YUKON DRUG PROGRAMS FORMULARY · 0076872 apo-cephalex apx 0.23 /tb y e y y 0058341 novo-lexin nop 0.23 /tb y e y y 50mg/ml 0034209 novo-lexin susp nop 0.35 /ml y e y y 500mg 0034211

YUKON DRUG PROGRAMSFORMULARY

Insured Health & Hearing Services (H-2) Printed: 2017-01-26Health and Social Services

Preamble Contents

CONTACT ADDRESSES AND PHONE NUMBERS 1

PREFACE / THE FORMULARY / DRUG REVIEW PROCESS 2

POLICY FOR FORMULARY DELETION 3

ELIGIBILITY FOR CHRONIC DISEASE PROGRAM 4

ELIGIBILITY FOR CHILDREN’S DRUG & OPTICAL PROGRAM 5

ELIGIBILITY FOR PHARMACARE PROGRAM 6

ELIGIBILITY FOR PALLIATIVE CARE COVERAGE 7

PRESCRIPTIONS 8

EXCEPTION DRUG STATUS 9

APPLICATION REVIEW FOR EXCEPTION DRUG STATUS 10

PHARMACARE AND EXTENDED BENEFITS 11

CHRONIC DISEASE AND DISABILITY 12

DOSAGE ABBREVIATIONS 13

PHARMACEUTICAL MANUFACTURERS LIST 14

1

CONTACT ADDRESSES AND PHONE NUMBERS

Health and Social Services

Insured Health & Hearing Services (H-2) Printed: 2017-01-26

2

PREFACE / THE FORMULARY / DRUG REVIEW PROCESS



3

POLICY FOR FORMULARY DELETION



4

ELIGIBILITY FOR CHRONIC DISEASE PROGRAM



5

ELIGIBILITY FOR CHILDREN’S DRUG & OPTICAL PROGRAM



6

ELIGIBILITY FOR PHARMACARE PROGRAM



7

ELIGIBILITY FOR PALLIATIVE CARE COVERAGE



8

PRESCRIPTIONS



9

EXCEPTION DRUG STATUS



10

APPLICATION REVIEW FOR EXCEPTION DRUG STATUS



11

PHARMACARE AND EXTENDED BENEFITS



12

CHRONIC DISEASE AND DISABILITY



13

DOSAGE ABBREVIATIONS



14

PHARMACEUTICAL MANUFACTURERS LIST



15

PHARMACEUTICAL MANUFACTURERS LIST



16

PHRM/CHRN/CDO/F02:10.00 null

02:00 null

ARTIFICIAL SALIVA

N/A

9123456 ARTIFICIAL SALIVA 0.2 N N N NN/A /null

04:00 ANTIHISTAMINE DRUGS

04:00.00 ANTIHISTAMINE DRUGS ------------------------------------------------------------

OLOPATADINE

0.1%

0235891 SANDOZ OLOPATADINE 5.23 Y N Y YSDZ /ML

0223314 PATANOL OPH DROPS 5.95 Y N Y YALC /ML

0230505 APO-OLOPATADINE 5.226 Y N Y YAPX /ML

0240398 CO OLOPATADINE 5.23 Y N Y YCOB /ML

0.2%

0240409 ACT OLOPATADINE 0.2% 10.45 Y N Y YACT /ML

0240282 APO-OLOPATADINE 10.45 Y N Y YAPX /ML

OLOPATDINE

0.2%

0242017 SANDOZ OLOPATADINE 0.2% 10.45 Y N Y YSDZ /ML

TRIMEPRAZINE

2.5MG

0192630 PANECTYL 0.36 Y N Y YAVT /TB

5MG

0192629 PANECTYL 0.44 Y N Y YAVT /TB

04:08.00 SECOND GENERATION ANTIHISTAMINES -----------------------------------------------

LORATADINE

10MG

0224388 APO-LORATADINE 0.63 N N Y NAPX /TB

08:00 ANTI-INFECTIVE AGENTS

08:04.00 AMEBICIDES ---------------------------------------------------------------------

DIIODOHYDROXYQUIN

650MG

0199775 DIODOQUIN 0.7545 Y N Y YGLW /TB

08:08.00 ANTHELMINTICS ------------------------------------------------------------------

MEBENDAZOLE

100MG

0055673 VERMOX 4.74 Y N Y YJAN /TB

PYRANTEL PAMOATE

125MG

0194436 COMBANTRIN 1.11 N N Y NPFI /TB

50MG/ML

0194435 COMBANTRIN SUSP 0.2789 N N Y NPFI /ML



17

PHRM/CHRN/CDO/F08:12.02 AMINOGLYCOSIDES

08:00 ANTI-INFECTIVE AGENTS (continued)

GENTAMICIN S04

08:12.02 AMINOGLYCOSIDES ----------------------------------------------------------------

10MG/ML

0226853 GENTAMICIN (2ML) 2.354 E E N YSDZ /ML

40MG/ML

0224265 GENTAMICIN (20ML) 4.26 E E N YSDZ /ML

TOBRAMYCIN

28MG

0236515 TOBI PODHALER 14.05 E E N YNVR /EA

TOBRAMYCIN SULFATE

40MG/ML

0224121 TOBRAMYCIN (2ML) INJ 3.71 E E N YSAB /ML

60MG/ML

0223963 TOBI INHALATION 54.49 E E N YCCL /ML

08:12.04 ANTIBIOTICS (ANTIFUNGALS) ------------------------------------------------------

FLUCONAZOLE

10MG/ML

0202415 DIFLUCAN PDR FOR SUSP 1 Y E Y YPFI /ML

100MG

0224564 PMS-FLUCONAZOLE 2.29 Y E Y YPMS /TB

0223737 APO-FLUCONAZOLE 2.29 Y E Y YAPX /TB

0224529 GEN-FLUCONAZOLE 2.29 Y E Y YGPM /TB

0089181 DIFLUCAN 8.6008 Y E Y YPFI /TB

0228127 CO-FLUCONAZOLE 2.29 Y E Y YCOB /TB

0223697 NOVO-FLUCONAZOLE 2.29 Y E Y YNOP /TB

150MG

0214144 DIFLUCAN 13.29 Y E Y YPFI /CP

0228234 PMS-FLUCONAZOLE 0.94 Y E Y NPMS /CP

0235213 APO-FLUCONAZOLE 11.83 Y E Y NAPX /CP

0232341 CO-FLUCONAZOLE 8.76 Y E Y NCOB /CP

0224364 NOVO-FLUCONAZOLE 9.19 Y E Y NNOP /CP

0224189 APO-FLUCONAZOLE 3.94 Y E Y NAPX /CP

0224569 GEN-FLUCONAZOLE 8.76 Y E Y NGPM /CP

0231169 CANESORAL 15.42 Y E Y YBAY /CP

4MG/ML

0089183 DIFLUCAN SUSP 0.3756 Y E Y YPFI /ML



18

PHRM/CHRN/CDO/F08:12.04 ANTIBIOTICS (ANTIFUNGALS) (continued)


FLUCONAZOLE (continued)

50MG

0223697 NOVO-FLUCONAZOLE 1.29 Y E Y YNOP /TB

0228126 CO-FLUCONAZOLE 1.29 Y E Y YCOB /TB

0224564 PMS-FLUCONAZOLE 1.29 Y E Y YPMS /TB

0224529 GEN-FLUCONAZOLE 1.29 Y E Y YGPM /TB

0089180 DIFLUCAN 4.8482 Y E Y YPFI /TB

0223737 APO-FLUCONAZOLE 1.29 Y E Y YAPX /TB

ITRACONAZOLE

10MG/ML

0223134 SPORANOX ORAL SOLN 0.78 E E Y YJAN /ML

100MG

0204745 SPORANOX 4.62 E E Y YJAN /CP

KETOCONAZOLE

200MG

0223106 NOVO-KETOCONAZOLE 0.94 Y E Y YNOP /TB

0223723 APO-KETOCONAZOLE 0.94 Y E Y YAPX /TB

NYSTATIN

100000U/ML

0243344 JAMP-NYSTATIN ORAL SUSP 0.05 Y E Y YJPC

/ML

0219420 RATIO-NYSTATIN ORAL SUSP 0.05 Y E Y YRTP /ML

0079266 PMS-NYSTATIN ORAL SUSP 0.05 Y E Y YPMS /ML

TERBINAFINE

250MG

0223989 APO-TERBINAFINE 1.85 Y E Y YAPX /TB

0224034 NOVO-TERBINAFINE 1.85 Y E Y YNOP /TB

0224250 GEN-TERBINAFINE 1.85 Y E Y YGPM /TB

0235312 SANIS-TERBINAFINE 1.85 Y E Y YSAN /TB

0203111 LAMISIL 4.21 Y E Y YNVR /TB

0229427 PMS-TERBINAFINE 1.85 Y E Y YPMS /TB

0225472 CO-TERBINAFINE 1.85 Y E Y YCOB /TB

VORICONAZOLE

200MG

0239925 SANDOZ-VORICONAZOLE 12.78 E E N YSDZ /TB

0225647 VFEND 51.11 E E N YPFI /TB

50MG

0239924 SANDOZ-VORICONAZOLE 3.2 E E N YSDZ /TB

08:12.06 CEPHALOSPORINS -----------------------------------------------------------------

CEFACLOR

25MG/ML

0046520 CECLOR SUSP 0.12 Y E Y YPHL /ML



19

PHRM/CHRN/CDO/F08:12.06 CEPHALOSPORINS


CEFACLOR (continued)

250MG

0223169 NOVO-CEFACLOR 0.9697 Y E Y YNOP /CP

0223026 APO-CEFACLOR 0.9697 Y E Y YAPX /CP

50MG/ML

0046521 CECLOR SUSP 0.22 Y E Y YPHL /ML

500MG

0223026 APO-CEFACLOR 1.93 Y E Y YAPX /CP

0223169 NOVO-CEFACLOR 1.93 Y E Y YNOP /CP

75MG/ML

0223750 APO-CEFACLOR SUSP 0.201 Y E Y YAPX /ML

0083280 CECLOR BID SUSP 0.2871 Y E Y YPHL /ML

CEFAZOLIN SODIUM

1GM PDR

0210812 CEFAZOLIN 1GM INJ PDR 3.23 Y E N YNOP /VL

CEFIXIME

20MG/ML

0086896 SUPRAX SUSP 0.43 Y E Y YAVT /ML

400MG

0086898 SUPRAX 3.62 Y E Y YAVT /TB

0243277 AURO-CEFIXIME 3.08 Y E Y YAUR /TB

CEFPROZIL

25MG/ML

0216367 CEFZIL SUSP 0.19 Y E Y YBMY /ML

0229394 APO-CEFPROZIL SUSP 0.12 Y E Y YAPX /ML

250MG

0229352 RAN-CEFPROZIL 1.13 Y E Y YRAN /TB

0216365 CEFZIL 1.93 Y E Y YBMY /TB

0229299 APO-CEFPROZIL 0.43 Y E Y YAPX /TB

50MG/ML

0216368 CEFZIL SUSP 0.38 Y E Y YBMY /ML

0229395 APO-CEFPROZIL SUSP 0.24 Y E Y YAPX /ML

500MG

0229353 RAN-CEFPROZIL 2.22 Y E Y YRAN /TB

0216366 CEFZIL 3.78 Y E Y YBMY /TB

0229300 APO-CEFPROZIL 0.85 Y E Y YAPX /TB

CEFTAZIDIME

1G/VIAL

0088697 CEFTAZIDIME FOR INJECTION 32 Y E N YPPC /VL

6GM VIAL

0221223 FORTAZ 6GM VIAL 122.89 Y E N YGSK /VL



20

PHRM/CHRN/CDO/F08:12.06 CEPHALOSPORINS (continued)


CEFTRIAXONE

CEFTRIAXONE

1GM

0229287 APO-CEFTRIAXONE FOR INJ 12.49 Y E N YAPX /VL

0229227 SANDOZ CEFTRIAXONE FOR INJ (1G 12.495 Y E N YSDZ /VL

2GM

0229228 SANDOZ CEFTRIAXONE FOR INJ (2G 24.14 Y E N YSDZ /VL

0229288 APO-CEFTRIAXONE FOR INJ 24.14 Y E N YAPX /VL

0232562 CEFTRIAXONE SODIUM FOR INJECTI 24.14 Y E Y YSTE /VL

CEFUROXIME AXETIL

25MG/ML

0221230 CEFTIN SUSP 0.17 Y E Y YGSK /ML

250MG

0234482 AURO-CEFUROXIME 0.72 Y E Y YAUR /TB

0224439 APO-CEFUROXIME 0.72 Y E Y YAPX /TB

0224265 RATIO-CEFUROXIME 0.72 Y E Y YRTP /TB

0221227 CEFTIN 1.68 Y E Y YGSK /TB

500MG

0234483 AURO-CEFUROXIME 1.43 Y E Y YAUR /TB

0224439 APO-CEFUROXIME 1.43 Y E Y YAPX /TB

0224265 RATIO-CEFUROXIME 1.43 Y E Y YRTP /TB

0221228 CEFTIN 3.32 Y E Y YGSK /TB

CEPHALEXIN

25MG/ML

0034210 NOVO-LEXIN SUSP 0.18 Y E Y YNOP /ML

250MG

0034208 NOVO-LEXIN 0.37 Y E Y YNOP /CP

0076872 APO-CEPHALEX 0.23 Y E Y YAPX /TB

0058341 NOVO-LEXIN 0.23 Y E Y YNOP /TB

50MG/ML

0034209 NOVO-LEXIN SUSP 0.35 Y E Y YNOP /ML

500MG

0034211 NOVO-LEXIN 0.69 Y E Y YNOP /CP

0086588 NU-CEPHALEX 0.299 Y N N YNXP /TB

0058342 NOVO-LEXIN 0.45 Y E Y YNOP /TB

0076871 APO-CEPHALEX 0.45 Y E Y YAPX /TB

08:12.12 MACROLIDES ---------------------------------------------------------------------

AZITHROMYCIN



21

PHRM/CHRN/CDO/F08:12.12 MACROLIDES (continued)


AZITHROMYCIN (continued)

20MG/ML

0233238 SDZ-AZITHRO 20M/ML (15ML) 0.37 Y E Y YSDZ /ML

0231515 NOVO-AZITHROMYCIN 0.37 Y E Y YNOP /ML

0227438 PMS-AZITHROMYCIN 0.37 Y E Y YPMS /ML

0222371 ZITHROMAX SUSP 1.09 Y E Y YPFI /ML

250MG

0226784 NOVO-AZITHROMYCIN 1.23 Y E Y YNOP /TB

0226582 SANDOZ AZITHROMYCIN 1.23 Y E Y YSDZ /TB

0226163 PMS-AZITHROMYCIN 1.23 Y E Y YPMS /TB

0233088 SANIS-AZITHROMYCIN 1.23 Y E Y YSAN /TB

0225534 CO AZITHROMYCIN 1.23 Y E Y YCOB /TB

0224742 APO-AZITHROMYCIN 1.23 Y E Y YAPX /TB

0221202 ZITHROMAX 5.03 Y E Y YPFI /TB

0227835 MYLAN-AZITHROMYCIN 1.23 Y E Y YMYL /TB

0227528 RATIO AZITHROMYCIN 1.23 Y E Y YRPH /TB

40MG/ML

0222372 ZITHROMAX SUSP 1.5087 Y E Y YPFI /ML

0231516 NOVO-AZITHROMYCIN 1.058 Y E Y YNOP /ML

0233239 SDZ-AZITHRO 40M/ML (15ML) 1.058 Y E Y YSDZ /ML

0227439 PMS-AZITHROMYCIN 1.058 Y E Y YPMS /ML

0227457 GD-AZITHROMYCIN 0.53 Y E Y YGDI /ML

600MG

0225608 CO AZITHROMYCIN 6 Y E Y YCOB /TB

0223114 ZITHROMAX 12.07 Y E Y YPFI /TB

0233091 SANIS-AZITHROMYCIN 6 Y E Y YSAN /TB

0226164 PMS-AZITHROMYCIN 6 Y E Y YPMS /TB

CLARITHROMYCIN

25MG/ML

0240898 CLARITHROMYCIN 0.2 Y E Y YSAI /ML

0239044 ACCEL-CLARITHROMYCIN 0.2 Y E Y YACC /ML

0214690 BIAXIN SUSP 0.3 Y E Y YABB /ML

250MG

0224781 RATIO-CLARITHROMYCIN 0.41 Y E Y YRTP /TB

0224757 PMS-CLARITHROMYCIN 0.41 Y E Y YPMS /TB

0226653 SDZ-CLARITHROMYCIN 0.41 Y E Y YSDZ /TB

0236142 RAN-CLARITHROMYCIN 0.41 Y E Y YRAN /TB

0198485 BIAXIN 1.683 Y E Y YABB /TB

0227474 APO-CLARITHROMYCIN 0.41 Y E Y YAPX /TB

0224885 MYLAN-CLARITHROMYCIN 0.41 Y E Y YMYL /TB

0224880 TEVA-CLARITHROMYCIN 0.42 Y E Y YTVM /TB



22

PHRM/CHRN/CDO/F08:12.12 MACROLIDES (continued)


CLARITHROMYCIN (continued)

250/5ML

0239045 ACCEL-CLARITHROMYCIN 0.4 Y E Y YACC /ML

250MG/5ML

0240899 CLARITHROMYCIN 0.4 Y E Y YSAI /ML

0224464 BIAXIN SUSP 0.58 Y E Y YABB /ML

500MG

0226654 SDZ-CLARITHROMYCIN 1.63 Y E Y YSDZ /TB

0224885 MYLAN-CLARITHROMYCIN 1.63 Y E Y YMYL /TB

0224880 TEVA-CLARITHROMYCIN 1.63 Y E Y YTVM /TB

0224781 RATIO-CLARITHROMYCIN 1.63 Y E Y YRTP /TB

0224757 PMS-CLARITHROMYCIN 1.63 Y E Y YPMS /TB

0227475 APO-CLARITHROMYCIN 1.63 Y E Y YAPX /TB

0236143 RAN-CLARITHROMYCIN 1.63 Y E Y YRAN /TB

0212671 BIAXIN 3.33 Y E Y YABB /TB

500MG XL

0241334 APO-CLARITHROMYCIN XL 1.26 Y E Y YAPX /TB

0224475 BIAXIN XL 2.5144 Y E Y YABB /TB

ERYTHROMYCIN BASE

250MG

0072667 APO-ERYTHRO CAP (E-C PELLETS) 0.39 Y E Y YAPX /CP

0060714 ERYC CAPSULE ( E-C PELLETS) 0.22 Y E Y YPFI /CP

0068202 APO-ERYTHRO-BASE 0.18 Y E Y YAPX /TB

333MG

0087345 ERYC CAPSULE ( E-C PELLETS) 0.478 Y E Y YPFI /CP

0192593 APO ERYTHRO CAP(E-C PELLETS) 0.43 Y E Y YAPX /CP

ERYTHROMYCIN

25MG/ML

0002117 NOVO-RYTHRO ESTOLATE SUSP 0.0368 Y E Y YNOP /ML

50MG/ML

0026259 NOVO-RYTHRO ESTOLATE SUSP 0.13 Y E Y YNOP /ML

ERYTHROMYCIN

40MG/ML

0060585 NOVO-RYTHRO ETHYLSUCC.SUSP 0.097 Y E Y YNOP /ML

0000029 EES 200 SUSP 0.0796 Y E Y YABB /ML

80MG/ML

0045361 EES 400 SUSP 0.1207 Y E Y YABB /ML

0065231 NOVO-RYTHRO ETHYLSUCC.SUSP 0.14 Y E Y YNOP /ML

ERYTHROMYCIN

250MG

0054567 APO-ERYTHRO-S EC CAPSULE 0.21 Y E Y YAPX /TB



23

PHRM/CHRN/CDO/F08:12.16 PENICILLINS


AMOXICILLIN (AMOXYCILLIN)

08:12.16 PENICILLINS --------------------------------------------------------------------

125MG

0203634 TEVA-AMOX CHEW TAB 0.458 Y E Y YTVM /TB

25MG/ML

0223024 PMS-AMOXICILLIN 0.0353 Y E Y YPMS /ML

0235276 SANIS-AMOX LOW SUGAR SUSP 0.0353 Y E Y YSAN /ML

0235274 SANIS-AMOXICILLIN SUSP 0.0353 Y E Y YSAN /ML

0045214 TEVA-AMOX SUSP 0.0353 Y E Y YTVM /ML

0193417 TEVA-AMOX LOW SUGAR SUSP 0.0353 Y E Y YTVM /ML

0062813 APO-AMOXI SUSP 0.0353 Y E Y YAPX /ML

250MG

0235271 SANIS-AMOXICILLIN 250 0.18 Y E Y YSAN /CP

0223024 PMS-AMOXICILLIN 0.18 Y E N YPMS /CP

0062811 APO-AMOXI 0.18 Y E Y YAPX /CP

0040672 TEVA-AMOX 250 0.18 Y E Y YTVM /CP

0223817 GEN-AMOXICILLIN 0.18 Y E Y YGPM /CP

0203635 TEVA-AMOX CHEW TAB 0.68 Y E Y YTVM /TB

50MG/ML

0193416 TEVA-AMOX LOW SUGAR SUSP 0.054 Y E Y YTVM /ML

0223024 PMS-AMOXICILLIN 0.054 Y E Y YPMS /ML

0235278 SANIS-AMOX LOW SUGAR SUSP 0.054 Y E Y YSAN /ML

0235275 SANIS-AMOXICILLIN SUSP 0.054 Y E Y YSAN /ML

0062815 APO-AMOXI SUSP 0.054 Y E Y YAPX /ML

0045213 TEVA-AMOX SUSP 0.054 Y E Y YTVM /ML

500MG

0223817 GEN-AMOXICILLIN 0.342 Y E Y YGPM /CP

0235272 SANIS-AMOXICILLIN 500 0.342 Y E Y YSAN /CP

0062812 APO-AMOXI 0.342 Y E Y YAPX /CP

0040671 TEVA-AMOX 500 0.342 Y E Y YTVM /CP

0223024 PMS-AMOXICILLIN 0.342 Y E Y YPMS /CP

AMOXICILLIN/CLAVULAN

125MG/31.2

0224398 APO-AMOXI CLAV SUSP 0.052 Y E Y YAPX /ML

0224464 RATIO-ACLAVULANATE 125F SUSP 0.052 Y E Y YRAT /ML

0191688 CLAVULIN-125F SUSP (125/5ML) 0.117 Y E Y YGSK /ML

200MG/26.5

0223883 CLAVULIN-200 SUSP (200MG/5ML) 0.144 Y E Y YGSK /ML

250MG/125

0224335 APO-AMOXI CLAV 250/125 TAB 0.9375 Y E Y YAPX /TB



24

PHRM/CHRN/CDO/F08:12.16 PENICILLINS (continued)


AMOXICILLIN/CLAVULANIC ACID (continued)

250MG/62.5

0224464 RATIO-ACLAVULANATE 250F SUSP 0.183 Y E Y YRAT /ML

0191687 CLAVULIN-250F SUSP (250/5ML) 0.2011 Y E Y YGSK /ML

0224398 APO-AMOXI CLAV SUSP 0.183 Y E Y YAPX /ML

400MG/57

0223883 CLAVULIN-400 SUSP (400MG/5ML) 0.2753 Y E Y YGSK /ML

500MG/125

0224335 APO-AMOXI CLAV 500/125 TAB 7.4 Y E Y YAPX /TB

0224377 RATIO-AMOXI CLAV TAB 0.668 Y E Y YRTP /TB

0191685 CLAVULIN-500 TAB 7.4 Y E Y YGSK /TB

875MG/125

0223882 CLAVULIN-875 TAB 2.2203 Y E Y YGSK /TB

0224702 RATIO-AMOXI CLAV TAB 0.56 Y E Y YRTP /TB

0224813 NOVO-CLAVAMOXIN 0.555 Y E Y YNOP /TB

0224562 APO-AMOXI CLAV TAB 0.56 Y E Y YAPO /TB

AMPICILLIN

250MG

0002087 NOVO-AMPICILLIN 0.38 Y E Y YNOP /CP

0060327 APO-AMPI 0.0819 Y E Y YAPX /CP

500MG

0002088 NOVO-AMPICILLIN 0.73 Y E Y YNOP /CP

0060329 APO-AMPI 0.73 Y E Y YAPX /CP

CLOXACILLIN

25MG/ML

0064463 APO-CLOXI ORAL LIQUID 0.045 Y E Y YAPX /ML

0033775 NOVO-CLOXIN ORAL LIQUID 0.091 Y E Y YNOP /ML

250MG

0033776 NOVO-CLOXIN 0.37 Y E Y YNOP /CP

0061829 APO-CLOXI 0.185 Y E Y YAPX /CP

500MG

0061828 APO-CLOXI 0.3498 Y E Y YAPX /CP

0033777 NOVO-CLOXIN 0.73 Y E Y YNOP /CP

0191242 CLOXACILLIN SODIUM VIAL 5.51 Y E N YNOP /VL

PENICILLIN V

25MG/ML

0064222 APO-PEN-VK ORAL SOLN 0.054 Y E Y YAPX /ML

300MG

0064221 APO-PEN-VK 0.19 Y E Y YAPX /TB

0002120 NOVO-PEN-VK 0.071 Y E Y YNOP /TB



25

PHRM/CHRN/CDO/F08:12.16 PENICILLINS (continued)


PENICILLIN V (POTASSIUM) (continued)

300MG/5ML

0064223 APO-PEN VK PWS SUSP 0.062 Y E Y YAPX /ML

0039160 NOVO-PEN-VK SUSP 0.047 Y E Y YNOP /ML

PIPERACILLIN/TAZOBAC

3GM/375MG

0217079 TAZOCIN INJ 17.88 Y E N YWYA /VL

08:12.24 TETRACYCLINES ------------------------------------------------------------------

DOXYCYCLINE

100MG

0074071 APO-DOXY 0.59 Y E Y YAPX /CP

0072525 TEVA-DOXYLIN 0.59 Y E Y YTVM /CP

0235123 SANIS-DOXYCYCLINE 0.586 Y E Y YSAN /CP

0081712 DOXYCIN 0.586 Y E Y YRIV /CP

0002436 VIBRAMYCIN 1.75 Y E Y YPFI /CP

0087425 APO-DOXY 0.59 Y E Y YAPX /TB

0235124 SANIS-DOXYCYCLINE TB 0.59 Y E Y YSAN /TB

0086075 DOXYCIN 0.586 Y E Y YRIV /TB

0215857 TEVA-DOXYLIN TB 0.59 Y E Y YTVM /TB

MINOCYCLINE HCL

100MG

0223923 PMS-MINOCYCLINE 1.0332 Y E Y YPMS /CP

0229442 PMS-MINOCYCLINE HCL 0.59 Y E Y Ynull /CP

0223731 SANDOZ-MINOCYCLINE 0.59 Y E Y YSDZ /CP

0208410 APO-MINOCYCLINE 0.59 Y E Y YAPX /CP

0210815 TEVA-MINOCYCLINE 0.59 Y E Y YTVM /CP

0228723 SANIS-MINOCYCLINE 0.59 Y E Y YSAN /CP

0223073 GEN-MINOCYCLINE 0.59 Y E Y YGPM /CP

0191414 RATIO-MINOCYCLINE 1.0332 Y E Y YRTP /CP

50MG


0191413 RATIO-MINOCYCLINE 0.535 Y E Y YRTP /CP

0208409 APO-MINOCYCLINE 0.31 Y E Y YAPX /CP

0223731 SANDOZ-MINOCYCLINE 0.31 Y E Y YSAN /CP

0223073 GEN-MINOCYCLINE 0.31 Y E Y YGPM /CP

0228722 SANIS-MINOCYCLINE 0.31 Y E Y YSAN /CP

0210814 TEVA-MINOCYCLINE 0.31 Y E Y YTVM /CP


TETRACYCLINE

250MG

0058092 APO-TETRA 0.07 Y E Y YAPX /CP



26

PHRM/CHRN/CDO/F08:12.28 ANTIBIOTICS (MISCELLANEOUS ANTIBIOTICS)


CLINDAMYCIN HCL

08:12.28 ANTIBIOTICS (MISCELLANEOUS ANTIBIOTICS) ----------------------------------------

150MG

0224523 APO-CLINDAMYCIN 0.22 Y E Y YAPX /CP

0225833 GEN-CLINDAMYCIN 0.22 Y E Y YGEN /CP

0224170 NOVO-CLINDAMYCIN 0.22 Y E Y YPHU /CP

0003057 DALACIN C 0.95 Y E Y YPHU /CP

300MG

0224523 APO-CLINDAMYCIN 0.44 Y E Y YAPX /CP

0225835 GEN-CLINDAMYCIN 0.44 Y E Y YGEN /CP

0218286 DALACIN C 1.9 Y E Y YPHU /CP

0224171 NOVO-CLINDAMYCIN 0.44 Y E Y YNOP /CP

CLINDAMYCIN

15MG/ML

0022585 DALACIN C SOLN 0.13 Y E Y YPHU /ML

RIFABUTIN

150MG

0206378 MYCOBUTIN 5.2 Y E N YPHU /CP

RIFAMPIN

150MG

0039344 ROFACT 0.66 Y E N YICN /CP

300MG

0034361 ROFACT 1.03 Y E N YICN /CP

RIFAXIMIN

550MG

0241070 ZAXINE 7.68 E E N YLUP /TB

VANCOMYCIN HCL

125MG

0240774 JAMP-VANCOMYCIN 5.18 Y E N YJPC

/CP

0080043 VANCOCIN 5.18 Y E N YLIL /CP

0237747 VANCOMYCIN HYDROCHLORIDE 5.18 Y E N YPPC /CP

250MG

0078871 VANCOCIN 10.36 Y E N YLIL /CP

500MG

0223019 VANCOMYCIN HCL INJ (VIAL) 42.77 Y E N YHOS /VL

0239462 VANCOMYCIN HCL FOR INJECTION 31.05 Y E N YSDZ /VL

0234285 VAL-VANCOMYCIN 31.05 Y E N YVAE /VL

08:18.00 ANTIVIRALS ---------------------------------------------------------------------

ACYCLOVIR



27

PHRM/CHRN/CDO/F08:18.00 ANTIVIRALS (continued)


ACYCLOVIR (continued)

200MG

0220762 APO-ACYCLOVIR 0.64 Y E Y YAPX /TB

0224278 GEN-ACYCLOVIR 0.64 Y E Y YGPM /TB

0063450 ZOVIRAX 1.326 Y E Y YGSK /TB

0207862 RATIO-AVIRAX 0.64 Y E Y YRTP /TB

200MG/5ML

0088615 ZOVIRAX SUSP 0.26 Y E Y YGSK /ML

400MG



0191162 ZOVIRAX WELLSTAT PAC 2.67 Y E Y YGSK /TB


800MG



0228597 TEVA-ACYCLOVIR 1.27 Y E Y YTEV /TB


AMANTADINE

10MG/ML

0202282 PMS-AMANTADINE SYRUP 0.11 Y E Y YPMS /ML

100MG

0199040 PMS-AMANTADINE 0.53 Y E Y YPMS /CP

0213920 GEN-AMANTADINE 0.518 Y E Y YGPM /CP

FAMCICLOVIR

125MG

0222911 FAMVIR 2.96 Y E Y YGSK /TB

0229202 APO-FAMCICLOVIR 2.02 Y E Y YAPX /TB

0227863 SANDOZ-FAMCICLOVIR 2.02 Y E Y YSDZ /TB

0227808 PMS-FAMCICLOVIR 2.02 Y E Y YPMS /TB

250MG





5OOMG

0230570 ACT FAMCICLOVIR 4.23 Y E Y YACT /TB

500MG







28

PHRM/CHRN/CDO/F08:18.00 ANTIVIRALS (continued)


GANCICLOVIR SO4

GANCICLOVIR SO4

500MG

0216269 CYTOVENE INJ 4.1214 Y E N YHLR /ML

RIBAVIRIN/PEGINTERFER

200MG180UG

0225342 PEGASYS RBV (CAPS+0.5MLVIAL) 395.84 E E N YHLR /KT

0225341 PEGASYS RBV (CAPS+1MLVIAL) 395.84 E E N YHLR /KT

RIBAVIRIN/PEGINTERFER

200MG100UG

0225460 PEGETRON REDIPEN(70CP+2VL) 774.77 E E N YSCH /KT

200MG120UG


200MG150UG


0224603 PEGETRON ( 84CP / 2VL / KIT) 856.12 E E N YSCH /KT

200MG50UG

0224602 PEGETRON ( 56CP / 2VL / KIT) 774.77 E E N YSCH /KT

200MG80UG


VALACYCLOVIR

1000MG

0235156 MYLAN-VALACYCLOVIR 3.392 Y E Y YMYL /TB

0224655 VALTREX 6.89 Y E Y YGSK /TB

0238123 PMS-VALACYCLOVIR 1.72 Y N N YPMS /TB

0235470 APO-VALACYCLOVIR 1.72 Y E Y YAPX /TB

500MG

0235753 TEVA-VALACYCLOVIR 0.85 Y E Y YTEV /TB

0229845 PMS-VALACYCLOVIR 0.86 Y E Y YPMS /TB

0229582 APO-VALACYCLOVIR 0.86 Y E Y YAPX /TB

0240504 AURO-VALACYCLOVIR 0.85 Y E Y YAUR /TB

0221949 VALTREX 3.44 Y E Y YGSK /TB

0233174 CO-VALACYCLOVIR 0.85 Y E Y YCOB /TB

0235157 MYLAN-VALACYCLOVIR 0.85 Y E Y YMYL /TB

VALGANCICLOVIR

450MG

0239382 APO-VALGANCICLOVIR 17.41 E E N YAPX /TB

0224577 VALCYTE 23.21 E E N YHLR /TB

08:18.08 ANTIRETROVIRAL AGENTS ----------------------------------------------------------



29

PHRM/CHRN/CDO/F08:18.08 ANTIRETROVIRAL AGENTS


ABACAVIR

ABACAVIR

300MG

0224035 ZIAGEN TAB 6.87 Y Y N YGSK /TB

0239676 APO-ABACAVIR 5.92 Y Y N YAPX /TB

ABACAVIR (ABACAVIR

20MG/ML

0224035 ZIAGEN 0.457 Y Y N YGSK /ML

ABACAVIR/DOLUTEGRAV

600/50/300MG

0243093 TRIUMEQ 41.38 E E N YVII /TB

ABACAVIR/LAMIVUDINE

600/300MG

0239953 APO-ABACAVIR-LAMIVUDINE 20.36 Y Y N YAPX /TB

ABACAVIR/LAMIVUDINE/

300/150/300MG

0241625 APO-ABACAVIR-LAMIVUDINE- 15.46 Y Y N YAPX /TB

0224475 TRIZIVIR 17.94 Y Y N YGSK /TB

ADEFOVIR DIPIVOXIL

10MG

0242033 APO-ADEFOVIR 24.34 E E N YAPX /TB

0224782 HEPSERA 24.34 E E N YGIL /TB

ATAZANAVIR

150MG

0224861 REYATAZ 11.06 Y Y N YBMY /CP

200 MG


300MG


COBICISTAT/DARUNAVIR

150/800MG

0242650 PREZCOBIX 23.87 E E N YJAN /TB

COBICISTAT/EMTRICITA

150MG/200MG/150MG/

0239713 STRIBILD 45.52 E E N YGSI /TB

DARUNAVIR

800MG

0239305 PREZISTA 21.72 E E N YJAN /TB

DIDANOSINE

125MG

0224459 VIDEX EC 3.86 Y Y N YBRI /CP



30

PHRM/CHRN/CDO/F08:18.08 ANTIRETROVIRAL AGENTS (continued)


DIDANOSINE (continued)

200MG


250MG


400MG


DOLUTEGRAVIR

50MG

0241494 TIVICAY 18.67 E E N YVII /TB

EFAVIRENZ

200MG

0223988 SUSTIVA 4.98 Y Y N YMSD /CP

50MG

0223988 SUSTIVA 1.25 Y Y N YMSD /CP

600MG

0241842 AURO-EFAVIRENZ 11.21 Y Y N YAUR /TB

0224604 SUSTIVA 14.95 Y Y N YBMY /TB

0238976 TEVA-EFAVIRENZ 11.21 Y Y N YTEV /TB

0238152 MYLAN-EFAVIRENZ 11.21 Y Y N YMYL /TB

EFAVIRENZ/TENOFOVIR/

600MG/300/200

0230069 ATRIPLA 43.25 E E N YBMY /TB

EMTRICITABINE/RILPIVIRI

200/25/300MG

0237412 COMPLERA 42.53 E E N YGSI /TB

ENTECAVIR

0.5MG

0244877 AURO-ENTECAVIR 5.5 E E N YAUR /TB

0239695 APO-ENTECAVIR 11 E E N YAPX /TB

0228222 BARACLUDE 22 E E N YBMY /TB

INDINAVIR SULPHATE

200MG

0222916 CRIXIVAN 1.35 Y Y N YMSD /CP

KIVEXA

600/300MG

0226934 ABACAVIR/LAMIVUDINE 23.62 Y Y N YVII /TB

LAMIVUDINE

10MG/ML

0219269 3TC ORAL SOLN 0.31 Y Y N YGSK /ML



31



LAMIVUDINE (continued)

100MG

0239323 APO-LAMIVUDINE HBV 3.53 Y Y N YAPX /TB

0223919 HEPTOVIR 4.71 Y Y N YGSK /TB

150 MG

0236905 APO-LAMIVUDINE 3.63 Y Y N YAPX /TB

150MG

0219268 3TC 4.84 Y Y N YGSK /TB

300 MG

0236906 APO-LAMIVUDINE 7.25 Y Y N YAPX /TB

300MG

0224782 3TC 9.67 Y Y N YGSK /TB

LAMIVUDINE/ZIDOVUDI

150MG/300MG

0223921 COMBIVIR TAB 10.44 Y Y N YGSK /TB

0237554 APO-LAMIVUDINE/ZIDOVUDINE 7.83 Y Y N YAPX /TB

0238724 TEVA-LAMIVUDINE/ZIDOVUDINE 7.83 Y Y N YTVM /TB

LOPINAVIR/RITONAVIR

200MG/50MG

0228553 KALETRA 5.69 Y Y N YABB /TB

NELFINAVIR MESYLATE

250MG

0223861 VIRACEPT 1.85 Y Y N YAGR /TB

50MG/GM

0223861 VIRACEPT ORAL POWDER 0.37 Y Y N YAGR /GM

NEVIRAPINE

200MG

0231860 AURO-NEVIRAPINE 2.47 Y Y N YAUR /TB

0223874 VIRAMUNE 4.94 Y Y N YBOE /TB

0235289 TEVA-NEVIRAPINE 2.47 Y Y N YTVM /TB

0240577 PMS-NEVIRAPINE 2.47 Y Y N YPMS /TB

RALTEGRAVIR

400MG

0230188 ISENTRESS 13.5 E E N YMSD /TB

RILPIVIRINE HCL

25MG

0237060 EDURANT 14.7 E E N YJAN /TB

RITONAVIR

100MG

0224148 NORVIR SEC 1.4671 Y Y N YABB /CP

0235759 NORVIR 1.4671 Y Y N YABB /TB



32



RITONAVIR (continued)

80MG/ML

0222914 NORVIR ORAL SOLN 1.2 Y Y N YABB /ML

SAQUINAVIR

200MG

0221696 INVIRASE 1.87 Y Y N YHLR /CP

STAVUDINE

15MG

0221608 ZERIT 4.7 Y Y N YBRI /CP

20MG


30MG


40MG


TENOFOVIR

300MG

0224712 VIREAD 18.77 E E N YGIL /TB

TENOFOVIR/EMTRICITAB

200MG/300MG

0227490 TRUVADA 28.04 E E N YGIL /TB

ZIDOVUDINE

10MG/ML

0190265 RETROVIR SOLN 0.197 Y Y N YGSK /ML

0190264 RETROVIR INJ 16.59 Y Y N YGSK /VL

100MG

0190266 RETROVIR 1.86 Y Y N YGSK /CP

0194632 APO-ZIDOVUDINE 1.4 Y Y N YAPX /CP

08:18.32 NUCLEOSIDES AND NUCLEOTIDES ----------------------------------------------------

RIBAVIRIN

200MG

0243921 IBAVYR 7.25 E E N YPED /TB

400MG


600MG


08:18.40 HCV Protease Inhibitors --------------------------------------------------------

LEDIPASVIR/SOFOSBUVIR

90MG/400MG

0243222 HARVONI 797.619 E E N YGIL /TB



33

PHRM/CHRN/CDO/F08:18.40 HCV Protease Inhibitors


OMBITASVIR/PARITAPREVIR/RITONA

OMBITASVIR/PARITAPRE

250/12.5/75/50MG

0243602 HOLKIRA PAK 688.52 E E N YABV /DY

SIMEPREVIR

150MG

0241644 GALEXOS 434.55 E E N YJAN /CP

08:18.92 MISCELLANEOUS ANTIVIRALS -------------------------------------------------------

BOCEPREVIR

200MG

0237081 VICTRELIS 2100 E E N YMRK /EA

BOCEPREVIR/RIBAVIRIN/

200MG/80MCG/0.5ML

0237144 VICTRELIS TRIPLE 2652.55 E E N YMRK /KT

SOFOSBUVIR

400MG

0241835 SOVALDI 654.76 E E N YGSI /TB

TELAPREVIR

375MG

0237155 INCIVEK 69.381 E E N YVER /KT

08:20.00 ANTIMALARIAL AGENTS ------------------------------------------------------------

HYDROXYCHLOROQUINE

200MG

0224669 APO-HYDROXYQUINE 0.26 Y Y N YAPX /TB

0225260 MYLAN-HYDROXYCHLOROQUINE 0.26 Y Y N YGPM /TB

0201770 PLAQUENIL 0.63 Y Y N YSAW /TB

0242499 MINT-HYDROXYCHLOROQUINE 0.26 Y Y N YMNT /TB

08:22.00 QUINOLONES ---------------------------------------------------------------------

CIPROFLOXACIN

100MG/ML

0223751 CIPRO SUSP 0.58 Y E N YBAY /ML

1000MG XL

0225178 CIPRO XL 3.11 Y E N YBAY /TB



34

PHRM/CHRN/CDO/F08:22.00 QUINOLONES (continued)


CIPROFLOXACIN (continued)

250MG

0222952 APO-CIPROFLOX 0.62 Y E N YAPX /TB

0230372 RAN-CIPROFLOX 0.62 Y E N YRAN /TB

0216173 TEVA-CIPROFLOXACIN 0.62 Y E N YTVM /TB

0224564 MYLAN-CIPROFLOXACIN 0.62 Y E N YMYL /TB

0235331 SANIS-CIPROFLOXACIN 0.62 Y E N YSAN /TB

0231742 MINT-CIPROFLOXACIN 0.62 Y E N YMNT /TB

0224682 RATIO-CIPROFLOXACIN 0.62 Y E N YRTP /TB

0224875 SANDOZ-CIPROFLOXACIN 0.62 Y E N YSDZ /TB

0224843 PMS-CIPROFLOXACIN 0.62 Y E N YPMS /TB

0215595 CIPRO 2.5 Y E N YBAY /TB

0224733 CO CIPROFLOXACIN 0.62 Y E N YCOB /TB

500MG

0224734 CO CIPROFLOXACIN 0.7 Y E Y YCOB /TB



0235332 SANIS-CIPROFLOXACIN 0.7 Y E Y YSAN /TB

0231743 MINT-CIPROFLOXACIN 0.7 Y E N YMNT /TB

0242356 MINT-CIPROFLOX 0.7 Y E N YMNT /TB


0224682 RATIO-CIPROFLOXACIN 0.7 Y E N YRTP /TB

0222952 APO-CIPROFLOX 0.7 Y E N YAPX /TB




500 MG XL

0224791 CIPRO XL 3.11 Y E N YBAY /TB

0241643 PMS-CIPROFLOXACIN XL 1.88 Y E N YPMS /TB

750MG




0224734 CO CIPROFLOXACIN 1.28 Y E N YCOB /TB



0224682 RATIO-CIPROFLOXACIN 1.28 Y E N YRPH /TB


0222952 APO-CIPROFLOX 1.28 Y E N YAPO /TB

0235333 SANIS-CIPROFLOXACIN 1.28 Y E N YSAN /TB



35

PHRM/CHRN/CDO/F08:22.00 QUINOLONES (continued)


LEVOFLOXACIN

LEVOFLOXACIN

250MG

0231542 CO LEVOFLOXACIN 1.2 Y E N YCOB /TB

0228467 PMS-LEVOFLOXACIN 1.2 Y E N YPMS /TB

0228470 APO-LEVOFLOXACIN 1.2 Y E N YAPX /TB

0229863 SANDOZ LEVOFLOXACIN 1.2 Y E N YSDZ /TB

0231397 MYLAN-LEVOFLOXACIN 1.2 Y E N YMYL /TB

0224826 NOVO-LEVOFLOXACIN 1.2 Y E N YNOP /TB

0223684 LEVAQUIN 6.01 Y E N YJAN /TB

500MG

0228468 PMS-LEVOFLOXACIN 1.37 Y E N YPMS /TB


0231398 MYLAN-LEVOFLOXACIN 1.37 Y E N YMYL /TB





750MG




0230558 PMS-LEVOFLOXACIN 4.85 Y E N YCOB /TB



LEVOFLOXACIN IV

5MG/ML

0223683 LEVAQUIN INJ (IV BAG) 0.305 E E N YJAN /ML

MOXIFLOXACIN

400MG

0224296 AVELOX 6.09 E E N YBAY /TB

0243224 AURO-MOXIFLOXACIN 1.52 E E N YAUR /TB

0240492 APO-MOXIFLOXACIN 1.52 E E N YSDZ /TB

0237570 TEVA-MOXIFLOXACIN 1.52 E E N YTVM /TB

NORFLOXACIN

400MG

0223768 NOVO-NORFLOXACIN 0.54 Y E Y YNOP /TB

0224659 PMS-NORFLOXACIN 0.545 Y E Y YPMS /TB

0222952 APO-NORFLOX 0.54 Y E Y YAPX /TB



36

PHRM/CHRN/CDO/F08:26.00 SULFONES


DAPSONE

08:26.00 SULFONES -----------------------------------------------------------------------

100MG

0204151 DAPSONE 1.3391 Y E Y YJAP /TB

08:36.00 URINARY ANTI-INFECTIVES --------------------------------------------------------

METHENAMINE

500MG

0049901 MANDELAMINE ENTERIC TAB 0.37 Y N N YPFI /TB

NITROFURANTOIN

100MG

0223101 NOVO-FURANTOIN CAP 0.7 Y E Y YNOP /CP

0031273 APO-NITROFURANTOIN 0.22 Y E Y YAPX /TB

50MG

0223101 NOVO-FURANTOIN CAP 0.35 Y E Y YNOP /CP

0031951 APO-NITROFURANTOIN 0.17 Y E Y YAPX /TB

NITROFURANTOIN

100MG

0206366 MACROBID MACROCRYSTALS 0.71 Y E Y YPGA /CP

TRIMETHOPRIM

100MG

0224311 APO-TRIMETHOPRIM 0.2566 Y E Y YAPO /TB

200MG

0224311 APO-TRIMETHOPRIM 0.5273 Y E Y YAPO /TB

08:40.00 MISCELLANEOUS ANTI-INFECTIVES --------------------------------------------------

ATOVAQUONE

150MG/ML

0221742 MEPRON SUSP 2.66 Y E N YGSK /ML

METRONIDAZOLE

250MG

0054506 APO-METRONIDAZOLE 0.059 Y E Y YAPX /TB

500MG

0224856 APO-METRONIDAZOLE 0.7 Y E Y YAPX /CP

0192685 FLAGYL 1.07 Y E Y YAVT /CP

0078313 TRIKACIDE 0.7 Y E Y YPMS /CP

SULFA/TRIMETH(CO-

100/20MG

0044526 APO-SULFATRIM PEDIATRIC TAB 0.0911 Y E Y YAPX /TB

400/80MG

0051063 NOVO-TRIMEL TAB 0.05 Y E Y YNOP /TB

0044527 APO-SULFATRIM TAB 0.05 Y E Y YAPX /TB

40/8MG

0072654 NOVO-TRIMEL SUSP(40/8/ML) 0.1 Y E Y YNOP /ML



37

PHRM/CHRN/CDO/F08:40.00 MISCELLANEOUS ANTI-INFECTIVES (continued)


SULFA/TRIMETH(CO-TRIMOXAZOLE) (continued)

800/160

0051064 NOVO-TRIMEL DS TAB 0.1221 Y E Y YNOP /TB

0044528 APO-SULFATRIM DS TAB 0.1221 Y E Y YAPX /TB

10:00 ANTINEOPLASTIC AGENTS

10:00.00 ANTINEOPLASTIC AGENTS ----------------------------------------------------------

ABIRATERONE ACETATE

250MG

0237106 ZYTIGA 29.18 E E N YJAN /TB

AFATINIB

20MG

0241566 GIOTRIF 73.3 E E N YBOE /TB

30MG


40MG


ANAGRELIDE HCL

0.5MG

0226010 SANDOZ-ANAGRELIDE 3.3491 Y Y N YSDZ /CP

0225305 GEN-ANAGRELIDE 5.78 Y Y N YGPM /CP

0227494 PMS-ANAGRELIDE 3.3491 Y Y N YPMS /CP

0223685 AGRYLIN 5.78 Y Y N YRBP /CP

ANASTROZOLE

1MG

0233846 SANDOZ-ANASTROZOLE 2.55 Y Y N YSDZ /TB

0237442 APO-ANASTROZOLE 2.55 Y Y N YAPX /TB

0232073 PMS-ANASTROZOLE 2.55 Y Y N YPMS /TB

0222413 ARIMIDEX 5.12 Y Y N YAST /TB

0236565 TARO-ANASTROZOLE 1.27 Y Y N YTAR /TB

BEVACIZUMAB

25MG/ML

0227099 AVASTIN 125 E E N YHLR /ML

BICALUTAMIDE



38

PHRM/CHRN/CDO/F10:00.00 ANTINEOPLASTIC AGENTS (continued)

10:00 ANTINEOPLASTIC AGENTS (continued)

BICALUTAMIDE (continued)

50 MG

0227022 NOVO-BICALUTAMIDE 6.87 Y Y N YNOP /TB

0218447 CASODEX 6.87 Y Y N YAST /TB

0227608 SANDOZ-BICALUTAMIDE 4.0573 Y Y N YSDZ /TB

0230240 MYLAN-BICALUTAMIDE 4.0573 Y Y N YMYL /TB

0229606 APO-BICALUTAMIDE 4.06 Y Y N YAPX /TB

0227433 CO-BICALUTAMIDE 4.0573 Y Y N YCOB /TB

0227558 PMS-BICALUTAMIDE 4.0573 Y Y N YPMS /TB

0237132 RAN-BICALUTAMIDE 4.06 Y Y N YRAN /TB

0227770 RATIO-BICALUTAMIDE 4.0573 Y Y N YRPH /TB

50MG

0232598 TEVA-BICALUTAMIDE 4.057 Y Y N YWHL /TB

BOSUTINIB

100MG

0241914 BOSULIF 36.59 E E N YPFI /TB

500MG

0241915 BOSULIF 146.34 E E N YPFI /TB

CAPECITABINE

150 MG

0240002 TEVA-CAPECITABINE 1.46 E E N YTVM /TB

0242675 ACH-CAPECITABINE 1.46 E E N YACH /TB

0223845 XELODA 1.83 E E N YHLR /TB

500 MG

0240003 TEVA-CAPECITABINE 4.88 E E N YTVM /TB

0242676 ACH-CAPECITABINE 4.88 E E N YACH /TB

0223845 XELODA 6.1 E E N YHLR /TB

0242192 SANDOZ CAPECITABINE 4.88 E E N YSDZ /TB

CHLORAMBUCIL

2MG

0000462 LEUKERAN 1.43 Y Y N YGSK /TB

CRIZOTINIB

200MG

0238425 XALKORI 146.67 E E N YPFI /CP

250MG

0238426 XALKORI 146.67 E E N YPFI /CP

CYCLOPHOSPAMIDE

10MG/ML

0224179 PROCYTOX 0.3537 Y Y N YAST /ML

25MG

0224179 PROCYTOX 0.5 Y Y N YAST /TB



39



CYCLOPHOSPAMIDE (continued)

50MG

0224179 PROCYTOX 1.22 Y Y N YAST /TB

CYPROTERONE ACETATE

50MG

0224589 APO-CYPROTERONE 1.41 Y Y N YAPX /TB

0070443 ANDROCUR 1.4 Y Y N YBEX /TB

DABRAFENIB MESYLATE

50MG

0240960 TAFINLAR 42.22 E E N YGSK /CP

75MG

0240961 TAFINLAR 63.33 E E N YGSK /CP

DASATINIB

100 MG

0232019 SPRYCEL 152.86 E E N YBMY /TB

DEGARELIX

120MG

0233703 FIRMAGON 405.5 Y N N YFEI /VL

80MG

0233702 FIRMAGON 300 Y N N YFEI /VL

DOCETAXEL

40ML/.5ML

0217709 TAXOTERE INJ 5.71 Y Y N YAVT /ML

40ML/2ML

0217708 TAXOTERE INJ 22.84 Y Y N YAVT /ML

ENZALUTAMIDE

40MG

0240732 XTANDI 28.35 E E N YASL /CP

ERLOTINIB

100MG

0237770 TEVA-ERLOTINIB 47.47 E E N YTVM /TB

0226901 TARCEVA 53.33 E E N YHLR /TB

150MG

0226902 TARCEVA 80 E E N YHLR /TB


25MG


ETOPOSIDE

50MG

0061619 VEPESID 37.33 Y Y N YBRI /CP



40



EVEROLIMUS

EVEROLIMUS

10MG

0233952 AFINITOR 200.09 E E N YNVR /TB

2.5MG


5MG


EXEMESTANE

25MG

0224270 AROMASIN 5.28 Y Y N YPMS /TB

0239018 ACT EXEMESTANE 3.9 Y Y N YACT /TB

FLUDARABINE

10MG

0224622 FLUDARA 37 Y Y N YBEX /TB

FLUTAMIDE

250MG

0223856 APO-FLUTAMIDE 1.35 Y Y N YAPX /TB

0223008 NOVO-FLUTAMIDE 1.35 Y Y N YNOP /TB

0063772 EUFLEX TAB 1.46 Y Y N YSCH /TB

GEFITINIB

250MG

0224867 IRESSA 73.3 E E N YAST /TB

HYDROXYUREA

500MG

0224292 MYLAN-HYDROXYUREA 1.02 Y Y N YMYL /CP

0224793 APO-HYDROXYUREA 1.0203 Y Y N YAPX /CP

0234309 SANIS-HYDROXYUREA 1.02 Y Y N YSAN /CP

0046528 HYDREA 1.02 Y Y N YSQU /CP

IBRUTINIB

140MG

0243440 IMBRUVICA 90.65 E E N YJAN /CP

IDELALISIB

100MG

0243879 ZYDELIG 85.35 E E N YGSI /TB

150MG

0243880 ZYDELIG 85.35 E E N YGSI /TB

IMATINIB

100 MG

0225327 GLEEVEC 27.88 E E N YNVR /TB



41



IMATINIB (continued)

100MG

0235533 APO-IMATINIB 20.46 E E N YAPX /TB

0239980 TEVA-IMATINIB 20.46 E E N YTVM /TB

400 MG

0225328 GLEEVEC 111.52 E E N YNVR /TB

400MG

0235534 APO-IMATINIB 81.82 E E N YAPX /TB

0239981 TEVA-IMATINIB 81.82 E E N YTEV /TB

INTERFERON ALFA-2B

10 MILL IU

0222340 INTRON-A KIT 125.82 E E N YSCH /KT

10M IU/1ML

0223867 INTRON-A INJ 121.53 E E N YSCH /KT

18M IU/PEN

0224069 INTRON A PEN MULTIDOSE KIT 218.76 E E N YSCH /KT

18M IU/3ML

0223867 INTRON-A INJ 72.92 E E N YSCH /KT

30M IU/PEN

0224069 INTRON A PEN MULTIDOSE KIT 350.1 E E N YSCH /KT

60M IU/PEN

0224069 INTRON A PEN MULTIDOSE KIT 719 E E N YSCH /KT

IPILIMUMAB

5MG/ML

0237938 YERVOY 580 E E N YBMY /ML

LAPATINIB

250MG

0232644 TYKERB 23.5 E E N YGSK /TB

LENALIDOMIDE

10MG

0230490 REVLIMID 361 E E N YCEL /CP

15MG


20MG


25MG


5MG




42



LETROZOLE

LETROZOLE

2.5MG

0235851 APO-LETROZOLE 2.76 Y Y N YAPX /TB

0237342 MAR-LETROZOLE 3.06 Y Y N YMRC /TB

0234481 SANDOZ-LETROZOLE 2.76 Y Y N YSDZ /TB

0234365 TEVA-LETROZOLE 2.76 Y Y N YTVM /TB

0233845 LETROZOLE USP 2.76 Y Y N YACC /TB

0232231 MED-LETROZOLE 3.06 Y Y N YMED /TB

0230911 PMS-LETROZOLE 2.76 Y Y N YPMS /TB

0234896 LETROZOLE 2.76 Y Y N YACT /TB

0237216 MYLAN-LETROZOLE 2.76 Y Y N YMYL /TB

0223138 FEMARA 6.89 Y Y N YNVR /TB

LEUPROLIDE

11.25MG

0223983 LUPRON DEPOT INJ 1034.41 Y Y N YABB /VI

22.5MG

0223024 LUPRON DEPOT INJ 1071 Y Y N YABB /KT

0224824 ELIGARD 22.5MG 891 Y Y N YAVT /SYR

3.75MG/ML

0088450 LUPRON DEPOT INJ 347.18 Y Y N YABB /KT

30MG

0224899 ELIGARD 30MG 1285.2 Y Y N YAVT /SYR

0223983 LUPRON DEPOT INJ 1428 Y Y N YABB /VI

45MG

0226889 ELIGARD 45MG 1450 Y Y N YAVT /SYR

7.5MG

0224823 ELIGARD 7.5MG 310.72 Y Y N YAVT /SYR

7.5MG/ML

0083627 LUPRON DEPOT INJ 387.97 Y Y N YABB /KT

LOMUSTINE

10MG

0036043 CEENU 7.08 Y Y N YBMY /CP

100MG


40MG


MEGESTROL ACETATE

160MG

0219592 APO-MEGESTROL 4.26 Y Y N YAPX /TB

40MG

0219591 APO-MEGESTROL 1.01 Y Y N YAPX /TB



43



MEGESTROL ACETATE (continued)

40MG/ML

0216897 MEGACE OS SUSP 1.8 Y Y N YBMY /ML

MELPHALAN

2MG

0000471 ALKERAN 1.65 Y Y N YGSK /TB

MERCAPTOPURINE

50MG

0241527 MERCAPTOPURINE TABLETS USP 2.86 Y Y N YSTE /TB

0000472 PURINETHOL 2.86 Y Y N YGSK /TB

METHOTREXATE

10 MG

0218275 METHOTREXATE 2.71 Y Y N YDBU /TB

2.5MG

0218296 APO-METHOTREXATE 0.63 Y Y Y YDBU /TB

0217069 METHOTREXATE 0.64 Y Y Y YWYA /TB

0224479 RATIO-METHOTREXATE 0.63 Y Y Y YRTP /TB

METHOTREXATE SODIUM

10MG/ML

0218294 METHOTREXATE INJ 7.87 Y Y N YDBU /ML

25MG/ML



0209970 METHOTREXATE INJ 5.63 Y Y N YNOP /ML

METHOTREXATE SODIUM

25MG/ML

0239842 SANDOZ-METHOTREXATE 5.63 Y Y N YSDZ /ML

NILUTAMIDE

50MG

0222186 ANANDRON 2.24 Y Y N YAVT /TB

OBINUTUZUMAB

25MG/ML

0243480 GAZYVA 5275.5 E E N YHLR /VL

PAZOPANIB HCL

200MG

0235230 VOTRIENT 34.41 Y Y N YGSK /TB

PEMBROLIZUMAB

50MG

0244115 KEYTRUDA 2200 E E N YMSD /VL



44



PERTUZUMAB/TRASTUZUMAB

PERTUZUMAB/TRASTUZ

420/440MG

0240502 PERJETA-HERCEPTIN 5929.89 E N N YHLR /KT

POMALIDOMIDE

1MG

0241958 POMALYST 500 E E N YCEL /CP

2MG


3MG


4MG


PONATINIB HCL

15MG

0243733 ICLUSIG 142.84 E E N YPAL /TB

45MG

0243734 ICLUSIG 331.48 E E N YPAL /TB

PROCARBAZINE

50MG

0001275 MATULANE 57.49 Y Y N YN/A /CP

RAMUCIRUMAB

10MG/ML

0244380 CYRAMZA 626.28 E E N YLIL /VL

REGORAFENIB

40MG

0240339 STIVARGA 72.62 E E N YBAY /TB

RITUXIMAB

10 MG/ML

0224192 RITUXAN IV SOL (2 X10ML PK) 46.63 E E N YHLR /EA

ROMIDEPSIN

10MG/VL

0241429 ISTODAX 2582 E E N YCEL /EA

RUXOLITINIB

15MG

0238801 JAKAVI 82.19 E N N YNVR /TB

20MG


5MG




45



SUNITINIB

SUNITINIB

12.5MG

0228079 SUTENT 63.72 E E N YPFI /CP

25MG


50MG


TAMOXIFEN CITRATE

10MG

0081240 APO-TAMOX 0.18 Y Y N YAPX /TB

0208842 GEN-TAMOXIFEN 0.18 Y Y N YGPM /TB

0085196 NOVO-TAMOXIFEN 0.18 Y Y N YNOP /TB

20MG

0085197 NOVO-TAMOXIFEN 0.35 Y Y N YNOP /TB

0204848 NOLVADEX-D 0.37 Y Y N YAST /TB

0208985 GEN-TAMOXIFEN 0.35 Y Y N YGPM /TB

0081239 APO-TAMOX 0.35 Y Y N YAPX /TB

TEMOZOLOMIDE

100MG

0224109 TEMODAL 156.01 Y Y N YSCH /CP

0244351 TARO-TEMOZOLOMIDE 113.6 Y Y N YTAR /CP

140MG



20MG



250MG


0224109 TEMODAL 390 Y Y N YSCH /CP

5MG



TRAMETINIB

0.5MG

0240962 MEKINIST 72.5 E E N YGSK /TB

2MG

0240965 MEKINIST 290 E E N YGSK /TB



46



TRASTUZUMAB EMTANSINE

TRASTUZUMAB

20MG/ML

0241236 KADCYLA 20 E E N YHLR /ML

VISMODEGIB

150MG

0240926 ERIVEDGE 294.22 E E N YHLR /CP

12:00 AUTONOMIC DRUGS

12:04.00 PARASYMPATHOMEMETIC (CHOLINERGIC) AGENTS ---------------------------------------

BETHANECHOL

10MG

0194795 DUVOID 0.3 Y Y N YRBP /TB

0075917 PMS-BETHANECHOL 0.3 Y Y N YPMS /TB

25MG

0073916 PMS-BETHANECHOL 0.48 Y Y N YPMS /TB


50MG


DONEPEZIL

10MG

0242849 SEPTA DONEPEZIL 0.83 E E N YSEP

/TB

0241987 ACCEL-DONEPEZIL 0.81 E E N YACC /TB

0223204 ARICEPT 4.86 E E N YPFI /TB

0236227 APO-DONEPEZIL 0.83 E E N YAPX /TB

0234061 TEVA-DONEPEZIL 0.83 E E N YTVM /TB

0232868 SANDOZ DONEPEZIL 0.83 E E N YSDZ /TB

0232235 PMS-DONEPEZIL 0.83 E E N YPMS /TB

0240265 DONEPEZIL HYDROCHLORIDE 0.83 E E N YACD /TB

0240058 AURO-DONEPEZIL 0.83 E E N YAUR /TB

0239760 CO DONEPEZIL 0.83 E E N YCOB /TB

0238151 RAN-DONEPEZIL 0.83 E E N YRAN /TB

5MG

0240264 DONEPEZIL HYDROCHLORIDE 0.83 E E N YACD /TB

0242848 SEPTA DONEPEZIL 0.83 E E N YSEP

/TB

0238150 RAN-DONEPEZIL 0.83 E E N YRAN /TB

0241986 ACCEL-DONEPEZIL 0.81 E E N YACC /TB

0239759 CO DONEPEZIL 0.83 E E N YCOB /TB

0223204 ARICEPT 4.86 E E N YPFI /TB

0236226 APO-DONEPEZIL 0.83 E E N YAPX /TB

0234060 TEVA-DONEPEZIL 0.83 E E N YTVM /TB

0232866 SANDOZ DONEPEZIL 0.83 E E N YSDZ /TB

0232233 PMS-DONEPEZIL 0.83 E E N YPMS /TB



47

PHRM/CHRN/CDO/F12:04.00 PARASYMPATHOMEMETIC (CHOLINERGIC) AGENTS (continued)

12:00 AUTONOMIC DRUGS (continued)

DONEPEZIL HYSROCHLORIDE

DONEPEZIL

5MG

0240441 JAMP-DONEPEZIL 0.83 E E N YJPC

/TB

GALANTAMINE

16MG

0239838 PMS-GALANTAMINE ER 1.25 E E N YPMS /CP

0231695 PAT-GALANTAMINE 1.25 E E N YPAT /CP

0237796 TEVA-GALANTAMINE 1.25 E E N YTVM /CP

0233944 MYLAN-GALANTAMINE 1.25 E E N YMYL /CP

0226672 REMINYL ER 5.15 E E N YJAN /CP

24MG





8MG





NEOSTIGMINE BROMIDE

15MG

0086994 PROSTIGMIN 0.48 Y N N YICN /TB

PILOCARPINE HCL

5MG

0221634 SALAGEN 1.38 Y N N YPHU /TB

0240248 PILOCARPINE HYDROCHLORIDE 0.78 Y N N YSTE /TB

PYRIDOSTIGMINE

180MG

0086995 MESTINON 1.04 Y N N YICN /TB

60MG

0086996 MESTINON 0.48 Y N N YICN /TB

RIVASTIGMINE

1.5MG

0230603 PMS-RIVASTIGMINE 0.65 E E N YPMS /CP

0232456 SDZ-RIVASTIGMINE 0.65 E E N YSDZ /CP

0233671 APO-RIVASTIGMINE 0.65 E E N YAPX /CP

0224211 EXELON 2.61 E E N YNVR /CP

18MG/10 SQ CM

0230285 EXELON PATCH 4.5 E E N YNVR /PT



48

PHRM/CHRN/CDO/F12:04.00 PARASYMPATHOMEMETIC (CHOLINERGIC) AGENTS (continued)


RIVASTIGMINE (continued)

3MG



0232457 SDZ-RIVASTIGMINE 0.65 E E N YSDZ /CP


4.5MG


0232459 SDZ-RIVASTIGMINE 0.65 E E N YNVR /CP



6MG




0232460 SDZ-RIVASTIGMINE 0.65 E E N YSDZ /TB

9MG/5 SQ CM

0230284 EXELON PATCH 4.86 E E N YNVR /PT

12:08.04 ANTIPARKINSONIAN AGENTS --------------------------------------------------------

BENZTROPINE MESYLATE

1MG

0070653 PMS-BENZTROPINE TAB 0.05 Y Y N YPMS /TB

1MG/ML

0223890 BENZTROPINE OMEGA (2ML) 7.65 Y Y N YOMG /ML

2MG

0042685 APO-BENZTROPINE 0.06 Y Y N YAPX /TB

0058726 PMS-BENZTROPINE 0.05 Y Y N YPMS /TB

ETHOPROPAZINE

50MG

0192774 PARSITAN 0.23 Y Y N YAVT /TB

PROCYCLIDINE HCL

0.5MG/ML

0058736 PMS-PROCYCLIDINE ELIXIR 0.27 Y Y N YPMS /ML

2.5MG

0064939 PMS-PROCYCLIDINE 0.07 Y Y N YPMS /TB

5MG

0058735 PMS-PROCYCLIDINE 0.14 Y Y N YPMS /TB

TRIHEXYPHENIDYL HCL

2MG

0054505 APO-TRIHEX 0.04 Y Y N YAPX /TB

5MG

0054507 APO-TRIHEX 0.07 Y Y N YAPX /TB



49

PHRM/CHRN/CDO/F12:08.08 ANTIMUSCARINICS ANTISPASMODICS


ACLIDINIUM BROMIDE

12:08.08 ANTIMUSCARINICS ANTISPASMODICS -------------------------------------------------

400MCG

0240972 TUDORZA 0.89 E E N YALM /DS

ACLIDINIUM/FORMOTER

400/12MCG

0243953 DUAKLIR GENUAIR 1 E E N YAST /DS

BELLADONNA/ERGOT/P

.2/.6/40MG

0017614 BELLERGAL SPACETABS SRT 1.45 Y N N YNVR /TB

GLYCOPYRRONIUM

50UG CP

0239493 SEEBRI BREEZHALER 1.77 E E N YNVO /CP

GLYCOPYRRONIUM/IND

50/110MCG

0241828 ULTIBRO BREEZHALER 2.68 E E N YNVR /DS

HYOSCINE

10MG

0036381 BUSCOPAN 0.34 Y N Y YBOE /TB

IPRATROPIUM

0.5/2.5MG

0223167 COMBIVENT (2.5ML) INHAL. SOLN 0.603 Y Y N YBOE /ML

0224606 GEN-COMBO STERINEBS (2.5ML) 0.411 Y Y N YGEN /ML

0224378 RATIO-IPRA SAL UDV (2.5ML) 0.2936 Y Y N YRAT /ML

IPRATROPIUM BROMIDE

125MCG/ML

0209717 RATIO-IPRATROPIUM UDV 6.59 Y Y N YRTP /ML

0223113 PMS-IPRATROPIUM (20X2ML) 6.59 Y Y N YPMS /ML

20MCG/DS

0224768 ATROVENT HFA INHALER 0.1 Y Y N YBOE /DS

21MCG/DOSE

0224608 APO-IPRAVENT NASAL SPRAY 0.76 Y N Y YAPO /DS

0223962 PMS-IPRATROPIUM NASAL SPRAY 0.76 Y N Y YPMS /DS

0216370 ATROVENT NASAL SPRAY 0.99 Y N Y YBOE /DS



50

PHRM/CHRN/CDO/F12:08.08 ANTIMUSCARINICS ANTISPASMODICS (continued)


IPRATROPIUM BROMIDE (continued)

250MCG/ML

0209716 RATIO-IPRATROPIUM UDV (2ML) 0.659 Y Y N YRTP /ML

0212622 APO-IPRAVENT INHAL.SOLN 0.32 Y Y N YAPX /ML

0221047 NOVO-IPRAMIDE INHAL. SOLN 0.32 Y Y N YNOP /ML

0221622 GEN-IPRATROPIUM (2ML) 6.59 Y Y N YGPM /ML

0223913 GEN-IPRATROPIUM INHAL. SOLN 0.32 Y Y N YGPM /ML

0223113 PMS-IPRATROPIUM INHAL. SOLN 0.32 Y Y N YPMS /ML

0223124 PMS-IPRATROPIUM (1ML UD) 0.659 Y Y N YPMS /ML

0223124 PMS-IPRATROPIUM (2ML) 6.59 Y Y N YPMS /ML

42MCG/DOSE

0224608 APO-IPRAVENT NASAL SPRAY 1.49 Y N Y YAPO /DS

0216371 ATROVENT NASAL SPRAY 1.99 Y N Y YBOE /DS

IPRATROPIUM/SALBUTA

0.5/2.5MG

0227269 TEVA-COMBO STERINEBS 0.53 Y Y N YTVM /ML

20/100MCG

0241910 COMBIVENT RESPIMAT 0.24 Y Y N YBOE /DS

OLODATEROL/TIOTROPI

2.5/2.5MCG

0244188 INSPIOLTO RESPIMAT 2.03 E E N YBOE /DS

OPIUM & BELLADONNA

65MG/15MG

0190186 OPIUM & BELLADONNA SUP. 4.14 Y E N YSDZ /SP

PINAVERIUM BROMIDE

100MG

0223068 DICETEL 100 MG 0.62 Y N Y YSLV /TB

50MG

0195059 DICETEL 0.35 Y N Y YSLV /TB

TIOTROPIUM

18 MCG CP

0224679 SPIRIVA (CP FOR INHALATION) 1.73 E E N YBOE /CP

2.5MCG

0243538 SPIRIVA RESPIMAT 1.73 E E N YBOE /DS

TRIMEBUTINE MALEATE

100MG

0224566 APO-TRIMEBUTINE 0.269 Y N Y YAPX /TB

200MG

0080349 MODULON 0.7 Y N Y YAXC /TB

0224566 APO-TRIMEBUTINE 0.5235 Y N Y YAPX /TB



51

PHRM/CHRN/CDO/F12:08.08 ANTIMUSCARINICS ANTISPASMODICS (continued)


UMECLIDINIUM

UMECLIDINIUM

62.5MCG

0242359 INCRUSE ELLIPTA 1.67 E E N YGSK /EA

12:12.00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS --------------------------------------------

EPINEPHRINE

0.15MG/DS

0226820 TWINJECT 0.15MG AUTO-INJECTOR 82.46 E N Y YPAL /EA

0057865 EPIPEN JR INJ 83.86 E N Y YDEY /EA

0.15MG/0.15ML

0238205 ALLERJECT 83.35 E N Y YWHL /EA

0.3MG/DS

0224731 TWINJECT 0.3MG AUTO-INJECTOR 82.46 E N Y YPAL /EA

0050955 EPIPEN INJ 1:1000 INJ 83.86 E N Y YDEY /EA

0.3MG/0.3ML

0238206 ALLERJECT 83.35 E N Y YWHL /EA

EPINEPHRINE HCL

1MG/ML

0072189 EPINEPHRINE (1ML) INJ 3.85 E N Y YABB /ML

0015535 ADRENALIN INJ 30ML VIAL 0.72 E N Y YPFI /VL

FLUTICASONE

100UG/25UG

0240887 BREO ELLIPTA 2.74 E E N YGSK /DS

200UG/25UG

0244418 BREO ELLIPTA 4.29 E E N YGSK /DS

FORMOTEROL

12MCG/CP

0223089 FORADIL (CP FOR INHALATION) 0.84 E E N YNVR /CP

12MCG/DS

0223722 OXEZE TURBUHALER 0.74 E E N YAST /DS

6 MCG/DS

0223722 OXEZE TURBUHALER 0.56 E E N YAST /DS

FORMOTEROL

100/6MCG

0224538 SYMBICORT 100 TURBUHALER 0.53 E E N YAST /DS

200/6MCG

0224538 SYMBICORT 200 TURBUHALER 0.69 E E N YAST /DS

INDACATEROL

75MCG

0237693 ONBREZ BREEZHALER 1.55 E E N YNVO /DS



52

PHRM/CHRN/CDO/F12:12.00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS (continued)


