Simpra Advantage (PPO I-SNP) 2020 Formulary List of ...simpra.com/.../uploads/documents/SIMPRA_Drug-List-Formulary_ISN… · SNP) network pharmacy, and other plan rules are followed

2020 Part D Model Formulary (Comprehensive)

May 2019

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Simpra Advantage (PPO D-SNP)

2020 Formulary

List of Covered Drugs

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION

ABOUT THE DRUGS WE COVER IN THIS PLAN

HPMS Approved Formulary File Submission ID, 00020292, Version Number 17

This formulary was updated on 10/01/2020.For more recent information or other questions, please contact

Simpra Advantage (PPO D-SNP) Member Services at (844)637-4770 or, for TTY users, 711, Hours of

Operation: 8a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through

March 31 and Monday to Friday (except holidays) from April 1 through September 30, or visit Simpra.com.

Note to existing members: This formulary has changed since last year. Please review this document to

make sure that it still contains the drugs you take.

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H4091_2020Form_C 2


When this drug list (formulary) refers to “we,” “us”, or “our,” it means Simpra Advantage (PPO D-SNP).

When it refers to “plan” or “our plan,” it means Simpra Advantage (PPO D-SNP).

This document includes list of the drugs (formulary) for our plan which is current as of 10/01/2020. For an

updated formulary, please contact us. Our contact information, along with the date we last updated the

formulary, appears on the front and back cover pages.

You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary,

pharmacy network, and/or copayments/coinsurance may change on January 1, 2020, and from time to time

during the year.

What is the Simpra Advantage (PPO D-SNP) Formulary?

A formulary is a list of covered drugs selected by Simpra Advantage (PPO D-SNP) in consultation with a

team of health care providers, which represents the prescription therapies believed to be a necessary part of a

quality treatment program. Simpra Advantage (PPO D-SNP) will generally cover the drugs listed in our

formulary as long as the drug is medically necessary, the prescription is filled at a Simpra Advantage (PPO

D-SNP) network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

Can the Formulary (drug list) change?

Most changes in drug coverage happen on January 1, but we may add or remove drugs on the Drug List

during the year, move them to different cost-sharing tiers, or add new restrictions. We must follow Medicare

rules in making these changes.

Changes that can affect you this year: In the below cases, you will be affected by coverage changes

during the year:

New generic drugs. We may immediately remove a brand name drug on our Drug List if we are

replacing it with a new generic drug that will appear on the same or lower cost sharing tier and with

the same or fewer restrictions. Also, when adding the new generic drug, we may decide to keep the

brand name drug on our Drug List, but immediately move it to a different cost-sharing tier or add

new restrictions. If you are currently taking that brand name drug, we may not tell you in advance

before we make that change, but we will later provide you with information about the specific

change(s) we have made.

o If we make such a change, you or your prescriber can ask us to make an exception and

continue to cover the brand name drug for you. The notice we provide you will also include

information on how to request an exception, and you can also find information in the section

below entitled “How do I request an exception to the Simpra Advantage (PPO D-SNP)

Formulary?”

Drugs removed from the market. If the Food and Drug Administration deems a drug on our

formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will

immediately remove the drug from our formulary and provide notice to members who take the drug.


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Other changes. We may make other changes that affect members currently taking a drug. For

instance, we may add a generic drug that is not new to market to replace a brand name drug currently

on the formulary or add new restrictions to the brand name drug or move it to a different cost-sharing

tier. Or we may make changes based on new clinical guidelines. If we remove drugs from our

formulary, [or] add prior authorization, quantity limits and/or step therapy restrictions on a drug, we

must notify affected members of the change at least 30 days before the change becomes effective, or

at the time the member requests a refill of the drug, at which time the member will receive a 30-day

supply of the drug.

o If we make these other changes, you or your prescriber can ask us to make an exception and

continue to cover the brand name drug for you. The notice we provide you will also include

information on how to request an exception, and you can also find information in the section

below entitled “How do I request an exception to the Simpra Advantage (PPO D-SNP)

Formulary?”

Changes that will not affect you if you are currently taking the drug. Generally, if you are taking a drug

on our 2020 formulary that was covered at the beginning of the year, we will not discontinue or reduce

coverage of the drug during the 2020 coverage year except as described above. This means these drugs will

remain available at the same cost-sharing and with no new restrictions for those members taking them for the

remainder of the coverage year.

The enclosed formulary is current as of 10/01/2020. To get updated information about the drugs covered by

Simpra Advantage (PPO D-SNP) please contact us. Our contact information appears on the front and back

cover pages.

How do I use the Formulary?

There are two ways to find your drug within the formulary:

Medical Condition

The formulary begins on page 8. The drugs in this formulary are grouped into categories depending

on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart

condition are listed under the category, Cardiovascular Agents. If you know what your drug is used

for, look for the category name in the list that begins on page 8. Then look under the category name

for your drug.

Alphabetical Listing

If you are not sure what category to look under, you should look for your drug in the Index that begins

on page 112. The Index provides an alphabetical list of all the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next

to your drug, you will see the page number where you can find coverage information. Turn to the page

listed in the Index and find the name of your drug in the first column of the list.


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What are generic drugs?

Simpra Advantage (PPO D-SNP) covers both brand name drugs and generic drugs. A generic drug is

approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic

drugs cost less than brand name drugs.

Are there any restrictions on my coverage?

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits

may include:

Prior Authorization: Simpra Advantage (PPO D-SNP) requires you [or your physician] to get prior

authorization for certain drugs. This means that you will need to get approval from before you fill

your prescriptions. If you don’t get approval, Simpra Advantage (PPO D-SNP) may not cover the

drug.

Quantity Limits: For certain drugs, Simpra Advantage (PPO D-SNP) limits the amount of the drug

that Simpra Advantage (PPO D-SNP) will cover. For example, Simpra Advantage (PPO D-SNP)

provides 120 units per prescription for morphine sulfate 15mg er tablets. This may be in addition to a

standard one-month or three-month supply.

Step Therapy: In some cases, Simpra Advantage (PPO D-SNP) requires you to first try certain drugs

to treat your medical condition before we will cover another drug for that condition. For example, if

Drug A and Drug B both treat your medical condition, Simpra Advantage (PPO D-SNP) may not

cover Drug B unless you try Drug A first. If Drug A does not work for you, Simpra Advantage (PPO

D-SNP) will then cover Drug B.

You can find out if your drug has any additional requirements or limits by looking in the formulary that

begins on page 8. You can also get more information about the restrictions applied to specific covered drugs

by visiting our Web site We have posted online documents that explain our prior authorization and step

therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date

we last updated the formulary, appears on the front and back cover pages.

You can ask Simpra Advantage (PPO D-SNP) to make an exception to these restrictions or limits or for a list

of other, similar drugs that may treat your health condition. See the section, “How do I request an exception

to the Simpra Advantage (PPO D-SNP) formulary?” on page 5 for information about how to request an

exception.


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What if my drug is not on the Formulary?

If your drug is not included in this formulary (list of covered drugs), you should first contact Member

Services and ask if your drug is covered. For more information, please contact us. Our contact information,

along with the date we last updated the formulary, appears on the front and back cover pages.

If you learn that Simpra Advantage (PPO D-SNP) does not cover your drug, you have two options:

You can ask Member Services for a list of similar drugs that are covered by Simpra Advantage (PPO

D-SNP). When you receive the list, show it to your doctor and ask him or her to prescribe a similar

drug that is covered by Simpra Advantage (PPO D-SNP).

You can ask Simpra Advantage (PPO D-SNP) to make an exception and cover your drug. See below

for information about how to request an exception.

How do I request an exception to the Simpra Advantage (PPO D-SNP) Formulary?

You can ask Simpra Advantage (PPO D-SNP) to make an exception to our coverage rules. There are several

types of exceptions that you can ask us to make.

You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be

covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the

drug at a lower cost-sharing level.

You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs,

Simpra Advantage (PPO D-SNP) limits the amount of the drug that we will cover. If your drug has a

quantity limit, you can ask us to waive the limit and cover a greater amount.

Generally, Simpra Advantage (PPO D-SNP) will only approve your request for an exception if the

alternative drugs included on the plan’s formulary, [the lower cost-sharing drug] or additional utilization

restrictions would not be as effective in treating your condition and/or would cause you to have adverse

medical effects.

You should contact us to ask us for an initial coverage decision for a formulary. When you request a

formulary, you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescriber’s supporting statement.

You can request an expedited (fast) exception if you or your doctor believe that your health could be

seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must

give you a decision no later than 24 hours after we get a supporting statement from your doctor or other

prescriber.


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What do I do before I can talk to my doctor about changing my drugs or requesting an

exception?

As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you

may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need

a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide

if you should switch to an appropriate drug that we cover or request a formulary exception so that we will

cover the drug you take. While you talk to your doctor to determine the right course of action for you, we

may cover your drug in certain cases during the first 90 days you are a member of our plan.

For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will

cover a temporary 31-day supply. If your prescription is written for fewer days, we’ll allow refills to provide

up to a maximum 31-day supply of medication. After your first 31-day supply, we will not pay for these

drugs, even if you have been a member of the plan less than 90 days.

If you are a resident of a long-term care facility and you need a drug that is not on our formulary or if your

ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will

cover a 31-day emergency supply of that drug while you pursue a formulary exception.

We will provide a one-time 31-day transition supply per drug, which will cover a temporary supply if you

have a change in your medications due to a level-of-care change. A level of care change may include:

• Entering or leaving a LTC facility

• Discharged from a hospital or home

• End a Medicare Part A skilled nursing facility stay

• Give up Hospice status and revert back to standard Medicare benefits

• End an LTC Facility stay and return to their home

For more information

For more detailed information about your Simpra Advantage (PPO D-SNP) prescription drug coverage,

please review your Evidence of Coverage and other plan materials.

If you have questions about Simpra Advantage (PPO D-SNP), please contact us. Our contact information,

along with the date we last updated the formulary, appears on the front and back cover pages.

If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800-

MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users should call 1-877-486-2048. Or,

visit http://www.medicare.gov.

Simpra Advantage (PPO D-SNP)’s Formulary

The formulary below provides coverage information about the drugs covered by Simpra Advantage (PPO D-

SNP). If you have trouble finding your drug in the list, turn to the Index that begins on page 112.


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H4091_2020Form_C 7

The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., VYVANSE 10MG

CAP) and generic drugs are listed in lower-case italics (e.g., atomoxetine 100mg cap).

The information in the Requirements/Limits column tells you if Simpra Advantage (PPO D-SNP) has any

special requirements for coverage of your drug.

First Fill Limited to one-month supply (FF): You may be able to receive greater than a 1-month

supply of most of the drugs on your Formulary. Drugs noted with “FF” are limited to a 1-month

supply for both Retail and Mail Order on your first fill only. After the first fill, an extended day

supply would be available.

Limited Distribution (LD): The symbol [LD] next to a drug name indicates that the drug has been

noted as being restricted to certain pharmacies by the Food and Drug Administration. These drugs

can only be obtained at specialty designated pharmacies able to appropriately handle the drugs.

Non-Extended Day Supply (NDS): You may be able to receive greater than a 1-month supply of

most of the drugs on your Formulary via mail order at a reduced cost share. Drugs noted with “NDS”

are limited to a 1-month supply for both Retail and Mail Order.

Prior Authorization (PA): Simpra Advantage (PPO D-SNP) requires you [or your physician] to get

prior authorization for certain drugs. This means that you will need to get approval from The Plan

before you fill your prescriptions. If you don’t get approval, The Plan may not cover the drug.

Prior Authorization Restriction for Part B vs Part D Determination (PA_BvD): This drug may be

eligible for payment under Medicare Part B or Part D. You (or your physician) are required to get

prior authorization from The Plan to determine that this drug is covered under Medicare Part D

before you fill your prescription for this drug. Without prior approval, The Plan may not cover this

drug.

Prior Authorization Restriction for New Starts Only (PA_NSO): If this drug is new to the member,

you (or your physician) are required to get prior authorization from The Plan before you fill your

prescription for this drug. Without prior approval, The Plan may not cover this drug.

Quantity Limits (QL): For certain drugs, The Plan limits the amount of the drug that The Plan will

cover. This could include a: per fill, daily, monthly, or yearly limitation.

Step Therapy (ST): In some cases, The Plan requires you to first try certain drugs to treat your

medical condition before we will cover another drug for that condition. For example, if Drug A and

Drug B both treat your medical condition, The Plan may not cover Drug B unless you try Drug A

first. If Drug A does not work for you, The Plan will then cover Drug B.

Step Therapy for New Starts Only (ST_NSO): If this drug is new to the member, you are required to

first try certain drugs to treat your medical condition before we will cover another drug for that

condition.

DRUG NAME DRUG TIER REQUIREMENTS/LIMITS

You can find information on what the symbols and abbreviations on this table mean by going to the

beginning of this table.

8

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS

AMPHETAMINES

amphetamine/dextroamphetamine 10mg ER cap 1

amphetamine/dextroamphetamine 10mg tab 1

amphetamine/dextroamphetamine 12.5mg tab 1










amphetamine/dextroamphetamine 7.5mg tab 1

dextroamphetamine sulfate 10mg er cap 1

dextroamphetamine sulfate 10mg tab 1



dextroamphetamine sulfate 5mg tab 1

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS

atomoxetine 100mg cap 1 QL=60 EA/30 Days







guanfacine 1mg er tab 1




DOPAMINE AND NOREPINEPHRINE REUPTAKE INHIBITORS (DNRIS)

SUNOSI 150MG TAB 1 PA QL=30 EA/30 Days

SUNOSI 75MG TAB 1 PA QL=30 EA/30 Days

HISTAMINE H3-RECEPTOR ANTAGONIST/INVERSE AGONISTS

WAKIX 17.8MG TAB 1 PA QL=60 EA/30 Days

WAKIX 4.45MG TAB 1 PA QL=60 EA/30 Days

STIMULANTS - MISC.

armodafinil 150mg tab 1 PA QL=30 EA/30 Days






9


BX RATING - METHYLPHENIDATE 18MG SR TAB 1




dexmethylphenidate 10mg er cap 1

dexmethylphenidate 10mg tab 1


dexmethylphenidate 2.5mg tab 1








methylphenidate 10mg cr cap 1

methylphenidate 10mg er tab 1

methylphenidate 10mg la cap 1

methylphenidate 10mg tab 1

methylphenidate 18mg sr tab 1

methylphenidate 1mg/ml oral soln 1






methylphenidate 2mg/ml oral soln 1










modafinil 100mg tab 1 PA QL=60 EA/30 Days

modafinil 200mg tab 1 PA QL=60 EA/30 Days

AMINOGLYCOSIDES

AMINOGLYCOSIDES

amikacin 250mg/ml inj 1




10

ARIKAYCE 70.3MG/ML INH SOLN 1 PA QL=252 ML/30 Days

GENTAMICIN SULFATE 0.8MG/ML INJ 1

gentamicin sulfate 1.2mg/ml inj 1

GENTAMICIN SULFATE 1.6MG/ML INJ 1

GENTAMICIN SULFATE 1MG/ML INJ 1

gentamicin sulfate 40mg/ml inj 1

neomycin sulfate 500mg tab 1

paromomycin 250mg cap 1

STREPTOMYCIN 100MG INJ 1

TOBI PODHALER KIT 28MG PACK 1 PA

TOBRAMYCIN 10MG/ML INJ 1

tobramycin 40mg/ml inj 1

tobramycin 60mg/ml inh soln 1 PA

ANALGESICS - ANTI-INFLAMMATORY

ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES

HUMIRA 10MG/0.1ML SYRINGE 1 PA




HUMIRA 40MG/0.4ML PEN INJECTOR 1 PA


HUMIRA 40MG/0.8ML AUTO-INJECTOR 1 PA


HUMIRA PEDIATRIC CROHN'S STARTER PACK (3)

80MG/0.8ML INJ

1 PA

HUMIRA PEDIATRIC CROHN'S STARTER PACK

SYRINGE (2) 40MG/0.4ML 80MG/0.8ML

1 PA

HUMIRA PEN - CROHN'S STARTER PACK

40MG/0.8ML INJ

1 PA

HUMIRA PEN - CROHN'S STARTER PACK

80MG/0.8ML INJ

1 PA

HUMIRA PEN - PSORIASIS STARTER PACK

40MG/0.8ML INJ

1 PA

HUMIRA PEN - PSORIASIS STARTER PACK

80MG/0.8ML INJ

1 PA

SIMPONI 100MG/ML AUTO-INJECTOR 1 PA

SIMPONI 100MG/ML INJ 1 PA

SIMPONI 50MG/0.5ML AUTO-INJECTOR 1 PA

SIMPONI 50MG/0.5ML SYRINGE 1 PA

ANTIRHEUMATIC - ENZYME INHIBITORS

OLUMIANT 1MG TAB 1 PA

OLUMIANT 2MG TAB 1 PA




11

RINVOQ 15MG ER TAB 1 PA

XELJANZ 10MG TAB 1 PA

XELJANZ 5MG TAB 1 PA

GOLD COMPOUNDS

RIDAURA 3MG CAP 1

INTERLEUKIN-1 BLOCKERS

ARCALYST 220MG INJ 1 PA

INTERLEUKIN-6 RECEPTOR INHIBITORS

ACTEMRA 162MG/0.9ML AUTO-INJECTOR 1 PA

ACTEMRA 162MG/0.9ML SYRINGE 1 PA

KEVZARA 150MG/1.14ML AUTO-INJECTOR 1 PA

KEVZARA 150MG/1.14ML PF INJ 1 PA

KEVZARA 200MG/1.14ML AUTO-INJECTOR 1 PA

KEVZARA 200MG/1.14ML PF INJ 1 PA

NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)

celecoxib 100mg cap 1 QL=60 EA/30 Days




diclofenac potassium 50mg tab 1

diclofenac sodium 100mg er tab 1

diclofenac sodium 25mg dr tab 1


diclofenac sodium 50mg/misoprostol 0.2mg tab 1


diclofenac sodium 75mg/misoprostol 0.2mg tab 1

etodolac 200mg cap 1


etodolac 400mg er tab 1

etodolac 400mg tab 1




flurbiprofen 100mg tab 1

ibu 600mg tab 1

ibu 800mg tab 1

ibuprofen 20mg/ml susp 1

ibuprofen 400mg tab 1



INDOCIN 50MG RECTAL SUPP 1

KETOPROFEN 25MG CAP 1




12

ketorolac tromethamine 10mg tab 1 QL=20 EA/5 Days

meloxicam 15mg tab 1

meloxicam 7.5mg tab 1

nabumetone 500mg tab 1


naproxen 250mg tab 1

naproxen 375mg dr tab 1




naproxen sodium 275mg tab 1


oxaprozin 600mg tab 1

piroxicam 10mg cap 1


sulindac 150mg tab 1


PHOSPHODIESTERASE 4 (PDE4) INHIBITORS

OTEZLA 28-DAY STARTER PACK 1 PA

OTEZLA 30MG TAB 1 PA

PYRIMIDINE SYNTHESIS INHIBITORS

leflunomide 10mg tab 1


SELECTIVE COSTIMULATION MODULATORS

ORENCIA 125MG/ML AUTO-INJECTOR 1 PA

ORENCIA 125MG/ML SYRINGE 1 PA

ORENCIA 50MG/0.4ML SYRINGE 1 PA

ORENCIA 87.5MG/0.7ML SYRINGE 1 PA

SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS

ENBREL 25MG INJ 1 PA

ENBREL 25MG/0.5ML SYRINGE 1 PA

ENBREL 50MG/ML CARTRIDGE 1 PA

ENBREL 50MG/ML SURECLICK INJ 1 PA

ENBREL 50MG/ML SYRINGE 1 PA

ANALGESICS - NONNARCOTIC

SALICYLATES

diflunisal 500mg tab 1

ANALGESICS - OPIOID

OPIOID AGONISTS

CODEINE SULFATE 15MG TAB 1 QL=240 EA/30 Days






13

fentanyl 0.012mg/hr patch 1 QL=10 EA/30 Days




FENTANYL 0.1MG BUCCAL TAB 1 PA QL=120 EA/30 Days



fentanyl 0.2mg lozenge 1 PA QL=120 EA/30 Days









FENTORA 100MCG BUCCAL TAB 1 PA QL=120 EA/30 Days





hydromorphone 10mg/ml (1ml) inj 1

hydromorphone 10mg/ml (5ml) inj 1

hydromorphone 1mg/ml oral soln 1 QL=2400 ML/30 Days

hydromorphone 2mg tab 1 QL=450 EA/30 Days



HYSINGLA 100MG ER TAB 1 QL=30 EA/30 Days







methadone 10mg tab 1 QL=360 EA/30 Days

METHADONE 1MG/ML ORAL SOLN 1 QL=3600 ML/30 Days

METHADONE 2MG/ML ORAL SOLN 1 QL=1800 ML/30 Days

methadone 5mg tab 1 QL=360 EA/30 Days

morphine sulfate 100mg er tab 1 QL=120 EA/30 Days


MORPHINE SULFATE 15MG TAB 1 QL=180 EA/30 Days





14

morphine sulfate 20mg/ml oral soln 1 QL=180 ML/30 Days



MORPHINE SULFATE 30MG TAB 1 QL=180 EA/30 Days



NUCYNTA 100MG ER TAB 1 QL=60 EA/30 Days





oxycodone 10mg tab 1 QL=180 EA/30 Days


oxycodone 1mg/ml oral soln 1 QL=5400 ML/30 Days


oxycodone 20mg/ml oral soln 1 QL=270 ML/30 Days


oxycodone 5mg cap 1 QL=360 EA/30 Days


oxymorphone 10mg tab 1 QL=360 EA/30 Days

oxymorphone 5mg tab 1 QL=360 EA/30 Days

tramadol 100mg er tab 1 QL=60 EA/30 Days

tramadol 100mg er tab (matrix delivery) 1 QL=60 EA/30 Days





tramadol 50mg tab 1 QL=240 EA/30 Days

XTAMPZA 13.5MG ER CAP 1 QL=120 EA/30 Days

XTAMPZA 18MG ER CAP 1 QL=120 EA/30 Days




OPIOID COMBINATIONS

acetaminophen 21.7mg/ml/hydrocodone bitartrate0.5mg/ml oral soln

1 QL=5400 ML/30 Days

acetaminophen 24mg/ml/codeine phosphate 2.4mg/mloral soln

1 QL=4980 ML/30 Days

acetaminophen 300mg/codeine phosphate 15mg tab 1 QL=390 EA/30 Days



acetaminophen 300mg/hydrocodone bitartrate 10mg tab 1 QL=390 EA/30 Days




15


acetaminophen 300mg/hydrocodone bitartrate 7.5mg tab 1 QL=390 EA/30 Days



acetaminophen 325mg/hydrocodone bitartrate 7.5mg tab 1 QL=360 EA/30 Days

acetaminophen 325mg/oxycodone 10mg tab 1 QL=360 EA/30 Days

acetaminophen 325mg/oxycodone 2.5mg tab 1 QL=360 EA/30 Days

acetaminophen 325mg/oxycodone 5mg tab 1 QL=360 EA/30 Days

acetaminophen 325mg/oxycodone 7.5mg tab 1 QL=360 EA/30 Days

acetaminophen 325mg/tramadol 37.5mg tab 1 QL=360 EA/30 Days

aspirin 325mg/oxycodone 4.84mg tab 1 QL=360 EA/30 Days

endocet 10-325mg tab 1 QL=360 EA/30 Days

endocet 5-325mg tab 1 QL=360 EA/30 Days

endocet 7.5-325mg tab 1 QL=360 EA/30 Days

hydrocodone 10mg/ibuprofen 200mg tab 1 QL=480 EA/30 Days

hydrocodone 5mg/ibuprofen 200mg tab 1 QL=480 EA/30 Days

hydrocodone bitartrate 7.5mg/ibuprofen 200mg tab 1 QL=480 EA/30 Days

lorcet 10-325mg tab 1 QL=360 EA/30 Days

lorcet 5-325mg tab 1 QL=360 EA/30 Days

OPIOID PARTIAL AGONISTS

buprenorphine 2mg sl tab 1

buprenorphine 2mg/naloxone 0.5mg sl tab 1


buprenorphine 8mg/naloxone 2mg sl tab 1

buprenorphine/naloxone 12-3mg strip 1

buprenorphine/naloxone 2-0.5mg strip 1



butorphanol tartrate 10mg/ml nasal spray 1 QL=10 ML/30 Days

ZUBSOLV 11.4-2.9MG SL TAB 1 QL=60 EA/30 Days





ANDROGENS-ANABOLIC

ANABOLIC STEROIDS

ANADROL-50 50MG TAB 1

oxandrolone 10mg tab 1

oxandrolone 2.5mg tab 1

ANDROGENS

ANDRODERM 2MG/24HR PATCH 1 PA QL=60 EA/30 Days

ANDRODERM 4MG/24HR PATCH 1 PA QL=30 EA/30 Days




16

danazol 100mg cap 1

danazol 200mg cap 1

danazol 50mg cap 1

testosterone 1% (25mg) gel 1 PA QL=300 GM/30 Days

testosterone 1% (50mg) gel 1 PA QL=300 GM/30 Days

TESTOSTERONE 1% GEL PUMP 1 PA QL=300 GM/30 Days

testosterone 1.62% (1.25gm) gel 1 PA QL=75 GM/30 Days

testosterone 1.62% (2.5gm) gel 1 PA QL=150 GM/30 Days

testosterone 1.62% gel pump 1 PA QL=150 GM/30 Days

testosterone cypionate (1ml) 200mg/ml inj 1

testosterone cypionate 100mg/ml inj 1

testosterone cypionate 200mg/ml inj 1

testosterone enanthate 200mg/ml inj 1

ANORECTAL AGENTS

INTRARECTAL STEROIDS

hydrocortisone 1.67mg/ml enema 1

UCERIS 2MG/ACT FOAM 1 PA

RECTAL COMBINATIONS

hydrocortisone/pramoxine 1-1% rectal cream 1

RECTAL STEROIDS

procto-med 2.5% cream 1

procto-pak 1% rectal cream 1

proctosol 2.5% cream 1

proctozone hc 2.5% cream 1

VASODILATING AGENTS

RECTIV 0.4% RECTAL OINTMENT 1 QL=30 GM/30 Days

ANTHELMINTICS

ANTHELMINTICS

albendazole 200mg tab 1

BENZNIDAZOLE 100MG TAB 1 PA

BENZNIDAZOLE 12.5MG TAB 1 PA

ivermectin 3mg tab 1

ANTI-INFECTIVE AGENTS - MISC.

ANTI-INFECTIVE AGENTS - MISC.

metronidazole 250mg tab 1

metronidazole 375mg cap 1


metronidazole 5mg/ml inj 1

NEBUPENT 300MG INH SOLN 1 PA BvD

PENTAM 300MG INJ 1

pentamidine isethionate 300mg inj 1

pentamidine isethionate 50mg/ml inh soln 1 PA BvD




17

tinidazole 250mg tab 1


trimethoprim 100mg tab 1

XIFAXAN 200MG TAB 1 PA QL=9 EA/3 Days

XIFAXAN 550MG TAB 1 PA QL=60 EA/30 Days

ANTI-INFECTIVE MISC. - COMBINATIONS

sulfamethoxazole 400mg/trimethoprim 80mg tab 1

sulfamethoxazole 40mg/ml/trimethoprim 8mg/ml susp 1

sulfamethoxazole 800mg/trimethoprim 160mg tab 1

ANTIPROTOZOAL AGENTS

ALINIA 100MG/5ML SUSP 1 PA QL=150 ML/3 Days

ALINIA 500MG TAB 1 PA QL=6 EA/3 Days

atovaquone 150mg/ml susp 1

CARBAPENEMS

cilastatin 2.5mg/ml/imipenem 2.5mg/ml inj 1

cilastatin 5mg/ml/imipenem 5mg/ml inj 1

ertapenem 1gm inj 1

meropenem 1gm inj 1

meropenem 500mg inj 1

CYCLIC LIPOPEPTIDES

DAPTOMYCIN 350MG INJ 1

daptomycin 500mg inj 1

GLYCOPEPTIDES

DALVANCE 500MG INJ 1

FIRVANQ 25MG/ML ORAL SOLN 1

FIRVANQ 50MG/ML ORAL SOLN 1

vancomycin 100mg/ml inj 1

vancomycin 125mg cap 1 QL=120 EA/30 Days

vancomycin 250mg cap 1 QL=120 EA/30 Days

VANCOMYCIN 250MG INJ 1


VANCOMYCIN 50MG/ML ORAL SOLN 1


vancomycin 750mg inj 1

LEPROSTATICS

dapsone 100mg tab 1

dapsone 25mg tab 1

LINCOSAMIDES

clindamycin 12mg/ml inj 1

clindamycin 150mg cap 1

clindamycin 150mg/ml (2ml) inj 1





18


clindamycin 15mg/ml oral soln 1





MONOBACTAMS

aztreonam 333mg/ml inj 1

CAYSTON 75MG INH SOLN 1 PA

OXAZOLIDINONES

linezolid 20mg/ml susp 1 PA

linezolid 2mg/ml inj 1 PA

linezolid 600mg tab 1 PA

SIVEXTRO 200MG INJ 1 PA QL=6 EA/6 Days

SIVEXTRO 200MG TAB 1 PA QL=6 EA/6 Days

PLEUROMUTILINS

XENLETA 600MG TAB 1 PA QL=14 EA/7 Days

POLYMYXINS

colistin 75mg/ml inj 1

polymyxin b 250000unit/ml inj 1

ANTIANGINAL AGENTS

ANTIANGINALS-OTHER

ranolazine 1000mg er tab 1


NITRATES

isosorbide dinitrate 10mg tab 1


ISOSORBIDE DINITRATE 30MG TAB 1


isosorbide mononitrate 10mg tab 1

isosorbide mononitrate 120mg er tab 1

isosorbide mononitrate 20mg tab 1



minitran 0.1mg/hr patch 1




NITRO-BID 2% OINTMENT 1

NITRO-DUR 0.3MG/HR PATCH 1

NITRO-DUR 0.8MG/HR PATCH 1

nitroglycerin 0.1mg/hr patch 1




19


nitroglycerin 0.3mg sl tab 1


nitroglycerin 0.4mg/act spray 1




ANTIANXIETY AGENTS

ANTIANXIETY AGENTS - MISC.

buspirone 10mg tab 1



buspirone 5mg tab 1

buspirone 7.5mg tab 1

hydroxyzine 10mg tab 1


hydroxyzine 2mg/ml oral soln 1


HYDROXYZINE PAMOATE 100MG CAP 1

hydroxyzine pamoate 25mg cap 1

hydroxyzine pamoate 50mg cap 1

BENZODIAZEPINES

alprazolam 0.25mg odt 1

alprazolam 0.25mg tab 1

alprazolam 0.5mg er tab 1



alprazolam 1mg er tab 1

alprazolam 1mg odt 1

alprazolam 1mg tab 1





chlordiazepoxide 10mg cap 1



clorazepate dipotassium 15mg tab 1

clorazepate dipotassium 3.75mg tab 1

clorazepate dipotassium 7.5mg tab 1

diazepam 10mg tab 1

DIAZEPAM 1MG/ML ORAL SOLN 1




20

diazepam 2mg tab 1

diazepam 5mg tab 1

diazepam 5mg/ml oral soln 1

lorazepam 0.5mg tab 1

lorazepam 1mg tab 1

lorazepam 2mg tab 1

lorazepam 2mg/ml conc 1

OXAZEPAM 10MG CAP 1

oxazepam 15mg cap 1

OXAZEPAM 30MG CAP 1

ANTIARRHYTHMICS

ANTIARRHYTHMICS TYPE I-A

disopyramide 100mg cap 1 PA

disopyramide 150mg cap 1 PA

NORPACE 100MG ER CAP 1 PA

NORPACE 150MG ER CAP 1 PA

quinidine gluconate 324mg er tab 1

QUINIDINE SULFATE 200MG TAB 1

QUINIDINE SULFATE 300MG TAB 1

ANTIARRHYTHMICS TYPE I-C

flecainide acetate 100mg tab 1



propafenone 150mg tab 1

propafenone 225mg er cap 1




propafenone 425mg sr cap 1

ANTIARRHYTHMICS TYPE III

amiodarone 200mg tab 1


dofetilide 125mcg cap 1



MULTAQ 400MG TAB 1

pacerone 200mg tab 1


ANTIASTHMATIC AND BRONCHODILATOR AGENTS

ANTI-INFLAMMATORY AGENTS

cromolyn sodium 10mg/ml inh soln 1 PA BvD

ANTIASTHMATIC - MONOCLONAL ANTIBODIES




21

DUPIXENT 200MG/ML PF SYRINGE 1 PA

FASENRA 30MG/ML AUTO-INJECTOR 1 PA

FASENRA 30MG/ML SYRINGE 1 PA

NUCALA 100MG INJ 1 PA

NUCALA 100MG/ML AUTO-INJECTOR 1 PA

NUCALA 100MG/ML SYRINGE 1 PA

XOLAIR 150MG INJ 1 PA

XOLAIR 150MG/ML PF INJ 1 PA

XOLAIR 75MG/0.5ML PF INJ 1 PA

BRONCHODILATORS - ANTICHOLINERGICS

ATROVENT 17MCG INH 1

INCRUSE 62.5MCG INH 1

ipratropium bromide 0.02% inh soln 1 PA BvD

LONHALA 0.0025% INH SOLN 1 ST

SPIRIVA 1.25MCG RESPIMAT INH 1 ST QL=4 GM/30 Days

LEUKOTRIENE MODULATORS

montelukast 10mg tab 1

montelukast 4mg chew tab 1

montelukast 4mg granules 1


zafirlukast 10mg tab 1


SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS

DALIRESP 250MCG TAB 1


STEROID INHALANTS

ARNUITY 100MCG INH 1 QL=30 EA/30 Days



ASMANEX 100MCG (120ACT) HFA INH 1 QL=13 GM/30 Days

ASMANEX 110MCG (30ACT) INH 1 QL=1 EA/30 Days

ASMANEX 200MCG (120ACT) HFA INH 1 QL=13 GM/30 Days




ASMANEX 50MCG HFA INH 1 QL=13 GM/30 Days

budesonide 0.125mg/ml inh soln 1 PA BvD QL=120 ML/30 Days



FLOVENT 100MCG DISKUS 1 QL=60 EA/30 Days

FLOVENT 110MCG HFA INH 1 QL=24 GM/30 Days

FLOVENT 220MCG HFA INH 1 QL=24 GM/30 Days




22


FLOVENT 44MCG HFA INH 1 QL=21.20 GM/30 Days


SYMPATHOMIMETICS

ADVAIR 115-21MCG HFA INH 1 QL=12 GM/30 Days



albuterol 0.21mg/ml (0.63mg/3ml) inh soln 1 PA BvD

albuterol 0.417mg/ml (1.25mg/3ml) inh soln 1 PA BvD

albuterol 0.4mg/ml (2mg/5ml) oral oral soln 1

albuterol 0.83mg/ml (0.083%) inh soln 1 PA BvD

albuterol 1mg/ml (0.5%) inh soln 1 PA BvD

albuterol 2mg tab 1

ALBUTEROL 4MG ER TAB 1

albuterol 4mg tab 1


ANORO 62.5-25MCG ELLIPTA INH 1 QL=60 EA/30 Days

BREO 100-25MCG ELLIPTA INH 1 QL=60 EA/30 Days

BREO 200-25MCG ELLIPTA INH 1 QL=60 EA/30 Days

COMBIVENT RESPIMAT 20-100MCG INH 1

DULERA 100-5MCG INH 1 QL=13 GM/30 Days

DULERA 200-5MCG INH 1 QL=13 GM/30 Days

DULERA INHALER 50-5MCG 1 QL=13 GM/30 Days

fluticasone propionate/salmeterol 100-50mcg/act drypowder inh

1 QL=60 EA/30 Days


1 QL=60 EA/30 Days


1 QL=60 EA/30 Days

FLUTICASONE PROPIONATE/SALMETEROL

XINAFOATE 113-14MCG/ACT POWDER INH

1 QL=1 EA/30 Days



1 QL=1 EA/30 Days



1 QL=1 EA/30 Days

ipratropium/albuterol 0.5-2.5mg/3ml inh soln 1 PA BvD

levalbuterol 0.31mg inh soln 1 PA BvD




METAPROTERENOL SULFATE 2MG/ML ORAL

SOLN

1




23

SEREVENT 50MCG/DOSE INH 1

STIOLTO 2.5-2.5MCG INH 1 QL=4 GM/30 Days

terbutaline sulfate 2.5mg tab 1

terbutaline sulfate 5mg tab 1

TRELEGY 62.5-25MCG ELLIPTA INH 1 QL=60 EA/30 Days

VENTOLIN 108MCG INH 1 QL=36 GM/30 Days

wixela 100-50mcg inh 1 QL=60 EA/30 Days



XANTHINES

theophylline 300mg er tab 1


theophylline 5.33mg/ml oral soln 1


ANTICOAGULANTS

COUMARIN ANTICOAGULANTS

jantoven 10mg tab 1

jantoven 1mg tab 1

jantoven 2.5mg tab 1

jantoven 2mg tab 1

jantoven 3mg tab 1

jantoven 4mg tab 1

jantoven 5mg tab 1

jantoven 6mg tab 1


warfarin sodium 10mg tab 1


warfarin sodium 2.5mg tab 1







DIRECT FACTOR XA INHIBITORS

ELIQUIS 2.5MG TAB 1

ELIQUIS 30-DAY STARTER PACK 1

ELIQUIS 5MG TAB 1

XARELTO 10MG TAB 1

XARELTO 15MG TAB 1

XARELTO 2.5MG TAB 1

XARELTO 20MG TAB 1




24

XARELTO STARTER PACK 1

HEPARINS AND HEPARINOID-LIKE AGENTS

enoxaparin sodium 100mg/1ml syringe 1 QL=60 ML/30 Days

enoxaparin sodium 120mg/0.8ml syringe 1 QL=48 ML/30 Days

enoxaparin sodium 150mg/1ml syringe 1 QL=60 ML/30 Days





fondaparinux sodium 12.5mg/ml (0.4ml) syringe 1



fondaparinux sodium 5mg/ml syringe 1

FRAGMIN 10000UNIT/ML SYRINGE 1

FRAGMIN 12500UNIT/0.5ML SYRINGE 1






FRAGMIN 95000UNIT/3.8ML INJ 1

heparin sodium porcine 10000unit/ml inj 1 PA BvD




THROMBIN INHIBITORS

PRADAXA 110MG CAP 1

PRADAXA 150MG CAP 1

PRADAXA 75MG CAP 1

ANTICONVULSANTS

AMPA GLUTAMATE RECEPTOR ANTAGONISTS

FYCOMPA 0.5MG/ML SUSP 1 PA NSO

FYCOMPA 10MG TAB 1 PA NSO






ANTICONVULSANTS - BENZODIAZEPINES

clobazam 10mg tab 1

clobazam 2.5mg/ml susp 1

clobazam 20mg tab 1




25

clonazepam 0.125mg odt 1



clonazepam 0.5mg tab 1

clonazepam 1mg odt 1

clonazepam 1mg tab 1



DIASTAT 10MG APPLICATOR 1

DIASTAT 2.5MG APPLICATOR 1

DIASTAT 20MG APPLICATOR 1

DIAZEPAM 2.5MG/0.5ML RECTAL GEL 1

DIAZEPAM 20MG/4ML RECTAL GEL 1

NAYZILAM 5MG/0.1ML NASAL SPRAY 1

SYMPAZAN 10MG STRIP 1 ST_NSO



VALTOCO 10MG DOSE KIT 10MG/0.1ML PACK 1

VALTOCO 15MG DOSE KIT 7.5MG/0.1ML PACK 1



ANTICONVULSANTS - MISC.

