VIRTRATE-3sodium/potassium/potassium citrate/sodiumcitrate/cit ac

BRAND 1

VIRTRATE-K BRAND 1



potassium citrate/citric acid

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (ADRENAL)

ACTHARcorticotropin

BRAND 1 PA

betamethasone dp aug 0.05% crm generic 1

betamethasone sod phos-acetate generic 1

betamethasone va 0.1% cream generic 1

CELESTONEbetamethasone acetate/betamethasone sodiumphosphate

BRAND 1

clobetasol emollient 0.05% crm generic 1

CLOBETASOL PROPIONATE (OINTMENT,GEL, CREAM, SOLUTION)

generic 1

DERMA-SMOOTHE-FS (SCALP, BODY)fluocinolone acetonide

BRAND 1

DEXAMETHASONE (6 MG TABLET, 0.5 MGTABLET, 2 MG TABLET, 0.75 MG TABLET,0.5 MG/5 ML ELX, 4 MG TABLET, 1.5 MGTABLET, 1 MG TABLET, 0.5 MG/5 ML LIQ)

generic 1

DEXAMETHASONE SODIUM PHOSPHATE(10 MG/ML SYRING, 4 MG/ML VIAL, 120MG/30 ML VL, 20 MG/5 ML VIAL, 10 MG/MLVIAL, 100 MG/10 ML VL, 4 MG/ML SYRINGE)

generic 1

fludrocortisone acetate generic 1

FLUTICASONE PROPIONATE (0.05%CREAM, 0.005% OINT)

generic 1

HALOBETASOL PROPIONATE (CREAM,OINTMNT)

generic 1

HYDROCORTISONE (5 MG TABLET, 1%OINTMENT, 10 MG TABLET, 2.5% CREAM,20 MG TABLET, 1% CREAM, 2.5%OINTMENT)

generic 1

METHYLPREDNISOLONE (4 MG TABLET, 32MG TAB, 4 MG DOSEPK, 8 MG TAB)

generic 1

METHYLPREDNISOLONE ACETATE (40MG/ML, 80 MG/ML)

generic 1

methylprednisolone sodium succ generic 1

MOMETASONE FUROATE (OINT, CREAM,SOLN)

generic 1

prednisolone 15 mg/5 ml soln generic 1



prednisolone sodium phos odt generic 1 AL Up to 11 yrs old

PREDNISOLONE SODIUM PHOSPHATE(SOD PH 25 ML, 5 ML SOLN)

generic 1

PREDNISONE (5 MG TAB DOSE PACK, 2.5MG TABLET, 1 MG TABLET, 10 MG TABDOSE PACK, 5 MG TABLET, 50 MG TABLET,5 MG/5 ML SOLUTION, 20 MG TABLET, 10MG TABLET)

generic 1

SOLU-CORTEF (100 MG ACT-O-VIAL, 250MG ACT-O-VIAL, 500 MG ACT-O-VIAL, 100MG VIAL, 1,000 MG ACT-O-VL)hydrocortisone sodium succinate/pf

BRAND 1

TRIAMCINOLONE ACETONIDE (0.025%OINT, 0.1% OINTMENT, 0.5% OINTMENT,0.1% CREAM, 0.5% CREAM, 0.025% CREAM,0.05% OINTMENT)

generic 1

TRIDERM 0.1% CREAMtriamcinolone acetonide

BRAND 1

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PITUITARY)

DESMOPRESSIN ACETATE (ACETATE 0.2MG TB, AC 4 MCG/ML VIAL, 40 MCG/10 MLVIAL, ACETATE 0.1 MG TB, 10 MCG/0.1 MLSPR, AC 4 MCG/ML AMPUL)

generic 1

GENOTROPIN (MINIQUICK 2 MG, 5 MGCARTRIDGE, MINIQUICK 1.6 MG, MINIQUICK1.2 MG, MINIQUICK 0.4 MG, MINIQUICK 1.8MG, MINIQUICK 0.6 MG, MINIQUICK 1 MG,MINIQUICK 0.8 MG, MINIQUICK 1.4 MG, 12MG CARTRIDGE, MINIQUICK 0.2 MG)somatropin

BRAND 1PA

AL Up to 16 yrs old

NORDITROPIN FLEXPROsomatropin

BRAND 1PA

AL Up to 16 yrs old

STIMATEdesmopressin acetate

BRAND 1

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEX HORMONES/MODIFIERS)

ANDROGENS

ANDRODERMtestosterone

BRAND 1PA


ANDROGEL (1.62%(1.25G) PCKT, 1.62%PUMP, 1.62%(2.5G) PCKT, 1%(5G) PACKET,1%(2.5G) PACKET)

BRAND 1PA




testosterone

danazol generic 1

TESTOSTERONE CYPIONATE(TESTOSTERON 2,000 MG/10 ML,TESTOSTERONE 100 MG/ML,TESTOSTERONE 200 MG/ML,TESTOSTERON 1,000 MG/10 ML)

generic 1

testosterone enanthate generic 1

ESTROGENS

AFIRMELLElevonorgestrel/ethinyl estradiol


ALTAVERAlevonorgestrel/ethinyl estradiol


ALYACENnorethindrone-ethinyl estradiol


AMETHIAlevonorgestrel/ethinyl estradiol and ethinylestradiol


AMETHIA LOlevonorgestrel/ethinyl estradiol and ethinylestradiol


AMETHYSTlevonorgestrel/ethinyl estradiol


ANNOVERAsegesterone acetate/ethinyl estradiol


APRIdesogestrel-ethinyl estradiol


ARANELLEnorethindrone-ethinyl estradiol


ASHLYNAlevonorgestrel/ethinyl estradiol and ethinylestradiol


AUBRAlevonorgestrel/ethinyl estradiol


AUBRA EQlevonorgestrel/ethinyl estradiol


AUROVELAnorethindrone acetate-ethinyl estradiol


AUROVELA 24 FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate




AUROVELA FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


AVIANElevonorgestrel/ethinyl estradiol


AYUNAlevonorgestrel/ethinyl estradiol


AZURETTEdesogestrel-ethinyl estradiol/ethinyl estradiol


BALCOLTRAlevonorgestrel/ethinyl estradiol/ferrousbisglycinate


BALZIVAnorethindrone-ethinyl estradiol


BEKYREEdesogestrel-ethinyl estradiol/ethinyl estradiol


BEYAZdrospirenone/ethinyl estradiol/levomefolatecalcium


BLISOVI 24 FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


BLISOVI FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


BRIELLYNnorethindrone-ethinyl estradiol


CAMRESElevonorgestrel/ethinyl estradiol and ethinylestradiol


CAMRESE LOlevonorgestrel/ethinyl estradiol and ethinylestradiol


CAZIANTdesogestrel-ethinyl estradiol


CHATEALlevonorgestrel/ethinyl estradiol


CHATEAL EQlevonorgestrel/ethinyl estradiol


CLIMARA PROestradiol/levonorgestrel

BRAND 1

COMBIPATCH BRAND 1



estradiol/norethindrone acetate

CRYSELLEnorgestrel-ethinyl estradiol


CYCLAFEMnorethindrone-ethinyl estradiol


CYREDdesogestrel-ethinyl estradiol


CYRED EQdesogestrel-ethinyl estradiol


DASETTAnorethindrone-ethinyl estradiol


DAYSEElevonorgestrel/ethinyl estradiol and ethinylestradiol


desogestr-eth estrad eth estra generic 1 AL At least 12 yrs old

desogestrel-ethinyl estradiol generic 1 AL At least 12 yrs old

drospirenone-eth estra-levomef generic 1 AL At least 12 yrs old

drospirenone-ethinyl estradiol generic 1 AL At least 12 yrs old

ELINESTnorgestrel-ethinyl estradiol


ELURYNGetonogestrel/ethinyl estradiol


EMOQUETTEdesogestrel-ethinyl estradiol


ENPRESSElevonorgestrel/ethinyl estradiol


ENSKYCEdesogestrel-ethinyl estradiol


ESTARYLLAnorgestimate-ethinyl estradiol


ESTRADIOL (TDS 0.075 MG/DAY, 0.5 MGTABLET, 0.0375 MG/DAY PATCH, TDS0.0375 MG/DAY, 0.06 MG/DAY PATCH, 1 MGTABLET, TDS 0.05 MG/DAY, 0.075 MG/DAYPATCH, 2 MG TABLET, TDS 0.06 MG/DAY,TDS 0.025 MG/DAY, TDS 0.1 MG/DAY)

generic 1

estradiol valerate generic 1

estradiol-norethindrone acetat generic 1 AL At least 18 yrs old

ESTRING BRAND 1



estradiol

estrogen-methyltestosterone generic 1

ESTROSTEP FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


ethynodiol-ethinyl estradiol generic 1 AL At least 12 yrs old

etonogestrel-ethinyl estradiol generic 1 AL At least 12 yrs old

FALMINAlevonorgestrel/ethinyl estradiol


FAYOSIMlevonorgestrel/ethinyl estradiol and ethinylestradiol


FEMHRTnorethindrone acetate-ethinyl estradiol

BRAND 1

FEMYNORnorgestimate-ethinyl estradiol


GENERESS FEnorethindrone-ethinyl estradiol/ferrous fumarate


GIANVIethinyl estradiol/drospirenone


HAILEYnorethindrone acetate-ethinyl estradiol


HAILEY 24 FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


INTROVALElevonorgestrel/ethinyl estradiol


ISIBLOOMdesogestrel-ethinyl estradiol


JAIMIESSlevonorgestrel/ethinyl estradiol and ethinylestradiol


JASMIELethinyl estradiol/drospirenone


JOLESSAlevonorgestrel/ethinyl estradiol


JULEBERdesogestrel-ethinyl estradiol


JUNELnorethindrone acetate-ethinyl estradiol




JUNEL FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


JUNEL FE 24norethindrone acetate-ethinyl estradiol/ferrousfumarate


KAITLIB FEnorethindrone-ethinyl estradiol/ferrous fumarate


KALLIGAdesogestrel-ethinyl estradiol


KARIVAdesogestrel-ethinyl estradiol/ethinyl estradiol


KELNOR 1-35ethynodiol diacetate-ethinyl estradiol


KELNOR 1-50ethynodiol diacetate-ethinyl estradiol


KURVELOlevonorgestrel/ethinyl estradiol


LARINnorethindrone acetate-ethinyl estradiol


LARIN 24 FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


LARIN FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


LARISSIAlevonorgestrel/ethinyl estradiol


LAYOLIS FEnorethindrone-ethinyl estradiol/ferrous fumarate


LEENAnorethindrone-ethinyl estradiol


LESSINAlevonorgestrel/ethinyl estradiol


LEVONESTlevonorgestrel/ethinyl estradiol


levonorg-eth estrad eth estrad generic 1 AL At least 12 yrs old

levonorgestrel-eth estradiol generic 1 AL At least 12 yrs old

LEVORA-28levonorgestrel/ethinyl estradiol


1



LILLOWlevonorgestrel/ethinyl estradiol


LO LOESTRIN FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


LO-ZUMANDIMINEethinyl estradiol/drospirenone


LOESTRINnorethindrone acetate-ethinyl estradiol


LOESTRIN FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


LOJAIMIESSlevonorgestrel/ethinyl estradiol and ethinylestradiol


LORYNAethinyl estradiol/drospirenone


LOSEASONIQUElevonorgestrel/ethinyl estradiol and ethinylestradiol


LOW-OGESTRELnorgestrel-ethinyl estradiol


LUTERAlevonorgestrel/ethinyl estradiol


MARLISSAlevonorgestrel/ethinyl estradiol


MELODETTA 24 FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


MIBELAS 24 FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


MICROGESTIN FE 1.5-30 TABnorethindrone acetate-ethinyl estradiol/ferrousfumarate


MILInorgestimate-ethinyl estradiol


MINASTRIN 24 FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


MIRCETTEdesogestrel-ethinyl estradiol/ethinyl estradiol


1



MONO-LINYAHnorgestimate-ethinyl estradiol


NATAZIAestradiol valerate/dienogest


NECON 0.5-35-28 TABLETnorethindrone-ethinyl estradiol


NIKKIethinyl estradiol/drospirenone


NORETHIN-ETH ESTRA-FERROUS FUM(NORET-ESTR-FE 0.4-0.035(21)-75,NORETH-ESTRAD-FE 1-0.02(21)-75,NORETH-ESTRAD-FE 1-0.02(24)-75,NORETHIN-ESTRA-FE 0.8-0.025 MG)


