20 core formulary effective 01/01/2020

2020

January 2020 Southern Scripts – Core Formulary 1 | P a g e

2020 Core Formulary Effective 01/01/2020

This Core Formulary list includes common FDA-approved generic (Tier 1) and brand preferred (Tier 2) drugs within select therapeutic categories. Brand drugs not identified on this list as generic or brand preferred are designated as non-preferred brands (Tier 3). This Core Formulary list is not a complete list of medications, nor may be covered by your plan. Please refer to your benefit plan documents provided by your employer or plan sponsors for benefit coverage and restrictions.

The Core Formulary list is revised periodically as new drugs and new prescribing information becomes available and may change at any time during the year. You may receive notice when necessary. To get updated formulary information covered by your plan, please contact us at 1-800-710-9341.

RESTRICTIONS/LIMITATIONS

Southern Scripts incorporates drug utilization management programs such as prior authorization, step therapy and quantity limits. Some covered generics and brand medications may enforce these coverage restrictions or limitations.

Prior Authorization (PA): it is a program that promotes the use of safe, effective and reasonably-priced drug therapy. This ensures the member has met specific criteria based on the most current evidence-based medical literature and prescription drugs are prescribed appropriately and are medically necessary. Your healthcare provider is required to provide additional medical information to determine coverage. If your prior authorization is denied, please consult with your healthcare provider if the alternative, preferred drug therapy is appropriate for you.

Step Therapy (ST): it is a program that requires members to initially try preferred, medically proven and less expensive prescription drugs before “stepping up” to more expensive drugs. The goal of step therapy is to control costs and to save dollars for both member and plan. Step Therapy is an automatic process in our system, however, some costly, step therapy drugs will require a prior authorization.

Quantity Limit (QL): it is a program that ensures the drug is prescribed correctly and safely. Generics and Brands may be limited to a certain quantity per month or over a specific amount of time. We use FDA-approved recommendations and clinical guidelines to set our quantity limits. A prior authorization will be required if the drug is beyond our quantity limit and will require documentation as to why you need to exceed the quantity limit.

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January 2020 Southern Scripts – Core Formulary 2 | P a g e

HOW TO USE THIS FORMULARY

Core Formulary is organized by:

DRUG GROUP DRUG CLASS

DRUG NAME, FORM AND STRENGTH

TIER INFORMATION Note: Some benefits may require a deductible be met before copays apply. Please refer to your benefit plan documents for additional information.

Generics (Tier 1)- $

Generics are shown in lower-case and boldface type. They are as safe and effective as brands at a reduced cost. Not all generics may be included in the Core Formulary. Some generics are followed by a reference brand drug in (parentheses). The reference brand drug is not classified as a generic, rather the intent is for completion purposes. Specialty Generics are listed as generics and are subject to a specialty generic copay. Restrictions/Limitations (PA, ST, QL) may apply.

Brand Preferred (Tier 2) - $$

Brand-Preferred Drugs are shown in UPPERCASE. They are a higher cost than generics. Not all brand preferred drugs may be included in the Core Formulary. Specialty brand preferred drugs are listed as brand preferred and are subject to a specialty brand preferred copay. Restrictions/Limitations (PA, ST, QL) may apply.

ABBREVIATION/ACRONYM KEY:

caps- capsules inhal- inhalation sa – sustained action chew – chewable inj- injection sl – sublingual conc- concentrate liq- liquid soln – solution

CR- controlled release lotn- lotion SR- sustained release DR – delayed release nebu- nebulizer suppos – suppositories

EC- enteric coated ODT- orally disintegrating tablet susp – suspension effe- effervescent oint- ointment tab – tablets equiv- equivalent osm- osmotic release td - transdermal

ER- extended release powd - powder

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Drug Name

ANTI-INFECTIVE AGENTSPENICILLINSAMOXICILLIN – amoxicillin (trihydrate) chew tab 125 mgAMOXICILLIN – amoxicillin (trihydrate) chew tab 250 mgamoxicillin (trihydrate) cap 250 mgamoxicillin (trihydrate) cap 500 mgamoxicillin (trihydrate) for susp 125 mg/5mlamoxicillin (trihydrate) for susp 200 mg/5mlamoxicillin (trihydrate) for susp 250 mg/5mlamoxicillin (trihydrate) for susp 400 mg/5mlamoxicillin (trihydrate) tab 500 mgamoxicillin (trihydrate) tab 875 mgamoxicillin & k clavulanate for susp 200-28.5 mg/5mlamoxicillin & k clavulanate for susp 250-62.5 mg/5ml

(Augmentin)amoxicillin & k clavulanate for susp 400-57 mg/5mlamoxicillin & k clavulanate for susp 600-42.9 mg/5ml

(Augmentin es-600)amoxicillin & k clavulanate tab 250-125 mgamoxicillin & k clavulanate tab 500-125 mg

(Augmentin)amoxicillin & k clavulanate tab 875-125 mg

(Augmentin)AMOXICILLIN/CLAVULANATE P – amoxicillin & k

clavulanate tab er 12hr 1000-62.5 mgAMOXICILLIN/CLAVULANATE P – amoxicillin & k

clavulanate chew tab 200-28.5 mgAMOXICILLIN/CLAVULANATE P – amoxicillin & k

clavulanate chew tab 400-57 mgAMPICILLIN – ampicillin cap 500 mgAUGMENTIN – amoxicillin & k clavulanate for susp

125-31.25 mg/5mldicloxacillin sodium cap 250 mgdicloxacillin sodium cap 500 mgPENICILLIN V POTASSIUM – penicillin v potassium for

soln 125 mg/5mlPENICILLIN V POTASSIUM – penicillin v potassium for

soln 250 mg/5mlpenicillin v potassium tab 250 mgpenicillin v potassium tab 500 mgCEPHALOSPORINScefaclor cap 250 mg

Drug Name

cefaclor cap 500 mgcefadroxil cap 500 mgcefadroxil for susp 250 mg/5mlcefadroxil for susp 500 mg/5mlcefadroxil tab 1 gmcefdinir cap 300 mgcefdinir for susp 125 mg/5mlcefdinir for susp 250 mg/5mlcefixime cap 400 mg (Suprax)cefixime for susp 100 mg/5ml (Suprax)cefixime for susp 200 mg/5ml (Suprax)cefpodoxime proxetil for susp 50 mg/5mlcefpodoxime proxetil for susp 100 mg/5mlcefpodoxime proxetil tab 100 mgcefpodoxime proxetil tab 200 mgcefprozil for susp 125 mg/5mlcefprozil for susp 250 mg/5mlcefprozil tab 250 mgcefprozil tab 500 mgceftriaxone sodium for inj 250 mgceftriaxone sodium for inj 500 mg (Rocephin)ceftriaxone sodium for inj 1 gm (Rocephin)ceftriaxone sodium for inj 2 gmcefuroxime axetil tab 250 mg (Ceftin)cefuroxime axetil tab 500 mg (Ceftin)cephalexin cap 250 mg (Keflex)cephalexin cap 500 mg (Keflex)cephalexin for susp 125 mg/5mlcephalexin for susp 250 mg/5mlSUPRAX – cefixime for susp 500 mg/5mlSUPRAX – cefixime chew tab 100 mgSUPRAX – cefixime chew tab 200 mgMACROLIDESAZITHROMYCIN – azithromycin powd pack for susp 1

gmazithromycin for susp 100 mg/5ml (Zithromax)azithromycin for susp 200 mg/5ml (Zithromax)azithromycin tab 250 mg (Zithromax)azithromycin tab 500 mg (Zithromax)azithromycin tab 600 mg (Zithromax)

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Drug Name

CLARITHROMYCIN – clarithromycin for susp 125mg/5ml

CLARITHROMYCIN – clarithromycin for susp 250mg/5ml

clarithromycin tab er 24hr 500 mgclarithromycin tab 250 mg (Biaxin)clarithromycin tab 500 mg (Biaxin)TETRACYCLINESdemeclocycline hcl tab 150 mgdemeclocycline hcl tab 300 mgdoxycycline hyclate cap 50 mgdoxycycline hyclate cap 100 mg (Vibramycin)doxycycline hyclate tab 20 mgdoxycycline hyclate tab 100 mgdoxycycline monohydrate cap 50 mgdoxycycline monohydrate cap 75 mg (Monodox)doxycycline monohydrate cap 100 mg (Monodox)doxycycline monohydrate cap 150 mg (Adoxa)doxycycline monohydrate tab 50 mg (Adoxa)doxycycline monohydrate tab 75 mg (Adoxa)doxycycline monohydrate tab 100 mg (Adoxa pak

1/100)doxycycline monohydrate tab 150 mg (Adoxa pak

1/150)minocycline hcl cap 50 mg (Minocin)minocycline hcl cap 75 mg (Minocin)minocycline hcl cap 100 mg (Minocin)minocycline hcl tab 50 mgminocycline hcl tab 75 mgminocycline hcl tab 100 mgtetracycline hcl cap 250 mg (Tetracycline hcl)tetracycline hcl cap 500 mg (Tetracycline hcl)FLUOROQUINOLONESciprofloxacin for oral susp 500 mg/5ml (10%)

(10 gm/100ml) (Cipro)CIPROFLOXACIN HCL – ciprofloxacin hcl tab 100 mg

(base equiv)ciprofloxacin hcl tab 250 mg (base equiv) (Cipro)ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)ciprofloxacin hcl tab 750 mg (base equiv)levofloxacin oral soln 25 mg/ml (Levaquin)

Drug Name

levofloxacin tab 250 mg (Levaquin)levofloxacin tab 500 mg (Levaquin)levofloxacin tab 750 mg (Levaquin)ofloxacin tab 400 mgAMINOGLYCOSIDESneomycin sulfate tab 500 mgparomomycin sulfate cap 250 mgtobramycin nebu soln 300 mg/5ml (Tobi)SULFADIAZINE – sulfadiazine tab 500 mgANTIMYCOBACTERIAL AGENTSethambutol hcl tab 100 mg (Myambutol)ethambutol hcl tab 400 mg (Myambutol)ISONIAZID – isoniazid syrup 50 mg/5mlisoniazid tab 100 mgisoniazid tab 300 mgPRIFTIN – rifapentine tab 150 mgpyrazinamide tab 500 mgrifabutin cap 150 mg (Mycobutin)rifampin cap 150 mg (Rifadin)rifampin cap 300 mg (Rifadin)ANTIFUNGALSfluconazole for susp 10 mg/ml (Diflucan)fluconazole for susp 40 mg/ml (Diflucan)fluconazole tab 50 mg (Diflucan)fluconazole tab 100 mg (Diflucan)fluconazole tab 150 mg (Diflucan)fluconazole tab 200 mg (Diflucan)flucytosine cap 250 mg (Ancobon)flucytosine cap 500 mg (Ancobon)griseofulvin microsize susp 125 mg/5mlgriseofulvin microsize tab 500 mg (Grifulvin v)itraconazole cap 100 mg (Sporanox)itraconazole oral soln 10 mg/ml (Sporanox)NOXAFIL – posaconazole tab delayed release 100 mgNOXAFIL – posaconazole susp 40 mg/mlnystatin tab 500000 unitposaconazole tab delayed release 100 mg (Noxafil)terbinafine hcl tab 250 mg (Lamisil)voriconazole for susp 40 mg/ml (Vfend)

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Drug Name

voriconazole tab 50 mg (Vfend)voriconazole tab 200 mg (Vfend)ANTIVIRALSabacavir sulfate soln 20 mg/ml (base equiv) (Ziagen)abacavir sulfate tab 300 mg (base equiv) (Ziagen)abacavir sulfate-lamivudine tab 600-300 mg (Epzicom)abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg (Trizivir)acyclovir cap 200 mg (Zovirax)acyclovir susp 200 mg/5ml (Zovirax)acyclovir tab 400 mg (Zovirax)acyclovir tab 800 mg (Zovirax)adefovir dipivoxil tab 10 mg (Hepsera)atazanavir sulfate cap 150 mg (base equiv) (Reyataz)atazanavir sulfate cap 200 mg (base equiv) (Reyataz)atazanavir sulfate cap 300 mg (base equiv) (Reyataz)ATRIPLA – efavirenz-emtricitabine-tenofovir df tab

600-200-300 mgBARACLUDE – entecavir oral soln 0.05 mg/mlBIKTARVY – bictegravir-emtricitabine-tenofovir af tab

50-200-25 mgCIMDUO – lamivudine-tenofovir disoproxil fumarate tab

300-300 mgDELSTRIGO – doravirine-lamivudine-tenofovir df tab

100-300-300 mgDESCOVY – emtricitabine-tenofovir alafenamide

fumarate tab 200-25 mgDIDANOSINE – didanosine delayed release capsule 400

mgdidanosine delayed release capsule 200 mg (Videx ec)didanosine delayed release capsule 250 mg (Videx ec)efavirenz cap 50 mg (Sustiva)efavirenz cap 200 mg (Sustiva)efavirenz tab 600 mg (Sustiva)entecavir tab 0.5 mg (Baraclude)entecavir tab 1 mg (Baraclude)EPCLUSA – sofosbuvir-velpatasvir tab 400-100 mgEPIVIR HBV – lamivudine oral soln 5 mg/ml (hbv)EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg

(base equiv)famciclovir tab 125 mg (Famvir)famciclovir tab 250 mg (Famvir)

Drug Name

famciclovir tab 500 mg (Famvir)GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab

150-150-200-10 mgHARVONI – ledipasvir-sofosbuvir tab 45-200 mgHARVONI – ledipasvir-sofosbuvir tab 90-400 mgINTELENCE – etravirine tab 25 mgINTELENCE – etravirine tab 100 mgINTELENCE – etravirine tab 200 mgISENTRESS – raltegravir potassium packet for susp 100

mg (base equiv)ISENTRESS – raltegravir potassium tab 400 mg (base

equiv)ISENTRESS – raltegravir potassium chew tab 25 mg

(base equiv)ISENTRESS – raltegravir potassium chew tab 100 mg

(base equiv)ISENTRESS HD – raltegravir potassium tab 600 mg

(base equiv)KALETRA – lopinavir-ritonavir tab 100-25 mgKALETRA – lopinavir-ritonavir tab 200-50 mglamivudine oral soln 10 mg/ml (Epivir)lamivudine tab 100 mg (hbv) (Epivir hbv)lamivudine tab 150 mg (Epivir)lamivudine tab 300 mg (Epivir)lamivudine-zidovudine tab 150-300 mg (Combivir)LEDIPASVIR/SOFOSBUVIR – ledipasvir-sofosbuvir tab

90-400 mglopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)

(Kaletra)MAVYRET – glecaprevir-pibrentasvir tab 100-40 mgnevirapine susp 50 mg/5ml (Viramune)nevirapine tab er 24hr 100 mg (Viramune xr)nevirapine tab er 24hr 400 mg (Viramune xr)nevirapine tab 200 mg (Viramune)NORVIR – ritonavir oral soln 80 mg/mlNORVIR – ritonavir powder packet 100 mgODEFSEY – emtricitabine-rilpivirine-tenofovir af tab

200-25-25 mgoseltamivir phosphate cap 30 mg (base equiv)

(Tamiflu)oseltamivir phosphate cap 45 mg (base equiv)

(Tamiflu)

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Drug Name

oseltamivir phosphate cap 75 mg (base equiv)(Tamiflu)

oseltamivir phosphate for susp 6 mg/ml (base equiv)(Tamiflu)

PEGASYS – peginterferon alfa-2a inj 180 mcg/mlPEGASYS – peginterferon alfa-2a inj 180 mcg/0.5mlPEGASYS PROCLICK – peginterferon alfa-2a inj 180

mcg/0.5mlPREZCOBIX – darunavir-cobicistat tab 800-150 mgPREZISTA – darunavir ethanolate susp 100 mg/ml (base

equiv)PREZISTA – darunavir ethanolate tab 75 mg (base




equiv)ribavirin cap 200 mg (Rebetol)ribavirin tab 200 mg (Copegus)ritonavir tab 100 mg (Norvir)SOFOSBUVIR/VELPATASVIR – sofosbuvir-velpatasvir

tab 400-100 mgSOVALDI – sofosbuvir tab 200 mgSOVALDI – sofosbuvir tab 400 mgstavudine cap 15 mg (Zerit)stavudine cap 20 mg (Zerit)stavudine cap 30 mg (Zerit)stavudine cap 40 mg (Zerit)SYMFI – efavirenz-lamivudine-tenofovir df tab

600-300-300 mgSYMFI LO – efavirenz-lamivudine-tenofovir df tab

400-300-300 mgtenofovir disoproxil fumarate tab 300 mg (Viread)TIVICAY – dolutegravir sodium tab 10 mg (base equiv)TIVICAY – dolutegravir sodium tab 25 mg (base equiv)TIVICAY – dolutegravir sodium tab 50 mg (base equiv)TRIUMEQ – abacavir-dolutegravir-lamivudine tab

600-50-300 mgTRUVADA – emtricitabine-tenofovir disoproxil fumarate

tab 100-150 mg

Drug Name

TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 133-200 mg



valacyclovir hcl tab 500 mg (Valtrex)valacyclovir hcl tab 1 gm (Valtrex)valganciclovir hcl for soln 50 mg/ml (base equiv)

(Valcyte)valganciclovir hcl tab 450 mg (base equivalent)

(Valcyte)VIDEX – didanosine for soln 2 gmVIREAD – tenofovir disoproxil fumarate oral powder 40

mg/gmVIREAD – tenofovir disoproxil fumarate tab 150 mgVIREAD – tenofovir disoproxil fumarate tab 200 mgVIREAD – tenofovir disoproxil fumarate tab 250 mgVOSEVI – sofosbuvir-velpatasvir-voxilaprevir tab

400-100-100 mgzidovudine cap 100 mg (Retrovir)zidovudine syrup 10 mg/ml (Retrovir)zidovudine tab 300 mgANTIMALARIALSatovaquone-proguanil hcl tab 62.5-25 mg (Malarone)atovaquone-proguanil hcl tab 250-100 mg (Malarone)CHLOROQUINE PHOSPHATE – chloroquine phosphate

tab 250 mgchloroquine phosphate tab 500 mg (Aralen)COARTEM – artemether-lumefantrine tab 20-120 mgDARAPRIM – pyrimethamine tab 25 mghydroxychloroquine sulfate tab 200 mg (Plaquenil)MEFLOQUINE HCL – mefloquine hcl tab 250 mgprimaquine phosphate tab 26.3 mg (15 mg base)

(Primaquine phosphate)ANTHELMINTICSalbendazole tab 200 mg (Albenza)BENZNIDAZOLE – benznidazole tab 12.5 mgBENZNIDAZOLE – benznidazole tab 100 mgivermectin tab 3 mg (Stromectol)praziquantel tab 600 mg (Biltricide)ANTI-INFECTIVE AGENTS - MISC.

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Drug Name

ALINIA – nitazoxanide tab 500 mgALINIA – nitazoxanide for susp 100 mg/5mlclindamycin hcl cap 75 mg (Cleocin)clindamycin hcl cap 150 mg (Cleocin)clindamycin hcl cap 300 mg (Cleocin)clindamycin palmitate hcl for soln 75 mg/5ml (base

equiv) (Cleocin pediatric gr)dapsone tab 25 mgdapsone tab 100 mgIMPAVIDO – miltefosine cap 50 mglinezolid for susp 100 mg/5ml (Zyvox)linezolid tab 600 mg (Zyvox)metronidazole tab 250 mg (Flagyl)metronidazole tab 500 mg (Flagyl)NEBUPENT – pentamidine isethionate for nebulization

soln 300 mgSIVEXTRO – tedizolid phosphate tab 200 mgsulfamethoxazole-trimethoprim susp 200-40 mg/5mlsulfamethoxazole-trimethoprim tab 400-80 mg

(Bactrim)sulfamethoxazole-trimethoprim tab 800-160 mg

(Bactrim ds)trimethoprim tab 100 mgvancomycin hcl cap 125 mg (base equivalent)

(Vancocin hcl)vancomycin hcl cap 250 mg (base equivalent)

(Vancocin hcl)XIFAXAN – rifaximin tab 550 mgBIOLOGICALSPASSIVE IMMUNIZING AGENTSSYNAGIS – palivizumab im soln 50 mg/0.5mlSYNAGIS – palivizumab im soln 100 mg/mlANTINEOPLASTIC AGENTSANTINEOPLASTICSabiraterone acetate tab 250 mg (Zytiga)ACTIMMUNE – interferon gamma-1b inj 100 mcg/0.5ml

(2000000 unit/0.5ml)AFINITOR – everolimus tab 2.5 mgAFINITOR – everolimus tab 5 mgAFINITOR – everolimus tab 7.5 mgAFINITOR – everolimus tab 10 mg

Drug Name

AFINITOR DISPERZ – everolimus tab for oral susp 2 mgAFINITOR DISPERZ – everolimus tab for oral susp 3 mgAFINITOR DISPERZ – everolimus tab for oral susp 5 mgALECENSA – alectinib hcl cap 150 mg (base equivalent)ALUNBRIG – brigatinib tab initiation therapy pack 90 mg

& 180 mgALUNBRIG – brigatinib tab 30 mgALUNBRIG – brigatinib tab 90 mgALUNBRIG – brigatinib tab 180 mganastrozole tab 1 mg (Arimidex)bexarotene cap 75 mg (Targretin)bicalutamide tab 50 mg (Casodex)BOSULIF – bosutinib tab 100 mgBOSULIF – bosutinib tab 400 mgBOSULIF – bosutinib tab 500 mgcapecitabine tab 150 mg (Xeloda)capecitabine tab 500 mg (Xeloda)CAPRELSA – vandetanib tab 100 mgCAPRELSA – vandetanib tab 300 mgCOMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60

mg dose) kitCOMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 1 x 20

mg (100 dose) kitCOMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 3 x 20

mg (140 dose) kitCOTELLIC – cobimetinib fumarate tab 20 mg (base

equivalent)cyclophosphamide cap 25 mg (Cyclophosphamide)cyclophosphamide cap 50 mg (Cyclophosphamide)EMCYT – estramustine phosphate sodium cap 140 mgERIVEDGE – vismodegib cap 150 mgERLEADA – apalutamide tab 60 mgerlotinib hcl tab 25 mg (base equivalent) (Tarceva)erlotinib hcl tab 100 mg (base equivalent) (Tarceva)erlotinib hcl tab 150 mg (base equivalent) (Tarceva)ETOPOSIDE – etoposide cap 50 mgexemestane tab 25 mg (Aromasin)FARYDAK – panobinostat lactate cap 10 mg (base

equivalent)FARYDAK – panobinostat lactate cap 15 mg (base

equivalent)

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Drug Name

FARYDAK – panobinostat lactate cap 20 mg (baseequivalent)

flutamide cap 125 mgGILOTRIF – afatinib dimaleate tab 20 mg (base

equivalent)GILOTRIF – afatinib dimaleate tab 30 mg (base

equivalent)GILOTRIF – afatinib dimaleate tab 40 mg (base

equivalent)GLEOSTINE – lomustine cap 10 mgGLEOSTINE – lomustine cap 40 mgGLEOSTINE – lomustine cap 100 mgHYCAMTIN – topotecan hcl cap 0.25 mg (base equiv)HYCAMTIN – topotecan hcl cap 1 mg (base equiv)hydroxyurea cap 500 mg (Hydrea)IBRANCE – palbociclib cap 75 mgIBRANCE – palbociclib cap 100 mgIBRANCE – palbociclib cap 125 mgICLUSIG – ponatinib hcl tab 15 mg (base equiv)ICLUSIG – ponatinib hcl tab 45 mg (base equiv)imatinib mesylate tab 100 mg (base equivalent)

(Gleevec)imatinib mesylate tab 400 mg (base equivalent)

(Gleevec)IMBRUVICA – ibrutinib cap 70 mgIMBRUVICA – ibrutinib cap 140 mgIMBRUVICA – ibrutinib tab 140 mgIMBRUVICA – ibrutinib tab 280 mgIMBRUVICA – ibrutinib tab 420 mgIMBRUVICA – ibrutinib tab 560 mgINLYTA – axitinib tab 1 mgINLYTA – axitinib tab 5 mgIRESSA – gefitinib tab 250 mgJAKAFI – ruxolitinib phosphate tab 5 mg (base

equivalent)JAKAFI – ruxolitinib phosphate tab 10 mg (base



equivalent)

Drug Name

JAKAFI – ruxolitinib phosphate tab 25 mg (baseequivalent)

KISQALI – ribociclib succinate tab pack 200 mg dailydose

KISQALI – ribociclib succinate tab pack 400 mg dailydose (200 mg tab)

KISQALI – ribociclib succinate tab pack 600 mg dailydose (200 mg tab)

KISQALI FEMARA 200 DOSE – ribociclib 200 mg dose(200 mg tab) & letrozole 2.5 mg tbpk



LENVIMA 10 MG DAILY DOSE – lenvatinib cap therapypack 10 mg (10 mg daily dose)

LENVIMA 12MG DAILY DOSE – lenvatinib cap therapypack 4 (3) mg (12 mg daily dose)

LENVIMA 14 MG DAILY DOSE – lenvatinib cap therapypack 10 & 4 mg (14 mg daily dose)

LENVIMA 18 MG DAILY DOSE – lenvatinib cap therapypack 10 & 4 (2) mg (18 mg daily dose)

LENVIMA 20 MG DAILY DOSE – lenvatinib cap therapypack 10 (2) mg (20 mg daily dose)

LENVIMA 24 MG DAILY DOSE – lenvatinib cap therapypack 10 (2) & 4 mg (24 mg daily dose)

LENVIMA 4 MG DAILY DOSE – lenvatinib cap therapypack 4 mg (4 mg daily dose)

LENVIMA 8 MG DAILY DOSE – lenvatinib cap therapypack 4 (2) mg (8 mg daily dose)

letrozole tab 2.5 mg (Femara)LEUCOVORIN CALCIUM – leucovorin calcium tab 10 mgLEUCOVORIN CALCIUM – leucovorin calcium tab 15 mgleucovorin calcium tab 5 mgleucovorin calcium tab 25 mgLEUKERAN – chlorambucil tab 2 mgLONSURF – trifluridine-tipiracil tab 15-6.14 mgLONSURF – trifluridine-tipiracil tab 20-8.19 mgLYNPARZA – olaparib tab 100 mgLYNPARZA – olaparib tab 150 mgLYSODREN – mitotane tab 500 mgMATULANE – procarbazine hcl cap 50 mgmegestrol acetate susp 40 mg/ml (Megace oral)

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Drug Name

megestrol acetate tab 20 mgmegestrol acetate tab 40 mgMEKINIST – trametinib dimethyl sulfoxide tab 0.5 mg

(base equivalent)MEKINIST – trametinib dimethyl sulfoxide tab 2 mg (base

equivalent)melphalan tab 2 mg (Alkeran)mercaptopurine tab 50 mg (Purinethol)MESNEX – mesna tab 400 mgmethotrexate sodium tab 2.5 mg (base equiv)MYLERAN – busulfan tab 2 mgNEXAVAR – sorafenib tosylate tab 200 mg (base

equivalent)nilutamide tab 150 mg (Nilandron)NINLARO – ixazomib citrate cap 2.3 mg (base

equivalent)NINLARO – ixazomib citrate cap 3 mg (base equivalent)NINLARO – ixazomib citrate cap 4 mg (base equivalent)ODOMZO – sonidegib phosphate cap 200 mg (base

equivalent)PIQRAY 200MG DAILY DOSE – alpelisib tab therapy

pack 200 mg daily dosePIQRAY 250MG DAILY DOSE – alpelisib tab pack 250

mg daily dose (200 mg & 50 mg tabs)PIQRAY 300MG DAILY DOSE – alpelisib tab pack 300

mg daily dose (2x150 mg tab)POMALYST – pomalidomide cap 1 mgPOMALYST – pomalidomide cap 2 mgPOMALYST – pomalidomide cap 3 mgPOMALYST – pomalidomide cap 4 mgPURIXAN – mercaptopurine susp 2000 mg/100ml (20

mg/ml)RYDAPT – midostaurin cap 25 mgSOLTAMOX – tamoxifen citrate oral soln 10 mg/5ml

(base equivalent)SPRYCEL – dasatinib tab 20 mgSPRYCEL – dasatinib tab 50 mgSPRYCEL – dasatinib tab 70 mgSPRYCEL – dasatinib tab 80 mgSPRYCEL – dasatinib tab 100 mgSPRYCEL – dasatinib tab 140 mgSTIVARGA – regorafenib tab 40 mg

Drug Name

SUTENT – sunitinib malate cap 12.5 mg (baseequivalent)

SUTENT – sunitinib malate cap 25 mg (base equivalent)SUTENT – sunitinib malate cap 37.5 mg (base

equivalent)SUTENT – sunitinib malate cap 50 mg (base equivalent)SYLATRON – peginterferon alfa-2b for inj kit 200 mcgSYLATRON – peginterferon alfa-2b for inj kit 300 mcgSYLATRON – peginterferon alfa-2b for inj kit 600 mcgTABLOID – thioguanine tab 40 mgTAFINLAR – dabrafenib mesylate cap 50 mg (base

equivalent)TAFINLAR – dabrafenib mesylate cap 75 mg (base

equivalent)TAGRISSO – osimertinib mesylate tab 40 mg (base

equivalent)TAGRISSO – osimertinib mesylate tab 80 mg (base

equivalent)tamoxifen citrate tab 10 mg (base equivalent)tamoxifen citrate tab 20 mg (base equivalent)TASIGNA – nilotinib hcl cap 50 mg (base equivalent)TASIGNA – nilotinib hcl cap 150 mg (base equivalent)TASIGNA – nilotinib hcl cap 200 mg (base equivalent)temozolomide cap 5 mg (Temodar)temozolomide cap 20 mg (Temodar)temozolomide cap 100 mg (Temodar)temozolomide cap 140 mg (Temodar)temozolomide cap 180 mg (Temodar)temozolomide cap 250 mg (Temodar)toremifene citrate tab 60 mg (base equivalent)

(Fareston)tretinoin cap 10 mgTYKERB – lapatinib ditosylate tab 250 mg (base equiv)VENCLEXTA – venetoclax tab 10 mgVENCLEXTA – venetoclax tab 50 mgVENCLEXTA – venetoclax tab 100 mgVENCLEXTA STARTING PACK – venetoclax tab therapy

starter pack 10 & 50 & 100 mgVERZENIO – abemaciclib tab 50 mgVERZENIO – abemaciclib tab 100 mgVERZENIO – abemaciclib tab 150 mgVERZENIO – abemaciclib tab 200 mg

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January 2020 8

Drug Name

VITRAKVI – larotrectinib sulfate oral soln 20 mg/ml (baseequivalent)

VITRAKVI – larotrectinib sulfate cap 25 mg (baseequivalent)

VITRAKVI – larotrectinib sulfate cap 100 mg (baseequivalent)

VOTRIENT – pazopanib hcl tab 200 mg (base equiv)XALKORI – crizotinib cap 200 mgXALKORI – crizotinib cap 250 mgXTANDI – enzalutamide cap 40 mgYONSA – abiraterone acetate tab 125 mgZELBORAF – vemurafenib tab 240 mgZOLINZA – vorinostat cap 100 mgZYDELIG – idelalisib tab 100 mgZYDELIG – idelalisib tab 150 mgZYKADIA – ceritinib tab 150 mgZYTIGA – abiraterone acetate tab 500 mgENDOCRINE AND METABOLIC DRUGSCORTICOSTEROIDSbudesonide delayed release particles cap 3 mg

(Entocort ec)CORTISONE ACETATE – cortisone acetate tab 25 mgDEXAMETHASONE – dexamethasone soln 0.5 mg/5mlDEXAMETHASONE – dexamethasone tab 1 mgDEXAMETHASONE – dexamethasone tab 2 mgdexamethasone elixir 0.5 mg/5mlDEXAMETHASONE INTENSOL – dexamethasone conc

1 mg/mldexamethasone tab 0.5 mgdexamethasone tab 0.75 mgdexamethasone tab 1.5 mgdexamethasone tab 4 mgdexamethasone tab 6 mgfludrocortisone acetate tab 0.1 mghydrocortisone tab 5 mg (Cortef)hydrocortisone tab 10 mg (Cortef)hydrocortisone tab 20 mg (Cortef)methylprednisolone tab therapy pack 4 mg (21)

(Medrol dosepak)methylprednisolone tab 4 mg (Medrol)methylprednisolone tab 8 mg (Medrol)

Drug Name

methylprednisolone tab 16 mg (Medrol)methylprednisolone tab 32 mg (Medrol)PREDNISOLONE – prednisolone syrup 15 mg/5ml (usp

solution equivalent)prednisolone sod phosph oral soln 6.7 mg/5ml

(5 mg/5ml base) (Pediapred)prednisolone sod phosphate oral soln 15 mg/5ml

(base equiv) (Orapred)PREDNISONE – prednisone tab 50 mgPREDNISONE – prednisone oral soln 5 mg/5mlprednisone tab therapy pack 5 mg (21)prednisone tab therapy pack 5 mg (48)prednisone tab therapy pack 10 mg (21)prednisone tab therapy pack 10 mg (48)prednisone tab 1 mgprednisone tab 2.5 mgprednisone tab 5 mgprednisone tab 10 mgprednisone tab 20 mgANDROGEN-ANABOLICdanazol cap 50 mgdanazol cap 100 mgdanazol cap 200 mgtestosterone cypionate im inj in oil 100 mg/ml (Depo-

testosterone)testosterone cypionate im inj in oil 200 mg/ml (Depo-

testosterone)testosterone enanthate im inj in oil 200 mg/mltestosterone td gel 25 mg/2.5gm (1%) (Androgel)testosterone td gel 50 mg/5gm (1%) (Androgel)testosterone td gel 12.5 mg/act (1%) (Androgel pump)testosterone td gel 20.25 mg/1.25gm (1.62%)

(Androgel)testosterone td gel 40.5 mg/2.5gm (1.62%) (Androgel)testosterone td gel 20.25 mg/act (1.62%) (Androgel

pump)testosterone td soln 30 mg/act (Axiron)ESTROGENSCLIMARA PRO – estradiol-levonorgestrel td patch

weekly 0.045-0.015 mg/dayDIVIGEL – estradiol td gel 0.25 mg/0.25gm (0.1%)DIVIGEL – estradiol td gel 0.5 mg/0.5gm (0.1%)

2020

January 2020 9

Drug Name

DIVIGEL – estradiol td gel 0.75 mg/0.75gm (0.1%)DIVIGEL – estradiol td gel 1 mg/gm (0.1%)estradiol & norethindrone acetate tab 0.5-0.1 mg

(Activella)estradiol & norethindrone acetate tab 1-0.5 mg

(Activella)estradiol tab 0.5 mg (Estrace)estradiol tab 1 mg (Estrace)estradiol tab 2 mg (Estrace)estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-

dot)estradiol td patch twice weekly 0.0375 mg/24hr

(Vivelle-dot)estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-

dot)estradiol td patch twice weekly 0.075 mg/24hr (Vivelle-

dot)estradiol td patch twice weekly 0.1 mg/24hr (Vivelle-

dot)estradiol td patch weekly 0.025 mg/24hr (Climara)estradiol td patch weekly 0.0375 mg/24hr

(37.5 mcg/24hr) (Climara)estradiol td patch weekly 0.05 mg/24hr (Climara)estradiol td patch weekly 0.06 mg/24hr (Climara)estradiol td patch weekly 0.075 mg/24hr (Climara)estradiol td patch weekly 0.1 mg/24hr (Climara)ESTROGEL – estradiol gel 0.06% (0.75 mg/1.25 gm

metered-dose pump)norethindrone acetate-ethinyl estradiol tab

0.5 mg-2.5 mcg (Femhrt low dose)norethindrone acetate-ethinyl estradiol tab

1 mg-5 mcgPREMARIN – estrogens, conjugated tab 0.3 mgPREMARIN – estrogens, conjugated tab 0.45 mgPREMARIN – estrogens, conjugated tab 0.625 mgPREMARIN – estrogens, conjugated tab 0.9 mgPREMARIN – estrogens, conjugated tab 1.25 mgPREMPHASE – conj est 0.625(14)/conj est-medroxypro

ac tab 0.625-5mg(14)PREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.3-1.5 mgPREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.45-1.5 mg

Drug Name

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-2.5 mg

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-5 mg

CONTRACEPTIVESdesogest-eth estrad & eth estrad tab

0.15-0.02/0.01 mg(21/5) (Mircette)desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg (Cyclessa)desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg

(Desogen)drospirenone-ethinyl estradiol tab 3-0.02 mg (Yaz)drospirenone-ethinyl estradiol tab 3-0.03 mg (Yasmin

28)ELLA – ulipristal acetate tab 30 mgethynodiol diacetate & ethinyl estradiol tab

1 mg-35 mcgethynodiol diacetate & ethinyl estradiol tab

1 mg-50 mcg (Zovia 1/50e)levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7) (Loseasonique)levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7) (Seasonique)levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mglevonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcglevonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcglevonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcgmedroxyprogesterone acetate im susp prefilled syr

150 mg/ml (Depo-provera contrac)medroxyprogesterone acetate im susp 150 mg/ml

(Depo-provera contrac)MIRENA – levonorgestrel releasing iud 20 mcg/day (52

mg total)norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg

(Ovcon-35)norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg

(Brevicon-28)norethindrone & ethinyl estradiol tab 1 mg-35 mcg

(Norinyl 1+35)norethindrone & ethinyl estradiol-fe chew tab

0.4 mg-35 mcg (Femcon fe)norethindrone ac-ethinyl estrad-fe tab

1-20/1-30/1-35 mg-mcg (Estrostep fe)

2020

January 2020 10

Drug Name

norethindrone ace & ethinyl estradiol tab1 mg-20 mcg (Loestrin 1/20-21)

norethindrone ace & ethinyl estradiol tab1.5 mg-30 mcg (Loestrin 1.5/30-21)

norethindrone ace & ethinyl estradiol-fe tab1 mg-20 mcg (Loestrin fe 1/20)

norethindrone ace & ethinyl estradiol-fe tab1.5 mg-30 mcg (Loestrin fe 1.5/30)

norethindrone tab 0.35 mg (Nor-qd)norethindrone-eth estradiol tab

0.5-35/0.75-35/1-35 mg-mcg (Ortho-novum 7/7/7)norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-

mcg (Tri-norinyl 28)norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg

(Ortho-cyclen)norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg (Ortho tri-cyclen lo)norgestimate-eth estrad tab

0.18-35/0.215-35/0.25-35 mg-mcg (Ortho tri-cyclen)norgestrel & ethinyl estradiol tab 0.3 mg-30 mcgNUVARING – etonogestrel-ethinyl estradiol va ring

0.120-0.015 mg/24hrOGESTREL – norgestrel & ethinyl estradiol tab 0.5

mg-50 mcgSKYLA – levonorgestrel releasing iud 14 mcg/day (13.5

mg total)XULANE – norelgestromin-ethinyl estradiol td ptwk

150-35 mcg/24hrPROGESTINSmedroxyprogesterone acetate tab 2.5 mg (Provera)medroxyprogesterone acetate tab 5 mg (Provera)medroxyprogesterone acetate tab 10 mg (Provera)norethindrone acetate tab 5 mg (Aygestin)progesterone micronized cap 100 mg (Prometrium)progesterone micronized cap 200 mg (Prometrium)ANTIDIABETICSacarbose tab 25 mg (Precose)acarbose tab 50 mg (Precose)acarbose tab 100 mg (Precose)glimepiride tab 1 mg (Amaryl)glimepiride tab 2 mg (Amaryl)glimepiride tab 4 mg (Amaryl)glipizide tab er 24hr 2.5 mg (Glucotrol xl)

Drug Name

glipizide tab er 24hr 5 mg (Glucotrol xl)glipizide tab er 24hr 10 mg (Glucotrol xl)glipizide tab 5 mg (Glucotrol)glipizide tab 10 mg (Glucotrol)glipizide-metformin hcl tab 2.5-250 mgglipizide-metformin hcl tab 2.5-500 mgglipizide-metformin hcl tab 5-500 mgGLUCAGON EMERGENCY KIT – glucagon (rdna) for inj

kit 1 mgglyburide micronized tab 1.5 mg (Glynase)glyburide micronized tab 3 mg (Glynase)glyburide micronized tab 6 mg (Glynase)glyburide tab 1.25 mgglyburide tab 2.5 mgglyburide tab 5 mgglyburide-metformin tab 1.25-250 mg (Glucovance)glyburide-metformin tab 2.5-500 mg (Glucovance)glyburide-metformin tab 5-500 mg (Glucovance)GLYXAMBI – empagliflozin-linagliptin tab 10-5 mgGLYXAMBI – empagliflozin-linagliptin tab 25-5 mgINVOKAMET – canagliflozin-metformin hcl tab 50-500

mgINVOKAMET – canagliflozin-metformin hcl tab 50-1000



mgINVOKAMET XR – canagliflozin-metformin hcl tab er

24hr 50-500 mgINVOKAMET XR – canagliflozin-metformin hcl tab er



24hr 150-1000 mgINVOKANA – canagliflozin tab 100 mgINVOKANA – canagliflozin tab 300 mgJANUMET – sitagliptin-metformin hcl tab 50-500 mgJANUMET – sitagliptin-metformin hcl tab 50-1000 mgJANUMET XR – sitagliptin-metformin hcl tab er 24hr

50-500 mg

2020

January 2020 11

Drug Name

JANUMET XR – sitagliptin-metformin hcl tab er 24hr50-1000 mg

JANUMET XR – sitagliptin-metformin hcl tab er 24hr100-1000 mg

JANUVIA – sitagliptin phosphate tab 25 mg (base equiv)JANUVIA – sitagliptin phosphate tab 50 mg (base equiv)JANUVIA – sitagliptin phosphate tab 100 mg (base equiv)JARDIANCE – empagliflozin tab 10 mgJARDIANCE – empagliflozin tab 25 mgKOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr

