Your 2021 Prescription Drug List - University of Arizona

Your 2021 Prescription Drug List

Advantage 3-Tier

This Prescription Drug List (PDL) is accurate as of Jan. 1, 2021 and is subject to change after this date. This PDL applies to members of our UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers, Level 2 and Oxford medical plans with a pharmacy benefit subject to the Advantage 3-Tier PDL. Your estimated coverage and copayment/coinsurance may vary based on the benefit plan you choose and the effective date of the plan.

Effective Jan. 1, 2021

Pharmacy | PDL

Understanding your Prescription Drug List (PDL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Medication tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Reading your PDL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Analgesics

Drugs for Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Drugs for Pain and Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Anti-Addiction / Substance Abuse Treatment Agents . . . . . . . . . . . . . . . . . . . . . . . . . 9Antibacterials

Drugs for Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Anticoagulants

Drugs to Treat or Prevent Blood Clots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Anticonvulsants

Drugs for Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Antidementia Agents

Drugs for Alzheimer’s Disease and Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Antidepressants

Drugs for Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Antiemetics

Drugs for Nausea and Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Antifungals

Drugs for Fungal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Antigout Agents

Drugs for Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Antimigraine Agents

Drugs for Migraines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Antineoplastics

Drugs for Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antiparasitics

Drugs for Parasitic Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antiparkinson Agents

Drugs for Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antiplatelets

Drugs for Heart Attack and Stroke Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antipsychotics

Drugs for Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antivirals

Drugs for Viral Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Anxiolytics

Drugs for Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Bipolar Agents

Drugs for Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Cardiovascular Agents

Drugs for Heart and Circulation Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Central Nervous System Agents

Drugs for Attention Deficit Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Drugs for Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Dental and Oral Agents Drugs for Mouth and Throat Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Table of contents

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Dermatological Agents Drugs for Skin Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Diabetes Glucose Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Non-Insulin Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Drugs for Blood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Drugs for Sexual Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Electrolytes / Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Gastrointestinal Agents Drugs for Acid Reflux and Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Drugs for Bowel, Intestine and Stomach Conditions . . . . . . . . . . . . . . . . . . . . . . . 23

Genetic or Enzyme Disorder Drugs for Replacement, Modification, Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 23

Genitourinary Agents Drugs for Bladder, Genital and Kidney Conditions. . . . . . . . . . . . . . . . . . . . . . . . . 23 Drugs for Prostate Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Hormonal Agents Hormone Replacement and Birth Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Oral Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Testosterone Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Immunological Agents Drugs for Immune System Stimulation or Suppression . . . . . . . . . . . . . . . . . . . . . 27

Infertility Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Inflammatory Bowel Disease Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Metabolic Bone Disease Agents Drugs for Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Ophthalmic Agents Drugs for Eye Allergy, Infection and Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . 28 Drugs for Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Drugs for Miscellaneous Eye Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Otic Agents Drugs for Ear Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Respiratory Drugs for Anaphylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Respiratory Tract / Pulmonary Agents Drugs for Allergies, Cough, Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Drugs for Asthma and COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Drugs for Cystic Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Drugs for Pulmonary Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Skeletal Muscle Relaxants Drugs for Muscle Pain and Spasm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Sleep Disorder Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

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4

Understanding your Prescription Drug List (PDL)

What is a PDL?This document is a list of the most commonly prescribed medications. It includes both brand-name and generic prescription medications approved by the Food and Drug Administration (FDA). Medications are listed by common categories or classes and placed in tiers that represent the cost you pay out-of-pocket. They are then listed in alphabetical order.

How do I use my PDL?You and your doctor can consult the PDL to help you select the most cost-effective prescription medications. This guide tells you if a medication is generic or a brand name, and if there are coverage requirements or limits. Bring this list with you when you see your doctor. If your medication is not listed here, please visit your plan’s member website or call the toll-free member phone number on your health plan ID card.

What are tiers?Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, set by your employer or benefit plan. This is how much you will pay when you fill a prescription. See page 6 for more information.

When does the PDL change?PDL changes typically occur 2-3 times per year. However, changes that have a positive impact for you — such as coverage for new medications or cost savings — may occur at any time. You can log in to the member website listed on your ID card at any time to check your medication coverage and lower-cost options.

Why are some medications excluded from coverage?We review medications based on their total value, including effectiveness and safety, how much they cost, and the availability of alternative medications to treat the same or similar medical conditions. Certain medications may be excluded from coverage or be subject to prior authorization (sometimes referred to as precertification)1 if similar alternatives are available at a lower cost. Examples include medications that work the same way, but one is much more expensive than the other, or options that are available without a prescription (also referred to as over-the-counter medications2). There are also some instances where the same product can be made by two or more manufacturers, but greatly vary in cost. In these instances, only the lower-cost product may be covered.

You should review your benefit plan documents to confirm if any medications are excluded from your plan. You can log in to the member website listed on your ID card at any time to check your medication coverage. Talk to your doctor to see if there are lower-cost options or over-the-counter medications available.

Who decides which medications are covered?Thousands of medications are already available and more come to the market regularly. Often, several medications are available to treat the same condition. The UnitedHealthcare® Pharmacy and Therapeutics Committee, which includes both internal and external doctors and pharmacists, meets regularly to provide clinical reviews of all medications. Using this information, the PDL Management Committee, which includes senior UnitedHealth Group® doctors and business leaders, meets to evaluate overall health care value. They also set coverage and tier status for all medications.

About this PDLWhere differences exist between this PDL and your benefit plan documents, the benefit plan documents rule. This PDL is not a complete list of medications, and not all medications listed may be covered by your plan. Please look at the benefit plan documents provided by your employer or health plan to see which medications are covered under your plan.

5

Medication tips

What is the difference between brand-name and generic medications?Generic medications contain the same active ingredients (what makes the medication work) as brand-name medications, but they often cost less. Once the patent for a brand-name medication ends, the FDA can approve a generic version with the same active ingredients. These types of medications are known as generic medications. Sometimes, the same company that makes a brand-name medication also makes the generic version.

What if my doctor writes a brand-name prescription?If your doctor gives you a prescription for a brand-name medication, ask if a generic equivalent or lower-cost option is available and could be right for you. Generic medications are usually your lowest-cost option, but not always. For some benefit plans, if a brand-name drug is prescribed and a generic equal is available, your cost-share may be the copayment PLUS the cost difference between the brand-name drug and the generic equivalent.

What if I am taking a specialty medication?Specialty medications are high-cost and are used to treat rare or complex conditions that require additional care and support. For most plans, these medications are managed through the specialty pharmacy program. Take advantage of personalized support designed to help you get the most out of your treatment plan. Visit the member website listed on your ID card or call the toll-free phone number on your ID card to learn more.

Please note, not all specialty medications are listed here. If you’re taking a specialty medication that is on a higher tier, call the toll-free phone number on your ID card to talk with a pharmacist about finding lower-cost options.

1. Depending on your benefit, you may have notification or medical necessity requirements for select medications.

2. For New York and New Jersey plans, a prescription drug product that is therapeutically equal to an over-the-counter drug may be covered if it is determined to be medically necessary.

Over-the-counter (OTC) medicationsAn OTC medication may be the right treatment option for some conditions. Talk to your doctor about available OTC options. Even though these medications may not be covered by your pharmacy benefit, they may cost less than a prescription medication.

6

Reading your PDLThe PDL gives you choices so you and your doctor can decide your best course of treatment. In this PDL, brand-name medications are shown in UPPERCASE and generic medications in lowercase.

Tier informationUsing lower-tier medications can help you pay your lowest out-of-pocket cost. Your plan may have multiple or no tiers. Please note: If you have a high deductible plan, the tier cost levels may apply once you hit your deductible.

In the chart below, overall value indicates medications’ effectiveness and safety, cost, and the availability of alternative medications to treat the same or similar medical condition(s).

Drug Tier Includes Helpful Tips

Tier 1 $ Lower-cost Medications that provide the highest overall value. Mostly generic drugs. Some brand-name drugs may also be included.

Use Tier 1 drugs for the lowest out-of-pocket costs.

Tier 2 $$ Mid-range cost Medications that provide good overall value. A mix of brand name and generic drugs.

Use Tier 2 drugs, instead of Tier 3, to help reduce your out-of-pocket costs.

Tier 3 $$$ Highest-cost Medications that provide the lowest overall value. Mostly brand-name drugs, as well as some generics.

Ask your doctor if a Tier 1 or Tier 2 option could work for you.

Drug list informationIn this drug list, some medications are noted with letters next to them to help you see which ones may have coverage requirements or limits. Your benefit plan sets how these medications may be covered for you.

E May be excluded from coverage or subject to Prior Authorization in Connecticut, New Jersey and New York. (Referred to as First Start in New Jersey) — Lower-cost options are available and covered.

H Health Care Reform Preventive — This medication is part of a health care reform preventive benefit and may be available at no additional cost to you.

H-PA Health Care Reform Preventive with Prior Authorization — May be part of health care reform preventive and available at no additional cost to you if prior authorization criteria is met.

PA Prior Authorization (sometimes referred to as precertification)3 — Requires your doctor to provide information about why you are taking a medication to determine how it may be covered by your plan.

QL Quantity Limits — Specifies the largest quantity of medication covered per copayment or in a defined period of time.

RS Refill and Save Program4 — Save money on your copayment when you refill your prescription on time as prescribed. Program eligibility may vary.

SP Specialty Medication — Specialty medications treat complex or rare conditions and may require special storage and handling. You may be required to obtain these medications from a specialty pharmacy.

ST Step Therapy (referred to as First Start in New Jersey) — Requires prior authorization and may require you to try one or more other medications before the medication you are requesting may be covered.

3. Depending on your benefit, you may have notification or medical necessity requirements for select medications.

4. Not applicable to Neighborhood Health Plan and Oxford plans.

7

Reading your PDL (continued)

Coverage detailsSome drug classes in this PDL have additional/important coverage details. Review this list to see if drug classes that apply to you are noted.

• Diabetes: blood glucose monitoring; insulin; non-insulin Diabetic supplies and prescription medications may be subject to different cost-share arrangements for Oxford plans. Please see your Summary of Benefits and Coverage (SBC) for specifics. Medications that require step therapy may require prior authorization (sometimes referred to as precertification) if covered under another benefit.

• Diabetes: continuous glucose monitors, sensors Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share. Diabetic self-management items, including continuous glucose monitors, may be covered under the consumer pharmacy and/or medical plan depending on the benefit.

• Endocrine: growth hormone Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share.

• Infertility Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share. Prior authorization (sometimes referred to as precertification) may be required for Oxford plans or where a state mandates infertility drug coverage. This is not a covered benefit for Neighborhood Health Plan.

• Medications for sexual dysfunction Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share.

And, if home delivery services are included in your pharmacy benefit, you can also:

• Refill prescriptions

• Check the status of your order

• Set up reminders for refills

• Manage your account

For the most current list of covered medications or if you have questions:

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

Visit your plan’s member website listed on your ID card to:

• View your pharmacy benefit and coverage information, including prescription history

• View medication interactions and side effects

• Locate a participating retail pharmacy by ZIP code

• Look up possible lower-cost medication alternatives

• Compare medication pricing and options

Questions

See page 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY.

8

Drug Name Drug Tier

Requirements& Limits

Analgesics - Drugs for Paing acetaminophen-codeine 1g acetaminophen-codeine #2 1g acetaminophen-codeine #3 1g acetaminophen-codeine #4 1g apap-caff-dihydrocodeine oral

capsule3 QL

B ARYMO ER E PA, ST, QLB BELBUCA 3 PA, QLg butalbital-apap-caffeine oral capsule

50-300-40 mg3 QL

g butalbital-apap-caffeine oral capsule 50-325-40 mg

1 QL

g butalbital-apap-caffeine oral tablet 1 QLB CONZIP E QLB DILAUDID ORAL 3B DVORAH E QLg endocet 1B ESGIC 3 QLg fentanyl transdermal patch 72 hour

100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr

2 PA, QL

g fentanyl transdermal patch 72 hour 37.5 mcg/hr, 62.5 mcg/hr, 87.5 mcg/hr

E PA, ST, QL

B FIORICET 3 QLg hydrocodone-acetaminophen oral

solution 10-325 mg/15ml1

g hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml

2

g hydrocodone-acetaminophen oral tablet 10-300 mg, 5-300 mg, 7.5-300 mg

E

g hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg

1

g hydromorphone hcl er 3 PA, ST, QLg hydromorphone hcl oral 1g hydromorphone hcl rectal 1B HYSINGLA ER E PA, ST, QLB KADIAN ORAL CAPSULE

EXTENDED RELEASE 24 HOUR 200 MG

E PA, ST, QL

g lidocaine external ointment 2 QL

Drug Name Drug Tier


g lidocaine external patch 5 % 3 PA, QLg lidocaine-prilocaine external cream 1g lorcet 1g lorcet hd 1g lorcet plus 1B LORTAB 3B MORPHABOND ER E PA, ST, QLg morphine sulfate (concentrate) oral

solution 100 mg/5ml, 20 mg/ml1

g morphine sulfate er oral capsule extended release 24 hour

E PA, ST, QL

g morphine sulfate er oral tablet extended release

1 PA, QL

g morphine sulfate oral 1g morphine sulfate rectal 1B MS CONTIN 3 PA, ST, QLB NALOCET E QLB NORCO 3B NUCYNTA 3 QLB NUCYNTA ER 3 PA, QLB OXAYDO E QLB OXYCODONE HCL ER E PA, ST, QLg oxycodone hcl oral capsule 1g oxycodone hcl oral concentrate

100 mg/5ml1

g oxycodone hcl oral solution 1g oxycodone hcl oral tablet 1g oxycodone-acetaminophen oral

tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1

B OXYCONTIN E PA, ST, QLg premium lidocaine 2 QLB PRIMLEV EB ROXICODONE ORAL TABLET

15 MG, 30 MG3

B ROXICODONE ORAL TABLET 5 MG 3B SUBSYS E PA, QLg tramadol hcl er (biphasic) E QLB TRAMADOL HCL ER ORAL

CAPSULE EXTENDED RELEASE 24 HOUR 100 MG, 200 MG, 300 MG

E QL

g tramadol hcl er oral capsule extended release 24 hour 150 mg

1 QL


9

Drug Name Drug Tier


g tramadol hcl er oral tablet extended release 24 hour

2 QL

g tramadol hcl oral tablet 50 mg 1B TREZIX 3 QLB TYLENOL WITH CODEINE #3 3B ULTRAM 3B VANATOL LQ 2 PA, QLB VANATOL S 2 PA, QLg vicodin hp oral tablet 10-300 mg EB XTAMPZA ER 2 PA, QLB ZEBUTAL 3 QLB ZTLIDO E PA, QL

Analgesics - Drugs for Pain and Inflammationg celecoxib oral 2 QLg diclofenac potassium 1g diclofenac sodium er 1g diclofenac sodium oral 1g diclofenac sodium transdermal

gel 1 %E QL

g diclofenac sodium transdermal solution

E

B EC-NAPROSYN 3g ec-naproxen 1g etodolac 1g etodolac er 1g ibu 1g ibuprofen oral suspension Eg ibuprofen oral tablet 400 mg,

600 mg, 800 mg1

B INDOCIN 3g indomethacin er 1g indomethacin oral capsule 25 mg,

50 mg1

g ketorolac tromethamine oral 1g meloxicam oral 1B MOBIC 3g nabumetone oral 1B NAPRELAN ORAL TABLET


E

B NAPROSYN ORAL SUSPENSION 3 PAg naproxen dr 1g naproxen oral suspension 1 PA

Drug Name Drug Tier


g naproxen oral tablet 1g naproxen sodium er Eg naproxen sodium oral tablet

275 mg, 550 mg1

B PENNSAID EB QMIIZ ODT EB RELAFEN DS EB SPRIX 3 ST, QLB VIVLODEX E QLB ZIPSOR E

Anti-Addiction / Substance Abuse Treatment AgentsB BUNAVAIL E PA, QLg buprenorphine hcl sublingual 1 QLg buprenorphine hcl-naloxone hcl 2 QLB CHANTIX 3 PA, HB EVZIO E PA, QLg naloxone hcl injection solution 1g naloxone hcl injection solution

cartridge1

g naloxone hcl injection solution prefilled syringe

1

g naltrexone hcl oral 1B NARCAN 2 QLB ZUBSOLV 2 QL

Antibacterials - Drugs for Infectionsg amoxicillin 1g amoxicillin-potassium clavulanate er Eg amoxicillin-potassium clavulanate

oral1

B AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

E

g avidoxy 1g azithromycin oral 1B BACTRIM 3B BACTRIM DS 3g cefadroxil 1g cefdinir 1g cefuroxime axetil 1B CENTANY 3 QLB CENTANY AT Eg cephalexin 1B CIPRO ORAL TABLET 3


10

Drug Name Drug Tier


g ciprofloxacin hcl oral 1g clarithromycin er 2g clarithromycin oral suspension

reconstituted2

g clarithromycin oral tablet 1B CLEOCIN ORAL CAPSULE 150 MG,

300 MG3

B CLEOCIN ORAL CAPSULE 75 MG 2g clindamycin hcl oral 1B CLINDESSE 2g coremino E PAB DIFICID 3 QLB DORYX MPC Eg doxycycline hyclate oral capsule 2g doxycycline hyclate oral tablet

100 mg2

g doxycycline hyclate oral tablet 150 mg, 50 mg, 75 mg

E

g doxycycline hyclate oral tablet 20 mg

1

g doxycycline hyclate oral tablet delayed release

E

g doxycycline monohydrate oral capsule 100 mg, 50 mg

1

g doxycycline monohydrate oral capsule 150 mg, 75 mg

E

g doxycycline monohydrate oral suspension reconstituted

3

g doxycycline monohydrate oral tablet 1B FLAGYL 3B KEFLEX 3B LEVAQUIN ORAL TABLET 500 MG,

750 MG3

g levofloxacin oral 1B MACROBID 3B MACRODANTIN 3g metronidazole oral 1g metronidazole vaginal 2g minocycline hcl er oral tablet

extended release 24 hour 105 mg, 115 mg, 55 mg, 65 mg, 80 mg

E PA

g minocycline hcl er oral tablet extended release 24 hour 135 mg, 45 mg, 90 mg

E PA

Drug Name Drug Tier


g minocycline hcl oral capsule 1g minocycline hcl oral tablet EB MINOLIRA E PAg mondoxyne nl oral capsule 100 mg 1g mondoxyne nl oral capsule 75 mg Eg morgidox oral 2g mupirocin calcium 3 QLg mupirocin external 1 QLg nitrofurantoin macrocrystal oral 1g nitrofurantoin monohydrate

macrocrystals1

B NUVESSA Eg okebo Eg penicillin v potassium 1g sulfamethoxazole-trimethoprim oral 1g sulfatrim pediatric 1g vandazole 2B VIBRAMYCIN ORAL CAPSULE 3B VIBRAMYCIN ORAL SUSPENSION

RECONSTITUTED3

B XEPI 3 QLB XIMINO E PAB ZITHROMAX ORAL 3B ZITHROMAX TRI-PAK 3B ZITHROMAX Z-PAK 3

Anticoagulants - Drugs to Treat or Prevent Blood ClotsB BEVYXXA 3 QLB COUMADIN 3B ELIQUIS 2 QLg enoxaparin sodium 2 QLg jantoven 1B PRADAXA 2 QLg warfarin sodium oral 1B XARELTO 2 QL

Anticonvulsants - Drugs for Seizuresg carbamazepine er oral capsule

extended release 12 hour2

g carbamazepine er oral tablet extended release 12 hour

3

g carbamazepine oral 1B CARBATROL 3B DEPAKOTE 3 PA


11

Drug Name Drug Tier


B DEPAKOTE ER 3 PA, STB DEPAKOTE SPRINKLES 3 PA, STg divalproex sodium er 2g divalproex sodium oral capsule

delayed release sprinkle2

g divalproex sodium oral tablet delayed release

1

g epitol 1g gabapentin oral 1B KEPPRA ORAL 3 PA, STB KEPPRA XR 3 PA, STB LAMICTAL 3 PA, STB LAMICTAL ODT ORAL KIT 3 PA, STB LAMICTAL ODT ORAL TABLET

DISPERSIBLE3 PA, ST

B LAMICTAL STARTER 3 PA, STB LAMICTAL XR 3 PA, STg lamotrigine er 3 PA, STg lamotrigine oral tablet 1g lamotrigine oral tablet chewable 1g lamotrigine oral tablet dispersible 3 PA, STg lamotrigine starter kit-blue 1g lamotrigine starter kit-green 1g lamotrigine starter kit-orange 1g levetiracetam er 2g levetiracetam oral 1B NAYZILAM SPRAY 5 MG 3 PA, QLB NEURONTIN 3 PA, STg oxcarbazepine 1B OXTELLAR XR E PA, STg roweepra 1g roweepra xr 2B SPRITAM E PA, STg subvenite 1g subvenite starter kit-blue 1g subvenite starter kit-green 1g subvenite starter kit-orange 1B TEGRETOL 3B TEGRETOL-XR 3B TOPAMAX 3 PA, STB TOPAMAX SPRINKLE 3 PA, STg topiramate er E PA, ST

Drug Name Drug Tier


g topiramate oral 1B TRILEPTAL 3 PA, STB TROKENDI XR E PA, STB VALTOCO 3 PA, QLB VIMPAT ORAL 3 PAB XCOPRI PAK 3 PAB XCOPRI TABLET 3 PAB ZONEGRAN 3 PA, STg zonisamide oral 1

Antidementia Agents - Drugs for Alzheimer's Disease and Dementia

B ARICEPT ORAL TABLET 10 MG, 5 MG

3

g donepezil hcl oral tablet 10 mg, 5 mg 1g donepezil hcl oral tablet 23 mg Eg donepezil hcl oral tablet dispersible 1

Antidepressants - Drugs for Depressiong amitriptyline hcl oral 1g bupropion hcl er (sr) 1g bupropion hcl er (xl) oral tablet

extended release 24 hour 150 mg, 300 mg

1

B BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG

E QL

g bupropion hcl oral 1g citalopram hydrobromide 1g desvenlafaxine succinate er 3 QLg doxepin hcl oral capsule 1g doxepin hcl oral concentrate 1B DRIZALMA SPRINKLE 3 PA, QLg duloxetine hcl oral capsule delayed

release particles 20 mg, 30 mg, 60 mg

2 QL

g duloxetine hcl oral capsule delayed release particles 40 mg

E

g escitalopram oxalate oral solution 3g escitalopram oxalate oral tablet 1g fluoxetine hcl oral capsule 1g fluoxetine hcl oral capsule delayed

release3 QL

g fluoxetine hcl oral solution 1g fluoxetine hcl oral tablet 10 mg 3 QLg fluoxetine hcl oral tablet 20 mg 3


12

Drug Name Drug Tier


g fluoxetine hcl oral tablet 60 mg Eg fluvoxamine maleate 1g fluvoxamine maleate er 3 QLB FORFIVO XL E QLg mirtazapine oral 1g nortriptyline hcl oral 1B PAMELOR 3g paroxetine hcl 1g paroxetine hcl er 3 QLB PAXIL CR 3 QLB PAXIL ORAL SUSPENSION 3B PAXIL ORAL TABLET 3B REMERON 3B REMERON SOLTAB 3g sertraline hcl oral 1g trazodone hcl oral 1B TRINTELLIX 3 ST, QLg venlafaxine hcl 1g venlafaxine hcl er oral capsule


g venlafaxine hcl er oral tablet extended release 24 hour

E QL

B VIIBRYD 3 QL

Antiemetics - Drugs for Nausea and VomitingB BONJESTA E PAg doxylamine-pyridoxine E PAg metoclopramide hcl oral solution

5 mg/5ml1

g metoclopramide hcl oral tablet 1g metoclopramide hcl oral tablet

dispersibleE

g ondansetron hcl oral 1g ondansetron odt 1g phenadoz 1g prochlorperazine maleate oral 1g promethazine hcl oral tablet 1g promethazine hcl rectal 1g promethegan 1B REGLAN 3g scopolamine 3B TRANSDERM-SCOP (1.5 MG) 3B VARUBI (180 MG DOSE) 2 QL

Drug Name Drug Tier


B ZOFRAN 3B ZUPLENZ E QL

Antifungals - Drugs for Fungal Infectionsg ciclodan 1g ciclopirox external gel 1g ciclopirox external shampoo 2g ciclopirox external solution 1g ciclopirox treatment EB CRESEMBA ORAL 3B DIFLUCAN ORAL SUSPENSION

RECONSTITUTED3

B DIFLUCAN ORAL TABLET 100 MG, 150 MG, 200 MG

3

B DIFLUCAN ORAL TABLET 50 MG 3B EXTINA 3 QLg fluconazole oral 1B GYNAZOLE-1 3g ketoconazole external cream 1 QLg ketoconazole external foam 3 QLg ketoconazole external shampoo 1g ketodan external foam 3 QLB NIZORAL 3g nyamyc 1 QLg nystatin external 1 QLg nystatin mouth/throat 1g nystop 1 QLg terbinafine hcl oral 1 QLg terconazole 1B XOLEGEL 3