NORETHINDRON-ETHINYL ESTRADIOL(NORETHIN-ETH 1 MG-5 MCG, NORETHIND-ETH 0.5-2.5)

generic 1

NORETHINDRON-ETHINYL ESTRADIOL(NORETHIND-ETH ESTRAD 1-0.02 MG,NORETHIN-EE 1.5-0.03 MG(21) TB)


norethindrone-eth estradiol-fe generic 1 AL At least 12 yrs old

norgestimate-ethinyl estradiol generic 1 AL At least 12 yrs old

NORTRELnorethindrone-ethinyl estradiol


NUVARINGetonogestrel/ethinyl estradiol


OCELLAethinyl estradiol/drospirenone


OGESTRELnorgestrel-ethinyl estradiol


ORSYTHIAlevonorgestrel/ethinyl estradiol


ORTHO TRI-CYCLENnorgestimate-ethinyl estradiol


ORTHO-NOVUMnorethindrone-ethinyl estradiol


PHILITHnorethindrone-ethinyl estradiol


PIMTREAdesogestrel-ethinyl estradiol/ethinyl estradiol


PIRMELLA (7-7-7-28, 1-35 28)norethindrone-ethinyl estradiol




PORTIAlevonorgestrel/ethinyl estradiol


PREMARIN VAGINAL CREAM-APPLestrogens, conjugated

BRAND 1

PREMARIN (1.25 MG, 0.3 MG, 0.45 MG, 0.625MG, 0.9 MG)estrogens, conjugated

BRAND 1

PREMPHASEestrogens, conjugated/medroxyprogesteroneacetate

BRAND 1

PREMPROestrogens, conjugated/medroxyprogesteroneacetate

BRAND 1

PREVIFEMnorgestimate-ethinyl estradiol


QUARTETTElevonorgestrel/ethinyl estradiol and ethinylestradiol


RECLIPSENdesogestrel-ethinyl estradiol


RIVELSAlevonorgestrel/ethinyl estradiol and ethinylestradiol


SAFYRALdrospirenone/ethinyl estradiol/levomefolatecalcium


SEASONIQUElevonorgestrel/ethinyl estradiol and ethinylestradiol


SETLAKINlevonorgestrel/ethinyl estradiol


SIMLIYAdesogestrel-ethinyl estradiol/ethinyl estradiol


SIMPESSElevonorgestrel/ethinyl estradiol and ethinylestradiol


SPRINTECnorgestimate-ethinyl estradiol


SRONYXlevonorgestrel/ethinyl estradiol


SYEDAethinyl estradiol/drospirenone


1



TARINA 24 FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


TARINA FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


TARINA FE 1-20 EQnorethindrone acetate-ethinyl estradiol/ferrousfumarate


TAYTULLAnorethindrone acetate-ethinyl estradiol/ferrousfumarate


TILIA FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


TRI FEMYNORnorgestimate-ethinyl estradiol


TRI-ESTARYLLAnorgestimate-ethinyl estradiol


TRI-LEGEST FEnorethindrone acetate-ethinyl estradiol/ferrousfumarate


TRI-LINYAHnorgestimate-ethinyl estradiol


TRI-LO-ESTARYLLAnorgestimate-ethinyl estradiol


TRI-LO-MARZIAnorgestimate-ethinyl estradiol


TRI-LO-MILInorgestimate-ethinyl estradiol


TRI-LO-SPRINTECnorgestimate-ethinyl estradiol


TRI-MILInorgestimate-ethinyl estradiol


TRI-PREVIFEMnorgestimate-ethinyl estradiol


TRI-SPRINTECnorgestimate-ethinyl estradiol


TRI-VYLIBRAnorgestimate-ethinyl estradiol


TRI-VYLIBRA LOnorgestimate-ethinyl estradiol




TRIVORA-28levonorgestrel/ethinyl estradiol


TYDEMYdrospirenone/ethinyl estradiol/levomefolatecalcium


VAGIFEMestradiol

BRAND 1 QL

VELIVETdesogestrel-ethinyl estradiol


VIENVAlevonorgestrel/ethinyl estradiol


VIORELEdesogestrel-ethinyl estradiol/ethinyl estradiol


VOLNEAdesogestrel-ethinyl estradiol/ethinyl estradiol


VYFEMLAnorethindrone-ethinyl estradiol


VYLIBRAnorgestimate-ethinyl estradiol


WERAnorethindrone-ethinyl estradiol


WYMZYA FEnorethindrone-ethinyl estradiol/ferrous fumarate


XULANEnorelgestromin/ethinyl estradiol


YASMIN 28ethinyl estradiol/drospirenone


YAZethinyl estradiol/drospirenone


ZARAHethinyl estradiol/drospirenone


ZOVIA 1-35Eethynodiol diacetate-ethinyl estradiol


ZUMANDIMINEethinyl estradiol/drospirenone


PROGESTERONE AGONISTS/ANTAGONISTS

ELLAulipristal acetate


PROGESTINS



CAMILAnorethindrone


DEBLITANEnorethindrone


DEPO-PROVERA (150 MG/ML SYRINGE, 150MG/ML VIAL)medroxyprogesterone acetate


DEPO-SUBQ PROVERA 104medroxyprogesterone acetate


ERRINnorethindrone


HEATHERnorethindrone


hydroxyprogest 250 mg/ml vial generic 1PA


INCASSIAnorethindrone


JENCYCLAnorethindrone


KYLEENAlevonorgestrel

BRAND 1 QL

LILETTAlevonorgestrel

BRAND 1 QL

LYZAnorethindrone


MAKENA (275 MG/1.1 ML AUTOINJCT, 250MG/ML VIAL)hydroxyprogesterone caproate/pf

BRAND 1PA


medroxyprogesterone 150 mg/ml generic 1 AL At least 12 yrs old

MEDROXYPROGESTERONE ACETATE (2.5MG, 10 MG, 5 MG)

generic 1

MEGESTROL ACETATE (ACET 40 MG/MLSUSP, 40 MG TABLET, 625 MG/5 ML SUSP,ACET 400 MG/10 ML, 20 MG TABLET)

generic 1

MIRENAlevonorgestrel

BRAND 1 QL

NEXPLANONetonogestrel

BRAND 1 QL

NORA-BEnorethindrone




norethindrone generic 1 AL At least 12 yrs old

norethindrone ac (lupaneta) generic 1PA


norethindrone acetate generic 1

NORLYDAnorethindrone


ORTHO MICRONORnorethindrone


PROGESTERONE (500 MG/10 ML VIAL, 200MG CAPSULE, 100 MG CAPSULE)

generic 1

PROMETRIUMprogesterone, micronized

BRAND 1

SHAROBELnorethindrone


SKYLAlevonorgestrel

BRAND 1 QL

SLYNDdrospirenone


TULANAnorethindrone


HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (THYROID)

ARMOUR THYROIDthyroid,pork

BRAND 1

LEVOTHYROXINE SODIUM (150 MCGTABLET, 200 MCG TABLET, 500 MCG/5 MLVL, 112 MCG TABLET, 200 MCG/5 ML VL,300 MCG TABLET, 125 MCG TABLET, 50MCG TABLET, 88 MCG TABLET, 175 MCGTABLET, 100 MCG/5 ML VL, 100 MCGTABLET, 25 MCG TABLET, 75 MCG TABLET,137 MCG TABLET)

generic 1

LEVOXYLlevothyroxine sodium

BRAND 1

LIOTHYRONINE SODIUM (50 MCG, 5 MCG,25 MCG)

generic 1

NP THYROIDthyroid,pork

BRAND 1

THYROID (30 MG, 15 MG, 90 MG, 120 MG, 60MG)thyroid,pork

BRAND 1



THYROLAR-1liotrix

BRAND 1

THYROLAR-1/2liotrix

BRAND 1

THYROLAR-1/4liotrix

BRAND 1

THYROLAR-2liotrix

BRAND 1

THYROLAR-3liotrix

BRAND 1

UNITHROIDlevothyroxine sodium

BRAND 1

HORMONAL AGENTS, SUPPRESSANT (PITUITARY)

cabergoline generic 1

LEUPROLIDE ACETATE (14 MG/2.8 ML VL, 1MG/0.2 ML KIT, 14 MG/2.8 ML KT)

generic 1 PA

LUPANETA PACKleuprolide acetate/norethindrone acetate

BRAND 1PA


LUPRON DEPOTleuprolide acetate

BRAND 1PA


LUPRON DEPOT (LUPANETA)leuprolide acetate

BRAND 1PA


LUPRON DEPOT-PED (11.25 MG 3MO, 30MG 3MO KIT, 7.5 MG KIT, 11.25 MG KIT, 15MG KIT)leuprolide acetate

BRAND 1PA

AL 2.0 to 12.0 yrs old

OCTREOTIDE ACETATE (ACET 0.05 MG/MLVL, ACET 50 MCG/ML AMP, 1,000 MCG/5 MLVIAL, 5,000 MCG/5 ML VIAL, ACET 100MCG/ML AMP, ACET 500 MCG/ML AMP,1,000 MCG/ML VIAL, ACET 50 MCG/ML SYR,ACET 100 MCG/ML VL, ACET 500 MCG/MLSYR, ACET 500 MCG/ML VL, ACET 50MCG/ML VIAL, ACET 200 MCG/ML VL, ACET100 MCG/ML SYR)

generic 1

ORILISSAelagolix sodium

BRAND 1 PA

SYNARELnafarelin acetate

BRAND 1 PA

TRIPTODUR BRAND 1 PA



triptorelin pamoateAL 2.0 to 12.0 yrs old

HORMONAL AGENTS, SUPPRESSANT (THYROID)

ANTITHYROID AGENTS

methimazole generic 1

propylthiouracil generic 1

IMMUNOLOGICAL AGENTS

ANGIOEDEMA AGENTS

BERINERT (500 VIAL, 500 KIT)c1 esterase inhibitor

BRAND 1PA


FIRAZYRicatibant acetate

BRAND 1PA


IMMUNE SUPPRESSANTS

azathioprine generic 1

CELLCEPT 200 MG/ML ORAL SUSPmycophenolate mofetil


CELLCEPT 500 MG VIALmycophenolate mofetil hcl

BRAND 1

cyclosporine 250 mg/5 ml ampul generic 1

CYCLOSPORINE MODIFIED (50 MG, 25 MG,100 MG)

generic 1

cyclosporine modified 100mg/ml generic 1 AL Up to 11 yrs old

ENBREL (50 MG/ML SYRINGE, 25 MG KIT, 25MG/0.5 ML SYRINGE)etanercept

BRAND 1PA


ENBREL MINIetanercept

BRAND 1PA


ENBREL SURECLICKetanercept

BRAND 1PA


HUMIRAadalimumab

BRAND 1 PA

HUMIRA PENadalimumab

BRAND 1 PA

1



HUMIRA PEN CROHN'S-UC-HSadalimumab

BRAND PA

HUMIRA PEN PSOR-UVEITS-ADOL HSadalimumab

BRAND 1 PA

HUMIRA(CF)adalimumab

BRAND 1 PA

HUMIRA(CF) PEDIATRIC CROHN'Sadalimumab

BRAND 1 PA

HUMIRA(CF) PENadalimumab

BRAND 1 PA

HUMIRA(CF) PEN CROHN'S-UC-HSadalimumab

BRAND 1 PA

HUMIRA(CF) PEN PSOR-UV-ADOL HSadalimumab

BRAND 1 PA

METHOTREXATE (250 MG/10 ML VIAL, 50MG/2 ML VIAL, 2.5 MG TABLET, 1 GM VIAL)

generic 1

methotrexate sodium generic 1

MYCOPHENOLATE MOFETIL (500 MG VIAL,250 MG CAPSULE, 500 MG TABLET)

generic 1

RAPAMUNE 1 MG/ML ORAL SOLNsirolimus

BRAND 1

SANDIMMUNE 50 MG/ML AMPULcyclosporine

BRAND 1

SIROLIMUS (1 MG, 2 MG, 0.5 MG) generic 1

TACROLIMUS (1 MG, 5 MG, 0.5 MG) generic 1

XELJANZtofacitinib citrate

BRAND 1PA


IMMUNIZING AGENTS, PASSIVE

BIVIGAM 10% VIALimmune globulin,gamm(igg)/glycine/iga greaterthan 50 mcg/ml

BRAND 1 PA

GAMMAGARD S-Dimmune globulin,gamm(igg)/glycine/glucose/iga0 to 50 mcg/ml

BRAND 1 PA

HYPERRHO S-Drho(d) immune globulin

BRAND 1

IMMUNOMODULATORS

ACTIMMUNEinterferon gamma-1b,recomb.

BRAND 1



leflunomide generic 1

VACCINES

ADACEL TDAP (VIAL, SYRINGE)diphtheria,pertussis(acellular),tetanusvaccine/pf

BRAND 1

BOOSTRIX TDAP (VIAL, SYRINGE)diphtheria,pertussis(acellular),tetanus vaccine

BRAND 1

DAPTACEL DTAPdiphtheria, pertussis (acell), tetanus pediatricvaccine/pf

BRAND 1

HAVRIX (1,440 UNITS/ML VIAL, 720UNITS/0.5 ML VIAL, 720 UNIT/0.5 MLSYRINGE, 1,440 UNITS/ML SYRINGE)hepatitis a virus vaccine/pf


INFANRIX DTAP (SYRINGE, VIAL)diphtheria, pertussis (acell), tetanus pediatricvaccine/pf

BRAND 1

SHINGRIXvaricella-zoster virus glycoprotein e,rec/as01badjuvant/pf


SHINGRIX ADJUVANT COMPONENTvaccine adjuvant system, as01b/pf, componentvial 1 of 2


SHINGRIX GE ANTIGEN COMPONENTvaricella-zoster virus glycoproteine,rec,component 2 of 2


VAQTA (50 UNITS/ML SYRINGE, 25UNITS/0.5 ML SYRINGE, 25 UNITS/0.5 MLVIAL, 50 UNITS/ML VIAL)hepatitis a virus vaccine/pf


INFLAMMATORY BOWEL DISEASE AGENTS

AMINOSALICYLATES

APRISOmesalamine

BRAND 1

balsalazide disodium generic 1

mesalamine 1,000 mg supp generic 1

mesalamine dr generic 1

GLUCOCORTICOIDS

ANUSOL-HC 2.5% CREAMhydrocortisone

BRAND 1



budesonide ec generic 1

hydrocortisone 100 mg/60 ml generic 1

PROCTO-MED HChydrocortisone

BRAND 1

PROCTOSOL-HChydrocortisone

BRAND 1

PROCTOZONE-HChydrocortisone

BRAND 1

SULFONAMIDES

sulfasalazine generic 1

sulfasalazine dr generic 1

METABOLIC BONE DISEASE AGENTS

ALENDRONATE SODIUM (10 MG TAB, 70MG TAB, 35 MG TAB, 5 MG TABLET)

generic 1

calcitonin-salmon generic 1 AL At least 18 yrs old

CALCITRIOL (1 MCG/ML SOLUTION, 0.5MCG CAPSULE, 0.25 MCG CAPSULE, 1MCG/ML AMPUL)

generic 1

DOXERCALCIFEROL (1 MCG CAPSULE, 4MCG/2 ML VL, 0.5 MCG CAP, 2.5 MCG CAP)

generic 1

pamidronate disodium generic 1

PARICALCITOL (2 MCG/ML VIAL, 2 MCGCAPSULE, 5 MCG/ML VIAL, 10 MCG/2 MLVIAL, 4 MCG CAPSULE, 1 MCG CAPSULE)

generic 1

vitamin d2 generic 1

ZOLEDRONIC ACID (4 MG/5 ML VIAL, 4 MGVIAL, 4 MG/100 ML, 5 MG/100 ML)

generic 1

MISCELLANEOUS THERAPEUTIC AGENTS

acetylcysteine 6 gram/30 ml vl generic 1

methylergonovine 0.2 mg tablet generic 1

PARAGARD T 380-Acopper

BRAND 1 QL

bacteriostatic saline vial generic 1

sorbitol generic 1

sorbitol-mannitol generic 1

STERILE WATER FOR IC-GREEN BRAND 1



water for injection,sterile

STERILE WATER FOR KCENTRAwater for injection,sterile

BRAND 1

sterile water for irrigation generic 1

WATER (FOR INJECTION VIAL, STERILEFOR INJECTION, BACTERIOSTATIC VIAL)

generic 1

OPHTHALMIC AGENTS

OPHTHALMIC AGENTS, OTHER

AK-POLY-BACbacitracin/polymyxin b sulfate

BRAND 1

ATROPINE SULFATE (DROPS, OINTMENT) generic 1

bacitracin-polymyxin generic 1

balanced salt generic 1

CYCLOPENTOLATE HCL (0.5% EYE, 1%EYE, HCL 2%)