2.5-1000 mgKOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr

5-500 mgKOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr

5-1000 mgmetformin hcl tab er 24hr 500 mg (Glucophage xr)metformin hcl tab er 24hr 750 mg (Glucophage xr)metformin hcl tab 500 mg (Glucophage)metformin hcl tab 850 mg (Glucophage)metformin hcl tab 1000 mg (Glucophage)nateglinide tab 60 mg (Starlix)nateglinide tab 120 mg (Starlix)ONGLYZA – saxagliptin hcl tab 2.5 mg (base equiv)ONGLYZA – saxagliptin hcl tab 5 mg (base equiv)OZEMPIC – semaglutide soln pen-inj 0.25 or 0.5 mg/

dose (2 mg/1.5ml)OZEMPIC – semaglutide soln pen-inj 1 mg/dose (2

mg/1.5ml)pioglitazone hcl tab 15 mg (base equiv) (Actos)pioglitazone hcl tab 30 mg (base equiv) (Actos)pioglitazone hcl tab 45 mg (base equiv) (Actos)pioglitazone hcl-metformin hcl tab 15-500 mg

(Actoplus met)pioglitazone hcl-metformin hcl tab 15-850 mg

(Actoplus met)PROGLYCEM – diazoxide susp 50 mg/mlrepaglinide tab 0.5 mg (Prandin)repaglinide tab 1 mg (Prandin)repaglinide tab 2 mg (Prandin)SYNJARDY – empagliflozin-metformin hcl tab 5-500 mgSYNJARDY – empagliflozin-metformin hcl tab 5-1000 mg

Drug Name

SYNJARDY – empagliflozin-metformin hcl tab 12.5-500mg

SYNJARDY – empagliflozin-metformin hcl tab 12.5-1000mg

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr5-1000 mg


SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr12.5-1000 mg


TRULICITY – dulaglutide soln pen-injector 0.75 mg/0.5mlTRULICITY – dulaglutide soln pen-injector 1.5 mg/0.5mlVICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/

ml)Rapid-Acting InsulinsFIASP – insulin aspart (with niacinamide) inj 100 unit/mlFIASP FLEXTOUCH – insulin aspart (with niacinamide)

sol pen-inj 100 unit/mlFIASP PENFILL – insulin aspart (with niacinamide) soln

cartridge 100 unit/mlNOVOLOG – insulin aspart inj 100 unit/mlNOVOLOG FLEXPEN – insulin aspart soln pen-injector

100 unit/mlNOVOLOG PENFILL – insulin aspart soln cartridge 100

unit/mlShort-Acting InsulinsHUMULIN R U-500 (CONCENTR – insulin regular

(human) inj 500 unit/mlHUMULIN R U-500 KWIKPEN – insulin regular (human)

soln pen-injector 500 unit/mlNOVOLIN R – insulin regular (human) inj 100 unit/mlIntermediate-Acting InsulinsNOVOLIN N – insulin nph (human) (isophane) inj 100

unit/mlNOVOLIN 70/30 – insulin nph isophane & regular human

inj 100 unit/ml (70-30)NOVOLIN 70/30 FLEXPEN – insulin nph & regular susp

pen-inj 100 unit/ml (70-30)NOVOLOG MIX 70/30 – insulin aspart prot & aspart

(human) inj 100 unit/ml (70-30)NOVOLOG MIX 70/30 PREFILL – insulin aspart prot &

aspart sus pen-inj 100 unit/ml (70-30)

2020

January 2020 12

Drug Name

Basal InsulinsLANTUS – insulin glargine inj 100 unit/mlLANTUS SOLOSTAR – insulin glargine soln pen-injector

100 unit/mlLEVEMIR – insulin detemir inj 100 unit/mlLEVEMIR FLEXTOUCH – insulin detemir soln pen-

injector 100 unit/mlTOUJEO MAX SOLOSTAR – insulin glargine soln pen-

injector 300 unit/ml (2 unit dial)TOUJEO SOLOSTAR – insulin glargine soln pen-injector

300 unit/ml (1 unit dial)TRESIBA – insulin degludec inj 100 unit/mlTRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 100 unit/mlTRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 200 unit/mlTHYROID AGENTS

OXYTOCICSmethylergonovine maleate tab 0.2 mgENDOCRINE and METABOLIC AGENTS - MISC.ALENDRONATE SODIUM – alendronate sodium tab 5

mgALENDRONATE SODIUM – alendronate sodium tab 40

mg

Drug Name

alendronate sodium tab 10 mgalendronate sodium tab 35 mgalendronate sodium tab 70 mg (Fosamax)cabergoline tab 0.5 mgcalcitonin (salmon) nasal soln 200 unit/act (Miacalcin)calcitriol cap 0.25 mcg (Rocaltrol)calcitriol cap 0.5 mcg (Rocaltrol)calcitriol oral soln 1 mcg/ml (Rocaltrol)CHORIONIC GONADOTROPIN – chorionic gonadotropin

for im inj 10000 unitcinacalcet hcl tab 30 mg (base equiv) (Sensipar)cinacalcet hcl tab 60 mg (base equiv) (Sensipar)cinacalcet hcl tab 90 mg (base equiv) (Sensipar)CLOMIPHENE CITRATE – clomiphene citrate tab 50 mgCYSTADANE – betaine powder for oral solutiondesmopressin acetate nasal spray soln 0.01%

(Ddavp)desmopressin acetate nasal spray soln 0.01%

(refrigerated)desmopressin acetate tab 0.1 mg (Ddavp)desmopressin acetate tab 0.2 mg (Ddavp)FOLLISTIM AQ – follitropin beta inj 300 unit/0.36mlFOLLISTIM AQ – follitropin beta inj 600 unit/0.72mlFOLLISTIM AQ – follitropin beta inj 900 unit/1.08mlganirelix acetate soln prefilled syringe 250 mcg/0.5ml

(Ganirelix acetate)ibandronate sodium tab 150 mg (base equivalent)

(Boniva)INCRELEX – mecasermin inj 40 mg/4ml (10 mg/ml)levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)levocarnitine tab 330 mg (Carnitor)MENOPUR – menotropins for subcutaneous inj 75 unitnitisinone cap 2 mg (Orfadin)nitisinone cap 5 mg (Orfadin)nitisinone cap 10 mg (Orfadin)NITYR – nitisinone tab 2 mgNITYR – nitisinone tab 5 mgNITYR – nitisinone tab 10 mgNORDITROPIN FLEXPRO – somatropin inj 5 mg/1.5mlNORDITROPIN FLEXPRO – somatropin inj 10 mg/1.5mlNORDITROPIN FLEXPRO – somatropin inj 15 mg/1.5ml

Armour Thyroidlevothyroxine sodium tab 25 mcg (Synthroid)levothyroxine sodium tab 50 mcg (Synthroid)levothyroxine sodium tab 75 mcg (Synthroid)levothyroxine sodium tab 88 mcg (Synthroid)levothyroxine sodium tab 100 mcg (Synthroid)levothyroxine sodium tab 112 mcg (Synthroid)levothyroxine sodium tab 125 mcg (Synthroid)levothyroxine sodium tab 137 mcg (Synthroid)levothyroxine sodium tab 150 mcg (Synthroid)levothyroxine sodium tab 175 mcg (Synthroid)levothyroxine sodium tab 200 mcg (Synthroid)levothyroxine sodium tab 300 mcg (Synthroid)liothyronine sodium tab 5 mcg (Cytomel)liothyronine sodium tab 25 mcg (Cytomel)liothyronine sodium tab 50 mcg (Cytomel)methimazole tab 5 mg (Tapazole)methimazole tab 10 mg (Tapazole)Nature-throidpropylthiouracil tab 50 mgSynthroid

2020

January 2020 13

Drug Name

NORDITROPIN FLEXPRO – somatropin inj 30 mg/3mlNOVAREL – chorionic gonadotropin for im inj 5000 unitoctreotide acetate inj 50 mcg/ml (0.05 mg/ml)

(Sandostatin)octreotide acetate inj 100 mcg/ml (0.1 mg/ml)



(Sandostatin)octreotide acetate inj 1000 mcg/ml (1 mg/ml)

(Sandostatin)ORFADIN – nitisinone susp 4 mg/mlORFADIN – nitisinone cap 2 mgORFADIN – nitisinone cap 5 mgORFADIN – nitisinone cap 10 mgORFADIN – nitisinone cap 20 mgORILISSA – elagolix sodium tab 150 mg (base equiv)ORILISSA – elagolix sodium tab 200 mg (base equiv)paricalcitol cap 1 mcg (Zemplar)paricalcitol cap 2 mcg (Zemplar)paricalcitol cap 4 mcg (Zemplar)PREGNYL W/DILUENT BENZYL – chorionic

gonadotropin for im inj 10000 unitPROLIA – denosumab inj soln prefilled syringe 60 mg/mlraloxifene hcl tab 60 mg (Evista)REVCOVI – elapegademase-lvlr im soln 2.4 mg/1.5ml

(1.6 mg/ml)risedronate sodium tab 5 mg (Actonel)risedronate sodium tab 30 mg (Actonel)risedronate sodium tab 35 mg (Actonel)risedronate sodium tab 150 mg (Actonel)SANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 10 mgSANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 20 mgSANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 30 mgSTIMATE – desmopressin acetate nasal soln 1.5 mg/mlSTRENSIQ – asfotase alfa subcutaneous inj 18

mg/0.45mlSTRENSIQ – asfotase alfa subcutaneous inj 28 mg/0.7ml

Drug Name

STRENSIQ – asfotase alfa subcutaneous inj 40 mg/mlSTRENSIQ – asfotase alfa subcutaneous inj 80 mg/0.8mlTYMLOS – abaloparatide subcutaneous soln pen-injector

3120 mcg/1.56mlCARDIOVASCULAR AGENTSCARDIOTONICSDIGOXIN – digoxin oral soln 0.05 mg/mldigoxin oral soln 0.05 mg/ml (Digoxin)digoxin tab 125 mcg (0.125 mg) (Lanoxin)digoxin tab 250 mcg (0.25 mg) (Lanoxin)ANTIANGINAL AGENTSISOSORBIDE DINITRATE – isosorbide dinitrate tab 30

mgisosorbide dinitrate tab 5 mg (Isordil titradose)isosorbide dinitrate tab 10 mgisosorbide dinitrate tab 20 mgisosorbide mononitrate tab er 24hr 30 mgisosorbide mononitrate tab er 24hr 60 mgisosorbide mononitrate tab er 24hr 120 mgisosorbide mononitrate tab 10 mgisosorbide mononitrate tab 20 mgNITRO-BID – nitroglycerin oint 2%nitroglycerin sl tab 0.3 mg (Nitrostat)nitroglycerin sl tab 0.4 mg (Nitrostat)nitroglycerin sl tab 0.6 mg (Nitrostat)nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur)nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur)nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur)nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur)BETA BLOCKERSacebutolol hcl cap 200 mg (Sectral)acebutolol hcl cap 400 mg (Sectral)atenolol tab 25 mg (Tenormin)atenolol tab 50 mg (Tenormin)atenolol tab 100 mg (Tenormin)bisoprolol fumarate tab 5 mg (Zebeta)bisoprolol fumarate tab 10 mg (Zebeta)Bystoliccarvedilol tab 3.125 mg (Coreg)carvedilol tab 6.25 mg (Coreg)carvedilol tab 12.5 mg (Coreg)

2020

January 2020 14

Drug Name

carvedilol tab 25 mg (Coreg)labetalol hcl tab 100 mg (Trandate)labetalol hcl tab 200 mg (Trandate)labetalol hcl tab 300 mg (Trandate)metoprolol succinate tab er 24hr 25 mg (tartrate

equiv) (Toprol xl)metoprolol succinate tab er 24hr 50 mg (tartrate



equiv) (Toprol xl)metoprolol tartrate tab 25 mgmetoprolol tartrate tab 50 mg (Lopressor)metoprolol tartrate tab 100 mg (Lopressor)nadolol tab 20 mg (Corgard)nadolol tab 40 mg (Corgard)nadolol tab 80 mg (Corgard)pindolol tab 5 mgpindolol tab 10 mgPROPRANOLOL HCL – propranolol hcl oral soln 20

mg/5mlPROPRANOLOL HCL – propranolol hcl oral soln 40

mg/5mlpropranolol hcl cap er 24hr 60 mg (Inderal la)propranolol hcl cap er 24hr 80 mg (Inderal la)propranolol hcl cap er 24hr 120 mg (Inderal la)propranolol hcl cap er 24hr 160 mg (Inderal la)propranolol hcl tab 10 mgpropranolol hcl tab 20 mgpropranolol hcl tab 40 mgpropranolol hcl tab 60 mgpropranolol hcl tab 80 mgsotalol hcl (afib/afl) tab 80 mg (Betapace af)sotalol hcl (afib/afl) tab 120 mg (Betapace af)sotalol hcl (afib/afl) tab 160 mg (Betapace af)sotalol hcl tab 80 mg (Betapace)sotalol hcl tab 120 mg (Betapace)sotalol hcl tab 160 mg (Betapace)sotalol hcl tab 240 mgTIMOLOL MALEATE – timolol maleate tab 10 mg

Drug Name

TIMOLOL MALEATE – timolol maleate tab 20 mgtimolol maleate tab 5 mgCALCIUM CHANNEL BLOCKERSamlodipine besylate tab 2.5 mg (base equivalent)

(Norvasc)amlodipine besylate tab 5 mg (base equivalent)

(Norvasc)amlodipine besylate tab 10 mg (base equivalent)

(Norvasc)DILT-XR – diltiazem hcl cap er 24hr 120 mgdiltiazem hcl cap er 24hr 180 mgdiltiazem hcl cap er 24hr 240 mgdiltiazem hcl coated beads cap er 24hr 120 mg

(Cardizem cd)diltiazem hcl coated beads cap er 24hr 180 mg

(Cardizem cd)diltiazem hcl coated beads cap er 24hr 240 mg

(Cardizem cd)diltiazem hcl coated beads cap er 24hr 300 mgdiltiazem hcl coated beads cap er 24hr 360 mg

(Cardizem cd)diltiazem hcl extended release beads cap er 24hr

120 mg (Tiazac)diltiazem hcl extended release beads cap er 24hr





420 mg (Tiazac)diltiazem hcl tab 30 mg (Cardizem)diltiazem hcl tab 60 mg (Cardizem)diltiazem hcl tab 90 mgdiltiazem hcl tab 120 mg (Cardizem)felodipine tab er 24hr 2.5 mgfelodipine tab er 24hr 5 mgfelodipine tab er 24hr 10 mgnifedipine tab er 24hr 30 mg (Adalat cc)nifedipine tab er 24hr 60 mg (Adalat cc)nifedipine tab er 24hr 90 mg (Adalat cc)

2020

January 2020 15

Drug Name

nifedipine tab er 24hr osmotic release 30 mg(Procardia xl)



nimodipine cap 30 mgverapamil hcl cap er 24hr 120 mg (Verelan)verapamil hcl cap er 24hr 180 mg (Verelan)verapamil hcl cap er 24hr 240 mg (Verelan)VERAPAMIL HCL SR – verapamil hcl cap er 24hr 360

mgverapamil hcl tab er 120 mg (Calan sr)verapamil hcl tab er 180 mg (Calan sr)verapamil hcl tab er 240 mg (Calan sr)verapamil hcl tab 40 mgverapamil hcl tab 80 mg (Calan)verapamil hcl tab 120 mg (Calan)ANTIARRHYTHMICSamiodarone hcl tab 100 mgamiodarone hcl tab 200 mg (Cordarone)amiodarone hcl tab 400 mgdisopyramide phosphate cap 100 mg (Norpace)disopyramide phosphate cap 150 mg (Norpace)flecainide acetate tab 50 mgflecainide acetate tab 100 mgflecainide acetate tab 150 mgMEXILETINE HCL – mexiletine hcl cap 150 mgMEXILETINE HCL – mexiletine hcl cap 200 mgMEXILETINE HCL – mexiletine hcl cap 250 mgMULTAQ – dronedarone hcl tab 400 mg (base

equivalent)propafenone hcl cap er 12hr 225 mg (Rythmol sr)propafenone hcl cap er 12hr 325 mg (Rythmol sr)propafenone hcl cap er 12hr 425 mg (Rythmol sr)propafenone hcl tab 150 mg (Rythmol)propafenone hcl tab 225 mg (Rythmol)propafenone hcl tab 300 mgquinidine gluconate tab er 324 mgQUINIDINE SULFATE – quinidine sulfate tab 200 mgQUINIDINE SULFATE – quinidine sulfate tab 300 mg

Drug Name

ANTIHYPERTENSIVESamlodipine besylate-benazepril hcl cap 2.5-10 mg

(Lotrel)amlodipine besylate-benazepril hcl cap 5-10 mg





(Lotrel)amlodipine besylate-valsartan tab 5-160 mg (Exforge)amlodipine besylate-valsartan tab 5-320 mg (Exforge)amlodipine besylate-valsartan tab 10-160 mg

(Exforge)amlodipine besylate-valsartan tab 10-320 mg

(Exforge)amlodipine-valsartan-hydrochlorothiazide tab

5-160-12.5 mg (Exforge hct)amlodipine-valsartan-hydrochlorothiazide tab

5-160-25 mg (Exforge hct)amlodipine-valsartan-hydrochlorothiazide tab

10-160-12.5 mg (Exforge hct)amlodipine-valsartan-hydrochlorothiazide tab

10-160-25 mg (Exforge hct)amlodipine-valsartan-hydrochlorothiazide tab

10-320-25 mg (Exforge hct)atenolol & chlorthalidone tab 50-25 mg (Tenoretic 50)atenolol & chlorthalidone tab 100-25 mg (Tenoretic

100)benazepril & hydrochlorothiazide tab 5-6.25 mgbenazepril & hydrochlorothiazide tab 10-12.5 mg

(Lotensin hct)benazepril & hydrochlorothiazide tab 20-12.5 mg

(Lotensin hct)benazepril & hydrochlorothiazide tab 20-25 mg

(Lotensin hct)benazepril hcl tab 5 mgbenazepril hcl tab 10 mg (Lotensin)benazepril hcl tab 20 mg (Lotensin)benazepril hcl tab 40 mg (Lotensin)

2020

January 2020 16

Drug Name

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg(Ziac)

bisoprolol & hydrochlorothiazide tab 5-6.25 mg (Ziac)bisoprolol & hydrochlorothiazide tab 10-6.25 mg

(Ziac)candesartan cilexetil tab 4 mg (Atacand)candesartan cilexetil tab 8 mg (Atacand)candesartan cilexetil tab 16 mg (Atacand)candesartan cilexetil tab 32 mg (Atacand)candesartan cilexetil-hydrochlorothiazide tab

16-12.5 mg (Atacand hct)candesartan cilexetil-hydrochlorothiazide tab

32-12.5 mg (Atacand hct)candesartan cilexetil-hydrochlorothiazide tab

32-25 mg (Atacand hct)captopril tab 12.5 mgcaptopril tab 25 mgcaptopril tab 50 mgcaptopril tab 100 mgCAPTOPRIL/HYDROCHLOROTHIA – captopril &

hydrochlorothiazide tab 25-15 mgCAPTOPRIL/HYDROCHLOROTHIA – captopril &



hydrochlorothiazide tab 50-25 mgclonidine hcl tab 0.1 mg (Catapres)clonidine hcl tab 0.2 mg (Catapres)clonidine hcl tab 0.3 mg (Catapres)clonidine td patch weekly 0.1 mg/24hr (Catapres-tts-1)clonidine td patch weekly 0.2 mg/24hr (Catapres-tts-2)clonidine td patch weekly 0.3 mg/24hr (Catapres-tts-3)doxazosin mesylate tab 1 mg (Cardura)doxazosin mesylate tab 2 mg (Cardura)doxazosin mesylate tab 4 mg (Cardura)doxazosin mesylate tab 8 mg (Cardura)enalapril maleate & hydrochlorothiazide tab

5-12.5 mgenalapril maleate & hydrochlorothiazide tab 10-25 mg

(Vaseretic)enalapril maleate tab 2.5 mg (Vasotec)

Drug Name

enalapril maleate tab 5 mg (Vasotec)enalapril maleate tab 10 mg (Vasotec)enalapril maleate tab 20 mg (Vasotec)eplerenone tab 25 mg (Inspra)eplerenone tab 50 mg (Inspra)fosinopril sodium & hydrochlorothiazide tab

10-12.5 mgfosinopril sodium & hydrochlorothiazide tab

20-12.5 mgfosinopril sodium tab 10 mgfosinopril sodium tab 20 mgfosinopril sodium tab 40 mgguanfacine hcl tab 1 mg (Tenex)guanfacine hcl tab 2 mg (Tenex)hydralazine hcl tab 10 mghydralazine hcl tab 25 mghydralazine hcl tab 50 mghydralazine hcl tab 100 mgirbesartan tab 75 mg (Avapro)irbesartan tab 150 mg (Avapro)irbesartan tab 300 mg (Avapro)irbesartan-hydrochlorothiazide tab 150-12.5 mg

(Avalide)irbesartan-hydrochlorothiazide tab 300-12.5 mg

(Avalide)lisinopril & hydrochlorothiazide tab 10-12.5 mg

(Zestoretic)lisinopril & hydrochlorothiazide tab 20-12.5 mg

(Zestoretic)lisinopril & hydrochlorothiazide tab 20-25 mg

(Zestoretic)lisinopril tab 2.5 mg (Zestril)lisinopril tab 5 mg (Prinivil)lisinopril tab 10 mg (Prinivil)lisinopril tab 20 mg (Prinivil)lisinopril tab 30 mg (Zestril)lisinopril tab 40 mg (Zestril)losartan potassium & hydrochlorothiazide tab

50-12.5 mg (Hyzaar)losartan potassium & hydrochlorothiazide tab

100-12.5 mg (Hyzaar)

2020

January 2020 17

Drug Name

losartan potassium & hydrochlorothiazide tab100-25 mg (Hyzaar)

losartan potassium tab 25 mg (Cozaar)losartan potassium tab 50 mg (Cozaar)losartan potassium tab 100 mg (Cozaar)methyldopa tab 250 mgmethyldopa tab 500 mgmetoprolol & hydrochlorothiazide tab 50-25 mg

(Lopressor hct)metoprolol & hydrochlorothiazide tab 100-25 mg

(Lopressor hct)METOPROLOL/HYDROCHLOROTHI – metoprolol &

hydrochlorothiazide tab 100-50 mgminoxidil tab 2.5 mgminoxidil tab 10 mgmoexipril hcl tab 7.5 mg (Univasc)moexipril hcl tab 15 mg (Univasc)olmesartan medoxomil tab 5 mg (Benicar)olmesartan medoxomil tab 20 mg (Benicar)olmesartan medoxomil tab 40 mg (Benicar)olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg (Benicar hct)olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg (Benicar hct)olmesartan medoxomil-hydrochlorothiazide tab

40-25 mg (Benicar hct)perindopril erbumine tab 2 mgperindopril erbumine tab 4 mg (Aceon)perindopril erbumine tab 8 mg (Aceon)phenoxybenzamine hcl cap 10 mg (Dibenzyline)prazosin hcl cap 1 mg (Minipress)prazosin hcl cap 2 mg (Minipress)prazosin hcl cap 5 mg (Minipress)PROPRANOLOL/HYDROCHLOROTH – propranolol &

hydrochlorothiazide tab 40-25 mgPROPRANOLOL/HYDROCHLOROTH – propranolol &

hydrochlorothiazide tab 80-25 mgquinapril hcl tab 5 mg (Accupril)quinapril hcl tab 10 mg (Accupril)quinapril hcl tab 20 mg (Accupril)quinapril hcl tab 40 mg (Accupril)

Drug Name

quinapril-hydrochlorothiazide tab 10-12.5 mg(Accuretic)

quinapril-hydrochlorothiazide tab 20-12.5 mg(Accuretic)

quinapril-hydrochlorothiazide tab 20-25 mg(Accuretic)

ramipril cap 1.25 mg (Altace)ramipril cap 2.5 mg (Altace)ramipril cap 5 mg (Altace)ramipril cap 10 mg (Altace)telmisartan tab 20 mg (Micardis)telmisartan tab 40 mg (Micardis)telmisartan tab 80 mg (Micardis)telmisartan-hydrochlorothiazide tab 40-12.5 mg

(Micardis hct)telmisartan-hydrochlorothiazide tab 80-12.5 mg

(Micardis hct)telmisartan-hydrochlorothiazide tab 80-25 mg

(Micardis hct)terazosin hcl cap 1 mg (base equivalent)terazosin hcl cap 2 mg (base equivalent)terazosin hcl cap 5 mg (base equivalent)terazosin hcl cap 10 mg (base equivalent)trandolapril tab 1 mg (Mavik)trandolapril tab 2 mg (Mavik)trandolapril tab 4 mg (Mavik)valsartan tab 40 mg (Diovan)valsartan tab 80 mg (Diovan)valsartan tab 160 mg (Diovan)valsartan tab 320 mg (Diovan)valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovan

hct)valsartan-hydrochlorothiazide tab 160-12.5 mg

(Diovan hct)valsartan-hydrochlorothiazide tab 160-25 mg (Diovan

hct)valsartan-hydrochlorothiazide tab 320-12.5 mg

(Diovan hct)valsartan-hydrochlorothiazide tab 320-25 mg (Diovan

hct)DIURETICSacetazolamide cap er 12hr 500 mg (Diamox)

2020

January 2020 18

Drug Name

acetazolamide tab 125 mgacetazolamide tab 250 mgamiloride & hydrochlorothiazide tab 5-50 mgamiloride hcl tab 5 mgbumetanide tab 0.5 mgbumetanide tab 1 mgbumetanide tab 2 mgCHLOROTHIAZIDE – chlorothiazide tab 250 mgCHLOROTHIAZIDE – chlorothiazide tab 500 mgchlorthalidone tab 25 mgchlorthalidone tab 50 mgfurosemide oral soln 10 mg/mlfurosemide tab 20 mg (Lasix)furosemide tab 40 mg (Lasix)furosemide tab 80 mg (Lasix)hydrochlorothiazide cap 12.5 mg (Microzide)hydrochlorothiazide tab 12.5 mghydrochlorothiazide tab 25 mghydrochlorothiazide tab 50 mgindapamide tab 1.25 mgindapamide tab 2.5 mgmethazolamide tab 25 mg (Neptazane)methazolamide tab 50 mg (Neptazane)metolazone tab 2.5 mg (Zaroxolyn)metolazone tab 5 mg (Zaroxolyn)metolazone tab 10 mgspironolactone & hydrochlorothiazide tab 25-25 mg

(Aldactazide)spironolactone tab 25 mg (Aldactone)spironolactone tab 50 mg (Aldactone)spironolactone tab 100 mg (Aldactone)torsemide tab 5 mg (Demadex)torsemide tab 10 mg (Demadex)torsemide tab 20 mg (Demadex)torsemide tab 100 mg (Demadex)triamterene & hydrochlorothiazide cap 37.5-25 mg

(Dyazide)triamterene & hydrochlorothiazide tab 37.5-25 mg

(Maxzide-25)

Drug Name

triamterene & hydrochlorothiazide tab 75-50 mg(Maxzide)

VASOPRESSORSepinephrine solution auto-injector 0.15 mg/0.3ml

(1:2000) (Epipen-jr 2-pak)epinephrine solution auto-injector 0.3 mg/0.3ml

(1:1000) (Epipen 2-pak)EPIPEN-JR 2-PAK – epinephrine solution auto-injector

0.15 mg/0.3ml (1:2000)midodrine hcl tab 2.5 mgmidodrine hcl tab 5 mgmidodrine hcl tab 10 mgSYMJEPI – epinephrine soln prefilled syringe 0.15

mg/0.3ml (1:2000)SYMJEPI – epinephrine solution prefilled syringe 0.3

mg/0.3ml (1:1000)ANTIHYPERLIPIDEMICSatorvastatin calcium tab 10 mg (base equivalent)

(Lipitor)atorvastatin calcium tab 20 mg (base equivalent)



(Lipitor)cholestyramine light powder packets 4 gmcholestyramine light powder 4 gm/dose (Questran

light)cholestyramine powder packets 4 gm (Questran)cholestyramine powder 4 gm/dose (Questran)choline fenofibrate cap dr 45 mg (fenofibric acid

equiv) (Trilipix)choline fenofibrate cap dr 135 mg (fenofibric acid

equiv) (Trilipix)colesevelam hcl packet for susp 3.75 gm (Welchol)colesevelam hcl tab 625 mg (Welchol)colestipol hcl granule packets 5 gm (Colestid flavored)colestipol hcl granules 5 gm (Colestid flavored)colestipol hcl tab 1 gm (Colestid)ezetimibe tab 10 mg (Zetia)ezetimibe-simvastatin tab 10-10 mg (Vytorin)ezetimibe-simvastatin tab 10-20 mg (Vytorin)ezetimibe-simvastatin tab 10-40 mg (Vytorin)

2020

January 2020 19

Drug Name

ezetimibe-simvastatin tab 10-80 mg (Vytorin)fenofibrate micronized cap 67 mg (Lofibra)fenofibrate micronized cap 134 mg (Lofibra)fenofibrate micronized cap 200 mg (Lofibra)fenofibrate tab 48 mg (Tricor)fenofibrate tab 54 mg (Lofibra)fenofibrate tab 145 mg (Tricor)fenofibrate tab 160 mg (Lofibra)gemfibrozil tab 600 mg (Lopid)lovastatin tab 10 mglovastatin tab 20 mg (Mevacor)lovastatin tab 40 mg (Mevacor)niacin tab er 500 mg (antihyperlipidemic) (Niaspan)niacin tab er 750 mg (antihyperlipidemic) (Niaspan)niacin tab er 1000 mg (antihyperlipidemic) (Niaspan)pravastatin sodium tab 10 mgpravastatin sodium tab 20 mg (Pravachol)pravastatin sodium tab 40 mg (Pravachol)pravastatin sodium tab 80 mg (Pravachol)REPATHA – evolocumab subcutaneous soln prefilled

syringe 140 mg/mlREPATHA PUSHTRONEX SYSTEM – evolocumab

subcutaneous soln cartridge/infusor 420 mg/3.5mlREPATHA SURECLICK – evolocumab subcutaneous

soln auto-injector 140 mg/mlrosuvastatin calcium tab 5 mg (Crestor)rosuvastatin calcium tab 10 mg (Crestor)rosuvastatin calcium tab 20 mg (Crestor)rosuvastatin calcium tab 40 mg (Crestor)simvastatin tab 5 mg (Zocor)simvastatin tab 10 mg (Zocor)simvastatin tab 20 mg (Zocor)simvastatin tab 40 mg (Zocor)simvastatin tab 80 mg (Zocor)CARDIOVASCULAR AGENTS - MISC.ambrisentan tab 5 mg (Letairis)ambrisentan tab 10 mg (Letairis)bosentan tab 62.5 mg (Tracleer)bosentan tab 125 mg (Tracleer)ENTRESTO – sacubitril-valsartan tab 24-26 mg

Drug Name

ENTRESTO – sacubitril-valsartan tab 49-51 mgENTRESTO – sacubitril-valsartan tab 97-103 mgOPSUMIT – macitentan tab 10 mgsildenafil citrate tab 20 mg (Revatio)tadalafil tab 20 mg (pah) (Adcirca)tadalafil tab 2.5 mg (Cialis)tadalafil tab 5 mg (Cialis)tadalafil tab 10 mg (Cialis)tadalafil tab 20 mg (Cialis)TRACLEER – bosentan tab for oral susp 32 mgUPTRAVI – selexipag tab therapy pack 200 mcg (140) &

800 mcg (60)UPTRAVI – selexipag tab 200 mcgUPTRAVI – selexipag tab 400 mcgUPTRAVI – selexipag tab 600 mcgUPTRAVI – selexipag tab 800 mcgUPTRAVI – selexipag tab 1000 mcgUPTRAVI – selexipag tab 1200 mcgUPTRAVI – selexipag tab 1400 mcgUPTRAVI – selexipag tab 1600 mcgVYNDAMAX – tafamidis cap 61 mgVYNDAQEL – tafamidis meglumine (cardiac) cap 20 mgRESPIRATORY AGENTSANTIHISTAMINEScetirizine hcl oral soln 1 mg/ml (5 mg/5ml)cyproheptadine hcl syrup 2 mg/5mlcyproheptadine hcl tab 4 mgDESLORATADINE ODT – desloratadine tab orally

disintegrating 2.5 mgDESLORATADINE ODT – desloratadine tab orally

disintegrating 5 mgdesloratadine tab 5 mg (Clarinex)levocetirizine dihydrochloride soln 2.5 mg/5ml

(0.5 mg/ml) (Xyzal)levocetirizine dihydrochloride tab 5 mg (Xyzal)promethazine hcl suppos 12.5 mgpromethazine hcl suppos 25 mgpromethazine hcl suppos 50 mgpromethazine hcl syrup 6.25 mg/5mlpromethazine hcl tab 12.5 mg

2020

January 2020 20

Drug Name

promethazine hcl tab 25 mgpromethazine hcl tab 50 mgNASAL AGENTS - SYSTEMIC and TOPICALazelastine hcl nasal spray 0.1% (137 mcg/spray)azelastine hcl nasal spray 0.15% (205.5 mcg/spray)

(Astepro)FLUNISOLIDE – flunisolide nasal soln 25 mcg/act

(0.025%)fluticasone propionate nasal susp 50 mcg/act

(Flonase)ipratropium bromide nasal soln 0.03% (21 mcg/spray)

(Atrovent)ipratropium bromide nasal soln 0.06% (42 mcg/spray)

(Atrovent)mometasone furoate nasal susp 50 mcg/act

(Nasonex)COUGH/COLD/ALLERGYacetylcysteine inhal soln 10%acetylcysteine inhal soln 20%ANTIASTHMATIC and BRONCHODILATOR AGENTSADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21

mcg/actADVAIR HFA – fluticasone-salmeterol inhal aerosol

115-21 mcg/actADVAIR HFA – fluticasone-salmeterol inhal aerosol

230-21 mcg/actalbuterol sulfate HFAalbuterol sulfate soln nebu 0.083% (2.5 mg/3ml)albuterol sulfate soln nebu 0.5% (5 mg/ml)albuterol sulfate soln nebu 0.63 mg/3ml (base equiv)albuterol sulfate soln nebu 1.25 mg/3ml (base equiv)albuterol sulfate syrup 2 mg/5mlalbuterol sulfate tab 2 mg & 4 mgANORO ELLIPTA – umeclidinium-vilanterol aero powd ba

62.5-25 mcg/inhARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 50 mcg/actARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 100 mcg/actARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 200 mcg/actASMANEX HFA – mometasone furoate inhal aerosol

suspension 100 mcg/act

Drug Name

ASMANEX HFA – mometasone furoate inhal aerosolsuspension 200 mcg/act

ASMANEX TWISTHALER 120 ME – mometasonefuroate inhal powd 220 mcg/inh (breath activated)

ASMANEX TWISTHALER 30 MET – mometasonefuroate inhal powd 110 mcg/inh (breath activated)



ATROVENT HFA – ipratropium bromide hfa inhal aerosol17 mcg/act

BREO ELLIPTA – fluticasone furoate-vilanterol aeropowd ba 100-25 mcg/inh

BREO ELLIPTA – fluticasone furoate-vilanterol aeropowd ba 200-25 mcg/inh

budesonide inhalation susp 0.25 mg/2ml (Pulmicort)budesonide inhalation susp 0.5 mg/2ml (Pulmicort)budesonide inhalation susp 1 mg/2ml (Pulmicort)COMBIVENT RESPIMAT – ipratropium-albuterol inhal

aerosol soln 20-100 mcg/actcromolyn sodium soln nebu 20 mg/2mlDULERA – mometasone furoate-formoterol fumarate

aerosol 100-5 mcg/actDULERA – mometasone furoate-formoterol fumarate

aerosol 200-5 mcg/actFLOVENT DISKUS – fluticasone propionate aer pow ba

50 mcg/blisterFLOVENT DISKUS – fluticasone propionate aer pow ba

100 mcg/blisterFLOVENT DISKUS – fluticasone propionate aer pow ba

250 mcg/blisterFLOVENT HFA – fluticasone propionate hfa inhal aero 44

mcg/act (50/valve)FLOVENT HFA – fluticasone propionate hfa inhal aer 110

mcg/act (125/valve)FLOVENT HFA – fluticasone propionate hfa inhal aer 220

mcg/act (250/valve)FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 55-14 mcg/actFLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 113-14 mcg/actFLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 232-14 mcg/act

2020

January 2020 21

Drug Name

INCRUSE ELLIPTA – umeclidinium br aero powd breathact 62.5 mcg/inh (base eq)

ipratropium bromide inhal soln 0.02%ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml

(Duoneb)levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base

equiv)levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)

(Xopenex)levalbuterol hcl soln nebu 0.63 mg/3ml (base equiv)

(Xopenex)levalbuterol hcl soln nebu 1.25 mg/3ml (base equiv)

(Xopenex)montelukast sodium chew tab 4 mg (base equiv)

(Singulair)montelukast sodium chew tab 5 mg (base equiv)

(Singulair)montelukast sodium oral granules packet 4 mg (base

equiv) (Singulair)montelukast sodium tab 10 mg (base equiv)

(Singulair)PROAIR HFA – albuterol sulfate inhal aero 108 mcg/act

(90mcg base equiv)PROAIR RESPICLICK – albuterol sulfate aer pow ba 108

mcg/act (90 mcg base equiv)QVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 40 mcg/actQVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 80 mcg/actSEREVENT DISKUS – salmeterol xinafoate aer pow ba

50 mcg/dose (base equiv)SPIRIVA HANDIHALER – tiotropium bromide

monohydrate inhal cap 18 mcg (base equiv)SPIRIVA RESPIMAT – tiotropium bromide monohydrate

inhal aerosol 1.25 mcg/actSPIRIVA RESPIMAT – tiotropium bromide monohydrate

inhal aerosol 2.5 mcg/actSTIOLTO RESPIMAT – tiotropium br-olodaterol inhal

aero soln 2.5-2.5 mcg/actSYMBICORT – budesonide-formoterol fumarate dihyd

aerosol 80-4.5 mcg/actSYMBICORT – budesonide-formoterol fumarate dihyd

aerosol 160-4.5 mcg/actterbutaline sulfate tab 2.5 mgterbutaline sulfate tab 5 mg

Drug Name

THEOCHRON – theophylline tab er 12hr 100 mgTHEOCHRON – theophylline tab er 12hr 200 mgTHEOPHYLLINE ER – theophylline tab er 12hr 450 mgtheophylline tab er 12hr 300 mgtheophylline tab er 24hr 400 mgtheophylline tab er 24hr 600 mgTRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol

aepb 100-62.5-25 mcg/inhVENTOLIN HFA – albuterol sulfate inhal aero 108 mcg/

act (90mcg base equiv)zafirlukast tab 10 mg (Accolate)zafirlukast tab 20 mg (Accolate)RESPIRATORY AGENTS - MISC.KALYDECO – ivacaftor tab 150 mgKALYDECO – ivacaftor packet 25 mgKALYDECO – ivacaftor packet 50 mgKALYDECO – ivacaftor packet 75 mgPULMOZYME – dornase alfa inhal soln 1 mg/mlSYMDEKO – tezacaftor-ivacaftor 50-75 mg & ivacaftor 75

mg tab tbpkSYMDEKO – tezacaftor-ivacaftor 100-150 mg & ivacaftor

150 mg tab tbpkGASTROINTESTINAL AGENTSLAXATIVESlactulose solution 10 gm/15mlpeg 3350-kcl-sod bicarb-nacl for soln 420 gm

(Nulytely/flavor pack)peg 3350-kcl-na bicarb-nacl-na sulfate for soln

236 gm (Golytely)peg 3350-kcl-na bicarb-nacl-na sulfate for soln

240 gm (Colyte-flavor packs)ANTIDIARRHEALSdiphenoxylate w/ atropine tab 2.5-0.025 mg (Lomotil)DIPHENOXYLATE/ATROPINE – diphenoxylate w/

atropine liq 2.5-0.025 mg/5mlloperamide hcl cap 2 mgULCER DRUGSCIMETIDINE HCL – cimetidine hcl soln 300 mg/5mlcimetidine tab 300 mgcimetidine tab 400 mgcimetidine tab 800 mgdicyclomine hcl cap 10 mg (Bentyl)

2020

January 2020 22

Drug Name

dicyclomine hcl oral soln 10 mg/5mldicyclomine hcl tab 20 mg (Bentyl)esomeprazole magnesium cap delayed release 20 mg

(base eq) (Nexium)esomeprazole magnesium cap delayed release 40 mg

(base eq) (Nexium)famotidine tab 20 mg (Pepcid)famotidine tab 40 mg (Pepcid)glycopyrrolate tab 1 mg (Robinul)glycopyrrolate tab 2 mg (Robinul forte)lansoprazole cap delayed release 15 mg (Prevacid)lansoprazole cap delayed release 30 mg (Prevacid)methscopolamine bromide tab 2.5 mg (Pamine)methscopolamine bromide tab 5 mg (Pamine forte)misoprostol tab 100 mcg (Cytotec)misoprostol tab 200 mcg (Cytotec)NEXIUM – esomeprazole magnesium for delayed release

susp pack 2.5 mgNEXIUM – esomeprazole magnesium for delayed release

susp packet 5 mgNEXIUM – esomeprazole magnesium for delayed release



susp packet 40 mgomeprazole cap delayed release 10 mg (Prilosec)omeprazole cap delayed release 20 mg (Prilosec)omeprazole cap delayed release 40 mg (Prilosec)pantoprazole sodium ec tab 20 mg (base equiv)

