2019 cigna rx plus 5-tier prescription drug list

2019 CIGNA RX PLUS 5-TIER PRESCRIPTION DRUG LIST

Starting January 1, 2019

924127 12/18 © 2018 Cigna

Cigna HealthCare of Illinois, Inc.

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View your drug list online

Questions? – Call the toll-free number on the back of your Cigna ID card, or 866.494.2111. We’re here to help.

The myCigna® website – Once you’re registered, log in and select Estimate Health Care Costs, then select Get drug costs.

Cigna.com/druglist – Select your state from the drop down menu, then choose your search method. You can either search for a medication name or view the full drug list.

Table of Contents

Your prescription drug list 3

How to read your drug list 3

How to find your medication 5

Specialty medications 32

Prescription drug list FAQs 34

2019 Exclusions and Limitations 36

Getting started

* Drug list originally created: 10/21/2013 Last updated: 08/01/2018 Next planned update: 08/01/19

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DRUG NAME Tier NOTES (PA, ST, QL, AGE)

8-MOP 4

ABACAVIR 2

ABACAVIR-LAMIVUDINE 2

ABACAVIR-LAMIVUDINE-ZIDOVUDINE 2

ABSORICA 4 QL

ACAMPROSATE CALCIUM 2

ACARBOSE 2

ACEBUTOLOL HCL 2

ACETAMIN-CAFF-DIHYDROCOD 320.5 2

ACETAMINOPHEN-CODEINE 2

ACETASOL HC 2

ACETAZOLAMIDE 2

ACETIC ACID 2

ACETIC ACID-ALUMINUM 2

ACETYLCYSTEINE 10% VIAL 2

ACETYLCYSTEINE 20% VIAL 2

ACITRETIN 2

ACYCLOVIR 200 MG CAPSULE 1

ACYCLOVIR 200 MG/5 ML SUSP 2

ACYCLOVIR 400 MG TABLET 2

ACYCLOVIR 5% OINTMENT 2

ACYCLOVIR 800 MG TABLET 2

ADAPALENE 2 AGE

Your prescription drug list

Tier (cost-share level) gives you an idea of how much you may pay for a medication

Medications that have extra coverage requirements will have an abbreviation in the Notes section

Medications are listed in alphabetical order

This document shows the prescription medications covered on the 2019 Cigna Rx Plus Prescription Drug List as of January 1, 2019.1 All of these medications are approved by the U.S. Food and Drug Administration (FDA). Medications are listed alphabetically by medication name. If you don’t see a specific medication on this list, please check myCigna.com to view the most current list of medications your plan covers.

How to read your drug listUse the sample chart below to help you understand this drug list. This chart is just an example. It may not show how these medications are actually covered on the 2019 Cigna Rx Plus Prescription Drug List.

This chart is just a sample. It may not show how these medications are actually covered on the 2019 Cigna Rx Plus Prescription Drug List.

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Tiers Covered medications are divided into tiers or cost-share levels. Typically, the higher the tier, the higher the price you’ll pay to fill the prescription.

Abbreviations next to medicationsSome medications on your drug list have extra requirements before your plan will cover them. This helps to make sure you’re receiving coverage for the right medication, at the right cost, in the right amount and for the right situation. These medications will have an abbreviation next to them in the Notes column in the drug list. Here’s what each of the abbreviations mean.

PA Prior Authorization – Cigna will review information provided by your doctor to make sure you meet coverage guidelines for the medication. If approved, your plan will cover the medication.

ST Step Therapy – Step Therapy is a prior authorization program that requires you to try other medications available to treat the same condition before the medication with the “ST” is covered.

QL Quantity Limits – For some medications, your plan will only cover up to a certain amount over a certain length of time. For example, 30mg per day for 30 days. Your plan will only cover a larger amount if your doctor requests and receives approval from Cigna.

AGE Age Requirements – You must be within a specific age range for your plan to cover the medication.

LDD Limited Distribution Drugs are medications that are only available at specific pharmacies in the United States because of manufacturer restrictions.

Tier 1 – Preferred Generic Medications. This tier typically includes preferred generic medications. These medications have the same strength, and active ingredients as brand name medications, but often cost much less. Preferred generic medications are covered at your plan’s lowest cost share.

Tier 2 – Generic Medications. This tier typically includes most generic medications and some low cost brand name medications. Generic medications have the same strength and active ingredients as brand name medications, but often cost much less.

Tier 3 – Preferred Brand Medications. This tier typically includes preferred brand name medications and some high cost generic medications.

Tier 4 – Non-Preferred Medications. This tier typically includes non-preferred brand name medications and some high cost generic medications.

Tier 5 – Specialty and Other High Cost Medications. This tier typically includes Specialty medications and high cost generic and brand name medications.

(Lower-cost medication) $

(Medium-cost medication) $$

(Higher-cost medication) $$$

$$$$

$$$$$

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Medication name Page

A–B 6–10

C–D 10–14

E–G 14–16

H–J 16–18

K–L 18–20

M–N 20–23

0–P 23–26

Q–S 26–28

T–U 28–30

V–Z 30–31

Brand name medications are capitalized

In this drug list, brand name medications are capitalized and generic medications are lowercase.

Specialty medications are listed on page 32

Specialty medications are used to treat complex conditions like multiple sclerosis, hepatitis C and rheumatoid arthritis. In this drug list, specialty medications are listed on page 32. Specialty medications are limited to a 30-day supply in all states except for IL and NC. Please log in to the myCigna website or app, or check your plan materials, to learn more about how your plan covers specialty medications.

Plan exclusions

Your plan excludes certain types of medications or products from coverage. This is known as a “plan (or benefit) exclusion.” This means that your plan doesn’t cover any prescription medications in the drug class or to treat the specific condition. There’s also no option to receive coverage through a medication review process. Please log in to the myCigna website or app, or check your plan materials, to find out if your plan excludes your medication from coverage.

How to find your medication Find your medication using the alphabetical list below. Then go to that page to see how your plan covers the medication.

6* Not covered in IL

MEDICATION NAME Tier NOTES (PA, ST, QL, AGE)

ALENDRONATE SOD 70 MG/75 ML 2ALENDRONATE SODIUM 10 MG TAB 1ALENDRONATE SODIUM 35 MG TAB 1ALENDRONATE SODIUM 40 MG TAB 1ALENDRONATE SODIUM 5 MG TABLET 1ALENDRONATE SODIUM 70 MG TAB 2ALFUZOSIN HCL ER 2ALINIA 4ALLOPURINOL 1ALMOTRIPTAN MALATE 2 QLALOCRIL 4ALOGLIPTIN 2 QLALOGLIPTIN-METFORMIN 2 QLALOGLIPTIN-PIOGLITAZONE 2 QLALOMIDE 4ALOSETRON HCL 4ALPRAZOLAM 2ALPRAZOLAM ER 2ALPRAZOLAM INTENSOL 2ALPRAZOLAM ODT 2ALPRAZOLAM XR 2ALTABAX 4ALTACAINE 2ALTAVERA 1ALYACEN 1AMABELZ 2AMANTADINE 2AMCINONIDE 2AMETHIA 1AMETHIA LO 1AMETHYST 1AMILORIDE HCL 2AMILORIDE-HYDROCHLOROTHIAZIDE 2AMIODARONE HCL 100 MG TABLET 2AMIODARONE HCL 200 MG TABLET 2AMIODARONE HCL 400 MG TABLET 2AMITIZA 4AMITRIPTYLINE HCL 1AMLODIPINE BESYLATE 2AMLODIPINE BESYLATE-BENAZEPRIL 2AMLODIPINE-ATORVASTATIN 2AMLODIPINE-OLMESARTAN 2AMLODIPINE-VALSARTAN 2AMLODIPINE-VALSARTAN-HCTZ 2AMMONIUM LACTATE 12% CREAM 2AMMONIUM LACTATE 12% LOTION 2AMNESTEEM 2 QLAMOXAPINE 2

2019 Cigna Rx Plus Prescription Drug List

Please visit Cigna.com/ifp-drug-list to see a complete listing.


8-MOP 4ABACAVIR 2ABACAVIR-LAMIVUDINE 2ABACAVIR-LAMIVUDINE-ZIDOVUDINE 2ACAMPROSATE CALCIUM 1ACARBOSE 2ACEBUTOLOL HCL 2ACETAMIN-CAFF-DIHYDROCOD 320.5 2ACETAMINOPHEN-CODEINE 2ACETAZOLAMIDE 2ACETIC ACID 2ACETIC ACID-ALUMINUM 2ACETYLCYSTEINE 10% VIAL 2ACETYLCYSTEINE 20% VIAL 2ACITRETIN 4ACYCLOVIR 200 MG CAPSULE 1ACYCLOVIR 200 MG/5 ML SUSP 2ACYCLOVIR 400 MG TABLET 2ACYCLOVIR 5% OINTMENT 2ACYCLOVIR 800 MG TABLET 2ADAPALENE 2 AGEADEFOVIR DIPIVOXIL 2ADRENALIN CHLORIDE 4ADVAIR DISKUS 3ADVAIR HFA 3AFEDITAB CR 2AFTERA 4AK-POLY-BAC 2ALA-CORT 2.5% CREAM 1ALBENZA 4ALBUTEROL 2.5 MG/0.5 ML SOL 2ALBUTEROL 5 MG/ML SOLUTION 2ALBUTEROL SUL 0.63 MG/3 ML SOL 2ALBUTEROL SUL 1.25 MG/3 ML SOL 2ALBUTEROL SUL 2.5 MG/3 ML SOLN 1ALBUTEROL SULF 2 MG/5 ML SYRUP 2ALBUTEROL SULFATE 2 MG TAB 2ALBUTEROL SULFATE 4 MG TAB 2ALBUTEROL SULFATE ER 4 MG TAB 2ALBUTEROL SULFATE ER 8 MG TAB 2ALCLOMETASONE DIPROPIONATE 2ALCOHOL PADS 3ALCOHOL PREP PADS 3ALCOHOL PREP SWABS 3ALCOHOL SWAB 3ALCOHOL SWABS 3ALCOHOL WIPES 3ALDACTAZIDE 4



AMOX-CLAV 200-28.5 MG TAB CHEW 2AMOX-CLAV 200-28.5 MG/5 ML SUS 2AMOX-CLAV 250-125 MG TABLET 2AMOX-CLAV 250-62.5 MG/5 ML SUS 2AMOX-CLAV 400-57 MG TAB CHEW 2AMOX-CLAV 400-57 MG/5 ML SUSP 2AMOX-CLAV 500-125 MG TABLET 2AMOX-CLAV 600-42.9 MG/5 ML SUS 2AMOX-CLAV 875-125 MG TABLET 2AMOXICILLIN 1AMOXICILLIN-CLAVULANATE POT ER 2AMPICILLIN TRIHYDRATE 2ANADROL-50 4 PAANAGRELIDE HCL 2ANALPRAM HC 4ANASTROZOLE 2ANDROXY 2ANORO ELLIPTA 3ANTABUSE 3ANUCORT-HC 2APEXICON E 2APIDRA 4 STAPIDRA SOLOSTAR 4 STAPRACLONIDINE HCL 2APREPITANT 2 QLAPRI 1APRISO 3APTIOM 4 QLAPTIVUS 3ARANELLE 1ARBINOXA 2ARCAPTA NEOHALER 4 STARIPIPRAZOLE 2ARIPIPRAZOLE ODT 2ARMODAFINIL 2 PAARMOUR THYROID 2ARNUITY ELLIPTA 3ASA-BUTALB-CAFFEINE-CODEINE 2ASCOMP WITH CODEINE 2ASHLYNA 1ASMANEX 4 STASMANEX HFA 4 STASPIRIN-CAFFEINE-DIHYDROCODEIN 2ASPIRIN-DIPYRIDAMOLE ER 2ATAZANAVIR SULFATE 2ATENOLOL 1ATENOLOL-CHLORTHALIDONE 1ATOMOXETINE HCL 2



ATORVASTATIN CALCIUM 2ATOVAQUONE 2ATOVAQUONE-PROGUANIL HCL 2ATRIPLA 3ATROPINE 1% EYE DROPS 2ATROPINE 1% EYE OINTMENT 2AUBRA 1AVANDIA 4AVIANE 1AZASITE 4AZATHIOPRINE 2AZELASTINE HCL 2AZITHROMYCIN 1 GM PWD PACKET 2AZITHROMYCIN 100 MG/5 ML SUSP 2AZITHROMYCIN 200 MG/5 ML SUSP 2AZITHROMYCIN 250 MG TABLET 2AZITHROMYCIN 500 MG TABLET 2AZITHROMYCIN 600 MG TABLET 2AZOPT 3AZUPHEN MB 2AZURETTE 1BACITRACIN 500 UNIT/GM OPHTH 2BACITRACIN-POLYMYXIN EYE OINT 2BACLOFEN 10 MG TABLET 1BACLOFEN 20 MG TABLET 1BACLOFEN 5 MG TABLET 2BAL-CARE DHA 1BALCOLTRA 4BALSALAZIDE DISODIUM 2BALZIVA 1BANZEL 4 QLBASAGLAR KWIKPEN U-100 3BD 3 ML SYRINGE 18GX1-1/2" 3BD 3 ML SYRINGE 20GX1-1/2" 3BD 3 ML SYRINGE 25GX1" 3BD 3 ML SYRINGE 25GX1-1/2" 3BD 3 ML SYRINGE WITH NEEDLE 3BD AUTO INJECTOR 3BD AUTOSHIELD DUO NDL 5MMX30G 3BD AUTOSHIELD NEEDLE 5MMX29G 3BD AUTOSHIELD NEEDLE 8MMX29G 3BD BLUNT NEEDLE 18GX1-1/2" 3BD ECLIPSE 30GX1/2" SYRINGE 3BD ECLIPSE LUER-LOK SYR 3 ML 3BD ECLIPSE NEEDLE 18GX1 1/2" 3BD ECLIPSE NEEDLE 21GX1" 3BD ECLIPSE NEEDLE 22GX1" 3BD ECLIPSE NEEDLE 23GX1" 3


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BD ECLIPSE NEEDLE 25GX1" 3BD ECLIPSE NEEDLE 25GX1.5" 3BD ECLIPSE NEEDLE 25GX5/8" 3BD ECLIPSE NEEDLE 27GX1/2" 3BD ECLIPSE NEEDLE 30GX1/2" 3BD ECLIPSE NEEDLES 21GX1.5" 3BD FILTER NEEDLE 3BD INS SYR 0.3 ML 8MMX31G(1/2) 3BD INS SYR U-500 1/2ML 6MMX31G 3BD INS SYR UF 0.3ML 12.7MMX30G 3BD INS SYR UF 0.5ML 12.7MMX30G 3BD INS SYRN UF 1 ML 12.7MMX30G 3BD INS SYRNG 0.3 ML 29GX12.7MM 3BD INS SYRNG 0.5 ML 29GX12.7MM 3BD INS SYRNG UF 0.3 ML 8MMX31G 3BD INS SYRNG UF 0.5 ML 8MMX31G 3BD INSUL SYR 0.3 ML 31GX15/64" 3BD INSUL SYR 0.5 ML 31GX15/64" 3BD INSULIN SYR 0.3 ML 28GX1/2" 3BD INSULIN SYR 0.3 ML 29GX1/2" 3BD INSULIN SYR 0.3 ML 31GX5/16 3BD INSULIN SYR 0.3 ML 8MMX31G 3BD INSULIN SYR 0.5 ML 28GX1/2" 3BD INSULIN SYR 0.5 ML 29GX1/2" 3BD INSULIN SYR 0.5 ML 30GX1/2" 3BD INSULIN SYR 0.5 ML 8MMX31G 3BD INSULIN SYR 0.5ML 31GX5/16" 3BD INSULIN SYR 1 ML 12.7MMX30G 3BD INSULIN SYR 1 ML 25GX1" 3BD INSULIN SYR 1 ML 25GX5/8" 3BD INSULIN SYR 1 ML 26GX1/2" 3BD INSULIN SYR 1 ML 27GX12.7MM 3BD INSULIN SYR 1 ML 27GX5/8" 3BD INSULIN SYR 1 ML 28GX1/2" 3BD INSULIN SYR 1 ML 29GX1/2" 3BD INSULIN SYR 1 ML 29GX12.7MM 3BD INSULIN SYR 1 ML 30GX1/2" 3BD INSULIN SYR 1 ML 31GX15/64" 3BD INSULIN SYR 1 ML 31GX5/16" 3BD INSULIN SYR 1 ML 8MMX31G 3BD INSULIN SYR UF 1 ML 8MMX31G 3BD INSULIN SYRINGE 1 ML 3BD INSULIN U100-3/10 ML SYR 3BD INTEGRA NEEDLE 25G X 5/8" 3BD INTEGRA RETRA NEEDLE 23GX1" 3BD INTEGRA SYR 1 ML 29GX1/2" 3BD INTEGRA SYR 3 ML 21GX1 1/2" 3BD LUER-LOK SYR 3 ML 25GX5/8" 3