generic 1

CYSTARANcysteamine hcl

BRAND 1

neomycin-bacitracin-poly-hc generic 1

neomycin-bacitracin-polymyxin generic 1

NEOMYCIN-POLYMYXIN-DEXAMETH(NEOMYC-POLYM-DEXAMETH DROP,NEOMYC-POLYM-DEXAMET OINTM)

generic 1

PHENYLEPHRINE HCL (10% DROPS, 2.5%DROP)

generic 1

POLYCINbacitracin/polymyxin b sulfate

BRAND 1

polymyxin b sul-trimethoprim generic 1

RESTASIScyclosporine

BRAND 1

RESTASIS MULTIDOSEcyclosporine

BRAND 1

sulfacetamide-prednisolone generic 1

TOBRADEX (DROPS, OINTMENT)tobramycin/dexamethasone

BRAND 1

ZYLETtobramycin/loteprednol etabonate

BRAND 1

OPHTHALMIC ANTI-ALLERGY AGENTS



cromolyn 4% eye drops generic 1

olopatadine hcl 0.1% eye drops generic 1

PAZEOolopatadine hcl

BRAND 1

OPHTHALMIC ANTI-INFLAMMATORIES

ALREXloteprednol etabonate

BRAND 1

dexamethasone 0.1% eye drop generic 1

diclofenac 0.1% eye drops generic 1

DUREZOLdifluprednate

BRAND 1

FLAREXfluorometholone acetate

BRAND 1

FML FORTEfluorometholone

BRAND 1

FML S.O.P.fluorometholone

BRAND 1

ILEVROnepafenac

BRAND 1

ketorolac 0.5% ophth solution generic 1

LOTEMAX 0.5% EYE DROPSloteprednol etabonate

BRAND 1

MAXIDEXdexamethasone

BRAND 1

prednisolone ac 1% eye drop generic 1

OPHTHALMIC ANTIGLAUCOMA AGENTS

brimonidine 0.2% eye drop generic 1

carteolol hcl generic 1

COMBIGANbrimonidine tartrate/timolol maleate

BRAND 1

dorzolamide hcl generic 1

dorzolamide-timolol eye drops generic 1

levobunolol hcl generic 1

methazolamide generic 1

RHOPRESSAnetarsudil mesylate


ROCKLATAN BRAND 1 AL At least 18 yrs old



netarsudil mesylate/latanoprost

TIMOLOL MALEATE (0.25% GFS GEL-SOLUTION, 0.5% EYE DROP, 0.5% GFSGEL-SOLUTION, 0.5% GEL-SOLUTION,MALEATE 0.5% EYE DROPS, 0.25% GEL-SOLUTION, MALEATE 0.25% EYE DROP)

generic 1

OPHTHALMIC PROSTAGLANDIN AND PROSTAMIDE ANALOGS

latanoprost 0.005% eye drops generic 1

TRAVATAN Ztravoprost

BRAND 1

OTIC AGENTS

acetic acid 2% ear solution generic 1

CIPRODEXciprofloxacin hcl/dexamethasone

BRAND 1

DERMOTICfluocinolone acetonide oil

BRAND 1

neomycin-polymyxin-hc ear susp generic 1

neomycin-polymyxin-hydrocort generic 1

RESPIRATORY TRACT/PULMONARY AGENTS

ANTI-INFLAMMATORIES, INHALED CORTICOSTEROIDS

ASMANEX (TWISTHALER 220 MCG #60,TWISTHALER 110 MCG #30, TWISTHALER220 MCG #14, TWISTHALR 220 MCG #120,TWISTHALER 220 MCG #30)mometasone furoate


budesonide generic 1 AL 1.0 to 8.0 yrs old

FLOVENT HFAfluticasone propionate

BRAND 1

fluticasone prop 50 mcg spray generic 1

ANTIHISTAMINES

AZELASTINE HCL (0.1% (137 MCG) SPRY,0.15% NASAL SPRAY)

generic 1

CARBINOXAMINE MALEATE (4 MG/5 MLLIQUID, MALEATE 4 MG TAB)

generic 1

cetirizine hcl generic 1 AL Up to 11 yrs old

clemastine fumarate generic 1

1



CYPROHEPTADINE HCL (2 MG/5 ML SYRUP,4 MG TABLET, 2 MG/5 ML SOLN, 4 MG/10 MLSYRP)

generic

DIPHENHYDRAMINE HCL (50 MG/MLSYRNG, 50 MG/ML VIAL, 50 MG/ML CRPJT,25 MG/10 ML, 12.5 MG/5 ML)

generic 1

HYDROXYZINE HCL (HCL 10 MG TABLET, 50MG/ML VIAL, 10 MG/5 ML SYRUP, 100 MG/2ML VIAL, HCL 50 MG TABLET, 10 MG/5 MLSOLN, 25 MG/ML VIAL, HCL 25 MG TABLET)

generic 1

hydroxyzine pamoate generic 1

levocetirizine 5 mg tablet generic 1

PROMETHAZINE HCL (50 MG/ML VIAL, 50MG/ML AMPUL, 6.25 MG/5 ML SYRP, 25MG/ML VIAL, 6.25 MG/5 ML SOLN, 25 MG/MLAMPUL)

generic 1

ANTILEUKOTRIENES

MONTELUKAST SODIUM (4 MG TAB CHEW,10 MG TABLET, 5 MG TAB CHEW)

generic 1

BRONCHODILATORS, ANTICHOLINERGIC

ATROVENT HFAipratropium bromide

BRAND 1

ipratropium br 0.02% soln generic 1

SPIRIVAtiotropium bromide


BRONCHODILATORS, SYMPATHOMIMETIC

ALBUTEROL SULFATE (SUL 1.25 MG/3 MLSOL, SULF 2 MG/5 ML SYRUP, 5 MG/MLSOLUTION)

generic 1

ALBUTEROL SULFATE (SUL 0.63 MG/3 MLSOL, SUL 2.5 MG/3 ML SOLN, 2.5 MG/0.5 MLSOL)

generic 1

EPINEPHRINE (0.15 MG AUTO-INJCT, 0.3MG AUTO-INJECT)

generic 1

PROAIR HFAalbuterol sulfate

BRAND 1

PROVENTIL HFAalbuterol sulfate

BRAND 1

SEREVENT DISKUSsalmeterol xinafoate

BRAND 1QL




terbutaline sulf 1 mg/ml vial generic 1

CYSTIC FIBROSIS AGENTS

BETHKIStobramycin

BRAND 1 PA

KITABIS PAKtobramycin/nebulizer

BRAND 1 PA

PULMOZYMEdornase alfa

BRAND 1

QL

PA

AL Up to 65 yrs old

MAST CELL STABILIZERS

cromolyn 20 mg/2 ml neb soln generic 1

PHOSPHODIESTERASE INHIBITORS, AIRWAYS DISEASE

CAFFEINE CITRATE (60 ML VIAL, 60 MLORAL)

generic 1

ELIXOPHYLLINtheophylline anhydrous

BRAND 1

THEO-24theophylline anhydrous

BRAND 1

THEOPHYLLINE (80 MG/15 ML SOLN, ER400 MG TABLET, ER 600 MG TABLET)

generic 1

THEOPHYLLINE ANHYDROUS (ER 450 MGTAB, ER 300 MG TAB, ER 100 MG TABLET)

generic 1

theophylline er 200 mg tablet generic 1

PULMONARY ANTIHYPERTENSIVES

epoprostenol sodium generic 1

LETAIRISambrisentan

BRAND 1 PA

SILDENAFIL CITRATE (20 MG TABLET, 10MG/ML ORAL SUSP)

generic 1 PA

tadalafil 20 mg tablet generic 1 PA

TRACLEER (125 MG, 62.5 MG)bosentan

BRAND 1 PA

VENTAVISiloprost tromethamine

BRAND 1 PA

RESPIRATORY TRACT AGENTS, OTHER

ACETYLCYSTEINE (20%, 10%) generic 1



ADVAIR DISKUSfluticasone propionate/salmeterol xinafoate

BRAND 1QL


ADVAIR HFAfluticasone propionate/salmeterol xinafoate

BRAND 1QL


benzonatate generic 1 AL Up to 20 yrs old

BEVESPI AEROSPHEREglycopyrrolate/formoterol fumarate

BRAND 1

brompheniramine-pseudoephed-dm generic 1 AL Up to 20 yrs old

COMBIVENT RESPIMATipratropium bromide/albuterol sulfate

BRAND 1

DULERA (200 MCG, 100 MCG)mometasone furoate/formoterol fumarate

BRAND 1QL


DULERA 50 MCG-5 MCG INHALERmometasone furoate/formoterol fumarate


HYDROCODONE-HOMATROPINE MBR(SOLN, SYRUP)

generic 1 AL 18.0 to 20.0 yrs old

ipratropium-albuterol generic 1

promethazine-dm generic 1 AL Up to 20 yrs old

promethazine-phenylephrine generic 1 AL Up to 20 yrs old

ribavirin 6 gm inhalation vial generic 1PA


sodium chloride 0.9% inhal vl generic 1

sodium chloride 10% vial generic 1 PA

STIOLTO RESPIMATtiotropium bromide/olodaterol hcl

BRAND 1

SYMBICORT 160-4.5 MCG INHALERbudesonide/formoterol fumarate

BRAND 1QL


SYMBICORT 80-4.5 MCG INHALERbudesonide/formoterol fumarate

BRAND 1QL


UTIBRON NEOHALERindacaterol maleate/glycopyrrolate

BRAND 1

SKELETAL MUSCLE RELAXANTS

chlorzoxazone 500 mg tablet generic 1



CYCLOBENZAPRINE HCL (10 MG, 5 MG) generic 1

METHOCARBAMOL (750 MG, 500 MG) generic 1

SLEEP DISORDER AGENTS

GABA RECEPTOR MODULATORS

TEMAZEPAM (15 MG, 30 MG) generic 1 AL At least 18 yrs old

zaleplon generic 1 AL At least 18 yrs old

zolpidem tartrate 10 mg tablet generic 1PA


zolpidem tartrate 5 mg tablet generic 1 AL At least 18 yrs old

SLEEP DISORDERS, OTHER

modafinil generic 1PA


ROZEREMramelteon



Index of covered drugs33 DAY VAGINAL 2

3-DAY VAGINAL CREAM 2

88 HOUR ACETAMINOPHEN 2

8 HOUR PAIN RELIEF 3

8HR ARTHRITIS PAIN 3

8HR MUSCLE ACHES-PAIN 3

AABACAVIR SULFATE 39

ABACAVIR SULFATE/DOLUTEGRAVIR

SODIUM/LAMIVUDINE 39

ABACAVIR SULFATE/LAMIVUDINE 38

ABACAVIR SULFATE/LAMIVUDINE/ZIDOVUDINE 38

ABILIFY MAINTENA 34

ABIRATERONE ACETATE 30

ACAMPROSATE CALCIUM 14

ACARBOSE 41

ACEBUTOLOL HCL 49

ACETAMINOPHEN 4

ACETAMINOPHEN WITH CODEINE PHOSPHATE 13

ACETAZOLAMIDE 51

ACETIC ACID 91

ACETYLCYSTEINE 93

ACITRETIN 54

ACTHAR 70

ACTIMMUNE 86

ACYCLOVIR 40

ADACEL TDAP 87

ADALIMUMAB 86

ADAPALENE 55

ADULT ASPIRIN REGIMEN 1

ADULT TUSSIN CHEST CONGESTION 8

ADULT TUSSIN COUGH CONGEST DM 8

ADVAIR DISKUS 93

ADVAIR HFA 94

ADVATE 45

ADYNOVATE 45

AFIRMELLE 72

AFSTYLA 45

AFTERA 7

AGALSIDASE BETA 68

AGGRENOX 48

AK-POLY-BAC 89

ALA-QUIN 55

ALBENDAZOLE 33

ALBUTEROL SULFATE 92

ALEMTUZUMAB 32

ALENDRONATE SODIUM 88

ALFUZOSIN HCL 68

ALIMTA 30

ALITRETINOIN 32

ALKERAN 29

ALL DAY ALLERGY 7

ALL DAY ALLERGY-D 8

ALLERGY 7

ALLERGY COMPLETE-D 8

ALLERGY RELIEF 8

ALLERGY RELIEF D-24HR 9

ALLERGY RELIEF-NASAL DECONGEST 9

ALLERGY-CONGESTION 12HR 9

ALLERGY-CONGESTION RELIEF 9

ALLOPURINOL 28

ALOSETRON HCL 66

ALPHA-1-PROTEINASE INHIBITOR 68

ALPHANATE 45

ALPHANINE SD 45

ALPRAZOLAM 41

ALPROLIX 46

ALREX 90

ALTAVERA 72

ALTEPLASE 44

ALYACEN 72

AMANTADINE HCL 33

AMBRISENTAN 93

AMETHIA 72

AMETHIA LO 72

AMETHYST 72

AMICAR 46


AMILORIDE HCL 51

AMILORIDE HCL/HYDROCHLOROTHIAZIDE 50

AMINO ACID 2.36 % NO.1/D6.8W/FAT

EMULSIONS/ELECTROLYTES NO.9 64

AMINO ACID 3.31 % NO.1/D9.8W/FAT

EMULSIONS/ELECTROLYTE NO.10 64

AMINO ACIDS 10 % 62

AMINO ACIDS 3 %/ELECTROLYTE-TPN

SOLN/GLYCERIN 61

AMINO ACIDS 3.5 %/ELECTROLYTE-M

SOLUTION 57

AMINO ACIDS 4.25 %/DEXTROSE 10 % IN

WATER 57

AMINO ACIDS 5 %/CALCIUM/ELECTROLYTE-TPN

SOLN/DEXTROSE 20 % 57

AMINO ACIDS 5.4 % 60

AMINO ACIDS 7 % 57

AMINO ACIDS 8 % 59

AMINO ACIDS 8.5 %/ELECTROLYTE-TPN SOLN 57

AMINOCAPROIC ACID 46

AMINOSYN 56

AMINOSYN II 57

AMINOSYN II WITH ELECTROLYTES 57

AMINOSYN M 57

AMINOSYN WITH ELECTROLYTES 57

AMINOSYN-HBC 57

AMINOSYN-PF 57

AMINOSYN-RF 57

AMIODARONE HCL 49

AMITRIPTYLINE HCL 26

AMITRIPTYLINE HCL/CHLORDIAZEPOXIDE 25

AMLODIPINE BESYLATE 49

AMLODIPINE BESYLATE/BENAZEPRIL HCL 50

AMLODIPINE BESYLATE/OLMESARTAN

MEDOXOMIL 50

AMLODIPINE BESYLATE/VALSARTAN 50

AMMONIUM LACTATE 55

AMNESTEEM 55

AMOXAPINE 26

AMOXICILLIN 18

AMOXICILLIN/POTASSIUM CLAVULANATE 18

AMPHETAMINE 52

AMPHOTERICIN B 27

AMPICILLIN SODIUM 18

AMPICILLIN SODIUM/SULBACTAM SODIUM 18

AMPICILLIN TRIHYDRATE 18

ANAGRELIDE HCL 45

ANASTROZOLE 32

ANDRODERM 71

ANDROGEL 71

ANIDULAFUNGIN 27

ANNOVERA 72

ANTACID 7

ANTACID CALCIUM 6

ANTACID EXTRA STRENGTH 6

ANTACID ULTRA STRENGTH 6

ANTI-INHIBITOR COAGULANT COMPLEX 46

ANTIHEMOPHILIC FACTOR (FACTOR VIII)