Antigout Agents - Drugs for Goutg allopurinol oral 1B COLCHICINE ORAL CAPSULE Eg colchicine oral tablet EB COLCRYS Eg febuxostat 3 ST, QLB GLOPERBA 3 PAB MITIGARE 2B ZYLOPRIM 3

Antimigraine Agents - Drugs for MigrainesB AIMOVIG 2 PA, ST, QLB AMERGE 3 QL


13

Drug Name Drug Tier


g eletriptan hydrobromide 2 QLB EMGALITY 2 PA, ST, QLB EMGALITY (300 MG DOSE) 2 PA, ST, QLg naratriptan hcl 1 QLB ONZETRA XSAIL E QLB REYVOW TABLET 2 PA, ST, QLg rizatriptan benzoate 1 QLg sumatriptan succinate oral 1 QLg sumatriptan succinate refill 1 QLg sumatriptan succinate

subcutaneous1 QL

B UBRELVY TABLET 2 PA, ST, QLB ZEMBRACE SYMTOUCH E QL

Antineoplastics - Drugs for Cancerg anastrozole oral 1g bexarotene E SPg capecitabine E QL, SPB ERLEADA 2 PA, QL, SPB IBRANCE ORAL CAPSULE 2 PA, QL, SPB IDHIFA 2 PA, QL, SPg imatinib mesylate 1 PA, QL, SPg letrozole oral 1B LYNPARZA 2 PA, QL, SPg mercaptopurine oral 1B NUBEQA 2 PA, QL, SPB PURIXAN 3 PA, SPB REVLIMID 2 PA, QL, SPB SOLTAMOX Eg tamoxifen citrate oral tablet 10 mg 1g tamoxifen citrate oral tablet 20 mg 1 H-PAB TARGRETIN EXTERNAL 3 QL, SPB TARGRETIN ORAL 2 SPB TASIGNA 2 PA, ST, QL, SPB VERZENIO 2 PA, QL, SPB XELODA 1 QL, SPB ZEJULA 2 PA, QL, SP

Antiparasitics - Drugs for Parasitic InfectionsB ARAKODA 3 QLg atovaquone-proguanil hcl 2B ELIMITE 3g hydroxychloroquine sulfate oral 1 QL

Drug Name Drug Tier


B KRINTAFEL 1 QLB MALARONE 3g permethrin external 1

Antiparkinson Agents - Drugs for Parkinson's Diseaseg carbidopa-levodopa 1g carbidopa-levodopa er 1B DUOPA 3 PAB INBRIJA 3 PA, QL, SPB MIRAPEX 3B NOURIANZ ORAL TABLET 3 PA, QLg pramipexole dihydrochloride 1g pramipexole dihydrochloride er Eg ropinirole hcl 1g ropinirole hcl er EB RYTARY EB SINEMET 3

Antiplatelets - Drugs for Heart Attack and Stroke Prevention

B BRILINTA 3 QLg clopidogrel bisulfate oral 1B ZONTIVITY 3 QL

Antipsychotics - Drugs for Mood DisordersB ABILIFY MYCITE E PA, QLg aripiprazole oral solution 3g aripiprazole oral tablet 2 QLg aripiprazole oral tablet dispersible 2 QLB LATUDA 3 QLg olanzapine oral tablet 1 QLg olanzapine oral tablet dispersible 2 QLg quetiapine fumarate 1g quetiapine fumarate er 3 QLg risperidone 1B SAPHRIS 3 QLg ziprasidone hcl 2 QL

Antivirals - Drugs for Viral Infectionsg acyclovir oral 1B ATRIPLA E ST, QLB BARACLUDE ORAL SOLUTION 2 SPB BIKTARVY 3 QLB CIMDUO 2 QLB DESCOVY E PA, ST, QL


14

Drug Name Drug Tier


B DOVATO 2 QLg emtricitabine/tenofovir disoproxil

fumarate1 QL, H

g entecavir 1 SPB EPCLUSA 2 PA, QL, SPB GENVOYA 3 QLB HARVONI 2 PA, ST, QL, SPB ISENTRESS 2B ISENTRESS HD 2B JULUCA 2 QLB LEDIPASVIR-SOFOSBUVIR 2 PA, ST, QL, SPB LEDIP-SOFOSB ORAL TABLET

90-400MG2 PA, ST, QL, SP

B MAVYRET 2 PA, QL, SPB NORVIR ORAL PACKET 2B NORVIR ORAL SOLUTION 2B ODEFSEY 3 QLg oseltamivir phosphate oral capsule 2g oseltamivir phosphate oral

suspension reconstituted2 QL

B PREZCOBIX 2B PREZISTA 2g ritonavir 2 SPB SITAVIG E QLB SOFOS/VELPAT ORAL TABLET

400-1002 PA, QL, SP

B SOFOSBUVIR-VELPATASVIR 2 PA, QL, SPB STRIBILD 3 QLB SYMFI 2 QLB SYMFI LO 2 QLB TEMIXYS E QLg tenofovir disoproxil fumarate 2 H-PAB TIVICAY 3B TRIUMEQ 2 QLB TRUVADA E QLg valacyclovir hcl oral 1 QLB VEMLIDY 3 ST, SPB VIREAD ORAL POWDER 3B VIREAD ORAL TABLET 150 MG,

200 MG, 250 MG2

B VOSEVI 2 PA, QL, SPB XOFLUZA 3 QL

Drug Name Drug Tier


B ZEPATIER 2 PA, QL, SPB ZOVIRAX ORAL SUSPENSION 3

Anxiolytics - Drugs for Anxietyg alprazolam er 1g alprazolam intensol 1g alprazolam oral 1g alprazolam xr 1g buspirone hcl oral 1g clonazepam oral 1g diazepam intensol 1g diazepam oral 1B HALCION 3g hydroxyzine hcl oral 1g hydroxyzine pamoate oral 1g lorazepam intensol 1g lorazepam oral concentrate 2 mg/ml 1g lorazepam oral tablet 1g triazolam 1B VISTARIL 3

Bipolar Agents - Drugs for Mood Disordersg lithium carbonate er 1g lithium carbonate oral 1B LITHOBID 3

Cardiovascular Agents - Drugs for Heart and Circulation Conditions

B ACCUPRIL 3g acetazolamide er 1g acetazolamide oral 1B ADALAT CC ORAL TABLET


3

B ALDACTONE 3g aliskiren fumarate 3B ALTACE 3B ALTOPREV Eg amiodarone hcl oral 1g amlodipine besylate oral 1g amlodipine besylate-benazepril hcl 1g amlodipine besylate-valsartan 2g atenolol oral 1g atenolol-chlorthalidone 1


15

Drug Name Drug Tier


g atorvastatin calcium oral tablet 10 mg, 20 mg

1 QL, H-PA

g atorvastatin calcium oral tablet 40 mg, 80 mg

1 QL

B AVALIDE 3B AVAPRO 3g benazepril hcl oral 1g benazepril-hydrochlorothiazide 1B BIDIL 2g bisoprolol fumarate 1g bisoprolol-hydrochlorothiazide 1B BYSTOLIC EB CALAN SR 3B CARDIZEM LA ORAL TABLET


E

B CARDURA 3B CAROSPIR 3 PAg cartia xt 2g carvedilol 1B CATAPRES 3g chlorthalidone 1g clonidine hcl oral 1g colesevelam hcl EB COREG 3B CORGARD 3B CORLANOR 3 PA, QLB COZAAR 3g diltiazem hcl er coated beads 2g diltiazem hcl er oral capsule


g diltiazem hcl oral 1g dilt-xr 1g doxazosin mesylate oral 1B DYAZIDE 3B EDARBI 3B EDARBYCLOR 3g enalapril maleate oral 1B EPANED 3 PAB EZALLOR SPRINKLE 3 PAg ezetimibe 2g ezetimibe-simvastatin 3

Drug Name Drug Tier


g fenofibrate oral capsule 150 mg, 50 mg

E

g fenofibrate oral tablet 120 mg, 40 mg, 48 mg

E

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

2

g flecainide acetate 1B FLOLIPID 3 PAg furosemide oral 1g gemfibrozil oral 1B GONITRO E QLg guanfacine hcl 1B HEMANGEOL Eg hydralazine hcl oral 1g hydrochlorothiazide oral 1B HYZAAR 3g irbesartan 1g irbesartan-hydrochlorothiazide 1g isosorbide mononitrate 1g isosorbide mononitrate er 1B KAPSPARGO SPRINKLE 3g labetalol hcl oral 1B LASIX 3B LIPOFEN Eg lisinopril oral 1g lisinopril-hydrochlorothiazide 1B LOPID 3B LOPRESSOR 3g losartan potassium 1g losartan potassium-hctz 1B LOTENSIN 3B LOTENSIN HCT 3B LOTREL 3g lovastatin 1 Hg matzim la 2B MAXZIDE 3B MAXZIDE-25 3g metoprolol succinate er oral tablet

extended release 24 hour 100 mg, 200 mg, 50 mg

2

g metoprolol succinate er oral tablet extended release 24 hour 25 mg

1


16

Drug Name Drug Tier


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

1

g metoprolol tartrate oral tablet 37.5 mg, 75 mg

E

B MINIPRESS 3g minitran 1B MULTAQ 3 PAg nadolol oral 1B NEXLETOL TABLET 2 PA, ST, QLB NEXLIZET TABLET 2 PA, ST, QLg niacin (antihyperlipidemic) 2g niacin er (antihyperlipidemic) 3g niacor 2B NIASPAN 2g nifedipine er 1g nifedipine er osmotic release 1g nifedipine oral 1B NITRO-BID 2B NITRO-DUR 3g nitroglycerin sublingual 1g nitroglycerin transdermal 1g nitroglycerin translingual E QLB NITROMIST 3 QLB NITROSTAT 3g nitro-time 1g olmesartan medoxomil oral 2g olmesartan medoxomil-hctz 2g omega-3-acid ethyl esters 3B PACERONE ORAL TABLET

100 MG, 400 MG3

g pacerone oral tablet 200 mg 1B PRALUENT 2 PA, ST, QLB PRAVACHOL 3g pravastatin sodium 1g prazosin hcl oral 1B PRINIVIL 3B PROCARDIA 3B PROCARDIA XL 3g propranolol hcl er 2g propranolol hcl oral 1B QBRELIS 3 PAg quinapril hcl 1

Drug Name Drug Tier


g ramipril 1g ranolazine er 2B REPATHA 2 PA, ST, QLg rosuvastatin calcium 2 QLg simvastatin oral tablet 10 mg,

20 mg, 40 mg, 5 mg1 H-PA

g simvastatin oral tablet 80 mg 1g sotalol hcl oral 1B SOTYLIZE 3 PAg spironolactone oral 1B TEKTURNA 3B TEKTURNA HCT 3g telmisartan 2B TOPROL XL 3g torsemide 1g triamterene-hctz 1g valsartan 2g valsartan-hydrochlorothiazide 1B VASCEPA ORAL CAPSULE 0.5 GM 3 PAB VASCEPA ORAL CAPSULE 1 GM 3 PAg verapamil hcl er oral capsule

extended release 24 hour 100 mg, 200 mg, 300 mg

3

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

1

g verapamil hcl er oral tablet extended release

1

g verapamil hcl oral 1B VERELAN 3B VERELAN PM 3B WELCHOL 2B ZIAC ORAL TABLET 10-6.25 MG,

2.5-6.25 MG3

B ZIAC ORAL TABLET 5-6.25 MG 3B ZOCOR ORAL TABLET 10 MG,

20 MG, 40 MG, 80 MG3

Central Nervous System Agents - Drugs for Attention Deficit Disorder

B ADDERALL XR 2 QLB ADHANSIA XR E PA, QLg amphetamine-dextroamphetamine 1 PAg amphetamine-dextroamphetamine er E QL


17

Drug Name Drug Tier


B APTENSIO XR E PA, QLg atomoxetine hcl 3 QLB CONCERTA 2 PA, QLg dexmethylphenidate hcl 1 PAg dexmethylphenidate hcl er 3 PA, QLg dextroamphetamine sulfate er 3 PAg dextroamphetamine sulfate oral

solution1 PA

g dextroamphetamine sulfate oral tablet

3 PA

B FOCALIN 3 PAg guanfacine hcl er 2 QLB JORNAY PM E PA, QLg metadate er 3 PA, QLB METHYLIN 3 PAg methylphenidate hcl er (cd) 2 PA, QLg methylphenidate hcl er (la) 2 PA, QLg methylphenidate hcl er oral tablet

extended release 10 mg, 20 mg3 PA, QL

g methylphenidate hcl er oral tablet extended release 18 mg, 27 mg, 36 mg, 54 mg, 72 mg

E PA, QL

g methylphenidate hcl er oral tablet extended release 24 hour

E PA, QL

g methylphenidate hcl oral solution 1 PAg methylphenidate hcl oral tablet 1 PAg methylphenidate hcl oral tablet

chewable3 PA

B MYDAYIS E PA, QLB PROCENTRA 3 PAB QUILLICHEW ER E PA, QLB QUILLIVANT XR E PA, QLg relexxii E PA, QLB RITALIN 3 PAB VYVANSE 3 PA, QLB ZENZEDI ORAL TABLET 15 MG,

2.5 MG, 20 MG, 30 MG, 7.5 MGE PA

Central Nervous System Agents - Drugs for Multiple Sclerosis

B AUBAGIO 3 PA, QL, SPB AVONEX 2 PA, QL, SPB BAFIERTAM CAPSULE 2 PA, QL, SPB BETASERON 2 PA, QL, SP

Drug Name Drug Tier


g dalfampridine er 2 PA, QL, SPg dimethyl fumarate 2 PA, QL, SPB EXTAVIA E PA, ST, QL, SPB GILENYA ORAL CAPSULE 3 PA, QL, SPg glatiramer acetate 2 PA, QL, SPg glatopa 2 PA, QL, SPB MAVENCLAD 3 PA, ST, QL, SPB MAYZENT 3 PA, QL, SPB PLEGRIDY 3 PA, QL, SPB REBIF 3 PA, ST, QL, SPB REBIF REBIDOSE 3 PA, ST, QL, SPB TECFIDERA E PA, QL, SP

Central Nervous System Agents - MiscellaneousB AUSTEDO 2 PA, QL, SPB LYRICA 3 PA, ST, QLB LYRICA CR E ST, QLB NUEDEXTA 2 PAg pregabalin oral capsule 2 QLg pregabalin oral solution 3 QLB RILUTEK 3 SPg riluzole 1 SPB TIGLUTIK 3 PA

Dental and Oral Agents - Drugs for Mouth and Throat Conditions

g cavarest 1g chlorhexidine gluconate mouth/

throat1

g clinpro 5000 1g denta 5000 plus 1g dentagel 1g fluoridex 1g fluoridex enhanced whitening 1g lidocaine hcl mouth/throat 1g lidocaine viscous hcl 1B NAFRINSE DAILY/NEUTRAL 2B NAFRINSE WEEKLY 3g neutral sodium fluoride 1g paroex 1B PERIDEX 3g periogard 1B PREVIDENT 5000 BOOSTER PLUS 3B PREVIDENT 5000 DRY MOUTH 3


18

Drug Name Drug Tier


B PREVIDENT 5000 ORTHO DEFENSE

3

B PREVIDENT 5000 PLUS 3B PREVIDENT DENTAL 3B PREVIDENT MOUTH/THROAT 3g sf 1g sf 5000 plus 1g sodium fluoride 5000 plus 1g sodium fluoride dental 1

Dermatological Agents - Drugs for Skin ConditionsB ABSORICA E PAB ACZONE EXTERNAL GEL 3 QLB ALA SCALP 3g ala-cort external cream 1 % Eg ala-cort external cream 2.5 % 1B ALDARA 3 QLB ALTRENO E PA, QLg amnesteem 2B AMZEEQ AER 4% 3 PA, QLg azelaic acid external 3g betamethasone dipropionate aug

external cream1

g betamethasone dipropionate aug external gel

1

g betamethasone dipropionate aug external lotion

3

g betamethasone dipropionate aug external ointment

3

g betamethasone dipropionate external cream

2

g betamethasone dipropionate external lotion

1

g betamethasone dipropionate external ointment

2

g calcipotriene-betameth diprop external ointment

3 QL

g calcitriol external 1 QLB CAPEX 2B CARAC 2g claravis 2B CLEOCIN-T EXTERNAL GEL 3 QLB CLEOCIN-T EXTERNAL LOTION 3g clindacin etz external swab 1

Drug Name Drug Tier


g clindacin-p 1B CLINDAGEL E QLg clindamycin phos-benzoyl perox

external gel 1.2-5 %3 QL

g clindamycin phosphate external foam

3

g clindamycin phosphate external lotion

3

g clindamycin phosphate external solution

1 QL

g clindamycin phosphate external swab

1

B CLINDAMYCIN PHOSPHATE GEL 1 % EXTERNAL

E

g clindamycin phosphate gel 1 % external

3 QL

g clobetasol propionate external cream

2 QL

g clobetasol propionate external foam E QLg clobetasol propionate external gel 2 QLg clobetasol propionate external liquid 1 QLg clobetasol propionate external lotion E QLg clobetasol propionate external

ointment2 QL

g clobetasol propionate external shampoo

E QL

g clobetasol propionate external solution

1 QL

g clodan external shampoo E QLg clotrimazole-betamethasone

external cream1 QL

g clotrimazole-betamethasone external lotion

1

g dapsone external gel 5 % E QLB DERMA-SMOOTHE/FS BODY 3 QLB DERMA-SMOOTHE/FS SCALP 3g desonide cream, lotion, ointment 3 QLg desonide gel 3 ST, QLB DESOWEN 3 QLB DIPROLENE 3B DIPROLENE AF 3B DUPIXENT 3 PA, ST, QL, SPB EFUDEX 3B ENSTILAR 3 QL


19

Drug Name Drug Tier


B EUCRISA 3 ST, QLB EVOCLIN 3B FINACEA EXTERNAL GEL, FOAM 3g fluocinolone acetonide body 3 QLg fluocinolone acetonide external

cream3 QL

g fluocinolone acetonide external ointment

2 QL

g fluocinolone acetonide external solution

3 QL

g fluocinolone acetonide scalp 3g fluocinonide external cream 0.05 % 1g fluocinonide external cream 0.1 % E QLg fluocinonide external gel 1g fluocinonide external ointment 1g fluocinonide external solution 1B FLUOROPLEX 3B FLUOROURACIL EXTERNAL

CREAM 0.5 %3

g fluorouracil external cream 5 % 1g fluorouracil external solution 1g hydrocortisone external cream 1 % Eg hydrocortisone external cream 2.5 % 1g hydrocortisone external lotion 2.5 % 1g hydrocortisone external ointment

1 %, 2.5 %1

g imiquimod external 1 QLB IMIQUIMOD PUMP E QLB IMPOYZ E QLg isotretinoin oral 2B METROCREAM 3B METROLOTION 3g metronidazole external cream 1g metronidazole external gel 0.75 % 1g metronidazole external gel 1 % Eg metronidazole external lotion 1B MIRVASO 3 PA, QLg mometasone furoate external 1g myorisan 2g neuac external gel 3 QLB NORITATE EB PICATO 3 QL

Drug Name Drug Tier


B RHOFADE CREAM 1% 3 PA, QLg rosadan external cream 1g rosadan external gel 1B SERNIVO E QLB SOOLANTRA CREAM 1% 3 QLg sss 10-5 1g sulfacetamide sodium-sulfur

external cream 10-2 %, 10-5 %1

g sulfacetamide sodium-sulfur external emulsion

1

g sulfacetamide sodium-sulfur external liquid 9-4 %, 9-4.5 %

1

g sulfacetamide sodium-sulfur external lotion 10-5 %

1

g sulfacetamide sodium-sulfur external pad

1

g sulfacetamide sodium-sulfur external suspension 10-5 %

1

g sulfacleanse 8/4 Eg sulfamez wash 1B TACLONEX EXTERNAL

SUSPENSION3 QL

g tazarotene external 3 PA, QLB TAZORAC EXTERNAL CREAM 0.1 % 3 PA, QLB TAZORAC EXTERNAL GEL 3 PA, QLB TEMOVATE 3 QLB TEXACORT 2B TOLAK Eg tretinoin external cream 3 QLg triamcinolone acetonide external

aerosol solution2 QL

g triamcinolone acetonide external cream 0.025 %, 0.1 %

1

g triamcinolone acetonide external cream 0.5 %

1 QL

g triamcinolone acetonide external lotion

1

g triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 %

1

g triamcinolone acetonide external ointment 0.05 %

E

g trianex Eg triderm external cream 0.1 % 1g triderm external cream 0.5 % 1 QL


20

Drug Name Drug Tier


B TRIDESILON 3 QLB VERDESO E QLg zenatane 2B ZYCLARA E QLB ZYCLARA PUMP E QL

Diabetes - Glucose MonitoringB ACCU-CHEK AVIVA CONNECT KIT

W/DEVICEE

B ACCU-CHEK AVIVA DEVICE EB ACCU-CHEK AVIVA PLUS KIT

W/DEVICEE

B ACCU-CHEK AVIVA PLUS TEST STRIPS

E QL

B ACCU-CHEK COMPACT PLUS CARE KIT

E

B ACCU-CHEK COMPACT PLUS TEST STRIPS

E QL

B ACCU-CHEK GUIDE/GUIDE ME KIT W/DEVICE

3

B ACCU-CHEK GUIDE TEST STRIPS 3 QLB ACCU-CHEK NANO SMARTVIEW

KIT W/DEVICEE

B ACCU-CHEK SMARTVIEW TEST STRIPS

E QL

B ACCU-CHEK SOFTCLIX LANCET DEVICE KIT

1

B BD AUTOSHIELD DUO PEN NEEDLES

2

B BD ULTRA-FINE INSULIN SYRINGES

2

B BD ULTRA-FINE PEN NEEDLES 2B CONTOUR NEXT EZ BLOOD

GLUCOSE MONITORING SYSTEM2

B CONTOUR NEXT MONITOR 2B CONTOUR NEXT ONE BLOOD

GLUCOSE MONITORING SYSTEM2

B CONTOUR NEXT TEST 2 QLB CONTOUR TEST E QLB DEXCOM G4 / G5 / G6 RECEIVER,

TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC)

3 PA, QL

B DEXCOM G4 / G5 / G6 RECEIVER, TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC) DEVICE

3 PA, QL

Drug Name Drug Tier


B FREESTYLE LIBRE 14 DAY READER

3 PA, QL

B FREESTYLE LIBRE 14 DAY SENSOR

3 PA, QL

B FREESTYLE LIBRE READER 3 PA, QLB FREESTYLE LIBRE SENSOR

SYSTEM3 PA, QL

B GUARDIAN CONNECT TRANSMITTER

3

B GUARDIAN CONNECT TRANSMITTER

3 PA, QL

B GUARDIAN LINK 3 TRANSMITTER 3B GUARDIAN SENSOR (3) 3 PAB INSULIN SYRINGES 2B LANCETS 1B NOVOFINE AUTOCOVER PEN

NEEDLE2

B NOVOFINE PEN NEEDLE 2B NOVOFINE PLUS PEN NEEDLE 2B ONETOUCH ULTRA 2 KIT

W/DEVICE1

B ONETOUCH ULTRA BLUE TEST STRIPS IN VITRO STRIP

1 QL

B ONETOUCH ULTRA MINI KIT W/DEVICE

1

B ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE

1

B ONETOUCH VERIO IQ SYSTEM 1B ONETOUCH VERIO KIT W/DEVICE 1B ONETOUCH VERIO SYNC SYSTEM

KIT W/DEVICE1

B ONETOUCH VERIO TEST STRIPS 1 QLB SOFTCLIX 1

Diabetes - InsulinB ADMELOG E QLB AFREZZA INHALATION POWDER E PA, QLB BASAGLAR KWIKPEN E QLB HUMALOG KWIKPEN 2 QLB HUMALOG MIX 50/50 KWIKPEN 2 QLB HUMALOG MIX 50/50 VIAL 1 QLB HUMALOG MIX 75/25 KWIKPEN 2 QLB HUMALOG MIX 75/25 VIAL 1 QLB HUMALOG SUBCUTANEOUS

SOLUTION1 QL


21

Drug Name Drug Tier


B HUMALOG SUBCUTANEOUS SOLUTION CARTRIDGE

2 QL

B HUMALOG U-100 JUNIOR KWIKPEN

2 QL

B HUMULIN 70/30 KWIKPEN 2 QLB HUMULIN 70/30 VIAL 1 QLB HUMULIN N KWIKPEN 2 QLB HUMULIN N VIAL 1 QLB HUMULIN R U-500 KWIKPEN 2 QLB HUMULIN R U-500 VIAL

(CONCENTRATED)1 QL

B HUMULIN R VIAL 1 QLB INSULIN ASPART E ST, QLB INSULIN LISPRO E QLB LANTUS SOLOSTAR 1 QLB LANTUS U-100 VIAL 1 QLB LEVEMIR E QLB NOVOLIN 70/30 E ST, QLB NOVOLIN N E ST, QLB NOVOLIN R E ST, QLB NOVOLOG E ST, QLB TOUJEO MAX SOLOSTAR 2 QLB TOUJEO SOLOSTAR 2 QLB TRESIBA E QLB TRESIBA FLEXTOUCH E QL