BD LUER-LOK SYRINGE 1 ML 3BD MAGNI-GUIDE MAGNIFIER 3BD MEDSAVER SYRINGE 3BD NEEDLE 18GX1 1/2" 3BD NEEDLE 19GX1 1/2" 3BD NEEDLE 20GX1 1/2" 3BD NEEDLE 21GX1 1/2" 3BD NEEDLE 21GX1" 3BD NEEDLE 22GX1 1/2" 3BD NEEDLE 22GX1" 3BD NEEDLE 22GX3/4" 3BD NEEDLE 23GX1 1/2" 3BD NEEDLE 23GX1" 3BD NEEDLE 24GX1" 3BD NEEDLE 25GX1" 3BD NEEDLE 25GX5/8" 3BD NEEDLE 26GX0.625" 3BD NEEDLES 16GX1" 3BD NEEDLES 16GX1.5" 3BD NEEDLES 18GX1" 3BD NEEDLES 18GX1.5" 3BD NEEDLES 19GX1" 3BD NEEDLES 19GX1.5" 3BD NEEDLES 20GX1" 3BD NEEDLES 20GX1.5" 3BD NEEDLES 21GX1" 3BD NEEDLES 21GX1.5" 3BD NEEDLES 21GX2" 3BD NEEDLES 22GX1" 3BD NEEDLES 22GX1.5" 3BD NEEDLES 23GX0.75" 3BD NEEDLES 23GX1.25" 3BD NEEDLES 25GX0.625" 3BD NEEDLES 25GX0.875" 3BD NEEDLES 25GX1.5" 3BD NEEDLES 26GX0.375" 3BD NEEDLES 26GX0.5" 3BD NEEDLES 27GX0.5" 3BD NEEDLES 27GX1X1.25" 3BD NEEDLES 30GX0.5" 3BD NEEDLES 30GX1" 3BD NOKOR ADMIX NEEDLE 18GX1.5" 3BD NOKOR NEEDLE 16GX1" 3BD NOKOR NEEDLE 18GX1" 3BD PEN NEEDLE 29GX1/2" 3BD PRECISIONGLI 27GX1-1/2" NDL 3BD PRECISIONGLIDE 3 ML 22GX3/4 3BD PRECISIONGLIDE NEEDLE 25G 3

Please visit Cigna.com/ifp-drug-list to see a complete listing.* Not covered in IL



BD SAFETGLD INS 0.3 ML 8MMX31G 3BD SAFETGLD INS 0.3ML 13MMX29G 3BD SAFETGLD INS 0.5 ML 8MMX30G 3BD SAFETYGLID INS 1 ML 6MMX31G 3BD SAFETYGLIDE 3 ML SYRINGE 3BD SAFETYGLIDE NEEDLE 3BD SAFETYGLIDE NEEDLE 18GX1.5" 3BD SAFETYGLIDE NEEDLE 21GX1" 3BD SAFETYGLIDE NEEDLE 21GX1.5" 3BD SAFETYGLIDE NEEDLE 22GX1.5" 3BD SAFETYGLIDE NEEDLE 25GX1" 3BD SAFETYGLIDE NEEDLE 27GX5/8" 3BD SAFETYGLIDE SYRINGE 27GX5/8 3BD SAFTYGLD INS 0.3 ML 6MMX31G 3BD SAFTYGLD INS 0.5 ML 6MMX31G 3BD SYR 0.3 ML 6MMX31G (1/2) 3BD SYR 0.3 ML 8MMX31G (1/2) 3BD SYRINGE 0.3 ML 12.7MMX30G 3BD SYRINGE 0.5 ML 12.7MMX30G 3BD SYRINGE-SAFETY GLIDE 3BD UF MICRO PEN NEEDLE 6MMX32G 3BD UF MINI PEN NEEDLE 5MMX31G 3BD UF NANO PEN NEEDLE 4MMX32G 3BD UF ORIG PEN NDL 12.7MMX29G 3BD UF SHORT PEN NEEDLE 8MMX31G 3BD VEO INS 0.3ML 6MMX31G (1/2) 3BD VEO INS SYRING 1 ML 6MMX31G 3BD VEO INS SYRN 0.3 ML 6MMX31G 3BD VEO INS SYRN 0.5 ML 6MMX31G 3BECONASE AQ 4 STBEKYREE 1BELLADONNA-OPIUM 2BENAZEPRIL HCL 1BENAZEPRIL-HYDROCHLOROTHIAZIDE 2BENZEPRO 6% FOAMING CLOTHS 2BENZEPRO 7% CREAMY WASH 2BENZONATATE 2BENZTROPINE MES 0.5 MG TAB 2BENZTROPINE MES 1 MG TABLET 2BENZTROPINE MES 2 MG TABLET 2BEPREVE 4BESIVANCE 4BETADINE 4BETAMETHASONE DIPROP AUGMENTED 2BETAMETHASONE DIPROPIONATE 2BETAMETHASONE VALERATE 2BETAXOLOL HCL 2BETHANECHOL CHLORIDE 2



BEXAROTENE 4 PABEYAZ 3BICALUTAMIDE 2BILTRICIDE 4BIMATOPROST 0.03% EYE DROPS 2BINOSTO 4BISOPROLOL FUMARATE 2BISOPROLOL-HYDROCHLOROTHIAZIDE 1BLISOVI 24 FE 1BLISOVI FE 1BP WASH 7% LIQUID 2BP WASH ACNE 4% TREATMENT PACK 2BPO 4% CREAMY WASH PACK 2BPO 4% GEL 2BPO 6% FOAMING CLOTHS 2BPO 8% GEL 2BREO ELLIPTA 3BREVICON 4BRIELLYN 1BRILINTA 4BRIMONIDINE TARTRATE 2BROMFED DM 2BROMFENAC SODIUM 2BROMOCRIPTINE MESYLATE 2BROMPHENIRAMINE-PSEUDOEPHED-DM

2

BROVANA 4BUDESONIDE 0.25 MG/2 ML SUSP 4BUDESONIDE 0.5 MG/2 ML SUSP 4BUDESONIDE 1 MG/2 ML INH SUSP 4BUDESONIDE 32 MCG NASAL SPRAY 2BUDESONIDE EC 3 MG CAPSULE 4BUMETANIDE 0.5 MG TABLET 1BUMETANIDE 1 MG TABLET 1BUMETANIDE 2 MG TABLET 1BUNAVAIL 3BUPRENORPHINE PATCH 2 QLBUPRENORPHINE 2 MG TABLET SL 1BUPRENORPHINE 8 MG TABLET SL 1BUPRENORPHINE-NALOXONE 1BUPROPION HCL 2 QLBUPROPION HCL SR 2 QLBUPROPION HCL SR 150MG (SMOKING CESSATION)

1 QL

BUPROPION XL 2 QLBUSPIRONE HCL 2BUTALB-ACETAMINOPH-CAFF-CODEIN 2BUTALB-CAFF-ACETAMINOPH-CODEIN 2




BUTALBITAL COMPOUND-CODEINE 2BUTALBITAL-ACETAMINOPHEN-CAFFE 2BUTALBITAL-ACETAMINOPHN 50-325 2BUTALBITAL-ASPIRIN-CAFFEINE 2BUTISOL SODIUM 4BUTORPHANOL 10 MG/ML SPRAY 2 QLBYDUREON 3 QLBYDUREON BCISE 3 QLBYDUREON PEN 3 QLBYETTA 3 QLBYSTOLIC 4 QLCABERGOLINE 2 QLCAFFEINE CIT 60 MG/3 ML ORAL 2CALCIPOTRIENE 2CALCIPOTRIENE-BETAMETHASONE DP 2CALCITONIN-SALMON 2CALCITRENE 2CALCITRIOL 0.25 MCG CAPSULE 2CALCITRIOL 0.5 MCG CAPSULE 2CALCITRIOL 1 MCG/ML SOLUTION 2CALCITRIOL 3 MCG/G OINTMENT 2 QLCALCIUM ACETATE 667 MG CAPSULE 2CALCIUM ACETATE 667 MG GELCAP 2CALCIUM ACETATE 667 MG TABLET 2CAMBIA 4CAMILA 1CAMRESE 1CAMRESE LO 1CANDESARTAN CILEXETIL 2CANDESARTAN-HYDROCHLOROTHIAZID 2CAPACET 2CAPCOF 4CAPECITABINE 4CAPTOPRIL 1CAPTOPRIL-HYDROCHLOROTHIAZIDE 2 QLCARBAGLU 4 PACARBAMAZEPINE 100 MG TAB CHEW 1CARBAMAZEPINE 100 MG/5 ML SUSP 2CARBAMAZEPINE 200 MG TABLET 1CARBAMAZEPINE ER 2CARBIDOPA 2CARBIDOPA-LEVODOPA 2CARBIDOPA-LEVODOPA ER 2CARBIDOPA-LEVODOPA-ENTACAPONE 2CARBINOXAMINE 4 MG/5 ML LIQUID 2CARBINOXAMINE MALEATE 4 MG TAB 2CARETOUCH ALCOHOL PREP PAD 3CARISOPRODOL 2



CARISOPRODOL COMPOUND 2CARISOPRODOL COMPOUND-CODEINE 2CARISOPRODOL-ASPIRIN 2CARISOPRODOL-ASPIRIN-CODEINE 2CARNITOR SF 4CARTEOLOL HCL 2CARTIA XT 2CARVEDILOL 1CAZIANT 1CEFACLOR 2CEFACLOR ER 2CEFADROXIL 2CEFDINIR 2CEFDITOREN PIVOXIL 2CEFIXIME 2CEFPODOXIME PROXETIL 2CEFPROZIL 2CEFTIBUTEN 2CEFUROXIME 2CELECOXIB 2 QLCELONTIN 4CENTERGY 2CENTERGY DM 2CEPHALEXIN 125 MG/5 ML SUSP 1CEPHALEXIN 250 MG CAPSULE 1CEPHALEXIN 250 MG TABLET 1CEPHALEXIN 250 MG/5 ML SUSP 1CEPHALEXIN 500 MG CAPSULE 1CEPHALEXIN 500 MG TABLET 1CEPHALEXIN 750 MG CAPSULE 2CESAMET 4CETIRIZINE HCL 1 MG/ML SOLN 2CETIRIZINE HCL 1 MG/ML SYRUP 2CEVIMELINE HCL 2CHANTIX 3CHATEAL 1CHEMET 4CHENODAL 4 LDDCHERATUSSIN AC 2CHLORDIAZEPOXIDE HCL 2CHLORDIAZEPOXIDE-AMITRIPTYLINE 2CHLORDIAZEPOXIDE-CLIDINIUM 2CHLORHEXIDINE 0.12% RINSE 2CHLOROQUINE PHOSPHATE 2CHLOROTHIAZIDE 2CHLORPROMAZINE 10 MG TABLET 2CHLORPROMAZINE 100 MG TABLET 2CHLORPROMAZINE 200 MG TABLET 2




CHLORPROMAZINE 25 MG TABLET 2CHLORPROMAZINE 50 MG TABLET 2CHLORPROPAMIDE 1CHLORTHALIDONE 2CHLORZOXAZONE 500 MG TABLET 2CHOLESTYRAMINE 2CHOLESTYRAMINE LIGHT 2CHOLINE MAG TRISALICYLATE 2CHORIONIC GONADOTROPIN 2 PA*CIALIS 4 PA, QLCICLODAN 0.77% CREAM 2CICLODAN 8% SOLUTION 2CICLOPIROX 0.77% CREAM 2CICLOPIROX 0.77% GEL 2CICLOPIROX 0.77% TOPICAL SUSP 2CICLOPIROX 1% SHAMPOO 2CICLOPIROX 8% SOLUTION 2CILOSTAZOL 2CILOXAN 4CIMETIDINE 200 MG TABLET 1CIMETIDINE 300 MG TABLET 1CIMETIDINE 300 MG/5 ML SOLN 2CIMETIDINE 400 MG TABLET 1CIMETIDINE 800 MG TABLET 1CIPRO HC 4CIPRODEX 4CIPROFLOXACIN 0.2% OTIC SOLN 2CIPROFLOXACIN 0.3% EYE DROP 2CIPROFLOXACIN 250 MG/5 ML SUSP 2CIPROFLOXACIN 500 MG/5 ML SUSP 2CIPROFLOXACIN ER 2CIPROFLOXACIN HCL 100 MG TAB 1CIPROFLOXACIN HCL 250 MG TAB 1CIPROFLOXACIN HCL 500 MG TAB 1CIPROFLOXACIN HCL 750 MG TAB 1CITALOPRAM HBR 10 MG TABLET 1 QLCITALOPRAM HBR 10 MG/5 ML SOLN 2 QLCITALOPRAM HBR 20 MG TABLET 1 QLCITALOPRAM HBR 40 MG TABLET 1 QLCLARAVIS 2 QLCLARITHROMYCIN 2CLARITHROMYCIN ER 2CLEMASTINE FUMARATE 2CLINDACIN ETZ 1% PLEDGET 2CLINDACIN P 2CLINDAMYCIN 2% VAGINAL CREAM 2CLINDAMYCIN HCL 2CLINDAMYCIN PALMITATE HCL 2



CLINDAMYCIN PEDIATRIC 2CLINDAMYCIN PH 1% GEL 2CLINDAMYCIN PH 1% SOLUTION 2CLINDAMYCIN PHOS 1% PLEDGET 2CLINDAMYCIN PHOS-BENZOYL PEROX 2CLINDAMYCIN PHOSP 1% LOTION 2CLINDAMYCIN PHOSPHATE 1% FOAM 2CLINDAMYCIN PHOS-TRETINOIN 2CLINDAMYCIN-BENZOYL PEROXIDE 2CLINDESSE 4CLOBETASOL 0.05% CREAM 2CLOBETASOL 0.05% GEL 2CLOBETASOL 0.05% OINTMENT 2CLOBETASOL 0.05% SHAMPOO 2CLOBETASOL 0.05% SOLUTION 2CLOBETASOL 0.05% TOPICAL LOTN 2CLOBETASOL EMOLLIENT 2CLOBETASOL EMULSION 2CLOBETASOL PROP 0.05% FOAM 2CLOBETASOL PROP 0.05% SPRAY 2CLOCORTOLONE PIVALATE 2CLODAN 0.05% SHAMPOO 2CLOMIPRAMINE HCL 4CLONAZEPAM 2CLONIDINE 2CLONIDINE HCL 0.1 MG TABLET 2CLONIDINE HCL 0.2 MG TABLET 2CLONIDINE HCL 0.3 MG TABLET 2CLONIDINE HCL ER 2CLOPIDOGREL 2CLORAZEPATE DIPOTASSIUM 2CLORPRES 2CLOTRIMAZOLE 1% CREAM 2CLOTRIMAZOLE 1% SOLUTION 2CLOTRIMAZOLE 10 MG TROCHE 2CLOTRIMAZOLE-BETAMETHASONE 2CLOZAPINE 2CLOZAPINE ODT 100 MG TABLET 4CLOZAPINE ODT 12.5 MG TABLET 4CLOZAPINE ODT 150 MG TABLET 4CLOZAPINE ODT 200 MG TABLET 4CLOZAPINE ODT 25 MG TABLET 4C-NATE DHA 1COARTEM 4 QLCODEINE SULFATE 2CODEINE-GUAIFEN 10-100 MG/5 ML 2COLCHICINE 2COLESEVELAM HCL 2




COLESTIPOL HCL 2COLOCORT 2COLY-MYCIN S 4COMBIGAN 4COMPLERA 3COMPLETE NATAL DHA 1COMPLETENATE 1COMPRO 2CONSTULOSE 2CORDRAN 4COREMINO 2CORMAX 2CORTISONE ACETATE 2CORTISPORIN 4COVARYX 2COVARYX H.S. 2CREON 4CRIXIVAN 3CROMOLYN 100 MG/5 ML ORAL CONC 2CROMOLYN 20 MG/2 ML NEB SOLN 2CROMOLYN 4% EYE DROPS 2CRYSELLE 1CUPRIMINE 4CURITY ALCOHOL PREPS 3CYANOCOBALAMIN INJECTION 2CYCLAFEM 1CYCLESSA 1CYCLOBENZAPRINE 10 MG TABLET 1CYCLOBENZAPRINE 5 MG TABLET 1CYCLOBENZAPRINE 7.5 MG TABLET 3CYCLOMYDRIL 4CYCLOPENTOLATE HCL 2CYCLOPHOSPHAMIDE 25 MG CAPSULE 3CYCLOPHOSPHAMIDE 50 MG CAPSULE 3CYCLOSERINE 2CYCLOSET 4CYCLOSPORINE 100 MG CAPSULE 2CYCLOSPORINE 25 MG CAPSULE 2CYCLOSPORINE MODIFIED 2CYPROHEPTADINE 2 MG/5 ML SYRUP 2CYPROHEPTADINE 4 MG TABLET 2CYRED 1CYSTARAN 4 LDDCYTRA-2 2CYTRA-3 2CYTRA-K 2DALIRESP 250 MCG TABLET 4 QLDALIRESP 500 MCG TABLET 4



DANAZOL 2DANTROLENE SODIUM 2DAPSONE 4DARAPRIM 4 PADARIFENACIN ER 2DASETTA 1DAYSEE 1DEBLITANE 1DECADRON 0.5 MG/5 ML ELIXIR 1DECARA 25,000 UNIT VEGICAP 4 QLDECARA 50,000 UNIT SOFTGEL 4 QLDELYLA 1DEMECLOCYCLINE HCL 2DEMSER 4DENAVIR 4DENTA 5000 PLUS 2DENTAGEL 2DEPADE 2DEPEN 4DESCOVY 3DESIPRAMINE HCL 2DESLORATADINE 2 QLDESMOPRESSIN 0.01% SOLUTION 2DESMOPRESSIN 0.01% SPRAY 2DESMOPRESSIN 0.1 MG/ML SOL 2DESMOPRESSIN 10 MCG/0.1 ML SPR 2DESMOPRESSIN ACETATE 0.1 MG TB 2DESMOPRESSIN ACETATE 0.2 MG TB 2DESOGEN 4DESOGESTREL-ETHINYL ESTRADIOL 1DESOGESTR-ETH ESTRAD ETH ESTRA 1DESONIDE 2DESOXIMETASONE 2DESVENLAFAXINE SUCCINATE ER 2 QLDEXAMETHASONE 1DEXAMETHASONE 0.1% EYE DROP 2DEXAMETHASONE INTENSOL 1DEXILANT 3 ST, QLDEXMETHYLPHENIDATE ER 10 MG CP 2DEXMETHYLPHENIDATE ER 15 MG CP 2DEXMETHYLPHENIDATE ER 20 MG CP 2DEXMETHYLPHENIDATE ER 25 MG CP 2DEXMETHYLPHENIDATE ER 30 MG CP 2DEXMETHYLPHENIDATE ER 35 MG CP 2DEXMETHYLPHENIDATE ER 40 MG CP 2DEXMETHYLPHENIDATE ER 5 MG CAP 2DEXMETHYLPHENIDATE HCL 2DEXTROAMPHETAMINE SULFATE 2