RECOMB,B-DOMAIN DELETED 47

ANTIHEMOPHILIC FACTOR (FVIII) REC, B-DOM

TRUNCATED PEG-EXEI 46

ANTIHEMOPHILIC FACTOR (FVIII) REC, B-DOMAIN

DELETED PEG-AUCL 46

ANTIHEMOPHILIC FACTOR (FVIII) RECOMBINANT,

FC FUSION PROTEIN 46

ANTIHEMOPHILIC FACTOR (FVIII) RECOMBINANT,

FULL LENGTH, PEG 45

ANTIHEMOPHILIC FACTOR (FVIII)

RECOMBINANT,FULL LENGTH 46

ANTIHEMOPHILIC FACTOR VIII REC HEK CELL, B-

DOMAIN DELETED 47

ANTIHEMOPHILIC FACTOR VIII RECOMB,SINGLE-

CHN,B-DOM TRUNCATED 45

ANTIHEMOPHILIC FACTOR VIII RECOMBINANT, B-

DOMAIN TRUNCATED 47

ANTIHEMOPHILIC FACTOR VIII, HUMAN

RECOMBINANT 47

ANTIHEMOPHILIC FACTOR VIII, RECOMBINANT

PORCINE SEQUENCE 47

ANTIHEMOPHILIC FACTOR, HUMAN 46

ANTIHEMOPHILIC FACTOR, HUMAN/VON

WILLEBRAND FACTOR,HUMAN 47


ANUSOL-HC 87

APIXABAN 44

APREPITANT 27

APRI 72

APRISO 87

APTENSIO XR 53

APTIOM 23

APTIVUS 39

AQUADEKS 5

ARALAST NP 67

ARANELLE 72

ARANESP 45

ARIPIPRAZOLE 35

ARIPIPRAZOLE LAUROXIL 35

ARIPIPRAZOLE LAUROXIL, SUBMICRONIZED 35

ARISTADA 35

ARISTADA INITIO 35

ARMOUR THYROID 83

ARTHRITIS PAIN 3

ARTHRITIS PAIN RELIEF 3

ARYMO ER 12

ARZERRA 32

ASCORBIC ACID 63

ASHLYNA 72

ASMANEX 91

ASPIR 81 1

ASPIR-LOW 1

ASPIRIN 1

ASPIRIN/DIPYRIDAMOLE 48

ATAZANAVIR SULFATE 40

ATAZANAVIR SULFATE/COBICISTAT 39

ATENOLOL 49

ATENOLOL/CHLORTHALIDONE 50

ATOMOXETINE HCL 53

ATORVASTATIN CALCIUM 51

ATOVAQUONE 33

ATRIPLA 37

ATROPINE SULFATE 89

ATROVENT HFA 92

AUBAGIO 54

AUBRA 72

AUBRA EQ 72

AUROVELA 72

AUROVELA 24 FE 72

AUROVELA FE 72

AUSTEDO 53

AVIANE 73

AVITA 55

AVONEX 54

AVONEX PEN 54

AYUNA 73

AZACITIDINE 30

AZACTAM 17

AZATHIOPRINE 85

AZELAIC ACID 56

AZELASTINE HCL 91

AZITHROMYCIN 19

AZTREONAM 17

AZURETTE 73

BBACITRACIN/POLYMYXIN B SULFATE 89

BACLOFEN 36

BACMIN 63

BACTERIOSTATIC SODIUM CHLORIDE 88

BALANCED SALT IRRIG SOLN NO.2 89

BALCOLTRA 73

BALSALAZIDE DISODIUM 87

BALZIVA 73

BANZEL 24

BASAGLAR KWIKPEN U-100 43

BEKYREE 73

BENAZEPRIL HCL 48

BENDAMUSTINE HCL 29

BENEFIX 46

BENZONATATE 94

BENZTROPINE MESYLATE 33

BERINERT 85

BETAINE 67

BETAMETHASONE ACETATE/BETAMETHASONE

SODIUM PHOSPHATE 70


BETAMETHASONE DIPROPIONATE/PROPYLENE

GLYCOL 70

BETAMETHASONE VALERATE 70

BETASERON 54

BETHANECHOL CHLORIDE 69

BETHKIS 93

BEVESPI AEROSPHERE 94

BEYAZ 73

BICALUTAMIDE 29

BICILLIN C-R 18

BICILLIN L-A 18

BICNU 29

BICTEGRAVIR

SODIUM/EMTRICITABINE/TENOFOVIR

ALAFENAMIDE FUMAR 37

BIKTARVY 37

BILTRICIDE 33

BISOPROLOL FUMARATE 49

BISOPROLOL

FUMARATE/HYDROCHLOROTHIAZIDE 50

BIVIGAM 86

BLEOMYCIN SULFATE 30

BLISOVI 24 FE 73

BLISOVI FE 73

BOOSTRIX TDAP 87

BORTEZOMIB 30

BOSENTAN 93

BRIELLYN 73

BRILINTA 48

BRIMONIDINE TARTRATE 90

BRIMONIDINE TARTRATE/TIMOLOL MALEATE 90

BRIVARACETAM 20

BRIVIACT 20

BROMPHENIRAMINE

MALEATE/PSEUDOEPHEDRINE

HCL/DEXTROMETHORPHAN 94

BUDESONIDE 91

BUDESONIDE/FORMOTEROL FUMARATE 94

BUMETANIDE 51

BUPIVACAINE HCL/EPINEPHRINE 14

BUPIVACAINE HCL/PF 14

BUPRENORPHINE 13

BUPRENORPHINE HCL 14

BUPRENORPHINE HCL/NALOXONE HCL 15

BUPROPION HCL 25

BUSPIRONE HCL 40

BUSULFAN 29

BUTALBITAL/ACETAMINOPHEN 53

BUTALBITAL/ACETAMINOPHEN/CAFFEINE 53

BUTALBITAL/ACETAMINOPHEN/CAFFEINE/CODEIN

E PHOSPHATE 13

BUTALBITAL/ASPIRIN/CAFFEINE 13

BUTOCONAZOLE NITRATE 27

BYDUREON PEN 41

BYETTA 42

CC1 ESTERASE INHIBITOR 85

CABERGOLINE 84

CAFFEINE CITRATE 93

CAL-GEST 6

CALCIPOTRIENE 55

CALCITONIN,SALMON,SYNTHETIC 88

CALCITRATE 4

CALCITRIOL 88

CALCIUM ACETATE 62

CALCIUM ANTACID 6

CALCIUM CARBONATE 7

CALCIUM CHLORIDE 57

CALCIUM CITRATE 4

CALCIUM GLUCONATE 57

CAMILA 81

CAMPATH 32

CAMRESE 73

CAMRESE LO 73

CANAGLIFLOZIN 42

CANAGLIFLOZIN/METFORMIN HCL 42

CAPECITABINE 30

CARBAMAZEPINE 41

CARBATROL 24

CARBIDOPA/LEVODOPA 34

CARBIDOPA/LEVODOPA/ENTACAPONE 33


CARBINOXAMINE MALEATE 91

CARBOPLATIN 31

CARMUSTINE 29

CARTEOLOL HCL 90

CARVEDILOL 49

CATAPRES-TTS 1 48

CATAPRES-TTS 2 48

CATAPRES-TTS 3 48

CATHFLO ACTIVASE 44

CAZIANT 73

CEFACLOR 17

CEFADROXIL 17

CEFAZOLIN SODIUM 17

CEFDINIR 17

CEFEPIME HCL 17

CEFIXIME 17

CEFOTAXIME SODIUM 17

CEFOTETAN DISODIUM 17

CEFOTETAN DISODIUM IN ISO-OSMOTIC

DEXTROSE 17

CEFOXITIN SODIUM 17

CEFOXITIN SODIUM/DEXTROSE, ISO-OSMOTIC 17

CEFPROZIL 17

CEFTRIAXONE SODIUM 17

CEFTRIAXONE SODIUM IN ISO-OSMOTIC

DEXTROSE 17

CEFUROXIME AXETIL 17

CEFUROXIME SODIUM 17

CELECOXIB 12

CELESTONE 70

CELLCEPT 85

CENTRATEX 57

CEPHALEXIN 17

CETIRIZINE HCL 91

CETIRIZINE HCL/PSEUDOEPHEDRINE HCL 9

CHANTIX 15

CHATEAL 73

CHATEAL EQ 73

CHEST CONGESTION RELIEF 9

CHILD MUCINEX CHEST MINI-MELTS 9

CHILD MUCINEX COUGH MINI-MELTS 9

CHILD MUCUS-COUGH RELIEF 9

CHILDREN'S ALL DAY ALLERGY 8

CHILDREN'S ALLERGY 8

CHILDREN'S ALLERGY RELIEF 8

CHILDREN'S MAPAP 3

CHILDREN'S MUCUS RELIEF 9

CHILDREN'S PAIN RELIEF 3

CHILDREN'S PAIN RELIEVER 3

CHILDREN'S PAIN-FEVER 3

CHILDREN'S SILAPAP 3

CHLORAMBUCIL 29

CHLORDIAZEPOXIDE HCL 41

CHLORHEXIDINE GLUCONATE 54

CHLOROQUINE PHOSPHATE 33

CHLOROTHIAZIDE 51

CHLORPROMAZINE HCL 34

CHLORTHALIDONE 51

CHLORZOXAZONE 94

CHOLESTYRAMINE (WITH SUGAR) 52

CHOLESTYRAMINE/ASPARTAME 52

CHROMIC CHLORIDE 57

CICLOPIROX 27

CILOSTAZOL 48

CIMDUO 38

CIPRO 19

CIPRODEX 91

CIPROFLOXACIN 19

CIPROFLOXACIN HCL 19

CIPROFLOXACIN HCL/DEXAMETHASONE 91

CIPROFLOXACIN LACTATE/DEXTROSE 5 % IN

WATER 19

CISPLATIN 31

CITALOPRAM HYDROBROMIDE 25

CITRANATAL B-CALM 63

CITRIC ACID/GLUCONOLACTONE/MAGNESIUM

CARBONATE 69

CITRIC ACID/SODIUM CITRATE 69

CLADRIBINE 30

CLARAVIS 55

CLARITHROMYCIN 19

CLEARLAX 7


CLEMASTINE FUMARATE 91

CLENPIQ 66

CLEOCIN 16

CLEOCIN PHOSPHATE 16

CLIMARA PRO 73

CLINDAMYCIN HCL 16

CLINDAMYCIN PALMITATE HCL 16

CLINDAMYCIN PHOSPHATE 16

CLINDAMYCIN PHOSPHATE/BENZOYL

PEROXIDE 55

CLINDESSE 16

CLINIMIX 57

CLINIMIX E 57

CLINISOL 57

CLIOQUINOL/HYDROCORTISONE 55

CLOBAZAM 21

CLOBETASOL PROPIONATE 70

CLOBETASOL PROPIONATE/EMOLLIENT BASE 70

CLOMIPRAMINE HCL 26

CLONAZEPAM 41

CLONIDINE 48

CLONIDINE HCL 48

CLOPIDOGREL BISULFATE 48

CLORAZEPATE DIPOTASSIUM 41

CLOTRIMAZOLE 27

CLOTRIMAZOLE/BETAMETHASONE

DIPROPIONATE 55

CLOZAPINE 36

CLOZARIL 36

COAGADEX 46

COAGULATION FACTOR VIIA (RECOMBINANT) 47

COAGULATION FACTOR X 46

COBICISTAT 39

CODEINE SULFATE 13

COLCHICINE 28

COLESTID 52

COLESTIPOL HCL 52

COLISTIN (AS COLISTIMETHATE SODIUM) 16

COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 56

COLLOIDAL BISMUTH

SUBCITRATE/METRONIDAZOLE/TETRACYCLINE

HCL 66

COMBIGAN 90

COMBIPATCH 73

COMBIVENT RESPIMAT 94

COMPLERA 37

COMPLETE NATAL DHA 63

CONCEPT DHA 63

CONCEPT OB 63

COPAXONE 54

COPPER 88

CORIFACT 46

CORTICOTROPIN 70

CORTISPORIN 55

CORVITA 5

COSENTYX (2 SYRINGES) 55

COSENTYX PEN 55

COSENTYX PEN (2 PENS) 55

COSENTYX SYRINGE 55

COUGH DM 9

COUMADIN 44

CREON 67

CRISABOROLE 55

CRIXIVAN 39

CROMOLYN SODIUM 93

CRYSELLE 74

CUPRIC CHLORIDE 57

CYANOCOBALAMIN (VITAMIN B-12) 63

CYANOCOBALAMIN/FOLIC ACID 63

CYCLAFEM 74

CYCLOBENZAPRINE HCL 94

CYCLOPENTOLATE HCL 89

CYCLOPHOSPHAMIDE 29

CYCLOSPORINE 89

CYCLOSPORINE, MODIFIED 85

CYPROHEPTADINE HCL 91

CYRED 74

CYRED EQ 74

CYSTADANE 67

CYSTAGON 67


CYSTARAN 89

CYSTEAMINE BITARTRATE 67

CYSTEAMINE HCL 89

CYTARABINE/PF 30

DDABIGATRAN ETEXILATE MESYLATE 44

DACARBAZINE 31

DALFAMPRIDINE 54

DANAZOL 72

DAPAGLIFLOZIN PROPANEDIOL 42

DAPSONE 29

DAPTACEL DTAP 87

DARBEPOETIN ALFA IN POLYSORBATE 80 45

DARUNAVIR

ETH/COBICISTAT/EMTRICITABINE/TENOFOVIR

ALAFENAMIDE 40

DARUNAVIR ETHANOLATE 40

DARUNAVIR ETHANOLATE/COBICISTAT 40

DASETTA 74

DAUNORUBICIN HCL 31

DAYSEE 74

DAYTRANA 53

DEBLITANE 82

DECITABINE 31

DEFEROXAMINE MESYLATE 62

DELFLEX WITH 1.5% DEXTROSE 57

DELSTRIGO 37

DENAVIR 40

DEPAKOTE 20

DEPAKOTE ER 20

DEPAKOTE SPRINKLE 20

DEPO-PROVERA 82

DEPO-SUBQ PROVERA 104 82

DERMA-SMOOTHE-FS 70

DERMOTIC 91

DESCOVY 39

DESIPRAMINE HCL 26

DESMOPRESSIN ACETATE 71

DESOGESTREL-ETHINYL ESTRADIOL 81

DESOGESTREL-ETHINYL ESTRADIOL/ETHINYL

ESTRADIOL 81

DESVENLAFAXINE SUCCINATE 25

DEUTETRABENAZINE 53