APTIOM 200MG TAB 1 PA NSO




BANZEL 200MG TAB 1

BANZEL 400MG TAB 1

BANZEL 40MG/ML SUSP 1

BRIVIACT 100MG TAB 1 PA NSO QL=60 EA/30 Days


BRIVIACT 10MG/ML ORAL SOLN 1 PA NSO




carbamazepine 100mg chew tab 1

carbamazepine 100mg er cap 1

carbamazepine 100mg er tab 1



carbamazepine 200mg tab 1

carbamazepine 20mg/ml susp 1




26



EPIDIOLEX 100MG/ML ORAL SOLN 1 PA NSO

epitol 200mg tab 1

FINTEPLA 2.2MG/ML ORAL SOLN 1 PA NSO QL=360 ML/30 Days

gabapentin 100mg cap 1



gabapentin 50mg/ml oral soln 1

gabapentin 600mg tab 1


LAMICTAL XR BLUE KIT 1

LAMICTAL XR GREEN KIT 1

LAMICTAL XR ORANGE KIT 1

lamotrigine 100mg er tab 1

lamotrigine 100mg odt 1

lamotrigine 100mg tab 1






lamotrigine 25mg (35) tab starter pack 1

lamotrigine 25mg chew tab 1








lamotrigine tab 25mg (42)/100mg (7) starter pack 1

lamotrigine tab 25mg (84)/100mg (14) starter pack 1

levetiracetam 1000mg tab 1

levetiracetam 100mg/ml oral soln 1


levetiracetam 500mg er tab 1




oxcarbazepine 150mg tab 1





27


oxcarbazepine 60mg/ml susp 1

OXTELLAR 150MG XR TAB 1



pregabalin 100mg cap 1



pregabalin 20mg/ml oral soln 1






primidone 250mg tab 1


QUDEXY 100MG XR CAP 1 PA NSO





roweepra 1000mg tab 1

roweepra 500mg er tab 1




SPRITAM 1000MG ODT 1 PA NSO




TOPIRAMATE 100MG ER CAP 1 PA NSO

topiramate 100mg tab 1


topiramate 15mg cap 1








TROKENDI 100MG XR CAP 1 PA NSO




28




VIMPAT 100MG TAB 1 QL=60 EA/30 Days

VIMPAT 10MG/ML ORAL SOLN 1




zonisamide 100mg cap 1



CARBAMATES

felbamate 120mg/ml susp 1

felbamate 400mg tab 1


XCOPRI 100MG TAB 1

XCOPRI 12.5/25MG TITRATION PACK 1

XCOPRI 150/200MG PACK TAB 1

XCOPRI 150/200MG TITRATION PACK 1

XCOPRI 150MG TAB 1

XCOPRI 200MG TAB 1

XCOPRI 50/100MG TITRATION PACK 1

XCOPRI 50/200MG PACK TAB 1

XCOPRI 50MG TAB 1

GABA MODULATORS

tiagabine 12mg tab 1


tiagabine 2mg tab 1

tiagabine 4mg tab 1

vigabatrin 500mg tab 1 PA NSO

vigabatrin 50mg/ml oral soln 1 PA NSO

vigadrone 500mg oral soln 1 PA NSO

HYDANTOINS

DILANTIN 30MG ER CAP 1

PEGANONE 250MG TAB 1

phenytoin 25mg/ml susp 1

phenytoin 50mg chew tab 1

phenytoin sodium 100mg er cap 1



SUCCINIMIDES

CELONTIN 300MG CAP 1




29

ethosuximide 250mg cap 1

ethosuximide 50mg/ml oral soln 1

VALPROIC ACID

divalproex sodium 125mg dr cap 1

divalproex sodium 125mg dr tab 1


divalproex sodium 250mg er tab 1


divalproex sodium 500mg er tab 1

valproic acid 250mg cap 1

valproic acid 50mg/ml oral soln 1

ANTIDEPRESSANTS

ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)

mirtazapine 15mg odt 1

mirtazapine 15mg tab 1





mirtazapine 7.5mg tab 1

ANTIDEPRESSANTS - MISC.

APLENZIN 174MG ER TAB 1 ST_NSO



bupropion 100mg sr tab 1

bupropion 100mg tab 1

bupropion 150mg sr (12 hr) tab 1

bupropion 150mg xl (24 hr) tab 1


bupropion 300mg xl tab 1


MAPROTILINE 25MG TAB 1



MONOAMINE OXIDASE INHIBITORS (MAOIS)

EMSAM 12MG/24HR PATCH 1



MARPLAN 10MG TAB 1

phenelzine 15mg tab 1

tranylcypromine 10mg tab 1

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)




30

citalopram 10mg tab 1


citalopram 2mg/ml oral soln 1


escitalopram 10mg tab 1

escitalopram 1mg/ml oral soln 1



fluoxetine 10mg cap 1

fluoxetine 10mg tab 1




fluoxetine 4mg/ml oral soln 1

fluvoxamine maleate 100mg er cap 1 ST_NSO

fluvoxamine maleate 100mg tab 1

fluvoxamine maleate 150mg er cap 1 ST_NSO



paroxetine 10mg tab 1 PA NSO

paroxetine 12.5mg er tab 1 PA NSO


paroxetine 25mg er tab 1 PA NSO


paroxetine 37.5mg er tab 1 PA NSO


PAXIL 10MG/5ML SUSP 1 PA NSO

PEXEVA 10MG TAB 1 PA NSO




sertraline 100mg tab 1

sertraline 20mg/ml oral soln 1



SEROTONIN MODULATORS

NEFAZODONE 100MG TAB 1





trazodone 100mg tab 1




31




TRINTELLIX 10MG TAB 1 ST_NSO QL=30 EA/30 Days



VIIBRYD 10/20MG STARTER PACK 1 ST_NSO QL=30 EA/30 Days

VIIBRYD 10MG TAB 1 ST_NSO QL=30 EA/30 Days



SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)

desvenlafaxine succinate 100mg er tab 1



DRIZALMA 20MG DR CAP 1 ST_NSO




duloxetine 20mg dr cap 1


duloxetine 40mg dr cap 1 ST_NSO QL=30 EA/30 Days


FETZIMA 120MG ER CAP 1 ST_NSO QL=30 EA/30 Days




FETZIMA PACK 1 ST_NSO QL=30 EA/30 Days

venlafaxine 100mg tab 1

venlafaxine 150mg er cap 1


venlafaxine 37.5mg er cap 1

venlafaxine 37.5mg tab 1




TRICYCLIC AGENTS

amitriptyline 100mg tab 1 PA NSO









32

AMOXAPINE 100MG TAB 1 PA NSO




clomipramine 25mg cap 1 PA NSO



desipramine 100mg tab 1 PA NSO






doxepin 100mg cap 1 PA NSO


doxepin 10mg/ml oral soln 1 PA NSO

DOXEPIN 150MG CAP 1 PA NSO




imipramine 10mg tab 1 PA NSO



imipramine pamoate 100mg cap 1 PA NSO




nortriptyline 10mg cap 1


NORTRIPTYLINE 2MG/ML ORAL SOLN 1



protriptyline 10mg tab 1 PA NSO

protriptyline 5mg tab 1 PA NSO

trimipramine 100mg cap 1 PA NSO



ANTIDIABETICS

ALPHA-GLUCOSIDASE INHIBITORS

acarbose 100mg tab 1

acarbose 25mg tab 1

acarbose 50mg tab 1




33

miglitol 100mg tab 1

miglitol 25mg tab 1

miglitol 50mg tab 1

ANTIDIABETIC COMBINATIONS

glipizide 2.5mg/metformin 250mg tab 1

glipizide 2.5mg/metformin 500mg tab 1

glipizide 5mg/metformin 500mg tab 1

glyburide 1.25mg/metformin 250mg tab 1

glyburide 2.5mg/metformin 500mg tab 1

glyburide 5mg/metformin 500mg tab 1

GLYXAMBI 10-5MG TAB 1 QL=30 EA/30 Days

GLYXAMBI 25-5MG TAB 1 QL=30 EA/30 Days

JANUMET 100-1000MG XR TAB 1 QL=30 EA/30 Days

JANUMET 50-1000MG TAB 1 QL=60 EA/30 Days


JANUMET 50-500MG TAB 1 QL=60 EA/30 Days


JENTADUETO 2.5-1000MG TAB 1 QL=60 EA/30 Days

JENTADUETO 2.5-1000MG XR TAB 1 QL=30 EA/30 Days



JENTADUETO 5-1000MG XR TAB 1 QL=30 EA/30 Days

SOLIQUA 100UNIT-0.033MG/ML PEN INJ 1 PA QL=15 ML/25 Days

SYNJARDY 12.5-1000MG TAB 1 QL=60 EA/30 Days

SYNJARDY 12.5-500MG TAB 1 QL=60 EA/30 Days

SYNJARDY 5-1000MG TAB 1 QL=60 EA/30 Days

SYNJARDY 5-500MG TAB 1 QL=60 EA/30 Days

SYNJARDY XR 10-1000MG TAB 1 QL=30 EA/30 Days

SYNJARDY XR 12.5-1000MG TAB 1 QL=60 EA/30 Days



TRIJARDY 10-5-1000MG ER TAB 1 QL=30 EA/30 Days

TRIJARDY 12.5-2.5-1000MG ER TAB 1 QL=60 EA/30 Days

TRIJARDY 25-5-1000MG ER TAB 1 QL=30 EA/30 Days

TRIJARDY 5-2.5-1000MG ER TAB 1 QL=60 EA/30 Days

XIGDUO 10-1000MG XR TAB 1 QL=30 EA/30 Days


XIGDUO 2.5-1000MG XR TAB 1 QL=60 EA/30 Days



XULTOPHY 100UNIT-3.6MG/ML PEN INJ 1 PA QL=15 ML/30 Days

BIGUANIDES




34

metformin 1000mg tab 1

metformin 500mg er tab 1




DIABETIC OTHER

BAQSIMI 3MG/DOSE NASAL POWDER 1 QL=2 EA/7 Days

diazoxide 50mg/ml susp 1

GLUCAGEN 1MG INJ 1 QL=2 EA/7 Days

GLUCAGON 1MG INJ 1 QL=2 EA/7 Days

GVOKE 0.5MG/0.1ML AUTO-INJECTOR 1 QL=.20 ML/7 Days

GVOKE 0.5MG/0.1ML SYRINGE 1 QL=.20 ML/7 Days

GVOKE 1MG/0.2ML AUTO-INJECTOR 1 QL=.40 ML/7 Days

GVOKE 1MG/0.2ML SYRINGE 1 QL=.40 ML/7 Days

KORLYM 300MG TAB 1 PA

PROGLYCEM 50MG/ML SUSP 1

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS

JANUVIA 100MG TAB 1 QL=30 EA/30 Days



TRADJENTA 5MG TAB 1 QL=30 EA/30 Days

INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)

BYDUREON 2.35MG/ML AUTO-INJECTOR 1 QL=3.40 ML/28 Days

BYDUREON 2MG PEN INJ 1 QL=4 EA/28 Days

OZEMPIC 2MG/1.5ML PEN INJ 1 QL=1.50 ML/28 Days

OZEMPIC 2MG/1.5ML PEN INJ (1MG DOSE) 1 QL=3 ML/28 Days

RYBELSUS 14MG TAB 1 QL=30 EA/30 Days



TRULICITY 0.75MG/0.5ML AUTO-INJECTOR 1 QL=2 ML/28 Days

TRULICITY 1.5MG/0.5ML AUTO-INJECTOR 1 QL=2 ML/28 Days

VICTOZA 18MG/3ML PEN INJ 1 QL=9 ML/30 Days

INSULIN

FIASP 100UNIT/ML CARTRIDGE 1

FIASP 100UNIT/ML INJ 1 PA BvD

FIASP 100UNIT/ML PEN INJ 1

HUMULIN R 500UNIT/ML INJ 1 PA BvD

HUMULIN R 500UNIT/ML PEN INJ 1

LANTUS 100UNIT/ML INJ 1

LANTUS 100UNIT/ML SOLOSTAR 1

LEVEMIR 100UNIT/ML FLEXTOUCH 1

LEVEMIR 100UNIT/ML INJ 1




35

NOVOLIN 100UNIT/ML INJ 1

NOVOLIN MIX (70/30) FLEXPEN 100UNIT/ML 1

NOVOLIN N 100UNIT/ML INJ 1

NOVOLIN N 100UNIT/ML PEN INJ 1

NOVOLIN R 100UNIT/ML INJ 1

NOVOLIN R 100UNIT/ML PEN INJ 1

NOVOLOG 100UNIT/ML FLEXPEN 1

NOVOLOG 100UNIT/ML INJ 1

NOVOLOG 100UNIT/ML PENFILL 1

NOVOLOG MIX 100UNIT/ML FLEXPEN 1

NOVOLOG MIX 100UNIT/ML INJ 1

TOUJEO 300UNIT/ML PEN INJ 1

TOUJEO MAX 300UNIT/ML PEN INJ (3ML) 1

TRESIBA 100UNIT/ML FLEXTOUCH PEN INJ 1

TRESIBA 100UNIT/ML INJ (VIAL) 1

TRESIBA 200UNIT/ML FLEXTOUCH PEN INJ 1

INSULIN SENSITIZING AGENTS

AVANDIA 2MG TAB 1

AVANDIA 4MG TAB 1

pioglitazone 15mg tab 1



MEGLITINIDE ANALOGUES

nateglinide 120mg tab 1


repaglinide 0.5mg tab 1

repaglinide 1mg tab 1


SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS

FARXIGA 10MG TAB 1 QL=30 EA/30 Days

FARXIGA 5MG TAB 1 QL=30 EA/30 Days

JARDIANCE 10MG TAB 1 QL=30 EA/30 Days

JARDIANCE 25MG TAB 1 QL=30 EA/30 Days

SULFONYLUREAS

glimepiride 1mg tab 1



glipizide 10mg er tab 1

glipizide 10mg tab 1

glipizide 2.5mg er tab 1


glipizide 5mg tab 1




36

ANTIDIARRHEAL/PROBIOTIC AGENTS

ANTIPERISTALTIC AGENTS

ATROPINE SULFATE 0.005MG/ML/

DIPHENOXYLATE 0.5MG/ML ORAL SOLN

1

atropine sulfate 0.025mg/diphenoxylate 2.5mg tab 1

loperamide 2mg cap 1

ANTIDOTES

ANTIDOTES - CHELATING AGENTS

CHEMET 100MG CAP 1

FERRIPROX 100MG/ML ORAL SOLN 1 PA

JADENU 180MG TAB 1

JADENU 90MG TAB 1

OPIOID ANTAGONISTS

VIVITROL 380MG INJ 1

ANTIDOTES AND SPECIFIC ANTAGONISTS

ANTIDOTES - CHELATING AGENTS

deferasirox 125mg tab for oral susp 1

deferasirox 180mg tab 1





FERRIPROX 1000MG TAB 1 PA

FERRIPROX 500MG TAB 1 PA

JADENU 180MG GRANULE PACKET 1


JADENU 360MG TAB 1


OPIOID ANTAGONISTS

NALOXONE 0.4MG/ML CARTRIDGE 1 QL=2 ML/2 Days

naloxone 0.4mg/ml inj 1 QL=2 ML/2 Days

NALOXONE 1MG/ML SYRINGE 1 QL=4 ML/2 Days

naltrexone 50mg tab 1

NARCAN 4MG/0.1ML NASAL SPRAY 1

ANTIEMETICS

5-HT3 RECEPTOR ANTAGONISTS

granisetron 1mg tab 1 PA BvD QL=60 EA/30 Days

ondansetron 0.8mg/ml oral soln 1 PA BvD

ondansetron 24mg tab 1 PA BvD

ondansetron 4mg odt 1 PA BvD


ondansetron 8mg odt 1 PA BvD




37


ANTIEMETICS - ANTICHOLINERGIC

meclizine 12.5mg tab 1

meclizine 25mg tab 1

scopolamine 0.0139mg/hr patch 1

TRANSDERM SCOP 1MG/3DAYS PATCH 1 QL=10 EA/30 Days

trimethobenzamide 300mg cap 1

ANTIEMETICS - MISCELLANEOUS

dronabinol 10mg cap 1 PA

dronabinol 2.5mg cap 1 PA

dronabinol 5mg cap 1 PA

SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS

aprepitant 125mg cap 1 PA BvD QL=3 EA/2 Days

aprepitant 125mg/80mg pack 1 PA BvD QL=6 EA/4 Days



VARUBI 90MG TAB 1 PA BvD QL=4 EA/28 Days

ANTIFUNGALS

ANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS)

CASPOFUNGIN ACETATE 50MG INJ 1

CASPOFUNGIN ACETATE 70MG INJ 1

ERAXIS 100MG INJ 1

ERAXIS 50MG INJ 1

micafungin 100mg soln 1


MYCAMINE 100MG INJ 1

MYCAMINE 50MG INJ 1

ANTIFUNGALS

ABELCET 5MG/ML INJ 1 PA BvD

AMBISOME 50MG INJ 1 PA BvD

AMPHOTERICIN B 50MG INJ 1 PA BvD

flucytosine 250mg cap 1


griseofulvin 125mg tab 1


griseofulvin 25mg/ml susp 1


nystatin 500000unit tab 1

terbinafine 250mg tab 1

IMIDAZOLE-RELATED ANTIFUNGALS

fluconazole 100mg tab 1

fluconazole 10mg/ml susp 1




38



fluconazole 2mg/ml (100ml) inj 1

fluconazole 2mg/ml inj 1



itraconazole 100mg cap 1 PA

ketoconazole 200mg tab 1

NOXAFIL 100MG DR TAB 1 PA

NOXAFIL 40MG/ML SUSP 1 PA

posaconazole 100mg dr tab 1 PA

voriconazole 200mg inj 1 PA

voriconazole 200mg tab 1 PA

voriconazole 40mg/ml susp 1 PA

voriconazole 50mg tab 1 PA

ANTIHISTAMINES

ANTIHISTAMINES - NON-SEDATING

cetirizine 1mg/ml oral soln 1

desloratadine 5mg tab 1

levocetirizine 0.5mg/ml oral soln 1

levocetirizine 5mg tab 1

ANTIHISTAMINES - PHENOTHIAZINES

promethazine 1.25mg/ml oral soln 1

promethazine 12.5mg rectal supp 1

promethazine 12.5mg tab 1

promethazine 25mg rectal supp 1

promethazine 25mg tab 1


promethegan 25mg rectal supp 1

promethegan 50mg rectal supp 1

ANTIHYPERLIPIDEMICS

ANTIHYPERLIPIDEMICS - MISC.

omega-3 acid ethyl esters (usp) 1000mg cap 1

VASCEPA 1GM CAP 1 QL=120 EA/30 Days

VASCEPA 500MG CAP 1 QL=120 EA/30 Days

BILE ACID SEQUESTRANTS

cholestyramine resin 4gm sf powder for oral susp 1

cholestyramine resin 66.7mg/ml susp 1

colesevelam hcl 3.75gm packet 1

colesevelam hcl 625mg tab 1

colestipol 1000mg tab 1

colestipol 5000mg granules 1




39

prevalite 4gm/dose susp 1

FIBRIC ACID DERIVATIVES

fenofibrate 134mg cap 1

fenofibrate 145mg tab 1

FENOFIBRATE 150MG CAP 1







fenofibric acid 135mg dr cap 1


gemfibrozil 600mg tab 1

HMG COA REDUCTASE INHIBITORS

atorvastatin 10mg tab 1




fluvastatin 20mg cap 1


fluvastatin 80mg er tab 1

lovastatin 10mg tab 1



pravastatin sodium 10mg tab 1




rosuvastatin 10mg tab 1




simvastatin 10mg tab 1





INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS

ezetimibe 10mg tab 1 QL=30 EA/30 Days

MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN (MTP) INHIBITORS

JUXTAPID 10MG CAP 1 PA




40






NICOTINIC ACID DERIVATIVES

niacin 1000mg er tab 1



PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 INHIBITORS

PRALUENT 150MG/ML AUTO-INJECTOR 1 PA QL=2 ML/28 Days

PRALUENT 75MG/ML AUTO-INJECTOR 1 PA QL=2 ML/28 Days

REPATHA 120MG/ML CARTRIDGE 1 PA QL=3.50 ML/28 Days

REPATHA 140MG/ML AUTO-INJECTOR 1 PA QL=2 ML/28 Days

REPATHA 140MG/ML SYRINGE 1 PA QL=2 ML/28 Days

ANTIHYPERTENSIVES

ACE INHIBITORS

benazepril 10mg tab 1




captopril 100mg tab 1

captopril 12.5mg tab 1



enalapril maleate 10mg tab 1

enalapril maleate 2.5mg tab 1



fosinopril sodium 10mg tab 1



lisinopril 10mg tab 1

lisinopril 2.5mg tab 1





moexipril 15mg tab 1

moexipril 7.5mg tab 1

perindopril erbumine 2mg tab 1





41


QBRELIS 1MG/ML ORAL SOLN 1 PA

quinapril 10mg tab 1



quinapril 5mg tab 1

ramipril 1.25mg cap 1

ramipril 10mg cap 1


ramipril 5mg cap 1

trandolapril 1mg tab 1



AGENTS FOR PHEOCHROMOCYTOMA

DEMSER 250MG CAP 1

phenoxybenzamine 10mg cap 1

ANGIOTENSIN II RECEPTOR ANTAGONISTS

irbesartan 150mg tab 1



losartan potassium 100mg tab 1



olmesartan medoxomil 20mg tab 1



telmisartan 20mg tab 1



valsartan 160mg tab 1




ANTIADRENERGIC ANTIHYPERTENSIVES

clonidine 0.00417mg/hr patch 1



clonidine 0.1mg tab 1



doxazosin 1mg tab 1

doxazosin 2mg tab 1




42

doxazosin 4mg tab 1

doxazosin 8mg tab 1

prazosin 1mg cap 1

prazosin 2mg cap 1

prazosin 5mg cap 1

terazosin 10mg cap 1

terazosin 1mg cap 1

terazosin 2mg cap 1

terazosin 5mg cap 1

ANTIHYPERTENSIVE COMBINATIONS

amlodipine 10mg/benazepril 20mg cap 1


amlodipine 10mg/hydrochlorothiazide 12.5mg/valsartan160mg tab

1

amlodipine 10mg/hydrochlorothiazide 25mg/valsartan160mg tab

1


1

amlodipine 10mg/olmesartan medoxomil 20mg tab 1


amlodipine 10mg/valsartan 160mg tab 1


amlodipine 2.5mg/benazepril 10mg cap 1




amlodipine 5mg/hydrochlorothiazide 12.5mg/valsartan160mg tab

1


1





atenolol 100mg/chlorthalidone 25mg tab 1

atenolol 50mg/chlorthalidone 25mg tab 1

benazepril 10mg/hydrochlorothiazide 12.5mg tab 1


benazepril 20mg/hydrochlorothiazide 25mg tab 1


bisoprolol fumarate 10mg/hydrochlorothiazide 6.25mgtab

1




43

bisoprolol fumarate 2.5mg/hydrochlorothiazide 6.25mgtab

1

bisoprolol fumarate 5mg/hydrochlorothiazide 6.25mgtab

1

CAPTOPRIL 25MG/HYDROCHLOROTHIAZIDE

15MG TAB

1


25MG TAB

1

CAPTOPRIL 50MG/HYDROCHLOROTHIAZIDE 15MGTAB

1


25MG TAB

1

enalapril maleate 10mg/hydrochlorothiazide 25mg tab 1

enalapril maleate 5mg/hydrochlorothiazide 12.5mg tab 1

fosinopril sodium 10mg/hydrochlorothiazide 12.5mg tab 1

fosinopril sodium 20mg/hydrochlorothiazide 12.5mg tab 1

hydrochlorothiazide 12.5mg/irbesartan 150mg tab 1

hydrochlorothiazide 12.5mg/irbesartan 300mg tab 1

hydrochlorothiazide 12.5mg/lisinopril 10mg tab 1

hydrochlorothiazide 12.5mg/lisinopril 20mg tab 1

hydrochlorothiazide 12.5mg/losartan potassium 100mgtab

1

hydrochlorothiazide 12.5mg/losartan potassium 50mgtab

1

hydrochlorothiazide 12.5mg/olmesartan medoxomil20mg tab

1

hydrochlorothiazide 12.5mg/olmesartan medoxomil40mg tab

1

hydrochlorothiazide 12.5mg/quinapril 10mg tab 1

hydrochlorothiazide 12.5mg/quinapril 20mg tab 1

hydrochlorothiazide 12.5mg/telmisartan 40mg tab 1

hydrochlorothiazide 12.5mg/telmisartan 80mg tab 1

hydrochlorothiazide 12.5mg/valsartan 160mg tab 1



hydrochlorothiazide 25mg/lisinopril 20mg tab 1

hydrochlorothiazide 25mg/losartan potassium 100mg tab 1

hydrochlorothiazide 25mg/metoprolol tartrate 100mg tab 1

hydrochlorothiazide 25mg/metoprolol tartrate 50mg tab 1

hydrochlorothiazide 25mg/olmesartan medoxomil 40mgtab

1

HYDROCHLOROTHIAZIDE 25MG/PROPRANOLOL

40MG TAB

1




44

HYDROCHLOROTHIAZIDE 25MG/PROPRANOLOL

80MG TAB

1

hydrochlorothiazide 25mg/quinapril 20mg tab 1

hydrochlorothiazide 25mg/telmisartan 80mg tab 1

hydrochlorothiazide 25mg/valsartan 160mg tab 1

hydrochlorothiazide 25mg/valsartan 320mg tab 1

HYDROCHLOROTHIAZIDE 50MG/METOPROLOL

TARTRATE 100MG TAB

1

TRANDOLAPRIL 1MG/VERAPAMIL 240MG ER

TAB

1

trandolapril 2mg/verapamil 180mg er tab 1



DIRECT RENIN INHIBITORS

aliskiren 150mg tab 1


SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)

eplerenone 25mg tab 1


VASODILATORS

hydralazine 100mg tab 1




minoxidil 10mg tab 1

minoxidil 2.5mg tab 1

ANTIMALARIALS

ANTIMALARIAL COMBINATIONS

atovaquone 250mg/proguanil 100mg tab 1

atovaquone 62.5mg/proguanil 25mg tab 1

COARTEM 20-120MG TAB 1

ANTIMALARIALS

CHLOROQUINE PHOSPHATE 250MG TAB 1

chloroquine phosphate 500mg tab 1

DARAPRIM 25MG TAB 1 QL=90 EA/30 Days

hydroxychloroquine sulfate 200mg tab 1

KRINTAFEL 150MG TAB 1

MEFLOQUINE 250MG TAB 1

PRIMAQUINE PHOSPHATE 26.3MG TAB 1

pyrimethamine 25mg tab 1 QL=90 EA/30 Days

quinine sulfate 324mg cap 1

ANTIMYASTHENIC/CHOLINERGIC AGENTS




45

ANTIMYASTHENIC/CHOLINERGIC AGENTS

GUANIDINE 125MG TAB 1

pyridostigmine bromide 180mg er tab 1

pyridostigmine bromide 60mg tab 1

RUZURGI 10MG TAB 1 PA

ANTIMYCOBACTERIAL AGENTS

ANTIMYCOBACTERIAL AGENTS

ethambutol 100mg tab 1


isoniazid 100mg tab 1

ISONIAZID 10MG/ML ORAL SOLN 1


PASER D/R 4GM GRANULES 1

PRIFTIN 150MG TAB 1

pyrazinamide 500mg tab 1

rifabutin 150mg cap 1

rifampin 150mg cap 1


rifampin 60mg/ml inj 1

SIRTURO 100MG TAB 1 PA

SIRTURO 20MG TAB 1 PA

TRECATOR 250MG TAB 1

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES

ALKYLATING AGENTS

CYCLOPHOSPHAMIDE 25MG CAP 1 PA BvD

CYCLOPHOSPHAMIDE 50MG CAP 1 PA BvD

GLEOSTINE 100MG CAP 1



LEUKERAN 2MG TAB 1

ANTIMETABOLITES

mercaptopurine 50mg tab 1

methotrexate 2.5mg tab 1

methotrexate 250mg/10ml inj 1


PURIXAN 2000MG/100ML SUSP 1

TABLOID 40MG TAB 1

TREXALL 10MG TAB 1

TREXALL 15MG TAB 1

TREXALL 5MG TAB 1

TREXALL 7.5MG TAB 1

XATMEP 2.5MG/ML ORAL SOLN 1 PA




46

ANTINEOPLASTIC - BCL-2 INHIBITORS

VENCLEXTA 10/100/50MG STARTING PACK 1 PA NSO

VENCLEXTA 100MG TAB 1 PA NSO



ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS

DAURISMO 100MG TAB 1 PA NSO

DAURISMO 25MG TAB 1 PA NSO

ERIVEDGE 150MG CAP 1 PA NSO

ODOMZO 200MG CAP 1 PA NSO

ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS

abiraterone 250mg tab 1 QL=120 EA/30 Days

anastrozole 1mg tab 1

bicalutamide 50mg tab 1

DEPO-PROVERA 400MG/ML INJ 1

ELIGARD 22.5MG SYRINGE 1

ELIGARD 30MG SYRINGE 1



EMCYT 140MG CAP 1

ERLEADA 60MG TAB 1 PA NSO QL=120 EA/30 Days

exemestane 25mg tab 1

FIRMAGON 120MG INJ 1 PA NSO

FIRMAGON 80MG INJ 1 PA NSO

flutamide 125mg cap 1

letrozole 2.5mg tab 1

leuprolide acetate 5mg/ml inj 1

LUPRON 11.25MG (1.5ML) SYRINGE 1

LUPRON 22.5MG SYRINGE 1


LUPRON 30MG SYRINGE 1



LYSODREN 500MG TAB 1

megestrol acetate 20mg tab 1 PA NSO

megestrol acetate 40mg tab 1 PA NSO

megestrol acetate 40mg/ml susp 1 PA

nilutamide 150mg tab 1

NUBEQA 300MG TAB 1 PA NSO QL=120 EA/30 Days

SOLTAMOX 10MG/5ML ORAL SOLN 1 PA NSO

tamoxifen 10mg tab 1





47

toremifene 60mg tab 1

TRELSTAR 11.25MG INJ 1



XTANDI 40MG CAP 1 PA NSO QL=120 EA/30 Days

ANTINEOPLASTIC - IMMUNOMODULATORS

POMALYST 1MG CAP 1 PA NSO




ANTINEOPLASTIC - XPO1 INHIBITORS

XPOVIO 100MG ONCE WEEKLY PACK 1 PA NSO


XPOVIO 40MG TWICE WEEKLY PACK 1 PA NSO





ANTINEOPLASTIC COMBINATIONS

KISQALI/FEMARA TAB CO-PACK 200MG 1 PA NSO QL=49 EA/28 Days



LONSURF 15-6.14MG TAB 1 PA NSO

LONSURF 20-8.19MG TAB 1 PA NSO

ANTINEOPLASTIC ENZYME INHIBITORS

AFINITOR 10MG TAB 1 PA NSO QL=30 EA/30 Days

AFINITOR 2.5MG TAB 1 PA NSO QL=30 EA/30 Days

AFINITOR 2MG SUSP 1 PA NSO



AFINITOR 5MG TAB 1 PA NSO QL=30 EA/30 Days

AFINITOR 7.5MG TAB 1 PA NSO QL=30 EA/30 Days

ALECENSA 150MG CAP 1 PA NSO QL=240 EA/30 Days

ALUNBRIG 180MG TAB 1 PA NSO QL=30 EA/30 Days



ALUNBRIG TAB STARTER PACK 1 PA NSO QL=30 EA/30 Days

AYVAKIT 100MG TAB 1 PA NSO QL=30 EA/30 Days



BALVERSA 3MG TAB 1 PA NSO QL=60 EA/30 Days





48


BOSULIF 100MG TAB 1 PA NSO



BRAFTOVI 75MG CAP 1 PA NSO QL=180 EA/30 Days

BRUKINSA 80MG CAP 1 PA NSO QL=120 EA/30 Days

CABOMETYX 20MG TAB 1 PA NSO



CALQUENCE 100MG CAP 1 PA NSO QL=60 EA/30 Days

CAPRELSA 100MG TAB 1 PA NSO QL=60 EA/30 Days

CAPRELSA 300MG TAB 1 PA NSO QL=30 EA/30 Days

COMETRIQ 100MG DAILY DOSE CARTON PACK 1 PA NSO



COPIKTRA 15MG CAP 1 PA NSO QL=60 EA/30 Days

COPIKTRA 25MG CAP 1 PA NSO QL=60 EA/30 Days

COTELLIC 20MG TAB 1 PA NSO QL=63 EA/28 Days

erlotinib 100mg tab 1 PA NSO



everolimus 2.5mg tab 1 PA NSO QL=30 EA/30 Days

everolimus 5mg tab 1 PA NSO QL=30 EA/30 Days

everolimus 7.5mg tab 1 PA NSO QL=30 EA/30 Days

FARYDAK 10MG CAP 1 PA NSO

FARYDAK 20MG CAP 1 PA NSO

GILOTRIF 20MG TAB 1 PA NSO QL=30 EA/30 Days



IBRANCE 100MG CAP 1 PA NSO QL=21 EA/28 Days

IBRANCE 100MG TAB 1 PA NSO QL=30 EA/30 Days





ICLUSIG 15MG TAB 1 PA NSO QL=60 EA/30 Days

ICLUSIG 45MG TAB 1 PA NSO QL=30 EA/30 Days

IDHIFA 100MG TAB 1 PA NSO QL=30 EA/30 Days

IDHIFA 50MG TAB 1 PA NSO QL=30 EA/30 Days

imatinib 100mg tab 1


IMBRUVICA 140MG CAP 1 PA NSO QL=90 EA/30 Days




49

IMBRUVICA 140MG TAB 1 PA NSO QL=30 EA/30 Days




IMBRUVICA 70MG CAP 1 PA NSO QL=30 EA/30 Days

INLYTA 1MG TAB 1 PA NSO

INLYTA 5MG TAB 1 PA NSO

INREBIC 100MG CAP 1 PA NSO QL=120 EA/30 Days

IRESSA 250MG TAB 1 PA NSO

JAKAFI 10MG TAB 1 PA NSO QL=60 EA/30 Days





KISQALI 200MG DAILY DOSE PACK 1 PA NSO QL=21 EA/28 Days



KOSELUGO 10MG CAP 1 PA NSO

KOSELUGO 25MG CAP 1 PA NSO

LENVIMA (10) 10MG PACK 1 PA NSO


LENVIMA (14) PACK 1 PA NSO






LORBRENA 100MG TAB 1 PA NSO QL=30 EA/30 Days

LORBRENA 25MG TAB 1 PA NSO QL=90 EA/30 Days

LYNPARZA 100MG TAB 1 PA NSO QL=120 EA/30 Days

LYNPARZA 150MG TAB 1 PA NSO QL=120 EA/30 Days

MEKINIST 0.5MG TAB 1 PA NSO QL=90 EA/30 Days

MEKINIST 2MG TAB 1 PA NSO QL=30 EA/30 Days

MEKTOVI 15MG TAB 1 PA NSO QL=180 EA/30 Days

NERLYNX 40MG TAB 1 PA NSO

NEXAVAR 200MG TAB 1 PA NSO

NINLARO 2.3MG CAP 1 PA NSO

NINLARO 3MG CAP 1 PA NSO

NINLARO 4MG CAP 1 PA NSO

PEMAZYRE 13.5MG TAB 1 PA NSO QL=14 EA/21 Days

PEMAZYRE 4.5MG TAB 1 PA NSO QL=14 EA/21 Days

PEMAZYRE 9MG TAB 1 PA NSO QL=14 EA/21 Days




50

PIQRAY 200MG DAILY DOSE PACK 1 PA NSO QL=30 EA/30 Days

PIQRAY 250MG DAILY DOSE PACK 1 PA NSO QL=60 EA/30 Days

PIQRAY 300MG DAILY DOSE 150MG PACK 1 PA NSO QL=60 EA/30 Days

QINLOCK 50MG TAB 1 PA NSO QL=90 EA/30 Days

RETEVMO 40MG CAP 1 PA NSO QL=180 EA/30 Days

RETEVMO 80MG CAP 1 PA NSO QL=120 EA/30 Days

ROZLYTREK 100MG CAP 1 PA NSO QL=30 EA/30 Days

ROZLYTREK 200MG CAP 1 PA NSO QL=90 EA/30 Days

RUBRACA 200MG TAB 1 PA NSO QL=120 EA/30 Days



RYDAPT 25MG CAP 1 PA NSO

SPRYCEL 100MG TAB 1 PA NSO






STIVARGA 40MG TAB 1 PA NSO QL=120 EA/30 Days

SUTENT 12.5MG CAP 1 PA NSO

SUTENT 25MG CAP 1 PA NSO

SUTENT 37.5MG CAP 1 PA NSO

SUTENT 50MG CAP 1 PA NSO

TABRECTA 150MG TAB 1 PA NSO QL=120 EA/30 Days

TABRECTA 200MG TAB 1 PA NSO QL=120 EA/30 Days

TAFINLAR 50MG CAP 1 PA NSO QL=120 EA/30 Days

TAFINLAR 75MG CAP 1 PA NSO QL=120 EA/30 Days

TAGRISSO 40MG TAB 1 PA NSO

TAGRISSO 80MG TAB 1 PA NSO

TALZENNA 0.25MG CAP 1 PA NSO QL=90 EA/30 Days

TALZENNA 1MG CAP 1 PA NSO QL=30 EA/30 Days

TASIGNA 150MG CAP 1 PA NSO



TAZVERIK 200MG TAB 1 PA NSO QL=240 EA/30 Days

TIBSOVO 250MG TAB 1 PA NSO QL=60 EA/30 Days

TUKYSA 150MG TAB 1 PA NSO QL=120 EA/30 Days

TUKYSA 50MG TAB 1 PA NSO QL=120 EA/30 Days

TURALIO 200MG CAP 1 PA NSO QL=120 EA/30 Days

TYKERB 250MG TAB 1 PA NSO

VERZENIO 100MG TAB 1 PA NSO QL=56 EA/28 Days





51



VITRAKVI 100MG CAP 1 PA NSO

VITRAKVI 20MG/ML ORAL SOLN 1 PA NSO

VITRAKVI 25MG CAP 1 PA NSO

VIZIMPRO 15MG TAB 1 PA NSO QL=30 EA/30 Days



VOTRIENT 200MG TAB 1 PA NSO

XALKORI 200MG CAP 1 PA NSO QL=60 EA/30 Days

XALKORI 250MG CAP 1 PA NSO QL=60 EA/30 Days

XOSPATA 40MG TAB 1 PA NSO

ZEJULA 100MG CAP 1 PA NSO QL=90 EA/30 Days

ZELBORAF 240MG TAB 1 PA NSO QL=240 EA/30 Days

ZOLINZA 100MG CAP 1 PA NSO

ZYDELIG 100MG TAB 1 PA NSO QL=60 EA/30 Days

ZYDELIG 150MG TAB 1 PA NSO QL=60 EA/30 Days

ZYKADIA 150MG TAB 1 PA NSO QL=150 EA/30 Days

ANTINEOPLASTICS MISC.