IPRATROPIUM/FENOTEROL

IPRATROPIUM/FENOTER

0.5/1.25MG

0214863 DUOVENT INHAL. SOLN 0.8264 Y Y N YBOE /ML

MIDODRINE

2.5MG

0227867 APO-MIDODRINE 0.34 Y Y N YAPX /TB

5MG

0227868 MIDODRINE 0.59 Y Y N YAPX /TB

ORCIPRENALINE SO4

2MG/ML

0223678 APO-ORCIPRENALINE SYRUP 0.06 Y Y Y YAPX /ML

SALBUTAMOL

0.4MG/ML

0209118 PMS-SALBUTAMOL ORAL LIQUID 0.0486 Y Y Y YPMS /ML

0.5MG/ML

0220824 PMS-SALBUTAMOL INHAL. SOLN 0.07 Y Y Y YPMS /ML

0223936 RATIO-SALBUTAMOL INHAL. SOLN 0.07 Y Y Y YRAT /ML

1MG/ML


0198686 RATIO-SALBUTAMOL INHAL. SOLN 0.2434 Y Y Y YRTP /ML

0221341 VENTOLIN NEBULES P.F. 1.0335 Y Y Y YGSK /ML

0192693 GEN-SALBUTAMOL STERINEB 0.2434 Y Y Y YGPM /ML

100MCG/DS

0241985 SALBUTAMOL HFA 0.03 Y Y Y YSAI /DS

0224149 VENTOLIN HFA INHALER 0.0325 Y Y Y YGSK /DS

0224566 APO-SALVENT CFC FREE INHALER 0.03 Y Y Y YAPX /DS

0232645 TEVA-SALBUTAMOL 0.03 Y Y Y YTVM /DS

0223257 AIROMIR (CFC-FREE) INHALER 0.026 Y Y Y YHLR /DS

2MG

0214684 APO-SALVENT TAB 0.13 Y Y Y YAPX /TB

2MG/ML

0221342 VENTOLIN NEBULES P.F. 0.797 Y Y Y YGCH /ML


0223936 RATIO-SALBUTAMOL INHAL. SOLN 0.2748 Y Y Y YRTP /ML

0217336 GEN-SALBUTAMOL STERINEB 0.27 Y Y Y YGPM /ML

4MG

0214685 APO-SALVENT TAB 0.2134 Y Y Y YAPX /TB



53

PHRM/CHRN/CDO/F12:12.00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS (continued)


SALBUTAMOL (SALBUTAMOL SO4) (continued)

5MG/ML

0206957 PMS-SALBUTAMOL INHAL.SOLN 0.35 Y Y Y YPMS /ML

0215441 SANDOZ-SALBUTAMOL INH SOLN 0.35 Y Y Y YSDZ /ML

0086080 RATIO-SALBUTAMOL INHAL SOLN 0.35 Y Y Y YRTP /ML

0221348 VENTOLIN INHAL. SOLN. 1.02 Y Y Y YGSK /ML

SALMETEROL

100MCG/DS

0224083 ADVAIR 100 DISKUS 1.36 E E N YGSK /DS

250MCG/DS


25/125MCG

0224512 ADVAIR 0.81 E E N YGSK /DS

25/250MCG

0224512 ADVAIR 1.15 E E N YGSK /DS

500MCG/DS


SALMETEROL

50MCG/DOSE

0223112 SEREVENT DISKUS 0.94 E E N YGSK /DS

0221426 SEREVENT DISKHALER DISK 0.94 E E N YGSK /DS

TERBUTALINE SULPHATE

0.5MG/DOSE

0078661 BRICANYL TURBUHALER 0.08 Y Y Y YAST /DS

UMECLIDINIUM/VILANTE

62.5/25MCG

0241840 ANORO ELLIPTA 2.7 E E N YGSK /DS

12:16.00 SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS -------------------------------------

ALMOTRIPTAN MALATE

12.5MG

0224812 AXERT 13.04 Y N Y YJAN /TB

6.25MG

0224812 AXERT 13.04 Y N Y YJAN /TB

BELLADONNA

100MG

0017609 CAFERGOT 0.828 Y N Y YNVR /TB

DIHYDROERGOTAMINE

1MG/ML

0224116 DIHYDROERGOTAMINE MESYLAT 3.793 Y N Y YSAB /ML

0002724 DIHYDROERGOTAMINE-SANDOZ 3.878 Y N Y YNVR /ML

4MG/ML

0222894 MIGRANAL NASAL SPRAY 10.356 Y N Y YNVR /ML



54

PHRM/CHRN/CDO/F12:16.00 SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS (continued)


FLUNARIZINE HCL

FLUNARIZINE HCL

5MG

0224608 APO-FLUNARIZINE 0.72 Y N Y YAPX /CP

NARATRIPTAN HCL

1MG

0223782 AMERGE 14.17 Y N Y YGSK /TB

0231429 NOVO-NARATRIPTAN 11.34 Y N Y YTVM /TB

2.5MG

0231430 NOVO-NARATRIPTAN 6.14 Y N Y YTVM /TB

0223782 AMERGE 14.94 Y N Y YGSK /TB

PIZOTYLINE HYDROGEN

0.5MG

0032932 SANDOMIGRAN 0.37 Y N Y YNVR /TB

1MG

0051155 SANDOMIGRAN DS 0.69 Y N Y YNVR /TB

RIZATRIPTAN

10MG

0224051 MAXALT WAFERS 16.52 Y N N YMSD /EA

0239337 PMS-RIZATRIPTAN RDT 3.71 Y N N YPMS /EA

0237474 CO RIZATRIPTAN ODT 3.7 Y N N YCOB /EA

0238046 JAMP-RIZATRIPTAN 3.71 Y N N YJAM /TB

0237967 MAR-RIZATRIPTAN 4.31 Y N N YMAR /TB

0244291 RIZATRIPTAN ODT 3.72 Y N N YSAI /TB

0243958 MINT-RIZATRIPTAN ODT 4.13 Y N N YMNT /TB

0224052 MAXALT 16.52 Y N N YMSD /TB

0235188 SANDOZ-RIZATRIPTAN 3.71 Y N N YSDZ /TB

5MG

0239336 PMS-RIZATRIPTAN RDT 3.71 Y N N Ynull /EA

0224051 MAXALT WAFERS 16.52 Y N N YMSD /EA

SUMATRIPTAN

100MG

0225790 CO SUMATRIPTAN 7.86 Y N Y YCOB /TB

0223936 TEVA-SUMATRIPTAN 7.86 Y N Y YTVM /TB

0225644 PMS-SUMATRIPTAN 7.86 Y N Y YPMS /TB

0221216 IMITREX DF 16.7 Y N Y YGSK /TB

0228683 TEVA-SUMATRIPTAN DF 7.86 Y N Y YTVM /TB

0228654 SANIS-SUMATRIPTAN 7.86 Y N Y YSAN /TB

0226892 GEN-SUMATRIPTAN 7.86 Y N Y YGPM /TB

0226839 APO-SUMATRIPTAN 7.86 Y N Y YAPX /TB

0226303 SANDOZ-SUMATRIPTAN 7.86 Y N Y YSDZ /TB



55

PHRM/CHRN/CDO/F12:16.00 SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS (continued)


SUMATRIPTAN (continued)

20MG

0223042 IMITREX NASAL SPRAY 15.03 Y N Y YGSK /EA

25MG


5MG

0223041 IMITREX NASAL SPRAY 14.6 Y N Y YGSK /EA

50MG

0225789 CO SUMATRIPTAN 7.14 Y N Y YCOB /TB

0225643 PMS-SUMATRIPTAN 7.14 Y N Y YPMS /TB

0221215 IMITREX DF 15.16 Y N Y YGSK /TB

0228652 SANIS-SUMATRIPTAN 7.14 Y N Y YSAN /TB


0226838 APO-SUMATRIPTAN 7.14 Y N Y YAPX /TB

6MG/0.5ML

0221218 IMITREX INJ 79.43 Y N Y YGSK /EA

0236169 TARO-SUMATRIPTAN 33.18 Y N Y YTAR /EA

ZOLMITRIPTAN

2.5MG

0232422 PMS-ZOLMITRIPTAN 3.54 Y N Y YPMS /TB

0236298 SDZ-ZOLMITRIPTAN 4.61 Y N Y YSDZ /TB

0223866 ZOMIG 14.01 Y N Y YAST /TB

0231396 TEVA-ZOLMITRIPTAN 3.54 Y N Y YTVM /TB

0236903 MYLAN-ZOLMITRIPTAN 4.61 Y N Y YMYL /TB

2.5MG ODT

0242847 SEPTA-ZOLMITRIPTAN-ODT 2.97 Y N Y YSPT /TB

0236299 SDZ-ZOLMITRIPTAN ODT 4.61 Y N Y YSDZ /TB

0232476 PMS-ZOLMITRIPTAN ODT 4.61 Y N Y YPMS /TB

0234254 TEVA-ZOLMITRIPTAN ODT 4.61 Y N Y YTVM /TB

0224304 ZOMIG RAPIMELT 14.15 Y N Y YAST /TB

12:20.00 SKELETAL MUSCLE RELAXANTS ------------------------------------------------------

BACLOFEN

10MG

0208839 MYLAN-BACLOFEN 0.16 Y Y Y YMYL /TB

0213933 APO-BACLOFEN 0.16 Y Y Y YAPX /TB

0206373 PMS-BACLOFEN 0.77 Y Y Y YPMS /TB

0045588 LIORESAL 0.77 Y Y Y YNVR /TB

0223650 RATIO-BACLOFEN 0.16 Y Y Y YRPH /TB

0228702 SANIS-BACLOFEN 0.16 Y Y Y YSAN /TB



56

PHRM/CHRN/CDO/F12:20.00 SKELETAL MUSCLE RELAXANTS (continued)


BACLOFEN (continued)

20MG

0223650 RATIO-BACLOFEN 0.31 Y Y Y YRPH /TB

0206374 PMS-BACLOFEN 1.49 Y Y Y YPMS /TB

0228704 SANIS-BACLOFEN 0.31 Y Y Y YSAN /TB

0063657 LIORESAL-DS 1.49 Y Y Y YNVR /TB

0213939 APO-BACLOFEN 0.31 Y Y Y YAPX /TB

0208840 GEN-BACLOFEN 0.31 Y Y Y YGPM /TB

CYCLOBENZAPRINE HCL

10MG

0223650 RATIO-CYCLOBENZAPRINE 0.37 Y Y Y YRPH /TB

0228706 SANIS-CYCLOBENZAPRINE 0.3727 Y Y Y YSAN /TB

0217714 APO-CYCLOBENZAPRINE 0.3727 Y Y Y YAPX /TB

0221204 PMS-CYCLOBENZAPRINE 0.3727 Y Y Y YPMS /TB

0208005 NOVO-CYCLOPRINE 0.3727 Y Y Y YNOP /TB

0223135 GEN-CYCLOPRINE 0.3727 Y Y Y YGPM /TB

DANTROLENE SODIUM

100MG

0199765 DANTRIUM 0.7684 Y Y N YPGA /CP

25MG

0199760 DANTRIUM 0.39 Y Y N YPGA /CP

METHOCARBAMOL/ACET

400/325MG

0202680 ROBAXACET S 0.403 Y N N NWHI /CP

0223079 MUSCLE & BACK PAIN RELIEF 0.11 Y N N NVIT /CP

0224305 MUSCLE & BACK PAIN RELIEF 0.1014 Y N N NLIF /TB

400/500MG

0223117 ROBAXACET EXTRA STRENGTH 0.443 Y N N NWHI /CP

0223914 EX STRENGTH MUSCLE & BACK 0.2089 Y N N NVIT /CP

0224305 MUSCLE & BACK PAIN RELIEF 0.1566 Y N N NLIF /TB

METHOCARBAMOL/COD

400/15MG

0193478 ROBAXISAL C1/4 0.96 Y N N YWHI /TB

400/30MG

0193479 ROBAXISAL C1/2 1.12 Y N N YWHI /TB

400/8MG

0193476 ROBAXACET-8 0.681 Y N N NWHI /TB

ORPHENADRINE CITRATE

100MG

0196615 NORFLEX 0.776 Y N N NMDA /TB

0224355 SANDOZ-ORPHENADRINE CITRATE 0.75 Y N N NSDZ /TB



57

PHRM/CHRN/CDO/F12:92.00 MISCELLANEOUS AUTONOMIC DRUGS


VARENICLINE

12:92.00 MISCELLANEOUS AUTONOMIC DRUGS --------------------------------------------------

0.5MG

0229117 CHAMPIX 1.84 Y N N YPFI /TB

0.5/1.0MG

0229830 CHAMPIX STARTER KIT(25) 1.84 Y N N YPFI /TB

1.0MG

0229118 CHAMPIX 1.84 Y N N YPFI /TB

20:00 BLOOD FORMATION AND COAGULATION

20:04.04 IRON PREPARATIONS --------------------------------------------------------------

FERROUS FUMARATE

300MG

0223755 EURO-FER 0.1397 Y N Y NEUR /CP

0003108 FERROUS FUMARATE 300 MG 0.11 Y N Y NWAM /CP

8002423 JAMP-FERROUS FUMARATE 300MG 0.13 Y N Y NJPC

/CP

0048206 NEO FER 0.203 Y N Y NNEO /CP

0192342 PALAFER CAPS 0.2293 Y N Y NGSK /CP

FERROUS GLUCONATE

300MG

8000043 NOVO-FERROUS GLUCONATE 0.025 Y N Y NNOP /TB

0224453 FERROUS GLUCONATE 0.025 Y N Y NWHL /TB

0054503 APO-FERROUS GLUCONATE 0.04 Y N Y NAPC /TB

0003109 FERROUS GLUCONATE 0.021 Y N Y NWAM /TB

324MG

0058272 FERROUS GLUCONATE 0.0246 Y N Y NVTH /TB

FERROUS SULPHATE

300MG

0034691 FERROUS SULPHATE SC 0.023 Y N Y NPHM /TB

0003110 FERROUS SULPHATE 0.0625 Y N Y NWAM /TB

0058632 PMS-FERROUS SULFATE 0.0296 Y N Y NPMS /TB

0078211 FERROUS SULPHATE 0.0279 Y N Y NVTH /TB

8000331 FERROUS SULPHATE 0.0296 Y N Y NGFR /TB

0191251 APO-FERROUS SULPHATE 0.024 Y N Y NAPC /TB

0212547 SULFATE FERREUX 0.023 Y N Y NWHL /TB

IRON (FERRIC

12.5MG

0224333 FERRLECIT INJ 5.272 E E N YAVT /ML

IRON (FERROUS

150MG/5ML

0001788 FERINSOL 0.052 E N Y NMEA /ML

8000829 JAMP-FERROUS SULFATE 0.04 E N Y NJPC

/null



58

PHRM/CHRN/CDO/F20:04.04 IRON PREPARATIONS (continued)

20:00 BLOOD FORMATION AND COAGULATION (continued)

IRON (FERROUS SULFATE) (continued)

75MG/ML

0076295 FER IN SOL DROPS 0.256 E N Y NMEJ /ML

IRON DEXTRAN

50MG/ML

0222178 INFUFER (2ML) INJ 14.75 E E N YSAB /ML

IRON POLYSACCHARIDE

150MG

8001321 FERAMAX 0.435 E E N YBSY /CP

IRON SUCROSE

20 MG/ML

0224371 VENOFER 7.5 E E N YWHL /ML

20:12.04 ANTICOAGULANTS -----------------------------------------------------------------

ACENOCOUMAROL

1MG

0001038 SINTROM 0.55 Y Y Y YNVR /TB

4MG

0001039 SINTROM 1.71 Y Y Y YNVR /TB

APIXABAN

2.5MG

0237723 ELIQUIS 1.6 E E N YBMS /TB

5MG

0239771 ELIQUIS 1.6 E E N YBMS /TB

DALTEPARIN SODIUM

10000IU SYR

0235265 FRAGMIN 10000IU(ANTI-XA)/0. 20.478 Y E N YPFI /SYR

12500IU SYR

0235266 FRAGMIN 12500IU(ANTI-XA)/0. 25.83 Y E N YPFI /SYR

15000IU SYR

0235267 FRAGMIN 15000IU(ANTI-XA)/0.6 31.61 Y E N YPFI /SYR

18000IU SYR

0235268 FRAGMIN 18000IU(ANTI-XA)/0.2M 36.32 Y E N YPFI /SYR

2500IU SYR

0213262 FRAGMIN '2500IU(ANTI-XA)/0.2ML 5.12 Y E N YPFI /SYR

25000IU/ML VIAL

0223117 FRAGMIN (3.8ML VIAL) 153.58 Y E N YPHU /VL

5000IU SYR

0213264 FRAGMIN '5000IU(ANTI-XA)/0.2ML 10.33 Y E N YPFI /SYR

7500IU SYR

0235264 FRAGMIN 7500IU(ANTI-XA)/0.3ML 15.358 Y E N YPFI /SYR



59

PHRM/CHRN/CDO/F20:12.04 ANTICOAGULANTS (continued)


ENOXAPARIN

ENOXAPARIN

100MG/ML

0223656 LOVENOX (WITH PRESERV.) (3 ML 21.2 Y E N YAVT /ML

150MG/ML

0237846 LOVENOX HP 32.44 Y E N YSAN /ML

150 MG/ML

0224269 LOVENOX-HP 25.44 Y E N YAVT /SYR

30 MG/.3MG

0201247 LOVENOX SYR (30MG/0.3ML) 6.19 Y E N YAVT /EA

40 MG/.4ML

0223688 LOVENOX SYRINGE 8.48 Y E N YAVT /EA

60 MG/.6ML

0237842 LOVENOX SYR (60MG/0.6ML) 12.72 Y E N YAVT /EA

FONDAPARINUX SODIUM

2.5MG/0.5ML

0240685 FONDAPARINUX SODIUM INJ 11.19 E E N YDRR /SYR

0224553 ARIXTRA SYRINGES 15.99 E E N YGSK /SYR

7.5MG/0.6ML

0240689 FONDAPARINUX SODIUM INJ 18.14 E E N YDRR /SYR

0225805 ARIXTRA SYRINGES 25.91 E E N YGSK /SYR

HEPARIN

10UNIT/ML

0072532 HEPARIN LOCK-FLUSH SOLN 0.329 Y Y N YWHL /ML

100UNIT/ML

0072752 HEPARIN LEO 100UNIT/ML INJ 4.65 Y Y N YLEO /ML

0072531 HEPARIN LOCK-FLUSH SOLN 0.282 Y Y N YHOS /ML

1000UN/ML

0226431 HEPARIN INJ 0.57 Y Y N YPHC /ML

0045381 HEPARIN LEO INJ 5.47 Y Y N YLEO /ML

10000UN/ML

0057971 HEPARIN LEO INJ (5ML) 2.606 Y Y N YLEO /ML

NADROPARIN CALCIUM

19000U/ML

0224011 FRAXIPARINE FORTE 18.11 Y E N YGCH /SYR

RIVAROXABAN

10MG

0231698 XARELTO 2.84 E E N YBAY /TB

TINZAPARIN

10000IU

0216784 INNOHEP 10X2ML INJ 17.01 Y E N YLEO /ML

0223147 INNOHEP 2X0.5ML INJ 36.75 Y E N YLEO /SYR



60



TINZAPARIN (continued)

20000IU

0222951 INNOHEP (2X 2ML VIALS 37.68 Y E N YLEO /EA

WARFARIN

1MG

0224292 APO-WARFARIN 0.08 Y Y Y YAPX /TB

0224268 TARO-WARFARIN 0.08 Y Y Y YTAR /TB

0224446 MYLAN-WARFARIN 0.08 Y Y Y YMYL /TB

0191831 COUMADIN 0.36 Y Y Y YBMY /TB

0226527 NOVO-WARFARIN 0.08 Y Y Y YNOP /TB

0234402 SANIS-WARFARIN 0.08 Y Y Y YSAN /TB

10MG






2MG



0224446 MYLAN-WARFARIN 0.08 Y Y Y YGPM /TB




2.5MG







3MG









61



WARFARIN (continued)

4MG


0224446 MYLAN-WARFARIN 0.1 Y Y Y YGPM /TB





5MG







6MG





7.5MG




20:12.18 PLATELET AGGREGATION INHIBITORS ------------------------------------------------

TICAGRELOR

90MG

0236854 BRILINTA 1.5 E E N YAST /TB

20:15.00 null -------------------------------------------------------------------------------

(SEE A/P FILES)

N/A

0000004 (SEE A/P FILES) 0 N Y N YN/A /null

20:16.00 HEMATOPOIETIC AGENTS -----------------------------------------------------------

DARBEPOETIN ALFA

10MCG/.4ML

0239231 ARANESP 107.2 E E N YAMG /KT

100MCG/.5ML

0239177 ARANESP (HSA-FREE)4X0.5MLSYR 1072 E E N YAMG /KT

150MCG/0.3

0224636 ARANESP (HSA-FREE)4X0.3MLSYR 1608 E E N YAMG /KT



62

PHRM/CHRN/CDO/F20:16.00 HEMATOPOIETIC AGENTS (continued)


DARBEPOETIN ALFA (continued)

20MCG/.5ML

0224635 ARANESP (HSA-FREE)4X0.5MLSYR 214.4 E E N YAMG /KT

0239232 ARANESP (HSA-FREE)4X0.5ML 214.4 E E N YAMG /KT

30MCG/.3ML


40MCG/.4ML

0239174 ARANESP-(HSA-FREE) 428.8 E E N YAMG /KT

500MCG/ML

0239179 ARANESP-(HSA-FREE) 1608 E E N YAMG /KT

50UG/0.5ML

0239175 ARANESP (HSA-FREE) 134 E E N YAMG /ML

60MCG/.3ML

0239235 ARANESP-(HSA-FREE) 643.2 E E N YAMG /KT

80MCG/.4ML


EPOETIN ALFA

1000IU

0223158 EPREX (0.5MLX6 SYR/KIT) 85.5 E E N YJAN /KT

10000IU

0223158 EPREX (1ML X 6 SYR/KIT) 855 E E N YJAN /KT

2000IU

0223158 EPREX (0.5ML X 6 SYR/KIT) 171 E E N YJAN /KT

20000IU

0224323 EPREX (0.5ML X 1 SYR/KIT) 267.9 E E N YJAN /KT

3000IU


30000IU

0228868 EPREX STERILE SOLUTION 357.19 E E N YJAN /KT

4000IU


40000IU

0224072 EPREX (1ML X 1 SYR/KIT) 420.94 E E N YJAN /KT

5000IU


6000IU


8000IU




63

PHRM/CHRN/CDO/F20:16.00 HEMATOPOIETIC AGENTS (continued)


FILGRASTIM

FILGRASTIM

300MCG/ML

0196801 NEUPOGEN (10X1.0ML) INJ 173.19 E E N YAMG /KT

PEGFILGRASTIM

10MG/ML

0224979 NEULASTA 6MG (0.6ML SYR) 2504.97 E E N YAMG /EA

20:24.00 HEMORRHEOLOGIC AGENTS ----------------------------------------------------------

CLOPIDOGREL

75MG

0223868 PLAVIX 2.71 Y Y N YSAW /TB

0230302 CO-CLOPIDOGREL 0.47 Y Y N YCOB /TB

0235153 MYLAN-CLOPIDOGREL 0.47 Y Y N YMYL /TB

0234800 PMS-CLOPIDOGREL 0.47 Y Y N YPMS /TB

0240055 CLOPIDOGREL 0.47 Y Y N YSAI /TB

0240891 MINT-CLOPIDOGREL 0.47 Y Y N YMNT /TB

0235931 SDZ-CLOPIDOGREL 0.47 Y Y N YSDZ /TB

0225276 APO-CLOPIDOGREL 0.47 Y Y N YAPX /TB

PENTOXIFYLLINE

400MG

0223009 APO-PENTOXIFYLLINE 0.58 Y Y N YAPX /TB

TICLOPIDINE HCL

250MG

0223648 TEVA-TICLOPIDINE 0.6885 Y Y N YTVM /TB

0234304 SANIS-TICLOPIDINE 0.31 Y Y N YSAN /TB

0223770 APO-TICLOPIDINE 0.31 Y Y N YAPX /TB

0223974 GEN-TICLOPIDINE 0.31 Y Y N YGPM /TB

24:00 CARDIOVASCULAR DRUGS

24:04.00 CARDIAC DRUGS ------------------------------------------------------------------

ACEBUTOLOL HCL

100MG

0225759 SANDOZ-ACEBUTOLOL 0.163 Y Y N YSDZ /TB

0220451 TEVA-ACEBUTOLOL 0.08 Y Y N YTVM /TB

0228624 SANIS-ACEBUTOLOL 0.08 Y Y N YSAN /TB

0223772 MYLAN-ACEBUTOLOL 0.08 Y Y N YMYL /TB

0223788 MYLAN-ACEBUTOLOL (TYPE S) 0.08 Y Y N YMYL /TB

0214760 APO-ACEBUTOLOL 0.08 Y Y N YAPX /TB

0192654 SECTRAL 0.35 Y Y N YAVT /TB



64

PHRM/CHRN/CDO/F24:04.00 CARDIAC DRUGS (continued)

24:00 CARDIOVASCULAR DRUGS (continued)

ACEBUTOLOL HCL (continued)

200MG






0223788 MYLAN-ACEBUTOLOL (TYPE S) 0.12 Y Y N YMYL /TB


400MG



0223788 MYLAN-ACEBUTOLOL TYPE S 0.25 Y Y N YMYL /TB





AMIODARONE

100MG

0229217 PMS-AMIODARONE 0.76 Y Y N YPMS /TB

200MG

0236433 SANIS-AMIODARONE 0.51 Y Y N YSAN /TB

0224060 MYLAN-AMIODARONE 0.51 Y Y N YMYL /TB

0203628 CORDARONE 2.0589 Y Y N YWYA /TB

0224007 RATIO-AMIODARONE 0.515 Y Y N YRTP /TB

0223983 TEVA-AMIODARONE 0.51 Y Y N YTVM /TB

0224247 PMS-AMIODARONE 0.51 Y Y N YPMS /TB

0224383 SANDOZ-AMIODARONE 0.515 Y Y N YSDZ /TB

0224619 APO-AMIODARONE 0.51 Y Y N YAPX /TB

AMLODIPINE BESYLATE



65



AMLODIPINE BESYLATE (continued)

10MG

0227212 GEN-AMLODIPINE 0.36 Y Y N YGPM /TB

0233129 SANIS-AMLODIPINE 0.36 Y Y N YSAN /TB

0229749 CO-AMLODIPINE 0.36 Y Y N YCOB /TB

0232186 RAN-AMLODIPINE 0.36 Y Y N YRAN /TB

0236267 MINT-AMLODIPINE 0.36 Y Y Y YMNT /TB

0228439 SDZ-AMLODIPINE 0.36 Y Y N YSDZ /TB

0228407 PMS-AMLODIPINE 0.36 Y Y N YPMS /TB

0227338 AP0-AMLODIPINE 0.36 Y Y N YAPX /TB

0087893 NORVASC 1.99 Y Y N YPFI /TB

0237877 ODAN-AMLODIPINE BESYLATE 0.36 Y Y N YODN /TB

0225050 TEVA-AMLODIPINE 0.36 Y Y N YTVM /TB

0225961 RATIO-AMLODIPINE 0.36 Y Y N YRTP /TB

2.5MG




5MG


0232185 RAN-AMLODIPINE 0.242 Y Y N YRAN /TB


0087892 NORVASC 1.34 Y Y N YPFI /TB

0237876 ODAN-AMLODIPINE BESYLATE 0.242 Y Y N YODN /TB

0233128 SANIS-AMLODIPINE 0.242 Y Y N YSAN /TB

0236265 MINT-AMLODIPINE BESYLATE 0.242 Y Y N YMNT /TB

0227337 APO-AMLODIPINE 0.242 Y Y N YAPX /TB

0227211 GEN-AMLODIPINE 0.242 Y Y N YGPM /TB

0225049 TEVA-AMLODIPINE 0.242 Y Y N YTVM /TB

0225960 RATIO-AMLODIPINE 0.242 Y Y N YRTP /TB


ATENOLOL



66



ATENOLOL (continued)

100MG

0223760 PMS-ATENOLOL 0.24 Y Y N YPMS /TB

0203954 TENORMIN 1.01 Y Y N YAST /TB

0191205 NOVO-ATENOL 0.24 Y Y N YNOP /TB

0214743 GEN-ATENOLOL 0.24 Y Y N YGPM /TB

0217180 RATIO-ATENOLOL 0.24 Y Y N YRTP /TB

0077369 APO-ATENOL 0.24 Y Y N YAPX /TB

0236804 MINT-ATENOL 0.24 Y Y N YMNT /TB

0237199 MAR-ATENOLOL 0.24 Y Y N YMAR /TB

0226799 RAN-ATENOLOL 0.24 Y Y N YRAN /TB

0225555 CO-ATENOLOL 0.24 Y Y N YCOB /TB

0223173 SANDOZ-ATENOLOL 3.78 Y Y N YSDZ /TB

25MG

0236801 MINT-ATENOL 0.068 Y Y N YMNT /TB


0237197 MAR-ATENOLOL 0.068 Y Y N YMAR /TB


0226666 NOVO ATENOLOL 0.068 Y Y N YNOP /TB

0230364 MYLAN-ATENOLOL 0.068 Y Y N YMYL /TB

50MG

0237198 MAR-ATENOLOL 0.14 Y Y N YWHL /TB


0225554 CO-ATENOLOL 0.14 Y Y N YCOB /TB

0223173 SANDOZ-ATENOLOL 0.23 Y Y N YSDZ /TB

0236802 MINT-ATENOLOL 0.14 Y Y N YMNT /TB

0077368 APO-ATENOL 0.62 Y Y N YAPX /TB

0217179 RATIO-ATENOLOL 0.14 Y Y N YRTP /TB

0214689 GEN-ATENOLOL 0.14 Y Y N YGPM /TB


0203953 TENORMIN 0.62 Y Y N YAST /TB

0191206 NOVO-ATENOL 0.14 Y Y N YNOP /TB

BISOPROLOL FUMARATE

10MG

0230264 PMS-BISOPROLOL 0.15 Y Y N YPMS /TB

0225617 APO-BISOPROLOL 0.15 Y Y N YAPX /TB

0239159 SANIS-BISOPROLOL FUMARATE 0.15 Y Y N YSAI /TB

0226748 NOVO-BISOPROLOL 0.15 Y Y N YNOP /TB

0224744 SANDOZ-BISOPROLOL 0.15 Y Y N YSDZ /TB



67



BISOPROLOL FUMARATE (continued)

5MG

0224743 SANDOZ-BISOPROLOL 0.1 Y Y N YSDZ /TB

0225613 APO-BISOPROLOL 0.1 Y Y N YAPX /TB

0230263 PMS-BISOPROLOL 0.1 Y Y N YPMS /TB

0239158 SANIS-BISOPROLOL FUMARATE 0.1 Y Y N YSAI /TB

0238441 MYLAN-BISOPROLOL 0.1 Y Y N YMYL /TB

0226747 NOVO-BISOPROLOL 0.1 Y Y N YNOP /TB

CAPTOPRIL

100MG

0089362 APO-CAPTO 0.519 Y Y N YAPX /TB

0223020 PMS-CAPTOPRIL 1.0395 Y Y N YPMS /TB

0194299 NOVO-CAPTORIL 0.519 Y Y N YNOP /TB

0216359 GEN-CAPTOPRIL 0.52 Y Y N YGPM /TB

12.5MG





25MG





50MG





6.25MG


CARVEDILOL

12.5MG

0224653 TEVA-CARVEDILOL 0.8001 Y Y N YTVM /TB

0225232 RATIO-CARVEDILOL 0.34 Y Y N YRTP /TB

0226804 RAN-CARVEDILOL 0.34 Y Y N YRAN /TB

0236494 SANIS-CARVEDILOL 0.34 Y Y N YSAN /TB

0234755 MYLAN-CARVEDILOL 0.34 Y Y N YMYL /TB

0224793 APO-CARVEDILOL 0.34 Y Y N YAPX /TB

0224591 PMS-CARVEDILOL 0.34 Y Y N YPMS /TB



68



CARVEDILOL (continued)

25MG




0225233 RATIO-CARVEDILOL 0.34 Y Y N YRTP /TB




3.125MG

0225230 RATIO-CARVEDILOL 0.34 Y Y N YRPH /TB







6.25MG




0225231 RATIO-CARVEDILOL 0.34 Y Y N YRTO /TB




DIGOXIN

0.05MG/ML

0224232 TOLOXIN 1.09 Y Y N YPED /ML

0.0625MG

0224542 PMS-DIGOXIN 0.152 Y Y N YPMS /TB

0233570 TOLOXIN 0.26 Y Y N YMM /TB

0228123 APO-DIGOXIN 0.152 Y Y N YAPX /TB

0224232 LANOXIN 0.2402 Y Y N YVIR /TB

0.125MG



0224232 LANOXIN CSD 0.2402 Y Y N YVIR /TB




69



DIGOXIN (continued)

0.25MG

0224232 LANOXIN 0.2402 Y Y N YVIR /TB




DILTIAZEM HCL

120MG

0209724 CARDIZEM CD 1.61 Y Y N YBVL /CP

0222978 RATIO-DILTIAZEM CD 0.35 Y Y N YRTP /CP

0237061 CO-DILTIAZEM CD 0.35 Y Y N YCOB /CP

0223099 APO-DILTIAZ CD 0.35 Y Y N YAPX /CP

0240042 DILTIAZEM CD 0.35 Y Y N YSAI /CP

0235575 PMS-DILTIAZEM CD 0.35 Y Y N YPMS /CP

0224253 NOVO-DILTAZEM CD 0.35 Y Y N YNOP /CP

0224333 SANDOZ-DILTIAZEM CD 0.35 Y Y N YSDZ /CP

120MG ER

0223115 TIAZAC 0.89 Y Y N YBVL /CP

0227160 NOVO-DILTIAZEM ER 0.21 Y Y N YNOP /CP

0224591 SANDOZ DILTIAZEM T 0.21 Y Y N YSDZ /CP

0225673 TIAZAC XC 0.83 Y Y N YBVL /TB

180MG


0237063 CO DILTIAZEM CD 0.47 Y Y N YCOB /CP







180MG ER


0227161 NOVO DILTIAZEM ER 0.29 Y Y N YNOP /CP





70



DILTIAZEM HCL (continued)

240MG








240MG ER



0237050 COBALT-DILTIAZEM HCL 0.383 Y Y N YCOB /CP


0225675 TIAZAC XC 1.47 Y Y N YDVL /TB

30MG

0086292 NOVO-DILTAZEM 0.19 Y Y N YNOP /TB

0077137 APO-DILTIAZ 0.19 Y Y N YAPX /TB

300MG







300MG ER





360MG

0237052 CO DILTIAZEM T 0.58 Y Y N YCOB /CP

360MG ER





60MG

0077138 APO-DILTIAZ 0.33 Y Y N YAPX /TB

0086293 NOVO-DILTAZEM 0.33 Y Y N YNOP /TB



71



EANALAPRIL MALEATE

EANALAPRIL MALEATE

10MG

0240067 ENALAPRIL 0.26 Y Y N YSAI /TB

ENALAPRIL

10MG

0235225 RAN-ENALAPRIL 0.26 Y Y N YRAN /TB

ENALAPRIL /HCTZ

10MG/25MG

0230023 NOVO-ENALAPRIL/HCTZ 0.5479 Y Y N YNOP /TB

0235293 APO-ENALAPRIL/HCTZ 1.07 Y Y N YAPX /TB

0065729 VASERETIC 1.26 Y Y N YMSD /TB

5MG/12.5MG

0235292 APO-ENALAPRIL/HCTZ 0.49 Y Y N YAPX /TB

0230022 NOVO-ENALAPRIL/HCTZ 0.49 Y Y N YNOP /TB

ENALAPRIL MALEATE

10MG

0230000 RATIO-ENALAPRIL 0.5932 Y Y N YRTP /TB

0230005 MYLAN-ENALAPRIL 0.26 Y Y N YMYL /TB

0229996 SANDOZ ENALAPRIL 0.26 Y Y N YSDZ /TB

0201989 APO-ENALAPRIL 0.26 Y Y N YAPX /TB

0067090 VASOTEC 1.26 Y Y N YMSD /TB

0229189 CO-ENALAPRIL 0.26 Y Y N YCOB /TB

2.5MG







0240065 ENALAPRIL 0.19 Y Y N YSAI /null

20MG










72



ENALAPRIL MALEATE (continued)

5MG








ENALAPRIL SODIUM

2MG


20MG


4MG

0230008 PMS-ENALAPRIL 4MG(5MG) 0.22 Y Y N YPMS /TB

8MG

0230009 PMS-ENALAPRIL 0.26 Y Y N YPMS /TB

0223300 TEVA-ENALAPRIL 0.26 Y Y N YTVM /TB

FLECAINIDE

100MG

0227554 APO-FLECAINIDE 0.79 Y Y N YAPX /TB

0196620 TAMBOCOR 1.077 Y Y N YMDA /TB

50MG

0196619 TAMBOCOR 0.5384 Y Y N YMDA /TB

0227553 APO-FLECAINIDE 0.4 Y Y N YAPX /TB

LISINOPRIL

10MG

0229424 RAN-LISINOPRIL 0.16 Y Y N YRAN /TB

0221750 APO-LISINOPRIL (TYPE Z) 0.16 Y Y N YAPX /TB

0228920 SANDOZ LISINOPRIL 0.16 Y Y N YSDZ /TB

0227145 CO-LISINOPRIL 0.16 Y Y N YCOB /TB

0229988 RATIO-LISINOPRIL Z 0.16 Y Y N YRTP /TB

0228512 NOVO-LISINOPRIL 0.16 Y Y N YNOP /TB

0083939 PRINIVIL 0.8 Y Y N YMSD /TB

0204937 ZESTRIL 0.69 Y Y N YAST /TB



73



LISINOPRIL (continued)

20MG


0221751 APO-LISINOPRIL (TYPE Z) 0.19 Y Y N YAPX /TB







5MG






0221748 APO-LISINOPRIL 0.13 Y Y N YAPX /TB



LISINOPRIL/HYDROCHLO

10/12.5MG

0230236 SDZ-LISINOPRIL/HCT 0.21 Y Y N YSDZ /TB

0236294 LISINOPRIL/HCTZ (TYPE Z) 0.21 Y Y N YSAI /TB

0210372 ZESTORETIC 0.89 Y Y N YAST /TB

0226197 APO-LISINOPRIL/HCTZ 0.208 Y Y N YAPX /TB

20/12.5MG

0230177 TEVA-LISINOPRIL/HCTZ (TYPE Z) 0.25 Y Y N YTEV /TB



0088441 PRINZIDE 0.95 Y Y N YMSD /TB


0226198 APO-LISINOPRIL/HCTZ 0.25 Y Y N YAPX /TB

20/25MG

0230178 TEVA-LISINOPRIL/HCTZ (TYPE Z) 0.25 Y Y N YTVM /TB

0229775 MYLAN-LISINOPRIL HCTZ 0.25 Y Y N YMYL /TB




METOPROLOL TARTRATE



74



METOPROLOL TARTRATE (continued)

100MG

0223080 RTP-METOPROLOL-L 0.13 Y Y N YRTP /TB

0084265 TEVA-METOPROL (UNCOATED) 0.13 Y Y N YTVM /TB

0064804 TEVA-METOPROL 0.13 Y Y N YTVM /TB

0217455 GEN-METOPROLOL (TYPE L) 0.13 Y Y N YGPM /TB

0235040 SANIS-METOPROLOL FC-TYPE L 0.13 Y Y N YSAN /TB

0075117 APO-METOPROLOL-TYPE L 0.13 Y Y N YAPX /TB

0039743 LOPRESOR 0.65 Y Y N YNVR /TB

0061864 APO-METOPROLOL 0.13 Y Y N YAPX /TB

100MG SR

0230339 SDZ-METOPROLOL SR 0.12 Y Y N YSDZ /TB

0065885 LOPRESOR-SR 0.36 Y Y N YNVR /TB

0228516 APO-METOPROLOL SR 0.12 Y Y N YAPX /TB

200MG SR

0230341 SDZ METOPROLOL SR 200MG 0.25 Y Y N YSDZ /TB

0053456 LOPRESOR-SR 0.65 Y Y N YNVR /TB

0228517 APO-METOPROLOL SR 0.25 Y Y N YAPX /TB

25MG


0224885 PMS-METOPROLOL-L 0.06 Y Y N YPMS /TB

0226189 TEVA-METOPROLOL 0.06 Y Y N YTVM /TB

0230205 MYLAN-METOPROLOL-TYPE L 0.06 Y Y N YMYL /TB

50MG

0235418 SANDOZ METOPROLOL (TYPE L) 0.06 Y Y N YSDZ /TB

0235039 SANIS-METOPROLOL FC-TYPE L 0.06 Y Y N YSAN /TB

0223080 PMS-METOPROLOL-L 0.06 Y Y N YPMS /TB


0217454 GEN-METOPROLOL (TYPE L) 0.06 Y Y N YGPM /TB

0064803 TEVA-METOPROL 0.06 Y Y N YTVM /TB

0039742 LOPRESOR 0.3 Y Y N YNVR /TB

0084264 TEVA-METOPROL (UNCOATED) 0.06 Y Y N YTVM /TB

0074935 APO-METOPROLOL-TYPE L 0.06 Y Y N YAPX /TB

MEXILETINE HCL

100MG

0223035 NOVO-MEXILETINE 1.35 Y Y N YNOP /CP

200MG

0223036 NOVO-MEXILETINE 1.81 Y Y N YNOP /CP

NADOLOL

160MG

0078247 APO-NADOL 1.2 Y Y N YAPX /TB



75



NADOLOL (continued)

40MG

0212675 NOVO-NADOLOL 0.25 Y Y N YNOP /TB


80MG


0212676 NOVO-NADOLOL 0.35 Y Y N YNOP /TB

NIFEDIPINE

10MG

0075590 APO-NIFED 0.49 Y Y Y YAPX /CP

20MG ER

0223761 ADALAT XL 1.25 Y Y Y YBAY /TB

30MG ER


0234916 MYLAN-NIFEDIPINE XR 30 0.62 Y Y Y YMYL /TB

5MG

0072511 APO-NIFED 0.37 Y Y Y YAPX /CP

60MG ER

0232114 MYLAN-NIFEDIPINE XR 60 0.94 Y Y Y YMYL /TB


PINDOLOL

10MG

0086901 NOVO-PINDOL 0.23 Y Y N YNOP /TB

0075588 APO-PINDOL 0.23 Y Y N YAPX /TB

0044317 VISKEN 1.11 Y Y N YNVR /TB

0223153 PMS-PINDOLOL 0.23 Y Y N YPMS /TB

15MG




0223153 PMS-PINDOLOL 0.34 Y Y N YNVR /TB

5MG

0223153 PMS-PINDOLOL 0.14 Y Y N YPMS /TB




PROCAINAMIDE HCL

250MG

0071332 APO-PROCAINAMIDE 0.1763 Y Y N YAPX /CP

250MG SR

0063869 PROCAN-SR 0.47 Y Y N YPFI /TB



76



PROCAINAMIDE HCL (continued)

375MG


500MG


500MG SR


750MG SR


PROPAFENONE HCL

150MG

0224332 APO-PROPAFENONE 0.3 Y Y N YAPX /TB

0229455 PMS-PROPAFENONE 0.427 Y Y N YPMS /TB


0234305 SANIS-PROPAFENONE 0.4303 Y Y N YSAN /TB

0060370 RYTHMOL 1.26 Y Y N YABB /TB

0224537 GEN-PROPAFENONE 0.3 Y Y N YGPM /TB

300MG


0060371 RYTHMOL 2.22 Y Y N YABB /TB

0234306 SANIS-PROPAFENONE 0.754 Y Y N YSAN /TB

0224332 APO-PROPAFENONE 0.53 Y Y N YAPX /TB

0224537 GEN-PROPAFENONE 0.52 Y Y N YGPH /TB

PROPRANOLOL

10MG

0049648 NOVO-PRANOL 0.05 Y Y Y YNOP /TB

0040278 APO-PROPRANOLOL 0.05 Y Y Y YAPX /TB

0058225 PMS-PROPRANOLOL 0.05 Y Y Y YPMS /TB

120MG


120MG LA

0204226 INDERAL-LA 1.09 Y Y Y YWYA /CP

160MG LA


20MG



40MG






77



PROPRANOLOL (continued)

60MG LA


80MG




80MG LA


RAMIPRIL

1.25MG

0222182 ALTACE 0.72 Y Y N YHLR /CP

0229536 PMS-RAMIPRIL 0.128 Y Y N YPMS /CP

0228769 RATIO-RAMIPRIL 0.1274 Y Y N YRPH /CP

0231050 RAN-RAMIPRIL 0.13 Y Y N YRAN /CP

0225151 APO-RAMIPRIL 0.13 Y Y N YAPX /CP

0229548 CO-RAMIPRIL 0.13 Y Y N YCOB /CP

10MG


0242132 MINT-RAMIPRIL 0.19 Y Y N YMNT /CP


0237486 SANIS-RAMIPRIL 0.19 Y Y N YSAI /CP




0224794 NOVO-RAMIPRIL 0.19 Y Y N YNOP /CP

15MG

0242050 MAR-RAMIPRIL 0.86 Y Y N YMAR /CP

0228111 ALTACE 1.17 Y Y N YAVT /CP


0231119 RATIO-RAMIPRIL 0.86 Y Y N YRTP /CP

2.5MG












78



RAMIPRIL (continued)

5MG










RAMIPRIL/HCTZ

10MG/12.5MG

0241265 RAMIPRIL-HCTZ 0.26 Y Y N YSAI /TB

0234215 PMS-RAMIPRIL/HCTZ 0.26 Y Y N YPMS /TB

0228316 ALTACE HCT 0.488 Y Y N YAVT /TB

10MG/25MG



2.5MG/12.5MG




5MG/12.5MG




5MG/25MG



SOTALOL HCL

160MG

0227063 CO-SOTALOL 0.41 Y Y N YCOB /TB

0223832 PMS-SOTALOL 0.16 Y Y N YPMS /TB

0223118 NOVO-SOTALOL 0.21 Y Y N YNOP /TB

0216779 APO-SOTALOL 0.16 Y Y N YAPX /TB

0222977 GEN-SOTALOL 0.16 Y Y N YGPM /TB

0208423 RATIO-SOTALOL 0.16 Y Y N YRTP /TB



79



SOTALOL HCL (continued)

80MG

0227062 CO-SOTALOL 0.37 Y Y N YCOB /TB

0236861 JAMP-SOTALOL 0.3 Y Y N YJPC

/TB

0223832 PMS-SOTALOL 0.3 Y Y N YPMS /TB

0221042 APO-SOTALOL 0.3 Y Y N YAPX /TB

0223118 NOVO-SOTALOL 0.3 Y Y N YNOP /TB

0208422 RATIO-SOTALOL 0.3 Y Y N YRTP /TB

0222977 GEN-SOTALOL 0.3 Y Y N YGPM /TB

TIMOLOL MALEATE

10MG

0194781 NOVO-TIMOL 0.26 Y Y N YNOP /TB

0075585 APO-TIMOL 0.26 Y Y N YAPX /TB

20MG



5MG



VERAPAMIL HCL

120MG

0223792 GEN-VERAPAMIL 0.43 Y Y Y YGPM /TB

0078249 APO-VERAP 0.43 Y Y Y YAPX /TB

120MG SR

0190712 ISOPTIN SR 1.45 Y Y Y YABB /TB

0221034 GEN-VERAPAMIL SR 0.51 Y Y Y YGPM /TB

0224689 APO-VERAPAMIL 0.51 Y Y Y YAPX /TB

180MG SR




240MG SR


0223779 PMS-VERAPAMIL SR 0.51 Y Y Y YPMS /TB



0221192 NOVO-VERAMIL SR 0.51 Y Y Y YNOP /TB

80MG

0223792 GEN-VERAPAMIL 0.2735 Y Y Y YGPM /TB

0078248 APO-VERAP 0.2735 Y Y Y YAPX /TB



80

PHRM/CHRN/CDO/F24:04.04 ANTIARRHYTHMIC AGENTS


DISOPYRAMIDE

24:04.04 ANTIARRHYTHMIC AGENTS ----------------------------------------------------------

100MG

0222480 RYTHMODAN 0.28 Y N N YAVT /CP

24:06.00 ANTILIPEMIC DRUGS --------------------------------------------------------------

ATORVASTATIN

10MG

0235029 RATIO-ATORVASTATIN 0.31 Y Y N YRTP /TB

0232494 SDZ-ATORVASTATIN 0.31 Y Y N YSDZ /TB

0234870 SANIS ATORVASTATIN 0.31 Y Y N YSAN /TB

0231370 RAN-ATORVASTATIN 0.31 Y Y N YRAN /TB

0231089 CO-ATORVASTATIN 0.3138 Y Y N YCOB /TB

0230267 TEVA-ATORVASTATIN 0.3138 Y Y N YTVM /TB

0229526 APO-ATORVASTATIN 0.31 Y Y N YAPX /TB

0223071 LIPITOR 1.77 Y Y N YPFI /TB

0237320 MYLAN-ATORVASTATIN CALCIUM 0.31 Y Y N YMYL /TB

20MG







0239938 PMS-ATORVASTATIN 0.39 Y Y N YPMS /TB




40MG












81

PHRM/CHRN/CDO/F24:06.00 ANTILIPEMIC DRUGS (continued)


ATORVASTATIN CALCIUM (continued)

80MG









BEZAFIBRATE

200MG

0224033 PMS-BEZAFIBRATE 0.8833 Y Y N YPMS /TB

400MG

0208352 BEZALIP SR 2.22 Y Y N YHLR /TB

CHOLESTYRAMINE RESIN

444MG/G

0221032 PMS-CHOLESTYRAMINE RG (4GX30) 1.53 Y Y N YPMS /GM

800MG/G

0089096 PMS-CHOLESTYRAMINE (4GX30) 1.53 Y Y N YPMS /GM

COLESTIPOL HCL RESIN

1G

0213268 COLESTID 0.26 Y Y N YPHU /TB

5G

0064297 COLESTID GRANULES 5.66 Y Y N YPHU /GM

7.5G

0213269 COLESTID GRANULES 0.9346 Y Y N YPHU /GM

EZETIMIBE

10 MG

0242782 APO-EZETIMIBE 0.33 E E N YAPX /TB

0241677 SANDOZ EZETIMIBE 0.33 E E N YSDZ /TB

0242323 JAMP-EZETIMIBE 0.33 E E N YJPC

/TB

0242324 MINT-EZETIMIBE 0.33 E E N YMNT /TB

0224752 EZETROL 1.84 E E N YMSD /TB

10MG

0241471 ACT EZETIMIBE 0.33 E E N YACT /TB

0243130 EZETIMIBE 0.33 E E N YSAI /TB

FENOFIBRATE

100MG

0222598 APO-FENOFIBRATE 0.61 Y Y N YAPX /CP

0235657 FENOFIBRATE-S 0.54 Y Y N YSAI /TB

0228804 SANDOZ FENOFIBRATE S 0.54 Y Y N YSDZ /TB



82



FENOFIBRATE (continued)

100MG T

0224160 LIPIDIL SUPRA 1.11 Y Y N YFFR /TB

0224685 APO-FENO-SUPER 0.54 Y Y N YAPX /TB

0228908 NOVO-FENOFIBRATE-S 0.54 Y Y N YNOP /TB

160MG

0228805 SANDOZ FENOFIBRATE S 0.27 Y Y N YSDZ /TB

0235658 FENOFIBRATE-S 0.27 Y Y N YSAI /TB

160MG T

0224686 APO-FENO-SUPER 0.27 Y Y N YAPX /TB

0228909 NOVO-FENOFIBRATE-S 0.27 Y Y N YNOP /TB

0224160 LIPIDIL SUPRA 1.28 Y Y N YFOU /TB

200MG

0223178 PMS-FENOFIBRATE MICRO 1.089 Y Y N YPMS /CP

0224021 GEN-FENOFIBRATE MICRO 0.27 Y Y N YGPM /CP

0223986 APO-FENO-MICRO 0.27 Y Y N YAPX /CP

0224355 NOVO-FENOFIBRATE MICRO 0.27 Y Y N YNOP /CP

0214695 LIPIDIL-MICRO 1.09 Y Y N YFFR /CP

0227355 PMS-FENOFIBRATE MICRO 0.27 Y Y N YPMS /CP

0228609 SANIS-FENOFIBRATE MICRO 0.27 Y Y N YSAN /CP

0225003 RATIO-FENOFIBRATE MC 0.27 Y Y N YTRP /CP

FLUVASTATIN SODIUM

20MG

0206156 LESCOL 0.91 Y Y N YNVR /CP

0240023 SANDOZ FLUVASTATIN 0.22 Y Y N YSDZ /CP

0229922 TEVA-FLUVASTATIN 0.22 Y Y N YTVM /CP

40MG

0206157 LESCOL 1.28 Y Y N YNVR /CP

0240024 SANDOZ FLUVASTATIN 0.31 Y Y N YSDZ /CP

GEMFIBROZIL

300MG

0218540 GEN-GEMFIBROZIL 0.13 Y Y N YGPM /CP

0223995 PMS-GEMFIBROZIL 0.13 Y Y N YPMS /CP

0197957 APO-GEMFIBROZIL 0.13 Y Y N YAPX /CP

0224170 NOVO-GEMFIBROZIL 0.13 Y Y N YNOP /CP

600MG

0214207 NOVO-GEMFIBROZIL 0.52 Y Y N YNOP /TB

0223047 GEN-GEMFIBROZIL 0.52 Y Y N YGPM /TB

0223018 PMS-GEMFIBROZIL 0.52 Y Y N YPMS /TB

0197958 APO-GEMFIBROZIL 0.52 Y Y N YAPX /TB



83



LOVASTATIN

LOVASTATIN

20MG

0079586 MEVACOR 2 Y Y N YMSD /TB

0222017 APO-LOVASTATIN 0.49 Y Y N YAPX /TB

0224312 MYLAN-LOVASTATIN 0.49 Y Y N YMYL /TB

0224601 PMS-LOVASTATIN 0.49 Y Y N YPMS /TB

0224654 TEVA-LOVASTATIN 0.49 Y Y N YTVM /TB

0224705 SANDOZ-LOVASTATIN 0.49 Y Y N YSDZ /TB

0224857 CO LOVASTATIN 0.49 Y Y N YCOB /TB

0235322 SANIS-LOVASTATIN 0.49 Y Y N YSAN /TB

40MG

0224601 PMS-LOVASTATIN 0.9 Y Y N YPMS /TB

0224857 CO LOVASTATIN 0.9 Y Y N YCOB /TB

0224654 TEVA-LOVASTATIN 0.9 Y Y N YTVM /TB

0079585 MEVACOR 3.66 Y Y N YMSD /TB

0235323 SANIS-LOVASTATIN 0.9 Y Y N YSAN /TB

0224312 MYLAN-LOVASTATIN 0.9 Y Y N YMYL /TB

0222018 APO-LOVASTATIN 0.9 Y Y N YAPX /TB

0224705 SANDOZ-LOVASTATIN 0.9 Y Y N YSDZ /TB

PRAVASTATIN

10MG

0224785 SANDOZ-PRAVASTATIN 0.41 Y Y N YSDZ /TB

0224765 PMS-PRAVASTATIN 0.41 Y Y N YPMS /TB

0228442 RAN-PRAVASTATIN 0.41 Y Y N YRAN /TB

0089374 PRAVACHOL 0.953 Y Y N YSQU /TB

0235654 SANIS-PRAVASTATIN 0.41 Y Y N YSAN /TB

0224350 APO-PRAVASTATIN 0.41 Y Y N YAPX /TB

0224700 TEVA-PRAVASTATIN 0.41 Y Y N YTVM /TB

0224693 RATIO-PRAVASTATIN 0.953 Y Y N YRPH /TB

0225709 GEN-PRAVASTATIN 0.41 Y Y N YGPM /TB

0224818 CO PRAVASTATIN 0.41 Y Y N YCOB /TB



84



PRAVASTATIN (continued)

20MG





0231747 MINT-PRAVASTATIN 0.48 Y N N YMNT /TB







40MG











ROSUVASTATIN

10MG

0235461 TEVA-ROSUVASTATIN 0.24 Y Y N YTVM /TB

0224716 CRESTOR 1.4 Y Y N YAST /TB

0237853 PMS-ROSUVASTATIN 0.24 Y Y N YPMS /TB

0238265 RAN-ROSUVASTATIN 0.24 Y Y N YRAN /TB

0233977 CO-ROSUVASTATIN 0.24 Y Y N YCOB /TB

0233873 SANDOZ-ROSUVASTATIN 0.24 Y Y N YSDZ /TB

0233798 APO-ROSUVASTATIN 0.24 Y Y N YAPX /TB

0239780 MINT-ROSUVASTATIN 0.24 Y Y N YMNT /TB

0240563 ROSUVASTATIN 0.24 Y Y N YSAI /TB

0238127 MYLAN-ROSUVASTATIN 0.24 Y Y N YMYL /TB



85



ROSUVASTATIN (continued)

20MG











40MG











5MG










SIMVASTATIN



86



SIMVASTATIN (continued)

10MG

0232915 RAN-SIMVASTATIN 0.36 Y Y N YRAN /TB

0225015 TEVA-SIMVASTATIN 0.36 Y Y N YNOP /TB

0228473 SANIS-SIMVASTATIN 0.36 Y Y N YSAN /TB

0088433 ZOCOR 2.34 Y Y N YMSD /TB

0226926 PMS-SIMVASTATIN 0.36 Y Y N YPMS /TB

0237294 MINT-SIMVASTATIN 0.36 Y Y N YMNT /TB

0224658 MYLAN-SIMVASTATIN 0.36 Y Y N YGPM /TB

0224810 CO SIMVASTATIN 0.36 Y Y N YCOB /TB

0224782 SANDOZ-SIMVASTATIN 0.36 Y Y N YSDZ /TB

0224701 APO-SIMVASTATIN 0.36 Y Y N YAPX /TB

0224706 RATIO-SIMVASTATIN 0.36 Y Y N YRPH /TB

20MG









0224810 CO-SIMVASTATIN 0.45 Y Y N YCOB /TB



40MG















87



SIMVASTATIN (continued)

5MG











80MG




0224810 CO-SIMVASTATIN 0.45 Y Y N YCOB /TB








24:06.04 BILE ACID SEQUESTRANTS ---------------------------------------------------------

COLESEVELAM

625MG

0237395 LODALIS 1.1 Y Y N Ynull /TB

24:06.06 FRIBIC ACID DERIVATIVES --------------------------------------------------------

FENOFIBRATE

145MG

0239070 SANDOZ FENOFIBRATE E 0.91 Y Y N YSDZ /TB

0226908 LIPIDIL EZ 1.1 Y Y N YBGP /TB

48MG

0239069 SANDOZ FENOFIBRATE E 0.36 Y Y N YSDZ /TB

24:08.00 HYPOTENSIVE DRUGS --------------------------------------------------------------

ATENOLOL/CHLORTHALI

100/25MG

0204998 TENORETIC 1.12 Y Y N YAST /TB

0224876 APO-ATENIDONE 1.12 Y Y N YAPX /TB



88

PHRM/CHRN/CDO/F24:08.00 HYPOTENSIVE DRUGS (continued)


ATENOLOL/CHLORTHALIDONE (continued)

50/25MG

0204996 TENORETIC 0.68 Y Y N YAST /TB

0224876 APO-ATENIDONE 0.68 Y Y N YAPX /TB

BENAZEPRIL HCL

10MG

0229034 APO-BENAZEPRIL 0.6595 Y Y N YAPX /TB

20MG


0088585 LOTENSIN 1.21 Y Y N YNVR /TB

5MG


0088583 LOTENSIN 0.89 Y Y N YNVR /TB

CANDESARTAN

16MG

0238070 RAN-CANDESARTAN 0.29 Y Y N YRAN /TB

0236536 APO-CANDESARTAN 0.29 Y Y N YAPX /TB

0223909 ATACAND 1.2 Y Y N YAST /TB

0232697 SDZ-CANDESARTAN 0.29 Y Y N YSDZ /TB

0237654 CO-CANDESARTAN 0.29 Y Y N YCOB /TB

0238893 SANIS - CANDESARTAN CILEXETIL 0.29 Y Y N YSAI /TB

32MG


0241734 SANDOZ CANDESARTAN 0.29 Y Y N YSDZ /TB


4MG


0237912 MYLAN-CANDESARTAN 0.34 Y Y N YMYL /TB





0238890 CANDESARTAN 0.34 Y Y N YSAI /TB

8MG


0236631 TEVA-CANDESARTAN 0.29 Y Y N YTVM /TB



0238892 SANIS-CANDESARTAN CILEXETIL 0.29 Y Y N YSAI /TB





89



CANDESARTAN/HCTZ

CANDESARTAN/HCTZ

16/12.5 MG

0238865 CO CANDESARTAN/HCT 0.299 Y Y N YCOB /TB

16/12.5MG

0236786 APO-CANDESARTAN/HCTZ 0.3 Y Y N YAPX /TB

0232790 SANDOZ-CANDESARTAN/HCTZ 0.3 Y Y N YSDZ /TB

0224402 ATACAND PLUS 1.2 Y Y N YAST /TB

0237489 MYLAN-CANDESARTAN/HCTZ 0.299 Y Y N YMYL /TB

32/12.5MG

0233292 ATACAND PLUS 1.2 Y Y N YAST /TB

0239512 APO-CANDESARTAN/HCTZ 0.3 Y Y N YAPX /TB

CANDESARTAN/HYDROC

16/12.5

0239480 CANDESARTAN/HCTZ 0.299 Y Y N YSAI /TB

CANDESARTEN

32

0243584 CANDESARTAN 0.29 Y Y N YSAI /TB

CILAZAPRIL

1 MG

0229113 APO-CILAZAPRIL 0.1557 Y Y N YAPX /TB

0235096 SANIS-CILAZAPRIL 0.3717 Y Y N YSAN /TB

0226635 TEVA-CILAZAPRIL 0.1557 Y Y N YTVM /TB

0228044 PMS-CILAZAPRIL 0.1557 Y Y N YPMS /TB

0228377 GEN-CILAZAPRIL 0.16 Y Y N YGPM /TB

2.5 MG





0191147 INHIBACE 0.74 Y Y N YHLR /TB


0228521 CO CILAZAPRIL 0.18 Y Y N YCOB /TB

5 MG



0228522 CO CILAZAPRIL 0.21 Y Y N YCOB /TB



0191148 INHIBACE 0.86 Y Y N YHLR /TB




90



CILAZAPRIL/HCTZ

CILAZAPRIL/HCTZ

5MG/12.5MG

0228498 APO-CILAZAPRIL/HCTZ 0.417 Y Y N YAPX /TB

0231373 TEVA-CILAZAPRIL/HCTZ 0.417 Y Y N YTVM /TB

0218147 INHIBACE PLUS 0.86 Y Y N YHLR /TB

CLONIDINE HCL

0.025MG

0224873 APO-CLONIDINE 0.1817 Y N N YAPX /TB

0051925 DIXARIT 0.27 Y N N YBOE /TB

0230416 TEVA-CLONIDINE 0.26 Y Y Y YTVM /TB

0.1MG

0204612 TEVA-CLONIDINE 0.1765 Y Y N YTVM /TB

0025952 CATAPRES 0.19 Y Y N YBOE /TB

0086894 APO-CLONIDINE 0.1765 Y Y N YAPX /TB

0.2MG

0086895 APO-CLONIDINE 0.3149 Y Y N YAPX /TB

0029188 CATAPRES 0.3306 Y Y N YBOE /TB

0204614 TEVA-CLONIDINE 0.3149 Y Y N YTVM /TB

DOXAZOSIN MESYLATE

1MG

0195810 CARDURA-1 0.58 Y Y N YPFI /TB

0224272 NOVO-DOXAZOSIN 0.14 Y Y N YNOP /TB

0224049 GEN-DOXAZOSIN 0.14 Y Y N YGPM /TB

0224058 APO-DOXAZOSIN 0.14 Y Y N YAPX /TB

2MG





4MG





EPROSARTAN

400MG

0224043 TEVETEN 0.72 Y Y N YSLV /TB

600MG

0224394 TEVETEN 1.11 Y Y N YSLV /TB



91



EPROSARTAN/HYDROCHLOROTHIAZIDE

EPROSARTAN/HYDROCH

600/12.5MG

0225363 TEVETEN PLUS 1.11 Y Y N YABB /TB

FELODIPINE

10MG

0222200 RENEDIL 0.67 Y Y N YHLR /TB

0228027 SANDOZ FELODIPINE 0.84 Y Y N YSDZ /TB

0085178 PLENDIL 1.03 Y Y N YAST /TB

2.5MG



5MG

0228026 SANDOZ FELODIPINE 0.56 Y Y N YSDZ /TB



FOSINOPRIL

10MG

0226600 APO-FOSINOPRIL 0.22 Y Y N YAPX /TB

0226240 MYLAN-FOSINOPRIL 0.22 Y Y N YGEN /TB

0224780 NOVO-FOSINOPRIL 0.22 Y Y N YNOP /TB

0225594 PMS-FOSINOPRIL 0.4977 Y Y N YPMS /TB

20MG

0226601 APO-FOSINOPRIL 0.26 Y Y N YAPX /TB

0226242 MYLAN-FOSINOPRIL 0.26 Y Y N YGEN /TB

0224780 NOVO-FOSINOPRIL 0.26 Y Y N YNOP /TB

0225595 PMS-FOSINOPRIL 0.5987 Y Y N YPMS /TB

HYDRALAZINE HCL

10MG

0044161 APO-HYDRALAZINE 0.13 Y Y N YAPX /TB

25MG


50MG


INDAPAMIDE/PERINDOP

1.25MG/4MG

0224656 COVERSYL PLUS 1.01 Y Y N YSEV /TB

2.5MG/8MG

0232165 COVERSYL PLUS HD 1.13 Y Y N YSEV /TB



92



IRBESARTAN

IRBESARTAN

150MG

0232808 CO-IRBESARTAN 0.3025 Y Y N YCOB /TB

0223792 AVAPRO 1.27 Y Y N YBMY /TB

0232848 SDZ-IRBESARTAN 0.3 Y Y N YSDZ /TB

0231707 PMS-IRBESARTAN 0.3 Y Y N YPMS /TB

0231641 RATIO-IRBESARTAN 0.3 Y Y N YRTP /TB

0231599 TEVA-IRBESARTAN 0.3 Y Y N YTVM /TB

0237237 SANIS-IRBESARTAN 0.3 Y Y N YSAI /TB

300MG








75MG








IRBESARTAN/HYDROCHL

150/12.5MG

0233051 RATIO-IRBESARTAN/HCTZ 0.3 Y Y N YRTP /TB

0232851 PMS-IRBESARTAN/HCTZ 0.3 Y Y N YPMS /TB

0233742 SDZ-IRBESARTAN HCT 0.3 Y Y N YSDZ /TB

0224181 AVALIDE 1.27 Y Y N YSAN /TB

0231601 TEVA-IRBESARTAN/HCTZ 0.3 Y Y N YTVM /TB

0235739 CO-IRBESARTAN/HCTZ 0.3 Y Y N YCOB /TB

150MG/12.5MG

0237288 SANIS- 0.3 Y Y N YSAI /TB



93



IRBESARTAN/HYDROCHLOROTHIAZIDE (continued)

300/12.5MG




0224181 AVALIDE 1.27 Y Y N YSAN /TB



300MG/12.5MG


300/25MG






300MG/25MG


LABETALOL HCL

100MG

0210627 TRANDATE 0.33 Y Y N YRBP /TB

200MG

0210628 TRANDATE 0.58 Y Y N YRBP /TB

LOSARTAN

100/12.5MG

0236244 SANDOZ-LOSARTAN 0.31 Y Y N YSDZ /TB

0237124 APO-LOSARTAN-HCTZ 100/12.5 0.31 Y Y N YAPX /TB

100MG/12.5MG

0237714 TEVA-LOSARTAN 0.31 Y Y N YTVM /TB

0237808 MYLAN-LOSARTAN 0.31 Y Y N YMYL /TB

0229784 HYZAAR 100/12.5 1.35 Y Y N YMSD /TB

100/25MG



0224100 HYZAAR DS 100/25 1.37 Y Y N YMSD /TB

0237125 APO-LOSARTAN-HCTZ 100/25 0.31 Y Y N YAPX /TB



94



LOSARTAN /HYDROCHLOROTHIAZIDE (continued)

50/12.5MG


0238965 MINT-LOSARTAN/HCTZ 0.3147 Y Y N YMNT /TB


0237123 APO-LOSARTAN-HCTZ 50/12.5 0.31 Y Y N YAPX /TB


0223004 HYZAAR 50/12.5 1.37 Y Y N YMSD /TB

LOSARTAN POTASSIUM

100MG


0238889 SANIS-LOSARTAN POTASSIUM 0.31 Y Y N YSAI /TB

0235351 APO-LOSARTAN 0.31 Y Y N YAPX /TB

0240576 MINT-LOSARTAN 0.36 Y Y N YMNT /TB

0218288 COZAAR 1.37 Y Y N YMSD /TB

0230977 PMS-LOSARTAN 0.31 Y Y N YPMS /TB

0231335 SANDOZ-LOSARTAN POTASSIUM 0.31 Y Y N Ynull /TB

0235797 TEVA-LOSARTAN POTASSIUM 0.31 Y Y N YTVM /TB

0235484 COBALT-LOSARTAN POTASSIUM 0.31 Y Y N YCOB /TB

25MG





0231333 SANDOZ-LOSARTAN POTASSIUM 0.31 Y Y N YSDZ /TB



0238886 SANIS-LOSARTAN 0.31 Y Y N YSAI /TB

50MG


0231334 SANDOZ-LOSARTAN POTASSIUM 0.31 Y Y N YSDZ /TB



0238887 SANIS-LOSARTAN POTASSIUM 0.31 Y Y N YSAI /TB



0240574 MINT-LOSARTAN 0.36 Y Y N YMNT /TB


LOSARTAN/HYDROCHLO

100/12.5MG

0238966 MINT-LOSARTAN/HCTZ 0.31 Y Y N YMNT /TB

0238827 CO LOSARTAN/HCT 0.31 Y Y N YCOB /TB



95



LOSARTAN/HYDROCHLOROTHIAZIDE (continued)

100/25MG

0242766 LOSARTAN/HCTZ 0.31 Y Y N YSAI /TB

0238828 CO LOSARTAN/HCT 0.31 Y Y N YCOB /TB

0238967 MINT-LOSARTAN/HCTZ DS 0.31 Y Y N YMNT /TB

0239224 PMS-LOSARTAN-HCTZ 0.31 Y Y N YPMS /TB

50/12.5MG

0242764 LOSARTAN/HCTZ 0.31 Y Y N YSAN /TB

0238825 CO 0.31 Y Y N YCOB /TB

0239222 PMS-LOSARTAN-HCTZ 0.31 Y Y N YPMS /TB

METHYLDOPA

125MG

0036025 APO-METHYLDOPA 0.1 Y Y N YAPX /TB

250MG


500MG


METHYLDOPA/HYDROC

250/15MG

0044170 APO-METHAZIDE-15 0.168 Y Y N YAPX /TB

250/25MG

0044171 APO-METHAZIDE-25 0.1835 Y Y N YAPX /TB

MINOXIDIL

10MG

0051450 LONITEN 0.76 Y Y N YPHU /TB

2.5MG

0051449 LONITEN 0.35 Y Y N YPHU /TB

OLMESARTAN

20MG

0231866 OLMETEC 1.08 Y Y N YSCP /TB

40MG

0231867 OLMETEC 1.08 Y Y N YSCP /TB

OLMESARTAN/HYDROC

20/12.5MG

0231961 OLMETEC PLUS 1.08 Y Y N YMSD /TB

40/25MG

0231963 OLMETEC PLUS 1.1 Y Y N YMSD /TB

PERINDOPRIL ERBUMINE

2MG

0212327 COVERSYL 0.65 Y Y N YSEV /TB

4MG




96



PERINDOPRIL ERBUMINE (continued)

8MG


PINDOLOL/HYDROCHLO

10/25MG

0056862 VISKAZIDE 1 Y Y N YNVR /TB

10/50MG

0056863 VISKAZIDE 1 Y Y N YNVR /TB

PRAZOSIN

1MG

0088280 APO-PRAZO 0.26 Y Y N YAPX /TB

0193419 NOVO-PRAZIN 0.26 Y Y N YNOP /TB

2MG



5MG



QUINAPRIL HCL

10MG

0194767 ACCUPRIL 0.91 Y Y N YPFI /TB

0224850 APO-QUINAPRIL 0.69 Y Y N Ynull /TB

0229099 GD-QUINAPRIL 0.69 Y Y N YGDI /TB

0234056 PMS-QUINAPRIL 0.69 Y Y N YPMS /TB

20MG



0224850 APO-QUINAPRIL 0.23 Y Y N YAPX /TB

0229100 GD-QUINAPRIL 0.23 Y Y N YGDI /TB

40MG




5MG



QUINAPRIL/HYDROCHLO

10/12.5MG

0223736 ACCURETIC 0.91 Y Y N YPFI /TB

0240876 APO-QUINAPRIL/HCTZ 0.69 Y Y N YAPX /TB



97



QUINAPRIL/HYDROCHLOROTHIAZIDE (continued)

20/12.5MG

0240877 APO-QUINAPRIL/HCTZ 0.69 Y Y N YAPX /TB


25/20MG

0240878 APO- 0.65 Y Y N YAPX /TB


TELMISARTAN

40MG

0232017 TEVA-TELMISARTAN 0.28 Y Y N YTVM /TB

0237671 MYLAN-TELMISARTAN 0.28 Y Y N YMYL /TB

0237595 SANDOZ-TELMISARTAN 0.28 Y Y N YSDZ /TB

0224076 MICARDIS 1.17 Y Y N YBOE /TB

0238894 SANIS-TELMISARTAN 0.28 Y Y N YSAI /TB

80MG

0239325 ACT TELMISARTAN 0.28 Y Y N YACT /TB

0224077 MICARDIS 1.17 Y Y N YBOE /TB

0232018 TEVA-TELMISARTAN 0.28 Y Y N YTVM /TB

0237672 MYLAN-TELMISARTAN 0.28 Y Y N YMYL /TB

0237596 SANDOZ-TELMISARTAN 0.28 Y Y N YSDZ /TB

0238895 SANIS-TELMISARTAN 0.282 Y Y N YSAI /TB

TELMISARTAN/AMLODIPI

5/40MG

0237102 TWYNSTA 0.68 Y Y N YBOE /TB

5/80MG


80/10MG


TELMISARTAN/HCTZ

80/12.5MG

0239355 SANDOZ-TELMISARTAN/HCTZ 0.28 Y Y N YSDZ /TB

0233028 TEVA-TELMISARTAN/HCTZ 0.28 Y Y N YTVM /TB

0239535 TELMISARTAN/HCTZ 0.28 Y Y N YSAI /TB

0237356 MYLAN-TELMISARTAN/HCTZ 0.28 Y Y N YMYL /TB

0224434 MICARDIS PLUS 1.17 Y Y N YBOE /TB

80/25MG

0239356 SANDOZ-TELMISARTAN HCT 0.28 Y Y N YSDZ /TB

0237357 MYLAN-TELMISARTAN/HCTZ 0.28 Y Y N YMYL /TB

0237925 TEVA-TELMISARTAN/HCTZ 0.28 Y Y N YTVM /TB

0240167 PMS-TELMISARTAN-HCTZ 0.28 Y Y N YPMS /TB

0239536 TELMISARTAN/HCTZ 0.28 Y Y N YSAI /TB

0231870 MICARDIS PLUS 1.17 Y Y N YBOE /TB



98



TERAZOSIN HCL

TERAZOSIN HCL

1MG

0224351 PMS-TERAZOSIN 0.18 Y Y N YPMS /TB

0081865 HYTRIN 0.79 Y Y N YABB /TB

0221894 RATIO-TERAZOSIN 0.18 Y Y N YRTP /TB

0235047 SANIS-TERAZOSIN 0.18 Y Y N YSAN /TB

0223450 APO-TERAZOSIN 0.18 Y Y N YAPX /TB

0223080 TEVA-TERAZOSIN 0.18 Y Y N YTVM /TB

10MG







2MG







5MG







TRANDOLAPRIL

0.5MG

0223145 MAVIK 0.27 Y Y N YABB /CP

1MG


2MG


4MG




99



TRIAMTERENE/HYDROCHLOROTHIAZID

TRIAMTERENE/HYDROC

50/25MG

0053265 NOVO-TRIAMZIDE 0.0608 Y Y N YNOP /TB

0044177 APO-TRIAZIDE 0.0608 Y Y N YAPX /TB

VALSARTAN

160MG

0233750 CO-VALSARTAN 0.3 Y Y N YCOB /TB

0224478 DIOVAN 1.199 Y Y N YNVR /TB

0235676 SDZ-VALSARTAN 0.3 Y Y N YSDZ /TB

0236311 RAN-VALSARTAN 0.3 Y Y N YRAN /TB

0235667 TEVA-VALSARTAN 0.3 Y Y N YTVM /TB

320MG


0236697 VALSARTAN 0.28 Y Y N YSAI /TB

0235677 SANDOZ VALSARTAN 0.284 Y Y N YSDZ /TB


40MG

0236694 SANIS-VALSARTAN 0.523 Y Y N YSAI /TB

0227052 DIOVAN 1.167 Y Y N YNVR /TB


0231299 PMS-VALSARTAN 0.52 Y Y N YRAN /TB




80MG


0236695 SANIS-VALSARTAN 0.3 Y Y N YSAI /TB

0224478 DIOVAN 1.2 Y Y N YNVO /TB




VALSARTAN/HYDROCHL

160/12.5MG

0235700 TEVA-VALSARTAN/HCTZ 0.3 Y Y N YTVM /TB

0224190 DIOVAN-HCT 1.2 Y Y N YNVR /TB


0235670 SDZ-VALSARTAN/HCTZ 0.3 Y Y N YSDZ /TB



100



VALSARTAN/HYDROCHLOROTHIAZIDE (continued)