(Protonix)pantoprazole sodium ec tab 40 mg (base equiv)

(Protonix)PROPANTHELINE BROMIDE – propantheline bromide

tab 15 mgranitidine hcl cap 150 mgranitidine hcl cap 300 mgranitidine hcl syrup 15 mg/ml (75 mg/5ml)ranitidine hcl tab 150 mg (Zantac)ranitidine hcl tab 300 mg (Zantac)sucralfate tab 1 gm (Carafate)ANTIEMETICS

Drug Name

aprepitant capsule therapy pack 80 & 125 mg (Emend)aprepitant capsule 40 mg (Emend)aprepitant capsule 80 mg (Emend)aprepitant capsule 125 mg (Emend)EMEND – aprepitant for oral susp 125 mg (125 mg/5ml)fosaprepitant dimeglumine for iv infusion 150 mg

(base eq) (Emend)granisetron hcl tab 1 mgmeclizine hcl tab 12.5 mgmeclizine hcl tab 25 mgONDANSETRON HCL – ondansetron hcl tab 24 mgondansetron hcl oral soln 4 mg/5ml (Zofran)ondansetron hcl tab 4 mg (Zofran)ondansetron hcl tab 8 mg (Zofran)ondansetron orally disintegrating tab 4 mg (Zofran

odt)ondansetron orally disintegrating tab 8 mg (Zofran

odt)scopolamine td patch 72hr 1 mg/3days (Transderm-

scop)trimethobenzamide hcl cap 300 mg (Tigan)DIGESTIVE AIDSCREON – pancrelipase (lip-prot-amyl) dr cap

3000-9500-15000 unitCREON – pancrelipase (lip-prot-amyl) dr cap




36000-114000-180000 unitZENPEP – pancrelipase (lip-prot-amyl) dr cap





20000-63000-84000 unit

2020

January 2020 23

Drug Name

ZENPEP – pancrelipase (lip-prot-amyl) dr cap25000-79000-105000 unit

ZENPEP – pancrelipase (lip-prot-amyl) dr cap40000-126000-168000 unit

GASTROINTESTINAL AGENTS- MISC.APRISO – mesalamine cap er 24hr 0.375 gmbalsalazide disodium cap 750 mg (Colazal)calcium acetate (phosphate binder) cap 667 mg

(169 mg ca) (Phoslo)calcium acetate (phosphate binder) tab 667 mg

(Eliphos)CHENODAL – chenodiol tab 250 mglactulose (encephalopathy) solution 10 gm/15mlmesalamine cap dr 400 mg (Delzicol)mesalamine enema 4 gmmesalamine suppos 1000 mg (Canasa)mesalamine tab delayed release 800 mg (Asacol hd)mesalamine tab delayed release 1.2 gm (Lialda)metoclopramide hcl soln 5 mg/5ml (10 mg/10ml)

(base equiv)metoclopramide hcl tab 5 mg (base equivalent)

(Reglan)metoclopramide hcl tab 10 mg (base equivalent)

(Reglan)sevelamer carbonate packet 0.8 gm (Renvela)sevelamer carbonate packet 2.4 gm (Renvela)sevelamer carbonate tab 800 mg (Renvela)sulfasalazine tab delayed release 500 mg (Azulfidine

en-tabs)sulfasalazine tab 500 mg (Azulfidine)SYMPROIC – naldemedine tosylate tab 0.2 mg (base

equivalent)TRULANCE – plecanatide tab 3 mgursodiol cap 300 mg (Actigall)ursodiol tab 250 mg (Urso 250)ursodiol tab 500 mg (Urso forte)VELPHORO – sucroferric oxyhydroxide chew tab 500 mgVIBERZI – eluxadoline tab 75 mgVIBERZI – eluxadoline tab 100 mgGENITOURINARY AGENTSURINARY ANTI-INFECTIVES

Drug Name

nitrofurantoin macrocrystalline cap 25 mg(Macrodantin)



nitrofurantoin monohydrate macrocrystalline cap100 mg (Macrobid)

nitrofurantoin susp 25 mg/5ml (Furadantin)URINARY ANTISPASMODICSoxybutynin chloride syrup 5 mg/5mloxybutynin chloride tab er 24hr 5 mg (Ditropan xl)oxybutynin chloride tab er 24hr 10 mg (Ditropan xl)oxybutynin chloride tab er 24hr 15 mg (Ditropan xl)oxybutynin chloride tab 5 mgsolifenacin succinate tab 5 mg (Vesicare)solifenacin succinate tab 10 mg (Vesicare)tolterodine tartrate cap er 24hr 2 mg (Detrol la)tolterodine tartrate cap er 24hr 4 mg (Detrol la)tolterodine tartrate tab 1 mg (Detrol)tolterodine tartrate tab 2 mg (Detrol)VAGINAL PRODUCTSclindamycin phosphate vaginal cream 2% (Cleocin)ENDOMETRIN – progesterone vaginal insert 100 mgestradiol vaginal cream 0.1 mg/gm (Estrace)metronidazole vaginal gel 0.75% (Metrogel-vaginal)TERCONAZOLE – terconazole vaginal cream 0.8%terconazole vaginal cream 0.4% (Terazol 7)terconazole vaginal suppos 80 mg (Terazol 3)VAGIFEM – estradiol vaginal tab 10 mcgGENITOURINARY AGENTS - MISC.alfuzosin hcl tab er 24hr 10 mg (Uroxatral)CYSTAGON – cysteamine bitartrate cap 50 mgCYSTAGON – cysteamine bitartrate cap 150 mgdutasteride cap 0.5 mg (Avodart)finasteride tab 5 mg (Proscar)K-PHOS NO 2 – potassium & sodium acid phosphates

tab 305-700 mgpotassium citrate tab er 5 meq (540 mg) (Urocit-k 5)potassium citrate tab er 10 meq (1080 mg) (Urocit-k

10)

2020

January 2020 24

Drug Name

potassium citrate tab er 15 meq (1620 mg) (Urocit-k15)

sodium citrate & citric acid soln 500-334 mg/5ml(Shohls solution modi)

tamsulosin hcl cap 0.4 mg (Flomax)CENTRAL NERVOUS SYSTEM DRUGSANTIANXIETY AGENTSalprazolam tab er 24hr 0.5 mg (Xanax xr)alprazolam tab er 24hr 1 mg (Xanax xr)alprazolam tab er 24hr 2 mg (Xanax xr)alprazolam tab er 24hr 3 mg (Xanax xr)alprazolam tab 0.25 mg (Xanax)alprazolam tab 0.5 mg (Xanax)alprazolam tab 1 mg (Xanax)alprazolam tab 2 mg (Xanax)buspirone hcl tab 5 mgbuspirone hcl tab 10 mgbuspirone hcl tab 15 mgbuspirone hcl tab 30 mgDIAZEPAM – diazepam oral soln 1 mg/mldiazepam tab 2 mg (Valium)diazepam tab 5 mg (Valium)diazepam tab 10 mg (Valium)hydroxyzine hcl syrup 10 mg/5mlhydroxyzine hcl tab 10 mghydroxyzine hcl tab 25 mghydroxyzine hcl tab 50 mgHYDROXYZINE PAMOATE – hydroxyzine pamoate cap

100 mghydroxyzine pamoate cap 25 mg (Vistaril)hydroxyzine pamoate cap 50 mg (Vistaril)lorazepam conc 2 mg/ml (Lorazepam intensol)lorazepam tab 0.5 mg (Ativan)lorazepam tab 1 mg (Ativan)lorazepam tab 2 mg (Ativan)ANTIDEPRESSANTSamitriptyline hcl tab 10 mgamitriptyline hcl tab 25 mgamitriptyline hcl tab 50 mgamitriptyline hcl tab 75 mg

Drug Name

amitriptyline hcl tab 100 mgamitriptyline hcl tab 150 mgbupropion hcl tab er 12hr 100 mg (Wellbutrin sr)bupropion hcl tab er 12hr 150 mg (Wellbutrin sr)bupropion hcl tab er 12hr 200 mg (Wellbutrin sr)bupropion hcl tab er 24hr 150 mg (Wellbutrin xl)bupropion hcl tab er 24hr 300 mg (Wellbutrin xl)bupropion hcl tab 75 mg (Wellbutrin)bupropion hcl tab 100 mg (Wellbutrin)citalopram hydrobromide oral soln 10 mg/5mlcitalopram hydrobromide tab 10 mg (base equiv)

(Celexa)citalopram hydrobromide tab 20 mg (base equiv)

(Celexa)citalopram hydrobromide tab 40 mg (base equiv)

(Celexa)clomipramine hcl cap 25 mg (Anafranil)clomipramine hcl cap 50 mg (Anafranil)clomipramine hcl cap 75 mg (Anafranil)desipramine hcl tab 10 mg (Norpramin)desipramine hcl tab 25 mg (Norpramin)desipramine hcl tab 50 mg (Norpramin)desipramine hcl tab 75 mg (Norpramin)desipramine hcl tab 100 mg (Norpramin)desipramine hcl tab 150 mg (Norpramin)desvenlafaxine succinate tab er 24hr 25 mg (base

equiv) (Pristiq)desvenlafaxine succinate tab er 24hr 50 mg (base

equiv) (Pristiq)desvenlafaxine succinate tab er 24hr 100 mg (base

equiv) (Pristiq)doxepin hcl cap 10 mgdoxepin hcl cap 25 mgdoxepin hcl cap 50 mgdoxepin hcl cap 75 mgdoxepin hcl cap 100 mgdoxepin hcl conc 10 mg/mlduloxetine hcl enteric coated pellets cap 20 mg (base

eq) (Cymbalta)duloxetine hcl enteric coated pellets cap 30 mg (base

eq) (Cymbalta)

2020

January 2020 25

Drug Name

duloxetine hcl enteric coated pellets cap 60 mg (baseeq) (Cymbalta)

escitalopram oxalate soln 5 mg/5ml (base equiv)(Lexapro)

escitalopram oxalate tab 5 mg (base equiv) (Lexapro)escitalopram oxalate tab 10 mg (base equiv) (Lexapro)escitalopram oxalate tab 20 mg (base equiv) (Lexapro)fluoxetine hcl cap 10 mg (Prozac)fluoxetine hcl cap 20 mg (Prozac)fluoxetine hcl cap 40 mg (Prozac)fluoxetine hcl solution 20 mg/5mlfluoxetine hcl tab 10 mgfluoxetine hcl tab 20 mgfluvoxamine maleate tab 25 mgfluvoxamine maleate tab 50 mgfluvoxamine maleate tab 100 mgimipramine hcl tab 10 mg (Tofranil)imipramine hcl tab 25 mg (Tofranil)imipramine hcl tab 50 mg (Tofranil)mirtazapine tab 7.5 mgmirtazapine tab 15 mg (Remeron)mirtazapine tab 30 mg (Remeron)mirtazapine tab 45 mg (Remeron)NORTRIPTYLINE HCL – nortriptyline hcl soln 10 mg/5mlnortriptyline hcl cap 10 mg (Pamelor)nortriptyline hcl cap 25 mg (Pamelor)nortriptyline hcl cap 50 mg (Pamelor)nortriptyline hcl cap 75 mg (Pamelor)paroxetine hcl tab er 24hr 12.5 mg (Paxil cr)paroxetine hcl tab er 24hr 25 mg (Paxil cr)paroxetine hcl tab er 24hr 37.5 mg (Paxil cr)paroxetine hcl tab 10 mg (Paxil)paroxetine hcl tab 20 mg (Paxil)paroxetine hcl tab 30 mg (Paxil)paroxetine hcl tab 40 mg (Paxil)phenelzine sulfate tab 15 mg (Nardil)sertraline hcl oral concentrate for solution 20 mg/ml

(Zoloft)sertraline hcl tab 25 mg (Zoloft)sertraline hcl tab 50 mg (Zoloft)

Drug Name

sertraline hcl tab 100 mg (Zoloft)tranylcypromine sulfate tab 10 mg (Parnate)trazodone hcl tab 50 mgtrazodone hcl tab 100 mgtrazodone hcl tab 150 mgtrazodone hcl tab 300 mgvenlafaxine hcl cap er 24hr 37.5 mg (base equivalent)

(Effexor xr)venlafaxine hcl cap er 24hr 75 mg (base equivalent)

(Effexor xr)venlafaxine hcl cap er 24hr 150 mg (base equivalent)

(Effexor xr)venlafaxine hcl tab 25 mg (base equivalent)venlafaxine hcl tab 37.5 mg (base equivalent)venlafaxine hcl tab 50 mg (base equivalent)venlafaxine hcl tab 75 mg (base equivalent)venlafaxine hcl tab 100 mg (base equivalent)ANTIPSYCHOTICSaripiprazole tab 2 mg (Abilify)aripiprazole tab 5 mg (Abilify)aripiprazole tab 10 mg (Abilify)aripiprazole tab 15 mg (Abilify)aripiprazole tab 20 mg (Abilify)aripiprazole tab 30 mg (Abilify)chlorpromazine hcl tab 10 mgchlorpromazine hcl tab 25 mgchlorpromazine hcl tab 50 mgchlorpromazine hcl tab 100 mgchlorpromazine hcl tab 200 mgclozapine tab 25 mg (Clozaril)clozapine tab 50 mgclozapine tab 100 mg (Clozaril)clozapine tab 200 mgfluphenazine decanoate inj 25 mg/mlFLUPHENAZINE HCL – fluphenazine hcl oral conc 5 mg/

mlFLUPHENAZINE HCL – fluphenazine hcl tab 1 mgFLUPHENAZINE HCL – fluphenazine hcl tab 2.5 mgFLUPHENAZINE HCL – fluphenazine hcl tab 5 mgFLUPHENAZINE HCL – fluphenazine hcl tab 10 mg

2020

January 2020 26

Drug Name

FLUPHENAZINE HYDROCHLORID – fluphenazine hclelixir 2.5 mg/5ml

haloperidol decanoate im soln 50 mg/ml (Haldoldecanoate 50)

haloperidol decanoate im soln 100 mg/ml (Haldoldecanoate 100)

haloperidol lactate oral conc 2 mg/mlhaloperidol tab 0.5 mghaloperidol tab 1 mghaloperidol tab 2 mghaloperidol tab 5 mghaloperidol tab 10 mghaloperidol tab 20 mgLITHIUM – lithium oral solution 8 meq/5mlLITHIUM CARBONATE – lithium carbonate cap 150 mglithium carbonate cap 150 mg (Lithium carbonate)lithium carbonate cap 300 mglithium carbonate cap 600 mg (Lithium carbonate)lithium carbonate tab er 300 mg (Lithobid)lithium carbonate tab er 450 mglithium carbonate tab 300 mgloxapine succinate cap 5 mg (Loxitane)loxapine succinate cap 10 mgloxapine succinate cap 25 mgloxapine succinate cap 50 mgolanzapine orally disintegrating tab 5 mg (Zyprexa

zydis)olanzapine orally disintegrating tab 10 mg (Zyprexa



zydis)olanzapine tab 2.5 mg (Zyprexa)olanzapine tab 5 mg (Zyprexa)olanzapine tab 7.5 mg (Zyprexa)olanzapine tab 10 mg (Zyprexa)olanzapine tab 15 mg (Zyprexa)olanzapine tab 20 mg (Zyprexa)perphenazine tab 2 mgperphenazine tab 4 mg

Drug Name

perphenazine tab 8 mgperphenazine tab 16 mgprochlorperazine maleate tab 5 mg (base equivalent)

(Compazine)prochlorperazine maleate tab 10 mg (base equivalent)

(Compazine)prochlorperazine suppos 25 mgquetiapine fumarate tab er 24hr 50 mg (Seroquel xr)quetiapine fumarate tab er 24hr 150 mg (Seroquel xr)quetiapine fumarate tab er 24hr 200 mg (Seroquel xr)quetiapine fumarate tab er 24hr 300 mg (Seroquel xr)quetiapine fumarate tab er 24hr 400 mg (Seroquel xr)quetiapine fumarate tab 25 mg (Seroquel)quetiapine fumarate tab 50 mg (Seroquel)quetiapine fumarate tab 100 mg (Seroquel)quetiapine fumarate tab 200 mg (Seroquel)quetiapine fumarate tab 300 mg (Seroquel)quetiapine fumarate tab 400 mg (Seroquel)RISPERIDONE ODT – risperidone orally disintegrating

tab 0.25 mgrisperidone orally disintegrating tab 0.5 mg (Risperdal

m-tab)risperidone orally disintegrating tab 1 mg (Risperdal




m-tab)risperidone soln 1 mg/ml (Risperdal)risperidone tab 0.25 mg (Risperdal)risperidone tab 0.5 mg (Risperdal)risperidone tab 1 mg (Risperdal)risperidone tab 2 mg (Risperdal)risperidone tab 3 mg (Risperdal)risperidone tab 4 mg (Risperdal)thiothixene cap 1 mgthiothixene cap 2 mgthiothixene cap 5 mgthiothixene cap 10 mgtrifluoperazine hcl tab 1 mg (base equivalent)

2020

January 2020 27

Drug Name

trifluoperazine hcl tab 2 mg (base equivalent)trifluoperazine hcl tab 5 mg (base equivalent)trifluoperazine hcl tab 10 mg (base equivalent)ziprasidone hcl cap 20 mg (Geodon)ziprasidone hcl cap 40 mg (Geodon)ziprasidone hcl cap 60 mg (Geodon)ziprasidone hcl cap 80 mg (Geodon)HYPNOTICSBELSOMRA – suvorexant tab 5 mgBELSOMRA – suvorexant tab 10 mgBELSOMRA – suvorexant tab 15 mgBELSOMRA – suvorexant tab 20 mgestazolam tab 1 mgestazolam tab 2 mgeszopiclone tab 1 mg (Lunesta)eszopiclone tab 2 mg (Lunesta)eszopiclone tab 3 mg (Lunesta)phenobarbital elixir 20 mg/5mlphenobarbital tab 15 mgphenobarbital tab 16.2 mgphenobarbital tab 30 mgphenobarbital tab 32.4 mgphenobarbital tab 60 mgphenobarbital tab 100 mgtemazepam cap 7.5 mg (Restoril)temazepam cap 15 mg (Restoril)temazepam cap 22.5 mg (Restoril)temazepam cap 30 mg (Restoril)zaleplon cap 5 mg (Sonata)zaleplon cap 10 mg (Sonata)zolpidem tartrate tab er 6.25 mg (Ambien cr)zolpidem tartrate tab er 12.5 mg (Ambien cr)zolpidem tartrate tab 5 mg (Ambien)zolpidem tartrate tab 10 mg (Ambien)ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTSADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 5 mgADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 10 mg

Drug Name

ADDERALL XR – amphetamine-dextroamphetamine caper 24hr 15 mg




amphetamine-dextroamphetamine cap er 24hr 5 mg(Adderall xr)






amphetamine-dextroamphetamine tab 5 mg (Adderall)amphetamine-dextroamphetamine tab 7.5 mg

(Adderall)amphetamine-dextroamphetamine tab 10 mg

(Adderall)amphetamine-dextroamphetamine tab 12.5 mg




(Adderall)armodafinil tab 50 mg (Nuvigil)armodafinil tab 150 mg (Nuvigil)armodafinil tab 200 mg (Nuvigil)armodafinil tab 250 mg (Nuvigil)atomoxetine hcl cap 10 mg (base equiv) (Strattera)atomoxetine hcl cap 18 mg (base equiv) (Strattera)atomoxetine hcl cap 25 mg (base equiv) (Strattera)atomoxetine hcl cap 40 mg (base equiv) (Strattera)atomoxetine hcl cap 60 mg (base equiv) (Strattera)atomoxetine hcl cap 80 mg (base equiv) (Strattera)atomoxetine hcl cap 100 mg (base equiv) (Strattera)

2020

January 2020 28

Drug Name

caffeine citrate oral soln 60 mg/3ml (10 mg/ml baseequiv) (Cafcit)

CONCERTA – methylphenidate hcl tab er osmoticrelease (osm) 18 mg




dexmethylphenidate hcl cap er 24 hr 5 mg (Focalin xr)dexmethylphenidate hcl cap er 24 hr 10 mg (Focalin

xr)dexmethylphenidate hcl cap er 24 hr 15 mg (Focalin






xr)dexmethylphenidate hcl tab 2.5 mg (Focalin)dexmethylphenidate hcl tab 5 mg (Focalin)dexmethylphenidate hcl tab 10 mg (Focalin)dextroamphetamine sulfate cap er 24hr 5 mg

(Dexedrine)dextroamphetamine sulfate cap er 24hr 10 mg

(Dexedrine)dextroamphetamine sulfate cap er 24hr 15 mg

(Dexedrine)dextroamphetamine sulfate tab 5 mgdextroamphetamine sulfate tab 10 mgguanfacine hcl tab er 24hr 1 mg (base equiv) (Intuniv)guanfacine hcl tab er 24hr 2 mg (base equiv) (Intuniv)guanfacine hcl tab er 24hr 3 mg (base equiv) (Intuniv)guanfacine hcl tab er 24hr 4 mg (base equiv) (Intuniv)methylphenidate hcl tab er 10 mgmethylphenidate hcl tab er 20 mgmethylphenidate hcl tab 5 mg (Ritalin)

Drug Name

methylphenidate hcl tab 10 mg (Ritalin)methylphenidate hcl tab 20 mg (Ritalin)modafinil tab 100 mg (Provigil)modafinil tab 200 mg (Provigil)SUNOSI – solriamfetol hcl tab 75 mg (base equiv)SUNOSI – solriamfetol hcl tab 150 mg (base equiv)VYVANSE – lisdexamfetamine dimesylate cap 10 mgVYVANSE – lisdexamfetamine dimesylate cap 20 mgVYVANSE – lisdexamfetamine dimesylate cap 30 mgVYVANSE – lisdexamfetamine dimesylate cap 40 mgVYVANSE – lisdexamfetamine dimesylate cap 50 mgVYVANSE – lisdexamfetamine dimesylate cap 60 mgVYVANSE – lisdexamfetamine dimesylate cap 70 mgVYVANSE – lisdexamfetamine dimesylate chew tab 10

mgVYVANSE – lisdexamfetamine dimesylate chew tab 20





mgPSYCHOTHERAPEUTIC and NEUROLOGICALAGENTS - MISC.acamprosate calcium tab delayed release 333 mg

(Campral)AUBAGIO – teriflunomide tab 7 mgAUBAGIO – teriflunomide tab 14 mgAVONEX – interferon beta-1a im prefilled syringe kit 30

mcg/0.5mlAVONEX PEN – interferon beta-1a im auto-injector kit 30

mcg/0.5mlBETASERON – interferon beta-1b for inj kit 0.3 mgbupropion hcl (smoking deterrent) tab er 12hr 150 mg

(Zyban)CHANTIX – varenicline tartrate tab 0.5 mg (base equiv)CHANTIX – varenicline tartrate tab 1 mg (base equiv)CHANTIX CONTINUING MONTH – varenicline tartrate

tab 1 mg (base equiv)

2020

January 2020 29

Drug Name

CHANTIX STARTING MONTH PA – varenicline tartratetab 0.5 mg x 11 & tab 1 mg x 42 pack

COPAXONE – glatiramer acetate soln prefilled syringe 20mg/ml

COPAXONE – glatiramer acetate soln prefilled syringe 40mg/ml

disulfiram tab 250 mg (Antabuse)disulfiram tab 500 mg (Antabuse)donepezil hydrochloride orally disintegrating tab

5 mg (Aricept odt)donepezil hydrochloride orally disintegrating tab

10 mg (Aricept odt)donepezil hydrochloride tab 5 mg (Aricept)donepezil hydrochloride tab 10 mg (Aricept)GALANTAMINE HYDROBROMIDE – galantamine

hydrobromide oral soln 4 mg/mlgalantamine hydrobromide cap er 24hr 8 mg

(Razadyne er)galantamine hydrobromide cap er 24hr 16 mg

(Razadyne er)galantamine hydrobromide cap er 24hr 24 mg

(Razadyne er)galantamine hydrobromide tab 4 mg (Razadyne)galantamine hydrobromide tab 8 mg (Razadyne)galantamine hydrobromide tab 12 mg (Razadyne)GILENYA – fingolimod hcl cap 0.5 mg (base equiv)glatiramer acetate soln prefilled syringe 20 mg/ml

(Copaxone)glatiramer acetate soln prefilled syringe 40 mg/ml

(Copaxone)MAVENCLAD – cladribine tab therapy pack 10 mg (4

tabs)MAVENCLAD – cladribine tab therapy pack 10 mg (5






tabs)

Drug Name

MAYZENT – siponimod fumarate tab 0.25 mg (baseequiv)

MAYZENT – siponimod fumarate tab 2 mg (base equiv)memantine hcl oral solution 2 mg/ml (Namenda)memantine hcl tab 5 mg (Namenda)memantine hcl tab 10 mg (Namenda)memantine hcl tab 5 mg (28) & 10 mg (21) titration

pak (Namenda titration pa)NICOTROL INHALER – nicotine inhaler system 10 mg (4

mg delivered)NICOTROL NS – nicotine nasal spray 10 mg/ml (0.5 mg/

spray)PIMOZIDE – pimozide tab 1 mgPIMOZIDE – pimozide tab 2 mgPLEGRIDY – peginterferon beta-1a soln pen-injector 125

mcg/0.5mlPLEGRIDY – peginterferon beta-1a soln prefilled syringe

125 mcg/0.5mlPLEGRIDY STARTER PACK – peginterferon beta-1a

soln pen-inj 63 & 94 mcg/0.5ml packPLEGRIDY STARTER PACK – peginterferon beta-1a

soln pref syr 63 & 94 mcg/0.5ml packREBIF – interferon beta-1a soln pref syr 22 mcg/0.5ml

(12mu/ml)REBIF – interferon beta-1a soln pref syr 44 mcg/0.5ml

(24mu/ml)REBIF REBIDOSE – interferon beta-1a soln auto-inj 22

mcg/0.5ml (12mu/ml)REBIF REBIDOSE – interferon beta-1a soln auto-inj 44

mcg/0.5ml (24mu/ml)REBIF REBIDOSE TITRATION – interferon beta-1a auto-

inj 6x8.8 mcg/0.2ml & 6x22 mcg/0.5mlREBIF TITRATION PACK – interferon beta-1a pref syr

6x8.8 mcg/0.2ml & 6x22 mcg/0.5mlrivastigmine tartrate cap 1.5 mg (base equivalent)rivastigmine tartrate cap 3 mg (base equivalent)rivastigmine tartrate cap 4.5 mg (base equivalent)rivastigmine tartrate cap 6 mg (base equivalent)TECFIDERA – dimethyl fumarate capsule delayed

release 120 mgTECFIDERA – dimethyl fumarate capsule delayed

release 240 mgTECFIDERA STARTER PACK – dimethyl fumarate

capsule dr starter pack 120 mg & 240 mg

2020

January 2020 30

Drug Name

tetrabenazine tab 12.5 mg (Xenazine)tetrabenazine tab 25 mg (Xenazine)ANALGESICS AND ANESTHETICSANALGESICS - NON-NARCOTICbutalbital-acetaminophen tab 50-325 mgbutalbital-acetaminophen-caffeine tab 50-325-40 mg

(Esgic)butalbital-aspirin-caffeine cap 50-325-40 mg (Fiorinal)TENCON – butalbital-acetaminophen tab 50-325 mgANALGESICS - NARCOTICacetaminophen w/ codeine soln 120-12 mg/5mlacetaminophen w/ codeine tab 300-15 mg (Tylenol/

codeine)acetaminophen w/ codeine tab 300-30 mg (Tylenol/

codeine #3)acetaminophen w/ codeine tab 300-60 mg (Tylenol/

codeine #4)buprenorphine hcl sl tab 2 mg (base equiv)buprenorphine hcl sl tab 8 mg (base equiv)butalbital-aspirin-caff w/ codeine cap

50-325-40-30 mg (Fiorinal/codeine #3)codeine sulfate tab 30 mgfentanyl citrate lozenge on a handle 200 mcg (Actiq)fentanyl citrate lozenge on a handle 400 mcg (Actiq)fentanyl citrate lozenge on a handle 600 mcg (Actiq)fentanyl citrate lozenge on a handle 800 mcg (Actiq)fentanyl citrate lozenge on a handle 1200 mcg (Actiq)fentanyl citrate lozenge on a handle 1600 mcg (Actiq)fentanyl td patch 72hr 12 mcg/hr (Duragesic)fentanyl td patch 72hr 25 mcg/hr (Duragesic)fentanyl td patch 72hr 50 mcg/hr (Duragesic)fentanyl td patch 72hr 75 mcg/hr (Duragesic)fentanyl td patch 72hr 100 mcg/hr (Duragesic)hydrocodone-acetaminophen soln 7.5-325 mg/15ml

(Hycet)hydrocodone-acetaminophen tab 10-325 mg (Norco)hydrocodone-acetaminophen tab 5-325 mg (Norco)hydrocodone-acetaminophen tab 7.5-325 mg (Norco)hydrocodone-ibuprofen tab 5-200 mg (Reprexain)hydrocodone-ibuprofen tab 7.5-200 mg (Vicoprofen)hydrocodone-ibuprofen tab 10-200 mg (Ibudone)

Drug Name

hydromorphone hcl liqd 1 mg/ml (Dilaudid)hydromorphone hcl tab 2 mg (Dilaudid)hydromorphone hcl tab 4 mg (Dilaudid)hydromorphone hcl tab 8 mg (Dilaudid)methadone hcl conc 10 mg/ml (Methadose)methadone hcl soln 5 mg/5ml (Methadone hcl)methadone hcl soln 10 mg/5ml (Methadone hcl)methadone hcl tab for oral susp 40 mgmethadone hcl tab 5 mg (Dolophine hcl)methadone hcl tab 10 mg (Dolophine)MORPHINE SULFATE – morphine sulfate tab 15 mgMORPHINE SULFATE – morphine sulfate tab 30 mgMORPHINE SULFATE ER – morphine sulfate beads cap

er 24hr 30 mgMORPHINE SULFATE ER – morphine sulfate beads cap





er 24hr 120 mgmorphine sulfate oral soln 10 mg/5mlmorphine sulfate oral soln 20 mg/5mlmorphine sulfate oral soln 100 mg/5ml (20 mg/ml)morphine sulfate tab er 15 mg (Ms contin)morphine sulfate tab er 30 mg (Ms contin)morphine sulfate tab er 60 mg (Ms contin)morphine sulfate tab er 100 mg (Ms contin)morphine sulfate tab er 200 mg (Ms contin)morphine sulfate tab 15 mg (Morphine sulfate)morphine sulfate tab 30 mg (Morphine sulfate)NUCYNTA ER – tapentadol hcl tab er 12hr 50 mgNUCYNTA ER – tapentadol hcl tab er 12hr 100 mgNUCYNTA ER – tapentadol hcl tab er 12hr 150 mgNUCYNTA ER – tapentadol hcl tab er 12hr 200 mgNUCYNTA ER – tapentadol hcl tab er 12hr 250 mgoxycodone hcl cap 5 mg

2020

January 2020 31

Drug Name

oxycodone hcl conc 100 mg/5ml (20 mg/ml)(Oxycodone hcl)

oxycodone hcl soln 5 mg/5ml (Oxycodone hcl)oxycodone hcl tab 5 mg (Roxicodone)oxycodone hcl tab 10 mgoxycodone hcl tab 15 mg (Roxicodone)oxycodone hcl tab 20 mgoxycodone hcl tab 30 mg (Roxicodone)oxycodone w/ acetaminophen tab 5-325 mg (Percocet)oxycodone w/ acetaminophen tab 7.5-325 mg

(Percocet)oxycodone w/ acetaminophen tab 10-325 mg

(Percocet)OXYCODONE/ASPIRIN – oxycodone-aspirin tab

4.8355-325 mgOXYCONTIN – oxycodone hcl tab er 12hr deter 10 mgOXYCONTIN – oxycodone hcl tab er 12hr deter 15 mgOXYCONTIN – oxycodone hcl tab er 12hr deter 20 mgOXYCONTIN – oxycodone hcl tab er 12hr deter 30 mgOXYCONTIN – oxycodone hcl tab er 12hr deter 40 mgOXYCONTIN – oxycodone hcl tab er 12hr deter 60 mgOXYCONTIN – oxycodone hcl tab er 12hr deter 80 mgtramadol hcl tab er 24hr 100 mgtramadol hcl tab er 24hr 200 mgtramadol hcl tab er 24hr 300 mgtramadol hcl tab 50 mg (Ultram)tramadol-acetaminophen tab 37.5-325 mg (Ultracet)ANALGESICS - ANTI-INFLAMMATORYcelecoxib cap 50 mg (Celebrex)celecoxib cap 100 mg (Celebrex)celecoxib cap 200 mg (Celebrex)celecoxib cap 400 mg (Celebrex)diclofenac potassium tab 50 mg (Cataflam)diclofenac sodium tab delayed release 25 mgdiclofenac sodium tab delayed release 50 mgdiclofenac sodium tab delayed release 75 mgdiclofenac sodium tab er 24hr 100 mgENBREL – etanercept for subcutaneous inj 25 mgENBREL – etanercept subcutaneous soln prefilled

syringe 25 mg/0.5ml

Drug Name

ENBREL – etanercept subcutaneous soln prefilledsyringe 50 mg/ml

ENBREL MINI – etanercept subcutaneous solutioncartridge 50 mg/ml

ENBREL SURECLICK – etanercept subcutaneoussolution auto-injector 50 mg/ml

etodolac cap 200 mgetodolac cap 300 mgetodolac tab er 24hr 400 mgetodolac tab er 24hr 500 mgetodolac tab er 24hr 600 mgetodolac tab 400 mgetodolac tab 500 mgflurbiprofen tab 50 mgflurbiprofen tab 100 mgHUMIRA – adalimumab prefilled syringe kit 10 mg/0.1mlHUMIRA – adalimumab prefilled syringe kit 10 mg/0.2mlHUMIRA – adalimumab prefilled syringe kit 20 mg/0.2mlHUMIRA – adalimumab prefilled syringe kit 20 mg/0.4mlHUMIRA – adalimumab prefilled syringe kit 40 mg/0.8mlHUMIRA – adalimumab prefilled syringe kit 40 mg/0.4mlHUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 40 mg/0.8mlHUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 80 mg/0.8mlHUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 80 mg/0.8ml & 40 mg/0.4mlHUMIRA PEN – adalimumab pen-injector kit 40 mg/0.8mlHUMIRA PEN – adalimumab pen-injector kit 40 mg/0.4mlHUMIRA PEN-CD/UC/HS START – adalimumab pen-

injector kit 40 mg/0.8mlHUMIRA PEN-CD/UC/HS START – adalimumab pen-

injector kit 80 mg/0.8mlHUMIRA PEN-PS/UV STARTER – adalimumab pen-

injector kit 40 mg/0.8mlHUMIRA PEN-PS/UV STARTER – adalimumab pen-

injector kit 80 mg/0.8ml & 40 mg/0.4mlibuprofen susp 100 mg/5mlibuprofen tab 400 mgibuprofen tab 600 mgibuprofen tab 800 mgILARIS – canakinumab subcutaneous inj 150 mg/ml

2020

January 2020 32

Drug Name

indomethacin cap 25 mgindomethacin cap 50 mgleflunomide tab 10 mg (Arava)leflunomide tab 20 mg (Arava)meloxicam tab 7.5 mg (Mobic)meloxicam tab 15 mg (Mobic)nabumetone tab 500 mgnabumetone tab 750 mgnaproxen sodium tab 275 mg (Anaprox)naproxen sodium tab 550 mg (Anaprox ds)naproxen susp 125 mg/5ml (Naprosyn)naproxen tab ec 375 mg (Ec-naprosyn)naproxen tab ec 500 mg (Ec-naprosyn)naproxen tab 250 mg (Naprosyn)naproxen tab 375 mg (Naprosyn)naproxen tab 500 mg (Naprosyn)OTEZLA – apremilast tab starter therapy pack 10 mg &

20 mg & 30 mgOTEZLA – apremilast tab 30 mgOTREXUP – methotrexate soln pf auto-injector 10

mg/0.4mlOTREXUP – methotrexate soln pf auto-injector 12.5

mg/0.4mlOTREXUP – methotrexate soln pf auto-injector 15





mg/0.4mloxaprozin tab 600 mg (Daypro)piroxicam cap 10 mg (Feldene)piroxicam cap 20 mg (Feldene)RINVOQ – upadacitinib tab er 24hr 15 mgsulindac tab 150 mgsulindac tab 200 mgMIGRAINE PRODUCTSAIMOVIG – erenumab-aooe subcutaneous soln auto-

injector 70 mg/ml

Drug Name

AIMOVIG – erenumab-aooe subcutaneous soln auto-injector 140 mg/ml

dihydroergotamine mesylate inj 1 mg/ml (D.h.e. 45)eletriptan hydrobromide tab 20 mg (base equivalent)

(Relpax)eletriptan hydrobromide tab 40 mg (base equivalent)

(Relpax)EMGALITY – galcanezumab-gnlm subcutaneous soln

auto-injector 120 mg/mlEMGALITY – galcanezumab-gnlm subcutaneous soln

prefilled syr 100 mg/mlEMGALITY – galcanezumab-gnlm subcutaneous soln

prefilled syr 120 mg/mlMIGRANAL – dihydroergotamine mesylate nasal spray 4

mg/mlnaratriptan hcl tab 1 mg (base equiv) (Amerge)naratriptan hcl tab 2.5 mg (base equiv) (Amerge)rizatriptan benzoate oral disintegrating tab 5 mg

(base eq) (Maxalt-mlt)rizatriptan benzoate oral disintegrating tab 10 mg

(base eq) (Maxalt-mlt)rizatriptan benzoate tab 5 mg (base equivalent)

(Maxalt)rizatriptan benzoate tab 10 mg (base equivalent)

(Maxalt)sumatriptan nasal spray 5 mg/act (Imitrex)sumatriptan nasal spray 20 mg/act (Imitrex)SUMATRIPTAN SUCCINATE – sumatriptan succinate

solution prefilled syringe 6 mg/0.5mlsumatriptan succinate inj 6 mg/0.5ml (Imitrex statdose

ref)sumatriptan succinate solution auto-injector

4 mg/0.5ml (Imitrex statdose sys)sumatriptan succinate solution auto-injector

6 mg/0.5ml (Imitrex statdose sys)sumatriptan succinate solution cartridge 4 mg/0.5ml

(Imitrex statdose ref)sumatriptan succinate solution cartridge 6 mg/0.5ml

(Imitrex statdose ref)sumatriptan succinate tab 25 mg (Imitrex)sumatriptan succinate tab 50 mg (Imitrex)sumatriptan succinate tab 100 mg (Imitrex)GOUT AGENTSallopurinol tab 100 mg (Zyloprim)

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January 2020 33

Drug Name

allopurinol tab 300 mg (Zyloprim)colchicine w/ probenecid tab 0.5-500 mgMITIGARE – colchicine cap 0.6 mgprobenecid tab 500 mgNEUROMUSCULAR DRUGSANTICONVULSANTSBANZEL – rufinamide tab 200 mgBANZEL – rufinamide tab 400 mgcarbamazepine cap er 12hr 100 mg (Carbatrol)carbamazepine cap er 12hr 200 mg (Carbatrol)carbamazepine cap er 12hr 300 mg (Carbatrol)carbamazepine chew tab 100 mgcarbamazepine susp 100 mg/5ml (Tegretol)carbamazepine tab er 12hr 100 mg (Tegretol-xr)carbamazepine tab er 12hr 200 mg (Tegretol-xr)carbamazepine tab er 12hr 400 mg (Tegretol-xr)carbamazepine tab 200 mg (Tegretol)CELONTIN – methsuximide cap 300 mgclonazepam tab 0.5 mg (Klonopin)clonazepam tab 1 mg (Klonopin)clonazepam tab 2 mg (Klonopin)DIASTAT ACUDIAL – diazepam rectal gel delivery

system 10 mgDIASTAT ACUDIAL – diazepam rectal gel delivery

system 20 mgDIASTAT PEDIATRIC – diazepam rectal gel delivery

system 2.5 mgDILANTIN – phenytoin sodium extended cap 30 mgDILANTIN – phenytoin sodium extended cap 100 mgDILANTIN-125 – phenytoin susp 125 mg/5mldivalproex sodium cap delayed release sprinkle

125 mg (Depakote sprinkles)divalproex sodium tab delayed release 125 mg

(Depakote)divalproex sodium tab delayed release 250 mg

(Depakote)divalproex sodium tab delayed release 500 mg

(Depakote)divalproex sodium tab er 24 hr 250 mg (Depakote er)divalproex sodium tab er 24 hr 500 mg (Depakote er)EPIDIOLEX – cannabidiol soln 100 mg/ml