ACTIMMUNE 2000000UNIT/0.5ML INJ 1 PA NSO

bexarotene 75mg cap 1 PA NSO

hydroxyurea 500mg cap 1

INTRON A 10MU INJ 1

INTRON A 18MU INJ 1

INTRON A 25MU INJ 1

INTRON A 50MU INJ 1

INTRON A 6000000UNIT/ML INJ 1

MATULANE 50MG CAP 1

SYNRIBO 3.5MG INJ 1

tretinoin 10mg cap 1

CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS

LEUCOVORIN 10MG TAB 1


leucovorin 25mg tab 1


MESNEX 400MG TAB 1

ANTIPARKINSON AGENTS

ANTIPARKINSON DOPAMINERGICS

amantadine 100mg cap 1

amantadine 10mg/ml oral soln 1

bromocriptine 2.5mg tab 1

bromocriptine 5mg cap 1




52

carbidopa 10mg/levodopa 100mg odt 1

carbidopa 10mg/levodopa 100mg tab 1

CARBIDOPA 12.5MG/ENTACAPONE 200MG/

LEVODOPA 50MG TAB

1


LEVODOPA 75MG TAB

1

CARBIDOPA 25MG/ENTACAPONE 200MG/

LEVODOPA 100MG TAB

1

carbidopa 25mg/levodopa 100mg er tab 1





LEVODOPA 125MG TAB

1


LEVODOPA 150MG TAB

1

CARBIDOPA 50MG/ENTACAPONE 200MG/

LEVODOPA 200MG TAB

1

carbidopa 50mg/levodopa 200mg er tab 1

NEUPRO 1MG/24HR PATCH 1






pramipexole 0.125mg tab 1


pramipexole 0.375mg er tab 1






pramipexole 1mg tab 1



pramipexole 3mg er tab 1


ropinirole 0.25mg tab 1


ropinirole 12mg er tab 1





53

ropinirole 3mg tab 1






ANTIPARKINSON AND RELATED THERAPY AGENTS

ANTIPARKINSON ADJUVANTS

carbidopa 25mg tab 1

ANTIPARKINSON ANTICHOLINERGICS

benztropine mesylate 0.5mg tab 1

benztropine mesylate 1mg tab 1


trihexyphenidyl 0.4mg/ml oral soln 1

trihexyphenidyl 2mg tab 1


ANTIPARKINSON COMT INHIBITORS

entacapone 200mg tab 1

tolcapone 100mg tab 1

ANTIPARKINSON DOPAMINERGICS

amantadine 100mg tab 1

APOKYN 10MG/ML CARTRIDGE 1




ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS

rasagiline 0.5mg tab 1

rasagiline 1mg tab 1

selegiline 5mg cap 1

selegiline 5mg tab 1

ANTIPSYCHOTICS/ANTIMANIC AGENTS

ANTIMANIC AGENTS

LITHIUM CARBONATE 150MG CAP 1

lithium carbonate 300mg cap 1

lithium carbonate 300mg er tab 1

lithium carbonate 300mg tab 1

lithium carbonate 450mg er tab 1

LITHIUM CARBONATE 600MG CAP 1

LITHIUM CITRATE 60MG/ML ORAL SOLN 1

ANTIPSYCHOTICS - MISC.

CAPLYTA 42MG CAP 1 PA NSO QL=30 EA/30 Days

EQUETRO 100MG ER CAP 1




54



GEODON 20MG INJ 1

LATUDA 120MG TAB 1 ST_NSO QL=30 EA/30 Days





NUPLAZID 10MG TAB 1 PA NSO QL=30 EA/30 Days

NUPLAZID 34MG CAP 1 PA NSO QL=30 EA/30 Days

VRAYLAR 1.5/3MG MIXED PACK 1 PA NSO QL=30 EA/30 Days

VRAYLAR 1.5MG CAP 1 PA NSO QL=30 EA/30 Days

VRAYLAR 3MG CAP 1 PA NSO QL=30 EA/30 Days

VRAYLAR 4.5MG CAP 1 PA NSO QL=30 EA/30 Days

VRAYLAR 6MG CAP 1 PA NSO QL=30 EA/30 Days

ziprasidone 20mg cap 1

ziprasidone 20mg inj 1




BENZISOXAZOLES

FANAPT 10MG TAB 1 PA NSO QL=60 EA/30 Days







FANAPT TITRATION PACK 1 PA NSO QL=60 EA/30 Days

INVEGA 117MG/0.75ML SYRINGE 1 PA NSO

INVEGA 156MG/ML SYRINGE 1 PA NSO








paliperidone 1.5mg er tab 1 PA NSO QL=30 EA/30 Days

paliperidone 3mg er tab 1 PA NSO QL=30 EA/30 Days






55

PERSERIS 120MG SYRINGE 1 PA NSO

PERSERIS 90MG SYRINGE 1 PA NSO

RISPERDAL 12.5MG INJ 1 PA NSO

RISPERDAL 25MG INJ 1 PA NSO

RISPERDAL 37.5MG INJ 1 PA NSO

RISPERDAL 50MG INJ 1 PA NSO

risperidone 0.25mg odt 1

risperidone 0.25mg tab 1



risperidone 1mg odt 1

risperidone 1mg tab 1

risperidone 1mg/ml oral soln 1







BUTYROPHENONES

haloperidol 0.5mg tab 1

haloperidol 10mg tab 1




haloperidol 2mg/ml oral soln 1


haloperidol 5mg/ml inj 1

haloperidol decanoate 100mg/ml inj 1

haloperidol decanoate 500mg/5ml inj 1

haloperidol decanoate 50mg/ml inj 1

DIBENZAPINES

clozapine 100mg odt 1

clozapine 100mg tab 1

clozapine 12.5mg odt 1

CLOZAPINE 150MG ODT 1






loxapine 10mg cap 1




56

loxapine 25mg cap 1

loxapine 50mg cap 1

loxapine 5mg cap 1

olanzapine 10mg inj 1

olanzapine 10mg odt 1

olanzapine 10mg tab 1



olanzapine 2.5mg tab 1






quetiapine 100mg tab 1

quetiapine 150mg xr tab 1










SAPHRIS 10MG SL TAB 1 PA NSO QL=60 EA/30 Days

SAPHRIS 2.5MG SL TAB 1 PA NSO QL=60 EA/30 Days

SAPHRIS 5MG SL TAB 1 PA NSO QL=60 EA/30 Days

SECUADO 3.8MG/24HR PATCH 1 PA NSO QL=30 EA/30 Days



VERSACLOZ 50MG/ML SUSP 1

ZYPREXA 210MG INJ 1

DIHYDROINDOLONES

MOLINDONE 10MG TAB 1


MOLINDONE 5MG TAB 1

PHENOTHIAZINES

chlorpromazine 100mg tab 1







57


compro 25mg rectal supp 1

FLUPHENAZINE 0.5MG/ML ORAL SOLN 1

fluphenazine 10mg tab 1


fluphenazine 2.5mg tab 1

FLUPHENAZINE 2.5MG/ML INJ 1


FLUPHENAZINE 5MG/ML ORAL SOLN 1

fluphenazine decanoate 25mg/ml inj 1

perphenazine 16mg tab 1




prochlorperazine 10mg tab 1

prochlorperazine 25mg rectal supp 1


thioridazine 100mg tab 1




trifluoperazine 10mg tab 1




QUINOLINONE DERIVATIVES

ABILIFY 300MG MAINTENA INJ 1 PA NSO

ABILIFY 300MG MAINTENA PF SYRINGE 1 PA NSO

ABILIFY 400MG MAINTENA INJ 1 PA NSO

ABILIFY 400MG MAINTENA PF SYRINGE 1 PA NSO

aripiprazole 10mg odt 1 PA NSO QL=60 EA/30 Days

aripiprazole 10mg tab 1

aripiprazole 15mg odt 1 PA NSO QL=60 EA/30 Days


aripiprazole 1mg/ml oral soln 1 PA NSO





ARISTADA 1064MG/3.9ML SYRINGE 1 PA NSO






58



REXULTI 0.25MG TAB 1 PA NSO QL=30 EA/30 Days

REXULTI 0.5MG TAB 1 PA NSO QL=30 EA/30 Days

REXULTI 1MG TAB 1 PA NSO QL=30 EA/30 Days




THIOXANTHENES

thiothixene 10mg cap 1




ANTIVIRALS

ANTIRETROVIRALS

abacavir 20mg/ml oral soln 1

abacavir 300mg tab 1

abacavir 300mg/lamivudine 150mg/zidovudine 300mgtab

1

abacavir 600mg/lamivudine 300mg tab 1

APTIVUS 100MG/ML ORAL SOLN 1

APTIVUS 250MG CAP 1

atazanavir 150mg cap 1



ATRIPLA 600-200-300MG TAB 1

BIKTARVY 50-200-25MG TAB 1

CIMDUO 300-300MG TAB 1

COMPLERA 200-25-300MG TAB 1

CRIXIVAN 200MG CAP 1


DELSTRIGO 100-300-300MG TAB 1

DESCOVY 200-25MG TAB 1

didanosine 250mg dr cap 1


DOVATO 50-300MG TAB 1

EDURANT 25MG TAB 1

efavirenz 200mg cap 1



EMTRIVA 10MG/ML ORAL SOLN 1

EMTRIVA 200MG CAP 1




59

EVOTAZ 300-150MG TAB 1

fosamprenavir 700mg tab 1

FUZEON 90MG INJ 1

GENVOYA 150-150-200-10MG TAB 1

INTELENCE 100MG TAB 1



INVIRASE 500MG TAB 1

ISENTRESS 100MG CHEW TAB 1

ISENTRESS 100MG SUSP 1

ISENTRESS 25MG CHEW TAB 1

ISENTRESS 400MG TAB 1


JULUCA 50-25MG TAB 1

KALETRA 100-25MG TAB 1


lamivudine 10mg/ml oral soln 1

lamivudine 150mg tab 1

lamivudine 150mg/zidovudine 300mg tab 1


LEXIVA 50MG/ML SUSP 1

lopinavir 80mg/ml/ritonavir 20mg/ml oral solution 1

nevirapine 100mg er tab 1

nevirapine 10mg/ml oral susp 1

nevirapine 200mg tab 1


NORVIR 100MG POWDER PACKET 1

NORVIR 80MG/ML ORAL SOLN 1

ODEFSEY 200-25-25MG TAB 1

PIFELTRO 100MG TAB 1

PREZCOBIX 800-150MG TAB 1

PREZISTA 100MG/ML SUSP 1

PREZISTA 150MG TAB 1


PREZISTA 75MG TAB 1


REYATAZ 50MG ORAL POWDER 1

ritonavir 100mg tab 1

RUKOBIA 600MG ER TAB 1

SELZENTRY 150MG TAB 1

SELZENTRY 20MG/ML ORAL SOLN 1





60



stavudine 15mg cap 1




STRIBILD 150-150-200-300MG TAB 1

SYMFI 600-300-300MG TAB 1

SYMFI LO 400-300-300MG TAB 1

SYMTUZA 800-150-200-10MG TAB 1

tenofovir disoproxil fumarate 300mg tab 1

TIVICAY 10MG TAB 1

TIVICAY 25MG TAB 1

TIVICAY 50MG TAB 1

TIVICAY 5MG TAB FOR ORAL SUSP 1

TRIUMEQ 600-50-300MG TAB 1

TRUVADA 100-150MG TAB 1




TYBOST 150MG TAB 1

VIRACEPT 250MG TAB 1


VIREAD 150MG TAB 1

VIREAD 200MG TAB 1

VIREAD 250MG TAB 1

VIREAD 40MG/GM ORAL POWDER 1

zidovudine 100mg cap 1

zidovudine 10mg/ml oral soln 1

zidovudine 300mg tab 1

CMV AGENTS

PREVYMIS 240MG TAB 1 PA QL=30 EA/30 Days

PREVYMIS 480MG TAB 1 PA QL=30 EA/30 Days

valganciclovir 450mg tab 1

valganciclovir 50mg/ml oral soln 1

HEPATITIS AGENTS

adefovir dipivoxil 10mg tab 1

entecavir 0.5mg tab 1

entecavir 1mg tab 1

EPIVIR HBV 5MG/ML ORAL SOLN 1


MAVYRET 100-40MG TAB 1 PA QL=90 EA/30 Days




61

PEGASYS 180MCG/0.5ML AUTO-INJECTOR 1

PEGASYS 180MCG/0.5ML SYRINGE 1

PEGASYS 180MCG/ML INJ 1

ribavirin 200mg cap 1

ribavirin 200mg tab 1

SOFOSBUVIR/VELPATASVIR 400-100MG TAB 1 PA QL=30 EA/30 Days

VEMLIDY 25MG TAB 1

VOSEVI 400-100-100MG TAB 1 PA QL=30 EA/30 Days

HERPES AGENTS

acyclovir 200mg cap 1

acyclovir 400mg tab 1

acyclovir 40mg/ml susp 1

acyclovir 50mg/ml inj 1 PA BvD


famciclovir 125mg tab 1



valacyclovir 1000mg tab 1


INFLUENZA AGENTS

oseltamivir 30mg cap 1 QL=84 EA/180 Days


oseltamivir 6mg/ml oral susp 1 QL=540 ML/180 Days


RELENZA 5MG/BLISTER INH 1 QL=120 EA/30 Days

rimantadine 100mg tab 1

XOFLUZA 20MG THERAPY PACK 1 QL=2 EA/30 Days

XOFLUZA 40MG THERAPY PACK 1 QL=2 EA/30 Days

ASSORTED CLASSES

IMMUNOSUPPRESSIVE AGENTS

AZASAN 100MG TAB 1 PA BvD

AZASAN 75MG TAB 1 PA BvD

azathioprine 50mg tab 1 PA BvD

cyclosporine 100mg cap 1 PA BvD

cyclosporine 25mg cap 1 PA BvD

cyclosporine modified 100mg cap 1 PA BvD

cyclosporine modified 25mg cap 1 PA BvD

gengraf 100mg cap 1 PA BvD

gengraf 100mg/ml oral soln 1 PA BvD

gengraf 25mg cap 1 PA BvD

mycophenolate mofetil 200mg/ml susp 1 PA BvD

mycophenolate mofetil 250mg cap 1 PA BvD




62

mycophenolate mofetil 500mg tab 1 PA BvD

mycophenolic acid 180mg dr tab 1 PA BvD

mycophenolic acid 360mg dr tab 1 PA BvD

SANDIMMUNE 100MG/ML ORAL SOLN 1 PA BvD

sirolimus 0.5mg tab 1 PA BvD

sirolimus 1mg tab 1 PA BvD

sirolimus 2mg tab 1 PA BvD

tacrolimus 0.5mg cap 1 PA BvD

tacrolimus 1mg cap 1 PA BvD

tacrolimus 5mg cap 1 PA BvD

POTASSIUM REMOVING RESINS

kionex 250mg/ml susp 1

sodium polystyrene sulfonate 15gm oral susp 1

sodium polystyrene sulfonate 250mg/ml susp 1

sps 250mg/ml oral susp 1

BETA BLOCKERS

ALPHA-BETA BLOCKERS

carvedilol 12.5mg tab 1

carvedilol 25mg tab 1



labetalol 100mg tab 1



BETA BLOCKERS CARDIO-SELECTIVE

acebutolol 200mg cap 1


atenolol 100mg tab 1

atenolol 25mg tab 1

atenolol 50mg tab 1

betaxolol 10mg tab 1


bisoprolol fumarate 10mg tab 1


BYSTOLIC 10MG TAB 1

BYSTOLIC 2.5MG TAB 1

BYSTOLIC 20MG TAB 1

BYSTOLIC 5MG TAB 1

metoprolol succinate 100mg er tab 1







63

metoprolol tartrate 100mg tab 1



BETA BLOCKERS NON-SELECTIVE

nadolol 20mg tab 1

nadolol 40mg tab 1

nadolol 80mg tab 1

pindolol 10mg tab 1

pindolol 5mg tab 1

propranolol 10mg tab 1

propranolol 120mg er cap 1




PROPRANOLOL 4MG/ML ORAL SOLN 1





PROPRANOLOL 8MG/ML ORAL SOLN 1

sorine 120mg tab 1

sorine 160mg tab 1

sorine 240mg tab 1

sorine 80mg tab 1

sotalol 120mg tab 1

sotalol 160mg tab 1

sotalol 240mg tab 1

sotalol 80mg tab 1

sotalol af 120mg tab 1

sotalol AF 160mg tab 1


timolol 10mg tab 1

TIMOLOL 20MG TAB 1

timolol 5mg tab 1

CALCIUM CHANNEL BLOCKERS

CALCIUM CHANNEL BLOCKERS

amlodipine 10mg tab 1

amlodipine 2.5mg tab 1


cartia 120mg er cap 1






64


dilt 120mg xr cap 1

dilt 180mg xr cap 1

dilt 240mg xr cap 1

diltiazem 120mg er (12 hr) cap 1

diltiazem 120mg er (24 hr) cap 1

diltiazem 120mg tab 1

diltiazem 180mg er cap 1










felodipine 10mg er tab 1

felodipine 2.5mg er tab 1


isradipine 2.5mg cap 1

isradipine 5mg cap 1

matzim 180mg er tab 1





nicardipine 20mg cap 1


nifedipine 30mg er tab 1

nifedipine 30mg osmotic er tab 1





nimodipine 30mg cap 1

nisoldipine 17mg er tab 1

NISOLDIPINE 20MG ER TAB 1

NISOLDIPINE 25.5MG ER TAB 1







65

nisoldipine 8.5mg er tab 1

taztia 120mg er cap 1





tiadylt 120mg er cap 1






verapamil 100mg er cap 1


verapamil 120mg er tab 1

verapamil 120mg tab 1







VERAPAMIL 360MG SR CAP 1



CARDIOTONICS

CARDIAC GLYCOSIDES

digitek 0.125mg tab 1


digox 0.125mg tab 1

digox 0.25mg tab 1

DIGOXIN 0.05MG/ML ORAL SOLN 1

digoxin 0.125mg tab 1


CARDIOVASCULAR AGENTS - MISC.

CARDIOVASCULAR AGENTS MISC. - COMBINATIONS

amlodipine 10mg/atorvastatin 10mg tab 1




amlodipine 2.5mg/atorvastatin 10mg tab 1





66






BIDIL 20-37.5MG TAB 1

ENTRESTO 24-26MG TAB 1 QL=60 EA/30 Days



PROSTAGLANDIN VASODILATORS

ORENITRAM 0.125MG ER TAB 1 PA


ORENITRAM 1MG ER TAB 1 PA


ORENITRAM 5MG ER TAB 1 PA

VENTAVIS 10MCG/ML INH SOLN 1 PA

VENTAVIS 20MCG/ML INH SOLN 1 PA

PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS

ambrisentan 10mg tab 1 PA QL=30 EA/30 Days

ambrisentan 5mg tab 1 PA QL=30 EA/30 Days

bosentan 125mg tab 1 PA QL=60 EA/30 Days

bosentan 62.5mg tab 1 PA QL=60 EA/30 Days

OPSUMIT 10MG TAB 1 PA QL=30 EA/30 Days

TRACLEER 32MG TAB FOR ORAL SUSP 1 PA QL=120 EA/30 Days

PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS

alyq 20mg tab 1 PA

sildenafil 20mg tab 1 PA

tadalafil 20mg tab(PAH) 1 PA

PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST

UPTRAVI 1000MCG TAB 1 PA








UPTRAVI TITRATION PACK 1 PA QL=200 EA/28 Days

PULMONARY HYPERTENSION - SOL GUANYLATE CYCLASE STIMULATOR

ADEMPAS 0.5MG TAB 1 PA


ADEMPAS 1MG TAB 1 PA




67


ADEMPAS 2MG TAB 1 PA

SINUS NODE INHIBITORS

CORLANOR 5MG TAB 1 PA

CORLANOR 5MG/5ML ORAL SOLN 1 PA

CORLANOR 7.5MG TAB 1 PA

TRANSTHYRETIN STABILIZERS

VYNDAMAX 61MG CAP 1 PA QL=30 EA/30 Days

CEPHALOSPORINS

CEPHALOSPORIN COMBINATIONS

AVYCAZ 2-0.5GM INJ 1

ZERBAXA 1.5GM INJ 1

CEPHALOSPORINS - 1ST GENERATION

cefadroxil 1000mg tab 1

cefadroxil 100mg/ml susp 1

cefadroxil 500mg cap 1


cefazolin 1gm inj 1

cefazolin 200mg/ml inj 1

cefazolin 500mg inj 1

cephalexin 250mg cap 1

cephalexin 25mg/ml susp 1



CEPHALOSPORINS - 2ND GENERATION

cefaclor 250mg cap 1

CEFACLOR 25MG/ML SUSP 1




cefotetan 1000mg inj 1


cefoxitin 1000mg inj 1


cefoxitin 200mg/ml inj 1

cefprozil 250mg tab 1

cefprozil 25mg/ml susp 1



cefuroxime 1.5gm inj 1

cefuroxime 250mg tab 1





68

cefuroxime 750mg inj 1

cefuroxime 95mg/ml inj 1

CEPHALOSPORINS - 3RD GENERATION

cefdinir 25mg/ml susp 1

cefdinir 300mg cap 1


cefixime 20mg/ml susp 1

cefixime 400mg cap 1


cefpodoxime 100mg tab 1

cefpodoxime 10mg/ml susp 1



ceftazidime 1000mg inj 1


ceftazidime 200mg/ml inj 1

ceftriaxone 1000mg inj 1

ceftriaxone 100mg/ml inj 1




SUPRAX 400MG CAP 1

tazicef 1gm inj 1

tazicef 2gm inj 1

tazicef 6gm inj 1

CEPHALOSPORINS - 4TH GENERATION

cefepime 1gm inj 1

cefepime 2gm inj 1

CEPHALOSPORINS - 5TH GENERATION

TEFLARO 400MG INJ 1

TEFLARO 600MG INJ 1

CONTRACEPTIVES

COMBINATION CONTRACEPTIVES - ORAL

altavera 28 day pack 1

alyacen 1/35 28 day pack 1

amethia 91 day pack 1

amethia lo 91 day pack 1

apri 28 day pack 1

aranelle 28 pack 1

ashlyna 91 day pack 1

aubra 28 day pack 1

aviane 28 pack 1




69

balziva 28 day pack 1

blisovi 21 fe 1.5/30 28 day 1

blisovi 24 fe 1/20 28 day pack 1

briellyn 28 day pack 1

camrese lo 91 day pack 1

caziant 28 day pack 1

cryselle 28 pack 1

cyclafem 1/35 28 day pack 1

cyclafem 7/7/7 28 day pack 1

cyred 28 day pack 1

desogestrel/ethinyl estradiol pack 1

drospirenone 3mg/ethinyl estradiol 0.02mg/inert 1 mgpack

1

drospirenone 3mg/ethinyl estradiol 0.03mg/inertingredients 1mg pack

1

emoquette pack 1

enpresse 28 day pack 1

enskyce 28 day pack 1

estarylla 28 day pack 1

ethinyl estradiol 0.01mg/ethinyl estradiol 0.02mg/levonorgestrel 0.1mg 91 day pack