160/25MG





320/12.5MG

0236703 VALSARTAN HCT 0.29 Y Y N YSAI /TB


320/25MG




80/12.5MG



0236700 VALSARTAN HCT 0.3 Y Y N YSAN /TB


24:12.00 VASODILATING DRUGS -------------------------------------------------------------

DIPYRIDAMOLE

25MG

0089564 APO-DIPYRIDAMOLE (FC) 0.2633 Y Y N YAPX /TB

50MG

0089565 APO-DIPYRIDAMOLE FC 0.3685 Y Y N YAPX /TB

75MG

0089566 APO-DIPYRIDAMOLE-FC 0.4963 Y Y N YAPX /TB

DIPYRIDAMOLE/ASA

200MG/25MG

0224211 AGGRENOX 0.85 E E N YBOE /CP

ISOSORBIDE DINITRATE

10MG

0044168 APO-ISDN 0.04 Y Y N YAPX /TB

30MG


5MG


ISOSORBIDE-5

60MG

0212655 IMDUR 0.71 Y Y N YAST /TB

0230128 PMS-ISMN 0.35 Y Y N YPMS /TB

0227283 APO-ISMN 0.35 Y Y N YAPX /TB



101

PHRM/CHRN/CDO/F24:12.00 VASODILATING DRUGS (continued)


NITROGLYCERIN

NITROGLYCERIN

0.2MG/HR

0058422 TRANSDERM-NITRO 0.2 PATCH 0.77 Y Y N YNVR /PT

0223073 TRINIPATCH 0.2 PATCH 0.59 Y Y N YSAN /PT

0240744 MYLAN-NITRO PATCH 0.2 0.45 Y Y N YMYL /PT

0216280 MINITRAN 0.2 PATCH 0.62 Y Y N YMDA /PT

0191191 NITRO-DUR 0.2 PATCH 0.62 Y Y N YKEY /PT

0.3MG

0003761 NITROSTAT SL TAB 0.12 Y Y N YPFI /TB

0.4MG/HR






0.6MG

0003762 NITROSTAT SL TAB 0.12 Y Y N YPFI /TB

0.6MG/HR


0240746 MYLAN-NITRO PATCH 0.6 0.47 Y Y N Ynull /PT




0.8MG/HR



2%

0192645 NITROL 2% OINTMENT 0.68 Y Y N YAVT /GM

200 DOSE

0239343 APO-NITROGLYCERIN 0.04 Y Y N YAPX /DS

0224358 GEN-NITRO SUBLINGUAL SPR 0.04 Y Y N YN/A /DS

0223899 RHO-NITRO PUMPSPRAY 0.04 Y Y N YRHO /DS

0223144 NITROLINGUAL PUMP SPRAY 0.07 Y Y N YAVT /DS

SILDENAFIL

20MG

0231950 RATIO-SILDENAFIL R 7.29 E E N YRTP /TB

0227940 REVATIO 11.12 N E N YPFI /TB

TADALAFIL

20MG

0242193 APO-TADALAFIL PAH 11.47 E E N YAPX /TB



102

PHRM/CHRN/CDO/F24:12.92 MISCELLANEOUS VASODILATATING AGENTS


RIOCIGUAT

24:12.92 MISCELLANEOUS VASODILATATING AGENTS --------------------------------------------

0.5MG

0241276 ADEMPAS 42.75 E N N YBAY /TB

1MG


1.5MG


2MG


2.5MG


24:32.20 MINERALOCORTICOID (ALDOSTERONE) RECEPTOR ANTAGONISTS ---------------------------

EPLERENONE

25MG

0232305 INSPRA 2.64 E E N YPFI /TB

50MG

0232306 INSPRA 2.64 E E N YPFI /TB

28:00 CENTRAL NERVOUS SYSTEM DRUGS

28:08.04 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS ------------------------------------------

ACETYLSALICYLIC ACID

150MG/SUP

0078554 ASA SUPPOSITORIES 0.95 Y N N NPMS /SP

325MG

0001033 ENTROPHEN E.C. 0.028 Y N N NWAM /TB

0053033 ASA 325MG 0.022 Y N N NWHL /TB

0003614 ASA 0.03 Y N N NWAM /TB

0228452 PMS-ASA EC 0.03 Y N N NPMS /TB

0004085 PMS-ASA 0.059 Y N N NPMS /TB

0021666 NOVASEN E.C. 0.0304 Y N N NNOP /TB

0205016 ENTROPHEN 0.0503 Y N N NWAM /TB

0215041 COATED ASPIRIN S E-C 0.05 Y N N NBAY /TB

650MG

0190539 ENTROPHEN 650MG E.C. 0.0862 Y N N NWAM /CP

0058286 ASA 650 SUPPOS. 1.1 Y N N NPMS /SP

0022929 NOVASEN E.C. 0.052 Y N N NNOP /TB

0001034 ENTROPHEN E.C. 0.08 Y N N NWAM /TB

80MG

0200901 ASAPHEN 0.056 Y N N NPMS /TB

0223854 ASAPHEN E.C. 0.056 Y N N NPMS /TB



103

PHRM/CHRN/CDO/F28:08.04 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (continued)

28:00 CENTRAL NERVOUS SYSTEM DRUGS (continued)

ACETYLSALICYLIC ACID (continued)

81MG

0237217 ASA 81 MG 0.053 Y N N NVIT /TB

0223772 COATED ASPIRIN DAILY LOW 0.08 Y N N NBAY /TB

0242681 ASA EC 0.53 Y N N NSAI /TB

0224310 LIFE DAILY LOW DOSE ASA EC 0.0725 Y N N NPMS /TB

0224499 ASA 81MG(MEDICINE CENTER)EC 0.0725 Y N N NMCT /TB

0224389 EXACT ASA 81 MG EC 0.0725 Y N N NEXA /TB

0224380 EQUATE DAILY LOW-DOSE ASA 0.0725 Y N N NWAL /TB

0228370 PMS-ASA EC (BLUE) 0.053 Y N N NPMS /TB

0224228 ENTROPHEN 81MG EC 0.06 Y N N NPMS /TB

CELECOXIB

100MG

0229197 GD-CELECOXIB 0.17 Y Y Y YGEN /CP

0232124 SANDOZ CELECOXIB 0.17 Y Y Y YSDZ /CP

0235544 PMS-CELECOXIB 0.18 Y Y Y YPMS /CP

0242327 MYLAN-CELECOXIB 0.18 Y Y Y YMYL /CP

0242015 ACT CELECOXIB 0.18 Y Y Y YACT /CP

0241893 APO-CELECOXIB 0.18 Y Y Y YAPX /CP

0241249 MINT-CELECOXIB 0.18 Y Y Y YMNT /CP

0243629 CELECOXIB 0.17 Y Y Y YSAI /CP

0241237 RAN-CELECOXIB 0.17 Y Y Y YRAN /CP

0243563 ACCEL-CELECOXIB 0.14 Y Y Y YACC /CP

0223994 CELEBREX 0.7 Y Y Y YPHU /CP

0228891 TEVA-CELECOXIB 0.17 Y Y Y YTVM /CP

200MG

0232125 SANDOZ-CELECOXIB 0.35 Y Y Y YSDZ /CP

0241238 RAN-CELECOXIB 0.36 Y Y Y YRAN /CP

0228892 TEVA-CELECOXIB 0.35 Y Y Y YTVM /CP

0241250 MINT-CELECOXIB 0.36 Y Y Y YMNT /CP

0241894 APO-CELECOXIB 0.36 Y Y Y YAPX /CP

0242016 ACT CELECOXIB 0.36 Y Y Y YACT /CP

0243564 ACCEL-CELECOXIB 0.28 Y Y Y YACC /CP

0235545 PMS-CELECOXIB 0.36 Y Y Y YPMS /CP

0239988 MYLAN-CELECOXIB 0.35 Y Y Y YMYL /CP

0243630 CELECOXIB 0.35 Y Y Y YSAI /CP

0223994 CELEBREX 1.4 Y Y Y YPHU /CP

DICLOFENAC

1.16% GEL

0229037 VOLTAREN EMULGEL 0.07 Y N N NNVR /GM



104



DICLOFENAC POTASSIUM

DICLOFENAC

50MG

0223935 TEVA-DIFENAC-K 0.3937 Y Y Y YTVM /TB

0224343 APO-DICLO RAPIDE 0.3937 Y Y Y YAPX /TB

0088163 VOLTAREN RAPIDE 0.95 Y Y Y YNOP /TB

0235168 SANIS-DIFENAC-K 0.3937 Y Y Y YSAN /TB

0223975 PMS-DICLOFENAC K 0.3937 Y Y Y YPHA /TB

DICLOFENAC SODIUM

100MG

0063273 VOLTAREN SUPPOS. 2 Y Y Y YNVR /SP

0223150 PMS-DICLOFENAC SUPPOS. 0.584 Y Y Y YPMS /SP

0217468 TEVA-DIFENAC SUPPOS. 0.8397 Y Y Y YTVM /SP

0059082 VOLTAREN-SR 1.74 Y Y Y YNVR /TB

0226194 SANDOZ DICLOFENAC SR 0.4048 Y Y Y YSDZ /TB

0204869 TEVA-DIFENAC SR 0.4048 Y Y Y YTVM /TB

0209119 APO-DICLO SR 0.4048 Y Y Y YAPX /TB

0223150 PMS-DICLOFENAC-SR 0.4048 Y Y Y YPMS /TB

25MG

0083917 APO-DICLO E.C. 0.0781 Y Y Y YAPX /TB

0080853 TEVA-DIFENAC E.C. 0.0781 Y Y Y YTVM /TB

0223150 PMS-DICLFENAC EC 0.1902 Y Y Y YPMS /TB

50MG

0217467 TEVA-DIFENAC SUPPOS. 0.6237 Y Y Y YTVM /SP

0063272 VOLTAREN SUPPOS. 1.49 Y Y Y YNVR /SP

0223150 PMS-DICLOFENAC SUPPOS. 0.434 Y Y Y YPMS /SP

0226196 SANDOZ-DICLOFENAC 0.2 Y Y Y YSDZ /TB

0230262 PMS-DICLOFENAC 0.2 Y Y Y YPMS /TB

0080854 TEVA-DIFENAC E.C. 0.2 Y Y Y YTVM /TB

0235239 SANIS-DICLOFENAC SODIUM E.C. 0.2 Y Y Y YSAN /TB

0083918 APO-DICLO E.C. 0.2 Y Y Y YAPX /TB

0051401 VOLTAREN 1.07 Y Y Y YNVR /TB

0223150 PMS-DICLOFENAC EC 0.38 Y Y Y YPMS /TB

75MG

0235240 SANIS-DICLOFENAC SR 0.23 Y Y Y YSAN /TB

0226190 SANDOZ-DICLOFENAC SR 0.234 Y Y Y YSDZ /TB

0223150 PMS-DICLOFENAC-SR 0.23 Y Y Y YPMS /TB

0215858 TEVA-DIFENAC SR 0.234 Y Y Y YTVM /TB

0216281 APO-DICLO SR 0.23 Y Y Y YAPX /TB

0078245 VOLTAREN-SR 1.22 Y Y Y YNVR /TB



105



DICLOFENAC SODIUM/MISOPROSTOL

DICLOFENAC

50/200UG

0239714 CO DICLO-MISO 0.45 Y Y Y YCOB /TB

0191705 ARTHROTEC 0.61 Y Y Y YPHU /TB

75/200UG

0239715 CO DICLO-MISO 0.62 Y Y Y YCOB /TB

0234169 GD-DICLOFENAC/MISOPROSTOL 0.43 Y Y Y YGDI /TB

0222983 ARTHROTEC 75 0.84 Y Y Y YPHU /TB

DICLOFENAC

50/200UG

0234168 GD-DICLOFENAC/MISOPROSTOL 0.31 Y Y Y YGDI /TB

DIFLUNISAL

250MG

0204849 NOVO-DIFLUNISAL 0.5647 Y Y Y YNOP /TB

0203948 APO-DIFLUNISAL 0.5647 Y Y Y YAPX /TB

500MG

0203949 APO-DIFLUNISAL 0.72 Y Y Y YAPX /TB

ETODOLAC

200MG

0223231 APO-ETODOLAC 0.76 Y Y Y YAPX /CP

300MG

0223231 APO-ETODOLAC 0.76 Y Y Y YAPX /CP

FLURBIPROFEN

100MG

0210051 NOVO-FLURPROFEN 0.3 Y Y Y YNOP /TB

0191203 APO-FLURBIPROFEN 0.3 Y Y Y YAPX /TB

50MG

0191204 APO-FLURBIPROFEN 0.22 Y Y Y YAPX /TB

0210050 NOVO-FLURPROFEN 0.22 Y Y Y YNOP /TB

IBUPROFEN

200MG

0044164 APO-IBUPROFEN 0.04 Y N N NAPX /TB

0218693 MOTRIN IB 0.07 Y N N NMCL /TB

0193355 ADVIL 0.08 Y N N NWHI /TB

0193353 ADVIL 0.1 Y N N NWHI /TB

300MG

0044165 APO-IBUPROFEN 0.14 Y N N NAPX /TB

0224263 MOTRIN IB 0.13 Y N N YMCL /TB



106



IBUPROFEN (continued)

400MG

0240129 JAMP-IBUPROFEN 0.09 Y N N YJPC

/TB

0224265 MOTRIN IB 0.17 Y N N YMCL /TB

0062934 NOVO-PROFEN 0.09 Y N N YTVM /TB

0050605 APO-IBUPROFEN 0.09 Y N Y NAPX /TB

600MG

0058511 APO-IBUPROFEN 0.13 Y Y Y YAPX /TB

0062935 NOVO-PROFEN 0.13 Y Y Y YNOP /TB

INDOMETHACIN

100MG

0193413 RATIO-INDOMETHACIN SUPPOS 0.89 Y N Y YRTP /SP

0223180 SANDOZ-INDOMETHACIN SUPP 0.89 Y N Y YSDZ /SP

25MG

0061115 APO-INDOMETHACIN 0.0871 Y Y Y YAPX /CP

0033742 NOVO-METHACIN 0.23 Y Y Y YNOP /CP

50MG

0061116 APO-INDOMETHACIN 0.1511 Y Y Y YAPX /CP

0033743 NOVO-METHACIN 0.45 Y Y Y YNOP /CP

0223179 SANDOZ-INDOMETHACIN SUPP 0.88 Y N Y YSDZ /SP

KETOPROFEN

100MG

0201595 PMS-KETOPROFEN SUPPOS. 1.22 Y N Y YPMS /SP

100MG EC

0084266 APO-KETO-E 0.68 Y Y Y YAPX /TB

0215082 PMS-KETOPROFEN-EC 0.3078 Y Y Y YPMS /TB

200MG SR

0217257 APO-KETOPROFEN SR 1.39 Y Y Y YAPX /TB

50MG

0079042 APO-KETO CAP 0.34 Y Y Y YAPX /CP

0215080 PMS-KETOPROFEN 0.1662 Y Y Y YPMS /CP

50MG EC

0079043 APO-KETO-E 0.34 Y Y Y YAPX /TB

KETOROLAC

30MG/ML

0223994 SDZ-KETOROLAC 30MG/ML INJ 4.41 Y N N YSDZ /ML

KETOROLAC

10MG

0216266 TORADOL 0.7 Y Y Y YHLR /TB

0222908 KETOROLAC 0.52 Y Y Y YAPX /TB

0223020 NOVO-KETOROLAC 0.41 Y Y Y YNOP /TB



107



MEFENAMIC ACID

MEFENAMIC ACID

250MG

0223120 PMS-MEFENAMIC ACID 0.3308 Y Y Y YPMS /CP

0222945 APO-MEFENAMIC 0.5 Y Y Y YAPX /CP

MELOXICAM

15 MG

0225832 TEVA-MELOXICAM 0.57 Y Y Y YTVM /TB

0235315 SANIS-MELOXICAM 0.57 Y Y Y YSAN /TB

0224278 MOBICOX 0.92 Y Y Y YBOE /TB

0224803 RATIO-MELOXICAM 0.567 Y Y Y YRTP /TB

0225002 CO-MELOXICAM 0.57 Y Y Y YCOB /TB

0224897 APO-MELOXICAM 0.57 Y Y Y YAPX /TB

0224826 PMS-MELOXICAM 0.57 Y Y Y YPMS /TB

7.5 MG

0224788 RATIO-MELOXICAM 0.4914 Y Y Y YRTP /TB

0225831 TEVA-MELOXICAM 0.49 Y Y Y YTVM /TB

0225001 CO-MELOXICAM 0.49 Y Y Y YCOB /TB

0224278 MOBICOX 0.8 Y Y Y YBOE /TB

0224897 APO-MELOXICAM 0.49 Y Y Y YAPO /TB

0235314 SANIS-MELOXICAM 0.49 Y Y Y YSAN /TB

0224826 PMS-MELOXICAM 0.49 Y Y Y YPMS /TB

NABUMETONE

500MG

0224086 NOVO-NABUMETONE 0.36 Y Y Y YNOP /TB

0223863 APO-NABUMETONE 0.36 Y Y Y YAPX /TB

750MG

0224086 NOVO-NABUMETONE 0.92 Y Y Y YNOP /TB

NAPROXEN

125MG

0052267 APO-NAPROXEN 0.08 Y Y Y YAPX /TB

25MG/ML

0216243 NAPROSYN SUSP 0.06 Y Y Y YHLR /ML

250MG


0056535 NOVO-NAPROX 0.107 Y Y Y YNOP /TB

0235075 SANIS-NAPROXEN 0.107 Y Y Y YSAN /TB

250MG/ECT

0216279 NAPROSYN E 0.42 Y Y Y YHLR /TB

0224669 APO-NAPROXEN EC 0.2 Y Y Y YAPX /TB

0224331 NOVO-NAPROX EC 0.11 Y Y Y YNOP /TB



108



NAPROXEN (continued)

325MG/ECT

0216241 NAPROSYN E 0.56 Y Y Y YHLR /TB

375MG




375MG/ECT

0224343 GEN-NAPROXEN EC 0.15 Y Y Y YGPM /TB

0235079 NAPROXEN EC 0.15 Y Y Y YSAI /TB



500MG

0201723 PMS-NAPROXEN SUPPOS. 0.94 Y N Y YPMS /SP




500MG/ECT

0235080 NAPROXEN EC 0.21 Y Y Y YSAI /TB



0229471 PMS-NAPROXEN EC 0.21 Y Y Y YPMS /TB

0224102 GEN-NAPROXEN EC 0.21 Y Y Y YGPM /TB

0216242 NAPROSYN E 1 Y Y Y YHLR /TB

750MG

0217707 APO-NAPROXEN SR 1.0048 Y Y N YAPX /TB

0216246 NAPROSYN-S.R. 1.48 Y Y N YHLR /TB

NAPROXEN SODIUM

275MG

0078435 APO-NAPRO-NA 0.34 Y Y Y YAPX /TB


0235101 SANIS-NAPROXEN SODIUM 0.34 Y Y Y YSAN /TB

550MG

0235102 SANIS-NAPROXEN SODIUM 0.67 Y Y Y YSAN /TB

0194030 APO-NAPROXEN DS 0.67 Y Y Y YAPX /TB

0202660 NOVO-NAPROX DS 0.67 Y Y Y YNOP /TB

PIROXICAM

10MG

0064288 APO-PIROXICAM 0.44 Y Y Y YAPX /CP

0069571 NOVO-PIROCAM 0.44 Y Y Y YNOP /CP



109



PIROXICAM (continued)

20MG

0064289 APO-PIROXICAM 0.74 Y Y Y YAPX /CP

0083623 PMS-PIROXICAM 0.74 Y Y Y YPMS /CP

0069569 NOVO-PIROCAM 0.74 Y Y Y YNOP /CP

0215446 PMS-PIROXICAM SUPPOS. 2.21 Y Y Y YPMS /SP

SULINDAC

150MG

0074558 NOVO-SUNDAC 0.3824 Y Y Y YNOP /TB

0077835 APO-SULIN 0.3824 Y Y Y YAPX /TB

200MG

0074559 NOVO-SUNDAC 0.39 Y Y Y YNOP /TB

0077836 APO-SULIN 0.39 Y Y Y YAPX /TB

TIAPROFENIC ACID

200MG

0223082 PMS-TIAPROFENIC 0.3437 Y Y Y YPMS /TB

0213611 APO-TIAPROFENIC 0.3437 Y Y Y YAPX /TB

0217967 NOVO-TIAPROFENIC 0.49 Y Y Y YNOP /TB

300MG

0223082 PMS-TIAPROFENIC 0.4104 Y Y Y YPMS /TB

0217968 NOVO-TIAPROFENIC 0.68 Y Y Y YNOP /TB

0213612 APO-TIAPROFENIC 0.33 Y Y Y YAPX /TB

28:08.08 OPIATE AGONISTS ----------------------------------------------------------------

ACETAMINOPHEN/CAFFE

15MG COD

0065324 RATIO-LENOLTEC NO.2 (15MG 0.1 Y Y N YRTP /TB

0216393 TYLENOL WITH CODEINE NO.2 0.1 Y Y N YJAN /TB

0029350 ATASOL-15 'WITH 15MG CODEINE 0.091 Y Y N YHOR /TB

30MG COD

0065327 RATIO-LENOLTEC NO.3 (30MG 0.11 Y Y Y YRTP /TB

0223238 EXDOL-30 (W 30MG CODEINE) 0.1594 Y Y N YLIH /TB


325/15/30MG

0029351 ATASOL-30 WITH 30MG CODEINE 0.061 Y Y N YHOR /TB

8MG COD

0218106 TYLENOL WITH CODEINE NO.1 8MG 0.14 Y N N NMCL /TB

0223742 ACETAMINOPHEN 8MG CODEINE 0.0342 Y N N NCAN /TB

0202533 ACETAMINOPHEN 8 MG CODEINE 0.02 Y N N NPMS /TB

0029349 ATASOL 8 WITH 8MG CODEINE 0.07 Y N N NHOR /TB

0070622 ACETAMINOPHEN 8MG CODEINE 0.0342 Y N N NVTH /TB

0065323 LENOLTEC NO.1( 8MG COD) 0.14 Y N N NRTP /TB



110

PHRM/CHRN/CDO/F28:08.08 OPIATE AGONISTS (continued)


ACETAMINOPHEN/CODEINE

ACETAMINOPHEN/CODEI

300MG/30MG

0060888 RATIO-EMTEC 0.17 E E N YRTP /TB

300MG/60MG


0062146 RATIO-LENOLTEC NO.4 0.23 Y Y N YRTP /TB

ASA/CAFFEINE/CODEINE

325/15/8MG

0010816 222 0.14 Y N N NJJM

/TB

375/30/15

0223451 282 MG 0.0655 Y Y N YLIH /TB

375/30/30

0223864 292 MG 0.18 Y Y N YLIH /TB

CODEINE

100MG

0216374 CODEINE CONTIN 0.68 Y E N YPFR /TB

150MG


200MG


50MG


CODEINE PHOSPHATE

15MG

0224397 PMS-CODEINE 0.0641 Y Y N YPHA /TB

0077945 CODEINE PHOSPHATE 0.0618 Y Y N YROG /TB

0059343 RATIO-CODEINE 0.08 Y Y N YRTP /TB

30MG

0059345 RATIO-CODEINE 0.13 Y Y N YRTP /TB

0224397 PMS-CODEINE 0.0773 Y Y N YPMS /TB

5MG/ML

0005002 CODEINE PHOSPHATE SYRUP 0.05 Y Y N YLAB /ML

0077947 RATIO-CODEINE SYRUP 0.03 Y Y N YRTP /ML

FENTANYL

100MCG

0239674 MYLAN-FENTANYL MATRIX PATCH 12.05 Y Y N YMYL /PT



111



FENTANYL (continued)

100UG/HR

0228298 RATIO-FENTANYL 100 PATCH 12.05 Y Y N YRPH /PT

0233015 RAN-FENTANYL 100 MATRIX 12.05 Y Y N YRAN /PT

0231466 TEVA-FENTANYL 100 PATCH 12.05 Y Y N YTVM /PT

0238689 CO FENTANYL 12.05 Y Y N YCOB /PT

0234141 PMS-FENTANYL 100 PATCH 12.05 Y Y N YPMS /PT

0232716 SDZ-FENTANYL 100 PATCH 12.05 Y Y N YSDZ /PT

12MCG


12UG/HR


0231192 RATIO-FENTANYL 12 UG PATCH 2.23 Y Y N YRPH /PT



0233010 RAN-FENTANYL 12 MATRIX PATCH 2.23 Y Y N YRAN /PT

25MCG


25UG/HR




0234138 PMS-FENTANYL 25 PATCH 3.66 Y Y N YPMD /PT


37UG/HR

0232713 SDZ-TENTANYL PATCH 8.5 Y Y N YSDZ /PT

50 UG/HR


50UG/HR






75UG/HR





0239673 MYLAN-FENTANYL 75 MATRIX 9.68 Y Y N YMYL /PT





112



FENTANYL CITRATE

FENTANYL CITRATE

100MCG S/L

0236417 ABSTRAL 10.9 N N N YPAL /TB

200MCG S/L


300MCG S/L


400MCG S/L


600MCG S/L


800MCG S/L


HYDROMORPHONE

1MG/ML

0191658 HYCODAN ORAL LIQUID 0.13 Y N N YBMY /ML

HYDROMORPHONE HCL

1MG

0231940 TEVA-HYDROMORPHONE 0.1 Y Y N YTVM /TB

0070543 DILAUDID 0.1 Y Y N YABB /TB

0088544 PMS-HYDROMORPHONE 0.1 Y Y N YPMS /TB

0236411 APO-HYDROMORPHONE 0.1 Y Y N YAPX /TB

1MG/ML

0191638 PMS-HYDROMORPHONE ORAL LQ 0.07 Y Y N YPMS /ML

0078653 DILAUDID ORAL LIQUID 0.08 Y Y N YABB /ML

10MG/ML

0062213 DILAUDID-HP (1ML) INJ 2.651 Y Y N YABB /ML

0214592 HYDROMORPHONE HP 10 (1ML)INJ 3.78 Y Y N YSAB /ML

12MG

0212536 HYDROMORPH CONTIN 1.86 Y Y N YPFR /CP

18MG

0224356 HYDROMORPH CONTIN 2.68 Y Y N YPUR /CP

2MG




0236412 APO-HYDROMORPHONE 0.14 Y Y N Ynull /TB

2MG/ML

0214590 HYDROMORPHONE HCL (1ML)INJ 1.78 Y Y N YSAB /ML

0062710 DILAUDID (1ML) INJ 1.0832 Y Y N YABB /ML



113



HYDROMORPHONE HCL (continued)

20MG/ML


24MG


3MG


0191639 PMS-HYDROMORPHONE SUPP 3.15 Y Y N YPMS /SP

30MG


4MG




4.5MG


50MG/ML


6MG


8MG




9MG


MEPERIDINE HCL

100MG/ML

0072574 MEPERIDINE 100 (1ML) INJ 1.34 Y Y N YSAB /ML

50MG

0213801 DEMEROL 0.15 Y Y Y YSAW /TB

50MG/ML


75MG/ML


METHADONE

10MG/ML

0239459 METHADOSE 0.15 Y N N YMAL /ML

0239461 METHADOSE 0.15 Y N N YMAL /ML



114



MORPHINE

MORPHINE

1MG/ML

0048658 M.O.S. 1MG/ML (ORAL SOLN) 0.02 Y Y Y YICN /ML

0060776 RATIO-MORPHINE 1MG/ML SOLN 0.02 Y Y Y YRTP /ML

0059146 STATEX 1MG/ML (ORAL SOLN) 0.02 Y Y Y YPMS /ML

10MG

0063220 STATEX SUPPOS. 1.9 Y Y N YPMS /SP

0069019 M.O.S. 10MG TAB 0.17 Y Y Y YICN /TB

0200976 MOS-SULFATE 0.18 Y Y Y YICN /TB

0201421 MSIR 0.19 Y Y Y YPFR /TB

0059464 STATEX 0.17 Y Y Y YPMS /TB

10MG/ML

0063250 M.O.S.10MG/ML (ORAL SOLN) 0.1988 Y Y Y YICN /ML


10MG ER

0201993 M-ESLON 0.3 Y Y N YAVT /CP

10MG SR

0224216 KADIAN 10MG 0.38 Y Y N YFAU /CP

100MG SR

0218445 KADIAN SR 2.73 Y Y N YABB /CP


0230279 NOVO-MORPHINE SR 2.68 Y Y N YNOP /TB

0201431 MS CONTIN 2.83 Y Y N YPFR /TB

15MG ER

0217774 M-ESLON ER CAP 0.35 Y Y N YAVT /CP

15MG SR

0235081 SANIS-MORPHINE 0.23 Y Y N YSAI /TB

0224479 RATIO-MORPHINE SR 0.23 Y Y N YRTP /TB

0230276 TEVA-MORPHINE SR 0.23 Y Y N YTEV /TB


20MG

0059696 STATEX SUPPOS 2.26 Y Y N YPMS /SP


0069020 M.O.S. 20MG TAB 0.3243 Y Y Y YICN /TB

20MG/ML


0063248 M.O.S.20MG/ML (ORAL SOLN) 0.524 Y Y Y YICN /ML

0062193 STATEX 20MG/ML (ORAL SOLN) 0.51 Y Y Y YPMS /ML

20MG SR




115



MORPHINE (continued)

200MG ER

0217775 M-ESLON ER CAP 3.99 Y Y N YAVT /CP

200MG SR



25MG



30MG


0201425 MSIR 0.44 Y Y N YPFR /TB

30MG ER


30MG SR



0235089 MORPHINE SR 0.35 Y Y N YSAI /TB


0077618 M.O.S.-S.R. 0.48 Y Y N YICN /TB

40MG

0069022 M.O.S. 40MG TAB 0.4214 Y Y N YICN /TB

5MG





5MG/ML

0051421 M.O.S. 5MG/ML (ORAL SOLN) 0.0842 Y Y Y YICN /ML

0059147 STATEX 5MG/ML (ORAL SOLN ) 0.08 Y Y Y YPMS /ML


50MG

0200970 MOS-SULFATE 0.36 Y Y N YICN /TB

0067596 STATEX 0.35 Y Y N YPMS /TB

50MG/ML

0069023 MOS-50 ORAL CONCENTRATE 1.2426 Y Y N YICN /ML

50MG SR


60MG

0069024 M.O.S. 60MG TAB 0.5851 Y Y N YICN /TB

60MG ER




116



MORPHINE (continued)

60MG SR

0235091 MORPHINE SR 0.62 Y Y N YSAI /TB




0077620 M.O.S.-S.R. 0.84 Y Y N YICN /TB

MORPHINE INJ

10MG/ML

0039258 MORPHINE SO4 (1ML) INJ 2.07 Y Y N YSAB /ML

15MG/ML

0039256 MORPHINE SO4 (1ML) INJ 1.26 Y Y N YSAB /ML

2MG/ML

0224248 MORPHINE SULPHATE INJ. 2.14 Y Y N YSAB /ML

50MG/ML

0061728 MORPHINE HP 50 (1ML) INJ 5.05 Y Y N YSAB /ML

OXYCODONE

10MG

0231998 PMS-OXYCODONE 0.19 Y Y Y YPMS /TB

0044394 SUPEUDOL 0.19 Y Y Y YSAB /TB

0224013 OXY-IR 0.39 Y Y Y YPUR /TB

20MG


0226298 SUPEUDOL 0.3 Y Y Y YSDZ /TB


5MG


0078973 SUPEUDOL 0.13 Y Y Y YSAB /TB


OXYCODONE

5MG/325MG

0236136 OXYCODONE/ACET 0.13 Y Y Y YSAI /TB

0060816 RATIO-OXYCOCET 0.13 Y Y Y YRTP /TB

OXYCODONE

5MG/325MG

0191654 ENDOCET 0.1285 Y Y Y YLIN /TB

0224575 PMS-OXYCODONE- 0.1285 Y Y Y YPMS /TB

0191647 PERCOCET 0.85 Y Y Y YBMY /TB

0232462 APO-OXYCODONE HCL/ACET 0.1285 Y Y Y YAPX /TB

0230789 NOVO-OXYCODONE ACET 0.1285 Y Y Y YNOP /TB



117



OXYCODONE/ACETYLSALICYLIC ACID

OXYCODONE/ACETYLSA

5MG/325MG

0060815 OXYCODAN COMPRIMES 0.4 Y Y N YTEC /TB

PROPOXYPHENE

100MG

0026143 DARVON-N 0.6268 Y Y Y YPMS /CP

28:08.12 OPIATE PARTIAL AGONISTS --------------------------------------------------------

BUPRENORPHINE/NALOX

2/0.5MG

0242485 TEVA-BUPRENORPHINE/NALOXONE 1.34 Y E N YTVM /TB

0240809 MYLAN- 1.34 Y E N YMYL /TB

8/2MG

0242487 TEVA-BUPRENORPHINE/NALOXONE 2.37 Y E N YTVM /TB

0240810 MYLAN- 2.37 Y E N YMYL /TB

PENTAZOCINE

50 MG

0213798 TALWIN 0.46 Y N N YAVT /TB

28:08.92 MISCELLANEOUS ANALGESICS AND ANTIPYRETICS --------------------------------------

ACETAMINOPHEN

325MG

0193808 ACETAMINOPHEN 0.012 Y N N NJPC

/TB

0236234 ACETAMINOPHEN CAPLETS 325MG 0.03 Y N N NAPX /TB

0223741 ACETAMINOPHEN 0.0359 Y N N NCAN /TB

0055939 TYLENOL REGULAR STRENGTH 0.07 Y N N NMCL /TB

0054498 APO-ACETAMINOPHEN 0.03 Y N N NAPX /TB

0074354 ACETAMINOPHEN USP 0.0138 Y N N NWHL /TB

0225280 ACETAMINOPHEN 325MG TABLETS 0.02 Y N N NPHM /TB

0060575 ACETAMINOPHEN TAB 0.0237 Y N N NVTH /TB

0038921 NOVO-GESIC 0.03 Y N N NNOP /TB



118

PHRM/CHRN/CDO/F28:08.92 MISCELLANEOUS ANALGESICS AND ANTIPYRETICS (continued)


ACETAMINOPHEN (continued)

500MG

0222997 APO-ACETAMINOPHEN 0.03 Y N N NAPX /CAPLE

0224281 ACETAMINOPHEN EXTRA 0.257 Y N N NWHL /CP

0048232 NOVO-GESIC FORTE 500 0.07 Y N N NNOP /TB

0060577 ACETAMINOPHEN EXTRA STREN 0.031 Y N N NVTH /TB

0072390 TYLENOL EXTRA STRENGTH 0.07 Y N N NMCL /TB

0055940 TYLENOL EXTRA STRENGTH 0.07 Y N N NMCL /TB

0054970 ACETAMINOPHEN 0.03 Y N N NSDM /TB

0054500 APO ACETAMINOPHEN 0.03 Y N N NAPX /TB

0225525 ACETAMINOPHEN EXTRA 0.257 Y N N NWHL /TB

0225281 ACETAMINOPHEN (LIFE BRAND) 0.03 Y N N NSDM /TB

0228579 ACETAMINOPHEN 500 MG 0.095 Y N N NVIT /TB

0223741 ACETAMINOPHEN EXTRA STREN 0.03 Y N N NCAN /TB

0089250 PMS-ACETAMINOPHEN 0.03 Y N N NPMS /TB

0078979 ACETAMINOPHEN TAB 0.03 Y N N NTRA /TB

0193912 JAMP-ACETAMINOPHEN 0.03 Y N N NJPC

/TB

80MG/5ML

0190584 ACETAMINOPHEN 0.031 Y N N NLAB /ML

ACETAMINOPHEN

160/5ML

0202779 PEDIATRIX 0.02 Y N N NTVM /ML

0079269 PMS-ACETAMINOPHEN LIQUID 0.03 Y N N NPMS /ML

0222687 ACETAMINOPHEN LIQ 160MG/5ML 0.03 Y N N NRIV /ML

ASA/CAFF/CODEINE/BU

15MG COD

0017619 FIORINAL C1/4 1.84 Y N N YNVR /CP

30MG COD

0060818 RATIO-TECNAL C1/2 2.2 Y N N YRPH /CP

0017620 FIORINAL C1/2 2.2 Y N N YSAN /CP

330//40MG

0022632 FIORINAL 1.72 Y N N YNVR /CP

FLOCTAFENINE

200MG

0224468 APO-FLOCTAFENINE 0.42 Y N Y YAPX /TB

400MG

0224468 APO-FLOCTAFENINE 0.81 Y N Y YAPX /TB

28:10.00 OPIATE ANTAGONISTS -------------------------------------------------------------

NALTREXONE HCL

50MG

0244427 APO-NALTREXONE 7.3 Y E N YAPX /TB

0221382 REVIA 14.32 Y E Y YBMY /TB



119

PHRM/CHRN/CDO/F28:12.04 BARBITURATES


PHENOBARBITAL

28:12.04 BARBITURATES -------------------------------------------------------------------

100MG

0017882 PHENOBARBITAL 0.2 Y Y Y YPMS /TB

15MG


30MG


5MG/ML

0064557 PHENOBARBITAL ELIXIR 0.12 Y Y Y YPMS /ML

60MG


PHENOBARBITAL

120MG/ML

0230409 PHENOBARBITAL SODIUM INJ 13 N N N YSDZ /ML

PRIMIDONE

125MG

0039931 APO-PRIMIDONE 0.06 Y Y N YAPX /TB

250MG

0039676 APO-PRIMIDONE 0.09 Y Y N YAPX /TB

28:12.08 BENZODIAZEPINES ----------------------------------------------------------------

CLOBAZAM

10MG

0223833 NOVO-CLOBAZAM 0.22 Y Y N YNOP /TB

0224447 PMS-CLOBAZAM 0.22 Y Y N YPMS /TB

0224463 APO-CLOBAZAM 0.22 Y Y Y YAPX /TB

0222179 FRISIUM 0.4393 Y Y N YHLR /TB

CLONAZEPAM

0.25MG

0217966 PMS-CLONAZEPAM 0.08 Y Y N YPMS /TB

0.5MG

0223036 CLONAPAM 0.1166 Y Y N YICN /TB

0217788 APO-CLONAZEPAM 0.05 Y Y N YAPX /TB

0220781 PMS-CLONAZEPAM-R 0.05 Y Y N YPMS /TB

0223095 GEN-CLONAZEPAM 0.05 Y Y N YGPM /TB

0223396 SANDOZ-CLONAZEPAM 0.05 Y Y N YSDZ /TB

0227064 CO-CLONAZEPAM 0.05 Y Y N YCOB /TB

0223902 NOVO-CLONAZEPAM 0.05 Y Y N YNOP /TB


0210365 RATIO-CLONAZEPAM 0.1166 Y Y N YRTP /TB

0038282 RIVOTRIL 0.2 Y Y N YHLR /TB



120

PHRM/CHRN/CDO/F28:12.08 BENZODIAZEPINES (continued)


CLONAZEPAM (continued)

1MG



0214523 CLONAZEPAM 0.186 Y Y N YPHL /TB



2MG

0038284 RIVOTRIL 0.35 Y Y N YHLR /TB


0223902 NOVO-CLONAZEPAM 0.09 Y Y N YNOP /TB

0210373 RATIO-CLONAZEPAM 0.201 Y Y N YRTP /TB



0217789 APO-CLONAZEPAM 0.09 Y Y N YAPX /TB

0223095 GEN-CLONAZEPAM 0.09 Y Y N YGPM /TB


NITRAZEPAM

10MG

0224523 APO-NITRAZEPAM 0.05 Y Y N YAPX /TB

0223400 SANDOZ-NITRAZEPAM 0.05 Y Y N YSDZ /TB

0222965 NITRAZADON 0.11 Y Y N YICN /TB

0051153 MOGADON 0.23 Y Y N YICN /TB

5MG

0224523 APO-NITRAZEPAM 0.04 Y Y N YAPX /TB

0223400 SANDOZ-NITRAZEPAM 0.04 Y Y N YSDZ /TB

0222965 NITRAZADON 0.07 Y Y N YICN /TB

0051152 MOGADON 0.15 Y Y N YICN /TB

28:12.12 HYDANTOINS ---------------------------------------------------------------------

LEVOCARNITINE

100MG/ML

0214433 CARNITOR ORAL SOLN 0.4 N E N YSIG /ML

330MG

0214432 CARNITOR 330MG TAB 1.31 N E N YSIG /TB

PHENYTOIN

100MG

0002278 DILANTIN 0.08 Y Y N YPFI /CP

25MG/ML

0225089 TARO-PHENYTOIN ORAL SUSP 0.03 Y Y N YTAR /ML

0002345 DILANTIN ORAL SUSP 0.05 Y Y N YPFI /ML

30MG

0002277 DILANTIN 0.05 Y Y N YPFI /CP



121

PHRM/CHRN/CDO/F28:12.12 HYDANTOINS (continued)


PHENYTOIN (continued)

50MG

0002369 DILANTIN 0.07 Y Y N YPFI /TB

6MG/ML

0002344 DILANTIN ORAL SUSP 0.04 Y Y N YPFI /ML

28:12.20 SUCCINIMIDES -------------------------------------------------------------------

ETHOSUXIMIDE

250MG

0002279 ZARONTIN 0.34 Y Y N YPFI /CP

50MG/ML

0002348 ZARONTIN ORAL SYRUP 0.06 Y Y N YPFI /ML

METHSUXIMIDE

300MG

0002280 CELONTIN 1.08 Y Y N YPFI /CP

28:12.92 MISCELLANEOUS ANTICONVULSANTS --------------------------------------------------

CARBAMAZEPINE

100MG CH

0224440 TARO-CARBAMAZEPINE CHEWTAB 0.12 Y Y N YTAR /TB

0223154 PMS-CARBAMAZEPINE CHEWTAB 0.038 Y Y N YPMS /TB

0036981 TEGRETOL CHEW TAB 0.18 Y Y N YNVR /TB

20MG/ML

0219433 TEGRETOL ORAL SUSP 0.09 Y Y N YNVR /ML

200MG

0040269 APO-CARBAMAZEPINE 0.15 Y Y N YAPX /TB

0240751 TARO-CARBAMAZEPINE 0.15 Y Y N YTAR /TB

0001040 TEGRETOL 0.43 Y Y N YNVR /TB

0078271 NOVO-CARBAMAZ 0.23 Y Y N YNOP /TB

200MG CH

0223154 PMS-CARBAMAZEPINE CHEWTAB 0.0749 Y Y N YPMS /TB

0066508 TEGRETOL CHEW TAB 0.36 Y Y N YNVR /TB

0224440 TARO-CARBAMAZEPINE CHEWTAB 0.24 Y Y N YTAR /TB

200MG CR

0077361 TEGRETOL CR 0.45 Y Y N YNVR /TB

0223790 TARO-CARBAMAZEPINE CR 0.1887 Y Y N YTAR /TB

0224188 GEN-CARBAMAZEPINE CR 0.09 Y Y N YGPM /TB

0223154 PMS-CARBAMAZEPINE CR 0.093 Y Y N YPMS /TB

0226183 SDZ-CARBAMAZEPINE CR 0.09 Y Y N YSDZ /TB



122

PHRM/CHRN/CDO/F28:12.92 MISCELLANEOUS ANTICONVULSANTS (continued)


CARBAMAZEPINE (continued)

400MG CR

0226184 SDZ-CARBAMAZEPINE CR 0.19 Y Y N YSDZ /TB

0075558 TEGRETOL CR 0.89 Y Y N YNVR /TB

0224188 GEN-CARBAMAZEPINE CR 0.19 Y Y N YGPM /TB

0223790 TARO-CARBAMAZEPINE CR 0.3775 Y Y N YTAR /TB

0223154 PMS-CARBAMAZEPINE CR 0.19 Y Y N YPMS /TB

DIVALPROEX SODIUM

125MG

0059641 EPIVAL EC 0.31 Y Y N YABB /TB

0226513 GEN-DIVALPROEX EC 0.1377 Y Y N YGPM /TB

0240049 DIVALPROEX 0.07 Y Y N YSAI /TB

0223970 NOVO-DIVALPROEX EC 0.07 Y Y N YNOP /TB

0223969 APO-DIVALPROEX EC 0.07 Y Y N YAPX /TB

250MG






500MG






ESLICARBAZEPINE

200MG

0242686 APTIOM 9.56 E E N YSUN /TB

400MG


600MG


800MG


GABAPENTIN



123



GABAPENTIN (continued)

100MG

0235324 SANIS-GABAPENTIN 0.07 Y Y N YSAN /CP

0225614 CO-GABAPENTIN 0.07 Y Y N YCOB /CP

0208426 NEURONTIN 0.43 Y Y N YPFI /CP

0224344 PMS-GABAPENTIN 0.07 Y Y N YPMS /CP

0224825 MYLAN-GABAPENTIN 0.07 Y Y N YMYL /CP

0224451 TEVA-GABAPENTIN 0.07 Y Y N YTVM /CP

0224430 APO-GABAPENTIN 0.07 Y Y N YAPX /CP

0231905 RAN-GABAPENTIN 0.07 Y Y N YRAN /CP

300MG









400MG









600MG

0225589 PMS-GABAPENTIN 0.33 Y Y N YPMS /TB

0224845 TEVA-GABAPENTIN 0.33 Y Y N YTVM /TB

0243128 GABAPENTIN 0.33 Y Y N YSAI /TB

0223971 NEURONTIN 1.86 Y Y N YPFI /TB

0228584 GD-GABAPENTIN 0.33 Y Y N YGDI /TB

0229335 APO-GABAPENTIN 0.33 Y Y N YAPX /TB



124



GABAPENTIN (continued)

800MG

0226092 RATIO-GABAPENTIN 1.7393 Y Y N YRAT /TB

0243129 GABAPENTIN 0.43 Y Y N YSAI /TB

0223971 NEURONTIN 2.49 Y Y N YPFI /TB

0228585 GD-GABAPENTIN 1.74 Y Y N YGDI /TB

0229336 APO-GABAPENTIN 0.43 Y Y N YAPX /TB

0224734 TEVA-GABAPENTIN 0.43 Y Y N YTVM /TB

0225590 PMS-GABAPENTIN 0.43 Y Y N YPMS /TB

LACOSAMIDE

100MG

0235762 VIMPAT 3.46 E E N YUCB /TB

150MG


200MG


50MG


LAMOTRIGINE

100MG

0224689 PMS-LAMOTRIGINE 0.37 Y Y N YPMS /TB

0214210 LAMICTAL 1.55 Y Y N YGSK /TB

0224823 TEVA-LAMOTRIGINE 0.37 Y Y N YNVO /TB

0226550 GEN-LAMOTRIGINE 0.37 Y Y N YGPM /TB

0234302 SANIS-LAMOTRIGINE 0.37 Y Y N YSAN /TB

0224520 APO-LAMOTRIGINE 0.37 Y Y N YAPX /TB

0224335 RATIO-LAMOTRIGINE 0.37 Y Y N YRPH /TB

150MG


0224696 RATIO-LAMOTRIGINE 0.55 Y Y N YRAT /TB



0224823 TEVA-LAMOTRIGINE 0.55 Y Y N YTVM /TB





125



LAMOTRIGINE (continued)

25MG

0224823 TEVA-LAMOTRIGINE 0.09 Y Y N YTVM /TB




0224335 RATIO-LAMOTRIGINE 0.09 Y Y N YRAT /TB



5MG

0224011 LAMICTAL CHEW TAB 0.17 Y Y N YGSK /TB

LEVETIRACETAM

250MG

0228592 APO-LEVETIRACETAM 0.45 Y Y N YAPX /TB

0239610 RAN-LEVETIRACETAM 0.4 Y Y N YRAN /TB

0227418 CO-LEVETIRACETAM 0.8 Y Y N YCOB /TB

0235334 SANIS-LEVETIRACETAM 0.8 Y Y N YSAN /TB

0224702 KEPPRA 1.76 Y Y N YUCB /TB

500MG

0237525 AURO-LEVETIRACETAM 0.98 Y Y N YAUR /TB

0229612 PMS-LEVETIRACETAM 0.54 Y Y N YPMS /TB






750MG






OXCARBAZEPINE

150 MG

0228429 APO-OXCARBAZEPINE 0.62 Y Y N YAPX /TB

0224206 TRILEPTAL 0.8278 Y Y N YNVR /TB

300 MG



60MG/ML

0224467 TRILEPTAL ORAL SUSP 0.331 E E N YNVR /ML



126



OXCARBAZEPINE (continued)

600 MG



PERAMPANEL

6MG

0240453 FYCOMPA 9.45 E E N YEIS /TB

8MG

0240454 FYCOMPA 9.45 E E N YEIS /TB

PREGABALIN

150MG

0235963 PMS-PREGABALIN 1.727 Y Y N YPMS /CP

0239284 RAN-PREGABALIN 1.73 Y Y N YRAN /CP

0239084 SANDOZ-PREGABALIN 1.727 Y Y N YSDZ /CP

0240295 CO-PREGABALIN 1.73 Y Y N YCOB /CP

0226845 LYRICA 2.302 Y Y N YPFI /CP

0239427 APO-PREGABALIN 1.73 Y Y N YAPX /CP

0242420 MINT-PREGABALIN 1.73 Y Y N YMNT /CP

0236017 GD-PREGABALIN 1.73 Y Y N YGDI /CP

0236120 TEVA-PREGABALIN 1.727 Y Y N YTVM /CP

0240556 PREGABALIN 1.73 Y Y N YSAI /CP

225MG








25MG

0236115 TEVA-PREGABALIN 0.617 Y Y N YTVM /AP












127



PREGABALIN (continued)

300MG










50MG











75MG











TOPIRAMATE



128



TOPIRAMATE (continued)

100MG

0243534 ACCEL-TOPIRAMATE 0.47 Y Y N YACC /TB

0224886 TEVA-TOPIRAMATE 0.59 Y Y N YTVM /TB

0223089 TOPAMAX 2.46 Y Y N YJAN /TB

0227963 APO-TOPIRAMATE 0.59 Y Y N YAPX /TB

0228777 CO-TOPIRAMATE 0.59 Y Y N YCOB /TB

0231565 MINT-TOPIRAMATE 0.59 Y Y N Ynull /TB

0234583 AURO-TOPIRAMATE 0.59 Y Y N YAUR /TB

0226337 GEN-TOPIRAMATE 0.59 Y Y N YGPM /TB

0226300 PMS-TOPIRAMATE 0.59 Y Y N YPMS /TB

0226006 SANDOZ TOPIRAMATE 0.59 Y Y N YSDZ /TB

0235686 SANIS-TOPIRAMATE 0.59 Y Y N YSAN /TB

15MG

0223990 TOPAMAX SPRINKLE CAP 1.2 E E N YJAN /CP

200MG









0231566 MINT-TOPIRAMATE 0.93 Y Y N YMNT /TB


25MG

0223990 TOPAMAX SPRINKLE CAP 1.26 E E N YJAN /CP







0231564 MINT-TOPIRAMATE 0.31 Y Y N YMNT /TB


0234580 AURO-TOPIRAMATE 0.31 Y Y N YAUR /TB



50MG




129



VALPROIC ACID

VALPROIC ACID

250MG

0044384 DEPAKENE 0.58 Y Y N YABB /CP

0223804 APO-VALPROIC 0.29 Y Y N YAPX /CP

0214004 RATIO-VALPROIC 0.29 Y Y N YRTP /CP

0223076 PMS-VALPROIC 0.29 Y Y N YPMS /CP

50MG/ML

0223680 PMS-VALPROIC ACID ORAL SYRUP 0.04 Y Y N YPMS /ML

0214006 RATIO-VALPROIC ORAL SYRUP 0.04 Y Y N YRTP /ML

0044383 DEPAKENE ORAL SYRUP 0.12 Y Y N YABB /ML

0223837 APO-VALPROIC ORAL SYRUP 0.06 Y Y N YAPX /ML

500MG

0221832 NOVO-VALPROIC EC 0.5197 Y Y N YNOP /CP

0222962 PMS-VALPROIC ACID E.C. 0.55 Y Y N YPMS /CP

VIGABATRIN

500MG

0206803 SABRIL SACHET 0.911 Y Y N YHLR /DS

0206581 SABRIL 0.911 Y Y N YHLR /TB

28:16.04 PSYCHOTHERAPEUTIC AGENTS (ANTIDEPRESSANTS) -------------------------------------

AMITRIPTYLINE

10MG

0232604 TEVA-AMITRIPTYLINE 0.07 Y Y Y YTVM /TB

0033505 ELAVIL (AA) AMITRIPTYLINE 0.066 Y Y Y YAA /TB

0065452 PMS-AMITRIPTYLINE TABLETS 0.07 Y Y Y YPMS /TB

0240313 APO-AMITRIPTYLINE 0.066 Y Y Y YAPX /TB

25MG




0065451 PMS-AMITRIPTYLINE TABLETS 0.12 Y Y Y YPMS /TB

50MG

0065450 PMS-AMITRIPTYLINE 0.23 Y Y Y YPMS /TB




75MG


0075412 ELAVIL 0.3634 Y Y Y YAA /TB



130

PHRM/CHRN/CDO/F28:16.04 PSYCHOTHERAPEUTIC AGENTS (ANTIDEPRESSANTS) (continued)


BUPROPION HYDROCHLORIDE

BUPROPION

100MG

0232537 PMS-BUPROPION SR 0.15 Y Y Y YPMS /TB

0239156 SANIS-BUPROPION SR 0.15 Y Y Y YSAI /TB

0227507 SANDOZ BUPROPION SR 0.15 Y Y Y YSDZ /TB

0228565 RATIO-BUPROPION SR 0.15 Y Y Y YRPH /TB

150MG

0227508 SANDOZ BUPROPION SR 0.23 Y Y Y YSDZ /TB

0228566 RATIO-BUPROPION SR 0.23 Y Y Y YRPH /TB

0223782 WELLBUTRIN SR 0.98 Y Y Y YBVL /TB

0239157 SANIS-BUPROPION 0.23 Y Y Y YSAI /TB

0231342 PMS-BUPROPION SR 0.23 Y Y Y YPMS /TB

0226023 NOVO-BUPROPION SR 0.504 Y Y Y YNOP /TB

150MG XL

0243965 ACT BUPROPION XL 0.29 Y Y Y YACT /TB

0238207 MYLAN-BUPROPION 0.4 Y Y Y Ynull /TB

0227509 WELLBUTRIN XL 0.57 Y Y Y YBVL /TB

300MG XL

0227510 WELLBUTRIN XL 1.13 Y Y Y Ynull /TB

0238208 MYLAN-BUPROPION 0.8 Y Y Y YMYL /TB

0243966 ACT BUPROPION XL 0.59 Y Y Y YACT /TB

CITALOPRAM

10MG

0231233 TEVA-CITALOPRAM 0.14 Y Y Y YTVM /TB

0237007 MINT-CITALOPRAM 0.14 Y Y Y YMNT /TB

0244571 CITALOPRAM 0.14 Y Y Y YSAI /TB

0235524 ACCEL-CITALOPRAM TABLETS 0.14 Y Y Y YACC /TB


0227060 PMS-CITALOPRAM 0.14 Y Y Y YPMS /TB



131



CITALOPRAM (continued)

20MG

0223960 CELEXA 1.37 Y Y Y YLUD /TB



0224659 MYLAN-CITALOPRAM 0.24 Y Y Y YMYL /TB

0224605 APO-CITALOPRAM 0.24 Y Y Y YAPX /TB

0224817 SDZ-CITALOPRAM 0.24 Y Y Y YSDZ /TB

0224805 CO CITALOPRAM 0.24 Y Y Y YCOB /TB


0228562 RAN-CITALO 0.24 Y Y Y YRAN /TB


0235525 ACCEL-CITALOPRAM 0.23 Y Y Y YACC /TB

0235366 SANIS-CITALOPRAM 0.24 Y Y Y YSAN /TB

30MG

0229615 CTP 30 0.88 Y Y Y YSEP

/TB

40MG

0235367 SANIS-CITALOPRAM 0.24 Y Y Y YSAN /TB

0224659 MYLAN-CITALOPRAM 0.24 Y Y Y YMYL /TB


0235526 ACCEL-CITALOPRAM 0.23 Y Y Y YACC /TB

0224605 APO-CITALOPRAM 0.24 Y Y Y YAPX /TB

0228563 RAN-CITALO 0.24 Y Y Y YRAN /TB


0224817 SDZ-CITALOPRAM 0.24 Y Y Y YSDZ /TB



0224805 CO CITALOPRAM 0.24 Y Y Y YCOB /TB

0223960 CELEXA 1.37 Y Y Y YLUD /TB

CLOMIPRAMINE HCL

10MG

0033056 ANAFRANIL 0.29 Y Y Y YNVR /TB

0204078 APO-CLOMIPRAMINE 0.13 Y Y Y YAPX /TB

0224481 CO-CLOMIPRAMINE 0.13 Y Y Y YCOB /TB

25MG




50MG






132



DESIPRAMINE HCL

DESIPRAMINE HCL

10MG

0221624 APO-DESIPRAMINE 0.3804 Y Y Y YAPX /TB

0194625 PMS-DESIPRAMINE 0.1905 Y Y Y YPMS /TB

100MG


25MG



50MG



75MG



DOXEPIN HCL

10MG

0204999 APO-DOXEPIN 0.25 Y Y Y YAPX /CP

0002432 SINEQUAN 0.08 Y Y Y YPFI /CP

100MG


0191346 NOVO-DOXEPIN 0.345 Y Y Y YNOP /CP


150MG


25MG




50MG




75MG




DULOXETINE



133



DULOXETINE (continued)

30MG

0230148 CYMBALTA 1.93 Y Y N YLIL /CP

0243994 SANDOZ DULOXETINE 0.48 Y Y N YSDZ /CP

0244042 APO-DULOXETINE 0.48 Y Y N YAPX /CP

0243664 AURO-DULOXETINE 0.48 Y Y N YAUR /CP

0243898 MINT-DULOXETINE 0.48 Y Y N YMNT /CP

60MG

0243995 SANDOZ DULOXETINE 0.98 Y Y N YSDZ /CP


0230149 CYMBALTA 3.86 Y Y N YLIL /CP

0244043 APO-DULOXETINE 0.98 Y Y N YAPX /CP

0243665 AURO-DULOXETINE 0.98 Y Y N YAUR /CP

ESCITALOPRAM

10MG

0226323 CIPRALEX 1.73 Y Y N YLUN /TB

0229501 APO-ESCITALOPRAM 0.43 Y Y N YAPX /TB

0240741 MINT-ESCITALOPRAM 0.43 Y Y N YMNT /TB

0243011 ESCITALOPRAM 0.43 Y Y N YSAN /TB

0242978 JAMP-ESCITALOPRAM 0.43 Y Y N YJAM /TB

0236407 SANDOZ ESCITALOPRAM 0.43 Y Y N YSDZ /TB

0238548 RAN-ESCITALOPRAM 0.35 Y Y N YRAN /TB

0231356 CO ESCITALOPRAM 0.43 Y Y Y YCOB /TB

0230946 MYLAN-ESCITALOPRAM 0.43 Y Y N YMYL /TB

0230394 PMS-ESCITALOPRAM 0.43 Y Y N YPMS /TB

0231818 TEVA-ESCITALOPRAM 0.43 Y Y N YTEV /TB

20MG

0229502 APO-ESCITALOPRAM 0.46 Y Y N YAPX /TB

0240743 MINT-ESCITALOPRAM 0.46 Y Y N YMNT /TB

0231358 CO ESCITALOPRAM 0.46 Y Y N YCOB /TB

0236408 SANDOZ ESCITALOPRAM 0.46 Y Y N Ynull /TB

0230947 MYLAN-ESCITALOPRAM 0.46 Y Y N YMYL /TB

0226325 CIPRALEX 1.84 Y Y N YLUN /TB

0230396 PMS-ESCITALOPRAM 0.46 Y Y N YPMS /TB

0238550 RAN-ESCITALOPRAM 0.37 Y Y N YRAN /TB

0231820 TEVA-ESCITALOPRAM 0.46 Y Y N YTEV /TB

0243012 ESCITALOPRAM 0.46 Y Y N YSAN /TB

0242979 JAMP-ESCITALOPRAM 0.46 Y Y N YJAM /TB

FLUOXETINE



134



FLUOXETINE (continued)

10MG

0240039 ACCEL-FLUOXETINE 0.37 Y Y Y YACC /CP

0217757 PMS-FLUOXETINE 0.46 Y Y Y YPMS /CP

0224348 SDZ-FLUOXETINE 0.87 Y Y Y YSDZ /CP

0224217 CO FLUOXETINE 0.46 Y Y Y YCOB /CP

0201898 PROZAC 1.85 Y Y Y YLIL /CP

0221658 TEVA-FLUOXETINE 0.46 Y Y Y YTVM /CP

0223781 GEN-FLUOXETINE 0.46 Y Y Y YGPM /CP

0224137 RATIO-FLUOXETINE 0.46 Y Y Y YRTP /CP

0221635 APO-FLUOXETINE 0.46 Y Y Y YAPX /CP

0238056 MINT-FLUOXETINE 0.46 Y Y Y YMNT /CP

0228606 SANIS-FLUOXETINE 0.46 Y Y Y YSAN /CP

20MG

0217758 PMS-FLUOXETINE 0.46 Y Y Y YPMS /CP

0221659 TEVA-FLUOXETINE 0.46 Y Y Y YTVM /CP

0221636 APO-FLUOXETINE 0.46 Y Y Y YAPX /CP

0223781 GEN-FLUOXETINE 0.46 Y Y Y YGPM /CP

0063662 PROZAC 1.85 Y Y Y YLIL /CP

0224348 SDZ-FLUOXETINE 0.46 Y Y Y YSDZ /CP

0238057 MINT-FLUOXETINE 0.46 Y Y Y YMNT /CP

0228607 SANIS-FLUOXETINE 0.46 Y Y Y YSAN /CP

0224137 RATIO-FLUOXETINE 0.46 Y Y Y YRTP /CP

0224217 CO FLUOXETINE 0.46 Y Y Y YCOB /CP

0240040 ACCEL-FLUOXETINE 0.37 Y Y Y YACC /CP

4MG/ML

0223132 APO-FLUOXETINE ORAL SOLN 0.59 Y Y Y YAPX /ML

FLUVOXAMINE MALEATE

100MG

0223133 APO-FLUVOXAMINE 0.38 Y Y Y YAPX /TB

0191936 LUVOX 1.61 Y Y Y YSLV /TB

0224068 PMS-FLUVOXAMINE 0.605 Y Y Y YPMS /TB

0225553 CO-FLUVOXAMINE 0.38 Y Y Y YCOB /TB

0223995 NOVO-FLUVOXAMINE 0.55 Y Y Y YNOP /TB

0224705 SANDOZ FLUVOXAMINE 0.38 Y Y Y YSDZ /TB

0221846 RATIO-FLUVOXAMINE 0.38 Y Y Y YRTP /TB



135



FLUVOXAMINE MALEATE (continued)

50MG

0224068 PMS-FLUVOXAMINE 0.337 Y Y Y YPMS /TB

0223995 NOVO-FLUVOXAMINE 0.21 Y Y Y YNOP /TB

0221845 RATIO-FLUVOXAMINE 0.21 Y Y Y YRTP /TB

0191934 LUVOX 0.9 Y Y Y YSLV /TB

0225552 CO-FLUVOXAMINE 0.21 Y Y Y YCOB /TB

0223132 APO-FLUVOXAMINE 0.21 Y Y Y YAPX /TB

IMIPRAMINE

10MG

0036020 APO-IMIPRAMINE 0.14 Y Y Y YAPX /TB

25MG


50MG


75MG


L-TRYPTOPHAN

1000MG

0065453 TRYPTAN 1.54 Y Y N YICN /TB

0223020 TRYPTOPHAN 0.858 Y Y N YPMS /TB

MAPROTILINE

25MG

0215861 NOVO-MAPROTILINE 0.6 Y Y Y YNOP /TB

50MG


75MG


MIRTAZAPINE

15MG

0227394 PMS-MIRTAZAPINE 0.1 Y Y N YPMS /TB

0228661 APO-MIRTAZAPINE 0.38 Y Y N YAPX /TB

0225609 GEN-MIRTAZAPINE 0.1 Y Y N YGPM /TB

0241169 AURO-MIRTAZAPINE 0.38 Y Y N YAUR /TB

0225059 SANDOZ-MIRTAZAPINE 0.38 Y Y N YSDZ /TB

15 MG ODT

0224854 REMERON RD 0.44 Y Y N YORG /TB

0227989 NOVO-MIRTAZAPINE OD 0.27 Y Y N YNOP /TB



136



MIRTAZAPINE (continued)

30MG

0224391 REMERON 1.51 Y Y N YORG /TB

0227092 RATIO-MIRTAZAPINE 0.69 Y Y N YRPH /TB

0237068 SANIS-MIRTAZAPINE 0.2 Y Y N YSAI /TB


0225060 SANDOZ-MIRTAZAPINE 0.2 Y Y N YSDZ /TB

0224876 PMS-MIRTAZAPINE 0.2 Y Y N YPMS /TB


0225935 NOVO-MIRTAZAPINE 0.2 Y Y N YNOP /TB


30 MG ODT

0227990 NOVO-MIRTAZAPIINE OD 0.55 Y Y N YNOP /TB

0229982 AURO-MIRTAZAPINE OD 0.55 Y Y N YAUR /TB


45MG




45 MG ODT

0227991 NOVO-MIRTAZAPINE OD 0.82 Y Y N YNOP /TB


MOCLOBEMIDE

100MG

0223214 APO-MOCLOBEMIDE 0.25 Y Y Y YAPX /TB

150MG

0223974 NOVO-MOCLOBEMIDE 0.31 Y Y Y YNOP /TB


0089935 MANERIX 0.64 Y Y Y YHLR /TB

300MG


0216674 MANERIX 1.26 Y Y Y YHLR /TB

0223974 NOVO-MOCLOBEMIDE 0.61 Y Y Y YNOP /TB

NORTRIPTYLINE

10MG

0217769 PMS-NORTRIPTYLINE 0.05 Y Y Y YPMS /CP

0001522 AVENTYL 0.25 Y Y Y YMM /CP

0223178 NOVO-NORTRIPTYLINE 0.05 Y Y Y YNOP /CP

0223036 NORVENTYL 0.126 Y Y Y YVAL /CP

0222351 APO-NORTRIPTYLINE 0.05 Y Y Y YAPX /CP



137



NORTRIPTYLINE (continued)

25MG

0001523 AVENTYL 0.51 Y Y Y YMM /CP

0223178 NOVO-NORTRIPTYLINE 0.1 Y Y Y YNOP /CP

0222353 APO-NORTRIPTYLINE 0.1 Y Y Y YAPX /CP

0223036 NORVENTYL 0.2547 Y Y Y YVAL /CP

0217770 PMS-NORTRIPTYLINE 0.1 Y Y Y YPMS /CP

PAROXETINE

10MG

0224781 RATIO-PAROXETINE 1.043 Y Y Y YRPH /TB

0226274 CO PAROXETINE 1.04 Y Y Y YCOB /TB

0224775 PMS-PAROXETINE 1.043 Y Y Y YPMS /TB

0224855 TEVA-PAROXETINE 1.04 Y Y Y YTEV /TB

0202788 PAXIL 1.692 Y Y Y YGSK /TB

0224090 APO-PAROXETINE 1.043 Y Y Y YAPX /TB

0228284 SANIS-PAROXETINE 1.043 Y Y Y YSAN /TB

0224801 GEN-PAROXETINE 1.043 Y Y Y YGPM /TB

20MG





0224855 NOVO-PAROXETINE 0.45 Y Y Y YNOP /TB




30MG




0242139 MINT-PAROXETINE 0.48 Y Y Y YMNT /TB

0224855 NOVO-PAROXETINE 0.48 Y Y Y YNOP /TB





PHENELZINE SO4

15MG

0047655 NARDIL 0.38 Y Y Y YPFI /TB



138



SERTRALINE HYDROCHLORIDE

SERTRALINE

100MG

0224252 MYLAN-SERTRALINE 0.42 Y Y Y YMYL /CP

0224484 PMS-SERTRALINE 0.42 Y Y Y YPMS /CP

0224578 RATIO-SERTRALINE 1.1025 Y Y Y YRPH /CP

0223828 APO-SERTRALINE 0.42 Y Y Y YAPX /CP

0224048 TEVA-SERTRALINE 0.42 Y Y Y YTVM /CP

0196277 ZOLOFT 1.79 Y Y Y YPFI /CP

0240240 MINT-SERTALINE 0.42 Y Y Y YMNT /CP

0235354 SANIS-SERTRALINE 0.42 Y Y Y YSAN /CP

0228741 CO-SERTRALINE 0.42 Y Y Y YCOB /CP

25MG









0240237 MINT-SERTRALINE 0.2 Y Y Y YMNT /CP

50MG


0240239 MINT-SERTRALINE 0.4 Y Y Y YMNT /CP








TRANYLCYPROMINE SO4

10MG

0191959 PARNATE 0.38 Y Y Y YGSK /TB

TRAZODONE



139



TRAZODONE (continued)

100MG

0214764 APO-TRAZODONE 0.1 Y Y Y YAPX /TB

0223168 GEN-TRAZODONE 0.13 Y Y Y YGPM /TB

0227735 RATIO TRAZODONE 0.3956 Y Y Y YRTP /TB

0234878 SANIS-TRAZODONE 0.1 Y Y Y YSAN /TB

0214427 TEVA-TRAZODONE 0.1 Y Y Y YTVM /TB

0223028 TRAZOREL 0.4 Y Y Y YICN /TB

0193723 PMS-TRAZODONE 0.1 Y Y Y YPMS /TB

150MG



0227736 RATIO-TRAZODONE 0.5812 Y Y Y YRTP /TB

0214765 APO-TRAZODONE D 0.15 Y Y Y YAPX /TB

50MG

0223168 GEN-TRAZODONE 0.06 Y Y Y YGPM /TB

0227734 RATIO-TRAZODONE 0.2214 Y Y Y YRTP /TB

0223028 TRAZOREL 0.2214 Y Y Y YICN /TB



0214763 APO-TRAZODONE 0.06 Y Y Y YAPX /TB


68.25MG


TRIMIPRAMINE

100MG

0074082 APO-TRIMIP 0.9273 Y Y Y YAPX /TB

12.5MG


25MG


50MG


75MG

0207098 APO-TRIMIP 0.73 Y Y Y YAPX /CP

TRYPTOPHAN

500MG

0071814 TRYPTAN 0.77 Y Y N YICN /CP

0224033 TEVA-TRYPTOPHAN 0.36 Y Y N YTVM /CP



140



VENLAFAXINE HYDROCHLORIDE

VENLAFAXINE

150MG

0227505 NOVO-VENLAFAXINE XR 0.35 Y Y Y YNOP /CP

0231029 MYLAN-VENLAFAXINE XR 0.35 Y Y Y YMYL /CP

0223728 EFFEXOR XR 1.98 Y Y Y YWYA /CP

0230433 CO-VENLAFAXINE XR 0.35 Y Y Y YCOB /CP

0227398 RATIO-VENLAFAXINE 0.35 Y Y Y YRTP /CP

0235474 SANIS-VENLAFAXINE XR 0.35 Y Y Y YSAN /CP

0227856 PMS-VENLAFAXINE XR 0.35 Y Y Y YPMS /CP

0233170 APO-VENLAFAXINE XR 0.35 Y Y Y YAPX /CP

0238009 RAN-VENLAFAXINE XR 0.35 Y Y Y YRAN /CP

0231033 SDZ-VENLAFAXINE XR 0.35 Y Y Y YPMS /CP

37.5MG





0231031 SDZ-VENLAFAXINE XR 0.16 Y Y Y YSDZ /CP

0227396 RATIO-VENLAFAXINE XR 0.1643 Y Y Y YRTP /CP



75MG


0231032 SDZ-VENLAFAXINE XR 0.33 Y Y Y YSDZ /CP





0227397 RATIO-VENLAFAXINE XR 0.33 Y Y Y YRTP /CP


VENLAFAXINE

75MG

0238008 RAN-VENLAFAXINE XR 0.33 Y Y Y YRAN /CP

28:16.08 PSYCHOTHERAPEUTIC AGENTS (ANTIPSYCHOTIC AGENTS) --------------------------------

ARIPIPRAZOLE

10MG

0232239 ABILIFY 3.87 E E N YBMY /TB

15MG


2MG




141

PHRM/CHRN/CDO/F28:16.08 PSYCHOTHERAPEUTIC AGENTS (ANTIPSYCHOTIC AGENTS) (continued)


ARIPIPRAZOLE (continued)