DEXTROAMPHETAMINE SULFATE ER 2DEXTROAMPHETAMINE-AMPHET ER 2DEXTROAMPHETAMINE-AMPHETAMINE 2DIAZEPAM 10 MG RECTAL GEL SYST 2DIAZEPAM 10 MG TABLET 2DIAZEPAM 2 MG TABLET 2DIAZEPAM 2.5 MG RECTAL GEL SYS 2DIAZEPAM 20 MG RECTAL GEL SYST 2DIAZEPAM 5 MG TABLET 2DIAZEPAM 5 MG/5 ML ORAL SOLN 2DIAZEPAM 5 MG/5 ML SOLUTION 2DIAZEPAM 5 MG/ML ORAL CONC 2DICLOFENAC 0.1% EYE DROPS 2DICLOFENAC 1.5% TOPICAL SOLN 2DICLOFENAC POTASSIUM 2DICLOFENAC SOD DR 25 MG TAB 2DICLOFENAC SOD DR 50 MG TAB 2DICLOFENAC SOD DR 75 MG TAB 2DICLOFENAC SOD EC 25 MG TAB 2DICLOFENAC SOD EC 50 MG TAB 2DICLOFENAC SOD EC 75 MG TAB 2DICLOFENAC SODIUM 1% GEL 2 QLDICLOFENAC SODIUM ER 2DICLOFENAC SODIUM-MISOPROSTOL 2DICLOXACILLIN SODIUM 2DICYCLOMINE 10 MG CAPSULE 1DICYCLOMINE 10 MG/5 ML SOLN 2DICYCLOMINE 20 MG TABLET 1DIDANOSINE 2DIFICID 4 PADIFLORASONE DIACETATE 2DIFLUNISAL 2DIGITEK 1DIGOX 1DIGOXIN 0.05 MG/ML SOLUTION 2DIGOXIN 0.125 MG TABLET 1DIGOXIN 0.25 MG TABLET 1DIGOXIN 125 MCG TABLET 1DIGOXIN 250 MCG TABLET 1DIHYDROERGOTAMINE MESYLATE 4 QLDILATRATE-SR 4DILTIAZEM 120 MG TABLET 1DILTIAZEM 12HR ER 2DILTIAZEM 24HR CD 2DILTIAZEM 24HR ER 2DILTIAZEM 30 MG TABLET 1DILTIAZEM 60 MG TABLET 1DILTIAZEM 90 MG TABLET 1



DILTIAZEM ER 2DILT-XR 2DIPENTUM 4DIPHENHYDRAMINE 12.5 MG/5 ML 2DIPHENHYDRAMINE 25 MG/10 ML 2DIPHENOXYLATE-ATROPINE 2DIPYRIDAMOLE 25 MG TABLET 2DIPYRIDAMOLE 50 MG TABLET 2DIPYRIDAMOLE 75 MG TABLET 2DISKETS 2 PADISOPYRAMIDE PHOSPHATE 2DISULFIRAM 1DIVALPROEX SODIUM 2DIVALPROEX SODIUM ER 2DOFETILIDE 4 QLDONEPEZIL HCL 2DONEPEZIL HCL ODT 2DORZOLAMIDE HCL 2DORZOLAMIDE-TIMOLOL 2DOTHELLE DHA 1DOXAZOSIN MESYLATE 1DOXEPIN 10 MG CAPSULE 2DOXEPIN 10 MG/ML ORAL CONC 2DOXEPIN 100 MG CAPSULE 2DOXEPIN 150 MG CAPSULE 2DOXEPIN 25 MG CAPSULE 2DOXEPIN 5% CREAM 4DOXEPIN 50 MG CAPSULE 2DOXEPIN 75 MG CAPSULE 2DOXERCALCIFEROL 0.5 MCG CAP 2DOXERCALCIFEROL 1 MCG CAPSULE 2DOXERCALCIFEROL 2.5 MCG CAP 2DOXYCYCLINE HYC DR 100 MG TAB 2DOXYCYCLINE HYC DR 150 MG TAB 2DOXYCYCLINE HYC DR 200 MG TAB 2DOXYCYCLINE HYC DR 50 MG TAB 2DOXYCYCLINE HYC DR 75 MG TAB 2DOXYCYCLINE HYCLATE 100 MG CAP 2DOXYCYCLINE HYCLATE 100 MG TAB 2DOXYCYCLINE HYCLATE 20 MG TAB 2DOXYCYCLINE HYCLATE 50 MG CAP 2DOXYCYCLINE MONOHYDRATE 2DRONABINOL 4DROSPIRENONE-EE 3-0.02 MG TAB 1DROSPIRENONE-EE 3-0.03 MG TAB 1DROSPIRENONE-ETH ESTRA-LEVOMEF 1DUAVEE 4DULOXETINE HCL 2 QL




DUREZOL 4DUTASTERIDE 2DUTASTERIDE-TAMSULOSIN 2DYMISTA 4DYRENIUM 4EASY TOUCH ALCOHOL PREP PADS 3ECONAZOLE NITRATE 2ECONTRA EZ 4EDARBI 4 ST, QLEDARBYCLOR 4 ST, QLED-SPAZ 1EDURANT 3EEMT 2EEMT H.S. 2EFAVIRENZ 2EFFER-K 4ELETRIPTAN HBR 2 QLELIDEL 4ELINEST 1ELIPHOS 2ELITE OB DHA 1ELITE-OB 1ELITE-OB 400 1ELLA 4ELMIRON 4EMADINE 4EMOQUETTE 1EMSAM 4 QLEMTRIVA 3EMVERM 2ENALAPRIL MALEATE 1ENALAPRIL-HYDROCHLOROTHIAZIDE 2ENDOCET 2ENDOMETRIN 4 PAENLYTE 4ENOXAPARIN SODIUM 4 QLENPRESSE 1ENSKYCE 1ENTACAPONE 2ENTECAVIR 0.5 MG TABLET 4ENTECAVIR 1 MG TABLET 4ENTRESTO 3 PAENULOSE 2EPIFOAM 4EPINASTINE HCL 2EPINEPHRINE 0.15 MG AUTO-INJCT 2 QLEPINEPHRINE 0.3 MG AUTO-INJECT 2 QLEPITOL 1



EPLERENONE 2EPROSARTAN MESYLATE 2ERGOLOID MESYLATES 1ERGOMAR 4ERRIN 1ERTACZO 4ERY 2ERYTHROCIN STEARATE 2ERYTHROMYCIN 2ERYTHROMYCIN ETHYLSUCCINATE 2ERYTHROMYCIN-BENZOYL PEROXIDE 2ESCITALOPRAM OXALATE 2 QLESOMEPRAZOLE MAG DR 20 MG CAP 2 QLESOMEPRAZOLE MAG DR 40 MG CAP 2 QLESOMEPRAZOLE STRONTIUM 2 QLESTARYLLA 1ESTAZOLAM 2ESTRADIOL 0.025 MG PATCH 2ESTRADIOL 0.0375 MG PATCH 2ESTRADIOL 0.0375 MG/DAY PATCH 2ESTRADIOL 0.05 MG PATCH 2ESTRADIOL 0.06 MG/DAY PATCH 2ESTRADIOL 0.075 MG PATCH 2ESTRADIOL 0.075 MG/DAY PATCH 2ESTRADIOL 0.1 MG PATCH 2ESTRADIOL 0.5 MG TABLET 1ESTRADIOL 1 MG TABLET 1ESTRADIOL 10 MCG VAGINAL INSRT 2ESTRADIOL 2 MG TABLET 1ESTRADIOL TDS 0.025 MG/DAY 2ESTRADIOL TDS 0.0375 MG/DAY 2ESTRADIOL TDS 0.05 MG/DAY 2ESTRADIOL TDS 0.06 MG/DAY 2ESTRADIOL TDS 0.075 MG/DAY 2ESTRADIOL TDS 0.1 MG/DAY 2ESTRADIOL-NORETHINDRONE ACETAT 2ESTROGEN-METHYLTESTOSTERONE 2ESTROPIPATE 2ESTROSTEP FE 4ESZOPICLONE 2ETHACRYNIC ACID 2ETHAMBUTOL HCL 2ETHOSUXIMIDE 2ETHYL CHLORIDE 2ETHYNODIOL-ETHINYL ESTRADIOL 1ETIDRONATE DISODIUM 2ETODOLAC 2ETODOLAC ER 2




ETOPOSIDE 4EURAX 4EVOTAZ 3EXELDERM 4EXEMESTANE 2EXTRA-VIRT PLUS DHA 1EZETIMIBE 2EZETIMIBE-SIMVASTATIN 2FACTIVE 4FALLBACK SOLO 4FALMINA 1FAMCICLOVIR 2FAMOTIDINE 20 MG TABLET 1FAMOTIDINE 40 MG TABLET 1FAMOTIDINE 40 MG/5 ML SUSP 2FANAPT 4 ST, QLFARESTON 4FARXIGA 3 QLFAYOSIM 1FELBAMATE 400 MG TABLET 4FELBAMATE 600 MG TABLET 4FELBAMATE 600 MG/5 ML SUSP 4FELODIPINE ER 2FEM PH 2FEMCON FE 4FEMYNOR 1FENOFIBRATE 2FENOFIBRIC ACID 2FENOPROFEN 600 MG TABLET 2FENTANYL PATCH 2 PA, QLFENTANYL CIT OTFC 1,200 MCG 4 PAFENTANYL CIT OTFC 1,600 MCG 4 PAFENTANYL CITRATE OTFC 200 MCG 4 PAFENTANYL CITRATE OTFC 400 MCG 4 PAFENTANYL CITRATE OTFC 600 MCG 4 PAFENTANYL CITRATE OTFC 800 MCG 4 PAFERRIPROX 4 LDDFETZIMA 4 ST, QLFEXOFENADINE HCL 180 MG TABLET 2FEXOFENADINE HCL 30 MG TABLET 2FEXOFENADINE HCL 60 MG TABLET 2FINACEA 4FINASTERIDE 5 MG TABLET 2FIORICET 2FLAVOXATE HCL 2FLECAINIDE ACETATE 2FLECTOR 4 QLFLOVENT DISKUS 3



FLOVENT HFA 3FLUCONAZOLE 10 MG/ML SUSP 2FLUCONAZOLE 100 MG TABLET 2FLUCONAZOLE 150 MG TABLET 1FLUCONAZOLE 200 MG TABLET 2FLUCONAZOLE 40 MG/ML SUSP 2FLUCONAZOLE 50 MG TABLET 2FLUCYTOSINE 4FLUDROCORTISONE ACETATE 2FLUNISOLIDE 2FLUOCINOLONE ACETONIDE 2FLUOCINOLONE ACETONIDE OIL 2FLUOCINONIDE 0.05% CREAM 2FLUOCINONIDE 0.05% GEL 2FLUOCINONIDE 0.05% OINTMENT 2FLUOCINONIDE 0.05% SOLUTION 2FLUOCINONIDE 0.1% CREAM 2FLUOCINONIDE-E 2FLUORABON 2FLUOR-A-DAY 4FLUORIDE 2FLUORIDEX 2FLUORIDEX DAILY DEFENSE 2FLUORITAB 2FLUOROMETHOLONE 2FLUOROURACIL 0.5% CREAM 2FLUOROURACIL 2% TOPICAL SOLN 2FLUOROURACIL 5% CREAM 2FLUOROURACIL 5% TOPICAL SOLN 2FLUOXETINE 20 MG/5 ML SOLUTION 2 QLFLUOXETINE DR 2 QLFLUOXETINE HCL 10 MG CAPSULE 1 QLFLUOXETINE HCL 10 MG TABLET 1 QLFLUOXETINE HCL 20 MG CAPSULE 1 QLFLUOXETINE HCL 20 MG TABLET 1 QLFLUOXETINE HCL 40 MG CAPSULE 1 QLFLUOXETINE HCL 60 MG TABLET 1 QLFLUPHENAZINE 1 MG TABLET 2FLUPHENAZINE 10 MG TABLET 2FLUPHENAZINE 2.5 MG TABLET 2FLUPHENAZINE 2.5 MG/5 ML ELIX 2FLUPHENAZINE 5 MG TABLET 2FLUPHENAZINE 5 MG/ML CONC 2FLURA-DROPS 2FLURANDRENOLIDE 2FLURAZEPAM HCL 2FLURBIPROFEN 2FLURBIPROFEN SODIUM 2




FLUTAMIDE 2FLUTICASONE PROP 0.005% OINT 2FLUTICASONE PROP 0.05% CREAM 2FLUTICASONE PROP 0.05% LOTION 2FLUTICASONE PROP 50 MCG SPRAY 2FLUTICASONE-SALMETEROL 2FLUVASTATIN ER 2FLUVASTATIN SODIUM 2FLUVOXAMINE MALEATE 2 QLFLUVOXAMINE MALEATE ER 2 QLFOCALGIN 90 DHA 1FOCALGIN CA 1FOLIC ACID 1 MG TABLET 2FOLIVANE-OB 1FONDAPARINUX SODIUM 4 QLFORMADON 2FORMALDEHYDE 2FORMA-RAY 4FORTICAL 2FOSAMPRENAVIR CALCIUM 2FOSINOPRIL SODIUM 1FOSINOPRIL-HYDROCHLOROTHIAZIDE 2FOSRENOL 4FROVATRIPTAN SUCCINATE 2 QLFULYZAQ 4FUROSEMIDE 10 MG/ML SOLUTION 1FUROSEMIDE 20 MG TABLET 1FUROSEMIDE 40 MG TABLET 1FUROSEMIDE 40 MG/5 ML SOLN 1FUROSEMIDE 80 MG TABLET 1FYAVOLV 2FYCOMPA 10 MG TABLET 4 QLFYCOMPA 12 MG TABLET 4 QLFYCOMPA 2 MG TABLET 4 QLFYCOMPA 4 MG TABLET 4 QLFYCOMPA 6 MG TABLET 4 QLFYCOMPA 8 MG TABLET 4 QLGABAPENTIN 2GALANTAMINE ER 2 QLGALANTAMINE HBR 2GALANTAMINE HYDROBROMIDE 2GALZIN 4GATIFLOXACIN 2GAVILYTE-C 2GAVILYTE-G 2GAVILYTE-H AND BISACODYL 2GAVILYTE-N 2GEMFIBROZIL 2



GENERESS FE 4GENERLAC 2GENGRAF 2GENTAK 2GENTAMICIN 0.1% CREAM 2GENTAMICIN 0.1% OINTMENT 2GENTAMICIN 0.3% EYE DROPS 2GENTAMICIN 0.3% EYE OINTMENT 2GENTAMICIN 3 MG/ML EYE DROPS 2GENVOYA 3GIANVI 1GILDAGIA 1GILDESS 1GILDESS 24 FE 1GILDESS FE 1GLEOSTINE 4GLIMEPIRIDE 1GLIPIZIDE 1GLIPIZIDE ER 1GLIPIZIDE XL 1GLIPIZIDE-METFORMIN 2GLUCAGEN 1 MG HYPOKIT 3GLUCAGON EMERGENCY KIT 3GLYBURIDE 1GLYBURIDE MICRONIZED 1GLYBURIDE-METFORMIN HCL 2GLYCINE 1.5% IRRIGATION 2GLYCOPYRROLATE 1 MG TABLET 2GLYCOPYRROLATE 2 MG TABLET 2GLYDO 2GRANISETRON HCL 0.1 MG/ML VIAL 2GRANISETRON HCL 1 MG TABLET 2GRANISETRON HCL 1 MG/ML VIAL 2GRANISETRON HCL 4 MG/4 ML VIAL 2GRISEOFULVIN 2GRISEOFULVIN ULTRAMICROSIZE 2GUAIATUSSIN AC 2GUAIFEN-CODEINE 100-10 MG/5 ML 2GUAIFENESIN AC 2GUAIFENESIN-CODEINE SYRUP 2GUANFACINE HCL 1GUANFACINE HCL ER 2GUANIDINE HCL 2GYNAZOLE 1 2HALOBETASOL PROPIONATE 2HALOG 4HALOPERIDOL 0.5 MG TABLET 2HALOPERIDOL 1 MG TABLET 2