1

ethinyl estradiol 0.01mg/ethinyl estradiol 0.03mg/levonorgestrel 0.15mg pack

1

ethinyl estradiol 0.025mg/ferrous fumarate 75mg/norethindrone 0.8mg pack

1

ethinyl estradiol 0.025mg/inert/norgestimate0.18mg/0.215mg/0.25mg pack

1

ethinyl estradiol 0.02mg/inert ingredients 1mg/levonorgestrel 0.1mg pack

1

ethinyl estradiol 0.02mg/norethindrone 1mg 21 day pack 1

ethinyl estradiol 0.035mg/ethynodiol 1mg 28 day pack 1

ethinyl estradiol 0.035mg/ferrous fumarate 75mg/norethindrone 0.4mg pack

1

ethinyl estradiol 0.035mg/inert/norgestimate0.18mg/0.215mg/0.25mg pack

1

ethinyl estradiol 0.035mg/norgestimate 0.25mg pack 1

ethinyl estradiol 0.03mg/0.04mg /inert/levonorgestrel0.05mg/ 0.075mg pack

1

ethinyl estradiol 0.03mg/inert ingredients 1mg/levonorgestrel 0.15mg pack

1

ethinyl estradiol 0.03mg/levonorgestrel 0.15mg tab 28day pack

1




70

ethinyl estradiol 0.05mg/ethynodiol 1mg/inertingredients 1mg 28 day pack

1

ethinyl estradiol/levonorgestrel 91 day pack 1

falmina 28 day pack 1

fayosim 91 day pack 1

femynor 28 day pack 1

gianvi 28-day pack 1

hailey 24 fe 28 day pack 1

introvale 91 day pack 1

isibloom 28 day pack 1

jasmiel 28 day pack 1

juleber 28 day pack 1

junel 1.5/30 21 day pack 1

junel 1/20 21 day pack 1

junel fe 1.5/30 28 day pack 1

junel fe 1/20 28 day pack 1

junel fe 24 1/20 28 day pack 1

kaitlib fe 28 day pack 1

kariva 28 day pack 1

kelnor 1/35 28 day pack 1


kurvelo 28 day pack 1

larin 1.5/30 pack 1

larin 1/20 pack 1

larin fe 1.5/30 pack 1

larin fe 1/20 pack 1

larissia 28 day pack 1

layolis fe 28 pack 1

leena 28 day pack 1

lessina 28 day pack 1

levonest 28 day pack 1

levora 0.15/30 28 day pack 1

loryna 28 day pack 1

low-ogestrel 28 day pack 1

lutera 28 day pack 1

marlissa 28 day pack 1

microgestin 1.5/30 21 day pack 1

microgestin 1/20 21 day pack 1

microgestin fe 1.5/30 28 day pack 1

microgestin fe 1/20 28 day pack 1

mili 28 day pack 1

NATAZIA 28 DAY PACK 1




71

necon 0.5/35 28 day pack 1

nikki 28 day pack 1

nortrel 0.5/35 28 day pack 1

nortrel 1/35 21 day pack 1


nortrel 7/7/7 28 day pack 1

ocella 28 day pack 1

orsythia 28 day pack 1

pimtrea pack 1

pirmella 1/35 28 day pack 1

portia 28 day pack 1

previfem 28 day pack 1

reclipsen 28 day pack 1

rivelsa 91 day pack 1

setlakin 91 day pack 1

sprintec 28 day pack 1

sronyx 28 day pack 1

syeda 28 day pack 1

tarina 24 fe 1/20 28 day pack 1

tarina fe 1/20 28 day pack 1

tri-estarylla 28 day pack 1

tri-legest 28 day pack 1

tri-lo-estarylla 28 day pack 1

tri-lo-sprintec 28 day pack 1

tri-mili 28 day pack 1

tri-previfem 28 day pack 1

tri-sprintec 28 day pack 1

tri-vylibra 28 day pack 1

tri-vylibra lo 28 day pack 1

trivora 28 day pack 1

velivet 28 day pack 1

vienva 28 day pack 1

vyfemla 28 day pack 1

vylibra 28 day pack 1

wymzya fe 28 day pack 1

zarah 3-0.03mg pack 1

zovia 1/35e 28 day pack 1

COMBINATION CONTRACEPTIVES - TRANSDERMAL

XULANE 150-35MCG PATCH 1

COMBINATION CONTRACEPTIVES - VAGINAL

eluryng 0.120-0.015mg/24hr vaginal ring 1




72

etonogestrel-ethinyl estradiol 0.120-0.015mg/24hrvaginal ring

1

NUVARING VAGINAL RING 1

PROGESTIN CONTRACEPTIVES - INJECTABLE

medroxyprogesterone acetate 150mg/ml inj 1

medroxyprogesterone acetate 150mg/ml syringe 1

PROGESTIN CONTRACEPTIVES - ORAL

camila 28 day 0.35mg pack 1

deblitane 28 day 0.35mg pack 1

errin 28 day 0.35mg pack 1

incassia 28 day 0.35mg pack 1

lyza 0.35mg pack 1

nora-be 28 day 0.35mg pack 1

norethindrone 0.35mg pack 1

sharobel 28 day 0.35mg pack 1

CORTICOSTEROIDS

GLUCOCORTICOSTEROIDS

budesonide 3mg dr cap 1

budesonide 9mg er tab 1 PA QL=30 EA/30 Days

CORTISONE ACETATE 25MG TAB 1

dexamethasone 0.1mg/ml oral soln 1

dexamethasone 0.5mg tab 1



DEXAMETHASONE 1MG TAB 1

DEXAMETHASONE 1MG/ML ORAL SOLN 1

DEXAMETHASONE 2MG TAB 1

dexamethasone 4mg tab 1


hydrocortisone 10mg tab 1



MEDROL 2MG TAB 1

methylprednisolone 16mg tab 1


methylprednisolone 4mg pack 1



prednisolone 10mg odt 1


prednisolone 1mg/ml oral soln 1





73

PREDNISOLONE 3MG/ML ORAL SOLN 1

prednisone 10mg tab 1


PREDNISONE 1MG/ML ORAL SOLN 1

prednisone 2.5mg tab 1


PREDNISONE 50MG TAB 1


PREDNISONE 5MG/ML ORAL SOLN 1

MINERALOCORTICOIDS

fludrocortisone 0.1mg tab 1

COUGH/COLD/ALLERGY

COUGH/COLD/ALLERGY COMBINATIONS

CLARINEX-D 2.5-120MG ER TAB 1

PHENYLEPHRINE 1MG/ML/PROMETHAZINE

1.25MG/ML ORAL SOLN

1

MUCOLYTICS

acetylcysteine 10% inh soln 1 PA BvD

acetylcysteine 20% inh soln 1 PA BvD

DERMATOLOGICALS

ACNE PRODUCTS

adapalene 0.1% cream 1 PA

adapalene 0.1% gel 1 PA

adapalene 0.3% gel 1 PA

adapalene/benzoyl peroxide 0.1-2.5% gel 1 PA

amnesteem 10mg cap 1



avita 0.025% cream 1 PA

avita 0.025% gel 1 PA

claravis 10mg cap 1

claravis 20mg cap 1

claravis 30mg cap 1

claravis 40mg cap 1

clindacin 1% pad 1

clindamycin 1% foam 1

clindamycin 1% gel 1

clindamycin 1% lotion 1

clindamycin 1% pad 1

clindamycin 1% topical soln 1 QL=300 ML/30 Days

clindamycin/benzoyl peroxide 1-5% gel 1

DIFFERIN 0.1% LOTION 1 PA




74

EPIDUO 0.3-2.5% GEL 1 PA

ery 2% pad 1

erythromycin 2% gel 1

erythromycin 2% topical soln 1

erythromycin/benzoyl peroxide 5-3% gel 1

isotretinoin 10mg cap 1




myorisan 10mg cap 1

myorisan 20mg cap 1

myorisan 30mg cap 1

myorisan 40mg cap 1

sulfacetamide sodium 10% lotion 1

tretinoin 0.01% gel 1 PA

tretinoin 0.025% cream 1 PA







zenatane 10mg cap 1

zenatane 20mg cap 1

zenatane 30mg cap 1

zenatane 40mg cap 1

ANTI-INFLAMMATORY AGENTS - TOPICAL

diclofenac sodium 1% gel 1 QL=1000 GM/30 Days

diclofenac sodium 1.5% topical soln 1 QL=450 ML/30 Days

ANTIBIOTICS - TOPICAL

gentamicin sulfate 0.1% cream 1

gentamicin sulfate 0.1% ointment 1

mupirocin 2% ointment 1 QL=220 GM/30 Days

ANTIFUNGALS - TOPICAL

betamethasone/clotrimazole 1-0.05% cream 1

betamethasone/clotrimazole 1-0.05% lotion 1

ciclopirox 0.77% cream 1

ciclopirox 0.77% gel 1

ciclopirox 0.77% lotion 1

ciclopirox 1% shampoo 1

ciclopirox 8% topical soln 1

clotrimazole 1% cream 1




75

clotrimazole 1% topical soln 1

econazole nitrate 1% cream 1

ERTACZO 2% CREAM 1

ketoconazole 2% cream 1

ketoconazole 2% shampoo 1

ketoconazole 20mg/ml foam 1

ketodan 2% foam 1

naftifine 1% cream 1


nyamyc 100000unit/gm powder 1

nystatin 100000unit/ml cream 1

nystatin 100unit/mg ointment 1

nystatin 100unit/mg powder 1

nystop 100000unit/gm powder 1

ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL

diclofenac sodium 3% gel 1 PA QL=300 GM/30 Days

FLUOROPLEX 1% CREAM 1

FLUOROURACIL 0.5% CREAM 1

FLUOROURACIL 2% TOPICAL SOLN 1

fluorouracil 5% cream 1

FLUOROURACIL 5% TOPICAL SOLN 1

PANRETIN 0.1% GEL 1

PICATO 0.015% GEL 1 QL=3 EA/10 Days

PICATO 0.05% GEL 1 QL=2 EA/10 Days

TARGRETIN 1% GEL 1 PA NSO

TOLAK 4% CREAM 1

VALCHLOR 0.016% GEL 1 PA NSO QL=240 GM/30 Days

ANTIPSORIATICS

acitretin 10mg cap 1

acitretin 17.5mg cap 1


calcipotriene 0.005% cream 1 QL=240 GM/30 Days

calcipotriene 0.005% ointment 1 QL=240 GM/30 Days

calcipotriene 0.005% topical soln 1

COSENTYX 150MG/ML AUTO-INJECTOR 1 PA

COSENTYX 150MG/ML SYRINGE 1 PA

methoxsalen 10mg cap 1

SKYRIZI SYRINGE 150MG DOSE PACK 1 PA

STELARA 45MG/0.5ML INJ 1 PA

STELARA 45MG/0.5ML SYRINGE 1 PA

STELARA 90MG/ML SYRINGE 1 PA

tazarotene 1% cream 1




76

TAZORAC 0.05% CREAM 1

TAZORAC 0.05% GEL 1

TAZORAC 0.1% GEL 1

ANTISEBORRHEIC PRODUCTS

selenium sulfide 2.5% lotion/shampoo 1

ANTIVIRALS - TOPICAL

acyclovir 5% ointment 1

DENAVIR 1% CREAM 1

BURN PRODUCTS

silver sulfadiazine 1% cream 1

ssd 1% cream 1

SULFAMYLON 85MG/GM CREAM 1

CORTICOSTEROIDS - TOPICAL

ala-cort 1% cream 1

alclometasone dipropionate 0.05% cream 1

alclometasone dipropionate 0.05% ointment 1

AMCINONIDE 0.1% CREAM 1 PA

AMCINONIDE 0.1% OINTMENT 1 PA

beser 0.05% lotion 1 PA

betamethasone 0.05% aug cream 1

BETAMETHASONE 0.05% AUG GEL 1

betamethasone 0.05% aug lotion 1

betamethasone 0.05% aug ointment 1

betamethasone 0.05% cream 1

betamethasone 0.05% lotion 1

betamethasone 0.05% ointment 1




betamethasone valerate 0.12% foam 1 PA

calcipotriene/betamethasone 0.005-0.064% ointment 1 QL=420 GM/30 Days

clobetasol propionate 0.05% cream 1

clobetasol propionate 0.05% e cream 1

clobetasol propionate 0.05% e foam 1 PA

clobetasol propionate 0.05% foam 1

clobetasol propionate 0.05% gel 1

clobetasol propionate 0.05% lotion 1

clobetasol propionate 0.05% ointment 1

clobetasol propionate 0.05% shampoo 1

clobetasol propionate 0.05% spray 1

clobetasol propionate 0.05% topical soln 1 QL=450 ML/30 Days

clodan 0.05% shampoo 1




77

desonide 0.05% cream 1 PA

desonide 0.05% lotion 1 PA

desonide 0.05% ointment 1

desoximetasone 0.05% gel 1

desoximetasone 0.25% cream 1

desoximetasone 0.25% ointment 1

fluocinolone acetonide 0.01% cream 1

fluocinolone acetonide 0.01% topical soln 1

fluocinolone acetonide 0.025% cream 1

fluocinolone acetonide 0.025% ointment 1

fluocinolone acetonide 0.1mg/ml oil 1

fluocinonide 0.05% e cream 1

fluocinonide 0.05% gel 1

fluocinonide 0.05% ointment 1

fluocinonide 0.05% topical soln 1

fluticasone propionate 0.005% ointment 1

fluticasone propionate 0.05% cream 1

fluticasone propionate 0.05% lotion 1 PA

halobetasol propionate 0.05% cream 1

halobetasol propionate 0.05% ointment 1

hydrocortisone 1% cream 1

hydrocortisone 2.5% cream 1

hydrocortisone 2.5% lotion 1

hydrocortisone 2.5% ointment 1

hydrocortisone valerate 0.2% cream 1

hydrocortisone valerate 0.2% ointment 1

mometasone furoate 0.1% cream 1

mometasone furoate 0.1% lotion 1

mometasone furoate 0.1% ointment 1

PREDNICARBATE 0.1% CREAM 1

PREDNICARBATE 0.1% OINTMENT 1

tovet 0.05% e foam 1 PA

triamcinolone acetonide 0.025% cream 1

triamcinolone acetonide 0.025% lotion 1

triamcinolone acetonide 0.025% ointment 1


triamcinolone acetonide 0.1% lotion 1


triamcinolone acetonide 0.147mg/ml spray 1



triderm 0.1% cream 1




78

ECZEMA AGENTS

DUPIXENT 300MG/2ML AUTO-INJECTOR 1 PA

DUPIXENT 300MG/2ML PF SYRINGE 1 PA

EMOLLIENTS

ammonium lactate 12% cream 1

ammonium lactate 12% lotion 1

ENZYMES - TOPICAL

SANTYL 250UNIT/GM OINTMENT 1 QL=90 GM/30 Days

IMMUNOMODULATING AGENTS - TOPICAL

imiquimod 5% cream 1

ZYCLARA 2.5% CREAM 1

IMMUNOSUPPRESSIVE AGENTS - TOPICAL

pimecrolimus 1% cream 1

tacrolimus 0.03% ointment 1 QL=100 GM/30 Days

tacrolimus 0.1% ointment 1 QL=100 GM/30 Days

KERATOLYTIC/ANTIMITOTIC AGENTS

podofilox 0.5% topical soln 1

LOCAL ANESTHETICS - TOPICAL

lidocaine 2% gel 1

lidocaine 4% topical soln 1

lidocaine 5% ointment 1 PA QL=107 GM/30 Days

lidocaine 5% patch 1 PA QL=90 EA/30 Days

lidocaine/prilocaine 2.5-2.5% cream 1 QL=60 GM/30 Days

ROSACEA AGENTS

azelaic acid 15% gel 1

FINACEA 15% FOAM 1

metronidazole 0.75% cream 1

metronidazole 0.75% gel 1

metronidazole 0.75% lotion 1

metronidazole 1% gel 1

SCABICIDES & PEDICULICIDES

LINDANE 1% SHAMPOO 1

malathion 0.5% lotion 1

permethrin 5% cream 1

WOUND CARE PRODUCTS

REGRANEX 0.01% GEL 1 QL=30 GM/15 Days

DIGESTIVE AIDS

DIGESTIVE ENZYMES

CREON 12000-38000-60000UNIT DR CAP 1

CREON 24000-76000-120000UNIT DR CAP 1

CREON 3000-9500-15000UNIT DR CAP 1

CREON 36000-114000-180000UNIT DR CAP 1




79

CREON 6000-19000-30000UNIT DR CAP 1

SUCRAID 8500UNIT/ML ORAL SOLN 1 PA

ZENPEP 10000-32000-42000UNIT DR CAP 1 ST







DIURETICS

CARBONIC ANHYDRASE INHIBITORS

acetazolamide 125mg tab 1


acetazolamide 500mg er cap 1

methazolamide 25mg tab 1


DIURETIC COMBINATIONS

amiloride 5mg/hydrochlorothiazide 50mg tab 1

hydrochlorothiazide 25mg/spironolactone 25mg tab 1

hydrochlorothiazide 25mg/triamterene 37.5mg cap 1

hydrochlorothiazide 25mg/triamterene 37.5mg tab 1

hydrochlorothiazide 50mg/triamterene 75mg tab 1

LOOP DIURETICS

bumetanide 0.25mg/ml inj 1

bumetanide 0.5mg tab 1

bumetanide 1mg tab 1


ethacrynic acid 25mg tab 1

furosemide 10mg/ml inj 1

furosemide 10mg/ml oral soln 1

furosemide 10mg/ml syringe 1

furosemide 20mg tab 1



FUROSEMIDE 8MG/ML ORAL SOLN 1

torsemide 100mg tab 1



torsemide 5mg tab 1

POTASSIUM SPARING DIURETICS

amiloride 5mg tab 1

DYRENIUM 100MG CAP 1




80

DYRENIUM 50MG CAP 1

spironolactone 100mg tab 1



triamterene 100mg cap 1


THIAZIDES AND THIAZIDE-LIKE DIURETICS

chlorthalidone 25mg tab 1


DIURIL 250MG/5ML SUSP 1

hydrochlorothiazide 12.5mg cap 1

hydrochlorothiazide 12.5mg tab 1

hydrochlorothiazide 25mg tab 1


indapamide 1.25mg tab 1


metolazone 10mg tab 1

metolazone 2.5mg tab 1


ENDOCRINE AND METABOLIC AGENTS - MISC.

BONE DENSITY REGULATORS

ALENDRONATE 0.933MG/ML ORAL SOLN 1

alendronate 10mg tab 1



FORTEO 600MCG/2.4ML PEN INJ 1

ibandronate 150mg tab 1 QL=1 EA/30 Days

NATPARA 100MCG CARTRIDGE 1 PA




PROLIA 60MG/ML SYRINGE 1 PA

risedronate sodium 150mg tab 1


risedronate sodium 35mg (12) pack 1

risedronate sodium 35mg (4) pack 1



salmon calcitonin 200unit/act nasal spray 1

TYMLOS 2MG/ML PEN INJECTOR 1

XGEVA 120MG/1.7ML INJ 1 PA

GNRH/LHRH ANTAGONISTS




81

ORILISSA 150MG TAB 1 PA QL=30 EA/30 Days

ORILISSA 200MG TAB 1 PA QL=60 EA/30 Days

GROWTH HORMONE RECEPTOR ANTAGONISTS

SOMAVERT 10MG INJ 1 PA





GROWTH HORMONES

GENOTROPIN 0.2MG SYRINGE 1 PA








GENOTROPIN 12MG CARTRIDGE 1 PA

GENOTROPIN 1MG SYRINGE 1 PA

GENOTROPIN 2MG SYRINGE 1 PA

GENOTROPIN 5MG CARTRIDGE 1 PA

HORMONE RECEPTOR MODULATORS

OSPHENA 60MG TAB 1 PA

raloxifene 60mg tab 1

INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS)

INCRELEX 40MG/4ML INJ 1 PA

LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS

LUPANETA PACK 1-MONTH PACK 1

LUPANETA PACK 3-MONTH PACK 1

SYNAREL 2MG/ML NASAL SPRAY 1

METABOLIC MODIFIERS

calcitriol 0.00025mg cap 1 PA BvD

calcitriol 0.0005mg cap 1 PA BvD

calcitriol 0.001mg/ml oral soln 1 PA BvD

CARBAGLU 200MG SUSP 1 PA

cinacalcet 30mg tab 1 PA BvD



doxercalciferol 0.0005mg cap 1 PA BvD



GALAFOLD 123MG CAP 1 PA QL=15 EA/30 Days




82

KUVAN 100MG POWDER FOR ORAL SOLN 1 PA

KUVAN 100MG TAB 1 PA

KUVAN 500MG POWDER FOR ORAL SOLN 1 PA

levocarnitine 100mg/ml oral soln 1 PA BvD

levocarnitine 330mg tab 1 PA BvD

nitisinone 10mg cap 1 PA



ORFADIN 10MG CAP 1 PA



ORFADIN 4MG/ML SUSP 1 PA


PALYNZIQ 10MG/0.5ML SYRINGE 1 PA

PALYNZIQ 2.5MG/0.5ML SYRINGE 1 PA

PALYNZIQ 20MG/ML SYRINGE 1 PA

paricalcitol 0.001mg cap 1 PA BvD



RAVICTI 1.1GM/ML ORAL SOLN 1 PA

sodium phenylbutyrate 0.94mg/mg oral powder 1

POSTERIOR PITUITARY HORMONES

desmopressin acetate 0.01% nasal spray 1

desmopressin acetate 0.1mg tab 1

desmopressin acetate 0.2mg tab 1

STIMATE 1.5MG/ML NASAL SPRAY 1

PROLACTIN INHIBITORS

cabergoline 0.5mg tab 1

SOMATOSTATIC AGENTS

octreotide 0.05mg/ml inj 1




octreotide 1mg/ml inj 1

SIGNIFOR 0.3MG/ML INJ 1 PA QL=60 ML/30 Days



SOMATULINE 120MG/0.5ML SYRINGE 1



VASOPRESSIN RECEPTOR ANTAGONISTS

JYNARQUE 15/15MG PACK 1 PA QL=60 EA/30 Days




83

JYNARQUE 15MG TAB 1 PA QL=120 EA/30 Days

JYNARQUE 30/15MG PACK 1 PA QL=60 EA/30 Days

JYNARQUE 30MG TAB 1 PA QL=120 EA/30 Days

JYNARQUE 45/15 THERAPY PACK 1 PA QL=60 EA/30 Days



ESTROGENS

ESTROGEN COMBINATIONS

amabelz 0.5/0.1mg 28 day pack 1

amabelz 1/0.5mg 28 day pack 1

COMBIPATCH 0.05-0.14MG PATCH 1

COMBIPATCH 0.05-0.25MG PATCH 1

estradiol 0.5mg/norethindrone acetate 0.1mg pack 1

estradiol 1mg/norethindrone acetate 0.5mg pack 1

ethinyl estradiol 0.0025mg/norethindrone acetate 0.5mgtab

1

ethinyl estradiol 0.005mg/norethindrone acetate 1mg tab 1

fyavolv 0.5mg-2.5mcg tab 1

fyavolv 1mg-5mcg tab 1

jinteli tab 1

lopreeza 1/0.5mg 28 day pack 1

mimvey pack 1

PREMPHASE 28 DAY PACK 1

PREMPRO 0.3/1.5MG 28 DAY PACK 1

PREMPRO 0.45/1.5 28 DAY PACK 1

PREMPRO 0.625/2.5MG 28 DAY PACK 1

PREMPRO 0.625/5MG 28 DAY PACK 1

ESTROGENS

dotti 0.025mg/24hr patch 1





estradiol 0.00104mg/hr twice weekly patch 1

estradiol 0.00104mg/hr weekly patch 1











84



estradiol 0.5mg tab 1

estradiol 1mg tab 1

estradiol 20mg/ml inj 1

estradiol 2mg tab 1


PREMARIN 0.3MG TAB 1





FLUOROQUINOLONES

FLUOROQUINOLONES

BAXDELA 450MG TAB 1 PA QL=60 EA/30 Days

ciprofloxacin 250mg tab 1

ciprofloxacin 2mg/ml inj 1



levofloxacin 250mg tab 1

levofloxacin 25mg/ml inj 1

levofloxacin 25mg/ml oral soln 1


levofloxacin 5mg/ml (150ml) inj 1



moxifloxacin 1.6mg/ml inj 1

moxifloxacin 400mg tab 1

ofloxacin 400mg tab 1

GASTROINTESTINAL AGENTS - MISC.

BILE ACID SYNTHESIS DISORDER AGENTS

CHOLBAM 250MG CAP 1 PA

CHOLBAM 50MG CAP 1 PA

FARNESOID X RECEPTOR (FXR) AGONISTS

OCALIVA 10MG TAB 1 PA QL=30 EA/30 Days

OCALIVA 5MG TAB 1 PA QL=30 EA/30 Days

GALLSTONE SOLUBILIZING AGENTS

CHENODAL 250MG TAB 1

ursodiol 250mg tab 1

ursodiol 300mg cap 1


GASTROINTESTINAL ANTIALLERGY AGENTS




85

cromolyn sodium 20mg/ml oral soln 1

GASTROINTESTINAL STIMULANTS

metoclopramide 10mg tab 1

metoclopramide 1mg/ml oral soln 1


INFLAMMATORY BOWEL AGENTS

APRISO 0.375GM ER CAP 1

balsalazide disodium 750mg cap 1

CIMZIA 200MG INJ 1 PA

CIMZIA 200MG/ML SYRINGE 1 PA

DIPENTUM 250MG CAP 1

mesalamine 1.2gm tab 1

mesalamine 1000mg rectal supp 1

mesalamine 375mg er cap 1

mesalamine 400mg dr cap 1

mesalamine 66.7mg/ml enema 1

mesalamine 800mg dr tab 1

sulfasalazine 500mg dr tab 1

sulfasalazine 500mg tab 1

INTESTINAL ACIDIFIERS

enulose 10gm/15ml oral soln 1

generlac 10gm/15ml oral soln 1

IRRITABLE BOWEL SYNDROME (IBS) AGENTS

alosetron 0.5mg tab 1

alosetron 1mg tab 1

LINZESS 145MCG CAP 1 PA



PERIPHERAL OPIOID RECEPTOR ANTAGONISTS

MOVANTIK 12.5MG TAB 1 PA

MOVANTIK 25MG TAB 1 PA

RELISTOR 12MG/0.6ML INJ 1 PA

RELISTOR 12MG/0.6ML SYRINGE 1 PA

RELISTOR 8MG/0.4ML SYRINGE 1 PA

SYMPROIC 0.2MG TAB 1 PA

PHOSPHATE BINDER AGENTS

AURYXIA 210MG TAB 1 PA

calcium acetate 667mg cap 1

calcium acetate 667mg tab 1

FOSRENOL 1000MG ORAL POWDER 1

FOSRENOL 750MG ORAL POWDER 1

lanthanum carbonate 1000mg chew tab 1




86



PHOSLYRA 667MG/5ML ORAL SOLN 1

sevelamer carbonate 2400mg oral susp 1

sevelamer carbonate 800mg oral susp 1

sevelamer carbonate 800mg tab 1

SHORT BOWEL SYNDROME (SBS) AGENTS

GATTEX 5MG INJ 1 PA

GENITOURINARY AGENTS - MISCELLANEOUS

ALKALINIZERS

potassium citrate 10meq er tab 1

potassium citrate 15 meq er tab 1

potassium citrate 5 meq er tab 1

CYSTINOSIS AGENTS

CYSTAGON 150MG CAP 1

CYSTAGON 50MG CAP 1

GENITOURINARY IRRIGANTS

sodium chloride 0.9% soln 1

INTERSTITIAL CYSTITIS AGENTS

ELMIRON 100MG CAP 1

PROSTATIC HYPERTROPHY AGENTS

alfuzosin 10mg er tab 1

dutasteride 0.5mg cap 1

dutasteride 0.5mg/tamsulosin 0.4mg cap 1

finasteride 5mg tab 1

silodosin 4mg cap 1

silodosin 8mg cap 1

tamsulosin 0.4mg cap 1

URINARY STONE AGENTS

LITHOSTAT 250MG TAB 1

THIOLA 100MG DR TAB 1

THIOLA 100MG TAB 1


GOUT AGENTS

GOUT AGENT COMBINATIONS

colchicine 0.5mg/probenecid 500mg tab 1

GOUT AGENTS

allopurinol 100mg tab 1


COLCHICINE 0.6MG CAP 1

COLCHICINE 0.6MG TAB 1

febuxostat 40mg tab 1 ST




87

febuxostat 80mg tab 1 ST

MITIGARE 0.6MG CAP 1

URICOSURICS

probenecid 500mg tab 1

HEMATOLOGICAL AGENTS - MISC.

BRADYKININ B2 RECEPTOR ANTAGONISTS

icatibant 10mg/ml syringe 1 PA

COMPLEMENT INHIBITORS

BERINERT 500UNIT INJ 1 PA

CINRYZE 500UNIT INJ 1 PA

HAEGARDA 2000UNT INJ 1 PA

HAEGARDA 3000UNT INJ 1 PA

RUCONEST 2100UNIT INJ 1 PA

HEMATAOLOGIC - TYROSINE KINASE INHIBITORS

TAVALISSE 100MG TAB 1 PA QL=60 EA/30 Days

TAVALISSE 150MG TAB 1 PA QL=60 EA/30 Days

HEMATORHEOLOGIC AGENTS

pentoxifylline 400mg er tab 1

PLASMA KALLIKREIN INHIBITORS

TAKHZYRO 300MG/2ML INJ 1 PA QL=4 ML/28 Days

PLATELET AGGREGATION INHIBITORS

anagrelide 0.5mg cap 1

anagrelide 1mg cap 1

aspirin 25mg/dipyridamole 200mg cap 1

BRILINTA 60MG TAB 1

BRILINTA 90MG TAB 1

cilostazol 100mg tab 1


clopidogrel 75mg tab 1

prasugrel 10mg tab 1

prasugrel 5mg tab 1

HEMATOPOIETIC AGENTS

AGENTS FOR GAUCHER DISEASE

CERDELGA 84MG CAP 1 PA QL=60 EA/30 Days

miglustat 100mg cap 1 PA

AGENTS FOR SICKLE CELL ANEMIA

DROXIA 200MG CAP 1

DROXIA 300MG CAP 1

DROXIA 400MG CAP 1

ENDARI 5000MG POWDER FOR ORAL SOLN 1 PA QL=180 EA/30 Days

AGENTS FOR SICKLE CELL DISEASE

OXBRYTA 500MG TAB 1 PA QL=90 EA/30 Days




88

HEMATOPOIETIC GROWTH FACTORS

ARANESP 100MCG/0.5ML SYRINGE 1 PA BvD ST

ARANESP 100MCG/ML INJ 1 PA BvD ST











ARANESP 500MCG/ML SYRINGE 1 PA BvD ST



DOPTELET 20MG TAB 1 PA QL=60 EA/30 Days

DOPTELET 40MG DAILY DOSE PACK 1 PA QL=10 EA/5 Days

DOPTELET 60MG DAILY DOSE PACK 1 PA QL=15 EA/5 Days

FULPHILA 6/0.6ML SYRINGE 1

LEUKINE 250MCG INJ 1 PA

MULPLETA 3MG TAB 1 PA QL=7 EA/7 Days

NIVESTYM 300MCG/0.5ML PF INJ 1

NIVESTYM 300MCG/1ML INJ 1

NIVESTYM 480MCG/0.8ML PF INJ 1

NIVESTYM 480MCG/1.6ML INJ 1

PROMACTA 12.5MG POWDER FOR ORAL SUSP 1 PA

PROMACTA 12.5MG TAB 1 PA

PROMACTA 25MG POWDER FOR ORAL SUSP 1 PA

PROMACTA 25MG TAB 1 PA



RETACRIT 10000UNIT/ML INJ 1 PA BvD





UDENYCA 6MG/0.6ML SYRINGE 1

ZARXIO 300MCG/0.5ML SYRINGE 1

ZARXIO 480MCG/0.8ML SYRINGE 1

ZIEXTENZO 6MG/0.6ML SYRINGE 1

HEMOSTATICS




89

HEMOSTATICS - SYSTEMIC

tranexamic acid 650mg tab 1

HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS

BARBITURATE HYPNOTICS

phenobarbital 100mg tab 1


phenobarbital 16.2mg tab 1



phenobarbital 4mg/ml oral soln 1




NON-BARBITURATE HYPNOTICS

estazolam 1mg tab 1

estazolam 2mg tab 1

eszopiclone 1mg tab 1 QL=30 EA/30 Days



FLURAZEPAM 15MG CAP 1


temazepam 15mg cap 1

temazepam 22.5mg cap 1



triazolam 0.125mg tab 1


zaleplon 10mg cap 1 QL=30 EA/30 Days

zaleplon 5mg cap 1 QL=30 EA/30 Days

zolpidem tartrate 10mg tab 1 QL=30 EA/30 Days

zolpidem tartrate 5mg tab 1 QL=60 EA/30 Days

SELECTIVE MELATONIN RECEPTOR AGONISTS

HETLIOZ 20MG CAP 1 PA QL=30 EA/30 Days

ramelteon 8mg tab 1 QL=30 EA/30 Days

LAXATIVES

LAXATIVE COMBINATIONS

CLENPIQ POWDER 1

gavilyte-c oral soln 1

gavilyte-g powder for oral soln 1

gavilyte-n powder for oral soln 1

peg 3350/electrolyte oral soln 1




90

peg 3350/kcl/sodium bicarbonate/sodium chloridepowder for oral soln

1

trilyte powder for oral soln 1

LAXATIVES - MISCELLANEOUS

constulose 10gm/15ml oral soln 1

lactulose 667mg/ml oral soln 1

MACROLIDES

AZITHROMYCIN

azithromycin 20mg/ml susp 1

azithromycin 250mg pack 1

azithromycin 250mg tab 1

azithromycin 2mg/ml inj 1


azithromycin 500mg (3) tab pack 1



CLARITHROMYCIN

clarithromycin 250mg tab 1

CLARITHROMYCIN 25MG/ML SUSP 1

clarithromycin 500mg er tab 1


CLARITHROMYCIN 50MG/ML SUSP 1

ERYTHROMYCINS

ERYTHROCIN LACTOBIONATE 500MG INJ 1

erythromycin 250mg dr cap 1

erythromycin 250mg tab 1


erythromycin ethylsuccinate 40mg/ml susp 1

erythromycin ethylsuccinate 80mg/ml oral susp 1

MEDICAL DEVICES

PARENTERAL THERAPY SUPPLIES

INSULIN SYRINGE (DISP) U-100 1/2ML 1

MEDICAL DEVICES AND SUPPLIES

BANDAGES-DRESSINGS-TAPE

GAUZE PAD 1

MISC. DEVICES

ISOPROPYL ALCOHOL 0.7ML/ML PAD 1

PARENTERAL THERAPY SUPPLIES

INSULIN PEN NEEDLE 1

INSULIN SYRINGE (DISP) U-100 0.3ML 1

INSULIN SYRINGE (DISP) U-100 1ML 1

INSULIN SYRINGE MIS 1ML/29G 1




91

MIGRAINE PRODUCTS

MIGRAINE PRODUCTS

DIHYDROERGOTAMINE MESYLATE 0.5MG/ACT

NASAL SPRAY

1 QL=16 ML/30 Days

MIGRAINE PRODUCTS - MONOCLONAL ANTIBODIES

AIMOVIG 140MG/ML AUTO-INJECTOR 1 PA

AIMOVIG 70MG/ML AUTO-INJECTOR 1 PA

EMGALITY 100MG/ML SYRINGE 1 PA

EMGALITY 120MG/ML AUTO-INJECTOR 1 PA

EMGALITY 120MG/ML SYRINGE 1 PA

SEROTONIN AGONISTS

eletriptan 20mg tab 1 QL=18 EA/30 Days

eletriptan 40mg tab 1 QL=18 EA/30 Days

naratriptan 1mg tab 1 QL=18 EA/30 Days

naratriptan 2.5mg tab 1 QL=18 EA/30 Days

rizatriptan 10mg odt 1 QL=36 EA/60 Days

rizatriptan 10mg tab 1 QL=36 EA/60 Days

rizatriptan 5mg odt 1 QL=36 EA/60 Days

rizatriptan 5mg tab 1 QL=36 EA/60 Days

sumatriptan 100mg tab 1 QL=18 EA/30 Days

sumatriptan 12mg/ml auto-injector 1 QL=5 ML/30 Days

sumatriptan 12mg/ml inj 1 QL=5 ML/30 Days

SUMATRIPTAN 12MG/ML SYRINGE 1 QL=5 ML/30 Days

sumatriptan 20mg/act nasal spray 1 QL=12 EA/30 Days


sumatriptan 4mg cartridge 1 QL=5 ML/30 Days


sumatriptan 5mg/act nasal spray 1 QL=12 EA/30 Days

sumatriptan 6mg cartridge 1 QL=5 ML/30 Days

sumatriptan 8mg/ml auto-injector 1 QL=5 ML/30 Days

zolmitriptan 2.5mg odt 1 QL=18 EA/30 Days

zolmitriptan 2.5mg tab 1 QL=18 EA/30 Days

zolmitriptan 5mg odt 1 QL=18 EA/30 Days

zolmitriptan 5mg tab 1 QL=18 EA/30 Days

ZOMIG 2.5MG NASAL SPRAY 1 QL=16 EA/30 Days

ZOMIG 5MG NASAL SPRAY 1 QL=12 EA/30 Days

MINERALS & ELECTROLYTES

ELECTROLYTE MIXTURES

GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0342

MEQ/ML INJ

1 PA BvD


MEQ/ML INJ

1 PA BvD




92


MEQ/ML INJ

1

glucose 50 mg/ml/potassium chloride 0.04meq/ml/sodium chloride 4.5mg/ml inj

1

glucose 50mg/ml/potassium chloride 0.01 meq/ml/sodium chloride 0.0769 meq/ml inj

1

glucose 50mg/ml/potassium chloride 0.02 meq/ml inj 1


1


1

glucose 50mg/ml/potassium chloride 0.02meq/ml/sodiumchloride 4.5mg/ml inj

1


1

GLUCOSE 50MG/ML/POTASSIUM CHLORIDE 0.04

MEQ/ML/SODIUM CHLORIDE 0.154 MEQ/ML INJ

1

glucose 50mg/ml/sodium chloride 0.0342 meq/ml inj 1

glucose 50mg/ml/sodium chloride 4.5mg/ml inj 1

glucose 50mg/ml/sodium chloride 9mg/ml inj 1

ISOLYTE P INJ 1

ISOLYTE S INJ 1

KCL/D5W/LR INJ 0.15% 1

NORMOSOL-M INJ 1

NORMOSOL-R INJ 1

PLASMA-LYTE 148 INJ 1

PLASMALYTE A INJ 1

potassium chloride 0.02 meq/ml/sodium chloride 0.0769meq/ml inj

1


1


1

TPN ELECTROLYTES INJ 1 PA BvD

MAGNESIUM

magnesium sulfate 50% inj 1

magnesium sulfate 50% syringe 1

POTASSIUM

K-TAB 20MEQ ER TAB 1

K-TAB 8MEQ ER TAB 1

klor-con 10meq er micro tab 1

klor-con 10meq er tab 1

KLOR-CON 15MEQ ER TAB 1




93


klor-con 20meq powder 1


potassium chloride 0.1 meq/ml inj 1

potassium chloride 0.2meq/ml inj 1


potassium chloride 10% oral soln 1

potassium chloride 10meq er cap 1

potassium chloride 10meq er micro tab 1

potassium chloride 10meq er tab 1

potassium chloride 20% oral soln 1

potassium chloride 20meq er micro tab 1

POTASSIUM CHLORIDE 20MEQ ER TAB 1

potassium chloride 20meq powder for oral soln 1

potassium chloride 2meq/ml inj 1

potassium chloride 40meq/20ml inj 1

potassium chloride 8 meq er cap 1

potassium chloride 8 meq er tab 1

SODIUM

sodium chloride 0.45% inj 1


sodium chloride 3% inj 1


MISCELLANEOUS THERAPEUTIC CLASSES

CHELATING AGENTS

clovique 250mg cap 1 PA

DEPEN 250MG TAB 1

penicillamine 250mg tab 1

trientine 250mg tab 1 PA

IMMUNOMODULATORS

REVLIMID 10MG CAP 1 PA NSO QL=30 EA/30 Days


REVLIMID 2.5MG CAP 1 PA NSO QL=30 EA/30 Days




THALOMID 100MG CAP 1 PA NSO




IMMUNOSUPPRESSIVE AGENTS

ASTAGRAF 0.5MG XL CAP 1 PA BvD




94

ASTAGRAF 1MG XL CAP 1 PA BvD

ASTAGRAF 5MG XL CAP 1 PA BvD

cyclosporine modified 100mg/ml oral soln 1 PA BvD

CYCLOSPORINE MODIFIED 50MG CAP 1 PA BvD

ENVARSUS 0.75MG ER TAB 1 PA BvD

ENVARSUS 1MG ER TAB 1 PA BvD

ENVARSUS 4MG ER TAB 1 PA BvD

everolimus 0.25mg tab 1 PA BvD



PROGRAF 0.2MG GRANULES PACKET 1 PA BvD

PROGRAF 1MG GRANULES PACKET 1 PA BvD

sirolimus 1mg/ml oral soln 1 PA BvD

ZORTRESS 0.25MG TAB 1 PA BvD



ZORTRESS 1MG TAB 1 PA BvD

POTASSIUM REMOVING AGENTS

LOKELMA 10GM PACKET 1 PA

LOKELMA 5GM PACKET 1 PA

VELTASSA 16.8GM POWDER FOR ORAL SUSP 1 PA



SYSTEMIC LUPUS ERYTHEMATOSUS AGENTS

BENLYSTA 200MG/ML AUTO-INJECTOR 1 PA QL=4 ML/28 Days

BENLYSTA 200MG/ML SYRINGE 1 PA QL=4 ML/28 Days

MOUTH/THROAT/DENTAL AGENTS

ANESTHETICS TOPICAL ORAL


ANTI-INFECTIVES - THROAT

clotrimazole 10mg lozenge 1

nystatin 100000unit/ml susp 1

ANTISEPTICS - MOUTH/THROAT

chlorhexidine gluconate 0.12% mouthwash 1

STEROIDS - MOUTH/THROAT

triamcinolone acetonide 0.1% paste 1

THROAT PRODUCTS - MISC.

cevimeline 30mg cap 1

pilocarpine 5mg tab 1

pilocarpine 7.5mg tab 1

MUSCULOSKELETAL THERAPY AGENTS

CENTRAL MUSCLE RELAXANTS




95

baclofen 10mg tab 1

baclofen 20mg tab 1

carisoprodol 350mg tab 1

CHLORZOXAZONE 500MG TAB 1

cyclobenzaprine 10mg tab 1


cyclobenzaprine 7.5mg tab 1

METAXALONE 400MG TAB 1

metaxalone 800mg tab 1

methocarbamol 500mg tab 1


orphenadrine citrate 100mg er tab 1

tizanidine 2mg cap 1

tizanidine 2mg tab 1




DIRECT MUSCLE RELAXANTS

dantrolene sodium 100mg cap 1



NASAL AGENTS - SYSTEMIC AND TOPICAL

NASAL ANTIALLERGY

azelastine 0.1% (137mcg) nasal inhaler 1

azelastine 0.15% (205.5mcg) nasal inhaler 1

olopatadine 0.6% nasal inhaler 1

NASAL ANTICHOLINERGICS

ipratropium bromide 0.03% nasal inhaler 1

ipratropium bromide 0.06% nasal inhaler 1

NASAL STEROIDS

FLUNISOLIDE 25MCG NASAL INHALER 1 QL=50 ML/30 Days

fluticasone propionate 50mcg nasal inhaler 1 QL=32 GM/30 Days

NEUROMUSCULAR AGENTS

ALS AGENTS

riluzole 50mg tab 1

NUTRIENTS

CARBOHYDRATES

glucose 10% inj 1 PA BvD

glucose 100mg/ml inj 1

LIPIDS

intralipid 200mg/ml inj 1 PA BvD

nutrilipid 20% iv soln 1 PA BvD




96

PROTEINS

AMINOSYN II 10% INJ 1 PA BvD

AMINOSYN-PF 7% INJ 1 PA BvD

CLINIMIX 4.25/10 INJ 1 PA BvD

CLINIMIX 4.25/5 INJ 1 PA BvD

CLINIMIX 5/15 INJ 1 PA BvD

CLINIMIX 5/20 INJ 1 PA BvD

CLINIMIX E 2.75/5 INJ 1 PA BvD



CLINIMIX E 5/15 INJ 1 PA BvD

CLINIMIX E 5/20 INJ 1 PA BvD

clinisol 15% inj 1 PA BvD

FREAMINE 6.9% INJ 1 PA BvD

HEPATAMINE 8% INJ 1 PA BvD

NEPHRAMINE 5.4% INJ 1 PA BvD

plenamine 15% inj 1 PA BvD

PREMASOL 10% INJ 1 PA BvD

PROCALAMINE 3% INJ 1 PA BvD

PROSOL 20% INJ 1 PA BvD

TRAVASOL 10% INJ 1 PA BvD

TROPHAMINE 10% INJ 1 PA BvD

OPHTHALMIC AGENTS

ARTIFICIAL TEARS AND LUBRICANTS

LACRISERT 5MG IMPLANT 1

BETA-BLOCKERS - OPHTHALMIC

betaxolol 0.5% ophth soln 1

BETIMOL 0.25% OPHTH SOLN 1

BETIMOL 0.5% OPHTH SOLN 1

BETOPTIC S 0.25% OPHTH SUSP 1

CARTEOLOL 1% OPHTH SOLN 1

COMBIGAN 0.2-0.5% OPHTH SOLN 1

dorzolamide 20mg/ml/timolol 5mg/ml ophth soln 1

dorzolamide/timolol 22.3-6.8mg/ml ophth soln(preservative-free)

1

levobunolol 0.5% ophth soln 1

TIMOLOL 0.25% OPHTH GEL 1

timolol 0.25% ophth soln 1

TIMOLOL 0.5% OPHTH GEL 1


timolol 5mg/ml ophth 24hr ophth soln 1

TIMOPTIC-XE 0.25% OPHTH GEL 1




97

TIMOPTIC-XE 0.5% OPHTH GEL 1

CYCLOPLEGIC MYDRIATICS

ATROPINE SULFATE 1% OPHTH SOLN 1

MIOTICS

PHOSPHOLINE IODIDE 0.125% OPHTH SOLN 1

pilocarpine 1% ophth soln 1



OPHTHALMIC ADRENERGIC AGENTS

ALPHAGAN P 0.1% OPHTH SOLN 1

apraclonidine 0.5% ophth soln 1

brimonidine tartrate 0.15% ophth soln 1

brimonidine tartrate 0.2% ophth soln 1

IOPIDINE 1% OPHTH SOLN 1

SIMBRINZA 1-0.2% OPHTH SUSP 1

OPHTHALMIC ANTI-INFECTIVES

AZASITE 1% OPHTH SOLN 1

BACITRACIN 0.5UNIT/MG OPHTH OINTMENT 1

bacitracin 0.5unit/mg/polymyxin b 10unit/mg ophthointment

1

ciprofloxacin 0.3% ophth soln 1

erythromycin 0.005mg/mg ophth ointment 1

gatifloxacin 0.5% ophth soln 1

GENTAK 0.3% OPHTH OINTMENT 1

gentamicin sulfate 0.3% ophth soln 1

GRAMICIDIN 0.025MG/ML/NEOMYCIN 1.75MG/

ML/POLYMYXIN B 10000UNIT/ML OPHTH SOLN

1

levofloxacin 0.5% ophth soln 1

moxifloxacin 0.5% ophth soln 1

NATACYN 5% OPHTH SUSP 1

neomycin/bacitracin/polymyxin ophth ointment5(3.5)mg-400unit-10000unit

1

ofloxacin 0.3% ophth soln 1

polymyxin b 10000unit/ml/trimethoprim 1mg/ml ophthsoln

1

SULFACETAMIDE SODIUM 10% OPHTH

OINTMENT

1

sulfacetamide sodium 10% ophth soln 1

tobramycin 0.3% ophth soln 1

TRIFLURIDINE 1% SOLN 1

ZIRGAN 0.15% OPHTH GEL 1

OPHTHALMIC IMMUNOMODULATORS




98

RESTASIS 0.05% OPHTH SUSP 1

OPHTHALMIC LOCAL ANESTHETICS

proparacaine 0.5% ophth soln 1

OPHTHALMIC NERVE GROWTH FACTORS

OXERVATE 0.002% OPHTH SOLN 1 PA QL=112 ML/365 Days

OPHTHALMIC STEROIDS

ALREX 0.2% OPHTH SUSP 1

BLEPHAMIDE 10-0.2% OPHTH SUSP 1

DEXAMETHASONE 0.1% OPHTH SOLN 1

dexamethasone/neomycin/polymyxin b 0.1% ophthointment

1

dexamethasone/neomycin/polymyxin b 0.1% ophth susp 1

dexamethasone/tobramycin 0.3-0.1% ophth susp 1

DUREZOL 0.05% OPHTH SUSP 1

fluorometholone 0.1% ophth susp 1

HYDROCORTISONE 10MG/ML/NEOMYCIN 3.5MG/

ML/POLYMYXIN B 10000UNIT/ML OPHTH SUSP

1

LOTEMAX 0.5% OPHTH GEL 1

LOTEMAX 0.5% OPHTH OINTMENT 1

loteprednol etabonate 0.5% ophth susp 1

MAXIDEX 0.1% OPHTH SUSP 1

neomycin/polymyxin/bacitracin/hydrocortisone ophthointmentment 1%

1

PRED MILD 0.12% OPHTH SUSP 1

PRED-G 0.3-1% OPHTH SUSP 1

PREDNISOLONE 1% OPHTH SOLN 1

PREDNISOLONE ACETATE 1% OPHTH SUSP 1

PREDNISOLONE SODIUM PHOSPHATE 2.5MG/

ML/SULFACETAMIDE SODIUM 100MG/ML OPHTH

SOLN

1

TOBRADEX 0.3-0.1% OPHTH OINTMENT 1

ZYLET 0.5-0.3% OPHTH SUSP 1

OPHTHALMICS - MISC.