20MG


30MG


300MG

0242086 ABILIFY MAINTENA 456.18 E E N YOTS /EA

400MG

0242087 ABILIFY MAINTENA 456.18 E E N YOTS /EA

5MG


ASENAPINE

10MG

0237481 SAPHRIS 1.43 E E N YMSD /TB

5MG

0237480 SAPHRIS 1.43 E E N YMSD /TB

CHLORPROMAZINE

100MG

0023283 NOVO-CHLORPROMAZINE 0.68 Y Y N YNOP /TB

25MG


50MG


CLOZAPINE

100MG

0089474 CLOZARIL 3.78 Y Y N YNVR /TB

0224803 APO-CLOZAPINE 2.6446 Y Y N YAPX /TB

0224724 GEN-CLOZAPINE 2.6446 Y Y N YGPM /TB

25MG

0224724 GEN-CLOZAPINE 0.6594 Y Y N YGPM /TB

0224803 APO-CLOZAPINE 0.6594 Y Y N YAPX /TB

0089473 CLOZARIL 0.94 Y Y N YNVR /TB

50MG

0230500 GEN-CLOZAPINE 1.32 Y Y N YGEN /TB

FLUPENTHIXOL

100MG/ML

0215604 FLUANXOL DEPOT (2ML) INJ 35.93 Y Y N YLUD /ML

20MG/ML

0215603 FLUANXOL DEPOT (10ML) INJ 7.186 Y Y N YLUD /ML



142



FLUPENTHIXOL DIHYDROCHLORIDE

FLUPENTHIXOL

0.5MG

0215600 FLUANXOL 0.26 Y Y N YLUD /TB

3MG

0215601 FLUANXOL 0.55 Y Y N YLUD /TB

FLUPHENAZINE

100MG/ML

0075557 MODECATE CONC. (1ML) INJ 29.78 Y Y N YSQU /ML

0224192 PMS-FLUPHENAZINE (1ML) INJ 29.78 Y Y N YPMS /ML

25MG/ML

0223963 FLUPHENAXINE OMEGA 4.98 Y Y N YOME /ML

0209127 PMS-FLUPHENAZINE DECAN.5ML 4.632 Y Y N YPMS /ML

FLUPHENAZINE HCL

1MG

0040534 APO-FLUPHENAZINE 0.17 Y Y N YAPX /TB

2MG


5MG


0072635 PMS-FLUPHENAZINE HCL 0.17 Y Y N YPMS /TB

HALOPERIDOL

0.5MG

0036368 NOVO-PERIDOL 0.12 Y Y N YNOP /TB

0039679 APO-HALOPERIDOL 0.12 Y Y N YAPX /TB

1MG



10MG



2MG



2MG/ML

0075950 PMS-HALOPERIDOL ORAL SOLN 0.1073 Y Y N YPMS /ML

5MG



5MG/ML

0080865 HALOPERIDOL (1ML) INJ 4.83 Y Y N YSAB /ML

0236601 HALOPERIDOL (1ML) INJ 4.9 Y Y N YOMG /ML



143



HALOPERIDOL DECANOATE

HALOPERIDOL

100MG/ML

0213030 HALOPERIDOL LA (5ML) INJ 16.92 Y Y N YSAB /ML

50MG/ML

0213029 HALOPERIDOL LA (5ML) INJ 8.46 Y Y N YSAB /ML

LOXAPINE SUCCINATE

10MG

0223083 PMS-LOXAPINE 0.29 Y Y N YPMS /TB

25MG


5MG


50MG


50MG/ML

0216999 LOXAPAC IM INJ 9.46 Y Y N YWYA /ML

LURASIDONE HCL

120MG

0238778 LATUDA 4.08 E E N YSUN /TB

20MG


40MG


60MG


80MG


METHOTRIMEPRAZINE

2MG

0223840 APO-METHOPRAZINE 0.07 Y Y N YAPX /TB

25MG


25MG/ML

0192769 NOZINAN INJ 3.53 Y Y N YAVT /ML

5MG


50MG




144



OLANZAPINE

OLANZAPINE

10MG

0240309 RAN-OLANZAPINE 1.28 Y Y N YRAN /TB

0237284 SANIS-OLANZAPINE 1.28 Y Y N YSAI /TB

0228182 APO-OLANZAPINE 1.28 Y Y N YAPX /TB

0227674 NOVO-OLANZAPINE 1.28 Y Y N YNOP /TB

0222928 ZYPREXA 7.19 Y Y N YLIL /TB

0230317 PMS-OLANZAPINE 1.28 Y Y N YPMS /TB

0232568 ACT OLANZAPINE 1.28 Y Y N YACT /TB

10 MG ODT

0236062 APO-OLANZAPINE ODT 1.29 Y Y N YAPX /TB

10MG ODT

0232757 CO-OLANZAPINE ODT 1.29 Y Y N YCOB /TB

0224308 ZYPREXA ZYDIS 7.14 Y Y N YLIL /TB

0232135 TEVA-OLANZAPINE 1.29 Y Y N YTVM /TB



0232778 SDZ-OLANZAPINE ODT 1.29 Y Y N YSDZ /TB

15MG






15MG ODT

0232779 SDZ-OLANZAPINE ODT 1.93 Y Y N YSDZ /ODT






2.5MG







20MG

0235970 TEVA-OLANZAPINE 2.59 N Y N YTVM /TB




145



OLANZAPINE (continued)

20MG ODT






20MGODT

0241412 RAN-OLANZAPINE ODT 2.54 Y Y N YRAN /TB

5MG


0240307 RAN-OLANZAPINE 0.64 Y Y N YRAN /TB


0228180 APO-OLANZAPINE 0.64 Y Y N YAPO /TB




5 MG ODT


5MG ODT







7.5MG






PALIPERIDONE

100MG/ML

0235423 INVEGA SUSTENNA 476.87 E E N YJAN /EA

150MG/1.5ML


3MG

0230027 INVEGA 3.72 E E N YJAN /TB

50MG/0.5ML




146



PALIPERIDONE (continued)

6MG


75MG/0,75ML


9MG


PERICYAZINE

10MG

0192677 NEULEPTIL 0.41 Y Y N YAVT /CP

10MG/ML

0192675 NEULEPTIL ORAL DROPS 0.41 Y Y N YAVT /ML

20MG


5MG


PERPHENAZINE

16MG

0033509 APO-PERPHENAZINE 0.13 Y Y N YAPX /TB

2MG


4MG


8MG


PIMOZIDE

2MG

0031381 ORAP 0.3186 Y Y N YPHL /TB

0224543 APO-PIMOZIDE 0.309 Y Y N YAPX /TB

4MG

0031382 ORAP 0.48 Y Y N YPHL /TB

0224543 APO-PIMOZIDE 0.41 Y Y N YAPX /TB

PROCHLORPERAZINE

10MG

0078972 PROCHLORPERAZINE SUPP 1.38 Y Y Y YSDZ /SP

0075368 PMS-PROCHLORPERAZINE SUPP 0.83 Y Y Y YPMS /SP

0088643 APO-PROCHLORAZINE 0.2 Y Y Y YAPX /TB

0075363 PMS-PROCHLORPERAZINE 0.2 Y Y Y YPMS /TB

5MG

0075366 PMS-PROCHLORPERAZINE 0.166 Y Y Y YPMS /TB

0088644 APO-PROHCHLORAZINE 0.17 Y Y Y YAPX /TB



147



PROCHLORPERAZINE (continued)

5MG/ML

0078974 PROCHLORPERAZINE (2ML) INJ 13.06 Y Y Y YSAB /ML

QUETIAPINE

100MG

0235317 SANIS-QUETIAPINE 0.24 Y Y N YSAN /TB

0230781 MYLAN-QUETIAPINE 0.24 Y Y N YMYL /TB

0231171 RATIO-QUETIAPINE 0.24 Y Y N YRTP /TB

0231392 APO-QUETIAPINE 0.24 Y Y N YAPX /TB

0223695 SEROQUEL 1.39 Y Y N YAST /TB

0243801 MINT-QUETIAPINE 0.24 Y Y N YMNT /TB

0240035 ACCEL-QUETIAPINE 0.24 Y Y N YACC /TB

0231400 SDZ-QUETIAPINE 0.24 Y Y N YSDZ /TB

0228424 TEVA-QUETIAPINE 0.24 Y Y N YTVM /TB

0229657 PMS-QUETIAPINE 0.24 Y Y N YPMS /TB

0231609 CO-QUETIAPINE 0.23 Y Y N YCOB /TB

150MG XR

0239545 TEVA-QUETIAPINE XR 0.78 Y Y N YTVM /TB

0240769 SANDOX QUETIAPINE XRT 0.78 Y Y N YSDZ /TB

200MG




0228427 TEVA-QUETIAPINE 0.48 Y Y N YNOP /TB







200MG XR

0240770 SANDOZ QUETIAPINE XRT 1.05 Y Y N YSDZ /TB

0230019 SEROQUEL XR 2.62 Y Y N YAST /TB



148



QUETIAPINE (continued)

25MG










0243800 MINT-QUETIAPINE 0.09 Y Y N YMNT /TB


300MG











300MG XR

0230020 SEROQUEL XR 3.86 Y Y N YAST /TB


50MG XR


0239544 TEVA-QUETIAPINE XR 0.4 Y Y N YTVM /TB

RISPERIDONE

0.25MG

0235688 SANIS-RISPERIDONE 0.13 Y Y N YSAN /TB

0226475 RATIO-RISPERIDONE 0.2615 Y Y N YRTP /TB

0235979 MINT-RISPERIDON 0.13 Y Y N YMNT /TB

0232830 RBX-RISPERIDONE 0.13 Y Y N YRAN /TB

0225200 PMS-RISPERIDONE 0.13 Y Y N YPMS /TB

0228211 APO-RISPERIDONE 0.13 Y Y N YAPX /TB

0224055 RISPERDAL 0.25MG 0.58 Y Y N YJAN /TB

0228269 TEVA-RISPERIDONE 0.13 Y Y N YTVM /TB

0228258 CO RISPERIDONE 0.13 Y Y N YCOB /TB



149



RISPERIDONE (continued)

0.5MG








0224055 RISPERDAL 0.5MG 0.96 Y Y N YJAN /TB


0.5 MG ODT

0241348 MYLAN-RISPERIDONE ODT 0.56 Y Y N YMNT /TB

0224770 RISPERDAL M-TAB 0.75 Y Y N YJAN /TB

1MG


0202528 RISPERDAL 1.33 Y Y N YJAN /TB

0228226 MYLAN-RISPERIDONE 0.29 Y Y N YMYL /TB

0235954 JAMP-RISPERIDONE 0.29 Y Y N YJPC

/TB

0235981 MINT-RISPERIDONE 0.29 Y Y N YMNT /TB







1MG/ML

0227926 PMS-RISPERIDONE ORAL SOLN 0.71 Y Y N YPMS /ML

0223695 RISPERDAL ORAL SOLN 1.42 Y Y N YJAN /ML

1 MG ODT

0229178 PMS-RISPERIDONE ODT 0.52 Y Y N YPMS /TB


0241349 MYLAN-RISPERIDONE ODT 0.52 Y Y N YMYL /TB



150




2MG


0235955 JAMP-RISPERIDONE 0.58 Y Y N YJPC

/TB









2 MG ODT



0241350 MYLAN-RISPERIDONE ODT 1.02 Y Y N YMYL /null

25MG

0225570 RISPERDAL CONSTA INJ 161.09 E E N YJOI /KT

3 MG







3MG




3 MG ODT



0226808 RISPERDAL M 3.06 Y Y N YJAN /TB

37.5MG


4 MG








151




4MG




4 MG ODT


0226809 RISPERDAL M 4.09 Y Y N YJAN /TB

0237070 PMS-RISPERIDONE ODT 2.04 Y Y N YPMS /null

50MG


THIOTHIXENE

10MG

0002445 NAVANE 0.56 Y Y N YPFI /CP

2MG


5MG


TRIFLUOPERAZINE

1MG

0034553 APO-TRIFLUOPERAZINE 0.13 Y Y N YAPX /TB

10MG


2MG


5MG


ZIPRASIDONE

20MG

0229859 ZELDOX 1.8 Y Y N YPFI /CP

40MG


60MG


80MG


ZUCLOPENTHIXOL

50MG/ML

0223040 CLOPIXOL ACUPHASE (1ML)INJ 14.914 Y Y N YLUD /ML



152



ZUCLOPENTHIXOL DECANOATE

ZUCLOPENTHIXOL

200MG/ML

0223040 CLOPIXOL DEPOT (10ML) INJ 14.91 Y Y N YLUD /ML

ZUCLOPENTHIXOL

10MG

0223040 CLOPIXOL 0.4 Y Y N YLUD /TB

25MG

0223040 CLOPIXOL 0.99 Y Y N YLUD /TB

28:20.00 ANOREXIGENIC AGENTS & RESPIRATORY AND CEREBRAL STIMULANTS ----------------------

BUPROPION

150MG

0223844 ZYBAN SR 0.96 Y N Y YBVL /TB

DEXTROAMPHETAMINE

10MG

0192455 DEXEDRINE SPANSULE 0.96 E E N YGSK /CP

15MG

0192456 DEXEDRINE SPANSULE 1.18 E E N YGSK /CP

5MG

0244323 APO-DEXTROAMPHETAMINE 0.51 E E N YAPX /TB

0192451 DEXEDRINE 0.67 E E N YGSK /TB

METHYLPHENIDATE HCL

10MG

0058499 PMS-METHYLPHENIDATE 0.08 E E N YPMS /TB

0000560 RITALIN 0.4 E E N YNVR /TB

0224932 APO-METHYLPHENIDATE 0.08 E E N YAPX /TB

10 MG ER

0227716 BIPHENTIN 0.7 E E N YPFR /CP

15 MG ER


18MG ER

0224773 CONCERTA 2.1 E E N YJAN /TB

0231506 NOVO-METHYLPHENIDATE ER-C 1.43 E E N YNOP /TB

0241372 PMS-METHYLPHENIDATE ER 1.43 E E N YPMS /TB

20MG


0000561 RITALIN 0.71 E E N YNVR /TB


20 MG ER




153

PHRM/CHRN/CDO/F28:20.00 ANOREXIGENIC AGENTS & RESPIRATORY AND CEREBRAL STIMULANTS


METHYLPHENIDATE HCL (continued)

20MG SR

0063277 RITALIN SR 0.71 E E N YNVR /TB


0232031 SDZ-METHYLPHENIDATE 0.28 E E N YSDZ /TB

27MG ER




30 MG ER


36MG ER




40 MG ER


5MG



50 MG ER


54MG ER


0233037 APO-METHYLPHENIDATE ER 2.31 E E N YAPX /TB



60 MG ER


80 MG ER


MODAFINIL

100MG

0223966 ALERTEC 1.37 E E N YDPY /TB

0228539 APO-MODAFINIL 1 E E N YAPX /TB

28:20.04 AMPHETAMINES -------------------------------------------------------------------

LISDEXAMFETAMINE

10MG

0243960 VYVANSE 2.18 E E N YSCI /CP

30MG




154

PHRM/CHRN/CDO/F28:20.04 AMPHETAMINES (continued)


LISDEXAMFETAMINE DIMESYLATE (continued)

40MG


50MG


60MG


LISDEXAMFETAMINE

20MG


28:24.08 BENZODIAZEPINES ----------------------------------------------------------------

ALPRAZOLAM

0.25MG

0054835 XANAX 0.249 Y N Y YPHU /TB

0234919 SANIS-ALPRAZOLAM 0.061 Y N Y YSAN /TB

0213753 MYLAN-ALPRAZOLAM 0.061 Y N Y YMYL /TB

0191348 TEVA-ALPRAZOL 0.061 Y N Y YTVM /TB

0086539 APO-ALPRAZ 0.061 Y N Y YAPX /TB

0.5MG

0191349 TEVA-ALPRAZOL 0.073 Y N Y YTVM /TB


0234920 SANIS-ALPRAZOLAM 0.073 Y N Y YSAN /TB



1MG




2MG

0224361 APO-ALPRAZ TS 0.55 Y N Y YAPX /TB


BROMAZEPAM

1.5MG

0217715 APO-BROMAZEPAM 0.1 Y N Y YAPX /TB

3MG

0051812 LECTOPAM 0.15 Y N Y YHLR /TB


0223058 NOVO-BROMAZEPAM 0.08 Y N Y YNOP /TB

6MG


0223058 NOVO-BROMAZEPAM 0.11 Y N Y YNOP /TB

0051813 LECTOPAM 0.23 Y N Y YHLR /TB



155



CHLORDIAZEPOXIDE

CHLORDIAZEPOXIDE

10MG

0052298 APO-CHLORDIAZEPOXIDE 0.107 Y N Y YAPX /CP

25MG


5MG


CLORAZEPATE

15MG

0086069 APO-CLORAZEPATE 0.39 Y N N YAPX /CP

0062821 NOVO-CLOPATE 0.3856 Y N N YNOP /CP

3.75MG



7.5MG



DIAZEPAM

1MG/ML

0089179 PMS-DIAZEPAM SOLUTION 1MG/ML 0.12 N N N YPMS /ML

10MG

0040533 APO-DIAZEPAM 0.09 Y N Y YAPX /TB

0224749 PMS-DIAZEPAM 0.09 Y N Y YPMS /TB

2MG



5MG

0001328 VALIUM 0.16 Y N Y YHLR /TB



5MG/ML

0238614 DIAZEPAM INJ SDZ 1.24 Y E N YSDZ /ML

0039972 DIAZEPAM INJ 1.24 Y E N YSAB /ML

0223816 DIASTAT 76.79 N Y N YN/A /SP

FLURAZEPAM HCL

15MG

0052169 APO-FLURAZEPAM 0.12 Y N Y YAPX /CP

30MG

0052170 APO-FLURAZEPAM 0.14 Y N Y YAPX /CP



156



LORAZEPAM

LORAZEPAM

0.5MG

0065574 APO-LORAZEPAM 0.04 Y N Y YAPX /TB

0235107 SANIS-LORAZEPAM 0.04 Y N Y YSAN /TB

0071110 TEVA-LORAZEPAM 0.04 Y N Y YTVM /TB

0204141 ATIVAN 0.04 Y N Y YWYA /TB

0.5MG SL

0241074 APO-LORAZEPAM SUBLINGUAL 0.0875 Y N Y YAPX /TB

0204145 ATIVAN SUBLINGUAL 0.11 Y N Y YWYA /TB

1MG


0072819 PMS-LORAZEPAM 0.04 Y N Y YPMS /TB


0063774 TEVALORAZEPAM 0.04 Y N Y YTVM /TB


1MG SL



2MG




0063775 TEVA-LORAZEPAM 0.07 Y N Y YTVM /TB

2MG SL



4MG/ML

0224327 LORAZEPAM INJ 21.2 Y E N YSAB /ML

OXAZEPAM

10MG

0040268 APO-OXAZEPAM 0.04 Y N Y YAPX /TB

15MG


30MG


TEMAZEPAM

15MG

0222596 APO-TEMAZEPAM 0.13 Y N Y YAPX /CP

0224481 CO TEMAZEPAM 0.04 Y N Y YCOB /CP

0060445 RESTORIL 0.2 Y N Y YNVR /CP

0223009 NOVO-TEMAZEPAM 0.04 Y N Y YNOP /CP



157



TEMAZEPAM (continued)

30MG

0222597 APO-TEMAZEPAM 0.16 Y N Y YAPX /CP

0060446 RESTORIL 0.24 Y N Y YNVR /CP

0223010 NOVO-TEMAZEPAM 0.05 Y N Y YNOP /CP

0224481 CO TEMAZEPAM 0.05 Y N Y YCOB /CP

TRIAZOLAM

0.125MG

0080856 APO-TRIAZO 1.5 Y N Y YAPX /TB

0.25MG

0080857 APO-TRIAZO 0.25 Y N Y YAPX /TB

ZOPICLONE

5MG

0224342 PMS-ZOPICLONE 0.18 Y N Y YPMS /TB

0224507 APO-ZOPICLONE 0.18 Y N Y YAPX /TB

0224653 RATIO-ZOPICLONE 0.18 Y N Y YRPH /TB

0221616 IMOVANE 1.06 Y N Y YAVT /TB

0239171 MINT-ZOPICLONE 0.18 Y N Y YMNT /TB

0234412 SANIS ZOPICLONE 0.18 Y N Y YSAN /TB

0225757 SANDOZ ZOPICLONE 0.18 Y N Y YSDZ /TB

0226791 RAN-ZOPICLONE 0.18 Y N Y YRAP /TB

0227193 CO ZOPICLONE 0.18 Y N Y YCOB /TB

7.5MG

0227195 CO ZOPICLONE 0.23 Y N Y YC0B /TB

0226792 RAN-ZOPICLONE 0.23 Y N Y YRAN /TB

0224248 RATIO-ZOPICLONE 0.23 Y N Y YRTP /TB

0192679 IMOVANE 1.34 Y N Y YAVT /TB

0224060 PMS-ZOPICLONE 0.23 Y N Y YPMS /TB

0228244 SANIS ZOPICLONE 0.23 Y N Y YSAN /TB

0239172 MINT-ZOPICLONE 0.23 Y N Y YMNT /TB

0238691 SEPTA-ZOPICLONE 0.23 Y N Y YWHL /TB

0221831 APO-ZOPICLONE 0.23 Y N Y YAPX /TB

0200820 RHOVANE 0.31 Y N Y YROP /TB

0223859 GEN-ZOPICLONE 0.31 Y N Y YGPM /TB

28:24.92 MISCELLANEOUS ANXIOLYTICS SEDATIVES AND HYPNOTICS ------------------------------

BUSPIRONE

10MG

0223094 PMS-BUSPIRONE 0.352 Y Y Y YPMS /TB

0223149 NOVO-BUSPIRONE 0.352 Y Y Y YNOP /TB

0221107 APO-BUSPIRONE 0.352 Y Y Y YAPX /TB



158

PHRM/CHRN/CDO/F28:24.92 MISCELLANEOUS ANXIOLYTICS SEDATIVES AND HYPNOTICS (continued)


CHLORAL HYDRATE

CHLORAL HYDRATE

100MG/ML

0079265 PMS-CHLORAL HYDRATE SYRUP 0.05 Y E Y YPMS /ML

HYDROXYZINE

10MG

0064605 APO-HYDROXYZINE 0.11 Y Y Y YAPX /CP

0073882 NOVO-HYDROXYZIN 0.11 Y Y Y YNOP /CP

2MG/ML

0002469 ATARAX ORAL SYRUP 0.05 Y Y Y YPFI /ML

0074181 PMS-HYDROXYZINE ORAL SYRUP 0.05 Y Y Y YPMS /ML

25MG



50MG



28:28.00 ANTIMANIC AGENTS ---------------------------------------------------------------

LITHIUM CARBONATE

150MG

0221613 PMS-LITHIUM CARBONATE 0.04 Y Y N YPMS /CP

0224283 APO-LITHIUM CARBONATE 0.07 Y Y N YAPX /CP

0046173 CARBOLITH 0.12 Y Y N YICN /CP

300MG

0224283 APO-LITHIUM CARBONATE 0.07 Y Y N YAPX /CP


0040677 LITHANE 0.1 Y Y N YPFI /CP


300MG SR

0226669 LITHMAX 0.25 Y Y N YAA /TB

600MG



28:36.16 DOPAMINE PRECURSORS ------------------------------------------------------------

CARBIDOPA/LEVODOPA

5MG/20MG/ML

0229216 DUODOPA 1.66 E E N YABV /ML

28:92.00 MISCELLANEOUS CENTRAL NERVOUS SYSTEM AGENTS ------------------------------------

ACAMPROSATE CALCIUM

333MG

0229326 CAMPRAL 0.8 Y E N YMYL /TB



159

PHRM/CHRN/CDO/F28:92.00 MISCELLANEOUS CENTRAL NERVOUS SYSTEM AGENTS


ATOMOXETINE

ATOMOXETINE

10MG

0226280 STRATTERA 2.69 E E N YLIL /CP

0231802 APO-ATOMOXETINE 2.314 E E N YAPX /CP

0231454 TEVA-ATOMOXETINE 2.69 E E N YTVM /CP

100MG


18MG




0238642 SANDOZ ATOMOXETINE 2.65 E E N YSDZ /CP

25MG



40MG





60MG





80MG

0231807 APO-ATOMOXETINE 4 E E N YAPX /CP

0238646 SANDOZ ATOMOXETINE 4 E E N YSDZ /CP

CARBIDOPA/ENTACAPO

18.75/200/75MG

0233782 STALEVO 1.68 Y Y N YNVR /TB

25/200/100MG

0230594 STALEVO (100) 1.68 Y Y N YNVR /TB

37.5/200/150MG

0230596 STALEVO (150) 1.68 Y Y N YNVR /TB

DIMETHYL FUMARATE

120MG

0240450 TECFIDERA 16.52 E E N YBGN /CP

240MG

0242020 TECFIDERA 33.03 E E N YBGN /CP



160

PHRM/CHRN/CDO/F28:92.00 MISCELLANEOUS CENTRAL NERVOUS SYSTEM AGENTS (continued)


ENTACAPONE

ENTACAPONE

200MG

0238000 SANDOZ-ENTACAPONE 0.4 Y Y N YSDZ /TB

0237555 TEVA-ENTACAPONE 0.4 Y Y N YTEV /TB

0224376 COMTAN 1.65 Y Y N YNVR /TB

LEVODOPA/BENZERAZID

100/25MG

0038646 PROLOPA 0.47 Y Y N YHLR /CP

200/50MG


50/12.5MG


LEVODOPA/CARBIDOPA

100/10MG

0035565 SINEMET 0.53 Y Y N YMSD /TB

0219593 APO-LEVOCARB 0.19 Y Y N YAPX /TB

0224449 NOVO-LEVOCARBIDOPA 0.19 Y Y N YNOP /TB

100/25MG




0242148 PMS-LEVOCARB CR 0.39 Y Y N YPMS /TB

0227287 APO-LEVOCARB CR 0.39 Y Y N YAPX /TB

100/25MG X

0202878 SINEMET CR 0.82 Y Y N YMSD /TB

200/50MG

0242149 PMS-LEVOCARB CR 0.71 Y Y N YPMS /TB

0224521 APO-LEVOCARB CR 0.71 Y Y N YAPX /TB

0087093 SINEMET CR 1.51 Y Y N YMSD /TB

250/25MG




PRAMIPEXOLE



161



PRAMIPEXOLE DIHYDROCHLORIDE (continued)

0.25MG

0229011 PMS-PRAMIPEXOLE 0.26 Y Y N YPMS /TB

0226930 NOVO-PRAMIPEXOLE 0.26 Y Y N YNOP /TB

0223714 MIRAPEX 1.08 Y Y N YBOE /TB

0237635 MYLAN-PRAMIPEXOLE 0.26 Y Y N YMYL /TB

0236760 PRAMIPEXOLE 0.26 Y Y N YSAI /TB

0231526 SANDOZ PRAMIPEXOLE 0.26 Y Y N YSDZ /TB

0229237 APO-PRAMIPEXOLE 0.26 Y Y N YAPX /TB

0229730 CO-PRAMIPEXOLE 0.26 Y Y N YCOB /TB

0.5MG

0237636 MYLAN-PRAMIPEXOLE 1.05 Y Y N YMYL /TB








1MG








1.5MG







RASAGILINE

1MG

0228465 AZILECT 7.21 E E N YTVM /TB

0240469 APO-RASAGILINE 6.13 E E N YAPX /TB

0241844 TEVA-RASAGILINE 6.13 E E N YTVM /TB



162



RILUZOLE

RILUZOLE

50MG

0224276 RILUTEK 10.05 E E N YAVT /TB

ROPINIROLE

0.25MG

0223256 REQUIP 0.29 Y Y N YGSK /TB

0235304 SANIS-ROPINIROLE 0.07 Y Y N YSAN /TB

0232659 PMS-ROPINIROLE 0.07 Y Y N YPMS /TB

0231684 CO-ROPINIROLE 0.07 Y Y N YCOB /TB

0231403 RAN-ROPINIROLE 0.07 Y Y N YRAN /TB

0.5MG


1MG






2MG






5MG






SELEGILINE HCL

5MG

0223810 PMS-SELEGILINE 1.265 Y Y N YPMS /TB

0206808 NOVO-SELEGILINE 0.5 Y Y N YNOP /TB

0223103 GEN-SELEGILINE 0.5 Y Y N YGPM /TB

0223064 APO-SELEGILINE 0.5 Y Y N YAPX /TB

28::0.4. null -------------------------------------------------------------------------------

KETAMINE HCL

10MG/ML

0224679 KETAMINE HCL INJ 1.65 Y N N YSDZ /ML



163

PHRM/CHRN/CDO/F28::0.4. null


KETAMINE HCL (continued)

50MG/ML

0224679 KETAMINE HCL INJ 4.95 Y N N YSDZ /ML

40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE

40:12.00 REPLACEMENT PREPARATIONS -------------------------------------------------------

MAGNESIUM

100MG/ML

0002669 ROUGIER MAGNESIUM ORAL SOLN 0.02 E E N YROU /ML

MAGNESIUM

500MG

0055512 MAGLUCATE 0.118 E N N NPMS /TB

MAGNESIUM OXIDE

420 MG

0029944 MAGNESIUM OXIDE (SWISS) 0.033 E N Y NSWI /TB

PHOSPHORUS

500MG

8002720 PHOSPHATE NOVARTIS EFFERV. 0.85 Y E N YNVR /TB

POTASSIUM CHLORIDE

1.3MMOL/ML

0223860 PMS-POTASSIUM CHL.ORAL SOLN 0.015 Y N N YPMS /ML

0191830 K-10 ORAL SOLN 0.016 Y N N YGSK /ML

100MG/ML

8002436 K10 ORAL SOLUTION 0.02 Y N N YGSK /ML

1500MG

8001300 JAMP-K-20 0.199 Y N N YJPC

/TB

2.1GM

0208599 K-LYTE S (OR.F) 0.555 Y N N YWEL /TB

20MMOL

0224226 EURO-K 0.2 Y N N YWHL /TB

0071337 K-DUR 0.21 Y N N YSCH /TB

8MMOL

0204230 MICRO-K EXTENCAPS 0.093 Y N N YWYA /CP

8001300 JAMP-K-8 0.089 Y N N YJAM /TB

0060288 APO-K 0.0899 Y N N YAPX /TB

8004022 SLOW-K 0.12 Y N N YNVR /TB

POTASSIUM CITRATE

1080MG

0224376 K-CITRA 0.29 Y N N NWHL /TB

SODIUM CHLORIDE



164

PHRM/CHRN/CDO/F40:12.00 REPLACEMENT PREPARATIONS (continued)

40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE (continued)

SODIUM CHLORIDE (continued)

0.9%

0215020 SODIUM CHLORIDE 0.9% INJ 3.25 Y N N NOME /ML

0205823 DEY-PAK INH SOLN (100X3ML ) 3.4 Y N N NDEY /ML

0003781 BACTERIOSTATIC NACI INJ 2.73 Y N N NABB /ML

0230434 SODIUM CHLORIDE INJ USP 0.9% 0.23 Y Y N NALV /ML

0006020 NORMAL SALINE IV BAG 500ML 1.86 Y N N YBAX /ML

0003779 SODIUM CHLORIDE 0.9% INJ 4.06 Y N N NABB /ML

SODIUM CHLORIDE NEBS

15M

0221597 SODIUM CHLORIDE NEBS 15M 0.25 Y Y N NWHL /ML

40:18.00 POTASSIUM-REMOVING RESINS ------------------------------------------------------

CALCIUM POLYSTYRENE

999MG/G

0201774 RESONIUM CALCIUM (CALC 0.36 Y N N YAVT /G

SOD POLYSTYRENE

250 MG/ML

0076954 SOLYSTAT 0.14 Y N N YPMS /ML

SODIUM POLYSTYRENE

1G/1MMOL K

0075533 PMS-SOD POLYSTYRENE SULF PDR 0.17 Y N N YPMS /GM

0202696 KAYEXALATE POWDER 0.19 Y N N YSAW /GM

40:28.00 DIURETICS ----------------------------------------------------------------------

BUMETANIDE

1MG

0072828 BURINEX 0.77 E E N YLEO /TB

CHLORTHALIDONE

100MG

0036028 APO-CHLORTHALIDONE 0.094 Y Y N YAPX /TB

50MG

0036027 APO-CHLORTHALIDONE 0.1242 Y Y N YAPX /TB

FUROSEMIDE

10MG/ML

0052703 FUROSEMIDE INJ 0.87 Y N N YSDZ /ML

0222472 LASIX ORAL SOLN 0.28 Y Y N YHLR /ML

20MG

0235142 SANIS-FUROSEMIDE 0.04 Y Y N YSAN /TB

0222469 LASIX 0.087 Y Y N YHLR /TB

0039678 APO-FUROSEMIDE 0.04 Y Y N YAPX /TB

0224749 PMS-FUROSEMIDE 0.04 Y Y N YPMS /TB

0033773 TEVA-FUROSEMIDE 0.04 Y Y N YTVM /TB



165

PHRM/CHRN/CDO/F40:28.00 DIURETICS (continued)


FUROSEMIDE (continued)

40MG




0222470 LASIX 0.131 Y Y N YHLR /TB

0224749 PMS-FUROSEMIDE 0.07 Y Y N YPMS /TB

500 MG

0222475 LASIX SPECIAL 3.09 E E N YAVT /TB

80MG




HYDROCHLOROTHIAZID

12.5MG

0232785 APO-HYDRO 0.034 Y Y Y YAPX /TB

0227408 PMS-HYDROCHLOROTHIAZIDE 0.034 Y Y Y YPMS /TB

25MG

0236059 SANIS-HYDROCHLOROTHIAZIDE 0.02 Y Y Y YSAN /TB

0002147 TEVA-HYDROCHLOROTHIAZIDE 0.02 Y Y Y YTVM /TB


0224738 PMS-HYDROCHLOROTHIAZIDE 0.04 Y Y Y YPMS /TB

50MG

0002148 TEVA-HYDROCHLOROTHIAZIDE 0.02 Y Y Y YTVM /TB

0236060 SANIS-HYDROCHLOROTHIAZIDE 0.02 Y Y Y YSAN /TB


INDAPAMIDE

1.25MG

0224006 GEN-INDAPAMIDE 0.0745 Y Y N YGPM /TB

0223961 PMS-INDAPAMIDE 0.0745 Y Y N YPMS /TB

0244582 INDAPAMIDE 0.0745 Y Y N YSAI /TB

0224524 APO-INDAPAMIDE 0.0745 Y Y N YAPX /TB

0217970 LOZIDE 0.3 Y Y N YSEV /TB

2.5MG

0244583 INDAPAMIDE 0.12 Y Y N YSAI /TB

0056496 LOZIDE 0.49 Y Y N YSEV /TB

0223118 NOVO-INDAPAMIDE 0.12 Y Y N YNOP /TB

0223962 PMS-INDAPAMIDE 0.12 Y Y N YPMS /TB

0222367 APO-INDAPAMIDE 0.12 Y Y N YAPX /TB

0215348 GEN-INDAPAMIDE 0.12 Y Y N YGPM /TB



166

PHRM/CHRN/CDO/F40:28.00 DIURETICS (continued)


METOLAZONE

METOLAZONE

2.5MG

0088840 ZAROXOLYN 0.2 Y Y N YAVT /TB

SPIRONOLAC/HYDROCH

25/25MG

0018040 ALDACTAZIDE-25 0.13 Y Y N YPHU /TB

0061323 NOVO-SPIROZINE 0.12 Y Y N YNOP /TB

50/50MG

0065718 NOVO-SPIROZINE 0.26 Y Y N YNOP /TB

0059437 ALDACTAZIDE-50 0.28 Y Y N YPHU /TB

40:28.10 POTASSIUM SPARING DIURETICS ----------------------------------------------------

AMILORIDE HCL

5MG

0224951 APO-AMILORIDE 0.2717 Y Y N YAPX /TB

AMILORIDE/HYDROCHL

5/50MG

0078440 APO-AMILZIDE 0.084 Y Y N YAPX /TB

0193721 NOVAMILOR 0.084 Y Y N YNOP /TB

SPIRONOLACTONE

100MG

0028545 ALDACTONE 0.31 Y Y Y YPHU /TB

0061322 NOVO-SPIROTON 0.28 Y Y Y YNOP /TB

25MG

0002860 ALDACTONE 0.13 Y Y Y YPHU /TB

0061321 NOVO-SPIROTON 0.12 Y Y Y YNOP /TB

40:40.00 URICOSURIC AGENTS --------------------------------------------------------------

SULFINPYRAZONE

200MG

0044176 APO-SULFINPYRAZONE 0.2997 Y Y N YAPX /TB

40::2.8. null -------------------------------------------------------------------------------

FUROSEMIDE

10MG/ML

0040163 FUROSEMIDE SPECIAL 0.87 Y N N YSDZ /ML

48:00 COUGH PREPARATIONS

48:02.00 null -------------------------------------------------------------------------------

NINTEDANIB

100MG

0244306 OFEV 27.18 E E N YBOE /CP

150MG

0244307 OFEV 54.36 E E N YBOE /CP



167

PHRM/CHRN/CDO/F48:08.00 ANTITUSSIVES

48:00 COUGH PREPARATIONS (continued)

CODEINE PHOSPHATE

48:08.00 ANTITUSSIVES -------------------------------------------------------------------

10MG/5ML

0216912 RATIO-COTRIDIN 0.05 Y N N YRTP /ML

0006859 COACTIFED SYRUP 0.16 Y N N YGSK /ML

0205340 RATIO-COTRIDIN EXPECTNT 0.06 Y N N YRTP /ML

CODEINE/GUAIFENES/PH

2MG COD/ML

0193474 ROBITUSSIN A-C SYR 0.0995 Y N N YWHI /ML

HYDROCODONE

5/10MG

0191696 TUSSIONEX SRT 1.63 Y N Y YRHO /TB

5/10MG/5ML

0191697 TUSSIONEX SRS 0.33 Y N Y YRHO /ML

5/20MG/5ML

0204948 NOVAHISTEX DH SYR 0.17 Y N Y YAVT /ML

48:14.12 null -------------------------------------------------------------------------------

IVACAFTOR

150MG

0239741 KALYDECO 420 E E N YVER /TB

48:24.00 MUCOLYTIC AGENTS ---------------------------------------------------------------

ACETYLCYSTEINE

200MG/ML

0230043 ACETYLCYSTEINE INJECTION 6.5 E N N YALV /ML

0224309 ACETYLCYSTEINE SOLN 6.5 E N N YSDZ /ML

0209152 MUCOMYST (30ML) SOLN 0.59 E N N YRBP /ML

DORNASE ALFA

1MG/ML

0204673 PULMOZYME (2.5ML) INH SOLN 37.99 E E N YHLR /ML

48:92.00 RESPIRATORY AGENTS, MISCELLANEOUS ----------------------------------------------

OMALIZUMAB

150MG/VL

0226056 XOLAIR 624.24 E N N YNVO /EA

52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS

52:04.04 ANTIBACTERIALS -----------------------------------------------------------------

CHLORAMPHENICOL

10MG/GM

0198056 PENTAMYCETIN OPHT OINT 1.497 Y N Y YSAB /GM

5MG/ML

0216405 PENTAMYCETIN OPHT SOLN 0.442 Y N Y YSAB /ML



168

PHRM/CHRN/CDO/F52:04.04 ANTIBACTERIALS (continued)

52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS (continued)

CHORAMPHENICOL/HC

CHORAMPHENICOL/HC

10MG/GM

0198058 PENTAMYCETIN/HC 2.829 Y N Y YSDZ /GM

ERYTHROMYCIN

5MG/GM

0232666 ERYTHROMYCIN OPH OINT 1.21 Y N Y YSTR /GM

0191275 PMS ERYTHROMYCIN OPH OINT 2.86 Y N Y YPMS /GM

0214157 DIOMYCIN OPHT OINT 1.1514 Y N Y YDIO /GM

GATIFLOXACIN

0.3%

0225727 ZYMAR OPHT SOLN 2.6 Y N N YALL /ML

GENTAMICIN SO4

.3%

0202377 DIOGENT OPHTHALMIC OINTMENT 1.2429 Y N Y YSDZ /GM

0223088 SAB-GENTAMICIN OPHT OINTMENT 1.1429 Y N Y YSAB /GM

0077652 PMS-GENTAMYCIN OPHTH SOLN 0.406 Y N Y YPMS /ML

0051219 GARAMYCIN OPHTHALMIC SOLN 0.406 Y N Y YSCH /ML

0051218 GARAMYCIN OTIC SOLN 1.032 Y N Y YSCH /ML

0202382 DIOGENT OPHTHALMIC SOLN 0.428 Y N Y YSDZ /ML

0223088 PMS-GENTAMICIN OTIC SOLN 1.032 Y N Y YPMS /ML

0222944 GENTAMICIN SO4 OTIC SOLN 1.032 Y N Y YSAB /ML

0222944 SANDOZ GENTAMICIN OPHT SOLN 0.406 Y N Y YSDZ /ML

MOXIFLOXACIN

0.5%

0240637 APO-MOXIFLOXACIN 3.76 Y N Y YAPX /ML

0240465 ACT MOXIFLOXACIN 3.98 Y N Y YACA /ML

0241152 SANDOZ MOXIFLOXACIN 3.76 Y N Y YSDZ /ML

0225226 VIGAMOX OPHT SOLN 4.35 Y N Y YALC /ML

POLYMIXIN

1MG/ML

0223923 SANDOZ POLYTRIMETHOPRIM 2.51 Y N Y Ynull /ML

POLYMYXIN

1MG/ML

0224036 PMS-POLYTRIMETHOPRIM OPHT 2.388 Y N Y YPMS /ML

0201195 POLYTRIM OPHTHALMIC SOLN 3.29 Y N Y YALL /ML

POLYMYXIN/NEOMYCIN/

/2.5MG/ML

0080743 OPTIMYXIN PLUS E/E SOLN 0.725 Y N Y YSAB /ML



169

PHRM/CHRN/CDO/F52:04.04 ANTIBACTERIALS (continued)


TOBRAMYCIN

TOBRAMYCIN

0.3%

0061425 TOBREX OPHTHALMIC OINT (4G) 2.511 Y N Y YALC /GM

0224175 SAB-TOBRAMYCIN OPHT SOLN 1.05 Y N Y YSAB /ML

0051396 TOBREX 5ML OPHTHALMIC SOLN 1.79 Y N Y YALC /ML

0223957 PMS-TOBRAMYCIN OPHT SOLN 0.656 Y N Y YPMS /ML

52:04.06 ANTI-INFECTIVES (ANTIVIRALS) ---------------------------------------------------

TRIFLURIDINE

1%

0068745 VIROPTIC OPHT SOLN 3.084 Y N Y YGSK /ML

0224852 SANDOZ TRIFLURIDINE OPHT SOLN 3.039 Y N Y YSDZ /ML

52:04.08 SULFONAMIDES -------------------------------------------------------------------

SULFACETAMIDE

10%

0002805 SODIUM SULAMYD OPHT SOLN 0.493 Y N Y YSCH /ML

0062296 DIOSULF OPHT SOLN 0.0789 Y N Y YAKN /ML

52:04.12 ANTI-INFECTIVES (MISCELLANEOUS) ------------------------------------------------

CIPROFLOXACIN

0.3%

0220086 CILOXAN OPHT OINTMENT 2.946 Y N Y YALC /GM

0226313 APO-CIPROFLOX OPHT SOLN 1.76 Y N Y YAPX /ML

0238713 SANDOZ CIPROFLOXACIN 1.86 Y N Y YSDZ /ML

0194527 CILOXAN OPHT SOLN 2.1 Y N Y YALC /ML

FUSIDIC ACID

10MG/GM

0224386 FUCITHALMIC VISCOUS DROPS 2.06 Y N Y YLEO /GM

OFLOXACIN

0.3%

0214329 OCUFLOX OPHT SOLN 2.5 Y N Y YALL /ML

0224839 APO-OFLOXACIN OPHT SOLN 1.47 Y N Y YAPX /ML

0225257 PMS-OFLOXACIN OPHT SOLN 0.978 Y N Y YPMS /ML

52:08.00 ANTI-INFLAMMATORY AGENTS -------------------------------------------------------

BECLOMETHASONE

50UG/DS

0217271 GEN-BECLO AQ. NASAL SPR 0.06 Y N Y YGPM /DS

0223879 APO-BECLOMETHASONE AQ.NASAL 0.06 Y N Y YAPX /DS

BUDESONIDE

100UG/DS

0203532 RHINOCORT TURBUHALER 0.12 Y N Y YAST /DS

0223064 GEN-BUDESONIDE AQ NASAL SPR 0.1 Y N Y YGPM /DS



170

PHRM/CHRN/CDO/F52:08.00 ANTI-INFLAMMATORY AGENTS (continued)


BUDESONIDE (continued)

64UG/DS

0223192 RHINOCORT AQUA NASAL SPR 0.089 Y N Y YAST /DS

0224100 GEN-BUDESONIDE NASAL SPR 0.084 Y N Y YGPM /DS

CIPROFLOXACIN/DEXAM

0.3%/0.1%

0225271 CIPRODEX OTIC SOLUTION 3.61 Y N Y YALC /ML

DEXAMETHASONE

0.1%

0004257 MAXIDEX OPHTH OINTMENT (4G) 2.73 Y E Y YALC /GM

0004256 MAXIDEX OPHTHALMIC SUSP 1.65 Y E Y YALC /ML

0202386 DIODEX E/E SOLN 0.712 Y E Y YAKN /ML

0078526 PMS-DEXAMETHASONE E/E SOLN 0.676 Y E Y YPMS /ML

0073983 DEXAMETHASONE E/E SOLN 1.38 Y E Y YSAB /ML

FLUNISOLIDE

0.025%

0223928 APO-FLUNISOLIDE NASAL SOLN 0.75 Y N Y YAPX /DS

0216268 RHINALAR NASAL SOLN 0.792 Y N Y YHLR /DS

FLUOROMEHTOLONE

0.1%

0043281 SANDOZ FLUOROMETHOLONE 1.788 Y N Y YSDZ /ML

FLUOROMETHOLONE

.25%

0070751 FML FORTE OPHT SUSP 2.76 Y E Y YALL /ML

0.1%

0223856 PMS-FLUOROMETHOLONE OPHT 1.79 Y N Y YPMS /ML

0024785 FML OPHTHALMIC SUSP 3.21 Y N Y YALL /ML

FLUOROMETHOLONE

0.1%

0075678 FLAREX OPHT SUSP 1.87 Y N Y YALC /ML

FLUTICASONE FUROATE

27.5UG/DS

0229858 AVAMYS 0.209 Y N Y YGCH /DS

FLUTICASONE

50UG/DS

0229607 RATIO- FLUTICASONE NASAL 0.18 Y N Y YRTP /DS

0221367 FLONASE AQ NASAL SPR 120DS 0.26 Y N Y YGSK /DS

0229474 APO-FLUTICASONE NASAL SPRAY 0.18 Y N Y YAPX /DS

FRAMYCETIN/GRAMICIDI

12.5MG/ML

0222486 SOFRAMYCIN E/E SOLN 2.7 Y N Y YERF /ML



171



FRAMYCETIN/GRAMICIDIN/DEXAMETH (continued)

5MG//ML

0222462 SOFRACORT E/E SOLN 1.91 Y N Y YAVT /ML

0224792 SANDOZ OPTICORT E/E SOLN 0.98 Y N Y YSDZ /ML

GENTAMICIN/BETAMETH

0.3%/0.1%

0058670 GARASONE OPHT OINT 2.8943 Y N Y YSCH /GM

0224499 SAB-PENTASONE E/E SOLN 1.2813 Y N Y YSAB /ML

0068221 GARASONE E/E SOLN 1.2813 Y N Y YSCH /ML

IODOCHLORHYDROXYQ

1%/0.02%

0007445 LOCACORTEN-VIOFORM OTIC 1.58 Y N Y YNVR /ML

KETOROLAC

0.5%

0224746 RATIO-KETOROLAC OPHT SOLN 1.6 Y N Y YRAT /ML

0196830 ACULAR OPHT SOLN 3.46 Y N Y YALL /ML

0224582 APO-KETOROLAC OPHT SOLN 2.6 Y N Y YAPO /ML

MOMETASONE FUROATE

50MCG/MD

0223846 NASONEX NASAL SPR 0.21 Y N Y YSCH /DS

0244981 SANDOZ MOMETASONE 0.11 Y N Y YSDZ /DS

0240358 APO-MOMETASONE FUROATE 0.15 Y N Y YAPX /DS

POLYMYX/NEOMYC/HYD

5/10MG/ML

0223038 SAB-CORTIMYXIN OTIC SOLN 1.14 Y N Y YSAB /ML

POLYMYX/NEOMYCIN/D

5MG/1MG/G

0035817 MAXITROL OPHT OINT 2.6543 Y N Y YALC /GM

5MG/1MG/ML

0004267 MAXITROL OPHT SOLN 2.04 Y N Y YALC /ML

PREDNISOLONE

0.12%

0029940 PRED MILD OPHTHALMIC SUSP 1.83 Y N Y YALL /ML

0191618 PREDNISOLONE OPHT SUSP 1.345 Y N Y YSAB /ML

1.0%

0030117 PRED FORTE OPHTHALMIC SUSP 5.288 Y E Y YALL /ML

0191620 PREDNISOLONE OPHT SUSP 1.94 Y E Y YSDZ /ML

0070040 RATIO-PREDNISOLONE OPHT SUSP 4.13 Y E Y YRTP /ML

PREDNISOLONE SODIUM

0.5%

0214849 PREDNISOLONE MINIMS 0.5% 2 E N N YCHA /EA



172



RIMEXOLONE

RIMEXOLONE

1%

0216369 VEXOL OPHTHALMIC SUSP 1% 3.56 Y N N YALC /ML

SULFACETAMIDE/PREDNI

0.2%;10%

0080778 BLEPHAMIDE OPHT SUSP 2.8 Y N Y YALL /ML

0.5%;10%

0202381 DIOPTIMYD OPHT SUSP 1.25 Y N Y YAKN /ML

100MG/2MG

0030724 BLEPHAMIDE S.O.P. OPH OINT 3.457 Y N Y YALL /GM

TOBRAMYCIN/DEXAMET

0.3%/0.1%

0077891 TOBRADEX (4GM) OPHT OINT 3.05 Y N Y YALC /GM

0077890 TOBRADEX OPHTHALMIC SUSP 2.09 Y N Y YALC /ML

TRIAMCINOLONE

55MCG/DS

0243763 APO-TRIAMCINOLONE AQ 0.17 Y N Y YAPX /DS

0221383 NASACORT AQ NASAL SPR 0.2 Y N Y YAVT /DS

52:08.08 CORTICOSTEROIDS ----------------------------------------------------------------

FLUTIASONE FUROATE

200MCG

0244658 ARNUITY ELLIPTA 2.54 Y Y Y YGSK /DS

FLUTICASONE FUROATE

100MCG

0244656 ARNUITY ELLIPTA 1.27 Y Y Y YGSK /DS

52:10.00 CARBONIC ANHYDRASE INHIBITORS --------------------------------------------------

ACETAZOLAMIDE

250MG

0054501 APO-ACETAZOLAMIDE 0.12 Y Y N YAPX /TB

BRINZOLAMIDE

1%

0223887 AZOPT OPHTHALMIC SUSP 3.37 Y Y N YALC /ML

DORZOLAMIDE HCL

2%

0231630 SANDOZ-DORZOLAMIDE OPHTH 3.16 Y Y N YSDZ /ML

0221620 TRUSOPT OPHT SOLN 4.09 Y Y N YMSD /ML

METHAZOLAMIDE

50MG

0224588 APO-METHAZOLAMIDE 0.48 Y Y N YAPX /TB



173

PHRM/CHRN/CDO/F52:20.00 MIOTICS


PILOCARPINE HCL

52:20.00 MIOTICS ------------------------------------------------------------------------

1%

0000084 ISOPTO CARPINE OPHT SOLN 0.22 Y Y Y YALC /ML

2%


0202374 DIOCARPINEOPHTHALMIC SOLN 0.204 Y Y Y YAKN /ML

4%

0202373 DIOCARPINE OPHTHALMIC SOLN 0.2327 Y Y Y YAKN /ML


52:24.00 MYDRIATICS ---------------------------------------------------------------------

ATROPINE SO4

1%

0003501 ISOPTO ATROPINE OPHT SOLN 0.64 Y N Y YALC /ML

CYCLOPENTOLATE HCL

1%

0025250 CYCLOGYL OPHTHALMIC DROPS 0.87 Y N Y YALC /ML

DIPIVEFRIN HCL

0.1%

0223786 PMS-DIPIVEFRIN OPHT SOLN 0.996 Y N Y YPMS /ML

HOMATROPINE

2%

0000077 ISOPTO HOMATROPINE OPHT SOLN 0.65 Y E Y YALC /ML

5%

0000078 ISOPTO HOMATROPINE OPHT SOLN 0.78 Y E Y YALC /ML

52:28.00 MOUTHWASHES AND GARGLES --------------------------------------------------------

BENZYDAMINE

0.15%

0222979 NOVO-BENZYDAMINE RINSE 0.029 Y E Y YNOP /ML

0222977 PHARIXIA 0.08 Y E Y YPMS /ML

0223904 APO-BENZYDAMINE RINSE 0.029 Y E Y YAPX /ML

0196606 TANTUM LIQ 0.133 Y E Y YMDA /ML

CHLORHEXIDINE

0.12%

0224043 PERICHLOR 0.0181 Y N Y YPMS /ML

0223745 PERIDEX ORAL RINSE 0.0218 Y N Y YZIL /ML

0238427 GUM PAROEX 0.015 Y N Y YSUN /ML

0220779 PERIOGARD 0.0164 Y N Y YCOL /ML

52:36.00 MISCELLANEOUS E.E.N.T. DRUGS ---------------------------------------------------



174

PHRM/CHRN/CDO/F52:36.00 MISCELLANEOUS E.E.N.T. DRUGS


APRACLONIDINE HCL

APRACLONIDINE HCL

0.5%

0207630 IOPIDINE OPHTHALMIC SOLN (5ML) 4.56 Y Y Y YALC /ML

1%

0088835 IOPIDINE OPHTHALMIC (12X0.1ML) 134.4 Y Y Y YALC /KT

BETAXOLOL HCL

0.25%

0190844 BETOPTIC S OPHTHALMIC SUSP 2.36 Y Y N YALC /ML

0.5%

0223597 SANDOZ BETAXOLOL 1X 1.822 Y Y N YSDZ /ML

BIMATOPROST

0.01%

0232499 LUMIGAN RC OPHTHALM SOLN 10.976 Y Y N YALL /ML

0.03%

0242906 VISTITAN 9.52 Y Y N YSDZ /ML

BRIMONIDINE TARTRATE

0.15%

0230133 APO-BRIMONIDINE P 2.43 Y Y N YAPX /ML

0224815 ALPHAGAN P OPHT SOLN 2.43 Y Y N YALL /ML

0.2%

0224628 PMS-BRIMONIDINE OPHT SOLN 1.16 Y Y N YPMS /ML

0226007 APO-BRIMONIDINE 1.16 Y Y N YAPX /ML

0224302 RATIO-BRIMONIDINE OPHT SOLN 3.44 Y Y N YRAT /ML

0223687 ALPHAGAN OPHTHALMIC SOLN 3.44 Y Y N YALL /ML

0230542 SANDOZ BRIMONIDINE 1.15 Y Y N YSDZ /ML

BRIMONIDINE

0.2%/0.5%

0224834 COMBIGAN OPHT SOLN 4.19 Y Y N YALL /ML

BRINZOLAMIDE/TIMOLO

1%/0.5%

0233162 AZARGA(1%/0.5%) 4.39 Y Y N YALC /ML

DICLOFENAC SODIUM

0.1%

0245480 SANDOZ DICLOFENAC OPHTHA 2.66 Y N Y YSDZ /ML

0194041 VOLTAREN OPTHA SOLN 2.58 Y N Y YNVO /ML

DORZOLAMIDE

20/5MG

0225869 COSOPT (2%/0.5%) OPHT SOLN (UD 0.51 E E N YMSD /EA

0229961 APO-DORZO-TIMOP OPT SOLN 1.99 Y Y N YAPX /ML

0234435 SANDOZ-DORZOLAMIDE/TIMOLOL 2.33 Y Y N YSDZ /ML

0224011 COSOPT (2%/0.5%) OPHT SOLN 6.35 Y Y N YMSD /ML



175

PHRM/CHRN/CDO/F52:36.00 MISCELLANEOUS E.E.N.T. DRUGS (continued)


DORZOLAMIDE HCL/TIMOLOL (continued)

20/5MG/ML

0232052 TEVA-DORZOLAMIDE/TIMOLOL 1.989 Y Y N YTVM /ML

DORZOLAMIDE/TIMOLO

20/5MG

0240438 CO DORZOTIMOLOL 2.33 Y Y N YCOB /ML

LATANOPROST

50MCG/ML

0236733 SANDOZ LATANOPROST 3.63 Y Y N YSDZ /ML

0223149 XALATAN OPHT SOLN 11.18 Y Y N YPMS /ML

0229652 APO-LATANOPROST 3.63 Y Y N YAPX /ML

0225478 CO-LATANOPROST 3.63 Y Y N YCOB /ML

LATANOPROST/TIMOLO

50MCG/5MG

0224661 XALACOM 12.65 Y Y N YPFI /ML

0239468 SANDOZ-LATANOPROST/TIMOLOL 4.428 Y Y N YSDZ /ML

0243625 ACT LATANOPROST/TIMOLOL 4.428 Y Y N YACT /null

LEVOBUNOLOL HCL

0.25%

0203115 RATIO-LEVOBUNOLOL OPHT SOLN 3.9 Y Y N YRTP /ML

0075128 BETAGAN OPHTHALMIC SOLN 2.127 Y Y N YALL /ML

0.5%

0203116 RATIO-LEVOBUNOLOL OPHT SOLN 1.15 Y Y N YRTP /ML

0063766 BETAGAN OPHTHALMIC SOLN 3.36 Y Y N YALL /ML

0223799 PMS-LEVOBUNOLOL OPHT SOLN 1.32 Y Y N YPMS /ML

LEVOCABASTINE

0.5MG/ML

0202001 LIVOSTIN SUS NASAL SPR 1.79 Y N Y YJAN /ML

LODOXAMIDE

0.1%

0089356 ALOMIDE OPHTHALMIC SOLN 1.12 Y N Y YALC /ML

NEPAFENAC

0.1%

0230898 NEVANAC OPHTHALMIC 3.99 Y N N YALC /ML

RANIBIZUMAB

10MG/ML

0229681 LUCENTIS INTRAVITREAL INJ 1575 E E N YNVO /VL

SODIUM

2%

0223139 APO-CROMOLYN NASAL MIST 0.5292 Y N Y YAPX /ML



176

PHRM/CHRN/CDO/F52:36.00 MISCELLANEOUS E.E.N.T. DRUGS (continued)


TIMOLOL MALEATE

TIMOLOL MALEATE

0.25%

0075582 APO-TIMOP OPHTHALMIC SOLN 0.97 Y Y N YAPX /ML

0216671 SANDOZ TIMOLOL 0.97 Y Y N YSDZ /ML

0208335 PMS-TIMOLOL OPHTHALMIC SOLN 0.97 Y Y N YPMS /ML

0.25%GEL

0217188 TIMOPTIC-XE OPHT GELLAN SOLN 4.5 Y Y N YMSD /ML

0224227 TIMOLOL MALEATE-EX GEL SOLN 3.22 Y Y N YALC /ML

0.5%

0045120 TIMOPTIC OPHTHALMIC SOLN 4.22 Y Y N YMSD /ML

0075583 APO-TIMOP OPHTHALMIC SOLN 1.21 Y Y N YAPX /ML

0208334 PMS-TIMOLOL OPHTHALMIC SOLN 1.21 Y Y N YPMS /ML

0216672 SAB-TIMOLOL OPHT SOLN 1.21 Y Y N YSAB /ML

0.5%GEL


0217189 TIMOPTIC-XE OPHT GELLAN SOLN 5.39 Y Y N YMSD /ML

TIMOLOL/TRAVOPROST

0.5%/0.004%

0227825 DUOTRAV 13.28 Y Y N YALC /ML

TRAVOPROST

0.004%

0241316 SANDOZ TRAVOPROST 4.03 Y Y N YSDZ /ML

0241206 TEVA-TRAVOPROST Z OPHT SOLN 4.03 Y Y N YTVM /ML

0231800 TRAVATAN Z OPHT SOLN 11.36 Y Y N YALC /ML

0.5%/0.004%

0241573 APO-TRAVOPROST Z 4.03 Y Y N YAPX /ML

52:40.04 ALPHA-ADRENERGIC AGONISTS ------------------------------------------------------

BRIMONIDINE/BRINZOLA

0.2/1%

0243541 SIMBRINZA 4.57 Y Y N YALC /ML

52:92.00 EENT DRUGS, MISCELLANEOUS ------------------------------------------------------

AFLIBERCEPT

40MG/ML

0241599 EYLEA 1418 E E N YBAY /ML

56:00 GASTROINTESTINAL DRUGS

56:08.00 ANTIDIARRHEA AGENTS ------------------------------------------------------------

DIPHENOXYLATE HCL

2.5MG

0003632 LOMOTIL 0.45 Y Y Y YPHU /TB



177

PHRM/CHRN/CDO/F56:14.00 CHOLELITHOLYTIC AGENTS

56:00 GASTROINTESTINAL DRUGS (continued)

URSODIOL

56:14.00 CHOLELITHOLYTIC AGENTS ---------------------------------------------------------

250MG

0227349 PMS-URSODIOL C 0.99 Y Y N YPMS /TB

0223898 URSO 1.45 Y Y N YAXC /TB

500MG

0224589 URSO DS 2.76 Y Y N YAXC /TB

0227350 PMS-URSODIOL C 1.88 Y Y N YPMS /TB

56:16.00 DIGESTANTS ---------------------------------------------------------------------

PANCRELIPASE

10000U//

0220010 CREON 10 0.2723 Y Y N YSLV /CP

10000U/ EC

0078943 PANCREASE MT 10 1.5 Y Y N YJAN /CP

16000U//


0224193 VIOKASE 0.37 Y Y N YAXC /TB

20000U/ EC

0082137 COTAZYM ECS 20 0.96 Y Y N YORG /CP

25000U//

0198520 CREON 25 0.8507 Y Y N YSLV /CP

4000U//


5000U//

0223900 CREON 5 MINIMICROSPHERES 0.1703 Y Y N YSLV /CP

8000U//

0026381 COTAZYM' 0.2 Y Y N YORG /CP

0223001 VIOKASE 0.24 Y Y N YAXC /TB

8000U// EC

0050279 COTAZYM ECS 8 0.36 Y Y N YORG /CP

56:16.01 null -------------------------------------------------------------------------------

PANCRELIPASE

12000//

0204583 ULTRASE MT12 0.46 Y Y N YAXC /CP

20000U//

0204586 ULTRASE MT20 0.79 Y Y N YAXC /CP

56:22.00 ANTI-EMETICS -------------------------------------------------------------------

APREPITANT

125MG

0229880 EMEND 31.55 E E N YMSD /CP

125MG/80MG/80MG

0229881 EMEND TRI-PACK 93.24 E E N YMSD /CP



178

PHRM/CHRN/CDO/F56:22.00 ANTI-EMETICS (continued)


APREPITANT (continued)

80MG

0229879 EMEND 31.55 E E N YMSD /CP

DOLASETRON

100MG

0223137 ANZEMET 29.6 E E N YSAW /TB

DOXYLAMINE

10/10MG

0060912 DICLECTIN 1.27 N N Y YDUI /TB

GRANISETRON

1MG

0230889 APO-GRANISETRON 9 E E N YAPX /TB

0218588 KYTRIL 18 E E N YHLR /TB

MECLIZINE HCL

25MG

0236883 BONAMINE 0.442 Y N N NMCN /TB

NABILONE

0.5MG

0238488 TEVA-NABILONE 0.78 E E N YTVM /CP

0238090 PMS-NABILONE 0.78 E E N YPMS /CP

0225619 CESAMET 3.29 E E N YVAE /CP

0235808 RAN-NABILONE 0.78 E E N YRAN /CP

1MG

0239360 ACT NABILONE 1.55 E E N YACT /CP

0054837 CESAMET 6.58 E E N YVAE /CP

0238489 TEVA-NABILONE 1.551 E E N YTVM /CP

0235809 RAN-NABILONE 1.55 E E N YRAN /CP

0238091 PMS-NABILONE 1.55 E E N YPMS /CP

ONDANSETRON

2MG/ML

0227942 ONDANSETRON INJ (PRESERV FREE) 5.94 E E N YSDZ /ML

0227943 ONDANSETRON INJ- SANDOZ 3.46 E E N YSDZ /ML

0227441 ONDANSETRON HCL INJ 3.46 E E N YSDZ /ML

0226552 ONDANSETRON INJ- NOVO 6.8 E E N YNOP /ML



179

PHRM/CHRN/CDO/F56:22.00 ANTI-EMETICS (continued)


ONDANSETRON (continued)

4MG

0225818 PMS-ONDANSETRON 3.27 E E N YPMS /TB

0230621 ONDANSETRON-ODAN 3.35 E E N YODN /TB

0227431 SANDOZ ONDANSETRON 3.27 E E N YSDZ /TB

0227852 RATIO-ONDANSETRON 3.35 E E N Ynull /TB

0226405 NOVO-ONDANSETRON 3.27 E E N YNOP /TB

0242140 ONDANSETRON 3.35 E E N YSAI /TB

0221356 ZOFRAN 13.6 E E N YGSK /TB

0228818 APO-ONDANSETRON 3.27 E E N YAPX /TB

0229634 CO-ONDANSETRON 3.27 E E N YCOB /TB

0229786 MYLAN-ONDANSETRON 3.27 E E N YMYL /TB

0230525 MINT-ONDANSETRON 3.27 E E N YMNT /TB

0231224 RAN-ONDANSETRON 3.27 E E N YRAN /TB

4MG ODT

0238998 ONDISSOLVE 3.27 E E N YTAK /TB

0244467 SANDOZ ONDANSETRON ODT 3.27 E E N YSDZ /TB

0223937 ZOFRAN ODT 13.089 E E N YGSK /TB

4MG/5ML

0222963 ZOFRAN (50ML) ORAL LIQ 2.04 E E N YGSK /ML

8MG

0221357 ZOFRAN 20.75 E E N YGSK /TB

0226406 NOVO-ONDANSETRON 4.99 E E N YNOP /TB

0230622 ONDANSETRON-ODAN 5.11 E E N YODN /TB

0228819 APO-ONDANSETRON 4.99 E E N YAPX /TB

0230526 MINT-ONDANSETRON 4.99 E E N YMNT /TB

0227853 RATIO-ONDANSETRON 5.11 E E N YRPH /TB

0242141 ONDANSETRON 5.11 E E N YSAI /TB

0231225 RAN-ONDANSETRON 4.99 E E N YRAN /TB

0227432 SANDOZ ONDANSETRON 4.99 E E N YSDZ /TB

0225819 PMS-ONDANSETRON 4.99 E E N YPMS /TB

8MG ODT

0238999 ONDISSOLVE ODF 4.99 E E N YTAK /TB

0223937 ZOFRAN ODT 19.972 E E N YGSK /TB

56:40.00 MISCELLANEOUS GASTROINTESTINAL DRUGS -------------------------------------------

5-AMINOSALICYLIC

1GM ER

0239946 PENTASA 1.11 Y Y Y YFEI /TB

1.0G SUP

0224214 SALOFALK 1.85 Y Y Y YAXC /SP

1.0G SUPP

0215356 PENTASA SUPP 1.65 Y Y Y YFEI /SP



180

PHRM/CHRN/CDO/F56:40.00 MISCELLANEOUS GASTROINTESTINAL DRUGS (continued)


5-AMINOSALICYLIC ACID (continued)

1.0G/100ML

0215352 QUINTASA RET.ENEMA 0.27 Y Y Y YFEI /ML

1.2G ER

0229755 MEZAVANT 1.63 Y Y N YSCI /TB

2.0G/60G

0211279 SALOFALK RET.ENEMA 0.47 Y Y Y YAXC /GM

4.0G/100ML

0215355 PENTASA RET.ENEMA 0.32 Y Y Y YFEI /ML

4.0G/60G

0211280 SALOFALK RET.ENEMA 0.8 Y Y Y YAXC /GM

400MG EC

0217192 NOVO-5-ASA EC 0.47 Y Y Y YNOP /TB

400MG ECT

0199758 ASACOL EC 0.552 Y Y Y YPGA /TB

500MG CR

0209968 PENTASA (DELAYED REL) 0.57 Y Y Y YFEI /TB

500MG EC

0211278 SALOFALK EC 0.57 Y Y Y YAXC /TB

500MG ECT

0191403 MESASAL EC 0.64 Y Y Y YGSK /TB

500MG SUPP

0211276 SALOFALK SUPP 1.26 Y Y Y YAXC /SP

800MG EC

0226721 ASACOL EC 1.08 Y Y Y YPGA /TB

BETAMETHASONE

5MG/100ML

0206088 BETNESOL ENEMA (100ML) 0.71 Y Y Y YRBP /ML

BUDESONIDE

0.02MG/ML

0205243 ENTOCORT ENEMA (100ML) 0.52 Y Y Y YAST /ML

3MG

0222929 ENTOCORT CONTR ILEAL RELEASE 1.63 Y Y N YAST /CP

CIMETIDINE

300MG

0048787 APO-CIMETIDINE 0.18 Y N Y YAPX /TB

0222971 PMS-CIMETIDINE 0.086 Y N Y YPMS /TB

0222744 GEN-CIMETIDINE 0.086 Y N Y YGPM /TB

0058241 NOVO-CIMETINE 0.086 Y N Y YNOP /TB



181



CIMETIDINE (continued)

400MG





600MG





0086583 NU-CIMET 0.172 Y N Y YNXP /TB

DOMPERIDONE MALEATE

10MG

0215719 NOVO-DOMPERIDONE 0.06 Y Y Y YNOP /TB

0223646 PMS-DOMPERIDONE 0.06 Y Y Y YPMS /TB

0226807 RAN-DOMPERIDONE 0.06 Y Y Y YRAP /TB

0210361 APO-DOMPERIDONE 0.06 Y Y Y YAPX /TB

0235044 DOMPERIDONE 0.06 Y Y Y YSAI /TB

0191207 RATIO-DOMPERIDONE 0.06 Y Y Y YRTP /TB

FAMOTIDINE

20MG

0219601 GEN-FAMOTIDINE 0.27 Y N Y YGPM /TB

0195384 APO-FAMOTIDINE 0.27 Y N Y YAPX /TB

0235110 SANIS-FAMOTIDINE 0.27 Y N Y YSAN /TB

0202213 TEVA-FAMOTIDINE 0.27 Y N Y YTVM /TB

40MG

0202214 TEVA-FAMOTIDINE 0.48 Y N Y YTVM /TB

0235111 SANIS-FAMOTIDINE 0.48 Y N Y YSAN /TB

0195383 APO-FAMOTIDINE 0.48 Y N Y YAPX /TB

0219602 GEN-FAMOTIDINE 0.48 Y N Y YGPM /TB

HYDROCORTISONE

100MG/60ML

0023031 HYCORT ENEMA (60ML) 0.09 Y Y Y YICN /EA

0211273 CORTENEMA ENEMA (60ML) 0.12 Y Y Y YAXC /ML

LANSOPRAZOLE



182



LANSOPRAZOLE (continued)

15MG

0216550 PREVACID 2 Y E Y YABB /CP

0243300 LANSOPRAZOLE 0.5 Y E Y YPMS /CP

0240261 RAN-LANSOPRAZOLE 0.5 Y E Y YRAN /CP

0235768 SANIS-LANSOPRAZOLE 0.5 Y E Y YSAN /CP

0235383 MYLAN-LANSOPRAZOLE 0.5 Y E Y YMYL /CP

0229381 APO-LANSOPRAZOLE 0.5 Y E Y YAPX /CP

0228051 TEVA-LANSOPRAZOLE 0.5 Y E Y YTVM /CP

30MG

0240262 RAN-LANSOPRAZOLE 0.5 Y E Y YRAN /CP

0243302 LANSOPRAZOLE 0.5 Y E Y YPMS /CP

0235769 SANIS-LANSOPRAZOLE 0.5 Y E Y YSAN /CP

0229383 APO-LANSOPRAZOLE 0.5 Y E Y YAPX /CP

0216551 PREVACID 2 Y E Y YABB /CP

0239526 PMS-LANSOPRAZOLE 0.5 Y E Y YPMS /CP

0228052 TEVA-LANSOPRAZOLE 0.5 Y E Y YTVM /CP

0235384 MYLAN-LANSOPRAZOLE 0.5 Y E Y YMYL /CP

LANSOPRAZOLE/CLARIT

30/500/500

0223852 HP-PAC (30/500/500MG 7-DAY 12.15 Y N Y YABB /PK

METOCLOPRAMIDE HCL

1MG/ML

0223043 PMS-METOCLOPRAMIDE ORAL 0.05 Y Y Y YPMS /ML

10MG

0084283 APO-METOCLOP 0.0583 Y Y Y YAPX /TB

0223043 PMS-METOCLOPRAMIDE 0.06 Y Y Y YPMS /TB

5MG

0223043 PMS-METOCLOPRAMIDE 0.06 Y Y Y YPMS /TB

0084282 APO-METOCLOP 0.0556 Y Y Y YAPX /TB

5MG/ML

0218543 METOCLOPRAMIDE HCL INJ 3.14 Y Y Y YSAB /ML

MISOPROSTOL

100MCG

0224402 APO-MISOPROSTOL 0.26 Y Y Y YAPX /TB

200MCG

0224402 APO-MISOPROSTOL 0.43 Y Y Y YAPX /TB

0224412 PMS-MISOPROSTOL 0.4303 Y Y Y YPMS /TB

NIZATIDINE



183



NIZATIDINE (continued)

150MG

0224045 NOVO-NIZATIDINE 0.21 Y N Y YNOP /CP

0217771 PMS-NIZATIDINE 0.21 Y N Y YPMS /CP

0222015 APO-NIZATIDINE 0.21 Y N Y YAPX /CP

0077833 AXID 1.01 Y N Y YPHL /CP

300MG

0222016 APO-NIZATIDINE 0.38 Y N Y YAPX /CP

0224045 NOVO-NIZATIDINE 0.38 Y N Y YNOP /CP

0077834 AXID 1.5206 Y N Y YPHL /CP

0217772 PMS-NIZATIDINE 0.38 Y N Y YPMS /CP

OLSALAZINE SODIUM

250MG

0206380 DIPENTUM 0.56 Y Y Y YPHU /CP

OMEPRAZOLE

10MG

0223073 LOSEC TAB 1.86 Y E Y YAST /CP

0232942 MYLAN-OMEPRAZOLE 0.82 Y E Y YMYL /CP

0229643 SANDOZ-OMEPRAZOLE 0.82 Y E N YSDZ /CP

0229540 TEVA-OMEPRAZOLE 0.82 Y E N YTEV /TB

20MG

0232085 PMS-OMEPRAZOLE 0.41 Y E Y YPMS /CP

0224505 APO-OMEPRAZOLE 0.41 Y E Y YAPX /CP

0229644 SANDOZ-OMEPRAZOLE 0.41 Y E Y YSDZ /CP

0232943 MYLAN-OMEPRAZOLE 0.41 Y E Y YMYL /CP

0234869 SANIS-OMEPRAZOLE 0.41 Y E Y YSAN /CP

0241654 OMEPRAZOLE MAGNESIUM DR 0.41 Y E Y YACC /TB

0237487 RAN-OMEPRAZOLE 0.41 Y E Y YRAN /TB

0226086 RATIO-OMEPRAZOLE 0.41 Y E Y YRPH /TB

0229541 TEVA-OMEPRAZOLE 0.41 Y E Y YTEV /TB

0219091 LOSEC TAB 2.34 Y E Y YAST /TB

0231026 PMS-OMEPRAZOLE 0.41 Y E Y YPMS /TB

PANTOPRAZOLE



184



PANTOPRAZOLE (continued)

40MG

0222945 PANTOLOC 2.08 Y E Y YATA /TB

0228548 TEVA-PANTOPRAZOLE 0.36 Y E Y YTVM /TB

0229292 APO-PANTOPRAZOLE 0.36 Y E Y YAPX /TB

0229958 MYLAN-PANTOPRAZOLE 0.36 Y E Y YMYL /TB

0230048 CO-PANTOPRAZOLE 0.36 Y E Y YCOB /TB

0230108 SANDOZ-PANTOPRAZOLE 0.36 Y E Y YSDZ /TB

0226723 TECTA 0.75 Y E Y YNYC /TB

0230787 PMS-PANTOPRAZOLE 0.36 Y E Y YPMS /TB

0230870 RATIO-PANTOPRAZOLE 0.36 Y E Y YRTP /TB

0230504 RAN-PANTOPRAZOLE 0.36 Y E Y YRAN /TB

0237080 SANIS-PANTOPRAZOLE 0.36 Y E Y YSAN /TB

0240857 MYLAN-PANTOPRAZOLE T 0.19 Y E Y YMYL /TB

0241744 MINT-PANTOPRAZOLE 0.36 Y E Y YMNT /TB

PANTOPRAZOLE

40MG

0244062 TEVA-PANTOPRAZOLE MAGNESIUM 0.19 Y E Y YTVM /TB

RABEPRAZOLE

10MG

0235651 SANIS-RABEPRAZOLE 0.12 Y E Y YSAN /TB

0231417 SANDOZ RABEPRAZOLE 0.12 Y E Y YSDZ /TB

0224379 PARIET ECT 0.69 Y E Y YJAN /TB

0231080 PMS-RABEPRAZOLE 0.1204 Y E Y YPMS /TB

0229807 RAN-RABEPRAZOLE 0.12 Y E Y YRAN /TB

0229663 TEVA-RABEPRAZOLE 0.12 Y E Y YTVM /TB

20MG

0238174 PAT-RABEPRAZOLE 0.24 Y E Y YPAT /TB

0235653 SANIS-RABEPRAZOLE 0.24 Y E Y YSAN /TB

0234558 APO-RABEPRAZOLE 0.24 Y E Y YAPX /TB

0231418 SANDOZ RABEPRAZOLE 0.24 Y E Y YSDZ /TB

0229664 TEVA-RABEPRAZOLE 0.24 Y E Y YTVM /TB

0231081 PMS-RABEPRAZOLE 0.2408 Y E Y YPMS /TB

0229808 RAN-RABEPRAZOLE 0.24 Y E Y YRAN /TB

0224379 PARIET ECT 1.37 Y E Y YJAN /TB

RANITIDINE

15MG/ML

0228083 APO-RANITIDINE 0.15 Y N Y YAPX /ML

0224294 NOVO-RANIDINE ORAL SOLN 0.15 Y N Y YNVP /ML



185



RANITIDINE (continued)

