Plan for your best health - fm.formularynavigator.comfm.formularynavigator.com/FBO/41/2018_Aetna_Value_Plus_Plan_.pdf · Plan for your best health . 2018 Aetna Pharmacy Drug Guide

Plan for your best health

2018 Aetna Pharmacy Drug Guide Aetna Value Plus Plan

aetna.com 05.02.354.1 L (9/18)

How to use this guide

Your guide includes a list of commonly used drugs covered on your pharmacy plan. The amount you pay depends on the drug your doctor prescribes. It’s either a flat fee or a percentage of the prescription’s price after you meet your deductible, if applicable. Preferred generic drugs cost less. Preferred brand drugs will have a higher cost.

Your plan includes

• Brand and generic drugs that are hand-picked for their quality and effectiveness

• Aetna Specialty Pharmacy® fills specialty drug prescriptions (ones that are injected, infused or taken by mouth) — and provides services that include personal support, helpful resources and training, and free secure home delivery

• Aetna Rx Home Delivery® pharmacy that delivers maintenance drugs to your home or wherever you choose (for drugs that are taken regularly to treat conditions like arthritis, diabetes or asthma)

What you can expect to pay

With your pharmacy plan, the amount you pay depends on the drug your doctor prescribes. It’s either a flat fee or a percentage of the drug’s/medicine’s price.

Each drug is grouped as a generic, a brand or a specialty drug. The preferred drugs within these groups will generally save you money compared to a non-preferred drug. Generic drugs are less expensive than brands.

Specialty prescription drugs typically include higher-cost drugs that require special handling, special storage or monitoring. These types of drugs may include, but are not limited to, drugs that are injected, infused, inhaled or taken by mouth.

You’re covered for all types of medicine — some more expensive, and some less.

• Preferred generic: the lowest cost

• Preferred brand: a slightly higher cost

• Non-preferred brand and generic: a higher cost

• Preferred Specialty: lower cost for specialty drugs

• Non-preferred specialty: higher cost for non-preferred specialty drugs

Your pharmacy plan may not have all the coverage levels listed above so check your plan documents to see how much you will pay.

For your exact coverage and cost, and to learn more about your plan

Visit the website that’s on your member ID card. Then log in to your account, where you can:

• Find out the coverage and estimate of cost for specific drugs

• View your deductibles and plan limits

• Order medications

• Check your pharmacy order status

• Get a member ID card

• View your claims, Explanation of Benefits and more

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. Aetna Pharmacy Management administers, but does not offer, insure or otherwise underwrite the prescription drug benefits portion of your health plan and has no financial responsibility therefor. Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through specialty pharmacy prescription fulfillment.

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Have more questions about your pharmacy benefits?

We’re here to help. There are several ways you can learn more about your benefits:

• Check your Plan Design and Benefits Summary in your enrollment kit.

• Call the toll-free number on your member ID card.

• Review our pharmacy frequently asked questions (FAQs) and answers. Just visit the website that’s on your member ID card to search for the “Pharmacy FAQ.”

Aetna Specialty Pharmacy

Aetna Specialty Pharmacy® medicine and support services is our in-house specialty pharmacy that can fill your prescriptions for specialty drugs. These are the types of drugs that may be injected, infused or taken by mouth. They often need special storage and handling. And they need to be delivered quickly. A nurse or pharmacist may monitor you during your treatment, if needed. With Aetna Specialty Pharmacy, you can get this medicine sent right to your mailbox.

How to get started with Aetna Specialty Pharmacy

Ordering your prescription through Aetna Specialty Pharmacy is easy. And we typically offer a 30-day medicine supply.

• To transfer your prescription, just call us toll-free at 1-866-353-1892.

• For a new prescription, your doctor can send it to us in one of four ways:

1. Electronically: Through e-prescribe

2. Fax: 1-866-FAX-ASRX (1-866-329-2779)

3. Mail: Aetna Specialty Pharmacy 503 Sunport Lane Orlando, FL 32809

4. Phone: 1-866-782-ASRX (1-866-782-2779), option 2

If you mail in your own prescription, please send it with a completed Patient Profile Form. To find this form, just visit the website that’s on your member ID card, to search for the “Patient Profile Form.”

Aetna Rx Home Delivery

You can have maintenance drugs sent right to your home or anywhere else you choose with Aetna Rx Home Delivery® pharmacy. These are drugs that are taken regularly for chronic conditions like arthritis, diabetes or asthma. Depending on your plan, you can get up to a 90-day supply of medicine for less cost. It’s fast and convenient, and standard shipping is always free.

Get started right away

You can submit your order using one of these options:

1. Online — Visit your secure member website and sign in to your account. There you can add or remove your prescriptions.

2. Phone — Call us toll-free, 24/7 at 1-888-792-3862. If you need the help of a telephone device for the deaf, call 1-877-833-2779.

3. Mail — Get a new prescription from your doctor. Then mail it to us with a completed order form. You can find the form on your secure member website. The mailing address is on the form.

Your doctor can submit your order using one of these options:

1. Online — They can submit your prescriptions using the e-prescribe services on our provider website.

2. Fax — They can fax your prescription to 1-877-270-3317. Make sure they include your member ID number, date of birth and mailing address on the fax cover sheet. Only a doctor may fax a prescription.

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Frequently asked questions

How can I save on prescriptions?

Here are some tips to pay less out of pocket for your prescription drugs:

• Ask your doctor to consider prescribing drugs that are on the Pharmacy Drug Guide (formulary).

• Ask your doctor to consider prescribing generic drugs instead of brand-name drugs.

• Check to see if your plan includes our home delivery pharmacy service. Depending upon your plan, our home delivery service may save you money. For more information, visit the website on your member ID card and log in to your account.

• Remind your doctor to check your plan to make sure you get maximum coverage.

What are generic drugs?

Generic drugs are proven to be just as safe and effective as brand-name drugs. They contain the same active ingredients in the same amounts as the brand-name drugs and work the same way. So they have the same risks and benefits as brand-name drugs. However, they typically cost less.

When appropriate, your doctor may decide to prescribe a generic drug or allow the pharmacist to substitute a generic drug.

What is precertification?

Precertification is one way that we can help you and your doctor find safe, appropriate drugs and keep costs down. Precertification means that you or your doctor need to get approval from the plan before certain drugs will be covered. Generally, precertification applies to drugs that:

• Are often taken in the wrong way

• Should only be used for certain conditions

• Often cost more than other drugs that are proven to be just as effective

Keep in mind that your doctor must contact us to request approval of coverage for these drugs.

What is step therapy?

Some drugs require step therapy. This means that you must try one or more prerequisite drug(s) before a step therapy drug is covered.

The prerequisite drugs are equally effective, have U.S. Food and Drug Administration (FDA) approval and may cost less. They treat the same condition as the step therapy drug.

If you don’t try the appropriate alternative drug first, you may need to pay full cost for the brand-name version.

What are quantity limits?

Quantity limits help your doctor and pharmacist make sure that you use your drug correctly and safely. We use medical guidelines and FDA-approved recommendations from drug makers to set these coverage limits. The quantity limit program includes:

• Dose efficiency edits — Limits prescription coverage to one dose per day for drugs that have approval for once-daily dosing

• Maximum daily dose — If a prescription is lower than the minimum or higher than the maximum allowed dose, a message is sent to the pharmacy

• Quantity limits over time — Limits prescription coverage to a specific number of units over a specific amount of time

What if I need a drug that requires an exception to the precertification, step therapy or quantity limits requirements? Or what if I need a drug that’s not covered under my plan?

In certain cases, you or your prescriber can request a medical exception to the precertification, step therapy or quantity limits requirements. And also for a drug that’s not covered in your plan. If you ask for your request to be expedited, a coverage determination will be made within 24 hours of receiving it.

We’ll then contact you or your prescriber with our decision. All medically necessary outpatient prescription drugs will be covered. If a medical exception is approved, you only need to pay the copay after the deductible. This amount is based on your pharmacy plan design.

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How can your provider request a medical exception?

• Submit their request through our secure provider website on NaviNet®.

• Call the Aetna Pharmacy Precertification Unit at 1-855-240-0535.

• Fax the completed request form to 1-877-269-9916.

• Mail the completed request form to: Aetna Pharmacy Management 1300 East Campbell Road Richardson, TX 75081

How is the formulary (drug list) developed?

Our Pharmacy and Therapeutics Committee meets regularly to review new drugs and new information about current drugs. We review them for their safety, effectiveness and current use in therapy.

This committee includes licensed pharmacists and doctors. They are currently in practice or are Aetna employees.

Once we complete our clinical review, we also consider overall value before adding or removing a drug from the formulary. We may recommend moving a drug to a different coverage level. Or that it be placed on our Formulary Exclusions List and no longer be covered.

Can the formulary change during the year?

The formulary can change throughout the year. Some reasons why they can change include:

• New drugs are approved.

• Existing drugs are removed from the market.

• Prescription drugs may become available over the counter (without a prescription). Over-the-counter drugs are not generally covered in a formulary.

• Brand-name drugs lose patent protection and generic versions become available. When this happens, the brand-name drug is likely to be covered at a higher cost. And the generic versions cost less. See the “What are generic drugs?” section above for more information.

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Commercial 1557 Nondiscrimination Notice

Aetna complies with applicable Federal civil rights laws and does not discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, or disability.

Aetna provides free aids/services to people with disabilities and to people who need language assistance.

If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card.

If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil Rights Coordinator by contacting:

Civil Rights Coordinator, P.O. Box 14462, Lexington, KY 40512 (CA HMO customers: PO Box 24030 Fresno, CA 93779), 1-800-648-7817, TTY: 711, Fax: 859-425-3379 (CA HMO customers: 860-262-7705), [email protected].

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or at:

U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, or at 1-800-368-1019, 800-537-7697 (TDD).

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company, Coventry Health Care plans and their affiliates (Aetna).

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Remember to visit the website on your member ID card. Then sign in to your account for the most up-to-date information.

Please note that if your prescription drug benefits plan changes, the information here may no longer apply. A copayment is a flat fee. Coinsurance is a percentage of the rate that Aetna negotiates with the plan sponsor for covered prescriptions except as required by law to be otherwise. Some drugs on the Preferred Drug List are subject to manufacturer rebates. Coinsurance is calculated before any rebates are subtracted. That means it may be possible for your cost of a preferred drug to be higher than your cost of a non-preferred drug. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna’s Pharmacy Drug (formulary) Guide. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Information is subject to change. The drugs on the Pharmacy Drug (formulary) Guide, Formulary Exclusions, Precertification, and Quantity Limit Lists are subject to change. The quantity limits and drug coverage review programs are not available in all service areas. In accordance with state law, commercial fully insured members in Louisiana and Texas (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added or removed from the Pharmacy Drug (formulary) Guide, Precertification, Quantity Limits or Step-Therapy Lists during the plan year will continue to have those medications covered at the same benefit level until their plan’s renewal date. In Texas, precertification approval is known as “pre-service utilization review.” It is not “verification” as defined by Texas law. In accordance with state law, fully insured Commercial California health maintenance organization (HMO) members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-Therapy Lists will continue to have those medications covered, for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee’s medical condition. In accordance with state law, fully insured Commercial Connecticut preferred provider organization (PPO) members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-Therapy Lists will continue to have those medications covered for as long as the treating physician prescribes them, provided the drug is medically necessary and more medically beneficial than other covered drugs. Nothing in this section shall preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions. This material is for information only. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is subject to change.

aetna.com ©2018 Aetna Inc. 05.02.354.1 L (9/18)

2018 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan

Table of Contents

*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*....................................................17*AGENTS FOR NARCOTIC WITHDRAWAL***.................................................................................18*AMEBICIDES*........................................................................................................................................18*AMINO ACIDS***..................................................................................................................................18*AMINOGLYCOSIDES*..........................................................................................................................18*ANALGESICS - ANTI-INFLAMMATORY*........................................................................................ 19*ANALGESICS - NONNARCOTIC*.......................................................................................................22*ANALGESICS - OPIOID*.......................................................................................................................22*ANDROGENS-ANABOLIC*................................................................................................................. 26*ANORECTAL AGENTS*....................................................................................................................... 27*ANTHELMINTICS*............................................................................................................................... 28*ANTIANGINAL AGENTS*................................................................................................................... 28*ANTIANXIETY AGENTS*....................................................................................................................28*ANTIARRHYTHMICS*.........................................................................................................................29*ANTIASTHMATIC AND BRONCHODILATOR AGENTS*.............................................................. 30*ANTICOAGULANTS*........................................................................................................................... 32*ANTICONVULSANTS*......................................................................................................................... 33*ANTIDEMENTIA AGENT COMBINATIONS***............................................................................... 36*ANTIDEPRESSANTS*........................................................................................................................... 36*ANTIDIABETICS*..................................................................................................................................38*ANTIDIARRHEALS*.............................................................................................................................42*ANTIDOTES AND SPECIFIC ANTAGONISTS*.................................................................................42*ANTIDOTES*..........................................................................................................................................43*ANTIEMETICS*..................................................................................................................................... 43*ANTIFUNGALS*....................................................................................................................................44*ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES***...........................................45*ANTIHISTAMINES*.............................................................................................................................. 45*ANTIHYPERLIPIDEMICS*.................................................................................................................. 46*ANTIHYPERTENSIVES*.......................................................................................................................48*ANTI-INFECTIVE AGENTS - MISC.*..................................................................................................51*ANTIMALARIALS*............................................................................................................................... 52*ANTIMYASTHENIC AGENTS*........................................................................................................... 53*ANTIMYASTHENIC/CHOLINERGIC AGENTS*.............................................................................. 53*ANTIMYCOBACTERIAL AGENTS*................................................................................................... 53*ANTINEOPLASTIC - BCL-2 INHIBITORS***.....................................................................................53*ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*................................................................. 54*ANTIPARKINSON AGENTS*.............................................................................................................. 58*ANTIPSYCHOTICS/ANTIMANIC AGENTS*..................................................................................... 59*ANTIRETROVIRALS ADJUVANTS***...............................................................................................61*ANTIVIRALS*........................................................................................................................................ 61*ASSORTED CLASSES*.......................................................................................................................... 64*ATOPIC DERMATITIS - MONOCLONAL ANTIBODIES***............................................................66*BETA BLOCKER & ANGIOTENSIN II RECEPTOR ANTAGONIST COMB***............................. 66*BETA BLOCKERS*................................................................................................................................ 66*BILE ACID SYNTHESIS DISORDER AGENTS***............................................................................ 67*BIOLOGICALS MISC*........................................................................................................................... 67*CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG***................................67

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*CALCIUM CHANNEL BLOCKERS*................................................................................................... 67*CARDIOTONICS*.................................................................................................................................. 69*CARDIOVASCULAR AGENTS - MISC.*.............................................................................................69*CEPHALOSPORINS*............................................................................................................................. 70*CIC AGENTS - GUANYLATE CYCLASE-C (GC-C) AGONISTS***.................................................72*CONTRACEPTIVES*............................................................................................................................. 72*CORTICOSTEROIDS*........................................................................................................................... 77*COUGH/COLD/ALLERGY*..................................................................................................................78*CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS***.............................................................. 79*CYSTIC FIBROSIS AGENT - COMBINATIONS***............................................................................79*DERMATOLOGICALS*........................................................................................................................ 79*DIAGNOSTIC PRODUCTS*................................................................................................................. 90*DIGESTIVE AIDS*................................................................................................................................. 94*DIRECT-ACTING P2Y12 INHIBITORS***..........................................................................................94*DIURETICS*........................................................................................................................................... 94*ENDOCRINE AND METABOLIC AGENTS - MISC.*........................................................................95*ESTROGENS*......................................................................................................................................... 98*ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB***..............................99*FARNESOID X RECEPTOR (FXR) AGONISTS***............................................................................ 99*FLUOROQUINOLONES*......................................................................................................................99*GASTROINTESTINAL AGENTS - MISC.*........................................................................................ 100*GENITOURINARY AGENTS - MISCELLANEOUS*....................................................................... 102*GOUT AGENTS*.................................................................................................................................. 102*HEMATOLOGICAL AGENTS - MISC.*.............................................................................................103*HEMATOPOIETIC AGENTS*.............................................................................................................105*HEMOSTATICS*...................................................................................................................................109*HEPATITIS C AGENT - COMBINATIONS***.................................................................................. 109*HEREDITARY OROTIC ACIDURIA TREATMENT - AGENTS**.................................................109*HYPNOTICS*........................................................................................................................................109*HYPOPHOSPHATASIA (HPP) AGENTS***...................................................................................... 110*IBS AGENT - MU-OPIOID RECEPTOR AGONISTS***................................................................... 110*INSULIN-INCRETIN MIMETIC COMBINATIONS***................................................................... 110*INTEGRIN RECEPTOR ANTAGONISTS***.................................................................................... 110*INTERLEUKIN ANTAGONISTS***.................................................................................................. 110*INTERLEUKIN-5 ANTAGONISTS (IGG1 KAPPA)***.................................................................... 110*INTERLEUKIN-5 ANTAGONISTS (IGG4 KAPPA)***.................................................................... 110*ISOCITRATE DEHYDROGENASE-1 (IDH1) INHIBITORS***.......................................................111*ISOCITRATE DEHYDROGENASE-2 (IDH2) INHIBITORS***.......................................................111*LAXATIVES*........................................................................................................................................ 111*LEPTIN ANALOGUES***................................................................................................................... 111*LHRH/GNRH AGONIST ANALOG COMBINATIONS***.............................................................. 111*LYMPHOCYTE FUNCTION-ASSOCIATED ANTIGEN-1 (LFA-1) ANTAG***............................112*LYSOSOMAL ACID LIPASE (LAL) DEFICIENCY - AGENTS***.................................................. 112*MACROLIDES*.................................................................................................................................... 112*MEDICAL DEVICES*.......................................................................................................................... 112*MIGRAINE PRODUCTS*....................................................................................................................115*MINERALS & ELECTROLYTES*.......................................................................................................116*MONOBACTAMS***........................................................................................................................... 117*MOUTH/THROAT/DENTAL AGENTS*............................................................................................117*MUCOPOLYSACCHARIDOSIS IV (MPS IV) - AGENTS***............................................................ 118

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*MULTIPLE VITAMINS W/ MINERALS & FLUORIDE-IRON-FOLIC ACID***.......................... 118*MULTIVITAMINS*..............................................................................................................................118*MUSCULOSKELETAL THERAPY AGENTS*.................................................................................. 119*NASAL AGENTS - SYSTEMIC AND TOPICAL*.............................................................................. 120*NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB***.............................121*NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS***.......................................121*NEUROMUSCULAR AGENTS*.........................................................................................................121*OPHTHALMIC AGENTS*................................................................................................................... 122*OPHTHALMIC RHO KINASE INHIBITORS***...............................................................................126*OREXIN RECEPTOR ANTAGONISTS***.........................................................................................126*OTIC AGENTS*.................................................................................................................................... 126*OXABOROLE-RELATED ANTIFUNGALS - TOPICAL***............................................................. 127*OXYTOCICS*........................................................................................................................................127*PASSIVE IMMUNIZING AGENTS - COMBINATIONS***............................................................. 127*PASSIVE IMMUNIZING AGENTS*...................................................................................................127*PCSK9 INHIBITORS***....................................................................................................................... 128*PEDIATRIC MULTIPLE VITAMINS W/FLUORIDE-IRON-ZINC***............................................128*PENICILLINS*......................................................................................................................................129*PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS***................................................... 129*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS - TOPICAL***.....................................................129*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS***.........................................................................129*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS**......................................................130*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS***.....................................................130*POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS***................................130*POTASSIUM REMOVING AGENTS***.............................................................................................130*PROGESTINS*...................................................................................................................................... 130*PROTEASE-ACTIVATED RECEPTOR-1 (PAR-1) ANTAGONISTS***.......................................... 131*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*..........................................131*PULMONARY FIBROSIS AGENTS - KINASE INHIBITORS***....................................................133*PULMONARY FIBROSIS AGENTS***..............................................................................................133*PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST***........................133*RESPIRATORY AGENTS - MISC.*.................................................................................................... 134*SEROTONIN MODULATORS***.......................................................................................................134*SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS***......................................................134*SINUS NODE INHIBITORS**.............................................................................................................134*SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB***..................... 134*SPLEEN TYROSINE KINASE (SYK) INHIBITORS***.................................................................... 135*SULFONAMIDES*............................................................................................................................... 135*TETRACYCLINES*..............................................................................................................................135*THYROID AGENTS*........................................................................................................................... 136*TRYPTOPHAN HYDROXYLASE INHIBITORS***......................................................................... 136*ULCER DRUGS*.................................................................................................................................. 136*URINARY ANTI-INFECTIVES*.........................................................................................................139*URINARY ANTISPASMODICS*........................................................................................................ 139*VAGINAL PRODUCTS*...................................................................................................................... 140*VASOPRESSORS*.................................................................................................................................141*VITAMINS*........................................................................................................................................... 141

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lowercase italics = Generic drugsUPPERCASE = Brand name drugs

Drug StatusCE = Copay Exception: Available to some members at no cost with a prescription from your provider when obtained at an in-network pharmacy. Certain limitations may apply.NC = Not CoveredNP = Non-Preferred Brand and GenericNPS = Non-Preferred SpecialtyPB = Preferred BrandPG = Preferred GenericPSP = Preferred Specialty

Drug Details# = Brand-name drug expected to become available generically in the near future. After the generic drug becomes available, the brand-name drug may be covered at a higher non-preferred copay and/or added to the Formulary Exclusion List. The brand-name drug may also be subject to precertification and/or step-therapy.AL = Age LimitLGC = Lowest Generic CopayMPG = PG tier applies to members residing in Massachusetts.MST = Step Therapy does not apply to members residing in Massachusetts.N1 = Refer to member plan documents for erectile dysfuncition use/coveragePA = Prior Authorization QL = Quantity LimitSelect OTC = Select OTC Program if your pharmacy plan includes this program you may have coverage for products noted with a doctors prescription. Please see your plan benefit information for specific coverage details.SP = You may pay higher out of pocket costs and may be required to get these products at an Aetna Specialty Pharmacy network provider, like Aetna Specialty Pharmacy. Specialty products are

limited to a 30 day supply.ST = Step Therapy


The formulary is updated the first week of each month.

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Drug Name Drug Status Drug Details

*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*

ADDERALL NP ST; QL

ADDERALL XR NP ST; QL

ADZENYS ER NP PA; ST; QL

ADZENYS XR-ODT NP PA; ST; QL

amphetamine-dextroamphet er PG QL

amphetamine-dextroamphetamine PG QL

APTENSIO XR NP PA; ST; #; QL

armodafinil PG PA; QL

atomoxetine hcl PG QL

clonidine hcl er PG PA; QL

CONCERTA NP ST; QL

COTEMPLA XR-ODT NP PA; ST; QL

DAYTRANA NP PA; ST; #; QL

DESOXYN NP PA; ST; QL

DEXEDRINE ORAL CAPSULE EXTENDED RELEASE 24 HOUR

NP ST; QL

dexmethylphenidate hcl PG QL

dexmethylphenidate hcl er PG QL

dextroamphetamine sulfate er PG QL

dextroamphetamine sulfate oral solution PG PA; QL

dextroamphetamine sulfate oral tablet PG QL

DIDREX NP

DYANAVEL XR NP PA; ST; QL

EVEKEO NP PA; ST; QL

FOCALIN NP ST; QL

FOCALIN XR NP ST; QL

guanfacine hcl er NP PA; QL

INTUNIV NP PA; ST; QL

KAPVAY ORAL TABLET EXTENDED RELEASE 12 HOUR

NP PA; ST; QL

METADATE ER ORAL TABLET EXTENDED RELEASE 20 MG

PG QL

methamphetamine hcl PG PA; QL

METHYLIN ORAL SOLUTION NP ST; QL



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methylphenidate hcl er PG QL

methylphenidate hcl er (cd) PG QL

methylphenidate hcl er (la) PG QL

methylphenidate hcl oral solution 10 mg/5ml PG QL

methylphenidate hcl oral solution 5 mg/5ml NP QL

methylphenidate hcl oral tablet PG QL

methylphenidate hcl oral tablet chewable NP QL

modafinil PG PA; QL

MYDAYIS NP PA; ST; QL

NUVIGIL NP PA; QL

PROCENTRA NP PA; ST; QL

PROVIGIL NP PA; QL

QUILLICHEW ER NP PA; ST; QL

QUILLIVANT XR NP PA; ST; #; QL

RELEXXII PG QL

RITALIN NP ST; QL

RITALIN LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 20 MG, 30 MG, 40 MG

NP ST; QL

STRATTERA NP ST; QL

VYVANSE PB QL

ZENZEDI ORAL TABLET 10 MG, 5 MG PG QL

ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG

NC

*AGENTS FOR NARCOTIC WITHDRAWAL***

LUCEMYRA NP QL

*AMEBICIDES*

SOLOSEC NC

*AMINO ACIDS***

ENDARI NP PA; ST; QL

*AMINOGLYCOSIDES*

BETHKIS NPS SP; QL

gentamicin sulfate injection NC

neomycin sulfate oral PG

paromomycin sulfate oral PG



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streptomycin sulfate intramuscular NC

TOBI NPS SP; QL

TOBI PODHALER PSP SP; QL

tobramycin inhalation PSP SP; QL

tobramycin sulfate injection solution 10 mg/ml, 2 gm/50ml

NC

tobramycin sulfate injection solution reconstituted

NC

*ANALGESICS - ANTI-INFLAMMATORY*

ACTEMRA INTRAVENOUS NPS PA; ST; SP

ACTEMRA SUBCUTANEOUS NPS PA; ST; SP; QL

ANAPROX DS NP

ARAVA NP QL

ARCALYST NPS PA; SP

ARTHROTEC ORAL TABLET DELAYED RELEASE

NP

CELEBREX NP QL

celecoxib oral NP QL

DAYPRO NP

diclofenac potassium PG

diclofenac sodium er PG

diclofenac sodium oral tablet delayed release 25 mg, 50 mg

PG

diclofenac sodium oral tablet delayed release 75 mg

PG LGC

diclofenac-misoprostol oral tablet delayed release

PG

DUEXIS NC

EC-NAPROSYN NP

ENBREL MINI PSP PA; ST; SP; QL

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PSP PA; ST; SP; QL

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

PSP PA; ST; SP; QL

etodolac er PG

etodolac oral PG



09/01/201819


FELDENE NP

fenoprofen calcium oral PG

flurbiprofen oral PG

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML, 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML

NPS PA; ST; SP; QL

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT

NPS PA; ST; SP; QL

HUMIRA PEN-CD/UC/HS STARTER NPS PA; ST; SP; QL

HUMIRA PEN-PS/UV STARTER NPS PA; ST; SP; QL

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT

NPS PA; ST; SP; QL

IBUPROFEN COMFORT PAC NC

ibuprofen oral tablet 400 mg, 600 mg, 800 mg PG LGC

IC 400 NC

IC 800 NC

ILARIS SUBCUTANEOUS SOLUTION NPS PA; SP

INDOCIN ORAL NP

INDOCIN RECTAL NP

indomethacin er PG

indomethacin oral PG QL

ketoprofen er PG

ketorolac tromethamine oral PG QL

KEVZARA NPS PA; ST; SP; QL

KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

NPS PA; ST; SP; QL

leflunomide oral PG QL

LODINE NP

meclofenamate sodium oral PG

mefenamic acid oral NP QL

meloxicam oral tablet PG LGC

MOBIC ORAL TABLET NP

nabumetone oral PG

NALFON ORAL CAPSULE 400 MG NP



09/01/201820


NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 375 MG, 500 MG, 750 MG

NC

NAPROSYN ORAL TABLET 250 MG, 500 MG

NP

NAPROXEN COMFORT PAC NC

naproxen dr PG

naproxen oral suspension PG

naproxen oral tablet PG LGC

naproxen sodium er NC

naproxen sodium oral tablet 275 mg, 550 mg PG

OLUMIANT NPS PA; ST; SP; QL

ORENCIA CLICKJECT NPS PA; ST; SP; QL

ORENCIA INTRAVENOUS NPS PA; ST; SP

ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

NPS PA; ST; SP; QL

OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.4ML, 15 MG/0.4ML, 17.5 MG/0.4ML, 20 MG/0.4ML, 22.5 MG/0.4ML, 25 MG/0.4ML

NPS ST; SP

OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 12.5 MG/0.4ML

NPS ST

oxaprozin PG

piroxicam oral PG

PONSTEL NP QL

RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.2ML, 12.5 MG/0.25ML, 15 MG/0.3ML, 17.5 MG/0.35ML, 20 MG/0.4ML, 22.5 MG/0.45ML, 25 MG/0.5ML, 30 MG/0.6ML, 7.5 MG/0.15ML

NPS ST; SP

RIDAURA NP

SIMPONI ARIA PSP PA; ST; SP; QL

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR

PSP PA; ST; SP; QL

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PSP PA; ST; SP; QL

SPRIX NC #



09/01/201821


sulindac oral PG

TIVORBEX NC

tolmetin sodium PG

VIMOVO NC

VIVLODEX NC

XELJANZ PSP PA; ST; SP; QL

XELJANZ XR PSP PA; ST; SP; QL

ZIPSOR NC

ZORVOLEX NC

*ANALGESICS - NONNARCOTIC*

ALLZITAL NC

BUPAP ORAL TABLET 50-300 MG NC

butalbital-acetaminophen oral capsule NC

butalbital-acetaminophen oral tablet 50-300 mg NC

butalbital-acetaminophen oral tablet 50-325 mg PG

butalbital-apap-caffeine oral capsule PG

butalbital-apap-caffeine oral tablet 50-325-40 mg

PG

butalbital-asa-caffeine PG

choline-mag trisalicylate PG

diflunisal oral PG

eq aspirin low dose oral tablet chewable CE

eq aspirin low dose oral tablet delayed release CE

ESGIC ORAL CAPSULE PG

FIORICET ORAL CAPSULE NP

FIORINAL NP

PRIALT NPS SP

salsalate oral PG

VANATOL LQ NC

ZEBUTAL ORAL CAPSULE 50-325-40 MG PG

*ANALGESICS - OPIOID*

ABSTRAL NP PA; ST; #; QL

acetaminophen-codeine PG PA; QL

acetaminophen-codeine #2 PG PA; QL




09/01/201822



ACTIQ NP PA; ST; QL

apap-caff-dihydrocodeine oral capsule NP PA; QL

apap-caff-dihydrocodeine oral tablet 325-30-16 mg

NC

ARYMO ER NP PA; ST; MPG; QL

ASCOMP-CODEINE PG PA; QL

BELBUCA NP PA; QL

BUNAVAIL NP ST; MST; QL

buprenorphine PG PA; QL

buprenorphine hcl sublingual PG QL

buprenorphine hcl-naloxone hcl sublingual tablet sublingual

PG QL

butalbital-apap-caff-cod PG PA; QL

butalbital-asa-caff-codeine PG PA; QL

butorphanol tartrate nasal NP PA; QL

BUTRANS NP PA; QL

codeine sulfate oral tablet PG PA; QL

CONZIP NC

DILAUDID ORAL NP PA; QL

DOLOPHINE NP PA; QL

DURAGESIC-100 NP PA; ST; QL





EMBEDA PB PA; MPG; QL

ENDOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG

PG PA; QL

EXALGO ORAL TABLET ER 24 HOUR ABUSE-DETERRENT

NP PA; ST; QL

fentanyl PG PA; QL

fentanyl citrate buccal NP PA; ST; QL

FENTORA BUCCAL TABLET 100 MCG, 200 MCG, 400 MCG, 600 MCG, 800 MCG

NP PA; ST; #; QL



09/01/201823


FIORICET/CODEINE ORAL CAPSULE 50-300-40-30 MG

NP PA; QL

FIORINAL/CODEINE #3 NP PA; QL

hydrocodone-acetaminophen oral solution 2.5-108 mg/5ml, 5-217 mg/10ml, 7.5-325 mg/15ml

NP PA; QL

hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 2.5-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg

PG PA; QL

hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg

PG PA; QL

hydromorphone hcl er NP PA; QL

hydromorphone hcl oral PG PA; QL

hydromorphone hcl rectal PG PA; QL

HYSINGLA ER PB PA; #; QL

IBUDONE ORAL TABLET 10-200 MG NP PA; QL

ibudone oral tablet 5-200 mg PG PA; QL

KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 100 MG, 20 MG, 200 MG, 30 MG, 40 MG, 50 MG, 60 MG, 80 MG

NP PA; ST; QL

LAZANDA NC

levorphanol tartrate oral NP PA; QL

LORCET PG PA; QL

LORCET HD PG PA; QL

LORCET PLUS ORAL TABLET 7.5-325 MG PG PA; QL

LORTAB ORAL ELIXIR 10-300 MG/15ML NP PA; QL

meperidine hcl oral PG PA; QL

METHADONE HCL INTENSOL NP PA; QL

methadone hcl oral concentrate NP PA; QL

methadone hcl oral solution PG PA; QL

methadone hcl oral tablet PG PA; QL

METHADOSE ORAL CONCENTRATE 10 MG/ML

NP PA; QL

METHADOSE SUGAR-FREE NP PA; QL

MORPHABOND ER NP PA; ST; MPG; QL

morphine sulfate (concentrate) oral solution 100 mg/5ml

PG PA; QL



09/01/201824


morphine sulfate er beads PG PA; QL

morphine sulfate er oral capsule extended release 24 hour

PG PA; QL

morphine sulfate er oral tablet extended release PG PA; QL

morphine sulfate oral PG PA; QL

morphine sulfate rectal PG PA; QL

MS CONTIN ORAL TABLET EXTENDED RELEASE

NP PA; ST; QL

nalbuphine hcl injection NC

nalocet NC

NORCO NP PA; QL

NUCYNTA NP PA; ST; QL

NUCYNTA ER NP PA; ST; QL

OPANA ER ORAL TABLET ER 12 HOUR ABUSE-DETERRENT

NP PA; ST; QL

OPANA ORAL NP PA; QL

OXAYDO PB PA; MPG; QL

oxycodone hcl er oral tablet er 12 hour abuse-deterrent

PG PA; QL

oxycodone hcl oral capsule PG PA; QL

oxycodone hcl oral concentrate 100 mg/5ml PG PA; QL

oxycodone hcl oral solution PG PA; QL

oxycodone hcl oral tablet PG PA; QL

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

PG PA; QL

oxycodone-aspirin oral tablet 4.8355-325 mg PG PA; QL

oxycodone-ibuprofen PG PA; QL

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT

PB PA; QL

oxymorphone hcl PG PA; QL

oxymorphone hcl er PG PA; QL

pentazocine-naloxone hcl NP PA; QL

PERCOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG

NP PA; QL

PRIMLEV NC

ROXICODONE ORAL TABLET NP PA; QL



09/01/201825


SUBOXONE SUBLINGUAL FILM NP #; QL

SUBSYS NC

tramadol hcl er (biphasic) oral tablet extended release 24 hour 100 mg, 200 mg, 300 mg

PG PA; QL

tramadol hcl er oral capsule extended release 24 hour

NC

tramadol hcl er oral tablet extended release 24 hour

PG PA; QL

tramadol hcl oral PG PA; QL

tramadol-acetaminophen PG PA; QL

TREZIX ORAL CAPSULE 320.5-30-16 MG NP PA; QL

TYLENOL WITH CODEINE #3 NP PA; QL

TYLENOL WITH CODEINE #4 NP PA; QL

ULTRACET NP PA; QL

ULTRAM NP PA; QL

VERDROCET PG PA; QL

vicodin es oral tablet 7.5-300 mg PG PA; QL

vicodin hp oral tablet 10-300 mg PG PA; QL

vicodin oral tablet 5-300 mg PG PA; QL

XODOL ORAL TABLET 5-300 MG, 7.5-300 MG

NP PA; QL

XTAMPZA ER NP PA; ST; QL

ZOHYDRO ER ORAL CAPSULE ER 12 HOUR ABUSE-DETERRENT

NP PA; ST; QL

ZUBSOLV NP ST; MST; QL

*ANDROGENS-ANABOLIC*

ANADROL-50 NP

ANDRODERM TRANSDERMAL PATCH 24 HOUR

NC

ANDROGEL PUMP TRANSDERMAL GEL 20.25 MG/ACT (1.62%)

PB PA; #; QL

ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 40.5 MG/2.5GM (1.62%)

PB PA; #; QL

ANDROGEL TRANSDERMAL GEL 25 MG/2.5GM (1%), 50 MG/5GM (1%)