DEXAMETHASONE 90

DEXAMETHASONE SODIUM PHOSPHATE 90

DEXMETHYLPHENIDATE HCL 53

DEXRAZOXANE HCL 31

DEXTROAMPHETAMINE SULF-

SACCHARATE/AMPHETAMINE SULF-

ASPARTATE 52

DEXTROAMPHETAMINE SULFATE 52

DEXTROMETHORPHAN HBR/QUINIDINE

SULFATE 53

DEXTROSE 10 % AND 0.2 % SODIUM CHLORIDE 57

DEXTROSE 10 % AND 0.45 % SODIUM

CHLORIDE 57

DEXTROSE 2.5 % AND 0.45 % SODIUM

CHLORIDE 57

DEXTROSE 30 % IN WATER 58





DEXTROSE 5 % IN LACTATED RINGERS 58

DEXTROSE 5 % IN WATER 58

DIALYVITE 63

DIALYVITE 3000 63

DIALYVITE 5000 63

DIALYVITE SUPREME D 63

DIALYVITE ZINC 63

DIASTAT 21

DIASTAT ACUDIAL 21

DIAZEPAM 41

DIAZOXIDE 43

DICLEGIS 26

DICLOFENAC SODIUM 90

DICLOXACILLIN SODIUM 18

DICYCLOMINE HCL 66

DIDANOSINE 38

DIFFERIN 55


DIFLUPREDNATE 90

DIGOXIN 50

DILANTIN 24

DILANTIN-125 24

DILTIAZEM HCL 50

DIMETHYL FUMARATE 54

DIPHENHYDRAMINE HCL 92

DIPHENOXYLATE HCL/ATROPINE SULFATE 66

DIPHTHERIA, PERTUSSIS (ACELL), TETANUS

PEDIATRIC VACCINE/PF 87

DIPHTHERIA,PERTUSSIS(ACELLULAR),TETANUS

VACCINE 87

DIPHTHERIA,PERTUSSIS(ACELLULAR),TETANUS

VACCINE/PF 87

DIPYRIDAMOLE 48

DISULFIRAM 14

DIURIL 51

DIVALPROEX SODIUM 21

DOBUTAMINE HCL 50

DOBUTAMINE HCL IN DEXTROSE 5 % IN WATER 50

DOCETAXEL 31

DOCUSATE SODIUM 7

DOFETILIDE 49

DOLUTEGRAVIR SODIUM 37

DOLUTEGRAVIR SODIUM/LAMIVUDINE 39

DOLUTEGRAVIR SODIUM/RILPIVIRINE HCL 39

DONEPEZIL HCL 25

DORAVIRINE 37

DORAVIRINE/LAMIVUDINE/TENOFOVIR

DISOPROXIL FUMARATE 37

DORNASE ALFA 93

DORZOLAMIDE HCL 90

DORZOLAMIDE HCL/TIMOLOL MALEATE 90

DOVATO 39

DOXAZOSIN MESYLATE 48

DOXEPIN HCL 55

DOXERCALCIFEROL 88

DOXORUBICIN HCL 31

DOXORUBICIN HCL PEGYLATED LIPOSOMAL 31

DOXYCYCLINE HYCLATE 20

DOXYLAMINE SUCCINATE/PYRIDOXINE HCL

(B6) 26

DROPERIDOL 34

DROSPIRENONE 83

DROSPIRENONE/ETHINYL

ESTRADIOL/LEVOMEFOLATE CALCIUM 81

DULERA 94

DULOXETINE HCL 54

DUREZOL 90

DUTASTERIDE 69

DYANAVEL XR 52

EE.E.S. 200 19

ECONAZOLE NITRATE 27

ECONTRA EZ 7

ECONTRA ONE-STEP 7

ECPIRIN 1

ED-APAP 3

EDURANT 37

EFAVIRENZ 38

EFAVIRENZ/EMTRICITABINE/TENOFOVIR


EFAVIRENZ/LAMIVUDINE/TENOFOVIR


EFFER-K 58

ELAGOLIX SODIUM 84

ELECTROLYTE-148 SOLUTION 60

ELECTROLYTE-48 SOLUTION/DEXTROSE 5 % IN

WATER 58

ELECTROLYTE-A SOLUTION 60

ELECTROLYTE-B SOLUTION/DEXTROSE 5 % IN

WATER 59

ELECTROLYTE-M SOLUTION/DEXTROSE 5 % IN

WATER 60

ELECTROLYTE-MB SOLUTION/DEXTROSE 5 % IN

WATER 59

ELECTROLYTE-P SOLUTION/DEXTROSE 5 % IN

WATER 59

ELECTROLYTE-R (PH 7.4) 60

ELECTROLYTE-R SOLUTION 60


ELECTROLYTE-R SOLUTION/DEXTROSE 5 % IN

WATER 60

ELECTROLYTE-S SOLUTION 59

ELELYSO 68

ELIDEL 55

ELINEST 74

ELIQUIS 44

ELIXOPHYLLIN 93

ELLA 81

ELOCTATE 46

ELURYNG 74

ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TEN

OFOVIR ALAFENAMIDE 37

ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TEN

OFOVIR DISOPROXIL 37

EMGALITY PEN 28

EMGALITY SYRINGE 28

EMICIZUMAB-KXWH 46

EMOQUETTE 74

EMPAGLIFLOZIN 42

EMPAGLIFLOZIN/LINAGLIPTIN 42

EMTRICITABINE 38

EMTRICITABINE/RILPIVIRINE HCL/TENOFOVIR

ALAFENAMIDE FUMARATE 37

EMTRICITABINE/RILPIVIRINE HCL/TENOFOVIR


EMTRICITABINE/TENOFOVIR ALAFENAMIDE

FUMARATE 39

EMTRICITABINE/TENOFOVIR DISOPROXIL

FUMARATE 38

EMTRIVA 38

ENALAPRIL MALEATE 48

ENALAPRIL MALEATE/HYDROCHLOROTHIAZIDE 50

ENBREL 85

ENBREL MINI 85

ENBREL SURECLICK 85

ENEMEEZ 7

ENFUVIRTIDE 39

ENOXAPARIN SODIUM 44

ENPRESSE 74

ENSKYCE 74

ENTECAVIR 36

ENTRESTO 50

ENZALUTAMIDE 30

EPINEPHRINE 92

EPIRUBICIN HCL 31

EPITOL 24

EPIVIR 38

EPIVIR HBV 36

EPLERENONE 51

EPOETIN ALFA 45

EPOPROSTENOL SODIUM (GLYCINE) 93

EQUETRO 41

ERAXIS (WATER DILUENT) 27

ERGOCALCIFEROL (VITAMIN D2) 88

ERRIN 82

ERYTHROMYCIN BASE 19

ERYTHROMYCIN ETHYLSUCCINATE 19

ESCITALOPRAM OXALATE 25

ESLICARBAZEPINE ACETATE 23

ESOMEPRAZOLE MAGNESIUM 67

ESPEROCT 46

ESTARYLLA 74

ESTRADIOL 81

ESTRADIOL VALERATE 74

ESTRADIOL VALERATE/DIENOGEST 78

ESTRADIOL/LEVONORGESTREL 73

ESTRADIOL/NORETHINDRONE ACETATE 74

ESTRING 74

ESTROGENS, CONJUGATED 79

ESTROGENS,

CONJUGATED/MEDROXYPROGESTERONE

ACETATE 79

ESTROGENS,ESTERIFIED/METHYLTESTOSTERON

E 75

ESTROSTEP FE 75

ETANERCEPT 85

ETHAMBUTOL HCL 29

ETHINYL ESTRADIOL/DROSPIRENONE 81

ETHOSUXIMIDE 20

ETHYNODIOL DIACETATE-ETHINYL ESTRADIOL 81

ETONOGESTREL 82


ETONOGESTREL/ETHINYL ESTRADIOL 78

ETOPOSIDE 32

ETRAVIRINE 37

EUCRISA 55

EVOTAZ 39

EXELON 25

EXEMESTANE 32

EXENATIDE 42

EXENATIDE MICROSPHERES 41

EZETIMIBE 52

FFABRAZYME 68

FACTOR IX 47

FACTOR IX (HUMAN) RECOMBINANT,

PEGYLATED 47

FACTOR IX COMPLEX, PROTHROMBIN CPLX

CONC(PCC) NO.4, 3-FACTOR 47

FACTOR IX HUMAN RECOMBINANT 47

FACTOR IX HUMAN RECOMBINANT, THREONINE

148 46

FACTOR IX RECOMBINANT, FC FUSION

PROTEIN 46

FACTOR IX RECOMBINANT,ALBUMIN FUSION

PROTEIN 46

FACTOR XIII 46

FACTOR XIII A-SUBUNIT, RECOMBINANT 47

FALMINA 75

FAMOTIDINE 66

FAMOTIDINE/PF 66

FANAPT 35

FARXIGA 42

FAT EMULSIONS 60

FAYOSIM 75

FEIBA NF 46

FELBAMATE 22

FELBATOL 22

FELODIPINE 50

FEMHRT 75

FEMYNOR 75

FENOFIBRATE NANOCRYSTALLIZED 51

FENTANYL 12

FEOSOL 4

FER-IN-SOL 4

FERATE 4

FEROSUL 4

FERRIMIN 150 5

FERRO-TIME 5

FERROUS FUMARATE 5

FERROUS FUMARATE/ASCORBIC ACID/B12-

IF/FOLIC ACID 62

FERROUS FUMARATE/ASCORBIC

ACID/CYANOCOBALAMIN/FOLIC ACID 58

FERROUS FUMARATE/FOLIC ACID 59

FERROUS FUMARATE/FOLIC ACID/MULTIVITAMIN-

MINERALS NO.15 58

FERROUS GLUCONATE 5

FERROUS SULFATE 5

FERROUSUL 5

FESOTERODINE FUMARATE 68

FILGRASTIM 45

FINACEA 56

FINASTERIDE 69

FINGOLIMOD HCL 54

FIRAZYR 85

FIRVANQ 16

FLAREX 90

FLECAINIDE ACETATE 49

FLOVENT HFA 91

FLOXURIDINE 30

FLUCONAZOLE 27

FLUCONAZOLE IN SODIUM CHLORIDE, ISO-

OSMOTIC 27

FLUDARABINE PHOSPHATE 31

FLUDROCORTISONE ACETATE 70

FLUOCINOLONE ACETONIDE 70

FLUOCINOLONE ACETONIDE OIL 91

FLUORIDE (SODIUM) 62

FLUOROMETHOLONE 90

FLUOROMETHOLONE ACETATE 90

FLUOROURACIL 30

FLUOXETINE HCL 25


FLUPHENAZINE DECANOATE 34

FLUPHENAZINE HCL 34

FLUTAMIDE 30

FLUTICASONE PROPIONATE 91

FLUTICASONE PROPIONATE/SALMETEROL

XINAFOATE 94

FLUVOXAMINE MALEATE 25

FML FORTE 90

FML S.O.P. 90

FOCALIN XR 53

FOLIC ACID 63

FOLIC ACID/MULTIVITAMIN,THER AND

MINERALS/LYCOPENE/LUTEIN 5

FOLIC ACID/VITAMIN B COMP AND

C/SELENIUM/MINERALS/ZINC 63

FOLIC ACID/VITAMIN B COMPLEX AND VITAMIN

C 63

FOLIVANE-OB 63

FOLTRATE 63

FORTAMET 42

FOSAMPRENAVIR CALCIUM 40

FOSINOPRIL SODIUM 49

FOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDE 50

FREAMINE III 58

FUROSEMIDE 51

FUSION PLUS 58

FUZEON 39

FYCOMPA 22

GGABAPENTIN 21

GABITRIL 21

GALCANEZUMAB-GNLM 28

GAMMAGARD S-D 86

GANCICLOVIR SODIUM 36

GEFITINIB 32

GEMCITABINE HCL 30

GEMFIBROZIL 51

GENERESS FE 75

GENOTROPIN 71

GENTAMICIN SULFATE 15

GENTAMICIN SULFATE IN SODIUM CHLORIDE,

ISO-OSMOTIC 15

GENVOYA 37

GIANVI 75

GILENYA 54

GLASSIA 68

GLATIRAMER ACETATE 54

GLECAPREVIR/PIBRENTASVIR 36

GLIMEPIRIDE 42

GLIPIZIDE 42

GLIPIZIDE/METFORMIN HCL 42

GLUCAGEN 43

GLUCAGON EMERGENCY KIT 43

GLUCAGON HCL 43

GLUCAGON,HUMAN RECOMBINANT 43

GLUMETZA 42

GLYBURIDE 42

GLYBURIDE,MICRONIZED 42

GLYBURIDE/METFORMIN HCL 42

GLYCOPYRROLATE 66

GLYCOPYRROLATE/FORMOTEROL FUMARATE 94

GLYCOPYRROLATE/PF 66

GLYRX-PF 66

GLYSET 42

GLYXAMBI 42

GOLYTELY 67

GOSERELIN ACETATE 32

GRANISETRON HCL/PF 27

GRANIX 45

GRISEOFULVIN, MICROSIZE 27

GUAIFENESIN 11

GUAIFENESIN/DEXTROMETHORPHAN HBR 11

GUANFACINE HCL 53

GUANIDINE HCL 28

GYNAZOLE 1 27

HHAILEY 75

HAILEY 24 FE 75

HALOBETASOL PROPIONATE 70

HALOPERIDOL 34


HALOPERIDOL DECANOATE 34

HALOPERIDOL LACTATE 34

HAVRIX 87

HEATHER 82

HEMATOGEN FA 58

HEMLIBRA 46

HEMOCYTE 5

HEMOCYTE PLUS 58

HEMOCYTE-F 59

HEMOFIL M 46

HEPARIN SODIUM,PORCINE 44

HEPARIN SODIUM,PORCINE IN 0.9 % SODIUM

CHLORIDE/PF 44

HEPARIN SODIUM,PORCINE/PF 44

HEPATAMINE 59

HEPATITIS A VIRUS VACCINE/PF 87

HUMALOG 43

HUMALOG KWIKPEN U-100 43

HUMALOG MIX 50-50 43

HUMALOG MIX 50-50 KWIKPEN 43

HUMALOG MIX 75-25 43

HUMALOG MIX 75-25 KWIKPEN 43

HUMATE-P 46

HUMIRA 85

HUMIRA PEN 85

HUMIRA PEN CROHN'S-UC-HS 85