150MG

0235301 SANIS-RANITIDINE 0.18 Y N Y NSAN /TB

0233648 RAN-RANITIDINE 0.18 Y N Y NRAN /TB

0224322 SANDOZ RANITIDINE 0.18 Y N Y NSDZ /TB

0073305 APO-RANITIDINE 0.18 Y N Y NAPX /TB

0224245 PMS-RANITIDINE 0.18 Y N Y NPMS /TB

0224159 SCHEINPHARM RANITIDINE 0.4042 Y N Y NSCN /TB

0221233 ZANTAC 0.18 Y N Y NGSK /TB

0224857 CO RANITIDINE 0.18 Y N Y NCOB /TB

0082882 RATIO-RANITIDINE 0.18 Y N Y NRTP /TB

0082856 TEVA-RANIDINE 0.18 Y N Y NTVM /TB

0220776 MYLAN-RANITIDINE 0.18 Y N Y NMYL /TB

25MG/ML

0225671 SDZ-RANITIDINE INJ 1.4 Y N Y YSDZ /ML

300MG

0235302 SANIS-RANITIDINE 0.36 Y N Y YSAN /TB

0224857 CO RANITIDINE 0.36 Y N Y YCOB /TB

0224245 PMS-RANITIDINE 0.36 Y N Y YPMS /TB

0082868 RATIO-RANITIDINE 0.36 Y N Y YRTP /TB

0082855 TEVA-RANIDINE 0.36 Y N Y YTVM /TB

0220778 MYLAN-RANITIDINE 0.36 Y N Y YMYL /TB

0073306 APO-RANITIDINE 0.36 Y N Y YAPX /TB

SUCRALFATE

1G

0212525 APO-SUCRALFATE 0.31 Y Y Y YAPX /TB

0204570 NOVO-SUCRALATE 0.31 Y Y Y YNOP /TB

0210062 SULCRATE 0.61 Y Y Y YHLR /TB

200MG/ML

0210356 SULCRATE PLUS ORAL SUSP 0.11 Y Y Y YHLR /ML

SULFASALAZINE

500MG

0206448 SALAZOPYRIN 0.32 Y Y Y YPHU /TB

0059846 PMS-SULFASALAZINE 0.23 Y Y Y YPMS /TB

500MG EC

0206447 SALAZOPYRIN EC 0.39 Y Y Y YPHU /TB

0059848 PMS-SULFASALAZINE EC 0.36 Y Y Y YPMS /TB

60:00 GOLD COMPOUNDS

60:00.00 GOLD COMPOUNDS -----------------------------------------------------------------



186

PHRM/CHRN/CDO/F60:00.00 GOLD COMPOUNDS

60:00 GOLD COMPOUNDS

AURANOFIN

AURANOFIN

3MG

0191682 RIDAURA 6.01 Y Y N YXED /CP

SODIUM

10MG/ML

0192762 MYOCHRYSINE (1ML) INJ 12.07 Y Y N YAVT /ML

0224545 SODIUM AUROTHIOMALATE(1ML) 9.66 Y Y N YSAB /ML

25MG/ML



50MG/ML



64:00 HEAVY METAL ANTAGONISTS

64:00.00 HEAVY METAL ANTAGONISTS --------------------------------------------------------

DEFERIPRONE

100MG/ML

0243652 FERRIPROX 3.036 E E N YAPX /ML

1000MG

0243655 FERRIPROX 30.36 E E N YAPP /TB

DEFEROXAMINE

500MG

0224205 PMS-DEFEROXAMINE VIAL 5.031 Y N N YPMS /VL

0198124 DESFERAL VIAL 15.19 Y N N YNVO /VL

PENICILLAMINE

250MG

0001605 CUPRIMINE 3.5 Y N N YMSD /CP

66:00 null

66:16.12 null -------------------------------------------------------------------------------

RALOXIFENE

60MG

0235884 COBALT-RALOXIFENE 0.458 Y E N YCOB /TB

68:00 HORMONES AND SUBSTITUTES

68:04.00 ADRENALS -----------------------------------------------------------------------

BECLOMETHASONE

100UG

0224203 QVAR INH 0.31 Y Y Y YMDA /DS

50UG

0224202 QVAR INH 0.15 Y Y Y YMDA /DS



187

PHRM/CHRN/CDO/F68:04.00 ADRENALS (continued)

68:00 HORMONES AND SUBSTITUTES (continued)

BUDESONIDE

BUDESONIDE

0.125MG/ML

0222909 PULMICORT NEBUAMP (2ML) 0.44 Y Y N YAST /ML

0.25MG/ML


0.5MG/ML


100UG

0085207 PULMICORT TURBUHALER 0.16 Y Y Y YAST /DS

200UG


400UG


CICLESONIDE

100UG/DS

0228560 ALVESCO 0.3795 Y Y N YNYC /DS

200UG/DS

0228561 ALVESCO 0.63 Y Y N YNYC /DS

50UG/DS

0230367 OMNARIS 0.21 Y N N YNYC /DS

0241731 APO-CICLESONIDE 0.18 Y N N YAPX /DS

CORTISONE ACETATE

25MG

0028043 CORTISONE 0.33 Y Y Y YICN /TB

DESAMETHASONE

0.5MG/5ML

0194689 PMS-DEXAMETHASONE ELIXER 0.38 Y Y Y YPMS /ML

DEXAMETHASONE

0.5MG

0224068 RATIO-DEXAMETHASONE 0.0782 Y Y Y YRTP /TB

0196497 PMS-DEXAMETHASONE 0.0782 Y Y Y YPMS /TB

0226108 APO-DEXAMETHASONE 0.0782 Y Y Y YAPX /TB

0.75MG


0028547 DEXASONE 0.45 Y Y Y YICN /TB

2MG




188



DEXAMETHASONE (continued)

4MG

0225005 APO-DEXAMETHASONE 0.3046 Y Y Y YAPX /TB

0048915 DEXASONE 0.81 Y Y Y YICN /TB


0224068 RATIO-DEXAMETHASONE 0.3046 Y Y Y YRTP /TB

DEXAMETHASONE 21-

4MG/ML

0197754 DEXAMETHASONE SOD PHO INJ 1.69 Y Y Y YCYT /ML

0220426 DEXAMETHASONE SOD PHO INJ 1.61 Y Y N YOME /ML

0066422 DEXAMETHASONE SOD PHO INJ 1.69 Y Y Y YSAB /ML

DEXAMETHASONE

10MG/ML

0078390 PMS-DEXAMETHASONE INJ 1.28 Y Y N YPMS /ML

DEXAMETHASONE

10MG/ML

0087458 SANDOZ-DEXAMETHASONE SOD 4.56 Y Y N YSDZ /ML

FLUDROCORTISONE

0.1MG

0208602 FLORINEF 0.26 Y Y Y YRBP /TB

FLUTICASONE

100UG/DS

0223724 FLOVENT DISKUS 0.4 Y Y Y YGSK /DS

125UG

0224429 FLOVENT HFA INHALER 0.34 Y Y Y YGSK /DS

250UG


250UG/DS


50UG


500UG/DS


HYDROCORTISONE

10MG

0003091 CORTEF 0.2 Y Y Y YPHU /TB

20MG

0003092 CORTEF 0.35 Y Y Y YPHU /TB

METHYLPREDNISOLONE

16MG

0003612 MEDROL 1 Y Y Y YPHU /TB



189



METHYLPREDNISOLONE (continued)

4MG

0003098 MEDROL 0.35 Y Y Y YPHU /TB

METHYLPREDNISOLONE

10MG/ML

0026042 DEPO-MEDROL W LIDOCANE INJ 6.13 Y Y N YPMS /ML

40MG/ML

0003075 DEPO-MEDROL (1ML) INJ 5.82 Y Y N YPHU /ML

0224540 METHYLPREDNISOLONE(1ML)INJ 4.1 Y Y N YSAB /ML

0224540 SDZ- METHYLPREDNISOLONE 40 4.1 Y Y N YSDZ /ML

80MG/ML

0224540 METHYLPREDNISOLONE(5ML)INJ 6.99 Y Y N YSDZ /ML

0003076 DEPO-MEDROL (1ML) INJ 9.7 Y Y N YPHU /ML

0224540 METHYLPREDNISOLONE(1ML)INJ 8.2 Y Y N YSAB /ML

80MG/ML PR

0193434 DEPO-MEDROL W PRESERV.(5ML)INJ 8.09 Y Y N YPHU /ML

METHYLPREDNISOLONE

1GM

0224122 METHYLPREDNISOLONE SOD INJ 34.41 Y Y N YNOP /VL

0003613 SOLU-MEDROL INJ 55.09 Y Y N YPHU /VL

0236797 SOLU-MEDROL 60.19 Y Y N YPFI /VL

0223275 METHYLPREDNISOLONE 1GM INJ 18.99 Y Y N YFAU /VL

PREDNISOLONE SODIUM

1MG/ML

0223061 PEDIAPRED ORAL LIQ 0.13 Y Y Y YAVT /ML

0224553 PMS-PREDNISOLONE ORAL SOLN 0.1 Y Y Y YPMS /ML

PREDNISONE

1MG

0027137 WINPRED 0.11 Y Y Y YICN /TB

0059819 APO-PREDNISONE 0.104 Y Y Y YAPX /TB

5MG

0002169 NOVO-PREDNISONE 0.04 Y Y Y YNOP /TB


50MG


0023237 NOVO-PREDNISONE 0.17 Y Y Y YNOP /TB

TRIAMCINOLONE

20MG/ML

0219415 ARISTOSPAN INJ SUSP 6.17 Y Y Y YSTI /ML



190



TRIAMCINOLONE ACETONIDE

TRIAMCINOLONE

10MG/ML

0199976 KENALOG 10 (5ML) INJ 3.29 Y Y Y YWSD /ML

0222954 TRIAMCINOLONE ACET. (5ML) INJ 2.68 Y Y Y YSAB /ML

40MG/ML

0222955 TRIAMCINOLONE ACET. (1ML) 4.38 Y Y Y YSAB /ML

0197756 TRIAMCINOLONE ACET. (1ML) INJ 5.5 Y Y Y YCYT /ML

0199986 KENALOG 40 (1ML) INJ 7.65 Y Y Y YWSD /ML

68:08.00 ANDROGENS ----------------------------------------------------------------------

DANAZOL

100MG

0201815 CYCLOMEN 1.37 Y N Y YSAW /CP

200MG


50MG


TESTOSTERONE

100MG/ML

0003078 DEPO-TESTOSTERONE OILY(10ML) 4.2 Y N N YPHU /ML

0224606 TESTOSTERONE CYP. OILY(10ML)IN 2.36 Y N N YSAB /ML

TESTOSTERONE

200MG/ML

0002924 DELATESTRYL OILY (ML)INJ 10.13 Y E N YPPZ /ML

TESTOSTERONE

40MG

0232249 PMS-TESTOSTERONE 0.47 Y N N YPMS /CP

0078232 ANDRIOL 0.94 Y N N YORG /CP

0242118 TARO-TESTOSTERONE 0.71 Y N N YTAR /CP

68:12.00 CONTRACEPTIVES -----------------------------------------------------------------

ETHINYL ESTRADIOL &

2.6/11.4MG

0225318 NUVARING 15.15 N N Y YSCP /EA

ETHINYL ESTRADIOL

.02/3MG

0232115 YAZ 0.57 N N Y YBAY /TB

ETHINYL

0.03/0.15MG

0241025 MIRVALA 28 0.28 N N Y YAPX /TB

21

0242081 RECLIPSEN 0.37 N N Y YACV /TB

0204248 MARVELON 0.84 N N Y YORG /TB



191

PHRM/CHRN/CDO/F68:12.00 CONTRACEPTIVES (continued)


ETHINYL ESTRADIOL/DESOGESTREL (continued)

28

0241746 RECLIPSEN 0.28 N N Y YACV /TB

0204253 ORTHO-CEPT 0.79 N N Y YJAN /TB

0204247 MARVELON 0.63 N N Y YORG /TB

ETHINYL

.02/3MG

0241538 MYA 0.42 N N Y YAPO /TB

21

0226172 YASMIN 21 0.57 N N Y YBAY /TB

28

0226173 YASMIN 28 0.43 N N Y YBAY /TB

ETHINYL

21

0046932 DEMULEN 30 0.6 N N Y YPHU /TB

28

0047152 DEMULEN 30 0.48 N N Y YPHU /TB

ETHINYL ESTRADIOL/L-

20/100MCG

0229854 AVIANE 28 0.27 N N Y YBAR /TB

0238788 ALYSENA 28 0.27 N N Y YBAR /TB

0223697 ALESSE 21 S 0.71 N N Y YWYA /TB

0223697 ALESSE 28 S 0.54 N N Y YWYA /TB

0229853 AVIANE 21 0.36 N N Y YBAR /TB

21

0204232 MIN-OVRAL 0.71 N N Y YWYA /TB

0229594 PORTIA 21 0.35 N N Y YAPX /TB

0070760 TRIQUILAR 0.74 N N Y YBEX /TB

28

0229595 PORTIA 28 0.26 N N Y YAPX /TB

0204233 MIN-OVRAL 0.53 N N Y YWYA /TB

0070750 TRIQUILAR 0.55 N N Y YBEX /TB

ETHINYL

21

0196844 CYCLEN 1.05 N N Y YJAN /TB

0202870 TRI-CYCLEN 1.05 N N Y YJAN /TB

28

0202942 TRI-CYCLEN 0.79 N N Y YJAN /TB

0199287 CYCLEN 0.79 N N Y YJAN /TB

0225858 TRI-CYCLEN LO 0.45 N N Y YJAN /TB



192



ETHINYLESTRADIOL/LEVONORGESTRE

ETHINYLESTRADIOL/LEV

28(0.03/0.15)MG

0229665 SEASONALE 0.62 N N Y YTVM /TB

ETHINYLESTRADIOL/NO

21

0218710 SYNPHASIC 0.5 N N Y YPHU /TB

21 (0.5/35

0031704 ORTHO 0.5/35 1.05 N N Y YJAN /TB

0218708 BREVICON 0.55 N N Y YPHU /TB

21 (1.5/30

0029714 LOESTRIN 1.5/30 0.64 N N Y YPFI /TB

21 (1/20)

0031596 MINESTRIN 1/20 0.64 N N Y YPFI /TB

21 (1/35)

0218905 BREVICON 1/35 0.55 N N Y YPHU /TB

0037284 ORTHO 1/35 1.05 N N Y YJAN /TB

0219750 SELECT 1/35 0.37 N N Y YDIS /TB

21 (777)

0060295 ORTHO 7/7/7 1.05 N N Y YJAN /TB

28

0218711 SYNPHASIC 0.38 N N Y YPHU /TB

28 (0.5/35

0034073 ORTHO 0.5/35 0.79 N N Y YJAN /TB

0218709 BREVICON 0.41 N N Y YPHU /TB

0035302 LOESTRIN 1.5/30 0.48 N N Y YPFI /TB

28 (1/20)

0034383 MINESTRIN 1/20 0.48 N N Y YPFI /TB

28 (1/35)

0218906 BREVICON 1/35 0.41 N N Y YPHU /TB

0037283 ORTHO 1/35 0.79 N N Y YJAN /TB

0219929 SELECT 1/35 0.27 N N Y YDIS /TB

28 (777)

0060296 ORTHO 7/7/7 0.79 N N Y YJAN /TB

LEVONORGESTREL

0.75MG

0224167 PLAN B 8.6 N N Y YTEV /TB

13.5MG

0240829 JAYDESS 270.68 N N Y YBAY /EA

52MG

0224300 MIRENA INSERT 336.22 N N Y YBEX /EA



193



NORETHINDRONE

NORETHINDRONE

0.35MG

0003760 MICRONOR (28 ) 0.79 N N Y YJAN /TB

68:16.04 ESTROGENS ----------------------------------------------------------------------

CONJUGATED

0.3 MG

0204339 PREMARIN 0.3 Y N N YWYA /TB

0.3MG

0241467 PREMARIN 0.3 Y N N YPFI /TB

0.625 MG


0.625MG

0026547 C.E.S. 0.1014 Y N N YICN /TB


0.625MG/G

0204344 PREMARIN VAGINAL CREAM 0.64 Y N N YWYA /GM

1.25 MG


1.25MG


ESTRADIOL

0.39MG

0224567 ESTRADOT 25 2.67 Y N N YNVR /PT

0.585MG

0224399 ESTRADOT 37.5 2.68 Y N N YNVR /PT

0.780MG

0224696 SANDOZ-ESTRADIOL 2.41 Y N N YSDZ /PT


1.17MG



1.56MG

0224400 ESTRADOT100 3.24 Y N N YNVR /PT


10MCG

0232546 VAGIFEM VAG TABLET 3.72 Y N N YNOO /TB

ESTRADIOL &

0.06%

0223870 ESTROGEL TRANSDERMAL GEL SPR 0.42 Y N N YSCH /GM

0.5MG

0222519 ESTRACE 0.14 Y N N YRBP /TB



194

PHRM/CHRN/CDO/F68:16.04 ESTROGENS (continued)


ESTRADIOL & NORETHINDRONE (continued)

1MG


140/50MCG

0224183 ESTALIS 3.23 Y N N YNVR /EA

2MG

0216889 ESTRING VAGINAL RING(7.5 69.73 Y N N YPHU /EA


250/50MCG

0224183 ESTALIS 3.23 Y N N YNVR /EA

5UG/1MG

0224253 FEMHRT 1/5 0.74 Y N N YPFI /TB

ESTRADIOL

3.8MG

0223150 CLIMARA 50 5.25 Y N N YBAY /EA

68:16.12 ESTROGEN AGONIST-ANTAGONISTS ---------------------------------------------------

RALOXIFENE

60MG

0223902 EVISTA 1.88 Y E N YELI /TB

0227921 APO-RALOXIFENE 0.46 Y E N YAPX /TB

68:20.04 BIGUANIDES ---------------------------------------------------------------------

LINAGLIPTIN/METFORMI

2.5/1000MG

0240327 JENTADUETO 1.33 E E N YBOE /TB

2.5/500MG


2.5/850MG


METFORMIN/SAXAGLIPTI

1000/2.5MG

0238918 KOMBOGLYZE 1.27 E E N YAST /TB

500/2.5MG


850/2.5MG


68:20.05 DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS --------------------------------------

LINAGLIPTIN

5MG

0237092 TRAJENTA 2.55 E E N YBOE /TB



195

PHRM/CHRN/CDO/F68:20.05 DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS


SAXAGLIPTIN HCL

SAXAGLIPTIN HCL

2.5MG

0237584 ONGLYZA 2.4 E E N YAST /TB

5MG

0233355 ONGLYZA 2.86 E E N YAST /TB

68:20.08 INSULINS -----------------------------------------------------------------------

INSULIN LISPRO

100U/ML

0224029 HUMALOG MIX (10ML) 3.67 Y Y N YLIL /ML

INSULIN (REGULAR)

100U/ML

0222970 HUMALOG (10ML) 2.76 Y Y N YLIL /ML

0222970 HUMALOG CARTRIDGE (5X3ML) 3.63 Y Y N YLIL /ML

INSULIN ASPART

100U/ML

0224539 NOVORAPID VIAL (10ML) 2.9 Y Y N YNOO /ML

100U/ML PN

0224435 NOVORAPID PENFILL (5X3ML) 3.89 Y Y N YNOO /ML

0237720 NOVORAPID FLEXTOUCH 4.08 Y Y N YNOO /ML

INSULIN DETEMIR

100U/ML

0241282 LEVEMIR FLEXTOUCH 7.12 E E N YNOO /ML

0227184 LEVEMIR PENFILL 6.78 E E N YNOO /ML

INSULIN GLARGINE

100U/ML

0225193 LANTUS CARTRIDGE(5X3ML 6.09 E E N YAVT /ML

0224568 LANTUS INSULIN (10 ML VIAL) 6.11 E E N YAVT /ML

0229433 LANTUS SOLOSTAR (5X3ML 6.09 E E N YAVT /ML

INSULIN GLULISINE

100U/ML

0227947 APIDRA 3ML CARTRIDGE 3.28 Y Y N YSNF /ML

0227946 APIDRA 10ML VIAL 2.51 Y Y N YAVT /ML

INSULIN ISOPHANE

100U/ML

0240344 HUMULIN N KWIKPEN 3 Y Y N YLIL /ML

INSULIN ISOPHANE PORK

100 U/ML

0227586 HYPURIN NPH INSULIN 9.9 Y Y N YWHL /ML



196

PHRM/CHRN/CDO/F68:20.08 INSULINS (continued)


INSULIN LISPRO

INSULIN LISPRO

100U/ML

0240341 HUMALOG KWIKPEN 3.63 Y Y N YLIL /ML

INSULIN PORK

100 U/ML

0227587 HYPURIN REGULAR INSULIN 9.9 Y Y N YWHL /ML

INSULIN

100U/ML PN

0226543 NOVOMIX 30 PENFILL 3.66 Y Y N YNOO /ML

INSULIN(ISOPHANE)

100U/ML

0058773 HUMULIN-N (10ML) 2.25 Y Y N YLIL /ML

0202422 NOVOLIN GE NPH (10ML) 2.15 Y Y N YNOO /ML

100U/ML PN

0202426 NOVOLIN GE NPH PENFILL (5X3ML) 2.715 Y Y N YNOO /ML

0195923 HUMULIN-N CARTRIDGE (5X3ML) 3 Y Y N YLIL /ML

INSULIN(LENTE)HUMAN

100U/ML

0064614 HUMULIN-L (10ML) 1.638 Y Y N YLIL /ML

INSULIN(REG./ISOPHANE)

100U/ML

0202421 NOVOLIN GE 30/70 (10ML) 2.16 Y Y N YNOO /ML

0079587 HUMULIN 30/70 (10ML) 2.25 Y Y N YLIL /ML

0195921 HUMULIN 30/70 CARTRIDGE 3 Y Y N YLIL /ML

100U/ML PN

0202432 NOVOLIN GE 50/50 PENFILL 2.778 Y Y N YNOO /ML



INSULIN(REGULAR)

100U/ML

0058671 HUMULIN-R (10ML) 2.25 Y Y N YLIL /ML

0195922 HUMULIN-R CARTRIDGE (5X3ML) 3 Y Y N YLIL /ML

0202423 NOVOLIN GE TORONTO (10ML) 2.1 Y Y N YNOO /ML

100U/ML PN

0202428 NOVOLIN GE TORONTO PENFIL 2.725 Y Y N YNOO /ML

68:20.18 Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors ------------------------------

CANAGLIFLOZIN

100MG

0242548 INVOKANA 2.62 E E N YJAN /TB

300MG

0242549 INVOKANA 2.62 E E N YJAN /TB



197

PHRM/CHRN/CDO/F68:20.18 Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors (continued)


DAPAGLIFLOZIN

DAPAGLIFLOZIN

10MG

0243547 FORXIGA 2.62 E E N YAST /TB

5MG

0243546 FORXIGA 2.62 E E N YAST /TB

EMPAGLIFLOZIN

10MG

0244393 JARDIANCE 2.62 E E N YBOE /TB

25MG

0244394 JARDIANCE 2.62 E E N YBOE /TB

68:20.20 SULFONYLUREAS ------------------------------------------------------------------

ACARBOSE

100MG

0219089 GLUCOBAY 0.37 Y Y N YBAY /TB

50MG

0219088 GLUCOBAY 0.27 Y Y N YBAY /TB

CHLORPROPAMIDE

100MG

0039930 APO-CHLORPROPAMIDE 0.0745 Y Y N YAPX /TB

250MG

0031271 APO-CHLORPROPAMIDE 0.076 Y Y N YAPX /TB

GLICLAZIDE

30MG

0242976 ACT GLICLAZIDE MR 0.09 Y Y N YWHL /TB

0229779 APO-GLICLAZIDE MR 0.14 Y Y N YAPX /TB

0242328 MINT-GLICLAZIDE MR 0.14 Y Y N YMNT /TB

30MG ER

0224298 DIAMICRON MR 0.14 Y Y N YSEV /TB

60MG

0240712 APO-GLICLAZIDE MR 0.22 Y Y N YAPX /TB

0235642 DIAMICRON MR 0.25 Y Y N YSEV /TB

80MG

0224524 APO-GLICLAZIDE 0.09 Y Y N YAPX /TB

0228707 SANIS-GLICLAZIDE 0.09 Y Y N YSAN /TB

0076599 DIAMICRON 0.37 Y Y N YSEV /TB

0223810 TEVA-GLICLAZIDE 0.09 Y Y N YTVM /TB

0222951 MYLAN-GLICLAZIDE 0.09 Y Y N YMYL /TB

GLYBURIDE



198

PHRM/CHRN/CDO/F68:20.20 SULFONYLUREAS (continued)


GLYBURIDE (continued)

2.5MG

0191367 TEVA-GLYBURIDE 0.0321 Y Y N YTVM /TB

0080873 GEN-GLYBE 0.032 Y Y N YGPM /TB

0190092 RATIO-GLYBURIDE 0.0321 Y Y N YRTP /TB

0222455 DIABETA 0.14 Y Y N YAVT /TB

0191365 APO-GLYBURIDE 0.03 Y Y N YAPX /TB

5MG

0072094 EUGLUCON 0.0683 Y Y N YPMS /TB

0223673 PMS-GLYBURIDE 0.06 Y Y N YPMS /TB

0235046 SANIS-GLYBURIDE 0.06 Y Y N YSAN /TB

0080874 GEN-GLYBE 0.06 Y Y N YGPM /TB

0191368 TEVA-GLYBURIDE 0.06 Y Y N YTVM /TB

0191366 APO-GLYBURIDE 0.06 Y Y N YAPX /TB

0190093 RATIO-GLYBURIDE 0.057 Y Y N YRTP /TB

0222456 DIABETA 0.24 Y Y N YHLR /TB

TOLBUTAMIDE

500MG

0031276 APO-TOLBUTAMIDE 0.1089 Y Y N YAPX /TB

68:20.90 null -------------------------------------------------------------------------------

METFORMIN

850MG

0224682 SANDOZ METFORMIN FC 0.06 Y Y N YSDZ /TB

68:20.92 ANTI DIABETIC DRUGS ------------------------------------------------------------

GLUCAGON

1 MG

0224329 GLUCAGON POWDER (RDNA) 86.35 Y Y N YLIL /ML

METFORMIN



199

PHRM/CHRN/CDO/F68:20.92 ANTI DIABETIC DRUGS (continued)


METFORMIN (continued)

500MG

0222951 GLYCON 0.1216 Y Y N YICN /TB

0204571 TEVA-METFORMIN 0.04 Y Y N YTVM /TB

0224682 SANDOZ-METFORMIN 0.04 Y Y N YSDZ /TB

0226903 RAN-METFORMIN 0.04 Y Y N YRAP /TB

0222356 PMS-METFORMIN 0.04 Y Y N YPMS /TB

0225772 CO METFORMIN 0.04 Y Y N YCOB /TB

0216778 APO-METFORMIN 0.04 Y Y N YAPX /TB

0214876 MYLAN-METFORMIN 0.04 Y Y N YMYL /TB

0235337 SANIS-METFORMIN 0.04 Y Y N YSAN /TB

0224297 RATIO-METFORMIN 0.04 Y Y N YRTP /TB

0209923 GLUCOPHAGE 0.25 Y Y N YHLR /TB

0237862 MAR-METFORMIN 0.04 Y Y N YMRC /TB

0238019 JAMP-METFORMIN 0.04 Y Y N YJPC

/TB

0238876 MINT-METFORMIN 0.04 Y Y N YMNT /null

850MG

0226905 RAN-METFORMIN 0.06 Y Y N YRAP /TB

0235338 SANIS-METFORMIN 0.06 Y Y N YSAN /TB

0225773 CO METFORMIN 0.06 Y Y N YCOB /TB

0224293 RATIO-METFORMIN 0.06 Y Y N YRTP /TB

0224258 PMS-METFORMIN 0.06 Y Y N YPMS /TB

0224279 METFORMIN 0.209 Y Y N YZYP /TB

0216284 GLUCOPHAGE 0.36 Y Y N YAVT /TB

0223921 GLYCON 0.209 Y Y N YVAE /TB

0223047 TEVA-METFORMIN 0.06 Y Y N YTVM /TB

0222978 APO-METFORMIN 0.06 Y Y N YAPX /TB

0222965 MYLAN-METFORMIN 850MG 0.06 Y Y N YMYL /TB

METFORMIN

850MG

0238877 MINT-METFORMIN 0.06 Y Y N YMNT /TB

PIOGLITAZONE



200



PIOGLITAZONE (continued)

15MG

0232647 MINT-PIOGLITAZONE 0.58 E E N YMNT /TB

0230344 ACCEL PIOGLITAZONE 0.46 E E N YACC /TB

0224257 ACTOS 2.51 E E N YTAK /TB

0229790 SANDOZ PIOGLITAZONE 0.58 E E N YSDZ /TB

0227491 NOVO-PIOGLITAZONE 0.58 E E N YNOP /TB

0230312 PMS-PIOGLITAZONE 0.58 E E N YPMS /TB

0230294 APO-PIOGLITAZONE 0.5 E E N YAPX /TB

0230286 CO-PIOGLITAZONE 0.58 E E N YCOB /TB

0230142 RATIO-PIOGLITAZONE 0.58 E E N YRTP /TB

0239160 ACCORD-PIOGLITAZONE 0.58 E E N YWHL /TB

0237585 RAN-PIOGLITAZONE 0.58 E E N YRAN /TB

0229827 GEN-PIOGLITAZONE 0.58 E E N YGPM /TB

30MG

0232648 MINT-PIOGLITAZONE 0.81 E E N YMNT /TB

0233958 ACCORD-PIOGLITAZONE 0.81 E E N YWHL /TB


0227492 TEVA-PIOGLITAZONE 0.81 E E N YTVM /TB






0230313 PMS-PIOGLITAZONE 0.81 E E N YPMS /TB



45MG








0227493 NOVO-PIOGLITAZONE 1.22 E E N YNOP /TB


0230314 PMS-PIOGLITAZONE 1.22 E E N Ynull /TB

0233959 PIOGLITAZONE HYDROCHLORIDE 1.1 E E N YACD /TB



201



REPAGLINIDE

REPAGLINIDE

0.5MG

0235492 PMS-REPAGLINIDE 0.1 Y Y N YPMS /TB

0232147 CO-REPAGLINIDE 0.1 Y Y N YCOB /TB

0235745 SDZ-REPAGLINIDE 0.1 Y Y N YSDZ /TB

0223992 GLUCONORM 0.32 Y Y N YNOO /TB

1MG





2MG





ROSIGLITAZONE

2MG

0224111 AVANDIA 1.3755 E E N YGSK /TB

4MG


8MG


SITAGLIPTIN

100MG

0230392 JANUVIA 2.98 E E N YMSD /TB

25MG


50MG


SITAGLIPTIN/METFORMI

50/1000MG

0233387 JANUMET 1.62 E E N YMDS /TB

0241679 JANUMET XR 1.62 E E N YMDS /TB

50/500MG


50/850MG




202

PHRM/CHRN/CDO/F68:24.00 PARATHYROID


CALCITONIN

68:24.00 PARATHYROID --------------------------------------------------------------------

200IU/ML

0192669 CALCIMAR INJ 28.29 E E N YAVT /ML

68:28.00 PITUITARY ----------------------------------------------------------------------

DESMOPRESSIN

0.1MG

0082430 D.D.A.V.P. 1.3217 E E Y YFEI /TB

0228773 NOVO-DESMOPRESSIN 0.33 E E Y YNOP /TB

0228403 APO-DESMOPRESSIN 0.33 E E Y YAPX /TB

0230436 PMS-DESMOPRESSIN 0.33 E E Y YPMS /TB

0.2MG

0082414 D.D.A.V.P. 2.6433 E E Y YFEI /TB

0228774 NOVO-DESMOPRESSIN 0.661 E E Y YNOP /TB

0228404 APO-DESMOPRESSIN 0.661 E E Y YAPX /TB

0230437 PMS-DESMOPRESSIN 0.661 E E Y YPMS /TB

10MCG/DS

0083636 D.D.A.V.P. (NASAL SPR) 1.916 E E Y YFEI /DS

0224246 AA-DESMOPRESSIN NASAL SPR 1.416 E E Y YAA /DS

0040251 D.D.A.V.P. (NASAL SOLN) 19.448 E E Y YFEI /EA

SOMATROPIN

1.6MG/SYR

0240181 GENOTROPIN 62.3 N Y N YPFI /null

10MG

0232507 OMNITROPE 207.73 N Y N YSDZ /VL

12MG

0224307 HUMATROPE INJ 560.04 N Y N YLIL /KT

12MG/PEN

0240171 GENOTROPIN 467.28 N Y N YPFI /null

24MG

0224307 HUMATROPE INJ 1120.08 N Y N YLIL /EA

3.33MG

0221513 SAIZEN (10IU) INJ KIT 147.07 N Y N YSRO /KT

5MG

0074562 HUMATROPE 1MG/ML (6X5ML)INJ 233.35 N Y N YLIL /KT

0223797 SAIZEN INJ 220.78 N Y N YSRO /KT

0232506 OMNITROPE 155.8 N Y N YSDZ /VL

6MG

0224307 HUMATROPE INJ 280.02 N Y N YLIL /EA

8.8MG

0227208 SAIZEN INJ CLK EZ 353.25 N Y N YSRO /VL



203

PHRM/CHRN/CDO/F68:32.00 PROGESTINS


MEDROXYPROGESTERONE ACETATE

68:32.00 PROGESTINS ---------------------------------------------------------------------

10MG

0227729 APO-MEDROXY 0.17 Y N Y YAPX /TB

0072997 PROVERA 0.67 Y N Y YPHU /TB

0222130 NOVO-MEDRONE 0.17 Y N Y YNOP /TB

150MG/ML

0058509 DEPO-PROVERA (1ML) INJ 27.96 Y N Y YPHU /ML

2.5MG




5MG




50MG/ML

0003084 DEPO-PROVERA (5ML) INJ 5.42 Y N Y YPHU /ML

PROGESTERONE

100MG

0216670 PROMETRIUM 1.5 Y N N YSCH /CP

68:36.04 THYROID AGENTS -----------------------------------------------------------------

LEVOTHYROXINE

0.025MG

0217206 SYNTHROID 0.08 Y Y N YABB /TB

0.05 MG


0221319 ELTROXIN 0.03 Y Y N YGSK /TB

0.075MG


0.088MG


0.1 MG



0.112MG


0.125MG


0.137MG




204

PHRM/CHRN/CDO/F68:36.04 THYROID AGENTS (continued)


LEVOTHYROXINE (SODIUM) (continued)

0.15 MG



0.175MG


0.2 MG



0.3 MG


0.3MG


LIOTHYRONINE SODIUM

25UG

0191946 CYTOMEL 1.39 Y Y N YGSK /TB

5UG

0191945 CYTOMEL 12.82 Y Y N YGSK /TB

68:36.08 ANTITHYROID AGENTS -------------------------------------------------------------

METHIMAZOLE

10MG

0229603 TAPAZOLE 0.53 Y Y N YLIL /TB

5MG

0001574 TAPAZOLE 0.27 Y Y N YLIL /TB

PROPYLTHIOURACIL

100MG

0001021 PROPYL-THYRACIL 0.36 Y Y Y YMSD /TB

50MG

0001020 PROPYL-THYRACIL 0.23 Y Y Y YMSD /TB

68:60.00 null -------------------------------------------------------------------------------

THYROTROPIN

0.9MG/ML

0224601 THYROGEN 1715.9 Y Y N YGDI /ML

80:00 SERUMS, TOXOIDS AND VACCINES

80:12.00 VACCINES -----------------------------------------------------------------------

BACILLUS CALMETTE-

50MG/DS

0215351 ONCOTICE 260.13 E E N YMSD /MG



205

PHRM/CHRN/CDO/F84:04.04 ANTIBIOTICS

84:00 SKIN AND MUCOUS MEMBRANE AGENTS

BENZOYL PEROXIDE CLINDAMYCIN

84:00 SKIN AND MUCOUS MEMBRANE AGENTS

50MG/G/10M

0224847 BENACLIN 0.95 N N Y YSAV /GM

BENZOYL PEROXIDE/

50/10MG/GM

0224315 CLINDOXYL TOPICAL GEL 0.91 Y N Y YSTI /GM

BENZOYL PEROXIDE/

50MG/30MG/

0222527 BENZAMYCIN TOPICAL GEL 0.942 N N Y YSAN /GM

BENZOYL

3%/1%W/W

0238282 CLINDOXYL ADV GEL 0.86 N N Y YGSK /GM

CLINDAMYCIN

1% SOLN

0226693 TARO CLINDAMYCIN 0.2262 Y N Y YTAR /ML

0058230 DALACIN T TOPICAL 0.33 Y N Y YPHU /ML

20MG/GM

0206060 DALACIN VAGINAL CREAM 0.76 Y N Y YPMS /ML

CLINDAMYCIN/BENZOYL

1/5%

0244018 TARO-CLINDAMYCIN/BENZOYL 0.78 N N Y YTAR /GM

FRAMYCETIN SO4

1% GAUZE

0198884 SOFRA-TULLE (10CM X 10CM) 1.03 Y N Y YHLR /EA

0198768 SOFRA-TULLE (30CM X 10CM) 3.6 Y N Y YHLR /EA

FUSIDIC ACID

2% CRM

0058666 FUCIDIN TOPICAL CREAM 0.69 Y N Y YLEO /GM

2% OINT

0058667 FUCIDIN TOPICAL OINTMENT 0.69 Y N Y YLEO /GM

FUSIDIC ACID 2%

2% /1%CRM

0223857 FUCIDIN H TOPICAL CREAM 1.26 Y Y Y YLEO /GM

GENTAMICIN

1MG/GM

0080538 RATIO-GENTAMICIN CREAM 0.44 Y N Y YRTP /GM

1MG/GM OINT

0080502 RATIO-GENTAMICIN OINTMENT 0.43 Y N Y YRTP /GM



206

PHRM/CHRN/CDO/F84:04.04 ANTIBIOTICS (continued)

84:00 SKIN AND MUCOUS MEMBRANE AGENTS (continued)

MUPIROCIN

MUPIROCIN

2% CRM

0223975 BACTROBAN CREAM 0.55 Y N Y YGSK /GM

2% OINT

0227998 TARO-MUPIROCIN OINT 0.44 Y N Y YTAR /GM

0191694 BACTROBAN OINTMENT 0.55 Y N Y YGSK /GM

POLYMYX/NEOMYCIN/B

5000U//G

0066612 NEOSPORIN TOPICAL OINTMENT 0.47 Y N Y YGSK /GM

84:04.06 ANTIVIRALS ---------------------------------------------------------------------

ACYCLOVIR

5%

0203952 ZOVIRAX CREAM 13.18 Y N Y YGSK /GM

5% OINT

0056977 ZOVIRAX OINTMENT 13.18 Y N Y YGSK /GM

84:04.08 ANTIFUNGALS --------------------------------------------------------------------

CICLOPIROX OLAMINE

1%

0222180 LOPROX TOPICAL CREAM 0.31 Y N Y YHLR /GM

0222181 LOPROX TOPICAL LOTION 0.32 Y N Y YHLR /ML

1.5%

0224722 STIEPROX SHAMPOO 0.13 Y N Y YGSK /ML

CLOTRIMAZOLE

1%

0081238 CLOTRIMADERM TOP CRM 1% 0.22 Y N Y NTAR /GM

0081236 CLOTRIMADERM VAGINAL CREAM 0.19 Y N Y NTAR /GM

0223943 CANESTEN EXTERNAL CREAM 0.377 Y N Y NBCD /GM

0215086 CANESTEN TOPICAL CREAM 0.3 Y N Y NBCD /GM

0215089 CANESTEN-6 VAGINAL CREAM 0.24 Y N Y NBCD /GM

0222938 CLOTRIMAZOLE TOP CRM 1% 0.21 Y N Y NTAR /GM

0222937 CLOTRIMAZOLE VAG CR 1% 0.13 Y N Y NSAI /GM

2%

0215090 CANESTEN-3 VAGINAL CREAM 0.49 Y N Y NBCD /GM

0222937 CLOTRIMAZOLE VAGINAL CREAM 0.34 Y N Y NTAR /GM

0081237 CLOTRIMADERM VAGINAL CREAM 0.39 Y N Y NTAR /GM

500MG

0215094 CANESTEN-1-COMBI-PAK 12.08 Y N Y NBCD /GM

KETOCONAZOLE

2%

0224566 KETODERM TOPICAL CREAM 0.32 Y N Y YTAR /GM

0218292 NIZORAL SHAMPOO 0.09 N N Y NMCL /ML



207

PHRM/CHRN/CDO/F84:04.08 ANTIFUNGALS (continued)


MICONAZOLE NITRATE

MICONAZOLE NITRATE

100MG

0212625 MONISTAT 7 DUOPAK 13.76 Y N Y YMCL /PK

2%

0212656 MONISTAT DERM CREAM TOPICAL 0.35 Y N Y NMCL /GM

0208430 MONISTAT-7 VAGINAL CREAM 0.34 Y N Y NMCL /GM

0208585 MICATIN TOPICAL CREAM 0.3 Y N Y NMCL /GM

0223110 MICOZOLE 0.26 Y N Y NTAR /GM

4%

0224400 MONISTAT 3 VAGINAL CREAM 0.8 Y N Y NMCL /GM

400MG

0212624 MONISTAT 3 COMBINATION 13.76 Y N Y NMCL /PK

0217177 MICONAZOLE 3 DAY OVULE 4.8 Y N Y NSDM /PK

0212660 MONISTAT-3 VAGINAL OVULES 4.01 Y N Y NMCL /PK

NYSTATIN

100000U/G

0071687 NYADERM TOPICAL CREAM 0.07 Y N Y NTAR /GM

0071689 NYADERM TOPICAL OINTMENT 0.0903 Y N Y NTAR /GM

0219423 RATIO-NYSTATIN TOPICAL CREAM 0.06 Y N Y NRTP /GM

0219416 RATIO-NYSTATIN VAGINAL CREAM 0.32 Y N Y YRTP /GM

100000U/G OINT

0219422 RATIO-NYSTATIN TOPICAL 0.12 Y N Y NRTP /GM

25000U/G

0071690 NYADERM VAGINAL CREAM 0.13 Y N Y YTAR /GM

TERBINAFINE HCL

1%

0203109 LAMISIL TOPICAL CREAM 0.53 Y N Y YNVR /GM

10MG/GM

0223870 LAMISIL SPRAY 0.54 Y N Y YNVR /GM

TERCONAZOLE

0.4%

0224765 TARO-TERCONAZOLE VAG CRM 0.46 Y N Y YTAR /GM

0089472 TERAZOL-7 VAGINAL CREAM (PKG) 0.64 Y N Y YJAN /GM

80MG

0213087 TERAZOL-3 DUAL-PAK 9.21 Y N Y YJAN /EA

84:04.12 SCABICIDES AND PEDICULICIDES ---------------------------------------------------

CROTAMITON

10%

0062337 EURAX TOPICAL CREAM 0.3584 Y N Y NCLC /GM



208

PHRM/CHRN/CDO/F84:04.12 SCABICIDES AND PEDICULICIDES


PERMETHRIN

PERMETHRIN

1%

0077136 NIX CREME RINSE 0.159 N N Y NINS /ML

0223148 KWELLADA-P CREME RINSE 0.2328 N N Y NGCH /ML

5%

0221990 NIX DERMAL CREAM 0.5 N N Y NGCH /GM

0223134 KWELLADA-P TOPICAL LOTION 0.5053 N N Y NGCH /ML

PETROLEUM DISTILLATE

0.33//%

0212544 R&C SHAMPOO/CONDITIONER 0.09 N N Y NGCH /ML

84:04.16 MISCELLANEOUS ANTI-INFECTIVES --------------------------------------------------

METRONIDAZOLE

0.75%

0222683 METROCREAM TOPICAL CREAM 0.66 Y N Y YGAC /GM

0209283 METROGEL TOPICAL GEL 1.26 Y N Y YGAC /GM

0212522 NIDAGEL VAGINAL GEL 0.3 Y N Y YFEI /GM

0224820 METROLOTION 0.526 Y N Y YGAC /ML

1%

0229780 METROGEL TOPICAL GEL 0.64 Y N Y YGAC /GM

0215609 NORITATE TOPICAL CREAM 0.57 Y N Y YDER /GM

10%

0192686 FLAGYL VAGINAL CREAM 0.24 Y N Y YAVT /GM

10MG/GM

0224291 ROSASOL CREAM 0.53 Y N N YSTI /GM

500MG

0192682 FLAGYSTATIN VAGINAL OVULE 3.2 Y N Y YAVT /TB

500/4.5GM

0192684 FLAGYSTATIN CRM 0.58 Y N Y YAVT /GM

SILVER SULFADIAZINE

1%

0032309 FLAMAZINE CREAM TUBE 0.13 Y N Y YSNI /GM

SULFACETAMIDE/COLLO

10%/5%

0222040 SULFACET-R TOPICAL LOTION 1.02 Y N Y YDER /GM

84:06.00 ANTI-INFLAMMATORY AGENTS -------------------------------------------------------

AMCINONIDE



209



AMCINONIDE (continued)

0.1%

0224709 RATIO-AMCINONIDE TOPICAL 0.19 Y Y Y YRPH /GM

0224671 TARO-AMCINONIDE CREAM 0.1% 0.19 Y Y Y YTAR /GM

0219228 CYCLOCORT TOPICAL CREAM 0.42 Y Y Y YSTI /GM

0219227 CYCLOCORT TOPICAL LOTION 0.35 Y Y Y YSTI /ML

0224709 RATIO-AMCINONIDE LOTION 0.4 Y Y Y YRTP /ML

0.1% OINT

0219226 CYCLOCORT TOPICAL OINTMENT 0.42 Y Y Y YSTI /GM

BECLOMETHASONE

0.025%

0208960 PROPADERM TOPICAL CREAM 0.43 Y Y Y YRBP /GM

BETAMETHASONE

0.05%/1%

0061117 LOTRIDERM TOPICAL CREAM 0.92 Y Y Y YSCH /GM

0.05%/2%

0224568 RATIO-DIPROSALIC TOPICAL LOTIO 0.52 Y Y Y YRTP /ML

0057842 DIPROSALIC TOPICAL LOTION 0.52 Y Y Y YSCH /ML

0.05%/3% O

0057843 DIPROSALIC TOPICAL OINTMENT 1.05 Y Y Y YSCH /GM

BETAMETHASONE

0.05%

0068862 DIPROLENE TOPICAL GLYCOL 0.5187 Y Y Y YSCH /GM

0192535 TARO-SONE TOPICAL CREAM 0.2 Y Y Y YTAR /GM

0084965 RATIO-TOPILENE TOPICAL GLY CR 0.5187 Y Y Y YRTP /GM

0080499 RATIO-TOPISONE CRM 0.2 Y Y Y YRTP /GM

0032307 DIPROSONE TOPICAL CREAM 0.2 Y Y Y YSCH /GM

0192791 RATIO-TOPILENE TOP GLY LOT 0.27 Y Y Y YRTP /ML

0086297 DIPROLENE TOPICAL GLYCOL 0.27 Y Y Y YSCH /ML

0080918 RATIO-TOPISONE TOPICAL LOTION 0.198 Y Y Y YRTP /ML

0194444 TARO-SONE TOPICAL LOTION 0.198 Y Y Y YTAR /ML

0041724 DIPROSONE TOPICAL LOTION 0.198 Y Y Y YSCH /ML

0.05% OINT

0084966 RATIO-TOPILENE TOPICAL GYL OT 0.5187 Y Y Y YRTP /GM

0080500 RATIO-TOPISONE TOPICAL 0.22 Y Y Y YRTP /GM

0062936 DIPROLENE TOPICAL GYLCOL OINT 0.5187 Y Y Y YSCH /GM

0034492 DIPROSONE TOPICAL OINTMENT 0.22 Y Y Y YSCH /GM

BETAMETHASONE

0.05%

0071661 BETADERM TOPICAL CREAM 0.06 Y Y Y YTAR /GM

0053542 RATIO-ECTOSONE MILD TOPICAL 0.06 Y Y Y YRTP /GM

0065320 RATIO-ECTOSONE TOPICAL 0.26 Y Y Y YRTP /ML



210



BETAMETHASONE VALERATE (continued)

0.05% OINT

0071664 BETADERM TOPICAL OINTMENT 0.06 Y Y Y YTAR /GM

0.1%

0071662 BETADERM TOPICAL CREAM 0.1 Y Y Y YTAR /GM

0053543 RATIO-ECTOSONE REG TOPICAL CR 0.1 Y Y Y YRTP /GM

0065321 RATIO-ECTOSONE SCALP LOTION 0.09 Y Y N YRTP /ML

0071663 BETADERM SCALP LOTION 0.09 Y Y Y YTAR /ML

0002794 VALISONE SCALP LOTION 0.09 Y Y Y YSCH /ML

0075005 RATIO-ECTOSONE TOPICAL 0.317 Y Y Y YRTP /ML

0.1% OINT

0071665 BETADERM TOPICAL OINTMENT 0.09 Y Y Y YTAR /GM

CLOBETASOL

0.05%

0223219 PMS-CLOBETASOL CREAM 0.3 Y Y Y YPMS /GM

0191027 RATIO-CLOBETASOL TOPICAL 0.23 Y Y Y YRTP /GM

0224552 TARO-CLOBETASOL TOPICAL CRM 0.26 Y Y Y YTAR /GM

0202418 GEN-CLOBETASOL CRM 0.05% 0.23 Y Y Y YGPM /GM

0209316 NOVO-CLOBETASOL TOPICAL 0.23 Y Y Y YNOP /GM

0191029 RATIO-CLOBETASOL SCALP APP 0.2 Y Y Y YRTP /ML

0221328 DERMOVATE SCALP APPLICATION 0.72 Y Y Y YGSK /ML

0224552 TARO-CLOBETASOL TOICAL 0.25 Y Y Y YTPM /ML

0221621 GEN-CLOBETASOL SCALP APP 0.2 Y Y Y YGPM /ML

0.05% OINT

0223219 PMS-CLOBETASOL OINTMENT 0.375 Y Y Y YPMS /GM

0212619 NOVO-CLOBETASOL TOPICAL 0.23 Y Y Y YNOP /GM

0191028 RATIO-CLOBETASOL TOPICAL 0.23 Y Y Y YRTP /GM

0224552 TARO-CLOBETASOL TOPICAL OINT 0.23 Y Y Y YTAR /GM

0202676 GEN-CLOBETASOL OINTMENT 0.23 Y Y Y YGPM /GM

CLOBETASONE

0.05%

0221441 EUMOVATE TOPICAL CREAM 0.38 Y Y Y YGSK /GM

DESONIDE

0.05%

0222931 PMS-DESONIDE TOPICAL CREAM 0.33 Y Y Y YPMS /GM

0215486 TRIDESILON TOPICAL CREAM 0.388 Y Y Y YBAY /GM

0211551 DESOCORT TOPICAL LOTION 0.25 Y Y Y YGAC /ML

0.05% OINT

0215487 TRIDESILON TOPICAL OINTMENT 0.3867 Y Y Y YBAY /GM

0222932 PMS-DESONIDE TOPICAL 0.31 Y Y Y YPMS /GM

0211552 DESOCORT TOPICAL OINTMENT 0.315 Y Y Y YGAC /GM



211



DESOXIMETASONE

DESOXIMETASONE

0.05%

0222191 TOPICORT MILD TOPICAL CREAM 0.42 Y Y Y YHLR /GM

0223906 DESOXI TOPICAL CREAM 0.2785 Y Y Y YOPT /GM

0.25%

0222189 TOPICORT TOPICAL CREAM 0.63 Y Y Y YHLR /GM

DIFLUCORTOLONE

0.1%

0058782 NERISONE TOPICAL CREAM 0.394 Y Y Y YSTI /GM

0058781 NERISONE TOPICAL OILY CREAM 0.394 Y Y Y YSTI /GM

0.1% OINT

0058783 NERISONE TOPICAL OINTMENT 0.386 Y Y Y YSTI /GM

FLUMETHASONE

3.0/0.02%

0007446 LOCACORTEN VIOFORM TOP CR 0.91 Y N Y YPAL /ML

FLUOCINOLONE

0.01%

0071678 FLUODERM TOPICAL CREAM 0.0694 Y Y Y YTAR /GM

0087329 DERMA SMOOTH/FS LIQ 0.28 Y Y Y YHIL /ML

0.01%SOL

0216250 SYNALAR TOPICAL 0.41 Y Y Y YMDC /ML

0.025%

0071679 FLUODERM TOPICAL CREAM 0.31 Y Y Y YTAR /GM

0.025% OIN

0216251 SYNALAR REG TOPICAL OINTMENT 0.43 Y Y Y YMDC /GM

0071681 FLUODERM TOPICAL OINTMENT 0.0889 Y Y Y YTAR /GM

0.1% SHP

0224273 CAPEX SHAMPOO 0.72 Y Y Y YGAC /ML

FLUOCINONIDE

0.05%

0071686 LYDERM TOPICAL CREAM 0.24 Y Y Y YTAR /GM

0216192 LIDEX TOPICAL CREAM 0.24 Y Y Y YMDC /GM

0216315 LIDEMOL IN EMOLLIENT BASE 0.2 Y Y Y YMDC /GM

0.05% GEL

0223699 LYDERM TOPICAL GEL 0.31 Y Y Y YTAR /GM

0216197 LIDEX GEL 0.05% 0.31 Y Y Y YMDC /GM

0.05% OINT

0216196 LIDEX TOPICAL OINTMENT 0.3 Y Y Y YHLR /GM

0223699 LYDERM TOPICAL OINTMENT 0.3 Y Y Y YTAR /GM



212



HALOBETASOL

HALOBETASOL

0.05%

0196270 ULTRAVATE CREAM 0.91 E E N YWSD /GM

0.05% OINT

0196272 ULTRAVATE OINTMENT 0.05% 0.88 E E N YWSD /GM

HYDROCORTISONE

0.5% CRM

0071682 HYDERM TOPICAL CREAM 0.189 Y N Y NTAR /GM

0051328 CORTATE TOPICAL CREAM 0.1333 Y N N NSCH /GM

0.5% OINT

0071668 CORTODERM TOPICAL OINTMENT 0.155 Y N Y NTAR /GM

1%

0019260 EMO-CORT TOPICAL LOTION 0.16 Y N Y NSTI /ML

0057854 SARNA HC TOPICAL LOTION 0.094 Y N Y NSTI /ML

1% CRM

0019259 EMO-CORT TOPICAL CREAM 0.17 Y N Y NSTI /GM

0071683 HYDERM TOPICAL CREAM 0.09 Y N Y NTAR /GM

1% OINT

0071669 CORTODERM TOPICAL OINTMENT 0.04 Y Y Y YTAR /GM

2%

0074983 TOPIDERM HC 2% TOPICAL CREAM 0.29 Y N Y YTPI /GM

2.5%

0059579 EMO-CORT TOPICAL CREAM 0.2 Y Y Y YSTI /GM

0059580 EMO-CORT TOPICAL LOTION 0.21 Y Y Y YSTI /ML

0085671 SARNA HC TOPICAL LOTION 0.18 Y Y Y YSTI /ML

20/50GM

0007450 VIOFORM HYDROCORTISONE 0.86 Y N Y YNVR /GM

HYDROCORTISONE

0.5/.5%ZIN

0212844 ANODAN-HC OINTMENT 0.39 Y N Y YODN /GM

0060778 HEMCORT HC OINTMENT 0.39 Y N Y YTEC /GM

0224769 SANDOZ ANUZINC HC 0.38 Y N Y YSDZ /GM

0050577 ANUSOL HC OINTMENT 0.76 Y N Y YPFI /GM

0.5/1/0.5%ZINC

0223446 PROCTODAN-HC OINTMENT 0.73 Y N Y YODN /GM

0050578 ANUGESIC HC OINTMENT 0.91 Y N Y YPFI /GM

10%

0057933 CORTIFOAM 6.54 Y Y Y YGSK /GM



213



HYDROCORTISONE ACETATE (continued)

10/10MG ZINC

0047628 ANUSOL HC SUPOSITORIES 1 Y N Y YPFI /SP

0223639 ANODAN-HC SUPPOSITORIES 0.58 Y N Y YODN /SP

0060779 HEMCORT HC SUPPOSITORIES 0.58 Y N Y YTEC /SP

0224279 SAB-ANUZINC HC SUPPOSITORIES 0.58 Y N Y YSDZ /SP

10/20/10MG

0224085 PROCTODAN-HC SUPP 0.78 Y N Y YODA /SP

0047624 ANUGESIC HC SUPP 1.37 Y N Y YPFI /SP

1%/1%

0036301 PROCTOFOAM-HC 1.71 Y N Y YGCH /GM

5/5/10/10MG FRAMYC

0222325 PROCTOSEDYL OINTMENT 0.83 Y N Y YAVT /GM

0224732 PROCTOL OINTMENT 0.4 Y N Y YODN /GM

0224252 SAB-PROCTOMYXIN HC OINT 0.4 Y N Y YSAB /GM

0222638 RATIO-PROCTOSONE OINTMENT 0.4 Y N Y YRPH /GM

0224788 PROCTOL SUPPOS 0.6 Y N Y YODN /SP

0222326 PROCTOSEDYL SUPPOS 1.09 Y N Y YAVT /SP

0224252 SAB-PROCTOMYXIN HC SUPPOS 0.6 Y N Y YSAB /SP

0222639 RATIO-PROCTOSONE SUPPOS 0.6 Y N Y YRPH /SP

HYDROCORTISONE

0.2%

0224298 HYDROVAL CR TOPICAL CREAM 0.17 Y Y Y YOPT /GM

0.2% OINT

0224298 HYDROVAL OINTMENT TOP OINT 0.17 Y Y Y YOPT /GM

HYDROCORTISONE/PRA

1%/1%

0077095 PRAMOX HC TOPICAL CREAM 0.44 N N Y NDPL /GM

MOMETASONE FUROATE

0.1%

0085174 ELOCOM TOPICAL CREAM 0.68 Y Y Y YSCH /GM

0236715 TARO-MOMETASONE TOPICAL 0.57 Y Y Y YTAR /GM

0226638 TARO-MOMETASONE LOTION 0.34 Y Y Y YTAR /ML

0087109 ELOCOM TOPICAL LOTION 0.48 Y Y Y YSCH /ML

0.1% OINT

0224476 PMS-MOMETASONE TOPICAL 0.3493 Y Y Y YPMS /GM

0226474 TARO-MOMETASONE TOPICAL 0.28 Y Y Y YTAR /GM

0085173 ELOCOM TOPICAL OINTMENT 0.61 Y Y Y YSCH /GM

0224813 RATIO-MOMETASONE TOPICAL 0.57 Y Y Y YRPH /GM



214



NEOMYC/GRAM/NYS/TRIAMCINOLONE

NEOMYC/GRAM/NYS/TR

2.5//G CRM

0071700 VIADERM-KC 0.24 Y N Y YTAR /GM

2.5//G OINT

0071702 VIADERM-KC 0.47 Y N Y YTAR /GM

0055050 RATIO-TRIACOMB REG CRM 0.226 Y N Y YRTP /GM

POLYMYX/BACIT/NEOM/

5000U//G

0066624 CORTISPORIN TOPICAL OINT 0.79 Y N Y YGSK /GM

TRIAMCINOLONE

0.025%

0071695 TRIADERM TOPICAL CREAM 0.0464 Y Y Y YTAR /GM

0.1%

0071696 TRIADERM TOPICAL CREAM 0.05 Y Y Y YTAR /GM

0219405 ARISTOCORT R TOPICAL CREAM 0.05 Y Y Y YSTI /GM

0.1% OINT

0071698 TRIADERM TOPICAL OINTMENT 0.0716 Y Y Y YTAR /GM

0219403 ARISTOCORT R TOPICAL OINTMENT 0.13 Y Y Y YSTI /GM

0.1% PASTE

0196405 ORACORT DENTAL PASTE 1.23 Y N Y YTAR /GM

0.5%

0219406 ARISTOCORT C TOPICAL CREAM 1.152 Y Y Y YSTI /GM

84:12.00 ASTRINGENTS AND DEODORANTS -----------------------------------------------------

ALUMINUM

0.35/.023%

0057994 BURO-SOL POWDER (2.36G PK) 0.751 N N Y NSTI /EA

84:16.00 CELL STIMULANTS AND PROLIFERANTS -----------------------------------------------

ERYTHROMYCIN

0.01%

0201599 STIEVAMYCIN MILD TOPICAL GEL 0.84 N N Y YSTI /GM

4%;025%

0190511 STIEVAMYCIN GEL 0.84 N N Y YSTI /GM

TRETINOIN

0.01%

0065720 STIEVA-A TOPICAL CREAM 0.3 N N Y YSTI /GM

0089732 RETIN A TOPICAL CREAM 0.356 N N Y YJAN /GM

0.01% GEL

0087001 RETIN A TOPICAL GEL 0.3737 N N Y YJAN /GM

0192646 VITAMIN A ACID TOPICAL GEL 0.31 N N Y YDER /GM



215

PHRM/CHRN/CDO/F84:16.00 CELL STIMULANTS AND PROLIFERANTS (continued)


TRETINOIN (continued)

0.025%



0.025% GEL

0044381 RETIN A TOPICAL GEL 0.4 N N Y YJAN /GM


0.05%



0.05% GEL


0.1%

0066234 STIEVA-A FORTE TOPICAL CREAM 0.3 N N Y YSTI /GM


84:24.04 BASIC LOTIONS AND LINIMENTS ----------------------------------------------------

CAPSAICIN

0.025%

0215710 CAPSAICIN REGULAR(STIEFEL 0.179 Y N N NSTI /GM

0074030 ZOSTRIX CREAM 0.2192 Y N N NMED /GM

0.075%

0215712 CAPSAICIN FORTE (STIEFEL) 0.225 Y N N NSTI /GM

0200424 ZOSTRIX HP CREAM 0.28 Y N N NMED /GM

84:28.00 KERATOLYTIC AGENTS -------------------------------------------------------------

ADAPALENE

0.1%

0223159 DIFFERIN CR 1.86 N N Y YGAC /GM

0214874 DIFFERIN TOPICAL GEL 1.71 N N Y YGAL /GM

BENZOYL PEROXIDE

10%

0026369 PANOXYL-10 TOPI GEL (ALCOH BS) 0.1458 Y N Y YSTI /GM

0191243 BENZAC AC GEL (AQUEOUS BASE) 0.333 Y N Y YGAC /GM

0043293 OXYDERM TOPICAL LOTION 0.1545 Y N Y YICN /ML

10% BAR

0052766 PANOXYL BAR 0.1123 Y N Y YSTI /GM

10% WASH

0192519 BENZAC W WASH 0.31 Y N Y YGAC /GM

20%

0037303 PANOXYL-20 TOP GEL (ALCO BASE) 0.19 Y N Y YSTI /GM

0037431 OXYDERM TOPICAL LOTION 0.2005 Y N Y YICN /ML



216

PHRM/CHRN/CDO/F84:28.00 KERATOLYTIC AGENTS (continued)


COAL TAR/JUNIPER TAR/PINE TAR

COAL TAR/JUNIPER

1.0%

0024986 POLYTAR SHAMPOO 0.04 N N Y NSTI /ML

DITHRANOL

0.1%

0053759 ANTHRANOL TOPICAL CREAM 0.5616 Y N N NMED /GM

0.2%

0053760 ANTHRANOL TOPICAL CREAM 0.592 Y N N NMED /GM

0.4%

0069535 ANTHRASCALP LOTION 0.7 Y N N NMED /ML

1% OINT

0056675 ANTHRAFORTE-1 OINTMENT 0.7646 Y N N NMED /GM

2% OINT

0056674 ANTHRAFORTE-2 OINTMENT 0.81 Y N N NMED /GM

LACTIC ACID/SALICYLIC

16.7/16.7%

0037057 DUOFILM 0.54 N N Y NSTI /ML

PODOPHYLLOTOXIN

0.5%

0194514 CONDYLINE TOPICAL (PACKAGE) 11.089 Y N Y YCDX /ML

0207478 WARTEC TOPICAL (PACKAGE) 16.1 Y N Y YPMS /ML

84:36.00 MISCELLANEOUS SKIN & MUCOUS MEMBRANE AGENTS ------------------------------------

ACITRETIN

10MG

0207084 SORIATANE 2.04 E E N YHLR /CP

25MG

0207086 SORIATANE 3.59 E E N YHLR /CP

ALITRETINOIN

10MG

0233763 TOCTINO 21.99 N E N YGSK /CP

30MG

0233764 TOCTINO 21.99 N E N YGSK /CP

CALCIPOTRIOL

50UG/G

0215095 DOVONEX TOPICAL CREAM 0.8 Y Y N YLEO /GM

50UG/G OIN

0197613 DOVONEX TOPICAL OINTMENT 0.76 Y Y N YLEO /GM

50UG/ML

0219434 DOVONEX 0.8 Y Y N YLEO /ML



217

PHRM/CHRN/CDO/F84:36.00 MISCELLANEOUS SKIN & MUCOUS MEMBRANE AGENTS (continued)


CALCIPOTRIOL/BETAMETHASONE DIP

CALCIPOTRIOL/BETAMET

0.5MG/50UG/G

0224412 DOVOBET OINTMENT 1.46 Y Y N YLEO /GM

50UG/0.5MG/G

0231901 DOVOBET GEL 1.54 Y Y N YLEO /GM

CYPROTERONE/ESTROGE

2MG/35MCG

0223354 DIANE-35 1.61 N N Y YBEX /TB

FLUOROURACIL

5%

0033058 EFUDEX TOPICAL CREAM 0.84 Y N N YICN /GM

IMIQUIMOD

5%

0240782 APO-IMIQUIMOD 11.03 E E N YAPX /EA

0223950 ALDARA 5% CREAM 50.13 E E N YVAE /EA

ISOTRETINOIN

10MG

0058234 ACCUTANE 0.93 N N Y YHLR /CP

40MG

0058235 ACCUTANE 1.9 N N Y YHLR /CP

PODOPHYLLIN

250MG/ML

0059820 PODOFILM LIQ (25%) 1.26 Y N Y YPAL /ML

TAZAROTENE

0.05%

0223078 TAZORAC TOPICAL GEL 1.36 N Y N YALL /GM

0.1%

0223078 TAZORAC TOPICAL GEL 1.36 N Y N YALL /GM

84:50.06 PIGMENTING AGENTS --------------------------------------------------------------

METHOXSALEN

1%

0190747 OXSORALEN TOPICAL LOTION 1.51 N E N YICN /ML

10MG

0000726 OXSORALEN 0.884 N E N YICN /CP

84:92.00 MISC. SKIN AND MUCOUS MEMBRANE AGENTS ------------------------------------------

AZELAIC ACID

15%

0227081 FINACEA 0.6 Y N Y YBAY /GM



218

PHRM/CHRN/CDO/F84:92.00 MISC. SKIN AND MUCOUS MEMBRANE AGENTS


SECUKINUMAB

SECUKINUMAB

150MG/ML

0243807 COSENTYX 1645 E E N YNVR /KT

86:00 SMOOTH MUSCLE RELAXANTS

86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS ------------------------------------------

DARIFENACIN

15MG ER

0227322 ENABLEX 1.55 E E N YNVR /TB

7.5MG ER

0227321 ENABLEX 1.5 E E N YNVR /TB

FLAVOXATE HCL

200MG

0072817 URISPAS 0.494 Y Y Y YPMS /TB

0224484 APO-FLAVOXATE 0.727 Y Y Y YAPX /TB

OXYBUTYNIN CHLORIDE

1MG/ML

0223108 APO-OXYBUTYNIN SYRUP 0.0622 Y N Y YAPX /ML

0222337 PMS-OXYBUTYNIN SYRUP 0.134 Y N Y YPMS /ML

10 MG ER

0224396 DITROPAN XL 10MG 2.28 E N N YJAN /TB

2.5MG

0224054 PMS-OXYBUTYNIN 0.15 Y N Y YPMS /TB

5MG

0235023 SANIS-OXYBUTYNIN 0.1 Y N Y YSAI /TB

0223080 GEN-OXYBUTYNIN 0.1 Y N Y YGPM /TB

0216354 APO-OXYBUTYNIN 0.1 Y N Y YAPX /TB

0224055 PMS-OXYBUTYNIN 0.1 Y N Y YPMS /TB

0223039 NOVO-OXYBUTYNIN 0.1 Y N Y YNOP /TB

5 MG ER

0224396 DITROPAN XL 2.28 E N N YJAN /TB

SOLIFENACIN

10MG

0242224 ACT SOLIFENACIN 0.42 Y N N YACA /TB

0239904 SANDOZ SOLIFENACIN 0.42 Y N N YSDZ /TB

0227727 VESICARE 1.5 Y N N YAST /TB

5MG

0242223 ACT SOLIFENACIN 0.42 Y N N YACA /TB

0239903 SANDOZ SOLIFENACIN 0.42 Y N N YSDZ /TB

0227726 VESICARE 1.5 Y N N YAST /TB



219

PHRM/CHRN/CDO/F86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS (continued)

86:00 SMOOTH MUSCLE RELAXANTS (continued)

TOLTERODINE

TOLTERODINE

1MG

0223906 DETROL 0.98 Y N N YPMS /TB

0242330 MINT-TOLTERODINE 0.49 Y N N YMNT /TB

2MG

0240418 MYLAN-TOLTERODINE ER 1.47 E N N YMYL /CP

0241219 TEVA-TOLTERODINE LA 0.49 E N N YTVM /CP

0224461 DETROL LA 1.96 E N N YPHU /CP

0223906 DETROL 0.98 Y N N YPMS /TB

0242331 MINT-TOLTERODINE 0.49 Y N N YMNT /TB

4MG

0241220 TEVA-TOLTERODINE LA 0.49 E N N YTVM /CP

0240419 MYLAN-TOLTERODINE ER 1.47 E N N YMYL /CP

0224461 DETROL LA 1.96 E N N YPHU /CP

86:12.04 null -------------------------------------------------------------------------------

SOLIFENACIN

5MG

0239790 TEVA-SOLIFENACIN 0.42 Y N N YTVM /TB

86:12.08 null -------------------------------------------------------------------------------

MIRABEGRON

25MG

0240287 MYRBETRIQ 1.46 E N N YASL /TB

50MG

0240288 MYRBETRIQ 1.46 E N N YASL /TB

86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS --------------------------------------------

OXTRIPHYLLINE

100MG

0044172 APO-OXTRIPHYLLINE 0.0475 Y Y N YAPX /TB

20MG/ML

0047636 CHOLEDYL ELIXIR 0.03 Y Y N YPFI /ML

0079294 PMS-OXTRIPHYLLINE ELIXIR 0.03 Y Y N YPMS /ML

200MG


300MG


OXTRIPHYLLINE/GUAIFE

20/10MG/ML

0047637 CHOLEDYL EXPECTORANT 0.1 Y Y N YPFI /ML



220

PHRM/CHRN/CDO/F86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS (continued)

86:00 SMOOTH MUSCLE RELAXANTS (continued)

THEOPHYLLINE (ANHYDROUS)

THEOPHYLLINE

100MG

0223008 NOVO-THEOPHYL SR 0.13 Y Y N YNOP /TB

0069268 APO-THEO-LA 0.13 Y Y N YAPX /TB

200MG


0223008 NOVO-THEOPHYL SR 0.14 Y Y N YNOP /TB

300MG


0223008 NOVO-THEOPHYL SR 0.14 Y Y Y YNOP /TB

400MG

0201416 UNIPHYL 0.5 Y Y N YPFR /TB

400MG ER

0236010 THEO ER 0.3735 Y Y N YAA /TB

5.33MG/ML

0196621 THEOLAIR LIQUID 0.03 Y Y N YMDA /ML

600MG

0201418 UNIPHYL 0.61 Y Y N YPFR /TB

600MG ER

0236012 THEO ER 0.452 Y Y N YAA /TB

88:00 VITAMINS

88:08.00 VITAMIN B COMPLEX --------------------------------------------------------------

CYANOCOBALAMIN

1MG/ML

0198700 CYANOCOBALAMIN (10ML) 0.45 Y E N YCYT /ML

0052151 VITAMIN B12 (10ML) 0.3 Y E N YSAB /ML

0205271 CYANOCOBALAMIN (10ML) 0.31 Y E N YTAR /ML

0062611 VITAMIN B12 (10ML) 0.31 Y E N YOMG /ML

100MCG

0033101 VITAMIN B12 0.0548 Y E N NJAM /TB

100MCG/ML

0224150 VITAMIN B12 (1ML) 1.49 Y E N YSAB /ML

1000MCG

8000357 VITAMIN B12 0.056 Y E N NSDM /TB

0223773 VITAMIN B12 0.08 Y E N NSWI /TB

250MCG

0033594 VITAMIN B12 0.0625 Y E N NJAM /TB

8000405 VITAMIN B12 0.04 Y N N NSAI /TB

500MCG

0068972 VITAMIN B12 0.0686 Y E N NWHL /TB

8000079 VITAMIN B12 (NATURES) 0.06 Y E N NNAT /TB



221

PHRM/CHRN/CDO/F88:08.00 VITAMIN B COMPLEX (continued)

88:00 VITAMINS (continued)

CYANOCOBALMIN

CYANOCOBALMIN

250MCG


FOLIC ACID

5MG

0236606 JAMP-FOLIC 0.04 Y N Y YJPC

/TB

0228567 EURO-FOLIC ACID 0.02 Y N Y YWHL /TB

0042684 APO-FOLIC 0.04 Y N Y YAPX /TB

LEUCOVORIN CALC.