NC

danazol oral PG



09/01/201826


DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION

NP

FORTESTA NC

methitest NP

methyltestosterone oral PG

NATESTO NC

OXANDRIN ORAL TABLET 10 MG NP

STRIANT NC

TESTIM NC

testosterone cypionate intramuscular solution200 mg/ml

PG

testosterone enanthate intramuscular solution PG

testosterone transdermal gel 10 mg/act (2%) PG QL

testosterone transdermal gel 12.5 mg/act (1%), 25 mg/2.5gm (1%), 50 mg/5gm (1%)

PG PA; QL

testosterone transdermal solution NP PA; ST; QL

VOGELXO PUMP NC

VOGELXO TRANSDERMAL GEL 50 MG/5GM (1%)

NC

*ANORECTAL AGENTS*

ANA-LEX NC

ANALPRAM-HC RECTAL CREAM NP

ANALPRAM-HC RECTAL LOTION 2.5-1 %

NP

anucort-hc NC

ANUSOL-HC RECTAL CREAM NP

ANUSOL-HC RECTAL SUPPOSITORY NC

CORTIFOAM NC

hydrocortisone ace-pramoxine rectal cream 2.5-1 %

NC

hydrocortisone acetate rectal NC

hydrocortisone rectal cream 2.5 % PG

lidocaine-hydrocortisone ace rectal NC

PROCTOCORT NC

PROCTOFOAM HC NC

PROCTO-PAK PG



09/01/201827


PROCTOZONE-HC RECTAL PG

RECTIV NP QL

UCERIS RECTAL NP PA; #; QL

*ANTHELMINTICS*

ALBENZA NP QL

benznidazole NP PA; QL

BILTRICIDE NP

EMVERM NP QL

ivermectin oral PG

praziquantel oral PG

STROMECTOL NP

*ANTIANGINAL AGENTS*

DILATRATE-SR NP

GONITRO NP

ISORDIL TITRADOSE NP

isosorbide dinitrate er PG

isosorbide dinitrate oral PG

isosorbide mononitrate PG

isosorbide mononitrate er PG

MINITRAN PG

NITRO-BID NP

NITRO-DUR NP

nitroglycerin er oral capsule extended release 9 mg

PG

nitroglycerin sublingual PG

nitroglycerin transdermal patch 24 hour PG

nitroglycerin translingual solution PG

NITROLINGUAL NP

NITROMIST NP

NITROSTAT NP ST

NITRO-TIME ORAL CAPSULE EXTENDED RELEASE 9 MG

PG

RANEXA PB #; QL

*ANTIANXIETY AGENTS*

alprazolam er PG QL; AL



09/01/201828


ALPRAZOLAM INTENSOL NP

alprazolam oral PG AL

alprazolam xr PG QL; AL

ATIVAN ORAL NC

buspirone hcl oral tablet 10 mg, 5 mg PG LGC

buspirone hcl oral tablet 15 mg, 30 mg, 7.5 mg PG

chlordiazepoxide hcl PG AL

clorazepate dipotassium PG AL

DIAZEPAM INTENSOL PG

diazepam oral concentrate PG

diazepam oral solution 5 mg/5ml PG

diazepam oral tablet PG

hydroxyzine hcl oral syrup PG

hydroxyzine hcl oral tablet PG

hydroxyzine pamoate oral PG

lorazepam oral PG

meprobamate PG

oxazepam PG AL

TRANXENE-T ORAL TABLET 7.5 MG NP AL

VALIUM NP

VISTARIL NP

XANAX NC AL

XANAX XR NC AL

*ANTIARRHYTHMICS*

amiodarone hcl oral PG

disopyramide phosphate oral PG

dofetilide PG

flecainide acetate PG

mexiletine hcl oral PG

MULTAQ NP QL

NORPACE NP

NORPACE CR NP

propafenone hcl PG

propafenone hcl er PG SP; QL

quinidine gluconate er PG



09/01/201829


quinidine sulfate oral PG

RYTHMOL SR NP QL

TIKOSYN NP

*ANTIASTHMATIC AND BRONCHODILATOR AGENTS*

ACCOLATE NP QL

ADVAIR DISKUS NP #; QL

ADVAIR HFA NP QL

AIRDUO RESPICLICK 113/14 NP PA; ST; QL



albuterol sulfate er PG

albuterol sulfate inhalation PG

albuterol sulfate oral PG

ALVESCO NP PA; ST; QL

ANORO ELLIPTA PB QL

ARCAPTA NEOHALER NP PA; ST; QL

ARMONAIR RESPICLICK 113 NP PA; ST; QL



ARNUITY ELLIPTA NP QL

ASMANEX 120 METERED DOSES PB #; QL





ASMANEX HFA PB QL

ATROVENT HFA NP QL

BEVESPI AEROSPHERE NP PA; ST; QL

BREO ELLIPTA PB QL

BROVANA NP PA; ST; QL

budesonide inhalation PG PA; QL; AL

COMBIVENT RESPIMAT PB QL

cromolyn sodium inhalation PG

DALIRESP NP PA; ST; QL



09/01/201830


DULERA PB QL

ELIXOPHYLLIN NP

FLOVENT DISKUS NP #; QL

FLOVENT HFA NP QL

fluticasone-salmeterol PG QL

INCRUSE ELLIPTA PB QL

ipratropium bromide inhalation PG

ipratropium-albuterol PG

levalbuterol hcl inhalation nebulization solution0.31 mg/3ml, 0.63 mg/3ml, 1.25 mg/0.5ml, 1.25 mg/3ml

PG

LONHALA MAGNAIR REFILL KIT NP PA; ST; QL

LONHALA MAGNAIR STARTER KIT NP PA; ST; QL

metaproterenol sulfate oral PG

montelukast sodium oral PG QL

PERFOROMIST NP PA; ST; QL

PROAIR HFA PB #

PROAIR RESPICLICK PB

PROVENTIL HFA NP ST; #

PULMICORT NP PA; QL; AL

PULMICORT FLEXHALER NP PA; ST; QL

QVAR REDIHALER PB QL

SEEBRI NEOHALER NP PA; ST; QL

SEREVENT DISKUS PB QL

SINGULAIR NP QL

SPIRIVA HANDIHALER PB QL

SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 1.25 MCG/ACT, 2.5 MCG/ACT

PB QL

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 2.5-2.5 MCG/ACT

PB QL

STRIVERDI RESPIMAT NP PA; ST; QL

SYMBICORT PB QL

terbutaline sulfate oral PG

THEO-24 PB



09/01/201831


THEOCHRON ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG, 200 MG, 300 MG

PG

theophylline PG

theophylline er PG

TRELEGY ELLIPTA PB QL

TUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED

NP PA; ST; QL

UTIBRON NEOHALER NP PA; ST; QL

VENTOLIN HFA PB

XOLAIR PSP PA; ST; SP

XOPENEX NP

XOPENEX CONCENTRATE NP

XOPENEX HFA NP ST; QL

zafirlukast PG QL

zileuton er NP QL

ZYFLO NP QL

ZYFLO CR NP QL

*ANTICOAGULANTS*

ARIXTRA NP QL

BEVYXXA NP PA; ST; QL

COUMADIN ORAL NP

ELIQUIS PB QL

ELIQUIS STARTER PACK PB QL

enoxaparin sodium PG QL

fondaparinux sodium NP QL

FRAGMIN SUBCUTANEOUS SOLUTION 10000 UNIT/ML, 12500 UNIT/0.5ML, 15000 UNIT/0.6ML, 18000 UNT/0.72ML, 2500 UNIT/0.2ML, 5000 UNIT/0.2ML, 7500 UNIT/0.3ML, 95000 UNIT/3.8ML

NP QL

heparin sodium (porcine) injection solution 1000 unit/ml, 10000 unit/ml, 20000 unit/ml, 5000 unit/ml

PG

heparin sodium (porcine) pf PG

IPRIVASK NP QL



09/01/201832


JANTOVEN PG

LOVENOX NP QL

PRADAXA NP ST; QL

SAVAYSA NP ST; QL

warfarin sodium oral PG LGC

XARELTO PB QL

XARELTO STARTER PACK PB QL

*ANTICONVULSANTS*

APTIOM NP QL

BANZEL ORAL TABLET NP QL

BRIVIACT ORAL NP PA; QL

carbamazepine er PG

carbamazepine oral PG

CARBATROL PB

CELONTIN PB

clonazepam oral PG

DEPAKENE ORAL CAPSULE NP

DEPAKENE ORAL SOLUTION NP

DEPAKOTE NP

DEPAKOTE ER NP

DEPAKOTE SPRINKLES ORAL CAPSULE DELAYED RELEASE SPRINKLE

NP

DIASTAT ACUDIAL PB QL

DIASTAT PEDIATRIC PB QL

diazepam rectal PG QL

DILANTIN PB

DILANTIN INFATABS PB

divalproex sodium er oral tablet extended release 24 hour

PG

divalproex sodium oral capsule delayed release sprinkle

PG

divalproex sodium oral tablet delayed release PG

EPITOL PG

ethosuximide oral PG

felbamate PG



09/01/201833


FELBATOL NP

FYCOMPA ORAL SUSPENSION NP

FYCOMPA ORAL TABLET NP QL

gabapentin oral capsule PG QL

gabapentin oral solution 250 mg/5ml PG

gabapentin oral tablet PG QL

GABITRIL NP QL

KEPPRA ORAL NP

KEPPRA XR NP QL

KLONOPIN NP

LAMICTAL ODT ORAL KIT NP

LAMICTAL ODT ORAL TABLET DISPERSIBLE

NP QL

LAMICTAL ORAL TABLET NP

LAMICTAL ORAL TABLET CHEWABLE 25 MG, 5 MG

NP

LAMICTAL STARTER NP

LAMICTAL XR ORAL KIT NP

LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR

NP QL

lamotrigine er PG QL

lamotrigine oral tablet PG

lamotrigine oral tablet chewable PG

lamotrigine oral tablet dispersible NP QL

lamotrigine starter kit-blue PG

lamotrigine starter kit-green PG

lamotrigine starter kit-orange PG

levetiracetam er PG QL

levetiracetam oral PG

LYRICA PB #

MYSOLINE NP

NEURONTIN ORAL CAPSULE NP QL

NEURONTIN ORAL SOLUTION NP

NEURONTIN ORAL TABLET NP QL

ONFI ORAL SUSPENSION NP #



09/01/201834


ONFI ORAL TABLET 10 MG, 20 MG NP #; QL

oxcarbazepine PG

OXTELLAR XR NP QL

PEGANONE NP

PHENYTEK PB

PHENYTOIN INFATABS PG

phenytoin oral suspension 125 mg/5ml PG

phenytoin oral tablet chewable PG

phenytoin sodium extended PG

primidone oral PG

QUDEXY XR NP QL

SABRIL ORAL PACKET NPS PA; SP; QL

SABRIL ORAL TABLET NPS PA; #; SP; QL

SPRITAM NP ST; QL

TEGRETOL ORAL SUSPENSION PB

TEGRETOL ORAL TABLET PB

TEGRETOL-XR PB

tiagabine hcl PG QL

TOPAMAX NP

TOPAMAX SPRINKLE NP QL

topiramate oral capsule sprinkle PG QL

topiramate oral tablet PG

TRILEPTAL NP

TROKENDI XR NP #; QL

valproate sodium oral solution PG

valproic acid oral capsule PG

valproic acid oral solution PG

vigabatrin PSP PA; SP; QL

VIGADRONE PSP PA; SP; QL

VIMPAT ORAL NP #; QL

ZARONTIN NP

ZONEGRAN NP

zonisamide oral PG



09/01/201835


*ANTIDEMENTIA AGENT COMBINATIONS***

NAMZARIC ORAL CAPSULE ER 24 HOUR THERAPY PACK

PB PA; AL

NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR 14-10 MG, 21-10 MG, 28-10 MG, 7-10 MG