Diabetes - Non-Insulin AgentsB ADLYXIN 3 PA, ST, QLB ALOGLIPTIN BENZOATE E QLB ALOGLIPTIN-METFORMIN HCL E QLB ALOGLIPTIN-PIOGLITAZONE E QLB AMARYL 3B BAQSIMI ONE PACK 2 QLB BAQSIMI TWO PACK 2 QLB BYDUREON 2 PA, ST, QLB BYDUREON BCISE

AUTOINJECTOR2 PA, ST, QL

B BYETTA 2 PA, ST, QLB FARXIGA E ST, QLg glimepiride 1g glipizide er 1g glipizide ir 1g glipizide xl 1

Drug Name Drug Tier


B GLUCAGON EMERGENCY KIT INJECTION KIT

2 QL

B GLUCOTROL 3B GLUCOTROL XL 3B GLUCOVANCE ORAL TABLET

5-500 MG3

g glyburide oral 1g glyburide-metformin 1B GLYXAMBI 2 ST, QLB GVOKE PFS 2 QLB INVOKANA E ST, QLB JANUVIA E ST, QLB JARDIANCE 2 ST, QLB JENTADUETO 2 QLB JENTADUETO XR 2 QLB KAZANO 2 QLB KOMBIGLYZE XR 2 QLg metformin hcl er 1g metformin hcl er (mod) E PAg metformin hcl er (osm) E PAB METFORMIN HCL ORAL

SOLUTION3

g metformin hcl oral tablet 1B NESINA 2 QLB ONGLYZA 2 QLB OSENI 2 QLB OZEMPIC 2 PA, ST, QLg pioglitazone hcl 1 QLB RIOMET 3B RYBELSUS 2 PA, ST, QLB SOLIQUA 2 QLB SYNJARDY 2 QLB SYNJARDY XR 2 QLB TRADJENTA 2 QLB TRIJARDY XR 2 QLB TRULICITY 2 PA, ST, QLB VICTOZA SOLUTION PEN-

INJECTOR 18 MG/3ML SUBCUTANEOUS (2 PACK)

2 PA, ST, QL

B VICTOZA SOLUTION PEN-INJECTOR 18 MG/3ML SUBCUTANEOUS (3 PACK)

3 PA, ST, QL


22

Drug Name Drug Tier


Drugs for Blood DisordersB ADVATE 2 SPB ADYNOVATE 3 PA, SPB AFSTYLA INTRAVENOUS KIT 3 PA, SPB ARANESP (ALBUMIN FREE) 2 QL, SPB ELOCTATE 3 PA, SPB JIVI 3 PA, SPB KOGENATE FS 2 SPB KOVALTRY 2 SPB MULPLETA 2 PA, QL, SPB NEULASTA 3 SPB NOVOEIGHT 2 SPB NUWIQ 2 SPB RECOMBINATE PA, SPB RETACRIT 2 QL, SPB ZARXIO 2 SPB ZIEXTENZO 3 SP

Drugs for Sexual DysfunctionB ADDYI 3 PA, QLB IMVEXXY 3 QLB INTRAROSA 3 QLB OSPHENA 3 PA, QLg sildenafil citrate oral tablet 100 mg,

25 mg, 50 mg2 QL

B STENDRA 3 PA, QLg tadalafil oral tablet 10 mg, 20 mg 2 QLg tadalafil oral tablet 2.5 mg, 5 mg 2 ST, QLB VYLEESI 3 PA, QL

Electrolytes / VitaminsB DRISDOL 3B ERGOCAL 3g ergocalciferol oral capsule 1B FLORIVA PLUS 3g folic acid oral tablet 1 mg 1g klor-con 1g klor-con 10 1g klor-con m10 1g KLOR-CON M15 3g klor-con m20 1g klor-con sprinkle 1B K-TAB 3

Drug Name Drug Tier


B LOKELMA 3 PA, QLg multi-vitamin/fluoride 1g multivitamin/fluoride oral solution 1g multivitamin/fluoride oral tablet

chewable 0.25 mg, 0.5 mg, 1 mg1

g multivitamins/fluoride 1g mvc-fluoride 1B NASCOBAL 3B POLY-VI-FLOR 3g potassium chloride crys er 1g potassium chloride er 1g potassium chloride oral 1g potassium citrate er 1B QUFLORA PEDIATRIC 3B UROCIT-K 10 3B UROCIT-K 15 3B UROCIT-K 5 3B VELTASSA 3 PA, QLg vitamin d (ergocalciferol) oral

capsule 1.25 mg (50000 ut)1

Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer

B ACIPHEX SPRINKLE E QLB CARAFATE 3B CYTOTEC 3B DEXILANT 3 QLg misoprostol oral 1B OMECLAMOX-PAK 3 QLg omeprazole oral capsule delayed

release1

g pantoprazole sodium tablet delayed release 20 mg oral

1

g pantoprazole sodium tablet delayed release 40 mg oral

1

B PROTONIX ORAL PACKET EB PYLERA 3 QLB RABEPRAZOLE SODIUM ORAL

CAPSULE SPRINKLEE QL

g rabeprazole sodium oral tablet delayed release

2 QL

g sucralfate oral suspension 3g sucralfate oral tablet 1


23

Drug Name Drug Tier


Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions

B ACTIGALL 3B AEMCOLO 3 QLB ANASPAZ 2B CLENPIQ 3g dicyclomine hcl oral 1g diphenoxylate-atropine 1g ed-spaz 1g gavilyte-c 1 Hg gavilyte-g 1 QL, HB GOLYTELY ORAL SOLUTION

RECONSTITUTED 227.1 GM2 QL

B GOLYTELY ORAL SOLUTION RECONSTITUTED 236 GM

3 QL

g hyoscyamine sulfate er 1g hyoscyamine sulfate oral 1g hyoscyamine sulfate sl 1g hyoscyamine sulfate sublingual 1g hyosyne 1B LEVBID 3B LEVSIN ORAL 3B LEVSIN/SL 3B LINZESS 2 PA, QLB LOMOTIL 3B MOTEGRITY 3 PA, QLB MOVIPREP 3 QLB NULEV 3g oscimin 1g oscimin sr 1g peg-3350/electrolytes 1 QL, HB PLENVU 3 QLB PREPOPIK 3 QLB SUPREP BOWEL PREP KIT 3 QLB SYMAX DUOTAB 3g symax-sl 1g symax-sr 1B SYMPROIC 2 PA, QLB URSO 250 3B URSO FORTE 3g ursodiol oral 1B VIBERZI 3 PA, QL

Drug Name Drug Tier


B XIFAXAN 3 PA, QLB ZELNORM 3 PA, ST, QL

Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment

B CERDELGA 2 PA, SPg clovique E PA, SPB CREON 2B CUPRIMINE E SPB DEPEN TITRATABS 2 SPB ENDARI 3 PA, QLg nitisinone E PA, SPB NITYR 2 PA, SPB ORFADIN ORAL CAPSULE 20 MG E PA, SPB ORFADIN ORAL SUSPENSION E PA, SPB PANCREAZE 3 STg penicillamine oral capsule 3 SPB PERTZYE 3 STB STRENSIQ 2 PA, QL, SPB SYPRINE 3 PA, SPB TEGSEDI 2 PA, QL, SPg trientine hcl E PA, SPB VIOKACE 3 STB ZENPEP 2

Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions

B AURYXIA 3B DITROPAN XL 3B GELNIQUE Eg oxybutynin chloride er 2g oxybutynin chloride oral 1g phenazo oral tablet 200 mg 1g phenazopyridine hcl oral tablet

100 mg, 200 mg1

B PYRIDIUM 3B TOVIAZ 3B VELPHORO 2

Genitourinary Agents - Drugs for Prostate Conditionsg alfuzosin hcl er 1g finasteride oral tablet 5 mg 1B PROSCAR 3g tamsulosin hcl 1


24

Drug Name Drug Tier


g terazosin hcl 1B UROXATRAL 3

Hormonal Agents - Hormone Replacement and Birth Control

g afirmelle 1 HB ALORA TRANSDERMAL PATCH

TWICE WEEKLY 0.025 MG/24HR, 0.075 MG/24HR, 0.1 MG/24HR

3 QL

g altavera 1 Hg alyacen 1/35 1 Hg amethia 3g amethia lo 3g apri 1 Hg ashlyna 3g aubra 1 Hg aubra eq 1 Hg aurovela 1.5/30 2g aurovela 1/20 2g aurovela 24 fe 3g aurovela fe 1.5/30 1 Hg aurovela fe 1/20 1 Hg aviane 1 HB AYGESTIN 3g ayuna 1 Hg azurette 2g balziva 2g bekyree 2B BIJUVA 3g blisovi 24 fe 3g blisovi fe 1.5/30 1 Hg blisovi fe 1/20 1 Hg briellyn 2g camila 1 Hg camrese 3g camrese lo 3g chateal 1 Hg chateal eq 1 HB CLIMARA PRO 3 QLg cryselle-28 1 Hg cyclafem 1/35 1 Hg cyred 1 Hg cyred eq 1 H

Drug Name Drug Tier


g dasetta 1/35 1 Hg daysee 3g deblitane 1 Hg delyla 1 HB DEPO-PROVERA

INTRAMUSCULAR SUSPENSION 150 MG/ML

3 QL

B DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3

B DEPO-SUBQ PROVERA 104 2 QLg desogestrel-ethinyl estradiol oral

tablet 0.15-0.02/0.01 mg (21/5)2

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

1 H

B DIVIGEL TRANSDERMAL GEL 3g dotti E QLg drospiren-eth estrad-levomefol Eg drospirenone-ethinyl estradiol 3B DUAVEE 3 QLB ELESTRIN 3g elinest 1 Hg eluryng Eg emoquette 1 Hg enskyce 1 Hg errin 1 Hg estarylla 1 HB ESTRACE ORAL 3B ESTRACE VAGINAL 3g estradiol oral 1g estradiol patch twice weekly

transdermal (generic MINIVELLE)2 QL

g estradiol patch twice weekly transdermal (generic VIVELLE-DOT)

E QL

g estradiol transdermal patch weekly (generic CLIMARA)

1 QL

g estradiol vaginal cream Eg estradiol vaginal tablet 2B ESTRING 2 QLB ESTROGEL 3 QLg etonogestrel-ethinyl estradiol EB EVAMIST 2g falmina 1 H


25

Drug Name Drug Tier


g fayosim Eg femynor 1 Hg gianvi 3g hailey 1.5/30 2g hailey 24 fe 3g heather 1 Hg incassia 1 Hg introvale 2 Hg isibloom 1 Hg jasmiel 3g jencycla 1 Hg jolessa 2 Hg juleber 1 Hg junel 1.5/30 2g junel 1/20 2g junel fe 1.5/30 1 Hg junel fe 1/20 1 Hg junel fe 24 3g kalliga 1 Hg kariva 2g kurvelo 1 Hg larin 1.5/30 2g larin 1/20 2g larin 24 fe 3g larin fe 1.5/30 1 Hg larin fe 1/20 1 Hg larissia 1 Hg lessina 1 Hg levonorgest-eth est & eth est Eg levonorgest-eth estrad 91-day oral

tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 & 0.01 mg

3

g levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg

2 H

g levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg

1 H

g levora 0.15/30 (28) 1 Hg lillow 1 HB LO LOESTRIN FE 3B LOESTRIN 1.5/30 (21) 3B LOESTRIN 1/20 (21) 3B LOESTRIN FE 1.5/30 3

Drug Name Drug Tier


B LOESTRIN FE 1/20 3g loryna 3B LOSEASONIQUE 3g low-ogestrel 1 Hg lo-zumandimine 3g lutera 1 Hg lyza 1 Hg marlissa 1 Hg medroxyprogesterone acetate

intramuscular suspension1 QL, H

g medroxyprogesterone acetate intramuscular suspension prefilled syringe

1 H

g medroxyprogesterone acetate oral 1g melodetta 24 fe EB MENOSTAR 3 QLg mibelas 24 fe Eg microgestin 1.5/30 2g microgestin 1/20 2g microgestin fe 1.5/30 1 Hg microgestin fe 1/20 1 Hg mili 1 HB MIRCETTE 3g mono-linyah 1 HB NATAZIA 2g necon 0.5/35 (28) 1 Hg nikki 3g nora-be 1 Hg norethin ace-eth estrad-fe oral tablet

1-20 mg-mcg(24)3

g norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg

1 H

g norethin ace-eth estrad-fe oral tablet chewable

E

g norethindrone acetate oral 1g norethindrone acet-ethinyl est 2g norethindrone oral 1 Hg norgestimate-eth estradiol 1 Hg norgestimate-ethinyl estradiol

triphasic oral tablet 0.18/0.215/ 0.25 mg-25 mcg

2

g norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/ 0.25 mg-35 mcg

1 H


26

Drug Name Drug Tier


g norlyda 1 Hg norlyroc 1 Hg nortrel 0.5/35 (28) 1 Hg nortrel 1/35 (21) 1 Hg nortrel 1/35 (28) 1 HB NUVARING 1 Hg ocella 3g ogestrel 2g orsythia 1 HB ORTHO MICRONOR 3g philith 2g pimtrea 2g pirmella 1/35 1 Hg portia-28 1 HB PREMARIN ORAL 3B PREMARIN VAGINAL 3B PREMPHASE 3B PREMPRO 3g previfem 1 Hg progesterone micronized oral 2B PROVERA 3g reclipsen 1 Hg rivelsa EB SEASONIQUE 3g setlakin 2 Hg sharobel 1 Hg simliya 2g simpesse 3g sprintec 28 1 Hg sronyx 1 Hg syeda 3g tarina 24 fe 3g tarina fe 1/20 1 Hg tarina fe 1/20 eq 1 HB TAYTULLA Eg tri femynor 1 Hg tri-estarylla 1 Hg tri-linyah 1 Hg tri-lo-estarylla 2g tri-lo-mili 2g tri-lo-sprintec 2

Drug Name Drug Tier


g tri-mili 1 Hg tri-previfem 1 Hg tri-sprintec 1 Hg tri-vylibra 1 Hg tri-vylibra lo 2g tulana 1 Hg tydemy Eg vienva 1 Hg viorele 2B VIVELLE-DOT 2 QLg vyfemla 2g vylibra 1 Hg wera 1 Hg xulane 3 HB YASMIN 28 2B YAZ 2g yuvafem 2g zarah 3g zumandimine 3

Hormonal Agents - Oral SteroidsB CORTEF 3B DECADRON Eg dexamethasone intensol 1g dexamethasone oral elixir 1g dexamethasone oral solution 1g dexamethasone oral tablet 1g dexamethasone oral tablet therapy

pack3

B DEXPAK 3g hydrocortisone oral 1B MEDROL ORAL TABLET 16 MG,

4 MG, 8 MG3

B MEDROL ORAL TABLET 2 MG 2B MEDROL ORAL TABLET 32 MG 3B MEDROL ORAL TABLET THERAPY

PACK3

g methylprednisolone oral 1B MILLIPRED 2B ORAPRED ODT 3B PEDIAPRED 2g prednisolone oral solution 1


27

Drug Name Drug Tier


g prednisolone sodium phosphate oral

1

g prednisone intensol 1g prednisone oral 1B RAYOS EB TAPERDEX 3

Hormonal Agents - Otherg cabergoline 2B DDAVP INJECTION 3B DDAVP ORAL 3g desmopressin acetate injection 1g desmopressin acetate oral 1B GENOTROPIN E PA, QL, SPB GENOTROPIN MINIQUICK E PA, QL, SPB HUMATROPE E PA, QL, SPB NOCDURNA 3 PA, QLB NORDITROPIN FLEXPRO E PA, QL, SPB NUTROPIN AQ NUSPIN 10 2 PA, QL, SPB NUTROPIN AQ NUSPIN 20 2 PA, QL, SPB NUTROPIN AQ NUSPIN 5 2 PA, QL, SPB OMNITROPE E PA, QL, SPB ORILISSA 3 PA, QLB STIMATE 3B ZOMACTON E PA, QL, SP

Hormonal Agents - Testosterone ReplacementB ANDRODERM 2 PA, QLB DEPO-TESTOSTERONE

INTRAMUSCULAR SOLUTION 100 MG/ML

3

B DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 200 MG/ML

3

B NATESTO E PA, QLB STRIANT 3 PA, QLB TESTIM 2 PA, QLB TESTOSTERONE CYPIONATE

INJECTIONE

g testosterone cypionate intramuscular

1

g testosterone enanthate intramuscular

1

g testosterone transdermal E PA, QLB XYOSTED E PA

Drug Name Drug Tier


Hormonal Agents - ThyroidB ARMOUR THYROID 3g euthyrox 1g levo-t 1g levothyroxine sodium oral 1g levoxyl 2g liothyronine sodium oral 2g methimazole oral 1B NATURE-THROID 3g np thyroid 1B SYNTHROID EB TAPAZOLE 3g thyroid oral tablet 120 mg, 15 mg,

30 mg, 60 mg, 90 mg1

B TIROSINT EB TIROSINT-SOL 3 PAg unithroid 1B WESTHROID 3B WP THYROID 3

Immunological Agents - Drugs for Immune System Stimulation or Suppression

B ACTEMRA 3 PA, ST, QL, SPB ASTAGRAF XL E SPB AZASAN 3g azathioprine oral 1B CIMZIA 2 PA, QL, SPB COSENTYX 3 PA, ST, QL, SPg cyclosporine modified 1 SPB ENBREL 3 PA, ST, QL, SPB ENVARSUS XR E SPB FIRAZYR 2 PA, QL, SPg gengraf 1 SPB HAEGARDA 2 PA, QL, SPB HUMIRA 2 PA, QL, SPg icatibant acetate E PA, QL, SPg methotrexate oral 1g methotrexate sodium oral 1g mycophenolate mofetil 1 SPg mycophenolate sodium 2 SPB OLUMIANT ORAL TABLET 2 PA, QL, SPB OTEZLA 2 PA, QL, SP


28

Drug Name Drug Tier


B OTREXUP E QLB PROGRAF ORAL PACKET 3 PA, SPB RAPAMUNE ORAL SOLUTION 3 SPB RASUVO 2 QLB RINVOQ 2 PA, QL, SPB RUCONEST 3 PA, QL, SPB SIMPONI 2 PA, QL, SPg sirolimus oral solution 2 SPg sirolimus oral tablet 1 SPB SKYRIZI (150 MG DOSE) 2 PA, QL, SPB STELARA 2 PA, QL, SPg tacrolimus oral 1 SPB TAKHZYRO 2 PA, QL, SPB TREMFYA 2 PA, QL, SPB TREXALL 2B XELJANZ 2 PA, ST, QL, SPB XELJANZ XR ORAL TABLET


2 PA, ST, QL, SP

Infertility Agentsg chorionic gonadotropin

intramuscular3 SP

B CRINONE VAGINAL GEL 4 % 3 PA, STB CRINONE VAGINAL GEL 8 % 3 PA, STB ENDOMETRIN 2 PAB FOLLISTIM AQ 2 SPg ganirelix acetate solution

prefilled syringe 250 mcg/0.5ml subcutaneous (Ferring)

3 QL, SP

g ganirelix acetate solution prefilled syringe 250 mcg/0.5ml subcutaneous (Merck/Organon)

2 QL, SP

g novarel intramuscular solution reconstituted 10000 unit

3 SP

B NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT

3 SP

g pregnyl 1 SP

Inflammatory Bowel Disease AgentsB APRISO 2B AZULFIDINE 3B AZULFIDINE EN-TABS 3g budesonide er Eg budesonide oral 2

Drug Name Drug Tier


B CORTIFOAM 2B DIPENTUM 3g hydrocortisone ace-pramoxine

external cream 1-1 %1

g hydrocort-pramoxine (perianal) 1B LIALDA 2g mesalamine er Eg mesalamine oral Eg mesalamine rectal enema 1g mesalamine rectal suppository 2B PENTASA EB PROCORT EB PROCTOFOAM HC 2B SFROWASA 3g sulfasalazine oral tablet 1B UCERIS ORAL 3B UCERIS RECTAL 2

Metabolic Bone Disease Agents - Drugs for Osteoporosis

g alendronate sodium 1B BONIVA ORAL 3B FORTEO E PA, ST, SPB FOSAMAX 3g ibandronate sodium oral 2B TERIPARATIDE 3 PA, SPB TYMLOS 3 PA, SP

Metabolic Bone Disease Agents - Otherg calcitriol oral 1B ROCALTROL 3

Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation

B ACULAR 3B ACULAR LS 3B ACUVAIL EB ALREX 3 QLB AZASITE 3g azelastine hcl ophthalmic 1B BESIVANCE 3B CILOXAN OPHTHALMIC

OINTMENT3

B CILOXAN OPHTHALMIC SOLUTION 3g ciprofloxacin hcl ophthalmic 1


29

Drug Name Drug Tier


g erythromycin ophthalmic 1B ILEVRO EB INVELTYS 3g ketorolac tromethamine ophthalmic 1B LASTACAFT 3 QLB LOTEMAX OPHTHALMIC GEL EB LOTEMAX OPHTHALMIC

OINTMENT3

B LOTEMAX OPHTHALMIC SUSPENSION

3 QL

B LOTEMAX SM 3 QLg loteprednol etabonate 3 QLB MAXITROL 3B MOXEZA 3g moxifloxacin hcl ophthalmic 3g neomycin-polymyxin-dexameth

ophthalmic ointment1

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

1

B NEVANAC 3B OCUFLOX 3g ofloxacin ophthalmic 1g olopatadine hcl ophthalmic solution

0.1 %3 QL

g olopatadine hcl ophthalmic solution 0.2 %

E QL

g polymyxin b-trimethoprim 1B POLYTRIM 3B PRED FORTE 3B PRED MILD 3g prednisolone acetate ophthalmic 1B TOBRADEX OPHTHALMIC

OINTMENT3

B TOBRADEX OPHTHALMIC SUSPENSION

3

B TOBRADEX ST Eg tobramycin ophthalmic 1g tobramycin-dexamethasone 2B TOBREX OPHTHALMIC OINTMENT 3B TOBREX OPHTHALMIC SOLUTION 3

Drug Name Drug Tier


Ophthalmic Agents - Drugs for GlaucomaB ALPHAGAN P OPHTHALMIC

SOLUTION 0.1 %2 QL

B ALPHAGAN P OPHTHALMIC SOLUTION 0.15 %

3 QL

B AZOPT 2 QLB BETIMOL 2 QLg bimatoprost ophthalmic E QLg brimonidine tartrate ophthalmic

solution 0.15 %2 QL

g brimonidine tartrate ophthalmic solution 0.2 %

1

B COMBIGAN 2 QLB COSOPT 3g dorzolamide hcl-timolol mal 2g dorzolamide hcl-timolol mal pf E QLB ISTALOL 3g latanoprost ophthalmic 1B LUMIGAN 2B RHOPRESSA 3 QLB ROCKLATAN 3 QLg timolol maleate ophthalmic gel

forming solution1

g timolol maleate ophthalmic solution 0.25 %, 0.5 %

1

g timolol maleate ophthalmic solution 0.5 % (daily)

3

B TIMOPTIC 3B TIMOPTIC OCUDOSE 2B TIMOPTIC-XE 3B TRAVATAN Z 3 QLg travoprost (bak free) 2 QLB VYZULTA E ST, QLB XELPROS 3 QL

Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions

B CEQUA E PA, QLB RESTASIS 3 PA, QLB RESTASIS MULTIDOSE E PA, QLB XIIDRA 3 PA, QL


30

Drug Name Drug Tier


Otic Agents - Drugs for Ear ConditionsB CIPRODEX 3g neomycin-polymyxin-hc otic 1g ofloxacin otic 2

Respiratory - Drugs for AnaphylaxisB AUVI-Q E QLg epinephrine solution auto-injector

0.15 mg/0.3ml injection (generic EPIPEN Jr)

2 QL

g epinephrine solution auto-injector 0.3 mg/0.3ml injection (generic EPIPEN)

2 QL

B SYMJEPI 2 QL

Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold

g azelastine hcl nasal solution 0.1 %, 137 mcg/spray

3

g azelastine hcl nasal solution 0.15 % Eg benzonatate oral capsule 100 mg,

200 mg1

g benzonatate oral capsule 150 mg Eg bromfed dm 1g cyproheptadine hcl oral 1g fluticasone propionate nasal 2 QLg hydrocodone polst-cpm polst er 3 PA, QLg ipratropium bromide nasal 1g levocetirizine dihydrochloride oral

solution3

g levocetirizine dihydrochloride oral tablet

1

B OMNARIS E QLg promethazine hcl oral solution 1g promethazine hcl oral syrup 1g promethazine-codeine 1 PA, QLg promethazine-dm 1g pseudoephedrine-bromphen-dm 1B TESSALON PERLES 3B TUSSICAPS 3 PA, QLB XHANCE E QLB ZETONNA 3 QL