HALOPERIDOL 10 MG TABLET 2HALOPERIDOL 2 MG TABLET 2HALOPERIDOL 20 MG TABLET 2HALOPERIDOL 5 MG TABLET 2HALOPERIDOL LAC 2 MG/ML CONC 2HEATHER 1HEMENATAL OB 1HEMENATAL OB + DHA 1HEMMOREX-HC 2HEPARIN SOD 5,000 UNIT/ 0.5 ML 2HEPARIN SOD 5,000 UNIT/0.5 ML 2HOMATROPAIRE 2HOMATROPINE HYDROBROMIDE 2HUMALOG 3HUMALOG JUNIOR KWIKPEN 3HUMALOG KWIKPEN U-100 3HUMALOG KWIKPEN U-200 3HUMALOG MIX 50-50 3HUMALOG MIX 50-50 KWIKPEN 3HUMALOG MIX 75-25 3HUMALOG MIX 75-25 KWIKPEN 3HUMULIN 70/30 KWIKPEN 3HUMULIN 70-30 3HUMULIN N 3HUMULIN N KWIKPEN 3HUMULIN R 3HUMULIN R U-500 3HUMULIN R U-500 KWIKPEN 3HYDRALAZINE 10 MG TABLET 2HYDRALAZINE 100 MG TABLET 2HYDRALAZINE 25 MG TABLET 2HYDRALAZINE 50 MG TABLET 2HYDROCHLOROTHIAZIDE 1HYDROCOD-CPM-PSEUDOEPHEDRINE 2HYDROCODONE-ACETAMIN 10-300 MG 2HYDROCODONE-ACETAMIN 10-325 MG 2HYDROCODONE-ACETAMIN 2.5-108/5 2HYDROCODONE-ACETAMIN 2.5-325 2HYDROCODONE-ACETAMIN 5-217/10 2HYDROCODONE-ACETAMIN 5-300 MG 2HYDROCODONE-ACETAMIN 5-325 MG 2HYDROCODONE-ACETAMIN 7.5-300 2HYDROCODONE-ACETAMIN 7.5-325 2HYDROCODONE-ACETAMN 7.5-325/15 2HYDROCODONE-CHLORPHENIRAMNE ER 2HYDROCODONE-HOMATROPINE MBR 2HYDROCODONE-IBUPROFEN 2HYDROCORTISONE 1% ABSORBASE 2



HYDROCORTISONE 1% CREAM 2HYDROCORTISONE 1% OINTMENT 2HYDROCORTISONE 10 MG TABLET 2HYDROCORTISONE 100 MG/60 ML 2HYDROCORTISONE 2.5% CREAM 2HYDROCORTISONE 2.5% LOTION 2HYDROCORTISONE 2.5% OINTMENT 2HYDROCORTISONE 20 MG TABLET 2HYDROCORTISONE 5 MG TABLET 2HYDROCORTISONE AC 25 MG SUPP 2HYDROCORTISONE AC 30 MG SUPP 2HYDROCORTISONE BUTYRATE 2HYDROCORTISONE VALERATE 2HYDROCORTISONE-ACETIC ACID 2HYDROCORTISONE-PRAMOXINE 2HYDROMET 2HYDROMORPHONE 1 MG/ML SOLUTION 2HYDROMORPHONE 2 MG TABLET 2HYDROMORPHONE 3 MG SUPPOS 2HYDROMORPHONE 4 MG TABLET 2HYDROMORPHONE 5 MG/5 ML SOLN 2HYDROMORPHONE 8 MG TABLET 2HYDROMORPHONE ER 2 QLHYDROXYCHLOROQUINE SULFATE 2HYDROXYUREA 2HYDROXYZINE 10 MG/5 ML SOLN 2HYDROXYZINE 10 MG/5 ML SYRUP 2HYDROXYZINE HCL 10 MG TABLET 2HYDROXYZINE HCL 25 MG TABLET 2HYDROXYZINE HCL 50 MG TABLET 2HYDROXYZINE PAMOATE 2HYOPHEN 2HYOSCYAMINE 0.125 MG ODT 1HYOSCYAMINE 0.125 MG TAB SL 1HYOSCYAMINE 0.125 MG/5 ML ELIX 2HYOSCYAMINE 0.125 MG/ML DROP 2HYOSCYAMINE SULF 0.125 MG TAB 1HYOSCYAMINE SULFATE ER 1HYOSCYAMINE SULFATE SR 1HYOSYNE 2IBANDRONATE SODIUM 150 MG TAB 2IBU 1IBUDONE 2IBUPROFEN 100 MG/5 ML SUSP 1IBUPROFEN 400 MG TABLET 1IBUPROFEN 600 MG TABLET 1IBUPROFEN 800 MG TABLET 1ILEVRO 4




IMATINIB MESYLATE 4 PAIMIPRAMINE HCL 2IMIPRAMINE PAMOATE 2IMIQUIMOD 2INCONTROL ALCOHOL PADS 3INCRUSE ELLIPTA 3INDAPAMIDE 1INDOMETHACIN 25 MG CAPSULE 2INDOMETHACIN 50 MG CAPSULE 2INDOMETHACIN ER 2INTELENCE 200 MG TABLET 3INTELENCE 25 MG TABLET 3INTROVALE 1IODOSORB 2IOPHEN-C NR 2IPRATROPIUM 0.03% SPRAY 2IPRATROPIUM 0.06% SPRAY 2IPRATROPIUM BR 0.02% SOLN 1IPRATROPIUM-ALBUTEROL 2IRBESARTAN 2IRBESARTAN-HYDROCHLOROTHIAZIDE 2ISENTRESS 3ISENTRESS HD 3ISIBLOOM 1ISOCHRON 2ISONIAZID 100 MG TABLET 1ISONIAZID 300 MG TABLET 1ISONIAZID 50 MG/5 ML SOLUTION 2ISOSORBIDE DINITRATE 2ISOSORBIDE DINITRATE ER 2ISOSORBIDE MONONITRATE 1ISOSORBIDE MONONITRATE ER 1ISOTRETINOIN 2 QLISOXSUPRINE HCL 2ISRADIPINE 2ITRACONAZOLE 3IV ANTISEPTIC WIPES 3IV PREP WIPES 3IVERMECTIN 2JANTOVEN 1JENCYCLA 1JEVANTIQUE LO 2JINTELI 2JOLESSA 1JOLIVETTE 1JULEBER 1JULUCA 4JUNEL 1



JUNEL FE 1JUNEL FE 24 1KAITLIB FE 1KALETRA 100-25 MG TABLET 3KALETRA 200-50 MG TABLET 3KARIVA 1KELNOR 1-35 1KELNOR 1-50 1KETEK 4KETOCONAZOLE 2KETOPROFEN 2KETOROLAC 0.4% OPHTH SOLUTION 2KETOROLAC 0.5% OPHTH SOLUTION 2KETOROLAC 10 MG TABLET 2 QLKETOROLAC 15 MG/ML CARPUJECT 2 QLKETOROLAC 15 MG/ML ISECURE SYR 2 QLKETOROLAC 15 MG/ML SYRINGE 2 QLKETOROLAC 15 MG/ML VIAL 2 QLKETOROLAC 30 MG/ML CARPUJECT 2 QLKETOROLAC 30 MG/ML ISECURE SYR 2 QLKETOROLAC 30 MG/ML SYRINGE 2 QLKETOROLAC 30 MG/ML VIAL 2 QLKETOROLAC 300 MG/10 ML VIAL 2 QLKETOROLAC 60 MG/2 ML CARPUJECT 2 QLKETOROLAC 60 MG/2 ML SYRINGE 2 QLKETOROLAC 60 MG/2 ML VIAL 2 QLKIMIDESS 1KIONEX 2KLOR-CON 10 2KLOR-CON 20 MEQ PACKET 2KLOR-CON 25 MEQ PACKET 4KLOR-CON 8 2KLOR-CON M10 2KLOR-CON M15 4KLOR-CON M20 2KLOR-CON SPRINKLE 2KOMBIGLYZE XR 3 QLK-PHOS NO.2 4K-PHOS ORIGINAL 4KRISTALOSE 4K-SOL 2K-TAB ER 8 MEQ TABLET 2KURVELO 1LABETALOL HCL 100 MG TABLET 2LABETALOL HCL 200 MG TABLET 2LABETALOL HCL 300 MG TABLET 2LACRISERT 4LACTATED RINGERS IRRIGATION 2




LACTULOSE 2LAMICTAL XR (BLUE) 4LAMICTAL XR (GREEN) 4LAMICTAL XR (ORANGE) 4LAMIVUDINE 2LAMIVUDINE HBV 2LAMIVUDINE-ZIDOVUDINE 2LAMOTRIGINE 2LAMOTRIGINE (BLUE) 2LAMOTRIGINE (GREEN) 2LAMOTRIGINE (ORANGE) 2LAMOTRIGINE ER 2LAMOTRIGINE ODT 2LAMOTRIGINE ODT (BLUE) 2LAMOTRIGINE ODT (GREEN) 2LAMOTRIGINE ODT (ORANGE) 2LANSOPRAZOL-AMOXICIL-CLARITHRO 2LANSOPRAZOLE DR 15 MG CAPSULE 2 QLLANSOPRAZOLE DR 30 MG CAPSULE 2 QLLANTHANUM CARBONATE 2LARIN 1LARIN 24 FE 1LARIN FE 1LARISSIA 1LASTACAFT 4LATANOPROST 0.005% EYE DROPS 2LATUDA 4 ST, QLLAYOLIS FE 4LEENA 1LEFLUNOMIDE 2LESSINA 1LETROZOLE 2LEUCOVORIN CALCIUM 10 MG TAB 2LEUCOVORIN CALCIUM 15 MG TAB 2LEUCOVORIN CALCIUM 25 MG TAB 2LEUCOVORIN CALCIUM 5 MG TAB 2LEUKERAN 4LEUPROLIDE 2WK 1 MG/0.2 ML KIT 2 PALEUPROLIDE 2WK 14 MG/2.8 ML KT 2 PALEVALBUTEROL CONCENTRATE 2LEVALBUTEROL HCL 2LEVALBUTEROL TARTRATE HFA 2LEVATOL 4LEVEMIR 4 STLEVEMIR FLEXTOUCH 4 STLEVETIRACETAM 1,000 MG TABLET 2LEVETIRACETAM 100 MG/ML SOLN 2LEVETIRACETAM 250 MG TABLET 2



LEVETIRACETAM 500 MG TABLET 2LEVETIRACETAM 500 MG/5 ML SOLN 2LEVETIRACETAM 750 MG TABLET 2LEVETIRACETAM ER 2LEVLEN 28 1LEVOBUNOLOL HCL 2LEVOCARNITINE 1 G/10 ML SOLN 2LEVOCARNITINE 200 MG/ML VIAL 2LEVOCARNITINE 330 MG TABLET 2LEVOCETIRIZINE 2.5 MG/5 ML SOL 2LEVOCETIRIZINE 5 MG TABLET 2LEVOFLOXACIN 0.5% EYE DROPS 2LEVOFLOXACIN 25 MG/ML SOLUTION 2LEVOFLOXACIN 250 MG TABLET 2LEVOFLOXACIN 250 MG/10 ML SOLN 2LEVOFLOXACIN 500 MG TABLET 2LEVOFLOXACIN 500 MG/20 ML SOLN 2LEVOFLOXACIN 750 MG TABLET 2LEVOMEFOLATE DHA 1LEVOMEFOLATE-ALGAL 15 MG CAP 2LEVOMEFOLATE-ALGAL 7.5 MG CAP 2LEVONEST 1LEVONORGESTREL-ETH ESTRADIOL 1LEVONORG-ETH ESTRAD ETH ESTRAD 1LEVORA-28 1LEVORPHANOL TARTRATE 2LEVOTHYROXINE 100 MCG TABLET 1LEVOTHYROXINE 112 MCG TABLET 1LEVOTHYROXINE 125 MCG TABLET 1LEVOTHYROXINE 137 MCG TABLET 1LEVOTHYROXINE 150 MCG TABLET 1LEVOTHYROXINE 175 MCG TABLET 1LEVOTHYROXINE 200 MCG TABLET 1LEVOTHYROXINE 25 MCG TABLET 1LEVOTHYROXINE 300 MCG TABLET 1LEVOTHYROXINE 50 MCG TABLET 1LEVOTHYROXINE 75 MCG TABLET 1LEVOTHYROXINE 88 MCG TABLET 1LEVOXYL 1LEVULAN 4 LDDLEXIVA 50 MG/ML SUSPENSION 3LIDOCAINE 5% OINTMENT 2 QLLIDOCAINE 5% PATCH 2LIDOCAINE HCL 2% JELLY 2LIDOCAINE HCL 4% SOLUTION 2LIDOCAINE HCL VISCOUS 1LIDOCAINE-HC 2.8-0.55% GEL 2LIDOCAINE-HC 3-0.5% CREAM 2




LIDOCAINE-HC 3-0.5% CREAM KIT 2LIDOCAINE-HYDROCORT 3-2.5% GEL 2LIDOCAINE-PRILOCAINE 2LILLOW 1LINDANE 2LINEZOLID 100 MG/5 ML SUSP 4 PALINEZOLID 600 MG TABLET 2 PALINZESS 4LIOTHYRONINE SOD 25 MCG TAB 2LIOTHYRONINE SOD 5 MCG TAB 2LIOTHYRONINE SOD 50 MCG TAB 2LISINOPRIL 1LISINOPRIL-HYDROCHLOROTHIAZIDE 1LITHIUM 2LITHIUM CARBONATE 150 MG CAP 1LITHIUM CARBONATE 300 MG CAP 1LITHIUM CARBONATE 300 MG TAB 1LITHIUM CARBONATE 600 MG CAP 1LITHIUM CARBONATE ER 2LITHIUM ER 450 MG TABLET 2LITHOSTAT 4LIVALO 4 ST, QLL-METHYLFOLATE 2L-METHYLFOLATE CALCIUM 2L-METHYLFOLATE FORTE 2LO LOESTRIN FE 3LOESTRIN 4LOESTRIN FE 4LOMEDIA 24 FE 1LOPERAMIDE 2 MG CAPSULE 2LOPINAVIR-RITONAVIR 2LOPREEZA 2LORAZEPAM 0.5 MG TABLET 2LORAZEPAM 1 MG TABLET 2LORAZEPAM 2 MG TABLET 2LORAZEPAM 2 MG/ML ORAL CONCENT 2LORAZEPAM INTENSOL 2LORCET 2LORCET HD 2LORCET PLUS 2LORTAB 10 MG-300 MG/15 ML ELXR 2LORYNA 1LOSARTAN POTASSIUM 1LOSARTAN-HYDROCHLOROTHIAZIDE 1LOSEASONIQUE 4LOTEMAX 4LOVASTATIN 1LOW-OGESTREL 1



LOXAPINE 2LUCEMYRA 3 QLLUDENT FLUORIDE 2LUGOL'S SOLUTION 2LUMIGAN 4LUTERA 1LYRICA 4 QLLYSODREN 4LYZA 1MACNATAL CN DHA 1MALATHION 2MAPROTILINE HCL 2MARGESIC 2MARLISSA 1MARPLAN 4MARTEN-TAB 2MATERNITY 1MATZIM LA 2MECLIZINE 12.5 MG TABLET 2MECLIZINE 25 MG TABLET 2MECLOFENAMATE SODIUM 2MEDROL 4MEDROXYPROGESTERONE ACETATE 1MEFENAMIC ACID 2MEFLOQUINE HCL 2 QLMEGESTROL ACETATE 2MELODETTA 24 FE 1MELOXICAM 15 MG TABLET 1MELOXICAM 7.5 MG TABLET 1MELOXICAM 7.5 MG/5 ML SUSP 2MELPHALAN 2MEMANTINE HCL 2MENEST 4MENTAX 4MEPERIDINE 100 MG TABLET 2MEPERIDINE 50 MG TABLET 2MEPERIDINE 50 MG/5 ML SOLUTION 2MEPHYTON 4MEPROBAMATE 2MERCAPTOPURINE 2MESALAMINE 4METADATE ER 2METAPROTERENOL SULFATE 2METAXALL 2METAXALONE 2METFORMIN HCL 1METFORMIN HCL ER 500 MG TABLET 2METFORMIN HCL ER 750 MG TABLET 2




METHADONE 10 MG/5 ML SOLUTION 2 PAMETHADONE 10 MG/ML ORAL CONC 2 PAMETHADONE 40 MG TABLET DISPR 2 PAMETHADONE 5 MG/5 ML SOLUTION 2 PAMETHADONE HCL 10 MG TABLET 2 PAMETHADONE HCL 5 MG TABLET 2 PAMETHADONE INTENSOL 2 PAMETHADOSE 40 MG TABLET DISPR 2 PAMETHAMPHETAMINE HCL 2METHAZOLAMIDE 2METHENAMINE HIPPURATE 2METHENAMINE MANDELATE 2METHERGINE 2METHIMAZOLE 2METHITEST 2METHOCARBAMOL 500 MG TABLET 2

METHOCARBAMOL 750 MG TABLET 2METHOTREXATE 2.5 MG TABLET 2METHOXSALEN 4METHSCOPOLAMINE BROMIDE 2METHYCLOTHIAZIDE 2METHYLDOPA 1METHYLDOPA-HYDROCHLOROTHIAZIDE 2METHYLERGONOVINE 0.2 MG TABLET 2METHYLPHENIDATE ER 10 MG CAP 2METHYLPHENIDATE ER 10 MG TAB 2METHYLPHENIDATE ER 18 MG TAB 2METHYLPHENIDATE ER 20 MG CAP 2METHYLPHENIDATE ER 20 MG TAB 2METHYLPHENIDATE ER 27 MG TAB 2METHYLPHENIDATE ER 30 MG CAP 2METHYLPHENIDATE ER 36 MG TAB 2METHYLPHENIDATE ER 40 MG CAP 2METHYLPHENIDATE ER 54 MG TAB 2METHYLPHENIDATE HCL 2METHYLPHENIDATE HCL CD 2METHYLPHENIDATE HCL ER 2METHYLPHENIDATE LA 2METHYLPREDNISOLONE 2METHYLTESTOSTERONE 2METIPRANOLOL 2METOCLOPRAMIDE 10 MG TABLET 1METOCLOPRAMIDE 10 MG/10 ML SOL 1METOCLOPRAMIDE 5 MG TABLET 1METOCLOPRAMIDE 5 MG/5 ML SOLN 1METOCLOPRAMIDE HCL ODT 2METOLAZONE 2METOPROLOL SUCCINATE 2