Drug Name

ethosuximide cap 250 mg (Zarontin)ethosuximide soln 250 mg/5ml (Zarontin)gabapentin cap 100 mg (Neurontin)gabapentin cap 300 mg (Neurontin)gabapentin cap 400 mg (Neurontin)gabapentin oral soln 250 mg/5ml (Neurontin)gabapentin tab 600 mg (Neurontin)gabapentin tab 800 mg (Neurontin)lamotrigine tab chewable dispersible 5 mg (Lamictal

chewable di)lamotrigine tab chewable dispersible 25 mg (Lamictal

chewable di)lamotrigine tab 25 mg (Lamictal)lamotrigine tab 100 mg (Lamictal)lamotrigine tab 150 mg (Lamictal)lamotrigine tab 200 mg (Lamictal)levetiracetam oral soln 100 mg/ml (Keppra)levetiracetam tab er 24hr 500 mg (Keppra xr)levetiracetam tab er 24hr 750 mg (Keppra xr)levetiracetam tab 250 mg (Keppra)levetiracetam tab 500 mg (Keppra)levetiracetam tab 750 mg (Keppra)levetiracetam tab 1000 mg (Keppra)pregabalin soln 20 mg/mlpregabalin cap 25 mgpregabalin cap 50 mgpregabalin cap 75 mgpregabalin cap 100 mgpregabalin cap 150 mgpregabalin cap 200 mgpregabalin cap 225 mgpregabalin cap 300 mgoxcarbazepine susp 300 mg/5ml (60 mg/ml) (Trileptal)oxcarbazepine tab 150 mg (Trileptal)oxcarbazepine tab 300 mg (Trileptal)oxcarbazepine tab 600 mg (Trileptal)phenytoin chew tab 50 mg (Dilantin infatabs)phenytoin sodium extended cap 100 mg (Dilantin)phenytoin sodium extended cap 200 mg (Phenytek)phenytoin sodium extended cap 300 mg (Phenytek)

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January 2020 34

Drug Name

phenytoin susp 125 mg/5ml (Dilantin)pregabalin cap 25 mg (Lyrica)pregabalin cap 50 mg (Lyrica)pregabalin cap 75 mg (Lyrica)pregabalin cap 100 mg (Lyrica)pregabalin cap 150 mg (Lyrica)pregabalin cap 200 mg (Lyrica)pregabalin cap 225 mg (Lyrica)pregabalin cap 300 mg (Lyrica)pregabalin soln 20 mg/ml (Lyrica)primidone tab 50 mg (Mysoline)primidone tab 250 mg (Mysoline)topiramate sprinkle cap 15 mg (Topamax sprinkle)topiramate sprinkle cap 25 mg (Topamax sprinkle)topiramate tab 25 mg (Topamax)topiramate tab 50 mg (Topamax)topiramate tab 100 mg (Topamax)topiramate tab 200 mg (Topamax)valproate sodium oral soln 250 mg/5ml (base equiv)

(Depakene)valproic acid cap 250 mg (Depakene)vigabatrin powd pack 500 mg (Sabril)vigabatrin tab 500 mg (Sabril)zonisamide cap 25 mg (Zonegran)zonisamide cap 50 mgzonisamide cap 100 mg (Zonegran)ANTIPARKINSON AGENTSamantadine hcl cap 100 mgamantadine hcl syrup 50 mg/5mlbenztropine mesylate tab 0.5 mgbenztropine mesylate tab 1 mgbenztropine mesylate tab 2 mgcarbidopa & levodopa orally disintegrating tab

10-100 mg (Parcopa)carbidopa & levodopa orally disintegrating tab

25-100 mg (Parcopa)carbidopa & levodopa orally disintegrating tab

25-250 mg (Parcopa)carbidopa & levodopa tab er 25-100 mg (Sinemet cr)carbidopa & levodopa tab er 50-200 mg (Sinemet cr)

Drug Name

carbidopa & levodopa tab 10-100 mg (Sinemet)carbidopa & levodopa tab 25-100 mg (Sinemet)carbidopa & levodopa tab 25-250 mg (Sinemet)CARBIDOPA/LEVODOPA/ENTACA – carbidopa-

levodopa-entacapone tabs 12.5-50-200 mgCARBIDOPA/LEVODOPA/ENTACA – carbidopa-


levodopa-entacapone tabs 25-100-200 mgCARBIDOPA/LEVODOPA/ENTACA – carbidopa-



levodopa-entacapone tabs 50-200-200 mgentacapone tab 200 mg (Comtan)INBRIJA – levodopa inhal powder cap 42 mgpramipexole dihydrochloride tab 0.125 mg (Mirapex)pramipexole dihydrochloride tab 0.25 mg (Mirapex)pramipexole dihydrochloride tab 0.5 mg (Mirapex)pramipexole dihydrochloride tab 0.75 mg (Mirapex)pramipexole dihydrochloride tab 1 mg (Mirapex)pramipexole dihydrochloride tab 1.5 mg (Mirapex)rasagiline mesylate tab 0.5 mg (base equiv) (Azilect)rasagiline mesylate tab 1 mg (base equiv) (Azilect)ropinirole hydrochloride tab 0.25 mg (Requip)ropinirole hydrochloride tab 0.5 mg (Requip)ropinirole hydrochloride tab 1 mg (Requip)ropinirole hydrochloride tab 2 mg (Requip)ropinirole hydrochloride tab 3 mg (Requip)ropinirole hydrochloride tab 4 mg (Requip)ropinirole hydrochloride tab 5 mg (Requip)SELEGILINE HCL – selegiline hcl cap 5 mgSELEGILINE HCL – selegiline hcl tab 5 mgtrihexyphenidyl hcl elixir 0.4 mg/mltrihexyphenidyl hcl tab 2 mgtrihexyphenidyl hcl tab 5 mgNEUROMUSCULAR AGENTSriluzole tab 50 mg (Rilutek)MUSCULOSKELETAL THERAPY AGENTSbaclofen tab 10 mg

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January 2020 35

Drug Name

baclofen tab 20 mgCHLORZOXAZONE – chlorzoxazone tab 500 mgcyclobenzaprine hcl tab 5 mgcyclobenzaprine hcl tab 10 mgdantrolene sodium cap 25 mg (Dantrium)dantrolene sodium cap 50 mg (Dantrium)dantrolene sodium cap 100 mg (Dantrolene sodium)EUFLEXXA – sodium hyaluronate intra-articular soln pref

syr 20 mg/2mlmethocarbamol tab 500 mg (Robaxin)methocarbamol tab 750 mg (Robaxin-750)orphenadrine citrate tab er 12hr 100 mgSYNVISC – hylan intra-articular solution prefilled syringe

16 mg/2mlSYNVISC ONE – hylan intra-articular solution prefilled

syringe 48 mg/6mltizanidine hcl tab 2 mg (base equivalent)tizanidine hcl tab 4 mg (base equivalent) (Zanaflex)ANTIMYASTHENIC AGENTSpyridostigmine bromide tab 60 mg (Mestinon)NUTRITIONAL PRODUCTSVITAMINSergocalciferol cap 1.25 mg (50000 unit) (Drisdol)phytonadione tab 5 mg (Mephyton)MULTIVITAMINSKOSHER PRENATAL PLUS IRON – prenatal vit w/ iron

carbonyl-fa tab 30-1 mgPRENATABS RX – prenatal vit w/ iron carbonyl-fa tab

29-1 mgPRENATAL PLUS IRON – prenatal vit w/ iron carbonyl-fa

tab 29-1 mgPRENATAL VITAMINS PLUS LO – prenatal vit w/ fe

fumarate-fa tab 27-1 mgPRENATAL 19 – prenatal vit w/ fe fumarate-fa chew tab

29-1 mgPRENATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab

29-1 mgPRENATAL-U – prenatal w/o a vit w/ fe fumarate-fa cap

106.5-1 mgSE-NATAL 19 – prenatal vit w/ fe fumarate-fa chew tab

29-1 mgSE-NATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab

29-1 mg

Drug Name

TRINATE – prenatal vit w/ fe fumarate-fa tab 28-1 mgVINATE II – prenatal vit w/ fe bisglycinate chelate-fa tab

29-1 mgVINATE M – prenatal vit w/ sel-fe fumarate-fa tab 27-1

mgVINATE ONE – prenatal vit w/ fe fumarate-fa tab 60-1 mgMINERALS and ELECTROLYTESFLURA-DROPS – sodium fluoride soln 0.25 mg/drop f

(from 0.55 mg/drop naf)K-PHOS – potassium phosphate monobasic tab 500 mgpot phos monobasic w/sod phos di & monobas tab

155-852-130mg (K-phos neutral)potassium chloride cap er 8 meq (Micro-k)potassium chloride cap er 10 meq (Micro-k)POTASSIUM CHLORIDE ER – potassium chloride tab er

8 meq (600 mg)potassium chloride microencapsulated crys er tab 10

meqpotassium chloride microencapsulated crys er tab 20

meqpotassium chloride oral soln 10% (20 meq/15ml)potassium chloride oral soln 20% (40 meq/15ml)potassium chloride powder packet 20 meq (K-lor

hospital pack)potassium chloride tab er 8 meq (600 mg)potassium chloride tab er 10 meq (K-tab)SODIUM FLUORIDE – sodium fluoride tab 0.5 mg f (from

1.1 mg naf)SODIUM FLUORIDE – sodium fluoride tab 1 mg f (from

2.2 mg naf)sodium fluoride chew tab 0.25 mg f (from 0.55 mg

naf) (Luride)sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)

(Luride)sodium fluoride chew tab 1 mg f (from 2.2 mg naf)

(Luride)sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop

naf)sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)

(Luride)HEMATOLOGICAL AGENTSHEMATOPOIETIC AGENTSARANESP ALBUMIN FREE – darbepoetin alfa soln

prefilled syringe 10 mcg/0.4ml

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January 2020 36

Drug Name

ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 25 mcg/0.42ml







ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 500 mcg/ml

ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 25mcg/ml



ARANESP ALBUMIN FREE – darbepoetin alfa soln inj100 mcg/ml



cyanocobalamin inj 1000 mcg/mlfolic acid tab 1 mgFULPHILA – pegfilgrastim-jmdb soln prefilled syringe 6

mg/0.6mlGRANIX – tbo-filgrastim soln prefilled syringe 300

mcg/0.5mlGRANIX – tbo-filgrastim soln prefilled syringe 480

mcg/0.8mlGRANIX – tbo-filgrastim subcutaneous inj 300 mcg/mlGRANIX – tbo-filgrastim subcutaneous inj 480 mcg/1.6ml

(300 mcg/ml)NEULASTA – pegfilgrastim soln prefilled syringe 6

mg/0.6mlNEULASTA ONPRO KIT – pegfilgrastim soln prefilled

syringe kit 6 mg/0.6mlNEUPOGEN – filgrastim soln prefilled syringe 300

mcg/0.5ml

Drug Name

NEUPOGEN – filgrastim soln prefilled syringe 480mcg/0.8ml (600 mcg/ml)

NEUPOGEN – filgrastim inj 300 mcg/mlNEUPOGEN – filgrastim inj 480 mcg/1.6ml (300 mcg/ml)NIVESTYM – filgrastim-aafi soln prefilled syringe 300

mcg/0.5mlNIVESTYM – filgrastim-aafi soln prefilled syringe 480

mcg/0.8mlNIVESTYM – filgrastim-aafi inj 300 mcg/mlNIVESTYM – filgrastim-aafi inj 480 mcg/1.6ml (300 mcg/

ml)PROCRIT – epoetin alfa inj 2000 unit/mlPROCRIT – epoetin alfa inj 3000 unit/mlPROCRIT – epoetin alfa inj 4000 unit/mlPROCRIT – epoetin alfa inj 10000 unit/mlPROCRIT – epoetin alfa inj 20000 unit/mlPROCRIT – epoetin alfa inj 40000 unit/mlRETACRIT – epoetin alfa-epbx inj 2000 unit/mlRETACRIT – epoetin alfa-epbx inj 3000 unit/mlRETACRIT – epoetin alfa-epbx inj 4000 unit/mlRETACRIT – epoetin alfa-epbx inj 10000 unit/mlRETACRIT – epoetin alfa-epbx inj 40000 unit/mlUDENYCA – pegfilgrastim-cbqv soln prefilled syringe 6

mg/0.6mlZARXIO – filgrastim-sndz soln prefilled syringe 300

mcg/0.5mlZARXIO – filgrastim-sndz soln prefilled syringe 480

mcg/0.8mlANTICOAGULANTSELIQUIS – apixaban tab 2.5 mgELIQUIS – apixaban tab 5 mgELIQUIS STARTER PACK – apixaban tab 5 mgenoxaparin sodium inj 30 mg/0.3ml (Lovenox)enoxaparin sodium inj 40 mg/0.4ml (Lovenox)enoxaparin sodium inj 60 mg/0.6ml (Lovenox)enoxaparin sodium inj 80 mg/0.8ml (Lovenox)enoxaparin sodium inj 100 mg/ml (Lovenox)enoxaparin sodium inj 120 mg/0.8ml (Lovenox)enoxaparin sodium inj 150 mg/ml (Lovenox)enoxaparin sodium inj 300 mg/3ml (Lovenox)warfarin sodium tab 1 mg (Coumadin)

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January 2020 37

Drug Name

warfarin sodium tab 2 mg (Coumadin)warfarin sodium tab 2.5 mg (Coumadin)warfarin sodium tab 3 mg (Coumadin)warfarin sodium tab 4 mg (Coumadin)warfarin sodium tab 5 mg (Coumadin)warfarin sodium tab 6 mg (Coumadin)warfarin sodium tab 7.5 mg (Coumadin)warfarin sodium tab 10 mg (Coumadin)XARELTO – rivaroxaban tab 2.5 mgXARELTO – rivaroxaban tab 10 mgXARELTO – rivaroxaban tab 15 mgXARELTO – rivaroxaban tab 20 mgXARELTO STARTER PACK – rivaroxaban tab starter

therapy pack 15 mg & 20 mgHEMATOLOGICAL AGENTS - MISC.anagrelide hcl cap 0.5 mg (Agrylin)anagrelide hcl cap 1 mgBRILINTA – ticagrelor tab 60 mgBRILINTA – ticagrelor tab 90 mgcilostazol tab 50 mg (Pletal)cilostazol tab 100 mg (Pletal)CINRYZE – c1 esterase inhibitor (human) for iv inj 500

unitclopidogrel bisulfate tab 75 mg (base equiv) (Plavix)dipyridamole tab 25 mg (Persantine)dipyridamole tab 50 mg (Persantine)dipyridamole tab 75 mg (Persantine)FIRAZYR – icatibant acetate inj 30 mg/3ml (base

equivalent)HAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 2000 unitHAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 3000 uniticatibant acetate inj 30 mg/3ml (base equivalent)

(Firazyr)pentoxifylline tab er 400 mgprasugrel hcl tab 5 mg (base equiv) (Effient)prasugrel hcl tab 10 mg (base equiv) (Effient)TOPICAL PRODUCTSOPHTHALMIC AGENTSALPHAGAN P – brimonidine tartrate ophth soln 0.1%ALPHAGAN P – brimonidine tartrate opth soln 0.15%

Drug Name

ALREX – loteprednol etabonate ophth susp 0.2%ATROPINE SULFATE – atropine sulfate ophth soln 1%azelastine hcl ophth soln 0.05% (Optivar)AZOPT – brinzolamide ophth susp 1%BACITRACIN – bacitracin ophth oint 500 unit/gmbacitracin-polymyxin b ophth ointbacitracin-polymyxin-neomycin-hc ophth oint 1%brimonidine tartrate ophth soln 0.15% (Alphagan p)brimonidine tartrate ophth soln 0.2%CARTEOLOL HCL – carteolol hcl ophth soln 1%CILOXAN – ciprofloxacin hcl ophth oint 0.3%ciprofloxacin hcl ophth soln 0.3% (base equivalent)

(Ciloxan)cromolyn sodium ophth soln 4%cyclopentolate hcl ophth soln 1% (Cyclogyl)DEXAMETHASONE SODIUM PHOS – dexamethasone

sodium phosphate ophth soln 0.1%diclofenac sodium ophth soln 0.1%dorzolamide hcl ophth soln 2% (Trusopt)dorzolamide hcl-timolol maleate ophth soln

22.3-6.8 mg/ml (Cosopt)erythromycin ophth oint 5 mg/gmfluorometholone ophth susp 0.1% (Fml liquifilm)FLURBIPROFEN SODIUM – flurbiprofen sodium ophth

soln 0.03%GENTAK – gentamicin sulfate ophth oint 0.3%gentamicin sulfate ophth soln 0.3% (Garamycin)ketorolac tromethamine ophth soln 0.4% (Acular ls)ketorolac tromethamine ophth soln 0.5% (Acular)latanoprost ophth soln 0.005% (Xalatan)levobunolol hcl ophth soln 0.5% (Betagan)LOTEMAX – loteprednol etabonate ophth oint 0.5%LOTEMAX – loteprednol etabonate ophth gel 0.5%LOTEMAX SM – loteprednol etabonate ophth gel 0.38%loteprednol etabonate ophth susp 0.5% (Lotemax)LUMIGAN – bimatoprost ophth soln 0.01%moxifloxacin hcl ophth soln 0.5% (base equiv)

(Vigamox)NATACYN – natamycin ophth susp 5%neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin

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January 2020 38

Drug Name

neomycin-polymyxin-dexamethasone ophth oint0.1% (Maxitrol)

neomycin-polymyxin-dexamethasone ophth susp0.1% (Maxitrol)

NEOMYCIN/POLYMYXIN/GRAMIC – neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml

ofloxacin ophth soln 0.3% (Ocuflox)olopatadine hcl ophth soln 0.1% (base equivalent)

(Patanol)olopatadine hcl ophth soln 0.2% (base equivalent)

(Pataday)PAZEO – olopatadine hcl ophth soln 0.7% (base

equivalent)pilocarpine hcl ophth soln 1% (Isopto carpine)pilocarpine hcl ophth soln 2% (Isopto carpine)pilocarpine hcl ophth soln 4% (Isopto carpine)polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1% (Polytrim)PREDNISOLONE ACETATE – prednisolone acetate

ophth susp 1%SIMBRINZA – brinzolamide-brimonidine tartrate ophth

susp 1-0.2%sulfacetamide sodium ophth soln 10% (Bleph-10)SULFACETAMIDE SODIUM/PRED – sulfacetamide

sodium-prednisolone ophth soln 10-0.23(0.25)%timolol maleate ophth soln 0.25% (Timoptic)timolol maleate ophth soln 0.5% (Timoptic)TIMOLOL MALEATE OPHTHALMI – timolol maleate

ophth gel forming soln 0.25%TIMOLOL MALEATE OPHTHALMI – timolol maleate

ophth gel forming soln 0.5%tobramycin ophth soln 0.3% (Tobrex)tobramycin-dexamethasone ophth susp 0.3-0.1%

(Tobradex)TRAVATAN Z – travoprost ophth soln 0.004%

(benzalkonium free) (bak free)TRIFLURIDINE – trifluridine ophth soln 1%tropicamide ophth soln 0.5%tropicamide ophth soln 1% (Mydriacyl)ZYLET – loteprednol etabonate-tobramycin ophth susp

0.5-0.3%OTIC AGENTSacetic acid otic soln 2%

Drug Name

CIPRO HC – ciprofloxacin-hydrocortisone otic susp0.2-1%

CIPRODEX – ciprofloxacin-dexamethasone otic susp0.3-0.1%

hydrocortisone w/ acetic acid otic soln 1-2% (Vosolhc)

neomycin-polymyxin-hc otic soln 1% (Cortisporin)neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%ofloxacin otic soln 0.3%MOUTH/THROAT/DENTAL AGENTScevimeline hcl cap 30 mg (Evoxac)chlorhexidine gluconate soln 0.12% (Peridex)clotrimazole troche 10 mglidocaine hcl viscous soln 2%nystatin susp 100000 unit/mlpilocarpine hcl tab 5 mg (Salagen)pilocarpine hcl tab 7.5 mg (Salagen)sodium fluoride cream 1.1% (Prevident 5000 plus)sodium fluoride gel 1.1% (0.5% f) (Prevident fluoride)triamcinolone acetonide dental paste 0.1%ANORECTAL AGENTSCORTIFOAM – hydrocortisone acetate rectal foam 10%

(90 mg/dose)hydrocortisone acetate suppos 25 mghydrocortisone enema 100 mg/60ml (Cortenema)hydrocortisone rectal cream 2.5% (Anusol-hc)DERMATOLOGICALSacitretin cap 10 mg (Soriatane)acitretin cap 17.5 mg (Soriatane)acitretin cap 25 mg (Soriatane)adapalene cream 0.1% (Differin)adapalene gel 0.1% (Differin)adapalene gel 0.3% (Differin)adapalene-benzoyl peroxide gel 0.1-2.5% (Epiduo)alclometasone dipropionate cream 0.05% (Aclovate)alclometasone dipropionate oint 0.05%AMCINONIDE – amcinonide cream 0.1%AUGMENTED BETAMETHASONE D – betamethasone

dipropionate augmented gel 0.05%azelaic acid gel 15% (Finacea)

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Drug Name

benzoyl peroxide-erythromycin gel 5-3%(Benzamycin)

betamethasone dipropionate augmented cream0.05% (Diprolene af)

betamethasone dipropionate augmented lotion 0.05%(Diprolene)

betamethasone dipropionate augmented oint 0.05%(Diprolene)

betamethasone dipropionate cream 0.05%betamethasone dipropionate lotion 0.05%betamethasone dipropionate oint 0.05%betamethasone valerate cream 0.1% (base

equivalent)betamethasone valerate lotion 0.1% (base equivalent)betamethasone valerate oint 0.1% (base equivalent)calcipotriene cream 0.005% (Dovonex)calcipotriene oint 0.005%calcipotriene soln 0.005% (50 mcg/ml)CARAC – fluorouracil cream 0.5%ciclopirox gel 0.77% (Loprox)ciclopirox olamine cream 0.77% (base equiv)ciclopirox olamine susp 0.77% (base equiv)ciclopirox shampoo 1% (Loprox shampoo)ciclopirox solution 8% (Penlac nail lacquer)clindamycin phosph-benzoyl peroxide (refrig) gel 1.2

(1)-5% (Duac)clindamycin phosphate gel 1% (Cleocin-t)clindamycin phosphate lotion 1% (Cleocin-t)clindamycin phosphate soln 1% (Cleocin-t)clindamycin phosphate swab 1% (Cleocin-t)clindamycin phosphate-benzoyl peroxide gel 1-5%

(Benzaclin)clobetasol propionate cream 0.05% (Temovate)clobetasol propionate emollient base cream 0.05%

(Temovate e)clobetasol propionate foam 0.05% (Olux)clobetasol propionate gel 0.05% (Temovate)clobetasol propionate oint 0.05% (Temovate)clobetasol propionate soln 0.05% (Temovate)COSENTYX – secukinumab subcutaneous soln prefilled

syringe 150 mg/ml

Drug Name

COSENTYX – secukinumab subcutaneous pref syr 150mg/ml (300 mg dose)

COSENTYX SENSOREADY PEN – secukinumabsubcutaneous soln auto-injector 150 mg/ml

COSENTYX SENSOREADY PEN – secukinumabsubcutaneous auto-inj 150 mg/ml (300 mg dose)

desonide cream 0.05% (Desowen)desonide lotion 0.05% (Desowen)desonide oint 0.05% (Desowen)desoximetasone cream 0.05% (Topicort)desoximetasone cream 0.25% (Topicort)desoximetasone gel 0.05% (Topicort)desoximetasone oint 0.25% (Topicort)diclofenac sodium (actinic keratoses) gel 3%

(Solaraze)diclofenac sodium gel 1% (Voltaren)DIFFERIN – adapalene lotion 0.1%DIFLORASONE DIACETATE – diflorasone diacetate

cream 0.05%diflorasone diacetate oint 0.05%econazole nitrate cream 1%ENSTILAR – calcipotriene-betamethasone dipropionate

foam 0.005-0.064%EPIDUO FORTE – adapalene-benzoyl peroxide gel

0.3-2.5%erythromycin gel 2% (Erygel)erythromycin pads 2%erythromycin soln 2%FINACEA – azelaic acid foam 15%fluocinolone acetonide cream 0.01%fluocinolone acetonide cream 0.025% (Synalar)fluocinolone acetonide oil 0.01% (body oil) (Derma-

smoothe/fs bod)fluocinolone acetonide oil 0.01% (scalp oil) (Derma-

smoothe/fs sca)fluocinolone acetonide oint 0.025% (Synalar)fluocinolone acetonide soln 0.01% (Synalar)fluocinonide cream 0.05%fluocinonide emulsified base cream 0.05%fluocinonide gel 0.05%fluocinonide oint 0.05%fluocinonide soln 0.05%

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Drug Name

FLUOROPLEX – fluorouracil cream 1%FLUOROURACIL – fluorouracil soln 2%FLUOROURACIL – fluorouracil soln 5%fluorouracil cream 5% (Efudex)fluticasone propionate cream 0.05% (Cutivate)fluticasone propionate oint 0.005% (Cutivate)gentamicin sulfate cream 0.1%gentamicin sulfate oint 0.1%halobetasol propionate cream 0.05% (Ultravate)halobetasol propionate oint 0.05% (Ultravate)hydrocortisone cream 2.5%hydrocortisone lotion 2.5%hydrocortisone oint 2.5%hydrocortisone valerate cream 0.2%hydrocortisone valerate oint 0.2% (Westcort)imiquimod cream 5% (Aldara)isotretinoin cap 10 mgisotretinoin cap 20 mgisotretinoin cap 30 mg (Claravis)isotretinoin cap 40 mgketoconazole cream 2%ketoconazole shampoo 2% (Nizoral)lidocaine hcl gel 2%lidocaine hcl soln 4% (Xylocaine)lidocaine oint 5%lidocaine patch 5% (Lidoderm)lidocaine-prilocaine cream 2.5-2.5% (Emla)LINDANE – lindane shampoo 1%malathion lotion 0.5% (Ovide)metronidazole cream 0.75% (Metrocream)metronidazole gel 0.75%metronidazole gel 1% (Metrogel)metronidazole lotion 0.75% (Metrolotion)mometasone furoate cream 0.1% (Elocon)mometasone furoate oint 0.1% (Elocon)mometasone furoate solution 0.1% (lotion) (Elocon)mupirocin oint 2% (Bactroban)nystatin cream 100000 unit/gmnystatin oint 100000 unit/gm

Drug Name

nystatin topical powder 100000 unit/gmnystatin-triamcinolone cream 100000-0.1 unit/gm-%nystatin-triamcinolone oint 100000-0.1 unit/gm-%ORACEA – doxycycline (rosacea) cap delayed release

40 mgpermethrin cream 5% (Elimite)PICATO – ingenol mebutate gel 0.015%PICATO – ingenol mebutate gel 0.05%pimecrolimus cream 1% (Elidel)podofilox soln 0.5% (Condylox)selenium sulfide lotion 2.5%silver sulfadiazine cream 1% (Silvadene)SKYRIZI – risankizumab-rzaa sol prefilled syringe 2 x 75

mg/0.83ml kitSOOLANTRA – ivermectin cream 1%STELARA – ustekinumab inj 45 mg/0.5mlSTELARA – ustekinumab soln prefilled syringe 45

mg/0.5mlSTELARA – ustekinumab soln prefilled syringe 90 mg/mlsulfacetamide sodium lotion 10% (acne) (Klaron)tacrolimus oint 0.03% (Protopic)tacrolimus oint 0.1% (Protopic)tazarotene cream 0.1% (Tazorac)TAZORAC – tazarotene cream 0.05%TAZORAC – tazarotene gel 0.05%TAZORAC – tazarotene gel 0.1%TREMFYA – guselkumab soln pen-injector 100 mg/mlTREMFYA – guselkumab soln prefilled syringe 100 mg/

mltretinoin cream 0.025% (Retin-a)tretinoin cream 0.05% (Retin-a)tretinoin cream 0.1% (Retin-a)tretinoin gel 0.01% (Retin-a)tretinoin gel 0.025%, NF = Avita (Retin-a)tretinoin microsphere gel 0.04% (Retin-a micro)tretinoin microsphere gel 0.1% (Retin-a micro)triamcinolone acetonide cream 0.025%triamcinolone acetonide cream 0.1%triamcinolone acetonide cream 0.5%triamcinolone acetonide lotion 0.025%

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January 2020 41

Drug Name

triamcinolone acetonide lotion 0.1%triamcinolone acetonide oint 0.025%triamcinolone acetonide oint 0.1%triamcinolone acetonide oint 0.5%VALCHLOR – mechlorethamine hcl gel 0.016% (base

equivalent)ZYCLARA – imiquimod cream 3.75%ZYCLARA PUMP – imiquimod cream 2.5%ZYCLARA PUMP – imiquimod cream 3.75%MISCELLANEOUS PRODUCTSANTIDOTESCHEMET – succimer cap 100 mgNALOXONE HCL – naloxone hcl soln cartridge 0.4 mg/mlnaloxone hcl inj 0.4 mg/mlnaloxone hcl inj 4 mg/10mlnaltrexone hcl tab 50 mg (Revia)NARCAN – naloxone hcl nasal spray 4 mg/0.1mlDIABETIC SUPPLIESASCENCIA CONTOUR, CONTOUR NEXT calibration

liquid; test stripsASCENSIA CONTOUR, CONTOUR NEXT/EZ/LINK/ONE

blood glucose meterASCENSIA DIASTIX, KETO-DIASTIX, KETOSTIX urine

test productsINSULIN PEN NEEDLES - variousINSULIN SYRINGES - variousLANCET DEVICES - variousLANCETS - variousMEDICAL DEVICESINHALER ASSIST DEVICES - SPACERSASSORTED CLASSESazathioprine tab 50 mg (Imuran)buprenorphine hcl-naloxone hcl sl film 2-0.5 mg

(base equiv) (Suboxone)buprenorphine hcl-naloxone hcl sl film 4-1 mg (base

equiv) (Suboxone)buprenorphine hcl-naloxone hcl sl film 8-2 mg (base

equiv) (Suboxone)buprenorphine hcl-naloxone hcl sl film 12-3 mg (base

equiv) (Suboxone)buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (base

equiv)

Drug Name

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (baseequiv)

cyclosporine cap 25 mg (Sandimmune)cyclosporine cap 100 mg (Sandimmune)CYCLOSPORINE MODIFIED – cyclosporine modified

cap 50 mgcyclosporine modified cap 25 mg (Neoral)cyclosporine modified cap 100 mg (Neoral)cyclosporine modified oral soln 100 mg/ml (Neoral)DEPEN TITRATABS – penicillamine tab 250 mgmycophenolate mofetil cap 250 mg (Cellcept)mycophenolate mofetil for oral susp 200 mg/ml

(Cellcept)mycophenolate mofetil tab 500 mg (Cellcept)mycophenolate sodium tab dr 180 mg (mycophenolic

acid equiv) (Myfortic)mycophenolate sodium tab dr 360 mg (mycophenolic

acid equiv) (Myfortic)REVLIMID – lenalidomide caps 2.5 mgREVLIMID – lenalidomide cap 5 mgREVLIMID – lenalidomide cap 10 mgREVLIMID – lenalidomide cap 15 mgREVLIMID – lenalidomide cap 20 mgREVLIMID – lenalidomide cap 25 mgsirolimus oral soln 1 mg/ml (Rapamune)sirolimus tab 0.5 mg (Rapamune)sirolimus tab 1 mg (Rapamune)sirolimus tab 2 mg (Rapamune)sodium polystyrene sulfonate oral susp 15 gm/60ml

(Sps)sodium polystyrene sulfonate powder (Kayexalate)tacrolimus cap 0.5 mg (Prograf)tacrolimus cap 1 mg (Prograf)tacrolimus cap 5 mg (Prograf)THALOMID – thalidomide cap 50 mgTHALOMID – thalidomide cap 100 mgTHALOMID – thalidomide cap 150 mgTHALOMID – thalidomide cap 200 mgZORTRESS – everolimus tab 0.25 mgZORTRESS – everolimus tab 0.5 mgZORTRESS – everolimus tab 0.75 mg

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Drug Name

ZORTRESS – everolimus tab 1 mg

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January 2020 43

INDEX

Aabacavir sulfate-lamivudine tab 600-300 mg

(Epzicom)...........................................................................3abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg (Trizivir).................................................3abacavir sulfate soln 20 mg/ml (base equiv)

(Ziagen)..............................................................................3abacavir sulfate tab 300 mg (base equiv) (Ziagen).........3abiraterone acetate tab 250 mg (Zytiga).......................... 5acamprosate calcium tab delayed release 333 mg

(Campral).........................................................................28acarbose tab 25 mg (Precose)........................................ 10acarbose tab 50 mg (Precose)........................................ 10acarbose tab 100 mg (Precose)...................................... 10acebutolol hcl cap 200 mg (Sectral)...............................13acebutolol hcl cap 400 mg (Sectral)...............................13acetaminophen w/ codeine soln 120-12 mg/5ml........... 30acetaminophen w/ codeine tab 300-15 mg (Tylenol/

codeine)...........................................................................30acetaminophen w/ codeine tab 300-30 mg (Tylenol/

codeine #3)..................................................................... 30acetaminophen w/ codeine tab 300-60 mg (Tylenol/

codeine #4)..................................................................... 30acetazolamide cap er 12hr 500 mg (Diamox)................ 17acetazolamide tab 125 mg............................................... 18acetazolamide tab 250 mg............................................... 18acetic acid otic soln 2%...................................................38acetylcysteine inhal soln 10%.........................................20acetylcysteine inhal soln 20%.........................................20acitretin cap 10 mg (Soriatane).......................................38acitretin cap 17.5 mg (Soriatane)....................................38acitretin cap 25 mg (Soriatane).......................................38ACTIMMUNE – interferon gamma-1b inj 100 mcg/0.5ml

(2000000 unit/0.5ml)..........................................................5acyclovir cap 200 mg (Zovirax).........................................3acyclovir susp 200 mg/5ml (Zovirax)............................... 3acyclovir tab 400 mg (Zovirax)..........................................3acyclovir tab 800 mg (Zovirax)..........................................3adapalene-benzoyl peroxide gel 0.1-2.5% (Epiduo)......38adapalene cream 0.1% (Differin).....................................38adapalene gel 0.1% (Differin).......................................... 38adapalene gel 0.3% (Differin).......................................... 38ADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 5 mg.................................................................... 27ADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 10 mg.................................................................. 27ADDERALL XR – amphetamine-dextroamphetamine cap



er 24hr 25 mg.................................................................. 27

ADDERALL XR – amphetamine-dextroamphetamine caper 24hr 30 mg.................................................................. 27

adefovir dipivoxil tab 10 mg (Hepsera)............................3ADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21

mcg/act............................................................................. 20ADVAIR HFA – fluticasone-salmeterol inhal aerosol 115-21

mcg/act............................................................................. 20ADVAIR HFA – fluticasone-salmeterol inhal aerosol

230-21 mcg/act................................................................ 20AFINITOR DISPERZ – everolimus tab for oral susp 2

mg....................................................................................... 5AFINITOR DISPERZ – everolimus tab for oral susp 3

mg....................................................................................... 5AFINITOR DISPERZ – everolimus tab for oral susp 5

mg....................................................................................... 5AFINITOR – everolimus tab 2.5 mg.....................................5AFINITOR – everolimus tab 5 mg........................................5AFINITOR – everolimus tab 7.5 mg.....................................5AFINITOR – everolimus tab 10 mg......................................5AIMOVIG – erenumab-aooe subcutaneous soln auto-

injector 70 mg/ml............................................................. 32AIMOVIG – erenumab-aooe subcutaneous soln auto-

injector 140 mg/ml........................................................... 32albendazole tab 200 mg (Albenza)....................................4albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)..........20albuterol sulfate soln nebu 0.5% (5 mg/ml)...................20albuterol sulfate soln nebu 0.63 mg/3ml (base

equiv)............................................................................... 20albuterol sulfate soln nebu 1.25 mg/3ml (base

equiv)............................................................................... 20albuterol sulfate syrup 2 mg/5ml....................................20albuterol sulfate tab 2 mg................................................20albuterol sulfate tab 4 mg................................................20alclometasone dipropionate cream 0.05%

(Aclovate)........................................................................ 38alclometasone dipropionate oint 0.05%.........................38ALECENSA – alectinib hcl cap 150 mg (base

equivalent).......................................................................... 5ALENDRONATE SODIUM – alendronate sodium tab 5

mg.....................................................................................12ALENDRONATE SODIUM – alendronate sodium tab 40

mg.....................................................................................12alendronate sodium tab 10 mg....................................... 12alendronate sodium tab 35 mg....................................... 12alendronate sodium tab 70 mg (Fosamax)....................12alfuzosin hcl tab er 24hr 10 mg (Uroxatral)................... 23ALINIA – nitazoxanide for susp 100 mg/5ml........................5ALINIA – nitazoxanide tab 500 mg...................................... 5allopurinol tab 100 mg (Zyloprim).................................. 32allopurinol tab 300 mg (Zyloprim).................................. 33ALPHAGAN P – brimonidine tartrate ophth soln 0.1%...... 37alprazolam tab er 24hr 0.5 mg (Xanax xr)......................24alprazolam tab er 24hr 1 mg (Xanax xr).........................24alprazolam tab er 24hr 2 mg (Xanax xr).........................24alprazolam tab er 24hr 3 mg (Xanax xr).........................24alprazolam tab 0.25 mg (Xanax)......................................24

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alprazolam tab 0.5 mg (Xanax)........................................24alprazolam tab 1 mg (Xanax)...........................................24alprazolam tab 2 mg (Xanax)...........................................24ALREX – loteprednol etabonate ophth susp 0.2%.............37ALUNBRIG – brigatinib tab initiation therapy pack 90 mg &

180 mg............................................................................... 5ALUNBRIG – brigatinib tab 30 mg.......................................5ALUNBRIG – brigatinib tab 90 mg.......................................5ALUNBRIG – brigatinib tab 180 mg.....................................5amantadine hcl cap 100 mg............................................ 34amantadine hcl syrup 50 mg/5ml....................................34ambrisentan tab 5 mg (Letairis)......................................19ambrisentan tab 10 mg (Letairis)....................................19AMCINONIDE – amcinonide cream 0.1%......................... 38amiloride & hydrochlorothiazide tab 5-50 mg............... 18amiloride hcl tab 5 mg..................................................... 18amiodarone hcl tab 100 mg.............................................15amiodarone hcl tab 400 mg.............................................15amiodarone hcl tab 200 mg (Cordarone).......................15amitriptyline hcl tab 10 mg..............................................24amitriptyline hcl tab 25 mg..............................................24amitriptyline hcl tab 50 mg..............................................24amitriptyline hcl tab 75 mg..............................................24amitriptyline hcl tab 100 mg............................................24amitriptyline hcl tab 150 mg............................................24amlodipine besylate-benazepril hcl cap 2.5-10 mg

(Lotrel)............................................................................. 15amlodipine besylate-benazepril hcl cap 5-10 mg





(Lotrel)............................................................................. 15amlodipine besylate tab 2.5 mg (base equivalent)

(Norvasc)......................................................................... 14amlodipine besylate tab 5 mg (base equivalent)

(Norvasc)......................................................................... 14amlodipine besylate tab 10 mg (base equivalent)

(Norvasc)......................................................................... 14amlodipine besylate-valsartan tab 5-160 mg

(Exforge)..........................................................................15amlodipine besylate-valsartan tab 5-320 mg



(Exforge)..........................................................................15amlodipine-valsartan-hydrochlorothiazide tab

5-160-12.5 mg (Exforge hct)......................................... 15amlodipine-valsartan-hydrochlorothiazide tab 5-160-25

mg (Exforge hct)............................................................ 15

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforge hct)....................................... 15

amlodipine-valsartan-hydrochlorothiazide tab10-160-25 mg (Exforge hct).......................................... 15

amlodipine-valsartan-hydrochlorothiazide tab10-320-25 mg (Exforge hct).......................................... 15

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 200-28.5 mg................................... 1

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 400-57 mg...................................... 1

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate tab er 12hr 1000-62.5 mg..............................1

amoxicillin & k clavulanate for susp 200-28.5mg/5ml............................................................................... 1

amoxicillin & k clavulanate for susp 400-57 mg/5ml...... 1amoxicillin & k clavulanate for susp 250-62.5 mg/5ml

(Augmentin)...................................................................... 1amoxicillin & k clavulanate for susp 600-42.9 mg/5ml

(Augmentin es-600)..........................................................1amoxicillin & k clavulanate tab 250-125 mg.................... 1amoxicillin & k clavulanate tab 500-125 mg

(Augmentin)...................................................................... 1amoxicillin & k clavulanate tab 875-125 mg

(Augmentin)...................................................................... 1AMOXICILLIN – amoxicillin (trihydrate) chew tab 125

mg....................................................................................... 1AMOXICILLIN – amoxicillin (trihydrate) chew tab 250

mg....................................................................................... 1amoxicillin (trihydrate) cap 250 mg..................................1amoxicillin (trihydrate) cap 500 mg..................................1amoxicillin (trihydrate) for susp 125 mg/5ml...................1amoxicillin (trihydrate) for susp 200 mg/5ml...................1amoxicillin (trihydrate) for susp 250 mg/5ml...................1amoxicillin (trihydrate) for susp 400 mg/5ml...................1amoxicillin (trihydrate) tab 500 mg...................................1amoxicillin (trihydrate) tab 875 mg...................................1amphetamine-dextroamphetamine cap er 24hr 5 mg

(Adderall xr)....................................................................27amphetamine-dextroamphetamine cap er 24hr 10 mg





(Adderall xr)....................................................................27amphetamine-dextroamphetamine tab 5 mg

(Adderall).........................................................................27amphetamine-dextroamphetamine tab 7.5 mg

(Adderall).........................................................................27amphetamine-dextroamphetamine tab 10 mg

(Adderall).........................................................................27amphetamine-dextroamphetamine tab 12.5 mg

(Adderall).........................................................................27

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amphetamine-dextroamphetamine tab 15 mg(Adderall).........................................................................27



AMPICILLIN – ampicillin cap 500 mg.................................. 1anagrelide hcl cap 1 mg.................................................. 37anagrelide hcl cap 0.5 mg (Agrylin)............................... 37anastrozole tab 1 mg (Arimidex).......................................5ANORO ELLIPTA – umeclidinium-vilanterol aero powd ba

62.5-25 mcg/inh............................................................... 20aprepitant capsule 40 mg (Emend).................................22aprepitant capsule 80 mg (Emend).................................22aprepitant capsule 125 mg (Emend)...............................22aprepitant capsule therapy pack 80 & 125 mg