5 MG

0217049 LEUCOVORIN LEDERLE 6.82 Y E N YWYA /TB

NIACIN

100MG

0026858 NIACIN 0.031 Y N N NICN /TB

0023245 NIACIN 0.0257 Y N N NLEA /TB

50MG


500MG

0055741 NIACIN 0.023 Y N N NVIT /TB

0023244 NIACIN 0.0546 Y N N NLEA /TB


0030973 NIACIN 0.055 Y N N NJAM /TB

PYDIROXINE HCL

100MG

8000366 VITAMIN B6 0.05 Y E Y NWEB /TB

PYRIDOXINE HCL

100MG

0032918 VITAMIN B6 0.0625 Y E Y NJAM /TB

0223934 VITAMIN B6 0.059 Y E Y NPMS /TB

25MG

0023247 PYRIDOXINE HCL 0.0245 Y E Y NLEA /TB

0026860 VITAMIN B6 0.0258 Y E Y NICN /TB

250MG

0033103 VITAMIN B6 0.102 Y E Y NJAM /TB

VITAMIN B12

100MCG


1000MCG

8000693 LIFE BRAND VITAMIN B12 0.059 Y N N NWHL /TB



222

PHRM/CHRN/CDO/F88:08.08 null


VITAMIN B COMPLEX &VITAMIN C

88:08.08 null -------------------------------------------------------------------------------

MULTI

8000143 RENAVITE 0.064 E E N NMAC /TB

88:16.00 VITAMIN D ----------------------------------------------------------------------

ALFACALCIDOL

0.25UG

0047451 ONE-ALPHA 0.47 Y E N YLEO /CP

1.0UG

0047452 ONE ALPHA 1.42 Y E N YLEO /CP

CALCIFEROL

8288IU/ML

0201759 DRISDOL 0.4268 Y N N NSAW /ML

CALCITRIOL

0.25UG

0048182 ROCALTROL 0.93 Y E N YHLR /CP

0243163 CALCITRIOL-ODAN 0.7 Y E N YODN /CP

0.5UG

0048181 ROCALTROL 1.48 Y E N YHLR /CP

0243164 CALCITRIOL-ODAN 1.11 Y E N YODN /CP

VITAMIN D

10,000IU

0082177 D-TABS 10,000 0.21 Y N N YRIV /TB

0237900 JAMP-VITAMIN D 0.21 Y N N YJAM /TB

1000IU

8001220 VITAMIN D 0.02 Y N Y NLIF /CP

8000366 LIFE BRAND VITAMIN D 0.031 Y N N NWHL /TB

0224584 VITAMIN D 0.0362 Y N N NWHL /TB

0032317 VITAMIN D 0.028 Y N Y NSWI /TB

8000043 VITAMIN D 0.03 Y N N NJAM /TB

8000013 VITAMIN D EQUATE 0.023 Y N Y NWHL /TB

400IU

0224387 VITAMIN D DROPS 0.14 N N Y NWHL /ML

8001593 JAMIESON-VITAMIN D 0.04 N N Y NWHL /TB

8000879 VITAMIN D 0.064 N N Y NWHL /TB

0223872 VITAMIN D .. 0.0209 Y N Y NVTH /TB

0224085 VITAMIN D 0.039 Y N Y NPMS /TB

8000245 LIFE BRAND VITAMIN D 0.02 Y N N NWHL /TB

50000IU

0223745 D-FORTE 0.1986 Y E N YEUR /CP

0230191 OSTO-D2 0.2 Y E N YTRI /CP



223

PHRM/CHRN/CDO/F88:28.01 VITAMINS AND MINERALS


PRENATAL VITAMINS

88:28.01 VITAMINS AND MINERALS ----------------------------------------------------------

MULTI

0223188 MATERNA 0.125 N N Y NWYA /TB

88:29.00 CALCIUM ------------------------------------------------------------------------

CALCIUM 500MG

500MG

0224604 JAMP-CALCIUM 500MG 0.02 Y N Y NJPC

/TB

CALCIUM CARBONATE

500MG

0224024 CALCIUM 500MG 0.026 Y N Y NPHM /TB

0062244 O-CALCIUM 500 0.027 Y N Y NVTH /TB

8001367 O-CALCIUM 500 0.02 Y N Y NBMD /TB

8001096 CALCIUM 500MG 0.027 Y N Y NWHL /TB

0068203 APO-CAL 500 0.029 Y N Y NAPX /TB

600MG

0197914 CALCIUM CARBONATE 0.0187 Y N Y NPHM /TB

650MG

8003124 EXACT CALCIUM CARBONATE 650 0.02 Y N Y NEXA /TB

CALCIUM CARBONATE

350MG

0204088 CHEWABLE CALCIUM 0.0446 Y N Y NJAM /TB

400 MG

0215113 TUMS ULTRA STRENGTH 0.0419 Y N Y NGSK /TB

500MG

0070537 CHEWABLE CALCIUM 0.056 Y N Y NWAM /TB

CALCIUM

500MG/125

0207418 CALCIUM CARB W/VIT D3 0.0321 Y N N NVTH /TB

0077568 O CALCIUM 500 PLUS D 0.0287 Y N N NVTH /TB

0073059 CALCIUM CARB W/VIT D3 0.0264 Y N N NPHM /TB

500MG/200

8000028 CALCIUM 500MG W/VIT D 200 0.038 Y N N NWEB /TB

500MG/400IU

8000212 CALCIUM CARBONATE/VITAMIN D 0.17 Y N N NJPC

/TB

92:00 MISCELLANEOUS THERAPEUTIC AGENTS

92:00.00 MISCELLANEOUS THERAPEUTIC AGENTS -----------------------------------------------

ADALIMUMAB

40MG/0.8ML

0225859 HUMIRA 1525.14 E E N YABB /KT



224

PHRM/CHRN/CDO/F92:00.00 MISCELLANEOUS THERAPEUTIC AGENTS

92:00 MISCELLANEOUS THERAPEUTIC AGENTS (continued)

ALENDRONATE

ALENDRONATE

10MG

0238148 ACH-ALENDRONATE 0.5 Y E N YACH /TB

0224737 TEVA-ALENDRONATE 0.5 Y E N YTVM /TB

0240112 ACCEL-ALENDRONATE 0.4 Y E N YACC /TB

0224872 APO-ALENDRONATE 0.5 Y E N YAPX /TB

40MG

0225810 CO ALENDRONATE 3.08 Y E N YCOB /TB

5MG



70MG

0227527 RATIO-ALENDRONATE 2.52 Y E N YRTP /TB


0225811 CO ALENDRONATE 2.51 Y E N YCOB /TB

0228400 PMS-ALENDRONATE 2.51 Y E N YPMS /TB


0240113 ACCEL-ALENDRONATE 2.01 Y E N YACC /TB

0235296 SANIS-ALENDRONATE 2.52 Y E N YSAN /TB

0224532 FOSAMAX 10.55 Y E N YMSD /TB

0239487 MINT-ALENDRONATE 2.52 Y E N YMNT /TB

ALENDRONATE/CHOLEC

70MG/5600IU

0240364 TEVA- 2.31 Y E N YTVM /TB

0245447 APO-ALENDRONATE/VITAMIN D3 1.22 Y E N YAPX /TB

ALFUZOSIN

10MG

0230467 SDZ-ALFUZOSIN 0.26 Y N N YSDZ /TB

0224556 XATRAL 1.04 Y N N YSAN /TB

0231428 TEVA-ALFUZOSIN 0.5 Y N N YTVM /TB

0231586 APO-ALFUZOSIN 0.5 Y N N YAPX /TB

ALLOPURINOL

100MG

0239632 MAR-ALLOPURINOL 0.08 Y Y N YWHL /TB

0040281 ZYLOPRIM 0.078 Y Y N YAAA /TB

0240276 APO-ALLOPURINOL 0.078 Y Y N YAPX /TB

200MG






225

PHRM/CHRN/CDO/F92:00.00 MISCELLANEOUS THERAPEUTIC AGENTS (continued)


ALLOPURINOL (continued)

300MG




ANAKINRA

150MG/ML

0224591 KINERET 48.06 E E N YSOB /EA

AZATHIOPRINE

50MG

0224290 APO-AZATHIOPRINE 0.24 Y Y N YAPX /TB

0223681 NOVO-AZATHIOPRINE 0.24 Y Y N YNOP /TB

0000459 IMURAN 1.01 Y Y N YGSK /TB

0223149 GEN-AZATHIOPRINE 1.01 Y Y N YGPM /TB

0234300 SANIS-AZATHIOPRINE 0.24 Y Y N YSAN /TB

BETAHISTINE

16MG

0233021 PMS-BETAHISTINE 0.177 Y N N YPMS /TB

0228019 TEVA-BETAHISTINE 0.18 Y N N YTVM /TB

0244915 AURO-BETAHISTINE 0.12 Y N N YAUR /TB

0224387 SERC 16 MG 0.47 Y N N YSLV /TB

0237475 CO-BETAHISTINE 0.177 Y N N YCOB /TB

24MG

0233023 PMS-BETAHISTINE 0.49 Y N N YPMS /TB


0224799 SERC 0.7 Y N N YSLV /TB

0237476 CO-BETAHISTINE 0.49 Y N N YCOB /TB

8MG


BOTULINUM TOXIN TYPE

100U

0198150 BOTOX 357 E E N YALL /VL

BROMOCRIPTINE

2.5MG

0223170 PMS-BROMOCRIPTINE 0.4328 Y Y N YPMS /TB

0208732 APO-BROMOCRIPTINE 0.9782 Y Y N YAPX /TB

5MG

0223694 PMS-BROMOCRIPTINE 0.917 Y Y N YPMS /CP

0223045 APO-BROMOCRIPTINE 1.46 Y Y N YAPX /CP



226



BUSERELIN ACETATE

BUSERELIN ACETATE

9.45MG/IMP

0224074 SUPREFACT DEPOT 3 MONTHS 1137.26 Y Y N YAVT /EA

CERTOLIZUMAB PEGOL

200MG/ML

0233167 CIMZIA 1329.02 E E N YUCB /KT

CLODRONATE DISODIUM

400MG

0198484 BONEFOS 1.96 Y Y N YAVT /CP

0224582 CLASTEON 1.21 Y Y N YSUN /CP

60MG/ML

0198483 BONEFOS 63.51 Y Y N YBEX /ML

COLCHICINE

0.6MG

0028787 COLCHICINE 0.2565 Y Y N YWHL /TB

0240218 PMS-COLCHICINE 0.26 Y Y N YPMS /TB

0057234 COLCHICINE-ODAN 0.2565 Y Y N YODN /TB

COMPOUNDED

CPD INJ

0099002 COMPOUNDED INJECTABLES 100 E E N YCPD /ML

COMPOUNDED ORAL

CPD ORAL

0099002 COMPOUNDED ORAL PREPS 100 E E Y YCPD /EA

COMPOUNDED

CPD TOP

0099001 COMPOUNDED TOPICALS 100 Y E Y YCPD /GM

CYCLOSPORINE

10MG

0223767 NEORAL 0.6238 Y Y N YNVR /CP

100MG

0224282 SANDOZ CYCLOSPORINE 5.09 Y Y N YSDZ /CP


100MG/ML

0215069 NEORAL 5.0276 Y Y N YNVR /ML

25MG



50MG





227



DENOSUMAB

DENOSUMAB

60MG/ML

0234354 PROLIA 354.09 E E N YAMG /ML

DICITRATE SOLN

66.8/100MG

0072134 CITRIC ACID - SODIUM CITRATE 0.046 E N N NPMS /ML

DUTASTERIDE

0.5MG

0240420 APO-DUTASTERIDE 0.42 Y N N YAPX /CP

0244305 DUTASTERIDE 0.42 Y N N YSAI /CP

0241269 ACT DUTASTERIDE 0.42 Y N N YACT /CP

0224781 AVODART 1.68 Y N N YGCH /CP

ETANERCEPT

25MG/ML

0224290 ENBREL (4 VIALS) 776.98 E E N YIMM /KT

50MG/ML

0227472 ENBREL 405.99 E E N YIMM /KT

ETIDRONATE /CALCIUM

400/500MG

0224732 GEN-ETI-CAL CAREPAC 19.99 Y E N YGPM /KT

0217601 DIDROCAL 44.48 Y E N YPRO /KT

0226386 CO-ETIDROCAL COMBO KIT 29.99 Y E N YCOB /KT

0235321 SANIS-ETIDROCAL COMBO KIT 19.99 Y E N YSAN /KT

ETIDRONATE DISODIUM

200MG

0224533 GEN-ETIDRONATE 0.36 Y E N YGEN /TB

0224868 CO-ETIDRONATE 0.36 Y E N YCOB /TB

FEBUXOSTAT

80MG

0235738 ULORIC 1.59 E E N YTAK /TB

FINASTERIDE

5MG

0230690 RATIO-FINASTERIDE 0.46 Y N N YRPH /TB

0231011 PMS-FINASTERIDE 0.46 Y N N YPMS /TB

0232257 SANDOZ FINASTERIDE 0.46 Y N N YSDZ /TB

0238987 MINT-FINASTERIDE 0.463 Y N N YMNT /TB

0235446 ACT FINASTERIDE 0.46 Y N N YACT /TB

0244507 FINASTERIDE 0.46 Y N N YSAI /TB

0201090 PROSCAR 2.06 Y N N YMSD /TB

0234850 TEVA-FINASTERIDE 0.46 Y N N YTVM /TB



228



FINGOLIMOD

FINGOLIMOD

0.5MG

0236548 GILENYA 85.17 E E N YNVR /CP

GLATIRAMER ACETATE

20MG/1.0ML

0224561 COPAXONE (30X1ML) 45.21 E E N YN/A /EA

GOLIMUMAB

100 MG/ML

0241318 SIMPONI 1555.17 E E N YJAN /KT

50 MG/ML

0232478 SIMPONI 1555.17 E E N Ynull /KT

GOSERELIN ACETATE

10.8MG/IMP

0222590 ZOLADEX LA INJ 1157.95 Y Y N YAST /EA

3.6MG

0204932 ZOLADEX 398.3 Y Y N YAST /EA

INCOBOTULINUMTOXIN

100U/VIAL

0232403 XEOMIN 330 E E N YMER /EA

50U/VIAL

0237108 XEOMIN 165 E E N YMER /EA

INFLIXIMAB

100 MG

0224401 REMICADE 987.56 E E N YCEN /EA

0241947 INFLECTRA 525 E E N YHOS /EA

INTERFERON BETA-1A

22UG

0223731 REBIF (6MILLION IU) 122.28 E E N YSRO /EA

22UG (3DOSES)

0231825 REBIF (66UG/1.5ML) CART 3X4 366.82 E E N YSRO /KT

30IU/0.5ML

0226920 AVONEX 395.97 E E N YBGN /KT

44UG

0223732 REBIF (12 MILLION IU) 148.85 E E N YSRO /EA

44UG (3DOSES)

0231826 REBIF (132UG/1.5ML) CART 3X4 470.55 E E N YSRO /KT

INTERFERON BETA-1B

0.3MG

0216964 BETASERON 99.33 E E N YBEX /KT



229



LEFLUNOMIDE

LEFLUNOMIDE

10MG

0235166 SANIS-LEFLUNOMIDE 2.64 E E N YSAN /TB

0225649 APO-LEFLUNOMIDE 2.64 E E N YAPX /TB

0224188 ARAVA 11.07 E E N YAVT /TB

0226125 NOVO-LEFLUNOMIDE 2.64 E E N YNOP /TB

20MG

0224188 ARAVA 11.07 E E N YAVT /TB

0235167 SANIS-LEFLUNOMIDE 2.64 E E N YSAN /TB

0226127 NOVO-LEFLUNOMIDE 2.64 E E N YNOP /TB

0225650 APO-LEFLUNOMIDE 2.64 E E N YAPX /TB

0228397 SANDOZ LEFLUNOMIDE 2.64 E E N YSDZ /TB

MONTELUKAST SODIUM

10MG

0237460 APO-MONTELUKAST 0.82 E E N YAPX /TB

0240864 MINT-MONTELUKAST 0.82 E E N YMNT /TB

0237394 PMS-MONTELUKAST 0.82 E E N YPMS /TB

0235552 TEVA-MONTELUKAST 0.82 E E N YTVM /TB

0239142 JAMP-MONTELUKAST 0.82 E E N YJAM /TB

0238951 RAN-MONTELUKAST 1.77 E E N YRAN /TB

0237933 SANIS-MONTELUKAST SODIUM 0.82 E E N YSAI /TB

0232859 SDZ-MONTELUKAST 0.82 E E N YSDZ /TB

0223821 SINGULAIR 2.48 E E N YMSD /TB

0236822 MYLAN-MONTELUKAST 0.82 E E N YMYL /TB

4MG CH

0237931 MONTELUKAST 0.36 E E N YSAI /TB





4/500MG

0224799 SINGULAIR 1.532 E E N YMSD /PK

0235861 SDZ-MONTELUKAST GRANULES 0.84 E E N YSDZ /PK

5MG CH





0240280 RAN-MONTELUKAST 0.56 E E N YRAN /TB

0237932 MONTELUKAST 0.56 E E N YSAI /TB



230



MYCOPHENOLATE

MYCOPHENOLATE

500MG

0238038 JAMP-MYCOPHENOLATE 2.06 Y Y N YJPC

/TB

MYCOPHENOLATE

250MG

0237115 MYLAN-MYCOPHENOLATE 1.03 Y Y N YMYL /CP

0219274 CELLCEPT 2.06 Y Y N YHLR /CP

0232063 SDZ-MYCOPHENOLATE 1.03 Y Y N YSDZ /CP

0236488 TEVA-MYCOPHENOLATE 1.03 Y Y N YTVM /CP

0235255 APO-MYCOPHENOLATE 1.03 Y Y N YAPX /CP

500MG

0237054 MYLAN-MYCOPHENOLATE 2.06 Y Y N YMYL /CP

0237999 CO-MYCOPHENOLATE 2.06 Y Y N YCOB /CP

0234867 TEVA-MYCOPHENOLATE 2.06 Y Y N YTVM /CP

0231385 SDZ-MYCOPHENOLATE 2.06 Y Y N YSDZ /CP

0235256 APO-MYCOPHENOLATE 2.06 Y Y N YAPX /CP

0223748 CELLCEPT 4.12 Y Y N YHLR /TB

MYCOPHENOLIC ACID

180MG

0237273 APO-MYCOPHENOLIC ACID 1.69 Y Y N YAPX /TB

360MG

0237274 APO-MYCOPHENOLIC ACID 3.4 Y Y N YAPX /TB

NATALIZUMAB

20MG/ML

0228638 TYSABRI 3392.84 E E N YBGN /VL

OCRIPLASMIN

2.5MG/ML

0241081 JETREA 3950 E E N YALC /ML

OCTREOTIDE

100UG

0224864 OCTREOTIDE ACETATE OMEGA 4.03 Y N N YOMG /ML

0241320 OCPHYL 3.3 Y N N YPED /ML

0083920 SANDOSTATIN (1ML) 10.09 Y N N YNVR /ML

200UG/ML


50UG





231



OCTREOTIDE (continued)

500UG

0224864 OCTREOTIDE ACETATE OMEGA 52.3 Y N N YOME /ML



OCTREOTIDE ACETATE

10MG

0223932 SANDOSTATIN LAR VIAL IM INJEC. 1315.74 Y E N YNVR /KT

20MG


30MG


PAMIDRONATE

30MG

0224455 PAMIDRONATE DISODIUM 3.01 Y Y N YDBU /ML

0205976 AREDIA 166.93 Y Y N YNVR /VL

0224599 PMS-PAMIDRONATE 99.98 Y Y N YPMS /VL

6MG/ML

0224967 PAMIDRONATE DISODIUM OMEGA 17.67 Y Y N YOMG /ML

90MG

0224455 PAMIDRONATE DISODIUM 9.02 Y Y N YDBU /ML

0205978 AREDIA 500.79 Y Y N YNVR /VL

0224599 PMS-PAMIDRONATE 315 Y Y N YPMS /VL

PENTOSAN

100MG

0202944 ELMIRON 2.17 Y N Y YJAN /CP

PIMECROLIMUS

1.0%

0224723 ELIDEL OINTMENT 2.28 E E N YNVO /GM

RISEDRONATE

35MG

0235798 MYLAN-RISEDRONATE 2.43 Y E N YMYL /TB

RISEDRONATE SODIUM

30MG

0223914 ACTONEL 12.36 Y N N YPGA /TB

0229838 TEVA-RISEDRONATE 10.12 Y E N YTVM /TB



232



RISEDRONATE SODIUM (continued)

35MG

0230220 PMS-RISEDRONATE 2.43 Y E N YPMS /TB

0224689 ACTONEL 10.44 Y E N YPGA /TB


0237025 SANIS-RISEDRONATE SODIUM 2.43 Y E N YSAI /TB

0231986 RATIO-RISEDRONATE 2.43 Y E N YRTP /TB

0232729 SANDOZ-RISEDRONATE 2.43 Y E N YSDZ /TB

0235368 APO-RISEDRONATE 2.43 Y E N YAPX /TB

5MG

0224251 ACTONEL 2.01 Y E N YPGA /TB


SEVELAMER

800MG

0224431 RENAGEL 1.64 E E N YGPM /MG

SIROLIMUS

1 MG

0224711 RAPAMUNE 7.91 Y Y N YWYA /TB

1.0MG/ML

0224323 RAPAMUNE ORAL 7.91 Y Y N YWYA /ML

SODIUM

10MG/ML

0204611 PMS-SODIUM CROMOGLYCATE 0.79 Y N N YPMS /ML

0223143 APO-CROMOLYN (2ML) 0.2423 Y N N YAPX /ML

100MG

0050089 NALCROM 1.46 Y N Y YAVT /CP

TACROLIMUS

0.5MG

0241681 SANDOZ TACROLIMUS 1.48 Y Y N YSDZ /CP

0224314 PROGRAF 1.97 Y Y N YFUJ /CP

0229646 ADVAGRAF 1.97 Y Y N YASL /CP

1MG




3MG


5MG






233



TACROLIMUS (continued)

5MG/ML

0217600 PROGRAF AMPOULE (10X1ML) 124.5 Y Y N YFUJ /KT

TACROLIMUS TOPICAL

0.03%

0224414 PROTOPIC 2.15 E E N YFUJ /GM

0.1%

0224414 PROTOPIC 2.3 E E N YFUJ /GM

TAMSULOSIN HCL

0.4MG

0231921 SANDOZ TAMSULOSIN 0.15 Y N N Ynull /CP

0229857 MYLAN-TAMSULOSIN 0.24 Y N N YMYL /CP

0236240 APO-TAMSULOSIN HCL 0.15 Y N N YAPX /TB

0242711 TAMSULOSIN CR 0.15 Y N Y YSAN /TB

0.4MG SR

0229426 RATIO-TAMSULOSIN 0.15 Y N N YRPH /CP

0228139 NOVO-TAMSULOSIN 0.15 Y N N YNOP /CP

0229512 SANDOZ-TAMSULOSIN 0.15 Y N N YSDZ /CP

0234020 SDZ-TAMSULOSIN CR 0.15 Y N N YSDZ /TB

0227010 FLOMAX CR 0.62 Y N N YBOE /TB

TERIFLUNOMIDE

14MG

0241632 AUBAGIO 53.97 E E N YGNZ /TB

TETRABENAZINE

25MG

0219927 NITOMAN 6.87 Y Y N YBVL /TB

TIZANIDINE

4MG

0227205 GEN-TIZANIDINE 0.37 Y Y N YGPM /TB

0225989 APO-TIZANIDINE 0.6884 Y Y N YAPX /TB

0223917 ZANAFLEX 0.81 Y Y N YELA /TB

TOCILIZUMAB

162MG/0.9ML

0242477 ACTEMRA 355 E E N YHLR /EA

200MG/10ML

0235010 ACTEMRA 45.2 E E N YHLR /VL

400MG/20ML

0235011 ACTEMRA 45.2 E E N YHLR /VL

80MG/4ML

0235009 ACTEMRA 45.2 E E N YHLR /ML



234



TRANEXAMIC ACID

TRANEXAMIC ACID

500MG

0240123 TRANEXAMIC ACID TABLETS 0.58 Y N N YSTE /TB

0206440 CYKLOKAPRON 1.16 Y N N YPHU /TB

USTEKINUMAB

45MG/0.5ML

0232067 STELARA 4593.14 E E N YJAN /KT

90MG/ML

0232068 STELARA 4593.14 E E N YJAN /KT

VALGANCICLOVIR

50MG/ML

0230608 VALCYTE 2.56 E E N YHLR /ML

ZAFIRLUKAST

20MG

0223660 ACCOLATE 0.77 E E N YAST /TB

ZOLEDRONIC ACID

5MG/100ML

0241510 TARO-ZOLEDRONIC ACID 3.35 E E N YTAR /ML

0240808 ZOLEDRONIC ACID INJECTION 3.35 E E N YTEV /ML

92:24.00 BONE RESORPTION INHIBITORS -----------------------------------------------------

DENOSUMAB

120MG/1.7ML

0236815 XGEVA 558.79 E E N YAMG /KT

92:32.00 COMPLEMENT INHIBITORS ----------------------------------------------------------

ICATIBANT ACETATE

10MG/ML

0242569 FIRAZYR 2700 E N N YSCI /EA

92:36.00 DISEASE-MODIFYING ANTIRHEUMATIC AGENTS -----------------------------------------

TOFACITINIB

5MG

0242389 XELJANZ 23.56 E E N YPFI /TB

92:44.00 IMMUNOSUPPRESSIVE AGENTS -------------------------------------------------------

PIRFENIDONE

267MG

0239375 ESBRIET 13.0302 E E N YINT /CP

92:92.00 OTHER MISCELLANEOUS THERAPEUTIC AGENTS -----------------------------------------

CINACALCET

30MG

0245269 APO-CINACALCET 10.19 E E N YAPX /TB



235

PHRM/CHRN/CDO/F92:92.00 OTHER MISCELLANEOUS THERAPEUTIC AGENTS


CINACALCET HYDROCHLORIDE

CINACALCET

30MG

0225713 SENSIPAR 11.4 E E N YAMG /TB

99:00 PALLIATIVE CARE

99:00.00 PALLIATIVE CARE ----------------------------------------------------------------

ALGINIC

313/63MG

0223153 GAVISCON 0.19 Y N N NGSK /TB

99:00.98 CD PALLIATIVE RX ---------------------------------------------------------------

ACETYLCYSTEINE

200MG/ML

0230043 ACETYLCYSTEINE INJECTION 6.5 Y Y N YALV /ML

CIPROFLOXACIN/DEXAM

0.3%/0.1%

0225271 CIPRODEX OTIC SOLUTION 3.61 Y Y N YALC /ML

CITALOPRAM

20MG

0224801 PMS-CITALOPRAM 0.24 Y Y N YPMS /TB

CLINDAMYCIN

20MG/GM

0206060 DALACIN VAGINAL CREAM 0.76 Y Y N YPMS /ML

CLONAZEPAM

0.25MG


CONJUGATED

0.3 MG

0204339 PREMARIN 0.3 Y Y N YWYA /TB

DIAZEPAM

1MG/ML

0089179 PMS-DIAZEPAM SOLUTION 1MG/ML 0.12 Y Y N YPMS /ML

DULOXETINE

30MG


FENTANYL CITRATE

100MCG S/L

0236417 ABSTRAL 10.9 Y Y N YPAL /TB

200MCG S/L


300MCG S/L




236

PHRM/CHRN/CDO/F99:00.98 CD PALLIATIVE RX (continued)

99:00 PALLIATIVE CARE (continued)

FENTANYL CITRATE (continued)

400MCG S/L


600MCG S/L


800MCG S/L


FLUCONAZOLE

50MG

0224564 PMS-FLUCONAZOLE 1.29 Y Y N YPMS /TB

FUROSEMIDE

10MG/ML

0040163 FUROSEMIDE SPECIAL 0.87 Y Y N YSDZ /ML

0052703 FUROSEMIDE INJ 0.87 Y Y N YSDZ /ML

HALOPERIDOL

5MG/ML

0080865 HALOPERIDOL (1ML) INJ 4.83 Y Y N YSAB /ML

HYOSCINE

10MG

0036381 BUSCOPAN 0.34 Y Y N YBOE /TB

KETAMINE HCL

10MG/ML

0224679 KETAMINE HCL INJ 1.65 Y Y N YSDZ /ML

50MG/ML

0224679 KETAMINE HCL INJ 4.95 Y Y N YSDZ /ML

KETOCONAZOLE

2%

0224566 KETODERM TOPICAL CREAM 0.32 Y Y N YTAR /GM

LORAZEPAM

0.5MG SL

0241074 APO-LORAZEPAM SUBLINGUAL 0.0875 Y Y N YAPX /TB

1MG SL

0241075 APO-LORAZEPAM SUBLINGUAL 0.11 Y Y N YAPX /TB

0204146 ATIVAN SUBLINGUAL 0.14 Y Y N YWYA /TB

MEDROXYPROGESTERON

2.5MG

0224472 APO-MEDROXY 0.04 Y Y N YAPX /TB

METHADONE

1MG

0224769 METADOL 0.18 E E N YPMS /TB

1MG/ML

0224769 METADOL SOLN 0.11 N N N YPMS /ML



237



METHADONE (continued)

10MG


10MG/ML

0224137 METADOL SOLN 0.39 Y N N YPMS /ML

25MG


5MG


METHOTRIMEPRAZINE

25MG/ML

0192769 NOZINAN INJ 3.53 Y Y N YAVT /ML

METHYLPHENIDATE HCL

5MG

0223474 PMS-METHYLPHENIDATE 0.1 Y Y N YPMS /TB

MIDAZOLAM

1MG/ML

0224290 MIDAZOLAM INJECTION 5.8 Y N N YPPC /ML

5MG/ML

0224290 MIDAZOLAM INJECTION 3 Y N N YFMC /ML

0224028 MIDAZOLAM INJECTION 2.53 Y N N YSDZ /ML

OCTREOTIDE

100UG

0241320 OCPHYL 3.3 Y Y N YPED /ML

500UG

0083921 SANDOSTATIN (1ML) 45.65 Y Y N YNVR /ML

0224864 OCTREOTIDE ACETATE OMEGA 52.3 Y Y N YOME /ML

0241321 OCPHYL 16.17 Y Y N YPED /ML

OLANZAPINE

5MG ODT


ONDANSETRON

4MG ODT

0238998 ONDISSOLVE 3.27 Y Y N YTAK /TB

OXYCODONE

10MG

0044394 SUPEUDOL 0.19 Y Y N YSAB /TB

PANTOPRAZOLE

40MG

0237080 SANIS-PANTOPRAZOLE 0.36 Y Y N YSAN /TB



238



PENTAZOCINE

PENTAZOCINE

50 MG

0213798 TALWIN 0.46 Y Y N YAVT /TB

PHENOBARBITAL

120MG/ML

0230409 PHENOBARBITAL SODIUM INJ 13 Y Y N YSDZ /ML

POLYMIXIN

1MG/ML

0223923 SANDOZ POLYTRIMETHOPRIM 2.51 Y Y N Ynull /ML

POTASSIUM CHLORIDE

1.3MMOL/ML

0223860 PMS-POTASSIUM CHL.ORAL SOLN 0.015 Y Y N YPMS /ML

8MMOL

8004022 SLOW-K 0.12 Y Y N YNVR /TB

8001300 JAMP-K-8 0.089 Y Y N YJAM /TB

PROPOXYPHENE

100MG

0026143 DARVON-N 0.6268 Y Y N YPMS /CP

RANITIDINE

25MG/ML

0225671 SDZ-RANITIDINE INJ 1.4 Y Y N YSDZ /ML

SALBUTAMOL

100MCG/DS

0224566 APO-SALVENT CFC FREE INHALER 0.03 Y Y N YAPX /DS

0241985 SALBUTAMOL HFA 0.03 Y Y N YSAI /DS

SODIUM CHLORIDE

0.9%

0006020 NORMAL SALINE IV BAG 500ML 1.86 Y Y N YBAX /ML

SODIUM POLYSTYRENE

1G/1MMOL K

0202696 KAYEXALATE POWDER 0.19 Y Y N YSAW /GM

TIMOLOL MALEATE

0.5%GEL


ZOPICLONE

7.5MG

0238691 SEPTA-ZOPICLONE 0.23 Y Y N YWHL /TB

99:00.99 CD PALLIATIVE OTC --------------------------------------------------------------



239

PHRM/CHRN/CDO/F99:00.99 CD PALLIATIVE OTC


ACETAMINOPHEN

ACETAMINOPHEN

325MG

0225280 ACETAMINOPHEN 325MG TABLETS 0.02 Y Y N NPHM /TB

0236234 ACETAMINOPHEN CAPLETS 325MG 0.03 Y Y N NAPX /TB

0193808 ACETAMINOPHEN 0.012 Y Y N NJPC

/TB

0038921 NOVO-GESIC 0.03 Y Y N NNOP /TB

500MG

0193912 JAMP-ACETAMINOPHEN 0.03 Y Y N NJPC

/TB

ACETAMINOPHEN

160/5ML

0202779 PEDIATRIX 0.02 Y Y N NTVM /ML

0222687 ACETAMINOPHEN LIQ 160MG/5ML 0.03 Y Y N NRIV /ML

ACETYLSALICYLIC ACID

81MG

0224389 EXACT ASA 81 MG EC 0.0725 Y Y N NEXA /TB

ARTIFICIAL SALIVA

N/A

9123456 ARTIFICIAL SALIVA 0.2 Y Y N NN/A /null

FERROUS GLUCONATE

300MG

8000043 NOVO-FERROUS GLUCONATE 0.025 Y Y N NNOP /TB

IBUPROFEN

400MG

0050605 APO-IBUPROFEN 0.09 Y Y N NAPX /TB

NYSTATIN

100000U/G

0219423 RATIO-NYSTATIN TOPICAL CREAM 0.06 Y Y N NRTP /GM

SODIUM CHLORIDE

0.9%

0003779 SODIUM CHLORIDE 0.9% INJ 4.06 Y Y N NABB /ML

VITAMIN D

1000IU

0032317 VITAMIN D 0.028 Y Y N NSWI /TB

99:01.00 ANALGESICS ---------------------------------------------------------------------

ACETAMINOPHEN

650MG

0223043 PMS-ACETAMIN SUPP 0.85 Y N N NPMS /SUPP

FENTANYL

50MCG/ML

0238412 FENTANYL CITRATE INJ SDZ 2.6 Y N N YSDZ /ML

0224043 FENTANYL INJECTION 2.6 Y N N YSDZ /ML



240

PHRM/CHRN/CDO/F99:01.00 ANALGESICS (continued)


IBUPROFEN

IBUPROFEN

100MG/5ML

0223229 CHILDRENS ADVIL 0.06 Y N N NPFI /ML

0224236 MOTRIN 0.05 Y N N NMCL /ML

SUFENTANIL

50MCG/ML

0224414 SANDOZ SUFENTANIL INJ 8.538 Y N N YSDZ /ML

99:03.00 STOOL SOFTENERS ----------------------------------------------------------------

SODIUM DIOCTYL

10MG/ML

0209016 COLACE DROPS 0.177 Y N N NWEL /ML

99:04.00 LAXATIVES ----------------------------------------------------------------------

BISACODYL

10MG

0058288 PMS-BISACODYL 0.4681 Y N N NPMS /SP

0075459 APO-BISACODYL 0.72 Y N N NAPX /SP

0040480 RATIO-BISACODYL 0.72 Y N N NRTP /SP

0000387 DULCOLAX SUPP 0.57 Y N N NBOE /SP

5MG

0054502 APO-BISACODYL 0.05 Y N N NAPX /TB

0058727 PMS-BISACODYL 0.05 Y N N NPMS /TB

GLYCERINE

2.6 G/SUP

0087346 GLYCERINE (ADULT SIZE) 0.0821 Y N N NMCT /SP

KCL/SOD.

4L

0067744 COLYTE 4.82 Y N N YZYP /ML

0065251 G0LYTELY GI LAVAGE 3.37 Y N N YWHL /ML

LACTULOSE

667 MG/ML

0070348 PMS-LACTULOSE SYR 0.01 Y N N NPMS /ML

0241226 LACTULOSE 0.01 Y N N NSAI /ML

667MG/ML

0224281 APO-LACTULOSE SYRUP 0.01 Y N N NAPX /ML

0085440 RATIO-LACTULOSE SYRUP 0.01 Y N N NRTP /ML

MAG OXIDE/CITRIC

3.5G/12G/10MG

0231796 PURG-ODAN 4.8 Y N N NODA /EA

0225479 PICO-SALEX 6 Y N N NFER /EA



241

PHRM/CHRN/CDO/F99:04.00 LAXATIVES (continued)


MAGNESIUM CITRATE

MAGNESIUM CITRATE

15GM/300ML

0026260 CITRO MAG 0.014 Y N N NROU /ML

MAGNESIUM

60MG/ML

0020204 MAGNOLAX 0.01 Y N N NWAM /ML

MINERAL OIL

100%

0010787 FLEET MINERAL OIL ENEMA 0.04 Y N N NJJM

/ML

POLYETHYLENE GLYCOL

3350

0235803 PEG 3350 LAXATIVE 0.03 Y N N NWHL /GM

0231768 LAX-A-DAY 0.04 Y N N NPEN /GM

0231816 RESTORALAX 0.04 Y N N NSCH /GM

SENNA

1.7MG/ML

8002439 SENNAQUIL LIQUID 0.032 Y N N NJPC

/ML

0036772 SENOKOT 0.044 Y N N NPUR /ML

12MG

0089640 PMS-SENNOSIDES 0.074 Y N N NPMS /TB

187MG

0002615 SENOKOT 0.157 Y N N NPFR /TB

8.6MG

0206810 SENNATAB 0.266 Y N N NPMS /TB

0223710 SENNA LAXATIVE 0.054 Y N N NVTH /TB

0195739 SENNA LAXATIVE 0.052 Y N N NTAN /TB

0089641 PMS-SENNOSIDES 0.063 Y N N NPMS /TB

0224623 SENNA LAXATIVE 0.0528 Y N N NPMS /TB

SENNA/SOD DIOCT.

187MG

0002612 SENOKOT S 0.117 Y N N NPFR /TB

SENNOSIDES

25MG

0224500 LB LAXATIVE X-STRENGTH 0.108 Y N N NSAI /TB

SOD

90/9/625ML

0206390 MICROLAX MICRO-ENEMA 2.89 Y N N NPMS /ML

SOD PHOSPHATE DI- &

180/480MG

0223039 PHOSPHATES 0.086 Y N N NPMS /ML



242

PHRM/CHRN/CDO/F99:04.00 LAXATIVES (continued)


SOD PHOSPHATE DI- & MONOBASIC (continued)

6GM/100ML

0209690 ENEMOL LIQ RT 0.023 Y N N NPMS /ML

0000991 FLEET ENEMA 0.0298 Y N N NJJM

/ML

900MG/2.4G

0220621 FLEET PHOSPHO-SODA ORAL 0.0838 Y N N NJJ

/ML

99:05.00 ANTIEMETICS --------------------------------------------------------------------

DIMENHYDRINATE

100MG

0001360 GRAVOL 0.538 Y N N NHOR /SP

0039254 SAB-DIMENHYDRINATE 0.56 Y N N NSAB /SP

15MG/5ML

0023019 GRAVOL ORAL LIQUID 0.0708 Y N N YHOR /ML

25MG

0078359 GRAVOL 0.496 Y N N NHOR /SUPP

50MG

0060578 TRAVEL AID 0.01 Y N N NVTH /TB

0036376 APO-DIMENHYDRINATE 0.02 Y N N NAPX /TB

0002142 NOVO-DIMENATE 0.06 Y N N NNOP /TB

0001380 GRAVOL 0.13 Y N N NHOR /TB

0224526 DIMENHYDRINATE 0.0135 Y N N NPRO /TB

0237717 ANTI-NAUSEANT 0.02 Y N N NAPX /TB

50MG/ML

0039253 DIMENHYDRINATE IM (5ML) 1.38 Y N N YSAB /ML

0001357 GRAVOL (5ML) 1.151 Y N N YHOR /ML

LANSOPRAZOLE

15MG

0224946 PREVACID FASTAB 2 Y N N YTAP /TB

30MG

0224947 PREVACID FASTAB 2 Y N N YTAP /TB

99:06.00 ARTIFICIAL SALIVA & TEARS ------------------------------------------------------

CARBOXYMETHYL

10MG/ML

0224465 REFRESH LIQUIGEL 0.42 Y N N NALL /ML

CHLORHEXIDINE

0.12%

0220905 ORO-CLENSE RINSE 0.0165 Y N Y YWHL /ML

99:07.00 ANTISPASMOTICS -----------------------------------------------------------------

ATROPINE SULFATE

0.4MG/ML

0039278 ATROPINE SULFATE INJ 2.29 Y N N YSDZ /ML



243

PHRM/CHRN/CDO/F99:07.00 ANTISPASMOTICS


ATROPINE SULFATE (continued)

0.6 MG/ML

0039269 ATROPINE SULFATE INJ 2.49 Y N N YSDZ /ML

GLYCOPYRROLATE

0.2MG/ML

0203950 GLYCOPYRROLATE INJECTION 3.98 Y N N YSDZ /ML

SCOPOLAMINE N-

0.6MG/ML

0054187 HYOSCINE BUTYLBROMIDE INJ 5.36 Y N N YHOS /ML

20MG/ML

0222986 HYOSCINE BUTYLBROMIDE INJ 4.52 Y N N YSAB /ML

99:09.00 VITAMIN SUPPLEMENTS/FOOD SUPPLEMENTS -------------------------------------------

CALCIUM

100MG/5ML

8000687 CALCIUM LIQUID 0.1066 Y N N NWAM /ML

99:10.00 ANTI-INFECTIVES ----------------------------------------------------------------

SECURA

NA

8000862 EXTRA PROTECTIVE CR 0.08 Y N N NSEC /GM

99:11.00 APPETITE STIMULANTS ------------------------------------------------------------

CYPROHEPTADINE

4 MG

0075771 PMS-CYPROHEPTADINE HCL 0.23 Y N N NPMS /TB

99:13.00 ANTIPRURITICS AND LOCAL ANESTHETICS --------------------------------------------

DIPHENHYDRAMINE

2%

0201970 BENADRYL CREAM 2% 0.27 Y N N NPFC /GM

LIDOCAINE

10MG/ML

0229619 XYLOCAINE 1% INJ 1.6 Y N N NALV /ML

20MG/ML

0000169 XYLOCAINE 2% JELLY 0.47 Y N N NAST /ML

LIDOCAINE 1%-50 ML

10MG/ML

0000173 XYLOCAINE 1% INJ-50 ML 0.93 Y N N NAST /ML

LIDOCAINE/PRILOCAINE

25MG

0088685 EMLA 1.3 Y N N NAST /GM

99:14.00 PARENTERAL/IV SOLUTIONS --------------------------------------------------------



244

PHRM/CHRN/CDO/F99:14.00 PARENTERAL/IV SOLUTIONS


DEXTROSE/SODIUM CHLORIDE

DEXTROSE/SODIUM

3.3%.3%

0006071 DEXTROSE/SOD.CHLORIDE IV 0.09 Y N N YBAX /ML

5%/0.45%

0003890 DEXTROSE 5% IN 0.45% NACL 0.002 Y N N YHOS /ML

99:15.00 MISC.GASTROINTESTINAL DRUGS ----------------------------------------------------

ALUMINUM/MAGNESIUM

200/200/20MG

0224468 MAALOX ANTACID PLUS 0.01 Y N N NNVR /ML

LOPERAMIDE

2MG

0213259 NOVO-LOPERAMIDE 0.15 Y N N NTVM /TB

0225756 SANDOZ LOPERAMIDE 0.27 Y N N NSDZ /TB

0224899 DIARRHEA RELIEF 0.2466 Y N N NPMS /TB

0222835 PMS-LOPERAMIDE 0.15 Y N N NPMS /TB

RANITIDINE

25MG/ML

0221236 ZANTAC 1.421 Y N N YGSK /ML

99:16.00 ANTIHISTAMINE ------------------------------------------------------------------

CETIRIZINE

10MG

0224026 ALLERGY - RELIEF 0.5 Y N N NAPX /TB

0223160 APO-CETIRIZINE 0.4083 Y N N NAPX /TB

0222355 REACTINE 0.39 Y N N NPFC /TB

20MG

0190097 REACTINE 0.8595 Y N N NPFI /TB

DIPHENHYDRAMINE

25MG

0075768 PMS-DIPHENHYDRAMINE 0.09 Y N N NPMS /CP

0222949 ALLERGY FORUMULA - 0.1186 Y N N NVIT /TB

50MG

0075769 PMS-DIPHENHYDRAMINE CAP 0.11 Y N N NWHL /CP

0201967 BENADRYL S 0.2514 Y N N NPFI /CP

50MG/ML

0059661 DIPHENHYDRAMINE INJECTION 4.04 Y N N NSDZ /ML

Exception Drug Status TableChronic Disease Program (CHRN)

Pharmacare Program (PHRM)

08.00 ANTI-INFECTIVE AGENTS

08:12.02 -AMINOGLYCOSIDES



245

TOBRAMYCIN CHRNPHRM

For Cystic Fibrosis patients who cannot tolerate injectable, preservative-free tobramycin when used for inhalation. Specialist's consult to beprovided.

TOBRAMYCIN SULFATE CHRNPHRM

For Cystic Fibrosis patients who cannot tolerate injectable, preservative-free tobramycin when used for inhalation. Specialist's consult to beprovided.

TOBRAMYCIN SULFATE CHRNPHRM

For inhalation therapy for the treatment of cystic fibrosis.

GENTAMICIN S04 CHRNPHRM

For treatment of resistant organisms or other special circumstances.

08:12.04 - ANTIBIOTICS(ANTIFUNGALS)ITRACONAZOLE CHRN

PHRMFor severe systemic fungal infections or severe or resistant fungalinfections in immunocompromised patients, or for the treatment of severeonychomycosis caused by dermatophyte fungi as confirmed by labratoryresults. (secondary to approved chronic condition for patients on theChronic Disease Program).

VORICONAZOLE CHRNPHRM

For severe systemic fungal infections or severe or resistant fungalinfections in immunocompromised patients, or for the treatment of severeonychomycosis caused by dermatophyte fungi as confirmed by labratoryresults. (secondary to approved chronic condition for patients on theChronic Disease Program).

NYSTATIN CHRN Treatment of a serious fungal infection in immuno-compromised patients.Treatment of a condition secondary to an approved chronic disease. Pleaseprovide a description of the infection.

FLUCONAZOLE CHRN Treatment of a serious fungal infection in immuno-compromized patientssecondary to an approved chronic condition. Please provide description ofinfection.

KETOCONAZOLE CHRN Treatment of a serious fungal infection in immuno-compromized patientssecondary to an approved chronic condition. Please provide description ofinfection.

NYSTATIN CHRN Treatment of a serious fungal infection in immuno-compromized patientssecondary to an approved chronic condition. Please provide description ofinfection.

TERBINAFINE CHRN Treatment of a serious fungal infection in immuno-compromized patientssecondary to an approved chronic condition. Please provide description ofinfection.

08:12.06 -CEPHALOSPORINSCEFACLOR CHRN Case-by-case basis: For treatment of chronic infections secondary to an

approved chronic condition. (Please include anticipated duration oftherapy).

CEFAZOLIN SODIUM CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

CEFIXIME CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

CEFPROZIL CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

CEFTAZIDIME CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

CEFTRIAXONE CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).



246

CEFUROXIME AXETIL CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

CEPHALEXIN MONOHYDRATE CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

08:12.12 - MACROLIDES

AZITHROMYCIN CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

CLARITHROMYCIN CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

ERYTHROMYCIN BASE CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

ERYTHROMYCIN ESTOLATE CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

ERYTHROMYCINETHYLSUCCINATE

CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

ERYTHROMYCIN STEARATE CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

08:12.16 - PENICILLINS

AMOXICILLIN (AMOXYCILLIN) CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

AMOXICILLIN/CLAVULANICACID


AMPICILLIN CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

CLOXACILLIN CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

PENICILLIN V (POTASSIUM) CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

PIPERACILLIN/TAZOBACTAM CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

08:12.24 - TETRACYCLINES

DOXYCYCLINE CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

MINOCYCLINE HCL CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

TETRACYCLINE CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

MINOCYCLINE HCL CHRN For treatment of RA - recommendation of Rheumatologist. Consult fromspecialist to be provided.



247

08:12.28 - ANTIBIOTICS(MISCELLANEOUSANTIBIOTICS)CLINDAMYCIN HCL CHRN Case-by-case basis: For treatment of chronic infections secondary to an

approved chronic condition. (Please include anticipated duration oftherapy).

CLINDAMYCIN PALMITATEHCL


RIFABUTIN CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

RIFAMPIN CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

VANCOMYCIN HCL CHRN Case-by-case basis: For treatment of chronic infections secondary to anapproved chronic condition. (Please include anticipated duration oftherapy).

RIFAXIMIN CHRNPHRM

For reducing the risk of overt hepatic encephalopathy (HE) recurrence(after 2 or more episodes), if the following criteria are met:-patient is unable to achieve adequate control of HE recurrence withmaximal tolerated dose of lactulose alone -must be used in combination with a maximal dose of lactulose-for patients not maintained on lactulose, details are required regardingthe nature of the patient's intolerance to lactulose

08:18.00 - ANTIVIRALS

ACYCLOVIR CHRN Case-by-case basis: Treatment of immuno-compromised patients,secondary to an approved condtion.

AMANTADINE CHRN Case-by-case basis: Treatment of immuno-compromised patients,secondary to an approved condtion.

FAMCICLOVIR CHRN Case-by-case basis: Treatment of immuno-compromised patients,secondary to an approved condtion.

GANCICLOVIR SO4 CHRN Case-by-case basis: Treatment of immuno-compromised patients,secondary to an approved condtion.

VALACYCLOVIR CHRN Case-by-case basis: Treatment of immuno-compromised patients,secondary to an approved condtion.

VALGANCICLOVIR CHRNPHRM

Case-by-case basis: Treatment of immuno-compromised patients.Approval x 6 months.

RIBAVIRIN/PEGINTERFERONALFA2A

CHRNPHRM

Positive Hepatitis C serology and ALT > 1.5 times normal for 6 months andon recommendation of Gastroenterologist or Infectious Disease Specialist.Specialists consult to be provided. Review on case-by-case basis.COVERAGE WILL BE PROVIDED FOR 1 YEAR. Coverage for one course oftreatment only.

RIBAVIRIN/PEGINTERFERONALFA2B

CHRNPHRM

Positive Hepatitis C serology and ALT > 1.5 times normal for 6 months andon recommendation of Gastroenterologist or Infectious Disease Specialist.Specialists consult to be provided. Review on case-by-case basis.COVERAGE WILL BE PROVIDED FOR 1 YEAR. Coverage for one course oftreatment only.

08:18.08 -ANTIRETROVIRAL AGENTSCOBICISTAT/EMTRICITABINE/ELVIT

CHRNPHRM

As a complete regimen for antiretroviral treatment-naïve HIV-1 infectedpatients in whom efavirenz is not indicated.

EMTRICITABINE/RILPIVIRINE/TENO

CHRNPHRM

As a complete regimen for antiretroviral treatment-naïve HIV-1 infectedpatients in whom efavirenz is not indicated.

EFAVIRENZ/TENOFOVIR/EMTRICITAB

CHRNPHRM

Case-by-case basis: On recommendation of Specialist.



248

ENTECAVIR CHRNPHRM


RALTEGRAVIR CHRNPHRM


TENOFOVIR CHRNPHRM


TENOFOVIR/EMTRICITABINE CHRNPHRM


ADEFOVIR DIPIVOXIL CHRNPHRM

For chronic hepatitis B patients who developed resistance or failed a 3month trial of lamivudine when prescribed by a specialist.

DOLUTEGRAVIR CHRNPHRM

For the treatment of HIV in both treatment-naive and treatment-experienced adults and children 12 years of age and older weighing atleast 40kg, in combination with other antiretrovirals.

COBICISTAT/DARUNAVIR CHRNPHRM

For treatment of human immunodeficiency virus (HIV) infection intreatment-naive and treatment-experienced patients without darunavir(DRV) resistance-associated mutations, when prescribed by an infectiousdisease specialist.

ABACAVIR/DOLUTEGRAVIR/LAMIVUDI

CHRNPHRM

When prescribed by an infectious disease specialist.

DARUNAVIR CHRNPHRM


RILPIVIRINE HCL CHRNPHRM


08:18.32 - NUCLEOSIDESAND NUCLEOTIDESRIBAVIRIN CHRN

PHRMOn recommendation of an infectious disease specialist for use within acombination therapy regimen for the treatment of chronic hepatitis C, inaccordance with the specific eligibility criteria for approved agents, used totreat this condition.

08:18.40 - HCV ProteaseInhibitors



249

OMBITASVIR/PARITAPREVIR/RITONA

CHRNPHRM

For patients that meet the eligibility criteria below clinicians areencouraged to use Holkira Pak as one of the preferred therapeutic optionsover other covered therapies (eg: interferon-based regimens with NS3/4Aprotease inhibitors or polymerase inhibitors). This recommendation isbased on Holkira Pak's advantages in some patient populations, includingpotentially higher SVR rates, improved tolerability, no need forconcommitant interferon, and a shorter course of therapy.For treatment-naive and treatment-experienced adult patients withchronic hepatitis C genotype 1 infection, with compensated liver disease(including compensated cirrhosis*) according to the following criteria:-prescribed by an infectious disease specialist or hepatologist. Consult tobe provided.-lab-confirmed hepatitis C genotype 1, subtype 1a and 1b required-patient has quantitative HCV RNA value within the last 6 months-fibrosis stafe F2 or greater (Metavir scale or equivalent)DURATION OF THERAPY REIMBURSED:12 weeks for treatment naive & experienced # genotype 1b, non-cirrhotic12 weeks in combination with ribavirin for:treatment naive & experienced genotype 1a, non-cirrhotic;OR for treatment naive & expereinced genotype 1b, cirrhoticOR for treatment naive & expereinced (prior relapsers & prior partialresponders) genotype 1a, cirrhotic24 weeks in combination with ribavirin for treatment experiencedgenotype 1a, with cirrhosis & who have had a previous null response topegIFN and RBVEXCLUSION CRITERIA;-patients currently being treated with another HCV antiviral agent-patients who have received a previous trial of Holkira Pak (re-treatmentrequests will NOT be considered)-decompensated patients-no funding for other genotypes except as noted above for genotype 1-patients who have received previous NS3/4A protease inhibitor-basedregimens (ie:boceprevir, telaprevir & simeprevir based regimens)-patients who have received previous sofosbuvir-based regimensCommentsHIV-HCV co-infected patients with genotype 1 may be considered as percriteria listed aboveHolkira Pak is recommended in patients with unknown genotype 1 subtypeor with mixed genotype 1 infection * compensated cirrhosis is defined as cirrhosis with a Child Pugh Score =A(5-6)# treatment experienced patients are defined as those who have previouslybeen treated with PegINF/RBV and did NOT receive adequate response



250

LEDIPASVIR/SOFOSBUVIR CHRNPHRM

For patients that meet the eligibility criteria outlined below clinicians areencouraged to use Harvoni as one of the preferred therapeutic option overother covered therapies(eg: interferon-based regimens with NS3/4Aprotease inhibitors or polymerase inhibitors). This recommendation isbased on Harvoni's advantages in some patient populations, includingpotentially higher SVR rates, improved tolerability, no need forconcomitant interferon or ribavirin therapy, shorter course of therapy, andonce daily dosing.For treatment-naive and treatment-experienced adult patients withchronic hepatitis C genotype 1 infection, with compensated liver disease,(including compensated cirrhosis*) according to the following criteria:-Prescribed by an infectious disease specilaist or hepatologist. Consult tobe provided.-Lab-confirmed hepatitis C genotype 1-Patient has quantitative HCV RNA value within the last 6 months-Fibrosis stage F2 or greater (Metavir scale or equivalent)Duration of therapy reimbursed:8 weeks for treatment-naive, non-cirrhotic patients, with viral load <6 MIU/ml#12 weeks for treatment-naive, non-cirrhotic patients, with viral load 6 MIU/ml, treatment naive cirrhotic patients OR treatment- experienced non-cirrhotic patients@24 weeks for treatment-experienced cirrhotic patientsExclusion criteria:-Patients currently being treated with another HCV antiviral agent-Patients who have received a previous trial of Harvoni (Re-treatmentrequests will NOT be considered)Notes:* Compensated cirrhosis is defined as cirrhosis with a Child Pugh Score =A(5-6)# Treatment regimens of up to 12 weeks may be considered for patientswith borderline or severe fibrosis (F3-4) or if they are co-infected with HIV.@ Treatment experinced is defined as those who failed prior therapy withan interferon-based regimen, including regimens containing an HCVprotease inhibitorTreatment of decompensated HCV may be considered for coverage on anexceptional case-by-case basis.

SIMEPREVIR CHRNPHRM

In combination with peginterferon alfa and ribavirin, for the treatment ofchronic hepatitis C genotype 1 infection in adults with compensated liverdisease if the following clinical criteria & conditions are met:Detectable levels of hepatitis C virus (HCV) RNA in the last 6 months; ANDA fibrosis stage of F2, F3 or F4Conditions:Patients should have their HCV strain tested for NS3 Q80K polymorphismDosage: 150mg once daily for 12 weeks in combination with peginterferonalfa & ribavirinResponse-guided therapy (RGT) for treatment naive patients or treatmentexperienced patients as per Product Monograph & Treatment Futility Ruleas per Product MonographRenewals ar not consideredExclusion Criteria:Patients with the NS3 Q80K polymorphismPatients who have received a prior treatment with boceprevir or telaprevirin combination with pegINF/RBV and did NOT receive an adequateresponsePatients not genotype 1Fibrosis stage less than F2 (metavir scale or equivalent)Decompensated liver diseasePatients less than 18 years of ageSimeprevir monotherapySimeprevir in combination with sofosbuvir

08:18.92 - MISCELLANEOUSANTIVIRALS



251

BOCEPREVIR CHRNPHRM

For hepatitis c patients with detectable levels of Hepatitis C virus RNA inthe last 6 months and a fibrosis stage of F2, F3, or F4. One course of treatment only (up to 44 weeks)

BOCEPREVIR/RIBAVIRIN/PEGINTERF

CHRNPHRM

For hepatitis c patients with detectable levels of Hepatitis C virus RNA inthe last 6 months and a fibrosis stage of F2, F3, or F4. One course of treatment only (up to 44 weeks)

SOFOSBUVIR CHRNPHRM

For the treatment of adult patients with chronic hepatitis C infection withcompensated liver disease, (including compensated cirrhosis)(1) asfollows:Genotype 1 (for 12 weeks in combination with Pegylated interferon(pegIFN)/Ribavirin (RBV)): treatment-naive patients ORGenotype 2 (for 12 weeks in combination with RBV): treatment-naivepatients in whom interferon (IFN) is medically contraindicated(2) ORPegIFN/RBV treatment-experienced(3) patients ORGenotype 3 (for 24 weeks in combination with RBV): treatment-naivepatients in whom IFN is medically contraindicated OR PegIFN/RBVtreatment-experienced patientsAND who meet ALL of the following:A. Prescribed by a hepatologist, gastroenterologist or infectious diseasespecialist. Consult to be provided.B. Lab-confirmed hepatitis C genotype 1, 2 or 3C. Patient has a quantitative HCV RNA value within the last 6 monthsD. Fibrosis stage F2 or greater (Metavir scale or equivalent)Exclusion criteria:-patients currently being treated with another HCV antiviral agent-patients who have previously received a treatment course of Sovaldi (Re-treatment requests will NOT be considered).Notes:(1) Compensated cirrhosisis is defined as cirrhosis with a Child Pugh Score= A (5-6)(2) Medical contraindication to IFN is defined as hypersensitivity toperinterferon or interferon alfa-2a or 2b, polyethylene glycol or anycomponent of the formulation resulting in discontinuation of therapy; ORpresence of significant clinical co-morbidities which are deemed to have ahigh risk of worsening with IFN treatment. Details are required regardingpatient's contraindications or risk of worsening comorbidities. (3) Treatment-experienced patients (with genotype 2 or 3) are defined aspatients who have previously been treated with PegIFN/RBV and did NOTreceive adequate response.HIV-HCV co-infected patients may be considered as per above criteria.Treatment of decompensated HCV may be considered for coverage on anexceptional case-by-case basis. Provide complete documentation.

TELAPREVIR CHRNPHRM

For the treatment of chronic hepatitis C with detectable levels of HepatitisC virus in the last 6 months and a fibrosis stage of F2, F3, or F4. Not to beused in patients co-infected with HIVOne course of treatment only.

08:22.00 - QUINOLONES

CIPROFLOXACIN CHRNCHRNPHRM

For treatment of resistant organisms or those not responding toalternative agents. (Please put anticipated duration entered on applicationform).

LEVOFLOXACIN CHRNCHRNPHRM


MOXIFLOXACIN CHRNCHRNPHRM


NORFLOXACIN CHRNCHRNPHRM




252

MOXIFLOXACIN CHRNPHRM

For treatment of resistant organisms and when alternate agents cannot beused.

LEVOFLOXACIN IV CHRNPHRM

When unable to tolerate oral form.

08:26.00 - SULFONES

DAPSONE CHRN On recommendation of a specialist. Specialists consult to be provided.

08:36.00 - URINARY ANTI-INFECTIVESNITROFURANTOIN CHRN For treatment secondary to an appproved chronic condition.

NITROFURANTOINMONOHYDRATE

CHRN For treatment secondary to an appproved chronic condition.

TRIMETHOPRIM CHRN For treatment secondary to an appproved chronic condition.

NITROFURANTOIN CHRN For treatments secondary to an approved chronic condition.

08:40.00 - MISCELLANEOUSANTI-INFECTIVESATOVAQUONE CHRN For treatment of resistant organisms or other special circumstances.

Treatment of a condition secondary to an approved chronic disease.

METRONIDAZOLE CHRN For treatment of resistant organisms or other special circumstances.Treatment of a condition secondary to an approved chronic disease.

SULFA/TRIMETH(CO-TRIMOXAZOLE)

CHRN For treatment of resistant organisms or other special circumstances.Treatment of a condition secondary to an approved chronic disease.

10.00 ANTINEOPLASTIC AGENTS

10:00.00 -ANTINEOPLASTIC AGENTSLENALIDOMIDE CHRN

PHRMA) Any newly identified Multiple Myeloma patient who has failed at leastone prior therapy, including transplant,B)Any patient with transfusion-dependent anemia due to low orintermediate-1-risk MDS associated with a deletion 5q cytogeneticabnormality with or without additional cytogenetic abnormalities,C) Any newly diagnosed Multiple Myeloma patient following autologousstem-cell transplantation & the patient's disease is stable or better with noevidence of disease progression i) the patient will continue to be eligible provided that the patient'sdisease is not progressing & that the patient is not experiencingunacceptable toxicity ii) the recommended dosage is 10mg daily. Dosage adjustments in therange of 5mg to 15mg may be necessary based on individual patientcharacteristics/responsesD) Any newly diagnosed Multiple Myeloma patient as an option for first linetreatment who are not eligible for autologous stem-cell transplantation(TNE). Treatment should be in combination with dexamethasone forpatients with an ECOG performance status less than or equal to 2 & untildisease progression.



253

EVEROLIMUS CHRNPHRM

Advanced Breast Cancer: For the treatment of hormone-receptor positive,HER2 negative advanced breast cancer, in postmenopausal women withECOG performance status 2 after recurrence or progression following anon-steroidal aromatase inhibitor (NSAI), if the treating oncologist wouldconsider using exemestane. Dosing 10mg dailyPancreatic Neuroendocrine Tumours: For the treatment of patients withprogressive, unresectable, well or moderately differentiated locallyadvanced or metastatic pancreatic neuroendocrine tumours (pNET) withgood performance status (ECOG o-2), until disease profression. NOTE:Patients whose disease progresses on everolimus are not eligible forfunded treatment with sunitinib for pNET. Dosing: 10mg dailyMetastatic Renal Cell Carcinoma: For the treatment of metastatic renal cellcarcinoma with clear cell morphology, in patients previously treated with afunded tyrosine kinase inhibitor. Dosing 10mg daily

TRASTUZUMAB EMTANSINE CHRNPHRM

As a second line therapy for patients with HER2-positive, unresectablelocally advanced or metastatic breast cancer with an ECOG statusperformance of 0 or 1, who have received prior treatment withtrastuzumab plus chemotherapy in the metastatic setting or have diseaserecurrence during or within 6 months of completing adjuvant therapy withtrastuzumab plus chemotherapy.

IPILIMUMAB CHRNPHRM

First line treatment of adult patients with advanced (unresectable ormetastatic) melanoma: for a dosing schedule of 3mg/kg, every 3 weeks for4 doses as a first-line therapy for patients with primary cutaneousunresectable state IIIC or IV melanoma, regardless of BRAF mutationstatus, who have an ECOG PS 1 and are not currently receivingimmunosuppressive therapy. If brain metastases are present, patientsshould be asymptomatic or stable.ANDFor the treatment of advanced melanoma (unresectable or metastatic StageIII or Stage IV) in patients who have received prior systemic therapy.

BEVACIZUMAB CHRNPHRM

For cervical cancer in combination with chemotherapy for the treatment ofpatients with metastatic (Stage IVB), persistent, or recurrent carcinoma ofthe cervix of all histologic subtypes (except small cell) AND patient hasECOG 1.For ovarian cancer in combination with paclitaxel and carboplatin for thefront-line treatment of epithelial ovarian, fallopian tube or primaryperitoneal cancer patients with high risk of relapse (stage III sub-optimallydebulked, or stage III unresectable, or stage IV patients); AND patient hasECOG 2.For colorectal cancer as per BCCA protocol.

AFATINIB CHRNPHRM

For first line treatment of patients with EGFR mutation positive advancedor metastatic adenocarcinoma of the lung and with an ECOG performancestatus of 0 or1.

RUXOLITINIB PHRM For patients with intermediate to high risk symptomatic Myelofibrosis (MF)as assessed using the Dynamic International Prognostic Scoring System(DIPSS) Plus or patients with symptomatic splenomegaly. Patients shouldhave ECOG performance status 3 and be either previously untreated orrefractory to other treatment. Dosing 5 to 25 mg bid

REGORAFENIB CHRNPHRM

For patients with metastatic and/or unresectable gastrointensintal stromaltumours (GIST) who have had disease progression on, or intolerance to,imatinib and sunitinib; ANDPatient has ECOG less than or equal to 1

VISMODEGIB CHRNPHRM

For patients with metastatic basal cell carcinoma (BCC) or with locallyadvanced BCC (including patients with basal cell nevus syndrome, ie.Gorlin Syndrome) who have measurable metastatic disease or locallyadvanced disease, which is considered inoperable or inappropriate forsurgery and inappropriate for radiotherapy; ANDPatient is 18 years or older; ANDPatient has ECOG less than or equal to 2



254

POMALIDOMIDE CHRNPHRM

For patients with relapsed and/or refractory multiple myeloma who havepreviously failed at least two treatments, including both bortezomib &lenalidomide & demonstrated disease progression on the last treatment.Pomalidomide is also be an option in rare instances where bortezimib iscontraindicated or when patients are intolerant to it; however in all casespatients should have failed lenalidomide which they may have received inthe maintenance setting.Treatment failure of bortezomib includes those patients who havepreviously received a course of bortezomib during which there was nodisease progression, but are not eligible for bortezomib retreatment at thetime of disease relapse.

ROMIDEPSIN CHRNPHRM

For patients with relapsed or refractory peripheral T-cell lymphoma (PTCL)who are ineligible for transplant & who have undergone previous systemictherapy.Eastern Cooperative Performance Status (ECOG) of 0 to 2.Dosing: Romidepsin 14mg/m2 intravenously on days 1, 8 and 15 (cyclelength is 28 days)Treatment will continue until progression or unacceptable toxicity.

RITUXIMAB CHRNPHRM

For severe RA, when used in combination with methotrexate and whenfailure of anti-TNF trial. On recommendation of a Specialist.Specialistsconsult to be provided. COVERAGE FOR 6 MONTHS. Re-treatmentconsidered for patients who have achieved a response, followed by loss ofeffect after an interval of no less than 6 months since dose.

PEMBROLIZUMAB CHRNPHRM

For the treatment of patients with advanced melanoma (unresectable ormetastatic melanoma) for the following indications;-patients who are naive to ipilimumab treatment (patients with BRAFmutation positive may or may not have received BRAF targeted therapy)and-patients who have failed ipilimumab and, if BRAF mutation positive, havealso failed BRAF mutation therapyTreatment in either setting should be in patients with an ECOGperformance status 0 or 1, and who have stable brain metastases (ifpresent).

PONATINIB HCL CHRNPHRM

For the treatment of patients with chronic phase, accelerated phase orblast phase chronic myeloid leukemia (CML) or Philadelphia chromosomepositive acute lymphoblastic leukemia (Ph+ ALL) for whom other tyrosinekinase inhibitor (TKI) therapy is not appropriate, including CML or Ph+ ALLthat is T315i mutation positive or where there is resistance or intoleranceto prior TKI therapy. Funding will be for ECOG performance status 0-2.Treatment should continue until unacceptable toxicity or diseaseprogression. Other TKI therapy is not appropriate for patients who;-have confirmed T315i mutation positive disease, independent of previousTKI therapy-have CML or Ph+ ALL who have resistance/disease progression after atleast two prior lines of TKI therapy where Iclusig would be available asthird line TKI option, or who have intolerance to prior TKI therapy

BOSUTINIB CHRNPHRM

For treatment of patients with chronic, accelerated or blast phasePhiladelphia chromosome positive (Ph+) chronic myelogenous leukemia(CML) who have resistance/disease progression after at least one prior lineof tyrosine kinase inhibitor (TKI) therapy or who have intolerance to priorTKI therapy and for whom treatment with bosutinib is considered the mostclinically appropriate option.



255

ENZALUTAMIDE CHRNPHRM

For treatment of patients with metastatic castration resistant prostatecancer, who have progressed on docetaxel-based chemotherapy with anECOG performance status 2 and no risk factors for seizures and would bean alternative to abiraterone for patients in the post-docetaxel setting butwould would not be an add-on therapy to abiraterone treatment;ANDFor the treatment of patients with asymptomatic or mildly symptomaticmetastatic castration-resistant prostate cancer (mCRPC) who haveevidence of disease progression following androgen deprivation therapy(ADT), who have not received prior chemotherapy for mCRPC and whohave an ECOG performance status of 0 or 1, and no risk factor forseizures.

IDELALISIB CHRNPHRM

Idelalisib (Zydelig) in combination with rituximab for the treatment ofpatients with relapsed chronic lymphocytic leukemia (CLL). Treatmentshould continue until unacceptable toxicity or disease progression.

OBINUTUZUMAB CHRNPHRM

In combination with chlorambucil for previously untreated chroniclymphocytic leukemia (CLL) & adequate renal function, for whomfludarabine-based treatment is considered inappropriate.ORIn combination with chlorambucil for previously untreated CLL wherefludarabine-based therapy is considered inappropriate & the patient hasinitated treatment with single-agent chlorambucil in the past 3 months.

RAMUCIRUMAB CHRNPHRM

In combination with paclitaxel for the treatment of patients with advancedor metastatic gastric cancer or gastro-esophageal junction (GEJ)adenocarcinoma with an Eastern Cooperative Oncology Group (ECOG)performance status of 0 or 1 and with disease progression following first-line chemotherapy.

ABIRATERONE ACETATE CHRNPHRM

In combination with prednisone for the treatment of metastatic prostatecancer (castration-resistant prostate cancer) in patients who:-are asymptomatic or mildly symptomatic after failure of androgendeprivation therapy AND-have received prior chemotherapy containing docetaxel after failure ofandrogen deprivation therapy

DABRAFENIB MESYLATE CHRNPHRM

Monotherapy as a first-line BRAF-mutation targeted treatment for patientswith BRAF V600 mutation-positive, unresectable or metastatic melanomawith an ECOG performance status of 0 or 1. If brain metastases arepresent, patients should be asymptomatic or have stable symptoms.Treatment should continue until disease progression or the developmentof unacceptable toxicity.Tafinlar and Mekinist combination therapy as a first-line BRAF-mutationtargeted treatment for patients with BRAF V600 mutation postitive,unresectable or metastatic melanoma & who have an ECOG performancestatus of 0 or 1. Treatment should continue until disease progression. Ifbrain metastases are present, patients shuld be asymptomatic or havestable symptoms.Tafinlar is NOT approved in patients who have progressed on a prior BRAFinhibitor therapy.

TRAMETINIB CHRNPHRM

Monotherapy as a first-line BRAF-mutation targeted treatment of patientswith BRAF V600 mutation-positive, unresectable or metastatic melanomaand with an ECOG performance of 0 or 1. If brain metastases are present,patients should be asymptomatic or have stable symptoms. Treatmentshould continue until disease progression or the development ofunacceptable toxicity.Mekinist and Tafinlar combination therapy as a first-line BRAF-mutationtargeted treatment for patients with BRAF V600 mutation positive,unresectable or metastatic melanoma and who have an ECOG performancestatus of 0 or 1. If brain metastases are present patients should beasymptomatic or have stable symptoms. Treatment should continue untildisease progression.Mekinist is NOT approved in patients who have progressed on a prior BRAFinhibitor therapy.



256

BEVACIZUMAB CHRNPHRM

On recommendation of a specialist for treatment of age-related maculardegeneration, or diabetic macular edema, or visual impairment due tomacular edema secondary to central vein occlusion.

IBRUTINIB CHRNPHRM

On recommendation of an oncologist. For patients with chroniclymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL) who havereceived at least one prior therapy and are considered inappropriate fortreatment or retreatment with a fludarabine-based regimen.

GEFITINIB CHRNPHRM

On recommendation of an oncologist.For the first line, monotherapy treatment of locally advanced (notamenable to curative therapy) or metastatic non-small cell lung cancer(NSCLC) in patients who are EGFR Positive.The patient is to be assessed for disease status at least every two monthsand treatment will be discontinued if there is evidnece of diseaseprogression.Dose reimbursed: 250mg orally once dailyIressa will NOT be granted funding in the following circumstances;-Patients with EGFR wild-type mutation (ie. negative for mutation); Patientswith EGFR unknown mutation;-2nd or 3rd line or maintenance NSCLC;Renewal will be considered for patients until there is any evidence ofdisease progression, at which point, treatment with gefitinib must bediscontinued.Approval for 6 months

CAPECITABINE CHRNPHRM

On recommendation of oncologist and all criteria established by canceragency must be followed. Coverage for 12 months.

DASATINIB CHRNPHRM


EVEROLIMUS CHRNPHRM


LAPATINIB CHRNPHRM


PERTUZUMAB/TRASTUZUMAB CHRNPHRM


IMATINIB CHRNPHRM

On recommendation of oncologist. a) For treatment of patients with newly diagnosed Philadelphiachromosome-positive (Ph+ALL)b)For treatment of patients with Philadelphia chromosome-positive (Ph+)chronic myeloid leukemia (CML)c) For treatment of gastrointestinal stromal tumours (GIST), confirmed byC-Kit positivity, when tumours are inoperable

ERLOTINIB CHRNPHRM

On recommendation of specialist. Specialists consult to be provided. Initialapproval for 6 months to be followed by written confirmation that there isno evidnece of disease progression.

SUNITINIB CHRNPHRM

On recommendation of specialist. Specialists consult to be provided. Initialapproval for 6 months to be followed by written confirmation that there isno evidnece of disease progression.

INTERFERON ALFA-2B CHRNPHRM

Positive Hepatitis C serology and ALT > 1.5 times normal for 6 monthswithout any other cause for hepatitis (i.e. Alcohol), and onrecommendation of Gastroenterologist or Infectious DiseaseSpecialist. COVERAGE WILL BE PROVIDED FOR 1 YEAR. Coverage for onecourse of treatment only.

CRIZOTINIB CHRNPHRM

Second-line therapy for patients with ALK-positive advanced non-smallcell lung cancer (NSCLC) with an ECOG performance status 2.ANDFirst-line therapy for patients with an ALK-positive NSCLC with an ECOGperformance status of 0 - 2.

12.00 AUTONOMIC DRUGS



257

12:04.00 -PARASYMPATHOMEMETIC(CHOLINERGIC) AGENTSDONEPEZIL HYDROCHLORIDE CHRN

PHRMFor mild or moderate Alzheimer's (with MMSE score 10-26 within previous3 months). Reviewed on a case-by-case basis. Review after first 6 months,then yearly. Reapply with updated MMSE score each time. Only one drugapproved at any time; no combination therapy. Not for patients alreadyliving in a dementia care facility.

DONEPEZIL HYSROCHLORIDE CHRNPHRM

For mild or moderate Alzheimer's (with MMSE score 10-26 within previous3 months). Reviewed on a case-by-case basis. Review after first 6 months,then yearly. Reapply with updated MMSE score each time. Only one drugapproved at any time; no combination therapy. Not for patients alreadyliving in a dementia care facility.

GALANTAMINEHYDROBROMIDE

CHRNPHRM


RIVASTIGMINE CHRNPHRM


RIVASTIGMINE CHRNPHRM

For patients who cannot use the oral form.

12:08.08 -ANTIMUSCARINICSANTISPASMODICSGLYCOPYRRONIUM BROMIDE CHRN

PHRM1) For COPD, if symptoms persist after 2-3 months of short actingbronchodilator therapy (salbutamol or ipratropium at optimal doses). 2)Please provide post-bronchodilator spirometric evidence of at leastmoderate to severe airflow obstruction. * 3) If spirometry cannot beobtained, other evidence regarding severity of condition must be providedfor consideration. * moderate to severe airflow obstruction, ie FEV1< 65%and FEV1/ FVC ratio < 0.7, and significant symptoms (i.e. MRC 3-5 fromCanadian Thoracic Society COPD Guidelines) MRC=Medical ResearchCouncil Dyspnea Scale. Note: Coverage of combination therapy withGlycopyrronium or Tiotropium + LABA/ ICS considered for moderate tosevere COPD.