ALOCRIL 2% OPHTH SOLN 1

ALOMIDE 0.1% OPHTH SOLN 1

azelastine 0.05% ophth soln 1

AZOPT 1% OPHTH SUSP 1

BROMFENAC 0.09% OPHTH SOLN 1

cromolyn sodium 4% ophth soln 1

CYSTARAN 0.44% OPHTH SOLN 1 PA QL=60 ML/30 Days

diclofenac sodium 0.1% ophth soln 1

dorzolamide 2% ophth soln 1




99

epinastine 0.05% ophth soln 1

flurbiprofen sodium 0.03% ophth soln 1

ILEVRO 0.3% OPHTH SUSP 1

ketorolac tromethamine 0.4% ophth soln 1

ketorolac tromethamine 0.5% ophth soln 1

NEVANAC 0.1% OPHTH SUSP 1

olopatadine 1mg/ml ophth soln 1

olopatadine 2% ophth soln 1

PROSTAGLANDINS - OPHTHALMIC

bimatoprost 0.03% ophth soln 1 QL=5 ML/30 Days

latanoprost 0.005% ophth soln 1 QL=5 ML/30 Days

LUMIGAN 0.01% OPHTH SOLN 1 QL=5 ML/30 Days

TRAVATAN Z 0.004% OPHTH SOLN 1 QL=5 ML/30 Days

travoprost 0.004% ophth soln 1 QL=5 ML/30 Days

OTIC AGENTS

OTIC AGENTS - MISCELLANEOUS

acetic acid 2% otic soln 1

OTIC ANTI-INFECTIVES

CETRAXAL 0.2% OTIC SOLN 1

CIPROFLOXACIN 0.2% OTIC SOLN 1

ofloxacin 0.3% otic soln 1

OTIC COMBINATIONS

CIPRODEX 0.3-0.1% OTIC SUSP 1

hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxinb 10000unit/ml otic soln

1

hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxinb 10000unit/ml otic susp

1

OTIC STEROIDS

acetic acid/hydrocortisone 1-2% otic soln 1

fluocinolone acetonide 0.01% otic oil 1

fluocinolone acetonide 0.01% otic soln 1

PASSIVE IMMUNIZING AND TREATMENT AGENTS

IMMUNE SERUMS

BIVIGAM 5GM/50ML INJ 1 PA

FLEBOGAMMA 10% INJ 1 PA

GAMMAGARD 10GM INJ 1 PA

GAMMAGARD 2.5GM/25ML INJ 1 PA

GAMMAGARD 5GM INJ 1 PA

GAMMAKED 1GM/10ML INJ 1 PA

GAMMAPLEX 10GM/100ML INJ 1 PA






100


GAMUNEX 1GM/10ML INJ 1 PA

OCTAGAM 25GM/500ML INJ 1 PA

OCTAGAM 2GM/20ML INJ 1 PA

PANZYGA 10GM/100ML IV SOLN 1 PA


PANZYGA 2.5GM/25ML IV SOLN 1 PA




PRIVIGEN 20GM/200ML INJ 1 PA

VARIZIG 124.8/1.2ML INJ 1

PENICILLINS

AMINOPENICILLINS

AMOXICILLIN 125MG CHEW TAB 1

amoxicillin 250mg cap 1

AMOXICILLIN 250MG CHEW TAB 1

amoxicillin 25mg/ml susp 1



amoxicillin 500mg tab 1




ampicillin 100mg/ml inj 1

AMPICILLIN 125MG/ML INJ 1


AMPICILLIN 500MG CAP 1

NATURAL PENICILLINS

BICILLIN L-A 1200000UNIT/2ML SYRINGE 1

BICILLIN L-A 2400000UNIT/4ML SYRINGE 1

BICILLIN L-A 600000UNIT/ML SYRINGE 1

penicillin g potassium 1000000unit/ml inj 1

PENICILLIN G POTASSIUM 40000UNIT/ML INJ 1

PENICILLIN G POTASSIUM 60000UNIT/ML INJ 1

PENICILLIN G PROCAINE 600000UNIT/ML

SYRINGE

1

PENICILLIN G SODIUM 100000UNIT/ML INJ 1

penicillin v potassium 250mg tab 1

PENICILLIN V POTASSIUM 25MG/ML ORAL SOLN 1

penicillin v potassium 500mg tab 1

PENICILLIN V POTASSIUM 50MG/ML ORAL SOLN 1




101

PENICILLIN COMBINATIONS

amoxicillin 120mg/ml/clavulanate 8.58mg/ml susp 1

AMOXICILLIN 200MG/CLAVULANATE 28.5MG

CHEW TAB

1

amoxicillin 250mg/clavulanate 125mg tab 1

AMOXICILLIN 400MG/CLAVULANATE 57MG

CHEW TAB

1






ampicillin 20mg/ml/sulbactam 10mg/ml inj 1

ampicillin 250mg/ml/sulbactam 125mg/ml inj 1

BICILLIN 300000-300000UNIT/ML SYRINGE 1

BICILLIN 450000-150000UNIT/ML SYRINGE 1

piperacillin 2000mg/tazobactam 250mg inj 1

piperacillin 200mg/ml/tazobactam 25mg/ml inj 1



ZOSYN 40-5MG/ML INJ 1

ZOSYN 60-7.5MG/ML INJ 1

PENICILLINASE-RESISTANT PENICILLINS

dicloxacillin 250mg cap 1


nafcillin 100mg/ml inj 1

nafcillin 1gm inj 1

nafcillin 2gm inj 1

oxacillin 100mg/ml inj 1

oxacillin 1gm inj 1

oxacillin 2000mg inj 1

OXACILLIN 20MG/ML INJ 1

OXACILLIN 40MG/ML INJ 1

PROGESTINS

PROGESTINS

medroxyprogesterone acetate 10mg tab 1

medroxyprogesterone acetate 2.5mg tab 1

medroxyprogesterone acetate 5mg tab 1

megestrol acetate 125mg/ml susp 1 PA

norethindrone acetate 5mg tab 1

progesterone 100mg cap 1





102

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.

AGENTS FOR CHEMICAL DEPENDENCY

acamprosate calcium 333mg dr tab 1

disulfiram 250mg tab 1


ANTI-CATAPLECTIC AGENTS

XYREM 500MG/ML ORAL SOLN 1 PA QL=540 ML/30 Days

ANTIDEMENTIA AGENTS

donepezil 10mg odt 1 QL=30 EA/30 Days

donepezil 10mg tab 1

donepezil 23mg tab 1 ST QL=30 EA/30 Days

donepezil 5mg odt 1 QL=30 EA/30 Days

donepezil 5mg tab 1

galantamine 12mg tab 1



galantamine hydrobromide 16mg er cap 1


GALANTAMINE HYDROBROMIDE 4MG/ML ORAL

SOLN

1


memantine 10mg tab 1

memantine 10mg/memantine 5mg pack 1

memantine 14mg er cap 1



memantine 2mg/ml oral soln 1

memantine 5mg tab 1


rivastigmine 1.5mg cap 1

rivastigmine 13.3mg/24hr patch 1

rivastigmine 3mg cap 1





COMBINATION PSYCHOTHERAPEUTICS

AMITRIPTYLINE 10MG/PERPHENAZINE 2MG TAB 1


AMITRIPTYLINE 12.5MG/CHLORDIAZEPOXIDE

5MG TAB

1




103

AMITRIPTYLINE 25MG/CHLORDIAZEPOXIDE

10MG TAB

1




fluoxetine 25mg/olanzapine 12mg cap 1





FIBROMYALGIA AGENTS

SAVELLA 100MG TAB 1 QL=60 EA/30 Days

SAVELLA 12.5MG TAB 1 QL=60 EA/30 Days


SAVELLA 4-WEEK TITRATION PACK 1


MOVEMENT DISORDER DRUG THERAPY

AUSTEDO 12MG TAB 1 PA



INGREZZA 40MG CAP 1 PA

INGREZZA 80MG CAP 1 PA

tetrabenazine 12.5mg tab 1 PA

tetrabenazine 25mg tab 1 PA

MULTIPLE SCLEROSIS AGENTS

AUBAGIO 14MG TAB 1

AUBAGIO 7MG TAB 1

AVONEX 30MCG/0.5ML AUTO-INJECTOR 1

AVONEX 30MCG/0.5ML SYRINGE 1

dalfampridine 10mg er tab 1 PA QL=60 EA/30 Days

EXTAVIA 0.3MG INJ 1

GILENYA 0.5MG CAP 1

glatiramer 20mg/ml syringe 1


glatopa 20mg/ml syringe 1


MAYZENT 0.25MG TAB 1

MAYZENT 2MG TAB 1

PLEGRIDY 125MCG/0.5ML AUTO-INJECTOR 1

PLEGRIDY 125MCG/0.5ML SYRINGE 1

PLEGRIDY PEN STARTER PACK 1

PLEGRIDY STARTER PACK 1




104

REBIF 22MCG/0.5ML AUTO-INJECTOR 1

REBIF 22MCG/0.5ML SYRINGE 1

REBIF 44MCG/0.5ML AUTO-INJECTOR 1

REBIF 44MCG/0.5ML SYRINGE 1

REBIF REBIDOSE PACK 1

REBIF TITRATION PACK 1

TECFIDERA 120MG DR CAP 1

TECFIDERA 240MG DR CAP 1

TECFIDERA 30-DAY STARTER PACK 1

PSEUDOBULBAR AFFECT (PBA) AGENTS

NUEDEXTA 20-10MG CAP 1 PA QL=60 EA/30 Days

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.

ERGOLOID MESYLATES 1MG TAB 1

PIMOZIDE 1MG TAB 1

PIMOZIDE 2MG TAB 1

SMOKING DETERRENTS


CHANTIX 0.5MG TAB 1

CHANTIX 1MG TAB 1

CHANTIX CONTINUING MONTHS OF THERAPY

1MG PACK

1

CHANTIX FIRST MONTH OF THERAPY PACK 1

NICOTROL 10MG INHALER 1

NICOTROL 10MG/ML NASAL INHALER 1

TRANSTHYRETIN AMYLOIDOSIS AGENTS

TEGSEDI 189MG/ML SYRINGE 1 PA QL=6 ML/28 Days

RESPIRATORY AGENTS - MISC.

ALPHA-PROTEINASE INHIBITOR (HUMAN)

ARALAST 500MG INJ 1

GLASSIA 1000MG/50ML INJ 1

PROLASTIN 1000MG INJ 1

ZEMAIRA 1000MG INJ 1

CYSTIC FIBROSIS AGENTS

KALYDECO 150MG TAB 1 PA QL=60 EA/30 Days

KALYDECO 25MG GRANULES 1 PA QL=60 EA/30 Days

KALYDECO 50MG GRANULES PACKET 1 PA QL=60 EA/30 Days

KALYDECO 75MG GRANULES PACKET 1 PA QL=60 EA/30 Days

ORKAMBI 100-125MG GRANULES PACKET 1 PA QL=60 EA/30 Days

ORKAMBI 100-125MG TAB 1 PA QL=120 EA/30 Days

ORKAMBI 188-150MG GRANULES PACKET 1 PA QL=60 EA/30 Days

ORKAMBI 200-125MG TAB 1 PA QL=120 EA/30 Days

PULMOZYME 1MG/ML INH SOLN 1 PA BvD




105

SYMDEKO 50-75MG/75MG PACK 1 PA QL=60 EA/30 Days

SYMDEKO TAB 4-WEEK PACK 1 PA QL=60 EA/30 Days

TRIKAFTA 100-50-75MG/150MG PACK 1 PA QL=90 EA/30 Days

PULMONARY FIBROSIS AGENTS

ESBRIET 267MG CAP 1 PA

ESBRIET 267MG TAB 1 PA

ESBRIET 801MG TAB 1 PA

OFEV 100MG CAP 1 PA

OFEV 150MG CAP 1 PA

SULFONAMIDES

SULFONAMIDES

SULFADIAZINE 500MG TAB 1

TETRACYCLINES

AMINOMETHYLCYCLINES

NUZYRA 150MG TAB 1 PA QL=30 EA/14 Days

GLYCYLCYCLINES

TIGECYCLINE 50MG INJ 1

TETRACYCLINES

demeclocycline 150mg tab 1


doxy 100mg inj 1

doxycycline hyclate 100mg cap 1

doxycycline hyclate 100mg tab 1

doxycycline hyclate 20mg tab 1

doxycycline hyclate 50mg cap 1

doxycycline monohydrate 100mg cap 1

doxycycline monohydrate 100mg tab 1

doxycycline monohydrate 50mg cap 1


doxycycline monohydrate 5mg/ml susp 1


minocycline 100mg cap 1

minocycline 100mg tab 1





mondoxyne 100mg cap 1

tetracycline 250mg cap 1


THYROID AGENTS

ANTITHYROID AGENTS




106

methimazole 10mg tab 1


propylthiouracil 50mg tab 1

THYROID HORMONES

euthyrox 100mcg tab 1











levo-t 100mcg tab 1

levo-t 112mcg tab 1

levo-t 125mcg tab 1

levo-t 137mcg tab 1

levo-t 150mcg tab 1

levo-t 175mcg tab 1

levo-t 200mcg tab 1

levo-t 25mcg tab 1

levo-t 300mcg tab 1

levo-t 50mcg tab 1

levo-t 75mcg tab 1

levo-t 88mcg tab 1

levothyroxine sodium 100mcg tab 1












levoxyl 100mcg tab 1






107





levoxyl 25mcg tab 1

levoxyl 50mcg tab 1

levoxyl 75mcg tab 1

levoxyl 88mcg tab 1

liothyronine sodium 0.005mg tab 1



SYNTHROID 100MCG TAB 1












unithroid 100mcg tab 1











TOXOIDS

TOXOID COMBINATIONS

ADACEL INJ 1

ADACEL SYRINGE 1

BOOSTRIX INJ 1

BOOSTRIX SYRINGE 1

DAPTACEL INJ 1

DIPHTHERIA/TETANUS TOXOID INJ 1 PA BvD




108

INFANRIX INJ 1

KINRIX INJ 1

KINRIX PF INJ 1

PEDIARIX INJ 1

QUADRACEL INJ 1

TDVAX 4-4UNIT/ML INJ 1 PA BvD

TENIVAC SYRINGE 1 PA BvD

ULCER DRUGS

H-2 ANTAGONISTS

cimetidine 200mg tab 1




famotidine 20mg tab 1


famotidine 8mg/ml susp 1

nizatidine 150mg cap 1


MISC. ANTI-ULCER

sucralfate 1000mg tab 1

PROTON PUMP INHIBITORS

esomeprazole 20mg dr cap 1

lansoprazole 15mg dr cap 1


NEXIUM 10MG SUSP 1

NEXIUM 2.5MG SUSP 1

NEXIUM 20MG SUSP 1

NEXIUM 40MG SUSP 1

NEXIUM 5MG SUSP 1

omeprazole 20mg dr cap 1

pantoprazole 20mg dr tab 1


rabeprazole sodium 20mg dr tab 1

ULCER DRUGS - PROSTAGLANDINS

misoprostol 0.1mg tab 1


ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS

ANTISPASMODICS

dicyclomine 10mg cap 1

dicyclomine 20mg tab 1

dicyclomine 2mg/ml oral soln 1

glycopyrrolate 1mg tab 1




109


methscopolamine 2.5mg tab 1

methscopolamine 5mg tab 1

H-2 ANTAGONISTS

CIMETIDINE 60MG/ML ORAL SOLN 1

NIZATIDINE 15MG/ML ORAL SOLN 1

MISC. ANTI-ULCER

sucralfate 100mg/ml susp 1

PROTON PUMP INHIBITORS

esomeprazole 10mg granules for oral susp 1





ULCER THERAPY COMBINATIONS

amoxicillin 500mg/clarithromycin 500mg/lansoprazole30mg pack

1

PYLERA 140-125-125MG CAP 1

URINARY ANTI-INFECTIVES

URINARY ANTI-INFECTIVES

methenamine hippurate 1000mg tab 1

MONUROL 3000MG ORAL SOLN 1

nitrofurantoin 5mg/ml susp 1

nitrofurantoin macro 100mg cap 1


nitrofurantoin macro 25mg/nitrofurantoin mono 75mgcap

1


URINARY ANTISPASMODICS

URINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC)