PB PA; AL

*ANTIDEPRESSANTS*

amitriptyline hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg, 75 mg

PG LGC

amitriptyline hcl oral tablet 150 mg PG

amoxapine PG

ANAFRANIL NP

APLENZIN NC

bupropion hcl er (sr) PG QL

bupropion hcl er (xl) PG QL

bupropion hcl oral PG QL

CELEXA ORAL TABLET NP QL

citalopram hydrobromide oral solution PG

citalopram hydrobromide oral tablet PG LGC; QL

clomipramine hcl oral PG

CYMBALTA NP QL

desipramine hcl oral PG

desvenlafaxine er NP QL

desvenlafaxine succinate er NP PA; ST; QL

doxepin hcl oral PG

duloxetine hcl oral PG QL

EFFEXOR XR NP QL

EMSAM NP #; QL

escitalopram oxalate oral solution PG

escitalopram oxalate oral tablet PG QL

FETZIMA NP PA; ST; QL

FETZIMA TITRATION NP PA; ST; QL

fluoxetine hcl oral capsule PG LGC; QL

fluoxetine hcl oral capsule delayed release PG QL

fluoxetine hcl oral solution PG



09/01/201836


fluoxetine hcl oral tablet 10 mg, 20 mg PG QL

fluoxetine hcl oral tablet 60 mg NP QL

fluvoxamine maleate PG QL

fluvoxamine maleate er PG QL

FORFIVO XL NC #

imipramine hcl oral PG

imipramine pamoate NP

KHEDEZLA NP PA; ST; QL

LEXAPRO ORAL TABLET NP QL

maprotiline hcl PG QL

MARPLAN NP

mirtazapine oral PG QL

NARDIL NP

nefazodone hcl NP

NORPRAMIN ORAL TABLET 10 MG, 25 MG

NP

nortriptyline hcl oral capsule 10 mg, 25 mg PG LGC

nortriptyline hcl oral capsule 50 mg, 75 mg PG

nortriptyline hcl oral solution PG

PAMELOR ORAL CAPSULE NP

PARNATE NP

paroxetine hcl er PG QL

paroxetine hcl oral tablet PG LGC; QL

PAXIL NP QL

PAXIL CR NP QL

PEXEVA NC

phenelzine sulfate oral PG

PRISTIQ NP PA; ST; QL

protriptyline hcl PG

PROZAC ORAL CAPSULE NP QL

REMERON ORAL TABLET 15 MG, 30 MG NP QL

REMERON SOLTAB NP QL

sertraline hcl oral concentrate PG

sertraline hcl oral tablet PG LGC; QL

SURMONTIL NP



09/01/201837


TOFRANIL NP

tranylcypromine sulfate PG

trazodone hcl oral tablet 100 mg, 150 mg, 50 mg PG LGC

trazodone hcl oral tablet 300 mg PG

trimipramine maleate oral NP

TRINTELLIX NP PA; ST; QL

venlafaxine hcl PG QL

venlafaxine hcl er oral capsule extended release 24 hour

PG QL

venlafaxine hcl er oral tablet extended release 24 hour

NP QL

VIIBRYD ORAL TABLET NP QL

VIIBRYD STARTER PACK NP

WELLBUTRIN SR NP QL

WELLBUTRIN XL NC

ZOLOFT ORAL CONCENTRATE NP

ZOLOFT ORAL TABLET NP QL

*ANTIDIABETICS*

acarbose PG

ACTOPLUS MET NP QL

ACTOPLUS MET XR NP QL

ACTOS NP QL

ADLYXIN NC

ADLYXIN STARTER PACK NC

ADMELOG NC

ADMELOG SOLOSTAR NC

AFREZZA INHALATION POWDER 12 UNIT, 4 & 8 & 12 UNIT, 4 (90) & 8 (90) UNIT, 4 UNIT, 8 UNIT

NP PA

alogliptin benzoate PG QL

alogliptin-metformin hcl PG QL

alogliptin-pioglitazone PG QL

AMARYL NP

APIDRA NC

APIDRA SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

NC



09/01/201838


AVANDIA ORAL TABLET 2 MG, 4 MG NP QL

BASAGLAR KWIKPEN PB

BYDUREON BCISE NC

BYDUREON SUBCUTANEOUS PEN-INJECTOR

NC

BYDUREON SUBCUTANEOUS SUSPENSION RECONSTITUTED ER

NC

BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

NC #

BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

NC #

chlorpropamide PG

CYCLOSET NP QL

DUETACT NP QL

FARXIGA NP QL

FIASP NC

FIASP FLEXTOUCH NC

FORTAMET NC

glimepiride PG LGC

glipizide er oral tablet extended release 24 hour10 mg, 5 mg

PG LGC

glipizide er oral tablet extended release 24 hour2.5 mg

PG

glipizide oral PG LGC

glipizide xl PG

glipizide-metformin hcl PG

GLUCAGEN HYPOKIT PB QL

GLUCAGON EMERGENCY PB QL

GLUCOPHAGE NP

GLUCOPHAGE XR NP

GLUCOTROL NP

GLUCOTROL XL NP

GLUCOVANCE ORAL TABLET 5-500 MG NP

GLUMETZA NC

glyburide micronized oral tablet 1.5 mg PG

glyburide micronized oral tablet 3 mg, 6 mg PG LGC



09/01/201839


glyburide oral tablet 1.25 mg PG

glyburide oral tablet 2.5 mg, 5 mg PG LGC

glyburide-metformin PG

GLYNASE NP

GLYSET NP

HUMALOG PB

HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML, 200 UNIT/ML

PB

HUMALOG MIX 50/50 PB

HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

PB

HUMALOG MIX 75/25 PB

HUMALOG MIX 75/25 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

PB

HUMULIN 70/30 PB

HUMULIN 70/30 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

PB

HUMULIN N PB

HUMULIN N KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

PB

HUMULIN R PB

HUMULIN R U-500 (CONCENTRATED) PB

HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

PB

INVOKANA PB QL

JANUMET PB QL

JANUMET XR PB QL

JANUVIA PB QL

JARDIANCE PB QL

JENTADUETO PB QL

JENTADUETO XR PB QL



09/01/201840


KAZANO NC

KOMBIGLYZE XR NC

KORLYM NPS PA; SP; QL

LANTUS NC

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

NC

LEVEMIR PB

LEVEMIR FLEXTOUCH PB

metformin hcl er (mod) NC

metformin hcl er (osm) oral tablet extended release 24 hour 1000 mg, 500 mg

NC

metformin hcl er oral tablet extended release 24 hour 500 mg

PG LGC

metformin hcl er oral tablet extended release 24 hour 750 mg

PG

metformin hcl oral tablet PG LGC

miglitol PG

nateglinide NP

NESINA NC

NOVOLIN 70/30 NC

NOVOLIN 70/30 RELION NC

NOVOLIN N NC

NOVOLIN N RELION NC

NOVOLIN R NC

NOVOLIN R RELION NC

NOVOLOG NC

NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

NC

NOVOLOG MIX 70/30 NC

NOVOLOG MIX 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

NC

NOVOLOG PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE

NC

ONGLYZA NC

OSENI NC



09/01/201841


OZEMPIC NC

pioglitazone hcl PG QL

pioglitazone hcl-glimepiride PG QL

pioglitazone hcl-metformin hcl PG QL

PRANDIN ORAL TABLET 1 MG, 2 MG NP

PRECOSE NP

PROGLYCEM NP

repaglinide NP

repaglinide-metformin hcl NP QL

RIOMET NP

STARLIX NP

STEGLATRO NC

SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN-INJECTOR

NP PA; #; QL

SYMLINPEN 60 SUBCUTANEOUS SOLUTION PEN-INJECTOR

NP PA; #

tolazamide PG

tolbutamide NP

TOUJEO MAX SOLOSTAR NC

TOUJEO SOLOSTAR NC

TRADJENTA PB QL

TRESIBA FLEXTOUCH PB

TRULICITY PB PA; ST; QL

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR

PB PA; ST; QL

*ANTIDIARRHEALS*

diphenatol PG

diphenoxylate-atropine PG

LOMOTIL ORAL TABLET NP

MOTOFEN NP

MYTESI NP PA; ST; QL

opium NP

*ANTIDOTES AND SPECIFIC ANTAGONISTS*

deferoxamine mesylate PSP SP



09/01/201842


DESFERAL INJECTION SOLUTION RECONSTITUTED 500 MG

NPS SP

VISTOGARD PSP SP; QL

*ANTIDOTES*

CHEMET NP

deferoxamine mesylate PSP SP

DESFERAL INJECTION SOLUTION RECONSTITUTED 500 MG

NPS SP

EVZIO INJECTION SOLUTION AUTO-INJECTOR 2 MG/0.4ML

NC

EXJADE NPS PA; #; SP

FERRIPROX ORAL SOLUTION NPS PA

FERRIPROX ORAL TABLET NPS PA; SP

JADENU NPS PA; #; SP

JADENU SPRINKLE NPS PA; SP

naltrexone hcl oral PG

NARCAN PB #; QL

RADIOGARDASE NP

VISTOGARD PSP SP; QL

VIVITROL NP

*ANTIEMETICS*

AKYNZEO ORAL NP PA; ST; QL

ALOXI INTRAVENOUS SOLUTION 0.25 MG/5ML

NC #

ANZEMET ORAL NP QL

aprepitant PG QL

BONJESTA NP PA; ST; QL

CESAMET NP QL

DICLEGIS NP PA; QL

dronabinol NP PA; QL

EMEND ORAL CAPSULE 125 MG, 40 MG, 80 MG

NP QL

EMEND ORAL SUSPENSION RECONSTITUTED

PB

granisetron hcl oral NP

MARINOL NP PA; QL



09/01/201843


ondansetron PG

ondansetron hcl oral PG

SANCUSO NP QL

scopolamine PG

SYNDROS NP PA; QL

TIGAN INTRAMUSCULAR NC

TIGAN ORAL NP

TRANSDERM-SCOP (1.5 MG) NP

trimethobenzamide hcl oral PG

VARUBI ORAL NP QL

ZOFRAN ODT NP

ZOFRAN ORAL NP

ZUPLENZ NC

*ANTIFUNGALS*

ANCOBON NP

CRESEMBA ORAL NP

DIFLUCAN NP

fluconazole oral suspension reconstituted PG AL

fluconazole oral tablet PG

flucytosine oral NP

griseofulvin microsize oral PG

griseofulvin ultramicrosize PG

itraconazole oral PG QL

ketoconazole oral PG QL

LAMISIL ORAL TABLET NP

NOXAFIL ORAL SUSPENSION NP

NOXAFIL ORAL TABLET DELAYED RELEASE

NP QL

nystatin oral tablet PG

SPORANOX ORAL CAPSULE NP QL

SPORANOX ORAL SOLUTION NP

SPORANOX PULSEPAK NP QL

terbinafine hcl oral PG

VFEND NP

voriconazole oral tablet PG



09/01/201844


*ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES***

HEMLIBRA NPS PA; SP

*ANTIHISTAMINES*

ALAVERT ORAL TABLET DISPERSIBLE PG Select OTC

ALLEGRA ALLERGY PG Select OTC; QL

ALLEGRA ALLERGY CHILDRENS ORAL SUSPENSION

PG Select OTC

ALLEGRA ALLERGY CHILDRENS ORAL TABLET DISPERSIBLE

PG Select OTC

allergy relief oral tablet dispersible PG Select OTC

carbinoxamine maleate oral tablet 4 mg PG

carbinoxamine maleate oral tablet 6 mg NC

cetirizine hcl oral tablet PG Select OTC

cetirizine hcl oral tablet chewable PG Select OTC

childrens loratadine PG Select OTC

CLARINEX ORAL SYRUP NP

CLARINEX ORAL TABLET NP QL

CLARITIN PG Select OTC

CLARITIN REDITABS PG Select OTC

cyproheptadine hcl oral PG

desloratadine oral tablet NP QL

desloratadine oral tablet dispersible 2.5 mg NP QL

desloratadine oral tablet dispersible 5 mg NP

fexofenadine hcl childrens PG Select OTC

fexofenadine hcl oral tablet 180 mg, 60 mg PG Select OTC

KARBINAL ER ORAL SUSPENSION EXTENDED RELEASE

NP

levocetirizine dihydrochloride oral NC

loratadine childrens oral solution PG Select OTC

loratadine childrens oral syrup PG Select OTC

loratadine oral capsule PG Select OTC

loratadine oral solution PG Select OTC

loratadine oral tablet PG Select OTC

loratadine oral tablet chewable PG Select OTC



09/01/201845


PHENADOZ RECTAL SUPPOSITORY 12.5 MG

PG

promethazine hcl oral solution PG AL

promethazine hcl oral syrup PG AL

promethazine hcl oral tablet PG

promethazine hcl rectal PG AL

PROMETHEGAN RECTAL SUPPOSITORY 25 MG, 50 MG

PG

RYVENT NC

TRIAMINIC ALLERCHEWS PG Select OTC

XYZAL ALLERGY 24HR PG Select OTC

XYZAL ALLERGY 24HR CHILDRENS PG Select OTC

ZYRTEC ALLERGY ORAL CAPSULE PG Select OTC

ZYRTEC ALLERGY ORAL TABLET PG Select OTC

*ANTIHYPERLIPIDEMICS*

ALTOPREV NP #; QL

ANTARA ORAL CAPSULE 30 MG, 90 MG NP #; QL

atorvastatin calcium oral tablet 10 mg CE QL

atorvastatin calcium oral tablet 20 mg, 40 mg, 80 mg

PG QL

cholestyramine light PG

cholestyramine oral PG

colesevelam hcl PG

COLESTID NP

COLESTID FLAVORED NP

colestipol hcl PG

CRESTOR NP ST; QL

ezetimibe PG QL

ezetimibe-simvastatin PG QL

fenofibrate micronized oral capsule 130 mg, 43 mg

NP QL

fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg

PG QL

fenofibrate oral capsule 150 mg, 50 mg NP QL

fenofibrate oral tablet 120 mg, 40 mg NC



09/01/201846


fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg

PG QL

fenofibric acid PG QL

FENOGLIDE NC

FIBRICOR NP QL

flolipid NC

fluvastatin sodium PG QL

fluvastatin sodium er NP QL

gemfibrozil oral PG LGC

JUXTAPID NPS PA; ST; SP; QL

KYNAMRO SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

NPS PA; ST; SP; QL

LESCOL ORAL CAPSULE 20 MG NP QL

LESCOL XL NP QL

LIPITOR NP QL

LIPOFEN NP QL

LIVALO NP ST; QL

LOPID NP

lovastatin PG LGC; QL

LOVAZA NP QL

MEVACOR ORAL TABLET 40 MG NP QL

niacin er (antihyperlipidemic) PG

NIACOR NP

NIASPAN NP

omega-3-acid ethyl esters PG QL

PRAVACHOL ORAL TABLET 20 MG, 40 MG, 80 MG

NP QL

pravastatin sodium PG QL

PREVALITE PG

QUESTRAN NP

QUESTRAN LIGHT ORAL POWDER NP

rosuvastatin calcium PG QL

simvastatin oral tablet 10 mg, 5 mg CE LGC; QL

simvastatin oral tablet 20 mg, 40 mg, 80 mg PG LGC; QL

TRICOR NP QL



09/01/201847


TRIGLIDE ORAL TABLET 160 MG NP QL

TRILIPIX NP QL

VASCEPA PB QL

VYTORIN NP ST; QL

WELCHOL NP #

ZETIA NP ST; QL

ZOCOR NP QL

ZYPITAMAG NC

*ANTIHYPERTENSIVES*

ACCUPRIL NP

ACCURETIC NP

ALTACE ORAL CAPSULE NP

amlodipine besy-benazepril hcl PG

amlodipine besylate-valsartan PG QL

amlodipine-olmesartan NP QL

amlodipine-valsartan-hctz PG QL

ATACAND NP QL

ATACAND HCT NP QL

atenolol-chlorthalidone PG

AVALIDE ORAL TABLET 150-12.5 MG, 300-12.5 MG

NP QL

AVAPRO NP QL

AZOR NP ST; QL

benazepril hcl oral PG LGC

benazepril-hydrochlorothiazide PG

BENICAR NP ST; QL

BENICAR HCT NP ST; QL

bisoprolol-hydrochlorothiazide PG LGC

candesartan cilexetil PG QL

candesartan cilexetil-hctz PG QL

captopril oral PG

captopril-hydrochlorothiazide PG

CARDURA NP

CATAPRES NP

CATAPRES-TTS-1 NP



09/01/201848


CATAPRES-TTS-2 NP

CATAPRES-TTS-3 NP

clonidine hcl oral PG LGC

clonidine hcl transdermal NP

CORZIDE NP

COZAAR ORAL TABLET 100 MG NP

COZAAR ORAL TABLET 25 MG, 50 MG NP QL

DEMSER NPS ST; SP

DIBENZYLINE NPS ST; QL

DIOVAN NP QL

DIOVAN HCT NP QL

doxazosin mesylate oral PG

DUTOPROL NC

EDARBI NP ST; QL

EDARBYCLOR NP ST; QL

enalapril maleate oral PG LGC

enalapril-hydrochlorothiazide PG LGC

EPANED ORAL SOLUTION NP PA; #; QL

eplerenone NP

eprosartan mesylate NP QL

EXFORGE NP QL

EXFORGE HCT NP QL

fosinopril sodium PG

fosinopril sodium-hctz PG

guanfacine hcl oral PG

hydralazine hcl oral tablet 10 mg, 100 mg, 50 mg PG

hydralazine hcl oral tablet 25 mg PG LGC

HYZAAR NP

INSPRA NP

irbesartan PG QL

irbesartan-hydrochlorothiazide PG QL

lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg PG LGC

lisinopril oral tablet 30 mg, 40 mg PG

lisinopril-hydrochlorothiazide PG LGC



09/01/201849


LOPRESSOR HCT ORAL TABLET 50-25 MG

NP

losartan potassium oral tablet 100 mg PG LGC

losartan potassium oral tablet 25 mg, 50 mg PG LGC; QL

losartan potassium-hctz PG LGC

LOTENSIN ORAL TABLET 20 MG, 40 MG NP

LOTREL ORAL CAPSULE 10-20 MG, 10-40 MG, 5-10 MG, 5-20 MG

NP

MAVIK ORAL TABLET 4 MG NP

methyldopa oral PG

methyldopa-hydrochlorothiazide PG

metoprolol-hctz er NC

metoprolol-hydrochlorothiazide PG

MICARDIS NP QL

MICARDIS HCT NP QL

MINIPRESS NP

minoxidil oral PG

moexipril hcl PG

moexipril-hydrochlorothiazide PG

nadolol-bendroflumethiazide NP

olmesartan medoxomil oral PG QL

olmesartan medoxomil-hctz PG QL

olmesartan-amlodipine-hctz NP QL

perindopril erbumine NP

phenoxybenzamine hcl oral PSP QL

prazosin hcl oral PG

PRESTALIA NP #

PRINIVIL NP

propranolol-hctz PG

QBRELIS NP PA

quinapril hcl PG

quinapril-hydrochlorothiazide PG

ramipril PG

TARKA ORAL TABLET EXTENDED RELEASE 2-180 MG, 2-240 MG, 4-240 MG

NP



09/01/201850


TEKTURNA NP ST; #; QL

TEKTURNA HCT NP ST; QL

telmisartan PG QL

telmisartan-amlodipine NP ST; QL

telmisartan-hctz PG QL

TENORETIC 100 NP

TENORETIC 50 NP

terazosin hcl oral PG LGC

trandolapril PG

trandolapril-verapamil hcl er PG

TRIBENZOR NP ST; QL

TWYNSTA NP ST; QL

valsartan PG QL

valsartan-hydrochlorothiazide PG QL

VASERETIC NP

VASOTEC NC

VECAMYL NPS PA; ST; SP; QL

ZESTORETIC NP

ZESTRIL NP

ZIAC NP

*ANTI-INFECTIVE AGENTS - MISC.*

ALINIA NP #; QL

atovaquone oral PG

BACTRIM NP

BACTRIM DS NP

CLEOCIN ORAL NP

CLEOCIN PHOSPHATE INJECTION NC

CLEOCIN PHOSPHATE INTRAVENOUS SOLUTION 600 MG/4ML, 900 MG/6ML

NC

clindamycin hcl oral PG

clindamycin phosphate injection solution 9 gm/60ml, 9000 mg/60ml

NC

clindamycin phosphate intravenous solution 900 mg/6ml

NC

COLY-MYCIN M NPS SP



09/01/201851


dapsone oral PG

FIRVANQ ORAL SOLUTION RECONSTITUTED 25 MG/ML

NP

FLAGYL NP

IMPAVIDO NP PA; QL

linezolid oral PG QL

MEPRON NP

metronidazole oral PG

NEBUPENT PB

SIVEXTRO ORAL NP QL

sulfamethoxazole-trimethoprim oral suspension200-40 mg/5ml

PG LGC

sulfamethoxazole-trimethoprim oral tablet PG LGC

TINDAMAX ORAL TABLET 500 MG NP

tinidazole oral NP

trimethoprim oral PG

trimpex NP

VANCOCIN HCL NP

vancomycin hcl oral NP

XIFAXAN ORAL TABLET 200 MG NP QL

XIFAXAN ORAL TABLET 550 MG PB PA; QL

ZYVOX ORAL SUSPENSION RECONSTITUTED

PB QL

ZYVOX ORAL TABLET NP QL

*ANTIMALARIALS*

atovaquone-proguanil hcl NP

chloroquine phosphate oral PG

COARTEM NP

DARAPRIM PB

hydroxychloroquine sulfate oral PG

MALARONE NP

mefloquine hcl NP

PLAQUENIL NP

primaquine phosphate oral PG

QUALAQUIN NP



09/01/201852


quinine sulfate oral NP

*ANTIMYASTHENIC AGENTS*

guanidine hcl oral PG

MESTINON NP

pyridostigmine bromide er PG

pyridostigmine bromide oral PG

*ANTIMYASTHENIC/CHOLINERGIC AGENTS*

guanidine hcl oral PG

MESTINON NP

pyridostigmine bromide er PG

pyridostigmine bromide oral PG

*ANTIMYCOBACTERIAL AGENTS*

CAPASTAT SULFATE NC

cycloserine oral NP

ethambutol hcl oral PG

isoniazid oral PG

MYAMBUTOL ORAL TABLET 400 MG NP

MYCOBUTIN NP

PASER NP

PRIFTIN NP

pyrazinamide oral PG

rifabutin PG

RIFADIN ORAL NP

RIFAMATE NP

rifampin oral PG

RIFATER NP

SIRTURO NPS PA; SP; QL

TRECATOR NP

*ANTINEOPLASTIC - BCL-2 INHIBITORS***

VENCLEXTA NPS PA; SP; QL

VENCLEXTA STARTING PACK NPS PA; SP; QL



09/01/201853


*ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*

ACTIMMUNE NPS PA; SP

AFINITOR NPS PA; SP; QL

AFINITOR DISPERZ NPS PA; SP; QL

ALECENSA NPS PA; SP; QL

ALFERON N NPS SP

ALKERAN INTRAVENOUS NC

ALKERAN ORAL NP ST

ALUNBRIG NPS PA; SP; QL

anastrozole oral PG

ARIMIDEX NP

AROMASIN NP

ARRANON NC #

ARZERRA NC

bexarotene PSP PA; SP

bicalutamide PG QL

BOSULIF NPS PA; ST; SP; QL

BRAFTOVI NPS PA; SP; QL

BUSULFEX NC

CABOMETYX PSP PA; SP; QL

CALQUENCE NPS PA; SP; QL

CAMPTOSAR NC

capecitabine PG PA; SP

CAPRELSA NPS PA; SP; QL

CASODEX NP QL

COMETRIQ (100 MG DAILY DOSE) NPS PA; SP; QL



COTELLIC NPS PA; SP; QL

cyclophosphamide injection NC

cyclophosphamide oral capsule PG

ELIGARD NPS PA; SP

EMCYT PB

ERIVEDGE NPS PA; SP; QL



09/01/201854


ERLEADA NPS PA; SP; QL

ETHYOL NC

etoposide intravenous solution 100 mg/5ml, 500 mg/25ml

NC

etoposide oral PG

exemestane PG

FARESTON PB

FARYDAK NPS PA; SP; QL

FASLODEX INTRAMUSCULAR SOLUTION 250 MG/5ML

NPS PA; #; SP

FEMARA NP

FIRMAGON NPS PA; SP

flutamide PG

GILOTRIF NPS PA; SP; QL

GLEEVEC NC SP

GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG

NP PA

HEXALEN PB

HYCAMTIN ORAL NPS PA; SP

HYDREA NP

hydroxyurea oral PG

ICLUSIG NPS PA; SP; QL

imatinib mesylate PG PA; SP; QL

IMBRUVICA ORAL CAPSULE 70 MG NPS PA; SP; QL

IMBRUVICA ORAL TABLET NPS PA; SP; QL

INLYTA NPS PA; SP; QL

INTRON A NPS PA; SP

IRESSA NPS PA; QL

irinotecan hcl NC

JAKAFI ORAL TABLET 10 MG NPS PA; SP

JAKAFI ORAL TABLET 15 MG, 20 MG, 25 MG, 5 MG

NPS PA; SP; QL

JEVTANA NC

KISQALI FEMARA 200 DOSE NPS PA; SP; QL





09/01/201855


LENVIMA 10 MG DAILY DOSE NPS PA; SP; QL






letrozole oral PG

leucovorin calcium oral PG

LEUKERAN PB

leuprolide acetate injection PG PA; SP

LONSURF NPS PA; QL

LUPRON DEPOT (1-MONTH) NPS PA; #; SP




LYSODREN PB

MATULANE PB

megestrol acetate oral tablet PG

MEKINIST NPS PA; SP; QL

MEKTOVI NPS PA; SP; QL

melphalan PG

melphalan hcl NC

mercaptopurine oral PG

methotrexate oral PG

methotrexate sodium (pf) injection solution 1 gm/40ml, 250 mg/10ml, 50 mg/2ml

PG

MYLERAN PB

NERLYNX NPS PA; SP; QL

NEXAVAR NPS PA; SP; QL

NILANDRON PB

nilutamide PG

NINLARO NPS PA; QL

ODOMZO NPS PA; QL

POMALYST NPS PA; SP; QL

PURIXAN NPS PA; ST; SP; QL



09/01/201856


RYDAPT NPS PA; SP; QL

SOLTAMOX NP #

SPRYCEL NPS PA; ST; SP; QL

STIVARGA NPS PA; SP; QL

SUTENT PSP PA; SP; QL

SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG

NPS PA; SP

SYNRIBO NC

TABLOID PB

TAFINLAR NPS PA; SP; QL

TAGRISSO NPS PA; SP; QL

tamoxifen citrate oral CE

TARCEVA PSP PA; #; SP; QL

TARGRETIN ORAL NPS PA; SP

TASIGNA NPS PA; ST; SP; QL

TEMODAR ORAL NC

temozolomide PG PA; SP

toposar intravenous solution 100 mg/5ml NC

TORISEL NC #

TRELSTAR MIXJECT NPS PA; #; SP

tretinoin oral PG SP

TYKERB NPS PA; SP

VANTAS NPS PA; SP

VELCADE INJECTION NC #

VORAXAZE NC

VOTRIENT NPS PA; SP; QL

XALKORI NPS PA; SP; QL

XATMEP NP PA

XELODA NC

XTANDI NPS PA; ST; SP; QL

YERVOY NC

YONSA NPS PA; ST; SP; QL

ZANOSAR NC

ZELBORAF NPS PA; SP; QL

ZOLADEX NPS PA; SP



09/01/201857


ZOLINZA NPS PA; SP; QL

ZYKADIA NPS PA; SP

ZYTIGA PSP PA; #; SP; QL

*ANTIPARKINSON AGENTS*

amantadine hcl oral PG

AZILECT NP QL

benztropine mesylate oral PG LGC

bromocriptine mesylate oral PG

carbidopa oral PG

carbidopa-levodopa PG

carbidopa-levodopa er oral tablet extended release 25-100 mg, 50-200 mg

PG

carbidopa-levodopa-entacapone NP

COMTAN NP

DUOPA ENTERAL NPS PA; ST

ELDEPRYL NP

entacapone PG

GOCOVRI NC

LODOSYN NP

MIRAPEX NP

MIRAPEX ER NP QL

NEUPRO NP #; QL

OSMOLEX ER NC

PARLODEL ORAL CAPSULE NP

pramipexole dihydrochloride PG

pramipexole dihydrochloride er NP QL

rasagiline mesylate oral PG QL

REQUIP NP

REQUIP XL NP QL

ropinirole hcl PG

ropinirole hcl er NP QL

RYTARY NP #

selegiline hcl oral PG

SINEMET NP

SINEMET CR NP



09/01/201858


STALEVO 100 NP

STALEVO 125 NP

STALEVO 150 NP

STALEVO 200 NP

STALEVO 50 NP

STALEVO 75 NP

TASMAR ORAL TABLET 100 MG NP

tolcapone NP

trihexyphenidyl hcl oral elixir PG

trihexyphenidyl hcl oral tablet 2 mg PG LGC

trihexyphenidyl hcl oral tablet 5 mg PG

XADAGO NP PA; ST; QL

ZELAPAR NC

*ANTIPSYCHOTICS/ANTIMANIC AGENTS*

ABILIFY ORAL TABLET NP PA; ST; QL

aripiprazole PG QL

chlorpromazine hcl oral PG

clozapine PG QL

CLOZARIL NP PA; ST; QL

COMPRO PG

EQUETRO NP

FANAPT NP ST; QL

FANAPT TITRATION PACK NP ST

FAZACLO NP PA; ST; QL

fluphenazine hcl oral PG

GEODON ORAL NP PA; ST; QL

haloperidol lactate oral PG

haloperidol oral PG

INVEGA NP PA; ST; QL

LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 80 MG

PB ST; #; QL

LATUDA ORAL TABLET 60 MG PB ST; #

lithium PG

lithium carbonate er PG



09/01/201859


lithium carbonate oral PG

LITHOBID NP

loxapine succinate oral PG

NUPLAZID NPS PA; SP; QL

olanzapine oral PG QL

paliperidone er NP QL

perphenazine oral PG

prochlorperazine PG

prochlorperazine maleate oral PG

quetiapine fumarate PG QL

quetiapine fumarate er NP QL

REXULTI NP PA; ST; QL

RISPERDAL ORAL SOLUTION NP PA; ST

RISPERDAL ORAL TABLET NP PA; ST; QL

RISPERIDONE M-TAB ORAL TABLET DISPERSIBLE 0.5 MG, 1 MG, 2 MG

PG QL

risperidone oral solution PG

risperidone oral tablet PG QL

risperidone oral tablet dispersible 0.25 mg PG

risperidone oral tablet dispersible 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg

PG QL

SAPHRIS NP PA; ST; QL

SEROQUEL NP PA; ST; QL

SEROQUEL XR NP PA; ST; QL

thioridazine hcl oral PG

thiothixene oral PG

trifluoperazine hcl oral PG

VERSACLOZ NP PA; ST

VRAYLAR ORAL CAPSULE NP PA; ST; QL

VRAYLAR ORAL CAPSULE THERAPY PACK

NP PA; ST

ziprasidone hcl PG QL

ZYPREXA ORAL NP PA; ST; QL

ZYPREXA ZYDIS NP PA; ST; QL



09/01/201860


*ANTIRETROVIRALS ADJUVANTS***

TYBOST NP QL

*ANTIVIRALS*

abacavir sulfate PG

abacavir sulfate-lamivudine PG

abacavir-lamivudine-zidovudine PG

acyclovir oral capsule PG LGC

acyclovir oral suspension PG

acyclovir oral tablet 400 mg PG LGC

acyclovir oral tablet 800 mg PG

adefovir dipivoxil PG SP; QL

APTIVUS PB

atazanavir sulfate PG QL

ATRIPLA PB QL

BARACLUDE ORAL SOLUTION NPS SP

BARACLUDE ORAL TABLET NPS SP; QL

BIKTARVY NP PA

cidofovir intravenous PG SP

CIMDUO NP QL

COMBIVIR NP

COMPLERA PB QL

CRIXIVAN ORAL CAPSULE 200 MG, 400 MG

NP

CYTOVENE NPS SP

DAKLINZA NPS PA; ST; SP; QL

DESCOVY NP QL

didanosine oral capsule delayed release 200 mg, 250 mg, 400 mg

PG

EDURANT NP QL

efavirenz PG

EMTRIVA ORAL CAPSULE PB QL

EMTRIVA ORAL SOLUTION PB

entecavir PG SP; QL

EPIVIR NP

EPIVIR HBV ORAL SOLUTION NP #



09/01/201861


EPIVIR HBV ORAL TABLET NP

EPZICOM NP

EVOTAZ NP

famciclovir oral PG QL

FLUMADINE NP

fosamprenavir calcium PG

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED

NPS PA; #; SP

ganciclovir sodium intravenous solution reconstituted

PG SP

GENVOYA NP PA; QL

HEPSERA NPS SP; QL

INTELENCE NP QL

INVIRASE NP

ISENTRESS HD PB QL

ISENTRESS ORAL PACKET PB

ISENTRESS ORAL TABLET PB QL

ISENTRESS ORAL TABLET CHEWABLE PB QL

JULUCA NP ST; QL

KALETRA ORAL SOLUTION NP

KALETRA ORAL TABLET PB #

lamivudine PG

lamivudine-zidovudine PG

LEXIVA PB #

lopinavir-ritonavir PG

MODERIBA 1200 DOSE PACK NPS SP

MODERIBA 800 DOSE PACK NPS SP

moderiba oral tablet 200 mg PG SP

nevirapine er PG QL

nevirapine oral tablet PG

NORVIR ORAL CAPSULE PB #

NORVIR ORAL PACKET PB

NORVIR ORAL SOLUTION PB #

NORVIR ORAL TABLET NP #

ODEFSEY NP QL



09/01/201862


oseltamivir phosphate oral PG QL

PEGASYS PROCLICK NPS PA; SP

PEGASYS SUBCUTANEOUS SOLUTION NPS PA; SP

PREVYMIS ORAL NPS PA; SP; QL

PREZCOBIX PB

PREZISTA ORAL SUSPENSION PB QL

PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG

PB QL

REBETOL NPS SP

RELENZA DISKHALER NP QL

RESCRIPTOR NP

RETROVIR INTRAVENOUS NC

RETROVIR ORAL CAPSULE NP

RETROVIR ORAL SYRUP NP

REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG

NP QL

REYATAZ ORAL PACKET PB #

ribasphere PG SP

ribasphere ribapak oral tablet 400 mg, 600 mg PG SP

ribavirin oral capsule PG SP

ribavirin oral tablet 200 mg PG SP

rimantadine hcl PG

ritonavir PG

SELZENTRY ORAL SOLUTION NP QL

SELZENTRY ORAL TABLET 150 MG, 25 MG, 75 MG

NP QL

SELZENTRY ORAL TABLET 300 MG NP

SITAVIG NC

SOVALDI PSP PA; SP; QL

stavudine oral capsule PG

STRIBILD NP PA; QL

SUSTIVA NP

SYMFI NP

SYMFI LO NP

TAMIFLU ORAL CAPSULE NP QL



09/01/201863


TAMIFLU ORAL SUSPENSION RECONSTITUTED 6 MG/ML

NP QL

tenofovir disoproxil fumarate PG QL

TIVICAY PB QL

TRIUMEQ PB QL

TRIZIVIR NP

TRUVADA PB

valacyclovir hcl oral PG

VALCYTE NPS PA; SP; QL

valganciclovir hcl PG PA; SP; QL

VALTREX NP ST

VEMLIDY NPS PA; ST; SP; QL

VIDEX PB

VIDEX EC NP

VIRACEPT ORAL TABLET NP

VIRAMUNE NP

VIRAMUNE XR NP QL

VIREAD ORAL POWDER PB #

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG

PB #; QL

VIREAD ORAL TABLET 300 MG NP QL

ZERIT NP

ZIAGEN NP

zidovudine PG

ZOVIRAX ORAL NP

*ASSORTED CLASSES*

ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 0.5 MG, 1 MG

NPS #; SP; QL

ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 5 MG

NPS #; SP

ATGAM NPS SP

azathioprine oral PG

BENLYSTA INTRAVENOUS NPS PA; ST; SP

BENLYSTA SUBCUTANEOUS NPS PA; ST; SP; QL

CELLCEPT NPS SP



09/01/201864


CUPRIMINE ORAL CAPSULE 250 MG NPS PA; ST; #

cyclosporine intravenous PG SP

cyclosporine modified PG

cyclosporine oral capsule PG

DEPEN TITRATABS PSP PA

ENVARSUS XR NPS

gengraf oral capsule 100 mg, 25 mg PG

gengraf oral solution PG

HYLAFEM NC

IMURAN NP

KIONEX ORAL SUSPENSION PG

morcin NC

mycophenolate mofetil PG SP

mycophenolate sodium PG SP

MYFORTIC NPS SP

NEORAL NPS SP

NULOJIX NPS SP

PROGRAF NPS SP

RAPAMUNE NPS SP

REVLIMID NPS PA; SP; QL

SANDIMMUNE NPS SP

SIMULECT NPS SP

sirolimus oral PG SP

sodium polystyrene sulfonate oral PG

SPS PG

SYPRINE NPS PA; #

tacrolimus oral PG SP

THALOMID NPS PA; #; SP

THYMOGLOBULIN NPS SP

TRAUMEEL EXTERNAL OINTMENT NC

trientine hcl PSP PA; SP

VELTASSA NP PA; QL

XIAFLEX PSP SP

ZORTRESS NPS #; SP



09/01/201865


*ATOPIC DERMATITIS - MONOCLONAL ANTIBODIES***

DUPIXENT NPS PA; SP; QL

*BETA BLOCKER & ANGIOTENSIN II RECEPTOR ANTAGONIST COMB***

BYVALSON NP PA; ST; QL

*BETA BLOCKERS*

acebutolol hcl oral PG

atenolol oral PG LGC

BETAPACE AF NP

BETAPACE ORAL TABLET 120 MG, 160 MG, 80 MG

NP

betaxolol hcl oral NP

bisoprolol fumarate PG

BYSTOLIC NP PA; ST; QL

carvedilol PG LGC

carvedilol phosphate er NP QL

COREG NP

COREG CR NP QL

CORGARD NP

HEMANGEOL NP PA

INDERAL LA NC

INDERAL XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 80 MG

NP QL

INNOPRAN XL NP QL

KAPSPARGO SPRINKLE NP

labetalol hcl oral PG

metoprolol succinate er PG QL

metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg

PG LGC

metoprolol tartrate oral tablet 37.5 mg, 75 mg PG

nadolol oral tablet 20 mg, 40 mg, 80 mg PG

pindolol PG

propranolol hcl er PG

propranolol hcl oral solution PG



09/01/201866


propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 80 mg

PG LGC

propranolol hcl oral tablet 60 mg PG

sotalol hcl (af) oral tablet 120 mg PG LGC

sotalol hcl (af) oral tablet 160 mg, 80 mg PG

sotalol hcl oral tablet 120 mg, 80 mg PG LGC

sotalol hcl oral tablet 160 mg, 240 mg PG

SOTYLIZE NP

TENORMIN NP

timolol maleate oral PG

TOPROL XL NP QL

*BILE ACID SYNTHESIS DISORDER AGENTS***

CHOLBAM NPS PA

*BIOLOGICALS MISC*

ADAGEN NPS SP

mixed vespid venom protein injection solution reconstituted

NC

VENOMIL MIXED VESPID VENOM NC

*CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG***

AIMOVIG NP PA; ST; QL

AIMOVIG 140 DOSE NP PA; ST; QL

*CALCIUM CHANNEL BLOCKERS*

ADALAT CC NP QL

AFEDITAB CR PG QL

amlodipine besylate oral PG LGC

CALAN ORAL TABLET 120 MG, 80 MG NP

CALAN SR NP

CARDIZEM CD ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 360 MG

NC

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG

NP QL

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 420 MG

NP



09/01/201867


CARDIZEM ORAL TABLET 120 MG, 30 MG, 60 MG

NP

CARTIA XT PG QL

diltiazem cd PG QL

diltiazem hcl er beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

PG QL

diltiazem hcl er coated beads oral capsule extended release 24 hour

PG QL

diltiazem hcl er coated beads oral tablet extended release 24 hour 180 mg, 240 mg, 300 mg, 360 mg

NP QL

diltiazem hcl er coated beads oral tablet extended release 24 hour 420 mg

NP

diltiazem hcl er oral capsule extended release 12 hour

PG

diltiazem hcl er oral capsule extended release 24 hour 120 mg, 180 mg

PG

diltiazem hcl er oral capsule extended release 24 hour 240 mg

PG QL

diltiazem hcl oral PG LGC

dilt-xr oral capsule extended release 24 hour 120 mg, 180 mg

PG

dilt-xr oral capsule extended release 24 hour 240 mg

PG QL

felodipine er PG QL

isradipine PG

MATZIM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 180 MG, 240 MG, 300 MG, 360 MG

NP QL

MATZIM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 420 MG

NP

nicardipine hcl oral PG

NIFEDICAL XL ORAL TABLET EXTENDED RELEASE 24 HOUR 60 MG

PG QL

nifedipine er PG QL

nifedipine er osmotic release PG QL

nifedipine oral PG



09/01/201868


nimodipine oral PG

nisoldipine er oral tablet extended release 24 hour 17 mg, 20 mg, 30 mg, 34 mg, 40 mg, 8.5 mg