Drug Name Drug Tier


Respiratory Tract / Pulmonary Agents - Drugs for Asthma and COPD

B ADVAIR DISKUS 3 QL, RSB ADVAIR HFA 3 QL, RSB AIRDUO RESPICLICK 113/14 E QLB AIRDUO RESPICLICK 232/14 E QLB AIRDUO RESPICLICK 55/14 E QLg albuterol sulfate er 1g albuterol sulfate hfa aerosol solution

108 (90 base) mcg/act inhalation (generic PROAIR HFA, PROVENTIL HFA)

3 QL

B ALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) MCG/ACT INHALATION (VENTOLIN HFA)

E QL

g albuterol sulfate inhalation 1g albuterol sulfate oral 3 PAB ALVESCO E QLB ANORO ELLIPTA 3 QLB ARNUITY ELLIPTA 1 QLB ASMANEX E QLB ASMANEX HFA INHALATION

AEROSOL 100 MCG/ACT, 200 MCG/ACT

E QL

B ATROVENT HFA 3 QLB BEVESPI AEROSPHERE 2 QLB BREO ELLIPTA 3 QL, RSg budesonide inhalation 2 QLB COMBIVENT RESPIMAT 3 QLB EASIVENT 3B FASENRA PEN 3 PA, QL, SPB FLOVENT DISKUS 1 QLB FLOVENT HFA 1 QLg fluticasone-salmeterol inhalation

aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

E QL, RS

B FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT

2 QL

B INCRUSE ELLIPTA E QLg ipratropium-albuterol 2


31

Drug Name Drug Tier


B LEVALBUTEROL HFA INHALATION AEROSOL 45 MCG/ACT

3 QL

g montelukast sodium oral packet 2g montelukast sodium oral tablet 1g montelukast sodium oral tablet

chewable1

B NUCALA 3 PA, QL, SPB PERFOROMIST 3 QLB PROAIR HFA 3 QLB PROAIR RESPICLICK 3 QLB PROVENTIL HFA 3 QLB PULMICORT FLEXHALER 1 QLB QVAR REDIHALER E QLB SEREVENT DISKUS 2 QLB SINGULAIR ORAL PACKET 3B SPIRIVA HANDIHALER 2 QLB SPIRIVA RESPIMAT 2 QLB STRIVERDI RESPIMAT 2 QLB SYMBICORT 3 QL, RSB TRELEGY ELLIPTA 3 QL, RSB VENTOLIN HFA 2 QLg wixela inhub E QL, RSB XOPENEX HFA 3 QLB YUPELRI 3 PA, QL

Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis

B BETHKIS 2 PA, QL, SPB KITABIS PAK E PA, QL, SPB PULMOZYME 2 PA, QL, SPB TOBI PODHALER 3 PA, QL, SPg tobramycin nebulization solution

300 mg/5ml inhalationE PA, QL, SP

B TOBRAMYCIN NEBULIZATION SOLUTION 300 MG/5ML INHALATION

E PA, QL, SP

Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension

B ADEMPAS 2 PA, QL, SPg bosentan 2 PA, QL, SPB OPSUMIT 2 PA, QL, SPB ORENITRAM 3 PA, QL, SPB TRACLEER 2 PA, QL, SPB TYVASO 2 PA, SP

Drug Name Drug Tier


Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm

g baclofen oral 1g carisoprodol oral tablet 250 mg Eg carisoprodol oral tablet 350 mg 1g cyclobenzaprine hcl er Eg cyclobenzaprine hcl oral 5 mg,

10 mg1

g metaxalone 3g methocarbamol oral 1B OZOBAX 3 PAB ROBAXIN-750 3B SOMA ORAL TABLET 350 MG 3g tizanidine hcl oral capsule 3g tizanidine hcl oral tablet 1B ZANAFLEX ORAL CAPSULE 3

Sleep Disorder AgentsB EDLUAR E QLg eszopiclone 2 QLg modafinil 2 PA, QLB RESTORIL 3B SUNOSI 3 PA, QLg temazepam 1B WAKIX 3 PA, QL, SPB XYREM 3 PA, QL, SPg zolpidem tartrate er 3 QLg zolpidem tartrate oral 1 QLg zolpidem tartrate sublingual E QL

32

A

ABILIFY MYCITE . . . . . . . . . . . . . . . . 13ABSORICA . . . . . . . . . . . . . . . . . . . . . 18ACCU-CHEK AVIVA CONNECT KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . 20ACCU-CHEK AVIVA DEVICE . . . . . . 20ACCU-CHEK AVIVA PLUS KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . 20ACCU-CHEK AVIVA PLUS TEST STRIPS . . . . . . . . . . . . . . . . . . . . . . . . 20ACCU-CHEK COMPACT PLUS CARE KIT . . . . . . . . . . . . . . . . . . . . . . 20ACCU-CHEK COMPACT PLUS TEST STRIPS . . . . . . . . . . . . . . . . . . . 20ACCU-CHEK GUIDE TEST STRIPS . 20ACCU-CHEK GUIDE/GUIDE ME KIT W/DEVICE . . . . . . . . . . . . . . . . . . 20ACCU-CHEK NANO SMARTVIEW KIT W/DEVICE . . . . . . . . . . . . . . . . . . 20ACCU-CHEK SMARTVIEW TEST STRIPS . . . . . . . . . . . . . . . . . . . . . . . . 20ACCU-CHEK SOFTCLIX LANCET DEVICE KIT . . . . . . . . . . . . . . . . . . . . 20ACCUPRIL . . . . . . . . . . . . . . . . . . . . . 14acetaminophen-codeine . . . . . . . . . . . 8acetaminophen-codeine #2 . . . . . . . . 8acetaminophen-codeine #3 . . . . . . . . 8acetaminophen-codeine #4 . . . . . . . . 8acetazolamide er . . . . . . . . . . . . . . . . 14acetazolamide oral . . . . . . . . . . . . . . 14ACIPHEX SPRINKLE . . . . . . . . . . . . . 22ACTEMRA . . . . . . . . . . . . . . . . . . . . . 27ACTIGALL . . . . . . . . . . . . . . . . . . . . . 23ACULAR . . . . . . . . . . . . . . . . . . . . . . . 28ACULAR LS . . . . . . . . . . . . . . . . . . . . 28ACUVAIL . . . . . . . . . . . . . . . . . . . . . . . 28acyclovir oral . . . . . . . . . . . . . . . . . . . 13ACZONE EXTERNAL GEL . . . . . . . . 18ADALAT CC ORAL TABLET EXTENDED RELEASE 24 HOUR 60 MG . . . . . . . . . . . . . . . . . . . . . . . . . 14ADDERALL XR . . . . . . . . . . . . . . . . . 16ADDYI . . . . . . . . . . . . . . . . . . . . . . . . . 22ADEMPAS . . . . . . . . . . . . . . . . . . . . . 31ADHANSIA XR . . . . . . . . . . . . . . . . . . 16ADLYXIN . . . . . . . . . . . . . . . . . . . . . . . 21ADMELOG . . . . . . . . . . . . . . . . . . . . . 20

IndexADVAIR DISKUS . . . . . . . . . . . . . . . . 30ADVAIR HFA . . . . . . . . . . . . . . . . . . . . 30ADVATE . . . . . . . . . . . . . . . . . . . . . . . 22ADYNOVATE . . . . . . . . . . . . . . . . . . . 22AEMCOLO . . . . . . . . . . . . . . . . . . . . . 23afirmelle . . . . . . . . . . . . . . . . . . . . . . . 24AFREZZA INHALATION POWDER . 20AFSTYLA INTRAVENOUS KIT . . . . . 22AIMOVIG. . . . . . . . . . . . . . . . . . . . . . . 12AIRDUO RESPICLICK 113/14 . . . . . 30AIRDUO RESPICLICK 232/14 . . . . . 30AIRDUO RESPICLICK 55/14 . . . . . . 30ALA SCALP . . . . . . . . . . . . . . . . . . . . 18ala-cort external cream 1 % . . . . . . . 18ala-cort external cream 2.5 % . . . . . 18albuterol sulfate er . . . . . . . . . . . . . . . 30albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation (generic PROAIR HFA, PROVENTIL HFA) . . . . . . . . . . . . . . . 30ALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) MCG/ACT INHALATION (VENTOLIN HFA) . . . . . . . . . . . . . . . . 30albuterol sulfate inhalation . . . . . . . . 30albuterol sulfate oral . . . . . . . . . . . . . 30ALDACTONE . . . . . . . . . . . . . . . . . . . 14ALDARA . . . . . . . . . . . . . . . . . . . . . . . 18alendronate sodium . . . . . . . . . . . . . 28alfuzosin hcl er . . . . . . . . . . . . . . . . . . 23aliskiren fumarate . . . . . . . . . . . . . . . 14allopurinol oral . . . . . . . . . . . . . . . . . . 12ALOGLIPTIN BENZOATE . . . . . . . . . 21ALOGLIPTIN-METFORMIN HCL . . . 21ALOGLIPTIN-PIOGLITAZONE . . . . . 21ALORA TRANSDERMAL PATCH TWICE WEEKLY 0.025 MG/24HR, 0.075 MG/24HR, 0.1 MG/24HR . . . . 24ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % . . . . . . . . . . . . . . . . 29ALPHAGAN P OPHTHALMIC SOLUTION 0.15 % . . . . . . . . . . . . . . . 29alprazolam er . . . . . . . . . . . . . . . . . . . 14alprazolam intensol . . . . . . . . . . . . . . 14alprazolam oral . . . . . . . . . . . . . . . . . 14alprazolam xr . . . . . . . . . . . . . . . . . . . 14ALREX . . . . . . . . . . . . . . . . . . . . . . . . 28

ALTACE . . . . . . . . . . . . . . . . . . . . . . . . 14altavera . . . . . . . . . . . . . . . . . . . . . . . . 24ALTOPREV . . . . . . . . . . . . . . . . . . . . . 14ALTRENO . . . . . . . . . . . . . . . . . . . . . . 18ALVESCO . . . . . . . . . . . . . . . . . . . . . . 30alyacen 1/35 . . . . . . . . . . . . . . . . . . . . 24AMARYL . . . . . . . . . . . . . . . . . . . . . . . 21AMERGE . . . . . . . . . . . . . . . . . . . . . . 12amethia . . . . . . . . . . . . . . . . . . . . . . . . 24amethia lo . . . . . . . . . . . . . . . . . . . . . . 24amiodarone hcl oral . . . . . . . . . . . . . 14amitriptyline hcl oral . . . . . . . . . . . . . 11amlodipine besylate oral . . . . . . . . . . 14amlodipine besylate-benazepril hcl . 14amlodipine besylate-valsartan . . . . . 14amnesteem . . . . . . . . . . . . . . . . . . . . 18amoxicillin . . . . . . . . . . . . . . . . . . . . . . . 9amoxicillin-potassium clavulanate er . 9amoxicillin-potassium clavulanate oral . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9amphetamine-dextroamphetamine . 16amphetamine-dextroamphetamine er . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16AMZEEQ AER 4% . . . . . . . . . . . . . . . 18ANASPAZ . . . . . . . . . . . . . . . . . . . . . . 23anastrozole oral . . . . . . . . . . . . . . . . . 13ANDRODERM . . . . . . . . . . . . . . . . . . 27ANORO ELLIPTA . . . . . . . . . . . . . . . . 30apap-caff-dihydrocodeine oral capsule . . . . . . . . . . . . . . . . . . . . . . . . . 8apri . . . . . . . . . . . . . . . . . . . . . . . . . . . 24APRISO . . . . . . . . . . . . . . . . . . . . . . . 28APTENSIO XR . . . . . . . . . . . . . . . . . . 17ARAKODA . . . . . . . . . . . . . . . . . . . . . 13ARANESP (ALBUMIN FREE) . . . . . . 22ARICEPT ORAL TABLET 10 MG, 5 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 11aripiprazole oral solution . . . . . . . . . 13aripiprazole oral tablet . . . . . . . . . . . 13aripiprazole oral tablet dispersible . 13ARMOUR THYROID . . . . . . . . . . . . . 27ARNUITY ELLIPTA . . . . . . . . . . . . . . 30ARYMO ER . . . . . . . . . . . . . . . . . . . . . . 8ashlyna . . . . . . . . . . . . . . . . . . . . . . . . 24ASMANEX . . . . . . . . . . . . . . . . . . . . . 30

33

ASMANEX HFA INHALATION AEROSOL 100 MCG/ACT, 200 MCG/ACT . . . . . . . . . . . . . . . . . . 30ASTAGRAF XL . . . . . . . . . . . . . . . . . . 27atenolol oral . . . . . . . . . . . . . . . . . . . . 14atenolol-chlorthalidone . . . . . . . . . . . 14atomoxetine hcl . . . . . . . . . . . . . . . . . 17atorvastatin calcium oral tablet 10 mg, 20 mg . . . . . . . . . . . . . . . . . . . 15atorvastatin calcium oral tablet 40 mg, 80 mg . . . . . . . . . . . . . . . . . . . 15atovaquone-proguanil hcl . . . . . . . . . 13ATRIPLA . . . . . . . . . . . . . . . . . . . . . . . 13ATROVENT HFA . . . . . . . . . . . . . . . . 30AUBAGIO . . . . . . . . . . . . . . . . . . . . . . 17aubra . . . . . . . . . . . . . . . . . . . . . . . . . . 24aubra eq . . . . . . . . . . . . . . . . . . . . . . . 24AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML . . . . . . . . . . . . . . . 9aurovela 1/20 . . . . . . . . . . . . . . . . . . . 24aurovela 1.5/30 . . . . . . . . . . . . . . . . . 24aurovela 24 fe . . . . . . . . . . . . . . . . . . . 24aurovela fe 1/20 . . . . . . . . . . . . . . . . . 24aurovela fe 1.5/30 . . . . . . . . . . . . . . . 24AURYXIA . . . . . . . . . . . . . . . . . . . . . . 23AUSTEDO . . . . . . . . . . . . . . . . . . . . . . 17AUVI-Q . . . . . . . . . . . . . . . . . . . . . . . . 30AVALIDE . . . . . . . . . . . . . . . . . . . . . . . 15AVAPRO . . . . . . . . . . . . . . . . . . . . . . . 15aviane . . . . . . . . . . . . . . . . . . . . . . . . . 24avidoxy . . . . . . . . . . . . . . . . . . . . . . . . . 9AVONEX . . . . . . . . . . . . . . . . . . . . . . . 17AYGESTIN . . . . . . . . . . . . . . . . . . . . . 24ayuna . . . . . . . . . . . . . . . . . . . . . . . . . 24AZASAN . . . . . . . . . . . . . . . . . . . . . . . 27AZASITE . . . . . . . . . . . . . . . . . . . . . . . 28azathioprine oral . . . . . . . . . . . . . . . . 27azelaic acid external . . . . . . . . . . . . . 18azelastine hcl nasal solution 0.1 %, 137 mcg/spray . . . . . . . . . . . . . . . . . . 30azelastine hcl nasal solution 0.15 % . 30azelastine hcl ophthalmic . . . . . . . . . 28azithromycin oral . . . . . . . . . . . . . . . . . 9AZOPT . . . . . . . . . . . . . . . . . . . . . . . . 29AZULFIDINE . . . . . . . . . . . . . . . . . . . . 28AZULFIDINE EN-TABS . . . . . . . . . . . 28azurette . . . . . . . . . . . . . . . . . . . . . . . . 24

B

baclofen oral . . . . . . . . . . . . . . . . . . . 31BACTRIM . . . . . . . . . . . . . . . . . . . . . . . 9BACTRIM DS . . . . . . . . . . . . . . . . . . . . 9BAFIERTAM CAPSULE . . . . . . . . . . . 17balziva . . . . . . . . . . . . . . . . . . . . . . . . . 24BAQSIMI ONE PACK . . . . . . . . . . . . . 21BAQSIMI TWO PACK . . . . . . . . . . . . 21BARACLUDE ORAL SOLUTION . . . 13BASAGLAR KWIKPEN . . . . . . . . . . . 20BD AUTOSHIELD DUO PEN NEEDLES . . . . . . . . . . . . . . . . . . . . . . 20BD ULTRA-FINE INSULIN SYRINGES . . . . . . . . . . . . . . . . . . . . . 20BD ULTRA-FINE PEN NEEDLES . . . 20bekyree . . . . . . . . . . . . . . . . . . . . . . . . 24BELBUCA . . . . . . . . . . . . . . . . . . . . . . . 8benazepril hcl oral . . . . . . . . . . . . . . . 15benazepril-hydrochlorothiazide . . . . 15benzonatate oral capsule 100 mg, 200 mg . . . . . . . . . . . . . . . . . . . . . . . . 30benzonatate oral capsule 150 mg . . 30BESIVANCE . . . . . . . . . . . . . . . . . . . . 28betamethasone dipropionate aug external cream . . . . . . . . . . . . . . . . . . 18betamethasone dipropionate aug external gel . . . . . . . . . . . . . . . . . . . . . 18betamethasone dipropionate aug external lotion . . . . . . . . . . . . . . . . . . 18betamethasone dipropionate aug external ointment . . . . . . . . . . . . . . . . 18betamethasone dipropionate external cream . . . . . . . . . . . . . . . . . . 18betamethasone dipropionate external lotion . . . . . . . . . . . . . . . . . . 18betamethasone dipropionate external ointment . . . . . . . . . . . . . . . . 18BETASERON . . . . . . . . . . . . . . . . . . . 17BETHKIS . . . . . . . . . . . . . . . . . . . . . . 31BETIMOL . . . . . . . . . . . . . . . . . . . . . . 29BEVESPI AEROSPHERE . . . . . . . . . 30BEVYXXA . . . . . . . . . . . . . . . . . . . . . . 10bexarotene . . . . . . . . . . . . . . . . . . . . . 13BIDIL . . . . . . . . . . . . . . . . . . . . . . . . . . 15BIJUVA . . . . . . . . . . . . . . . . . . . . . . . . 24BIKTARVY . . . . . . . . . . . . . . . . . . . . . 13bimatoprost ophthalmic . . . . . . . . . . 29bisoprolol fumarate . . . . . . . . . . . . . . 15bisoprolol-hydrochlorothiazide . . . . 15

blisovi 24 fe . . . . . . . . . . . . . . . . . . . . 24blisovi fe 1/20 . . . . . . . . . . . . . . . . . . . 24blisovi fe 1.5/30 . . . . . . . . . . . . . . . . . 24BONIVA ORAL . . . . . . . . . . . . . . . . . . 28BONJESTA . . . . . . . . . . . . . . . . . . . . . 12bosentan . . . . . . . . . . . . . . . . . . . . . . 31BREO ELLIPTA . . . . . . . . . . . . . . . . . 30briellyn . . . . . . . . . . . . . . . . . . . . . . . . 24BRILINTA . . . . . . . . . . . . . . . . . . . . . . 13brimonidine tartrate ophthalmic solution 0.15 % . . . . . . . . . . . . . . . . . . 29brimonidine tartrate ophthalmic solution 0.2 % . . . . . . . . . . . . . . . . . . . 29bromfed dm . . . . . . . . . . . . . . . . . . . . 30budesonide er . . . . . . . . . . . . . . . . . . 28budesonide inhalation. . . . . . . . . . . . 30budesonide oral . . . . . . . . . . . . . . . . . 28BUNAVAIL . . . . . . . . . . . . . . . . . . . . . . 9buprenorphine hcl sublingual . . . . . . 9buprenorphine hcl-naloxone hcl . . . . 9bupropion hcl er (sr) . . . . . . . . . . . . . 11bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg . . . . . . . . . . . . . . . . . . . . . . . . 11BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG . . . . . . . . . . . . . . . 11bupropion hcl oral . . . . . . . . . . . . . . . 11buspirone hcl oral . . . . . . . . . . . . . . . 14butalbital-apap-caffeine oral capsule 50-300-40 mg . . . . . . . . . . . . 8butalbital-apap-caffeine oral capsule 50-325-40 mg . . . . . . . . . . . . 8butalbital-apap-caffeine oral tablet . . 8BYDUREON . . . . . . . . . . . . . . . . . . . . 21BYDUREON BCISE AUTOINJECTOR . . . . . . . . . . . . . . . . 21BYETTA . . . . . . . . . . . . . . . . . . . . . . . 21BYSTOLIC . . . . . . . . . . . . . . . . . . . . . 15

C

cabergoline . . . . . . . . . . . . . . . . . . . . 27CALAN SR . . . . . . . . . . . . . . . . . . . . . 15calcipotriene-betameth diprop external ointment . . . . . . . . . . . . . . . . 18calcitriol external . . . . . . . . . . . . . . . . 18calcitriol oral . . . . . . . . . . . . . . . . . . . . 28camila . . . . . . . . . . . . . . . . . . . . . . . . . 24camrese . . . . . . . . . . . . . . . . . . . . . . . 24

34

camrese lo . . . . . . . . . . . . . . . . . . . . . 24capecitabine . . . . . . . . . . . . . . . . . . . 13CAPEX . . . . . . . . . . . . . . . . . . . . . . . . 18CARAC . . . . . . . . . . . . . . . . . . . . . . . . 18CARAFATE . . . . . . . . . . . . . . . . . . . . . 22carbamazepine er oral capsule extended release 12 hour . . . . . . . . . 10carbamazepine er oral tablet extended release 12 hour . . . . . . . . . 10carbamazepine oral . . . . . . . . . . . . . 10CARBATROL . . . . . . . . . . . . . . . . . . . 10carbidopa-levodopa . . . . . . . . . . . . . 13carbidopa-levodopa er . . . . . . . . . . . 13CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG . . . . . . . . . . . . . . . . . . . . . . . . 15CARDURA . . . . . . . . . . . . . . . . . . . . . 15carisoprodol oral tablet 250 mg . . . . 31carisoprodol oral tablet 350 mg . . . . 31CAROSPIR . . . . . . . . . . . . . . . . . . . . . 15cartia xt . . . . . . . . . . . . . . . . . . . . . . . . 15carvedilol . . . . . . . . . . . . . . . . . . . . . . 15CATAPRES . . . . . . . . . . . . . . . . . . . . . 15cavarest . . . . . . . . . . . . . . . . . . . . . . . 17cefadroxil . . . . . . . . . . . . . . . . . . . . . . . 9cefdinir . . . . . . . . . . . . . . . . . . . . . . . . . 9cefuroxime axetil . . . . . . . . . . . . . . . . . 9celecoxib oral. . . . . . . . . . . . . . . . . . . . 9CENTANY . . . . . . . . . . . . . . . . . . . . . . . 9CENTANY AT . . . . . . . . . . . . . . . . . . . . 9cephalexin . . . . . . . . . . . . . . . . . . . . . . 9CEQUA . . . . . . . . . . . . . . . . . . . . . . . . 29CERDELGA . . . . . . . . . . . . . . . . . . . . 23CHANTIX . . . . . . . . . . . . . . . . . . . . . . . 9chateal . . . . . . . . . . . . . . . . . . . . . . . . 24chateal eq . . . . . . . . . . . . . . . . . . . . . . 24chlorhexidine gluconate mouth/throat. . . . . . . . . . . . . . . . . . . . . . . . . . 17chlorthalidone . . . . . . . . . . . . . . . . . . 15chorionic gonadotropin intramuscular . . . . . . . . . . . . . . . . . . . 28ciclodan . . . . . . . . . . . . . . . . . . . . . . . 12ciclopirox external gel . . . . . . . . . . . . 12ciclopirox external shampoo . . . . . . 12ciclopirox external solution . . . . . . . . 12ciclopirox treatment . . . . . . . . . . . . . 12CILOXAN OPHTHALMIC OINTMENT . . . . . . . . . . . . . . . . . . . . . 28