(Emend)........................................................................... 22APRISO – mesalamine cap er 24hr 0.375 gm...................23ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 25

mcg/ml.............................................................................. 36ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 40

mcg/ml.............................................................................. 36ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 60

mcg/ml.............................................................................. 36ARANESP ALBUMIN FREE – darbepoetin alfa soln inj

100 mcg/ml.......................................................................36ARANESP ALBUMIN FREE – darbepoetin alfa soln inj

200 mcg/ml.......................................................................36ARANESP ALBUMIN FREE – darbepoetin alfa soln inj

300 mcg/ml.......................................................................36ARANESP ALBUMIN FREE – darbepoetin alfa soln

prefilled syringe 10 mcg/0.4ml........................................ 35ARANESP ALBUMIN FREE – darbepoetin alfa soln

prefilled syringe 25 mcg/0.42ml...................................... 36ARANESP ALBUMIN FREE – darbepoetin alfa soln







prefilled syringe 500 mcg/ml........................................... 36aripiprazole tab 2 mg (Abilify).........................................25aripiprazole tab 5 mg (Abilify).........................................25aripiprazole tab 10 mg (Abilify).......................................25aripiprazole tab 15 mg (Abilify).......................................25aripiprazole tab 20 mg (Abilify).......................................25aripiprazole tab 30 mg (Abilify).......................................25armodafinil tab 50 mg (Nuvigil).......................................27armodafinil tab 150 mg (Nuvigil).....................................27

armodafinil tab 200 mg (Nuvigil).....................................27armodafinil tab 250 mg (Nuvigil).....................................27ARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 50 mcg/act................................................... 20ARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 100 mcg/act................................................. 20ARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 200 mcg/act................................................. 20ASCENCIA CONTOUR, CONTOUR NEXTcalibration

liquid; test strips...............................................................41ASCENSIA CONTOUR, CONTOUR NEXT/EZ/LINK/

ONEblood glucose meter................................................ 41ASCENSIA DIASTIX, KETO-DIASTIX, KETOSTIXurine

test products.....................................................................41ASMANEX HFA – mometasone furoate inhal aerosol

suspension 100 mcg/act..................................................20ASMANEX HFA – mometasone furoate inhal aerosol

suspension 200 mcg/act..................................................20ASMANEX TWISTHALER 120 ME – mometasone furoate

inhal powd 220 mcg/inh (breath activated).....................20ASMANEX TWISTHALER 30 MET – mometasone furoate

inhal powd 110 mcg/inh (breath activated)..................... 20ASMANEX TWISTHALER 30 MET – mometasone furoate

inhal powd 220 mcg/inh (breath activated).....................20ASMANEX TWISTHALER 60 MET – mometasone furoate

inhal powd 220 mcg/inh (breath activated).....................20atazanavir sulfate cap 150 mg (base equiv)

(Reyataz)............................................................................3atazanavir sulfate cap 200 mg (base equiv)

(Reyataz)............................................................................3atazanavir sulfate cap 300 mg (base equiv)

(Reyataz)............................................................................3atenolol & chlorthalidone tab 50-25 mg (Tenoretic

50).....................................................................................15atenolol & chlorthalidone tab 100-25 mg (Tenoretic

100)...................................................................................15atenolol tab 25 mg (Tenormin)........................................ 13atenolol tab 50 mg (Tenormin)........................................ 13atenolol tab 100 mg (Tenormin)...................................... 13atomoxetine hcl cap 10 mg (base equiv) (Strattera).....27atomoxetine hcl cap 18 mg (base equiv) (Strattera).....27atomoxetine hcl cap 25 mg (base equiv) (Strattera).....27atomoxetine hcl cap 40 mg (base equiv) (Strattera).....27atomoxetine hcl cap 60 mg (base equiv) (Strattera).....27atomoxetine hcl cap 80 mg (base equiv) (Strattera).....27atomoxetine hcl cap 100 mg (base equiv)

(Strattera)........................................................................ 27atorvastatin calcium tab 10 mg (base equivalent)

(Lipitor)............................................................................ 18atorvastatin calcium tab 20 mg (base equivalent)



(Lipitor)............................................................................ 18

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atovaquone-proguanil hcl tab 62.5-25 mg(Malarone)......................................................................... 4

atovaquone-proguanil hcl tab 250-100 mg(Malarone)......................................................................... 4

ATRIPLA – efavirenz-emtricitabine-tenofovir df tab600-200-300 mg.................................................................3

ATROPINE SULFATE – atropine sulfate ophth soln1%.....................................................................................37

ATROVENT HFA – ipratropium bromide hfa inhal aerosol17 mcg/act........................................................................20

AUBAGIO – teriflunomide tab 7 mg...................................28AUBAGIO – teriflunomide tab 14 mg.................................28AUGMENTED BETAMETHASONE D – betamethasone

dipropionate augmented gel 0.05%................................ 38AUGMENTIN – amoxicillin & k clavulanate for susp

125-31.25 mg/5ml.............................................................. 1AVONEX – interferon beta-1a im prefilled syringe kit 30

mcg/0.5ml......................................................................... 28AVONEX PEN – interferon beta-1a im auto-injector kit 30

mcg/0.5ml......................................................................... 28azathioprine tab 50 mg (Imuran).....................................41azelaic acid gel 15% (Finacea)........................................38azelastine hcl nasal spray 0.1% (137 mcg/spray)......... 20azelastine hcl nasal spray 0.15% (205.5 mcg/spray)

(Astepro)..........................................................................20azelastine hcl ophth soln 0.05% (Optivar)..................... 37AZITHROMYCIN – azithromycin powd pack for susp 1

gm....................................................................................... 1azithromycin for susp 100 mg/5ml (Zithromax).............. 1azithromycin for susp 200 mg/5ml (Zithromax).............. 1azithromycin tab 250 mg (Zithromax).............................. 1azithromycin tab 500 mg (Zithromax).............................. 1azithromycin tab 600 mg (Zithromax).............................. 1AZOPT – brinzolamide ophth susp 1%..............................37

BBACITRACIN – bacitracin ophth oint 500 unit/gm............. 37bacitracin-polymyxin b ophth oint..................................37bacitracin-polymyxin-neomycin-hc ophth oint 1%.......37baclofen tab 10 mg...........................................................34baclofen tab 20 mg...........................................................35balsalazide disodium cap 750 mg (Colazal).................. 23BANZEL – rufinamide tab 200 mg..................................... 33BANZEL – rufinamide tab 400 mg..................................... 33BARACLUDE – entecavir oral soln 0.05 mg/ml...................3BELSOMRA – suvorexant tab 5 mg.................................. 27BELSOMRA – suvorexant tab 10 mg................................ 27BELSOMRA – suvorexant tab 15 mg................................ 27BELSOMRA – suvorexant tab 20 mg................................ 27benazepril & hydrochlorothiazide tab 5-6.25 mg.......... 15benazepril & hydrochlorothiazide tab 10-12.5 mg

(Lotensin hct)................................................................. 15benazepril & hydrochlorothiazide tab 20-12.5 mg

(Lotensin hct)................................................................. 15benazepril & hydrochlorothiazide tab 20-25 mg

(Lotensin hct)................................................................. 15

benazepril hcl tab 5 mg................................................... 15benazepril hcl tab 10 mg (Lotensin)...............................15benazepril hcl tab 20 mg (Lotensin)...............................15benazepril hcl tab 40 mg (Lotensin)...............................15BENZNIDAZOLE – benznidazole tab 12.5 mg.................... 4BENZNIDAZOLE – benznidazole tab 100 mg..................... 4benzoyl peroxide-erythromycin gel 5-3%

(Benzamycin).................................................................. 39benztropine mesylate tab 0.5 mg....................................34benztropine mesylate tab 1 mg.......................................34benztropine mesylate tab 2 mg.......................................34betamethasone dipropionate augmented cream 0.05%

(Diprolene af)..................................................................39betamethasone dipropionate augmented lotion 0.05%

(Diprolene).......................................................................39betamethasone dipropionate augmented oint 0.05%

(Diprolene).......................................................................39betamethasone dipropionate cream 0.05%................... 39betamethasone dipropionate lotion 0.05%....................39betamethasone dipropionate oint 0.05%....................... 39betamethasone valerate cream 0.1% (base

equivalent).......................................................................39betamethasone valerate lotion 0.1% (base

equivalent).......................................................................39betamethasone valerate oint 0.1% (base

equivalent).......................................................................39BETASERON – interferon beta-1b for inj kit 0.3 mg.......... 28bexarotene cap 75 mg (Targretin).....................................5bicalutamide tab 50 mg (Casodex)...................................5BIKTARVY – bictegravir-emtricitabine-tenofovir af tab

50-200-25 mg.....................................................................3bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg

(Ziac)................................................................................ 16bisoprolol & hydrochlorothiazide tab 5-6.25 mg

(Ziac)................................................................................ 16bisoprolol & hydrochlorothiazide tab 10-6.25 mg

(Ziac)................................................................................ 16bisoprolol fumarate tab 5 mg (Zebeta)...........................13bisoprolol fumarate tab 10 mg (Zebeta).........................13bosentan tab 62.5 mg (Tracleer)..................................... 19bosentan tab 125 mg (Tracleer)...................................... 19BOSULIF – bosutinib tab 100 mg........................................ 5BOSULIF – bosutinib tab 400 mg........................................ 5BOSULIF – bosutinib tab 500 mg........................................ 5BREO ELLIPTA – fluticasone furoate-vilanterol aero powd

ba 100-25 mcg/inh...........................................................20BREO ELLIPTA – fluticasone furoate-vilanterol aero powd

ba 200-25 mcg/inh...........................................................20BRILINTA – ticagrelor tab 60 mg....................................... 37BRILINTA – ticagrelor tab 90 mg....................................... 37brimonidine tartrate ophth soln 0.2%.............................37brimonidine tartrate ophth soln 0.15% (Alphagan

p).......................................................................................37budesonide delayed release particles cap 3 mg

(Entocort ec)..................................................................... 8

2020

January 2020 47

budesonide inhalation susp 0.25 mg/2ml(Pulmicort).......................................................................20

budesonide inhalation susp 0.5 mg/2ml(Pulmicort).......................................................................20

budesonide inhalation susp 1 mg/2ml (Pulmicort).......20bumetanide tab 0.5 mg.................................................... 18bumetanide tab 1 mg........................................................18bumetanide tab 2 mg........................................................18buprenorphine hcl-naloxone hcl sl film 2-0.5 mg (base

equiv) (Suboxone)..........................................................41buprenorphine hcl-naloxone hcl sl film 4-1 mg (base



equiv) (Suboxone)..........................................................41buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (base

equiv)............................................................................... 41buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base

equiv)............................................................................... 41buprenorphine hcl sl tab 2 mg (base equiv)................. 30buprenorphine hcl sl tab 8 mg (base equiv)................. 30bupropion hcl (smoking deterrent) tab er 12hr 150 mg

(Zyban).............................................................................28bupropion hcl tab er 12hr 100 mg (Wellbutrin sr).........24bupropion hcl tab er 12hr 150 mg (Wellbutrin sr).........24bupropion hcl tab er 12hr 200 mg (Wellbutrin sr).........24bupropion hcl tab er 24hr 150 mg (Wellbutrin xl)......... 24bupropion hcl tab er 24hr 300 mg (Wellbutrin xl)......... 24bupropion hcl tab 75 mg (Wellbutrin)............................ 24bupropion hcl tab 100 mg (Wellbutrin).......................... 24buspirone hcl tab 5 mg....................................................24buspirone hcl tab 10 mg..................................................24buspirone hcl tab 15 mg..................................................24buspirone hcl tab 30 mg..................................................24butalbital-acetaminophen-caffeine tab 50-325-40 mg

(Esgic)..............................................................................30butalbital-acetaminophen tab 50-325 mg.......................30butalbital-aspirin-caffeine cap 50-325-40 mg

(Fiorinal).......................................................................... 30butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg

(Fiorinal/codeine #3)......................................................30

Ccabergoline tab 0.5 mg.................................................... 12caffeine citrate oral soln 60 mg/3ml (10 mg/ml base

equiv) (Cafcit)................................................................. 28calcipotriene cream 0.005% (Dovonex)..........................39calcipotriene oint 0.005%.................................................39calcipotriene soln 0.005% (50 mcg/ml).......................... 39calcitonin (salmon) nasal soln 200 unit/act

(Miacalcin)....................................................................... 12calcitriol cap 0.25 mcg (Rocaltrol)..................................12calcitriol cap 0.5 mcg (Rocaltrol)....................................12calcitriol oral soln 1 mcg/ml (Rocaltrol).........................12

calcium acetate (phosphate binder) cap 667 mg (169mg ca) (Phoslo)..............................................................23

calcium acetate (phosphate binder) tab 667 mg(Eliphos).......................................................................... 23

candesartan cilexetil-hydrochlorothiazide tab 16-12.5mg (Atacand hct)........................................................... 16

candesartan cilexetil-hydrochlorothiazide tab 32-12.5mg (Atacand hct)........................................................... 16

candesartan cilexetil-hydrochlorothiazide tab 32-25mg (Atacand hct)........................................................... 16

candesartan cilexetil tab 4 mg (Atacand)...................... 16candesartan cilexetil tab 8 mg (Atacand)...................... 16candesartan cilexetil tab 16 mg (Atacand).................... 16candesartan cilexetil tab 32 mg (Atacand).................... 16capecitabine tab 150 mg (Xeloda).................................... 5capecitabine tab 500 mg (Xeloda).................................... 5CAPRELSA – vandetanib tab 100 mg................................. 5CAPRELSA – vandetanib tab 300 mg................................. 5CAPTOPRIL/HYDROCHLOROTHIA – captopril &

hydrochlorothiazide tab 25-15 mg...................................16CAPTOPRIL/HYDROCHLOROTHIA – captopril &



hydrochlorothiazide tab 50-25 mg...................................16captopril tab 12.5 mg........................................................16captopril tab 25 mg...........................................................16captopril tab 50 mg...........................................................16captopril tab 100 mg.........................................................16CARAC – fluorouracil cream 0.5%.....................................39carbamazepine cap er 12hr 100 mg (Carbatrol)............33carbamazepine cap er 12hr 200 mg (Carbatrol)............33carbamazepine cap er 12hr 300 mg (Carbatrol)............33carbamazepine chew tab 100 mg................................... 33carbamazepine susp 100 mg/5ml (Tegretol)..................33carbamazepine tab er 12hr 100 mg (Tegretol-xr).......... 33carbamazepine tab er 12hr 200 mg (Tegretol-xr).......... 33carbamazepine tab er 12hr 400 mg (Tegretol-xr).......... 33carbamazepine tab 200 mg (Tegretol)............................33CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 12.5-50-200 mg................................... 34CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 18.75-75-200 mg................................. 34CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 25-100-200 mg.................................... 34CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 31.25-125-200 mg............................... 34CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 37.5-150-200 mg................................. 34CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 50-200-200 mg.................................... 34carbidopa & levodopa orally disintegrating tab 10-100

mg (Parcopa).................................................................. 34carbidopa & levodopa orally disintegrating tab 25-100

mg (Parcopa).................................................................. 34

2020

January 2020 48

carbidopa & levodopa orally disintegrating tab 25-250mg (Parcopa).................................................................. 34

carbidopa & levodopa tab er 25-100 mg (Sinemetcr)..................................................................................... 34

carbidopa & levodopa tab er 50-200 mg (Sinemetcr)..................................................................................... 34

carbidopa & levodopa tab 10-100 mg (Sinemet)...........34carbidopa & levodopa tab 25-100 mg (Sinemet)...........34carbidopa & levodopa tab 25-250 mg (Sinemet)...........34CARTEOLOL HCL – carteolol hcl ophth soln 1%..............37carvedilol tab 3.125 mg (Coreg)......................................13carvedilol tab 6.25 mg (Coreg)........................................13carvedilol tab 12.5 mg (Coreg)........................................13carvedilol tab 25 mg (Coreg)...........................................14cefaclor cap 250 mg........................................................... 1cefaclor cap 500 mg........................................................... 1cefadroxil cap 500 mg........................................................1cefadroxil for susp 250 mg/5ml........................................ 1cefadroxil for susp 500 mg/5ml........................................ 1cefadroxil tab 1 gm.............................................................1cefdinir cap 300 mg............................................................1cefdinir for susp 125 mg/5ml............................................ 1cefdinir for susp 250 mg/5ml............................................ 1cefixime cap 400 mg (Suprax)...........................................1cefixime for susp 100 mg/5ml (Suprax)........................... 1cefixime for susp 200 mg/5ml (Suprax)........................... 1cefpodoxime proxetil for susp 50 mg/5ml.......................1cefpodoxime proxetil for susp 100 mg/5ml.....................1cefpodoxime proxetil tab 100 mg..................................... 1cefpodoxime proxetil tab 200 mg..................................... 1cefprozil for susp 125 mg/5ml...........................................1cefprozil for susp 250 mg/5ml...........................................1cefprozil tab 250 mg...........................................................1cefprozil tab 500 mg...........................................................1ceftriaxone sodium for inj 2 gm........................................1ceftriaxone sodium for inj 1 gm (Rocephin)....................1ceftriaxone sodium for inj 250 mg....................................1ceftriaxone sodium for inj 500 mg (Rocephin)................1cefuroxime axetil tab 250 mg (Ceftin).............................. 1cefuroxime axetil tab 500 mg (Ceftin).............................. 1celecoxib cap 50 mg (Celebrex)......................................31celecoxib cap 100 mg (Celebrex)....................................31celecoxib cap 200 mg (Celebrex)....................................31celecoxib cap 400 mg (Celebrex)....................................31CELONTIN – methsuximide cap 300 mg...........................33cephalexin cap 250 mg (Keflex)........................................1cephalexin cap 500 mg (Keflex)........................................1cephalexin for susp 125 mg/5ml.......................................1cephalexin for susp 250 mg/5ml.......................................1cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)................... 19cevimeline hcl cap 30 mg (Evoxac)................................38CHANTIX CONTINUING MONTH – varenicline tartrate tab

1 mg (base equiv)............................................................28CHANTIX STARTING MONTH PA – varenicline tartrate

tab 0.5 mg x 11 & tab 1 mg x 42 pack............................29

CHANTIX – varenicline tartrate tab 0.5 mg (baseequiv)................................................................................ 28

CHANTIX – varenicline tartrate tab 1 mg (base equiv)......28CHEMET – succimer cap 100 mg......................................41CHENODAL – chenodiol tab 250 mg.................................23chlorhexidine gluconate soln 0.12% (Peridex)..............38CHLOROQUINE PHOSPHATE – chloroquine phosphate

tab 250 mg.........................................................................4chloroquine phosphate tab 500 mg (Aralen)...................4CHLOROTHIAZIDE – chlorothiazide tab 250 mg..............18CHLOROTHIAZIDE – chlorothiazide tab 500 mg..............18chlorpromazine hcl tab 10 mg........................................ 25chlorpromazine hcl tab 25 mg........................................ 25chlorpromazine hcl tab 50 mg........................................ 25chlorpromazine hcl tab 100 mg...................................... 25chlorpromazine hcl tab 200 mg...................................... 25chlorthalidone tab 25 mg.................................................18chlorthalidone tab 50 mg.................................................18CHLORZOXAZONE – chlorzoxazone tab 500 mg............ 35cholestyramine light powder 4 gm/dose (Questran

light)................................................................................. 18cholestyramine light powder packets 4 gm.................. 18cholestyramine powder 4 gm/dose (Questran).............18cholestyramine powder packets 4 gm (Questran)........18choline fenofibrate cap dr 45 mg (fenofibric acid

equiv) (Trilipix)................................................................18choline fenofibrate cap dr 135 mg (fenofibric acid

equiv) (Trilipix)................................................................18CHORIONIC GONADOTROPIN – chorionic gonadotropin

for im inj 10000 unit.........................................................12ciclopirox gel 0.77% (Loprox)......................................... 39ciclopirox olamine cream 0.77% (base equiv)...............39ciclopirox olamine susp 0.77% (base equiv).................39ciclopirox shampoo 1% (Loprox shampoo).................. 39ciclopirox solution 8% (Penlac nail lacquer).................39cilostazol tab 50 mg (Pletal)............................................37cilostazol tab 100 mg (Pletal)..........................................37CILOXAN – ciprofloxacin hcl ophth oint 0.3%................... 37CIMDUO – lamivudine-tenofovir disoproxil fumarate tab

300-300 mg........................................................................ 3CIMETIDINE HCL – cimetidine hcl soln 300 mg/5ml.........21cimetidine tab 300 mg......................................................21cimetidine tab 400 mg......................................................21cimetidine tab 800 mg......................................................21cinacalcet hcl tab 30 mg (base equiv) (Sensipar).........12cinacalcet hcl tab 60 mg (base equiv) (Sensipar).........12cinacalcet hcl tab 90 mg (base equiv) (Sensipar).........12CINRYZE – c1 esterase inhibitor (human) for iv inj 500

unit.................................................................................... 37CIPRODEX – ciprofloxacin-dexamethasone otic susp

0.3-0.1%........................................................................... 38ciprofloxacin for oral susp 500 mg/5ml (10%) (10

gm/100ml) (Cipro)............................................................ 2CIPROFLOXACIN HCL – ciprofloxacin hcl tab 100 mg

(base equiv)....................................................................... 2

2020

January 2020 49

ciprofloxacin hcl ophth soln 0.3% (base equivalent)(Ciloxan).......................................................................... 37

ciprofloxacin hcl tab 750 mg (base equiv).......................2ciprofloxacin hcl tab 250 mg (base equiv) (Cipro)..........2ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)..........2CIPRO HC – ciprofloxacin-hydrocortisone otic susp

0.2-1%.............................................................................. 38citalopram hydrobromide oral soln 10 mg/5ml............. 24citalopram hydrobromide tab 10 mg (base equiv)

(Celexa)............................................................................24citalopram hydrobromide tab 20 mg (base equiv)

(Celexa)............................................................................24citalopram hydrobromide tab 40 mg (base equiv)

(Celexa)............................................................................24CLARITHROMYCIN – clarithromycin for susp 125

mg/5ml................................................................................ 2CLARITHROMYCIN – clarithromycin for susp 250

mg/5ml................................................................................ 2clarithromycin tab er 24hr 500 mg................................... 2clarithromycin tab 250 mg (Biaxin).................................. 2clarithromycin tab 500 mg (Biaxin).................................. 2CLIMARA PRO – estradiol-levonorgestrel td patch weekly

0.045-0.015 mg/day...........................................................8clindamycin hcl cap 75 mg (Cleocin)...............................5clindamycin hcl cap 150 mg (Cleocin).............................5clindamycin hcl cap 300 mg (Cleocin).............................5clindamycin palmitate hcl for soln 75 mg/5ml (base

equiv) (Cleocin pediatric gr)...........................................5clindamycin phosphate-benzoyl peroxide gel 1-5%

(Benzaclin)...................................................................... 39clindamycin phosphate gel 1% (Cleocin-t)....................39clindamycin phosphate lotion 1% (Cleocin-t)............... 39clindamycin phosphate soln 1% (Cleocin-t)..................39clindamycin phosphate swab 1% (Cleocin-t)................ 39clindamycin phosphate vaginal cream 2%

(Cleocin).......................................................................... 23clindamycin phosph-benzoyl peroxide (refrig) gel 1.2

(1)-5% (Duac).................................................................. 39clobetasol propionate cream 0.05% (Temovate)...........39clobetasol propionate emollient base cream 0.05%

(Temovate e)................................................................... 39clobetasol propionate foam 0.05% (Olux)......................39clobetasol propionate gel 0.05% (Temovate)................ 39clobetasol propionate oint 0.05% (Temovate)...............39clobetasol propionate soln 0.05% (Temovate).............. 39CLOMIPHENE CITRATE – clomiphene citrate tab 50

mg.....................................................................................12clomipramine hcl cap 25 mg (Anafranil)........................24clomipramine hcl cap 50 mg (Anafranil)........................24clomipramine hcl cap 75 mg (Anafranil)........................24clonazepam tab 0.5 mg (Klonopin).................................33clonazepam tab 1 mg (Klonopin)....................................33clonazepam tab 2 mg (Klonopin)....................................33clonidine hcl tab 0.1 mg (Catapres)............................... 16clonidine hcl tab 0.2 mg (Catapres)............................... 16clonidine hcl tab 0.3 mg (Catapres)............................... 16

clonidine td patch weekly 0.1 mg/24hr (Catapres-tts-1)................................................................................. 16



clopidogrel bisulfate tab 75 mg (base equiv)(Plavix).............................................................................37

clotrimazole troche 10 mg............................................... 38clozapine tab 50 mg......................................................... 25clozapine tab 200 mg....................................................... 25clozapine tab 25 mg (Clozaril).........................................25clozapine tab 100 mg (Clozaril).......................................25COARTEM – artemether-lumefantrine tab 20-120 mg........ 4codeine sulfate tab 30 mg............................................... 30colchicine w/ probenecid tab 0.5-500 mg...................... 33colesevelam hcl packet for susp 3.75 gm

(Welchol)..........................................................................18colesevelam hcl tab 625 mg (Welchol).......................... 18colestipol hcl granule packets 5 gm (Colestid

flavored)...........................................................................18colestipol hcl granules 5 gm (Colestid flavored).......... 18colestipol hcl tab 1 gm (Colestid)...................................18COMBIVENT RESPIMAT – ipratropium-albuterol inhal

aerosol soln 20-100 mcg/act...........................................20COMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60

mg dose) kit....................................................................... 5COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 1 x 20

mg (100 dose) kit...............................................................5COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 3 x 20

mg (140 dose) kit...............................................................5CONCERTA – methylphenidate hcl tab er osmotic release

(osm) 18 mg.....................................................................28CONCERTA – methylphenidate hcl tab er osmotic release



(osm) 54 mg.....................................................................28COPAXONE – glatiramer acetate soln prefilled syringe 20

mg/ml................................................................................ 29COPAXONE – glatiramer acetate soln prefilled syringe 40

mg/ml................................................................................ 29CORTIFOAM – hydrocortisone acetate rectal foam 10%

(90 mg/dose)....................................................................38CORTISONE ACETATE – cortisone acetate tab 25 mg...... 8COSENTYX – secukinumab subcutaneous pref syr 150

mg/ml (300 mg dose)...................................................... 39COSENTYX – secukinumab subcutaneous soln prefilled

syringe 150 mg/ml........................................................... 39COSENTYX SENSOREADY PEN – secukinumab

subcutaneous auto-inj 150 mg/ml (300 mg dose)...........39COSENTYX SENSOREADY PEN – secukinumab

subcutaneous soln auto-injector 150 mg/ml................... 39COTELLIC – cobimetinib fumarate tab 20 mg (base

equivalent).......................................................................... 5

2020

January 2020 50

CREON – pancrelipase (lip-prot-amyl) dr cap3000-9500-15000 unit......................................................22

CREON – pancrelipase (lip-prot-amyl) dr cap6000-19000-30000 unit....................................................22

CREON – pancrelipase (lip-prot-amyl) dr cap12000-38000-60000 unit..................................................22

CREON – pancrelipase (lip-prot-amyl) dr cap24000-76000-120000 unit................................................22

CREON – pancrelipase (lip-prot-amyl) dr cap36000-114000-180000 unit..............................................22

cromolyn sodium ophth soln 4%....................................37cromolyn sodium soln nebu 20 mg/2ml........................ 20cyanocobalamin inj 1000 mcg/ml................................... 36cyclobenzaprine hcl tab 5 mg.........................................35cyclobenzaprine hcl tab 10 mg.......................................35cyclopentolate hcl ophth soln 1% (Cyclogyl)................37cyclophosphamide cap 25 mg (Cyclophosphamide)..... 5cyclophosphamide cap 50 mg (Cyclophosphamide)..... 5cyclosporine cap 25 mg (Sandimmune)........................ 41cyclosporine cap 100 mg (Sandimmune)...................... 41cyclosporine modified cap 25 mg (Neoral)....................41cyclosporine modified cap 100 mg (Neoral)..................41CYCLOSPORINE MODIFIED – cyclosporine modified cap

50 mg............................................................................... 41cyclosporine modified oral soln 100 mg/ml

(Neoral)............................................................................ 41cyproheptadine hcl syrup 2 mg/5ml...............................19cyproheptadine hcl tab 4 mg.......................................... 19CYSTADANE – betaine powder for oral solution...............12CYSTAGON – cysteamine bitartrate cap 50 mg................23CYSTAGON – cysteamine bitartrate cap 150 mg..............23

Ddanazol cap 50 mg..............................................................8danazol cap 100 mg............................................................8danazol cap 200 mg............................................................8dantrolene sodium cap 25 mg (Dantrium)..................... 35dantrolene sodium cap 50 mg (Dantrium)..................... 35dantrolene sodium cap 100 mg (Dantrolene

sodium)............................................................................35dapsone tab 25 mg.............................................................5dapsone tab 100 mg...........................................................5DARAPRIM – pyrimethamine tab 25 mg............................. 4DELSTRIGO – doravirine-lamivudine-tenofovir df tab

100-300-300 mg.................................................................3demeclocycline hcl tab 150 mg........................................ 2demeclocycline hcl tab 300 mg........................................ 2DEPEN TITRATABS – penicillamine tab 250 mg.............. 41DESCOVY – emtricitabine-tenofovir alafenamide fumarate

tab 200-25 mg....................................................................3desipramine hcl tab 10 mg (Norpramin)........................ 24desipramine hcl tab 25 mg (Norpramin)........................ 24desipramine hcl tab 50 mg (Norpramin)........................ 24desipramine hcl tab 75 mg (Norpramin)........................ 24desipramine hcl tab 100 mg (Norpramin)...................... 24desipramine hcl tab 150 mg (Norpramin)...................... 24

DESLORATADINE ODT – desloratadine tab orallydisintegrating 2.5 mg....................................................... 19

DESLORATADINE ODT – desloratadine tab orallydisintegrating 5 mg.......................................................... 19

desloratadine tab 5 mg (Clarinex).................................. 19desmopressin acetate nasal spray soln 0.01%

(Ddavp)............................................................................ 12desmopressin acetate nasal spray soln 0.01%

(refrigerated)................................................................... 12desmopressin acetate tab 0.1 mg (Ddavp)....................12desmopressin acetate tab 0.2 mg (Ddavp)....................12desogest-eth estrad & eth estrad tab 0.15-0.02/0.01

mg(21/5) (Mircette)...........................................................9desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg (Cyclessa)..... 9desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg

(Desogen).......................................................................... 9desonide cream 0.05% (Desowen)................................. 39desonide lotion 0.05% (Desowen).................................. 39desonide oint 0.05% (Desowen)......................................39desoximetasone cream 0.05% (Topicort).......................39desoximetasone cream 0.25% (Topicort).......................39desoximetasone gel 0.05% (Topicort)............................ 39desoximetasone oint 0.25% (Topicort)...........................39desvenlafaxine succinate tab er 24hr 25 mg (base

equiv) (Pristiq)................................................................24desvenlafaxine succinate tab er 24hr 50 mg (base

equiv) (Pristiq)................................................................24desvenlafaxine succinate tab er 24hr 100 mg (base

equiv) (Pristiq)................................................................24DEXAMETHASONE – dexamethasone soln 0.5

mg/5ml................................................................................ 8DEXAMETHASONE – dexamethasone tab 1 mg................8DEXAMETHASONE – dexamethasone tab 2 mg................8dexamethasone elixir 0.5 mg/5ml..................................... 8DEXAMETHASONE INTENSOL – dexamethasone conc 1

mg/ml.................................................................................. 8DEXAMETHASONE SODIUM PHOS – dexamethasone

sodium phosphate ophth soln 0.1%................................37dexamethasone tab 0.5 mg............................................... 8dexamethasone tab 0.75 mg............................................. 8dexamethasone tab 1.5 mg............................................... 8dexamethasone tab 4 mg.................................................. 8dexamethasone tab 6 mg.................................................. 8dexmethylphenidate hcl cap er 24 hr 5 mg (Focalin

xr)..................................................................................... 28dexmethylphenidate hcl cap er 24 hr 10 mg (Focalin





xr)..................................................................................... 28

2020

January 2020 51

dexmethylphenidate hcl cap er 24 hr 35 mg (Focalinxr)..................................................................................... 28

dexmethylphenidate hcl cap er 24 hr 40 mg (Focalinxr)..................................................................................... 28

dexmethylphenidate hcl tab 2.5 mg (Focalin)............... 28dexmethylphenidate hcl tab 5 mg (Focalin).................. 28dexmethylphenidate hcl tab 10 mg (Focalin)................ 28dextroamphetamine sulfate cap er 24hr 5 mg

(Dexedrine)......................................................................28dextroamphetamine sulfate cap er 24hr 10 mg

(Dexedrine)......................................................................28dextroamphetamine sulfate cap er 24hr 15 mg

(Dexedrine)......................................................................28dextroamphetamine sulfate tab 5 mg.............................28dextroamphetamine sulfate tab 10 mg...........................28DIASTAT ACUDIAL – diazepam rectal gel delivery system

10 mg............................................................................... 33DIASTAT ACUDIAL – diazepam rectal gel delivery system

20 mg............................................................................... 33DIASTAT PEDIATRIC – diazepam rectal gel delivery

system 2.5 mg................................................................. 33DIAZEPAM – diazepam oral soln 1 mg/ml.........................24diazepam tab 2 mg (Valium)............................................24diazepam tab 5 mg (Valium)............................................24diazepam tab 10 mg (Valium)..........................................24diclofenac potassium tab 50 mg (Cataflam)..................31diclofenac sodium (actinic keratoses) gel 3%

(Solaraze)........................................................................ 39diclofenac sodium gel 1% (Voltaren)..............................39diclofenac sodium ophth soln 0.1%...............................37diclofenac sodium tab delayed release 25 mg..............31diclofenac sodium tab delayed release 50 mg..............31diclofenac sodium tab delayed release 75 mg..............31diclofenac sodium tab er 24hr 100 mg.......................... 31dicloxacillin sodium cap 250 mg...................................... 1dicloxacillin sodium cap 500 mg...................................... 1dicyclomine hcl cap 10 mg (Bentyl)...............................21dicyclomine hcl oral soln 10 mg/5ml............................. 22dicyclomine hcl tab 20 mg (Bentyl)................................22didanosine delayed release capsule 200 mg (Videx

ec).......................................................................................3didanosine delayed release capsule 250 mg (Videx

ec).......................................................................................3DIDANOSINE – didanosine delayed release capsule 400

mg....................................................................................... 3DIFFERIN – adapalene lotion 0.1%...................................39DIFLORASONE DIACETATE – diflorasone diacetate

cream 0.05%....................................................................39diflorasone diacetate oint 0.05%.....................................39DIGOXIN – digoxin oral soln 0.05 mg/ml...........................13digoxin oral soln 0.05 mg/ml (Digoxin).......................... 13digoxin tab 125 mcg (0.125 mg) (Lanoxin).................... 13digoxin tab 250 mcg (0.25 mg) (Lanoxin)...................... 13dihydroergotamine mesylate inj 1 mg/ml (D.h.e.

45).....................................................................................32DILANTIN – phenytoin sodium extended cap 30 mg.........33

DILANTIN – phenytoin sodium extended cap 100 mg.......33DILANTIN-125 – phenytoin susp 125 mg/5ml................... 33diltiazem hcl cap er 24hr 180 mg....................................14diltiazem hcl cap er 24hr 240 mg....................................14diltiazem hcl coated beads cap er 24hr 300 mg............14diltiazem hcl coated beads cap er 24hr 120 mg

(Cardizem cd)................................................................. 14diltiazem hcl coated beads cap er 24hr 180 mg



(Cardizem cd)................................................................. 14diltiazem hcl extended release beads cap er 24hr 120

mg (Tiazac)..................................................................... 14diltiazem hcl extended release beads cap er 24hr 180





mg (Tiazac)..................................................................... 14diltiazem hcl tab 90 mg....................................................14diltiazem hcl tab 30 mg (Cardizem)................................14diltiazem hcl tab 60 mg (Cardizem)................................14diltiazem hcl tab 120 mg (Cardizem)..............................14DILT-XR – diltiazem hcl cap er 24hr 120 mg.....................14DIPHENOXYLATE/ATROPINE – diphenoxylate w/

atropine liq 2.5-0.025 mg/5ml..........................................21diphenoxylate w/ atropine tab 2.5-0.025 mg

(Lomotil).......................................................................... 21dipyridamole tab 25 mg (Persantine)............................. 37dipyridamole tab 50 mg (Persantine)............................. 37dipyridamole tab 75 mg (Persantine)............................. 37disopyramide phosphate cap 100 mg (Norpace).......... 15disopyramide phosphate cap 150 mg (Norpace).......... 15disulfiram tab 250 mg (Antabuse).................................. 29disulfiram tab 500 mg (Antabuse).................................. 29divalproex sodium cap delayed release sprinkle 125

mg (Depakote sprinkles)...............................................33divalproex sodium tab delayed release 125 mg

(Depakote)....................................................................... 33divalproex sodium tab delayed release 250 mg

(Depakote)....................................................................... 33divalproex sodium tab delayed release 500 mg

(Depakote)....................................................................... 33divalproex sodium tab er 24 hr 250 mg (Depakote

er)..................................................................................... 33divalproex sodium tab er 24 hr 500 mg (Depakote

er)..................................................................................... 33DIVIGEL – estradiol td gel 0.25 mg/0.25gm (0.1%).............8DIVIGEL – estradiol td gel 0.5 mg/0.5gm (0.1%).................8DIVIGEL – estradiol td gel 0.75 mg/0.75gm (0.1%).............9

2020

January 2020 52

DIVIGEL – estradiol td gel 1 mg/gm (0.1%).........................9donepezil hydrochloride orally disintegrating tab 5 mg

(Aricept odt)....................................................................29donepezil hydrochloride orally disintegrating tab 10

mg (Aricept odt).............................................................29donepezil hydrochloride tab 5 mg (Aricept)..................29donepezil hydrochloride tab 10 mg (Aricept)................29dorzolamide hcl ophth soln 2% (Trusopt)..................... 37dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml (Cosopt)...............................................................37doxazosin mesylate tab 1 mg (Cardura)........................16doxazosin mesylate tab 2 mg (Cardura)........................16doxazosin mesylate tab 4 mg (Cardura)........................16doxazosin mesylate tab 8 mg (Cardura)........................16doxepin hcl cap 10 mg.....................................................24doxepin hcl cap 25 mg.....................................................24doxepin hcl cap 50 mg.....................................................24doxepin hcl cap 75 mg.....................................................24doxepin hcl cap 100 mg...................................................24doxepin hcl conc 10 mg/ml............................................. 24doxycycline hyclate cap 50 mg.........................................2doxycycline hyclate cap 100 mg (Vibramycin)................2doxycycline hyclate tab 20 mg......................................... 2doxycycline hyclate tab 100 mg....................................... 2doxycycline monohydrate cap 50 mg.............................. 2doxycycline monohydrate cap 150 mg (Adoxa)..............2doxycycline monohydrate cap 75 mg (Monodox)...........2doxycycline monohydrate cap 100 mg (Monodox).........2doxycycline monohydrate tab 50 mg (Adoxa)................ 2doxycycline monohydrate tab 75 mg (Adoxa)................ 2doxycycline monohydrate tab 100 mg (Adoxa pak

1/100)..................................................................................2doxycycline monohydrate tab 150 mg (Adoxa pak

1/150)..................................................................................2drospirenone-ethinyl estradiol tab 3-0.03 mg (Yasmin

28).......................................................................................9drospirenone-ethinyl estradiol tab 3-0.02 mg (Yaz)........9DULERA – mometasone furoate-formoterol fumarate

aerosol 100-5 mcg/act.....................................................20DULERA – mometasone furoate-formoterol fumarate

aerosol 200-5 mcg/act.....................................................20duloxetine hcl enteric coated pellets cap 20 mg (base

eq) (Cymbalta)................................................................ 24duloxetine hcl enteric coated pellets cap 30 mg (base

eq) (Cymbalta)................................................................ 24duloxetine hcl enteric coated pellets cap 60 mg (base

eq) (Cymbalta)................................................................ 25dutasteride cap 0.5 mg (Avodart)................................... 23

Eeconazole nitrate cream 1%............................................ 39efavirenz cap 50 mg (Sustiva)...........................................3efavirenz cap 200 mg (Sustiva).........................................3efavirenz tab 600 mg (Sustiva)..........................................3eletriptan hydrobromide tab 20 mg (base equivalent)

(Relpax)............................................................................32

eletriptan hydrobromide tab 40 mg (base equivalent)(Relpax)............................................................................32

ELIQUIS – apixaban tab 2.5 mg........................................ 36ELIQUIS – apixaban tab 5 mg........................................... 36ELIQUIS STARTER PACK – apixaban tab 5 mg............... 36ELLA – ulipristal acetate tab 30 mg.....................................9EMCYT – estramustine phosphate sodium cap 140 mg......5EMEND – aprepitant for oral susp 125 mg (125

mg/5ml).............................................................................22EMGALITY – galcanezumab-gnlm subcutaneous soln

auto-injector 120 mg/ml...................................................32EMGALITY – galcanezumab-gnlm subcutaneous soln

prefilled syr 100 mg/ml.................................................... 32EMGALITY – galcanezumab-gnlm subcutaneous soln

prefilled syr 120 mg/ml.................................................... 32enalapril maleate & hydrochlorothiazide tab 5-12.5

mg.....................................................................................16enalapril maleate & hydrochlorothiazide tab 10-25 mg