PG QL

nisoldipine er oral tablet extended release 24 hour 25.5 mg

PG

NORVASC NP

NYMALIZE ORAL SOLUTION 60 MG/20ML

NP QL

PROCARDIA NP

PROCARDIA XL NP QL

SULAR ORAL TABLET EXTENDED RELEASE 24 HOUR 17 MG, 34 MG, 8.5 MG

NP QL

TAZTIA XT PG QL

TIAZAC NP QL

verapamil hcl er oral capsule extended release 24 hour 100 mg, 200 mg, 300 mg

PG QL

verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg

PG

verapamil hcl er oral tablet extended release 120 mg

PG LGC

verapamil hcl er oral tablet extended release 180 mg, 240 mg

PG

verapamil hcl oral PG LGC

VERELAN NP

VERELAN PM NP QL

*CARDIOTONICS*

DIGITEK PG

DIGOX PG

digoxin oral PG

LANOXIN ORAL NP

*CARDIOVASCULAR AGENTS - MISC.*

ADCIRCA NPS PA; ST; #; SP; QL

ADEMPAS NPS PA; ST; SP; QL

amlodipine-atorvastatin NC

BIDIL NP



09/01/201869


CADUET ORAL TABLET 10-10 MG, 10-20 MG, 10-40 MG, 10-80 MG, 5-10 MG, 5-20 MG, 5-40 MG, 5-80 MG

NC

CIALIS ORAL TABLET 2.5 MG, 5 MG PB PA; N1; #; QL

epoprostenol sodium PG PA; SP

FLOLAN NPS PA; SP

LETAIRIS PSP PA; #; SP

OPSUMIT PSP PA; SP; QL

ORENITRAM ORAL TABLET EXTENDED RELEASE 0.125 MG, 0.25 MG, 1 MG, 2.5 MG

NPS PA; ST; SP

ORENITRAM ORAL TABLET EXTENDED RELEASE 5 MG

NPS PA; SP

REMODULIN NPS PA; #; SP

REVATIO INTRAVENOUS NPS PA; ST; SP

REVATIO ORAL SUSPENSION RECONSTITUTED

NPS PA; ST; #; SP

REVATIO ORAL TABLET NPS PA; ST; SP; QL

sildenafil citrate oral tablet 20 mg PG PA; SP; QL

TRACLEER ORAL TABLET PSP PA; #; SP

TRACLEER ORAL TABLET SOLUBLE PSP PA; SP

TYVASO NPS PA; ST; SP; QL

TYVASO REFILL NPS PA; ST; SP; QL

TYVASO STARTER NPS PA; ST; SP; QL

VELETRI NPS PA; SP

VENTAVIS NPS PA; SP

*CEPHALOSPORINS*

cefaclor PG

cefaclor er PG

cefadroxil PG

cefazolin sodium injection NC

cefazolin sodium intravenous solution reconstituted

NC

cefdinir PG

cefditoren pivoxil NP

cefepime hcl NC



09/01/201870


cefepime-dextrose NC

cefixime NP

cefotaxime sodium injection solution reconstituted 1 gm, 500 mg

NC

cefotetan disodium NC

cefoxitin sodium NC

cefoxitin sodium-dextrose NC

cefpodoxime proxetil PG

cefprozil PG

ceftazidime injection solution reconstituted 1 gm, 2 gm, 6 gm

NC

ceftriaxone sodium injection solution reconstituted 1 gm, 2 gm, 250 mg, 500 mg

NC

ceftriaxone sodium intravenous NC

cefuroxime axetil oral tablet PG

cefuroxime sodium injection solution reconstituted 7.5 gm, 750 mg

NC

cefuroxime sodium intravenous solution reconstituted 1.5 gm

NC

cephalexin oral capsule 250 mg, 500 mg PG LGC

cephalexin oral capsule 750 mg PG

cephalexin oral suspension reconstituted PG

cephalexin oral tablet PG

DAXBIA NC

KEFLEX NP

MAXIPIME INJECTION SOLUTION RECONSTITUTED 1 GM, 2 GM

NC

MAXIPIME INTRAVENOUS NC

ROCEPHIN INJECTION SOLUTION RECONSTITUTED 1 GM

NC

SPECTRACEF ORAL TABLET 400 MG NP

SUPRAX ORAL CAPSULE NP #

SUPRAX ORAL SUSPENSION RECONSTITUTED

NP

SUPRAX ORAL TABLET CHEWABLE NP #

tazicef injection NC



09/01/201871


tazicef intravenous solution reconstituted NC

TEFLARO NC

*CIC AGENTS - GUANYLATE CYCLASE-C (GC-C) AGONISTS***

TRULANCE PB QL

*CONTRACEPTIVES*

ALTAVERA CE

alyacen 1/35 CE

alyacen 7/7/7 CE

AMETHIA CE

AMETHIA LO CE

APRI CE

ARANELLE PG

AVIANE CE

AZURETTE PG

BALCOLTRA NP

BALZIVA PG

BEYAZ NP

briellyn CE

CAMRESE CE

CAMRESE LO CE

CAZIANT CE

CHATEAL CE

CRYSELLE-28 PG

CYCLAFEM 1/35 PG

DASETTA 1/35 PG

DASETTA 7/7/7 PG

DAYSEE CE

DELYLA CE

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 MG/ML

NP

desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg

CE

drospirenone-ethinyl estradiol oral tablet 3-0.02 mg

PG



09/01/201872


drospirenone-ethinyl estradiol oral tablet 3-0.03 mg

CE

ELINEST CE

ELLA CE #

EMOQUETTE CE

ENPRESSE-28 PG

ENSKYCE ORAL TABLET 0.15-30 MG-MCG

CE

ERRIN PG

ESTARYLLA PG

ESTROSTEP FE NP

FALMINA CE

FAYOSIM CE

GENERESS FE NP

GIANVI PG

GILDESS FE 1.5/30 PG

GILDESS FE 1/20 PG

HEATHER CE

INTROVALE CE

ISIBLOOM CE

JENCYCLA PG

JOLESSA CE

JOLIVETTE PG

JUNEL 1.5/30 PG

JUNEL 1/20 PG

JUNEL FE 1.5/30 PG

JUNEL FE 1/20 PG

KARIVA PG

KELNOR 1/35 CE

KURVELO PG

KYLEENA CE

LARIN 1.5/30 CE

LARIN 1/20 CE

LARIN FE 1.5/30 CE

LARIN FE 1/20 CE



09/01/201873


LEENA CE

LESSINA CE

LEVONEST CE

levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 mg

CE

levonorgestrel oral tablet 1.5 mg CE

levonorgestrel-ethinyl estrad CE

LEVORA 0.15/30 (28) PG

LO LOESTRIN FE NP

LOESTRIN 1.5/30 (21) NP

LOESTRIN 1/20 (21) NP

LORYNA PG

LOSEASONIQUE NP

LOW-OGESTREL PG

LUTERA CE

LYZA PG

marlissa CE

medroxyprogesterone acetate intramuscular suspension

CE

MIBELAS 24 FE CE

MICROGESTIN 1.5/30 PG

MICROGESTIN 1/20 PG

MICROGESTIN FE 1.5/30 PG

MICROGESTIN FE 1/20 PG

MINASTRIN 24 FE NP

MIRCETTE NP

MIRENA (52 MG) CE #

MONO-LINYAH PG

MONONESSA PG

NATAZIA NP

NECON 0.5/35 (28) PG

NECON 1/35 (28) CE

NEXPLANON CE

NEXT CHOICE ONE DOSE CE

NIKKI PG



09/01/201874


NORA-BE PG

norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg

CE

norethin ace-eth estrad-fe oral tablet chewable CE

norethindrone oral CE

norethin-eth estradiol-fe oral tablet chewable0.8-25 mg-mcg

CE

norgestimate-eth estradiol oral tablet 0.25-35 mg-mcg

CE

norgestim-eth estrad triphasic oral tablet0.18/0.215/0.25 mg-35 mcg

CE

NORTREL 0.5/35 (28) PG

NORTREL 1/35 (21) PG

NORTREL 1/35 (28) PG

NORTREL 7/7/7 PG

NUVARING CE #

OCELLA PG

OGESTREL PG

OPTION 2 CE

ORSYTHIA CE

ORTHO MICRONOR NP

ORTHO TRI-CYCLEN (28) NP

ORTHO TRI-CYCLEN LO NP

ORTHO-CYCLEN (28) NP

ORTHO-NOVUM 1/35 (28) NP

ORTHO-NOVUM 7/7/7 (28) NP

PARAGARD INTRAUTERINE COPPER NP

PHILITH PG

PIMTREA CE

PIRMELLA 1/35 CE

PLAN B ONE-STEP PG

PORTIA-28 PG

PREVIFEM PG

QUARTETTE NP

QUASENSE CE

RAJANI CE



09/01/201875


RECLIPSEN PG

RIVELSA CE

SAFYRAL NP #

SEASONIQUE NP

SKYLA CE

SPRINTEC 28 PG

SRONYX CE

SYEDA PG

TAKE ACTION CE

TAYTULLA NP

TILIA FE CE

TRI FEMYNOR CE

TRI-ESTARYLLA PG

TRI-LEGEST FE PG

TRI-LINYAH PG

TRI-MILI CE

TRINESSA (28) PG

TRI-NORINYL (28) NP

TRI-PREVIFEM PG

TRI-SPRINTEC PG

TRIVORA (28) PG

TULANA CE

TYDEMY CE

VELIVET PG

VESTURA PG

VYFEMLA CE

WERA CE

WYMZYA FE CE

XULANE CE

YASMIN 28 NP

YAZ NP

ZARAH PG

ZENCHENT PG

ZOVIA 1/35E (28) PG



09/01/201876


*CORTICOSTEROIDS*

budesonide er oral tablet extended release 24 hour

PG QL

budesonide oral PG

CORTEF NP

cortisone acetate oral PG

DEXAMETHASONE INTENSOL NP

dexamethasone oral elixir PG

dexamethasone oral solution PG

dexamethasone oral tablet PG

EMFLAZA NC

ENTOCORT EC ORAL CAPSULE DELAYED RELEASE PARTICLES

NP

fludrocortisone acetate oral PG

hydrocortisone oral PG

MEDROL NP

methylprednisolone oral PG

MILLIPRED NP

ORAPRED ODT NP

prednisolone oral solution PG

prednisolone sodium phosphate oral solution 10 mg/5ml, 20 mg/5ml

NP

prednisolone sodium phosphate oral solution 25 mg/5ml, 6.7 (5 base) mg/5ml

PG

prednisolone sodium phosphate oral tablet dispersible

NP

PREDNISONE INTENSOL NP

prednisone oral solution PG

prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg

PG LGC

prednisone oral tablet 50 mg PG

prednisone oral tablet therapy pack PG

RAYOS NC

TAPERDEX 12-DAY NC

TAPERDEX 6-DAY NC

UCERIS ORAL NP ST; #; QL



09/01/201877


VERIPRED 20 NP

*COUGH/COLD/ALLERGY*

acetylcysteine inhalation PG

ALAVERT ALLERGY/SINUS PG Select OTC

ALLEGRA-D ALLERGY & CONGESTION PG Select OTC

benzonatate PG

cetirizine-pseudoephedrine er PG Select OTC

CLARINEX-D 12 HOUR NP QL

CLARITIN-D 12 HOUR PG Select OTC

CLARITIN-D 24 HOUR PG Select OTC

fexofenadine-pseudoephed er oral tablet extended release 24 hour

PG Select OTC

guaifenesin ac NC

guaifenesin-codeine oral syrup NC

hydrocod polst-cpm polst er oral suspension extended release

NP QL

hydrocodone-homatropine PG

loratadine-d 12hr PG Select OTC

loratadine-d 24hr PG Select OTC

NEBUSAL INHALATION NEBULIZATION SOLUTION 3 %

PG

promethazine vc PG

promethazine vc/codeine PG

promethazine-dm PG

pseudoeph-chlorphen-hydrocod NP

SEMPREX-D NP

sodium chloride inhalation nebulization solution10 %, 3 %

PG

SSKI PB

TESSALON PERLES NP

TUSNEL C NC

TUSSICAPS NP QL

TUSSIONEX PENNKINETIC ER ORAL SUSPENSION EXTENDED RELEASE

NP QL

ZYRTEC-D ALLERGY & CONGESTION PG Select OTC



09/01/201878


*CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS***

IBRANCE NPS PA; SP; QL

KISQALI 200 DOSE NPS PA; SP; QL



VERZENIO NPS PA; SP; QL

*CYSTIC FIBROSIS AGENT - COMBINATIONS***

ORKAMBI ORAL TABLET NPS PA; QL

SYMDEKO NPS PA; SP; QL

*DERMATOLOGICALS*

ABREVA PG Select OTC

ABSORICA NC

ACANYA NC #

acitretin PG QL

acyclovir external NP

ACZONE NP ST; QL

adapalene external cream NP PA; AL

adapalene external gel 0.1 % NC

adapalene external gel 0.3 % NP PA; AL

adapalene external lotion NP PA; AL

adapalene-benzoyl peroxide PG PA; AL

AKTIPAK NP

ALA-QUIN NC

alclometasone dipropionate PG

ALCORTIN A NC

ALDARA NP QL

ALTABAX NP

amcinonide NP

AMELUZ NP

AMNESTEEM NP PA; QL

APEXICON E NP

ASTERO NC

ATRALIN NC



09/01/201879


AVAR CLEANSER NC

AVAR LS CLEANSER NC

avar-e emollient NC

avar-e green NC

AVAR-E LS NC

avita PG PA; AL

AZELEX NP

BACTROBAN EXTERNAL CREAM NP QL

bensal hp NC

BENZACLIN NC

BENZACLIN WITH PUMP NC

BENZAMYCIN NP

benzoyl peroxide-erythromycin PG

betamethasone dipropionate aug external cream PG

betamethasone dipropionate aug external gel PG QL

betamethasone dipropionate aug external lotion PG QL

betamethasone dipropionate aug external ointment

PG QL

betamethasone valerate external NP

bp 10-1 NC

calcipotriene external cream NP ST

calcipotriene external ointment NP ST

calcipotriene external solution NP

calcipotriene-betameth diprop NC

calcitrene NP ST

calcitriol external NP

CAPEX NC

CARAC NC

CEM-UREA NC

CENTANY NP QL

CICLODAN EXTERNAL SOLUTION PG

CICLODAN SOLUTION NC

ciclopirox external gel NP

ciclopirox external shampoo NP

ciclopirox external solution PG



09/01/201880


ciclopirox olamine external cream PG

ciclopirox treatment NC

claravis NP PA; QL

CLEOCIN-T NP

CLINDACIN ETZ EXTERNAL KIT NC

CLINDACIN PAC NC

CLINDAGEL NP

clindamycin phos-benzoyl perox NC

clindamycin phosphate external NP

clindamycin-tretinoin NP PA; AL

clobetasol propionate e NP QL

clobetasol propionate emulsion NP QL

clobetasol propionate external NP QL

CLOBEX NP QL

CLOBEX SPRAY NP QL

clocortolone pivalate NP

clodan external shampoo NP QL

CLODERM NP

CLODERM PUMP NP

clotrimazole-betamethasone external cream PG

coal tar external solution PG

CONDYLOX EXTERNAL GEL NP

CORDRAN EXTERNAL CREAM NP QL

CORDRAN EXTERNAL LOTION NP QL

CORDRAN EXTERNAL OINTMENT NP QL

CORDRAN EXTERNAL TAPE NP #; QL

CORTISPORIN EXTERNAL OINTMENT PB

COSENTYX NPS PA; ST; SP

COSENTYX SENSOREADY PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML

NPS PA; ST; SP

CROTAN PG

CUTIVATE EXTERNAL LOTION NP

dapsone external PG QL

DENAVIR NP



09/01/201881


DERMA-SMOOTHE/FS BODY PB

DERMA-SMOOTHE/FS SCALP PB

DESONATE NP #

desonide external NP

DESOWEN EXTERNAL CREAM NP

DESOWEN EXTERNAL LOTION NP

desoximetasone external cream NP

desoximetasone external gel NP

desoximetasone external liquid NC

desoximetasone external ointment NP

diclofenac sodium transdermal gel 1 % PG QL

diclofenac sodium transdermal gel 3 % NC

diclofenac sodium transdermal solution NC

DICLOFEX DC NC

DIFFERIN EXTERNAL CREAM NP PA; AL

DIFFERIN EXTERNAL GEL 0.1 % PG PA; Select OTC; AL

DIFFERIN EXTERNAL GEL 0.3 % NP PA; ST; AL

DIFFERIN EXTERNAL LOTION NP PA; ST; AL

diflorasone diacetate external NP

DIPROLENE NP QL

DIPROLENE AF NP

DOVONEX EXTERNAL CREAM NP ST

doxepin hcl external NP QL

doxycycline NC

DUAC NC

econazole nitrate external NP QL

ECOZA NC

EFUDEX EXTERNAL CREAM NC

ELIDEL NP PA; ST; #

ELIMITE NP

ELOCON EXTERNAL CREAM NP

ELOCON EXTERNAL OINTMENT NP

ENSTILAR NP QL

EPIDUO PB PA; AL

EPIDUO FORTE PB PA; #; AL



09/01/201882


ERTACZO NC

ery PG

erythromycin external pad PG

erythromycin external solution PG

EURAX NP

EVOCLIN NP

EXELDERM NC

EXTINA NC

FABIOR NP PA; ST; AL

FINACEA EXTERNAL FOAM NP

FINACEA EXTERNAL GEL NP #

FLECTOR NC #

fluocinolone acetonide body PG

fluocinolone acetonide external cream NP

fluocinolone acetonide external ointment NP

fluocinolone acetonide scalp PG

fluocinonide external cream NP ST; QL

fluocinonide external gel NP QL

fluocinonide external ointment NP QL

fluocinonide external solution PG QL

FLUOROPLEX NC

fluorouracil external cream 0.5 % NC

fluorouracil external cream 5 % PG

fluorouracil external solution PG

flurandrenolide NP QL

fluticasone propionate external cream NP

fluticasone propionate external lotion NP

fluticasone propionate external ointment PG

gentamicin sulfate external PG

GORDONS UREA EXTERNAL OINTMENT 22 %

NC

halobetasol propionate NP QL

HALOG NP

hydrocortisone ace-pramoxine external cream2.5-1 %

NC



09/01/201883


hydrocortisone acetate NC

hydrocortisone butyr lipo base PG

hydrocortisone butyrate external cream PG

hydrocortisone butyrate external lotion NP

hydrocortisone butyrate external ointment PG

hydrocortisone butyrate external solution PG

hydrocortisone external cream 2.5 % PG

hydrocortisone external lotion 2.5 % PG

hydrocortisone external ointment 2.5 % PG

hydrocortisone valerate PG

imiquimod external PG QL

IMPOYZ NC

JUBLIA NP PA; ST

KENALOG EXTERNAL NP

KERALYT EXTERNAL GEL 6 % NP

ketoconazole external foam NC

KLARON NP

KLOFENSAID II NC

lactic acid external lotion NP

LDO PLUS NC

LEVULAN KERASTICK NP QL

lidocaine external ointment NP PA; QL

lidocaine external patch 5 % NP PA; ST; QL

lidocaine hcl external solution PG

lidocaine pak NP PA; QL

lidocaine-prilocaine external cream PG PA; QL

lidocaine-tetracaine PG QL

LIDODERM NP PA; ST; QL

lindane external shampoo PB

LOCOID EXTERNAL CREAM NP

LOCOID EXTERNAL LOTION NC #

LOCOID LIPOCREAM NP

LOPROX EXTERNAL KIT 0.77 % NC

LOPROX EXTERNAL SHAMPOO NP

LOTRISONE EXTERNAL CREAM NP



09/01/201884


luliconazole NC

LUXIQ NP

LUZU NC

malathion external PG

methoxsalen rapid PG

METROCREAM NP

METROGEL EXTERNAL GEL NP

METROLOTION NP

metronidazole external cream PG

metronidazole external gel 0.75 % PG

metronidazole external gel 1 % NP

metronidazole external lotion PG

MICORT-HC NC

MIRVASO NC

mometasone furoate external cream NP

mometasone furoate external ointment NP

mometasone furoate external solution PG

mupirocin calcium PG QL

mupirocin external PG QL

myorisan oral capsule 10 mg, 20 mg, 40 mg NP PA; QL

MYORISAN ORAL CAPSULE 30 MG NP PA; QL

naftifine hcl external cream 1 % NP

naftifine hcl external cream 2 % NC

NAFTIN EXTERNAL CREAM 2 % NC

NAFTIN EXTERNAL GEL 1 % NC

NAFTIN EXTERNAL GEL 2 % NC #

napro external NC

NATROBA NP

NEO-SYNALAR EXTERNAL CREAM NP

NEUAC EXTERNAL GEL NC

NOLIX EXTERNAL LOTION NP QL

NORITATE NP

NUCORT NC

nystatin external cream PG

nystatin external ointment PG



09/01/201885


nystatin-triamcinolone PG

OLUX NP QL

OLUX-E NP QL

ONEXTON NC #

ORACEA NC

OVACE WASH NP

OVIDE NP

oxiconazole nitrate NC

OXISTAT NC

OXSORALEN ULTRA NP

PANDEL NP

PANRETIN PB

PENLAC NP PA; ST

PENNSAID TRANSDERMAL SOLUTION 2 %

NC

permethrin external cream PG

PICATO PB QL

PLEXION NC

PLEXION CLEANSER EXTERNAL LIQUID

NC

PLEXION CLEANSING CLOTH EXTERNAL PAD

NC

podocon NP

podofilox external PG

PRAMOSONE EXTERNAL CREAM 1-1 % NP

PRAMOSONE EXTERNAL LOTION NP

prednicarbate NP

PROTOPIC NP PA; ST

PRUDOXIN NP QL

psorcon NP

REGRANEX NP PA; QL

RETIN-A NP PA; ST; AL

RETIN-A MICRO NP PA; ST; AL

RETIN-A MICRO PUMP NP PA; ST; AL

RHOFADE NP QL



09/01/201886


ROSADAN EXTERNAL CREAM PG

ROSADAN EXTERNAL GEL NP

ROSADAN EXTERNAL KIT NC

ROSANIL CLEANSER NC

rynoderm NC

SALEX EXTERNAL SHAMPOO NP

salicylic acid external cream NP

salicylic acid external gel NP

salicylic acid external liquid NP

salicylic acid external lotion NP

salicylic acid external shampoo NP

SANTYL NP QL

seb-prev wash NP

selenium sulfide external lotion PG

selenium sulfide external shampoo 2.25 % NC

SELRX NC

SELSUN BLUE MEDICATED NC

SERNIVO NP

SILIQ NPS PA; ST; SP; QL

SILVADENE NP

silver nitrate external NP

silver sulfadiazine external PG

sodium sulfacetamide external shampoo NP

SOOLANTRA NP ST

SORIATANE ORAL CAPSULE 10 MG, 25 MG

NP QL

SORILUX NC

spinosad PG

sss 10-5 NC

STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PSP PA; ST; SP; QL

sulfacetamide sodium external gel NP

sulfacetamide sodium external liquid NP

sulfacetamide sodium-sulfur external cream NC

sulfacetamide sodium-sulfur external emulsion NC



09/01/201887


sulfacetamide sodium-sulfur external liquid 10-2 %, 9.8-4.8 %

NC

sulfacetamide sodium-sulfur external lotion NC

sulfacetamide sodium-sulfur external pad 10-4 % NC

sulfacetamide sodium-sulfur external suspension NC

sulfacetamide sod-sulfur wash external kit NC

sulfacetamide-sulfur in urea external emulsion PG

sulfacleanse 8/4 NC

SULFAMYLON NP

SUMADAN NC

SUMADAN XLT NC

SUMAXIN NC

SUMAXIN CP NC

SUMAXIN TS NC

SYNALAR NP

SYNALAR (CREAM) NC

SYNALAR (OINTMENT) NC

SYNALAR TS NC

SYNERA NP QL

TACLONEX EXTERNAL OINTMENT NC

TACLONEX EXTERNAL SUSPENSION NP QL

tacrolimus external NP PA; ST

TALTZ NPS PA; ST; SP

TARGRETIN EXTERNAL PSP SP

tazarotene external PG PA; AL

TAZORAC NP PA; ST; AL

TEMOVATE EXTERNAL CREAM NP QL

TEMOVATE EXTERNAL OINTMENT NP QL

TOLAK NC #

TOPICORT EXTERNAL CREAM NP

TOPICORT EXTERNAL GEL NP

TOPICORT EXTERNAL OINTMENT NP

TOPICORT SPRAY NC

TREMFYA PSP PA; ST; SP; QL

tretinoin external cream PG PA; AL



09/01/201888


tretinoin external gel 0.01 %, 0.025 % PG PA; AL

tretinoin external gel 0.05 % NP PA

tretinoin microsphere PG PA; AL

tretinoin microsphere pump PG PA; AL

triamcinolone acetonide external aerosol solution

PG

triamcinolone acetonide external cream PG LGC

triamcinolone acetonide external ointment PG LGC

TRIDERM EXTERNAL CREAM PG

TRIDESILON NP

ULESFIA NP QL

ULTRAVATE NP QL

ULTRAVATE X (CREAM) NC

ULTRAVATE X (OINTMENT) NC

UTOPIC NC

VALCHLOR NPS PA; SP; QL

VANOS NC

VANOXIDE-HC NP

VECTICAL NP

VELTIN NP PA; ST; AL

VENIPUNCTURE CPI NC

VERDESO NC

VEREGEN NP

VOLTAREN TRANSDERMAL PB QL

XELITRAL NC

XERESE NP

XOLEGEL NC

zenatane oral capsule 10 mg, 20 mg, 40 mg NP PA; QL

ZENATANE ORAL CAPSULE 30 MG NP PA; QL

ZIANA NP PA; ST; AL

ZONALON NP QL

ZOVIRAX EXTERNAL CREAM NP

ZOVIRAX EXTERNAL OINTMENT NC

ZYCLARA NC #



09/01/201889


ZYCLARA PUMP EXTERNAL CREAM 2.5 %

NC

ZYCLARA PUMP EXTERNAL CREAM 3.75 %

NC #

*DIAGNOSTIC PRODUCTS*

ACCU-CHEK AVIVA PLUS IN VITRO NC

ACCU-CHEK COMPACT PLUS NC

ACCU-CHEK SMARTVIEW NC

ACCUTREND GLUCOSE NC

ADVANCE INTUITION TEST NC

ADVANCE MICRO-DRAW TEST NC

ADVOCATE REDI-CODE IN VITRO NC

ADVOCATE REDI-CODE+ TEST NC

ADVOCATE TEST NC

AGAMATRIX AMP TEST NC

AGAMATRIX JAZZ TEST NC

AGAMATRIX KEYNOTE TEST NC

AGAMATRIX PRESTO TEST NC

ASSURE 3 TEST NC

ASSURE 4 TEST NC

ASSURE II NC

ASSURE II CHECK NC

ASSURE PLATINUM NC

ASSURE PRISM MULTI TEST NC

ASSURE PRO TEST NC

BAYER BREEZE 2 TEST NC

BAYER CONTOUR TEST NC

BIOSCANNER GLUCOSE TEST NC

blood glucose test NC

CARESENS N GLUCOSE TEST NC

CLEVER CHEK AUTO-CODE TEST NC

CLEVER CHEK AUTO-CODE VOICE IN VITRO

NC

CLEVER CHEK TEST NC

CLEVER CHOICE AUTO-CODE TEST NC



09/01/201890


CLEVER CHOICE MICRO TEST NC

COOL BLOOD GLUCOSE TEST STRIPS NC

CVS ADVANCED GLUCOSE TEST NC

diatrue plus test NC

DUO-CARE TEST NC

easy plus blood glucose test NC

EASY STEP TEST NC

easy talk blood glucose test NC

EASY TOUCH TEST NC

easy trak blood glucose test NC

EASYGLUCO IN VITRO NC

EASYGLUCO PLUS IN VITRO NC

EASYMAX 15 TEST NC

EASYMAX TEST NC

easyplus blood glucose test NC

EASYPRO BLOOD GLUCOSE TEST NC

EASYPRO PLUS IN VITRO NC

element compact test NC

ELEMENT TEST NC

EMBRACE BLOOD GLUCOSE TEST NC

EMBRACE EVO BLOOD GLUCOSE TEST NC

EMBRACE PRO GLUCOSE TEST NC

EVENCARE BLOOD GLUCOSE TEST NC

EVENCARE G2 TEST NC

EVENCARE G3 TEST NC

EVENCARE MINI GLUCOSE TEST NC

EVOLUTION AUTOCODE IN VITRO NC

EZ SMART BLOOD GLUCOSE TEST NC

EZ SMART PLUS GLUCOSE TEST NC

FIFTY50 GLUCOSE TEST 2.0 NC

FORA D15G BLOOD GLUCOSE TEST NC

FORA D20 BLOOD GLUCOSE TEST NC

FORA D40/G31 BLOOD GLUCOSE NC

FORA G20 BLOOD GLUCOSE TEST NC

FORA G30/PREM V10 GLUCOSE TEST NC



09/01/201891


FORA GD20 TEST NC

FORA GD50 BLOOD GLUCOSE TEST NC

FORA TN'G/TN'G VOICE NC

FORA V10 BLOOD GLUCOSE TEST NC



FORA V30A BLOOD GLUCOSE TEST NC

FORACARE GD40 TEST NC

FORACARE PREMIUM V10 TEST NC

FORACARE TEST N GO TEST NC

FORTISCARE TEST NC

FREESTYLE INSULINX TEST PB QL

FREESTYLE LITE TEST PB QL

FREESTYLE PRECISION NEO TEST PB QL

FREESTYLE TEST PB QL

ge100 blood glucose test NC

GENSTRIP 50 NC

ght test NC

GLUCO PERFECT 3 TEST NC

GLUCOCARD 01 SENSOR PLUS NC

GLUCOCARD EXPRESSION TEST NC

GLUCOCARD SHINE TEST NC

GLUCOCARD VITAL TEST NC

GLUCOCARD X-SENSOR NC

GLUCOCOM TEST NC

GLUCONAVII BLOOD GLUCOSE TEST NC

IN TOUCH BLOOD GLUCOSE TEST NC

INFINITY BLOOD GLUCOSE TEST NC

kroger blood glucose test NC

kroger test NC

LIBERTY NEXT GENERATION TEST NC

liberty test NC

meijer blood glucose test NC

MEIJER TRUETEST TEST NC

MEIJER TRUETRACK TEST NC



09/01/201892


MICRODOT TEST NC

MYGLUCOHEALTH TEST NC

NEUTEK 2TEK TEST NC

NOVA MAX GLUCOSE TEST NC

ON CALL EXPRESS BLOOD GLUCOSE NC

ON CALL PLUS BLOOD GLUCOSE NC

ON CALL VIVID BLOOD GLUCOSE NC

ONETOUCH ULTRA BLUE PB QL

ONETOUCH VERIO IN VITRO STRIP PB QL

POCKETCHEM EZ TEST NC

PRECISION PCX PB QL

PRECISION PCX PLUS TEST PB QL

PRECISION POINT OF CARE TEST PB QL

PRECISION QID TEST PB QL

PRECISION SOF-TACT TEST PB QL

PRECISION XTRA BLOOD GLUCOSE PB QL

PRODIGY NO CODING BLOOD GLUC NC

PTS PANELS GLUCOSE TEST NC

RA TRUETEST TEST NC

SMART SENSE VALUE TEST NC

SMARTEST BLOOD GLUCOSE TEST NC

SOLUS V2 TEST NC

SUPREME TEST NC

SURE EDGE TEST NC

SURECHEK BLOOD GLUCOSE TEST NC

SURE-TEST EASYPLUS MINI TEST NC

TELCARE BLOOD GLUCOSE TEST NC

THYROGEN PSP SP

TRUE METRIX BLOOD GLUCOSE TEST NC

TRUETEST TEST NC

TRUETRACK TEST NC

ULTIMA TEST NC

ULTRATRAK PRO TEST NC

ULTRATRAK ULTIMATE TEST NC

UNISTRIP1 GENERIC NC



09/01/201893


VICTORY AGM-4000 TEST NC

VOCAL POINT BLOOD GLUCOSE TEST NC

*DIGESTIVE AIDS*

CREON PB

PANCREAZE NP ST

PERTZYE NP ST

SUCRAID NPS SP

VIOKACE NP ST

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT, 15000-47000 UNIT, 20000-63000 UNIT, 25000-79000 UNIT, 3000-14000 UNIT, 40000-126000 UNIT, 5000-24000 UNIT

PB

*DIRECT-ACTING P2Y12 INHIBITORS***

BRILINTA PB QL

*DIURETICS*

acetazolamide er NC

acetazolamide oral PG

ALDACTAZIDE NP

ALDACTONE NP

amiloride hcl oral PG

amiloride-hydrochlorothiazide PG LGC

bumetanide oral PG

CAROSPIR NC

chlorothiazide oral PG

chlorthalidone oral tablet 25 mg, 50 mg PG

DEMADEX ORAL TABLET 10 MG, 20 MG NP

DIURIL NP

DYAZIDE NP

DYRENIUM NP

EDECRIN NP

ethacrynic acid oral NP

furosemide oral tablet PG LGC

hydrochlorothiazide oral capsule PG LGC

hydrochlorothiazide oral tablet 12.5 mg PG

hydrochlorothiazide oral tablet 25 mg, 50 mg PG LGC



09/01/201894


indapamide oral PG

KEVEYIS NPS PA; QL

LASIX NP

MAXZIDE NP

MAXZIDE-25 NP

methazolamide oral PG

methyclothiazide oral NP

metolazone PG

MICROZIDE NP

spironolactone oral tablet 100 mg, 50 mg PG

spironolactone oral tablet 25 mg PG LGC

spironolactone-hctz PG

torsemide oral PG

triamterene-hctz oral capsule 37.5-25 mg PG LGC

triamterene-hctz oral tablet PG LGC

*ENDOCRINE AND METABOLIC AGENTS - MISC.*

ACTONEL ORAL TABLET 150 MG, 30 MG, 35 MG, 5 MG

NP ST; QL

ALDURAZYME NPS PA; SP

alendronate sodium oral solution PG

alendronate sodium oral tablet 10 mg, 35 mg, 40 mg, 5 mg

PG QL

alendronate sodium oral tablet 70 mg PG LGC; QL

AMMONUL NPS SP

ATELVIA NP QL

BINOSTO NC

BONIVA INTRAVENOUS NPS SP

BONIVA ORAL TABLET 150 MG NP ST; QL

BUPHENYL ORAL POWDER 3 GM/TSP NPS PA; SP

BUPHENYL ORAL TABLET NPS PA; SP; QL

cabergoline PG

calcitonin (salmon) PG QL

calcitriol oral capsule PG

CARBAGLU NPS PA; #; SP



09/01/201895


CARNITOR ORAL SOLUTION NP

CARNITOR SF NP

CYSTADANE NPS PA; SP

DDAVP INJECTION SOLUTION 4 MCG/ML

NC

DDAVP NASAL NP

DDAVP ORAL NP

DDAVP RHINAL TUBE NP

desmopressin ace spray refrig PG

desmopressin acetate injection NC

desmopressin acetate oral PG

desmopressin acetate spray PG

doxercalciferol intravenous NC

doxercalciferol oral PG QL

ELAPRASE PSP PA; SP

etidronate disodium NP

EVISTA NP

FABRAZYME NPS PA; SP

FORTEO SUBCUTANEOUS SOLUTION 600 MCG/2.4ML

NPS PA; ST; SP

FOSAMAX ORAL TABLET 70 MG NP QL

FOSAMAX PLUS D NP QL

GENOTROPIN NPS PA; ST; SP

GENOTROPIN MINIQUICK NPS PA; ST; SP

HECTOROL INTRAVENOUS NC

HP ACTHAR NPS PA; SP

HUMATROPE NPS PA; ST; SP

ibandronate sodium intravenous solution 3 mg/3ml

PG SP

ibandronate sodium oral NP ST; QL

INCRELEX PSP PA; SP

JYNARQUE PSP PA; SP

KUVAN NPS PA; SP

levocarnitine oral solution PG

LUMIZYME NPS PA; SP



09/01/201896


LUPRON DEPOT-PED (1-MONTH) NPS PA; #; SP

LUPRON DEPOT-PED (3-MONTH) NPS PA; #; SP

MIACALCIN NASAL NP ST; QL

NAGLAZYME NPS PA; SP

NATPARA NPS PA; QL

NITYR NPS PA; SP

NOCTIVA PB QL; AL

NORDITROPIN FLEXPRO NPS PA; ST; SP

NUTROPIN AQ NUSPIN 10 NPS PA; ST; SP



octreotide acetate injection solution 100 mcg/ml, 1000 mcg/ml, 200 mcg/ml, 50 mcg/ml, 500 mcg/ml

PG PA; SP

OMNITROPE PSP PA; SP

ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG

NPS PA; SP

ORFADIN ORAL CAPSULE 20 MG NPS PA

ORFADIN ORAL SUSPENSION NPS PA; SP

ORILISSA NPS PA; SP; QL

OSPHENA NP QL

PALYNZIQ NPS PA; ST; SP; QL

pamidronate disodium PG SP

paricalcitol intravenous NC

paricalcitol oral PG QL

PROLIA NPS PA; ST; SP

raloxifene hcl PG

RAVICTI NPS PA; ST; SP; QL

RAYALDEE NP PA; ST; QL

RECLAST NPS SP

risedronate sodium oral tablet 150 mg NP ST; QL

risedronate sodium oral tablet 30 mg, 35 mg, 5 mg

NP QL

risedronate sodium oral tablet delayed release NP QL

ROCALTROL NP

SAIZEN NPS PA; ST; SP



09/01/201897


SAMSCA PSP PA; #; SP; QL

SANDOSTATIN INJECTION SOLUTION 100 MCG/ML, 50 MCG/ML, 500 MCG/ML

NPS PA; SP

SANDOSTATIN LAR DEPOT NPS PA; #; SP

SENSIPAR NP PA; #; QL

SEROSTIM SUBCUTANEOUS SOLUTION RECONSTITUTED 4 MG, 5 MG, 6 MG

NPS PA; SP

SIGNIFOR NPS PA; SP; QL

sod benz-sod phenylacet PG

sodium phenylbutyrate oral powder 3 gm/tsp PSP PA; SP

sodium phenylbutyrate oral tablet PSP PA; SP; QL

SOMATULINE DEPOT NPS PA; SP

SOMAVERT NPS PA; #; SP

STIMATE NP PA

SUPPRELIN LA PSP PA; SP

SYNAREL NPS PA; SP

TRIPTODUR NPS PA; SP

TYMLOS PSP PA; ST; SP; QL

XGEVA NPS PA; ST; SP

ZEMPLAR INTRAVENOUS NC

ZEMPLAR ORAL CAPSULE 1 MCG, 2 MCG

NP ST; QL

zoledronic acid intravenous concentrate PG SP

zoledronic acid intravenous solution PG SP

ZOMACTON NPS PA; ST; SP

ZOMETA NPS SP

ZORBTIVE NPS PA; SP

*ESTROGENS*

ACTIVELLA NP QL

ALORA NP QL

AMABELZ PG QL

ANGELIQ NP

CLIMARA NP QL

CLIMARA PRO NP #; QL

COMBIPATCH NP QL



09/01/201898


DIVIGEL NP

ELESTRIN NP QL

ESTRACE ORAL NP

estradiol oral PG LGC

estradiol transdermal PG QL

estradiol valerate intramuscular oil 20 mg/ml PG

estradiol-norethindrone acet PG QL

ESTROGEL NP QL

EVAMIST NP QL

FEMHRT LOW DOSE NP

FYAVOLV PG

jevantique lo PG

JINTELI PG

MENEST ORAL TABLET 0.3 MG, 0.625 MG

PB

MENEST ORAL TABLET 1.25 MG NP

MENOSTAR NP #; QL

MIMVEY PG QL

MIMVEY LO PG QL

MINIVELLE NP #; QL

norethindrone-eth estradiol PG

PREFEST NP QL

PREMARIN ORAL PB

PREMPHASE PB

PREMPRO PB

VIVELLE-DOT NP QL

*ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB***

DUAVEE PB QL

*FARNESOID X RECEPTOR (FXR) AGONISTS***

OCALIVA ORAL TABLET 5 MG NPS PA; ST; SP; QL

*FLUOROQUINOLONES*

AVELOX ORAL NP

BAXDELA ORAL NP PA; QL



09/01/201899


CIPRO ORAL SUSPENSION RECONSTITUTED

NP

CIPRO ORAL TABLET 250 MG, 500 MG NP

CIPRO XR NP

ciprofloxacin hcl oral tablet 100 mg, 750 mg PG

ciprofloxacin hcl oral tablet 250 mg, 500 mg PG LGC

ciprofloxacin oral suspension reconstituted 500 mg/5ml (10%)

PG

ciprofloxacin-ciproflox hcl er PG

LEVAQUIN ORAL TABLET NP

levofloxacin oral PG

moxifloxacin hcl oral PG

ofloxacin oral tablet 300 mg PG QL

ofloxacin oral tablet 400 mg PG

*GASTROINTESTINAL AGENTS - MISC.*

ACTIGALL NP

alosetron hcl PG PA; ST

AMITIZA NP ST; QL

APRISO NP #; QL

ASACOL HD NP ST; QL

AZULFIDINE NP QL

AZULFIDINE EN-TABS NP QL

balsalazide disodium PG QL

CANASA PB #; QL

CHENODAL NP PA

CIMZIA PREFILLED NPS PA; ST; SP; QL

CIMZIA STARTER KIT NPS PA; ST; SP; QL

CIMZIA SUBCUTANEOUS KIT 2 X 200 MG

NPS PA; ST; SP; QL

COLAZAL NP ST; QL

DELZICOL PB #; QL

DIPENTUM NP ST; QL

enulose PG LGC

FOSRENOL ORAL PACKET NP

FOSRENOL ORAL TABLET CHEWABLE 1000 MG, 500 MG, 750 MG

NP



09/01/2018100


GATTEX NPS PA; SP; QL

INFLECTRA PSP PA; ST; SP

lactulose encephalopathy PG LGC

lanthanum carbonate NP

LIALDA PB QL

LINZESS PB QL

LOTRONEX NP PA; ST

mesalamine oral PG QL

mesalamine rectal PG

metoclopramide hcl oral solution 5 mg/5ml PG LGC

metoclopramide hcl oral tablet 10 mg PG LGC

metoclopramide hcl oral tablet 5 mg PG

metoclopramide hcl oral tablet dispersible PG

MOVANTIK PB QL

PENTASA PB QL

PHOSLO NP

REGLAN ORAL NP

RELISTOR ORAL NP PA; #; QL

RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6ML, 8 MG/0.4ML

NP PA; QL

REMICADE PSP PA; ST; SP

RENAGEL ORAL TABLET 800 MG NP #

RENFLEXIS PSP PA; ST; SP

RENVELA PB

sevelamer carbonate PG

SFROWASA NP

sulfasalazine oral PG QL

SULFAZINE PG QL

SYMPROIC NP PA; ST; QL

URSO 250 NP

URSO FORTE NP

ursodiol oral capsule PG

ursodiol oral tablet NP

VELPHORO NP #



09/01/2018101


*GENITOURINARY AGENTS - MISCELLANEOUS*

acetic acid irrigation PG

alfuzosin hcl er PG QL

AVODART NP QL

CARDURA XL NP QL

CYSTAGON NP PA

cytra-2 NC

CYTRA-3 PG

cytra-k PG

dutasteride oral PG QL

dutasteride-tamsulosin hcl PG

ELMIRON PB QL

finasteride oral tablet 5 mg PG PA

FLOMAX NP

JALYN NP

PHENAZO ORAL TABLET 200 MG PG

phenazopyridine hcl oral tablet 100 mg, 200 mg PG

potassium citrate er PG

PROCYSBI NPS PA; ST; SP; QL

PROSCAR NP PA

PYRIDIUM ORAL TABLET 100 MG NP

RAPAFLO PB #

SHOHLS MODIFIED NC

sod citrate-citric acid NC

tamsulosin hcl PG LGC

THIOLA NPS PA; ST

tricitrates PG

UROCIT-K 10 NP

UROCIT-K 15 NP

UROCIT-K 5 NP

UROXATRAL NP QL

*GOUT AGENTS*

allopurinol oral PG LGC

colchicine oral PG QL



09/01/2018102


colchicine-probenecid PG

COLCRYS NC

DUZALLO NP PA; ST; QL

KRYSTEXXA NPS PA; ST; SP

MITIGARE NP QL

probenecid oral PG

ULORIC NP QL

ZURAMPIC NP PA; ST; QL

ZYLOPRIM NP

*HEMATOLOGICAL AGENTS - MISC.*

ADVATE PSP PA; SP

adynovate intravenous solution reconstituted1000 unit, 2000 unit, 250 unit, 500 unit

NPS PA

adynovate intravenous solution reconstituted1500 unit, 3000 unit, 750 unit

NPS PA; SP

AFSTYLA NPS PA; SP

AGGRENOX NP

AGRYLIN NP

ALPHANATE/VWF COMPLEX/HUMAN NPS PA; SP

ALPHANINE SD NPS PA; SP

ALPROLIX NPS PA; SP

anagrelide hcl PG

aspirin-dipyridamole er PG

BEBULIN NPS PA; SP

BENEFIX INTRAVENOUS KIT PSP PA; SP

BERINERT NPS PA; ST; SP

BRILINTA PB QL

cilostazol PG

CINRYZE NPS PA; ST; SP; QL

clopidogrel bisulfate oral PG QL

COAGADEX NPS PA

CORIFACT NPS PA; SP

dipyridamole oral PG

DURLAZA NP

EFFIENT NP PA; QL



09/01/2018103


ELOCTATE NPS PA; SP

FEIBA PSP PA; SP

FIBRYGA PSP PA; SP

FIRAZYR NPS PA; ST; #; SP; QL

HAEGARDA PSP PA; ST; SP; QL

HELIXATE FS NPS PA; SP

HEMOFIL M INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 1700 UNIT, 250 UNIT, 500 UNIT

NPS PA; SP

HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED 1000-2400 UNIT, 500-1200 UNIT

NPS PA; SP

IDELVION NPS PA; SP

IXINITY NPS PA; SP

KALBITOR NPS PA; ST; SP

KCENTRA NPS PA

KOATE NPS PA; SP

KOATE-DVI NPS PA; SP

KOGENATE FS NPS PA; SP

KOGENATE FS BIO-SET INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 3000 UNIT

NPS PA; SP

KOVALTRY NPS PA; SP

MONOCLATE-P INTRAVENOUS KIT 1000 UNIT, 1500 UNIT

PSP PA; SP

MONONINE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT

PSP PA; SP

NOVOEIGHT NPS PA; SP

NOVOSEVEN RT PSP PA; SP

NUWIQ NPS PA; SP

pentoxifylline er PG

PLAVIX NP QL

prasugrel hcl NP PA; QL

PROFILNINE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 500 UNIT

NPS PA; SP

PROFILNINE INTRAVENOUS SOLUTION RECONSTITUTED 1500 UNIT

NPS PA



09/01/2018104


PROFILNINE SD NPS PA; SP

REBINYN NPS PA; SP

RECOMBINATE NPS PA; SP

RIASTAP PSP PA; SP

RIXUBIS NPS PA; SP

RUCONEST NPS PA; SP

TRETTEN NPS PA; SP

VONVENDI NPS PA

WILATE INTRAVENOUS KIT NPS PA; SP

XYNTHA INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 500 UNIT

NPS PA; SP

XYNTHA SOLOFUSE NPS PA; SP

YOSPRALA NC

*HEMATOPOIETIC AGENTS*

ABANEU-SL NC

active fe NC

AIRAVITE NC

ANIMI-3 NC

ANIMI-3/VITAMIN D NC

ARANESP (ALBUMIN FREE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML, 60 MCG/ML

PSP PA; SP

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 100 MCG/0.5ML, 150 MCG/0.3ML, 200 MCG/0.4ML, 25 MCG/0.42ML, 300 MCG/0.6ML, 40 MCG/0.4ML, 500 MCG/ML, 60 MCG/0.3ML

PSP PA; SP

av-vite fb NC

b-6 folic acid NC

BIFERARX NC

bp vit 3 NC

CENFOL NC

CENTRATEX NC

CERDELGA PSP PA; SP; QL



09/01/2018105


CEREZYME INTRAVENOUS SOLUTION RECONSTITUTED 400 UNIT

PSP PA; SP

CIFEREX NC

CORVITA 150 NC

CORVITE 150 ORAL TABLET 150-1.25 MG NC

cyanocobalamin injection PG

DIVISTA NC

DOPTELET ORAL TABLET 20 MG NPS PA; SP; QL

durachol NC

ELELYSO NPS PA; SP

EPOGEN INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML

NPS PA; SP

fabb NC

fa-vitamin b-6-vitamin b-12 NC

FERIVA 21/7 NC

ferocon NC

ferotrinsic NC

ferraplus 90 NC

FERRLECIT NPS SP

FERROCITE PLUS ORAL TABLET NC

FERRO-PLEX HEMATINIC NC

FERROTRIN NC

folbee NC

FOLGARD RX NC

folic acid oral capsule 20 mg PG

folic acid oral tablet 1 mg CE LGC

folic acid oral tablet 400 mcg PG

FOLIVANE-F NC

FOLIVANE-PLUS NC

folplex 2.2 NC

foltrin NC

FULPHILA PSP PA; SP

FUSION PLUS NC

gnp folic acid PG



09/01/2018106


GRANIX NPS PA; ST; SP

hematinic plus vit/minerals NC

hematinic/folic acid NC

HEMATOGEN FA NC

HEMATOGEN FORTE NC

hemetab NC

HEMOCYTE PLUS NC

HEMOCYTE-F ORAL TABLET NC

hemocyte-plus oral tablet 106-1 mg NC

hm folic acid PG

INTEGRA F NC

INTEGRA PLUS NC

IROSPAN 24/6 NC

IS 24/6 NC

kp folic acid oral tablet 800 mcg CE

K-TAN PLUS NC

LEUKINE INTRAVENOUS NPS PA; SP

MAXFE ORAL TABLET NC

miglustat PSP PA; SP; QL

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 100 MCG/0.3ML, 200 MCG/0.3ML, 50 MCG/0.3ML, 75 MCG/0.3ML

NPS PA

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 150 MCG/0.3ML, 30 MCG/0.3ML

NPS PA; SP

MOZOBIL NC

MULTIGEN NC

MULTIGEN FOLIC NC

MULTIGEN PLUS NC

na ferric gluc cplx in sucrose PSP

NASCOBAL NC

NEPHRON FA NC

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PSP PA



09/01/2018107


NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6ML

NPS PA; ST; SP

NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE

NPS PA; ST

neurin-sl NC

NPLATE NPS PA; SP

NUFOL NC

ortho d NC

PROCRIT PSP PA; SP

PROFERRIN-FORTE NC

PROMACTA NPS PA; SP; QL

PROTECTIRON NC

purefe plus NC

purevit dualfe plus NC

px folic acid PG

ra folic acid oral tablet 400 mcg PG

RETACRIT PSP PA; SP

revesta NC

se-tan plus NC

SIKLOS NP PA

sm folic acid PG

TANDEM F NC

TANDEM PLUS NC

taron forte NC

tl gard rx NC

tl icon NC

TRICON NC

trigels-f forte NC

VENOFER NPS SP

VIRT-GARD NC

VPRIV PSP PA; SP

ZARXIO PSP PA

zavara NC

ZAVESCA NPS PA; #; SP; QL



09/01/2018108


*HEMOSTATICS*

AMICAR ORAL SOLUTION NP

AMICAR ORAL TABLET PB

LYSTEDA NP QL

tranexamic acid oral NP QL

*HEPATITIS C AGENT - COMBINATIONS***

EPCLUSA PSP PA; SP; QL

HARVONI PSP PA; SP

MAVYRET NPS PA; ST; SP; QL

TECHNIVIE NPS PA; ST; QL

VIEKIRA PAK NPS PA; ST; SP

VIEKIRA XR NPS PA; ST; QL

VOSEVI PSP PA; SP; QL

ZEPATIER PSP PA; SP; QL

*HEREDITARY OROTIC ACIDURIA TREATMENT - AGENTS**

XURIDEN PSP PA; SP; QL

*HYPNOTICS*

AMBIEN NP QL; AL

AMBIEN CR NP QL; AL

BUTISOL SODIUM ORAL TABLET 30 MG NP

DORAL NP

EDLUAR NC AL

estazolam PG AL

eszopiclone PG QL; AL

flurazepam hcl oral capsule 15 mg PG

flurazepam hcl oral capsule 30 mg PG AL

HALCION NP AL

HETLIOZ NPS PA; SP

INTERMEZZO NC AL

LUNESTA NP QL; AL

phenobarbital oral PG

quazepam NP



09/01/2018109


RESTORIL ORAL CAPSULE 15 MG, 30 MG

NP AL

RESTORIL ORAL CAPSULE 22.5 MG, 7.5 MG

NP QL; AL

ROZEREM NP ST; #; QL; AL

SILENOR NC AL

SONATA NP QL

temazepam oral capsule 15 mg, 30 mg PG AL

temazepam oral capsule 22.5 mg, 7.5 mg NP QL; AL

triazolam PG AL

zolpidem tartrate er NP QL; AL

zolpidem tartrate oral PG QL; AL

zolpidem tartrate sublingual NC

ZOLPIMIST NC #

*HYPOPHOSPHATASIA (HPP) AGENTS***

STRENSIQ NPS PA; SP

*IBS AGENT - MU-OPIOID RECEPTOR AGONISTS***

VIBERZI PB PA; QL

*INSULIN-INCRETIN MIMETIC COMBINATIONS***

SOLIQUA PB ST; QL

XULTOPHY PB ST; QL

*INTEGRIN RECEPTOR ANTAGONISTS***

ENTYVIO PSP PA; ST; SP

*INTERLEUKIN ANTAGONISTS***

STELARA INTRAVENOUS PSP PA; ST; SP

*INTERLEUKIN-5 ANTAGONISTS (IGG1 KAPPA)***

NUCALA NPS PA; SP; QL

*INTERLEUKIN-5 ANTAGONISTS (IGG4 KAPPA)***

CINQAIR NPS PA; SP



09/01/2018110


*ISOCITRATE DEHYDROGENASE-1 (IDH1) INHIBITORS***

TIBSOVO NPS PA; SP; QL

*ISOCITRATE DEHYDROGENASE-2 (IDH2) INHIBITORS***

IDHIFA NPS PA; SP; QL

*LAXATIVES*

CLENPIQ CE

COLYTE WITH FLAVOR PACKS ORAL SOLUTION RECONSTITUTED 240 GM

NP QL

gavilax oral packet CE

GAVILYTE-H CE

GOLYTELY NP

KRISTALOSE NP QL

lactulose oral solution 10 gm/15ml PG LGC

lactulose oral solution 20 gm/30ml PG

MIRALAX CE

MOVIPREP CE #

NULYTELY WITH FLAVOR PACKS NP

OSMOPREP CE #

peg 3350 CE

peg 3350/electrolytes CE

peg 3350-kcl-na bicarb-nacl CE

peg-3350/electrolytes CE

PEG-PREP CE

polyethylene glycol 3350 oral CE

PREPOPIK CE #

SUPREP BOWEL PREP KIT CE

TRILYTE CE

*LEPTIN ANALOGUES***

MYALEPT PSP PA; SP; QL

*LHRH/GNRH AGONIST ANALOG COMBINATIONS***

LUPANETA PACK NPS PA; SP



09/01/2018111


*LYMPHOCYTE FUNCTION-ASSOCIATED ANTIGEN-1 (LFA-1) ANTAG***

XIIDRA PB

*LYSOSOMAL ACID LIPASE (LAL) DEFICIENCY - AGENTS***

KANUMA PSP PA; SP

*MACROLIDES*

azithromycin oral packet PG

azithromycin oral suspension reconstituted PG

azithromycin oral tablet 250 mg, 500 mg, 600 mg

PG

BIAXIN ORAL TABLET 500 MG NP

clarithromycin er PG

clarithromycin oral PG

DIFICID NP QL

E.E.S. 400 ORAL TABLET NP

E.E.S. GRANULES NP

ERYPED 200 NP

ERYPED 400 NP

ERY-TAB NP

ERYTHROCIN STEARATE ORAL TABLET 250 MG

NP

erythromycin base oral tablet PG

erythromycin ethylsuccinate oral tablet PG

erythromycin stearate oral tablet 250 mg PG

ZITHROMAX ORAL NP

ZITHROMAX TRI-PAK NP

ZITHROMAX Z-PAK NP

*MEDICAL DEVICES*

ACCU-CHEK FASTCLIX LANCETS NP

ACCU-CHEK MULTICLIX LANCETS NP

ACCU-CHEK SOFT TOUCH LANCETS NP

ACCU-CHEK SOFTCLIX LANCETS NP

ACTIVE 1ST BLOOD LANCETS 30G NP

ASSURE LANCETS NP



09/01/2018112


BAYER MICROLET LANCETS NP

BD AUTOSHIELD 29G X 5MM , 29G X 8MM

PB

BD INSULIN SYRINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML, 26G X 1/2" 1 ML, 27.5G X 5/8" 2 ML, 27G X 1/2" 1 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.5 ML, 31G X 5/16" 0.3 ML, U-100 1 ML