CILOXAN OPHTHALMIC SOLUTION . . . . . . . . . . . . . . . . . . . . . 28CIMDUO . . . . . . . . . . . . . . . . . . . . . . . 13CIMZIA . . . . . . . . . . . . . . . . . . . . . . . . 27CIPRO ORAL TABLET . . . . . . . . . . . . 9CIPRODEX . . . . . . . . . . . . . . . . . . . . . 30ciprofloxacin hcl ophthalmic . . . . . . 28ciprofloxacin hcl oral . . . . . . . . . . . . . 10citalopram hydrobromide . . . . . . . . . 11claravis . . . . . . . . . . . . . . . . . . . . . . . . 18clarithromycin er . . . . . . . . . . . . . . . . 10clarithromycin oral suspension reconstituted . . . . . . . . . . . . . . . . . . . 10clarithromycin oral tablet . . . . . . . . . 10CLENPIQ . . . . . . . . . . . . . . . . . . . . . . 23CLEOCIN ORAL CAPSULE 150 MG, 300 MG . . . . . . . . . . . . . . . . . . . 10CLEOCIN ORAL CAPSULE 75 MG . 10CLEOCIN-T EXTERNAL GEL . . . . . . 18CLEOCIN-T EXTERNAL LOTION . . . 18CLIMARA PRO . . . . . . . . . . . . . . . . . 24clindacin etz external swab . . . . . . . 18clindacin-p . . . . . . . . . . . . . . . . . . . . . 18CLINDAGEL . . . . . . . . . . . . . . . . . . . . 18clindamycin hcl oral . . . . . . . . . . . . . 10clindamycin phos-benzoyl perox external gel 1.2-5 % . . . . . . . . . . . . . . 18clindamycin phosphate external foam . . . . . . . . . . . . . . . . . . . . . . . . . . 18clindamycin phosphate external lotion . . . . . . . . . . . . . . . . . . . . . . . . . . 18clindamycin phosphate external solution . . . . . . . . . . . . . . . . . . . . . . . . 18clindamycin phosphate external swab . . . . . . . . . . . . . . . . . . . . . . . . . . 18CLINDAMYCIN PHOSPHATE GEL 1 % EXTERNAL . . . . . . . . . . . . . . . . . 18CLINDESSE . . . . . . . . . . . . . . . . . . . . 10clinpro 5000 . . . . . . . . . . . . . . . . . . . . 17clobetasol propionate external cream . . . . . . . . . . . . . . . . . . . . . . . . . 18clobetasol propionate external foam . . . . . . . . . . . . . . . . . . . . . . . . . . 18clobetasol propionate external gel . 18clobetasol propionate external liquid . . . . . . . . . . . . . . . . . . . . . . . . . . 18clobetasol propionate external lotion . . . . . . . . . . . . . . . . . . . . . . . . . . 18clobetasol propionate external ointment . . . . . . . . . . . . . . . . . . . . . . . 18

clobetasol propionate external shampoo . . . . . . . . . . . . . . . . . . . . . . 18clobetasol propionate external solution . . . . . . . . . . . . . . . . . . . . . . . . 18clodan external shampoo . . . . . . . . . 18clonazepam oral . . . . . . . . . . . . . . . . 14clonidine hcl oral . . . . . . . . . . . . . . . . 15clopidogrel bisulfate oral . . . . . . . . . 13clotrimazole-betamethasone external cream . . . . . . . . . . . . . . . . . . 18clotrimazole-betamethasone external lotion . . . . . . . . . . . . . . . . . . 18clovique . . . . . . . . . . . . . . . . . . . . . . . 23[Co-Brand Logo] *****COLCHICINE ORAL CAPSULE . . . . 12colchicine oral tablet . . . . . . . . . . . . . 12COLCRYS . . . . . . . . . . . . . . . . . . . . . . 12colesevelam hcl . . . . . . . . . . . . . . . . . 15COMBIGAN . . . . . . . . . . . . . . . . . . . . 29COMBIVENT RESPIMAT . . . . . . . . . 30CONCERTA . . . . . . . . . . . . . . . . . . . . 17CONTOUR NEXT EZ BLOOD GLUCOSE MONITORING SYSTEM . 20CONTOUR NEXT MONITOR . . . . . . 20CONTOUR NEXT ONE BLOOD GLUCOSE MONITORING SYSTEM . 20CONTOUR NEXT TEST . . . . . . . . . . 20CONTOUR TEST . . . . . . . . . . . . . . . . 20CONZIP . . . . . . . . . . . . . . . . . . . . . . . . 8COREG . . . . . . . . . . . . . . . . . . . . . . . . 15coremino . . . . . . . . . . . . . . . . . . . . . . 10CORGARD . . . . . . . . . . . . . . . . . . . . . 15CORLANOR . . . . . . . . . . . . . . . . . . . . 15CORTEF . . . . . . . . . . . . . . . . . . . . . . . 26CORTIFOAM . . . . . . . . . . . . . . . . . . . 28COSENTYX . . . . . . . . . . . . . . . . . . . . 27COSOPT . . . . . . . . . . . . . . . . . . . . . . . 29COUMADIN . . . . . . . . . . . . . . . . . . . . 10COZAAR . . . . . . . . . . . . . . . . . . . . . . 15CREON . . . . . . . . . . . . . . . . . . . . . . . . 23CRESEMBA ORAL . . . . . . . . . . . . . . 12CRINONE VAGINAL GEL 4 % . . . . . 28CRINONE VAGINAL GEL 8 % . . . . . 28cryselle-28 . . . . . . . . . . . . . . . . . . . . . 24CUPRIMINE . . . . . . . . . . . . . . . . . . . . 23cyclafem 1/35 . . . . . . . . . . . . . . . . . . 24cyclobenzaprine hcl er . . . . . . . . . . . 31

35

cyclobenzaprine hcl oral 5 mg, 10 mg . . . . . . . . . . . . . . . . . . . . . . . . . 31cyclosporine modified . . . . . . . . . . . 27cyproheptadine hcl oral . . . . . . . . . . 30cyred . . . . . . . . . . . . . . . . . . . . . . . . . . 24cyred eq . . . . . . . . . . . . . . . . . . . . . . . 24CYTOTEC . . . . . . . . . . . . . . . . . . . . . . 22

D

dalfampridine er. . . . . . . . . . . . . . . . . 17dapsone external gel 5 % . . . . . . . . . 18dasetta 1/35 . . . . . . . . . . . . . . . . . . . . 24daysee . . . . . . . . . . . . . . . . . . . . . . . . 24DDAVP INJECTION . . . . . . . . . . . . . . 27DDAVP ORAL. . . . . . . . . . . . . . . . . . . 27deblitane . . . . . . . . . . . . . . . . . . . . . . . 24DECADRON . . . . . . . . . . . . . . . . . . . . 26delyla . . . . . . . . . . . . . . . . . . . . . . . . . 24denta 5000 plus . . . . . . . . . . . . . . . . . 17dentagel . . . . . . . . . . . . . . . . . . . . . . . 17DEPAKOTE . . . . . . . . . . . . . . . . . . 10, 11DEPAKOTE ER . . . . . . . . . . . . . . . . . . 11DEPAKOTE SPRINKLES . . . . . . . . . . 11DEPEN TITRATABS . . . . . . . . . . . . . . 23DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 MG/ML . . . . . . . . . . . . . . . . . . . . 24DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE . . . . . . . . . . . . 24DEPO-SUBQ PROVERA 104 . . . . . . 24DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 100 MG/ML . . . . . . . . . . . . . . . . . . . . 27DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 200 MG/ML . . . . . . . . . . . . . . . . . . . . 27DERMA-SMOOTHE/FS BODY . . . . . 18DERMA-SMOOTHE/FS SCALP . . . . 18DESCOVY. . . . . . . . . . . . . . . . . . . . . . 13desmopressin acetate injection . . . . 27desmopressin acetate oral . . . . . . . . 27desogestrel-ethinyl estradiol oral tablet 0.15-0.02/0.01 mg (21/5) . . . . 24desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg . . . . . . . . . . . 24desonide cream, lotion, ointment . . 18desonide gel . . . . . . . . . . . . . . . . . . . 18DESOWEN . . . . . . . . . . . . . . . . . . . . . 18

desvenlafaxine succinate er . . . . . . . 11dexamethasone intensol . . . . . . . . . . 26dexamethasone oral elixir . . . . . . . . . 26dexamethasone oral solution . . . . . . 26dexamethasone oral tablet . . . . . . . . 26dexamethasone oral tablet therapy pack . . . . . . . . . . . . . . . . . . . . . . . . . . 26DEXCOM G4 / G5 / G6 RECEIVER, TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC) . . . . . . . . . . 20DEXCOM G4 / G5 / G6 RECEIVER, TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC) DEVICE . . . 20DEXILANT . . . . . . . . . . . . . . . . . . . . . 22dexmethylphenidate hcl . . . . . . . . . . 17dexmethylphenidate hcl er . . . . . . . . 17DEXPAK . . . . . . . . . . . . . . . . . . . . . . . 26dextroamphetamine sulfate er . . . . . 17dextroamphetamine sulfate oral solution . . . . . . . . . . . . . . . . . . . . . . . . 17dextroamphetamine sulfate oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 17diazepam intensol . . . . . . . . . . . . . . . 14diazepam oral . . . . . . . . . . . . . . . . . . 14diclofenac potassium . . . . . . . . . . . . . 9diclofenac sodium er . . . . . . . . . . . . . . 9diclofenac sodium oral . . . . . . . . . . . . 9diclofenac sodium transdermal gel 1 % . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9diclofenac sodium transdermal solution . . . . . . . . . . . . . . . . . . . . . . . . . 9dicyclomine hcl oral . . . . . . . . . . . . . 23DIFICID . . . . . . . . . . . . . . . . . . . . . . . . 10DIFLUCAN ORAL SUSPENSION RECONSTITUTED . . . . . . . . . . . . . . . 12DIFLUCAN ORAL TABLET 100 MG, 150 MG, 200 MG . . . . . . . . . . . . . . . . 12DIFLUCAN ORAL TABLET 50 MG . . 12DILAUDID ORAL . . . . . . . . . . . . . . . . . 8dilt-xr . . . . . . . . . . . . . . . . . . . . . . . . . . 15diltiazem hcl er coated beads . . . . . 15diltiazem hcl er oral capsule extended release 12 hour . . . . . . . . . 15diltiazem hcl oral . . . . . . . . . . . . . . . . 15dimethyl fumarate . . . . . . . . . . . . . . . 17DIPENTUM . . . . . . . . . . . . . . . . . . . . . 28diphenoxylate-atropine . . . . . . . . . . . 23DIPROLENE . . . . . . . . . . . . . . . . . . . . 18

DIPROLENE AF . . . . . . . . . . . . . . . . . 18DITROPAN XL . . . . . . . . . . . . . . . . . . 23divalproex sodium er . . . . . . . . . . . . . 11divalproex sodium oral capsule delayed release sprinkle . . . . . . . . . . 11divalproex sodium oral tablet delayed release . . . . . . . . . . . . . . . . . 11DIVIGEL TRANSDERMAL GEL . . . . 24donepezil hcl oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 11donepezil hcl oral tablet 23 mg . . . . 11donepezil hcl oral tablet dispersible . . . . . . . . . . . . . . . . . . . . . 11DORYX MPC . . . . . . . . . . . . . . . . . . . 10dorzolamide hcl-timolol mal . . . . . . . 29dorzolamide hcl-timolol mal pf . . . . . 29dotti . . . . . . . . . . . . . . . . . . . . . . . . . . . 24DOVATO . . . . . . . . . . . . . . . . . . . . . . . 14doxazosin mesylate oral . . . . . . . . . . 15doxepin hcl oral capsule . . . . . . . . . . 11doxepin hcl oral concentrate . . . . . . 11doxycycline hyclate oral capsule . . . 10doxycycline hyclate oral tablet 100 mg . . . . . . . . . . . . . . . . . . . . . . . . 10doxycycline hyclate oral tablet 150 mg, 50 mg, 75 mg . . . . . . . . . . . 10doxycycline hyclate oral tablet 20 mg . . . . . . . . . . . . . . . . . . . . . . . . . 10doxycycline hyclate oral tablet delayed release . . . . . . . . . . . . . . . . . 10doxycycline monohydrate oral capsule 100 mg, 50 mg . . . . . . . . . . 10doxycycline monohydrate oral capsule 150 mg, 75 mg . . . . . . . . . . . 10doxycycline monohydrate oral suspension reconstituted . . . . . . . . . 10doxycycline monohydrate oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 10doxylamine-pyridoxine . . . . . . . . . . . 12DRISDOL . . . . . . . . . . . . . . . . . . . . . . 22DRIZALMA SPRINKLE . . . . . . . . . . . 11drospiren-eth estrad-levomefol . . . . 24drospirenone-ethinyl estradiol . . . . . 24DUAVEE . . . . . . . . . . . . . . . . . . . . . . . 24duloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 60 mg . . . . . . . . . . . . . . . . . . . . . . . . . 11duloxetine hcl oral capsule delayed release particles 40 mg . . . . . . . . . . 11DUOPA . . . . . . . . . . . . . . . . . . . . . . . . 13

36

DUPIXENT . . . . . . . . . . . . . . . . . . . . . 18DVORAH . . . . . . . . . . . . . . . . . . . . . . . . 8DYAZIDE . . . . . . . . . . . . . . . . . . . . . . . 15

E

EASIVENT . . . . . . . . . . . . . . . . . . . . . 30EC-NAPROSYN . . . . . . . . . . . . . . . . . . 9ec-naproxen . . . . . . . . . . . . . . . . . . . . . 9ed-spaz . . . . . . . . . . . . . . . . . . . . . . . . 23EDARBI . . . . . . . . . . . . . . . . . . . . . . . . 15EDARBYCLOR . . . . . . . . . . . . . . . . . . 15EDLUAR . . . . . . . . . . . . . . . . . . . . . . . 31EFUDEX . . . . . . . . . . . . . . . . . . . . . . . 18ELESTRIN . . . . . . . . . . . . . . . . . . . . . . 24eletriptan hydrobromide . . . . . . . . . . 13ELIMITE . . . . . . . . . . . . . . . . . . . . . . . 13elinest . . . . . . . . . . . . . . . . . . . . . . . . . 24ELIQUIS . . . . . . . . . . . . . . . . . . . . . . . 10ELOCTATE . . . . . . . . . . . . . . . . . . . . . 22eluryng . . . . . . . . . . . . . . . . . . . . . . . . 24EMGALITY . . . . . . . . . . . . . . . . . . . . . 13EMGALITY (300 MG DOSE) . . . . . . . 13emoquette . . . . . . . . . . . . . . . . . . . . . 24emtricitabine/tenofovir disoproxil fumarate . . . . . . . . . . . . . . . . . . . . . . . 14enalapril maleate oral . . . . . . . . . . . . 15ENBREL . . . . . . . . . . . . . . . . . . . . . . . 27ENDARI . . . . . . . . . . . . . . . . . . . . . . . . 23endocet . . . . . . . . . . . . . . . . . . . . . . . . 8ENDOMETRIN . . . . . . . . . . . . . . . . . . 28enoxaparin sodium . . . . . . . . . . . . . . 10enskyce . . . . . . . . . . . . . . . . . . . . . . . 24ENSTILAR . . . . . . . . . . . . . . . . . . . . . 18entecavir . . . . . . . . . . . . . . . . . . . . . . . 14ENVARSUS XR . . . . . . . . . . . . . . . . . 27EPANED . . . . . . . . . . . . . . . . . . . . . . . 15EPCLUSA . . . . . . . . . . . . . . . . . . . . . . 14epinephrine solution auto-injector 0.15 mg/0.3ml injection (generic EPIPEN Jr) . . . . . . . . . . . . . . . . . . . . . 30epinephrine solution auto-injector 0.3 mg/0.3ml injection (generic EPIPEN) . . . . . . . . . . . . . . . . . . . . . . . 30epitol . . . . . . . . . . . . . . . . . . . . . . . . . . 11ERGOCAL . . . . . . . . . . . . . . . . . . . . . 22ergocalciferol oral capsule . . . . . . . . 22ERLEADA . . . . . . . . . . . . . . . . . . . . . . 13errin . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

erythromycin ophthalmic . . . . . . . . . 29escitalopram oxalate oral solution . . 11escitalopram oxalate oral tablet . . . . 11ESGIC . . . . . . . . . . . . . . . . . . . . . . . . . . 8estarylla . . . . . . . . . . . . . . . . . . . . . . . 24ESTRACE ORAL . . . . . . . . . . . . . . . . 24ESTRACE VAGINAL . . . . . . . . . . . . . 24estradiol oral . . . . . . . . . . . . . . . . . . . 24estradiol patch twice weekly transdermal (generic MINIVELLE) . . 24estradiol patch twice weekly transdermal (generic VIVELLE-DOT) . . . . . . . . . . . . . . . . . . 24estradiol transdermal patch weekly (generic CLIMARA) . . . . . . . . . . . . . . 24estradiol vaginal cream . . . . . . . . . . . 24estradiol vaginal tablet . . . . . . . . . . . 24ESTRING . . . . . . . . . . . . . . . . . . . . . . 24ESTROGEL . . . . . . . . . . . . . . . . . . . . 24eszopiclone . . . . . . . . . . . . . . . . . . . . 31etodolac . . . . . . . . . . . . . . . . . . . . . . . . 9etodolac er . . . . . . . . . . . . . . . . . . . . . . 9etonogestrel-ethinyl estradiol . . . . . . 24EUCRISA . . . . . . . . . . . . . . . . . . . . . . 19euthyrox . . . . . . . . . . . . . . . . . . . . . . . 27EVAMIST . . . . . . . . . . . . . . . . . . . . . . 24EVOCLIN . . . . . . . . . . . . . . . . . . . . . . 19EVZIO . . . . . . . . . . . . . . . . . . . . . . . . . . 9EXTAVIA . . . . . . . . . . . . . . . . . . . . . . . 17EXTINA . . . . . . . . . . . . . . . . . . . . . . . . 12EZALLOR SPRINKLE . . . . . . . . . . . . 15ezetimibe . . . . . . . . . . . . . . . . . . . . . . 15ezetimibe-simvastatin . . . . . . . . . . . . 15

F

falmina . . . . . . . . . . . . . . . . . . . . . . . . 24FARXIGA . . . . . . . . . . . . . . . . . . . . . . 21FASENRA PEN . . . . . . . . . . . . . . . . . . 30fayosim . . . . . . . . . . . . . . . . . . . . . . . . 25febuxostat . . . . . . . . . . . . . . . . . . . . . 12femynor . . . . . . . . . . . . . . . . . . . . . 25, 26fenofibrate oral capsule 150 mg, 50 mg . . . . . . . . . . . . . . . . . . . . . . . . . 15fenofibrate oral tablet 120 mg, 40 mg, 48 mg . . . . . . . . . . . . . . . . . . . 15fenofibrate oral tablet 160 mg, 145 mg, 54 mg . . . . . . . . . . . . . . . . . . 15

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr . . . . . . . . . . . . . 8fentanyl transdermal patch 72 hour 37.5 mcg/hr, 62.5 mcg/hr, 87.5 mcg/hr . . . . . . . . . . . . . . . . . . . . . 8FINACEA EXTERNAL GEL, FOAM . 19finasteride oral tablet 5 mg . . . . . . . . 23FIORICET . . . . . . . . . . . . . . . . . . . . . . . 8FIRAZYR . . . . . . . . . . . . . . . . . . . . . . 27FLAGYL . . . . . . . . . . . . . . . . . . . . . . . 10flecainide acetate . . . . . . . . . . . . . . . 15FLOLIPID . . . . . . . . . . . . . . . . . . . . . . 15FLORIVA PLUS . . . . . . . . . . . . . . . . . 22FLOVENT DISKUS . . . . . . . . . . . . . . . 30FLOVENT HFA . . . . . . . . . . . . . . . . . . 30fluconazole oral . . . . . . . . . . . . . . . . . 12fluocinolone acetonide body . . . . . . 19fluocinolone acetonide external cream . . . . . . . . . . . . . . . . . . . . . . . . . 19fluocinolone acetonide external ointment . . . . . . . . . . . . . . . . . . . . . . . 19fluocinolone acetonide external solution . . . . . . . . . . . . . . . . . . . . . . . . 19fluocinolone acetonide scalp . . . . . . 19fluocinonide external cream 0.05 % 19fluocinonide external cream 0.1 % . . 19fluocinonide external gel . . . . . . . . . 19fluocinonide external ointment . . . . . 19fluocinonide external solution . . . . . 19fluoridex . . . . . . . . . . . . . . . . . . . . . . . 17fluoridex enhanced whitening . . . . . 17FLUOROPLEX . . . . . . . . . . . . . . . . . . 19FLUOROURACIL EXTERNAL CREAM 0.5 % . . . . . . . . . . . . . . . . . . 19fluorouracil external cream 5 % . . . . 19fluorouracil external solution . . . . . . 19fluoxetine hcl oral capsule . . . . . . . . 11fluoxetine hcl oral capsule delayed release . . . . . . . . . . . . . . . . . . . . . . . . 11fluoxetine hcl oral solution . . . . . . . . 11fluoxetine hcl oral tablet 10 mg . . . . 11fluoxetine hcl oral tablet 20 mg . . . . 11fluoxetine hcl oral tablet 60 mg . . . . 12fluticasone propionate nasal . . . . . . 30fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose . . . . . . . . . . 30

37

FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT . . . . . . . . . . . . . . . . . . . . . . 30fluvoxamine maleate . . . . . . . . . . . . . 12fluvoxamine maleate er . . . . . . . . . . . 12FOCALIN . . . . . . . . . . . . . . . . . . . . . . 17folic acid oral tablet 1 mg . . . . . . . . . 22FOLLISTIM AQ . . . . . . . . . . . . . . . . . . 28FORFIVO XL . . . . . . . . . . . . . . . . . . . . 12FORTEO . . . . . . . . . . . . . . . . . . . . . . . 28FOSAMAX . . . . . . . . . . . . . . . . . . . . . 28FREESTYLE LIBRE 14 DAY READER . . . . . . . . . . . . . . . . . . . . . . . 20FREESTYLE LIBRE 14 DAY SENSOR . . . . . . . . . . . . . . . . . . . . . . . 20FREESTYLE LIBRE READER . . . . . . 20FREESTYLE LIBRE SENSOR SYSTEM . . . . . . . . . . . . . . . . . . . . . . . 20furosemide oral . . . . . . . . . . . . . . . . . 15

G

gabapentin oral . . . . . . . . . . . . . . . . . 11ganirelix acetate solution prefilled syringe 250 mcg/0.5ml subcutaneous (Ferring) . . . . . . . . . . . 28ganirelix acetate solution prefilled syringe 250 mcg/0.5ml subcutaneous (Merck/Organon) . . . 28gavilyte-c . . . . . . . . . . . . . . . . . . . . . . 23gavilyte-g . . . . . . . . . . . . . . . . . . . . . . 23GELNIQUE . . . . . . . . . . . . . . . . . . . . . 23gemfibrozil oral . . . . . . . . . . . . . . . . . 15gengraf . . . . . . . . . . . . . . . . . . . . . . . . 27GENOTROPIN . . . . . . . . . . . . . . . . . . 27GENOTROPIN MINIQUICK. . . . . . . . 27GENVOYA . . . . . . . . . . . . . . . . . . . . . . 14gianvi. . . . . . . . . . . . . . . . . . . . . . . . . . 25GILENYA ORAL CAPSULE . . . . . . . . 17glatiramer acetate . . . . . . . . . . . . . . . 17glatopa . . . . . . . . . . . . . . . . . . . . . . . . 17glimepiride . . . . . . . . . . . . . . . . . . . . . 21glipizide er . . . . . . . . . . . . . . . . . . . . . 21glipizide ir . . . . . . . . . . . . . . . . . . . . . . 21glipizide xl . . . . . . . . . . . . . . . . . . . . . . 21GLOPERBA . . . . . . . . . . . . . . . . . . . . 12GLUCAGON EMERGENCY KIT INJECTION KIT . . . . . . . . . . . . . . . . . 21GLUCOTROL . . . . . . . . . . . . . . . . . . . 21

GLUCOTROL XL . . . . . . . . . . . . . . . . 21GLUCOVANCE ORAL TABLET 5-500 MG . . . . . . . . . . . . . . . . . . . . . . 21glyburide oral . . . . . . . . . . . . . . . . . . . 21glyburide-metformin . . . . . . . . . . . . . 21GLYXAMBI . . . . . . . . . . . . . . . . . . . . . 21GOLYTELY ORAL SOLUTION RECONSTITUTED 227.1 GM . . . . . . 23GOLYTELY ORAL SOLUTION RECONSTITUTED 236 GM . . . . . . . 23GONITRO . . . . . . . . . . . . . . . . . . . . . . 15guanfacine hcl . . . . . . . . . . . . . . . 15, 17guanfacine hcl er . . . . . . . . . . . . . . . . 17GUARDIAN CONNECT TRANSMITTER . . . . . . . . . . . . . . . . . 20GUARDIAN LINK 3 TRANSMITTER 20GUARDIAN SENSOR (3) . . . . . . . . . . 20GVOKE PFS . . . . . . . . . . . . . . . . . . . . 21GYNAZOLE-1 . . . . . . . . . . . . . . . . . . . 12