HUMIRA PEN PSOR-UVEITS-ADOL HS 86

HUMIRA(CF) 86

HUMIRA(CF) PEDIATRIC CROHN'S 86

HUMIRA(CF) PEN 86

HUMIRA(CF) PEN CROHN'S-UC-HS 86

HUMIRA(CF) PEN PSOR-UV-ADOL HS 86

HUMULIN 70-30 2

HUMULIN 70/30 KWIKPEN 2

HUMULIN N 2

HUMULIN N KWIKPEN 2

HUMULIN R 2

HYDRALAZINE HCL 52

HYDROCHLOROTHIAZIDE 51

HYDROCODONE BITARTRATE 12

HYDROCODONE

BITARTRATE/ACETAMINOPHEN 14

HYDROCODONE BITARTRATE/HOMATROPINE

METHYLBROMIDE 94

HYDROCODONE/IBUPROFEN 13

HYDROCORTISONE 88

HYDROCORTISONE ACETATE/LIDOCAINE

HCL/ALOE VERA 56

HYDROCORTISONE ACETATE/PRAMOXINE HCL 56

HYDROCORTISONE SODIUM SUCCINATE/PF 71

HYDROMORPHONE HCL 13

HYDROXYCHLOROQUINE SULFATE 33

HYDROXYPROGESTERONE CAPROATE/PF 82

HYDROXYUREA 30

HYDROXYZINE HCL 92

HYDROXYZINE PAMOATE 92

HYOSCYAMINE SULFATE 66

HYPERLYTE CR 59

HYPERRHO S-D 86

HYSINGLA ER 12

IIBALIZUMAB-UIYK 39

IBU 12

IBUPROFEN 12

ICATIBANT ACETATE 85

IDARUBICIN HCL 31

IDELVION 46

IFEREX 150 FORTE 59

IFOSFAMIDE 29

ILEVRO 90

ILOPERIDONE 35

ILOPROST TROMETHAMINE 93

IMATINIB MESYLATE 32

IMIPENEM/CILASTATIN SODIUM 17

IMIPRAMINE HCL 26

IMIQUIMOD 56

IMMUNE

GLOBULIN,GAMM(IGG)/GLYCINE/GLUCOSE/IGA 0

TO 50 MCG/ML 86


IMMUNE GLOBULIN,GAMM(IGG)/GLYCINE/IGA

GREATER THAN 50 MCG/ML 86

INCASSIA 82

INDACATEROL MALEATE/GLYCOPYRROLATE 94

INDAPAMIDE 51

INDINAVIR SULFATE 39

INDOMETHACIN 12

INFANRIX DTAP 87

INFANT PAIN-FEVER 3

INFANTS' PAIN RELIEF 4

INFANTS' PAIN-FEVER 4

INFUVITE ADULT 63

INFUVITE PEDIATRIC 63

INGREZZA 53

INSULIN ASPART 44

INSULIN ASPART PROTAMINE HUMAN/INSULIN

ASPART 44

INSULIN DETEMIR 44

INSULIN GLARGINE,HUMAN RECOMBINANT

ANALOG 43

INSULIN LISPRO 43

INSULIN LISPRO PROTAMINE AND INSULIN

LISPRO 43

INSULIN NPH HUMAN ISOPHANE 2

INSULIN NPH HUMAN ISOPHANE/INSULIN

REGULAR, HUMAN 2

INSULIN REGULAR, HUMAN 2

INTEGRA F 59

INTEGRA PLUS 59

INTELENCE 37

INTERFERON ALFA-2B,RECOMB. 36

INTERFERON BETA-1A 54

INTERFERON BETA-1A/ALBUMIN HUMAN 54

INTERFERON BETA-1B 54

INTERFERON GAMMA-1B,RECOMB. 86

INTRALIPID 59

INTRON A 36

INTROVALE 75

INVEGA SUSTENNA 35

INVEGA TRINZA 35

INVIRASE 39

INVOKAMET 42

INVOKANA 42

IODOPEN 59

IONOSOL B WITH DEXTROSE 5% 59

IONOSOL MB-DEXTROSE 5% 59

IPRATROPIUM BROMIDE 92

IPRATROPIUM BROMIDE/ALBUTEROL SULFATE 94

IRBESARTAN 48

IRESSA 32

IRINOTECAN HCL 31

IRON FUM,POLYSAC COMP/FOLIC ACID/VIT B

COMPC NO.18/L. CASEI 58

IRON FUMARATE,POLYSAC COMP/FOLIC

ACID/VITAMIN C/NIACINAMIDE 59

IRON FUMARATE,POLYSAC CPLEX/FOLIC

ACID/VITB COMP WITH C NO.9 65

IRON FUMARATE-IRON POLYSACCH CPLEX/FOLIC

ACID/MULTIVIT NO.18 62

IRON POLYSACCHARIDE

COMPLEX/CYANOCOBALAMIN/FOLIC ACID 59

ISENTRESS 37

ISENTRESS HD 37

ISIBLOOM 75

ISOLYTE P WITH DEXTROSE 59

ISOLYTE S 59

ISONIAZID 29

ISOSORBIDE DINITRATE 52

ISOSORBIDE MONONITRATE 52

ISOTRETINOIN 56

IVERMECTIN 33

IXINITY 46

JJAIMIESS 75

JANTOVEN 44

JANUMET 42

JANUMET XR 42

JANUVIA 42

JARDIANCE 42

JASMIEL 75

JENCYCLA 82


JENTADUETO 42

JIVI 46

JOLESSA 75

JR. STR NON-ASPIRIN PAIN 4

JULEBER 75

JULUCA 39

JUNEL 75

JUNEL FE 75

JUNEL FE 24 76

KK-PHOS NEUTRAL 69

K-PHOS NO.2 69

K-PHOS ORIGINAL 69

KABIVEN 64

KAITLIB FE 76

KALETRA 39

KALLIGA 76

KARIVA 76

KELNOR 1-35 76

KELNOR 1-50 76

KEPPRA 20

KEPPRA XR 20

KETOCONAZOLE 27

KETOROLAC TROMETHAMINE 90

KITABIS PAK 93

KLONOPIN 41

KLOR-CON 59

KLOR-CON 10 59

KLOR-CON 8 59

KLOR-CON M10 59

KLOR-CON M15 59

KLOR-CON M20 59

KLOR-CON-EF 59

KOATE 46

KOGENATE FS 46

KOMBIGLYZE XR 42

KOVALTRY 46

KURVELO 76

KYLEENA 82

LLABETALOL HCL 49

LACOSAMIDE 24

LACTULOSE 67

LAMICTAL 22

LAMICTAL (BLUE) 22

LAMICTAL (GREEN) 22

LAMICTAL (ORANGE) 22

LAMICTAL ODT 22

LAMICTAL ODT (BLUE) 22

LAMICTAL ODT (GREEN) 22

LAMICTAL ODT (ORANGE) 22

LAMICTAL XR 22

LAMICTAL XR (BLUE) 22

LAMICTAL XR (GREEN) 22

LAMICTAL XR (ORANGE) 22

LAMIVUDINE 38

LAMIVUDINE/TENOFOVIR DISOPROXIL

FUMARATE 38

LAMIVUDINE/ZIDOVUDINE 38

LAMOTRIGINE 23

LANSOPRAZOLE 67

LANTUS 43

LANTUS SOLOSTAR 43

LARIN 76

LARIN 24 FE 76

LARIN FE 76

LARISSIA 76

LATANOPROST 91

LATUDA 35

LAYOLIS FE 76

LEENA 76

LEFLUNOMIDE 86

LENALIDOMIDE 30

LESSINA 76

LETAIRIS 93

LETROZOLE 32

LEUCOVORIN CALCIUM 31

LEUKERAN 29

LEUKINE 45


LEUPROLIDE ACETATE 84

LEUPROLIDE ACETATE/NORETHINDRONE

ACETATE 84

LEVEMIR 44

LEVEMIR FLEXTOUCH 44

LEVETIRACETAM 20

LEVOBUNOLOL HCL 90

LEVOCARNITINE (WITH SUGAR) 60

LEVOCETIRIZINE DIHYDROCHLORIDE 92

LEVOFLOXACIN 19

LEVOFLOXACIN/DEXTROSE 5 % IN WATER 19

LEVONEST 76

LEVONORGESTREL 83

LEVONORGESTREL/ETHINYL ESTRADIOL 81

LEVONORGESTREL/ETHINYL ESTRADIOL AND

ETHINYL ESTRADIOL 79

LEVONORGESTREL/ETHINYL

ESTRADIOL/FERROUS BISGLYCINATE 73

LEVORA-28 76

LEVOTHYROXINE SODIUM 84

LEVOXYL 83

LEXIVA 40

LIDOCAINE 14

LIDOCAINE HCL 14

LIDOCAINE HCL IN DEXTROSE 7.5 % IN

WATER/PF 14

LIDOCAINE HCL/EPINEPHRINE 14

LIDOCAINE HCL/EPINEPHRINE BITARTRATE 14

LIDOCAINE HCL/PF 14

LIDOCAINE/PRILOCAINE 14

LILETTA 82

LILLOW 76

LINACLOTIDE 66

LINAGLIPTIN 43

LINAGLIPTIN/METFORMIN HCL 42

LINCOMYCIN HCL 16

LINEZOLID 16

LINZESS 66

LIOTHYRONINE SODIUM 83

LIOTRIX 84

LIPASE/PROTEASE/AMYLASE 68

LIQUITUSS GG 9

LISDEXAMFETAMINE DIMESYLATE 53

LISINOPRIL 49

LISINOPRIL/HYDROCHLOROTHIAZIDE 50

LITHIUM CARBONATE 41

LO LOESTRIN FE 77

LO-ZUMANDIMINE 77

LOESTRIN 77

LOESTRIN FE 77

LOJAIMIESS 77

LOPERAMIDE HCL 66

LOPINAVIR/RITONAVIR 39

LORATA-DINE D 9

LORATADINE 8

LORATADINE-D 9

LORATADINE/PSEUDOEPHEDRINE SULFATE 9

LORAZEPAM 41

LORAZEPAM INTENSOL 41

LORYNA 77

LOSARTAN POTASSIUM 48

LOSARTAN

POTASSIUM/HYDROCHLOROTHIAZIDE 50

LOSEASONIQUE 77

LOTEMAX 90

LOTEPREDNOL ETABONATE 90

LOTRONEX 66

LOVASTATIN 52

LOW-OGESTREL 77

LOXAPINE SUCCINATE 34

LUPANETA PACK 84

LUPRON DEPOT 84

LUPRON DEPOT (LUPANETA) 84

LUPRON DEPOT-PED 84

LURASIDONE HCL 35

LUTERA 77

LYZA 82

MM-NATAL PLUS 64

M-PAP 4

M.V.I. ADULT 64


M.V.I. PEDIATRIC 64

MAGNESIUM CHLORIDE 60

MAGNESIUM SULFATE IN STERILE WATER 60

MAKENA 82

MANGANESE CHLORIDE 60

MANGANESE SULFATE 60

MANNITOL/SORBITOL SOLUTION 88

MAPAP ARTHRITIS PAIN 4

MARAVIROC 39

MARLISSA 77

MATULANE 29

MAVYRET 36

MAXIDEX 90

MECLIZINE HCL 26

MEDROXYPROGESTERONE ACETATE 82

MEFLOQUINE HCL 33

MEGESTROL ACETATE 82

MELODETTA 24 FE 77

MELOXICAM 12

MELPHALAN 29

MELPHALAN HCL 29

MEMANTINE HCL 25

MEPHYTON 47

MERCAPTOPURINE 30

MEROPENEM 18

MEROPENEM IN 0.9 % SODIUM CHLORIDE 18

MESALAMINE 87

MESNA 32

MESTINON 28

METFORMIN HCL 43

METHAZOLAMIDE 90

METHENAMINE HIPPURATE 16

METHENAMINE MANDELATE 16

METHIMAZOLE 85

METHOCARBAMOL 95

METHOTREXATE SODIUM 86

METHOTREXATE SODIUM/PF 86

METHYLDOPA 48

METHYLERGONOVINE MALEATE 88

METHYLPHENIDATE 53

METHYLPHENIDATE HCL 53

METHYLPREDNISOLONE 70

METHYLPREDNISOLONE ACETATE 70

METHYLPREDNISOLONE SODIUM SUCCINATE 70

METOCLOPRAMIDE HCL 26

METOLAZONE 51

METOPROLOL SUCCINATE 49

METOPROLOL TARTRATE 49

METRONIDAZOLE 56

METRONIDAZOLE IN SODIUM CHLORIDE 16

MEXILETINE HCL 49

MIBELAS 24 FE 77

MICONAZOLE 3 2

MICONAZOLE NITRATE 27

MICROGESTIN FE 77

MIDODRINE HCL 48

MIGLITOL 42

MIGLUSTAT 68

MILI 77

MILRINONE LACTATE 50

MILRINONE LACTATE/DEXTROSE 5 % IN WATER50

MINASTRIN 24 FE 77

MINOCYCLINE HCL 20

MINOXIDIL 52

MIRCETTE 77

MIRENA 82

MIRTAZAPINE 25

MISOPROSTOL 67

MITOMYCIN 31

MITOXANTRONE HCL 31

MODAFINIL 95

MOMETASONE FUROATE 91

MOMETASONE FUROATE/FORMOTEROL

FUMARATE 94

MONO-LINYAH 77

MONONINE 47

MONTELUKAST SODIUM 92

MORPHABOND ER 12

MORPHINE SULFATE 13

MOVANTIK 66

MOXIFLOXACIN HCL 19

MUCINEX 9


MUCINEX DM 10

MUCOSA 10

MUCUS DM MAX ER 10

MUCUS ER 10

MUCUS RELIEF 10

MUCUS RELIEF CHEST CONGESTION 10

MUCUS RELIEF DM COUGH 10

MUCUS RELIEF DM ER 10

MUCUS RELIEF DM MAX 10

MUCUS RELIEF DM MAX ER 10

MUCUS RELIEF ER 10

MUCUS-CHEST CONGESTION 10

MUCUS-ER MAX 10

MULTITRACE-4 60

MULTITRACE-5 60

MULTIVIT WITH MINS10/FOLIC ACID/VIT D3/A

LIPOIC ACID/LUTEIN 64

MULTIVITAMIN INFUSION, ADULT NO.1 WITH

WITAMIN K 64

MULTIVITAMIN INFUSION, ADULT NO.4 WITH

VITAMIN K 63