TIOTROPIUM CHRNPHRM

1) For COPD, if symptoms persist after 2-3 months of short actingbronchodilator therapy (salbutamol or ipratropium at optimal doses). 2)Please provide post-bronchodilator spirometric evidence of at leastmoderate to severe airflow obstruction. * 3) If spirometry cannot beobtained, other evidence regarding severity of condition must be providedfor consideration. * moderate to severe airflow obstruction, ie FEV1< 65%and FEV1/ FVC ratio < 0.7, and significant symptoms (i.e. MRC 3-5 fromCanadian Thoracic Society COPD Guidelines) MRC=Medical ResearchCouncil Dyspnea Scale. Note: Coverage of combination therapy withGlycopyrronium or Tiotropium + LABA/ ICS considered for moderate tosevere COPD.

UMECLIDINIUM CHRNPHRM

1) For COPD, if symptoms persist after 2-3 months of short actingbronchodilator therapy (salbutamol or ipratropium at optimal doses). 2)Please provide post-bronchodilator spirometric evidence of at leastmoderate to severe airflow obstruction. * 3) If spirometry cannot beobtained, other evidence regarding severity of condition must be providedfor consideration. * moderate to severe airflow obstruction, ie FEV1< 65%and FEV1/ FVC ratio < 0.7, and significant symptoms (i.e. MRC 3-5 fromCanadian Thoracic Society COPD Guidelines) MRC=Medical ResearchCouncil Dyspnea Scale. Note: Coverage of combination therapy withGlycopyrronium or Tiotropium + LABA/ ICS considered for moderate tosevere COPD.



258

OPIUM & BELLADONNA SUP. CHRN For an approved chronic conidtion. Specialist's consult with full detailsrequired.

ACLIDINIUM BROMIDE CHRNPHRM

For patients diagnosed with COPD where spirometry measures are:FEV1 as a percentage of predicted value less than or equal to 65% ANDratio of actual FEV1/FVC less than 0.7 ANDinadequate response after 3 month trial of ipratropium at maximumdosage

ACLIDINIUM/FORMOTEROL CHRNPHRM

For treatment of moderate to severe COPD (Medical Research Councildyspnea scale score 3 to 5 and spirometric results of FEV1 < 60% andFEV1/FVC < 0.7) Spirometric results to be provided. ANDInadequate response to long-acting bronchodilator (long-acting beta-2-agonist (LABA) or long-acting anticholinergic (LAAC))

GLYCOPYRRONIUM/INDACATEROL

CHRNPHRM


OLODATEROL/TIOTROPIUM CHRNPHRM


12:12.00 -SYMPATHOMIMETIC(ADRENERGIC) AGENTSFORMOTEROLFUMARATE/BUDESONIDE

CHRNPHRM

1. Treatment of asthma -for patients not adequately controlled on optimalanti-inflammatory treatment - for patients who are stabilized on inhaledcorticosteroids & a long-acting beta2-agonist2. For treatment of moderate to severe COPD (MRC dyspnea scale score 3to 5 and spirometric results of FEV1< 60% and FEV1/FVC < 0.7)MRC=medical research council

SALMETEROL /FLUTICASONE CHRNPHRM

1. Treatment of asthma -for patients not adequately controlled on optimalanti-inflammatory treatment - for patients who are stabilized on inhaledcorticosteroids & a long-acting beta2-agonist2. For treatment of moderate to severe COPD (MRC dyspnea scale score 3to 5 and spirometric results of FEV1< 60% and FEV1/FVC < 0.7)MRC=medical research council

EPINEPHRINE PHRM Cases reviewed individully: For patients at very high risk of anaphylaxis.

EPINEPHRINE HCL PHRM Cases reviewed individully: For patients at very high risk of anaphylaxis.

UMECLIDINIUM/VILANTEROL CHRNPHRM

For treatment of moderate to severe COPD (Medical Research Councildyspnea scale score 3 to 5 and spirometric results of FEV1 < 60% andFEV1/FVC < 0.7) ANDInadequate response to a long-acting bronchodilator (long-acting beta-2agonist (LABA) or long-acting anticholinergic (LAAC))

FLUTICASONEFUROATE/VILANTEROL

CHRNPHRM

For treatment of moderate to severe COPD (Medical Research Councildyspnea scale score 3 to 5 and spirometric results of FEV1 < 60% andFEV1/FVC < 0.7).In Asthma;For patients not adequately controlled on optimal anti-inflammatorytherapy ORFor patients who are stabilized on inhaled corticosteroids & a long actingbeta2-agonist



259

INDACATEROL CHRNPHRM

For treatment of moderate to severe COPD (Medical Research Councildyspnea scale score 3 to 5 and spirometric results of FEV1 < 60% andFEV1/FVC < 0.7).In Asthma;For patients not adequately controlled on optimal anti-inflammatorytherapy ORFor patients who are stabilized on inhaled corticosteroids & a long actingbeta2-agonist

FORMOTEROL FUMARATE CHRNPHRM

Treatment of asthma -for patients not adequately controlled on optimalanti-inflammatory treatmentCOPD-for moderate to severe COPD (MRC dyspnea scale score 3 to 5 &spirometric results FEV1<60% & FEV1/FVC < 0.7) MRC=medical researchcouncil

SALMETEROL XINAFOATE CHRNPHRM

Treatment of asthma -for patients not adequately controlled on optimalanti-inflammatory treatmentCOPD-for moderate to severe COPD (MRC dyspnea scale score 3 to 5 &spirometric results FEV1<60% & FEV1/FVC < 0.7) MRC=medical researchcouncil

12:16.00 - SYMPATHOLYTIC(ADRENERGIC BLOCKING)AGENTSRIZATRIPTAN CHRN Treatment secondary to an approved chronic disease.

12:92.00 - MISCELLANEOUSAUTONOMIC DRUGSVARENICLINE PHRM For adults who have failed to quit smoking and desire pharmacologic

assistance. Limited to 12 weeks course (165 tablets) within a 12 monthperiod and should be combined with intensive counselling.

VARENICLINE PHRM Will be provided for 12 months only.

20.00 BLOOD FORMATION AND COAGULATION

20:04.04 - IRONPREPARATIONSIRON (FERRIC GLUCONATECOMPLEX

CHRNPHRM

On recommendation of a specialist for renal failure/dialysis. Specialistsconsult to be provided.

IRON DEXTRAN CHRNPHRM


IRON POLYSACCHARIDECOMPLEX

CHRNPHRM


IRON SUCROSE CHRNPHRM


IRON (FERROUS SULFATE) PHRM Patients unable to swallow solid oral dosage forms.

20:12.04 -ANTICOAGULANTS



260

APIXABAN CHRNPHRM

For at-risk patients with NON-VALVULAR ATRIAL FIBRILLATION, for theprevention of stroke and systemic embolism AND in whom:1. Anticoagulation is inadequate following at least a 2 month trial ofwarfarin OR2. Anticoagulation with warfarin is contraindicated or not possible due toinability to regularly monitor the patient via International Normalized Ratio(INR) testing (no reasonable access to INR testing services at a healthcenter, labratory or clinic)Exclusions: Patients with impaired renal function (creatinine clearance orestimated glomerular filtration rate < 25mL/min) OR;patients who have prosthetic heart valves OR;patients with hemodynamically significant rheumatic valvular heart disease(especially mitral stenosis) OR;patients > 75 years of age who do NOT have documented stable renalfunction NOTES:At-risk patients with atrial fibrillation are defined as those with a CHADS2score of 1. Prescribers may consider an antiplatelet regimen or oralanticoagulation for patients with a CHADS2 score of 1.Inadequate anticoagulation is defined as INR testing results that areoutside the desired INR range for at least 35% of the tests during themonitoring period (adequate anticoagulation is defined as INR test resultsthat are within the desired INR range for at least 65% of the tests duringthe monitoring period).Dosing: the usual recommended dose is 5mg twice daily; a reduced doseof apixaban 2.5mg twice daily is recommended for patients with at leasttwo of the following; 80 years of age, body weight 60kg, or serumcreatinine 133 micromole/litre.Since renal impairment can increase bleeding risk, renal function shouldbe regularly monitored. Other factors that increase bleeding risk shouldalso be assessed & monitoredVTE PROPHYLAXIS:For the prophylaxis of venous thromboembolism (VTE) following electivetotal hip replacement surgery or elective total knee replacement surgery,where the inital post-operative doses are administered in an acute care(hospital) setting.Dose: 2.5mf twice dailyApproval period: Up to a 35 days total following hip replacement and up toa 14 day total following knee replacementNOTES:The first dose is typically given 12 to 24 hours after surgery if adequatehemostasis has been achieved.The ADVANCE clinical trial program did not evaluate the efficacy or safetyof sequential use of molecular weight heparin followed by apixaban for theprophylaxis of VTE. As such, Yukon coverage is not intended for thispractice.Apixaban has not been studied in clinical trials in patients undergoing hipfracture surgery, & is not recommended in these patients.VTE TREATMENTFor the treatment of VTE (deep vein thrombosis (DVT) or pulmonaryembolism(PE))Approval period up to 6 months total.The recommended dosage for patients initiating treatment is 10mg twicedaily for 7 days, followed by 5mg twice daily for up to 6 months.Drug plan coverage of apixaban is an alternative to heparin/warfarin forup to 6 months. When used for more than 6 months, apixaban is morecostly than heparin/warfarin. Patients with an intended duration of therapyof more than 6 months should be considered for initiation onheparin/warfarin.Since renal impairment can increase bleeding risk, it is important tomonitor renal function regularly. Other factors that increase bleeding risksshould also be assessed and monitored.



261

RIVAROXABAN CHRNPHRM

For prophylaxis of venous thromboembolism following total knee or hipreplacement surgery, as alternative to low molecular weight heparins. Upto 35 days after surgery.

DALTEPARIN SODIUM CHRN For treatment of approved chronic condition. (Please specify treatmentduration). For long-term outpatient prophylaxis in patients who areintolerant to, or have failed, Warfarin therapy.

ENOXAPARIN CHRN For treatment of approved chronic condition. (Please specify treatmentduration). For long-term outpatient prophylaxis in patients who areintolerant to, or have failed, Warfarin therapy.

FONDAPARINUX SODIUM CHRN For treatment of approved chronic condition. (Please specify treatmentduration). For long-term outpatient prophylaxis in patients who areintolerant to, or have failed, Warfarin therapy.

NADROPARIN CALCIUM CHRN For treatment of approved chronic condition. (Please specify treatmentduration). For long-term outpatient prophylaxis in patients who areintolerant to, or have failed, Warfarin therapy.

TINZAPARIN CHRN For treatment of approved chronic condition. (Please specify treatmentduration). For long-term outpatient prophylaxis in patients who areintolerant to, or have failed, Warfarin therapy.

20:12.18 - PLATELETAGGREGATION INHIBITORSTICAGRELOR CHRN

PHRMIn combination with ASA 75mg-150mg (see note a) below) daily forpatients with acute coronary syndrome (ie: ST elevation myocardialinfarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) orunstable angina (UA) with ONE of the following;1. Failure on optimal clopidogrel & ASA therapy as defined by definitestent thrombosis (see note b) below), or recurrent STEMI, or NSTEMI or UAafter revascularization via percutaneous coronary intervention (PCI), ifprescribed by the interventional cardiologist OR2. STEMI, NSTEMI or UA & undergoing revascularization via PCI, ifprescribed by the interventional cardiologist ORFunding approval is for up to one year.Notes:a) Co-administration of ticagrelor with high maintenance dose ASA(greater than 150mg daily) is not recommended.b) Definite stent thrombosis, according to the Academic ResearchConsortium, is a total occlusion originating in or within 5mm of the stent,or is a visible thrombus within the stent, or is within 5mm of the stent inthe presence of an acute ischemic clinical syndrome within 48 hours.Definite stent thrombosis must be confirmed by angiography or bypathologic confirmation of acute thrombosis.c) Ticagrelor is contraindicated in patients with active pathologicalbleeding, in those with a history of intracranial hemorrhage & moderate tosevere hepatic impairment.

20:16.00 - HEMATOPOIETICAGENTSDARBEPOETIN ALFA CHRN

PHRMFor treatment of anemia in chronic renal disease prior to initiation ofdialysis on recommendation of Specialist. Specialists consult to beprovided.

FILGRASTIM CHRNPHRM

On recommendation of Hematologist or Specialist. Specialists consult to beprovided. For cancer: restricted to curative treatment protocolsrecommended by Cancer Agency.

PEGFILGRASTIM CHRNPHRM

On recommendation of Hematologist or Specialist. Specialists consult to beprovided. For cancer: restricted to curative treatment protocolsrecommended by Cancer Agency.

EPOETIN ALFA CHRNPHRM

~ For anemia in chronic renal disease on recommendation of Nephrologist.Specialists consult to be provided. ~ For anemia in HIV or transplantpatients on recommendation of Specialist. Specialists consult to beprovided. ~ For cancer: non-myeloid malignancies with curative treatentprotocols recommended by cancer Agency.



262

20:24.00 -HEMORRHEOLOGIC AGENTSCLOPIDOGREL BISULFATE CHRN

PHRM1) For the prevention of cerebrovascular (e.g. stroke, TIA) and non-cerebrovascular ischemic events in patients who have a contraindication toASA. 2) For treatment of patients who have experienced a TIA or strokewhile on ASA. 3) For prevention of thrombosis when prescribed followingintracoronary stent placement. Coverage provided for maxiumum oneyear. 4) For reduction of recurrent risk of MI in patients with acutecoronary syndrome (ie. unstable angina or non-STEMI) concurrently withASA. Coverage provided for maximum one year.

24.00 CARDIOVASCULAR DRUGS

24:06.00 - ANTILIPEMICDRUGSEZETIMIBE CHRN

PHRMFor patients intolerant to statins or patients not adequately managed onoptimum doses of statins.

24:12.00 - VASODILATINGDRUGSSILDENAFIL CHRN

PHRMFor NYHA functional class III or IV PAH; idiopathic (primary) PAH, familial(heritable) PAH, anorexigen-induced PAH, or PAH secondary to connectivetissue disease.Diagnosis of PAH to be confirmed by right heart catheterization.Approved after an inadequate response to maximal appropriateconventional therapy such as calcium channel blockers. Please providedetails.Specialist's consult to be provided.Only a 30 day's supply to be dispensed at one time for the first twomonths.First approval for one year. Subsequent renewals approved for five years.

TADALAFIL CHRNPHRM

For NYHA functional class III or IV PAH; idiopathic (primary) PAH, familial(heritable) PAH, anorexigen-induced PAH, or PAH secondary to connectivetissue disease.Diagnosis of PAH to be confirmed by right heart catheterization.Approved after an inadequate response to maximal appropriateconventional therapy such as calcium channel blockers. Please providedetails.Specialist's consult to be provided.Only a 30 day's supply to be dispensed at one time for the first twomonths.First approval for one year. Subsequent renewals approved for five years.

DIPYRIDAMOLE/ASA CHRNPHRM

For treatment of patients who have had a stoke or TIA while on ASA.

24:12.92 - MISCELLANEOUSVASODILATATING AGENTSRIOCIGUAT PHRM For the treatment of inoperable chronic thromboembolic pulmonary

hypertension (CTEPH, World Health Organization (WHO) Group 4) orpersistent or recurrent CTEPH after surgical treatment in adult patients (18 years of age) with WHO Functional Class 2 or 3 pulmonaryhypertension.Specialist's consult to be provided.

24:32.20 -MINERALOCORTICOID(ALDOSTERONE) RECEPTORANTAGONISTSEPLERENONE CHRN

PHRMOn recommendation of a specialist; consult to be provided.For persons suffering from New York Heart Association (NYHA) class IIchronic heart failure with left ventricular systolic dysfunction (with ejectionfraction 35%), as a complement to standard therapy.

28.00 CENTRAL NERVOUS SYSTEM DRUGS



263

28:08.04 - NONSTEROIDALANTI-INFLAMMATORYAGENTSCELECOXIB CHRN Treatment of approved chronic disease where NSAIDSs are contraindicated

or patient on concurrent Warfarin or Prednisone therapy. For treatmentfailure or intolerance to at least three listed NSAIDS¿s in Formulary.Additionally, for OA patients, a failure of adequate Acetaminophen trialmust be documented.

28:08.08 - OPIATEAGONISTSACETAMINOPHEN/CODEINE CHRN

PHRMFor patients with contraindication or intolerance to caffeine.

CODEINE CHRN Treatment in approved conditions where the use of immediate releaseCodiene preparations are no longer effective.

28:08.12 - OPIATE PARTIALAGONISTSBUPRENORPHINE/NALOXONE CHRN Secondary to an approved mental health Chronic condition. As an adjunct

for patients currently receiving mental health pharmacotherapy.

28:10.00 - OPIATEANTAGONISTSNALTREXONE HCL CHRN Secondary to an approved mental health Chronic condition. As an adjunct

for patients currently receiving mental health pharmacotherapy.

28:12.12 - HYDANTOINS

LEVOCARNITINE CHRN Recommended by a Specialist. Specialists consult to be provided.

28:12.92 - MISCELLANEOUSANTICONVULSANTSPERAMPANEL CHRN

PHRMAs adjunctive therapy in patients with refractory partial-onset seizureswho have had an inadequate response or significant intolerance to at leastthree other less costly anticonvulsants. On recommendation of aneurologist.

OXCARBAZEPINE CHRNPHRM

For patients unable to use the solid dosage form.

TOPIRAMATE CHRNPHRM

For patients unable to use the solid dosage form.

ESLICARBAZEPINE ACETATE CHRNPHRM

For patients with refractory partial-onset seizures who are under the careof a physician experienced in the treatment of epilepsy, and are currentlyreceiving two or more antiepileptic agents, and in whom all otherantiepileptic medications are ineffective or not appropriate.

LACOSAMIDE CHRNPHRM

For patients with refractory partial-onset seizures who

• are under the care of a physician experienced in the treatment ofepilepsy, and • are currently receiving two or more antiepileptic agents, and • in whom all other antiepileptic medications are ineffective or notappropriate

28:16.04 -PSYCHOTHERAPEUTICAGENTS(ANTIDEPRESSANTS)



264

DULOXETINE CHRNPHRM

As per the Common Drug Review, duloxetine is not a benefit for thetreatment of depression.In the Chronic Disease Program, only for neuropathic pain secondary to anapproved condition covered by the program, eg: diabetes. In Pharmacareand the Chronic Disease program, for treatment of neuropathic painin patients unresponsive to adequate courses of at least two less costlyalternatives such as tricyclic antidepressant or anticonvulsant agent.Maximum daily dose 60mg.

ESCITALOPRAM CHRNPHRM

For treatment of depression where adequate trials (at least 2 months) ofcitalopram, and at least 2 other antidepressants, have failed.

28:16.08 -PSYCHOTHERAPEUTICAGENTS (ANTIPSYCHOTICAGENTS)ASENAPINE CHRN

PHRMFor the treatment of manic or mixed episodes associated with bipolar Idisorder. As co-therapy with lithium or divalproex, after sufficient trials ofless expensive antipsychotic agents have failed due to intolerance or lackof response. OR as monotherapy, after sufficient trials of lithium ordivalproex have failed AND trials of less expensive atypical antipsychoticagents have failed.History of drug therapy must be included.

ARIPIPRAZOLE CHRNPHRM

For treatment of schizophrenia & related disorders in patients who havefailed other, less expensive antipsychotic agents because of intolerance orlack of response, and on recommendation of a psychiatrist. Specialistsconsult to be provided.

LURASIDONE HCL CHRNPHRM

For treatment of schizophrenia & related disorders in patients who havefailed other, less expensive antipsychotic agents because of intolerance orlack of response, and on recommendation of a psychiatrist. Specialistsconsult to be provided.

ARIPIPRAZOLE CHRNPHRM

On recommendation of a psychiatrist. Specialist's consult to be provided.For treatment of schizophrenia & related disorders in patients who havefailed other, less expensive antipsychotic agents because of intolerance orlack of response after an adequate trial.Injectible formulation is for patients with a history of non-adherence toantipsychotic medications resulting in negative outcomes such as repeatedhospitalizations.

PALIPERIDONE CHRNPHRM

On recommendation of a psychiatrist. Specialist's consult to be provided.For treatment of schizophrenia & related disorders in patients who havefailed other, less expensive antipsychotic agents because of intolerance orlack of response after an adequate trial.Injectible formulation is for patients with a history of non-adherence toantipsychotic medications resulting in negative outcomes such as repeatedhospitalizations.

RISPERIDONE CHRNPHRM

Treatment of schizophrenia and related disorders on recommendation ofPsychiatrist. Consult to be provided. For patients who have tried oralrisperidone AND at least one other antipsychotic agent AND continure tobe inadequately controlled at maximally tolerated doseOR for patients who are currently on a conventional depot antipsychoticAND experiencing significant side effects such as extrapyramidalsymptoms or tardive dyskinesiaOR patients with a history of non-adherence to antipsychotic medicationsresulting in important negative outcomes such as repeatedhospitalizations

28:20.00 - ANOREXIGENICAGENTS & RESPIRATORYAND CEREBRALSTIMULANTS



265

DEXTROAMPHETAMINE SO4 CHRNPHRM

-for the treatment of psychiatric disorders on recommendation of aPsychiatrist or Pediatrician. Specialist's consult to be provided.-for the treatment of fatigue in multiple sclerosis. Approval for 3 monthsto start, then can be renewed indefinitely.

METHYLPHENIDATE HCL CHRNPHRM

Treatment of psychiatric disorder on recommendation of Psychiatrist orPediatrician after a trial of short-acting formulations. Specialists consult tobeprovided.


Treatment of psychiatric disorder on recommendation of Psychiatrist orPediatrician. Specialists consult to be provided.

MODAFINIL PHRM ~ on the advice of a Neurologist or sleep disorder Specialist forPharmacare. Specialists consult to be provided.

MODAFINIL CHRN ~ on the advice of a Neurologist or sleep disorder Specialist for approvedcondition For chronic Disease. Specialists consult to be provided.-for the treatment of fatigue in multiple sclerosis. Approval for 3 monthsto start, then can be renewed indefinitely.

28:20.04 - AMPHETAMINES

LISDEXAMFETAMINEDIMESYLATE

CHRNPHRM

For the treatment of psychiatric disorders on recommendation of apsychiatrist or pediatrician. Specialist consult to be provided.

LISDEXAMFETAMINEDIMESYLAYE

CHRNPHRM

For the treatment of psychiatric disorders on recommendation of apsychiatrist or pediatrician. Specialist consult to be provided.

28:24.08 -BENZODIAZEPINESLORAZEPAM CHRN For short term only treatment of approved psychiatric condition, or as a

muscle relaxant for appropriate condition.

DIAZEPAM CHRN For use in the treatment of epilepsy.

LORAZEPAM CHRN Not covered for chronic treatment.

28:24.92 - MISCELLANEOUSANXIOLYTICS SEDATIVESAND HYPNOTICSCHLORAL HYDRATE CHRN Treatment of approved psychiatric condition.

28:36.16 - DOPAMINEPRECURSORSCARBIDOPA/LEVODOPA CHRN

PHRMInitial patient assessment and approval as appropriate for Duodopatreatment must be made at a movement disorders clinic and approval bythe STEDT Program in Alberta (or a comparable program when it becomesavailable in B.C.). Specialist's consult to be provided and must includedetails pertaining to the severity of the patient's disability while in the offstate and a complete history of all previous & current medications (eg.,name, start date & duration of therapy, dosages used & response). Forpatients with-at least 25% of the waking day in the off state AND-have severe disability while in the off state as assessed by a MovementDisorder specialist AND-have received an adequate trial of maximally tolerated doses of levodopa,with demonstrated clinical response AND-have failed adequate trials of other adjunctive medications (entacapone,dopamine agonists, MAO-B inhibitors) if not contraindicated.(contraindication must be specified)Patients are not eligible if they have-a contraindication to a PEG tube OR-severe psychosis or demenia

28:92.00 - MISCELLANEOUSCENTRAL NERVOUS SYSTEMAGENTSRILUZOLE CHRN

PHRMFor patients diagnosed with ALS on recommendation of Specialist.Specialists consult to be provided.



266

ATOMOXETINE CHRNPHRM

For treatment of ADHD in patients who failed treatment ofmethylphenidate & an amphetamine, on recommendation of a specialist.Specialists consult to be provided.

DIMETHYL FUMARATE CHRNPHRM

Initial: As monotherapy for the treatment of RRMS when prescribed by anMS neurologist. Specialist's consult to be provided. For patients who meetALL of the following criteria:-patient has had at least two (2) clinical relapses in the previous two (2)years AND-patient is ambulatory with or without aid (EDSS of 6.5 or less) AND-patient is 18 years or olderApproval period: 1 yearRenewal: When prescribed by an MS neurologist for patients whodemonstrate continued therapeutic benefit outweighing any potentialrisks, as shown by relapse rate, EDSS, MRI scan (when possible), andoverall clinical impression. Specialist's consult to be provided.A relapse is defined as the appearance of new symptoms or worsening ofold symptoms, lasting at least 24 hours in the absence of fever, andpreceded by stability for at least one (1) month. Approval for 1 year.Only a one month supply to be dispensed at a time for the first year.

ACAMPROSATE CALCIUM CHRN Secondary to an approved mental health Chronic condition. As an adjunctfor patients currently receiving mental health pharmacotherapy.

RASAGILINE CHRNPHRM

Used as adjunct therapy for Parkinson's Disease on advice of Specialist.Specialists consult to be provided.

40.00 ELECTROLYTIC, CALORIC AND WATER BALANCE

40:12.00 - REPLACEMENTPREPARATIONSPHOSPHORUS CHRN For treatment of dialysis patients.

MAGNESIUMGLUCOHEPTONATE

CHRN Treatment of hypomagnesemia secondary to an approved chronic disease(renal/ dialysis).

MAGNESIUMGLUCOHEPTONATE

PHRM Treatment of hypomagnesemia.

MAGNESIUM GLUCONATE PHRM Treatment of hypomagnesemia.

MAGNESIUM OXIDE PHRM Treatment of hypomagnesemia.

40:28.00 - DIURETICS

FUROSEMIDE CHRNPHRM

As recommended by a Specialist. Specialists consult to be provided.

BUMETANIDE CHRNPHRM

Patients unable to tolerate Furosemide.

48.00 COUGH PREPARATIONS

48:02.00 -



267

NINTEDANIB CHRNPHRM

For adult patients with a diagnosis of mild to moderate idiopathicpulmonary fibrosis (IPF):-diagnosis confirmed by a respirologist & a high-resolution CT scan withinthe previous 24 months.-all other causes of restrictive lung disease (e,g, collagen vasculardisorder, or hypersensitivity pneumonitis) should be excluded.-mild to moderate IPF is defined as forced vital capacity (FVC) greater thanor equal to 50% of predicted.-patient is under the care of a physician with experience in IPF-Specialists consult to be provided.Initial approval period: seven months (including 4 weeks allowed for repeatpulmonary function tests)First Renewal Criteria at 6 months:-Patients must NOT demonstrate progression of disease defined as anabsolute decline in percent predicted FVC of 10% from initiation oftherapy until renewal (first 6 month treatment period) If a patient hasexperienced progression as defined above, then the results should bevalidated with a confirmatory pulmonary function test conducted 4 weekslater.Approval period: 6 monthsSecond and subsequent renewals (at 12 months & thereafter):Patients must not demonstrate progression of disease defined as anabsolute decline in percent predicted FVC of 10% within any 12 monthperiod. If a patient has experienced progression as defined above, then theresults should be validated with a confirmatory pulmonary function testconducted 4 weeks later.Approval period for 12 months.Note: Combination use of Ofev and Esbriet will not be funded. Patientswho have experienced intolerance or failure to Ofev or Esbriet will beconsidered for the alternate agent provided that the patient continues tomeet the above coverage criteria.

48:14.12 -

IVACAFTOR CHRN For the treatment of cystic fibrosis (CF) in patients age 6 years & older whohave a documented G551D mutation in the Cystic FibrosisTransmembraneconductance Regulator (CFTR) gene. Initial coverage may be approved forup to 150mg every 12 hours for 6 months. Patients will be limited toreceiving a one-month supply per prescription.Renewal Criteria: The sweat chloride level will then be re-checked 6months after starting treatment to determine whether the full reduction (asdetailed below) has been achieved. Thereafter sweat chloride levels will bechecked annually.Patients will be considered to have responded to treatment if either:a) the patient's sweat chloride test falls below 60mmol/litre: ORb) the patient's sweat chloride test falls by at least 30%In cases where the baseline sweat chloride test is already below60mmol/litre, the patient will be considered to have responded totreatment if eitherc) the patient's sweat chloride test falls by at least 30%; ORd) the patient demonstrates a sustained absolute improvement in FEV1 ofat least 5%. In this instance FEV1 will be compared with the baseline pre-treatment level one month and three months after starting treatment.If the expected reduction in sweat chloride does not occur, the patient's CFclinician will first explore any problems in following the recommendeddosing schedule for ivacaftor. The patient's sweat chloride will then beretested around one week later & funding discontinued if the patient doesnot meet the above criteria. Renewal coverage may be approved for up to 150mg every 12 hours for 6months. Patients will be limited to receiving a one-month supply perprescription.

48:24.00 - MUCOLYTICAGENTSACETYLCYSTEINE PHRM As a mucolytic agent, by inhalation/ nebulization.



268

DORNASE ALFA CHRNPHRM

On recommendation of Specialist (Cystic Fibrosis). Specialists consult to beprovided.

48:92.00 - RESPIRATORYAGENTS, MISCELLANEOUSOMALIZUMAB PHRM For patients with moderate to severe chronic idiopathic urticaria (CIU) who

remain symptomatic (presence of hives/or associated itching) despiteoptimum management with available oral therapies defined as-H1 antihistamines at up to 4 times the standard daily dose-montelukastSpecialist's consult requiredInitial approval period of 24 weeks at a maximum dose of 300mg every 4weeks.Continued coverage will be authorized if the patient has achieved;-complete symptom control for less than 12 consecutive weeks; OR-partial response to treatment, defined as at least a 9.5 point reductionin baseline urticaria activity score over 7 days (UAS7)Treatment cessation should be considered for patients who experiencecomplete symptom control for at least 12 consecutive weeks at the end ofa 24 week treatment period.In patients where treatment is discontinued due to temporoary symptomcontrol, treatment re-initiation should be considered should CIUsymptoms reappear.

52.00 EYE, EAR, NOSE AND THROAT PREPARATIONS

52:08.00 - ANTI-INFLAMMATORY AGENTSPREDNISOLONE SODIUMPHOSPHATE

PHRM For patients who cannot effectively use a dropper bottle.

DEXAMETHASONE CHRN Ophthalmic conditions secondary to approved chronic disease.

FLUOROMETHOLONE CHRN Ophthalmic conditions secondary to approved chronic disease.

PREDNISOLONE ACETATE CHRN Ophthalmic conditions secondary to approved chronic disease.

52:24.00 - MYDRIATICS

HOMATROPINEHYDROBROMIDE

CHRN For Palliative only.

52:28.00 - MOUTHWASHESAND GARGLESBENZYDAMINE CHRN For treatment of mucositis, ulcerative complications of chemotherapy. For

use in immuno-compromised patients at risk of mucosal breakdown.

52:36.00 - MISCELLANEOUSE.E.N.T. DRUGSBRIMONIDINE TARTRATE CHRN

PHRMFor patients intolerant to Benzalkonium Chloride.

DORZOLAMIDE HCL/TIMOLOL CHRNPHRM

For patients intolerant to Benzalkonium Chloride.

RANIBIZUMAB CHRNPHRM

On recommendation of a specialist for treatment of age-related maculardegeneration, or visual imparment due to macular edema secondary tocentral vein occlusion..

52:92.00 - EENT DRUGS,MISCELLANEOUSAFLIBERCEPT CHRN

PHRMOn recommendation of a specialist for age-related macular degeneration,or diabetic macular edema, or visual impairment due to macular edemasecondary to central vein occlusion.

56.00 GASTROINTESTINAL DRUGS

56:22.00 - ANTI-EMETICS



269

APREPITANT CHRNPHRM

For use with emetogenic chemotherapy as per cancer agency protocol.Approval for 1 year, then renew as required.

DOLASETRON CHRNPHRM


GRANISETRON CHRNPHRM


ONDANSETRON CHRNPHRM


NABILONE CHRNPHRM

For use with emotogenic chemotherapy as per cancer agency protocol.Approval for one year then renew.

56:40.00 - MISCELLANEOUSGASTROINTESTINAL DRUGSLANSOPRAZOLE CHRN Approved on case-by-case basis: For treatment of patients at high risk for

GI bleeding when NSAID or steroid therapy cannot be avoided for approvedchronic disease. For patients with Barrett's Esophagus. Standard doseapproved - include reasons if high dose required. GERD, dyspepsia orpeptic ulcer disease are not covered by Chronic Disease Program.

OMEPRAZOLE CHRN Approved on case-by-case basis: For treatment of patients at high risk forGI bleeding when NSAID or steroid therapy cannot be avoided for approvedchronic disease. For patients with Barrett's Esophagus. Standard doseapproved - include reasons if high dose required. GERD, dyspepsia orpeptic ulcer disease are not covered by Chronic Disease Program.

PANTOPRAZOLE CHRN Approved on case-by-case basis: For treatment of patients at high risk forGI bleeding when NSAID or steroid therapy cannot be avoided for approvedchronic disease. For patients with Barrett's Esophagus. Standard doseapproved - include reasons if high dose required. GERD, dyspepsia orpeptic ulcer disease are not covered by Chronic Disease Program.

RABEPRAZOLE CHRN Approved on case-by-case basis: For treatment of patients at high risk forGI bleeding when NSAID or steroid therapy cannot be avoided for approvedchronic disease. For patients with Barrett's Esophagus. Standard doseapproved - include reasons if high dose required. GERD, dyspepsia orpeptic ulcer disease are not covered by Chronic Disease Program.

64.00 HEAVY METAL ANTAGONISTS

64:00.00 - HEAVY METALANTAGONISTSDEFERIPRONE CHRN

PHRMFor the treatment of patients with transfusional iron overload due tothalassemia syndromes when current chelation therapy is inadequate.

66.00

66:16.12 -

RALOXIFENE CHRN For treatment of osteoporosis in women unable to tolerate listedbisphosphonates.

68.00 HORMONES AND SUBSTITUTES

68:08.00 - ANDROGENS

TESTOSTERONE ENANTHATE CHRN Coverage for hormonal replacement required for an approved chroniccondition (e.g. primary hypogonadism, pituitary disorders). Cases reviewedindividually.

68:16.12 - ESTROGENAGONIST-ANTAGONISTSRALOXIFENE CHRN

For treatment of osteoporosis in patients unable to tolerate listedbisphosphonates.

68:20.04 - BIGUANIDES



270

LINAGLIPTIN/METFORMIN CHRNPHRM

For combination treatment of Type II diabetes for patients approved forlinagliptin coverage and already stabilized on combination treatment withmetformin.

METFORMIN/SAXAGLIPTIN CHRNPHRM

For the treatment of Type II diabetes for patients who are alreadystabilized on therapy with metformin, a sulfonylurea and saxagliptin toreplace the individual components of saxagliptin and metformin AND forwhom insulin is not an option, for reasons other than "needle phobia"..

68:20.05 - DIPEPTIDYLPEPTIDASE-4 (DPP-4)INHIBITORSLINAGLIPTIN CHRN

PHRMIn addition to metformin and a sulfonylurea for patients with inadequateglycemic control on metformin and a sulfonylurea AND for whom insulin isnot an option, for reasons other than "needle phobia".

SAXAGLIPTIN HCL CHRNPHRM

In addition to metformin and a sulfonylurea for patients with inadequateglycemic control on metformin and a sulfonylurea AND for whom insulin isnot an option, for reasons other than "needle phobia".

68:20.08 - INSULINS

INSULIN DETEMIR CHRNPHRM • Adults diagnosed with Type 1 or 2 diabetes requiring insulin & are

currently taking insulin NPH and/or pre-mix insulin at optimal dosingAND • Have experienced unexplained nocturnal hypoglycemia at least oncea month despite optimal management OR • Have documented severe or continuing allergic reaction to existinginsulin (full documentation required) • must be prescribed by an endocrinologist or visiting internalmedicine specialist. Specialists consult to be provided.

INSULIN GLARGINE CHRNPHRM • Adults diagnosed with Type 1 or 2 diabetes requiring insulin & are

currently taking insulin NPH and/or pre-mix insulin at optimal dosingAND • Have experienced unexplained nocturnal hypoglycemia at least oncea month despite optimal management OR • Have documented severe or continuing allergic reaction to existinginsulin (full documentation required) • must be prescribed by an endocrinologist or visiting internalmedicine specialist. Specialists consult to be provided.

68:20.18 - Sodium-GlucoseCotransporter 2 (SGLT2)InhibitorsDAPAGLIFLOZIN CHRN

PHRMAdded on to metformin for patients: -who have inadequate glycemic control on metformin -who have a contraindication or intolerance to a sulfonylurea-for whom insulin is not an option, for reasons other than needle phobiaAdded on to a sulfonylurea for patients;-who have inadequate glycemic control on a sulfonylurea-who have a contraindication or intolerance to metformin-for whom insulin is not an option, for reasons other than needle phobia

CANAGLIFLOZIN CHRNPHRM

In addition to metformin and a sulfonylurea for patients with inadequateglycemic control on metformin and a sulfonylurea AND for whom insulin isnot an option, for reasons other than needle phobia.

EMPAGLIFLOZIN CHRNPHRM

In addition to metformin and a sulfonylurea for patients with inadequateglycemic control on metformin and a sulfonylurea AND for whom insulin isnot an option, for reasons other than needle phobia.

68:20.92 - ANTI DIABETICDRUGS



271

SITAGLIPTIN CHRNPHRM

As add-on therapy for the treatment of Type 2 diabetes in patients withinadequate glycemic control on:metformin AND a sulfonylureaAND for whom insulin is not an option, for reasons other than "needlephobia".

SITAGLIPTIN/METFORMIN CHRNPHRM

For combination treatment of type 2 diabetes mellitus for patientsapproved for sitagliptin coverage and already stabilized on combinationtreatment with the individual components of metformin and sitagliptin.

PIOGLITAZONE CHRNPHRM

Treatment of diabetes in patients who are not adequately controlled onmaximum tolerated doses of metformin AND a sulfonylurea.

ROSIGLITAZONE CHRNPHRM

Treatment of diabetes in patients who are not adequately controlled onmaximum tolerated doses of metformin AND a sulfonylurea.

68:24.00 - PARATHYROID

CALCITONIN CHRNPHRM

For the treatment of fracture with bone pain for a maximum duration of 3months.

68:28.00 - PITUITARY

DESMOPRESSIN CHRNPHRM

For treatment of vasopressin sensitive central diabetes insipidus.

80.00 SERUMS, TOXOIDS AND VACCINES

80:12.00 - VACCINES

BACILLUS CALMETTE-GUERIN(BCG)

CHRNPHRM

On recommendation of an oncologist.

84.00 SKIN AND MUCOUS MEMBRANE AGENTS

84:06.00 - ANTI-INFLAMMATORY AGENTSHALOBETASOL CHRN

PHRMHigh potency corticosteroid for resistant/severe psoriasis. Review dosageprecautions.

84:36.00 - MISCELLANEOUSSKIN & MUCOUS MEMBRANEAGENTSIMIQUIMOD CHRN

PHRMFor treatment of actinic keratosis, or superficial basal cell carcinoma, inpatients who have failed treatment with cryotherapy (where appropriate)AND 5-fluorouracil. Approval for 4 months.

ALITRETINOIN CHRN For treatment of severe chronic hand eczema in patients meeting both ofthe following criteria1. refractory to 2 months of high or ultra-high potency topical steroids2. prescribed by a dermatologist. Specialists consult to be provided.

ACITRETIN CHRNPHRM

For treatment of severe psoriasis on recommendation of Dermatologist.Specialists consult to be provided.

84:50.06 - PIGMENTINGAGENTSMETHOXSALEN CHRN On recommndation of a specialist. Specialists consult to be provided.

84:92.00 - MISC. SKIN ANDMUCOUS MEMBRANEAGENTS



272

SECUKINUMAB CHRNPHRM

For plaque psoriasis on recommendation of a dermatologist. Consult to beprovided. For patients with body surface involvement (BSA) of >10% and aPASI of >10OR significant involvement of the face, hands, feet or genitals.For patients who are refractory or intolerant to a 12 week trial ofparenteral methotrexate AND a 12 week trial of cyclosporine.Approval for 1 year period.For maintenance therapy a yearly consult from the dermatologist isrequired showing that the patient has maintained at least 50% reductionboth in PASI and BSA from baseline.Coverage may be approved as follows: Initial dosing of 300mg doses atweeks 0, 1, 2 and 3, followed by monthly maintenance dosing of 300mgdoses starting at week 4.

86.00 SMOOTH MUSCLE RELAXANTS

86:12.00 - GENITOURINARYSMOOTH MUSCLERELAXANTSDARIFENACIN CHRN

PHRMFor patients who have insufficient response to adequate trials ofimmediate-release formulations of oxybutynin or tolterodine.

OXYBUTYNIN CHLORIDE CHRNPHRM

For patients who have insufficient response to adequate trials ofimmediate-release formulations of oxybutynin or tolterodine.

SOLIFENACIN CHRNPHRM


TOLTERODINE CHRNPHRM


86:12.08 -

MIRABEGRON CHRNPHRM

For the treatment of overactive bladder (OAB) for patients intolerant to, orwith an inadequate response to an adequate trial of oxybutinin.Not to be used in combination with other pharmacological treaments forOAB.

88.00 VITAMINS

88:08.00 - VITAMIN BCOMPLEXLEUCOVORIN CALC.(FOLINICACID)

CHRNPHRM

For folic acid deficiency from long term drug treatment, where treatmentwith folic acid is insufficient.

CYANOCOBALAMIN CHRN Treatment of pernicious anemia. For dialysis patients.

CYANOCOBALMIN CHRN Treatment of pernicious anemia. For dialysis patients.

VITAMIN B12 CHRN Treatment of pernicious anemia. For dialysis patients.

PYRIDOXINE HCL CHRN For dialysis patients.

88:08.08 -

VITAMIN B COMPLEX&VITAMIN C

CHRNPHRM

For dialysis patients

88:16.00 - VITAMIN D

CALCITRIOL CHRN For treatment of hypoparathyroidism.For treatment of hypocalcemia in dialysis patients.

VITAMIN D CHRN For treatment of hypoparathyroidism.For treatment of hypocalcemia in dialysis patients.

ALFACALCIDOL CHRN For chronic renal failure.

92.00 MISCELLANEOUS THERAPEUTIC AGENTS

92:00.00 - MISCELLANEOUSTHERAPEUTIC AGENTS



273

OCRIPLASMIN CHRNPHRM Clinical Criteria

• Diagnosis of VMA should be confirmed through optical coherencetomography.• Patient does not have any of the following: large diameter macular holes(> 400 micrometre), high myopia (> 8 dioptre spherical correction or axiallength > 28 millimetre), aphakia, history of retinal detachment, lenszonule instability, recent ocular surgery or intraocular injection (includinglaser therapy), proliferative diabetic retinopathy, ischemic retinopathies,retinal vein occlusions, exudative age-related macular degeneration, orvitreous hemorrhage.Conditions• Ocriplasmin should be administered by retinal specialist, or qualifiedophthalmologist experienced in intravitreal injections.• Treatment with ocriplasmin should be limited to a single injection pereye (i.e. retreatments are not covered).

ADALIMUMAB CHRNPHRM For severely active Rheumatoid Arthritis on recommendation of RA

Specialist. Specialist's consult to be provided. For patients refractory orintolerant to parenteral methotrexate after at least a 12 week trial. ANDA 3 month trial of at leats 2 of the following; leflunomide, sulfasalazine,azathioprine ANDA 3 month trial of at least one DMARD combination such as a)methotrexate & cyclosporine b)methotrexate with hydroxychloroquine andsulfaslazine c) methotrexate with leflunomideFor Ankylosing Spondylitis patients with a BASDAI score greater than orequal to 4. For patients with predominantly axial diesease who arerefractory or intolerant to a minimum 4 week trial of 2 NSAIDs at maximaldosage.OR for predominantly peripheral disease, patients refractory to a 3 monthtrial of parenteral methotrexate and a 3 month trial of sulfasalazine.Rheumatologists consult to be provided.For Psoriatic Arthritis patients with moderate to severe disease who arerefractory or intolerant to a 12 week trial of parenteral methotrexate ANDan adequate trial (at least 4 months) of at least one other DMARD.Specialists consult to be provided.Approval for 12 months. After first year, a 24 month approval may berequested. For Plaque Psoriasis on recommendation of Dermatologist. Consult to beprovided. For patients with body surface involvement (BSA) of > 10%, ORsignificant involvement of face, hands, feet or genitals, AND have a PASI>12. For patientswho are refractory or intolerant to a 12 week trial ofparenteral methotrexate AND a 12 week trial of cyclosporine.For moderate to severely Active Crohn's Disease, on recommendation of aspecialist. Consult to be provided. For patients with a current HarveyBradshaw Index (HBI) >7, who are intolerant or refractory to 5-ASA (3gdaily for at least 6 weeks) AND are refractory, intolerant or dependent onglucocorticoids. AND who are refractory or intolerant to at least one ofazathioprine, 6-mercaptopurine or methotrexate after a 3 month trial.For Fistulizing Crohn's Disease on recommendation of a specialist. Consultto be provided. For patients with actively draining fistula(s) despite at leasta 3 week trial of ciprofloxacin or metronidazole, AND at least a 6 week trialof azathioprine or 6-mercaptopurine.Only one month's dose to be dispensed at a time for the first 4 months.Approval for 12 month period.



274

DENOSUMAB CHRNPHRM

A) For the treatment of osteoporosis in patients who have experienced afurther significant decline in bone mineral density (BMD) after 1 yearcontinuous bisphosphonate therapy AND meet at least two of the followingcriteria:i) age > 75 yearsii) a BMD T-score -2.5iii) prior frigility fractureB) For the treatment of osteoporosis in patients with two of the above riskfactors, but for whom bisphosphonates are contraindicated due toa) immune-mediated hypersensitivity b) an untreatable abnormality of the esophagus, such as esophagealstricture or achalasiac) demonstrated severe gastrointestinal intolerance to a course of therapywith either alendronate or risedronate as manifested by weight loss orvomiting directly attributable to the oral bisphosphonates.

ZOLEDRONIC ACID CHRNPHRM

For patients requiring treatment of osteoporosis with at least two of thefollowing risk factorsi) age > 75yearsii) a prior fragility fractureiii) a bone mineral density (BMD) T-score -2.5AND for whom bisphosphonates are contraindicated due toa) immune-mediated hypersensitivityb) an untreatable abnormality of the esophagus, such as esophagealstricture or achalasiac) demonstrated, severe gastrointestinal intolerance to a course of therapywith either alendronate or risedronate as manifested by weight loss orvomiting directly attributable to the oral bisphosphonates.

FEBUXOSTAT CHRNPHRM

For patients with symptomatic gout who have documented hypersensitivityto allopurinol.

USTEKINUMAB CHRNPHRM

For plaque psoriasis on recommendation of a dermatologist. Consult to beprovided.For patients with body surface involvement (BSA) of >10%, and a PASI of>10, OR significant involvement of the face, hands, feet or genitals. For patients who are refractory or intolerant to a 12 week trial ofparenteral methotrexate AND a 12 week trial of cyclosporine.Only one month's dose to be dispensed at a time for the first 4 months.Approval for 1 year period.For maintenence therapy a yearly consult from the dermatologist isrequired showing that the patient has maintained at least a 50% reductionboth in PASI and BSA from baseline.



275

CERTOLIZUMAB PEGOL CHRNPHRM

For severely active Rheumatoid Arthritis on recommendation of RASpecialist. Specialist's consult to be provided. For patients refractory orintolerant to parenteral methotrexate after at least a 12 week trial. ANDA 3 month trial of at least 2 of the following; leflunomide, sulfasalazine,azaathioprine ANDA 3 month trial of at least one DMARD combination such as a)methotrexate & cyclosporine b) methotrexate with hydroxychloroquine andsulfasalazine c)methotrexate with leflunomideOnly 1 month's dose to be dispensed at a time for the first 4 months

For Ankylosing Spondylitis patients with a BASDAI score greater than orequal to 4. For patients with predominantly axial disease who arerefractory or intolerant to a minimum 4 week trial of 2 NSAIDs at maximaldosage.OR for predominantly peripheral disease, patients refractory to a 3 monthtrial of parenteral methotrexate and a 3 month trial of sulfasalazine.Rheumatologists consult to be provided.For Psoriatic Arthritis patients with moderate to severe disease who arerefractory or intolerant to a 12 week trial of parenteral methotrexate ANDan adequate trial (at least 4 months) of at least one other DMARD.Approval for 12 month period. After first 12 months, 24 month approvalscan be requested.Only one month's dose to be dispensed at a time for the first 4 months..For Ulcerative Colitis on recommendation of a specialist. Consult to beprovided. For patients with a Mayo score >6 AND an endoscopic subscore 2 (within last 12 months)AND failed 2 weeks of oral prednisone 40mg (or 1 week IV equivalent)AND 3 months of azathioprine or 6-mercaptopurineOR stablizied on prednisone as above but the prednisone dose cannot betapered despite 3 months of DMARDS.Only one month's dose to be dispensed at a time. Approval for 12 monthperiod.

GOLIMUMAB CHRNPHRM

For severely active Rheumatoid Arthritis on recommendation of RASpecialist. Specialist's consult to be provided. For patients refractory orintolerant to parenteral methotrexate after at least a 12 week trial. ANDA 3 month trial of at least 2 of the following; leflunomide, sulfasalazine,azaathioprine ANDA 3 month trial of at least one DMARD combination such as a)methotrexate & cyclosporine b) methotrexate with hydroxychloroquine andsulfasalazine c)methotrexate with leflunomideOnly 1 month's dose to be dispensed at a time for the first 4 months

For Ankylosing Spondylitis patients with a BASDAI score greater than orequal to 4. For patients with predominantly axial disease who arerefractory or intolerant to a minimum 4 week trial of 2 NSAIDs at maximaldosage.OR for predominantly peripheral disease, patients refractory to a 3 monthtrial of parenteral methotrexate and a 3 month trial of sulfasalazine.Rheumatologists consult to be provided.For Psoriatic Arthritis patients with moderate to severe disease who arerefractory or intolerant to a 12 week trial of parenteral methotrexate ANDan adequate trial (at least 4 months) of at least one other DMARD.Approval for 12 month period. After first 12 months, 24 month approvalscan be requested.Only one month's dose to be dispensed at a time for the first 4 months..For Ulcerative Colitis on recommendation of a specialist. Consult to beprovided. For patients with a Mayo score >6 AND an endoscopic subscore 2 (within last 12 months)AND failed 2 weeks of oral prednisone 40mg (or 1 week IV equivalent)AND 3 months of azathioprine or 6-mercaptopurineOR stablizied on prednisone as above but the prednisone dose cannot betapered despite 3 months of DMARDS.Only one month's dose to be dispensed at a time. Approval for 12 monthperiod.



276

ETANERCEPT CHRNPHRM

For severely active Rheumatoid Arthritis on recommendation of RASpecialist. Specialist's consult to be provided. For patients refractory orintolerant to parenteral methotrexate after at least a 12 week trial. ANDA 3 month trial of at least 2 of the following; leflunomide, sulfasalazine,azathioprine ANDA 3 month trial of at least one DMARD combination such as a)methotrexate & cyclosporine b) methotrexate with hydroxychloroquine andsulfasalazine c)methotrexate with leflunomide

For Ankylosing Spondylitis patients with a BASDAI score greater than orequal to 4. For patients with predominantly axial disease who arerefractory or intolerant to a minimum 4 week trial of 2 NSAIDs at maximaldosage.OR for predominantly peripheral disease, patients refractory to a 3 monthtrial of parenteral methotrexate and a 3 month trial of sulfasalazine.Rheumatologists consult to be provided.For Psoriatic Arthritis patients with moderate to severe disease who arerefractory or intolerant to a 12 week trial of parenteral methotrexate ANDan adequate trial (at least 4 months) of at least one other DMARD.Inital approval for 12 months, then for 24 months after first year. For Plaque Psoriasis on recommendation of Dermatologist. Consult to beprovided. For patients with body surface involvement (BSA) of > 10%, ORsignificant involvement of face, hands, feet or genitals, AND have a PASI>12. For patientswho are refractory or intolerant to a 12 week trial ofparenteral methotrexate AND a 12 week trial of cyclosporine.Only one month's dose to be dispensed at a time for the first 4 months. Approval for 12 month period.



277

INFLIXIMAB CHRNPHRM

For severely active Rheumatoid Arthritis on recommendation of specialist.Specialist's consult to be provided. For patients refractory or intolerant toparenteral methotrexate after at least a 12 week trial ANDA 3 month trial of at least 2 of the following; leflunomide, sulfasalazine,azathioprine ANDA 3 month trial of at least one DMARD combination such as a)methotrexate & cyclosporine b) methotrexate with hydroxychloroquine andsulfasalazine c) methotrexate with leflunomide.For Ankylosing Spondylitis patients with a BASDAI score 4. For patientswith predominantly axial disease who are refractory or intolerant to aminimum 4 week trial of 2 NSAIDs at maximal dosage.OR for predominantly peripheral disease, patients refractory to a 3 monthtrial of parenteral methotrexate and a 3 month trial of sulfasalazine.Specialist's consult to be provided.For Psoriatic Arthritis patients with moderate to severe disease who arerefractroy or intolerant to a 12 week trial of parenteral methotrexate ANDan adequate trial (at least 4 months) of at least one other DMARD.Specialist's consult to be provided.Approval for 12 months. After first year, a 24 month approval may berequested.For Plaque Psoriasis on recommendation of Dermatologist. Consult to beprovided. For patients with body surface involvement (BSA) of > 10%, ORsignificant involvement of face, hands, feet or genitals, AND have a PASI >12. For patients who are refractory or intolerant to a 12 week trial ofparenteral methotrexate AND a 12 week trial of cyclosporine.For moderate to severely active Crohn's Disease on recommendation of aspecialist. Consult to be provided. For patients with a current HarveyBradshaw Index (HBI) >7, who are intolerant or refractroy to 5-ASA (3 gdaily for at least 6 weeks) AND are refractory, intolerant or dependant onglucocorticoids, AND who are refractory or intolerant to at least one ofazathioprine, 6-mercaptopurine or methotrexate after a 3 month trial.For fistulizing Crohn's Disease on recommendation of a specialist. Consultto be provided. For patients with actively draining fistula(s) despite a 3week trial of ciprofloxacin or metronidazole, AND at least a 6 week trial ofazathioprine or 6-mercaptopurine.For Ulcerative Colitis on recommendation of a specialist.Consult to beprovided. For patients with a Mayo score >6 AND an endoscopic subscore 2 (within last 12 months)AND failed 2 weeks of oral prednisone 40mg (or 1 week IV equivalent)AND 3 months of azathioprine or 6-mercaptopurineOR stablizied on prednisone as above but the prednisone dose cannot betapered despite 3 months of DMARDS.Only one month's dose to be dispensed at a time. Approval for 12 monthperiod.NB: All new infliximab patients will be covered for Inflectra brand only.



278

INFLIXIMAB CHRNPHRM

For severely active Rheumatoid Arthritis on recommendation of specialist.Specialist's consult to be provided. For patients refractory or intolerant toparenteral methotrexate after at least a 12 week trial ANDA 3 month trial of at least 2 of the following; leflunomide, sulfasalazine,azathioprine ANDA 3 month trial of at least one DMARD combination such as a)methotrexate & cyclosporine b) methotrexate with hydroxychloroquine andsulfasalazine c) methotrexate with leflunomide.For Ankylosing Spondylitis patients with a BASDAI score 4. For patientswith predominantly axial disease who are refractory or intolerant to aminimum 4 week trial of 2 NSAIDs at maximal dosage.OR for predominantly peripheral disease, patients refractory to a 3 monthtrial of parenteral methotrexate and a 3 month trial of sulfasalazine.Specialist's consult to be provided.For Psoriatic Arthritis patients with moderate to severe disease who arerefractroy or intolerant to a 12 week trial of parenteral methotrexate ANDan adequate trial (at least 4 months) of at least one other DMARD.Specialist's consult to be provided.Approval for 12 months. After first year, a 24 month approval may berequested.For Plaque Psoriasis on recommendation of Dermatologist. Consult to beprovided. For patients with body surface involvement (BSA) of > 10%, ORsignificant involvement of face, hands, feet or genitals, AND have a PASI >12. For patients who are refractory or intolerant to a 12 week trialof parenteral methotrexate AND a 12 week trial of cyclosporine.For moderate to severely active Crohn's Disease on recommendation of aspecialist. Consult to be provided. For patients with a current HarveyBradshaw Index (HBI) >7, who are intolerant or refractroy to 5-ASA (3 gdaily for at least 6 weeks) AND are refractory, intolerant or dependant onglucocorticoids, AND who are refractory or intolerant to at least one ofazathioprine, 6-mercaptopurine or methotrexate after a 3 month trial.For fistulizing Crohn's Disease on recommendation of a specialist. Consultto be provided. For patients with actively draining fistula(s) despite a 3week trial of ciprofloxacin or metronidazole, AND at least a 6 week trial ofazathioprine or 6-mercaptopurine.For Ulcerative Colitis on recommendation of a specialist.Consult to beprovided. For patients with a Mayo score >6 AND an endoscopicsubscore 2 (within last 12 months)AND failed 2 weeks of oral prednisone 40mg (or 1 week IV equivalent)AND 3 months of azathioprine or 6-mercaptopurineOR stablizied on prednisone as above but the prednisone dose cannot betapered despite 3 months of DMARDS.Only one month's dose to be dispensed at a time. Approval for 12 monthperiod.OR

ANAKINRA CHRNPHRM

For severely active rheumatoid arthritis on recommendation of RASpecialist. Specialist's consult to be provided. For patients refractory orintolerant to parenteral methotrexate after at least a 12 week trial. ANDA 3 month trial of at least 2 of the following; leflunomide, sulfasalazine,azathioprine ANDA 3 month trial of at least one DMARD combination such as a)methotrexate & cyclosporine b) methotrexate with hydroxychloroquine andsulfasalazine c) methotrexate with lefunomideOnly 1 month's dose to be dispensed at a time for the first 4 monthsApproval for 12 month period. After the first year, a 24 month approvalmay be requested.



279

TOCILIZUMAB CHRNPHRM

For severely active rheumatoid arthritis on recommendation of RASpecialist. Specialist's consult to be provided. For patients refractory orintolerant to parenteral methotrexate after at least a 12 week trial. ANDA 3 month trial of at least 2 of the following; leflunomide, sulfasalazine,azathioprine ANDA 3 month trial of at least one DMARD combination such as a)methotrexate & cyclosporine b) methotrexate with hydroxychloroquine andsulfasalazine c) methotrexate with lefunomideOnly 1 month's dose to be dispensed at a time for the first 4 monthsApproval for 12 month period. After the first year, a 24 month approvalmay be requested.

VALGANCICLOVIR CHRNPHRM

For the treatment and prophylaxis of CMC infection in transplant patients.Approval for 6 months.

NATALIZUMAB CHRNPHRM

For the treatment of Relapsing-Remitting Multiple Sclerosis (RRMS)patients who meet all the following criteriaa) for patients who have failed to respond to a full & adequate course oftreatment (6 months) with at least one of interferon OR glatiramer acetateOR dimethyl fumarate, or have contraindications/intolerance to at leasttwo of the previous three drugs ANDb) has had ONE of the following types of relapses in the past year- the occurence of one relapse with partial recovery AND has at least ONEgadolinium-enhancing lesion on brain MRI, OR significant increase in T2lesion load compared to previous MRI (ie: 3 or more new lesions) OR-the occurence of two or more relapses with partial recovery OR-the occurence of two or more relapses with complete recovery AND atleast ONE gadolinium-enhancing lesion on brain MRI, OR significantincrease in T2 lesion load compared to previous MRI c) on recommendation of a neurologist experienced in the management ofRRMS. Specialists consult to be provided.d) have a current EDSS less than or equal to 5.0e) MRI not required for intial request but detailed documentation of theabove isf) not used in combination with other disease-modifying therapyg) approval period 1 year

INCOBOTULINUMTOXIN A CHRNPHRM

For the treatment of blepharospasm ORCervical dystonia of a predominantely rotational form (SpasmoticTorticollis) ORPost-stroke spasticity of the upper limb



280

FINGOLIMOD CHRNPHRM

For treatment of Relapsing Remitting Multiple Sclerosis (RRMS) in patientswho meet all of the following criteria -approval period for one year-Failure to respond to adequate courses* (at least 6 months) of any onetherapy listed on the Yukon formulary OR documented intolerance** to 2therapies listed in the formulary. Intolerance does NOT include: needlephobia, skin reactions at injection site or patient preference for oral form-One or more clinical relapse in the previous year; the appearance of newsymptoms or worsening of old symptoms, lasting at least 24 hours in theabsence of fever, & preceded by stability for at least one month -Significant increase in T2 lesion load (3 or more new lesions) or at leastone gadolinium-enhancing lesion-requested and followed by a neurologist experienced with RRMS.Specialists consult to be provided.-recently expanded EDSS score (EDSS less than or equal to 5.5)***NB -will not be funded in combination with any other disease modifyingagent; in patients with EDSS > 5.5; in patients with heart conditions; or inpatients under age 18* failure to respond to full & adequate courses: defined as a trial of at least6 months of one therapy listed in the Yukon formulary AND experienced atleast one disabling relapse while on that therapy.** Intolerance is defined as: documented serious adverse effects orcontraindications that are incompatable with further use of that class ofdrug. ***Recently Expanded Disability Status Scale (EDSS) score less than orequal to 5.5 (patients must be able to ambulate at least 100 meterswithout assistance)Approval for 2 years.

BOTULINUM TOXIN TYPE A CHRNPHRM

For treatment of dystonias and other neuromuscular spasticity problems.Botox requires written prior approval and the recommendation of aSpecialist. Specialists consult to be provided.

LEFLUNOMIDE CHRNPHRM

For treatment of rheumatoid arthritis in patients who are not adequatelycontrolled or are intolerant to at least two other DMARDs or asrecommended by a Specialist. Specialists consult to be provided.

COMPOUNDED INJECTABLES CHRNPHRM

For use where manufactured products are not available or not costeffective. Must contain at least one ingredient included in the formulary.

COMPOUNDED ORALPREPARATIONS

CHRNPHRM

For use where manufactured products are not available or not costeffective. Must contain at least one ingredient included in the formulary.

COMPOUNDED TOPICALS CHRN For use where manufactured products are not available or not costeffective. Must contain at least one ingredient included in the formulary.

ALENDRONATE CHRN In order for patients to be eligible for coverage for osteoporosis treatment,the physician submitting the application must provide either the results ofa bone density test, or list at least four of the following risk factors thatpertain to the patient. High Risk Factors: - significant family history -genetic predisposition (Asian or Caucasian descent) - thin, small frame -early menopause, before age 45 - past menopause - prolonged use ofosteopenic medication - low trauma fracture

ALENDRONATE/CHOLECALCIFEROL

CHRN In order for patients to be eligible for coverage for osteoporosis treatment,the physician submitting the application must provide either the results ofa bone density test, or list at least four of the following risk factors thatpertain to the patient. High Risk Factors: - significant family history -genetic predisposition (Asian or Caucasian descent) - thin, small frame -early menopause, before age 45 - past menopause - prolonged use ofosteopenic medication - low trauma fracture

ETIDRONATE /CALCIUMCARBONATE

CHRN In order for patients to be eligible for coverage for osteoporosis treatment,the physician submitting the application must provide either the results ofa bone density test, or list at least four of the following risk factors thatpertain to the patient. High Risk Factors: - significant family history -genetic predisposition (Asian or Caucasian descent) - thin, small frame -early menopause, before age 45 - past menopause - prolonged use ofosteopenic medication - low trauma fracture



281

ETIDRONATE DISODIUM CHRN In order for patients to be eligible for coverage for osteoporosis treatment,the physician submitting the application must provide either the results ofa bone density test, or list at least four of the following risk factors thatpertain to the patient. High Risk Factors: - significant family history -genetic predisposition (Asian or Caucasian descent) - thin, small frame -early menopause, before age 45 - past menopause - prolonged use ofosteopenic medication - low trauma fracture

RISEDRONATE CHRN In order for patients to be eligible for coverage for osteoporosis treatment,the physician submitting the application must provide either the results ofa bone density test, or list at least four of the following risk factors thatpertain to the patient. High Risk Factors: - significant family history -genetic predisposition (Asian or Caucasian descent) - thin, small frame -early menopause, before age 45 - past menopause - prolonged use ofosteopenic medication - low trauma fracture

RISEDRONATE SODIUM CHRN In order for patients to be eligible for coverage for osteoporosis treatment,the physician submitting the application must provide either the results ofa bone density test, or list at least four of the following risk factors thatpertain to the patient. High Risk Factors: - significant family history -genetic predisposition (Asian or Caucasian descent) - thin, small frame -early menopause, before age 45 - past menopause - prolonged use ofosteopenic medication - low trauma fracture

GLATIRAMER ACETATE CHRNPHRM

Initial: As first or second-line monotherapy for the treatment of RRMSwhen prescribed by an MS neurologist. Specialist's consult to be provided.For patients who meet ALL of the following criteria:-patient has had at least two (2) clinical relapses in the previous two (2)years AND-patient is ambulatory with or without aid (EDSS of 6.5 or less), AND-patient is 18 years or olderApproval period: 1 yearRenewal: When prescribed by an MS neurologist for patients whodemonstrate continued therapeutic benefit outweighing any potentialrisks, as shown by relapse rate, EDSS, MRI scan (when possible), andoverall clinical impression. Specialist's consult to be provided. A relapse is defined as the appearance of new symptoms or worsening ofold symptoms, lasting at least 24 hours in the absence of fever, andpreceded by stability for at least one (1) month. Approval for 1 year.Only a one month supply to be dispensed at a time for the first year.

INTERFERON BETA-1A CHRNPHRM




282

INTERFERON BETA-1B CHRNPHRM


TERIFLUNOMIDE CHRNPHRM


PIMECROLIMUS CHRNPHRM

On recommendation of Dermatologist. Specialists consult to be provided.

TACROLIMUS TOPICAL CHRNPHRM

On recommendation of Dermatologist. Specialists consult to be provided.

DICITRATE SOLN PHRM On recommendation of a specialist for renal failure. Specialists consult tobe provided.

OCTREOTIDE ACETATE CHRN On recommendation of an oncologist.

MONTELUKAST SODIUM CHRNPHRM

Treatment of asthma in patients on concurrent steroid therapy.

ZAFIRLUKAST CHRNPHRM

Treatment of asthma in patients on concurrent steroid therapy.

SEVELAMER HYDROCHLORIDECHRNPHRM

For treatment of patients in end stage renal disease with intolerance toaluminum or calcium containing phosphate binding agents.

92:24.00 - BONERESORPTION INHIBITORSDENOSUMAB CHRN

PHRMOn a case-by-case basis. Specialist's consult to be provided.

92:32.00 - COMPLEMENTINHIBITORS



283

ICATIBANT ACETATE PHRM For the treatment of acute attacks of hereditary angioedema (HAE) inadults with lab confirmed c1-esterase inhibitor deficiency (type l or ll) ifthe following conditions are met:a) treatment of non-laryngeal attacks of at least moderate severity, orb) treatment of acute laryngeal attacksANDLimited to a single dose for self-administration per attackANDPrescribed by a physician with experience in the treatment of HAE

92:36.00 - DISEASE-MODIFYINGANTIRHEUMATIC AGENTSTOFACITINIB CHRN

PHRMFor severely active rheumatoid arthritis on recommendation of RAspecialist. Specialist's consult to be provided. For patients refractory orintolerant to parenteral methotrexate after at least a 12 week trial ANDA 3 month trial of at least 2 of the following; leflunomide, sulfasalazine,azathioprine ANDA 3 month trial of at least one DMARD combination such as a)methotrexate & cyclosporine b) methotrexate with hydroxychloroquine &sulfasalazine c) methotrexate & leflunomide

92:44.00 -IMMUNOSUPPRESSIVEAGENTSPIRFENIDONE CHRN

PHRMInitial Approval:Adult patients who have a diagnosis of mild to moderate idiopathicpulmonary fibrosis (IPF)-Confirmed by a respirologist and a high-resolution CT scan within theprevious 24 months.-All other causes of restrictive lung disease (e.g. collagen vascular disorderor hypersensitivity pneumonitis) should be excluded.-Mild to moderate IPF is defined as forced vital capacity (FVC) greater thanor equal to 50% of predicted.-Patient is under the care of a physician with experience in IPF. Consult tobe provided.Initial approval period: 7 months (including allowing 4 weeks for repeatpulmonary function tests)Initial Renewal Criteria:Patients must NOT demonstrate progression of disease defined as anabsolute decline in percent predicted FVC of 10% from initiation oftherapy until renewal (initial 6 month treatment period). If a patient hasexperienced progression as defined above, then the results should bevalidated with a confrimatory pulmonary function test conducted 4 weekslater.Approval period: 6 monthsSecond renewal (12 months after initiation of therapy) :Patients must NOT demonstrate progression of disease defined as anabsolute decline in percent predicted FVC of 10% within any 12 monthperiod. If a patient has experienced progression as defined above, then theresults should be validated with a confirmatory pulmonary function testconducted 4 weeks later.Approval period: 12 monthsExclusion criteria: Combination use of Esbriet and Ofev will not be funded.Notes: Patients who have experienced intolerance or failure to Esbriet orOfev will be considered for the alternate agent provided that the patientcontinues to meet the above criteria.

92:92.00 - OTHERMISCELLANEOUSTHERAPEUTIC AGENTSCINACALCETHYDROCHLORIDE

CHRNPHRM

On recommendation of a specialist. Specialist's consult to be provided.

99.00 PALLIATIVE CARE



284

99:00.98 - CD PALLIATIVERXPANTOPRAZOLE CHRN Approved on case-by-case basis: For treatment of patients at high risk for

GI bleeding when NSAID or steroid therapy cannot be avoided for approvedchronic disease. For patients with Barrett's Esophagus. Standard doseapproved - include reasons if high dose required. GERD, dyspepsia orpeptic ulcer disease are not covered by Chronic Disease Program.

ACETYLCYSTEINE PHRM As a mucolytic agent, by inhalation/ nebulization.

METHADONE CHRNPHRM

Case-by-case basis for palliative patients.

ONDANSETRON CHRNPHRM



Treatment of psychiatric disorder on recommendation of Psychiatrist orPediatrician. Specialists consult to be provided.

FLUCONAZOLE CHRN Treatment of a serious fungal infection in immuno-compromized patientssecondary to an approved chronic condition. Please provide description ofinfection.