oxybutynin chloride 10mg er tab 1


oxybutynin chloride 1mg/ml oral soln 1


oxybutynin chloride 5mg tab 1

solifenacin succinate 10mg tab 1

solifenacin succinate 5mg tab 1

tolterodine tartrate 1mg tab 1

tolterodine tartrate 2mg er cap 1


tolterodine tartrate 4mg er cap 1

trospium chloride 20mg tab 1




110

trospium chloride 60mg er cap 1

URINARY ANTISPASMODICS - BETA-3 ADRENERGIC AGONISTS

MYRBETRIQ 25MG ER TAB 1

MYRBETRIQ 50MG ER TAB 1

URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS

bethanechol chloride 10mg tab 1




URINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS

flavoxate 100mg tab 1

VACCINES

BACTERIAL VACCINES

ACTHIB INJ 1

BCG LIVE TICE STRAIN 50MG/ML INJ 1

BEXSERO SYRINGE 1

HIBERIX INJ 1

MENACTRA INJ 1

MENVEO INJ 1

PEDVAXHIB 7.5MCG/0.5ML INJ 1

TRUMENBA SYRINGE 1

TYPHIM VI 25MCG/0.5ML INJ 1

TYPHIM VI 25MCG/0.5ML SYRINGE 1

VIRAL VACCINES

ENGERIX-B 10MCG/0.5ML SYRINGE 1 PA BvD

ENGERIX-B 20MCG/ML SYRINGE 1 PA BvD

GARDASIL 9 INJ 1

GARDASIL 9 SYRINGE 1

HAVRIX 1440UNIT INJ 1

HAVRIX 1440UNIT SYRINGE 1

HAVRIX 720UNIT SYRINGE 1

IMOVAX 2.5UNIT/ML INJ 1 PA BvD

IPOL INJ 1

IXIARO SYRINGE 1

M-M-R II INJ 1

PROQUAD INJ 1

RABAVERT 2.5UNIT/ML INJ 1 PA BvD

RECOMBIVAX 10MCG/ML SYRINGE 1 PA BvD

RECOMBIVAX 40MCG/ML INJ 1 PA BvD

RECOMBIVAX 5MCG/0.5ML SYRINGE 1 PA BvD

RECOMBIVAX HB 10MCG/ML INJ 1 PA BvD

ROTARIX SUSP 1




111

ROTATEQ SUSP 1

SHINGRIX INJ 1

TWINRIX 720UNIT SYRINGE 1

VAQTA 25UNIT/0.5ML SYRINGE 1

VAQTA 50UNIT/0.5ML INJ 1

VAQTA 50UNIT/1ML INJ 1

VAQTA 50UNIT/ML SYRINGE 1

VARIVAX 1350PFU/0.5ML INJ 1

YF-VAX 4000UNIT/ML INJ 1

VAGINAL PRODUCTS

VAGINAL ANTI-INFECTIVES

clindamycin 2% vaginal cream 1

metronidazole 0.75% vaginal gel 1

terconazole 0.4% vaginal cream 1

TERCONAZOLE 0.8% VAGINAL CREAM 1

terconazole 80mg vaginal supp 1

vandazole 0.75% vaginal gel 1

VAGINAL ESTROGENS

estradiol 0.1mg/ml vaginal cream 1

ESTRING 2MG VAGINAL RING 1 ST

PREMARIN 0.625MG/GM VAGINAL CREAM 1

VAGINAL PROGESTINS

CRINONE 4% VAGINAL GEL 1 PA

CRINONE 8% VAGINAL GEL 1 PA

VASOPRESSORS

ANAPHYLAXIS THERAPY AGENTS

EPINEPHRINE 0.15MG/0.3ML AUTO-INJECTOR 1 QL=2 EA/15 Days

epinephrine 0.3mg/0.3ml auto-injector 1 QL=2 EA/15 Days

SYMJEPI 0.15MG/0.3ML SYRINGE 1 QL=2 EA/15 Days

SYMJEPI 0.3MG/0.3ML SYRINGE 1 QL=2 EA/15 Days

NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS

NORTHERA 100MG CAP 1 PA



VASOPRESSORS

midodrine 10mg tab 1

midodrine 2.5mg tab 1

midodrine 5mg tab 1IDX_112

ALPHABETICAL LISTING OF DRUGS


beginning of this table. 112

A

abacavir 20mg/ml oral soln 58

abacavir 300mg/lamivudine150mg/zidovudine 300mgtab 58

abacavir 300mg tab 58

abacavir 600mg/lamivudine300mg tab 58

ABELCET 5MG/ML INJ 37

ABILIFY 300MG

MAINTENA INJ 57

ABILIFY 300MG

MAINTENA PF

SYRINGE 57

ABILIFY 400MG

MAINTENA INJ 57

ABILIFY 400MG

MAINTENA PF

SYRINGE 57

abiraterone 250mg tab 46

acamprosate calcium 333mgdr tab 102






acetaminophen21.7mg/ml/hydrocodonebitartrate 0.5mg/ml oralsoln 14

acetaminophen24mg/ml/codeinephosphate 2.4mg/ml oralsoln 14

acetaminophen300mg/codeine phosphate15mg tab 14



acetaminophen300mg/hydrocodonebitartrate 10mg tab 14


acetaminophen300mg/hydrocodonebitartrate 7.5mg tab 15



acetaminophen325mg/hydrocodonebitartrate 7.5mg tab 15

acetaminophen325mg/oxycodone 10mgtab 15

acetaminophen325mg/oxycodone 2.5mgtab 15

acetaminophen325mg/oxycodone 5mg tab 15

acetaminophen325mg/oxycodone 7.5mgtab 15

acetaminophen325mg/tramadol 37.5mgtab 15



acetazolamide 500mg er cap 79

acetic acid/hydrocortisone1-2% otic soln 99

acetic acid 2% otic soln 99

acetylcysteine 10% inh soln 73

acetylcysteine 20% inh soln 73


acitretin 17.5mg cap 75


ACTEMRA 162MG/0.9ML

AUTO-INJECTOR 11

ACTEMRA 162MG/0.9ML

SYRINGE 11

ACTHIB INJ 110

ACTIMMUNE

2000000UNIT/0.5ML INJ 51

acyclovir 200mg cap 61


acyclovir 40mg/ml susp 61

acyclovir 5% ointment 76

acyclovir 50mg/ml inj 61


ADACEL INJ 107

ADACEL SYRINGE 107

adapalene/benzoyl peroxide0.1-2.5% gel 73

adapalene 0.1% cream 73

adapalene 0.1% gel 73

adapalene 0.3% gel 73

adefovir dipivoxil 10mg tab 60

ADEMPAS 0.5MG TAB 66


ADEMPAS 1MG TAB 66


ADEMPAS 2MG TAB 67

ADVAIR 115-21MCG HFA

INH 22

ADVAIR 230-21MCG HFA

INH 22

ADVAIR 45-21MCG HFA

INH 22

AFINITOR 10MG TAB 47

AFINITOR 2.5MG TAB 47

AFINITOR 2MG SUSP 47



AFINITOR 5MG TAB 47

AFINITOR 7.5MG TAB 47

AIMOVIG 140MG/ML

AUTO-INJECTOR 91




AIMOVIG 70MG/ML

AUTO-INJECTOR 91

ala-cort 1% cream 76

albendazole 200mg tab 16

albuterol 0.21mg/ml(0.63mg/3ml) inh soln 22

albuterol 0.417mg/ml(1.25mg/3ml) inh soln 22

albuterol 0.4mg/ml (2mg/5ml)oral oral soln 22

albuterol 0.83mg/ml (0.083%)inh soln 22

albuterol 1mg/ml (0.5%) inhsoln 22

albuterol 2mg tab 22


albuterol 4mg tab 22


alclometasone dipropionate0.05% cream 76

alclometasone dipropionate0.05% ointment 76

ALECENSA 150MG CAP 47

ALENDRONATE

0.933MG/ML ORAL

SOLN 80




alfuzosin 10mg er tab 86

ALINIA 100MG/5ML SUSP 17

ALINIA 500MG TAB 17





ALOCRIL 2% OPHTH

SOLN 98

ALOMIDE 0.1% OPHTH

SOLN 98

alosetron 0.5mg tab 85

alosetron 1mg tab 85

ALPHAGAN P 0.1%

OPHTH SOLN 97



alprazolam 0.5mg er tab 19










ALREX 0.2% OPHTH SUSP 98

altavera 28 day pack 68

ALUNBRIG 180MG TAB 47



ALUNBRIG TAB STARTER

PACK 47

alyacen 1/35 28 day pack 68

alyq 20mg tab 66

amabelz 0.5/0.1mg 28 daypack 83

amabelz 1/0.5mg 28 day pack 83

amantadine 100mg cap 51

amantadine 100mg tab 53

amantadine 10mg/ml oralsoln 51

AMBISOME 50MG INJ 37

ambrisentan 10mg tab 66

ambrisentan 5mg tab 66

AMCINONIDE 0.1%

CREAM 76

AMCINONIDE 0.1%

OINTMENT 76

amethia 91 day pack 68

amethia lo 91 day pack 68

amikacin 250mg/ml inj 9

amiloride5mg/hydrochlorothiazide50mg tab 79

amiloride 5mg tab 79

AMINOSYN II 10% INJ 96

AMINOSYN-PF 7% INJ 96



amitriptyline 100mg tab 31

AMITRIPTYLINE

10MG/PERPHENAZINE

2MG TAB 102

AMITRIPTYLINE

10MG/PERPHENAZINE

4MG TAB 102


AMITRIPTYLINE

12.5MG/

CHLORDIAZEPOXIDE

5MG TAB 102


AMITRIPTYLINE

25MG/

CHLORDIAZEPOXIDE

10MG TAB 103

AMITRIPTYLINE

25MG/PERPHENAZINE

2MG TAB 103

AMITRIPTYLINE

25MG/PERPHENAZINE

4MG TAB 103


AMITRIPTYLINE

50MG/PERPHENAZINE

4MG TAB 103



amlodipine 10mg/atorvastatin10mg tab 65




amlodipine 10mg/benazepril20mg cap 42





amlodipine10mg/hydrochlorothiazide12.5mg/valsartan 160mgtab 42

amlodipine10mg/hydrochlorothiazide25mg/valsartan 160mg tab 42


amlodipine 10mg/olmesartanmedoxomil 20mg tab 42


amlodipine 10mg/valsartan160mg tab 42



amlodipine2.5mg/atorvastatin 10mgtab 65



amlodipine 2.5mg/benazepril10mg cap 42

amlodipine 2.5mg tab 63








amlodipine5mg/hydrochlorothiazide12.5mg/valsartan 160mgtab 42







ammonium lactate 12% cream78

ammonium lactate 12% lotion 78




AMOXAPINE 100MG TAB 32




amoxicillin120mg/ml/clavulanate8.58mg/ml susp 101

AMOXICILLIN 125MG

CHEW TAB 100

AMOXICILLIN

200MG/CLAVULANATE

28.5MG CHEW TAB 101

amoxicillin250mg/clavulanate 125mgtab 101


AMOXICILLIN 250MG

CHEW TAB 100


AMOXICILLIN

400MG/CLAVULANATE

57MG CHEW TAB 101



amoxicillin500mg/clarithromycin500mg/lansoprazole 30mgpack 109










amphetamine/dextroamphetamine 10mgER cap 8

amphetamine/dextroamphetamine 10mgtab 8

amphetamine/dextroamphetamine12.5mg tab 8













amphetamine/dextroamphetamine 7.5mgtab 8

AMPHOTERICIN B 50MG

INJ 37


AMPICILLIN 125MG/ML

INJ 100

ampicillin20mg/ml/sulbactam10mg/ml inj 101

ampicillin250mg/ml/sulbactam125mg/ml inj 101


AMPICILLIN 500MG CAP 100

ANADROL-50 50MG TAB 15

anagrelide 0.5mg cap 87

anagrelide 1mg cap 87

anastrozole 1mg tab 46

ANDRODERM 2MG/24HR

PATCH 15

ANDRODERM 4MG/24HR

PATCH 15

ANORO 62.5-25MCG

ELLIPTA INH 22

APLENZIN 174MG ER TAB 29



APOKYN 10MG/ML

CARTRIDGE 53

apraclonidine 0.5% ophthsoln 97

aprepitant 125mg/80mg pack 37

aprepitant 125mg cap 37



apri 28 day pack 68

APRISO 0.375GM ER CAP 85

APTIOM 200MG TAB 25

APTIOM 400MG TAB 25

APTIOM 600MG TAB 25

APTIOM 800MG TAB 25

APTIVUS 100MG/ML

ORAL SOLN 58

APTIVUS 250MG CAP 58

ARALAST 500MG INJ 104

aranelle 28 pack 68

ARANESP 100MCG/0.5ML

SYRINGE 88

ARANESP 100MCG/ML INJ 88

ARANESP 10MCG/0.4ML

SYRINGE 88


SYRINGE 88


SYRINGE 88



SYRINGE 88



SYRINGE 88


ARANESP 40MCG/0.4ML

SYRINGE 88


ARANESP 500MCG/ML

SYRINGE 88

ARANESP 60MCG/0.3ML

SYRINGE 88


ARCALYST 220MG INJ 11

ARIKAYCE 70.3MG/ML

INH SOLN 10

aripiprazole 10mg odt 57


aripiprazole 15mg odt 57


aripiprazole 1mg/ml oral soln 57





ARISTADA 1064MG/3.9ML

SYRINGE 57


SYRINGE 57


SYRINGE 57


SYRINGE 58


SYRINGE 58

armodafinil 150mg tab 8




ARNUITY 100MCG INH 21



ashlyna 91 day pack 68

ASMANEX 100MCG

(120ACT) HFA INH 21

ASMANEX 110MCG

(30ACT) INH 21

ASMANEX 200MCG

(120ACT) HFA INH 21

ASMANEX 220MCG

(120ACT) INH 21




ASMANEX 220MCG

(30ACT) INH 21

ASMANEX 220MCG

(60ACT) INH 21

ASMANEX 50MCG HFA

INH 21

aspirin 25mg/dipyridamole200mg cap 87

aspirin 325mg/oxycodone4.84mg tab 15

ASTAGRAF 0.5MG XL CAP 93

ASTAGRAF 1MG XL CAP 94

ASTAGRAF 5MG XL CAP 94




atenolol100mg/chlorthalidone25mg tab 42



atenolol 50mg/chlorthalidone25mg tab 42


atomoxetine 100mg cap 8











atovaquone 150mg/ml susp 17

atovaquone 250mg/proguanil100mg tab 44

atovaquone 62.5mg/proguanil25mg tab 44

ATRIPLA 600-200-300MG

TAB 58

ATROPINE SULFATE

0.005MG/ML/

DIPHENOXYLATE

0.5MG/ML ORAL SOLN 36

atropine sulfate0.025mg/diphenoxylate2.5mg tab 36

ATROPINE SULFATE 1%

OPHTH SOLN 97

ATROVENT 17MCG INH 21

AUBAGIO 14MG TAB 103

AUBAGIO 7MG TAB 103

aubra 28 day pack 68

AURYXIA 210MG TAB 85

AUSTEDO 12MG TAB 103

AUSTEDO 6MG TAB 103

AUSTEDO 9MG TAB 103

AVANDIA 2MG TAB 35

AVANDIA 4MG TAB 35

aviane 28 pack 68

avita 0.025% cream 73

avita 0.025% gel 73

AVONEX 30MCG/0.5ML

AUTO-INJECTOR 103

AVONEX 30MCG/0.5ML

SYRINGE 103

AVYCAZ 2-0.5GM INJ 67

AYVAKIT 100MG TAB 47



AZASAN 100MG TAB 61

AZASAN 75MG TAB 61

AZASITE 1% OPHTH SOLN97

azathioprine 50mg tab 61

azelaic acid 15% gel 78

azelastine 0.05% ophth soln 98

azelastine 0.1% (137mcg)nasal inhaler 95

azelastine 0.15% (205.5mcg)nasal inhaler 95


azithromycin 250mg pack 90


azithromycin 2mg/ml inj 90


azithromycin 500mg (3) tabpack 90



AZOPT 1% OPHTH SUSP 98

aztreonam 333mg/ml inj 18

B

bacitracin0.5unit/mg/polymyxin b10unit/mg ophth ointment 97

BACITRACIN 0.5UNIT/MG

OPHTH OINTMENT 97

baclofen 10mg tab 95

baclofen 20mg tab 95

balsalazide disodium 750mgcap 85

BALVERSA 3MG TAB 47

BALVERSA 4MG TAB 47

BALVERSA 5MG TAB 48

balziva 28 day pack 69

BANZEL 200MG TAB 25

BANZEL 400MG TAB 25

BANZEL 40MG/ML SUSP 25

BAQSIMI 3MG/DOSE

NASAL POWDER 34

BAXDELA 450MG TAB 84

BCG LIVE TICE STRAIN

50MG/ML INJ 110

benazepril10mg/hydrochlorothiazide12.5mg tab 42



benazepril20mg/hydrochlorothiazide25mg tab 42








BENLYSTA 200MG/ML

AUTO-INJECTOR 94

BENLYSTA 200MG/ML

SYRINGE 94

BENZNIDAZOLE 100MG

TAB 16

BENZNIDAZOLE 12.5MG

TAB 16

benztropine mesylate 0.5mgtab 53



BERINERT 500UNIT INJ 87

beser 0.05% lotion 76

betamethasone/clotrimazole1-0.05% cream 74

betamethasone/clotrimazole1-0.05% lotion 74

betamethasone 0.05% augcream 76

BETAMETHASONE 0.05%

AUG GEL 76

betamethasone 0.05% auglotion 76

betamethasone 0.05% augointment 76



betamethasone 0.05%ointment 76




betamethasone valerate0.12% foam 76

betaxolol 0.5% ophth soln 96



bethanechol chloride 10mgtab 110




BETIMOL 0.25% OPHTH

SOLN 96

BETIMOL 0.5% OPHTH

SOLN 96

BETOPTIC S 0.25% OPHTH

SUSP 96

bexarotene 75mg cap 51

BEXSERO SYRINGE 110

bicalutamide 50mg tab 46

BICILLIN

300000-300000UNIT/ML

SYRINGE 101

BICILLIN

450000-150000UNIT/ML

SYRINGE 101

BICILLIN L-A

1200000UNIT/2ML

SYRINGE 100

BICILLIN L-A

2400000UNIT/4ML

SYRINGE 100

BICILLIN L-A

600000UNIT/ML

SYRINGE 100

BIDIL 20-37.5MG TAB 66

BIKTARVY 50-200-25MG

TAB 58

bimatoprost 0.03% ophth soln 99

bisoprolol fumarate10mg/hydrochlorothiazide6.25mg tab 42


bisoprolol fumarate2.5mg/hydrochlorothiazide6.25mg tab 43

bisoprolol fumarate5mg/hydrochlorothiazide6.25mg tab 43


BIVIGAM 5GM/50ML INJ 99

BLEPHAMIDE 10-0.2%

OPHTH SUSP 98

blisovi 21 fe 1.5/30 28 day 69

blisovi 24 fe 1/20 28 day pack 69

BOOSTRIX INJ 107

BOOSTRIX SYRINGE 107

bosentan 125mg tab 66

bosentan 62.5mg tab 66

BOSULIF 100MG TAB 48



BRAFTOVI 75MG CAP 48

BREO 100-25MCG

ELLIPTA INH 22

BREO 200-25MCG

ELLIPTA INH 22

briellyn 28 day pack 69

BRILINTA 60MG TAB 87

BRILINTA 90MG TAB 87

brimonidine tartrate 0.15%ophth soln 97

brimonidine tartrate 0.2%ophth soln 97

BRIVIACT 100MG TAB 25

BRIVIACT 10MG/ML

ORAL SOLN 25





BROMFENAC 0.09%

OPHTH SOLN 98

bromocriptine 2.5mg tab 51

bromocriptine 5mg cap 51

BRUKINSA 80MG CAP 48

budesonide 0.125mg/ml inhsoln 21

budesonide 0.25mg/ml inhsoln 21

budesonide 0.5mg/ml inh soln 21

budesonide 3mg dr cap 72

budesonide 9mg er tab 72

bumetanide 0.25mg/ml inj 79

bumetanide 0.5mg tab 79






buprenorphine/naloxone12-3mg strip 15

buprenorphine/naloxone2-0.5mg strip 15



buprenorphine 2mg/naloxone0.5mg sl tab 15


buprenorphine 8mg/naloxone2mg sl tab 15




bupropion 150mg sr (12 hr)tab 29


bupropion 150mg xl (24 hr)tab 29


bupropion 300mg xl tab 29






buspirone 7.5mg tab 19

butorphanol tartrate 10mg/mlnasal spray 15

BX RATING -

METHYLPHENIDATE

18MG SR TAB 9

BX RATING -

METHYLPHENIDATE

27MG SR TAB 9

BX RATING -

METHYLPHENIDATE

36MG SR TAB 9

BX RATING -

METHYLPHENIDATE

54MG SR TAB 9

BYDUREON 2.35MG/ML

AUTO-INJECTOR 34

BYDUREON 2MG PEN INJ 34

BYSTOLIC 10MG TAB 62

BYSTOLIC 2.5MG TAB 62

BYSTOLIC 20MG TAB 62

BYSTOLIC 5MG TAB 62

C

cabergoline 0.5mg tab 82

CABOMETYX 20MG TAB 48



calcipotriene/betamethasone0.005-0.064% ointment 76

calcipotriene 0.005% cream 75

calcipotriene 0.005%ointment 75

calcipotriene 0.005% topicalsoln 75

calcitriol 0.00025mg cap 81

calcitriol 0.0005mg cap 81

calcitriol 0.001mg/ml oralsoln 81

calcium acetate 667mg cap 85

calcium acetate 667mg tab 85

CALQUENCE 100MG CAP 48

camila 28 day 0.35mg pack 72

camrese lo 91 day pack 69

CAPLYTA 42MG CAP 53

CAPRELSA 100MG TAB 48

CAPRELSA 300MG TAB 48


captopril 12.5mg tab 40

CAPTOPRIL

25MG/

HYDROCHLOROTHIAZIDE

15MG TAB 43

CAPTOPRIL

25MG/

HYDROCHLOROTHIAZIDE

25MG TAB 43


CAPTOPRIL50MG/HYDROCHLOROTHIAZIDE15MG TAB 43

CAPTOPRIL

50MG/

HYDROCHLOROTHIAZIDE

25MG TAB 43


CARBAGLU 200MG SUSP 81

carbamazepine 100mg chewtab 25





carbamazepine 200mg tab 25

carbamazepine 20mg/ml susp 25



carbidopa 10mg/levodopa100mg odt 52

carbidopa 10mg/levodopa100mg tab 52

CARBIDOPA

12.5MG/ENTACAPONE

200MG/LEVODOPA

50MG TAB 52

CARBIDOPA

18.75MG/ENTACAPONE

200MG/LEVODOPA

75MG TAB 52

CARBIDOPA

25MG/ENTACAPONE

200MG/LEVODOPA

100MG TAB 52

carbidopa 25mg/levodopa100mg er tab 52








carbidopa 25mg tab 53

CARBIDOPA

31.25MG/ENTACAPONE

200MG/LEVODOPA

125MG TAB 52

CARBIDOPA

37.5MG/ENTACAPONE

200MG/LEVODOPA

150MG TAB 52

CARBIDOPA

50MG/ENTACAPONE

200MG/LEVODOPA

200MG TAB 52

carbidopa 50mg/levodopa200mg er tab 52

carisoprodol 350mg tab 95

CARTEOLOL 1% OPHTH

SOLN 96






carvedilol 25mg tab 62



CASPOFUNGIN ACETATE

50MG INJ 37

CASPOFUNGIN ACETATE

70MG INJ 37

CAYSTON 75MG INH

SOLN 18

caziant 28 day pack 69


CEFACLOR 25MG/ML

SUSP 67


CEFACLOR 50MG/ML

SUSP 67

CEFACLOR 75MG/ML

SUSP 67

cefadroxil 1000mg tab 67


cefadroxil 500mg cap 67


cefazolin 1gm inj 67

cefazolin 200mg/ml inj 67

cefazolin 500mg inj 67


cefdinir 300mg cap 68


cefepime 1gm inj 68

cefepime 2gm inj 68


cefixime 400mg cap 68






cefoxitin 200mg/ml inj 67











ceftazidime 200mg/ml inj 68


ceftriaxone 100mg/ml inj 68




cefuroxime 1.5gm inj 67



cefuroxime 750mg inj 68

cefuroxime 95mg/ml inj 68

celecoxib 100mg cap 11




CELONTIN 300MG CAP 28





CERDELGA 84MG CAP 87

cetirizine 1mg/ml oral soln 38

CETRAXAL 0.2% OTIC

SOLN 99

cevimeline 30mg cap 94

CHANTIX 0.5MG TAB 104

CHANTIX 1MG TAB 104

CHANTIX CONTINUING

MONTHS OF THERAPY

1MG PACK 104

CHANTIX FIRST MONTH

OF THERAPY PACK 104

CHEMET 100MG CAP 36

CHENODAL 250MG TAB 84




chlorhexidine gluconate0.12% mouthwash 94

CHLOROQUINE

PHOSPHATE 250MG

TAB 44

chloroquine phosphate 500mgtab 44








CHLORZOXAZONE 500MG

TAB 95

CHOLBAM 250MG CAP 84




CHOLBAM 50MG CAP 84

cholestyramine resin 4gm sfpowder for oral susp 38

cholestyramine resin66.7mg/ml susp 38

ciclopirox 0.77% cream 74

ciclopirox 0.77% gel 74

ciclopirox 0.77% lotion 74

ciclopirox 1% shampoo 74

ciclopirox 8% topical soln 74

cilastatin 2.5mg/ml/imipenem2.5mg/ml inj 17

cilastatin 5mg/ml/imipenem5mg/ml inj 17



CIMDUO 300-300MG TAB 58




CIMETIDINE 60MG/ML

ORAL SOLN 109


CIMZIA 200MG/ML

SYRINGE 85

CIMZIA 200MG INJ 85

cinacalcet 30mg tab 81



CINRYZE 500UNIT INJ 87

CIPRODEX 0.3-0.1% OTIC

SUSP 99

CIPROFLOXACIN 0.2%

OTIC SOLN 99

ciprofloxacin 0.3% ophth soln 97


ciprofloxacin 2mg/ml inj 84





citalopram 2mg/ml oral soln 30


claravis 10mg cap 73




CLARINEX-D 2.5-120MG

ER TAB 73


CLARITHROMYCIN

25MG/ML SUSP 90

clarithromycin 500mg er tab 90


CLARITHROMYCIN

50MG/ML SUSP 90

CLENPIQ POWDER 89

clindacin 1% pad 73

clindamycin/benzoyl peroxide1-5% gel 73

clindamycin 1% foam 73

clindamycin 1% gel 73

clindamycin 1% lotion 73

clindamycin 1% pad 73

clindamycin 1% topical soln 73


clindamycin 150mg/ml (2ml)inj 17




clindamycin 15mg/ml oralsoln 18


clindamycin 2% vaginalcream 111




CLINIMIX 4.25/10 INJ 96

CLINIMIX 4.25/5 INJ 96

CLINIMIX 5/15 INJ 96

CLINIMIX 5/20 INJ 96

CLINIMIX E 2.75/5 INJ 96



CLINIMIX E 5/15 INJ 96

CLINIMIX E 5/20 INJ 96

clinisol 15% inj 96

clobazam 10mg tab 24

clobazam 2.5mg/ml susp 24

clobazam 20mg tab 24

clobetasol propionate 0.05%cream 76

clobetasol propionate 0.05%e cream 76

clobetasol propionate 0.05%e foam 76

clobetasol propionate 0.05%foam 76

clobetasol propionate 0.05%gel 76

clobetasol propionate 0.05%lotion 76

clobetasol propionate 0.05%ointment 76

clobetasol propionate 0.05%shampoo 76

clobetasol propionate 0.05%spray 76

clobetasol propionate 0.05%topical soln 76

clodan 0.05% shampoo 76

clomipramine 25mg cap 32






clonazepam 0.5mg tab 25














clopidogrel 75mg tab 87

clorazepate dipotassium15mg tab 19

clorazepate dipotassium3.75mg tab 19

clorazepate dipotassium7.5mg tab 19

clotrimazole 1% cream 74

clotrimazole 1% topical soln 75

clotrimazole 10mg lozenge 94

clovique 250mg cap 93



clozapine 12.5mg odt 55







COARTEM 20-120MG TAB 44

CODEINE SULFATE 15MG

TAB 12


TAB 12


TAB 12

colchicine 0.5mg/probenecid500mg tab 86

COLCHICINE 0.6MG CAP 86

COLCHICINE 0.6MG TAB 86

colesevelam hcl 3.75gmpacket 38

colesevelam hcl 625mg tab 38

colestipol 1000mg tab 38

colestipol 5000mg granules 38

colistin 75mg/ml inj 18

COMBIGAN 0.2-0.5%

OPHTH SOLN 96

COMBIPATCH 0.05-0.14MG

PATCH 83

COMBIPATCH 0.05-0.25MG

PATCH 83

COMBIVENT RESPIMAT

20-100MCG INH 22

COMETRIQ 100MG DAILY

DOSE CARTON PACK 48

COMETRIQ 140MG DAILY

DOSE CARTON PACK 48

COMETRIQ 60MG DAILY

DOSE CARTON PACK 48

COMPLERA 200-25-300MG

TAB 58

compro 25mg rectal supp 57

constulose 10gm/15ml oralsoln 90

COPIKTRA 15MG CAP 48

COPIKTRA 25MG CAP 48

CORLANOR 5MG/5ML

ORAL SOLN 67

CORLANOR 5MG TAB 67

CORLANOR 7.5MG TAB 67

CORTISONE ACETATE

25MG TAB 72

COSENTYX 150MG/ML

AUTO-INJECTOR 75

COSENTYX 150MG/ML

SYRINGE 75

COTELLIC 20MG TAB 48

CREON

12000-38000-60000UNIT

DR CAP 78

CREON

24000-76000-120000UNIT

DR CAP 78

CREON

3000-9500-15000UNIT

DR CAP 78

CREON

36000-114000-180000UNIT

DR CAP 78

CREON

6000-19000-30000UNIT

DR CAP 79

CRINONE 4% VAGINAL

GEL 111

CRINONE 8% VAGINAL

GEL 111



cromolyn sodium 10mg/mlinh soln 20

cromolyn sodium 20mg/mloral soln 85

cromolyn sodium 4% ophthsoln 98

cryselle 28 pack 69

cyclafem 1/35 28 day pack 69

cyclafem 7/7/7 28 day pack 69



cyclobenzaprine 7.5mg tab 95

CYCLOPHOSPHAMIDE

25MG CAP 45

CYCLOPHOSPHAMIDE

50MG CAP 45

cyclosporine 100mg cap 61

cyclosporine 25mg cap 61

cyclosporine modified100mg/ml oral soln 94

cyclosporine modified 100mgcap 61

cyclosporine modified 25mgcap 61

CYCLOSPORINE

MODIFIED 50MG CAP 94

cyred 28 day pack 69



CYSTARAN 0.44% OPHTH

SOLN 98

D

dalfampridine 10mg er tab 103



DALVANCE 500MG INJ 17

danazol 100mg cap 16

danazol 200mg cap 16

danazol 50mg cap 16







dapsone 100mg tab 17

dapsone 25mg tab 17

DAPTACEL INJ 107

DAPTOMYCIN 350MG INJ 17

daptomycin 500mg inj 17

DARAPRIM 25MG TAB 44

DAURISMO 100MG TAB 46

DAURISMO 25MG TAB 46

deblitane 28 day 0.35mg pack 72

deferasirox 125mg tab fororal susp 36






DELSTRIGO

100-300-300MG TAB 58



DEMSER 250MG CAP 41

DENAVIR 1% CREAM 76

DEPEN 250MG TAB 93

DEPO-PROVERA

400MG/ML INJ 46

DESCOVY 200-25MG TAB 58

desipramine 100mg tab 32






desloratadine 5mg tab 38

desmopressin acetate 0.01%nasal spray 82

desmopressin acetate 0.1mgtab 82

desmopressin acetate 0.2mgtab 82

desogestrel/ethinyl estradiolpack 69

desonide 0.05% cream 77

desonide 0.05% lotion 77

desonide 0.05% ointment 77

desoximetasone 0.05% gel 77

desoximetasone 0.25% cream 77

desoximetasone 0.25%ointment 77

desvenlafaxine succinate100mg er tab 31



dexamethasone/neomycin/polymyxin b 0.1% ophthointment 98

dexamethasone/neomycin/polymyxin b 0.1% ophthsusp 98

dexamethasone/tobramycin0.3-0.1% ophth susp 98

DEXAMETHASONE 0.1%

OPHTH SOLN 98

dexamethasone 0.1mg/ml oralsoln 72




DEXAMETHASONE

1MG/ML ORAL SOLN 72

DEXAMETHASONE 1MG

TAB 72

DEXAMETHASONE 2MG

TAB 72



dexmethylphenidate 10mg ercap 9



dexmethylphenidate 2.5mg tab 9






dexmethylphenidate 5mg er cap9


dextroamphetamine sulfate10mg er cap 8

dextroamphetamine sulfate10mg tab 8



dextroamphetamine sulfate5mg tab 8

DIASTAT 10MG

APPLICATOR 25

DIASTAT 2.5MG

APPLICATOR 25

DIASTAT 20MG

APPLICATOR 25

diazepam 10mg tab 19

DIAZEPAM 1MG/ML ORAL

SOLN 19

DIAZEPAM 2.5MG/0.5ML

RECTAL GEL 25

DIAZEPAM 20MG/4ML

RECTAL GEL 25

diazepam 2mg tab 20

diazepam 5mg/ml oral soln 20

diazepam 5mg tab 20

diazoxide 50mg/ml susp 34

diclofenac potassium 50mgtab 11

diclofenac sodium 0.1%ophth soln 98




diclofenac sodium 1.5%topical soln 74

diclofenac sodium 1% gel 74

diclofenac sodium 100mg ertab 11

diclofenac sodium 25mg drtab 11

diclofenac sodium 3% gel 75

diclofenac sodium50mg/misoprostol 0.2mgtab 11


diclofenac sodium75mg/misoprostol 0.2mgtab 11




dicyclomine 10mg cap 108

dicyclomine 20mg tab 108

dicyclomine 2mg/ml oralsoln 108



DIFFERIN 0.1% LOTION 73

diflunisal 500mg tab 12



digox 0.125mg tab 65

digox 0.25mg tab 65

DIGOXIN 0.05MG/ML

ORAL SOLN 65



DIHYDROERGOTAMINE

MESYLATE 0.5MG/ACT

NASAL SPRAY 91

DILANTIN 30MG ER CAP 28

dilt 120mg xr cap 64



diltiazem 120mg er (12 hr)cap 64

diltiazem 120mg er (24 hr)cap 64












DIPENTUM 250MG CAP 85

DIPHTHERIA/TETANUS

TOXOID INJ 107

disopyramide 100mg cap 20

disopyramide 150mg cap 20



DIURIL 250MG/5ML SUSP 80

divalproex sodium 125mg drcap 29

divalproex sodium 125mg drtab 29


divalproex sodium 250mg ertab 29


divalproex sodium 500mg ertab 29




donepezil 10mg odt 102



donepezil 5mg odt 102


DOPTELET 20MG TAB 88

DOPTELET 40MG DAILY

DOSE PACK 88

DOPTELET 60MG DAILY

DOSE PACK 88

dorzolamide/timolol22.3-6.8mg/ml ophth soln(preservative-free) 96

dorzolamide 2% ophth soln 98

dorzolamide 20mg/ml/timolol5mg/ml ophth soln 96






DOVATO 50-300MG TAB 58

doxazosin 1mg tab 41




doxepin 100mg cap 32

doxepin 10mg/ml oral soln 32

doxepin 10mg cap 32

DOXEPIN 150MG CAP 32

doxepin 25mg cap 32

doxepin 50mg cap 32

doxepin 75mg cap 32

doxercalciferol 0.0005mg cap 81



doxy 100mg inj 105

doxycycline hyclate 100mgcap 105

doxycycline hyclate 100mgtab 105

doxycycline hyclate 20mgtab 105

doxycycline hyclate 50mgcap 105

doxycycline monohydrate100mg cap 105

doxycycline monohydrate100mg tab 105




doxycycline monohydrate50mg cap 105


doxycycline monohydrate5mg/ml susp 105


DRIZALMA 20MG DR CAP 31




dronabinol 10mg cap 37

dronabinol 2.5mg cap 37

dronabinol 5mg cap 37

drospirenone 3mg/ethinylestradiol 0.02mg/inert 1mg pack 69

drospirenone 3mg/ethinylestradiol 0.03mg/inertingredients 1mg pack 69

DROXIA 200MG CAP 87

DROXIA 300MG CAP 87

DROXIA 400MG CAP 87

DULERA 100-5MCG INH 22

DULERA 200-5MCG INH 22

DULERA INHALER

50-5MCG 22





DUPIXENT 200MG/ML PF

SYRINGE 21

DUPIXENT 300MG/2ML

AUTO-INJECTOR 78

DUPIXENT 300MG/2ML PF

SYRINGE 78

DUREZOL 0.05% OPHTH

SUSP 98

dutasteride 0.5mg/tamsulosin0.4mg cap 86

dutasteride 0.5mg cap 86



E

econazole nitrate 1% cream 75

EDURANT 25MG TAB 58




eletriptan 20mg tab 91

eletriptan 40mg tab 91

ELIGARD 22.5MG

SYRINGE 46




ELIQUIS 2.5MG TAB 23

ELIQUIS 30-DAY STARTER

PACK 23

ELIQUIS 5MG TAB 23

ELMIRON 100MG CAP 86

eluryng 0.120-0.015mg/24hrvaginal ring 71

EMCYT 140MG CAP 46

EMGALITY 100MG/ML

SYRINGE 91

EMGALITY 120MG/ML

AUTO-INJECTOR 91

EMGALITY 120MG/ML

SYRINGE 91

emoquette pack 69

EMSAM 12MG/24HR

PATCH 29



EMTRIVA 10MG/ML ORAL

SOLN 58

EMTRIVA 200MG CAP 58

enalapril maleate10mg/hydrochlorothiazide25mg tab 43


enalapril maleate 2.5mg tab 40


enalapril maleate5mg/hydrochlorothiazide12.5mg tab 43


ENBREL 25MG/0.5ML

SYRINGE 12

ENBREL 25MG INJ 12

ENBREL 50MG/ML

CARTRIDGE 12

ENBREL 50MG/ML

SURECLICK INJ 12

ENBREL 50MG/ML

SYRINGE 12

ENDARI 5000MG POWDER

FOR ORAL SOLN 87

endocet 10-325mg tab 15

endocet 5-325mg tab 15

endocet 7.5-325mg tab 15

ENGERIX-B 10MCG/0.5ML

SYRINGE 110

ENGERIX-B 20MCG/ML

SYRINGE 110

enoxaparin sodium100mg/1ml syringe 24

enoxaparin sodium120mg/0.8ml syringe 24

enoxaparin sodium150mg/1ml syringe 24





enpresse 28 day pack 69

enskyce 28 day pack 69

entacapone 200mg tab 53

entecavir 0.5mg tab 60

entecavir 1mg tab 60

ENTRESTO 24-26MG TAB 66






enulose 10gm/15ml oral soln 85

ENVARSUS 0.75MG ER

TAB 94

ENVARSUS 1MG ER TAB 94

ENVARSUS 4MG ER TAB 94

EPIDIOLEX 100MG/ML

ORAL SOLN 26

EPIDUO 0.3-2.5% GEL 74

epinastine 0.05% ophth soln 99

EPINEPHRINE

0.15MG/0.3ML

AUTO-INJECTOR 111

epinephrine 0.3mg/0.3mlauto-injector 111

epitol 200mg tab 26

EPIVIR HBV 5MG/ML

ORAL SOLN 60






ERAXIS 100MG INJ 37

ERAXIS 50MG INJ 37

ERGOLOID MESYLATES

1MG TAB 104

ERIVEDGE 150MG CAP 46

ERLEADA 60MG TAB 46

erlotinib 100mg tab 48



errin 28 day 0.35mg pack 72

ERTACZO 2% CREAM 75

ertapenem 1gm inj 17

ery 2% pad 74

ERYTHROCIN

LACTOBIONATE 500MG

INJ 90

erythromycin/benzoylperoxide 5-3% gel 74

erythromycin 0.005mg/mgophth ointment 97

erythromycin 2% gel 74

erythromycin 2% topical soln 74

erythromycin 250mg dr cap 90



erythromycin ethylsuccinate40mg/ml susp 90

erythromycin ethylsuccinate80mg/ml oral susp 90

ESBRIET 267MG CAP 105

ESBRIET 267MG TAB 105

ESBRIET 801MG TAB 105


escitalopram 1mg/ml oralsoln 30



esomeprazole 10mg granulesfor oral susp 109





estarylla 28 day pack 69

estazolam 1mg tab 89

estazolam 2mg tab 89

estradiol 0.00104mg/hr twiceweekly patch 83

estradiol 0.00104mg/hrweekly patch 83





estradiol 0.0025mg/hr weeklypatch 83





estradiol 0.1mg/ml vaginalcream 111

estradiol0.5mg/norethindroneacetate 0.1mg pack 83

estradiol 0.5mg tab 84

estradiol 1mg/norethindroneacetate 0.5mg pack 83

estradiol 1mg tab 84


estradiol 2mg tab 84


ESTRING 2MG VAGINAL

RING 111

eszopiclone 1mg tab 89



ethacrynic acid 25mg tab 79



ethinylestradiol/levonorgestrel 91day pack 70

ethinyl estradiol0.0025mg/norethindroneacetate 0.5mg tab 83

ethinyl estradiol0.005mg/norethindroneacetate 1mg tab 83

ethinyl estradiol0.01mg/ethinyl estradiol0.02mg/levonorgestrel0.1mg 91 day pack 69

ethinyl estradiol0.01mg/ethinyl estradiol0.03mg/levonorgestrel0.15mg pack 69

ethinyl estradiol0.025mg/ferrous fumarate




75mg/norethindrone 0.8mgpack 69

ethinyl estradiol0.025mg/inert/norgestimate0.18mg/0.215mg/0.25mgpack 69

ethinyl estradiol 0.02mg/inertingredients1mg/levonorgestrel 0.1mgpack 69

ethinyl estradiol0.02mg/norethindrone 1mg21 day pack 69

ethinyl estradiol0.035mg/ethynodiol 1mg28 day pack 69

ethinyl estradiol0.035mg/ferrous fumarate75mg/norethindrone 0.4mgpack 69

ethinyl estradiol0.035mg/inert/norgestimate0.18mg/0.215mg/0.25mgpack 69

ethinyl estradiol0.035mg/norgestimate0.25mg pack 69

ethinyl estradiol0.03mg/0.04mg /inert/levonorgestrel 0.05mg/0.075mg pack 69

ethinyl estradiol 0.03mg/inertingredients1mg/levonorgestrel 0.15mgpack 69

ethinyl estradiol0.03mg/levonorgestrel0.15mg tab 28 day pack 69

ethinyl estradiol0.05mg/ethynodiol1mg/inert ingredients 1mg28 day pack 70

ethosuximide 250mg cap 29

ethosuximide 50mg/ml oralsoln 29








etonogestrel-ethinyl estradiol0.120-0.015mg/24hrvaginal ring 72












everolimus 0.25mg tab 94




everolimus 5mg tab 48


EVOTAZ 300-150MG TAB 59

exemestane 25mg tab 46

EXTAVIA 0.3MG INJ 103

ezetimibe 10mg tab 39

F

falmina 28 day pack 70






famotidine 8mg/ml susp 108

FANAPT 10MG TAB 54

FANAPT 12MG TAB 54

FANAPT 1MG TAB 54

FANAPT 2MG TAB 54

FANAPT 4MG TAB 54

FANAPT 6MG TAB 54

FANAPT 8MG TAB 54

FANAPT TITRATION PACK 54

FARXIGA 10MG TAB 35

FARXIGA 5MG TAB 35

FARYDAK 10MG CAP 48

FARYDAK 20MG CAP 48

FASENRA 30MG/ML

AUTO-INJECTOR 21

FASENRA 30MG/ML

SYRINGE 21

fayosim 91 day pack 70

febuxostat 40mg tab 86

febuxostat 80mg tab 87

felbamate 120mg/ml susp 28




felodipine 2.5mg er tab 64


femynor 28 day pack 70



FENOFIBRATE 150MG CAP39









fentanyl 0.012mg/hr patch 13





FENTANYL 0.1MG

BUCCAL TAB 13




FENTANYL 0.2MG

BUCCAL TAB 13

fentanyl 0.2mg lozenge 13

FENTANYL 0.4MG

BUCCAL TAB 13


FENTANYL 0.6MG

BUCCAL TAB 13


FENTANYL 0.8MG

BUCCAL TAB 13




FENTORA 100MCG

BUCCAL TAB 13

FENTORA 200MCG

BUCCAL TAB 13

FENTORA 400MCG

BUCCAL TAB 13

FENTORA 600MCG

BUCCAL TAB 13

FENTORA 800MCG

BUCCAL TAB 13

FERRIPROX 1000MG TAB 36

FERRIPROX 100MG/ML

ORAL SOLN 36

FERRIPROX 500MG TAB 36

FETZIMA 120MG ER CAP 31




FETZIMA PACK 31

FIASP 100UNIT/ML

CARTRIDGE 34

FIASP 100UNIT/ML INJ 34

FIASP 100UNIT/ML PEN

INJ 34

FINACEA 15% FOAM 78

finasteride 5mg tab 86

FINTEPLA 2.2MG/ML

ORAL SOLN 26

FIRMAGON 120MG INJ 46

FIRMAGON 80MG INJ 46

FIRVANQ 25MG/ML ORAL

SOLN 17

FIRVANQ 50MG/ML ORAL

SOLN 17

flavoxate 100mg tab 110

FLEBOGAMMA 10% INJ 99




FLOVENT 100MCG

DISKUS 21

FLOVENT 110MCG HFA

INH 21

FLOVENT 220MCG HFA

INH 21

FLOVENT 250MCG

DISKUS 22

FLOVENT 44MCG HFA INH22

FLOVENT 50MCG DISKUS 22





fluconazole 2mg/ml (100ml)inj 38

fluconazole 2mg/ml inj 38





fludrocortisone 0.1mg tab 73

FLUNISOLIDE 25MCG

NASAL INHALER 95

fluocinolone acetonide 0.01%cream 77

fluocinolone acetonide 0.01%otic oil 99

fluocinolone acetonide 0.01%otic soln 99

fluocinolone acetonide 0.01%topical soln 77

fluocinolone acetonide0.025% cream 77

fluocinolone acetonide0.025% ointment 77

fluocinolone acetonide0.1mg/ml oil 77

fluocinonide 0.05% e cream 77

fluocinonide 0.05% gel 77

fluocinonide 0.05% ointment 77

fluocinonide 0.05% topicalsoln 77

fluorometholone 0.1% ophthsusp 98

FLUOROPLEX 1% CREAM 75

FLUOROURACIL 0.5%

CREAM 75

FLUOROURACIL 2%

TOPICAL SOLN 75

fluorouracil 5% cream 75

FLUOROURACIL 5%

TOPICAL SOLN 75





fluoxetine 25mg/olanzapine12mg cap 103




fluoxetine 4mg/ml oral soln 30



FLUPHENAZINE




FLUPHENAZINE

2.5MG/ML INJ 57

fluphenazine 2.5mg tab 57

FLUPHENAZINE 5MG/ML

ORAL SOLN 57





fluphenazine decanoate25mg/ml inj 57



flurbiprofen 100mg tab 11

flurbiprofen sodium 0.03%ophth soln 99

flutamide 125mg cap 46

fluticasonepropionate/salmeterol100-50mcg/act dry powderinh 22



FLUTICASONE

PROPIONATE/

SALMETEROL

XINAFOATE

113-14MCG/ACT

POWDER INH 22

FLUTICASONE

PROPIONATE/

SALMETEROL

XINAFOATE

232-14MCG/ACT

POWDER INH 22

FLUTICASONE

PROPIONATE/

SALMETEROL

XINAFOATE

55-14MCG/ACT

POWDER INH 22

fluticasone propionate0.005% ointment 77

fluticasone propionate 0.05%cream 77

fluticasone propionate 0.05%lotion 77

fluticasone propionate 50mcgnasal inhaler 95



fluvastatin 80mg er tab 39

fluvoxamine maleate 100mger cap 30

fluvoxamine maleate 100mgtab 30

fluvoxamine maleate 150mger cap 30



fondaparinux sodium12.5mg/ml (0.4ml) syringe 24



fondaparinux sodium 5mg/mlsyringe 24

FORTEO 600MCG/2.4ML

PEN INJ 80

fosamprenavir 700mg tab 59

fosinopril sodium10mg/hydrochlorothiazide12.5mg tab 43


fosinopril sodium20mg/hydrochlorothiazide12.5mg tab 43



FOSRENOL 1000MG ORAL

POWDER 85

FOSRENOL 750MG ORAL

POWDER 85

FRAGMIN 10000UNIT/ML

SYRINGE 24

FRAGMIN

12500UNIT/0.5ML

SYRINGE 24

FRAGMIN

15000UNIT/0.6ML

SYRINGE 24

FRAGMIN

18000UNIT/0.72ML

SYRINGE 24

FRAGMIN

2500UNIT/0.2ML

SYRINGE 24

FRAGMIN

5000UNIT/0.2ML

SYRINGE 24

FRAGMIN

7500UNIT/0.3ML

SYRINGE 24

FRAGMIN

95000UNIT/3.8ML INJ 24

FREAMINE 6.9% INJ 96

FULPHILA 6/0.6ML

SYRINGE 88

furosemide 10mg/ml inj 79

furosemide 10mg/ml oral soln 79

furosemide 10mg/ml syringe 79




FUROSEMIDE 8MG/ML

ORAL SOLN 79

FUZEON 90MG INJ 59

fyavolv 0.5mg-2.5mcg tab 83

fyavolv 1mg-5mcg tab 83

FYCOMPA 0.5MG/ML SUSP24

FYCOMPA 10MG TAB 24

FYCOMPA 12MG TAB 24

FYCOMPA 2MG TAB 24

FYCOMPA 4MG TAB 24

FYCOMPA 6MG TAB 24

FYCOMPA 8MG TAB 24

G







gabapentin 50mg/ml oral soln 26



GALAFOLD 123MG CAP 81




galantamine hydrobromide16mg er cap 102


GALANTAMINE

HYDROBROMIDE

4MG/ML ORAL SOLN 102


GAMMAGARD 10GM INJ 99

GAMMAGARD

2.5GM/25ML INJ 99

GAMMAGARD 5GM INJ 99

GAMMAKED 1GM/10ML

INJ 99

GAMMAPLEX

10GM/100ML INJ 99

GAMMAPLEX

10GM/200ML INJ 99

GAMMAPLEX

20GM/200ML INJ 99

GAMMAPLEX 5GM/50ML

INJ 100

GAMUNEX 1GM/10ML

INJ 100

GARDASIL 9 INJ 110

GARDASIL 9 SYRINGE 110

gatifloxacin 0.5% ophth soln 97

GATTEX 5MG INJ 86

GAUZE PAD 90

gavilyte-c oral soln 89

gavilyte-g powder for oralsoln 89

gavilyte-n powder for oralsoln 89

gemfibrozil 600mg tab 39

generlac 10gm/15ml oral soln 85

gengraf 100mg/ml oral soln 61

gengraf 100mg cap 61

gengraf 25mg cap 61

GENOTROPIN 0.2MG

SYRINGE 81

GENOTROPIN 0.4MG

SYRINGE 81

GENOTROPIN 0.6MG

SYRINGE 81

GENOTROPIN 0.8MG

SYRINGE 81

GENOTROPIN 1.2MG

SYRINGE 81

GENOTROPIN 1.4MG

SYRINGE 81

GENOTROPIN 1.6MG

SYRINGE 81

GENOTROPIN 1.8MG

SYRINGE 81

GENOTROPIN 12MG

CARTRIDGE 81

GENOTROPIN 1MG

SYRINGE 81

GENOTROPIN 2MG

SYRINGE 81

GENOTROPIN 5MG

CARTRIDGE 81

GENTAK 0.3% OPHTH

OINTMENT 97

gentamicin sulfate 0.1%cream 74

gentamicin sulfate 0.1%ointment 74

gentamicin sulfate 0.3%ophth soln 97

GENTAMICIN SULFATE

0.8MG/ML INJ 10

gentamicin sulfate 1.2mg/mlinj 10

GENTAMICIN SULFATE

1.6MG/ML INJ 10

GENTAMICIN SULFATE

1MG/ML INJ 10

gentamicin sulfate 40mg/mlinj 10

GENVOYA

150-150-200-10MG TAB 59

GEODON 20MG INJ 54

gianvi 28-day pack 70

GILENYA 0.5MG CAP 103

GILOTRIF 20MG TAB 48



GLASSIA 1000MG/50ML

INJ 104













glipizide 2.5mg/metformin250mg tab 33

glipizide 2.5mg/metformin500mg tab 33

glipizide 2.5mg er tab 35

glipizide 5mg/metformin500mg tab 33



GLUCAGEN 1MG INJ 34

GLUCAGON 1MG INJ 34

glucose 10% inj 95

GLUCOSE

100MG/ML/SODIUM

CHLORIDE 0.0342

MEQ/ML INJ 91

GLUCOSE

100MG/ML/SODIUM




CHLORIDE 0.0769

MEQ/ML INJ 91

glucose 100mg/ml inj 95

GLUCOSE

25MG/ML/SODIUM

CHLORIDE 0.0769

MEQ/ML INJ 92

glucose 50mg/ml/potassiumchloride 0.01meq/ml/sodium chloride0.0769 meq/ml inj 92



glucose 50mg/ml/potassiumchloride0.02meq/ml/sodiumchloride 4.5mg/ml inj 92

glucose 50mg/ml/potassiumchloride 0.02 meq/ml inj 92


GLUCOSE

50MG/ML/POTASSIUM

CHLORIDE 0.04

MEQ/ML/SODIUM

CHLORIDE 0.154

MEQ/ML INJ 92

glucose 50 mg/ml/potassiumchloride0.04meq/ml/sodiumchloride 4.5mg/ml inj 92

glucose 50mg/ml/sodiumchloride 0.0342 meq/ml inj 92

glucose 50mg/ml/sodiumchloride 4.5mg/ml inj 92

glucose 50mg/ml/sodiumchloride 9mg/ml inj 92

glyburide 1.25mg/metformin250mg tab 33

glyburide 2.5mg/metformin500mg tab 33

glyburide 5mg/metformin500mg tab 33



GLYXAMBI 10-5MG TAB 33

GLYXAMBI 25-5MG TAB 33

GRAMICIDIN

0.025MG/ML/

NEOMYCIN

1.75MG/ML/

POLYMYXIN B

10000UNIT/ML OPHTH

SOLN 97

granisetron 1mg tab 36



griseofulvin 25mg/ml susp 37






GUANIDINE 125MG TAB 45

GVOKE 0.5MG/0.1ML

AUTO-INJECTOR 34

GVOKE 0.5MG/0.1ML

SYRINGE 34

GVOKE 1MG/0.2ML

AUTO-INJECTOR 34

GVOKE 1MG/0.2ML

SYRINGE 34

H

HAEGARDA 2000UNT INJ 87

HAEGARDA 3000UNT INJ 87

hailey 24 fe 28 day pack 70

halobetasol propionate 0.05%cream 77

halobetasol propionate 0.05%ointment 77

haloperidol 0.5mg tab 55




haloperidol 2mg/ml oral soln 55


haloperidol 5mg/ml inj 55


haloperidol decanoate100mg/ml inj 55

haloperidol decanoate500mg/5ml inj 55

haloperidol decanoate50mg/ml inj 55

HAVRIX 1440UNIT INJ 110

HAVRIX 1440UNIT

SYRINGE 110

HAVRIX 720UNIT

SYRINGE 110

heparin sodium porcine10000unit/ml inj 24




HEPATAMINE 8% INJ 96

HETLIOZ 20MG CAP 89

HIBERIX INJ 110

HUMIRA 10MG/0.1ML

SYRINGE 10

HUMIRA 10MG/0.2ML

SYRINGE 10

HUMIRA 20MG/0.2ML

SYRINGE 10

HUMIRA 20MG/0.4ML

SYRINGE 10

HUMIRA 40MG/0.4ML PEN

INJECTOR 10

HUMIRA 40MG/0.4ML

SYRINGE 10




HUMIRA 40MG/0.8ML

AUTO-INJECTOR 10

HUMIRA 40MG/0.8ML

SYRINGE 10

HUMIRA PEDIATRIC

CROHN'S STARTER

PACK (3) 80MG/0.8ML

INJ 10

HUMIRA PEDIATRIC

CROHN'S STARTER

PACK SYRINGE (2)