METOPROLOL TARTRATE 100 MG TAB 1METOPROLOL TARTRATE 25 MG TAB 1METOPROLOL TARTRATE 37.5 MG TB 2METOPROLOL TARTRATE 50 MG TAB 1METOPROLOL TARTRATE 75 MG TAB 2METOPROLOL-HYDROCHLOROTHIAZIDE 2METRONIDAZOLE 0.75% CREAM 2METRONIDAZOLE 0.75% LOTION 2METRONIDAZOLE 250 MG TABLET 2METRONIDAZOLE 375 MG CAPSULE 2METRONIDAZOLE 500 MG TABLET 2METRONIDAZOLE TOP 1% GEL PUMP 2METRONIDAZOLE TOPICAL 0.75% GL 2METRONIDAZOLE TOPICAL 1% GEL 2METRONIDAZOLE VAGINAL 0.75% GL 2MEXILETINE HCL 2MIBELAS 24 FE 1MICONAZOLE 3 200 MG VAG SUPP 1MICORT-HC 2MICROGESTIN 1MICROGESTIN 24 FE 3MICROGESTIN FE 1.5-30 TAB 1MICROGESTIN FE 1-20 TABLET 4MIDAZOLAM HCL 2 MG/ML SYRUP 2MIDODRINE HCL 2MIGERGOT 2MIGLITOL 2MILI 1MIMVEY 2MIMVEY LO 2MINASTRIN 24 FE 3MINITRAN 2MINOCYCLINE ER 135 MG TABLET 2MINOCYCLINE ER 45 MG TABLET 2MINOCYCLINE ER 90 MG TABLET 2MINOCYCLINE HCL 2MINOXIDIL 10 MG TABLET 2MINOXIDIL 2.5 MG TABLET 2MIRCETTE 4MIRTAZAPINE 2MISOPROSTOL 2MODAFINIL 4 PAMODERIBA 2MODICON 4MOEXIPRIL HCL 2MOEXIPRIL-HYDROCHLOROTHIAZIDE 2MOLINDONE HCL 2MOMETASONE FUROATE 2



MONDOXYNE NL 2MONO-LINYAH 1MONONESSA 1MONTELUKAST SODIUM 2MONUROL 4MORGIDOX 100 MG CAPSULE 2MORGIDOX 50 MG CAPSULE 2MORPHINE SULF 10 MG SUPPOS 2MORPHINE SULF 10 MG/5 ML SOLN 2MORPHINE SULF 100 MG/5 ML SOLN 2MORPHINE SULF 20 MG SUPPOS 2MORPHINE SULF 20 MG/5 ML SOLN 2MORPHINE SULF 30 MG SUPPOS 2MORPHINE SULF 5 MG SUPPOS 2MORPHINE SULFATE ER 2 QLMORPHINE SULFATE IR 15 MG TAB 2MORPHINE SULFATE IR 30 MG TAB 2MOVIPREP 4MOXEZA 3MOXIFLOXACIN 0.5% EYE DROPS 2MOXIFLOXACIN HCL 400 MG TABLET 2MULTAQ 4MULTIVITAMIN AND FLUORIDE 2MULTI-VITAMIN W-FLUORIDE 2MULTI-VITAMIN WITH FLUORIDE 2MULTI-VITAMIN-FLUOR-IRON 2MULTIVITAMIN-IRON-FLUORIDE 2MULTIVITAMINS CHEWABLES TABLET 2MULTIVITAMINS W-FLUORIDE-IRON 2MULTIVITAMINS WITH FLUORIDE 2MULTIVIT-FLUOR 0.25 MG TAB CHW 2MULTIVIT-FLUOR 0.25 MG/ML DROP 2MULTIVIT-FLUOR 0.5 MG TAB CHEW 2MULTIVIT-FLUOR 0.5 MG/ML DROP 2MULTIVIT-FLUORIDE 1 MG TAB CHW 2MULTIVIT-FLUOR-IRON 0.25 MG/ML 2MULTIVIT-IRON-FL 0.25 MG/ML 2MUPIROCIN 2MVW COMPLETE FORMLTN PEDIATRIC 2MVW COMPLETE FORMULATION D3000 2MVW COMPLETE FORMULATION D5000 2MVW COMPLETE FORMULTN MULTIVIT 2MY WAY 4MYCOPHENOLATE 200 MG/ML SUSP 2MYCOPHENOLATE 250 MG CAPSULE 2MYCOPHENOLATE 500 MG TABLET 2MYCOPHENOLIC ACID 2MYLERAN 4


MYNATAL 1MYNATAL ADVANCE 1MYNATAL PLUS 1MYNATAL-Z 1MYNATE 90 PLUS 1MYORISAN 2 QLMYRBETRIQ 4 ST, QLMYTESI 4MYZILRA 1NABUMETONE 2NADOLOL 1NADOLOL-BENDROFLUMETHIAZIDE 2NAFTIFINE HCL 2NAFTIN 4NALOXONE 0.4 MG/ML CARPUJECT 2NALOXONE 2 MG/2 ML SYRINGE 2NALTREXONE HCL 1NAPROXEN 125 MG/5 ML SUSPEN 2NAPROXEN 250 MG TABLET 1NAPROXEN 375 MG TABLET 1NAPROXEN 500 MG KIT 1NAPROXEN 500 MG TABLET 1NAPROXEN DR 375 MG TABLET 1NAPROXEN DR 500 MG TABLET 1NAPROXEN SOD ER 375 MG TABLET 2NAPROXEN SODIUM 275 MG TAB 1NAPROXEN SODIUM 550 MG TAB 1NAPROXEN SODIUM DS 1NARATRIPTAN 2 QLNARATRIPTAN HCL 2 QLNARCAN 4 MG NASAL SPRAY 3NASCOBAL 4NATACYN 4NATAZIA 4NATEGLINIDE 2NATURE-THROID 1NEBUPENT 4NEBUSAL 3% VIAL 2NECON 1NEFAZODONE HCL 2NEOMYCIN SULFATE 2NEOMYCIN-BACITRACIN-POLY-HC 2NEOMYCIN-BACITRACIN-POLYMYXIN 2NEOMYCIN-POLYMYXIN B 2NEOMYCIN-POLYMYXIN-DEXAMETH 2NEOMYCIN-POLYMYXIN-GRAMICIDIN 2NEOMYCIN-POLYMYXIN-HC 2NEOMYCIN-POLYMYXIN-HYDROCORT 2





NEO-POLYCIN 2NEO-POLYCIN HC 2NEUAC GEL 2NEUPRO 4NEVANAC 4NEVIRAPINE 2NEVIRAPINE ER 2NEWGEN 1NEXT CHOICE ONE DOSE 4NIACIN ER 2NICARDIPINE 20 MG CAPSULE 2NICARDIPINE 30 MG CAPSULE 2NICOTROL 3NICOTROL NS 3NIFEDICAL XL 2NIFEDIPINE 2NIFEDIPINE ER 2NIKKI 1NILUTAMIDE 2NIMODIPINE 2NISOLDIPINE 2 QLNITRO-BID 2NITRO-DUR 4NITROFURANTOIN 2NITROFURANTOIN MONO-MACRO 2NITROGLYCERIN 0.3 MG TABLET SL 2NITROGLYCERIN 0.4 MG TABLET SL 2NITROGLYCERIN 0.6 MG TABLET SL 2NITROGLYCERIN 400 MCG SPRAY 2NITROGLYCERIN ER 2.5 MG CAP 2NITROGLYCERIN ER 6.5 MG CAP 2NITROGLYCERIN ER 9 MG CAPSULE 2NITROGLYCERIN LINGUAL 0.4 MG 2NITROGLYCERIN PATCH 2NITRO-TIME 2NIVA-PLUS 1NIZATIDINE 15 MG/ML SOLUTION 2NIZATIDINE 150 MG CAPSULE 1NIZATIDINE 300 MG CAPSULE 1NOLIX 2NORA-BE 1NORETHIND-ETH ESTRAD 0.5-2.5 2NORETHIND-ETH ESTRAD 1-0.02 MG 1NORETHINDRONE 1NORETHINDRONE ACETATE 2NORETHIN-ETH ESTRAD 1 MG-5 MCG 2NORETHIN-ETH ESTRA-FERROUS FUM 1NORGESTIMATE-ETHINYL ESTRADIOL 1


NORINYL 1-35 4NORITATE 4NORLYDA 1NORLYROC 1NORPACE CR 4NOR-Q-D 4NORTREL 1NORTRIPTYLINE 10 MG/5 ML SOLN 2NORTRIPTYLINE HCL 10 MG CAP 1NORTRIPTYLINE HCL 25 MG CAP 1NORTRIPTYLINE HCL 50 MG CAP 1NORTRIPTYLINE HCL 75 MG CAP 1NORVIR 3NOVOFINE 30G X 1/3" NEEDLES 3NOVOFINE 32G NEEDLES 3NOVOFINE AUTOCOVER 30G NEEDLE 3NOVOFINE PLUS PEN NDL 32GX1/6" 3NOVOLOG 4 STNOVOLOG FLEXPEN 4 STNOVOLOG MIX 70-30 4 STNOVOLOG MIX 70-30 FLEXPEN 4 STNOVOTWIST NEEDLE 30G 8MM 3NOVOTWIST NEEDLE 32G 5MM 3NOXAFIL 4NP THYROID 1NUCYNTA 4 QLNUCYNTA ER 4 ST, QLNUEDEXTA 4NULEV 1NUVARING 3NYAMYC 2NYATA 100,000 UNIT/GM POWDER 2NYSTATIN 100,000 UNIT/GM CREAM 1NYSTATIN 100,000 UNIT/GM POWD 2NYSTATIN 100,000 UNIT/ML SUSP 2NYSTATIN 100,000 UNITS/GM OINT 1NYSTATIN 150,000,000 UNITS PWD 2NYSTATIN 500,000 UNIT ORAL TAB 2NYSTATIN 500,000 UNIT/5 ML SUS 2NYSTATIN 500,000,000 UNITS PWD 2NYSTATIN-TRIAMCINOLONE 1NYSTOP 2OBSTETRIX DHA 1OBSTETRIX ONE 1O-CAL FA 4O-CAL PRENATAL 4OCELLA 1OCTREOTIDE ACETATE 2 PA





ODEFSEY 3OFLOXACIN 2OGESTREL 1OKEBO 2OLANZAPINE 10 MG TABLET 2OLANZAPINE 15 MG TABLET 2OLANZAPINE 2.5 MG TABLET 2OLANZAPINE 20 MG TABLET 2OLANZAPINE 5 MG TABLET 2OLANZAPINE 7.5 MG TABLET 2OLANZAPINE ODT 2OLANZAPINE-FLUOXETINE HCL 2OLMESARTAN MEDOXOMIL 2OLMESARTAN-AMLODIPINE-HCTZ 2OLMESARTAN-HYDROCHLOROTHIAZIDE 2OLOPATADINE HCL 2OMEGA-3 ACID ETHYL ESTERS 2OMEPRAZOLE DR 10 MG CAPSULE 2 QLOMEPRAZOLE DR 20 MG CAPSULE 2 QLOMEPRAZOLE DR 40 MG CAPSULE 2 QLONDANSETRON HCL 2ONDANSETRON ODT 2ONETOUCH DELICA 30G LANCETS 3ONETOUCH DELICA 33G LANCETS 3ONETOUCH DELICA LANCING DEV 3ONETOUCH SURESOFT 18G LANC DEV 3ONETOUCH SURESOFT 21G LANC DEV 3ONETOUCH SURESOFT 28G LANC DEV 3ONETOUCH ULTRA BLUE TEST STRP 3ONETOUCH ULTRA2 1ONETOUCH ULTRAMINI 1ONETOUCH ULTRASOFT LANCETS 3ONETOUCH VERIO FLEX 1ONETOUCH VERIO IQ 1ONETOUCH VERIO METER SYSTEM 1ONETOUCH VERIO TEST STRIP 3ONGLYZA 3 QLONMEL 4 QLOPCICON ONE-STEP 1OPIUM TINCTURE 2ORACIT 4ORALONE 2ORPHENADRINE ER 100 MG TABLET 2ORSYTHIA 1ORTHO MICRONOR 4ORTHO TRI-CYCLEN 4ORTHO TRI-CYCLEN LO 4ORTHO-CYCLEN 4


ORTHO-NOVUM 4OSCIMIN 0.125 MG ODT 1OSCIMIN 0.125 MG TABLET 2OSCIMIN SL 1OSCIMIN SR 2OSELTAMIVIR PHOSPHATE 2 QLOSMOPREP 4OTOVEL 4OVCON-35 1OXANDROLONE 2 PAOXAPROZIN 2OXAZEPAM 2OXCARBAZEPINE 2OXICONAZOLE NITRATE 2OXISTAT 4OXTELLAR XR 4 QLOXYBUTYNIN 5 MG TABLET 1OXYBUTYNIN 5 MG/5 ML SYRUP 2OXYBUTYNIN CHLORIDE ER 2OXYCODON-ACETAMINOPHEN 2.5-325 2OXYCODON-ACETAMINOPHEN 7.5-325 2OXYCODONE HCL 2OXYCODONE HCL-ASPIRIN 2OXYCODONE HCL-IBUPROFEN 2OXYCODONE-ACETAMINOPHEN 10-325 2OXYCODONE-ACETAMINOPHEN 5-325 2OXYMORPHONE HCL 2OXYMORPHONE HCL ER 2 QLPACERONE 200 MG TABLET 2PALIPERIDONE ER 2PANCREAZE 4PANTOPRAZOLE SOD DR 20 MG TAB 2 QLPANTOPRAZOLE SOD DR 40 MG TAB 2 QLPAREGORIC 2PARICALCITOL 1 MCG CAPSULE 2PARICALCITOL 2 MCG CAPSULE 2PARICALCITOL 4 MCG CAPSULE 2PAROEX 2PAROMOMYCIN SULFATE 2PAROXETINE CR 2 QLPAROXETINE ER 2 QLPAROXETINE HCL 1 QLPASER 4PCE 4PEG 3350-ELECTROLYTE 2PEG-3350 AND ELECTROLYTES 2PEG-3350 WITH FLAVOR PACKS 2PEGANONE 4





PEG-PREP 2PENICILLIN V POTASSIUM 1PENTAZOCINE-NALOXONE HCL 2PENTOXIFYLLINE 2PERFOROMIST 4PERINDOPRIL ERBUMINE 2PERMETHRIN 5% CREAM 2PERPHENAZINE 2PERPHENAZINE-AMITRIPTYLINE 2PERTZYE 4 LDDPEXEVA 4 ST, QLPHENADOZ 2PHENAZOPYRIDINE HCL 1PHENELZINE SULFATE 2PHENOBARBITAL 100 MG TABLET 2PHENOBARBITAL 15 MG TABLET 2PHENOBARBITAL 16.2 MG TABLET 2PHENOBARBITAL 20 MG/5 ML ELIX 2PHENOBARBITAL 20 MG/5 ML SOLN 2PHENOBARBITAL 30 MG TABLET 2PHENOBARBITAL 32.4 MG TABLET 2PHENOBARBITAL 60 MG TABLET 2PHENOBARBITAL 64.8 MG TABLET 2PHENOBARBITAL 97.2 MG TABLET 2PHENOXYBENZAMINE HCL 10 MG CAP 2PHENYLEPHRINE 10% EYE DROPS 2PHENYLEPHRINE 2.5% EYE DROP 2PHENYTOIN 2PHENYTOIN SODIUM EXTENDED 2PHILITH 1PHOSLYRA 4PHOSPHA 250 NEUTRAL 2PHOSPHASAL 2PHOSPHOLINE IODIDE 4PHRENILIN FORTE 2PHYSIOSOL 4PHYTONADIONE 5 MG TABLET 2PICATO 4PILOCARPINE HCL 2PIMOZIDE 2PIMTREA 1PINDOLOL 2PIOGLITAZONE HCL 2PIOGLITAZONE-GLIMEPIRIDE 2PIOGLITAZONE-METFORMIN 2PIRMELLA 1PIROXICAM 2PLAN B ONE-STEP 4


PNV 29-1 1PNV OB+DHA 1PNV-DHA 1PNV-DHA + DOCUSATE 1PNV-FERROUS FUMARATE-DOCU-FA 1PNV-OMEGA 1PNV-SELECT 1PNV-VP-U 1PODOFILOX 2POLYCIN 2POLYETHYLENE GLYCOL 3350 POWD 2POLYMYXIN B SUL-TRIMETHOPRIM 2PORTIA 1POTASS CIT-SOD CIT-CITRIC ACID 2POTASSIUM CITRATE ER 2POTASSIUM CITRATE-CITRIC ACID 2POTASSIUM CL 10% (20 MEQ/15 ML 2POTASSIUM CL 10% (40 MEQ/30 ML 2POTASSIUM CL 20 MEQ PACKET 2POTASSIUM CL 20% (40 MEQ/15 ML 2POTASSIUM CL 25 MEQ TAB EFF 2POTASSIUM CL ER 10 MEQ CAPSULE 2POTASSIUM CL ER 10 MEQ TABLET 2POTASSIUM CL ER 20 MEQ TABLET 2POTASSIUM CL ER 8 MEQ CAPSULE 2POTASSIUM CL ER 8 MEQ TABLET 2POTIGA 4PR BENZOYL PEROXIDE 2PR BENZOYL PEROXIDE 7% WASH 2PR NATAL 400 1PR NATAL 400 EC 1PR NATAL 430 1PR NATAL 430 EC 1PRADAXA 4 ST, QLPRAMCORT 2PRAMIPEXOLE DIHYDROCHLORIDE 2PRAMIPEXOLE ER 2PRAMOSONE 4PRAMOSONE E 4PRASUGREL HCL 2PRAVASTATIN SODIUM 1PRAZIQUANTEL 2PRAZOSIN HCL 2PRED-G 4PREDNICARBATE 2PREDNISOLONE 2PREDNISOLONE 15 MG/5 ML SOLN 2PREDNISOLONE 5 MG/5 ML SOLN 2