(Vaseretic)....................................................................... 16enalapril maleate tab 2.5 mg (Vasotec)..........................16enalapril maleate tab 5 mg (Vasotec).............................16enalapril maleate tab 10 mg (Vasotec)...........................16enalapril maleate tab 20 mg (Vasotec)...........................16ENBREL – etanercept for subcutaneous inj 25 mg........... 31ENBREL – etanercept subcutaneous soln prefilled syringe

25 mg/0.5ml..................................................................... 31ENBREL – etanercept subcutaneous soln prefilled syringe

50 mg/ml...........................................................................31ENBREL MINI – etanercept subcutaneous solution

cartridge 50 mg/ml...........................................................31ENBREL SURECLICK – etanercept subcutaneous

solution auto-injector 50 mg/ml....................................... 31ENDOMETRIN – progesterone vaginal insert 100 mg...... 23enoxaparin sodium inj 30 mg/0.3ml (Lovenox)............. 36enoxaparin sodium inj 40 mg/0.4ml (Lovenox)............. 36enoxaparin sodium inj 60 mg/0.6ml (Lovenox)............. 36enoxaparin sodium inj 80 mg/0.8ml (Lovenox)............. 36enoxaparin sodium inj 100 mg/ml (Lovenox)................ 36enoxaparin sodium inj 120 mg/0.8ml (Lovenox)........... 36enoxaparin sodium inj 150 mg/ml (Lovenox)................ 36enoxaparin sodium inj 300 mg/3ml (Lovenox).............. 36ENSTILAR – calcipotriene-betamethasone dipropionate

foam 0.005-0.064%..........................................................39entacapone tab 200 mg (Comtan)...................................34entecavir tab 0.5 mg (Baraclude)......................................3entecavir tab 1 mg (Baraclude).........................................3ENTRESTO – sacubitril-valsartan tab 24-26 mg............... 19ENTRESTO – sacubitril-valsartan tab 49-51 mg............... 19ENTRESTO – sacubitril-valsartan tab 97-103 mg............. 19EPCLUSA – sofosbuvir-velpatasvir tab 400-100 mg........... 3EPIDIOLEX – cannabidiol soln 100 mg/ml........................ 33EPIDUO FORTE – adapalene-benzoyl peroxide gel

0.3-2.5%........................................................................... 39epinephrine solution auto-injector 0.15 mg/0.3ml

(1:2000) (Epipen-jr 2-pak)............................................. 18

2020

January 2020 53

epinephrine solution auto-injector 0.3 mg/0.3ml(1:1000) (Epipen 2-pak)................................................. 18

EPIPEN-JR 2-PAK – epinephrine solution auto-injector0.15 mg/0.3ml (1:2000)................................................... 18

EPIVIR HBV – lamivudine oral soln 5 mg/ml (hbv)..............3eplerenone tab 25 mg (Inspra)........................................16eplerenone tab 50 mg (Inspra)........................................16ergocalciferol cap 1.25 mg (50000 unit) (Drisdol).........35ERIVEDGE – vismodegib cap 150 mg................................ 5ERLEADA – apalutamide tab 60 mg....................................5erlotinib hcl tab 25 mg (base equivalent) (Tarceva)........5erlotinib hcl tab 100 mg (base equivalent) (Tarceva)......5erlotinib hcl tab 150 mg (base equivalent) (Tarceva)......5erythromycin gel 2% (Erygel)..........................................39erythromycin ophth oint 5 mg/gm..................................37erythromycin pads 2%..................................................... 39erythromycin soln 2%...................................................... 39escitalopram oxalate soln 5 mg/5ml (base equiv)

(Lexapro)......................................................................... 25escitalopram oxalate tab 5 mg (base equiv)



(Lexapro)......................................................................... 25esomeprazole magnesium cap delayed release 20 mg

(base eq) (Nexium)........................................................ 22esomeprazole magnesium cap delayed release 40 mg

(base eq) (Nexium)........................................................ 22estazolam tab 1 mg.......................................................... 27estazolam tab 2 mg.......................................................... 27estradiol & norethindrone acetate tab 0.5-0.1 mg

(Activella)...........................................................................9estradiol & norethindrone acetate tab 1-0.5 mg

(Activella)...........................................................................9estradiol tab 0.5 mg (Estrace)...........................................9estradiol tab 1 mg (Estrace)..............................................9estradiol tab 2 mg (Estrace)..............................................9estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-

dot)..................................................................................... 9estradiol td patch twice weekly 0.0375 mg/24hr

(Vivelle-dot)....................................................................... 9estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-

dot)..................................................................................... 9estradiol td patch twice weekly 0.075 mg/24hr (Vivelle-

dot)..................................................................................... 9estradiol td patch twice weekly 0.1 mg/24hr (Vivelle-

dot)..................................................................................... 9estradiol td patch weekly 0.025 mg/24hr (Climara).........9estradiol td patch weekly 0.05 mg/24hr (Climara)...........9estradiol td patch weekly 0.06 mg/24hr (Climara)...........9estradiol td patch weekly 0.075 mg/24hr (Climara).........9estradiol td patch weekly 0.1 mg/24hr (Climara).............9estradiol td patch weekly 0.0375 mg/24hr (37.5

mcg/24hr) (Climara)......................................................... 9estradiol vaginal cream 0.1 mg/gm (Estrace)................23

ESTROGEL – estradiol gel 0.06% (0.75 mg/1.25 gmmetered-dose pump)..........................................................9

eszopiclone tab 1 mg (Lunesta)......................................27eszopiclone tab 2 mg (Lunesta)......................................27eszopiclone tab 3 mg (Lunesta)......................................27ethambutol hcl tab 100 mg (Myambutol)......................... 2ethambutol hcl tab 400 mg (Myambutol)......................... 2ethosuximide cap 250 mg (Zarontin)..............................33ethosuximide soln 250 mg/5ml (Zarontin)..................... 33ethynodiol diacetate & ethinyl estradiol tab 1 mg-35

mcg.....................................................................................9ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg (Zovia 1/50e).............................................................9etodolac cap 200 mg........................................................ 31etodolac cap 300 mg........................................................ 31etodolac tab er 24hr 400 mg........................................... 31etodolac tab er 24hr 500 mg........................................... 31etodolac tab er 24hr 600 mg........................................... 31etodolac tab 400 mg.........................................................31etodolac tab 500 mg.........................................................31ETOPOSIDE – etoposide cap 50 mg...................................5EUFLEXXA – sodium hyaluronate intra-articular soln pref

syr 20 mg/2ml.................................................................. 35EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg

(base equiv)....................................................................... 3exemestane tab 25 mg (Aromasin)...................................5ezetimibe-simvastatin tab 10-10 mg (Vytorin)...............18ezetimibe-simvastatin tab 10-20 mg (Vytorin)...............18ezetimibe-simvastatin tab 10-40 mg (Vytorin)...............18ezetimibe-simvastatin tab 10-80 mg (Vytorin)...............19ezetimibe tab 10 mg (Zetia)............................................. 18

Ffamciclovir tab 125 mg (Famvir)....................................... 3famciclovir tab 250 mg (Famvir)....................................... 3famciclovir tab 500 mg (Famvir)....................................... 3famotidine tab 20 mg (Pepcid)........................................22famotidine tab 40 mg (Pepcid)........................................22FARYDAK – panobinostat lactate cap 10 mg (base

equivalent).......................................................................... 5FARYDAK – panobinostat lactate cap 15 mg (base

equivalent).......................................................................... 5FARYDAK – panobinostat lactate cap 20 mg (base

equivalent).......................................................................... 6felodipine tab er 24hr 2.5 mg.......................................... 14felodipine tab er 24hr 5 mg............................................. 14felodipine tab er 24hr 10 mg........................................... 14fenofibrate micronized cap 67 mg (Lofibra).................. 19fenofibrate micronized cap 134 mg (Lofibra)................ 19fenofibrate micronized cap 200 mg (Lofibra)................ 19fenofibrate tab 54 mg (Lofibra)....................................... 19fenofibrate tab 160 mg (Lofibra)..................................... 19fenofibrate tab 48 mg (Tricor)......................................... 19fenofibrate tab 145 mg (Tricor)....................................... 19fentanyl citrate lozenge on a handle 200 mcg

(Actiq).............................................................................. 30

2020

January 2020 54

fentanyl citrate lozenge on a handle 400 mcg(Actiq).............................................................................. 30





fentanyl td patch 72hr 12 mcg/hr (Duragesic)...............30fentanyl td patch 72hr 25 mcg/hr (Duragesic)...............30fentanyl td patch 72hr 50 mcg/hr (Duragesic)...............30fentanyl td patch 72hr 75 mcg/hr (Duragesic)...............30fentanyl td patch 72hr 100 mcg/hr (Duragesic).............30FIASP FLEXTOUCH – insulin aspart (with niacinamide)

sol pen-inj 100 unit/ml..................................................... 11FIASP – insulin aspart (with niacinamide) inj 100 unit/

ml...................................................................................... 11FIASP PENFILL – insulin aspart (with niacinamide) soln

cartridge 100 unit/ml........................................................ 11FINACEA – azelaic acid foam 15%................................... 39finasteride tab 5 mg (Proscar)........................................ 23FIRAZYR – icatibant acetate inj 30 mg/3ml (base

equivalent)........................................................................ 37flecainide acetate tab 50 mg........................................... 15flecainide acetate tab 100 mg......................................... 15flecainide acetate tab 150 mg......................................... 15FLOVENT DISKUS – fluticasone propionate aer pow ba

50 mcg/blister...................................................................20FLOVENT DISKUS – fluticasone propionate aer pow ba

100 mcg/blister.................................................................20FLOVENT DISKUS – fluticasone propionate aer pow ba

250 mcg/blister.................................................................20FLOVENT HFA – fluticasone propionate hfa inhal aer 110

mcg/act (125/valve)..........................................................20FLOVENT HFA – fluticasone propionate hfa inhal aer 220

mcg/act (250/valve)..........................................................20FLOVENT HFA – fluticasone propionate hfa inhal aero 44

mcg/act (50/valve)............................................................20fluconazole for susp 10 mg/ml (Diflucan)........................2fluconazole for susp 40 mg/ml (Diflucan)........................2fluconazole tab 50 mg (Diflucan)......................................2fluconazole tab 100 mg (Diflucan)....................................2fluconazole tab 150 mg (Diflucan)....................................2fluconazole tab 200 mg (Diflucan)....................................2flucytosine cap 250 mg (Ancobon)...................................2flucytosine cap 500 mg (Ancobon)...................................2fludrocortisone acetate tab 0.1 mg...................................8FLUNISOLIDE – flunisolide nasal soln 25 mcg/act

(0.025%)........................................................................... 20fluocinolone acetonide cream 0.01%............................. 39fluocinolone acetonide cream 0.025% (Synalar)...........39fluocinolone acetonide oil 0.01% (body oil) (Derma-

smoothe/fs bod)............................................................. 39

fluocinolone acetonide oil 0.01% (scalp oil) (Derma-smoothe/fs sca)..............................................................39

fluocinolone acetonide oint 0.025% (Synalar)...............39fluocinolone acetonide soln 0.01% (Synalar)................39fluocinonide cream 0.05%............................................... 39fluocinonide emulsified base cream 0.05%...................39fluocinonide gel 0.05%.....................................................39fluocinonide oint 0.05%....................................................39fluocinonide soln 0.05%...................................................39fluorometholone ophth susp 0.1% (Fml liquifilm)........ 37FLUOROPLEX – fluorouracil cream 1%............................ 40fluorouracil cream 5% (Efudex)...................................... 40FLUOROURACIL – fluorouracil soln 2%........................... 40FLUOROURACIL – fluorouracil soln 5%........................... 40fluoxetine hcl cap 10 mg (Prozac)..................................25fluoxetine hcl cap 20 mg (Prozac)..................................25fluoxetine hcl cap 40 mg (Prozac)..................................25fluoxetine hcl solution 20 mg/5ml.................................. 25fluoxetine hcl tab 10 mg.................................................. 25fluoxetine hcl tab 20 mg.................................................. 25fluphenazine decanoate inj 25 mg/ml.............................25FLUPHENAZINE HCL – fluphenazine hcl oral conc 5 mg/

ml...................................................................................... 25FLUPHENAZINE HCL – fluphenazine hcl tab 1 mg.......... 25FLUPHENAZINE HCL – fluphenazine hcl tab 2.5 mg....... 25FLUPHENAZINE HCL – fluphenazine hcl tab 5 mg.......... 25FLUPHENAZINE HCL – fluphenazine hcl tab 10 mg........ 25FLUPHENAZINE HYDROCHLORID – fluphenazine hcl

elixir 2.5 mg/5ml...............................................................26FLURA-DROPS – sodium fluoride soln 0.25 mg/drop f

(from 0.55 mg/drop naf).................................................. 35FLURBIPROFEN SODIUM – flurbiprofen sodium ophth

soln 0.03%....................................................................... 37flurbiprofen tab 50 mg......................................................31flurbiprofen tab 100 mg................................................... 31flutamide cap 125 mg.........................................................6FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 55-14 mcg/act....................... 20FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 113-14 mcg/act......................20FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 232-14 mcg/act..................... 20fluticasone propionate cream 0.05% (Cutivate)............ 40fluticasone propionate nasal susp 50 mcg/act

(Flonase)..........................................................................20fluticasone propionate oint 0.005% (Cutivate).............. 40fluvoxamine maleate tab 25 mg......................................25fluvoxamine maleate tab 50 mg......................................25fluvoxamine maleate tab 100 mg....................................25folic acid tab 1 mg............................................................36FOLLISTIM AQ – follitropin beta inj 300 unit/0.36ml..........12FOLLISTIM AQ – follitropin beta inj 600 unit/0.72ml..........12FOLLISTIM AQ – follitropin beta inj 900 unit/1.08ml..........12fosaprepitant dimeglumine for iv infusion 150 mg

(base eq) (Emend)......................................................... 22

2020

January 2020 55

fosinopril sodium & hydrochlorothiazide tab 10-12.5mg.....................................................................................16

fosinopril sodium & hydrochlorothiazide tab 20-12.5mg.....................................................................................16

fosinopril sodium tab 10 mg........................................... 16fosinopril sodium tab 20 mg........................................... 16fosinopril sodium tab 40 mg........................................... 16FULPHILA – pegfilgrastim-jmdb soln prefilled syringe 6

mg/0.6ml...........................................................................36furosemide oral soln 10 mg/ml....................................... 18furosemide tab 20 mg (Lasix)......................................... 18furosemide tab 40 mg (Lasix)......................................... 18furosemide tab 80 mg (Lasix)......................................... 18

Ggabapentin cap 100 mg (Neurontin)...............................33gabapentin cap 300 mg (Neurontin)...............................33gabapentin cap 400 mg (Neurontin)...............................33gabapentin oral soln 250 mg/5ml (Neurontin)...............33gabapentin tab 600 mg (Neurontin)................................33gabapentin tab 800 mg (Neurontin)................................33galantamine hydrobromide cap er 24hr 8 mg

(Razadyne er)..................................................................29galantamine hydrobromide cap er 24hr 16 mg

(Razadyne er)..................................................................29galantamine hydrobromide cap er 24hr 24 mg

(Razadyne er)..................................................................29GALANTAMINE HYDROBROMIDE – galantamine

hydrobromide oral soln 4 mg/ml......................................29galantamine hydrobromide tab 4 mg (Razadyne).........29galantamine hydrobromide tab 8 mg (Razadyne).........29galantamine hydrobromide tab 12 mg (Razadyne).......29ganirelix acetate soln prefilled syringe 250 mcg/0.5ml

(Ganirelix acetate)..........................................................12gemfibrozil tab 600 mg (Lopid).......................................19GENTAK – gentamicin sulfate ophth oint 0.3%................. 37gentamicin sulfate cream 0.1%.......................................40gentamicin sulfate oint 0.1%...........................................40gentamicin sulfate ophth soln 0.3% (Garamycin).........37GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab

150-150-200-10 mg........................................................... 3GILENYA – fingolimod hcl cap 0.5 mg (base equiv)..........29GILOTRIF – afatinib dimaleate tab 20 mg (base

equivalent).......................................................................... 6GILOTRIF – afatinib dimaleate tab 30 mg (base

equivalent).......................................................................... 6GILOTRIF – afatinib dimaleate tab 40 mg (base

equivalent).......................................................................... 6glatiramer acetate soln prefilled syringe 20 mg/ml

(Copaxone)......................................................................29glatiramer acetate soln prefilled syringe 40 mg/ml

(Copaxone)......................................................................29GLEOSTINE – lomustine cap 10 mg................................... 6GLEOSTINE – lomustine cap 40 mg................................... 6GLEOSTINE – lomustine cap 100 mg................................. 6glimepiride tab 1 mg (Amaryl).........................................10

glimepiride tab 2 mg (Amaryl).........................................10glimepiride tab 4 mg (Amaryl).........................................10glipizide-metformin hcl tab 2.5-250 mg..........................10glipizide-metformin hcl tab 2.5-500 mg..........................10glipizide-metformin hcl tab 5-500 mg.............................10glipizide tab er 24hr 2.5 mg (Glucotrol xl)..................... 10glipizide tab er 24hr 5 mg (Glucotrol xl)........................ 10glipizide tab er 24hr 10 mg (Glucotrol xl)...................... 10glipizide tab 5 mg (Glucotrol)..........................................10glipizide tab 10 mg (Glucotrol)........................................10GLUCAGON EMERGENCY KIT – glucagon (rdna) for inj

kit 1 mg............................................................................ 10glyburide-metformin tab 1.25-250 mg

(Glucovance)...................................................................10glyburide-metformin tab 2.5-500 mg (Glucovance)...... 10glyburide-metformin tab 5-500 mg (Glucovance)......... 10glyburide micronized tab 1.5 mg (Glynase)...................10glyburide micronized tab 3 mg (Glynase)......................10glyburide micronized tab 6 mg (Glynase)......................10glyburide tab 1.25 mg.......................................................10glyburide tab 2.5 mg.........................................................10glyburide tab 5 mg............................................................10glycopyrrolate tab 1 mg (Robinul)..................................22glycopyrrolate tab 2 mg (Robinul forte).........................22GLYXAMBI – empagliflozin-linagliptin tab 10-5 mg........... 10GLYXAMBI – empagliflozin-linagliptin tab 25-5 mg........... 10granisetron hcl tab 1 mg................................................. 22GRANIX – tbo-filgrastim soln prefilled syringe 300

mcg/0.5ml......................................................................... 36GRANIX – tbo-filgrastim soln prefilled syringe 480

mcg/0.8ml......................................................................... 36GRANIX – tbo-filgrastim subcutaneous inj 300 mcg/ml.....36GRANIX – tbo-filgrastim subcutaneous inj 480 mcg/1.6ml

(300 mcg/ml).................................................................... 36griseofulvin microsize susp 125 mg/5ml......................... 2griseofulvin microsize tab 500 mg (Grifulvin v)..............2guanfacine hcl tab er 24hr 1 mg (base equiv)

(Intuniv)............................................................................28guanfacine hcl tab er 24hr 2 mg (base equiv)



(Intuniv)............................................................................28guanfacine hcl tab 1 mg (Tenex).................................... 16guanfacine hcl tab 2 mg (Tenex).................................... 16

HHAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 2000 unit............................................. 37HAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 3000 unit............................................. 37halobetasol propionate cream 0.05% (Ultravate)..........40halobetasol propionate oint 0.05% (Ultravate)..............40haloperidol decanoate im soln 50 mg/ml (Haldol

decanoate 50)................................................................. 26

2020

January 2020 56

haloperidol decanoate im soln 100 mg/ml (Haldoldecanoate 100)............................................................... 26

haloperidol lactate oral conc 2 mg/ml............................26haloperidol tab 0.5 mg..................................................... 26haloperidol tab 1 mg........................................................ 26haloperidol tab 2 mg........................................................ 26haloperidol tab 5 mg........................................................ 26haloperidol tab 10 mg...................................................... 26haloperidol tab 20 mg...................................................... 26HARVONI – ledipasvir-sofosbuvir tab 45-200 mg................3HARVONI – ledipasvir-sofosbuvir tab 90-400 mg................3HUMIRA – adalimumab prefilled syringe kit 10

mg/0.1ml...........................................................................31HUMIRA – adalimumab prefilled syringe kit 10





mg/0.4ml...........................................................................31HUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 40 mg/0.8ml................................................... 31HUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 80 mg/0.8ml................................................... 31HUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 80 mg/0.8ml & 40 mg/0.4ml.......................... 31HUMIRA PEN – adalimumab pen-injector kit 40

mg/0.8ml...........................................................................31HUMIRA PEN – adalimumab pen-injector kit 40

mg/0.4ml...........................................................................31HUMIRA PEN-CD/UC/HS START – adalimumab pen-

injector kit 40 mg/0.8ml................................................... 31HUMIRA PEN-CD/UC/HS START – adalimumab pen-

injector kit 80 mg/0.8ml................................................... 31HUMIRA PEN-PS/UV STARTER – adalimumab pen-

injector kit 40 mg/0.8ml................................................... 31HUMIRA PEN-PS/UV STARTER – adalimumab pen-

injector kit 80 mg/0.8ml & 40 mg/0.4ml.......................... 31HUMULIN R U-500 (CONCENTR – insulin regular

(human) inj 500 unit/ml....................................................11HUMULIN R U-500 KWIKPEN – insulin regular (human)

soln pen-injector 500 unit/ml........................................... 11HYCAMTIN – topotecan hcl cap 0.25 mg (base equiv)....... 6HYCAMTIN – topotecan hcl cap 1 mg (base equiv)............ 6hydralazine hcl tab 10 mg............................................... 16hydralazine hcl tab 25 mg............................................... 16hydralazine hcl tab 50 mg............................................... 16hydralazine hcl tab 100 mg............................................. 16hydrochlorothiazide cap 12.5 mg (Microzide)............... 18hydrochlorothiazide tab 12.5 mg.................................... 18hydrochlorothiazide tab 25 mg....................................... 18hydrochlorothiazide tab 50 mg....................................... 18

hydrocodone-acetaminophen soln 7.5-325 mg/15ml(Hycet)..............................................................................30

hydrocodone-acetaminophen tab 7.5-325 mg(Norco).............................................................................30

hydrocodone-acetaminophen tab 5-325 mg(Norco).............................................................................30

hydrocodone-acetaminophen tab 10-325 mg(Norco).............................................................................30

hydrocodone-ibuprofen tab 10-200 mg (Ibudone)........ 30hydrocodone-ibuprofen tab 5-200 mg (Reprexain).......30hydrocodone-ibuprofen tab 7.5-200 mg

(Vicoprofen).................................................................... 30hydrocortisone acetate suppos 25 mg.......................... 38hydrocortisone cream 2.5%.............................................40hydrocortisone enema 100 mg/60ml (Cortenema)........38hydrocortisone lotion 2.5%............................................. 40hydrocortisone oint 2.5%.................................................40hydrocortisone rectal cream 2.5% (Anusol-hc)............ 38hydrocortisone tab 5 mg (Cortef)..................................... 8hydrocortisone tab 10 mg (Cortef)................................... 8hydrocortisone tab 20 mg (Cortef)................................... 8hydrocortisone valerate cream 0.2%..............................40hydrocortisone valerate oint 0.2% (Westcort)...............40hydrocortisone w/ acetic acid otic soln 1-2% (Vosol

hc).....................................................................................38hydromorphone hcl liqd 1 mg/ml (Dilaudid)..................30hydromorphone hcl tab 2 mg (Dilaudid)........................30hydromorphone hcl tab 4 mg (Dilaudid)........................30hydromorphone hcl tab 8 mg (Dilaudid)........................30hydroxychloroquine sulfate tab 200 mg (Plaquenil).......4hydroxyurea cap 500 mg (Hydrea)................................... 6hydroxyzine hcl syrup 10 mg/5ml...................................24hydroxyzine hcl tab 10 mg.............................................. 24hydroxyzine hcl tab 25 mg.............................................. 24hydroxyzine hcl tab 50 mg.............................................. 24hydroxyzine pamoate cap 25 mg (Vistaril).................... 24hydroxyzine pamoate cap 50 mg (Vistaril).................... 24HYDROXYZINE PAMOATE – hydroxyzine pamoate cap

100 mg............................................................................. 24

Iibandronate sodium tab 150 mg (base equivalent)

(Boniva)........................................................................... 12IBRANCE – palbociclib cap 75 mg...................................... 6IBRANCE – palbociclib cap 100 mg.................................... 6IBRANCE – palbociclib cap 125 mg.................................... 6ibuprofen susp 100 mg/5ml.............................................31ibuprofen tab 400 mg....................................................... 31ibuprofen tab 600 mg....................................................... 31ibuprofen tab 800 mg....................................................... 31icatibant acetate inj 30 mg/3ml (base equivalent)

(Firazyr)............................................................................37ICLUSIG – ponatinib hcl tab 15 mg (base equiv)................ 6ICLUSIG – ponatinib hcl tab 45 mg (base equiv)................ 6ILARIS – canakinumab subcutaneous inj 150 mg/ml........ 31

2020

January 2020 57

imatinib mesylate tab 100 mg (base equivalent)(Gleevec)............................................................................6

imatinib mesylate tab 400 mg (base equivalent)(Gleevec)............................................................................6

IMBRUVICA – ibrutinib cap 70 mg.......................................6IMBRUVICA – ibrutinib cap 140 mg.....................................6IMBRUVICA – ibrutinib tab 140 mg..................................... 6IMBRUVICA – ibrutinib tab 280 mg..................................... 6IMBRUVICA – ibrutinib tab 420 mg..................................... 6IMBRUVICA – ibrutinib tab 560 mg..................................... 6imipramine hcl tab 10 mg (Tofranil)............................... 25imipramine hcl tab 25 mg (Tofranil)............................... 25imipramine hcl tab 50 mg (Tofranil)............................... 25imiquimod cream 5% (Aldara).........................................40IMPAVIDO – miltefosine cap 50 mg.....................................5INBRIJA – levodopa inhal powder cap 42 mg................... 34INCRELEX – mecasermin inj 40 mg/4ml (10 mg/ml).........12INCRUSE ELLIPTA – umeclidinium br aero powd breath

act 62.5 mcg/inh (base eq)............................................. 21indapamide tab 1.25 mg...................................................18indapamide tab 2.5 mg.....................................................18indomethacin cap 25 mg................................................. 32indomethacin cap 50 mg................................................. 32INHALER ASSIST DEVICES -........................................... 41INLYTA – axitinib tab 1 mg...................................................6INLYTA – axitinib tab 5 mg...................................................6INSULIN PEN NEEDLES - various....................................41INSULIN SYRINGES - various...........................................41INTELENCE – etravirine tab 25 mg.....................................3INTELENCE – etravirine tab 100 mg...................................3INTELENCE – etravirine tab 200 mg...................................3INVOKAMET – canagliflozin-metformin hcl tab 50-500

mg.....................................................................................10INVOKAMET – canagliflozin-metformin hcl tab 50-1000



mg.....................................................................................10INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr

50-500 mg........................................................................ 10INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr

50-1000 mg......................................................................10INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr

150-500 mg......................................................................10INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr

150-1000 mg....................................................................10INVOKANA – canagliflozin tab 100 mg..............................10INVOKANA – canagliflozin tab 300 mg..............................10ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml

(Duoneb)..........................................................................21ipratropium bromide inhal soln 0.02%...........................21ipratropium bromide nasal soln 0.03% (21 mcg/spray)

(Atrovent)........................................................................ 20ipratropium bromide nasal soln 0.06% (42 mcg/spray)

(Atrovent)........................................................................ 20

irbesartan-hydrochlorothiazide tab 150-12.5 mg(Avalide)...........................................................................16

irbesartan-hydrochlorothiazide tab 300-12.5 mg(Avalide)...........................................................................16

irbesartan tab 75 mg (Avapro)........................................ 16irbesartan tab 150 mg (Avapro)...................................... 16irbesartan tab 300 mg (Avapro)...................................... 16IRESSA – gefitinib tab 250 mg............................................ 6ISENTRESS HD – raltegravir potassium tab 600 mg (base

equiv).................................................................................. 3ISENTRESS – raltegravir potassium chew tab 25 mg

(base equiv)....................................................................... 3ISENTRESS – raltegravir potassium chew tab 100 mg

(base equiv)....................................................................... 3ISENTRESS – raltegravir potassium packet for susp 100

mg (base equiv).................................................................3ISENTRESS – raltegravir potassium tab 400 mg (base

equiv).................................................................................. 3ISONIAZID – isoniazid syrup 50 mg/5ml............................. 2isoniazid tab 100 mg.......................................................... 2isoniazid tab 300 mg.......................................................... 2ISOSORBIDE DINITRATE – isosorbide dinitrate tab 30

mg.....................................................................................13isosorbide dinitrate tab 10 mg........................................13isosorbide dinitrate tab 20 mg........................................13isosorbide dinitrate tab 5 mg (Isordil titradose)........... 13isosorbide mononitrate tab er 24hr 30 mg.................... 13isosorbide mononitrate tab er 24hr 60 mg.................... 13isosorbide mononitrate tab er 24hr 120 mg.................. 13isosorbide mononitrate tab 10 mg................................. 13isosorbide mononitrate tab 20 mg................................. 13isotretinoin cap 10 mg..................................................... 40isotretinoin cap 20 mg..................................................... 40isotretinoin cap 40 mg..................................................... 40isotretinoin cap 30 mg (Claravis)....................................40itraconazole cap 100 mg (Sporanox)................................2itraconazole oral soln 10 mg/ml (Sporanox)................... 2ivermectin tab 3 mg (Stromectol)..................................... 4

JJAKAFI – ruxolitinib phosphate tab 5 mg (base

equivalent).......................................................................... 6JAKAFI – ruxolitinib phosphate tab 10 mg (base




equivalent).......................................................................... 6JANUMET – sitagliptin-metformin hcl tab 50-500 mg........10JANUMET – sitagliptin-metformin hcl tab 50-1000 mg......10JANUMET XR – sitagliptin-metformin hcl tab er 24hr

50-500 mg........................................................................ 10JANUMET XR – sitagliptin-metformin hcl tab er 24hr

50-1000 mg......................................................................11

2020

January 2020 58

JANUMET XR – sitagliptin-metformin hcl tab er 24hr100-1000 mg....................................................................11

JANUVIA – sitagliptin phosphate tab 25 mg (baseequiv)................................................................................ 11



JARDIANCE – empagliflozin tab 10 mg.............................11JARDIANCE – empagliflozin tab 25 mg.............................11

KKALETRA – lopinavir-ritonavir tab 100-25 mg.....................3KALETRA – lopinavir-ritonavir tab 200-50 mg.....................3KALYDECO – ivacaftor packet 25 mg............................... 21KALYDECO – ivacaftor packet 50 mg............................... 21KALYDECO – ivacaftor packet 75 mg............................... 21KALYDECO – ivacaftor tab 150 mg................................... 21ketoconazole cream 2%................................................... 40ketoconazole shampoo 2% (Nizoral)..............................40ketorolac tromethamine ophth soln 0.5% (Acular)....... 37ketorolac tromethamine ophth soln 0.4% (Acular

ls)......................................................................................37KISQALI FEMARA 200 DOSE – ribociclib 200 mg dose

(200 mg tab) & letrozole 2.5 mg tbpk............................... 6KISQALI FEMARA 400 DOSE – ribociclib 400 mg dose

(200 mg tab) & letrozole 2.5 mg tbpk............................... 6KISQALI FEMARA 600 DOSE – ribociclib 600 mg dose

(200 mg tab) & letrozole 2.5 mg tbpk............................... 6KISQALI – ribociclib succinate tab pack 200 mg daily

dose.................................................................................... 6KISQALI – ribociclib succinate tab pack 400 mg daily dose

(200 mg tab)...................................................................... 6KISQALI – ribociclib succinate tab pack 600 mg daily dose

(200 mg tab)...................................................................... 6KOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr

2.5-1000 mg.....................................................................11KOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr

5-500 mg.......................................................................... 11KOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr

5-1000 mg........................................................................ 11KOSHER PRENATAL PLUS IRON – prenatal vit w/ iron

carbonyl-fa tab 30-1 mg.................................................. 35K-PHOS NO 2 – potassium & sodium acid phosphates tab

305-700 mg......................................................................23K-PHOS – potassium phosphate monobasic tab 500

mg.....................................................................................35

Llabetalol hcl tab 100 mg (Trandate)................................14labetalol hcl tab 200 mg (Trandate)................................14labetalol hcl tab 300 mg (Trandate)................................14lactulose (encephalopathy) solution 10 gm/15ml......... 23lactulose solution 10 gm/15ml........................................ 21lamivudine oral soln 10 mg/ml (Epivir)............................ 3lamivudine tab 150 mg (Epivir)......................................... 3

lamivudine tab 300 mg (Epivir)......................................... 3lamivudine tab 100 mg (hbv) (Epivir hbv)........................3lamivudine-zidovudine tab 150-300 mg (Combivir)........ 3lamotrigine tab chewable dispersible 5 mg (Lamictal

chewable di)....................................................................33lamotrigine tab chewable dispersible 25 mg (Lamictal

chewable di)....................................................................33lamotrigine tab 25 mg (Lamictal)....................................33lamotrigine tab 100 mg (Lamictal)..................................33lamotrigine tab 150 mg (Lamictal)..................................33lamotrigine tab 200 mg (Lamictal)..................................33LANCET DEVICES - various..............................................41LANCETS - various............................................................ 41lansoprazole cap delayed release 15 mg

(Prevacid)........................................................................ 22lansoprazole cap delayed release 30 mg

(Prevacid)........................................................................ 22LANTUS – insulin glargine inj 100 unit/ml......................... 12LANTUS SOLOSTAR – insulin glargine soln pen-injector

100 unit/ml........................................................................12latanoprost ophth soln 0.005% (Xalatan).......................37LEDIPASVIR/SOFOSBUVIR – ledipasvir-sofosbuvir tab

90-400 mg.......................................................................... 3leflunomide tab 10 mg (Arava)........................................32leflunomide tab 20 mg (Arava)........................................32LENVIMA 14 MG DAILY DOSE – lenvatinib cap therapy

pack 10 & 4 mg (14 mg daily dose)..................................6LENVIMA 18 MG DAILY DOSE – lenvatinib cap therapy

pack 10 & 4 (2) mg (18 mg daily dose)............................ 6LENVIMA 24 MG DAILY DOSE – lenvatinib cap therapy

pack 10 (2) & 4 mg (24 mg daily dose)............................ 6LENVIMA 10 MG DAILY DOSE – lenvatinib cap therapy

pack 10 mg (10 mg daily dose)........................................ 6LENVIMA 12MG DAILY DOSE – lenvatinib cap therapy

pack 4 (3) mg (12 mg daily dose).....................................6LENVIMA 20 MG DAILY DOSE – lenvatinib cap therapy

pack 10 (2) mg (20 mg daily dose)...................................6LENVIMA 4 MG DAILY DOSE – lenvatinib cap therapy

pack 4 mg (4 mg daily dose)............................................ 6LENVIMA 8 MG DAILY DOSE – lenvatinib cap therapy

pack 4 (2) mg (8 mg daily dose).......................................6letrozole tab 2.5 mg (Femara)........................................... 6LEUCOVORIN CALCIUM – leucovorin calcium tab 10

mg....................................................................................... 6LEUCOVORIN CALCIUM – leucovorin calcium tab 15

mg....................................................................................... 6leucovorin calcium tab 5 mg.............................................6leucovorin calcium tab 25 mg...........................................6LEUKERAN – chlorambucil tab 2 mg.................................. 6levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base

equiv)............................................................................... 21levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)

(Xopenex)........................................................................ 21levalbuterol hcl soln nebu 0.63 mg/3ml (base equiv)

(Xopenex)........................................................................ 21

2020

January 2020 59

levalbuterol hcl soln nebu 1.25 mg/3ml (base equiv)(Xopenex)........................................................................ 21

LEVEMIR FLEXTOUCH – insulin detemir soln pen-injector100 unit/ml........................................................................12

LEVEMIR – insulin detemir inj 100 unit/ml.........................12levetiracetam oral soln 100 mg/ml (Keppra)..................33levetiracetam tab er 24hr 500 mg (Keppra xr)...............33levetiracetam tab er 24hr 750 mg (Keppra xr)...............33levetiracetam tab 250 mg (Keppra).................................33levetiracetam tab 500 mg (Keppra).................................33levetiracetam tab 750 mg (Keppra).................................33levetiracetam tab 1000 mg (Keppra)...............................33levobunolol hcl ophth soln 0.5% (Betagan).................. 37levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)...... 12levocarnitine tab 330 mg (Carnitor)................................12levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5 mg/

ml) (Xyzal)....................................................................... 19levocetirizine dihydrochloride tab 5 mg (Xyzal)............19levofloxacin oral soln 25 mg/ml (Levaquin).................... 2levofloxacin tab 250 mg (Levaquin)................................. 2levofloxacin tab 500 mg (Levaquin)................................. 2levofloxacin tab 750 mg (Levaquin)................................. 2levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mg......................................................................9levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg.....................................................................................9levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg.....................................................................................9levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg.................................. 9levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7) (Loseasonique).............................................. 9levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7) (Seasonique).................................................. 9levothyroxine sodium tab 25 mcg (Synthroid)..............12levothyroxine sodium tab 50 mcg (Synthroid)..............12levothyroxine sodium tab 75 mcg (Synthroid)..............12levothyroxine sodium tab 88 mcg (Synthroid)..............12levothyroxine sodium tab 100 mcg (Synthroid)............12levothyroxine sodium tab 112 mcg (Synthroid)............ 12levothyroxine sodium tab 125 mcg (Synthroid)............12levothyroxine sodium tab 137 mcg (Synthroid)............12levothyroxine sodium tab 150 mcg (Synthroid)............12levothyroxine sodium tab 175 mcg (Synthroid)............12levothyroxine sodium tab 200 mcg (Synthroid)............12levothyroxine sodium tab 300 mcg (Synthroid)............12lidocaine hcl gel 2%......................................................... 40lidocaine hcl soln 4% (Xylocaine)...................................40lidocaine hcl viscous soln 2%........................................ 38lidocaine oint 5%...............................................................40lidocaine patch 5% (Lidoderm)....................................... 40lidocaine-prilocaine cream 2.5-2.5% (Emla).................. 40LINDANE – lindane shampoo 1%......................................40linezolid for susp 100 mg/5ml (Zyvox).............................5linezolid tab 600 mg (Zyvox)............................................. 5liothyronine sodium tab 5 mcg (Cytomel)..................... 12

liothyronine sodium tab 25 mcg (Cytomel)................... 12liothyronine sodium tab 50 mcg (Cytomel)................... 12lisinopril & hydrochlorothiazide tab 10-12.5 mg

(Zestoretic)......................................................................16lisinopril & hydrochlorothiazide tab 20-12.5 mg

(Zestoretic)......................................................................16lisinopril & hydrochlorothiazide tab 20-25 mg

(Zestoretic)......................................................................16lisinopril tab 5 mg (Prinivil)............................................. 16lisinopril tab 10 mg (Prinivil)...........................................16lisinopril tab 20 mg (Prinivil)...........................................16lisinopril tab 2.5 mg (Zestril)........................................... 16lisinopril tab 30 mg (Zestril)............................................ 16lisinopril tab 40 mg (Zestril)............................................ 16lithium carbonate cap 300 mg.........................................26lithium carbonate cap 150 mg (Lithium carbonate)......26lithium carbonate cap 600 mg (Lithium carbonate)......26LITHIUM CARBONATE – lithium carbonate cap 150

mg.....................................................................................26lithium carbonate tab er 450 mg.....................................26lithium carbonate tab er 300 mg (Lithobid)................... 26lithium carbonate tab 300 mg......................................... 26LITHIUM – lithium oral solution 8 meq/5ml........................26LONSURF – trifluridine-tipiracil tab 15-6.14 mg...................6LONSURF – trifluridine-tipiracil tab 20-8.19 mg...................6loperamide hcl cap 2 mg................................................. 21lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)

(Kaletra)............................................................................. 3lorazepam conc 2 mg/ml (Lorazepam intensol)............ 24lorazepam tab 0.5 mg (Ativan)........................................ 24lorazepam tab 1 mg (Ativan)........................................... 24lorazepam tab 2 mg (Ativan)........................................... 24losartan potassium & hydrochlorothiazide tab 50-12.5

mg (Hyzaar).....................................................................16losartan potassium & hydrochlorothiazide tab 100-12.5

mg (Hyzaar).....................................................................16losartan potassium & hydrochlorothiazide tab 100-25

mg (Hyzaar).....................................................................17losartan potassium tab 25 mg (Cozaar).........................17losartan potassium tab 50 mg (Cozaar).........................17losartan potassium tab 100 mg (Cozaar).......................17LOTEMAX – loteprednol etabonate ophth gel 0.5%..........37LOTEMAX – loteprednol etabonate ophth oint 0.5%.........37LOTEMAX SM – loteprednol etabonate ophth gel

0.38%................................................................................37loteprednol etabonate ophth susp 0.5% (Lotemax)......37lovastatin tab 10 mg.........................................................19lovastatin tab 20 mg (Mevacor).......................................19lovastatin tab 40 mg (Mevacor).......................................19loxapine succinate cap 10 mg........................................ 26loxapine succinate cap 25 mg........................................ 26loxapine succinate cap 50 mg........................................ 26loxapine succinate cap 5 mg (Loxitane)........................26LUMIGAN – bimatoprost ophth soln 0.01%.......................37LYNPARZA – olaparib tab 100 mg.......................................6LYNPARZA – olaparib tab 150 mg.......................................6

2020

January 2020 60

pregabalin cap 25 mg..........................................................33pregabalin cap 50 mg..........................................................33pregabalin cap 75 mg..........................................................33pregabalin cap 100 mg........................................................33pregabalin cap 150 mg........................................................33pregabalin cap 200 mg........................................................33pregabalin cap 225 mg........................................................33pregabalin cap 300 mg........................................................33pregabalin soln 20 mg/ml.................................................... 33LYSODREN – mitotane tab 500 mg.....................................6