285

Alphabetical Index of Pharmaceutical Products

PCCF: Pharmacare, Chronic Disease, Children's Drugs, Fill Fee

Values: (Y)es, (N)o, or (E)xception

PCCF Product Name Pharma Page

(SEE A/P FILES) ..................................................... 20:15.00NYNY 46

5-AMINOSALICYLIC ACID ............................................... 56:40.00YYYY 164

ABACAVIR ............................................................ 08:18.08YYNY 14

ABACAVIR ............................................................ 08:18.08YYNY 14

ABACAVIR (ABACAVIR SULPHATE) ........................................ 08:18.08YYNY 14

ABACAVIR/DOLUTEGRAVIR/LAMIVUDI ...................................... 08:18.08EENY 14

ABACAVIR/LAMIVUDINE ................................................. 08:18.08YYNY 14

ABACAVIR/LAMIVUDINE/ZIDOVUDINE ...................................... 08:18.08YYNY 14

ABIRATERONE ACETATE ................................................. 10:00.00EENY 22

ACAMPROSATE CALCIUM ................................................. 28:92.00YENY 143

ACARBOSE ............................................................ 68:20.20YYNY 182

ACEBUTOLOL HCL ...................................................... 24:04.00YYNY 48

ACENOCOUMAROL ....................................................... 20:12.04YYYY 43

ACETAMINOPHEN ....................................................... 28:08.92YNNN 102

ACETAMINOPHEN ....................................................... 99:00.99YYNN 224

ACETAMINOPHEN ....................................................... 99:00.99YYNN 224

ACETAMINOPHEN ....................................................... 99:01.00YNNN 224

ACETAMINOPHEN LIQUID ................................................ 28:08.92YNNN 103

ACETAMINOPHEN LIQUID ................................................ 99:00.99YYNN 224

ACETAMINOPHEN/CAFFEINE/CODEINE ...................................... 28:08.08YYNY 94

ACETAMINOPHEN/CODEINE ............................................... 28:08.08EENY 95

ACETAMINOPHEN/CODEINE ............................................... 28:08.08EENY 95

ACETAZOLAMIDE ....................................................... 52:10.00YYNY 157

ACETYLCYSTEINE ...................................................... 48:24.00ENNY 152

ACETYLCYSTEINE ...................................................... 99:00.98YYNY 220

ACETYLSALICYLIC ACID ................................................ 28:08.04YNNN 87

ACETYLSALICYLIC ACID ................................................ 99:00.99YYNN 224

ACITRETIN ........................................................... 84:36.00EENY 201

ACLIDINIUM BROMIDE .................................................. 12:08.08EENY 34

ACLIDINIUM/FORMOTEROL ............................................... 12:08.08EENY 34

ACYCLOVIR ........................................................... 08:18.00YEYY 11

ACYCLOVIR ........................................................... 84:04.06YNYY 191

ADALIMUMAB .......................................................... 92:00.00EENY 208

ADAPALENE ........................................................... 84:28.00NNYY 200

ADEFOVIR DIPIVOXIL .................................................. 08:18.08EENY 14

AFATINIB ............................................................ 10:00.00EENY 22

AFLIBERCEPT ......................................................... 52:92.00EENY 161

ALENDRONATE ......................................................... 92:00.00YENY 209

ALENDRONATE ......................................................... 92:00.00YENY 209

ALENDRONATE/CHOLECALCIFEROL ......................................... 92:00.00YENY 209

ALFACALCIDOL ........................................................ 88:16.00YENY 207

ALFUZOSIN HYDROCHLORIDE ............................................. 92:00.00YNNY 209



286





ALGINIC ACID/MAGNESIUM CARB ......................................... 99:00.00YNNN 220

ALITRETINOIN ........................................................ 84:36.00NENY 201

ALLOPURINOL ......................................................... 92:00.00YYNY 209

ALMOTRIPTAN MALATE .................................................. 12:16.00YNYY 38

ALPRAZOLAM .......................................................... 28:24.08YNYY 139

ALUMINUM ACET/BENZETHONIUM CHL ...................................... 84:12.00NNYN 199

ALUMINUM/MAGNESIUM/SIMETHICONE ...................................... 99:15.00YNNN 229

AMANTADINE .......................................................... 08:18.00YEYY 12

AMCINONIDE .......................................................... 84:06.00YYYY 193

AMILORIDE HCL ....................................................... 40:28.10YYNY 151

AMILORIDE/HYDROCHLOROTHIAZIDE ....................................... 40:28.10YYNY 151

AMIODARONE .......................................................... 24:04.00YYNY 49

AMITRIPTYLINE ....................................................... 28:16.04YYYY 114

AMLODIPINE BESYLATE ................................................. 24:04.00YYNY 49

AMOXICILLIN (AMOXYCILLIN) ........................................... 08:12.16YEYY 8

AMOXICILLIN/CLAVULANIC ACID ......................................... 08:12.16YEYY 8

AMPICILLIN .......................................................... 08:12.16YEYY 9

ANAGRELIDE HCL ...................................................... 10:00.00YYNY 22

ANAKINRA ............................................................ 92:00.00EENY 210

ANASTROZOLE ......................................................... 10:00.00YYNY 22

APIXABAN ............................................................ 20:12.04EENY 43

APRACLONIDINE HCL ................................................... 52:36.00YYYY 159

APRACLONIDINE HCL ................................................... 52:36.00YYYY 159

APREPITANT .......................................................... 56:22.00EENY 162

ARIPIPRAZOLE ........................................................ 28:16.08EENY 125

ARTIFICIAL SALIVA ................................................... 02:10.00NNNN 1

ARTIFICIAL SALIVA ................................................... 99:00.99YYNN 224

ASA/CAFF/CODEINE/BUTALBITAL ......................................... 28:08.92YNNY 103

ASA/CAFFEINE/CODEINE ................................................ 28:08.08YNNN 95

ASENAPINE ........................................................... 28:16.08EENY 126

ATAZANAVIR .......................................................... 08:18.08YYNY 14

ATENOLOL ............................................................ 24:04.00YYNY 50

ATENOLOL/CHLORTHALIDONE ............................................. 24:08.00YYNY 72

ATOMOXETINE ......................................................... 28:92.00EENY 144

ATOMOXETINE ......................................................... 28:92.00EENY 144

ATORVASTATIN CALCIUM ................................................ 24:06.00YYNY 65

ATOVAQUONE .......................................................... 08:40.00YENY 21

ATROPINE SO4 ........................................................ 52:24.00YNYY 158

ATROPINE SULFATE .................................................... 99:07.00YNNY 227

AURANOFIN ........................................................... 60:00.00YYNY 171

AURANOFIN ........................................................... 60:00.00YYNY 171

AZATHIOPRINE ........................................................ 92:00.00YYNY 210



287





AZELAIC ACID ........................................................ 84:92.00YNYY 202

AZITHROMYCIN ........................................................ 08:12.12YEYY 5

BACILLUS CALMETTE-GUERIN (BCG) ...................................... 80:12.00EENY 189

BACLOFEN ............................................................ 12:20.00YYYY 40

BECLOMETHASONE DIPROPIONATE ......................................... 52:08.00YNYY 154

BECLOMETHASONE DIPROPIONATE ......................................... 68:04.00YYYY 171

BECLOMETHASONE DIPROPIONATE ......................................... 84:06.00YYYY 194

BELLADONNA /PENTOBARBITAL ........................................... 12:16.00YNYY 38

BELLADONNA/ERGOT/PHENOBARBITAL ...................................... 12:08.08YNNY 34

BENAZEPRIL HCL ...................................................... 24:08.00YYNY 73

BENZOYL PEROXIDE .................................................... 84:28.00YNYY 200

BENZOYL PEROXIDE CLINDAMYCIN ........................................ 84:04.04NNYY 190

BENZOYL PEROXIDE/ CLINDAMYCIN ....................................... 84:04.04YNYY 190

BENZOYL PEROXIDE/ ERYTHROMYCIN ...................................... 84:04.04NNYY 190

BENZOYL PEROXIDE/CLINDAMYCIN ........................................ 84:04.04NNYY 190

BENZTROPINE MESYLATE ................................................ 12:08.04YYNY 33

BENZYDAMINE ......................................................... 52:28.00YEYY 158

BETAHISTINE HYDROCHLORIDE ........................................... 92:00.00YNNY 210

BETAMETHASONE DIPROP/SALICYLIC ...................................... 84:06.00YYYY 194

BETAMETHASONE DIPROPIONATE .......................................... 84:06.00YYYY 194

BETAMETHASONE DISODIUM PHOS ......................................... 56:40.00YYYY 165

BETAMETHASONE VALERATE .............................................. 84:06.00YYYY 194

BETAXOLOL HCL ....................................................... 52:36.00YYNY 159

BETHANECHOL CHLORIDE ................................................ 12:04.00YYNY 31

BEVACIZUMAB ......................................................... 10:00.00EENY 22

BEZAFIBRATE ......................................................... 24:06.00YYNY 66

BICALUTAMIDE ........................................................ 10:00.00YYNY 22

BIMATOPROST ......................................................... 52:36.00YYNY 159

BISACODYL ........................................................... 99:04.00YNNN 225

BISOPROLOL FUMARATE ................................................. 24:04.00YYNY 51

BOCEPREVIR .......................................................... 08:18.92EENY 18

BOCEPREVIR/RIBAVIRIN/PEGINTERF ...................................... 08:18.92EENY 18

BOSUTINIB ........................................................... 10:00.00EENY 23

BOTULINUM TOXIN TYPE A .............................................. 92:00.00EENY 210

BRIMONIDINE TARTRATE ................................................ 52:36.00YYNY 159

BRIMONIDINE TARTRATE/TIMOLOL ........................................ 52:36.00YYNY 159

BRIMONIDINE/BRINZOLAMIDE ............................................ 52:40.04YYNY 161

BRINZOLAMIDE ........................................................ 52:10.00YYNY 157

BRINZOLAMIDE/TIMOLOL ................................................ 52:36.00YYNY 159

BROMAZEPAM .......................................................... 28:24.08YNYY 139

BROMOCRIPTINE MESYLATE .............................................. 92:00.00YYNY 210

BUDESONIDE .......................................................... 52:08.00YNYY 154



288





BUDESONIDE .......................................................... 56:40.00YYYY 165

BUDESONIDE .......................................................... 68:04.00YYNY 172

BUDESONIDE .......................................................... 68:04.00YYNY 172

BUMETANIDE .......................................................... 40:28.00EENY 149

BUPRENORPHINE/NALOXONE .............................................. 28:08.12YENY 102

BUPROPION HYDROCHLORIDE ............................................. 28:16.04YYYY 115

BUPROPION HYDROCHLORIDE ............................................. 28:16.04YYYY 115

BUPROPION HYDROCHLORIDE ............................................. 28:20.00YNYY 137

BUSERELIN ACETATE ................................................... 92:00.00YYNY 211

BUSERELIN ACETATE ................................................... 92:00.00YYNY 211

BUSPIRONE ........................................................... 28:24.92YYYY 142

CALCIFEROL .......................................................... 88:16.00YNNN 207

CALCIPOTRIOL ........................................................ 84:36.00YYNY 201

CALCIPOTRIOL/BETAMETHASONE DIP ...................................... 84:36.00YYNY 202

CALCIPOTRIOL/BETAMETHASONE DIP ...................................... 84:36.00YYNY 202

CALCITONIN .......................................................... 68:24.00EENY 187

CALCITRIOL .......................................................... 88:16.00YENY 207

CALCIUM ............................................................. 99:09.00YNNN 228

CALCIUM POLYSTYRENE SULFONATE ...................................... 40:18.00YNNY 149

CALCIUM 500MG ....................................................... 88:29.00YNYN 208

CALCIUM CARBONATE ................................................... 88:29.00YNYN 208

CALCIUM CARBONATE CHEW TABS ......................................... 88:29.00YNYN 208

CALCIUM CARBONATE/VITAMIN D ......................................... 88:29.00YNNN 208

CANAGLIFLOZIN ....................................................... 68:20.18EENY 181

CANDESARTAN CILEXETIL ............................................... 24:08.00YYNY 73

CANDESARTAN/HCTZ .................................................... 24:08.00YYNY 74

CANDESARTAN/HCTZ .................................................... 24:08.00YYNY 74

CANDESARTAN/HYDROCHLOROTHIAZID ...................................... 24:08.00YYNY 74

CANDESARTEN CILEXETIL ............................................... 24:08.00YYNY 74

CAPECITABINE ........................................................ 10:00.00EENY 23

CAPSAICIN ........................................................... 84:24.04YNNN 200

CAPTOPRIL ........................................................... 24:04.00YYNY 52

CARBAMAZEPINE ....................................................... 28:12.92YYNY 106

CARBIDOPA/ENTACAPONE/LEVODOPA ....................................... 28:92.00YYNY 144

CARBIDOPA/LEVODOPA .................................................. 28:36.16EENY 143

CARBOXYMETHYL CELLULOSE ............................................. 99:06.00YNNN 227

CARVEDILOL .......................................................... 24:04.00YYNY 52

CEFACLOR ............................................................ 08:12.06YEYY 3

CEFAZOLIN SODIUM .................................................... 08:12.06YENY 4

CEFIXIME ............................................................ 08:12.06YEYY 4

CEFPROZIL ........................................................... 08:12.06YEYY 4

CEFTAZIDIME ......................................................... 08:12.06YENY 4



289





CEFTRIAXONE ......................................................... 08:12.06YENY 5

CEFTRIAXONE ......................................................... 08:12.06YENY 5

CEFUROXIME AXETIL ................................................... 08:12.06YEYY 5

CELECOXIB ........................................................... 28:08.04YYYY 88

CEPHALEXIN MONOHYDRATE .............................................. 08:12.06YEYY 5

CERTOLIZUMAB PEGOL .................................................. 92:00.00EENY 211

CETIRIZINE .......................................................... 99:16.00YNNN 229

CHLORAL HYDRATE ..................................................... 28:24.92YEYY 143

CHLORAL HYDRATE ..................................................... 28:24.92YEYY 143

CHLORAMBUCIL ........................................................ 10:00.00YYNY 23

CHLORAMPHENICOL ..................................................... 52:04.04YNYY 152

CHLORDIAZEPOXIDE .................................................... 28:24.08YNYY 140

CHLORDIAZEPOXIDE .................................................... 28:24.08YNYY 140

CHLORHEXIDINE GLUCONATE ............................................. 52:28.00YNYY 158

CHLORHEXIDINE GLUCONATE ............................................. 99:06.00YNYY 227

CHLORPROMAZINE ...................................................... 28:16.08YYNY 126

CHLORPROPAMIDE ...................................................... 68:20.20YYNY 182

CHLORTHALIDONE ...................................................... 40:28.00YYNY 149

CHOLESTYRAMINE RESIN ................................................ 24:06.00YYNY 66

CHORAMPHENICOL/HC ................................................... 52:04.04YNYY 153

CHORAMPHENICOL/HC ................................................... 52:04.04YNYY 153

CICLESONIDE ......................................................... 68:04.00YYNY 172

CICLOPIROX OLAMINE .................................................. 84:04.08YNYY 191

CILAZAPRIL .......................................................... 24:08.00YYNY 74

CILAZAPRIL/HCTZ ..................................................... 24:08.00YYNY 75

CILAZAPRIL/HCTZ ..................................................... 24:08.00YYNY 75

CIMETIDINE .......................................................... 56:40.00YNYY 165

CINACALCET .......................................................... 92:92.00EENY 219

CINACALCET HYDROCHLORIDE ............................................ 92:92.00EENY 220

CINACALCET HYDROCHLORIDE ............................................ 92:92.00EENY 220

CIPROFLOXACIN ....................................................... 08:22.00YENY 18

CIPROFLOXACIN ....................................................... 52:04.12YNYY 154

CIPROFLOXACIN/DEXAMTHEASONE ......................................... 52:08.00YNYY 155

CIPROFLOXACIN/DEXAMTHEASONE ......................................... 99:00.98YYNY 220

CITALOPRAM .......................................................... 28:16.04YYYY 115

CITALOPRAM .......................................................... 99:00.98YYNY 220

CLARITHROMYCIN ...................................................... 08:12.12YEYY 6

CLINDAMYCIN HCL ..................................................... 08:12.28YEYY 11

CLINDAMYCIN PALMITATE HCL ........................................... 08:12.28YEYY 11

CLINDAMYCIN PHOSPHATE ............................................... 84:04.04YNYY 190

CLINDAMYCIN PHOSPHATE ............................................... 99:00.98YYNY 220

CLINDAMYCIN/BENZOYL PEROXIDE ........................................ 84:04.04NNYY 190



290





CLOBAZAM ............................................................ 28:12.08YYNY 104

CLOBETASOL PROPIONATE ............................................... 84:06.00YYYY 195

CLOBETASONE BUTYRATE ................................................ 84:06.00YYYY 195

CLODRONATE DISODIUM ................................................. 92:00.00YYNY 211

CLOMIPRAMINE HCL .................................................... 28:16.04YYYY 116

CLONAZEPAM .......................................................... 28:12.08YYNY 104

CLONAZEPAM .......................................................... 99:00.98YYNY 220

CLONIDINE HCL ....................................................... 24:08.00YNNY 75

CLOPIDOGREL BISULFATE ............................................... 20:24.00YYNY 48

CLORAZEPATE DIPOTASSIUM ............................................. 28:24.08YNNY 140

CLOTRIMAZOLE ........................................................ 84:04.08YNYN 191

CLOXACILLIN ......................................................... 08:12.16YEYY 9

CLOZAPINE ........................................................... 28:16.08YYNY 126

COAL TAR/JUNIPER TAR/PINE TAR ....................................... 84:28.00NNYN 201

COAL TAR/JUNIPER TAR/PINE TAR ....................................... 84:28.00NNYN 201

COBICISTAT/DARUNAVIR ................................................ 08:18.08EENY 14

COBICISTAT/EMTRICITABINE/ELVIT ...................................... 08:18.08EENY 14

CODEINE ............................................................. 28:08.08YENY 95

CODEINE PHOSPHATE ................................................... 28:08.08YYNY 95

CODEINE PHOSPHATE ................................................... 48:08.00YNNY 152

CODEINE/GUAIFENES/PHENIRAMINE ....................................... 48:08.00YNNY 152

COLCHICINE .......................................................... 92:00.00YYNY 211

COLESEVELAM HYDROCHLORIDE ........................................... 24:06.04YYNY 72

COLESTIPOL HCL RESIN ................................................ 24:06.00YYNY 66

COMPOUNDED INJECTABLES .............................................. 92:00.00EENY 211

COMPOUNDED ORAL PREPARATIONS ........................................ 92:00.00EEYY 211

COMPOUNDED TOPICALS ................................................. 92:00.00YEYY 211

CONJUGATED ESTROGENS ................................................ 68:16.04YNNY 178

CONJUGATED ESTROGENS ................................................ 99:00.98YYNY 220

CORTISONE ACETATE ................................................... 68:04.00YYYY 172

CRIZOTINIB .......................................................... 10:00.00EENY 23

CROTAMITON .......................................................... 84:04.12YNYN 192

CYANOCOBALAMIN ...................................................... 88:08.00YENY 205

CYANOCOBALMIN ....................................................... 88:08.00YENN 206

CYANOCOBALMIN ....................................................... 88:08.00YENN 206

CYCLOBENZAPRINE HCL ................................................. 12:20.00YYYY 41

CYCLOPENTOLATE HCL .................................................. 52:24.00YNYY 158

CYCLOPHOSPAMIDE ..................................................... 10:00.00YYNY 23

CYCLOSPORINE ........................................................ 92:00.00YYNY 211

CYPROHEPTADINE HYDROCHLORIDE ........................................ 99:11.00YNNN 228

CYPROTERONE ACETATE ................................................. 10:00.00YYNY 24

CYPROTERONE/ESTROGEN ................................................ 84:36.00NNYY 202



291





DABRAFENIB MESYLATE ................................................. 10:00.00EENY 24

DALTEPARIN SODIUM ................................................... 20:12.04YENY 43

DANAZOL ............................................................. 68:08.00YNYY 175

DANTROLENE SODIUM ................................................... 12:20.00YYNY 41

DAPAGLIFLOZIN ....................................................... 68:20.18EENY 182

DAPAGLIFLOZIN ....................................................... 68:20.18EENY 182

DAPSONE ............................................................. 08:26.00YEYY 21

DARBEPOETIN ALFA .................................................... 20:16.00EENY 46

DARIFENACIN ......................................................... 86:12.00EENY 203

DARUNAVIR ........................................................... 08:18.08EENY 14

DASATINIB ........................................................... 10:00.00EENY 24

DEFERIPRONE ......................................................... 64:00.00EENY 171

DEFEROXAMINE MESYLATE ............................................... 64:00.00YNNY 171

DEGARELIX ........................................................... 10:00.00YNNY 24

DENOSUMAB ........................................................... 92:00.00EENY 212

DENOSUMAB ........................................................... 92:00.00EENY 212

DENOSUMAB ........................................................... 92:24.00EENY 219

DESAMETHASONE ....................................................... 68:04.00YYYY 172

DESIPRAMINE HCL ..................................................... 28:16.04YYYY 117

DESIPRAMINE HCL ..................................................... 28:16.04YYYY 117

DESMOPRESSIN ........................................................ 68:28.00EEYY 187

DESONIDE ............................................................ 84:06.00YYYY 195

DESOXIMETASONE ...................................................... 84:06.00YYYY 196

DESOXIMETASONE ...................................................... 84:06.00YYYY 196

DEXAMETHASONE ....................................................... 52:08.00YEYY 155

DEXAMETHASONE ....................................................... 68:04.00YYYY 172

DEXAMETHASONE 21-PHOSPHATE .......................................... 68:04.00YYYY 173

DEXAMETHASONE PHOSPHATE ............................................. 68:04.00YYNY 173

DEXAMETHASONE SODIUM-PHOSPHATE ...................................... 68:04.00YYNY 173

DEXTROAMPHETAMINE SO4 ............................................... 28:20.00EENY 137

DEXTROSE/SODIUM CHLORIDE ............................................ 99:14.00YNNY 229

DEXTROSE/SODIUM CHLORIDE ............................................ 99:14.00YNNY 229

DIAZEPAM ............................................................ 28:24.08NNNY 140

DIAZEPAM ............................................................ 99:00.98YYNY 220

DICITRATE SOLN ...................................................... 92:00.00ENNN 212

DICLOFENAC DIETHYLAMINE ............................................. 28:08.04YNNN 88

DICLOFENAC POTASSIUM ................................................ 28:08.04YYYY 89

DICLOFENAC POTASSIUM ................................................ 28:08.04YYYY 89

DICLOFENAC SODIUM ................................................... 28:08.04YYYY 89

DICLOFENAC SODIUM ................................................... 52:36.00YNYY 159

DICLOFENAC SODIUM/MISOPROSTOL ....................................... 28:08.04YYYY 90

DICLOFENAC SODIUM/MISOPROSTOL ....................................... 28:08.04YYYY 90



292





DICLOFENAC SODIUM/MISOPROTOL ........................................ 28:08.04YYYY 90

DIDANOSINE .......................................................... 08:18.08YYNY 14

DIFLUCORTOLONE VALERATE ............................................. 84:06.00YYYY 196

DIFLUNISAL .......................................................... 28:08.04YYYY 90

DIGOXIN ............................................................. 24:04.00YYNY 53

DIHYDROERGOTAMINE MESYLATE .......................................... 12:16.00YNYY 38

DIIODOHYDROXYQUIN ................................................... 08:04.00YNYY 1

DILTIAZEM HCL ....................................................... 24:04.00YYNY 54

DIMENHYDRINATE ...................................................... 99:05.00YNNN 227

DIMETHYL FUMARATE ................................................... 28:92.00EENY 144

DIPHENHYDRAMINE HYDROCHLORIDE ....................................... 99:13.00YNNN 228

DIPHENHYDRAMINE HYDROCHLORIDE ....................................... 99:16.00YNNN 229

DIPHENOXYLATE HCL ................................................... 56:08.00YYYY 161

DIPIVEFRIN HCL ...................................................... 52:24.00YNYY 158

DIPYRIDAMOLE ........................................................ 24:12.00YYNY 85

DIPYRIDAMOLE/ASA .................................................... 24:12.00EENY 85

DISOPYRAMIDE ........................................................ 24:04.04YNNY 65

DITHRANOL ........................................................... 84:28.00YNNN 201

DIVALPROEX SODIUM ................................................... 28:12.92YYNY 107

DOCETAXEL ........................................................... 10:00.00YYNY 24

DOLASETRON .......................................................... 56:22.00EENY 163

DOLUTEGRAVIR ........................................................ 08:18.08EENY 15

DOMPERIDONE MALEATE ................................................. 56:40.00YYYY 166

DONEPEZIL HYDROCHLORIDE ............................................. 12:04.00EENY 31

DONEPEZIL HYSROCHLORIDE ............................................. 12:04.00EENY 32

DONEPEZIL HYSROCHLORIDE ............................................. 12:04.00EENY 32

DORNASE ALFA ........................................................ 48:24.00EENY 152

DORZOLAMIDE HCL ..................................................... 52:10.00YYNY 157

DORZOLAMIDE HCL/TIMOLOL ............................................. 52:36.00EENY 159

DORZOLAMIDE/TIMOLOL ................................................. 52:36.00YYNY 160

DOXAZOSIN MESYLATE .................................................. 24:08.00YYNY 75

DOXEPIN HCL ......................................................... 28:16.04YYYY 117

DOXYCYCLINE ......................................................... 08:12.24YEYY 10

DOXYLAMINE /PYRIDOXINE HCL .......................................... 56:22.00NNYY 163

DULOXETINE .......................................................... 28:16.04YYNY 117

DULOXETINE .......................................................... 99:00.98YYNY 220

DUTASTERIDE ......................................................... 92:00.00YNNY 212

EANALAPRIL MALEATE .................................................. 24:04.00YYNY 56

EANALAPRIL MALEATE .................................................. 24:04.00YYNY 56

EFAVIRENZ ........................................................... 08:18.08YYNY 15

EFAVIRENZ/TENOFOVIR/EMTRICITAB ...................................... 08:18.08EENY 15

EMPAGLIFLOZIN ....................................................... 68:20.18EENY 182



293





EMTRICITABINE/RILPIVIRINE/TENO ...................................... 08:18.08EENY 15

ENALAPRIL ........................................................... 24:04.00YYNY 56

ENALAPRIL /HCTZ ..................................................... 24:04.00YYNY 56

ENALAPRIL MALEATE ................................................... 24:04.00YYNY 56

ENALAPRIL SODIUM .................................................... 24:04.00YYNY 57

ENOXAPARIN .......................................................... 20:12.04YENY 44

ENOXAPARIN .......................................................... 20:12.04YENY 44

ENTACAPONE .......................................................... 28:92.00YYNY 145

ENTACAPONE .......................................................... 28:92.00YYNY 145

ENTECAVIR ........................................................... 08:18.08EENY 15

ENZALUTAMIDE ........................................................ 10:00.00EENY 24

EPINEPHRINE ......................................................... 12:12.00ENYY 36

EPINEPHRINE HCL ..................................................... 12:12.00ENYY 36

EPLERENONE .......................................................... 24:32.20EENY 87

EPOETIN ALFA ........................................................ 20:16.00EENY 47

EPROSARTAN .......................................................... 24:08.00YYNY 75

EPROSARTAN/HYDROCHLOROTHIAZIDE ...................................... 24:08.00YYNY 76

EPROSARTAN/HYDROCHLOROTHIAZIDE ...................................... 24:08.00YYNY 76

ERLOTINIB ........................................................... 10:00.00EENY 24

ERYTHROMYCIN ........................................................ 52:04.04YNYY 153

ERYTHROMYCIN BASE ................................................... 08:12.12YEYY 7

ERYTHROMYCIN ESTOLATE ............................................... 08:12.12YEYY 7

ERYTHROMYCIN ETHYLSUCCINATE ......................................... 08:12.12YEYY 7

ERYTHROMYCIN STEARATE ............................................... 08:12.12YEYY 7

ERYTHROMYCIN TRETINOIN .............................................. 84:16.00NNYY 199

ESCITALOPRAM ........................................................ 28:16.04YYNY 118

ESLICARBAZEPINE ACETATE ............................................. 28:12.92EENY 107

ESTRADIOL ........................................................... 68:16.04YNNY 178

ESTRADIOL & NORETHINDRONE ........................................... 68:16.04YNNY 178

ESTRADIOL HEMIHYDRATE ............................................... 68:16.04YNNY 179

ETANERCEPT .......................................................... 92:00.00EENY 212

ETHINYL ESTRADIOL & ETONOGESTR ...................................... 68:12.00NNYY 175

ETHINYL ESTRADIOL DROSPIRENONE ...................................... 68:12.00NNYY 175

ETHINYL ESTRADIOL/DESOGESTREL ....................................... 68:12.00NNYY 175

ETHINYL ESTRADIOL/DROSPIRENONE ...................................... 68:12.00NNYY 176

ETHINYL ESTRADIOL/ETHYNODIOL ........................................ 68:12.00NNYY 176

ETHINYL ESTRADIOL/L-NORGESTREL ...................................... 68:12.00NNYY 176

ETHINYL ESTRADIOL/NORGESTIMATE ...................................... 68:12.00NNYY 176

ETHINYLESTRADIOL/LEVONORGESTRE ...................................... 68:12.00NNYY 177

ETHINYLESTRADIOL/LEVONORGESTRE ...................................... 68:12.00NNYY 177

ETHINYLESTRADIOL/NORETHINDRONE ...................................... 68:12.00NNYY 177

ETHOPROPAZINE ....................................................... 12:08.04YYNY 33



294





ETHOSUXIMIDE ........................................................ 28:12.20YYNY 106

ETIDRONATE /CALCIUM CARBONATE ....................................... 92:00.00YENY 212

ETIDRONATE DISODIUM ................................................. 92:00.00YENY 212

ETODOLAC ............................................................ 28:08.04YYYY 90

ETOPOSIDE ........................................................... 10:00.00YYNY 24

EVEROLIMUS .......................................................... 10:00.00EENY 25

EVEROLIMUS .......................................................... 10:00.00EENY 25

EXEMESTANE .......................................................... 10:00.00YYNY 25

EZETIMIBE ........................................................... 24:06.00EENY 66

FAMCICLOVIR ......................................................... 08:18.00YEYY 12

FAMOTIDINE .......................................................... 56:40.00YNYY 166

FEBUXOSTAT .......................................................... 92:00.00EENY 212

FELODIPINE .......................................................... 24:08.00YYNY 76

FENOFIBRATE ......................................................... 24:06.00YYNY 66

FENOFIBRATE ......................................................... 24:06.06YYNY 72

FENTANYL ............................................................ 28:08.08YYNY 95

FENTANYL ............................................................ 99:01.00YNNY 224

FENTANYL CITRATE .................................................... 28:08.08NNNY 97

FENTANYL CITRATE .................................................... 28:08.08NNNY 97

FENTANYL CITRATE .................................................... 99:00.98YYNY 220

FERROUS FUMARATE .................................................... 20:04.04YNYN 42

FERROUS GLUCONATE ................................................... 20:04.04YNYN 42

FERROUS GLUCONATE ................................................... 99:00.99YYNN 224

FERROUS SULPHATE .................................................... 20:04.04YNYN 42

FILGRASTIM .......................................................... 20:16.00EENY 48

FILGRASTIM .......................................................... 20:16.00EENY 48

FINASTERIDE ......................................................... 92:00.00YNNY 212

FINGOLIMOD .......................................................... 92:00.00EENY 213

FINGOLIMOD .......................................................... 92:00.00EENY 213

FLAVOXATE HCL ....................................................... 86:12.00YYYY 203

FLECAINIDE .......................................................... 24:04.00YYNY 57

FLOCTAFENINE ........................................................ 28:08.92YNYY 103

FLUCONAZOLE ......................................................... 08:12.04YEYY 2

FLUCONAZOLE ......................................................... 99:00.98YYNY 221

FLUDARABINE PHOSPHATE ............................................... 10:00.00YYNY 25

FLUDROCORTISONE ACETATE ............................................. 68:04.00YYYY 173

FLUMETHASONE PIVALATE ............................................... 84:06.00YNYY 196

FLUNARIZINE HCL ..................................................... 12:16.00YNYY 39

FLUNARIZINE HCL ..................................................... 12:16.00YNYY 39

FLUNISOLIDE ......................................................... 52:08.00YNYY 155

FLUOCINOLONE ACETONIDE .............................................. 84:06.00YYYY 196

FLUOCINONIDE ........................................................ 84:06.00YYYY 196



295





FLUOROMEHTOLONE ..................................................... 52:08.00YNYY 155

FLUOROMETHOLONE ..................................................... 52:08.00YEYY 155

FLUOROMETHOLONE ACETATE ............................................. 52:08.00YNYY 155

FLUOROURACIL ........................................................ 84:36.00YNNY 202

FLUOXETINE .......................................................... 28:16.04YYYY 118

FLUPENTHIXOL DECANOATE .............................................. 28:16.08YYNY 126

FLUPENTHIXOL DIHYDROCHLORIDE ........................................ 28:16.08YYNY 127

FLUPENTHIXOL DIHYDROCHLORIDE ........................................ 28:16.08YYNY 127

FLUPHENAZINE DECANOATE .............................................. 28:16.08YYNY 127

FLUPHENAZINE HCL .................................................... 28:16.08YYNY 127

FLURAZEPAM HCL ...................................................... 28:24.08YNYY 140

FLURBIPROFEN ........................................................ 28:08.04YYYY 90

FLUTAMIDE ........................................................... 10:00.00YYNY 25

FLUTIASONE FUROATE .................................................. 52:08.08YYYY 157

FLUTICASONE FUROATE ................................................. 52:08.00YNYY 155

FLUTICASONE FUROATE ................................................. 52:08.08YYYY 157

FLUTICASONE FUROATE/VILANTEROL ...................................... 12:12.00EENY 36

FLUTICASONE PROPIONATE .............................................. 52:08.00YNYY 155

FLUTICASONE PROPIONATE .............................................. 68:04.00YYYY 173

FLUVASTATIN SODIUM .................................................. 24:06.00YYNY 67

FLUVOXAMINE MALEATE ................................................. 28:16.04YYYY 119

FOLIC ACID .......................................................... 88:08.00YNYY 206

FONDAPARINUX SODIUM ................................................. 20:12.04EENY 44

FORMOTEROL FUMARATE ................................................. 12:12.00EENY 36

FORMOTEROL FUMARATE/BUDESONIDE ...................................... 12:12.00EENY 36

FOSINOPRIL .......................................................... 24:08.00YYNY 76

FRAMYCETIN SO4 ...................................................... 84:04.04YNYY 190

FRAMYCETIN/GRAMICIDIN/DEXAMETH ...................................... 52:08.00YNYY 155

FUROSEMIDE .......................................................... 40:28.00YNNY 149

FUROSEMIDE .......................................................... 40::2.8.YNNY 151

FUROSEMIDE .......................................................... 99:00.98YYNY 221

FUSIDIC ACID ........................................................ 52:04.12YNYY 154

FUSIDIC ACID ........................................................ 84:04.04YNYY 190

FUSIDIC ACID 2%/HYDROCORTISONE ...................................... 84:04.04YYYY 190

GABAPENTIN .......................................................... 28:12.92YYNY 107

GALANTAMINE HYDROBROMIDE ............................................ 12:04.00EENY 32

GANCICLOVIR SO4 ..................................................... 08:18.00YENY 13

GANCICLOVIR SO4 ..................................................... 08:18.00YENY 13

GATIFLOXACIN ........................................................ 52:04.04YNNY 153

GEFITINIB ........................................................... 10:00.00EENY 25

GEMFIBROZIL ......................................................... 24:06.00YYNY 67

GENTAMICIN .......................................................... 84:04.04YNYY 190



296





GENTAMICIN S04 ...................................................... 08:12.02EENY 2

GENTAMICIN SO4 ...................................................... 52:04.04YNYY 153

GENTAMICIN/BETAMETHASONE SOD ........................................ 52:08.00YNYY 156

GLATIRAMER ACETATE .................................................. 92:00.00EENY 213

GLICLAZIDE .......................................................... 68:20.20YYNY 182

GLUCAGON ............................................................ 68:20.92YYNY 183

GLYBURIDE ........................................................... 68:20.20YYNY 182

GLYCERINE ........................................................... 99:04.00YNNN 225

GLYCOPYRROLATE ...................................................... 99:07.00YNNY 228

GLYCOPYRRONIUM BROMIDE .............................................. 12:08.08EENY 34

GLYCOPYRRONIUM/INDACATEROL .......................................... 12:08.08EENY 34

GOLIMUMAB ........................................................... 92:00.00EENY 213

GOSERELIN ACETATE ................................................... 92:00.00YYNY 213

GRANISETRON ......................................................... 56:22.00EENY 163

HALOBETASOL ......................................................... 84:06.00EENY 197

HALOBETASOL ......................................................... 84:06.00EENY 197

HALOPERIDOL ......................................................... 28:16.08YYNY 127

HALOPERIDOL ......................................................... 99:00.98YYNY 221

HALOPERIDOL DECANOATE ............................................... 28:16.08YYNY 128

HALOPERIDOL DECANOATE ............................................... 28:16.08YYNY 128

HEPARIN ............................................................. 20:12.04YYNY 44

HOMATROPINE HYDROBROMIDE ............................................ 52:24.00YEYY 158

HYDRALAZINE HCL ..................................................... 24:08.00YYNY 76

HYDROCHLOROTHIAZIDE ................................................. 40:28.00YYYY 150

HYDROCODONE /PHENYLEPHRINE HCL ...................................... 48:08.00YNYY 152

HYDROCORTISONE ...................................................... 56:40.00YYYY 166

HYDROCORTISONE ...................................................... 68:04.00YYYY 173

HYDROCORTISONE ...................................................... 84:06.00YNYN 197

HYDROCORTISONE ACETATE .............................................. 84:06.00YNYY 197

HYDROCORTISONE VALERATE ............................................. 84:06.00YYYY 198

HYDROCORTISONE/PRAMOXINE ............................................ 84:06.00NNYN 198

HYDROMORPHONE BITARTRATE ............................................ 28:08.08YNNY 97

HYDROMORPHONE HCL ................................................... 28:08.08YYNY 97

HYDROXYCHLOROQUINE SO4 .............................................. 08:20.00YYNY 18

HYDROXYUREA ......................................................... 10:00.00YYNY 25

HYDROXYZINE ......................................................... 28:24.92YYYY 143

HYOSCINE BUTYLBROMIDE ............................................... 12:08.08YNYY 34

HYOSCINE BUTYLBROMIDE ............................................... 99:00.98YYNY 221

IBRUTINIB ........................................................... 10:00.00EENY 25

IBUPROFEN ........................................................... 28:08.04YNNN 90

IBUPROFEN ........................................................... 99:00.99YYNN 224

IBUPROFEN ........................................................... 99:01.00YNNN 225



297





IBUPROFEN ........................................................... 99:01.00YNNN 225

ICATIBANT ACETATE ................................................... 92:32.00ENNY 219

IDELALISIB .......................................................... 10:00.00EENY 25

IMATINIB ............................................................ 10:00.00EENY 25

IMIPRAMINE .......................................................... 28:16.04YYYY 120

IMIQUIMOD ........................................................... 84:36.00EENY 202

INCOBOTULINUMTOXIN A ................................................ 92:00.00EENY 213

INDACATEROL ......................................................... 12:12.00EENY 36

INDAPAMIDE .......................................................... 40:28.00YYNY 150

INDAPAMIDE/PERINDOPRIL .............................................. 24:08.00YYNY 76

INDINAVIR SULPHATE .................................................. 08:18.08YYNY 15

INDOMETHACIN ........................................................ 28:08.04YNYY 91

INFLIXIMAB .......................................................... 92:00.00EENY 213

INSULIN LISPRO (BIPHASIC) .......................................... 68:20.08YYNY 180

INSULIN (REGULAR) LISPRO ............................................ 68:20.08YYNY 180

INSULIN ASPART ...................................................... 68:20.08YYNY 180

INSULIN DETEMIR ..................................................... 68:20.08EENY 180

INSULIN GLARGINE .................................................... 68:20.08EENY 180

INSULIN GLULISINE ................................................... 68:20.08YYNY 180

INSULIN ISOPHANE HUMAN BIOSYNT ...................................... 68:20.08YYNY 180

INSULIN ISOPHANE PORK ............................................... 68:20.08YYNY 180

INSULIN LISPRO ...................................................... 68:20.08YYNY 181

INSULIN LISPRO ...................................................... 68:20.08YYNY 181

INSULIN PORK ........................................................ 68:20.08YYNY 181

INSULIN(ASPART/ASPART PROTAMIN ...................................... 68:20.08YYNY 181

INSULIN(ISOPHANE) HUMAN BIOSYN ...................................... 68:20.08YYNY 181

INSULIN(LENTE)HUMAN BIOSYNTHET ...................................... 68:20.08YYNY 181

INSULIN(REG./ISOPHANE) HUMAN ........................................ 68:20.08YYNY 181

INSULIN(REGULAR)HUMAN BIOSYNTH ...................................... 68:20.08YYNY 181

INTERFERON ALFA-2B .................................................. 10:00.00EENY 26

INTERFERON BETA-1A .................................................. 92:00.00EENY 213

INTERFERON BETA-1B .................................................. 92:00.00EENY 213

IODOCHLORHYDROXYQUIN/FLUMETHAS ...................................... 52:08.00YNYY 156

IPILIMUMAB .......................................................... 10:00.00EENY 26

IPRATROPIUM /SALBUTAMOL ............................................. 12:08.08YYNY 34

IPRATROPIUM BROMIDE ................................................. 12:08.08YYNY 34

IPRATROPIUM/FENOTEROL ............................................... 12:12.00YYNY 37

IPRATROPIUM/FENOTEROL ............................................... 12:12.00YYNY 37

IPRATROPIUM/SALBUTAMOL .............................................. 12:08.08YYNY 35

IRBESARTAN .......................................................... 24:08.00YYNY 77

IRBESARTAN .......................................................... 24:08.00YYNY 77

IRBESARTAN/HYDROCHLOROTHIAZIDE ...................................... 24:08.00YYNY 77



298





IRON (FERRIC GLUCONATE COMPLEX ...................................... 20:04.04EENY 42

IRON (FERROUS SULFATE) .............................................. 20:04.04ENYN 42

IRON DEXTRAN ........................................................ 20:04.04EENY 43

IRON POLYSACCHARIDE COMPLEX ......................................... 20:04.04EENY 43

IRON SUCROSE ........................................................ 20:04.04EENY 43

ISOSORBIDE DINITRATE ................................................ 24:12.00YYNY 85

ISOSORBIDE-5 MONONITRATE ............................................ 24:12.00YYNY 85

ISOTRETINOIN ........................................................ 84:36.00NNYY 202

ITRACONAZOLE ........................................................ 08:12.04EEYY 3

IVACAFTOR ........................................................... 48:14.12EENY 152

KCL/SOD.BICARB/NACI/CARBOWAX ........................................ 99:04.00YNNY 225

KETAMINE HCL ........................................................ 28::0.4.YNNY 147

KETAMINE HCL ........................................................ 99:00.98YYNY 221

KETOCONAZOLE ........................................................ 08:12.04YEYY 3

KETOCONAZOLE ........................................................ 84:04.08YNYY 191

KETOCONAZOLE ........................................................ 99:00.98YYNY 221

KETOPROFEN .......................................................... 28:08.04YNYY 91

KETOROLAC ........................................................... 28:08.04YNNY 91

KETOROLAC TROMETHAMINE .............................................. 28:08.04YYYY 91

KETOROLAC TROMETHAMINE .............................................. 52:08.00YNYY 156

KIVEXA .............................................................. 08:18.08YYNY 15

L-TRYPTOPHAN ........................................................ 28:16.04YYNY 120

LABETALOL HCL ....................................................... 24:08.00YYNY 78

LACOSAMIDE .......................................................... 28:12.92EENY 109

LACTIC ACID/SALICYLIC ACID .......................................... 84:28.00NNYN 201

LACTULOSE ........................................................... 99:04.00YNNN 225

LAMIVUDINE .......................................................... 08:18.08YYNY 15

LAMIVUDINE/ZIDOVUDINE ............................................... 08:18.08YYNY 16

LAMOTRIGINE ......................................................... 28:12.92YYNY 109

LANSOPRAZOLE ........................................................ 56:40.00YEYY 166

LANSOPRAZOLE ........................................................ 99:05.00YNNY 227

LANSOPRAZOLE/CLARITHROMYC/AMOX ...................................... 56:40.00YNYY 167

LAPATINIB ........................................................... 10:00.00EENY 26

LATANOPROST ......................................................... 52:36.00YYNY 160

LATANOPROST/TIMOLOL ................................................. 52:36.00YYNY 160

LEDIPASVIR/SOFOSBUVIR ............................................... 08:18.40EENY 17

LEFLUNOMIDE ......................................................... 92:00.00EENY 214

LEFLUNOMIDE ......................................................... 92:00.00EENY 214

LENALIDOMIDE ........................................................ 10:00.00EENY 26

LETROZOLE ........................................................... 10:00.00YYNY 27

LETROZOLE ........................................................... 10:00.00YYNY 27

LEUCOVORIN CALC.(FOLINIC ACID) ...................................... 88:08.00YENY 206



299





LEUPROLIDE .......................................................... 10:00.00YYNY 27

LEVETIRACETAM ....................................................... 28:12.92YYNY 110

LEVOBUNOLOL HCL ..................................................... 52:36.00YYNY 160

LEVOCABASTINE HYDROCHLORIDE ......................................... 52:36.00YNYY 160

LEVOCARNITINE ....................................................... 28:12.12NENY 105

LEVODOPA/BENZERAZIDE ................................................ 28:92.00YYNY 145

LEVODOPA/CARBIDOPA .................................................. 28:92.00YYNY 145

LEVOFLOXACIN ........................................................ 08:22.00YENY 20

LEVOFLOXACIN ........................................................ 08:22.00YENY 20

LEVOFLOXACIN IV ..................................................... 08:22.00EENY 20

LEVONORGESTREL ...................................................... 68:12.00NNYY 177

LEVOTHYROXINE (SODIUM) .............................................. 68:36.04YYNY 188

LIDOCAINE ........................................................... 99:13.00YNNN 228

LIDOCAINE 1%-50 ML .................................................. 99:13.00YNNN 228

LIDOCAINE/PRILOCAINE ................................................ 99:13.00YNNN 228

LINAGLIPTIN ......................................................... 68:20.05EENY 179

LINAGLIPTIN/METFORMIN ............................................... 68:20.04EENY 179

LIOTHYRONINE SODIUM ................................................. 68:36.04YYNY 189

LISDEXAMFETAMINE DIMESYLATE ......................................... 28:20.04EENY 138

LISDEXAMFETAMINE DIMESYLAYE ......................................... 28:20.04EENY 139

LISINOPRIL .......................................................... 24:04.00YYNY 57

LISINOPRIL/HYDROCHLOROTHIAZIDE ...................................... 24:04.00YYNY 58

LITHIUM CARBONATE ................................................... 28:28.00YYNY 143

LODOXAMIDE TROMETHAMINE ............................................. 52:36.00YNYY 160

LOMUSTINE ........................................................... 10:00.00YYNY 27

LOPERAMIDE .......................................................... 99:15.00YNNN 229

LOPINAVIR/RITONAVIR ................................................. 08:18.08YYNY 16

LORATADINE .......................................................... 04:08.00NNYN 1

LORAZEPAM ........................................................... 28:24.08YNYY 141

LORAZEPAM ........................................................... 28:24.08YNYY 141

LORAZEPAM ........................................................... 99:00.98YYNY 221

LOSARTAN /HYDROCHLOROTHIAZIDE ....................................... 24:08.00YYNY 78

LOSARTAN POTASSIUM .................................................. 24:08.00YYNY 79

LOSARTAN/HYDROCHLOROTHIAZIDE ........................................ 24:08.00YYNY 79

LOVASTATIN .......................................................... 24:06.00YYNY 68

LOVASTATIN .......................................................... 24:06.00YYNY 68

LOXAPINE SUCCINATE .................................................. 28:16.08YYNY 128

LURASIDONE HCL ...................................................... 28:16.08EENY 128

MAG OXIDE/CITRIC ACID/PICOSULF ...................................... 99:04.00YNNN 225

MAGNESIUM CITRATE ................................................... 99:04.00YNNN 226

MAGNESIUM CITRATE ................................................... 99:04.00YNNN 226

MAGNESIUM GLUCOHEPTONATE ............................................ 40:12.00EENY 148



300





MAGNESIUM GLUCONATE ................................................. 40:12.00ENNN 148

MAGNESIUM HYDROX/MINERAL OIL ........................................ 99:04.00YNNN 226

MAGNESIUM OXIDE ..................................................... 40:12.00ENYN 148

MAPROTILINE ......................................................... 28:16.04YYYY 120

MEBENDAZOLE ......................................................... 08:08.00YNYY 1

MECLIZINE HCL ....................................................... 56:22.00YNNN 163

MEDROXYPROGESTERONE ACETATE ......................................... 68:32.00YNYY 188

MEDROXYPROGESTERONE ACETATE ......................................... 99:00.98YYNY 221

MEFENAMIC ACID ...................................................... 28:08.04YYYY 92

MEFENAMIC ACID ...................................................... 28:08.04YYYY 92

MEGESTROL ACETATE ................................................... 10:00.00YYNY 27

MELOXICAM ........................................................... 28:08.04YYYY 92

MELPHALAN ........................................................... 10:00.00YYNY 28

MEPERIDINE HCL ...................................................... 28:08.08YYNY 98

MERCAPTOPURINE ...................................................... 10:00.00YYNY 28

METFORMIN ........................................................... 68:20.90YYNY 183

METFORMIN ........................................................... 68:20.92YYNY 183

METFORMIN HYDROCHLORIDE ............................................. 68:20.92YYNY 184

METFORMIN/SAXAGLIPTIN ............................................... 68:20.04EENY 179

METHADONE ........................................................... 99:00.98EENY 221

METHADONE HYDROCHLORIDE ............................................. 28:08.08YNNY 98

METHAZOLAMIDE ....................................................... 52:10.00YYNY 157

METHENAMINE MANDELATE ............................................... 08:36.00YNNY 21

METHIMAZOLE ......................................................... 68:36.08YYNY 189

METHOCARBAMOL/ACETAMINOPHEN ......................................... 12:20.00YNNN 41

METHOCARBAMOL/CODEINE ............................................... 12:20.00YNNY 41

METHOTREXATE ........................................................ 10:00.00YYNY 28

METHOTREXATE SODIUM ................................................. 10:00.00YYNY 28

METHOTREXATE SODIUM INJ ............................................. 10:00.00YYNY 28

METHOTRIMEPRAZINE ................................................... 28:16.08YYNY 128

METHOTRIMEPRAZINE ................................................... 99:00.98YYNY 222

METHOXSALEN ......................................................... 84:50.06NENY 202

METHSUXIMIDE ........................................................ 28:12.20YYNY 106

METHYLDOPA .......................................................... 24:08.00YYNY 80

METHYLDOPA/HYDROCHLOROTHIAZIDE ...................................... 24:08.00YYNY 80

METHYLPHENIDATE HCL ................................................. 28:20.00EENY 137

METHYLPHENIDATE HCL ................................................. 99:00.98YYNY 222

METHYLPREDNISOLONE .................................................. 68:04.00YYYY 173

METHYLPREDNISOLONE ACETATE .......................................... 68:04.00YYNY 174

METHYLPREDNISOLONE SOD SUCCIN ....................................... 68:04.00YYNY 174

METOCLOPRAMIDE HCL .................................................. 56:40.00YYYY 167

METOLAZONE .......................................................... 40:28.00YYNY 151



301





METOLAZONE .......................................................... 40:28.00YYNY 151

METOPROLOL TARTRATE ................................................. 24:04.00YYNY 58

METRONIDAZOLE ....................................................... 08:40.00YEYY 21

METRONIDAZOLE ....................................................... 84:04.16YNYY 193

MEXILETINE HCL ...................................................... 24:04.00YYNY 59

MICONAZOLE NITRATE .................................................. 84:04.08YNYY 192

MICONAZOLE NITRATE .................................................. 84:04.08YNYY 192

MIDAZOLAM ........................................................... 99:00.98YNNY 222

MIDODRINE ........................................................... 12:12.00YYNY 37

MINERAL OIL ......................................................... 99:04.00YNNN 226

MINOCYCLINE HCL ..................................................... 08:12.24YEYY 10

MINOXIDIL ........................................................... 24:08.00YYNY 80

MIRABEGRON .......................................................... 86:12.08ENNY 204

MIRTAZAPINE ......................................................... 28:16.04YYNY 120

MISOPROSTOL ......................................................... 56:40.00YYYY 167

MOCLOBEMIDE ......................................................... 28:16.04YYYY 121

MODAFINIL ........................................................... 28:20.00EENY 138

MOMETASONE FUROATE .................................................. 52:08.00YNYY 156

MOMETASONE FUROATE .................................................. 84:06.00YYYY 198

MONTELUKAST SODIUM .................................................. 92:00.00EENY 214

MORPHINE ............................................................ 28:08.08YYYY 99

MORPHINE ............................................................ 28:08.08YYYY 99

MORPHINE INJ ........................................................ 28:08.08YYNY 101

MOXIFLOXACIN ........................................................ 08:22.00EENY 20

MOXIFLOXACIN HYDROCHLORIDE .......................................... 52:04.04YNYY 153

MUPIROCIN ........................................................... 84:04.04YNYY 191

MUPIROCIN ........................................................... 84:04.04YNYY 191

MYCOPHENOLATE ....................................................... 92:00.00YYNY 215

MYCOPHENOLATE ....................................................... 92:00.00YYNY 215

MYCOPHENOLATE MOFETIL ............................................... 92:00.00YYNY 215

MYCOPHENOLIC ACID ................................................... 92:00.00YYNY 215

NABILONE ............................................................ 56:22.00EENY 163

NABUMETONE .......................................................... 28:08.04YYYY 92

NADOLOL ............................................................. 24:04.00YYNY 59

NADROPARIN CALCIUM .................................................. 20:12.04YENY 44

NALTREXONE HCL ...................................................... 28:10.00YENY 103

NAPROXEN ............................................................ 28:08.04YYYY 92

NAPROXEN SODIUM ..................................................... 28:08.04YYYY 93

NARATRIPTAN HCL ..................................................... 12:16.00YNYY 39

NATALIZUMAB ......................................................... 92:00.00EENY 215

NELFINAVIR MESYLATE ................................................. 08:18.08YYNY 16

NEOMYC/GRAM/NYS/TRIAMCINOLONE ....................................... 84:06.00YNYY 199



302





NEOMYC/GRAM/NYS/TRIAMCINOLONE ....................................... 84:06.00YNYY 199

NEOSTIGMINE BROMIDE ................................................. 12:04.00YNNY 32

NEPAFENAC ........................................................... 52:36.00YNNY 160

NEVIRAPINE .......................................................... 08:18.08YYNY 16

NIACIN .............................................................. 88:08.00YNNN 206

NIFEDIPINE .......................................................... 24:04.00YYYY 60

NILUTAMIDE .......................................................... 10:00.00YYNY 28

NINTEDANIB .......................................................... 48:02.00EENY 151

NITRAZEPAM .......................................................... 28:12.08YYNY 105

NITROFURANTOIN ...................................................... 08:36.00YEYY 21

NITROFURANTOIN MONOHYDRATE .......................................... 08:36.00YEYY 21

NITROGLYCERIN ....................................................... 24:12.00YYNY 86

NITROGLYCERIN ....................................................... 24:12.00YYNY 86

NIZATIDINE .......................................................... 56:40.00YNYY 167

NORETHINDRONE ....................................................... 68:12.00NNYY 178

NORETHINDRONE ....................................................... 68:12.00NNYY 178

NORFLOXACIN ......................................................... 08:22.00YEYY 20

NORTRIPTYLINE ....................................................... 28:16.04YYYY 121

NYSTATIN ............................................................ 08:12.04YEYY 3

NYSTATIN ............................................................ 84:04.08YNYN 192

NYSTATIN ............................................................ 99:00.99YYNN 224

OBINUTUZUMAB ........................................................ 10:00.00EENY 28

OCRIPLASMIN ......................................................... 92:00.00EENY 215

OCTREOTIDE .......................................................... 92:00.00YNNY 215

OCTREOTIDE .......................................................... 99:00.98YYNY 222

OCTREOTIDE ACETATE .................................................. 92:00.00YENY 216

OFLOXACIN ........................................................... 52:04.12YNYY 154

OLANZAPINE .......................................................... 28:16.08YYNY 129

OLANZAPINE .......................................................... 28:16.08YYNY 129

OLANZAPINE .......................................................... 99:00.98YYNY 222

OLMESARTAN .......................................................... 24:08.00YYNY 80

OLMESARTAN/HYDROCHLOROTHIAZIDE ...................................... 24:08.00YYNY 80

OLODATEROL/TIOTROPIUM ............................................... 12:08.08EENY 35

OLOPATADINE ......................................................... 04:00.00YNYY 1

OLOPATDINE .......................................................... 04:00.00YNYY 1

OLSALAZINE SODIUM ................................................... 56:40.00YYYY 168

OMALIZUMAB .......................................................... 48:92.00ENNY 152

OMBITASVIR/PARITAPREVIR/RITONA ...................................... 08:18.40EENY 18

OMBITASVIR/PARITAPREVIR/RITONA ...................................... 08:18.40EENY 18

OMEPRAZOLE .......................................................... 56:40.00YEYY 168

ONDANSETRON ......................................................... 56:22.00EENY 163

ONDANSETRON ......................................................... 99:00.98YYNY 222



303





OPIUM & BELLADONNA SUP. ............................................. 12:08.08YENY 35

ORCIPRENALINE SO4 ................................................... 12:12.00YYYY 37

ORPHENADRINE CITRATE ................................................ 12:20.00YNNN 41

OXAZEPAM ............................................................ 28:24.08YNYY 141

OXCARBAZEPINE ....................................................... 28:12.92YYNY 110

OXTRIPHYLLINE ....................................................... 86:16.00YYNY 204

OXTRIPHYLLINE/GUAIFENESIN ........................................... 86:16.00YYNY 204

OXYBUTYNIN CHLORIDE ................................................. 86:12.00YNYY 203

OXYCODONE ........................................................... 28:08.08YYYY 101

OXYCODONE ........................................................... 99:00.98YYNY 222

OXYCODONE HCL/ACETAMINOPHEN ......................................... 28:08.08YYYY 101

OXYCODONE HCL/ACETOMINOPHEN ......................................... 28:08.08YYYY 101

OXYCODONE/ACETYLSALICYLIC ACID ...................................... 28:08.08YYNY 102

OXYCODONE/ACETYLSALICYLIC ACID ...................................... 28:08.08YYNY 102

PALIPERIDONE ........................................................ 28:16.08EENY 130

PAMIDRONATE DISODIUM ................................................ 92:00.00YYNY 216

PANCRELIPASE (LIPASE/AMYL/PROT ...................................... 56:16.01YYNY 162

PANCRELIPASE(LIPASE/AMYL/PROT) ...................................... 56:16.00YYNY 162

PANTOPRAZOLE ........................................................ 56:40.00YEYY 168

PANTOPRAZOLE ........................................................ 99:00.98YYNY 222

PANTOPRAZOLE MAGNESIUM .............................................. 56:40.00YEYY 169

PAROXETINE .......................................................... 28:16.04YYYY 122

PAZOPANIB HCL ....................................................... 10:00.00YYNY 28

PEGFILGRASTIM ....................................................... 20:16.00EENY 48

PEMBROLIZUMAB ....................................................... 10:00.00EENY 28

PENICILLAMINE ....................................................... 64:00.00YNNY 171

PENICILLIN V (POTASSIUM) ............................................ 08:12.16YEYY 9

PENTAZOCINE ......................................................... 28:08.12YNNY 102

PENTAZOCINE ......................................................... 99:00.98YYNY 223

PENTAZOCINE ......................................................... 99:00.98YYNY 223

PENTOSAN POLYSULFATE SO4 ............................................ 92:00.00YNYY 216

PENTOXIFYLLINE ...................................................... 20:24.00YYNY 48

PERAMPANEL .......................................................... 28:12.92EENY 111

PERICYAZINE ......................................................... 28:16.08YYNY 131

PERINDOPRIL ERBUMINE ................................................ 24:08.00YYNY 80

PERMETHRIN .......................................................... 84:04.12NNYN 193

PERMETHRIN .......................................................... 84:04.12NNYN 193

PERPHENAZINE ........................................................ 28:16.08YYNY 131

PERTUZUMAB/TRASTUZUMAB .............................................. 10:00.00ENNY 29

PERTUZUMAB/TRASTUZUMAB .............................................. 10:00.00ENNY 29

PETROLEUM DISTILLATE ................................................ 84:04.12NNYN 193

PHENELZINE SO4 ...................................................... 28:16.04YYYY 122



304





PHENOBARBITAL ....................................................... 28:12.04YYYY 104

PHENOBARBITAL SODIUM ................................................ 28:12.04NNNY 104

PHENOBARBITAL SODIUM ................................................ 99:00.98YYNY 223

PHENYTOIN ........................................................... 28:12.12YYNY 105

PHOSPHORUS .......................................................... 40:12.00YENY 148

PILOCARPINE HCL ..................................................... 12:04.00YNNY 32

PILOCARPINE HCL ..................................................... 52:20.00YYYY 158

PIMECROLIMUS ........................................................ 92:00.00EENY 216

PIMOZIDE ............................................................ 28:16.08YYNY 131

PINAVERIUM BROMIDE .................................................. 12:08.08YNYY 35

PINDOLOL ............................................................ 24:04.00YYNY 60

PINDOLOL/HYDROCHLOROTHIAZIDE ........................................ 24:08.00YYNY 81

PIOGLITAZONE ........................................................ 68:20.92EENY 184

PIPERACILLIN/TAZOBACTAM ............................................. 08:12.16YENY 10

PIRFENIDONE ......................................................... 92:44.00EENY 219

PIROXICAM ........................................................... 28:08.04YYYY 93

PIZOTYLINE HYDROGEN MALATE .......................................... 12:16.00YNYY 39

PODOPHYLLIN ......................................................... 84:36.00YNYY 202

PODOPHYLLOTOXIN ..................................................... 84:28.00YNYY 201

POLYETHYLENE GLYCOL 3350 ............................................ 99:04.00YNNN 226

POLYMIXIN B/TRIMETHOPRIM ............................................ 52:04.04YNYY 153

POLYMIXIN B/TRIMETHOPRIM ............................................ 99:00.98YYNY 223

POLYMYX/BACIT/NEOM/HYDROCORT ........................................ 84:06.00YNYY 199

POLYMYX/NEOMYC/HYDROCORTISONE ....................................... 52:08.00YNYY 156

POLYMYX/NEOMYCIN/BACITRACIN ......................................... 84:04.04YNYY 191

POLYMYX/NEOMYCIN/DEXAMETHASONE ...................................... 52:08.00YNYY 156

POLYMYXIN B/TRIMETHOPRIM ............................................ 52:04.04YNYY 153

POLYMYXIN/NEOMYCIN/GRAMICIDIN ....................................... 52:04.04YNYY 153

POMALIDOMIDE ........................................................ 10:00.00EENY 29

PONATINIB HCL ....................................................... 10:00.00EENY 29

POTASSIUM CHLORIDE .................................................. 40:12.00YNNY 148

POTASSIUM CHLORIDE .................................................. 99:00.98YYNY 223

POTASSIUM CITRATE ................................................... 40:12.00YNNN 148

PRAMIPEXOLE DIHYDROCHLORIDE ......................................... 28:92.00YYNY 145

PRAVASTATIN ......................................................... 24:06.00YYNY 68

PRAZOSIN ............................................................ 24:08.00YYNY 81

PREDNISOLONE ACETATE ................................................ 52:08.00YNYY 156

PREDNISOLONE SODIUM PHOSPHATE ....................................... 52:08.00ENNY 156

PREDNISOLONE SODIUM PHOSPHATE ....................................... 68:04.00YYYY 174

PREDNISONE .......................................................... 68:04.00YYYY 174

PREGABALIN .......................................................... 28:12.92YYNY 111

PRENATAL VITAMINS ................................................... 88:28.01NNYN 208



305





PRIMIDONE ........................................................... 28:12.04YYNY 104

PROCAINAMIDE HCL .................................................... 24:04.00YYNY 60

PROCARBAZINE ........................................................ 10:00.00YYNY 29

PROCHLORPERAZINE .................................................... 28:16.08YYYY 131

PROCYCLIDINE HCL .................................................... 12:08.04YYNY 33

PROGESTERONE ........................................................ 68:32.00YNNY 188

PROPAFENONE HCL ..................................................... 24:04.00YYNY 61

PROPOXYPHENE ........................................................ 28:08.08YYYY 102

PROPOXYPHENE ........................................................ 99:00.98YYNY 223

PROPRANOLOL ......................................................... 24:04.00YYYY 61

PROPYLTHIOURACIL .................................................... 68:36.08YYYY 189

PYDIROXINE HCL ...................................................... 88:08.00YEYN 206

PYRANTEL PAMOATE .................................................... 08:08.00NNYN 1

PYRIDOSTIGMINE BROMIDE .............................................. 12:04.00YNNY 32

PYRIDOXINE HCL ...................................................... 88:08.00YEYN 206

QUETIAPINE .......................................................... 28:16.08YYNY 132

QUINAPRIL HCL ....................................................... 24:08.00YYNY 81

QUINAPRIL/HYDROCHLOROTHIAZIDE ....................................... 24:08.00YYNY 81

RABEPRAZOLE ......................................................... 56:40.00YEYY 169

RALOXIFENE .......................................................... 66:16.12YENY 171

RALOXIFENE .......................................................... 68:16.12YENY 179

RALTEGRAVIR ......................................................... 08:18.08EENY 16

RAMIPRIL ............................................................ 24:04.00YYNY 62

RAMIPRIL/HCTZ ....................................................... 24:04.00YYNY 63

RAMUCIRUMAB ......................................................... 10:00.00EENY 29

RANIBIZUMAB ......................................................... 52:36.00EENY 160

RANITIDINE .......................................................... 56:40.00YNYY 169

RANITIDINE .......................................................... 99:00.98YYNY 223

RANITIDINE .......................................................... 99:15.00YNNY 229

RASAGILINE .......................................................... 28:92.00EENY 146

REGORAFENIB ......................................................... 10:00.00EENY 29

REPAGLINIDE ......................................................... 68:20.92YYNY 186

REPAGLINIDE ......................................................... 68:20.92YYNY 186

RIBAVIRIN ........................................................... 08:18.32EENY 17

RIBAVIRIN/PEGINTERFERON ALFA2A ...................................... 08:18.00EENY 13

RIBAVIRIN/PEGINTERFERON ALFA2B ...................................... 08:18.00EENY 13

RIFABUTIN ........................................................... 08:12.28YENY 11

RIFAMPIN ............................................................ 08:12.28YENY 11

RIFAXIMIN ........................................................... 08:12.28EENY 11

RILPIVIRINE HCL ..................................................... 08:18.08EENY 16

RILUZOLE ............................................................ 28:92.00EENY 147

RILUZOLE ............................................................ 28:92.00EENY 147



306





RIMEXOLONE .......................................................... 52:08.00YNNY 157

RIMEXOLONE .......................................................... 52:08.00YNNY 157

RIOCIGUAT ........................................................... 24:12.92ENNY 87

RISEDRONATE ......................................................... 92:00.00YENY 216

RISEDRONATE SODIUM .................................................. 92:00.00YNNY 216

RISPERIDONE ......................................................... 28:16.08YYNY 133

RITONAVIR ........................................................... 08:18.08YYNY 16

RITUXIMAB ........................................................... 10:00.00EENY 29

RIVAROXABAN ......................................................... 20:12.04EENY 44

RIVASTIGMINE ........................................................ 12:04.00EENY 32

RIZATRIPTAN ......................................................... 12:16.00YNNY 39

ROMIDEPSIN .......................................................... 10:00.00EENY 29

ROPINIROLE .......................................................... 28:92.00YYNY 147

ROSIGLITAZONE ....................................................... 68:20.92EENY 186

ROSUVASTATIN ........................................................ 24:06.00YYNY 69

RUXOLITINIB ......................................................... 10:00.00ENNY 29

SALBUTAMOL (SALBUTAMOL SO4) ......................................... 12:12.00YYYY 37

SALBUTAMOL (SALBUTAMOL SO4) ......................................... 99:00.98YYNY 223

SALMETEROL /FLUTICASONE ............................................. 12:12.00EENY 38

SALMETEROL XINAFOATE ................................................ 12:12.00EENY 38

SAQUINAVIR .......................................................... 08:18.08YYNY 17

SAXAGLIPTIN HCL ..................................................... 68:20.05EENY 180

SAXAGLIPTIN HCL ..................................................... 68:20.05EENY 180

SCOPOLAMINE N-BUTYLBROMIDE .......................................... 99:07.00YNNY 228

SECUKINUMAB ......................................................... 84:92.00EENY 203

SECUKINUMAB ......................................................... 84:92.00EENY 203

SECURA .............................................................. 99:10.00YNNN 228

SELEGILINE HCL ...................................................... 28:92.00YYNY 147

SENNA ............................................................... 99:04.00YNNN 226

SENNA/SOD DIOCT.SULFOSUCCINATE ...................................... 99:04.00YNNN 226

SENNOSIDES .......................................................... 99:04.00YNNN 226

SERTRALINE HYDROCHLORIDE ............................................ 28:16.04YYYY 123

SERTRALINE HYDROCHLORIDE ............................................ 28:16.04YYYY 123

SEVELAMER HYDROCHLORIDE ............................................. 92:00.00EENY 217

SILDENAFIL .......................................................... 24:12.00EENY 86

SILVER SULFADIAZINE ................................................. 84:04.16YNYY 193

SIMEPREVIR .......................................................... 08:18.40EENY 18

SIMVASTATIN ......................................................... 24:06.00YYNY 70

SIROLIMUS ........................................................... 92:00.00YYNY 217

SITAGLIPTIN ......................................................... 68:20.92EENY 186

SITAGLIPTIN/METFORMIN ............................................... 68:20.92EENY 186

SOD CITRATE/SULFOACET/SORBITOL ...................................... 99:04.00YNNN 226



307





SOD PHOSPHATE DI- & MONOBASIC ....................................... 99:04.00YNNN 226

SOD POLYSTYRENE SULFONATE SUSP ...................................... 40:18.00YNNY 149

SODIUM AUROTHIOMALATE ............................................... 60:00.00YYNY 171

SODIUM CHLORIDE ..................................................... 40:12.00YNNN 148

SODIUM CHLORIDE ..................................................... 99:00.98YYNY 223

SODIUM CHLORIDE ..................................................... 99:00.99YYNN 224

SODIUM CHLORIDE NEBS ................................................ 40:12.00YYNN 149

SODIUM CROMOGLYCATE ................................................. 52:36.00YNYY 160

SODIUM CROMOGLYCATE ................................................. 92:00.00YNNY 217

SODIUM DIOCTYL SULFOSUCCINATE ....................................... 99:03.00YNNN 225

SODIUM POLYSTYRENE SULFONATE ........................................ 40:18.00YNNY 149

SODIUM POLYSTYRENE SULFONATE ........................................ 99:00.98YYNY 223

SOFOSBUVIR .......................................................... 08:18.92EENY 18

SOLIFENACIN ......................................................... 86:12.00YNNY 203

SOLIFENACIN ......................................................... 86:12.04YNNY 204

SOMATROPIN .......................................................... 68:28.00NYNY 187

SOTALOL HCL ......................................................... 24:04.00YYNY 63

SPIRONOLAC/HYDROCHLOROTHIAZIDE ...................................... 40:28.00YYNY 151

SPIRONOLACTONE ...................................................... 40:28.10YYYY 151

STAVUDINE ........................................................... 08:18.08YYNY 17

SUCRALFATE .......................................................... 56:40.00YYYY 170

SUFENTANIL .......................................................... 99:01.00YNNY 225

SULFA/TRIMETH(CO-TRIMOXAZOLE) ....................................... 08:40.00YEYY 21

SULFACETAMIDE (SODIUM) .............................................. 52:04.08YNYY 154

SULFACETAMIDE/COLLOIDALSULPHUR ...................................... 84:04.16YNYY 193

SULFACETAMIDE/PREDNISOLONE .......................................... 52:08.00YNYY 157

SULFASALAZINE ....................................................... 56:40.00YYYY 170

SULFINPYRAZONE ...................................................... 40:40.00YYNY 151

SULINDAC ............................................................ 28:08.04YYYY 94

SUMATRIPTAN ......................................................... 12:16.00YNYY 39

SUNITINIB ........................................................... 10:00.00EENY 30

SUNITINIB ........................................................... 10:00.00EENY 30

TACROLIMUS .......................................................... 92:00.00YYNY 217

TACROLIMUS TOPICAL .................................................. 92:00.00EENY 218

TADALAFIL ........................................................... 24:12.00EENY 86

TAMOXIFEN CITRATE ................................................... 10:00.00YYNY 30

TAMSULOSIN HCL ...................................................... 92:00.00YNNY 218

TAZAROTENE .......................................................... 84:36.00NYNY 202

TELAPREVIR .......................................................... 08:18.92EENY 18

TELMISARTAN ......................................................... 24:08.00YYNY 82

TELMISARTAN/AMLODIPINE .............................................. 24:08.00YYNY 82

TELMISARTAN/HCTZ .................................................... 24:08.00YYNY 82



308





TEMAZEPAM ........................................................... 28:24.08YNYY 141

TEMOZOLOMIDE ........................................................ 10:00.00YYNY 30

TENOFOVIR ........................................................... 08:18.08EENY 17

TENOFOVIR/EMTRICITABINE ............................................. 08:18.08EENY 17

TERAZOSIN HCL ....................................................... 24:08.00YYNY 83

TERAZOSIN HCL ....................................................... 24:08.00YYNY 83

TERBINAFINE ......................................................... 08:12.04YEYY 3

TERBINAFINE HCL ..................................................... 84:04.08YNYY 192

TERBUTALINE SULPHATE ................................................ 12:12.00YYYY 38

TERCONAZOLE ......................................................... 84:04.08YNYY 192

TERIFLUNOMIDE ....................................................... 92:00.00EENY 218

TESTOSTERONE CYPIONATE .............................................. 68:08.00YNNY 175

TESTOSTERONE ENANTHATE .............................................. 68:08.00YENY 175

TESTOSTERONE UNDECANOATE ............................................ 68:08.00YNNY 175

TETRABENAZINE ....................................................... 92:00.00YYNY 218

TETRACYCLINE ........................................................ 08:12.24YEYY 10

THEOPHYLLINE (ANHYDROUS) ............................................ 86:16.00YYNY 205

THEOPHYLLINE (ANHYDROUS) ............................................ 86:16.00YYNY 205

THIOTHIXENE ......................................................... 28:16.08YYNY 136

THYROTROPIN ......................................................... 68:60.00YYNY 189

TIAPROFENIC ACID .................................................... 28:08.04YYYY 94

TICAGRELOR .......................................................... 20:12.18EENY 46

TICLOPIDINE HCL ..................................................... 20:24.00YYNY 48

TIMOLOL MALEATE ..................................................... 24:04.00YYNY 64




TIMOLOL/TRAVOPROST .................................................. 52:36.00YYNY 161

TINZAPARIN .......................................................... 20:12.04YENY 44

TIOTROPIUM .......................................................... 12:08.08EENY 35

TIZANIDINE .......................................................... 92:00.00YYNY 218

TOBRAMYCIN .......................................................... 08:12.02EENY 2

TOBRAMYCIN .......................................................... 52:04.04YNYY 154

TOBRAMYCIN .......................................................... 52:04.04YNYY 154

TOBRAMYCIN SULFATE .................................................. 08:12.02EENY 2

TOBRAMYCIN/DEXAMETHASONE ............................................ 52:08.00YNYY 157

TOCILIZUMAB ......................................................... 92:00.00EENY 218

TOFACITINIB ......................................................... 92:36.00EENY 219

TOLBUTAMIDE ......................................................... 68:20.20YYNY 183

TOLTERODINE ......................................................... 86:12.00YNNY 204

TOLTERODINE ......................................................... 86:12.00YNNY 204

TOPIRAMATE .......................................................... 28:12.92YYNY 112



309





TRAMETINIB .......................................................... 10:00.00EENY 30

TRANDOLAPRIL ........................................................ 24:08.00YYNY 83

TRANEXAMIC ACID ..................................................... 92:00.00YNNY 219

TRANEXAMIC ACID ..................................................... 92:00.00YNNY 219

TRANYLCYPROMINE SO4 ................................................. 28:16.04YYYY 123

TRASTUZUMAB EMTANSINE ............................................... 10:00.00EENY 31

TRASTUZUMAB EMTANSINE ............................................... 10:00.00EENY 31

TRAVOPROST .......................................................... 52:36.00YYNY 161

TRAZODONE ........................................................... 28:16.04YYYY 123

TRETINOIN ........................................................... 84:16.00NNYY 199

TRIAMCINOLONE ....................................................... 68:04.00YYYY 174

TRIAMCINOLONE ACETONIDE ............................................. 52:08.00YNYY 157

TRIAMCINOLONE ACETONIDE ............................................. 68:04.00YYYY 175



TRIAMTERENE/HYDROCHLOROTHIAZID ...................................... 24:08.00YYNY 84

TRIAMTERENE/HYDROCHLOROTHIAZID ...................................... 24:08.00YYNY 84

TRIAZOLAM ........................................................... 28:24.08YNYY 142

TRIFLUOPERAZINE ..................................................... 28:16.08YYNY 136

TRIFLURIDINE ........................................................ 52:04.06YNYY 154

TRIHEXYPHENIDYL HCL ................................................. 12:08.04YYNY 33

TRIMEBUTINE MALEATE ................................................. 12:08.08YNYY 35

TRIMEPRAZINE TARTRATE ............................................... 04:00.00YNYY 1

TRIMETHOPRIM ........................................................ 08:36.00YEYY 21

TRIMIPRAMINE ........................................................ 28:16.04YYYY 124

TRYPTOPHAN .......................................................... 28:16.04YYNY 124

UMECLIDINIUM ........................................................ 12:08.08EENY 36

UMECLIDINIUM ........................................................ 12:08.08EENY 36

UMECLIDINIUM/VILANTEROL ............................................. 12:12.00EENY 38

URSODIOL ............................................................ 56:14.00YYNY 162

USTEKINUMAB ......................................................... 92:00.00EENY 219

VALACYCLOVIR ........................................................ 08:18.00YEYY 13

VALGANCICLOVIR ...................................................... 08:18.00EENY 13

VALGANCICLOVIR ...................................................... 92:00.00EENY 219

VALPROIC ACID ....................................................... 28:12.92YYNY 114

VALPROIC ACID ....................................................... 28:12.92YYNY 114

VALSARTAN ........................................................... 24:08.00YYNY 84

VALSARTAN/HYDROCHLOROTHIAZIDE ....................................... 24:08.00YYNY 84

VANCOMYCIN HCL ...................................................... 08:12.28YENY 11

VARENICLINE ......................................................... 12:92.00YNNY 42

VENLAFAXINE HYDROCHLORIDE ........................................... 28:16.04YYYY 125

VENLAFAXINE HYDROCHLORIDE ........................................... 28:16.04YYYY 125



310





VENLAFAXINE HYDRPCHLORIDE ........................................... 28:16.04YYYY 125

VERAPAMIL HCL ....................................................... 24:04.00YYYY 64

VIGABATRIN .......................................................... 28:12.92YYNY 114

VISMODEGIB .......................................................... 10:00.00EENY 31

VITAMIN B COMPLEX &VITAMIN C ........................................ 88:08.08EENN 207

VITAMIN B12 ......................................................... 88:08.00YENN 206

VITAMIN D ........................................................... 88:16.00YNNY 207

VITAMIN D ........................................................... 99:00.99YYNN 224

VORICONAZOLE ........................................................ 08:12.04EENY 3

WARFARIN ............................................................ 20:12.04YYYY 45

ZAFIRLUKAST ......................................................... 92:00.00EENY 219

ZIDOVUDINE .......................................................... 08:18.08YYNY 17

ZIPRASIDONE ......................................................... 28:16.08YYNY 136

ZOLEDRONIC ACID ..................................................... 92:00.00EENY 219

ZOLMITRIPTAN ........................................................ 12:16.00YNYY 40

ZOPICLONE ........................................................... 28:24.08YNYY 142

ZOPICLONE ........................................................... 99:00.98YYNY 223

ZUCLOPENTHIXOL ACETATE .............................................. 28:16.08YYNY 136

ZUCLOPENTHIXOL DECANOATE ............................................ 28:16.08YYNY 137

ZUCLOPENTHIXOL DECANOATE ............................................ 28:16.08YYNY 137

ZUCLOPENTHIXOL DIHYDROCHLORIDE ...................................... 28:16.08YYNY 137



311



Documents

YUKON DRUG PROGRAMS FORMULARY · 0076872 apo-cephalex apx 0.23 /tb y e y y 0058341 novo-lexin nop 0.23 /tb y e y y 50mg/ml 0034209 novo-lexin susp nop 0.35 /ml y e y y 500mg 0034211