PB

BD INSULIN SYRINGE HALF-UNIT PB

BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML

PB

BD INSULIN SYRINGE U-500 PB

BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML

PB

BD LANCET ULTRAFINE 30G NP

BD LANCET ULTRAFINE 33G NP

BD MICROTAINER LANCETS NP

BD PEN PB

BD PEN MINI PB

BD PEN NEEDLE MINI U/F PB

BD PEN NEEDLE NANO U/F PB

BD PEN NEEDLE SHORT U/F PB

BD PEN NEEDLE ULTRAFINE PB

BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.5 ML, 30G X 5/16" 0.5 ML

PB

BD SAFETY-LOK INSULIN SYRINGE PB

bullseye mini safety lancets NP

BULLSEYE SAFETY LANCETS NP

COAGUCHEK LANCETS NP

comfort assured lancets 28g NP

comfort assured lancets 33g NP

EASY TOUCH LANCETS 21G NP




09/01/2018113



EASY TOUCH LANCETS 26G/TWIST NP








EASY TOUCH LANCING DEVICE NP

EASY TOUCH SAFETY LANCETS 21G NP




EASY TWIST & CAP LANCETS NP

FC2 FEMALE CONDOM CE

FEMCAP CE

FINGERSTIX LANCETS NP

FREESTYLE LANCETS NP

FREESTYLE UNISTICK II LANCETS NP

insulin syringe PG

insulin syringe/needle PG

insulin syringe-needle u-100 31g x 1/4" 0.3 ml, 31g x 1/4" 0.5 ml, 31g x 1/4" 1 ml

PG

lancets PG

lancets super thin 28g NP

LANCETS ULTRA THIN NP

lancets ultra thin 30g NP

LIFESCAN UNISTIK 2 NP

LIFESCAN UNISTIK II LANCETS NP

lite touch lancets NP

LITETOUCH LANCETS NP

MICROLET LANCETS NP

MICROTAINER SAFETY FLOW LANCET NP

ONETOUCH CLUB LANCETS FINE PT NP



09/01/2018114


ONETOUCH COMBO PACK NP

ONETOUCH DELICA LANCETS 33G NP

ONETOUCH DELICA LANCETS FINE NP

ONETOUCH DELICA LANCING DEV NP

ONETOUCH FINEPOINT LANCETS NP

ONETOUCH ULTRASOFT LANCETS NP

pen needles PG

pen needles 1/2" PG

pen needles 3/16" PG

pen needles 5/16" PG

SAFETY LET LANCETS NP

SAFETY-GLIDE SYRINGE PB

sapscare twist top lancets NP

SIMPLE DIAGNOSTICS LANCING DEV NP

super thin lancets NP

TRUEPLUS LANCETS 26G NP

TRUEPLUS LANCETS 30G NP

TRUEPLUS SAFETY LANCETS 28G NP

VANISHPOINT INSULIN SYRINGE 30G X 3/16" 0.5 ML, 30G X 3/16" 1 ML

NP

WIDE-SEAL DIAPHRAGM 60 CE








*MIGRAINE PRODUCTS*

almotriptan malate NP QL

AMERGE NP QL

CAFERGOT PB

CAMBIA NC

D.H.E. 45 NP

dihydroergotamine mesylate injection NP



09/01/2018115


dihydroergotamine mesylate nasal NP ST; QL

eletriptan hydrobromide NP QL

ERGOMAR NP

FROVA NP QL

frovatriptan succinate NP QL

IMITREX NP QL

IMITREX STATDOSE REFILL SUBCUTANEOUS SOLUTION CARTRIDGE

NP QL

IMITREX STATDOSE SYSTEM SUBCUTANEOUS SOLUTION AUTO-INJECTOR

NP QL

MAXALT ORAL TABLET 10 MG NP QL

MAXALT-MLT NP QL

MIGRANAL NC

naratriptan hcl PG QL

ONZETRA XSAIL NP ST; QL

RELPAX NP QL

rizatriptan benzoate PG QL

sumatriptan nasal PG QL

sumatriptan succinate oral PG QL

sumatriptan succinate refill subcutaneous solution cartridge

PG QL

sumatriptan succinate subcutaneous solution 6 mg/0.5ml

PG QL

sumatriptan succinate subcutaneous solution auto-injector 4 mg/0.5ml, 6 mg/0.5ml

PG QL

sumatriptan-naproxen sodium NC

TREXIMET NC #

ZEMBRACE SYMTOUCH NP ST; QL

zolmitriptan oral PG QL

ZOMIG NP QL

ZOMIG ZMT NP QL

*MINERALS & ELECTROLYTES*

FLUORABON CE



09/01/2018116


FLURA-DROPS ORAL SOLUTION 0.55 (0.25 F) MG/DROP

CE

GALZIN NP

KLOR-CON 10 PG

KLOR-CON ORAL PACKET 20 MEQ NP QL

K-PHOS-NEUTRAL NP

K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ

NP

potassium chloride crys er oral tablet extended release 10 meq

PG LGC

potassium chloride er oral capsule extended release 10 meq

PG LGC

potassium chloride er oral capsule extended release 8 meq

PG

potassium chloride er oral tablet extended release 10 meq, 20 meq

PG

potassium chloride er oral tablet extended release 8 meq

PG LGC

potassium chloride oral packet NP QL

potassium chloride oral solution 20 meq/15ml (10%)

PG

potassium chloride oral solution 40 meq/15ml (20%)

NP

sodium fluoride oral solution CE

sodium fluoride oral tablet PG

sodium fluoride oral tablet chewable PG

*MONOBACTAMS***

AZACTAM NC

aztreonam NC

CAYSTON NPS SP; QL

*MOUTH/THROAT/DENTAL AGENTS*

cevimeline hcl PG QL

chlorhexidine gluconate mouth/throat PG

clotrimazole mouth/throat PG

DEBACTEROL NP

EVOXAC PG QL

GELCLAIR NC



09/01/2018117


lidocaine viscous PG

NEUTRASAL NC

nystatin mouth/throat PG

ORAVIG NP QL

paroex PG

periogard PG

SALAGEN NP

triamcinolone acetonide mouth/throat PG

*MUCOPOLYSACCHARIDOSIS IV (MPS IV) - AGENTS***

VIMIZIM PSP PA; SP

*MULTIPLE VITAMINS W/ MINERALS & FLUORIDE-IRON-FOLIC ACID***

QUFLORA FE NP

*MULTIVITAMINS*

CITRANATAL 90 DHA ORAL 90-1 & 300 MG

NP

CITRANATAL B-CALM NP

CITRANATAL DHA NP

CITRANATAL HARMONY ORAL CAPSULE 27-1-260 MG

NP

CITRANATAL MEDLEY NP

CITRANATAL RX NP

MYNATAL ADVANCE PG

MYNATAL ORAL TABLET PG

mynatal plus PG

mynatal-z PG

NEEVO DHA ORAL CAPSULE 27-1.13 MG NP

NESTABS NP

NICOMIDE ORAL TABLET 750-27-2-0.5 MG

NP

OB COMPLETE GOLD NP

O-CAL PRENATAL NP

OCUVEL ORAL CAPSULE 0.5 MG NP

POLY-VI-FLOR FS ORAL STRIP 1 MG CE



09/01/2018118


POLY-VI-FLOR ORAL TABLET CHEWABLE

PB

PREFERAOB ONE NP

PRENATABS RX NP

PRENATE MINI ORAL CAPSULE 18-0.6-0.4-350 MG

NP QL

QUFLORA FE PEDIATRIC NP

QUFLORA PEDIATRIC NP

SYNAGEX NC

SYNATEK NC

TRICARE PRENATAL DHA ONE ORAL CAPSULE 27-1-500 MG

NP

TRINATE PG

TRI-VI-FLOR ORAL SUSPENSION 0.25 MG/ML

PB

TRI-VI-FLOR ORAL SUSPENSION 0.5 MG/ML

NP

VINATE DHA RF NP

VITAFOL FE+ NP

VITAFOL GUMMIES NP

VITAPEARL NP

VITATRUE NP

VIVA DHA NP

*MUSCULOSKELETAL THERAPY AGENTS*

AMRIX NC #

baclofen oral tablet 10 mg PG LGC

baclofen oral tablet 20 mg, 5 mg PG

carisoprodol oral tablet 250 mg NC

carisoprodol oral tablet 350 mg PG

carisoprodol-aspirin NP

carisoprodol-aspirin-codeine NP

chlorzoxazone oral tablet 250 mg NC

chlorzoxazone oral tablet 500 mg PG

cyclobenzaprine hcl oral tablet 10 mg, 5 mg PG LGC

cyclobenzaprine hcl oral tablet 7.5 mg PG



09/01/2018119


DANTRIUM ORAL CAPSULE 25 MG, 50 MG

NP

dantrolene sodium oral PG

DUROLANE INTRA-ARTICULAR NPS PA; ST; SP

EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

PSP PA; SP

GEL-ONE INTRA-ARTICULAR PREFILLED SYRINGE

NPS PA; ST; SP

GELSYN-3 NPS PA; ST

HYALGAN NPS PA; ST; SP

HYMOVIS NPS PA; ST; SP

LORZONE NC

metaxalone NP

methocarbamol oral PG

MONOVISC PSP PA; SP

orphenadrine citrate er PG

ORTHOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

PSP PA; SP

ROBAXIN ORAL NP

SKELAXIN NP

SOMA NC

SYNVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

NPS PA; ST; SP

SYNVISC ONE INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

NPS PA; ST; SP

TIZANIDINE COMFORT PAC NC

tizanidine hcl oral capsule NC

tizanidine hcl oral tablet PG

ZANAFLEX NC

*NASAL AGENTS - SYSTEMIC AND TOPICAL*

ADRENALIN NASAL PB

ASTEPRO NASAL SOLUTION 0.15 % NP

azelastine hcl nasal solution 0.1 % PG

azelastine hcl nasal solution 0.15 % NP

BACTROBAN NASAL PB SP



09/01/2018120


BECONASE AQ NP ST

budesonide nasal NP Select OTC

DYMISTA NC

FLONASE NC

FLONASE ALLERGY RELIEF PG Select OTC

flunisolide nasal solution 25 mcg/act (0.025%) PG

fluticasone propionate nasal PG Select OTC

ipratropium bromide nasal PG QL

mometasone furoate nasal PG

NASACORT ALLERGY 24HR PG Select OTC; QL

NASACORT ALLERGY 24HR CHILDREN PG Select OTC; QL

nasal allergy 24 hour PG Select OTC; QL

NASONEX NP ST

olopatadine hcl nasal NP

OMNARIS NP ST; #

PATANASE NP

QNASL NP ST

QNASL CHILDRENS NP ST

RHINOCORT ALLERGY PG Select OTC

triamcinolone acetonide nasal aerosol PG Select OTC; QL

XHANCE NC

ZETONNA NP ST

*NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB***

ENTRESTO PB PA; QL

*NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS***

NORTHERA NPS PA; ST; SP; QL

*NEUROMUSCULAR AGENTS*

BOTOX PSP PA; ST; SP

DYSPORT NPS PA; SP

RILUTEK NP PA

riluzole PG PA

XEOMIN NPS PA; SP



09/01/2018121


*OPHTHALMIC AGENTS*

ACULAR NP

ACULAR LS NP

ACUVAIL NP

AKTEN NC

ALAWAY PG Select OTC

ALAWAY CHILDRENS ALLERGY PG Select OTC

allergy eye drops PG Select OTC

ALOCRIL NP

ALOMIDE NP

ALPHAGAN P NP

ALREX PB

altafluor NP

apraclonidine hcl PG

atropine sulfate ophthalmic PG

AZASITE NP #

azelastine hcl ophthalmic PG

AZOPT PB

bacitracin ophthalmic PG

bacitracin-polymyxin b ophthalmic ointment500-10000 unit/gm

PG

BEPREVE NP #

BESIVANCE NP

BETAGAN NP

betaxolol hcl ophthalmic PG

BETIMOL NP

BETOPTIC-S NP

bimatoprost ophthalmic NP PA; ST

bio glo NP

BLEPH-10 NP

BLEPHAMIDE NP

BLEPHAMIDE S.O.P. NP

brimonidine tartrate ophthalmic solution 0.15 % NP

brimonidine tartrate ophthalmic solution 0.2 % PG

bromfenac sodium (once-daily) NP



09/01/2018122


BROMSITE NP

carteolol hcl PG

CILOXAN NP

CLARITIN EYE PG Select OTC

COMBIGAN PB

COSOPT NP

COSOPT PF NP #

cromolyn sodium ophthalmic PG

CYCLOGYL NP

CYCLOMYDRIL NP

cyclopentolate hcl ophthalmic PG

CYSTARAN NPS PA; SP; QL

dexamethasone sodium phosphate ophthalmic PG

diclofenac sodium ophthalmic PG

dorzolamide hcl ophthalmic PG

dorzolamide hcl-timolol mal PG

DUREZOL PB #

ELESTAT NP

EMADINE NP

epinastine hcl PG

erythromycin ophthalmic PG

eye itch relief PG Select OTC

EYLEA INTRAVITREAL NPS PA; SP

FLAREX NP

flucaine NC

fluorescein-benoxinate NP

fluor-i-strips a.t. NP

fluorometholone ophthalmic PG

flurbiprofen sodium PG

FML PB

FML FORTE NP

FML LIQUIFILM NP

FUL-GLO OPHTHALMIC STRIP 0.6 MG NP

ful-glo ophthalmic strip 1 mg NP

gatifloxacin ophthalmic NP



09/01/2018123


gentamicin sulfate ophthalmic solution PG

ILEVRO NP

IOPIDINE NP

ISOPTO CARPINE NP

ISTALOL NP

JETREA INTRAVITREAL SOLUTION 0.375 MG/0.3ML

NPS PA; SP

ketorolac tromethamine ophthalmic NP

ketotifen fumarate ophthalmic PG Select OTC

LACRISERT NP

LASTACAFT NP

latanoprost ophthalmic PG

levobunolol hcl ophthalmic solution 0.5 % PG

levofloxacin ophthalmic PG

LOTEMAX OPHTHALMIC GEL PB #

LOTEMAX OPHTHALMIC OINTMENT PB

LOTEMAX OPHTHALMIC SUSPENSION PB

LUCENTIS INTRAVITREAL SOLUTION PREFILLED SYRINGE

NPS PA; SP

LUMIGAN OPHTHALMIC SOLUTION 0.01 %

NP PA; ST

MACUGEN NPS PA; SP

MAXIDEX NP

MAXITROL NP

metipranolol PG

MOXEZA NP #

moxifloxacin hcl ophthalmic PG

MYDRIACYL NP

NATACYN NP

neomycin-polymyxin-dexameth ophthalmic ointment

PG

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

PG

NEOSPORIN NP

NEVANAC NP

OCUFLOX NP



09/01/2018124


ofloxacin ophthalmic PG

olopatadine hcl ophthalmic PG

OMNIPRED NP

PATADAY NP

PATANOL NP

PAZEO NP

PHOSPHOLINE IODIDE PB

pilocarpine hcl ophthalmic solution 1 %, 2 %, 4 %

PG

polymyxin b-trimethoprim PG

POLYTRIM NP

PRED FORTE NP

PRED MILD NP

PRED-G NP

PRED-G S.O.P. NP

prednisolone acetate ophthalmic PG

prednisolone sodium phosphate ophthalmic PG

PROLENSA NP

proparacaine-fluorescein NC

RESTASIS PB #

RESTASIS MULTIDOSE PB #

SIMBRINZA NP

sulfacetamide sodium ophthalmic PG

sulfacetamide-prednisolone ophthalmic solution PG

sulfacetamide-prednisolone ophthalmic suspension

PB

timolol maleate ophthalmic gel forming solution PG

timolol maleate ophthalmic solution 0.25 %, 0.5 %

PG

timolol maleate ophthalmic solution 0.5 % (daily)

NP

TIMOPTIC NP

TIMOPTIC OCUDOSE NP

TIMOPTIC-XE OPHTHALMIC GEL FORMING SOLUTION 0.5 %

NP

TOBRADEX NP



09/01/2018125


TOBRADEX ST NP

TOBREX NP

TRAVATAN Z PB #

trifluridine ophthalmic PG

tropicamide ophthalmic NP

TRUSOPT NP

VIGAMOX NP

VIROPTIC NP

VISUDYNE NPS PA; #; SP

VYZULTA NP PA; ST

XALATAN NP PA; ST

ZADITOR PG Select OTC

ZIOPTAN NP PA; ST

ZIRGAN NP #

ZYLET NP

ZYMAXID NP

*OPHTHALMIC RHO KINASE INHIBITORS***

RHOPRESSA NP ST

*OREXIN RECEPTOR ANTAGONISTS***

BELSOMRA NP ST; QL; AL

*OTIC AGENTS*

ACETASOL HC PG

acetic acid otic PG

CETRAXAL NP

CIPRO HC NP #

CIPRODEX PB #

ciprofloxacin hcl otic NP

COLY-MYCIN S NP

CORTANE-B AQUEOUS NC

CORTANE-B OTIC NC

cortic-nd NC

cyotic NC

DERMOTIC NP

exotic-hc NC



09/01/2018126


FLOXIN OTIC NP

fluocinolone acetonide otic NP

hydrocortisone-acetic acid PG

neomycin-polymyxin-hc otic solution 1 % PG

neomycin-polymyxin-hc otic suspension PG

ofloxacin otic PG

OTICIN HC NR NC

OTIPRIO NP

otomax-hc NC

OTOVEL NP

*OXABOROLE-RELATED ANTIFUNGALS - TOPICAL***

KERYDIN NP PA; ST

*OXYTOCICS*

CERVIDIL NP

METHERGINE ORAL PG QL

PREPIDIL NP

*PASSIVE IMMUNIZING AGENTS - COMBINATIONS***

HYQVIA NPS PA; ST; SP

*PASSIVE IMMUNIZING AGENTS*

BIVIGAM NPS PA; ST; SP

CARIMUNE NF INTRAVENOUS SOLUTION RECONSTITUTED 12 GM, 6 GM

NPS PA; ST; SP

CUVITRU NPS PA; ST

CYTOGAM PSP SP

FLEBOGAMMA DIF INTRAVENOUS SOLUTION 0.5 GM/10ML, 10 GM/200ML, 2.5 GM/50ML, 20 GM/400ML, 5 GM/100ML, 5 GM/50ML

PSP PA; SP

FLEBOGAMMA DIF INTRAVENOUS SOLUTION 10 GM/100ML, 20 GM/200ML

PSP PA

GAMASTAN S/D INTRAMUSCULAR INJECTABLE

NPS SP

GAMMAGARD NPS PA; ST; SP

GAMMAGARD S/D LESS IGA NPS PA; ST; SP



09/01/2018127


GAMMAKED NPS PA; ST; SP

GAMMAPLEX INTRAVENOUS SOLUTION 10 GM/200ML, 20 GM/400ML, 5 GM/100ML

PSP PA; SP

GAMUNEX-C PSP PA; SP

HEPAGAM B PSP

HIZENTRA SUBCUTANEOUS SOLUTION 1 GM/5ML, 10 GM/50ML, 2 GM/10ML, 4 GM/20ML

PSP PA; SP

HYPERHEP B S/D NPS SP

HYPERRAB NPS SP

HYPERRHO S/D INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

NPS SP

HYPERTET S/D PSP SP

MICRHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

NPS SP

NABI-HB NPS SP

OCTAGAM PSP PA; SP

PRIVIGEN NPS PA; ST; SP

RHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

NPS SP

RHOPHYLAC INJECTION SOLUTION PREFILLED SYRINGE

PSP SP

SYNAGIS PSP PA; SP

WINRHO SDF NPS SP

*PCSK9 INHIBITORS***

PRALUENT SUBCUTANEOUS SOLUTION PEN-INJECTOR

PSP PA; ST; QL

REPATHA PSP PA; ST; QL

REPATHA PUSHTRONEX SYSTEM PSP PA; ST; QL

REPATHA SURECLICK PSP PA; ST; QL

*PEDIATRIC MULTIPLE VITAMINS W/FLUORIDE-IRON-ZINC***

TEXAVITE LQ CE



09/01/2018128


*PENICILLINS*

amoxicillin oral capsule PG LGC

amoxicillin oral suspension reconstituted PG LGC

amoxicillin oral tablet PG

amoxicillin oral tablet chewable 125 mg, 250 mg PG

amoxicillin-pot clavulanate er PG

amoxicillin-pot clavulanate oral PG

ampicillin oral capsule 500 mg PG

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

PB

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 250-62.5 MG/5ML

NP

AUGMENTIN ORAL TABLET 500-125 MG, 875-125 MG

NP

AUGMENTIN XR NP

dicloxacillin sodium PG

MOXATAG NP

penicillin v potassium oral solution reconstituted125 mg/5ml

PG LGC

penicillin v potassium oral solution reconstituted250 mg/5ml

PG

penicillin v potassium oral tablet 250 mg PG LGC

penicillin v potassium oral tablet 500 mg PG

piperacillin sod-tazobactam so intravenous solution reconstituted 2.25 (2-0.25) gm, 3.375 (3-0.375) gm, 4.5 (4-0.5) gm, 40.5 (36-4.5) gm

NC

ZOSYN INTRAVENOUS SOLUTION RECONSTITUTED

NC

*PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS***

ZYDELIG NPS PA; SP; QL

*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS - TOPICAL***

EUCRISA NC

*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS***

OTEZLA ORAL TABLET PSP PA; ST; SP; QL



09/01/2018129


OTEZLA ORAL TABLET THERAPY PACK

PSP PA; ST; SP; QL

*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS**

LYNPARZA NPS PA; SP; QL

RUBRACA ORAL TABLET 200 MG, 300 MG

NPS PA; QL

RUBRACA ORAL TABLET 250 MG NPS PA; SP; QL

ZEJULA NPS PA; SP; QL

*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS***

LYNPARZA NPS PA; SP; QL

RUBRACA ORAL TABLET 200 MG, 300 MG

NPS PA; QL

RUBRACA ORAL TABLET 250 MG NPS PA; SP; QL

ZEJULA NPS PA; SP; QL

*POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS***

GRALISE NP ST; QL

GRALISE STARTER NP ST; QL

LYRICA CR PB QL

*POTASSIUM REMOVING AGENTS***

KIONEX ORAL SUSPENSION PG

sodium polystyrene sulfonate oral PG

SPS PG

VELTASSA NP PA; QL

*PROGESTINS*

AYGESTIN NP

hydroxyprogesterone caproate intramuscular oil PSP PA; SP

MAKENA INTRAMUSCULAR NC #

MAKENA SUBCUTANEOUS NPS PA; SP; QL

medroxyprogesterone acetate oral PG LGC

MEGACE ES NP

megestrol acetate oral suspension 625 mg/5ml NP

PROMETRIUM NP QL

PROVERA NP



09/01/2018130


*PROTEASE-ACTIVATED RECEPTOR-1 (PAR-1) ANTAGONISTS***

ZONTIVITY NP PA; QL

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*

acamprosate calcium NP QL

AMPYRA NPS PA; #; SP; QL

ANTABUSE NP

ARICEPT ORAL TABLET 10 MG, 23 MG, 5 MG

NP PA; AL

AUBAGIO PSP PA; SP; QL

AUSTEDO NPS PA; ST; SP; QL

AVONEX PSP PA; SP; QL

AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT

PSP PA; SP; QL

AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT

PSP PA; SP; QL

BETASERON SUBCUTANEOUS KIT PSP PA; SP; QL

BRISDELLE NP PA; ST; QL

bupropion hcl er (smoking det) CE QL

CHANTIX CE QL

CHANTIX CONTINUING MONTH PAK CE QL

CHANTIX STARTING MONTH PAK CE

chlordiazepoxide-amitriptyline NP

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML

NC SP

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 40 MG/ML

PSP PA; SP

disulfiram oral PG

donepezil hcl oral tablet 10 mg, 5 mg PG PA; AL

donepezil hcl oral tablet 23 mg NP PA; AL

donepezil hcl oral tablet dispersible PG PA; AL

ergoloid mesylates oral NP

EXELON TRANSDERMAL NP PA



09/01/2018131


EXTAVIA SUBCUTANEOUS KIT NPS PA; ST; SP; QL

fluoxetine hcl (pmdd) PG

galantamine hydrobromide NP PA; AL

galantamine hydrobromide er NP PA; AL

GILENYA ORAL CAPSULE 0.25 MG PSP PA; SP; QL

GILENYA ORAL CAPSULE 0.5 MG PSP PA; #; SP; QL

GRALISE NP ST; QL

GRALISE STARTER NP ST; QL

HORIZANT ORAL TABLET EXTENDED RELEASE

NP PA; ST; QL

INGREZZA NPS PA; SP; QL

LEMTRADA PSP PA; SP; QL

LYRICA CR PB QL

memantine hcl er PG PA; AL

memantine hcl oral tablet PG PA; AL

NAMENDA ORAL TABLET NP PA

NAMENDA TITRATION PAK NP PA

NAMENDA XR PB PA; #; AL

NAMENDA XR TITRATION PACK PB PA; #; AL

nicotine CE QL

nicotine polacrilex mouth/throat CE QL

NICOTROL CE QL

NICOTROL NS CE QL

NUEDEXTA PB QL

olanzapine-fluoxetine hcl oral capsule 12-25 mg, 12-50 mg, 6-25 mg, 6-50 mg

NP QL

olanzapine-fluoxetine hcl oral capsule 3-25 mg NP

ORAP NP

paroxetine mesylate NP PA; QL

perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4-25 mg

PG

pimozide NP

PLEGRIDY PSP PA; SP; QL

PLEGRIDY STARTER PACK PSP PA; SP; QL

RAZADYNE ER NP AL



09/01/2018132


RAZADYNE ORAL TABLET NP PA; AL

REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR

PSP PA; SP; QL

REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

PSP PA; SP; QL

REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PSP PA; SP; QL

REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PSP PA; SP; QL

rivastigmine NP PA

rivastigmine tartrate NP PA

SARAFEM ORAL TABLET 10 MG, 20 MG PG

SAVELLA NP ST; QL

SAVELLA TITRATION PACK NP ST; QL

SYMBYAX ORAL CAPSULE 12-25 MG, 12-50 MG, 6-25 MG, 6-50 MG

NP QL

SYMBYAX ORAL CAPSULE 3-25 MG NP

TECFIDERA PSP PA; SP; QL

tetrabenazine PSP PA; QL

TYSABRI NPS PA; ST; SP

XENAZINE NPS PA; ST; SP; QL

XYREM NPS PA; SP

ZYBAN NP QL

*PULMONARY FIBROSIS AGENTS - KINASE INHIBITORS***

OFEV NPS PA; SP; QL

*PULMONARY FIBROSIS AGENTS***

ESBRIET NPS PA; SP; QL

*PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST***

UPTRAVI ORAL TABLET 1000 MCG, 1200 MCG, 1400 MCG, 1600 MCG, 400 MCG, 600 MCG, 800 MCG

NPS PA; SP; QL

UPTRAVI ORAL TABLET 200 MCG NPS PA; SP



09/01/2018133


UPTRAVI ORAL TABLET THERAPY PACK

NPS PA; SP

*RESPIRATORY AGENTS - MISC.*

ARALAST NP INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG, 500 MG

NPS PA; SP

GLASSIA NPS PA; SP

KALYDECO NPS PA; SP; QL

PROLASTIN-C INTRAVENOUS SOLUTION

NPS PA; SP

PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG

NPS PA; SP

PULMOZYME PSP PA; SP; QL

ZEMAIRA NPS PA; SP

*SEROTONIN MODULATORS***

nefazodone hcl NP

trazodone hcl oral tablet 100 mg, 150 mg, 50 mg PG LGC

trazodone hcl oral tablet 300 mg PG

TRINTELLIX NP PA; ST; QL

VIIBRYD ORAL TABLET NP QL

VIIBRYD STARTER PACK NP

*SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS***

GLYXAMBI PB QL

QTERN NC

STEGLUJAN NC

*SINUS NODE INHIBITORS**

CORLANOR NP PA; ST; QL

*SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB***

INVOKAMET PB QL

INVOKAMET XR PB QL

SEGLUROMET NC

SYNJARDY PB QL

SYNJARDY XR PB QL

XIGDUO XR NP QL



09/01/2018134


*SPLEEN TYROSINE KINASE (SYK) INHIBITORS***

TAVALISSE NPS PA; SP; QL

*SULFONAMIDES*

sulfadiazine oral NP

*TETRACYCLINES*

ACTICLATE NC

avidoxy NC

AVIDOXY DK NC

COREMINO NC

demeclocycline hcl oral NP

DORYX MPC NC

DORYX ORAL TABLET DELAYED RELEASE 200 MG, 50 MG

NC

doxycycline hyclate oral capsule PG

doxycycline hyclate oral tablet 100 mg, 50 mg PG

doxycycline hyclate oral tablet 150 mg, 75 mg NC

doxycycline hyclate oral tablet 20 mg NP

doxycycline hyclate oral tablet delayed release NC

doxycycline monohydrate oral capsule 100 mg, 50 mg

PG

doxycycline monohydrate oral capsule 150 mg, 75 mg

NC

doxycycline monohydrate oral suspension reconstituted

PG

doxycycline monohydrate oral tablet NC

MINOCIN ORAL CAPSULE 100 MG, 50 MG

NP

minocycline hcl er NC

minocycline hcl oral capsule PG

minocycline hcl oral tablet NC

MORGIDOX COMBINATION NC

MORGIDOX ORAL CAPSULE 100 MG PG

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HOUR 105 MG, 115 MG, 55 MG, 65 MG, 80 MG