Mmalathion lotion 0.5% (Ovide).........................................40MATULANE – procarbazine hcl cap 50 mg......................... 6MAVENCLAD – cladribine tab therapy pack 10 mg (4

tabs)..................................................................................29MAVENCLAD – cladribine tab therapy pack 10 mg (5






tabs)..................................................................................29MAVYRET – glecaprevir-pibrentasvir tab 100-40 mg.......... 3MAYZENT – siponimod fumarate tab 0.25 mg (base

equiv)................................................................................ 29MAYZENT – siponimod fumarate tab 2 mg (base

equiv)................................................................................ 29meclizine hcl tab 12.5 mg................................................22meclizine hcl tab 25 mg...................................................22medroxyprogesterone acetate im susp 150 mg/ml

(Depo-provera contrac)................................................... 9medroxyprogesterone acetate im susp prefilled syr

150 mg/ml (Depo-provera contrac)................................9medroxyprogesterone acetate tab 2.5 mg

(Provera)..........................................................................10medroxyprogesterone acetate tab 5 mg (Provera).......10medroxyprogesterone acetate tab 10 mg (Provera).....10MEFLOQUINE HCL – mefloquine hcl tab 250 mg...............4megestrol acetate susp 40 mg/ml (Megace oral)............ 6megestrol acetate tab 20 mg.............................................7megestrol acetate tab 40 mg.............................................7MEKINIST – trametinib dimethyl sulfoxide tab 0.5 mg

(base equivalent)............................................................... 7MEKINIST – trametinib dimethyl sulfoxide tab 2 mg (base

equivalent).......................................................................... 7meloxicam tab 7.5 mg (Mobic)........................................32meloxicam tab 15 mg (Mobic).........................................32melphalan tab 2 mg (Alkeran)...........................................7memantine hcl oral solution 2 mg/ml (Namenda)......... 29

memantine hcl tab 5 mg (28) & 10 mg (21) titration pak(Namenda titration pa).................................................. 29

memantine hcl tab 5 mg (Namenda).............................. 29memantine hcl tab 10 mg (Namenda)............................ 29MENOPUR – menotropins for subcutaneous inj 75

unit.................................................................................... 12mercaptopurine tab 50 mg (Purinethol)...........................7mesalamine cap dr 400 mg (Delzicol)............................ 23mesalamine enema 4 gm................................................. 23mesalamine suppos 1000 mg (Canasa)......................... 23mesalamine tab delayed release 1.2 gm (Lialda)..........23mesalamine tab delayed release 800 mg (Asacol

hd).................................................................................... 23MESNEX – mesna tab 400 mg............................................7metformin hcl tab er 24hr 500 mg (Glucophage xr)......11metformin hcl tab er 24hr 750 mg (Glucophage xr)......11metformin hcl tab 500 mg (Glucophage)....................... 11metformin hcl tab 850 mg (Glucophage)....................... 11metformin hcl tab 1000 mg (Glucophage)..................... 11methadone hcl conc 10 mg/ml (Methadose)................. 30methadone hcl soln 5 mg/5ml (Methadone hcl)............30methadone hcl soln 10 mg/5ml (Methadone hcl)..........30methadone hcl tab for oral susp 40 mg.........................30methadone hcl tab 10 mg (Dolophine)...........................30methadone hcl tab 5 mg (Dolophine hcl).......................30methazolamide tab 25 mg (Neptazane)..........................18methazolamide tab 50 mg (Neptazane)..........................18methimazole tab 5 mg (Tapazole)................................... 12methimazole tab 10 mg (Tapazole).................................12methocarbamol tab 750 mg (Robaxin-750)....................35methocarbamol tab 500 mg (Robaxin)...........................35methotrexate sodium tab 2.5 mg (base equiv)................7methscopolamine bromide tab 2.5 mg (Pamine).......... 22methscopolamine bromide tab 5 mg (Pamine

forte).................................................................................22methyldopa tab 250 mg................................................... 17methyldopa tab 500 mg................................................... 17methylergonovine maleate tab 0.2 mg...........................12methylphenidate hcl tab er 10 mg..................................28methylphenidate hcl tab er 20 mg..................................28methylphenidate hcl tab 5 mg (Ritalin).......................... 28methylphenidate hcl tab 10 mg (Ritalin)........................ 28methylphenidate hcl tab 20 mg (Ritalin)........................ 28methylprednisolone tab 4 mg (Medrol)............................8methylprednisolone tab 8 mg (Medrol)............................8methylprednisolone tab 16 mg (Medrol)..........................8methylprednisolone tab 32 mg (Medrol)..........................8methylprednisolone tab therapy pack 4 mg (21)

(Medrol dosepak)............................................................. 8metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) (base

equiv)............................................................................... 23metoclopramide hcl tab 5 mg (base equivalent)

(Reglan)........................................................................... 23metoclopramide hcl tab 10 mg (base equivalent)

(Reglan)........................................................................... 23metolazone tab 10 mg......................................................18

2020

January 2020 61

metolazone tab 2.5 mg (Zaroxolyn)................................18metolazone tab 5 mg (Zaroxolyn)...................................18METOPROLOL/HYDROCHLOROTHI – metoprolol &

hydrochlorothiazide tab 100-50 mg.................................17metoprolol & hydrochlorothiazide tab 50-25 mg

(Lopressor hct)...............................................................17metoprolol & hydrochlorothiazide tab 100-25 mg

(Lopressor hct)...............................................................17metoprolol succinate tab er 24hr 25 mg (tartrate equiv)

(Toprol xl)........................................................................14metoprolol succinate tab er 24hr 50 mg (tartrate equiv)

(Toprol xl)........................................................................14metoprolol succinate tab er 24hr 100 mg (tartrate

equiv) (Toprol xl)............................................................14metoprolol succinate tab er 24hr 200 mg (tartrate

equiv) (Toprol xl)............................................................14metoprolol tartrate tab 25 mg......................................... 14metoprolol tartrate tab 50 mg (Lopressor).................... 14metoprolol tartrate tab 100 mg (Lopressor).................. 14metronidazole cream 0.75% (Metrocream).................... 40metronidazole gel 0.75%..................................................40metronidazole gel 1% (Metrogel).................................... 40metronidazole lotion 0.75% (Metrolotion)......................40metronidazole tab 250 mg (Flagyl)................................... 5metronidazole tab 500 mg (Flagyl)................................... 5metronidazole vaginal gel 0.75% (Metrogel-

vaginal)............................................................................ 23MEXILETINE HCL – mexiletine hcl cap 150 mg................15MEXILETINE HCL – mexiletine hcl cap 200 mg................15MEXILETINE HCL – mexiletine hcl cap 250 mg................15midodrine hcl tab 2.5 mg.................................................18midodrine hcl tab 5 mg....................................................18midodrine hcl tab 10 mg..................................................18MIGRANAL – dihydroergotamine mesylate nasal spray 4

mg/ml................................................................................ 32minocycline hcl cap 50 mg (Minocin).............................. 2minocycline hcl cap 75 mg (Minocin).............................. 2minocycline hcl cap 100 mg (Minocin)............................ 2minocycline hcl tab 50 mg................................................ 2minocycline hcl tab 75 mg................................................ 2minocycline hcl tab 100 mg.............................................. 2minoxidil tab 2.5 mg.........................................................17minoxidil tab 10 mg..........................................................17MIRENA – levonorgestrel releasing iud 20 mcg/day (52

mg total)............................................................................. 9mirtazapine tab 7.5 mg.....................................................25mirtazapine tab 15 mg (Remeron).................................. 25mirtazapine tab 30 mg (Remeron).................................. 25mirtazapine tab 45 mg (Remeron).................................. 25misoprostol tab 100 mcg (Cytotec)................................ 22misoprostol tab 200 mcg (Cytotec)................................ 22MITIGARE – colchicine cap 0.6 mg...................................33modafinil tab 100 mg (Provigil).......................................28modafinil tab 200 mg (Provigil).......................................28moexipril hcl tab 7.5 mg (Univasc).................................17moexipril hcl tab 15 mg (Univasc)..................................17

mometasone furoate cream 0.1% (Elocon)................... 40mometasone furoate nasal susp 50 mcg/act

(Nasonex)........................................................................ 20mometasone furoate oint 0.1% (Elocon)........................40mometasone furoate solution 0.1% (lotion)

(Elocon)........................................................................... 40montelukast sodium chew tab 4 mg (base equiv)

(Singulair)........................................................................21montelukast sodium chew tab 5 mg (base equiv)

(Singulair)........................................................................21montelukast sodium oral granules packet 4 mg (base

equiv) (Singulair)............................................................21montelukast sodium tab 10 mg (base equiv)

(Singulair)........................................................................21MORPHINE SULFATE ER – morphine sulfate beads cap

er 24hr 30 mg.................................................................. 30MORPHINE SULFATE ER – morphine sulfate beads cap





er 24hr 120 mg................................................................ 30MORPHINE SULFATE – morphine sulfate tab 15 mg....... 30MORPHINE SULFATE – morphine sulfate tab 30 mg....... 30morphine sulfate oral soln 10 mg/5ml........................... 30morphine sulfate oral soln 20 mg/5ml........................... 30morphine sulfate oral soln 100 mg/5ml (20 mg/ml)...... 30morphine sulfate tab er 15 mg (Ms contin)................... 30morphine sulfate tab er 30 mg (Ms contin)................... 30morphine sulfate tab er 60 mg (Ms contin)................... 30morphine sulfate tab er 100 mg (Ms contin)................. 30morphine sulfate tab er 200 mg (Ms contin)................. 30morphine sulfate tab 15 mg (Morphine sulfate)............30morphine sulfate tab 30 mg (Morphine sulfate)............30moxifloxacin hcl ophth soln 0.5% (base equiv)

(Vigamox)........................................................................ 37MULTAQ – dronedarone hcl tab 400 mg (base

equivalent)........................................................................ 15mupirocin oint 2% (Bactroban).......................................40mycophenolate mofetil cap 250 mg (Cellcept)..............41mycophenolate mofetil for oral susp 200 mg/ml

(Cellcept)......................................................................... 41mycophenolate mofetil tab 500 mg (Cellcept)...............41mycophenolate sodium tab dr 180 mg (mycophenolic

acid equiv) (Myfortic).................................................... 41mycophenolate sodium tab dr 360 mg (mycophenolic

acid equiv) (Myfortic).................................................... 41MYLERAN – busulfan tab 2 mg...........................................7

Nnabumetone tab 500 mg.................................................. 32nabumetone tab 750 mg.................................................. 32

2020

January 2020 62

nadolol tab 20 mg (Corgard)........................................... 14nadolol tab 40 mg (Corgard)........................................... 14nadolol tab 80 mg (Corgard)........................................... 14naloxone hcl inj 0.4 mg/ml.............................................. 41naloxone hcl inj 4 mg/10ml............................................. 41NALOXONE HCL – naloxone hcl soln cartridge 0.4 mg/

ml...................................................................................... 41naltrexone hcl tab 50 mg (Revia)....................................41naproxen sodium tab 275 mg (Anaprox)....................... 32naproxen sodium tab 550 mg (Anaprox ds)..................32naproxen susp 125 mg/5ml (Naprosyn).........................32naproxen tab ec 375 mg (Ec-naprosyn).........................32naproxen tab ec 500 mg (Ec-naprosyn).........................32naproxen tab 250 mg (Naprosyn)................................... 32naproxen tab 375 mg (Naprosyn)................................... 32naproxen tab 500 mg (Naprosyn)................................... 32naratriptan hcl tab 1 mg (base equiv) (Amerge)........... 32naratriptan hcl tab 2.5 mg (base equiv) (Amerge)........ 32NARCAN – naloxone hcl nasal spray 4 mg/0.1ml............. 41NATACYN – natamycin ophth susp 5%............................. 37nateglinide tab 60 mg (Starlix)........................................11nateglinide tab 120 mg (Starlix)......................................11NEBUPENT – pentamidine isethionate for nebulization

soln 300 mg....................................................................... 5NEOMYCIN/POLYMYXIN/GRAMIC – neomycin-polymy-

gramicid op sol 1.75-10000-0.025mg-unt-mg/ml............ 38neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin................................ 37neomycin-polymyxin-dexamethasone ophth oint 0.1%

(Maxitrol)......................................................................... 38neomycin-polymyxin-dexamethasone ophth susp

0.1% (Maxitrol)................................................................38neomycin-polymyxin-hc otic soln 1% (Cortisporin)..... 38neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%....................................................................... 38neomycin sulfate tab 500 mg............................................2NEULASTA ONPRO KIT – pegfilgrastim soln prefilled

syringe kit 6 mg/0.6ml..................................................... 36NEULASTA – pegfilgrastim soln prefilled syringe 6

mg/0.6ml...........................................................................36NEUPOGEN – filgrastim inj 300 mcg/ml............................36NEUPOGEN – filgrastim inj 480 mcg/1.6ml (300 mcg/

ml).....................................................................................36NEUPOGEN – filgrastim soln prefilled syringe 300

mcg/0.5ml......................................................................... 36NEUPOGEN – filgrastim soln prefilled syringe 480

mcg/0.8ml (600 mcg/ml)..................................................36nevirapine susp 50 mg/5ml (Viramune)........................... 3nevirapine tab er 24hr 100 mg (Viramune xr)..................3nevirapine tab er 24hr 400 mg (Viramune xr)..................3nevirapine tab 200 mg (Viramune)....................................3NEXAVAR – sorafenib tosylate tab 200 mg (base

equivalent).......................................................................... 7NEXIUM – esomeprazole magnesium for delayed release

susp packet 5 mg............................................................ 22

NEXIUM – esomeprazole magnesium for delayed releasesusp packet 10 mg.......................................................... 22



NEXIUM – esomeprazole magnesium for delayed releasesusp pack 2.5 mg............................................................ 22

niacin tab er 500 mg (antihyperlipidemic)(Niaspan)......................................................................... 19



NICOTROL INHALER – nicotine inhaler system 10 mg (4mg delivered)................................................................... 29

NICOTROL NS – nicotine nasal spray 10 mg/ml (0.5 mg/spray)................................................................................29

nifedipine tab er 24hr 30 mg (Adalat cc)........................14nifedipine tab er 24hr 60 mg (Adalat cc)........................14nifedipine tab er 24hr 90 mg (Adalat cc)........................14nifedipine tab er 24hr osmotic release 30 mg

(Procardia xl).................................................................. 15nifedipine tab er 24hr osmotic release 60 mg

(Procardia xl).................................................................. 15nifedipine tab er 24hr osmotic release 90 mg

(Procardia xl).................................................................. 15nilutamide tab 150 mg (Nilandron)................................... 7nimodipine cap 30 mg......................................................15NINLARO – ixazomib citrate cap 2.3 mg (base

equivalent).......................................................................... 7NINLARO – ixazomib citrate cap 3 mg (base

equivalent).......................................................................... 7NINLARO – ixazomib citrate cap 4 mg (base

equivalent).......................................................................... 7nitisinone cap 2 mg (Orfadin)......................................... 12nitisinone cap 5 mg (Orfadin)......................................... 12nitisinone cap 10 mg (Orfadin)....................................... 12NITRO-BID – nitroglycerin oint 2%.................................... 13nitrofurantoin macrocrystalline cap 25 mg

(Macrodantin)..................................................................23nitrofurantoin macrocrystalline cap 50 mg

(Macrodantin)..................................................................23nitrofurantoin macrocrystalline cap 100 mg

(Macrodantin)..................................................................23nitrofurantoin monohydrate macrocrystalline cap 100

mg (Macrobid)................................................................ 23nitrofurantoin susp 25 mg/5ml (Furadantin)..................23nitroglycerin sl tab 0.3 mg (Nitrostat)............................ 13nitroglycerin sl tab 0.4 mg (Nitrostat)............................ 13nitroglycerin sl tab 0.6 mg (Nitrostat)............................ 13nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur)..........13nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur)..........13nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur)..........13nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur)..........13NITYR – nitisinone tab 2 mg..............................................12

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January 2020 63

NITYR – nitisinone tab 5 mg..............................................12NITYR – nitisinone tab 10 mg............................................12NIVESTYM – filgrastim-aafi inj 300 mcg/ml.......................36NIVESTYM – filgrastim-aafi inj 480 mcg/1.6ml (300 mcg/

ml).....................................................................................36NIVESTYM – filgrastim-aafi soln prefilled syringe 300

mcg/0.5ml......................................................................... 36NIVESTYM – filgrastim-aafi soln prefilled syringe 480

mcg/0.8ml......................................................................... 36NORDITROPIN FLEXPRO – somatropin inj 5

mg/1.5ml...........................................................................12NORDITROPIN FLEXPRO – somatropin inj 10



mg/3ml..............................................................................13norethindrone & ethinyl estradiol-fe chew tab 0.4

mg-35 mcg (Femcon fe)..................................................9norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg

(Brevicon-28).....................................................................9norethindrone & ethinyl estradiol tab 1 mg-35 mcg

(Norinyl 1+35)................................................................... 9norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg

(Ovcon-35).........................................................................9norethindrone ace & ethinyl estradiol-fe tab 1 mg-20

mcg (Loestrin fe 1/20)................................................... 10norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30

mcg (Loestrin fe 1.5/30)................................................ 10norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg

(Loestrin 1/20-21)........................................................... 10norethindrone ace & ethinyl estradiol tab 1.5 mg-30

mcg (Loestrin 1.5/30-21)............................................... 10norethindrone acetate-ethinyl estradiol tab 1 mg-5

mcg.....................................................................................9norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5

mcg (Femhrt low dose)...................................................9norethindrone acetate tab 5 mg (Aygestin)...................10norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35

mg-mcg (Estrostep fe).................................................... 9norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-

mcg (Ortho-novum 7/7/7)..............................................10norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-

mcg (Tri-norinyl 28)....................................................... 10norethindrone tab 0.35 mg (Nor-qd)...............................10norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg

(Ortho-cyclen).................................................................10norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35

mg-mcg (Ortho tri-cyclen)............................................ 10norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25

mg-mcg (Ortho tri-cyclen lo)........................................10norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg.........10nortriptyline hcl cap 10 mg (Pamelor)............................25nortriptyline hcl cap 25 mg (Pamelor)............................25nortriptyline hcl cap 50 mg (Pamelor)............................25nortriptyline hcl cap 75 mg (Pamelor)............................25

NORTRIPTYLINE HCL – nortriptyline hcl soln 10mg/5ml..............................................................................25

NORVIR – ritonavir oral soln 80 mg/ml................................3NORVIR – ritonavir powder packet 100 mg.........................3NOVAREL – chorionic gonadotropin for im inj 5000

unit.................................................................................... 13NOVOLIN 70/30 FLEXPEN – insulin nph & regular susp

pen-inj 100 unit/ml (70-30).............................................. 11NOVOLIN 70/30 – insulin nph isophane & regular human

inj 100 unit/ml (70-30)......................................................11NOVOLIN N – insulin nph (human) (isophane) inj 100 unit/

ml...................................................................................... 11NOVOLIN R – insulin regular (human) inj 100 unit/ml....... 11NOVOLOG FLEXPEN – insulin aspart soln pen-injector

100 unit/ml........................................................................11NOVOLOG – insulin aspart inj 100 unit/ml........................ 11NOVOLOG MIX 70/30 – insulin aspart prot & aspart

(human) inj 100 unit/ml (70-30).......................................11NOVOLOG MIX 70/30 PREFILL – insulin aspart prot &

aspart sus pen-inj 100 unit/ml (70-30)............................ 11NOVOLOG PENFILL – insulin aspart soln cartridge 100

unit/ml............................................................................... 11NOXAFIL – posaconazole susp 40 mg/ml...........................2NOXAFIL – posaconazole tab delayed release 100 mg......2NUCYNTA ER – tapentadol hcl tab er 12hr 50 mg............30NUCYNTA ER – tapentadol hcl tab er 12hr 100 mg..........30NUCYNTA ER – tapentadol hcl tab er 12hr 150 mg..........30NUCYNTA ER – tapentadol hcl tab er 12hr 200 mg..........30NUCYNTA ER – tapentadol hcl tab er 12hr 250 mg..........30NUVARING – etonogestrel-ethinyl estradiol va ring

0.120-0.015 mg/24hr....................................................... 10nystatin cream 100000 unit/gm.......................................40nystatin oint 100000 unit/gm...........................................40nystatin susp 100000 unit/ml.......................................... 38nystatin tab 500000 unit.....................................................2nystatin topical powder 100000 unit/gm........................40nystatin-triamcinolone cream 100000-0.1 unit/gm-

%.......................................................................................40nystatin-triamcinolone oint 100000-0.1 unit/gm-%....... 40

Ooctreotide acetate inj 50 mcg/ml (0.05 mg/ml)

(Sandostatin)...................................................................13octreotide acetate inj 100 mcg/ml (0.1 mg/ml)



(Sandostatin)...................................................................13octreotide acetate inj 1000 mcg/ml (1 mg/ml)

(Sandostatin)...................................................................13ODEFSEY – emtricitabine-rilpivirine-tenofovir af tab

200-25-25 mg.....................................................................3ODOMZO – sonidegib phosphate cap 200 mg (base

equivalent).......................................................................... 7ofloxacin ophth soln 0.3% (Ocuflox)..............................38

2020

January 2020 64

ofloxacin otic soln 0.3%...................................................38ofloxacin tab 400 mg..........................................................2OGESTREL – norgestrel & ethinyl estradiol tab 0.5 mg-50

mcg................................................................................... 10olanzapine orally disintegrating tab 5 mg (Zyprexa

zydis)................................................................................26olanzapine orally disintegrating tab 10 mg (Zyprexa



zydis)................................................................................26olanzapine tab 2.5 mg (Zyprexa).....................................26olanzapine tab 5 mg (Zyprexa)........................................26olanzapine tab 7.5 mg (Zyprexa).....................................26olanzapine tab 10 mg (Zyprexa)......................................26olanzapine tab 15 mg (Zyprexa)......................................26olanzapine tab 20 mg (Zyprexa)......................................26olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg (Benicar hct)...............................................17olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg (Benicar hct)...............................................17olmesartan medoxomil-hydrochlorothiazide tab 40-25

mg (Benicar hct)............................................................ 17olmesartan medoxomil tab 5 mg (Benicar)................... 17olmesartan medoxomil tab 20 mg (Benicar)................. 17olmesartan medoxomil tab 40 mg (Benicar)................. 17olopatadine hcl ophth soln 0.2% (base equivalent)

(Pataday)......................................................................... 38olopatadine hcl ophth soln 0.1% (base equivalent)

(Patanol).......................................................................... 38omeprazole cap delayed release 10 mg (Prilosec)....... 22omeprazole cap delayed release 20 mg (Prilosec)....... 22omeprazole cap delayed release 40 mg (Prilosec)....... 22ONDANSETRON HCL – ondansetron hcl tab 24 mg........ 22ondansetron hcl oral soln 4 mg/5ml (Zofran)................22ondansetron hcl tab 4 mg (Zofran).................................22ondansetron hcl tab 8 mg (Zofran).................................22ondansetron orally disintegrating tab 4 mg (Zofran

odt)................................................................................... 22ondansetron orally disintegrating tab 8 mg (Zofran

odt)................................................................................... 22ONGLYZA – saxagliptin hcl tab 2.5 mg (base equiv).........11ONGLYZA – saxagliptin hcl tab 5 mg (base equiv)............11OPSUMIT – macitentan tab 10 mg....................................19ORACEA – doxycycline (rosacea) cap delayed release 40

mg.....................................................................................40ORFADIN – nitisinone cap 2 mg........................................13ORFADIN – nitisinone cap 5 mg........................................13ORFADIN – nitisinone cap 10 mg......................................13ORFADIN – nitisinone cap 20 mg......................................13ORFADIN – nitisinone susp 4 mg/ml................................. 13ORILISSA – elagolix sodium tab 150 mg (base equiv)......13ORILISSA – elagolix sodium tab 200 mg (base equiv)......13orphenadrine citrate tab er 12hr 100 mg....................... 35

oseltamivir phosphate cap 30 mg (base equiv)(Tamiflu).............................................................................3



oseltamivir phosphate for susp 6 mg/ml (base equiv)(Tamiflu).............................................................................4

OTEZLA – apremilast tab 30 mg....................................... 32OTEZLA – apremilast tab starter therapy pack 10 mg & 20

mg & 30 mg..................................................................... 32OTREXUP – methotrexate soln pf auto-injector 10

mg/0.4ml...........................................................................32OTREXUP – methotrexate soln pf auto-injector 12.5

mg/0.4ml...........................................................................32OTREXUP – methotrexate soln pf auto-injector 15





mg/0.4ml...........................................................................32oxaprozin tab 600 mg (Daypro).......................................32oxcarbazepine susp 300 mg/5ml (60 mg/ml)

(Trileptal)......................................................................... 33oxcarbazepine tab 150 mg (Trileptal)............................. 33oxcarbazepine tab 300 mg (Trileptal)............................. 33oxcarbazepine tab 600 mg (Trileptal)............................. 33oxybutynin chloride syrup 5 mg/5ml..............................23oxybutynin chloride tab er 24hr 5 mg (Ditropan xl)......23oxybutynin chloride tab er 24hr 10 mg (Ditropan

xl)......................................................................................23oxybutynin chloride tab er 24hr 15 mg (Ditropan

xl)......................................................................................23oxybutynin chloride tab 5 mg......................................... 23OXYCODONE/ASPIRIN – oxycodone-aspirin tab

4.8355-325 mg.................................................................31oxycodone hcl cap 5 mg................................................. 30oxycodone hcl conc 100 mg/5ml (20 mg/ml)

(Oxycodone hcl).............................................................31oxycodone hcl soln 5 mg/5ml (Oxycodone hcl)............31oxycodone hcl tab 10 mg................................................ 31oxycodone hcl tab 20 mg................................................ 31oxycodone hcl tab 5 mg (Roxicodone).......................... 31oxycodone hcl tab 15 mg (Roxicodone)........................ 31oxycodone hcl tab 30 mg (Roxicodone)........................ 31oxycodone w/ acetaminophen tab 5-325 mg

(Percocet)........................................................................ 31oxycodone w/ acetaminophen tab 7.5-325 mg

(Percocet)........................................................................ 31oxycodone w/ acetaminophen tab 10-325 mg

(Percocet)........................................................................ 31

2020

January 2020 65

OXYCONTIN – oxycodone hcl tab er 12hr deter 10mg.....................................................................................31







OZEMPIC – semaglutide soln pen-inj 1 mg/dose (2mg/1.5ml)..........................................................................11

OZEMPIC – semaglutide soln pen-inj 0.25 or 0.5 mg/dose(2 mg/1.5ml).....................................................................11

Ppantoprazole sodium ec tab 20 mg (base equiv)

(Protonix).........................................................................22pantoprazole sodium ec tab 40 mg (base equiv)

(Protonix).........................................................................22paricalcitol cap 1 mcg (Zemplar).................................... 13paricalcitol cap 2 mcg (Zemplar).................................... 13paricalcitol cap 4 mcg (Zemplar).................................... 13paromomycin sulfate cap 250 mg.................................... 2paroxetine hcl tab er 24hr 12.5 mg (Paxil cr)................ 25paroxetine hcl tab er 24hr 25 mg (Paxil cr)................... 25paroxetine hcl tab er 24hr 37.5 mg (Paxil cr)................ 25paroxetine hcl tab 10 mg (Paxil).....................................25paroxetine hcl tab 20 mg (Paxil).....................................25paroxetine hcl tab 30 mg (Paxil).....................................25paroxetine hcl tab 40 mg (Paxil).....................................25PAZEO – olopatadine hcl ophth soln 0.7% (base

equivalent)........................................................................ 38PEGASYS – peginterferon alfa-2a inj 180 mcg/ml.............. 4PEGASYS – peginterferon alfa-2a inj 180 mcg/0.5ml......... 4PEGASYS PROCLICK – peginterferon alfa-2a inj 180

mcg/0.5ml........................................................................... 4peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm

(Colyte-flavor packs)..................................................... 21peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm

(Golytely)......................................................................... 21peg 3350-kcl-sod bicarb-nacl for soln 420 gm

(Nulytely/flavor pack).................................................... 21PENICILLIN V POTASSIUM – penicillin v potassium for

soln 125 mg/5ml................................................................ 1PENICILLIN V POTASSIUM – penicillin v potassium for

soln 250 mg/5ml................................................................ 1penicillin v potassium tab 250 mg....................................1penicillin v potassium tab 500 mg....................................1pentoxifylline tab er 400 mg............................................37perindopril erbumine tab 2 mg....................................... 17perindopril erbumine tab 4 mg (Aceon).........................17

perindopril erbumine tab 8 mg (Aceon).........................17permethrin cream 5% (Elimite)........................................40perphenazine tab 2 mg.................................................... 26perphenazine tab 4 mg.................................................... 26perphenazine tab 8 mg.................................................... 26perphenazine tab 16 mg.................................................. 26phenelzine sulfate tab 15 mg (Nardil)............................ 25phenobarbital elixir 20 mg/5ml........................................27phenobarbital tab 15 mg..................................................27phenobarbital tab 16.2 mg...............................................27phenobarbital tab 30 mg..................................................27phenobarbital tab 32.4 mg...............................................27phenobarbital tab 60 mg..................................................27phenobarbital tab 100 mg................................................27phenoxybenzamine hcl cap 10 mg (Dibenzyline)......... 17phenytoin chew tab 50 mg (Dilantin infatabs)...............33phenytoin sodium extended cap 100 mg (Dilantin)...... 33phenytoin sodium extended cap 200 mg

(Phenytek)....................................................................... 33phenytoin sodium extended cap 300 mg

(Phenytek)....................................................................... 33phenytoin susp 125 mg/5ml (Dilantin)........................... 34phytonadione tab 5 mg (Mephyton)............................... 35PICATO – ingenol mebutate gel 0.015%........................... 40PICATO – ingenol mebutate gel 0.05%............................. 40pilocarpine hcl ophth soln 1% (Isopto carpine)............ 38pilocarpine hcl ophth soln 2% (Isopto carpine)............ 38pilocarpine hcl ophth soln 4% (Isopto carpine)............ 38pilocarpine hcl tab 5 mg (Salagen).................................38pilocarpine hcl tab 7.5 mg (Salagen)..............................38pimecrolimus cream 1% (Elidel)..................................... 40PIMOZIDE – pimozide tab 1 mg........................................ 29PIMOZIDE – pimozide tab 2 mg........................................ 29pindolol tab 5 mg..............................................................14pindolol tab 10 mg............................................................14pioglitazone hcl-metformin hcl tab 15-500 mg

(Actoplus met)................................................................11pioglitazone hcl-metformin hcl tab 15-850 mg

(Actoplus met)................................................................11pioglitazone hcl tab 15 mg (base equiv) (Actos)...........11pioglitazone hcl tab 30 mg (base equiv) (Actos)...........11pioglitazone hcl tab 45 mg (base equiv) (Actos)...........11PIQRAY 250MG DAILY DOSE – alpelisib tab pack 250 mg

daily dose (200 mg & 50 mg tabs)....................................7PIQRAY 300MG DAILY DOSE – alpelisib tab pack 300 mg

daily dose (2x150 mg tab).................................................7PIQRAY 200MG DAILY DOSE – alpelisib tab therapy pack

200 mg daily dose............................................................. 7piroxicam cap 10 mg (Feldene).......................................32piroxicam cap 20 mg (Feldene).......................................32PLEGRIDY – peginterferon beta-1a soln pen-injector 125

mcg/0.5ml......................................................................... 29PLEGRIDY – peginterferon beta-1a soln prefilled syringe

125 mcg/0.5ml..................................................................29PLEGRIDY STARTER PACK – peginterferon beta-1a soln

pen-inj 63 & 94 mcg/0.5ml pack..................................... 29

2020

January 2020 66

PLEGRIDY STARTER PACK – peginterferon beta-1a solnpref syr 63 & 94 mcg/0.5ml pack.................................... 29

podofilox soln 0.5% (Condylox)......................................40polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1% (Polytrim)..........................................................38POMALYST – pomalidomide cap 1 mg............................... 7POMALYST – pomalidomide cap 2 mg............................... 7POMALYST – pomalidomide cap 3 mg............................... 7POMALYST – pomalidomide cap 4 mg............................... 7posaconazole tab delayed release 100 mg (Noxafil)...... 2potassium chloride cap er 8 meq (Micro-k)...................35potassium chloride cap er 10 meq (Micro-k).................35POTASSIUM CHLORIDE ER – potassium chloride tab er

8 meq (600 mg)...............................................................35potassium chloride microencapsulated crys er tab 10

meq...................................................................................35potassium chloride microencapsulated crys er tab 20

meq...................................................................................35potassium chloride oral soln 10% (20 meq/15ml).........35potassium chloride oral soln 20% (40 meq/15ml).........35potassium chloride powder packet 20 meq (K-lor

hospital pack).................................................................35potassium chloride tab er 10 meq (K-tab)..................... 35potassium chloride tab er 8 meq (600 mg)....................35potassium citrate tab er 5 meq (540 mg) (Urocit-k

5).......................................................................................23potassium citrate tab er 10 meq (1080 mg) (Urocit-k

10).....................................................................................23potassium citrate tab er 15 meq (1620 mg) (Urocit-k

15).....................................................................................24pot phos monobasic w/sod phos di & monobas tab

155-852-130mg (K-phos neutral)..................................35pramipexole dihydrochloride tab 0.125 mg

(Mirapex)..........................................................................34pramipexole dihydrochloride tab 0.25 mg

(Mirapex)..........................................................................34pramipexole dihydrochloride tab 0.5 mg (Mirapex)......34pramipexole dihydrochloride tab 0.75 mg

(Mirapex)..........................................................................34pramipexole dihydrochloride tab 1 mg (Mirapex).........34pramipexole dihydrochloride tab 1.5 mg (Mirapex)......34prasugrel hcl tab 5 mg (base equiv) (Effient)................37prasugrel hcl tab 10 mg (base equiv) (Effient)..............37pravastatin sodium tab 10 mg........................................ 19pravastatin sodium tab 20 mg (Pravachol)....................19pravastatin sodium tab 40 mg (Pravachol)....................19pravastatin sodium tab 80 mg (Pravachol)....................19praziquantel tab 600 mg (Biltricide)................................. 4prazosin hcl cap 1 mg (Minipress)................................. 17prazosin hcl cap 2 mg (Minipress)................................. 17prazosin hcl cap 5 mg (Minipress)................................. 17PREDNISOLONE ACETATE – prednisolone acetate ophth

susp 1%............................................................................38PREDNISOLONE – prednisolone syrup 15 mg/5ml (usp

solution equivalent)............................................................8

prednisolone sod phosphate oral soln 15 mg/5ml(base equiv) (Orapred).................................................... 8

prednisolone sod phosph oral soln 6.7 mg/5ml (5mg/5ml base) (Pediapred)...............................................8

PREDNISONE – prednisone oral soln 5 mg/5ml.................8PREDNISONE – prednisone tab 50 mg.............................. 8prednisone tab 1 mg.......................................................... 8prednisone tab 2.5 mg....................................................... 8prednisone tab 5 mg.......................................................... 8prednisone tab 10 mg........................................................ 8prednisone tab 20 mg........................................................ 8prednisone tab therapy pack 5 mg (21)........................... 8prednisone tab therapy pack 5 mg (48)........................... 8prednisone tab therapy pack 10 mg (21)......................... 8prednisone tab therapy pack 10 mg (48)......................... 8pregabalin cap 25 mg (Lyrica)........................................ 34pregabalin cap 50 mg (Lyrica)........................................ 34pregabalin cap 75 mg (Lyrica)........................................ 34pregabalin cap 100 mg (Lyrica)...................................... 34pregabalin cap 150 mg (Lyrica)...................................... 34pregabalin cap 200 mg (Lyrica)...................................... 34pregabalin cap 225 mg (Lyrica)...................................... 34pregabalin cap 300 mg (Lyrica)...................................... 34pregabalin soln 20 mg/ml (Lyrica).................................. 34PREGNYL W/DILUENT BENZYL – chorionic gonadotropin

for im inj 10000 unit.........................................................13PREMARIN – estrogens, conjugated tab 0.3 mg.................9PREMARIN – estrogens, conjugated tab 0.45 mg...............9PREMARIN – estrogens, conjugated tab 0.625 mg.............9PREMARIN – estrogens, conjugated tab 0.9 mg.................9PREMARIN – estrogens, conjugated tab 1.25 mg...............9PREMPHASE – conj est 0.625(14)/conj est-medroxypro

ac tab 0.625-5mg(14)........................................................ 9PREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.3-1.5 mg...................................................... 9PREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.45-1.5 mg.................................................... 9PREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.625-2.5 mg.................................................. 9PREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.625-5 mg..................................................... 9PRENATABS RX – prenatal vit w/ iron carbonyl-fa tab 29-1

mg.....................................................................................35PRENATAL PLUS IRON – prenatal vit w/ iron carbonyl-fa

tab 29-1 mg......................................................................35PRENATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab

29-1 mg............................................................................ 35PRENATAL 19 – prenatal vit w/ fe fumarate-fa chew tab

29-1 mg............................................................................ 35PRENATAL-U – prenatal w/o a vit w/ fe fumarate-fa cap

106.5-1 mg....................................................................... 35PRENATAL VITAMINS PLUS LO – prenatal vit w/ fe

fumarate-fa tab 27-1 mg..................................................35PREZCOBIX – darunavir-cobicistat tab 800-150 mg...........4PREZISTA – darunavir ethanolate susp 100 mg/ml (base

equiv).................................................................................. 4

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January 2020 67

PREZISTA – darunavir ethanolate tab 75 mg (baseequiv).................................................................................. 4




PRIFTIN – rifapentine tab 150 mg....................................... 2primaquine phosphate tab 26.3 mg (15 mg base)

(Primaquine phosphate)..................................................4primidone tab 50 mg (Mysoline)..................................... 34primidone tab 250 mg (Mysoline)................................... 34PROAIR HFA – albuterol sulfate inhal aero 108 mcg/act

(90mcg base equiv)......................................................... 21PROAIR RESPICLICK – albuterol sulfate aer pow ba 108

mcg/act (90 mcg base equiv)..........................................21probenecid tab 500 mg.................................................... 33prochlorperazine maleate tab 5 mg (base equivalent)

(Compazine)....................................................................26prochlorperazine maleate tab 10 mg (base equivalent)

(Compazine)....................................................................26prochlorperazine suppos 25 mg.....................................26PROCRIT – epoetin alfa inj 2000 unit/ml...........................36PROCRIT – epoetin alfa inj 3000 unit/ml...........................36PROCRIT – epoetin alfa inj 4000 unit/ml...........................36PROCRIT – epoetin alfa inj 10000 unit/ml.........................36PROCRIT – epoetin alfa inj 20000 unit/ml.........................36PROCRIT – epoetin alfa inj 40000 unit/ml.........................36progesterone micronized cap 100 mg

(Prometrium)...................................................................10progesterone micronized cap 200 mg

(Prometrium)...................................................................10PROGLYCEM – diazoxide susp 50 mg/ml.........................11PROLIA – denosumab inj soln prefilled syringe 60 mg/

ml...................................................................................... 13promethazine hcl suppos 12.5 mg................................. 19promethazine hcl suppos 25 mg.................................... 19promethazine hcl suppos 50 mg.................................... 19promethazine hcl syrup 6.25 mg/5ml............................. 19promethazine hcl tab 12.5 mg.........................................19promethazine hcl tab 25 mg............................................20promethazine hcl tab 50 mg............................................20propafenone hcl cap er 12hr 225 mg (Rythmol sr)....... 15propafenone hcl cap er 12hr 325 mg (Rythmol sr)....... 15propafenone hcl cap er 12hr 425 mg (Rythmol sr)....... 15propafenone hcl tab 300 mg........................................... 15propafenone hcl tab 150 mg (Rythmol)......................... 15propafenone hcl tab 225 mg (Rythmol)......................... 15PROPANTHELINE BROMIDE – propantheline bromide

tab 15 mg.........................................................................22PROPRANOLOL/HYDROCHLOROTH – propranolol &

hydrochlorothiazide tab 40-25 mg...................................17PROPRANOLOL/HYDROCHLOROTH – propranolol &

hydrochlorothiazide tab 80-25 mg...................................17propranolol hcl cap er 24hr 60 mg (Inderal la)..............14

propranolol hcl cap er 24hr 80 mg (Inderal la)..............14propranolol hcl cap er 24hr 120 mg (Inderal la)............14propranolol hcl cap er 24hr 160 mg (Inderal la)............14PROPRANOLOL HCL – propranolol hcl oral soln 20

mg/5ml..............................................................................14PROPRANOLOL HCL – propranolol hcl oral soln 40

mg/5ml..............................................................................14propranolol hcl tab 10 mg............................................... 14propranolol hcl tab 20 mg............................................... 14propranolol hcl tab 40 mg............................................... 14propranolol hcl tab 60 mg............................................... 14propranolol hcl tab 80 mg............................................... 14propylthiouracil tab 50 mg.............................................. 12PULMOZYME – dornase alfa inhal soln 1 mg/ml.............. 21PURIXAN – mercaptopurine susp 2000 mg/100ml (20 mg/

ml)....................................................................................... 7pyrazinamide tab 500 mg...................................................2pyridostigmine bromide tab 60 mg (Mestinon)............. 35