PREDNISOLONE ACETATE 2PREDNISOLONE SOD 1% EYE DROP 2PREDNISOLONE SOD PH 25 MG/5 ML 2PREDNISOLONE SODIUM PHOS ODT 2PREDNISONE 2PREDNISONE INTENSOL 2PREFEST 2PREMARIN 4PRENA1 TRUE 1PRENAISSANCE 1PRENAISSANCE NEXT 1PRENAISSANCE PLUS 1PRENATAL 19 1PRENATAL LOW IRON 1PRENATAL PLUS 1PRENATAL PLUS-DHA COMBO PACK 1PRENATAL VITAMIN PLUS LOW IRON 1PRENATAL-U 1PREPLUS 1PREPOPIK 4PRETAB 1PREVALITE 2PREVIFEM 1PREZCOBIX 3PREZISTA 3PRIFTIN 4PRIMAQUINE 2PRIMIDONE 2PRIMLEV 2PRIMSOL 4PRO COMFORT ALCOHOL PADS 3PROBENECID 2PROBENECID-COLCHICINE 2PROCENTRA 2PROCHLORPERAZINE 2PROCHLORPERAZINE MALEATE 2PROCTO-MED HC 2PROCTO-PAK 2PROCTOSOL-HC 2PROCTOZONE-HC 2PROFENO 2PROGESTERONE 100 MG CAPSULE 2PROGESTERONE 200 MG CAPSULE 2PROGLYCEM 4PROMETHAZINE 12.5 MG SUPPOS 2PROMETHAZINE 12.5 MG TABLET 2PROMETHAZINE 25 MG SUPPOSITORY 2PROMETHAZINE 25 MG TABLET 2


PROMETHAZINE 50 MG SUPPOSITORY 2PROMETHAZINE 50 MG TABLET 2PROMETHAZINE 6.25 MG/5 ML SOLN 2PROMETHAZINE 6.25 MG/5 ML SYRP 2PROMETHAZINE VC 2PROMETHAZINE VC-CODEINE 2PROMETHAZINE-CODEINE 2PROMETHAZINE-DM 2PROMETHAZINE-PHENYLEPH-CODEINE 2PROMETHAZINE-PHENYLEPHRINE 2PROMETHEGAN 2PROPAFENONE HCL 2PROPAFENONE HCL ER 2PROPANTHELINE BROMIDE 2PROPARACAINE 0.5% EYE DROPS 2PROPRANOLOL 10 MG TABLET 2PROPRANOLOL 20 MG TABLET 2PROPRANOLOL 20 MG/5 ML SOLN 2PROPRANOLOL 40 MG TABLET 2PROPRANOLOL 40 MG/5 ML SOLN 2PROPRANOLOL 60 MG TABLET 2PROPRANOLOL 80 MG TABLET 2PROPRANOLOL HCL ER 2PROPRANOLOL-HYDROCHLOROTHIAZID 2PROPYLTHIOURACIL 2PROTRIPTYLINE HCL 2PRUDOXIN 2PSORCON 2PULMOSAL 2PYRAZINAMIDE 2PYRIDOSTIGMINE BROMIDE 2PYRIDOSTIGMINE BROMIDE ER 2QUARTETTE 4QUASENSE 1QUAZEPAM 15 MG TABLET 2QUETIAPINE FUMARATE 2QUETIAPINE FUMARATE ER 2QUILLIVANT XR 4 STQUINAPRIL HCL 2QUINAPRIL-HYDROCHLOROTHIAZIDE 2QUINIDINE GLUC ER 324 MG TAB 2QUINIDINE SULFATE 2QUININE SULFATE 2QUTENZA 4RABEPRAZOLE SODIUM 2 QLRAJANI 1RALOXIFENE HCL 2RAMIPRIL 2





RANEXA 4 STRANITIDINE 15 MG/ML SYRUP 2RANITIDINE 150 MG CAPSULE 1RANITIDINE 150 MG TABLET 1RANITIDINE 150 MG/10 ML SYRUP 2RANITIDINE 300 MG CAPSULE 1RANITIDINE 300 MG TABLET 1RAPAFLO 4 QLRASAGILINE MESYLATE 2RECLIPSEN 1RECTIV 4REGRANEX 4 PARELENZA 4 QLRELISTOR 4 PARELNATE DHA 1RENACIDIN 4RENAGEL 4REPAGLINIDE 2REPAGLINIDE-METFORMIN HCL 2REPREXAIN 2RESPA A.R. 4RESTASIS 4RESTASIS MULTIDOSE 4REYATAZ 3RIBASPHERE 2RIBAVIRIN 200 MG CAPSULE 2RIBAVIRIN 200 MG TABLET 2RIDAURA 4RIFABUTIN 2RIFAMATE 4RIFAMPIN 150 MG CAPSULE 2RIFAMPIN 300 MG CAPSULE 2RIFATER 4RILUZOLE 2RIMANTADINE HCL 2RISEDRONATE SODIUM 2RISEDRONATE SODIUM DR 2RISPERIDONE 2RISPERIDONE ODT 2RITONAVIR 2RIVASTIGMINE 2RIVELSA 1RIZATRIPTAN 2 QLR-NATAL OB 1ROPINIROLE ER 2ROPINIROLE HCL 2ROSADAN 0.75% CREAM 2ROSADAN 0.75% GEL 2


ROSUVASTATIN CALCIUM 2ROWEEPRA 2ROWEEPRA XR 2ROZEREM 4 ST, QLRULAVITE DHA 1SAFYRAL 4SALICYLIC ACID 27.5% LIQUID 2SALSALATE 2SANTYL 4SAPHRIS 4 ST, QLSAVAYSA 4 ST, QLSAVELLA 4SCOPOLAMINE 2SEASONIQUE 4SECONAL SODIUM 2SELEGILINE HCL 2SELENIUM SULFIDE 2.25% SHAMPOO 2SELENIUM SULFIDE 2.5% LOTION 2SE-NATAL 19 1SEREVENT DISKUS 3SERTRALINE 20 MG/ML ORAL CONC 2 QLSERTRALINE 20 MG/ML ORAL SOLN 2 QLSERTRALINE HCL 100 MG TABLET 1 QLSERTRALINE HCL 25 MG TABLET 1 QLSERTRALINE HCL 50 MG TABLET 1 QLSETLAKIN 1SEVELAMER CARBONATE 800 MG TAB 2SF 2SF 5000 PLUS 2SHAROBEL 1SILDENAFIL 2 PASILENOR 4 ST, QLSILVER NITRATE 2SILVER SULFADIAZINE 2SIMBRINZA 3SIMVASTATIN 10 MG TABLET 1SIMVASTATIN 20 MG TABLET 1SIMVASTATIN 40 MG TABLET 1SIMVASTATIN 5 MG TABLET 1SIMVASTATIN 80 MG TABLET 1 QLSINGLE USE SWAB 3SIROLIMUS 2SIRTURO 4 PASKLICE 4SODIUM CHLORIDE 0.9% INHAL VL 2SODIUM CHLORIDE 0.9% IRRIG. 2SODIUM CHLORIDE 10% VIAL 2SODIUM CHLORIDE 3% VIAL 2





SODIUM CHLORIDE 7% VIAL 2SODIUM CITRATE-CITRIC ACID 2SODIUM FLUORIDE 2SODIUM PHENYLBUTYRATE 2SODIUM POLYSTYRENE SULFONATE 2SOLOXIDE 2SOLTAMOX 4SOTALOL 1SOTALOL AF 1SPINOSAD 2SPIRONOLACTONE 2SPIRONOLACTONE-HCTZ 2SPRINTEC 1SPRIX 4 QL, LDDSPS 2SRONYX 1SSKI 4STAVUDINE 2STERILE WATER FOR IRRIGATION 2STRIBILD 3STRONG IODINE 2SUBOXONE 3SUBVENITE 2SUBVENITE (BLUE) 2SUBVENITE (GREEN) 2SUBVENITE (ORANGE) 2SUCRALFATE 2SULFACETAMIDE SODIUM 2SULFACETAMIDE-PREDNISOLONE 2SULFADIAZINE 2SULFAMETHOXAZOLE-TMP DS TABLET 2SULFAMETHOXAZOLE-TMP SS TABLET 2SULFAMETHOXAZOLE-TMP SUSP 2SULFAMYLON 4SULFASALAZINE 2SULFASALAZINE DR 2SULINDAC 2SUMATRIPTAN 2 QLSUMATRIPTAN SUCCINATE 2 QLSUPRAX 4SUPREP 4SURE COMFORT ALCOHOL 3SURE-PREP ALCOHOL PREP PADS 3SUSTIVA 3SYEDA 1SYMAX 1SYMAX-SL 1SYMAX-SR 2


SYMLINPEN 120 4 QLSYMLINPEN 60 4 QLSYNERA 4SYNTHROID 4SYPRINE 4TABLOID 4TACROLIMUS 2TAKE ACTION 4TAMIFLU 30 MG CAPSULE 4 QLTAMIFLU 45 MG CAPSULE 4 QLTAMIFLU 75 MG CAPSULE 4 QLTAMOXIFEN CITRATE 2TAMSULOSIN HCL 2TARINA FE 1TARON-C DHA 1TARON-PREX PRENATAL 1TAYTULLA 3TAZAROTENE 2TAZORAC 4TAZTIA XT 2TEKTURNA 4 QLTELMISARTAN 2TELMISARTAN-AMLODIPINE 2TELMISARTAN-HYDROCHLOROTHIAZID 2TEMAZEPAM 2TEMOZOLOMIDE 4 PATENCON 2TENOFOVIR DISOPROXIL FUMARATE 2TERAZOSIN HCL 1TERBINAFINE HCL 1TERBUTALINE SULFATE 2.5 MG TAB 2TERBUTALINE SULFATE 5 MG TAB 2TERCONAZOLE 2TESTOSTERONE 10 MG GEL PUMP 2 QLTESTOSTERONE 12.5 MG/1.25 GRAM 2 QLTESTOSTERONE 25 MG/2.5 GM PKT 2 QLTESTOSTERONE 50 MG/5 GRAM GEL 2 QLTESTOSTERONE 50 MG/5 GRAM PKT 2 QLTESTOSTERONE CYPIONATE 2TESTOSTERONE ENANTHATE 2TETCAINE 2TETRABENAZINE 2 PATETRACAINE 0.5% EYE DROPS 2TETRACAINE 0.5% STERI-UNIT SOL 2TETRACYCLINE HCL 1TETRAVISC 4TEXACORT 4THEOCHRON 2





THEOPHYLLINE 2THEOPHYLLINE ANHYDROUS 2THIOLA 4 LDDTHIORIDAZINE HCL 2THIOTHIXENE 2THRIVITE 19 1THYROID 1THYROLAR-1 4THYROLAR-1/2 4THYROLAR-1/4 4THYROLAR-2 4THYROLAR-3 4TIAGABINE HCL 2TICLOPIDINE HCL 2TILIA FE 1TIMOLOL 0.25% GEL-SOLUTION 2TIMOLOL 0.25% GFS GEL-SOLUTION 2TIMOLOL 0.5% GEL-SOLUTION 2TIMOLOL 0.5% GFS GEL-SOLUTION 2TIMOLOL MALEATE 0.25% EYE DROP 2TIMOLOL MALEATE 0.5% EYE DROPS 2TIMOLOL MALEATE 10 MG TABLET 2TIMOLOL MALEATE 20 MG TABLET 2TIMOLOL MALEATE 5 MG TABLET 2TINIDAZOLE 2TIS-U-SOL PENTALYTE 4TIVICAY 3TIZANIDINE HCL 2TL-SELECT 1TOBRADEX 4TOBRADEX ST 4TOBRAMYCIN 2TOBRAMYCIN-DEXAMETHASONE 2TOBREX 4TOLAZAMIDE 2TOLBUTAMIDE 2TOLCAPONE 2TOLMETIN SODIUM 2TOLTERODINE TARTRATE 2TOLTERODINE TARTRATE ER 2TOPIRAMATE 2TOPIRAMATE ER 2TORSEMIDE 2TOVIAZ 4 ST, QLTRAMADOL ER 100 MG TABLET 2 QLTRAMADOL ER 200 MG TABLET 2 QLTRAMADOL ER 300 MG TABLET 2 QLTRAMADOL HCL 2 QL


TRAMADOL HCL ER 100 MG TABLET 2 QLTRAMADOL HCL ER 150 MG CAPSULE 2 QLTRAMADOL HCL ER 200 MG TABLET 2 QLTRAMADOL HCL ER 300 MG TABLET 2 QLTRAMADOL HCL-ACETAMINOPHEN 2 QLTRANDOLAPRIL 2TRANDOLAPRIL-VERAPAMIL ER 2TRANEXAMIC ACID 650 MG TABLET 2TRANYLCYPROMINE SULFATE 2TRAVATAN Z 3TRAZODONE HCL 1TRECATOR 4TRETINOIN 0.01% GEL 2 AGETRETINOIN 0.025% CREAM 2 AGETRETINOIN 0.025% GEL 2 AGETRETINOIN 0.05% CREAM 2 AGETRETINOIN 0.05% GEL 2 AGETRETINOIN 0.1% CREAM 2 AGETRETINOIN 10 MG CAPSULE 4 PATRETINOIN MICROSPHERE 2 AGETRETIN-X 4 AGETRI FEMYNOR 1TRIADVANCE 1TRIAMCINOLONE 0.025% CREAM 2TRIAMCINOLONE 0.025% LOTION 2TRIAMCINOLONE 0.025% OINT 2TRIAMCINOLONE 0.1% CREAM 2TRIAMCINOLONE 0.1% LOTION 2TRIAMCINOLONE 0.1% OINTMENT 2TRIAMCINOLONE 0.1% PASTE 2TRIAMCINOLONE 0.147 MG/G SPRAY 2TRIAMCINOLONE 0.5% CREAM 2TRIAMCINOLONE 0.5% OINTMENT 2TRIAMTERENE-HYDROCHLOROTHIAZID 2TRIAZOLAM 2TRICITRATES 2TRIDERM 2TRIENTINE HCL 4TRI-ESTARYLLA 1TRIFLUOPERAZINE HCL 2TRIFLURIDINE 2TRIHEXYPHENIDYL HCL 2TRIKLO 2TRI-LEGEST FE 1TRI-LINYAH 1TRI-LO-ESTARYLLA 1TRI-LO-MARZIA 1TRI-LO-SPRINTEC 1





TRILYTE WITH FLAVOR PACKETS 2TRIMETHOBENZAMIDE HCL 2TRIMETHOPRIM 2TRI-MILI 1TRIMIPRAMINE MALEATE 2TRIMPEX 4TRINATAL GT 1TRINATAL RX 1 1TRINESSA 1TRINESSA LO 1TRI-NORINYL 4TRINTELLIX 4 ST, QLTRIPLE-VITAMIN W-FLUORIDE 2TRI-PREVIFEM 1TRI-SPRINTEC 1TRI-TABS DHA 1TRIUMEQ 3TRIVEEN-DUO DHA 1TRIVEEN-ONE 1TRIVEEN-PRX RNF 1TRIVEEN-U 1TRI-VIT WITH FLUORIDE-IRON 2TRI-VITAMIN WITH FLUORIDE 2TRIVORA-28 1TRI-VYLIBRA 1TROPICAMIDE 2TROSPIUM CHLORIDE 2TROSPIUM CHLORIDE ER 2TRULICITY 3 QLTRUST NATAL DHA 1TRUVADA 3TULANA 1TUSSIGON 2TYBOST 3TYDEMY 1TYZINE 4ULESFIA 4ULORIC 4 QLULTILET ALCOHOL SWAB 3ULTIMATECARE ONE 1ULTIMATECARE ONE NF 1UNITHROID 1UR N-C 2URIN D.S. 2UROPHEN MB 2UROQID-ACID NO.2 4URSODIOL 2USTELL 2


UTIRA-C 2VALACYCLOVIR 2VALGANCICLOVIR HCL 2VALPROIC ACID 2VALSARTAN 2VALSARTAN-HYDROCHLOROTHIAZIDE 2VANCOMYCIN HCL 125 MG CAPSULE 2VANCOMYCIN HCL 250 MG CAPSULE 2VANDAZOLE 2VASCAZEN 4VASCEPA 4VECAMYL 2 LDDVELIVET 1VELPHORO 4VEMAVITE-PRX 2 1VENA-BAL DHA 1VENATAL COMPLETE DHA 1VENLAFAXINE HCL 2 QLVENLAFAXINE HCL ER 2 QLVENTOLIN HFA 3VERAPAMIL 120 MG TABLET 2VERAPAMIL 360 MG CAP PELLET 2VERAPAMIL 40 MG TABLET 2VERAPAMIL 80 MG TABLET 2VERAPAMIL ER 2VERAPAMIL ER PM 2VERAPAMIL SR 2VERDROCET 2VEREGEN 4VESICARE 4 ST, QLVESTURA 1VEXOL 4VIDEX 3VIENVA 1VIGABATRIN 2 QLVIIBRYD 4 ST, QLVIMPAT 10 MG/ML SOLUTION 4 QLVIMPAT 100 MG TABLET 4 QLVIMPAT 150 MG TABLET 4 QLVIMPAT 200 MG TABLET 4 QLVIMPAT 50 MG TABLET 4 QLVINACAL 1VINATE GT 1VINATE II 1VINATE ONE 1VINATE PN CARE 1VINATE ULTRA 1VINATE-M 1