40MG/0.4ML

80MG/0.8ML 10

HUMIRA PEN - CROHN'S

STARTER PACK

40MG/0.8ML INJ 10

HUMIRA PEN - CROHN'S

STARTER PACK

80MG/0.8ML INJ 10

HUMIRA PEN - PSORIASIS

STARTER PACK

40MG/0.8ML INJ 10

HUMIRA PEN - PSORIASIS

STARTER PACK

80MG/0.8ML INJ 10

HUMULIN R 500UNIT/ML

INJ 34

HUMULIN R 500UNIT/ML

PEN INJ 34





hydrochlorothiazide12.5mg/irbesartan 150mgtab 43

hydrochlorothiazide12.5mg/irbesartan 300mgtab 43

hydrochlorothiazide12.5mg/lisinopril 10mg tab 43

hydrochlorothiazide12.5mg/lisinopril 20mg tab 43

hydrochlorothiazide12.5mg/losartan potassium100mg tab 43

hydrochlorothiazide12.5mg/losartan potassium50mg tab 43

hydrochlorothiazide12.5mg/olmesartanmedoxomil 20mg tab 43

hydrochlorothiazide12.5mg/olmesartanmedoxomil 40mg tab 43

hydrochlorothiazide12.5mg/quinapril 10mg tab 43

hydrochlorothiazide12.5mg/quinapril 20mg tab 43

hydrochlorothiazide12.5mg/telmisartan 40mgtab 43

hydrochlorothiazide12.5mg/telmisartan 80mgtab 43

hydrochlorothiazide12.5mg/valsartan 160mgtab 43

hydrochlorothiazide12.5mg/valsartan 320mgtab 43

hydrochlorothiazide12.5mg/valsartan 80mg tab43

hydrochlorothiazide 12.5mgcap 80

hydrochlorothiazide 12.5mgtab 80

hydrochlorothiazide25mg/lisinopril 20mg tab 43

hydrochlorothiazide25mg/losartan potassium100mg tab 43

hydrochlorothiazide25mg/metoprolol tartrate100mg tab 43

hydrochlorothiazide25mg/metoprolol tartrate50mg tab 43

hydrochlorothiazide25mg/olmesartanmedoxomil 40mg tab 43

HYDROCHLOROTHIAZIDE

25MG/PROPRANOLOL

40MG TAB 43

HYDROCHLOROTHIAZIDE

25MG/PROPRANOLOL

80MG TAB 44

hydrochlorothiazide25mg/quinapril 20mg tab 44

hydrochlorothiazide25mg/spironolactone 25mgtab 79

hydrochlorothiazide25mg/telmisartan 80mg tab44

hydrochlorothiazide25mg/triamterene 37.5mgcap 79

hydrochlorothiazide25mg/triamterene 37.5mgtab 79

hydrochlorothiazide25mg/valsartan 160mg tab 44

hydrochlorothiazide25mg/valsartan 320mg tab 44


HYDROCHLOROTHIAZIDE

50MG/METOPROLOL

TARTRATE 100MG TAB 44

hydrochlorothiazide50mg/triamterene 75mg tab79


hydrocodone 10mg/ibuprofen200mg tab 15

hydrocodone 5mg/ibuprofen200mg tab 15

hydrocodone bitartrate7.5mg/ibuprofen 200mg tab15

hydrocortisone/pramoxine1-1% rectal cream 16




hydrocortisone 1.67mg/mlenema 16

hydrocortisone 1% cream 77

HYDROCORTISONE

10MG/ML/NEOMYCIN

3.5MG/ML/POLYMYXIN

B 10000UNIT/ML

OPHTH SUSP 98

hydrocortisone10mg/ml/neomycin3.5mg/ml/polymyxin b10000unit/ml otic soln 99

hydrocortisone10mg/ml/neomycin3.5mg/ml/polymyxin b10000unit/ml otic susp 99


hydrocortisone 2.5% cream 77

hydrocortisone 2.5% lotion 77

hydrocortisone 2.5% ointment 77



hydrocortisone valerate 0.2%cream 77

hydrocortisone valerate 0.2%ointment 77

hydromorphone 10mg/ml(1ml) inj 13

hydromorphone 10mg/ml(5ml) inj 13

hydromorphone 1mg/ml oralsoln 13

hydromorphone 2mg tab 13



hydroxychloroquine sulfate200mg tab 44

hydroxyurea 500mg cap 51



hydroxyzine 2mg/ml oral soln 19


HYDROXYZINE PAMOATE

100MG CAP 19

hydroxyzine pamoate 25mgcap 19

hydroxyzine pamoate 50mgcap 19

HYSINGLA 100MG ER TAB13

HYSINGLA 120MG ER TAB13

HYSINGLA 20MG ER TAB 13





I

ibandronate 150mg tab 80

IBRANCE 100MG CAP 48

IBRANCE 100MG TAB 48

IBRANCE 125MG CAP 48

IBRANCE 125MG TAB 48

IBRANCE 75MG CAP 48

IBRANCE 75MG TAB 48

ibu 600mg tab 11

ibu 800mg tab 11

ibuprofen 20mg/ml susp 11




icatibant 10mg/ml syringe 87

ICLUSIG 15MG TAB 48

ICLUSIG 45MG TAB 48

IDHIFA 100MG TAB 48

IDHIFA 50MG TAB 48

ILEVRO 0.3% OPHTH SUSP99



IMBRUVICA 140MG CAP 48

IMBRUVICA 140MG TAB 49




IMBRUVICA 70MG CAP 49

imipramine 10mg tab 32



imipramine pamoate 100mgcap 32




imiquimod 5% cream 78

IMOVAX 2.5UNIT/ML INJ 110

incassia 28 day 0.35mg pack 72

INCRELEX 40MG/4ML INJ 81

INCRUSE 62.5MCG INH 21



INDOCIN 50MG RECTAL

SUPP 11

INFANRIX INJ 108

INGREZZA 40MG CAP 103

INGREZZA 80MG CAP 103

INLYTA 1MG TAB 49

INLYTA 5MG TAB 49

INREBIC 100MG CAP 49

INSULIN PEN NEEDLE 90

INSULIN SYRINGE (DISP)

U-100 0.3ML 90


U-100 1/2ML 90


U-100 1ML 90

INSULIN SYRINGE MIS

1ML/29G 90




intralipid 200mg/ml inj 95

INTRON A 10MU INJ 51




INTRON A

6000000UNIT/ML INJ 51

introvale 91 day pack 70




INVEGA 117MG/0.75ML

SYRINGE 54

INVEGA 156MG/ML

SYRINGE 54

INVEGA 234MG/1.5ML

SYRINGE 54

INVEGA 273MG/0.875ML

SYRINGE 54

INVEGA 39MG/0.25ML

SYRINGE 54


SYRINGE 54

INVEGA 546MG/1.75ML

SYRINGE 54

INVEGA 78MG/0.5ML

SYRINGE 54


SYRINGE 54

INVIRASE 500MG TAB 59

IOPIDINE 1% OPHTH

SOLN 97

IPOL INJ 110

ipratropium/albuterol0.5-2.5mg/3ml inh soln 22

ipratropium bromide 0.02%inh soln 21

ipratropium bromide 0.03%nasal inhaler 95

ipratropium bromide 0.06%nasal inhaler 95




IRESSA 250MG TAB 49

ISENTRESS 100MG CHEW

TAB 59

ISENTRESS 100MG SUSP 59

ISENTRESS 25MG CHEW

TAB 59



isibloom 28 day pack 70

ISOLYTE P INJ 92

ISOLYTE S INJ 92


ISONIAZID 10MG/ML

ORAL SOLN 45


ISOPROPYL ALCOHOL

0.7ML/ML PAD 90



ISOSORBIDE DINITRATE

30MG TAB 18


isosorbide mononitrate 10mgtab 18

isosorbide mononitrate120mg er tab 18

isosorbide mononitrate 20mgtab 18

isosorbide mononitrate 30mger tab 18

isosorbide mononitrate 60mger tab 18





isradipine 2.5mg cap 64

isradipine 5mg cap 64

itraconazole 100mg cap 38

ivermectin 3mg tab 16

IXIARO SYRINGE 110

J

JADENU 180MG

GRANULE PACKET 36

JADENU 180MG TAB 36

JADENU 360MG

GRANULE PACKET 36

JADENU 360MG TAB 36

JADENU 90MG GRANULE

PACKET 36

JADENU 90MG TAB 36

JAKAFI 10MG TAB 49

JAKAFI 15MG TAB 49

JAKAFI 20MG TAB 49

JAKAFI 25MG TAB 49

JAKAFI 5MG TAB 49

jantoven 10mg tab 23

jantoven 1mg tab 23


jantoven 2mg tab 23

jantoven 3mg tab 23

jantoven 4mg tab 23

jantoven 5mg tab 23

jantoven 6mg tab 23


JANUMET 100-1000MG XR

TAB 33

JANUMET 50-1000MG TAB 33

JANUMET 50-1000MG XR

TAB 33

JANUMET 50-500MG TAB 33

JANUMET 50-500MG XR

TAB 33

JANUVIA 100MG TAB 34

JANUVIA 25MG TAB 34

JANUVIA 50MG TAB 34

JARDIANCE 10MG TAB 35

JARDIANCE 25MG TAB 35

jasmiel 28 day pack 70

JENTADUETO 2.5-1000MG

TAB 33


XR TAB 33


TAB 33


TAB 33

JENTADUETO 5-1000MG

XR TAB 33

jinteli tab 83

juleber 28 day pack 70

JULUCA 50-25MG TAB 59

junel 1/20 21 day pack 70

junel 1.5/30 21 day pack 70

junel fe 1/20 28 day pack 70

junel fe 1.5/30 28 day pack 70

junel fe 24 1/20 28 day pack 70

JUXTAPID 10MG CAP 39







JUXTAPID 5MG CAP 40


JYNARQUE 15/15MG PACK 82

JYNARQUE 15MG TAB 83

JYNARQUE 30/15MG PACK 83

JYNARQUE 30MG TAB 83

JYNARQUE 45/15

THERAPY PACK 83

JYNARQUE 60/30

THERAPY PACK 83

JYNARQUE 90/30

THERAPY PACK 83

K

kaitlib fe 28 day pack 70



KALYDECO 150MG TAB 104

KALYDECO 25MG

GRANULES 104

KALYDECO 50MG

GRANULES PACKET 104

KALYDECO 75MG

GRANULES PACKET 104

kariva 28 day pack 70

KCL/D5W/LR INJ 0.15% 92



ketoconazole 2% cream 75

ketoconazole 2% shampoo 75

ketoconazole 200mg tab 38

ketoconazole 20mg/ml foam 75

ketodan 2% foam 75

KETOPROFEN 25MG CAP 11

ketorolac tromethamine 0.4%ophth soln 99

ketorolac tromethamine 0.5%ophth soln 99

ketorolac tromethamine 10mgtab 12

KEVZARA 150MG/1.14ML

AUTO-INJECTOR 11


PF INJ 11


AUTO-INJECTOR 11


PF INJ 11

KINRIX INJ 108

KINRIX PF INJ 108

kionex 250mg/ml susp 62

KISQALI/FEMARA TAB

CO-PACK 200MG 47

KISQALI/FEMARA TAB

CO-PACK 400MG 47

KISQALI/FEMARA TAB

CO-PACK 600MG 47

KISQALI 200MG DAILY

DOSE PACK 49

KISQALI 400MG DAILY

DOSE PACK 49

KISQALI 600MG DAILY

DOSE PACK 49



KLOR-CON 15MEQ ER

TAB 92


klor-con 20meq powder 93


KORLYM 300MG TAB 34

KOSELUGO 10MG CAP 49

KOSELUGO 25MG CAP 49

KRINTAFEL 150MG TAB 44



kurvelo 28 day pack 70

KUVAN 100MG POWDER

FOR ORAL SOLN 82

KUVAN 100MG TAB 82

KUVAN 500MG POWDER

FOR ORAL SOLN 82

L




LACRISERT 5MG

IMPLANT 96

lactulose 667mg/ml oral soln 90

LAMICTAL XR BLUE KIT 26

LAMICTAL XR GREEN KIT26

LAMICTAL XR ORANGE

KIT 26


lamivudine 10mg/ml oral soln 59

lamivudine 150mg/zidovudine300mg tab 59











lamotrigine 25mg (35) tabstarter pack 26









lamotrigine tab 25mg(42)/100mg (7) starterpack 26

lamotrigine tab 25mg(84)/100mg (14) starterpack 26






lanthanum carbonate 1000mgchew tab 85



LANTUS 100UNIT/ML INJ 34

LANTUS 100UNIT/ML

SOLOSTAR 34

larin 1/20 pack 70

larin 1.5/30 pack 70

larin fe 1/20 pack 70

larin fe 1.5/30 pack 70

larissia 28 day pack 70

latanoprost 0.005% ophthsoln 99

LATUDA 120MG TAB 54

LATUDA 20MG TAB 54

LATUDA 40MG TAB 54

LATUDA 60MG TAB 54

LATUDA 80MG TAB 54

layolis fe 28 pack 70

leena 28 day pack 70



LENVIMA (10) 10MG PACK49

LENVIMA (12) 4MG PACK 49

LENVIMA (14) PACK 49


LENVIMA (20) 10MG PACK49




lessina 28 day pack 70

letrozole 2.5mg tab 46





LEUKERAN 2MG TAB 45

LEUKINE 250MCG INJ 88

leuprolide acetate 5mg/ml inj 46

levalbuterol 0.31mg inh soln 22




LEVEMIR 100UNIT/ML

FLEXTOUCH 34

LEVEMIR 100UNIT/ML INJ 34


levetiracetam 100mg/ml oralsoln 26






levobunolol 0.5% ophth soln 96

levocarnitine 100mg/ml oralsoln 82

levocarnitine 330mg tab 82

levocetirizine 0.5mg/ml oralsoln 38

levocetirizine 5mg tab 38

levofloxacin 0.5% ophth soln 97



levofloxacin 25mg/ml oralsoln 84


levofloxacin 5mg/ml (150ml)inj 84



levonest 28 day pack 70

levora 0.15/30 28 day pack 70

levo-t 100mcg tab 106












levothyroxine sodium 100mcgtab 106























LEXIVA 50MG/ML SUSP 59

lidocaine/prilocaine 2.5-2.5%cream 78

lidocaine 2% gel 78



lidocaine 5% ointment 78

lidocaine 5% patch 78

LINDANE 1% SHAMPOO 78




linezolid 20mg/ml susp 18

linezolid 2mg/ml inj 18

linezolid 600mg tab 18

LINZESS 145MCG CAP 85



liothyronine sodium 0.005mgtab 107




lisinopril 2.5mg tab 40





LITHIUM CARBONATE

150MG CAP 53

lithium carbonate 300mg cap 53

lithium carbonate 300mg ertab 53

lithium carbonate 300mg tab 53

lithium carbonate 450mg ertab 53

LITHIUM CARBONATE

600MG CAP 53

LITHIUM CITRATE

60MG/ML ORAL SOLN 53

LITHOSTAT 250MG TAB 86

LOKELMA 10GM PACKET 94

LOKELMA 5GM PACKET 94

LONHALA 0.0025% INH

SOLN 21

LONSURF 15-6.14MG TAB 47

LONSURF 20-8.19MG TAB 47

loperamide 2mg cap 36

lopinavir 80mg/ml/ritonavir20mg/ml oral solution 59

lopreeza 1/0.5mg 28 day pack 83

lorazepam 0.5mg tab 20

lorazepam 1mg tab 20

lorazepam 2mg/ml conc 20

lorazepam 2mg tab 20

LORBRENA 100MG TAB 49

LORBRENA 25MG TAB 49

lorcet 10-325mg tab 15

lorcet 5-325mg tab 15

loryna 28 day pack 70

losartan potassium 100mg tab41



LOTEMAX 0.5% OPHTH

GEL 98

LOTEMAX 0.5% OPHTH

OINTMENT 98

loteprednol etabonate 0.5%ophth susp 98




low-ogestrel 28 day pack 70

loxapine 10mg cap 55



loxapine 5mg cap 56

LUMIGAN 0.01% OPHTH

SOLN 99

LUPANETA PACK

1-MONTH PACK 81

LUPANETA PACK

3-MONTH PACK 81

LUPRON 11.25MG (1.5ML)

SYRINGE 46






lutera 28 day pack 70

LYNPARZA 100MG TAB 49

LYNPARZA 150MG TAB 49

LYSODREN 500MG TAB 46

lyza 0.35mg pack 72

M

magnesium sulfate 50% inj 92

magnesium sulfate 50%syringe 92

malathion 0.5% lotion 78




marlissa 28 day pack 70

MARPLAN 10MG TAB 29

MATULANE 50MG CAP 51






MAVYRET 100-40MG TAB 60

MAXIDEX 0.1% OPHTH

SUSP 98

MAYZENT 0.25MG TAB 103

MAYZENT 2MG TAB 103

meclizine 12.5mg tab 37

meclizine 25mg tab 37

MEDROL 2MG TAB 72

medroxyprogesterone acetate10mg tab 101

medroxyprogesterone acetate150mg/ml inj 72

medroxyprogesterone acetate150mg/ml syringe 72

medroxyprogesterone acetate2.5mg tab 101

medroxyprogesterone acetate5mg tab 101

MEFLOQUINE 250MG TAB 44

megestrol acetate 125mg/mlsusp 101

megestrol acetate 20mg tab 46

megestrol acetate 40mg/mlsusp 46

megestrol acetate 40mg tab 46

MEKINIST 0.5MG TAB 49

MEKINIST 2MG TAB 49

MEKTOVI 15MG TAB 49

meloxicam 15mg tab 12

meloxicam 7.5mg tab 12




memantine 10mg/memantine5mg pack 102





memantine 2mg/ml oral soln 102



MENACTRA INJ 110

MENVEO INJ 110

mercaptopurine 50mg tab 45

meropenem 1gm inj 17

meropenem 500mg inj 17

mesalamine 1.2gm tab 85

mesalamine 1000mg rectalsupp 85

mesalamine 375mg er cap 85

mesalamine 400mg dr cap 85

mesalamine 66.7mg/ml enema 85

mesalamine 800mg dr tab 85

MESNEX 400MG TAB 51

METAPROTERENOL

SULFATE 2MG/ML

ORAL SOLN 22

METAXALONE 400MG

TAB 95

metaxalone 800mg tab 95






methadone 10mg tab 13

METHADONE 1MG/ML

ORAL SOLN 13

METHADONE 2MG/ML

ORAL SOLN 13

methadone 5mg tab 13



methenamine hippurate1000mg tab 109





methotrexate 2.5mg tab 45



methoxsalen 10mg cap 75

methscopolamine 2.5mg tab 109

methscopolamine 5mg tab 109






methylphenidate 1mg/ml oralsoln 9






methylphenidate 2mg/ml oralsoln 9












methylprednisolone 4mg pack 72




metoclopramide 1mg/ml oralsoln 85



metolazone 2.5mg tab 80


metoprolol succinate 100mger tab 62

metoprolol succinate 200mger tab 62

metoprolol succinate 25mg ertab 62

metoprolol succinate 50mg ertab 62

metoprolol tartrate 100mg tab63



metronidazole 0.75% cream 78

metronidazole 0.75% gel 78

metronidazole 0.75% lotion 78

metronidazole 0.75% vaginalgel 111

metronidazole 1% gel 78


metronidazole 375mg cap 16


metronidazole 5mg/ml inj 16



microgestin 1/20 21 day pack 70

microgestin 1.5/30 21 daypack 70

microgestin fe 1/20 28 daypack 70

microgestin fe 1.5/30 28 daypack 70


midodrine 2.5mg tab 111





miglustat 100mg cap 87

mili 28 day pack 70

mimvey pack 83














minoxidil 10mg tab 44

minoxidil 2.5mg tab 44







mirtazapine 7.5mg tab 29



MITIGARE 0.6MG CAP 87

M-M-R II INJ 110

modafinil 100mg tab 9

modafinil 200mg tab 9

moexipril 15mg tab 40

moexipril 7.5mg tab 40




mometasone furoate 0.1%cream 77

mometasone furoate 0.1%lotion 77

mometasone furoate 0.1%ointment 77

mondoxyne 100mg cap 105

montelukast 10mg tab 21


montelukast 4mg granules 21


MONUROL 3000MG ORAL

SOLN 109

morphine sulfate 100mg ertab 13

morphine sulfate 15mg er tab 13

MORPHINE SULFATE

15MG TAB 13

morphine sulfate 200mg ertab 13

morphine sulfate 20mg/mloral soln 14

morphine sulfate 2mg/ml oralsoln 14


MORPHINE SULFATE

30MG TAB 14

morphine sulfate 4mg/ml oralsoln 14


MOVANTIK 12.5MG TAB 85

MOVANTIK 25MG TAB 85

moxifloxacin 0.5% ophth soln 97

moxifloxacin 1.6mg/ml inj 84

moxifloxacin 400mg tab 84

MULPLETA 3MG TAB 88

MULTAQ 400MG TAB 20

mupirocin 2% ointment 74



mycophenolate mofetil200mg/ml susp 61

mycophenolate mofetil 250mgcap 61

mycophenolate mofetil 500mgtab 62

mycophenolic acid 180mg drtab 62

mycophenolic acid 360mg drtab 62

myorisan 10mg cap 74




MYRBETRIQ 25MG ER

TAB 110

MYRBETRIQ 50MG ER

TAB 110

N



nadolol 20mg tab 63

nadolol 40mg tab 63

nadolol 80mg tab 63

nafcillin 100mg/ml inj 101

nafcillin 1gm inj 101

nafcillin 2gm inj 101



NALOXONE 0.4MG/ML

CARTRIDGE 36

naloxone 0.4mg/ml inj 36

NALOXONE 1MG/ML

SYRINGE 36

naltrexone 50mg tab 36








naratriptan 1mg tab 91

naratriptan 2.5mg tab 91

NARCAN 4MG/0.1ML

NASAL SPRAY 36

NATACYN 5% OPHTH

SUSP 97

NATAZIA 28 DAY PACK 70



NATPARA 100MCG

CARTRIDGE 80

NATPARA 25MCG

CARTRIDGE 80

NATPARA 50MCG

CARTRIDGE 80

NATPARA 75MCG

CARTRIDGE 80

NAYZILAM 5MG/0.1ML

NASAL SPRAY 25

NEBUPENT 300MG INH

SOLN 16

necon 0.5/35 28 day pack 71









neomycin/bacitracin/polymyxin ophth ointment5(3.5)mg-400unit-10000unit97

neomycin/polymyxin/bacitracin/hydrocortisoneophth ointmentment 1% 98

neomycin sulfate 500mg tab 10

NEPHRAMINE 5.4% INJ 96

NERLYNX 40MG TAB 49

NEUPRO 1MG/24HR PATCH52






NEVANAC 0.1% OPHTH

SUSP 99


nevirapine 10mg/ml oral susp 59

nevirapine 200mg tab 59


NEXAVAR 200MG TAB 49

NEXIUM 10MG SUSP 108

NEXIUM 2.5MG SUSP 108



NEXIUM 5MG SUSP 108






NICOTROL 10MG/ML

NASAL INHALER 104

NICOTROL 10MG

INHALER 104


nifedipine 30mg osmotic ertab 64





nikki 28 day pack 71

nilutamide 150mg tab 46

nimodipine 30mg cap 64

NINLARO 2.3MG CAP 49

NINLARO 3MG CAP 49

NINLARO 4MG CAP 49


NISOLDIPINE 20MG ER

TAB 64

NISOLDIPINE 25.5MG ER

TAB 64

NISOLDIPINE 30MG ER

TAB 64


NISOLDIPINE 40MG ER

TAB 64

nisoldipine 8.5mg er tab 65

nitisinone 10mg cap 82



NITRO-BID 2% OINTMENT 18

NITRO-DUR 0.3MG/HR

PATCH 18

NITRO-DUR 0.8MG/HR

PATCH 18

nitrofurantoin 5mg/ml susp 109

nitrofurantoin macro 100mgcap 109

nitrofurantoin macro25mg/nitrofurantoin mono75mg cap 109






nitroglycerin 0.4mg/act spray 19





NIVESTYM

300MCG/0.5ML PF INJ 88

NIVESTYM 300MCG/1ML

INJ 88

NIVESTYM

480MCG/0.8ML PF INJ 88

NIVESTYM

480MCG/1.6ML INJ 88


NIZATIDINE 15MG/ML

ORAL SOLN 109


nora-be 28 day 0.35mg pack 72

norethindrone 0.35mg pack 72

norethindrone acetate 5mgtab 101

NORMOSOL-M INJ 92

NORMOSOL-R INJ 92

NORPACE 100MG ER CAP 20

NORPACE 150MG ER CAP 20

NORTHERA 100MG CAP 111



nortrel 0.5/35 28 day pack 71



nortrel 7/7/7 28 day pack 71



NORTRIPTYLINE 2MG/ML

ORAL SOLN 32



NORVIR 100MG POWDER

PACKET 59

NORVIR 80MG/ML ORAL

SOLN 59

NOVOLIN 100UNIT/ML INJ 35

NOVOLIN MIX (70/30)