MULTIVITAMIN INFUSION, PEDIATRIC NO.1 WITH

VITAMIN K 63

MULTIVITAMIN INFUSION, PEDIATRIC NO.2 WITH

VITAMIN K 64

MULTIVITAMIN WITH MINERALS NO.20/IRON/FOLIC

ACID 63

MULTIVITAMIN, MINERALS NO.51/FOLIC ACID/VIT

K1/UBIDECARENONE 5

MULTIVITAMIN-MINERALS NO.25/FOLIC

ACID/VITAMIN D3 63

MULTIVITAMINS WITH MINERALS NO.11/FOLIC

ACID 63

MUPIROCIN 16

MUTAMYCIN 31

MV-MIN 75/FERROUS FUM/IRON PS CPLX/FOLIC

AC/OMEGA-3/DHA/EPA 65

MV-MINS NO.74/FERROUS FUMARATE/IRON PS

CPLX/FOLIC ACID 63

MY CHOICE 7

MY WAY 7

MYCOPHENOLATE MOFETIL 86

MYCOPHENOLATE MOFETIL HCL 85

MYLERAN 29

MYORISAN 56

MYSOLINE 21

NNABUMETONE 12

NAFARELIN ACETATE 84

NALOXEGOL OXALATE 66

NALOXONE HCL 15

NALTREXONE HCL 14

NALTREXONE MICROSPHERES 14

NAPROXEN 12

NARCAN 15

NATAZIA 78

NATROBA 56

NEBUPENT 33

NECON 78

NELFINAVIR MESYLATE 40

NEOMYCIN SULFATE 15

NEOMYCIN SULFATE/BACITRACIN

ZINC/POLYMYXIN B/HYDROCORTISONE 89

NEOMYCIN SULFATE/BACITRACIN/POLYMYXIN

B 89

NEOMYCIN SULFATE/POLYMYXIN B SULFATE 16

NEOMYCIN SULFATE/POLYMYXIN B

SULFATE/HYDROCORTISONE 91

NEOMYCIN/BACITRACIN/POLYMYXIN

B/HYDROCORTISONE 55

NEOMYCIN/POLYMYXIN B

SULFATE/DEXAMETHASONE 89

NEPAFENAC 90

NEPHPLEX RX 64

NEPHRAMINE 60

NEPHRO-VITE RX 64

NETARSUDIL MESYLATE 90

NETARSUDIL MESYLATE/LATANOPROST 90

NEULASTA 45

NEUPOGEN 45

NEURONTIN 21


NEVIRAPINE 38

NEW DAY 7

NEXIUM 67

NEXPLANON 82

NIACIN 52

NICORETTE 1

NICOTINE 1

NICOTINE POLACRILEX 1

NIFEDIPINE 50

NIKKI 78

NIMODIPINE 50

NITROFURANTOIN MACROCRYSTAL 16

NITROFURANTOIN

MONOHYDRATE/MACROCRYSTALS 16

NITROGLYCERIN 52

NORA-BE 82

NORDITROPIN FLEXPRO 71

NORELGESTROMIN/ETHINYL ESTRADIOL 81

NORETHINDRONE 83

NORETHINDRONE ACETATE 83

NORETHINDRONE ACETATE-ETHINYL

ESTRADIOL 78

NORETHINDRONE ACETATE-ETHINYL

ESTRADIOL/FERROUS FUMARATE 80

NORETHINDRONE-ETHINYL ESTRADIOL 81

NORETHINDRONE-ETHINYL

ESTRADIOL/FERROUS FUMARATE 81

NORGESTIMATE-ETHINYL ESTRADIOL 81

NORGESTREL-ETHINYL ESTRADIOL 78

NORLYDA 83

NORMOSOL-M AND DEXTROSE 60

NORMOSOL-R 60

NORMOSOL-R AND DEXTROSE 60

NORMOSOL-R PH 7.4 60

NORTREL 78

NORTRIPTYLINE HCL 26

NORVIR 40

NOVOEIGHT 47

NOVOLIN N 2

NOVOLIN R 2

NOVOLOG 44

NOVOLOG FLEXPEN 44

NOVOLOG MIX 70-30 44

NOVOLOG MIX 70-30 FLEXPEN 44

NOVOSEVEN RT 47

NP THYROID 83

NUEDEXTA 53

NUTRILIPID 60

NUVARING 78

NUWIQ 47

NYSTATIN 27

NYSTATIN/TRIAMCINOLONE ACETONIDE 28

OOBIZUR 47

OCELLA 78

OCTREOTIDE ACETATE 84

ODEFSEY 37

OFATUMUMAB 32

OFLOXACIN 19

OGESTREL 78

OLANZAPINE 35

OLMESARTAN MEDOXOMIL 48

OLOPATADINE HCL 90

OMEPRAZOLE 67

ONCASPAR 31

ONDANSETRON 27

ONDANSETRON HCL 27

ONFI 21

ONGLYZA 43

OPCICON ONE-STEP 7

OPIUM/BELLADONNA ALKALOIDS 13

ORACIT 69

ORILISSA 84

ORSYTHIA 78

ORTHO MICRONOR 83

ORTHO TRI-CYCLEN 78

ORTHO-NOVUM 78

OSELTAMIVIR PHOSPHATE 40

OXALIPLATIN 31

OXAZEPAM 41

OXCARBAZEPINE 24


OXTELLAR XR 24

OXYBUTYNIN CHLORIDE 68

OXYCODONE HCL 13

OXYCODONE HCL/ACETAMINOPHEN 13

OXYCODONE MYRISTATE 13

OYSCO-500 5

PPACLITAXEL 31

PAIN RELIEF 4

PAIN RELIEVER JUNIOR STRENGTH 4

PALIPERIDONE PALMITATE 35

PAMIDRONATE DISODIUM 88

PANCREAZE 68

PANRETIN 32

PANTOPRAZOLE SODIUM 67

PARAGARD T 380-A 88

PARAPLATIN 31

PARENTERAL AMINO ACID 10 % COMBINATION

NO.2 56


NO.4 58


NO.6 62

PARENTERAL AMINO ACID 10% COMBINATION

NO.7 61


NO.1 60


NO.5 57


NO.1 61

PARENTERAL AMINO ACID 5.2 % COMBINATION

NO.1 (RENAL) 57


NO.1 (PEDIATRIC) 57


NO.2 57

PARICALCITOL 88

PAROXETINE HCL 25

PAZEO 90

PAZOPANIB HCL 32

PEDIATRIC MULTIVITAMIN A,C,AND D3 NO.38

WITH SODIUM FLUORIDE 6

PEDIATRIC MULTIVITAMIN NO.33 WITH SODIUM

FLUORIDE 5

PEDIATRIC MULTIVITAMIN NO.33/SODIUM

FLUORIDE/IRON CARBONYL 5

PEDIATRIC MULTIVITAMIN NO.40/PHYTONADIONE

(VIT K1) 5

PEDIATRIC MULTIVITAMINS NO.17 WITH SODIUM

FLUORIDE 64

PEG 3350/SOD SULF/SOD BICARB/SOD

CHLORIDE/POTASSIUM CHLORIDE 67

PEGASPARGASE 31

PEGASYS 36

PEGFILGRASTIM 45

PEGINTERFERON ALFA-2A 36

PEGINTERFERON ALFA-2B 36

PEGINTRON 36

PEMETREXED DISODIUM 30

PENCICLOVIR 40

PENICILLIN G BENZATHINE 18

PENICILLIN G BENZATHINE/PENICILLIN G

PROCAINE 18

PENICILLIN G PROCAINE 18

PENICILLIN G SODIUM 18

PENICILLIN V POTASSIUM 18

PENTAMIDINE ISETHIONATE 33

PENTOXIFYLLINE 50

PERAMPANEL 22

PERIKABIVEN 64

PERITONEAL DIALYSIS SOLUTION NO.19 AND

DEXTROSE 1.5 % 57

PERMETHRIN 33

PERPHENAZINE 26

PERPHENAZINE/AMITRIPTYLINE HCL 25

PERSERIS 35

PERTZYE 68

PHENAZOPYRIDINE HCL 69

PHENOBARBITAL 21


PHENOBARBITAL/HYOSCYAMINE SULF/ATROPINE

SULF/SCOPOLAMINE HB 66

PHENYLEPHRINE HCL 89

PHENYLEPHRINE HCL/PROMETHAZINE HCL 94

PHENYTOIN 24

PHENYTOIN SODIUM EXTENDED 24

PHILITH 78

PHOSPHA 250 NEUTRAL 69

PHYTONADIONE (VIT K1) 47

PIFELTRO 37

PILOCARPINE HCL 54

PIMECROLIMUS 55

PIMOZIDE 34

PIMTREA 78

PIOGLITAZONE HCL 43

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 18

PIPERONYL BUTOXIDE/PYRETHRINS 4

PIRMELLA 78

PLAN B ONE-STEP 7

PLASMA-LYTE 148 60

PLASMA-LYTE A PH 7.4 60

PLENAMINE 60

PNV 29-1 64

PODOFILOX 56

POLY-VI-FLOR 5

POLY-VI-FLOR WITH IRON 5

POLYCIN 89

POLYETHYLENE GLYCOL 3350 7

POLYMYXIN B SULFATE 16

POLYMYXIN B SULFATE/TRIMETHOPRIM 89

POMALIDOMIDE 30

POMALYST 30

PORTIA 78

POTASSIUM ACETATE 60

POTASSIUM BICARBONATE/CITRIC ACID 59

POTASSIUM CHLORIDE 59

POTASSIUM CHLORIDE IN 0.45 % SODIUM

CHLORIDE 61

POTASSIUM CHLORIDE IN 0.9 % SODIUM

CHLORIDE 60

POTASSIUM CHLORIDE IN 5 % DEXTROSE IN

WATER 58

POTASSIUM CHLORIDE IN DEXTROSE 5 % AND 0.9

% SODIUM CHLORIDE 58

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.2 %

SODIUM CHLORIDE 58

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.45 %

SODIUM CHLORIDE 58

POTASSIUM CHLORIDE IN DEXTROSE 5% AND 0.3

% SODIUM CHLORIDE 58

POTASSIUM CHLORIDE IN LACTATED RINGERS

AND 5 % DEXTROSE 61

POTASSIUM CHLORIDE IN WATER FOR

INJECTION, STERILE 60

POTASSIUM CITRATE 69

POTASSIUM CITRATE/CITRIC ACID 69

POTASSIUM PHOSPHATE,MONOBASIC 69

POTASSIUM PHOSPHATE,MONOBASIC-DIBASIC 61

PRADAXA 44

PRAMIPEXOLE DI-HCL 33

PRASUGREL HCL 48

PRAVASTATIN SODIUM 52

PRAZIQUANTEL 33

PRAZOSIN HCL 48

PREDNISOLONE 70

PREDNISOLONE ACETATE 90

PREDNISOLONE SODIUM PHOSPHATE 71

PREDNISONE 71

PREGABALIN 54

PREMARIN 79

PREMASOL 61

PREMPHASE 79

PREMPRO 79

PRENATAL VIT NO.112/IRON PHOSPH/FOLIC

ACID/OMEGA-3S/DHA/EPA 65

PRENATAL VIT NO.128/IRON POLYSACCHARIDE

COMPLEX/FOLIC ACID 64

PRENATAL VIT NO.2/IRON BG CHEL,SUCC-

PROT/FOLIC ACID/OMEGA-3 65

PRENATAL VIT NO.67/IRON

POLYSACCHARIDES/FOLATE COMB.NO.1/DHA 65


PRENATAL VIT WITH CALCIUM 53/IRON BIS,S-

P/FOLIC ACID/OMEGA-3 65

PRENATAL VITAMIN 27 WITH CALCIUM/FERROUS

FUMARATE/FOLIC ACID 65

PRENATAL VITAMIN

NO.48/IRON,CARBONYL,GLUCONATE/FOLIC

ACID/B6 63

PRENATAL VITAMIN WITH CALCIUM

NO.76/IRON,CARBONYL/FOLIC ACID 65

PRENATAL VITAMINS NO.33/IRON POLYSACH

COMPLEX/FOLIC ACID/DHA 64

PRENATAL VITS NO.26/IRON POLYSACCHARIDE

CPLEX/FOLIC ACID/DHA 65

PRENATAL VITS WITH CALCIUM 118/FERROUS


PRENATAL VITS WITH CALCIUM NO.10/FERROUS

FUM/FOLIC ACID/DHA 65





PREPLUS 64

PREVACID 67

PREVIFEM 79

PREZCOBIX 40

PREZISTA 40

PRIMAQUINE PHOSPHATE 33

PRIMIDONE 21

PROAIR HFA 92

PROBENECID 28

PROBENECID/COLCHICINE 28

PROCALAMINE 61

PROCARBAZINE HCL 29

PROCHLORPERAZINE MALEATE 26

PROCRIT 45

PROCTO-MED HC 88

PROCTOFOAM-HC 56

PROCTOSOL-HC 88

PROCTOZONE-HC 88

PROFILNINE 47

PROGESTERONE 83

PROGESTERONE, MICRONIZED 83

PROGLYCEM 43

PROLASTIN C 68

PROMETHAZINE HCL 92

PROMETHAZINE HCL/DEXTROMETHORPHAN

HBR 94

PROMETHEGAN 27

PROMETRIUM 83

PROPAFENONE HCL 49

PROPANTHELINE BROMIDE 66

PROPRANOLOL HCL 49

PROPYLTHIOURACIL 85

PROSOL 61

PROTONIX 67

PROTOPIC 56

PROVENTIL HFA 92

PULMOZYME 93

PUREVIT DUALFE PLUS 61

PYLERA 66

PYRAZINAMIDE 29

PYRIDOSTIGMINE BROMIDE 28

PYRIDOXINE HCL (VITAMIN B6) 64

QQUARTETTE 79

QUDEXY XR 23

QUETIAPINE FUMARATE 35

QUILLICHEW ER 53

QUILLIVANT XR 53

QUINAPRIL HCL 49

QUINAPRIL HCL/HYDROCHLOROTHIAZIDE 50

QUINIDINE SULFATE 49

RRALTEGRAVIR POTASSIUM 37

RAMELTEON 95

RAMIPRIL 49