VIOKACE 4VIORELE 1VIREAD 3VIRT-ADVANCE 1VIRT-C DHA 1VIRT-NATE 1VIRT-NATE DHA 1VIRT-PHOS 250 NEUTRAL 2VIRT-PN 1VIRT-PN DHA 1VIRT-PN PLUS 1VIRTPREX 1VIRTRATE-2 2VIRTRATE-3 2VIRTRATE-K 2VIRT-SELECT 1VIRT-VITE GT 1VIT D2 1.25 MG (50,000 UNIT) 2VITAFOL-OB 1VITAMINS A,C,D AND FLUORIDE 2VITASPIRE 1VITEKTA 3VOL-NATE 1VOL-PLUS 1VOL-TAB RX 1VORICONAZOLE 200 MG TABLET 2 PAVORICONAZOLE 40 MG/ML SUSP 2 PAVORICONAZOLE 50 MG TABLET 2 PAVP-CH PLUS 1VP-CH-PNV 1VP-GGR-B6 1VP-HEME OB 1VP-HEME ONE 1VRAYLAR 4 ST, QLVYFEMLA 1VYLIBRA 1VYNATAL-FA 1VYVANSE 10 MG CAPSULE 4 STVYVANSE 20 MG CAPSULE 4 STVYVANSE 30 MG CAPSULE 4 STVYVANSE 40 MG CAPSULE 4 STVYVANSE 50 MG CAPSULE 4 STVYVANSE 60 MG CAPSULE 4 STVYVANSE 70 MG CAPSULE 4 STWARFARIN SODIUM 1WEBCOL 3WELCHOL 4WERA 1


WESTHROID 1WP THYROID 1WYMZYA FE 1XARELTO 3 QLXERAC AC 4XERESE 4XIFAXAN 4XIGDUO XR 3 QLXTAMPZA ER 3 QLXULANE 1XYLON 10 2YASMIN 28 4YAZ 4YUVAFEM 2ZAFIRLUKAST 2ZALEPLON 2ZARAH 1ZATEAN-CH 1ZATEAN-PN DHA 1ZATEAN-PN PLUS 1ZAZOLE 2ZENATANE 2 QLZENCHENT 1ZENCHENT FE 1ZENPEP 3ZETONNA 4 STZIDOVUDINE 2ZILEUTON ER 2ZIOPTAN 4ZIPRASIDONE HCL 2ZIRGAN 4ZOLMITRIPTAN 2 QLZOLMITRIPTAN ODT 2 QLZOLPIDEM TARTRATE 2ZOLPIDEM TARTRATE ER 2ZONISAMIDE 2ZOVIA 1-35E 1ZOVIA 1-50E 1ZUBSOLV 3ZUPLENZ 4 QLZYBAN 3ZYLET 4



32

Specialty medications

The following specialty medications are typically covered on Tier 5

A

ACTEMRA 162 MG/0.9 ML SYRINGE (PA, LDD)ACTIMMUNE (PA, LDD)ADCIRCA (PA)ADEMPAS (PA, LDD)AFINITOR (PA, LDD)AFINITOR DISPERZ (PA, LDD)AKYNZEO 300-0.5 MG CAPSULE (PA, QL)ALECENSA (PA, LDD)AMPYRA (PA, LDD)ANZEMET (PA, QL)APOKYN (PA)ARANESP (PA)ARCALYST (PA, LDD)ASTAGRAF XLAVONEX (PA)AVONEX PEN (PA)

B

BARACLUDE 0.05 MG/ML SOLUTIONBOSULIF (PA, LDD)

C

CABOMETYX (PA, LDD)CAPRELSA (PA, LDD)CAYSTON (PA, ST, LDD)CHOLBAM (PA, LDD)CIMZIA (PA, ST)COMETRIQ (PA, LDD)COSENTYX (2 SYRINGES) (PA, LDD)COSENTYX PEN (2 PENS) (PA, LDD)COSENTYX PEN (PA, LDD)COSENTYX SYRINGE (PA, LDD)COTELLIC (PA, LDD)CYSTADANE (LDD)CYSTAGON (LDD)

E

EGRIFTA (PA, LDD)EMCYTEMEND 125 MG POWDER PACKET (PA, QL)ENBREL (PA)ENBREL MINI (PA)ENBREL SURECLICK (PA)EPCLUSA (PA)EPIVIR HBV 25 MG/5 ML SOLNEPOGEN (PA)

ERIVEDGE (PA, LDD)ESBRIET (PA, LDD)EXJADE (LDD)

F

FARYDAK (PA, LDD)FIRAZYR (PA, LDD)FIRMAGON 2 X 120 MG KIT (PA)FIRMAGON 80 MG KIT (PA)FORTEOFRAGMIN (QL)FUZEON (LDD)

G

GATTEX (PA, LDD)GENOTROPIN (PA, ST)GILOTRIF (PA, LDD)GLATIRAMER ACETATE (PA)GLATOPA (PA)GRANIX

H

HARVONI (PA)HETLIOZ (PA)HEXALENHUMATROPE (PA)HUMIRA (PA)HUMIRA PEDIATRIC CROHN’S (PA)HUMIRA PEN (PA)HUMIRA PEN CROHN-UC-HS STARTER (PA)HUMIRA PEN PSORIASIS-UVEITIS (PA)HYCAMTIN 0.25 MG CAPSULE (PA)HYCAMTIN 1 MG CAPSULE (PA)

I

IBRANCE (PA, LDD)ICLUSIG (PA, LDD)ILARIS (PA, LDD)IMBRUVICA (PA, LDD)INCRELEX (PA)INLYTA (PA, LDD)INTRON A (PA)IRESSA (PA, LDD)

J

JADENU (LDD)JADENU SPRINKLE (LDD)JAKAFI (PA, LDD)

K

KALYDECO (PA, LDD)KINERET (PA, ST, LDD)KUVAN (PA, LDD)

L

LENVIMA (PA, LDD)LETAIRIS (PA, LDD)LEUKINELONSURF (PA, LDD)LUPRON DEPOT (LUPANETA) (PA)LUPRON DEPOT (PA)LUPRON DEPOT-PED (PA)LYNPARZA (PA, LDD)

M

MATULANE (LDD)MEKINIST (PA)MESNEX 400 MG TABLETMIGLUSTAT (PA)MYALEPT (PA)

N

NATPARA (PA, LDD)NEULASTA (PA)NEUPOGEN (PA, ST)NEXAVAR (PA)NINLARO (PA, LDD)NORDITROPIN FLEXPRO (PA, ST)NUTROPIN AQ (PA, ST)NUTROPIN AQ NUSPIN (PA, ST)

O

ODOMZO (PA, LDD)OMNITROPE (PA, ST)OPSUMIT (PA, LDD)ORENITRAM ER (PA, LDD)ORKAMBI 200 MG-125 MG TABLET (PA, LDD)OTEZLA (PA, LDD)

P

PANRETINPEGASYS (PA)PEGASYS PROCLICK (PA)PEGINTRON (PA)PEGINTRON REDIPEN (PA)POMALYST (PA, LDD)

33

Specialty medications

The following specialty medications are typically covered on Tier 5

PRALUENT PEN (PA, ST, LDD)PRALUENT SYRINGE (PA, ST, LDD)PROMACTA (PA)PULMOZYME (PA)

R

RAPAMUNE 1 MG/ML ORAL SOLNREBETOLREPATHA PUSHTRONEX (PA, ST)REPATHA SURECLICK (PA, ST)REPATHA SYRINGE (PA, ST)REVLIMID (PA, LDD)

S

SABRIL 500 MG TABLET (QL)SAIZEN (PA, ST)SAIZEN-SAIZENPREP (PA, ST)SAMSCA (LDD)SENSIPARSEROSTIM (PA, ST, LDD)SIGNIFOR (PA)SIMPONI (PA, ST, LDD)SIMPONI ARIA (PA, ST, LDD)SOMATULINE DEPOT (PA, LDD)SOMAVERT (PA, LDD)SOVALDI (PA)SPRYCEL (PA)STELARA 45 MG/0.5 ML SYRINGE (PA, ST, LDD)

STELARA 45 MG/0.5 ML VIAL (PA, ST, LDD)STELARA 90 MG/ML SYRINGE (PA, ST, LDD)STIVARGA (PA, LDD)SUCRAID (LDD)SUTENT (PA, LDD)SYLATRON (PA, LDD)SYNAREL

T

TAFINLAR (PA, LDD)TAGRISSO (PA)TARCEVA (PA, LDD)TARGRETIN 1% GELTASIGNA (PA, LDD)TECFIDERA (PA, LDD)THALOMID (PA, LDD)TRACLEER (PA, LDD)TYKERB (PA)TYVASO (PA, LDD)TYVASO INSTITUTIONAL START KIT (PA, LDD)TYVASO REFILL KIT (PA, LDD)TYVASO STARTER KIT (PA, LDD)TYZEKA

V

VALCHLOR (LDD)VARUBI 90 MG TABLET (PA, QL)VENCLEXTA (PA)

VENCLEXTA STARTING PACK (PA)VENTAVIS (PA)VISTOGARD (LDD)VOTRIENT (PA)

X

XALKORI (PA, LDD)XELJANZ (PA, ST, LDD)XELJANZ XR (PA, ST, LDD)XOLAIR (PA, LDD)XTANDI (PA, ST, LDD)XURIDEN (PA)XYREM (PA, LDD)

Z

ZARXIO (LDD)ZAVESCA (PA, LDD)ZELBORAF (PA, LDD)ZOLADEX 10.8 MG IMPLANT SYRN (PA)ZOLADEX 3.6 MG IMPLANT SYRN (PA)ZOLINZA (PA)ZORTRESSZYDELIG (PA)ZYKADIA (PA, LDD)ZYTIGA (PA, LDD)

34

Prescription drug list FAQs

Understanding your prescription medication coverage can be confusing. Below are answers to some commonly asked questions.

Why do you make changes to the drug list?

Cigna regularly reviews and updates the prescription drug list. We make changes for many reasons – like when new medications become available or are no longer available, or when medication prices change. We try to give you many options to choose from to treat your health condition. Here are some changes that typically take place:

› Moving a medication to a higher cost tier and/or no longer covering a medication.

› Adding requirements to a medication. For example, requiring approval from Cigna before a medication may be covered or adding a quantity limit to a medication.

› Moving a medication to a lower cost tier.

› No longer covering a brand medication when a generic becomes available.

When we make a change to the coverage of a medication you’re taking, we’ll send you a letter three months before the change takes place so you have time to prepare. It’s important to know that when a medication changes tiers or is no longer covered, you may pay a different amount to fill that medication.

Why doesn’t my plan cover certain medications?

To help lower your overall health care costs, your plan doesn’t cover certain high-cost brand medications because they have lower-cost, covered alternatives which are used to treat the same condition. Meaning, the alternative works the same or similar to the non-covered medication. If you’re taking a medication that isn’t covered by your plan and your doctor feels an alternative medication isn’t right for you, he or she can ask Cigna to consider approving coverage of your medication.

Your plan may also exclude certain medications or products from coverage. This is known as a “plan (or benefit) exclusion.” For example, your plan excludes medications that aren’t approved by the U.S. Food and Drug Administration (FDA).

How do you decide which medications are covered?

The Prescription Drug List is managed by the Business Decision Team, which makes, subject to the P&T Committee’s review and approval of the Prescription Drug List, coverage tier placement decisions of Prescription Drugs or Related Supplies and/or applies

utilization management requirements to certain Prescription Drugs or Related Supplies. Your Policy’s coverage tiers may contain Prescription Drugs or Related Supplies that are Generic Drugs, Brand Drugs or Specialty Medications. Placement of any Prescription Drug or Related Supplies in a specific tier, and application of utilization management requirements to a Prescription Drug, depends on a number of clinical and economic factors. Clinical factors include, without limitation, the P&T Committee’s evaluations of the place in therapy, or relative safety or relative efficacy of the Prescription Drug or Related Supplies, and economic factors include, without limitation, the cost and/or available rebates for Prescription Drugs or Related Supplies. Whether a particular Prescription Drug or Related Supplies is appropriate for You or any of Your Family Member(s), regardless of its eligibility coverage under Your Policy, is a determination that is made by You (or Your Family Member) and the prescribing Physician.

The coverage status of a Prescription Drug or Related Supply may change periodically during the Policy Year for various reasons. For example, a Prescription Drug or Related Supply may be removed from the market, a new Prescription Drug in the same therapeutic class may become available, or the cost of a Prescription Drug or Related Supply may increase.

As a result of coverage changes, You may be required to pay more or less for that Prescription Drug or Related Supply, or try another covered Prescription Drug or Related Supply. Please access www.mycigna.com or call Customer Service at the telephone number on your ID card for the most up-to-date coverage tier status, utilization management, or other coverage limitations for Prescription Drugs or Related Supplies.

Which medications are covered under the health care reform law?The Patient Protection and Affordable Care Act (PPACA), commonly referred to as “health care reform,” was signed into law on March 23, 2010. Under this law, certain preventive medications (including some over-the-counter medicines) may be available to you at no cost-share ($0), depending on your plan. Log in to the myCigna website or app or check your plan materials to learn more about how your plan covers preventive medications. You can also view the PPACA No Cost-Share Preventive Medications drug list on Cigna.com/ifp-drug-list.

For more information about health care reform, visit www.informedonreform.com or Cigna.com.

35

Are medications newly approved by the FDA covered on my drug list?

All new Food and Drug Administration (FDA)-approved drug products are designated as not covered under your drug list until the Cigna business decision team makes a placement decision on the new drug (or new indication), which decision shall be based in part on the P&T Committee’s clinical review of the drug. The P&T Committee makes a reasonable effort to review all new FDA approved drug products (or new FDA approved indications) within 90 days of its release to the market. The business decision team must make a reasonable effort to review a new FDA approved drug product (or new indications) within 90 days, and make a decision on each new FDA approved drug product (or new FDA approved indication) within 180 days of its release onto the market, or a clinical justification must be documented if this timeframe is not met. If your doctor feels a currently covered medication isn’t right for you, he or she can ask Cigna to consider approving coverage of the newly approved medication.

How can I find out how much I’ll pay for a specific medication?

Use the Drug Cost tool on the myCigna website or app to estimate how much your medication may cost and view lower cost1 alternatives, if available.

How can I save money on my prescription medications?

You may be able to save money by switching to a medication that’s on a lower tier (ex. preferred generic or generic) or by filling a 90-day supply, if your plan allows. Talk with your doctor to find out if one of these options may work for you.

What’s the difference between brand name and generic medications?

The FDA requires generic equivalent medications to have the same quality and performance as brand name medications. A generic equivalent medication is the same as a brand name medication in dosage form, active ingredient, strength, route of administration, quality, performance characteristics and intended use. Generics typically cost much less than brand name medications – in some cases, up to 85% less.2 Just because generics cost less than brands, it doesn’t mean they’re lower-quality medications.

How can I get help with my specialty medication?

Cigna Specialty PharmacySM can help you manage your health and prescription needs. Their team of medical condition experts provide personalized, 24/7 support. They’ll help you get approval for coverage of your medication, answer any questions you have about your medication and its cost, help you work through any side effects and make sure you have any supplies you need (at no extra cost). They’ll also give you information about financial assistance programs (if you need help paying for your medication). To learn more about the services they provide, please call 800.351.3606 or go to cigna.com/specialty-pharmacyservices.

Can I fill my prescriptions by mail? If you take a medication every day to treat an ongoing health condition (like diabetes, high blood pressure, high cholesterol or asthma), you can order up to a 90-day supply through Cigna Home Delivery Pharmacy.SM To get started, call 800.835.3784. To learn more about the services they provide, go to cigna.com/home-delivery-pharmacy.

If you’re taking a specialty medication to treat a complex condition like multiple sclerosis, hepatitis C and rheumatoid arthritis, you can fill your prescription through Cigna Specialty Pharmacy (our home delivery pharmacy). To get started, call 800.351.3606. To learn more about the services they provide, go to cigna.com/specialty-pharmacy-services.

Where can I find more information about my prescription medication plan?

Use the online tools and resources on the myCigna website or app to help you better understand your pharmacy benefits. You can view your prescription drug list or search for a specific medication, use the Drug Cost tool to estimate how much your medication may cost, find an in-network pharmacy near you, review your pharmacy claims and payment history, and fill and track your home delivery orders.

Prescription drug list FAQs (cont)

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Exclusions

Any services which are not described as covered in the Benefit Schedule, Covered Services and Benefits section, or in an attached rider, or are specifically excluded in the Services and Benefits section benefit language or an attached rider, are not covered under this EOC.

Benefit Exclusions

1. Care for health conditions that has not been provided by, or provided by Referral from, Your PCP or has not been authorized by Your PCP or the Cigna Medical Director, except for immediate treatment of an Emergency Medical Condition.

2. Services received before the Effective Date of coverage.

3. Services received after coverage under this EOC ends.

4. Professional services or supplies received or purchased directly or on Your behalf by anyone, including a Physician, from any of the following:

a. Yourself or Your employer;

b. a person who lives in the Member’s home, or that person’s employer;

c. a person who is related to the Member by blood, marriage or adoption, or that person’s employer.

d. A facility or health care professional that provides remuneration to You, directly or indirectly, or to an organization from which you receive, directly or indirectly, remuneration.

5. Care for health conditions that are required by state or local law to be treated in a public facility.

6. Care required by state or federal law to be supplied by a public schools system or school district.

7. Care for military service disabilities treatable through governmental services if the Member is legally entitled to such treatment and facilities are reasonably available.

8. Treatment of an Illness or Injury which is due to war, declared or undeclared.

9. Charges for which you are not obligated to pay or for which you are not billed or would not have been billed except that you were covered under this EOC.

10. Services of a Hospital emergency room for any condition that is not an Emergency Medical Condition as defined by this EOC.

11. Assistance in the activities of daily living, including, but not limited to, eating, bathing, dressing or other Custodial Services or self care activities, homemaker services and services primarily for rest, domiciliary or convalescent care.