H

HAEGARDA . . . . . . . . . . . . . . . . . . . . 27hailey 1.5/30 . . . . . . . . . . . . . . . . . . . . 25hailey 24 fe . . . . . . . . . . . . . . . . . . . . . 25HALCION . . . . . . . . . . . . . . . . . . . . . . 14HARVONI . . . . . . . . . . . . . . . . . . . . . . 14heather . . . . . . . . . . . . . . . . . . . . . . . . 25HEMANGEOL . . . . . . . . . . . . . . . . . . 15HUMALOG KWIKPEN . . . . . . . . . . . . 20HUMALOG MIX 50/50 KWIKPEN . . 20HUMALOG MIX 50/50 VIAL . . . . . . . 20HUMALOG MIX 75/25 KWIKPEN . . 20HUMALOG MIX 75/25 VIAL . . . . . . . 20HUMALOG SUBCUTANEOUS SOLUTION . . . . . . . . . . . . . . . . . . 20, 21HUMALOG SUBCUTANEOUS SOLUTION CARTRIDGE . . . . . . . . . 21HUMALOG U-100 JUNIOR KWIKPEN . . . . . . . . . . . . . . . . . . . . . . 21HUMATROPE . . . . . . . . . . . . . . . . . . . 27HUMIRA . . . . . . . . . . . . . . . . . . . . . . . 27HUMULIN 70/30 KWIKPEN . . . . . . . 21HUMULIN 70/30 VIAL . . . . . . . . . . . . 21HUMULIN N KWIKPEN . . . . . . . . . . . 21HUMULIN N VIAL . . . . . . . . . . . . . . . 21HUMULIN R U-500 KWIKPEN . . . . . 21HUMULIN R U-500 VIAL (CONCENTRATED) . . . . . . . . . . . . . . 21HUMULIN R VIAL . . . . . . . . . . . . . . . 21

hydralazine hcl oral . . . . . . . . . . . . . . 15hydrochlorothiazide oral . . . . . . . . . . 15hydrocodone polst-cpm polst er . . . 30hydrocodone-acetaminophen oral solution 10-325 mg/15ml . . . . . . . . . . 8hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml . . . . . . . . . . 8hydrocodone-acetaminophen oral tablet 10-300 mg, 5-300 mg, 7.5-300 mg . . . . . . . . . . . . . . . . . . . . . . 8hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg . . . . . . . . . . . . . . . . . . . . . . 8hydrocort-pramoxine (perianal) . . . . 28hydrocortisone ace-pramoxine external cream 1-1 % . . . . . . . . . . . . . 28hydrocortisone external cream 1 % . . . . . . . . . . . . . . . . . . . . . . . . . . . 19hydrocortisone external cream 2.5 % . . . . . . . . . . . . . . . . . . . . . . . . . . 19hydrocortisone external lotion 2.5 % . . . . . . . . . . . . . . . . . . . . . . . . . . 19hydrocortisone external ointment 1 %, 2.5 % . . . . . . . . . . . . . . . . . . . . . . 19hydrocortisone oral . . . . . . . . . . . . . . 26hydromorphone hcl er . . . . . . . . . . . . 8hydromorphone hcl oral . . . . . . . . . . . 8hydromorphone hcl rectal . . . . . . . . . 8hydroxychloroquine sulfate oral . . . . 13hydroxyzine hcl oral . . . . . . . . . . . . . 14hydroxyzine pamoate oral . . . . . . . . 14hyoscyamine sulfate er . . . . . . . . . . . 23hyoscyamine sulfate oral . . . . . . . . . 23hyoscyamine sulfate sl . . . . . . . . . . . 23hyoscyamine sulfate sublingual . . . . 23hyosyne . . . . . . . . . . . . . . . . . . . . . . . 23HYSINGLA ER . . . . . . . . . . . . . . . . . . . 8HYZAAR . . . . . . . . . . . . . . . . . . . . . . . 15

I

ibandronate sodium oral . . . . . . . . . . 28IBRANCE ORAL CAPSULE . . . . . . . 13ibu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9ibuprofen oral suspension . . . . . . . . . 9ibuprofen oral tablet 400 mg, 600 mg, 800 mg . . . . . . . . . . . . . . . . . 9icatibant acetate . . . . . . . . . . . . . . . . 27IDHIFA. . . . . . . . . . . . . . . . . . . . . . . . . 13ILEVRO . . . . . . . . . . . . . . . . . . . . . . . . 29

38

imatinib mesylate . . . . . . . . . . . . . . . . 13imiquimod external . . . . . . . . . . . . . . 19IMIQUIMOD PUMP . . . . . . . . . . . . . . 19IMPOYZ . . . . . . . . . . . . . . . . . . . . . . . 19IMVEXXY . . . . . . . . . . . . . . . . . . . . . . 22INBRIJA . . . . . . . . . . . . . . . . . . . . . . . 13incassia . . . . . . . . . . . . . . . . . . . . . . . . 25INCRUSE ELLIPTA . . . . . . . . . . . . . . 30INDOCIN . . . . . . . . . . . . . . . . . . . . . . . . 9indomethacin er . . . . . . . . . . . . . . . . . . 9indomethacin oral capsule 25 mg, 50 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 9INSULIN ASPART . . . . . . . . . . . . . . . 21INSULIN LISPRO . . . . . . . . . . . . . . . . 21INSULIN SYRINGES . . . . . . . . . . . . . 20INTRAROSA. . . . . . . . . . . . . . . . . . . . 22introvale . . . . . . . . . . . . . . . . . . . . . . . 25INVELTYS . . . . . . . . . . . . . . . . . . . . . . 29INVOKANA . . . . . . . . . . . . . . . . . . . . . 21ipratropium bromide nasal . . . . . . . . 30ipratropium-albuterol . . . . . . . . . . . . 30irbesartan . . . . . . . . . . . . . . . . . . . . . . 15irbesartan-hydrochlorothiazide . . . . 15ISENTRESS . . . . . . . . . . . . . . . . . . . . 14ISENTRESS HD . . . . . . . . . . . . . . . . . 14isibloom . . . . . . . . . . . . . . . . . . . . . . . 25isosorbide mononitrate . . . . . . . . . . . 15isosorbide mononitrate er . . . . . . . . 15isotretinoin oral . . . . . . . . . . . . . . . . . 19ISTALOL . . . . . . . . . . . . . . . . . . . . . . . 29

J

jantoven . . . . . . . . . . . . . . . . . . . . . . . 10JANUVIA . . . . . . . . . . . . . . . . . . . . . . . 21JARDIANCE . . . . . . . . . . . . . . . . . . . . 21jasmiel. . . . . . . . . . . . . . . . . . . . . . . . . 25jencycla. . . . . . . . . . . . . . . . . . . . . . . . 25JENTADUETO . . . . . . . . . . . . . . . . . . 21JENTADUETO XR . . . . . . . . . . . . . . . 21JIVI . . . . . . . . . . . . . . . . . . . . . . . . . . . 22jolessa. . . . . . . . . . . . . . . . . . . . . . . . . 25JORNAY PM . . . . . . . . . . . . . . . . . . . . 17juleber . . . . . . . . . . . . . . . . . . . . . . . . . 25JULUCA . . . . . . . . . . . . . . . . . . . . . . . 14junel 1/20 . . . . . . . . . . . . . . . . . . . . . . 25junel 1.5/30 . . . . . . . . . . . . . . . . . . . . 25junel fe 1/20 . . . . . . . . . . . . . . . . . . . . 25

junel fe 1.5/30 . . . . . . . . . . . . . . . . . . 25junel fe 24 . . . . . . . . . . . . . . . . . . . . . . 25

K

K-TAB . . . . . . . . . . . . . . . . . . . . . . . . . 22KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 200 MG . . . . . . . . . . . . . . . . . . . . . . . . . 8kalliga . . . . . . . . . . . . . . . . . . . . . . . . . 25KAPSPARGO SPRINKLE . . . . . . . . . 15kariva . . . . . . . . . . . . . . . . . . . . . . . . . 25KAZANO . . . . . . . . . . . . . . . . . . . . . . 21KEFLEX. . . . . . . . . . . . . . . . . . . . . . . . 10KEPPRA ORAL . . . . . . . . . . . . . . . . . 11KEPPRA XR . . . . . . . . . . . . . . . . . . . . 11ketoconazole external cream . . . . . . 12ketoconazole external foam . . . . . . . 12ketoconazole external shampoo . . . 12ketodan external foam . . . . . . . . . . . 12ketorolac tromethamine ophthalmic . . . . . . . . . . . . . . . . . . . . . 29ketorolac tromethamine oral . . . . . . . 9KITABIS PAK . . . . . . . . . . . . . . . . . . . 31klor-con . . . . . . . . . . . . . . . . . . . . . . . . 22klor-con 10 . . . . . . . . . . . . . . . . . . . . . 22klor-con m10 . . . . . . . . . . . . . . . . . . . 22KLOR-CON M15 . . . . . . . . . . . . . . . . 22klor-con m20 . . . . . . . . . . . . . . . . . . . 22klor-con sprinkle . . . . . . . . . . . . . . . . 22KOGENATE FS . . . . . . . . . . . . . . . . . . 22KOMBIGLYZE XR . . . . . . . . . . . . . . . 21KOVALTRY . . . . . . . . . . . . . . . . . . . . . 22KRINTAFEL . . . . . . . . . . . . . . . . . . . . 13kurvelo . . . . . . . . . . . . . . . . . . . . . . . . 25

L

labetalol hcl oral . . . . . . . . . . . . . . . . 15LAMICTAL . . . . . . . . . . . . . . . . . . . . . 11LAMICTAL ODT ORAL KIT . . . . . . . . 11LAMICTAL ODT ORAL TABLET DISPERSIBLE . . . . . . . . . . . . . . . . . . 11LAMICTAL STARTER . . . . . . . . . . . . 11LAMICTAL XR . . . . . . . . . . . . . . . . . . 11lamotrigine er . . . . . . . . . . . . . . . . . . . 11lamotrigine oral tablet . . . . . . . . . . . . 11lamotrigine oral tablet chewable . . . 11lamotrigine oral tablet dispersible . . 11lamotrigine starter kit-blue . . . . . . . . 11

lamotrigine starter kit-green . . . . . . . 11lamotrigine starter kit-orange . . . . . . 11LANCETS . . . . . . . . . . . . . . . . . . . . . . 20LANTUS SOLOSTAR . . . . . . . . . . . . 21LANTUS U-100 VIAL . . . . . . . . . . . . . 21larin 1/20 . . . . . . . . . . . . . . . . . . . . . . 25larin 1.5/30 . . . . . . . . . . . . . . . . . . . . . 25larin 24 fe . . . . . . . . . . . . . . . . . . . . . . 25larin fe 1/20 . . . . . . . . . . . . . . . . . . . . 25larin fe 1.5/30 . . . . . . . . . . . . . . . . . . . 25larissia . . . . . . . . . . . . . . . . . . . . . . . . . 25LASIX . . . . . . . . . . . . . . . . . . . . . . . . . 15LASTACAFT . . . . . . . . . . . . . . . . . . . . 29latanoprost ophthalmic . . . . . . . . . . . 29LATUDA . . . . . . . . . . . . . . . . . . . . . . . 13LEDIP-SOFOSB ORAL TABLET 90-400MG . . . . . . . . . . . . . . . . . . . . . 14LEDIPASVIR-SOFOSBUVIR . . . . . . . 14lessina . . . . . . . . . . . . . . . . . . . . . . . . . 25letrozole oral . . . . . . . . . . . . . . . . . . . 13LEVALBUTEROL HFA INHALATION AEROSOL 45 MCG/ACT . . . . . . . . . 31LEVAQUIN ORAL TABLET 500 MG, 750 MG . . . . . . . . . . . . . . . . . . . . . . . . 10LEVBID . . . . . . . . . . . . . . . . . . . . . . . . 23LEVEMIR . . . . . . . . . . . . . . . . . . . . . . 21levetiracetam er . . . . . . . . . . . . . . . . . 11levetiracetam oral . . . . . . . . . . . . . . . 11levo-t . . . . . . . . . . . . . . . . . . . . . . . . . . 27levocetirizine dihydrochloride oral solution . . . . . . . . . . . . . . . . . . . . . . . . 30levocetirizine dihydrochloride oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 30levofloxacin oral . . . . . . . . . . . . . . . . . 10levonorgest-eth est & eth est . . . . . . 25levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 & 0.01 mg . . . . . . . . . . . . . . 25levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg . . . . . . . . . . . . . . 25levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg . . . . . . . . . . . . . . . . . 25levora 0.15/30 (28) . . . . . . . . . . . . . . . 25levothyroxine sodium oral . . . . . . . . . 27levoxyl . . . . . . . . . . . . . . . . . . . . . . . . . 27LEVSIN ORAL . . . . . . . . . . . . . . . . . . 23LEVSIN/SL . . . . . . . . . . . . . . . . . . . . . 23LIALDA . . . . . . . . . . . . . . . . . . . . . . . . 28

39

lidocaine external ointment . . . . . . . . 8lidocaine external patch 5 % . . . . . . . 8lidocaine hcl mouth/throat . . . . . . . . 17lidocaine viscous hcl . . . . . . . . . . . . . 17lidocaine-prilocaine external cream . 8lillow . . . . . . . . . . . . . . . . . . . . . . . . . . 25LINZESS . . . . . . . . . . . . . . . . . . . . . . . 23liothyronine sodium oral . . . . . . . . . . 27LIPOFEN . . . . . . . . . . . . . . . . . . . . . . . 15lisinopril oral . . . . . . . . . . . . . . . . . . . . 15lisinopril-hydrochlorothiazide . . . . . . 15lithium carbonate er . . . . . . . . . . . . . 14lithium carbonate oral . . . . . . . . . . . . 14LITHOBID . . . . . . . . . . . . . . . . . . . . . . 14LO LOESTRIN FE. . . . . . . . . . . . . . . . 25lo-zumandimine . . . . . . . . . . . . . . . . . 25LOESTRIN 1/20 (21) . . . . . . . . . . . . . 25LOESTRIN 1.5/30 (21) . . . . . . . . . . . . 25LOESTRIN FE 1/20 . . . . . . . . . . . . . . 25LOESTRIN FE 1.5/30 . . . . . . . . . . . . . 25LOKELMA . . . . . . . . . . . . . . . . . . . . . . 22LOMOTIL . . . . . . . . . . . . . . . . . . . . . . 23LOPID . . . . . . . . . . . . . . . . . . . . . . . . . 15LOPRESSOR . . . . . . . . . . . . . . . . . . . 15lorazepam intensol . . . . . . . . . . . . . . 14lorazepam oral concentrate 2 mg/ml . . . . . . . . . . . . . . . . . . . . . . . 14lorazepam oral tablet . . . . . . . . . . . . 14lorcet . . . . . . . . . . . . . . . . . . . . . . . . . . . 8lorcet hd . . . . . . . . . . . . . . . . . . . . . . . . 8lorcet plus . . . . . . . . . . . . . . . . . . . . . . . 8LORTAB . . . . . . . . . . . . . . . . . . . . . . . . 8loryna . . . . . . . . . . . . . . . . . . . . . . . . . 25losartan potassium . . . . . . . . . . . . . . 15losartan potassium-hctz . . . . . . . . . . 15LOSEASONIQUE . . . . . . . . . . . . . . . . 25LOTEMAX OPHTHALMIC GEL . . . . 29LOTEMAX OPHTHALMIC OINTMENT . . . . . . . . . . . . . . . . . . . . . 29LOTEMAX OPHTHALMIC SUSPENSION . . . . . . . . . . . . . . . . . . 29LOTEMAX SM . . . . . . . . . . . . . . . . . . 29LOTENSIN . . . . . . . . . . . . . . . . . . . . . 15LOTENSIN HCT . . . . . . . . . . . . . . . . . 15loteprednol etabonate . . . . . . . . . . . . 29LOTREL . . . . . . . . . . . . . . . . . . . . . . . 15lovastatin . . . . . . . . . . . . . . . . . . . . . . 15

low-ogestrel . . . . . . . . . . . . . . . . . . . . 25LUMIGAN . . . . . . . . . . . . . . . . . . . . . . 29lutera . . . . . . . . . . . . . . . . . . . . . . . . . . 25LYNPARZA . . . . . . . . . . . . . . . . . . . . . 13LYRICA . . . . . . . . . . . . . . . . . . . . . . . . 17LYRICA CR . . . . . . . . . . . . . . . . . . . . . 17lyza . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

M

MACROBID . . . . . . . . . . . . . . . . . . . . 10MACRODANTIN . . . . . . . . . . . . . . . . 10MALARONE . . . . . . . . . . . . . . . . . . . . 13marlissa . . . . . . . . . . . . . . . . . . . . . . . 25matzim la . . . . . . . . . . . . . . . . . . . . . . 15MAVENCLAD . . . . . . . . . . . . . . . . . . . 17MAVYRET . . . . . . . . . . . . . . . . . . . . . 14MAXITROL . . . . . . . . . . . . . . . . . . . . . 29MAXZIDE . . . . . . . . . . . . . . . . . . . . . . 15MAXZIDE-25 . . . . . . . . . . . . . . . . . . . 15MAYZENT . . . . . . . . . . . . . . . . . . . . . . 17MEDROL ORAL TABLET 16 MG, 4 MG, 8 MG . . . . . . . . . . . . . . . . . . . . 26MEDROL ORAL TABLET 2 MG . . . . 26MEDROL ORAL TABLET 32 MG . . . 26MEDROL ORAL TABLET THERAPY PACK . . . . . . . . . . . . . . . . . . . . . . . . . . 26medroxyprogesterone acetate intramuscular suspension . . . . . . . . 25medroxyprogesterone acetate intramuscular suspension prefilled syringe . . . . . . . . . . . . . . . . . . . . . . . . 25medroxyprogesterone acetate oral . 25melodetta 24 fe . . . . . . . . . . . . . . . . . 25meloxicam oral . . . . . . . . . . . . . . . . . . 9MENOSTAR . . . . . . . . . . . . . . . . . . . . 25mercaptopurine oral . . . . . . . . . . . . . 13mesalamine er . . . . . . . . . . . . . . . . . . 28mesalamine oral . . . . . . . . . . . . . . . . 28mesalamine rectal enema . . . . . . . . 28mesalamine rectal suppository . . . . 28metadate er . . . . . . . . . . . . . . . . . . . . 17metaxalone . . . . . . . . . . . . . . . . . . . . 31metformin hcl er . . . . . . . . . . . . . . . . 21metformin hcl er (mod) . . . . . . . . . . . 21metformin hcl er (osm) . . . . . . . . . . . 21METFORMIN HCL ORAL SOLUTION . . . . . . . . . . . . . . . . . . . . . 21metformin hcl oral tablet . . . . . . . . . . 21

methimazole oral . . . . . . . . . . . . . . . . 27methocarbamol oral . . . . . . . . . . . . . 31methotrexate oral . . . . . . . . . . . . . . . 27methotrexate sodium oral . . . . . . . . . 27METHYLIN . . . . . . . . . . . . . . . . . . . . . 17methylphenidate hcl er (cd) . . . . . . . 17methylphenidate hcl er (la) . . . . . . . . 17methylphenidate hcl er oral tablet extended release 10 mg, 20 mg . . . 17methylphenidate hcl er oral tablet extended release 18 mg, 27 mg, 36 mg, 54 mg, 72 mg . . . . . . . . . . . . 17methylphenidate hcl er oral tablet extended release 24 hour . . . . . . . . . 17methylphenidate hcl oral solution . . 17methylphenidate hcl oral tablet . . . . 17methylphenidate hcl oral tablet chewable . . . . . . . . . . . . . . . . . . . . . . 17methylprednisolone oral . . . . . . . . . . 26metoclopramide hcl oral solution 5 mg/5ml . . . . . . . . . . . . . . . . . . . . . . 12metoclopramide hcl oral tablet . . . . 12metoclopramide hcl oral tablet dispersible . . . . . . . . . . . . . . . . . . . . . 12metoprolol succinate er oral tablet extended release 24 hour 100 mg, 200 mg, 50 mg . . . . . . . . . . . . . . . . . . 15metoprolol succinate er oral tablet extended release 24 hour 25 mg . . . 15metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg . . . . . . . . . . . 16metoprolol tartrate oral tablet 37.5 mg, 75 mg . . . . . . . . . . . . . . . . . 16METROCREAM . . . . . . . . . . . . . . . . . 19METROLOTION . . . . . . . . . . . . . . . . . 19metronidazole external cream . . . . . 19metronidazole external gel 0.75 % . . 19metronidazole external gel 1 % . . . . 19metronidazole external lotion . . . . . . 19metronidazole oral . . . . . . . . . . . . . . . 10metronidazole vaginal . . . . . . . . . . . . 10mibelas 24 fe . . . . . . . . . . . . . . . . . . . 25microgestin 1/20 . . . . . . . . . . . . . . . . 25microgestin 1.5/30 . . . . . . . . . . . . . . 25microgestin fe 1/20 . . . . . . . . . . . . . . 25microgestin fe 1.5/30 . . . . . . . . . . . . 25mili . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25MILLIPRED . . . . . . . . . . . . . . . . . . . . . 26MINIPRESS . . . . . . . . . . . . . . . . . . . . 16

40

minitran . . . . . . . . . . . . . . . . . . . . . . . . 16minocycline hcl er oral tablet extended release 24 hour 105 mg, 115 mg, 55 mg, 65 mg, 80 mg . . . . . 10minocycline hcl er oral tablet extended release 24 hour 135 mg, 45 mg, 90 mg . . . . . . . . . . . . . . . . . . . 10minocycline hcl oral capsule . . . . . . 10minocycline hcl oral tablet . . . . . . . . 10MINOLIRA . . . . . . . . . . . . . . . . . . . . . 10MIRAPEX . . . . . . . . . . . . . . . . . . . . . . 13MIRCETTE . . . . . . . . . . . . . . . . . . . . . 25mirtazapine oral . . . . . . . . . . . . . . . . . 12MIRVASO . . . . . . . . . . . . . . . . . . . . . . 19misoprostol oral . . . . . . . . . . . . . . . . . 22MITIGARE . . . . . . . . . . . . . . . . . . . . . 12MOBIC . . . . . . . . . . . . . . . . . . . . . . . . . 9modafinil . . . . . . . . . . . . . . . . . . . . . . . 31mometasone furoate external . . . . . 19mondoxyne nl oral capsule 100 mg . . . . . . . . . . . . . . . . . . . . . . . . 10mondoxyne nl oral capsule 75 mg . . 10mono-linyah . . . . . . . . . . . . . . . . . . . . 25montelukast sodium oral packet . . . 31montelukast sodium oral tablet . . . . 31montelukast sodium oral tablet chewable . . . . . . . . . . . . . . . . . . . . . . 31morgidox oral . . . . . . . . . . . . . . . . . . . 10MORPHABOND ER . . . . . . . . . . . . . . . 8morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml . . . . . 8morphine sulfate er oral capsule extended release 24 hour . . . . . . . . . . 8morphine sulfate er oral tablet extended release . . . . . . . . . . . . . . . . . 8morphine sulfate oral . . . . . . . . . . . . . 8morphine sulfate rectal . . . . . . . . . . . . 8MOTEGRITY . . . . . . . . . . . . . . . . . . . 23MOVIPREP . . . . . . . . . . . . . . . . . . . . . 23MOXEZA . . . . . . . . . . . . . . . . . . . . . . . 29moxifloxacin hcl ophthalmic . . . . . . . 29MS CONTIN . . . . . . . . . . . . . . . . . . . . . 8MULPLETA . . . . . . . . . . . . . . . . . . . . . 22MULTAQ . . . . . . . . . . . . . . . . . . . . . . . 16multi-vitamin/fluoride . . . . . . . . . . . . 22multivitamin/fluoride oral solution . . 22multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg . . . 22multivitamins/fluoride . . . . . . . . . . . . 22

mupirocin calcium . . . . . . . . . . . . . . . 10mupirocin external . . . . . . . . . . . . . . . 10mvc-fluoride . . . . . . . . . . . . . . . . . . . . 22mycophenolate mofetil . . . . . . . . . . . 27mycophenolate sodium . . . . . . . . . . 27MYDAYIS . . . . . . . . . . . . . . . . . . . . . . 17myorisan . . . . . . . . . . . . . . . . . . . . . . . 19

N

nabumetone oral . . . . . . . . . . . . . . . . . 9nadolol oral . . . . . . . . . . . . . . . . . . . . 16NAFRINSE DAILY/NEUTRAL . . . . . . 17NAFRINSE WEEKLY . . . . . . . . . . . . . 17NALOCET . . . . . . . . . . . . . . . . . . . . . . . 8naloxone hcl injection solution . . . . . . 9naloxone hcl injection solution cartridge . . . . . . . . . . . . . . . . . . . . . . . . 9naloxone hcl injection solution prefilled syringe . . . . . . . . . . . . . . . . . . 9naltrexone hcl oral . . . . . . . . . . . . . . . . 9NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 750 MG . . . . . . . . . . . . . . . . . . . . . . . . . 9NAPROSYN ORAL SUSPENSION . . . 9naproxen dr . . . . . . . . . . . . . . . . . . . . . 9naproxen oral suspension . . . . . . . . . 9naproxen oral tablet . . . . . . . . . . . . . . 9naproxen sodium er . . . . . . . . . . . . . . 9naproxen sodium oral tablet 275 mg, 550 mg . . . . . . . . . . . . . . . . . . 9naratriptan hcl . . . . . . . . . . . . . . . . . . 13NARCAN . . . . . . . . . . . . . . . . . . . . . . . 9NASCOBAL . . . . . . . . . . . . . . . . . . . . 22NATAZIA . . . . . . . . . . . . . . . . . . . . . . . 25NATESTO . . . . . . . . . . . . . . . . . . . . . . 27NATURE-THROID . . . . . . . . . . . . . . . 27NAYZILAM SPRAY 5 MG . . . . . . . . . 11necon 0.5/35 (28) . . . . . . . . . . . . . . . 25neomycin-polymyxin-dexameth ophthalmic ointment . . . . . . . . . . . . . 29neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1 . . . . . . . . . . . . . . . . . . . 29neomycin-polymyxin-hc otic . . . . . . . 30NESINA . . . . . . . . . . . . . . . . . . . . . . . . 21neuac external gel . . . . . . . . . . . . . . . 19NEULASTA . . . . . . . . . . . . . . . . . . . . . 22NEURONTIN . . . . . . . . . . . . . . . . . . . 11neutral sodium fluoride . . . . . . . . . . . 17