RANEXA 51

RANOLAZINE 51

RAPAMUNE 86

REBIF 54


REBIF REBIDOSE 54

REBINYN 47

RECLIPSEN 79

RECOMBINATE 47

RENACIDIN 69

RENVELA 62

REPAGLINIDE 43

RESTASIS 89

RESTASIS MULTIDOSE 89

RETIN-A 56

RETROVIR 38

REVLIMID 30

REYATAZ 40

RHO(D) IMMUNE GLOBULIN 86

RHOPRESSA 90

RIBAVIRIN 94

RIFABUTIN 29

RIFAMPIN 29

RILPIVIRINE HCL 37

RILUZOLE 54

RINGER'S SOLUTION 61

RINGER'S SOLUTION,LACTATED 60

RISPERDAL CONSTA 35

RISPERIDONE 35

RISPERIDONE MICROSPHERES 35

RITONAVIR 40

RITUXAN 32

RITUXIMAB 32

RIVAROXABAN 44

RIVASTIGMINE 25

RIVELSA 79

RIXUBIS 47

RIZATRIPTAN BENZOATE 28

ROBAFEN 10

ROBAFEN DM COUGH 10

ROBAFEN DM PEAK COLD 10

ROCKLATAN 90

ROPINIROLE HCL 33

ROSUVASTATIN CALCIUM 52

ROWEEPRA 20

ROZEREM 95

RUFINAMIDE 24

SSABRIL 21

SACUBITRIL/VALSARTAN 50

SAFYRAL 79

SALICYLIC ACID 56

SALMETEROL XINAFOATE 92

SALSALATE 12

SANDIMMUNE 86

SANTYL 56

SAQUINAVIR MESYLATE 39

SARGRAMOSTIM 45

SAXAGLIPTIN HCL 43

SAXAGLIPTIN HCL/METFORMIN HCL 42

SCOPOLAMINE 27

SE-NATAL 19 64

SE-TAN PLUS 61

SEASONIQUE 79

SECUKINUMAB 55

SEGESTERONE ACETATE/ETHINYL ESTRADIOL 72

SELECT-OB 64

SELECT-OB + DHA 64

SELEGILINE HCL 34

SELENIUM SULFIDE 56

SELZENTRY 39

SEREVENT DISKUS 92

SERTRALINE HCL 25

SETLAKIN 79

SEVELAMER CARBONATE 62

SEVELAMER HCL 62

SHAROBEL 83

SHINGRIX 87

SHINGRIX ADJUVANT COMPONENT 87

SHINGRIX GE ANTIGEN COMPONENT 87

SILDENAFIL CITRATE 93

SILTUSSIN SA 10

SILVER NITRATE 56

SILVER SULFADIAZINE 19

SIMLIYA 79

SIMPESSE 79


SIMVASTATIN 52

SIROLIMUS 86

SITAGLIPTIN PHOSPHATE 42

SITAGLIPTIN PHOSPHATE/METFORMIN HCL 42

SKYLA 83

SLYND 83

SODIUM ACETATE 61

SODIUM BICARBONATE 61

SODIUM CHLORIDE 0.45 % 61

SODIUM CHLORIDE FOR INHALATION 94

SODIUM CHLORIDE/POT CHLORIDE/MAG SUL/SOD

PHOS,DB/POT PHOS,MB 62

SODIUM CHLORIDE/SODIUM

BICARBONATE/POTASSIUM CHLORIDE/PEG 67

SODIUM IODIDE 59

SODIUM PHOSPHATE,DIBASIC/POT

PHOS,MONOB/SOD PHOSPHATE MONO 69

SODIUM PHOSPHATE,MONOBASIC-DIBASIC 62

SODIUM PHOSPHATE,MONOBASIC/POTASSIUM

PHOSPHATE,MONOBASIC 69

SODIUM PICOSULFATE/MAGNESIUM

OXIDE/CITRIC ACID 66

SODIUM POLYSTYRENE SULFONATE 62

SODIUM POLYSTYRENE SULFONATE/SORBITOL

SOLUTION 62

SODIUM/POTASSIUM/MAGNESIUM/CALCIUM/CHLO

RIDE/ACETATE 62

SODIUM/POTASSIUM/POTASSIUM

CITRATE/SODIUM CITRATE/CIT AC 69

SOFOSBUVIR/VELPATASVIR 36

SOFOSBUVIR/VELPATASVIR/VOXILAPREVIR 36

SOLIFENACIN SUCCINATE 68

SOLU-CORTEF 71

SOMATROPIN 71

SORBITOL SOLUTION 88

SOTALOL HCL 49

SPINOSAD 56

SPIRIVA 92

SPIRONOLACTONE 51

SPIRONOLACTONE/HYDROCHLOROTHIAZIDE 51

SPRINTEC 79

SPS 62

SRONYX 79

STAVUDINE 38

STERILE WATER FOR IC-GREEN 88

STERILE WATER FOR KCENTRA 89

STIMATE 71

STIOLTO RESPIMAT 94

STRIBILD 37

STROVITE ONE 64

SUBLOCADE 13

SUBOXONE 15

SUBVENITE 23

SUBVENITE (BLUE) 23

SUBVENITE (GREEN) 23

SUBVENITE (ORANGE) 23

SUCRALFATE 67

SULFACETAMIDE SODIUM/PREDNISOLONE

SODIUM PHOSPHATE 89

SULFAMETHOXAZOLE/TRIMETHOPRIM 19

SULFASALAZINE 88

SUMATRIPTAN 28

SUMATRIPTAN SUCCINATE 28

SUNITINIB MALATE 32

SUSTIVA 38

SUTENT 32

SYEDA 79

SYMBICORT 94

SYMFI 38

SYMFI LO 38

SYMPAZAN 21

SYMTUZA 40

SYNAREL 84

SYNTHAMIN 17 WITHOUT ELTYE 62

TTACROLIMUS 86

TADALAFIL 93

TAKE ACTION 7

TALIGLUCERASE ALFA 68

TAMOXIFEN CITRATE 30

TAMSULOSIN HCL 69


TANDEM PLUS 62

TARINA 24 FE 79

TARINA FE 80

TARINA FE 1-20 EQ 80

TARON-C DHA 65

TAYTULLA 80

TBO-FILGRASTIM 45

TECFIDERA 54

TEGRETOL 24

TEGRETOL XR 24

TEMAZEPAM 95

TEMIXYS 38

TEMODAR 29

TEMOZOLOMIDE 29

TENOFOVIR DISOPROXIL FUMARATE 38

TERAZOSIN HCL 48

TERBINAFINE HCL 28

TERBUTALINE SULFATE 92

TERCONAZOLE 28

TERIFLUNOMIDE 54

TESTOSTERONE 71

TESTOSTERONE CYPIONATE 72

TESTOSTERONE ENANTHATE 72

TETRABENAZINE 54

THEO-24 93

THEOPHYLLINE ANHYDROUS 93

THIAMINE HCL 65

THIOLA 69

THIORIDAZINE HCL 34

THIOTEPA 31

THIOTHIXENE 34

THRIVITE RX 65

THYROID 83

THYROID,PORK 83

THYROLAR-1 83

THYROLAR-1/2 84

THYROLAR-1/4 84

THYROLAR-2 84

THYROLAR-3 84

TIAGABINE HCL 21

TICAGRELOR 48

TIKOSYN 49

TILIA FE 80

TIMOLOL MALEATE 91

TINIDAZOLE 16

TIOPRONIN 69

TIOTROPIUM BROMIDE 92

TIOTROPIUM BROMIDE/OLODATEROL HCL 94

TIPRANAVIR/VITAMIN E TPGS 39

TIS-U-SOL PENTALYTE 62

TIVICAY 37

TIZANIDINE HCL 36

TOBRADEX 89

TOBRAMYCIN 93

TOBRAMYCIN SULFATE 15

TOBRAMYCIN/DEXAMETHASONE 89

TOBRAMYCIN/LOTEPREDNOL ETABONATE 89

TOBRAMYCIN/NEBULIZER 93

TOFACITINIB CITRATE 86

TOPAMAX 23

TOPIRAMATE 23

TOPOTECAN HCL 32

TORSEMIDE 51

TOVIAZ 68

TPN ELECTROLYTES 62

TPN ELECTROLYTES II 62

TRACLEER 93

TRADJENTA 43

TRAMADOL HCL 13

TRANEXAMIC ACID 47

TRANEXAMIC ACID IN SODIUM CHLORIDE,ISO-

OSMOTIC 47

TRANSDERM-SCOP 27

TRAVASOL 62

TRAVATAN Z 91

TRAVOPROST 91

TRAZODONE HCL 26

TREANDA 29

TRETINOIN 56

TRETTEN 47

TRI FEMYNOR 80

TRI-ESTARYLLA 80


TRI-LEGEST FE 80

TRI-LINYAH 80

TRI-LO-ESTARYLLA 80

TRI-LO-MARZIA 80

TRI-LO-MILI 80

TRI-LO-SPRINTEC 80

TRI-MILI 80

TRI-PREVIFEM 80

TRI-SPRINTEC 80

TRI-VI-FLOR 6

TRI-VYLIBRA 80

TRI-VYLIBRA LO 80

TRIAMCINOLONE ACETONIDE 71

TRIAMTERENE/HYDROCHLOROTHIAZIDE 51

TRICITRATES 69

TRICON 62

TRIDERM 71

TRIFLUOPERAZINE HCL 34

TRIFLURIDINE 40

TRIHEXYPHENIDYL HCL 33

TRILEPTAL 24

TRILYTE WITH FLAVOR PACKETS 67

TRIMETHOPRIM 16

TRINATAL RX 1 65

TRINTELLIX 26

TRIPTODUR 84

TRIPTORELIN PAMOATE 84

TRIUMEQ 39

TRIVEEN-DUO DHA 65

TRIVORA-28 80

TRIZIVIR 38

TROGARZO 39

TROKENDI XR 23

TROPHAMINE 62

TRUST NATAL DHA 65

TRUVADA 38

TULANA 83

TUMS 6

TUMS FRESHERS 6

TUMS SMOOTHIES 6

TUMS ULTRA 6

TUMS ULTRA STRENGTH 6

TUMS X-STR 6

TUSSIN 10

TUSSIN CHEST CONGESTION 10

TUSSIN DM 11

TUSSIN DM MAX 11

TUSSIN HONEY 11

TUSSIN MUCUS-CHEST CONGESTION 11

TYBOST 39

TYDEMY 81

UULIPRISTAL ACETATE 81

ULTRA STRENGTH ANTACID 6

UNITHROID 84

UREA 56

URSODIOL 66

UTIBRON NEOHALER 94

VVACCINE ADJUVANT SYSTEM, AS01B/PF,

COMPONENT VIAL 1 OF 2 87

VAGIFEM 81

VALACYCLOVIR HCL 40

VALBENAZINE TOSYLATE 53

VALGANCICLOVIR HCL 36

VALPROIC ACID 21

VALRUBICIN 31

VALSTAR 31

VANALICE 4

VANCOMYCIN HCL 16

VANCOMYCIN IN 0.9 % SODIUM CHLORIDE 17

VANCOMYCIN IN 5 % DEXTROSE IN WATER 17

VAQTA 87

VARENICLINE TARTRATE 15

VARICELLA-ZOSTER VIRUS GLYCOPROTEIN

E,REC,COMPONENT 2 OF 2 87

VARICELLA-ZOSTER VIRUS GLYCOPROTEIN

E,REC/AS01B ADJUVANT/PF 87

VELIVET 81

VENLAFAXINE HCL 26


VENTAVIS 93

VERAPAMIL HCL 50

VICODIN HP 14

VIDEX 38

VIENVA 81

VIGABATRIN 22

VIGADRONE 22

VIIBRYD 26

VILAZODONE HCL 26

VIMPAT 24

VINBLASTINE SULFATE 31

VINCRISTINE SULFATE 32

VINORELBINE TARTRATE 32

VIOKACE 68

VIORELE 81

VIRACEPT 40

VIRAMUNE 38

VIREAD 38

VIRT-C DHA 65

VIRT-FEFA PLUS 65

VIRT-PHOS 250 NEUTRAL 69

VIRTRATE-3 69

VIRTRATE-K 69

VIT B COMPLEX NO.3/FOLIC ACID/ASCORBIC

ACID/BIOTIN/ZINC OXID 64

VIT B COMPLEX NO.4/VIT D3/ASCORBIC

ACID/FOLIC ACID/ZINC OXID 65

VITAFOL GUMMIES 65

VITAFOL ULTRA 65

VITAFOL-OB 65

VITAFOL-OB+DHA 65

VITAFOL-ONE 65

VITAL-D RX 65

VITAMIN B COMPLEX NO.11/FOLIC ACID/VIT

C/BIOTIN/ZINC OXIDE 63

VITAMIN B COMPLEX NO.3/FOLIC ACID/ASCORBIC

ACID(VITC)/BIOTIN 65

VIVITROL 14

VOLNEA 81

VON WILLEBRAND FACTOR (RECOMBINANT) 47

VONVENDI 47

VORTIOXETINE HYDROBROMIDE 26

VOSEVI 36

VOTRIENT 32

VP-VITE RX 65

VYFEMLA 81

VYLIBRA 81

VYVANSE 53

WWARFARIN SODIUM 44

WATER FOR INJECTION,STERILE 89

WATER FOR IRRIGATION,STERILE 89

WERA 81

WILATE 47

WYMZYA FE 81

XXARELTO 44

XELJANZ 86

XELODA 30

XTAMPZA ER 13

XTANDI 30

XULANE 81

XYNTHA 47

XYNTHA SOLOFUSE 47

YYASMIN 28 81

YAZ 81

ZZALEPLON 95

ZARAH 81

ZARONTIN 20

ZAVESCA 68

ZEMAIRA 68

ZENATANE 56

ZENPEP 68

ZIAGEN 39

ZIDOVUDINE 39

ZINC CHLORIDE 62


ZINC SULFATE 62

ZINC SULFATE/COPPER

SULFATE/MANGANESE/CHROMIUM/SELENIUM 60

ZINC SULFATE/CUPRIC SULFATE/MANGANESE

SULF/CHROMIC CHLORIDE 60

ZIPRASIDONE HCL 35

ZOLADEX 32

ZOLEDRONIC ACID IN MANNITOL AND WATER

FOR INJECTION 88

ZOLPIDEM TARTRATE 95

ZONISAMIDE 20

ZOVIA 1-35E 81

ZOVIRAX 40

ZTLIDO 14

ZUBSOLV 15

ZUMANDIMINE 81

ZYLET 89

ZYTIGA 30


Documents

LIST OF COVERED OVER-THE-COUNTER MEDICATIONS