NC #



09/01/2018135


TARGADOX NC

tetracycline hcl oral PG

VIBRAMYCIN NP

XIMINO NC

*THYROID AGENTS*

ARMOUR THYROID ORAL TABLET 120 MG

PG

ARMOUR THYROID ORAL TABLET 15 MG, 180 MG, 240 MG, 30 MG, 300 MG, 60 MG, 90 MG

NP

CYTOMEL NP

levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg

PG LGC

levothyroxine sodium oral tablet 300 mcg PG

LEVOXYL PG

liothyronine sodium oral PG

methimazole oral PG

NATURE-THROID NP

np thyroid oral tablet 30 mg, 60 mg, 90 mg PG

propylthiouracil oral PG

SYNTHROID NP

TAPAZOLE NP

TIROSINT NP

UNITHROID PG

UNITHROID DIRECT PG

WESTHROID ORAL TABLET 130 MG, 195 MG, 32.5 MG, 65 MG, 97.5 MG

NP

WP THYROID ORAL TABLET 113.75 MG, 130 MG, 32.5 MG, 65 MG

NP

*TRYPTOPHAN HYDROXYLASE INHIBITORS***

XERMELO NPS PA; SP; QL

*ULCER DRUGS*

acid reducer maximum strength oral tablet 150 mg

NC

acid reducer oral tablet 150 mg NC



09/01/2018136


ACIPHEX NP PA; ST; QL

ACIPHEX SPRINKLE NP PA; ST; #; QL

amoxicill-clarithro-lansopraz PG

BENTYL ORAL CAPSULE NP

CARAFATE NP

chlordiazepoxide-clidinium NC

cimetidine hcl oral PG

cimetidine oral tablet 200 mg NC

cimetidine oral tablet 300 mg, 400 mg, 800 mg PG

CUVPOSA NP

CYTOTEC NP

DEXILANT NC

dicyclomine hcl oral capsule PG LGC

dicyclomine hcl oral tablet PG LGC

esomeprazole magnesium oral capsule delayed release 20 mg

PG Select OTC; QL

esomeprazole magnesium oral capsule delayed release 40 mg

PG QL

esomeprazole strontium oral capsule delayed release 49.3 mg

NC

famotidine oral tablet 10 mg PG

famotidine oral tablet 40 mg PG LGC

FIRST-LANSOPRAZOLE NC

FIRST-OMEPRAZOLE NC

glycopyrrolate oral tablet 1 mg, 2 mg NP

heartburn relief 150 max st NC

hyoscyamine sulfate NC

lansoprazole oral capsule delayed release 15 mg PG Select OTC; QL

lansoprazole oral capsule delayed release 30 mg PG QL

lansoprazole oral tablet dispersible NP QL

LIBRAX NC

misoprostol oral PG

NEXIUM 24HR PG Select OTC; QL

NEXIUM ORAL CAPSULE DELAYED RELEASE 20 MG

NC



09/01/2018137


NEXIUM ORAL CAPSULE DELAYED RELEASE 40 MG

NP QL

NEXIUM ORAL PACKET NP #; QL

nizatidine PG

OMECLAMOX-PAK NP

omeprazole magnesium PG Select OTC

omeprazole oral capsule delayed release 10 mg, 40 mg

PG

omeprazole oral tablet delayed release PG Select OTC

OMEPRAZOLE+SYRSPEND SF ALKA NC

omeprazole-sodium bicarbonate oral capsule 20-1100 mg

PG Select OTC; QL

omeprazole-sodium bicarbonate oral capsule 40-1100 mg

NC

omeprazole-sodium bicarbonate oral packet NC

pantoprazole sodium oral PG

PEPCID ORAL SUSPENSION RECONSTITUTED

NP

PEPCID ORAL TABLET 40 MG NP

PREVACID 24HR PG Select OTC; QL

PREVACID ORAL CAPSULE DELAYED RELEASE 15 MG

NC

PREVACID ORAL CAPSULE DELAYED RELEASE 30 MG

NP QL

PREVACID SOLUTAB NP PA; ST; QL; AL

PREVPAC NP

PRILOSEC ORAL PACKET NC

PRILOSEC OTC PG Select OTC

propantheline bromide NC

propantheline bromide oral PG

PROTONIX ORAL NP

PYLERA NP #

rabeprazole sodium PG QL

ranitidine hcl oral capsule PG

ranitidine hcl oral tablet 300 mg PG LGC

ROBINUL ORAL NP



09/01/2018138


ROBINUL-FORTE NP

sucralfate oral PG

SYMAX DUOTAB NC

ZANTAC ORAL TABLET 300 MG NP

ZEGERID NC

ZEGERID OTC PG Select OTC; QL

*URINARY ANTI-INFECTIVES*

FURADANTIN NP

HIPREX NP

hyophen NC

MACROBID NP

MACRODANTIN NP

methenamine hippurate PG

methenamine mandelate oral PG

MONUROL NP

nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg

PG

nitrofurantoin monohyd macro PG

nitrofurantoin oral suspension PG

phosphasal NC

urelle NC

uretron d/s NC

uribel NC

URIMAR-T NC

urin ds NC

uro-mp NC

ustell NC

utira-c NC

utrona-c NC

*URINARY ANTISPASMODICS*

bethanechol chloride oral PG

darifenacin hydrobromide er NP QL

DETROL NP ST

DETROL LA NP ST; QL

DITROPAN XL NP ST; QL



09/01/2018139


ENABLEX NP ST; QL

flavoxate hcl PG

GELNIQUE TRANSDERMAL GEL 10 % NP ST

MYRBETRIQ PB ST; QL

oxybutynin chloride er PG QL

oxybutynin chloride oral syrup PG

oxybutynin chloride oral tablet PG LGC; QL

OXYTROL NC #

OXYTROL FOR WOMEN PG #; Select OTC; QL

tolterodine tartrate PG

tolterodine tartrate er NP QL

TOVIAZ NP ST; QL

trospium chloride PG QL

trospium chloride er PG QL

URECHOLINE NP

VESICARE NP ST; #; QL

*VAGINAL PRODUCTS*

AVC VAGINAL NP

CLEOCIN VAGINAL NP

clindamycin phosphate vaginal PG

CLINDESSE NP

CRINONE VAGINAL GEL 4 % NP

ESTRACE VAGINAL NP

estradiol vaginal cream PG

estradiol vaginal tablet NP

ESTRING NP

FEM PH NP

FEMRING NP #; QL

GYNAZOLE-1 NP

IMVEXXY MAINTENANCE PACK NP ST

IMVEXXY STARTER PACK NP ST

INTRAROSA NP QL

METROGEL-VAGINAL NP

metronidazole vaginal PG

miconazole 3 vaginal suppository NP



09/01/2018140


NUVESSA NP

PREMARIN VAGINAL PB

RELAGARD NP

TERAZOL 7 NP

terconazole PG

TODAY SPONGE CE

VAGIFEM VAGINAL TABLET 10 MCG NP

VANDAZOLE PG

VCF VAGINAL CONTRACEPTIVE VAGINAL FILM

CE

VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM

CE

YUVAFEM NP

*VASOPRESSORS*

ADYPHREN NP QL

ADYPHREN AMP II NP QL

ADYPHREN II NP QL

AUVI-Q INJECTION SOLUTION AUTO-INJECTOR

NC

epinephrine injection solution auto-injector PG QL

EPIPEN 2-PAK INJECTION SOLUTION AUTO-INJECTOR

PB #; QL

EPIPEN JR 2-PAK INJECTION SOLUTION AUTO-INJECTOR

PB #; QL

EPISNAP NP QL

midodrine hcl PG SP

*VITAMINS*

BPROTECTED PEDIA D-VITE CE

CALCIDOL NC

CALCIFEROL NC

cvs d3 oral capsule 2000 unit, 5000 unit NC

cvs d3 oral capsule 400 unit CE

d 10000 NC

d 2000 NC

d 400 oral tablet CE

d 5000 NC



09/01/2018141


d-2000 maximum strength NC

d2000 ultra strength NC

D3 DOTS NC

d3 maximum strength NC

d3 super strength NC

d3-1000 oral tablet CE

d-3-5 NC

D3-50 NC

d-5000 NC

DDROPS ORAL LIQUID 2000 UNT/0.03ML, 2000 UT/0.028ML

NC

DECARA ORAL CAPSULE 25000 UNIT, 50000 UNIT

NC

DIALYVITE VITAMIN D 5000 NC

DIALYVITE VITAMIN D3 MAX NC

DRISDOL ORAL CAPSULE NP

D-VI-SOL CE

eql vitamin d3 oral capsule 2000 unit, 5000 unit NC

ergocal NP

ergocalciferol oral capsule PG

ergocalciferol oral solution NC

gnp vitamin d maximum strength NC

gnp vitamin d oral tablet chewable CE

gnp vitamin d super strength NC

hm vitamin d3 NC

MAXIMUM D3 NC

MEPHYTON PB QL

nat-rul vitamin d oral tablet 2000 unit, 5000 unit NC

natural vitamin d-3 NC

OPTIMAL D3 M NC

OPTIMAL-D NC

OPURITY VITAMIN D NC

pa vitamin d-3 oral capsule NC

phytonadione oral PG QL

ra vitamin d-3 oral capsule NC



09/01/2018142


REPLESTA NC

REPLESTA CHILDRENS NC

REPLESTA NX NC

sm vitamin d3 oral capsule 2000 unit, 4000 unit NC

super daily d3 oral liquid 2000 ut/0.028ml NC

THERA-D 2000 NC

THERA-D 4000 NC

THERA-D RAPID REPLETION NC

vitamin d (ergocalciferol) oral capsule 50000 unit

PG

vitamin d oral capsule 2000 unit NC

vitamin d oral tablet 2000 unit NC

vitamin d2 oral tablet 2000 unit NC

vitamin d3 maximum strength NC

vitamin d-3 oral capsule CE

vitamin d3 oral capsule 10000 unit, 2000 unit, 5000 unit, 50000 unit

NC

vitamin d3 oral liquid 5000 unit/ml NC

vitamin d3 oral tablet 10000 unit, 2000 unit, 3000 unit, 5000 unit, 50000 unit

NC

vitamin d3 oral tablet chewable 2000 unit, 5000 unit

NC

vitamin d3 super strength oral tablet NC



09/01/2018143

Index

abacavir sulfate ........................ 61abacavir sulfate-lamivudine ...... 61abacavir-lamivudine-zidovudine 61ABANEU-SL........................ 105ABILIFY................................ 59ABREVA................................ 79ABSORICA............................ 79ABSTRAL.............................. 22acamprosate calcium .............. 131ACANYA............................... 79acarbose ...................................38ACCOLATE........................... 30ACCU-CHEK AVIVA PLUS.90ACCU-CHEK COMPACT PLUS...................................... 90ACCU-CHEK FASTCLIX LANCETS............................ 112ACCU-CHEK MULTICLIX LANCETS............................ 112ACCU-CHEK SMARTVIEW........................ 90ACCU-CHEK SOFT TOUCH LANCETS............. 112ACCU-CHEK SOFTCLIX LANCETS............................ 112ACCUPRIL............................ 48ACCURETIC......................... 48ACCUTREND GLUCOSE....90acebutolol hcl ........................... 66acetaminophen-codeine .............22acetaminophen-codeine #2 ........22acetaminophen-codeine #3 ........22acetaminophen-codeine #4 ........23ACETASOL HC................... 126acetazolamide .......................... 94acetazolamide er ...................... 94acetic acid .......................102, 126acetylcysteine ...........................78acid reducer ............................136acid reducer maximum strength...............................................136ACIPHEX.............................137ACIPHEX SPRINKLE........ 137acitretin ................................... 79ACTEMRA............................ 19ACTICLATE........................ 135ACTIGALL.......................... 100ACTIMMUNE....................... 54ACTIQ.................................... 23

ACTIVE 1ST BLOOD LANCETS 30G.....................112active fe ..................................105ACTIVELLA.......................... 98ACTONEL............................. 95ACTOPLUS MET.................. 38ACTOPLUS MET XR............38ACTOS................................... 38ACULAR..............................122ACULAR LS........................ 122ACUVAIL............................ 122acyclovir .............................61, 79ACZONE................................79ADAGEN............................... 67ADALAT CC......................... 67adapalene .................................79adapalene-benzoyl peroxide ......79ADCIRCA..............................69ADDERALL.......................... 17ADDERALL XR....................17adefovir dipivoxil ......................61ADEMPAS............................. 69ADLYXIN..............................38ADLYXIN STARTER PACK..................................... 38ADMELOG............................38ADMELOG SOLOSTAR.......38ADRENALIN...................... 120ADVAIR DISKUS................. 30ADVAIR HFA....................... 30ADVANCE INTUITION TEST.......................................90ADVANCE MICRO-DRAW TEST.......................................90ADVATE.............................. 103ADVOCATE REDI-CODE... 90ADVOCATE REDI-CODE+ TEST.......................................90ADVOCATE TEST................ 90adynovate ...............................103ADYPHREN........................ 141ADYPHREN AMP II...........141ADYPHREN II.................... 141ADZENYS ER....................... 17ADZENYS XR-ODT............. 17AFEDITAB CR......................67AFINITOR.............................54AFINITOR DISPERZ........... 54AFREZZA..............................38

AFSTYLA............................ 103AGAMATRIX AMP TEST... 90AGAMATRIX JAZZ TEST...90AGAMATRIX KEYNOTE TEST.......................................90AGAMATRIX PRESTO TEST.......................................90AGGRENOX....................... 103AGRYLIN............................103AIMOVIG.............................. 67AIMOVIG 140 DOSE.............67AIRAVITE........................... 105AIRDUO RESPICLICK 113/14...................................... 30AIRDUO RESPICLICK 232/14...................................... 30AIRDUO RESPICLICK 55/14........................................30AKTEN.................................122AKTIPAK.............................. 79AKYNZEO.............................43ALA-QUIN............................ 79ALAVERT..............................45ALAVERT ALLERGY/SINUS.................78ALAWAY.............................122ALAWAY CHILDRENS ALLERGY........................... 122ALBENZA..............................28albuterol sulfate ....................... 30albuterol sulfate er ................... 30alclometasone dipropionate .......79ALCORTIN A........................79ALDACTAZIDE....................94ALDACTONE........................94ALDARA............................... 79ALDURAZYME....................95ALECENSA........................... 54alendronate sodium ...................95ALFERON N......................... 54alfuzosin hcl er ....................... 102ALINIA.................................. 51ALKERAN.............................54ALLEGRA ALLERGY......... 45ALLEGRA ALLERGY CHILDRENS......................... 45ALLEGRA-D ALLERGY & CONGESTION...................... 78allergy eye drops .................... 122

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allergy relief .............................45allopurinol ..............................102ALLZITAL.............................22almotriptan malate ................. 115ALOCRIL.............................122alogliptin benzoate ................... 38alogliptin-metformin hcl ........... 38alogliptin-pioglitazone .............. 38ALOMIDE............................122ALORA.................................. 98alosetron hcl ...........................100ALOXI....................................43ALPHAGAN P.....................122ALPHANATE/VWF COMPLEX/HUMAN...........103ALPHANINE SD................. 103alprazolam ............................... 29alprazolam er ........................... 28ALPRAZOLAM INTENSOL 29alprazolam xr ...........................29ALPROLIX.......................... 103ALREX.................................122ALTABAX............................. 79ALTACE................................ 48altafluor ................................. 122ALTAVERA...........................72ALTOPREV........................... 46ALUNBRIG........................... 54ALVESCO.............................. 30alyacen 1/35 ............................. 72alyacen 7/7/7 ............................ 72AMABELZ............................. 98amantadine hcl ......................... 58AMARYL...............................38AMBIEN.............................. 109AMBIEN CR........................ 109amcinonide ...............................79AMELUZ............................... 79AMERGE............................. 115AMETHIA............................. 72AMETHIA LO....................... 72AMICAR.............................. 109amiloride hcl ............................ 94amiloride-hydrochlorothiazide .. 94amiodarone hcl .........................29AMITIZA............................. 100amitriptyline hcl ....................... 36amlodipine besy-benazepril hcl ..48amlodipine besylate .................. 67amlodipine besylate-valsartan ...48

amlodipine-atorvastatin ............ 69amlodipine-olmesartan ............. 48amlodipine-valsartan-hctz .........48AMMONUL...........................95AMNESTEEM....................... 79amoxapine ............................... 36amoxicill-clarithro-lansopraz ..137amoxicillin ............................. 129amoxicillin-pot clavulanate ..... 129amoxicillin-pot clavulanate er . 129amphetamine-dextroamphet er . 17amphetamine-dextroamphetamine ..................17ampicillin ............................... 129AMPYRA............................. 131AMRIX.................................119ANADROL-50....................... 26ANAFRANIL........................ 36anagrelide hcl ......................... 103ANA-LEX.............................. 27ANALPRAM-HC...................27ANAPROX DS.......................19anastrozole ...............................54ANCOBON............................ 44ANDRODERM......................26ANDROGEL..........................26ANDROGEL PUMP..............26ANGELIQ.............................. 98ANIMI-3...............................105ANIMI-3/VITAMIN D........ 105ANORO ELLIPTA.................30ANTABUSE......................... 131ANTARA............................... 46anucort-hc ................................27ANUSOL-HC......................... 27ANZEMET.............................43apap-caff-dihydrocodeine ......... 23APEXICON E........................ 79APIDRA................................. 38APIDRA SOLOSTAR............38APLENZIN............................ 36apraclonidine hcl .................... 122aprepitant ................................ 43APRI.......................................72APRISO................................ 100APTENSIO XR...................... 17APTIOM.................................33APTIVUS................................61ARALAST NP......................134ARANELLE...........................72

ARANESP (ALBUMIN FREE)...................................105ARAVA.................................. 19ARCALYST........................... 19ARCAPTA NEOHALER.......30ARICEPT............................. 131ARIMIDEX............................54aripiprazole ..............................59ARIXTRA.............................. 32armodafinil .............................. 17ARMONAIR RESPICLICK 113...........................................30ARMONAIR RESPICLICK 232...........................................30ARMONAIR RESPICLICK 55.............................................30ARMOUR THYROID.........136ARNUITY ELLIPTA............ 30AROMASIN...........................54ARRANON............................54ARTHROTEC........................19ARYMO ER........................... 23ARZERRA............................. 54ASACOL HD........................100ASCOMP-CODEINE.............23ASMANEX 120 METERED DOSES....................................30ASMANEX 14 METERED DOSES....................................30ASMANEX 30 METERED DOSES....................................30ASMANEX 60 METERED DOSES....................................30ASMANEX 7 METERED DOSES....................................30ASMANEX HFA................... 30aspirin-dipyridamole er ...........103ASSURE 3 TEST....................90ASSURE 4 TEST....................90ASSURE II............................. 90ASSURE II CHECK.............. 90ASSURE LANCETS............ 112ASSURE PLATINUM...........90ASSURE PRISM MULTI TEST.......................................90ASSURE PRO TEST..............90ASTAGRAF XL.....................64ASTEPRO.............................120ASTERO.................................79ATACAND............................ 48

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ATACAND HCT................... 48atazanavir sulfate ..................... 61ATELVIA............................... 95atenolol .................................... 66atenolol-chlorthalidone ............. 48ATGAM................................. 64ATIVAN................................. 29atomoxetine hcl ........................17atorvastatin calcium ................. 46atovaquone ...............................51atovaquone-proguanil hcl ..........52ATRALIN.............................. 79ATRIPLA............................... 61atropine sulfate .......................122ATROVENT HFA................. 30AUBAGIO............................131AUGMENTIN..................... 129AUGMENTIN XR...............129AUSTEDO............................131AUVI-Q................................ 141AVALIDE.............................. 48AVANDIA..............................39AVAPRO................................ 48AVAR CLEANSER............... 80AVAR LS CLEANSER..........80avar-e emollient ........................80avar-e green ............................. 80AVAR-E LS............................80AVC VAGINAL................... 140AVELOX................................ 99AVIANE................................. 72avidoxy .................................. 135AVIDOXY DK.....................135avita .........................................80AVODART...........................102AVONEX..............................131AVONEX PEN..................... 131AVONEX PREFILLED.......131av-vite fb ................................ 105AYGESTIN.......................... 130AZACTAM...........................117AZASITE..............................122azathioprine ............................. 64azelastine hcl .................. 120, 122AZELEX.................................80AZILECT............................... 58azithromycin .......................... 112AZOPT..................................122AZOR..................................... 48aztreonam .............................. 117

AZULFIDINE......................100AZULFIDINE EN-TABS.... 100AZURETTE........................... 72b-6 folic acid ...........................105bacitracin ............................... 122bacitracin-polymyxin b ........... 122baclofen ..................................119BACTRIM..............................51BACTRIM DS........................51BACTROBAN........................80BACTROBAN NASAL........120BALCOLTRA........................ 72balsalazide disodium ...............100BALZIVA............................... 72BANZEL................................ 33BARACLUDE........................61BASAGLAR KWIKPEN....... 39BAXDELA............................. 99BAYER BREEZE 2 TEST......90BAYER CONTOUR TEST....90BAYER MICROLET LANCETS............................ 113BD AUTOSHIELD.............. 113BD INSULIN SYRINGE.....113BD INSULIN SYRINGE HALF-UNIT........................ 113BD INSULIN SYRINGE MICROFINE........................113BD INSULIN SYRINGE U-500.........................................113BD INSULIN SYRINGE ULTRAFINE....................... 113BD LANCET ULTRAFINE 30G........................................113BD LANCET ULTRAFINE 33G........................................113BD MICROTAINER LANCETS............................ 113BD PEN................................ 113BD PEN MINI......................113BD PEN NEEDLE MINI U/F........................................113BD PEN NEEDLE NANO U/F........................................113BD PEN NEEDLE SHORT U/F........................................113BD PEN NEEDLE ULTRAFINE....................... 113BD SAFETYGLIDE INSULIN SYRINGE........... 113

BD SAFETY-LOK INSULIN SYRINGE........... 113BEBULIN............................. 103BECONASE AQ................... 121BELBUCA..............................23BELSOMRA.........................126benazepril hcl ........................... 48benazepril-hydrochlorothiazide . 48BENEFIX............................. 103BENICAR.............................. 48BENICAR HCT..................... 48BENLYSTA............................64bensal hp .................................. 80BENTYL...............................137BENZACLIN......................... 80BENZACLIN WITH PUMP..80BENZAMYCIN..................... 80benznidazole .............................28benzonatate ..............................78benzoyl peroxide-erythromycin .80benztropine mesylate ................ 58BEPREVE.............................122BERINERT.......................... 103BESIVANCE........................ 122BETAGAN........................... 122betamethasone dipropionate aug ...........................................80betamethasone valerate ............ 80BETAPACE............................66BETAPACE AF......................66BETASERON.......................131betaxolol hcl ..................... 66, 122bethanechol chloride ............... 139BETHKIS............................... 18BETIMOL.............................122BETOPTIC-S........................ 122BEVESPI AEROSPHERE..... 30BEVYXXA............................. 32bexarotene ............................... 54BEYAZ................................... 72BIAXIN................................ 112bicalutamide .............................54BIDIL..................................... 69BIFERARX.......................... 105BIKTARVY............................61BILTRICIDE..........................28bimatoprost ............................ 122BINOSTO............................... 95bio glo .................................... 122

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BIOSCANNER GLUCOSE TEST.......................................90bisoprolol fumarate .................. 66bisoprolol-hydrochlorothiazide ..48BIVIGAM.............................127BLEPH-10.............................122BLEPHAMIDE.................... 122BLEPHAMIDE S.O.P.......... 122blood glucose test ..................... 90BONIVA................................. 95BONJESTA............................ 43BOSULIF............................... 54BOTOX.................................121bp 10-1 .....................................80bp vit 3 ................................... 105BPROTECTED PEDIA D-VITE..................................... 141BRAFTOVI............................ 54BREO ELLIPTA.................... 30briellyn .....................................72BRILINTA......................94, 103brimonidine tartrate ................122BRISDELLE.........................131BRIVIACT............................. 33bromfenac sodium (once-daily)...............................................122bromocriptine mesylate ............ 58BROMSITE.......................... 123BROVANA.............................30budesonide .................. 30, 77, 121budesonide er ............................77bullseye mini safety lancets ..... 113BULLSEYE SAFETY LANCETS............................ 113bumetanide ...............................94BUNAVAIL........................... 23BUPAP................................... 22BUPHENYL...........................95buprenorphine .......................... 23buprenorphine hcl ..................... 23buprenorphine hcl-naloxone hcl .23bupropion hcl ........................... 36bupropion hcl er (smoking det)...............................................131bupropion hcl er (sr) ................ 36bupropion hcl er (xl) ................36buspirone hcl ............................ 29BUSULFEX........................... 54butalbital-acetaminophen ......... 22butalbital-apap-caff-cod ........... 23

butalbital-apap-caffeine ............22butalbital-asa-caff-codeine ....... 23butalbital-asa-caffeine .............. 22BUTISOL SODIUM.............109butorphanol tartrate ................. 23BUTRANS............................. 23BYDUREON..........................39BYDUREON BCISE..............39BYETTA 10 MCG PEN......... 39BYETTA 5 MCG PEN........... 39BYSTOLIC............................. 66BYVALSON........................... 66cabergoline ...............................95CABOMETYX....................... 54CADUET................................70CAFERGOT.........................115CALAN.................................. 67CALAN SR.............................67CALCIDOL.......................... 141CALCIFEROL..................... 141calcipotriene .............................80calcipotriene-betameth diprop ...80calcitonin (salmon) .................. 95calcitrene ................................. 80calcitriol ............................. 80, 95CALQUENCE........................54CAMBIA.............................. 115CAMPTOSAR........................54CAMRESE............................. 72CAMRESE LO....................... 72CANASA.............................. 100candesartan cilexetil .................48candesartan cilexetil-hctz ......... 48CAPASTAT SULFATE......... 53capecitabine ............................. 54CAPEX................................... 80CAPRELSA............................54captopril ...................................48captopril-hydrochlorothiazide ... 48CARAC.................................. 80CARAFATE......................... 137CARBAGLU.......................... 95carbamazepine ......................... 33carbamazepine er ..................... 33CARBATROL........................ 33carbidopa ................................. 58carbidopa-levodopa .................. 58carbidopa-levodopa er .............. 58carbidopa-levodopa-entacapone 58carbinoxamine maleate .............45

CARDIZEM...........................68CARDIZEM CD.................... 67CARDIZEM LA.....................67CARDURA............................ 48CARDURA XL.................... 102CARESENS N GLUCOSE TEST.......................................90CARIMUNE NF.................. 127carisoprodol ........................... 119carisoprodol-aspirin ................119carisoprodol-aspirin-codeine ... 119CARNITOR........................... 96CARNITOR SF......................96CAROSPIR............................ 94carteolol hcl ............................123CARTIA XT...........................68carvedilol ................................. 66carvedilol phosphate er ............. 66CASODEX............................. 54CATAPRES............................48CATAPRES-TTS-1.................48CATAPRES-TTS-2.................49CATAPRES-TTS-3.................49CAYSTON............................117CAZIANT.............................. 72cefaclor .................................... 70cefaclor er ................................ 70cefadroxil .................................70cefazolin sodium .......................70cefdinir .....................................70cefditoren pivoxil ......................70cefepime hcl ............................. 70cefepime-dextrose .....................71cefixime ................................... 71cefotaxime sodium ....................71cefotetan disodium ....................71cefoxitin sodium ....................... 71cefoxitin sodium-dextrose .........71cefpodoxime proxetil ................ 71cefprozil ................................... 71ceftazidime ...............................71ceftriaxone sodium ................... 71cefuroxime axetil ..................... 71cefuroxime sodium ................... 71CELEBREX............................19celecoxib .................................. 19CELEXA................................ 36CELLCEPT............................ 64CELONTIN............................33CEM-UREA........................... 80

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CENFOL.............................. 105CENTANY.............................80CENTRATEX...................... 105cephalexin ................................ 71CERDELGA.........................105CEREZYME.........................106CERVIDIL........................... 127CESAMET..............................43cetirizine hcl .............................45cetirizine-pseudoephedrine er .... 78CETRAXAL......................... 126cevimeline hcl ......................... 117CHANTIX............................ 131CHANTIX CONTINUING MONTH PAK...................... 131CHANTIX STARTING MONTH PAK...................... 131CHATEAL............................. 72CHEMET............................... 43CHENODAL........................ 100childrens loratadine .................. 45chlordiazepoxide hcl ................. 29chlordiazepoxide-amitriptyline131chlordiazepoxide-clidinium ..... 137chlorhexidine gluconate .......... 117chloroquine phosphate .............. 52chlorothiazide ...........................94chlorpromazine hcl ................... 59chlorpropamide ........................ 39chlorthalidone .......................... 94chlorzoxazone ........................ 119CHOLBAM............................ 67cholestyramine ......................... 46cholestyramine light ................. 46choline-mag trisalicylate ...........22CIALIS................................... 70CICLODAN........................... 80CICLODAN SOLUTION...... 80ciclopirox ................................. 80ciclopirox olamine .................... 81ciclopirox treatment ................. 81cidofovir ...................................61CIFEREX............................. 106cilostazol ................................ 103CILOXAN............................ 123CIMDUO................................61cimetidine ...............................137cimetidine hcl ......................... 137CIMZIA................................100CIMZIA PREFILLED......... 100

CIMZIA STARTER KIT..... 100CINQAIR............................. 110CINRYZE.............................103CIPRO.................................. 100CIPRO HC............................126CIPRO XR............................100CIPRODEX.......................... 126ciprofloxacin .......................... 100ciprofloxacin hcl ............. 100, 126ciprofloxacin-ciproflox hcl er ..100citalopram hydrobromide ..........36CITRANATAL 90 DHA...... 118CITRANATAL B-CALM.... 118CITRANATAL DHA...........118CITRANATAL HARMONY...............................................118CITRANATAL MEDLEY...118CITRANATAL RX..............118claravis .................................... 81CLARINEX............................45CLARINEX-D 12 HOUR...... 78clarithromycin ........................ 112clarithromycin er .................... 112CLARITIN............................. 45CLARITIN EYE...................123CLARITIN REDITABS.........45CLARITIN-D 12 HOUR........78CLARITIN-D 24 HOUR........78CLENPIQ............................. 111CLEOCIN....................... 51, 140CLEOCIN PHOSPHATE.......51CLEOCIN-T........................... 81CLEVER CHEK AUTO-CODE TEST...........................90CLEVER CHEK AUTO-CODE VOICE........................ 90CLEVER CHEK TEST.......... 90CLEVER CHOICE AUTO-CODE TEST...........................90CLEVER CHOICE MICRO TEST.......................................91CLIMARA............................. 98CLIMARA PRO.....................98CLINDACIN ETZ................. 81CLINDACIN PAC................. 81CLINDAGEL.........................81clindamycin hcl .........................51clindamycin phos-benzoyl perox ....................................... 81clindamycin phosphate .51, 81, 140

clindamycin-tretinoin ................81CLINDESSE.........................140clobetasol propionate ................81clobetasol propionate e ............. 81clobetasol propionate emulsion . 81CLOBEX................................ 81CLOBEX SPRAY...................81clocortolone pivalate .................81clodan ...................................... 81CLODERM............................ 81CLODERM PUMP................ 81clomipramine hcl ...................... 36clonazepam .............................. 33clonidine hcl ............................. 49clonidine hcl er ......................... 17clopidogrel bisulfate ................103clorazepate dipotassium ............29clotrimazole ........................... 117clotrimazole-betamethasone ..... 81clozapine .................................. 59CLOZARIL............................ 59COAGADEX........................103COAGUCHEK LANCETS..113coal tar .................................... 81COARTEM............................ 52codeine sulfate ..........................23COLAZAL............................100colchicine ............................... 102colchicine-probenecid ..............103COLCRYS............................ 103colesevelam hcl .........................46COLESTID.............................46COLESTID FLAVORED...... 46colestipol hcl ............................ 46COLY-MYCIN M.................. 51COLY-MYCIN S..................126COLYTE WITH FLAVOR PACKS..................................111COMBIGAN........................ 123COMBIPATCH...................... 98COMBIVENT RESPIMAT....30COMBIVIR............................ 61COMETRIQ (100 MG DAILY DOSE)....................... 54COMETRIQ (140 MG DAILY DOSE)....................... 54COMETRIQ (60 MG DAILY DOSE).....................................54comfort assured lancets 28g .... 113comfort assured lancets 33g .... 113

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COMPLERA.......................... 61COMPRO............................... 59COMTAN...............................58CONCERTA.......................... 17CONDYLOX..........................81CONZIP..................................23COOL BLOOD GLUCOSE TEST STRIPS.........................91COPAXONE.........................131CORDRAN............................ 81COREG.................................. 66COREG CR............................ 66COREMINO.........................135CORGARD............................ 66CORIFACT.......................... 103CORLANOR........................ 134CORTANE-B........................126CORTANE-B AQUEOUS... 126CORTEF................................ 77cortic-nd .................................126CORTIFOAM........................ 27cortisone acetate ...................... 77CORTISPORIN......................81CORVITA 150...................... 106CORVITE 150.......................106CORZIDE.............................. 49COSENTYX........................... 81COSENTYX SENSOREADY PEN............. 81COSOPT............................... 123COSOPT PF..........................123COTELLIC.............................54COTEMPLA XR-ODT.......... 17COUMADIN..........................32COZAAR................................49CREON.................................. 94CRESEMBA...........................44CRESTOR.............................. 46CRINONE............................ 140CRIXIVAN............................ 61cromolyn sodium ...............30, 123CROTAN................................81CRYSELLE-28....................... 72CUPRIMINE......................... 65CUTIVATE............................ 81CUVITRU............................ 127CUVPOSA............................ 137CVS ADVANCED GLUCOSE TEST................... 91cvs d3 ..................................... 141

cyanocobalamin ......................106CYCLAFEM 1/35...................72cyclobenzaprine hcl .................119CYCLOGYL.........................123CYCLOMYDRIL.................123cyclopentolate hcl ................... 123cyclophosphamide .................... 54cycloserine ............................... 53CYCLOSET............................39cyclosporine ............................. 65cyclosporine modified ............... 65CYMBALTA.......................... 36cyotic ..................................... 126cyproheptadine hcl ....................45CYSTADANE........................ 96CYSTAGON.........................102CYSTARAN.........................123CYTOGAM.......................... 127CYTOMEL........................... 136CYTOTEC............................ 137CYTOVENE...........................61cytra-2 ................................... 102CYTRA-3..............................102cytra-k ................................... 102d 10000 .................................. 141d 2000 .................................... 141d 400 ...................................... 141d 5000 .................................... 141D.H.E. 45.............................. 115d-2000 maximum strength ...... 142d2000 ultra strength ................142D3 DOTS.............................. 142d3 maximum strength ............. 142d3 super strength .................... 142d3-1000 .................................. 142d-3-5 ...................................... 142D3-50.....................................142d-5000 ....................................142DAKLINZA........................... 61DALIRESP.............................30danazol .................................... 26DANTRIUM........................ 120dantrolene sodium ...................120dapsone .............................. 52, 81DARAPRIM.......................... 52darifenacin hydrobromide er ... 139DASETTA 1/35.......................72DASETTA 7/7/7......................72DAXBIA.................................71DAYPRO................................19

DAYSEE.................................72DAYTRANA......................... 17DDAVP.................................. 96DDAVP RHINAL TUBE...... 96DDROPS.............................. 142DEBACTEROL....................117DECARA..............................142deferoxamine mesylate ....... 42, 43DELYLA................................ 72DELZICOL...........................100DEMADEX............................94demeclocycline hcl .................. 135DEMSER................................49DENAVIR..............................81DEPAKENE...........................33DEPAKOTE...........................33DEPAKOTE ER.....................33DEPAKOTE SPRINKLES.... 33DEPEN TITRATABS............ 65DEPO-PROVERA..................72DEPO-TESTOSTERONE...... 27DERMA-SMOOTHE/FS BODY..................................... 82DERMA-SMOOTHE/FS SCALP.................................... 82DERMOTIC......................... 126DESCOVY..............................61DESFERAL............................43desipramine hcl .........................36desloratadine ............................45desmopressin ace spray refrig ... 96desmopressin acetate ................ 96desmopressin acetate spray .......96desogestrel-ethinyl estradiol ......72DESONATE........................... 82desonide ................................... 82DESOWEN.............................82desoximetasone ........................ 82DESOXYN............................. 17desvenlafaxine er ......................36desvenlafaxine succinate er .......36DETROL.............................. 139DETROL LA........................ 139dexamethasone .........................77DEXAMETHASONE INTENSOL............................ 77dexamethasone sodium phosphate ............................... 123DEXEDRINE.........................17DEXILANT..........................137

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dexmethylphenidate hcl ............ 17dexmethylphenidate hcl er ........ 17dextroamphetamine sulfate .......17dextroamphetamine sulfate er ...17DIALYVITE VITAMIN D 5000....................................... 142DIALYVITE VITAMIN D3 MAX..................................... 142DIASTAT ACUDIAL............33DIASTAT PEDIATRIC.........33diatrue plus test ........................ 91diazepam ............................ 29, 33DIAZEPAM INTENSOL.......29DIBENZYLINE..................... 49DICLEGIS..............................43diclofenac potassium .................19diclofenac sodium ........ 19, 82, 123diclofenac sodium er ................. 19diclofenac-misoprostol ..............19DICLOFEX DC..................... 82dicloxacillin sodium ................ 129dicyclomine hcl .......................137didanosine ................................ 61DIDREX.................................17DIFFERIN............................. 82DIFICID...............................112diflorasone diacetate .................82DIFLUCAN........................... 44diflunisal .................................. 22DIGITEK............................... 69DIGOX................................... 69digoxin .....................................69dihydroergotamine mesylate....................................... 115, 116DILANTIN............................ 33DILANTIN INFATABS........ 33DILATRATE-SR................... 28DILAUDID............................23diltiazem cd ..............................68diltiazem hcl .............................68diltiazem hcl er .........................68diltiazem hcl er beads ............... 68diltiazem hcl er coated beads .... 68dilt-xr ...................................... 68DIOVAN................................ 49DIOVAN HCT....................... 49DIPENTUM......................... 100diphenatol ................................ 42diphenoxylate-atropine .............42DIPROLENE......................... 82

DIPROLENE AF................... 82dipyridamole .......................... 103disopyramide phosphate ............29disulfiram ...............................131DITROPAN XL................... 139DIURIL.................................. 94divalproex sodium .................... 33divalproex sodium er ................ 33DIVIGEL................................99DIVISTA.............................. 106dofetilide .................................. 29DOLOPHINE.........................23donepezil hcl ...........................131DOPTELET.......................... 106DORAL................................ 109DORYX................................ 135DORYX MPC...................... 135dorzolamide hcl ...................... 123dorzolamide hcl-timolol mal ....123DOVONEX............................ 82doxazosin mesylate ...................49doxepin hcl ......................... 36, 82doxercalciferol ......................... 96doxycycline .............................. 82doxycycline hyclate ................ 135doxycycline monohydrate ....... 135DRISDOL.............................142dronabinol ................................43drospirenone-ethinyl estradiol...........................................72, 73DUAC.....................................82DUAVEE................................99DUETACT............................. 39DUEXIS................................. 19DULERA................................31duloxetine hcl ........................... 36DUO-CARE TEST.................91DUOPA.................................. 58DUPIXENT............................66durachol ................................. 106DURAGESIC-100.................. 23DURAGESIC-12....................23DURAGESIC-25....................23DURAGESIC-50....................23DURAGESIC-75....................23DUREZOL........................... 123DURLAZA...........................103DUROLANE........................120dutasteride ............................. 102dutasteride-tamsulosin hcl .......102

DUTOPROL.......................... 49DUZALLO........................... 103D-VI-SOL............................. 142DYANAVEL XR................... 17DYAZIDE.............................. 94DYMISTA............................ 121DYRENIUM..........................94DYSPORT............................ 121E.E.S. 400.............................. 112E.E.S. GRANULES..............112easy plus blood glucose test .......91EASY STEP TEST..................91easy talk blood glucose test .......91EASY TOUCH LANCETS 21G........................................113EASY TOUCH LANCETS 23G........................................113EASY TOUCH LANCETS 26G........................................114EASY TOUCH LANCETS 26G/TWIST...........................114EASY TOUCH LANCETS 28G........................................114EASY TOUCH LANCETS 28G/TWIST...........................114EASY TOUCH LANCETS 30G........................................114EASY TOUCH LANCETS 30G/TWIST...........................114EASY TOUCH LANCETS 32G........................................114EASY TOUCH LANCETS 32G/TWIST...........................114EASY TOUCH LANCETS 33G/TWIST...........................114EASY TOUCH LANCING DEVICE................................114EASY TOUCH SAFETY LANCETS 21G.....................114EASY TOUCH SAFETY LANCETS 23G.....................114EASY TOUCH SAFETY LANCETS 26G.....................114EASY TOUCH SAFETY LANCETS 28G.....................114EASY TOUCH TEST.............91easy trak blood glucose test ...... 91EASY TWIST & CAP LANCETS............................ 114EASYGLUCO........................ 91

150

EASYGLUCO PLUS............. 91EASYMAX 15 TEST..............91EASYMAX TEST.................. 91easyplus blood glucose test ........91EASYPRO BLOOD GLUCOSE TEST................... 91EASYPRO PLUS................... 91EC-NAPROSYN.................... 19econazole nitrate ...................... 82ECOZA................................... 82EDARBI................................. 49EDARBYCLOR.....................49EDECRIN.............................. 94EDLUAR..............................109EDURANT............................ 61efavirenz .................................. 61EFFEXOR XR....................... 36EFFIENT..............................103EFUDEX................................82ELAPRASE............................ 96ELDEPRYL........................... 58ELELYSO.............................106element compact test ................ 91ELEMENT TEST...................91ELESTAT............................. 123ELESTRIN............................. 99eletriptan hydrobromide ..........116ELIDEL..................................82ELIGARD.............................. 54ELIMITE................................82ELINEST................................73ELIQUIS.................................32ELIQUIS STARTER PACK.. 32ELIXOPHYLLIN...................31ELLA...................................... 73ELMIRON............................102ELOCON................................82ELOCTATE..........................104EMADINE........................... 123EMBEDA............................... 23EMBRACE BLOOD GLUCOSE TEST................... 91EMBRACE EVO BLOOD GLUCOSE TEST................... 91EMBRACE PRO GLUCOSE TEST.......................................91EMCYT.................................. 54EMEND..................................43EMFLAZA............................. 77EMOQUETTE........................73