NEVANAC . . . . . . . . . . . . . . . . . . . . . . 29NEXLETOL TABLET . . . . . . . . . . . . . 16NEXLIZET TABLET . . . . . . . . . . . . . . 16niacin (antihyperlipidemic) . . . . . . . . 16niacin er (antihyperlipidemic) . . . . . . 16niacor . . . . . . . . . . . . . . . . . . . . . . . . . 16NIASPAN . . . . . . . . . . . . . . . . . . . . . . 16nifedipine er . . . . . . . . . . . . . . . . . . . . 16nifedipine er osmotic release . . . . . . 16nifedipine oral . . . . . . . . . . . . . . . . . . 16nikki . . . . . . . . . . . . . . . . . . . . . . . . . . . 25nitisinone . . . . . . . . . . . . . . . . . . . . . . 23NITRO-BID . . . . . . . . . . . . . . . . . . . . . 16NITRO-DUR . . . . . . . . . . . . . . . . . . . . 16nitro-time . . . . . . . . . . . . . . . . . . . . . . 16nitrofurantoin macrocrystal oral . . . . 10nitrofurantoin monohydrate macrocrystals . . . . . . . . . . . . . . . . . . 10nitroglycerin sublingual . . . . . . . . . . . 16nitroglycerin transdermal . . . . . . . . . 16nitroglycerin translingual . . . . . . . . . 16NITROMIST . . . . . . . . . . . . . . . . . . . . 16NITROSTAT . . . . . . . . . . . . . . . . . . . . 16NITYR . . . . . . . . . . . . . . . . . . . . . . . . . 23NIZORAL . . . . . . . . . . . . . . . . . . . . . . 12NOCDURNA . . . . . . . . . . . . . . . . . . . . 27nora-be . . . . . . . . . . . . . . . . . . . . . . . . 25NORCO . . . . . . . . . . . . . . . . . . . . . . . . 8NORDITROPIN FLEXPRO . . . . . . . . 27norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg(24) . . . . . . . . . . . 25norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg. . . . . . . . . . . . . . . . . . 25norethin ace-eth estrad-fe oral tablet chewable . . . . . . . . . . . . . . . . . 25norethindrone acet-ethinyl est . . . . . 25norethindrone acetate oral . . . . . . . . 25norethindrone oral . . . . . . . . . . . . . . . 25norgestimate-eth estradiol . . . . . . . . 25norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/ 0.25 mg-25 mcg . . . . . . . . . . . . . . . . . 25norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/ 0.25 mg-35 mcg. . . . . . . . . . . . . . . . . 25NORITATE . . . . . . . . . . . . . . . . . . . . . 19norlyda . . . . . . . . . . . . . . . . . . . . . . . . 26norlyroc . . . . . . . . . . . . . . . . . . . . . . . 26

41

nortrel 0.5/35 (28) . . . . . . . . . . . . . . . 26nortrel 1/35 (21) . . . . . . . . . . . . . . . . . 26nortrel 1/35 (28) . . . . . . . . . . . . . . . . . 26nortriptyline hcl oral . . . . . . . . . . . . . 12NORVIR ORAL PACKET . . . . . . . . . . 14NORVIR ORAL SOLUTION . . . . . . . 14NOURIANZ ORAL TABLET . . . . . . . 13novarel intramuscular solution reconstituted 10000 unit . . . . . . . . . . 28NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT . . . . . . . . . . . . . . . . . . . . . 28NOVOEIGHT . . . . . . . . . . . . . . . . . . . 22NOVOFINE AUTOCOVER PEN NEEDLE . . . . . . . . . . . . . . . . . . . . . . . 20NOVOFINE PEN NEEDLE . . . . . . . . . 20NOVOFINE PLUS PEN NEEDLE . . . 20NOVOLIN 70/30 . . . . . . . . . . . . . . . . . 21NOVOLIN N . . . . . . . . . . . . . . . . . . . . 21NOVOLIN R . . . . . . . . . . . . . . . . . . . . 21NOVOLOG . . . . . . . . . . . . . . . . . . . . . 21np thyroid . . . . . . . . . . . . . . . . . . . . . . 27NUBEQA. . . . . . . . . . . . . . . . . . . . . . . 13NUCALA . . . . . . . . . . . . . . . . . . . . . . . 31NUCYNTA . . . . . . . . . . . . . . . . . . . . . . . 8NUCYNTA ER . . . . . . . . . . . . . . . . . . . . 8NUEDEXTA . . . . . . . . . . . . . . . . . . . . 17NULEV . . . . . . . . . . . . . . . . . . . . . . . . 23NUTROPIN AQ NUSPIN 10 . . . . . . . 27NUTROPIN AQ NUSPIN 20 . . . . . . . 27NUTROPIN AQ NUSPIN 5 . . . . . . . . 27NUVARING . . . . . . . . . . . . . . . . . . . . . 26NUVESSA . . . . . . . . . . . . . . . . . . . . . . 10NUWIQ . . . . . . . . . . . . . . . . . . . . . . . . 22nyamyc . . . . . . . . . . . . . . . . . . . . . . . . 12nystatin external . . . . . . . . . . . . . . . . 12nystatin mouth/throat . . . . . . . . . . . . 12nystop . . . . . . . . . . . . . . . . . . . . . . . . . 12

O

ocella . . . . . . . . . . . . . . . . . . . . . . . . . 26OCUFLOX . . . . . . . . . . . . . . . . . . . . . . 29ODEFSEY . . . . . . . . . . . . . . . . . . . . . . 14ofloxacin ophthalmic . . . . . . . . . . . . . 29ofloxacin otic . . . . . . . . . . . . . . . . . . . 30ogestrel . . . . . . . . . . . . . . . . . . . . . . . . 26okebo . . . . . . . . . . . . . . . . . . . . . . . . . 10olanzapine oral tablet . . . . . . . . . . . . 13

olanzapine oral tablet dispersible . . 13olmesartan medoxomil oral . . . . . . . 16olmesartan medoxomil-hctz . . . . . . . 16olopatadine hcl ophthalmic solution 0.1 % . . . . . . . . . . . . . . . . . . . . . . . . . . 29olopatadine hcl ophthalmic solution 0.2 % . . . . . . . . . . . . . . . . . . . . . . . . . . 29OLUMIANT ORAL TABLET . . . . . . . 27OMECLAMOX-PAK . . . . . . . . . . . . . . 22omega-3-acid ethyl esters . . . . . . . . 16omeprazole oral capsule delayed release . . . . . . . . . . . . . . . . . . . . . . . . 22OMNARIS . . . . . . . . . . . . . . . . . . . . . . 30OMNITROPE . . . . . . . . . . . . . . . . . . . 27ondansetron hcl oral . . . . . . . . . . . . . 12ondansetron odt . . . . . . . . . . . . . . . . 12ONETOUCH ULTRA 2 KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . 20ONETOUCH ULTRA BLUE TEST STRIPS IN VITRO STRIP . . . . . . . . . 20ONETOUCH ULTRA MINI KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . 20ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE . . . . . . . . . . . . . . . . . . 20ONETOUCH VERIO IQ SYSTEM . . . 20ONETOUCH VERIO KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . 20ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE . . . . . . . . . . . . . . . . . . 20ONETOUCH VERIO TEST STRIPS . 20ONGLYZA . . . . . . . . . . . . . . . . . . . . . . 21ONZETRA XSAIL . . . . . . . . . . . . . . . . 13OPSUMIT . . . . . . . . . . . . . . . . . . . . . . 31ORAPRED ODT . . . . . . . . . . . . . . . . . 26ORENITRAM . . . . . . . . . . . . . . . . . . . 31ORFADIN ORAL CAPSULE 20 MG . 23ORFADIN ORAL SUSPENSION . . . . 23ORILISSA . . . . . . . . . . . . . . . . . . . . . . 27orsythia . . . . . . . . . . . . . . . . . . . . . . . . 26ORTHO MICRONOR . . . . . . . . . . . . . 26oscimin . . . . . . . . . . . . . . . . . . . . . . . . 23oscimin sr . . . . . . . . . . . . . . . . . . . . . . 23oseltamivir phosphate oral capsule . 14oseltamivir phosphate oral suspension reconstituted . . . . . . . . . 14OSENI . . . . . . . . . . . . . . . . . . . . . . . . . 21OSPHENA . . . . . . . . . . . . . . . . . . . . . 22OTEZLA . . . . . . . . . . . . . . . . . . . . . . . 27OTREXUP . . . . . . . . . . . . . . . . . . . . . . 28

OXAYDO . . . . . . . . . . . . . . . . . . . . . . . . 8oxcarbazepine . . . . . . . . . . . . . . . . . . 11OXTELLAR XR . . . . . . . . . . . . . . . . . . 11oxybutynin chloride er . . . . . . . . . . . 23oxybutynin chloride oral . . . . . . . . . . 23OXYCODONE HCL ER . . . . . . . . . . . . 8oxycodone hcl oral capsule . . . . . . . . 8oxycodone hcl oral concentrate 100 mg/5ml . . . . . . . . . . . . . . . . . . . . . 8oxycodone hcl oral solution . . . . . . . . 8oxycodone hcl oral tablet . . . . . . . . . . 8oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg . . . . . . . . . . . . . 8OXYCONTIN . . . . . . . . . . . . . . . . . . . . 8OZEMPIC . . . . . . . . . . . . . . . . . . . . . . 21OZOBAX . . . . . . . . . . . . . . . . . . . . . . . 31

P

PACERONE ORAL TABLET 100 MG, 400 MG . . . . . . . . . . . . . . . . 16pacerone oral tablet 200 mg . . . . . . 16PAMELOR . . . . . . . . . . . . . . . . . . . . . 12PANCREAZE . . . . . . . . . . . . . . . . . . . 23pantoprazole sodium tablet delayed release 20 mg oral . . . . . . . . . . . . . . . 22pantoprazole sodium tablet delayed release 40 mg oral . . . . . . . . . . . . . . . 22paroex . . . . . . . . . . . . . . . . . . . . . . . . . 17paroxetine hcl . . . . . . . . . . . . . . . . . . 12paroxetine hcl er . . . . . . . . . . . . . . . . 12PAXIL CR . . . . . . . . . . . . . . . . . . . . . . 12PAXIL ORAL SUSPENSION . . . . . . . 12PAXIL ORAL TABLET . . . . . . . . . . . . 12PEDIAPRED . . . . . . . . . . . . . . . . . . . . 26peg-3350/electrolytes . . . . . . . . . . . . 23penicillamine oral capsule . . . . . . . . 23penicillin v potassium . . . . . . . . . . . . 10PENNSAID . . . . . . . . . . . . . . . . . . . . . . 9PENTASA . . . . . . . . . . . . . . . . . . . . . . 28PERFOROMIST . . . . . . . . . . . . . . . . . 31PERIDEX . . . . . . . . . . . . . . . . . . . . . . . 17periogard . . . . . . . . . . . . . . . . . . . . . . 17permethrin external . . . . . . . . . . . . . . 13PERTZYE . . . . . . . . . . . . . . . . . . . . . . 23phenadoz . . . . . . . . . . . . . . . . . . . . . . 12phenazo oral tablet 200 mg . . . . . . . 23phenazopyridine hcl oral tablet 100 mg, 200 mg . . . . . . . . . . . . . . . . . 23

42

philith . . . . . . . . . . . . . . . . . . . . . . . . . 26PICATO . . . . . . . . . . . . . . . . . . . . . . . . 19pimtrea . . . . . . . . . . . . . . . . . . . . . . . . 26pioglitazone hcl . . . . . . . . . . . . . . . . . 21pirmella 1/35 . . . . . . . . . . . . . . . . . . . 26PLEGRIDY . . . . . . . . . . . . . . . . . . . . . 17PLENVU . . . . . . . . . . . . . . . . . . . . . . . 23POLY-VI-FLOR . . . . . . . . . . . . . . . . . . 22polymyxin b-trimethoprim . . . . . . . . . 29POLYTRIM . . . . . . . . . . . . . . . . . . . . . 29portia-28 . . . . . . . . . . . . . . . . . . . . . . . 26potassium chloride crys er . . . . . . . . 22potassium chloride er . . . . . . . . . . . . 22potassium chloride oral . . . . . . . . . . 22potassium citrate er. . . . . . . . . . . . . . 22PRADAXA . . . . . . . . . . . . . . . . . . . . . 10PRALUENT. . . . . . . . . . . . . . . . . . . . . 16pramipexole dihydrochloride . . . . . . 13pramipexole dihydrochloride er . . . . 13PRAVACHOL . . . . . . . . . . . . . . . . . . . 16pravastatin sodium . . . . . . . . . . . . . . 16prazosin hcl oral . . . . . . . . . . . . . . . . 16PRED FORTE . . . . . . . . . . . . . . . . . . . 29PRED MILD . . . . . . . . . . . . . . . . . . . . 29prednisolone acetate ophthalmic . . 29prednisolone oral solution . . . . . . . . 26prednisolone sodium phosphate oral . . . . . . . . . . . . . . . . . . . . . . . . . . . 27prednisone intensol . . . . . . . . . . . . . . 27prednisone oral . . . . . . . . . . . . . . . . . 27pregabalin oral capsule . . . . . . . . . . 17pregabalin oral solution . . . . . . . . . . 17pregnyl . . . . . . . . . . . . . . . . . . . . . . . . 28PREMARIN ORAL . . . . . . . . . . . . . . . 26PREMARIN VAGINAL . . . . . . . . . . . . 26premium lidocaine . . . . . . . . . . . . . . . . 8PREMPHASE . . . . . . . . . . . . . . . . . . . 26PREMPRO . . . . . . . . . . . . . . . . . . . . . 26PREPOPIK . . . . . . . . . . . . . . . . . . . . . 23PREVIDENT 5000 BOOSTER PLUS . . . . . . . . . . . . . . . . . . . . . . . . . . 17PREVIDENT 5000 DRY MOUTH . . . 17PREVIDENT 5000 ORTHO DEFENSE . . . . . . . . . . . . . . . . . . . . . . 18PREVIDENT 5000 PLUS . . . . . . . . . . 18PREVIDENT DENTAL . . . . . . . . . . . . 18PREVIDENT MOUTH/THROAT . . . . 18

previfem . . . . . . . . . . . . . . . . . . . . . . . 26PREZCOBIX . . . . . . . . . . . . . . . . . . . . 14PREZISTA . . . . . . . . . . . . . . . . . . . . . . 14PRIMLEV . . . . . . . . . . . . . . . . . . . . . . . 8PRINIVIL . . . . . . . . . . . . . . . . . . . . . . . 16PROAIR HFA . . . . . . . . . . . . . . . . 30, 31PROAIR RESPICLICK . . . . . . . . . . . . 31PROCARDIA . . . . . . . . . . . . . . . . . . . 16PROCARDIA XL . . . . . . . . . . . . . . . . . 16PROCENTRA . . . . . . . . . . . . . . . . . . . 17prochlorperazine maleate oral . . . . . 12PROCORT . . . . . . . . . . . . . . . . . . . . . 28PROCTOFOAM HC . . . . . . . . . . . . . . 28progesterone micronized oral . . . . . 26PROGRAF ORAL PACKET . . . . . . . . 28promethazine hcl oral solution . . . . . 30promethazine hcl oral syrup . . . . . . . 30promethazine hcl oral tablet . . . . . . . 12promethazine hcl rectal . . . . . . . . . . 12promethazine-codeine . . . . . . . . . . . 30promethazine-dm . . . . . . . . . . . . . . . 30promethegan . . . . . . . . . . . . . . . . . . . 12propranolol hcl er . . . . . . . . . . . . . . . 16propranolol hcl oral . . . . . . . . . . . . . . 16PROSCAR . . . . . . . . . . . . . . . . . . . . . 23PROTONIX ORAL PACKET . . . . . . . 22PROVENTIL HFA . . . . . . . . . . . . . 30, 31PROVERA . . . . . . . . . . . . . . . . . . . 24, 26pseudoephedrine-bromphen-dm . . 30PULMICORT FLEXHALER . . . . . . . . 31PULMOZYME . . . . . . . . . . . . . . . . . . 31PURIXAN . . . . . . . . . . . . . . . . . . . . . . 13PYLERA . . . . . . . . . . . . . . . . . . . . . . . 22PYRIDIUM . . . . . . . . . . . . . . . . . . . . . 23

Q

QBRELIS . . . . . . . . . . . . . . . . . . . . . . 16QMIIZ ODT . . . . . . . . . . . . . . . . . . . . . . 9quetiapine fumarate . . . . . . . . . . . . . 13quetiapine fumarate er . . . . . . . . . . . 13QUFLORA PEDIATRIC . . . . . . . . . . . 22QUILLICHEW ER . . . . . . . . . . . . . . . . 17QUILLIVANT XR . . . . . . . . . . . . . . . . . 17quinapril hcl . . . . . . . . . . . . . . . . . . . . 16QVAR REDIHALER . . . . . . . . . . . . . . 31

R

RABEPRAZOLE SODIUM ORAL CAPSULE SPRINKLE . . . . . . . . . . . . 22rabeprazole sodium oral tablet delayed release . . . . . . . . . . . . . . . . . 22ramipril . . . . . . . . . . . . . . . . . . . . . . . . 16ranolazine er . . . . . . . . . . . . . . . . . . . 16RAPAMUNE ORAL SOLUTION . . . . 28RASUVO . . . . . . . . . . . . . . . . . . . . . . . 28RAYOS . . . . . . . . . . . . . . . . . . . . . . . . 27REBIF . . . . . . . . . . . . . . . . . . . . . . . . . 17REBIF REBIDOSE . . . . . . . . . . . . . . . 17reclipsen . . . . . . . . . . . . . . . . . . . . . . . 26RECOMBINATE . . . . . . . . . . . . . . . . . 22REGLAN . . . . . . . . . . . . . . . . . . . . . . . 12RELAFEN DS . . . . . . . . . . . . . . . . . . . . 9relexxii . . . . . . . . . . . . . . . . . . . . . . . . 17REMERON . . . . . . . . . . . . . . . . . . . . . 12REMERON SOLTAB . . . . . . . . . . . . . 12REPATHA . . . . . . . . . . . . . . . . . . . . . . 16RESTASIS . . . . . . . . . . . . . . . . . . . . . . 29RESTASIS MULTIDOSE . . . . . . . . . . 29RESTORIL . . . . . . . . . . . . . . . . . . . . . 31RETACRIT . . . . . . . . . . . . . . . . . . . . . 22REVLIMID . . . . . . . . . . . . . . . . . . . . . . 13REYVOW TABLET . . . . . . . . . . . . . . . 13RHOFADE CREAM 1% . . . . . . . . . . . 19RHOPRESSA . . . . . . . . . . . . . . . . . . . 29RILUTEK . . . . . . . . . . . . . . . . . . . . . . . 17riluzole . . . . . . . . . . . . . . . . . . . . . . . . 17RINVOQ . . . . . . . . . . . . . . . . . . . . . . . 28RIOMET . . . . . . . . . . . . . . . . . . . . . . . 21risperidone . . . . . . . . . . . . . . . . . . . . . 13RITALIN . . . . . . . . . . . . . . . . . . . . . . . 17ritonavir . . . . . . . . . . . . . . . . . . . . . . . . 14rivelsa . . . . . . . . . . . . . . . . . . . . . . . . . 26rizatriptan benzoate . . . . . . . . . . . . . . 13ROBAXIN-750 . . . . . . . . . . . . . . . . . . 31ROCALTROL . . . . . . . . . . . . . . . . . . . 28ROCKLATAN . . . . . . . . . . . . . . . . . . . 29ropinirole hcl . . . . . . . . . . . . . . . . . . . 13ropinirole hcl er . . . . . . . . . . . . . . . . . 13rosadan external cream . . . . . . . . . . 19rosadan external gel . . . . . . . . . . . . . 19rosuvastatin calcium . . . . . . . . . . . . . 16roweepra . . . . . . . . . . . . . . . . . . . . . . 11roweepra xr . . . . . . . . . . . . . . . . . . . . 11

43

ROXICODONE ORAL TABLET 15 MG, 30 MG . . . . . . . . . . . . . . . . . . . 8ROXICODONE ORAL TABLET 5 MG . . . . . . . . . . . . . . . . . . . . . . . . . . . 8RUCONEST . . . . . . . . . . . . . . . . . . . . 28RYBELSUS . . . . . . . . . . . . . . . . . . . . . 21RYTARY . . . . . . . . . . . . . . . . . . . . . . . 13

S

SAPHRIS . . . . . . . . . . . . . . . . . . . . . . 13scopolamine . . . . . . . . . . . . . . . . . . . 12SEASONIQUE . . . . . . . . . . . . . . . . . . 26SEREVENT DISKUS . . . . . . . . . . . . . 31SERNIVO . . . . . . . . . . . . . . . . . . . . . . 19sertraline hcl oral . . . . . . . . . . . . . . . . 12setlakin . . . . . . . . . . . . . . . . . . . . . . . . 26sf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18sf 5000 plus . . . . . . . . . . . . . . . . . . . . 18SFROWASA . . . . . . . . . . . . . . . . . . . . 28sharobel . . . . . . . . . . . . . . . . . . . . . . . 26sildenafil citrate oral tablet 100 mg, 25 mg, 50 mg . . . . . . . . . . . . . . . . . . . 22simliya . . . . . . . . . . . . . . . . . . . . . . . . . 26simpesse . . . . . . . . . . . . . . . . . . . . . . 26SIMPONI . . . . . . . . . . . . . . . . . . . . . . . 28simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg . . . . . . . . . . . . . 16simvastatin oral tablet 80 mg . . . . . . 16SINEMET . . . . . . . . . . . . . . . . . . . . . . 13SINGULAIR ORAL PACKET . . . . . . . 31sirolimus oral solution . . . . . . . . . . . . 28sirolimus oral tablet . . . . . . . . . . . . . . 28SITAVIG . . . . . . . . . . . . . . . . . . . . . . . 14SKYRIZI (150 MG DOSE) . . . . . . . . . 28sodium fluoride 5000 plus . . . . . . . . 18sodium fluoride dental . . . . . . . . . . . 18SOFOS/VELPAT ORAL TABLET 400-100 . . . . . . . . . . . . . . . . . . . . . . . . 14SOFOSBUVIR-VELPATASVIR . . . . . . 14SOFTCLIX . . . . . . . . . . . . . . . . . . . . . 20SOLIQUA . . . . . . . . . . . . . . . . . . . . . . 21SOLTAMOX . . . . . . . . . . . . . . . . . . . . 13SOMA ORAL TABLET 350 MG . . . . 31SOOLANTRA CREAM 1% . . . . . . . . 19sotalol hcl oral . . . . . . . . . . . . . . . . . . 16SOTYLIZE . . . . . . . . . . . . . . . . . . . . . . 16SPIRIVA HANDIHALER . . . . . . . . . . . 31SPIRIVA RESPIMAT . . . . . . . . . . . . . 31

spironolactone oral . . . . . . . . . . . . . . 16sprintec 28 . . . . . . . . . . . . . . . . . . . . . 26SPRITAM . . . . . . . . . . . . . . . . . . . . . . 11SPRIX . . . . . . . . . . . . . . . . . . . . . . . . . . 9sronyx . . . . . . . . . . . . . . . . . . . . . . . . . 26sss 10-5 . . . . . . . . . . . . . . . . . . . . . . . 19STELARA . . . . . . . . . . . . . . . . . . . . . . 28STENDRA . . . . . . . . . . . . . . . . . . . . . . 22STIMATE . . . . . . . . . . . . . . . . . . . . . . . 27STRENSIQ . . . . . . . . . . . . . . . . . . . . . 23STRIANT. . . . . . . . . . . . . . . . . . . . . . . 27STRIBILD . . . . . . . . . . . . . . . . . . . . . . 14STRIVERDI RESPIMAT . . . . . . . . . . . 31SUBSYS . . . . . . . . . . . . . . . . . . . . . . . . 8subvenite . . . . . . . . . . . . . . . . . . . . . . 11subvenite starter kit-blue . . . . . . . . . 11subvenite starter kit-green . . . . . . . . 11subvenite starter kit-orange . . . . . . . 11sucralfate oral suspension . . . . . . . . 22sucralfate oral tablet . . . . . . . . . . . . . 22sulfacetamide sodium-sulfur external cream 10-2 %, 10-5 % . . . . . 19sulfacetamide sodium-sulfur external emulsion . . . . . . . . . . . . . . . 19sulfacetamide sodium-sulfur external liquid 9-4 %, 9-4.5 % . . . . . . 19sulfacetamide sodium-sulfur external lotion 10-5 % . . . . . . . . . . . . 19sulfacetamide sodium-sulfur external pad . . . . . . . . . . . . . . . . . . . . 19sulfacetamide sodium-sulfur external suspension 10-5 % . . . . . . . 19sulfacleanse 8/4 . . . . . . . . . . . . . . . . . 19sulfamethoxazole-trimethoprim oral 10sulfamez wash . . . . . . . . . . . . . . . . . . 19sulfasalazine oral tablet . . . . . . . . . . 28sulfatrim pediatric . . . . . . . . . . . . . . . 10sumatriptan succinate oral . . . . . . . . 13sumatriptan succinate refill . . . . . . . 13sumatriptan succinate subcutaneous . . . . . . . . . . . . . . . . . . 13SUNOSI . . . . . . . . . . . . . . . . . . . . . . . 31SUPREP BOWEL PREP KIT . . . . . . . 23syeda . . . . . . . . . . . . . . . . . . . . . . . . . 26SYMAX DUOTAB . . . . . . . . . . . . . . . . 23symax-sl . . . . . . . . . . . . . . . . . . . . . . . 23symax-sr . . . . . . . . . . . . . . . . . . . . . . . 23SYMBICORT . . . . . . . . . . . . . . . . . . . 31