12. Any services and supplies for or in connection with Experimental, Investigational or Unproven Procedures. Experimental, Investigational or Unproven Procedures do not include routine patient care costs related to qualified clinical trials as described in your EOC document.

13. Cosmetic surgery, therapy or surgical procedures primarily for the purpose of altering appearance (except as provided in the definition of Reconstructive Surgery or the description of the Reconstructive Surgery benefit in this EOC); Cosmetic surgery, therapy or surgical procedures primarily for the purpose of altering appearance. This exclusion does not apply to Reconstructive Surgery to restore a bodily function or to correct a deformity caused by Injury or congenital defect of a Newborn child, or for Medically Necessary Reconstructive Surgery performed to restore symmetry incident to a mastectomy or lumpectomy. Cosmetic surgery or therapy is defined as surgery or therapy performed to improve or alter appearance or self-esteem or to treat psychological symptomatology or psychosocial complaints related to one’s appearance. The exclusions include surgical excision or reformation of any sagging skin on any part of the body, including, the eyelids, face, neck, abdomen, arms, legs or buttocks; and services performed in connection with the enlargement, reduction, implantation, or change in appearance of portion of the body, including, the breast, face, lips, jaw, chin, nose, ears or genital; hair transplantation; chemical face peels or abrasion of the skin; electrolysis diplation; or any other surgical or non-surgical procedures which are primarily for the purpose of altering appearance. This does not exclude services or benefits that are primarily for the purpose of restoring normal bodily function, or surgery, which is Medically Necessary.

The following services are excluded from coverage regardless of clinical indications;

a. macromastia or gynecomastia surgeries;

b. Surgical treatment of varicose veins;

c. abdominoplasty;

d. panniculectomy;

e. rhinoplasty;

Illinois Benefit Exclusions And Limitations

37

f. blepharoplasty;

g. redundant skin surgery;

i. removal of skin tags;

j. acupressure;

k. craniosacral/cranial therapy;

l. dance therapy, movement therapy;

m. applied kinesiology;

n. rolfing;

o. prolotherapy; and

p. extracorporeal shock wave lithotripsy (ESWL) for musculoskeletal and orthopedic conditions.

14. Dental treatment of the teeth, gums or structures directly supporting the teeth, including dental x rays, examinations, repairs, orthodontics, periodontics, casts, splints and services for dental malocclusion, for any condition. Any medical and surgical services for the treatment or control of obesity that are not included under the “Covered Services and Benefits” section of this EOC;

15. Unless otherwise covered under “Covered Services and Benefits,” reports, evaluations, physical examinations, or hospitalization not required for health reasons including, employment, insurance or government licenses, and court ordered, forensic, or custodial evaluations.

16. Court ordered treatment or hospitalization, unless such treatment is being sought by a Participating Physician or otherwise specifically covered under “Covered Services and Benefits.”

17. Reversal of male and female voluntary sterilization procedures.

18. Procedures, surgery or treatments to change characteristics of the body to those of the opposite sex unless such services are deemed Medically Necessary or otherwise meet applicable coverage requirements.

19. Any treatment, prescription drug, service or supply to treat sexual dysfunction, enhance sexual performance or increase sexual desire.

20. Medical and Hospital care and costs for the infant child of a Dependent, unless this infant child is otherwise eligible under the EOC.

21. Charges for animal to human organ transplants.

22. Non medical counseling or ancillary services including, but not limited to Custodial Services, education, training, vocational rehabilitation, biofeedback, neurofeedback, hypnosis, sleep therapy, employment counseling, back school,

return-to-work services, work hardening programs, driving safety and services, training, except otherwise specifically covered in this EOC.

23. Therapy or treatment intended primarily to improve or maintain general physical condition or for the purpose of enhancing job, school, athletic or recreational performance, including, but not limited to routine, long-term or maintenance which is provided after the resolution of the acute medical problem and when significant therapeutic improvement is not expected, except as specifically stated in this EOC.

24. Complementary and alternative medicine services, including but not limited to: animal therapy, including but not limited to equine therapy or canine therapy; art therapy; meditation; visualization; acupuncture; acupressure; reflexology; light therapy; aromatherapy; music or sound therapy; dance therapy; sleep therapy; hypnotism; energy-balancing; breathing exercises; movement and/or exercise therapy including but not limited to yoga, pilates, tai-chi, walking, hiking, swimming, golf; and any other alternative treatment as defined by the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health. Services specifically listed as covered under “Rehabilitative Therapy” and “Habilitative Therapy” are not subject to this exclusion

25. Any services or supplies provided by or at a place for the aged, a nursing home, or any facility a significant portion of the activities of which include rest, recreation, leisure, or any other services that are not Covered Services.

26. Educational services except for Diabetes Self-Management Training; treatment for autism; counseling/ educational services for breastfeeding; physician counseling regarding alcohol misuse, preventive medication, obesity, nutrition, tobacco cessation and depression; preventive counseling and educational services specifically required under Patient Protection and Affordable Care Act (PPACA) and as specifically provided or arranged by Cigna.

27. Consumable medical supplies other than ostomy supplies and urinary catheters. Excluded supplies include, but are not limited to bandages and other disposable medical supplies, skin preparations and test strips, except as specified in the “Inpatient Hospital Services”, “Outpatient Facility Services”, “Home Health Services”, Diabetic Services”, or “Breast Reconstruction and Breast Prostheses” sections of the “Covered Services and Benefits” section. Unless covered in connection with the

38

services described in the “Inpatient Services at Other Participating Health Care Facilities” or “Home Health Services” provisions, Durable Medical Equipment items that are not covered, include but are not limited to those listed below:

a. Hygienic or self-help items or equipment;

b. Items or equipment primarily used for comfort or convenience such as bathtub chairs, safety grab bars, stair gliders or elevators, over-the-bed tables, saunas or exercise equipment;

c. Environmental control equipment, such as air purifiers, humidifiers and electrostatic machines;

d. Institutional equipment, such as air fluidized beds and diathermy machines;

e. Elastic stockings and wigs;

f. Equipment used for the purpose of participation in sports or other recreational activities including, but not limited to, braces and Splints;

g. Items, such as auto tilt chairs, paraffin bath units and whirlpool baths, which are not generally accepted by the medical profession as being therapeutically effective;

h. Items which under normal use would constitute a fixture to real property, such as lifts, ramps, railings, and grab bars; and

i. Hearing aid batteries (except those for cochlear implants) and chargers.

28. Private hospital rooms and/or private duty nursing except as provided in the “Home Health Services” or “Hospice Services” section of “Covered Services and Benefits.”, or when deemed medically appropriate by Us.

29. Personal or comfort items such as personal care kits provided on admission to a hospital, television, telephone, newborn infant photographs, complimentary meals, birth announcements, and other articles which are not for the specific treatment of illness or injury.

30. Orthopedic shoes (except when joined to braces), shoe inserts, foot orthotic devices except as required by law for diabetic patients.

31. Artificial aids including, but not limited to, corrective orthopedic shoes, arch supports, orthotics, elastic stockings, garter belts, corsets, dentures and wigs, except as provided in “Covered Services and Benefits” section of the EOC.

32. Aids or devices that assist with non-verbal communications, including, but not limited to communication boards, pre-recorded speech devices, laptop computers, desktop computers,

Personal Digital Assistants (PDAs), Braille typewriters, visual alert systems for the deaf and memory books.

33. Eyeglass lenses and frames and contact lenses (except for the first pair of contact lenses for treatment of keratoconus or post cataract surgery and pediatric vision).

34. Routine refraction, eye exercises and surgical treatment for the correction of a refractive error, including radial keratotomy, except for pediatric vision.

35. Treatment by acupuncture.

36. All non-injectable prescription drugs, injectable prescription drugs that do not require physician supervision and are typically considered self-administered drugs, non prescription drugs, Experimental, Investigational and Unproven drugs, except as provided in “Covered Services and Benefits.”

37. Routine foot care, including the paring and removing of corns and calluses or trimming of nails. However, services associated with foot care for diabetes and peripheral vascular disease are covered when Medically Necessary as part of another Covered Service.

38. Membership costs or fees associated with health clubs and weight loss programs.

39. Genetic screening or pre-implantation genetic screening. General population-based genetic screening is a testing method performed in the absence of any symptoms or any significant, proven risk factors for genetically-linked inheritable disease.

40. Dental implants for any condition.

41. Fees associated with the collection or donation of blood or blood products, except for autologous donation in anticipation of scheduled services where in the Cigna Medical Director’s opinion the likelihood of excess blood loss is such that transfusion is an expected adjunct to surgery.

42. Blood administration for the purpose of general improvement in physical condition.

43. Cost of biologicals that are immunizations or medications for purposes of travel, or to protect against occupational hazards and risks unless Medically Necessary or indicated.

44. Cosmetics, dietary supplements and health and beauty aids.

45. All nutritional supplements and formulae are excluded, except for infant formula needed for the treatment of inborn errors of metabolism.

46. All vitamins and medications and contraceptives available without a prescription (“over-the-counter”) except for those covered under mandate of the 2010 Patient Protection and Affordable Care Act (PPACA).

47. Expenses incurred for or in connection with an injury or illness arising out of, or in the course of, any employment for wage or profit.

48. The following mental health and substance use disorder services are specifically excluded from coverage under this EOC:

a. Any court ordered treatment or therapy, or any treatment or therapy ordered as a condition of parole, probation or custody or visitation evaluations unless Medically Necessary and otherwise covered under this EOC;

b. Treatment of mental disorders that have been diagnosed as organic mental disorders associated with permanent dysfunction of the brain.

c. Treatment of chronic conditions not subject to favorable modification according to generally accepted standards of medical practice;

d. Developmental disorders, including but not limited to, developmental reading disorders, developmental arithmetic disorders, developmental language disorders or developmental articulation disorders.

e. Counseling for activities of an educational nature.

f. Counseling for borderline intellectual functioning.

g. Counseling for occupational problems.

h. Counseling related to consciousness raising.

i. Vocational or religious counseling.

j. I.Q. testing.

k. Residential treatment (unless associated with Mental Health or chemical or alcohol dependency as described in the Mental Health Residential Treatment Services or the Substance Use Disorder Residential Treatment provisions);

l. marriage counseling;

m. Custodial Care, including but not limited to geriatric day care.

n. Psychological testing on children requested by or for a school system

o. Occupational/recreational therapy programs even if combined with supportive therapy for age-related cognitive decline; and

p. Biofeedback is not covered for reasons other than pain management.

39

1. Prices are not guaranteed, and even though a price is displayed in the Drug Cost tool, it’s not a guarantee of coverage. Your costs and coverage may change by the time you fill your prescription at the pharmacy, and medication costs at individual pharmacies can vary. Coverage and pricing may change. For example, your pharmacy’s retail cash price for a specific medication may be less than the price shown in the Drug Cost tool.

2. U.S. Food and Drug Administration (FDA) website, “Generic Drug Facts.” Last updated 06/04/18.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina, Inc., Tel-Drug, Inc., and Tel-Drug of Pennsylvania, L.L.C. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. The Cigna name, logo and other Cigna marks are owned by Cigna Intellectual Property, Inc.

924127 12/18 © 2018 Cigna. Some content provided under license.

Cigna reserves the right to make changes to this drug list without notice. Please reference Cigna.com/ifp-drug-list for an up-to-date listing. Your plan may cover additional medications; please refer to your policy/service agreement for details. Cigna does not take responsibility for any medication decisions made by the doctor or pharmacist. Cigna may receive payments from manufacturers of certain preferred brand medications, and in limited instances, certain non-preferred brand medications, that may or may not be shared with your plan depending on its arrangement with Cigna. Depending upon plan design, market conditions, the extent to which manufacturer payments are shared with your plan and other factors as of the date of service, the preferred brand medication may or may not represent the lowest-cost brand medication within its class for you and/or your plan.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. ATTENTION: If you speak languages other than English, language assistance services, free of charge are available to you. For current Cigna customers, call the number on the back of your ID card. Otherwise, call 1.800.244.6224 (TTY: Dial 711). ATENCIÓN: Si usted habla un idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Si es un cliente actual de Cigna, llame al número que figura en el reverso de su tarjeta de identificación. Si no lo es, llame al 1.800.244.6224 (los usuarios de TTY deben llamar al 711).

896375a 05/17 © 2017 Cigna.

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

Cigna:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:– Qualified sign language interpreters– Written information in other formats (large print, audio, accessible electronic formats,

other formats)• Provides free language services to people whose primary language is not English, such as:

– Qualified interpreters– Information written in other languages

If you need these services, contact customer service at the toll-free number shown on your ID card, and ask a Customer Service Associate for assistance.

If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by sending an email to [email protected] or by writing to the following address:

CignaNondiscrimination Complaint CoordinatorPO Box 188016Chattanooga, TN 37422

If you need assistance filing a written grievance, please call the number on the back of your ID card or send an email to [email protected]. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, DC 202011.800.368.1019, 800.537.7697 (TDD)Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

DISCRIMINATION IS AGAINST THE LAWMedical coverage

Proficiency of Language Assistance Services

English – ATTENTION: Language assistance services, free of charge, are available to you. For current Cigna customers, call the number on the back of your ID card. Otherwise, call 1.800.244.6224 (TTY: Dial 711).

Spanish – ATENCIÓN: Hay servicios de asistencia de idiomas, sin cargo, a su disposición. Si es un cliente actual de Cigna, llame al número que figura en el reverso de su tarjeta de identificación. Si no lo es, llame al 1.800.244.6224 (los usuarios de TTY deben llamar al 711).

Chinese – 注意：我們可為您免費提供語言協助服務。對於 Cigna 的現有客戶，請致電您的 ID 卡背面的號碼。其他客戶請致電 1.800.244.6224 （聽障專線：請撥 711）。

Vietnamese – XIN LƯU Ý: Quý vị được cấp dịch vụ trợ giúp về ngôn ngữ miễn phí. Dành cho khách hàng hiện tại của Cigna, vui lòng gọi số ở mặt sau thẻ Hội viên. Các trường hợp khác xin gọi số 1.800.244.6224 (TTY: Quay số 711).

Korean – 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 현재 Cigna 가입자님들께서는 ID 카드 뒷면에 있는 전화번호로 연락해주십시오. 기타 다른 경우에는 1.800.244.6224 (TTY: 다이얼 711)번으로 전화해주십시오.

Tagalog – PAUNAWA: Makakakuha ka ng mga serbisyo sa tulong sa wika nang libre. Para sa mga kasalukuyang customer ng Cigna, tawagan ang numero sa likuran ng iyong ID card. O kaya, tumawag sa 1.800.244.6224 (TTY: I-dial ang 711).

Russian – ВНИМАНИЕ: вам могут предоставить бесплатные услуги перевода. Если вы уже участвуете в плане Cigna, позвоните по номеру, указанному на обратной стороне вашей идентификационной карточки участника плана. Если вы не являетесь участником одного из наших планов, позвоните по номеру 1.800.244.6224 (TTY: 711).

Arabic – برجاء الانتباه خدمات الترجمة المجانية متاحة لكم. لعملاء Cigna الحاليين برجاء الاتصال بالرقم المدون علي ظهر بطاقتكم الشخصية. او اتصل ب 1.800.244.6224 (TTY: اتصل ب 711).

French Creole – ATANSYON: Gen sèvis èd nan lang ki disponib gratis pou ou. Pou kliyan Cigna yo, rele nimewo ki dèyè kat ID ou. Sinon, rele nimewo 1.800.244.6224 (TTY: Rele 711).

French – ATTENTION: Des services d’aide linguistique vous sont proposés gratuitement. Si vous êtes un client actuel de Cigna, veuillez appeler le numéro indiqué au verso de votre carte d’identité. Sinon, veuillez appeler le numéro 1.800.244.6224 (ATS : composez le numéro 711).

Portuguese – ATENÇÃO: Tem ao seu dispor serviços de assistência linguística, totalmente gratuitos. Para clientes Cigna atuais, ligue para o número que se encontra no verso do seu cartão de identificação. Caso contrário, ligue para 1.800.244.6224 (Dispositivos TTY: marque 711).

Polish – UWAGA: w celu skorzystania z dostępnej, bezpłatnej pomocy językowej, obecni klienci firmy Cigna mogą dzwonić pod numer podany na odwrocie karty identyfikacyjnej. Wszystkie inne osoby prosimy o skorzystanie z numeru 1 800 244 6224 (TTY: wybierz 711).

Japanese – 注意事項：日本語を話される場合、無料の言語支援サービスをご利用いただけます。現在のCignaのお客様は、IDカード裏面の電話番号まで、お電話にてご連絡ください。その他の方は、1.800.244.6224（TTY: 711）まで、お電話にてご連絡ください。

Italian – ATTENZIONE: Sono disponibili servizi di assistenza linguistica gratuiti. Per i clienti Cigna attuali, chiamare il numero sul retro della tessera di identificazione. In caso contrario, chiamare il numero 1.800.244.6224 (utenti TTY: chiamare il numero 711).

German – ACHTUNG: Die Leistungen der Sprachunterstützung stehen Ihnen kostenlos zur Verfügung. Wenn Sie gegenwärtiger Cigna-Kunde sind, rufen Sie bitte die Nummer auf der Rückseite Ihrer Krankenversicherungskarte an. Andernfalls rufen Sie 1.800.244.6224 an (TTY: Wählen Sie 711).

Persian (Farsi) – توجه: خدمات کمک زبانی٬ به صورت رايگان به شما ارائه می شود. برای مشتريان فعلی ٬Cigna لطفاً با شماره ای که در پشت کارت شناسايی شماست تماس بگيريد. در غير اينصورت با شماره 1.800.244.6224 تماس بگيريد (شماره تلفن ويژه ناشنوايان: شماره 711 را

شماره گيری کنيد). 896375a 05/17

2019 cigna rx plus 5-tier prescription drug list

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