EMSAM..................................36EMTRIVA..............................61EMVERM.............................. 28ENABLEX............................140enalapril maleate ......................49enalapril-hydrochlorothiazide ... 49ENBREL................................ 19ENBREL MINI...................... 19ENBREL SURECLICK......... 19ENDARI.................................18ENDOCET............................. 23enoxaparin sodium ................... 32ENPRESSE-28........................73ENSKYCE..............................73ENSTILAR.............................82entacapone ............................... 58entecavir .................................. 61ENTOCORT EC.....................77ENTRESTO..........................121ENTYVIO.............................110enulose ................................... 100ENVARSUS XR.....................65EPANED................................ 49EPCLUSA.............................109EPIDUO................................. 82EPIDUO FORTE................... 82epinastine hcl ..........................123epinephrine .............................141EPIPEN 2-PAK.................... 141EPIPEN JR 2-PAK............... 141EPISNAP.............................. 141EPITOL.................................. 33EPIVIR................................... 61EPIVIR HBV.................... 61, 62eplerenone ................................ 49EPOGEN.............................. 106epoprostenol sodium ................. 70eprosartan mesylate ..................49EPZICOM.............................. 62eq aspirin low dose ....................22eql vitamin d3 ......................... 142EQUETRO............................. 59ergocal ................................... 142ergocalciferol ......................... 142ergoloid mesylates .................. 131ERGOMAR..........................116ERIVEDGE............................54ERLEADA............................. 55ERRIN....................................73ERTACZO..............................83

ery ........................................... 83ERYPED 200........................ 112ERYPED 400........................ 112ERY-TAB............................. 112ERYTHROCIN STEARATE...............................................112erythromycin .................... 83, 123erythromycin base .................. 112erythromycin ethylsuccinate ....112erythromycin stearate .............112ESBRIET.............................. 133escitalopram oxalate ................ 36ESGIC.....................................22esomeprazole magnesium ........137esomeprazole strontium .......... 137ESTARYLLA......................... 73estazolam ............................... 109ESTRACE....................... 99, 140estradiol ............................99, 140estradiol valerate ......................99estradiol-norethindrone acet ..... 99ESTRING............................. 140ESTROGEL............................99ESTROSTEP FE.....................73eszopiclone ............................. 109ethacrynic acid ......................... 94ethambutol hcl ..........................53ethosuximide ............................ 33ETHYOL................................ 55etidronate disodium .................. 96etodolac ................................... 19etodolac er ............................... 19etoposide .................................. 55EUCRISA............................. 129EUFLEXXA......................... 120EURAX.................................. 83EVAMIST...............................99EVEKEO................................ 17EVENCARE BLOOD GLUCOSE TEST................... 91EVENCARE G2 TEST...........91EVENCARE G3 TEST...........91EVENCARE MINI GLUCOSE TEST................... 91EVISTA.................................. 96EVOCLIN...............................83EVOLUTION AUTOCODE..91EVOTAZ................................ 62EVOXAC.............................. 117EVZIO.................................... 43

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EXALGO................................23EXELDERM.......................... 83EXELON.............................. 131exemestane ...............................55EXFORGE............................. 49EXFORGE HCT.................... 49EXJADE................................. 43exotic-hc ................................ 126EXTAVIA.............................132EXTINA................................. 83eye itch relief ..........................123EYLEA................................. 123EZ SMART BLOOD GLUCOSE TEST................... 91EZ SMART PLUS GLUCOSE TEST................... 91ezetimibe ..................................46ezetimibe-simvastatin ............... 46fabb ........................................106FABIOR................................. 83FABRAZYME....................... 96FALMINA............................. 73famciclovir ............................... 62famotidine .............................. 137FANAPT................................ 59FANAPT TITRATION PACK..................................... 59FARESTON........................... 55FARXIGA..............................39FARYDAK............................ 55FASLODEX........................... 55fa-vitamin b-6-vitamin b-12 .....106FAYOSIM.............................. 73FAZACLO..............................59FC2 FEMALE CONDOM... 114FEIBA...................................104felbamate ................................. 33FELBATOL............................34FELDENE..............................20felodipine er ............................. 68FEM PH................................140FEMARA............................... 55FEMCAP.............................. 114FEMHRT LOW DOSE.......... 99FEMRING........................... 140fenofibrate ..........................46, 47fenofibrate micronized ..............46fenofibric acid .......................... 47FENOGLIDE......................... 47fenoprofen calcium ................... 20

fentanyl ....................................23fentanyl citrate .........................23FENTORA............................. 23FERIVA 21/7........................ 106ferocon ................................... 106ferotrinsic ...............................106ferraplus 90 ............................ 106FERRIPROX......................... 43FERRLECIT........................ 106FERROCITE PLUS............. 106FERRO-PLEX HEMATINIC....................... 106FERROTRIN....................... 106FETZIMA.............................. 36FETZIMA TITRATION........36fexofenadine hcl ....................... 45fexofenadine hcl childrens .........45fexofenadine-pseudoephed er .... 78FIASP..................................... 39FIASP FLEXTOUCH............ 39FIBRICOR............................. 47FIBRYGA............................ 104FIFTY50 GLUCOSE TEST 2.0............................................91FINACEA.............................. 83finasteride .............................. 102FINGERSTIX LANCETS... 114FIORICET..............................22FIORICET/CODEINE...........24FIORINAL.............................22FIORINAL/CODEINE #3.....24FIRAZYR.............................104FIRMAGON.......................... 55FIRST-LANSOPRAZOLE...137FIRST-OMEPRAZOLE.......137FIRVANQ.............................. 52FLAGYL................................ 52FLAREX.............................. 123flavoxate hcl ...........................140FLEBOGAMMA DIF..........127flecainide acetate ......................29FLECTOR.............................. 83FLOLAN................................ 70flolipid ..................................... 47FLOMAX............................. 102FLONASE............................ 121FLONASE ALLERGY RELIEF................................ 121FLOVENT DISKUS.............. 31FLOVENT HFA.....................31

FLOXIN OTIC..................... 127flucaine .................................. 123fluconazole ...............................44flucytosine ................................44fludrocortisone acetate ............. 77FLUMADINE........................62flunisolide ...............................121fluocinolone acetonide .......83, 127fluocinolone acetonide body ...... 83fluocinolone acetonide scalp ......83fluocinonide ..............................83FLUORABON......................116fluorescein-benoxinate ............ 123fluor-i-strips a.t. ..................... 123fluorometholone ..................... 123FLUOROPLEX......................83fluorouracil .............................. 83fluoxetine hcl ...................... 36, 37fluoxetine hcl (pmdd) .............132fluphenazine hcl ........................59FLURA-DROPS.................. 117flurandrenolide ......................... 83flurazepam hcl ........................109flurbiprofen .............................. 20flurbiprofen sodium .................123flutamide ..................................55fluticasone propionate ....... 83, 121fluticasone-salmeterol ...............31fluvastatin sodium .................... 47fluvastatin sodium er ................ 47fluvoxamine maleate .................37fluvoxamine maleate er .............37FML......................................123FML FORTE........................123FML LIQUIFILM................123FOCALIN.............................. 17FOCALIN XR........................17folbee ..................................... 106FOLGARD RX.................... 106folic acid ................................ 106FOLIVANE-F...................... 106FOLIVANE-PLUS............... 106folplex 2.2 .............................. 106foltrin .....................................106fondaparinux sodium ................ 32FORA D15G BLOOD GLUCOSE TEST................... 91FORA D20 BLOOD GLUCOSE TEST................... 91

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FORA D40/G31 BLOOD GLUCOSE..............................91FORA G20 BLOOD GLUCOSE TEST................... 91FORA G30/PREM V10 GLUCOSE TEST................... 91FORA GD20 TEST................ 92FORA GD50 BLOOD GLUCOSE TEST................... 92FORA TN'G/TN'G VOICE....92FORA V10 BLOOD GLUCOSE TEST................... 92FORA V12 BLOOD GLUCOSE TEST................... 92FORA V20 BLOOD GLUCOSE TEST................... 92FORA V30A BLOOD GLUCOSE TEST................... 92FORACARE GD40 TEST..... 92FORACARE PREMIUM V10 TEST................................92FORACARE TEST N GO TEST.......................................92FORFIVO XL........................ 37FORTAMET.......................... 39FORTEO................................ 96FORTESTA............................27FORTISCARE TEST............. 92FOSAMAX.............................96FOSAMAX PLUS D.............. 96fosamprenavir calcium ..............62fosinopril sodium ...................... 49fosinopril sodium-hctz ...............49FOSRENOL......................... 100FRAGMIN.............................32FREESTYLE INSULINX TEST.......................................92FREESTYLE LANCETS..... 114FREESTYLE LITE TEST......92FREESTYLE PRECISION NEO TEST..............................92FREESTYLE TEST............... 92FREESTYLE UNISTICK II LANCETS............................ 114FROVA.................................116frovatriptan succinate ............. 116FUL-GLO.............................123ful-glo .................................... 123FULPHILA.......................... 106FURADANTIN................... 139

furosemide ................................94FUSION PLUS.....................106FUZEON................................62FYAVOLV............................. 99FYCOMPA.............................34gabapentin ............................... 34GABITRIL............................. 34galantamine hydrobromide ..... 132galantamine hydrobromide er ..132GALZIN............................... 117GAMASTAN S/D.................127GAMMAGARD...................127GAMMAGARD S/D LESS IGA....................................... 127GAMMAKED......................128GAMMAPLEX.................... 128GAMUNEX-C......................128ganciclovir sodium ....................62gatifloxacin ............................ 123GATTEX.............................. 101gavilax ................................... 111GAVILYTE-H......................111ge100 blood glucose test ........... 92GELCLAIR.......................... 117GELNIQUE..........................140GEL-ONE.............................120GELSYN-3........................... 120gemfibrozil ............................... 47GENERESS FE...................... 73gengraf .....................................65GENOTROPIN...................... 96GENOTROPIN MINIQUICK..........................96GENSTRIP 50........................ 92gentamicin sulfate ....... 18, 83, 124GENVOYA............................ 62GEODON............................... 59ght test .....................................92GIANVI..................................73GILDESS FE 1.5/30................73GILDESS FE 1/20.................. 73GILENYA............................ 132GILOTRIF............................. 55GLASSIA..............................134GLEEVEC.............................. 55GLEOSTINE.......................... 55glimepiride ............................... 39glipizide ................................... 39glipizide er ............................... 39glipizide xl ............................... 39

glipizide-metformin hcl ............. 39GLUCAGEN HYPOKIT.......39GLUCAGON EMERGENCY.......................39GLUCO PERFECT 3 TEST...92GLUCOCARD 01 SENSOR PLUS...................................... 92GLUCOCARD EXPRESSION TEST..............92GLUCOCARD SHINE TEST.......................................92GLUCOCARD VITAL TEST.......................................92GLUCOCARD X-SENSOR...92GLUCOCOM TEST...............92GLUCONAVII BLOOD GLUCOSE TEST................... 92GLUCOPHAGE.....................39GLUCOPHAGE XR.............. 39GLUCOTROL........................39GLUCOTROL XL................. 39GLUCOVANCE.....................39GLUMETZA..........................39glyburide .................................. 40glyburide micronized ................ 39glyburide-metformin .................40glycopyrrolate ........................ 137GLYNASE............................. 40GLYSET.................................40GLYXAMBI.........................134gnp folic acid .......................... 106gnp vitamin d ..........................142gnp vitamin d maximum strength ..................................142gnp vitamin d super strength ... 142GOCOVRI..............................58GOLYTELY......................... 111GONITRO..............................28GORDONS UREA................ 83GRALISE......................130, 132GRALISE STARTER...130, 132granisetron hcl ......................... 43GRANIX.............................. 107griseofulvin microsize ............... 44griseofulvin ultramicrosize ........44guaifenesin ac ...........................78guaifenesin-codeine .................. 78guanfacine hcl .......................... 49guanfacine hcl er ...................... 17guanidine hcl ............................ 53

153

GYNAZOLE-1..................... 140HAEGARDA....................... 104HALCION............................ 109halobetasol propionate ..............83HALOG.................................. 83haloperidol ............................... 59haloperidol lactate ....................59HARVONI............................109heartburn relief 150 max st ..... 137HEATHER............................. 73HECTOROL...........................96HELIXATE FS..................... 104HEMANGEOL...................... 66hematinic plus vit/minerals ......107hematinic/folic acid .................107HEMATOGEN FA.............. 107HEMATOGEN FORTE.......107hemetab ..................................107HEMLIBRA........................... 45HEMOCYTE PLUS............. 107HEMOCYTE-F.................... 107hemocyte-plus .........................107HEMOFIL M....................... 104HEPAGAM B.......................128heparin sodium (porcine) ......... 32heparin sodium (porcine) pf ..... 32HEPSERA.............................. 62HETLIOZ............................. 109HEXALEN............................. 55HIPREX................................139HIZENTRA..........................128hm folic acid ...........................107hm vitamin d3 .........................142HORIZANT......................... 132HP ACTHAR......................... 96HUMALOG........................... 40HUMALOG KWIKPEN....... 40HUMALOG MIX 50/50......... 40HUMALOG MIX 50/50 KWIKPEN............................. 40HUMALOG MIX 75/25......... 40HUMALOG MIX 75/25 KWIKPEN............................. 40HUMATE-P......................... 104HUMATROPE.......................96HUMIRA............................... 20HUMIRA PEDIATRIC CROHNS START.................. 20HUMIRA PEN.......................20

HUMIRA PEN-CD/UC/HS STARTER.............................. 20HUMIRA PEN-PS/UV STARTER.............................. 20HUMULIN 70/30................... 40HUMULIN 70/30 KWIKPEN............................. 40HUMULIN N.........................40HUMULIN N KWIKPEN.....40HUMULIN R.........................40HUMULIN R U-500 (CONCENTRATED)............. 40HUMULIN R U-500 KWIKPEN............................. 40HYALGAN.......................... 120HYCAMTIN.......................... 55hydralazine hcl ......................... 49HYDREA............................... 55hydrochlorothiazide ..................94hydrocod polst-cpm polst er ...... 78hydrocodone-acetaminophen .....24hydrocodone-homatropine ........ 78hydrocodone-ibuprofen ............. 24hydrocortisone .............. 27, 77, 84hydrocortisone ace-pramoxine...........................................27, 83hydrocortisone acetate ........ 27, 84hydrocortisone butyr lipo base .. 84hydrocortisone butyrate ............84hydrocortisone valerate ............ 84hydrocortisone-acetic acid ...... 127hydromorphone hcl ...................24hydromorphone hcl er ............... 24hydroxychloroquine sulfate .......52hydroxyprogesterone caproate 130hydroxyurea .............................55hydroxyzine hcl ........................ 29hydroxyzine pamoate ............... 29HYLAFEM............................ 65HYMOVIS............................120hyophen ..................................139hyoscyamine sulfate ................137HYPERHEP B S/D...............128HYPERRAB.........................128HYPERRHO S/D................. 128HYPERTET S/D...................128HYQVIA...............................127HYSINGLA ER..................... 24HYZAAR............................... 49ibandronate sodium .................. 96

IBRANCE.............................. 79IBUDONE..............................24ibudone .................................... 24ibuprofen ..................................20IBUPROFEN COMFORT PAC........................................ 20IC 400......................................20IC 800......................................20ICLUSIG................................ 55IDELVION........................... 104IDHIFA................................ 111ILARIS................................... 20ILEVRO................................124imatinib mesylate ..................... 55IMBRUVICA......................... 55imipramine hcl ..........................37imipramine pamoate ................. 37imiquimod ................................ 84IMITREX............................. 116IMITREX STATDOSE REFILL................................ 116IMITREX STATDOSE SYSTEM...............................116IMPAVIDO............................ 52IMPOYZ.................................84IMURAN............................... 65IMVEXXY MAINTENANCE PACK.....140IMVEXXY STARTER PACK....................................140IN TOUCH BLOOD GLUCOSE TEST................... 92INCRELEX............................ 96INCRUSE ELLIPTA............. 31indapamide ...............................95INDERAL LA........................66INDERAL XL........................66INDOCIN...............................20indomethacin ............................20indomethacin er ........................20INFINITY BLOOD GLUCOSE TEST................... 92INFLECTRA........................101INGREZZA..........................132INLYTA................................. 55INNOPRAN XL.....................66INSPRA..................................49insulin syringe ........................ 114insulin syringe/needle ..............114insulin syringe-needle u-100 .... 114

154

INTEGRA F.........................107INTEGRA PLUS..................107INTELENCE..........................62INTERMEZZO.................... 109INTRAROSA....................... 140INTRON A.............................55INTROVALE......................... 73INTUNIV............................... 17INVEGA.................................59INVIRASE............................. 62INVOKAMET...................... 134INVOKAMET XR............... 134INVOKANA.......................... 40IOPIDINE............................ 124ipratropium bromide ......... 31, 121ipratropium-albuterol ............... 31IPRIVASK..............................32irbesartan .................................49irbesartan-hydrochlorothiazide . 49IRESSA...................................55irinotecan hcl ............................55IROSPAN 24/6......................107IS 24/6................................... 107ISENTRESS........................... 62ISENTRESS HD.................... 62ISIBLOOM............................. 73isoniazid ...................................53ISOPTO CARPINE.............. 124ISORDIL TITRADOSE.........28isosorbide dinitrate ................... 28isosorbide dinitrate er ............... 28isosorbide mononitrate ............. 28isosorbide mononitrate er ..........28isradipine ................................. 68ISTALOL..............................124itraconazole ............................. 44ivermectin ................................ 28IXINITY...............................104JADENU................................ 43JADENU SPRINKLE............43JAKAFI.................................. 55JALYN..................................102JANTOVEN........................... 33JANUMET............................. 40JANUMET XR...................... 40JANUVIA...............................40JARDIANCE......................... 40JENCYCLA............................73JENTADUETO...................... 40JENTADUETO XR............... 40

JETREA................................124jevantique lo ............................. 99JEVTANA.............................. 55JINTELI................................. 99JOLESSA................................73JOLIVETTE........................... 73JUBLIA.................................. 84JULUCA.................................62JUNEL 1.5/30......................... 73JUNEL 1/20............................ 73JUNEL FE 1.5/30................... 73JUNEL FE 1/20...................... 73JUXTAPID.............................47JYNARQUE...........................96KADIAN................................ 24KALBITOR.......................... 104KALETRA............................. 62KALYDECO........................ 134KANUMA............................112KAPSPARGO SPRINKLE....66KAPVAY................................17KARBINAL ER..................... 45KARIVA.................................73KAZANO............................... 41KCENTRA........................... 104KEFLEX................................ 71KELNOR 1/35........................ 73KENALOG............................ 84KEPPRA.................................34KEPPRA XR.......................... 34KERALYT............................. 84KERYDIN............................127ketoconazole .......................44, 84ketoprofen er ............................20ketorolac tromethamine .... 20, 124ketotifen fumarate .................. 124KEVEYIS............................... 95KEVZARA............................. 20KHEDEZLA.......................... 37KINERET.............................. 20KIONEX......................... 65, 130KISQALI 200 DOSE.............. 79KISQALI 400 DOSE.............. 79KISQALI 600 DOSE.............. 79KISQALI FEMARA 200 DOSE......................................55KISQALI FEMARA 400 DOSE......................................55KISQALI FEMARA 600 DOSE......................................55

KLARON............................... 84KLOFENSAID II...................84KLONOPIN........................... 34KLOR-CON......................... 117KLOR-CON 10.....................117KOATE.................................104KOATE-DVI........................ 104KOGENATE FS...................104KOGENATE FS BIO-SET...104KOMBIGLYZE XR...............41KORLYM...............................41KOVALTRY........................ 104kp folic acid ............................107K-PHOS-NEUTRAL............117KRISTALOSE......................111kroger blood glucose test .......... 92kroger test ................................92KRYSTEXXA...................... 103K-TAB.................................. 117K-TAN PLUS....................... 107KURVELO.............................73KUVAN..................................96KYLEENA............................. 73KYNAMRO........................... 47labetalol hcl ..............................66LACRISERT........................ 124lactic acid .................................84lactulose ................................. 111lactulose encephalopathy ........ 101LAMICTAL........................... 34LAMICTAL ODT.................. 34LAMICTAL STARTER.........34LAMICTAL XR.....................34LAMISIL................................44lamivudine ................................62lamivudine-zidovudine .............. 62lamotrigine ...............................34lamotrigine er ...........................34lamotrigine starter kit-blue ....... 34lamotrigine starter kit-green ..... 34lamotrigine starter kit-orange ...34lancets ....................................114lancets super thin 28g ............. 114LANCETS ULTRA THIN... 114lancets ultra thin 30g .............. 114LANOXIN..............................69lansoprazole ........................... 137lanthanum carbonate .............. 101LANTUS................................ 41LANTUS SOLOSTAR........... 41

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LARIN 1.5/30......................... 73LARIN 1/20............................ 73LARIN FE 1.5/30................... 73LARIN FE 1/20...................... 73LASIX.....................................95LASTACAFT....................... 124latanoprost ............................. 124LATUDA................................59LAZANDA.............................24LDO PLUS............................. 84LEENA................................... 74leflunomide ...............................20LEMTRADA........................132LENVIMA 10 MG DAILY DOSE......................................56LENVIMA 14 MG DAILY DOSE......................................56LENVIMA 18 MG DAILY DOSE......................................56LENVIMA 20 MG DAILY DOSE......................................56LENVIMA 24 MG DAILY DOSE......................................56LENVIMA 8 MG DAILY DOSE......................................56LESCOL................................. 47LESCOL XL........................... 47LESSINA................................74LETAIRIS.............................. 70letrozole ................................... 56leucovorin calcium ....................56LEUKERAN.......................... 56LEUKINE............................ 107leuprolide acetate ..................... 56levalbuterol hcl ......................... 31LEVAQUIN..........................100LEVEMIR.............................. 41LEVEMIR FLEXTOUCH..... 41levetiracetam ............................34levetiracetam er ........................34levobunolol hcl ........................124levocarnitine .............................96levocetirizine dihydrochloride ... 45levofloxacin .................... 100, 124LEVONEST............................74levonorgest-eth estrad 91-day ... 74levonorgestrel ...........................74levonorgestrel-ethinyl estrad ..... 74LEVORA 0.15/30 (28).............74levorphanol tartrate ..................24

levothyroxine sodium ..............136LEVOXYL............................136LEVULAN KERASTICK......84LEXAPRO..............................37LEXIVA..................................62LIALDA............................... 101LIBERTY NEXT GENERATION TEST........... 92liberty test ................................92LIBRAX............................... 137lidocaine ...................................84lidocaine hcl ............................. 84lidocaine pak ............................ 84lidocaine viscous ..................... 118lidocaine-hydrocortisone ace .....27lidocaine-prilocaine .................. 84lidocaine-tetracaine .................. 84LIDODERM.......................... 84LIFESCAN UNISTIK 2.......114LIFESCAN UNISTIK II LANCETS............................ 114lindane ..................................... 84linezolid ................................... 52LINZESS.............................. 101liothyronine sodium ................ 136LIPITOR.................................47LIPOFEN............................... 47lisinopril ...................................49lisinopril-hydrochlorothiazide ... 49lite touch lancets .....................114LITETOUCH LANCETS.....114lithium ..................................... 59lithium carbonate ..................... 60lithium carbonate er ................. 59LITHOBID............................. 60LIVALO..................................47LO LOESTRIN FE.................74LOCOID................................. 84LOCOID LIPOCREAM.........84LODINE................................. 20LODOSYN............................. 58LOESTRIN 1.5/30 (21)........... 74LOESTRIN 1/20 (21).............. 74LOMOTIL.............................. 42LONHALA MAGNAIR REFILL KIT.......................... 31LONHALA MAGNAIR STARTER KIT...................... 31LONSURF............................. 56LOPID.................................... 47

lopinavir-ritonavir .................... 62LOPRESSOR HCT.................50LOPROX................................ 84loratadine .................................45loratadine childrens .................. 45loratadine-d 12hr ......................78loratadine-d 24hr ......................78lorazepam ................................ 29LORCET................................ 24LORCET HD......................... 24LORCET PLUS......................24LORTAB................................ 24LORYNA............................... 74LORZONE........................... 120losartan potassium ....................50losartan potassium-hctz ............ 50LOSEASONIQUE..................74LOTEMAX...........................124LOTENSIN............................ 50LOTREL.................................50LOTRISONE..........................84LOTRONEX.........................101lovastatin ................................. 47LOVAZA................................ 47LOVENOX............................. 33LOW-OGESTREL................. 74loxapine succinate .................... 60LUCEMYRA......................... 18LUCENTIS...........................124luliconazole .............................. 85LUMIGAN...........................124LUMIZYME.......................... 96LUNESTA............................ 109LUPANETA PACK............. 111LUPRON DEPOT (1-MONTH)................................ 56LUPRON DEPOT (3-MONTH)................................ 56LUPRON DEPOT (4-MONTH)................................ 56LUPRON DEPOT (6-MONTH)................................ 56LUPRON DEPOT-PED (1-MONTH)................................ 97LUPRON DEPOT-PED (3-MONTH)................................ 97LUTERA................................ 74LUXIQ....................................85LUZU..................................... 85LYNPARZA.........................130

156

LYRICA................................. 34LYRICA CR................. 130, 132LYSODREN...........................56LYSTEDA............................ 109LYZA......................................74MACROBID.........................139MACRODANTIN................139MACUGEN..........................124MAKENA............................ 130MALARONE......................... 52malathion .................................85maprotiline hcl ......................... 37MARINOL............................. 43marlissa ................................... 74MARPLAN............................ 37MATULANE......................... 56MATZIM LA......................... 68MAVIK...................................50MAVYRET...........................109MAXALT............................. 116MAXALT-MLT................... 116MAXFE................................ 107MAXIDEX........................... 124MAXIMUM D3................... 142MAXIPIME............................71MAXITROL......................... 124MAXZIDE............................. 95MAXZIDE-25.........................95meclofenamate sodium ............. 20MEDROL...............................77medroxyprogesterone acetate......................................... 74, 130mefenamic acid .........................20mefloquine hcl .......................... 52MEGACE ES........................130megestrol acetate .............. 56, 130meijer blood glucose test ...........92MEIJER TRUETEST TEST.. 92MEIJER TRUETRACK TEST.......................................92MEKINIST.............................56MEKTOVI..............................56meloxicam ................................20melphalan .................................56melphalan hcl ........................... 56memantine hcl ........................ 132memantine hcl er .................... 132MENEST................................ 99MENOSTAR.......................... 99meperidine hcl .......................... 24

MEPHYTON........................142meprobamate ........................... 29MEPRON............................... 52mercaptopurine ........................ 56mesalamine ............................ 101MESTINON........................... 53METADATE ER....................17metaproterenol sulfate ..............31metaxalone .............................120metformin hcl ........................... 41metformin hcl er ....................... 41metformin hcl er (mod) ............41metformin hcl er (osm) ............ 41methadone hcl .......................... 24METHADONE HCL INTENSOL............................ 24METHADOSE....................... 24METHADOSE SUGAR-FREE...................................... 24methamphetamine hcl ...............17methazolamide ......................... 95methenamine hippurate ...........139methenamine mandelate ..........139METHERGINE................... 127methimazole ........................... 136methitest .................................. 27methocarbamol .......................120methotrexate ............................56methotrexate sodium (pf) ........ 56methoxsalen rapid .................... 85methyclothiazide ...................... 95methyldopa .............................. 50methyldopa-hydrochlorothiazide ..................50METHYLIN...........................17methylphenidate hcl ..................18methylphenidate hcl er ..............18methylphenidate hcl er (cd) ......18methylphenidate hcl er (la) ...... 18methylprednisolone ...................77methyltestosterone ................... 27metipranolol ........................... 124metoclopramide hcl .................101metolazone ...............................95metoprolol succinate er .............66metoprolol tartrate ................... 66metoprolol-hctz er .................... 50metoprolol-hydrochlorothiazide 50METROCREAM................... 85METROGEL.......................... 85

METROGEL-VAGINAL.....140METROLOTION...................85metronidazole ..............52, 85, 140MEVACOR............................ 47mexiletine hcl ........................... 29MIACALCIN......................... 97MIBELAS 24 FE.................... 74MICARDIS............................ 50MICARDIS HCT................... 50miconazole 3 ...........................140MICORT-HC......................... 85MICRHOGAM ULTRA-FILTERED PLUS................ 128MICRODOT TEST................ 93MICROGESTIN 1.5/30.......... 74MICROGESTIN 1/20.............74MICROGESTIN FE 1.5/30.... 74MICROGESTIN FE 1/20....... 74MICROLET LANCETS.......114MICROTAINER SAFETY FLOW LANCET.................. 114MICROZIDE......................... 95midodrine hcl ..........................141miglitol .................................... 41miglustat ................................ 107MIGRANAL........................ 116MILLIPRED.......................... 77MIMVEY................................99MIMVEY LO......................... 99MINASTRIN 24 FE............... 74MINIPRESS........................... 50MINITRAN........................... 28MINIVELLE.......................... 99MINOCIN............................ 135minocycline hcl .......................135minocycline hcl er ................... 135minoxidil ..................................50MIRALAX........................... 111MIRAPEX..............................58MIRAPEX ER........................58MIRCERA............................107MIRCETTE............................74MIRENA (52 MG)................. 74mirtazapine .............................. 37MIRVASO..............................85misoprostol .............................137MITIGARE.......................... 103mixed vespid venom protein ...... 67MOBIC................................... 20modafinil ..................................18

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moderiba .................................. 62MODERIBA 1200 DOSE PACK..................................... 62MODERIBA 800 DOSE PACK..................................... 62moexipril hcl ............................ 50moexipril-hydrochlorothiazide .. 50mometasone furoate ..........85, 121MONOCLATE-P..................104MONO-LINYAH................... 74MONONESSA....................... 74MONONINE........................ 104MONOVISC......................... 120montelukast sodium ..................31MONUROL..........................139morcin ......................................65MORGIDOX........................135MORPHABOND ER............. 24morphine sulfate .......................25morphine sulfate (concentrate) .24morphine sulfate er ...................25morphine sulfate er beads ......... 25MOTOFEN............................ 42MOVANTIK........................ 101MOVIPREP.......................... 111MOXATAG..........................129MOXEZA............................. 124moxifloxacin hcl ............. 100, 124MOZOBIL............................ 107MS CONTIN.......................... 25MULTAQ...............................29MULTIGEN.........................107MULTIGEN FOLIC............ 107MULTIGEN PLUS.............. 107mupirocin ................................. 85mupirocin calcium .................... 85MYALEPT........................... 111MYAMBUTOL...................... 53MYCOBUTIN........................53mycophenolate mofetil ..............65mycophenolate sodium ..............65MYDAYIS..............................18MYDRIACYL......................124MYFORTIC........................... 65MYGLUCOHEALTH TEST. 93MYLERAN............................ 56MYNATAL.......................... 118MYNATAL ADVANCE......118mynatal plus ...........................118mynatal-z ............................... 118

myorisan .................................. 85MYORISAN...........................85MYRBETRIQ.......................140MYSOLINE........................... 34MYTESI................................. 42na ferric gluc cplx in sucrose ... 107NABI-HB..............................128nabumetone ..............................20nadolol ..................................... 66nadolol-bendroflumethiazide .....50naftifine hcl .............................. 85NAFTIN................................. 85NAGLAZYME.......................97nalbuphine hcl .......................... 25NALFON................................20nalocet ..................................... 25naltrexone hcl ...........................43NAMENDA......................... 132NAMENDA TITRATION PAK...................................... 132NAMENDA XR...................132NAMENDA XR TITRATION PACK.............132NAMZARIC.......................... 36NAPRELAN.......................... 21napro ....................................... 85NAPROSYN.......................... 21naproxen ..................................21NAPROXEN COMFORT PAC........................................ 21naproxen dr ..............................21naproxen sodium ...................... 21naproxen sodium er .................. 21naratriptan hcl ........................116NARCAN............................... 43NARDIL.................................37NASACORT ALLERGY 24HR.....................................121NASACORT ALLERGY 24HR CHILDREN...............121nasal allergy 24 hour .............. 121NASCOBAL......................... 107NASONEX........................... 121NATACYN...........................124NATAZIA.............................. 74nateglinide ................................41NATESTO.............................. 27NATPARA............................. 97NATROBA.............................85nat-rul vitamin d .....................142

natural vitamin d-3 ................. 142NATURE-THROID.............136NEBUPENT........................... 52NEBUSAL..............................78NECON 0.5/35 (28).................74NECON 1/35 (28)....................74NEEVO DHA....................... 118nefazodone hcl .................. 37, 134neomycin sulfate .......................18neomycin-polymyxin-dexameth...............................................124neomycin-polymyxin-hc ..........127NEORAL................................65NEOSPORIN........................124NEO-SYNALAR....................85NEPHRON FA.....................107NERLYNX.............................56NESINA................................. 41NESTABS............................. 118NEUAC.................................. 85NEULASTA......................... 107NEUPOGEN........................ 108NEUPRO................................58neurin-sl ................................. 108NEURONTIN........................ 34NEUTEK 2TEK TEST...........93NEUTRASAL...................... 118NEVANAC...........................124nevirapine .................................62nevirapine er .............................62NEXAVAR.............................56NEXIUM...................... 137, 138NEXIUM 24HR................... 137NEXPLANON....................... 74NEXT CHOICE ONE DOSE.74niacin er (antihyperlipidemic) .. 47NIACOR.................................47NIASPAN...............................47nicardipine hcl .......................... 68NICOMIDE..........................118nicotine .................................. 132nicotine polacrilex .................. 132NICOTROL..........................132NICOTROL NS....................132NIFEDICAL XL.................... 68nifedipine ................................. 68nifedipine er ............................. 68nifedipine er osmotic release ..... 68NIKKI.................................... 74NILANDRON........................56

158

nilutamide ................................ 56nimodipine ................................69NINLARO..............................56nisoldipine er ............................ 69NITRO-BID........................... 28NITRO-DUR......................... 28nitrofurantoin .........................139nitrofurantoin macrocrystal .... 139nitrofurantoin monohyd macro139nitroglycerin .............................28nitroglycerin er .........................28NITROLINGUAL................. 28NITROMIST.......................... 28NITROSTAT..........................28NITRO-TIME........................ 28NITYR....................................97nizatidine ................................138NOCTIVA.............................. 97NOLIX....................................85NORA-BE.............................. 75NORCO.................................. 25NORDITROPIN FLEXPRO. 97norethin ace-eth estrad-fe ......... 75norethindrone ........................... 75norethindrone-eth estradiol ....... 99norethin-eth estradiol-fe ........... 75norgestimate-eth estradiol ........ 75norgestim-eth estrad triphasic ...75NORITATE............................85NORPACE............................. 29NORPACE CR.......................29NORPRAMIN....................... 37NORTHERA........................ 121NORTREL 0.5/35 (28)............75NORTREL 1/35 (21)...............75NORTREL 1/35 (28)...............75NORTREL 7/7/7.....................75nortriptyline hcl ........................37NORVASC............................. 69NORVIR.................................62NOVA MAX GLUCOSE TEST.......................................93NOVOEIGHT.......................104NOVOLIN 70/30.....................41NOVOLIN 70/30 RELION.....41NOVOLIN N.......................... 41NOVOLIN N RELION.......... 41NOVOLIN R.......................... 41NOVOLIN R RELION.......... 41NOVOLOG............................ 41

NOVOLOG FLEXPEN..........41NOVOLOG MIX 70/30.......... 41NOVOLOG MIX 70/30 FLEXPEN.............................. 41NOVOLOG PENFILL........... 41NOVOSEVEN RT................ 104NOXAFIL.............................. 44np thyroid ...............................136NPLATE...............................108NUCALA............................. 110NUCORT............................... 85NUCYNTA............................ 25NUCYNTA ER...................... 25NUEDEXTA........................ 132NUFOL.................................108NULOJIX............................... 65NULYTELY WITH FLAVOR PACKS.................111NUPLAZID............................60NUTROPIN AQ NUSPIN 10 97NUTROPIN AQ NUSPIN 20 97NUTROPIN AQ NUSPIN 5.. 97NUVARING.......................... 75NUVESSA............................ 141NUVIGIL............................... 18NUWIQ................................ 104NYMALIZE........................... 69nystatin .......................44, 85, 118nystatin-triamcinolone ..............86OB COMPLETE GOLD.......118O-CAL PRENATAL............ 118OCALIVA.............................. 99OCELLA................................ 75OCTAGAM.......................... 128octreotide acetate ..................... 97OCUFLOX........................... 124OCUVEL.............................. 118ODEFSEY.............................. 62ODOMZO...............................56OFEV.................................... 133ofloxacin ................. 100, 125, 127OGESTREL............................75olanzapine ................................60olanzapine-fluoxetine hcl ........ 132olmesartan medoxomil ............. 50olmesartan medoxomil-hctz ...... 50olmesartan-amlodipine-hctz ......50olopatadine hcl ................121, 125OLUMIANT.......................... 21OLUX..................................... 86