SYMFI . . . . . . . . . . . . . . . . . . . . . . . . . 14SYMFI LO . . . . . . . . . . . . . . . . . . . . . . 14SYMJEPI . . . . . . . . . . . . . . . . . . . . . . . 30SYMPROIC . . . . . . . . . . . . . . . . . . . . . 23SYNJARDY . . . . . . . . . . . . . . . . . . . . . 21SYNJARDY XR . . . . . . . . . . . . . . . . . . 21SYNTHROID . . . . . . . . . . . . . . . . . . . . 27SYPRINE. . . . . . . . . . . . . . . . . . . . . . . 23

T

TACLONEX EXTERNAL SUSPENSION . . . . . . . . . . . . . . . . . . 19tacrolimus oral . . . . . . . . . . . . . . . . . . 28tadalafil oral tablet 10 mg, 20 mg . . 22tadalafil oral tablet 2.5 mg, 5 mg . . . 22TAKHZYRO . . . . . . . . . . . . . . . . . . . . 28tamoxifen citrate oral tablet 10 mg . 13tamoxifen citrate oral tablet 20 mg . 13tamsulosin hcl . . . . . . . . . . . . . . . . . . 23TAPAZOLE . . . . . . . . . . . . . . . . . . . . . 27TAPERDEX . . . . . . . . . . . . . . . . . . . . . 27TARGRETIN EXTERNAL . . . . . . . . . 13TARGRETIN ORAL . . . . . . . . . . . . . . 13tarina 24 fe . . . . . . . . . . . . . . . . . . . . . 26tarina fe 1/20 . . . . . . . . . . . . . . . . . . . 26tarina fe 1/20 eq . . . . . . . . . . . . . . . . . 26TASIGNA . . . . . . . . . . . . . . . . . . . . . . 13TAYTULLA . . . . . . . . . . . . . . . . . . . . . 26tazarotene external . . . . . . . . . . . . . . 19TAZORAC EXTERNAL CREAM 0.1 % . . . . . . . . . . . . . . . . . . . . . . . . . . 19TAZORAC EXTERNAL GEL . . . . . . . 19TECFIDERA . . . . . . . . . . . . . . . . . . . . 17TEGRETOL . . . . . . . . . . . . . . . . . . . . . 11TEGRETOL-XR . . . . . . . . . . . . . . . . . . 11TEGSEDI. . . . . . . . . . . . . . . . . . . . . . . 23TEKTURNA . . . . . . . . . . . . . . . . . . . . 16TEKTURNA HCT . . . . . . . . . . . . . . . . 16telmisartan . . . . . . . . . . . . . . . . . . . . . 16temazepam . . . . . . . . . . . . . . . . . . . . 31TEMIXYS . . . . . . . . . . . . . . . . . . . . . . 14TEMOVATE . . . . . . . . . . . . . . . . . . . . . 19tenofovir disoproxil fumarate . . . . . . 14terazosin hcl . . . . . . . . . . . . . . . . . . . . 24terbinafine hcl oral . . . . . . . . . . . . . . . 12terconazole . . . . . . . . . . . . . . . . . . . . 12TERIPARATIDE . . . . . . . . . . . . . . . . . 28

44

TESSALON PERLES . . . . . . . . . . . . . 30TESTIM . . . . . . . . . . . . . . . . . . . . . . . . 27TESTOSTERONE CYPIONATE INJECTION . . . . . . . . . . . . . . . . . . . . . 27testosterone cypionate intramuscular . . . . . . . . . . . . . . . . . . . 27testosterone enanthate intramuscular . . . . . . . . . . . . . . . . . . . 27testosterone transdermal . . . . . . . . . 27TEXACORT . . . . . . . . . . . . . . . . . . . . 19thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg . . . . . . . . . . . . 27TIGLUTIK . . . . . . . . . . . . . . . . . . . . . . 17timolol maleate ophthalmic gel forming solution . . . . . . . . . . . . . . . . . 29timolol maleate ophthalmic solution 0.25 %, 0.5 % . . . . . . . . . . . . . . . . . . . 29timolol maleate ophthalmic solution 0.5 % (daily) . . . . . . . . . . . . . . . . . . . . 29TIMOPTIC . . . . . . . . . . . . . . . . . . . . . 29TIMOPTIC OCUDOSE . . . . . . . . . . . . 29TIMOPTIC-XE . . . . . . . . . . . . . . . . . . . 29TIROSINT . . . . . . . . . . . . . . . . . . . . . . 27TIROSINT-SOL . . . . . . . . . . . . . . . . . . 27TIVICAY. . . . . . . . . . . . . . . . . . . . . . . . 14tizanidine hcl oral capsule . . . . . . . . 31tizanidine hcl oral tablet . . . . . . . . . . 31TOBI PODHALER . . . . . . . . . . . . . . . 31TOBRADEX OPHTHALMIC OINTMENT . . . . . . . . . . . . . . . . . . . . . 29TOBRADEX OPHTHALMIC SUSPENSION . . . . . . . . . . . . . . . . . . 29TOBRADEX ST . . . . . . . . . . . . . . . . . 29tobramycin nebulization solution 300 mg/5ml inhalation . . . . . . . . . . . 31tobramycin ophthalmic . . . . . . . . . . . 29tobramycin-dexamethasone . . . . . . . 29TOBREX OPHTHALMIC OINTMENT . . . . . . . . . . . . . . . . . . . . . 29TOBREX OPHTHALMIC SOLUTION . . . . . . . . . . . . . . . . . . . . . 29TOLAK . . . . . . . . . . . . . . . . . . . . . . . . 19TOPAMAX . . . . . . . . . . . . . . . . . . . . . 11TOPAMAX SPRINKLE . . . . . . . . . . . . 11topiramate er . . . . . . . . . . . . . . . . . . . 11topiramate oral . . . . . . . . . . . . . . . . . . 11TOPROL XL . . . . . . . . . . . . . . . . . . . . 16torsemide . . . . . . . . . . . . . . . . . . . . . . 16TOUJEO MAX SOLOSTAR . . . . . . . . 21

TOUJEO SOLOSTAR . . . . . . . . . . . . 21TOVIAZ . . . . . . . . . . . . . . . . . . . . . . . . 23TRACLEER . . . . . . . . . . . . . . . . . . . . . 31TRADJENTA . . . . . . . . . . . . . . . . . . . . 21tramadol hcl er (biphasic) . . . . . . . . . . 8TRAMADOL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG, 200 MG, 300 MG . . . . . . . . . . . . . . . . . . . . . . . . . 8tramadol hcl er oral capsule extended release 24 hour 150 mg . . . 8tramadol hcl er oral tablet extended release 24 hour . . . . . . . . . . . . . . . . . . 9tramadol hcl oral tablet 50 mg . . . . . . 9TRANSDERM-SCOP (1.5 MG) . . . . . 12TRAVATAN Z . . . . . . . . . . . . . . . . . . . 29travoprost (bak free) . . . . . . . . . . . . . 29trazodone hcl oral . . . . . . . . . . . . . . . 12TRELEGY ELLIPTA . . . . . . . . . . . . . . 31TREMFYA . . . . . . . . . . . . . . . . . . . . . . 28TRESIBA . . . . . . . . . . . . . . . . . . . . . . . 21TRESIBA FLEXTOUCH . . . . . . . . . . . 21tretinoin external cream . . . . . . . . . . 19TREXALL . . . . . . . . . . . . . . . . . . . . . . 28TREZIX . . . . . . . . . . . . . . . . . . . . . . . . . 9tri femynor . . . . . . . . . . . . . . . . . . . . . 26tri-estarylla . . . . . . . . . . . . . . . . . . . . . 26tri-linyah . . . . . . . . . . . . . . . . . . . . . . . 26tri-lo-estarylla . . . . . . . . . . . . . . . . . . . 26tri-lo-mili . . . . . . . . . . . . . . . . . . . . . . . 26tri-lo-sprintec . . . . . . . . . . . . . . . . . . . 26tri-mili . . . . . . . . . . . . . . . . . . . . . . . . . 26tri-previfem . . . . . . . . . . . . . . . . . . . . . 26tri-sprintec . . . . . . . . . . . . . . . . . . . . . 26tri-vylibra . . . . . . . . . . . . . . . . . . . . . . . 26tri-vylibra lo . . . . . . . . . . . . . . . . . . . . . 26triamcinolone acetonide external aerosol solution . . . . . . . . . . . . . . . . . 19triamcinolone acetonide external cream 0.025 %, 0.1 % . . . . . . . . . . . . 19triamcinolone acetonide external cream 0.5 % . . . . . . . . . . . . . . . . . . . . 19triamcinolone acetonide external lotion . . . . . . . . . . . . . . . . . . . . . . . . . . 19triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 % . . . . 19triamcinolone acetonide external ointment 0.05 % . . . . . . . . . . . . . . . . . 19triamterene-hctz . . . . . . . . . . . . . . . . 16

trianex . . . . . . . . . . . . . . . . . . . . . . . . . 19triazolam . . . . . . . . . . . . . . . . . . . . . . . 14triderm external cream 0.1 % . . . . . . 19triderm external cream 0.5 % . . . . . . 19TRIDESILON . . . . . . . . . . . . . . . . . . . 20trientine hcl. . . . . . . . . . . . . . . . . . . . . 23TRIJARDY XR . . . . . . . . . . . . . . . . . . 21TRILEPTAL . . . . . . . . . . . . . . . . . . . . . 11TRINTELLIX . . . . . . . . . . . . . . . . . . . . 12TRIUMEQ . . . . . . . . . . . . . . . . . . . . . . 14TROKENDI XR . . . . . . . . . . . . . . . . . . 11TRULICITY . . . . . . . . . . . . . . . . . . . . . 21TRUVADA . . . . . . . . . . . . . . . . . . . . . . 14tulana . . . . . . . . . . . . . . . . . . . . . . . . . 26TUSSICAPS . . . . . . . . . . . . . . . . . . . . 30tydemy . . . . . . . . . . . . . . . . . . . . . . . . 26TYLENOL WITH CODEINE #3 . . . . . . 9TYMLOS . . . . . . . . . . . . . . . . . . . . . . . 28TYVASO . . . . . . . . . . . . . . . . . . . . . . . 31

U

UBRELVY TABLET . . . . . . . . . . . . . . 13UCERIS ORAL . . . . . . . . . . . . . . . . . . 28UCERIS RECTAL . . . . . . . . . . . . . . . . 28ULTRAM . . . . . . . . . . . . . . . . . . . . . . . . 9unithroid . . . . . . . . . . . . . . . . . . . . . . . 27UROCIT-K 10 . . . . . . . . . . . . . . . . . . . 22UROCIT-K 15 . . . . . . . . . . . . . . . . . . . 22UROCIT-K 5 . . . . . . . . . . . . . . . . . . . . 22UROXATRAL . . . . . . . . . . . . . . . . . . . 24URSO 250 . . . . . . . . . . . . . . . . . . . . . 23URSO FORTE . . . . . . . . . . . . . . . . . . 23ursodiol oral . . . . . . . . . . . . . . . . . . . . 23

V

valacyclovir hcl oral . . . . . . . . . . . . . . 14valsartan . . . . . . . . . . . . . . . . . . . . . . . 16valsartan-hydrochlorothiazide . . . . . 16VALTOCO . . . . . . . . . . . . . . . . . . . . . . 11VANATOL LQ . . . . . . . . . . . . . . . . . . . . 9VANATOL S . . . . . . . . . . . . . . . . . . . . . 9vandazole . . . . . . . . . . . . . . . . . . . . . . 10VARUBI (180 MG DOSE) . . . . . . . . . . 12VASCEPA ORAL CAPSULE 0.5 GM 16VASCEPA ORAL CAPSULE 1 GM . . 16VELPHORO . . . . . . . . . . . . . . . . . . . . 23VELTASSA . . . . . . . . . . . . . . . . . . . . . 22

45

VEMLIDY . . . . . . . . . . . . . . . . . . . . . . 14venlafaxine hcl . . . . . . . . . . . . . . . . . . 12venlafaxine hcl er oral capsule extended release 24 hour . . . . . . . . . 12venlafaxine hcl er oral tablet extended release 24 hour . . . . . . . . . 12VENTOLIN HFA . . . . . . . . . . . . . . 30, 31verapamil hcl er oral capsule extended release 24 hour 100 mg, 200 mg, 300 mg . . . . . . . . . . . . . . . . 16verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg . . . . . . . . . 16verapamil hcl er oral tablet extended release . . . . . . . . . . . . . . . . 16verapamil hcl oral . . . . . . . . . . . . . . . 16VERDESO . . . . . . . . . . . . . . . . . . . . . . 20VERELAN . . . . . . . . . . . . . . . . . . . . . . 16VERELAN PM . . . . . . . . . . . . . . . . . . 16VERZENIO . . . . . . . . . . . . . . . . . . . . . 13VIBERZI . . . . . . . . . . . . . . . . . . . . . . . 23VIBRAMYCIN ORAL CAPSULE . . . . 10VIBRAMYCIN ORAL SUSPENSION RECONSTITUTED . . . . . . . . . . . . . . . 10vicodin hp oral tablet 10-300 mg . . . . 9VICTOZA SOLUTION PEN-INJECTOR 18 MG/3ML SUBCUTANEOUS (2 PACK) . . . . . . . 21VICTOZA SOLUTION PEN-INJECTOR 18 MG/3ML SUBCUTANEOUS (3 PACK) . . . . . . . 21vienva . . . . . . . . . . . . . . . . . . . . . . . . . 26VIIBRYD . . . . . . . . . . . . . . . . . . . . . . . 12VIMPAT ORAL . . . . . . . . . . . . . . . . . . 11VIOKACE . . . . . . . . . . . . . . . . . . . . . . 23viorele . . . . . . . . . . . . . . . . . . . . . . . . . 26VIREAD ORAL POWDER . . . . . . . . . 14VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG . . . . . . . . . . . . . . . . 14VISTARIL . . . . . . . . . . . . . . . . . . . . . . 14vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut) . . . . . . . 22VIVELLE-DOT . . . . . . . . . . . . . . . . 24, 26VIVLODEX . . . . . . . . . . . . . . . . . . . . . . 9VOSEVI . . . . . . . . . . . . . . . . . . . . . . . . 14vyfemla . . . . . . . . . . . . . . . . . . . . . . . . 26VYLEESI . . . . . . . . . . . . . . . . . . . . . . . 22vylibra . . . . . . . . . . . . . . . . . . . . . . . . . 26VYVANSE . . . . . . . . . . . . . . . . . . . . . . 17VYZULTA . . . . . . . . . . . . . . . . . . . . . . 29

W

WAKIX . . . . . . . . . . . . . . . . . . . . . . . . . 31warfarin sodium oral . . . . . . . . . . . . . 10WELCHOL . . . . . . . . . . . . . . . . . . . . . 16wera . . . . . . . . . . . . . . . . . . . . . . . . . . 26WESTHROID . . . . . . . . . . . . . . . . . . . 27wixela inhub . . . . . . . . . . . . . . . . . . . . 31WP THYROID . . . . . . . . . . . . . . . . . . . 27

X

XARELTO . . . . . . . . . . . . . . . . . . . . . . 10XCOPRI PAK . . . . . . . . . . . . . . . . . . . 11XCOPRI TABLET . . . . . . . . . . . . . . . . 11XELJANZ . . . . . . . . . . . . . . . . . . . . . . 28XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 11 MG . . . . . . . . . . . . . . . . . . . . . . . . . . . 28XELODA . . . . . . . . . . . . . . . . . . . . . . . 13XELPROS . . . . . . . . . . . . . . . . . . . . . . 29XEPI . . . . . . . . . . . . . . . . . . . . . . . . . . 10XHANCE . . . . . . . . . . . . . . . . . . . . . . . 30XIFAXAN . . . . . . . . . . . . . . . . . . . . . . . 23XIIDRA . . . . . . . . . . . . . . . . . . . . . . . . 29XIMINO . . . . . . . . . . . . . . . . . . . . . . . . 10XOFLUZA . . . . . . . . . . . . . . . . . . . . . . 14XOLEGEL . . . . . . . . . . . . . . . . . . . . . . 12XOPENEX HFA . . . . . . . . . . . . . . . . . . 31XTAMPZA ER . . . . . . . . . . . . . . . . . . . . 9xulane . . . . . . . . . . . . . . . . . . . . . . . . . 26XYOSTED . . . . . . . . . . . . . . . . . . . . . . 27XYREM . . . . . . . . . . . . . . . . . . . . . . . . 31

Y

YASMIN 28 . . . . . . . . . . . . . . . . . . . . . 26YAZ . . . . . . . . . . . . . . . . . . . . . . . . . . . 26YUPELRI . . . . . . . . . . . . . . . . . . . . . . . 31yuvafem . . . . . . . . . . . . . . . . . . . . . . . 26

Z

ZANAFLEX ORAL CAPSULE . . . . . . 31zarah . . . . . . . . . . . . . . . . . . . . . . . . . . 26ZARXIO . . . . . . . . . . . . . . . . . . . . . . . 22ZEBUTAL . . . . . . . . . . . . . . . . . . . . . . . 9ZEJULA . . . . . . . . . . . . . . . . . . . . . . . 13ZELNORM . . . . . . . . . . . . . . . . . . . . . 23ZEMBRACE SYMTOUCH . . . . . . . . . 13zenatane . . . . . . . . . . . . . . . . . . . . . . . 20ZENPEP . . . . . . . . . . . . . . . . . . . . . . . 23

ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG . . . . 17ZEPATIER . . . . . . . . . . . . . . . . . . . . . . 14ZETONNA. . . . . . . . . . . . . . . . . . . . . . 30ZIAC ORAL TABLET 10-6.25 MG, 2.5-6.25 MG . . . . . . . . . . . . . . . . . . . . 16ZIAC ORAL TABLET 5-6.25 MG . . . 16ZIEXTENZO . . . . . . . . . . . . . . . . . . . . 22ziprasidone hcl. . . . . . . . . . . . . . . . . . 13ZIPSOR . . . . . . . . . . . . . . . . . . . . . . . . . 9ZITHROMAX ORAL . . . . . . . . . . . . . . 10ZITHROMAX TRI-PAK . . . . . . . . . . . . 10ZITHROMAX Z-PAK . . . . . . . . . . . . . . 10ZOCOR ORAL TABLET 10 MG, 20 MG, 40 MG, 80 MG . . . . . . . . . . . 16ZOFRAN . . . . . . . . . . . . . . . . . . . . . . . 12zolpidem tartrate er . . . . . . . . . . . . . . 31zolpidem tartrate oral . . . . . . . . . . . . 31zolpidem tartrate sublingual . . . . . . . 31ZOMACTON . . . . . . . . . . . . . . . . . . . . 27ZONEGRAN . . . . . . . . . . . . . . . . . . . . 11zonisamide oral . . . . . . . . . . . . . . . . . 11ZONTIVITY . . . . . . . . . . . . . . . . . . . . . 13ZOVIRAX ORAL SUSPENSION . . . . 14ZTLIDO . . . . . . . . . . . . . . . . . . . . . . . . . 9ZUBSOLV . . . . . . . . . . . . . . . . . . . . . . . 9zumandimine . . . . . . . . . . . . . . . . . . . 26ZUPLENZ . . . . . . . . . . . . . . . . . . . . . . 12ZYCLARA . . . . . . . . . . . . . . . . . . . . . . 20ZYCLARA PUMP . . . . . . . . . . . . . . . . 20ZYLOPRIM . . . . . . . . . . . . . . . . . . . . . 12

46

Nondiscrimination notice and access to communication services UnitedHealthcare® and its subsidiaries do not discriminate on the basis of race, color, national origin, age, disability or sex in their health programs or activities.

If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator.

Online: [email protected]

Mail: Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance P.O. Box 30608 Salt Lake City, UT 84130

You must send the complaint within 60 days of your experience. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll-free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m., or at the times listed in your health plan documents.

You can also file a complaint with the U.S. Dept. of Health and Human Services.

Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

Phone: Toll-free 1-800-368-1019, 800-537-7697 (TDD)

Mail: U.S. Dept. of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C. 20201

We provide free services to help you communicate with us, including letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll-free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m., or at the times listed in your health plan documents.

47

Multi-language interpreter servicesMulti-language interpreter services

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Please call the toll-free phone number listed on your identification card.

ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al número de teléfono gratuito que aparece en su tarjeta de identificación.

請注意：如果您說中文 (Chinese)，我們免費為您提供語言協助服務。請撥打會員卡所列的免付費會員電話號碼。

XIN LƯU Ý: Nếu quý vị nói tiếng Việt (Vietnamese), quý vị sẽ được cung cấp dịch vụ trợ giúp về ngôn ngữ miễn phí. Vui lòng gọi số điện thoại miễn phí ở mặt sau thẻ hội viên của quý vị.

알림: 한국어(Korean)를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다. 귀하의 신분증 카드에 기재된 무료 회원 전화번호로 문의하십시오.

PAALALA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Pakitawagan ang toll-free na numero ng telepono na nasa iyong identification card.

ВНИМАНИЕ: бесплатные услуги перевода доступны для людей, чей родной язык является русском (Russian). Позвоните по бесплатному номеру телефона, указанному на вашей идентификационной карте.

تنبيه: إذا كنت تتحدث العربية (Arabic)، فإن خدمات المساعدة اللغوية المجانية متاحة لك. الرجاء الاتصال على رقم الهاتف المجاني الموجود على معرّف العضوية.

ATANSYON: Si w pale Kreyòl ayisyen (Haitian Creole), ou kapab benefisye sèvis ki gratis pou ede w nan lang pa w. Tanpri rele nimewo gratis ki sou kat idantifikasyon w.

ATTENTION : Si vous parlez français (French), des services d’aide linguistique vous sont proposés gratuitement. Veuillez appeler le numéro de téléphone gratuit figurant sur votre carte d’identification.

UWAGA: Jeżeli mówisz po polsku (Polish), udostępniliśmy darmowe usługi tłumacza. Prosimy zadzwonić pod bezpłatny numer telefonu podany na karcie identyfikacyjnej.

ATENÇÃO: Se você fala português (Portuguese), contate o serviço de assistência de idiomas gratuito. Ligue gratuitamente para o número encontrado no seu cartão de identificação.

ATTENZIONE: in caso la lingua parlata sia l’italiano (Italian), sono disponibili servizi di assistenza linguistica gratuiti. Per favore chiamate il numero di telefono verde indicato sulla vostra tessera identificativa.

ACHTUNG: Falls Sie Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Bitte rufen Sie die gebührenfreie Rufnummer auf der Rückseite Ihres Mitgliedsausweises an.

注意事項：日本語(Japanese)を話される場合、無料の言語支援サービスをご利用いただけます。健康保険証に記載されているフリーダイヤルにお電話ください。

توجه: اگر زبان شما فارسی (Farsi) است، خدمات امداد زبانی به طور رايگان در اختيار شما می باشد. لطفا با شماره تلفن رايگانی که روی کارت شناسايی شما قيد شده تماس بگيريد.

ध्यान दें: यदि आप हिंदी (Hindi) बोलते है, आपको भाषा सहायता सेबाए,ं नि:शुल्क उपलब्ध हैं। कृपया अपने पहचान पत्र पर सूचीबद्ध टोल-फ्री फोन नंबर पर कॉल करें।CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu deb dawb uas teev muaj nyob rau ntawm koj daim yuaj cim qhia tus kheej.

ចំណាប់អារម្មណ៍ៈ បើសិនអ្នកនិយាយភាសាខ្មែរ(Khmer)សេវាជំនួយភាសាដោយឥតគិតថ្លៃ គឺមានសំរាប់អ្នក។ សូមទូរស័ព្ទទៅលេខឥតគិតថ្លៃ ដែលមាននៅលើអត្ដសញ្ញាណប័ណ្ណរបស់អ្នក។PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti toll-free a numero ti telepono nga nakalista ayan iti identification card mo.

DÍÍ BAA’ÁKONÍNÍZIN: Diné (Navajo) bizaad bee yániłti’go, saad bee áka›anída›awo›ígíí, t’áá jíík’eh, bee ná’ahóót’i’. T’áá shǫǫdí ninaaltsoos nitł’izí bee nééhozinígíí bine’dę́ę́› t’áá jíík’ehgo béésh bee hane’í biká’ígíí bee hodíilnih.

OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wac lambarka telefonka khadka bilaashka ee ku yaalla kaarkaaga aqoonsiga.

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Your 2021 Prescription Drug List - University of Arizona