FLEXPEN 100UNIT/ML 35




NOVOLIN N 100UNIT/ML

INJ 35

NOVOLIN N 100UNIT/ML

PEN INJ 35

NOVOLIN R 100UNIT/ML

INJ 35

NOVOLIN R 100UNIT/ML

PEN INJ 35

NOVOLOG 100UNIT/ML

FLEXPEN 35

NOVOLOG 100UNIT/ML

INJ 35

NOVOLOG 100UNIT/ML

PENFILL 35

NOVOLOG MIX

100UNIT/ML FLEXPEN 35

NOVOLOG MIX

100UNIT/ML INJ 35

NOXAFIL 100MG DR TAB 38

NOXAFIL 40MG/ML SUSP 38

NUBEQA 300MG TAB 46

NUCALA 100MG/ML

AUTO-INJECTOR 21

NUCALA 100MG/ML

SYRINGE 21

NUCALA 100MG INJ 21

NUCYNTA 100MG ER TAB 14





NUEDEXTA 20-10MG CAP104

NUPLAZID 10MG TAB 54

NUPLAZID 34MG CAP 54

nutrilipid 20% iv soln 95

NUVARING VAGINAL

RING 72

NUZYRA 150MG TAB 105

nyamyc 100000unit/gmpowder 75

nystatin 100000unit/ml cream 75

nystatin 100000unit/ml susp 94

nystatin 100unit/mg ointment 75

nystatin 100unit/mg powder 75

nystatin 500000unit tab 37

nystop 100000unit/gm powder75

O

OCALIVA 10MG TAB 84

OCALIVA 5MG TAB 84

ocella 28 day pack 71

OCTAGAM 25GM/500ML

INJ 100

OCTAGAM 2GM/20ML INJ100





octreotide 1mg/ml inj 82

ODEFSEY 200-25-25MG

TAB 59

ODOMZO 200MG CAP 46

OFEV 100MG CAP 105

OFEV 150MG CAP 105

ofloxacin 0.3% ophth soln 97

ofloxacin 0.3% otic soln 99

ofloxacin 400mg tab 84

olanzapine 10mg inj 56











olmesartan medoxomil 20mgtab 41



olopatadine 0.6% nasalinhaler 95

olopatadine 1mg/ml ophthsoln 99

olopatadine 2% ophth soln 99

OLUMIANT 1MG TAB 10

OLUMIANT 2MG TAB 10

omega-3 acid ethyl esters(usp) 1000mg cap 38



ondansetron 0.8mg/ml oralsoln 36

ondansetron 24mg tab 36

ondansetron 4mg odt 36


ondansetron 8mg odt 36


OPSUMIT 10MG TAB 66

ORENCIA 125MG/ML

AUTO-INJECTOR 12

ORENCIA 125MG/ML

SYRINGE 12

ORENCIA 50MG/0.4ML

SYRINGE 12

ORENCIA 87.5MG/0.7ML

SYRINGE 12

ORENITRAM 0.125MG ER

TAB 66

ORENITRAM 0.25MG ER

TAB 66

ORENITRAM 1MG ER TAB 66

ORENITRAM 2.5MG ER

TAB 66

ORENITRAM 5MG ER TAB 66

ORFADIN 10MG CAP 82

ORFADIN 20MG CAP 82

ORFADIN 2MG CAP 82

ORFADIN 4MG/ML SUSP 82

ORFADIN 5MG CAP 82

ORILISSA 150MG TAB 81

ORILISSA 200MG TAB 81

ORKAMBI 100-125MG

GRANULES PACKET 104

ORKAMBI 100-125MG

TAB 104

ORKAMBI 188-150MG

GRANULES PACKET 104




ORKAMBI 200-125MG

TAB 104

orphenadrine citrate 100mger tab 95

orsythia 28 day pack 71

oseltamivir 30mg cap 61


oseltamivir 6mg/ml oral susp 61


OSPHENA 60MG TAB 81

OTEZLA 28-DAY STARTER

PACK 12

OTEZLA 30MG TAB 12

oxacillin 100mg/ml inj 101

oxacillin 1gm inj 101

oxacillin 2000mg inj 101

OXACILLIN 20MG/ML INJ101

OXACILLIN 40MG/ML INJ101

oxandrolone 10mg tab 15

oxandrolone 2.5mg tab 15

oxaprozin 600mg tab 12

OXAZEPAM 10MG CAP 20

oxazepam 15mg cap 20

OXAZEPAM 30MG CAP 20

OXBRYTA 500MG TAB 87




oxcarbazepine 60mg/ml susp 27

OXERVATE 0.002% OPHTH

SOLN 98

OXTELLAR 150MG XR

TAB 27

OXTELLAR 300MG XR

TAB 27

OXTELLAR 600MG XR

TAB 27

oxybutynin chloride 10mg ertab 109


oxybutynin chloride 1mg/mloral soln 109


oxybutynin chloride 5mg tab 109

oxycodone 10mg tab 14


oxycodone 1mg/ml oral soln 14

oxycodone 20mg/ml oral soln 14



oxycodone 5mg cap 14


oxymorphone 10mg tab 14

oxymorphone 5mg tab 14

OZEMPIC 2MG/1.5ML PEN

INJ 34

OZEMPIC 2MG/1.5ML PEN

INJ (1MG DOSE) 34

P



paliperidone 1.5mg er tab 54

paliperidone 3mg er tab 54



PALYNZIQ 10MG/0.5ML

SYRINGE 82

PALYNZIQ 2.5MG/0.5ML

SYRINGE 82

PALYNZIQ 20MG/ML

SYRINGE 82

PANRETIN 0.1% GEL 75



PANZYGA 10GM/100ML IV

SOLN 100

PANZYGA 1GM/10ML IV

SOLN 100

PANZYGA 2.5GM/25ML IV

SOLN 100


SOLN 100


SOLN 100

PANZYGA 5GM/50ML IV

SOLN 100

paricalcitol 0.001mg cap 82



paromomycin 250mg cap 10

paroxetine 10mg tab 30

paroxetine 12.5mg er tab 30


paroxetine 25mg er tab 30


paroxetine 37.5mg er tab 30


PASER D/R 4GM

GRANULES 45

PAXIL 10MG/5ML SUSP 30

PEDIARIX INJ 108

PEDVAXHIB

7.5MCG/0.5ML INJ 110

peg 3350/electrolyte oral soln 89

peg 3350/kcl/sodiumbicarbonate/sodiumchloride powder for oralsoln 90

PEGANONE 250MG TAB 28

PEGASYS 180MCG/0.5ML

AUTO-INJECTOR 61

PEGASYS 180MCG/0.5ML

SYRINGE 61

PEGASYS 180MCG/ML INJ 61

PEMAZYRE 13.5MG TAB 49

PEMAZYRE 4.5MG TAB 49

PEMAZYRE 9MG TAB 49

penicillamine 250mg tab 93

penicillin g potassium1000000unit/ml inj 100

PENICILLIN G

POTASSIUM


PENICILLIN G

POTASSIUM





PENICILLIN G PROCAINE

600000UNIT/ML

SYRINGE 100

PENICILLIN G SODIUM


penicillin v potassium 250mgtab 100

PENICILLIN V

POTASSIUM 25MG/ML

ORAL SOLN 100

penicillin v potassium 500mgtab 100

PENICILLIN V

POTASSIUM 50MG/ML

ORAL SOLN 100

PENTAM 300MG INJ 16

pentamidine isethionate300mg inj 16

pentamidine isethionate50mg/ml inh soln 16

pentoxifylline 400mg er tab 87




permethrin 5% cream 78





PERSERIS 120MG

SYRINGE 55

PERSERIS 90MG SYRINGE 55

PEXEVA 10MG TAB 30

PEXEVA 20MG TAB 30

PEXEVA 30MG TAB 30

PEXEVA 40MG TAB 30

phenelzine 15mg tab 29






phenobarbital 4mg/ml oralsoln 89




phenoxybenzamine 10mg cap 41

PHENYLEPHRINE

1MG/ML/

PROMETHAZINE


phenytoin 25mg/ml susp 28

phenytoin 50mg chew tab 28

phenytoin sodium 100mg ercap 28



PHOSLYRA 667MG/5ML

ORAL SOLN 86

PHOSPHOLINE IODIDE

0.125% OPHTH SOLN 97

PICATO 0.015% GEL 75

PICATO 0.05% GEL 75

PIFELTRO 100MG TAB 59




pilocarpine 5mg tab 94

pilocarpine 7.5mg tab 94

pimecrolimus 1% cream 78

PIMOZIDE 1MG TAB 104

PIMOZIDE 2MG TAB 104

pimtrea pack 71

pindolol 10mg tab 63

pindolol 5mg tab 63




piperacillin2000mg/tazobactam250mg inj 101

piperacillin200mg/ml/tazobactam25mg/ml inj 101



PIQRAY 200MG DAILY

DOSE PACK 50

PIQRAY 250MG DAILY

DOSE PACK 50

PIQRAY 300MG DAILY

DOSE 150MG PACK 50

pirmella 1/35 28 day pack 71



PLASMA-LYTE 148 INJ 92

PLASMALYTE A INJ 92

PLEGRIDY 125MCG/0.5ML

AUTO-INJECTOR 103

PLEGRIDY 125MCG/0.5ML

SYRINGE 103

PLEGRIDY PEN STARTER

PACK 103

PLEGRIDY STARTER

PACK 103

plenamine 15% inj 96

podofilox 0.5% topical soln 78

polymyxin b10000unit/ml/trimethoprim1mg/ml ophth soln 97

polymyxin b 250000unit/mlinj 18

POMALYST 1MG CAP 47

POMALYST 2MG CAP 47

POMALYST 3MG CAP 47

POMALYST 4MG CAP 47

portia 28 day pack 71

posaconazole 100mg dr tab 38

potassium chloride 0.02meq/ml/sodium chloride0.0769 meq/ml inj 92







potassium chloride 0.2meq/mlinj 93

potassium chloride 0.4meq/mlinj 93

potassium chloride 10% oralsoln 93

potassium chloride 10meq ercap 93

potassium chloride 10meq ermicro tab 93

potassium chloride 10meq ertab 93

potassium chloride 20% oralsoln 93

potassium chloride 20meq ermicro tab 93

POTASSIUM CHLORIDE

20MEQ ER TAB 93

potassium chloride 20meqpowder for oral soln 93

potassium chloride 2meq/mlinj 93

potassium chloride40meq/20ml inj 93

potassium chloride 8 meq ercap 93

potassium chloride 8 meq ertab 93

potassium citrate 10meq ertab 86

potassium citrate 15 meq ertab 86

potassium citrate 5 meq er tab86

PRADAXA 110MG CAP 24

PRADAXA 150MG CAP 24

PRADAXA 75MG CAP 24

PRALUENT 150MG/ML

AUTO-INJECTOR 40

PRALUENT 75MG/ML

AUTO-INJECTOR 40









pramipexole 1mg tab 52



pramipexole 3mg er tab 52








prazosin 1mg cap 42

prazosin 2mg cap 42

prazosin 5mg cap 42

PRED-G 0.3-1% OPHTH

SUSP 98

PRED MILD 0.12% OPHTH

SUSP 98

PREDNICARBATE 0.1%

CREAM 77

PREDNICARBATE 0.1%

OINTMENT 77

PREDNISOLONE 1%

OPHTH SOLN 98



prednisolone 1mg/ml oralsoln 72


PREDNISOLONE 3MG/ML

ORAL SOLN 73

PREDNISOLONE ACETATE

1% OPHTH SUSP 98

PREDNISOLONE SODIUM

PHOSPHATE

2.5MG/ML/

SULFACETAMIDE

SODIUM 100MG/ML

OPHTH SOLN 98


PREDNISONE 1MG/ML

ORAL SOLN 73


prednisone 2.5mg tab 73


PREDNISONE 50MG TAB 73

PREDNISONE 5MG/ML

ORAL SOLN 73





pregabalin 20mg/ml oral soln 27








PREMARIN 0.625MG/GM

VAGINAL CREAM 111




PREMASOL 10% INJ 96

PREMPHASE 28 DAY PACK 83

PREMPRO 0.3/1.5MG 28

DAY PACK 83

PREMPRO 0.45/1.5 28 DAY

PACK 83

PREMPRO 0.625/2.5MG 28

DAY PACK 83

PREMPRO 0.625/5MG 28

DAY PACK 83

prevalite 4gm/dose susp 39

previfem 28 day pack 71




PREVYMIS 240MG TAB 60

PREVYMIS 480MG TAB 60

PREZCOBIX 800-150MG

TAB 59

PREZISTA 100MG/ML

SUSP 59





PRIFTIN 150MG TAB 45

PRIMAQUINE PHOSPHATE

26.3MG TAB 44



PRIVIGEN 20GM/200ML

INJ 100

probenecid 500mg tab 87

PROCALAMINE 3% INJ 96


prochlorperazine 25mg rectalsupp 57


procto-med 2.5% cream 16

procto-pak 1% rectal cream 16

proctosol 2.5% cream 16

proctozone hc 2.5% cream 16



PROGLYCEM 50MG/ML

SUSP 34

PROGRAF 0.2MG

GRANULES PACKET 94

PROGRAF 1MG

GRANULES PACKET 94

PROLASTIN 1000MG INJ 104

PROLIA 60MG/ML

SYRINGE 80

PROMACTA 12.5MG

POWDER FOR ORAL

SUSP 88

PROMACTA 12.5MG TAB 88

PROMACTA 25MG

POWDER FOR ORAL

SUSP 88

PROMACTA 25MG TAB 88



promethazine 1.25mg/ml oralsoln 38

promethazine 12.5mg rectalsupp 38

promethazine 12.5mg tab 38

promethazine 25mg rectalsupp 38



promethegan 25mg rectalsupp 38

promethegan 50mg rectalsupp 38






propafenone 425mg sr cap 20

proparacaine 0.5% ophth soln98






PROPRANOLOL 4MG/ML

ORAL SOLN 63





PROPRANOLOL 8MG/ML

ORAL SOLN 63

propylthiouracil 50mg tab 106

PROQUAD INJ 110

PROSOL 20% INJ 96

protriptyline 10mg tab 32

protriptyline 5mg tab 32

PULMOZYME 1MG/ML

INH SOLN 104

PURIXAN 2000MG/100ML

SUSP 45

PYLERA 140-125-125MG

CAP 109

pyrazinamide 500mg tab 45

pyridostigmine bromide180mg er tab 45

pyridostigmine bromide 60mgtab 45

pyrimethamine 25mg tab 44

Q

QBRELIS 1MG/ML ORAL

SOLN 41

QINLOCK 50MG TAB 50

QUADRACEL INJ 108

QUDEXY 100MG XR CAP 27




















quinidine gluconate 324mg ertab 20

QUINIDINE SULFATE

200MG TAB 20

QUINIDINE SULFATE

300MG TAB 20




quinine sulfate 324mg cap 44

R

RABAVERT 2.5UNIT/ML

INJ 110

rabeprazole sodium 20mg drtab 108

raloxifene 60mg tab 81

ramelteon 8mg tab 89


ramipril 10mg cap 41


ramipril 5mg cap 41



rasagiline 0.5mg tab 53

rasagiline 1mg tab 53

RAVICTI 1.1GM/ML ORAL

SOLN 82

REBIF 22MCG/0.5ML

AUTO-INJECTOR 104

REBIF 22MCG/0.5ML

SYRINGE 104

REBIF 44MCG/0.5ML

AUTO-INJECTOR 104

REBIF 44MCG/0.5ML

SYRINGE 104

REBIF REBIDOSE PACK 104

REBIF TITRATION PACK 104

reclipsen 28 day pack 71

RECOMBIVAX 10MCG/ML

SYRINGE 110

RECOMBIVAX 40MCG/ML

INJ 110

RECOMBIVAX

5MCG/0.5ML SYRINGE 110

RECOMBIVAX HB

10MCG/ML INJ 110

RECTIV 0.4% RECTAL

OINTMENT 16

REGRANEX 0.01% GEL 78

RELENZA 5MG/BLISTER

INH 61

RELISTOR 12MG/0.6ML

INJ 85

RELISTOR 12MG/0.6ML

SYRINGE 85

RELISTOR 8MG/0.4ML

SYRINGE 85

repaglinide 0.5mg tab 35



REPATHA 120MG/ML

CARTRIDGE 40

REPATHA 140MG/ML

AUTO-INJECTOR 40

REPATHA 140MG/ML

SYRINGE 40

RESTASIS 0.05% OPHTH

SUSP 98

RETACRIT 10000UNIT/ML

INJ 88


INJ 88


INJ 88


INJ 88


INJ 88

RETEVMO 40MG CAP 50

RETEVMO 80MG CAP 50

REVLIMID 10MG CAP 93


REVLIMID 2.5MG CAP 93



REVLIMID 5MG CAP 93

REXULTI 0.25MG TAB 58

REXULTI 0.5MG TAB 58

REXULTI 1MG TAB 58

REXULTI 2MG TAB 58

REXULTI 3MG TAB 58

REXULTI 4MG TAB 58

REYATAZ 50MG ORAL

POWDER 59

ribavirin 200mg cap 61

ribavirin 200mg tab 61

RIDAURA 3MG CAP 11

rifabutin 150mg cap 45



rifampin 60mg/ml inj 45

riluzole 50mg tab 95

rimantadine 100mg tab 61

RINVOQ 15MG ER TAB 11

risedronate sodium 150mg tab80


risedronate sodium 35mg (12)pack 80

risedronate sodium 35mg (4)pack 80



RISPERDAL 12.5MG INJ 55

RISPERDAL 25MG INJ 55

RISPERDAL 37.5MG INJ 55

RISPERDAL 50MG INJ 55





risperidone 1mg/ml oral soln 55









ritonavir 100mg tab 59


rivastigmine 13.3mg/24hrpatch 102









rivelsa 91 day pack 71

rizatriptan 10mg odt 91

rizatriptan 10mg tab 91

rizatriptan 5mg odt 91

rizatriptan 5mg tab 91

















ROTARIX SUSP 110

ROTATEQ SUSP 111






ROZLYTREK 100MG CAP 50

ROZLYTREK 200MG CAP 50

RUBRACA 200MG TAB 50



RUCONEST 2100UNIT INJ 87

RUKOBIA 600MG ER TAB 59

RUZURGI 10MG TAB 45

RYBELSUS 14MG TAB 34

RYBELSUS 3MG TAB 34

RYBELSUS 7MG TAB 34

RYDAPT 25MG CAP 50

S

salmon calcitonin 200unit/actnasal spray 80

SANDIMMUNE 100MG/ML

ORAL SOLN 62

SANTYL 250UNIT/GM

OINTMENT 78

SAPHRIS 10MG SL TAB 56

SAPHRIS 2.5MG SL TAB 56

SAPHRIS 5MG SL TAB 56

SAVELLA 100MG TAB 103

SAVELLA 12.5MG TAB 103


SAVELLA 4-WEEK

TITRATION PACK 103


scopolamine 0.0139mg/hrpatch 37

SECUADO 3.8MG/24HR

PATCH 56

SECUADO 5.7MG/24HR

PATCH 56

SECUADO 7.6MG/24HR

PATCH 56

selegiline 5mg cap 53

selegiline 5mg tab 53

selenium sulfide 2.5%lotion/shampoo 76


SELZENTRY 20MG/ML

ORAL SOLN 59




SEREVENT 50MCG/DOSE

INH 23


sertraline 20mg/ml oral soln 30



setlakin 91 day pack 71

sevelamer carbonate 2400mgoral susp 86

sevelamer carbonate 800mgoral susp 86

sevelamer carbonate 800mgtab 86

sharobel 28 day 0.35mg pack 72

SHINGRIX INJ 111

SIGNIFOR 0.3MG/ML INJ 82



sildenafil 20mg tab 66

silodosin 4mg cap 86

silodosin 8mg cap 86

silver sulfadiazine 1% cream 76

SIMBRINZA 1-0.2%

OPHTH SUSP 97

SIMPONI 100MG/ML

AUTO-INJECTOR 10

SIMPONI 100MG/ML INJ 10

SIMPONI 50MG/0.5ML

AUTO-INJECTOR 10

SIMPONI 50MG/0.5ML

SYRINGE 10






sirolimus 0.5mg tab 62

sirolimus 1mg/ml oral soln 94

sirolimus 1mg tab 62

sirolimus 2mg tab 62

SIRTURO 100MG TAB 45

SIRTURO 20MG TAB 45

SIVEXTRO 200MG INJ 18

SIVEXTRO 200MG TAB 18

SKYRIZI SYRINGE 150MG

DOSE PACK 75



sodium chloride 0.9% soln 86



sodium phenylbutyrate0.94mg/mg oral powder 82




sodium polystyrene sulfonate15gm oral susp 62

sodium polystyrene sulfonate250mg/ml susp 62

SOFOSBUVIR/

VELPATASVIR

400-100MG TAB 61

solifenacin succinate 10mgtab 109

solifenacin succinate 5mgtab 109

SOLIQUA

100UNIT-0.033MG/ML

PEN INJ 33

SOLTAMOX 10MG/5ML

ORAL SOLN 46

SOMATULINE

120MG/0.5ML SYRINGE 82

SOMATULINE


SOMATULINE


SOMAVERT 10MG INJ 81





sorine 120mg tab 63

sorine 160mg tab 63

sorine 240mg tab 63

sorine 80mg tab 63

sotalol 120mg tab 63



sotalol 80mg tab 63

sotalol af 120mg tab 63



SPIRIVA 1.25MCG

RESPIMAT INH 21




sprintec 28 day pack 71

SPRITAM 1000MG ODT 27




SPRYCEL 100MG TAB 50

SPRYCEL 140MG TAB 50

SPRYCEL 20MG TAB 50

SPRYCEL 50MG TAB 50

SPRYCEL 70MG TAB 50

SPRYCEL 80MG TAB 50

sps 250mg/ml oral susp 62

sronyx 28 day pack 71

ssd 1% cream 76





STELARA 45MG/0.5ML INJ 75

STELARA 45MG/0.5ML

SYRINGE 75

STELARA 90MG/ML

SYRINGE 75

STIMATE 1.5MG/ML

NASAL SPRAY 82

STIOLTO 2.5-2.5MCG INH 23

STIVARGA 40MG TAB 50

STREPTOMYCIN 100MG

INJ 10

STRIBILD

150-150-200-300MG TAB 60

SUCRAID 8500UNIT/ML

ORAL SOLN 79

sucralfate 1000mg tab 108

sucralfate 100mg/ml susp 109

sulfacetamide sodium 10%lotion 74

SULFACETAMIDE

SODIUM 10% OPHTH

OINTMENT 97

sulfacetamide sodium 10%ophth soln 97

SULFADIAZINE 500MG

TAB 105

sulfamethoxazole400mg/trimethoprim 80mgtab 17

sulfamethoxazole40mg/ml/trimethoprim8mg/ml susp 17

sulfamethoxazole800mg/trimethoprim160mg tab 17

SULFAMYLON 85MG/GM

CREAM 76

sulfasalazine 500mg dr tab 85

sulfasalazine 500mg tab 85



sumatriptan 100mg tab 91

sumatriptan 12mg/mlauto-injector 91

sumatriptan 12mg/ml inj 91

SUMATRIPTAN 12MG/ML

SYRINGE 91

sumatriptan 20mg/act nasalspray 91


sumatriptan 4mg cartridge 91


sumatriptan 5mg/act nasalspray 91

sumatriptan 6mg cartridge 91

sumatriptan 8mg/mlauto-injector 91

SUNOSI 150MG TAB 8

SUNOSI 75MG TAB 8

SUPRAX 400MG CAP 68

SUTENT 12.5MG CAP 50

SUTENT 25MG CAP 50

SUTENT 37.5MG CAP 50

SUTENT 50MG CAP 50

syeda 28 day pack 71

SYMDEKO 50-75MG/75MG

PACK 105

SYMDEKO TAB 4-WEEK

PACK 105

SYMFI 600-300-300MG TAB60




SYMFI LO 400-300-300MG

TAB 60

SYMJEPI 0.15MG/0.3ML

SYRINGE 111

SYMJEPI 0.3MG/0.3ML

SYRINGE 111

SYMPAZAN 10MG STRIP 25



SYMPROIC 0.2MG TAB 85

SYMTUZA

800-150-200-10MG TAB 60

SYNAREL 2MG/ML

NASAL SPRAY 81

SYNJARDY 12.5-1000MG

TAB 33

SYNJARDY 12.5-500MG

TAB 33

SYNJARDY 5-1000MG TAB 33

SYNJARDY 5-500MG TAB 33

SYNJARDY XR 10-1000MG

TAB 33

SYNJARDY XR

12.5-1000MG TAB 33


TAB 33


TAB 33

SYNRIBO 3.5MG INJ 51

SYNTHROID 100MCG

TAB 107

SYNTHROID 112MCG

TAB 107

SYNTHROID 125MCG

TAB 107

SYNTHROID 137MCG

TAB 107

SYNTHROID 150MCG

TAB 107

SYNTHROID 175MCG

TAB 107

SYNTHROID 200MCG

TAB 107


SYNTHROID 300MCG

TAB 107




T

TABLOID 40MG TAB 45

TABRECTA 150MG TAB 50

TABRECTA 200MG TAB 50

tacrolimus 0.03% ointment 78

tacrolimus 0.1% ointment 78

tacrolimus 0.5mg cap 62

tacrolimus 1mg cap 62

tacrolimus 5mg cap 62

tadalafil 20mg tab(PAH) 66

TAFINLAR 50MG CAP 50

TAFINLAR 75MG CAP 50

TAGRISSO 40MG TAB 50

TAGRISSO 80MG TAB 50

TAKHZYRO 300MG/2ML

INJ 87

TALZENNA 0.25MG CAP 50

TALZENNA 1MG CAP 50



tamsulosin 0.4mg cap 86

TARGRETIN 1% GEL 75

tarina 24 fe 1/20 28 day pack 71

tarina fe 1/20 28 day pack 71

TASIGNA 150MG CAP 50

TASIGNA 200MG CAP 50

TASIGNA 50MG CAP 50

TAVALISSE 100MG TAB 87

TAVALISSE 150MG TAB 87

tazarotene 1% cream 75

tazicef 1gm inj 68

tazicef 2gm inj 68

tazicef 6gm inj 68

TAZORAC 0.05% CREAM 76

TAZORAC 0.05% GEL 76

TAZORAC 0.1% GEL 76






TAZVERIK 200MG TAB 50

TDVAX 4-4UNIT/ML INJ 108

TECFIDERA 120MG DR

CAP 104

TECFIDERA 240MG DR

CAP 104

TECFIDERA 30-DAY

STARTER PACK 104

TEFLARO 400MG INJ 68

TEFLARO 600MG INJ 68

TEGSEDI 189MG/ML

SYRINGE 104








TENIVAC SYRINGE 108

tenofovir disoproxil fumarate300mg tab 60





terbinafine 250mg tab 37

terbutaline sulfate 2.5mg tab 23

terbutaline sulfate 5mg tab 23

terconazole 0.4% vaginalcream 111

TERCONAZOLE 0.8%

VAGINAL CREAM 111

terconazole 80mg vaginalsupp 111

testosterone 1.62% (1.25gm)gel 16

testosterone 1.62% (2.5gm)gel 16

testosterone 1.62% gel pump 16

testosterone 1% (25mg) gel 16




testosterone 1% (50mg) gel 16

TESTOSTERONE 1% GEL

PUMP 16

testosterone cypionate (1ml)200mg/ml inj 16

testosterone cypionate100mg/ml inj 16

testosterone cypionate200mg/ml inj 16

testosterone enanthate200mg/ml inj 16

tetrabenazine 12.5mg tab 103

tetrabenazine 25mg tab 103



THALOMID 100MG CAP 93






theophylline 5.33mg/ml oralsoln 23



THIOLA 100MG TAB 86




















TIBSOVO 250MG TAB 50

TIGECYCLINE 50MG INJ 105

TIMOLOL 0.25% OPHTH

GEL 96


TIMOLOL 0.5% OPHTH

GEL 96


timolol 10mg tab 63

TIMOLOL 20MG TAB 63

timolol 5mg/ml ophth 24hrophth soln 96

timolol 5mg tab 63

TIMOPTIC-XE 0.25%

OPHTH GEL 96

TIMOPTIC-XE 0.5%

OPHTH GEL 97



TIVICAY 10MG TAB 60

TIVICAY 25MG TAB 60

TIVICAY 50MG TAB 60

TIVICAY 5MG TAB FOR

ORAL SUSP 60






TOBI PODHALER KIT

28MG PACK 10

TOBRADEX 0.3-0.1%

OPHTH OINTMENT 98

tobramycin 0.3% ophth soln 97

TOBRAMYCIN 10MG/ML

INJ 10

tobramycin 40mg/ml inj 10

tobramycin 60mg/ml inh soln 10

TOLAK 4% CREAM 75

tolcapone 100mg tab 53


tolterodine tartrate 2mg ercap 109


tolterodine tartrate 4mg ercap 109

TOPIRAMATE 100MG ER

CAP 27


TOPIRAMATE 150MG ER

CAP 27


TOPIRAMATE 200MG ER

CAP 27



TOPIRAMATE 25MG ER

CAP 27


TOPIRAMATE 50MG ER

CAP 27


toremifene 60mg tab 47





TOUJEO 300UNIT/ML PEN

INJ 35

TOUJEO MAX

300UNIT/ML PEN INJ

(3ML) 35

tovet 0.05% e foam 77

TPN ELECTROLYTES INJ 92

TRACLEER 32MG TAB

FOR ORAL SUSP 66

TRADJENTA 5MG TAB 34

tramadol 100mg er tab 14

tramadol 100mg er tab(matrix delivery) 14





tramadol 50mg tab 14




TRANDOLAPRIL

1MG/VERAPAMIL

240MG ER TAB 44


trandolapril 2mg/verapamil180mg er tab 44





tranexamic acid 650mg tab 89

TRANSDERM SCOP

1MG/3DAYS PATCH 37

tranylcypromine 10mg tab 29

TRAVASOL 10% INJ 96

TRAVATAN Z 0.004%

OPHTH SOLN 99

travoprost 0.004% ophth soln 99





TRECATOR 250MG TAB 45

TRELEGY 62.5-25MCG

ELLIPTA INH 23




TRESIBA 100UNIT/ML

FLEXTOUCH PEN INJ 35

TRESIBA 100UNIT/ML INJ

(VIAL) 35

TRESIBA 200UNIT/ML

FLEXTOUCH PEN INJ 35

tretinoin 0.01% gel 74

tretinoin 0.025% cream 74







tretinoin 10mg cap 51

TREXALL 10MG TAB 45

TREXALL 15MG TAB 45

TREXALL 5MG TAB 45

TREXALL 7.5MG TAB 45

triamcinolone acetonide0.025% cream 77

triamcinolone acetonide0.025% lotion 77

triamcinolone acetonide0.025% ointment 77

triamcinolone acetonide 0.1%cream 77

triamcinolone acetonide 0.1%lotion 77

triamcinolone acetonide 0.1%ointment 77

triamcinolone acetonide 0.1%paste 94

triamcinolone acetonide0.147mg/ml spray 77

triamcinolone acetonide 0.5%cream 77

triamcinolone acetonide 0.5%ointment 77





triderm 0.1% cream 77

trientine 250mg tab 93

tri-estarylla 28 day pack 71





TRIFLURIDINE 1% SOLN 97

trihexyphenidyl 0.4mg/mloral soln 53



TRIJARDY 10-5-1000MG

ER TAB 33

TRIJARDY

12.5-2.5-1000MG ER TAB 33

TRIJARDY 25-5-1000MG

ER TAB 33

TRIJARDY 5-2.5-1000MG

ER TAB 33

TRIKAFTA

100-50-75MG/150MG

PACK 105

tri-legest 28 day pack 71

tri-lo-estarylla 28 day pack 71

tri-lo-sprintec 28 day pack 71

trilyte powder for oral soln 90

trimethobenzamide 300mgcap 37

trimethoprim 100mg tab 17

tri-mili 28 day pack 71

trimipramine 100mg cap 32



TRINTELLIX 10MG TAB 31



tri-previfem 28 day pack 71

tri-sprintec 28 day pack 71

TRIUMEQ 600-50-300MG

TAB 60

trivora 28 day pack 71

tri-vylibra 28 day pack 71

tri-vylibra lo 28 day pack 71

TROKENDI 100MG XR CAP27

TROKENDI 200MG XR CAP28

TROKENDI 25MG XR CAP 28

TROKENDI 50MG XR CAP 28

TROPHAMINE 10% INJ 96

trospium chloride 20mg tab 109

trospium chloride 60mg ercap 110

TRULICITY 0.75MG/0.5ML

AUTO-INJECTOR 34

TRULICITY 1.5MG/0.5ML

AUTO-INJECTOR 34

TRUMENBA SYRINGE 110








TUKYSA 150MG TAB 50

TUKYSA 50MG TAB 50

TURALIO 200MG CAP 50

TWINRIX 720UNIT

SYRINGE 111

TYBOST 150MG TAB 60

TYKERB 250MG TAB 50

TYMLOS 2MG/ML PEN

INJECTOR 80

TYPHIM VI 25MCG/0.5ML

INJ 110

TYPHIM VI 25MCG/0.5ML

SYRINGE 110

U

UCERIS 2MG/ACT FOAM 16

UDENYCA 6MG/0.6ML

SYRINGE 88












UPTRAVI 1000MCG TAB 66








UPTRAVI TITRATION

PACK 66


ursodiol 300mg cap 84


V



VALCHLOR 0.016% GEL 75

valganciclovir 450mg tab 60

valganciclovir 50mg/ml oralsoln 60

valproic acid 250mg cap 29

valproic acid 50mg/ml oralsoln 29





VALTOCO 10MG DOSE

KIT 10MG/0.1ML PACK 25

VALTOCO 15MG DOSE

KIT 7.5MG/0.1ML PACK 25

VALTOCO 20MG DOSE

KIT 10MG/0.1ML PACK 25

VALTOCO 5MG DOSE KIT

5MG/0.1ML PACK 25


vancomycin 125mg cap 17

vancomycin 250mg cap 17

VANCOMYCIN 250MG INJ 17


VANCOMYCIN 50MG/ML

ORAL SOLN 17


vancomycin 750mg inj 17

vandazole 0.75% vaginal gel 111

VAQTA 25UNIT/0.5ML

SYRINGE 111

VAQTA 50UNIT/0.5ML INJ 111

VAQTA 50UNIT/1ML INJ 111

VAQTA 50UNIT/ML

SYRINGE 111

VARIVAX 1350PFU/0.5ML

INJ 111

VARIZIG 124.8/1.2ML INJ 100

VARUBI 90MG TAB 37

VASCEPA 1GM CAP 38

VASCEPA 500MG CAP 38

velivet 28 day pack 71

VELTASSA 16.8GM

POWDER FOR ORAL

SUSP 94

VELTASSA 25.2GM

POWDER FOR ORAL

SUSP 94

VELTASSA 8.4GM

POWDER FOR ORAL

SUSP 94

VEMLIDY 25MG TAB 61

VENCLEXTA 10/100/50MG

STARTING PACK 46

VENCLEXTA 100MG TAB 46






venlafaxine 37.5mg er cap 31

venlafaxine 37.5mg tab 31




VENTAVIS 10MCG/ML INH

SOLN 66

VENTAVIS 20MCG/ML INH

SOLN 66

VENTOLIN 108MCG INH 23











VERAPAMIL 360MG SR

CAP 65






VERSACLOZ 50MG/ML

SUSP 56

VERZENIO 100MG TAB 50




VICTOZA 18MG/3ML PEN

INJ 34

vienva 28 day pack 71

vigabatrin 500mg tab 28

vigabatrin 50mg/ml oral soln 28

vigadrone 500mg oral soln 28

VIIBRYD 10/20MG

STARTER PACK 31

VIIBRYD 10MG TAB 31

VIIBRYD 20MG TAB 31

VIIBRYD 40MG TAB 31

VIMPAT 100MG TAB 28

VIMPAT 10MG/ML ORAL

SOLN 28

VIMPAT 150MG TAB 28

VIMPAT 200MG TAB 28

VIMPAT 50MG TAB 28



VIREAD 150MG TAB 60

VIREAD 200MG TAB 60

VIREAD 250MG TAB 60

VIREAD 40MG/GM ORAL

POWDER 60

VITRAKVI 100MG CAP 51

VITRAKVI 20MG/ML

ORAL SOLN 51

VITRAKVI 25MG CAP 51

VIVITROL 380MG INJ 36

VIZIMPRO 15MG TAB 51



voriconazole 200mg inj 38

voriconazole 200mg tab 38

voriconazole 40mg/ml susp 38

voriconazole 50mg tab 38

VOSEVI 400-100-100MG

TAB 61

VOTRIENT 200MG TAB 51

VRAYLAR 1.5/3MG MIXED

PACK 54

VRAYLAR 1.5MG CAP 54

VRAYLAR 3MG CAP 54

VRAYLAR 4.5MG CAP 54

VRAYLAR 6MG CAP 54

vyfemla 28 day pack 71

vylibra 28 day pack 71

VYNDAMAX 61MG CAP 67

W

WAKIX 17.8MG TAB 8

WAKIX 4.45MG TAB 8










wixela 100-50mcg inh 23



wymzya fe 28 day pack 71

X

XALKORI 200MG CAP 51

XALKORI 250MG CAP 51

XARELTO 10MG TAB 23

XARELTO 15MG TAB 23

XARELTO 2.5MG TAB 23

XARELTO 20MG TAB 23

XARELTO STARTER PACK 24

XATMEP 2.5MG/ML ORAL

SOLN 45

XCOPRI 100MG TAB 28

XCOPRI 12.5/25MG

TITRATION PACK 28

XCOPRI 150/200MG PACK

TAB 28

XCOPRI 150/200MG

TITRATION PACK 28

XCOPRI 150MG TAB 28

XCOPRI 200MG TAB 28

XCOPRI 50/100MG

TITRATION PACK 28

XCOPRI 50/200MG PACK

TAB 28

XCOPRI 50MG TAB 28

XELJANZ 10MG TAB 11

XELJANZ 5MG TAB 11

XENLETA 600MG TAB 18

XGEVA 120MG/1.7ML INJ 80

XIFAXAN 200MG TAB 17

XIFAXAN 550MG TAB 17

XIGDUO 10-1000MG XR

TAB 33

XIGDUO 10-500MG XR

TAB 33

XIGDUO 2.5-1000MG XR

TAB 33

XIGDUO 5-1000MG XR

TAB 33

XIGDUO 5-500MG XR TAB 33

XOFLUZA 20MG

THERAPY PACK 61

XOFLUZA 40MG

THERAPY PACK 61

XOLAIR 150MG/ML PF INJ 21

XOLAIR 150MG INJ 21

XOLAIR 75MG/0.5ML PF

INJ 21

XOSPATA 40MG TAB 51

XPOVIO 100MG ONCE

WEEKLY PACK 47

XPOVIO 40MG ONCE

WEEKLY PACK 47

XPOVIO 40MG TWICE

WEEKLY PACK 47

XPOVIO 60MG ONCE

WEEKLY PACK 47

XPOVIO 60MG TWICE

WEEKLY PACK 47




XPOVIO 80MG ONCE

WEEKLY PACK 47

XPOVIO 80MG TWICE

WEEKLY PACK 47

XTAMPZA 13.5MG ER CAP 14

XTAMPZA 18MG ER CAP 14




XTANDI 40MG CAP 47

XULANE 150-35MCG

PATCH 71

XULTOPHY

100UNIT-3.6MG/ML PEN

INJ 33

XYREM 500MG/ML ORAL

SOLN 102

Y

YF-VAX 4000UNIT/ML INJ111

Z



zaleplon 10mg cap 89

zaleplon 5mg cap 89

zarah 3-0.03mg pack 71

ZARXIO 300MCG/0.5ML

SYRINGE 88

ZARXIO 480MCG/0.8ML

SYRINGE 88

ZEJULA 100MG CAP 51

ZELBORAF 240MG TAB 51

ZEMAIRA 1000MG INJ 104

zenatane 10mg cap 74




ZENPEP

10000-32000-42000UNIT

DR CAP 79

ZENPEP

15000-47000-63000UNIT

DR CAP 79

ZENPEP

20000-63000-84000UNIT

DR CAP 79

ZENPEP

25000-79000-105000UNIT

DR CAP 79

ZENPEP

3000-10000-14000UNIT

DR CAP 79

ZENPEP

40000-126000-168000UNIT

DR CAP 79

ZENPEP

5000-17000-24000UNIT

DR CAP 79

ZERBAXA 1.5GM INJ 67

zidovudine 100mg cap 60

zidovudine 10mg/ml oral soln 60

zidovudine 300mg tab 60

ZIEXTENZO 6MG/0.6ML

SYRINGE 88


ziprasidone 20mg inj 54




ZIRGAN 0.15% OPHTH

GEL 97

ZOLINZA 100MG CAP 51

zolmitriptan 2.5mg odt 91

zolmitriptan 2.5mg tab 91

zolmitriptan 5mg odt 91

zolmitriptan 5mg tab 91

zolpidem tartrate 10mg tab 89

zolpidem tartrate 5mg tab 89

ZOMIG 2.5MG NASAL

SPRAY 91

ZOMIG 5MG NASAL

SPRAY 91




ZORTRESS 0.25MG TAB 94



ZORTRESS 1MG TAB 94

ZOSYN 40-5MG/ML INJ 101

ZOSYN 60-7.5MG/ML INJ 101

zovia 1/35e 28 day pack 71

ZUBSOLV 1.4-0.36MG SL

TAB 15


TAB 15


TAB 15


TAB 15


TAB 15

ZYCLARA 2.5% CREAM 78

ZYDELIG 100MG TAB 51

ZYDELIG 150MG TAB 51

ZYKADIA 150MG TAB 51

ZYLET 0.5-0.3% OPHTH

SUSP 98

ZYPREXA 210MG INJ 56

DATA CONTAINED IN THIS DOCUMENT IS CONSIDERED CONFIDENTIAL AND PROPRIETARY INFORMATION AND ITS DUPLICATION USE OR DISCLOSURE IS PROHIBITED WITHOUT PRIOR APPROVAL OF SIMPRA ADVANTAGE © 2019 Simpra Advantage H4091_2020NDN_C

Non-Discrimination Notice

Simpra Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Simpra Advantage does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Simpra Advantage:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters • Written information in other formats (e.g., large print, audio, accessible electronic formats,

Braille, other formats)

Provides free language services to people whose primary language is not English, such as:

• Qualified interpreters • Information written in other languages

If you need these services, contact Simpra Advantage Member Services at the contact information below.

If you believe that Simpra Advantage has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Simpra Advantage, P.O. Box 2190, Glen Allen, VA 23058; (844) 317-9059; (TTY 711); fax: 800-335-0270; email: [email protected].

You can file a grievance in person or by mail, fax, or e-mail. If you need help filing a grievance, the Simpra Advantage Member Services is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services at the Office for Civil Rights Complaint Portal, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building Washington, DC 20201, 1-800-368-1019 TTY/TDD: 1-800-537-7637 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

mailto:[email protected]

mailto:[email protected]

http://www.hhs.gov/ocr/office/file/index.html

http://www.hhs.gov/ocr/office/file/index.html

H4091_2020MLIAL_C

Multi-Language Interpreter Services

Arabic )رقم هاتف الصم 4770-637-844-1 ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم

(.711والبكم:

Chinese

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-844-637-4770（TTY：711）。

French ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.

Appelez le 1-844-637-4770 (ATS : 711).

German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur

Verfügung. Rufnummer: 1-844-637-4770 (TTY: 711).

Gujarati

જો તમે [ગજુરાતી] બોલો છો, તો ભાષા સહાય સેવાઓ તમારા માટે મફતઉપલબ્ધ છે. 1-844-637-

4770 ને કૉલ કરો (ટી.ટી.વાય: 711).

Hindi

ध्यान दें: यदद आप ह िंदी बोलते हैं तो आपके ललए मफु्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-844-637-4770

(TTY: 711) पर कॉल करें।

Japanese

注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-844-637-4770

（TTY:711）まで、お電話にてご連絡ください。

Korean

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-844-637-4770

(TTY: 711) 번으로 전화해 주십시오.

Laotian

ໝາຍເຫດ: ຖ້າທ່ານເວ ້ າ [ພາສາລາວ], ຈະມີ ການບໍ ລິ ການຊ່ວຍເຫ ຼື ອທາງດ້ານພາສາໂດຍບໍ່ ມີ ຄ່າໃຊ້ຈ່າຍໃດໆ

ສໍ າລັບທ່ານ. ຈ ່ ງໂທຫາເບີ 1-844-637-4770 (TTY: 711).

Portuguese ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-844-637-

4770 (TTY: 711).

Russian ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.

Звоните 1-844-637-4770 (телетайп: 711).

H4091_2020MLIAL_C

Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-

844-637-4770 (TTY: 711).

Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang

walang bayad. Tumawag sa 1-844-637-4770 (TTY: 711).

Turkish DİKKAT: Eğer Türkçe konuşuyor iseniz, dil yardımı hizmetlerinden ücretsiz olarak yararlanabilirsiniz. 1-844-

637-4770 (TTY: 711) irtibat numaralarını arayın.

Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-844-637-

4770 (TTY: 711)

May 2019

H4091_2020Form_C 8


Simpra is a PPO with a Medicare contract. Enrollment in Simpra depends on contract renewal.

This formulary was updated on 10/01/2020. For more recent information or other questions, please contact

Simpra Advantage (PPO D-SNP) Member Services at 844-637-4770 or, for TTY users, 711, Hours of

Operation: 8a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1

through March 31 and Monday to Friday (except holidays) from April 1 through September 30, or visit

Simpra.com.

Documents

Simpra Advantage (PPO I-SNP) 2020 Formulary List of ...simpra.com/.../uploads/documents/SIMPRA_Drug-List-Formulary_ISN… · SNP) network pharmacy, and other plan rules are followed