Qquetiapine fumarate tab er 24hr 50 mg (Seroquel

xr)..................................................................................... 26quetiapine fumarate tab er 24hr 150 mg (Seroquel




xr)..................................................................................... 26quetiapine fumarate tab 25 mg (Seroquel).................... 26quetiapine fumarate tab 50 mg (Seroquel).................... 26quetiapine fumarate tab 100 mg (Seroquel).................. 26quetiapine fumarate tab 200 mg (Seroquel).................. 26quetiapine fumarate tab 300 mg (Seroquel).................. 26quetiapine fumarate tab 400 mg (Seroquel).................. 26quinapril hcl tab 5 mg (Accupril)....................................17quinapril hcl tab 10 mg (Accupril)..................................17quinapril hcl tab 20 mg (Accupril)..................................17quinapril hcl tab 40 mg (Accupril)..................................17quinapril-hydrochlorothiazide tab 10-12.5 mg

(Accuretic).......................................................................17quinapril-hydrochlorothiazide tab 20-12.5 mg

(Accuretic).......................................................................17quinapril-hydrochlorothiazide tab 20-25 mg

(Accuretic).......................................................................17quinidine gluconate tab er 324 mg.................................15QUINIDINE SULFATE – quinidine sulfate tab 200 mg.......15QUINIDINE SULFATE – quinidine sulfate tab 300 mg.......15QVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 40 mcg/act.....................................................21QVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 80 mcg/act.....................................................21

Rraloxifene hcl tab 60 mg (Evista)....................................13

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January 2020 68

ramipril cap 1.25 mg (Altace).......................................... 17ramipril cap 2.5 mg (Altace)............................................ 17ramipril cap 5 mg (Altace)............................................... 17ramipril cap 10 mg (Altace)............................................. 17ranitidine hcl cap 150 mg................................................ 22ranitidine hcl cap 300 mg................................................ 22ranitidine hcl syrup 15 mg/ml (75 mg/5ml).................... 22ranitidine hcl tab 150 mg (Zantac)..................................22ranitidine hcl tab 300 mg (Zantac)..................................22rasagiline mesylate tab 0.5 mg (base equiv)

(Azilect)............................................................................34rasagiline mesylate tab 1 mg (base equiv) (Azilect)..... 34REBIF – interferon beta-1a soln pref syr 22 mcg/0.5ml

(12mu/ml)......................................................................... 29REBIF – interferon beta-1a soln pref syr 44 mcg/0.5ml

(24mu/ml)......................................................................... 29REBIF REBIDOSE – interferon beta-1a soln auto-inj 22

mcg/0.5ml (12mu/ml)....................................................... 29REBIF REBIDOSE – interferon beta-1a soln auto-inj 44

mcg/0.5ml (24mu/ml)....................................................... 29REBIF REBIDOSE TITRATION – interferon beta-1a auto-

inj 6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml...........................29REBIF TITRATION PACK – interferon beta-1a pref syr

6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml................................29repaglinide tab 0.5 mg (Prandin).................................... 11repaglinide tab 1 mg (Prandin)....................................... 11repaglinide tab 2 mg (Prandin)....................................... 11REPATHA – evolocumab subcutaneous soln prefilled

syringe 140 mg/ml........................................................... 19REPATHA PUSHTRONEX SYSTEM – evolocumab

subcutaneous soln cartridge/infusor 420 mg/3.5ml........ 19REPATHA SURECLICK – evolocumab subcutaneous soln

auto-injector 140 mg/ml...................................................19RETACRIT – epoetin alfa-epbx inj 2000 unit/ml................ 36RETACRIT – epoetin alfa-epbx inj 3000 unit/ml................ 36RETACRIT – epoetin alfa-epbx inj 4000 unit/ml................ 36RETACRIT – epoetin alfa-epbx inj 10000 unit/ml.............. 36RETACRIT – epoetin alfa-epbx inj 40000 unit/ml.............. 36REVCOVI – elapegademase-lvlr im soln 2.4 mg/1.5ml (1.6

mg/ml)...............................................................................13REVLIMID – lenalidomide cap 5 mg..................................41REVLIMID – lenalidomide cap 10 mg................................41REVLIMID – lenalidomide cap 15 mg................................41REVLIMID – lenalidomide cap 20 mg................................41REVLIMID – lenalidomide cap 25 mg................................41REVLIMID – lenalidomide caps 2.5 mg............................. 41ribavirin cap 200 mg (Rebetol)..........................................4ribavirin tab 200 mg (Copegus)........................................ 4rifabutin cap 150 mg (Mycobutin).....................................2rifampin cap 150 mg (Rifadin)...........................................2rifampin cap 300 mg (Rifadin)...........................................2riluzole tab 50 mg (Rilutek)............................................. 34RINVOQ – upadacitinib tab er 24hr 15 mg........................32risedronate sodium tab 5 mg (Actonel)......................... 13risedronate sodium tab 30 mg (Actonel)....................... 13risedronate sodium tab 35 mg (Actonel)....................... 13

risedronate sodium tab 150 mg (Actonel)..................... 13RISPERIDONE ODT – risperidone orally disintegrating tab

0.25 mg............................................................................ 26risperidone orally disintegrating tab 0.5 mg (Risperdal

m-tab)...............................................................................26risperidone orally disintegrating tab 1 mg (Risperdal




m-tab)...............................................................................26risperidone soln 1 mg/ml (Risperdal).............................26risperidone tab 0.25 mg (Risperdal)...............................26risperidone tab 0.5 mg (Risperdal).................................26risperidone tab 1 mg (Risperdal)....................................26risperidone tab 2 mg (Risperdal)....................................26risperidone tab 3 mg (Risperdal)....................................26risperidone tab 4 mg (Risperdal)....................................26ritonavir tab 100 mg (Norvir).............................................4rivastigmine tartrate cap 1.5 mg (base equivalent)...... 29rivastigmine tartrate cap 3 mg (base equivalent)......... 29rivastigmine tartrate cap 4.5 mg (base equivalent)...... 29rivastigmine tartrate cap 6 mg (base equivalent)......... 29rizatriptan benzoate oral disintegrating tab 5 mg (base

eq) (Maxalt-mlt).............................................................. 32rizatriptan benzoate oral disintegrating tab 10 mg

(base eq) (Maxalt-mlt)....................................................32rizatriptan benzoate tab 5 mg (base equivalent)

(Maxalt)............................................................................ 32rizatriptan benzoate tab 10 mg (base equivalent)

(Maxalt)............................................................................ 32ropinirole hydrochloride tab 0.25 mg (Requip)............. 34ropinirole hydrochloride tab 0.5 mg (Requip)............... 34ropinirole hydrochloride tab 1 mg (Requip).................. 34ropinirole hydrochloride tab 2 mg (Requip).................. 34ropinirole hydrochloride tab 3 mg (Requip).................. 34ropinirole hydrochloride tab 4 mg (Requip).................. 34ropinirole hydrochloride tab 5 mg (Requip).................. 34rosuvastatin calcium tab 5 mg (Crestor)....................... 19rosuvastatin calcium tab 10 mg (Crestor)..................... 19rosuvastatin calcium tab 20 mg (Crestor)..................... 19rosuvastatin calcium tab 40 mg (Crestor)..................... 19RYDAPT – midostaurin cap 25 mg...................................... 7

SSANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 10 mg..................................................................... 13SANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 20 mg..................................................................... 13SANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 30 mg..................................................................... 13scopolamine td patch 72hr 1 mg/3days (Transderm-

scop)................................................................................ 22SELEGILINE HCL – selegiline hcl cap 5 mg..................... 34

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January 2020 69

SELEGILINE HCL – selegiline hcl tab 5 mg......................34selenium sulfide lotion 2.5%........................................... 40SE-NATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab 29-1

mg.....................................................................................35SE-NATAL 19 – prenatal vit w/ fe fumarate-fa chew tab

29-1 mg............................................................................ 35SEREVENT DISKUS – salmeterol xinafoate aer pow ba

50 mcg/dose (base equiv)...............................................21sertraline hcl oral concentrate for solution 20 mg/ml

(Zoloft)............................................................................. 25sertraline hcl tab 25 mg (Zoloft)..................................... 25sertraline hcl tab 50 mg (Zoloft)..................................... 25sertraline hcl tab 100 mg (Zoloft)................................... 25sevelamer carbonate packet 0.8 gm (Renvela)............. 23sevelamer carbonate packet 2.4 gm (Renvela)............. 23sevelamer carbonate tab 800 mg (Renvela).................. 23sildenafil citrate tab 20 mg (Revatio)............................. 19silver sulfadiazine cream 1% (Silvadene)...................... 40SIMBRINZA – brinzolamide-brimonidine tartrate ophth

susp 1-0.2%..................................................................... 38simvastatin tab 5 mg (Zocor).......................................... 19simvastatin tab 10 mg (Zocor)........................................ 19simvastatin tab 20 mg (Zocor)........................................ 19simvastatin tab 40 mg (Zocor)........................................ 19simvastatin tab 80 mg (Zocor)........................................ 19sirolimus oral soln 1 mg/ml (Rapamune).......................41sirolimus tab 0.5 mg (Rapamune)...................................41sirolimus tab 1 mg (Rapamune)......................................41sirolimus tab 2 mg (Rapamune)......................................41SIVEXTRO – tedizolid phosphate tab 200 mg.....................5SKYLA – levonorgestrel releasing iud 14 mcg/day (13.5

mg total)........................................................................... 10SKYRIZI – risankizumab-rzaa sol prefilled syringe 2 x 75

mg/0.83ml kit....................................................................40sodium citrate & citric acid soln 500-334 mg/5ml

(Shohls solution modi)..................................................24sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf)

(Luride)............................................................................ 35sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)

(Luride)............................................................................ 35sodium fluoride chew tab 1 mg f (from 2.2 mg naf)

(Luride)............................................................................ 35sodium fluoride cream 1.1% (Prevident 5000 plus)...... 38sodium fluoride gel 1.1% (0.5% f) (Prevident

fluoride)........................................................................... 38SODIUM FLUORIDE – sodium fluoride tab 0.5 mg f (from

1.1 mg naf).......................................................................35SODIUM FLUORIDE – sodium fluoride tab 1 mg f (from

2.2 mg naf).......................................................................35sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop

naf)................................................................................... 35sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)

(Luride)............................................................................ 35sodium polystyrene sulfonate oral susp 15 gm/60ml

(Sps).................................................................................41

sodium polystyrene sulfonate powder(Kayexalate).................................................................... 41

SOFOSBUVIR/VELPATASVIR – sofosbuvir-velpatasvir tab400-100 mg........................................................................ 4

solifenacin succinate tab 5 mg (Vesicare).....................23solifenacin succinate tab 10 mg (Vesicare)...................23SOLTAMOX – tamoxifen citrate oral soln 10 mg/5ml (base

equivalent).......................................................................... 7SOOLANTRA – ivermectin cream 1%............................... 40sotalol hcl (afib/afl) tab 80 mg (Betapace af).................14sotalol hcl (afib/afl) tab 120 mg (Betapace af)...............14sotalol hcl (afib/afl) tab 160 mg (Betapace af)...............14sotalol hcl tab 240 mg......................................................14sotalol hcl tab 80 mg (Betapace)....................................14sotalol hcl tab 120 mg (Betapace)..................................14sotalol hcl tab 160 mg (Betapace)..................................14SOVALDI – sofosbuvir tab 200 mg...................................... 4SOVALDI – sofosbuvir tab 400 mg...................................... 4SPIRIVA HANDIHALER – tiotropium bromide

monohydrate inhal cap 18 mcg (base equiv)..................21SPIRIVA RESPIMAT – tiotropium bromide monohydrate

inhal aerosol 1.25 mcg/act.............................................. 21SPIRIVA RESPIMAT – tiotropium bromide monohydrate

inhal aerosol 2.5 mcg/act................................................ 21spironolactone & hydrochlorothiazide tab 25-25 mg

(Aldactazide)................................................................... 18spironolactone tab 25 mg (Aldactone)...........................18spironolactone tab 50 mg (Aldactone)...........................18spironolactone tab 100 mg (Aldactone).........................18SPRYCEL – dasatinib tab 20 mg.........................................7SPRYCEL – dasatinib tab 50 mg.........................................7SPRYCEL – dasatinib tab 70 mg.........................................7SPRYCEL – dasatinib tab 80 mg.........................................7SPRYCEL – dasatinib tab 100 mg.......................................7SPRYCEL – dasatinib tab 140 mg.......................................7stavudine cap 15 mg (Zerit)...............................................4stavudine cap 20 mg (Zerit)...............................................4stavudine cap 30 mg (Zerit)...............................................4stavudine cap 40 mg (Zerit)...............................................4STELARA – ustekinumab inj 45 mg/0.5ml.........................40STELARA – ustekinumab soln prefilled syringe 45

mg/0.5ml...........................................................................40STELARA – ustekinumab soln prefilled syringe 90 mg/

ml...................................................................................... 40STIMATE – desmopressin acetate nasal soln 1.5 mg/

ml...................................................................................... 13STIOLTO RESPIMAT – tiotropium br-olodaterol inhal aero

soln 2.5-2.5 mcg/act........................................................ 21STIVARGA – regorafenib tab 40 mg....................................7STRENSIQ – asfotase alfa subcutaneous inj 18

mg/0.45ml.........................................................................13STRENSIQ – asfotase alfa subcutaneous inj 28

mg/0.7ml...........................................................................13STRENSIQ – asfotase alfa subcutaneous inj 40 mg/

ml...................................................................................... 13

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January 2020 70

STRENSIQ – asfotase alfa subcutaneous inj 80mg/0.8ml...........................................................................13

sucralfate tab 1 gm (Carafate).........................................22SULFACETAMIDE SODIUM/PRED – sulfacetamide

sodium-prednisolone ophth soln 10-0.23(0.25)%........... 38sulfacetamide sodium lotion 10% (acne) (Klaron)........40sulfacetamide sodium ophth soln 10% (Bleph-10)....... 38SULFADIAZINE – sulfadiazine tab 500 mg......................... 2sulfamethoxazole-trimethoprim susp 200-40

mg/5ml............................................................................... 5sulfamethoxazole-trimethoprim tab 400-80 mg

(Bactrim)............................................................................5sulfamethoxazole-trimethoprim tab 800-160 mg

(Bactrim ds)...................................................................... 5sulfasalazine tab delayed release 500 mg (Azulfidine

en-tabs)............................................................................23sulfasalazine tab 500 mg (Azulfidine)............................ 23sulindac tab 150 mg......................................................... 32sulindac tab 200 mg......................................................... 32sumatriptan nasal spray 5 mg/act (Imitrex)...................32sumatriptan nasal spray 20 mg/act (Imitrex).................32sumatriptan succinate inj 6 mg/0.5ml (Imitrex statdose

ref).................................................................................... 32sumatriptan succinate solution auto-injector 4

mg/0.5ml (Imitrex statdose sys)...................................32sumatriptan succinate solution auto-injector 6

mg/0.5ml (Imitrex statdose sys)...................................32sumatriptan succinate solution cartridge 4 mg/0.5ml

(Imitrex statdose ref).....................................................32sumatriptan succinate solution cartridge 6 mg/0.5ml

(Imitrex statdose ref).....................................................32SUMATRIPTAN SUCCINATE – sumatriptan succinate

solution prefilled syringe 6 mg/0.5ml...............................32sumatriptan succinate tab 25 mg (Imitrex)....................32sumatriptan succinate tab 50 mg (Imitrex)....................32sumatriptan succinate tab 100 mg (Imitrex)..................32SUNOSI – solriamfetol hcl tab 75 mg (base equiv)........... 28SUNOSI – solriamfetol hcl tab 150 mg (base equiv)......... 28SUPRAX – cefixime chew tab 100 mg................................ 1SUPRAX – cefixime chew tab 200 mg................................ 1SUPRAX – cefixime for susp 500 mg/5ml........................... 1SUTENT – sunitinib malate cap 12.5 mg (base

equivalent).......................................................................... 7SUTENT – sunitinib malate cap 25 mg (base

equivalent).......................................................................... 7SUTENT – sunitinib malate cap 37.5 mg (base

equivalent).......................................................................... 7SUTENT – sunitinib malate cap 50 mg (base

equivalent).......................................................................... 7SYLATRON – peginterferon alfa-2b for inj kit 200 mcg....... 7SYLATRON – peginterferon alfa-2b for inj kit 300 mcg....... 7SYLATRON – peginterferon alfa-2b for inj kit 600 mcg....... 7SYMBICORT – budesonide-formoterol fumarate dihyd

aerosol 80-4.5 mcg/act....................................................21SYMBICORT – budesonide-formoterol fumarate dihyd

aerosol 160-4.5 mcg/act..................................................21

SYMDEKO – tezacaftor-ivacaftor 50-75 mg & ivacaftor 75mg tab tbpk...................................................................... 21

SYMDEKO – tezacaftor-ivacaftor 100-150 mg & ivacaftor150 mg tab tbpk...............................................................21

SYMFI – efavirenz-lamivudine-tenofovir df tab600-300-300 mg.................................................................4

SYMFI LO – efavirenz-lamivudine-tenofovir df tab400-300-300 mg.................................................................4

SYMJEPI – epinephrine soln prefilled syringe 0.15mg/0.3ml (1:2000)............................................................18

SYMJEPI – epinephrine solution prefilled syringe 0.3mg/0.3ml (1:1000)............................................................18

SYMPROIC – naldemedine tosylate tab 0.2 mg (baseequivalent)........................................................................ 23

SYNAGIS – palivizumab im soln 50 mg/0.5ml.....................5SYNAGIS – palivizumab im soln 100 mg/ml........................5SYNJARDY – empagliflozin-metformin hcl tab 5-500

mg.....................................................................................11SYNJARDY – empagliflozin-metformin hcl tab 5-1000

mg.....................................................................................11SYNJARDY – empagliflozin-metformin hcl tab 12.5-500

mg.....................................................................................11SYNJARDY – empagliflozin-metformin hcl tab 12.5-1000

mg.....................................................................................11SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

5-1000 mg........................................................................ 11SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

10-1000 mg......................................................................11SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

12.5-1000 mg...................................................................11SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

25-1000 mg......................................................................11SYNVISC – hylan intra-articular solution prefilled syringe

16 mg/2ml........................................................................ 35SYNVISC ONE – hylan intra-articular solution prefilled

syringe 48 mg/6ml........................................................... 35

TTABLOID – thioguanine tab 40 mg...................................... 7tacrolimus cap 0.5 mg (Prograf)..................................... 41tacrolimus cap 1 mg (Prograf)........................................ 41tacrolimus cap 5 mg (Prograf)........................................ 41tacrolimus oint 0.03% (Protopic).................................... 40tacrolimus oint 0.1% (Protopic)...................................... 40tadalafil tab 2.5 mg (Cialis)..............................................19tadalafil tab 5 mg (Cialis).................................................19tadalafil tab 10 mg (Cialis)...............................................19tadalafil tab 20 mg (Cialis)...............................................19tadalafil tab 20 mg (pah) (Adcirca)................................. 19TAFINLAR – dabrafenib mesylate cap 50 mg (base

equivalent).......................................................................... 7TAFINLAR – dabrafenib mesylate cap 75 mg (base

equivalent).......................................................................... 7TAGRISSO – osimertinib mesylate tab 40 mg (base

equivalent).......................................................................... 7

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January 2020 71

TAGRISSO – osimertinib mesylate tab 80 mg (baseequivalent).......................................................................... 7

tamoxifen citrate tab 10 mg (base equivalent)................7tamoxifen citrate tab 20 mg (base equivalent)................7tamsulosin hcl cap 0.4 mg (Flomax).............................. 24TASIGNA – nilotinib hcl cap 50 mg (base equivalent)......... 7TASIGNA – nilotinib hcl cap 150 mg (base equivalent)....... 7TASIGNA – nilotinib hcl cap 200 mg (base equivalent)....... 7tazarotene cream 0.1% (Tazorac)....................................40TAZORAC – tazarotene cream 0.05%...............................40TAZORAC – tazarotene gel 0.05%.................................... 40TAZORAC – tazarotene gel 0.1%...................................... 40TECFIDERA – dimethyl fumarate capsule delayed release

120 mg............................................................................. 29TECFIDERA – dimethyl fumarate capsule delayed release

240 mg............................................................................. 29TECFIDERA STARTER PACK – dimethyl fumarate

capsule dr starter pack 120 mg & 240 mg......................29telmisartan-hydrochlorothiazide tab 40-12.5 mg

(Micardis hct)..................................................................17telmisartan-hydrochlorothiazide tab 80-12.5 mg

(Micardis hct)..................................................................17telmisartan-hydrochlorothiazide tab 80-25 mg

(Micardis hct)..................................................................17telmisartan tab 20 mg (Micardis).................................... 17telmisartan tab 40 mg (Micardis).................................... 17telmisartan tab 80 mg (Micardis).................................... 17temazepam cap 7.5 mg (Restoril)................................... 27temazepam cap 15 mg (Restoril).................................... 27temazepam cap 22.5 mg (Restoril)................................. 27temazepam cap 30 mg (Restoril).................................... 27temozolomide cap 5 mg (Temodar).................................. 7temozolomide cap 20 mg (Temodar)................................7temozolomide cap 100 mg (Temodar)..............................7temozolomide cap 140 mg (Temodar)..............................7temozolomide cap 180 mg (Temodar)..............................7temozolomide cap 250 mg (Temodar)..............................7TENCON – butalbital-acetaminophen tab 50-325 mg....... 30tenofovir disoproxil fumarate tab 300 mg (Viread)......... 4terazosin hcl cap 1 mg (base equivalent)......................17terazosin hcl cap 2 mg (base equivalent)......................17terazosin hcl cap 5 mg (base equivalent)......................17terazosin hcl cap 10 mg (base equivalent)....................17terbinafine hcl tab 250 mg (Lamisil).................................2terbutaline sulfate tab 2.5 mg......................................... 21terbutaline sulfate tab 5 mg............................................ 21TERCONAZOLE – terconazole vaginal cream 0.8%.........23terconazole vaginal cream 0.4% (Terazol 7).................. 23terconazole vaginal suppos 80 mg (Terazol 3)..............23testosterone cypionate im inj in oil 100 mg/ml (Depo-

testosterone).....................................................................8testosterone cypionate im inj in oil 200 mg/ml (Depo-

testosterone).....................................................................8testosterone enanthate im inj in oil 200 mg/ml...............8testosterone td gel 12.5 mg/act (1%) (Androgel

pump).................................................................................8

testosterone td gel 20.25 mg/act (1.62%) (Androgelpump).................................................................................8

testosterone td gel 25 mg/2.5gm (1%) (Androgel).......... 8testosterone td gel 50 mg/5gm (1%) (Androgel)............. 8testosterone td gel 20.25 mg/1.25gm (1.62%)

(Androgel)..........................................................................8testosterone td gel 40.5 mg/2.5gm (1.62%)

(Androgel)..........................................................................8testosterone td soln 30 mg/act (Axiron).......................... 8tetrabenazine tab 12.5 mg (Xenazine)............................ 30tetrabenazine tab 25 mg (Xenazine)............................... 30tetracycline hcl cap 250 mg (Tetracycline hcl)................2tetracycline hcl cap 500 mg (Tetracycline hcl)................2THALOMID – thalidomide cap 50 mg................................ 41THALOMID – thalidomide cap 100 mg.............................. 41THALOMID – thalidomide cap 150 mg.............................. 41THALOMID – thalidomide cap 200 mg.............................. 41THEOCHRON – theophylline tab er 12hr 100 mg............. 21THEOCHRON – theophylline tab er 12hr 200 mg............. 21THEOPHYLLINE ER – theophylline tab er 12hr 450

mg.....................................................................................21theophylline tab er 12hr 300 mg.....................................21theophylline tab er 24hr 400 mg.....................................21theophylline tab er 24hr 600 mg.....................................21thiothixene cap 1 mg........................................................26thiothixene cap 2 mg........................................................26thiothixene cap 5 mg........................................................26thiothixene cap 10 mg......................................................26TIMOLOL MALEATE OPHTHALMI – timolol maleate ophth

gel forming soln 0.25%....................................................38TIMOLOL MALEATE OPHTHALMI – timolol maleate ophth

gel forming soln 0.5%......................................................38timolol maleate ophth soln 0.25% (Timoptic)................38timolol maleate ophth soln 0.5% (Timoptic)..................38timolol maleate tab 5 mg................................................. 14TIMOLOL MALEATE – timolol maleate tab 10 mg............ 14TIMOLOL MALEATE – timolol maleate tab 20 mg............ 14TIVICAY – dolutegravir sodium tab 10 mg (base equiv)...... 4TIVICAY – dolutegravir sodium tab 25 mg (base equiv)...... 4TIVICAY – dolutegravir sodium tab 50 mg (base equiv)...... 4tizanidine hcl tab 2 mg (base equivalent)......................35tizanidine hcl tab 4 mg (base equivalent)

(Zanaflex).........................................................................35tobramycin-dexamethasone ophth susp 0.3-0.1%

(Tobradex)....................................................................... 38tobramycin nebu soln 300 mg/5ml (Tobi)........................ 2tobramycin ophth soln 0.3% (Tobrex)............................38tolterodine tartrate cap er 24hr 2 mg (Detrol la)............23tolterodine tartrate cap er 24hr 4 mg (Detrol la)............23tolterodine tartrate tab 1 mg (Detrol)............................. 23tolterodine tartrate tab 2 mg (Detrol)............................. 23topiramate sprinkle cap 15 mg (Topamax sprinkle)..... 34topiramate sprinkle cap 25 mg (Topamax sprinkle)..... 34topiramate tab 25 mg (Topamax).................................... 34topiramate tab 50 mg (Topamax).................................... 34topiramate tab 100 mg (Topamax)..................................34

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January 2020 72

topiramate tab 200 mg (Topamax)..................................34toremifene citrate tab 60 mg (base equivalent)

(Fareston).......................................................................... 7torsemide tab 5 mg (Demadex).......................................18torsemide tab 10 mg (Demadex).....................................18torsemide tab 20 mg (Demadex).....................................18torsemide tab 100 mg (Demadex)...................................18TOUJEO MAX SOLOSTAR – insulin glargine soln pen-

injector 300 unit/ml (2 unit dial).......................................12TOUJEO SOLOSTAR – insulin glargine soln pen-injector

300 unit/ml (1 unit dial)....................................................12TRACLEER – bosentan tab for oral susp 32 mg...............19tramadol-acetaminophen tab 37.5-325 mg

(Ultracet)..........................................................................31tramadol hcl tab er 24hr 100 mg.....................................31tramadol hcl tab er 24hr 200 mg.....................................31tramadol hcl tab er 24hr 300 mg.....................................31tramadol hcl tab 50 mg (Ultram).....................................31trandolapril tab 1 mg (Mavik).......................................... 17trandolapril tab 2 mg (Mavik).......................................... 17trandolapril tab 4 mg (Mavik).......................................... 17tranylcypromine sulfate tab 10 mg (Parnate)................25TRAVATAN Z – travoprost ophth soln 0.004%

(benzalkonium free) (bak free)........................................38trazodone hcl tab 50 mg.................................................. 25trazodone hcl tab 100 mg................................................25trazodone hcl tab 150 mg................................................25trazodone hcl tab 300 mg................................................25TRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol

aepb 100-62.5-25 mcg/inh.............................................. 21TREMFYA – guselkumab soln pen-injector 100 mg/ml..... 40TREMFYA – guselkumab soln prefilled syringe 100 mg/

ml...................................................................................... 40TRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 100 unit/ml.......................................................... 12TRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 200 unit/ml.......................................................... 12TRESIBA – insulin degludec inj 100 unit/ml...................... 12tretinoin cap 10 mg.............................................................7tretinoin cream 0.025% (Retin-a).....................................40tretinoin cream 0.05% (Retin-a).......................................40tretinoin cream 0.1% (Retin-a).........................................40tretinoin gel 0.025%, NF = Avita (Retin-a)......................40tretinoin gel 0.01% (Retin-a)............................................ 40tretinoin microsphere gel 0.04% (Retin-a micro).......... 40tretinoin microsphere gel 0.1% (Retin-a micro)............ 40triamcinolone acetonide cream 0.025%......................... 40triamcinolone acetonide cream 0.1%............................. 40triamcinolone acetonide cream 0.5%............................. 40triamcinolone acetonide dental paste 0.1%.................. 38triamcinolone acetonide lotion 0.025%..........................40triamcinolone acetonide lotion 0.1%..............................41triamcinolone acetonide oint 0.025%............................. 41triamcinolone acetonide oint 0.1%................................. 41triamcinolone acetonide oint 0.5%................................. 41

triamterene & hydrochlorothiazide cap 37.5-25 mg(Dyazide)..........................................................................18

triamterene & hydrochlorothiazide tab 37.5-25 mg(Maxzide-25)....................................................................18

triamterene & hydrochlorothiazide tab 75-50 mg(Maxzide)......................................................................... 18

trifluoperazine hcl tab 1 mg (base equivalent)..............26trifluoperazine hcl tab 2 mg (base equivalent)..............27trifluoperazine hcl tab 5 mg (base equivalent)..............27trifluoperazine hcl tab 10 mg (base equivalent)............27TRIFLURIDINE – trifluridine ophth soln 1%.......................38trihexyphenidyl hcl elixir 0.4 mg/ml............................... 34trihexyphenidyl hcl tab 2 mg...........................................34trihexyphenidyl hcl tab 5 mg...........................................34trimethobenzamide hcl cap 300 mg (Tigan).................. 22trimethoprim tab 100 mg................................................... 5TRINATE – prenatal vit w/ fe fumarate-fa tab 28-1 mg...... 35TRIUMEQ – abacavir-dolutegravir-lamivudine tab

600-50-300 mg...................................................................4tropicamide ophth soln 0.5%.......................................... 38tropicamide ophth soln 1% (Mydriacyl)......................... 38TRULANCE – plecanatide tab 3 mg.................................. 23TRULICITY – dulaglutide soln pen-injector 0.75

mg/0.5ml...........................................................................11TRULICITY – dulaglutide soln pen-injector 1.5

mg/0.5ml...........................................................................11TRUVADA – emtricitabine-tenofovir disoproxil fumarate

tab 100-150 mg..................................................................4TRUVADA – emtricitabine-tenofovir disoproxil fumarate



tab 200-300 mg..................................................................4TYKERB – lapatinib ditosylate tab 250 mg (base equiv)..... 7TYMLOS – abaloparatide subcutaneous soln pen-injector

3120 mcg/1.56ml............................................................. 13

UUDENYCA – pegfilgrastim-cbqv soln prefilled syringe 6

mg/0.6ml...........................................................................36UPTRAVI – selexipag tab 200 mcg....................................19UPTRAVI – selexipag tab 400 mcg....................................19UPTRAVI – selexipag tab 600 mcg....................................19UPTRAVI – selexipag tab 800 mcg....................................19UPTRAVI – selexipag tab 1000 mcg..................................19UPTRAVI – selexipag tab 1200 mcg..................................19UPTRAVI – selexipag tab 1400 mcg..................................19UPTRAVI – selexipag tab 1600 mcg..................................19UPTRAVI – selexipag tab therapy pack 200 mcg (140) &

800 mcg (60)....................................................................19ursodiol cap 300 mg (Actigall)........................................23ursodiol tab 250 mg (Urso 250)...................................... 23ursodiol tab 500 mg (Urso forte).................................... 23

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VVAGIFEM – estradiol vaginal tab 10 mcg.......................... 23valacyclovir hcl tab 1 gm (Valtrex)................................... 4valacyclovir hcl tab 500 mg (Valtrex)............................... 4VALCHLOR – mechlorethamine hcl gel 0.016% (base

equivalent)........................................................................ 41valganciclovir hcl for soln 50 mg/ml (base equiv)

(Valcyte).............................................................................4valganciclovir hcl tab 450 mg (base equivalent)

(Valcyte).............................................................................4valproate sodium oral soln 250 mg/5ml (base equiv)

(Depakene)...................................................................... 34valproic acid cap 250 mg (Depakene)............................34valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovan

hct)................................................................................... 17valsartan-hydrochlorothiazide tab 160-12.5 mg (Diovan

hct)................................................................................... 17valsartan-hydrochlorothiazide tab 160-25 mg (Diovan

hct)................................................................................... 17valsartan-hydrochlorothiazide tab 320-12.5 mg (Diovan

hct)................................................................................... 17valsartan-hydrochlorothiazide tab 320-25 mg (Diovan

hct)................................................................................... 17valsartan tab 40 mg (Diovan).......................................... 17valsartan tab 80 mg (Diovan).......................................... 17valsartan tab 160 mg (Diovan)........................................ 17valsartan tab 320 mg (Diovan)........................................ 17vancomycin hcl cap 125 mg (base equivalent)

(Vancocin hcl)...................................................................5vancomycin hcl cap 250 mg (base equivalent)

(Vancocin hcl)...................................................................5VELPHORO – sucroferric oxyhydroxide chew tab 500

mg.....................................................................................23VENCLEXTA STARTING PACK – venetoclax tab therapy

starter pack 10 & 50 & 100 mg.........................................7VENCLEXTA – venetoclax tab 10 mg..................................7VENCLEXTA – venetoclax tab 50 mg..................................7VENCLEXTA – venetoclax tab 100 mg................................7venlafaxine hcl cap er 24hr 37.5 mg (base equivalent)

(Effexor xr)...................................................................... 25venlafaxine hcl cap er 24hr 75 mg (base equivalent)

(Effexor xr)...................................................................... 25venlafaxine hcl cap er 24hr 150 mg (base equivalent)

(Effexor xr)...................................................................... 25venlafaxine hcl tab 25 mg (base equivalent).................25venlafaxine hcl tab 37.5 mg (base equivalent)..............25venlafaxine hcl tab 50 mg (base equivalent).................25venlafaxine hcl tab 75 mg (base equivalent).................25venlafaxine hcl tab 100 mg (base equivalent)...............25VENTOLIN HFA – albuterol sulfate inhal aero 108 mcg/act

(90mcg base equiv)......................................................... 21verapamil hcl cap er 24hr 120 mg (Verelan).................. 15verapamil hcl cap er 24hr 180 mg (Verelan).................. 15verapamil hcl cap er 24hr 240 mg (Verelan).................. 15

VERAPAMIL HCL SR – verapamil hcl cap er 24hr 360mg.....................................................................................15

verapamil hcl tab er 120 mg (Calan sr)..........................15verapamil hcl tab er 180 mg (Calan sr)..........................15verapamil hcl tab er 240 mg (Calan sr)..........................15verapamil hcl tab 40 mg.................................................. 15verapamil hcl tab 80 mg (Calan).....................................15verapamil hcl tab 120 mg (Calan)...................................15VERZENIO – abemaciclib tab 50 mg...................................7VERZENIO – abemaciclib tab 100 mg.................................7VERZENIO – abemaciclib tab 150 mg.................................7VERZENIO – abemaciclib tab 200 mg.................................7VIBERZI – eluxadoline tab 75 mg......................................23VIBERZI – eluxadoline tab 100 mg....................................23VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/

ml).....................................................................................11VIDEX – didanosine for soln 2 gm.......................................4vigabatrin powd pack 500 mg (Sabril)........................... 34vigabatrin tab 500 mg (Sabril).........................................34VINATE II – prenatal vit w/ fe bisglycinate chelate-fa tab

29-1 mg............................................................................ 35VINATE M – prenatal vit w/ sel-fe fumarate-fa tab 27-1

mg.....................................................................................35VINATE ONE – prenatal vit w/ fe fumarate-fa tab 60-1

mg.....................................................................................35VIREAD – tenofovir disoproxil fumarate oral powder 40

mg/gm.................................................................................4VIREAD – tenofovir disoproxil fumarate tab 150 mg........... 4VIREAD – tenofovir disoproxil fumarate tab 200 mg........... 4VIREAD – tenofovir disoproxil fumarate tab 250 mg........... 4VITRAKVI – larotrectinib sulfate cap 25 mg (base

equivalent).......................................................................... 8VITRAKVI – larotrectinib sulfate cap 100 mg (base

equivalent).......................................................................... 8VITRAKVI – larotrectinib sulfate oral soln 20 mg/ml (base

equivalent).......................................................................... 8voriconazole for susp 40 mg/ml (Vfend)..........................2voriconazole tab 50 mg (Vfend)........................................3voriconazole tab 200 mg (Vfend)......................................3VOSEVI – sofosbuvir-velpatasvir-voxilaprevir tab

400-100-100 mg.................................................................4VOTRIENT – pazopanib hcl tab 200 mg (base equiv).........8VYNDAMAX – tafamidis cap 61 mg...................................19VYNDAQEL – tafamidis meglumine (cardiac) cap 20

mg.....................................................................................19VYVANSE – lisdexamfetamine dimesylate cap 10 mg...... 28VYVANSE – lisdexamfetamine dimesylate cap 20 mg...... 28VYVANSE – lisdexamfetamine dimesylate cap 30 mg...... 28VYVANSE – lisdexamfetamine dimesylate cap 40 mg...... 28VYVANSE – lisdexamfetamine dimesylate cap 50 mg...... 28VYVANSE – lisdexamfetamine dimesylate cap 60 mg...... 28VYVANSE – lisdexamfetamine dimesylate cap 70 mg...... 28VYVANSE – lisdexamfetamine dimesylate chew tab 10

mg.....................................................................................28VYVANSE – lisdexamfetamine dimesylate chew tab 20

mg.....................................................................................28

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January 2020 74

VYVANSE – lisdexamfetamine dimesylate chew tab 30mg.....................................................................................28




Wwarfarin sodium tab 1 mg (Coumadin).......................... 36warfarin sodium tab 2 mg (Coumadin).......................... 37warfarin sodium tab 2.5 mg (Coumadin)....................... 37warfarin sodium tab 3 mg (Coumadin).......................... 37warfarin sodium tab 4 mg (Coumadin).......................... 37warfarin sodium tab 5 mg (Coumadin).......................... 37warfarin sodium tab 6 mg (Coumadin).......................... 37warfarin sodium tab 7.5 mg (Coumadin)....................... 37warfarin sodium tab 10 mg (Coumadin)........................ 37

XXALKORI – crizotinib cap 200 mg....................................... 8XALKORI – crizotinib cap 250 mg....................................... 8XARELTO – rivaroxaban tab 2.5 mg..................................37XARELTO – rivaroxaban tab 10 mg...................................37XARELTO – rivaroxaban tab 15 mg...................................37XARELTO – rivaroxaban tab 20 mg...................................37XARELTO STARTER PACK – rivaroxaban tab starter

therapy pack 15 mg & 20 mg..........................................37XIFAXAN – rifaximin tab 550 mg......................................... 5XTANDI – enzalutamide cap 40 mg.....................................8XULANE – norelgestromin-ethinyl estradiol td ptwk 150-35

mcg/24hr...........................................................................10

YYONSA – abiraterone acetate tab 125 mg.......................... 8

Zzafirlukast tab 10 mg (Accolate)..................................... 21zafirlukast tab 20 mg (Accolate)..................................... 21zaleplon cap 5 mg (Sonata).............................................27zaleplon cap 10 mg (Sonata)...........................................27ZARXIO – filgrastim-sndz soln prefilled syringe 300

mcg/0.5ml......................................................................... 36ZARXIO – filgrastim-sndz soln prefilled syringe 480

mcg/0.8ml......................................................................... 36ZELBORAF – vemurafenib tab 240 mg............................... 8ZENPEP – pancrelipase (lip-prot-amyl) dr cap

3000-10000-14000 unit....................................................22ZENPEP – pancrelipase (lip-prot-amyl) dr cap

5000-17000-24000 unit....................................................22ZENPEP – pancrelipase (lip-prot-amyl) dr cap

10000-32000-42000 unit..................................................22ZENPEP – pancrelipase (lip-prot-amyl) dr cap

15000-47000-63000 unit..................................................22

ZENPEP – pancrelipase (lip-prot-amyl) dr cap20000-63000-84000 unit..................................................22

ZENPEP – pancrelipase (lip-prot-amyl) dr cap25000-79000-105000 unit................................................23

ZENPEP – pancrelipase (lip-prot-amyl) dr cap40000-126000-168000 unit............................................. 23

zidovudine cap 100 mg (Retrovir).....................................4zidovudine syrup 10 mg/ml (Retrovir)..............................4zidovudine tab 300 mg.......................................................4ziprasidone hcl cap 20 mg (Geodon)............................. 27ziprasidone hcl cap 40 mg (Geodon)............................. 27ziprasidone hcl cap 60 mg (Geodon)............................. 27ziprasidone hcl cap 80 mg (Geodon)............................. 27ZOLINZA – vorinostat cap 100 mg...................................... 8zolpidem tartrate tab er 6.25 mg (Ambien cr)................27zolpidem tartrate tab er 12.5 mg (Ambien cr)................27zolpidem tartrate tab 5 mg (Ambien)..............................27zolpidem tartrate tab 10 mg (Ambien)............................27zonisamide cap 50 mg..................................................... 34zonisamide cap 25 mg (Zonegran)................................. 34zonisamide cap 100 mg (Zonegran)............................... 34ZORTRESS – everolimus tab 0.25 mg.............................. 41ZORTRESS – everolimus tab 0.5 mg................................ 41ZORTRESS – everolimus tab 0.75 mg.............................. 41ZORTRESS – everolimus tab 1 mg................................... 42ZYCLARA – imiquimod cream 3.75%................................41ZYCLARA PUMP – imiquimod cream 2.5%...................... 41ZYCLARA PUMP – imiquimod cream 3.75%.................... 41ZYDELIG – idelalisib tab 100 mg.........................................8ZYDELIG – idelalisib tab 150 mg.........................................8ZYKADIA – ceritinib tab 150 mg.......................................... 8ZYLET – loteprednol etabonate-tobramycin ophth susp

0.5-0.3%........................................................................... 38ZYTIGA – abiraterone acetate tab 500 mg..........................8

20 core formulary effective 01/01/2020

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