OLUX-E................................. 86OMECLAMOX-PAK...........138omega-3-acid ethyl esters ..........47omeprazole .............................138omeprazole magnesium ...........138OMEPRAZOLE+SYRSPEND SF ALKA..........................138omeprazole-sodium bicarbonate ............................ 138OMNARIS............................121OMNIPRED.........................125OMNITROPE........................ 97ON CALL EXPRESS BLOOD GLUCOSE............... 93ON CALL PLUS BLOOD GLUCOSE..............................93ON CALL VIVID BLOOD GLUCOSE..............................93ondansetron ..............................44ondansetron hcl ........................ 44ONETOUCH CLUB LANCETS FINE PT............ 114ONETOUCH COMBO PACK....................................115ONETOUCH DELICA LANCETS 33G.....................115ONETOUCH DELICA LANCETS FINE.................. 115ONETOUCH DELICA LANCING DEV...................115ONETOUCH FINEPOINT LANCETS............................ 115ONETOUCH ULTRA BLUE......................................93ONETOUCH ULTRASOFT LANCETS............................ 115ONETOUCH VERIO.............93ONEXTON.............................86ONFI.................................34, 35ONGLYZA.............................41ONZETRA XSAIL...............116OPANA.................................. 25OPANA ER............................ 25opium .......................................42OPSUMIT...............................70OPTIMAL D3 M.................. 142OPTIMAL-D........................ 142OPTION 2...............................75OPURITY VITAMIN D...... 142ORACEA................................86

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ORAP....................................132ORAPRED ODT....................77ORAVIG...............................118ORENCIA.............................. 21ORENCIA CLICKJECT........21ORENITRAM........................70ORFADIN..............................97ORILISSA.............................. 97ORKAMBI............................. 79orphenadrine citrate er ............120ORSYTHIA............................75ortho d ................................... 108ORTHO MICRONOR........... 75ORTHO TRI-CYCLEN (28).. 75ORTHO TRI-CYCLEN LO... 75ORTHO-CYCLEN (28)..........75ORTHO-NOVUM 1/35 (28)... 75ORTHO-NOVUM 7/7/7 (28).. 75ORTHOVISC........................120oseltamivir phosphate ............... 63OSENI.................................... 41OSMOLEX ER.......................58OSMOPREP......................... 111OSPHENA..............................97OTEZLA....................... 129, 130OTICIN HC NR................... 127OTIPRIO.............................. 127otomax-hc .............................. 127OTOVEL...............................127OTREXUP............................. 21OVACE WASH...................... 86OVIDE....................................86OXANDRIN.......................... 27oxaprozin .................................21OXAYDO............................... 25oxazepam .................................29oxcarbazepine .......................... 35oxiconazole nitrate ................... 86OXISTAT............................... 86OXSORALEN ULTRA......... 86OXTELLAR XR.................... 35oxybutynin chloride ................ 140oxybutynin chloride er ............ 140oxycodone hcl .......................... 25oxycodone hcl er .......................25oxycodone-acetaminophen ........25oxycodone-aspirin .................... 25oxycodone-ibuprofen ................ 25OXYCONTIN........................ 25oxymorphone hcl ...................... 25

oxymorphone hcl er .................. 25OXYTROL........................... 140OXYTROL FOR WOMEN..140OZEMPIC.............................. 42pa vitamin d-3 .........................142paliperidone er ..........................60PALYNZIQ............................ 97PAMELOR.............................37pamidronate disodium .............. 97PANCREAZE........................ 94PANDEL................................ 86PANRETIN............................86pantoprazole sodium ...............138PARAGARD INTRAUTERINE COPPER..75paricalcitol ............................... 97PARLODEL........................... 58PARNATE............................. 37paroex ....................................118paromomycin sulfate ................ 18paroxetine hcl ...........................37paroxetine hcl er .......................37paroxetine mesylate ................132PASER....................................53PATADAY........................... 125PATANASE..........................121PATANOL............................125PAXIL.................................... 37PAXIL CR.............................. 37PAZEO..................................125peg 3350 .................................111peg 3350/electrolytes .............. 111peg 3350-kcl-na bicarb-nacl .... 111peg-3350/electrolytes .............. 111PEGANONE.......................... 35PEGASYS...............................63PEGASYS PROCLICK..........63PEG-PREP............................111pen needles ............................. 115pen needles 1/2" ...................... 115pen needles 3/16" .................... 115pen needles 5/16" .................... 115penicillin v potassium ..............129PENLAC.................................86PENNSAID............................ 86PENTASA............................ 101pentazocine-naloxone hcl ..........25pentoxifylline er ..................... 104PEPCID................................ 138PERCOCET............................25

PERFOROMIST.................... 31perindopril erbumine .................50periogard ................................118permethrin ................................86perphenazine ............................ 60perphenazine-amitriptyline ..... 132PERTZYE.............................. 94PEXEVA.................................37PHENADOZ.......................... 46PHENAZO........................... 102phenazopyridine hcl ................ 102phenelzine sulfate ..................... 37phenobarbital ......................... 109phenoxybenzamine hcl ..............50PHENYTEK...........................35phenytoin ................................. 35PHENYTOIN INFATABS.... 35phenytoin sodium extended ....... 35PHILITH................................ 75PHOSLO...............................101phosphasal ..............................139PHOSPHOLINE IODIDE....125phytonadione ..........................142PICATO..................................86pilocarpine hcl ........................ 125pimozide .................................132PIMTREA.............................. 75pindolol .................................... 66pioglitazone hcl ........................ 42pioglitazone hcl-glimepiride ...... 42pioglitazone hcl-metformin hcl ..42piperacillin sod-tazobactam so 129PIRMELLA 1/35.................... 75piroxicam .................................21PLAN B ONE-STEP...............75PLAQUENIL......................... 52PLAVIX................................104PLEGRIDY.......................... 132PLEGRIDY STARTER PACK....................................132PLEXION...............................86PLEXION CLEANSER......... 86PLEXION CLEANSING CLOTH...................................86POCKETCHEM EZ TEST.....93podocon ....................................86podofilox ..................................86polyethylene glycol 3350 .........111polymyxin b-trimethoprim ...... 125POLYTRIM..........................125

160

POLY-VI-FLOR...................119POLY-VI-FLOR FS............. 118POMALYST...........................56PONSTEL...............................21PORTIA-28.............................75potassium chloride .................. 117potassium chloride crys er .......117potassium chloride er .............. 117potassium citrate er ................ 102PRADAXA.............................33PRALUENT......................... 128pramipexole dihydrochloride .....58pramipexole dihydrochloride er .58PRAMOSONE....................... 86PRANDIN..............................42prasugrel hcl ...........................104PRAVACHOL........................47pravastatin sodium ................... 47praziquantel ............................. 28prazosin hcl .............................. 50PRECISION PCX...................93PRECISION PCX PLUS TEST.......................................93PRECISION POINT OF CARE TEST........................... 93PRECISION QID TEST.........93PRECISION SOF-TACT TEST.......................................93PRECISION XTRA BLOOD GLUCOSE..............................93PRECOSE...............................42PRED FORTE......................125PRED MILD........................ 125PRED-G................................125PRED-G S.O.P..................... 125prednicarbate ........................... 86prednisolone ............................. 77prednisolone acetate ............... 125prednisolone sodium phosphate......................................... 77, 125prednisone ................................77PREDNISONE INTENSOL.. 77PREFERAOB ONE..............119PREFEST............................... 99PREMARIN................... 99, 141PREMPHASE........................ 99PREMPRO............................. 99PRENATABS RX.................119PRENATE MINI..................119PREPIDIL............................ 127

PREPOPIK........................... 111PRESTALIA...........................50PREVACID.......................... 138PREVACID 24HR................138PREVACID SOLUTAB....... 138PREVALITE.......................... 47PREVIFEM............................ 75PREVPAC............................ 138PREVYMIS............................ 63PREZCOBIX.......................... 63PREZISTA............................. 63PRIALT.................................. 22PRIFTIN................................ 53PRILOSEC........................... 138PRILOSEC OTC...................138primaquine phosphate ...............52primidone ................................. 35PRIMLEV.............................. 25PRINIVIL...............................50PRISTIQ................................. 37PRIVIGEN........................... 128PROAIR HFA........................31PROAIR RESPICLICK......... 31probenecid ..............................103PROCARDIA.........................69PROCARDIA XL.................. 69PROCENTRA........................ 18prochlorperazine .......................60prochlorperazine maleate ..........60PROCRIT............................. 108PROCTOCORT......................27PROCTOFOAM HC..............27PROCTO-PAK....................... 27PROCTOZONE-HC...............28PROCYSBI........................... 102PRODIGY NO CODING BLOOD GLUC...................... 93PROFERRIN-FORTE......... 108PROFILNINE...................... 104PROFILNINE SD................ 105PROGLYCEM....................... 42PROGRAF............................. 65PROLASTIN-C.................... 134PROLENSA..........................125PROLIA..................................97PROMACTA........................ 108promethazine hcl ...................... 46promethazine vc ....................... 78promethazine vc/codeine ........... 78promethazine-dm ......................78

PROMETHEGAN................. 46PROMETRIUM...................130propafenone hcl ........................ 29propafenone hcl er .................... 29propantheline bromide ............ 138proparacaine-fluorescein .........125propranolol hcl ................... 66, 67propranolol hcl er ..................... 66propranolol-hctz .......................50propylthiouracil ......................136PROSCAR............................ 102PROTECTIRON.................. 108PROTONIX..........................138PROTOPIC.............................86protriptyline hcl ........................37PROVENTIL HFA.................31PROVERA............................130PROVIGIL............................. 18PROZAC................................ 37PRUDOXIN...........................86pseudoeph-chlorphen-hydrocod . 78psorcon .................................... 86PTS PANELS GLUCOSE TEST.......................................93PULMICORT.........................31PULMICORT FLEXHALER........................ 31PULMOZYME.....................134purefe plus ..............................108purevit dualfe plus .................. 108PURIXAN.............................. 56px folic acid ............................108PYLERA...............................138pyrazinamide ............................53PYRIDIUM..........................102pyridostigmine bromide ............ 53pyridostigmine bromide er ........ 53QBRELIS................................50QNASL................................. 121QNASL CHILDRENS......... 121QTERN.................................134QUALAQUIN........................52QUARTETTE........................ 75QUASENSE........................... 75quazepam ............................... 109QUDEXY XR.........................35QUESTRAN...........................47QUESTRAN LIGHT............. 47quetiapine fumarate ..................60quetiapine fumarate er ..............60

161

QUFLORA FE..................... 118QUFLORA FE PEDIATRIC...............................................119QUFLORA PEDIATRIC.....119QUILLICHEW ER.................18QUILLIVANT XR................. 18quinapril hcl ............................. 50quinapril-hydrochlorothiazide ... 50quinidine gluconate er ...............29quinidine sulfate ....................... 30quinine sulfate .......................... 53QVAR REDIHALER.............31ra folic acid ............................ 108RA TRUETEST TEST........... 93ra vitamin d-3 ......................... 142rabeprazole sodium .................138RADIOGARDASE................ 43RAJANI..................................75raloxifene hcl ........................... 97ramipril ....................................50RANEXA............................... 28ranitidine hcl .......................... 138RAPAFLO............................102RAPAMUNE......................... 65rasagiline mesylate ................... 58RASUVO................................ 21RAVICTI................................97RAYALDEE.......................... 97RAYOS...................................77RAZADYNE........................ 133RAZADYNE ER..................132REBETOL.............................. 63REBIF...................................133REBIF REBIDOSE.............. 133REBIF REBIDOSE TITRATION PACK.............133REBIF TITRATION PACK 133REBINYN............................ 105RECLAST.............................. 97RECLIPSEN...........................76RECOMBINATE................. 105RECTIV..................................28REGLAN..............................101REGRANEX..........................86RELAGARD........................ 141RELENZA DISKHALER......63RELEXXII............................. 18RELISTOR........................... 101RELPAX...............................116REMERON............................ 37

REMERON SOLTAB............ 37REMICADE......................... 101REMODULIN....................... 70RENAGEL........................... 101RENFLEXIS........................ 101RENVELA............................101repaglinide ............................... 42repaglinide-metformin hcl .........42REPATHA............................128REPATHA PUSHTRONEX SYSTEM...............................128REPATHA SURECLICK.... 128REPLESTA...........................143REPLESTA CHILDRENS...143REPLESTA NX....................143REQUIP................................. 58REQUIP XL........................... 58RESCRIPTOR........................63RESTASIS............................ 125RESTASIS MULTIDOSE....125RESTORIL........................... 110RETACRIT.......................... 108RETIN-A................................86RETIN-A MICRO..................86RETIN-A MICRO PUMP......86RETROVIR............................63REVATIO...............................70revesta ....................................108REVLIMID............................ 65REXULTI...............................60REYATAZ............................. 63RHINOCORT ALLERGY.. 121RHOFADE.............................86RHOGAM ULTRA-FILTERED PLUS................ 128RHOPHYLAC......................128RHOPRESSA....................... 126RIASTAP..............................105ribasphere ................................ 63ribasphere ribapak ....................63ribavirin ................................... 63RIDAURA............................. 21rifabutin ................................... 53RIFADIN............................... 53RIFAMATE........................... 53rifampin ................................... 53RIFATER...............................53RILUTEK.............................121riluzole ................................... 121rimantadine hcl ........................ 63

RIOMET.................................42risedronate sodium ................... 97RISPERDAL.......................... 60risperidone ............................... 60RISPERIDONE M-TAB........ 60RITALIN................................18RITALIN LA......................... 18ritonavir ................................... 63rivastigmine ............................133rivastigmine tartrate ............... 133RIVELSA............................... 76RIXUBIS.............................. 105rizatriptan benzoate ................116ROBAXIN............................ 120ROBINUL............................ 138ROBINUL-FORTE.............. 139ROCALTROL........................ 97ROCEPHIN............................71ropinirole hcl ............................ 58ropinirole hcl er ........................ 58ROSADAN.............................87ROSANIL CLEANSER......... 87rosuvastatin calcium ................. 47ROXICODONE..................... 25ROZEREM...........................110RUBRACA...........................130RUCONEST......................... 105RYDAPT................................ 57rynoderm ..................................87RYTARY................................58RYTHMOL SR...................... 30RYVENT................................46SABRIL.................................. 35SAFETY LET LANCETS.... 115SAFETY-GLIDE SYRINGE...............................................115SAFYRAL..............................76SAIZEN.................................. 97SALAGEN............................118SALEX....................................87salicylic acid .............................87salsalate ................................... 22SAMSCA................................ 98SANCUSO..............................44SANDIMMUNE.................... 65SANDOSTATIN.................... 98SANDOSTATIN LAR DEPOT................................... 98SANTYL.................................87SAPHRIS................................60

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sapscare twist top lancets ........115SARAFEM........................... 133SAVAYSA.............................. 33SAVELLA.............................133SAVELLA TITRATION PACK....................................133scopolamine ............................. 44SEASONIQUE....................... 76seb-prev wash ........................... 87SEEBRI NEOHALER............31SEGLUROMET................... 134selegiline hcl .............................58selenium sulfide ........................ 87SELRX....................................87SELSUN BLUE MEDICATED........................ 87SELZENTRY......................... 63SEMPREX-D......................... 78SENSIPAR............................. 98SEREVENT DISKUS............ 31SERNIVO...............................87SEROQUEL........................... 60SEROQUEL XR.....................60SEROSTIM............................ 98sertraline hcl ............................ 37se-tan plus .............................. 108sevelamer carbonate ............... 101SFROWASA.........................101SHOHLS MODIFIED..........102SIGNIFOR............................. 98SIKLOS.................................108sildenafil citrate ........................70SILENOR............................. 110SILIQ...................................... 87SILVADENE..........................87silver nitrate ............................. 87silver sulfadiazine ..................... 87SIMBRINZA........................ 125SIMPLE DIAGNOSTICS LANCING DEV...................115SIMPONI................................21SIMPONI ARIA.....................21SIMULECT............................ 65simvastatin ...............................47SINEMET...............................58SINEMET CR........................ 58SINGULAIR.......................... 31sirolimus .................................. 65SIRTURO...............................53SITAVIG................................ 63

SIVEXTRO.............................52SKELAXIN.......................... 120SKYLA................................... 76sm folic acid ........................... 108sm vitamin d3 ......................... 143SMART SENSE VALUE TEST.......................................93SMARTEST BLOOD GLUCOSE TEST................... 93sod benz-sod phenylacet ............98sod citrate-citric acid .............. 102sodium chloride ........................ 78sodium fluoride .......................117sodium phenylbutyrate ..............98sodium polystyrene sulfonate......................................... 65, 130sodium sulfacetamide ................87SOLIQUA.............................110SOLODYN........................... 135SOLOSEC...............................18SOLTAMOX.......................... 57SOLUS V2 TEST.................... 93SOMA................................... 120SOMATULINE DEPOT........ 98SOMAVERT.......................... 98SONATA.............................. 110SOOLANTRA........................ 87SORIATANE......................... 87SORILUX...............................87sotalol hcl .................................67sotalol hcl (af) ......................... 67SOTYLIZE............................. 67SOVALDI...............................63SPECTRACEF....................... 71spinosad ................................... 87SPIRIVA HANDIHALER.....31SPIRIVA RESPIMAT............31spironolactone .......................... 95spironolactone-hctz .................. 95SPORANOX...........................44SPORANOX PULSEPAK..... 44SPRINTEC 28........................ 76SPRITAM...............................35SPRIX.....................................21SPRYCEL...............................57SPS.................................. 65, 130SRONYX................................76SSKI........................................78sss 10-5 .................................... 87STALEVO 100........................ 59

STALEVO 125........................ 59STALEVO 150........................ 59STALEVO 200........................ 59STALEVO 50..........................59STALEVO 75..........................59STARLIX............................... 42stavudine .................................. 63STEGLATRO.........................42STEGLUJAN....................... 134STELARA.......................87, 110STIMATE...............................98STIOLTO RESPIMAT...........31STIVARGA............................ 57STRATTERA......................... 18STRENSIQ........................... 110streptomycin sulfate ................. 19STRIANT............................... 27STRIBILD.............................. 63STRIVERDI RESPIMAT...... 31STROMECTOL..................... 28SUBOXONE...........................26SUBSYS..................................26SUCRAID.............................. 94sucralfate ............................... 139SULAR................................... 69sulfacetamide sodium ........ 87, 125sulfacetamide sodium-sulfur 87, 88sulfacetamide sod-sulfur wash ...88sulfacetamide-prednisolone ..... 125sulfacetamide-sulfur in urea ......88sulfacleanse 8/4 ........................ 88sulfadiazine ............................ 135sulfamethoxazole-trimethoprim 52SULFAMYLON.....................88sulfasalazine ...........................101SULFAZINE........................ 101sulindac ....................................22SUMADAN............................88SUMADAN XLT................... 88sumatriptan ............................ 116sumatriptan succinate ............. 116sumatriptan succinate refill .....116sumatriptan-naproxen sodium .116SUMAXIN............................. 88SUMAXIN CP........................88SUMAXIN TS........................88super daily d3 ......................... 143super thin lancets ....................115SUPPRELIN LA.................... 98SUPRAX................................ 71

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SUPREME TEST................... 93SUPREP BOWEL PREP KIT...............................................111SURE EDGE TEST................93SURECHEK BLOOD GLUCOSE TEST................... 93SURE-TEST EASYPLUS MINI TEST............................ 93SURMONTIL........................ 37SUSTIVA................................63SUTENT.................................57SYEDA................................... 76SYLATRON...........................57SYMAX DUOTAB...............139SYMBICORT......................... 31SYMBYAX...........................133SYMDEKO............................ 79SYMFI....................................63SYMFI LO..............................63SYMLINPEN 120...................42SYMLINPEN 60.................... 42SYMPROIC..........................101SYNAGEX........................... 119SYNAGIS............................. 128SYNALAR............................. 88SYNALAR (CREAM)........... 88SYNALAR (OINTMENT).....88SYNALAR TS........................88SYNAREL..............................98SYNATEK............................119SYNDROS..............................44SYNERA................................ 88SYNJARDY......................... 134SYNJARDY XR...................134SYNRIBO...............................57SYNTHROID.......................136SYNVISC..............................120SYNVISC ONE.................... 120SYPRINE............................... 65TABLOID...............................57TACLONEX...........................88tacrolimus ...........................65, 88TAFINLAR............................57TAGRISSO.............................57TAKE ACTION..................... 76TALTZ....................................88TAMIFLU........................ 63, 64tamoxifen citrate ......................57tamsulosin hcl .........................102TANDEM F......................... 108

TANDEM PLUS.................. 108TAPAZOLE..........................136TAPERDEX 12-DAY............ 77TAPERDEX 6-DAY.............. 77TARCEVA............................. 57TARGADOX........................136TARGRETIN................... 57, 88TARKA.................................. 50taron forte ..............................108TASIGNA...............................57TASMAR................................59TAVALISSE......................... 135TAYTULLA...........................76tazarotene ................................ 88tazicef ................................ 71, 72TAZORAC............................. 88TAZTIA XT........................... 69TECFIDERA........................133TECHNIVIE.........................109TEFLARO..............................72TEGRETOL........................... 35TEGRETOL-XR.................... 35TEKTURNA.......................... 51TEKTURNA HCT................. 51TELCARE BLOOD GLUCOSE TEST................... 93telmisartan ...............................51telmisartan-amlodipine ............. 51telmisartan-hctz ....................... 51temazepam ............................. 110TEMODAR............................ 57TEMOVATE.......................... 88temozolomide ........................... 57tenofovir disoproxil fumarate ....64TENORETIC 100................... 51TENORETIC 50..................... 51TENORMIN.......................... 67TERAZOL 7......................... 141terazosin hcl ............................. 51terbinafine hcl .......................... 44terbutaline sulfate .....................31terconazole .............................141TESSALON PERLES.............78TESTIM..................................27testosterone ..............................27testosterone cypionate .............. 27testosterone enanthate .............. 27tetrabenazine ..........................133tetracycline hcl ....................... 136TEXAVITE LQ.....................128

THALOMID.......................... 65THEO-24................................ 31THEOCHRON....................... 32theophylline ..............................32theophylline er ..........................32THERA-D 2000.................... 143THERA-D 4000.................... 143THERA-D RAPID REPLETION........................ 143THIOLA............................... 102thioridazine hcl .........................60thiothixene ............................... 60THYMOGLOBULIN.............65THYROGEN..........................93tiagabine hcl .............................35TIAZAC..................................69TIBSOVO..............................111TIGAN................................... 44TIKOSYN...............................30TILIA FE................................76timolol maleate ................. 67, 125TIMOPTIC........................... 125TIMOPTIC OCUDOSE....... 125TIMOPTIC-XE.....................125TINDAMAX.......................... 52tinidazole ................................. 52TIROSINT............................136TIVICAY................................64TIVORBEX............................ 22TIZANIDINE COMFORT PAC.......................................120tizanidine hcl .......................... 120tl gard rx ................................108tl icon .....................................108TOBI....................................... 19TOBI PODHALER................ 19TOBRADEX.........................125TOBRADEX ST................... 126tobramycin ...............................19tobramycin sulfate ....................19TOBREX.............................. 126TODAY SPONGE................141TOFRANIL............................38TOLAK...................................88tolazamide ................................42tolbutamide .............................. 42tolcapone ..................................59tolmetin sodium ........................22tolterodine tartrate ................. 140tolterodine tartrate er ............. 140

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TOPAMAX............................ 35TOPAMAX SPRINKLE........ 35TOPICORT............................ 88TOPICORT SPRAY...............88topiramate ............................... 35toposar .....................................57TOPROL XL.......................... 67TORISEL................................57torsemide ................................. 95TOUJEO MAX SOLOSTAR. 42TOUJEO SOLOSTAR............42TOVIAZ................................140TRACLEER........................... 70TRADJENTA.........................42tramadol hcl ............................. 26tramadol hcl er ......................... 26tramadol hcl er (biphasic) ........ 26tramadol-acetaminophen .......... 26trandolapril .............................. 51trandolapril-verapamil hcl er .... 51tranexamic acid ......................109TRANSDERM-SCOP (1.5 MG)........................................ 44TRANXENE-T.......................29tranylcypromine sulfate ............ 38TRAUMEEL.......................... 65TRAVATAN Z..................... 126trazodone hcl .................... 38, 134TRECATOR...........................53TRELEGY ELLIPTA............ 32TRELSTAR MIXJECT..........57TREMFYA.............................88TRESIBA FLEXTOUCH...... 42tretinoin ........................ 57, 88, 89tretinoin microsphere ................89tretinoin microsphere pump ...... 89TRETTEN............................ 105TREXIMET..........................116TREZIX..................................26TRI FEMYNOR.................... 76triamcinolone acetonide..................................89, 118, 121TRIAMINIC ALLERCHEWS..................... 46triamterene-hctz ....................... 95triazolam ................................110TRIBENZOR......................... 51TRICARE PRENATAL DHA ONE............................ 119tricitrates ............................... 102

TRICON............................... 108TRICOR................................. 47TRIDERM............................. 89TRIDESILON........................ 89trientine hcl .............................. 65TRI-ESTARYLLA................. 76trifluoperazine hcl .................... 60trifluridine ..............................126trigels-f forte .......................... 108TRIGLIDE............................. 48trihexyphenidyl hcl ................... 59TRI-LEGEST FE................... 76TRILEPTAL...........................35TRI-LINYAH.........................76TRILIPIX............................... 48TRILYTE............................. 111trimethobenzamide hcl ..............44trimethoprim ............................ 52TRI-MILI............................... 76trimipramine maleate ............... 38trimpex .................................... 52TRINATE.............................119TRINESSA (28)...................... 76TRI-NORINYL (28)...............76TRINTELLIX.................38, 134TRI-PREVIFEM.................... 76TRIPTODUR......................... 98TRI-SPRINTEC..................... 76TRIUMEQ............................. 64TRI-VI-FLOR...................... 119TRIVORA (28)....................... 76TRIZIVIR...............................64TROKENDI XR.................... 35tropicamide ............................ 126trospium chloride ....................140trospium chloride er ................140TRUE METRIX BLOOD GLUCOSE TEST................... 93TRUEPLUS LANCETS 26G115TRUEPLUS LANCETS 30G115TRUEPLUS SAFETY LANCETS 28G.....................115TRUETEST TEST..................93TRUETRACK TEST............. 93TRULANCE.......................... 72TRULICITY...........................42TRUSOPT............................ 126TRUVADA............................ 64TUDORZA PRESSAIR......... 32TULANA................................76

TUSNEL C............................. 78TUSSICAPS........................... 78TUSSIONEX PENNKINETIC ER...............78TWYNSTA.............................51TYBOST................................. 61TYDEMY...............................76TYKERB................................ 57TYLENOL WITH CODEINE #3......................... 26TYLENOL WITH CODEINE #4......................... 26TYMLOS................................98TYSABRI............................. 133TYVASO.................................70TYVASO REFILL................. 70TYVASO STARTER..............70UCERIS............................ 28, 77ULESFIA............................... 89ULORIC............................... 103ULTIMA TEST...................... 93ULTRACET........................... 26ULTRAM...............................26ULTRATRAK PRO TEST.... 93ULTRATRAK ULTIMATE TEST.......................................93ULTRAVATE........................ 89ULTRAVATE X (CREAM)...89ULTRAVATE X (OINTMENT)........................ 89UNISTRIP1 GENERIC......... 93UNITHROID....................... 136UNITHROID DIRECT....... 136UPTRAVI..................... 133, 134URECHOLINE.................... 140urelle ......................................139uretron d/s ..............................139uribel ......................................139URIMAR-T.......................... 139urin ds .................................... 139UROCIT-K 10...................... 102UROCIT-K 15...................... 102UROCIT-K 5........................ 102uro-mp ................................... 139UROXATRAL..................... 102URSO 250............................. 101URSO FORTE......................101ursodiol .................................. 101ustell ...................................... 139UTIBRON NEOHALER....... 32

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utira-c .................................... 139UTOPIC..................................89utrona-c ................................. 139VAGIFEM............................141valacyclovir hcl .........................64VALCHLOR.......................... 89VALCYTE..............................64valganciclovir hcl ......................64VALIUM................................ 29valproate sodium ...................... 35valproic acid .............................35valsartan .................................. 51valsartan-hydrochlorothiazide ...51VALTREX..............................64VANATOL LQ.......................22VANCOCIN HCL.................. 52vancomycin hcl .........................52VANDAZOLE......................141VANISHPOINT INSULIN SYRINGE.............................115VANOS...................................89VANOXIDE-HC.................... 89VANTAS................................ 57VARUBI................................. 44VASCEPA.............................. 48VASERETIC.......................... 51VASOTEC.............................. 51VCF VAGINAL CONTRACEPTIVE............. 141VECAMYL.............................51VECTICAL.............................89VELCADE..............................57VELETRI............................... 70VELIVET................................76VELPHORO......................... 101VELTASSA..................... 65, 130VELTIN..................................89VEMLIDY..............................64VENCLEXTA........................ 53VENCLEXTA STARTING PACK..................................... 53VENIPUNCTURE CPI..........89venlafaxine hcl ......................... 38venlafaxine hcl er ..................... 38VENOFER............................108VENOMIL MIXED VESPID VENOM..................................67VENTAVIS.............................70VENTOLIN HFA...................32verapamil hcl ............................69

verapamil hcl er ........................69VERDESO..............................89VERDROCET........................ 26VEREGEN............................. 89VERELAN............................. 69VERELAN PM.......................69VERIPRED 20........................78VERSACLOZ......................... 60VERZENIO............................ 79VESICARE........................... 140VESTURA..............................76VFEND...................................44VIBERZI...............................110VIBRAMYCIN.....................136vicodin ..................................... 26vicodin es ................................. 26vicodin hp .................................26VICTORY AGM-4000 TEST. 94VICTOZA...............................42VIDEX....................................64VIDEX EC..............................64VIEKIRA PAK.....................109VIEKIRA XR....................... 109vigabatrin .................................35VIGADRONE........................ 35VIGAMOX........................... 126VIIBRYD........................ 38, 134VIIBRYD STARTER PACK......................................... 38, 134VIMIZIM..............................118VIMOVO................................ 22VIMPAT................................. 35VINATE DHA RF............... 119VIOKACE.............................. 94VIRACEPT.............................64VIRAMUNE.......................... 64VIRAMUNE XR....................64VIREAD................................. 64VIROPTIC............................126VIRT-GARD........................ 108VISTARIL.............................. 29VISTOGARD......................... 43VISUDYNE..........................126VITAFOL FE+.....................119VITAFOL GUMMIES......... 119vitamin d ................................ 143vitamin d (ergocalciferol) .......143vitamin d2 .............................. 143vitamin d3 .............................. 143vitamin d-3 ............................. 143

vitamin d3 maximum strength .143vitamin d3 super strength ........ 143VITAPEARL........................ 119VITATRUE.......................... 119VIVA DHA........................... 119VIVELLE-DOT...................... 99VIVITROL............................. 43VIVLODEX............................22VOCAL POINT BLOOD GLUCOSE TEST................... 94VOGELXO............................. 27VOGELXO PUMP................. 27VOLTAREN...........................89VONVENDI......................... 105VORAXAZE.......................... 57voriconazole ............................. 44VOSEVI................................ 109VOTRIENT............................ 57VPRIV...................................108VRAYLAR.............................60VYFEMLA.............................76VYTORIN.............................. 48VYVANSE..............................18VYZULTA............................126warfarin sodium ....................... 33WELCHOL.............................48WELLBUTRIN SR................ 38WELLBUTRIN XL................38WERA.................................... 76WESTHROID.......................136WIDE-SEAL DIAPHRAGM 60...........................................115WIDE-SEAL DIAPHRAGM 65...........................................115WIDE-SEAL DIAPHRAGM 70...........................................115WIDE-SEAL DIAPHRAGM 75...........................................115WIDE-SEAL DIAPHRAGM 80...........................................115WIDE-SEAL DIAPHRAGM 85...........................................115WIDE-SEAL DIAPHRAGM 90...........................................115WIDE-SEAL DIAPHRAGM 95...........................................115WILATE............................... 105WINRHO SDF..................... 128WP THYROID..................... 136WYMZYA FE........................ 76

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XADAGO...............................59XALATAN........................... 126XALKORI..............................57XANAX..................................29XANAX XR........................... 29XARELTO............................. 33XARELTO STARTER PACK..................................... 33XATMEP................................57XELITRAL............................ 89XELJANZ.............................. 22XELJANZ XR........................22XELODA................................57XENAZINE..........................133XEOMIN.............................. 121XERESE................................. 89XERMELO...........................136XGEVA.................................. 98XHANCE............................. 121XIAFLEX...............................65XIFAXAN..............................52XIGDUO XR........................134XIIDRA................................ 112XIMINO............................... 136XODOL.................................. 26XOLAIR................................. 32XOLEGEL..............................89XOPENEX............................. 32XOPENEX CONCENTRATE.................. 32XOPENEX HFA.................... 32XTAMPZA ER.......................26XTANDI.................................57XULANE................................76XULTOPHY.........................110XURIDEN............................109XYNTHA............................. 105XYNTHA SOLOFUSE........ 105XYREM................................133XYZAL ALLERGY 24HR.... 46XYZAL ALLERGY 24HR CHILDRENS......................... 46YASMIN 28............................76YAZ........................................ 76YERVOY................................57YONSA...................................57YOSPRALA......................... 105YUVAFEM.......................... 141ZADITOR............................ 126zafirlukast ................................32

ZANAFLEX......................... 120ZANOSAR............................. 57ZANTAC.............................. 139ZARAH.................................. 76ZARONTIN........................... 35ZARXIO............................... 108zavara .................................... 108ZAVESCA............................ 108ZEBUTAL.............................. 22ZEGERID.............................139ZEGERID OTC....................139ZEJULA............................... 130ZELAPAR.............................. 59ZELBORAF........................... 57ZEMAIRA............................134ZEMBRACE SYMTOUCH. 116ZEMPLAR............................. 98zenatane ...................................89ZENATANE...........................89ZENCHENT...........................76ZENPEP................................. 94ZENZEDI...............................18ZEPATIER........................... 109ZERIT.....................................64ZESTORETIC........................ 51ZESTRIL................................ 51ZETIA.....................................48ZETONNA........................... 121ZIAC.......................................51ZIAGEN................................. 64ZIANA....................................89zidovudine ................................ 64zileuton er ................................ 32ZIOPTAN............................. 126ziprasidone hcl ..........................60ZIPSOR.................................. 22ZIRGAN...............................126ZITHROMAX...................... 112ZITHROMAX TRI-PAK..... 112ZITHROMAX Z-PAK......... 112ZOCOR...................................48ZOFRAN................................44ZOFRAN ODT...................... 44ZOHYDRO ER...................... 26ZOLADEX............................. 57zoledronic acid ......................... 98ZOLINZA...............................58zolmitriptan ............................116ZOLOFT.................................38zolpidem tartrate .................... 110

zolpidem tartrate er ................ 110ZOLPIMIST......................... 110ZOMACTON......................... 98ZOMETA............................... 98ZOMIG................................. 116ZOMIG ZMT....................... 116ZONALON.............................89ZONEGRAN..........................35zonisamide ............................... 35ZONTIVITY.........................131ZORBTIVE.............................98ZORTRESS............................ 65ZORVOLEX...........................22ZOSYN................................. 129ZOVIA 1/35E (28)................... 76ZOVIRAX.........................64, 89ZUBSOLV.............................. 26ZUPLENZ.............................. 44ZURAMPIC......................... 103ZYBAN.................................133ZYCLARA............................. 89ZYCLARA PUMP................. 90ZYDELIG.............................129ZYFLO................................... 32ZYFLO CR.............................32ZYKADIA..............................58ZYLET..................................126ZYLOPRIM..........................103ZYMAXID........................... 126ZYPITAMAG........................ 48ZYPREXA..............................60ZYPREXA ZYDIS................. 60ZYRTEC ALLERGY.............46ZYRTEC-D ALLERGY & CONGESTION...................... 78ZYTIGA................................. 58ZYVOX...................................52

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Plan for your best health - fm.formularynavigator.comfm.formularynavigator.com/FBO/41/2018_Aetna_Value_Plus_Plan_.pdf · Plan for your best health . 2018 Aetna Pharmacy Drug Guide